2014-11-17T10:50:02-06:00 2013-12-31 201941244 HORNE LLP 1020 HIGHLAND COLONY PKWY STE 400 RIDGELAND MS 39157 990 2013-01-01 201835779 LAIRD HOSPITAL INC LAIR 6017039992 25117 HWY 15 UNION MS 39365 DARRELL WILDMAN TREASURER 6017039992 2014-11-11 1 MARSHA H DIECKMAN CPA P00246741 6013261000 2014-10-29 2013 2015-11-30 17:44:51Z DARRELL WILDMAN 25117 HWY 15 UNION MS 39365 23052132 0 X RUSHHEALTHSYSTEMS.ORG X 2004 MS HOSPITAL AND CLINIC PATIENT SERVICE 7 7 315 9 0 0 1112780 1585239 17281905 20363671 2169 2793 1091216 1100429 19488070 23052132 455 920 0 0 7202970 9783885 0 0 0 11454836 13233067 18658261 23017872 829809 34260 9939374 13689068 7278455 10993889 2660919 2695179 X HOSPITAL AND CLINIC PATIENT SERVICE 0 0 16222770 920 21325688 LAIRD HOSPITAL IS A 25-BED ACUTE-CARE, CRITICAL ACCESS HOSPITAL LOCATED IN UNION, MS. UNION, MS IS LOCATED IN NEWTON COUNTY, MS. UNION HAS A POPULATION OF 1,988 AND NEWTON COUNTY HAS A POPULATION OF 21,720. LAIRD HOSPITAL'S SCOPE OF CARE INCLUDES A RANGE OF INPATIENT, OUTPATIENT AND EMERGENCY SERVICES. A VARIETY OF OTHER SERVICES ARE AVAILABLE ON AN INPATIENT AND OUTPATIENT BASIS THROUGH THE HOSPITAL'S IMAGING, LABORATORY AND REHABILITATIVE SERVICES, INCLUDING PHYSICAL, OCCUPATIONAL AND SPEECH THERAPY. A 24-HOUR EMERGENCY DEPARTMENT IS STAFFED WITH QUALIFIED EMERGENCY ROOM HOSPITALISTS AND FAMILY NURSE PRACTITIONERS AND IS OPEN 24 HOURS A DAY, SEVEN DAYS A WEEK. SKILLED NURSING AND REHABILITATIVE CARE ARE AVAILABLE AT LAIRD HOSPITAL THROUGH THE SWING BED PROGRAM. THOSE RECOVERING FROM SURGERY, A STROKE, A FRACTURE OR AN EXTENDED MEDICAL ILLNESS AND HOSPITALIZATION CAN RECEIVE REHABILITATIVE CARE AT LAIRD HOSPITAL, WHETHER OR NOT THEY WERE HOSPITALIZED IN ANOTHER LOCATION. LAIRD HOSPITAL IS AFFILIATED WITH RUSH HEALTH SYSTEMS OF MERIDIAN, MS. ADDITIONALLY, THE SLEEP DISORDERS PROGRAM OPERATED LAIRD HOSPITAL PROVIDES A VALUABLE SERVICE FOR DIAGNOSIS AND TREATMENT OF CHRONIC SLEEP-RELATED DISORDERS AND THE INTENSIVE OUTPATIENT PROGRAM DESIGNED TO PROVIDE CARE FOR SENIOR ADULTS SUFFERING FROM CHRONIC ANXIETY, DEPRESSION AND GRIEF.AS PRESENTED IN THE ATTACHED SCHEDULE H, LAIRD HOSPITAL PROVIDED FINANCIAL ASSISTANCE AND CERTAIN OTHER COMMUNITY BENEFITS DURING 2013 AT A COST OF $912,479. ALTHOUGH EQUITABLE PAYMENT FOR SERVICES IS ESSENTIAL TO THE ORGANIZATION'S FINANCIAL VIABILITY, LAIRD HOSPITAL RECOGNIZES THAT NOT ALL INDIVIDUALS POSSESS THE RESOURCES REQUIRED TO REIMBURSE THE HOSPITAL FOR ALL SERVICES PROVIDED. KEEPING ITS COMMITMENT TO THE COMMUNITY, LAIRD