2011-05-12T10:38:03-05:00 2010-06-30 DIXON HUGHES GOODMAN LLP 500 Ridgefield Court Asheville NC 28806 990 2009-07-01 560552787 NORTH CAROLINA BAPTIST HOSPITAL NORT 3367164445 MEDICAL CENTER BLVD WINSTON SALEM NC 27157 DONNY C LAMBETH 3367164445 2011-05-12 1 Amy Bibby 8282542254 2009 2016-02-24 21:20:13Z DONNY C LAMBETH MEDICAL CENTER BLVD WINSTON SALEM NC 27157 994267922 0 X WWW.WFUBMC.EDU X 1923 NC IMPROVING THE HEALTH OF OUR REGION, STATE, AND NATION 25 23 8803 1615 3878312 1642271 2771523 1313535 923230986 939125091 -42193215 23721260 3462211 3514793 887271505 967674679 113433 157954 0 447683864 448104945 0 309253 469539276 463568592 917336573 911831491 -30065068 55843188 1296161529 1373130564 587608407 611594543 708553122 761536021 WAKE FOREST UNIVERSITY BAPTIST MEDICAL CENTER'S MISSION IS TO IMPROVE THE HEALTH OF OUR REGION, STATE AND NATION BY: - GENERATING AND TRANSLATING KNOWLEDGE TO PREVENT, DIAGNOSE AND TREAT DISEASE; - TRAINING LEADERS IN HEALTH CARE AND BIOMEDICAL SCIENCE; - SERVING AS THE PREMIER HEALTH SYSTEM IN OUR REGION, WITH SPECIFIC CENTERS OF EXCELLENCE RECOGNIZED AS NATIONAL AND INTERNATIONAL CARE DESTINATIONS.IN 1975, WAKE FOREST BAPTIST MEDICAL CENTER, A NORTH CAROLINA NONPROFIT CORPORATION, WAS ESTABLISHED FOR THE PURPOSE OF COORDINATING THE ACTIVITIES OF NORTH CAROLINA BAPTIST HOSPITAL AND WAKE FOREST UNIVERSITY HEALTH SCIENCES THROUGH THE FORMULATION OF JOINT GENERAL POLICIES, FUNDRAISING ACTIVITIES, STRATEGIC PLANNING, PROGRAM DEVELOPMENT, MARKETING AND COMMUNITY COMMUNICATIONS. 0 0 807173808 157954 933348820 SEE SCHEDULE O FOR COMPLETE DESCRIPTION 807173808 1 1 0 1 0 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 1 1 0 0 0 0 0 0 0 0 1 1 1 0 0 0 0 1 1 0 0 1 164 0 1 8803 1 1 1 0 0 0 0 0 0 0 0 25 23 1 0 1 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 1 NC X DOUG LISCHKE CONTROLLER 3367164445 MEDICAL CENTER BLVD WINSTON SALEM NC 27157 WILLIAM C WARDEN JR 1.00 X X 0 0 0 ARTHUR A GIBEL 1.00 X X 0 0 0 JOSEPH R OVERBY JR MD 1.00 X 0 0 0 STEPHEN L ROBERTSON 1.00 X 0 0 0 STANLEY R AESCHLEMAN 1.00 X 0 0 0 A WILLIAM BLACKSTOCK JR MD 1.00 X 0 0 0 KATY M BOLES 1.00 X 0 0 0 JERRY N BROOKS 1.00 X 0 0 0 DALE M BROWN 1.00 X 0 0 0 REGINALD D CARTER 1.00 X 0 0 0 ROGER L COTHRAN 1.00 X 0 0 0 WILLIAM N HARTSELL 1.00 X 0 0 0 KATHYRN H HAMRICK 1.00 X 0 0 0 WILLIAM J IRELAND JR MD 1.00 X 0 0 0 RON D KESSINGER 1.00 X 0 0 0 KENNETH W LEWIS 1.00 X 0 0 0 STEPHEN R LITTLE 1.00 X 0 0 0 PEDRO L MARTINEZ 1.00 X 0 0 0 GERALD H QUINN 1.00 X 0 0 0 GEORGE E STUBBINS SR 1.00 X 0 0 0 SHEREE B WATSON 1.00 X 0 0 0 R MICHAEL WELLS 1.00 X 0 0 0 LARRY C CRAWFORD 1.00 X 0 0 0 LINWOOD L DAVIS 1.00 X 0 0 0 BRENDA B DIGGS 1.00 X 0 0 0 ERNEST L EVANS 1.00 X 0 0 0 H VARNELL MOORE 1.00 X 0 0 0 JOHN D MCCONNELL MD 40.00 X 1213616 0 468064 RAY N HOWELL III 1.00 X 0 0 0 JOHN D KIMBERLY 1.00 X 0 0 0 EDWIN L WELCH JR 1.00 X 0 0 0 DONNY C LAMBETH 40.00 X 691497 0 158024 G DOUGLAS ATKINSON 40.00 X 286289 0 39491 KAREN H HUEY 40.00 X 199775 0 28477 A PATRICIA JOHNSON 40.00 X 408149 0 54140 RONALD H SMALL 40.00 X 301092 0 114808 STEVEN C SNELGROVE 40.00 X 304368 0 42665 KAREN Q TURNER 40.00 X 68369 0 3299 J MCLAIN WALLACE JR 40.00 X 260936 0 25328 ROBERT S PARKER SR 40.00 X 251289 0 39837 SHARON ENGEBRETSON 40.00 X 133413 0 24172 MAUREEN E SINTICH 40.00 X 232599 0 29410 H GREGORY BRAY 40.00 X 184694 0 22767 JOANNE C RUHLAND 40.00 X 201106 0 29574 NORMAN D POTTER JR 40.00 X 233924 0 37850 MICHAEL L FREEMAN 40.00 X 202855 0 31958 CHERYL EH LOCKE 40.00 X 528894 0 39780 EDWARD G CHADWICK 40.00 X 690281 0 44001 VANCE MCVAY JR 40.00 X 204121 0 26535 ERIC STIEFEL 40.00 X 208564 0 19610 BETTY PETREE 40.00 X 275548 0 20767 MICHAEL REIKER 40.00 X 217404 0 19303 LINDA TRIMBLE 40.00 X 201019 0 32248 LEN B PRESLAR JR 40.00 X 420679 0 14572 GERALD T FINLEY 40.00 X 187119 0 38505 KERRY A GARRIGAN 40.00 X 24198 0 0 PAUL M LORUSSO 40.00 X 241894 0 10007 GINA B RAMSEY 40.00 X 218902 0 24624 WILLIAM G YATES 40.00 X 140560 0 23521 8708956 0 1463337 317 1 1 1 WAKE FOREST UNIVERSITY HEALTH SCIENCES MEDICAL CENTER BLVD WINSTON SALEM NC 27157 PHYSICIAN/OTHER PROFESSIONAL SERVICES 64601752 FORSYTH COUNTY FINANCE DEPARTMENT WINSTON SALEM NC 27101 PARAMEDIC SERVICES 941449 INGRAM & ASSOCIATES PO BOX 290303 NASHVILLE TN 37229 COLLECTION SERVICES 793074 KCI USA TREATMENT SYSTEMS INC RALEIGH NC 27617 PHYSICIAN/OTHER PROFESSIONAL SERVICES 677604 MEDICAL VOICE TECHNOLOGY SERVICES PO BOX 265 EAST BEND NC 27018 TECHNOLOGY SERVICES 618519 5 41445 1272090 30034 1313535 PATIENT SERVICE REVENU 621400 923075220 921514198 1561022 COST RECOV. & OTHER 900099 8390436 8119962 270474 DIETARY 722320 5619685 5619685 MEDICAL/LAB SERVICE 621500 2039750 2039750 939125091 27617145 27617145 417491 109063 308428 308428 308428 22588295 26484180 -3895885 -3895885 -3895885 GIFT SHOP REVENUE 453220 1294014 1294014 PARKING FEES 900099 1204536 1204536 TUITION 900099 158566 158566 549249 7066 542183 3206365 967674679 931357960 3878312 31124872 47275 47275 110679 110679 7191533 993578 5888702 309253 358467990 316541730 41926260 16695171 12521378 4173793 39845823 29884367 9961456 25904428 19428321 6476107 1629841 82387 1547454 68682691 56067867 12614824 3852593 2078555 1774038 263885779 251041149 12844630 9287867 5104420 4183447 