2018-03-23T08:41:26-05:00 2017-06-30 620713250 KRAFTCPAS PLLC 555 GREAT CIRCLE ROAD NASHVILLE TN 37228 990 2016-07-01 621046595 NORTHCREST MEDICAL CENTER NORT 6153841711 100 NORTHCREST DRIVE SPRINGFIELD TN 371723961 KIM PRIDGEN CFO 6153841711 2018-03-22 1 FRANCES E LEAHY P00713593 6152427351 2018-03-22 207.86.221.194 2018-03-22 17:05:09 CD P 4DFBCE3405B59618A236C4A4AD0BA98281972C87 C414C1CE83941E11D21CA06EEF7CA44AFF540A30 2016 2021-01-29 14:40:06Z KIM PRIDGEN 100 NORTHCREST DRIVE SPRINGFIELD TN 371723961 75647612 0 X WWW.NORTHCREST.COM X 1987 TN OPERATION OF A NONPROFIT 109-BED ACUTE CARE FACILITY IN SPRINGFIELD, TENNESSEE. 12 9 794 77 0 0 152043 273967 75647919 73312492 208828 284349 2017833 1776804 78026623 75647612 70320 72547 0 0 29054915 29028674 0 0 0 44175712 42411486 73300947 71512707 4725676 4134905 88223837 88293488 50054280 43519755 38169557 44773733 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 66426683 72547 73851307 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. 66426683 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 1 124 0 1 794 1 0 0 0 0 0 0 0 0 0 0 X 12 9 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X KIM PRIDGEN 6153841515 100 NORTHCREST DR SPRINGFIELD TN 37172 DAVID BELLAR TRUSTEE, CHAIRMAN 1.00 X X 3750 0 0 JAMES G BOWENS TRUSTEE 1.00 X 3000 0 0 HOWARD BRADLEY TRUSTEE 1.00 X 3000 0 0 TATIA CUMMINGS END 8312016 TRUSTEE 1.00 X 2250 0 0 GEORGE DAHIR END 8312016 TRUSTEE 1.00 X 2000 0 0 AMY GALLAGHER TRUSTEE 1.00 X 3000 0 0 KEITH GOLDBERG MD TRUSTEE 1.00 X 15000 0 0 DAN GREEN TRUSTEE 1.00 X 3000 0 0 TRACY LANGSTON SECRETARY TRUSTEE 1.00 X X 3000 0 0 JASON REYNOLDS TRUSTEE 1.00 X 3000 0 0 TED STUBBLEFIELD TRUSTEE 1.00 X 3000 0 0 SHILPA CARLSON DO TRUSTEE 1.00 X 1000 0 0 PAULA M FARMER TRUSTEE 1.00 X 0 0 0 JOSEPH KEVIN VAUGHN TRUSTEE 1.00 X 0 0 0 RANDY DAVIS PRESIDENT/CEO 40.00 1.00 X 315823 0 19203 ANGELA BEARD CCO/VP OF CLINICAL SERVICES 40.00 X 221048 0 19442 KIM PRIDGEN CFO 40.00 1.00 X 212853 0 19107 GRACE ROBERTS RN 40.00 X 111904 0 1734 ANGELA PITMAN APN 40.00 X 107724 0 1451 MIKE TINAL PFS DIRECTOR 40.00 X 105205 0 9494 1119557 0 70431 6 0 1 0 CARDINAL HEALTH 21377 NETWORK PLACE CHICAGO IL 60673 DRUGS & PHARMACY MANAGEMENT 4535210 C&A INDUSTRIES INC PO BOX 3037 OMAHA NE 68103 CONTRACT LABOR STAFFING 209251 LIFELINC ANESTHESIA SPRINGFIELD LLC 308 NORTHCREST DRIVE SPRINGFIELD TN 37172 ANESTHESIA SERVICES 176504 STAR PHYSICAL THERAPY LP PO BOX 681478 FRANKLIN TN 37068 PHYSICAL THERAPY SERVICES 169774 BIO-MEDICAL APPLICATIONS OF TENNESSEE I 16343 COLLECTIONS CENTER DRIVE CHICAGO IL 60693 RENAL DIALYSIS SERVICES 159663 10 41455 61495 171017 273967 HEALTHCARE REVENUE 621900 73312492 73312492 73312492 284349 284349 1237989 0 1237989 1237989 1237989 CAFETERIA SALES 722210 317720 317720 MISCELLANEOUS 623990 194560 194560 VENDING MACHINES 623990 26535 26535 538815 75647612 73851307 0 1522338 72547 72547 893121 838562 54559 23653923 22309717 1344206 2534863 2435525 99338 1946767 1866922 79845 178165 154029 24136 266072 263923 2149 673447 265421 408026 1118609 1109055 9554 130794 101796 28998 1782582 1782582 3403832 3403832 3530561 3049147 481414 SUPPLIES 12903049 12892096 10953 BAD DEBT EXPENSE 7487640 7487640 CONTRACT SERVICES 6694181 4355233 2338948 EQUIPMENT & RENTAL MAIN 3462510 3364288 98222 780044 674368 105676 71512707 66426683 5086024 0 8039284 3575049 2818296 117021 12574169 13211251 263217 293498 1393234 1357007 828378 774262 96395261 70587477 28032899 25807784 10685025 17876086 23589335 25281530 88223837 88293488 6146519 5275777 38165311 34401054 5742450 3842924 50054280 43519755 X 38169557 44773733 38169557 44773733 88223837 88293488 X 4134905 569746 1899526 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 8441 8441 0 PART II-B, LINE 1: NORTHCREST MEDICAL CENTER PAYS THE FOLLOWING DUES TO TENNESSEE HOSPITAL ASSOCIATION TOTALING $35,311, OF WHICH 15.48% ($5,466) IS ATTRIBUTABLE TO LOBBYING AND DUES TO AMERICAN HOSPITAL ASSOCIATION TOTALING $12,094, OF WHICH 24.6% ($2,975) IS ATTRIBUTABLE TO LOBBYING. 