2016-11-14T11:12:11-06:00 2015-12-31 990 2015-01-01 562120959 FORSYTH MEDICAL CENTER FOUNDATION FORS 3367182803 2085 FRONTIS PLAZA BLVD WINSTON SALEM NC 27103 FRED HARGETT EVP & CFO 3367182803 2016-11-14 2015 2017-02-10 21:41:12Z NOVANT HEALTH FOUNDATION FORSYTH MEDICAL CENTER KIMBERLY MCLOUGHLIN 2085 FRONTIS PLAZA BLVD WINSTON SALEM NC 27103 15455571 0 X WWW.NOVANTHEALTH.ORG X 1981 NC SEE SCHEDULE O 24 21 0 58 0 0 2509103 1966306 0 0 2542547 2195122 5365 -20916 5057015 4140512 5026818 2883884 0 0 0 0 0 0 302569 722787 826466 5749605 3710350 -692590 430162 60091596 58278929 295846 322198 59795750 57956731 X SEE SCHEDULE O 0 0 3213349 2883884 FORSYTH MEDICAL CENTER FOUNDATION FOCUSES ITS EFFORTS ON RAISING COMMUNITY SUPPORT AND FUNDING THROUGH CHARITABLE GIVING FOR MUCH-NEEDED PROGRAMS, IMPROVED FACILITIES, AND STATE-OF-THE-ART TECHNOLOGY FOR FORSYTH MEDICAL CENTER, KERNERSVILLE MEDICAL CENTER, AND CLEMMONS MEDICAL CENTER. 3213349 1 1 0 0 0 0 0 0 0 1 1 1 0 0 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 1 0 0 0 0 0 0 0 0 1 1 0 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 1 1 0 0 0 X 24 21 1 0 0 0 0 1 0 1 1 0 0 1 1 1 1 0 0 0 0 0 NC X KAREN DAUGHERTY 3367182803 2085 FRONTIS PLAZA BLVD WINSTON SALEM NC 27103 X ALEXANDER J CANTEY TRUSTEE 2.00 X 0 0 0 BRYANT TAYLOR TRUSTEE 2.00 X 0 0 0 CHADEN SHELBY TRUSTEE 2.00 X 0 0 0 CONSTABLE DOUG TRUSTEE 2.00 X 0 0 0 COPELAND DOUGLAS TRUSTEE 2.00 X 0 0 0 CRUTCHFIELD PEGGY TRUSTEE 2.00 X 0 0 0 DEAN WILLIAM TRUSTEE 2.00 X 0 0 0 DUNHAM ROBERT VICE CHAIR 2.00 X X 0 0 0 FULLER-ANDREWS LYNNE TRUSTEE 2.00 X 0 0 0 GREGORY CHERE MD TRUSTEE 2.00 X 0 552130 139308 HOLMES HAROLD TRUSTEE 2.00 X 0 0 0 KAMPMAN DEB TRUSTEE 2.00 X 0 0 0 MARLEY MORRIS TREAS 2.00 X X 0 0 0 MARTIN DAVIDA TRUSTEE 2.00 X 0 0 0 POLLARD III HAROLD CHAIR 2.00 X X 0 0 0 POPE SCOTT TRUSTEE 2.00 X 0 0 0 PROCTOR R ALAN TRUSTEE 2.00 X 0 0 0 SCHAEFER CLAUDIA TRUSTEE 2.00 X 0 0 0 SHORE RICHARD TRUSTEE 2.00 X 0 0 0 WELCH EDWIN TRUSTEE 2.00 X 0 0 0 WESTON CLAUDETTE TRUSTEE 2.00 X 0 0 0 WILEY C MARK TRUSTEE 2.00 X 0 0 0 YARBOROUGH D CHEFF TRUSTEE 2.00 X 0 0 0 ZEKAN PATRICIA SEC 2.00 X X 0 283389 72974 MCLOUGHLIN KIMBERLY SVP FOUNDATION & COM REL 60.00 X 0 190465 65562 MORRIS JOHN ASST SEC 2.00 X 0 315630 76931 MYERS SCOTT ASST SEC 2.00 X 0 559171 128586 VINCENT PAULA FMR SVP FNDNS 60.00 X 0 622327 71376 0 2523112 554737 0 1 1 0 0 141973 75000 74266 1675067 121262 1966306 933373 933373 12509350 700 11248210 91 1261140 609 1261749 1261749 45842 141973 66758 -20916 -20916 4140512 0 0 2174206 X 2860934 2860934 22950 22950 118372 118372 500743 245364 30045 225334 43498 21314 2610 19574 7435 3643 446 3346 3923 3923 612 300 37 275 10851 10851 2753 1349 165 1239 MISCELLANEOUS 117336 57495 7040 52801 SUPPLIES 18757 18757 DUES AND SUBSCRIPTIONS 2186 2186 3710350 3213349 194432 302569 940787 1193452 45600 0 6309 4907 78192 67927 11273 10265 46744188 44943552 12334224 12121686 9215 5067 60091596 58278929 295846 322198 295846 322198 X 48535835 47191787 11081639 10525354 178276 239590 59795750 57956731 60091596 58278929 X 430162 -4099020 1829839 X 0 1 X 1 0 X 3323750 2198496 2262534 2509103 1966306 12260189 3323750 2198496 2262534 2509103 1966306 12260189 1376247 10883942 727512 1174066 985630 1425875 933373 5246456 8942 8942 17515587 212397 0.62140 0.58010 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: MISCELLANEOUS INCOME - 2012 AMOUNT: $ 8,942. