FAIRBANKS HOSPITAL INC: Form 990, tax year 2016
View the entire original 990 at ProPublica ↗
- Organization
- FAIRBANKS HOSPITAL INC (EIN 35-0811197)
- Tax period
- 2016-07-01 to 2017-06-30
- Filed
- 2018-04-28
- IRS object ID
- 201811189349300001
- Schema version
- 2016v3.0
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule D
- Schedule G
- Schedule H
- Schedule I
- Schedule J
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2018-04-28T01:20:05-05:00 | ReturnTs |
| Tax Period End | 2017-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 351178661 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Blue & Co LLC | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 500 N Meridian St Suite 200 | AddressLine1Txt |
| City | Indianapolis | CityNm |
| State Abbreviation | IN | StateAbbreviationCd |
| ZIP | 46204 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2016-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 350811197 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Fairbanks Hospital Inc | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | FAIR | BusinessNameControlTxt |
| Phone | 3178498222 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 8102 Clearvista Parkway | AddressLine1Txt |
| City | Indianapolis | CityNm |
| State Abbreviation | IN | StateAbbreviationCd |
| ZIP | 46256 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Janine R Shopp | PersonNm |
| Person Title | Vice President and CFO | PersonTitleTxt |
| Phone | 3175729387 | PhoneNum |
| Signature | 2018-04-27 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Amber Kocher CPA | PreparerPersonNm |
| PTIN | P01286298 | PTIN |
| Phone | 3176334705 | PhoneNum |
| Preparation | 2018-04-23 | PreparationDt |
Filing Security Information FilingSecurityInformation
IP Address IPAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| I Pv4 Address | 50.90.4.15 | IPv4AddressTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IP | 2018-04-27 | IPDt |
| IP Tm | 08:10:53 | IPTm |
| IP Timezone | ED | IPTimezoneCd |
| Filing License Type | P | FilingLicenseTypeCd |
| At Submission Creation Device Id | DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | B19D0506B86ED19F1A0FD2AFEEB91090E576B51F | AtSubmissionFilingDeviceId |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2016 | TaxYr |
| Build TS | 2021-01-29 14:40:06Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | BARBARA ELLIOTT | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 8102 Clearvista Parkway | AddressLine1Txt |
| City | Indianapolis | CityNm |
| State Abbreviation | IN | StateAbbreviationCd |
| ZIP | 46256 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $22,961,255 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | www.fairbankscd.org | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1946 | FormationYr |
| Legal Domicile State | IN | LegalDomicileStateCd |
| Activity Or Mission | NONPROFIT ORGANIZATION FOCUSED ON RECOVERY FROM ALCOHOL AND OTHER DRUG PROBLEMS. | ActivityOrMissionDesc |
| Voting Members Governing Body | 16 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 15 | VotingMembersIndependentCnt |
| Total Employee | 398 | TotalEmployeeCnt |
| Total Volunteers | 267 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $525,943 | PYContributionsGrantsAmt |
| CY Contributions Grants | $477,164 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $22,000,186 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $21,034,391 | CYProgramServiceRevenueAmt |
| PY Investment Income | $126,046 | PYInvestmentIncomeAmt |
| CY Investment Income | $195,830 | CYInvestmentIncomeAmt |
| PY Other Revenue | $1,755,232 | PYOtherRevenueAmt |
| CY Other Revenue | $1,169,662 | CYOtherRevenueAmt |
| PY Total Revenue | $24,407,407 | PYTotalRevenueAmt |
| CY Total Revenue | $22,877,047 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $360,000 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $280,000 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $16,200,484 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $15,606,173 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $419,391 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $7,825,336 | PYOtherExpensesAmt |
| CY Other Expenses | $7,617,944 | CYOtherExpensesAmt |
| PY Total Expenses | $24,385,820 | PYTotalExpensesAmt |
| CY Total Expenses | $23,504,117 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $21,587 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$627,070 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $28,161,251 | TotalAssetsBOYAmt |
| Total Assets EOY | $27,524,705 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $2,118,484 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $2,199,838 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $26,042,767 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $25,324,867 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | FAIRBANKS IS A NONPROFIT ORGANIZATION FOCUSED ON RECOVERY FROM ALCOHOL AND OTHER DRUG PROBLEMS, SERVING AS A RESOURCE TO IMPROVE THE WELL-BEING OF INDIVIDUALS, FAMILIES AND COMMUNITIES BY OFFERING HOPE AND SUPPORT THROUGH ITS PROGRAMS AND SERVICES. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $9,012,698 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $10,143,751 | RevenueAmt |
| Desc | Adult Inpatient Services consisting of detoxification, rehabilitation and residential services. The detoxification phase is a medically managed level of care where the extent of the patient's addiction is determined and the physical and psychological impact of that addiction is assessed and the appropriate treatment course is initiated. For the current fiscal year, Fairbanks Hospital had 9,881 adult detox patient days.The rehabilitation phase occurs when further inpatient stabilization/treatment is needed and required continued medical supervision. The treatment process is multi-disciplinary and group oriented. For the current fiscal year, the hospital had 1,716 adult rehab patient days. The residential program is for the patient who requires a restrictive environment to abstain from using but who is medically stable. The patient participates in no less than four hours of therapy daily and nursing care is provided, if needed. For the current fiscal year, the hospital had 1,908 adult residential patient days. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $3,048,827 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $3,431,441 | RevenueAmt |
