2017-11-14T14:17:33-06:00 2016-12-31 454084437 Warren Averett LLC 2500 Acton Road Birmingham AL 35243 990 2016-01-01 630385130 RUSSELL HOSPITAL CORPORATION RUSS 2053297100 PO BOX 939 ALEXANDER CITY AL 35011 j matthew fisher CFO 2053297100 2017-10-13 1 JC Rouse P00081132 2059794100 2017-10-13 209.136.244.2 2017-10-13 08:38:40 CD P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 A75DF0C5F4A7A53254A3A5B1B1E369A3E01D1EAC 2016 2017-02-10 21:41:12Z JIM PEACE PO BOX 939 ALEXANDER CITY AL 35011 85740862 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 10 745 85 0 0 17127 7795 72697697 81061336 632664 2193695 1335682 1440730 74683170 84703556 0 0 0 0 31448806 33316374 0 0 0 43138489 49755960 74587295 83072334 95875 1631222 79493918 83829717 51754475 55962933 27739443 27866784 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 1567910 3776946 THE ADULT MEDICAL SURGICAL UNIT AT RUSSELL MEDICAL CENTER (RMC) PROVIDES MEDICAL CARE TO A WIDE RANGE OF DIAGNOSES AND PATIENTS RECOVERING FROM SURGERY. MEDICAL SURGICAL SERVICES ARE AVAILABLE TWENTY-FOUR HOURS PER DAY AND IS ALWAYS AVAILABLE TO SERVE THE PATIENTS OF RMC. DURING 2016, THE MEDICAL SURGICAL UNIT PROVIDED CARE FOR 5,438 PATIENT DAYS AND 7,899 EQUIVALENT PATIENT DAYS. 2557222 18340187 THE LABORATORY DEPARTMENT AT RUSSELL MEDICAL CENTER (RMC) PROVIDES A FULL SERVICE MEDICAL LABORATORY FOR HOSPITAL INPATIENTS, OUTPATIENTS, EMERGENCY PATIENTS, AND CLINIC PATIENTS. LABORATORY SERVICES ARE AVAILABLE TWENTY-FOUR HOURS PER DAY AND THE LAB IS ALWAYS AVAILABLE TO SERVE THE PATIENTS OF RMC. DURING 2016, THE LABORATORY COMPLETED 75,573 INPATIENT TESTS AND 187,379 OUTPATIENT TESTS FOR A TOTAL TEST VOLUME OF 262,952. 2135817 12492313 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 2016, THE PHARMACY DEPARTMENT FILLED 215,391 INPATIENT DRUG ORDERS AND 134,998 OUTPATIENT DRUG ORDERS FOR A TOTAL OF 350,389 DRUG ORDERS FILLED. 76811385 48040017 76811385 48040017 83072334 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 1 107 0 1 745 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 0.00 X 0 0 0 HUgh Neighbors III VICE CHAIRMAN 5.00 0.00 X 0 0 0 SCOTT HOWELL SECRETARY/TREASURER 5.00 0.00 X 0 0 0 LoTHER E PEACE PRESIDENT/CEO 40.00 5.00 X X 386567 0 138401 JAMES W BROWN JR dIRECTOR (Emeritus) 5.00 0.00 X 61791 0 0 BEN RUSSELL DIRECTOR 5.00 0.00 X 0 0 0 RALPH FROSHIN DIRECTOR 5.00 0.00 X 0 0 0 THOMAS RADNEY DIRECTOR 5.00 0.00 X 18460 0 0 RANDY HAYNES DIRECTOR 5.00 0.00 X 0 0 0 Arnold Tauro MD DIRECTOR 5.00 0.00 X 0 0 0 TONY MCLEOD MD DIRECTOR 5.00 0.00 X 0 0 0 paul r GOLDHAGEN MD DIRECTOR 5.00 0.00 X 0 0 0 J Matthew Fisher CFO 40.00 5.00 X 183440 0 10911 SARAH BETH GETTYS VP PATIENT SERVICES 40.00 5.00 X 267165 0 62856 TIM THORNTON CFO 40.00 5.00 X 129891 0 2212 brian dix md Physician - OB/GYN 40.00 0.00 X 434292 0 15441 MARY EMILY SHEFFIELD MD Physician - MEDICAL ONCOLOGY 40.00 0.00 X 424998 0 18561 JOHN N ELGIN MD DIRECTOR - PATHOLOGY 40.00 0.00 X 411956 0 4672 keri k brown md Physician - PULMONOLOGIST 40.00 0.00 X 406284 0 14978 JON W JONES MD PHYSICIAN - Surgical Services 40.00 0.00 X 406107 0 18561 3130951 0 286593 34 0 1 0 HOSPITAL MEDICINE ASSOCIATES INC PO BOX 634850 CINCINNATI OH 452634850 physician services 1147739 diversified clinical services INC 28525 NETWORK PLACE CHICAGO IL 606731285 wound care services 708778 anesthesia services of birmingham pc 2151 old rocky ridge road ste 106 