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 11259915 1107979 -36768 24547 1541635 10764944 11810510 1816278 31724 144134 2254463 11259915 11698867 1594460 -14581 67000 1401236 11810510 12235136 1737322 57605 65000 2266196 11698867 12021408 2173133 92226 14285 2034319 12238163 0.00000 0.02230 0.97770 0 0 78192 67927 10265 10265 OTHER SECURITIES 12121686 F 12121686 0 DUE TO AFFILIATE 322198 322198 X PART X, LINE 2: PART X, LINE 2: LIABILITY UNDER FIN 48 (ASC 740) FOOTNOTE THE AUDIT FOR NOVANT HEALTH AND ITS AFFILIATES IS PREPARED ON A CONSOLIDATED BASIS. THE COMPANY IS REQUIRED TO EVALUATE UNCERTAIN TAX POSITIONS. THIS EVALUATION INCLUDES A QUANTIFICATION OF TAX RISK IN AREAS SUCH AS UNRELATED BUSINESS TAXABLE INCOME AND THE TAXATION OF OUR FOR-PROFIT SUBSIDIARIES. THIS EVALUATION DID NOT HAVE A MATERIAL EFFECT ON THE COMPANY'S CONSOLIDATED STATEMENTS OF OPERATIONS AND CHANGES IN NET ASSETS FOR THE YEARS ENDED DECEMBER 31, 2015 AND 2014. PART V, LINE 4: INTENDED USES FOR ENDOWMENT FUNDS THE ENDOWMENT FUNDS ARE HELD FOR AFFILIATE HOSPITAL SERVICE COSTS RELATED TO VARIOUS CENTERS AT THE ACUTE CARE FACILITIES. ATHENA'S RUN 48750 48750 3028 150 14168 GARDEN PARTY 56416 32802 23614 14729 7265 9121 4 82649 60421 22228 2500 2672 3325 9800 187815 141973 45842 14729 2500 12965 3475 33089 66758 -20916 1 FORSYTH FUTURES 601 N CHERRY ST STE 250 WINSTON SALEM NC 27101 561092807 501(C)(3) 25000 COMMUNITY OUTREACH FORSYTH MEMORIAL HOSPITAL 3333 SILAS CREEK PARKWAY WINSTON SALEM NC 27103 560928089 501(C)(3) 1405974 COMMUNITY HEALTHCARE COMMUNITY CARE CENTER 2135 NEW WALKERTON RD WINSTON SALEM NC 27101 581403699 501(C)(3) 261870 COMMUNITY OUTREACH NOVANT HEALTH 2085 FRONTIS PLAZA BLVD WINSTON SALEM NC 27103 561376950 501(C)(3) 402586 COMMUNITY HEALTHCARE FORSYTH HEALTHCARE INC 501 N CLEVELAND AVE SUITE 4 WINSTON SALEM NC 27101 320097975 501(C)(3) 250000 COMMUNITY HEALTHCARE FOUNDATION HEALTH SYSTEMS CORP 2085 FRONTIS PLAZA BLVD WINSTON SALEM NC 27103 561373175 501(C)(3) 500000 COMMUNITY HEALTHCARE GIRLS ON THE RUN 1217 GRAYLAND STREET GREENSBORO NC 27408 471323812 501(C)(3) 7500 COMMUNITY OUTREACH 7 0 EMERGENCY ASSISTANCE 70 20950 SCHOLARSHIPS 2 2000 PART I, LINE 2: PROCEDURES FOR MONITORING THE USE OF GRANT FUNDS THE FILING ORGANIZATION IS PART OF THE INTEGRATED HEALTHCARE SYSTEM OPERATED BY NOVANT HEALTH, INC. ("NOVANT HEALTH"), THE PARENT ORGANIZATION. NOVANT HEALTH'S BYLAWS AUTHORIZE IT TO ESTABLISH CERTAIN POLICIES FOR ALL OF ITS SUBSIDIARIES WITHIN THE SYSTEM. NOVANT HEALTH HAS ESTABLISHED A SYSTEM-WIDE CORPORATE POLICY WITH STANDARDIZED GUIDELINES THAT ARE TO BE USED IN REVIEWING THE ELIGIBILITY AND SELECTION OF GRANTEES RECEIVING CERTAIN EXEMPT PURPOSE FUNDS. THE FILING ORGANIZATION MAINTAINS DOCUMENTATION OF THE ELIGIBILITY AND SELECTION CRITERIA AND RECORDS OF THE AMOUNTS ARE MAINTAINED VIA THE GENERAL LEDGER. FUNDS ARE GENERALLY NOT TRACKED AFTER BEING GRANTED, AS THE ORIGINAL ELIGIBILITY AND SELECTION CRITERIA HAVE ALREADY BEEN MET. 0 1 0 0 0 0 0 0 0 GREGORY CHERE MD TRUSTEE 0 359866 0 180717 0 11547 0 111045 0 28263 0 691438 0 0 ZEKAN PATRICIA SEC 0 272409 0 0 0 10980 0 57900 0 15074 0 356363 0 7500 MCLOUGHLIN KIMBERLY SVP FOUNDATION & COM REL 0 177746 0 0 0 12719 0 