2024-10-31T09:53:06-05:00 2023-12-31 990 2023-01-01 815300614 FORSYTH COMMUNITY PCC LLC FORS 3362772411 650 N HIGHLAND AVE 120 WINSTON SALEM NC 27101 RICHARD LORD MD BOARD CHAIR 3362772411 2024-10-31 0 2023 2024-10-15 13:58:12Z HIGHLAND AVENUE PRIMARY CARE CLINIC RICHARD LORD MD 650 N HIGHLAND AVE 120 WINSTON SALEM NC 27101 349937 0 X WWW.WAKEHEALTH.EDU X LLC 2016 NC TO PROVIDE HEALTHCARE SERVICES TO AN UNDERSERVED COMMUNITY IN FORSYTH COUNTY, NORTH CAROLINA. 8 8 0 8 0 0 0 144816 179338 198773 2342 6348 15 0 181695 349937 0 0 0 0 0 0 0 0 0 1041505 1050475 1041505 1050475 -859810 -700538 736528 1004734 319663 288407 416865 716327 X SEE SCHEDULE O 0 0 972197 0 198773 THE ORGANIZATION IS A JOINT VENTURE BETWEEN FORSYTH MEMORIAL HOSPITAL, INC. AND WAKE FOREST UNIVERSITY BAPTIST MEDICAL CENTER TO PROVIDE HEALTHCARE SERVICES IN FORSYTH COUNTY, NC. THE ORGANIZATION OPERATES A COMMUNITY CARE CLINIC, LOCATED IN A HISTORICALLY UNDERSERVED COMMUNITY, PROVIDING HEALTHCARE SERVICES AT NOMINAL FEES. DURING 2023, THE CLINIC HAD 21,018 OUTPATIENT ENCOUNTERS. 972197 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 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 0 0 X 8 8 1 1 0 0 1 1 1 1 1 0 0 1 1 1 1 0 0 0 0 0 X MELVINIA MCMILLAN 3367184770 650 N HIGHLAND AVE WINSTON SALEM NC 27101 X X AMANDA BURTON TREAS 0.20 0.00 X X 0 0 0 CHRISTOPHER PROUTY TRUSTEE 0.20 0.00 X 0 0 0 JOHN MANN MD VICE CHAIR (TO 12/31/23) 0.20 0.00 X X 0 0 0 JOYCE MOUNCE SECR (TO 12/31/23) 0.20 0.00 X X 0 0 0 LIA ERICKSON MD TRUSTEE (TO 12/31/23) 0.20 0.00 X 0 0 0 PAULA BIRD TRUSTEE (TO 12/31/23) 0.20 0.00 X 0 0 0 RICHARD LORD MD CHAIR 0.20 0.00 X X 0 0 0 STEVEN SCOGGIN TRUSTEE 0.20 0.00 X 0 0 0 0 0 0 0 0 0 0 WAKE FOREST UNIVERSITY BAPTIST MEDICAL C MEDICAL CENTER BLVD WINSTON SALEM NC 27157 PHYSICIAN SERVICES 399978 NOVANT MEDICAL GROUP INC 2085 FRONTIS PLAZA BLVD WINSTON SALEM NC 27103 MGMT & ADMIN SERVICES 349329 2 144816 144816 NET PATIENT REVENUE 621111 198773 198773 198773 6348 6348 349937 198773 0 6348 X 10385 10385 732600 732071 529 1188 1188 43092 7924 35168 13091 13091 81218 81218 1771 1771 107924 107668 256 17402 17402 BILLING FEES 13078 13078 PHARMACEUTICALS 11161 11161 MEDICAL SUPPLIES 10649 10649 OTHER SUPPLIES 1758 1432 326 5158 4024 1134 1050475 972197 78278 0 350435 745535 63485 41479 846870 630546 322608 216324 1396 736528 1004734 101045 287492 218618 915 319663 288407 X 416865 716327 416865 716327 736528 1004734 X -700538 1000000 X 0 1 X 1 0 X 144816 144816 63491 133232 242743 179353 198773 817592 63491 133232 242743 179353 343589 962408 0 0 0 962408 1826 