219553 133551 86002 461403 283221 178182 10757160 10757160 61713459 61351237 362222 7008598 5298945 1709653 BAD DEBT EXPENSE 34270889 34270889 RECRUITMENT/RELOCATION 1677609 1105121 572488 MISCELLANEOUS EXPENSE 121150 71978 49172 911831491 807173808 104348430 309253 40884345 27825998 49335952 58135794 144343377 165093603 3157093 10383218 11714276 111157 1309605 1181807851 756416318 424954332 425391533 518124349 613361983 96479843 61847344 8387863 8450428 1296161529 1373130564 100533357 121810500 330700000 333993335 156375050 155790708 587608407 611594543 X 703115677 756152864 2274927 2146704 3162518 3236453 708553122 761536021 1296161529 1373130564 X 0 1 1 X 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 0 1 0 0 1 193277 0 0 193277 0 Part II-B, Line 1i: Explanation of Other Lobbying Activities: Government Relations The Office of Government Relations was actively involved with several federal and state issues. The office assisted in developing political advocacy strategies regarding The Patient Protection and Affordable Care Act (P.L. 111-148) (a/k/a "the health care reform bill"), which included expansion of insurance coverage; Medicare and Medicaid payment changes; provisions related to workforce supply and graduate medical education training; funding for comparative effectiveness research, wellness and prevention; key delivery system reforms including accountable care organizations, value based purchasing and incentives to improve care coordination and quality; and language designed to reduce waste, fraud and abuse in the Medicare and Medicaid programs. Staff worked on the FY2011 Budget; the Center for Medicare and Medicaid Service's proposed rule regarding the Electronic Health Record Incentive Program and submitted a comment letter regarding its provisions; the FY 2011 Medicare Inpatient Prospective Payment System (PPS) Proposed Rule; legislation regarding the creation of healthcare innovation zones; Medicare Payment Advisory Commission's DGME and IME recommendations; changes to the Medicare policy known as the "72 Hour Rule"; legislation to increase residency slots; and Medicare physician payments (SGR adjustments). Staff also worked on many of the FY 2011 appropriations bills and proposed legislation and regulations that were introduced, including requests in the Department of Transportation; Department of Homeland Security; Department of Commerce; State; Justice; Department of Defense; Department of Health and Human Services; and Veterans Affairs (VA) Research and Medical Care funding. The office assisted with the following: (1) End stage renal disease payment system proposed rule; (2) FAA reauthorization bill amendments for air ambulances; (3) Employee free choice bill regarding unionization; (4) IRS property-tax exemptions for nonprofits guidelines and community benefits analysis; (5) tax bill for employee pensions, charitable donations; (6) NIH appropriations and funding for health professions and AHEC and the reauthorization of the National Science Foundation; (7) changes proposed by HHS regarding conflict of interest rules; (8) the implementation of the Truth in Lending Act regarding student loans; (9) False Claims Act amendments; and (10) patents and intellectual property issues. At the state level, efforts were concentrated with the FY 2010-11 Medicaid budget including the six month expansion of FMAP funding contained in the federal stimulus package, the Medicaid Reimbursement Initiative and Upper Payment Limit provisions; on legislation regarding certificate-of-need laws, business incentive tax laws, including the mill tax credit for the Piedmont Triad Research Park; and funding for allied health professional training at the community colleges, including Forsyth Technical Community College. 3788351 68200 78265 16625 3918191 4470108 117064 -780842 17979 3788351 0.03000 0.76000 0.21000 1 0 9241574 9241574 609952295 343857513 266094782 7442141 5458593 1983548 510245574 407100212 103145362 44926267 44926267 425391533 INVESTMENTS IN SUBSIDIARIES 61847344 C 61847344 UNAMORTIZED BOND ISSUANCE COSTS 3257070 OTHER ASSETS 5193358 8450428 OTHER LIABILITIES 45366645 PENSION LIABILITY 103558505 DEFERRED COMPENSATION 1475331 OTHER LONG-TERM LIABILITIES 5390227 155790708 967674679 911831491 55843188 42996940 13566 -45870795 -2860289 52982899 964869438 42996940 13566 -45815747 -2805241 967674679 0 967674679 911831491 0 911831491 0 911831491 Part V, Line 4: Description of Intended Use of Endowment Funds: THE HOSPITAL'S ENDOWMENT FUNDS ARE USED TO PROVIDE SUPPORT FOR EDUCATION, SCHOLARSHIPS, INDIGENT CARE, AND SUPPORT AS DESIGNATED BY THE INDIVIDUAL DONORS. Part XI, Line 8 - Other Adjustments: NET CHANGE IN RESTRICTED ASSETS: -54925. LOSS FROM AFFILIATES: -1837922. TRANSFERS TO AFFILIATES: -2682367. CHANGE IN PENSION LIABILITY: -13980400. AMORTIZATION OF CASH FLOW INTEREST RATE SWAP: 9950525. NET LOSS FROM DISCONTINUED OPERATIONS: -28172577. LOSS ON DEBT REFUNDING: -2755730. CHANGE IN VALUE OF INTEREST RATE SWAP: -6337903. OTHER ADJUSTMENTS: 504. Part XII, Line 2d - Other Adjustments: LOSS FROM AFFILIATES: -1837922. TRANSFERS TO AFFILIATES: -2682367. CHANGE IN PENSION LIABILITY: -13980400. AMORTIZATION OF CASH FLOW INTEREST RATE SWAP: 9950525. NET LOSS FROM DISCONTINUED OPERATIONS: -28172577. LOSS ON DEBT REFUNDING: -2755730. CHANGE IN VALUE OF INTEREST RATE SWAP: -6337903. OTHER ADJUSTMENT: 627. PART XI, LINE 8: CONSISTS OF AMOUNTS RELATED TO LOSS ON DEBT REFINANCING, CHANGE IN VALUE OF INTEREST RATE SWAP, EQUITY METHOD AFFILIATES, DISCONTINUED OPERATIONS, CHANGE IN PENSION LIABILITY, AMORTIZATION OF INEFFECTIVE INTEREST RATE SWAP, TRANSFERS, TEMPORARY AND PERMANENTLY RESTRICTED NET ASSET CHANGES, ADJUSTMENT DUE TO CHANGE IN PENSION MEASUREMENT DATE, AND LAND AND EQUIPMENT DONATIONS NOT RECOGNIZED AS REVENUE ON THE FORM 990. 