2019-05-14T12:14:36-05:00 2018-06-30 990 2017-07-01 562276994 DAVIE MEDICAL CENTER DAVI 3367164445 329 NC HWY 801N BERMUDA RUN NC 27006 BRADLEY A CLARK TREASURER 3367164445 2019-05-14 152.11.164.57 2019-05-14 11:54:16 ED P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 C519E53D4DD429C18E6E355385A0C45AA59A2EAE 2017 2019-02-21 02:37:17Z CHAD BROWN 329 NC HWY 801N BERMUDA RUN NC 27006 77096014 0 X WWW.WAKEHEALTH.EDU/DAVIE-MEDICAL-CENTER/ X 2001 NC PROVISION OF PATIENT-CENTERED HEALTHCARE SERVICES TO THE SURROUNDING AREA 14 13 0 71 0 0 0 0 54006395 77007733 42975 -51630 24851 69515 54074221 77025618 26950 27279 0 0 16875266 23114797 0 0 0 32461771 38904068 49363987 62046144 4710234 14979474 23257241 43180092 10321288 15264665 12935953 27915427 X DAVIE MEDICAL CENTER IS PART OF WAKE FOREST BAPTIST HEALTH, A PREEMINENT LEARNING HEALTH SYSTEM THAT PROMOTES BETTER HEALTH FOR ALL THROUGH COLLABORATION, EXCELLENCE AND INNOVATION. OUR MISSION IS TO IMPROVE THE HEALTH OF OUR REGION, STATE AND NATION BY: GENERATING AND TRANSLATING KNOWLEDGE TO PREVENT, DIAGNOSE AND TREAT DISEASE; TRAINING LEADERS IN HEALTH CARE AND BIOMEDICAL SCIENCE; AND SERVING AS THE PREMIER HEALTH SYSTEM IN OUR REGION, WITH SPECIFIC CENTERS OF EXCELLENCE RECOGNIZED AS NATIONAL AND INTERNATIONAL CARE DESTINATIONS. 0 0 57322038 27279 77077248 DAVIE MEDICAL CENTER PROVIDED MEDICAL, EMERGENCY, AND OUTPATIENT CARE SERVICES TO THE RESIDENTS OF DAVIE COUNTY, NORTH CAROLINA AND SURROUNDING AREAS. IN 2017, DAVIE MEDICAL CENTER CLOSED ITS 81 BED HOSPITAL IN MOCKSVILLE AND OPENED A NEW, STATE OF THE ART, 50 BED INPATIENT HOSPITAL THAT INCLUDES A 24/7 EMERGENCY ROOM AND AN ACUTE CARE FOR ELDERS (ACE) UNIT ON ITS BERMUDA RUN CAMPUS. DAVIE MEDICAL CENTER PROVIDES CLINICAL SERVICES AT ITS BERMUDA RUN CAMPUS IN BOTH MEDICAL PLAZA ONE AND MEDICAL PLAZA TWO THAT INCLUDES: CARDIOLOGY, OPHTHALMOLOGY, GASTROENTEROLOGY, NEUROLOGY, ORTHOPAEDICS, PULMONARY, PODIATRY, NEUROLOGY, SLEEP LAB, IMAGING, PHYSICAL THERAPY, OCCUPATIONAL THERAPY, ENDOSCOPY, LAB AND PHARMACY. DURING FISCAL YEAR 2018, THE HOSPITAL FACILITY HAD 2,861 PATIENT DAYS, WITH 1,504 INPATIENT ADMISSIONS, AND 16,899 EMERGENCY ROOM VISITS.AS PART OF WAKE FOREST BAPTIST HEALTH, DMC'S VISION IS A PREEMINENT LEARNING HEALTH SYSTEM THAT PROMOTES BETTER HEALTH FOR ALL THROUGH COLLABORATION, EXCELLENCE AND INNOVATION.THE HOSPITAL'S VALUES ARE AS FOLLOWS:-COMPASSION: RESPONSIVE TO THE PHYSICAL, EMOTIONAL, SPIRITUAL, AND INTELLECTUAL NEEDS OF ALL;-SERVICE: CULTIVATE SELFLESS CONTRIBUTION FOR THE GREATER GOOD;-EXCELLENCE: DEMONSTRATE THE HIGHEST STANDARDS OF PATIENT-CENTERED CARE, EDUCATION, RESEARCH, AND OPERATIONAL EFFECTIVENESS; - INTEGRITY: DEMONSTRATE FAIRNESS, HONESTY, SINCERITY, AND ACCOUNTABILITY;-COLLEGIALITY: FOSTER MUTUAL RESPECT, FACILITATE PROFESSIONAL GROWTH AND MENTORSHIP, AND REWARD TEAMWORK AND COLLABORATION; -INNOVATION: PROMOTE CREATIVITY TO ENHANCE DISCOVERY AND THE APPLICATION OF KNOWLEDGE; AND-DIVERSITY: HONOR INDIVIDUALITY AND PROTECT THE DIGNITY OF ALL. 57322038 1 0 0 1 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 10 0 1 0 0 0 0 0 0 0 0 0 0 0 X 14 13 0 1 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X JOSEPH DOLAN 3367164445 MEDICAL CENTER BOULEVARD WINSTONSALEM NC 27157 KEVIN P HIGH MD CHAIRMAN 0.30 6.50 X X 0 0 0 TERRY L BRALLEY BOARD MEMBER 2.00 X 0 0 0 WILLIAM JUNKER BOARD MEMBER 2.00 X 0 0 0 KEN PEACOCK BOARD MEMBER 2.00 X 0 0 0 MICHAEL CARTWRIGHT MD BOARD MEMBER 2.00 X 0 0 0 CRAIG M GREVEN MD BOARD MEMBER 2.00 X 0 0 0 RUSSELL HOWERTON MD BOARD MEMBER 1.30 X 0 0 0 L ANDREW KOMAN MD BOARD MEMBER 2.00 X 0 0 0 LYNN PITMAN BOARD MEMBER 2.00 38.00 X 0 222872 32499 KENNETH RETHMEIER BOARD MEMBER 2.00 X 0 0 0 MARY RITTLING PHD BOARD MEMBER 2.00 X 0 0 0 STEPHEN ROBERTSON BOARD MEMBER 2.00 X 0 0 0 CHARLES L BRANCH JR MD BOARD MEMBER 2.00 X 0 0 0 TERRY RENEGAR BOARD MEMBER 2.00 X 0 0 0 CHAD BROWN PRESIDENT 40.00 0.00 X 0 298620 70477 BRADLEY A CLARK TREASURER 0.30 39.70 X 0 483113 170979 J MCLAIN WALLACE JR SECRETARY 0.30 39.70 X 0 689120 71877 DINA MARTY ASSISTANT SECRETARY 1.00 X 0 0 0 DANNY SQUIRES FINANCE DIRECTOR 15.00 25.00 X 0 163031 28621 BRYAN C LEE CLINICAL INSTRUCTOR CRNA 40.00 X 0 179935 33664 SARA H SHIELDS PHARMACY MANAGER 40.00 X 0 