2014-05-14T07:36:58-05:00 2013-06-30 135565207 KPMG LLP 300 NORTH GREENE STREET GREENSBORO NC 27401 990 2012-07-01 560552787 NORTH CAROLINA BAPTIST HOSPITAL NORT 3367164445 MEDICAL CENTER BLVD WINSTONSALEM NC 27157 JOHN D MCCONNELL MD 3367164445 2014-05-12 0 P00008888 3362753394 2012 2015-11-30 17:44:51Z JOHN D MCCONNELL MD MEDICAL CENTER BLVD WINSTONSALEM NC 27157 1268161053 0 X WWW.WAKEHEALTH.EDU X 1923 NC IMPROVING THE HEALTH OF OUR REGION, STATE AND NATION 17 16 10138 1000 3483187 2085085 3031792 3462376 1186396254 1218479632 77580140 42423781 3718388 3626103 1270726574 1267991892 591467 1278528 0 0 539950281 547352388 0 0 0 629349396 712232895 1169891144 1260863811 100835430 7128081 1619889593 1778311980 671420988 815813924 948468605 962498056 X SEE SCHEDULE O FOR CONTINUATIONTHE ORGANIZATION IS PART OF WAKE FOREST BAPTIST MEDICAL CENTER, A PREEMINENT, INTERNATIONALLY RECOGNIZED ACADEMIC MEDICAL CENTER OF THE HIGHEST QUALITY WITH BALANCED EXCELLENCE IN PATIENT CARE, RESEARCH AND EDUCATION. WAKE FOREST BAPTIST MEDICAL CENTER'S MISSION IS TO IMPROVE THE HEALTH OF THE REGION, STATE AND NATION BY:- SERVING AS THE PREMIER HEALTH SYSTEM IN THE REGION, WITH SPECIFIC CENTERS OF EXCELLENCE RECOGNIZED AS NATIONAL AND INTERNATIONAL CARE DESTINATIONS.- GENERATING AND TRANSLATING KNOWLEDGE TO PREVENT, DIAGNOSE AND TREAT DISEASE.- TRAINING TOMORROW'S LEADERS IN HEALTH CARE AND BIOMEDICAL SCIENCE. 0 0 1147158690 1278528 1215255766 SEE SCHEDULE O FOR COMPLETE DESCRIPTIONTHE HOSPITAL IS AN INTEGRAL PART OF WAKE FOREST BAPTIST MEDICAL CENTER, A PREEMINENT, INTERNATIONALLY RECOGNIZED ACADEMIC MEDICAL CENTER OF THE HIGHEST QUALITY WITH BALANCED EXCELLENCE IN PATIENT CARE, RESEARCH AND EDUCATION. WAKE FOREST BAPTIST MEDICAL CENTER IS NORTHWEST NORTH CAROLINA'S SOLE ACADEMIC MEDICAL CENTER, BRINGING TO THE REGION THE RESOURCES OF ONE OF AMERICA'S TOP HOSPITALS AND INNOVATIVE RESEARCH CENTERS AND A PREMIER MEDICAL SCHOOL. WAKE FOREST UNIVERSITY BAPTIST MEDICAL CENTER IS A CORPORATION WHOSE MEMBERS ARE WAKE FOREST UNIVERSITY AND NORTH CAROLINA BAPTIST HOSPITAL. WAKE FOREST BAPTIST MEDICAL CENTER OPERATES WAKE FOREST SCHOOL OF MEDICINE AND HAS A FACULTY OF 1,165, INCLUDING PHYSICIANS AND BASIC SCIENTISTS. THE MEDICAL CENTER HAS 1,004 ACUTE CARE AND REHABILITATION BEDS OPERATIVE ACROSS THE SYSTEM, WHICH ENCOMPASSES ITS MAIN CAMPUS (885 BEDS), BRENNER CHILDREN'S HOSPITAL (160 BEDS, INCLUDED IN MAIN CAMPUS TOTAL); WAKE FOREST BAPTIST HEALTH-LEXINGTON MEDICAL CENTER (94 BEDS); AND WAKE FOREST BAPTIST HEALTH-DAVIE MEDICAL CENTER (25 BEDS). THE MEDICAL CENTER PRIMARILY SERVES A 24-COUNTY REGION IN NORTHWESTERN NORTH CAROLINA AND SOUTHWESTERN VIRGINIA, BUT DRAWS PATIENTS FROM ACROSS THE STATE AND NATION FOR SELECT SERVICES.WAKE FOREST SCHOOL OF MEDICINE IS THE DRIVING FORCE BEHIND THE ESTABLISHMENT OF WAKE FOREST INNOVATION QUARTER, A FAST-GROWING HUB FOR BIOMEDICAL AND MATERIAL SCIENCES AND INFORMATION TECHNOLOGY IN DOWNTOWN WINSTON-SALEM. IN 2014, THE INNOVATION QUARTER WILL WELCOME INMAR, AN INFORMATION SERVICES COMPANY THAT WILL HAVE 900 EMPLOYEES AT ITS NEW HOME IN A RENOVATED FORMER R.J. REYNOLDS TOBACCO CO. BUILDING. IT WILL BE IN ONE OF TWO NEW BUILDINGS TO BE OPENED IN THE INNOVATION QUARTER; THE SECOND BUILDING WILL BE HOME BOTH TO WAKE FOREST SCHOOL OF MEDICINE'S DIVISION OF PUBLIC HEALTH SCIENCES, ITS PHYSICIAN ASSISTANT PROGRAM AND TO A NEW CENTER FOR EMERGING TECHNOLOGIES THAT WILL BE OPENED BY FORSYTH TECHNICAL COMMUNITY COLLEGE. THE BUSINESS, ACADEMIC AND RESEARCH CORE AT THE INNOVATION QUARTER COMBINES WITH OTHER OFFERINGS SUCH AS A PUBLIC PARK (OFFERING OUTDOOR YOGA, A FILM SERIES AND MORE) AND A BRANCH OF THE YMCA TO MAKE IT A DIVERSE AREA OF GROWTH IN WINSTON-SALEM.1. CLINICAL SERVICES WAKE FOREST BAPTIST MEDICAL CENTER IS NATIONALLY RECOGNIZED FOR CLINICAL EXCELLENCE AND INTERNATIONALLY KNOWN FOR PIONEERING RESEARCH AND CLINICAL INNOVATION. IT OFFERS EXPERTISE IN MORE THAN 100 AREAS OF MEDICINE, ENCOMPASSING COMPREHENSIVE PREVENTIVE AND HIGHLY SPECIALIZED CARE FOR ALL AGES. THE WAKE FOREST BAPTIST MEDICAL CENTER INCLUDES 42 SUBSIDIARIES, JOINT VENTURES AND AFFILIATE HOSPITALS, AND OPERATES ABOUT 80 OUTREACH ACTIVITIES, INCLUDING SATELLITE SPECIALTY CLINICS, ACROSS NORTHWEST NORTH CAROLINA.IN THE PAST FISCAL YEAR, WAKE FOREST BAPTIST MEDICAL CENTER COMPLETED A $125 MILLION EXPANSION OF ITS COMPREHENSIVE CANCER CENTER, WHICH CONSOLIDATED INPATIENT AND OUTPATIENT SERVICES INTO A SINGLE LOCATION. THE NEW CENTER OFFERS 530,600 SQUARE FEET OF SPACE TO PATIENTS, MAKING IT THE LARGEST INTEGRATED CANCER CENTER IN NORTH CAROLINA. ALSO IN 2013, WAKE FOREST BAPTIST MEDICAL CENTER OPENED A NEW STATE-OF-THE-ART CLINICAL CAMPUS, DAVIE MEDICAL CENTER - BERMUDA RUN, WHICH INCLUDES A 24/7/365 EMERGENCY DEPARTMENT, AND A NEW WEIGHT MANAGEMENT CENTER AT ITS MEDICAL PLAZA - COUNTRY CLUB SITE THAT COMBINES MEDICAL AND SURGICAL WEIGHT LOSS PROGRAMS IN ONE LOCATION. OVERALL IN FY 2013, WAKE FOREST BAPTIST MEDICAL CENTER HAD 38,696 INPATIENT ADMISSIONS AND 1,051,359 OUTPATIENT ENCOUNTERS (EMERGENCY DEPARTMENT, DOWNTOWN HEALTH PLAZA, DAY HOSPITAL, AMBULATORY VISITS). THE TOTAL PATIENT ENCOUNTERS NUMBERED 1,090,055.2. OUTREACHTHE DOWNTOWN HEALTH PLAZA IS A FULL-SERVICE, OUTPATIENT MEDICAL CLINIC THAT SERVES MANY OF FORSYTH COUNTY'S UNINSURED AND UNDERINSURED RESIDENTS WITH A STATE-OF-THE-ART MEDICAL HOME. EXPERTS FROM 12 WAKE FOREST BAPTIST MEDICAL CENTER DEPARTMENTS PROVIDE COORDINATED CARE THAT INCLUDES ADULT MEDICINE, PEDIATRICS, OBSTETRICS AND GYNECOLOGY, AS WELL AS AN ONSITE PHARMACY, LABORATORY AND RADIOLOGY SERVICES (INCLUDING MAMMOGRAPHY). THE DOWNTOWN HEALTH PLAZA PLAYS A SIGNIFICANT ROLE IN COMMUNITY HEALTH, PROVIDING COMMUNITY HEALTH FAIRS, DIABETES EDUCATION AND A CENTERING PREGNANCY PROGRAM THAT IS REDUCING THE INCIDENCE OF LOW BIRTH-WEIGHT BABIES. A TOTAL OF 65,541 PATIENT VISITS WERE RECORDED AT THE PLAZA BETWEEN JULY 2012 AND JUNE 2013. COSTS ARE SUBSIDIZED BY WAKE FOREST BAPTIST MEDICAL CENTER. WAKE FOREST BAPTIST MEDICAL CENTER ALSO OPERATES NUMEROUS INNOVATIVE COMMUNITY OUTREACH PROGRAMS, INCLUDING:- BESTHEALTH, WHICH OFFERS HEALTH SEMINARS LED BY WAKE FOREST BAPTIST HEALTH EXPERTS, HEALTH SCREENINGS, COOKING AND FITNESS CLASSES, AND ONLINE HEALTH RESOURCES.- FAITHHEALTHNC, AN INITIATIVE THAT CONNECTS THE CARING STRENGTHS OF CONGREGATIONS, THE CLINICAL EXPERTISE OF PROVIDERS AND A NETWORK OF COMMUNITY RESOURCES TO EASE THOSE ON THE JOURNEY TO HEALTH AND HEALING, STRENGTHENING COMMUNITIES IN THE PROCESS.- BE INVOLVED, AN ONLINE RESOURCE THAT ALLOWS THE PUBLIC ACCESS TO INFORMATION ABOUT HUNDREDS OF CLINICAL STUDIES. THE SITE ALLOWS PEOPLE TO REGISTER TO BE NOTIFIED WHEN STUDIES BEGIN THAT COULD MATCH CONDITIONS THEY FACE.3. EDUCATIONAL MISSION AND ACCOMPLISHMENTS THE CONSTITUENT ORGANIZATIONS OF WAKE FOREST BAPTIST MEDICAL CENTER OPERATE A BROAD RANGE OF EDUCATIONAL PROGRAMS, GRADUATING SKILLED PRACTITIONERS. IT ATTRACTS SOME OF THE WORLD'S MOST COMPETITIVE MEDICAL STUDENTS, RESIDENTS AND FELLOWS, AS WELL AS STUDENTS IN CLINICAL PASTORAL CARE, NURSE ANESTHESIA AND OTHER AREAS. IN THE PAST YEAR, WAKE FOREST BAPTIST MEDICAL CENTER INVESTED MORE THAN $56 MILLION IN THE EDUCATION OF TOMORROW'S HEALTH CARE AND BIOMEDICAL LEADERS. THAT INVESTMENT SUPPORTED THE TRAINING OF 469 MEDICAL STUDENTS, 683 PHYSICIAN RESIDENTS AND FELLOWS, 308 GRADUATE STUDENTS AND 124 PHYSICIAN ASSISTANTS. ALSO LAST YEAR, THE NORTHWEST AREA HEALTH EDUCATION CENTER, PART OF WAKE FOREST SCHOOL OF MEDICINE, PROVIDED 1,910 CONTINUING MEDICAL EDUCATION ACTIVITIES FOR 33,518 PARTICIPANTS THROUGHOUT THE REGION. 