A rural hospital paid for the children of 2 top executives to become doctors. It won’t say how many other people have gotten similar help.

Buchanan General Hospital paid for the children of two of its top executives to become doctors through a program that was designed to provide loans for medical training, such as medical school or nursing school. However, the payments are listed as grants, not loans, on the nonprofit hospital’s tax filings, and the hospital has declined to answer questions about the discrepancy or say whether others received similar benefits.

The total amount of financial aid received by the two is also unclear because of how the transactions are recorded in the tax documents.

Hospital officials, members of its board and the two recipients did not answer questions about the program, so it is unclear how many other beneficiaries the hospital’s tuition program has or what conditions were placed on the funds given to Dr. Tyler Ruchti, son of CEO Robert Ruchti, and Dr. Lindsey Boyd, daughter of CFO Kimetha Boyd. 

The hospital’s tuition assistance program is designed to recruit clinicians to work in the rural, 111-bed facility. Under the program, Buchanan General pays for a student’s medical training in exchange for a commitment to return and work at the Grundy hospital for several years, according to Sam Bartley, public relations specialist for the hospital. If the new doctor fulfills those obligations, the loan is forgiven. If not, it must be repaid with interest. 

The hospital’s Internal Revenue Service Form 990 filings, however, show the payments to Ruchti and Boyd listed under Schedule L: grants to interested persons, a designation that does not require repayment. 

Boyd is in the final year of her residency; Ruchti is currently working at a hospital in Ohio.

Bartley declined to provide details about the agreements with Ruchti and Boyd. 

However, Dr. Seth Lowe, who participated in the program from 2015 to 2024, shared his contract. He was required to return to Grundy within 30 days of completing nine years of training to become a cardiac anesthesiologist. When he did not accept the hospital’s job offer, he had to repay the hospital $336,000 in 30 days, the contract said.

The hospital’s loan program has been in place for 30 years, according to Bartley. He declined to say how many people have used the program. He did say that the hospital typically requires loan recipients to repay the assistance within 30 days if they decline a job offer from the hospital. 

Members of the hospital board of directors did not respond to requests from Cardinal News. The hospital has not disclosed the eligibility requirements or selection criteria for its tuition assistance program. 

There is no cap on the amount of funding that can be awarded each year or the number of participants, Bartley said. Every applicant is assessed by the hospital’s board, which then approves or denies the application.

Bartley declined to answer multiple questions about the program and how it is administered, stating that the nonprofit hospital is a private corporation. 

Cardinal News asked why the allocation was labeled as “cash” on the IRS filings for several years beyond the students’ graduation dates. Cardinal News also requested copies of the hospital’s conflict-of-interest policy, information on how the policy is implemented and enforced, the total number of individuals who have participated in the tuition program and a breakdown of how many of them accepted employment at the hospital after completing their education.

Cardinal News also asked Bartley to facilitate interviews with people who had used the tuition assistance program and later accepted positions at Buchanan General Hospital. Bartley did not respond to those requests.

“We find ourselves still asking how this line of questioning benefits the healthcare needs in our underserved communities. It appears you are looking to put Buchanan General Hospital in an unfavorable light,” Bartley said by email.

Brian Mittendorf, an accounting professor at Ohio State University’s Fisher College of Business who reviewed the tax filings at the request of Cardinal News, confirmed that the funds to the executives’ children were reported as grants. 

Errors in nonprofit tax filings are not uncommon, he said; it’s possible that a mistake was made in Buchanan General’s tax filings spanning from 2016 to 2024, even though the documents were prepared by a public accounting firm headquartered in North Carolina.

Rising sums were listed as grants for nine years

The Internal Revenue Service requires organizations to disclose potential conflicts of interest, including payments to family members of leadership — such as Ruchti and Boyd. Lowe’s name is not listed on the hospital’s tax documents, nor are the names of any other recipients of the tuition assistance program. 

