AMELIA BROWN FRAZIER REHAB CTR INC BOARD DI: Form 990, tax year 2014
View the entire original 990 at ProPublica ↗
- Organization
- AMELIA BROWN FRAZIER REHAB CTR INC BOARD DI (EIN 35-1903507)
- Tax period
- 2014-01-01 to 2014-12-31
- Filed
- 2015-11-10
- IRS object ID
- 201533149349300048
- Schema version
- 2014v5.0
- 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 C
- Schedule D
- Schedule H
- Schedule J
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2015-11-10T09:52:46-06:00 | ReturnTs |
| Tax Period End | 2014-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BKD LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 600 N Hurstbourne Parkway 350 | AddressLine1Txt |
| City | Louisville | CityNm |
| State Abbreviation | KY | StateAbbreviationCd |
| ZIP | 40222 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2014-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 351903507 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | AMELIA BROWN FRAZIER REHAB CTR INC BOARD DIR | BusinessNameLine1Txt |
| Business Name Line2 | DBA SOUTHERN INDIANA REHABILITATION HOSPITAL | BusinessNameLine2Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| In Care Of | % TAMMY HOWELL | InCareOfNm |
| Business Name Control | AMEL | BusinessNameControlTxt |
| Phone | 8129416106 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3104 BLACKISTON BLVD | AddressLine1Txt |
| City | NEW ALBANY | CityNm |
| State Abbreviation | IN | StateAbbreviationCd |
| ZIP | 47150 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | RANDY NAPIER | PersonNm |
| Person Title | CEO | PersonTitleTxt |
| Phone | 8139416106 | PhoneNum |
| Signature | 2015-11-10 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Kim Scifres | PreparerPersonNm |
| PTIN | P01316095 | PTIN |
| Phone | 5025810435 | PhoneNum |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2014 | TaxYr |
| Build TS | 2016-02-25 16:41:14Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | Randy Napier | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3104 Blackiston Blvd | AddressLine1Txt |
| City | New Albany | CityNm |
| State Abbreviation | IN | StateAbbreviationCd |
| ZIP | 47150 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $17,056,910 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | www.sirh.org | WebsiteAddressTxt |
| Type Of Organization Assoc | Yes (X) | TypeOfOrganizationAssocInd |
| Formation | 1993 | FormationYr |
| Legal Domicile State | IN | LegalDomicileStateCd |
| Activity Or Mission | Assist Physically impaired individuals throughout the region. | ActivityOrMissionDesc |
| Voting Members Governing Body | 10 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 10 | VotingMembersIndependentCnt |
| Total Employee | 294 | TotalEmployeeCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| PY Contributions Grants | $50 | PYContributionsGrantsAmt |
| CY Contributions Grants | $83,910 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $18,164,799 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $16,936,989 | CYProgramServiceRevenueAmt |
| PY Investment Income | $1,346 | PYInvestmentIncomeAmt |
| CY Investment Income | $1,083 | CYInvestmentIncomeAmt |
| PY Other Revenue | $36,391 | PYOtherRevenueAmt |
| CY Other Revenue | $34,928 | CYOtherRevenueAmt |
| PY Total Revenue | $18,202,586 | PYTotalRevenueAmt |
| CY Total Revenue | $17,056,910 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $11,559,877 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $11,098,444 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $7,430 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $6,895,480 | PYOtherExpensesAmt |
| CY Other Expenses | $6,591,365 | CYOtherExpensesAmt |
| PY Total Expenses | $18,455,357 | PYTotalExpensesAmt |
| CY Total Expenses | $17,689,809 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$252,771 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$632,899 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $11,557,030 | TotalAssetsBOYAmt |
| Total Assets EOY | $10,192,749 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $4,025,866 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $5,321,610 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $7,531,164 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $4,871,139 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | SOUTHERN INDIANA REHAB HOSPITAL'S PRIMARY MISSION IS TO ASSIST PHYSICALLY IMPAIRED INDIVIDUALS THROUGHOUT THE REGION IN REALIZING THEIR OPTIMUM LEVEL OF FUNCTIONAL INDEPENDENCE, PRODUCTIVITY, SOCIAL ADJUSTMENT AND SELF-ESTEEM. | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $15,495,026 | ExpenseAmt |
| Revenue | $16,943,751 | RevenueAmt |
| Desc | Southern Indiana Rehabilitation Hospital (the Hospital) provides a full range of inpatient and outpatient rehabilitation services to those in need without regard to race, creed, national origin, age, sex, handicap or ability to pay. For the year ended December 31, 2014, the Hospital provided rehabilitation services to 1,289 inpatients totaling 15,126 patient days. Outpatient services were provided for a total of 90,304 outpatient units. Some earnings of the Hospital help absorb costs not paid for by patients in the Medicare and Medicaid programs whose care is partially reimbursed by federal and state governments, as well as free and/or reduced free care provided patients who qualify for charity care. Fees written off consistent with Southern Indiana Rehab Hospital charity care and teaching case guidelines were approximately $121,000 for the year ended 12/31/14. A wide range of comprehensive in- and outpatient therapies treat adults and children with injuries or diseases that result in temporary or permanent disability such as Traumatic Brain Injury, Stroke, Spinal Cord Injury and Amputation, as well as Chronic Obstructive Pulmonary Diseases including Emphysema, Chronic Bronchitis and Asthma. Treatment for Arthritis, Lymphedema Management and Multiple Sclerosis is also provided in addition to Orthopaedic rehab for patients with fractures, total joint replacements, spinal fusions and multiple traumas. SIRH Outpatient Services include physical, occupational, psychological and speech therapy focused on rehabilitating orthopaedic, neurological and developmental diagnoses on an outpatient basis. Our fully accessible building and convenient parking provides easy access for individuals with limited mobility. Programs include: -Acute Rehab for Brain Injury -Spinal Cord Injury Program -Cerebral Vascular Accident Stroke Services -Pediatrics The Southern Indiana Brain Injury Support Group-a chapter of the Brain Injury Association of Indiana meets at SIRH on a monthly basis. Camp Sir H- offers a fun-filled two-day/one-night camp for individuals age 18 and over who have sustained a brain injury, and provides respite for their caregivers. Brain Injury Prevention Program-Each year staff from SIRH teach approximately 2,000 first and second graders about the brain, where it is located, how it functions, what happens when it is injured and the importance of wearing a helmet while bike riding. Bike Rodeo- Children in grades 3-5 learn about bicycle safety in this interactive class that discusses the use of hand signals, the do's and don'ts of riding a bike in traffic and stresses the importance of wearing a helmet. Therapists also guide students through a specially constructed "mini-town" that provides a variety of road obstacles that children can actually ride through. Project P.L.A.Y.