Civic Intelligence

Forsyth Community Pcc LLC

990 • Fiscal year 2020 • EIN 81-5300614

Jan 01, 2020 to Dec 31, 2020 • Filed on Nov 12, 2021

650 N Highland Ave No 120Winston Salem, NC 27101

(336) 718-4770

Siviq Scores

Precomputed percentiles for this filing year versus similar nonprofits in the same peer cohort.

Liabilities / Assets

66th percentile

0.24x

Higher debt load relative to assets than 66% of similar nonprofits.

2020 filings • 501(c)3 • $1M-$5M nonprofits • Source year 2020

Liabilities / Revenue

91st percentile

2.10x

Higher debt load relative to revenue than 91% of similar nonprofits.

2020 filings • 501(c)3 • $1M-$5M nonprofits • Source year 2020

Net Margin

1st percentile

-614%

Higher net margin than 1% of similar nonprofits.

2020 filings • 501(c)3 • $1M-$5M nonprofits • Source year 2020

Top Officer Pay

37th percentile

$0

Higher top officer pay than 37% of similar nonprofits.

Top officer pay equals 0.0% of source-year revenue.

2020 filings • 501(c)3 • $1M-$5M nonprofits • Source year 2020

Asset Growth

34th percentile

0.5%

Faster asset growth than 34% of similar nonprofits.

2020 filings • 501(c)3 • $1M-$5M nonprofits • Annualized from 2019 to 2020

Revenue Growth

93rd percentile

104%

Faster revenue growth than 93% of similar nonprofits.

2020 filings • 501(c)3 • $1M-$5M nonprofits • Annualized from 2019 to 2020

Assets

Up

$1,152,697

Up $6,139 (+0.5%) from 2019

Net Assets

Down

$872,755

Down $109,224 (-11%) from 2019

Liabilities

Up

$279,942

Up $115,363 (+70%) from 2019

Revenue

Up

$133,506

Up $68,189 (+104%) from 2019

Expenses

Up

$952,649

Up $115,288 (+14%) from 2019

Net Income

Down

-$819,143

Down $47,099 (-6.1%) from 2019

Historical Trend

Balance Sheet Trend

The highlighted filing sits inside the broader history for assets, liabilities, and net assets.

$2.0M$1.0M$0-$1.0MAssets 2018: $1,862,723Liabilities 2018: $108,700Net Assets 2018: $1,754,0232018Assets 2019: $1,146,558Liabilities 2019: $164,579Net Assets 2019: $981,9792019Assets 2020: $1,152,697Liabilities 2020: $279,942Net Assets 2020: $872,7552020Assets 2021: $500,435Liabilities 2021: $823,760Net Assets 2021: -$323,3252021Assets 2022: $736,528Liabilities 2022: $319,663Net Assets 2022: $416,8652022Assets 2023: $1,004,734Liabilities 2023: $288,407Net Assets 2023: $716,3272023

Highlighted filing

2020

Assets$1,152,697
Liabilities$279,942
Net Assets$872,755

Operations Trend

Revenue, expenses, and net income across loaded years, with this filing highlighted.

$2.0M$1.0M$0-$1.0M-$2.0MRevenue 2018: $4,731Expenses 2018: $258,406Net Income 2018: -$253,6752018Revenue 2019: $65,317Expenses 2019: $837,361Net Income 2019: -$772,0442019Revenue 2020: $133,506Expenses 2020: $952,649Net Income 2020: -$819,1432020Revenue 2021: $243,254Expenses 2021: $1,439,334Net Income 2021: -$1,196,0802021Revenue 2022: $181,695Expenses 2022: $1,041,505Net Income 2022: -$859,8102022Revenue 2023: $349,937Expenses 2023: $1,050,475Net Income 2023: -$700,5382023

Highlighted filing

2020

Revenue$133,506
Expenses$952,649
Net Income-$819,143
Jump To
Filing Snapshot
Filing Period
Jan 1, 2020 to Dec 31, 2020
Signed
Nov 12, 2021
Return Version
2020v4.1
Gross Receipts
$133,506
Mission and Program Overview

Mission

Forsyth community pcc, llc is a joint venture formed in 2018 between forsyth memorial hospital, inc. And wake forest university baptist medical center to provide healthcare services to forsyth county, nc.

