NORTH CAROLINA HEALTH INFORMATION EXCHANGE: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization
NORTH CAROLINA HEALTH INFORMATION EXCHANGE (EIN 27-3541505)
Tax period
2011-01-01 to 2011-12-31
Filed
2012-11-06
IRS object ID
201233119349300123
Schema version
2011v1.2
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)
Timestamp2012-11-06T09:24:45-06:00Timestamp
Tax Period End Date2011-12-31TaxPeriodEndDate

Preparer Firm PreparerFirm

FieldValueIRS element (for citing)
EIN561965804EIN

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1THOMAS JUDY & TUCKER P ABusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line14700 FALLS OF NEUSE ROAD SUITE 400AddressLine1
CityRALEIGHCity
StateNCState
ZIP Code27609ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2011-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN273541505EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1NORTH CAROLINA HEALTH INFORMATION EXCHANGEBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlNORTNameControl
Phone9199261042Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line12300 REXWOODS DRIVE NO 390AddressLine1
CityRALEIGHCity
StateNCState
ZIP Code27607ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameJEFFREY D MILLERName
TitleCEOTitle
Phone9199261042Phone
Date Signed2012-11-06DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameKRISTEN HOYLE CPAName
PTINP00118964PTIN
Phone9195717055Phone
FieldValueIRS element (for citing)
Tax Year2011TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Initial ReturnXInitialReturn
Name Of Principal Officer PersonJEFFREY D MILLERNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line12300 REXWOODS DRIVE NO 390AddressLine1
CityRALEIGHCity
StateNCState
ZIP Code27607ZIPCode
FieldValueIRS element (for citing)
Gross Receipts3650862GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.NCHIE.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation2010YearFormation
State Legal DomicileNCStateLegalDomicile
Activity Or Mission DescriptionNORTH CAROLINA HEALTH INFORMATION EXCHANGE ("NC HIE") MAKES CRITICAL HEALTH CARE DATA AVAILABLE WHEN AND WHERE IT'S NEEDED TO IMPROVE HEALTH OUTCOMES AND CONTROL HEALTH CARE COSTS IN NORTH CAROLINA.ActivityOrMissionDescription
Nbr Voting Members Governing Body24NbrVotingMembersGoverningBody
Nbr Independent Voting Members24NbrIndependentVotingMembers
Total Nbr Employees6TotalNbrEmployees
Total Nbr Volunteers0TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Current Year3650862ContributionsGrantsCurrentYear
Program Service Revenue CY0ProgramServiceRevenueCY
Investment Income Current Year0InvestmentIncomeCurrentYear
Other Revenue Current Year0OtherRevenueCurrentYear
Total Revenue Current Year3650862TotalRevenueCurrentYear
Grants And Similar Amnts CY380000GrantsAndSimilarAmntsCY
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Current Year521210SalariesEtcCurrentYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expenses Current Year2724627OtherExpensesCurrentYear
Total Expenses Current Year3625837TotalExpensesCurrentYear
Revenues Less Expenses CY25025RevenuesLessExpensesCY
Total Assets EOY6808477TotalAssetsEOY
Total Liabilities EOY6783452TotalLiabilitiesEOY
