2024-07-03T09:58:19-05:00 2022-06-30 620713250 KRAFTCPAS PLLC 555 GREAT CIRCLE ROAD NASHVILLE TN 37228 990 2021-07-01 621046595 NMC SERVICES INC NMCS 6155046559 122 6TH AVENUE WEST SPRINGFIELD TN 37172 TERESA WILSON CHIEF WIND-DOWN OFFICER 6155046559 2024-07-03 1 TERESA WILSON 999009999 FRANCES E LEAHY P00713593 6152427351 2024-06-06 0 AAL1 IAL1 2021 2023-04-26 12:10:37Z TERESA WILSON 122 6TH AVENUE WEST SPRINGFIELD TN 37172 51250036 0 X N/A AFTER 9/1/21 X 1987 TN OPERATION OF A NONPROFIT 109-BED ACUTE CARE FACILITY IN SPRINGFIELD, TN THAT WAS SOLD 9/01/21 X 3 3 749 0 0 0 386000 0 71501412 11451025 969084 11502494 7318366 622022 80174862 23575541 334109 19663675 0 0 31907258 5973547 0 0 0 41047997 50138316 73289364 75775538 6885498 -52199997 98763260 6311126 41116696 1094416 57646564 5216710 X NORTHCREST MEDICAL CENTER WAS A TENNESSEE NONPROFIT CORPORATION THAT OPERATED A 109-BED GENERAL ACUTE CARE FACILITY. THE HOSPITAL PROVIDED A FULL RANGE OF MEDICAL SERVICES TO BOTH INPATIENTS AND OUTPATIENTS IN AND AROUND THE SPRINGFIELD, TENNESSEE AREA. THE FACILITY WAS SOLD TO HCA ON 9/01/21, THUS ONLY TWO MONTHS OF HOSPITAL OPERATIONS ARE SHOWN. 0 1 67173716 19663675 12073047 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. THE FACILTY WAS SOLD 9/01/2021 AND IS WINDING DOWN OPERATIONS. DONATIONS OF THE PROCEEDS FROM THE SALE ARE BEING MADE TO A NEW 501C3 FOUNDATION IN THE ROBERTSON COUNTY AREA TO ASSIST WITH HEALTHCARE NEEDS IN THE LOCAL COMMUNITY. 67173716 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 1 1 0 0 0 1 96 0 1 749 1 0 0 0 0 0 0 0 0 0 0 0 0 X 3 3 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 1 1 0 TN X TERESA WILSON 6155046559 122 6TH AVENUE WEST SPRINGFIELD TN 37172 HOWARD BRADLEY TRUSTEE (END 8.21) 1.00 X 2000 0 0 JASON REYNOLDS TRUSTEE (END 8.21) 1.00 X 2000 0 0 SAM RAMSEY TRUSTEE (END 8.21) 1.00 X 2000 0 0 JACK TERRY PEARSON MD TRUSTEE 1.00 1.00 X 1750 0 0 TRACY LANGSTON TRUSTEE (END 8.21) 1.00 X 2000 0 0 DAN GREEN TRUSTEE (END 8.21) 1.00 X 2000 0 0 DIANE GOODMAN SECRETARY 4.00 1.00 X X 2000 0 0 AMY GALLAGHER TRUSTEE (END 8.21) 1.00 X 8000 0 0 PAULA FARMER TRUSTEE (END 8.21) 1.00 X 1750 0 0 MARK SANDERS TRUSTEE (END 8.21) 1.00 X 2000 0 0 KEVIN VAUGHN CHAIRMAN OF THE BOARD 4.00 1.00 X X 2000 0 0 TERESA WILSON CHIEF WIND-DOWN OFFICER 40.00 X 138904 33333 16767 RANDALL DAVIS END 821 CEO 40.00 X 298833 0 32142 ANGELA BEARD END 821 CCO/ VP OF CLINICAL OPERATIONS 40.00 X 424365 0 32171 KENNETH WARD END 821 CFO 40.00 X 429261 0 23456 STEPHEN SANDERS END 821 DIRECTOR OF PLANT OPERATIONS 40.00 X 103391 0 20055 KAREN HEAD END 821 RN/ CHARGE NURSE 40.00 X 112099 0 27116 KIMBERLY WALKER END 821 DIRECTOR OF HUMAN RESOURCES 40.00 X 121236 0 9892 MICHAEL TINAL END 821 DIRECTOR OF PATIENT FINANCIAL SVC 40.00 X 161035 0 15796 CHRISTOPHER LOCKE END 821 VP BUSINESS DEVELOPMENT 40.00 X 194661 0 33437 2011285 33333 210832 9 0 1 0 CARDINAL HEALTH 21377 NETWORK PLACE CHICAGO IL 60673 PHARMACY STAFFING AND SUPPLIES 4772454 ARNALL GOLDEN GREGORY LLP 171 17TH STREET NW ATLANTA GA 30363 LEGAL SERVICES 2042648 PYA PC DEPT 888255 