2021-04-20T15:49:47-05:00 2020-06-30 621199757 LBMC PC PO BOX 1869 BRENTWOOD TN 370241869 990 2019-07-01 621046595 NORTHCREST MEDICAL CENTER NORT 6153841711 100 NORTHCREST DRIVE SPRINGFIELD TN 37172 KENNETH WARD CFO 6153841711 2021-04-19 1 JILL HUDSON P00061190 6153774600 2021-04-19 2019 2022-09-23 18:48:47Z KENNETH WARD 100 NORTHCREST DRIVE SPRINGFIELD TN 37172 74579149 0 X WWW.NORTHCREST.COM X 1987 TN OPERATION OF A NONPROFIT 109-BED ACUTE CARE FACILITY IN SPRINGFIELD, TENNESSEE. 11 7 797 65 0 0 712945 1008150 62810612 68346179 3119886 390888 2382486 4833932 69025929 74579149 68347 34534 0 0 31900481 31521007 0 0 0 39564639 38343327 71533467 69898868 -2507538 4680281 84320868 100531319 38065075 50461437 46255793 50069882 NORTHCREST MEDICAL CENTER IS A TENNESSEE NONPROFIT CORPORATION THAT OPERATES A 109-BED GENERAL ACUTE CARE FACILITY. THE HOSPITAL PROVIDES A FULL RANGE OF MEDICAL SERVICES TO BOTH INPATIENTS AND OUTPATIENTS IN AND AROUND THE SPRINGFIELD, TENNESSEE AREA. 0 0 49012942 34534 71816906 IN ADDITION TO HEALTH SERVICES, NORTHCREST MEDICAL CENTER SPONSORS MONTHLY SUPPORT GROUPS FOR GRIEF, CANCER AND DIABETES EDUCATION, HOSTS PRENATAL CLASSES, PUBLISHES A QUARTERLY NEWSLETTER, AND PROVIDES STROKE AND PROSTATE CANCER SCREENINGS ALONG WITH FREE BLOOD PRESSURE CHECKS. NORTHCREST MEDICAL CENTER ALSO CONDUCTS SEMINARS ON EXERCISE, NUTRITION, WEIGHT LOSS, ARTHRITIS AND SODIUM PROTECTION. 49012942 1 1 0 1 0 0 0 0 0 0 1 1 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 132 0 1 797 1 0 0 0 0 0 0 0 0 0 0 0 0 X 11 7 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 1 1 0 X KENNETH WARD 6153841515 100 NORTHCREST DRIVE SPRINGFIELD TN 37172 JASON REYNOLDS TRUSTEE 1.00 X 3000 0 0 AMY GALLAGHER TRUSTEE, CHAIRMAN 1.00 X X 12000 0 0 TRACY LANGSTON TRUSTEE 1.00 X 3000 0 0 GERALDINE FARMER HONORARY TRUSTEE 1.00 X 3000 0 0 DIANE GOODMAN TRUSTEE 1.00 X 3000 0 0 SAM RAMSEY TRUSTEE 1.00 X 2250 0 0 MARK SANDERS MD TRUSTEE 1.00 X 3000 0 0 PAULA FARMER TRUSTEE 1.00 X 2500 0 0 JOSEPH KEVIN VAUGHN TRUSTEE 1.00 X 2750 0 0 DAN GREEN TRUSTEE 1.00 X 3000 0 0 HOWARD BRADLEY TRUSTEE 1.00 X 3000 0 0 TERRY PEARSON MD TRUSTEE 1.00 X 750 0 0 ANGELA BEARD CCO/VP OF CLINICAL SERVICE 40.00 X 247150 0 29823 RANDY DAVIS CEO/OFFICER-PRESIDENT 40.00 1.00 X 345855 0 30313 KENNETH WARD CFO 40.00 X 87247 0 5040 CHRIS LOCKE VP BUSINESS DEVELOPMENT 40.00 X 145146 0 27999 KAREN HEAD RN 40.00 X 116118 0 16454 KIM WALKER HR DIRECTOR 40.00 X 109247 0 10065 MIKE TINAL PFS DIRECTOR 40.00 X 114307 0 16478 GRACE ROBERTS RN2 40.00 X 103849 0 1311 1310169 0 137483 7 0 1 0 CARDINAL HEALTH 21377 NETWORK PLACE CHICAGO