| Desc | Adult Outpatient Services Program consisting of Partial Hospitalization (PHP) and Intensive Outpatient Program (IOP). The PHP program is six to seven hours per day Monday through Friday and is a multi-disciplinary and group oriented treatment program. It will contain evaluation and education. It allows the patient to experience life on the "outside" while being involved in a very intense level of treatment. For the current fiscal year, the Hospital had 7,108 PHP visits.IOP is available to those whose addiction is not so severe as to require inpatient or PHP services. The patients must demonstrate the ability to remain drug-free during the entire treatment course and indicate a willingness to become involved in a 12-step program. IOP patients generally meet for three hours, three times per week. IOP offers education and group therapy. For the current fiscal year, the Hospital had 10,028 visits. | Desc |
Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $735,809 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $828,149 | RevenueAmt |
| Desc | Adolescent inpatient services consisting of detoxification, rehabilitation, and residential services. The detoxification phase is a medically managed level of care where the extent of the patient's addiction is determined and the physical and psychological impact of that addiction is assessed and the appropriate treatment course is initiated. Adolescent guidance specialists are members of the treatment team. During this phase of care, various multi-disciplinary evaluations are completed. Families and other support individuals (school, probation, caseworkers, etc) are involved. For the current fiscal year, Fairbanks Hospital had 269 adolescent detox patient days.The adolescent rehab phase is for patients needing further inpatient stabilization/treatment and requires medical supervision. This treatment process is multi-disciplinary and group-oriented. Adolescents receive information on developing social skills, communication, how to gain internal control over feelings, how to deal with anger, how to deal with peer pressure, and other development needs. For the current fiscal year, the hospital had 168 adolescent rehab patient days and 1,403 adolescent residential patient days. | Desc |
Prog Srvc Accom Acty Other ProgSrvcAccomActyOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $5,891,670 | ExpenseAmt |
| Grant | $280,000 | GrantAmt |
| Revenue | $6,833,588 | RevenueAmt |
| Desc | Young adult inpatient services consisting of detoxification, rehabilitation, and residential services for males between the ages of 19-23. The detoxification phase is a medically managed level of care where the extent of the patients addiction is determined and the physical and psychological impact of that addiction is determined and the appropriate treatment course is initiated. Young adult guidance specialists are members of the treatment team. During this phase of care, various multi-disciplinary evaluations are completed. Families and other support individuals (school, probation, caseworkers, etc.) are involved. For the current fiscal year, Fairbanks Hospital had 1,372 young adult detox patient days. The young adult rehab phase is for patients needing further inpatient stabilization/treatment and require medical supervision. This treatment process is multi-disciplinary and group oriented. An important part of the program includes family members of the patient. For the current fiscal year, the hospital had 199 young adult rehab patient days.The residential phase is for young adults in need of stabilization and treatment. Treatment is multi-disciplinary and group oriented. Young adults receive information on developing social skills, communication, how to gain internal control over feeling, how to deal with anger, how to deal with peer pressure, and other development needs. For the current fiscal year, the hospital had 1,570 young adult residential patient days.Adolescent outpatients services program served 1,251 PHP visits and 1,218 IOP visits during the current fiscal year. Young adult outpatient services program served 1,511 PHP visits and 1,615 IOP visits during the current fiscal year. Adult Halfway House served 373 patient days during the current fiscal year. Fairbanks hospital provided 3,142 patient days at Laverna Lodge for Men, 488 days at Laverna Lodge for women, and 26,953 patient days at supported livings facilities during the current fiscal year. | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Prog Srvc Expense | $5,891,670 | TotalOtherProgSrvcExpenseAmt |
| Total Other Prog Srvc Grant | $280,000 | TotalOtherProgSrvcGrantAmt |
| Total Other Prog Srvc Revenue | $6,833,588 | TotalOtherProgSrvcRevenueAmt |
| Total Program Service Expenses | $18,689,004 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Temp Or Permanent Endowments | Yes (1) | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | Yes (1) | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | Yes (1) | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (1) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | 0 | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 45 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 398 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | Yes (1) | QuidProQuoContributionsInd |
| Quid Pro Quo Contri Discl | Yes (1) | QuidProQuoContriDisclInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 16 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 15 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 0 | MembersOrStockholdersInd |
| Election Of Board Members | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | 0 | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | IN | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Janine R Shopp | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 3175729387 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 8102 Clearvista Parkway | AddressLine1Txt |
| City | Indianapolis | CityNm |
| State Abbreviation | IN | StateAbbreviationCd |
| ZIP | 46256 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | Yes (X) | InfoInScheduleOPartVIIInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (25 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| Faraz Abbasi | ||||||||
| Chairman | 1.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| Tom Flowers | ||||||||
| Vice Chair | 1.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| Kevin Murphy | ||||||||
| Treasurer | 1.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| Carol Brown Lukemeyer | ||||||||
