DAVIDSON HEALTHCARE INC: Form 990, tax year 2011
View the entire original 990 at ProPublica ↗
- Organization
- DAVIDSON HEALTHCARE INC (EIN 56-1474399)
- Tax period
- 2011-07-01 to 2012-06-28
- Filed
- 2013-05-14
- IRS object ID
- 201311349349301176
- Schema version
- 2011v1.5
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2013-05-14T08:57:48-05:00 | Timestamp |
| Tax Period End Date | 2012-06-28 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 560817345 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | TURLINGTON AND COMPANY LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1338 WESTGATE CENTER DRIVE | AddressLine1 |
| City | WINSTONSALEM | City |
| State | NC | State |
| ZIP Code | 27103 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2011-07-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 561474399 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DAVIDSON HEALTHCARE INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | DAVI | NameControl |
| Phone | 3362485161 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 1817 | AddressLine1 |
| City | LEXINGTON | City |
| State | NC | State |
| ZIP Code | 272931817 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | DANNY W SQUIRES | Name |
| Title | VICE PRESIDENT/CFO | Title |
| Phone | 3362485161 | Phone |
| Date Signed | 2013-05-13 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | TERRY J BERRIER | Name |
| PTIN | P01239877 | PTIN |
| Phone | 3367652410 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2011 | TaxYear |
| Build TS | 2016-02-25 16:41:14Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Terminated Return | X | TerminatedReturn |
| Name Of Principal Officer Person | DANNY W SQUIRES | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 250 HOSPITAL DRIVE | AddressLine1 |
| City | LEXINGTON | City |
| State | NC | State |
| ZIP Code | 27292 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 0 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | N/A | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1985 | YearFormation |
| State Legal Domicile | NC | StateLegalDomicile |
| Activity Or Mission Description | TO PROMOTE THE GENERAL HEALTH OF THE COMMUNITY IN SUPPORT OF LEXINGTON MEDICAL CENTER. TO PROMOTE CHARITABLE, EDUCATIONAL AND SCIENTIFIC PURPOSES BY SUPPORTING, COORDINATING AND OPERATING FOR THE BENEFIT OF LEXINGTON MEDICAL CENTER, A NOT FOR PROFIT CORPORATION EXEMPT FROM TAXATION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. | ActivityOrMissionDescription |
| Termination Or Contraction | X | TerminationOrContraction |
| Nbr Voting Members Governing Body | 18 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 17 | NbrIndependentVotingMembers |
| Total Nbr Employees | 0 | TotalNbrEmployees |
| Total Nbr Volunteers | 0 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 0 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 0 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 0 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 0 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 0 | InvestmentIncomePriorYear |
| Investment Income Current Year | 0 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 0 | OtherRevenuePriorYear |
| Other Revenue Current Year | 0 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 0 | TotalRevenuePriorYear |
| Total Revenue Current Year | 0 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 0 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 0 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 0 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 10565 | OtherExpensePriorYear |