-Positive Leisure Awareness for Youth- This education program for fifth graders increases their awareness of spinal cord injury and prevention. Students have the opportunity to participate in sports activities from a wheelchair level, to interact with a person with spinal cord injury and to see the special equipment adapted for his/her use. Senior Games Sponsorship - SIRH continues to be one of the hosts of the Senior Games each year. Last year, nearly 300 senior athletes ages 55 and above participated in seven days of competitive activities to help raise funds for LifeSpan Resources "Meals on Wheels" program. Free Stroke Clinic- Screening service for anyone who has experienced a stroke. Participants are screened by a variety of professionals including therapists, nurses and a physician, and recommendations are made to enhance recovery. Stroke Support Group- The focus of the monthly group meetings is to provide support for emotional and educational needs. Stroke Camp- SIRH offers a three-day, two-night "Adventure Days" Stroke Camp with two main goals: -Provide stroke survivors with the opportunity to take part in educational and leisure time activities in a secure environment. -Offer much-deserved respite for the caregivers of stroke survivors. | Desc |
| Total Program Service Expenses | $15,495,026 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (true) | ScheduleBRequiredInd |
| Political Campaign Acty | false | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (true) | LobbyingActivitiesInd |
| Subject To Proxy Tax | false | SubjectToProxyTaxInd |
| Donor Advised Fund | false | DonorAdvisedFundInd |
| Conservation Easements | false | ConservationEasementsInd |
| Collections Of Art | false | CollectionsOfArtInd |
| Credit Counseling | false | CreditCounselingInd |
| Temp Or Permanent Endowments | false | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (true) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | false | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | false | ReportProgramRelatedInvstInd |
| Report Other Assets | false | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (true) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (true) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (true) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | false | ConsolidatedAuditFinclStmtInd |
| School Operating | false | SchoolOperatingInd |
| Foreign Office | false | ForeignOfficeInd |
| Foreign Activities | false | ForeignActivitiesInd |
| More Than5000 K To Org | false | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividualsInd |
| Professional Fundraising | false | ProfessionalFundraisingInd |
| Fundraising Activities | false | FundraisingActivitiesInd |
| Gaming Activities | false | GamingActivitiesInd |
| Operate Hospital | Yes (true) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (true) | AuditedFinancialStmtAttInd |
| Grants To Organizations | false | GrantsToOrganizationsInd |
| Grants To Individuals | false | GrantsToIndividualsInd |
| Schedule J Required | Yes (true) | ScheduleJRequiredInd |
| Tax Exempt Bonds | false | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | false | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | false | PYExcessBenefitTransInd |
| Loan Outstanding | false | LoanOutstandingInd |
| Grant To Related Person | false | GrantToRelatedPersonInd |
| Business Rln With Org Mem | false | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | false | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | false | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | false | DeductibleNonCashContriInd |
| Deductible Art Contribution | false | DeductibleArtContributionInd |
| Terminate Operations | false | TerminateOperationsInd |
| Partial Liquidation | false | PartialLiquidationInd |
| Disregarded Entity | false | DisregardedEntityInd |
| Related Entity | Yes (true) | RelatedEntityInd |
| Related Organization Ctrl Ent | false | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | false | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | false | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (true) | ScheduleORequiredInd |
| IRP Document | 0 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 294 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (true) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | false | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | false | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | false | TaxablePartyNotificationInd |
| Nondeductible Contributions | false | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | false | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | false | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | false | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | false | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 10 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 10 | IndependentVotingMemberCnt |
| Family Or Business Rln | false | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | Yes (true) | DelegationOfMgmtDutiesInd |
| Change To Org Documents | false | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (true) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (true) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (true) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (true) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (true) | MinutesOfCommitteesInd |
| Officer Mailing Address | false | OfficerMailingAddressInd |
| Local Chapters | false | LocalChaptersInd |
