2018-05-14T09:18:41-05:00 2017-06-30 135565207 KPMG LLP 300 North Greene Street Greensboro NC 27401 990 2016-07-01 560552787 North Carolina Baptist Hospital NORT 3367164445 Medical Center Blvd WinstonSalem NC 27157 Bradley A Clark Treasurer 3367164445 2018-05-03 0 P00008888 3362753394 152.11.164.128 2018-05-03 09:35:37 ED P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 DC01AECBE81A4AD4CD4D193E44ADD2DAE604305A 2016 2021-01-29 14:40:06Z Julie Ann Freischlag MD Medical Center Blvd WinstonSalem NC 27157 1742241702 0 X www.wakehealth.edu X 1923 NC Improving the health of our region, state and nation 12 11 0 1953 5314446 2814419 3550774 3544874 1464555266 1714387607 12968573 13548008 6608827 6025132 1487683440 1737505621 1969391 1234809 0 0 591105105 609286376 0 0 0 863383655 1071651556 1456458151 1682172741 31225289 55332880 1847321313 1934393445 909679590 875307080 937641723 1059086365 X SEE SCHEDULE O FOR CONTINUATIONWake Forest Baptist Medical Center's mission is to improve the health of the region, state and nation by:- Serving as the premier health system in the region, with specific centers of excellence recognized as national and international care destinations.- Generating and translating knowledge to prevent, diagnose and treat disease.- Training tomorrow's leaders in health care and biomedical science. 0 0 1504840309 1234809 1711178764 See schedule O for complete descriptionNorth Carolina Baptist Hospital is an integral part of Wake Forest Baptist Medical Center, a preeminent, internationally recognized academic medical center of the highest quality with balanced excellence in patient care, research and education. The following paragraphs are provided to explain the relationship of the filing organization with other organizations which together comprise "Wake Forest Baptist Medical Center," the name not of any one corporate entity, but used generically to describe a large group of mostly tax-exempt 501 (c)(3) organizations performing various academic medical center activities in northwest North Carolina, including patient care, medical research, technology transfer and medical education. Because these activities are not all performed by each organization, the narrative that follows will include descriptions of activities that are performed by the filing organization and by a related (or unrelated but affiliated) organization; they are again provided to illustrate a complete picture of the filing organization's role in this integrated academic medical center's comprehensive activities. Wake Forest Baptist Medical Center is northwest North Carolina's sole academic medical center, bringing to the region the resources of one of America's top hospitals and innovative research centers and a premier medical school. Wake Forest University Baptist Medical Center is a corporation whose members are Wake Forest University and North Carolina Baptist Hospital. The medical center operates Wake Forest University School of Medicine, which has a faculty of 1,247, including physicians and basic scientists. The medical center has 1,029 acute care and rehabilitation beds operative across the system, which encompasses its main campus (885 beds), Wake Forest Baptist Health Lexington Medical Center (94 beds) and Wake Forest Baptist Health Davie Medical Center (50 beds). The medical center opened a $47 million, 50-bed inpatient facility at Davie Medical Center in the spring of 2017. Overall, Wake Forest Baptist Medical Center serves a 24-county region in northwestern North Carolina and southwestern Virginia and also draws patients from across the nation for select services.The medical center is the driving force behind the establishment of Wake Forest Innovation Quarter, a growing urban-based district for research, business and education in biomedical science, information technology, clinical services and advanced materials located in downtown Winston-Salem. Home to more than 152 companies, four leading institutions, more than 3,600 workers, 1,522 students and 8,000 workforce trainee participants, the Innovation Quarter currently comprises 1.9 million square feet of office, laboratory and educational space on its 337 developable acres. In July 2016, Wake Forest University Health Sciences students began their medical careers in the Bowman Gray Center for Medical Education in the Innovation Quarter. The $60 million building was designed with the next generation of physician-leaders in mind. It includes the latest technologies and simulation labs that allow students to prepare for real-life experiences. The opening of the Bowman Gray Center coincided with the adoption of a new medical school curriculum that is one of the most advanced in the country.In November 2016, Wake Forest Baptist Medical Center was awarded a five-year, $8.7 million grant from the National Institutes of Health for the establishment of a new center for research into Alzheimer's disease. The Alzheimer's Disease Core Center at Wake Forest Baptist is among 31 NIH-funded Alzheimer's research centers in the country and the only one in North Carolina. The center will provide training in translational research to new investigators and develop educational programs about Alzheimer's and dementia for health care professionals, patients and family members, and the community at large. The center already is offering groundbreaking clinical trials, including studies that examine how exercise, diet and new drugs may affect the development or progress of Alzheimer's and dementia.1. CLINICAL SERVICES Wake Forest Baptist Medical Center is nationally recognized for clinical excellence and internationally known for pioneering research and clinical innovation. Its clinical enterprise, Wake Forest Baptist Health, offers expertise in more than 100 areas of medicine, encompassing comprehensive preventive and highly specialized care for all ages. The medical center network includes the 167-bed Comprehensive Cancer Center and the 144-bed Brenner Children's Hospital, both of which are on the main campus in Winston-Salem, as well as community hospitals in neighboring Davidson and Davie counties. Across its service area of northwest North Carolina and southwest Virginia, Wake Forest Baptist has 3 emergency departments, 3 urgent care centers, 72 primary care clinics, 265 specialty clinics, 18 out-patient dialysis centers, 1 free-standing dialysis access-center, and freestanding imaging and endoscopy centers. The medical center employs 1,865 physicians, 3,184 registered nurses, and 716 residents and fellows. It has a total staff of 16,157. Overall in FY 2017, Wake Forest Baptist had 55,568 inpatient admissions, 158,344 Emergency Department visits and 1,868,802 outpatient encounters (ambulatory visits and outpatient encounters).2. OUTREACHWake Forest Baptist Medical Center continues a broad-based effort to reach underserved populations across its service area. The Medical Center's annual Community Benefits report reflects this commitment. In fiscal 2017, the Medical Center spent $374 million to support these areas: Subsidized health costs Community health outreach Charity care Research EducationOne anchor of outreach for the Medical Center is its Downtown Health Plaza, a full-service, outpatient medical clinic that serves many of Forsyth County's uninsured and underinsured residents with a state-of-the-art medical home. In addition to clinical care, the Downtown Health Plaza offers community health fairs, diabetes education and a Centering Pregnancy Program that is reducing the incidence of low birth weight babies. Altogether, 64,768 patient visits were recorded at the Downtown Health Plaza in the 2017 fiscal year, and another 13,348 visits were recorded at Winston