2015-11-12T15:57:37-06:00 2014-12-31 454084437 WARREN AVERETT LLC 2500 ACTON ROAD BIRMINGHAM AL 35243 990 2014-01-01 630385130 RUSSELL HOSPITAL CORPORATION RUSS 2053297100 PO BOX 939 ALEXANDER CITY AL 35011 TIMOTHY J THORNTON CFO 2053297100 2015-11-11 1 JC ROUSE P00081132 2059794100 2014 2016-02-25 16:41:14Z JIM PEACE PO BOX 939 ALEXANDER CITY AL 35011 89948070 0 X WWW.RUSSELLMEDCENTER.COM X 1923 AL RUSSELL HOSPITAL CORPORATION D/B/A RUSSELL MEDICAL CENTER OPERATES AN ACUTE CARE GENERAL HOSPITAL IN ALEXANDER CITY, AL INCLUDING AN URGENT CARE CENTER (MPFC) IN DADEVILLE, AL. OUR MISSION IS TO BE THE REGIONAL HEALTHCARE PROVIDER OF CHOICE. WE ARE COMMITTED TO QUALITY, TEAMWORK, PROFESSIONALISM AND PERSONALIZED CARE. 11 10 689 100 0 0 23800 14952 67058464 67856847 3154222 2510561 2632697 2006439 72869183 72388799 0 0 0 0 30265127 32772102 0 0 0 41548947 41484924 71814074 74257026 1055109 -1868227 91080715 92111000 54962009 62332216 36118706 29778784 RUSSELL MEDICAL CENTER AND ITS PHYSICIANS ARE COMMITTED TO PROVIDING THE HIGHEST STANDARDS OF PATIENT CARE AND CUSTOMER SERVICE. OUR MISSION IS SIMPLE...BEING THE BEST BECAUSE WE CARE. 0 0 2368546 0 15492051 THE LABORATORY DEPARTMENT AT RUSSELL MEDICAL CENTER (RMC) PROVIDES A FULL SERVICE MEDICAL LABORATORY FOR HOSPITAL INPATIENTS, OUTPATIENTS, AND EMERGENCY PATIENTS. LABORATORY SERVICES ARE AVAILABLE TWENTY-FOUR HOURS PER DAY AND THE LAB IS ALWAYS AVAILABLE TO SERVE THE PATIENTS OF RMC. DURING 2014, THE LABORATORY COMPLETED 72,455 INPATIENT TESTS AND 146,868 OUTPATIENT TESTS FOR A TOTAL TEST VOLUME OF 219,323. 2216531 0 8323780 THE SURGERY DEPARTMENT AT RUSSELL MEDICAL CENTER (RMC) OFFERS A WIDE RANGE OF SURGICAL PROCEDURES WITHIN MANY OF THE MEDICAL SPECIALTIES, INCLUDING ORTHOPAEDICS, GENERAL SURGERY, UROLOGY, AND GYNECOLOGY, AMONG OTHERS. DURING THE YEAR ENDED 12/31/14, THE SURGERY DEPARTMENT AT RMC PERFORMED 715 INPATIENT PROCEDURES AND 2,725 OUTPATIENT PROCEDURES FOR A DEPARTMENT TOTAL OF 3,440. 2191240 0 11136640 THE PHARMACY DEPARTMENT PROVIDES MEDICINES AND PHARMACEUTICALS TO THE INPATIENTS OF THE HOSPITAL. THE DEPARTMENT IS STAFFED TWENTY-FOUR HOURS PER DAY AND PROVIDES FULL PHARMACY SUPPORT FOR THE MEDICAL STAFF OF RMC FOR HOSPITAL INPATIENTS. THE PHARMACY ALSO PROVIDES MEDICINES AND DRUGS TO THE CENTRAL ALABAMA CANCER CENTER (CACC) FOR PATIENTS WHO ARE PRIMARILY OUTPATIENTS. THE PHARMACY DOES NOT PROVIDE RETAIL PHARMACY SERVICES TO OUTPATIENTS. DURING 2014, OVER 210,000 INPATIENT DRUG ORDERS WERE FILLED AS WELL AS 135,580 ORDERS FOR OUTPATIENT MEDICINES. TOTAL PHARMACY VOLUME WAS 345,580.. 