Department of the Treasury Internal Revenue Service
Public Charity Status and Public Support
Complete if the organization is a section 501(c)(3) organization or a section
4947(a)(1) nonexempt charitable trust.
Attach to Form 990 or Form 990-EZ. See separate instructions. Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public Inspection
Name of the organization
NORTH CAROLINA COMMUNITY CARE NETWORKS INC
Employer identification number
20-5408367
Part I
Reason for Public Charity Status
(All organizations must complete this part.) See instructions.
The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)
1
2
3
4
5
section 170(b)(1)(A)(iv). (Complete Part II.)
6
7
8
9
receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of
its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses
acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)
10
11
e
By checking this box, I certify that the organization is not controlled directly or indirectly by one or more disqualified persons other than foundation managers and other than one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2).
f
If the organization received a written determination from the IRS that it is a Type I, Type II, or Type III supporting organization, check this box
..................................................
g
Since August 17, 2006, has the organization accepted any gift or contribution from any of the following persons?
(i) A person who directly or indirectly controls, either alone or together with persons described in (ii)
Yes
No
and (iii) below, the governing body of the supported organization?
................
11g(i)
(ii)
A family member of a person described in (i) above?
......................
11g(ii)
(iii)
A 35% controlled entity of a person described in (i) or (ii) above?
................
11g(iii)
h
Provide the following information about the supported organization(s).
(i) Name of supported organization
(ii) EIN
(iii) Type of organization (described on lines 1- 9 above or IRC section (see instructions))
(iv) Is the organization in col. (i) listed in your governing document?
(v) Did you notify the organization in col. (i) of your support?
(vi) Is the organization in col. (i) organized in the U.S.?
(vii) Amount of monetary support
Yes
No
Yes
No
Yes
No
Total
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990EZ.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2013
Schedule A (Form 990 or 990-EZ) 2013
Page 2
Part II
Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi) (Complete only if you checked the box on line 5, 7, or 8 of Part I or if the
organization failed to qualify under Part III. If the organization fails to
qualify under the tests listed below, please complete Part III.)
Section A. Public Support
Calendar year (or fiscal year beginning in)
(a) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(f) Total
1
Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....
7,231,986
13,898,055
19,596,765
26,439,730
31,417,839
98,584,375
2
Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......
3
The value of services or facilities furnished by a governmental unit to the organization without charge..
35,327
85,560
75,318
37,360
233,565
4
Total. Add lines 1 through 3
7,231,986
13,933,382
19,682,325
26,515,048
31,455,199
98,817,940
5
The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included
on line 1 that exceeds 2% of the amount shown on line 11, column (f)..
1,402,434
6
Public support. Subtract line 5 from line 4.
97,415,506
Section B. Total Support
Calendar year
(or fiscal year beginning in)
(a) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(f) Total
7
Amounts from line 4..
7,231,986
13,933,382
19,682,325
26,515,048
31,455,199
98,817,940
8
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...
10,348
6,612
10,049
8,260
3,175
38,444
9
Net income from unrelated business activities, whether or not the business is regularly carried on..
8,153
8,153
10
Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)..
11
Total support (Add lines 7 through 10).
98,864,537
12
Gross receipts from related activities, etc. (see instructions)
..................
12
8,777,364
13
First five years.
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here.................................................
Section C. Computation of Public Support Percentage
14
Public support percentage for 2013 (line 6, column (f) divided by line 11, column (f))
.........
14
98.530 %
15
Public support percentage for 2012 Schedule A, Part II, line 14
...............
15
96.080 %
16a
33 1/3% support test—2013.
If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization
.......................
b
33 1/3% support test—2012.
If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization
.....................
17a
10%-facts-and-circumstances test—2013.
If the organization did not check a box on line 13, 16a, or 16b, and line 14
is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here. Explain
in Part IV how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported
organization
.....................................................
b
10%-facts-and-circumstances test—2012.
If the organization did not check a box on line 13, 16a, 16b, or 17a, and line
15 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here.
Explain in Part IV how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported organization
................................................