| Other Expenses Current Year | 12083 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 10565 | TotalExpensesPriorYear |
| Total Expenses Current Year | 12083 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | -10565 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | -12083 | RevenuesLessExpensesCY |
| Total Assets BOY | 1339892 | TotalAssetsBOY |
| Total Assets EOY | 0 | TotalAssetsEOY |
| Total Liabilities BOY | 26679 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 0 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 1313213 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 0 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | TO PROMOTE CHARITABLE, EDUCATIONAL AND SCIENTIFIC PURPOSES BY SUPPORTING, COORDINATING AND OPERATING FOR THE BENEFIT OF LEXINGTON MEDICAL CENTER, A NOT FOR PROFIT CORPORATION EXEMPT FROM TAXATION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 1 | SignificantChange |
| Expense | 12083 | Expense |
| Description | PROMOTED CHARITABLE, EDUCATIONAL AND SCIENTIFIC PURPOSES BY COORDINATING AND OPERATING FOR THE BENEFIT OF LEXINGTON MEDICAL CENTER, A NOT FOR PROFIT CORPORATION EXEMPT UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. | Description |
| Total Program Service Expense | 12083 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 0 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 0 | LobbyingActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 0 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 0 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 0 | ReportOtherAssets |
| Report Other Liabilities | 0 | ReportOtherLiabilities |
| Report Fin48 Footnote | 1 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 0 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 1 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 0 | Hospital |
| Grants To Organizations | 0 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 0 | TaxExemptBonds |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 1 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 1 | RelatedOrgControlledEntity |
| Transaction Related Entity | 0 | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 0 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Number Of Employees | 0 | NumberOfEmployees |
| Unrelated Business Income | 0 | UnrelatedBusinessIncome |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 18 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 17 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 1 | MembersOrStockholders |
| Election Of Board Members | 1 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 1 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 0 | CompensationProcessCEO |
| Compensation Process Other | 0 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| States Where Copy Of Return Is Filed | NC | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DANNY W SQUIRES | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 3362485161 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 1817 250 HOSPITAL DRIVE | AddressLine1 |
| City | LEXINGTON | City |
| State | NC | State |
| ZIP Code | 272931817 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | X | InfoInScheduleOPartVII |
Form990 Part VII Section A Form990PartVIISectionA (26 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | FormerFormer |
|---|---|---|---|---|---|---|---|
