LEXMEDICAL INC: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization
LEXMEDICAL INC (EIN 56-1941380)
Tax period
2011-07-01 to 2012-06-28
Filed
2013-05-14
IRS object ID
201321349349301177
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

FieldValueIRS element (for citing)
Timestamp2013-05-14T08:57:48-05:00Timestamp
Tax Period End Date2012-06-28TaxPeriodEndDate

Preparer Firm PreparerFirm

FieldValueIRS element (for citing)
EIN560817345EIN

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1TURLINGTON AND COMPANY LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line11338 WESTGATE CENTER DRIVEAddressLine1
CityWINSTONSALEMCity
StateNCState
ZIP Code27103ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2011-07-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN561941380EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1LEXMEDICAL INCBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlLEXMNameControl
Phone3362485161Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1PO BOX 1817 250 HOSPITAL DRIVEAddressLine1
CityLEXINGTONCity
StateNCState
ZIP Code272931817ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameDANNY W SQUIRESName
TitleVICE PRESIDENT/CFOTitle
Phone3362485161Phone
Date Signed2013-05-13DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameTERRY J BERRIERName
PTINP01239877PTIN
Phone3367652410Phone
FieldValueIRS element (for citing)
Tax Year2011TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Terminated ReturnXTerminatedReturn
Name Of Principal Officer PersonDANNY W SQUIRESNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1250 HOSPITAL DRIVEAddressLine1
CityLEXINGTONCity
StateNCState
ZIP Code27292ZIPCode
FieldValueIRS element (for citing)
Gross Receipts3780212GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.LEXMEDICAL.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1995YearFormation
State Legal DomicileNCStateLegalDomicile
Activity Or Mission DescriptionTO PROMOTE, IMPROVE, AND ENHANCE THE HEALTH AND WELFARE OF MEDICALLY UNDERSERVED COMMUNITIES.ActivityOrMissionDescription
Termination Or ContractionXTerminationOrContraction
Nbr Voting Members Governing Body6NbrVotingMembersGoverningBody
Nbr Independent Voting Members2NbrIndependentVotingMembers
Total Nbr Employees127TotalNbrEmployees
Total Nbr Volunteers0TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year2311113ContributionsGrantsPriorYear
Contributions Grants Current Year1200000ContributionsGrantsCurrentYear
Program Service Revenue Prior Year11807944ProgramServiceRevenuePriorYear
Program Service Revenue CY2579728ProgramServiceRevenueCY
Investment Income Prior Year1692InvestmentIncomePriorYear
Investment Income Current Year484InvestmentIncomeCurrentYear
Other Revenue Prior Year0OtherRevenuePriorYear
Other Revenue Current Year0OtherRevenueCurrentYear
Total Revenue Prior Year14120749TotalRevenuePriorYear
Total Revenue Current Year3780212TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year0GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year12229755SalariesEtcPriorYear
Salaries Etc Current Year3541722SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year4850550OtherExpensePriorYear
Other Expenses Current Year2028215OtherExpensesCurrentYear
Total Expenses Prior Year17080305TotalExpensesPriorYear
Total Expenses Current Year5569937TotalExpensesCurrentYear
Revenues Less Expenses Prior Year-2959556RevenuesLessExpensesPriorYear
Revenues Less Expenses CY-1789725RevenuesLessExpensesCY
Total Assets BOY4797575TotalAssetsBOY
Total Assets EOY0TotalAssetsEOY
Total Liabilities BOY2171812TotalLiabilitiesBOY
Total Liabilities EOY0TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY2625763NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY0NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionTO PROMOTE, IMPROVE, AND ENHANCE THE HEALTH AND WELFARE OF COMMUNITIES THROUGH THE SUPPORT OF OR INVOLVEMENT IN THE RECRUITMENT, FORMATION, DEVELOPMENT, MANAGEMENT, EQUIPPING, AND MAINTENANCE OF HEALTH CARE SERVICES PROVIDED IN AFFILIATION WITH LEXINGTON MEDICAL CENTER, A NOT FOR PROFIT CORPORATION EXEMPT FROM FEDERAL TAXATION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE, IN MEDICALLY UNDERSERVED COMMUNITIES.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change1SignificantChange
Expense5459299Expense
Revenue2579728Revenue
DescriptionPROVIDED HEALTH CARE SERVICES IN AFFILIATION WITH LEXINGTON MEDICAL CENTER, TO AREAS THAT ARE MEDICALLY UNDERSERVED.Description
Total Program Service Expense5459299TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities0LobbyingActivities
Subject To Proxy Tax0SubjectToProxyTax
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments0TermOrPermanentEndowments
Report Land Bldg Equip0ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets0ReportOtherAssets
Report Other Liabilities0ReportOtherLiabilities
Report Fin48 Footnote1ReportFin48Footnote
Independent Audit Financial Stmt0IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt1ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital0Hospital
Grants To Organizations0GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds0TaxExemptBonds
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated1Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity0RelatedOrgControlledEntity
Transaction Related Entity0TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With109622NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees127NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members6NbrVotingGoverningBodyMembers
Number Independent Voting Members2NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders1MembersOrStockholders
Election Of Board Members1ElectionOfBoardMembers
Decisions Subject To Approval1DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO0CompensationProcessCEO
Compensation Process Other0CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
States Where Copy Of Return Is FiledNCStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1DANNY W SQUIRESBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number3362485161TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1PO BOX 1817 250 HOSPITAL DRIVEAddressLine1
CityLEXINGTONCity
StateNCState
ZIP Code272931817ZIPCode
FieldValueIRS element (for citing)
Info In Schedule O Part VIIXInfoInScheduleOPartVII

