Attach to Form 990 or Form 990-EZ.
Go to
www.irs.gov/Form990 for instructions and the latest information.
| (i) Name of supported organization | (ii) EIN | (iii) Type of organization (described on lines 1- 10 above (see instructions)) | (iv) Is the organization listed in your governing document? | (v) Amount of monetary support (see instructions) | (vi) Amount of other support (see instructions) | |
|---|---|---|---|---|---|---|
| Yes | No | |||||
|
Total |
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Calendar year
(or fiscal year beginning in)
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(a) 2017 | (b) 2018 | (c) 2019 | (d) 2020 | (e) 2021 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") .. | 1,755,821 | 2,060,323 | 2,131,489 | 2,022,171 | 1,082,279 | 9,052,083 |
| 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.. | ||||||
| 4 | Total. Add lines 1 through 3 | 1,755,821 | 2,060,323 | 2,131,489 | 2,022,171 | 1,082,279 | 9,052,083 |
| 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) .. | ||||||
| 6 | Public support. Subtract line 5 from line 4. | 9,052,083 | |||||
Calendar year
(or fiscal year beginning in)
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(a) 2017 | (b) 2018 | (c) 2019 | (d) 2020 | (e) 2021 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | 1,755,821 | 2,060,323 | 2,131,489 | 2,022,171 | 1,082,279 | 9,052,083 |
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources... | ||||||
| 9 | Net income from unrelated business activities, whether or not the business is regularly carried on.. | ||||||
| 10 | Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.).. | ||||||
| 11 | Total support. Add lines 7 through 10 | 9,052,083 | |||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2017 | (b) 2018 | (c) 2019 | (d) 2020 | (e) 2021 | (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.) | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2017 | (b) 2018 | (c) 2019 | (d) 2020 | (e) 2021 | (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 on 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 VI.) .. | ||||||
| 13 | Total support. (Add lines 9, 10c, 11, and 12.).. | ||||||
| Section A - Adjusted Net Income | (A) Prior Year |
(B) Current Year (optional) |
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| 1 | Net short-term capital gain | 1 | ||||
| 2 | Recoveries of prior-year distributions | 2 | ||||
| 3 | Other gross income (see instructions) | 3 | ||||
| 4 | Add lines 1 through 3 | 4 | ||||
| 5 | Depreciation and depletion | 5 | ||||
| 6 | Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions) | 6 | ||||
| 7 | Other expenses (see instructions) | 7 | ||||
| 8 | Adjusted Net Income (subtract lines 5, 6 and 7 from line 4) | 8 | ||||
| Section B - Minimum Asset Amount | (A) Prior Year |
(B) Current Year (optional) |
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| 1 | Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year): | 1 | ||||
| a | Average monthly value of securities | 1a | ||||
| b | Average monthly cash balances | 1b | ||||
| c | Fair market value of other non-exempt-use assets | 1c | ||||
| d | Total (add lines 1a, 1b, and 1c) | 1d | ||||
| e |
Discount claimed for blockage or other factors (explain in detail in Part VI): |
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| 2 | Acquisition indebtedness applicable to non-exempt use assets | 2 | ||||
| 3 | Subtract line 2 from line 1d | 3 | ||||
| 4 | Cash deemed held for exempt use. Enter 0.015 of line 3 (for greater amount, see instructions). | 4 | ||||
| 5 | Net value of non-exempt-use assets (subtract line 4 from line 3) | 5 | ||||
| 6 | Multiply line 5 by 0.035 | 6 | ||||
| 7 | Recoveries of prior-year distributions | 7 | ||||
| 8 | Minimum Asset Amount (add line 7 to line 6) | 8 | ||||
| Section C - Distributable Amount | Current Year | |||||