Net Assets Or Fund Balances EOY25025NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionNC HIE WILL PROVIDE A SET OF SECURE AND SCALABLE SERVICES THAT PROMOTE THE ACCESS TO, THE EXCHANGE OF, AND THE ANALYSIS OF HEALTH CARE INFORMATION. NC HIE SERVICES WILL ALSO ENABLE PARTICIPATING ORGANIZATIONS TO IMPROVE MEDICAL DECISION-MAKING AND COORDINATION OF CARE, IMPROVE HEALTH OUTCOMES, AND CONTROL HEALTH CARE COSTS.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense2867193Expense
DescriptionNC DIRECT:NC DIRECT IS A HEALTH INFORMATION EXCHANGE SERVICE THAT FACILITATES SECURE CLINICAL MESSAGING, REDUCING MANUAL HANDLING OF PAPER RECORDS. NC DIRECT ALLOWS PROVIDERS TO SHARE A PATIENT'S MEDICAL HISTORY INCLUDING LAB RESULTS, DISCHARGE SUMMARIES, AND OTHER IMPORTANT INFORMATION WITH OTHER PROVIDERS WHO HAVE SEEN OR WILL SEE THE PATIENT - EVEN IF THOSE PROVIDERS ARE NOT PART OF THE SAME PRACTICE OR HEALTH SYSTEM. NC DIRECT DOES NOT REQUIRE PROVIDERS TO USE AN EHR OR TO PURCHASE SPECIAL SOFTWARE.THE NC DIRECT PROGRAM IS PART OF THE DIRECT PROJECT LAUNCHED BY THE OFFICE OF THE NATIONAL COORDINATOR FOR HEALTH INFORMATION TECHNOLOGY IN MARCH 2010 AS A PART OF THE NATIONWIDE HEALTH INFORMATION NETWORK. THE DIRECT PROJECT WAS CREATED TO SPECIFY A SIMPLE, SECURE, SCALABLE, STANDARDS-BASED WAY FOR PARTICIPANTS TO SEND AUTHENTICATED, ENCRYPTED HEALTH INFORMATION DIRECTLY TO KNOWN, TRUSTED RECIPIENTS OVER THE INTERNET.HIE CONNECTIVITY FABRIC:THE HIE CONNECTIVITY FABRIC PROVIDES THE FOUNDATIONAL ELEMENTS THAT ALLOW THE DIVERSE AND MULTIPLE SOURCES OF HEALTH INFORMATION TO BE CONNECTED IN A COMMON PATIENT AND PROVIDER CONTEXT. THE FOUNDATIONAL ELEMENTS OF THIS SERVICE PROVIDES THE CAPABILITY TO CONNECT PATIENT RECORDS AND INFORMATION ACROSS MULTIPLE ENTERPRISES, THE NORMALIZATION OF DATA FROM DIFFERENT SOURCES, AND THE ENFORCEMENT OF PRIVACY POLICIES AND CONSUMER CONSENT DECLARATIONS. THEN USING THESE FOUNDATIONAL ELEMENTS, THE HIE CONNECTIVITY FABRIC ALLOWS HEALTHCARE ORGANIZATIONS TO EXCHANGE INFORMATION THROUGH A COMMON MESSAGING ARCHITECTURE WITH PARTICIPATING SYSTEMS. KEY INTERFACE TECHNOLOGIES AND SPECIFICATIONS SUPPORTED INCLUDE CCD, HL7, AND WEB SERVICES. NC HIE FULLY UNDERSTANDS THAT FROM A TECHNOLOGY PERSPECTIVE THERE ARE MULTIPLES WAYS TO ACHIEVE HEALTH INFORMATION EXCHANGES THAT ARE IN ACCORDANCE WITH NC HIE PRIVACY AND SECURITY POLICIES. THEREFORE, AND TO MEET THE TECHNOLOGICAL CAPABILITIES OF ITS PARTICIPANTS, NC HIE SUPPORTS MULTIPLE INTEGRATION PROFILES ON THE CONTINUUM FROM A FEDERATED PROFILE TO A TIGHTLY INTEGRATED PROFILE.PATIENT RECORD NETWORK ("PRN"):THIS SERVICE PROVIDES NC HIE PARTICIPANTS WITH WEB-BASED ACCESS TO THE LONGITUDINAL PATIENT RECORD THAT IS ESTABLISHED BY THE HIE CONNECTIVITY FABRIC. FROM THIS PRN PORTAL, PARTICIPANTS CAN VIEW DEMOGRAPHIC AND DISCRETE CLINICAL INFORMATION SOURCED FROM MULTIPLE HEALTHCARE ORGANIZATIONS AND SYSTEMS. THIS TOOL ALSO PROVIDES THE ABILITY TO VIEW CLINICAL DOCUMENTS STORED IN REMOTE SYSTEMS, SEND OR RECEIVE MESSAGES TO OTHER HEALTHCARE PROVIDERS INCLUDING THE ABILITY TO ATTACH SPECIFIC PATIENT DATA, AND THE ABILITY TO SELECT ALERTS AND NOTIFICATIONS BASED ON CHANGES IN THEIR PATIENTS' HEALTH STATUS (E.G. ABNORMAL LAB RESULT).AS WITH ALL NC HIE SERVICES, ACCESS TO HEALTH INFORMATION FOR SPECIFIC PATIENT DATA IS RESTRICTED TO THOSE HEALTHCARE PROVIDERS WHO HAVE AN ESTABLISHED RELATIONSHIP WITH THE PATIENT OR AN EMERGENT MEDICAL NEED AND CAN ONLY BE USED FOR HIPAA APPROVED PURPOSES. ADDITIONALLY, ALL INFORMATION ACCESS RIGHTS ARE DICTATED BASED ON CONSUMER CONSENT DECLARATIONS AS MANDATED BY NC STATUTE.Description