| Form990 Provided To Gvrn Body | false | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (true) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (true) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (true) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (true) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (true) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (true) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (true) | CompensationProcessOtherInd |
| Investment In Joint Venture | false | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | IN | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | TAMMY HOWELL | PersonNm |
| Phone | 5025403888 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 539 S FOURTH STREET | AddressLine1Txt |
| City | LOUISVILLE | CityNm |
| State Abbreviation | KY | StateAbbreviationCd |
| ZIP | 40202 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (12 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 |
|---|---|---|---|---|---|---|---|---|
| DR GUY WALL | ||||||||
| SECRETARY/TREASURER | 4.0 | 0.0 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| Mark Shugarman | ||||||||
| DIRECTOR | 4.0 | 0.0 | Yes (X) | $0 | $0 | $0 | ||
| BEN JACKSON | ||||||||
| DIRECTOR | 4.0 | 0.0 | Yes (X) | $0 | $0 | $0 | ||
| MATT GIBSON | ||||||||
| VICE CHAIR | 4.0 | 0.0 | Yes (X) | Yes (X) | $0 | $420,927 | $46,000 | |
| MARTIN PADGETT | ||||||||
| DIRECTOR | 4.0 | 0.0 | Yes (X) | $0 | $0 | $0 | ||
| DEBBIE MEYER | ||||||||
| chairperson | 4.0 | 0.0 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| DR KERRI REMMEL | ||||||||
| DIRECTOR | 4.0 | 0.0 | Yes (X) | $0 | $0 | $0 | ||
| Jerol Miller | ||||||||
| director | 4.0 | 0.0 | Yes (X) | $0 | $0 | $0 | ||
| JOE GILENE | ||||||||
| DIRECTOR | 4.0 | 0.0 | Yes (X) | $0 | $563,422 | $42,784 | ||
| DAVE EHRINGER | ||||||||
| DIRECTOR | 4.0 | 0.0 | Yes (X) | $0 | $0 | $0 | ||
| RANDY NAPIER | ||||||||
| PRESIDENT & CEO | 20.0 | 20.0 | Yes (X) | $0 | $288,954 | $69,121 | ||
| LINDA PETREE-MOORE | ||||||||
| Director-Inpatient Therapy Svc | 40.0 | 0.0 | $112,026 | $0 | $418 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $112,026 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $1,273,303 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $158,323 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 1 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | false | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (true) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (4 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| D BRADLEY BURTON PHD | |||||
| 4035 TANGLEWOOD DR | FLOYDS KNOBS | IN | 47119 | Consulting | $141,304 |
| MORRISON MGMT SPECIALISTS | |||||
| 5801 PEACHTREE DUNWOODY RD | ATLANTA | GA | 303421503 | FOOD MGMT SERVICES | $444,698 |
| NATIONAL INFORMATION SOLUTIONS COOP | |||||
| ATTN CHRISTY BECKER | MANDAN | ND | 58554 | INFO TECHNOLOGY | $318,018 |
| FIDELITY | |||||
| PO BOX 5000 | CINCINNATI | OH | 452738300 | INVESTMENT ADVISOR | $118,418 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 4 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $83,910 | RelatedOrganizationsAmt |
| Total Contributions | $83,910 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| PATIENT SERVICE REVENUE | 621990 | $16,828,926 | $16,828,926 |
| CONTRACT SERVICE REVENUE | 621990 | $67,243 | $67,243 |
| MISCELLANEOUS | 900099 | $40,820 | $40,820 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $16,936,989 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,083 | TotalRevenueColumnAmt |
| Exclusion | $1,083 | ExclusionAmt |
Incm From Invest Bond Proceeds IncmFromInvestBondProceedsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Royalties Revenue RoyaltiesRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $25,236 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $25,236 | RealAmt |
| Personal | $0 | PersonalAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $25,236 | TotalRevenueColumnAmt |
| Exclusion | $25,236 | ExclusionAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Net Income From Gaming NetIncomeFromGamingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Net Income Or Loss NetIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Other Revenue Misc OtherRevenueMiscGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | ExclusionExclusionAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|---|
| VENDING | 721000 | $2,930 | $2,930 | |
| MEDICAL RECORDS | 900099 | $6,762 | $6,762 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $9,692 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $17,056,910 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $16,943,751 | RelatedOrExemptFuncIncomeAmt |
| Exclusion | $29,249 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Foreign Grants ForeignGrantsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Benefits To Members BenefitsToMembersGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Comp Disqual Persons CompDisqualPersonsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $9,279,316 | TotalAmt |
| Program Services | $8,073,005 | ProgramServicesAmt |
| Management And General | $1,206,311 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $271,046 | TotalAmt |
| Program Services | $235,810 | ProgramServicesAmt |
| Management And General | $35,236 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $878,075 | TotalAmt |
| Program Services | $763,925 | ProgramServicesAmt |
| Management And General | $114,150 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $670,007 | TotalAmt |
| Program Services | $582,906 | ProgramServicesAmt |
| Management And General | $87,101 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,220,004 | TotalAmt |
| Program Services | $1,061,403 | ProgramServicesAmt |
| Management And General | $158,601 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,026 | TotalAmt |
| Program Services | $6,983 | ProgramServicesAmt |
| Management And General | $1,043 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $61,372 | TotalAmt |
| Management And General | $61,372 | ManagementAndGeneralAmt |
Fees For Services Lobbying FeesForServicesLobbyingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Prof Fundraising FeesForServicesProfFundraising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $690,982 | TotalAmt |
| Program Services | $633,776 | ProgramServicesAmt |
| Management And General | $57,206 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,430 | TotalAmt |
