2020-11-12T11:47:31-06:00 2019-12-31 454084437 WARREN AVERETT LLC 2500 ACTON ROAD BIRMINGHAM AL 35243 990 2019-01-01 320453405 NORTHWEST MEDICAL CENTER INC NORT 2054877726 1530 US HIGHWAY 43 WINFIELD AL 35594 JIM DICKINSON CHAIRMAN 2054877726 2020-11-11 1 MEGAN RANDOLPH P00989558 2059794100 2020-11-11 99.4.118.175 2020-11-11 14:29:16 CS P 476F2095544EC66BFD9F846A02B49E10FDD1659F EAECE24E0AA866986F118FE911069C5045BA6FD0 2019 2021-01-29 14:40:06Z JIM DICKINSON 1530 US HIGHWAY 43 WINFIELD AL 35594 17411383 0 X WWW.NORTHWESTMEDCENTER.NET X 2014 AL NORTHWEST MEDICAL CENTER, INC., SEEKS TO IDENTIFY AND SERVE THE PRIMARY HEALTHCARE NEEDS OF INPATIENTS, OUTPATIENTS, SURGICAL, AND ER PATIENTS IN A RURAL ENVIRONMENT. X 5 5 308 1 0 0 0 0 26071347 16828559 0 0 310202 582824 26381549 17411383 0 0 0 0 12826894 8355191 0 0 0 17904596 10500798 30731490 18855989 -4349941 -1444606 7739443 0 9655947 0 -1916504 0 X NORTHWEST MEDICAL CENTER, INC., SEEKS TO IDENTIFY AND SERVE THE PRIMARY HEALTHCARE NEEDS OF INPATIENTS, OUTPATIENTS, SURGICAL, AND ER PATIENTS IN A RURAL ENVIRONMENT. 0 1 16401680 17123670 NORTHWEST MEDICAL CENTER, INC., SEEKS TO IDENTIFY AND SERVE THE PRIMARY HEALTHCARE NEEDS OF INPATIENTS, OUTPATIENTS, SURGICAL, AND ER PATIENTS IN A RURAL ENVIRONMENT. 16401680 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 1 51 0 1 308 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X 5 5 0 0 1 0 0 0 0 1 1 0 0 0 1 1 1 1 1 1 1 0 X TRACY MARTIN 2054877726 1530 US HWY 43 WINFIELD AL 35594 DAVID CORBETT MD BOARD MEMBER 0.00 0.00 X 0 0 0 JAMES R MOSS MD BOARD MEMBER 0.00 0.00 X 0 0 0 JIM DICKINSON CHAIRMAM 0.00 0.00 X X 0 0 0 RANDY PRICE BOARD MEMBER 0.00 0.00 X 0 0 0 RAYMOND SPANN JR BOARD MEMBER 0.00 0.00 X 0 0 0 GLENDA REYES CFO 40.00 0.00 X 119974 0 11888 MICHAEL ARNO CEO (ENDING 06/12/2019) 40.00 0.00 X 199674 0 0 ROBERT HENGER CEO (BEGINNING 06/17/2019) 40.00 0.00 X 51926 0 6708 JOSEPH WALKER MD PHYSICIAN 40.00 0.00 X 508320 0 19780 MARTIN HAJJAR MD PHYSICIAN 40.00 0.00 X 476123 0 19780 JERILL THOMAS MD PHYSICIAN 40.00 0.00 X 400259 0 19780 DEREK CANNON MD PHYSICIAN 40.00 0.00 X 397260 0 0 MUHAMMAD HUSAIN MD PHYSICIAN 40.00 0.00 X 397176 0 19780 2550712 0 97716 13 0 1 0 HARRIS MEDICAL HOSPITAL 1180 SATELLITE BLVD SUWANEE GA 300240000 LOCUM SERVICES 607813 NORTHWEST ANESTHESIA 160 ROCKWELL STREET WINFIELD AL 35594 ANESTHESIA SERVICES 516935 TRIMEDEX PO BOX 636129 CINCINNATI OH 452636129 CONTRACTED MAINTENANCE 299017 DIVERSIFIED CLINICAL SERVICES PO BOX 28525 NETWORK PLACE CHICAGO IL 606731285 CONTRACTED WOUND CARE SERVICES 247215 WESTERN HEALTHCARE PO BOX 203152 