2017-11-15T15:22:38-06:00 2016-12-31 621532536 COULTER & JUSTUS PC 9717 COGDILL ROAD SUITE 201 KNOXVILLE TN 37932 990 2016-01-01 320453405 NORTHWEST MEDICAL CENTER INC NORT 8652694074 121 LEINART STREET CLINTON TN 37716 TIM BROWN CHIEF ADMINISTRATIVE OFFICER 8652694074 2017-11-15 1 NAN C BOBBETT CPA P00119087 8656374161 2017-11-15 69.73.35.66 2017-11-15 16:04:21 ES P 7A4EF9AC64FBE830EA58DFFC6973B2E648D048A7 B91E052758ECDDE3CAD1E49FCBF94DD950095196 2016 2021-01-29 14:40:06Z TIM BROWN 121 LEINART STREET CLINTON TN 37716 25757811 0 X WWW.NORTHWESTMEDCENTER.NET X 2014 TN NORTHWEST MEDICAL CENTER, INC. SEEKS TO IMPROVE THE DELIVERY OF HEALTHCARE SERVICES IN RURAL AMERICA BY GIVING LOCAL HEALTHCARE ORGANIZATIONS AN ALTERNATIVE TO FOR-PROFIT HOSPITAL COMPANIES OR TERTIARY HEALTH SYSTEMS THAT VIEW RURAL HOSPITALS AS REFERRAL SOURCES AND WHICH ARE AGGRESSIVELY DIVESTING OR EVEN CLOSING DISTRESSED RURAL HOSPITALS. NORTHWEST MEDICAL CENTER HAS CREATED A NONPROFIT HEALTHCARE SYSTEM THAT FOCUSES ON STABILIZING RURAL HOSPITALS BY PROVIDING THEM WITH RURAL HEALTHCARE MANAGEMENT EXPERTISE AND MORE EFFICIENT LOW COST SERVICES THAT ARE TRADITIONALLY ONLY AVAILABLE THROUGH LARGER HEALTHCARE SYSTEMS. 11 11 223 1 0 0 0 0 23667636 25001013 0 0 147502 756798 23815138 25757811 0 0 0 0 12477126 11956649 0 0 0 12994546 15824342 25471672 27780991 -1656534 -2023180 6994455 14309793 3074970 12413488 3919485 1896305 X NORTHWEST MEDICAL CENTER, INC. SEEKS TO IMPROVE THE DELIVERY OF HEALTHCARE SERVICES IN RURAL AMERICA BY GIVING LOCAL HEALTHCARE ORGANIZATIONS AN ALTERNATIVE TO FOR-PROFIT HOSPITAL COMPANIES OR TERTIARY HEALTH SYSTEMS THAT VIEW RURAL HOSPITALS AS REFERRAL SOURCES AND WHICH ARE AGGRESSIVELY DIVESTING OR EVEN CLOSING DISTRESSED RURAL HOSPITALS. NORTHWEST MEDICAL CENTER HAS CREATED A NONPROFIT HEALTHCARE SYSTEM THAT FOCUSES ON STABILIZING RURAL HOSPITALS BY PROVIDING THEM WITH RURAL HEALTHCARE MANAGEMENT EXPERTISE AND MORE EFFICIENT LOW COST SERVICES THAT ARE TRADITIONALLY ONLY AVAILABLE THROUGH LARGER HEALTHCARE SYSTEMS. 0 0 19682447 25757811 TO IMPROVE THE DELIVERY OF HEALTHCARE SERVICES IN RURAL AMERICA BY GIVING LOCAL HEALTHCARE ORGANIZATIONS AN ALTERNATIVE TO FOR-PROFIT HOSPITAL COMPANIES OR TERTIARY HEALTH SYSTEMS THAT VIEW RURAL HOSPITALS AS REFERRAL SOURCES AND WHICH ARE AGGRESSIVELY DIVESTING OR EVEN CLOSING DISTRESSED RURAL HOSPITALS. 