| ROBERT B SMITH JR | |||||||
| CHAIRMAN | 2.00 | X | X | 0 | 0 | 0 | |
| JEFF MAST | |||||||
| VICE CHAIRMAN | 2.00 | X | X | 0 | 0 | 0 | |
| MARK BREEDEN | |||||||
| DIRECTOR | 2.00 | X | 0 | 0 | 0 | ||
| DAN BRIGGS | |||||||
| DIRECTOR | 2.00 | X | 0 | 0 | 0 | ||
| ROBERT CRAVEN | |||||||
| DIRECTOR | 2.00 | X | 0 | 0 | 0 | ||
| KAREN CRAVER | |||||||
| DIRECTOR | 2.00 | X | 0 | 0 | 0 | ||
| TERRA GREEN | |||||||
| DIRECTOR | 2.00 | X | 0 | 0 | 0 | ||
| TERRY L HALES JR | |||||||
| DIRECTOR | 2.00 | X | 0 | 0 | 0 | ||
| JAMES HOEKSTRA MD | |||||||
| DIRECTOR | 2.00 | X | 0 | 0 | 0 | ||
| RAY N HOWELL III | |||||||
| DIRECTOR | 2.00 | X | 0 | 0 | 0 | ||
| LARRY POTTS | |||||||
| DIRECTOR | 2.00 | X | 0 | 0 | 0 | ||
| J SIMMONS RIGGAN MD | |||||||
| DIRECTOR | 2.00 | X | 0 | 0 | 0 | ||
| PATRICIA SHOEMAKER | |||||||
| DIRECTOR | 2.00 | X | 0 | 0 | 0 | ||
| TOM SIBERT MD | |||||||
| DIRECTOR | 2.00 | X | 0 | 0 | 0 | ||
| GREG STABLER | |||||||
| DIRECTOR | 2.00 | X | 0 | 0 | 0 | ||
| DAVID WAGNER MD | |||||||
| DIRECTOR | 2.00 | X | 0 | 0 | 0 | ||
| WILLIAM W WOODRUFF MD | |||||||
| DIRECTOR | 2.00 | X | 0 | 0 | 0 | ||
| DONNY C LAMBETH | |||||||
| PRESIDENT/CEO | 40.00 | X | 2328700 | 0 | 143909 | ||
| STEVEN SNELGROVE | |||||||
| CHIEF OPERATING OFFICER | 40.00 | X | 329647 | 0 | 115765 | ||
| JOHNNY VEAL | |||||||
| VICE PRESIDENT | 40.00 | X | 208131 | 0 | 5161 | ||
| DANNY W SQUIRES | |||||||
| VICE PRESIDENT/TREASURER | 40.00 | X | 0 | 162611 | 19502 | ||
| BARBARA B SMITH | |||||||
| VICE PRESIDENT/SECRETARY | 40.00 | X | 0 | 175701 | 16954 | ||
| DENISE SNIDER | |||||||
| ASST. SECRETARY | 40.00 | X | 0 | 47761 | 1910 | ||
| CHRISTOPHER T WHITE | |||||||
| ASST. TREASURER | 40.00 | X | 0 | 94255 | 17584 | ||
| JOHN A CASHION | |||||||
| FORMER PRESIDENT | 40.00 | 0 | 1051152 | 6297 | X | ||
| DENNIS R AYERS | |||||||
| FORMER PRESIDENT | 40.00 | 0 | 120918 | 12034 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 2866478 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 1652398 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 339116 | TotalOtherCompensation |
| Number Individuals GT100 K | 0 | NumberIndividualsGT100K |
| Formers Listed | 1 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 1 | CompensationFromOtherSources |
| Number Of Contractors GT100 K | 0 | NumberOfContractorsGT100K |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
| Related Or Exempt Function Income | 0 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $0 | ExclusionAmount |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 9000 | Total |
| Program Services | 9000 | ProgramServices |
Other Expenses OtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | PROFESSIONAL FEES | Description |
| Total | 3083 | Total |
| Program Services | 3083 | ProgramServices |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 12083 | Total |
| Program Services | 12083 | ProgramServices |
| Management And General | 0 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 0 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 704 | BOY |
| EOY | 0 | EOY |
Pledges And Grants Receivable PledgesAndGrantsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 0 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 0 | EOY |
Receivables From Officers Etc ReceivablesFromOfficersEtc
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 0 | EOY |
Receivables From Disqual Persons ReceivablesFromDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 0 | EOY |