DALLAS TX 753203152 LOCUM SERVICES 163763 7 PATIENT SERVICE FEES 624100 16828559 16828559 16828559 287713 0 287713 287713 287713 MISCELLANEOUS 900099 133461 133461 WELLNESS CENTER 900099 103414 103414 CAFETERIA & VENDING 900099 58236 58236 295111 17411383 17123670 0 287713 7198053 6730416 467637 1157138 1128613 28525 69543 69350 193 85545 85308 237 974415 608415 366000 1180299 1143529 36770 40056 25011 15045 531 531 245908 245908 284804 33968 250836 CONTRACT SERVICES 3075597 2964247 111350 BAD DEBT EXPENSE 2879085 2879085 TAXES & ASSESSMENTS 895997 895997 DRUGS & MEDICAL SUPPLIE 675092 675092 93926 58646 35280 18855989 16401680 2454309 0 418348 0 2177756 0 472727 0 249063 0 0 0 4419014 0 2535 0 7739443 0 2369124 0 150887 0 7135936 0 9655947 0 X -1916504 0 -1916504 0 7739443 0 X -1444606 3361110 X X 0 1 X 1 0 X 0 X PART X, LINE 2: NWMC IS EXEMPT FROM INCOME TAXES UNDER SECTION 501(A) OF THE INTERNAL REVENUE CODE AS AN ORGANIZATION DESCRIBED IN SECTION 501(C)(3). NWMC ADHERES TO THE PROVISIONS OF THE ACCOUNTING STANDARDS CODIFICATION RELATING TO UNCERTAINTY IN INCOME TAXES THAT REQUIRES ENTITIES TO ASSESS THEIR UNCERTAIN TAX POSITIONS FOR THE LIKELIHOOD THAT THEY WOULD BE OVERTURNED UPON INTERNAL REVENUE SERVICE (IRS) EXAMINATION OR UPON EXAMINATION BY STATE TAXING AUTHORITIES. NWMC HAS DETERMINED THAT IT DOES NOT HAVE ANY POSITIONS AT DECEMBER 31, 2019 OR 2018, THAT IT WOULD BE UNABLE TO SUBSTANTIATE. NWMC HAS FILED ITS TAX RETURNS THROUGH DECEMBER 31, 2018. THE TAX RETURNS FOR THE YEARS ENDED DECEMBER 31, 2016, AND THEREAFTER ARE SUBJECT TO AUDIT BY THE TAXING AUTHORITIES. 1 1 X 1 X 1 X 1 0 0 32965 32965 0.00170 1956446 744956 1211490 0.06420 1989411 744956 1244455 0.06590 3146 3146 0.00020 7944 7944 0.00040 11090 11090 0.00060 2000501 744956 1255545 0.06650 1 6618602 234672 9821432 9271430 550002 X 1 1 1 1 NORTHWEST MEDICAL CENTER INC 1530 US HIGHWAY 43 WINFIELD AL 35594 WWW.NORTHWESTMEDCENTER.NET X X NORTHWEST MEDICAL CENTER INC 1 0 0 0 0 1 X 150.000000000000 300.000000000000 X X 1 1 X X X X 1 X WWW.NORTHWESTMEDCENTER.NET X WWW.NORTHWESTMEDCENTER.NET X WWW.NORTHWESTMEDCENTER.NET X X X X 1 X 0 X X X X X 1 X 0 0 NORTHWEST MEDICAL CENTER, INC PART V, SECTION B, LINE 20E: THE HOSPITAL: PROVIDES PATIENTS WITH WRITTEN NOTICE OF IMPENDING ECAS (EXTRAORDINARY COLLECTION ACTIONS) AND A PLAIN LANGUAGE SUMMARY OF THE FINANCIAL ASSISTANCE POLICY AT LEAST 30 DAYS BEFORE INITATING THOSE ECAS; MAKES A REASONABLE EFFORT TO ORALLY NOTIFY INDIVIDUALS ABOUT THE FAP AND FAP APPLICATION PROCESS; AND PROCESSES INCOMPLETE AND COMPLETE FAP APPLICATIONS. 