East Pediatrics, a nearby Wake Forest Baptist care facility serving the uninsured and underinsured.The Medical Center's programs and partnerships reflect innovative efforts to reach underserved populations. They include:*Regular community-based health clinics, including: the weekly Delivering Equal Access to Care (DEAC) Clinic at the Community Care Center in Winston-Salem, the monthly Triad Free Health Clinic at Community Mosque in Winston-Salem, the monthly Grace Clinic at New Light Missionary Baptist Church in Winston-Salem and the annual Share the Health Fair at the Downtown Health Plaza in Winston-Salem. These clinics, sponsored by private organizations and churches with volunteer assistance from Wake Forest Baptist physicians, nurses, medical students and others, attract thousands of people to screenings for acute and chronic conditions. * The School of Medicine's Physician Assistant (PA) program, which is increasing the number of PAs working in primary care in North Carolina's rural Appalachian counties through its second campus at Appalachian State University in Boone. * FaithHealthNC, an initiative that connects the caring strengths of congregations, the clinical expertise of providers and a network of community resources to ease those on the journey to health and healing, strengthening communities in the process. One example of this work is a FaithHealth program in which workers known as Supporters of Health connect patients with resources they need after a health incident or hospitalization. The goal is to help these patients avoid readmission, in particular to the emergency department. 3. EDUCATIONAL MISSION AND ACCOMPLISHMENTS The constituent organizations of Wake Forest Baptist Medical Center operate a broad range of educational programs, graduating skilled practitioners. It attracts some of the world's most competitive medical students, residents and fellows, as well as students in clinical pastoral care, nurse anesthesia and other areas. In the most recent reporting period, Wake Forest Baptist invested more than $107.3 million in the education of tomorrow's health care and biomedical leaders and in research funding not covered by outside sources. That investment supported the training of 491 medical students, 716 physician residents and fellows, 267 graduate students and 175 physician assistants. In addition, Wake Forest University School of Medicine offered 1,935 continuing medical education activities that drew 35,019 participants from throughout the region. 1504840309 1 1 0 1 0 0 0 0 0 1 1 1 1 0 1 1 0 1 0 0 1 0 0 0 0 0 1 1 1 1 1 1 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 1 1 1 0 0 1 275 0 1 0 1 1 0 0 0 0 0 0 0 0 0 X 12 11 1 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 1 X Joseph Dolan 3367164445 Medical Center Blvd Winston Salem NC 27157 X ARTHUR A GIBEL Trustee 2.00 4.00 X 0 0 0 KATHRYN H HAMRICK Trustee 2.00 2.00 X 0 0 0 A LEE HERRING Trustee 2.00 4.00 X 0 0 0 Carol F Polk Trustee 2.00 2.00 X 0 0 0 WILLIAM C WARDEN JR Chairman 2.00 4.00 X X 0 0 0 SHEREE B WATSON Vice Chairman 2.00 6.00 X X 0 0 0 RAY N HOWELL III D MIN Trustee 2.00 2.00 X 0 0 0 Stephen L Robertson Trustee 2.00 6.00 X 0 0 0 EDWIN L WELCH JR Trustee 2.00 0.00 X 0 0 0 George D Renfro Trustee 2.00 4.00 X 0 0 0 R Michael Wells Trustee 2.00 2.00 X 0 0 0 JOHN D MCCONNELL MD Trustee & CEO (to 4/26/17) 20.30 19.70 X X 2031055 0 266426 Julie A Freischlag MD CEO & Interim Dean (eff 4/27/17) 16.50 23.50 X X 0 0 0 J MCLAIN WALLACE JR SVP Gen Cnsl/Secretary 29.00 11.00 X 0 583744 151020 KAREN H HUEY VP Facilities 23.00 17.00 X 0 369171 88059 ERIC TOMLINSON Chief Innovation officer 5.20 34.80 X 799427 0 111994 NORMAN D POTTER JR VP Dev & Alumni Af (to 2/28/17) 20.00 20.00 X 426485 0 101230 Edward Abraham MD Dean, School of Medicine 5.00 35.00 X 934669 0 179169 Bradley A Clark Treasurer 17.50 22.50 X 0 355369 77288 Terry G Williams EVP Ch Strategy Officer 26.90 13.10 X 0 725787 170369 Chad A Eckes EVP, CFO, Asst Treas (to 6/11/17) 24.30 15.70 X 0 984048 231334 Kevin P High MD EVP, HS Affairs 27.20 12.80 X 817847 0 186831 Deette M Emon VP CIO 22.50 17.50 X 0 515506 108015 Robert Gfeller EVP - Chief Mrkting Officer 20.00 20.00 X 0 582269 144136 Steven Bloom VP, Chief HR Officer (to 8/22/16) 20.00 20.00 X 0 0 0 Lilicia Bailey SVP & Ch People Off (eff 8/23/16) 30.00 10.00 X 0 169508 24137 Michael T Waid Sr VP Hlth Sys Ops & Integ 34.60 5.40 X 0 490192 121840 Cathleen Wheatley Chief Nurse Exec, VP Clini 39.00 1.00 X 0 523022 110457 Charles R Vignos VP Managed Care 35.40 4.60 X 0 400298 89076 Conrad Emmerich Sr. VP Business Services 39.00 1.00 X 0 426433 100951 Victoria Russell VP, Clinical operations 40.00 0.00 X 0 534378 37176 JOANNE C RUHLAND Former Officer 20.00 20.00 X 0 320824 85065 Cheryl EH Locke Former Officer 30.00 10.00 X 0 535148 101973 RUSSELL M HOWERTON MD Former Officer 24.10 15.90 X 698389 0 177305 Lisa M Wyatt Former Officer 0.00 0.00 X 104500 0 122 K Barbara Carbone MD Former Officer 0.00 0.00 X 395567 0 122 6207939 7515697 2664095 0 1 1 1 Medtronic USA Inc 710 Medtronic Parkway Minneapolis MN 55432 Medical Products 16107657 Cardinal Health 7000 Cardinal Place Dublin OH 43017 Medical Products 11926842 Phillips Electronics North America 3000 Minuteman Road Andover MA 01810 Medical Technology 9411973 Stryker Corporation 2825 Airview Blvd Portage MI 49002 Medical Technology 8204292 Angelica Textile Services Inc 4 Anson St Durham NC 27703 Linens & Textile Srv 6860126 272 1015587 775568 1753719 346623 3544874 Patient Service Revenue 621990 1699768828 1699768828 Medical/Lab Service 621500 7031421 4203552 2827869 Dietary 722210 5915381 5534407 380974 Tuition 611600 1671977 1671977 1714387607 15049586 2105603 12943983 4541568 2387712 2153856 2153856 2153856 846791 0 2348369 846791 -2348369 -1501578 -1501578 Parking Fees 900099 3531367 3531367 Gift Shop Revenue 453220 339909 339909 3871276 1737505621 1711178764 5314446 17467537 X 1176376 1176376 58433 58433 17954491 7455791 10498700 479202470 385431422 93771048 37359977 28019983 9339994 36938974 29731072 7207902 37830464 28372848 9457616 116460 41365 75095 604427 604427 629088 629088 3387904 3387904 308237638 296340317 11897321 3087034 1241504 1845530 57465854 35229265 22236589 33495100 27465982 6029118 17875276 15744344 2130932 1218179 697400 520779 1017445 717758 299687 18493020 18161901 331119 80660867 80660867 2195522 2166578 28944 Medical Supplies 341409345 341168330 241015 Bad Debt 158285920 158285920 Provider Assessment 42655861 42655861 Income Taxes 816616 816616 1682172741 1504840309 177332432 0 95198908 107549664 292318616 258930978 21871266 20600547 33539256 35477898 14044565 15462829 1617570724 971419131 636661033 646151593 545390837 634322349 99540231 108363714 108192419 99707452 564182 7826421 1847321313 1934393445 256834225 268727950 479434631 469287569 11749528 173410734 125542033 909679590 875307080 X 931966631 1052738469 3187872 3786499 2487220 2561397 937641723 1059086365 1847321313 1934393445 X 55332880 46866105 19245657 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 0 0 0 0 1 422546 0 1 206542 629088 0 Part II-B, Line 1: SUPPORT OF GOVT. RELATIONS OFFICE AND Prorata portion of dues paid to state and local 501(c)(6) organizations that represents lobbying on behalf of its members. The Medical Center's Office of Government Relations was actively involved with several federal and state issues. The office assisted in developing political advocacy strategies regarding legislation addressing the opioid and heroin epidemic; federal student aid; emergency preparedness requirements; veterans reform legislation; passage and implementation of the 21st Century Cures Act; hospital star ratings, 340B drug pricing program