19682447 1 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 1 0 0 0 0 0 0 1 1 1 0 0 0 1 69 0 223 1 0 0 0 0 0 0 0 0 0 0 0 0 X 11 11 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X STEVE CLAPP 8652694074 121 LEINART STREET CLINTON TN 37716 X STEVE CLAPP BOARD MEMBER 0.00 0.00 X 0 0 0 DAVID CORBETT MD CHIEF OF STAFF 0.00 0.00 X 0 0 0 RANDY PRICE BOARD MEMBER 0.00 0.00 X 0 0 0 JAMES R MOSS MD BOARD MEMBER 0.00 0.00 X 0 0 0 BILL ATKINSON BOARD MEMBER 0.00 0.00 X 0 0 0 TOM MOORE BOARD MEMBER 0.00 0.00 X 0 0 0 DIANNA JUNKIN BOARD MEMBER 0.00 0.00 X 0 0 0 GERALD HUGHES BOARD MEMBER 0.00 0.00 X 0 0 0 JIM DICKINSON CHAIRMAN 0.00 0.00 X X 0 0 0 RUSSELL CAROTHERS VICE CHAIRMAN 0.00 0.00 X X 0 0 0 MICHAEL ARNO SECRETARY 0.00 0.00 X X 0 0 0 MARTIN HAJJAR PHYSICIAN 0.00 40.00 X 332872 0 14782 MARK RANDALL PHYSICIAN 0.00 40.00 X 293727 0 14208 SRILAKSHMI SETTIPALLI PHYSICIAN 0.00 33.00 X 182275 0 1123 MADHAV SONI PHYSICIAN 0.00 40.00 X 269502 0 8262 JERILL THOMAS PHYSICIAN 0.00 43.00 X 301608 0 2195 1379984 0 40570 5 0 1 0 DIVERSIFIED CLINICAL SERVICES PO BOX 636981 CINCINNATI OH 45263 WOUND CARE SERVICES 519763 NORTHWEST ANESTHESIA INC 160 ROCKWELL STREET WINFIELD AL 35594 ANESTHESIOLOGIST SERVICES 452119 ROBERT ADKINS 1591 CO HWY 61 GUIN AL 35563 CRNA SERVICES 220000 HARRIS MEDICAL HOSPITALIST 68 HOSPITAL ROAD SYLVA NC 28779 ER PHYSICIAN AND HOSPITALIST SERVICES 189558 PARALLON TECHNOLOGY SOLUTIONS MSC 30225 PO BOX 41500 NASHVILLE TN 37241 BILLING, COLLECTIONS, AND IT 143475 5 PATIENT SERVICE FEES 624100 25001013 25001013 25001013 OTHER REVENUE 900099 756798 756798 756798 25757811 25757811 0 0 1379984 1256819 123165 8611406 7842831 768575 1965259 674978 1290281 1214881 1071538 143343 332567 332567 590410 590410 261684 33034 228650 SUPPLIES 3814377 3770865 43512 CONTRACT SERVICES 3127937 1530357 1597580 PROFESSIONAL SERVICES 2266295 2261570 4725 TAXES AND ASSESSMENTS 1843923 5187 1838736 2372268 1235268 1137000 27780991 19682447 8098544 0 292211 65762 1937020 3288330 601520 586736 175135 176176 6261845 997367 3894791 5264478 4844243 93778 84068 6994455 14309793 723883 2390369 1036874 0 1314213 10023119 3074970 12413488 X 3919485 1896305 3919485 1896305 6994455 14309793 -2023180 0 X X 0 1 X 1 1 1 X 490000 490000 1744277 87692 1656585 3940403 909675 3030728 87165 87165 5264478 ACCRUED SALARIES AND BENEFITS 476510 INTERCOMPANY PAYABLES 8628766 ESTIMATED THIRD-PARTY SETTLEMENTS 807283 OTHER CURRENT LIABILITIES 110560 10023119 1 1 X 1 X 1 X 1 0 0 87693 87693 0.00320 3795048 3794743 305 0.00000 3882741 3794743 87998 0.00320 2588 2588 0.00010 1655 1655 0.00010 4243 4243 0.00020 3886984 3794743 92241 0.00340 1 8659975 569423 10873645 9961840 911805 1 1 1 1 NORTHWEST MEDICAL CENTER INC 1530 US HIGHWAY 43 WINFIELD AL 35594 