146544 18331 KIMBERLY DEE STANBERY NURSING DIRECTOR 40.00 X 0 135677 29140 MARTIN E GLASGO PHARMACIST 40.00 X 0 120213 19338 ANGIE M ROARK PHARMACY CLINICAL COORDINATOR 40.00 X 0 115987 14213 CHAD ECKES FORMER OFFICER (AS OF 6/12/17) 0.00 0.00 X 0 987032 33896 0 3542144 523035 0 1 1 0 NEVRO CORP 1800 BRIDGE PARKWAY REDWOOD CITY CA 94065 MEDICAL DEVICES 1643684 SMITH & NEPHEW ORTHO 150 MINUTEMAN ROAD ANDOVER MA 01810 MEDICAL DEVICES 1086391 MEDLINE INDUSTRIES INC 1 MEDLINE PLACE MUNDELEIN IL 60060 MEDICAL DEVICES 1072110 DEPUY JOINT RECONSTRUCTION 700 ORTHOPAEDIC DRIVE WARSAW IN 46582 MEDICAL DEVICES 957179 BOSTON SCIENTIFIC CORP 300 BOSTON SCIENTIFIC WAY MARLBOUROUGH MA 017521234 MEDICAL DEVICES 887651 20 PATIENT SERVICE REVENUE 621400 77007733 77007733 77007733 18766 18766 70396 -70396 -70396 -70396 DIETARY 621990 69515 69515 69515 77025618 77077248 0 -51630 27279 27279 412439 265652 146787 19634098 16290263 3343835 761045 570784 190261 1399302 1048475 350827 907913 680935 226978 3780 3780 5323089 5292200 30889 380364 277418 102946 240138 188666 51472 7101486 6846013 255473 13427 3098 10329 1191 1191 2272058 2272058 38761 38761 MEDICAL SUPPLIES 16350853 16336544 14309 BAD DEBT EXPENSE 6074761 6074761 PROVIDER ASSESSMENT TAX 1104160 1104160 62046144 57322038 4724106 0 8004037 22773864 6163816 8954410 1084489 1123927 19553923 9226032 8004899 10327891 23257241 43180092 8582148 13657976 1739140 1606689 10321288 15264665 X 12935953 27915427 12935953 27915427 23257241 43180092 14979474 0 X 0 1 X 1 0 X 0 0 0 0 0 0 0 0 1 3780 3780 0 PART II-B, LINE 1: THE ORGANIZATION IS A MEMBER OF THE AMERICAN HOSPITAL ASSOCIATION (AHA) AND THE NORTH CAROLINA HOSPITAL ASSOCIATION (NCHA). A PORTION OF THE MEMBERSHIP DUES PAID ARE ALLOCATED TO LOBBYING EFFORTS BY THOSE ORGANIZATIONS ON BEHALF OF THEIR MEMBERSHIP BODIES. 54909 9026 45883 15781018 9217006 6564012 3717996 3717996 10327891 ESTIMATED 3RD PARTY PAYABLE 1606689 1606689 X PART X, LINE 2: THE ORGANIZATION HAS EVALUATED UNCERTAIN TAX POSITIONS FOR ITS FISCAL YEARS ENDED JUNE 30, 2017 AND 2018, INCLUDING A QUANTIFICATION OF TAX RISK IN AREAS SUCH AS UNRELATED BUSINESS TAXABLE INCOME AND THE TAXATION OF ITS JOINT VENTURES. THIS EVALUATION DID NOT HAVE A MATERIAL EFFECT ON THE ORGANIZATION'S FINANCIAL STATEMENTS FOR THE YEARS ENDED JUNE 30, 2017 AND 2018. 1 1 1 X 1 X 1 1 0 1 1 1191221 0 1191221 0.02130 3101777 1328303 1773474 0.03170 2149897 1940137 209760 0.00370 6442895 3268440 3174455 0.05670 27279 0 27279 0.00050 27279 27279 0.00050 6470174 3268440 3201734 0.05720 1 1326054 22412362 25878416 -3466054 X 1 1 1 1 DAVIE MEDICAL CENTER 329 NC HWY 801N BERMUDA RUN NC 27006 WWW.WAKEHEALTH.EDU/DAVIE-MEDICAL-CENTE H0171 X X X X DAVIE MEDICAL CENTER 1 0 0 1 X X X X X X X X X 15 1 1 0 1 X SEE PART V, PAGE 8 X 1 16 1 SEE PART V, PAGE 8 0 1 X 200.000000000000 400.000000000000 X X X X X X 1 1 X X X 1 X HTTP://WWW.WAKEHEALTH.EDU/DAVIE-MEDICAL-CENTER/INFORMATION/FINANCIAL-ASSIST X HTTP://WWW.WAKEHEALTH.EDU/DAVIE-MEDICAL-CENTER/INFORMATION/FINANCIAL-ASSIST X HTTP://WWW.WAKEHEALTH.EDU/DAVIE-MEDICAL-CENTER/INFORMATION/FINANCIAL-ASSIST X X X X X X X 1 X 0 X X X X 1 X 0 0 DAVIE MEDICAL CENTER PART V, SECTION B, LINE 5: COMMUNITY INPUT WAS OBTAINED THROUGH THE FOLLOWING SOURCES: (1) THE DAVIE COUNTY HEALTH DEPARTMENT'S COMMUNITY HEALTH ASSESSMENT CONDUCTED IN SUMMER 2014 VIA SURVEY MONKEY; (2) TWO FAITHHEALTH NC (A DEPARTMENT OF WAKE FOREST BAPTIST MEDICAL CENTER) COMMUNITY ASSET MAPPING WORKSHOPS WHICH SOUGHT OPINIONS OF BOTH HEALTH PROVIDERS AND HEALTH SEEKERS IN DAVIE COUNTY'S MOST VULNERABLE COMMUNITIES; (3) TWO COMMUNITY HEALTH WORKSHOPS, AND (4) COMMENTS FROM PRIOR COMMUNITY HEALTH NEEDS ASSESSMENT AND IMPLEMENTATION STRATEGY.ADDITIONALLY, MORE THAN TEN SECONDARY DATA SOURCES WERE REVIEWED, INCLUDING THE COUNTY HEALTH RANKINGS & ROADMAPS, 2014 STATE OF THE COUNTY HEALTH, US CENSUS BUREAU, N.C. CENTER FOR HEALTH STATISTICS, CENTERS FOR DISEASE CONTROL YOUTH RISK BEHAVIOR SURVEILLANCE SYSTEM, BEHAVIOR RISK FACTOR SURVEILLANCE SYSTEM, HEALTHY PEOPLE 2020, HEALTHY NORTH CAROLINA 2020, AND CENTERS FOR MEDICARE & MEDICAID. DAVIE MEDICAL CENTER PART V, SECTION B, LINE 6A: THE HOSPITAL'S MOST RECENT CHNA WAS CONDUCTED IN COLLABORATION WITH NORTH CAROLINA BAPTIST