67480709 0 35022807 67480709 35022807 74257026 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 122 0 1 689 1 0 0 0 0 0 0 0 0 0 0 X 11 10 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X LEETA MCGILL 2563297170 PO BOX 939 ALEXANDER CITY AL 35011 JAMES D NABORS CHAIRMAN 5.00 X 0 0 0 HUGH NEIGHBORS III VICE CHAIRMAN 5.00 X 0 0 0 SCOTT HOWELL SECRETARY/TREASURER 5.00 X 0 0 0 LUTHER E PEACE PRESIDENT/CEO 40.00 5.00 X X 383453 0 145439 RALPH FROSHIN DIRECTOR 5.00 X 0 0 0 BEN RUSSELL DIRECTOR 5.00 X 0 0 0 THOMAS RADNEY DIRECTOR 5.00 X 0 0 0 RANDY HAYNES DIRECTOR 5.00 X 0 0 0 EDWARD HILL MD DIRECTOR 5.00 X 0 0 0 TONY MCLEOD MD DIRECTOR 5.00 X 0 0 0 MICHELE GOLDHAGEN MD DIRECTOR 5.00 X 0 0 0 SARAH BETH GETTYS VP PATIENT SERVICES 40.00 5.00 X 263000 0 65095 TIM THORNTON CFO 40.00 5.00 X 269590 0 16904 KERI K BROWN MD PULMONOLOGIST 40.00 X 463969 0 8805 JOHN ELGIN MD DIRECTOR - PATHOLOGY 40.00 X 412099 0 8018 MARY EMILY SHEFFIELD MD MEDICAL ONCOLOGIST 40.00 X 451939 0 22139 ZHENHONG ZHOU PHYSICIAN 40.00 X 323382 0 22463 JON W JONES MD PHYSICIAN 40.00 X 352167 0 23975 JAMES W BROWN JR FORMER DIRECTOR 5.00 X 61791 0 4879 2981390 0 317717 34 1 1 0 COMPHEALTH PO BOX 972651 DALLAS TX 75397 PHYSICIAN SERVICES 653585 DIVERSIFIED CLINICAL SERVICES INC PO BOX 636981 CINCINNATI OH 45263 WOUND CARE SERVICES 629292 LAB CORP OF AMERICA PO BOX 12140 BURLINGTON NC 27216 LAB SERVICES 350024 LINCOLN NATIONAL LIFE INSURANCE COMPANY PO BOX 0821 CAROL STREAM IL 60132 INSURANCE 307108 ANESTHESIA SERVICES OF BIRMINGHAM PC 2151 OLD ROCKY RIDGE ROAD STE 106 BIRMINGHAM AL 35216 ANESTHESIA SERVICES 300000 13 14952 14952 PATIENT REVENUE 900099 67856847 67856847 67856847 595806 595806 718051 830043 -111992 -111992 -111992 18597170 46813 16729228 0 1867942 46813 1914755 1914755 MISCELLANEOUS INCOME 900099 1270060 1270060 CAFETERIA INCOME 900099 473410 473410 DRUG SALES 900099 202146 202146 172815 172815 2118431 72388799 69975278 0 2398569 916043 916043 23408394 23408394 1066816 1066816 5686886 5686886 1693963 1693963 115573 115573 118895 118895 56979 56979 2334402 2334402 213149 213149 67291 67291 2010429 2010429 4230259 4230259 604471 604471 SUPPLIES 14853345 14853345 PROVISION FOR BAD DEBTS 8159648 8159648 PURCHASED SERVICES 3165401 3165401 MAINTENANCE AND REPAIRS 2063229 2063229 3491853 3491853 74257026 74257026 0 0 7593258 6749911 2376615 13036093 11970029 14226040 2595080 2701015 517017 470888 103743721 64719871 41040105 39023850 22227818 12653005 2760793 3250198 91080715 92111000 12376306 18963819 37215019 35534879 5370684 7833518 54962009 62332216 X 36118706 29778784 36118706 29778784 91080715 92111000 X -1868227 -1048016 -3423679 X X 0 1 X 1 0 X 1811667 1811667 58526449 29155978 29370471 81565 81565 0 42833970 35482328 7351642 490070 490070 39023850 ASSETS HELD