1 1 - NWMC-WINFIELD PHYSICIANS LLC 1530 US HIGHWAY 43 WINFIELD AL 35594 FAMILY MEDICINE PHYSICIAN FACILITY PART I, LN 7 COL(F): ACCOUNTS ARE EVALUATED FOR COLLECTABILITY ON A MONTHLY BASIS USING AGED PAYOR ACCOUNT CLASSIFICATIONS AND HISTORICAL COLLECTION EXPERIENCE. PART III, LINE 2: ACCOUNTS ARE EVALUATED FOR COLLECTABILITY ON A MONTHLY BASIS USING AGED PAYOR ACCOUNT CLASSIFICATIONS AND HISTORICAL COLLECTION EXPERIENCE. PART III, LINE 3: ACCOUNTS ARE EVALUATED FOR COLLECTABILITY ON A MONTHLY BASIS USING AGED PAYOR ACCOUNT CLASSIFICATIONS AND HISTORICAL COLLECTION EXPERIENCE. PART III, LINE 4: ACCOUNTS ARE EVALUATED FOR COLLECTABILITY ON A MONTHLY BASIS USING AGED PAYOR ACCOUNT CLASSIFICATIONS AND HISTORICAL COLLECTION EXPERIENCE. PART III, LINE 8: AS A NON-PROFIT ORGANIZATION, THE HOSPITAL ACCEPTS ALL PATIENTS REGARDLESS OF INSURANCE COVERAGE (OR LACK THEREOF) OR THE PATIENT'S ABILITY TO PAY. AMOUNTS REPORTED ARE BASED ON THE MEDICARE COST REPORT, WHICH IS PREPARED USING THE AUDITED TRIAL BALANCE AND IN ACCORDANCE WITH ALL APPLICABLE RULES AND REGULATIONS. PART III, LINE 9B: NORTHWEST MEDICAL CENTER OFFERS FINANCIAL ASSISTANCE TO PATIENTS AND GUARANTORS PURSUANT TO ITS FINANCIAL ASSISTANCE POLICY, WHICH IS BASED ON THE CURRENT FEDERAL POVERTY GUIDELINES (FPG). THOSE APPROVED FOR FINANCIAL ASSISTANCE ARE ELIGIBLE FOR DISCOUNTS APPLIED TO BALANCES OWED AFTER INSURANCE, AS WELL AS SELF-PAY BALANCES REMAINING AFTER THE UNINSURED DISCOUNT IS APPLIED. IF THE PATIENT'S FAMILY INCOME IS BETWEEN 0%-150% OF THE FEDERAL POVERTY GUIDELINES, A 100% DISCOUNT (CHARITY CARE) IS PROVIDED. IF THE PATIENT'S FAMILY INCOME IS BETWEEN 150%-250% OF THE FEDERAL POVERTY GUIDELINES, A 60% DISCOUNT (FINANCIAL ASSISTANCE) IS PROVIDED. IF THE PATIENT'S FAMILY INCOME IS BETWEEN 251%-300% OF THE FEDERAL POVERTY GUIDELINES, A 40% DISCOUNT (FINANCIAL ASSISTANCE) IS PROVIDED. THE FINANCIAL ASSISTANCE POLICY IS PUBLICIZED IN PATIENT REGISTRATION AREAS, BILLING STATEMENTS, AND ON THE HOSPITAL'S WEBSITE. PATIENTS NOT ELIGIBLE FOR CHARITY CARE OR WHO HAVE A BALANCE OWED AFTER THE APPLICATION OF CHARITY CARE OR UNINSURED DISCOUNT ARE SENT STATEMENTS AND/OR COLLECTION LETTERS AT LEAST EVERY 30 DAYS UNTIL THE BALANCE OWED IS PAID OR LONGER-TERM PAYMENT ARRANGEMENTS ARE MADE. ACCOUNTS THAT DO NOT HAVE SUFFICIENT PAYMENT ARRANGEMENTS ESTABLISHED ARE ELIGIBLE FOR OUTSIDE COLLECTIONS. ALL PATIENTS ARE NOTIFIED OF POSSIBLE COLLECTION ASSIGNMENT AT LEAST 30 DAYS BEFORE AN ASSIGNMENT IS MADE. IF A PATENT REQUESTS FINANCIAL ASSISTANCE AFTER STATEMENTS ARE SENT, THE ACCOUNT IS PLACED ON HOLD UNTIL A DETERMINATION