2012-05-14T07:53:53-05:00 2011-06-30 990 2010-07-01 900222618 WAKE FOREST UNIVERSITY HEALTH SCIENCES GROUP RETURN WAKE 3367164445 MEDICAL CENTER BLVD WINSTONSALEM NC 27157 JOHN D MCCONNELL MD 3367164445 2012-05-14 2010 2016-02-24 21:20:13Z JOHN D MCCONNELL MD MEDICAL CENTER BLVD WINSTON SALEM NC 27157 63339370 1 1 3884 X N/A X 2003 NC OUTPATIENT MEDICAL CLINICS FOR THE PROMOTION OF HEALTH FOR THE BENEFIT OF THE COMMUNITY. 4 0 0 0 0 0 0 0 63479453 63338388 2660 982 0 0 63482113 63339370 0 0 0 0 0 0 0 0 0 52729534 51630336 52729534 51630336 10752579 11709034 92321697 104213267 8038168 8220704 84283529 95992563 OUTPATIENT MEDICAL CLINICS FOR THE PROMOTION OF HEALTH FOR THE BENEFIT OF THE COMMUNITY AND AS A SUPPORTING ORGANIZATION EXCLUSIVELY FOR THE BENEFIT OF WAKE FOREST UNIVERSITY AND ITS SUPPORTING ORGANIZATION,WAKE FOREST UNIVERSITY HEALTH SCIENCES. 0 0 48264344 63338388 HEMODIALYSIS: THE CLINICS SERVE THE TEACHING AND RESEARCH PROGRAMS OF WAKE FOREST UNIVERSITY HEALTH SCIENCES AND WAKE FOREST UNIVERSITY BY PROVIDING DIALYSIS TREATMENTS TO END STAGE RENAL DISEASE PATIENTS (1,542 PATIENTS). 48264344 1 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 105 0 1 0 0 0 0 0 0 0 0 0 0 0 X 4 0 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 NC X HEALTH SYSTEMS MANAGEMENT INC 2293865505 PO BOX 7710 TIFTON GA 317937710 X WILLIAM B APPLEGATE MD 0710-1210 4.50 X X 0 643438 100103 JOHN D MCCONNELL MD EFF 1210 0.50 X X 0 1875612 624197 BARRY I FREEDMAN MD 1.00 X X 0 508485 41127 DOUGLAS L EDGETON 3.50 X X 0 613769 41279 TERRY L HALES JR 3.00 X X 0 441097 59536 J REID MORGAN 0.50 X 0 365229 49026 DONNA H HAMILTON 1.00 X 0 169998 31617 0 4617628 946885 0 0 1 0 HSM DIALYSIS CENTERS LLC PO BOX 7710 TIFTON GA 31793 MANAGEMENT COMPANY 6514415 NEPHROLOGY ASSOCIATES 730 HIGHLAND OAKS DRIVE WINSTONSALEM NC 27103 MEDICAL DIRECTOR 281667 IREDELL NEPHROLOGY CENTER 2043 SIMONTON RD SUITE B STATESVILLE NC 28625 MEDICAL DIRECTOR 110000 3 PAYMENTS FOR MEDICAL S 621300 63338388 63338388 63338388 982 982 63339370 63338388 0 982 103297 103297 43635 43635 26308746 22986394 3322352 376070 376070 21857630 21857630 2568279 2568279 135817 135817 35074 35074 5 5 201783 201783 51630336 48264344 3365992 0 0 2090766 3512180 12115362 11434872 0 0 1539970 1325650 20532 85498 0 0 0 0 76555067 87855067 92321697 104213267 6178228 6731410 1859940 1489294 8038168 8220704 X 84283529 95992563 84283529 95992563 92321697 104213267 11709034 0 X 0 1 1 X 0 X X X 0 0 0 WAKE FOREST UNIVERSITY 560532138 2 1 1 1 0 WAKE FOREST UNIVERSITY HEALTH SCIENCES 223849199 2 1 1 1 0 2 0 0 0 0 0 0 WFUHS CAPITAL CONTRIBUTION 87855067 87855067 DUE TO WFU 1489294 1489294 63339370 51630336 11709034 0 11709034 64131996 792626 792626 63339370 0 63339370 52443805 813469 813469 51630336 0 51630336 SCHEDULE D, PART XII AND PART XIII, LINE 2D: RECLASS DRUG & SUPPLIES REBATES PART X, LINE 2: IT IS THE OPINION OF MANAGEMENT THAT THE COMPANY HAS NO SIGNIFICANT TAX POSITIONS THAT WOULD BE SUBJECT TO CHANGE UPON EXAMINATION. 