2011-05-12T10:34:17-07:00 2010-06-30 990 2009-07-01 900222618 WAKE FOREST UNIVERSITY HEALTH SCIENCES GROUP RETURN WAKE 3367164445 Medical Center Boulevard Winston Salem NC 27157 William Applegate MD 3367164445 2011-05-12 2009 2016-02-24 21:20:13Z William B Applegate MD Medical Center Blvd Winston Salem NC 27157 63482113 1 1 3884 X X 2003 NC 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. 4 0 0 0 0 0 0 0 64187337 63479453 11179 2660 0 0 64198516 63482113 0 0 0 0 0 0 0 0 0 52195615 52729534 52195615 52729534 12002901 10752579 81105111 92321697 7574173 8038168 73530938 84283529 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 49117196 0 63479453 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 (1,510 patients). 0 0 0 49117196 1 0 0 0 0 0 0 0 0 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 1 98 0 1 0 0 0 0 0 0 0 0 0 0 4 0 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X Health Systems Management Inc 2293865505 PO Box 7710 Tifton GA 317937710 X William B Applegate MD 1 X X 0 920078 76628 Barry I Freedman MD 1 X X 0 467426 32877 Terry L Hales Jr 1 X X 0 444561 35561 Douglas L Edgeton 1 X X 0 862670 43532 J Reid Morgan 1 X 0 293567 48746 Donna H Hamilton 1 X 0 159384 31152 Richard H Dean MD 0 X 0 670228 8456 0 3817914 276952 0 1 1 0 Health Systems Management Dialysis Centers LLC P O Box 7710 Tifton GA 317937710 Coordination of Operations 5775019 Atlantic Janiserv Inc 457 Country Lane Winston Salem NC 27107 Housekeeping 482344 Nephrology Associates 730 Highland Oaks Dr Suite 103 Winston Salem NC 27103 Medical Directors 240809 3 0 0 0 0 0 0 0 0 Payments for Medical Service 621300 63479453 63479453 0 0 0 0 0 0 63479453 2660 2660 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 63482113 63482113 0 0 127150 127150 0 0 59891 0 59891 0 25417690 21865243 3552447 366803 366803 23984146 23984146 2345885 2345885 204099 204099 35221 35221 188649 188649 52729534 49117196 3612338 0 0 0 2905509 2090766 0 0 10383322 12115362 0 0 0 0 0 0 1269932 1539970 41281 20532 0 0 0 0 0 0 0 0 66505067 76555067 81105111 92321697 6386817 6178228 1187356 1859940 7574173 8038168 X 73530938 84283529 0 0 0 0 73530938 84283529 81105111 92321697 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 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 WFUHS Capital Contribution 76555067 76555067 0 Due to WFU 1859940 1859940 63482113 52729534 10752579 0 0 0 0 0 0 10752579 64275295 0 0 0 793182 793182 63482113 0 0 0 63482113 53522716 0 0 0 793182 793182 52729534 0 0 0 52729534 SchD_P10_S00_L00 Schedule D, Part X The Internal Revenue Service has determined that the Not-for-Profit corporations comprising the Organization qualify under section 501(c)(3) of the Internal Revenue Code and are, therefore, not subject to income tax under present income tax law. The Organization adopted the provisions of Financial Accounting Standards Board Accounting Standards Codification (FASB ASC) No. 740 Accounting for Income Taxes effective July 1, 2007. No liability for unrecognized tax benefits was recorded as a result of the implementation of FASB ASC No. 740 and, accordingly, there was no change to the Organization's net assets as of the date of implementation. SchD_P12_S00_L02d Schedule D, Part XII, Line 2d Reclass drug & supplies rebates SchD_P13_S00_L02d Schedule D, Part XIII, Line 2d Reclass drug & supplies rebates 1 1 0 0 0 0 0 0 0 William B Applegate MD 0 534843 0 378900 0 6335 0 39757 0 36871 0 996706 0 0 Douglas L Edgeton 0 491391 0 361600 0 9679 0 14706 0 28826 0 906202 0 0 J Reid Morgan 0 281576 0 0 0 11991 0 24500 0 24246 0 342313 0 0 Terry L Hales Jr 0 344348 0 89300 0 10913 0 13071 0 22490 0 480122 0 0 Barry I Freedman MD 0 162454 0 304702 0 270 0 12440 0 20437 0 500303 0 0 Richard H Dean MD 0 0 0 0 0 670228 0 0 0 8456 0 678684 0 0 Donna H Hamilton 0 159384 0 0 0 0 0 0 0 31152 0 190536 0 0 SchJ_P01_S00_L00 Schedule J, Part I As a retention strategy of a related organization, Wake Forest University Health Sciences, two executives (William B. Applegate, MD, President of that related organization, and Douglas L. Edgeton, Executive Vice President and COO of that related organization), received one-time bonuses for their key roles in fostering a successful integration of the related organization with certain affiliated organizations of the related organization. The bonuses were paid by the related organization, Wake Forest University Health Sciences, and the determination of the amount of the bonuses followed that organization's compensation procedures as outlined in Part VI, Section B, Line 15 of the Form 990. SchJ_P01_S00_L04 Schedule J, Part I, Line 4 Richard H. Dean, M.D.'s compensation (all of which was paid by a related organization, Wake Forest University Health Sciences, a member of the filing organization) was largely a retirement benefit based on more than 21 years of service as former President of Wake Forest University Health Sciences ("WFUHS"), former President of all WFUHS subsidiary organizations, and former Chair of the Department of Surgery.========================== William B. Applegate, MD, President of the filing organization during the tax period, participates in a supplemental nonqualified retirement plan (all of which is paid by a related organization, Wake Forest University Health Sciences, as part of his compensation as President of that related organization). Amount contributed to the plan totaled $25,000 for the year ended December 31, 2009, and this amount is included in Schedule J, Part II column C. F990_P06_S0A_L06 Form 990, Part VI, Section A, Line 6 Wake Forest University Health Sciences is the parent organization. F990_P06_S0A_L07a 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. F990_P06_S0A_L07b 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. F990_P06_S0B_L11 Form 990, Part VI, Section B, Line 11 The organization distributes a draft copy of the Form 990 to all members of the Board of Directors in adequate time for feedback prior to filing a finalized Form 990 with the IRS. F990_P06_S0B_L12c 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. F990_P06_S0B_L15 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 related organizations' compensation committees of its Board of Directors or Board of Trustees are responsible for reviewing and approving most officers' and some employees' compensation. The committees utilize independent compensation consultants, compensation surveys, and studies to determine the appropriateness of each such officer's and employee's compensation. F990_P06_S0C_L19 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. Wake Forest University PO Box 7201 Winston Salem NC 27109 560532138 Private, coed. inst. of higher ed. NC 501(c)(3) 2 N/A Wake Forest University Health Sciences Medical Center Blvd Winston Salem NC 27157 223849199 Health Care - Clinical Svcs, Research, Ed. NC 501(c)(3) 2 N/A Piedmont Triad Research Park Medical Center Blvd Winston Salem NC 27157 200177581 Research Park Development NC 501(c)(3) 11A N/A PTRP Development Corporation Medical Center Blvd Winston Salem NC 27157 061818498 Research Park Development NC 501(c)(3) 11A N/A Idealliance Medical Center Blvd Winston Salem NC 27157 562094067 Research Park Development NC 501(c)(6) N/A N/A Idealliance Foundation Medical Center Blvd Winston Salem NC 27157 562094000 Supp. Org. Idealliance NC 501(c)(3) 11A N/A 0 0 0 0 1 0 0 0 0 1 0 0 0 0 0 1 1 1