2014-11-14T08:11:40-06:00 2013-12-31 990 2013-01-01 562120959 FORSYTH MEDICAL CENTER FOUNDATION FORS 3367182803 2085 FRONTIS PLAZA BLVD WINSTON SALEM NC 27103 FRED HARGETT EVP & CFO 3367182803 2014-11-13 2013 2015-11-30 17:44:51Z NOVANT HEALTH FOUNDATION FORSYTH MEDICAL CENTER PAULA VINCENT 2085 FRONTIS PLAZA BLVD WINSTON SALEM NC 27103 12716948 0 X WWW.NOVANTHEALTH.ORG X 1981 NC SEE SCHEDULE O 23 19 0 107 0 0 2198496 2262534 0 0 1650326 2018019 36377 28086 3885199 4308639 4412118 3344606 0 0 0 0 0 0 242202 1041025 677883 5453143 4022489 -1567944 286150 53096918 60326734 725101 504456 52371817 59822278 X SEE SCHEDULE O 0 0 3608336 3344606 FORSYTH MEDICAL CENTER FOUNDATION FOCUSES ITS EFFORTS TO RAISE 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. 3608336 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 0 1 0 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 0 0 X 23 19 0 0 1 0 1 1 0 1 1 0 0 1 1 1 1 0 0 1 0 0 NC X KAREN DAUGHERTY 3367182803 2085 FRONTIS PLAZA BLVD WINSTON SALEM NC 27103 X CARTER PEGGY TRUSTEE 2.00 X 0 27728 0 GREGORY CHERE TRUSTEE 2.00 X 0 590646 53066 WALLEY BRUCE TRUSTEE 2.00 X 0 613981 61346 ZEKAN PATRICIA TRUSTEE 2.00 X 0 308185 431402 ALEXANDER J CANTEY TREAS 2.00 X X 0 0 0 BERNTHAL LISA TRUSTEE 2.00 X 0 0 0 CALLOWAY THOMAS TRUSTEE 2.00 X 0 0 0 CHADEN SHELBY TRUSTEE 2.00 X 0 0 0 COPELAND DOUGLAS TRUSTEE 2.00 X 0 0 0 DAVIS DERRICK TRUSTEE 2.00 X 0 0 0 DUNHAM ROBERT TRUSTEE 2.00 X 0 0 0 LIVENGOOD MICHELLE CHAIR 2.00 X X 0 0 0 MARLEY MORRIS TRUSTEE 2.00 X 0 0 0 MARTIN DAVIDA TRUSTEE 2.00 X 0 0 0 MILLER MICHAEL TRUSTEE 2.00 X 0 0 0 NEWELL WILLIAM TRUSTEE 2.00 X 0 0 0 PAULY SUSAN TRUSTEE 2.00 X 0 0 0 POLLARD III HAROLD VICE CHAIR 2.00 X X 0 0 0 POPE SCOTT TRUSTEE 2.00 X 0 0 0 PROCTOR RALAN TRUSTEE 2.00 X 0 0 0 SHORE RICHARD TRUSTEE 2.00 X 0 0 0 WESTON CLAUDETTE TRUSTEE 2.00 X 0 0 0 WODARZ NAN TRUSTEE 2.00 X 0 0 0 MCGEE LAWRENCE SEC (*SEE ADD'L INFO IN SCH J P3) 2.00 X 0 1280041 180634 MYERS SCOTT ASST SEC 2.00 X 0 466038 113223 VINCENT PAULA SVP FOUNDATIONS (*SEE ADD'L INFO IN SCH J P3) 60.00 X 0 3269464 66706 0 6556083 906377 0 0 1 0 0 32682 10000 57965 2161887 8776 2262534 985630 985630 9424746 8392357 1032389 1032389 1032389 44038 32682 15952 28086 28086 4308639 0 0 2046105 X 3308313 3308313 36293 36293 114989 114989 451182 221079 27071 203032 59628 29217 3578 26833 13081 6410 785 5886 1998 1998 5446 5446 4888 2395 293 2200 SUPPLIES 16819 16819 MISCELLANEOUS 9447 4629 567 4251 DUES AND SUBSCRIPTIONS 405 405 4022489 3608336 171951 242202 972401 1176514 136800 91200 0 7595 74627 66789 12726 7838 40884166 46791702 11064537 12250046 26288 1839 53096918 60326734 39150 4783 685951 499673 725101 504456 X 40672950 48011768 11623851 11733494 75016 77016 52371817 59822278 53096918 60326734 X 286150 5050121 2114190 X 0 1 X 1 0 X 3988952 3538294 3323750 2198496 2262534 15312026 3988952 3538294 