HOSPITAL AND LEXINGTON MEDICAL CENTER. BOTH LEXINGTON MEDICAL CENTER AND NORTH CAROLINA BAPTIST HOSPITAL ARE AFFILIATE HOSPITALS OF WAKE FOREST BAPTIST MEDICAL CENTER. DAVIE MEDICAL CENTER PART V, SECTION B, LINE 7D: N/APART V, SECTION B, LINE 7A:HTTP://WWW.WAKEHEALTH.EDU/DAVIE-MEDICAL-CENTER/ABOUT/COMMUNITY-BENEFITS/COMMUNITY-BENEFITS.HTMPART V, SECTION B, LINE 10A:HTTP://WWW.WAKEHEALTH.EDU/DAVIE-MEDICAL-CENTER/ABOUT/COMMUNITY-BENEFITS/COMMUNITY-BENEFITS.HTM DAVIE MEDICAL CENTER PART V, SECTION B, LINE 11: THE MOST RECENT COMMUNITY HEALTH NEEDS ASSESSMENT IDENTIFIED THE FOLLOWING SIGNIFICANT HEALTH NEEDS WITHIN THE COMMUNITY: (1) ACCESS TO HEALTH CARE, (2) CHRONIC DISEASE MANAGEMENT AND INFORMATION, (3) BEHAVIORAL AND MENTAL DISTRESS, (4) INADEQUATE EMERGENCY CARE, (5) DENTAL CARE, (6) HOUSING, (7) FOOD INSECURITIES, (8) LACK OF FINANCES, AND (9) LACK OF TRANSPORTATION.DAVIE MEDICAL CENTER (DMC) PRIORITIZED THE FOLLOWING THREE SIGNIFICANT COMMUNITY HEALTH NEEDS FOR ITS CURRENT CHNA AS FOLLOWS: (1) ACCESS TO CARE; (2) CHRONIC DISEASE MANAGEMENT; AND (3) BEHAVIORAL/MENTAL HEALTH DISTRESS. DMC PLANS TO PROVIDE COMMUNITY BENEFIT PROGRAMS RESPONSIVE TO THESE HEALTH NEEDS THROUGH ITS APPROVED CHNA IMPLEMENTATION STRATEGY. THE DMC CHNA IMPLEMENTATION STRATEGY OUTLINES THE IMPLEMENTATION OF PROGRAMS AND THE EVALUATION OF IMPACT OF THOSE PROGRAMS ON PRIORITY COMMUNITY HEALTH NEEDS IDENTIFIED FROM THE CHNA. SPECIFICALLY, THE HOSPITAL IS ADDRESSING THE SIGNIFICANT HEALTH NEEDS AS FOLLOWS:1. ACCESS TO CAREBARRIERS SUCH AS TRANSPORTATION AND ACCESS TO COMMUNITY CENTERED SOCIAL AND HEALTH EDUCATION SERVICES CAN LEAD TO UNMET HEALTH NEEDS. THE HOSPITAL'S CURRENT STRATEGIES INCLUDE:--REDUCING TRANSPORTATION BARRIERS FOR INDIVIDUALS IN RURAL AREAS OF THE COMMUNITY THROUGH 1.) ASSESSING NEED FOR TRANSPORTATION ASSISTANCE THROUGH VARIOUS COMMUNITY AGENCIES TO DETERMINE HOW TO EASE ACCESS THROUGH PUBLIC TRANSPORTATION OR ONSITE CLINICS IN HIGH NEED AREAS, AND 2.) WORKING WITH LOCAL AGENCIES TO DETERMINE RESOURCES AVAILABLE TO BRING CARE TO AREAS IMPACTED BY TRANSPORTATION ISSUES.--IMPROVING ACCESS TO COMMUNITY CENTERED SOCIAL AND HEALTH EDUCATION SERVICES AND REGULAR SOURCES OF HEALTH CARE THROUGH 1.) PROVIDING HEALTH EDUCATION EVENTS AND SCREENINGS AT VARIOUS LOCATIONS IN DAVIE COUNTY, 2.) CREATING OPPORTUNITIES TO INVOLVE FAMILIES IN REGULAR PROGRAMMING VIA THE HEALTHY DAVIE INITIATIVE, 3.) WORKING WITH LOCAL CHURCHES TO PROVIDE PROGRAMS AND ENLIST LAY LEADER SUPPORT TO ASSIST PARISHIONERS NEEDING ACCESS, 4.) CONTINUING TO EXPLORE THE USE OF A MOBILE MEDICAL CLINIC IN LOW ACCESS SERVICE AREAS, AND 5.) CONTINUING TO PROVIDE COMMUNITY ENGAGEMENT SUPPORT THROUGH 5 SUPPORTERS OF HEALTH, 311 CONGREGATIONAL PARTNERS, 25 CONNECTORS ACROSS THE SERVICE AREA AND 7 FAITHHEALTH FELLOWS.2. CHRONIC DISEASE MANAGEMENTDMC RECOGNIZES THE EFFECT OF CONTINUITY OF CARE WITH HEALTH CARE PROVIDERS ON PATIENT BEHAVIORS, DISEASE MANAGEMENT, AND HEALTH STATUS.THE HOSPITAL'S CURRENT STRATEGIES INCLUDE:--IMPROVING THE CAPACITY OF COMMUNITY BASED ORGANIZATIONS AND HEALTH CARE PROVIDERS TO SUPPORT EFFORTS RELATED TO CHRONIC DISEASE PREVENTION AND MANAGEMENT THROUGH 1.) CONTINUING TO SUPPORT FAITHHEALTH NC COMMUNITY HEALTH WORKERS TO ADDRESS CHRONIC DISEASE MANAGEMENT AND COMMUNITY HEALTH PROGRAMMING, 2.) INCREASING COMMUNITY AND HEALTHCARE PROVIDER ACCESS TO EXISTING CHRONIC DISEASE MANAGEMENT RESOURCES BY CENTRALIZING AND DISTRIBUTING INFORMATION AND 3.) PROVIDING AND EXPANDING CHRONIC DISEASE SELF-MANAGEMENT PROGRAMS OFFERED BY THE MEDICAL CENTER THROUGH EMMI SOFTWARE.--PROVIDING EDUCATION AND SUPPORT PROGRAMS TO REDUCE DIABETIC PREVALENCE AND IMPROVING DIABETES MANAGEMENT THROUGH 1.) WORKING WITH DAVIE COUNTY HEALTH DEPARTMENT TO IMPROVE ACCESS TO AREA DIABETES MANAGEMENT PROGRAMS FOR PRE-DIABETIC AND EARLY ONSET DIABETIC PATIENTS, 2.) CONTINUING TO PROVIDE BESTHEALTH DIABETES PREVENTION AND NUTRITION EDUCATION/COOKING CLASSES AT CONVENIENT LOCATIONS IN DAVIE COUNTY, AND 3.) EXPLORING PARTNERSHIP WITH DAVIE COUNTY AGENCIES TO FOCUS DIABETES PREVENTION AND MANAGEMENT PROGRAMS IN IDENTIFIED HIGH NEED NEIGHBORHOODS.