2014-02-17T15:14:01-06:00 2013-03-31 BKD LLP 1201 Walnut Suite 1700 Kansas City MO 641062246 990 2012-04-01 440580870 Northwest Medical Center Association Inc % JON DOOLITTLE NORT 6607263941 705 NORTH COLLEGE ST Suite ALBANY MO 64402 JON DOOLITTLE 8162216300 2014-02-15 true Michael J Engle 8162216300 2012 2015-11-30 17:44:51Z Northwest Medical Center JON DOOLITTLE 705 N COLLEGE ST ALBANY MO 64402 16103859 false X WWW.NORTHWESTMEDICALCENTER.ORG X 1955 MO WITH THE HELP OF TRUSTED, INTEGRATED PARTNERS, NORTHWEST MED. CENTER SERVES AS A COMPASSIONATE, EFFICIENT HEALTH HOME THAT ENCOURAGES WELLNESS, RESTORES HEALTH, AND PROMOTES A SUPERIOR QUALITY OF LIFE. 13 11 196 12 43083 1446 10633 12720 15346004 15543335 202461 201083 269045 331261 15828143 16088399 30776 17457 0 0 8822000 9315519 0 0 0 7358705 7194377 16211481 16527353 -383338 -438954 17718033 17450290 2948132 2991872 14769901 14458418 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 3169891 17457 3819520 INPATIENT HOSPITAL CARE - OUR ACUTE CARE AND SWINGBED PROGRAM SAW A TOTAL OF 2,807 PATIENT DAYS. MEDICARE PATIENT DAYS CONSISTED OF 2,447 DAYS OR 87%. MEDICAID PATIENT DAYS WERE 83 DAYS OR 2%. 2133510 2570748 EMERGENCY SERVICES - TOTAL PATIENTS SEEN IN THE EMERGENCY ROOM WERE 3,024. OF THAT AMOUNT 31.5% OF PATIENTS SEEN WERE MEDICARE PATIENTS AND 23.1% WERE MEDICAID. 7632051 9196150 OUTPATIENT SERVICES - THERE WERE 17,362 OUTPATIENT VISITS. MEDICARE PATIENTS ACCOUNTED FOR 55.4% AND MEDICAID PATIENTS WERE 9.2%. 12935452 true false false true false false false false false true true false false true false true true false false false false false false false true false true true true false true false false false false false false true false false false false false false false false false false true 50 0 true 196 true true true false false false false true true false false false false X 13 11 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 KEVIN HARDING 1.0 X X JOANN GIBBANY 1.0 X KIM FINDLEY 1.0 X MARY EWING 1.0 X NORMA HILL 1.0 X JIM HUMPHREY 1.0 X X ROBERT MILLER 1.0 X SERENA NAYLOR 1.0 X ROBERT SMITH 1.0 X DR NASER SOGHRATI 75.0 X 314702 6393 DR ANGELA MARTIN 40.0 X 240763 21549 MATTHEW PEARL 1.0 X CRAIG THOMPSON 1.0 X BARBARA AXON 36.0 X 105641 12282 DONNA WALTER 40.0 X 96253 24306 JAMES CROUCH 40.0 X 101924 18987 JON DOOLITTLE 40.0 X 130155 0 24986 NATHAN BLACKFORD 40.0 X 106898 17931 DR JACKIE MILLER 40.0 X 375232 10540 DR KATIE DIAS 40.0 X 164258 15352 1635826 0 152326 8 false true false HAVE A NICE DAY ANESTHESIA ANESTHESIA SERVICES 133020 DR ARTURO TENORIO ER PHYSICIAN 139945 BKD LLP ACCOUNTING SERVICES 119158 HEARTLAND HEALTH CLINICAL SERVICES 107155 KPS LOCUMS LLC ER PHYSICIAN 115837 5 6120 6600 12720 NET PATIENT SERVICE REVENUE 621110 15543335 15543335 15543335 201083 201083 0 0 7700 7700 0 7700 7700 0 0 32498 6120 15460 17038 17038 0 0 0 CAFETERIA 811000 79184 79184 VENDING MACHINE 900099 1058 1058 MISCELLANEOUS 900099 226281 43083 183198 226281 43083 183198 306523 16088399 15543335 43083 489261 17457 17457 0 0 0 1523315 746591 776724 61274 61274 5704716 5185192 519524 53198 43738 9460 1488121 1116354 371767 484895 398667 86228 0 0 152241 152241 0 0 0 1644543 834227 810316 21728 838 20890 885744 668665 217079 255234 174549 80685 0 262698 211752 50946 114472 