3323750 2198496 2262534 15312026 3605919 11706107 705934 680048 727512 1174066 985630 4273190 8942 8942 19594158 221739 0.59740 0.61060 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 11698867 1594460 -14581 67000 1401236 11810510 12235136 1737322 57605 65000 2266196 11698867 12021408 2173133 92226 14285 2034319 12238163 12847411 2286538 104407 2917 3214031 12021408 12692664 2430441 134613 4990 2405317 12847411 0.01000 0.99000 0 0 74627 66789 7838 7838 OTHER SECURITIES 12250046 F 12250046 0 DUE TO AFFILIATE 499673 499673 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 WAS 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 STATEMENT OF OPERATIONS FOR THE YEARS ENDED DECEMBER 31, 2013 AND 2012. 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. SMASH CANCER 21190 18332 2858 4101 GARDEN PARTY 55530 14350 41180 6607 5244 76720 32682 44038 10708 5244 15952 28086 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) 2217741 COMMUNITY HEALTHCARE SECU FAMILY HOUSE 1970 FAMILY HOUSE WAY WINSTON SALEM NC 27103 203604576 501(C)(3) 25000 COMMUNITY OUTREACH COMMUNITY CARE CENTER 2135 NEW WALKERTON RD WINSTON SALEM NC 27101 581403699 501(C)(3) 250000 COMMUNITY OUTREACH FOUNDATION HEALTH SYSTEMS CORP 2085 FRONTIS PLAZA BLVD WINSTON SALEM NC 27103 561373175 501(C)(3) 500000 COMMUNITY HEALTHCARE STOKES COUNTY EMS PO BOX 20 DANBURY NC 27016 566000340 STOKES COUNTY 5500 COMMUNITY OUTREACH NOVANT HEALTH 2085 FRONTIS PLAZA BLVD WINSTON SALEM NC 27103 561376950 501(C)(3) 64573 COMMUNITY HEALTHCARE FORSYTH HEALTHCARE INC 501 N CLEVELAND AVE SUITE 4 WINSTON SALEM NC 27101 320097975 501(C)(3) 215000 COMMUNITY HEALTHCARE 8 0 EMERGENCY ASSISTANCE 41 17730 SCHOLARSHIPS 54 18563 PART I, LINE 2 - PROCEDURES FOR MONITORING THE USE OF GRANT FUNDS THE ORGANIZATION IS AN AFFILIATE IN AN INTEGRATED HEALTHCARE SYSTEM AND FOLLOWS 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 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 TRUSTEE 0 400835 0 111420 0 78391 0 31810 0 21256 0 643712 0 0 WALLEY BRUCE TRUSTEE 0 349797 0 245580 0 18604 0 46117 0 15229 0 675327 0 0 ZEKAN PATRICIA TRUSTEE 0 262127 0 20050 0 26008 0 417026 0 14376 0 739587 0 7500 MCGEE LAWRENCE SEC (*SEE ADD'L INFO IN SCH J P3) 0 384909 0 304420 0 590712 0 156200 0 24434 0 1460675 0 445287 MYERS SCOTT ASST SEC 0 274388 0 179868 0 11782 0 107978 0 5245 0 579261 0 0 VINCENT PAULA SVP FOUNDATIONS (*SEE ADD'L INFO IN SCH J P3) 0 332914 0 247516 0 2689034 0 53755 0 12951 0 3336170 0 264675 PART I, LINE 3 PART I, LINE 3: THE FILING ORGANIZATION IS AN AFFILIATE IN AN INTEGRATED HEALTHCARE SYSTEM AND IS SUPPORTED BY A PARENT ORGANIZATION THAT 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 MCGEE, LAWRENCE 0 *437,787 0 VINCENT, PAULA 0 *2,653,713 0 *SCHEDULE J PART II COLUMN B (III): IN 2012, THE INDEPENDENT AND DISINTERESTED MEMBERS OF THE NOVANT HEALTH BOARD OF