BIRMINGHAM AL 35216 anesthesia services 540000 UAHSF - UAB Dept of Urology 1720 2nd Ave South FOT 1120 Birmingham AL 352940113 physician services 463891 LABORATORY CORPORATION OF AMERICA PO BOX 12140 BURLINGTON NC 272162140 LAB SERVICES 403620 42 7795 7795 PATIENT REVENUE 900099 81061336 81061336 81061336 482184 482184 887597 1034994 -147397 -147397 -147397 1713523 300 0 2312 1713523 -2012 1711511 1711511 MISCELLANEOUS INCOME 900099 595463 595463 CAFETERIA INCOME 900099 591127 591127 DRUG SALES 900099 137610 137610 263927 263927 1588127 84703556 82649463 0 2046298 985523 985523 24126675 24126675 1996658 1996658 4555495 4555495 1652023 1652023 119689 119689 186421 186421 74830 74830 3634117 3634117 87462 87462 64444 64444 2246778 2246778 4232243 4232243 651030 651030 SUPPLIES 17206233 17206233 PROVISION FOR BAD DEBTS 11318742 11318742 PURCHASED SERVICES 3985755 3985755 MAINTENANCE AND REPAIRS 2062187 2062187 3886029 3886029 83072334 83072334 0 0 2586881 2361517 3651756 3856128 10120267 16902686 3038527 2904899 635523 1076470 102426060 65359175 37570428 37066885 18987781 17117778 2902755 2543354 79493918 83829717 15956236 18856055 33791053 31613265 2007186 5493613 51754475 55962933 X 27739443 27866784 27739443 27866784 79493918 83829717 X 1631222 31475 -1535356 X X 0 1 X 1 0 X 1796935 1796935 59346640 32535620 26811020 81565 81565 0 40925254 32741990 8183264 275666 275666 37066885 ASSETS HELD BY TRUSTEE 1459044 F INVESTMENT IN COASTAL INSURANCE 360930 C COMMON STOCK 15297804 F 17117778 UNAMORTIZED BOND PREMIUM 493550 MISCELLANEOUS LIABILITIES 3595427 DUE to CONTRACTUAL AGENCIES 594636 OTHER LIABILITIES 467500 OTHER LIABILITIES - DEFERRED COMPENSATION 342500 5493613 X 74451283 31475 1034994 1066469 73384814 11318742 11318742 84703556 72788586 1034994 1034994 71753592 11318742 11318742 83072334 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, 2015. Tax returns for 2013 through 2015 are subject to audit by taxing authorities. Part XI, Line 2d - Other Adjustments: RENTAL EXPENSES SHOWN AS AN OFFSET TO REVENUE 1,034,994. Part XI, Line 4b - Other Adjustments: BAD DEBT EXPENSE SHOWN AS AN OFFSET TO REVENUE ON AFS 11,318,742. Part XII, Line 2d - Other Adjustments: RENTAL EXPENSES SHOWN AS AN OFFSET TO REVENUE 1,034,994. Part XII, Line 4b - Other Adjustments: BAD DEBT EXPENSE SHOWN AS AN OFFSET TO REVENUE ON AFS 11,318,742. 1 1 1 X 350.000000000000 1 X 1 1 0 0 3916831 3916831 0.05460 11150215 9526067 1624148 0.02260 15067046 9526067 5540979 0.07720 65626 15756 49870 0.00070 170191 170191 0.00240 235817 15756 220061 0.00310 15302863 9541823 5761040 0.08030 1 11318742 5659371 28727450 29511321 -783871 X 1 1 1 1 RUSSELL MEDICAL CENTER PO BOX 939 ALEXANDER CITY AL 350110939 X X X RUSSELL MEDICAL CENTER 1 0 0 1 X X X X X X X X X 16 1 0 0 1 X WWW.RUSSELLMEDCENTER.COM X 1 14 1 WWW.RUSSELLMEDCENTER.COM 0 1 X 350.000000000000 350.000000000000 X X X X 1 1 X X X X 1 X www.russellmedcenter.com X X X X 1 X 0 X 1 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 MANAGER - TALLAPOOSA COUNTY HEALTH DEPARTMENT. THE CONTRIBUTORS ALSO INCLUDED LEADERSHIP AND CLINICAL EMPLOYEES OF RUSSELL MEDICAL 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 2016 AND ADOPTED A COMPREHENSIVE IMPLEMENTATION STRATEGY FOR YEARS 2017-2019. THE FOLLOWING IS A SUMMARY OF ACTIVITIES CONDUCTED IN 2016: 1. DEVELOPING A BEHAVIORAL HEALTH TELEMEDICINE PROGRAM IN WHICH A PSYCHIATRIST CAN REMOTELY ASSESS BEHAVIORAL HEALTH PATIENTS WITHIN THE EMERGENCY DEPARTMENT AND CONSULT WITH THE EMERGENCY DEPARTMENT PHYSICIAN REGARDING TRANSFER OF BEHAVIORAL HEALTH PATIENTS. 