RUSSELLVILLE HOSPITAL INC: Form 990, tax year 2020
View the entire original 990 at ProPublica ↗
- Organization
- RUSSELLVILLE HOSPITAL INC (EIN 47-2378825)
- Tax period
- 2020-01-01 to 2020-12-31
- Filed
- 2021-11-15
- IRS object ID
- 202113199349324386
- Schema version
- 2020v4.1
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2021-11-15T14:31:55-08:00 | ReturnTs |
| Tax Period End | 2020-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Strickland & Barksdale CPA's | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO Box 506 | AddressLine1Txt |
| City | Russellville | CityNm |
| State Abbreviation | AL | StateAbbreviationCd |
| ZIP | 35653 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2020-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 472378825 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Russellville Hospital Inc | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | RUSS | BusinessNameControlTxt |
| Phone | 2563321611 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO Box 1089 | AddressLine1Txt |
| City | Russellville | CityNm |
| State Abbreviation | AL | StateAbbreviationCd |
| ZIP | 35653 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Ashoke A Mukherji | PersonNm |
| Person Title | President | PersonTitleTxt |
| Phone | 2563321611 | PhoneNum |
| Signature | 2021-10-29 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | Ashoke | PersonFirstNm |
| Person Last | Mukherji | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | XXX-XX-XXXX | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Donna S Barksdale CPA | PreparerPersonNm |
| PTIN | P00047643 | PTIN |
| Phone | 2563322275 | PhoneNum |
| Preparation | 2021-11-15 | PreparationDt |
| Self Employed | Yes (X) | SelfEmployedInd |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 3 | TrustedCustomerCd |
| Authentication Assurance Level | AAL1 | AuthenticationAssuranceLevelCd |
| Identity Assurance Level | IAL1 | IdentityAssuranceLevelCd |
| Federated Assurance Level | FAL1 | FederatedAssuranceLevelCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2020 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | Ashoke A Mukherji | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO Box 1089 | AddressLine1Txt |
| City | Russellville | CityNm |
| State Abbreviation | AL | StateAbbreviationCd |
| ZIP | 35653 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $26,432,970 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | RussellvilleHospital.com | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 2014 | FormationYr |
| Legal Domicile State | AL | LegalDomicileStateCd |
| Activity Or Mission | Our mission is making communities healthier. Russellville Hospital is a rural acute care hospital. | ActivityOrMissionDesc |
| Voting Members Governing Body | 8 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 6 | VotingMembersIndependentCnt |
| Total Employee | 307 | TotalEmployeeCnt |
| Total Volunteers | 0 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $15,835 | PYContributionsGrantsAmt |
| CY Contributions Grants | $4,355,232 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $22,391,480 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $21,877,505 | CYProgramServiceRevenueAmt |
| CY Investment Income | $0 | CYInvestmentIncomeAmt |
| PY Other Revenue | $317,894 | PYOtherRevenueAmt |
| CY Other Revenue | $200,233 | CYOtherRevenueAmt |
| PY Total Revenue | $22,725,209 | PYTotalRevenueAmt |
| CY Total Revenue | $26,432,970 | CYTotalRevenueAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $11,623,101 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $12,845,943 | CYSalariesCompEmpBnftPaidAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $11,854,399 | PYOtherExpensesAmt |
| CY Other Expenses | $13,694,971 | CYOtherExpensesAmt |
| PY Total Expenses | $23,477,500 | PYTotalExpensesAmt |
| CY Total Expenses | $26,540,914 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$752,291 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$107,944 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $6,332,870 | TotalAssetsBOYAmt |
| Total Assets EOY | $10,029,714 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $9,479,204 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $13,283,992 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | -$3,146,334 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | -$3,254,278 | NetAssetsOrFundBalancesEOYAmt |
| Mission | Our mission is making communities healthier. Russellville Hospital is a rural acute care hospital. | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $21,737,271 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $21,877,505 | RevenueAmt |
| Desc | Seeks to improve the delivery of healthcare services in rural America by giving local healthcare organizations an alternative to for-profit hospital companies or health systems. Seeks to make the community healthier. | Desc |
| Total Program Service Expenses | $21,737,271 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | false | ScheduleBRequiredInd |
| Political Campaign Acty | false | PoliticalCampaignActyInd |
| Lobbying Activities | false | LobbyingActivitiesInd |
| Subject To Proxy Tax | false | SubjectToProxyTaxInd |