| Fundraising | $7,430 | FundraisingAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $689,378 | TotalAmt |
| Program Services | $599,759 | ProgramServicesAmt |
| Management And General | $89,619 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Royalties RoyaltiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $381,501 | TotalAmt |
| Program Services | $331,906 | ProgramServicesAmt |
| Management And General | $49,595 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $20,537 | TotalAmt |
| Management And General | $20,537 | ManagementAndGeneralAmt |
Pymt Travel Entrtnmnt Pub Ofcl PymtTravelEntrtnmntPubOfclGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $57,240 | TotalAmt |
| Program Services | $57,240 | ProgramServicesAmt |
Payments To Affiliates PaymentsToAffiliatesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $745,586 | TotalAmt |
| Program Services | $745,586 | ProgramServicesAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $147,105 | TotalAmt |
| Program Services | $147,105 | ProgramServicesAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt |
|---|---|---|
| BAD DEBTS | $150,274 | $150,274 |
| CONTINUING EDUCATION | $24,328 | $24,328 |
| COMMUNITY BENEFIT EXPENSE | $22,232 | $22,232 |
| ANCILLARY SERV/MED SUPPLIES | $1,836,703 | $1,836,703 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $528,667 | TotalAmt |
| Program Services | $222,085 | ProgramServicesAmt |
| Management And General | $306,582 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $17,689,809 | TotalAmt |
| Program Services | $15,495,026 | ProgramServicesAmt |
| Management And General | $2,187,353 | ManagementAndGeneralAmt |
| Fundraising | $7,430 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,611,119 | BOYAmt |
| EOY | $2,952,339 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,065,085 | BOYAmt |
| EOY | $3,058,762 | EOYAmt |
Receivables From Officers Etc ReceivablesFromOfficersEtcGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $154,158 | BOYAmt |
| EOY | $27,213 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $20,908,041 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $16,810,342 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,677,145 | BOYAmt |
| EOY | $4,097,699 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $49,523 | BOYAmt |
| EOY | $56,736 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,557,030 | BOYAmt |
| EOY | $10,192,749 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,347,265 | BOYAmt |
| EOY | $1,556,242 | EOYAmt |
Grants Payable GrantsPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,350,000 | BOYAmt |
| EOY | $750,000 | EOYAmt |
Escrow Account Liability EscrowAccountLiabilityGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Loans From Officers Directors LoansFromOfficersDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,328,601 | BOYAmt |
| EOY | $3,015,368 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,025,866 | BOYAmt |
| EOY | $5,321,610 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,531,164 | BOYAmt |
| EOY | $4,871,139 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,531,164 | BOYAmt |
| EOY | $4,871,139 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,557,030 | BOYAmt |
| EOY | $10,192,749 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | -$632,899 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | -$2,027,126 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | false | AccountantCompileOrReviewInd |
| FS Audited | Yes (true) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (true) | AuditCommitteeInd |
| Federal Grant Audit Required | false | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
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 C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Grassroots Lobbying | TotalGrassrootsLobbyingGrp | |
| Total Direct Lobbying | TotalDirectLobbyingGrp | |
| Total Lobbying Expend | TotalLobbyingExpendGrp | |
| Other Exempt Purpose Expend | OtherExemptPurposeExpendGrp | |
| Total Exempt Purpose Expend | TotalExemptPurposeExpendGrp | |
| Lobbying Nontaxable Amount | LobbyingNontaxableAmountGrp | |
| Grassroots Nontaxable | GrassrootsNontaxableGrp | |
| Tot Lbbyng Grassroot Mns Non Tx | TotLbbyngGrassrootMnsNonTxGrp | |
| Tot Lbby Expend Mns Lbbyng Non Tx | TotLbbyExpendMnsLbbyngNonTxGrp | |
| Volunteers | false | VolunteersInd |
| Paid Staff Or Management | false | PaidStaffOrManagementInd |
| Media Advertisements | false | MediaAdvertisementsInd |
| Mailings Members | false | MailingsMembersInd |
| Publications Or Broadcast | false | PublicationsOrBroadcastInd |
| Grants Other Organizations | false | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | false | DirectContactLegislatorsInd |
| Rallies Demonstrations | false | RalliesDemonstrationsInd |
| Other Activities | Yes (true) | OtherActivitiesInd |
| Other Activities | $312 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $312 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | false | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCH C, PART II-B, LINE 1I | FormAndLineReferenceDesc |
| Explanation | LOBBYING EXPENSES ----------------- THE HOSPITAL PAYS DUES TO THE INDIANA HOSPITAL ASSOCIATION. A PORTION OF THESE DUES ARE ATTRIBUTABLE TO LOBBYING. | ExplanationTxt |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Art Public Exhibition Amounts | ArtPublicExhibitionAmountsGrp | |
| Held Works Art | HeldWorksArtGrp | |
| CY Minus3 Yr Endwmt Fund | CYMinus3YrEndwmtFundGrp | |
| CY Minus4 Yr Endwmt Fund | CYMinus4YrEndwmtFundGrp |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $425,000 | OtherCostOrOtherBasisAmt |
| Book Value | $425,000 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $15,195,314 | OtherCostOrOtherBasisAmt |
| Depreciation | $12,134,166 | DepreciationAmt |
| Book Value | $3,061,148 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Leasehold Improvements | LeaseholdImprovementsGrp |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $5,025,429 | OtherCostOrOtherBasisAmt |
| Depreciation | $4,549,667 | DepreciationAmt |
| Book Value | $475,762 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $262,298 | OtherCostOrOtherBasisAmt |
| Depreciation | $126,509 | DepreciationAmt |
| Book Value | $135,789 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $4,097,699 | TotalBookValueLandBuildingsAmt |
| Federal Income Tax Liability | $0 | FederalIncomeTaxLiabilityAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (4 entries)
| DescDesc | AmtAmt |
|---|---|
| RETIREMENT FUND PAYABLE | $2,509,595 |
