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 561941380 LEXMEDICAL INC LEXM 3362485161 PO BOX 1817 250 HOSPITAL DRIVE LEXINGTON NC 272931817 DANNY W SQUIRES 3362485161 2013-05-13 1 TERRY J BERRIER P01239877 3367652410 2011 2016-02-24 21:20:13Z X DANNY W SQUIRES 250 HOSPITAL DRIVE LEXINGTON NC 27292 3780212 0 X WWW.LEXMEDICAL.ORG X 1995 NC TO PROMOTE, IMPROVE, AND ENHANCE THE HEALTH AND WELFARE OF MEDICALLY UNDERSERVED COMMUNITIES. X 6 2 127 0 0 0 2311113 1200000 11807944 2579728 1692 484 0 0 14120749 3780212 0 0 0 0 12229755 3541722 0 0 0 4850550 2028215 17080305 5569937 -2959556 -1789725 4797575 0 2171812 0 2625763 0 X TO 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. 0 1 5459299 2579728 PROVIDED HEALTH CARE SERVICES IN AFFILIATION WITH LEXINGTON MEDICAL CENTER, TO AREAS THAT ARE MEDICALLY UNDERSERVED. 5459299 1 1 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 0 0 0 0 1 22 0 1 127 1 0 0 0 0 0 0 0 0 0 0 X 6 2 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 DONNY LAMBETH 4.00 X X 2328700 0 143909 JEFF MAST 2.00 X 0 0 0 SAM HARRIS MD 40.00 X 208576 0 8236 SOHAIL BAZEL MD 40.00 X 299595 0 8453 DAVID HOPE 6.00 X 0 0 0 STEVE SNELGROVE 40.00 X 329647 0 115765 DANNY W SQUIRES 6.00 X 0 162611 19502 BARBARA B SMITH 6.00 X 0 175701 16954 CHRISTOPHER T WHITE 6.00 X 0 94255 17584 WILLIAM G BLACKARD MD 40.00 X 335670 0 21165 MICHAEL J PHILLIPS MD 40.00 X 383354 0 9821 KAITE M TWOMLEY MD 40.00 X 358930 0 7371 WILLIAM Y ASIHENE MD 40.00 X 409533 0 21165 TIFFENY S CARROLL MD 40.00 X 324597 0 16265 DENNIS R AYERS 40.00 X 0 120918 12034 JOHN A CASHION 40.00 X 0 1051152 6297 4978602 1604637 424521 32 1 1 1 WEATHERBY LOCUMS PO BOX 972633 DALLAS TX 75397 INDEPENDENT CONTRACTOR 122500 1 1200000 1200000 NET PATIENT SERVICE RE 621110 2579728 2579728 2579728 484 484 3780212 2579728 0 484 524830 524830 2816913 2755098 61815 52440 52415 25 71713 71240 473 75826 74121 1705 400 400 1080 1080 1346 826 520 27559 27559 17271 17271 6163 6163 16271 13751 2520 71733 71638 95 FUNDS FLOW EXPENSE 985093 985093 BAD DEBT EXPENSE 764986 764986 CONTRACT SERVICES 45159 33725 11434 OTHER EXPENSE 38640 13409 25231 52514 46094 6420 5569937 5459299 110638 0 9033 0 0 0 3124426 0 0 0 0 0 3043 0 0 156391 0 0 0 0 1504682 0 0 4797575 0 1271147 227099 673566 0 2171812 0 X 2625763 0 2625763 0 4797575 0 X -1789725 -836038 X X 0 1 1 X 0 X 580000 1643750 2311113 1200000 5734863 8079557 6527436 10892042 11807944 2579728 39886707 8079557 7107436 12535792 14119057 3779728 45621570 0 0 0 45621570 487 134 1730 1695 484 4530 487 134 1730 1695 484 4530 8080044 7107570 12537522 14120752 3780212 45626100 0.99990 0.00010 X 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. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 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. X 1 1 0 0 0 0 0 0 0 DONNY LAMBETH 495595 0 181988 0 1651117 0 128399 0 15510 0 2472609 0 349414 0 SAM HARRIS MD 208576 0 0 0 0 0 8236 0 0 0 216812 0 0 0 SOHAIL BAZEL MD 204597 0 94998 0 0 0 8453 0 0 0 308048 0 0 0 STEVE SNELGROVE 251155 0 61652 0 16840 0 81277 0 34488 0 445412 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 WILLIAM G BLACKARD MD 322530 0 13140 0 0 0 7350 0 13815 0 356835 0 0 0 MICHAEL J PHILLIPS MD 224187 0 5000 0 154167 0 9800 0 21 0 393175 0 0 0 KAITE M TWOMLEY MD 297500 0 61430 0 0 0 7350 0 21 0 366301 0 0 0 WILLIAM Y ASIHENE MD 321193 0 88340 0 0 0 7350 0 13815 0 430698 0 0 0 TIFFENY S CARROLL MD 324597 0 0 0 0 0 2450 0 13815 0 340862 0 0 0 DENNIS R AYERS 0 0 0 0 0 120918 0 4709 0 7325 0 132952 0 0 JOHN A CASHION 0 0 0 0 0 1051152 0 1801 0 4496 0 1057449 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 $121,263, ACCOUNTS RECEIVABLE OF $178,302 AND PROPERTY AND EQUIPMENT(NET) $111,988, NET OF OUTSTANDING LIABILITIES $378,527 2012-06-28 33026 ACTUAL COST 560543238 LEXINGTON MEDICAL CENTER 250 HOSPITAL DRIVE LEXINGTON NC 27292 501(C)(3) GOODWILL OF $1,504,682, NET OF OUTSTANDING LIABILITIES $1,045,394 459288 ACTUAL COST WAKE FOREST BAPTIST HEALTH COMMUNITY PHSICIANS 3540 CLEMMONS ROAD SUITE 1 CLEMMONS NC 27012 1 1 0 0 0 1 1 0 0 0 CHANGES IN PROGRAM SERVICES FORM 990, PART III, LINE 3 ON 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 6 THE MEMBER OF THE CORPORATION SHALL BE DAVIDSON HEALTHCARE, INC. FORM 990, PART VI, SECTION A, LINE 7A DECISIONS 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 7B DECISIONS 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 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 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 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 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 2C NO CHANGES FROM PRIOR YEAR METHOD OF OVERSIGHT. DAVIDSON HEALTHCARE INC 250 HOSPITAL DRIVE LEXINGTON NC 27292 561474399 SUPPORT OF LEXINGTON MEDICAL CENTER NC 501(C)(3) LINE 11B, II WFUBMC 0 LEXINGTON MEDICAL CENTER 250 HOSPITAL DRIVE LEXINGTON NC 27292 560543238 HOSPITAL NC 501(C)(3) LINE 3 WFUBMC 0 LEXPROPERTIES INC 250 HOSPITAL DRIVE LEXINGTON NC 27292 561474401 HOLD REAL ESTATE NC 501(C)(2) DAVIDSON HEALTHCARE INC 0 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 0 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 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 1 1 1 1 1 1 1 0 0