274 511 2342 6348 11301 1826 274 511 2342 6348 11301 65317 133506 243254 181695 349937 973709 0.98840 0.98730 0.01160 0.01270 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 548898 425365 123533 297972 205181 92791 216324 0 THIRD PARTY PAYABLE 915 915 X PART X, LINE 2: THE COMPANY IS INCLUDED IN THE NOVANT HEALTH, INC. CONSOLIDATED FINANCIAL STATEMENTS UNDER GENERALLY ACCEPTED ACCOUNTING STANDARDS, BUT DOES NOT MEET THE CONTROL REQUIREMENTS TO BE CONSIDERED A RELATED ENTITY FOR FORM 990 REPORTING. NOVANT HEALTH IS REQUIRED TO EVALUATE UNCERTAIN TAX POSITIONS. THIS EVALUATION INCLUDES A QUANTIFICATION OF TAX RISK IN AREAS SUCH AS UNRELATED BUSINESS TAXABLE INCOME. THIS EVALUATION DID NOT HAVE A MATERIAL EFFECT ON THE COMPANY'S CONSOLIDATED STATEMENTS OF OPERATIONS AND CHANGES IN NET ASSETS FOR THE YEARS ENDED DECEMBER 31, 2023 AND 2022. FORM 990, PIII, L1: ORGANIZATION'S MISSION OR MOST SIGNIFICANT ACTIVITIES FORSYTH COMMUNITY PCC, LLC, DOING BUSINESS AS HIGHLAND AVENUE PRIMARY CARE CLINIC, IS A JOINT VENTURE HEALTH CARE CLINIC FORMED IN 2018 BETWEEN FORSYTH MEMORIAL HOSPITAL, INC. AND WAKE FOREST UNIVERSITY BAPTIST MEDICAL CENTER TO PROVIDE HEALTHCARE SERVICES IN FORSYTH COUNTY, NC. THIS JOINT COMMUNITY CARE CLINIC, LOCATED IN A HISTORICALLY UNDERSERVED COMMUNITY AND PROVIDING HEALTHCARE SERVICES AT NOMINAL FEES, IS COMMITTED TO ENSURING ACCESS TO HIGH-QUALITY, AFFORDABLE, COMPREHENSIVE HEALTHCARE FOR ALL RESIDENTS OF FORSYTH COUNTY, REGARDLESS OF THEIR INSURANCE STATUS OR ABILITY TO PAY. FORM 990, PART VI, SECTION A, LINE 2 FORM 990, PART VI, SECTION A, LINE 2: FAMILY AND/OR BUSINESS RELATIONSHIPS BUSINESS RELATIONSHIP RICHARD LORD AMANDA BURTON STEVEN SCOGGIN FORM 990, PART VI, SECTION A, LINE 3 THE ORGANIZATION HAS DELEGATED MANAGEMENT OF ITS ADMINISTRATIVE SUPPORT SERVICES. THE MANAGER IS RESPONSIBLE FOR NON-CLINICAL OPERATIONAL OVERSIGHT, UTILIZATION REVIEW AND QUALITY ASSURANCE, MARKETING AND BRANDING, FINANCIAL MANAGEMENT INCLUDING ACCOUNTING, BUDGET PREPARATION, BILLING AND COLLECTIONS, PROVIDER CONTRACTING AND CREDENTIALING, FACILITIES AND INFORMATION TECHNOLOGY MANAGEMENT, REGULATORY AND RISK MANAGEMENT, CONTRACTING/PURCHASING SERVICES, AND RECRUITMENT/PERSONNEL STAFFING SERVICES. NO TRUSTEES AND/OR OFFICERS ARE COMPENSATED BY THE MANAGEMENT COMPANY FOR SERVICES RENDERED TO THE ORGANIZATION DURING THE YEAR. FORM 990, PART VI, SECTION A, LINE 6 FORM 990, PART VI, SECTION A, LINE 6: CLASSES OF MEMBERS OR STOCKHOLDERS THE ORGANIZATION IS A NORTH CAROLINA LIMITED LIABILITY COMPANY WITH MEMBERS. FORM 990, PART VI, SECTION