0 1 0 0 0 0 0 0 0 WILLIAM B APPLEGATE MD 0710-1210 0 518231 0 99900 0 25307 0 76394 0 23709 0 743541 0 0 JOHN D MCCONNELL MD EFF 1210 0 878909 0 500000 0 496703 0 606145 0 18052 0 2499809 0 0 BARRY I FREEDMAN MD 0 163950 0 343615 0 920 0 19643 0 21484 0 549612 0 0 DOUGLAS L EDGETON 0 484360 0 111700 0 17709 0 18602 0 22677 0 655048 0 0 TERRY L HALES JR 0 347002 0 83000 0 11095 0 38602 0 20934 0 500633 0 0 J REID MORGAN 0 303894 0 50000 0 11335 0 24500 0 24526 0 414255 0 0 DONNA H HAMILTON 0 164278 0 5000 0 720 0 17087 0 14530 0 201615 0 0 PART I, LINE 4B CERTAIN EXECUTIVES OF THE FILING ORGANIZATION DURING THE TAX PERIOD, PARTICIPATED IN SUPPLEMENTAL NONQUALIFIED RETIREMENT PLANS AND EXECUTIVE BONUS PLANS (ALL OF WHICH COMPENSATION IS PAID BY RELATED ORGANIZATIONS, WAKE FOREST UNIVERSITY HEALTH SCIENCES AND WAKE FOREST UNIVERSITY, AS PART OF SUCH EXECUTIVES' COMPENSATION FROM THE RELATED ORGANIZATIONS). WILLIAM B. APPLEGATE, M.D. WAS A DIRECTOR OF THE FILING ORGANIZATION (UNTIL DECEMBER 2010 WHEN HE WAS SUCCEEDED BY JOHN D MCCONNELL, M.D.) AND AN OFFICER ("PRESIDENT OF HEALTH SCIENCES") OF THE FILING ORGANIZATION UNTIL JUNE 30, 2011. ALL COMPENSATION OF BOTH MEN WAS PAID BY RELATED ORGANIZATIONS FOR THEIR WORK AS EXECUTIVES OF SUCH RELATED ORGANIZATIONS. FORM 990, PART VI, SECTION A, LINE 6 WAKE FOREST UNIVERSITY HEALTH SCIENCES IS THE PARENT ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 7A THE MEMBERS OF THE BOARD OF DIRECTORS OF THE ORGANIZATION ARE APPOINTED BY THE GOVERNING BODY OF WAKE FOREST UNIVERSITY HEALTH SCIENCES OR BY A MEMBER OF THE GOVERNING BODY OR BY AN OFFICER OF WAKE FOREST UNIVERSITY HEALTH SCIENCES ACTING IN HIS OFFICIAL CAPACITY, IN ACCORDANCE WITH PROCEDURES PRESCRIBED BY THE BOARD OF DIRECTORS OF WAKE FOREST UNIVERSITY HEALTH SCIENCES. FORM 990, PART VI, SECTION A, LINE 7B DECISIONS OF THE ORGANIZATION'S GOVERNING BODY WHICH REQUIRE APPROVAL BY THE PARENT ORGANIZATION, WAKE FOREST UNIVERSITY HEALTH SCIENCES, INCLUDE AMENDMENTS TO THE ORGANIZATION'S GOVERNANCE DOCUMENTS (ARTICLES OF INCORPORATION AND BYLAWS), AND THE ELECTION AND REMOVAL OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 11 THE FILING ORGANIZATION'S BOARD OF DIRECTORS RECEIVES COPIES OF THE FORM 990 WITH SUFFICIENT