NORTHWEST COMMUNITY CARE NETWORK INC: Form 990, tax year 2014

View the entire original 990 at ProPublica ↗

Organization
NORTHWEST COMMUNITY CARE NETWORK INC (EIN 02-0774853)
Tax period
2014-07-01 to 2015-06-30
Filed
2016-05-13
IRS object ID
201631349349300843
Schema version
2014v6.0
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Return2016-05-13T08:07:23-05:00ReturnTs
Tax Period End2015-06-30TaxPeriodEndDt
Return Type990ReturnTypeCd
Tax Period Begin2014-07-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN020774853EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1NORTHWEST COMMUNITY CARE NETWORK INCBusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlNORTBusinessNameControlTxt
Phone3367162698PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line12000 WEST 1ST STREET NO 704AddressLine1Txt
CityWINSTON SALEMCityNm
State AbbreviationNCStateAbbreviationCd
ZIP27104ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonJIM GRAHAMPersonNm
Person TitleEXECUTIVE DIRECTORPersonTitleTxt
Phone3367162698PhoneNum
Signature2016-05-10SignatureDt
FieldValueIRS element (for citing)
Tax2014TaxYr
Build TS2016-08-17 19:52:53ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerJIM GRAHAMPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line12000 WEST 1ST STREET NO 704AddressLine1Txt
CityWINSTON SALEMCityNm
State AbbreviationNCStateAbbreviationCd
ZIP27104ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$13,896,999GrossReceiptsAmt
Group Return For Affiliates0GroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website AddressWWW.NWCOMMUNITYCARE.ORGWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation2006FormationYr
Legal Domicile StateNCLegalDomicileStateCd
Activity Or MissionDEVELOPING, IMPLEMENTING AND EVALUATING ENHANCED MANAGED CARE STRATEGIES FOR MEDICAID RECIPIENTS.ActivityOrMissionDesc
Voting Members Governing Body12VotingMembersGoverningBodyCnt
Voting Members Independent12VotingMembersIndependentCnt
Total Employee0TotalEmployeeCnt
Total Volunteers10TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$1,923,959PYContributionsGrantsAmt
CY Contributions Grants$2,055,197CYContributionsGrantsAmt
PY Program Service Revenue$10,993,684PYProgramServiceRevenueAmt
CY Program Service Revenue$11,835,320CYProgramServiceRevenueAmt
PY Investment Income$1,553PYInvestmentIncomeAmt
CY Investment Income$1,269CYInvestmentIncomeAmt
PY Other Revenue$7,900PYOtherRevenueAmt
CY Other Revenue$5,213CYOtherRevenueAmt
PY Total Revenue$12,927,096PYTotalRevenueAmt
CY Total Revenue$13,896,999CYTotalRevenueAmt
PY Grants And Similar Paid$751,234PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$481,527CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$0PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$0CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$12,999,553PYOtherExpensesAmt
CY Other Expenses$13,145,539CYOtherExpensesAmt
PY Total Expenses$13,750,787PYTotalExpensesAmt
CY Total Expenses$13,627,066CYTotalExpensesAmt
PY Revenues Less Expenses-$823,691PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$269,933CYRevenuesLessExpensesAmt
Total Assets BOY$5,092,185TotalAssetsBOYAmt
Total Assets EOY$5,226,226TotalAssetsEOYAmt
Total Liabilities BOY$1,079,249TotalLiabilitiesBOYAmt
Total Liabilities EOY$943,357TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$4,012,936NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$4,282,869NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part IIIYes (X)InfoInScheduleOPartIIIInd