| 1 | Adjusted net income for prior year (from Section A, line 8, Column A) | 1 | ||||
| 2 | Enter 85% of line 1 | 2 | ||||
| 3 | Minimum asset amount for prior year (from Section B, line 8, Column A) | 3 | ||||
| 4 | Enter greater of line 2 or line 3 | 4 | ||||
| 5 | Income tax imposed in prior year | 5 | ||||
| 6 | Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions) | 6 | ||||
| Section D - Distributions | Current Year | |
|---|---|---|
| 1 Amounts paid to supported organizations to accomplish exempt purposes | 1 | |
|
2
Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity |
2 | |
| 3 Administrative expenses paid to accomplish exempt purposes of supported organizations | 3 | |
| 4 Amounts paid to acquire exempt-use assets | 4 | |
| 5 Qualified set-aside amounts (prior IRS approval required - provide details in Part VI) | 5 | |
| 6 Other distributions (describe in Part VI). See instructions | 6 | |
| 7Total annual distributions. Add lines 1 through 6. | 7 | |
|
8
Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions |
8 | |
| 9 Distributable amount for 2021 from Section C, line 6 | 9 | |
| 10 Line 8 amount divided by Line 9 amount | 10 | |
| Section E - Distribution Allocations (see instructions) |
(i) Excess Distributions |
(ii) Underdistributions Pre-2021 |
(iii) Distributable Amount for 2021 |
|
|---|---|---|---|---|
| 1 Distributable amount for 2021 from Section C, line 6 | ||||
|
2
Underdistributions, if any, for years prior to 2021 (reasonable cause required-- explain in Part VI). See instructions. |
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| 3 Excess distributions carryover, if any, to 2021: | ||||
| a From 2016....... | ||||
| b From 2017....... | ||||
| c From 2018....... | ||||
| d From 2019....... | ||||
| e From 2020....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2021 distributable amount | ||||
|
i
Carryover from 2016 not applied (see instructions) |
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| j Remainder. Subtract lines 3g, 3h, and 3i from line 3f. | ||||
| 4Distributions for 2021 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2021 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from line 4. | ||||
|
5
Remaining underdistributions for years prior to 2021, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions. |
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|
6
Remaining underdistributions for 2021. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions. |
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7 Excess distributions carryover to 2022. Add lines 3j and 4c. |
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| 8 Breakdown of line 7: | ||||
| a Excess from 2017..... | ||||
| b Excess from 2018..... | ||||
| c Excess from 2019..... | ||||
| d Excess from 2020..... | ||||
| e Excess from 2021..... | ||||
| Facts And Circumstances Test |
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| Return Reference | Explanation |
|---|---|
| PART II, SHORT YEAR EXPLANATION: | PUBLIC SUPPORT IS MEASURED USING A 5 YEAR COMPUTATIONAL PERIOD THAT INCLUDES THE CURRENT SHORT TAX YEAR ENDING DECEMBER 31, 2021 AND THE FOUR PRIOR PERIODS, INCLUDING FISCAL YEARS ENDING JUNE 30, 2021, JUNE 30, 2020, JUNE 30, 2019, AND JUNE 30, 2018. |
| Software ID: | |
| Software Version: |
Attach to Form 990 or 990-EZ.
Go to www.irs.gov/Form990 for the latest information.
| Return Reference | Explanation |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 4 | THE FILING ORGANIZATION'S BYLAWS WERE AMENDED EFFECTIVE JULY 1, 2021 TO CHANGE THE FILING ORGANIZATION'S FISCAL YEAR FROM ONE ENDING JUNE 30 TO ONE ENDING DECEMBER 31. |