1147158690 1 1 0 1 0 0 0 0 0 1 1 0 0 0 1 1 0 1 0 0 1 0 0 0 0 0 1 1 1 1 1 1 0 0 0 0 0 0 0 0 1 1 1 0 0 0 1 1 1 1 0 0 1 186 0 1 10138 1 1 1 0 0 0 0 0 0 0 0 0 X 17 16 1 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 1 NC X DOUG LISCHKE 3367164445 MEDICAL CENTER BLVD WINSTON SALEM NC 27157 X ROGER L COTHRAN 2.00 4.00 X X 0 0 0 RON KESSINGER 2.00 6.00 X X 0 0 0 ARTHUR A GIBEL 2.00 4.00 X 0 0 0 KATHRYN H HAMRICK 2.00 2.00 X 0 0 0 A LEE HERRING 2.00 X 0 0 0 J WAYNE MEREDITH M D 2.00 2.00 X 0 0 0 STANLEY R AESCHLEMAN PH D 2.00 X 0 0 0 A WILLIAM BLACKSTOCK JR MD 2.00 2.00 X 0 0 0 KENNETH W LEWIS 2.00 2.00 X 0 0 0 WILLIAM C WARDEN JR 2.00 4.00 X 0 0 0 SHEREE B WATSON 2.00 4.00 X 0 0 0 KATY M BOLES 2.00 2.00 X 0 0 0 RAY N HOWELL III D MIN 2.00 2.00 X 0 0 0 JOHN D KIMBERLY 2.00 X 0 0 0 STEPHEN L ROBERTSON 2.00 6.00 X 0 0 0 EDWIN L WELCH JR 2.00 4.00 X 0 0 0 R MICHAEL WELLS 2.00 6.00 X 0 0 0 LINWOOD L DAVIS 2.00 X 0 0 0 BRENDA B DIGGS 2.00 X 0 0 0 ERNEST L EVANS 2.00 4.00 X 0 0 0 LOUIS B BALDWIN JR 2.00 X 0 0 0 GEORGE D RENFRO 2.00 4.00 X 0 0 0 JOHN D MCCONNELL MD 20.00 20.00 X X 1370748 0 690944 H GREG BRAY 30.20 9.80 X 231473 0 37925 J MCLAIN WALLACE JR 17.70 22.30 X 516658 0 110280 KAREN H HUEY 33.70 6.30 X 363748 0 71481 ERIC TOMLINSON 5.00 35.00 X 266943 0 31786 NORMAN D POTTER JR 20.00 20.00 X 348231 0 83878 CHERYL EH LOCKE 23.40 16.60 X 439652 0 97854 EDWARD G CHADWICK 29.80 10.20 X 709971 0 246494 THOMAS E SIBERT MD 26.60 13.40 X 885483 0 141102 LISA M WYATT 18.10 21.90 X 386954 0 75110 SHEILA M SANDERS 26.00 14.00 X 478904 0 104120 EDWARD ABRAHAM MD 5.00 35.00 X 669778 0 181890 BETTY PETREE 40.00 X 250470 0 37328 MICHAEL RIEKER 40.00 X 242909 0 45099 VANCE MCVAY JR 40.00 X 231310 0 39322 ERIC STIEFEL 40.00 X 193145 0 33982 CHARLES WARE 40.00 X 220774 0 39020 JOANNE C RUHLAND 20.00 20.00 X 255643 0 71023 RUSSELL M HOWERTON MD 20.00 20.00 X 602178 0 155013 DOUGLAS L EDGETON 1.00 39.00 X 606902 0 19712 STEVE C SNELGROVE 0.00 40.00 X 379156 0 86678 RONALD H SMALL 0.00 2.00 X 241797 0 6355 MAUREEN E SINTICH 34.00 6.00 X 390731 0 87080 ROBERT S PARKER SR 0.00 0.00 X 117589 0 4468 DONNY C LAMBETH 20.00 20.00 X 1137417 0 42640 SHARON ENGEBRETSON 35.00 5.00 X 173949 0 67457 11712513 0 2608041 437 1 1 1 INTELLECT RESOURCES INC 3824 N ELM STREET GREENSBORO NC 27455 TECHNOLOGY 6597090 FASTAFF INC 6399 S FIDDLERS GREEN GREENWOOD VILLAGE CO 80111 NURSING 5058061 MEDCOST 165 KIMEL PARK DRIVE WINSTON SALEM NC 27103 TPA 3253732 ARAMARK 2300 WARRENVILLE ROAD DOWNER GROVE IL 60515 MANAGEMENT SERVICES 2864085 ORACLE AMERICA INC 500 ORACLE PKWY REDWOOD SHORES CA 94065 TECHNOLOGY 2557598 120 405031 1022052 2035293 73316 3462376 PATIENT SERVICE REVENUE 621400 1198897791 1198897791 COST RECOV. & OTHER 900099 10108989 7720451 2388538 MEDICAL/LAB SERVICE 621500 4888948 3828442 1060506 DIETARY 722320 4583904 4549761 34143 1218479632 13994366 13994366 659246 0 659246 659246 659246 28598576 0 169161 28598576 -169161 28429415 28429415 GIFT SHOP REVENUE 453220 1458318 1458318 PARKING FEES 900099 1249218 1249218 TUITION 900099 259321 259321 2966857 1267991892 1215255766 3483187 45790563 X 799335 799335 479193 479193 4460290 2577907 1882383 430641699 389943893 40697806 21691102 16268172 5422930 58535634 52773005 5762629 32023663 24017749 8005914 25243 25243 284953 2369 282584 562889 562889 169243636 142854750 26388886 3662270 2181481 1480789 46597147 37699439 8897708 22864019 17682465 5181554 31073685 23874048 7199637 511803 338771 173032 1816624 1355404 461220 11947910 11947910 63671136 63671136 7274052 7255280 18772 MEDICAL SUPPLIES 252612372 251461811 1150561 INCOME TAXES 653680 653680 BAD DEBT 73332237 73332237 PROVIDER ASSESSMENT 25920249 25920249 178990 133954 45036 1260863811 1147158690 113705121 0 25325467 18762350 38604347 303304584 350307047 32041387 17078515 22269612 7131300 4712483 1451087502 807483628 553420299 643603874 608352455 627932795 41336484 65673237 25336142 13009195 1619889593 1778311980 159427458 272033669 317847467 494400200 96476032 97670031 49380055 671420988 815813924 X 940380300 957729652 4535459 2797220 3552846 1971184 948468605 962498056 1619889593 1778311980 X 7128081 882818 6018552 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 0 0 0 0 1 510138 0 1 52751 562889 0 EXPLANATION OF LOBBYING ACTIVITIES: PART II-B, LINE 1: GOVERNMENT RELATIONS THE OFFICE OF GOVERNMENT RELATIONS WAS ACTIVELY INVOLVED WITH SEVERAL FEDERAL AND STATE ISSUES. THE OFFICE ASSISTED IN DEVELOPING POLITICAL ADVOCACY STRATEGIES REGARDING THE CENTERS FOR MEDICARE & MEDICAID SERVICES' (CMS) POLICY ON REBILLING PART A CLAIMS; CMS' IMPLEMENTATION OF THE "TWO-MIDNIGHT" POLICY REGARDING PATIENT STATUS; CUTS TO PAYMENTS FOR EVALUATION AND MANAGEMENT SERVICES AND CERTAIN OTHER PROCEDURES PROVIDED IN HOSPITAL OUTPATIENT DEPARTMENTS (HOPD'S); REDUCTIONS TO PAYMENTS FOR GRADUATE MEDICAL EDUCATION (GME); CHANGES TO THE 340B DRUG DISCOUNT PROGRAM; REDUCTIONS IN PAYMENTS TO HOSPITALS FOR ASSISTANCE TO LOW-INCOME MEDICARE BENEFICIARIES (BAD DEBT); RESTRICTIONS ON MEDICAID PROVIDER ASSESSMENTS; REALIGNMENT OF MEANINGFUL USE STAGE 2 REQUIREMENTS TO ENSURE A SAFE, ORDERLY TRANSITION; MODIFICATIONS TO THE HOSPITAL READMISSIONS REDUCTION PROGRAM (HRRP); CHANGES TO THE HOSPITAL-ACQUIRED CONDITION (HACS) REDUCTION PROGRAM AND GUIDANCE REGARDING SEQUESTRATION FOR MEDICARE AND THE NIH. STAFF WORKED ON THE FY2014 BUDGET; FY 2014 MEDICARE INPATIENT PROSPECTIVE PAYMENT SYSTEM (PPS) PROPOSED RULE; CY2014 HOSPITAL OUTPATIENT PROSPECTIVE PAYMENT SYSTEM (HOPPS)/AMBULATORY SURGICAL CENTERS (ASC) PROPOSED RULE AND THE 2014 MEDICARE PHYSICIAN FEE SCHEDULE. THEY ALSO WORKED ON TAX REFORM REGARDING INVESTMENT TAX CREDITS AND MEDICARE PHYSICIAN PAYMENTS INCLUDING ADJUSTMENTS AND POSSIBLE REPEAL OF THE SUSTAINABLE GROWTH RATE (SGR). STAFF ALSO WORKED ON MANY OF THE FY 2014 APPROPRIATIONS BILLS AND PROPOSED LEGISLATION AND REGULATIONS THAT WERE INTRODUCED, INCLUDING DEPARTMENT OF DEFENSE; DEPARTMENT OF HEALTH AND HUMAN SERVICES; AND VETERANS AFFAIRS (VA) RESEARCH AND MEDICAL CARE FUNDING; THE "TRAINING TOMORROW'S DOCTORS TODAY ACT" (HR 1201), THE "RESIDENT PHYSICIAN SHORTAGE REDUCTION ACT OF 2013" (S577), THE "MEDICARE AUDIT IMPROVEMENT ACT" (HR 1250, S 1-12); THE "DSH REDUCTION RELIEF ACT" (HR 1920)AND THE "FAIRNESS IN HEALTH CARE CLAIMS, GUIDANCE AND INVESTIGATIONS ACT" (HR 2931). THE OFFICE ASSISTED WITH THE FOLLOWING: (1) IRS PROPERTY-TAX EXEMPTIONS FOR NONPROFITS GUIDELINES AND COMMUNITY BENEFITS ANALYSIS; (2) NIH APPROPRIATIONS AND FUNDING FOR HEALTH PROFESSIONS; (3) DELAY OF THE COMPLIANCE DATE FOR ICD-10-CM AND ICD-10-PCS MEDICAL DATA CODE SETS; AND (4) PATENTS AND INTELLECTUAL PROPERTY ISSUES. AT THE STATE LEVEL, EFFORTS WERE CONCENTRATED ON FUNDING FOR THE WAKE FOREST INSTITUTE FOR REGENERATIVE MEDICINE; LEGISLATION REGARDING ADDITIONAL FUNDING FOR AUTOPSIES; THE FEDERALLY RUN INSURANCE EXCHANGE AND MEDICAID EXPANSION UNDER THE AFFORDABLE CARE ACT; THE FY 2014-5 MEDICAID BUDGET, THE MEDICAID REIMBURSEMENT INITIATIVE AND UPPER PAYMENT LIMIT PROVISIONS; ON LEGISLATION REGARDING CERTIFICATE-OF-NEED LAWS, BUSINESS INCENTIVE TAX LAWS, INCLUDING THE MILL TAX CREDIT FOR THE PIEDMONT TRIAD RESEARCH PARK; MENTAL HEALTH ISSUES, TRANSPARENCY AND REFORMING THE TAX CODE INCLUDING SALES TAX REFUND PROTECTION PROVISIONS. PART II-B, LINE 1J - PRORATA PORTION OF DUES PAID TO STATE AND LOCAL 501(C)(6) ORGANIZATIONS THAT REPRESENTS LOBBYING ON BEHALF OF ITS MEMBERS. 8088305 616961 185112 4121974 4768404 7303928 1221778 -65209 124978 709300 -462086 8088305 5383158 841681 576477 113868 738112 -1354592 7303928 5437445 446548 259105 110679 649261 5383158 4470108 117064 -780842 17979 -1649094 5437445 0.41340 0.58660 0 0 12409538 12409538 681801862 416279094 265522768 393730 93844 299886 556678663 381076068 175602595 199803709 10034622 189769087 643603874 OTHER LIABILITIES 33312862 PENSION LIABILITIES 14478459 CAPITAL LEASE 1588734 49380055 X DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: THE HOSPITAL'S ENDOWMENT FUNDS ARE USED TO PROVIDE SUPPORT FOR EDUCATION, SCHOLARSHIPS, INDIGENT CARE, AND OTHER DEPARTMENTAL FUNDING. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X, LINE 2: THE ORGANIZATION HAS EVALUATED UNCERTAIN TAX POSITIONS FOR ITS FISCAL YEARS ENDED JUNE 30, 2013 AND 2012, INCLUDING A QUANTIFICATION OF TAX RISK IN AREAS SUCH AS UNRELATED BUSINESS TAXABLE INCOME AND THE TAXATION OF ITS FOR-PROFIT SUBSIDIARIES. THIS EVALUATION DID NOT HAVE A MATERIAL EFFECT ON THE ORGANIZATION'S FINANCIAL STATEMENTS FOR THE YEARS ENDED JUNE 30, 2013 AND 2012. CENTRAL AMERICA AND THE CARIBBEAN 0 0 INVESTMENTS 65020409 0 0 0 0 0 0 65020409 0 65020409 1 0 1 0 0 0 1 1 1 X 1 X 1 1 1 0 1 1 52840837 7148924 45691913 0.03620 213271887 221113529 -7841642 0.00000 27741302 18462791 9278511 0.00740 293854026 246725244 47128782 0.04360 2150873 2150873 0.00170 70673253 21482929 49190324 0.03900 1504434 1504434 0.00120 13346735 13346735 0.01060 876907 876907 0.00070 88552202 21482929 67069273 0.05320 382406228 268208173 114198055 0.09680 105489 105489 0.00010 270326 270326 0.00020 248782 248782 0.00020 624597 624597 0.00050 0 28000801 0 376979402 440408271 -63428869 X 1 1 1 1 NORTH CAROLINA BAPTIST HOSPITAL