BY TRUSTEE 3328590 F INVESTMENT IN COASTAL INSURANCE 360930 C COMMON STOCK 8963485 F 12653005 UNAMORTIZED BOND PREMIUM 284404 MISCELLANEOUS LIABILITIES 3886447 DUE TO CONTRACTUAL AGENCIES 3283430 OTHER LIABILITIES 179237 DUE TO BLUE CROSS 25000 OTHER LIABILITIES - CACC JV 175000 7833518 X 63964366 -1048016 830043 -217973 64182339 8206460 8206460 72388799 66880609 830043 830043 66050566 8206460 8206460 74257026 PART X, LINE 2: THE HOSPITAL IS EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(A) OF THE INTERNAL REVENUE CODE AS AN ORGANIZATION DESCRIBED IN SECTION 501(C)(3). THE HOSPITAL HAS EVALUATED ITS TAX POSITIONS AS REQUIRED UNDER THE RELEVANT ACCOUNTING STANDARDS AND HAS DETERMINED THAT IT DOES NOT HAVE ANY UNCERTAIN TAX POSITIONS THAT IT WOULD BE UNABLE TO SUBSTANTIATE UPON EXAMINATION. RETURNS HAVE BEEN FILED FOR ALL YEARS THROUGH DECEMBER 31, 2013. TAX RETURNS FOR 2011 THROUGH 2013 ARE SUBJECT TO AUDIT BY TAXING AUTHORITIES. PART XI, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES SHOWN AS AN OFFSET TO REVENUE 830,043. PART XI, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE SHOWN AS AN OFFSET TO REVENUE ON AFS 8,159,648. OTHER 46,812. PART XII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES SHOWN AS AN OFFSET TO REVENUE 830,043. PART XII, LINE 4B - OTHER ADJUSTMENTS: OTHER 46,812. BAD DEBT EXPENSE SHOWN AS AN OFFSET TO REVENUE ON AFS 8,159,648. 1 1 1 X 300.000000000000 1 X 1 1 0 0 3889420 3889420 0.05880 9735213 2190157 7545056 0.11420 13624633 2190157 11434476 0.17300 188226 188226 0.00280 188226 188226 0.00280 13812859 2190157 11622702 0.17580 1 8159648 4079824 28439409 31423287 -2983878 X 1 1 1 1 RUSSELL MEDICAL CENTER PO BOX 939 ALEXANDER CITY AL 35011 X X X RUSSELL MEDICAL CENTER 1 0 0 1 X X X X X X X X X 13 1 0 0 1 X WWW.RUSSELLMEDCENTER.COM X 1 14 1 WWW.RUSSELLMEDCENTER.COM 0 0 1 X 300.000000000000 350.000000000000 X X X X 1 1 X X X X 1 X X X X X 1 X 0 X 1 X 0 0 RUSSELL MEDICAL CENTER PART V, SECTION B, LINE 5: IN CONDUCTING THE CHNA, THE HOSPITAL CONSULTED WITH A BROAD RANGE OF PEOPLE REPRESENTING THE HEALTH INTERESTS OF RESIDENTS OF ALEXANDER CITY AND TALLAPOOSA COUNTY INCLUDING: EXECUTIVE DIRECTOR, LOCAL UNITED WAY; ADMINISTRATOR, LOCAL NURSING HOME; NURSE SUPERVISOR - TALLAPOOSA COUNTY HEALTH DEPARTMENT. THE CONTRIBUTORS ALSO INCLUDED LEADERSHIP AND CLINICAL EMPLOYEES OF RUSSELL MEDICAL CENTER AND MEMBERS OF THE MEDICAL STAFF OF THE HOSPITAL. RUSSELL MEDICAL CENTER PART V, SECTION B, LINE 11: RUSSELL MEDICAL CENTER ENGAGED LEGACY CONSULTING TO CONDUCT A COMMUNITY HEALTH NEEDS ASSESSMENT IN 2013 AND ADOPTED A COMPREHENSIVE IMPLEMENTATION STRATEGY FOR YEARS 2014- 2016. THE FOLLOWING IS A SUMMARY OF ACTIVITIES CONDUCTED IN 2014: (1) ANALYZED DATA AND DETERMINED GEOGRAPHIC LOCALE FOR A RURAL HEALTH CLINIC, TO BE ESTABLISHED IN 2015.