2016-02-16T14:57:44-06:00 2015-03-31 BKD LLP 1201 Walnut Suite 1700 Kansas City MO 641062246 990 2014-04-01 440580870 NORTHWEST MEDICAL CENTER ASSOCIATION INC % JON DOOLITTLE NORT 6607263941 705 N COLLEGE ST ALBANY MO 64402 JON DOOLITTLE REGIONAL PRESIDENT 6607263941 2016-02-15 true Michael J Engle P00482834 8162216300 2014 2016-08-17 19:52:53Z NORTHWEST MEDICAL CENTER JON DOOLITTLE 705 N COLLEGE ST ALBANY MO 64402 17039315 false X WWW.NORTHWESTMEDICALCENTER.ORG X 1955 MO NORTHWEST MEDICAL CENTER SERVES AS A COMPASSIONATE, EFFICIENT HEALTH HOME THAT ENCOURAGES WELLNESS, RESTORES HEALTH AND PROMOTES A SUPERIOR QUALITY OF LIFE. X 5 1 205 1 84257 -1529 69111 73661 16735436 16504393 211468 87217 497233 359869 17513248 17025140 15878 7212423 0 0 10311289 10414266 0 0 0 7824748 8529107 18151915 26155796 -638667 -9130656 16690097 17078840 2683717 12125198 14006380 4953642 WITH THE HELP OF TRUSTED, INTEGRATED PARTNERS, NORTHWEST MEDICAL CENTER SERVES AS A COMPASSIONATE, EFFICIENT HEALTH HOME THAT ENCOURAGES WELLNESS, RESTORES HEALTH AND PROMOTES A SUPERIOR QUALITY OF LIFE. false false 4846888 3708287 INPATIENT HOSPITAL CARE: OUR ACUTE CARE AND SWINGBED PROGRAM SAW A TOTAL OF 2,157 PATIENT DAYS. MEDICARE PATIENT DAYS CONSISTED OF 1,834 DAYS OR 85% OF TOTAL DAYS. MEDICAID PATIENT DAYS WERE 7% OR 152 PATIENT DAYS. 3295309 2521195 EMERGENCY SERVICES: TOTAL PATIENTS SEEN IN THE EMERGENCY ROOM WERE 2,563. OF THAT AMOUNT 40% OF REVENUE WAS FROM MEDICARE PATIENTS AND 17% WAS FROM MEDICAID PATIENTS 13539872 7212423 10359168 OUTPATIENT SERVICES: THERE WERE 24,105 OUPATIENT VISITS. MEDICARE PATIENTS ACCOUNTED FOR 52.44% AND MEDICAID PATIENTS WERE 10.26% 21682069 true true false true false false false false false true true false false false true false true true false false false false false false true false true true true false true false false false false false false false false false false false true false true true true false false true 72 0 true 205 true true true false false false false true true false false false false X 5 1 true false true false true true true true true false false true true true true true true true false false MO X JON DOOLITTLE 6607263941 705 N COLLEGE ALBANY MO 64402 SERENA NAYLOR DIRECTOR/ CHAIR 1.0 0.0 X X 0 0 0 JOANN GIBBANY DIRECTOR 1.0 0.0 X 0 0 0 KIM FINDLEY DIRECTOR 1.0 0.0 X 0 0 0 MARY EWING DIRECTOR 1.0 0.0 X 0 0 0 JIM HUMPHREY DIRECTOR/ VICE CHAIR 1.0 0.0 X X 0 0 0 ROBERT MILLER DIRECTOR 1.0 0.0 X 0 0 0 ROBERT SMITH DIRECTOR 1.0 0.0 X 0 0 0 MATTHEW PEARL DIRECTOR 1.0 0.0 X 0 0 0 DR NASER SOGHRATI ER PHYSICIAN 40.0 0.0 X 277742 0 13181 DR ANGELA MARTIN FAMILY PRACTICE PHYSICIAN 40.0 0.0 X 292121 0 15600 CRAIG THOMPSON DIRECTOR 1.0 0.0 X 0 0 0 MICHAEL PULIDO DIRECTOR/CHAIR 1.0 39.0 X X 0 398043 87832 JOHN P WILSON DIRECTOR, SECRETARY/TREASURER 1.0 39.0 X X 0 615593 55886 CURT KRETZINGER DIRECTOR/VICE-CHAIR 1.0 39.0 X X 0 697482 78576 S MARK LANEY MD DIRECTOR 1.0 39.0 X 0 1083762 34032 DONNA WALTER VP OF PATIENT CARE SERVICES 40.0 0.0 X 