2015-11-06T13:29:34-06:00 2014-09-30 420714325 MCGLADREY LLP 300 NORTH 3RD STREET FIFTH FLOOR WILMINGTON NC 28401 990 2013-10-01 566024172 WILSON MEDICAL CENTER INC WILS 2522812105 PO BOX 3697 WILSON NC 27895 DENISE O'HARA EXECUTIVE DIRECTOR 2522812105 2015-11-05 1 JOHN STANLEY P00881003 9107629671 2013 2016-03-07 17:11:31Z X X DENISE O'HARA PO BOX 3697 WILSON NC 27895 195374977 0 X WWW.HEALTHCAREFOUNDATIONOFWILSON.ORG X 1964 NC TO DELIVER QUALITY HEALTH CARE FOR THE PEOPLE OF WILSON COUNTY AND NEIGHBORING COMMUNITIES. 16 16 1374 158 49175 -1401 98115 0 162304285 65585788 7923289 8415062 0 1442608 170325689 75443458 7959 30600 0 0 67497921 48986211 0 0 0 96881748 64933451 164387628 113950262 5938061 -38506804 229516205 148214014 57048457 8228863 172467748 139985151 X WILSON MEDICAL CENTER, INC. DELIVERS QUALITY HEALTH CARE FOR THE PEOPLE OF WILSON COUNTY AND NEIGHBORING COMMUNITIES. IN KEEPING WITH OUR COMMITMENT TO SERVE ALL PEOPLE OF OUR COMMUNITY, WE RECOGNIZE THAT NOT ALL INDIVIDUALS CAN PURCHASE ESSENTIAL MEDICAL SERVICES. THEREFORE, FREE AND/OR SUBSIDIZED CARE, CARE PROVIDED TO PERSONS COVERED BY GOVERNMENTAL PROGRAMS AT BELOW COST, HEALTH PROGRAMS AND ACTIVITIES ARE CONSIDERED WHERE THE NEED AND/OR INDIVIDUAL'S INABILITY TO PAY COEXISTS. SUCH ACTIVITIES AVAILABLE TO THE COMMUNITY INCLUDE WELLNESS PROGRAMS, COMMUNITY EDUCATION PROGRAMS, SPECIAL PROGRAMS FOR UNDERSERVED AUDIENCES AND A BROAD RANGE OF SUPPORT THROUGH MANY MORE COMMUNITY SERVICE EVENTS AND ACTIVITIES. 1 1 104196982 65549179 WILSON MEDICAL CENTER, INC. SERVED 2,855 INPATIENTS AND RECEIVED MORE THAN 33,587 VISITS FOR HEALTHCARE SERVICES PROVIDED ON AN OUTPATIENT BASIS AND 19,134 VISITS FOR EMERGENCY SERVICES. REIMBURSEMENT FROM GOVERNMENT SOURCES FOR MEDICARE AND MEDICAID PATIENTS WAS $1.7 MILLION LESS THAN THE COST OF PROVIDING THOSE SERVICES. THE COST OF SERVICES DEEMED CHARITY CARE (FOR THOSE UNABLE TO PAY) WAS $1.7 MILLION AND BAD DEBTS (FOR THOSE UNWILLING TO PAY) WAS $6.6 MILLION. COMMUNITY BENEFIT/HEALTH PROGRAMS COST THE HOSPITAL $3.6 MILLION. 1065724 30600 TO SUPPORT PROGRAMS THAT FOSTER THE DELIVERY, QUALITY, OR AFFORDABILITY OF HEALTH CARE OR HEALTH CARE-RELATED SERVICES AND TO SUPPORT ANY ACTIVITY DESIGNED AND CARRIED ON TO SERVE THE GENERAL HEALTH AND WELL-BEING OF THE COMMUNITY. TO AID IN THE INSTRUCTION AND PROMOTION OF RESEARCH AND SCIENTIFIC INVESTIGATION IN ALL BRANCHES OF MEDICINE AND SURGERY AND THE GENERAL HEALTH AND WELL-BEING OF THE COMMUNITY. TO SUPPORT ANY EDUCATIONAL ACTIVITIES RELATED TO THE CARE OF THE SICK AND DISABLED, THE PROMOTION OF HEALTH AND PREVENTATIVE MEDICINE, AND THE GENERAL HEALTH AND WELL-BEING OF THE COMMUNITY. 105262706 1 0 0 1 0 0 0 0 0 0 1 1 1 0 1 0 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 1 168 0 1 1374 1 1 1 0 0 0 0 0 0 0 0 0 X 16 16 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 1 NC CA X HEALTHCARE FOUNDATION OF WILSON 2522812105 PO BOX 3697 WILSON NC 27895 CARLETHA WARD MEMBER 1.00 X 0 0 0 CARROLL COLEMAN MEMBER 1.00 X 0 0 0 FRANK BATTEN DVM CHAIRMAN 1.00 X 0 0 0 GEORGE ISAACS MD MEMBER 1.00 X 0 0 0 HUITTT MATTOX MD MEMBER 1.00 X 0 0 0 JEROME VICK MEMBER 1.00 X 0 0 0 JERRY WOODARD MD MEMBER 1.00 X 0 0 0 JOHN ANTHONY MEMBER 1.00 X 0 0 0 JOHN TILTON TREASURER 1.00 X 0 0 0 JONATHON DEWALD MD MEMBER 1.00 X 0 0 0 KEITH LERRO MD MEMBER 1.00 X 0 0 0 LEESA LAWRENCE MD MEMBER 1.00 X 0 0 0 PAGE THOMAS SMITH MEMBER 1.00 X 0 0 0 REV WILLIAM M PRESNELL MEMBER 1.00 X 0 0 0 SHERYLETTA LACEWELL SECRETARY 1.00 X 0 0 0 THOMAS LUCAS MEMBER 1.00 X 0 0 0 TOMMY SHINGLETON III MEMBER 1.00 X 0 0 0 VANCE FORBES VICE CHAIR 1.00 X 0 0 0 CATHERINE RHYNE VP CLINICAL SERVICE 40.00 X 171992 0 22300 DENISE O'HARA VP HUMAN RESOURCES 40.00 X 200326 0 29557 LYNN LAMBERT CHIEF FINANCIAL OFFICER 40.00 X 228647 0 30430 MELINDA K LAIRD PAST