2012-05-29T11:05:29-05:00 2011-07-31 Wendling Noe Nelson & Johnson LLC 534 S Kansas Ave Suite 1500 Topeka KS 666033491 990 2010-08-01 742842747 West Central Kansas Association Inc WEST 7854833131 200 S Main Russell KS 67665 Shelley Boden 7854832323 2012-05-23 1 John R Helms 7852334226 2012-05-23 2010 2016-02-24 21:20:13Z Russell Regional Hospital Shelley Boden 200 S Main Russell KS 67665 13716895 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 5 142 0 0 0 1844 9575 12685907 13303825 51169 3640 295933 363354 13034853 13680394 0 0 0 0 9210714 9022477 0 0 0 4868121 4937934 14078835 13960411 -1043982 -280017 3455961 3857845 3230961 3734278 225000 123567 To care for our communities and their citizens with the caring, compassion, quality and commitment that validates their trust in us. 0 0 12536428 13667179 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. 12536428 1 1 0 0 0 0 0 0 0 1 0 0 1 1 0 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 18 0 1 142 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 Shelley Boden 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 95517 0 18031 Mary Odom X 0 0 0 Janel Burch 40.00 X 38185 0 8734 Sambhundh Panichabhongse 40.00 X 150466 0 7844 Earl Merkel 40.00 X 296819 0 8914 Aaron Rowland 40.00 X 183021 0 7623 Andrea Herrera 40.00 X 220562 0 12744 Jill Doerfler-Iniguez 40.00 X 212524 0 8719 Alexander Chung 40.00 X 237833 0 2605 1434927 0 75214 8 0 1 0 Docs Who Care 1337 S Fountain Drive Olathe KS 66061 Physician ER & Clinic Coverage 153226 Shared Medical Services PO Box 330 Cottage Grove WI 53527 MRI services 123832 Dr John Whitehead 1659 Tamarisk Drive Wichita KS 67230 Physician ER & Clinic Coverage 117385 Etrans 2525 Perimeter Place Dr Nashville TN 37214 Medical record transcribing 103577 4 7075 2500 9575 Net patient service re 900099 13303825 13303825 13303825 40141 40141 7126 7126 7126 7126 36501 -36501 -36501 -36501 Ambulance services 621910 315000 315000 Cafeteria sales 722210 31181 31181 Meals on wheels 624210 5376 5376 4671 4671 356228 13680394 13667179 0 3640 203528 203528 7432700 6874429 558271 62942 58715 4227 836802 786067 50735 486505 439955 46550 685 685 185680 13362 172318 18977 17227 1750 112363 19839 92524 352264 341534 10730 18913 18703 210 74805 39454 35351 444548 444548 189776 189776 Bad debt provision 755676 755676 Pharmacy supplies 732995 732995 Purchased services 502685 453850 48835 Repairs and maintenance 472437 380037 92400 Medical supplies 427425 403444 23981 648705 566817 81888 13960411 12536428 1423983 0 275870 558489 52 1689167 1431199 169221 203699 111049 127510 2980068 1571634 984845 1408434 225757 128514 3455961 3857845 1179475 1080997 1096977 1480213 954509 1173068 3230961 3734278 X 225000 123567 225000 123567 3455961 3857845 X -280017 178584 X 0 1 0 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 59741 2902 56839 2036451 1501779 534672 883876 66953 816923 1408434 Due to lessor 1165209 Estimated third-party payor settlements 7859 1173068 13680394 13960411 -280017 178584 178584 -101433 13716895 0 13716895 -36501 -36501 13680394 13960411 0 13960411 0 13960411 Part XI, Line 8 - Other Adjustments: Transfer from lessor 389,363. Change in amount due to lessor -210,779. Part XII, Line 4b - Other Adjustments: Loss on disposal of assets -36,501. 1 1 1 X 130.000000000000 1 X 1 0 0 109560 109551 9 0.00000 763378 823582 -60204 0.00000 872938 933133 -60195 2988151 2339172 648979 0.04910 2988151 2339172 648979 0.04910 3861089 3272305 588784 0.04910 1 419778 0 6383261 6400651 -17390 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 Not required 1 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 $ 755676. 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.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 amount was obtained from the cost report filed with Medicare for the period ending 07/31/2011. Part VI, Line 2: 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 $36,135. Approximately 16.9% 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 6: The Hospital's governing body is comprised solely of local community members. All local physicians have admitting privileges at the Hospital. X 0 0 0 0 0 0 0 0 0 Sambhundh Panichabhongse 150466 0 0 0 0 0 0 0 7844 0 158310 0 64203 0 Earl Merkel 296819 0 0 0 0 0 0 0 8914 0 305733 0 111882 0 Aaron Rowland 183021 0 0 0 0 0 0 0 7623 0 190644 0 56020 0 Andrea Herrera 220562 0 0 0 0 0 0 0 12744 0 233306 0 76776 0 Jill Doerfler-Iniguez 212524 0 0 0 0 0 3907 0 4812 0 221243 0 90207 0 Alexander Chung 237833 0 0 0 0 0 0 0 2605 0 240438 0 142269 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 389,363. Change in amount due to lessor -210,779. Total to Form 990, Part XI, Line 5: 178,584.