| Donor Advised Fund | false | DonorAdvisedFundInd |
| Conservation Easements | false | ConservationEasementsInd |
| Collections Of Art | false | CollectionsOfArtInd |
| Credit Counseling | false | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | false | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (true) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | false | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | false | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (true) | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (true) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | false | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | false | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | false | ConsolidatedAuditFinclStmtInd |
| School Operating | false | SchoolOperatingInd |
| Foreign Office | false | ForeignOfficeInd |
| Foreign Activities | false | ForeignActivitiesInd |
| More Than5000 K To Org | false | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividualsInd |
| Professional Fundraising | false | ProfessionalFundraisingInd |
| Fundraising Activities | false | FundraisingActivitiesInd |
| Gaming Activities | false | GamingActivitiesInd |
| Operate Hospital | Yes (true) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (true) | AuditedFinancialStmtAttInd |
| Grants To Organizations | false | GrantsToOrganizationsInd |
| Grants To Individuals | false | GrantsToIndividualsInd |
| Schedule J Required | Yes (true) | ScheduleJRequiredInd |
| Tax Exempt Bonds | false | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | false | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | false | PYExcessBenefitTransInd |
| Loan Outstanding | Yes (true) | LoanOutstandingInd |
| Grant To Related Person | false | GrantToRelatedPersonInd |
| Business Rln With Org Mem | false | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | false | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | false | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | false | DeductibleNonCashContriInd |
| Deductible Art Contribution | false | DeductibleArtContributionInd |
| Terminate Operations | false | TerminateOperationsInd |
| Partial Liquidation | false | PartialLiquidationInd |
| Disregarded Entity | Yes (true) | DisregardedEntityInd |
| Related Entity | Yes (true) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (true) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | false | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | false | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | false | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (true) | ScheduleORequiredInd |
| IRP Document | 65 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (true) | BackupWthldComplianceInd |
| Employee | 307 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (true) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | false | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | false | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | false | TaxablePartyNotificationInd |
| Nondeductible Contributions | false | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | false | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | false | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | false | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | false | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 8 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 6 | IndependentVotingMemberCnt |
| Family Or Business Rln | false | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | Yes (true) | DelegationOfMgmtDutiesInd |
| Change To Org Documents | false | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | false | MembersOrStockholdersInd |
| Election Of Board Members | false | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | false | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (true) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (true) | MinutesOfCommitteesInd |
| Officer Mailing Address | false | OfficerMailingAddressInd |
| Local Chapters | false | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (true) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (true) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (true) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (true) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (true) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (true) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (true) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (true) | CompensationProcessOtherInd |
| Investment In Joint Venture | false | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Shannon Hughes | PersonNm |
| Phone | 2563328625 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 15155 Highway 43 | AddressLine1Txt |
| City | Russellville | CityNm |
| State Abbreviation | AL | StateAbbreviationCd |
| ZIP | 35653 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (17 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd | Key EmployeeKeyEmployeeInd |
|---|---|---|---|---|---|---|---|
| Bill Foster | |||||||
| Board Moderator | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| Keith Morrow DO | |||||||