Activity2 Activity2

FieldValueIRS element (for citing)
Expense424333Expense
Grants380000Grants
DescriptionCHALLENGE GRANT - MEDICATION MANAGEMENT APPLICATION:NC HIE WILL WORK WITH THE INFORMATICS CENTER FOR COMMUNITY CARE OF NORTH CAROLINA ("N3CN") TO BUILD ON N3CN'S EXISTING "PHARMACY HOME" APPLICATION, A MODEL WEB-BASED MEDICATION MANAGEMENT APPLICATION THAT PROVIDES A BASIC MANAGEMENT TOOL TO PROVIDERS FOR USE WITH ITS 1.2 MILLION N3CN MEDICAL HOME MEDICAID ENROLLEES. UNDER THIS GRANT, NC HIE AND N3CN WILL ENHANCE THE "PHARMACY HOME" APPLICATION TO CONNECT IT TO THE NC HIE AS A VALUE ADDED SERVICE TO ENCOMPASS ALL PAYERS AND PROVIDERS. BY PROJECT COMPLETION, THE NC HIE WILL BE THE PRIMARY INBOUND SOURCE OF THE DISPARATE MEDICATION LISTS TO THE APPLICATION, AS WELL AS THE CONDUIT FOR OUTBOUND COMMUNICATION WITH NC HIE PARTICIPANTS, INCLUDING A PROVIDER'S OWN ELECTRONIC SYSTEM OF RECORD.Description

