2024-11-12T16:00:52-06:00 2021-12-31 454084437 WARREN AVERETT LLC 2500 ACTON ROAD BIRMINGHAM AL 35243 990 2021-01-01 472378825 RUSSELLVILLE HOSPITAL INC RUSS 2563321611 PO BOX 1089 RUSSELLVILLE AL 35653 CHRIS WARE CURRENT CEO 2563321611 2024-11-11 1 MEGAN RANDOLPH P00989558 2059794100 2024-11-11 2021 2024-10-15 13:58:12Z CHRIS WARE PO BOX 1089 RUSSELLVILLE AL 35653 28273288 0 X RUSSELLVILLEHOSPITAL.COM X 2014 AL OUR MISSION IS MAKING COMMUNITIES HEALTHIER. 7 7 213 7 0 0 4355232 1402733 21877505 26697913 0 1250 200233 171392 26432970 28273288 0 815 0 0 12845943 12549092 0 0 0 13694971 18205267 26540914 30755174 -107944 -2481886 10029714 8676712 13283992 12080873 -3254278 -3404161 OUR MISSION IS MAKING COMMUNITIES HEALTHIER. 0 0 22754660 815 26869305 SEEKS TO IMPROVE THE DELIVERY OF HEALTHCARE SERVICES IN RURAL AMERICA BY GIVING LOCAL HEALTHCARE ORGANIZATIONS AN ALTERNATIVE TO FOR-PROFIT HOSPITAL COMPANIES OR HEALTH SYSTEMS. SEEKS TO MAKE THE COMMUNITY HEALTHIER. 22754660 1 1 0 0 0 0 0 0 0 0 1 0 0 0 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 1 0 1 0 0 0 1 13 0 1 213 1 0 0 0 0 0 0 0 0 0 0 0 0 X 7 7 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X SHANNON HUGHES 2563328625 15155 HIGHWAY 43 RUSSELLVILLE AL 35653 KEITH MORROW CHIEF OF STAFF 1.00 0.00 X 0 0 0 LLOYD DYAS BOARD MEMBER 1.00 0.00 X 0 0 0 JEFFREY MANORD BOARD MEMBER 1.00 0.00 X 0 0 0 JERRY GROCE BOARD MEMBER 1.00 0.00 X 0 0 0 MIRANDA DECKER BOARD MEMBER 1.00 0.00 X 0 0 0 ROGER BEDFORD BOARD MEMBER 1.00 0.00 X 0 0 0 MARILYN MAYFIELD BOARD MEMBER 1.00 0.00 X 0 0 0 STEPHEN PROCTOR CEO/BOARD SECRETARY 40.00 0.00 X 195132 0 9218 SHANNON HUGHES CFO 40.00 0.00 X 144800 0 7356 JOHN ALMIROL PHYSICIAN 40.00 0.00 X 422468 0 5874 TRACY VINSON PHARMACIST 40.00 0.00 X 134080 0 0 RUSSELL BURKS PHYSICAL THERAPIST 40.00 0.00 X 123148 0 5874 KAREN WADDELL MED SURG/ICU/NURSING DIRECTOR 40.00 0.00 X 114791 0 10334 LANCE WILLIS PHYSICAL THERAPIST 40.00 0.00 X 109326 0 17159 1243745 0 55815 7 0 1 0 INTEGRATED BEHAVIORAL HEALTH 600 SUN TEMPLE DRIVE MADISON AL 35631 PHYSICIAN SERVICES 1941170 CORRECT CARE INC 229 SAINT JOHN LANE COVINGTON LA 70433 PHYSICIAN SERVICES 843467 JMJ ANESTHESIA PO BOX 757 SUITE F FLORENCE AL 35631 PROVIDER SERVICES 481007 SOLOMON CONSULTING SERVICES 119 W MAIN STREET SUITE 20 MCMINNVILLE TN 37110 BILLING SERVICES 446225 JAVA MEDICAL GROUP 6 CASTLEWOOD COURT NASHVILLE TN 37215 MANAGEMENT SERVICES 360000 8 1234829 167904 1402733 PATIENT SERVICE FEES 623990 26570804 26570804 MEDICAL CLINIC RENT 623990 127109 127109 26697913 1250 0 1250 1250 1250 OTHER REVENUE 900099 