4333348 4333348 47817867 29815198 18002669 43939331 40772279 3167052 304715 304715 25807784 MUTUAL FUNDS 15015027 C ETF'S 2861059 C 17876086 DUE FROM AFFILIATES 24794396 OTHER RECEIVABLES 487134 25281530 INTEREST RATE SWAP AGREEMENT 3842924 3842924 X 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 $5,011,000 AT JUNE 30, 2017 AND $4,270,000 AT JUNE 30, 2016 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 APPROXIMATELY $21,450,000 OF NET OPERATING LOSSES AVAILABLE AT JUNE 30,2017 THAT MAY BE USED TO OFFSET FUTURE TAXABLE INCOME. THE NET OPERATING LOSSES EXPIRE IN VARIOUS YEARS BEGINNING JUNE 30, 2019. 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 PENALITIES, ACCOUNTING IN INTERIM PERIODS AND REQUIRED DISCLOSURES. THE HOSPITAL HAS DETERMINED THAT THERE ARE NO SIGNFICIANT UNCERTAIN TAX POSITIONS AT JUNE 30, 2017 OR 2016. 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 3059685 3059685 0.04780 10612489 6383341 4229148 0.06610 13672174 6383341 7288833 0.11390 13672174 6383341 7288833 0.11390 1 7487640 599011 14199659 15016935 -817276 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 16 1 0 0 1 X HTTP://WWW.NORTHCREST.COM/ X 1 16 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 NORTHCREST MEDICAL CENTER PART V, SECTION 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 2015, NORTHCREST IDENTIFIED KEY STAFF MEMBERS TO BEGIN WORK ON A COMPREHENSIVE CHNA. THE NORTHCREST EXECUTIVE COUNCIL IDENTIFIED KEY PERSONNEL TO SERVE ON THE NEWLY FORMED CHNA COMMITTEE. 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 PHYSICIAN SERVICESROB DEBERRY NORTHCREST COMMUNITY DEVELOPMENTMICHAEL LEWIS, MD COMMUNITY PHYSICIANHOWARD BRADLEY COUNTY MAJOR & FORMER EDUCATORDAVID LIMPUS ROBERTSON COUNTY YMCADANA HOLT ROBERTSON COUNTY SCHOOL NURSEVANESSA WATKINS DIRECTOR OF ROBERTSON COUNTY HEALTH DEPARTMENTJAMES BOWENS BOARD MEMBER/ROBERTSON COMMISSIONERFRANK CALLIS ELECTROLUXTHE 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 AND SECONDARY DATA SOURCES - IDENTIFYING KEY COMMUNITY PARTNERS - DEVELOPING 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 NORTHCREST MEDICAL CENTER PART V, SECTION B, LINE 13H: DEMOGRAPHICS NORTHCREST MEDICAL CENTER PART V, SECTION B, LINE 20E: COLLECTIONS AGENCY HAS THE HOSPITAL POLICY ON FINANCIAL ASSISTANCE AND SUPPLIES THIS DURING THE COLLECTIONS PROCESS IF REQUESTED. 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, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 7,487,640. 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 ACCOUNTS. 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 06/30/2017 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 III, LINE 3: THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25(A), 8% WAS AN ACCURATE ESTIMATE FOR BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE FINANCIAL ASSISTANCE POLICY. 