Activity3 Activity3

FieldValueIRS element (for citing)
Expense75709Expense
DescriptionNORTH CAROLINA PROGRAM TO ADVANCE TECHNOLOGY FOR HEALTH ("NC PATH"):BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA, IN COLLABORATION WITH THE NC HIE AND ALLSCRIPTS, LAUNCHED NC PATH - A PROGRAM CREATED TO PLACE NORTH CAROLINA AT THE FOREFRONT OF HEALTH CARE REFORM. NC PATH EQUIPS PHYSICIANS WITH ALLSCRIPTS EHR SOFTWARE AND SUPPORT, CONNECTS HEALTH CARE PROVIDERS ACROSS THE STATE THROUGH NC HIE AND PROVIDES ASSISTANCE TO PRACTICES WITH ACHIEVING MEANINGFUL USE AND PATIENT CENTER MEDICAL HOME RECOGNITION. DESIGNED TO MEET THE NEEDS OF BOTH PHYSICIANS AND PATIENTS, NC PATH WILL MOVE NORTH CAROLINA INTO A NEW ERA OF QUALITY HEALTH CARE. NC PATH STREAMLINES COORDINATED CARE, ELEVATES THE QUALITY OF PATIENT CARE, IMPROVES HEALTH OUTCOMES, REDUCES HEALTH CARE SPENDING, AND AIDS PRACTICES IN BECOMING HIT COMPLIANT.Description
FieldValueIRS element (for citing)
Total Program Service Expense3367235TotalProgramServiceExpense
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 Equip1ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets0ReportOtherAssets
Report Other Liabilities1ReportOtherLiabilities
Report Fin48 Footnote1ReportFin48Footnote
Independent Audit Financial Stmt1IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt0ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital0Hospital
Grants To Organizations1GrantsToOrganizations
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
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity0RelatedEntity
Related Org Controlled Entity0RelatedOrgControlledEntity
Transaction Related Entity0TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With109614NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees6NumberOfEmployees
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 Members24NbrVotingGoverningBodyMembers
Number Independent Voting Members24NumberIndependentVotingMembers
Family Or Business Relationship1FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders0MembersOrStockholders
Election Of Board Members0ElectionOfBoardMembers
Decisions Subject To Approval0DecisionsSubjectToApproval
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 CEO1CompensationProcessCEO
Compensation Process Other0CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1DAVID B WELKERBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number9199261042TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line12300 REXWOODS DRIVE STE 390AddressLine1
CityRALEIGHCity
StateNCState
ZIP Code27607ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (26 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationHighest Compensated EmployeeHighestCompensatedEmployee
WILLIAM ATKINSON
PAST CO-CHAIR2.00XX000
LANIER CANSLER
CO-CHAIR4.00XX000
ALLEN DOBSON MD
TREASURER4.00XX000
BRADLEY WILSON
SECRETARY2.00XX000
JOHN RICHTER
DIRECTOR2.00X000
STEVE CLINE DDS
EX-OFFICIO4.00X000
JERRY FRALICK
EX-OFFICIO1.00X000
CRAIGAN GRAY MD
EX-OFFICIO1.00X000
THOMAS BRIDGES
DIRECTOR1.00X000
HADLEY CALLAWAY MD
VICE-CHAIRMAN1.00XX000
ANTHONY CIVELLO
DIRECTOR1.00X000
SAMUEL CYKERT MD
DIRECTOR1.00X000
GLORIA FRELIX MD
DIRECTOR1.00X000
DAVID KING
DIRECTOR1.00X000
REBECCA KITZMILLER
DIRECTOR1.00X000
BENJAMIN MONEY
DIRECTOR1.00X000
WARREN NEWTON MD
DIRECTOR1.00X000
WILLIAM ROPER MD
DIRECTOR1.00X000
CHARLES SANDERS MD
CO-CHAIR1.00XX000
GEORGE SAUNDERS MD
DIRECTOR AT LARGE2.00XX000
SAM SPICER MD
DIRECTOR1.00X000
SENATOR JOSH STEIN
DIRECTOR1.00X000
DAVE TAYLOE MD
DIRECTOR1.00X000
SPEAKER TOM TILLIS
DIRECTOR1.00X000
JEFFREY D MILLER
CEO40.00X21752600
RODERICK SCOTT
CTO40.0010374404500X
FieldValueIRS element (for citing)
Total Reportable Comp From Org321270TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation4500TotalOtherCompensation
Number Individuals GT100 K2NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
MANATT PHELPS & PHILLIPS
11355 WEST OLYMPIC BLVDLOS ANGELESCA90064CONSULTANT TO REACH STATEWIDE HIE CAPABI884275
CAPGEMINI
2250 CORPORATE PARK DRIVEHERNDONVA20171IT FRAMEWORK FOR HIE DEPLOYMENT369320
MASSACHUSETTS EHEALTH COLLABORATIVE
860 WINTER STWALTHAMMA02451ASSIST ACQUISITION OF TECH SERVICES VEND221390
STATE OF NC - ITS
PO BOX 17209RALEIGHNC27619IT PROJECT MANAGER SERVICES132306
ALAN HIRSCH
2300 REXWOODS DRIVE STE 390RALEIGHNC27607INTERIM CEO/STRATEGIC ADVISOR123518
FieldValueIRS element (for citing)
Number Of Contractors GT100 K5NumberOfContractorsGT100K
Government Grants3563190GovernmentGrants
All Other Contributions87672AllOtherContributions
Total Contributions3650862TotalContributions

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column3650862TotalRevenueColumn
Related Or Exempt Function Income0RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$0ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total380000Total
Program Services380000ProgramServices

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total325770Total
Program Services325770ProgramServices

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total156247Total
Program Services86326ProgramServices
Management And General69921ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total6937Total
Program Services3188ProgramServices
Management And General3749ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total32256Total
Program Services26179ProgramServices
Management And General6077ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total76235Total
Program Services76235ProgramServices

