2016-06-13T08:13:50-05:00 2015-07-31 481026809 Wendling Noe Nelson & Johnson LLC 534 S Kansas Ave Suite 1500 Topeka KS 666033491 990 2014-08-01 742842747 West Central Kansas Association Inc WEST 7854833131 200 S Main Russell KS 67665 Harold Courtois CEO 7854833131 2016-06-08 1 Heather R Eichem P01515553 7852334226 2016-06-08 2014 2016-08-17 19:52:53Z Russell Regional Hospital Harold Courtois 200 S Main Russell KS 67665 15559556 0 X www.russellhospital.org X 1997 KS Dedicating our lives to improving yours. 5 5 208 5 0 0 14732 16156 13019792 15255241 44686 59996 68444 228163 13147654 15559556 0 0 0 0 8320262 9158417 0 0 0 4745085 6283924 13065347 15442341 82307 117215 4051972 4596798 4051972 4596798 0 0 Dedicating our lives to improving yours. 0 0 13638592 15483404 Russell Regional Hospital provides a variety of health care services including acute inpatient care, swingbed inpatient care, outpatient care, rural health clinic, and long-term care services to patients in need of care. 13638592 1 1 0 1 0 0 0 0 0 0 1 0 0 0 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 0 0 0 0 1 18 0 1 208 1 0 0 0 0 0 0 0 0 X 5 5 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 1 1 1 0 X X Harold Courtois CEO 7854832323 200 S Main Russell KS 67665 Morris Krug President 1.00 X X 0 0 0 Vance Ruggels Secretary 1.00 X X 0 0 0 John O Farmer III Treasurer 1.00 X X 0 0 0 Michael Holland Director 1.00 X 0 0 0 Mallory Davis Director 1.00 X 0 0 0 Kevin Kreutzer CFO 40.00 X 77605 0 1633 Harold Courtois CEO 40.00 X 114307 0 10228 Alexander Chung Physician 40.00 X 305213 0 11219 Earl Merkel Physician 40.00 X 307943 0 8440 Jill Doerfler-Iniguez Physician 40.00 X 182313 0 6159 Sambhundh Panichabhongse Physician 40.00 X 238322 0 8940 Christopher Zielinski Physician 40.00 X 221571 0 8259 1447274 0 54878 9 0 1 0 Sunflower Physician Services 1659 S Tamarisk Dr Wichita KS 67230 Physician services 334068 CPSI PO Box 850309 Mobile AL 366850309 Hardware/sofware support 295661 Shared Medical Services Inc 4253 Arogosy Court Madison WI 53714 MRI services 144785 Docs Who Care 1337 S Fountain Dr Olathe KS 66061 Emergency room coverage 140343 Quest Diagnostics PO Box 14730 St Louis MO 631504730 Lab services 133021 6 5859 10297 16156 Net patient service revenue 900099 13548840 13548840 340b retail pharmacy 446110 1694004 1694004 EHR payments received 900099 12397 12397 15255241 59996 59996 10029 0 10029 10029 10029 Contracted rheumatology 900099 120400 120400 Purchase discounts 900099 44624 44624 Cafeteria sales 722210 42672 42672 10438 10438 218134 15559556 15483404 0 59996 221298 221298 7549139 6886727 662412 63899 60215 3684 815636 738356 77280 508445 451741 56704 6021 6021 243958 9644 234314 34979 26725 8254 148518 57991 90527 290627 232502 58125 3204 1464 1740 31081 28457 2624 409418 327534 81884 130064 105190 24874 340b drug program expen 1288774 1288774 Pharmacy supplies 954188 954188 Physician fees 715387 715387 Purchased services 630885 584779 46106 1396820 1168918 227902 15442341 13638592 1803749 0 1150110 1642883 854 1693 1265109 1344308 241949 253180 98805 108036 4237705 3218745 1147226 1018960 147919 227738 4051972 4596798 963200 1022276 630906 520101 2457866 3054421 4051972 4596798 X 0 0 4051972 4596798 X 117215 -117215 X 0 1 X 0 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 3645 0 0 0 3645 0 Part II-B, Line 1: West Central Kansas Association, Inc. is a member of the Kansas Hospital Association and the American Hospital Association. Both of these organizations engage in lobbying activities for hospital and general health care interests as part of the services provided to members. 3048025 2356900 691125 1189680 861845 327835 1018960 Due to lessor 3054421 3054421 X 15559556 0 15559556 0 15559556 15442341 0 15442341 0 15442341 Part X, Line 2: Management is not aware of any uncertainties in income tax positions. 