TRUSTEES COMPENSATION AND LEADERSHIP COMMITTEE (THE "COMMITTEE") ENGAGED INTEGRATED HEALTHCARE STRATEGIES TO ASSESS THE MARKET AND DESIGN A NEW SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN ("NEW SERP") THAT WOULD BE MORE IN LINE WITH MARKET PRACTICE AND INDUSTRY TRENDS AND THAT WOULD BETTER ACCOMPLISH NOVANT HEALTH'S STRATEGIC EXECUTIVE RETENTION AND ATTRACTION GOALS, AND TO REPLACE THE EXISTING PLAN. IN 2013, THE COMMITTEE APPROVED A NEW DEFINED CONTRIBUTION SERP, TO BE EFFECTIVE 1/1/2014, AND TERMINATED THE EXISTING DEFINED BENEFIT PLAN, WHICH HAS BEEN DESCRIBED IN DETAIL IN PRIOR NOVANT HEALTH FORM 990S. AS 2013 WAS A TRANSITION YEAR, SERP BENEFITS PAID OUT AS A RESULT OF THE TERMINATION OF THE EXISTING DEFINED BENEFIT PLAN HAVE BEEN INCLUDED IN THE COMPENSATION AMOUNTS REPORTED IN PART VII AND IN COLUMN (B)(III) OF SCHEDULE J, AND DEFERRED COMPENSATION AMOUNTS THAT ACCRUED IN 2013 UNDER THE NEW SERP TO BE CONTRIBUTED TO PARTICIPANTS IN 2014 ARE REPORTED IN COLUMN (C) OF SCHEDULE J. THE AMOUNTS REFLECTED IN COLUMN F AS PREVIOUSLY REPORTED REFLECT THE CUMULATIVE AMOUNTS RECORDED ON PRIOR 990S IN COLUMN C AS DEFERRED COMPENSATION. THE AMOUNT IS THEN ADJUSTED FOR ANY PRIOR YEAR'S PAYMENTS THAT HAVE BEEN REPORTED PREVIOUSLY IN COLUMNS B(III) AND F. THE AMOUNTS PREVIOUSLY REPORTED AS DEFERRED COMPENSATION IN COLUMN C WERE DETERMINED USING AN ACTUARIAL CALCULATION THAT IS BASED ON SEVERAL FACTORS INCLUDING CURRENT AND FUTURE SALARY EXPECTATIONS, EXPECTED FUTURE YEARS OF SERVICE, AND DISCOUNTED USING INTEREST RATES IN PLACE AT THE TIME OF CALCULATION. THE AMOUNT REPORTED IN COLUMN B(III) FOR THE PLAN PAYOUT WILL NOT EXACTLY REFLECT THE CUMULATIVE ACCRUALS REPORTED IN COLUMN F BECAUSE OF THE VARIABILITY OF THE CALCULATION'S FACTORS OVER TIME. IN ADDITION, DUE TO THE LUMP SUM NATURE OF THE FINAL PAYOUT, THE AMOUNTS REPORTED IN COLUMN C AS ACCRUED IN THE PRIOR YEAR WOULD NOT INCLUDE A PORTION OF THE AMOUNTS ACCELERATED INTO 2013. THE EXISTING DEFINED BENEFIT PLAN PARTICIPANTS' PAYMENTS VARIED BASED ON LENGTH OF SERVICE TO THE ORGANIZATION, WHICH RANGED FROM 8 TO 37 YEARS, AND VESTING STATUS AT THE TIME OF PLAN TERMINATION. THE NEW 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. 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. 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 OFFICERS AND KEY EMPLOYEES 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; THIS MAXIMUM PERCENTAGE RANGES FROM 30% TO 70% OF BASE SALARY. 