2012-11-15T16:01:16-06:00 2011-12-31 910189318 MOSS ADAMS LLP PO BOX 22650 YAKIMA WA 989072650 990 2011-01-01 911266346 KADLEC HEALTH SYSTEM KADL 5099464611 888 SWIFT BLVD RICHLAND WA 993523583 JULIE MEEK 5099464611 2012-11-14 1 CATHY STERBENZ P00737078 5092487750 2011 2016-02-24 21:20:13Z JULIE MEEK 888 SWIFT BLVD RICHLAND WA 993523583 57152264 0 X WWW.KADLECMED.ORG X 1984 WA TO PROVIDE QUALITY HEALTHCARE FOR EVERY PATIENT. 12 12 390 0 7800 4400 0 0 39212414 41865461 142 0 140309 15232699 39352865 57098160 0 0 0 0 32610162 39838899 0 0 0 18758869 21695897 51369031 61534796 -12016166 -4436636 17209514 14344913 5782915 7332402 11426599 7012511 X TO PROVIDE QUALITY HEALTHCARE FOR EVERY PATIENT. THROUGH THE SUPPORT OF KADLEC REGIONAL MEDICAL CENTER (KRMC), KADLEC MEDICAL ASSOCIATES IS DEDICATED TO INPATIENT CARE, DEFINED BY QUALITY AND COMPASSION.THROUGH THE SUPPORT OF KADLEC HEALTH SYSTEM, KADLEC CLINIC SEEKS TO DELIVER EXCEPTIONAL, PATIENT-CENTERED CARE, TO PROVIDE A SUPERIOR PRACTICE ENVIRONMENT FOR ITS PHYSICIANS, AND TO ENSURE THE AVAILABILITY OF COMPREHENSIVE MEDICAL SERVICES FOR OUR COMMUNITIES. THROUGH THE SUPPORT OF KADLEC HEALTH SYSTEM, KADLEC NEUROSCIENCE CENTER PROVIDES EXCEPTIONAL PATIENT-CENTERED NEUROLOGICAL CARE FOR OUR COMMUNITIES AND A SUPERIOR PRACTICE ENVIRONMENT FOR OUR PHYSICIANS AND PROVIDERS.THROUGH THE SUPPORT OF KADLEC HEALTH SYSTEM, TRICITIES NEPHROLOGY PROVIDES EXCEPTIONAL PATIENT-CENTERED NEPHROLOGY CARE FOR OUR COMMUNITIES AND A SUPERIOR PRACTICE ENVIRONMENT FOR OUR PHYSICIANS AND PROVIDERS. 0 0 12316888 12922927 KADLEC MEDICAL ASSOCIATES LLC (KMA) IS A DISREGARDED ENTITY WITHIN KHS WHICH PROVIDES HOSPITAL-BASED PHYSICIAN SERVICES TO KADLEC REGIONAL MEDICAL CENTER. THIS SERVICE ALLOWS PHYSICIANS IN THE COMMUNITY TO REMAIN IN THEIR OFFICE AND SERVICE MORE PATIENTS IN THE OUTPATIENT SETTING. 24934609 20506694 KADLEC CLINIC LLC (KC) IS A DISREGARDED ENTITY PROVIDING PHYSICIAN SERVICES AT LOCATIONS THROUGHOUT THE COMMUNITY. BRING PRIMARY CARE PHYSICIANS AND SPECIALISTS TO UNDERSERVED AREAS IRREGARDLESS OF ABILITY TO PAY. 11194685 7729811 KADLEC NEUROSCIENCE CENTER LLC (KNC) IS A DISREGARDED ENTITY AND WAS STARTED IN APRIL OF 2008 TO BRING A RANGE OF NEUROSCIENCE RELATED PHYSICIANS AND SERVICES TO THE AREA IN ORDER TO SERVE THIS PATIENT POPULATION. 835404 15897964 TRICITIES NEPHROLOGY LLC (TCN) IS A DISREGARDED ENTITY AND WAS ACQUIRED IN FEBRUARY OF 2009 TO BRING A NEPHROLOGY PHYSICIAN AND SERVICES TO THE AREA IN ORDER TO SERVE THIS PATIENT POPULATION. KHS IS A HEALTHCARE SYSTEM PROVIDING HOSPITAL AND PHYSICIANS SERVICES TO THE SURROUNDING COMMUNITY. 