Ruchti’s name appeared in tax documents from 2016 through 2025, the most recent available filing. 

During Ruchti’s first year of medical school in 2016, Buchanan General’s tax records show a payment, listed as a grant, of $2,276 for tuition assistance.

The 2017 filing lists a grant of $55,317, and the 2018 filing lists a $112,376 grant. The payments continued to increase through his final year of medical school in 2020, when tax forms show $240,838 was directed toward tuition assistance.

The payments continued through 2024, as Ruchti completed an internship and a residency.

It’s unclear how much in total assistance Ruchti received. The grants are listed in the annual tax documents as though each year was a separate payout to him; approached that way, the nine years’ worth of grants added together total more than $1.7 million. 

But the total could also be cumulative, Mittendorf said. “They’re reporting these as if they’re individual amounts each year,” he said. “But the way it is stated, it’s almost like an accumulation, not year to year.”

According to Bartley, the sum in the 990 documents represents both tuition and interest. Tax forms describe the type of assistance as “cash” and the purpose of assistance described as “tuition.”

The 990s do not provide a breakdown of how much money represented tuition and how much represented interest, and Bartley declined to provide those details. 

The tuition assistance should be listed on the tax forms under “loans to interested persons,” Mittendorf said. “And it should say the amount of the loan, the purpose of the loan and the original amount borrowed and how much is left that they still owe.” 

None of these details are included in the tax forms through 2024.

Bartley said the cash assistance is paid directly to the educational institution. He declined to provide information about Boyd’s and Ruchti’s education, saying that the information was irrelevant. 

Ruchti graduated from Lincoln Memorial University Debusk College of Osteopathic Medicine in 2020 and is currently employed by Mercy Health in Ohio, according to Mercy’s website. During his first year of medical school, tuition came to about $44,322. By the time he graduated, tuition had increased to about $51,140, according to the school’s catalog. 

Medical training continues years beyond medical school graduation through internships, residencies and fellowships. Buchanan General holds the loan during this time. While repayment is deferred, interest continues to accumulate, according to Bartley.

Ruchti started an internal medicine internship in Florida, followed by an emergency medicine residency at East Carolina University, which he completed in 2024. Throughout those years, the growing balance in the tax forms continued to be listed as a grant and described as cash for tuition.

In 2024, the amount listed — now described as medical school tuition and interest — was approximately $316,850, still categorized as a grant. 

“They claim they gave a grant of $316,000 of cash that year to that individual,” Mittendorf said. “I don’t think that’s what they mean to claim, but that is what the financial statement is saying. … They are reporting it as a grant whose value accumulates, but grants are individual amounts.”

Ruchti is currently listed as clinical faculty for the emergency medicine residency program at Mercy Health in Ohio and was issued a medical license by the Ohio Board of Medicine in March 2024. According to the American Board of Physician Specialties, Ruchti has not completed his board certification yet, which is required under Virginia administrative code for emergency medicine physicians. 

Ruchti did not respond to phone calls seeking comment. 

Mercy Health declined to confirm Ruchti’s status at the Ohio hospital. He is listed as clinical faculty in the hospital’s emergency medicine residency program. It is unclear whether he is completing a fellowship, which would likely extend his loan period.

Similar questions surround the funds attached to Boyd’s name. She first received funds for medical school from Buchanan General Hospital in 2019 when $44,760 appeared in the tax documents as tuition assistance listed as grants to interested persons. 

Boyd graduated in 2022 from Edward Via Virginia College of Osteopathic Medicine, according to her profile with Wake Forest University School of Medicine, where she’s currently a resident. That year, tuition for a fourth-year medical student totaled $49,800; the same year’s tax form showed that $213,715 was directed toward Boyd’s education and was described as cash for tuition. 

The 2024 filing shows a grant of $252,539. 

As with Ruchti’s awards, it’s unclear whether the amounts are individual or cumulative.