Form990 Part VII Section A Form990PartVIISectionA (16 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationHighest Compensated EmployeeHighestCompensatedEmployeeFormerFormer
DONNY LAMBETH
PRESIDENT/CHAIRMAN4.00XX23287000143909
JEFF MAST
DIRECTOR2.00X000
SAM HARRIS MD
DIRECTOR40.00X20857608236
SOHAIL BAZEL MD
DIRECTOR40.00X29959508453
DAVID HOPE
DIRECTOR6.00X000
STEVE SNELGROVE
DIRECTOR40.00X3296470115765
DANNY W SQUIRES
VICE PRESIDENT/TREASURER6.00X016261119502
BARBARA B SMITH
SECRETARY6.00X017570116954
CHRISTOPHER T WHITE
ASSISTANT TREASURER6.00X09425517584
WILLIAM G BLACKARD MD
PHYSICIAN40.00335670021165X
MICHAEL J PHILLIPS MD
PHYSICIAN40.0038335409821X
KAITE M TWOMLEY MD
PHYSICIAN40.0035893007371X
WILLIAM Y ASIHENE MD
PHYSICIAN40.00409533021165X
TIFFENY S CARROLL MD
PHYSICIAN40.00324597016265X
DENNIS R AYERS
FORMER PRESIDENT40.00012091812034X
JOHN A CASHION
FORMER PRESIDENT40.00010511526297X
FieldValueIRS element (for citing)
Total Reportable Comp From Org4978602TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs1604637TotalReportableCompFrmRltdOrgs
Total Other Compensation424521TotalOtherCompensation
Number Individuals GT100 K32NumberIndividualsGT100K
Formers Listed1FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources1CompensationFromOtherSources

Contractor Compensation ContractorCompensation

Name Of Contractor NameOfContractor

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1WEATHERBY LOCUMSBusinessNameLine1

Address Of Contractor AddressOfContractor

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1PO BOX 972633AddressLine1
CityDALLASCity
StateTXState
ZIP Code75397ZIPCode
FieldValueIRS element (for citing)
Description Of ServicesINDEPENDENT CONTRACTORDescriptionOfServices
Compensation122500Compensation
FieldValueIRS element (for citing)
Number Of Contractors GT100 K1NumberOfContractorsGT100K
All Other Contributions1200000AllOtherContributions
Total Contributions1200000TotalContributions

Program Service Revenue ProgramServiceRevenue

FieldValueIRS element (for citing)
DescriptionNET PATIENT SERVICE REDescription
Business Code621110BusinessCode
Total Revenue Column2579728TotalRevenueColumn
Related Or Exempt Function Income2579728RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Program Service Revenue2579728TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column484TotalRevenueColumn
Exclusion$484ExclusionAmount

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column3780212TotalRevenueColumn
Related Or Exempt Function Income2579728RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$484ExclusionAmount

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total524830Total
Program Services524830ProgramServices

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total2816913Total
Program Services2755098ProgramServices
Management And General61815ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total52440Total
Program Services52415ProgramServices
Management And General25ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total71713Total
Program Services71240ProgramServices
Management And General473ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total75826Total
Program Services74121ProgramServices
Management And General1705ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total400Total
Management And General400ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total1080Total
Program Services1080ProgramServices