Other Notes Loans Receivable Net OtherNotesLoansReceivableNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 0 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 0 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 0 | EOY |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 0 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 0 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 0 | EOY |
Investments Program Related InvestmentsProgramRelated
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1339188 | BOY |
| EOY | 0 | EOY |
Intangible Assets IntangibleAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 0 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 0 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1339892 | BOY |
| EOY | 0 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 26679 | BOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 26679 | BOY |
| EOY | 0 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1313213 | BOY |
| EOY | 0 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1313213 | BOY |
| EOY | 0 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1339892 | BOY |
| EOY | 0 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | -12083 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | -1301130 | ReconcilationOtherChanges |
| Info In Schedule O Part XII | X | InfoInScheduleOPartXII |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
| Audit Committee | 1 | AuditCommittee |
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Supporting Organization509a3 | X | SupportingOrganization509a3 |
| Supporting Org509a3 Type1 | X | SupportingOrg509a3Type1 |
| Certification Checkbox | X | CertificationCheckbox |
| Contrib By Controlling Individual | 0 | ContribByControllingIndividual |
| Contribution By Related Party | 0 | ContributionByRelatedParty |
| Contrib By35 Controlled Entity | 0 | ContribBy35ControlledEntity |
Supported Org Information SupportedOrgInformation
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | LEXINGTON MEDICAL CENTER | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 560543238 | EIN |
| Type Of Organization | 3 | TypeOfOrganization |
| Listed In Governing Doc | 1 | ListedInGoverningDoc |
| Amount | $628,207 | Amount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Number Of Supported Orgs | 1 | TotalNumberOfSupportedOrgs |
| Sum Of Amounts | 628207 | SumOfAmounts |
| General Explanation | SCHEDULE A, PART IV, SUPPLEMENTAL INFORMATION: DURING THE YEAR ENDED JUNE 30, 2012, LEXINGTON MEMORIAL HOSPITAL, INC. AND SUBSIDIARY D/B/A WAKE FOREST BAPTIST HEALTH - LEXINGTON MEDICAL CENTER REORGANIZED AS LEXINGTON MEDICAL CENTER. LEXINGTON MEDICAL CENTER HAS ONE SUBSIDIARY, LEXINGTON MEDICAL CENTER FOUNDATION. PRIOR TO THE REORGANIZATION, LEXINGTON MEDICAL CENTER HAD ONE WHOLLY-OWNED SUBSIDIARY, LEXPOINT, LLC AND WAS A SUBSIDIARY OF DAVIDSON HEALTHCARE, INC. DAVIDSON HEALTHCARE, INC. WAS ORGANIZED TO BE PARENT AND SOLE MEMBER OF VARIOUS HEALTH CARE ORGANIZATIONS INCLUDING LEXINGTON MEMORIAL HOSPITAL, INC. AND SUBSIDIARY, LEXHEALTH, INC., LEXPROPERTIES, INC., LEXINGTON MEMORIAL HOSPITAL FOUNDATION, INC., MEDICAL PARK OFFICES UNIT OWNERS ASSOCIATION, LEXCARE, INC. D/B/A MEDICAL PARK PHARMACY, AND LEXMEDICAL, INC. AS PART OF THE REORGANIZATION, DAVIDSON HEALTHCARE, INC. AND THE OTHER SUBSIDIARIES MERGED INTO LEXINGTON MEDICAL CENTER. | GeneralExplanation |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 0 | TotalOfBookValueLandBuildings |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: | Identifier |