58594 0 6968 0 256027 0 0 MORRIS JOHN ASST SEC 0 261368 0 48750 0 5512 0 48854 0 28077 0 392561 0 0 MYERS SCOTT ASST SEC 0 359267 0 181976 0 17928 0 117021 0 11565 0 687757 0 7500 VINCENT PAULA FMR SVP FNDNS 0 371035 0 206746 0 44546 0 57124 0 14252 0 693703 0 7500 PART I, LINE 3 THE FILING ORGANIZATION IS AN INTEGRAL PART OF NOVANT HEALTH, AN INTEGRATED HEALTHCARE SYSTEM. NOVANT HEALTH, INC. IS THE PARENT ORGANIZATION AND USES THE PROCESS DESCRIBED IN PART VI, LINE 15A OF THIS RETURN TO ESTABLISH THE COMPENSATION OF THE TOP MANAGEMENT OFFICIAL OF THE FILING ORGANIZATION. THIS PROCESS ADHERES TO THE REQUIREMENTS SET FORTH TO SECURE THE REBUTTABLE PRESUMPTION OF REASONABLENESS AND INCLUDES A REVIEW AND APPROVAL BY INDEPENDENT AND DISINTERESTED MEMBERS OF A COMPENSATION COMMITTEE, CONSULTATION WITH INDEPENDENT COMPENSATION CONSULTANTS, THE UTILIZATION OF THIRD-PARTY COMPARABILITY DATA SUCH AS PUBLISHED COMPENSATION SURVEYS, AND CONTEMPORANEOUS SUBSTANTIATION OF THE DELIBERATION AND DECISION. PART I, LINE 4B PART I, LINE 4A-C: SEVERANCE, NONQUALIFIED, AND EQUITY-BASED PAYMENTS SEVERANCE NONQUALIFIED EQUITY-BASED GREGORY, CHERE 52,500 MCLOUGHLIN, KIMBERLY 23,975 MYERS, SCOTT 51,621 PART III - OTHER ADDITIONAL INFORMATION DESCRIPTIONS OF SUPPLEMENTAL EXECUTIVE BENEFITS INCLUDED IN PART VII AND SCHEDULE J: EXECUTIVE ANNUAL INCENTIVE PLAN: AS PART OF THE REPORTED COMPENSATION AMOUNTS, THE REPORTING ORGANIZATION PROVIDES ANNUAL INCENTIVE COMPENSATION TO CERTAIN KEY EXECUTIVES UNDER AN EXECUTIVE ANNUAL INCENTIVE PLAN. THE INCENTIVE PLAN IS DESIGNED TO OFFER OPPORTUNITIES FOR ADDITIONAL COMPENSATION, BUT ONLY TO THE EXTENT THAT ELIGIBLE EXECUTIVES HAVE PROVIDED EXTRAORDINARY SERVICES AND ACHIEVED EXTRAORDINARY RESULTS THAT MEET OR EXCEED PREDETERMINED GOALS IN THE AREAS OF QUALITY, PATIENT SATISFACTION, EMPLOYEE SATISFACTION AND FINANCIAL VITALITY. THESE GOALS ARE ESTABLISHED AND APPROVED BY INDEPENDENT AND DISINTERESTED MEMBERS OF THE NOVANT HEALTH BOARD OF TRUSTEES (WHO COMPRISE THE COMPENSATION AND LEADERSHIP COMMITTEE OF THE BOARD). THESE GOALS ARE WEIGHTED EQUALLY. THE ADDITIONAL COMPENSATION CAN RANGE ANYWHERE FROM ZERO TO A MAXIMUM PERCENTAGE OF BASE SALARY THAT DIFFERS BY THE CLASS OF EXECUTIVE. IN ADDITION, THE COMPENSATION AND LEADERSHIP COMMITTEE OF THE BOARD WHO OVERSEE THE INCENTIVE COMPENSATION PROGRAM APPLY TWO "CIRCUIT BREAKERS," WHICH ARE SUBSTANTIAL LEVELS OF ORGANIZATION-WIDE ACHIEVEMENT THAT MUST BE SATISFIED BEFORE ANY AWARDS ARE PAID TO ANY EXECUTIVE UNDER THE PROGRAM. THE INCENTIVE COMPENSATION AWARDS HAVE BEEN INCLUDED IN THE COMPENSATION AMOUNTS REPORTED IN PART VII AND IN COLUMN (B)(II) OF SCHEDULE J. THEY ARE REPORTED IN THE YEAR PAID. THE COMPENSATION AND LEADERSHIP COMMITTEE OF THE BOARD REVIEW, APPROVE, AND OVERSEE ALL ASPECTS AND ALL ELEMENTS OF EXECUTIVE COMPENSATION AND BENEFITS, INCLUDING THE AMOUNTS AWARDED UNDER THIS ANNUAL INCENTIVE PLAN. LONG-TERM INCENTIVE PLAN: THE REPORTING ORGANIZATION OFFERS A LONG-TERM INCENTIVE PLAN (THE "PLAN") TO CERTAIN KEY EXECUTIVES. THE PLAN TIES A KEY EXECUTIVE'S COMPENSATION TO THE ORGANIZATION'S LONG-TERM STRATEGIC PERFORMANCE, PROVIDES A RETENTION INCENTIVE FOR KEY EXECUTIVES, AND ALLOWS THE ORGANIZATION TO COMPETE IN THE MARKETPLACE FOR TOP LEADERSHIP TALENT. THE PLAN OPERATES ON THREE-YEAR PERFORMANCE