proposed rules; Department of Labor Overtime Rule delay; immigration executive orders; various ACA repeal and replace bills; Medicaid reform (1115 waiver) and proposed Medicaid restructuring (per capita payments); changes to the provisions of the Medicare Access and CHIP Reauthorization Act (MACRA); Childress Institute for Pediatric Trauma Congressional Briefing before House Energy and Commerce Committee; tax reform including Historic Tax Preservation Tax Credit for Wake Forest Innovation Quarter; bills to increase physician residency slots by 15,000 over five years at teaching hospitals; FY 2018 Inpatient Prospective Payment System (IPPS) Rule; Staff worked on the FY2018 Budget; and the CY 2018 Medicare Physician Fee Schedule and other changes to Medicare Part B reimbursement. Staff also worked on many of the FY 2018 appropriations bills and proposed legislation and regulations that were introduced, including the Department of Health and Human Services regarding the National Institutes of Health (NIH) budget and the proposed cuts to the Facilities and Administrative (F&A) expenses, and Veterans Affairs (VA) Research and Medical Care funding to ease access for veterans seeking health care from non-VA providers; and the Child Health Insurance Program (CHIP) reauthorization bill. At the state level, efforts were concentrated on restoration of $30 million Medicaid Graduate Medical Education (GME) funding and the repeal of the requirement to submit a state plan amendment to eliminate Medicaid GME funding to the Center for Medicare and Medicaid Services (CMS); language to permit a physician UPL extension payment; changes to the state Health Information Exchange (HIE) program; insurance coverage for oral chemotherapy; special provisions language in FY 17-18 budget for the Office of the Medical Examiner; funding for the Wake Forest Armed Forces Institute for Regenerative Medicine (AFIRM); repeal of the certificate of need law; defeat of proposed legislation to allow optometrists surgical privileges and protection of the $45 million hospital sales tax refund cap. 5675092 692865 347227 367288 6347896 5763723 1709682 -60213 1738100 5675092 5007181 2132638 26445 1402541 5763723 4768404 1443959 389849 1595031 5007181 8088305 616961 185112 4121974 4768404 0.40350 0.59650 0 0 35336326 35336326 921881744 537733352 384148392 2181509 735062 1446447 578635710 412285851 166349859 79535435 20664866 58870569 646151593 Publicly traded S&P index fund 108363714 F 108363714 Investments in Subsidiaries 99707452 C 99707452 PLI & Other Liabilities 45091214 Pension Liabilities 75171713 Capital Lease 5279106 125542033 X Part V, Line 4: THE HOSPITAL's ENDOWMENT FUNDS ARE USED TO PROVIDE SUPPORT FOR EDUCATION, SCHOLARSHIPS, INDIGENT CARE, AND other Departmental Funding. Part X, Line 2: The organization HAS evaluated uncertain tax positions FOR ITS FISCAL YEARS ENDED JUNE 30, 2017 AND 2016, INCLUDING A quantification of tax risk in areas such as unrelated business taxable income and the taxation of ITS for-profit subsidiaries. This evaluation did not have a material effect on the Organization's FINANCIAL statements for the years ended June 30, 2017 and 2016. Central America and the Caribbean - Antigua & Barbuda, Aruba, Bahamas, 0 0 Investments 69993380 0 0 0 0 0 0 69993380 0 69993380 1 0 1 0 0 0 1 1 1 X 1 X 1 1 0 1 1 35659143 10863221 24795922 0.01630 262447897 249347618 13100279 0.00860 49180233 30453843 18726390 0.01230 347287273 290664682 56622591 0.03720 2998726 2998726 0.00200 97858936 21437930 76421006 0.05010 2363103 2363103 0.00160 1351730 1351730 0.00090 104572495 21437930 83134565 0.05460 451859768 312102612 139757156 0.09180 359393 359393 0.00020 144412 144412 0.00010 503805 503805 0.00030 0 42814542 489701392 561982167 -72280775 X 1 1 1 1 North Carolina Baptist Hospital Medical Center Blvd Winston Salem NC 27157 H0011 X X X X North Carolina Baptist Hospital 1 0 0 1 X X X X X X X X 15 1 1 0 1 X See Part V, Page 7 X 1 16 1 See Part V, Page 7 0 1 X 200.000000000000 400.000000000000 X X X X X X 1 1 X X X 1 X www.wakehealth.edu/Financial-Assistance.htm X www.wakehealth.edu/Financial-Assistance.htm X www.wakehealth.edu/Financial-Assistance.htm X X X X X X X 1 X 0 X X X X 1 X 0 0 North Carolina Baptist Hospital Part V, Section B, Line 5: Community input was obtained through the following sources: (1) Forsyth County resident surveys conducted by Forsyth County Health Department; (2) eight FaithHealth NC (a department of the Hospital) Community Asset Mapping workshops which sought opinions of both health providers and health seekers in Forsyth County's most vulnerable communities, including four workshops held specifically in Hispanic communities; and (3) comments from prior community health needs assessment and implementation strategy.Additionally, more than ten secondary data sources were reviewed, including Wake Forest Baptist Medical Center Community Dashboard/Health Communities, County Health Rankings & Roadmaps, 2014 State of the County Health, US Census Bureau, NC Center for Health Statistics, Centers for Disease Control, Behavior Risk Factor Surveillance System, Healthy People 2020, Healthy NC 2020, Centers for Medicare/Medicaid Services, Forsyth Futures Access to Health Care Forsyth County Report 2014, Forsyth County's Community Food System 2013, and Status of Homelessness in Forsyth County 2014. North Carolina Baptist Hospital Part V, Section B, Line 6a: The hospital's most recent CHNA was conducted in collaboration with Lexington Medical Center and Davie Medical Center. Both Davie Medical Center and Lexington Medical Center are affiliate hospitals of Wake Forest Baptist Medical Center. North Carolina Baptist Hospital Part V, Section B, Line 7d: N/APart V, Section B, Line 7a:www.wakehealth.edu/HCI/Needs-Assessment-and-Implementation-Reports.htmPart V, Section B, Line 10a:www.wakehealth.edu/HCI/Needs-Assessment-and-Implementation-Reports.htm North Carolina Baptist Hospital Part V, Section B, Line 11: The most recent community health needs assessment ("CHNA") 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) financial cost of health care and prescription drugs, (5) racism, (6) healthcare resources and education, (7) lack of insurance and undocumented patients, and (8) compassionate care.North Carolina Baptist Hospital (NCBH) 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. NCBH plans to provide community benefit programs responsive to these health needs through its approved CHNA Implementation Strategy. The NCBH 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 lack of individual health insurance and high costs decrease access to quality health care and can lead to unmet health needs. The Hospital's current strategies include:--Encouraging appropriate emergency department utilization through care coordination across the community, hospital, and primary care through 1.) exploration of programs to coordinate care for the charity care population, addressing non-emergent care use and seeking funding to support recommended intervention, and 2.) continuation of support for the CarePlus care coordination model for Medicaid/self-pay/uninsured patients in the Downtown Health Plaza community.--Improving access to community centered social and health education services and regular sources of health care through 1.) continued negotiations with Novant Health to create a primary care clinic in East Winston for the self-pay/uninsured/Medicaid population; 2.) continued exploration of mobile medical clinic in low access WFBH service areas; 3.) development of pilot program for charity care patients with chronic conditions for care management services through linkage with primary care; and 4.) continued community engagement support through 5 supporters of health, 311 congregation partners, 25 connectors across the service area, and 7 FaithHealthNC fellows.