IL 60673 DRUGS & PHARMACY MANAGEMENT 3857819 PEDFORALL LLC 5050 THOROUGHBRED LANE STE C BRENTWOOD TN 37027 PEDIATRIC SERVICES 341667 LIFELLINC ANESTHESIA SPFD PLLC 3340 PLAYERS CLUB PARKWAY SUITE 350 MEMPHIS TN 38125 ANESTHESIA MANAGEMENT SOLUTIONS 256548 INFINITY MANAGEMENT LLC 210 25TH AVE NORTH SUITE 602 NASHVILLE TN 37203 RADIOLOGY SERVICES 225073 COMFORT CARE OF MIDDLE TENNESSEE LLC 245 CAHABA VALLEY PARKWAY SUITE 200 PELHAM AL 35124 HOSPICE 204895 14 35563 972587 1008150 HEALTHCARE REVENUE 621900 68346179 68346179 68346179 390888 390888 1363205 0 1363205 1363205 1363205 PANDEMIC RELIEF FUNDS 900099 2994064 2994064 CAFETERIA SALES 722210 278791 278791 VENDING MACHINES 623990 21247 21247 176625 176625 3470727 74579149 71816906 0 1754093 34534 34534 745428 260900 484528 23637290 16957452 6679838 5257559 3666513 1591046 1880730 1338173 542557 676895 675907 988 153748 153748 2203091 590506 1612585 50090 16162 33928 1494542 1494542 2186940 2186940 460265 460265 MEDICAL SUPPLIES 11526677 10784804 741873 BAD DEBT EXPENSE 7629449 7629449 CONTRACT SERVICES 6120097 3272718 2847379 MAINTENANCE EXPENSE 2493357 1559134 934223 3348176 2226690 1121486 69898868 49012942 20885926 0 1550423 19472041 2640689 598415 7039499 6892199 43533 33265 1551399 1524991 802213 794527 89717970 66330147 24701227 23387823 15011389 14246926 30980496 33581132 84320868 100531319 5160186 5570286 13633102 29830619 27520491 3074270 3737558 38065075 50461437 X 45578793 49173857 677000 896025 46255793 50069882 84320868 100531319 X 4680281 -202904 -663288 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 4611 4611 0 PART II-B, LINE 1, LOBBYING ACTIVITIES: NORTHCREST MEDICAL CENTER PAYS THE FOLLOWING DUES TO TENNESSEE HOSPITAL ASSOCIATION TOTALING $33,552, OF WHICH 4.15% ($1,392) IS ATTRIBUTABLE TO LOBBYING AND DUES TO AMERICAN HOSPITAL ASSOCIATION TOTALING $13,087, OF WHICH 24.6% ($3,219) IS ATTRIBUTABLE TO LOBBYING. 3171067 3171067 48814033 32832512 15981521 1647023 1201411 445612 26948323 23517147 3431176 9137524 8779077 358447 23387823 MUTUAL FUNDS 13799225 C ETF'S 447701 C 14246926 DUE FROM AFFILIATES 33428137 OTHER RECEIVABLES 152995 33581132 INTEREST RATE SWAP AGREEMENT 3737558 3737558 X PART X, LINE 2: THE HOSPITAL HAS DETERMINED THAT THERE ARE NO SIGNIFICANT UNCERTAIN TAX POSITIONS AT JUNE 30, 2020. IF INTEREST AND PENALTIES ARE INCURRED RELATED TO UNCERTAIN TAX POSITIONS, SUCH AMOUNTS WOULD BE RECOGNIZED IN INCOME TAX EXPENSE. PART X, LINE 2: THE HOSPITAL AND THE FOUNDATION ARE EXEMPT FROM FEDERAL INCOME TAXES UNDER THE PROVISIONS OF INTERNAL REVENUE CODE SECTION 501(C)(3), AND, ACCORDINGLY, NO