MissionNORTHWEST COMMUNITY CARE NETWORK OPERATES A PRIMARY CARE CASE MANAGEMENT PROGRAM (PPCM) THAT IS DESIGNED TO PROVIDE A MORE EFFICIENT AND EFFECTIVE HEALTHCARE DELIVERY SYSTEM FOR MEDICAID RECIPIENTS. IT BRINGS TOGETHER PRIMARY CARE PROVIDERS, HOSPITALS, HEALTH DEPARTMENTS, DEPARTMENT OF SOCIAL SERVICES AND OTHER COMMUNITY PROVIDERS TO MANAGE THE HEALTH CARE NEEDS OF MEDICAID RECIPIENTS. ITS SERVICE AREA INCLUDES THE COUNTIES OF DAVIE, DAVIDSON, FORSYTH, STOKES, SURRY, WILKES AND YADKIN. THESE COUNTIES COMPRISE THE NETWORK MEMBERS. ITS CARE MANAGERS ASSIST IN DEVELOPING, IMPLEMENTING AND EVALUATING ENHANCED MANAGED CARE STRATEGIES FOR MEDICAID RECIPIENTS. IT RECEIVES A MONTHLY FEE TO PERFORM THE SERVICE FROM THE STATE OF NORTH CAROLINA'S MEDICAID PROGRAM FOR EACH MEDICAID RECIPIENT ENROLLED.MissionDesc
Significant New Program Srvc0SignificantNewProgramSrvcInd
Significant Change0SignificantChangeInd
Expense$12,171,409ExpenseAmt
Grant$481,527GrantAmt
Revenue$11,840,533RevenueAmt
DescDURING OUR CURRENT FISCAL YEAR, WE CONTINUE TO COORDINATE, FACILITATE AND MANAGE THE DELIVERY OF MEDICAID SERVICES TO 130,000 CLIENTS IN THE NORTHWEST PIEDMONT AREA OF NORTH CAROLINA. WE HAVE BEEN SUCCESSFUL IN IMPROVING THE QUALITY OF MATERNITY CARE AND RELATED OUTCOMES FOR MOTHERS AND BABIES,AND REDUCING MEDICAL CARE COST FOR 8,598 CLIENTS. IN ADDITION, WE FOCUSE ON INDIGENT CARE THROUGH MEDICAID SERVICES IN THE NORTHWEST PIEDMONT AREA OF NORTH CAROLINA FOR 6,089 MEDICAID CLIENTS. OUR ANCHOR PROGRAM IS REDUCING MEDICARE READMISSIONS TO THE LOCAL HOSPITALS AND ITS BENEFITS CONTINUE TO GROW THROUGHOUT OUR AREA.Desc
Total Program Service Expenses$12,171,409TotalProgramServiceExpensesAmt
Described In Section501c3Yes (1)DescribedInSection501c3Ind
Schedule B RequiredYes (1)ScheduleBRequiredInd
Political Campaign Acty0PoliticalCampaignActyInd
Lobbying Activities0LobbyingActivitiesInd
Subject To Proxy Tax0SubjectToProxyTaxInd
Donor Advised Fund0DonorAdvisedFundInd
Conservation Easements0ConservationEasementsInd
Collections Of Art0CollectionsOfArtInd
Credit Counseling0CreditCounselingInd
Temp Or Permanent Endowments0TempOrPermanentEndowmentsInd
Report Land Building EquipmentYes (1)ReportLandBuildingEquipmentInd
Report Investments Other Sec0ReportInvestmentsOtherSecInd
Report Program Related Invst0ReportProgramRelatedInvstInd
Report Other Assets0ReportOtherAssetsInd
Report Other Liabilities0ReportOtherLiabilitiesInd
Include FIN48 FootnoteYes (1)IncludeFIN48FootnoteInd
Independent Audit Fincl StmtYes (1)IndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtYes (1)ConsolidatedAuditFinclStmtInd
School Operating0SchoolOperatingInd
Foreign Office0ForeignOfficeInd
Foreign Activities0ForeignActivitiesInd
More Than5000 K To Org0MoreThan5000KToOrgInd
More Than5000 K To Individuals0MoreThan5000KToIndividualsInd
Professional Fundraising0ProfessionalFundraisingInd
Fundraising Activities0FundraisingActivitiesInd
Gaming Activities0GamingActivitiesInd
Operate Hospital0OperateHospitalInd
Grants To OrganizationsYes (1)GrantsToOrganizationsInd
Grants To Individuals0GrantsToIndividualsInd
Schedule J RequiredYes (1)ScheduleJRequiredInd
Tax Exempt Bonds0TaxExemptBondsInd
Engaged In Excess Benefit Trans0EngagedInExcessBenefitTransInd
PY Excess Benefit Trans0PYExcessBenefitTransInd
Loan Outstanding0LoanOutstandingInd
Grant To Related Person0GrantToRelatedPersonInd
Business Rln With Org Mem0BusinessRlnWithOrgMemInd
Business Rln With Fam Mem0BusinessRlnWithFamMemInd
Business Rln With Officer Ent0BusinessRlnWithOfficerEntInd
Deductible Non Cash Contri0DeductibleNonCashContriInd
Deductible Art Contribution0DeductibleArtContributionInd
Terminate Operations0TerminateOperationsInd
Partial Liquidation0PartialLiquidationInd
Disregarded Entity0DisregardedEntityInd
Related EntityYes (1)RelatedEntityInd