OF ELIGIBILITY IS MADE. PART VI, LINE 2: THE HOSPITAL PERFORMS OUTREACH SERVICES AND PROVIDES HEALTH EDUCATION OPPORTUNITIES FOR THE COMMUNITY. FEEDBACK FROM THESE EFFORTS ALONG WITH THE EVALUATION OF THE PATIENTS SERVED ARE CONSIDERED IN ASSESSING THE COMMUNITY'S HEALTH CARE NEEDS.PART V, SECTION B, LINE 3:ON AUGUST 14, 2019, PRIOR TO THE ORGANIZATION'S YEAR END, NORTHWEST MEDICAL CENTER EXECUTED AN ASSET TRANSFER AND ASSIGNMENT AND ASSUMPTION AGREEMENT TO EFFECTIVELY TRANSFER ALL OF ITS ASSETS, LIABILITIES AND ACTIVITIES TO THE HEALTHCARE AUTHORITY OF WINFIELD, ALABAMA. THE HOSPITAL FACILITY WILL CONTINUE TO OPERATE AND CONDUCT ITS PROGRAMS THROUGH THE HEALTHCARE AUTHORITY, A POLITICAL SUBSIDIARY EXEMPT UNDER 115. AT THIS TIME, NORTHWEST MEDICAL CENTER CEASED OPERATING A HOSPITAL FACILITY AND THE REQUIREMENTS OF 501(R) NO LONGER APPLY THEREFORE, A COMMUNITY HEALTH NEEDS ASSESSMENT WAS NOT COMPLETED FOR THE YEAR ENDED DECEMBER 31, 2019. PART VI, LINE 3: INPATIENT SELF-PAY PATIENTS ARE SCREENED BY FINANCIAL COUNSELORS DURING THEIR STAY UPON APPLICATION BY THE PATIENT OR GUARANTOR. OUTPATIENT SERVICES ARE ALSO ELIGIBLE FOR FINANCIAL ASSISTANCE OR CHARITY UPON APPLICATION BY THE PATIENT OR GUARANTOR. SIGNAGE AT ALL REGISTRATION AREAS, MONTHLY STATEMENTS, AND THE WEBSITE REFERENCE PHONE NUMBERS TO CALLFOR FINANCIAL ASSISTANCE. PART VI, LINE 4: NORTHWEST MEDICAL CENTER PRIMARILY SERVES RESIDENTS OF WINFIELD, AL, INCLUDING THE COUNTIES OF MARION AND FAYETTE. THIS IS A RURAL COMMUNITY WITH A POPULATION BELOW 5,000 AND APPROXIMATELY 14% OF THE POPULATION FALLS BELOW THE POVERTY LINE. THE POPULATION IS PREDOMINANTLY CAUCASIAN (92%, AS OF THE MOST RECENT CENSUS). PART VI, LINE 5: THE HOSPITAL HAS A COMMUNITY BOARD OF VOLUNTEER DIRECTORS AND IS SERVED BY AN OPEN MEDICAL STAFF. THE FACILITY IS ALSO SUPPORTED BY LOCAL VOLUNTEERS. THE HOSPITAL ACTIVELY RECRUITS PRIMARY CARE PHYSICIANS AND SPECIALISTS TO MEET MEDICAL NEEDS IN THE COMMUNITY. IN ADDITION, THE HOSPITAL PERFORMS OUTREACH SERVICES AND PROVIDES HEALTH EDUCATION OPPORTUNITIES FOR THE COMMUNITY. 1 0 0 0 0 0 0 0 0 MICHAEL ARNO CEO (ENDING 06/12/2019) 173480 0 0 0 26194 0 0 0 0 0 199674 0 0 0 JOSEPH WALKER MD PHYSICIAN 508320 0 0 0 0 0 0 0 19780 0 528100 0 0 0 MARTIN HAJJAR MD PHYSICIAN 446423 0 29700 0 0 0 0 0 19780 0 495903 0 0 0 JERILL THOMAS MD PHYSICIAN 393859 0 6400 0 0 0 0 0 19780 0 420039 0 0 0 DEREK CANNON MD PHYSICIAN 395760 0 1500 0 0 0 0 0 0 0 397260 0 0 0 MUHAMMAD HUSAIN MD PHYSICIAN 377176 0 20000 0 0 0 0 0 19780 0 416956 0 0 0 PART I, LINE 4A MICHAEL ARNO, CEO, DEPARTED THE ORGANIZATION