2015-02-16T10:33:29-06:00 2014-03-31 BKD LLP 1201 Walnut Suite 1700 Kansas City MO 641062246 990 2013-04-01 440580870 Northwest Medical Center Association Inc % JON DOOLITTLE NORT 6607263941 705 NORTH COLLEGE ST Suite ALBANY MO 64402 JON DOOLITTLE PRESIDENT AND CEO 6607263941 2015-02-17 true Michael J Engle P00482834 6607263941 2013 2016-02-25 16:41:14Z NORTHWEST MEDICAL CENTER JON DOOLITTLE 705 N COLLEGE ST ALBANY MO 64402 17525841 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. 11 9 210 9 88657 4843 12720 69111 15543335 16735436 201083 211468 331261 497233 16088399 17513248 17457 15878 0 0 9315519 10311289 0 0 0 7194377 7824748 16527353 18151915 -438954 -638667 17450290 16690097 2991872 2683717 14458418 14006380 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 3262283 15828 3991356 INPATIENT HOSPITAL CARE- OUR ACUTE CARE AND SWINGBED PROGRAM SAW A TOTAL OF 2,070 PATIENT DAYS. MEDICARE PATIENT DAYS CONSISTED OF 1,790 DAYS OF 87%. MEDICAID PATIENT DAYS WERE 72 DAYS OR 4%. 2078041 2542453 EMERGENCY SERVICES - TOTAL PATIENTS SEEN IN THE EMERGENCY ROOM WERE 2,842. OF THAT AMOUNT 26% OF PATIENTS SEEN WERE MEDICARE PATIENTS AND 28% WERE MEDICAID. 8410630 10290284 OUTPATIENT SERVICES - THERE WERE 20,529 OUTPATIENT VISITS. MEDICARE PATIENTS ACCOUNTED FOR 55.4% AND MEDICAID PATIENTS WERE 11%. 13750954 true true false true false false false false false true true false false true false false true false false false false false false false true false true true true false true false false false false false false false false false false false false false false false false false true 56 0 true 210 true true true false false false false true true false false false false X 11 9 false false false false false 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 X X 0 0 0 JOANN GIBBANY DIRECTOR 1.0 X 0 0 0 KIM FINDLEY DIRECTOR 1.0 X 0 0 0 MARY EWING DIRECTOR 1.0 X 0 0 0 NORMA HILL DIRECTOR - RESIGNED AUG 13 1.0 X 0 0 0 JIM HUMPHREY DIRECTOR/ VICE CHAIR 1.0 X X 0 0 0 ROBERT MILLER DIRECTOR 1.0 X 0 0 0 ROBERT SMITH DIRECTOR 1.0 X 0 0 0 MATTHEW PEARL DIRECTOR 1.0 X 0 0 0 DR NASER SOGHRATI ER PHYSICIAN 75.0 X 319399 0 1404 DR ANGELA MARTIN FAMILY PRACTICE PHYSICIAN 40.0 X 241566 0 21097 CRAIG THOMPSON DIRECTOR 1.0 X 0 0 0 DONNA WALTER VP OF PATIENT CARE SERVICES 40.0 X 107187 0 20326 JAMES CROUCH VP OF INFORMATION TECHNOLOGY 40.0 X 93694 0 17098 JON DOOLITTLE PRESIDENT AND CEO 40.0 X 206429 0 20403 NATHAN BLACKFORD COO 40.0 X 117066 0 17926 BARB AXON EXECUTIVE VICE PRESIDENT 36.0 X 112129 0 10256 CHRISTINA GILLESPIE VP & CFO 40.0 X 21067 0 8633 DR JACKIE MILLER FAMILY PRACTICE PHYSICIAN 40.0 X 372199 0 8727 DR KATIE DIAS FAMILY PRACTICE PHYSICIAN 40.0 X 129489 0 14417 DR ARTURO TENORIO FAMILY PRACTICE PHYSICIAN 40.0 40.0 X 133726 0 353 1853951 0 140640 9 false true false HAVE A NICE DAY ANESTHESIA