(2) FORMED A PARTNERSHIP WITH A NEWLY ESTABLISHED COMMUNITY ORGANIZATION, C-PH (CITIZENS FOR PROSPERITY THROUGH HEALTH), TO GROW A HEALTHIER COMMUNITY THROUGH WELLNESS, HEALTH EDUCATION, NUTRITION AND PREVENTION OF DISEASES. PARTNERING ACTIVITIES INCLUDED: -COMPANY - TO - COMPANY WELLNESS CHALLENGE -FARMERS MARKET - FARM TO TABLE EDUCATION CLASSES ON SATURDAY MORNINGS -DEVELOPMENT OF A COMMUNITY GARDEN IN DOWNTOWN -SUN FESTIVAL COMMUNITY-WIDE HEALTH FAIR -WALKTOBER - COMMUNITY-WIDE WALKING PROGRAM AROUND DOWN TOWN DURING THE MONTH OF OCTOBER. (3) INCORPORATED OUTREACH ACTIVITIES TO ENHANCE DIABETES, HYPERTENSION AND HEART DISEASE EDUCATION AND DISEASE MANAGEMENT: -HEART DISEASE: CONDUCTED SPECIAL SCREENINGS THROUGHOUT FEBRUARY INCLUDING -CT IMAGING OF THE HEART, CAROTID ULTRASOUND, ECHOCARDIOGRAM PERIPHERAL ARTERIAL DISEASE: CONDUCTED A FREE PAD SCREENING -CARDIAC/PULMONARY EDUCATION SEMINARS WERE CONDUCTED QUARTERLY AND DIABETES EDUCATION FORUM CONDUCTED SEMI-ANNUALLY. IDENTIFIED NEED TO SECURE A CERTIFIED DIABETIC EDUCATOR TO ASSIST PATIENTS WITH UNDERSTANDING THEIR DISEASE PROCESSES AND MANAGEMENT TOOLS. -CONDUCTED CORPORATE HEALTH FAIRS WITH LOCAL INDUSTRY, FOCUSING ON BLOOD PRESSURE, CHOLESTEROL, BLOOD SUGAR AND WEIGHT MANAGEMENT. (4) INITIATED EFFORTS TO ADDRESS OBESITY AND HEALTHY NUTRITION, LIFESTYLE CHANGES AND EXERCISE WITHIN THE COMMUNITY. -SERVED AS OFFICIAL SITE FOR SCALE BACK ALABAMA - 12 WEEK WEIGHT LOSS PROGRAM/CONTEST. -FORMED A COUNTY-WIDE WELLNESS TASK FORCE PARTNERSHIP WITH CP-H GROUP TO SPONSOR EDUCATION SEMINARS AND "WALKTOBER." -HOSTED A 2.2 MILE WALK/RUN TO RAISE AWARENESS FOR BREAST CANCER. -TO MEET THE NEEDS OF ADOLESCENTS, HELD TLC (TOTAL LIFESTYLE CHANGES) CLASSES TO FOCUS ON EXERCISE, GOOD NUTRITION AND WORK WITH A LIFE COACH. (5) ADDRESSED ADOLESCENT HEALTH ISSUES INCLUDING TEEN SEXUALITY, SEXUALLY TRANSMITTED DISEASES, AND TEEN PREGNANCY. -THE HOSPITAL PROVIDES FUNDING FOR THE SCHOOL NURSE IN THE ALEXANDER CITY SCHOOL SYSTEM. -THE HOSPITAL'S COMMUNITY RELATIONS DEPARTMENT REVAMPED AND LAUNCHED A NEW BABY BOOT CAMP FOR EXPECTANT MOTHERS REGARDING PRENATAL CARE, THE IMPORTANCE OF FULL TERM PREGNANCY, AND BREAST FEEDING. -THE OB DEPARTMENT NOW HAS A LACTATION CONSULTANT AVAILABLE FOR ALL NEW MOTHERS. (6) CONTINUED TO EXPAND ACCESS TO MEDICAL TRANSPORTATION SERVICES FOR INDIVIDUALS WITH LIMITED RESOURCES TO TRAVEL TO HEALTH SERVICES. -RMC CONTRIBUTES A SIGNIFICANT AMOUNT OF FUNDING TO THE LOCAL ARISE PUBLIC TRANSPORTATION PROGRAM WHICH TRANSPORTS PATIENTS TO PHYSICIAN OFFICES, THE HOSPITAL