2014-11-12T17:08:44-06:00 2013-12-31 BKD LLP 600 N Hurstbourne Parkway 350 Louisville KY 40222 990 2013-01-01 351903507 AMELIA BROWN FRAZIER REHAB CTR INC BOARD DIR DBA SOUTHERN INDIANA REHABILITATION HOSPITAL % TAMMY HOWELL AMEL 8129416106 3104 BLACKISTON BLVD Suite NEW ALBANY IN 47150 RANDY NAPIER CHIEF EXECUTIVE OFFICER 8129416106 2014-11-12 true Kim Scifres P01316095 8129416106 2013 2015-11-30 17:44:51Z Randy Napier 3104 Blackiston Blvd New Albany IN 47150 18202586 false X www.sirh.org X 1993 IN Assist Physically impaired individuals throughout the region. 10 10 315 0 0 6007 50 18275551 18164799 2303 1346 38196 36391 18322057 18202586 15448 0 0 0 11359007 11559877 0 0 10934 6355299 6895480 17729754 18455357 592303 -252771 11995775 11557030 7108022 4025866 4887753 7531164 X 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. false false 16163417 18172724 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, 2013, the Hospital provided rehabilitation services to 1,312 inpatients totaling 15,745 patient days. Outpatient services were provided for a total of 85,451 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 $100,000 for the year ended 12/31/13. 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. 16163417 true false false true false false false false false false true false false false true false true false false false false false false false false false true true false false true false false false false false false false false false false false false false true false false false true 353 0 true 315 true false false false false false false false false false false X 10 10 false true false false true true true true true false false false true true true true true true true false IN X TAMMY HOWELL 5025403888 539 S FOURTH STREET LOUISVILLE KY 40202 DR GUY WALL DIRECTOR 4.0 X 0 0 0 Mark Shugarman DIRECTOR 4.0 X 0 0 0 BEN JACKSON DIRECTOR 4.0 X 0 0 0 MATT GIBSON DIRECTOR 4.0 X 0 0 0 MARTIN PADGETT DIRECTOR 4.0 X 0 0 0 DEBBIE MEYER DIRECTOR 4.0 X 0 0 0 DR KERRI REMMEL DIRECTOR 4.0 X 0 0 0 Jerol Miller CHAIRMAN 4.0 X X 0 0 0 BEV WEBER DIRECTOR 4.0 46.0 X 0 859654 33474 DAVE EHRINGER CHAIRMAN ELECT 4.0 X X 0 0 0 RANDY NAPIER PRESIDENT & CEO 20.0 30.0 X 0 296431 68364 SUZANN BYERS Director-Nursing 40.0 X 101425 0 4779 CATHERINE SPALDING Director-Outpatient Services 40.0 X 102358 0 11750 LINDA PETREE-MOORE Director-Inpatient Therapy Svc 40.0 X 114348 0 486 318131 1156085 118853 3 false true false D BRADLEY BURTON PHD 4035 TANGLEWOOD DR FLOYDS KNOBS IN 47119 Consulting 142460 MORRISON MGMT SPECIALISTS 5801 PEACHTREE DUNWOODY RD ATLANTA GA 303421503 FOOD MGMT SERVICES 408624 NATIONAL INFORMATION SOLUTIONS COOP ATTN CHRISTY BECKER MANDAN ND 58554 INFO TECHNOLOGY 268725 FIDELITY PO BOX 5000 CINCINNATI OH 452738300 INVESTMENT ADVISOR 120638 4 50 50 PATIENT SERVICE REVENUE 621990 18025269 18025269 CONTRACT SERVICE REVENUE 621990 74031 74031 MISCELLANEOUS 900099 65499 65499 18164799 1346 1346 0 0 24153 24153 0 24153 24153 0 0 0 0 VENDING 721000 4313 4313 MEDICAL RECORDS 900099 7925 7925 12238 18202586 18172724 0 29812 0 0 0 0 0 0 9379201 8159905 1219296 747670 650473 97197 773008 672517 100491 659998 574198 85800 1220259 1061625 158634 11353 9877 1476 57360 57360 0 0 0 703189 628110 75079 10934 10934 544537 473747 70790 0 0 343724 299040 44684 28263 28263 0 0 80783 80783 0 767459 767459 141843 141843 BAD DEBTS 428821 428821 CONTINUING EDUCATION 20708 20708 COMMUNITY BENEFIT EXPENSE 31626 31626 ANCILLARY SERV/MED SUPPLIES 1938959 1938959 565662 223726 341936 18455357 16163417 2281006 10934 3871011 3611119 0 0 0 0 2758391 3065085 0 0 0 0 0 0 0 0 75172 154158 20763911 16086766 5219667 4677145 0 0 0 0 0 0 0 0 71534 49523 11995775 11557030 1302685 1347265 0 0 0 0 1950000 1350000 0 0 0 0 0 0 0 0 3855337 1328601 7108022 4025866 X 4887753 7531164 0 0 0 0 4887753 7531164 11995775 11557030 X -252771 2896182 X false true X true false X false false false false false false false false true 360 360 false SCH C, PART II-B, LINE 1I -------------------------- THE HOSPITAL PAYS DUES TO THE INDIANA HOSPITAL ASSOCIATION. A PORTION OF THESE DUES ARE ATTRIBUTABLE TO LOBBYING. 