2023-11-14T11:01:41-06:00 2022-12-31 990 2022-01-01 020774853 NORTHWEST COMMUNITY CARE NETWORK INC NORT 3367164445 2000 WEST 1ST STREET 605 WINSTON SALEM NC 27104 GREG WALLIS INTERIM CEO 3367164445 2023-11-14 GREG WALLIS 999009999 1 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z TERRY WILLIAMS 2000 WEST 1ST STREET 605 WINSTON SALEM NC 27104 7826672 0 X WWW.NWCOMMUNITYCARE.ORG X 2006 NC DEVELOPING, IMPLEMENTING AND EVALUATING ENHANCED MANAGED CARE STRATEGIES FOR MEDICAID RECIPIENTS 10 8 0 7 0 0 131684 438874 3362966 7382723 1983 5075 0 0 3496633 7826672 0 0 0 0 2904519 5896486 0 0 0 1195385 2190838 4099904 8087324 -603271 -260652 8734876 8511749 543489 581014 8191387 7930735 X THE ORGANIZATION OPERATES A PRIMARY CARE CASE MANAGEMENT PROGRAM (PPCM) THAT IS DESIGNED TO PROVIDE A MORE EFFICIENT AND EFFECTIVE HEALTHCARE DELIVERY SYSTEM FOR MEDICAID RECIPIENTS, BRINGING TOGETHER PRIMARY CARE PROVIDERS, HOSPITALS, HEALTH DEPARTMENTS, DEPARTMENT OF SOCIAL SERVICES AND OTHER COMMUNITY PROVIDERS TO MANAGE THE HEALTH CARE NEEDS OF MEDICAID RECIPIENTS. THE ORGANIZATION'S SERVICE AREA INCLUDES THE COUNTIES OF DAVIE, DAVIDSON, FORSYTH, STOKES, SURRY, WILKES AND YADKIN. THESE COUNTIES COMPRISE THE NETWORK MEMBERS. THE ORGANIZATION RECEIVES A MONTHLY FEE FROM THE STATE OF NORTH CAROLINA'S MEDICAID PROGRAM TO ASSIST IN DEVELOPING, IMPLEMENTING AND EVALUATING ENHANCED MANAGED CARE STRATEGIES FOR MEDICAID RECIPIENTS. 0 0 7215360 7382723 THE ORGANIZATION COORDINATED, FACILITATED AND MANAGED THE DELIVERY OF MEDICAID DIRECT SERVICES TO APPROXIMATELY 10,000 DUALLY ENROLLED, MEDICAID/MEDICARE PATIENTS IN THE NORTHWEST PIEDMONT AREA OF NORTH CAROLINA, SUCCESSFULLY IMPROVING THE QUALITY OF MATERNITY CARE AND RELATED OUTCOMES FOR MOTHERS AND BABIES, AND REDUCING MEDICAL CARE COSTS DURING THE CALENDAR YEAR ENDED DECEMBER 31, 2022.EMTIRO HEALTH, LLC SUPPORTS PROVIDERS, SYSTEMS AND PAYERS WITH UNPARALLELED EXPERTISE AND KNOWLEDGE ACHIEVED THROUGH DATA ANALYTICS TO ACHIEVE IMPROVED OUTCOMES AND PATIENT EXPERIENCE AT A LOWER COST OF CARE, WORKING DIRECTLY WITH PATIENTS TO ADDRESS SYSTEMIC BARRIERS TO TOTAL WELLBEING AND BRIGHTER FUTURES THROUGH CARE MANAGEMENT SOLUTIONS. 7215360 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 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 9 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 X 10 8 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 X PAIGE W GRUBBS 3363244229 MEDICAL CENTER BOULEVARD WINSTON SALEM NC 27157 TERRY G WILLIAMS CHAIR 0.10 39.90 X X 1690428 0 289736 JENNIFER HOULIHAN BOARD MEMBER 2.00 38.00 X 0 325533 59179 JOSH SWIFT BOARD MEMBER 2.00 0.00 X 0 0 0 KAREN CANNON MD CPE BOARD MEMBER (TO 11/9/22) 2.00 0.00 X 0 0 0 RICHARD LORD MD BOARD MEMBER 2.00 38.00 X 0 0 0 RON BACZURIK BOARD MEMBER, TREASURER (TO 1/20/22) 2.00 0.00 X X 0 0 0 SAMANTHA B ANGE BOARD MEMBER 2.00 0.00 X 0 0 0 SCOTT VOGLER MD BOARD MEMBER 2.00 0.00 X 0 0 0 SUSAN ALBERT MD BOARD MEMBER, SECRETARY 2.00 0.00 X X 0 0 0 TED NIFONG MD BOARD MEMBER 2.00 0.00 X 0 0 0 1690428 325533 348915 0 0 1 1 INNOVACCER INC 101 MISSION STREET SUITE 1950 SAN FRANCISCO CA 94105 IT SOFTWARE & CONSULTING 1135550 WALLIS CONSULTING LLC 2047 ELIZABETH AVENUE WINSTONSALEM NC 27103 CONSULTING SERVICES 203800 2 438874 438874 CASE MANAGEMENT FEES 624100 5577157 