2023-05-12T13:12:57-05:00 2022-06-30 351178661 BLUE & CO LLC 2650 EASTPOINT PKWY SUITE 300 LOUISVILLE KY 40223 990 2021-07-01 610965365 RUSSELL COUNTY KENTUCKY HOSPITAL DISTRICT HEALTH FACILITIES CORP RUSS 2708664753 PO BOX 1610 153 DOWELL ROAD RUSSELL SPRINGS KY 42642 JANIE LANDIS CFO 2708664753 2023-05-12 1 JANIE LANDIS 999009999 EMILIE M KNIERIEM CPA P01330194 5029923500 2023-05-12 0 AAL1 IAL1 2021 2023-04-26 12:10:37Z JANIE LANDIS PO BOX 1610 153 DOWELL ROAD RUSSELL SPRINGS KY 42642 34970618 0 X WWW.RUSSELLCOHOSPITAL.ORG X 1979 KY TO PROVIDE QUALITY, COMPASSIONATE HEALTHCARE CONSISTENT WITH THE TRUST AND SUPPORT OF THE COMMUNITIES WE SERVE. 5 5 339 33 0 0 7809147 1487772 28177013 32441675 81928 78541 72773 962630 36140861 34970618 0 7770 0 0 18526370 20680544 0 0 0 11313151 13508343 29839521 34196657 6301340 773961 27239932 28774146 5124450 5884703 22115482 22889443 TO PROVIDE QUALITY, COMPASSIONATE HEALTHCARE CONSISTENT WITH THE TRUST AND SUPPORT OF THE COMMUNITIES WE SERVE. 0 0 28465804 7770 32467265 MEDICAL CARE PROVIDED BY HOSPITAL TO PATIENTS - CHARGES EXCLUDED FROM REVENUE UNDER THE HOSPITAL'S CHARITY CARE POLICY WERE APPROXIMATELY $388,092 FOR THE YEAR ENDED JUNE 30, 2022. THE HOSPITAL HOLDS AN ANNUAL HEALTH FAIR FOR THE COMMUNITY WHERE IT PROVIDES REDUCED COST TESTING. THE HOSPITAL SUPPORTS ITS EMPLOYEES' COMMUNITY INVOLVEMENT AND CONDUCTS OTHER PROGRAMS FOR COMMUNITY BENEFIT. 28465804 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 1 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 46 0 1 339 1 0 0 0 0 0 0 0 0 0 0 0 0 X 5 5 0 0 0 0 0 0 0 1 0 0 0 0 1 1 1 1 1 1 1 1 1 KY X JANIE LANDIS 2708664753 PO BOX 1610 153 DOWELL ROAD RUSSELL SPRINGS KY 42642 NEAL DALTON CHAIRPERSON/PRESIDENT 2.00 X X 0 0 0 DARYL HAMMOND VICE CHAIRPERSON 2.00 X X 0 0 0 WINFREY BATES SECRETARY/TREASURER 2.00 X X 0 0 0 STUART CARMAN BOARD MEMBER 2.00 X 0 0 0 STEVEN FLETCHER BOARD MEMBER 2.00 X 0 0 0 PATRICK BRANCO CEO (END 05/08/22) 40.00 X 180642 0 14148 SCOTT THOMPSON CEO (BEG 05/01/22) 40.00 X 0 0 0 JANIE LANDIS CFO 40.00 X 151249 0 48385 JENNIFER GOODE CHIEF HR OFFICER (END 4/30/22) 40.00 X 134843 0 41457 JUDY WITHERS CNO 40.00 X 147210 0 29809 RICHARD PERKINS PHYSICIAN 40.00 X 487331 0 41837 JONAS HURLEY PHYSICIAN 40.00 X 509333 0 47536 MILTON JACKSON PHYSICIAN 40.00 X 500827 0 34791 TOMMY SHELTON PHYSICIAN 40.00 X 642887 0 28823 LIESEL GRENTZ PHYSICIAN 40.00 X 237368 0 34989 