1 1 1 X 1 X 201.000000000000 1 1 1 0 1 1 40070889 5128780 34942109 0.03980 161792153 162131520 -339367 0.00000 18996528 14668824 4327704 0.00490 220859570 181929124 38930446 0.04470 3732779 0 3732779 0.00430 61315763 19433343 41882420 0.04770 4455652 4455652 0.00510 1434972 1434972 0.00160 622727 622727 0.00070 71561893 19433343 52128550 0.05940 292421463 201362467 91058996 0.10410 95742 95742 0.00010 122572 122572 0.00010 0 133697 133697 0.00020 0 473321 473321 0.00050 601419 601419 0.00070 0 1426751 1426751 0.00160 0 13654776 0 295909823 312981689 -17071866 X 1 1 NORTH CAROLINA BAPTIST HOSPITAL

MEDICAL CENTER BLVD WINSTON SALEM NC 27157

X X X X NORTH CAROLINA BAPTIST HOSPITAL AMBULANC

MEDICAL CENTER BLVD WINSTON SALEM NC 27157

AMBULANCE SERVICES Part I, Line 3c: THE ORGANIZATION USES A SLIDING SCALE OF THE FEDERAL POVERTY GUIDELINES TO DETERMINE ELIGIBILITY FOR DISCOUNTED CARE. BETWEEN 201% AND 300%, THE DISCOUNT IS 75%. BETWEEN 301% AND 400%, THE DISCOUNT IS 50%. AT 200% OR BELOW, THE INDIVIDUAL IS ELIGIBLE FOR FREE CARE. Part I, Line 7: THE ORGANIZATION USED THE WORKSHEETS PROVIDED IN THE INSTRUCTIONS TO SCHEDULE H TO COMPUTE ITS COST-TO-CHARGE RATIO FOR PURPOSES OF THE 2009 SCHEDULE H. Part I, Line 7f: THE ORGANIZATION'S BAD DEBT EXPENSE PER THE AUDITED FINANCIAL STATEMENTS WAS $34,270,889 FOR THE FISCAL YEAR. THIS AMOUNT HAS BEEN REMOVED FROM THE CALCULATION OF CHARITY CARE FOR PART I, LINE 7. Part III, Line 4: THE ORGANIZATION'S FINANCIAL STATEMENTS DO NOT INCLUDE A DISCRETE FOOTNOTE EXPLAINING BAD DEBT EXPENSE. BAD DEBT HAS NOT BEEN INCLUDED IN THE COMPUTATION OF COMMUNITY BENEFIT ON PART I, LINE 7. THE ORGANIZATION HAS A THOROUGH PROCESS OF EVALUATING BAD DEBT ACCOUNTS AS INFORMATION BECOMES AVAILABLE AND RECLASSIFIES BAD DEBT ACCOUNTS AS CHARITY CARE AS PROVIDED BY THE CHARITY CARE POLICY. AMOUNTS USED TO COMPUTE CHARITY CARE AND BAD DEBT ON SCHEDULE H USE THE MOST CURRENT DATA AVAILABLE AT TIME OF FILING. Part III, Line 8: FOR THE FISCAL YEAR, THE PORTION OF PAYORS FOR WHICH MEDICARE WAS THE PRIMARY SOURCE OF PAYMENT WAS 32.6%. OF THAT PORTION OF PATIENTS, 30.2% WERE FOUND TO HAVE ALSO QUALIFIED FOR MEDICAID AS A SECONDARY INSURANCE; THEREFORE BASED ON THIS RATIO, APPROXIMATELY 30%, OR $5.1 MILLION OF THE MEDICARE SHORTFALL MAY BE CONSIDERED A COMMUNITY BENEFIT. Part III, Line 9b: PATIENT FINANCIAL RESOURCE SERVICES WORKS WITH THE PATIENT FOR ANY PATIENT LIABILITY. OUR MAIN FOCUS IS PRIOR TO SERVICES AND/OR DISCHARGE; HOWEVER, WE DO WORK WITH PATIENTS AFTER SERVICES HAVE BEEN RECEIVED AND BILLED. PATIENT FINANCIAL RESOURCES SERVICES IS REALLY TWO AREAS IN ONE--THE RESOURCE RECOVERY SPECIALIST/RRS (FORMERLY FINANCIAL COUNSELING) AND THE MEDICAID ELIGIBILITY TEAM/MPS. THESE TWO AREAS WORK TOGETHER TO FIND A RESOLUTION TO PATIENT LIABILITY, SELF PAY OR INSURED. THE RRS WORKS TO NOTIFY THE PATIENT OF ANY PATIENT LIABILITY AND ASK FOR PAYMENT FOR THAT LIABILITY. IF THE PATIENT INDICATES THAT HE NEEDS ASSISTANCE, THEN THE RRS WILL COMPLETE A FINANCIAL STATEMENT ON THE PATIENT. WHILE TAKING THAT FINANCIAL STATEMENT THE RRS IS LOOKING FOR INFORMATION THAT COULD QUALIFY THE PATIENT FOR MEDICAID OR FOR OTHER AGENCY PROGRAMS THAT ARE AVAILABLE TO THE MEDICAL CENTER. WHEN THAT INFORMATION IS IDENTIFIED THE RRS WILL LET THE PATIENT KNOW THAT A REFERRAL WILL BE MADE FOR MEDICAID OR OTHER ASSISTANCE AND A MPS WILL BE IN TOUCH WITH HIM. THE RRS ALSO EXPLAINS TO THE PATIENT OR FAMILY THAT CHARITY CARE IS A LAST RESORT AND THEY MUST COOPERATE WITH ANY OTHER ASSISTANCE PROGRAMS THAT WE HAVE IDENTIFIED AND BE FOUND INELIGIBLE BEFORE CHARITY CARE WILL BE APPROVED/APPLIED. IT IS ALSO COMMUNICATED WITH THE PATIENT OR FAMILY IF ANY SUPPORTING DOCUMENTATION IS NEEDED FOR ANY ASSISTANCE, WHETHER THAT BE CHARITY, MEDICAID, OR OTHER PROGRAMS. Part VI, Line 2: DATA IS COLLECTED THROUGH PRIMARY AND SECONDARY COLLECTION PROCESSES. POPULATION, PREGNANCY, BIRTH AND MORTALITY, AND MORBIDITY DATA IS REVIEWED TO ASSESS THE POPULATION'S HEALTH. PRIMARY DATA COLLECTION INCLUDES DOOR-TO-DOOR INTERVIEWS WITH HIGH RISK COMMUNITIES, FOCUS GROUPS, AND A COMMUNITY HEALTH OPINION SURVEY THAT IS CONDUCTED THROUGH THE SCHOOL SYSTEM. SECONDARY DATA IS COLLECTED THROUGH DATA FROM THE NC DEPARTMENT OF HEALTH AND HUMAN SERVICES, VITAL STATISTICS, AND SURVEILLANCE REPORTS. OTHER COMMUNITY REPORTS SUCH AS THE UNITED WAY ANNUAL REPORT AND US CENSUS BUREAU COMMUNITY PROFILES ARE REVIEWED AS WELL. WFUBMC ALSO REGULARLY PULLS MARKET DATA TO IDENTIFY WHAT HEALTH SERVICES ARE BEING USED BY THE PUBLIC AND TO GAUGE THE AVAILABILITY OF THOSE SERVICES WITHIN THE COMMUNITIES THEY LIVE. THE PURPOSE OF DATA COLLECTION