2014-04-03T12:15:37-05:00 2013-06-30 621046406 JOHNSON HICKEY & MURCHISON PC 651 E 4TH ST STE 200 CHATTANOOGA TN 37403 990 2012-07-01 620544855 SWEETWATER HOSPITAL ASSOCIATION SWEE 8652138200 304 CHURCH STREET SWEETWATER TN 37874 SCOTT BOWMAN 8652138200 2014-03-19 1 BARRY R HUGGINS P00627334 4237560052 2012 2015-11-30 17:44:51Z SCOTT BOWMAN 304 CHURCH STREET SWEETWATER TN 37874 57367296 0 X WWW.SWEETWATERHOSPITAL.ORG X 1934 TN THE MISSION OF THE SWEETWATER HOSPITAL ASSOCIATION IS TO PROMOTE HEALTHY LIFESTYLES AND TO PROVIDE THE HIGHEST QUALITY PRIMARY HEALTH CARE TO THE REGION AT THE LOWEST POSSIBLE COST. 13 12 573 25 0 0 2075 2725 56452948 56766965 122502 68376 447967 527954 57025492 57366020 0 0 0 0 19732694 20224909 0 0 0 28428976 30340622 48161670 50565531 8863822 6800489 56017648 64012662 3413284 4611568 52604364 59401094 X THE MISSION OF THE SWEETWATER HOSPITAL ASSOCIATION IS TO PROMOTE HEALTHY LIFESTYLES AND TO PROVIDE THE HIGHEST QUALITY PRIMARY HEALTHCARE TO THE REGION AT THE LOWEST POSSIBLE COST. 0 0 5498472 7195738 PROVIDED FOR 294,532 LABORATORY TESTS DURING THE FISCAL YEAR ENDING 6/30/13 13792996 18050614 PROVIDED FOR 21,944 EMERGENCY ROOM VISITS DURING THE FISCAL YEAR ENDING 6/30/2013 9088105 11893418 PROVIDED FOR 66,367 X-RAY PROCEDURES DURING THE FISCAL YEAR ENDING 6/30/13 15404110 20155149 ALL OTHER SERVICES INCLUDE PHARMACY, ROUTINE CARE, OPERATING ROOM, MEDICAL SUPPLIES, THERAPY, HOME HEALTHCARE, LABOR AND DELIVERY. LESS CONTRACTUAL ADUSTMENTS AND POLICY DISCOUNTS 15404110 20155149 43783683 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 29 0 1 573 1 0 0 0 0 0 0 0 0 0 0 X 13 12 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X SWEETWATER HOSPITAL ASSOCIATION 8652138200 304 CHURCH STREET SWEETWATER TN 37874 X SCOTT BOWMAN 37.50 X X 219640 0 10863 DR THOMAS EVANS 1.00 X 326423 0 0 DOUG WARREN 1.00 X 0 0 0 RICK BETTIS 1.00 X 0 0 0 BARBARA WATSON 1.00 X 0 0 0 PEGGY WHITE 1.00 X 0 0 0 JON CARSON III 1.00 X 0 0 0 DR KENYA KOZAWA 1.00 X 1269017 0 0 DR KEN ARCHER 1.00 X 0 0 0 JIM FAIRWEATHER 1.00 X 0 0 0 GARY KIMSEY 1.00 X 0 0 0 TOM KORN 1.00 X 0 0 0 CHRIS WHITE 1.00 X 0 0 0 DEBBIE J THOMPSON 38.00 X 165326 0 8787 PATTI N THOMPSON 38.00 X 143075 0 9868 ROGER EVANS 38.00 X 101632 0 7551 ANDREA B HENRY 38.00 X 130658 0 9237 2355771 0 46306 7 0 1 0 EMERGENCY COVERAGE CORP PO BOX 634850 CINCINNATI OH 452634850 ER PHYSICIAN SERVICES 1560770 KEN KOZAWA I MD PC 132 FAIRLANE CIRCLE SWEETWATER TN 37874 PHYSICIAN SERVICES 1269017 CPSI PO BOX 850309 MOBILE AL 366850309 COMPUTER SUPPORT 661910 COUILLARD & ASSOCIATES 9413 WOODY HOLLOW DRIVE CHATTANOOGA TN 37421 PHYSICIAN SERVICES 557125 H S WHITSON CONSTRUCITON CO PO BOX 7343 KNOXVILLE TN 37934 CONSTRUCTION ARCHITECTS 521000 21 2725 2725 NET PATIENT REVENUE 621990 56766965 56766965 56766965 65753 65753 3899 1276 0 -1276 3899 2623 2623 MISCELLANEOUS INCOME 900099 287958 287958 CAFETERIA SALES 900099 196683 196683 MEDICAL RECORDS TRANSCRIPTS 900099 43313 43313 527954 57366020 57294919 0 68376 417495 417495 17104405 15044290 2060115 506091 506091 942208 942208 1254710 1087574 167136 8062 8062 39350 39350 2156066 1525364 630702 260667 3247 257420 843723 687829 155894 112309 78111 34198 119915 119915 3180614 2371200 809414 282709 282709 BAD DEBT 9410902 9410902 SUPPLIES 7124762 6953047 171715 FEES AND REGISTRATIONS 6437330 6419604 17726 LAUNDRY 132432 132432 231781 70083 161698 50565531 43783683 6781848 0 3190265 4864126 20391658 24441203 7174296 6989683 636271 582807 818178 871841 111836 119610 57272074 33532203 22412285 23739871 997721 1282859 1405800 56017648 64012662 2969002 4278907 444282 332661 3413284 4611568 X 52604364 59401094 52604364 59401094 56017648 64012662 X 6800489 -3759 X 0 1 X 1 0 X 1496323 1496323 20054459 11864763 8189696 27774207 21288906 6485301 7947085 378534 7568551 23739871 X 57366020 0 57366020 0 57366020 50569290 3759 3759 50565531 0 50565531 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X, LINE 2: THE ASSOCIATION IS A NOT-FOR-PROFIT CORPORATION AS DEFINED IN SECTION 501(C)(3) AND IS EXEMPT FROM FEDERAL TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. THE ACCOUNTING STANDARD ON ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES ADDRESSES THE DETERMINATION OF WHETHER TAX BENEFITS CLAIMED OR EXPECTED TO BE CLAIMED ON A TAX RETURN SHOULD BE RECORDED IN THE FINANCIAL STATEMENTS. UNDER THAT GUIDANCE, THE ASSOCIATION MAY RECOGNIZE THE TAX BENEFIT FROM AN UNCERTAIN TAX POSITION ONLY IF IT IS MORE LIKELY THAN NOT THAT THE TAX POSITION WILL BE SUSTAINED ON EXAMINATION BY TAXING AUTHORITIES BASED ON THE TECHNICAL MERITS OF THE POSITION. EXAMPLES OF TAX POSITIONS INCLUDE THE THE TAX-EXEMPT STATUS OF THE ASSOCIATION AND VARIOUS POSITIONS RELATED TO THE POTENTIAL SOURCES OF UNRELATED BUSINESS TAXABLE INCOME. THE TAX BENEFITS RECOGNIZED IN THE FINANCIAL STATEMENTS FROM SUCH A POSITION ARE MEASURED BASED ON THE LARGEST BENEFIT THAT HAS A GREATER THAN 50% LIKELIHOOD OF BEING REALIZED UPON ULTIMATE SETTLEMENT. THERE WERE NO UNRECOGNIZED TAX BENEFITS IDENTIFIED OR RECORDED AS LIABILITIES FOR THE FISCAL YEAR 2013 AND 2012. THE ASSOCIATION'S FORM 990, RETURN OF ORGANIZATION EXEMPT FROM INCOME TAX, FOR THE YEARS 2010, 2011,2012 AND 2013 ARE SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE, GENERALLY FOR THREE YEARS AFTER THEY ARE FILED. PART XII, LINE 2D - OTHER ADJUSTMENTS: IDEAL RENTAL EXPENSES 1 1 0 1 X 100.000000000000 0 0 0 4045743 719100 3326643 0.08080 4045743 719100 3326643 0.08080 12378 12378 0.00030 10348 10348 0.00030 3950 3950 0.00010 26676 26676 0.00070 4072419 719100 3353319 0.08150 10000 10000 0.00020 10000 10000 0.00020 1 9410902 2463063 10417216 10815836 -398620 X 1 1 1 1 SWEETWATER HOSPITAL ASSOCIATION