Related Organization Ctrl Ent0RelatedOrganizationCtrlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org0TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp0ActivitiesConductedPrtshpInd
Schedule O RequiredYes (1)ScheduleORequiredInd
IRP Document29IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (1)BackupWthldComplianceInd
Employee0EmployeeCnt
Unrelated Bus Incm Over Limit0UnrelatedBusIncmOverLimitInd
Foreign Financial Account0ForeignFinancialAccountInd
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTransInd
Taxable Party Notification0TaxablePartyNotificationInd
Nondeductible Contributions0NondeductibleContributionsInd
Quid Pro Quo Contributions0QuidProQuoContributionsInd
Form8282 Property Disposed Of0Form8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft Cntrct0RcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft Cntrct0PayPremiumsPrsnlBnftCntrctInd
Indoor Tanning Services0IndoorTanningServicesInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members12GoverningBodyVotingMembersCnt
Independent Voting Member12IndependentVotingMemberCnt
Family Or Business Rln0FamilyOrBusinessRlnInd
Delegation Of Mgmt Duties0DelegationOfMgmtDutiesInd
Change To Org Documents0ChangeToOrgDocumentsInd
Material Diversion Or Misuse0MaterialDiversionOrMisuseInd
Members Or StockholdersYes (1)MembersOrStockholdersInd
Election Of Board MembersYes (1)ElectionOfBoardMembersInd
Decisions Subject To Approva0DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (1)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (1)MinutesOfCommitteesInd
Officer Mailing Address0OfficerMailingAddressInd
Local Chapters0LocalChaptersInd
Form990 Provided To Gvrn BodyYes (1)Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (1)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (1)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (1)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (1)WhistleblowerPolicyInd
Document Retention Policy0DocumentRetentionPolicyInd
Compensation Process CEO0CompensationProcessCEOInd
Compensation Process Other0CompensationProcessOtherInd
Investment In Joint Venture0InvestmentInJointVentureInd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1PAIGE W GRUBBSBusinessNameLine1Txt
FieldValueIRS element (for citing)
Phone3367162344PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line12000 WEST 1ST STREET SUITE 704AddressLine1Txt
CityWINSTON SALEMCityNm
State AbbreviationNCStateAbbreviationCd
ZIP27104ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (14 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmt
ANN ABSHER
SECRETARY2.00Yes (X)Yes (X)$0$0$0
EDDIE WOOTEN
BOARD MEMBER2.00Yes (X)$768$0$0
MARLON HUNTER
TREASURER2.00Yes (X)Yes (X)$0$0$0
DAVID SWANN
BOARD MEMBER2.00Yes (X)$0$0$0
SCOTT L VOGLER MD
BOARD MEMBER2.00Yes (X)$0$0$0
SU ALBERT MD
BOARD MEMBER2.00Yes (X)$3,723$0$0
BILL SEBASTIAN
BOARD MEMBER2.00Yes (X)$0$0$0
TOM SIBERT MD
CHAIRMAN2.00Yes (X)Yes (X)$0$0$0
DICK STEVENSON
BOARD MEMBER2.00Yes (X)$0$0$0
RICHARD LORD
BOARD MEMBER2.00Yes (X)$0$0$0
K BARBARA CARBONE MD
BOARD MEMBER2.00Yes (X)$0$0$0
TERRY WILLIAMS
CHAIRMAN2.00Yes (X)Yes (X)$0$0$0
DAVID COOK MD
BOARD MEMBER2.00Yes (X)$0$0$0
JIM GRAHAM
EXECUTIVE DIRECTOR40.00Yes (X)$105,353$0$11,041
FieldValueIRS element (for citing)
Total Reportable Comp From Org$109,844TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$0TotReportableCompRltdOrgAmt
Total Other Compensation$11,041TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K0IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed0FormerOfcrEmployeesListedInd
Total Comp Greater Than150 K0TotalCompGreaterThan150KInd
Compensation From Other SrcsYes (1)CompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (3 entries)