AND THE DIALYSIS CENTER. RUSSELL MEDICAL CENTER PART V, SECTION B, LINE 22D: HOSPITAL CHARGES ARE DISCOUNTED 65%. PART V, SECTION B, LINE 16 FINANCIAL ASSISTANCE POLICY WEBSITE AVAILABILITY RUSSELL MEDICAL CENTER PART V, SECTION B, LINE 16A WEBSITE: WWW.RUSSELLMEDCENTER.COM 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 $ 8,159,648. PART III, LINE 3: IF PATIENTS PROPERLY COMPLETED APPICATION FORMS, TAXPAYER ESTIMATES AT LEAST 50% WOULD HAVE QUALIFIED FOR FINANCIAL ASSISTANCE. PART III, LINE 4: ALLOWANCES FOR DOUBTFUL ACCOUNTS ARE ESTIMATED BASED ON HISTORICAL WRITE-OFF PERCENTAGES AND REVIEW OF LARGE BALANCE SELF PAY ACCOUNTS, AND CONTRACTUAL ALLOWANCES ARE ESTIMATED BASED ON THE TERMS OF THIRD-PARTY INSURED CONTRACTS. DOUBTFUL ACCOUNTS ARE WRITTEN OFF AGAINST THE ALLOWANCE AFTER ADEQUATE COLLECTION EFFORT IS EXHAUSTED AND RECORDED AS RECOVERIES OF BAD DEBTS IF SUBSEQUENTLY COLLECTED. COST DETERMINED BY USING OVERALL COST TO CHARGE RATIO. PART III, LINE 9B: RUSSELL MEDICAL CENTER INFORMS AND EDUCATES PATIENTS AND PERSONS WHO MAY BE BILLED FOR PATIENT CARE ABOUT THEIR ELIGIBILITY FOR ASSISTANCE UNDER FEDERAL, STATE, OR LOCAL GOVERNMENT PROGRAMS OR THE ORGANZIATION'S CHARITY CARE POLICY IN SEVERAL DIFFERENT WAYS. EACH PATIENT BILL HAS A PRINTED STATEMENT ABOUT OUR FINANCIAL ASSISTANCE PROGRAM AND WHO THE PATIENT SHOULD CONTACT. THIS SAME PRINTED STATEMENT IS DISPLAYED IN ALL REGISTRATION AND ADMISSION AREAS THROUGHOUT RUSSELL MEDICAL CENTER, THE PROFESSIONAL OFFICE BUILDING AND THE CANCER CENTER. PATIENTS WHO PRESENT TO AN ADMISSIONS CLERK AS SELF PAY OR UNDER-INSURED ARE DIRECTED TO THE BUSINESS OFFICE FOR FINANCIAL COUNSELING. PATIENTS ARE OFFERED A CHARITY APPLICATION PACKET WHICH INSTRUCTS THEM ON THE REQUIREMENTS FOR COMPLETING THE APPLICATION PROCESS. IT IS ULTIMATELY THE PATIENT'S RESPONSIBILITY TO RETURN THE DOCUMENTATION TO THE BUSINESS OFFICE FOR ELIGIBILITY DETERMINATION. WHEN THE APPLICATION IS RETURNED, THE FINANCIAL COUNSELOR CHECKS FOR COMPLETENESS AND FORWARDS THIS TO THE SOCIAL WORKER. THE APPLICANT IS THEN SCREENED FOR ANY ADDITIONAL ASSISTANCE. IF IT IS DETERMINED THE PATIENT MAY BE ELIGIBLE FOR MEDICAID, THE SOCIAL WORKER CONTACTS THE PATIENT TO ASSIST IN THIS PROCESS. IF DETERMINATION IS MADE THAT NO OTHER ASSISTANCE IS AVAILABLE, THE APPLICATION IS RETURNED TO THE PATIENT ACCOUNTS SUPERVISOR. THE CURRENT FEDERAL POVERTY GUIDELINES ARE FOLLOWED TO DETERMINE THE AMOUNT OF CHARITY, IF ANY, THE PATIENT IS ELIGIBLE FOR. ACCOUNTS THAT TOTAL $5,000.00 AND LESS ARE SENT TO THE BUSINESS OFFICE DIRECTOR FOR APPROVAL AND ACCOUNTS GREATER THAN $5,000.00 ARE SENT TO THE CFO FOR APPROVAL. AFTER 3 MONTHS OF THE INTITIAL