KNOXVILLE TN 37995 ACCOUNTING SERVICES 329563 QUALIVIS LLC DEPARTMENT 3847 DALLAS TX 75312 STAFFING 215489 LIFELINC ANESTHESIA SPFD PLLC 3340 PLAYERS CLUB PARKWAY MEMPHIS TN 38125 ANESTHESIA STAFFING & SERVICES 171032 10 NET PATIENT REVENUE 621400 11404534 11404534 CAFETERIA SALES 722514 46491 46491 11451025 52863 52863 96446 39027680 0 27674495 96446 11353185 11449631 11449631 MISCELLANEOUS 621400 622022 622022 622022 23575541 12073047 0 11502494 19663675 19663675 923882 923882 3842734 1773684 2069050 1206931 370504 836427 3361705 2834882 526823 1278440 516133 762307 139635 139635 1429360 1429360 1334756 1334756 OTHER - W/O NCPS 37819297 37819297 MEDICAL SUPPLIES 1973621 186262 1787359 BAD DEBT EXPENSE 1176891 1176891 OTHER 747080 733571 13509 877531 371957 505574 75775538 67173716 8601822 0 8256870 5417770 117483 7105267 896934 21339 1696771 675585 0 21927575 21208860 37753510 -3578 98763260 6311126 5654714 1094416 7477511 25271679 2712792 0 41116696 1094416 X 57646564 5216710 57646564 5216710 98763260 6311126 -52199997 -228063 -1794 0 X 0 0 0 X 0 FORM 990. PAGE 3, PART IV, LINE 11F THE HOSPITAL HAS DETERMINED THAT THERE ARE NO SIGNIFICANT UNCERTAIN TAX POSITIONS AT JUNE 30, 2022. 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 0 218553 218553 0.00290 2071929 1042451 1029478 0.01380 2290482 1042451 1248031 0.01670 2290482 1042451 1248031 0.01670 1 1176891 94151 1828512 2629388 -800876 X 1 1 1 1 NMC SERVICES FKA NORTHCREST MEDICAL CENTER 100 NORTHCREST DRIVE SPRINGFIELD TN 37172 X X X NMC SERVICES FKA NORTHCREST MEDICAL CENT 0 0 1 X X X X X X X X X 19 1 0 0 1 X WWW.NORTHCREST.COM UNTIL 9/1/2021 X 1 19 1 WWW.NORTHCREST.COM UNTIL 9/1/2021 0 1 X 200.000000000000 200.000000000000 X X X 1 1 1 X 0 0 X X X X 1 0 0 FORM 990, SCHEDULE H, PART V, SECTION B THE HOSPITAL ONLY OPERATED FOR JULY AND AUGUST OF 2021, SO AFTER THE SALE ON 9/1/2021, THE WWW.NORTHCREST.COM WEBSITE WAS NO LONGER AVAILABLE. 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 $ 1,176,891. 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 08/31/2021 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. 1 ROBERTSON COMMUNITY HEALTH FOUNDATION 122 6TH AVENUE WEST SPRINGFIELD TN 37172 861599099 501(C)(3) 19661475 0 TO FURTHER EXEMPT PURPOSE OF ROBERTSON COMMUNITY HEALTH FOUNDATION 1 0 PART I, LINE 2: THE ACCOUNTING PERSONNEL FOR BOTH RCHF AND NMC SERVICES PERFORM ACCOUNTING FOR BOTH ENTITIES. GRANTS WERE MADE ACCORDING TO THE SALE AGREEMENT OF THE HOSPITAL. X X X 1 0 0 0 0 0 0 0 0 ANGELA BEARD END 821 CCO/ VP OF CLINICAL OPERATIONS 178894 0 32105 0 213366 0 1828 0 30343 0 456536 0 0 0 KENNETH WARD END 821 CFO 179292 0 32692 0 217277 0 0 0 23456 0 452717 0 0 0 RANDALL DAVIS END 821 CEO 239433 0 59400 0 0 0 2434 0 29708 0 330975 0 0 0 CHRISTOPHER LOCKE END 821 VP BUSINESS DEVELOPMENT 121362 0 0 0 73299 0 1124 0 32313 0 228098 0 0 0 TERESA WILSON CHIEF WIND-DOWN OFFICER 78211 33333 60693 0 0 0 696 0 11883 4188 151483 37521 0 0 MICHAEL TINAL END 821 DIRECTOR OF PATIENT FINANCIAL SVC 89005 0 72030 0 0 0 900 0 14896 0 176831 0 0 0 CLASS III, IV, V, VI AND VII ASSETS