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 -SUPPORT OF THE 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 AND PURSES FOR A PURPOSE, AUCTION OF DESIGNER HANDBAGS TO RAISE MONEY FOR A RESPIRATORY GATED RADIOTHERAPY TO PROTECT, VITAL ORGANS FOR LEFT BREAST RADIATION. -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 NURSEING IN THE ALEXANDER CITY SCHOOL SYSTEM. -THE HOSPITAL CONTINUES TO PROVIDE INFORMATION OUTREACH TO EXPECTANT MOTHERS REGARDING PRENATAL CARE, THE IMPORTANCE OF FULL TERM PREGNANCY, AND BREAST FEEDING. -THE OB DEPARTMENT IS OFFERING FREE FINNISH BABY BOX BASSINETS TO LOWER INFANT MORTALITY RATES FOR LOW INCOME MOTHERS.6. CONTINUED TO EXPAND ACCESS TO MEDICAL TRANSPORTATION SERVICES FOR INDIVIDUALS WITH LIMITED RESOURCES TO TRAVEL TO HEALTH SERVICES. -RUSSELL MEDICAL 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.7. ADDRESSING HEALTHCARE ACCESS ISSUES FOR INDIVIDUALS WITH LIMITED RESOURCES REQUIRING NON-URGENT ONGOING OR FOLLOW-UP PHYSICIAN CARE. RUSSELL MEDICAL HAS BROUGHT 4 NEW PRIMARY PHYSICIANS TO THE COMMUNITY. THE MEDICAL CENTER WILL OPEN A NEW URGENT CARE CENTER IN LATE 2017. 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 $ 11,318,742. Part III, Line 3: IF PATIENTS PROPERLY COMPLETED APPLICATION 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. 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 1 YEAR 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. 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 1 YEAR 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 2016, CAUCASIAN, AFRICAN AMERICAN, HISPANIC AND OTHER RACES ACCOUNTED FOR 70.74%, 27.39%, 0.66% AND 1.21% RESPECTIVELY, OF THE PATIENTS SERVED WHILE 1.71%, 57.74% AND 40.56% 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 13.2% OF MEDICAID AND 4.9% OF self pay PATIENTS IN TALLAPOOSA COUNTY AND 12.6% OF MEDICAID AND 5.5% OF self pay 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 LoTHER E PEACE PRESIDENT/CEO 305388 0 78857 0 2322 0 126200 0 13821 0 526588 0 0 0 J Matthew Fisher CFO 183099 0 0 0 341 0 0 0 12396 0 195836 0 0 0 SARAH BETH GETTYS VP PATIENT SERVICES 210266 0 54577 0 2322 0 54238 0 10238 0 331641 0 0 0 brian dix md Physician - OB/GYN 324309 0 109443 0 540 0 3240 0 13822 0 451354 0 0 0 MARY EMILY SHEFFIELD MD Physician - MEDICAL ONCOLOGY 406996 0 17516 0 486 0 6360 0 13822 0 445180 0 0 0 JOHN N ELGIN MD DIRECTOR - PATHOLOGY 409634 0 0 0 2322 0 0 0 6293 0 418249 0 0 0 keri k brown md Physician - PULMONOLOGIST 405798 0 0 0 486 0 6360 0 10239 0 422883 0 0 0 JON W JONES MD PHYSICIAN - Surgical Services 403785 0 0 0 2322 0 6360 0 13822 0 426289 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 0 0 B 0 0 0 0 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 11b 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 -2,809,759. NONCONTROLLING INTEREST IN CENTRAL ALABAMA CANCER CARE, LLC 1,274,403. 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) Line 12a, I RUSSELL HOSPITAL CORPORATION 1 RUSSELL HOSPITAL FOUNDATION PO BOX 939 ALEXANDER CITY AL 35011 630987401 FUNDRAISING ACTIVITIES AL 501(C)(3) 7 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 6007814 5294401 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