MEDICAL CENTER BLVD WINSTON SALEM NC 27157

X X X X NORTH CAROLINA BAPTIST HOSPITAL 1 1 X X X X X X X X X 12 1 1 1 X X X X X X X X X X X 0 0 1 1 200.000000000000 1 400.000000000000 1 X X X X X X 1 1 X X X X 1 0 X X X X 1 X 0 0 30 STRATFORD EXECUTIVE PARK ABDOMINAL ORGAN

140 CHARLOIS BOULEVARD WINSTONSALEM NC 271031522

ABDOMINAL ORGAN TRANSPLANT PROGRAM DOWNTOWN HEALTH PLAZA

1200 N MARTIN LUTHER KING JR DRIVE WINSTONSALEM NC 271013006

FAMILY MEDICINE WAKE FOREST UNIVERSITY BAPTIST IMAGING

265 EXECUTIVE PARK BLVD WINSTONSALEM NC 27103

IMAGING CENTER WINSTON EAST PEDIATRICS

2295 EAST 14TH STREET WINSTONSALEM NC 271056804

PEDIATRICS STRATFORD EXECUTIVE PARK INTERNAL MEDICI

500 SHEPHARD STREET SUITE 300 WINSTONSALEM NC 271031633

IM MULTISPECIALTY CLINICS MEDICAL PLAZA COUNTRY CLUB DERMATOLOGIC

4618 COUNTRY CLUB ROAD WINSTONSALEM NC 271043520

GENERAL DERMATOLOGY MEDICAL PLAZA COUNTRY CLUB GENERAL DERMA

4618 COUNTRY CLUB ROAD WINSTONSALEM NC 271043520

DERMATOLOGIC SURGERY STRATFORD EXECUTIVE PARK OBGYN

500 SHEPHARD STREET SUITE 201 WINSTONSALEM NC 271031633

OB/GYN WAKE FOREST BAPTIST HEALTH FAMILY MEDICI

1920 W FIRST STREET WINSTONSALEM NC 271044220

FAMILY MEDICINE STRATFORD EXECUTIVE PARK MATERNAL-FETAL

500 SHEPHARD STREET SUITE 200 WINSTONSALEM NC 271031633

MATERNAL-FETAL MEDICINE NCBH OUTPATIENT ENDOSCOPY CENTER LLC

100 CHARLOIS BLVD SUITE 100 WINSTONSALEM NC 27103

OUTPATIENT ENDOSCOPY MEDICAL PLAZA COUNTRY CLUB - JOSLIN ADUL

4610 COUNTRY CLUB ROAD WINSTONSALEM NC 271043520

ADULT DIABETES CENTER MEDICAL PLAZA COUNTRY CLUB - JOSLIN PEDI

4610 COUNTRY CLUB ROAD WINSTONSALEM NC 271043520

PEDIATRIC DIABETES CENTER MEDICAL PLAZA COUNTRY CLUB - UNIVERSITY

4614 COUNTRY CLUB ROAD WINSTONSALEM NC 271043520

INTERNAL MEDICINE MEDICAL PLAZA COUNTRY CLUB - CARDIOLOGY

4614 COUNTRY CLUB ROAD WINSTONSALEM NC 271043520

CARDIOLOGY MEDICAL PLAZA COUNTRY CLUB - WEIGHT MANA

4614 COUNTRY CLUB ROAD WINSTONSALEM NC 271043520

WEIGHT MANAGEMENT MEDICAL PLAZA CLEMMONS - BLDG 2311 GENER

2311 LEWISVILLE-CLEMMONS ROAD CLEMMONS NC 27012

PEDIATRICS MEDICAL PLAZA CLEMMONS - BLDG 2311 SPECI

2311 LEWISVILLE-CLEMMONS ROAD CLEMMONS NC 27012

PEDIATRIC SPECIALTIES MEDICAL PLAZA CLEMMONS - BLDG 2311 IMPR

2311 LEWISVILLE-CLEMMONS ROAD CLEMMONS NC 27012

INTERNAL MEDICINE & PRIMARY CARE MEDICAL PLAZA CLEMMONS - BLDG 2311 ALLER

2311 LEWISVILLE-CLEMMONS ROAD CLEMMONS NC 27012

ALLERGY, ASTHMA & IMMUNOLOGY MEDICAL PLAZA CLEMMONS - BLDG 2311 HEMO

2311 LEWISVILLE-CLEMMONS ROAD CLEMMONS NC 27012

ONCOLOGY COMP REHAB

131 MILLER STREET WINSTONSALEM NC 27103

REHABILITATION MEDICAL PLAZA CLEMMONS - BLDG 2341

2341 LEWISVILLE-CLEMMONS ROAD CLEMMONS NC 27012

BREAST CARE SERVICES MEDICAL PLAZA CLEMMONS - BLDG 2341

2341 LEWISVILLE-CLEMMONS ROAD CLEMMONS NC 27012

ENT/HEAD AND NECK SURGERY - CLEMMONS MT AIRY HEMATOLOGY & ONCOLOGY

450 PRICE STREET MT AIRY NC 27030

HEMATOLOGY AND ONCOLOGY MEDICAL PLAZA CLEMMONS - BLDG 2341

2341 LEWISVILLE-CLEMMONS ROAD CLEMMONS NC 27012

NEUROLOGY - CLEMMONS MEDICAL PLAZA CLEMMONS - BLDG 2341

2341 LEWISVILLE-CLEMMONS ROAD CLEMMONS NC 27012

OB/GYN PAIN CENTER BROOKSTOWN

605 COTTON STREET WINSTONSALEM NC 27101

PAIN CLINIC AND SERVICES MEDICAL PLAZA CLEMMONS - BLDG 2341

2341 LEWISVILLE-CLEMMONS ROAD CLEMMONS NC 27012

SPINE CENTER - CLEMMONS MEDICAL PLAZA CLEMMONS - BLDG 2341

2341 LEWISVILLE-CLEMMONS ROAD CLEMMONS NC 27012

VEIN SERVICES - CLEMMONS PART I, LINE 3C: THE ORGANIZATION ALSO EVALUATES CERTAIN CREDIT FILE DATA ELEMENTS TO IDENTIFY POTENTIAL SOURCES OF HIDDEN INCOME TO MORE ACCURATELY INFORM CHARITY CARE ELIGIBILITY ASSESSMENTS. PATIENTS WITH ESTIMATED HOUSEHOLD INCOME BELOW 200% OF FPG, WHO ARE IDENTIFIED AS HAVING COMMERCIAL CREDIT ACCOUNTS THAT ARE BEING SERVICED IN A MANNER THAT SUGGESTS ADDITIONAL SOURCES OF INCOME, ARE NOT AUTOMATICALLY GRANTED PRESUMPTIVE CHARITY CARE. PART I, LINE 7: THE ORGANIZATION USED THE WORKSHEETS PROVIDED IN THE INSTRUCTIONS TO SCHEDULE H TO COMPUTE ITS COST-TO-CHARGE RATIO FOR PURPOSES OF THE 2012 SCHEDULE H.PART I, LINE 7B MEDICAID DIRECT OFF SETTING REVENUETHE HOSPITAL PARTICIPATES IN A PROVIDER ASSESSMENT PROGRAM ADMINISTERED BY THE NORTH CAROLINA DEPARTMENT OF HEALTH AND HUMAN SERVICES. UNDER THE PROGRAM, A FEE IS ASSESSED AGAINST NON-MEDICAID NET PATIENT SERVICE REVENUES OF PRIVATE HOSPITALS. THE FEDERAL GOVERNMENT MATCHES THE ASSESSMENT ON A 2 TO 1 BASIS AND THESE AMOUNTS ARE ALLOCATED TO NORTH CAROLINA HOSPITALS ON A QUARTERLY BASIS. PART I, L7 COL(F): THE ORGANIZATION'S PATIENT BAD DEBT EXPENSE PER THE AUDITED FINANCIAL STATEMENTS WAS $73,332,237 FOR THE FISCAL YEAR ENDED JUNE 30, 2013. THIS AMOUNT HAS BEEN REMOVED FROM THE CALCULATION OF CHARITY CARE FOR PART I, LINE 7. PART II: THE HOSPITAL IS RESPONSIVE TO THE COMMUNITIES IT SERVES THROUGH A NUMBER OF ACTIVITIES, PROGRAMS AND INITIATIVES. THE HOSPITAL IS CURRENTLY ALIGNED WITH THE FORSYTH COUNTY HEALTH DEPARTMENT AND LEADS AND/OR PARTICIPATES IN A WIDE VARIETY OF PARTNERSHIPS AND LOCAL COALITIONS. THESE INCLUDE THE BE HEALTH- OBESITY COALITION, HEAT- HEALTH DISPARITIES AND THE CHRONIC DISEASE COALITION. COLLECTIVELY THESE COALITIONS ARE TASKED WITH IMPROVING THE HEALTH STATUS OF THE COMMUNITIES THEY SERVE WITH A SPECIFIC FOCUS ON CHRONIC DISEASE, PHYSICAL ACTIVITY/ NUTRITION AND TOBACCO USE. SPECIFICALLY, THE COALITIONS ARE WORKING COLLABORATIVELY TO 1) REDUCE THE CARDIOVASCULAR DISEASE MORTALITY RATE, 2) DECREASE THE INCIDENCE OF DIABETES, 3) INCREASE THE PERCENTAGE OF ADULTS REPORTING GOOD, VERY GOOD OR EXCELLENT HEALTH, 4) INCREASE THE PERCENTAGE OF HIGH SCHOOL STUDENTS WHO ARE NEITHER OVERWEIGHT NOR OBESE, 5) INCREASE THE PERCENTAGE OF ADULTS WHO REPORT THAT THEY CONSUME FRUITS AND VEGETABLES FIVE OR MORE TIMES PER DAY, 6) INCREASE THE PERCENTAGE OF ADULTS GETTING THE RECOMMENDED AMOUNT OF PHYSICAL ACTIVITY, AND 7) DECREASE THE PERCENTAGE OF HIGH SCHOOL STUDENTS REPORTING CURRENT USE OF ANY TOBACCO PRODUCT. THE HOSPITAL IS SPECIFICALLY RESPONSIVE TO THE CHRONIC HEALTH NEEDS OF THE COMMUNITY BY PROVIDING FREE CARE TO ITS RESIDENTS AND PROVIDES $4 MILLION IN SUBSIDY FUNDING FOR THE DOWNTOWN HEALTH PLAZA, A LEVEL 3 NCQA SITE AND NATIONAL HEALTH SERVICE CORP SITE. DOWNTOWN HEALTH PLAZA SERVES APPROXIMATELY 65,000 PATIENT VISITS PER YEAR INCLUDING 28,000 ADULTS, 29% OF WHICH ARE SELF-PAY; 19,000 ARE OB/GYN PATIENTS, 51% ARE SELF-PAY; AND 18,000 PEDIATRIC PATIENTS, 3% OF WHICH ARE SELF-PAY. MANY OF THE SELF-PAY PATIENTS ARE MANAGING CHRONIC DISEASES SUCH AS DIABETES, KIDNEY FAILURE AND HEART FAILURE, AND DHP PROVIDES CARE AND COUNSELING AT NO COST FOR THESE CONDITIONS. SPECIFICALLY DHP PROVIDES SIGNIFICANT BENEFIT TO THE COMMUNITY THROUGH THE FOLLOWING INITIATIVES: COLLABORATION WITH NORTHWEST COMMUNITY CARE NETWORK THROUGH ONSITE PEDIATRIC AND INTERNAL MEDICINE CASE MANAGERS; AS A PARTICIPATING WIC SITE; PROVIDES A COMMUNITY GARDEN PROVIDING FRESH VEGETABLES AND HERBS TO PATIENTS; PROVIDES A FREE FOOD PANTRY TO PATIENTS; OFFERS A CO-LOCATED MENTAL HEALTH COUNSELOR FOR CHILDREN IN PARTNERSHIP WITH THE CHILDREN'S HOME; AND A CO-LOCATED PARENT EDUCATOR PROGRAM IN PARTNERSHIP WITH IMPRINTS TO HELP FAMILIES ADDRESS DEVELOPMENTAL DELAYS. DHP ALSO COORDINATES WITH