--PROVIDING EDUCATION AND SUPPORT PROGRAMS TO REDUCE OBESITY PREVALENCE AND IMPROVE OBESITY MANAGEMENT THROUGH 1.) EXPANDING PROGRAMMING IN DAVIE COUNTY TO INCREASE EDUCATION AND AWARENESS OF NUTRITION AND HEALTHY LIFESTYLE CHOICES FOR UNINSURED AND MEDICAID PATIENTS, 2.) PROMOTING HEALTHY DIET AND WEIGHT MANAGEMENT THROUGH EMPLOYEE WELLNESS PROGRAMS, 3.) CONTINUING TO SUPPORT COMMUNITY WEIGHT MANAGEMENT EDUCATION THROUGH BESTHEALTH, 4.) INCREASING AWARENESS AMONG EXISTING PATIENTS AND EMPLOYEES OF WEIGHT MANAGEMENT PROGRAMS, AND 5.) WORKING WITH INDUSTRY AND DAVIE COUNTY SCHOOL SYSTEM TO IDENTIFY AT RISK INDIVIDUALS AND PROVIDE SUPPORT AND PROGRAMMING THROUGH THE HEALTHY DAVIE INITIATIVE.3. BEHAVIORAL/MENTAL HEALTH DISTRESSDMC RECOGNIZES THE OVERLAP OF MENTAL, MEDICAL AND SOCIAL DISPARITIES AND THE IMPORTANT ROLE OF BEHAVIORAL HEALTH IN TREATING THE WHOLE PERSON. THE HOSPITAL'S CURRENT STRATEGIES INCLUDE:--WORKING WITH CENTERPOINT TO IDENTIFY KEY RESOURCES FOR ACCESS AND PROGRAMMING FOR PATIENTS NEEDING MENTAL HEALTH SERVICES;--INCREASING THE CURRENT 30+ STAFF AT THE MEDICAL CENTER WHO WORK IN AREAS DEFINED AS INTEGRATED BEHAVIORAL HEALTH;--BUILDING CAPACITY AMONG LAY PERSONS IN THE COMMUNITY IN THE AREAS OF MENTAL HEALTH FIRST AID, COMMUNITY RESILIENCE MODEL AND SUICIDE PREVENTION PROGRAMS;--DEVELOPING A PLAN TO CREATE MORE INTEGRATED BEHAVIORAL HEALTH GRADUATE MEDICAL EDUCATION OFFERINGS FOR MEDICAL STUDENTS, RESIDENTS, FACULTY AND STAFF THAT SEE PATIENTS ACROSS THE MEDICAL CENTER NETWORK.ALL OF THE AFOREMENTIONED EFFORTS IN COMBINATION WITH THE HOSPITAL'S VALUES OF NONDISCRIMINATION AND COMPASSIONATE CARE ARE DESIGNED TO MEET THE SIGNIFICANT HEALTH NEEDS OF THE MOST RECENT COMMUNITY HEALTH NEEDS ASSESSMENT. DAVIE MEDICAL CENTER PART V, SECTION B, LINE 13H: THE HOSPITAL MAY USE COMMERCIALLY AVAILABLE FINANCIAL PROFILING AND CREDIT SCORING TECHNOLOGIES TO PRESUMPTIVELY SCREEN RESPONSIBLE INDIVIDUALS TO DETERMINE ELIGIBILITY FOR FINANCIAL ASSISTANCE DISCOUNTS. DAVIE MEDICAL CENTER PART V, SECTION B, LINE 16J: IN ADDITION TO THE METHODS PREVIOUSLY DESCRIBED, DAVIE MEDICAL CENTER INFORMS PATIENTS ABOUT ITS FAP DURING INTAKE AND DISCHARGE BY PROVIDING A PLAIN LANGUAGE SUMMARY OF THE FAP. THE HOSPITAL ALSO PLACES A CONSPICUOUS WRITTEN NOTICE OF THE FAP ON ITS PATIENT BILLING STATEMENTS. 8 1 - DMC BERMUDA RUN - GASTROENTEROLOGY 329 NC HWY 801 N BERMUDA RUN NC 27006 GASTROENTEROLOGY 2 - DMC BERMUDA RUN - SPINE 329 NC HWY 801 N BERMUDA RUN NC 27006 PHYSICAL MEDICINE/REHABILITATION SPINE 3 - DMC BERMUDA RUN - CARDIOLOGY 329 NC HWY 801 N BERMUDA RUN NC 27006 CARDIAC REHAB 4 - DMC BERMUDA RUN - PODIATRY 329 NC HWY 801 N BERMUDA RUN NC 27006 PODIATRY 5 - DMC BERMUDA RUN - ORTHOPAEDICS 329 NC HWY 801 N BERMUDA RUN NC 27006 X-RAY & ORTHOPAEDICS 6 - DMC BERMUDA RUN - PULMONOLOGY 329 NC HWY 801 N BERMUDA RUN NC 27006 PULMONARY 7 - DMC BERMUDA RUN - NEUROLOGY 329 NC HWY 801 N BERMUDA RUN NC 27006 EEG/EMG TESTING, SLEEP LAB 8 - DMC BERMUDA RUN - EYE CENTER 329 NC HWY 801 N BERMUDA RUN NC 27006 OPTHALMOLOGY PART I, LINE 3C: THE ORGANIZATION ALSO EVALUATES CERTAIN CREDIT FILE DATA ELEMENTS TO IDENTIFY POTENTIAL SOURCES OF INCOME TO MORE ACCURATELY INFORM CHARITY CARE ELIGIBILITY ASSESSMENTS. PATIENTS WITH ESTIMATED HOUSEHOLD INCOME BELOW 200% OF FPG, WHO ARE IDENTIFIED AS HAVING COMMERCIAL CREDIT ACCOUNTS THAT ARE BEING SERVICED IN A MANNER THAT SUGGESTS ADDITIONAL SOURCES OF INCOME, ARE NOT AUTOMATICALLY GRANTED PRESUMPTIVE CHARITY CARE. PART I, LINE 7: THE ORGANIZATION USED THE WORKSHEETS PROVIDED IN THE INSTRUCTIONS TO SCHEDULE H TO COMPUTE ITS COST TO CHARGE RATIO FOR PURPOSES OF THE 2017 SCHEDULE H.PART I, LINE 7B MEDICAID DIRECT OFF-SETTING REVENUETHE HOSPITAL PARTICIPATES IN A PROVIDER ASSESSMENT PROGRAM ADMINISTERED BY THE NORTH CAROLINA DEPARTMENT OF HEALTH AND HUMAN SERVICES. UNDER THE PROGRAM, A FEE IS ASSESSED AGAINST NON-MEDICAID PATIENT SERVICE REVENUE OF PRIVATE HOSPITALS. THE FEDERAL GOVERNMENT MATCHES THE ASSESSMENT AT A RATE OF 2 TO 1 AND THESE AMOUNTS ARE ALLOCATED TO NORTH CAROLINA HOSPITALS QUARTERLY. ADDITIONALLY, THE HOSPITAL PARTICIPATES IN THE NORTH CAROLINA MEDICAID REIMBURSEMENT INITIATIVE (MRI). UNDER THE MRI, THE HOSPITAL RECEIVES ADDITIONAL REIMBURSEMENT BASED ON MEDICAID COST DEFICITS AND TREATMENT OF A DISPROPORTIONATE SHARE OF UNINSURED PATIENTS. PART I, LN 