Balance Sheet Detail
LineBeginningEndChange
Assets
Land, Buildings, and Equipment, Net$646,674$538,653▼ $108,021
Accounts Receivable$42,835$381,701▲ $338,866
Cash and Non-Interest-Bearing Accounts$457,049$232,343▼ $224,706
Total Assets$1,146,558$1,152,697▲ $6,139
Liabilities
Accounts Payable and Accrued Expenses$86,980$215,887▲ $128,907
Other Liabilities$77,599$64,055▼ $13,544
Total Liabilities$164,579$279,942▲ $115,363
Net Assets / Fund Balance
Net Assets Without Donor Restrictions$981,979$872,755▼ $109,224
Total Net Assets Fund Balance$981,979$872,755▼ $109,224
Total Liabilities and Net Assets / Fund Balance$1,146,558$1,152,697▲ $6,139

Asset Categories

AssetBook ValueDepreciationBasis
Leasehold Improvements$370,598$178,300$548,898
Equipment$168,055$55,597$223,652
Compensation and Service Providers

Board Members and Trustees

NameTitle
Lord Richard MdMedical Director/chair
Mann John MdVice Chair
Erickson LiaTrustee
Lambeth MartyTrustee
Prouty ChristopherTrustee
Scoggins StevenTrustee
Holby LauraSec
Burton Amanda MdTreasurer

Highest Paid Contractors

ContractorServicesLocationCompensation
Novant Medical Group INCManagement And Admin Svcs2085 FRONTIS PLAZA BLVD, Winston Salem, NC 27103$450,977
Wake Forest University Baptist Medical CPhysician ServicesMEDICAL CENTER BLVD, Winston Salem, NC 27157$167,406
Revenue and Support

Revenue Composition

Contributions and Grants
$0
Program Service Revenue
$133,081
Investment Income
$274
Other Revenue
$151
Change in Net Assets
$-819,143
Expenses and Functional Allocation

Major Expense Lines

Line ItemAmount
Other Expenses$952,649
Grants and Similar Amounts Paid$0
Professional Fundraising Fees$0
Salaries, Compensation, and Employee Benefits$0
Total Fundraising Expense$0

Functional Expense Allocation

Line ItemProgramManagementFundraisingTotal
Fees for Services Other$529,185$3,002-$532,187
Depreciation Depletion$107,765$257-$108,022
Occupancy$91,935--$91,935
Fees for Services Management-$45,000-$45,000
Office Expenses$8,786$32,613-$41,399
Insurance$2,061$21,051-$23,112
All Other Expenses$14,139$462-$14,601
Other Expenses$12,037$1,428-$12,037
Information Technology$10,200--$10,200
Advertising$530--$530
Total Functional Expenses$800,836$151,813$0$952,649
Fundraising, Events, and Gaming
Fundraising activities
No
Gaming activities
No
Professional fundraiser used
No

Fundraising and Gaming Totals

Line ItemAmount
Professional Fundraising Fees$0
Political and Lobbying Activity
Political campaign activity
No
Lobbying activity
No
Subject to proxy tax
No
Debt and Bond Financing

Other Reported Liabilities

LiabilityAmount
Third Party Payable$64,055
Governance and Compliance

Governance Checklist

Compiled or reviewed by an accountant
No
Annual disclosure for covered persons
Yes
Audit committee
Yes
Business relationship with 35% controlled entity
No
Business relationship with family members
No
Business relationship with organization members
No
Material changes to governing documents
No
Compensation from other sources disclosed
No
CEO compensation reviewed
No
Other officer compensation reviewed
No
Conflict-of-interest policy
Yes
Audited financial statements prepared
Yes
Key decisions subject to board approval
Yes
Management duties delegated
Yes

Governance Explanations

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 chris prouty steven scoggins

Form 990, Part VI, Section A, Line 3

Forsyth community pcc, llc ("fcpcc") has delegated management of administrative support services. The manager is responsible for certain management and administrative services including 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 current or former officers, directors, trustees, key employees or highest compensated employees were compensated by the management company for any services provided to fcpcc 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 limited liability company with members.

Form 990, Part VI, Section A, Line 7A

The limited liability company's members, forsyth memorial hospital, inc. And and wake forest university baptist medical center, each appoint 1/2 of the board.

Form 990, Part VI, Section A, Line 7B

The limited liability company's members, forsyth memorial hospital, inc. And 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 return will be reviewed by the board prior to filing.

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 conflict of interest policy would be followed. The potential conflict of interest would be disclosed by the board member before a vote on the transaction and the rest of the board would determine whether a conflict of interest exists. If the rest of the board determined that a conflict of interest existed then the board member with the conflict of interest would not participate in the deliberations and vote.

Form 990, Part VI, Section C, Line 19

Form 990, part vi, section c, line 19: governing documents disclosure no documents available to the public.

FORM 990, PART VII, SECTION B: INDEPENDENT CONTRACTORS

The filing entity's accounts payable function is managed by their support services provider, novant medical group, inc. (nmg) and as such, they do not issue 1099s directly. Information reported in part vii, section b represents the expenses paid on behalf of the filing entity to independent contractors over $100,000.