PROVISION FOR INCOME TAXES IS INCLUDED IN THE CONSOLIDATED FINANCIAL STATEMENTS. THE HOSPITAL'S WHOLLY-OWNED SUBSIDIARIES ARE FOR-PROFIT CORPORATIONS AND ARE TAXED UNDER SUBCHAPTER "C" OF THE INTERNAL REVENUE CODE. THESE FOR-PROFIT CORPORATIONS HAVE INCURRED SIGNIFICANT TAX LOSSES. DUE TO THE UNCERTAINTY OF FUTURE TAXABLE INCOME, NET DEFERRED TAX ASSETS OF APPROXIMATELY $8,450,000 AT JUNE 30, 2020 AND $7,699,000 AT JUNE 30, 2019 HAVE BEEN FULLY RESERVED. THE MOST SIGNIFICANT DEFERRED ITEMS RELATE TO NET OPERATING LOSS CARRYFORWARDS, THE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND ACCRUED VACATION. THESE ENTITIES HAVE FEDERAL AND STATE NET OPERATING LOSS CARRYFORWARDS AVAILABLE TO OFFSET FUTURE TAXABLE INCOME OF APPROXIMATELY $30,114,000 AND $26,790,000 RESPECTIVELY AT JUNE 30, 2020. THE CARRYFORWARDS EXPIRE IN VARIOUS YEARS BEGINNING IN 2020. THE HOSPITAL FOLLOWS THE GUIDANCE FOR ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES RECOGNIZED IN THE HOSPITAL'S CONSOLIDATED FINANCIAL STATEMENTS THAT PRESCRIBES A RECOGNITION THRESHOLD OF MORE-LIKELY-THAN NOT TO BE SUSTAINED UPON EXAMINATION BY THE APPROPRIATE TAXING AUTHORITY. MEASUREMENT OF THE TAX UNCERTAINTY OCCURS IF THE RECOGNITION THRESHOLD HAS BEEN MET. THE GUIDANCE ALSO ADDRESSES THE DERECOGNITION, CLASSIFICATION, INTEREST AND PENALTIES, ACCOUNTING IN INTERIM PERIODS AND REQUIRED DISCLOSURES. THE HOSPITAL HAS DETERMINED THAT THERE ARE NO SIGNIFICANT UNCERTAIN TAX POSITIONS AT JUNE 30, 2020. IF INTEREST AND PENALTIES ARE INCURRED RELATED TO UNCERTAIN TAX POSITIONS, SUCH AMOUNTS WOULD BE RECOGNIZED IN INCOME TAX EXPENSE. 1 1 1 X 1 X 1 1 1 0 1 1 3076311 3076311 0.04400 8125233 6295115 1830118 0.02620 11201544 6295115 4906429 0.07020 11201544 6295115 4906429 0.07020 1 7629449 613556 12295337 12674422 -379085 X 1 1 1 1 NORTHCREST MEDICAL CENTER 100 NORTHCREST DRIVE SPRINGFIELD TN 37172 X X X NORTHCREST MEDICAL CENTER 1 0 0 1 X X X X X X X X X 19 1 0 0 1 X WWW.NORTHCREST.COM X 1 19 1 WWW.NORTHCREST.COM 0 1 X 200.000000000000 200.000000000000 X X X 1 1 1 X 0 0 X X X X 1 0 0 PART V, SECTION B, LINE 13H: DEMOGRAPHICS PART V, SECTION B, LINE 20E: COLLECTIONS AGENCY HAS THE HOSPITAL POLICY ON FINANCIAL ASSISTANCE AND SUPPLIES THIS DURING THE COLLECTIONS PROCESS IF REQUESTED. PART V, SCH B, LINE 5 THE NORTHCREST EXECUTIVE COUNCIL WAS CHARGED WITH THE CHNA PROCESS. THE COUNCIL DETERMINED A COMMITTEE WOULD BE CREATED TO CONDUCT THE CHNA AND THE ASSOCIATED IMPLEMENTATION STRATEGY. IN DECEMBER 2018, NORTHCREST IDENTIFIED KEY STAFF MEMBERS TO BEGIN WORK ON A COMPREHENSIVE CHNA. KEY COMMUNITY HEALTH AND SOCIAL SERVICE