NORTHWEST MEDICAL CENTER INC: Form 990, tax year 2015
View the entire original 990 at ProPublica ↗
- Organization
- NORTHWEST MEDICAL CENTER INC (EIN 32-0453405)
- Tax period
- 2015-01-01 to 2015-12-31
- Filed
- 2016-11-15
- IRS object ID
- 201603209349311245
- Schema version
- 2015v2.1
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule D
- Schedule H
- Schedule J
- Schedule L
- Schedule M
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2016-11-15T15:28:59-06:00 | ReturnTs |
| Tax Period End | 2015-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 621532536 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | COULTER & JUSTUS PC | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 9717 COGDILL ROAD SUITE 201 | AddressLine1Txt |
| City | KNOXVILLE | CityNm |
| State Abbreviation | TN | StateAbbreviationCd |
| ZIP | 37932 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2015-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 320453405 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | NORTHWEST MEDICAL CENTER INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | NORT | BusinessNameControlTxt |
| Phone | 8652694074 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 121 LEINART STREET | AddressLine1Txt |
| City | CLINTON | CityNm |
| State Abbreviation | TN | StateAbbreviationCd |
| ZIP | 37716 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | TIM BROWN | PersonNm |
| Person Title | CHIEF ADMINISTRATIVE OFFICER | PersonTitleTxt |
| Phone | 8652694074 | PhoneNum |
| Signature | 2016-11-15 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | KEVIN MCCOLLUM CPA | PreparerPersonNm |
| PTIN | P00119089 | PTIN |
| Phone | 8656374161 | PhoneNum |
| Preparation | 2016-11-15 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2015 | TaxYr |
| Build TS | 2017-02-10 21:41:12Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | TIM BROWN | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 121 LEINART STREET | AddressLine1Txt |
| City | CLINTON | CityNm |
| State Abbreviation | TN | StateAbbreviationCd |
| ZIP | 37716 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $28,201,909 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.NORTHWESTMEDCENTER.NET | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 2014 | FormationYr |
| Legal Domicile State | TN | LegalDomicileStateCd |
| Activity Or Mission | 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. | ActivityOrMissionDesc |
| Voting Members Governing Body | 11 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 11 | VotingMembersIndependentCnt |
| Total Employee | 274 | TotalEmployeeCnt |
| Total Volunteers | 1 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $0 | PYContributionsGrantsAmt |
| CY Contributions Grants | $4,101,383 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $0 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $23,953,023 | CYProgramServiceRevenueAmt |
| PY Investment Income | $0 | PYInvestmentIncomeAmt |
| CY Investment Income | $0 | CYInvestmentIncomeAmt |
| PY Other Revenue | $0 | PYOtherRevenueAmt |
| CY Other Revenue | $147,503 | CYOtherRevenueAmt |
| PY Total Revenue | $0 | PYTotalRevenueAmt |
| CY Total Revenue | $28,201,909 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $0 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $12,105,159 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $0 | PYOtherExpensesAmt |
| CY Other Expenses | $12,787,255 | CYOtherExpensesAmt |
| PY Total Expenses | $0 | PYTotalExpensesAmt |
| CY Total Expenses | $24,892,414 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $0 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $3,309,495 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $0 | TotalAssetsBOYAmt |
| Total Assets EOY | $6,382,747 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $0 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $3,073,252 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $0 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $3,309,495 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | 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. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $14,082,892 | ExpenseAmt |
| Revenue | $24,100,526 | RevenueAmt |
| Desc | 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. | Desc |
| Total Program Service Expenses | $14,082,892 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Temp Or Permanent Endowments | 0 | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | 0 | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | Yes (1) | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | Yes (1) | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | Yes (1) | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (1) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | 0 | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 69 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 274 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Form8899 Filedind | 0 | Form8899Filedind |
| Form1098 C Filed | 0 | Form1098CFiledInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 11 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 11 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | Yes (1) | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 0 | MembersOrStockholdersInd |