VP OF CLINICAL SERVICE 40.00 X 173630 0 5414 RICHARD HUDSON PRESIDENT 40.00 X 410477 0 30115 RICK GUARINO MD VP MEDICAL AFFAIRS 40.00 X 292467 0 28433 BENJAMIN M THOMAS NEUROLOGIST 40.00 X 309789 0 18230 FERNANDO X CASTRO PHYSICIAN 40.00 X 194362 0 21874 KENNETH LEE JOHNSON OTOLARYNGOLOGIST 40.00 X 349193 0 23561 LOUIS V ANTIGNANO GASTROENTEROLOGIST 40.00 X 443931 0 12845 NADINE SKINNER PHYSICIAN 40.00 X 167846 0 12066 2942660 0 234825 33 1 1 0 CC STAFFING INC PO BOX 404674 ATLANTA GA 30384 CONTRACT STAFFING 3489610 VIDANT HEALTH 600 MEDICAL DRIVE GREENVILLE NC 27834 HOSPITALIST 2689476 AMERICAN RED CROSS - WILSON CHAPTER PO BOX 905890 CHARLOTTE NC 28290 BLOOD PRODUCT PROCESSING 1418434 AMERICAN ANESTHESIOLOGY OF NC 3100 SPRING FOREST ROAD - SUITE 130 RALEIGH NC 27616 ANESTHESIA PROVIDER 1275610 MEDICAL SOLUTIONS INC 9101 WESTERN AVE SUITE 101 OMAHA NE 68114 CONTRACT STAFFING 800846 31 PATIENT REVENUE 621110 64323788 64323788 FOOD & NUTRITION 621110 483907 483907 PARTNERSHIP INCOME RELATED TO PRO 621110 112065 112065 OUTSIDE LAB & RADIOLOGY 621500 53245 53245 PARTNERSHIP LOSS 541900 -4070 -4070 616853 616853 65585788 2510824 2510824 63269082 62566675 57377410 62554109 5891672 12566 5904238 12566 5891672 GAIN ON OPS. OF DISCONTINUED 621110 1284406 1284406 WORKERS COMP 621110 113636 113636 OTHER REVENUE 621110 44566 44566 1442608 75443458 65549179 49175 9845104 30600 30600 1192869 435738 757131 22572179 21223404 1348775 21828896 20524535 1304361 1892086 1779027 113059 1500181 1410539 89642 73970 73970 686097 686097 3185296 2064545 1120751 144901 144901 441658 307611 134047 355015 66692 288323 1117423 1050653 66770 41867 38579 3288 44327 42361 1966 708000 708000 54000 54000 3825000 3825000 1452134 1452134 LOSS ON SALE OF DISCONT 18178414 18178414 BAD DEBT EXPENSE 16069402 16069402 MEDICAL SUPPLIES 8149421 8149421 LOSS ON BOND DEFEASANCE 4520077 4520077 5886449 5492108 394341 113950262 105262706 8687556 0 5262830 6545400 6598 11751223 26152520 1063261 13722378 4958049 3830714 0 1521308 83952 34446 26845 63843545 7601 108141459 108318292 264282 14907003 6770571 579233 229516205 148214014 6493104 6913797 29796796 0 20758557 1315066 57048457 8228863 X 172467748 139985151 172467748 139985151 229516205 148214014 X -38506804 1139232 211 4884764 X X 0 1 X 1 0 X FORM 990, SCHEDULE A, PART 1, LINE 3 EFFECTIVE MARCH 1, 2014, WILSON MEDICAL CENTER, INC. AND WILMED GENERATIONS, INC. ENTERED INTO AN AGREEMENT WITH DLP HEALTHCARE, LLC TO FORM A JOINT VENTURE, DLP WILSON HOLDING COMPANY, LLC, THAT WOULD OPERATE THE HOSPITAL AND NURSING HOME PREVIOUSLY OWNED AND OPERATED BY WILSON MEDICAL CENTER, INC. AND WILMED GENERATIONS, INC. WILSON MEDICAL CENTER, INC. CEASED DIRECTLY PROVIDING HEALTH CARE SERVICES AFTER FEBRUARY 28, 2014, AND IS PROVIDING MEDICAL SERVICES INDIRECTLY THROUGH THE JOINT VENTURE. EFFECTIVE OCTOBER 1, 2014, WILSON MEDICAL CENTER, INC. CHANGED ITS NAME TO HEALTHCARE FOUNDATION OF WILSON (THE "FOUNDATION"). THE GOVERNING DOCUMENTS OF THE JOINT VENTURE REQUIRE THAT THE JOINT VENTURE OPERATE THE HOSPITAL IN A MANNER AS TO SATISFY THE CHARITABLE PURPOSES GENERALLY REQUIRED OF HOSPITALS RECOGNIZED AS EXEMPT UNDER SECTION 501(C)(3) OF THE CODE, INCLUDING THAT THE HOSPITAL ACCEPT MEDICARE AND MEDICAID PATIENTS, MAINTAIN AN EMERGENCY DEPARTMENT THAT ACCEPTS ALL PATIENTS REGARDLESS OF THEIR ABILITY TO PAY, ADOPT THE CHARITY CARE POLICIES UTILIZED BY WILSON MEDICAL CENTER, INC. PRIOR TO THE TRANSFER OF THE HOSPITAL TO THE JOINT VENTURE, AND COMPLY WITH THE REQUIREMENTS OF SECTION 501(R) OF THE CODE REGARDING CHARITY CARE AND FINANCIAL ASSISTANCE POLICIES AND THE CONDUCTING OF COMMUNITY HEALTH NEEDS ASSESSMENTS. THE GOVERNING DOCUMENTS OF THE JOINT VENTURE INCLUDE PROVISIONS WHICH PROVIDE THE FOUNDATION, THROUGH ITS REPRESENTATIVES ON THE GOVERNING