2013-05-14T08:57:48-05:00 2012-06-28 560817345 TURLINGTON AND COMPANY LLP 1338 WESTGATE CENTER DRIVE WINSTONSALEM NC 27103 990 2011-07-01 561474399 DAVIDSON HEALTHCARE INC DAVI 3362485161 PO BOX 1817 LEXINGTON NC 272931817 DANNY W SQUIRES 3362485161 2013-05-13 1 TERRY J BERRIER P01239877 3367652410 2011 2016-02-25 16:41:14Z X DANNY W SQUIRES 250 HOSPITAL DRIVE LEXINGTON NC 27292 0 0 X N/A X 1985 NC 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. X 18 17 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 10565 12083 10565 12083 -10565 -12083 1339892 0 26679 0 1313213 0 X 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. 0 1 12083 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. 12083 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 1 0 0 1 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 X 18 17 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 NC X DANNY W SQUIRES 3362485161 PO BOX 1817 250 HOSPITAL DRIVE LEXINGTON NC 272931817 X ROBERT B SMITH JR 2.00 X X 0 0 0 JEFF MAST 2.00 X X 0 0 0 MARK BREEDEN 2.00 X 0 0 0 DAN BRIGGS 2.00 X 0 0 0 ROBERT CRAVEN 2.00 X 0 0 0 KAREN CRAVER 2.00 X 0 0 0 TERRA GREEN 2.00 X 0 0 0 TERRY L HALES JR 2.00 X 0 0 0 JAMES HOEKSTRA MD 2.00 X 0 0 0 RAY N HOWELL III 2.00 X 0 0 0 LARRY POTTS 2.00 X 0 0 0 J SIMMONS RIGGAN MD 2.00 X 0 0 0 PATRICIA SHOEMAKER 2.00 X 0 0 0 TOM SIBERT MD 2.00 X 0 0 0 GREG STABLER 2.00 X 0 0 0 DAVID WAGNER MD 2.00 X 0 0 0 WILLIAM W WOODRUFF MD 2.00 X 0 0 0 DONNY C LAMBETH 40.00 X 2328700 0 143909 STEVEN SNELGROVE 40.00 X 329647 0 115765 JOHNNY VEAL 40.00 X 208131 0 5161 DANNY W SQUIRES 40.00 X 0 162611 19502 BARBARA B SMITH 40.00 X 0 175701 16954 DENISE SNIDER 40.00 X 0 47761 1910 CHRISTOPHER T WHITE 40.00 X 0 94255 17584 JOHN A CASHION 40.00 X 0 1051152 6297 DENNIS R AYERS 40.00 X 0 120918 12034 2866478 1652398 339116 0 1 1 1 0 0 0 0 0 9000 9000 PROFESSIONAL FEES 3083 3083 12083 12083 0 0 0 704 0 0 0 0 0 0 0 0 0 0 0 1339188 0 0 0 1339892 0 26679 26679 0 X 1313213 0 1313213 0 1339892 0 X -12083 -1301130 X X 0 1 1 X 0 X X X 0 0 0 LEXINGTON MEDICAL CENTER 560543238 3 1 628207 1 628207 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. 0 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: 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 1 1 0 0 0 0 0 0 0 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 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 CASH OF $2,271 AND INVESTMENT IN SUBSIDIARY $1,363,092, NET OF OUTSTANDING LIABILITIES $26,329 2012-06-30 1339034 ACTUAL COST 560543238 LEXINGTON MEDICAL CENTER 250 HOSPITAL DRIVE LEXINGTON NC 27293 501(C)(3) 1 1 0 0 1 1 1 1 0 0 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. 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 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 0 1 1 0 0 0 0 0 0 0 0 0 1 1 1 1 0 0 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