CYCLES THAT BEGIN EACH YEAR. LONG-TERM STRATEGIC GOALS (IN THE PRINCIPAL AREAS OF QUALITY OF PATIENT CARE AND LONG-TERM FINANCIAL STRENGTH) ARE ESTABLISHED AND APPROVED FOR EACH CYCLE, IN ADVANCE, BY INDEPENDENT AND DISINTERESTED MEMBERS OF THE NOVANT HEALTH BOARD OF TRUSTEES (WHO COMPRISE THE COMPENSATION AND LEADERSHIP COMMITTEE OF THE BOARD). NOVANT HEALTH'S INTERNAL AUDIT DEPARTMENT REVIEWS THE METHODOLOGY AND PROCESS USED TO DETERMINE ACHIEVEMENT OF THE QUALITY METRICS. IN ADDITION, THE COMPENSATION AND LEADERSHIP COMMITTEE OF THE BOARD WHO OVERSEE THE INCENTIVE COMPENSATION PROGRAM APPLY TWO "CIRCUIT BREAKERS," RELATING TO COMMUNITY HEALTH NEEDS ASSESSMENTS AND IMPLEMENTATION PLANS, AND FINANCIAL PERFORMANCE; AWARDS ARE PAYABLE FOR A PARTICULAR THREE-YEAR PERFORMANCE CYCLE ONLY IF THE CIRCUIT BREAKERS ARE MET FOR THE RESPECTIVE THREE-YEAR PERFORMANCE PERIOD. IF AN AWARD IS EARNED AT THE END OF A PERFORMANCE CYCLE, THEN THE INCENTIVE AWARD IS PAID OUT AND IS INCLUDED IN THE COMPENSATION AMOUNTS REPORTED IN PART VII AND IN COLUMN (B)(II) OF SCHEDULE J. THEY ARE REPORTED IN THE YEAR PAID. THE COMPENSATION AND LEADERSHIP COMMITTEE OF THE BOARD REVIEWS, APPROVES, AND OVERSEES ALL ASPECTS AND ALL ELEMENTS OF EXECUTIVE COMPENSATION AND BENEFITS, INCLUDING THE AMOUNTS AWARDED UNDER THE PLAN. PART I, LINE 4A - SEVERANCE PLAN: ELIGIBLE EXECUTIVES MAY RECEIVE SEVERANCE PAY THAT IS BASED ON ANNUAL COMPENSATION FOR A SPECIFIED PERIOD OF TIME. THE SEVERANCE PAY WOULD BE PAID ONLY IN THE EVENT OF CERTAIN TYPES OF EMPLOYMENT TERMINATION, AND IS FURTHER CONTINGENT ON THE SATISFACTION OF OTHER CONDITIONS SUCH AS COMPLIANCE WITH A NON-COMPETITION COVENANT. ANY CURRENT YEAR PAYMENTS HAVE BEEN INCLUDED IN THE COMPENSATION AMOUNTS REPORTED IN PART VII AND IN COLUMN (B)(III) OF SCHEDULE J. THE COMPENSATION AND LEADERSHIP COMMITTEE OF THE BOARD REVIEWS, APPROVES, AND OVERSEES ALL ASPECTS AND ALL ELEMENTS OF EXECUTIVE COMPENSATION AND BENEFITS, INCLUDING THE AMOUNTS AWARDED UNDER THIS SEVERANCE PLAN. PART I, LINE 4B - SUPPLEMENTAL NONQUALIFIED RETIREMENT PLANS: THE SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN ("SERP") IS INTENDED TO SUPPORT RETENTION OF KEY EXECUTIVES, AND TO OFFER COMPETITIVE TOTAL COMPENSATION. ELIGIBLE EXECUTIVES WILL BE NOMINATED BY THE CEO AND APPROVED BY THE COMMITTEE TO PARTICIPATE. GENERALLY, ANNUAL CONTRIBUTIONS TO THE PLAN OR PAYMENTS TO PARTICIPANTS WILL BE BASED ON A PERCENTAGE OF THE PARTICIPANT'S BASE SALARY AS OF JANUARY 1ST OF THE PREVIOUS PLAN YEAR AND ARE REPORTED IN COLUMN (C) OF SCHEDULE J. PRIOR TO MAKING THE CONTRIBUTIONS OR PAYMENTS, THE COMMITTEE WILL APPROVE THE AMOUNTS AS TO REASONABLENESS, WHEN COMBINED WITH ALL OTHER ANNUAL COMPENSATION. A 3 YEAR CLASS-YEAR VESTING PERIOD WILL APPLY UP TO AGE 62, WHEN ALL MONEY WOULD BE VESTED AND PAID OUT TO THE PARTICIPANT. OTHERWISE, VESTING WILL OCCUR ON JANUARY 1ST OF EACH YEAR FOR THE APPROPRIATE CLASS-YEAR VESTING PERIOD. THE COMMITTEE REVIEWS, APPROVES, AND OVERSEES ALL ASPECTS AND ALL ELEMENTS OF EXECUTIVE COMPENSATION AND BENEFITS. X 403 111920 FMV X 3219 FMV X GIFT CARD/CERTIFICATE 33 4462 FMV X JEWELRY 5 808 FMV X HYGENE PRODUCTS 15 509 FMV X REHAB APPAREL 50 344 FMV 0 0 1 0 PART I, COLUMN (B): NUMBER OF ITEMS RECEIVED FORM 990, PI, L1: ORGANIZATION'S MISSION OR MOST