18
Private foundation.
If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions
.....................................................
Schedule A (Form 990 or 990-EZ) 2013
Schedule A (Form 990 or 990-EZ) 2013
Page 3
Part III
Support Schedule for Organizations Described in Section 509(a)(2) (Complete only if you checked the box on line 9 of Part I or if the organization
failed to qualify under Part II. If the organization fails to qualify under
the tests listed below, please complete Part II.)
Section A. Public Support
Calendar year (or fiscal year beginning in)
(a) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(f) Total
1
Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
2
Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose......
3
Gross receipts from activities that are not an unrelated trade or business under section 513..
4
Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
5
The value of services or facilities furnished by a governmental unit to the organization without charge..
6
Total. Add lines 1 through 5.
7a
Amounts included on lines 1, 2, and 3 received from disqualified persons...
b
Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.
c
Add lines 7a and 7b..
8
Public support (Subtract line 7c from line 6.)
Section B. Total Support
Calendar year (or fiscal year beginning in)
(a) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(f) Total
9
Amounts from line 6...
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c
Add lines 10a and 10b.
11
Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
12
Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)
..
13
Total support. (Add lines 9, 10c, 11, and 12.)..
14
First five years.
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here.............................................
Section C. Computation of Public Support Percentage
15
Public support percentage for 2013 (line 8, column (f) divided by line 13, column (f))
.........
15
16
Public support percentage from 2012 Schedule A, Part III, line 15
...............
16
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2013 (line 10c, column (f) divided by line 13, column (f))
......
17
18
Investment income percentage from 2012 Schedule A, Part III, line 17
.............
18
19a
33 1/3% support tests—2013.
If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
........
b
33 1/3% support tests—2012.
If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
.....
20
Private foundation.
If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions
.....
Schedule A (Form 990 or 990-EZ) 2013
Schedule A (Form 990 or 990-EZ) 2013
Page 4
Part IV
Supplemental Information.
Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; and Part III, line 12. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
Explanation
Schedule A (Form 990 or 990-EZ) 2013
Additional Data
Software ID:
Software Version:
-
TIN:
SCHEDULE O (Form 990 or 990-EZ)
Department of the Treasury Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ
Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
Attach to Form 990 or 990-EZ.
Information about Schedule O (Form 990 or 990-EZ) and its instructions is at
www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public Inspection
Name of the organization
NORTH CAROLINA COMMUNITY CARE NETWORKS INC
Employer identification number
20-5408367
Return Reference
Explanation
FORM 990, PART VI, SECTION A, LINE 3
NORTH CAROLINA COMMUNITY CARE NETWORKS HAS INDEPENDENT CONTRACTORS THAT SERVED IN THE ROLES OF PRESIDENT, CHIEF FINANCIAL OFFICER AND ASSISTANT TREASURER, CHIEF OF STAFF, AND CHIEF INFORMATION OFFICER DURING PART OF THE YEAR.
FORM 990, PART VI, SECTION A, LINE 4
THE FOLLOWING REPRESENT SIGNIFICANT CHANGES MADE TO GOVERNING DOCUMENTS: THE BOARD OF DIRECTORS SHALL CONSIST OF NOT LESS THAT FIVE NOR MORE THAN THIRTEEN PERSONS. DIRECTORS NEED NOT BE MEMBERS OF THE CORPORATION, BUT SHALL BE COMPOSED OF INDIVIDUALS WITH EXPERIENCE IN HEALTH CARE INCLUDING: (I) AN INDIVIDUAL WITH HEALTH CARE FINANCE OR HEALTH ACTUARIAL EXPERTISE; (II) AN INDIVIDUAL WITH EXPERTISE IN HEALTH INFORMATION TECHNOLOGY; (III) REPRESENTATIVES OF THE PROVIDER COMMUNITY; (IV) AN INDIVIDUAL WITH KNOWLEDGE OF AND EXPERIENCE WORKING IN THE HEALTH INSURANCE INDUSTRY, AND (V) INDIVIDUALS THAT BROADLY REPRESENT PARTICIPANTS IN THE COMMUNITY CARE OF NORTH CAROLINA PROGRAM. PROCESSES FOR TERMS, NOMINATION, APPROVAL, ELECTION, AND REMOVAL SHALL BE SET BY AND ARE RESERVED TO THE CORPORATE MEMBER. THE PRESIDENT OF THE CORPORATION, EX OFFICIO, SHALL BE A MEMBER OF THE BOARD OF DIRECTORS. A MAJORITY OF THE DIRECTORS IN OFFICE IMMEDIATELY BEFORE A MEETING BEGINS SHALL CONSTITUTE A QUORUM FOR THE TRANSACTION OF BUSINESS. SEE SCHEDULE O RESPONSES TO FORM 990, PART VI, QUESTIONS 6 AND 7 FOR ADDITIONAL CHANGES TO GOVERNING DOCUMENTS.