HOSPITAL PROVIDES FREE CARE AND SUBSIDIZED CARE WITHIN EXISTING RESOURCES WHERE THE NEED FOR SUCH CARE EXISTS. ALONG WITH BEING THE ONE OF THE COUNTY'S LARGEST EMPLOYERS AND A MAJOR ECONOMIC STIMULUS BY VIRTUE OF ITS PAYROLL, LAIRD HOSPITAL ALSO PROVIDES MANY BENEFITS TO THE BROADER COMMUNITY IN THE AREAS OF CIVIC INVOLVEMENT AND GIVING INCLUDING ACTIVELY SUPPORTING THE AMERICAN CANCER SOCIETY, SUPPORTING THE COMMUNITY WITH IT'S ANNUAL COUNTRY DAY PROGRAM, CONDUCTING AND ATTENDING COMMUNITY HEALTH FAIRS AND PROVIDING FREE MEDICAL SCREENING TESTS AND DISSEMINATION OF HEALTH INFORMATION AT CIVIC CLUB MEETINGS AND OTHER COMMUNITY FUNCTIONS. 16222770 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 41 0 1 315 1 0 0 0 0 0 0 0 0 0 0 X 7 7 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 MS X DARRELL WILDMAN 6017039992 1314 19TH AVENUE MERIDIAN MS 39301 RITA G JACKSON BOARD MEMBER 1.00 0.00 X 0 0 0 SUSAN EZELLE BOARD MEMBER 1.00 0.00 X 0 0 0 PJ HENRY BOARD MEMBER 1.00 0.00 X 0 0 0 DR PHIL SUTPHIN BOARD MEMBER 1.00 0.00 X 0 0 0 MICHAEL MCINNIS BOARD MEMBER 1.00 0.00 X 0 0 0 LARRY W DRISKELL BOARD MEMBER 1.00 0.00 X 0 0 0 LILA BRISENO BOARD MEMBER 1.00 0.00 X 0 0 0 CHUCK REECE PRESIDENT 3.00 57.00 X 0 595908 113748 RICK BARRY SECRETARY 1.00 13.00 X 0 0 0 CATHY ROBINSON CORPORATE COMPLIANCE OFFIC 3.00 46.00 X 0 210493 19422 DARRELL WILDMAN TREASURER 1.00 59.00 X 0 349531 35145 DALE ARMOUR CFO 1.00 48.00 X 0 276303 11636 TOMMY BARTLETT ADMINISTRATOR 40.00 0.00 X 0 134351 10605 JOHN CHARLES MUTZIGER MD PHYSICIAN 40.00 0.00 X 268167 0 12820 RUSSELL E BELENCHIA PHYSICIAN 40.00 0.00 X 213627 0 13385 WANDA D PRICE DIRECTOR 40.00 0.00 X 108834 0 14222 EDWARD D HENDERSON PHYSICIAN 40.00 0.00 X 99885 79527 9418 MARY E SPREAFICO NURSE PRACTITIONER 40.00 0.00 X 106463 0 15866 796976 1646113 256267 6 0 1 0 UNION SECURITY & INVESTIGATIONS PO BOX 112 UNION MS 39365 SECURITY SERVICES 569400 EMCARE INC 1032 COLLECTION CENTER DRIVE CHICAGO IL 60693 ER PHYSICIAN SERVICES 444675 INTEGRITY HEALTH SERVICES LLC 8348 HIGHWAY 21 SHUQUALAK MS 39361 IOP CONSULTANT SERVICES 220200 ALLIANCE HEALTHCARE SERVICES PO BOX 96485 CHICAGO IL 60693 MRI SERVICE 207270 MEDWORKS OF MISSISSIPPI LLC PO BOX 59368 BIRMINGHAM AL 352599368 IMAGING SERVICES 200055 6 1558689 26550 1585239 PATIENT FEES 621990 20363671 20363671 20363671 2793 2793 138412 0 138412 138412 138412 CAFETERIA 722210 497850 497850 MISCELLANEOUS 900099 464167 464167 962017 23052132 21325688 0 141205 920 920 8127827 8016366 111461 74492 74387 105 1023670 