| Chief of Staff | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| Lloyd Dyas MD | |||||||
| Board Member | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| Jeffrey Manord | |||||||
| Board Member | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| Jerry Groce | |||||||
| Board Member | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| Miranda Decker MD | |||||||
| Board Member | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| Roger Bedford | |||||||
| Board Member | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| Marilyn Mayfield | |||||||
| Board Member | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| Christine Stewart | |||||||
| CEO/Board Secretary | 40.00 | Yes (X) | $96,767 | $0 | $3,845 | Yes (X) | |
| Stephen Proctor | |||||||
| CEO/Board Secretary | 40.00 | Yes (X) | $152,759 | $0 | $14,459 | Yes (X) | |
| John Almirol | |||||||
| Physician | 40.00 | $396,548 | $0 | $51,489 | Yes (X) | ||
| Jeffrey Chenyi | |||||||
| Physician | 40.00 | $326,455 | $0 | $58,736 | Yes (X) | ||
| Tracy Martin | |||||||
| CFO | 40.00 | $39,548 | $0 | $1,664 | Yes (X) | ||
| Shannon Hughes | |||||||
| CFO | 40.00 | $78,574 | $0 | $4,937 | Yes (X) | ||
| Tracy Vinson | |||||||
| Pharmacy Director | 40.00 | $129,453 | $0 | $500 | Yes (X) | ||
| Russell Burks | |||||||
| Physical Therapy Director | 40.00 | $121,369 | $0 | $5,181 | Yes (X) | ||
| Karen Waddell | |||||||
| Med Surg/ICU/Nursing Director | 40.00 | $118,062 | $0 | $7,463 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,459,535 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $148,274 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 7 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | false | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (true) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| Correct Care Inc | |||||
| 229 Saint John Lane | Covington | LA | 70433 | Physician services | $802,008 |
| Integrated Behavioral Health | |||||
| 600 Sun Temple Drive | Madison | AL | 35758 | Billing services | $273,020 |
| Java Medical Group | |||||
| 6 Castlewood Ct | Nashville | TN | 37215 | Management services | $360,000 |
| JMJ Anesthesia PC | |||||
| PO Box 757 Suite F | Florence | AL | 356310757 | Anesthesiologist services | $415,329 |
| Community Health Care Trust Services | |||||
| PO Box 305172 Dept 123 | Nashville | TN | 372305172 | Rent | $140,175 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 7 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $4,338,828 | GovernmentGrantsAmt |
| All Other Contributions | $16,404 | AllOtherContributionsAmt |
| Total Contributions | $4,355,232 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | Patient service fees | Desc |
| Business | 622110 | BusinessCd |
| Total Revenue Column | $21,877,505 | TotalRevenueColumnAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $0 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $21,877,505 | TotalProgramServiceRevenueAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $139,673 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $139,673 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $139,673 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $139,673 | RelatedOrExemptFuncIncomeAmt |
Other Revenue Misc OtherRevenueMiscGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt | Unrelated Business RevenueUnrelatedBusinessRevenueAmt | ExclusionExclusionAmt |
|---|---|---|---|---|---|
| Cafeteria revenue | 900099 | $42,933 | $42,933 | $0 | $0 |
| Other revenue | 900099 | $17,627 | $17,627 | $0 | $0 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $60,560 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $26,432,970 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $22,077,738 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $0 | ExclusionAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,553,761 | TotalAmt |
| Program Services | $1,413,295 | ProgramServicesAmt |
| Management And General | $140,466 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $9,109,918 | TotalAmt |
| Program Services | $8,595,941 | ProgramServicesAmt |
| Management And General | $513,977 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,182,264 | TotalAmt |
| Program Services | $2,142,864 | ProgramServicesAmt |
| Management And General | $39,400 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $360,000 | TotalAmt |
| Program Services | $0 | ProgramServicesAmt |
| Management And General | $360,000 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,210,360 | TotalAmt |
| Program Services | $3,907,378 | ProgramServicesAmt |
| Management And General | $302,982 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $303,128 | TotalAmt |
| Program Services | $275,453 | ProgramServicesAmt |
| Management And General | $27,675 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $244,395 | TotalAmt |
| Program Services | $0 | ProgramServicesAmt |
| Management And General | $244,395 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $583,686 | TotalAmt |
| Program Services | $0 | ProgramServicesAmt |
| Management And General | $583,686 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $315,736 | TotalAmt |
| Program Services | $0 | ProgramServicesAmt |