| FORM 990, PART VI, SECTION A, LINE 7A | THE RESTATED BYLAWS OF THE FILING ORGANIZATION CALL FOR A BOARD OF DIRECTORS OF NOT LESS THAN 5 NOR MORE THAN 9. ONE DIRECTOR IS DESIGNATED AS THE PRINCIPAL INVESTIGATOR AND IS SPECIFICALLY NAMED IN THE BYLAWS AS DR. ATALA, WHO SERVES UNTIL HIS RESIGNATION, DEATH OR REMOVAL. FOUR DIRECTORS ARE TO BE APPOINTED BY WAKE FOREST UNIVERSITY HEALTH SCIENCES (WFUHS), OR ITS CEO. WFUHS IS A TAX EXEMPT EDUCATIONAL ORGANIZATION EXEMPT UNDER IRC SECTION 501(C)(3). UP TO FOUR DIRECTORS ("REGENMED DIRECTORS") ARE TO BE APPOINTED BY THE CORPORATION'S BOARD, SHALL BE WORKING IN THE REGENERATIVE MEDICINE FIELD, BUT SHALL NOT BE EMPLOYED BY WFUHS OR BE A BOARD MEMBER OF WFUHS OR A WFUHS AFFILIATE ORGANIZATION. AS OF THE END OF ITS FISCAL YEAR, THE BOARD CONSISTED OF THE DESIGNATED PRINCIPAL INVESTIGATOR AND THE FOUR WFUHS DIRECTORS. |
| 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 AND COMMENT, THE REVISED FORM 990 IS REDISTRIBUTED PRIOR TO ITS FILING WITH THE IRS, ALONG WITH A REPORT NOTING THE MODIFICATIONS. |
| FORM 990, PART VI, SECTION B, LINE 12C | THE ORGANIZATION REQUIRES ITS OFFICERS AND DIRECTORS TO DISCLOSE CONFLICTS OF INTEREST 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 ORGANIZATION PAYS NO COMPENSATION TO OFFICERS OR DIRECTORS FOR THEIR EFFORT DEVOTED TO THE FILING ORGANIZATION. ALL COMPENSATION PAID TO OFFICERS WAS PAID BY RELATED ORGANIZATIONS, WAKE FOREST UNIVERSITY HEALTH SCIENCES ("WFUHS") OR WAKE FOREST UNIVERSITY ("WFU"), FOR THEIR SERVICE AS EMPLOYEES OF SUCH RELATED ORGANIZATIONS. THE SENIOR EXECUTIVE COMPENSATION COMMITTEE OF THE WAKE FOREST UNIVERSITY BAPTIST MEDICAL CENTER ("WFUBMC") BOARD (ACTING, PURSUANT TO A DELEGATION, ON BEHALF OF WFUHS (WHICH ENTITY HAS THE RIGHT UNDER THE FILING ORGANIZATION'S BYLAWS TO APPOINT THE MAJORITY OF THE FILING ORGANIZATION'S BOARD MEMBERS) WITH RESPECT TO A FILING ORGANIZATION OFFICER AND DIRECTOR EMPLOYED BY WFUHS) IS RESPONSIBLE FOR REVIEWING AND APPROVING SUCH FILING ORGANIZATION OFFICER AND DIRECTOR'S COMPENSATION. ANOTHER FILING ORGANIZATION OFFICER AND DIRECTOR IS COMPENSATED BY RELATED ORGANIZATION WFU (THE PARENT OF WFUHS); HIS COMPENSATION IS REVIEWED AND APPROVED IN ACCORDANCE WITH THAT RELATED ORGANIZATION'S SIMILAR PROCEDURES CALLING FOR COMPENSATION COMMITTEE REVIEW AND APPROVAL. BOTH COMMITTEES USE INDEPENDENT COMPENSATION CONSULTANTS, COMPENSATION SURVEYS, AND STUDIES TO DETERMINE THE APPROPRIATENESS OF EACH SUCH OFFICER'S COMPENSATION. |
| 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 VII, SECTION A, COLUMN(B), AVERAGE HOURS PER WEEK | J. REID MORGAN FILING ORG 0.1 RELATED ORG 30.9 UNRELATED ORG 9.0 TERRY G. WILLIAMS FILING ORG 0.1 RELATED ORG 1.1 UNRELATED ORG 38.8 JULIE M. WATSON FILING ORG 0.5 RELATED ORG 19.5 ANTHONY ATALA, M.D. FILING ORG 0.5 RELATED ORG 39.5 TERRY L. HALES, JR. FILING ORG 0.1 RELATED ORG 39.9 A MEDICAL CENTER INTEGRATION AGREEMENT ("MCIA") WAS ORIGINALLY ENTERED INTO IN 2010 AMONG FOUR PARTIES: WAKE FOREST UNIVERSITY ("WFU"), WAKE FOREST UNIVERSITY HEALTH SCIENCES ("WFUHS"), WAKE FOREST UNIVERSITY BAPTIST MEDICAL CENTER ("WFUBMC"), AND NORTH CAROLINA BAPTIST HOSPITAL ("NCBH"). PURSUANT TO THE TERMS OF THE ORIGINAL MCIA, THE OPERATION OF WFUHS AND NCBH, AND ALL OF THE RESPECTIVE SUBSIDIARIES OF EACH, IS DELEGATED TO WFUBMC. ADDITIONALLY, THE CORPORATE OFFICERS OF WFUBMC GENERALLY SERVE AS THE CORPORATE OFFICERS OF WFUHS AND NCBH. THE MCIA WAS REVISED AND RESTATED IN 2020 TO DELEGATE OVERSIGHT AND MANAGEMENT AUTHORITY OVER WFUBMC TO ATRIUM HEALTH, INC. ("AHI"). CERTAIN DIRECTORS AND/OR CORPORATE OFFICERS OF WFUHS, NCBH, & WFUBMC ALSO SERVE AS DIRECTORS OR CORPORATE OFFICERS OF AHI. WFU AND WFUHS ARE ORGANIZATIONS RELATED TO THE FILING ORGANIZATION. NCBH, WFUBMC, AND AHI ARE ORGANIZATIONS UNRELATED TO THE FILING ORGANIZATION. THUS, CERTAIN DIRECTORS AND OFFICERS OF THE FILING ORGANIZATION DEVOTE HOURS TO RELATED ORGANIZATIONS (WFU & WFUHS) AND UNRELATED ORGANIZATIONS (WFUBMC, NCBH, AND AHI) AS SHOWN IN THE BREAKDOWN OF HOURS ABOVE. |
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