IS TO IDENTIFY FACTORS THAT AFFECT THE HEALTH OF FORSYTH COUNTY'S POPULATION AND DETERMINE THE AVAILABILITY OF RESOURCES WITHIN THE COMMUNITY TO ADEQUATELY ADDRESS THESE FACTORS. WFUBMC PARTICIPATES IN A COLLABORATIVE PROCESS WITH OTHER COMMUNITY LEADERS, PUBLIC HEALTH AGENCIES, HOSPITALS, AND PRIVATE PRACTITIONERS TO ANSWER THE KEY QUESTIONS OF (1) WHAT HEALTH CONCERNS OR NEEDS DOES THE COMMUNITY HAVE, AND (2) WHAT RESOURCES ARE AVAILABLE AND WHAT DO WE NEED IN THE COMMUNITY TO ADDRESS THESE CONCERNS. WORKGROUPS WHICH INCLUDE MEMBERS FROM WFUBMC, ALONG WITH A STATISTICIAN FROM THE PUBLIC HEALTH DEPARTMENT MEET TO DISCUSS THE PRIMARY AND SECONDARY DATA COLLECTED TO SYNTHESIZE TRENDS AND RANK PRIORITIZE THE TOP NEEDS SUCH AS "REDUCING INFANT MORTALITY" AND "REDUCING THE INCIDENCE OF COLON CANCER." RATES ARE MEASURED AGAINST PEER COUNTY AND STATE RANKINGS. STRATEGIES ARE RECOMMENDED AND VOTED UPON BY THE COMMUNITY ASSESSMENT TASK FORCE, WHICH INCLUDES COMMUNITY LEADERS, PUBLIC HEALTH AGENCIES, HOSPITALS, PRIVATE PRACTITIONERS, AND OTHER NON-PROFIT AGENCIES. THE LAST ASSESSMENT WAS IN 2009 AND THE LATEST ASSESSMENT OF COMMUNITY NEEDS WAS INITIATED IN OCTOBER 2010. WORK IS PLANNED TO BE COMPLETED BY SEPTEMBER 2011. WFUBMC HAS SEVERAL REPRESENTATIVES ON THE TASK FORCE MANAGED BY THE FORSYTH COUNTY HEALTH DEPARTMENT AND SEVERAL EMPLOYEES PARTICIPATE DIRECTLY IN DATA WORK GROUPS AND ARE PART OF REVIEWING THE EXISTING AND COLLECTING NEW COMMUNITY SPECIFIC DATA. WFUBMC EMPLOYEES ARE ALSO ON VARIOUS COMMUNITY HEALTH BOARDS WORKING TO ADDRESS SPECIFIC COMMUNITY HEALTH NEEDS SUCH AS THE INFANT MORTALITY REDUCTION BOARD, FORSYTH FUTURES, AND UNITED WAY, ALL OF WHICH ADDRESS DIFFERENT HEALTH DISPARITIES IN FORSYTH COUNTY. Part VI, Line 3: THE ORGANIZATION USES A VARIETY OF MEANS TO EDUCATE AND INFORM PATIENTS OF THEIR CHARITY CARE OPTIONS, INCLUDING INFORMATION ON A WEBSITE, BILLING PAMPHLETS AVAILABLE IN CLINICAL OFFICES AND THE BUSINESS OFFICE, SIGNS IN CHECK-IN AREAS, INFORMATION ON PATIENT BILL STATEMENTS, AND FROM STAFF MEMBERS DURING CONVERSATIONS CONCERNING A PATIENT'S LIABILITY FOR SERVICES.IF A PATIENT QUALIFIES FOR 100% CHARITY CARE PRIOR TO THE ACCOUNT BEING BILLED TO THE PATIENT, THE ACCOUNT IS CODED AND THE ADJUSTMENT IS TAKEN THE TIME THE BALANCE DROPS TO THE PATIENT AND WOULD NOT PROCEED THROUGH ANY FURTHER STATEMENTS OR COLLECTION PROCESS. IF THE PATIENT QUALIFIES FOR PARTIAL CHARITY, THE ADJUSTMENT IS TAKEN AND THE REMAINING BALANCE IS BILLED TO THE PATIENT AND WOULD FOLLOW THE NORMAL COLLECTION PRACTICES AND POSSIBLE BAD DEBT PLACEMENT. IF THE PATIENT QUALIFIES FOR 100% CHARITY AFTER BEING BILLED, THE ACCOUNT IS CODED AND THE ADJUSTMENT IS TAKEN AT THAT TIME AND WOULD NO LONGER RECEIVE ANY STATEMENTS OR COLLECTION ACTIVITY. IF THE PATIENT QUALIFIES FOR PARTIAL CHARITY, THE ACCOUNT IS ADJUSTED ACCORDINGLY AND HE WOULD STILL BE RESPONSIBLE FOR THE REMAINING BALANCE AND CONTINUE TO RECEIVE STATEMENTS OR COLLECTION CALLS AND BE SUBJECT FOR BAD DEBT PLACEMENT. Part VI, Line 4: NORTH CAROLINA BAPTIST HOSPITAL IS PART OF WAKE FOREST UNIVERSITY MEDICAL CENTER AND IS NORTH CAROLINA'S SOLE ACADEMIC MEDICAL CENTER SERVING A 26-COUNTY REGION IN NORTHWESTERN NORTH CAROLINA AND SOUTHWESTERN VIRGINIA. NORTH CAROLINA BAPTIST HOSPITAL IS ONE OF TWO MEDICAL CENTERS OPERATING WITHIN FORSYTH COUNTY. THE POPULATION OF OUR PRIMARY SERVICE AREA IS 2,491,984 ACCORDING TO THOMPSON-REUTERS HEALTHCARE MARKET PLANNER. 10.8% OF THE POPULATION IS AT OR BELOW THE POVERTY LINE. 78.8% OF THE POPULATION IS WHITE, 17.8% IS BLACK, AND 3.4% IS MADE UP OF OTHER RACES. THE UNEMPLOYMENT LEVEL AS OF SEPTEMBER 2010 WAS 9.9%. THE MEDIAN INCOME IS $40,632. THE GROWTH RATE OF THE COMMUNITY IS 1%. Part VI, Line 5: THROUGH COMMUNITY BUILDING NORTH CAROLINA BAPTIST HELPS THE COMMUNITY BY OPERATING "BEST HEALTH" WHICH IS A RESOURCE CENTER LOCATED AT A LOCAL SHOPPING MALL. THERE, THE PUBLIC CAN RESEARCH A WIDE VARIETY OF HEALTH AND WELLNESS TOPICS. OUR COMMUNITY ALSO BENEFITS FROM OUR PHYSICIAN RECRUITMENT PROGRAM, COMMUNITY TRAINING AND NETWORKS AS WELL AS OUR LEADERSHIP WINSTON-SALEM PROGRAM. WE FURTHER HELP OUR COMMUNITY BY SUPPORTING OUR LOCAL GOODWILL ENDEAVORS. Part VI, Line 6: NORTH CAROLINA BAPTIST HOSPITAL'S MISSION IS TO IMPROVE THE HEALTH OF OUR REGION, STATE AND NATION BY:1) GENERATING AND TRANSLATING KNOWLEDGE TO PREVENT, DIAGNOSE AND TREAT DISEASE.2) TRAINING LEADERS IN HEALTH CARE AND BIOMEDICAL SCIENCE.3) SERVING AS THE PREMIER HEALTH SYSTEM IN OUR REGION, WITH SPECIFIC CENTERS OF EXCELLENCE RECOGNIZED AS NATIONAL AND INTERNATIONAL CARE DESTINATIONS.THE HOSPITAL OPERATES THE FOLLOWING PROGRAMS CONSTITUTING COMMUNITY HEALTH IMPROVEMENT SERVICES AND COMMUNITY BENEFIT OPERATIONS REPORTED ON PART I, LINE 7E:WS/FC SCHOOLS ALLIED HEALTH PROGRAM $ 5,000PHYSICIAN RECRUITMENT FEES 1,500,000COMMUNITY HEALTH/HEALTHCARE ACCESS 15,655CHURCH COMMUNITY RELATIONS 357,785COMMUNITY HEALTH SALARIES 633,900PHYSICIANS COMMUNITY HEALTH ACCESS 201,331CARENET/PASTORAL COUNSELING 251,733ACCELLERATED BSN PROGRAM 696,816COUNTY RENT ON CLEVELAND DENTAL 70,559TOTAL TO PART I, LINE 7E: 3,732,779 Part VI, Line 7: NORTH CAROLINA BAPTIST HOSPITAL IS PART OF WAKE FOREST UNIVERSITY BAPTIST MEDICAL CENTER, WHICH IS