1011147 12523 557896 555682 2214 2293757 2293757 15500 15500 989760 989760 5581 703 4878 4197625 4197625 76917 71602 5315 1019 70 949 82916 82916 251864 251864 196050 196050 CONTRACT SERVICES 2298227 2211831 86396 SUPPLIES 740346 733208 7138 FOOD EXPENSE 638259 620095 18164 TAXES AND LICENSES 439601 439141 460 1005645 967028 38617 23017872 16222770 6795102 0 56260 200752 3889325 4270165 106080 198600 98847 50443 1973270 1029406 985283 943864 4803579 8025244 9939374 13689068 1386288 2005967 488560 5892167 8499362 7278455 10993889 X 0 0 0 0 2660919 2695179 2660919 2695179 9939374 13689068 34260 0 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 1143 1143 0 PART II-B, LINE 1: LAIRD PAYS DUES TO MISSISSIPPI HOSPITAL ASSOCIATION TOTALING $9,839, OF WHICH 11.62% ($1,143) IS ATTRIBUTABLE TO LOBBYING. 1185532 474317 711215 112600 45944 66656 675138 509145 165993 943864 OTHER ASSETS/INTANGIBLES 1644890 RELATED PARTY RECEIVABLES 6380354 8025244 RELATED PARTY PAYABLES 8499362 8499362 X PART X, LINE 2: RUSH HEALTH SYSTEMS, INC. AND THE AFFILIATES ARE NOT-FOR-PROFIT CORPORATIONS AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND ARE EXEMPT FROM FEDERAL INCOME TAXES ON THEIR INCOME UNDER SECTION 501(A) OF THE INTERNAL REVENUE CODE. THE SUBSIDIARIES, HOWEVER, ARE TAXABLE CORPORATIONS AND FILE CORPORATE INCOME TAX RETURNS. THE HEALTH SYSTEM FOLLOWS THE GUIDANCE FOR ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES RECOGNIZED IN THE HEALTH SYSTEM'S CONSOLIDATED FINANCIAL STATEMENTS THAT PRESCRIBES A RECOGNITION THRESHOLD OF MORE-LIKELY-THAN-NOT TO BE SUSTAINED UPON EXAMINATION BY THE APPROPRIATE TAXING AUTHORITY. MEASUREMENT OF THE TAX UNCERTAINTY OCCURS IF THE RECOGNITION THRESHOLD HAS BEEN MET. THE GUIDANCE ALSO ADDRESSES DERECOGNITION, CLASSIFICATION, INTEREST AND PENALTIES, ACCOUNTING IN INTERIM PERIODS, AND DISCLOSURE. MANAGEMENT HAS DETERMINED THAT THIS GUIDANCE HAD NO MATERIAL EFFECT ON THE CONSOLIDATED FINANCIAL STATEMENTS. THE HEALTH SYSTEM'S POLICY IS TO RECOGNIZE INTEREST RELATED TO UNRECOGNIZED TAX BENEFITS IN INTEREST EXPENSE AND PENALTIES IN GENERAL AND ADMINISTRATIVE EXPENSES. THERE WERE NO INTEREST OR PENALTIES RECOGNIZED ON THE CONSOLIDATED STATEMENTS OF OPERATIONS AND CHANGES IN NET ASSETS AS A RESULT OF THIS GUIDANCE. GENERALLY, TAX RETURNS FOR YEARS ENDED DECEMBER 31, 2010, AND THEREAFTER REMAIN SUBJECT TO EXAMINATION BY FEDERAL AND STATE TAX AUTHORITIES. DEFERRED TAXES ARE PROVIDED ON A LIABILITY METHOD WHEREBY DEFERRED TAX ASSETS ARE RECOGNIZED FOR DEDUCTIBLE