DAVIDSON HEALTHCARE INC: Form 990, tax year 2009
View the entire original 990 at ProPublica ↗
- Organization
- DAVIDSON HEALTHCARE INC (EIN 56-1474399)
- Tax period
- 2009-07-01 to 2010-06-30
- Filed
- 2011-05-12
- IRS object ID
- 201131329349303063
- Schema version
- 2009v1.7
- 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2011-05-12T14:16:08-05:00 | Timestamp |
| Tax Period End Date | 2010-06-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Turlington and Company LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1338 Westgate Center Drive | AddressLine1 |
| City | WinstonSalem | City |
| State | NC | State |
| ZIP Code | 27103 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2009-07-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 561474399 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Davidson Healthcare Inc | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | DAVI | NameControl |
| Phone | 3362485161 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO Box 1817 | AddressLine1 |
| City | Lexington | City |
| State | NC | State |
| ZIP Code | 272931817 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Danny W Squires | Name |
| Title | Treasurer | Title |
| Phone | 3362485161 | Phone |
| Date Signed | 2011-05-12 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Terry J Berrier | Name |
| Phone | 3367652410 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2009 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | Danny W Squires | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 250 Hospital Drive | AddressLine1 |
| City | Lexington | City |
| State | NC | State |
| ZIP Code | 27292 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 13 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c | X | Organization501c |
| Web Site | N/A | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1985 | YearFormation |
| State Legal Domicile | NC | StateLegalDomicile |
| Activity Or Mission Description | To promote the general health of the community in support of Lexington Memorial Hospital, Inc. To promote charitable, educational and scientific purposes by supporting, coordinating and operating for the benefit of Lexington Memorial Hospital, a not for profit corporation exempt from taxation under Section 501(c)(3) of the Internal Revenue Code. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 16 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 15 | NbrIndependentVotingMembers |
| Total Nbr Employees | 0 | TotalNbrEmployees |
| Total Nbr Volunteers | 0 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Current Year | 0 | ContributionsGrantsCurrentYear |
| Program Service Revenue CY | 0 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 23 | InvestmentIncomePriorYear |
| Investment Income Current Year | 13 | InvestmentIncomeCurrentYear |
| Other Revenue Current Year | 0 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 23 | TotalRevenuePriorYear |
| Total Revenue Current Year | 13 | TotalRevenueCurrentYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Current Year | 0 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 11523 | OtherExpensePriorYear |
| Other Expenses Current Year | 11377 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 11523 | TotalExpensesPriorYear |
| Total Expenses Current Year | 11377 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | -11500 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | -11364 | RevenuesLessExpensesCY |
| Total Assets BOY | 1213861 | TotalAssetsBOY |
| Total Assets EOY | 1358781 | TotalAssetsEOY |
| Total Liabilities BOY | 28128 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 28129 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 1185733 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 1330652 | NetAssetsOrFundBalancesEOY |
| Mission Description | To promote charitable, educational and scientific purposes by supporting, coordinating and operating for the benefit of Lexington Memorial Hospital, a not for profit corporation exempt from taxation under Section 501(c)(3) of the Internal Revenue Code. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 11377 | Expense |
| Description | Promoted charitable, educational and scientific purposes by coordinating and operating for the benefit of Lexington Memorial Hospital, a not for profit corporation exempt under Section 501(c)(3) of the Internal Revenue Code. | Description |
| Total Program Service Expense | 11377 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 0 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 0 | LobbyingActivities |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 0 | TermOrPermanentEndowments |
| Balance Sheet Amounts Reported | 1 | BalanceSheetAmountsReported |
| Independent Audit Financial Stmt | 0 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 1 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 0 | Hospital |
| Grants To Organizations | 0 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 0 | TaxExemptBonds |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 1 | RelatedOrgControlledEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 0 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Number Of Employees | 0 | NumberOfEmployees |