7 COL(F): THE ORGANIZATION'S PATIENT BAD DEBT EXPENSE PER THE AUDITED FINANCIAL STATEMENTS WAS $6,074,761 FOR THE FISCAL YEAR ENDED JUNE 30, 2018. THIS AMOUNT IS NOT INCLUDED IN THE CALCULATION OF CHARITY CARE FOR PART I, LINE 7. PART II, COMMUNITY BUILDING ACTIVITIES: WAKE FOREST BAPTIST HEALTH - DAVIE MEDICAL CENTER IS COMMITTED TO IMPROVING THE HEALTH OF THE INDIGENT AND MEDICALLY UNDERSERVED IN DAVIE COUNTY AND SURROUNDING AREAS. DAVIE MEDICAL CENTER REPRESENTATIVES ARE INVOLVED IN THE COMMUNITY THROUGH INITIATIVES SUCH AS HEALTHY DAVIE, PART OF THE DAVIE COMMUNITY FOUNDATION. THE MEDICAL CENTER HOSTS FREE CLASSES, SCREENINGS AND COOKING DEMONSTRATIONS THROUGH ITS BESTHEALTH PROGRAM. DAVIE MEDICAL CENTER PARTNERS WITH OTHER AGENCIES THROUGHOUT THE COMMUNITY TO CONTINUE TO IMPROVE HEALTH. AGENCIES INCLUDE SENIOR SERVICES, DRAGONFLY HOUSE, SMART START OF DAVIE COUNTY AND THE DAVIE YMCA. PART III, LINE 4: THE ORGANIZATION'S FINANCIAL STATEMENTS DO NOT INCLUDE A DISCRETE FOOTNOTE EXPLAINING BAD DEBT EXPENSE. BAD DEBT HAS NOT BEEN INCLUDED IN THE COMPUTATION OF COMMUNITY BENEFIT ON PART I, LINE 7. AMOUNTS USED TO COMPUTE CHARITY CARE AND BAD DEBT ON SCHEDULE H USE THE MOST CURRENT DATA AVAILABLE AT THE TIME OF FILING. THE ORGANIZATION USED WORKSHEET 2 OF THE 2017 SCHEDULE H INSTRUCTIONS TO COMPUTE A COST TO CHARGES RATIO USED TO CALCULATE BAD DEBT AT COST. PART III, LINE 8: THE HOSPITAL USES AN OVERALL COST TO CHARGE RATIO CALCULATION BASED ON AUDITED FINANCIAL STATEMENTS BUT REMOVES COST ASSOCIATED WITH BAD DEBT, COMMUNITY BUILDING, AND CHARITY CARE SO AS NOT TO COUNT THOSE COSTS TWICE. PART III, LINE 9B: THE HOSPITAL MAKES A REASONABLE EFFORT TO DETERMINE AN INDIVIDUAL'S ELIGIBILITY FOR FINANCIAL ASSISTANCE BEFORE ENGAGING IN ANY COLLECTION ACTIONS. ALL COLLECTION ACTIONS WILL BE SUSPENDED IF THE INDIVIDUAL SUBMITS A COMPLETED FAP APPLICATION DURING THE APPLICATION PERIOD, OR IF THE INDIVIDUAL SUBMITS AN INCOMPLETE APPLICATION DURING THE APPLICATION PERIOD THAT IS SUBSEQUENTLY COMPLETED WITHIN A REASONABLE TIME AFTER THE HOSPITAL REQUESTS FURTHER INFORMATION. IF THE INDIVIDUAL IS DETERMINED NOT TO BE ELIGIBLE FOR A FULL DISCOUNT UNDER THE FAP, ANY COLLECTION ACTIVITIES WILL BE RESUMED AS TO THE OUTSTANDING BALANCE OWED. IF THE INDIVIDUAL IS DETERMINED TO BE ELIGIBLE FOR ANY LEVEL OF ASSISTANCE UNDER THE FAP, APPROPRIATE MEASURES ARE TAKEN TO REFUND ANY AMOUNTS OWED TO THE INDIVIDUAL AND REVERSE OR MODIFY COLLECTION ACTIONS CONSISTENT WITH THE NEW BALANCE OWED AFTER APPLYING THE APPLICABLE FAP DISCOUNTS. PART VI, LINE 2: THE HOSPITAL'S CURRENT NEEDS ASSESSMENT PLAN WAS BASED ON A SET OF BEST PRACTICES FOR COMMUNITY HEALTH ASSESSMENTS WITH THE PURPOSE OF IDENTIFYING TWO TO THREE REGIONAL PRIORITY AREAS TO FOCUS ON FOR FY 2017-2019. THE PROCESS WAS DESIGNED TO RELY ON EXISTING PUBLIC DATA, DIRECTLY ENGAGING COMMUNITY STAKEHOLDERS AND COLLABORATE WITH LOCAL PUBLIC HEALTH, OTHER HEALTH PROVIDERS, AS WELL AS COMMUNITY PARTNERS SUCH AS FAITH NETWORKS RELEVANT TO THE SOCIAL FACTORS UNDERLYING PATTERNS OF ACCESS. THE HOSPITAL'S ASSESSMENT WAS CONDUCTED IN THREE STAGES: (1) DATA REVIEW (PRIMARY AND SECONDARY DATA), (2) SETTING PRIORITIES, AND (3) COMMUNITY ASSET INVENTORY. THE DATA REVIEW AND PRIORITY SETTING PHASE BEGAN WITH THE COMPILATION OF EXISTING HEALTH-RELATED DATA. STAKEHOLDERS REVIEWED MULTIPLE DATA SETS INCLUDING FORSYTH, DAVIDSON, AND THE DAVIE COUNTY HEALTH DEPARTMENT'S PUBLIC HEALTH NEEDS ASSESSMENTS, NORTH CAROLINA INDICATORS FOR COMMUNITY HEALTH ASSESSMENT, INTERNAL DISEASE REGISTRIES, AND COUNTY HEALTH RANKINGS. ONCE THE COMMUNITY HEALTH NEEDS WERE IDENTIFIED, AN INTERNAL STEERING COMMITTEE AND SENIOR LEADERSHIP REVIEW A SET OF CRITERIA TO DEVELOP THE PRIORITY RANKINGS. THE PRIORITIZATION PROCESS IDENTIFIED THE FOLLOWING TOP THREE PRIORITY CHALLENGES FOR THE COMMUNITY: (1) ACCESS/LACK OF MEDICAL SERVICES/SCREENINGS, (2) CHRONIC DISEASE - CANCER, DIABETES, OBESITY, AND (3) BEHAVIORAL/MENTAL HEALTH DISTRESS.FAITHHEALTHNC (A DIVISION OF THE MEDICAL CENTER) PROVIDED COMMUNITY ENGAGEMENT THROUGH A COMPREHENSIVE ASSET MAPPING STRATEGY BASED ON AN APPROACH FROM SOUTH AFRICA AND REDEFINED IN MEMPHIS, TN DESIGNED TO BUILD COMMUNITY PARTNERSHIPS ON THE ASSETS THAT EXIST, INSTEAD