| Secretary | 1.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| John Adams IV | ||||||||
| Board Member-term began Apr 2017 | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| Patrick Carr | ||||||||
| Board Member | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| David Corbitt | ||||||||
| Board Member | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| Greg Fulk | ||||||||
| Board Member-term began Apr 2017 | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| Marissa Manlove | ||||||||
| Board Member | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| William McKay II | ||||||||
| Board Member | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| Ann Merkel | ||||||||
| Board Member | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| Matthew Neff | ||||||||
| Board Member-term began Apr 2017 | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| John Ryan | ||||||||
| Board Member | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| Adrienne Takacs | ||||||||
| Board Member | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| Ronda Shrewsbury Weybright | ||||||||
| Board Member | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| Beverly Pitts | ||||||||
| Board Member-term end Oct 2016 | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| Karl Stout | ||||||||
| Board Member-term end Apr 2017 | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| Kent Brown | ||||||||
| President/CEO-term end Oct 2016 | 36.80 | 1.60 | Yes (X) | $264,597 | $0 | $9,626 | ||
| Barbara Elliot | ||||||||
| President/CEO-term began Dec 2016 | 32.40 | 3.60 | Yes (X) | Yes (X) | $186,517 | $0 | $32,391 | |
| Janine Shopp | ||||||||
| CFO-term began Feb 2017 | 32.40 | 3.60 | Yes (X) | $0 | $0 | $0 | ||
| Dr Darrin Mangiacarne | ||||||||
| Medical Director | 40.00 | 0.00 | Yes (X) | $320,478 | $0 | $31,584 | ||
| DrJames Meacham | ||||||||
| Physician | 40.00 | 0.00 | $139,146 | $0 | $10,554 | Yes (X) | ||
| Dr Andrew Sonderman | ||||||||
| Physician | 40.00 | 0.00 | $149,277 | $0 | $14,239 | Yes (X) | ||
| Robin Parsons | ||||||||
| CCO | 40.00 | 0.00 | $111,098 | $0 | $24,294 | Yes (X) | ||
| SHARON BAKER | ||||||||
| Director of Support Servic | 40.00 | 0.00 | $110,833 | $0 | $24,729 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,281,946 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $147,417 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 7 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| Sodexo Inc & Affiliates | |||||
| 4880 Paysphere Circle | Chicago | IL | 60674 | Food Service Management and staffing | $1,107,888 |
| Abbaspour Inc | |||||
| 7320 E 82nd St | Indianapolis | IN | 46256 | Pharmacy Services | $498,381 |
| South Bend Medical Foundation | |||||
| PO Box 2030 | Mishawaka | IN | 46546 | Lab Services | $330,397 |
| Netsmart Technologies | |||||
| PO Box 823519 | Philadelphia | PA | 19182 | IT Services | $232,540 |
| FA Wilhelm Construction Compabny | |||||
| PO Box 516 | Indianapolis | IN | 46206 | Construction Services | $174,841 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 6 | CntrctRcvdGreaterThan100KCnt |
| Fundraising | $53,073 | FundraisingAmt |
| All Other Contributions | $424,091 | AllOtherContributionsAmt |
| Total Contributions | $477,164 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | Patient Service Revenue | Desc |
| Business | 621300 | BusinessCd |
| Total Revenue Column | $21,034,391 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $21,034,391 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $21,034,391 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $170,780 | TotalRevenueColumnAmt |
| Exclusion | $170,780 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $144,600 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $0 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $144,600 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $144,600 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $144,600 | RelatedOrExemptFuncIncomeAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $25,050 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $0 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $25,050 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $25,050 | TotalRevenueColumnAmt |
| Exclusion | $25,050 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fundraising Gross Income | $117,489 | FundraisingGrossIncomeAmt |
| Contri Rpt Fundraising Event | $53,073 | ContriRptFundraisingEventAmt |
| Fundraising Direct Expenses | $84,208 | FundraisingDirectExpensesAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $33,281 | TotalRevenueColumnAmt |
| Exclusion | $33,281 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | ExclusionExclusionAmt |
|---|---|---|---|
| Assisted Living Program | 624229 | $685,113 | $685,113 |
| Gift Shop & Cafeteria Revenue | 624100 | $72,604 | $72,604 |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $234,064 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $57,938 | RelatedOrExemptFuncIncomeAmt |
| Exclusion | $176,126 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $991,781 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $22,877,047 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $21,236,929 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $1,162,954 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $280,000 | TotalAmt |
| Program Services | $280,000 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $771,592 | TotalAmt |
| Program Services | $320,478 | ProgramServicesAmt |
| Management And General | $451,114 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $11,261,829 | TotalAmt |
| Program Services | $9,136,693 | ProgramServicesAmt |
| Management And General | $1,848,805 | ManagementAndGeneralAmt |
| Fundraising | $276,331 | FundraisingAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $337,315 | TotalAmt |
| Program Services | $274,881 | ProgramServicesAmt |
| Management And General | $54,184 | ManagementAndGeneralAmt |
| Fundraising | $8,250 | FundraisingAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,327,661 | TotalAmt |
| Program Services | $1,876,133 | ProgramServicesAmt |
| Management And General | $395,272 | ManagementAndGeneralAmt |
| Fundraising | $56,256 | FundraisingAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $907,776 | TotalAmt |
| Program Services | $739,755 | ProgramServicesAmt |
| Management And General | $145,819 | ManagementAndGeneralAmt |
| Fundraising | $22,202 | FundraisingAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $120,586 | TotalAmt |