TEMPORARY DIFFERENCES AND OPERATING LOSS AND TAX CREDIT CARRYFORWARDS AND DEFERRED TAX LIABILITIES ARE RECOGNIZED FOR TAXABLE TEMPORARY DIFFERENCES. TEMPORARY DIFFERENCES ARE THE DIFFERENCES BETWEEN THE REPORTED AMOUNTS OF ASSETS AND LIABILITIES AND THEIR TAX BASES. THE SUBSIDIARIES' TEMPORARY DIFFERENCES RELATE PRIMARILY TO PROPERTY AND EQUIPMENT AND NET OPERATING LOSS CARRYFORWARDS. DEFERRED TAX ASSETS ARE REDUCED BY A VALUATION ALLOWANCE WHEN, IN THE OPINION OF MANAGEMENT, IT IS MORE-LIKELY-THAN-NOT THAT SOME PORTION OR ALL OF THE DEFERRED TAX ASSETS WILL NOT BE REALIZED. DEFERRED TAX ASSETS AND LIABILITIES ARE ADJUSTED FOR THE EFFECTS OF CHANGES IN TAX LAWS AND RATES ON THE DATE OF ENACTMENT. 1 1 1 X 1 X 1 1 1 0 0 1400298 1642666 -242368 0.00000 1925405 930226 995179 0.04400 112856 89498 23358 0.00100 3438559 2662390 776169 0.04500 45747 45747 0.00200 1568349 1478864 89485 0.00400 1078 1078 0.00000 1615174 1478864 136310 0.00600 5053733 4141254 912479 0.05100 1138 1138 0.00010 262 262 0.00000 7591 7591 0.00030 8991 8991 0.00040 1 404610 0 10891036 10692399 198637 X 1 1 1 1 LAIRD HOSPITAL 25117 HWY 15 UNION MS 39365 X X X LAIRD HOSPITAL 1 1 X X X X X X X X X 13 1 0 1 X HTTP://WWW.LAIRDHOSPITAL.COM X X X 1 0 1 1 150.000000000000 1 200.000000000000 1 X X X X 1 1 X 1 0 X 1 X 0 0 LAIRD HOSPITAL PART V, SECTION B, LINE 3: THE ASSESSMENT EMPLOYED A MULTI-METHOD APPROACH THAT INCLUDED A REVIEW OF EXISTING FEDERAL AND STATE DATA (SECONDARY DATA ANALYSIS) PAIRED WITH NEWLY GATHERED DATA FROMTHE COMMUNITY (PRIMARY DATA ANALYSIS). THE INITIAL STEP IN THIS PROCESS WAS TO CONDUCT "KEY INFORMANT" INTERVIEWS. KEY INFORMANTS ARE INDIVIDUALS WHO ARE HEAVILY INVOLVED WITH AND KNOWLEDGEABLE ABOUT THE COMMUNITY OF FOCUS. THIS INCLUDES COMMUNITY LEADERS IN THE PUBLIC AND PRIVATE SECTOR, AS WELL AS INDIVIDUALS WITH SPECIAL EXPERTISE IN HEALTHCARE. INFORMATION GATHERED THROUGH THESE INTERVIEWS, PAIRED WITH PUBLIC HEALTH INFORMATION, VITAL STATISTICS, AND ECONOMIC DATA PROVIDE A VERY GOOD SNAPSHOT OF THE COMMUNITY'S NEEDS. TO FURTHER AUGMENT OUR UNDERSTANDING OF THE NEEDS OF THE UNDERSERVED, A FOCUS GROUP WAS HELD FOR THE SPECIFIC PURPOSE OF GATHERING IDEAS ABOUT HOW TO BETTER SERVE THOSE WITH THE GREATEST HEALTH RISK: LOW-INCOME, ELDERLY, MINORITY, DISABLED, AND CHILDREN/YOUTH POPULATIONS. THE RESULTS OF THE INTERVIEWS AND FOCUS GROUP WERE COMPARED AND CROSS VALIDATED AGAINST THE EXISTING SECONDARY DATA. COMMUNITY HEALTH NEEDS WERE THEN PRIORITIZED ACCORDING TO DEGREE OF OVERLAP, SEVERITY, AND RESOURCES.KEY