| Management And General | $315,736 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,677,666 | TotalAmt |
| Program Services | $5,402,340 | ProgramServicesAmt |
| Management And General | $2,275,326 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $26,540,914 | TotalAmt |
| Program Services | $21,737,271 | ProgramServicesAmt |
| Management And General | $4,803,643 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $14,860 | BOYAmt |
| EOY | $1,394,605 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,812,494 | BOYAmt |
| EOY | $2,132,400 | EOYAmt |
Receivables From Officers Etc ReceivablesFromOfficersEtcGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $2,500,000 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $27,238 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $827,524 | BOYAmt |
| EOY | $772,368 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $248,916 | BOYAmt |
| EOY | $160,139 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $7,628,198 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $4,636,975 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,412,080 | BOYAmt |
| EOY | $2,991,223 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $16,996 | BOYAmt |
| EOY | $51,741 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,332,870 | BOYAmt |
| EOY | $10,029,714 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,502,699 | BOYAmt |
| EOY | $1,906,948 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,410,170 | BOYAmt |
| EOY | $5,191,796 | EOYAmt |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $1,761,873 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,566,335 | BOYAmt |
| EOY | $4,423,375 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,479,204 | BOYAmt |
| EOY | $13,283,992 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -$3,146,334 | BOYAmt |
| EOY | -$3,254,278 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -$3,146,334 | BOYAmt |
| EOY | -$3,254,278 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,332,870 | BOYAmt |
| EOY | $10,029,714 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | -$107,944 | ReconcilationRevenueExpnssAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | false | AccountantCompileOrReviewInd |
| FS Audited | false | FSAuditedInd |
| Federal Grant Audit Required | false | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
| Other Support Sum | $0 | OtherSupportSumAmt |
| Public Support CY170 | 0 | PublicSupportCY170Pct |
| Public Support Total509 | $0 | PublicSupportTotal509Amt |
| Public Support CY509 | 0 | PublicSupportCY509Pct |
| Investment Income CY | 0 | InvestmentIncomeCYPct |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | $0 | InvestmentCostOrOtherBasisAmt |
| Other Cost Or Other Basis | $810,000 | OtherCostOrOtherBasisAmt |
| Book Value | $810,000 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $2,296,794 | OtherCostOrOtherBasisAmt |
| Depreciation | $569,864 | DepreciationAmt |
| Book Value | $1,726,930 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $175,471 | OtherCostOrOtherBasisAmt |
| Depreciation | $66,195 | DepreciationAmt |
| Book Value | $109,276 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $4,319,553 | OtherCostOrOtherBasisAmt |
| Depreciation | $4,000,916 | DepreciationAmt |
| Book Value | $318,637 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $26,380 | OtherCostOrOtherBasisAmt |
| Depreciation | $0 | DepreciationAmt |
| Book Value | $26,380 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $2,991,223 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp (2 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| Current portion LTD | $245 |
| Deposits | $51,496 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $51,741 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (5 entries)
| DescDesc | AmtAmt |
|---|---|
| Accrued salaries/benefits | $924,332 |
| Other current liabilities | $3,392,455 |
| Bank overdrafts | $0 |
| A/P Lakeland Community Hospital | $0 |
| Accounts receivable - other | $106,588 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $4,423,375 | TotalLiabilityAmt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (true) | FinancialAssistancePolicyInd |
| Written Policy | Yes (true) | WrittenPolicyInd |
| FPG Reference Free Care | Yes (true) | FPGReferenceFreeCareInd |
| Percent200 | Yes (X) | Percent200Ind |
| FPG Reference Discounted Care | Yes (true) | FPGReferenceDiscountedCareInd |
| Percent300 | Yes (X) | Percent300Ind |
| Free Care Medically Indigent | Yes (true) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | false | FinancialAssistanceBudgetInd |
| Annual Community Bnft Report | false | AnnualCommunityBnftReportInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,420,372 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $1,420,372 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.05350 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $4,597,285 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,152,899 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $3,444,386 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.12980 | TotalExpensePct |