| INTEREST RATE SWAP LIABILITY | $13,828 |
| DUE TO THIRD PARTY PAYERS | $0 |
| ADVANCES FROM JHSMH | $491,945 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $3,015,368 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $17,056,910 | TotalRevEtcAuditedFinclStmtAmt |
| Revenue Subtotal | $17,056,910 | RevenueSubtotalAmt |
| Total Revenue Per Form990 | $17,056,910 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $17,689,809 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Subtotal | $17,689,809 | ExpensesSubtotalAmt |
| Total Expenses Per Form990 | $17,689,809 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCH D, PART X, LINE 2 | FormAndLineReferenceDesc |
| Explanation | UNCERTAIN TAX POSITIONS ------------------------ Financial Accounting Standards Board (FASB) Accounting Standards Codification (ASC) Topic 740 clarifies the accounting for uncertainty in income taxes recognized in an entitys financial statements and prescribes a recognition threshold and measurement attribute for the financial statement recognition and measurement of a tax position taken or expected to be taken in a tax return. The Hospital does not have any uncertain tax positions recognized for 2014 or 2013. | ExplanationTxt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (true) | FinancialAssistancePolicyInd |
| Written Policy | Yes (true) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | false | FPGReferenceFreeCareInd |
| FPG Reference Discounted Care | false | FPGReferenceDiscountedCareInd |
| Free Care Medically Indigent | Yes (true) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (true) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | false | ExpensesExceedBudgetInd |
| Annual Community Bnft Report | Yes (true) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (true) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $33,900 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $33,900 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00220 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,041,183 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $468,046 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $573,137 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.03740 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,075,083 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $468,046 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $607,037 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.03960 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,884,176 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,467,738 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,416,438 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.09230 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $21,847 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $21,847 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00140 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,906,023 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,467,738 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,438,285 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.09370 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $4,981,106 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,935,784 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,045,322 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.13330 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | false | BadDebtExpenseReportedInd |
| Bad Debt Expense | $150,274 | BadDebtExpenseAmt |
| Reimbursed By Medicare | $6,821,018 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $5,110,590 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | $1,710,428 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (true) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (true) | 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 | Southern Indiana Rehabilitation Hosp | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3104 Blackiston Blvd | AddressLine1Txt |
| City | New Albany | CityNm |
| State Abbreviation | IN | StateAbbreviationCd |
| ZIP | 47150 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| Other | Acute Rehabilitation Facility | OtherDesc |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Southern Indiana Rehabilitation Hosp | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | false | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | false | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (true) | 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 |
| Information Gaps | Yes (X) | InformationGapsInd |
| CHNA Conducted | 13 | CHNAConductedYr |
| Take Into Account Others Input | Yes (true) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | false | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | false | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (true) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | www.kentuckyonehealth.org | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (true) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 13 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (true) | StrategyPostedWebsiteInd |
| Strategy Website URL | www.kentuckyonehealth.org/southern-indiana-re | StrategyWebsiteURLTxt |
| Strategy Attached | Yes (true) | StrategyAttachedInd |
| Organization Incur Excise Tax | false | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (true) | EligCriteriaExplainedInd |
| Income Level Criteria | Yes (X) | IncomeLevelCriteriaInd |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Explained Basis | Yes (true) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (true) | 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 (true) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | X | FAPAvailableOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Notice Displayed | Yes (X) | FAPNoticeDisplayedInd |
| FAP Actions On Nonpayment | Yes (true) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | false | CollectionActivitiesInd |
| FAP Notified Upon Admission | Yes (X) | FAPNotifiedUponAdmissionInd |
| FAP Notified Before Discharge | Yes (X) | FAPNotifiedBeforeDischargeInd |
| FAP Notified All Patients | Yes (X) | FAPNotifiedAllPatientsInd |
| Documented Elig Determination | Yes (X) | DocumentedEligDeterminationInd |
| Nondis Emergency Care Policy | Yes (true) | NondisEmergencyCarePolicyInd |
| Other Method Used | Yes (X) | OtherMethodUsedInd |
| Amounts Generally Billed | false | AmountsGenerallyBilledInd |