2991690 0 321775 22 0 1 0 STEVE AITKEN CRNA 919 LILY CREEK RESORT ROAD JAMESTOWN KY 42629 ANESTHESIA SERVICES 328899 DR JASBIR DHILLON 5040 MURRAY LANE BRENTWOOD TN 37027 PHYSICIAN SERVICES 220200 DR JOHN KILGALLIN 124 DOWELL ROAD RUSSELL SPRINGS KY 42629 PHYSICIAN SERVICES 215075 INSIGHT DIRECT USA INC 2701 E INSIGHT WAY CHANDLER AZ 85286 IT SERVICES 176554 DR JERRY LAWSON 276 G V HALE AVE RUSSELL SPRINGS KY 42642 PHYSICIAN SERVICES 165900 19 1091339 396433 1487772 NET PATIENT SERVICE REVENUE 621999 29619180 29619180 PHARMACY SERVICES - 340B 621399 2822495 2822495 32441675 71011 71011 7969 0 7969 7969 7969 30 7500 0 0 30 7500 7530 7530 ADMIN TAX REVENUE 900099 909528 909528 CAFETERIA INCOME 722310 24181 24181 20952 1409 19543 954661 34970618 32467265 0 1015581 7770 7770 716897 597751 119146 15948576 13297967 2650609 277098 221678 55420 2547139 2037712 509427 1190834 952667 238167 25794 25794 61693 61693 2808667 2622014 186653 149638 963 148675 300048 263800 36248 835385 814153 21232 30304 27043 3261 6180 6094 86 74479 74479 1083708 1083708 286754 7222 279532 MEDICAL SUPPLIES & DRUG 6009492 6009492 REPAIRS AND MAINTENANCE 1050030 1032213 17817 PROVIDER TAX 406158 406158 FOOD & BEVERAGE 100706 100706 279307 60401 218906 34196657 28465804 5730853 0 1706985 191067 12266588 11025800 3368375 4619406 764814 810022 799571 806015 27192523 21269085 5437218 5923438 2365052 1509403 531329 3888995 27239932 28774146 2589977 2634750 298922 1149066 2235551 1600708 0 500179 5124450 5884703 X 22115482 22889443 22115482 22889443 27239932 28774146 773961 0 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 1482 1482 0 PART II-B, LINE 1: THE PORTION OF ORGANIZATION DUES PAID TO KENTUCKY HOSPITAL ASSOCIATION FOR FYE 2022 THAT ARE RELATED TO LOBBYING ARE APPROXIMATELY 11.0%. 344100 344100 5389701 2315391 3074310 21251237 18900690 2350547 207485 53004 154481 5923438 ASSETS WHOSE USE IS LIMITED 3873966 OTHER RECEIVABLES 15029 3888995 THIRD PARTY PAYABLE 500179 500179 X 34970618 0 34970618 0 34970618 34196657 0 34196657 0 34196657 PART X, LINE 2: THE HOSPITAL HAS BEEN RECOGNIZED AS EXEMPT FROM INCOME TAXES UNDER SECTION 501 OF THE INTERNAL REVENUE CODE AND A SIMILAR PROVISION OF STATE LAW. HOWEVER, THE HOSPITAL IS SUBJECT TO FEDERAL INCOME TAX ON ANY UNRELATED BUSINESS TAXABLE INCOME. THE HOSPITAL FILES TAX RETURNS IN THE U.S. FEDERAL JURISDICTION. 