| Unrelated Business Income | 0 | UnrelatedBusinessIncome |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Form8899 Filed | 1 | Form8899Filed |
| Form1098 C Filed | 1 | Form1098CFiled |
| Nbr Voting Governing Body Members | 16 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 15 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 1 | MembersOrStockholders |
| Election Of Board Members | 1 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 1 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 1 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| States Where Copy Of Return Is Filed | NC | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Danny W Squires | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 3362485161 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO Box 1817 250 Hospital Drive | AddressLine1 |
| City | Lexington | City |
| State | NC | State |
| ZIP Code | 272931817 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| No Listed Persons Compensated | X | NoListedPersonsCompensated |
Form990 Part VII Section A Form990PartVIISectionA (19 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation |
|---|---|---|---|---|---|---|
| Steven C Shultz | ||||||
| President/CEO | 1.00 | X | X | 0 | 0 | 0 |
| Charles D Miller Jr | ||||||
| Chairman | 1.00 | X | 0 | 0 | 0 | |
| W Leon Rives | ||||||
| Vice Chairman | 1.00 | X | 0 | 0 | 0 | |
| Dan Briggs | ||||||
| Director | 1.00 | X | 0 | 0 | 0 | |
| Terry L Hales Jr | ||||||
| Director | 1.00 | X | 0 | 0 | 0 | |
| Ray N HowellIII PhD | ||||||
| Director | 1.00 | X | 0 | 0 | 0 | |
| Gordon C Kammire MD | ||||||
| Director | 1.00 | X | 0 | 0 | 0 | |
| Evelyn Kepley | ||||||
| Director | 1.00 | X | 0 | 0 | 0 | |
| Donny C Lambeth | ||||||
| Director | 1.00 | X | 0 | 0 | 0 | |
| Jeff Mast | ||||||
| Director | 1.00 | X | 0 | 0 | 0 | |
| Staley J Nance | ||||||
| Director | 1.00 | X | 0 | 0 | 0 | |
| J Simmons Riggan MD | ||||||
| Director | 1.00 | X | 0 | 0 | 0 | |
| Patricia Shoemaker | ||||||
| Director | 1.00 | X | 0 | 0 | 0 | |
| Robert B Smith Jr | ||||||
| Director | 1.00 | X | 0 | 0 | 0 | |
| Mark Breeden | ||||||
| Director | 1.00 | X | 0 | 0 | 0 | |
| David Wagner MD | ||||||
| Director | 1.00 | X | 0 | 0 | 0 | |
| Danny W Squires | ||||||
| Vice President/Treasurer | 1.00 | X | 0 | 154681 | 20265 | |
| Barbara B Smith | ||||||
| SECRETARY | 1.00 | X | 0 | 168495 | 17638 | |
| CHRISTOPHER T WHITE | ||||||
| ASSISTANT TREASURER | 1.00 | X | 0 | 89989 | 18302 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 0 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 413165 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 56205 | TotalOtherCompensation |
| Number Individuals GT100 K | 0 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
| Number Of Contractors GT100 K | 0 | NumberOfContractorsGT100K |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 13 | TotalRevenueColumn |
| Exclusion | $13 | ExclusionAmount |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 13 | TotalRevenueColumn |
| Related Or Exempt Function Income | 0 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $13 | ExclusionAmount |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 9000 | Total |
| Program Services | 9000 | ProgramServices |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 37 | Total |
| Program Services | 37 | ProgramServices |
Other Expenses OtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | Professional Fees | Description |
| Total | 2340 | Total |
| Program Services | 2340 | ProgramServices |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 11377 | Total |
| Program Services | 11377 | ProgramServices |
| Management And General | 0 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 16457 | BOY |
| EOY | 54909 | EOY |
Investments Program Related InvestmentsProgramRelated
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1197404 | BOY |
| EOY | 1303872 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1213861 | BOY |
| EOY | 1358781 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 28128 | BOY |
| EOY | 28129 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 28128 | BOY |
| EOY | 28129 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1185733 | BOY |
| EOY | 1330652 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1185733 | BOY |
| EOY | 1330652 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1213861 | BOY |
| EOY | 1358781 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
| Audit Committee | 1 | AuditCommittee |
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Supporting Organization509a3 | X | SupportingOrganization509a3 |
| Supporting Org509a3 Type2 | X | SupportingOrg509a3Type2 |
| Certification Checkbox | X | CertificationCheckbox |
| Written IRS Determination | X | WrittenIRSDetermination |
| Contrib By Controlling Individual | 0 | ContribByControllingIndividual |
| Contribution By Related Party | 0 | ContributionByRelatedParty |
| Contrib By35 Controlled Entity | 0 | ContribBy35ControlledEntity |
Supported Org Information SupportedOrgInformation (2 entries)
| EINEIN | Type Of OrganizationTypeOfOrganization | Listed In Governing DocListedInGoverningDoc | Supported Organization NotifiedSupportedOrganizationNotified | Organized In USOrganizedInUS | AmountAmount |
|---|---|---|---|---|---|