| Election Of Board Members | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | STEVE CLAPP | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 8652694074 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 121 LEINART STREET | AddressLine1Txt |
| City | CLINTON | CityNm |
| State Abbreviation | TN | StateAbbreviationCd |
| ZIP | 37716 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| No Listed Persons Compensated | Yes (X) | NoListedPersonsCompensatedInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (16 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd | Key EmployeeKeyEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| STEVE CLAPP | ||||||||
| BOARD MEMBER | 0.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| DAVID CORBETT MD | ||||||||
| CHIEF OF STAFF | 0.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| RANDY PRICE | ||||||||
| BOARD MEMBER | 0.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| JAMES R MOSS MD | ||||||||
| BOARD MEMBER | 0.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| BILL ATKINSON | ||||||||
| BOARD MEMBER | 0.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| TOM MOORE | ||||||||
| BOARD MEMBER | 0.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| DIANNA JUNKIN | ||||||||
| BOARD MEMBER | 0.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| GERALD HUGHES | ||||||||
| BOARD MEMBER | 0.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| JIM DICKINSON | ||||||||
| CHAIRMAN | 0.00 | 0.00 | $0 | $0 | $0 | Yes (X) | ||
| RUSSELL CAROTHERS | ||||||||
| VICE CHAIRMAN | 0.00 | 0.00 | $0 | $0 | $0 | Yes (X) | ||
| MICHAEL WINDHAM | ||||||||
| SECRETARY | 0.00 | 0.00 | $0 | $0 | $0 | Yes (X) | ||
| MARTIN HAJJAR | ||||||||
| PHYSICIAN | 0.00 | 36.00 | $185,238 | $0 | $15,195 | Yes (X) | ||
| DONNA MANEICE | ||||||||
| PHYSICIAN | 0.00 | 40.00 | $160,929 | $0 | $17,170 | Yes (X) | ||
| MARK RANDALL | ||||||||
| PHYSICIAN | 0.00 | 40.00 | $229,178 | $0 | $26,296 | Yes (X) | ||
| SRILAKSHMI SETTIPALLI | ||||||||
| PHYSICIAN | 0.00 | 40.00 | $162,427 | $0 | $13,885 | Yes (X) | ||
| MADHAV SONI | ||||||||
| PHYSICIAN | 0.00 | 40.00 | $200,900 | $0 | $22,491 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $938,672 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $95,037 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 5 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| DIVERSIFIED CLINICAL SERVICES | |||||
| PO BOX 636981 | CINCINNATI | OH | 45263 | WOUND CARE SERVICES | $532,800 |
| NORTHWEST ANESTHESIA INC | |||||
| 160 ROCKWELL STREET | WINFIELD | AL | 35594 | ANESTHESIOLOGIST SERVICES | $415,000 |
| PARALLON TECHNOLOGY SOLUTIONS | |||||
| MSC 30225 PO BOX 41500 | NASHVILLE | TN | 37241 | BILLING, COLLECTIONS, AND IT | $225,781 |
| ROBERT ADKINS | |||||
| 1591 CO HWY 61 | GUIN | AL | 35563 | CRNA SERVICES | $201,667 |
| ELITE EMERGENCY SERVICES OF AL | |||||
| 12 CADILLAC DR STE 150 | BRENTWOOD | TN | 37027 | ER PHYSICIAN COVERAGE SERVICES | $164,400 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 7 | CntrctRcvdGreaterThan100KCnt |
| All Other Contributions | $4,101,383 | AllOtherContributionsAmt |
| Noncash Contributions | $4,101,383 | NoncashContributionsAmt |
| Total Contributions | $4,101,383 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | PATIENT SERVICE FEES | Desc |
| Business | 624100 | BusinessCd |
| Total Revenue Column | $23,953,023 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $23,953,023 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $23,953,023 | TotalProgramServiceRevenueAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | OTHER REVENUE | Desc |
| Business | 900099 | BusinessCd |
| Total Revenue Column | $147,503 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $147,503 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $147,503 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $28,201,909 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $24,100,526 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $0 | ExclusionAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $938,672 | TotalAmt |
| Program Services | $715,186 | ProgramServicesAmt |
| Management And General | $223,486 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,791,305 | TotalAmt |
| Program Services | $6,698,201 | ProgramServicesAmt |
| Management And General | $2,093,104 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,375,182 | TotalAmt |
| Program Services | $564,205 | ProgramServicesAmt |
| Management And General | $1,810,977 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,147,353 | TotalAmt |
| Program Services | $393,875 | ProgramServicesAmt |
| Management And General | $753,478 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $216,278 | TotalAmt |
| Management And General | $216,278 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $233,432 | TotalAmt |
| Management And General | $233,432 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $298,689 | TotalAmt |
| Program Services | $31,577 | ProgramServicesAmt |
| Management And General | $267,112 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| SUPPLIES | $3,118,103 | $2,717,940 | $400,163 |
| CONTRACT SERVICES | $2,790,432 | $985,611 | $1,804,821 |
| TAXES AND ASSESSMENTS | $2,009,709 | $86,996 | $1,922,713 |
| PROFESSIONAL SERVICES | $1,351,828 | $1,170,037 | $181,791 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,621,431 | TotalAmt |