1 1 X 1 X 1 X 1 1 0 0 177518 54845 122673 0.00360 7648916 6935617 713299 0.02090 7826434 6990462 835972 0.02450 14035 14035 0.00040 14035 14035 0.00040 7840469 6990462 850007 0.02490 1 1308809 0 4738527 8281489 -3542962 X 1 1 1 1 RUSSELL COUNTY HOSPITAL PO BOX 1610 153 DOWELL ROAD RUSSELL SPRINGS KY 42642 WWW.RUSSELLCOHOSPITAL.ORG 600081 X X X X RUSSELL COUNTY HOSPITAL 0 0 1 X X X X X X X X X 19 1 0 0 1 X WWW.RUSSELLCOHOSPITAL.ORG/DOCS/RUSSELL_COUNTY_HOSPITAL_CHNA_2019.PDF X 1 19 1 WWW.RUSSELLCOHOSPITAL.ORG/DOCS/RCH_CHNA_IMPLEMENTATION_STRATEGY_2020-2022 0 1 X 200.000000000000 200.000000000000 X 1 1 X X X 1 X WWW.RUSSELLCOHOSPITAL.ORG/GETPAGE.PHP?NAME=FINANCIALASSISTANCE X WWW.RUSSELLCOHOSPITAL.ORG/GETPAGE.PHP?NAME=FINANCIALASSISTANCE X WWW.RUSSELLCOHOSPITAL.ORG/GETPAGE.PHP?NAME=FINANCIALASSISTANCE X X X X 1 X 0 X X X X 1 X 0 0 RUSSELL COUNTY HOSPITAL PART V, SECTION B, LINE 5: INPUT FOR THE COMMUNITY HEALTH NEEDS ASSESSMENT REPORT WAS ASKED FROM INDIVIDUALS WITH KNOWLEDGE OF THE COMMUNITY AND EXPERTISE. INPUT WAS PROVIDED THROUGH KEY INFORMANT INTERVIEWS OF 10 STAKEHOLDERS. RUSSELL COUNTY HOSPITAL PART V, SECTION B, LINE 11: PER A REVIEW OF THE UPDATES TO THE ACTION PLANS AND STRATEGIES LISTED IN THE IMPLEMENTATION STRATEGY, THE PRIORITIES ARE IN THE PROCESS OF BEING MET. RUSSELL COUNTY HOSPITAL PART V, SECTION B, LINE 13B: UNINSURED PATIENTS ARE CONSISTENTLY SUPPLIED WITH THE STATE DSH APPLICATION. THIS APPLICATION IS PROCESSED BY DISABILITY MEDICAL CONSULTANTS TO DETERMINE IF THE PATIENT QUALIFIES FOR KENTUCKY FINANCIAL ASSISTANCE THROUGH THE STATE PROGRAM, THEN THE PATIENT'S INFORMATION IS SCREENED FOR INTERNAL CHARITY ASSISTANCE. UNINSURED PATIENTS SCHEDULED FOR HIGH DOLLAR PROCEDURES ARE NOT SCREENED PRIOR TO SERVICE. THEY ARE SUBJECT TO THE SAME SCREENNG PROCESS AS OTHER PATIENTS. UNINSURED PATIENTS ARE NOT ROUTINELY VISITED BY FINANCIAL COUNSELORS. THEY ARE VISITED UPON REQUEST AND PROVIDED A DSH APPLICATION TO START THE SCREENING PROCESS. DISABILITY MEDICAL CONSULTANTS CONDUCT THE SCREENING FOR FINANCIAL ASSISTANCE REQUESTS. DMC REVIEWS THE PATIENT'S APPLICATION AND INCOME/ASSET INFORMATION. IN-HOUSE CHARITY ASSISTANCE IS AWARDED BASED ON A SLIDING SCALE OF INCOME AND FAMILY SIZE. A LEVEL OF ASSISTANCE IS AVAILABLE TO PATIENTS WITH INCOMES UP TO 200% OF FEDERAL POVERTY LEVEL. KENTUCKY STATE DSH ASSISTANCE IS AWARDED ONLY TO UNINSURED PATIENTS WHO DO NOT QUALIFY FOR MEDICAID. RUSSELL COUNTY HOSPITAL EXTENDS CHARITY