INFORMANT INTERVIEWS:EACH INTERVIEW WAS STRUCTURED SIMILARLY, AND AVERAGED 60 MINUTES. QUESTIONS WERE OPEN-ENDED, AND DESIGNED TO CAPTURE THE INFORMANT'S PERCEPTION AND RANKING OF THE MOST CRITICAL HEALTH CHALLENGES FACING THE COMMUNITY. TO FURTHER BENEFIT FROM THE KNOWLEDGE AND EXPERTISE OF THE INTERVIEWEES (SEVERAL OF WHOM HAVE EXPERTISE IN PUBLIC HEALTH), WE ASKED FOR THEIR THOUGHTS AND OPINIONS ABOUT THE ROOT CAUSES OF HEALTH PROBLEMS, POTENTIAL SOLUTIONS TO THESE PROBLEMS, AND BARRIERS TO ACHIEVING SUCCESS IN IMPLEMENTING PROGRAMS TO ADDRESS AREAS OF NEED. CAREFUL NOTES WERE TAKEN DURING THE INTERVIEWS AND SUBSEQUENTLY, THESE NOTES WERE TRANSCRIBED, THEMATICALLY CATEGORIZED, AND SUMMARIZED.FOCUS GROUP:TO EXTEND THE BASE OF KNOWLEDGE GLEANED FROM KEY INFORMANT INTERVIEWS, A COMMUNITY FOCUSGROUP WAS HELD ON THE CAMPUS OF LAIRD HOSPITAL ON JUNE 11, 2013. PARTICIPANTS WERE RECRUITED BY AN OPEN ANNOUNCEMENT OF A "COMMUNITY MEETING" ADVERTISEMENT PLACED IN THE LOCAL NEWSPAPER.THE FOCUS GROUP WAS INTRODUCED TO THE FACILITATOR, WHO EXPLAINED THAT THE GOAL OF THE PROJECT WAS TO IDENTIFY AND PRIORITIZE LOCAL COMMUNITY HEALTHCARE NEEDS AND THAT THE FOCUS GROUP WAS STRUCTURED TO PROVIDE KEY INFORMATION TO AUGMENT THE SURVEY AND ARCHIVAL DATA PERTAINING TO THE HEALTH STATUS OF THE COMMUNITY.SPECIFICALLY, THE FOCUS GROUP WAS ASKED TO CONSIDER:1. STRENGTHS AND WEAKNESSES OF THE COMMUNITY AND ITS HEALTHCARE SYSTEM;2. MAJOR HEALTH ISSUES OF THE COMMUNITY, WITH SPECIAL ATTENTION TO CHILDREN, ELDERLY, LOWINCOME, AND MINORITY GROUPS3. RECOMMENDATIONS AND/OR PRIORITIES LAIRD HOSPITAL PART V, SECTION B, LINE 11: LAIRD HOSPITAL UTILIZES FOUR LEVELS FOR DETERMINING DISCOUNTS -1- HIGH INCOME AND/OR HIGH NET WORTH2- MODERATE INCOME AND/OR MODERATE NET WORTH3- LOW INCOME AND/OR LOW NET WORTH4- NO INCOME AND/OR NO NET WORTH LAIRD HOSPITAL PART V, SECTION B, LINE 20D: BILLED % OF CHARGES 150% FPG_____________________________________0% UP TO 50% 25% 50% TO 66%50% 66% TO 83%75% 83% TO 100% 5 DECATUR MEDICAL CLINIC 14884 HWY 15 DECATUR MS 39327 MEDICAL CLINIC FAMILY MEDICAL GROUP OF UNION 14345 HWY 15 UNION MS 39365 MEDICAL CLINIC RUSH MEDICAL CLINIC OF PHILADELPHIA 1106 CENTRAL DRIVE PHILADELPHIA MS 39350 MEDICAL CLINIC RUSH MEDICAL GROUP COLLINSVILLE 9097 COLLINSVILLE ROAD COLLINSVILLE MS 39325 MEDICAL CLINIC NEWTON FAMILY MEDICAL ASSOCIATES 252 NORTHSIDE DRIVE NEWTON MS 39345 MEDICAL CLINIC PART I, LINE 7: COSTING METHODOLOGY USED IN THE TABLE ON LINE 7 IS THE RATIO OF PATIENT CARE COST TO CHARGES DERIVED FROM WORKSHEET 2. 