| Return Reference | PART X: | ReturnReference |
| Explanation | THE ORGANIZATION 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 FOR-PROFIT SUBSIDIARIES. THIS EVALUATION DID NOT HAVE A MATERIAL EFFECT ON THE ORGANIZATION'S STATEMENT OF OPERATIONS FOR THE YEARS ENDED JUNE 30, 2012 AND 2011 | Explanation |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | 1 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 1 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (7 entries)
| Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| DONNY C LAMBETH | |||||||||||||
| 495595 | 0 | 181988 | 0 | 1651117 | 0 | 128399 | 0 | 15510 | 0 | 2472609 | 0 | 349414 | 0 |
| STEVEN SNELGROVE | |||||||||||||
| 251155 | 0 | 61652 | 0 | 16840 | 0 | 81277 | 0 | 34488 | 0 | 445412 | 0 | 0 | 0 |
| JOHNNY VEAL | |||||||||||||
| 179881 | 0 | 22830 | 0 | 5420 | 0 | 4317 | 0 | 844 | 0 | 213292 | 0 | 0 | 0 |
| DANNY W SQUIRES | |||||||||||||
| 0 | 150461 | 0 | 12150 | 0 | 0 | 0 | 5687 | 0 | 13815 | 0 | 182113 | 0 | 0 |
| BARBARA B SMITH | |||||||||||||
| 0 | 162651 | 0 | 13050 | 0 | 0 | 0 | 6185 | 0 | 10769 | 0 | 192655 | 0 | 0 |
| JOHN A CASHION | |||||||||||||
| 0 | 0 | 0 | 0 | 0 | 1051152 | 0 | 1801 | 0 | 4496 | 0 | 1057449 | 0 | 0 |
| DENNIS R AYERS | |||||||||||||
| 0 | 0 | 0 | 0 | 0 | 120918 | 0 | 4709 | 0 | 7325 | 0 | 132952 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)
| Return ReferenceReturnReference | ExplanationExplanation |
|---|---|
| PART I, LINES 4A-B | CERTAIN EXECUTIVES PARTICIPATE IN AND/OR RECEIVE PAYMENTS FROM SEVERANCE AND SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLANS PROVIDED BY A RELATED ORGANIZATION OR UNRELATED ORGANIZATIONS (NCBH). THE DETERMINATION OF THE AMOUNT OF THE SEVERANCE AND/OR NON-QUALIFIED RETIREMENT PLAN PAYMENTS FOLLOW THE RELATED/UNRELATED ORGANIZATION'S COMPENSATION PROCEDURES AS OUTLINED IN PART VI, SECTION B, LINE 15 OF THEIR FORM 990 |
| PART I, LINES 4A-B | THE FOLLOWING INDIVIDUALS RECEIVED SEVERANCE PACKAGES FROM LEXINGTON MEDICAL CENTER: DENNIS R. AYERS - $ 120,918 JOHN A. CASHION - 1,051,152 THE FOLLOWING INDIVIDUAL RECEIVED NON-QUAILIFED RETIREMENT PAYMENTS FROM NCBH: DONNY LAMBETH - $1,623,420 |
Schedule N IRS990ScheduleN
Liquidation Table LiquidationTable
Liquidation Detail LiquidationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description Of Asset | CASH OF $2,271 AND INVESTMENT IN SUBSIDIARY $1,363,092, NET OF OUTSTANDING LIABILITIES $26,329 | DescriptionOfAsset |
| Date Of Distribution | 2012-06-30 | DateOfDistribution |
| FMV Of Asset | 1339034 | FMVOfAsset |
| Method Of FMV Determination | ACTUAL COST | MethodOfFMVDetermination |
| EIN | 560543238 | EIN |
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | LEXINGTON MEDICAL CENTER | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 250 HOSPITAL DRIVE | AddressLine1 |
| City | LEXINGTON | City |
| State | NC | State |
| ZIP Code | 27293 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IRC Section | 501(C)(3) | IRCSection |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Director Of Successor | 1 | DirectorOfSuccessor |
| Employee Of Successor | 1 | EmployeeOfSuccessor |
| Owner Of Successor | 0 | OwnerOfSuccessor |
| Receive Compensation | 0 | ReceiveCompensation |
| Assets Distributed | 1 | AssetsDistributed |
| Required To Notify AG | 1 | RequiredToNotifyAG |
| AG Notified | 1 | AGNotified |
| Liabilities Paid | 1 | LiabilitiesPaid |
| Bonds Outstanding | 0 | BondsOutstanding |