425000 425000 15195316 11520955 3674361 4992735 4440770 551965 150862 125043 25819 4677145 0 RETIREMENT FUND PAYABLE 591548 INTEREST RATE SWAP LIABILITY 43558 DUE TO THIRD PARTY PAYERS 278634 ADVANCES FROM JHSMH 414861 1328601 18202586 18202586 18202586 18455357 18455357 18455357 SCH D, PART X, LINE 2 ------------------------- The organization's audited financial statements did not include a footnote that addressed the organization's liability for uncertain tax positions under FIN48 (ASC 740). Management has evaluated their income tax positions under the guidance included in ASC 740. Based on their review,management has not identified any material uncertain tax positions to be recorded or disclosed in the financial statements. true true X false false true true false true true 31400 31400 0.00170 987068 627993 359074 0.01990 1018468 627993 390474 0.02160 3990583 2383451 1607132 0.08920 31626 31626 0.00180 4022209 2383451 1638758 0.09100 5040677 3011444 2029232 0.11260 false 428821 7541142 6301821 1239321 X true true 1 1 Southern Indiana Rehabilitation Hosp 3104 Blackiston Blvd New Albany IN 47150 X Acute Rehabilitation Facility Southern Indiana Rehabilitation Hosp 1 true X X X X X X X X X 13 true false true X www.kentuckyonehealth.org X X X X X false false true false false true X X X X X X true true X X X X X true false X X X X true X false false 2 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 SCHedule H, PART I, LINE 3C & Schedule H, Part V, Lines 9 and 10 ------------------- 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. SCH H, PART I, LINE 7 ------------------- Bad Debts included in Part IX, Line 25 totaled $428,821. This amount has been removed from total expenses calculated in Column f on Schedule H, Part I and II. SCH H, PART III, LINE 4 ------------------- The audited financial statements do not contain a footnote that describes bad debt. SCH H, PART III, LINE 8 ------------------- 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. SCH H, PART III, LINE 9B ------------------- 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. SCH H, PART VI, QUESTION 2 ------------------- 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. SCH H, PART VI, QUESTION 3 ------------------- 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. SCH H, PART VI, QUESTION 4 ------------------- 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. SCH H, PART VI, QUESTION 5 ------------------- 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 H, Part V, Line 19d ---------------------------- 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. SCH H, PART V, QUESTION 3 --------------------------- 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. SCH H, PART V, QUESTION 7 -------------------------- 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 X X X X X false true false false false false false false false RANDY NAPIER PRESIDENT & CEO 0 230533 0 42334 0 23564 0 54869 0 13495 0 364795 0 BEV WEBER DIRECTOR 0 650685 0 117934 0 91035 0 20596 0 12878 0 893128 0 0 SCHEDULE J, PART I, LINE 4B --------------- PAYMENTS FROM NON-QUALIFIED RETIREMENT PLANS: Bev Weber $58,967 Contributions to non-qualified retirement plans: Randy Napier $21,167 FORM 990, PART VI, SECTION A, LINE 3 ------------------------- 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 ------------------------- 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 ------------------------- 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 ------------------------- 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 ------------------------- 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 ------------------------- 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 ------------------------- 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 ------------------------- Other Changes in Net Assets: Change in Pension Net Loss and Prior Service Cost $2,849,200 Change in Fair Value of Interest Rate Swap $46,982 ------------- $2,896,182 Jewish Hospital & St Mary's Healthcare 539 S Fourth Street Louisville KY 40202 611029768 Hospital KY 501(c) 3 JHHS Inc false false false false false false false false false false false false false false false true false false false Jewish Hospital & St Mary's HealthcareInc o 1220259 FMV