| Lexington Memorial Hospital Inc | |||||
| 560543238 | 3 | 1 | 1 | 1 | $5,701,710 |
| LexHealth Inc | |||||
| 561474400 | 3 | 1 | 1 | 1 | $356,976 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Number Of Supported Orgs | 2 | TotalNumberOfSupportedOrgs |
| Sum Of Amounts | 6058686 | SumOfAmounts |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 0 | TotalOfBookValueLandBuildings |
Investments Program Related InvestmentsProgramRelated
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | Investment in Subsidiary | Description |
| Book Value | 1303872 | BookValue |
| Method Of Valuation | C | MethodOfValuation |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Program Related | 1303872 | TotalOfBookValueProgramRelated |
| Total Revenue | 13 | TotalRevenue |
| Total Expenses | 11377 | TotalExpenses |
| Excess Or Deficit For Year | -11364 | ExcessOrDeficitForYear |
| Other | $156,283 | OtherAmount |
| Total Adjustments | 156283 | TotalAdjustments |
| Excess Or Deficit Per FS | 144919 | ExcessOrDeficitPerFS |
| Tot Revenue Etc Audited Fincl Stmt | 13 | TotRevenueEtcAuditedFinclStmt |
| Revenue Not Rptd F990 | 0 | RevenueNotRptdF990 |
| Revenue Subtotal | 13 | RevenueSubtotal |
| Revenue Not Rptd On Fin Stmt | 0 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 13 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 11377 | TotExpensesEtcAuditedFinclStmt |
| Expenses Not Rptd F990 | 0 | ExpensesNotRptdF990 |
| Expenses Subtotal | 11377 | ExpensesSubtotal |
| Expenses Not Rptd On Fin Stmt | 0 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 11377 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV (2 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| Part X: | Description of Uncertain Tax Positions Under FIN 48: | As required under accounting standards for income taxes, the corporation adopted the new standard regarding uncertain income tax positions effective July 1, 2009. Under this new standard, the impact of an uncertain income tax position on the income tax returns must be recognized at the largest amount that is more-likely-than-not to be required to be recognized upon audit by the relevant taxing authority. The standards also provide guidance on de-recognition, measurements, classification, interest and penalties, accounting for interim periods, disclosure, and transition issues with respect to tax positions. As a result of adoption of the new standards regarding uncertain income tax positions, the corporation has determined that they have no uncertain income tax positions as of the adoption date of July 1, 2009. Also, the corporation does not anticipate any increase or decrease in unrecognized tax benefits during the next twelve months that would result in a material change in their financial position. The corporation's income tax returns for years/periods ended after September 30, 2006 remain open for examination. The corporation includes interest and penalties in the consolidated financial statements as a component of income tax expense. No interest or penalties are included in the corporation's income tax expense for the year ended June 30, 2010. |
| Part XI, Line 8 - Other Adjustments: | Equity in Net Income of Subsidiary: 106468. Contributions to Affiliates (net): 49815. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | X | CompensationCommittee |
| Written Employment Contract | X | WrittenEmploymentContract |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 0 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 1 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (2 entries)
| Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Danny W Squires | |||||||||||||
| 0 | 147931 | 0 | 6750 | 0 | 0 | 0 | 5562 | 0 | 14703 | 0 | 174946 | 0 | 0 |
| Barbara B Smith | |||||||||||||
| 0 | 160995 | 0 | 7500 | 0 | 0 | 0 | 6061 | 0 | 11577 | 0 | 186133 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Reference | Part I, Line 7 | ReturnReference |
| Explanation | The Compensation Committee of Lexington Memorial Hospital, Inc. annually determines the annual compensation of the Executive Team based on factors as described in Part VI, Section B, Line 15 of this 990. A portion of this compensation is determined to be "at risk" based upon achievement of specified targeted performance indicators, which include actual to budgeted results, market share growth and other intangible measures such as creativity, analytical skills and community involvement. Certain following individuals listed in Part VII, Section A, Line 1a received payments under this arrangement. | Explanation |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (9 entries)
| IdentifierIdentifier | ExplanationExplanation | Return ReferenceReturnReference |
|---|---|---|
| Form 990, Part VI, Section A, line 6 | The members of the corporation are Wake Forest University Health Sciences and North Carolina Baptist Hospital. | |
| Form 990, Part VI, Section A, line 7a | Decisions of the Organization's governing body which require approval by the Organization's memebers, Wake Forest University Health Sciences and North Carolina Baptist Hospital, include amendements to certain fundamental documents (Articles of Incorporation and Bylaws); the conveyance or encumbrance of real estate; election and removal of directors; and annual approval of the Organization's budget | |