ANESTHESIA SERVICES 133020 BKD LLP ACCOUNTING SERVICES 120868 HEARTLAND HEALTH CLINICAL SERVICES 314425 WEATHERBY LOCUMS INC ER PHYSICIANS 219989 4 12000 51895 5216 69111 NET PATIENT SERVICE REVENUE 621110 15734900 15734900 EHR INCENTIVE PAYMENTS 621110 1000536 1000536 16735436 211448 211448 0 0 4200 4200 0 4200 4200 20 20 20 20 26898 12000 12593 14305 14305 0 0 CAFETERIA 811000 79005 79005 VENDING MACHINE 900099 566 566 All Other Misc Revenue 900099 399157 88657 310500 399157 88657 310500 478728 17513248 16735436 88657 620044 15828 15828 50 50 0 0 1466547 602967 863580 0 6526834 5658279 868555 0 1785648 1249068 536580 532260 416482 115778 0 0 133580 133580 0 0 2302 2302 1517835 748926 768909 24740 146 24594 928430 579415 349015 198124 122608 75516 0 316945 249505 67440 117632 90401 27231 0 0 59131 59131 0 829605 656225 173380 205553 162387 43166 BAD DEBT 1455865 1455865 REPAIRS AND MAINTENANCE 832085 582733 249352 EDUCATION 30288 20025 10263 MEDICAL SUPPLIES 1050954 1050940 14 121679 89104 32575 18151915 13750954 4400961 0 797659 1026436 21823 21839 0 0 3457808 2625375 0 0 0 0 0 0 292427 268265 223392 276602 14704804 8905741 6165703 5799063 2031519 1840394 0 0 0 0 0 0 4459959 4832123 17450290 16690097 1432065 1451773 0 0 21333 18387 0 0 0 0 0 0 1538474 1213557 0 0 0 0 2991872 2683717 X 10613997 10021833 3711656 3851782 132765 132765 14458418 14006380 17450290 16690097 X -638667 46503 140126 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false true 8066 false false false 8066 false 132765 56276 56276 132765 132765 42003 42003 132765 132765 6077 6077 132765 132765 36702 36702 132765 132765 14604 14604 132765 1.00000 false false 41867 41867 7619459 3993106 3626353 137810 9187 128623 6473859 4715252 1758607 431809 188196 243613 5799063 OTHER ASSETS 123165 INTEREST RECEIVABLE 111341 INTEREST IN TRUST ASSETS 3851782 Due from Third Party Payers 745835 4832123 15931780 46503 12593 59096 15872684 1640564 1640564 17513248 16680443 12593 12593 16667850 1484065 1484065 18151915 SCHEDULE D, PART V, LINE 4 THE ENDOWMENT IS USED FOR ANY AND ALL HOSPITAL EXPENSES OF ANY NATURE. SCHEDULE D, PART X, LINE 2 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 $ 12,593 LINE 4B: UBI GROSS RECEIPTS $ 28,200 NET ASSETS RELEASED FROM RESTRICTION 156,499 BAD DEBT EXPENSE 1,455,865 ---------- $ 1,640,564 SCHEDULE D, PART XII, LINE 4B LINE 2D: SPECIAL EVENT EXPENSES $ 12,593 LINE 4B: BAD DEBT EXPENSE $ 1,455,865 UBI GROSS RECEIPTS 28,200 ----------- TOTAL 1,484,065 GOLF TOURNAMENT 38898 12000 26898 340 250 1780 1690 400 8133 0 38898 12000 26898 340 250 1780 1690 400 8133 12593 14305 true true X true X 125. true X true true false true true 1090371 950864 139507 0.00840 2148026 1497011 651015 0.03900 3238397 2447875 790522 0.04740 28122 30641 -2519 0.00020 25912 0 25912 0.00160 15878 0 15878 0.00100 69912 30641 