124032 0 12415 JAMES CROUCH VP OF INFORMATION TECHNOLOGY 40.0 0.0 X 122874 0 12415 JON DOOLITTLE PRESIDENT AND CEO 40.0 0.0 X 203174 0 15600 NATHAN BLACKFORD COO 40.0 0.0 X 155800 0 15600 BARB AXON EXECUTIVE VICE PRESIDENT 36.0 0.0 X 3378 0 292 CHRISTINA GILLESPIE VP & CFO 40.0 0.0 X 111980 0 15600 JILL CLAIR SECRETARY 40.0 0.0 X 41491 0 15600 DR JACKIE MILLER FAMILY PRACTICE PHYSICIAN 40.0 0.0 X 433733 0 6945 DR KATIE DIAS FAMILY PRACTICE PHYSICIAN 40.0 0.0 X 188793 0 12581 DR ARTURO TENORIO FAMILY PRACTICE PHYSICIAN 40.0 0.0 X 275706 0 0 JENNA A GIBSON PHARMACY DIRECTOR 40.0 0.0 X 123394 0 14155 STACEY L KARNS PHYSICIANS ASSISTANT 40.0 0.0 X 110023 0 14155 2464241 2794880 420465 12 false true false HAVE A NICE DAY ANESTHESIA ANESTHESIA SERVICES 141795 BKD LLP ACCOUNTING SERVICES 121892 HEARTLAND REGIONAL MEDICAL CENTER CLINICAL SERVICES 116224 WEATHERBY LOCUMS INC ER PHYSICIANS 104905 DOCS WHO CARE CLINICIANS 249038 5 32744 39417 1500 73661 NET PATIENT SERVICE REVENUE 621110 15332394 15332394 EHR INCENTIVE PAYMENTS 621110 102112 102112 340(B) PHARMACY INCOME 621990 1069887 1069887 16504393 87217 87217 0 0 2567 2567 0 2567 2567 0 8320 32744 14175 -5855 -5855 0 0 CAFETERIA 811000 76033 76033 VENDING MACHINE 900099 769 769 MISCELLANEOUS 900099 286355 84257 202098 363157 17025140 16504393 84257 362829 7212423 7212423 0 0 0 1333972 495852 838120 0 6797379 5913527 883852 79280 62491 16789 1649945 1168469 481476 553690 434938 118752 0 0 167119 167119 0 0 2843 2843 1893737 1037078 856659 26471 26471 806051 487786 318265 217923 145230 72693 0 380459 273533 106926 102206 75985 26221 0 0 31600 31600 0 909702 719418 190284 283975 224340 59635 BAD DEBT 1132790 1132790 REPAIRS AND MAINTENANCE 798039 561050 236989 EDUCATION 23833 18231 5602 MEDICAL SUPPLIES 1662893 1662893 89466 56035 33431 26155796 21682069 4473727 0 1026436 4873379 21839 0 0 0 2625375 1875775 0 0 0 0 0 0 268265 183857 276602 290873 5351619 238355 5799063 5113264 1840394 4741692 0 0 0 0 0 0 4832123 0 16690097 17078840 1451773 1276942 0 0 18387 14176 0 0 0 0 0 0 1213557 105387 0 0 0 10728693 2683717 12125198 X 10021833 4820877 3851782 0 132765 132765 14006380 4953642 16690097 17078840 X -9130656 114909 -36991 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false true 11818 false false false 11818 false SCHEDULE C, PART II-B, LINE 1F A PORTION OF DUES PAID TO THE MHA AND AHA ARE USED FOR LOBBYING. 132765 24556 24556 132765 132765 56276 56276 132765 132765 42003 42003 132765 132765 6077 6077 132765 132765 36702 36702 132765 1.00000 false false 0 0 0 3734203 6891 3727312 1413511 138483 1275028 110924 0 110924 5113264 0 DUE TO NWMC FOUNDATION 7199288 DUE TO HEARTLAND REG MEDICAL CENTER 3529405 10728693 15963293 114909 14175 129084 15834209 1190931 1190931 17025140 17816743 14175 14175 17802568 8353228 8353228 26155796 SCHEDULE D, PART V, LINE 4 THE ENDOWMENT IS USED FOR ANY AND ALL HOSPITAL EXPENSES OF ANY NATURE. UNCERTAIN TAX POSITIONS DISCLOSURE MANAGEMENT HAS EVALUATED THEIR INCOME TAX POSITIONS