88489 25983 0 0 55896 55896 0 877897 693539 184358 198513 156825 41688 BAD DEBT 899586 899586 REPAIRS AND MAINTENANCE 783256 618036 165220 EDUCATION 16096 9315 6781 MEDICAL SUPPLIES 861842 861842 164631 148516 16115 16527353 12935452 3591901 0 584963 797659 19313 21823 0 0 3469775 3457808 0 0 0 0 0 0 245264 292427 171107 223392 14285288 8119585 6684416 6165703 1227176 2031519 0 0 0 0 0 0 5316019 4459959 17718033 17450290 1054908 1453398 0 0 0 0 0 0 0 0 0 0 1893224 1538474 0 0 0 0 2948132 2991872 X 11002130 10613997 3635006 3711656 132765 132765 14769901 14458418 17718033 17450290 X -438954 50821 76650 X false true X true false X false false false false false true 4161 false false false 4161 false 132765 42003 42003 132765 132765 6077 6077 132765 132765 36702 36702 132765 132765 14604 14604 132765 132765 0 0 132765 1.00000 false false 41867 41867 7619459 3756042 3863417 0 0 0 6115303 4189836 1925467 508659 173707 334952 6165703 OTHER ASSETS 117100 INTEREST RECEIVABLE 125203 INTEREST IN TRUST ASSETS 3711656 ANNUITIES 0 DUE FROM THIRD PARTY PAYERS 506000 4459959 0 0 15995645 50821 15460 66281 15929364 159035 159035 16088399 16535763 15460 15460 16520303 7050 7050 16527353 INTENDED USE OF ENDOWMENT FUNDS SCHEDULE D, PART V, LINE 4 THE ENDOWMENT IS USED FOR ANY AND ALL HOSPITAL EXPENSES OF ANY NATURE. UNCERTAIN TAX POSITIONS DISCLOSURE 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. RECONCILIATION OF REVENUE PER AUDIT REPORT SCHEDULE D, PART XI, LINES 2D & 4B LINE 2D: SPECIAL EVENT EXPENSES $ 15,460 RENTAL EXPENSES $ NONE ---------- $ 15,460 LINE 4B: NET ASSETS RELEASED FROM RESTRICTION $ 151,985 UBI GROSS RECIEPTS $ 7,050 ---------- $ 159,035 RECONCILIATION OF EXPENSES PER AUDIT REPORT SCHEDULE D, PART XII, LINE 4B LINE 2D: SPECIAL EVENT EXPENSES $ 15,460 RENTAL EXPENSES $ NONE ---------- $ 15,460 LINE 4B: UBI GROSS RECIEPTS $ 7,050 ---------- $ 159,035 $ 159,035 GOLF TOURNAMENT 38618 6120 32498 100 245 1810 3314 9991 0 38618 6120 32498 100 245 1810 3314 9991 15460 17038 true true X true X 125. true X true true true false true true 1304649 986489 318160 0.02040 2310509 1657572 652937 0.04180 3615158 2644061 971097 0.06220 34069 34069 0.00220 17457 17457 0.00110 51526 51526 0.00330 3666684 2644061 1022623 0.06550 17457 17457 0.00110 17457 17457 0.00110 false 899586 359834 7218854 7366455 -147601 X true true 1 1 NORTHWEST MEDICAL CENTER

705 NORTH COLLEGE ST ALBANY MO 64402

WWW.NORTHWESTMEDICAL.ORG X X X X NORTHWEST MEDICAL CENTER 1 true X X X X X X X X X 13 true false true X X 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 5 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 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 $899,586 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. COMMUNITY BUILDING ACTIVITIES SCHEDULE H, PART II WE HAVE A BOARD OF DIRECTORS THAT IS MADE UP OF 12 VOLUNTEERS OF THE COMMUNITY. 