--Improving access to health insurance through partnership with Healthcare Access leaders to assist in enrolling community members in available health insurance plans--Improving access to transportation to health care services, through 1.) raising awareness of existing transportation services for Medicaid patients among providers and the community, and 2.) exploring free transportation initiatives through UberCentral or other similar model2. Chronic Disease ManagementNCBH 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 capacity of community based organizations and health care providers to support efforts related to chronic disease prevention and management through 1.) continuing to support FaithHealthNC community workers, 2.) increasing community and healthcare provider access to existing chronic disease management resources by centralizing and distributing information, and 3.) expanding chronic disease self-management programs offered by NCBH through Emmi software.--Providing education and support programs to reduce diabetes prevalence and improve diabetes management through 1.) referring diabetic patients at Downtown Health Plaza to diabetes programs offered by NCBH and other community organizations, 2.) continuing to provide diabetic education at Downtown Health Plaza and the Endocrine clinic, 3.) continuing to provide BestHealth diabetes prevention and nutrition education to the community, and 4.) exploring partnership with United Way 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.) continuing to support Brenner Fit to increase education and awareness healthy lifestyle choices for uninsured/Medicaid patients and families, 2.) promoting healthy eating and weight management through Employee Wellness programs, and 3.) providing more awareness to Hospital patients and employees regarding opportunity for weight management programs.3. Behavioral/Mental Health DistressNCBH 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:--Continuing expansion of integrated care model currently operating at Downtown Health Plaza and Family Medicine Piedmont Plaza;--Increasing the current 30+ staff at the hospital 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;--Continuing work with vunerable populations and fragile homeless persons;--Developing a plan to create more integrated behavioral health graduate medical education offerings for medical students, residents, faculty and staff.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. North Carolina Baptist Hospital 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. North Carolina Baptist Hospital Part V, Section B, Line 16j: In addition to the methods previously described, North Carolina Baptist Hospital 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. 38 1 - Abdominal Organ Transplant - Charlois 140 Charlois Boulevard WinstonSalem NC 271031522 Abdominal Organ Transplant Program 2 - Allergy Asthma & Immunology - Clemmons 2311 Lewisville-Clemmons Road Clemmons NC 27012 Allergy, Asthma & Immunology 3 - Breast Care Services - Clemmons 2341 Lewisville-Clemmons Road Clemmons NC 27012 Breast Care Services 4 - Brenner Children's Specialty Services 2311 Lewisville-Clemmons Road Clemmons NC 27012 Pediatric Specialties 5 - Cardiology Country Club 4614 Country Club Road WinstonSalem NC 271043520 Cardiology 6 - Comprehensive Fetal Care Center 500 Shepherd Street Suite 200 WinstonSalem NC 271031633 Maternal-Fetal Medicine 7 - Comprehensive Rehab - Physical Med & Rehab 131 Miller Street WinstonSalem NC 27103 physical medicine, sports medicine, rehabilitation 8 - Comprehensive Rehab - Specialty 131 Miller Street WinstonSalem NC 27103 Endo, ENT, Neurology, psychology, surgery, rheum 9 - Diabetes Center Adult-Cntry Clb Med Plza 4610 Country Club Road WinstonSalem NC 271043520 Adult Diabetes Center 10 - Diabetes Center Chldr-Cntry Clb Med Plza 4610 Country Club Road WinstonSalem NC 271043520 Pediatric Diabetes Center 11 - Dialysis Access Group - Miller 120 Miller Street Ste B WinstonSalem NC 27103 Dialysis Center 12 - Downtown Health Plaza 1200 N Martin Luther King Jr Drive WinstonSalem NC 271013006 Adult Medicine 13 - Downtown Health Plaza - Specialty 1200 N Martin Luther King Jr Drive WinstonSalem NC 27101 Ob/GYN, neurology, nephrology, derm, cardiology 14 - ENTHead & Neck Surgery - Clemmons 2341 Lewisville-Clemmons Road Clemmons NC 27012 ENT/Head and Neck Surgery 15 - Hematology & Oncology - Clemmons 2311 Lewisville-Clemmons Road Clemmons NC 27012 Oncology 16 - Hematology & Oncology - Elkin 401 Eldon Parks Drive ELkin NC 28621 Hematology and oncology 17 - Hematology & Oncology - Premier Dr 4515 Premier Dive High Point NC 27265 Hematology and oncology 18 - Internal Medicine Specialty Clinics 500 Shepherd Street Suite 300 WinstonSalem NC 271031633 IM Multispecialty Clinics 19 - Medical Plaza Country Club Dermatology 4618 Country Club Road WinstonSalem NC 271043520 General Dermatology 20 - Medical Plaza Country Club General Derma 4618 Country Club Road WinstonSalem NC 271043520 Dermatology & Mohs Surgery 21 - Mt Airy Hematology & Oncology 450 Price Street Mt Airy NC 27030 Hematology and oncology 22 - NCBH Outpatient Endoscopy Center LLC 100 Charlois Blvd Suite 100 WinstonSalem NC 27103 Outpatient Endoscopy 23 - Neonatology 500 Shepherd Street Suite 201 WinstonSalem NC 271031633 Neonatology 24 - Neurology - Clemmons 2341 Lewisville-Clemmons Road Clemmons NC 27012 Neurology 25 - OBGYN Clinic 500 Shepherd Street Suite 201 WinstonSalem NC 271031633 OB/GYN, gyn onc, urological gyn 26 - Obstetrics and Gynecology - Clemmons 2341 Lewisville-Clemmons Road Clemmons NC 27012 Ob/GYN 27 - Pain Center Brookstown 605 Cotton Street WinstonSalem NC 27101 Pain Clinic and Services 28 - Pediatrics - Clemmons 2311 Lewisville-Clemmons Road Clemmons NC 27012 Pediatrics 29 - Pediatrics - Downtown Health Plaza 1200 N Martin Luther King Jr Drive WinstonSalem NC 27101 Pediatrics 30 - Sleep Center - Clemmons 2341 Lewisville-Clemmons Road Clemmons NC 27012 Sleep Medicine 31 - Sleep Center - Shepherd 500 Shepherd Street Suite 201 WinstonSalem NC 271031633 Sleep Medicine 32 - Spine Center - Clemmons 2341 Lewisville-Clemmons Road Clemmons NC 27012 Spine Center - Clemmons 33 - University Internal Medicine - Clemmons 2311 Lewisville-Clemmons Road Clemmons NC 27012 Internal Medicine & Primary Care 34 - University Internal Medicine Country Club 4614 Country Club Road WinstonSalem NC 271043520 Internal Medicine 35 - Vein Services - Clemmons 2341 Lewisville-Clemmons Road Clemmons NC 27012 Vein Services 36 - Wake Forest Baptist Health Family Medicine 1920 W First Street WinstonSalem NC 271044220 Family Medicine 37 - Wake Forest University Baptist Imaging 265 Executive Park Blvd WinstonSalem NC 27103 Imaging Center 38 - Winston East Pediatrics of Baptist Hosp 2295 East 14th Street WinstonSalem NC 27105 Pediatrics 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 2016 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 net patient service revenue of private hospitals. The federal government matches the assessment at a rate of nearly 2 to 1, and these amounts are allocated to North Carolina hospitals on a quarterly basis. 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 $158,285,920 for the fiscal year ended June 30, 2017. This amount is not included in the calculation of charity care for Part I, line 7. Part II, Community Building Activities: The Hospital is committed to give back and is responsive to the communities it serves through a number of activities, programs and initiatives. The following are some of these programs.