Address Line1ContractorAddress/USAddress/AddressLine1TxtCityContractorAddress/USAddress/CityNmState AbbreviationContractorAddress/USAddress/StateAbbreviationCdZIPContractorAddress/USAddress/ZIPCdServicesServicesDescCompensationCompensationAmt
MEDICATION MANAGEMENT LLC
PO BOX 35282GREENSBORONC27425NETWORK ADMIN$465,733
FRANK L BLUM CONSTRUCTION COMPANY
830 TWENTY FIFTH STWINSTON SALEMNC27105CONSTRUCTION$247,049
CENTERPOINT HUMAN SERVICES
4045 UNIVERSITY PKWYWINSTON SALEMNC27106BEHAVIORIAL HEALTH$153,531
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K3CntrctRcvdGreaterThan100KCnt
Government Grants$1,344,204GovernmentGrantsAmt
All Other Contributions$710,993AllOtherContributionsAmt
Total Contributions$2,055,197TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp

FieldValueIRS element (for citing)
DescCASE MANAGEMENT FEESDesc
Business624100BusinessCd
Total Revenue Column$11,835,320TotalRevenueColumnAmt
Related Or Exempt Func Income$11,835,320RelatedOrExemptFuncIncomeAmt
FieldValueIRS element (for citing)
Total Program Service Revenue$11,835,320TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$1,269TotalRevenueColumnAmt
Exclusion$1,269ExclusionAmt

Other Revenue Misc OtherRevenueMiscGrp

FieldValueIRS element (for citing)
DescOTHER INCOMEDesc
Business621400BusinessCd
Total Revenue Column$5,213TotalRevenueColumnAmt
Related Or Exempt Func Income$5,213RelatedOrExemptFuncIncomeAmt
FieldValueIRS element (for citing)
Other Revenue Total$5,213OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$13,896,999TotalRevenueColumnAmt
Related Or Exempt Func Income$11,840,533RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$1,269ExclusionAmt

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

FieldValueIRS element (for citing)
Total$481,527TotalAmt
Program Services$481,527ProgramServicesAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$11,835TotalAmt
Management And General$11,835ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$3,179TotalAmt
Management And General$3,179ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$96,041TotalAmt
Program Services$17,570ProgramServicesAmt
Management And General$78,471ManagementAndGeneralAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$11,940TotalAmt
Management And General$11,940ManagementAndGeneralAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$145,968TotalAmt
Program Services$145,968ProgramServicesAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$155,381TotalAmt
Program Services$155,381ProgramServicesAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$48,229TotalAmt
Management And General$48,229ManagementAndGeneralAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$79,466TotalAmt
Management And General$79,466ManagementAndGeneralAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$17,518TotalAmt
Management And General$17,518ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmt
NCCN OPERATIONAL COSTS$6,343,782$5,138,763$1,205,019
SERVICE REIMBURSEMENTS$4,818,672$4,818,672
PROJECT RESERVES$1,375,069$1,375,069
MEDICAL SUPPLIES$38,459$38,459

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$13,627,066TotalAmt
Program Services$12,171,409ProgramServicesAmt
Management And General$1,455,657ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$576,787BOYAmt
EOY$2,240,763EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$3,497,497BOYAmt
EOY$2,100,358EOYAmt

Pledges And Grants Receivable PledgesAndGrantsReceivableGrp

FieldValueIRS element (for citing)
EOY$101,294EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$171,272BOYAmt
EOY$61,383EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$60,129BOYAmt
EOY$1,060EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$953,936LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$232,568LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$786,500BOYAmt
EOY$721,368EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$5,092,185BOYAmt
EOY$5,226,226EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$1,079,249BOYAmt
EOY$943,357EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$1,079,249BOYAmt
EOY$943,357EOYAmt
FieldValueIRS element (for citing)
Organization Follows SFAS117Yes (X)OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

FieldValueIRS element (for citing)
BOY$3,934,317BOYAmt
EOY$4,007,165EOYAmt

Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp

FieldValueIRS element (for citing)
BOY$78,619BOYAmt
EOY$275,704EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$4,012,936BOYAmt
EOY$4,282,869EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$5,092,185BOYAmt
EOY$5,226,226EOYAmt
FieldValueIRS element (for citing)
Reconcilation Revenue Expnss$269,933ReconcilationRevenueExpnssAmt
Other Changes In Net Assets$0OtherChangesInNetAssetsAmt
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or Review0AccountantCompileOrReviewInd
FS AuditedYes (1)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Consol And Sep Basis Fincl StmtYes (X)ConsolAndSepBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (1)AuditCommitteeInd
Federal Grant Audit Required0FederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Public Organization170Yes (X)PublicOrganization170Ind