STAKEHOLDERS WERE ENGAGED TO ASSIST IN THE PROCESS TO ENSURE INPUT FROM THE UNDERSERVED, CHRONICALLY ILL, LOW INCOME AND MINORITY POPULATIONS IN THE NORTHCREST SERVICE AREA WAS TAKEN INTO ACCOUNT. SPECIFICALLY, THE FOLLOWING SERVED ON THE CHNA COMMITTEE: KIM PRIDGEN NORTHCREST ACCOUNTINGADELE WATTS NORTHCREST FOUNDATIONCHRIS LOCKE NORTHCREST BUSINESS DEVELOPMENTROB DEBERRY NORTHREST PHYSICIAN SERVICESMICHAEL LEWIS, MD COMMUNITY PHYSICIANKELLY MILLER D.N.P. DIRECTOR OF HIGHLAND CREST AND NURSE PRACRITIONERCHAD SMITH ROBERTSON COUNTY FAMILY YMCARACHEL WRIGHT ROBERTSON COUNTY PUBLIC HEALTH EDUCATORCASEY BLEW NORTHDREST COMMUNITY DEVELOPMENTTHE COMMITTEE MET THREE TIMES OVER THE SIX MONTH TIME-FRAME AND WAS REQUESTED TO ASSIST WITH AND PROVIDE DIRECTION FOR THE FOLLOWING RESPONSIBILITIES:* IDENTIFYING PRIMARY ADN SECONDARY DATA SOURCES* IDENTIFYING KEY COMMUNITY PARTNERS* DEVOLOPING THE ORGANIZATION'S CHNA INSTRUMENT AND METHODOLOGY* DEVELOPING TARGETED INTERVIEW QUESTIONS INCLUDING IDENTIFICATION OF ITS COMMUNITY'S POPULATION HEALTH EXPERTS* COMPILING AND INTERPRETING THE DATA ACCUMULATED THROUGH THE SURVEY* ACHIEVING CONSENSUS, WITH ITS IDENTIFIED COMMUNITY PARTNERS, CITIZENS AND PUBLIC HEALTH EXPERTS, IN IDENTIFYING THE TOP HEALTH ISSUES FACING ITS COMMUNITY* DEVELOPING THE HOSPITAL'S IMPLEMENTATION STRATEGY TO ADDRESS THE FINDINGS OF THE CHNA 2 1 - NORTHCREST IMAGING AND SPECIALTY CLINIC 2536 HWY 49 SUITE 120 PLEASANT VIEW TN 37146 DIAGNOSTIC CENTER 2 - NORTHCREST MEDICAL CARE IN WHITE HOUSE 121 HWY 76 WHITE HOUSE TN 37188 DIAGNOSTIC CENTER PART I, LN 7 COL(F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 24(B), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $7,629,449. PART III, LINE 3: THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 24(B), 8% WAS AN ACCURATE ESTIMATE FOR BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE FINANCIAL ASSISTANCE POLICY. PART III, LINE 4: AND PART III, LINE 2:PATIENT ACCOUNTS RECEIVABLE ARE REPORTED NET OF BOTH AN ESTIMATED ALLOWANCE FOR CONTRACTUAL ADJUSTMENTS AND AN ESTIMATED ALLOWANCE FOR UNCOLLECTIBLE AMOUNTS. THE CONTRACTUAL ALLOWANCE REPRESENTS THE DIFFERENCE BETWEEN ESTABLISHED BILLING RATES AND ESTIMATED REIMBURSEMENT FROM MEDICARE, TENNCARE AND OTHER THIRD PARTY PAYER PROGRAMS. RECEIVABLES ARE GENERALLY UNCOLLATERALIZED, BUT CREDIT RISK RELATING TO ACCOUNTS RECEIVABLE IS LIMITED TO SOME EXTENT BY THE DIVERSITY AND NUMBER OF PATIENTS AND PAYORS. THE HOSPITAL ROUTINELY ACCEPTS ASSIGNMENT OF, OR IS OTHERWISE ENTITLED TO RECEIVE, PATIENT BENEFITS PAYABLE UNDER HEALTH INSURANCE PROGRAMS, PLANS OR POLICIES. LATE FEES AND