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. AWARDS ARE PAYABLE FOR A PARTICULAR THREE-YEAR PERFORMANCE CYCLE ONLY IF THE REQUISITE LEVEL OF COMMUNITY BENEFIT AND CHARITY CARE, ALONG WITH THE REQUIRED LEVEL OF FINANCIAL PERFORMANCE TO DEMONSTRATE LONG-TERM FINANCIAL STRENGTH, HAVE BEEN MET FOR THAT 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. X 1 4000 FMV X POWER WHEELCH 1 4000 FMV X GIFT CARDS 12 600 FMV X FRAMING OF PA 1 176 FMV 0 0 1 0 PART I, COLUMN (B): NUMBER OF CONTRIBUTIONS FORM 990, PI, L1: ORGANIZATION'S MISSION OR MOST SIGNIFICANT ACTIVITIES THE FORSYTH MEDICAL CENTER FOUNDATION DOING BUSINESS AS THE NOVANT HEALTH FOUNDATION FORSYTH MEDICAL CENTER WAS FORMED TO ACCEPT GIFTS, SEEK GRANTS AND INVEST FUNDS TO SUPPORT NOVANT HEALTH FORSYTH MEDICAL CENTER'S MISSION TO IMPROVE THE HEALTH OF COMMUNITIES, ONE PERSON AT A TIME. IT HAS EXPANDED ITS REACH TO INCLUDE ADVISORY BOARDS AT NEW MEDICAL CENTERS IN KERNERSVILLE, NC AND CLEMMONS, NC. THE 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 IS RANKED AS ONE OF THE NATION'S TOP 25 INTEGRATED HEALTHCARE SYSTEMS CARING FOR PATIENTS AND COMMUNITIES IN GEORGIA, NORTH CAROLINA, SOUTH CAROLINA AND VIRGINIA. IN 2013, THE SYSTEM REPORTED $3.6 BILLION IN REVENUES. THE FOUNDATION SUPPORTS PEOPLE, PROGRAMS AND SERVICES WITHIN THE MEDICAL CENTER, 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. IN 2013, NEARLY 1,061 DONORS CONTRIBUTED TO THE MISSION OF THE FOUNDATION. GIFTS, GRANTS AND EARNINGS FROM INVESTMENTS TOUCHED VIRTUALLY EVERY SERVICE AREA AT NOVANT HEALTH FORSYTH MEDICAL CENTER. SOME EXAMPLES OF THIS 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 CLINICS. -THE FOUNDATION HELPED FUND A NEW HEMODIALYSIS UNIT THAT INCREASED CAPACITY BY 50 PERCENT AND CHANGED THE ENTIRE ATMOSPHERE OF THE SERVICE, TO THE PATIENTS' BENEFIT. -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 2013, THE COUNCIL FINISHED A THREE-YEAR, $195,000 GRANT COMMITMENT TO FUND A GYN CANCER NURSE NAVIGATOR. COMMUNITY BENEFIT REPORT: HTTP://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. IN THIS REPORT, THE NOVANT HEALTH SYSTEM'S COMMUNITY BENEFIT WAS APPROXIMATELY $566,000,000, INCLUDING $129,000,000 IN CHARITY CARE, IN 2013. 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. 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 EMPLOYEES OF NOVANT HEALTH AND OUR PHYSICIAN PARTNERS, 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: WE RECOGNIZE THAT EVERY PERSON IS DIFFERENT, EACH SHAPED BY UNIQUE LIFE EXPERIENCES. THIS ENABLES US TO BETTER UNDERSTAND ONE ANOTHER AND OUR CUSTOMERS. PERSONAL EXCELLENCE: WE STRIVE TO GROW PERSONALLY AND PROFESSIONALLY, AND 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. NOVANT HEALTH'S BRAND PROMISE: WE ARE MAKING YOUR HEALTHCARE EXPERIENCE REMARKABLE. WE WILL BRING YOU WORLD-CLASS TECHNOLOGY, CLINICIANS, AND CARE - WHEN AND WHERE YOU NEED IT. 