BODY OF THE JOINT VENTURE, WITH THE POWER TO ENFORCE COMPLIANCE WITH THESE CHARITABLE HOSPITAL REQUIREMENTS. WILSON MEDICAL CENTER, INC. WAS ALSO A "PUBLIC HOSPITAL" PURSUANT TO CHAPTER 131E, ARTICLE 2, OF THE NORTH CAROLINA GENERAL STATUTES (THE "PUBLIC HOSPITAL STATUTES"). THE PUBLIC HOSPITAL STATUTES AT THE TIME OF THE CREATION OF THE JOINT VENTURE REQUIRED THAT ANY TRANSFER OF A PUBLIC HOSPITAL FACILITY MUST BE MADE TO A CORPORATION, AND THE PUBLIC HOSPITAL STATUTES DID NOT PERMIT THE TRANSFER OF A PUBLIC HOSPITAL FACILITY TO A LIMITED LIABILITY COMPANY. WITH THE CREATION OF THIS JOINT VENTURE IN MIND, THE NORTH CAROLINA GENERAL ASSEMBLY PASSED A TECHNICAL CORRECTIONS STATUTE WHICH ENABLED THE TRANSFER OF A PUBLIC HOSPITAL FACILITY TO BE MADE TO A LIMITED LIABILITY COMPANY AS WELL AS TO A CORPORATION. THE EFFECTIVE DATE OF THE NORTH CAROLINA GENERAL ASSEMBLY'S CHANGE TO THE PUBLIC HOSPITAL STATUTE WAS OCTOBER 1, 2014, WHICH WAS AFTER THE CREATION OF THE JOINT VENTURE. IN ORDER TO COMPLY WITH THE REQUIREMENTS OF THE PUBLIC HOSPITAL STATUTE AT THAT TIME, THE HOSPITAL FACILITY WAS TRANSFERRED TO DLP WILSON MEDICAL CENTER, INC., WHICH WAS WHOLLY OWNED BY THE JOINT VENTURE, WITH THE INTENTION THAT DLP WILSON MEDICAL CENTER, INC., WOULD BE CONVERTED TO A LIMITED LIABILITY COMPANY AFTER THE ENACTMENT OF THE NORTH CAROLINA GENERAL ASSEMBLY'S TECHNICAL CORRECTION TO THE NORTH CAROLINA PUBLIC HOSPITAL STATUTES, AND THE CONVERSION WAS COMPLETED EFFECTIVE ON DECEMBER 31, 2014. AFTER THE CONVERSION OF DLP WILSON MEDICAL CENTER, INC., TO A LIMITED LIABILITY COMPANY, IT WAS TREATED AS A DISREGARDED ENTITY FOR FEDERAL TAX PURPOSES, AND THE JOINT VENTURE IS TREATED AS OPERATING THE HOSPITAL DIRECTLY. THE NORTH CAROLINA PUBLIC HOSPITAL STATUTES ALSO REQUIRE THAT THE JOINT VENTURE, AS THE TRANSFEREE OF THE PUBLIC HOSPITAL FACILITY, CONTINUE TO PROVIDE THE SAME HOSPITAL SERVICES, INDIGENT CARE, FINANCIAL ASSISTANCE POLICIES, AND MEDICARE AND MEDICAID SERVICES AS WERE PROVIDED BY WILSON MEDICAL CENTER, INC. PRIOR TO THE TRANSFER, AND THE JOINT VENTURE IS REQUIRED TO PROVIDE AN ANNUAL REPORT THAT SHOWS COMPLIANCE WITH THIS REQUIREMENT. FAILURE TO COMPLY WITH THIS REQUIREMENT WILL CAUSE THE HOSPITAL FACILITY TO REVERT TO WILSON COUNTY. 0 0 0 0 0 0 0 0 1 17079 17079 0 PART II-B, LINE 1: NORTH CAROLINA HOSPITAL ASSOCIATION MEMBERSHIP DUES (LOBBYING 27.14% X $35,000 = $9,499) AMERICAN HOSPITAL ASSOCIATION MEMBERSHIP DUES (LOBBYING 23.65% X $32,051 = $7,580) 34446 26845 7601 7601 INVESTMENTS 108318292 F 108318292 INVESTMENT IN DLP WILSON HOLDING COMPANY, LLC 14907003 F 14907003 ACCRUED UNEMPLOYMENT COMP 171792 ACCRUED PAYROLL 24076 INSURANCE LIABILITIES 816988 DEFERRED COMPENSATION 302210 1315066 1 1 1 X 1 X 1 1 1 0 0 1737466 1737466 0.01780 4248274 4248274 0.04340 18639546 18639546 0.19040 24625286 24625286 0.25160 3056891 3056891 0.03120 476665 476665 0.00490 0 0 54349 54349 0.00060 3587905 3587905 0.03670 28213191 28213191 0.28830 13636 13636 0.00010 13636 13636 0.00010 1 16069402 6618664 19992478 20679083 -686605 X 1 1 1 1 WILSON MEDICAL CENTER INC PO BOX 3697 WILSON NC 27895 X X X WILSON MEDICAL CENTER INC 1 1 X X X X X X X X X 13 1 0 1 X WWW.HEALTHCAREFOUNDATIONOFWILSON.ORG X HTTP://WWW.WILSON-CO.COM/85/HEALTH-DEPARTMENT X X X X X X X X 1 0 1 1 200.000000000000 1 300.000000000000 1 X X X X X X 1 1 X X X X X X 1 0 X X X X 1 X 0 0 WILSON MEDICAL CENTER, INC. PART V, SECTION B, LINE 3: WILSON MEDICAL CENTER WAS A PART OF COMMUNITY-BASED ASSESSMENT CONDUCTED BY THE WILSON COUNTY COMMUNITY HEALTH ASSESSMENT TEAM. THE HEALTH ASSESSMENT NEEDS OF THE COMMUNITY WERE DETERMINED BY THE WILSON COUNTY COMMUNITY. IN 2013, 1,000 WILSON COUNTY HEALTH ASSESSMENT SURVEYS WERE DISTRIBUTED THROUGHOUT THE COUNTY. FIVE HUNDRED AND THIRTEEN (513) RESIDENTS COMPLETED AND RETURNED