835404 15897964 49281586 1 0 0 0 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 1 39 0 1 390 1 1 1 0 0 0 0 0 0 0 0 0 X 12 12 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 1 WA X JULIE L MEEK 5099464611 888 SWIFT BLVD RICHLAND WA 99352 X TOM COWAN 2.00 X X 0 0 0 SANDRA GAMBLE 2.00 X X 0 0 0 SUSAN KREID 2.00 X X 0 0 0 DAVID LIPPES 2.00 X 0 0 0 WAYNE MARTIN PHD 2.00 X 0 0 0 DAVID MERKLEY MD 2.00 X X 0 0 0 THOMAS RADO MD 2.00 X 0 0 0 NEIL RAWLINS MD 2.00 X 150074 0 8397 JOHN T SAMSELL MD 2.00 X 0 0 0 RONALD SCHWARTZ MD 2.00 X 0 0 0 SAM VOLPENTIST 4.00 X 0 0 0 STEVE KING 2.00 X 0 0 0 RAND WORTMAN 56.00 X X 0 445123 318311 JULIE MEEK 50.00 X 0 319374 27823 DAVID R ROACH 50.00 X 0 247243 20097 JEFFREY A CLARK 50.00 X 0 241962 24372 WILLIAM T WINGO 50.00 X 0 279491 21720 MELVIN WAHL MD 50.00 X 1124962 0 12197 BRIAN O'GRADY MD 50.00 X 789991 0 4938 CHEERAG UPADHYAYA 50.00 X 654818 98750 3173 DEBRA STEELE 50.00 X 636628 82000 4069 MATTHEW FEWEL MD 50.00 X 739781 92000 12440 4096254 1805943 457537 77 0 1 0 DELTA LOCUM TENENS PO BOX 202940 DALLAS TX 753202056 PHYSICAN LOCUM SERVICES 2368120 COMPHEALTH PO BOX 972651 DALLAS TX 753972651 PHYSICAN LOCUM SERVICES 645409 D&Y P O BOX 635715 CINCINNATI OH 452635715 PHYSICAN LOCUM SERVICES 617086 PRAXIS MEDICAL MANAGEMENT 5825 CALLAGAHAN 203 SAN ANTONIO TX 78228 BILLING SERVICES FOR KMA 311527 WEATHERBY LOCUMS PO BOX 972633 DALLAS TX 753972633 PHYSICAN LOCUM SERVICES 203453 7 NET PATIENT REVENUE 621400 34184406 34184406 PROFESSIONAL FEES FOR 621400 7667777 7667777 MSO INCOME 624100 13278 13278 41865461 80305 6763 51702 2402 28603 4361 32964 32964 SUBSIDY FROM KRMC 900099 15101073 15101073 MEDICAL DIRECTOR FEES 900099 79031 79031 MISC. INCOME 900099 15464 7664 7800 4167 4167 15199735 57098160 57057396 7800 32964 158471 158471 35761824 31202779 4559045 297068 130042 167026 2083571 1814982 268589 1537965 1303976 233989 34697 34697 133954 133954 7892523 4998122 2894401 189913 80166 109747 3791286 3304743 486543 1150839 7132 1143707 3589263 2290196 1299067 411189 340275 70914 303659 303659 721706 305309 416397 920328 920328 UBI TAXES 1209 1209 BAD DEBT 1642377 1642377 TAXES 830382 738273 92109 RENTAL/LEASE EQUIPMENT 61756 38354 23402 20816 6061 14755 61534796 49281586 12253210 0 659657 788131 4999775 4466009 17301 41431 0 16350 11594416 2608571 9581811 8985845 1950970 47147 17209514 14344913 1446181 3118297 4334302 4211673 2432 2432 5782915 7332402 X 11426599 7012511 11426599 7012511 17209514 