| Bond Liabilities Discharged | 0 | BondLiabilitiesDischarged |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (12 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| CHANGES IN PROGRAM SERVICES | FORM 990, PART III, LINE 3 | ON JUNE 28, 2012, THE MEMBERS OF THE CORPORATION, WAKE FOREST UNIVERSITY HEALTH SCIENCES AND NORTH CAROLINA BAPTIST HOSPITAL, VOTED TO MERGE WITH LEXINGTON MEDICAL CENTER, NONPROFIT CORPORATION ORGANIZED UNDER THE LAWS OF NORTH CAROLINA. |
| FORM 990, PART VI, SECTION A, LINE 6 | THE MEMBERS OF THE CORPORATION SHALL BE WAKE FOREST UNIVERSITY HEALTH SCIENCES AND NORTH CAROLINA BAPTIST HOSPITAL. | |
| FORM 990, PART VI, SECTION A, LINE 7A | DECISIONS OF THE ORGANIZATION'S GOVERNING BODY WHICH REQUIRE APPROVAL BY THE ORGANIZATION'S MEMBERS, WAKE FOREST UNIVERSITY HEALTH SCIENCES AND NORTH CAROLINA BAPTIST HOSPITAL, INCLUDE AMENDEMENTS TO CERTAIN FUNDAMENTAL DOCUMENTS (ARTICLES OF INCORPORATION AND BYLAWS) AND ELECTION AND REMOVAL OF DIRECTORS. | |
| FORM 990, PART VI, SECTION A, LINE 7B | DECISIONS OF THE ORGANIZATION'S GOVERNING BODY WHICH REQUIRE APPROVAL BY THE ORGANIZATION'S MEMBERS, WAKE FOREST UNIVERSITY HEALTH SCIENCES AND NORTH CAROLINA BAPTIST HOSPITAL, INCLUDE AMENDEMENTS TO CERTAIN FUNDAMENTAL DOCUMENTS (ARTICLES OF INCORPORATION AND BYLAWS) AND ELECTION AND REMOVAL OF DIRECTORS. | |
| FORM 990, PART VI, SECTION B, LINE 11 | THE ORGANIZATION DISTRIBUTES A DRAFT COPY OF THE FORM 990 TO ALL MEMBERS OF THE ORGANIZATION IN ADEQUATE TIME FOR FEEDBACK PRIOR TO FILING A FINALIZED FORM 990 WITH THE IRS. | |
| FORM 990, PART VI, SECTION B, LINE 12C | THE ORGANIZATION HAS A CONFLICT OF INTEREST POLICY WHICH IS REVIEWED, ACCEPTED, AND SIGNED BY EACH OFFICER AND VOTING BOARD MEMBER ON AN ANNUAL BASIS. PURSUANT TO THIS POLICY EACH OFFICER AND BOARD MEMBER WILL RECUSE THEMSELVES FROM ANY DISCUSSION AND VOTE FOR WHICH A CONFLICT EXISTS FOR THEMSELVES OR THEIR FAMILY. DETERMINATIONS OF WHETHER A CONFLICT EXISTS ARE MADE AT A MANAGEMENT, BOARD MEMBER OFFICER, AND INDIVIDUAL LEVEL. ACTUAL CONFLICTS ARE REVIEWED WITHOUT THE PRESENCE OF THE INTERESTED PARTY. | |
| THE ORGANIZATION PAYS NO COMPENSATION TO OFFICERS, DIRECTORS OR KEY EMPLOYEES. ALL COMPENSATION PAID TO OFFICERS AND DIRECTORS AND FORMER OFFICERS AND DIRECTORS WAS PAID BY RELATED ORGANIZATIONS. COMPENSATION PAID TO THESE INDIVIDUALS ARE REVIEWED AND APPROVED IN ACCORDANCE WITH THE RELATED ORGANIZATION'S COMPENSATION POLICIES AND PROCEDURES WHICH INCLUDE INDEPENDENT COMPENSATION CONSULTANTS, COMPENSATION SURVEYS AND STUDIES TO DETERMINE THE APPROPRIATENESS OF EACH OFFICERS' AND DIRECTORS' COMPENSATION. | ||
| 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. | |
| FORM 990, PART VII, SECTION A, COLUMN B | THE ORGANIZATION HAS CERTAIN EXECUTIVES THAT PROVIDE SERVICES TO NOT ONLY THE ORGANIZATION, BUT ALSO TO SOME OR ALL OF THE OTHER TAX-EXEMPT ORGANIZATIONS WITHIN THE WAKE FOREST BAPTIST MEDICAL CENTER. FOR EXAMPLE, MANY OF THESE EXECUTIVES' ROLES FOCUS ON PARTICULAR SERVICE LINES WHICH CROSS THE VARIOUS MARKETS OUR ORGANIZATIONS SERVE, THUS THE SERVICES PROVIDED BY THESE EXECUTIVES MAY BENEFIT AND BE RECEIVED BY MULTIPLE ORGANIZATIONS WITHIN THE MEDICAL CENTER. 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 MEDICAL CENTER. | |
| PART VII, SECTION A, LINE 5 - COMPENSATION FROM UNRELATED ORGANIZATION | THE FOLLOWING INDIVIDUALS RECEIVED COMPENSATION FROM UNREALTED ORGANIZATIONS, NCBH, FOR SERVICES RENDERED TO THIS ORGANIZATION IN THEIR ROLES AS OFFICER AND DIRECTOR: DONNY C. LAMBETH - $2,328,700 STEVEN SNELGROVE - $ 329,647 JOHNNY VEAL - $ 208,131 | |