| Form 990, Part VI, Section A, line 7b | Decisions of the Organization's governing body which require approval by the Organization's memebers, Wake Forest University Health Sciences and North Carolina Baptist Hospital, include amendements to certain fundamental documents (Articles of Incorporation and Bylaws); the conveyance or encumbrance of real estate; election and removal of directors; and annual approval of the Organization's budget | |
| Form 990, Part VI, Section B, line 11 | The organization distributes a draft copy of the Form 990 to all members of the organization in adequate time for feedback prior to filing a finalized Form 990 with the IRS. | |
| Form 990, Part VI, Section B, line 12c | The Organization has a conflict of interest policy which is reviewed, accepted, and signed by each officer and voting board member on an annual basis. Pursuant to this policy each officer and board member will recuse themselves from any discussion and vote for which a conflict exists for themselves or their family. Determinations of whether a conflict exists are made at a management, board member officer, and individual level. Actual conflicts are reviewed without the presence of the interested party. | |
| Form 990, Part VI, Section B, line 15 | The Organization follows the process described in Treasury Regulation 4958 (6) (c) for establishing the rebuttable presumption of reasonableness in the review, approval, and documentation of officer, key management, and director compensation. As part of the annual budgeting process the entire governing board reviews and approves the entire compensation package of each person based on comparability factors including but not limited to the size of the Organization, the geographical location of the Organization, and the Employees length of service. The governing body appoints a compensation committee to gather comparable data and to make recommendations to the board. This process is conducted on an annual basis for the following positions: CEO, COO. | |
| Form 990, Part VI, Section C, line 19 | The Organization makes these documents available upon request at the administration offices. | |
| Form 990, Part VII, Column B | Steven C. Shultz - 50.00 hours Danny W. Squires - 50.00 hours Barbara B. Smith - 50.00 hours Christopher T. White - 50.00 hours | Total average hours per week devoted to this and all related organizations |
| Form 990, Part XI, Line 2c | No changes from prior year method of oversight. |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (5 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Direct Controlling Entity NADirectControllingEntityNA |
|---|---|---|---|---|---|---|---|---|---|
| Lexington Memorial Hospital Inc | |||||||||
| 250 Hospital Drive | Lexington | NC | 27292 | 560543238 | Hospital | NC | 501(c)(3) | Line 3 | N/A |
| LexProperties Inc | |||||||||
| 250 Hospital Drive | Lexington | NC | 27292 | 561474401 | Real Estate Holding Company | NC | 501(c)(2) | N/A | |
| LexHealth Inc | |||||||||
| 250 Hospital Drive | Lexington | NC | 27292 | 561474400 | Promoted and supported cost-effective health care for residents of the Triad | NC | 501(c)(3) | Line 11b, II | N/A |
| LexMedical Inc | |||||||||
| 250 Hospital Drive | Lexington | NC | 27292 | 561941380 | Physician practices | NC | 501(c)(3) | Line 3 | N/A |
| Lexington Memorial Hospital Foundation Inc | |||||||||
| 250 Hospital Drive | Lexington | NC | 27292 | 581876553 | Fundraising | NC | 501(c)(3) | Line 11b, II | N/A |
Form990 Schedule R Part IV Form990ScheduleRPartIV (2 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivityPrimaryActivity | Legal Domicile StateLegalDomicileState | Direct Controlling Entity NADirectControllingEntityNA | Type Of EntityTypeOfEntity | Share Of Total IncomeShareOfTotalIncome | Share Of EOY AssetsShareOfEOYAssets | Percentage OwnershipPercentageOwnership |
|---|---|---|---|---|---|---|---|---|---|---|---|
| LexCare Inc | |||||||||||
| 250 Hospital Drive | Lexington | NC | 27292 | 561474407 | Pharmacy | NC | N/A | C | 106468 | 1506546 | 1.00000 |
| Medical Park Offices Unit Owners Association | |||||||||||
| 250 Hospital Drive | Lexington | NC | 27292 | 561685147 | Condo owners association | NC | N/A | C | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 1 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 1 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 0 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 0 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 0 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 0 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 1 | SharingOfFacilities |
| Sharing Of Paid Employees | 1 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 1 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 1 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 0 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |
Transactions Related Orgs Table TransactionsRelatedOrgsTable (3 entries)
| Transaction TypeTransactionType | Amount InvolvedAmountInvolved |
|---|---|
| LexProperties Inc | |
| C | 257703 |
| LexMedical Inc | |
| B | 4505503 |
| LEXINGTON MEMORIAL HOSPITAL INC | |
| C | 5701710 |
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