NORTHWESTERN NORTH CAROLINA'S SOLE ACADEMIC MEDICAL CENTER, BRINGING TO THE REGION THE RESOURCES OF ONE OF AMERICA'S TOP 50 RANKED HOSPITALS AND A PREMIER MEDICAL SCHOOL. WAKE FOREST UNIVERSITY BAPTIST MEDICAL CENTER IS A CORPORATION ONE-HALF CONTROLLED BY WAKE FOREST UNIVERSITY AND ONE-HALF CONTROLLED BY NORTH CAROLINA BAPTIST HOSPITAL. THE MEDICAL CENTER OPERATES A HOSPITAL SYSTEM WITH 1,004 LICENSED ACUTE CARE AND REHABILITATION BEDS ACROSS THE SYSTEM, WHICH ENCOMPASSES NORTH CAROLINA BAPTIST HOSPITAL (885 BEDS), BRENNER CHILDREN'S HOSPITAL (160 BEDS, INCLUDED IN NCBH TOTAL); LEXINGTON MEMORIAL HOSPITAL (94 BEDS, AND ITS RELATED PHYSICIAN PRACTICE OF 32 LEXMED DOCTORS); AND DAVIE COUNTY HOSPITAL (25 BEDS). WAKE FOREST BAPTIST SERVES A PRIMARY 24-COUNTY REGION IN NORTHWESTERN NORTH CAROLINA AND SOUTHWESTERN VIRGINIA AND DRAWS PATIENTS FROM ACROSS THE STATE AND NATION FOR SELECT SERVICES. NC 1 CRISIS CONTROL MINISTRY INC 200 E TENTH STREET WINSTON SALEM NC 27101 237348168 501(C)(3) 35000 ANNUAL SUPPORT DONATION CDC FOUNDATION 55 PARK PLACE NE SUITE 400 ATLANTA GA 30303 582106707 501(C)(3) 5000 SPONSORSHIP CONTRIBUTION 2 0 WHITEHEAD NURSING SCHOLARSHIP 40 39500 WHITEHEAD MEDICAL TECH SCHOLARSHIP 4 13000 WHITEHEAD NURSE ANESTHESIA 7 25000 WL CARTER SCHOLARSHIP 18 33179 Procedure for Monitoring Grants in the U.S.: Part I, Line 2: Schedule I, Part I, Line 2: SCHOLARSHIPS ARE MONITORED TO ASSURE THE TERMS OF THE PROGRAM ARE MET. AN ANNUAL REPORT IS SENT TO THE ORGANIZATION STARING THE USE OF THE FUNDSAND THE IDENTIFICATION OF BENEFICIARIES TO ASSURE COMPLIANCE WITH SCHOLARSHIP PROVISIONS. LETITE PATE WHITEHEAD DETAILS THE LETTIE PATE WHITEHEAD FOUNDATION PROVIDES SCHOLARSHIPS TO TAX-EXEMPT, NON-PROFIT HOSPITALS OR INSTITUTIONS FOR THE CARE OF INDIGENT CHRISTIAN WOMEN IN SPECIFIED STATES INCLUDING NORTH CAROLINA. THE FINANCIAL NEED IS ESTABLISHED BY THE COLLEGES THAT THE STUDENTS ATTEND. NAMES OF STUDENTS ARE PROVIDED TO OUR STAFF DEVELOPMENT DEPARTMENT. THE WHITEHEAD FUNDS ARE REVIEWED AND ADMINISTERED BY A FUND CUSTODIAN. W.L. CARTER REQUIREMENTS TO RECEIVE THIS SCHOLARSHIP, AN EMPLOYEE MUST BE ACCEPTED INTO AN APPROVED NURSING PROGRAM AND RECOMMENDED BY HIS/HER MANAGER WITH SATISFACTORY PERFORMANCE EVALUATION AND ATTENDANCE. IN EXCHANGE FOR THE SCHOLARSHIP, THE EMPLOYEE AGREES TO MAKE ADEQUATE ACADEMIC PROGRESS TO COMPLETE HIS/HER DEGREE. X X X X X 1 1 X X X X X 1 1 0 0 0 0 0 0 0 JOHN D MCCONNELL MD 831288 0 266667 0 115661 0 441589 0 26475 0 1681680 0 0 0 DONNY C LAMBETH 604495 0 70030 0 16972 0 136459 0 21565 0 849521 0 0 0 G DOUGLAS ATKINSON 0 0 20727 0 265562 0 28728 0 10763 0 325780 0 0 0 KAREN H HUEY 175202 0 21096 0 3477 0 12033 0 16444 0 228252 0 0 0 A PATRICIA JOHNSON 0 0 52000 0 356149 0 41668 0 12472 0 462289 0 0 0 RONALD H SMALL 271424 0 24063 0 5605 0 100690 0 14118 0 415900 0 0 0 STEVEN C SNELGROVE 256208 0 27846 0 20314 0 23813 0 18852 0 347033 0 0 0 J MCLAIN WALLACE JR 228397 0 24214 0 8325 0 9175 0 16153 0 286264 0 0 0 ROBERT S PARKER SR 223318 0 21956 0 6015 0 28095 0 11742 0 291126 0 0 0 SHARON ENGEBRETSON 85773 0 5677 0 41963 0 14880 0 9292 0 157585 0 0 0 MAUREEN E SINTICH 206801 0 18864 0 6934 0 16291 0 13119 0 262009 0 0 0 H GREGORY BRAY 171066 0 9481 0 4147 0 8084 0 14683 0 207461 0 0 0 JOANNE C RUHLAND 157332 0 43000 0 774 0 10696 0 18878 0 230680 0 0 0 NORMAN D POTTER JR 183764 0 47900 0 2260 0 11917 0 25933 0 271774 0 0 0 MICHAEL L FREEMAN 178581 0 23860 0 414 0 12092 0 19866 0 234813 0 0 0 CHERYL EH LOCKE 336309 0 70700 0 121885 0 15052 0 24728 0 568674 0 0 0 EDWARD G CHADWICK 294218 0 350000 0 46063 0 16476 0 27525 0 734282 0 0 0 VANCE MCVAY JR 204121 0 0 0 0 0 13187 0 13348 0 230656 0 0 0 ERIC STIEFEL 208564 0 0 0 0 0 6482 0 13128 0 228174 0 0 0 BETTY PETREE 275548 0 0 0 0 0 11959 0 8808 0 296315 0 0 0 MICHAEL REIKER 211276 0 0 0 6128 0 4944 0 14359 0 236707 0 0 0 LINDA TRIMBLE 201019 0 0 0 0 0 21867 0 10381 0 233267 0 0 0 LEN B PRESLAR JR 0 0 0 0 420679 0 0 0 14572 0 435251 0 0 0 GERALD T FINLEY 164466 0 20117 0 2536 0 29014 0 9491 0 225624 0 0 0 PAUL M LORUSSO 0 0 0 0 241894 0 0 0 10007 0 251901 0 0 0 GINA B RAMSEY 182964 0 31093 0 4845 0 13379 0 11245 0 243526 0 0 0 WILLIAM G YATES 78633 0 15968 0 45959 0 16781 0 6740 0 164081 0 0 0 Part I, Line 1a CERTAIN EXECUTIVES WITHIN NCBH RECEIVE, AS PART OF THEIR APPROVED COMPENSATION PACKAGE, TAX INDEMNIFICATION AND GROSS-UP PAYMENTS, RELOCATION ASSISTANCE INCLUDING A HOUSING ALLOWANCE, AND HEALTH OR SOCIAL CLUB DUES OR INITIATION FEES. IN ADDITION, IF APPROVED BY A SUPERIOR AND RELATED DIRECTLY TO THE CONDUCT OF NCBH BUSINESS, CERTAIN EXECUTIVES UTILIZED SPOUSAL TRAVEL. Part I, Line 4a SEVERANCE PAYMENTS: THE FOLLOWING FORMER EMPLOYEES RECEIVED COMPENSATION FROM A SEVERANCE PACKAGE IN 2009. PLEASE SEE PART II, COLUMN C FOR DETAILS: LEN B. PRESLAR PATRICIA A. JOHNSON GEORGE D. ATKINSON PAUL LORUSSO DURING THE TAX PERIOD, THE FILING ORGANIZATION AND ITS AFFILIATE, WAKE FOREST UNIVERSITY HEALTH SCIENCES ("WFUHS") WERE OPERATING UNDER AN AGREEMENT THAT PROVIDED FOR A SINGLE EXECUTIVE GROUP TO PROVIDE FOR THE MANAGEMENT OF BOTH THE FILING ORGANIZATION AND WFUHS, WHICH ENTITIES TOGETHER HAVE COMBINED OPERATING REVENUES FOR THE TAX PERIOD OF $1.814 BILLION. THESE INDIVIDUALS WERE SOUGHT