SIGNIFICANT ACTIVITIES FORSYTH HOSPITAL FOUNDATION DOING BUSINESS AS NOVANT HEALTH FOUNDATION FORSYTH MEDICAL CENTER ("THE FOUNDATION") WAS FORMED TO ACCEPT GIFTS, SEEK GRANTS, AND INVEST FUNDS TO SUPPORT FORSYTH MEMORIAL HOSPITAL DOING BUSINESS AS NOVANT HEALTH FORSYTH MEDICAL CENTER AND ITS STRATEGIC PARTNERS PROVIDING HEALTHCARE IN THE COMMUNITY. THE FOUNDATION'S MISSION IS SUPPORTING THE NOVANT HEALTH SYSTEM AND IMPROVING THE HEALTH OF OUR COMMUNITIES, ONE PERSON AT A TIME. LOCATED IN WINSTON-SALEM, NC, IT HAS EXPANDED ITS REACH TO INCLUDE ADVISORY BOARDS AT NEW MEDICAL CENTERS IN KERNERSVILLE, NC AND CLEMMONS, NC. NOVANT HEALTH FOUNDATION FORSYTH MEDICAL CENTER IS AN INTEGRAL PART OF THE NOVANT HEALTH SYSTEM (COLLECTIVELY KNOWN AS "NOVANT HEALTH"), A NOT-FOR-PROFIT INTEGRATED GROUP OF HOSPITALS, PHYSICIAN CLINICS, OUTPATIENT CENTERS, AND OTHER HEALTHCARE SERVICE PROVIDERS. NOVANT HEALTH CONSISTS OF MORE THAN 1,300 PHYSICIANS AND NEARLY 24,000 EMPLOYEES WHO MAKE HEALTHCARE REMARKABLE AT OVER 500 LOCATIONS, INCLUDING 14 MEDICAL CENTERS AND HUNDREDS OF OUTPATIENT FACILITIES AND PHYSICIAN CLINICS. HEADQUARTERED IN WINSTON-SALEM, NC, NOVANT HEALTH IS COMMITTED TO MAKING HEALTHCARE REMARKABLE FOR PATIENTS AND COMMUNITIES, SERVING MORE THAN FOUR MILLION PATIENTS ANNUALLY. NOVANT HEALTH IS RANKED AS ONE OF THE NATION'S TOP 20 INTEGRATED DELIVERY NETWORKS BY IMS HEALTH. IN 2015 THE NOVANT HEALTH SYSTEM REPORTED $4.1 BILLION IN REVENUES. GENERAL INFORMATION THE FOUNDATION SUPPORTS PEOPLE, PROGRAMS AND SERVICES WITHIN THE MEDICAL CENTERS, PROVIDING EXPANDED TREATMENT AND PREVENTION OPTIONS. THE FOUNDATION ALSO PROVIDES MISSION-ALIGNED GRANTS TO COMMUNITY PARTNERS THAT HELP SUPPLEMENT HEALTHCARE AND PREVENTION PROGRAMS FOR UNDERSERVED PATIENTS. THE FOUNDATION'S DIVERSE BOARD OF COMMUNITY LEADERS IN WINSTON-SALEM, NC, CLEMMONS, NC, AND KERNERSVILLE, NC PROVIDES STEWARDSHIP AND OVERSIGHT OF THE ORGANIZATION'S OPERATIONS AND ACTIVITIES. COMMUNITY OUTREACH COMMUNITY OUTREACH IS A CRITICAL COMPONENT TO THE MISSION OF NOVANT HEALTH FOUNDATION FORSYTH MEDICAL CENTER. THE FOUNDATION HOSTS A WIDE RANGE OF EVENTS EACH YEAR, INCLUDING "COWGIRLS WITH A CAUSE," WHICH PROVIDES MAMMOGRAM SCREENINGS AND DIAGNOSTIC PROCEDURES FOR WOMEN WITH LIMITED FINANCIAL RESOURCES. THE FOUNDATION ALSO HOSTS THE "GARDEN PARTY" EVENT THROUGH THE WOMEN'S COUNCIL TO IMPROVE THE HEALTH OF ALL WOMEN IN THE LOCAL COMMUNITY. THE FOUNDATION EXISTS TO GIVE BACK TO THE COMMUNITY THROUGH OUTREACH EVENTS TO ADVOCATE FOR IMPROVED HEALTH. IN 2015, THE FOUNDATION RECEIVED MORE THAN 4,250 DONATIONS TO SUPPORT ITS MISSION. GIFTS, GRANTS, AND EARNINGS FROM INVESTMENTS TOUCHED VIRTUALLY EVERY SERVICE AREA AT NOVANT HEALTH FORSYTH MEDICAL CENTER. SOME EXAMPLES ARE AS FOLLOWS: -THE FOUNDATION MADE GRANTS TO SUPPORT TWO IMPORTANT FREE CLINICS: TODAY'S WOMAN, A PRENATAL CLINIC SEEKING TO REDUCE INFANT MORTALITY; AND THE COMMUNITY CARE CENTER, NORTH CAROLINA'S LARGEST FREE CLINIC. -RESTRICTED GIFTS FROM FOUNDATION FUNDS WENT TO SUPPORT NURSE NAVIGATORS, PATIENT SUPPORT, STAFF EDUCATION, RESEARCH, MAMMOGRAMS, DISEASE PREVENTION, SCREENINGS AND REHABILITATION. -THE WOMEN'S COUNCIL OF NOVANT HEALTH FOUNDATION FORSYTH MEDICAL CENTER HAS A MISSION TO ENGAGE COMMUNITY WOMEN IN RAISING THE STANDARD FOR WOMEN'S HEALTHCARE AND