39271 0.00240 3308309 2478516 829793 0.04980 15878 15878 0.00100 15878 15878 0.00100 false 1455865 582346 7824090 8167923 -343833 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 true X X X X X X X X X 13 true false true X http://northwestmedicalcenter.org/files/ X X X X X X false false true true 125. true 200. true X X true true X X true false X X X true X false false SCHEDULE H, PART V, LINE 3 SURVEYS WERE SENT TO A RANDOM SAMPLE OF 1000 FROM THE COMMUNITIES WE SERVE. SCHEDULE H, PART V, LINE 5A BOTH THE COMMUNITY HEALTH NEEDS ASSESSMENT AND IMPLEMENTATION PLAN CAN BE FOUND AT: http://northwestmedicalcenter.org/files/7013/6752/7627/Community_Health_Ne eds_Assessment.pdf SCHEDULE H, PART V, LINE 7 Several goals have been partially achieved. We did not partner with 3 area employers to develop "Employee Wellness Plans", Our increase in colonscopies, wellness visits and mammographies have not reached 10%. All deficiencies can be traced to lack of funding and staffing. 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 $1,455,865. 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 WE HAVE A BOARD OF DIRECTORS THAT IS MADE UP OF 9 VOLUNTEERS OF THE COMMUNITY AND 2 PHYSICIANS. 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 BUILDING OF THE COMMUNITY AROUND US. SCHEDULE H, PART III, LINE 3 THE AMOUNT OF BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE IS ESTIMATED AT 40% OF BAD DEBT EXPENSE BASED ON HISTRORICAL DATA. SCHEDULE H, PART III, LINE 4 ACCOUNTS ARE CONSIDERED DELINQUENT AND SUBSEQUENTLY WRITTEN OFF AS BAD DEBTS BASED ON INDIVIDUAL CREDIT EVALUATION AND SPECIFIC CIRCUMSTANCES OF THE ACCOUNT. OUR BAD DEBT IS FIGURED ON THE ALLOWANCE METHOD, THEREFORE, ANYTHING OUTSTANDING IN THE AGING BUCKETS WOULD BE INCLUDED IN THE ALLOWANCE CALCULATION. THIS ALSO MEANS THAT THERE WILL BE PEOPLE WHO ARE CURRENTLY IN THE PROCESS OF SUBMITTING CHARITY CARE PAPERWORK THAT ARE INCLUDED IN THE BAD DEBT NUMBER. SCHEDULE H, PART III, LINE 8 SERVING PATIENTS WITH GOVERNMENT HEALTH BENEFITS, SUCH AS MEDICARE, IS A COMPONENT OF THE COMMUNITY BENEFIT STANDARD THAT TAX-EXEMPT HOSPITALS ARE HELD TO. THIS IMPLIES THAT SERVING MEDICARE PATIENTS IS A COMMUNITY BENEFIT AND THAT THE HOSPITAL OPERATES TO PROMOTE THE HEALTH OF THE COMMUNITY. SCHEDULE H, PART III, LINE 9B IF THE PATIENT QUALIFIES FOR CHARITY CARE, THEN WE WRITE OFF THEIR BILL TO CHARITY CARE. THOSE PATIENTS NO LONGER OWE THE HOSPITAL WHAT IS OWED FOR THOSE PATIENT VISITS. 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 PERSONALLY VISITS WITH PATIENTS TO DISCUSS WITH THEM ALL OF THEIR OPTIONS AND WILL HELP IN ANY WAY TO FILL OUT PAPERWORK AND FILE IT WITH THE APPROPRIATE AGENCY, IF NECESSARY. WE HAVE A DESIGNATED PERSON IN FINANCIAL PATIENT SERVICES TO HELP IN SETTING UP PAYMENTS, GIVING OUT CHARITY CARE PACKETS, FOLLOWING UP ON MISSING OR INCOMPLETE FORMS, AND TO 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 IS MADE UP OF 18,093 PEOPLE. HARRISON COUNTY DOES HAVE ITS OWN RURAL HOSPITAL SO THAT IS NOT OUR TARGET COUNTY ALTHOUGH WE DO SEE SOME PATIENTS FROM THERE. 