5577157 PROVIDER SERVICE FEES 541610 1805566 1805566 7382723 5075 5075 7826672 7382723 0 5075 X 4759952 4301935 458017 1136534 1027173 109361 10584 10584 432 292 140 1715937 1455300 260637 28643 25383 3260 53226 47167 6059 24779 21958 2821 73737 65343 8394 54951 48696 6255 10311 9137 1174 195355 182114 13241 22883 20278 2605 8087324 7215360 871964 0 2528904 6577185 4005702 1325098 1254750 154048 154045 1090111 564342 721124 525769 8734876 8511749 531293 568818 12196 12196 543489 581014 X 8126844 7868193 64543 62542 8191387 7930735 8734876 8511749 -260652 0 X 0 1 X 1 0 X 166672 209291 120997 131684 438874 1067518 166672 209291 120997 131684 438874 1067518 1067518 471 24851 4262 1983 5075 36642 1104160 36466386 0.96680 0.97010 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 351273 99558 251715 738838 464784 274054 525769 X PART X, LINE 2: THE ORGANIZATION HAS EVALUATED UNCERTAIN TAX POSITIONS FOR ITS CALENDAR YEAR ENDED DECEMBER 31, 2022 AND SHORT PERIOD ENDED DECEMBER 31, 2021, INCLUDING A QUANTIFICATION OF TAX RISK IN AREAS SUCH AS UNRELATED BUSINESS TAXABLE INCOME AND THE TAXATION OF ITS JOINT VENTURES. THIS EVALUATION DID NOT HAVE A MATERIAL EFFECT ON THE ORGANIZATION'S FINANCIAL STATEMENTS FOR THE CALENDAR YEAR ENDED DECEMBER 31, 2022 AND SHORT PERIOD ENDED DECEMBER 31, 2021. 0 0 0 0 0 0 0 0 0 TERRY G WILLIAMS CHAIR 819455 0 833750 0 37223 0 258788 0 30948 0 1980164 0 0 0 JENNIFER HOULIHAN BOARD MEMBER 0 245308 0 79453 0 772 0 40860 0 18319 0 384712 0 0 FORM 990, PART VII, LINE 5 - COMPENSATION FROM UNRELATED ORGANIZATION TERRY G. WILLIAMS WAS COMPENSATED BY THE CHARLOTTE-MECKLENBURG HOSPITAL AUTHORITY ("CMHA", DOING BUSINESS AS ATRIUM HEALTH), AN AFFILIATED BUT UNRELATED ORGANIZATION, FOR SERVICES RENDERED TO THE ORGANIZATION. SEE PART VII AND SCHEDULE J FOR HIS COMPENSATION. FORM 990, PART VI, SECTION A, LINE 6 THE SOLE MEMBER OF THE CORPORATION IS WAKE FOREST UNIVERSITY BAPTIST MEDICAL CENTER, A NORTH CAROLINA NONPROFIT ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 7A THE ORGANIZATION'S SOLE MEMBER, WAKE FOREST UNIVERSITY BAPTIST MEDICAL CENTER, APPOINTS THREE DIRECTORS. THE BOARD OF DIRECTORS APPOINTS ONE DIRECTOR WHO IS A RESIDENT OF, OR IS OTHERWISE ASSOCIATED WITH, EACH OF THE COUNTIES THAT THE ORGANIZATION SERVES. THE BOARD OF DIRECTORS APPOINTS ONE DEPARTMENT OF SOCIAL SERVICES ("DSS") DIRECTOR TO REPRESENT THE INTERESTS OF DSS DEPARTMENTS. THE SEVERAL DSS IN THE COUNTIES JOINTLY DISCUSS AND SUBMIT TO THE BOARD OF DIRECTORS THEIR RECOMMENDED APPOINTEE. THE BOARD OF DIRECTORS APPOINTS ONE LOCAL MANAGEMENT ENTITIES ("LME") DIRECTOR TO REPRESENT THE INTERESTS OF SUCH LMES. THE SEVERAL LMES JOINTLY DISCUSS AND SUBMIT TO THE BOARD OF DIRECTORS THEIR RECOMMENDED APPOINTEE. THE BOARD OF DIRECTORS APPOINTS ONE PHYSICIAN WHOSE PRACTICE IS A PART OF THE ORGANIZATION'S AFFILIATED PRIMARY CARE NETWORK TO REPRESENT THE INTEREST OF SUCH PRIMARY CARE PHYSICIANS. THE BOARD OF DIRECTORS APPOINTS ONE INDIVIDUAL WHO IS EMPLOYED BY FORSYTH MEDICAL CENTER TO REPRESENT THE INTEREST OF ITS HOSPITALS AND PRIMARY CARE PRACTICES. THE BOARD OF DIRECTORS APPOINTS ONE MEDICARE BENEFICIARY WHO RESIDES IN THE ORGANIZATION'S AREA OF OPERATION TO REPRESENT THE INTEREST OF SUCH MEDICARE BENEFICIARIES. FORM 990, PART VI, SECTION A, LINE 7B THE SOLE MEMBER ALONE CAN AMEND THE ARTICLES AND BYLAWS OF THE ORGANIZATION. FORM 990, PART VI, SECTION B, LINE 11B THE FILING ORGANIZATION'S BOARD OF DIRECTORS RECEIVES A COPY OF THE FORM 990 WITH SUFFICIENT TIME TO PERMIT REVIEW, COMMENT AND QUESTIONS PRIOR TO ITS FILING. IF MODIFICATIONS ARE REQUIRED FOLLOWING SUCH REVIEW, THE REVISED FORM 990 IS REDISTRIBUTED PRIOR TO ITS FILING WITH THE IRS, ALONG WITH A SUMMARY OF THE MODIFICATIONS. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION REQUIRES OFFICERS, DIRECTORS AND KEY EMPLOYEES TO ANNUALLY REVIEW THE CONFLICT OF INTEREST POLICY AND DETERMINE ANY POTENTIAL CONFLICTS OF INTEREST. ALL OFFICERS, DIRECTORS AND KEY EMPLOYEES ARE REQUIRED TO DETERMINE AND REPORT POTENTIAL CONFLICTS ANNUALLY, AND AS THEY ARISE. ANY ITEMS DISCLOSED ARE REVIEWED AND MANAGED IN ACCORDANCE WITH THE ORGANIZATION'S POLICY ON CONFLICTS OF INTEREST. FORM 990, PART VI, SECTION B, LINE 15 THE FILING ORGANIZATION DOES NOT PAY COMPENSATION TO DIRECTORS FOR THEIR EFFORT DEVOTED TO THE ORGANIZATION. CERTAIN OFFICERS AND DIRECTORS ARE EMPLOYED BY A RELATED ORGANIZATION, WAKE FOREST UNIVERSITY BAPTIST MEDICAL CENTER AND BY AN UNRELATED BUT AFFILIATED ORGANIZATION, CHARLOTTE MECKLENBURG HOSPITAL AUTHORITY (CMHA) AND THE DETERMINATION OF THE COMPENSATION OF SUCH INDIVIDUALS IS CONDUCTED VIA THE PROCESS UTILIZED BY THE WFUBMC BOARD, AS FOLLOWS: THE DIVERSITY, INCLUSION, & COMPENSATION COMMITTEE (THE "COMMITTEE") OF THE ATRIUM HEALTH, INC. BOARD OF DIRECTORS HAS AUTHORITY AS THE WFUBMC BOARD DELEGATES TO IT, FOR THE REVIEW AND APPROVAL OF SENIOR EXECUTIVE COMPENSATION, INCLUDING SENIOR EXECUTIVE INCENTIVE PLANS. NO MEMBER OF THE COMMITTEE IS AN EMPLOYEE OF WFUBMC OR OF THE FILING ORGANIZATION. THE COMMITTEE RELIES UPON AN EXTERNAL, INDEPENDENT COMPENSATION CONSULTANT EXPERIENCED IN HEALTHCARE TO PROVIDE THE COMMITTEE WITH COMPENSATION COMPARABILITY DATA FOR NEW EXECUTIVE POSITION APPOINTMENTS AND FOR COMPENSATION REVIEWS FOR EXISTING EXECUTIVES. THE CONSULTANT, WHICH IS RETAINED DIRECTLY BY THE COMMITTEE, PROVIDES THIRD-PARTY INFORMATION AND EVALUATES THE COMPETITIVENESS AND REASONABLENESS OF EXECUTIVE COMPENSATION AND BENEFITS PROGRAMS IN RELATION TO MARKET PRACTICES FOR SIMILARLY SITUATED HEALTHCARE ORGANIZATIONS. THE COMMITTEE MAKES ITS DECISIONS WITH RESPECT TO EXECUTIVE COMPENSATION IN ACCORDANCE WITH WFUBMC AND FILING ORGANIZATION POLICIES, IRS REGULATIONS, AND STANDARD CORPORATE GOVERNANCE PRACTICES. SUCH POLICIES INCLUDE ADHERENCE TO EXECUTIVE COMPENSATION PHILOSOPHY AND REVIEW PROCESSES; PROCESSES ENSURING COMMITTEE MEMBER AND COMPENSATION CONSULTANT INDEPENDENCE; USE OF VALID MARKET COMPARISONS OF DATA FROM HEALTHCARE ORGANIZATIONS OF SIMILAR SIZE, STRUCTURE, AND COMPLEXITY AND ESTABLISHMENT OF THE REBUTTABLE PRESUMPTION OF REASONABLENESS, PER IRS GUIDELINES. MINUTES OF THE DELIBERATIONS OF THE COMMITTEE ARE MAINTAINED IN THE ATRIUM HEALTH, INC. LEGAL DEPARTMENT. 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. THE CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC ON REQUEST. FORM 990, PART IX, LINE 11G PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 1,455,300. MANAGEMENT AND GENERAL EXPENSES 260,637. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,715,937. 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