EXPANDING HEALTHCARE OPPORTUNITIES FOR ALL, REGARDLESS OF THEIR ECONOMIC CIRCUMSTANCES. IN 2015, THE COUNCIL PROVIDED SUPPORT FOR HEART DISEASE RISK ASSESSMENTS FOR HISPANIC WOMEN, BREAST MRIS, A PEER SUPPORT SPECIALIST IN THE BEHAVIORAL HEALTH UNIT, HEALTH COACHING FOR UNDERSERVED WOMEN, SCHOLARSHIPS TO "THE WEIGH FOR YOU" PROGRAM, AND SUPPORT FOR THE HIGH-RISK MATERNITY UNIT. THROUGH THESE GRANTS, THE WOMEN'S COUNCIL HAS PROVIDED APPROXIMATELY $425,000 IN SUPPORT SINCE 2008. COMMUNITY BENEFIT REPORT HTTPS://WWW.NOVANTHEALTH.ORG/HOME/ABOUT-US/COMPANY-INFORMATION/ FINANCIAL-PROFILE/COMMUNITY-BENEFIT-REPORT.ASPX THE COMMUNITY BENEFIT REPORT PREPARED BY NOVANT HEALTH IS A SYSTEM-WIDE REPORT THAT INCLUDES QUALITATIVE AND QUANTITATIVE INFORMATION. PLEASE NOTE THAT THE NUMERIC DATA IN THIS REPORT IS NOT BASED UPON THE FORM 990, SCHEDULE H CRITERIA, BUT RATHER IT HAS BEEN PREPARED IN ACCORDANCE WITH THE NORTH CAROLINA HOSPITAL ASSOCIATION REPORTING GUIDELINES. IT SHOULD NOT BE RELIED UPON AS THE ORGANIZATION'S FORM 990, SCHEDULE H COMMUNITY BENEFIT REPORT, ITS COMMUNITY HEALTH NEEDS ASSESSMENT, OR COMMUNITY BENEFIT IMPLEMENTATION STRATEGY. IN THIS REPORT, THE NOVANT HEALTH SYSTEM'S COMMUNITY BENEFIT WAS APPROXIMATELY $706,000,000, INCLUDING $125,000,000 IN CHARITY CARE FOR 2015. FORM 990, PART III, LINE 1: MISSION, VISION AND VALUES MISSION: NOVANT HEALTH EXISTS TO IMPROVE THE HEALTH OF COMMUNITIES, ONE PERSON AT A TIME. VISION: WE, THE NOVANT HEALTH TEAM, WILL DELIVER THE MOST REMARKABLE PATIENT EXPERIENCE, IN EVERY DIMENSION, EVERY TIME. VALUES: - COMPASSION: WE TREAT OUR CUSTOMERS AND THEIR FAMILIES, STAFF AND OTHER HEALTHCARE PROVIDERS AS FAMILY MEMBERS BY SHOWING THEM KINDNESS, PATIENCE, EMPATHY AND RESPECT. - DIVERSITY AND INCLUSION: WE RECOGNIZE THAT EVERY PERSON IS DIFFERENT, EACH SHAPED BY UNIQUE LIFE EXPERIENCES. THIS ENABLES US TO BETTER UNDERSTAND ONE ANOTHER AND OUR CUSTOMERS. BY ENGAGING THE STRENGTHS AND TALENTS OF EACH TEAM MEMBER, WE ENSURE A STRONG ORGANIZATION CAPABLE OF PROVIDING REMARKABLE HEALTHCARE TO OUR PATIENTS, FAMILIES AND COMMUNITIES. - PERSONAL EXCELLENCE: WE STRIVE TO GROW PERSONALLY AND PROFESSIONALLY, AND WE APPROACH EACH SERVICE OPPORTUNITY WITH A POSITIVE, FLEXIBLE ATTITUDE. HONESTY AND PERSONAL INTEGRITY GUIDE ALL THAT WE DO. - TEAMWORK: THE NEEDS AND EXPECTATIONS OF ANY ONE CUSTOMER ARE GREATER THAN THAT WHICH ONE PERSON'S SERVICE EFFORTS CAN SATISFY. WE SUPPORT EACH OTHER SO THAT TOGETHER AS A TEAM, WE CAN BE SUCCESSFUL IN THE EYE OF THE CUSTOMER AS A QUALITY SERVICE PROVIDER. - COURAGE: WE ACT BOLDLY IN MAKING THE CHANGES NECESSARY TO ACHIEVE OUR MISSION, VISION AND PROMISE OF DELIVERING REMARKABLE HEALTHCARE. OUR PROMISE TO PATIENTS: WE ARE MAKING YOUR HEALTHCARE EXPERIENCE REMARKABLE. WE WILL BRING YOU WORLD-CLASS CLINICIANS, CARE AND TECHNOLOGY - WHEN AND WHERE YOU NEED THEM. WE ARE REINVENTING THE HEALTHCARE EXPERIENCE TO BE SIMPLER, MORE CONVENIENT AND MORE AFFORDABLE, SO THAT YOU CAN FOCUS ON GETTING BETTER AND STAYING HEALTHY. FORM 990, PART I, LINE 6: THE NUMBER OF VOLUNTEERS REPORTED INCLUDES THOSE VOLUNTEERS SERVING AS BOARD MEMBERS. FORM 990, PART VI, SECTION A, LINE 2 FORM 990, PART VI, SECTION A, LINE 2: FAMILY AND/OR BUSINESS RELATIONSHIPS BUSINESS RELATIONSHIP MAMIE SUTPHIN ROBERT DUNHAM FORM 990, PART VI, SECTION