- Be Involved is an online resource that welcomes community members to learn more about hundreds of clinical trials and studies at Wake Forest Baptist for which they may be eligible. - BestHealth, the community wellness outreach program of Wake Forest Baptist Health, offers health seminars, screenings, cooking and fitness classes, online health resources and a membership program with special benefits. Seminars led by experts from Wake Forest Baptist provide the latest information about a variety of health topics in talks held at convenient locations throughout the community. Membership benefits include free health screenings, wellness challenges, discounts at participating local merchants, e-newsletters and priority notification of events and programs. - The Care Transitions program provides support to patients and their families after discharge from the Medical Center and helps them determine what services are available to them to assist with recovery. Seven options are offered through the program: enhanced care resource nurses, ANCHOR, CarePlus, advanced practice providers, skilled nursing facility partners, palliative care, and Wake Forest Baptist Health Care at Home, a joint program between Wake Forest Baptist and Gentiva Health Services that focuses on helping adult patients of all ages with complex health problems. - The Center for Worker Health provides a nexus for basic and translational research focused on all aspects of the work-health relationship. It brings together researchers, health care providers, community members and business leaders interested in protecting and promoting worker health and quality of life, as well as creating workplace solutions that are beneficial for employers, workers and their families.- The Community Partnership for Compassionate Care is a regional coalition of the North Carolina Partnership for Compassionate Care. The partnership is designed to educate the community about the importance of having an advance care plan and to help to with the planning process.- The DEAC Clinic, a program initiated and developed entirely by Wake Forest School of Medicine students. The clinic usually serves more than 250 patients per week. This free clinic provides routine primary health care to the local underserved community, and specialty care and testing when needed. Students from Wake Forest medical, physician assistant, graduate and undergraduate programs work together under the supervision of volunteer licensed physicians, physician assistants and pharmacy residents. Recently, students have been awarded grants for various health improvement initiatives implemented at DEAC, ranging from nutrition to smoking cessation.- The Downtown Health Plaza (DHP) is a full-service outpatient medical clinic subsidized by the Medical Center that serves many of Forsyth County's uninsured and underinsured residents in a state-of-the-art facility with an onsite pharmacy. During FY17, there were 64,768 patient visits at the Downtown Health Plaza. Its services include:_ Collaboration with the Northwest Community Care Network (NCCN), which has case managers on-site in pediatrics and internal medicine._ A satellite site for the Women, Infants and Children Nutrition Program (WIC)._ A behavioral health integration project that supports four health clinicians who provide behavioral health care in collaboration with the patients' medical providers._ A home patient navigator who visits patients after they are discharged from the hospital to assure that medications are filled, referrals are prepared and more._ A community garden that provides free, fresh vegetables and herbs for patients and their families and a food pantry where bagged nutritious foods are available._ Legal Aid of Northwest NC, which provides assistance with legal issues._ CenteringPregnancy, a program to reduce incidence of low-birth-weight babies._ CareNet Counseling, which helps families address behavioral concerns._ ImprintsCares, a program that helps parents address developmental delays in young children._ A high-risk obstetrics clinic._ Reach Out and Read, which provides free books to young patients._ The Care Plus Program, which offers home visits and intensive patient contact aimed at reducing readmissions and emergency department visits.- Grace Clinic is a free health clinic held the third Saturday of every month at New Light Missionary Baptist Church in Winston-Salem. Volunteers from Wake Forest Baptist are among those who assist with health management for patients with chronic and acute conditions such as high blood pressure, high blood sugar and high cholesterol. Wake Forest Baptist's FaithHealth program also supports the Grace Free Clinic.- The Share the Health Fair is a free, annual community heath day that offers screenings, health education and physician consultations, and typically reaches hundreds of people. It is open to adults regardless of age, insurance coverage, income level or immigration status. Interpreters are available for non-English speakers. The event is hosted by students from Wake Forest School of Medicine and supported by Northwest AHEC.- Transitional and Supportive Care is a family of programs that creates a bridge between acute care services and reintroduction to the community. The programs included in Transitional and Supportive Care are: Ambulatory Care Navigators, Bridging Home Visits, ED Enhanced Care Nurses, Palliative/Supportive Care Providers and Nurses, Readmissions Coordinator, Skilled Nursing Facility Collaborative, Social Work, Pharmacists and Wake Forest Baptist Health Care at Home.- Triad Free Health Clinic - Wake Forest Baptist Health physicians and nurses volunteer to support the Triad Free Health Clinic, held twice a month to serve the medical needs of the uninsured and underserved members of Winston-Salem and the Triad region. The clinic is held at the Community Mosque, 1419 Waughtown St., Winston-Salem. The Triad Free Health Clinic offers free care without discrimination based on race, religion or gender; its services include screenings to combat chronic diseases such as diabetes, obesity and cardiopulmonary disease.- Diversity, Inclusion and Health Equity - Wake Forest Baptist believes that creating a diverse, equitable and culturally attuned workplace is crucial to our mission to improve health in the communities we serve. The Office of Diversity and Inclusion oversees our practices to ensure diversity, inclusion, equity and respect for every member of the Wake Forest Baptist community. Wake Forest Baptist recognizes that diversity is not limited to race and ethnicity but must also take into account socioeconomic status, sexual orientation, gender identity and religious commitment. In order to eliminate the pervasive health disparities that exist in our region and country, the Medical Center is devoted to recruiting, retaining and training a diverse cadre of people and ensuring that educational programs enable health care professionals to provide culturally competent care and address health disparities. Wake Forest Baptist's clinical focus on health equity was recognized by the U.S. Human Rights Campaign Foundation, which designated the Medical Center a 2017 "Leader in LGBTQ Healthcare Equality."