OF JUST NEEDS. THE MAPPING DEVELOPED AN INVENTORY OF EXISTING PROGRAMS AND SERVICES WITHIN THE REGION RELATED TO THE PRIORITY AREAS IDENTIFIED IN THE NEEDS ASSESSMENT. THE INVENTORY INCLUDED THE LOCATION OF THE PROGRAM (HOSPITAL, CLINIC, OR COMMUNITY SERVICE) AS WELL AS THE NATURE OF THE INTANGIBLE FACTORS, ESPECIALLY TRUST, THAT DETERMINE ACCESS AND COLLABORATION AMONG COMMUNITY PARTNERS. THE PURPOSE OF THE INVENTORY WAS TO IDENTIFY GAPS IN SERVICES, OPPORTUNITIES FOR NEW WORK, WHERE AND WITH WHOM THERE IS ALREADY WORK BEING DONE, AND OPPORTUNITIES FOR PARTNERSHIP AND COLLABORATION. FROM THIS THREE STEP PROCESS, THE HOSPITAL DEVELOPED AN IMPLEMENTATION STRATEGY TO IDENTIFY THE MEANS THROUGH WHICH IT PLANS TO ADDRESS NEEDS THAT ARE CONSISTENT WITH THE CHARITABLE MISSION AS PART OF ITS COMMUNITY BENEFIT PROGRAMS FOR THE FISCAL YEARS 2017-2019. BEYOND THE PROGRAMS THAT WILL BE ADDRESSED IN THE IMPLEMENTATION STRATEGY, THE HOSPITAL WILL CONTINUE TO ADDRESS MANY OF THE PRIORITIES BY PROVIDING CARE TO ALL, REGARDLESS OF THE ABILITY TO PAY. PART VI, LINE 3: THE ORGANIZATION USES A VARIETY OF MEANS TO EDUCATE AND INFORM PATIENTS OF THEIR CHARITY CARE OPTIONS, INCLUDING INFORMATION ON A WEBSITE, PAMPHLETS, CONSPICUOUSLY DISPLAYED SIGNAGE, INFORMATION ON PATIENT BILL STATEMENTS, AND FROM STAFF MEMBERS DURING CONVERSATIONS CONCERNING A PATIENT'S LIABILITY FOR SERVICES. THE HOSPITAL EMPLOYS A PRE-SERVICE FINANCIAL CLEARANCE PROCESS THAT SCREENS PATIENTS PRIOR TO SERVICE DELIVERY FOR EXISTING OR AVAILABLE PAYER SOURCES AS A MEANS OF AVOIDING BAD DEBT AND INAPPROPRIATE BILLING TO PATIENTS WITHOUT THE MEANS TO PAY. IF A PAYER SOURCE IS IDENTIFIED, HOSPITAL STAFF WILL ASSIST THE PATIENT WITH ENROLLMENT. PART VI, LINE 4: DAVIE COUNTY IS LOCATED IN THE PIEDMONT TRIAD REGION OF NORTH CAROLINA, COVERING 264 SQUARE MILES WITH A POPULATION OF APPROXIMATELY 42,500. WIDELY RURAL, THE COUNTY IS CHARACTERIZED BY ROLLING FARMLAND. THE NEAREST METROPOLITAN AREA IS WINSTON-SALEM, LOCATED JUST 12 MILES TO THE NORTHEAST. OVER 80% OF THE COUNTY'S POPULATION LIVES IN UNINCORPORATED AREAS. APPROXIMATELY 61% OF DAVIE COUNTY'S RESIDENTS TRAVEL OUTSIDE OF THE COUNTY FOR EMPLOYMENT. THE MEDIAN INCOME FOR DAVIE COUNTY RESIDENTS IS APPROXIMATELY $51,662. THE DAVIE COUNTY UNEMPLOYMENT RATE AS REPORTED IN JUNE 2016 WAS 3.7%.THE FOLLOWING DEMOGRAPHIC FIGURES REFLECT THE POPULATION FOR DAVIE COUNTY: - 51% FEMALE, 49% MALE - BELOW 18 YEARS: 21.4% - AGE 65 AND OLDER: 20.4%THE COUNTY POPULATION BREAKDOWN BY RACE IS: - WHITE NON-HISPANIC (84.2%) - BLACK (6.5%) - HISPANIC (6.9%) - TWO OR MORE RACES (1.7%) - AMERICAN INDIAN (0.7%)THERE ARE SEVEN TOWNSHIPS IN DAVIE COUNTY. MOCKSVILLE IS THE LARGEST MUNICIPALITY WITH 5,271 RESIDENTS, AND IS ALSO THE COUNTY SEAT. APPROXIMATELY 70% OF DAVIE COUNTY'S POPULATION IS CONTAINED WITHIN RURAL AREAS OF THE COUNTY. PART VI, LINE 5: THE HOSPITAL HAS MAINTAINED A STRONG COMMITMENT TO PROMOTING AND EXPANDING COMMUNITY HEALTH PROGRAMS IN DAVIE COUNTY. SUCH PROGRAMS INCLUDE BESTHEALTH COMMUNITY EDUCATION CLASSES, CHRONIC DISEASES SELF MANAGEMENT PROGRAMS, PUBLIC SCREENINGS, AND OTHER HEALTH EDUCATION EVENTS HELD LOCALLY THROUGHOUT THE YEAR. IN FEBRUARY 2018, DAVIE MEDICAL CENTER AND BEST HEALTH, WAKE FOREST BAPTIST HEALTH'S COMMUNITY WELLNESS PROGRAM, INTRODUCED THE CAREGIVER ACADEMY PROGRAM, WHICH FEATURES FREE CLASSES TO EDUCATE THE COMMUNITY ON HOW TO PREPARE FOR CAREGIVING AND PROVIDE ASSISTANCE FOR LOVED ONES, INCLUDING FINDING THE RIGHT RESOURCES, BEING YOUR OWN HEALTH CARE ADVOCATE, AND DEALING WITH THE PAPERWORK AND FINANCIAL BURDENS. PART VI, LINE 6: THE FILING ORGANIZATION, NORTH CAROLINA BAPTIST HOSPITAL, LEXINGTON MEDICAL CENTER, WILKES REGIONAL MEDICAL CENTER, WAKE FOREST UNIVERSITY HEALTH SCIENCES, AND WAKE FOREST UNIVERSITY BAPTIST MEDICAL CENTER ARE INTEGRAL PARTS OF WAKE FOREST BAPTIST HEALTH, A PREEMINENT, INTERNATIONALLY RECOGNIZED ACADEMIC MEDICAL CENTER OF THE HIGHEST QUALITY WITH BALANCED EXCELLENCE IN PATIENT CARE, RESEARCH AND EDUCATION. WFUHS OPERATES THE UNIVERSITY'S SCHOOL OF MEDICINE AND WAKE FOREST INNOVATION QUARTER (RESEARCH PARK). THE MEDICAL CENTER COMPRISES 1,004 ACUTE CARE AND REHABILITATION BEDS AND OFFERS EXPERTISE IN MORE THAN 100 AREAS OF