128780 128780 CAFETERIA REVENUE 900099 42612 42612 171392 28273288 26869305 0 1250 X 815 815 356506 268606 87900 9671202 7286670 2384532 1805774 1360542 445232 715610 539169 176441 2733950 2059867 674083 52500 39556 12944 6267193 4721954 1545239 8740 6585 2155 221276 166718 54558 1043668 786341 257327 53242 40115 13127 134918 134918 419496 419496 381021 287076 93945 MEDICAL SUPPLIES 3395958 2558651 837307 TAXES 1557562 1173529 384033 REPAIR AND MAINTENANCE 905986 682606 223380 FOOD 150706 113548 37158 879051 662312 216739 30755174 22754660 8000514 0 1394605 1153877 2132400 4067057 2500000 0 27238 0 772368 832316 160139 222514 6706149 4376895 2991223 2329254 51741 71694 10029714 8676712 1906948 4700363 0 200000 5191796 3817866 1761873 1761873 4423375 1600771 13283992 12080873 X -3254278 -3404161 -3254278 -3404161 10029714 8676712 -2481886 2332003 0 X X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 810000 810000 1190034 234435 955599 175471 81429 94042 4530644 4061031 469613 2329254 MEDICARE ADVANCE PAYMENTS 1600771 1600771 28273288 0 28273288 0 28273288 30755174 0 30755174 0 30755174 1 1 1 X 1 X 1 0 1 1 163407 163407 0.00530 3944985 1105378 2839607 0.09230 4108392 1105378 3003014 0.09760 1396 1396 0.00000 2400 2400 0.00000 3796 3796 0.00000 4112188 1105378 3006810 0.09760 1 9342711 9820796 8666225 1154571 1 1 1 1 RUSSELLVILLE HOSPITAL INC 15155 HIGHWAY 43 RUSSELLVILLE AL 35653 RUSSELLVILLEHOSPITAL.COM H3001 X X X RUSSELLVILLE HOSPITAL INC 1 0 0 1 X X X X X X X X X 19 1 0 0 1 X RUSSELLVILLEHOSPITAL.COM X 1 19 1 RUSSELLVILLEHOSPITAL.COM 0 0 1 X 200.000000000000 300.000000000000 X X X X 1 1 X X X X 1 X RUSSELLVILLEHOSPITAL.COM X RUSSELLVILLEHOSPITAL.COM X RUSSELLVILLEHOSPITAL.COM X X X X 1 0 X X X X 1 X 0 0 RUSSELLVILLE HOSPITAL, INC. PART V, SECTION B, LINE 5: THE GOAL OF ESTABLISHING THE COMMUNITY HEALTH COMMITTEE WAS TO SOLICIT INPUT FROM RESIDENTS OF THE COMMUNITY AND TO PROMOTE THE BROAD INTEREST OF THOSE SERVED BY THE HOSPITAL. COMMUNITY MEMBERS OF THE COMMITTEE ARE AS FOLLOWS: BILL FOSTER, LEAH YOUM, MARIA MACIAS, THOMAS UPTAIN, AND DR. WAYNE RAY. THE COMMITTEE MET TO ULTIMATELY IDENTIFY THE TOP HEALTH ISSUES FACING THE COMMUNITY AND THE DEVELOPMENT OF THE HOSPITAL'S IMPLEMENTATION STRATEGY TO ADDRESS THE FINDINGS OF THE CHNA. AN ONLINE SURVEY WAS THE PRIMARY MEANS TO DETERMINE PUBLIC PERCEPTION ABOUT THE NEEDS OF THE COMMUNITY. INPUT WAS REQUESTED REGARDING DEMOGRAPHICS AND HEALTH STATUS. IN ORDER TO RECEIVE INPUT FROM THE MEDICALLY UNDERSERVED, CHRONICALLY ILL AND LOW-INCOME INDIVIDUALS, AND TO ENSURE DATA FROM THE OVERALL POPULATION, THE SURVEY WAS ADVERTISED BY VARIOUS COMMUNITY PARTNERS. THESE PARTNERS ALSO HELPED DISTRIBUTE THROUGH THEIR EMAIL LIST SERVICES. THE SURVEY WAS AVAILABLE TO THE PUBLIC THROUGH RUSSELLVILLEHOSPITAL.COM FOR A FIVE-WEEK PERIOD. 