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total1346Total
Program Services826ProgramServices
Management And General520ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total27559Total
Program Services27559ProgramServices

Travel Travel

FieldValueIRS element (for citing)
Total17271Total
Program Services17271ProgramServices

Interest Interest

FieldValueIRS element (for citing)
Total6163Total
Program Services6163ProgramServices

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total16271Total
Program Services13751ProgramServices
Management And General2520ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total71733Total
Program Services71638ProgramServices
Management And General95ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
FUNDS FLOW EXPENSE985093985093
BAD DEBT EXPENSE764986764986
CONTRACT SERVICES451593372511434
OTHER EXPENSE386401340925231

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total52514Total
Program Services46094ProgramServices
Management And General6420ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total5569937Total
Program Services5459299ProgramServices
Management And General110638ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY9033BOY
EOY0EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
EOY0EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
EOY0EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY3124426BOY
EOY0EOY

Receivables From Officers Etc ReceivablesFromOfficersEtc

FieldValueIRS element (for citing)
EOY0EOY

Receivables From Disqual Persons ReceivablesFromDisqualPersons

FieldValueIRS element (for citing)
EOY0EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

FieldValueIRS element (for citing)
EOY0EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
EOY0EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY3043BOY
EOY0EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis0LandBuildingsEquipmentBasis

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY156391BOY
EOY0EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
EOY0EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
EOY0EOY

Investments Program Related InvestmentsProgramRelated

FieldValueIRS element (for citing)
EOY0EOY

Intangible Assets IntangibleAssets

FieldValueIRS element (for citing)
BOY1504682BOY
EOY0EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
EOY0EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY4797575BOY
EOY0EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY1271147BOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY227099BOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY673566BOY
EOY0EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY2171812BOY
EOY0EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY2625763BOY
EOY0EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY2625763BOY
EOY0EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY4797575BOY
EOY0EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses-1789725ReconcilationRevenueExpenses
Reconcilation Other Changes-836038ReconcilationOtherChanges
Info In Schedule O Part XIIXInfoInScheduleOPartXII
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement ConsolidatedXFinancialStatementConsolidated
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org509a2XPubliclySupportedOrg509a2

Gifts Grants Contrib Received509 GiftsGrantsContribReceived509

FieldValueIRS element (for citing)
Current Tax Year Minus3 Years580000CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years1643750CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year2311113CurrentTaxYearMinus1Year
Current Tax Year1200000CurrentTaxYear
Total5734863Total

Gross Receipts From Admissions GrossReceiptsFromAdmissions

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years8079557CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years6527436CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years10892042CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year11807944CurrentTaxYearMinus1Year
Current Tax Year2579728CurrentTaxYear
Total39886707Total

Total509 Total509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years8079557CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years7107436CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years12535792CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year14119057CurrentTaxYearMinus1Year
Current Tax Year3779728CurrentTaxYear
Total45621570Total

Amts Recd From Disqual Persons AmtsRecdFromDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Amts From Subst Contributors AmtsFromSubstContributors

FieldValueIRS element (for citing)
Total0Total

Support From DQ Ps Etc SupportFromDQPsEtc

FieldValueIRS element (for citing)
Total0Total
FieldValueIRS element (for citing)
Public Support Total50945621570PublicSupportTotal509

Gross Investment Income509 GrossInvestmentIncome509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years487CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years134CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years1730CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year1695CurrentTaxYearMinus1Year
Current Tax Year484CurrentTaxYear
Total4530Total

Investment Income And UBTI InvestmentIncomeAndUBTI

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years487CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years134CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years1730CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year1695CurrentTaxYearMinus1Year
Current Tax Year484CurrentTaxYear
Total4530Total

Total Support Total TotalSupportTotal

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years8080044CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years7107570CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years12537522CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year14120752CurrentTaxYearMinus1Year
Current Tax Year3780212CurrentTaxYear
Total45626100Total
FieldValueIRS element (for citing)
Public Support Percentage5090.99990PublicSupportPercentage509
Investment Income Percentage0.00010InvestmentIncomePercentage
Thirty Three Percnt Tests CY509XThirtyThreePercntTestsCY509
General ExplanationSCHEDULE 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 B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Total Of Book Value Land Buildings0TotalOfBookValueLandBuildings

