| FORM 990, PART VI, SECTION A, LINE 6 |
THE SOLE MEMBER OF IMPACT HEALTH IS DOGWOOD HEALTH TRUST. |
| FORM 990, PART VI, SECTION A, LINE 7A |
DOGWOOD HEALTH TRUST, AS THE SOLE MEMBER, IS ENTITLED TO ALL RIGHTS AND POWERS OF A MEMBER SET FORTH IN THE BYLAWS AS PROVIDED UNDER NORTH CAROLINA LAW. |
| FORM 990, PART VI, SECTION A, LINE 7B |
THE FOLLOWING ACTIONS SHALL NOT BE EFFECTIVE UNLESS APPROVED BY DOGWOOD HEALTH TRUST, AS THE SOLE MEMBER: 1. ANY AMENDMENT TO THE ARTICLES OF INCORPORATION OR AMENDMENT OR REPEAL OF THE BYLAWS 2. ELECTION, APPOINTMENT, OR REMOVAL OF, WITH OR WITHOUT CAUSE, A DIRECTOR OF THE BOARD OF IMPACT HEALTH 3. MERGER, CONSOLIDATION, DISPOSITION, DISSOLUTION, OR LIQUIDATION OF IMPACT HEALTH, OR SALE OF ALL OR SUBSTANTIALLY ALL OF ITS ASSETS 4. THE SALE, LEASE, OR OTHER TRANSFER OF A MATERIAL PORTION, SUBSTANTIALLY ALL OR ALL OF THE ASSETS OF IMPACT HEALTH 5. THE SELECTION AND REMOVAL OF THE CHAIR OF IMPACT HEALTH 6. APPROVAL OF IMPACT HEALTH'S ANNUAL OPERATING AND CAPITAL BUDGETS AND AMENDMENTS THERETO 7. INCURRENCE OR GUARANTEE OF INDEBTEDNESS GREATER THAN $XXX |
| FORM 990, PART VI, SECTION B, LINE 11B |
THE ORGANIZATION'S FORM 990 IS PREPARED BY A NATIONALLY RECOGNIZED ACCOUNTING FIRM IN CONJUNCTION WITH THE ORGANIZATION'S SENIOR MANAGEMENT AND FINANCIAL TEAM. UPON COMPLETION, THE ORGANIZATION'S EXTERNAL ACCOUNTING FIRM PRESENTS THE FORM 990 TO THE FINANCE COMMITTEE OF THE BOARD OF DIRECTORS TO ENABLE THEM TO FULFILL THEIR DUE DILIGENCE AND OVERSIGHT RESPONSIBILITIES. A COPY OF THE FINAL FORM 990 IS SHARED WITH THE FULL BOARD OF DIRECTORS PRIOR TO ITS ELECTRONIC FILING WITH THE INTERNAL REVENUE SERVICE. |
| FORM 990, PART VI, SECTION B, LINE 12C |
EACH OFFICER, DIRECTOR, EMPLOYEE, AND SUBCONTRACTOR IS REQUIRED TO ANNUALLY DISCLOSE ANY CONFLICTS OF INTEREST THAT ARISE BY VIRTUE OF THEIR RELATIONSHIP TO THE ORGANIZATION, BOARD SERVICE, OR POSITION WITHIN THE ORGANIZATION. THE BOARD (OR COMMITTEE THEREOF), WITH ASSISTANCE FROM THE EXECUTIVE DIRECTOR, MONITORS COMPLIANCE WITH ITS CONFLICT OF INTEREST POLICY THROUGH AN ANNUAL QUESTIONNAIRE/DISCLOSURE STATEMENT THAT IS DISTRIBUTED TO THESE INDIVIDUALS. THE ORGANIZATION ALSO REQUESTS COIS FROM ITS NCDHHS-APPROVED SUBCONTRACTORS. POTENTIAL CONFLICTS ARE INVESTIGATED AND MANAGED IMMEDIATELY. IN THE EVENT OF A CONFLICT, INDIVIDUALS ARE PROHIBITED FROM PARTICIPATING IN GOVERNING BODY DELIBERATIONS AND DECISIONS TO WHICH THE CONFLICT IS RELATED. |
| FORM 990, PART VI, SECTION B, LINE 15 |
COMPENSATION OF THE ORGANIZATION'S PRESIDENT IS ESTABLISHED BY DOGWOOD HEALTH TRUST, A RELATED TAX-EXEMPT ORGANIZATION. COMPENSATION LEVELS ARE ESTABLISHED WITHIN COMPETITIVE RANGES DETERMINED VIA COMPARISON WITH OTHER SIMILAR ORGANIZATIONS AND LOCAL MARKET CONDITIONS. THE BOARD CONSIDERS COMPENSATION AGAINST BENCHMARKS THAT HR RECEIVES FROM AN EXTERNAL CONSULTANT FOR SALARY BENCHMARKING. CONTEMPORANEOUS DOCUMENTATION AND RECORDS ARE KEPT IN RELATION TO THE DECISIONS MADE. |
| FORM 990, PART VI, SECTION C, LINE 19 |
THE ORGANIZATION MAKES ITS FORM 990 AVAILABLE TO THE PUBLIC BY RETAINING A COPY AT ITS PLACE OF BUSINESS IN ADDITION TO POSTING IT ON THE ORGANIZATION'S WEBSITE. THE FORM 990 IS ALSO AVAILABLE ON WWW.GUIDESTAR.ORG. THE ORGANIZATION'S FINANCIAL STATEMENTS, GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE NOT ORDINARILY MADE AVAILABLE TO THE PUBLIC, BUT, IF REQUESTED, WILL BE PROVIDED AT MANAGEMENT'S DISCRETION. |
| FORM 990, PART IX, LINE 11G |
OTHER PROFESSIONAL SERVICES AND CONSULTING FEES: PROGRAM SERVICE EXPENSES 971,247. MANAGEMENT AND GENERAL EXPENSES 96,057. TOTAL EXPENSES 1,067,304. |
Attach to Form 990 or 990-EZ.