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total20402Total
Management And General20402ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total1674849Total
Program Services1580495ProgramServices
Management And General94354ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total39723Total
Program Services39723ProgramServices

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total14900Total
Program Services4757ProgramServices
Management And General10143ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total799327Total
Program Services784116ProgramServices
Management And General15211ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total36499Total
Program Services36499ProgramServices

Travel Travel

FieldValueIRS element (for citing)
Total20233Total
Program Services20129ProgramServices
Management And General104ManagementAndGeneral

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total2294Total
Program Services2294ProgramServices

Interest Interest

FieldValueIRS element (for citing)
Total1515Total
Management And General1515ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total4191Total
Management And General4191ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total5033Total
Program Services1524ProgramServices
Management And General3509ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalManagement And GeneralManagementAndGeneral
RELOCATION EXPENSES1611916119
VACATION ACCRUAL72807280
STAFF TRAINING & DEVELO26212621
DUES & SUBSCRIPTIONS439439

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total2967Total
Management And General2967ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total3625837Total
Program Services3367235ProgramServices
Management And General258602ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
EOY551212EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
EOY958302EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
EOY670EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
EOY5207400EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
EOY3363EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis80450LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec4191LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY0BOY
EOY76259EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
EOY11271EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY0BOY
EOY6808477EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
EOY1015615EOY

Deferred Revenue DeferredRevenue

FieldValueIRS element (for citing)
EOY5707400EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY0BOY
EOY60437EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY0BOY
EOY6783452EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
EOY25025EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY0BOY
EOY25025EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY0BOY
EOY6808477EOY
FieldValueIRS element (for citing)
Reconcilation Revenue Expenses25025ReconcilationRevenueExpenses
Reconcilation Other Changes0ReconcilationOtherChanges
Info In Schedule O Part XIIXInfoInScheduleOPartXII
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement SeparateXFinancialStatementSeparate
Federal Grant Audit Required1FederalGrantAuditRequired
Federal Grant Audit Performed1FederalGrantAuditPerformed

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org170b1 AviXPubliclySupportedOrg170b1Avi

Gifts Grants Contrib Received170 GiftsGrantsContribReceived170

FieldValueIRS element (for citing)
Current Tax Year3650862CurrentTaxYear
Total3650862Total

Total170 Total170

FieldValueIRS element (for citing)
Current Tax Year3650862CurrentTaxYear
Total3650862Total
FieldValueIRS element (for citing)
Public Support Total1703650862PublicSupportTotal170
Total Support3650862TotalSupport
First5 Years170XFirst5Years170

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

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis5000OtherCostOrOtherBasis
Depreciation1667Depreciation
Book Value3333BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis75450OtherCostOrOtherBasis
Depreciation2524Depreciation
Book Value72926BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings76259TotalOfBookValueLandBuildings

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
DescriptionCAPITAL LEASES PAYABLEDescription
Amount$60,437Amount
FieldValueIRS element (for citing)
Total Of Amounts60437TotalOfAmounts
Total Revenue3650862TotalRevenue
Total Expenses3625837TotalExpenses
Excess Or Deficit For Year25025ExcessOrDeficitForYear
Excess Or Deficit Per FS25025ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt3895431TotRevenueEtcAuditedFinclStmt
Donated Srvc And Use Of Facilities244569DonatedSrvcAndUseOfFacilities
Revenue Not Rptd F990244569RevenueNotRptdF990
Revenue Subtotal3650862RevenueSubtotal
Revenue Not Rptd On Fin Stmt0RevenueNotRptdOnFinStmt
Total Revenue Per Form9903650862TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt3870406TotExpensesEtcAuditedFinclStmt
Donated Services Use Of Facilities244569DonatedServicesUseOfFacilities
Expenses Not Rptd F990244569ExpensesNotRptdF990
Expenses Subtotal3625837ExpensesSubtotal
Expenses Not Rptd On Fin Stmt0ExpensesNotRptdOnFinStmt
Total Expenses Per Form9903625837TotalExpensesPerForm990