- Division of FaithHealth - The mission of the Division of FaithHealth is to build, align and animate religious and community assets to improve access to health care and the health of the community, beginning with those served by Wake Forest Baptist Medical Center. Supporting patients spiritually and offering ministries of growth, hope and healing is part of the work of Wake Forest Baptist Medical Center, which since its earliest days has been an innovator in forging health and spiritual connections.The division's programs include:_ FaithHealthNC, which helps ease the journey to health and healing for people and their communities thru caring strenghts of congregations, the clinical expertise of providers and a network of community resources._ FaithHealth Education - designs and conducts educational programs for interns and residents._ Chaplaincy and Clinical Ministries - chaplains provide spiritual ministry and support to patients and families._ CareNet - a partner of Faithhealth that provides faith integrated counseling and therapy_ Center for Congregational Health - provides ministry and training to faith communities, lay leaders and clergy. 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 2016 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, GME, 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 Davie County public health needs assessments, North Carolina indicators for community health assessment, internal disease registries, and county health rankings. An internal steering committee and senior leadership review a set of criteria to develop the priority rankings. The prioritization process identified the following 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 hospital) 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 next three fiscal years. 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: In Fiscal Year 2017, the medical center provided care to a nineteen county service area in North Carolina. The primary and secondary service area include:Primary Service Area Counties -Forsyth, Davie, Davidson, Guilford, Stokes, Surry, YadkinSecondary Service Area Counties - Rockingham, Randolph, Rowan, Iredell, Catawba, Alexander, Wilkes, Alleghany, Ashe, Watauga, Caldwell, BurkePercent of uninsured inpatients 6.8%Percent of inpatients who are Medicaid recipients 19.2%The hospital is located in central Forsyth County, which makes up the single largest county in total inpatient discharges. Accordingly, the hospital serves a wide service area; however, it is resource prohibitive to participate and fund health assessments in each community/county from which its patient population originates. Therefore, the primary community benefit service area (CBSA) is Forsyth County, North Carolina.Below is a demographic snapshot of Forsyth County based on 2015 estimated census data: Population and GeographyTotal population 369,000Population change since 2010 + 5.2%Land area 408.1 square milesPopulation density 904.19 persons per square mile Population by Race/EthnicityWhite 57.4%Black/African-American 27.2%Hispanic 12.7%Asian 2.4%American Indian/Alaskan Native 0.8%Native Hawaiian/Pacific Islander 0.1%Multiracial 2.2% Population by Age DistributionUnder 5 years old 6.3%Under 18 years old 23.6%=/+ 65 years old 14.7%Median age 37.5 years Population by SexMale 47.5%Female 52.5% Population by Educational Attainment Percent of persons = 25 years old who have:< High school diploma or GED 13.2%A high school diploma or GED 54.7%A bachelor's degree or higher 32.1%Persons in Poverty 19.7%Unemployment rate 5.8% County SchoolsK-12 Enrollment 54,000Graduation Rate 85.4% IncomeMedian family household (2014) $46,003Median non-family household (2014) $26,670 Part VI, Line 6: WAKE FOREST BAPTIST MEDICAL CENTER's MISSION IS TOIMPROVE THE HEALTH OF OUR REGION, STATE AND NATION BY:1) GENERATING AND TRANSLATING KNOWLEDGE TO PREVENT, DIAGNOSE AND TREATDISEASE.2) TRAINING LEADERS IN HEALTH CARE AND BIOMEDICAL SCIENCE.3) SERVING AS THE PREMIER HEALTH SYSTEM IN OUR REGION, WITH SPECIFICCENTERS OF EXCELLENCE RECOGNIZED AS NATIONAL AND INTERNATIONAL CAREDESTINATIONS. THE HOSPITAL, which is the inpatient component of wake forest baptist medical center, OPERATES THE FOLLOWING PROGRAMS CONSTITUTING COMMUNITY HEALTH IMPROVEMENT SERVICES AND COMMUNITY BENEFIT OPERATIONS REPORTED ON PART I,LINE 7E:Winston-Salem/Forsyth Cty SCHOOLS'ALLIED health program $5,000Brenner FIT $154,208Community EMS Preparedness $97,159Palliative Care Programs $684,887Community Training (BLS) $723,651Clinical Ministries $589,698PHYSICIANS COMMUNITY HEALTH ACCESS $251,299PASTORAL & Educational COUNSELING $402,828Patient/Family Centered Care $70,265Family Resources $19,731TOTAL TO PART I, LINE 7E: $2,998,726 Part VI, Line 7, Reports Filed With States NC 1 Alzheimer's Association 4615 Dudas Drive Greensboro NC 27407 561440727 501(c)(3) 5500 Supporting Alzheimer research programs Arts Council Winston Salem Forsyth Cty 206 N Spruce Street WinstonSalem NC 27101 560526856 501(c)(3) 30000 Supporting cultural programs in the community CareNet Medical Center Blvd WinstonSalem NC 27157 561977341 501(c)(3) 90000 Healthcare Counselor Residency Support El Buen Pastor Latino Community Services 4637 Tim Road WinstonSalem NC 27106 203751959 501(c)(3) 8500 Supporting program to equip Latino families to fulfill education and economi FaithHealth Innovations Inc Medical Center Blvd WinstonSalem NC 27157 237426944 501(c)(3) 32700 Leading Cause of Life Initiative, Stakeholder Health Forsyth Futures 100 N Cherry Street WinstonSalem NC 27101 561092807 501(c)(3) 50000 Community Support The Foundation of Forsyth Tech 2100 Silas Creek Pkwy WinstonSalem NC 27103 561070364 501(c)(3) 500000 Supporting Community Education & Technology Forsyth Backpack Program 380 H Knollwood St Box 402 WinstonSalem NC 27103 461940233 501(c)(3) 20117 Suppporting vulnerable students Habitat For Humanity 339 Witt St WinstonSalem NC 27103 561448955 501(c)(3) 32500 Community Support Hospice and Palliative Care Center 101 Hospice lane WinstonSalem NC 27103 581343313 501(c)(3) 10000 Supporting facilities & programs for seriously ill patients JDRF Piedmont Triad Chapter 312 N Eugene Street Greensboro NC 27401 231907729 501(c)(3) 22000 Supporting Juvenile Diabetes Research Make A Wish Foundation 1131 Harding Place Charlotte NC 28204 561492432 501(c)(3) 6000 Supporting children with life threatening illnesses Old Hickory Boy Scouts 6600 Silas Creek Parkway WinstonSalem NC 27106 560529985 501(c)(3) 35000 Supporting value based programs for the community's youth Old Salem Museums & Garden 600 main st WinstonSalem NC 27101 560587289 501(c)(3) 70000 Community Support Piedmont Regional Trauma Systems Medical Center Blvd WinstonSalem NC 27157 562036036 501(c)(3) 100000 Supporting integrated Trauma System Senior Services Inc 2895 Shorefair Drive winstonSalem NC 271054237 561085968 501(c)(3) 25000 Supporting program to provide services to senior adults to live independentl United Way of Forsyth County 301 N Main Street WinstonSalem NC 27101 237357234 501(c)(3) 50000 Community Support Winston Net 411 N cherry Street WinstonSalem NC 27101 311815083 501(c)(3) 10000 Supporting Community Technology teaching Winston Salem State University 601 S Martin Luther King Jr Dr WinstonSalem NC 27110 566001466 govt 20000 Sponsorship - Community support 19 0 Lettie Pate Whitehead Scholars 47 44000 medical scholarships 10 10433 Ruth Holleman Scholarships 4 4000 Part I, Line 2: The hospital follows the medical center's corporate policy used in reviewing the eligibility and selection of grantees receiving certain exempt purpose funds. The hospital maintains documentation of the eligibility and selection criteria and records of the amounts disbursed. X X X X X X 1 1 0 0 0 0 0 0 0 JOHN D MCCONNELL MD Trustee & CEO (to 4/26/17) 1026651 0 434548 0 569856 0 247313 0 19113 0 2297481 0 0 0 J MCLAIN WALLACE JR SVP Gen Cnsl/Secretary 0 439903 0 123909 0 19932 0 132622 0 18398 0 734764 0 0 KAREN H HUEY VP Facilities 0 287382 0 80814 0 975 0 67859 0 20200 0 457230 0 0 ERIC TOMLINSON Chief Innovation officer 404785 0 130952 0 263690 0 99845 0 12149 0 911421 0 235022 0 NORMAN D POTTER JR VP Dev & Alumni Af (to 2/28/17) 313307 0 94021 0 19157 0 78567 0 22663 0 527715 0 0 0 Edward Abraham MD Dean, School of Medicine 581304 0 205821 0 147544 0 161945 0 17224 0 1113838 0 124000 0 Bradley A Clark Treasurer 0 272946 0 81871 0 552 0 58504 0 18784 0 432657 0 0 Terry G Williams EVP Ch Strategy Officer 0 530336 0 194191 0 1260 0 147243 0 23126 0 896156 0 0 Chad A Eckes EVP, CFO, Asst Treas (to 6/11/17) 0 698706 0 284502 0 840 0 209328 0 22006 0 1215382 0 0 Kevin P High MD EVP, HS Affairs 585172 0 211063 0 21612 0 165135 0 21696 0 1004678 0 0 0 Deette M Emon VP CIO 0 401349 0 113392 0 765 0 98679 0 9336 0 623521 0 0 Robert Gfeller EVP - Chief Mrkting Officer 0 458293 0 120364 0 3612 0 123294 0 20842 0 726405 0 0 Lilicia Bailey SVP & Ch People Off (eff 8/23/16) 0 138204 0 0 0 31304 0 18520 0 5617 0 193645 0 0 Michael T Waid Sr VP Hlth Sys Ops & Integ 0 358207 0 112812 0 19173 0 100141 0 21699 0 612032 0 0 Cathleen Wheatley Chief Nurse Exec, VP Clini 0 411669 0 107741 0 3612 0 100708 0 9749 0 633479 0 0 Charles R Vignos VP Managed Care 0 285076 0 94250 0 20972 0 67710 0 21366 0 489374 0 0 Conrad Emmerich Sr. VP Business Services 0 326955 0 98810 0 668 0 82046 0 18905 0 527384 0 0 Victoria Russell VP, Clinical operations 0 304189 0 83819 0 146370 0 29149 0 8027 0 571554 0 0 JOANNE C RUHLAND Former Officer 0 266981 0 0 0 53843 0 67295 0 17770 0 405889 0 31600 Cheryl EH Locke Former Officer 0 354716 0 96131 0 84301 0 84065 0 17908 0 637121 0 61120 RUSSELL M HOWERTON MD Former Officer 520490 0 156287 0 21612 0 154739 0 22566 0 875694 0 0 0 Lisa M Wyatt Former Officer 0 0 0 0 104500 0 0 0 122 0 104622 0 0 0 K Barbara Carbone MD Former Officer 0 0 0 0 395567 0 0 0 122 0 395689 0 0 0 Part I, Line 3 The Governance and Compensation committee of the WFUBMC Board of Directors is responsible for reviewing and approving all medical center officers' compensation (including the compensation of the officers of NCBH). The committee utilizes an independent, external compensation consultant firm experienced in health care and higher education compensation that based recommendations on compensation surveys and studies to determine the appropriateness of each officer's compensation. These compensation consultants present total compensation comparability data for the positions for which compensation is being determined. The data is reviewed by the Governance and Compensation Committee of WFUBMC's governing board at its meeting; none of the members of that committee are employees of the filing organization. Minutes of the deliberations of the committee are contemporaneously recorded. In the event that any member of the Governance and Compensation committee has a conflict of interest, that committee member does not participate in the deliberation or approval process, and their abstention from the process is reflected in the minutes. Part I, Lines 4a-b CERTAIN EXECUTIVES PARTICIPATE IN OR RECEIVE SEVERANCE PAYMENTS AND PAYMENTS FROM SUPPLEMENTAL NON QUALIFIED RETIREMENT PLANS. THE DETERMINATION OF THE AMOUNT OF THE NON QUALIFIED RETIREMENT PLANS FOLLOWED THE FILING ORGANIZATION'S COMPENSATION PROCEDURES AS OUTLINED IN PART VI, SECTION B, LINE 15 OF THE FORM 990. THE FOLLOWING CURRENT AND FORMER OFFICERS RECEIVED SEVERANCE AND SERP PAYMENTS IN THEIR CALENDAR YEAR 2016 COMPENSATION: SEVERANCE PAYMENTS: BARBARA CARBONE 395,567 LISA WYATT 104,500 VICTORIA RUSSELL 145,000 SERP PAYMENTS: JOHN D. MCCONNELL, MD 546,312 ERIC TOMLINSON 235,022 JOANNE RUHLAND 31,600 CHERYL LOCKE 61,120 EDWARD ABRAHAM, MD 124,000 VICTORIA RUSSELL 146,548 Form 990, Part VII, Line 5 - Compensation from unrelated organization The following current and former officers were compensated by Wake Forest University Health Sciences for services performed as of officer of the Medical Center and Hospital. See Part VII and Schedule J, Part II for their compensation. John D. McConnell, MD, Kevin P. High, MD, Lisa Wyatt, Norman D. Potter, Jr., Edward Abraham, MD, Eric Tomlinson, DCS, PHD, K. Barbara Carbone, MD, Russell M. Howerton, MD, A North Carolina Medical Care Commission 521309402 65820hd67 2010-03-01 334002408 Current Refunding 0 0 0 B North Carolina Medical Care Commission 521309402 NONEAVAIL 2012-12-31 80000000 Various Capital Projects 0 0 0 C North Carolina Medical Care Commission 521309402 65821dmm0 2012-11-15 122822821 Various Capital Projects 0 0 0 A 60195000 334002408 3307037 330695371 2010 1 0 1 1 B 80000000 1000 79999000 2014 0 0 1 1 C 122822821 2485 122820336 2013 0 0 1 1 B 0 1 0 0 0 0 1 C 0 1 0 0 0 0 1 A 0 0 0 1 0 1 Deutsche Bank AG 5.000000000000 0 0 0 0 1 B 0 1 0 0 1 0 0 0 1 C 0 1 0 0 0 0 0 0 1 A 1 B 1 C 1 Part I, Row A, Column F Purpose of the issue was to refund issues dated 10/29/92, 6/27/96 and 1/29/09 Part II, Line 11, Column A Other spent proceeds are the current refunding proceeds of the issue Part III, Column A, All issues refunded by the 2010 issue are either prior to 12/31/02 or through a series of refundings that refund an issue prior to 12/31/02. Accordingly, this issue is exempt from Part III reporting. Part IV, Line 2C, Column A A rebate calculation was performed, with no rebate being due, on 6/31/2014 X 17400 FMV X 7 327960 FMV X Supplies & Food 2 1263 FMV 0 0 1 0 Part I, Column (b): the organization determines the number of contributions by using the total number of non-cash items received per donor per occurrance. 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, 2017 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 North Carolina Baptist Hospital (NCBH), Davie Medical Center, CareNet, Inc., The Hawthorne Inn and Conference Center, North Carolina Baptist Hospital Foundation and Clemmons Medical Park, LLC. All significant intercompany transactions have been eliminated in consolidation. Form 990, Part VI, Section A, line 2 Chad Eckes and Terry Williams, both officers of the filing organization, were Board members of MedCost Benefit Services. Form 990, Part VI, Section A, line 3 Effective July 1, 2010, the governing boards of four North Carolina nonprofit corporations (Wake Forest University, North Carolina Baptist Hospital, Wake Forest University Health Sciences, and Wake Forest University Baptist Medical Center) entered into an agreement (the "Medical Center Integration Agreement or "MCIA") under which the operation of each of North Carolina Baptist Hospital ("NCBH") and Wake Forest University Health Sciences ("WFUHS") was delegated to Wake Forest University Baptist Medical Center ("WFUBMC"). WFUHS is a wholly-controlled subsidiary entity of Wake Forest University ("WFU"). WFUBMC is a membership nonprofit corporation whose two equal members are NCBH (which entity is unrelated to WFUHS and WFU) and WFU. The goal is consolidation of management and governance in WFUBMC of the various academic medical center operations, subject to substantial reserved powers in both of the constituent members' boards. The MCIA was amended and restated on July 1, 2015. During calendar year 2016, Wake Forest University Health Sciences paid $193,077 to Foundation Works, Inc. for services provided by Steven C. Bloom as Wake Forest Baptist Medical Center's interim chief human resources officer and as vice president and chief human resources officer for the period May 2016 to August 2016. Form 990, Part VI, Section B, line 11b THE FILING ORGANIZATION's BOARD OF DIRECTORS RECEIVE a COPY OF THE FORM 990 WITH SUFFICIENT TIME TO PERMIT REVIEW, COMMENT, AND Pose QUESTIONS PRIOR TO ITS FILING. THE AUDIT AND COMPLIANCE COMMITTEE OF THE GOVERNING BOARD of WFUBMC, comprised of the audit and compliance committees OF WFUHS AND NCBH, REVIEW IN ADDITIONAL DETAIL THE FILING ORGANIZATION's FORM 990 WITH THE ORGANIZATION's CHIEF FINANCIAL OFFICER OR HIS DESIGNEE, WHO