| Program Services | $719,264 | ProgramServicesAmt |
| Management And General | $902,167 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $24,892,414 | TotalAmt |
| Program Services | $14,082,892 | ProgramServicesAmt |
| Management And General | $10,809,522 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $292,211 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $1,911,497 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $601,520 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $117,989 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $3,530,453 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $233,432 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $3,297,021 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $162,509 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $6,382,747 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $636,718 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $1,003,577 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $1,432,957 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $3,073,252 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $3,309,495 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $3,309,495 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $6,382,747 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $3,309,495 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $490,000 | OtherCostOrOtherBasisAmt |
| Book Value | $490,000 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,710,000 | OtherCostOrOtherBasisAmt |
| Depreciation | $43,846 | DepreciationAmt |
| Book Value | $1,666,154 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $970,997 | OtherCostOrOtherBasisAmt |
| Depreciation | $189,586 | DepreciationAmt |
| Book Value | $781,411 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $359,456 | OtherCostOrOtherBasisAmt |
| Book Value | $359,456 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $3,297,021 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (3 entries)
| DescDesc | AmtAmt |
|---|---|
| ACCRUED SALARIES AND BENEFITS | $490,144 |
| ACCRUED TAXES | $667,177 |
| INTERCOMPANY PAYABLES | $275,636 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $1,432,957 | TotalLiabilityAmt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent200 | Yes (X) | Percent200Ind |
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
| Percent250 | Yes (X) | Percent250Ind |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | 0 | FinancialAssistanceBudgetInd |
| Annual Community Bnft Report | 0 | AnnualCommunityBnftReportInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $71,375 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $71,375 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00290 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,404,026 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $4,234,973 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | -$830,947 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,475,401 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $4,234,973 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | -$759,572 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00290 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,424 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $2,424 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $16,547 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $16,547 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00070 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $18,971 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $18,971 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00080 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,494,372 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $4,234,973 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | -$740,601 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00370 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $6,428,327 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $487,506 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $11,094,536 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $9,270,610 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | $1,823,926 | MedicareSurplusOrShortfallAmt |
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | NORTHWEST MEDICAL CENTER INC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1530 US HIGHWAY 43 | AddressLine1Txt |
| City | WINFIELD | CityNm |
| State Abbreviation | AL | StateAbbreviationCd |
| ZIP | 35594 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| State License | H4701 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | NORTHWEST MEDICAL CENTER INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | Yes (1) | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | Yes (1) | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | 0 | CHNAConductedInd |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 200.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 250.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Provided Nonprofit Contact | Yes (X) | ProvidedNonprofitContactInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | WWW.NORTHWESTMEDCENTER.NET | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | WWW.NORTHWESTMEDCENTER.NET | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | WWW.NORTHWESTMEDCENTER.NET | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit Report To Credit Agency | Yes (X) | PermitReportToCreditAgencyInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| Other Actions Taken | Yes (X) | OtherActionsTakenInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Other Method Used | Yes (X) | OtherMethodUsedInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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. |