NORTHWEST COMMUNITY CARE NETWORK AND CENTERPOINT TO PROVIDE AN INNOVATIVE COMPREHENSIVE CARE MANAGEMENT FOR A HIGH RISK POPULATION (INCLUSIVE OF THE UNINSURED) THROUGH AN INTENSIVE CARE COORDINATION PROGRAM (HIGHER RISK FOR READMISSIONS AND ED VISITS). DHP ALSO PROVIDES AN ANNUAL SHARE THE HEALTH FREE HEALTH FAIR, PROVIDING FREE HEALTH SCREENINGS AND OTHER HEALTH-RELATED SERVICES AVAILABLE TO EVERYONE (ADULTS AND CHILDREN) REGARDLESS OF AGE, INSURANCE COVERAGE, AND INCOME LEVEL OR IMMIGRATION STATUS. THE HEALTH FAIR SERVES APPROXIMATELY 650 CHILDREN AND ADULTS ON AN ANNUAL BASIS. THE HOSPITAL ALSO PROVIDES A NUMBER OF PUBLIC EDUCATIONAL PROGRAMS THROUGH BEST HEALTH. BEST HEALTH IS THE COMMUNITY WELLNESS OUTREACH PROGRAM OF WAKE FOREST BAPTIST HEALTH AND IN FY 2013 IT PROVIDED 18 SUPPORT GROUP SESSIONS PRIMARILY FOR STROKE AND OBESE PATIENTS, 28 NUTRITION/HEALTHY COOKING CLASSES, 32 EXERCISE CLASSES FOR HEART/VASCULAR PATIENTS, AND 16 HEART HEALTH SCREENING IN THE COMMUNITY. BRENNER FIT (FAMILIES IN TRAINING) HAS THE LONGEST TRACK RECORD AND THE MOST EXPERIENCE IN PROVIDING PREVENTION AND TREATMENT PROGRAMS FOR OVERWEIGHT AND OBESE POPULATIONS IN THE HOSPITAL'S SERVICE AREA. OVER THE PAST FIVE YEARS, BRENNER FIT HAS ACCOMPLISHED THE FOLLOWING:- PROVIDED TREATMENT FOR MORE THAN 500 CHILDREN THROUGH THE BRENNER FIT CLINIC, MANY OF WHOM ARE UNINSURED/UNDERINSURED, REPRESENTING APPROXIMATELY 2000 DIFFERENT FAMILY MEMBERS FROM OUR COMMUNITY; - GAVE OVER 150 COMMUNITY PRESENTATIONS, REACHING AN ESTIMATED AUDIENCE OF 25,000; - PUBLISHED 30 JOURNAL ARTICLES, RESEARCH PAPERS AND BOOK CHAPTERS, AND HAVE BEEN REPRESENTED IN MULTIPLE ON-LINE MEDICAL RESOURCES;- PRESENTED OVER 60 TIMES TO ACADEMIC OR CLINICAL AUDIENCES;- FEATURED OVER 80 TIMES IN REGIONAL AND NATIONAL MEDIA;- TRAINED 15 STUDENTS, FELLOWS, AND INTERNS, IN ADDITION TO DEVELOPING A MEDICAL STUDENT WORKSHOP;AND-DEVELOPED 22 NEW PROGRAMS FOCUSED ON CHILDHOOD OBESITY PREVENTION AND TREATMENT.AS A HEART AND VASCULAR CENTER OF EXCELLENCE, THE HOSPITAL ALSO SPONSORS SEVERAL HEART RELATED SCREENINGS EACH YEAR INCLUDING FREE EKG SCREENINGS, HEART HEALTH TALKS, FREE COMMUNITY CPR CLASSES AND HEART AND STROKE PREVENTION CLASSES AT COUNTY GOVERNMENT WORKSITES. FINALLY, AS A CANCER CENTER OF EXCELLENCE AND AN NCI DESIGNATED CANCER CENTER, OUTREACH TO THE COMMUNITY IS A VITAL COMPONENT TO SERVING PATIENTS AND FAMILIES. OUTREACH AND COLLABORATIONS INCLUDE ANNUAL SKIN CANCER SCREENINGS , NUTRITION CLASSES, COORDINATION WITH THE BE HEALTHY COALITION TO ENCOURAGE PHYSICAL ACTIVITY AMONG ALL FORSYTH COUNTY RESIDENTS THROUGH A TWO-MONTH PROGRAM WITH STEP UP FORSYTH, A FREE COMMUNITY WIDE PROGRAM COLLABORATION WITH THE YMCA, A 6 WEEK CHRONIC DISEASE MANAGEMENT WORKSHOP , FREE YOGA FOR BREAST CANCER PATIENTS AND SURVIVORS, AS WELL AS SEVERAL FREE LUNCH AND LEARN WORKSHOPS ON CANCER AWARENESS AND PREVENTION.CURRENTLY THE HOSPITAL IS AN ACTIVE PARTICIPANT IN THE FORSYTH BEHAVIORAL HEALTH COALITION WHICH INCLUDES REPRESENTATIVES FROM WAKE FOREST BAPTIST MEDICAL CENTER, FORSYTH MEDICAL CENTER, CENTERPOINT AND NORTHWEST COMMUNITY CARE NETWORK (NCCN). THE COALITION IS ACTIVELY WORKING WITH THE NORTH CAROLINA HOSPITAL ASSOCIATION ON A COMPREHENSIVE PLAN TO TAKE TO THE NORTH CAROLINA STATE LEGISLATURE WITH THE FOLLOWING PRIORITIES:- DEVELOPMENT AND OBTAIN FUNDING FOR A COUNTY ED CRISIS INTERVENTION PROGRAM, AS THERE IS NO CURRENT CRISIS INTERVENTION SUPPORT IN FORSYTH OR SURROUNDING COUNTIES; AND- OBTAIN LEGISLATIVE SUPPORT FOR A WET SHELTER PROGRAM.THE COALITION IS ALSO WORKING TO ENSURE THAT WE HAVE STRUCTURES AND PROCESSES IN PLACE TO IMPROVE THE PATIENT FLOW AND TO ELIMINATE DUPLICATION OF SERVICES. LASTLY, NCCN IS WORKING WITH CENTERPOINT TO ENSURE THE BIDIRECTIONAL FLOW OF ELECTRONIC INFORMATION. PART III, LINE 4: THE ORGANIZATION'S FINANCIAL STATEMENTS DO NOT INCLUDE A DISCRETE FOOTNOTE EXPLAINING BAD DEBT EXPENSE. BAD DEBT HAS NOT BEEN INCLUDED IN THE COMPUTATION OF COMMUNITY BENEFIT ON PART I, LINE 7. THE ORGANIZATION HAS A THOROUGH PROCESS OF EVALUATING BAD DEBT ACCOUNTS AS INFORMATION BECOMES AVAILABLE AND RECLASSIFIES BAD DEBT ACCOUNTS AS CHARITY CARE AS PROVIDED BY THE CHARITY CARE POLICY. AMOUNTS USED TO COMPUTE CHARITY CARE AND BAD DEBT ON SCHEDULE H USE THE MOST CURRENT DATA AVAILABLE AT THE TIME OF FILING. THE ORGANIZATION USED WORKSHEET 2 OF THE 2012 SCHEDULE H INSTRUCTIONS TO COMPUTE A COST TO CHARGES RATIO USED TO CALCULATE BAD DEBT AT COST. PART III, LINE 8: THE HOSPITAL USES AN OVERALL COST TO CHARGE RATIO CALCULATION BASED ON AUDITED FINANCIAL STATEMENTS BUT REMOVES COST ASSOCIATED WITH BAD DEBT, GME, COMMUNITY BUILDING, AND CHARITY CARE SO AS NOT TO COUNT THOSE COSTS TWICE. PART III, LINE 9B: PATIENT FINANCIAL RESOURCES SERVICES WORKS WITH THE PATIENT FOR ANY PATIENT LIABILITY. OUR MAIN FOCUS IS PRIOR TO SERVICESAND/OR DISCHARGE; HOWEVER, WE DO WORK WITH PATIENTS AFTER SERVICES HAVEBEEN RECEIVED AND BILLED. PATIENT FINANCIAL RESOURCES SERVICES IS REALLYTWO AREAS IN ONE--THE RESOURCE RECOVERY SPECIALIST/RRS (FORMERLY FINANCIALCOUNSELING) AND THE MEDICAID ELIGIBILITY TEAM/MPS. THESE TWO AREAS WORKTOGETHER TO FIND A RESOLUTION TO PATIENT LIABILITY, SELF PAY OR INSURED.THE RRS WORKS TO NOTIFY THE PATIENT OF ANY PATIENT LIABILITY AND ASK FORPAYMENT FOR THAT LIABILITY. IF THE PATIENT INDICATES THAT HE/SHE NEEDSASSISTANCE, THEN THE RRS WILL COMPLETE A FINANCIAL STATEMENT ON THEPATIENT. WHILE TAKING THAT FINANCIAL STATEMENT THE RRS IS LOOKING FORINFORMATION THAT COULD QUALIFY THE PATIENT FOR MEDICAID OR FOR OTHERAGENCY PROGRAMS THAT ARE AVAILABLE TO THE MEDICAL CENTER. WHEN THATINFORMATION IS IDENTIFIED THE RRS WILL LET THE PATIENT KNOW THAT AREFERRAL WILL BE MADE FOR MEDICAID OR OTHER ASSISTANCE AND A MPS WILL BEIN TOUCH WITH HIM/HER. THE RRS ALSO EXPLAINS TO THE PATIENT OR FAMILY THATCHARITY CARE IS A LAST RESORT AND THEY MUST COOPERATE WITH ANY OTHERASSISTANCE PROGRAMS THAT WE HAVE IDENTIFIED AND BE FOUND INELIGIBLE BEFORECHARITY CARE WILL BE APPROVED/APPLIED. IT IS ALSO COMMUNICATED WITH THEPATIENT OR FAMILY IS INFORMED IF ANY SUPPORTING DOCUMENTATION IS NEEDED FOR ANY ASSISTANCE, WHETHER THAT BE CHARITY, MEDICAID, OR OTHER PROGRAMS. NORTH CAROLINA BAPTIST HOSPITAL PART V, SECTION B, LINE 3: COMMUNITY INPUT WAS OBTAINED THROUGH THREE SOURCES OF PRIMARY DATA COLLECTION; (1) DOOR TO DOOR SURVEY; (2) NINE FOCUS GROUPS WITH UNDERSERVED, LOW INCOME AND MINORITY COMMUNITIES; AND (3) A YOUTH RISK BEHAVIOR SURVEY. THE HOSPITAL WORKED WITH PUBLIC HEALTH EXPERTS FROM THE FORSYTH COUNTY DEPARTMENT OF HEALTH AND FORTY ONE COMMUNITY LEADERS REPRESENTING THE FAITH COMMUNITY, PRIVATE BUSINESS, HEALTHCARE, HIGHER EDUCATION, PUBLIC SAFETY, SOCIAL SERVICES, MENTAL HEALTH, GOVERNMENT AND PRIVATE AND PUBLIC FOUNDATIONS. NORTH CAROLINA BAPTIST HOSPITAL PART V, SECTION B, LINE 4: THE HOSPITAL'S CHNA WAS CONDUCTED IN COLLABORATION WITH FORSYTH MEMORIAL HOSPITAL (DBA FORSYTH MEDICAL CENTER), A TAX-EXEMPT HOSPITAL IN FORSYTH COUNTY. NORTH CAROLINA BAPTIST HOSPITAL PART V, SECTION B, LINE 5C: THE HOSPITAL'S COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) AND CHNA IMPLEMENTATION STRATEGY CAN BE LOCATED ON ITS WEBSITE AT WWW.WAKEHEALTH.EDU/COMMUNITY-HEALTH.HTM. IN