Gifts Grants Contri Rcvd170 GiftsGrantsContriRcvd170Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$749,864CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$646,025CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$644,702CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$1,923,959CurrentTaxYearMinus1YearAmt
Current Tax Year$2,055,197CurrentTaxYearAmt
Total$6,019,747TotalAmt

Total Calendar Year170 TotalCalendarYear170Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$749,864CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$646,025CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$644,702CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$1,923,959CurrentTaxYearMinus1YearAmt
Current Tax Year$2,055,197CurrentTaxYearAmt
Total$6,019,747TotalAmt
FieldValueIRS element (for citing)
Public Support Total170$6,019,747PublicSupportTotal170Amt

Gross Investment Income170 GrossInvestmentIncome170Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$19,437CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$4,076CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$3,187CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$1,553CurrentTaxYearMinus1YearAmt
Current Tax Year$1,269CurrentTaxYearAmt
Total$29,522TotalAmt

Other Income170 OtherIncome170Grp

FieldValueIRS element (for citing)
Current Tax Year Minus1 Year$7,900CurrentTaxYearMinus1YearAmt
Current Tax Year$5,213CurrentTaxYearAmt
Total$13,113TotalAmt
FieldValueIRS element (for citing)
Total Support$6,062,382TotalSupportAmt
Gross Receipts Rltd Activities$50,319,475GrossReceiptsRltdActivitiesAmt
Public Support CY1700.99300PublicSupportCY170Pct
Public Support PY1700.98070PublicSupportPY170Pct
Thirty Thr Pct Suprt Tests CY170Yes (X)ThirtyThrPctSuprtTestsCY170Ind

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

FieldValueIRS element (for citing)
ContributorRESTRICTEDContributorNum

Contributor Business Name ContributorBusinessName

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor US Address ContributorUSAddress

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Total ContributionsRESTRICTEDTotalContributionsAmt

Schedule D IRS990ScheduleD

Leasehold Improvements LeaseholdImprovementsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$639,091OtherCostOrOtherBasisAmt
Depreciation$134,564DepreciationAmt
Book Value$504,527BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$314,845OtherCostOrOtherBasisAmt
Depreciation$98,004DepreciationAmt
Book Value$216,841BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$721,368TotalBookValueLandBuildingsAmt
Footnote TextYes (X)FootnoteTextInd
Total Rev Etc Audited Fincl Stmt$13,896,999TotalRevEtcAuditedFinclStmtAmt
Revenue Not Reported$0RevenueNotReportedAmt
Revenue Subtotal$13,896,999RevenueSubtotalAmt
Revenue Not Reported Fincl Stmt$0RevenueNotReportedFinclStmtAmt
Total Revenue Per Form990$13,896,999TotalRevenuePerForm990Amt
Tot Expns Etc Audited Fincl Stmt$13,627,066TotExpnsEtcAuditedFinclStmtAmt
Expenses Not Reported$0ExpensesNotReportedAmt
Expenses Subtotal$13,627,066ExpensesSubtotalAmt
Expenses Not Rpt Fincl Stmt$0ExpensesNotRptFinclStmtAmt
Total Expenses Per Form990$13,627,066TotalExpensesPerForm990Amt

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePART X, LINE 2:FormAndLineReferenceDesc
ExplanationTHE COMPANY IS A TAX-EXEMPT ORGANIZATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (THE CODE) AND IS GENERALLY EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. ACCORDINGLY, NO PROVISION FOR INCOME TAXES IS MADE IN THE FINANCIAL STATEMENTS. THE COMPANY HAS EVALUATED UNCERTAIN TAX POSITIONS FOR ITS FISCAL YEARS ENDED JUNE 30, 2015 AND 2014, INCLUDING A QUANTIFICATION OF TAX RISKS IN AREAS SUCH AS UNRELATED BUSINESS INCOME AND TAXATION OF ITS FOR-PROFIT SUBSIDIARIES. THIS EVALUATION DID NOT HAVE A MATERIAL EFFECT ON THE COMPANY'S FINANCIAL STATEMENTS FOR THE YEARS ENDED JUNE 30, 2015 AND 2014.ExplanationTxt

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Grant Records MaintainedYes (1)GrantRecordsMaintainedInd