1 1 1 X 70.000000000000 1 X 1 1 0 1 0 70054 119532 -49478 0.00000 1104642 1161964 -57322 0.00000 1174696 1281496 -106800 15832 7000 8832 0.00060 3773233 3147675 625558 0.04050 511 511 0.00000 3789576 3154675 634901 0.04110 4964272 4436171 528101 0.04110 1 447087 0 4807116 4836664 -29548 X 1 1 1 1 Russell Regional Hospital 200 South Main Street Russell KS 67665 X X X X Long-term care facility, outpatient physician clinic Russell Regional Hospital 1 0 0 1 X X X X X X X X X 14 1 0 0 1 X www.russellhospital.org X 1 14 1 www.russellhospital.org 0 0 1 X 70.000000000000 200.000000000000 X X X 1 1 X X X 1 X http://www.russellhospital.org X http://www.russellhospital.org X http://www.russellhospital.org X X X X 1 X 0 X X X X 1 X 0 0 Russell Regional Hospital Part V, Section B, Line 5: A priority of the CHNA was to solicit input from a broad cross section of the community, not simply members of the local healthcare sector, in an effort to represent the community as a whole. Steering Committee participants include representatives from these local organizations: Russell County Area Community Foundation, Russell Regional Hospital, Russell County EMS, Russell Rotary Club, Russell Area Chamber of Commerce, Russell County Health Dept, Angels Care Home Health, Russell County Economic Development/CVB, Russell County Sheriff's Office, City of Russell, Russell County supervisor, county clergy, city law enforcement, and Russell County pharmacists. Russell Regional Hospital Part V, Section B, Line 11: The Russell Regional Hospital Community Health Needs Assessment for 2015 showed seven issues the community wanted to address. The seven issues are (1) Improve Mental Health Screenings/Placement, (2) Improve Chronic Disease Management (Diabetes, Heart, Stroke), (3) Improve Drugs/Alcohol & Placement, (4) Increase Availability of Affordable Quality Housing, (5) Expand Healthcare Transportation Out of County, (6) Provide Dentist Services, (7) Expand Child Care Offerings.Number 1RRH is developing a business plan to place a mental health provider in our Rural Health Clinic. The next phase is to implement an action plan for this mental health provider while partnering with the Kansas Community Behavioral Health Prevention Project led by the County Health Department. In addition RRH is utilizing the Avera eEmergency system for acute mental health issues in the ERNumber 2RRH in partnership with The Heart and Stroke Collaborative has hired a health coach to work with patients who have co-morbidities. This health coach will serve as a liaison between the physician and patient while making home visits and educational phone calls to make sure the patients are keeping appointments, taking medication correctly and observing a healthy lifestyle. RRH has engaged in a healthy hospital initiative that includes proper nutrition and exercise.Number 3The Russell County Sherriff Department will provide education for middle school students on the risks of alcohol and drug abuse.Number 4RRH provided testimony at the city council meeting and supported middle income town homes/lower income senior housing.Number 5After investigation it was determined that providing transportation within the city was feasible, but transportation within the county or outside the county could not be accomplished at this time. The city of Russell has public transportation in place at this time.Number 6Russell County Economic Development continues to recruit dentists.Number 7Russell Regional Hospital and USD 407 have started a joint venture to create a community preschool and daycare in the city of Russell. Russell Regional Hospital Part V, Section B, Line 22d: Amounts generally billed is calculated based on the average allowable percentage of all third party payors. Part V, Section B, Line 16 Financial Assistance Policy Website Availability Russell Regional Hospital Part V, Section B, line 16a website: http://www.russellhospital.org Russell Regional Hospital Part V, Section B, line 16b website: http://www.russellhospital.org Russell Regional Hospital Part