Filing and Contact Details

Filer

Filer Name
Forsyth Community Pcc LLC
EIN
81-5300614
Phone
3367184770
Address
650 N HIGHLAND AVE NO 120, WINSTON SALEM, NC 27101
Doing Business As
Highland Avenue Primary Care Clinic

Signing Officer

Name
Richard Lord
Title
Board Chair
Phone
3367184770
Signed
2021-11-12

Organization Details

Principal Officer
Richard Lord Md
Formed
2016
Legal Domicile
Nc
Voting Board Members
8
Independent Board Members
8
Employees
0
Volunteers
0
Supplemental Narrative

Additional Explanations

FORM 990, PI, L1: ORGANIZATION'S MISSION OR MOST SIGNIFICANT ACTIVITIES

The promotion of health for the benefit of the community is a charitable purpose. Federal health care reform and other changes relating to the provision of health care services have made it increasingly critical for hospital systems and their constituent hospitals to be able effectively to align with other health care providers and physicians as they assume a greater role in providing care for identified at-risk populations. Forsyth community pcc, llc is a joint venture formed in 2018 between forsyth memorial hospital, inc. ("fmh") and wake forest university baptist medical center ("wake") to provide healthcare services in forsyth county, nc. Access to care is regularly identified as a significant and critical need in our community health needs assessments and addressing it is critical to sustaining a healthy community. The same can be said for affordability. After extensive due diligence and in light of their complementary mission and values, fmh and wake determined that they could work together to address these issues by creating this joint community care clinic, locating it in a historically underserved community, and providing healthcare services at nominal fees. The clinic is committed to ensuring access to high-quality, affordable, comprehensive healthcare for all residents of forsyth county, regardless of their insurance status or their ability to pay.

Form 990, Part IX, Line 11G

Outside services: program service expenses 13,978. Management and general expenses 3,002. Fundraising expenses 0. Total expenses 16,980. Contracted services: program service expenses 347,801. Management and general expenses 0. Fundraising expenses 0. Total expenses 347,801. Physician services: program service expenses 167,406. Management and general expenses 0. Fundraising expenses 0. Total expenses 167,406.

FORM 990, PART XI, LINE 9:

Capital contributions 709,919.

Financial Statement Notes

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, 2020 and 2019.