INTEREST CHARGES, IF ANY, ARE RECOGNIZED WHEN RECEIVED. THE BAD DEBT ALLOWANCE IS ESTIMATED BASED UPON THE AGE OF THE ACCOUNT, PRIOR EXPERIENCE AND ANY UNUSUAL CIRCUMSTANCES WHICH AFFECT THE COLLECTIBILITY INCLUDING TRENDS IN FEDERAL AND STATE GOVERNMENTAL HEALTH CARE COVERAGE AND OTHER COLLECTION INDICATORS. PART III, LINE 8: MEDICARE ALLOWABLE COST WAS OBTAINED FROM THE 06/30/2020 COST REPORT. PART III, LINE 9B: THERE ARE NO COLLECTION EFFORTS TAKEN ON THE PATIENTS THAT QUALIFY FOR CHARITY CARE. THEIR ACCOUNTS ARE WRITTEN OFF SO NO MONEY IS OWED AND NO CHARGES ARE RECORDED AS INCOME. PART VI, LINE 2: NORTHCREST MEDICAL CENTER IS ALWAYS LOOKING FOR BETTER WAYS TO SERVE ITS COMMUNITY. WE USE MANY DIFFERENT SURVEYS TO GATHER INFORMATION ABOUT OUR HEALTHCARE SERVICES FROM OUR COMMUNITY. THE PATIENT SATISFACTION SURVEY PROVIDES OUR PATIENTS WITH THE OPPORTUNITY TO TELL US HOW WELL WE ARE PROVIDING OUR SERVICES. THE COMMUNITY PERCEPTION SURVEY ALLOWS THOSE THAT MAY NOT USE OUR FACILITY THE ABILITY TO PROVIDE US FEEDBACK. ALSO, ANOTHER OPPORTUNITY FOR FEEDBACK IS THE COMMUNITY NEEDS SURVEY WHICH ALLOWS THE COMMUNITY TO EXPRESS WHAT ADDITIONAL SERVICES IT WOULD LIKE FOR US TO PROVIDE. PART VI, LINE 3: PATIENTS ARE SCREENED UPON REGISTRATION TO SEE IF THEY QUALIFY FOR CHARITY CARE. THE PAPERWORK IS EXPLAINED AND PRESENTED AT THAT TIME. UNINSURED PATIENTS WITH NO MEANS OF PAYMENT ARE ALSO MAILED CHARITY APPLICATIONS AFTER DISCHARGE AND PRIOR TO COLLECTION AGENCY PLACEMENT. COLLECTION AGENCY IS ALSO EDUCATED IN EXPLAINING CHARITY POLICY AND WILL REFER QUALIFYING PATIENT TO HOSPITAL FOR REVIEW. WHILE SCREENING FOR CHARITY CARE QUALIFICATION, THE HOSPITAL DOES MEDICAID ELIGIBILITY SCREENING IF THE PATIENT IS MEDICAID ELIGIBLE. THE HOSPITAL ASSISTS THE PATIENT WITH THE APPLICATION AND FOLLOW UP. THIS BENEFITS THE PATIENTS LONG TERM WITH A PORTABLE INSURANCE OPTION. PART VI, LINE 4: NORTHCREST MEDICAL CENTER IS A COMMUNITY, NOT-FOR-PROFIT HOSPITAL LOCATED IN ROBERTSON COUNTY, WHICH IS LOCATED IN NORTHERN MIDDLE TENNESSEE AND INCLUDES EIGHT INDIVIDUAL MUNICIPALITIES. NORTHCREST MEDICAL CENTER IS THE ONLY HOSPITAL LOCATED IN THE COUNTY WITH A POPULATION OF APPROXIMATELY 68,575 CITIZENS. ROBERTSON COUNTY HAS A MEDIAN HOUSEHOLD INCOME OF $57,424, AND ITS POPULATION IS MADE UP OF 91% CAUCASIAN, 5% AFRICAN-AMERICAN, AND 4% HISPANIC. PART VI, LINE 5: NORTHCREST MEDICAL CENTER IS A NOT-FOR-PROFIT, INDEPENDENT, COMMUNITY HOSPITAL THAT HAS BEEN PROVIDING COMPASSIONATE, QUALITY HEALTHCARE SINCE 1956 WITH A MISSION OF ENHANCING COMMUNITY AND PATIENT WELLNESS. NORTHCREST PROVIDES INPATIENT, OUTPATIENT, AND