FORM 990, PART VI, SECTION A, LINE 6
THE SOLE CORPORATE MEMBER SHALL BE COMMUNITY CARE OF NORTH CAROLINA, INC. THE CORPORATE MEMBER SHALL ACT THROUGH ITS BOARD OF DIRECTORS AND SHALL BE ENTITLED TO VOTE ON ALL MATTERS RESERVED TO THE CORPORATE MEMBER, UNLESS OTHERWISE SPECIFIED IN THE BYLAWS. THE TERM OF THE CORPORATE MEMBER SHALL BE PERPETUAL.
FORM 990, PART VI, SECTION A, LINE 7A
THE CORPORATE MEMBER SHALL HAVE THE RIGHT TO APPROVE THE APPOINTMENT OF A DIRECTOR OF THE CORPORATION.
FORM 990, PART VI, SECTION A, LINE 7B
THE FOLLOWING REPRESENT GOVERNANCE DECISIONS SUBJECT TO APPROVAL OF THE CORPORATE MEMBER: 1) OPERATING AND CAPITAL BUDGETS OF THE CORPORATION, 2) INCURRENCE OF INDEBTEDNESS, 3) PROPOSED SALE, LEASE, EXCHANGE, OR OTHER DISPOSITION OF SUBSTANTIALLY ALL OF THE ORGANIZATION'S PROPERTY, 4) APPOINTMENT OR REMOVAL OF THE PRESIDENT OR DIRECTOR OF THE CORPORATION, 5) VOLUNTARY DISSOLUTION OF THE CORPORATION, 6) VENDOR AGREEMENTS INVOLVING 20% OR MORE OF THE CORPORATION'S OPERATING EXPENSE, AND 6) ESTABLISHMENT OF LONG RANGE PLANS AND STRATEGIES.
FORM 990, PART VI, SECTION B, LINE 11
FORM 990 IS REVIEWED BY MANAGEMENT AND PROVIDED TO EACH VOTING MEMBER OF THE BOARD IN FULL BEFORE FILING WITH THE INTERNAL REVENUE SERVICE.
FORM 990, PART VI, SECTION B, LINE 12C
EACH DIRECTOR, PRINCIPAL OFFICER AND EMPLOYEE SIGNS A STATEMENT ANNUALLY. THE CORPORATION SHALL CONDUCT PERIODIC REVIEWS OF ITS ACTIVITIES TO ENSURE THAT IT IS OPERATING IN A MANNER CONSISTENT WITH ITS CHARITABLE PURPOSES AND THAT IT IS NOT ENGAGING IN ACTIVITIES THAT COULD JEOPARDIZE ITS STATUS AS AN ORGANIZATION EXEMPT FROM FEDERAL INCOME TAX. IN ADDITION, IF THE BOARD OF DIRECTORS OR PRESIDENT/CEO HAS REASONABLE CAUSE TO BELIEVE THAT A DIRECTOR, OFFICER, OR EMPLOYEE FAILED TO DISCLOSE ACTUAL OR POSSIBLE CONFLICTS OF INTEREST, IT SHALL INFORM SUCH MEMBER OF THE BASIS FOR SUCH BELIEF AND AFFORD THE MEMBER AN OPPORTUNITY TO EXPLAIN THE ALLEGED FAILURE TO DISCLOSE. IF, AFTER HEARING THE REPONSE AND AFTER MAKING SUCH FURTHER INVESTIGATION AS MAY BE WARRANTED UNDER THE CIRCUMSTANCE, THE BOARD OF DIRECTORS DETERMINES THAT THE MEMBER HAS FAILED TO DISCLOSE AN ACTUAL OR POSSIBLE CONFLICT OF INTEREST, IT SHALL TAKE APPROPRIATE DISCIPLINARY AND CORRECTIVE ACTION.