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 4 FORM 990, PART VI, SECTION A, LINE 4: SIGNIFICANT CHANGES TO ORGANIZATIONAL DOCUMENTS THE ORGANIZATION AMENDED IT'S BYLAWS TO REVISE PURPOSE LANGUAGE TO BE CONSISTENT WITH PUBLIC CHARITY STATUS AND TO REMOVE REFERENCES TO SUPPORTING ORGANIZATION STATUS; TO ADD CERTAIN EX-OFFICIO MEMBERS OF THE BOARD; TO CLARIFY THAT BOARD MEMBERS DO NOT RECEIVE COMPENSATION; TO CLARIFY THAT THE BOARD WILL COMPLY WITH UPMIFA; AND TO REVISE INDEMNIFICATION PROVISIONS CONSISTENT WITH STATE LAW. FORM 990, PART VI, SECTION A, LINE 6 FORM 990, PART VI, SECTION A, LINE 6: CLASSES OF MEMBERS OR STOCKHOLDERS THE CORPORATION IS A NONPROFIT CORPORATION WITH MEMBERS (OR A MEMBER). 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. ELECTS 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, WHICH OVERSEES TAX MATTERS FOR NOVANT HEALTH. THE AUDIT AND COMPLIANCE COMMITTEE IS THE REVIEW BODY FOR ALL OF THE FORM 990S FILED FOR ORGANIZATIONS WITHIN THE NOVANT HEALTH SYSTEM. THE AUDIT AND COMPLIANCE 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 SENIOR DIRECTOR 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. ANY POSITIVE ANSWERS ON THE TRUSTEE ANNUAL DISCLOSURE FORM ARE REVIEWED BY THE GENERAL COUNSEL. IF THE RELATIONSHIP DISCLOSED IS DETERMINED NOT TO POSE A POTENTIAL CONFLICT OF INTEREST GENERALLY, THEN NO ACTION IS TAKEN. 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 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. ALL SUBSIDIARY ORGANIZATIONS FOLLOW ALL APPLICABLE NOVANT HEALTH CORPORATE POLICIES IN THEIR OPERATIONS. NOVANT HEALTH HAS ESTABLISHED A WHISTLEBLOWER POLICY, WHICH ALL SUBSIDIARY ORGANIZATIONS IN THE SYSTEM FOLLOW. 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 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. ALL SUBSIDIARY ORGANIZATIONS FOLLOW ALL APPLICABLE NOVANT HEALTH CORPORATE POLICIES IN THEIR OPERATIONS. NOVANT HEALTH HAS ESTABLISHED A DOCUMENT RETENTION AND DESTRUCTION POLICY, WHICH ALL SUBSIDIARY ORGANIZATIONS IN THE SYSTEM FOLLOW. 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 15A FORM 990, PART VI, SECTION B, LINE 15A: COMPENSATION PROCESS FOR TOP OFFICIAL INDEPENDENT AND DISINTERESTED MEMBERS OF THE NOVANT HEALTH BOARD OF TRUSTEES (WHO COMPRISE THE COMPENSATION AND LEADERSHIP COMMITTEE OF THE BOARD) REVIEW, APPROVE, AND OVERSEE ALL ASPECTS OF COMPENSATION AND BENEFITS FOR NOVANT HEALTH'S CEO AND FOR CERTAIN LEADERS AND EXECUTIVES ("EXECUTIVES") SERVING NOVANT HEALTH AND ITS RELATED OR DISREGARDED ENTITIES. THE COMMITTEE WORKS WITH AN INDEPENDENT COMPENSATION CONSULTANT, USES THIRD PARTY COMPARABILITY DATA FOR FUNCTIONALLY SIMILAR POSITIONS AT SIMILARLY SITUATED ORGANIZATIONS, AND MAKES SURE 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 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 19,395. MANAGEMENT AND GENERAL EXPENSES 2,375. FUNDRAISING EXPENSES 17,812. TOTAL EXPENSES 39,582. CONTRACTED SERVICES : PROGRAM SERVICE EXPENSES 201,684. MANAGEMENT AND GENERAL EXPENSES 24,696. FUNDRAISING EXPENSES 185,220. TOTAL EXPENSES 411,600. FORM 990, PART XI, LINE 9: AFFILIATE TRANSFERS 2,114,191. ROUNDING -1. 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