V, Section B, line 16c website: http://www.russellhospital.org 1 Russell Rgnl Hospital Physicians Clinin 200 South Main Street Russell KS 67665 Rural health clinic Part I, Line 7g: The costs of subsidized health services include costs attributable to a physician clinic in the amount of $2,283,861. Part III, Line 4: See Note 2A (page 7) of the audited financial statements regarding the allowance for uncollectible accounts.Part III, Line 2: The Hospital's bad debt at cost was determined by applying an overall ratio of cost to charges. Part III, Line 3: West Central Kansas Association, Inc. is unable to determine the amount of bad debt expense attributable to patients eligible under its charity care policy for the year covered by this return. Suggested methods for estimation were either not in place or proved to be unreliable. For example, the number of financial assistance applications distributed but not returned was not tracked. Using demographic data to estimate an amount did not provide reasonable results. Undoubtedly, there is bad debt expense attributed to patients who meet charity care guidelines. However, paperwork needed for approval of charity care was not returned or tracked. Rather than provide an estimate that can't be substantiated, West Central Kansas Association, Inc. has chosen to report zero dollars as bad debt expense attributable to charity care patients. Part III, Line 8: The amounts were obtained from the cost report filed with Medicare for the period ending 07/31/2015. The total amount of shortfall between Medicare revenue received and related allowable costs is considered community benefit. Part III, Line 9b: Patients who are known to qualify for financial assistance are qualified for up to three months. After three months, patients must reapply for financial assistance. A patient who has qualified for partial financial assistance payments are subject to our normal collection procedures. Part VI, Line 3: Patients receive information regarding federal, state and charity care programs upon request. Part VI, Line 4: The Hospital is located in Russell County, Kansas in the city of Russell and serves the surrounding area. The Russell community is a predominately agricultural one. The city of Russell and Russell County have an approximate population of 4,500 & 7,000 individuals respectively. The average Russell household annual income is approximately $40,369. Approximately 13.3% of the residents in Russell County have an annual income below the federal poverty level. Other hospitals in the area are located in Hays, Hoisington, and Great Bend. The distance between the Hospital and these facilities is approximately 26, 29, and 40 miles respectively. Part VI, Line 5: The Hospital's governing body is comprised solely of local community members. All local physicians have admitting privileges at the Hospital. X X 0 0 0 0 0 0 0 0 0 Alexander Chung Physician 238668 0 66500 0 45 0 1875 0 9344 0 316432 0 0 0 Earl Merkel Physician 208105 0 99838 0 0 0 0 0 8440 0 316383 0 0 0 Jill Doerfler-Iniguez Physician 154813 0 22500 0 5000 0 1558 0 4601 0 188472 0 0 0 Sambhundh Panichabhongse Physician 182822 0 55500 0 0 0 0 0 8940 0 247262 0 0 0 Christopher Zielinski Physician 183321 0 33250 0 5000 0 0 0 8259 0 229830 0 0 0 Form 990, Part VI, Section B, line 11 The Form 990 is reviewed by the governing body prior to filing. It is distributed by email to all governing body Board Members for review. Any questions and/or comments are directed to management for further discussion. Form 990, Part VI, Section B, line 15 The compensation of the organization's officers is voted on and approved by the Board of Directors. Form 990, Part VI, Section C, line 19 The organization makes its governing documents, conflict of interest policy, and audited financial statements available to the public upon written request. Form 990, Part XI, line 9: Transfer from lessor 479,340. Change in amount due to lessor -596,555.