Unreimbursed Costs UnreimbursedCostsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $6,017,657 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,152,899 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $4,864,758 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.18330 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $684 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $684 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,299 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $2,299 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Research ResearchGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,983 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $2,983 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $6,020,640 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,152,899 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $4,867,741 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.18340 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (true) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $11,569,611 | BadDebtExpenseAmt |
| Reimbursed By Medicare | $7,470,262 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $5,783,742 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | $1,686,520 | MedicareSurplusOrShortfallAmt |
| Written Debt Collection Policy | Yes (true) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (true) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Russellville Hospital Inc | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 15155 Highway 43 | AddressLine1Txt |
| City | Russellville | CityNm |
| State Abbreviation | AL | StateAbbreviationCd |
| ZIP | 35653 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | Russellville Hospital.com | WebsiteAddressTxt |
| State License | H3001 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Russellville Hospital Inc | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | false | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | false | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (true) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Prior CHNA Impact | Yes (X) | PriorCHNAImpactInd |
| CHNA Conducted | 19 | CHNAConductedYr |
| Take Into Account Others Input | Yes (true) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | false | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | false | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (true) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | RussellvilleHospital.com | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (true) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 19 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (true) | StrategyPostedWebsiteInd |
| Strategy Website URL | RussellvilleHospital.com | StrategyWebsiteURLTxt |
| Strategy Attached | false | StrategyAttachedInd |
| Organization Incur Excise Tax | false | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (true) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 200.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 300.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Explained Basis | Yes (true) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (true) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Provided Nonprofit Contact | Yes (X) | ProvidedNonprofitContactInd |
| Includes Publicity Measures | Yes (true) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | RussellvilleHospital.com | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | RussellvilleHospital.com | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | RussellvilleHospital.com | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| FAP Actions On Nonpayment | Yes (true) | FAPActionsOnNonpaymentInd |
| Permit Report To Credit Agency | Yes (X) | PermitReportToCreditAgencyInd |
| Collection Activities | false | CollectionActivitiesInd |
| Other Actions Taken | Yes (X) | OtherActionsTakenInd |
| Nondis Emergency Care Policy | Yes (true) | NondisEmergencyCarePolicyInd |
| Look Back Medicaid Medcr Prvt | Yes (X) | LookBackMedicaidMedcrPrvtInd |
| Amounts Generally Billed | false | AmountsGenerallyBilledInd |
| Gross Charges | false | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Russellville Hospital, Inc. Pt V Line 5 | The goal of establishing the community health committee was to solicit input from residents of the community and to promote the broad interest of those served by the hospital. Community members of the committee are as follows: Bill Foster, Leah Youm, Maria Macias, Thomas Uptain, and Dr. Wayne Ray. The committee met to ultimately identify the top health issues facing the community and the development of the hospital's implementation strategy to address the findings of the CHNA. An online survey was the primary means to determine public perception about the needs of the community. Input was requested regarding demographics and health status. In order to receive input from the medically underserved, chronically ill and low-income individuals, and to ensure data from the overall population, the survey was advertised by various community partners. These partners also helped distribute through their email list services. The survey was available to the public through RussellvilleHospital.com for a five-week period. |