WERE SOLD TO HCA SPRINGFIELD HEALTH SERVICES, LLC 2021-09-01 40000000 PURCHASE PRICE 854366763 SPRINGFIELD HEALTH SERVICES ONE PARK PLAZA NASHVILLE TN 37203 CORPORATION GRANT OF PROCEEDS FROM SALE OF HOSPITAL 2021-08-01 8761475 CASH 861599099 ROBERTSON COMMUNITY HEALTH FOUNDATION 122 6TH AVENUE WEST SPRINGFIELD TN 37172 501(C)(3) GRANT OF PROCEEDS FROM SALE OF HOSPITAL 2021-09-01 9500000 CASH 861599099 ROBERTSON COMMUNITY HEALTH FOUNDATION 122 6TH AVENUE WEST SPRINGFIELD TN 37172 501(C)(3) GRANT OF PROCEEDS FROM SALE OF HOSPITAL 2022-06-01 1400000 CASH 861599099 ROBERTSON COMMUNITY HEALTH FOUNDATION 122 6TH AVENUE WEST SPRINGFIELD TN 37172 501(C)(3) 1 1 0 0 PART II, LINE 2E: EXPLANATION OF INVOLVEMENT: KEVIN VAUGHN, DIANE GOODMAN, AND JACK TERRY PEARSON REMAINED BOARD MEMBERS OF NMC SERVICES, NCPS, AND NCSS AFTER THE SALE ON 9/1/2021. THEY ARE ALSO BOARD MEMBERS OF THE SUCCESSOR ORGANIZATION, ROBERTSON COMMUNITY HEALTH FOUNDATION (RCHF), AND ALL BUT ONE OF THE BOARD MEMBERS OF NORTHCREST MEDICAL CENTER BECAME BOARD MEMBERS OF RCHF. OFFICERS RANDALL DAVIS AND ANGELA BEARD BECAME EMPLOYED AT THE TRANSFEREE ORGANIZATION, HCA, AFTER THE SALE. MANY BOARD MEMBERS OF NMC SERVICES WERE APPOINTED TO HCAS BOARD OF DIRECTORS. FORM 990, PART I, LINES 9, 10, 11, 15, 17 THIS FY2022 RETURN WAS STILL BEING PREPARED AFTER THE FY2023 RETURN WAS FILED. SOME REVENUE AND EXPENSES WERE RECLASSIFIED AND THEREFORE THE CURRENT YEAR AMOUNTS ON THIS RETURN DO NOT MATCH WHAT WAS FILED FOR FY2023 FOR PRIOR YEAR LINES 9, 10, 11, 15, AND 17, BUT THE BOTTOM LINE REMAINED THE SAME. LINE 19 FOR THE CURRENT YEAR TIES TO THE FY2023 PRIOR YEAR LINE 19. FORM 990, PART III, LINE 3 THE FACILTY WAS SOLD 9/01/2021 AND IS WINDING DOWN OPERATIONS. DONATIONS OF THE PROCEEDS FROM THE SALE ARE BEING MADE TO A NEW 501C3 FOUNDATION IN THE ROBERTSON COUNTY AREA TO ASSIST WITH HEALTHCARE NEEDS IN THE LOCAL COMMUNITY. FORM 990, PART VI, SECTION B, LINE 11B AFTER COMPLETION OF FORM 990, THE RETURN IS REVIEWED BY THE CHIEF WIND-DOWN OFFICER 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. NO CURRENT EMPLOYEES OF THE ORGANIZATION. FORM 990, PART VI, SECTION C, LINE 19 THE REQUESTS FOR GOVERNING DOCUMENTS, CONFLICTS OF INTEREST POLICY AND FINANCIAL STATEMENTS GO THROUGH THE CHIEF WIND-DOWN OFFICER, AND THE LEGALLY REQUIRED DOCUMENTS ARE MADE AVAILABLE UPON REQUEST. NORTHCREST MEDICAL CENTER FOUNDATION - END 9121 100 NORTHCREST DRIVE SPRINGFIELD TN 37172 204224449 SUPPORT AND AID TN 501(C)(3) LINE 12A, I NMC SERVICES INC 0 ROBERTSON COMMUNITY HEALTH FOUNDATION 112 6TH AVENUE WEST SPRINGFIELD TN 37172 861599099 DISTRIBUTION OF SALE OF HOSPITAL TN 501(C)(3) LINE 7 NMC SERVICES INC 0 NCSS INC 112 6TH AVENUE WEST SPRINGFIELD TN 37172 621638556 CLOSING OPERATIONS DUE TO SALE ON 9/1/2021 TN C -4045 1.00000 0 NCPS INC 112 6TH AVENUE WEST SPRINGFIELD TN 37172 621638557 CLOSING OPERATIONS DUE TO SALE ON 9/1/2021 TN C -3528329 1.00000 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 ROBERTSON COMMUNITY HEALTH FOUNDATION B 19661475 SALE AGREEMENT NCSS INC O 37521 EXPENSE ALLOCATION