THE SURVEY. THE DATA WAS COMPILED AND FORMAL PRESENTATIONS WERE MADE TO THE WILSON COUNTY BOARD OF HEALTH AND WILSON MEDICAL CENTER HOSPITAL BOARD OF DIRECTORS. EACH TEAM MEMBER WAS PROVIDED WITH THE OPPORTUNITY TO VOTE ON THE TOP THREE (3) CONCERNS OF THE COMMUNITY OUT OF THE TOP TEN (10) CONCERNS. THE SURVEY WAS ANALYZED BY SURVEY MONKEY. THE WILSON COUNTY BOARD OF HEALTH INCLUDED DR. WILLIAM BOLES, III, DDS, DR. ERNESTINE FITCH, MD, DR. MARIE GLENNON, DVM, MICHAEL LAMONDS, GEORGE LEACH, THOMAS LUCAS, DR. JESSICA MCKEE, DR. RUSSELL STONE, OD, RON SUTTON, AND SAMUEL TERUEL-VELEZ. THE WILSON COUNTY BOARD OF DIRECTORS INCLUDED JIM PRIDGEN, PAGE THOMAS SMITH, CARLETHA WARD, CARROLL COLEMAN, WILLIAM BYNUM, IV, MD, JONATHON DEWALD, MD, SHERYLETTA LACEWELL, LEESA LAWRENCE, MD, THOMAS LUCAS, REV. WILLIAM PRESNELL, TOMMY SHINGLETON, JOHN TILTON, AND DAVID WEST. WILSON MEDICAL CENTER, INC. PART V, SECTION B, LINE 5D: A COPY OF THE CHNA IS AVAIABLE ON THE PUBLIC HEALTH DEPARTMENT'S WEBSITE AT HTTP://PUBLICHEALTH.NC.GOV/LHD/CHA/DOCS/CHAREPORTS/2011/2011-WILSONCHA.PDF. THE CHNA WAS ALSO REPORTED IN THE LOCAL NEWSPAPER AND IN THE LOCAL LIBRARIES WITHIN WILSON COUNTY, NC. WILSON MEDICAL CENTER, INC. PART V, SECTION B, LINE 7: WILSON MEDICAL CENTER REVIEWED THE HEALTHCARE NEEDS AND THREE PRIORITY AREAS WERE IDENTIFIED. THEY ARE 1) ACCESS TO CARE, 2) OBESITY, AND 3) SUBSTANCE ABUSE. ACTION PLANS ARE IN PLACE TO ADDRESS THESE NEEDS. OTHER BEHAVIORAL, AT-RISK BEHAVIOR IDENTIFIED IN THE CHNA, SUCH AS GANG VIOLENCE HAS BEEN ADDRESSED BY LAW ENFORCEMENT, AS THEY ARE EQUIPPED AND TRAINED TO DEAL WITH THIS ISSUE. THE ORGANIZATION WILL PROVIDE SUPPORT TO THE LAW ENFORCEMENT DEPARTMENTS AS NEEDED. PART I, LINE 3C: ELIGIBILITY IS GENERALLY DETERMINED BY MEASURING THE GROSS FAMILY INCOME AGAINST THE FEDERAL POVERTY INCOME GUIDELINES. IN ADDITION, OTHER RELEVENT NON-INCOME RESOURCES, INCLUDING BUT NOT LIMITED TO REAL ESTATE, SAVINGS, LIFE INSURANCE, MOTOR VEHICLES, ETC., WILL BE CONSIDERED IN REACHING A DETERMINATION OF ELIGIBILITY. ELIGIBILITY GUIDELINES WILL ALSO TAKE INTO CONSIDERATION CATASTROPHIC EVENTS FOR PATIENTS WHOSE INCOME FALLS OUTSIDE THE GUIDELINES. PATIENTS WHOSE GROSS INCOME IS LESS THAN THREE TIMES THE FEDERAL POVERTY INCOME GUIDELINES MAY BE ELIGIBLE FOR REDUCED MONTHLY PAYMENTS OR UNCOMPENSATED SERVICES IN PART OR IN FULL. PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 16,069,402. PART I, LINE 6A: NORTH CAROLINA HOSPITAL ASSOCIATION. SEE WWW.NCHA.ORG. FORM 990, SCHEDULE H EFFECTIVE MARCH 1, 2014, WILSON MEDICAL CENTER, INC. AND WILMED GENERATIONS, INC. ENTERED INTO AN AGREEMENT WITH DLP HEALTHCARE, LLC TO FORM A JOINT VENTURE, DLP WILSON HOLDING COMPANY, LLC, THAT WOULD OPERATE THE HOSPITAL AND NURSING HOME PREVIOUSLY OWNED AND OPERATED BY WILSON MEDICAL CENTER, INC. AND WILMED GENERATIONS, INC. WILSON MEDICAL CENTER, INC. CEASED DIRECTLY PROVIDING HEALTH CARE SERVICES AFTER FEBRUARY 28, 2014, AND IS PROVIDING MEDICAL SERVICES INDIRECTLY THROUGH THE JOINT VENTURE. EFFECTIVE OCTOBER 1, 2014, WILSON MEDICAL CENTER, INC. CHANGED ITS NAME TO HEALTHCARE FOUNDATION OF WILSON (THE "FOUNDATION"). THE GOVERNING DOCUMENTS OF THE JOINT VENTURE REQUIRE THAT THE JOINT VENTURE OPERATE THE HOSPITAL IN A MANNER AS TO SATISFY THE CHARITABLE PURPOSES GENERALLY REQUIRED OF HOSPITALS RECOGNIZED AS EXEMPT UNDER SECTION 501(C)(3) OF THE CODE, INCLUDING THAT THE HOSPITAL ACCEPT MEDICARE AND MEDICAID PATIENTS, MAINTAIN AN EMERGENCY DEPARTMENT THAT ACCEPTS ALL PATIENTS REGARDLESS OF THEIR ABILITY TO PAY, ADOPT THE CHARITY CARE POLICIES UTILIZED BY WILSON MEDICAL CENTER, INC. PRIOR TO THE TRANSFER OF THE HOSPITAL TO THE JOINT VENTURE, AND COMPLY WITH THE REQUIREMENTS OF SECTION 501(R) OF THE CODE REGARDING CHARITY CARE AND FINANCIAL ASSISTANCE POLICIES AND THE