UNDER THE GUIDANCE INCLUDED IN ASC 740. BASED ON THEIR REVIEW, MANAGEMENT HAS NOT IDENTIFIED ANY MATERIAL UNCERTAIN TAX POSITIONS TO BE RECORDED OR DISCLOSED IN THE FINANCIAL STATEMENTS. SCHEDULE D, PART XI, LINES 2D & 4B LINE 2D: SPECIAL EVENT EXPENSES $ 14,175 LINE 4B: UBI GROSS RECEIPTS $ 21,150 NET ASSETS RELEASED FROM RESTRICTION 36,991 BAD DEBT EXPENSE 1,132,790 ---------- $ 1,190,931 SCHEDULE D, PART XII, LINE 4B LINE 2D: SPECIAL EVENT EXPENSES $ 14,175 LINE 4B: BAD DEBT EXPENSE $ 1,132,790 UBI GROSS RECEIPTS 21,150 GRANTS TO NWMC FOUNDATION 7,199,288 ---------- TOTAL 8,353,228 GOLF TOURNAMENT 41064 32744 8320 575 560 1840 1843 1000 8357 0 41064 32744 8320 575 560 1840 1843 1000 8357 14175 -5855 true true true X 125. true X true true false true true 339396 339396 0.01360 3032973 1878024 1154949 0.04620 3372369 1878024 1494345 0.05980 9163 3050 6113 0.00020 9163 3050 6113 0.00020 3381532 1881074 1500458 0.06000 false 1132790 453116 8600529 9189680 -589151 X true true 1 1 NORTHWEST MEDICAL CENTER 705 NORTH COLLEGE ST ALBANY MO 64402 WWW.NORTHWESTMEDICAL.ORG 98-56 X X X X NORTHWEST MEDICAL CENTER 1 false true true X X X X X X X X X 13 true false false true X HTTP://NORTHWESTMEDICALCENTER.ORG/FILES/ X true 13 true HTTP://NORTHWESTMEDICALCENTER.ORG/FILES/5813/ false false true X 125. 200. X true true X true X WWW.NORTHWESTMEDICALCENTER.ORG X WWW.NORTHWESTMEDICALCENTER.ORG X NORTHWESTMEDICALCENTER.ORG X X X X X true X false X X X X true X false false SCHEDULE H, PART V, SECTION B, LINE 2 EFFECTIVE DECEMBER 29, 2014, THE MEDICAL CENTER ENTERED INTO AN AFFILIATION AGREEMENT (THE AGREEMENT) WITH HEARTLAND HEALTH (HEARTLAND), A MISSOURI NONPROFIT CORPORATION LOCATED IN ST. JOSEPH, MISSOURI THAT PROVIDES, THROUGH ITS VARIOUS SUBSIDIARIES AND AFFILIATES, AN INTEGRATED HEALTH DELIVERY SYSTEM, INCLUDING PATIENT AND OUTPATIENT CARE AND PHYSICIAN SERVICES TO RESIDENTS OF NORTHWEST MISSOURI AND ADJACENT AREAS IN KANSAS, IOWA AND NEBRASKA. BOTH THE MEDICAL CENTER AND HEARTLAND BELIEVE THE AGREEMENT WILL ENHANCE THE MEDICAL CENTER'S ABILITY TO CONTINUE TO RESPOND TO PATIENT NEEDS AND EXPECTATIONS FOR A HIGH QUALITY, ACCESSIBLE HEALTH SYSTEM. SCHEDULE H, PART V, SECTION B, LINE 5 NORTHWEST MEDICAL CENTER ESTABLISHED AN INTERNAL COMMUNITY HEALTH NEEDS ASSESSMENT TEAM AND AN EXTERNAL PARTNER COMMITTEE. THE EXTERNAL PARTNERS GROUP WAS COMPRISED OF AREA AGENCY REPRESENTATIVES, INVOLVED COMMUNITY MEMBERS, AND ADDITIONAL ADMINISTRATIVE OFFICIALS. WE UTILIZED RESOURCES AND AREA PARTNERSHIPS TO DEFINE WHAT THE PROCESSES WERE AND DETERMINE THE NECESSARY REQUIREMENTS. NMC ALSO PARTNERED WITH AREA HOSPITALS ST. FRANCIS (SSM HEALTH CARE PROVIDER) AND HEARTLAND HEALTH TO UTILIZE THEIR RESOURCES INCLUDING SPEAKER AND TRAINING OPPORTUNITIES. WE THEN RELAYED ALL LEARNED INFORMATION AND SUGGESTIONS TO NMC STAFF, TEAM MEMBERS, AND ASSESSMENT GROUPS. NMC DEVELOPED A PRIMARY DATA ASSESSMENT THAT INCLUDES A COMPREHENSIVE SURVEY AND FOCUS GROUP INPUT. THE SURVEY CONTENT WAS DIVIDED INTO