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 IS NORTHERN MIDDLE TENNESSEE AND INCLUDES EIGHT INDIVIDUAL MUNICIPALITIES. NORTHCREST MEDICAL CENTER IS THE ONLY HOSPITAL LOCATED IN THE COUNTY WITH A POPULATION OF APPROXIMATELY 69,000 CITIZENS. ROBERTSON COUNTY HAS AN AVERAGE HOUSEHOLD INCOME OF $56,331, AND ITS POPULATION IS MADE UP OF 84% CAUCASIAN, 8% AFRICAN-AMERICAN, AND 7% 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 ROBERTSON COUNTY BOARD OF EDUCATION 2121 WOODLAND STREET SPRINGFIELD TN 37172 626000810 9009 FAIR MARKET VALUE N/A TO FURTHER EXEMPT PURPOSE OF ROBERTSON COUNTY SCHOOLS ROBERTSON COUNTY FAMILY YMCA 3332 TOM AUSTIN HIGHWAY SPRINGFIELD TN 37172 620476243 501(C)(3) 10250 FAIR MARKET VALUE N/A TO FURTHER EXEMPT PURPOSE OF THE YMCA OF ROBERTSON COUNTY AMERICAN HEART ASSOCIATION PO BOX 50015 PRESCOTT AZ 86304 135613797 501(C)(3) 10000 FAIR MARKET VALUE N/A TO FURTHER EXEMPT PURPOSE OF THE AMERICAN HEART ASSOCIATION ROBERTON COUNTY COMMUNITY FOUNDATION 503 WEST COURT SQUARE SPRINGFIELD TN 37172 861055228 501(C)(3) 10250 FAIR MARKET VALUE N/A TO FURTHER EXEMPT PURPOSE OF THE ROBERTSON COUNTY COMMUNITY FOUNDATIONFLU SHOTS GIVEN AWAY 3 4 PART I, LINE 2: NORTHCREST MEDICAL CENTER ONLY PROVIDE 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 RANDY DAVIS PRESIDENT/CEO 315823 0 0 0 0 0 1918 0 17285 0 335026 0 0 0 ANGELA BEARD CCO/VP OF CLINICAL SERVICES 221048 0 0 0 0 0 1427 0 18015 0 240490 0 0 0 KIM PRIDGEN CFO 212853 0 0 0 0 0 1363 0 17744 0 231960 0 0 0 PART I, LINE 4 SEVERAL OFFICERS PARTICIPATED IN A RETIREMENT PLAN THROUGH THE MEDICAL CENTER IN 2017: RANDY DAVIS $1,918 ANGELA BEARD 1,427 KIM PRIDGEN 1,363 A THE HEALTH AND EDUCATIONAL FACILITIES BOARD OF THE CITY OF SPRINGFIELD TN 521353943 85141WAA8 2010-10-30 43400000 FUNDS BEING USED TO RESTRUCTURE DEBT 0 0 0 B THE HEALTH AND EDUCATIONAL FACILITIES BOARD OF THE CITY OF SPRINGFIELD TN 521353943 2016-08-24 16505900 FUNDS BEING USED TO RESTRUCTURE DEBT 0 0 0 C THE HEALTH AND EDUCATIONAL FACILITIES BOARD OF THE CITY OF SPRINGFIELD TN 521353943 2016-09-09 10000000 FUNDS BEING USED TO RESTRUCTURE DEBT 0 0 0 D THE HEALTH AND EDUCATIONAL FACILITIES BOARD OF THE CITY OF SPRINGFIELD TN 521353943 2016-09-27 7625000 FUNDS BEING USED TO RESTRUCTURE DEBT 0 0 0 A 43400000 43400000 43400000 1 0 1 1 B 134000 16505900 16505900 1 0 1 1 C 10000000 10000000 1 0 1 1 D 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 D 0 0 0 0 0 0 0 A 0 0 0 0 1 1 MORGAN KEEGAN 22.080000000000 0 0 0 0 0 B 0 0 0 0 1 0 0 0 0 C 0 0 0 0 1 0 0 0 0 D 0 0 0 0 1 0 0 0 0 A 0 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 REVIEWED THE FORM 990 PRIOR TO 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 1,899,526. INVESTMENT IN PHYSICIAN SERVICES AND OTHERS-RECLASS FROM LIABILITY 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 372123961 204224449 SUPPORT & AID TN 501(C)(3) 509(A)(3) NORTHCREST MEDICAL CENTER 1 NORTHCREST HEALTH NETWORK LLC 100 NORTHCREST DRIVE SPRINGFIELD TN 372123961 453765273 SUPPORT & AID TN 501(C)(3) 509(A)(3) NORTHCREST MEDICAL CENTER 1 NORTHCREST STRATEGIC SERVICES INC 100 NORTHCREST DRIVE SPRINGFIELD TN 37212 621638556 OPERATIONS LAB TN NORTHCREST MEDICAL CENTER C 12616 1.00000 0 NORTHCREST PHYSICIANS SERVICES INC 100 NORTHCREST DRIVE SPRINGFIELD TN 37212 621638557 FAMILY PHYSICIAN TN NORTHCREST STRATEGIC SERVICES INC C 10768747 1202103 1.00000 0 1 0 1 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0 NORTHCREST MEDICAL CENTER FOUNDATION C 41405 FAIR MARKET VALUE NORTHCREST PHYSICIAN SERVICES A 356298 FAIR MARKET VALUE NORTHCREST MEDICAL CENTER FOUNDATION O 595447 FAIR MARKET VALUE NORTHCREST PHYSICIAN SERVICES K 15080 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 $350,274 KIM PRIDGEN - TOTAL FISCAL YEAR COMPENSATION $246,173 NORTHCREST MEDICAL CENTER COMPENSATES THESE EMPLOYEES SINCE THE MAJORITY OF THE EMPLOYEES' TIME IS DEVOTED TO NORTHCREST MEDICAL CENTER.