FORM 990, PART VI, SECTION B, LINE 15
THE EVALUATION AND COMPENSATION COMMITTEE RECOMMENDED, AND THE BOARD APPROVED, A CORPORATE COMPENSATION PHILOSOPHY ON JUNE 3, 2013. THE PHILOSOPHY INCLUDES: PAYING AT A LEVEL TO ATTRACT AND RETAIN QUALIFIED AND TALENTED EXECUTIVES; COMPENSATION BASED ON BENCHMARKS AND SIMILARLY SIZED NON-PROFITS WITH SIMILAR EXECUTIVE STRUCTURES; COMPENSATION AT OR SLIGHTLY ABOVE MEDIAN; BASE SALARY INCREASES LINKED TO PERFORMANCE AND SKILLS. EXECUTIVE COMPENSATION IS EVALUATED AND APPROVED BY THE EVALUATION AND COMPENSATION COMMITTEE AND RATIFIED BY THE BOARD OF DIRECTORS. CEO COMPENSATION IS APPROVED BY THE BOARD OF DIRECTORS.
FORM 990, PART VI, SECTION C, LINE 19
ALL GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE UPON WRITTEN REQUEST AT THE OFFICE OF THE ORGANIZATION.
FORM 990, PART VII
MICHELLE BROOKS - 4207 DUNHAGAN ROAD, GREENVILLE, NC 27858. MARCI MILES - 3000 AERIAL CENTER PARKWAY STE. 101, MORRISVILLE, NC 27560. JOHN MORROW, MD - 201 GOVERNMENT CIRCLE, GREENVILLE, NC 27834. GARY SALAMIDO - 701 CORPORATE CENTER DRIVE, STE 400, RALEIGH, NC 27607. TOM SIBERT, MD - 760 SCOTT ROAD, LEWISVILLE, NC 27023. PAUL CUNNINGHAM, MD - 600 MOYE BLVD, AD52, GREENVILLE, NC 27834. PAM SHIPMAN - 4855 MILESTONE AVE, KANNAPOLIS, NC 28081. WILLIAM PULLY - 2400 WESTON PKWY, CARY, NC 27513. DANIEL A. EDELSON - 8104 FALLSTON COURT, RALEIGH, NC 27613. MICHAEL S. LANCASTER - 2320 HONEYSUCKLE COURT, CHAPEL HILL, NC 27514. MICHAEL RHOADES - 5100 NORTHCREEK DRIVE, WILMINGTON, NC 28409. ELIZABETH TILSON, MD - 2500 BLUE RIDGE ROAD, STE 330, RALEIGH, NC 27607. BRIAN TOOMEY - 299 LLOYD STREET, CARRBORO, NC 27510. RICHARD HUDSPETH, MD - 53 SOUTH FRENCH BLVD, SUITE 306, ASHEVILLE, NC 28801. LYDIA NEWMAN - 1209 CULBRETH DRIVE, SUITE 200, WILMINGTON, NC 28405.
FORM 990, PART XII, LINE 2C
NORTH CAROLINA COMMUNITY CARE NETWORKS HAS NOT CHANGED THEIR OVERSIGHT PROCESS OF THE AUDIT NOR THEIR SELECTION PROCESS FOR THEIR INDEPENDENT ACCOUNTANT FROM PRIOR YEARS. THE FINANCE COMMITTEE SERVES AS THE OVERSEEING COMMITTEE FOR THE AUDIT PROCESS.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.