SECTIONS RELATED TO INDIVIDUAL, FAMILY, AND COMMUNITY NEEDS. EACH SECTION ADDRESSED A SERIES OF FACTORS INCLUDING HEALTH BEHAVIORS, CLINICAL CARE, SOCIAL/ECONOMIC FACTORS, AND PHYSICAL ENVIRONMENT. THE SURVEY WAS RANDOMLY DISTRIBUTED TO 1,000 RESIDENCES IN NMC'S SERVICE AREA. (LOCAL COMPANY, THE PRINTERY DISTRIBUTED THE SURVEYS VIA MAIL.) 226 COMPLETED SURVEYS WERE RETURNED AND ANALYZED, ALONG WITH THE COMPILED SECONDARY DATA. NMC'S FOCUS GROUP MET TO DISCUSS HEALTH RELATED ISSUES THEY FELT IMPACTED THE AREA MOST. REPRESENTATIVES FROM AREA GROUP HOMES, SCHOOL DISTRICTS, HEALTH DEPARTMENT, JOHNSON CONTROLS (A TOP EMPLOYER IN REGION), AND AREA CITIZENS FORMED THE FOCUS GROUP. NMC WAS ABLE TO REACH A BROAD DEMOGRAPHIC TO SOLICIT INPUT FOR THE CHNA. THE SURVEY RESPONSE AND FOCUS GROUPS WERE WELL REPRESENTED. ONE AREA THAT WAS DIFFICULT TO REACH/DISCERN INFORMATION FROM WAS THE LOCAL AMISH COMMUNITIES. WHILE WE WERE ABLE TO DELIVER SURVEY'S TO THE ADDRESSES, IT IS UNCERTAIN IF THEY ADEQUATELY COMPREHENDED THE SURVEY IN ITS ENTIRETY AND RESPONDED APPROPRIATELY. SCHEDULE H, PART V, SECTION B, LINE 11 NORTHWEST MEDICAL CENTER HAS BEEN HOSTING A WOMEN'S HEALTH EXPO AS WELL AS FOCUSING ON THE IMPORTANCE OF PREVENTATIVE CARE IN OUR MARKETING AND ALSO LOCATIONS. WE HAVE SPONSORED SEVERAL FUN RUNS/RACES AND ARE CURRENTY HOSTING MUFFINS AND MEDICINE WHICH ARE INFORMATIONAL SESSIONS FOR THE COMMUNITY WITH TOPICS ON VARIOUS WELLNESS AND HEALTHY LIFE CHOICES. 6 NMC CLINIC EAST 1607 EAST HWY 136 ALBANY MO 64402 PHYSICIAN CLINIC NMC CLINIC WEST 402 EAST HWY 136 ALBANY MO 64402 PHYSICIAN CLINIC NMC HOME HEALTH AGENCY 1607 EAST HWY 136 ALBANY MO 64402 HOME HEALTH AGENCY NMC GRANT CITY CLINIC 16 WEST 4TH STREET GRANT CITY MO 64456 PHYSICIAN CLINIC STANBERRY RURAL HEALTH CLINIC 202 EAST MAIN STREET STANBERRY MO 64489 RURAL HEALTH CLINIC NMC NEW HAMPTON CLINIC 304 LINCOLN WAY NEW HAMPTON MO 64471 PHYSICIAN CLINIC SCHEDULE H, PART I, LINE 7, COLUMN F THE AMOUNT OF BAD DEBT EXPENSE REMOVED FROM TOTAL EXPENSES FOR CALCULATING THE NET COMMUNITY BENEFIT EXPENSE PERCENTAGE WAS $1,132,790. SCHEDULE H, PART I, LINE 7 THE COSTING METHODOLOGY USED TO CALCULATE THE AMOUNTS CONTAINED IN THE TABLE OF PART I, LINE 7, OF SCHEDULE H, IS A COST TO CHARGE RATIO. SCHEDULE H, PART II NORTHWEST MEDICAL CENTER PROVIDED STAFF TO HELP WITH RENOVATION AND PROGRAM DEVELOPMENT FOR THE SENIOR CENTER. NORTHWEST MEDICAL CENTER CONDUCTED A WOMEN'S HEALTH EXPO TO PROMOTE AWARENESS, PREVENTION AND IMPROVED WELLNESS FOR THE WOMEN IN ITS COVERED AREA. CERTAIN HEALTH SCREENINGS WERE PROVIDED AS PART OF EXPO. OF THE COMMUNITY AROUND US. WE PROVIDE FREE DENTAL CARE TO CHILDREN WHO CANNOT AFFORD DENTAL CARE ON THEIR OWN. WE HAVE ANNUAL HEALTH FAIRS AND SPORTS PHYSICALS AT ALL OUR AREA CLINICS. WE HAVE ALWAYS SUPPORTED LOCAL BUSINESSES AND SCHOOLS AS WELL AS ASSOCIATIONS. SCHEDULE H, PART III, SECTION A, LINE 2 IN EVALUATING THE COLLECTIBILITY OF ACCOUNTS RECEIVABLE, THE MEDICAL CENTER ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYER SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR UNCOLLECTIBLE ACCOUNTS. SCHEDULE H, PART III, SECTION A, LINE 3 APPROXIMATELY 40% OF ALL BAD DEBT WOULD QUALIFY FOR ASSISTANCE UNDER THE FINANCIAL ASSISTANCE POLICY. SCHEDULE H, PART III, SECTION A, LINE 4 SEE PAGE 7-8 OF THE AUDITED FINANCIAL STATEMENTS. SCHEDULE H, PART III, SECTION B, LINE 8 THE MEDICARE ALLOWABLE FAILS TO COVER COST. NON-PAYMENT BY MEDICARE RECIPIENTS FOR THEIR DEDUCTIBLE AND COINSURANCE AMOUNTS INCREASES FINANCIAL ASSISTANCE AND BAD DEBT. THESE SHORTFALLS DECREASE THE ORGANIZATION'S POOL OF ASSETS AND IT'S ABILITY TO SUCCESSFULLY ATTRACT HIGHLY-TRAINED STAFF AND INVEST IN MEDICAL TECHNOLOGY. IF SERVICES ARE TO BE MAINTAINED, THEN THE COSTS WILL HAVE TO BE COVERED BY THOSE WHO PAY. THE BURDEN FALLS ON THE COMMUNITY. SCHEDULE H, PART III, SECTION C, LINE 9B WE SEND EVERY PATIENT 3 STATEMENTS ALL WITH THE MESSAGE OF FINANCIAL ASSISTANCE. IF NO PAYMENTS ARE RECEIVED, WE SEND A LETTER TO THE PATIENT OFFERING ASSISTANCE AND INFORMING THE PATIENT TO CALL FOR A PAYMENT PLAN OR ASSISTANCE. SCHEDULE H, PART VI, LINE 2 WE DO OUR NEEDS ASSESSMENT THROUGH OUR BALANCED SCORECARD COMMITTEE. WE LOOK AT WHO WE SERVE AND WHAT WE NEED TO DO DIFFERENTLY TO MAKE SURE WE ARE MEETING THE NEEDS OF OUR COMMUNITY. SCHEDULE H, PART VI, LINE 3 OUR SOCIAL WORKER/PATIENT ADVOCATE VISITS WITH PATIENTS TO DISCUSS WITH THEM ALL OF THEIR OPTIONS AND HELPS TO FILL OUT PAPERWORK AND FILE IT WITH THE APPROPRIATE AGENCY, IF NECESSARY. WE HAVE A DESIGNATED PERSON IN PATIENT FINANCIAL SERVICES TO HELP SET UP PAYMENTS, PROVIDE CHARITY CARE PACKETS, FOLLOW UP ON MISSING OR INCOMPLETE FORMS AND ANSWER ALL QUESTIONS PERTAINING TO OUR CHARITY CARE POLICY. SCHEDULE H, PART VI, LINE 4 WE SERVE A THREE COUNTY (GENTRY, WORTH, HARRISON) RURAL AREA THAT HAS A POPULATION OF 18,093 PEOPLE. HARRISON COUNTY DOES HAVE ITS OWN RURAL HOSPITAL SO WE DO NOT TARGET THAT COUNTY. THE MEDIAN INCOME LEVEL FOR THESE COUNTIES IS $28,700 WHICH IS $13,280 LESS THAN THE NATIONAL AVERAGE. SCHEDULE H, PART VI, LINE 5 WE HAVE A 5 PERSON BOARD OF DIRECTORS. EVERY DECISION WE MAKE IS BASED ON HOW IT EFFECTS THE COMMUNITY. WE GIVE DONATIONS AND CHARITY CARE TO AID IN LOCAL NEEDS. BECAUSE WE ARE A SMALL RURAL HOSPITAL AND ARE ONE OF THE LARGEST EMPLOYERS IN THE AREA, EVERYTHING WE DO EFFECTS THE COMMUNITY AROUND US. WE HAVE ANNUAL HEALTH FAIRS, FLU CLINICS AND SPORT PHYSICALS AT ALL OUR AREA CLINICS. WE ALSO HAVE A LONG HISTORY OF SUPPORTING LOCAL BUSINESSES AND SCHOOLS AS WELL AS ASSOCIATIONS. SCHEDULE H, PART VI, LINE 6 NORTHWEST MEDICAL CENTER SHALL CONTINUE TO PROVIDE HIGH QUALITY, ACCESSIBLE HEALTH CARE TO PATIENTS IN ITS COVERAGE AREA WITH THE ADDITIONAL RESOURCES AND EFFICIENCIES IT WILL NOW HAVE AS AN AFFILIATE OF HEARTLAND HEALTH. HEARTLAND BRINGS AFFILIATION WITH THE MAYO CLINIC NETWORK, A STRONG SPECIALTY PHYSICIAN COMMUNITY AND OTHER RESOURCES TO NORTHWEST MEDICAL CENTER. SCHEDULE H, PART VI, LINE 7 MO true