| NORTHWEST MEDICAL CENTER, INC. | PART V, SECTION B, LINE 22D: THE HOSPITAL FACILITY USED A LOOK-BACK METHOD BASED ON CLAIMS ALLOWED BY MEDICAID, EITHER ALONE OR IN COMBINATION WITH MEDICARE FEE-FOR-SERVICE AND ALL PRIVATE HEALTH INSURERS THAT PAY CLAIMS TO THE HOSPITAL FACILITY DURING A PRIOR 12-MONTH PERIOD. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Form990 Of Other Organizations | Yes (X) | Form990OfOtherOrganizationsInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (5 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| MARTIN HAJJAR | ||||||||||||||
| PHYSICIAN | $185,238 | $0 | $0 | $0 | $0 | $0 | $4,452 | $0 | $10,743 | $0 | $200,433 | $0 | $0 | $0 |
| DONNA MANEICE | ||||||||||||||
| PHYSICIAN | $160,929 | $0 | $0 | $0 | $0 | $0 | $11,177 | $0 | $5,993 | $0 | $178,099 | $0 | $0 | $0 |
| MARK RANDALL | ||||||||||||||
| PHYSICIAN | $229,178 | $0 | $0 | $0 | $0 | $0 | $16,460 | $0 | $9,836 | $0 | $255,474 | $0 | $0 | $0 |
| SRILAKSHMI SETTIPALLI | ||||||||||||||
| PHYSICIAN | $162,427 | $0 | $0 | $0 | $0 | $0 | $13,885 | $0 | $0 | $0 | $176,312 | $0 | $0 | $0 |
| MADHAV SONI | ||||||||||||||
| PHYSICIAN | $200,900 | $0 | $0 | $0 | $0 | $0 | $15,692 | $0 | $6,799 | $0 | $223,391 | $0 | $0 | $0 |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp
Name Of Interested NameOfInterested
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | STRATEGIC HEALTHCARE RESOURCES LLC | PersonNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship Description | PRESIDENT IS THE SINGLE MEMBER OF STRATEGIC HEALTHCARE RESOURCES, LLC | RelationshipDescriptionTxt |
| Transaction | $493,941 | TransactionAmt |
| Transaction | MANAGEMENT FEES | TransactionDesc |
| Sharing Of Revenues | Yes (1) | SharingOfRevenuesInd |
Schedule M IRS990ScheduleM
Other Non Cash Contri Table OtherNonCashContriTableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Non Cash Checkbox | Yes (X) | NonCashCheckboxInd |
| Desc | INHERENT CONTRIBUTION OF HOSPITAL ASSETS | Desc |
| Contribution | 1 | ContributionCnt |
| Noncash Contributions Rpt F990 | $4,101,383 | NoncashContributionsRptF990Amt |
| Method Of Determining Revenues | AUDITED FINANCIAL ST | MethodOfDeterminingRevenuesTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Any Property That Must Be Held | 0 | AnyPropertyThatMustBeHeldInd |
| Review Process Unusual NC Gifts | 0 | ReviewProcessUnusualNCGiftsInd |
| Third Parties Used | 0 | ThirdPartiesUsedInd |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (8 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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 11 | 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. |
| FORM 990 | THE 2015 FORM 990 WILL BE AMENDED TO ATTACH THE AUDITED FINANCIAL STATEMENTS, AS WELL AS TO PROVIDE MORE ACCURATE INFORMATION WITHIN THE REQUIRED SCHEDULES. |
Schedule R IRS990ScheduleR
Id Disregarded Entities IdDisregardedEntitiesGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | NWMC-WINFIELD PHYSICIANS LLC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 121 LEINART ST | AddressLine1Txt |
| City | CLINTON | CityNm |
| State Abbreviation | TN | StateAbbreviationCd |
| ZIP | 37716 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 472498379 | EIN |
| Primary Activities | PROVIDE HEALTH CARE SERVICES | PrimaryActivitiesTxt |
| Legal Domicile State | AL | LegalDomicileStateCd |
| Total Income | $1,680,716 | TotalIncomeAmt |
| End Of Year Assets | $228,378 | EndOfYearAssetsAmt |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | NORTHWEST MEDICAL CENTER INC | BusinessNameLine1Txt |
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (3 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Direct Controlling NADirectControllingNACd | Controlled OrganizationControlledOrganizationInd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt |
|---|---|---|---|---|---|---|---|---|---|---|---|
| CURAE HEALTH INC | |||||||||||
| 121 LEINART STREET | CLINTON | TN | 37716 | 472275638 | HOSPITAL | AL | 501(C)(3) | LINE 3 | N/A | Yes (1) | |
| LAKELAND COMMUNITY HOSPITAL INC | |||||||||||
| 121 LEINART STREET | CLINTON | TN | 37716 | 472367677 | HOSPITAL | AL | 501(C)(3) | LINE 3 | Yes (1) | CURAE HEALTH INC | |
| RUSSELLVILLE HOSPITAL INC | |||||||||||
| 121 LEINART STREET | CLINTON | TN | 37716 | 472378825 | HOSPITAL | AL | 501(C)(3) | LINE 3 | Yes (1) | CURAE HEALTH INC | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | 0 | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | Yes (1) | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | 0 | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp
Other Organization Name OtherOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CURAE HEALTH INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Transaction Type | K | TransactionTypeTxt |
| Involved | $278,056 | InvolvedAmt |
| Method Of Amount Determination | FAIR MARKET VALUE | MethodOfAmountDeterminationTxt |
Comments