ON JUNE 12, 2019 AND RECEIVED SEVERANCE PAYMENTS TOTALING $26,194. TRANSFER OF ASSETS TO HEALTHCARE AUTHORITY OF WINFIELD, AL 2019-08-14 -3361110 FMV 824749088 HEALTHCARE AUTHORITY OF WINFIELD AL 7530 US HIGHWAY 43 WINFIELD AL 35594 POLITICAL SUBSIDIARY 1 1 0 0 PART II, LINE 2E: PERSON(S) INVOLVED: 2A: JIM DICKINSON, JAMES R. MOSS, MD, RAYMOND SPANN, JR, RANDY PRICE, & DAVID CORBETT, MD2B: ALL EMPLOYEES AND INDEPENDENT CONTRACTORS WILL BECOME EMPLOYEES AND INDEPENDENT CONTRACTORS OF THE HEALTHCARE AUTHORITY OF WINFIELD, ALABAMA FORM 990, PART III, LINE 3 ON AUGUST 14, 2019 NORTHWEST MEDICAL CENTER ADOPTED AN ASSET TRANSFER AND ASSIGNMENT AND ASSUMPTION AGREEMENT TO EFFECTIVELY TRANSFER ALL OF ITS ASSETS, LIABILITIES AND ACTIVITIES TO THE HEALTHCARE AUTHORITY OF WINFIELD, ALABAMA. THE ORGANIZATION WILL CONTINUE TO OPERATE AND CONDUCT ITS PROGRAMS THROUGH THE HEALTHCARE AUTHORITY. FORM 990, PART VI, SECTION A, LINE 4 ON AUGUST 14, 2019 NORTHWEST MEDICAL CENTER EXECUTED AN ASSET TRANSFER AND ASSIGNMENT AND ASSUMPTION AGREEMENT TO EFFECTIVELY TRANSFER ALL OF ITS ASSETS, LIABILITIES AND ACTIVITIES TO THE HEALTHCARE AUTHORITY OF WINFIELD, ALABAMA. THE ORGANIZATION WILL CONTINUE TO OPERATE AND CONDUCT ITS PROGRAMS THROUGH THE HEALTHCARE AUTHORITY. FORM 990, PART VI, SECTION B, LINE 11B DUE TO COVID-19 RESTRICTIONS, THE NOVEMBER 2020 BOARD MEETING WAS CANCELLED. THE FORM 990 WAS REVIEWED BY THE CHAIRMAIN AND CFO. FORM 990, PART VI, SECTION B, LINE 12C THE CONFLICT OF INTEREST POLICY IS DISCUSSED IN PERSON WITH EACH POTENTIAL BOARD MEMBER. WHEN MANAGEMENT BECOMES AWARE OF A POTENTIAL CONFLICT, IT IS DISCUSSED IN DEPTH WITH UPPER MANAGEMENT AND THE BOARD. FORM 990, PART VI, SECTION B, LINE 15 THE BOARD VOTED ON ALL COMPENSATION AS PART OF THEIR ANNUAL BUDGET PROCESS, WHICH INCLUDES A REVIEW OF ALL POTENTIAL RAISES AND COMPARISON OF COMPARABLE COMPENSATION DATA. FORM 990, PART VI, SECTION C, LINE 19 AS A GENERAL RULE, THE ORGANIZATION DOES NOT MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC. ANY WRITTEN REQUEST BY THE PUBLIC WOULD BE REVIEWED AND ACTED UPON BY THE BOARD. FORM 990, PART XI, LINE 9: TRANSFER OF ASSETS TO THE HEALTHCARE AUTHORITY OF WINFIELD, AL 3,361,110. FORM 990, PART XII, LINE 2C THE BOARD OF DIRECTORS ASSUMES RESPONSIBILITY FOR THE OVERSIGHT OF THE AUDIT OF ITS FINANCIAL STATEMENTS AND SELECTION OF AN INDEPENDENT ACCOUNTANT. THIS FUNCTION HAS NOT CHANGED FROM PRIOR YEARS. HEALTHCARE AUTHORITY OF WINFIELD AL 7530 HIGHWAY 43 WINFIELD AL 35594 824749088 HOSPITAL OWNERSHIP AL HCA N/A 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0