A, LINE 7A FORM 990, PART VI, SECTION A, LINE 7A: ELECTION OF MEMBERS AND THEIR RIGHTS FORSYTH MEMORIAL HOSPITAL, INC. APPOINTS THE MAJORITY OF THE FORSYTH MEDICAL CENTER FOUNDATION'S BOARD. FORM 990, PART VI, SECTION B, LINE 11 FORM 990, PART VI, SECTION B, LINE 11: ORGANIZATION'S PROCESS TO REVIEW FORM 990 THE BOARD HAS DELEGATED REVIEW OF THE FORM 990 TO NOVANT HEALTH'S AUDIT AND COMPLIANCE COMMITTEE ("THE COMMITTEE"), WHICH OVERSEES TAX MATTERS FOR NOVANT HEALTH. THE COMMITTEE IS THE REVIEW BODY FOR ALL OF THE FORM 990S FILED FOR ORGANIZATIONS WITHIN THE NOVANT HEALTH SYSTEM. THE COMMITTEE MEETS BEFORE THE FORM 990S ARE FILED WITH THE IRS AND AFTER ALL BOARD MEMBERS HAVE RECEIVED A COPY OF THE FORM 990 AND A SUMMARY OF ITS CONTENTS. THE VICE PRESIDENT OF TAX AND LEGAL COUNSEL FOR NOVANT HEALTH ATTEND THE MEETING TO ANSWER ANY QUESTIONS AND ADDRESS ANY SIGNIFICANT DISCLOSURES WITHIN THE FORM 990. FORM 990, PART VI, SECTION B, LINE 12C FORM 990, PART VI, SECTION B, LINE 12C: MONITORING AND ENFORCEMENT OF COI THE ORGANIZATION'S TRUSTEE CONFLICT OF INTEREST POLICY APPLIES TO ALL TRUSTEES, PRINCIPAL OFFICERS OR MEMBERS OF A COMMITTEE WITH BOARD DELEGATED POWERS INCLUDING ANY APPLICABLE DISREGARDED ENTITIES. ALL TRUSTEES ARE SENT AN ANNUAL DISCLOSURE FORM. THE TRUSTEE ANNUAL DISCLOSURE FORMS ARE REVIEWED BY THE LEGAL DEPARTMENT. WITH RESPECT TO PARTICULAR TRANSACTIONS THAT COME BEFORE THE BOARD, THE CONFLICT OF INTEREST POLICY WOULD BE FOLLOWED. THE POTENTIAL CONFLICT OF INTEREST WOULD BE DISCLOSED BY THE BOARD MEMBER BEFORE A VOTE ON THE TRANSACTION AND THE REST OF THE BOARD WOULD DETERMINE WHETHER A CONFLICT OF INTEREST EXISTS. IF THE REST OF THE BOARD DETERMINED THAT A CONFLICT OF INTEREST EXISTED THEN THE BOARD MEMBER WITH THE CONFLICT OF INTEREST WOULD NOT PARTICIPATE IN THE DELIBERATIONS AND VOTE. FORM 990, PART VI, SECTION B, LINE 13: WRITTEN WHISTLEBLOWER POLICY THE FILING ORGANIZATION IS PART OF THE INTEGRATED HEALTHCARE SYSTEM OPERATED BY NOVANT HEALTH, INC. ("NOVANT HEALTH"), THE PARENT ORGANIZATION. NOVANT HEALTH'S BYLAWS AUTHORIZE IT TO ESTABLISH CERTAIN POLICIES FOR ALL OF ITS SUBSIDIARIES WITHIN THE SYSTEM. NOVANT HEALTH HAS ESTABLISHED A WHISTLEBLOWER POLICY AND ALL SUBSIDIARY ORGANIZATIONS FOLLOW ALL APPLICABLE NOVANT HEALTH CORPORATE POLICIES IN THEIR OPERATIONS. THE INDIVIDUAL SUBSIDIARY ORGANIZATION'S BOARD OF TRUSTEES DO NOT SPECIFICALLY ADOPT OR APPROVE EACH OPERATING POLICY, AS THERE ARE HUNDREDS OF POLICIES THAT APPLY TO ALL SUBSIDIARY ORGANIZATIONS AND THEY CANNOT PRACTICABLY BE APPROVED BY ALL OF THE INDIVIDUAL BOARDS. FORM 990, PART VI, SECTION B, LINE 14: WRITTEN DOCUMENT RETENTION AND DESTRUCTION POLICY THE FILING ORGANIZATION IS PART OF THE INTEGRATED HEALTHCARE SYSTEM OPERATED BY NOVANT HEALTH, INC. ("NOVANT HEALTH"), THE PARENT ORGANIZATION. NOVANT HEALTH'S BYLAWS AUTHORIZE IT TO ESTABLISH CERTAIN POLICIES FOR ALL OF ITS SUBSIDIARIES WITHIN THE SYSTEM. NOVANT HEALTH HAS ESTABLISHED A DOCUMENT RETENTION AND DESTRUCTION POLICY AND ALL SUBSIDIARY ORGANIZATIONS FOLLOW ALL APPLICABLE NOVANT HEALTH CORPORATE POLICIES IN THEIR OPERATIONS. THE INDIVIDUAL SUBSIDIARY ORGANIZATION'S BOARD OF TRUSTEES DO NOT SPECIFICALLY ADOPT OR APPROVE EACH OPERATING POLICY, AS THERE ARE HUNDREDS OF POLICIES THAT APPLY TO ALL SUBSIDIARY ORGANIZATIONS