| Gross Charges | false | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (8 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| SCHEDULE H, PART I, LINE 3C & SCHEDULE H, PART V, LINE 13 | CRITERIA FOR DETERMINING ELIGIBILITY FOR FREE OR DISCOUNTED CARE ---------------------------------------------------------------- SIRH uses HUD Geographic Very Low-Income Guidelines to determine eligibility for Charity Care. A patient qualifies for 100% assistance if their annual income is below 130% of the HUD Geographic Very Low-Income Guidelines. Discounted Care is provided for patients with annual income greater than 130% but not in excess of 195% of the HUD Geographic Very Low-Income Guidelines. SIRH's method for determining Free and discounted care provides Free care at approximately 200% of the Federal Poverty Level and Discounted care up to approximately 400% of the Federal Poverty Level. In situations where patients have other assets, liquid assets are defined as investments that could be converted into cash within one year; these will be evaluated as cash available to meet living expenses. Assets that should not be considered as available to meet living expenses include: the patient's primary place of residence; adequate transportation; adequate life insurance; and sufficient financial reserves to provide normal living expenses if the wage earners are unemployed or disabled. |
| SCHEDULE H, PART I, LINE 7 | BAD DEBT EXP WITHIN COMMUNITY BENEFIT ------------------------------------- Bad Debts included in Part IX, Line 25 totaled $150,274. This amount has been removed from total expenses calculated in Column f on Schedule H, Part I and II. |
| SCHEDULE H, PART III, LINE 4 | BAD DEBT EXPENSE ---------------- The audited financial statements do not contain a footnote that describes bad debt. |
| SCHEDULE H, PART III, LINE 8 | CALCULATION OF MEDICARE ALLOWABLE COSTS --------------------------------------- Costs reported on Line 6 are obtained from the Medicare cost report which are based on a cost to charge ratio. Revenue and costs related to subsidized health services are excluded form lines 5 and 6. |
| SCHEDULE H, PART III, LINE 9B | COLLECTION PRACTICES -------------------- For patients known to have Charity eligibility, an approval letter is sent to the patient, which describes SIRH Policies regarding qualifying for Charity Care as well as contact information for assistance. Before accounts are turned over to collections, SIRH utilizes a Risk-Assessment Scoring system which predicts the likelihood of a patient qualifying for financial assistance and charity care. This predictive model uses 9,000 database sources comprising more than 2 billion public record sources to provide a socioeconomic score for these underserved patients. SIRH classifies patients as Charity Care if they qualify for Presumptive Charity based on their Charity Score. |
| SCHEDULE H, PART V, LINE 22 | Amounts Charged to FAP-Eligible individuals ------------------------------------------- THE MAXIMUM AMOUNT THAT CAN BE CHARGED TO FAP-ELIGIBLE INDIVIDUALS FOR EMERGENCY OR OTHER MEDICALLY NECESSARY CARE IS BASED UPON FEDERAL POVERTY LEVELS STATED IN THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY. |
| SCHEDULE H, PART V, LINE 5 | CHNA COMMUNITY INPUT -------------------- INPUT FOR THE COMMUNITY HEALTH NEEDS ASSESSMENT REPORT WAS ASKED FROM INDIVIDUALS WITH KNOWLEDGE OF THE COMMUNITY AND EXPERTISE. INPUT WAS PROVIDED THROUGH A COMBINATION OF COMMUNITY FORUMS AND FOCUS GROUPS, COMMUNITY SURVEYS AND KEY INFORMANT INTERVIEWS. |
| SCHEDULE H, PART V, LINE 11 | CHNA NEEDS NOT ADDRESSED ------------------------ THE HOSPITAL DID NOT ADDRESS EVERY NEED IDENTIFIED IN THE COMMUNITY HEALTH NEEDS ASSESSMENT BECAUSE SOME OF THE NEEDS FELL OUT OF THE SCOPE OF EXPERTISE AND RESOURCES OF THE HOSPITAL, WHILE OTHER NEEDS WERE ALREADY BEING ADDRESSED IN THE COMMUNITY. SEE THE FULL IMPLEMENTATION REPORT AT: https://www.kentuckyonehealth.org/documents/SIRH%20Implementation-Final.pd F |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 2 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| SIRH at Hunter Station | ||||
| 130 HUNTER STATION WAY | SELLERSBURG | IN | 47172 | OUTPATIENT REHABILITATION CLINIC |
| SIRH AT BRIDGEPOINTE | ||||
| 1329 APPLEGATE LANE | CLARKSVILLE | IN | 47129 | OUTPATIENT REHABILITATION CLINIC |
Supplemental Information Detail SupplementalInformationDetail (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| SCHEDULE H, PART VI, QUESTION 2 | NEEDS ASSESSMENT ----------------- Southern Indiana Rehabilitation Hospital (SIRH) performed a formal Community Needs Assessment to assess the health care needs and health risk factors of the community during the year ended 12/31/2013. See the Statement of Program Service Accomplishments at Form 990, Part III, Line 4 for a detailed description of the many services provided by SIRH. THE FULL REPORT CAN BE VIEWED AT: https://www.kentuckyonehealth.org/documents/SIRH%20CHNA-%20Final.pdf. |
| SCHEDULE H, PART VI, QUESTION 3 | PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE ----------------------------------------------- 1. Charity care policies and procedures are in place at all facilities to address any instances in which patients may be eligible for financial assistance when accessing services. 2. Signs will be posted in the access areas advising patients of the availability of financial assistance. Staff members will communicate the contents of the signs to people who do not appear to be able to read. 3. Patients receiving emergency services will be treated in accordance with Southern Indiana Rehab Hospital's (SIRH's) emergency services policy, developed in accordance with EMTALA and other requirements. Upon registration, patients without Medicare/Medicaid, other local health care financial assistance or adequate health insurance will receive either (1) a packet of information that addresses the financial assistance policy and procedures or (2) immediate financial counseling assistance from staff. The packet will clearly indicate that SIRH provides care, without regard to ability to pay, to individuals with limited financial resources, and explain how patients may apply for financial assistance. In instances where there are a significant number of patients not proficient in reading, writing or speaking English, additional information will be provided to complete necessary forms. 4. Upon registration, a non-emergency patient scheduling an admission or other procedure without Medicare/Medicaid, other local health care financial assistance or adequate health insurance shall receive either (1) a packet of information that addresses the financial assistance policy and procedures, including an application for such assistance, or (2) immediate financial counseling assistance from staff, including the presentation of the application for financial assistance. SIRH's Patient Access personnel should begin the process to assess financial ability as soon as patients contact the hospital to schedule a procedure or when they register as a patient. |