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 $ 404,610. PART II, COMMUNITY BUILDING ACTIVITIES: ALL ACTIVITIES ENGAGED IN BY LAIRD HOSPITAL ARE GEARED TOWARD PROMOTION AND IMPROVEMENT OF THE WELLBEING OF THE CITIZENS OF OUR PRIMARY SERVICE AREA. LAIRD PROMOTES HEALTH EDUCATION THROUGH SUPPORT OF ITS COMMUNITY BASED NURSING AND ALLIED HEALTH PROGRAMS AS WELL AS COMMUNITY HEALTH EDUCATION AND TRAINING SESSIONS. LAIRD ALSO SUPPORTS THE COMMUNITY BY ENSURING THE PROVISION OF MUCH NEEDED EMERGENCY MEDICINE. PART III, LINE 4: BAD DEBT EXPENSE IS REFLECTED AS AMOUNT OF CHARGES ACTUALLY WRITTEN OFF. PER NOTE 1 OF THE FINANCIAL STATEMENTS, PATIENT ACCOUNTS RECEIVABLE ARE REPORTED AT ESTIMATED NET REALIZABLE VALUE AFTER DEDUCTION OF ALLOWANCES FOR DOUBTFUL ACCOUNTS. THE ALLOWANCE FOR DOUBTFUL ACCOUNTS IS BASED ON HISTORICAL LOSSES AND AN ANALYSIS OF CURRENTLY OUTSTANDING AMOUNTS. THIS ACCOUNT IS GENERALLY INCREASED BY CHARGES TO A PROVISION FOR BAD DEBTS AND DECREASED BY WRITE OFFS OF ACCOUNTS DETERMINED BY MANAGEMENT TO BE UNCOLLECTIBLE. THE HEALTH SYSTEM ENGAGED A FIRM TO ANALYZE PATIENT ACCOUNTS RECEIVABLE TO DETERMINE WHICH ACCOUNTS QUALIFIED AS CHARITY CARE IN ORDER THAT THEY WERE PROPERLY CLASSIFIED. PART III, LINE 9B: THE HOSPITAL PROVIDES CARE TO PATIENTS WHO MEET CERTAIN CRITERIA UNDER ITS CHARITY CARE POLICY WITHOUT CHARGE OR AT AMOUNTS LESS THAT ITS ESTABLISHED RATES. BECAUSE THE HOSPITAL DOES NOT PURSUE COLLECTION OF AMOUNTS DETERMINED TO QUALIFY AS CHARITY CARE, THEY ARE NOT REPORTED AS REVENUE. ADDITIONALLY, THE HOSPITAL MAY UTILIZE OUTSIDE AGENCIES AS APPROPRIATE TO ASSIST IN DETERMINING ACCOUNTS THAT QUALIFY AS CHARITY CARE. ANY ACCOUNTS DETERMINED TO BE CHARITY BASED ON AN AGENCY'S RECOMMENDATION ARE REPORTED AS CHARITY CARE AND REVENUE REDUCED BY THIS AMOUNT AS OPPOSED TO BEING REPORTED AS BAD DEBT EXPENSE. PART VI, LINE 2: OUTSIDE CONSULTANTS ARE HIRED TO CONDUCT A COMMUNITY NEEDS ASSESSMENT PERIODICALLY.THE CHNA CAN BE ACCESSED ON THE HOSPITAL'S WEBSITE AT: HTTP://WWW.LAIRDHOSPITAL.COM/LH/INDEX.CFM/LINKSERVID/11BCDE33-155D-0204-931AF4AB2D667CB7/SHOWMETA/0/ PART VI, LINE 3: PATIENTS ARE PROVIDED AN APPLICATION FOR CHARITY CARE AND A CRITERIA FOR CHARITY CARE CHECKLIST AS CLOSE TO POINT OF SERVICE AS POSSIBLE. ADDITIONALLY, THE HOSPITAL UTILIZES AN OUTSIDE ELIGIBILITY COMPANY THAT REVIEWS ALL NO INSURANCE PATIENTS FOR POTENTIAL QUALIFICATION FOR OTHER GOVERNMENTAL PROGRAMS SUCH AS MEDICAID. PART VI, LINE 4: LAIRD HOSPITAL IS A CRITICAL ACCESS