APPLICATION, PATIENTS MUST PROVIDE ADDITIONAL DOCUMENTATION FOR ANY NEW ACCOUNTS. PART VI, LINE 2: HEALTH FAIRS, COMMUNITY EDUCATION PROGRAMS AND A VARIETY OF HEALTH SCREENINGS ARE PROVIDED THROUGHOUT THE YEAR, AND SHORT HEALTH QUESTIONNAIRES AND INTERVIEWS ARE SECURED THROUGH THESE EVENTS. IN ADDITION, A MARKET ANALYSIS TEAM WAS DEVELOPED AS PART OF THE HOSPITAL'S STRATEGIC PLAN TO RESEARCH, ANALYZE AND TREND THE DEMOGRAPHICS AND HEALTH STATUS OF OUR PRIMARY AND SECONDARY SERVICE AREA THROUGH VARIOUS DATA BASES INCLUDING REAL TIME MEDICAL DATA. THE HOSPITAL ALSO CONSIDERS INFORMATION PROVIDED BY LOCAL PEDIATRICIANS, PRIMARY CARE PHYSICIANS, INDUSTRY HR DIRECTORS AND THE TALLAPOOSA COUNTY PUBLIC HEALTH DEPARTMENT. PART VI, LINE 3: RUSSELL MEDICAL CENTER INFORMS AND EDUCATES PATIENTS AND PERSONS WHO MAY BE BILLED FOR PATIENT CARE ABOUT THEIR ELIGIBILITY FOR ASSISTANCE UNDER FEDERAL, STATE, OR LOCAL GOVERNMENT PROGRAMS OR THE ORGANZIATION'S CHARITY CARE POLICY IN SEVERAL DIFFERENT WAYS. EACH PATIENT BILL HAS A PRINTED STATEMENT ABOUT OUR FINANCIAL ASSISTANCE PROGRAM AND WHO THE PATIENT SHOULD CONTACT. THIS SAME PRINTED STATEMENT IS DISPLAYED IN ALL REGISTRATION AND ADMISSION AREAS THROUGHOUT RUSSELL MEDICAL CENTER, THE PROFESSIONAL OFFICE BUILDING AND THE CANCER CENTER. PATIENTS WHO PRESENT TO AN ADMISSIONS CLERK AS SELF PAY OR UNDER-INSURED ARE DIRECTED TO THE BUSINESS OFFICE FOR FINANCIAL COUNSELING. PATIENTS ARE OFFERED A CHARITY APPLICATION PACKET WHICH INSTRUCTS THEM ON THE REQUIREMENTS FOR COMPLETING THE APPLICATION PROCESS. IT IS ULTIMATELY THE PATIENT'S RESPONSIBILITY TO RETURN THE DOCUMENTATION TO THE BUSINESS OFFICE FOR ELIGIBILITY DETERMINATION. WHEN THE APPLICATION IS RETURNED, THE FINANCIAL COUNSELOR CHECKS FOR COMPLETENESS AND FORWARDS THIS TO THE SOCIAL WORKER. THE APPLICANT IS THEN SCREENED FOR ANY ADDITIONAL ASSISTANCE. IF IT IS DETERMINED THE PATIENT MAY BE ELIGIBLE FOR MEDICAID, THE SOCIAL WORKER CONTACTS THE PATIENT TO ASSIST IN THIS PROCESS. IF DETERMINATION IS MADE THAT NO OTHER ASSISTANCE IS AVAILABLE, THE APPLICATION IS RETURNED TO THE PATIENT ACCOUNTS SUPERVISOR. THE CURRENT FEDERAL POVERTY GUIDELINES ARE FOLLOWED TO DETERMINE THE AMOUNT OF CHARITY, IF ANY, THE PATIENT IS ELIGIBLE FOR. ACCOUNTS THAT TOTAL $5,000.00 AND LESS ARE SENT TO THE BUSINESS OFFICE DIRECTOR FOR APPROVAL AND ACCOUNTS GREATER THAN $5,000.00 ARE SENT TO THE CFO FOR APPROVAL. AFTER 3 MONTHS OF THE INTITIAL APPLICATION, PATIENTS MUST PROVIDE ADDITIONAL DOCUMENTATION FOR ANY NEW ACCOUNTS. PART VI, LINE 4: RUSSELL MEDICAL CENTER'S SERVICE AREAS ARE DETERMINED BY PATIENT ORIGIN PATTERNS. THE PRIMARY SERVICE AREA IS DEFINED BY THE NATURAL GEOGRAPHIC BOUNDARY POSTED