MEDICINE, ENCOMPASSING COMPREHENSIVE PREVENTIVE AND HIGHLY SPECIALIZED CARE FOR ALL AGES. WAKE FOREST BAPTIST MEDICAL CENTER HAS BEEN RANKED AS ONE OF "AMERICA'S TOP HOSPITALS" BY U.S. NEWS AND WORLD REPORT SINCE 1993. PART VI, LINE 7, REPORTS FILED WITH STATES NC 1 1 0 0 0 0 0 0 0 LYNN PITMAN BOARD MEMBER 0 204314 0 17540 0 1018 0 18496 0 14003 0 255371 0 0 CHAD BROWN PRESIDENT 0 244302 0 52597 0 1721 0 51184 0 19293 0 369097 0 0 BRADLEY A CLARK TREASURER 0 406688 0 75755 0 670 0 150891 0 20088 0 654092 0 0 J MCLAIN WALLACE JR SECRETARY 0 483693 0 102659 0 102768 0 55373 0 16504 0 760997 0 0 DANNY SQUIRES FINANCE DIRECTOR 0 162418 0 0 0 613 0 13032 0 15589 0 191652 0 0 BRYAN C LEE CLINICAL INSTRUCTOR CRNA 0 179814 0 0 0 121 0 15023 0 18641 0 213599 0 0 SARA H SHIELDS PHARMACY MANAGER 0 146453 0 0 0 91 0 10974 0 7357 0 164875 0 0 KIMBERLY DEE STANBERY NURSING DIRECTOR 0 123897 0 11683 0 97 0 8196 0 20944 0 164817 0 0 CHAD ECKES FORMER OFFICER (AS OF 6/12/17) 0 346612 0 0 0 640420 0 22984 0 10912 0 1020928 0 0 PART I, LINES 4A-B CERTAIN DIRECTORS AND OFFICERS OF THE FILING ORGANIZATION RECEIVED SEVERANCE PAYMENTS AND PARTICIPATED IN SUPPLEMENTAL NON QUALIFIED RETIREMENT PLANS (SERP), ALL OF WHICH WERE PAID BY A RELATED ORGANIZATION, WAKE FOREST UNIVERSITY BAPTIST MEDICAL CENTER, AS PART OF THE INDIVIDUAL'S COMPENSATION FROM THE RELATED ORGANIZATION. THE DETERMINATION OF THE AMOUNT OF THE NON QUALIFIED RETIREMENT PLANS FOLLOWED THE RELATED ORGANIZATION'S COMPENSATION PROCEDURES AS OUTLINED IN PART VI, SECTION B, LINE 15 OF THE FORM 990. THE FOLLOWING DIRECTOR AND OFFICER RECEIVED SERP PAYMENTS IN THEIR CALENDAR YEAR 2017 COMPENSATION: J. MCLAIN WALLACE $81,156 THE FOLLOWING FORMER OFFICER RECEIVED SEVERANCE PAYMENTS IN HIS CALENDAR YEAR 2017 COMPENSATION: CHAD ECKES $640,000 FORM 990, PART IV, LINE 20B THE HOSPITAL HAS ATTACHED A COPY OF ITS CONSOLIDATED AUDITED FINANCIAL STATEMENTS FOR ITS FISCAL YEAR ENDED JUNE 30, 2018 TO THE FORM 990. THE CONSOLIDATED FINANCIAL STATEMENTS HAVE BEEN PREPARED ON THE ACCRUAL BASIS IN CONFORMITY WITH U.S. GENERALLY ACCEPTED ACCOUNTING PRINCIPLES (GAAP) AND INCLUDE THE ASSETS AND OPERATIONS OF LEXINGTON MEDICAL CENTER AND AFFILIATE, NORTH CAROLINA BAPTIST HOSPITAL AND AFFILIATES, WAKE FOREST UNIVERSITY HEALTH SCIENCES AND AFFILIATES, DAVIE MEDICAL CENTER, NORTHWEST COMMUNITY CARE NETWORK, INC., FAITHHEALTH INNOVATIONS, WAKE FOREST UNIVERSITY BAPTIST MEDICAL CENTER (WFUBMC), CORNERSTONE HEALTH CARE, LLC, WILKES REGIONAL MEDICAL CENTER AND AFFILIATE, AND OTHER WFUBMC AFFILIATES. ALL SIGNIFICANT INTERCOMPANY TRANSACTIONS HAVE BEEN ELIMINATED IN CONSOLIDATION. FORM 990, PART VI, SECTION A, LINE 3 PURSUANT TO THE ORGANIZATION'S BYLAWS, THE BOARD OF TRUSTEES MAY ESTABLISH AN EXECUTIVE COMMITTEE CONSISTING OF THREE OR MORE TRUSTEES, THE MAJORITY OF WHOM SHALL BE SOLE MEMBER TRUSTEES (WAKE FOREST UNIVERSITY BAPTIST MEDICAL CENTER TRUSTEES) AND THE REMAINDER SHALL BE DAVIE COUNTY TRUSTEES. DURING THE INTERVALS BETWEEN MEETINGS OF THE BOARD OF TRUSTEES, THE EXECUTIVE COMMITTEE SHALL HAVE AND MAY EXERCISE THE POWERS OF THE BOARD OF TRUSTEES IN THE MANAGEMENT OF THE BUSINESS AND AFFAIRS OF THE CORPORATION; PROVIDED THAT THE EXECUTIVE COMMITTEE MAY NOT TAKE ANY ACTION THAT WOULD REQUIRE A SUPERMAJORITY VOTE OF THE BOARD OF TRUSTEES. FORM 990, PART VI, SECTION A, LINE 6 PURSUANT TO ITS ARTICLES OF AMENDMENT FILED ON MAY 1, 2017, THE SOLE MEMBER OF THE ORGANIZATION IS WAKE FOREST UNIVERSITY BAPTIST MEDICAL CENTER, A NORTH CAROLINA NONPROFIT CORPORATION. FORM 990, PART VI, SECTION A, LINE 7A THE SOLE MEMBER OF THE ORGANIZATION SHALL HAVE THE RIGHT AT ALL TIMES, WITH RESPECT TO THE ORGANIZATION, TO ELECT AND REMOVE THE TRUSTEES, AS PROVIDED IN THE ORGANIZATION'S BYLAWS. FORM 990, PART VI, SECTION A, LINE 7B AS PROVIDED IN THE ORGANIZATION'S BYLAWS, THE SOLE MEMBER OF THE ORGANIZATION SHALL HAVE THE RIGHT AT ALL TIMES, WITH RESPECT TO THE ORGANIZATION, TO APPROVE OF THE SALE, LEASE, OR TRANSFER OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS OF THE ORGANIZATION, TO APPROVE ANY AMENDMENTS TO THE ORGANIZATION'S ARTICLES OR BYLAWS, AND TO APPROVE THE MISSION, VISION AND VALUE STATEMENTS OF THE ORGANIZATION. THE SOLE MEMBER MAY ACT WITHOUT A MEETING. FORM 990, PART