CONDUCTING OF COMMUNITY HEALTH NEEDS ASSESSMENTS. THE GOVERNING DOCUMENTS OF THE JOINT VENTURE INCLUDE PROVISIONS WHICH PROVIDE THE FOUNDATION, THROUGH ITS REPRESENTATIVES ON THE GOVERNING BODY OF THE JOINT VENTURE, WITH THE POWER TO ENFORCE COMPLIANCE WITH THESE CHARITABLE HOSPITAL REQUIREMENTS. WILSON MEDICAL CENTER, INC. WAS ALSO A "PUBLIC HOSPITAL" PURSUANT TO CHAPTER 131E, ARTICLE 2, OF THE NORTH CAROLINA GENERAL STATUTES (THE "PUBLIC HOSPITAL STATUTES"). THE PUBLIC HOSPITAL STATUTES AT THE TIME OF THE CREATION OF THE JOINT VENTURE REQUIRED THAT ANY TRANSFER OF A PUBLIC HOSPITAL FACILITY MUST BE MADE TO A CORPORATION, AND THE PUBLIC HOSPITAL STATUTES DID NOT PERMIT THE TRANSFER OF A PUBLIC HOSPITAL FACILITY TO A LIMITED LIABILITY COMPANY. WITH THE CREATION OF THIS JOINT VENTURE IN MIND, THE NORTH CAROLINA GENERAL ASSEMBLY PASSED A TECHNICAL CORRECTIONS STATUTE WHICH ENABLED THE TRANSFER OF A PUBLIC HOSPITAL FACILITY TO BE MADE TO A LIMITED LIABILITY COMPANY AS WELL AS TO A CORPORATION. THE EFFECTIVE DATE OF THE NORTH CAROLINA GENERAL ASSEMBLY'S CHANGE TO THE PUBLIC HOSPITAL STATUTE WAS OCTOBER 1, 2014, WHICH WAS AFTER THE CREATION OF THE JOINT VENTURE. IN ORDER TO COMPLY WITH THE REQUIREMENTS OF THE PUBLIC HOSPITAL STATUTE AT THAT TIME, THE HOSPITAL FACILITY WAS TRANSFERRED TO DLP WILSON MEDICAL CENTER, INC., WHICH WAS WHOLLY OWNED BY THE JOINT VENTURE, WITH THE INTENTION THAT DLP WILSON MEDICAL CENTER, INC., WOULD BE CONVERTED TO A LIMITED LIABILITY COMPANY AFTER THE ENACTMENT OF THE NORTH CAROLINA GENERAL ASSEMBLY'S TECHNICAL CORRECTION TO THE NORTH CAROLINA PUBLIC HOSPITAL STATUTES, AND THE CONVERSION WAS COMPLETED EFFECTIVE ON DECEMBER 31, 2014. AFTER THE CONVERSION OF DLP WILSON MEDICAL CENTER, INC., TO A LIMITED LIABILITY COMPANY, IT WAS TREATED AS A DISREGARDED ENTITY FOR FEDERAL TAX PURPOSES, AND THE JOINT VENTURE IS TREATED AS OPERATING THE HOSPITAL DIRECTLY. THE NORTH CAROLINA PUBLIC HOSPITAL STATUTES ALSO REQUIRE THAT THE JOINT VENTURE, AS THE TRANSFEREE OF THE PUBLIC HOSPITAL FACILITY, CONTINUE TO PROVIDE THE SAME HOSPITAL SERVICES, INDIGENT CARE, FINANCIAL ASSISTANCE POLICIES, AND MEDICARE AND MEDICAID SERVICES AS WERE PROVIDED BY WILSON MEDICAL CENTER, INC. PRIOR TO THE TRANSFER, AND THE JOINT VENTURE IS REQUIRED TO PROVIDE AN ANNUAL REPORT THAT SHOWS COMPLIANCE WITH THIS REQUIREMENT. FAILURE TO COMPLY WITH THIS REQUIREMENT WILL CAUSE THE HOSPITAL FACILITY TO REVERT TO WILSON COUNTY. PART II, COMMUNITY BUILDING ACTIVITIES: THE "WILSON CHAMBER OF COMMERCE" PROGRAM PROVIDES FOR THE DEVELOPMENT AND GROWTH OF THE CITY OF WILSON, NORTH CAROLINA. PART III, LINE 4: THE WILSON MEDICAL CENTER, INC. PROVIDES SERVICES TO THE RESIDENTS OF WILSON AND SURROUNDING COUNTIES WITHOUT COLLATERAL. AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS IS PROVIDED IN AN AMOUNT EQUAL TO THE ESTIMATED LOSSES TO BE INCURRED IN COLLECTION OF THE RECEIVABLES. PART III, LINE 8: COSTS ARE DETERMINED USING THE STEP-DOWN METHODOLOGY FROM THE MEDICARE COST REPORT. PART III, LINE 9B: PATIENTS IDENTIFIED AS QUALIFYING FOR CHARITY CARE HAVE THEIR ACCOUNTS ADJUSTED OFF AS CHARITY CARE AND ARE NOT SUBJECTED TO COLLECTION EFFORTS. PART VI, LINE 3: STAFF WORKS DIRECTLY WITH PATIENTS TO PROVIDE AWARENESS OF EXISTING ASSISTANCE AND IN APPLYING FOR ANY APPLICABLE PROGRAMS. PART VI, LINE 4: BASED ON THE 2013 CENSUS ESTIMATES FOR WILSON COUNTY THERE ARE 81,667 PEOPLE; 31,932 HOUSEHOLDS; AND 21,292 FAMILIES. THE POPULATION DENSITY WAS 220.6 PEOPLE PER SQUARE MILE. THERE WERE 35,514 HOUSING UNITS. THE RACIAL MAKEUP OF THE COUNTY WAS WHITE ALONE (NOT HISPANIC/LATINO), 48.8%; BLACK OR AFRICAN AMERICAN, 39.6%; NATIVE AMERICAN, .5%; ASIAN, 1%; PACIFIC ISLANDER, .1%; HISPANIC OR LATINO, 10%. PEOPLE OF TWO OR MORE RACES ACCOUNTED FOR 1.4%. OF THE 31,932 HOUSEHOLDS, 28.2% FAMILIES WITH CHILDREN OF THEIR OWN WERE UNDER 18 YEARS OLD. 45% OF THEM WERE MARRIED COUPLES LIVING TOGETHER. 