TIME TO PERMIT REVIEW, COMMENT, AND QUESTIONS PRIOR TO ITS FILING. THE AUDIT AND COMPLIANCE COMMITTEES OF THE GOVERNING BOARD OF WFUHS REVIEWS IN ADDITIONAL DETAIL THE FILING ORGANIZATION'S FORM 990 WITH THE ORGANIZATION'S CHIEF FINANCIAL OFFICER OR HIS DESIGNEE, WHO ANSWERS QUESTIONS AND ADDRESSES CONCERNS RAISED BY SUCH COMMITTEE MEMBERS OR OTHER FILING ORGANIZATION DIRECTORS. IF MODIFICATIONS ARE REQUIRED FOLLOWING SUCH REVIEW AND COMMENT, THE REVISED FORM 990 IS REDISTRIBUTED TO ALL DIRECTORS PRIOR TO ITS FILING WITH THE IRS, ALONG WITH A REPORT NOTING THE MODIFICATIONS. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION REQUIRES ITS OFFICERS AND DIRECTORS TO DISCLOSE CONFLICTS OF INTEREST ANNUALLY, AND AS THEY ARISE. ANY ITEMS DISCLOSED ARE REVIEWED AND MANAGED IN ACCORDANCE WITH THE ORGANIZATION'S POLICY ON CONFLICTS OF INTEREST. FORM 990, PART VI, SECTION B, LINE 15 THE ORGANIZATION PAYS NO COMPENSATION TO OFFICERS OR DIRECTORS; AS THE ORGANIZATION HAS NO EMPLOYEES, IT DOES NOT PAY ANY COMPENSATION TO ANY KEY EMPLOYEES. ALL COMPENSATION PAID TO OFFICERS, DIRECTORS AND FORMER OFFICERS OR DIRECTORS WAS PAID BY RELATED ORGANIZATIONS. THE EXECUTIVE COMMITTEE OF THE WAKE FOREST UNIVERSITY BAPTIST MEDICAL CENTER BOARD IS (THROUGH AUTHORITY DELEGATED TO IT BY WAKE FOREST UNIVERSITY HEALTH SCIENCES - THE PARENT ORGANIZATION OF THE FILING ORGANIZATION) RESPONSIBLE FOR REVIEWING AND APPROVING MOST OFFICERS' COMPENSATION. THE COMMITTEE UTILIZES INDEPENDENT COMPENSATION CONSULTANTS, COMPENSATION SURVEYS, AND STUDIES TO DETERMINE THE APPROPRIATENESS OF EACH SUCH OFFICER'S 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. FORM 990, PART VII, SECTION A: THE FOLLOWING PERSONS WERE COMPENSATED DIRECTLY BY WAKE FOREST UNIVERSITY HEALTH SCIENCES, THE FILING ORGANIZATION, WAKE FOREST UNIVERSITY, A RELATED (SUPPORTED) ORGANIZATION OF THE FILING ORGANIZATION, OTHER ORGANIZATIONS RELATED TO WAKE FOREST UNIVERSITY, OR NORTH CAROLINA BAPTIST HOSPITAL, AN UNRELATED ORGANIZATION, FOR SERVICES PERFORMED FOR THE FILING ORGANIZATION. EACH PERSON'S POSITION IN EACH ORGANIZATION, AND THE AVERAGE HOURS PER WEEK THAT THEY DEVOTE TO EACH ENTITY, ARE SHOWN BELOW. J. REID MORGAN DIRECTOR, SECRETARY, FILING ORGANIZATION _0.5_ HOURS PER WEEK DIRECTOR, SECRETARY, PTRP _7_ HOURS PER WEEK SECRETARY AND GENERAL COUNSEL, WAKE FOREST UNIV _20_ HOURS PER WEEK SECRETARY, WFU FOUNDATION _.2_ HOURS PER WEEK SECRETARY, WFU DEVELOPMENT FOUNDATION _.3_ HOURS PER WEEK SECRETARY AND GENERAL COUNSEL, WFU HEALTH SCIENCES _5_ HOURS PER WEEK ASSISTANT SECRETARY, WFU BAPTIST MEDICAL CENTER _6_ HOURS PER WEEK DIRECTOR, SECRETARY, PTRP