| Russellville Hospital, Inc. Pt V Line 20e | Responsible parties are provided a written notice about extraordinary collection action and a plain language summary of the FAP at least 30 days before action is taken. A reasonable effort is made to orally notify responsible parties about the FAP and the FAP application process. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| Russellville Physicians LLC | ||||
| 15155 Highway 43 | Russellville | AL | 35653 | Family medicine physician facility |
| Russellville Physicians LLC | ||||
| 15155 Highway 43 | Russellville | AL | 35653 | Family medicine physician facility |
Supplemental Information Detail SupplementalInformationDetail (8 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Pt III Line 2 | Accounts are evaluated for collectability on a monthly basis using aged payor account classifications and historical collection experience. |
| Pt III Line 3 | Accounts are evaluated for collectability on a monthly basis using aged payor account classifications and historical collection experience. |
| Pt III Line 8 | As a non-profit organization, the hospital accepts all patients without regard to insurance or ability to pay. Amounts are based on the Medicare Cost Report. |
| Pt III Line 9b | Russellville Hospital offers financial assistance to patients and guarantors through a charity policy based on the current federal poverty guidelines (FPG). Those approved for financial assistance are eligible for discounts applied to balances owed after insurance. Self-pay balances remaining after the uninsured discount are also eligible for financial assistance.If the family income of the patient is between 0% and 200% of the FPG, a 100% discount may be applied (charity care). If the family income of the patient is between 201% and 250% of the FPG, a 60% discount may be applied (financial assistance). If the family income of the patient is between 251% and 300% of the FPG, a 40% discount may be applied (financial assistance). This policy is publicized in patient registration areas, included in billing statements, and is available on the hospital's web site. Patients with a balance remaining after application of discounts are sent statements and/or collection letters every 30 days until the balance is paid or payment arrangements are made. Accounts that do not have sufficient payment arrangements established are eligible to be referred to outside collections. All patients are notified of possible collection assignment at least 30 days before an assignment is made. If a request for financial assistance is made after statements are sent, the account is placed on hold until a determination of eligibility is made. |
| Pt VI Line 2 | The hospital performs outreach services and health education opportunities for the community. Feedback from these services as well as evaluation of the patients served are used to assess the community's health care needs. |
| Pt VI Line 3 | Both inpatient and outpatient services are eligible for financial assistance or charity upon application by the patient or guarantor. There is signage in registration areas, information included in monthly statments,and information on the hospital website with the phone number to call for financial assistance. |
| Pt III Line 4 | Russellville Hospital primarily serves residents of Russellville, Alabama and Franklin County, Alabama. Russellville is a rural community with population of just below 10,000 and approximately 22% of the population is below poverty level. The most recent census indicates the population is 73% caucasian. |
| Pt VI Line 5 | The hospital has a volunteer Board of Directors and is served by an open medical staff. The hospital actively recruits primary care physicians and specialists to meet medical needs in the community. The hospital also performs outreach services and provides health education opportunities for the community. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Form990 Of Other Organizations | Yes (X) | Form990OfOtherOrganizationsInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | false | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | false | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | false | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | false | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | false | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | false | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | false | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | Yes (true) | AnyNonFixedPaymentsInd |
| Initial Contract Exception | false | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (7 entries)
| Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Stephen Proctor | |||||||||||||
| $152,759 | $0 | $1,500 | $0 | $0 | $0 | $12,959 | $0 | $0 | $0 | $167,218 | $0 | $0 | $0 |
| John Almirol | |||||||||||||
| $396,548 | $0 | $46,808 | $0 | $0 | $0 | $4,681 | $0 | $0 | $0 | $448,037 | $0 | $0 | $0 |
| Jeffrey Chenyi | |||||||||||||
| $326,455 | $0 | $43,918 | $0 | $0 | $0 | $14,818 | $0 | $0 | $0 | $385,191 | $0 | $0 | $0 |
| Shannon Hughes | |||||||||||||
| $78,574 | $0 | $500 | $0 | $0 | $0 | $4,437 | $0 | $0 | $0 | $83,511 | $0 | $0 | $0 |
| Tracy Vinson | |||||||||||||
| $129,453 | $0 | $500 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $129,953 | $0 | $0 | $0 |