BY LAKE MARTIN, WHICH DIVIDES TALLAPOSSA COUNTY INTO A NORTHWEST SECTOR (INCLUDING ALEXANDER CITY) AND A SOUTHEAST SECTOR (INCLUDING DADEVILLE). THE PRIMARY SERVICE AREA CONSISTS OF ALEXANDER CITY, DADEVILLE, GOODWATER, KELLYTON AND JACKSON'S GAP. THE SECONDARY SERVICE AREA CONSISTS OF DAVISTON, EQUALITY, ROCKFORD AND CAMP HILL. OTHER AREAS NOT CONSIDERED PRIMARY OR SECONDARY BUT SUPPLYING RUSSELL MEDICAL CENTER WITH A FAIRLY SIGNIFICANT NUMBER OF PATIENTS (IN TOTAL) INCLUDE ASHLAND, LINEVILLE, ECLECTIC, WADLEY, TALLASSEE AND SYLACAUGA.DEMOGRAPHIC DATA INCLUDING RACE, GENDER AND AGE IS CAPTURED THROUGH THE REGISTRATION PROCESS. FOR 2014, CAUCASIAN, AFRICAN AMERICAN, HISPANIC AND OTHER RACES ACCOUNTED FOR 70%, 28%, LESS THAN 1% AND LESS THAN 1% RESPECTIVELY, OF THE PATIENTS SERVED WHILE 5%, 58% AND 37% WERE AGES 0-13, 14-65 AND 66+ YEARS, RESPECTIVELY. ECONOMIC DEMOGRAPHIC DATA IS NOT SPECIFICALLY CAPTURED; HOWEVER BASED ON THE LATEST MARKET SHARE DATA THE MEDICAL CENTER PROVIDED SERVICES TO 49% OF MEDICAID AND 29% OF UNINSURED/CHARITY PATIENTS IN TALLAPOOSA COUNTY AND 46% OF MEDICAID AND 23% OF UNINSURED/CHARITY PATIENTS IN COOSA COUNTY. PART VI, LINE 5: RUSSELL MEDICAL CENTER IS THE PRIMARY SOURCE OF ACUTE CARE IN OUR SERVICE AREA. THE HOSPITAL OPERATES AN OPEN MEDICAL STAFF AND ACTIVELY RECRUITS PHYSICIAN SPECIALTIES BASED ON NEED IN OUR COMMUNITY. THE HOSPITAL HAS A BOARD OF DIRECTORS COMPRISED OF COMMUNITY MEMBERS AND MEDICAL STAFF TO ENSURE WE ARE CONNECTED TO COMMUNITY NEEDS WITH THE HIGHEST QUALITY OF SERVICE. RUSSELL MEDICAL CENTER ANNUALLY PREPARES A COMMUNITY BENEFIT REPORT OUTLINING OUR NUMEROUS ACTIVITES AS WELL AS DOCUMENTS OUR FINANCIAL BENEFITS TO OUR LOCAL AREA. PART VI, LINE 6: ALL ORGANIZATIONS AFFILIATED WITH RUSSELL HOSPITAL CORPORATION ARE ORGANIZED FOR THE PURPOSE OF ENSURING THE HIGHEST QUALITY OF HEALTHCARE IN OUR SERVICE AREA. X X 1 1 X X X X 0 1 0 0 0 0 0 0 0 LUTHER E PEACE PRESIDENT/CEO 303167 0 77964 0 2322 0 126200 0 19239 0 528892 0 0 0 SARAH BETH GETTYS VP PATIENT SERVICES 207097 0 53994 0 1909 0 54206 0 10889 0 328095 0 0 0 TIM THORNTON CFO 212160 0 54468 0 2962 0 6240 0 10664 0 286494 0 0 0 KERI K BROWN MD PULMONOLOGIST 457086 0 6397 0 486 0 2400 0 6405 0 472774 0 0 0 JOHN ELGIN MD DIRECTOR - PATHOLOGY 409777 0 0 0 2322 0 0 0 8018 0 420117 0 0 0 MARY EMILY SHEFFIELD MD MEDICAL ONCOLOGIST 395502 0 55951 0 486 0 6240 0 15899 0 474078 0 0 0 ZHENHONG ZHOU PHYSICIAN 292016 0 30556 0 810 0 6240 0 16223 0 345845 0 0 0 JON W JONES MD PHYSICIAN 349845 0 0 0 2322 0 6240 0 17735 0 376142 0 0 0 JAMES W BROWN JR FORMER DIRECTOR 61791 0 0 0 0 0 0 0 4879 0 66670 0 0 0 PART I, LINE 4B LUTHER E. PEACE $120,000 SARAH BETH GETTYS $50,000 A THE SPECIAL CARE FACILITIES FINANCING AUTHORITY OF THE CITY OF ALEX CITY 631165091 014545CE5 2006-05-10 38792980 REFINANCE OUTSTANDING BONDS & CAPITAL LEASE OBLIGATIONS & PAY COST OF ISSUE 1 1 0 B THE SPECIAL CARE FACILITIES FINANCING AUTHORITY OF THE CITY OF ALEX CITY 631165091 2011-10-27 5000000 EQUIPMENT PURCHASE 0 1 0 A 38792980 2940180 579882 9603669 2008 0 1 1 1 B 5000000 5000000 2013 0 0 0 0 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 B 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 A 1 0 0 0 0 0 B 0 0 0 0 0 0 0 0 0 A 0 B 0 FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 IS PROVIDED TO THE BOARD FOR REVIEW AND IS AN AGENDA ITEM AT A REGULARLY SCHEDULED BOARD MEETING OPEN FOR ANY DISCUSSION BEFORE THE RETURN IS FILED. FORM 990, PART VI, SECTION B, LINE 12C ALL QUESTIONNAIRES COMPLETED DURING EMPLOYEE ORIENTATION ARE REVIEWED BY THE CORPORATE COMPLIANCE OFFICER. IF CONCERNS ARE IDENTIFIED, HOSPITAL ADMINISTRATION IS CONSULTED. EMPLOYEES ARE ALSO REQUIRED TO COMPLETE AN ANNUAL DISCLOSURE STATEMENT WITH THE ORGANIZATION. HOSPITAL BOARD MEMBERS ARE REQUIRED TO COMPLETE A DISCLOSURE FORM ANNUALLY. THEY ARE ASKED TO RECUSE THEMSELVES FROM ALL VOTES WHERE A CONFLICT MAY EXIST. THE BOARD, ALONG WITH HOSPITAL ADMINISTRATION, IS RESPONSIBLE FOR THE MONITORING OF EVENTS WHICH MAY GIVE RISE TO POTENTIAL CONFLICT. FORM 990, PART VI, SECTION B, LINE 15 RUSSELL MEDICAL CENTER DETERMINES APPROPRIATE COMPENSATION FOR OFFICERS AND OTHER KEY EMPLOYEES THROUGH THE USE OF AN INDEPENDENT CONSULTING GROUP WITH RESULTS AND RECOMMENDATIONS FORWARDED TO GOVERNING BOARD. FORM 990, PART VI, SECTION C, LINE 19 AS A GENERAL RULE, THE ORGANIZATION DOES NOT MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC. FORM 990, PART XI, LINE 9: MINIMUM PENSION LIABILITY -4,362,388. NONCONTROLLING INTEREST IN CENTRAL ALABAMA CANCER CARE, LLC 938,710. ROUNDING -1. FORM 990, PART XI, LINE 2C: THE ORGANIZATION MADE NO CHANGES TO ITS OVERSIGHT PROCESS OR SELECTION PROCESS DURING THE TAX YEAR. MEDICAL PARK HEALTHCARE CENTER INC PO BOX 939 ALEXANDER CITY AL 35011 630987400 MANAGEMENT OF HEALTHCARE FACILITIES AL 501(C)(3) 11A RUSSELL HOSPITAL CORPORATION 1 RUSSELL HOSPITAL FOUNDATION PO BOX 939 ALEXANDER CITY AL 35011 630987401 FUNDRAISING ACTIVITIES AL 501(C)(3) 11C MEDICAL PARK HEALTHCARE CENTER INC 0 CENTRAL ALABAMA CANCER CARE LLC PO BOX 939 ALEXANDER CITY AL 35011 453656764 CANCER TREATMENT AL RUSSELL HOSPITAL CORPORATION RELATED 3959022 3191409 0 1 0.51000 MEDICAL PARK DEVELOPMENT INC PO BOX 939 ALEXANDER CITY AL 35011 630987345 RENTAL REAL ESTATE AL MEDICAL PARK HEALTHCARE CENTER INC C 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0