14344913 X -4436636 22548 X X 0 1 1 X 0 X 885486 885486 6478555 545835 5932720 1798070 581023 1217047 2432305 1481713 950592 8985845 SECURITY DEPOSIT 2432 2432 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: EFFECTIVE JANUARY 1, 2009, THESE ENTITIES ADOPTED ACCOUNTING FOR UNCERTAIN TAX POSITIONS. THE ACCOUNTING STANDARD PRESCRIBES A RECOGNITION THRESHOLD AND MEASUREMENT PROCESS FOR UNCERTAIN TAX POSITIONS. AS OF DECEMBER 31, 2011 AND 2010, THERE WERE NO UNCERTAIN TAX POSITIONS REQUIRING ACCRUAL. X X 1 1 X X X 1 0 0 0 0 0 0 0 0 NEIL RAWLINS MD 149999 0 0 0 75 0 5250 0 3147 0 158471 0 0 0 RAND WORTMAN 0 335487 0 102376 0 7260 0 179839 0 138472 0 763434 0 0 JULIE MEEK 0 300581 0 17176 0 1617 0 22050 0 5773 0 347197 0 0 DAVID R ROACH 0 232887 0 14356 0 0 0 19156 0 941 0 267340 0 0 JEFFREY A CLARK 0 223401 0 18561 0 0 0 19454 0 4918 0 266334 0 0 WILLIAM T WINGO 0 257894 0 21597 0 0 0 18967 0 2753 0 301211 0 0 MELVIN WAHL MD 799992 0 324970 0 0 0 8905 0 3292 0 1137159 0 0 0 BRIAN O'GRADY MD 789991 0 0 0 0 0 0 0 4938 0 794929 0 0 0 CHEERAG UPADHYAYA 654818 0 0 0 0 98750 0 0 3173 0 657991 98750 0 0 DEBRA STEELE 636628 0 0 0 0 82000 0 0 4069 0 640697 82000 0 0 MATTHEW FEWEL MD 739781 0 0 0 0 92000 7518 0 4922 0 752221 92000 0 0 PART I, LINE 1A THE BOARD IS ALLOWED TO TAKE THEIR COMPANION ON THE ANNUAL BOARD RETREAT. RAND WORTMAN KHS PRESIDENT & CEO, KRMC CEO; WILLIAM WINGO, VP, CORPORATE COUNSEL FOR KRMC AND KHS; THEIR MEADOW SPRINGS COUNTRY CLUB DUES ARE PAID BY THE MEDICAL CENTER. PART I, LINE 4A THE KADLEC CLINIC PRESIDENT (HUGH MALONEY - $85,023.54) AND EXECUTIVE DIRECTOR (MICHAEL HUPPE - $61,404) BOTH RECEIVED SEVERANCE PAY IN 2011. FORM 990, PART VI, SECTION A, LINE 3 THE BOARD OF DIRECTORS HIRED QUORUM HEALTH RESOURCES AS A MANAGEMENT COMPANY TO OVERSEE DAY TO DAY OPERATIONS OF THE HEALTH SYSTEM. THE PRESIDENT AND CEO IS AN EMPLOYEE OF QUORUM HEALTH RESOURCES. FORM 990, PART VI, SECTION B, LINE 11 ONCE THE 990 IS PREPARED BY A THIRD PARTY, ACCOUNTING STAFF REVIEWS THE DOCUMENTS TO VERIFY INFORMATION HAS BEEN PROVIDED AND INPUT ACCURATELY. ONCE THIS PROCESS HAS BEEN COMPLETED, THE 990 IS REVIEWED AND APPROVED BY THE EXECUTIVE COMMITTEE OF THE BOARD. THE 990 IS ALSO UPLOADED TO THE BOARD WEBSITE AND IS AVAILABLE FOR ALL BOARD MEMBERS TO REVIEW. FORM 990, PART VI, SECTION B, LINE 12C IF SOMEONE IS SUSPECTED OF VIOLATING THE POLICY, THE COMPLIANCE OFFICER IS NOTIFIED AND RESEARCHES THE ISSUE. APPROPRIATE ACTIONS ARE TAKEN IF A VIOLATION OCCURS. EMPLOYEES MUST ANNUALLY ANSWER A NUMBER OF QUESTIONS REGARDING