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IRS990ScheduleD/OtherLiabilitiesOrgGrp/Desc0THIRD PARTY PAYABLE
IRS990ScheduleD/SupplementalInformationDetail/ExplanationTxt0THE 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, 2020 AND 2019.
IRS990ScheduleD/SupplementalInformationDetail/FormAndLineReferenceDesc0PART X, LINE 2:
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IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt0THE PROMOTION OF HEALTH FOR THE BENEFIT OF THE COMMUNITY IS A CHARITABLE PURPOSE. FEDERAL HEALTH CARE REFORM AND OTHER CHANGES RELATING TO THE PROVISION OF HEALTH CARE SERVICES HAVE MADE IT INCREASINGLY CRITICAL FOR HOSPITAL SYSTEMS AND THEIR CONSTITUENT HOSPITALS TO BE ABLE EFFECTIVELY TO ALIGN WITH OTHER HEALTH CARE PROVIDERS AND PHYSICIANS AS THEY ASSUME A GREATER ROLE IN PROVIDING CARE FOR IDENTIFIED AT-RISK POPULATIONS. FORSYTH COMMUNITY PCC, LLC IS A JOINT VENTURE FORMED IN 2018 BETWEEN FORSYTH MEMORIAL HOSPITAL, INC. ("FMH") AND WAKE FOREST UNIVERSITY BAPTIST MEDICAL CENTER ("WAKE") TO PROVIDE HEALTHCARE SERVICES IN FORSYTH COUNTY, NC. ACCESS TO CARE IS REGULARLY IDENTIFIED AS A SIGNIFICANT AND CRITICAL NEED IN OUR COMMUNITY HEALTH NEEDS ASSESSMENTS AND ADDRESSING IT IS CRITICAL TO SUSTAINING A HEALTHY COMMUNITY. THE SAME CAN BE SAID FOR AFFORDABILITY. AFTER EXTENSIVE DUE DILIGENCE AND IN LIGHT OF THEIR COMPLEMENTARY MISSION AND VALUES, FMH AND WAKE DETERMINED THAT THEY COULD WORK TOGETHER TO ADDRESS THESE ISSUES BY CREATING THIS JOINT COMMUNITY CARE CLINIC, LOCATING IT IN A HISTORICALLY UNDERSERVED COMMUNITY, AND PROVIDING HEALTHCARE SERVICES AT NOMINAL FEES. THE CLINIC IS COMMITTED TO ENSURING ACCESS TO HIGH-QUALITY, AFFORDABLE, COMPREHENSIVE HEALTHCARE FOR ALL RESIDENTS OF FORSYTH COUNTY, REGARDLESS OF THEIR INSURANCE STATUS OR THEIR ABILITY TO PAY.
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt1FORM 990, PART VI, SECTION A, LINE 2: FAMILY AND/OR BUSINESS RELATIONSHIPS BUSINESS RELATIONSHIP RICHARD LORD CHRIS PROUTY STEVEN SCOGGINS
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt2FORSYTH COMMUNITY PCC, LLC ("FCPCC") HAS DELEGATED MANAGEMENT OF ADMINISTRATIVE SUPPORT SERVICES. THE MANAGER IS RESPONSIBLE FOR CERTAIN MANAGEMENT AND ADMINISTRATIVE SERVICES INCLUDING 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 CURRENT OR FORMER OFFICERS, DIRECTORS, TRUSTEES, KEY EMPLOYEES OR HIGHEST COMPENSATED EMPLOYEES WERE COMPENSATED BY THE MANAGEMENT COMPANY FOR ANY SERVICES PROVIDED TO FCPCC DURING THE YEAR.
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt3FORM 990, PART VI, SECTION A, LINE 6: CLASSES OF MEMBERS OR STOCKHOLDERS THE ORGANIZATION IS A LIMITED LIABILITY COMPANY WITH MEMBERS.
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt4THE LIMITED LIABILITY COMPANY'S MEMBERS, FORSYTH MEMORIAL HOSPITAL, INC. AND AND WAKE FOREST UNIVERSITY BAPTIST MEDICAL CENTER, EACH APPOINT 1/2 OF THE BOARD.
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt5THE LIMITED LIABILITY COMPANY'S MEMBERS, FORSYTH MEMORIAL HOSPITAL, INC. AND AND WAKE FOREST UNIVERSITY BAPTIST MEDICAL CENTER, APPROVE CERTAIN TRANSACTIONS AND CHANGES TO THE OPERATING AGREEMENT.
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt6THE RETURN WILL BE REVIEWED BY THE BOARD PRIOR TO FILING.
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt7THE 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 CONFLICT OF INTEREST POLICY WOULD BE FOLLOWED. THE POTENTIAL CONFLICT OF INTEREST WOULD BE DISCLOSED BY THE BOARD MEMBER BEFORE A VOTE ON THE TRANSACTION AND THE REST OF THE BOARD WOULD DETERMINE WHETHER A CONFLICT OF INTEREST EXISTS. IF THE REST OF THE BOARD DETERMINED THAT A CONFLICT OF INTEREST EXISTED THEN THE BOARD MEMBER WITH THE CONFLICT OF INTEREST WOULD NOT PARTICIPATE IN THE DELIBERATIONS AND VOTE.
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt8FORM 990, PART VI, SECTION C, LINE 19: GOVERNING DOCUMENTS DISCLOSURE NO DOCUMENTS AVAILABLE TO THE PUBLIC.
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt9THE FILING ENTITY'S ACCOUNTS PAYABLE FUNCTION IS MANAGED BY THEIR SUPPORT SERVICES PROVIDER, NOVANT MEDICAL GROUP, INC. (NMG) AND AS SUCH, THEY DO NOT ISSUE 1099S DIRECTLY. INFORMATION REPORTED IN PART VII, SECTION B REPRESENTS THE EXPENSES PAID ON BEHALF OF THE FILING ENTITY TO INDEPENDENT CONTRACTORS OVER $100,000.
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt10OUTSIDE SERVICES: PROGRAM SERVICE EXPENSES 13,978. MANAGEMENT AND GENERAL EXPENSES 3,002. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 16,980. CONTRACTED SERVICES: PROGRAM SERVICE EXPENSES 347,801. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 347,801. PHYSICIAN SERVICES: PROGRAM SERVICE EXPENSES 167,406. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 167,406.
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt11CAPITAL CONTRIBUTIONS 709,919.
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc0FORM 990, PI, L1: ORGANIZATION'S MISSION OR MOST SIGNIFICANT ACTIVITIES
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc1FORM 990, PART VI, SECTION A, LINE 2
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc2FORM 990, PART VI, SECTION A, LINE 3
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc3FORM 990, PART VI, SECTION A, LINE 6
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc4FORM 990, PART VI, SECTION A, LINE 7A
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc5FORM 990, PART VI, SECTION A, LINE 7B
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc6FORM 990, PART VI, SECTION B, LINE 11B
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc7FORM 990, PART VI, SECTION B, LINE 12C
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc8FORM 990, PART VI, SECTION C, LINE 19
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc9FORM 990, PART VII, SECTION B: INDEPENDENT CONTRACTORS
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc10FORM 990, PART IX, LINE 11G
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc11FORM 990, PART XI, LINE 9:
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