ACUTE-CARE MEDICAL CENTER THAT SERVES INPATIENTS AND OUTPATIENTS, PRIMARILY IN THE UNION, MISSISSIPPI AREA. AS A CRITICAL ACCESS HOSPITAL, LAIRD TRANSFERS THE EMERGENT AND MORE COMPLICATED CASES THAT REQUIRE SPECIALISTS PRIMARILY TO THE LARGER ACUTE CARE HOSPITALS IN THE MERIDIAN, MS AREA. OF THE COUNTIES SERVED, THE FOLLOWING ARE COUNTIES IDENTIFIED BY HEALTH RESOURCES AND SERVICES ADMINISTRATION OF THE US DEPT OF HEALTH AND HUMAN SERVICES AS HEALTH PROFESSIONAL SHORTAGE AREAS: CHOCTAW AND SUMTER COUNTIES IN ALABAMA; CLARKE, KEMPER, LAUDERDALE, NESHOBA, NEWTON AND SCOTT COUNTIES IN MISSISSIPPI.ADDITIONAL INFORMATION ON THE COMMUNITY SERVED CAN BE FOUND IN THE CHNA. THE CHNA CAN BE ACCESSED ON THE HOSPITAL'S WEBSITE AT: HTTP://WWW.LAIRDHOSPITAL.COM/LH/INDEX.CFM/LINKSERVID/11BCDE33-155D-0204-931AF4AB2D667CB7/SHOWMETA/0/ PART VI, LINE 5: ALL MEMBERS OF LAIRD HOSPITAL'S BOARD RESIDE IN LAIRD'S PRIMARY SERVICE AREA. THE ORGANIZATION HAS AN OPEN MEDICAL STAFF EXTENDING PRIVILEGES TO ALL QUALIFIED PHYSICIANS AND NON-PHYSICIAN PRACTITIONERS THAT APPLY FOR PRIVILEGES AND MEET ALL REQUIREMENTS OF CREDENTIALING AND THE MEDICAL STAFF RULES AND REGS AND BY-LAWS. THE FACILITY UTILIZES SURPLUS FUNDS FOR ADDITIONAL MEDICAL TECHNOLOGY, RECRUITMENT OF MEDICAL STAFF THAT IS OTHERWISE UNAVAILABLE (I.E. NEUROSURGERY, MIDWIFERY, ETC.), FUNDING OF LOCAL AREA HEALTHCARE WORKFORCE TRAINING AND ECONOMIC DEVELOPMENT. PART VI, LINE 6: LAIRD HOSPITAL IS WHOLLY OWNED BY RUSH HEALTH SYSTEMS, A NON-PROFIT ORGANIZATION. WITHIN RUSH HEALTH SYSTEMS ARE THE SPECIALTY HOSPITAL OF MERIDIAN (A LONG TERM ACUTE CARE FACILITY), LAIRD HOSPITAL (A CRITICAL ACCESS HOSPITAL, HC WATKINS HOSPITAL (A CRITICAL ACCESS HOSPITAL), SCOTT HOSPITAL (A CRITICAL ACCESS HOSPITAL), MEDICAL FOUNDATION INC. (A CLINIC ORGANIZATION), AND RUSH MEDICAL GROUP (A CLINIC ORGANIZATION). EACH OF THESE ENTITES COORDINATE TO IMPROVE THE HEALTHCARE OF EAST MISSISSIPPI AND WEST ALABAMA. CLINICAL INTEGRATION BETWEEN OUTLYING CRITICAL ACCESS HOSPITALS, SPECIALIST PHYSICIANS AND THE GENERAL ACUTE CARE HOSPITAL PROVIDE FOR IMPROVED ACCESS AND IMPROVED OUTCOMES FOR THE POPULATION WE SERVE. X X X X X X 0 1 0 0 0 0 0 0 0 CHUCK REECE PRESIDENT 0 305863 0 284395 0 5650 0 50850 0 62898 0 709656 0 0 CATHY ROBINSON CORPORATE COMPLIANCE OFFIC 0 143936 0 60917 0 5640 0 4609 0 14813 0 229915 0 0 DARRELL WILDMAN TREASURER 0 221226 0 122760 0 5545 0 0 0 35145 0 384676 0 0 DALE ARMOUR CFO 0 182503 0 74000 0 19800 0 0 0 11636 0 287939 0 0 JOHN CHARLES MUTZIGER MD PHYSICIAN 