EMERGENCY MEDICAL SERVICES TO NORTHERN MIDDLE TENNESSEE AND SOUTHERN KENTUCKY. NORTHCREST MEDICAL CENTER IS GOVERNED BY A BOARD OF TRUSTEES MADE UP OF LOCAL COMMUNITY-MINDED MEN AND WOMEN. NORTHCREST'S LOCAL BOARD ALLOWS US TO FOCUS ON THE NEEDS OF OUR COMMUNITY AND USE THE MEDICAL CENTER'S RESOURCES TO PROVIDE ADVANCED, HIGH QUALITY CARE IN A CONVENIENT LOCATION FOR OUR CITIZENS AND SUPPORT OUR COMMUNITY'S ORGANIZATIONS AND EVENTS. NORTHCREST'S MEDICAL STAFF IS MADE UP OF HIGHLY TRAINED AND SKILLED PHYSICIANS FROM THROUGHOUT THE WORLD. THE MEDICAL STAFF IS DEDICATED TO SUPPORTING THE MEDICAL CENTER AND ITS MISSION. NORTHCREST IS ALSO LOOKING TO ADD SERVICES AND PHYSICIANS THAT ARE NEEDED FOR THE COMMUNITY. 1 APSU ATHLETICS 601 COLLEGE STREET PO BOX 4515 CLARKSVILLE TN 37040 620646576 501(C)(3) 14525 TO FURTHER EXEMPT PURPOSE OF APSU ATHLETICS ROBERTSON COUNTY BOARD OF EDUCATION 800 MS COUTS BLVD SUITE 4 SPRINGFIELD TN 37172 626000810 9009 TO FURTHER EXEMPT PURPOSE OF ROBERTSON COUNTY SCHOOLS ROBERTSON COUNTY CHAMBER OF COMMERCE 503 WEST COURT SQUARE SPRINGFIELD TN 37172 620439193 6000 TO FURTHER EXEMPT PURPOSE OF ROBERTSON COUNTY ASPIRE CLARKSVILLE FOUNDATION PO BOX 883 CLARKSVILLE TN 37041 201825049 501(C)(3) 5000 TO FURTHER EXEMPT PURPOSE OF ASPIRE CLARKSVILLE FOUNDATION 4 PART I, LINE 2: NORTHCREST MEDICAL CENTER ONLY PROVIDES FUNDS TO CHARITIES AND QUALIFIED GOVERNMENTAL ENTITIES TO SUPPORT PROJECTS RELATED TO THE HOSPITAL'S EXEMPT PURPOSES AND THOSE THAT BENEFIT THE COMMUNITY SERVED. 1 X X X 0 0 0 0 0 0 0 0 0 ANGELA BEARD CCO/VP OF CLINICAL SERVICE 247150 0 0 0 0 0 1520 0 28303 0 276973 0 0 0 RANDY DAVIS CEO/OFFICER-PRESIDENT 345855 0 0 0 0 0 2731 0 27582 0 376168 0 0 0 CHRIS LOCKE VP BUSINESS DEVELOPMENT 145146 0 0 0 0 0 1376 0 26623 0 173145 0 0 0 PART I, LINE 4: SEVERAL OFFICERS PARTICIPATED IN A RETIREMENT PLAN THROUGH THE MEDICAL CENTER IN 2020: RANDY DAVIS $2,731 ANGELA BEARD $1,520 KIM PRIDGEN $757 CHRIS LOCKE $1,376 A THE HEALTH AND EDUCATIONAL FACILITIES BOARD OF THE CITY OF SPRINGFIELD TN 521353943 NONEAVAIL 2016-08-24 16505900 FUNDS BEING USED TO RESTRUCTURE DEBT 0 0 0 B THE HEALTH AND EDUCATIONAL FACILITIES BOARD OF THE CITY OF SPRINGFIELD TN 521353943 NONEAVAIL 2016-09-09 10000000 FUNDS BEING USED TO RESTRUCTURE DEBT 0 0 0 C THE HEALTH AND EDUCATIONAL FACILITIES BOARD OF THE CITY OF SPRINGFIELD TN 521353943 NONEAVAIL 2016-09-27 7625000 FUNDS BEING USED TO RESTRUCTURE DEBT 0 0 0 A 1857459 16505900 16505900 1 0 1 1 B 10000000 10000000 1 0 1 1 C 4232185 7625000 7625000 1 0 1 1 A 0 0 0 0 0 0 0 B 0 0 0 0 0 0 0 C 0 0 0 0 0 0 0 A 0 0 0 0 1 0 25.800000000000 