NORTHWEST MEDICAL CENTER FOUNDATION INC 705 NORTH COLLEGE ST ALBANY MO 64402 473694893 PENDING 7199288 OPERATIONS 1 0 SCHEDULE I, PART I, LINE 2 ALL GRANTS WERE MADE AS PART OF THE AFFILIATION AGREEMENT WITH HEARTLAND HEALTH. AS PART OF THE AGREEMENT THE NORTHWEST MEDICAL CENTER FOUNDATION WAS CREATED AND WAS TO BE TRANSFERRED CERTAIN ASSETS OF NORTHWEST MEDICAL CENTER ASSOCIATION, INC. SCHEDULE I, PART II, LINE 1 THE NORTHWEST MEDICAL CENTER FOUNDATION FORM 1023 APPLICATION FOR RECOGNITION OR EXEMPTION IS IN PROCESS WITH THE EXPECTATION OF RECEIVING 501(C)(3) STATUS. X X X X X false true false false false false false false false DR NASER SOGHRATI ER PHYSICIAN 257188 0 0 0 20554 0 0 0 13181 0 290923 0 0 0 DR ANGELA MARTIN FAMILY PRACTICE PHYSICIAN 256565 0 0 0 35556 0 0 0 15600 0 307721 0 0 0 JON DOOLITTLE PRESIDENT AND CEO 150690 0 37500 0 14984 0 0 0 15600 0 218774 0 0 0 NATHAN BLACKFORD COO 121923 0 20000 0 13877 0 0 0 15600 0 171400 0 0 0 DR JACKIE MILLER FAMILY PRACTICE PHYSICIAN 395145 0 0 0 38588 0 0 0 6945 0 440678 0 0 0 DR KATIE DIAS FAMILY PRACTICE PHYSICIAN 145312 0 0 0 43481 0 0 0 12581 0 201374 0 0 0 DR ARTURO TENORIO FAMILY PRACTICE PHYSICIAN 259668 0 0 0 16038 0 0 0 0 0 275706 0 0 0 MICHAEL PULIDO DIRECTOR/CHAIR 0 309778 0 58800 0 29465 0 64531 0 23301 0 485875 0 0 JOHN P WILSON DIRECTOR, SECRETARY/TREASURER 0 448500 0 82797 0 84296 0 55886 0 0 0 671479 0 0 CURT KRETZINGER DIRECTOR/VICE-CHAIR 0 478592 0 94710 0 124180 0 70649 0 7927 0 776058 0 0 S MARK LANEY MD DIRECTOR 0 762051 0 316825 0 4886 0 10400 0 23632 0 1117794 0 0 SCHEDULE J, PART I, LINE 4B VESTED ACCRUED --------- --------- MICHAEL PULIDO $ 15,252 $ 53,739 JOHN P. WILSON $ 62,660 $ 45,486 CURT KRETZINGER $ 101,255 $ 60,249 THOSE LISTED ABOVE HAVE SIGNED SUPPLEMENTAL EXECUTIVE RETIREMENT PLANS WHICH RECOGNIZE THE VALUE OF THE INDIVIDUAL AND THE MUTUAL BENEFIT OF CONTINUED EMPLOYMENT FOR AN EXTENDED PERIOD OF TIME BY ESTABLISHING A 457F PLAN. THE PLAN IS FUNDED YEARLY AS THE RESULT OF A CALCULATION DESCRIBED IN THE AGREEMENT WHICH WILL REWARD THE INDIVIDUALS WITH 100% VESTING AT NORMAL RETIREMENT AGE OR UPON DEATH OR UPON SEPARATION FROM SERVICE DUE TO DISABILITY OR UPON INVOLUNTARY SEPARATION FROM SERVICE WITHOUT CAUSE, WITH LUMP SUM PAYMENT WITHIN 90 DAYS OF EACH SITUATION TAKING INTO CONSIDERATION A NON-COMPETE COVENANT. SEPARATION WITH CAUSE MAKES SUPPLEMENTAL EXECUTIVE RETIREMENT AGREEMENTS NULL AND VOID. HOSPITAL & CLINIC BUILDINGS/IMPROVEMENTS 2014-12-29 3503430 BOOK VALUE 473694893 NORTHWEST MEDICAL CENTER FOUNDATION 705 N COLLEGE ALBANY MO 64402 1023 IN-PROGRESS HOSPITAL & CLINIC LAND 2014-12-29 41867 BOOK VALUE 473694893 NORTHWEST MEDICAL CENTER FOUNDATION 705 N COLLEGE ALBANY MO 64402 1023 IN-PROGRESS FIXED EQUIPMENT 2014-12-29 173936 BOOK VALUE 473694893 NORTHWEST MEDICAL CENTER FOUNDATION 705 N COLLEGE ALBANY MO 64402 1023 IN-PROGRESS INVESTMENTS 2014-12-29 4671340 BOOK VALUE 473694893 NORTHWEST MEDICAL CENTER FOUNDATION 705 N COLLEGE ALBANY MO 64402 1023 IN-PROGRESS