2011-06-13T13:17:59-05:00 2010-07-31 Wendling Noe Nelson & Johnson LLC 534 S Kansas Ave Suite 1500 Topeka KS 666033491 990 2009-08-01 742842747 West Central Kansas Association Inc WEST 7854833131 200 S Main Russell KS 67665 Shelley Boden 7854832323 2011-06-07 1 Gary D Knoll 7852334226 2011-06-07 2009 2016-02-24 21:20:13Z Russell Regional Hospital Shelley Boden 200 S Main Russell KS 67665 13035069 0 X N/A 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 5 239 0 0 0 2500 1844 12815238 12685907 45660 51169 366735 295933 13230133 13034853 20315 0 0 9448745 9210714 0 0 4838752 4868121 14307812 14078835 -1077679 -1043982 3710678 3455961 3710678 3230961 0 225000 To care for our communities and their citizens with the caring, compassion, quality and commitment that validates their trust in us. 0 0 12532019 12981840 Russell Regional Hospital provides a variety of health care services including acute inpatient care, swingbed inpatient care, outpatient care, home health care, and long-term care services to patients in need of care. 12532019 1 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 7 0 239 1 0 0 0 0 0 0 0 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 99123 0 19399 Duane Fields 40.00 X 82231 0 0 Janel Burch 40.00 X 0 0 0 Earl Merkel 40.00 X 296282 0 0 Aaron Rowland 40.00 X 238664 0 0 Andrea Herrera 40.00 X 207899 0 11187 Jill Doerfler-Iniguez 40.00 X 222812 0 2886 Randal Moyers 40.00 X 169801 0 10863 1316812 0 44335 10 0 1 0 Docs Who Care 1337 S Fountain Drive Olathe KS 66061 Physician ER & Clinic Coverage 343648 Aegis Therapies PO Box 8103 Fort Smith AR 72902 Therapy Service 130192 2 1844 1844 Net patient service re 900099 12685907 12685907 12685907 51330 51330 7224 7224 7224 7224 55 216 -161 -161 -161 Ambulance services 621910 235810 235810 Cafeteria sales 722210 30302 30302 Miscellaneous income 900099 13982 13982 8615 8615 288709 13034853 12981840 0 51169 136689 136689 7542025 6894615 647410 60660 56451 4209 969389 892196 77193 501951 452066 49885 11860 11860 169697 9018 160679 34113 31898 2215 120675 20301 100374 322773 322287 486 14977 14850 127 91725 91725 433232 433232 168140 168140 Bad debt provision 731979 731979 Purchased services 620525 576838 43687 Pharmacy supplies 532983 532983 Repairs and maintenance 466953 368198 98755 Medical supplies 432678 401935 30743 715811 625032 90779 14078835 12532019 1546816 0 1414 275870 264114 52 1935631 1689167 190795 169221 85840 111049 2665301 1680456 1218741 984845 14143 225757 3710678 3455961 1254686 1179475 1012417 1096977 1443575 954509 3710678 3230961 X 225000 0 225000 3710678 3455961 X 0 1 0 X 0 X 6676 1076 5600 2580627 1641049 939578 77998 38331 39667 984845 Other receivables 757 Tax credit grant pledges receivable 225000 225757 Due to lessor 904430 Estimated third-party payor settlements 50079 954509 13034853 14078835 -1043982 1043982 1043982 0 13035014 0 13035014 -161 -161 13034853 14078835 0 14078835 0 14078835 Part X: Description of Uncertain Tax Positions Under FIN 48: N/A Part XI, Line 8 - Other Adjustments: Transfer from lessor: 597547. Change in amount due to lessor: 446435. Part XII, Line 4b - Other Adjustments: Loss on disposal of assets: -161. 1 1 0 1 X 1 1 0 0 109300 94664 14636 0.00110 975331 899050 76281 0.00570 1084631 993714 90917 0.00680 4134832 3437987 696845 0.05220 4134832 3437987 696845 0.05220 5219463 4431701 787762 0.05900 1 486327 0 6491705 6282366 209339 X 1 0 Russell Regional Hospital

200 South Main Street Russell KS 67665

X X X X Long-term care facility, outpatient physician clinic 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. 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 07/31/2010. 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 4,200 & 6,600 individuals respectively. The average Russell household annual income is approximately $31,181. Approximately 14.3% of the residents in the city of Russell have annual income below the federal poverty level and approximately 7.0% residents have 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 Earl Merkel 296282 0 0 0 0 0 0 0 0 0 296282 0 190917 0 Aaron Rowland 238664 0 0 0 0 0 0 0 0 0 238664 0 136220 0 Andrea Herrera 207899 0 0 0 0 0 0 0 11187 0 219086 0 132467 0 Jill Doerfler-Iniguez 222812 0 0 0 0 0 2886 0 0 0 225698 0 134880 0 Randal Moyers 169801 0 0 0 0 0 223 0 10640 0 180664 0 100932 0 Form 990, Part VI, Section B, line 11 The Form 990 is reviewed by the governing body prior to filing. 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.