A, LINE 7A THE LIMITED LIABILITY COMPANY'S MEMBERS, FORSYTH MEMORIAL HOSPITAL, INC. AND WAKE FOREST UNIVERSITY BAPTIST MEDICAL CENTER, EACH APPOINT ONE HALF OF THE BOARD. FORM 990, PART VI, SECTION A, LINE 7B THE LIMITED LIABILITY COMPANY'S MEMBERS, FORSYTH MEMORIAL HOSPITAL, INC. AND WAKE FOREST UNIVERSITY BAPTIST MEDICAL CENTER, APPROVE CERTAIN TRANSACTIONS AND CHANGES TO THE OPERATING AGREEMENT. FORM 990, PART VI, SECTION B, LINE 11B THE ORGANIZATION'S BOARD OF TRUSTEES RECEIVES A COPY OF FORM 990 WITH SUFFICIENT TIME TO REVIEW AND COMMENT PRIOR TO FILING. IF MATERIAL REVISIONS ARE REQUIRED FOLLOWING THE BOARD REVIEW PERIOD, A REVISED FORM 990 IS REDISTRIBUTED TO THE BOARD TRUSTEES PRIOR TO FILING WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION'S CONFLICT OF INTEREST POLICY APPLIES TO ALL TRUSTEES INCLUDING MEMBERS OF A COMMITTEE WITH BOARD DELEGATED POWERS. WITH RESPECT TO PARTICULAR TRANSACTIONS THAT COME BEFORE THE BOARD, THE POTENTIAL CONFLICT OF INTEREST WOULD BE DISCLOSED BY THE BOARD TRUSTEE BEFORE A VOTE ON THE TRANSACTION. THE REMAINING TRUSTEES WOULD DETERMINE WHETHER OR NOT A CONFLICT OF INTEREST EXISTS. IF IT IS DETERMINED THAT A CONFLICT OF INTEREST EXISTS, THEN THE BOARD TRUSTEE WITH THE CONFLICT OF INTEREST WOULD NOT PARTICPATE IN THE DELIBERATIONS AND VOTE FOR THAT PARTICULAR TRANSACTION. FORM 990, PART VI, SECTION C, LINE 19 FORM 990, PART VI, SECTION C, LINE 19: GOVERNING DOCUMENTS DISCLOSURE THE ORGANIZATION'S ARTICLES OF ORGANIZATION ARE AVAILABLE TO THE PUBLIC ON REQUEST AND ARE AVAILABLE ON THE WEBSITE OF THE NORTH CAROLINA SECRETARY OF STATE. THE OPERATING AGREEMENT IS NOT PUBLISHED OR AVAILABLE TO THE PUBLIC. FORM 990, PART VII, SECTION B: INDEPENDENT CONTRACTORS THE ORGANIZATION'S ACCOUNTS PAYABLE FUNCTION IS MANAGED BY THEIR MANAGEMENT/ADMINISTRATIVE SERVICE PROVIDER, NOVANT MEDICAL GROUP, INC., AN ORGANIZATION AFFILIATED WITH NOVANT HEALTH, INC. THE ORGANIZATION DOES NOT ISSUE FORMS 1099 DIRECTLY. THE INFORMATION REPORTED IN PART VII SECTION B REPRESENTS EXPENSES PAID ON BEHALF OF THE FILING ORGANIZATION BY NOVANT HEALTH, INC. FORM 990, PART IX, LINE 11G OUTSIDE SERVICES: PROGRAM SERVICE EXPENSES 11,349. MANAGEMENT AND GENERAL EXPENSES 529. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 11,878. CONTRACTED SERVICES: PROGRAM SERVICE EXPENSES 317,504. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 317,504. PROFESSIONAL PHYSICIAN SERVICES: PROGRAM SERVICE EXPENSES 403,218. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 403,218. FORM 990, PART XI, LINE 9: CAPITAL CONTRIBUTIONS 1,000,000.