CASH 2014-12-29 1706685 BOOK VALUE 473694893 NORTHWEST MEDICAL CENTER FOUNDATION 705 N COLLEGE ALBANY MO 64402 1023 IN-PROGRESS ACCOUNTS RECEIVABLE (NET) 2014-12-29 1720803 BOOK VALUE 473694893 NORTHWEST MEDICAL CENTER FOUNDATION 705 N COLLEGE ALBANY MO 64402 1023 IN-PROGRESS PREPAID EXPENSES 2014-12-29 146869 BOOK VALUE 473694893 NORTHWEST MEDICAL CENTER FOUNDATION 705 N COLLEGE ALBANY MO 64402 1023 IN-PROGRESS ACCOUNTS PAYABLE & OTHER LIAB 2014-12-29 -1126211 BOOK VALUE 473694893 NORTHWEST MEDICAL CENTER FOUNDATION 705 N COLLEGE ALBANY MO 64402 1023 IN-PROGRESS INVENTORY 2014-12-29 264356 BOOK VALUE 431283316 HEARTLAND HEALTH 5325 FARAON ST JOSEPH MO 64506 501 (C) (3) PREPAID INSURANCE 2014-12-29 181573 BOOK VALUE 431283316 HEARTLAND HEALTH 5325 FARAON ST JOSEPH MO 64506 501 (C) (3) ACCOUNTS RECEIVABLE 2014-12-29 60827 BOOK VALUE 431283316 HEARTLAND HEALTH 5325 FARAON ST JOSEPH MO 64506 501 (C) (3) EQUIPMENT AND SOFTWARE 2014-12-29 1413511 BOOK VALUE 431283316 HEARTLAND HEALTH 5325 FARAON ST JOSEPH MO 64506 501 (C) (3) CAPITAL LEASE OBLIGATIONS 2014-12-29 -117505 BOOK VALUE 431283316 HEARTLAND HEALTH 5325 FARAON ST JOSEPH MO 64506 501 (C) (3) LEASEHOLD IMPROVEMENTS 2014-12-29 107951 BOOK VALUE 431283316 HEARTLAND HEALTH 5325 FARAON ST JOSEPH MO 64506 501 (C) (3) CONSTRUCTION IN PROGRESS 2014-12-29 75279 BOOK VALUE 431283316 HEARTLAND HEALTH 5325 FARAON ST JOSEPH MO 64506 501 (C) (3) true true false false SCHEDULE N, PART II, LINE 2A SERENA NAYLOR, JOANN GIBBANY, KIM FINDLEY, MARY EWING, JIM HUMPHREY, ROBERT MILLER, ROBERT SMITH, MATTHEW PEARL, DR. NASER SOGHRATI, DR. ANGELA MARTIN, AND CRAIG THOMPSON BECAME DIRECTORS OF NORTHWEST MEDICAL CENTER FOUNDATION, INC. SCHEDULE N, PART II, LINE 2B JON D. DOOLITTLE WAS PRESIDENT OF THE FORMER ORGANIZATION AND IS NOW REGIONAL PRESIDENT OF NORTHWEST MEDICAL CENTER ASSOCIATION, INC. NATE BLACKFORD WAS FIRST VICE PRESIDENT AND CHIEF OPERATING OFFICER OF THE FORMER ORGANIZATION AND IS NOW A PROCESS LEADER REGIONAL OPERATIONS FOR NORTHWEST MEDICAL CENTER ASSOCIATION, INC. DONNA WALTER WAS A VICE PRESIDENT FOR THE FORMER ORGANIZATION AND IS NOW A TEAM LEADER QUALITY FOR NORTHWEST MEDICAL CENTER ASSOCIATION, INC. JIM CROUCH WAS A VICE PRESIDENT AND CHIEF INFORMATION OFFICER FOR THE FORMER ORGANIZATION AND IS NOW A TEAM LEADER OF REGIONAL TECHNICAL SERVICES FOR NORTHWEST MEDICAL CENTER ASSOCIATION, INC. CHRISTINA GILLESPIE WAS VICE PRESIDENT, CHIEF FINANCIAL OFFICER AND TREASURER FOR THE FORMER ORGANIZATION AND BECAME REGIONAL CFO/TEAM LEADER FOR NORTHWEST MEDICAL CENTER ASSOCIATION, INC. MIRANDA FLOYD WAS CHIEF NURSING OFFICER FOR THE FORMER ORGANIZATION AND IS NOW A TEAM LEADER NURSING SERVICES FOR NORTHWEST MEDICAL CENTER ASSOCIATION, INC. JILL CLAIR WAS SECRETARY FOR THE FORMER ORGANIZATION AND IS NOW ASSISTANT TO REGIONAL PRESIDENT FOR NORTHWEST MEDICAL CENTER ASSOCIATION, INC. FORM 990, PART VI, SECTION A, LINE 2 S. MARK LANEY, MD, MICHAEL PULIDO, JOHN P. WILSON, CURT KRETZINGER HAVE A BUSINESS RELATIONSHIP. FORM 