H4701 X X X NORTHWEST MEDICAL CENTER INC 1 1 1 0 0 1 X 200.000000000000 300.000000000000 1 1 X X X X 1 X WWW.NORTHWESTMEDCENTER.NET X WWW.NORTHWESTMEDCENTER.NET X WWW.NORTHWESTMEDCENTER.NET X X X 1 X 0 X 1 X 0 0 NORTHWEST MEDICAL CENTER, INC. PART V, SECTION B, LINE 20E: PROVIDED A WRITTEN NOTICE ABOUT UPCOMING ECAS (EXTRAORDINARY COLLECTION ACTION) AND A PLAIN LANGUAGE SUMMARY OF THE FAP AT LEAST 30 DAYS BEFORE INITATING THOSE ECAS; MADE A REASONABLE EFFORT TO ORALLY NOTIFY INDIVIDUALS ABOUT THE FAP AND FAP APPLICATION PROCESS; PROCESSED INCOMPLETE AND COMPLETE FAP APPLICATIONS. 1 1 - NWMC-WINFIELD PHYSICIANS LLC 121 LEINHART ST CLINTON TN 37716 FAMILY MEDICINE PHYSICIAN FACILITY PART I, LINE 3C: N/A PART 1, LINE 6A N/A PART III, LINE 2: ACCOUNTS ARE EVALUATED FOR COLLECTABILITY ON A MONTHLY BASIS USING AGED PAYOR ACCOUNT CLASSIFICATIONS AND HISTORICAL COLLETION EXPERIENCE. PART III, LINE 3: ACCOUNTS ARE EVALUATED FOR COLLECTABILITY ON A MONTHLY BASIS USING AGED PAYOR ACCOUNT CLASSIFICATIONS AND HISTORICAL COLLETION EXPERIENCE. PART III, LINE 4: ACCOUNTS ARE EVALUATED FOR COLLECTABILITY ON A MONTHLY BASIS USING AGED PAYOR ACCOUNT CLASSIFICATIONS AND HISTORICAL COLLETION EXPERIENCE. PART III, LINE 8: AS A NON-PROFIT ORGANIZATION, THE HOSPITAL ACCEPTS ALL PATIENTS WITHOUT REGARD TO INSURANCE OR LACK OF INSURANCE OR ABILITY TO PAY.AMOUNTS BASED ON THE MEDICARE COST REPORT, WHICH IS PREPARED USING THE AUDITED TRIAL BALANCE. THE MEDICARE COST REPORT IS PREPARED IN ACCORDANCE WITH ALL APPLICABLE RULES AND REGULATIONS. PART III, LINE 9B: NORTHWEST MEDICAL CENTER OFFERS FINANCIAL ASSISTANCE THROUGH OUR CHARITY POLICY, BASED ON THE CURRENT FEDERAL POVERTY GUIDELINES (FPG), TO PATIENTS AND GUARANTORS. THOSE APPROVED FOR FINANCIAL ASSISTANCE ARE ELIGIBLE FOR DISCOUNTS APPLIED TO BALANCES OWED AFTER INSURANCE, AS WELL AS SELF-PAY BALANCES REMAINING AFTER OUR UNINSURED DISCOUNT IS APPLIED. IF THE PATIENT'S FAMILY INCOME IS BETWEEN 0%-200% OF THE FEDERAL POVERTY GUIDELINES, 100% DISCOUNT (CHARITY CARE). IF THE PATIENT'S FAMILY INCOME IS BETWEEN 201%-250% OF THE FEDERAL POVERTY GUIDELINES, 60% DISCOUNT (FINANCIAL ASSISTANCE). IF THE PATIENT'S FAMILY INCOME IS BETWEEN 251%-300% OF THE FEDERAL POVERTY GUIDELINES, 40% DISCOUNT (FINANCIAL ASSISTANCE). THIS POLICY IS PUBLICIZED IN PATIENT REGISTRATION AREAS, BILLING STATEMENTS AND IS AVAILABLE ON OUR WEB SITE. PATIENTS NOT ELIGIBLE FOR CHARITY 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 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 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 