| SCHEDULE H, PART VI, QUESTION 4 | COMMUNITY INFORMATION ---------------------- Southern Indiana Rehab Hospital (SIRH) is a rehabilitation hospital providing comprehensive, high quality rehab and medical services for adults and children with injury, illness, or disability. This 60-bed inpatient facility combines traditional physical, occupational and speech therapies with rehab nursing and advanced technologies to improve an individual's functional abilities. SIRH provides inpatient, outpatient and contract services to residents throughout the southern Indiana and Louisville, Kentucky metropolitan area. |
| SCHEDULE H, PART VI, QUESTION 5 | COMMUNITY BUILDING ACTIVITIES ----------------------------- Southern Indiana Rehab Hospital sponsors The Bike Rodeo Program to benefit the local community. This innovative and exciting program is designed to educate our community's youth on bike safety and injury prevention. The children are instructed on the "rules of the road" and how and why to wear a bike helmet. A "safety town" is created utilizing cones, road signs and obstacles. The children ride their own bikes or bikes provided by SIRH through the course after receiving instructions from the recreation therapists leading the program. The children participate in a variety of games/activities to increase their bike handling skills. The children receive special instruction which includes: bike safety skills such as hand signals; how to cross railroad tracks; what to wear when riding a bike; how to properly fit a helmet; and why helmet wear is crucial for safety. Camp Sir H ---------- Camp Sir H is a two day/one night camp for individuals who have sustained a brain injury. The camp is designed to offer the campers two days of enjoyable, fun-filled activities and a respite for their caregivers. Camp Activities Campers are able to participate in a variety of activities with the assistance of trained professionals, in a structured and accessible environment. Camp activities include an accessible hayride, bonfire, tie-dye tee-shirts, guest speaker, arts and crafts and much much more! Participants will also have the opportunity to socialize with others who have sustained a brain injury and learn more about recovery and re-adjustment to leisure activities. Stroke Camp "Adventure Days" --------------------------- Stroke Camp is a four-day, three night camp for individuals who have experienced a stroke. Stroke Camp began in 1995 with two main goals. The first goal is to provide stroke survivors with a chance to participate in education and leisure activities while socializing with other stroke survivors. The second goal of Stroke Camp is to provide the campers caregivers with a much-deserved respite. |
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 | false | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (true) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | false | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | false | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | false | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | false | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | false | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | false | AnyNonFixedPaymentsInd |
| Initial Contract Exception | false | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (3 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| MATT GIBSON | ||||||||||||||
| VICE CHAIR | $0 | $357,034 | $0 | $42,480 | $0 | $21,413 | $0 | $30,052 | $0 | $15,948 | $0 | $466,927 | $0 | $0 |
| RANDY NAPIER | ||||||||||||||
| PRESIDENT & CEO | $0 | $232,098 | $0 | $33,280 | $0 | $23,576 | $0 | $54,869 | $0 | $14,252 | $0 | $358,075 | $0 | $0 |
| JOE GILENE | ||||||||||||||
| DIRECTOR | $0 | $407,468 | $0 | $39,294 | $0 | $116,660 | $0 | $40,230 | $0 | $2,554 | $0 | $606,206 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | NON-QUALIFIED RETIREMENT PLAN | FormAndLineReferenceDesc |
| Explanation | --------------- PAYMENTS FROM NON-QUALIFIED RETIREMENT PLANS: Bev Weber $58,967 Contributions to non-qualified retirement plans: Randy Napier $21,167 | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (8 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 3 | DELEGATION OF MANAGEMENT DUTIES ------------------------------- Southern Indiana Rehabilitation Hospital has entered into a Management Agreement with Jewish Hospital and St. Mary's Healthcare, Inc.(JHSMH). Under the management agreement, JHSMH is to provide the Chief Executive Officer of Southern Indiana Rehabilitation Hospital. Additionally, under the management agreement, JHSMH is to provide administrative and support services to support the hospital. Southern Indiana Rehabilitation Hospital reimburses JHSMH for the direct costs of management services on a monthly basis. |
| FORM 990, PART VI, SECTION A, LINES 6 & 7 | MEMBERS OF THE ORGANIZATION --------------------------- Southern Indiana Rehabilitation Hospital is a not-for-profit unincorporated association. The Hospital is a joint venture owned equally by the following tax-exempt hospitals: Clark Memorial Hospital Floyd Memorial Hospital Jewish Hospital & St. Mary's Healthcare, Inc. Each hospital above selects two members of the board of Directors. Additionally, The Chief Executive Officer of Clark and Floyd and the Senior vice President of Jewish Hospital & St. Mary's HealthCare, Inc. with authority over Frazier Rehab Center are members of the SIRH Board. Certain actions that may be taken by the Joint Venture will be taken only if Clark, Floyd and JHSMH separately consent to the taking of the action prior to its initiation. These actions include: a)Retaining funds for anticipated capital expenditures. b)Change in number of directors. c)Incurring any debt to any bank, other financial institution, bond purchaser, Joint Venturer, affiliate of any Joint Venturer, or any other corporation, partnership, firm or other entity of any sort, or any individual, other than ordinary and routine payables incurred in the course of routine operations. d)Engaging directly or indirectly in any provision of medical services or any other activity whatsoever beyond the operation of the Hospital and activities reasonably related or incidental thereto or contracting for, or leasing any of the Joint Venture's real estate for, the provision of any such other medical services or the conducting of any such other activity. e)Dissolution of the Joint Venture. |