16.4% HAD A FEMALE HEAD OF HOUSEHOLD WITH NO HUSBAND PRESENT. 33.3% WERE NON FAMILIES. 11.1% OF THE HOUSEHOLDS WERE MADE UP OF SOMEONE LIVING ALONE WHO IS 65 YEARS OLD AND OLDER. THE AVERAGE HOUSEHOLD SIZE WAS 2.48. THE AVERAGE FAMILY SIZE WAS 3.05. THE 81,667 PEOPLE WERE BROKEN DOWN IN THESE AGE GROUPS: 19,429 WERE UNDER THE AGE OF 18, 7,425 ARE AGED 18 TO 24 YEARS OLD, 19,416 ARE AGED 25 TO 44 YEARS OLD, 22,342 WERE AGED 45 TO 64 YEARS OLD, 13,055 WERE 65 YEARS OLD AND OLDER, AND 1,627 ARE PEOPLE AGED 85 YEARS OLD AND OLDER. THE MEDIAN AGE IS 39.8. OF THE 81,667 PEOPLE, 38,881 WERE MALE AND 42,786 WERE FEMALE. OF THE 62,238 PEOPLE AGED 18 AND OLDER, 28,913 WERE MALE AND 33,325 WERE FEMALE. THE MEDIAN INCOME FOR A HOUSEHOLD IN THE COUNTY WAS $38,398. THE MEDIAN INCOME FOR FAMILY WAS $47,647. MALES HAD A MEDIAN INCOME OF $38,297 VERSUS $30,861 FOR FEMALES. THE PER CAPITA INCOME FOR THE COUNTY WAS $20,671. 17% OF THE FAMILIES IN THE COUNTY LIVE BELOW THE POVERTY LINE. 22.8% OF THE POPULATION LIVES BELOW THE POVERTY LINE. 19.1% OF THOSE OVER THE AGE OF 18 LIVE BELOW THE POVERTY LINE. 12.6% OF THOSE AGED 65 AND OLDER LIVE BELOW THE POVERTY LINE. PART VI, LINE 5: WILSON MEDICAL CENTER, INC. HAS AN OPEN MEDICAL STAFF. THE BOARD OF DIRECTORS IS COMPRISED OF INDIVIDUALS THAT ARE ACTIVE IN OTHER ORGANIZATIONS IN THE COMMUNITY. SURPLUS FUNDS ARE RE-INVESTED IN THE FACILITY AND EQUIPMENT THAT PROVIDE HEALTHCARE SERVICES. PART VI, LINE 6: N/A 1 WILSON COUNTY HEALTH DEPARTMENT 1801 GLENDALE DRIVE WILSON NC 27893 566000351 501(C)(3) 30600 BREAST AND CERVICAL CANCER CONTROL PROGRAM 1 PART I, LINE 2: WILSON MEDICAL CENTER, INC. MAKES GRANTS TO OTHER 501(C)(3) ORGANIZATIONS. X X X X 0 0 0 0 0 0 0 0 0 CATHERINE RHYNE VP CLINICAL SERVICE 171992 0 0 0 0 0 22300 0 0 0 194292 0 0 0 DENISE O'HARA VP HUMAN RESOURCES 200326 0 0 0 0 0 23000 0 6557 0 229883 0 0 0 LYNN LAMBERT CHIEF FINANCIAL OFFICER 228647 0 0 0 0 0 22300 0 8130 0 259077 0 0 0 MELINDA K LAIRD PAST VP OF CLINICAL SERVICE 173630 0 0 0 0 0 0 0 5414 0 179044 0 0 0 RICHARD HUDSON PRESIDENT 410477 0 0 0 0 0 23000 0 7115 0 440592 0 0 0 RICK GUARINO MD VP MEDICAL AFFAIRS 292467 0 0 0 0 0 23000 0 5433 0 320900 0 0 0 BENJAMIN M THOMAS NEUROLOGIST 309789 0 0 0 0 0 10100 0 8130 0 328019 0 0 0 FERNANDO X CASTRO PHYSICIAN 194362 0 0 0 0 0 8752 0 13122 0 216236 0 0 0 KENNETH LEE JOHNSON OTOLARYNGOLOGIST 349193 0 0 0 0 0 17500 0 6061 0 372754 0 0 0 LOUIS V ANTIGNANO GASTROENTEROLOGIST 443931 0 0 0 0 0 5100 0 7745 0 456776 0 0 0 NADINE SKINNER PHYSICIAN 167846 0 0 0 0 0 3467 0 8599 0 179912 0 0 0 CASH 2014-03-01 6213 ACTUAL COST 901034226 DLP WILSON HOLDING COMPANY LLC 330 SEVEN SPRINGS WAY BRENTWOOD TN 37027 LIMITED LIABILITY COMPANY PATIENT ACCOUNT RECEIVABLES 2014-03-01 26383709 NET OF ALLOWANCE 901034226 DLP WILSON HOLDING COMPANY LLC 330 SEVEN SPRINGS WAY BRENTWOOD TN 37027 LIMITED LIABILITY COMPANY INVENTORIES 2014-03-01 3945620 ACTUAL COST 901034226 DLP WILSON HOLDING COMPANY LLC 330 SEVEN SPRINGS WAY BRENTWOOD TN 37027 LIMITED LIABILITY COMPANY NON-PATIENT RECEIVABLES 2014-03-01 604917 NET OF ALLOWANCE 901034226 DLP WILSON HOLDING COMPANY LLC 330 SEVEN SPRINGS WAY BRENTWOOD TN 37027 LIMITED LIABILITY COMPANY PREPAID EXPENSES 2014-03-01 1614686 ACTUAL COST 901034226 DLP WILSON HOLDING COMPANY LLC 330 SEVEN SPRINGS WAY BRENTWOOD TN 37027 LIMITED LIABILITY COMPANY PLANT, PROPERTY, & EQUIPMENT 2014-03-01 62466683 NET BOOK VALUE 901034226 DLP WILSON HOLDING COMPANY LLC 330 SEVEN SPRINGS WAY BRENTWOOD TN 37027 LIMITED LIABILITY COMPANY 1 0 0 0 PART II, LINE 2E: PERSON(S) INVOLVED: FRANK BATTEN, LEESA LAWRENCE, THOMAS LUCAS, JIM PRIDGEN, AND DAVID WEST. PART II, LINE 2E: EXPLANATION OF INVOLVEMENT: THE