ASSISTANCE TO ANY PATIENTS MEETING ITS INCOME GUIDELINE CRITERIA. CHARITY CARE RECIPIENTS MUST PAY TAXES IN RUSSELL COUNTY. THERE ARE NO CATASTROPHIC MAXIMUMS IN PLACE. PATIENTS CAN APPLY FOR CHARITY ASSISTANCE AND WILL BE JUDGED ON INCOME LEVELS AND FAMILY SIZE. ALSO, CHARITY CARE IS AWARDED FOR A PERIOD OF 6 MONTHS. PART III, LINE 2: BAD DEBT AMOUNTS ON THE FINANCIAL STATEMENTS REPRESENT UNPAID CO-INSURANCE AND DEDUCTIBLES AND ALL SELF-PAY ACCOUNTS THAT GO UNPAID. AMOUNTS ARE NOT WRITTEN OFF UNTIL RUSSELL COUNTY HOSPITAL KNOWS THEY WILL NOT BE PAID. FOR LINE 3, ANY AMOUNTS THAT COULD BE LISTED WOULD BE NEGLIGIBLE AND THUS ARE NOT ESTIMATED. RUSSELL COUNTY HOSPITAL HAS A POLICY OF PROVIDING CHARITY CARE TO PATIENTS WHO ARE UNABLE TO PAY. SUCH PATIENTS ARE IDENTIFIED BASED ON FINANCIAL INFORMATION OBTAINED FROM THE PATIENT AND SUBSEQUENT ANALYSIS. SINCE RUSSELL COUNTY HOSPITAL DOES NOT EXPECT PAYMENT, ESTIMATED CHARGES FOR CHARITY CARE ARE NOT REPORTED IN NET REVENUE, AND THUS WOULD NOT BE WRITTEN OFF TO BAD DEBT EXPENSE. PART III, LINE 8: THE HOSPITAL IS A CRITICAL ACCESS HOSPITAL. LINE 6 COSTS REPRESENT MEDICARE CHARGES MULTIPLIED BY A CALCULATED COST-TO-CHARGE RATIO FOR ANCILLARY SERVICES AND MEDICARE DAYS MULTIPLIED BY A CALCULATED PER DIEM AMOUNT FOR ROUTINE SERVICES. PART III, LINE 9B: FOR ANY PATIENT WHO MAY OR IS KNOWN TO QUALIFY FOR SERVICES UNDER CHARITY CARE, THE COLLECTION POLICY PROVIDES THAT THE HOSPITAL SHOULD GATHER SUPPORTING DOCUMENTATION AND DETERMINE WHETHER THE PATIENT NEEDS TO PAY. PART VI, LINE 2: IDENTIFIED HEALTH NEEDS WERE PRIORITIZED WITH INPUT FROM MEMBERS OF THE HOSPITAL'S MANAGEMENT TEAM UTILIZING A WEIGHTING METHOD THAT WEIGHS 1) THE SIZE OF THE PROBLEM, 2) THE SERIOUSNESS OF THE PROBLEM, 3) THE IMPACT OF THE ISSUES ON VULNERABLE POPULATIONS, 4) HOW IMPORTANT THE ISSUE IS TO THE COMMUNITY AND 5) THE PREVALENCE OF COMMON THEMES. SIGNIFICANT NEEDS WERE FURTHER REVIEWED AND ANALYZED REGARDING HOW CLOSELY THE NEED ALIGNS WITH THE HOSPITAL'S MISSION, CURRENT AND KEY SERVICE LINES, AND/OR STRATEGIC PRIORITIES. PART VI, LINE 3: EACH PATIENT IS INSTRUCTED ABOUT THE FINANCIAL ASSISTANCE POLICY AS THEY REGISTER FOR SERVICE. PATIENTS WITHOUT INSURANCE ARE ASKED TO COMPLETE A SHORT FORM TO DETERMINE THEIR ELIGIBILITY FOR CHARITY OR GOVERNMENT PROGRAMS. PART VI, LINE 4: THE HOSPITAL SERVICES A POPULATION OF MORE THAN 18,000 IN RUSSELL COUNTY KENTUCKY, AS