| Management And General | $120,586 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $62,850 | TotalAmt |
| Management And General | $62,850 | ManagementAndGeneralAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $27,515 | TotalAmt |
| Program Services | $27,515 | ProgramServicesAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,002,422 | TotalAmt |
| Program Services | $2,133,882 | ProgramServicesAmt |
| Management And General | $851,577 | ManagementAndGeneralAmt |
| Fundraising | $16,963 | FundraisingAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $365,380 | TotalAmt |
| Program Services | $329,172 | ProgramServicesAmt |
| Management And General | $33,213 | ManagementAndGeneralAmt |
| Fundraising | $2,995 | FundraisingAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $242,601 | TotalAmt |
| Program Services | $183,421 | ProgramServicesAmt |
| Management And General | $58,339 | ManagementAndGeneralAmt |
| Fundraising | $841 | FundraisingAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,212,403 | TotalAmt |
| Program Services | $1,153,612 | ProgramServicesAmt |
| Management And General | $58,791 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $49,957 | TotalAmt |
| Program Services | $48,088 | ProgramServicesAmt |
| Management And General | $1,606 | ManagementAndGeneralAmt |
| Fundraising | $263 | FundraisingAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $48,360 | TotalAmt |
| Program Services | $36,249 | ProgramServicesAmt |
| Management And General | $11,463 | ManagementAndGeneralAmt |
| Fundraising | $648 | FundraisingAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $11,914 | TotalAmt |
| Program Services | $11,914 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,178,669 | TotalAmt |
| Program Services | $1,089,668 | ProgramServicesAmt |
| Management And General | $89,001 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $290,418 | TotalAmt |
| Program Services | $226,482 | ProgramServicesAmt |
| Management And General | $63,936 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt | FundraisingFundraisingAmt |
|---|---|---|---|---|
| Miscellaneous | $622,707 | $591,460 | $26,039 | $5,208 |
| Equipment Maintenance a | $147,022 | $135,744 | $11,278 | |
| Printing and Publicatio | $41,899 | $10,654 | $22,773 | $8,472 |
| Postage and Shipping | $16,681 | $10,973 | $4,522 | $1,186 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $176,560 | TotalAmt |
| Program Services | $72,230 | ProgramServicesAmt |
| Management And General | $84,554 | ManagementAndGeneralAmt |
| Fundraising | $19,776 | FundraisingAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $23,504,117 | TotalAmt |
| Program Services | $18,689,004 | ProgramServicesAmt |
| Management And General | $4,395,722 | ManagementAndGeneralAmt |
| Fundraising | $419,391 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $722,783 | BOYAmt |
| EOY | $1,096,426 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,945,166 | BOYAmt |
| EOY | $5,645,055 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,565 | BOYAmt |
| EOY | $125 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,913,380 | BOYAmt |
| EOY | $3,809,668 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $644,123 | BOYAmt |
| EOY | $630,881 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $24,784,141 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $12,456,248 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $12,993,357 | BOYAmt |
| EOY | $12,327,893 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,741,793 | BOYAmt |
| EOY | $3,814,893 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $195,084 | BOYAmt |
| EOY | $199,764 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $28,161,251 | BOYAmt |
| EOY | $27,524,705 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,462,824 | BOYAmt |
| EOY | $1,624,759 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $23,050 | BOYAmt |
| EOY | $0 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $361,500 | BOYAmt |
| EOY | $316,077 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $271,110 | BOYAmt |
| EOY | $259,002 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,118,484 | BOYAmt |
| EOY | $2,199,838 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $25,803,519 | BOYAmt |
| EOY | $25,137,351 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $239,248 | BOYAmt |
| EOY | $187,516 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $26,042,767 | BOYAmt |
| EOY | $25,324,867 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $28,161,251 | BOYAmt |
| EOY | $27,524,705 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | -$627,070 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $185,932 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | -$276,762 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Form990 Schedule A Part VI Form990ScheduleAPartVIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Schedule A, Part 1, Line 3: | FormAndLineReferenceDesc |
| Explanation | Fairbanks Hospital, Inc. has been determined by the IRS to be a public charity under IRS code section 170(b)(1)(A)(iii). Per Schedule H instructions only organizations that operate at least one facility that is, or is required to be, licensed, registered, or similarly recognized by a state as a hospital is required to complete this schedule. Fairbank Hospital, Inc. is a private mental health institution and certified as an addictions service provider. Fairbanks Hospital is not licensed by the Indiana State Department of Health as a hospital, but is recognized by the Centers for Medicaid and Medicare as an acute care hospital. The completion of Schedule H is not required; however, Fairbanks' management has decided to complete Schedule H to provide information to the community regarding its financial assistance, community benefits, and facility information. | ExplanationTxt |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule D IRS990ScheduleD
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $1,013,434 | BeginningYearBalanceAmt |
| Contributions | $268,722 | ContributionsAmt |
| Other Expenditures | $317,960 | OtherExpendituresAmt |
| End Year Balance | $964,196 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $949,663 | BeginningYearBalanceAmt |
| Contributions | $324,621 | ContributionsAmt |
| Other Expenditures | $260,850 | OtherExpendituresAmt |
| End Year Balance | $1,013,434 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $861,341 | BeginningYearBalanceAmt |
| Contributions | $434,001 | ContributionsAmt |