Form990 Schedule D Part XIV Form990ScheduleDPartXIV

FieldValueIRS element (for citing)
IdentifierDESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48:Identifier
Return ReferencePART X:ReturnReference
ExplanationTHE 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

FieldValueIRS element (for citing)
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance Payment1SeverancePayment
Supplemental Nonqual Retire Plan1SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org0CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs0CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments0AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (13 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
DONNY LAMBETH
49559501819880165111701283990155100247260903494140
SAM HARRIS MD
208576000008236000216812000
SOHAIL BAZEL MD
2045970949980008453000308048000
STEVE SNELGROVE
2511550616520168400812770344880445412000
DANNY W SQUIRES
01504610121500005687013815018211300
BARBARA B SMITH
01626510130500006185010769019265500
WILLIAM G BLACKARD MD
32253001314000073500138150356835000
MICHAEL J PHILLIPS MD
224187050000154167098000210393175000
KAITE M TWOMLEY MD
29750006143000073500210366301000
WILLIAM Y ASIHENE MD
32119308834000073500138150430698000
TIFFENY S CARROLL MD
3245970000024500138150340862000
DENNIS R AYERS
000001209180470907325013295200
JOHN A CASHION
00000105115201801044960105744900

Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)

Return ReferenceReturnReferenceExplanationExplanation
PART I, LINES 4A-BCERTAIN 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-BTHE 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 (2 entries)

Description Of AssetDescriptionOfAssetDate Of DistributionDateOfDistributionFMV Of AssetFMVOfAssetMethod Of FMV DeterminationMethodOfFMVDeterminationEINEINAddress Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeIRC SectionIRCSection
LEXINGTON MEDICAL CENTER
CASH OF $121,263, ACCOUNTS RECEIVABLE OF $178,302 AND PROPERTY AND EQUIPMENT(NET) $111,988, NET OF OUTSTANDING LIABILITIES $378,5272012-06-2833026ACTUAL COST560543238250 HOSPITAL DRIVELEXINGTONNC27292501(C)(3)
WAKE FOREST BAPTIST HEALTH COMMUNITY PHSICIANS
GOODWILL OF $1,504,682, NET OF OUTSTANDING LIABILITIES $1,045,394459288ACTUAL COST3540 CLEMMONS ROAD SUITE 1CLEMMONSNC27012
FieldValueIRS element (for citing)
Director Of Successor1DirectorOfSuccessor
Employee Of Successor1EmployeeOfSuccessor
Owner Of Successor0OwnerOfSuccessor
Receive Compensation0ReceiveCompensation
Assets Distributed0AssetsDistributed
Required To Notify AG1RequiredToNotifyAG
AG Notified1AGNotified
Liabilities Paid0LiabilitiesPaid
Bonds Outstanding0BondsOutstanding
Bond Liabilities Discharged0BondLiabilitiesDischarged