VI, SECTION B, LINE 11B THE FILING ORGANIZATION'S BOARD OF DIRECTORS RECEIVE COPIES OF THE FORM 990 WITH SUFFICIENT TIME TO PERMIT REVIEW, COMMENT, AND QUESTIONS PRIOR TO ITS FILING. IF MODIFICATIONS ARE REQUIRED FOLLOWING SUCH REVIEW AND COMMENT, THE REVISED FORM 990 IS REDISTRIBUTED TO ALL DIRECTORS PRIOR TO ITS FILING WITH THE IRS, ALONG WITH A REPORT NOTING THE MODIFICATIONS. FORM 990, PART VI, SECTION B, LINE 12C ON AN ANNUAL BASIS (AND AS THEY ARISE), ALL TRUSTEES AND OFFICERS OF THE FILING ORGANIZATION ARE ASKED TO REVIEW THE APPLICABLE CONFLICTS OF INTEREST POLICY AND TO DESCRIBE ANY POTENTIAL CONFLICTS OF INTEREST THEY MAY HAVE. UPON COMPLETION OF THE CONFLICTS OF INTEREST SURVEY, THE LEGAL DEPARTMENT REVIEWS THE COMPLETED QUESTIONNAIRES ON BEHALF OF THE FILING ORGANIZATION. ANY CONFLICTS IDENTIFIED ARE COMMUNICATED TO THE FILING ORGANIZATION'S CHAIRMAN OF THE BOARD AND ARE PRESENTED TO THE MEDICAL CENTER GOVERNANCE AND COMPENSATION COMMITTEE. ALL CONFLICTS OF INTEREST ARE RESOLVED BY MANAGEMENT PLANS DEVELOPED BY THE MEDICAL CENTER GOVERNANCE AND COMPENSATION COMMITTEE AND THE INTERNAL AUDIT AND COMPLIANCE OFFICES. THE MEDICAL CENTER GOVERNANCE AND COMPENSATION COMMITTEE'S CHAIR PRESENTS AN ANNUAL REPORT ON CONFLICTS TO THE FULL BOARD OF THE FILING ORGANIZATION. FORM 990, PART VI, SECTION B, LINE 15 DAVIE MEDICAL CENTER IS AN INTEGRAL PART OF WAKE FOREST BAPTIST HEALTH, A PREEMINENT, INTERNATIONALLY RECOGNIZED ACADEMIC MEDICAL CENTER OF THE HIGHEST QUALITY WITH BALANCED EXCELLENCE IN PATIENT CARE, RESEARCH AND EDUCATION. THE FILING ORGANIZATION PAYS NO COMPENSATION TO OFFICERS, DIRECTORS AND KEY EMPLOYEES. ALL COMPENSATION PAID TO OFFICERS, DIRECTORS AND KEY EMPLOYEES WAS PAID BY A RELATED ORGANIZATION, WAKE FOREST UNIVERSITY BAPTIST MEDICAL CENTER, AN ENTITY WITHIN THE WAKE FOREST BAPTIST HEALTH LEGAL STRUCTURE. COMPENSATION PAID TO THESE INDIVIDUALS ARE REVIEWED AND APPROVED IN ACCORDANCE WITH THE APPLICABLE ORGANIZATION'S COMPENSATION POLICIES AND PROCEDURES WHICH INCLUDE INDEPENDENT COMPENSATION CONSULTANTS, COMPENSATION SURVEYS AND STUDIES TO DETERMINE THE APPROPRIATENESS OF EACH OFFICER'S AND DIRECTOR'S COMPENSATION. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S ARTICLES OF INCORPORATION ARE AVAILABLE TO THE PUBLIC ON REQUEST AND ARE AVAILABLE ON THE WEBSITE OF THE NORTH CAROLINA SECRETARY OF STATE. THE ORGANIZATION'S BYLAWS ARE NOT PUBLISHED, BUT PROVISIONS FROM THE BYLAWS ARE INCLUDED AS NECESSARY IN THE ORGANIZATION'S POLICIES, AND ARE ATTACHED TO THE FORM 1023 FILED FOR THE ORGANIZATION WITH THE IRS, WHICH IS PUBLICLY AVAILABLE. THE CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE NOT AVAILABLE TO THE PUBLIC. DAVIE COUNTY HOSPITAL FOUNDATION 156 ROLAND RD MOCKSVILLE NC 27028 581477280 SUPPORTING ORGANIZATION NC 501(C)(3) LINE 12C, III-FI N/A 0 WAKE FOREST UNIVERSITY BAPTIST MEDICAL CENTER MEDICAL CENTER BLVD WINSTON SALEM NC 27157 510190238 HEALTHCARE NC 501(C)(3) LINE 12A, I 0 LEXINGTON MEDICAL CENTER 250 HOSPITAL DRIVE LEXINGTON NC 27292 560543238 HEALTHCARE NC 501(C)(3) LINE 3 WAKE FOREST UNIVERSITY BAPTIST MEDICAL CENTER 0 LEXINGTON MEDICAL CENTER FOUNDATION 250 HOSPITAL DRIVE LEXINGTON NC 27292 581876553 FUNDRAISING NC 501(C)(3) LINE 12B, II LEXINGTON MEDICAL CENTER 0 NORTHWEST COMMUNITY CARE NETWORK 2000 WEST FIRST STREET WINSTON SALEM NC 27104 020774853 HEALTHCARE NC 501(C)(3) LINE 7 WAKE FOREST UNIVERSITY BAPTIST MEDICAL CENTER 0 FAITHHEALTH INNOVATIONS INC MEDICAL CENTER BLVD WINSTON SALEM NC 27157 237426944 HEALTHCARE NC 501(C)(3) LINE 10 WAKE FOREST UNIVERSITY BAPTIST MEDICAL CENTER 0 WRMC HOSPITAL OPERATING CORPORATION PO BOX 609 NORTH WILKESBORO NC 28659 830343789 HEALTHCARE NC 501(C)(3) LINE 3 WAKE FOREST UNIVERSITY BAPTIST MEDICAL CENTER 0 WILKES PHYSICIAN NETWORK INC PO BOX 609 NORTH WILKESBORO NC 28659 262971169 HEALTHCARE NC 501(C)(3) LINE 3 WRMC HOSPITAL OPERATING CORPORATION 0 WAKE FOREST EMERGENCY PROVIDERS (FKA WFUBMC COMM PHYS) MEDICAL CENTER BLVD WINSTON SALEM NC 27157 561903275 HEALTHCARE NC 501(C)(3) LINE 3 WAKE FOREST UNIVERSITY BAPTIST MEDICAL CENTER 0 MS LAND HOLDING CO LLC 1901 MOONEY STREET WINSTON SALEM NC 27103 824005370 REAL ESTATE NC N/A N/A 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 1 1 0 0