Boyd is in her fourth year of residency at Wake Forest. She holds a resident training license, which is up for renewal in November. 

Boyd is expected to complete her residency this year, according to Wake Forest.

She did not respond to email requests for comment.

“What we can take from this is the reporting is inconsistent,” Mittendorf said. “They [the tax filings] show that no one owes them money who is a family member of one of these interested individuals. At the same time, Schedule L seems to indicate there’s some sort of transaction there.” 

Lowe said he was offered a noncompetitive salary 

After nine years of medical training, Lowe was required to return to Grundy to fulfill his contract. He began coordinating with Buchanan General Hospital, but when the salary offer came through, Lowe hesitated. It was much lower than what he had expected. 

Buchanan General offered him an annual salary of $325,000, Lowe said. 

Cardiac anesthesiologists earned an average of $452,000 to $600,000 in 2024, according to a study published in the National Library of Medicine. Lowe declined to provide his starting salary at his current workplace in North Carolina.

“Their offer was such a huge slap in the face,” he said. He added that he could take a job as a traveler — a healthcare professional who takes short-term contracts to help medical facilities fill staffing gaps — and make three times that amount while working in the same region. 

The hospital wouldn’t budge, he said. His options were to work at Buchanan General for four years at what he described as a noncompetitive rate or pay back a loan that had been accruing 8% interest every year for nine years. 

Under his 2015 agreement, Buchanan General would lend him $188,000 to cover four years of medical school, along with $4,600 a year for textbooks.

The moment the contract is broken, the hospital requires that the loan be paid back within 30 days. Every additional month would add 1.5% interest to the loan.

Lowe said he was expected to return to Grundy immediately after completing a fellowship. 

In 2024, when he decided he could not work at Buchanan General, Lowe owed the hospital $336,000 for his medical school tuition. 

As a newly credentialed anesthesiologist, Lowe didn’t have the money. He wanted out of the contract, but said he felt trapped. That’s when his mother stepped in. 

Lowe grew up in Grundy, where his mother was a teacher and his father worked in the coal mines before he died when Lowe was a teenager. 

Lowe’s mom drew on the money his father had left them in order to pay the hospital back.

Now, Lowe is working for a hospital in North Carolina and offering financial support for his mother in Grundy.

Hospital is silent on its conflict of interest policy

Mittendorf, the Ohio State professor, also applies his accounting expertise to improve nonprofit research and programming. He said understanding Buchanan General Hospital’s conflict of interest policy is critical to clarifying what is represented in the tax filing and regaining trust in the community. 

“Are you offering these things to everyone or are you offering only to select individuals? And how do you determine that?” Mittendorf said. “We want to know, as the public or as an outside individual, that these transactions are all engaged to support the organization and a charitable mission. Not to support particular individuals. You’d want a conflict of interest policy built around that.”

Bartley did not respond to requests to see the hospital’s conflict of interest policy.

The money used for Rutchti and Boyd’s education isn’t reflected on the hospital’s balance sheet either, Mittendorf said. 

“If it were just a loan that got put as a grant, we should still see it on the balance sheet, and they’re not showing one,” Mittendorf said.

The hospital’s assets do equal its liabilities, indicating the transaction was recorded in some form, but it is unclear what was recorded or where. The amounts may be small relative to the hospital’s overall budget and could have been grouped into a broader category. The hospital has had a negative net income since 2023. In 2024, the hospital’s total revenue was $30.4 million, but expenses reached $32.3 million.

Mittendorf said that because these payments involve a potential conflict of interest, they should be clearly disclosed.

“Those are the sorts of payments they want to be very cautious and careful about tracking,” Mittendorf said. 

The hospital’s nonprofit status means it is exempt from paying federal and some state and local taxes, can issue tax-exempt bonds and can receive tax-deductible contributions. It also must meet the Internal Revenue Service Community Benefit Standard and publicly and extensively report the range of benefits and services it provides to its community.