1 0 0 0 B 0 0 0 0 1 0 25.800000000000 1 0 0 0 C 0 0 0 0 1 0 25.800000000000 1 0 0 0 A 1 B 1 C 1 FORM 990, PART VI, SECTION B, LINE 11B AFTER COMPLETION OF FORM 990, THE RETURN IS REVIEWED BY THE CFO FOR ACCURACY AND COMPLETION. THE BOARD OF DIRECTORS WERE PROVIDED A COMPLETE COPY OF THE FORM 990 AFTER FILING. FORM 990, PART VI, SECTION B, LINE 12C THE CONFLICT OF INTEREST POLICY IS REVIEWED ANNUALLY BY THE BOARD AND A CONFLICT DISCLOSURE IS SIGNED. FORM 990, PART VI, SECTION B, LINE 15 BOARD REVIEWS DIFFERENT SOURCES, SUCH AS MARKET ANALYSIS, BEFORE APPROVING COMPENSATION OF CEO. CEO THEN, IN TURN, REVIEWS AND APPROVES COMPENSATION OF KEY EMPLOYEES. FORM 990, PART VI, SECTION C, LINE 19 THE REQUESTS FOR GOVERNING DOCUMENTS, CONFLICTS OF INTEREST POLICY AND FINANCIAL STATEMENTS GO THROUGH THE COMPLIANCE OFFICER, AND THE LEGALLY REQUIRED DOCUMENTS ARE MADE AVAILABLE UPON REQUEST. FORM 990, PART XI, LINE 9: CHANGE IN FAIR VALUE OF INTEREST RATE SWAP AGREEMENT -663,288. FORM 990, PART XII, LINE 2C THE BOARD OF DIRECTORS HAS AN AUDIT COMMITTEE THAT IS RESPONSIBLE FOR OVERSIGHT OF THE AUDIT. THEIR PROCESSES FOR REVIEW AND SELECTION OF INDEPENDENT ACCOUNTANT HAVE NOT CHANGED FROM THE PRIOR YEAR. NORTHCREST MEDICAL CENTER FOUNDATION 100 NORTHCREST DRIVE SPRINGFIELD TN 37172 204224449 SUPPORT & AID TN 501(C)(3) 509(A)(3) NORTHCREST MEDICAL CENTER 1 NORTHCREST HEALTH NETWORK LLC 100 NORTHCREST DRIVE SPRINGFIELD TN 37172 453765273 SUPPORT & AID TN 501(C)(3) 509(A)(3) NORTHCREST MEDICAL CENTER 1 NORTHCREST STRATEGIC SERVICES INC 100 NORTHCREST DRIVE SPRINGFIELD TN 37172 621638556 OPERATIONS LAB TN NORTHCREST MEDICAL CENTER C 4045 1.00000 0 NORTHCREST PHYSICIANS SERVICES INC 100 NORTHCREST DRIVE SPRINGFIELD TN 37172 621638557 FAMILY PHYSICIAN TN NORTHCREST STRATEGIC SERVICES INC C 8879744 1381050 1.00000 0 1 0 1 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0 NORTHCREST PHYSICIAN SERVICES A 405716 FAIR MARKET VALUE NORTHCREST PHYSICIAN SERVICES K 12567 FAIR MARKET VALUE NORTHCREST MEDICAL CENTER FOUNDATION C 0 FAIR MARKET VALUE NORTHCREST MEDICAL CENTER FOUNDATION O 567091 FAIR MARKET VALUE FORM 990, SCHEDULE R, PART V, LINE 10 SHARING OF PAID EMPLOYEES WITH RELATED ORGANIZATIONS: NORTHCREST MEDICAL CENTER AND NORTHCREST MEDICAL CENTER FOUNDATION SHARE THE FOLLOWING PAID EMPLOYEES: RANDY DAVIS - TOTAL FISCAL YEAR COMPENSATION $387,825 KIM PRIDGEN - TOTAL FISCAL YEAR COMPENSATION $ 83,799 KEN WARD - TOTAL FISCAL YEAR COMPENSATION $ 95,467 NORTHCREST MEDICAL CENTER COMPENSATES THESE EMPLOYEES SINCE THE MAJORITY OF THE EMPLOYEES' TIME IS DEVOTED TO NORTHCREST MEDICAL CENTER.