AND HIRED AFTER NATIONAL SEARCHES IN A HIGHLY COMPETITIVE ENVIRONMENT, AND THE MEDICAL CENTER SOUGHT ONLY INDIVIDUALS AT THE HIGHEST LEVELS OF ABILITY, GIVEN THEIR TASK OF INITIATING THE NEW MANAGEMENT STRUCTURE DESIGNED TO OPTIMIZE THE EFFECTIVENESS OF BOTH ORGANIZATIONS IN THEIR TAX-EXEMPT MISSIONS. TWO EXECUTIVES (JOHN D. MCCONNELL, M.D., MEDICAL CENTER CEO; AND EDWARD G. CHADWICK, MEDICAL CENTER CFO), RECEIVED ONE-TIME RECRUITMENT BONUSES THAT INCLUDED RELOCATION INCENTIVES. ADDITIONALLY, DR. MCCONNELL RECEIVED A DEFERRED COMPENSATION ARRANGEMENT THAT REPLACED SIMILAR NON-VESTED BENEFITS FORFEITED FROM HIS PREVIOUS EMPLOYER. THE BONUSES WERE PAID BY ITS AFFILIATE, WFUHS, AND THE DETERMINATION OF THE AMOUNT OF THE BONUSES FOLLOWED THE FILING ORGANIZATION'S COMPENSATION PROCEDURES AS OUTLINED IN PART VI, SECTION B, LINE 15 OF THE FORM 990. THE COMPENSATION FOR EXECUTIVES JOHN D. MCCONNELL, M.D., MEDICAL CENTER CEO, AND EDWARD G. CHADWICK, MEDICAL CENTER CFO, IS PAID TO THEM BY AN AFFILIATE ORGANIZATION, WFUHS, BUT 50% OF THAT COMPENSATION IS REIMBURSED BY THE FILING ORGANIZATION. Supplemental Information Part III COMPENSATION BY UNRELATED ORGANIZATIONS: THE FOLLOWING INDIVIDUALS WERE COMPENSATED BY WFUHS, AN AFFILIATE, FOR SERVICES PERFORMED FOR NORTH CAROLINA BAPTIST HOSPITAL. JOHN D. MCCONNELL NORMAN D. POTTER, JR. EDWARD G. CHADWICK JOANNE C. RUHLAND MICHAEL L. FREEMAN CHERYL E.H. LOCKE PART I, LINE 3: THE NCBH COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS IS RESPONSIBLE FOR REVIEWING AND APPROVING ALL OFFICER COMPENSATION. THE COMMITTEE UTILIZED INDEPENDENT COMPENSATION CONSULTANTS, COMPENSATION SURVEYS, AND STUDIES TO DETERMINE THE APPROPRIATENESS OF EACH OFFICER'S COMPENSATION. AN EXTERNAL COMPENSATION CONSULTANT EXPERIENCED IN HEALTH CARE AND HIGHER EDUCATION COMPENSATION PRESENTS TOTAL COMPENSATION COMPARABILITY DATA FOR THE POSITIONS FOR WHICH COMPENSATION IS BEING DETERMINED. THE DATA IS REVIEWED BY THE COMPENSATION COMMITTEE OF THE ORGANIZATION'S GOVERNING BOARD AT ITS MEETING; NONE OF THE MEMBER OF THAT COMMITTEE ARE EMPLOYEES OF THE ORGANIZATION. MINUTES OF THE DELIBERATIONS OF THE COMMITTEE ARE CONTEMPORANEOUSLY RECORDED. IN THE EVENT THAT ANY MEMBER OF THE COMPENSATION COMMITTEE HAS A CONFLICT OF INTEREST, THAT COMMITTEE MEMBER DOES NOT PARTICIPATE IN THE DELIBERATION OR APPROVAL PROCESS, AND THEIR ABSTENTION FROM THE PROCESS IS REFLECTED IN THE MINUTES. THE COMPENSATION COMMITTEE'S RECOMMENDATIONS ON COMPENSATION ARE MADE TO THE FULL GOVERNING BOARD (OR ITS EXECUTIVE COMMITTEE, WHEN NECESSARY) AT ITS MEETING, WHERE FURTHER DISCUSSION AND THE FINAL APPROVAL TAKES PLACE. MINUTES OF THE FINAL APPROVAL ACTIONS ARE ALSO CONTEMPORANEOUSLY RECORDED. NORTH CAROLINA MEDICAL CARE COMMISSION 521309402 65820HD67 2010-03-01 334002408 CURRENT REFUNDING 0 0 334002408 34000 3307037 2010 1 0 1 1 0 0 1 LOOP FINANCIAL PRODUCTS I LLC 5.000000000000 0 0 1 ANN FLYNN FAMILY MEMBER OF DOUGLAS ATKINSON, OFFICER 37404 COMPENSATION AS EMPLOYEE OF HOSPITAL 0 DAVID BRANN FAMILY MEMBER OF DONNY LAMBETH, OFFICER 70158 COMPENSATION AS EMPLOYEE OF HOSPITAL 0 THOMAS P JOHNSON FAMILY MEMBER OF A. PATRICIA JOHNSON, OFFICER 11779 COMPENSATION AS EMPLOYEE OF HOSPITAL 0 SCOTT JOHNSON FAMILY MEMBER OF A. PATRICIA JOHNSON, OFFICER 21372 COMPENSATION AS EMPLOYEE OF HOSPITAL 0 JUDY SLOCUM FAMILY MEMBER OF MAUREEN SINTICH, OFFICER 45004 COMPENSATION AS EMPLOYEE OF HOSPITAL 0 ROBIN LEWIS FAMILY MEMBER OF KENNETH LEWIS, BOARD MEMBER 63833 COMPENSATION AS EMPLOYEE OF HOSPITAL 0 MEDCOST LLC OFFICERS OF ORGANIZATION SERVE AS OFFICERS OF MEDCOST, LLC 2733991 FEES PAID BY NCBH FOR VARIOUS INVESTMENT AND PENSION PLAN ADMINISTRATION 0 X 1921 FMV X 19983 FMV X EQUIPMENT 5 8130 FMV 0 0 0 Form 990, Part VI, Section A, line 2 Edward G. Chadwick, H. Gregory Bray, and Steven C. Snelgrove have a business relationship through their board/leadership position in MedCost, LLC, and unrelated organization. Form 990, Part VI, Section A, line 4 AMENDMENTS TO THE FILING ORGANIZATION'S BYLAWS WERE ADOPTED BY THE FILING ORGANIZATION, AND APPROVED (AS REQUIRED IN THE BYLAWS) BY THE BOARD OF THE FILING ORGANIZATION'S PARENT, WAKE FOREST UNIVERSITY ("WFU"), ON JULY 16, 2009. THE AMENDED BYLAWS CONFORM THE FILING ORGANIZATION'S BYLAWS TO THE PROVISIONS OF THE FUNCTIONAL INTEGRATION AGREEMENT (THE "FIA") ENTERED INTO AMONG THE FILING ORGANIZATION, ITS AFFILIATED HOSPITAL, NORTH CAROLINA BAPTIST HOSPITAL ("NCBH"), AND ITS (AND WFU'S) RELATED, SUPPORTING ORGANIZATION, WAKE FOREST UNIVERSITY BAPTIST MEDICAL CENTER ("WFUBMC"). THE AMENDMENTS RELATE TO: 1) THE WFUBMC CEO'S EX OFFICIO MEMBERSHIP ON THE FILING ORGANIZATION'S BOARD; 2) THE APPOINTMENT, REPORTING, AND REMOVAL OF THE FILING ORGANIZATION'S PRESIDENT; AND 3) THE LIMITATION REGARDING FURTHER AMENDMENT OF THESE PROVISIONS WITHOUT THE WRITTEN CONSENT OF THE OTHER PARTIES TO THE FIA. Form 990, Part VI, Section B, line 11 WFUBMC Financial Services will distribute to the Corporation's Board of Trustees copies of the Form 990 prior to their scheduled meeting. The Board has asked the Audit and Compliance committees of WFUHS and NCBH to review the detail of the Form 990 with the Corporation's Chief Financial Officer or a delegate from Financial