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 DOES NOT BELIEVE THERE ARE ANY MATERIAL UNCERTAIN TAX POSITIONS AND, ACCORDINGLY, IT WILL NOT RECOGNIZE ANY LIABILITY FOR UNRECOGNIZED TAX BENEFITS. THE ORGANIZATION IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER THERE ARE CURRENTLY NO AUDITS FOR ANY TAX YEARS IN PROGRESS. AT DECEMBER 31, 2011, THE ORGANIZATION HAS NO UNCERTAIN TAX POSITIONS THAT QUALIFY FOR EITHER RECOGNITION OR DISCLOSURE IN THE FINANCIAL STATEMENTS.Explanation

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records Maintained1RecordsMaintained

Recipient Table RecipientTable

Recipient Name Business RecipientNameBusiness

FieldValueIRS element (for citing)
Business Name Line1NC COMMUNITY CARE NETWORKSBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line12300 REXWOODS DR STE 200AddressLine1
CityRALEIGHCity
StateNCState
ZIP Code27607ZIPCode
FieldValueIRS element (for citing)
EIN Of Recipient205408367EINOfRecipient
IRC Section501(C)(3)IRCSection
Amount Of Cash Grant380000AmountOfCashGrant
Amount Of Non Cash Assistance0AmountOfNonCashAssistance
Purpose Of GrantTO PROVIDE MEDICATION MANAGEMENT APPLICATIONPurposeOfGrant
FieldValueIRS element (for citing)
Total Nbr Of501 C3 And Govt Grants1TotalNbrOf501C3AndGovtGrants

Form990 Schedule I Part IV Form990ScheduleIPartIV

FieldValueIRS element (for citing)
IdentifierPROCEDURE FOR MONITORING GRANTS IN THE U.S.:Identifier
Return ReferencePART I, LINE 2:ReturnReference
ExplanationSCHEDULE I, PART I, LINE 2: NC HIE UNDERTAKES APPROPRIATE MONITORING ACTIONS TO ENSURE COMPLIANCE WITH SUB-AGREEMENT PERFORMANCE REQUIREMENTS, FINANCIAL TERMS AND CONDITIONS, AND ALL APPLICABLE FEDERAL RULES AND REGULATIONS. NC HIE'S MONITORING PROCEDURES INCLUDE, BUT ARE NOT LIMITED TO: (1) ROUTINE RECEIPT AND REVIEW OF TECHNICAL PERFORMANCE REPORTS; (2) ROUTINE REVIEW OF EXPENSES-TO-BUDGET; (3) PERIODIC PERFORMANCE OF ON-SITE VISITS, IF NECESSARY; (4) THE OPTION TO PERFORM "AUDITS," IF NECESSARY; (5) REVIEW OF A-133 AUDIT REPORTS FILED BY SUBRECIPIENTS AS WELL AS REVIEW OF ANY AUDIT FINDINGS.Explanation

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Independent ConsultantXIndependentConsultant
Written Employment ContractXWrittenEmploymentContract
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan0SupplementalNonqualRetirePlan
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

FieldValueIRS element (for citing)
Name PersonJEFFREY D MILLERNamePerson
Base Compensation Filing Org200026BaseCompensationFilingOrg
Comp Based On Related Orgs0CompBasedOnRelatedOrgs
Bonus Filing Org17500BonusFilingOrg
Bonus Related Orgs0BonusRelatedOrgs
Other Compensation Filing Org0OtherCompensationFilingOrg
Other Compensation Related Orgs0OtherCompensationRelatedOrgs
Deferred Comp Filing Org0DeferredCompFilingOrg
Deferred Comp Related Orgs0DeferredCompRelatedOrgs
Nontaxable Benefits Filing Org0NontaxableBenefitsFilingOrg
Nontaxable Benefits Related Orgs0NontaxableBenefitsRelatedOrgs
Total Compensation Filing Org217526TotalCompensationFilingOrg
Total Compensation Related Orgs0TotalCompensationRelatedOrgs
Comp Report Prior990 Filing Org0CompReportPrior990FilingOrg
Comp Report Prior990 Related Orgs0CompReportPrior990RelatedOrgs

