2013-06-11T11:19:42-05:00 2012-07-31 481026809 Wendling Noe Nelson & Johnson LLC 534 S Kansas Ave Suite 1500 Topeka KS 666033491 990 2011-08-01 742842747 West Central Kansas Association Inc WEST 7854833131 200 S Main Russell KS 67665 Sharon Collins 7854832323 2013-06-03 1 John R Helms P00203953 7852334226 2013-06-03 2011 2016-02-25 16:41:14Z Russell Regional Hospital Sharon Collins 200 S Main Russell KS 67665 12906264 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. 5 5 213 0 0 0 9575 309911 13303825 12485536 3640 47438 363354 63379 13680394 12906264 0 0 0 0 9022477 8685376 0 0 0 4937934 4228887 13960411 12914263 -280017 -7999 3857845 3742583 3734278 3710099 123567 32484 To care for our communities and their citizens with the caring, compassion, quality and commitment that validates their trust in us. 0 0 11389119 12548915 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. 11389119 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 0 0 0 0 0 0 0 0 0 0 0 0 1 17 0 1 213 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 Sharon Collins Interim CEO 7854832323 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 Shelley Boden 40.00 X 98490 0 26493 Mary Odom 40.00 X 58500 0 158 Joy Bretz 40.00 X 0 0 0 Clark Eddy 40.00 X 297581 0 12375 Alexander Chung 40.00 X 298521 0 4486 Earl Merkel 40.00 X 291900 0 8813 Jill Doerfler-Iniguez 40.00 X 217422 0 8443 Sambhundh Panichabhongse 40.00 X 182179 0 8917 Andrea Herrera 40.00 X 153794 0 6997 1598387 0 76682 9 1 1 0 Dr John Whitehead 1659 Tamarisk Drive Wichita KS 67230 Physician ER & Clinic Coverage 194055 Docs Who Care 1337 S Fountain Drive Olathe KS 66061 Physician ER & Clinic Coverage 115500 2 307161 2750 309911 Net patient service re 900099 12485536 12485536 12485536 47438 47438 8456 0 8456 8456 8456 Cafeteria sales 722210 37697 37697 Contracted physical th 900099 6414 6414 Meals on wheels 611710 3504 3504 7308 7308 54923 12906264 12548915 0 47438 206687 206687 7163058 6566324 596734 60832 56207 4625 776545 716787 59758 478254 427684 50570 2180 2180 204506 7147 197359 28144 26953 1191 130761 78822 51939 286058 257452 28606 19226 16925 2301 85994 70468 15526 430926 387833 43093 148437 148437 Pharmacy supplies 755595 755595 Purchased services 609372 536732 72640 Physician fees 487823 487823 Medical supplies 394351 336435 57916 645514 511495 134019 12914263 11389119 1525144 0 558489 604899 710 1431199 1331781 203699 198968 127510 121373 3306947 2002559 1408434 1304388 128514 180464 3857845 3742583 1080997 1038759 1480213 1053487 1173068 1617853 3734278 3710099 X 123567 32484 123567 32484 3857845 3742583 X -7999 -83084 X 0 1 0 X 0 X 2144021 1746296 397725 1162926 256263 906663 1304388 Due to lessor 1617853 1617853 12906264 12914263 -7999 -83084 -83084 -91083 12906264 0 12906264 0 12906264 12914263 0 12914263 0 12914263 Description of Uncertain Tax Positions Under FIN 48: Part X: Management is not aware of any uncertainties in income tax positions. Part XI, Line 8 - Other Adjustments: Transfer from lessor 269,561. Change in amount due to lessor -452,644. Contributions temporarily restricted 99,999. Total to Schedule D, Part XI, Line 8: -83,084. 1 1 1 X 130.000000000000 1 X 1 0 0 101390 97798 3592 0.00030 1154180 1295276 -141096 0.00000 1255570 1393074 -137504 0.00030 3443369 2738018 705351 0.05460 3443369 2738018 705351 0.05460 4698939 4131092 567847 0.05490 1 380202 0 6007902 6203111 -195209 X 1 0 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 1 130.000000000000 1 200.000000000000 1 X X X X 1 1 X X X 1 X X 0 1 X 0 0 Part III, Line 4: The Hospital provides for accounts receivable that could become uncollectible in the future by establishing an allowance to reduce the carrying value of such receivables to their estimated net realizable value. The Hospital estimates this allowance based on the aging of its accounts receivable and its historical collection experience for each type of payor. Bad debt expense is included in net patient service revenue on Part VIII, Line 2a.The Hospital's bad debt at cost was determined by applying an overall ratio of cost to charges. Part III, Line 3West 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 07/31/2012. The total amount of shortfall between Medicare revenue received and relating allowable costs is considered community benefit. Russell Regional Hospital Part V, Section B, Line 19d: 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 and approximately 7.0% of residents have an annual income below 50% of 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 Clark Eddy 255956 0 41625 0 0 0 0 0 12375 0 309956 0 0 0 Alexander Chung 259208 0 39313 0 0 0 0 0 4486 0 303007 0 0 0 Earl Merkel 193829 0 98000 0 71 0 0 0 8813 0 300713 0 0 0 Jill Doerfler-Iniguez 187395 0 30000 0 27 0 3826 0 4617 0 225865 0 0 0 Sambhundh Panichabhongse 148054 0 34000 0 125 0 0 0 8917 0 191096 0 0 0 Andrea Herrera 98021 0 55759 0 14 0 0 0 6997 0 160791 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. Changes in Net Assets or Fund Balances: Form 990, Part XI, line 5: Transfer from lessor 269,561. Change in amount due to lessor -452,644. Contributions temporarily restricted 99,999. Total to Form 990, Part XI, Line 5: -83,084.