Services. Members of the Corporation's management team will answer questions and address any concerns the Committee Members or other Trustees raise. The minutes of the joint Audit and Compliance Committee Meeting will note that the Committee Members and other Trustees and Directors have reviewed and discussed the Form 990 with the Corporation's management. If modifications are required, Financial Services will redistribute the revised Form 990 to all Trustees and Directors, along with a report noting the modifications. Form 990, Part VI, Section B, line 12c ON AN ANNUAL BASIS, ALL TRUSTEES, OFFICERS, AND OTHER EMPLOYEES THAT HAVE SIGNIFICANT INFLUENCE OVER THE OPERATIONS OF THE ORGANIZATION ARE ASKED TO COMPLETE A QUESTIONNAIRE NOTING THE FOLLOWING: - ACKNOWLEDGEMENT OF RECEIPT OF THE CONFLICT OF INTEREST POLICY - ACKNOWLEDGEMENT THAT THEY HAVE READ AND UNDERSTAND THE POLICY - ACKNOWLEDGEMENT THAT THEY AGREE TO COMPLY WITH THE POLICY - DESCRIPTION OF ANY POTENTIAL CONFLICTS OF INTEREST THEY MAY HAVE GIVEN THEIR ROLE WITHIN THE ORGANIZATION. UPON COMPLETION OF THE CONFLICT OF INTEREST SURVEY, FINANCIAL SERVICES & COMPLIANCE AND LEGAL OFFICES REVIEW THE COMPLETED QUESTIONNAIRES. ANY SIGNIFICANT CONFLICTS IDENTIFIED ARE COMMUNICATED TO THE ORGANIZATION'S PRESIDENT AND PRESENTED TO THE ORGANIZATION'S BOARD AUDIT & COMPLIANCE COMMITTEE. THE AUDIT & COMPLIANCE COMMITTEE CHAIRMAN THEN PRESENTS THE ANNUAL REPORT TO THE FULL BOARD. ANY MATERIAL CONFLICTS OF INTEREST ARE MONITORED AT A BOARD AND ORGANIZATIONAL LEVEL BY THE AUDIT & COMPLIANCE COMMITTEE AND THE INTERNAL AUDIT & COMPLIANCE OFFICE AND CONFLICTED INDIVIDUALS ARE ASKED TO CONDUCT BUSINESS, AS IT RELATES TO THE IDENTIFIED CONFLICT, IN ACCORDANCE WITH THE CONFLICT OF INTEREST POLICY. OPPORTUNITIES EXIST FOR TRUSTEES, OFFICERS AND OTHER EMPLOYEES THAT HAVE SIGNIFICANT INFLUENCE OVER OPERATIONS OF THE ORGANIZATION TO REPORT CONFLICTS TO THE INTERNAL AUDIT & COMPLIANCE OFFICE SHOULD A CONFLICT OF INTEREST ARISE BETWEEN ANNUAL QUESTIONNAIRES. Form 990, Part VI, Section B, line 15 IT IS THE POLICY OF NORTH CAROLINA BAPTIST HOSPITAL (NCBH) TO ESTABLISH EXECUTIVE COMPENSATION AT A LEVEL APPROPRIATE TO ATTRACT AND RETAIN EXECUTIVE LEVEL PERSONNEL IN A MANNER THAT COMPLIES WITH INTERNAL REVENUE SERVICES' GUIDELINES FOR APPROVAL OF EXECUTIVE MANAGEMENT COMPENSATION, INCORPORATING PRACTICES CURRENTLY IN PLACE FROM THE COMPENSATION COMMITTEE RESPONSIBILITIES, EXECUTIVE COMPENSATION PHILOSOPHY AND THE MANAGEMENT INCENTIVE COMPENSATION PLAN. THE FOLLOWING POSITIONS AND CLASSES OF POSITIONS WILL BE COVERED UNDER THIS POLICY ("COVERED INDIVIDUALS") - PRESIDENT - VICE PRESIDENTS: INCLUDING CHIEF OPERATING OFFICER, CHIEF FINANCIAL OFFICER AND CHIEF NURSING OFFICER - OTHER EMPLOYEES THAT MEET THE IRS'S DEFINITION OF A "KEY EMPLOYEE" THE REVIEW AND APPROVAL OF COMPENSATION OF ANY COVERED INDIVIDUAL WILL BE PERFORMED BY THE COMPENSATION COMMITTEE OF NCBH'S BOARD OF TRUSTEES, VIA DELEGATED AUTHORITY OF THE BOARD OF TRUSTEES AS FOLLOWS: COMMITTEE PURPOSES THE PRIMARY PURPOSE OF THE COMPENSATION COMMITTEE IS TO OVERSEE THE HOSPITAL'S EXECUTIVE COMPENSATION PROGRAM TO INSURE THAT IT IS ADMINISTERED IN A MANNER WHICH IS CONSISTENT WITH THE COMPENSATION PHILOSOPHY ADOPTED BY THE BOARD OF TRUSTEES. SPECIFIC RESPONSIBILITIES OF COMMITTEE THE COMPENSATION COMMITTEE SHALL PROVIDE SYSTEMATIC REVIEW AND EVALUATION OF THE PRESIDENT'S PERFORMANCE AND SHALL OVERSEE THE HOSPITAL'S EXECUTIVE COMPENSATION PROGRAM TO INSURE THAT IT IS ADMINISTERED IN A MANNER THAT IS CONSISTENT WITH ANY POLICIES AND PLANS ADOPTED BY THE BOARD OF TRUSTEES AND IN COMPLIANCE WITH ANY APPLICABLE LEGAL REQUIREMENTS. THE COMPENSATION COMMITTEE SHALL INITIATE AND REVIEW THE HOSPITAL'S EXECUTIVE SUCCESSION PLANNING POLICIES AND PROCEDURES. THE MEMBERS OF THE COMPENSATION COMMITTEE SHALL BE THE CHAIRMAN OF THE CORPORATION, WHO SHALL BE THE CHAIRMAN OF THE COMPENSATION COMMITTEE, THE VICE CHAIRMAN OF THE CORPORATION, THE CHAIRMAN OF THE FINANCE COMMITTEE, AND THE CHAIRMAN OF THE GOVERNANCE AND NOMINATING COMMITTEE AND ANY OTHER TRUSTEES DEEMED NECESSARY TO SERVE THE COMMITTEE PURPOSE AND ELECTED BY THE BOARD OF TRUSTEES. Form 990, Part VI, Section C, line 18 PHOTOCOPIES OF THE FORM 1023 AND RECENT FILINGS OF THE FORM 990 ARE AVAILABLE UPON REQUEST AT THE ORGANIZATION'S ADMINISTRATIVE OFFICE. Form 990, Part VI, Section C, line 19 PHOTOCOPIES OF THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST AT THE ORGANIZATION'S ADMINISTRATIVE OFFICE. SCHEDULE K, PART II, LINE 5: UNDERWRITER'S DISCOUNT: $ 2,574,830 OTHER ISSUANCE COSTS: 732,207 TOTAL LINE 5: $ 3,307,037 FORM 990, PART III, LINE 4A: STATEMENT OF PROGRAM SERVICE ACCOMPLISHMENTS: OVERVIEW: WAKE FOREST UNIVERSITY BAPTIST MEDICAL CENTER IS NORTHWEST NORTH CAROLINA'S SOLE ACADEMIC MEDICAL CENTER, BRINGING TO THE REGION THE RESOURCES OF ONE OF AMERICA'S TOP 50 RANKED HOSPITALS AND A PREMIER MEDICAL SCHOOL. WAKE FOREST UNIVERSITY BAPTIST MEDICAL CENTER IS A CORPORATION ONE-HALF CONTROLLED BY WAKE FOREST UNIVERSITY AND ONE-HALF CONTROLLED BY NORTH CAROLINA BAPTIST HOSPITAL. THE MEDICAL CENTER OPERATES THE WAKE FOREST UNIVERSITY SCHOOL OF MEDICINE, WAKE FOREST UNIVERSITY HEALTH SCIENCES (INCLUDING ITS FACULTY PHYSICIAN