WELL AS PEOPLE IN THE SURROUNDING COUNTIES. RUSSELL COUNTY, KENTUCKY IS COMPRISED OF APPROXIMATELY 49% MALE AND 51% FEMALE. APPROXIMATELY 96% OF THE POPULATION IS CAUCASIAN. THE MEDIAN HOUSEHOLD INCOME IS $30,272, WITH APPROXIMATELY 22% OF THE POPULATION BELOW POVERTY LEVEL. X X 0 0 0 0 0 0 0 0 0 TOMMY SHELTON PHYSICIAN 641502 0 1250 0 135 0 5800 0 23023 0 671710 0 0 0 JONAS HURLEY PHYSICIAN 463384 0 1250 0 44699 0 2289 0 45247 0 556869 0 0 0 MILTON JACKSON PHYSICIAN 498389 0 1250 0 1188 0 5800 0 28991 0 535618 0 0 0 RICHARD PERKINS PHYSICIAN 453163 0 0 0 34168 0 4946 0 36891 0 529168 0 0 0 LIESEL GRENTZ PHYSICIAN 235848 0 1250 0 270 0 4065 0 30924 0 272357 0 0 0 JANIE LANDIS CFO 122911 0 1250 0 27088 0 2904 0 45481 0 199634 0 0 0 PATRICK BRANCO CEO (END 05/08/22) 177281 0 0 0 3361 0 3598 0 10550 0 194790 0 0 0 JUDY WITHERS CNO 132534 0 1250 0 13426 0 2961 0 26848 0 177019 0 0 0 JENNIFER GOODE CHIEF HR OFFICER (END 4/30/22) 111701 0 0 0 23142 0 2653 0 38804 0 176300 0 0 0 FORM 990, PART VI, SECTION A, LINE 8B PER THE BYLAWS, THERE IS NO OTHER COMMITTE WITH THE AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY. FORM 990, PART VI, SECTION B, LINE 11B THE CEO AND CFO ARE PROVIDED WITH A COPY OF THE 990 TO REVIEW IN ITS ENTIRETY BEFORE IT IS FILED. FORM 990, PART VI, SECTION B, LINE 12C CONFLICT OF INTEREST STATEMENTS ARE PREPARED AND REVEIWED ANNUALLY TO DETERMINE IF ANY CONFLICTS EXIST. FURTHER, CONFLICT ACTIVITY IS MONITORED THROUGHOUT THE YEAR TO MAKE SURE THAT CONFLICTS OF INTEREST DO NOT ARISE. SHOULD A CONFLICT ARISE, THE BOARD MEMBER WILL ABSTAIN FROM VOTING ON THE MATTER. FORM 990, PART VI, SECTION B, LINE 15 LINE 15A: THE BOARD OF DIRECTORS DETERMINES THE CEO'S COMPENSATION AND REVIEWS IT ANNUALLY. COMPENSATION SURVEYS AND EMPLOYMENT CONTRACTS ARE USED DURING THE PROCESS, WHICH IS REVEIWED ANNUALLY. LINE 15B: THE CEO, WITH APPROVAL FROM THE BOARD, DETERMINES THE CFO AND OTHER TOP MANAGEMENT OFFICIALS' COMPENSATION. COMPENSATION SURVEYS AND EMPLOYMENT CONTRACTS ARE USED DURING THE PROCESS, WHICH IS REVEIWED ANNUALLY. FORM 990, PART VI, SECTION C, LINE 19 THE HOSPITAL MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST AND AT THE DISCRETION OF THE BOARD OF DIRECTORS AND MANAGEMENT. RUSSELL COUNTY MEDICAL CLINIC PO BOX 1328 RUSSELL SPRINGS KY 42642 RENTAL KY RUSSELL COUNTY EXCLUDED 7706 5140 0 0 0.85720 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0