AND THEY CANNOT PRACTICABLY BE APPROVED BY ALL OF THE INDIVIDUAL BOARDS. FORM 990, PART VI, SECTION B, LINE 15 FORM 990, PART VI, SECTION B, LINE 15A: COMPENSATION PROCESS FOR TOP OFFICIAL THE FILING ORGANIZATION IS AN INTEGRAL PART OF NOVANT HEALTH, AN INTEGRATED HEALTHCARE SYSTEM COLLECTIVELY REFERRED TO AS "NOVANT HEALTH." NOVANT HEALTH, INC. IS THE PARENT ORGANIZATION AND INDEPENDENT AND DISINTERESTED MEMBERS OF THE NOVANT HEALTH, INC. BOARD OF TRUSTEES (WHO COMPRISE THE COMPENSATION AND LEADERSHIP COMMITTEE OF THE BOARD) REVIEW, APPROVE, AND OVERSEE ALL ASPECTS OF COMPENSATION AND BENEFITS FOR CERTAIN EXECUTIVES ("EXECUTIVES") SERVING AS THE TOP MANAGEMENT OFFICIAL(S) FOR NOVANT HEALTH ENTITIES. THE COMMITTEE WORKS WITH AN INDEPENDENT COMPENSATION CONSULTANT AND USES THIRD PARTY COMPARABILITY DATA FOR FUNCTIONALLY SIMILAR POSITIONS AT SIMILARLY SITUATED ORGANIZATIONS TO ENSURE THAT TOTAL COMPENSATION AND BENEFITS FOR EACH EXECUTIVE IS REASONABLE FOR THAT EXECUTIVE'S POSITION. THE COMMITTEE REVIEWS AND APPROVES EXECUTIVE COMPENSATION AND BENEFITS ANNUALLY, CONSISTENT WITH THE WRITTEN EXECUTIVE COMPENSATION PHILOSOPHY OF NOVANT HEALTH, AND IN A MANNER THAT QUALIFIES FOR THE REBUTTABLE PRESUMPTION OF REASONABLENESS, THEREBY ASSURING THAT TOTAL COMPENSATION AND BENEFITS PROVIDED TO EACH EXECUTIVE IS REASONABLE. FORM 990, PART VI, LINE 15B - COMPENSATION PROCESS FOR OFFICERS THE ORGANIZATION DOES NOT HAVE ANY KEY EMPLOYEES AND THE ORGANIZATION'S ONLY OFFICERS, OTHER THAN THE TOP MANAGEMENT OFFICIAL, ARE STATE LAW BOARD OFFICERS. THESE EMPLOYEES DO NOT HOLD A CORPORATE POSITION OF INFLUENCE THAT RESULTS IN REVIEW OF THEIR COMPENSATION BY THE PARENT ORGANIZATION'S COMPENSATION AND LEADERSHIP COMMITTEE, AS DESCRIBED IN LINE 15A. FORM 990, PART VI, SECTION C, LINE 19 FORM 990, PART VI, SECTION C, LINE 19: GOVERNING DOCUMENTS DISCLOSURE THE AUDITED CONSOLIDATED FINANCIAL STATEMENTS CONTAINING ALL ORGANIZATIONS IN THE NOVANT HEALTH SYSTEM ARE POSTED TO THE NOVANT HEALTH WEBSITE. THE GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE NOT AVAILABLE TO THE PUBLIC. FORM 990, PART VII, SECTION A, COLUMN B: RELATED ORGANIZATIONS THE ORGANIZATION EMPLOYS CERTAIN EXECUTIVES WHOSE ROLES ARE SUCH THAT THEY PROVIDE SERVICES TO NOT ONLY THE ORGANIZATION, BUT ALSO TO SOME OR ALL OF THE OTHER TAX-EXEMPT ORGANIZATIONS WITHIN THE NOVANT HEALTH HEALTHCARE SYSTEM. FOR EXAMPLE, MANY OF THESE EXECUTIVES' ROLES FOCUS ON PARTICULAR SERVICE LINES WHICH CROSS THE VARIOUS GEOGRAPHIC MARKETS OUR ORGANIZATIONS SERVE, THUS THE SERVICES PROVIDED BY THESE EXECUTIVES MAY BENEFIT AND BE RECEIVED BY MULTIPLE ORGANIZATIONS WITHIN THE SYSTEM. THE EXECUTIVES DO NOT ALLOCATE THEIR HOURS BETWEEN THE VARIOUS ORGANIZATIONS, BUT RATHER THEIR TIME SPENT ON SERVICES TO THE ORGANIZATION IS INCLUSIVE OF SERVICES TO ALL OF THE ORGANIZATIONS THEY SERVE WITHIN THE SYSTEM. FORM 990, PART IX, LINE 11G CONSULTING FEES : PROGRAM SERVICE EXPENSES 1,118. MANAGEMENT AND GENERAL EXPENSES 137. FUNDRAISING EXPENSES 1,027. TOTAL EXPENSES 2,282. CONTRACTED SERVICES : PROGRAM SERVICE EXPENSES 244,246. MANAGEMENT AND GENERAL EXPENSES 29,908. FUNDRAISING EXPENSES 224,307. TOTAL EXPENSES 498,461. FORM 990, PART XI, LINE 9: AFFILIATE TRANSFERS 1,829,838. ROUNDING 1. 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