ADDITION, A COPY OF THE HOSPITAL'S CHNA IS AVAILABLE AT THE FORSYTH COUNTY HEALTH DEPARTMENT. NORTH CAROLINA BAPTIST HOSPITAL PART V, SECTION B, LINE 7: MATERNAL AND INFANT HEALTH WAS NOT INCLUDED IN THE HOSPITAL'S TOP PRIORITIZED HEALTH NEEDS BECAUSE THE HOSPITAL DOES NOT DELIVER BABIES, EXCEPT IN EMERGENCY SITUATIONS. FORSYTH MEMORIAL HOSPITAL IS THE PRIMARY PROVIDER OF MATERNITY SERVICES IN THE COMMUNITY. NORTH CAROLINA BAPTIST HOSPITAL PART V, SECTION B, LINE 10: THE HOSPITAL USES THE FEDERAL POVERTY GUIDELINES TO DETERMINE ELIGIBILITY FOR FREE CARE. INDIVIDUALS AT OR BELOW 200% OF THE FEDERAL PROVERTY GUIDELINES ARE ELIGIBLE FOR FREE CARE. THE ORGANIZATION EVALUATES CERTAIN CREDIT FILE DATA ELEMENTS TO IDENTIFY POTENTIAL SOURCES OF HIDDEN INCOME TO MORE ACCURATELY INFORM CHARITY CARE ELIGIBILITY ASSESSMENTS. PATIENTS WITH ESTIMATED HOUSEHOLD INCOME BELOW 200% OF FPG, WHO ARE IDENTIFIED AS HAVING COMMERCIAL CREDIT ACCOUNTS THAT ARE BEING SERVICED IN A MANNER THAT SUGGESTS ADDITIONAL SOURCES OF INCOME, ARE NOT AUTOMATICALLY GRANTED PRESUMPTIVE CHARITY CARE. NORTH CAROLINA BAPTIST HOSPITAL PART V, SECTION B, LINE 11: THE ORGANIZATION USES A SLIDING SCALE OF THE FEDERAL POVERTY GUIDELINES TO DETERMINE ELIGIBILITY FOR DISCOUNTED CARE. INDIVIDUALS BETWEEN 201% AND 300% OF THE FEDERAL POVERTY GUIDELINES ARE GRANTED A 75% DISCOUNT AND INDIVIDUALS BETWEEN 301% AND 400% OF THE FEDERAL PROVERTY GUIDELINES ARE GRANTED A 60% DISCOUNT. NORTH CAROLINA BAPTIST HOSPITAL PART V, SECTION B, LINE 12H: RESIDENT OF THE MEDICAL CENTER'S 19 COUNTY SERVICE AREA. PART VI, LINE 2: TO COMPLETE A COMPREHENSIVE ASSESSMENT OF THE NEEDS OF THE COMMUNITY, AN INTERNAL COMMUNITY HEALTH TEAM RELIED ON THE ASSOCIATION FOR COMMUNITY HEALTH IMPROVEMENT'S (ACHI) 6-STEP COMMUNITY HEALTH ASSESSMENT PROCESS ALONG WITH PARTICIPATION IN THE NORTH CAROLINA DIVISION OF PUBLIC HEALTH ASSESSMENT PROCESS AS ORGANIZING METHODOLOGIES. A COMMUNITY WIDE TEAM COMPRISED OF THE FORSYTH COUNTY HEALTH DEPARTMENT, WAKE FOREST BAPTIST MEDICAL CENTER, FORSYTH MEDICAL CENTER AND VARIOUS COMMUNITY GROUPS INCLUDING THE UNITED WAY, THE YMCA, YWCA AND THE COUNTY GOVERNMENT AMONG MANY OTHERS HAS CONVENED TO CONDUCT A COLLABORATIVE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) EVERY THREE YEARS WITH INPUT FROM KEY COMMUNITY LEADERS, THE ACADEMIC COMMUNITY, THE SCHOOL DISTRICT, THE PUBLIC AND OTHERS. FOUNDED ON THE PRINCIPLES OF COLLABORATION, COMMUNITY MOBILIZATION AND EMPOWERMENT, THE COMMUNITY HEALTH ASSESSMENT PROCESS IS USED TO IDENTIFY PRIORITY HEALTH ISSUES AND TO PLAN INTERVENTIONS TO BUILD HEALTHIER COMMUNITIES WITH THE ULTIMATE GOAL OF MAKING NORTH CAROLINA, INCLUDING FORSYTH COUNTY, ONE OF THE HEALTHIEST STATES IN THE NATION. TO ENSURE A COMPLETE ASSESSMENT, THE HOSPITAL'S INTERNAL TEAM HAS ADOPTED THE ACHI PROCESS TO ENSURE BOTH PUBLIC HEALTH AND THE NEWLY REQUIRED COMMUNITY HEALTH NEEDS ASSESSMENT REQUIREMENTS INCLUDED IN THE AFFORDABLE CARE ACT WOULD BE MET. THE ASSESSMENT PROCESS CONSISTS OF COLLECTING PRIMARY AND SECONDARY DATA FOR EACH OF THE FOLLOWING COMPONENTS: A) COMMUNITY PERSPECTIVE B) HEALTH EXPERTS C) COMMUNITY LEADERS D) SOCIAL DETERMINANTS OF HEALTH (SDOH) E) HEALTH STATISTICS/INDICATORS F) WFBMC DATA-ED AND INPATIENT CHRONIC DISEASE DATA PART VI, LINE 3: THE ORGANIZATION USES A VARIETY OF MEANS TO EDUCATE AND INFORM PATIENTS OF THEIR CHARITY CARE OPTIONS, INCLUDING INFORMATION ON A WEBSITE, BILLING PAMPHLETS AVAILABLE IN CLINICAL OFFICES AND THE BUSINESS OFFICE, SIGNS IN CHECK-IN AREAS, INFORMATION ON PATIENT BILL STATEMENTS, AND FROM STAFF MEMBERS DURING CONVERSATIONS CONCERNING A PATIENT'S LIABILITY FOR SERVICES. THE HOSPITAL EMPLOYS A ROBUST PRE-SERVICE FINANCIAL CLEARANCE PROCESS THAT SCREENS PATIENTS PRIOR TO SERVICE DELIVERY FOR EXISTING OR AVAILABLE PAYER SOURCES AS A MEANS OF AVOIDING BAD DEBT AND INAPPROPRIATE BILLING TO PATIENTS WITHOUT THE MEANS TO PAY. IF A PAYER SOURCE IS IDENTIFIED, HOSPITAL STAFF ASSIST THE PATIENT WITH ENROLLMENT. PART VI, LINE 4: IN FISCAL YEAR 2013, THE MEDICAL CENTER PROVIDED CARE TO A NINETEEN COUNTY SERVICE AREA WHICH COMPRISES 3.5% OF TOTAL INPATIENT DISCHARGES FOR NORTH CAROLINA. THE PRIMARY AND SECONDARY SERVICE AREA INCLUDE:PRIMARY SERVICE AREA COUNTIES - FORSYTH, DAVIE, DAVIDSON, STOKES, SURRY, YADKINSECONDARY SERVICE AREA COUNTIES - ROCKINGHAM, GUILFORD, RANDOLPH, ROWAN, IREDELL, CATAWBA, ALEXANDER, WILKES, ALLEGHANY, ASHE, WATAUGA, CALDWELL, BURKE PERCENT OF UNINSURED INPATIENTS 7.3%PERCENT OF INPATIENTS WHO ARE MEDICAID RECIPIENTS 20.4%THE HOSPITAL IS LOCATED IN CENTRAL FORSYTH COUNTY, WHICH COMPRISES THE SINGLE LARGEST COUNTY IN TOTAL INPATIENT DISCHARGES, ACCOUNTING FOR 13,142 OR 29.6% OF ALL DISCHARGES IN FY 13. ACCORDINGLY, THE HOSPITAL SERVES A WIDE SERVICE AREA; HOWEVER, IT IS RESOURCE PROHIBITIVE TO PARTICIPATE AND FUND HEALTH ASSESSMENTS IN EACH COMMUNITY/COUNTY FROM WHICH ITS PATIENT POPULATION ORIGINATES. THEREFORE, THE PRIMARY COMMUNITY BENEFIT SERVICE AREA (CBSA)IS FORSYTH COUNTY, NORTH CAROLINA.BELOW IS A DEMOGRAPHIC SNAPSHOT OF FORSYTH COUNTY BASED ON 2010 CENSUS DATA: POPULATION AND GEOGRAPHY TOTAL POPULATION 350,670POPULATION CHANGE SINCE 2000 + 12.7%LAND AREA 408.1 SQUARE MILESPOPULATION DENSITY 859.5 PERSONS PER SQUARE MILE POPULATION BY RACE/ETHNICITYWHITE 58.7%BLACK/AFRICAN-AMERICAN 25.5%HISPANIC 11.9%ASIAN 1.8%AMERICAN INDIAN/ 0.3%ALASKA NATIVE NATIVE HAWAIIAN/ 0.04%PACIFIC ISLANDERMULTIRACIAL 1.5%OTHER 0.2% POPULATION BY AGE DISTRIBUTIONUNDER 5 YEARS OLD 6.8%UNDER 18 YEARS OLD 24.4%= 65 YEARS OLD 13.0%MEDIAN AGE 37.5 YEARS POPULATION BY SEXMALE 47.5%FEMALE 52.5% POPULATION BY EDUCATIONAL ATTAINMENT PERCENT OF PERSONS = 25 YEARS OLD WHO HAVE:< HIGH SCHOOL DIPLOMA OR GED 13.8%A HIGH SCHOOL DIPLOMA OR GED 28.2%A BACHELOR'S DEGREE 20.7%GRADUATE DEGREE 10.0%PERCENTAGE OF FAMILIES LIVING BELOW POVERTY LEVELALL FAMILIES 11.0%FAMILIES WITH A HOUSEHOLDER WHO IS:WHITE 4.6%BLACK/AFRICAN AMERICAN 21.6%HISPANIC 31.4%ASIAN 6.6%AMERICAN INDIAN/ 17.2%OTHER RACE 34.7 PERCENTAGE OF POPULATION LIVING BELOW POVERTY LEVELCHILDREN (0-17YR OLD) 22.8%ADULTS (18-64YR OLD) 12.9%SENIORS (= 65YR OLD) 7.1% COUNTY SCHOOLSK-12 ENROLLMENT 53,627GRADUATION RATE 72.7% UNEMPLOYMENT UNEMPLOYMENT RATE 9.9%LOST JOBS & LAYOFFS 1,900 INCOMEMEDIAN FAMILY HOUSEHOLD $55,075MEDIAN NON-FAMILY HOUSEHOLD $28,023 PART VI, LINE 6: WAKE FOREST BAPTIST MEDICAL CENTER'S MISSION IS TOIMPROVE THE HEALTH OF OUR REGION, STATE AND NATION BY:1) GENERATING AND TRANSLATING KNOWLEDGE TO PREVENT, DIAGNOSE AND TREATDISEASE.2) TRAINING LEADERS IN HEALTH CARE AND BIOMEDICAL SCIENCE.3) SERVING AS THE PREMIER HEALTH SYSTEM IN OUR REGION, WITH SPECIFICCENTERS OF EXCELLENCE RECOGNIZED AS NATIONAL AND INTERNATIONAL CAREDESTINATIONS. THE HOSPITAL, WHICH IS THE INPATIENT COMPONENT OF WAKE FOREST BAPTIST MEDICAL CENTER, OPERATES THE FOLLOWING PROGRAMS CONSTITUTING COMMUNITY HEALTH IMPROVEMENT SERVICES AND COMMUNITY BENEFIT OPERATIONS REPORTED ON PART I,LINE 7E:WINSTON-SALEM/FORSYTH CTY SCHOOLS'ALLIED HEALTH PROGRAM $4,889COMMUNITY HEALTH/HEALTHCARE ACCESS $1,500 CHURCH COMMUNITY RELATIONS $401,995COMMUNITY HEALTH SALARIES $343,925PHYSICIANS COMMUNITY HEALTH ACCESS $371,418CARENET/PASTORAL COUNSELING $294,399ACCELERATED BACHELOR OF SCIENCE IN NURSING PROGRAM $395,004COUNTY RENT ON CLEVELAND AVE DENTAL CLINIC $111,559DIABETIC EDUCATION $79,284BRENNER FIT $141,358FAMILY RESOURCES $5,542TOTAL TO PART I, LINE 7E: $2,150,873 REPORTS FILED WITH STATES PART VI, LINE 7 NC 1 ALLIANCE FOR NORTH CAROLINA NONPROFITS 2501 BLUE RIDGE ROAD RALEIGH NC 27607 461358968 501(C)3 100000 COMMUNITY SUPPORT AMERICAN HEART ASSOCIATION 101 CENTREPORT DRIVE STE 130 GREENSBORO NC 27409 135613797 501(C)3 50000 COMMUNITY SUPPORT ARTS FOR LIFE PO BOX 5132 WINSTON SALEM NC 27113 562250962 501(C)3 25000 COMMUNITY SUPPORT CANCER SERVICES 3175 MAPLEWOOD AVE WINSTON SALEM NC 27103 560656375 501(C)3 10000 COMMUNITY SUPPORT EL BUEN PASTOR LATINO COMMUNITY SERVICES 4637 TIM ROAD WINSTON SALEM NC 27106 203751959 501(C)3 7000 COMMUNITY SUPPORT FORSYTH TECHNICAL COMMUNITY COLLEGE 2100 SILAS CREEK PARKWAY WINSTON SALEM NC 27103 560792614 501(C)3 68360 GREENE HALL EXPANSION JDRF PIEDMONT TRIAD CHAPTER 312 N EUGENE STREET SUITE D GREENSBORO NC 27401 231907729 501(C)3 25000 COMMUNITY SUPPORT MAKE A WISH FOUNDATION 212 S TRYON ST SUITE 1080 CHARLOTTE NC 28281 860481941 501(C)3 6000 COMMUNITY SUPPORT MARCH OF DIMES 410 BROOKSTOWN AVENUE WINSTON SALEM NC 27101 131846366 501(C)3 7500 COMMUNITY SUPPORT NC TRIAD AFFILIATE - SUSAN G KOMEN FOR THE CURE 1106 BURKE STREET WINSTON SALEM NC 27101 751835298 501(C)3 25000 COMMUNITY SUPPORT RONALD MCDONALD HOUSE 419 S HAWTHORNE ROAD WINSTON SALEM NC 27103 581454715 501(C)3 12500 COMMUNITY SUPPORT SENIOR SERVICES 2895 SHOREFIELD DRIVE WINSTON SALEM NC 27105 561085968 501(C)3 30000 COMMUNITY SUPPORT THE WOMEN'S FUND OF WINSTON SALEM 860 W FIFTH STREET WINSTON SALEM NC 27101 566037615 501(C)3 10000 COMMUNITY SUPPORT WINSTON SALEM FOUNDATION 860 W FIFTH STREET WINSTON SALEM NC 27101 566037615 501(C)3 15000 COMMUNITY SUPPORT WS FORSYTH COUNTY SCHOOLS PO BOX 2513 WINSTON SALEM NC 27102 560795164 GOV'T ENTITY 250000 COMMUNITY SUPPORT YMCA 301 N MAIN STREET WINSTON SALEM NC 27101 560530015 501(C)3 10000 COMMUNITY SUPPORT 16 0 LETTIE PATE WHITEHEAD SCHOLARS 57 39500 WSSU NURSING 395004 MEDICAL SCHOLARSHIPS 29 44689 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: THE HOSPITAL FOLLOWS THE MEDICAL CENTER'S CORPORATE POLICY USED IN REVIEWING THE ELIGIBILITY AND SELECTION OF GRANTEES RECEIVING CERTAIN EXEMPT PURPOSE FUNDS. THE HOSPITAL MAINTAINS DOCUMENTATION OF THE ELIGIBILITY AND SELECTION CRITERIA AND RECORDS OF THE AMOUNTS DISBURSED. SCHEDULE I, PART III GRANTS & OTHER ASSISTANCE TO INDIVIDUALS IN THE U.S. THE HOSPITAL FOLLOWS WAKE FOREST BAPTIST MEDICAL CENTER'S POLICY USED IN REVIEWING THE ELIGIBILITY AND SELECTION OF GRANTEES RECEIVING SCHOLARSHIPS. THE HOSPITAL MONITORS THE ACADEMIC PERFORMANCE AND OTHER ACHIEVEMENTS OF STUDENTS RECEIVING SCHOLARSHIP FUNDS TO ENSURE THAT THE SCHOLARSHIP REQUIREMENTS ARE BEING MET BY THE STUDENTS. LETTIE PATE WHITEHEAD SCHOLARSHIPS THE LETTIE PATE WHITEHEAD FOUNDATION PROVIDES SCHOLARSHIPS TO TAX-EXEMPT HOSPITALS OR INSTITUTIONS FOR THE CARE OF INDIGENT CHRISTIAN WOMEN IN SPECIFIED STATES, INCLUDING NORTH CAROLINA. THE FINANCIAL NEED IS ESTABLISHED BY THE COLLEGES THAT THE STUDENTS ATTEND. NAMES OF THE STUDENTS ARE PROVIDED TO OUR STAFF DEVELOPMENT DEPARTMENT. THE WHITEHEAD FUNDS ARE REVIEWED AND ADMINISTERED BY A FUND CUSTODIAN. X X X 1 1 X X X X X X 1 1 0 0 0 0 0 1 0 JOHN D MCCONNELL MD 998061 0 334267 0 38420 0 670368 0 20576 0 2061692 0 0 0 H GREG BRAY 208575 0 20988 0 1910 0 19831 0 18094 0 269398 0 0 0 J MCLAIN WALLACE JR 391182 0 74659 0 50817 0 91097 0 19183 0 626938 0 31386 0 KAREN H HUEY 248083 0 55426 0 60239 0 49655 0 21826 0 435229 0 30346 0 ERIC TOMLINSON 199154 0 50000 0 17789 0 27667 0 4119 0 298729 0 0 0 NORMAN D POTTER JR 279198 0 61828 0 7205 0 62297 0 21581 0 432109 0 0 0 CHERYL EH LOCKE 358614 0 75494 0 5544 0 80419 0 17435 0 537506 0 0 0 EDWARD G CHADWICK 533120 0 152385 0 24466 0 225493 0 21001 0 956465 0 0 0 THOMAS E SIBERT MD 690081 0 164710 0 30692 0 119996 0 21106 0 1026585 0 0 0 LISA M WYATT 292924 0 70218 0 23812 0 67097 0 8013 0 462064 0 0 0 SHEILA M SANDERS 365614 0 79700 0 33590 0 85397 0 18723 0 583024 0 0 0 EDWARD ABRAHAM MD 478061 0 136885 0 54832 0 158364 0 23526 0 851668 0 0 0 BETTY PETREE 212853 0 20485 0 17132 0 28803 0 8525 0 287798 0 0 0 MICHAEL RIEKER 218222 0 23626 0 1061 0 21293 0 23806 0 288008 0 0 0 VANCE MCVAY JR 223143 0 0 0 8167 0 20378 0 18944 0 270632 0 0 0 ERIC STIEFEL 182037 0 0 0 11108 0 16478 0 17504 0 227127 0 0 0 CHARLES WARE 196162 0 18409 0 6203 0 25311 0 13709 0 259794 0 0 0 JOANNE C RUHLAND 234968 0 0 0 20675 0 53297 0 17726 0 326666 0 0 0 RUSSELL M HOWERTON MD 479102 0 102464 0 20612 0 126197 0 28816 0 757191 0 0 0 DOUGLAS L EDGETON 78648 0 91875 0 436379 0 5927 0 13785 0 626614 0 0 0 STEVE C SNELGROVE 262908 0 59250 0 56998 0 69197 0 17481 0 465834 0 36276 0 RONALD H SMALL 0 0 0 0 241797 0 0 0 6355 0 248152 0 0 0 MAUREEN E SINTICH 315758 0 52624 0 22349 0 69497 0 17583 0 477811 0 11958 0 ROBERT S PARKER SR 1537 0 116052 0 0 0 0 0 4468 0 122057 0 0 0 DONNY C LAMBETH 191296 0 134313 0 811808 0 27524 0 15116 0 1180057 0 99432 0 SHARON ENGEBRETSON 107217 0 27736 0 38996 0 19888 0 47569 0 241406 0 0 0 PART I, LINE 1A CERTAIN OFFICERS RECEIVE, AS PART OF THEIR APPROVED COMPENSATION PACKAGE,TAX INDEMNIFICATION AND GROSS-UP PAYMENTS, RELOCATION ASSISTANCE INCLUDING A HOUSING ALLOWANCE, AND HEALTH OR SOCIAL CLUB DUES OR INITIATION FEES. BELOW IS A SUMMARY OF THE BENEFITS INCLUDED IN THE OFFICERS' COMPENSATION FOR THE FISCAL YEAR ENDED JUNE 30, 2013: - TAX INDEMNIFICATION AND GROSS UP PAYMENTS - $1,486 FOR ONE FORMER OFFICER; - RELOCATION ASSISTANCE, INCLUDING A HOUSING ALLOWANCE - $117,601 FOR FOUR OFFICERS AND ONE FORMER OFFICER; AND - DUES AND INITIATION FEES - $285 FOR ONE OFFICER PART I, LINE 3 THE EXECUTIVE COMMITTEE OF THE WAKE FOREST UNIVERSITY BAPTIST MEDICAL CENTER ("WFUBMC") BOARD OF DIRECTORS IS RESPONSIBLE FOR REVIEWING AND APPROVING ALL WFUBMC OFFICERS' COMPENSATION. THE COMMITTEE UTILIZE AN INDEPENDENT, EXTERNAL COMPENSATION CONSULTANT FIRM EXPERIENCED IN HEALTH CARE AND HIGHER EDUCATION COMPENSATION THAT BASED RECOMMENDATIONS ON COMPENSATION SURVEYS AND STUDIES TO DETERMINE THE APPROPRIATENESS OF EACH OFFICER'S COMPENSATION. THESE COMPENSATION CONSULTANTS PRESENT TOTAL COMPENSATION COMPARABILITY DATA FOR THE POSITIONS FOR WHICH COMPENSATION IS BEING DETERMINED. THE DATA IS REVIEWED BY THE EXECUTIVE COMMITTEE OF WFUBMC'S GOVERNING BOARD AT ITS MEETING; NONE OF THE MEMBERS OF THAT COMMITTEE ARE EMPLOYEES OF THE FILING ORGANIZATION. MINUTES OF THE DELIBERATIONS OF THE COMMITTEE ARE CONTEMPORANEOUSLY RECORDED. IN THE EVENT THAT ANY MEMBER OF THE EXECUTIVE COMMITTEE HAS A CONFLICT OF INTEREST, THAT COMMITTEE MEMBER DOES NOT PARTICIPATE IN THE DELIBERATION OR APPROVAL PROCESS, AND THEIR ABSTENTION FROM THE PROCESS IS REFLECTED IN THE MINUTES. PART I, LINES 4A-B NAME SEVERANCE NON-QUAL RETIRE RONALD H SMALL 251,360 MAUREEN E SINTICH 20,648 ROBERT S PARKER, SR. 115,769 DONNY C LAMBETH 253,846 501,126 DOUG EDGETON 423,536 JERRY M WALLACE, JR. 31,386 KAREN H HUEY 58,468 STEVEN C SNELGROVE 36,276 PART I, LINE 7 OFFICERS, KEY EMPLOYEES AND FACULTY MEMBERS HAVE INCENTIVE COMPENSATION COMPONENTS CONTAINED