Recipient Table RecipientTable (9 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdRecipient EINRecipientEINIRC SectionIRCSectionDescCash GrantCashGrantAmtPurpose Of GrantPurposeOfGrantTxt
COMMUNITY CARE CENTER FOR FORSYTH COUNTY
2135 NEW WALKERTOWN RDWINSTON SALEMNC27101581403699501(C)(3)$102,211HEALTH NET GRANT
WILKES COUNTY HEALTH DEPARTMENT
306 COLLEGE STREETWILKESBORONC28697566000350GOV'T ENTITY$72,875HEALTH NET GRANT
SURRY COUNTY HEALTH AND NUTRITION
118 HAMBY ROADDOBSONNC27017566000341GOV'T ENTITY$40,635HEALTH NET GRANT
STOKES FAMILY HEALTH
PO BOX 187DANBURYNC27016566000340GOV'T ENTITY$40,950HEALTH NET GRANT
NORTH CAROLINA BAPTIST HOSPITAL
MEDICAL CENTER BLVDWINSTON SALEMNC27157560552787501(C)(3)$50,000DOWNTOWN HEALTH PLAZA - CARE PLUS PROGRAM
DAVIDSON COUNTY HEALTH DEPARTMENT
915 GREENSBORO STREETLEXINGTONNC27293566000294GOV'T ENTITY$6,000CHRONIC PAIN INITIATIVE
THE COALITION FOR DRUG ABUSE PREVENTION
8025 NORTH POINT BLVD SUITE 223WINSTON SALEMNC27106GOV'T ENTITY$20,000CHRONIC PAIN INITIATIVE
INSIGHT HUMAN SERVICES
7830 NORTHPOINT BLVD SUITE 200WINSTON SALEMNC27106560951129501(C)(3)$6,000CHRONIC PAIN INITIATIVE - STOKES
FORSYTH MEDICAL CENTER FOUNDATION
3333 SILAS CREEK PKWYWINSTON SALEMNC27103562120959501(C)(3)$140,000SAFEMED PROJECT
FieldValueIRS element (for citing)
Total501c3 Org9Total501c3OrgCnt
Total Other Org0TotalOtherOrgCnt

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePART I, LINE 2:FormAndLineReferenceDesc
ExplanationTHE ORGANIZATION DISTRIBUTES GRANT MONEY THAT HAS BEEN PRE-APPROVED TO DESIGNATED COUNTY AGENCIES. ANY QUESTIONS ARE DIRECTED TO THE OFFICE OF RURAL HEALTH.ExplanationTxt

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Severance Payment0SeverancePaymentInd
Supplemental Nonqual Rtr Plan0SupplementalNonqualRtrPlanInd
Equity Based Comp Arrngm0EquityBasedCompArrngmInd
Comp Based On Revenue Of Flng Org0CompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related Orgs0CompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng Org0CompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd Orgs0CompBsdNetEarnsRltdOrgsInd
Any Non Fixed Payments0AnyNonFixedPaymentsInd
Initial Contract Exception0InitialContractExceptionInd

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePART VII, SECTION A, LINE 5 - COMPENSATION FROM UNRELATED ORGANIZATIONFormAndLineReferenceDesc
ExplanationTHE ORGANIZATION'S EXECUTIVE DIRECTOR, JIM GRAHAM, WAS COMPENSATED BY AN UNRELATED ORGANIZATION, NORTH CAROLINA BAPTIST HOSPITAL, FOR HIS SERVICES DURING THE FISCAL YEAR ENDED JUNE 30, 2015. TOTAL COMPENSATION FOR HIS SERVICES WAS $116,394.ExplanationTxt