268167 0 0 0 0 0 1585 0 11235 0 280987 0 0 0 RUSSELL E BELENCHIA PHYSICIAN 213627 0 0 0 0 0 0 0 13385 0 227012 0 0 0 EDWARD D HENDERSON PHYSICIAN 99885 79527 0 0 0 0 0 0 9418 0 109303 79527 0 0 PART I, LINE 4B RUSH HEALTH SYSTEMS (SOLE MEMBER OF THE ORGANIZATION) PROVIDES A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN UNDER SECTION 457(F). THERE WERE NO CONTRIBUTIONS OR DISTRIBUTIONS DURING 2013. FORM 990, PART VI, SECTION A, LINE 6 RUSH HEALTH SYSTEMS, INC. IS THE PARENT ORGANIZATION AND SOLE MEMBER OF THIS ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 7A THE BOARD OF RUSH HEALTH SYSTEMS, INC. (SOLE MEMBER OF ORGANIZATION) APPOINTS BOARD MEMBERS FOR THE ORGANIZATION ANNUALLY FOR A ONE YEAR TERM. FORM 990, PART VI, SECTION A, LINE 7B THE BOARD OF RUSH HEALTH SYSTEMS, INC. (SOLE MEMBER OF ORGANIZATION) APPROVES AND RATIFIES THE ACTIONS OF THE ORGANIZATION'S BOARD. FORM 990, PART VI, SECTION B, LINE 11 THE BOARD OF RUSH HEALTH SYSTEMS, INC. (SOLE MEMBER OF THE ORGANIZATION) REVIEWED AND APPROVED THE FORM 990 PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION HAS A CONFLICT OF INTEREST POLICY. THE OFFICERS AND DIRECTORS OF THE ORGANIZATION REVIEW THE POLICY ANNUALLY AND SIGN A CONFLICT OF INTEREST STATEMENT STATING THEY HAVE READ AND UNDERSTAND THE POLICY AND ARE IN COMPLIANCE. EDUCATION IS GIVEN TO THE STAFF ON THE CONFLICT OF INTEREST POLICY WHICH INCLUDES DIRECTION TO VOICE ANY QUESTIONS OR CONCERNS THEY HAVE AND TO BRING FORTH ANY POTENTIAL CONFLICT OR CONCERN TO THE ATTENTION OF THE CORPORATE COMPLIANCE OFFICER. FORM 990, PART VI, SECTION B, LINE 15 EXECUTIVE COMPENSATION FOR THE AFFILIATED GROUP OF RUSH HEALTH SYSTEMS (SOLE MEMBER OF THE ORGANIZATION) IS REVIEWED ANNUALLY BY INDEPENDENT CONSULTANTS. CONSULTANTS COMPARE COMPENSATION ORDINARILY PROVIDED BY SIMILAR ORGANIZATIONS, UNDER LIKE CIRCUMSTANCES, AND ADJUSTED TO REFLECT CURRENT MARKET RATES. CONSULTANTS MEET WITH THE COMPENSATION COMMITTEE AND MAKE RECOMMENDATIONS WHICH ARE APPROVED AND RATIFIED BY THE BOARD. THE INDEPENDENT CONSULTANTS REGULARLY CONTRACTED TO PERFORM SUCH REVIEWS ARE HORNE LLP AND SULLIVAN, COTTER & ASSOCIATES, INC. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE FOR PUBLIC INSPECTION UPON REQUEST. PART XII, LINE 2C THE AUDIT/COMPENSATION COMMITTEE OF RUSH HEALTH SYSTEMS OVERSEES RESPONSIBILITY FOR THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS OF THE ORGANIZATION. THIS PROCESS HAS NOT CHANGED FROM PRIOR YEAR. 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