| Other Expenditures | $345,679 | OtherExpendituresAmt |
| End Year Balance | $949,663 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $898,546 | BeginningYearBalanceAmt |
| Contributions | $405,239 | ContributionsAmt |
| Other Expenditures | $442,444 | OtherExpendituresAmt |
| End Year Balance | $861,341 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $924,344 | BeginningYearBalanceAmt |
| Contributions | $2,368,777 | ContributionsAmt |
| Other Expenditures | $2,394,575 | OtherExpendituresAmt |
| End Year Balance | $898,546 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated Balance EOY | 0.80550 | BoardDesignatedBalanceEOYPct |
| Prmnnt Endowment Balance EOY | 0.00000 | PrmnntEndowmentBalanceEOYPct |
| Term Endowment Balance EOY | 0.19450 | TermEndowmentBalanceEOYPct |
| Endowments Held Unrelated Org | 0 | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | 0 | EndowmentsHeldRelatedOrgInd |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $138,876 | OtherCostOrOtherBasisAmt |
| Book Value | $138,876 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $16,426,090 | OtherCostOrOtherBasisAmt |
| Depreciation | $7,168,195 | DepreciationAmt |
| Book Value | $9,257,895 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $8,219,175 | OtherCostOrOtherBasisAmt |
| Depreciation | $5,288,053 | DepreciationAmt |
| Book Value | $2,931,122 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $12,327,893 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | Estimated third party settlements | Desc |
| Amt | $259,002 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $259,002 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $23,147,187 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | $185,932 | NetUnrealizedGainsInvstAmt |
| Other Revenue | $84,208 | OtherRevenueAmt |
| Revenue Not Reported | $270,140 | RevenueNotReportedAmt |
| Revenue Subtotal | $22,877,047 | RevenueSubtotalAmt |
| Revenue Not Reported Fincl Stmt | $0 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $22,877,047 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $23,588,325 | TotExpnsEtcAuditedFinclStmtAmt |
| Other Expenses Included | $84,208 | OtherExpensesIncludedAmt |
| Expenses Not Reported | $84,208 | ExpensesNotReportedAmt |
| Expenses Subtotal | $23,504,117 | ExpensesSubtotalAmt |
| Expenses Not Rpt Fincl Stmt | $0 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $23,504,117 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part V, Line 4: | Temporarily restricted net assets are those assets whose use has been limited by donors for a specific operating or capital purpose. Board designated funds are set aside by the Board for specific purposes including charity care. |
| Part X, Line 2: | Accounting principles generally accepted in the United States of America require management to evaluate tax positions taken by Fairbanks and the School and recognize a tax liability if Fairbanks or the School has taken an uncertain position that more likely than not would not be sustained upon examination by various federal and state taxing authorities. Management has analyzed the tax positions taken by Fairbanks and the School, and has concluded that as of June 30, 2017 and 2016, there are no uncertain positions taken or expected to be taken that would require recognition of a liability or disclosure in the accompanying financial statements. |
| Part XI, Line 2d - Other Adjustments: | Fundraising Event Activity 84,208. |
| Part XII, Line 2d - Other Adjustments: | Fundraising Event Activity 84,208. |
Schedule G IRS990ScheduleG
Fundraising Event Information FundraisingEventInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Event1 | Circle of Hope Dinner | Event1Nm |
| Gross Receipts Event1 | $170,562 | GrossReceiptsEvent1Amt |
| Charitable Contri Event1 | $53,073 | CharitableContriEvent1Amt |
| Gross Revenue Event1 | $117,489 | GrossRevenueEvent1Amt |
| Non Cash Prizes Event1 | $614 | NonCashPrizesEvent1Amt |
| Rent Facility Costs Event1 | $22,519 | RentFacilityCostsEvent1Amt |
| Food And Beverage Event1 | $34,844 | FoodAndBeverageEvent1Amt |
| Entertainment Event1 | $8,658 | EntertainmentEvent1Amt |
| Other Direct Expenses Event1 | $17,573 | OtherDirectExpensesEvent1Amt |
| Gross Receipts Total | $170,562 | GrossReceiptsTotalAmt |
| Charitable Contributions Tot | $53,073 | CharitableContributionsTotAmt |
| Gross Revenue Total Events | $117,489 | GrossRevenueTotalEventsAmt |
| Non Cash Prizes Total Events | $614 | NonCashPrizesTotalEventsAmt |
| Rent Fclty Costs Total Events | $22,519 | RentFcltyCostsTotalEventsAmt |
| Food And Beverage Total Events | $34,844 | FoodAndBeverageTotalEventsAmt |
| Entertainment Total Events | $8,658 | EntertainmentTotalEventsAmt |
| Oth Direct Expnss Total Events | $17,573 | OthDirectExpnssTotalEventsAmt |
| Direct Expense Summary Events | $84,208 | DirectExpenseSummaryEventsAmt |
| Net Income Summary | $33,281 | NetIncomeSummaryAmt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| FPG Reference Free Care | 0 | FPGReferenceFreeCareInd |
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
| Percent250 | Yes (X) | Percent250Ind |
| Free Care Medically Indigent | 0 | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | 0 | ExpensesExceedBudgetInd |
| Annual Community Bnft Report | Yes (1) | AnnualCommunityBnftReportInd |
| Report Publically Available | 0 | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $946,214 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $946,214 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.04030 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $5,724,905 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $5,252,674 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $472,231 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02010 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $6,671,119 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $5,252,674 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,418,445 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.06040 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,343,671 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $6,256 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,337,415 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.05690 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,343,671 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $6,256 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,337,415 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.05690 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $8,014,790 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $5,258,930 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,755,860 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.11730 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $1,919,804 | BadDebtExpenseAmt |