FIVE PEOPLE LISTED ABOVE BECAME MEMBERS OF THE BOARD OF GOVERNORS FOR THE TRANSFEREE ORGANIZATION, DLP WILSON HOLDING COMPANY, LLC. AMENDED FORM 990 THE WILSON MEDICAL CENTER, INC. IS AMENDING THE 2013 FORM 990 FOR THE FOLLOWING MATTERS. THE FIRST CHANGE IS TO REPORT THE CHNA INFORMATION ON SCHEDULE H, PART V, LINES 1 THRU 8C THAT WAS PREVIOUSLY NOT REPORTED ON THE ORIGINAL 2013 FORM 990. WILSON MEDICAL CENTER DID PARTICIPATE IN A COMMUNITY HEALTH NEEDS ASSESSMENT. THE ANSWER TO SCHEDULE H, PART V, LINE 17 WAS ALSO CHANGED FROM "YES" TO "NO" AFTER REEVALUATING THE QUESTION. THE THIRD CHANGE IS TO ELABORATE ON THE EXPLANATION PROVIDED ON FORM 990, PART III, LINE 3; SCHEDULE A, PART IV; AND SCHEDULE H, PART VI. THE FOURTH CHANGE IS TO REPORT ON SCHEDULE R, PART III WILSON MEDICAL CENTER'S RELATIONSHIP WITH DLP WILSON HOLDING COMPANY, LLC. THIS WAS NOT REPORTED PREVIOUSLY AS WILSON MEDICAL CENTER OWNS 20% AND IS NOT A MANAGING MEMEBER. HOWEVER, WILSON MEDICAL CENTER HAS CONTRACTUAL CONTROL OVER THE LLC. WILSON MEDICAL CENTER ALSO ADDED DLP WILSON MEDICAL CENTER, INC AND DLP WILMED NURSING CARE & REHABILITATION CENTER, INC. TO SCHEDULE R, PART IV AS DLP WILSON HOLDING COMPANY, LLC OWNS 100% OF BOTH CORPORATIONS. THE LAST CHANGE IS THE ORGANIZATION'S WEBSITE ADDRESS. SINCE FILING THE ORIGINAL 2013 FORM 990, THE ORGANIZATION'S WEBSITE ADDRESS HAS CHANGED AND IS UPDATED ON FORM 990, PAGE 1, LINE J. FORM 990, PART III, LINE 2 TO SUPPORT PROGRAMS THAT FOSTER THE DELIVERY, QUALITY, OR AFFORDABILITY OF HEALTH CARE OR HEALTH CARE-RELATED SERVICES AND TO SUPPORT ANY ACTIVITY DESIGNED AND CARRIED ON TO SERVE THE GENERAL HEALTH AND WELL-BEING OF THE COMMUNITY. TO AID IN THE INSTRUCTION AND PROMOTION OF RESEARCH AND SCIENTIFIC INVESTIGATION IN ALL BRANCHES OF MEDICINE AND SURGERY AND THE GENERAL HEALTH AND WELL-BEING OF THE COMMUNITY. TO SUPPORT ANY EDUCATIONAL ACTIVITIES RELATED TO THE CARE OF THE SICK AND DISABLED, THE PROMOTION OF HEALTH AND PREVENTATIVE MEDICINE, AND THE GENERAL HEALTH AND WELL-BEING OF THE COMMUNITY. FORM 990, PART III, LINE 3 EFFECTIVE MARCH 1, 2014, WILSON MEDICAL CENTER, INC. AND WILMED GENERATIONS, INC. ENTERED INTO AN AGREEMENT WITH DLP HEALTHCARE, LLC TO FORM A JOINT VENTURE, DLP WILSON HOLDING COMPANY, LLC, THAT WOULD OPERATE THE HOSPITAL AND NURSING HOME PREVIOUSLY OWNED AND OPERATED BY WILSON MEDICAL CENTER, INC. AND WILMED GENERATIONS, INC. WILSON MEDICAL CENTER, INC. CEASED DIRECTLY PROVIDING HEALTH CARE SERVICES AFTER FEBRUARY 28, 2014, AND IS PROVIDING MEDICAL SERVICES INDIRECTLY THROUGH THE JOINT VENTURE. EFFECTIVE OCTOBER 1, 2014, WILSON MEDICAL CENTER, INC. CHANGED ITS NAME TO HEALTHCARE FOUNDATION OF WILSON (THE "FOUNDATION"). THE GOVERNING DOCUMENTS OF THE JOINT VENTURE REQUIRE THAT THE JOINT VENTURE OPERATE THE HOSPITAL IN A MANNER AS TO SATISFY THE CHARITABLE PURPOSES GENERALLY REQUIRED OF HOSPITALS RECOGNIZED AS EXEMPT UNDER SECTION 501(C)(3) OF THE CODE, INCLUDING THAT THE HOSPITAL ACCEPT MEDICARE AND MEDICAID PATIENTS, MAINTAIN AN EMERGENCY DEPARTMENT THAT ACCEPTS ALL PATIENTS REGARDLESS OF THEIR ABILITY TO PAY, ADOPT THE CHARITY CARE POLICIES UTILIZED BY WILSON MEDICAL CENTER, INC. PRIOR TO THE TRANSFER OF THE HOSPITAL TO THE JOINT VENTURE, AND COMPLY WITH THE REQUIREMENTS OF SECTION 501(R) OF THE CODE REGARDING CHARITY CARE AND FINANCIAL ASSISTANCE POLICIES AND THE CONDUCTING OF COMMUNITY HEALTH NEEDS ASSESSMENTS. THE GOVERNING DOCUMENTS OF THE JOINT VENTURE INCLUDE PROVISIONS WHICH PROVIDE THE FOUNDATION, THROUGH ITS REPRESENTATIVES ON THE GOVERNING BODY OF THE JOINT VENTURE, WITH THE POWER TO ENFORCE COMPLIANCE WITH THESE CHARITABLE HOSPITAL REQUIREMENTS. WILSON MEDICAL CENTER, INC. WAS ALSO A "PUBLIC HOSPITAL" PURSUANT TO CHAPTER 131E, ARTICLE 2, OF THE NORTH CAROLINA GENERAL STATUTES (THE "PUBLIC HOSPITAL