| Russell Burks | |||||||||||||
| $121,369 | $0 | $500 | $0 | $0 | $0 | $4,681 | $0 | $0 | $0 | $126,550 | $0 | $0 | $0 |
| Karen Waddell | |||||||||||||
| $118,062 | $0 | $500 | $0 | $0 | $0 | $6,963 | $0 | $0 | $0 | $125,525 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Pt I Line 7 | FormAndLineReferenceDesc |
| Explanation | Physicians were eligible for productivity bonuses. | ExplanationTxt |
Schedule L IRS990ScheduleL
Loans Btwn Org Interested Prsn LoansBtwnOrgInterestedPrsnGrp
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Java Medical Group | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship With Org | Management Services | RelationshipWithOrgTxt |
| Loan Purpose | Business | LoanPurposeTxt |
| Loan To Organization | Yes (X) | LoanToOrganizationInd |
| Original Principal | $2,500,000 | OriginalPrincipalAmt |
| Balance Due | $2,500,000 | BalanceDueAmt |
| Default | false | DefaultInd |
| Board Or Committee Approval | false | BoardOrCommitteeApprovalInd |
| Written Agreement | false | WrittenAgreementInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Balance Due | $2,500,000 | TotalBalanceDueAmt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (14 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Pt VI, Line 3 | Management services were performed by Java Medical Group. |
| Pt VI, Line 11b | A copy of Form 990 was provided to each Board Member for review prior to the filing of the form. |
| Pt VI, Line 12c | The conflict of interest policy is reviewed annually with governing Board Members and a Conflict of Interest statement is completed annually. |
| Pt VI, Line 15a | The Board approves the operating budget which includes CEO and top management compensation. |
| Pt VI, Line 15b | The Board approves the operating budget which includes officer and key employee compensation. |
| Pt VI, Line 19 | Governing documents, conflict of interest policy and financial statements are made available to the public upon request. |
| Other | Part IV, Line 20b An audit has not been completed for the year ending December 31, 2020. |
| Form 990, Part IX, Line 11g | Professional fees 955836. 955836. 0. 0. |
| Form 990, Part IX, Line 11g | Purchased Services 3254524. 2951542. 302982. 0. |
| Form 990, Part IX, Line 24e | Taxes and assessments 1611953. 0. 1611953. 0. |
| Form 990, Part IX, Line 24e | Supplies and other 3953270. 3911260. 42010. 0. |
| Form 990, Part IX, Line 24e | Repairs and maintenance 898374. 689846. 208528. 0. |
| Form 990, Part IX, Line 24e | Utilities 679127. 571279. 107848. 0. |
| Form 990, Part IX, Line 24e | Other expense 534942. 229955. 304987. 0. |
Schedule R IRS990ScheduleR
Id Disregarded Entities IdDisregardedEntitiesGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Russellville Physicians LLC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 15155 Highway 43 | AddressLine1Txt |
| City | Russellville | CityNm |
| State Abbreviation | AL | StateAbbreviationCd |
| ZIP | 35653 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 472497573 | EIN |
| Primary Activities | Provide health care services | PrimaryActivitiesTxt |
| Legal Domicile State | TN | LegalDomicileStateCd |
| Total Income | $769,962 | TotalIncomeAmt |
| End Of Year Assets | $619,021 | EndOfYearAssetsAmt |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Russellville Hospital Inc | BusinessNameLine1Txt |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp
Related Organization Name RelatedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Russellville Medical II Condominum Assoc | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO Box 1089 | AddressLine1Txt |
| City | Russellville | CityNm |
| State Abbreviation | AL | StateAbbreviationCd |
| ZIP | 35653 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 630944658 | EIN |
| Primary Activities | Condo maint | PrimaryActivitiesTxt |
| Legal Domicile State | AL | LegalDomicileStateCd |
| Entity Type | C | EntityTypeTxt |
| Ownership | 0.50000 | OwnershipPct |
| Controlled Organization | false | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | false | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | false | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | false | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | false | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | false | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | false | DivRelatedOrganizationInd |
| Asset Sale To Other Org | false | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | false | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | false | AssetExchangeInd |
| Rental Of Facilities To Oth Org | false | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | false | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | false | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | false | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | false | SharingOfFacilitiesInd |
| Paid Employees Sharing | false | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | false | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | false | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | false | TransferToOtherOrgInd |
| Transfer From Other Org | false | TransferFromOtherOrgInd |