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (7 entries)

Return ReferenceReturnReferenceExplanationExplanation
FORM 990, PART VI, SECTION A, LINE 1THE GOVERNING BODY OF NC HIE MAY DELEGATE TO THE EXECUTIVE COMMITTEE ALL OR ANY PORTION OF THE AUTHORITY OF THE BOARD, EXCEPT THE AUTHORITY TO AMEND THE BYLAWS OR THE CORPORATION'S ARTICLES OF INCORPORATION, AND EXCEPT TO THE EXTENT PROHIBITED BY THE NORTH CAROLINA NONPROFIT CORPORATION ACT. THE EXECUTIVE COMMITTEE IS COMPRISED OF THE SIX PRINCIPAL OFFICERS OF NC HIE, THE IMMEDIATE PAST CO-CHAIRPERSON ELECTED BY THE BOARD, AND ONE DIRECTOR AT LARGE ELECTED BY THE BOARD, WITH THE CEO SERVING AS AN EX OFFICIO MEMBER WITHOUT VOTE.
FORM 990, PART VI, SECTION A, LINE 2JEFF MILLER AND ALLEN DOBSON; BUSINESS RELATIONSHIP JEFF MILLER AND BRAD WILSON; BUSINESS RELATIONSHIP
FORM 990, PART VI, SECTION B, LINE 11FORM 990 IS REVIEWED IN DETAIL BY MANAGEMENT AND PROVIDED TO EACH VOTING MEMBER OF THE BOARD IN FULL BEFORE FILING WITH THE INTERNAL REVENUE SERVICE.
FORM 990, PART VI, SECTION B, LINE 12CPRIOR TO TAKING HIS OR HER POSITION ON THE BOARD OF DIRECTORS, AND ANNUALLY THEREAFTER, EACH DIRECTOR SHALL COMPLETE AND SUBMIT TO THE SECRETARY OF THE BOARD OF DIRECTORS A CONFLICT OF INTEREST STATEMENT AS REQUIRED BY NC HIE'S CONFLICT OF INTEREST POLICY. THE CO-CHAIRPERSONS AND THE BOARD OF DIRECTORS SHALL BECOME FAMILIAR WITH THE STATEMENTS OF ALL DIRECTORS IN ORDER TO GUIDE THE CONDUCT OF THE BOARD OF DIRECTORS SHOULD SUCH A CONFLICT ARISE. AT SUCH TIME AS ANY MATTER COMES BEFORE THE BOARD OF DIRECTORS WHICH INVOLVES OR MAY INVOLVE A CONFLICT OF INTEREST, THE AFFECTED DIRECTOR SHALL MAKE KNOWN THE POTENTIAL CONFLICT, WHETHER DISCLOSED BY HIS OR HER WRITTEN STATEMENT OR NOT. SUCH DIRECTOR SHALL ANSWER ANY QUESTIONS THAT MIGHT BE ASKED OF HIM OR HER AND SHALL DISCLOSE ALL MATERIAL FACTS. AT THE REQUEST OF ONE OF THE CHAIRPERSONS, SUCH DIRECTOR SHALL WITHDRAW FROM THE MEETING FOR SO LONG AS THE MATTER SHALL CONTINUE UNDER DISCUSSION.
FORM 990, PART VI, SECTION B, LINE 15ATHE COMPENSATION, IF ANY, OF ALL OFFICERS AND AGENTS OF THE CORPORATION SHALL BE FIXED BY THE BOARD OF DIRECTORS. AN INDEPENDENT COMPENSATION CONSULTANT ALONG WITH A COMPENSATION STUDY WAS USED TO ESTABLISH THE COMPENSATION OF THE CEO. CEO COMPENSATION IS DOCUMENTED BY A WRITTEN EMPLOYMENT CONTRACT AND WAS APPROVED BY THE BOARD OF DIRECTORS IN 2011.
FORM 990, PART VI, SECTION C, LINE 19GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST.
THE BOARD OF DIRECTORS IS RESPONSIBLE FOR SELECTING THE INDEPENDENT AUDITORS.

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