990, PART VI, SECTION A, LINE 4 ON DECEMBER 29, 2014 THE MEDICAL CENTER ENTERED INTO AN AFFILIATION AGREEMENT WITH HEARTLAND HEALTH. AS A RESULT OF THE THIS AGREEMENT THE BY-LAWS WERE AMENDED BY THE BOARD OF DIRECTORS OF NORTHWEST MEDICAL CENTER ASSOCIATION MAKING HEARTLAND HEALTH THE SOLE MEMBER. IN ADDITION, TO THE CHANGE IN MEMBERSHIP THE NUMBER AND COMPOSITION OF THE BOARD OF DIRECTORS WAS CHANGED TO BE ELECTED BY HEARTLAND HEALTH AND INCLUDE ONE PERSON FROM THE RETIRING BOARD OF DIRECTORS OF NORTHWEST MEDICAL CENTER ASSOCIATION. FORM 990, PART VI, SECTION A, LINE 6 HEARTLAND HEALTH, A MISSOURI NONPROFIT CORPORATION, IS THE SOLE MEMBER OF NORTHWEST MEDICAL CENTER ASSOCIATION. FORM 990, PART VI, SECTION A, LINE 7A HEARTLAND HELATH BEING THE SOLE MEMBER OF NORTHWEST MEDICAL CENTER ASSOCIATION HAS THE RIGHT TO ELECT ALL THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION A, LINE 7B THE SOLE MEMBER (HEARTLAND HEALTH) SHALL HAVE THE FOLLOWING POWERS: OVERALL STRATEGIC DIRECTION, NUMBER AND ELECTION OF BOARD MEMBERS, APPOINTMENT OF AUDITORS AND LEGAL COUNSEL, ESTABLISHMENT OF BANKING RELATIONSHIPS AND MANAGEMENT OF CASH AND OTHER ASSETS, APPROVAL OF CHANGES TO THE ARTICLES OF INCORPORATION AND BYLAWS, LONG-RANGE PLANNING, ADOPTION OF ANNUAL OPERATING PLANS AND APPLICATION FOR CERTIFICATES OF NEED. FORM 990, PART VI, SECTION B, LINE 11B AN INDEPENDENT ACCOUNTING FIRM PREPARES AND REVIEWS THE FORM 990 WITH INFORMATION PROVIDED FROM THE ORGANIZATION'S ACCOUNTING STAFF. THE INDEPENDENT ACCOUNTING FIRM PROVIDES A DRAFT OF THE FORM 990 TO THE ACCOUNTING STAFF OF THE ORGANIZATION FOR REVIEW. THE DRAFT FORM 990 IS REVISED FOR ANY CORRECTIONS OR CLARIFICATIONS BASED ON THE REVIEW BY THE ORGANIZATION'S ACCOUNTING STAFF. AFTER ANY NECESSARY CORRECTIONS OR CLARIFICATIONS ARE MADE TO THE FORM 990 A COMPLETE COPY OF THE FORM 990 IS PROVIDED TO ALL VOTING MEMBERS OF THE BOARD VIA EMAIL PRIOR TO ELECTRONICALLY FILING THE RETURN. FORM 990, PART VI, SECTION B, LINE 12C EACH YEAR OFFICERS AND DIRECTORS READ AND SIGN A CONFLICT OF INTEREST STATEMENT STATING THEY UNDERSTAND WHAT THEY CAN AND CANNOT DO AND HOW THE REPORTING PROCESS IS HANDLED. IF THERE ARE ISSUES, ALL CONLFLICT OF INTEREST ARE REPORTED TO THE CORPORATE COMPLIANCE COMMITTEE FOR INVESTIGATION BY WHICH A RESOLUTION WILL BE SUGESTED TO THE GOVERNING BODY. ANY BOARD MEMBER THAT HAS A CONFLICT OF INTEREST DOES NOT VOTE ON THE ISSUE. FORM 990, PART VI, SECTION B, LINE 15A THE CEO'S COMPENSATION IS REVIEWED BY THE EXECUTIVE COMMITTEE ON A ANNUAL BASIS. THE EXECUTIVE COMMITTEE COMES UP WITH THE COMPENSATION PLAN AND GIVES THAT PLAN TO THE HUMAN RESOURCES DIRECTOR UPON APPROVAL FROM THE CHAIRMAN OF THE BOARD. FORM 990, PART VI, SECTION B, LINE 15B THE CEO REVIEWS ALL OTHER OFFICER'S COMPENSATION AND SHARES WITH THE HUMAN RESOURCES DIRECTOR ANY CHANGES. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. ALL OF THESE DOCUMENTS ARE LOCATED IN ADMINISTRATION. 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