CONFLICT OF INTEREST. FORM 990, PART VI, SECTION B, LINE 15 15A - SALARY SURVEYS WERE USED AND FINAL COMP AMOUNTS ARE APPROVED BY THE EXECUTIVE TEAM. 15B - SALARY SURVEYS WERE USED AND MGMA PHYSICIAN COMP GUIDELINES WERE ALSO USED. FORM 990, PART VI, SECTION C, LINE 19 FORMS 990, FORMS 1023,GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE KEPT IN THE ACCOUNTING OFFICE AT KADLEC REGIONAL MEDICAL CENTER AND ARE AVAILABLE TO ANYONE UPON REQUEST. AUDITED FINANCIAL STATEMENTS ARE ALSO SENT OUT TO WHOEVER REQUESTS THEM. FORM 990, PART VII, RELATED ORGANIZATION (1) TOM COWAN; KRMC - MEMBER; 2.00 (2) SANDRA GAMBLE; KRMC - TREASURER; 2.00 (3) SUSAN KREID; KRMC - CHAIR; 2.00 (5) WAYNE MARTIN, PHD; KRMC - MEMBER; 2.00 (6) DAVID MERKLEY, MD; KRMC - SECRETARY; 2.00 (9) JOHN T. SAMSELL, MD; KRMC - MEMBER; 2.00 (12) STEVE KING; KRMC - MEMBER; 2.00 CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: DISTRIBUTION TO RELATED ENTITY NOT REPORTED ON 990 22,548. TOTAL TO FORM 990, PART XI, LINE 5: 22,548. FORM 990, PART XII, LINE 2C NO CHANGES HAVE BEEN MADE IN THE PAST YEAR. KADLEC CLINIC LLC 945 GOETHALS SUITE 220 RICHLAND WA 99352 204265899 PRIMARY CARE PHYSICIAN SERVICES WA 22928722 4607725 KADLEC HEALTH SYSTEM KADLEC MEDICAL ASSOCIATES LLC 888 SWIFT BLVD RICHLAND WA 993523583 203980865 INPATIENT HOSPITALISTS SERVICES WA 12922029 1211186 KADLEC HEALTH SYSTEM KADLEC NEUROSCIENCE CENTER LLC 800 SWIFT BLVD SUITE 300 RICHLAND WA 993523583 201613946 NEUROLOGICAL RELATED PHYSICIAN SERVICES WA 8028179 1417174 KADLEC HEALTH SYSTEM TRICITIES NEPHROLOGY LLC 309 BRADLEY SUITE 109 RICHLAND WA 99352 271041915 NEPHROLOGY PHYSICIAN SERVICES WA 1008291 177489 KADLEC HEALTH SYSTEM KADLEC REGIONAL MEDICAL CENTER 888 SWIFT BLVD RICHLAND WA 99352 910655392 ACUTE CARE HOSPITAL WA 501(C)(3) LINE 3 KADLEC HEALTH SYSTEM 0 KADLEC FOUNDATION 800 SWIFT BLVD RICHLAND WA 99352 237005501 FUNDRAISING WA 501(C)(3) LINE 11A, I KADLEC HEALTH SYSTEM 0 KADLEC NEUROLOGICAL RESOURCE CENTER 712 SWIFT BLVD SUITE 1 RICHLAND WA 99352 911266345 EDUCATION ON NEUROLOGICAL DISORDERS WA 501(C)(3) LINE 7 KADLEC HEALTH SYSTEM 0 MID COLUMBIA MEDICAL ASSOCIATES 510 N COLORADO SUITE A KENNEWICK WA 99336 911987844 INFECTIOUS DISEASE AND NEPHROLOGY PHYSICIANS WA KADLEC HEALTH SYSTEM C 1.00000 KADLEC ENTERPRISES INC 888 SWIFT BOULEVARD RICHLAND WA 99352 911323736 ENGAGE IN BUSINESS RELATED TO HEALTHCARE AND TO SUPPORT KHS & AFFILIATES WA KADLEC HEALTH SYSTEM C 353 1.00000 0 0 0 0 0 0 0 0 1 1 1 0 0 1 0 0 0 1 KRMC J 1278894 KRMC N 794326 KRMC R 15101073 KRMC K 7378760