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. BAD DEBT EXPENSE 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. BAD DEBT EXPENSE 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. MEDICARE SHORTFALL 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. COLLECTION PRACTICES 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. COMMUNITY HEALTH NEEDS ASSESSMENT AVAILABILITY SCHEDULE H, PART V, LINE 5A BOTH THE COMMUNITY HEALTH NEEDS ASSESSMENT AND IMPLEMENTATION PLAN CAN BE FOUND AT: http://northwestmedicalcenter.org/news-and-events/community-health-needs-a ssessment/ SCHEDULE H, PART V, LINES 6D, 6E & 7 THE HOSPITAL IS IN THE PROCESS OF PARTICIPATING IN THE EXECUTION OF THE COMMUNITY WIDE PLAN, INCLUDING A COMMUNITY BENEFIT SECTION IN OPERATIONAL PLANS, AND ADDRESSING THE THE NEEDS IDENTIFIED IN ITS MOST RECENTLY CONDUCTED CHNA. NEEDS ASSESSMENT SCHEDULE H, PART VI, LINE 2 NORTHWEST MEDICAL CENTER COMPLETED A COMPREHENSIVE COMMUNITY HEALTH NEEDS ASSESSMENT FOCUSED ON ACCESS TO CARE, THE HEALTH BEHAVIORS OF INDIVIDUALS IN OUR COMMUNITY, SOCIAL/ECONOMIC FACTORS THAT IMPACT CARE AS WELL AS ENVIRONMENTAL QUALITY AND SAFETY. PATIENT EDUCATION OF ELGIBILITY FOR ASSISTANCE 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 ANY AND ALL QUESTIONS PERTAINING TO OUR CHARITY CARE POLICY. COMMUNITY INFORMATION SCHEDULE H, PART VI, LINE 4 NMC is located in Albany, MO and operates clinics in Albany, Grant City, and Stanberry. Its primary service area includes Northwest Missouri communities located in Gentry, Harrison, Nodaway, and Worth Counties with the majority of business serving residents in Gentry and Worth Counties. According to the 2010 U.S. Census, the service area included in NMCs primary service area is approximately 10,500 residents. PROMOTION OF COMMUNITY HEALTH SCHEDULE H, PART VI, LINE 5 WE HAVE A BOARD OF DIRECTORS THAT IS MADE UP OF 12 VOLUNTEERS OF THE COMMUNITY AND 2 DOCTORS. 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 HAVE ANNUAL HEALTH FAIRS AND SPORTS PHYSICALS AT ALL OUR AREA CLINICS. WE HAVE ALWAYS SUPPORTED LOCAL BUSINESSES AND SCHOOLS AS WELL AS ASSOCIATIONS. STATE FILING OF COMMUNITY BENEFIT REPORT SCHEDULE H, PART VI, LINE 7 MISSOURI true MONITORING OF GRANTS SCHEDULE I, PART I, LINE 2 THE RECIPIENTS OF THE GRANTS REQUEST AN EXACT AMOUNT OF FUNDS THAT IS SUPPORYED BY DOCUMENTATION THEY PROVIDE THE HOSPITAL. X X X X X false false false false false false false false false DR NASER SOGHRATI 314702 0 0 5814 579 321095 0 DR ANGELA MARTIN 240763 0 0 0 21549 262312 0 DR JACKIE MILLER 375232 0 0 1900 8640 385772 0 JON DOOLITTLE 130155 0 0 0 0 0 3131 0 21855 0 155141 0 0 0 DR KATIE DIAS 164258 0 0 0 0 15352 0 179610 0 0 0 SEE SCHEDULE L PART V BUSINESS TRANSACTIONS INVOLVING INTERESTED PERSONS SCHEDULE L, PART IV (A) SARAH FOUNTAIN (B) SARAH FOUNTAIN IS THE LABORATORY MANAGER AT NORTHWEST MEDICAL CENTER, AND IS THE DAUGHTER OF RHONDA SCHNEIDER WHO IS A BOARD MEMBER OF NORTHWEST MEDICAL CENTER. (C) $60,321 (D) SALARY FOR LABORATORY MANAGER SERVICES (E) NO MEMBERS OR STOCKHOLDERS 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 DECISIONS SUBJECT TO APPROVAL BY MEMBERS, STOCKHOLDERS, OR OTHER PERSONS. REVIEW OF THE 990 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. MONITORING OF CONFLICT OF INTEREST POLICY 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. COMPENSATION REVIEW 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. AVAILABIILITY OF DOCUMENTS 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. RECONCILIATION OF NET ASSETS FORM 990, PART XI, LINE 5 NET GAIN ON INTEREST IN TRUST ASSETS $ 228,635 NET ASSETS RELEASED FROM RESTRICTION $ (151,985) ------------ $ 76,650