2014-04-08T15:10:13-05:00 2013-07-31 481026809 Wendling Noe Nelson & Johnson LLC 534 S Kansas Ave Suite 1500 Topeka KS 666033491 990 2012-08-01 742842747 West Central Kansas Association Inc WEST 7854833131 200 S Main Russell KS 67665 Harold Courtois 7854833131 2014-04-01 1 Heather R Eichem P01515553 7852334226 2014-04-01 2012 2015-11-30 17:44:51Z Russell Regional Hospital Harold Courtois 200 S Main Russell KS 67665 12089075 0 X www.russellhospital.org X 1997 KS To provide a caring and compassionate team dedicated to the delivery of quality healthcare, and to meet the current and future healthcare needs of the community. 6 6 207 0 0 0 309911 23267 12485536 11931380 47438 45595 63379 88833 12906264 12089075 0 1000 0 0 8685376 7959138 0 0 0 4228887 4597450 12914263 12557588 -7999 -468513 3742583 4234259 3710099 4234259 32484 0 To care for our communities and their citizens with the caring, compassion, quality and commitment that validates their trust in us. 0 0 11066505 1000 12020213 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. 11066505 1 0 0 0 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 1 0 0 0 0 0 0 0 0 0 0 1 15 0 1 207 1 0 0 0 0 0 0 0 0 X 6 6 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 7854833131 200 S Main Russell KS 67665 Morris Krug 1.00 X X 0 0 0 Sylvia Newton 1.00 X X 0 0 0 John O Farmer III 1.00 X X 0 0 0 Michael Holland 1.00 X 0 0 0 Richard L Shields 1.00 X X 0 0 0 Vance Ruggels 1.00 X 0 0 0 Shelley Boden 40.00 X 98497 0 19254 Joy Bretz 40.00 X 26963 0 0 Sharon Collins 40.00 X 84487 0 14784 Kevin Kreutzer 40.00 X 0 0 0 Harold Courtois 40.00 X 0 0 0 Alexander Chung 40.00 X 319602 0 7025 Earl Merkel 40.00 X 291209 0 8713 Jill Doerfler-Iniguez 40.00 X 216498 0 8652 Sambhundh Panichabhongse 40.00 X 208200 0 7654 Curtis Sohm 40.00 X 133965 0 16476 1379421 0 82558 7 0 1 0 Dr John Whitehead 1659 Tamarisk Drive Wichita KS 67230 Physician ER & clinic coverage 170850 Docs Who Care 1337 S Fountain Drive Olathe KS 66061 Physician ER & clinic coverage 155768 Shared Medical Services Inc PO Box 330 Cottage Grove WI 53527 MRI services 138400 Aegis Therapies Inc PO Box 8103 Fort Smith AR 72902 Therapy services 112722 CPSI PO Box 850309 Mobile AL 366850309 Software and technical support 109857 8 21848 1419 23267 Net patient service revenue 900099 11931380 11931380 11931380 45595 45595 8554 0 8554 8554 8554 Cafeteria sales 722210 44204 44204 Purchase discounts 900099 20393 20393 Meals on wheels 611710 3693 3693 11989 11989 80279 12089075 12020213 0 45595 1000 1000 239231 239231 6526446 6041748 484698 61427 57411 4016 690913 643111 47802 441121 395604 45517 2845 2845 199875 6287 193588 18890 18890 143085 86919 56166 324851 259881 64970 13620 11783 1837 52169 52169 404680 323744 80936 138984 126206 12778 Pharmacy supplies 818266 818266 Physician fees 630558 630558 Purchased services 599010 553977 45033 Repairs and maintenance 537120 448054 89066 713497 590897 122600 12557588 11066505 1491083 0 604899 838783 710 708 1331781 1198556 198968 237849 121373 106165 3826771 2407239 1304388 1419532 180464 432666 3742583 4234259 1038759 1278450 1053487 840591 1617853 2115218 3710099 4234259 X 32484 0 32484 0 3742583 4234259 X -468513 436029 X 0 1 X 0 0 X 2642291 1944010 698281 1184480 463229 721251 1419532 Estimated third-party payor settlements 432666 432666 Due to lessor 2115218 2115218 X 12089075 0 12089075 0 12089075 12557588 0 12557588 0 12557588 Description of Uncertain Tax Positions Under FIN 48: 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 1 79593 96204 -16611 0.00000 824223 900777 -76554 0.00000 903816 996981 -93165 1882 0 1882 0.00010 1874261 1441946 432315 0.03440 1876143 1441946 434197 0.03450 2779959 2438927 341032 0.03450 1 416737 0 6064370 6273612 -209242 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 1 X X X X X X X X X 12 1 0 1 X X X X 1 0 1 1 70.000000000000 1 200.000000000000 1 X X X X 1 1 X X 1 0 X X X 1 X 0 0 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 total amount of the shortfall between Medicare revenue received and relating allowable costs is considered community benefit. The amounts were obtained from the cost report filed with Medicare for the period ending 07/31/2013. Russell Regional Hospital Part V, Section B, Line 3: 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, Hospice of Hays Medical Center, Russell County Economic Development/CVB, the office of Gary K. Crnic DDS, and Russell County Sheriff's Office. Russell Regional Hospital Part V, Section B, Line 20d: The Hospital utilizes a sliding scale to determine the level of financial assistance applicable for each individual. The FAP takes several factors into account such as the individuals income in comparison with published federal poverty guidelines. The patient liability is determined by reducing the gross charges of the services provided by the amount of financial assistance awarded. 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 $38,168. Approximately 13.9% 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 257573 0 61975 0 54 0 900 0 6125 0 326627 0 0 0 Earl Merkel 193138 0 98000 0 71 0 0 0 8713 0 299922 0 0 0 Jill Doerfler-Iniguez 193971 0 22500 0 27 0 3769 0 4883 0 225150 0 0 0 Sambhundh Panichabhongse 161578 0 46500 0 122 0 0 0 7654 0 215854 0 0 0 Curtis Sohm 133950 0 0 0 15 0 2960 0 13516 0 150441 0 0 0 Audrey Christian Daughter of Sharon Collins, Interim CEO 26350 Employment 0 Sarah Depiesse Daughter of Sharon Collins, Interim CEO 33469 Employment 0 Clarissa Schneider Daughter-in-law of Sharon Collins, Interim CEO 22862 Employment 0 Kelly Depiesse Son-in-law of Sharon Collins, Interim CEO 10171 Employment 0 Form 990, Part VI, Section B, line 11 The Form 990 is distributed by email to all governing body Board Members for review prior to filing the Form 990. 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. Changes in Net Assets or Fund Balances: Form 990, Part XI, line 9: Transfer from lessor 933,394. Change in amount due to lessor -497,365.