CALL FOR 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 POPULATION BELOW 5,000 AND APPROXIMATELY 14% OF THE POPULATION BELOW THE POVERTY LINE. THE POPULATION IS PREDOMINANTLY CAUCASIAN, 92%, AS OF THE MOST RECENT CENSUS. PART VI, LINE 5: THE HOSPITAL HAS A LOCAL BOARD OF VOLUNTEER COMMUNITY BOARD OF 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. PART VI, LINE 6: NORTHWEST MEDICAL CENTER IS PART OF CURAE HEALTH AND SERVES THE RESIDENTS OF WINFIELD, AL INCLUDING THE COUNTIES OF MARION AND FAYETTE. PART VI, LINE 7, REPORTS FILED WITH STATES AL X X X X 0 0 0 0 0 0 0 0 0 MARTIN HAJJAR PHYSICIAN 332872 0 0 0 0 0 3517 0 11265 0 347654 0 0 0 MARK RANDALL PHYSICIAN 293727 0 0 0 0 0 2423 0 11785 0 307935 0 0 0 SRILAKSHMI SETTIPALLI PHYSICIAN 182275 0 0 0 0 0 1123 0 0 0 183398 0 0 0 MADHAV SONI PHYSICIAN 269502 0 0 0 0 0 143 0 8119 0 277764 0 0 0 JERILL THOMAS PHYSICIAN 301608 0 0 0 0 0 835 0 1360 0 303803 0 0 0 STRATEGIC HEALTHCARE RESOURCES LLC PRESIDENT IS THE SINGLE MEMBER OF STRATEGIC HEALTHCARE RESOURCES, LLC 720691 MANAGEMENT FEES ARE DETERMINED AT ARMS-LENGTH AND ARE AT COMMERICALLY REASONABLE RATES 1 FORM 990, PART VI, SECTION A, LINE 3 NORTHWEST MEDICAL CENTER, INC. ENGAGES A MANAGEMENT COMPANY TO PROVIDE A FULL RANGE OF DAY-TO-DAY OPERATIONAL AND ADMINISTRATIVE SENIOR LEVEL MANAGEMENT SERVICES, INCLUDING THE APPOINTMENT OF MANAGEMENT PERSONNEL AT EACH OF THE HOSPITALS AND OTHER HEALTHCARE FACILITIES AND BUSINESS OF NORTHWEST MEDICAL CENTER, INC. FORM 990, PART VI, SECTION B, LINE 11B A COPY OF THE FORM 990 WAS PROVIDED TO EACH BOARD MEMEBER. THE RETURN WAS REVIEWED PRIOR TO THE FILING OF THE TAX RETURN. 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 18 DOCUMENTATION PROVIDED UPON REQUEST FORM 990, PART VI, SECTION C, LINE 19 DOCUMENTATION PROVIDED UPON REQUEST FORM 990, PART XII, LINE 2C: ORGANIZATION HAS A COMMITTEE THAT ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF ITS FINANCIAL STATEMENTS AND SELECTION OF AN INDEPENDENT ACCOUNTANT. NWMC-WINFIELD PHYSICIANS LLC 121 LEINART ST CLINTON TN 37716 472498379 PROVIDE HEALTH CARE SERVICES TN 2493860 366594 NORTHWEST MEDICAL CENTER INC CURAE HEALTH INC 121 LEINART STREET CLINTON TN 37716 472275638 HOSPITAL TN 501(C)(3) LINE 3 N/A 1 LAKELAND COMMUNITY HOSPITAL INC 121 LEINART STREET CLINTON TN 37716 472367677 HOSPITAL TN 501(C)(3) LINE 3 CURAE HEALTH INC 1 RUSSELLVILLE HOSPITAL INC 121 LEINART STREET CLINTON TN 37716 472378825 HOSPITAL TN 501(C)(3) LINE 3 CURAE HEALTH INC 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0