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (6 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PART VI, SECTION A, LINE 6THE ORGANIZATION HAS ONE MEMBER, WAKE FOREST UNIVERSITY BAPTIST MEDICAL CENTER.
FORM 990, PART VI, SECTION A, LINE 7AITS SOLE MEMBER, WAKE FOREST UNIVERSITY BAPTIST MEDICAL CENTER, SHALL APPOINT ONE DIRECTOR. THE BOARD OF DIRECTORS SHALL APPOINT ONE DIRECTOR WHO IS A RESIDENT OF, OR IS OTHERWISE ASSOCIATED WITH, EACH OF THE COUNTIES THAT THE ORGANIZATION SERVES.
FORM 990, PART VI, SECTION B, LINE 11THE FILING ORGANIZATION'S BOARD OF DIRECTORS RECEIVES A COPY OF THE FORM 990 WITH SUFFICIENT TIME TO PERMIT REVIEW, COMMENT AND QUESTIONS PRIOR TO ITS FILING. IF MODIFICATIONS ARE REQUIRED FOLLOWING SUCH REVIEW, THE REVISED FORM 990 IS REDISTRIBUTED PRIOR TO ITS FILING WITH THE IRS, ALONG WITH A SUMMARY OF THE MODIFICATIONS.
FORM 990, PART VI, SECTION B, LINE 12CTHE ORGANIZATION REQUIRES OFFICERS, DIRECTORS AND KEY EMPLOYEES TO ANNUALLY REVIEW THE CONFLICT OF INTEREST POLICY AND DETERMINE ANY POTENTIAL CONFLICTS OF INTEREST. ALL OFFICERS, DIRECTORS AND KEY EMPLOYEES ARE REQUIRED TO DETERMINE AND REPORT POTENTIAL CONFLICTS ANNUALLY, AND AS THEY ARISE. ANY ITEMS DISCLOSED ARE REVIEWED AND MANAGED IN ACCORDANCE WITH THE ORGANIZATION'S POLICY ON CONFLICTS OF INTEREST.
FORM 990, PART VI, SECTION B, LINE 15THE ORGANIZATION PAYS NO COMPENSATION TO OFFICERS, DIRECTORS OR KEY EMPLOYEES. ALL COMPENSATION PAID TO OFFICERS, DIRECTORS AND KEY EMPLOYEES WAS PAID BY AN AFFILIATED/UNRELATED ORGANIZATION. COMPENSATION PAID TO THESE INDIVIDUALS IS REVIEWED AND APPROVED IN ACCORDANCE WITH THE AFFILIATED/UNRELATED ORGANIZATION'S COMPENSATION POLICIES AND PROCEDURES WHICH INCLUDE INDEPENDENT COMPENSATION CONSULTANTS, COMPENSATION SURVEYS AND STUDIES TO DETERMINE THE APPROPRIATENESS OF EACH OFFICERS', DIRECTORS AND KEY EMPLOYEES' COMPENSATION.
FORM 990, PART VI, SECTION C, LINE 19THE ORGANIZATION'S RESTATED 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.

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (4 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdExempt Code SectionExemptCodeSectionTxtPublic Charity StatusPublicCharityStatusTxtDirect Controlling NADirectControllingNACdControlled OrganizationControlledOrganizationIndBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Txt
WAKE FOREST UNIVERSITY BAPTIST MEDICAL CENTER
MEDICAL CENTER BLVDWINSTON SALEMNC27157510190238HEALTHCARENC501(C)(3)LINE 11A, IN/A0
LEXINGTON MEDICAL CENTER
250 HOSPITAL DRIVELEXINGTONNC27292560543238HEALTHCARENC501(C)(3)LINE 30WAKE FOREST UNIVERSITY BAPTIST HOSPITAL
LEXINGTON MEDICAL CENTER FOUNDATION
250 HOSPITAL DRIVELEXINGTONNC27292581876553FUNDRAISINGNC501(C)(3)LINE 11B, II0LEXINGTON MEDICAL CENTER
FAITHHEALTH INNOVATIONS INC
MEDICAL CENTER BLVDWINSTON SALEMNC27157237426944HEALTHCARENC501(C)(3)LINE 90WAKE FOREST UNIVERSITY BAPTIST HOSPITAL
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts Rylts0ReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth Org0GiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth Org0GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth Org0LoansOrGuaranteesFromOthOrgInd
Div Related Organization0DivRelatedOrganizationInd
Asset Sale To Other Org0AssetSaleToOtherOrgInd
Asset Purchase From Other Org0AssetPurchaseFromOtherOrgInd
Asset Exchange0AssetExchangeInd
Rental Of Facilities To Oth Org0RentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth Org0RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth Org0PerformOfServicesForOthOrgInd
Perform Of Services By Other Org0PerformOfServicesByOtherOrgInd
Sharing Of Facilities0SharingOfFacilitiesInd
Paid Employees Sharing0PaidEmployeesSharingInd
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrgInd
Transfer To Other Org0TransferToOtherOrgInd
Transfer From Other Org0TransferFromOtherOrgInd

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