ANSWERS QUESTIONS AND ADDRESSES CONCERNS RAISED BY SUCH COMMITTEE MEMBERS OR OTHER FILING ORGANIZATION DIRECTORS. IF MODIFICATIONS ARE REQUIRED FOLLOWING SUCH REVIEW AND COMMENT, THE REVISED FORM 990 IS REDISTRIBUTED TO ALL board members 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 THE GOVERNANCE AND COMPENSATION COMMITTEE of Wake Forest University Baptist Medical Center ("WFUBMC") FUNCTIONS AS THE COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS AND PURSUANT TO A DELEGATION BY the filing organization, REVIEWS AND APPROVES THE APPOINTMENT AND COMPENSATION OF THE SENIOR EXECUTIVES OF THE FILING ORGANIZATION. NO MEMBER OF THE WFUBMC GOVERNANCE AND COMPENSATION COMMITTEE IS AN EMPLOYEE OF THE MEDICAL CENTER. THE GOVERNANCE AND COMPENSATION COMMITTEE RELIES UPON AN EXTERNAL, INDEPENDENT COMPENSATION CONSULTANT EXPERIENCED IN HEALTHCARE TO PROVIDE THE COMMITTEE WITH COMPENSATION COMPARABILITY DATA FOR NEW EXECUTIVE POSITION APPOINTMENTS AND FOR COMPENSATION REVIEWS FOR EXISTING EXECUTIVES. THE CONSULTANT, WHICH IS RETAINED DIRECTLY BY THE GOVERNANCE AND COMPENSATION COMMITTEE, PROVIDES THIRD-PARTY INFORMATION AND EVALUATES THE COMPETITIVENESS AND REASONABLENESS OF EXECUTIVE COMPENSATION AND BENEFITS PROGRAMS IN RELATION TO MARKET PRACTICES FOR SIMILARLY-SITUATED NONPROFIT HEALTHCARE ORGANIZATIONS. THE COMMITTEE MAKES ITS DECISIONS WITH RESPECT TO EXECUTIVE COMPENSATION IN ACCORDANCE WITH THE FILING ORGANIZATION'S POLICIES, IRS REGULATIONS, AND STANDARD CORPORATE GOVERNANCE PRACTICES. SUCH POLICIES INCLUDE ADHERENCE TO: BOARD-ESTABLISHED EXECUTIVE COMPENSATION PHILOSOPHY AND REVIEW PROCESSES; PROCESSES ENSURING GOVERNANCE AND COMPENSATION COMMITTEE MEMBER AND COMPENSATION CONSULTANT INDEPENDENCE; USE OF VALID MARKET COMPARISONS OF DATA FROM PEER ACADEMIC MEDICAL CENTERS OF SIMILAR ORGANIZATIONs of similar STRUCTURE, SIZE, AND COMPLEXITY; CAREFUL DOCUMENTATION OF ALL COMPENSATION DECISIONS; AND ESTABLISHMENT OF THE REBUTTABLE PRESUMPTION OF REASONABLENESS, PER IRS GUIDELINES. MINUTES OF THE DELIBERATIONS OF THE GOVERNANCE AND COMPENSATION COMMITTEE ARE CONTEMPORANEOUSLY MAINTAINED AND THAT COMPARABILITY DATA IS MAINTAINED IN THE MEDICAL CENTER'S OFFICE OF EXECUTIVE COMPENSATION SERVICES. IN THE EVENT THAT A MEMBER OF THE GOVERNANCE AND COMPENSATION COMMITTEE HAS A CONFLICT OF INTEREST RELATED TO EXECUTIVE APPOINTMENT OR COMPENSATION, THAT MEMBER DOES NOT PARTICIPATE IN THE DELIBERATION OR APPROVAL OF APPOINTMENT OR COMPENSATION AND SUCH ABSTENTION IS NOTED IN THE COMMITTEE'S MEETING MINUTES. 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. Part VII, Section A, Column B - Hours ARTHUR A GIBEL FILING ORG 2.0 RELATED ORG 4.0 KATHRYN H HAMRICK FILING ORG 2.0 RELATED ORG 2.0 A. LEE HERRING FILING ORG 2.0 RELATED ORG 4.0 CAROL F. POLK FILING ORG 2.0 RELATED ORG 2.0 WILLIAM C. WARDEN, JR. FILING ORG 2.0 RELATED ORG 4.0 SHEREE B WATSON FILING ORG 2.0 RELATED ORG 6.0 RAY N HOWELL, III D. MIN FILING ORG 2.0 RELATED ORG 2.0 STEPHEN L ROBERTSON FILING ORG 2.0 RELATED ORG 6.0 EDWIN L WELCH, JR. FILING ORG 2.0 RELATED ORG 0.0 GEORGE D RENFRO FILING ORG 2.0 RELATED ORG 4.0 MICHAEL T WELLS FILING ORG 2.0 RELATED ORG 2.0 JOHN D MCCONNELL, MD FILING ORG 20.3 RELATED ORG 6.0 UNRELATED ORG 13.7 JULIE A. FRIESCHLAG, M.D. FILING ORG 16.5 RELATED ORG 5.0 UNRELATED ORG 18.5 J MCLAIN WALLACE, JR FILING ORG 29.0 RELATED ORG 10.0 UNRELATED ORG 1.0 KAREN H HUEY FILING ORG 23.0 RELATED ORG 6.0 UNRELATED ORG 11.0 ERIC TOMLINSON FILING ORG 5.2 RELATED ORG 5.0 UNRELATED ORG 29.8 NORMAN D POTTER, JR. FILING ORG 20.0 RELATED ORG 5.0 UNRELATED ORG 15.0 CHERYL E.H. LOCKE FILING ORG 30.0 RELATED ORG 6.3 UNRELATED ORG 3.7 EDWARD ABRAHAM, MD FILING ORG 5.0 RELATED ORG 5.0 UNRELATED ORG 30.0 BRADLEY A. CLARK FILING ORG 17.5 RELATED ORG 9.2 UNRELATED ORG 13.3 TERRY G. WILLIAMS FILING ORG 26.9 RELATED ORG 6.5 UNRELATED ORG 6.6 CHAD A. ECKES FILING ORG 24.3 RELATED ORG 7.2 UNRELATED ORG 8.5 KEVIN HIGH, M.D. FILING ORG 27.2 RELATED ORG 7.0 UNRELATED ORG 5.8 DEETTE M. EMON FILING ORG 22.5 RELATED ORG 8.8 UNRELATED ORG 8.7 ROBERT GFELLER FILING ORG 20.0 RELATED ORG 5.0 UNRELATED ORG 15.0 LILICIA BAILEY FILING ORG 30.0 RELATED ORG 6.3 UNRELATED ORG 3.7 RUSSELL HOWERTON FILING ORG 24.1 RELATED ORG 1.0 UNRELATED ORG 14.9 STEVE BLOOM FILING ORG 20.0 RELATED ORG 5.0 UNRELATED ORG 15.0 JOANNE RUHLAND FILING ORG 20.0 RELATED ORG 5.0 UNRELATED ORG 15.0 CATHLEEN WHEATLEY FILING ORG 39.0 RELATED ORG 1.0 MICHAEL T. WAID FILING ORG 34.6 RELATED ORG 3.1 UNRELATED ORG 2.3 CHARLES R. VIGNOS FILING ORG 35.4 RELATED ORG 1.8 UNRELATED ORG 2.8 Victoria Russell FILING ORG 40.0 Conrad Emmerich FILING ORG 39.0 RELATED ORG 1.0 WAKE FOREST UNIVERSITY HEALTH SCIENCES IS AN UNRELATED ORGANIZATION TO THE FILING ORGANIZATION AND THE INFORMATION CONCERNING HOURS DEVOTED TO IT ARE NOT REQUIRED TO BE REPORTED, BUT ARE INCLUDED BECAUSE OF THE STRUCTURE OF WAKE FOREST UNIVERSITY BAPTIST MEDICAL CENTER, OF WHICH THE FILING ORGANIZATION AND WAKE FOREST UNIVERSITY HEALTH SCIENCES ARE PRINCIPAL PARTS. THE CORPORATE OFFICERS OF THE MEDICAL CENTER ALSO SERVE AS THE CORPORATE OFFICERS OF NORTH CAROLINA BAPTIST HOSPITAL AND WAKE FOREST UNIVERSITY HEALTH SCIENCES. Form 990, Part IX, line 11g Other Professional Fees: Program service expenses 46,152,491. Management and general expenses 11,897,321. Fundraising expenses 0. Total expenses 58,049,812. MCIA: Program service expenses 250,187,826. Management and general expenses 0. Fundraising expenses 0. Total expenses 250,187,826. Form 990, Part XI, line 9: Actuary Gain 25,377,475. Affiliate losses -6,131,818. Clemmons Medical Park LLC Medical Center Blvd Winston Salem NC 27157 800870210 Real Estate Holding Company NC 1208229 30562527 North Carolina Baptist Hospital North Carolina Baptist Hospital Foundation Medical Center Blvd Winston Salem NC 27157 561685120 Supporting Organization NC 501(c)(3) Line 12a, I North Carolina Baptist Hospital 1 The Rehabilitation & Skilled Nursing Medical Center Blvd Winston Salem NC 27157 561826396 Healthcare (Inactive) NC 501(c)(3) Line 10 North Carolina Baptist Hospital Foundation 1 The Hawthorne Inn & Conference Center Inc 420 High Street Winston Salem NC 27101 561793617 Lodging/Conference Accomodation NC 501(c)(3) Line 12a, I North Carolina Baptist Hospital 1 Carenet Inc 2000 West First Street Suite 410 Winston Salem NC 27104 561977341 Healthcare NC 501(c)(3) Line 12b, II North Carolina Baptist Hospital 1 Wake Forest University Baptist Medical Center Medical Center Blvd Winston Salem NC 27157 510190238 Healthcare NC 501(c)(3) Line 12a, I N/A 0 Davie Medical Center 329 NC HWY 801N Bermuda Run NC 27006 562276994 Healthcare NC 501(c)(3) Line 3 Wake Forest University Baptist Medical Center 1 Medical Fnd of WFUHS & NCBH Medical Center Blvd Winston Salem NC 27157 566036688 Healthcare NC 501(c)(3) Line 12a, I N/A 0 Cornerstone Health Enablement Strategic Solutions LLC 1701 Westchester Drive Ste 850 High Point NC 27262 461314057 Mgmt & Transform. Svc. - Medical Orgs NC North Carolina Baptist Hospital Unrelated 936265 4770386 0 0 0.72880 1 1 1 0 0 0 0 0 0 1 1 0 0 0 0 1 1 0 1 North Carolina Baptist Hospital Foundation A 63715 Cost The Hawthorne Inn & Conference Center Inc K 189799 Cost The Hawthorne Inn & Conference Center Inc P 25648 FMV The Hawthorne Inn & Conference Center Inc Q 824502 FMV Carenet Inc Q 2018741 fmv Davie Medical Center Q 22560943 fmv North Carolina Baptist Hospital Foundation Q 2993812 fmv North Carolina Baptist Hospital Foundation S 404768 Cost North Carolina Baptist Hospital Foundation C 1010000 cost Davie Medical Center J 4086645 Cost Carenet Inc B 90000 cost Clemmons Medical Park LLC K 1063242 cost Cornerstone Health Enablement Strategic Solutions LLC Q 188224 Cost