| Reimbursed By Medicare | $2,335,430 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $1,756,027 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | $579,403 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | FAIRBANKS HOSPITAL INC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 8102 Clearvista Parkway | AddressLine1Txt |
| City | Indianapolis | CityNm |
| State Abbreviation | IN | StateAbbreviationCd |
| ZIP | 46256 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | www.fairbankscd.org | WebsiteAddressTxt |
| State License | 83-5-1-PI-P | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| Other | Licensed Private Mental Health Institution | OtherDesc |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | FAIRBANKS HOSPITAL INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | 0 | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| CHNA Conducted | 15 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | 0 | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | 0 | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | http://www.fairbankscd.org | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Rpt Available Thru Other Method | Yes (X) | RptAvailableThruOtherMethodInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 16 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | See Part V, Page 7 | StrategyWebsiteURLTxt |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 0.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 250.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Income Level Criteria | Yes (X) | IncomeLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Provided Nonprofit Contact | Yes (X) | ProvidedNonprofitContactInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | http://www.fairbankscd.org/wp-content/uploads/F-7-charity-care.pdf | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | http://www.fairbankscd.org/wp-content/uploads/F-7-charity-care.pdf | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | http://www.fairbankscd.org/programs/category/cost-and-insurance/ | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| Notified FAP Copy Bill Display | Yes (X) | NotifiedFAPCopyBillDisplayInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| Provided Written Notice | Yes (X) | ProvidedWrittenNoticeInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Made Presumptive Elig Determ | Yes (X) | MadePresumptiveEligDetermInd |
| Nondis Emergency Care Policy | 0 | NondisEmergencyCarePolicyInd |
| No Emergency Care | Yes (X) | NoEmergencyCareInd |
| Look Back Medicaid Medcr Prvt | Yes (X) | LookBackMedicaidMedcrPrvtInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FAIRBANKS HOSPITAL, INC | Part V, Section B, Line 5: In conducting its most recent CHNA the Hospital took into account input from persons who represented the community it served including those with special knowledge through four focus groups. The groups were determined through discussion with academic and healthcare experts who have knowledge of the substance impacted population in the Indianapolis metropolitan area. The first group consisted of addiction service providers for low income and minority populations and community stakeholders from the state criminal justice department, task force on drug free Marion county, halfway houses, primary medical care coalition, and employee assistance programs. Adolescents attending the recovery high school comprised the second group; family members of those who received addiction treatment services were in the third group, and the fourth group consisted of adult patients who had successfully completed inpatient treatment. Focus group questions included identification of strengths and weaknesses in the addiction treatment system, barriers to services, gaps in services, and recommendations for the system of care. |
| FAIRBANKS HOSPITAL, INC | Part V, Section B, Line 7d: THE HOSPITAL FACILITY'S CHNA IS AVAILABLE TO THE PUBLIC ON THE HOSPITAL'S WEBSITE AT WWW.FAIRBANKSCD.ORG UNDER "ABOUT US AND CLICK ON "COMMUNITY NEEDS ASSESSMENT OR ENTER THE FOLLOWING WEB ADDRESS INTO THE BROWSER: https://www.fairbankscd.org/wp-content/uploads/community-needs-assessment-ppt.pdf |
| FAIRBANKS HOSPITAL, INC | Part V, Section B, Line 11: The hospital facility completed its most recent CHNA as of 6/30/16 (Tax Year 2015) and has identified six significant needs for its implementation strategy covering the tax years 2016 - 2018 and approved in tax year 2016. The Hospital has successfully implemented strategies to address each of the needs identified in the assessment. |
| FAIRBANKS HOSPITAL, INC | Part V, Section B, Line 16j: Financial Assistance Policy can be found at www.fairbankscd.org under "Cost and Insurance" under "Our Programs". |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 3 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (3 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| 1 - LAVERNA LODGE | ||||
| 8102 Clearvista Parkway | Indianapolis | IN | 46256 | Drug & Alcohol Residential Rehab - Separate LOCATION FOR MEN & WOMEN |
| 2 - Supported Living Program | ||||
| 8102 Clearvista Parkway | Indianapolis | IN | 46256 | Adult Halfway House & Drug & Alcohol Supported Living |
| 3 - PlainField Addictions Treatment Facility | ||||
| 6100 Clarks Creek Rd Ste 102 104 | Plainfield | IN | 46168 | outpatient Center |
Supplemental Information Detail SupplementalInformationDetail (10 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part I, Line 7: | Fairbanks uses the IRS Worksheets provided in the Instructions for Form 990, Schedule H to calculate a single cost to charge ratio which is applied to the charges for financial assistance and other benefits to provide amounts at cost. |
| Part I, Ln 7 Col(f): | Effective July 1, 2012, Fairbanks adopted Accounting Standards Update (ASU)2011-07, Healthcare Entities (Topic 954), "Presentation and Disclosure of Patient Service Revenue, Provision for Bad Debts, and the Allowance for Doubtful Accounts for Certain Healthcare Entities," which requires certain healthcare entities to present the provision for bad debts relating to patient service revenue as a deduction from patient service revenue in the consolidated statements of operations and changes in net assets rather than as an operating expense. Adoption of this standard has no impact on its financial position, results of operations, or cash flows. |