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (12 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
CHANGES IN PROGRAM SERVICESFORM 990, PART III, LINE 3ON JUNE 28, 2012, THE SOLE MEMBER OF THE CORPORATION, DAVIDSON HEALTHCARE, INC., ELECTED TO MERGE WITH LEXINGTON MEDICAL CENTER, NONPROFIT CORPORATION ORGANIZED UNDER THE LAWS OF NORTH CAROLINA. SIMULTANEOUS WITH THIS MERGER, LEXMEDICAL'S ASSETS WERE MERGED WITH LEXINGTON MEDICAL CENTER.
FORM 990, PART VI, SECTION A, LINE 6THE MEMBER OF THE CORPORATION SHALL BE DAVIDSON HEALTHCARE, INC.
FORM 990, PART VI, SECTION A, LINE 7ADECISIONS OF THE ORGANIZATION'S GOVERNING BODY WHICH REQUIRE APPROVAL BY THE ORGANIZATION'S MEMBER, DAVIDSON HEALTHCARE, INC., INCLUDE AMENDEMENTS TO CERTAIN FUNDAMENTAL DOCUMENTS (ARTICLES OF INCORPORATION AND BYLAWS) AND ELECTION AND REMOVAL OF DIRECTORS.
FORM 990, PART VI, SECTION A, LINE 7BDECISIONS OF THE ORGANIZATION'S GOVERNING BODY WHICH REQUIRE APPROVAL BY THE ORGANIZATION'S MEMBER, DAVIDSON HEALTHCARE, INC., INCLUDE AMENDEMENTS TO CERTAIN FUNDAMENTAL DOCUMENTS (ARTICLES OF INCORPORATION AND BYLAWS) AND ELECTION AND REMOVAL OF DIRECTORS.
FORM 990, PART VI, SECTION B, LINE 11THE 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 12CTHE BYLAWS OF THE FILING ORGANIZATION HAVE CONFLICT OF INTEREST PROVISIONS WHICH ARE REVIEWED, ACCEPTED, AND SIGNED BY EACH OFFICER AND VOTING BOARD MEMBER ON AN ANNUAL BASIS. PURSUANT TO THESE PROVISIONS 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.
COMPENSATION PAID TO TOP OFFICERS WAS PAID BY RELATED ORGANIZATIONS. COMPENSATION PAID TO OTHER OFFICERS WAS PAID BY THE ORGANIZATION. COMPENSATION PAID TO THESE INDIVIDUALS ARE REVIEWED AND APPROVED IN ACCORDANCE WITH COMPENSATION POLICIES AND PROCEDURES WHICH INCLUDE INDEPENDENT COMPENSATION CONSULTANTS, COMPENSATION SURVEYS AND STUDIES TO DETERMINE THE APPROPRIATENESS OF EACH OFFICERS' COMPENSATION.
FORM 990, PART VI, SECTION C, LINE 19THE 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 BTHE 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 ORGANIZATIONTHE FOLLOWING INDIVIDUALS RECEIVED COMPENSATION FROM AN UNREALTED ORGANIZATION, NCBH, FOR SERVICES RENDERED TO THIS ORGANIZATION IN HIS ROLE AS EMPLOYEE, OFFICER AND DIRECTOR: DONNY C. LAMBETH - $2,328,700 STEVEN SNELGROVE - 329,647
CHANGES IN NET ASSETS OR FUND BALANCES:FORM 990, PART XI, LINE 5:CONTRIBUTIONS TO AFFILIATES (NET) -803,012. NET ASSETS TRANSFERRED TO LEXINGTON MEDICAL CENTER PURSUANT TO MERGER AGREEMENT EFFECTIVE JUNE 28, 2012 -33,026. TOTAL TO FORM 990, PART XI, LINE 5: -836,038.
FORM 990, PART XI, LINE 2CNO CHANGES FROM PRIOR YEAR METHOD OF OVERSIGHT.

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (5 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Controlled OrgControlledOrg
DAVIDSON HEALTHCARE INC
250 HOSPITAL DRIVELEXINGTONNC27292561474399SUPPORT OF LEXINGTON MEDICAL CENTERNC501(C)(3)LINE 11B, IIWFUBMC0
LEXINGTON MEDICAL CENTER
250 HOSPITAL DRIVELEXINGTONNC27292560543238HOSPITALNC501(C)(3)LINE 3WFUBMC0
LEXPROPERTIES INC
250 HOSPITAL DRIVELEXINGTONNC27292561474401HOLD REAL ESTATENC501(C)(2)DAVIDSON HEALTHCARE INC0
LEXHEALTH INC
250 HOSPITAL DRIVELEXINGTONNC27292561474400PROMOTED AND SUPPORTED COST-EFFECTIVE HEALTH CARE FOR RESIDENTS OF THE TRIADNC501(C)(3)LINE 11B, IIDAVIDSON HEALTHCARE INC0
LEXINGTON MEDICAL CENTER FOUNDATION
250 HOSPITAL DRIVELEXINGTONNC27292581876553FUNDRAISINGNC501(C)(3)LINE 11B, IILEXINGTON MEDICAL CENTER0

Form990 Schedule R Part IV Form990ScheduleRPartIV (2 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivityPrimaryActivityLegal Domicile StateLegalDomicileStateBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Type Of EntityTypeOfEntity
LEXCARE INC
250 HOSPITAL DRIVELEXINGTONNC27292561474407PHARMACYNCDAVIDSON HEALTHCARE INCC
MEDICAL PARK OFFICES UNIT OWNERS ASSOCIATION
250 HOSPITAL DRIVELEXINGTONNC27292561685147CONDO OWNERS ASSOCIATIONNCDAVIDSON HEALTHCARE INCC
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org1GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org1GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org0LoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs0RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs1RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs1PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs1PerformOfServicesByOtherOrgs
Sharing Of Facilities1SharingOfFacilities
Sharing Of Paid Employees1SharingOfPaidEmployees
Reimbursement Paid To Other Org1ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org1ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org0OtherTransferFromOtherOrg

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