IN THEIR EMPLOYMENT AGREEMENTS. THESE ARE OFTEN GOAL-BASED AND ARE DETERMINED IN THE COURSE OF EVALUATION OF THE INDIVIDUAL'S PERFORMANCE BY HIS/HER DEPARTMENT CHAIR, SUPERVISOR OR THE COMPENSATION COMMITTEE OF THE BOARD, AS APPLICABLE. OTHER NON-FIXED PAYMENTS MAY INCLUDE SUMS FOR RELOCATION AND/OR TEMPORARY HOUSING THAT ARE TYPICALLY INCLUDED AS A PROVISION IN THE EMPLOYMENT AGREEMENT. ALL SUCH PAYMENTS ARE REFLECTED ON THE INDIVIDUAL'S W-2. SUPPLEMENTAL INFORMATION PART III SCHEDULE J, PART III IN JULY OF 2010, WAKE FOREST UNIVERSITY HEALTH SCIENCES (WFUHS), NORTH CAROLINA BAPTIST HOSPITAL (NCBH), WAKE FOREST UNIVERSITY BAPTIST MEDICAL CENTER (WFUBMC) AND WAKE FOREST UNIVERSITY (WFU)) APPROVED A MEDICAL CENTER INTEGRATION AGREEMENT THAT ALLOWS FOR THE LEVERAGING OF COMBINED RESOURCES OF NCBH AND WFUHS TO FULFILL A SINGLE MISSION OF IMPROVING HEALTH, OPTIMIZING PERFORMANCE WHILE BALANCING PATIENT CARE, EDUCATION AND RESEARCH. NCBH, WFUBMC, WFUHS AND THEIR SUBSIDIARIES HAVE COMBINED OPERATING REVENUES OF APPROXIMATELY $2 BILLION FOR THE FISCAL YEAR ENDED JUNE 30, 2013. IN GENERAL, EXECUTIVES PERFORMING KEY MANAGEMENT FUNCTIONS FOR THE MEDICAL CENTER ARE SOUGHT AND HIRED AFTER NATIONAL SEARCHES IN A HIGHLY COMPETITIVE ENVIRONMENT, AND ONLY INDIVIDUALS AT THE HIGHEST LEVELS OF ABILITY ARE HIRED AND GIVEN THE TASK OF OPTIMIZING THE EFFECTIVENESS OF THE MEDICAL CENTER AND ITS TAX-EXEMPT MISSION. CERTAIN EXECUTIVES HOLD THE IDENTICAL OFFICES/TITLES IN WFUHS, NCBH AND WFUBMC AND ARE ELIGIBLE TO RECEIVE INCENTIVE COMPENSATION AT THE END OF EACH FISCAL YEAR. THE INCENTIVE STRUCTURE IS BASED UPON GOALS ESTABLISHED BY THE EXECUTIVE COMMITTEE ON BEHALF OF THE FILING ORGANIZATION'S BOARD AT THE BEGINNING OF THE YEAR, INCLUDING MEASURES OF CLINICAL QUALITY, PATIENT SATISFACTION, AND FINANCIAL OPERATING PERFORMANCE. THE DETERMINATION OF THE AMOUNT OF INCENTIVE COMPENSATION IS SUBJECT TO THE FILING ORGANIZATION'S COMPENSATION PROCEDURES AS OUTLINED IN PART VI, SECTION B, LINE 15 OF THE 990. SCHEDULE J. PART I, LINE 4 - CERTAIN EXECUTIVES PARTICIPATE IN OR RECEIVE SEVERANCE PAYMENTS AND/OR PAYMENTS FROM SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLANS. THE DETERMINATION OF THE AMOUNT OF THE SEVERANCE AND/OR NON-QUALIFIED RETIREMENT PLAN PAYMENTS FOLLOW THE FILING ORGANIZATION'S COMPENSATION PROCEDURES AS OUTLINED ABOVE AND IN PART VI, SECTION B, LINE 15 OF THE FORM 990. FORM 990, PART VII, LINE 5 - COMPENSATION FROM UNRELATED ORGANIZATION THE FOLLOWING INDIVIDUALS WERE COMPENSATED BY WAKE FOREST UNIVERSITY HEALTH SCIENCES FOR SERVICES PERFORMED FOR THE HOSPITAL. SEE PART VII AND SCHEDULE J, PART II, FOR THEIR COMPENSATION: JOHN D MCCONNELL MD JOANNE C RUHLAND NORMAN D POTTER, JR. CHERYL E.H. LOCKE EDWARD G CHADWICK THOMAS E SIBERT, MD RUSSELL M HOWERTON, MD DOUGLAS L EDGETON LISA M WYATT SHEILA M SANDERS EDWARD ABRAHAM, MD ERIC TOMLINSON, DCS, PHD A NORTH CAROLINA MEDICAL CARE COMMISSION 521309402 65820HD67 2010-03-01 334002408 CURRENT REFUNDING 0 0 0 B NORTH CAROLINA MEDICAL CARE COMMISSION 521309402 NONEAVAIL 2012-12-31 80000000 VARIOUS CAPITAL PROJECTS 0 0 0 C NORTH CAROLINA MEDICAL CARE COMMISSION 521309402 65821DMM0 2012-11-15 122822821 VARIOUS CAPITAL PROJECTS 0 0 0 A 25240591 334002408 3307037 330695370 2010 1 0 1 1 B 80000000 1000 62893246 17105754 0 0 0 1 C 122822821 2485 122820336 2013 0 0 0 1 A 0 0 0 0 0 0 1 B 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 C 0 1 0 0 0.00000 0.00000 0.00000 0 0 1 A 0 1 0 0 0 1 DEUTSCHE BANK AG 5.000000000000 0 0 0 0 1 B 0 1 0 0 1 0 0 0 1 C 0 1 0 0 0 0 0 0 1 A 1 B 1 C 1 PART I, LINE A, COLUMN F CURRENT REFUNDING THE 2010 ISSUE CURRENTLY REFUNDED PRE 12/31/2002 ISSUES. PART II, COLUMN A, LINE 11 OTHER SPENT PROCEEDS THE OTHER SPENT PROCEEDS LISTED ARE THE CURRENT REFUNDING PROCEEDS OF THE ISSUE. DAVID E BRANN FAMILY MEMBER OF DONNY LAMBETH 108782 COMPENSATION 0 JUDY M SLOCUM FAMILY MEMBER OF MAUREEN SINTICH 56256 COMPENSATION 0 MEDCOST BOARD MEMBER EDWARD CHADWICK 2130677 THIRD PARTY ADMINISTRATOR 0 ROBIN LEWIS FAMILY MEMBER OF KENNETH LEWIS 69438 COMPENSATION 0 X 1735 FMV X 5729 FMV X 1 1093 X MEDICAL EQUIP 9 64759 FMV 0 0 1 0 METHOD FOR DETERMINING NUMBER OF CONTRIBUTIONS: PART I, COLUMN (B): THE ORGANIZATION DETERMINES THE NUMBER OF CONTRIBUTIONS BY USING THE TOTAL NUMBER OF NON-CASH ITEMS RECEIVED PER DONOR PER OCCURANCE. FORM 990, PART VI, SECTION A, LINE 2 EDWARD G. CHADWICK AND H. GREGORY BRAY HAVE A BUSINESS RELATIONSHIP THROUGH THEIR BOARD/LEADERSHIP POSITION IN MEDCOST, LLC, A JOINT VENTURE IN WHICH THE HOSPITAL HOLDS A 50% MEMBERSHIP INTEREST. FORM 990, PART VI, SECTION A, LINE 3 EFFECTIVE JULY 1, 2010, THE GOVERNING BOARDS OF FOUR NORTH CAROLINA NONPROFIT CORPORATIONS (WAKE FOREST UNIVERSITY, NORTH CAROLINA BAPTIST HOSPITAL, WAKE FOREST UNIVERSITY HEALTH SCIENCES, AND WAKE FOREST UNIVERSITY BAPTIST MEDICAL CENTER) ENTERED INTO AN AGREEMENT (THE MEDICAL CENTER INTEGRATION AGREEMENT OR MCIA) UNDER WHICH THE OPERATION OF EACH OF NORTH CAROLINA BAPTIST HOSPITAL (NCBH) AND WAKE FOREST UNIVERSITY HEALTH SCIENCES (WFUHS) WAS DELEGATED TO WAKE FOREST UNIVERSITY BAPTIST MEDICAL CENTER (WFUBMC). WFUHS IS A WHOLLY-CONTROLLED SUBSIDIARY ENTITY OF WAKE FOREST UNIVERSITY (WFU). WFUBMC IS NOW A MEMBERSHIP NONPROFIT CORPORATION WHOSE TWO EQUAL MEMBERS ARE NCBH AND WFU. THIS CONSOLIDATION OF MANAGEMENT IN WFUBMC OF THE VARIOUS ACADEMIC MEDICAL CENTER OPERATIONS, SUBJECT TO SUBSTANTIAL RESERVED POWERS IN EACH OF THE CONSTITUENT MEMBERS' (OR IN WFUHS') BOARDS, MANDATED CHANGES IN THE GOVERNANCE DOCUMENTS OF EACH ORGANIZATION. FORM 990, PART VI, SECTION B, LINE 11 THE FILING ORGANIZATION'S BOARD OF DIRECTORS RECEIVE A COPY OF THE FORM 990 WITH SUFFICIENT TIME TO PERMIT REVIEW, COMMENT, AND QUESTIONS PRIOR TO ITS FILING. THE AUDIT AND COMPLIANCE COMMITTEE OF THE GOVERNING BOARD OF WFUBMC, COMPRISED OF THE AUDIT AND COMPLIANCE COMMITTEES OF WFUHS AND NCBH, REVIEW IN ADDITIONAL DETAIL THE FILING ORGANIZATION'S FORM 990 WITH THE ORGANIZATION'S CHIEF FINANCIAL OFFICER OR HIS DESIGNEE, WHO ANSWERS QUESTIONS AND ADDRESSES CONCERNS RAISED BY SUCH COMMITTEE MEMBERS OR OTHER FILING ORGANIZATION DIRECTORS. IF MODIFICATIONS ARE REQUIRED FOLLOWING SUCH REVIEW AND COMMENT, THE REVISED FORM 990 IS REDISTRIBUTED TO ALL BOARD MEMBERS PRIOR TO ITS FILING WITH THE IRS, ALONG WITH A REPORT NOTING THE MODIFICATIONS. FORM 990, PART VI, SECTION B, LINE 12C ON AN ANNUAL BASIS (AND AS THEY ARISE), ALL TRUSTEES AND OFFICERS OF THE FILING ORGANIZATION ARE ASKED TO REVIEW THE APPLICABLE CONFLICTS OF INTEREST POLICY AND TO DESCRIBE ANY POTENTIAL CONFLICTS OF INTEREST THEY MAY HAVE. UPON COMPLETION OF THE CONFLICTS OF INTEREST SURVEY, THE LEGAL DEPARTMENT REVIEWS THE COMPLETED QUESTIONNAIRES ON BEHALF OF THE FILING ORGANIZATION. ANY CONFLICTS IDENTIFIED ARE COMMUNICATED TO THE FILING ORGANIZATION'S CHAIRMAN OF THE BOARD AND ARE PRESENTED TO THE AUDIT AND COMPLIANCE COMMITTEE. ALL CONFLICTS OF INTEREST ARE RESOLVED BY MANAGEMENT PLANS DEVELOPED BY THE FILING ORGANIZATION BOARD'S AUDIT AND COMPLIANCE COMMITTEE AND THE INTERNAL AUDIT AND COMPLIANCE OFFICES. THE AUDIT AND COMPLIANCE COMMITTEE'S CHAIR PRESENTS AN ANNUAL REPORT ON CONFLICTS TO THE FULL BOARD OF THE FILING