DEVELOPMENT CORPORATION _.6_ HOURS PER WEEK SECRETARY, IDEALLIANCE _.2_ HOURS PER WEEK SECRETARY, IDEALLIANCE FOUNDATION _.2_ HOURS PER WEEK DONNA HAMILTON ASSISTANT SECRETARY, FILING ORGANIZATION _1_ HOUR PER WEEK WILLIAM B. APPLEGATE, M.D. DIRECTOR/CHAIR, PRESIDENT, FILING ORGANIZATION _4.5_ HOURS PER WEEK PRESIDENT, DIRECTOR, WFU HEALTH SCIENCES _30_ HOURS PER WEEK DIRECTOR AND OFFICER, PTRP DEVELOPMENT CORPORATION _1_ HOUR PER WEEK OFFICER, IDEALLIANCE _.2_ HOURS PER WEEK OFFICER, IDEALLIANCE FOUNDATION _.2_ HOURS PER WEEK TRUSTEE, THE MEDICAL FOUNDATION _.1 _ HOURS PER WEEK PRES, DIALYSIS ACCESS GP OF WAKE FOREST UNIV, LLC _1_ HOUR PER WEEK OFFICER, PTRP _3_ HOURS PER WEEK DOUGLAS L. EDGETON DIRECTOR, VP/TREASURER, FILING ORGANIZATION _3.5_ HOURS PER WEEK EXECUTIVE VICE PRESIDENT, WFU HEALTH SCIENCES _15_ HOURS PER WEEK DIRECTOR, PRESIDENT, PTRP DEVELOPMENT CORPORATION _5_ HOURS PER WEEK DIRECTOR, PRESIDENT, IDEALLIANCE _.2_ HOURS PER WEEK DIRECTOR, PRESIDENT, IDEALLIANCE FOUNDATION _.2_ HOURS PER WEEK TRUSTEE, SECRETARY, TREASURER, THE MEDICAL FDTN _.1_ HOURS PER WEEK VICE PRESIDENT/TREASURER, DIALYSIS ACCESS GROUP OF WAKE FOREST UNIVERSITY, LLC _1_ HOUR PER WEEK PRESIDENT, PTRP _10_ HOURS PER WEEK EXECUTIVE VICE PRESIDENT, WFU BAPTIST MEDICAL CTR _5_ HOURS PER WEEK TERRY L. HALES, JR. DIRECTOR/ASSISTANT TREASURER, FILING ORGANIZATION _3_ HOURS PER WEEK VICE PRESIDENT, TREASURER, PTRP _6_ HOURS PER WEEK ASSISTANT TREAS, WAKE FOREST UNIV HEALTH SCIENC _27_ HOURS PER WEEK TREASURER, PTRP DEVELOPMENT CORPORATION _2.5_ HOURS PER WEEK DIRECTOR, TREASURER, IDEALLIANCE _.2_ HOURS PER WEEK DIRECTOR, TREASURER, IDEALLIANCE FOUNDATION _.2_ HOURS PER WEEK ASSIST TREAS, DIALYSIS ACCESS GP OF WAKE FOREST UNIVERSITY, LLC _1.1_ HOURS PER WEEK DIRECTOR, DAVIDSON HEALTHCARE INC. _3_ HOURS PER WEEK DIRECTOR, LEXINGTON MEMORIAL HOSPITAL _3_ HOURS PER WEEK JOHN D. MCCONNELL, M.D. DIRECTOR/CHAIR, PRESIDENT, FILING ORGANIZATION _.5_ HOURS PER WEEK DIRECTOR, PTRP _1_ HOUR PER WEEK DIRECTOR, CEO WFU HEALTH SCIENCES _11_ HOURS PER WEEK CEO, WFU BAPTIST MEDICAL CENTER _5_ HOURS PER WEEK DIRECTOR/CEO, NC BAPTIST HOSPITAL _20.6_ HOURS PER WEEK DIRECTOR, PTRP DEVELOPMENT CORPORATION _1_ HOUR PER WEEK DIRECTOR, IDEALLIANCE _.2_ HOURS PER WEEK DIRECTOR, IDEALLIANCE FOUNDATION _.2_ HOURS PER WEEK PRESIDENT, DIALYSIS ACCESS GP OF WAKE FOREST UNIV, LLC _.5_ HOURS PER WEEK BARRY I FREEDMAN, M.D. DIRECTOR, FILING ORGANIZATION _1_ HOUR PER WEEK _ WAKE FOREST UNIVERSITY PO BOX 7201 WINSTON SALEM NC 27109 561532138 PRIVATE, COED. INST. OF HIGHER ED. 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