2016-11-15T15:28:59-06:00 2015-12-31 621532536 COULTER & JUSTUS PC 9717 COGDILL ROAD SUITE 201 KNOXVILLE TN 37932 990 2015-01-01 320453405 NORTHWEST MEDICAL CENTER INC NORT 8652694074 121 LEINART STREET CLINTON TN 37716 TIM BROWN CHIEF ADMINISTRATIVE OFFICER 8652694074 2016-11-15 1 KEVIN MCCOLLUM CPA P00119089 8656374161 2016-11-15 2015 2017-02-10 21:41:12Z TIM BROWN 121 LEINART STREET CLINTON TN 37716 28201909 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 11 274 1 0 0 0 4101383 0 23953023 0 0 0 147503 0 28201909 0 0 0 0 0 12105159 0 0 0 0 12787255 0 24892414 0 3309495 0 6382747 0 3073252 0 3309495 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 14082892 24100526 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. 14082892 1 1 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 1 0 0 0 1 1 1 0 0 0 1 69 0 1 274 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 0 0 0 RUSSELL CAROTHERS VICE CHAIRMAN 0.00 0.00 X 0 0 0 MICHAEL WINDHAM SECRETARY 0.00 0.00 X 0 0 0 MARTIN HAJJAR PHYSICIAN 0.00 36.00 X 185238 0 15195 DONNA MANEICE PHYSICIAN 0.00 40.00 X 160929 0 17170 MARK RANDALL PHYSICIAN 0.00 40.00 X 229178 0 26296 SRILAKSHMI SETTIPALLI PHYSICIAN 0.00 40.00 X 162427 0 13885 MADHAV SONI PHYSICIAN 0.00 40.00 X 200900 0 22491 938672 0 95037 5 0 1 0 DIVERSIFIED CLINICAL SERVICES PO BOX 636981 CINCINNATI OH 45263 WOUND CARE SERVICES 532800 NORTHWEST ANESTHESIA INC 160 ROCKWELL STREET WINFIELD AL 35594 ANESTHESIOLOGIST SERVICES 415000 PARALLON TECHNOLOGY SOLUTIONS MSC 30225 PO BOX 41500 NASHVILLE TN 37241 BILLING, COLLECTIONS, AND IT 225781 ROBERT ADKINS 1591 CO HWY 61 GUIN AL 35563 CRNA SERVICES 201667 ELITE EMERGENCY SERVICES OF AL 12 CADILLAC DR STE 150 BRENTWOOD TN 37027 ER PHYSICIAN COVERAGE SERVICES 164400 7 4101383 4101383 4101383 PATIENT SERVICE FEES 624100 23953023 23953023 23953023 OTHER REVENUE 900099 147503 147503 147503 28201909 24100526 0 0 938672 715186 223486 8791305 6698201 2093104 2375182 564205 1810977 1147353 393875 753478 216278 216278 233432 233432 298689 31577 267112 SUPPLIES 3118103 2717940 400163 CONTRACT SERVICES 2790432 985611 1804821 TAXES AND ASSESSMENTS 2009709 86996 1922713 PROFESSIONAL SERVICES 1351828 1170037 181791 1621431 719264 902167 24892414 14082892 10809522 0 292211 1911497 601520 117989 3530453 233432 0 3297021 0 162509 0 6382747 636718 1003577 0 1432957 0 3073252 X 3309495 0 3309495 0 6382747 3309495 0 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 490000 490000 1710000 43846 1666154 970997 189586 781411 359456 359456 3297021 ACCRUED SALARIES AND BENEFITS 490144 ACCRUED TAXES 667177 INTERCOMPANY PAYABLES 275636 1432957 1 1 X 1 X 1 X 1 0 0 71375 71375 0.00290 3404026 4234973 -830947 0.00000 3475401 4234973 -759572 0.00290 2424 2424 0.00010 16547 16547 0.00070 18971 18971 0.00080 3494372 4234973 -740601 0.00370 1 6428327 487506 11094536 9270610 1823926 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 250.000000000000 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. 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. X X X X 0 0 0 0 0 0 0 0 0 MARTIN HAJJAR PHYSICIAN 185238 0 0 0 0 0 4452 0 10743 0 200433 0 0 0 DONNA MANEICE PHYSICIAN 160929 0 0 0 0 0 11177 0 5993 0 178099 0 0 0 MARK RANDALL PHYSICIAN 229178 0 0 0 0 0 16460 0 9836 0 255474 0 0 0 SRILAKSHMI SETTIPALLI PHYSICIAN 162427 0 0 0 0 0 13885 0 0 0 176312 0 0 0 MADHAV SONI PHYSICIAN 200900 0 0 0 0 0 15692 0 6799 0 223391 0 0 0 STRATEGIC HEALTHCARE RESOURCES LLC PRESIDENT IS THE SINGLE MEMBER OF STRATEGIC HEALTHCARE RESOURCES, LLC 493941 MANAGEMENT FEES 1 X INHERENT CONTRIBUTION OF HOSPITAL ASSETS 1 4101383 AUDITED FINANCIAL ST 0 0 0 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. NWMC-WINFIELD PHYSICIANS LLC 121 LEINART ST CLINTON TN 37716 472498379 PROVIDE HEALTH CARE SERVICES AL 1680716 228378 NORTHWEST MEDICAL CENTER INC CURAE HEALTH INC 121 LEINART STREET CLINTON TN 37716 472275638 HOSPITAL AL 501(C)(3) LINE 3 N/A 1 LAKELAND COMMUNITY HOSPITAL INC 121 LEINART STREET CLINTON TN 37716 472367677 HOSPITAL AL 501(C)(3) LINE 3 CURAE HEALTH INC 1 RUSSELLVILLE HOSPITAL INC 121 LEINART STREET CLINTON TN 37716 472378825 HOSPITAL AL 501(C)(3) LINE 3 CURAE HEALTH INC 1 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 CURAE HEALTH INC K 278056 FAIR MARKET VALUE