| CHANGES IN NET ASSETS OR FUND BALANCES: | FORM 990, PART XI, LINE 5: | NET ASSETS TRANSFERRED TO LEXINGTON MEDICAL CENTER PURSUANT TO MERGER AGREEMENT EFFECTIVE JUNE 28, 2012 -1,339,034. EQUITY INCREASE IN AFFILIATE AND UNCONSOLIDATED SUBSIDIARY 23,904. CONTRIBUTIONS FROM AFFILIATES (NET) 14,000. TOTAL TO FORM 990, PART XI, LINE 5: -1,301,130. |
| FORM 990, PART XI, LINE 2C | NO CHANGES FROM PRIOR YEAR METHOD OF OVERSIGHT. |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (5 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Controlled OrgControlledOrg |
|---|---|---|---|---|---|---|---|---|---|---|
| LEXINGTON MEDICAL CENTER | ||||||||||
| 250 HOSPITAL DRIVE | LEXINGTON | NC | 27292 | 560543238 | HOSPITAL | NC | 501(C)(3) | LINE 3 | WAKE FOREST UNIVERSITY BAPTIST MEDICAL CENTER | 0 |
| LEXPROPERTIES INC | ||||||||||
| 250 HOSPITAL DRIVE | LEXINGTON | NC | 27292 | 561474401 | HOLD REAL ESTATE | NC | 501(C)(2) | DAVIDSON HEALTHCARE INC | 1 | |
| LEXHEALTH INC | ||||||||||
| 250 HOSPITAL DRIVE | LEXINGTON | NC | 27292 | 561474400 | PROMOTED AND SUPPORTED COST-EFFECTIVE HEALTH CARE FOR RESIDENTS OF THE TRIAD | NC | 501(C)(3) | LINE 11B, II | DAVIDSON HEALTHCARE INC | 1 |
| LEXMEDICAL INC | ||||||||||
| 250 HOSPITAL DRIVE | LEXINGTON | NC | 27292 | 561941380 | PHYSICIAN PRACTICES | NC | 501(C)(3) | LINE 9 | DAVIDSON HEALTHCARE INC | 1 |
| LEXINGTON MEDICAL CENTER FOUNDATION | ||||||||||
| 250 HOSPITAL DRIVE | LEXINGTON | NC | 27292 | 581876553 | FUNDRAISING | NC | 501(C)(3) | LINE 11B, II | LEXINGTON MEDICAL CENTER | 0 |
Form990 Schedule R Part IV Form990ScheduleRPartIV (2 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivityPrimaryActivity | Legal Domicile StateLegalDomicileState | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Type Of EntityTypeOfEntity | Share Of Total IncomeShareOfTotalIncome | Percentage OwnershipPercentageOwnership |
|---|---|---|---|---|---|---|---|---|---|---|
| LEXCARE INC | ||||||||||
| 250 HOSPITAL DRIVE | LEXINGTON | NC | 27292 | 561474407 | PHARMACY | NC | DAVIDSON HEALTHCARE INC | C | 23904 | 1.00000 |
| MEDICAL PARK OFFICES UNIT OWNERS ASSOCIATION | ||||||||||
| 250 HOSPITAL DRIVE | LEXINGTON | NC | 27292 | 561685147 | CONDO OWNERS ASSOCIATION | NC | DAVIDSON HEALTHCARE INC | C | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 1 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 1 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 0 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 0 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 0 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 0 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 1 | SharingOfFacilities |
| Sharing Of Paid Employees | 1 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 1 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 1 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 0 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |
Transactions Related Orgs Table TransactionsRelatedOrgsTable (4 entries)
| Transaction TypeTransactionType | Amount InvolvedAmountInvolved | Method Of Amt DeterminationMethodOfAmtDetermination |
|---|---|---|
| LEXPROPERTIES INC | ||
| C | 186285 | FAIR MARKET VALUE |
| LEXMEDICAL INC | ||
| C | 343724 | FAIR MARKET VALUE |
| LEXINGTON MEDICAL CENTER | ||
| B | 628407 | FAIR MARKET VALUE |
| LEXINGTON MEDICAL CENTER FOUNDATION | ||
| C | 112398 | FAIR MARKET VALUE |
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