| FORM 990, PART VI, SECTION B, LINE 11 | REVIEW OF FORM 990 ------------------ Once the Form 990 is prepared by an outside accounting firm, the Form 990 is reviewed by SIRH's Chief Executive Officer. The Final Form 990 will be reviewED at the November board OF DIRECTORS Meeting. |
| FORM 990, PART VI, SECTION A, LINE 12C | MONITORING THE CONFLICT OF INTEREST POLICY ------------------------------------------ Annual Statements ------------------- Each trustee, director, officer and member of a committee with board delegated powers of Southern Indiana Rehabilitation Hospital (SIRH) shall annually sign a statement, which affirms that such person: Has received a copy of SIRH's conflicts of interest policy, Has read and understands this policy, Has agreed to comply with this policy, and Understands that SIRH is a charitable organization and that in order to maintain its federal tax exemption, SIRH must engage primarily in activities that accomplish one or more of their tax-exempt purposes. Annual Questionnaire -------------------- Each trustee, director, officer and member of a committee with board delegated powers of SIRH and key employee of SIRH, shall annually complete a Conflicts of Interest Questionnaire. Periodic Reviews ------------------- To ensure that SIRH operates in a manner consistent with its charitable purposes and that it does not engage in activities that could jeopardize its status as an organization exempt from federal income tax, periodic reviews shall be conducted. The periodic reviews shall, at a minimum, include the following subjects: Whether compensation arrangements and benefits are reasonable and are the result of arm's-length bargaining. Whether partnership and joint venture arrangements and arrangements with management service organizations and physician hospital organizations conform to written policies, are properly recorded, reflect reasonable payments for goods and services, further SIRH's charitable purposes and do not result in inurement or impermissible private benefit. Whether agreements to provide health care and agreements with other health care providers, employees, and third party payors further SIRH's charitable purposes and do not result in inurement or impermissible private benefit. In conducting such periodic reviews, SIRH may, but need not, use outside advisors. If outside experts are used, their use shall not relieve the governing board of its responsibility for ensuring that periodic reviews are conducted. |
| FORM 990, PART VI, SECTION B, LINES 15A & 15B | PROCESS FOR DETERMINING COMPENSATION ------------------------------------ Compensation for the top management official was established and paid by Catholic Health Initiatives (CHI), a related organization. CHI used the following to establish the top management official's compensation, (1) compensation committee, (2) independent compensation consultant, (3)Written employment contracts, (4) Compensation survey or study, (5) approval by the board or compensation committee. |
| FORM 990, PART VI, SECTION B, LINE 19 | MAKING DOCUMENTS AVAILABLE TO THE PUBLIC --------------------------------------- Southern Indiana Rehabilitation Hospital does not make its governing documents, conflict of interest policy or financial statements available to the general public. |
| FORM 990, PART VII, SECTION A | AVERAGE HOURS WORKED -------------------- Randy Napier works an average of 20 hours per week for Frazier Rehabilitation Hospital, a related organization in addition to working 30 hours for SIRH. Compensation reported in Column (E) is his total compensation paid by Frazier for services provided to both entities. |
| FORM 990, PART XI, LINE 9 | RECONCILIATION OF NET ASSETS ---------------------------- Other Changes in Net Assets: Change in Pension Net Loss and Prior Service Cost ($2,056,856) Change in Fair Value of Interest Rate Swap $29,730 ------------- ($2,027,126) |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Jewish Hospital & St Mary's Healthcare | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 539 S Fourth Street | AddressLine1Txt |
| City | Louisville | CityNm |
| State Abbreviation | KY | StateAbbreviationCd |
| ZIP | 40202 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 611029768 | EIN |
| Primary Activities | Hospital | PrimaryActivitiesTxt |
| Legal Domicile State | KY | LegalDomicileStateCd |
| Exempt Code Section | 501(c) | ExemptCodeSectionTxt |
| Public Charity Status | 3 | PublicCharityStatusTxt |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | JHHS Inc | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Controlled Organization | false | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | false | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | false | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | false | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | false | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | false | LoansOrGuaranteesFromOthOrgInd |
| Asset Sale To Other Org | false | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | false | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | false | AssetExchangeInd |
| Rental Of Facilities To Oth Org | false | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | false | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | false | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | false | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | false | SharingOfFacilitiesInd |
| Paid Employees Sharing | false | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (true) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | false | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | false | TransferToOtherOrgInd |
| Transfer From Other Org | false | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp
Other Organization Name OtherOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Jewish Hospital & St Mary's HealthcareInc | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Transaction Type | o | TransactionTypeTxt |
| Involved | $1,220,004 | InvolvedAmt |
| Method Of Amount Determination | FMV | MethodOfAmountDeterminationTxt |
Comments