1 1 - RUSSELLVILLE PHYSICIANS LLC 15155 HIGHWAY 43 RUSSELLVILLE AL 35653 FAMILY MEDICINE PHYSICIAN FACILITY PART III, LINE 2: ACCOUNTS ARE EVALUATED FOR COLLECTABILITY ON A MONTHLY BASIS USING AGED PAYOR ACCOUNT CLASSIFICATIONS AND HISTORICAL COLLECTION EXPERIENCE. PART III, LINE 3: ACCOUNTS ARE EVALUATED FOR COLLECTABILITY ON A MONTHLY BASIS USING AGED PAYOR ACCOUNT CLASSIFICATIONS AND HISTORICAL COLLECTION EXPERIENCE. PART III, LINE 8: AS A NON-PROFIT ORGANIZATION, THE HOSPITAL ACCEPTS ALL PATIENTS WITHOUT REGARD TO INSURANCE OR ABILITY TO PAY. AMOUNTS ARE BASED ON THE MEDICARE COST REPORT. PART III, LINE 9B: RUSSELLVILLE HOSPITAL OFFERS FINANCIAL ASSISTANCE TO PATIENTS AND GUARANTORS THROUGH A CHARITY POLICY BASED ON THE CURRENT FEDERAL POVERTY GUIDELINES (FPG). THOSE APPROVED FOR FINANCIAL ASSISTANCE ARE ELIGIBLE FOR DISCOUNTS APPLIED TO BALANCES OWED AFTER INSURANCE. SELF-PAY BALANCES REMAINING AFTER THE UNINSURED DISCOUNT ARE ALSO ELIGIBLE FOR FINANCIAL ASSISTANCE IF THE FAMILY INCOME OF THE PATIENT IS BETWEEN 0% AND 200% OF THE FPG A 100% DISCOUNT MAY BE APPLIED (CHARITY CARE). IF THE FAMILY INCOME OF THE PATIENT IS BETWEEN 201% AND 250% OF THE FPG, A 60% DISCOUNT MAY BE APPLIED (FINANCIAL ASSISTANCE). IF THE FAMILY INCOME OF THE PATIENT IS BETWEEN 251% AND 300% OF THE FPG, A 40% DISCOUNT MAY BE APPLIED (FINANCIAL ASSISTANCE). THIS POLICY IS PUBLICIZED IN PATIENT REGISTRATION AREAS, INCLUDED IN BILLING STATEMENTS, AND IS AVAILABLE ON THE HOSPITAL'S WEBSITE. PATIENTS WITH A BALANCE REMAINING AFTER APPLICATION OF DISCOUNTS ARE SENT STATEMENTS AND/OR COLLECTION LETTERS EVERY 30 DAYS UNTIL THE BALANCE IS PAID OR PAYMENT ARRANGEMENTS ARE MADE. ACCOUNTS THAT DO NOT HAVE SUFFICIENT PAYMENT ARRANGEMENTS ESTABLISHED ARE ELIGIBLE TO BE REFERRED TO OUTSIDE COLLECTIONS. ALL PATIENTS ARE NOTIFIED OF POSSIBLE COLLECTION ASSIGNMENT AT LEAST 30 DAYS BEFORE AN ASSIGNMENT IS MADE. IF A REQUEST FOR FINANCIAL ASSISTANCE IS MADE AFTER STATEMENTS ARE SENT, THE ACCOUNT IS PLACED ON HOLD UNTIL A DETERMINATION OF ELIGIBILITY IS MADE. PART VI, LINE 2: THE HOSPITAL PERFORMS OUTREACH SERVICES AND HEALTH EDUCATION OPPORTUNITIES FOR THE COMMUNITY. FEEDBACK FROM THESE SERVICES AS WELL AS EVALUATION OF THE PATIENTS SERVED ARE USED TO ASSESS THE COMMUNITY'S HEALTH CARE NEEDS. PART VI, LINE 3: BOTH INPATIENT AND OUTPATIENT SERVICES