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 11 MEMBER BOARD OF DIRECTORS THAT IS MADE UP OF 9 VOLUNTEERS OF THE COMMUNITY AS WELL AS 2 PHYSICIANS. 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 BUILDING 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 VI, LINE 7 MISSOURI true SCHEDULE I, PART I, LINE 2 THE RECIPIENTS OF THE GRANTS REQUEST AN EXACT AMOUNT OF FUNDS THAT IS SUPPORTED BY DOCUMENTATION THEY PROVIDE THE HOSPITAL. X X X X X false false false false false false false false false DR NASER SOGHRATI ER PHYSICIAN 316799 0 2600 0 0 0 0 0 1404 0 320803 0 DR ANGELA MARTIN FAMILY PRACTICE PHYSICIAN 241366 0 200 0 0 0 0 0 21097 0 262663 0 JON DOOLITTLE PRESIDENT AND CEO 143729 0 62700 0 0 0 0 0 20403 0 226832 0 DR JACKIE MILLER FAMILY PRACTICE PHYSICIAN 371999 0 200 0 0 0 0 0 8727 0 380926 0 FORM 990, PART III, LINE 2 NMC OPENED AN ADDITIONAL RURAL HEALTH CLINIC IN NEW HAMPTON, MO TO BETTER SERVE THE COMMUNITY. FORM 990, PART VI, SECTION A, LINES 7A AND 7B LINE 7A: OUR HOSPITAL HAS MEMBERS OF THE HOSPITALS ASSOCIATION THAT VOTE ON THE BOARD MEMBERS EVERY YEAR IN AUGUST. THEY ARE NOT PAID AND ARE PEOPLE FROM THE COMMUNITY WHO PAY $10 PER PERSON (WHICH IS USED AS A DONATION) THAT WILL VOTE ON THE NOMINATED BOARD MEMBERS THAT WERE PICKED BY THE NOMINATIONS COMMITTEE WHICH IS MADE UP OF CURRENT BOARD MEMBERS. LINE 7B: THE VOTE BY THE ASSOCIATION ON THE NOMINATIONS FOR NEW BOARD MEMBERS BY THE NOMINATIONS COMMITTEE IS THE ONLY DECISION SUBJECT TO APPROVAL BY MEMBERS, STOCKHOLDERS, OR OTHER PERSONS. FORM 990, PART VI, SECTION B, LINE 11B WE DISTRIBUTE THE 990 VIA EMAIL TO THE BOARD MEMBERS. THEY REVIEW IT AND RELAY ANY ISSUES OR QUESTIONS. THE CEO AND CFO BOTH REVIEW IT AS WELL. IF THERE ARE ANY CORRECTIONS, THE PREPARING COMPANY IS NOTIFIED. UPON ALL AGREEMENT, THE 990 IS APPROVED FOR SUBMISSION. FORM 990, PART VI, SECTION B, LINE 12C EVERY YEAR ALL OFFICERS AND BOARD MEMBERS HAVE TO 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 CONFLICTS OF INTEREST ARE REPORTED THROUGH THE CORPORATE COMPLIANCE COMMITTEE FOR INVESTIGATION BY WHICH A RESOLUTION WILL BE SUGGESTED 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, LINES 15A & 15B LINE 15A: THE CEO'S COMPENSATION IS REVIEWED BY THE EXECUTIVE COMMITTEE ON A YEARLY 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. 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, LINES 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. FORM 990, PART XI, LINE 5 NET GAIN ON INTEREST IN TRUST ASSETS $ 296,625 NET ASSETS RELEASED FROM RESTRICTION $ (156,499) ------------ $ 140,126