ORGANIZATION. FORM 990, PART VI, SECTION B, LINE 15 THE FILING ORGANIZATION HAS DELEGATED TO THE EXECUTIVE COMMITTEE OF THE WAKE FOREST UNIVERSITY BAPTIST MEDICAL CENTER'S BOARD OF DIRECTORS THE FUNCTION OF THE COMPENSATION COMMITTEE OF THE BOARD OF THE FILING ORGANIZATION AND AS SUCH, THAT COMMITTEE REVIEWS AND APPROVES THE APPOINTMENT AND COMPENSATION OF THE SENIOR EXECUTIVES OF WFUHS, WFUBMC, AND THE FILING ORGANIZATION. THE EXECUTIVE COMMITTEE RELIES UPON AN EXTERNAL, INDEPENDENT COMPENSATION CONSULTANT EXPERIENCED IN HEALTHCARE TO PROVIDE THE COMMITTEE WITH COMPENSATION COMPARABILITY DATA FOR NEW EXECUTIVE POSITION APPOINTMENTS AND FOR COMPENSATION REVIEWS FOR EXISTING EXECUTIVES. THE CONSULTANT, WHICH IS RETAINED DIRECTLY BY THE EXECUTIVE COMMITTEE, PROVIDES THIRD-PARTY INFORMATION AND EVALUATES THE COMPETITIVENESS AND REASONABLENESS OF EXECUTIVE COMPENSATION AND BENEFITS PROGRAMS IN RELATION TO MARKET PRACTICES FOR SIMILARLY-SITUATED NONPROFIT HEALTHCARE ORGANIZATIONS. THE COMMITTEE MAKES ITS DECISIONS WITH RESPECT TO EXECUTIVE COMPENSATION IN ACCORDANCE WITH THE FILING ORGANIZATION'S (AND WFUHS AND NCBH) POLICIES, IRS REGULATIONS, AND STANDARD CORPORATE GOVERNANCE PRACTICES. SUCH POLICIES INCLUDE ADHERENCE TO: BOARD-ESTABLISHED EXECUTIVE COMPENSATION PHILOSOPHY AND REVIEW PROCESSES; PROCESSES ENSURING EXECUTIVE COMMITTEE MEMBER AND COMPENSATION CONSULTANT INDEPENDENCE; USE OF VALID MARKET COMPARISONS OF DATA FROM PEER ACADEMIC MEDICAL CENTERS OF SIMILAR ORGANIZATIONAL STRUCTURE, SIZE, AND COMPLEXITY; CAREFUL DOCUMENTATION OF ALL COMPENSATION DECISIONS; AND ESTABLISHMENT OF THE REBUTTABLE PRESUMPTION OF REASONABLENESS, PER IRS GUIDELINES. MINUTES OF THE DELIBERATIONS OF THE EXECUTIVE COMMITTEE ARE CONTEMPORANEOUSLY MAINTAINED AND THAT COMPARABILITY DATA IS MAINTAINED IN THE MEDICAL CENTER'S OFFICE OF EXECUTIVE COMPENSATION SERVICES. IN THE EVENT THAT A MEMBER OF THE EXECUTIVE COMMITTEE HAS A CONFLICT OF INTEREST RELATED TO EXECUTIVE APPOINTMENT OR COMPENSATION, THAT MEMBER DOES NOT PARTICIPATE IN THE DELIBERATION OR APPROVAL OF APPOINTMENT OR COMPENSATION AND SUCH ABSTENTION IS NOTED IN THE COMMITTEE'S MEETING MINUTES. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S ARTICLES OF INCORPORATION ARE AVAILABLE TO THE PUBLIC ON REQUEST AND ARE AVAILABLE ON THE WEBSITE OF THE NORTH CAROLINA SECRETARY OF STATE. THE ORGANIZATION'S BYLAWS ARE NOT PUBLISHED, BUT PROVISIONS FROM THE BYLAWS ARE INCLUDED AS NECESSARY IN THE ORGANIZATION'S POLICIES, AND ARE ATTACHED TO THE FORM 1023 FILED FOR THE ORGANIZATION WITH THE IRS, WHICH IS PUBLICLY AVAILABLE. THE CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE NOT AVAILABLE TO THE PUBLIC. PART VII, SECTION A, COLUMN B - OFFICERS' AND FORMER OFFICERS' AVERAGE HOURS FOR RELATED ORGANIZATIONS H GREG BRAY FILING ORG 30.2 RELATED ORG 4.3 UNRELATED ORG 5.5 J MCLAIN WALLACE, JR FILING ORG 17.7 RELATED ORG 6.6 UNRELATED ORG 15.7 KAREN H HUEY FILING ORG 33.7 RELATED ORG 6.3 ERIC TOMLINSON FILING ORG 5.0 RELATED ORG 5.0 UNRELATED ORG 30.0 STEVE C SNELGROVE FILING ORG 0 RELATED ORG 6.0 UNRELATED ORG 34.0 MAUREEN E SINTICH FILING ORG 34.0 RELATED ORG 6.0 DONNY C LAMBETH FILING ORG 20.0 RELATED ORG 14.0 UNRELATED ORG 6.0 SHARON ENGEBRETSON FILING ORG 35.0 RELATED ORG 5.0 JOANNE C RUHLAND FILING ORG 20 RELATED ORG 5 UNRELATED ORG 15 NORMAN D POTTER, JR. FILING ORG 20 RELATED ORG 5 UNRELATED ORG 15 CHERYL E.H. LOCKE FILING ORG 23.4 RELATED ORG 5.3 UNRELATED ORG 11.3 EDWARD G CHADWICK FILING ORG 29.8 RELATED ORG 7.0 UNRELATED ORG 3.2 THOMAS E SIBERT, MD FILING ORG 26.6 RELATED ORG 7.0 UNRELATED ORG 3.2 RUSSELL M HOWERTON, MD FILING ORG 20 RELATED ORG 2 UNRELATED ORG 18 DOUGLAS L EDGETON FILING ORG 1.0 UNRELATED ORG 39.0 LISA M WYATT FILING ORG 18.1 RELATED ORG 6.8 UNRELATED ORG 15.1 SHEILA M SANDERS FILING ORG 26 RELATED ORG 5 UNRELATED ORG 9 JOHN D MCCONNELL, MD FILING ORG 20.0 RELATED ORG 5.0 UNRELATED ORG 15.0 EDWARD ABRAHAM, MD FILING ORG 5 RELATED ORG 5 UNRELATED ORG 30 WAKE FOREST UNIVERSITY HEALTH SCIENCES IS AN UNRELATED ORGANIZATION TO THE FILING ORGANIZATION AND THE INFORMATION CONCERNING HOURS DEVOTED TO IT ARE NOT REQUIRED TO BE REPORTED, BUT ARE INCLUDED BECAUSE OF THE STRUCTURE OF WAKE FOREST UNIVERSITY BAPTIST MEDICAL CENTER, OF WHICH THE FILING ORGANIZATION AND WAKE FOREST UNIVERSITY HEALTH SCIENCES ARE PRINCIPAL PARTS. THE CORPORATE OFFICERS OF THE MEDICAL CENTER ALSO SERVE AS THE CORPORATE OFFICERS OF NORTH CAROLINA BAPTIST HOSPITAL AND WAKE FOREST UNIVERSITY HEALTH SCIENCES. OTHER FEES FORM 990, PART IX, LINE 11G MCIA: PROGRAM SERVICE EXPENSES 36,156,000. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 36,156,000. MEDICAL FEES: PROGRAM SERVICE EXPENSES 67,268,456. MANAGEMENT AND GENERAL EXPENSES 1,710,086. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 68,978,542. OTHER PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 39,430,294. MANAGEMENT AND GENERAL EXPENSES 24,678,800. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 64,109,094. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 9: CHANGE IN PENSION LIABILITY 29,278,783. CHANGE IN VALUE OF INTEREST RATE SWAP -560,284. AFFILIATE EARNINGS & TRANSFERS -22,699,947. CLEMMONS MEDICAL PARK LLC MEDICAL CENTER BLVD WINSTON SALEM NC 27157 800870210 REAL ESTATE HOLDING COMPANY NC 597732 30423819 NORTH CAROLINA BAPTIST HOSPITAL NORTH CAROLINA BAPTIST HOSPITAL FOUNDATION MEDICAL CENTER BLVD WINSTON SALEM NC 27157 561685120 SUPPORTING ORGANIZATION NC 501(C)(3) LINE 11A, I NORTH CAROLINA BAPTIST HOSPITAL 1 THE REHABILITATION & SKILLED NURSING MEDICAL CENTER BLVD WINSTON SALEM NC 27157 561826396 HEALTHCARE (INACTIVE) NC 501(C)(3) LINE 9 NORTH CAROLINA BAPTIST HOSPITAL FOUNDATION 1 THE HAWTHORNE INN & CONFERENCE CENTER INC 420 HIGH STREET WINSTON SALEM NC 27101 561793617 LODGING/CONFERENCE ACCOMODATION NC 501(C)(3) LINE 11A, I NORTH CAROLINA BAPTIST HOSPITAL 1 CARENET INC 2000 WEST FIRST STREET SUITE 410 WINSTON SALEM NC 27104 561977341 HEALTHCARE NC 501(C)(3) LINE 11B, II NORTH CAROLINA BAPTIST HOSPITAL 1 WAKE FOREST UNIVERSITY BAPTIST MEDICAL CENTER MEDICAL CENTER BLVD WINSTON SALEM NC 27157 510190238 HEALTHCARE NC 501(C)(3) LINE 11A, I N/A 0 CENTER FOR CONGREGATIONAL HEALTH INC MEDICAL CENTER BLVD WINSTON SALEM NC 27157 237426944 HEALTHCARE NC 501(C)(3) LINE 9 NORTH CAROLINA BAPTIST HOSPITAL 1 DAVIE COUNTY EMERGENCY HEALTH CORPORATION 223 HOSPITAL STREET MOCKSVILLE NC 27028 562276994 HEALTHCARE NC 501(C)(3) LINE 3 NORTH CAROLINA BAPTIST HOSPITAL 1 MEDICAL FND OF WFUHS & NCBH MEDICAL CENTER BLVD WINSTON SALEM NC 27157 566036688 HEALTHCARE NC 501(C)(3) LINE 11A, I N/A 0 1 0 1 0 0 0 0 0 0 0 1 0 0 0 0 1 1 0 1 NORTH CAROLINA BAPTIST HOSPITAL FOUNDATION A 168344 COST THE HAWTHORNE INN & CONFERENCE CENTER INC K 227760 COST THE HAWTHORNE INN & CONFERENCE CENTER INC P 42133 COST CARENET INC Q 2723473 FMV CENTER FOR CONGREGATIONAL HEALTH INC Q 289726 FMV DAVIE COUNTY EMERGENCY HEALTH CORP Q 1342906 FMV NORTH CAROLINA BAPTIST HOSPITAL FOUNDATION Q 281385 FMV THE HAWTHORNE INN & CONFERENCE CENTER INC S 200000 COST NORTH CAROLINA BAPTIST HOSPITAL FOUNDATION S 300139 COST NORTH CAROLINA BAPTIST HOSPITAL FOUNDATION C 405031 COST THE HAWTHORNE INN & CONFERENCE CENTER INC Q 384069 FMV