ARE ELIGIBLE FOR FINANCIAL ASSISTANCE OR CHARITY UPON APPLICATION BY THE PATIENT OR GUARANTOR. THERE IS SIGNAGE IN REGISTRATION AREAS, INFORMATION INCLUDED IN MONTHLY STATEMENTS, AND INFORMATION ON THE HOSPITAL WEBSITE WITH THE PHONE NUMBER TO CALL FOR FINANCIAL ASSISTANCE. PART VI, LINE 4: RUSSELLVILLE HOSPITAL PRIMARILY SERVES RESIDENTS OF RUSSELLVILLE, ALABAMA AND FRANKLIN COUNTY, ALABAMA. RUSSELLVILLE IS A RURAL COMMUNITY WITH POPULATION OF JUST BELOW 10,000 AND APPROXIMATELY 22% OF THE POPULATION IS BELOW POVERTY LEVEL. THE MOST RECENT CENSUS INDICATES THE POPULATION IS 73% CAUCASIAN. PART VI, LINE 5: THE HOSPITAL HAS A VOLUNTEER BOARD OF DIRECTORS AND IS SERVED BY AN OPEN MEDICAL STAFF. THE HOSPITAL ACTIVELY RECRUITS PRIMARY CARE PHYSICIANS AND SPECIALISTS TO MEET MEDICAL NEEDS IN THE COMMUNITY. THE HOSPITAL ALSO PERFORMS OUTREACH SERVICES AND PROVIDES HEALTH EDUCATION OPPORTUNITIES FOR THE COMMUNITY. X X X X 0 0 0 0 0 0 0 0 0 JOHN ALMIROL PHYSICIAN 422468 0 0 0 0 0 0 0 5874 0 428342 0 0 0 STEPHEN PROCTOR CEO/BOARD SECRETARY 145132 0 50000 0 0 0 0 0 9218 0 204350 0 0 0 SHANNON HUGHES CFO 120800 0 24000 0 0 0 0 0 7356 0 152156 0 0 0 FORM 990, PART IV, LINE 12A: AT THE TIME OF FILING THE FINANCIAL STATEMENTS HAVE BEEN FINALIZED BUT NOT ISSUED. ATTACHED TO THIS RETURN IS THE FINAL AND UNISSUED AUDIT REPORT. FORM 990, PART IV, LINE 20B: AT THE TIME OF FILING THE FINANCIAL STATEMENTS HAVE BEEN FINALIZED BUT NOT ISSUED. ATTACHED TO THIS RETURN IS THE FINAL AND UNISSUED AUDIT REPORT. FORM 990, PART VI, SECTION A, LINE 3 MANAGEMENT SERVICES WERE PERFORMED BY JAVA MEDICAL GROUP. FORM 990, PART VI, SECTION B, LINE 11B A COPY OF FORM 990 WAS PROVIDED TO EACH BOARD MEMBER FOR REVIEW PRIOR TO THE FILING OF THE FORM. FORM 990, PART VI, SECTION B, LINE 12C THE CONFLICT OF INTEREST POLICY IS REVIEWED ANNUALLY WITH GOVERNING BOARD MEMBERS AND A CONFLICT OF INTEREST STATEMENT IS COMPLETED ANNUALLY. FORM 990, PART VI, SECTION B, LINE 15 THE BOARD APPROVED THE OPERATING BUDGET WHICH INCLUDES CEO AND TOP MANAGEMENT COMPENSATION. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS, CONFLICT OF INTERST POLICY AND FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART IX, LINE 11G OTHER FEES: PROGRAM SERVICE EXPENSES 4,721,954. MANAGEMENT AND GENERAL EXPENSES 1,545,239. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 6,267,193. FORM 990, PART XII, LINE 2C: THE PROCESS HAS NOT CHANGED FROM PRIOR YEARS. RUSSELLVILLE PHYSICIANS LLC 15155 HIGHWAY 43 RUSSELLVILLE AL 35653 472497573 PROVIDE HEALTHCARE SERVICES TN 1489795 243938 RUSSELLVILLE HOSPITAL INC