| Part III, Line 4: | Bad Debt Expense Footnote to audited financial statements is located on pages 7 and 8 of the attached audited financial statements under the heading "Allowance for Doubtful Accounts". |
| Part III, Line 8: | Medicare allowable costs are calculated by using the ratio of cost to charges. The source used to determine the amount of Medicare allowable costs reported for Part III, Section B, Medicare has been provided from the year ended June 30, 2017: Hospital Statement of Reimbursable Cost. |
| Part III, Line 9b: | When an account is identified as uncollectible, it becomes bad debt. If the financial position of the identified individual's account has been verified as being in a financial position of 250% Federal Poverty Level, the account will be reclassed as charity care. |
| Part VI, Line 2: | Fairbanks engaged the services of the Indiana University Center for Health Policy to conduct community focus groups. The groups were determined through discussion with academic and healthcare experts who have knowledge of the substance impacted population in the Indianapolis metropolitan area. Five separate focus groups were developed. The first group consisted of addiction service providers for low income and minority populations; the second group was composed of community stakeholders from the state criminal justice department, task force on drug free Marion County, halfway houses, primary medical care coalition, and Employee Assistance Programs. Adolescents attending the recovery high school comprised the third group; parents of adolescents who had received addiction treatment services were in the fourth, and the fifth group consisted of adult patients who had successfully completed inpatient treatment. Focus group questions included identification of strengths and weaknesses in the addiction treatment system, barriers to services, gaps in services, and recommendations for the system of care. |
| Part VI, Line 3: | Those individuals seeking admission to Fairbanks have the opportunity to meet with a financial counselor to determine what resources are available. In addition, an information booklet is given to the families during the admission process which notes that charity care is available. Lastly, signs are visible to patients in the access department where admissions take place. Fairbanks uses the local media to assist in educating the public concerning prevention, intervention and treatment. Also, Fairbanks participates in National Alcohol Awareness Month, Recovery Month community activities, and provides community education through the Susan Li Conference. |
| Part VI, Line 4: | For the fiscal year ended June 30, 2017, 20,395 persons were served; 61% from united way of central Indiana counties, 23% surrounding counties, 12% remaining Indiana counties, and 4% out of state. |
| Part VI, Line 5: | The organization furthers its exempt purpose by promoting health of the community through the following: the organization's governing body is comprised of a majority of independent persons who reside in the organization's primary service area. Surplus of funds when available are used to improve the patient care and medical education of the staff; and a percentage of operating income is restricted for patient scholarship funds. Fairbanks uses the local media to assist in educating the public concerning prevention, intervention and treatment. The organization also participates in National Alcohol Awareness Month, Recovery Month community activities and provides community education through the Susan Li Conference. |
| Part VI, Line 6: | n/a - organization is not part of an affiliated health care system. |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (1) | GrantRecordsMaintainedInd |
Recipient Table RecipientTable
Recipient Business Name RecipientBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | HOPE ACADEMY | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 8102 Clearvista Parkway | AddressLine1Txt |
| City | Indianapolis | CityNm |
| State Abbreviation | IN | StateAbbreviationCd |
| ZIP | 46256 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Recipient EIN | 203094377 | RecipientEIN |
| Cash Grant | $280,000 | CashGrantAmt |
| Valuation Method Used | Cost | ValuationMethodUsedDesc |
| Non Cash Assistance | Debt Forgiveness | NonCashAssistanceDesc |
| Purpose Of Grant | General Support | PurposeOfGrantTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 1 | Total501c3OrgCnt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part I, Line 2: | FormAndLineReferenceDesc |
| Explanation | There were no cash grant funds greater than $5,000 awarded during the year. Assistance was provided only to a 501(c)(3) public charity for general support. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Independent Consultant | Yes (X) | IndependentConsultantInd |
| Written Employment Contract | Yes (X) | WrittenEmploymentContractInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (4 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Kent Brown | ||||||||||||||
| President/CEO-term end Oct 2016 | $264,597 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $9,626 | $0 | $274,223 | $0 | $0 | $0 |
| Barbara Elliot | ||||||||||||||
| President/CEO-term began Dec 2016 | $186,517 | $0 | $0 | $0 | $0 | $0 | $10,549 | $0 | $21,842 | $0 | $218,908 | $0 | $0 | $0 |
| Dr Darrin Mangiacarne | ||||||||||||||
| Medical Director | $320,478 | $0 | $0 | $0 | $0 | $0 | $8,678 | $0 | $22,906 | $0 | $352,062 | $0 | $0 | $0 |
| Dr Andrew Sonderman | ||||||||||||||
| Physician | $149,277 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $14,239 | $0 | $163,516 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Schedule J, Part II | FormAndLineReferenceDesc |