PRACTICE OF MORE THAN 600 DOCTORS); A HOSPITAL SYSTEM WITH 1,004 LICENSED ACUTE CARE AND REHABILITATION BEDS ACROSS THE SYSTEM, WHICH ENCOMPASSES NORTH CAROLINA BAPTIST HOSPITAL (885 BEDS), BRENNER CHILDREN'S HOSPITAL (160 BEDS, INCLUDED IN NCBH TOTAL); LEXINGTON MEMORIAL HOSPITAL (94 BEDS, AND ITS RELATED PHYSICIAN PRACTICE OF 32 LEXMED DOCTORS); AND DAVIE COUNTY HOSPITAL (25 BEDS). WAKE FOREST BAPTIST SERVES A PRIMARY 26-COUNTY REGION IN NORTHWESTERN NORTH CAROLINA AND SOUTHWESTERN VIRGINIA AND DRAWS PATIENTS FROM ACROSS THE STATE AND NATION FOR SELECT SERVICES. CLINICAL SERVICES ACHIEVEMENTS AND STRENGTHS WAKE FOREST BAPTIST IS NATIONALLY RECOGNIZED FOR CLINICAL EXCELLENCE AND INTERNATIONALLY KNOWN FOR PIONEERING RESEARCH AND CLINICAL INNOVATION. IT HAS BEEN RANKED AS ONE OF "AMERICA'S BEST HOSPITALS" BY U.S. NEWS & WORLD REPORT SINCE 1993, HOLDS THE GOLD SEAL OF APPROVAL FROM THE JOINT COMMISSION, THE NATION'S ESTEEMED STANDARDS-SETTING AND ACCREDITING BODY FOR HEALTH CARE QUALITY, AND IS RANKED 27TH IN THE NATION BY AMERICA'S TOP DOCTORS FOR THE NUMBER OF ITS PHYSICIANS WHO ARE CONSIDERED BEST BY THEIR PEERS. THE "BEST DOCTORS IN AMERICA" 2011-2012 LISTING INCLUDES 293 WAKE FOREST BAPTIST PHYSICIANS, AN INCREASE OF 37 PERCENT OVER THE PREVIOUS YEAR; 92 PERCENT OF THE DOCTORS LISTED FOR FORSYTH COUNTY ARE WAKE FOREST DOCTORS. THE MEDICAL CENTER WAS FIRST IN THE CAROLINAS TO EARN MAGNET DESIGNATION FOR NURSING EXCELLENCE FROM THE AMERICAN NURSES CREDENTIALING CENTER, A DISTINCTION HELD SINCE 1999. IT ALSO HOLDS THE DISTINCTION OF BEING THE MOST PREFERRED HOSPITAL OF AREA RESIDENTS ACCORDING TO INDEPENDENT RESEARCH FROM THE NATIONAL RESEARCH CORPORATION. WAKE FOREST BAPTIST OFFERS EXPERTISE IN MORE THAN 100 AREAS OF MEDICINE, ENCOMPASSING COMPREHENSIVE PREVENTIVE AND HIGHLY SPECIALIZED CARE FOR ALL AGES. IT INCLUDES 21 SUBSIDIARY OR AFFILIATE HOSPITALS, AND OPERATES MORE THAN 120 OUTREACH ACTIVITIES, INCLUDING SATELLITE SPECIALTY CLINICS ACROSS NORTHWEST NORTH CAROLINA THAT EXTEND THE BENEFIT OF WAKE FOREST BAPTIST SUBSPECIALTY EXPERTISE THROUGHOUT THE REGION. AS PART OF A BUSY TERTIARY CARE CENTER, N.C. BAPTIST HOSPITAL RECORDED 34,854 INPATIENT ADMISSIONS IN FY 2010, AND A TOTAL OF 818,089 OUTPATIENT ENCOUNTERS (ED, DOWNTOWN HEALTH PLAZA, DAY HOSPITAL, AMBULATORY VISITS). TOTAL PATIENT ENCOUNTERS NUMBERED 852,943. IN ADDITION TO ITS CLINICAL LEADERSHIP, WAKE FOREST BAPTIST IS A MAJOR RESEARCH CENTER WITH MORE THAN 2,500 RESEARCH STUDIES UNDER WAY. IN THE ARENA OF CANCER RESEARCH ALONE, THERE ARE MORE THAN 475 STUDIES BEING CONDUCTED. THE MEDICAL CENTER OPERATES A TRANSLATIONAL SCIENCE INSTITUTE COMMITTED TO MULTI-DISCIPLINARY RESEARCH THAT WILL SPEED FINDINGS FROM THE LABORATORY TO THE BEDSIDE TO BENEFIT PATIENTS. ONE OF THE MEDICAL CENTER'S MOST INNOVATIVE AND GROWING PROGRAMS IS THE WAKE FOREST INSTITUTE FOR REGENERATIVE MEDICINE, WHERE SCIENTISTS ARE ACTIVELY ADVANCING KNOWLEDGE ABOUT BUILDING ORGANS AND VESSELS FROM PATIENTS' OWN TISSUE -- ADVANCING THE HORIZONS OF MEDICAL POSSIBILITY. NORTH CAROLINA BAPTIST HOSPITAL FOUNDATION MEDICAL CENTER BLVD WINSTON SALEM NC 27157 561685120 SUPPORTING ORGANIZATION NC 501(c)(3) Line 11a, I STOKES-REYNOLDS MEMORIAL HOSPITAL HWY 8 89 NORTH DANBURY NC 27016 561793620 HEALTHCARE NC 501(c)(3) Line 3 THE REHABILITATION & SKILLED NURSING FACILITY AT OAK SUMMIT MEDICAL CENTER BLVD WINSTON SALEM NC 27157 561826396 HEALTHCARE NC 501(c)(3) Line 9 NORTH CAROLINA BAPTIST HOSPITAL FOUNDATION DAVIE COUNTY EMERGENCY HEALTH CORP 223 HOSPITAL STREET MOCKSVILLE NC 27028 562276994 HEALTHCARE NC 501(c)(3) Line 3 BAPTIST HOSPITAL RX MEDICAL CENTER BLVD WINSTON SALEM NC 27157 542136894 HEALTHCARE NC 501(c)(3) Line 9 THE HAWTHORNE INN & CONFERENCE CENTER INC 420 HIGH STREET WINSTON SALEM NC 27101 561793617 LODGING/ CONFERENCE ACCOMMODATION NC 501(c)(3) Line 11a, I CARENET INC 2000 WEST FIRST STREET SUITE 410 WINSTON SALEM NC 27104 561977341 HEALTHCARE NC 501(c)(3) Line 11b, II WAKE FOREST UNIV BAPTIST MEDICAL CNTR COMMUNITY PHYSICIANS 3540 CLEMMONS ROAD CLEMMONS NC 27012 231903275 HEALTHCARE NC 501(c)(3) Line 3 CENTER FOR CONGREGATIONAL HEALTH INC MEDICAL CENTER BLVD WINSTON SALEM NC 27157 237426944 HEALTHCARE NC 501(c)(3) Line 9 1 1 1 0 0 0 0 0 0 1 0 0 0 0 1 1 1 1 NORTH CAROLINA BAPTIST HOSPITAL FOUNDATION A 228649 STOKES REYNOLDS MEMORIAL HOSPITAL A 14610 WFUBMC COMMUNITY PHYSICIANS A 107939 STOKES REYNOLDS MEMORIAL HOSPITAL B 29186185 NORTH CAROLINA BAPTIST HOSPITAL FOUNDATION C 15000 WFUBMC COMMUNITY PHYSICIANS C 13480 THE HAWTHORNE INN & CONFERENCE CENTER INC J 227760 DAVIE COUNTY EMERGENCY HEALTH CORP O 4153 THE HAWTHORNE INN & CONFERENCE CENTER INC O 52397 CARENET INC P 1983173 DAVIE COUNTY EMERGENCY HEALTH CORP P 423478 NORTH CAROLINA BAPTIST HOSPITAL FOUNDATION P 503055 STOKES REYNOLDS MEMORIAL HOSPITAL P 1817426 THE HAWTHORNE INN & CONFERENCE CENTER INC P 428972 CENTER FOR CONGREGATIONAL HEALTH INC P 203040 WFUBMC COMMUNITY PHYSICIANS P 1414768 WFUBMC COMMUNITY PHYSICIANS P 52131 STOKES REYNOLDS MEMORIAL HOSPITAL Q 11896 WFUBMC COMMUNITY PHYSICIANS Q 2695847 WFUBMC COMMUNITY PHYSICIANS Q 22571 STOKES REYNOLDS MEMORIAL HOSPITAL R 53259 THE HAWTHORNE INN & CONFERENCE CENTER INC R 508735 WFUBMC COMMUNITY PHYSICIANS R 80074