STATUTES"). THE PUBLIC HOSPITAL STATUTES AT THE TIME OF THE CREATION OF THE JOINT VENTURE REQUIRED THAT ANY TRANSFER OF A PUBLIC HOSPITAL FACILITY MUST BE MADE TO A CORPORATION, AND THE PUBLIC HOSPITAL STATUTES DID NOT PERMIT THE TRANSFER OF A PUBLIC HOSPITAL FACILITY TO A LIMITED LIABILITY COMPANY. WITH THE CREATION OF THIS JOINT VENTURE IN MIND, THE NORTH CAROLINA GENERAL ASSEMBLY PASSED A TECHNICAL CORRECTIONS STATUTE WHICH ENABLED THE TRANSFER OF A PUBLIC HOSPITAL FACILITY TO BE MADE TO A LIMITED LIABILITY COMPANY AS WELL AS TO A CORPORATION. THE EFFECTIVE DATE OF THE NORTH CAROLINA GENERAL ASSEMBLY'S CHANGE TO THE PUBLIC HOSPITAL STATUTE WAS OCTOBER 1, 2014, WHICH WAS AFTER THE CREATION OF THE JOINT VENTURE. IN ORDER TO COMPLY WITH THE REQUIREMENTS OF THE PUBLIC HOSPITAL STATUTE AT THAT TIME, THE HOSPITAL FACILITY WAS TRANSFERRED TO DLP WILSON MEDICAL CENTER, INC., WHICH WAS WHOLLY OWNED BY THE JOINT VENTURE, WITH THE INTENTION THAT DLP WILSON MEDICAL CENTER, INC., WOULD BE CONVERTED TO A LIMITED LIABILITY COMPANY AFTER THE ENACTMENT OF THE NORTH CAROLINA GENERAL ASSEMBLY'S TECHNICAL CORRECTION TO THE NORTH CAROLINA PUBLIC HOSPITAL STATUTES, AND THE CONVERSION WAS COMPLETED EFFECTIVE ON DECEMBER 31, 2014. AFTER THE CONVERSION OF DLP WILSON MEDICAL CENTER, INC., TO A LIMITED LIABILITY COMPANY, IT WAS TREATED AS A DISREGARDED ENTITY FOR FEDERAL TAX PURPOSES, AND THE JOINT VENTURE IS TREATED AS OPERATING THE HOSPITAL DIRECTLY. THE NORTH CAROLINA PUBLIC HOSPITAL STATUTES ALSO REQUIRE THAT THE JOINT VENTURE, AS THE TRANSFEREE OF THE PUBLIC HOSPITAL FACILITY, CONTINUE TO PROVIDE THE SAME HOSPITAL SERVICES, INDIGENT CARE, FINANCIAL ASSISTANCE POLICIES, AND MEDICARE AND MEDICAID SERVICES AS WERE PROVIDED BY WILSON MEDICAL CENTER, INC. PRIOR TO THE TRANSFER, AND THE JOINT VENTURE IS REQUIRED TO PROVIDE AN ANNUAL REPORT THAT SHOWS COMPLIANCE WITH THIS REQUIREMENT. FAILURE TO COMPLY WITH THIS REQUIREMENT WILL CAUSE THE HOSPITAL FACILITY TO REVERT TO WILSON COUNTY. FORM 990, PART VI, SECTION B, LINE 11 A DRAFT OF FORM 990 IS PROVIDED TO THE EXECUTIVE DIRECTOR AND ACCOUNTANT WHO REVIEW THE DRAFT PRIOR TO FILING WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C ONCE A YEAR, EACH PERSON IS REQUIRED TO REVIEW AND SIGN THE CONFLICT OF INTEREST POLICY. THIS IS ONE OF THE ANNUAL MODULES THAT MUST BE COMPLETED EACH YEAR. IT ENSURES THAT EMPLOYEES ARE FAMILIAR WITH THE POLICY. IF THERE IS A CONFLICT OF INTEREST, THE EXECUTIVE TEAM IS NOTIFIED AND A DISCUSSION SHOULD OCCUR AT THAT TIME TO DETERMINE THE EXTENT, WHETHER POTENTIAL OR ACTUAL. BOARD MEMBERS WITH CONFLICTS ARE RECUSED FROM VOTING. FORM 990, PART VI, SECTION B, LINE 15 AT LEAST EVERY TWO YEARS, AN INDEPENDENT FIRM IS UTILIZED TO DETERMINE THE APPROPRIATE COMPENSATION FOR THE EXECUTIVE TEAM. THE BOARD DETERMINED A STRATEGY AND GUIDELINES AS TO WHAT PERCENTILE AT WHICH THEY WOULD PLACE SALARIES FOR THE EXCUTIVE TEAM. UPON RECEIPT OF THE INDEPENDENT DATA, THE HR COMMITTEE OF THE BOARD REVIEWS THE DATA AND DETERMINES IF ANY ADJUSTMENTS SHOULD BE MADE. THIS PROCESS LAST TOOK PLACE DURING 2012. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS, POLICIES AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. FORM 990, PART XI, LINE 9: TRANSFER OF ASSETS/LIABILITIES FROM WILMED HEALTHCARE FOUNDATION 1,984,180. TRANSFER OF EQUITY FROM WILMED GENERATIONS, INC. 2,900,584. PART XII, LINE 2C THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. FORM 990 WILSON MEDICAL CENTER, INC. CHANGED ITS NAME TO THE HEALTHCARE FOUNDATION OF WILSON ON OCTOBER 1, 2014. THE NAME CHANGE WAS FILED WITH THE NC DEPARTMENT OF THE SECRETARY OF STATE AND ACCEPTED. THEREFORE, WILSON MEDICAL CENTER, INC. IS NOW DOING BUSINESS AS HEALTHCARE FOUNDATION OF WILSON. 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