| Explanation | MR. KENT BROWN IS COMPENSATED BY FAIRBANKS HOSPITAL, INC. FOR HIS DUTIES AS PRESIDENT/CEO OF THE HOSPITAL. A PORTION OF HIS COMPENSATION RECEIVED FROM FAIRBANKS HOSPITAL, INC. IS ALLOCATED TO HOPE ACADEMY FOR DUTIES PROVIDED. FOR CALENDAR YEAR 2016, 4% OF MR. BROWNS' HOURS OR SALARIES AND BENEFITS TOTALING $10,968 ARE ALLOCATED TO HOPE ACADEMY. MR. BROWN SERVED A PARTIAL YEAR (THROUGH OCTOBER 2016) BEFORE MS. BARBARA ELLIOTT SUCCEEDED TO THE CEO POSITION IN NOVEMBER OF 2016. MS. BARBARA ELLIOTT IS COMPENSATED BY FAIRBANKS HOSPITAL, INC. FOR HER DUTIES AS CFO AND EVENTUALLY PRESIDENT/CEO OF THE HOSPITAL. A PORTION OF HER COMPENSATION RECEIVED FROM FAIRBANKS HOSPITAL, INC. IS ALLOCATED TO HOPE ACADEMY FOR DUTIES PROVIDED. For the period SERVING AS CFO, 10% OF MS. ELLIOTT'S HOURS OR SALARIES AND BENEFITS TOTALING $9,121 ARE ALLOCATED TO HOPE ACADEMY and for the period AS CEO, 4% OF MS. ELLIOTT'S HOURS OR SALARIES AND BENEFITS TOTALING $5,108 ARE ALLOCATED TO HOPE ACADEMY. For Calendar Year 2016, Ms. Elliott's total combined hours or salaries and benefits totaling $14,229 are allocated to Hope Academy MS. JANINE SHOPP SERVED AS CFO BEGINNING IN EARLY 2017. MS. JANINE SHOPP IS COMPENSATED BY FAIRBANKS HOSPITAL, INC. FOR HER DUTIES AS VICE PRESIDENT AND CFO OF THE HOSPITAL. A PORTION OF HER COMPENSATION RECEIVED FROM FAIRBANKS HOSPITAL, INC. IS ALLOCATED TO HOPE ACADEMY FOR DUTIES PROVIDED. AS SHE BEGAN IN 2017, SHE RECEIVED NO 2016 WAGES FROM FAIRBANKS. FOR FY 17, 10% OF MS. SHOPP'S HOURS will be ALLOCATED TO HOPE ACADEMY. | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (8 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part VI, Section B, line 11b | THE PROCESS OF REVIEWING THE FORM 990 INCLUDES A DETAILED REVIEW OF THE FORM 990 AND REQUIRED SCHEDULES BY THE CHIEF EXECUTIVE OFFICER, CHIEF FINANCIAL OFFICER, AND BOARD FINANCE COMMITTEE. EACH VOTING MEMBER OF THE GOVERNING BODY REVIEWS AND APPROVES THE FORM 990 AT THE BOARD OF DIRECTOR MEETING PRIOR TO FILING WITH THE IRS. |
| Form 990, Part VI, Section B, line 12c | The Board members must complete a conflict of interest form annually. Board members who have a potential for conflict must recuse themselves from voting on subjects that might pose a conflict. The Corporate Compliance Officer reviews any potential conflicts that are reported. |
| Form 990, Part VI, Section B, line 15a | All current members of the board of directors are given a written evaluation form to rate the CEO. All information is then compiled in a final report and presented by the board chair to the CEO. For compensation, we compile data provided by our independent auditors from the Indiana hospital association, other mental health providers, and NAATP (national association of addiction treatment providers) to ensure the salary is competitive and reasonable. Members of the executive compensation committee of the board of directors meet to discuss and review that data and make a final decision regarding compensation that is then reviewed and approved by the executive committee of the board of directors. |
| Form 990, Part VI, Section C, line 19 | THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND DETAILED FINANCIAL STATEMENT INFORMATION IS AVAILABLE TO THE PUBLIC UPON REQUEST. The audited financial statements are attached to the Form 990 per regulation 1.6033-2(a)(2)(ii)(l)(1). Additionally, SUMMARY FINANCIAL STATEMENT INFORMATION IS AVAILABLE IN THE ANNUAL REPORTS ON THE ORGANIZATION'S WEBSITE. |
| Form 990, Part VII, Section A, Line 1a: Related Organization Hours | MR. KENT BROWN IS COMPENSATED BY FAIRBANKS HOSPITAL, INC. FOR HIS DUTIES AS PRESIDENT/CEO OF THE HOSPITAL. A PORTION OF HIS COMPENSATION RECEIVED FROM FAIRBANKS HOSPITAL, INC. IS ALLOCATED TO HOPE ACADEMY FOR DUTIES PROVIDED. FOR CALENDAR YEAR 2016, 4% OF MR. BROWNS' HOURS OR SALARIES AND BENEFITS TOTALING $10,968 ARE ALLOCATED TO HOPE ACADEMY. MR. BROWN SERVED A PARTIAL YEAR (THROUGH OCTOBER 2016) BEFORE MS. BARBARA ELLIOTT SUCCEEDED TO THE CEO POSITION IN NOVEMBER OF 2016. MS. BARBARA ELLIOTT IS COMPENSATED BY FAIRBANKS HOSPITAL, INC. FOR HER DUTIES AS CFO AND EVENTUALLY PRESIDENT/CEO OF THE HOSPITAL. A PORTION OF HER COMPENSATION RECEIVED FROM FAIRBANKS HOSPITAL, INC. IS ALLOCATED TO HOPE ACADEMY FOR DUTIES PROVIDED. FOR THE PERIOD SERVING AS CFO, 10% OF MS. ELLIOTT'S HOURS OR SALARIES AND BENEFITS TOTALING $9,121 ARE ALLOCATED TO HOPE ACADEMY AND FOR THE PERIOD AS CEO, 4% OF MS. ELLIOTT'S HOURS OR SALARIES AND BENEFITS TOTALING $5,108 ARE ALLOCATED TO HOPE ACADEMY. FOR CALENDAR YEAR 2016, MS. ELLIOTT'S TOTAL COMBINED HOURS OR SALARIES AND BENEFITS TOTALING $14,229 ARE ALLOCATED TO HOPE ACADEMY MS. JANINE SHOPP SERVED AS CFO BEGINNING IN EARLY 2017. MS. JANINE SHOPP IS COMPENSATED BY FAIRBANKS HOSPITAL, INC. FOR HER DUTIES AS VICE PRESIDENT AND CFO OF THE HOSPITAL. A PORTION OF HER COMPENSATION RECEIVED FROM FAIRBANKS HOSPITAL, INC. IS ALLOCATED TO HOPE ACADEMY FOR DUTIES PROVIDED. AS SHE BEGAN IN 2017, SHE RECEIVED NO 2016 WAGES FROM FAIRBANKS. FOR FY 17, 10% OF MS. SHOPP'S HOURS WILL BE ALLOCATED TO HOPE ACADEMY. |
| Form 990, Part IX, line 11g | Purchase Services: Program service expenses 2,133,882. Management and general expenses 851,577. Fundraising expenses 16,963. Total expenses 3,002,422. |
| Form 990, Part XI, line 9: | Net Assets Transferred to Hope Academy -276,762. |
| Form 990, Part XI, Line 2c: Audit Oversight | The organization utilizes the audit and finance committee of the Board of Directors to oversee the audit procedures and selection of the independent accounting firm. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | The Recovery High School at Fairbanks Inc dba Hope Academy | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 8102 Clearvista Parkway | AddressLine1Txt |
| City | Indianapolis | CityNm |
| State Abbreviation | IN | StateAbbreviationCd |
| ZIP | 46256 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 203094377 | EIN |
| Primary Activities | Charter School | PrimaryActivitiesTxt |
| Legal Domicile State | IN | LegalDomicileStateCd |
| Exempt Code Section | 501(c)(3) | ExemptCodeSectionTxt |
| Public Charity Status | Line 2 | PublicCharityStatusTxt |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Fairbanks Hospital Inc | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Controlled Organization | Yes (1) | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | Yes (1) | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | 0 | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | Yes (1) | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | Yes (1) | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | Yes (1) | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (1) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (1) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (2 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt |
|---|---|---|
| The Recovery High School at Fairbanks Inc dba Hope Academy | ||
| B | $556,762 | cost |
| THE RECOVERY HIGH SCHOOL AT FAIRBANKS INC DBA HOPE ACADEMY | ||
| J | $144,600 | cost |