304 WRIGHT ST SWEETWATER TN 37874

X X X SWEETWATER HOSPITAL ASSOCIATION 1 1 X X X X X X X X X 12 1 0 1 X X X X X X X X 1 0 1 0 1 100.000000000000 1 X X X X X X X 1 1 X X X X 1 0 X X 1 X 0 0 1 SWEETWATER HOSPITAL HOME HEALTH

304 WRIGHT STREET SWEETWATER TN 37874

HOME HEALTH PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 9410902. PART II: (1)NUTRITION OBESITY: PROVIDED COMMUNITY BASED FITNESS OPPORTUNITIES IN THE SCHOOLS,THROUGH THE CITY PARKS AND HEALTH DEPARTMENT. DONATION OF $10,000 TO THE CITY OF SWEETWATER TO COMPLETE FUNDING FOR COMMUNITY OUTDOOR PART AT THE RECREATIONAL COMPLEX.(2)ACCESS TO HEALTH CARE: PROVIDED HIGH QUALITY CARE IN AN EFFICIENT MANNER TO ALL PATIENTS WHO PRESENT TO THE EMERGENCY DEPARTMENT REGARDLESS OF THE LEVEL OF COMPLAINT OR ABILITY TO PAY.(3)SUBSTANCE ABUSE AND MENTAL HEALTH: SUPPORTED LOCAL NONABUSE MEETINGS, SCHOOL BASED EDUCATION AND POLICE TASK FORCES. COMMUNITY BASED ADULT AND YOUTH EDUCATION AND CRISIS SERVICES WERE PROVIDED. IN COUNTY SERVICES FOR MENTAL HEALTH WERE PROVIDED BY HIAWASSEE MENTAL HEALTH MOBILE CRISIS. COMMUNITY MENTAL HEALTH FORUM TO MEET TO PROVIDE A NETWORKING OPPORTUNITY FOR ALL MENTAL HEALTH PROVIDERS.(4)PREVENTION OF CHRONIC DISEASES: EDUCATION WAS PROVIDER BASED. THE HOSPITAL CONTINUES TO REVIEW IN FUTURE LONG RANGE PLANNING COMMITTEES.HEALTH FAIRS FOR SCHOOLS, HEALTH SCREENING AND DIABETIC TRAINING WERE AMONG SOME OF THE COMMUNITY EVENTS THAT THE HOSPITAL PARTICIPATED IN. PART III, LINE 4: THE ASSOCIATION ACCEPTS PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. A PATIENT IS CLASSIFIED AS A CHARITY PATIENT WHEN NO PAYMENT IS ANTICIPATED. IN ASSESSING A PATIENT'S ABILITY TO PAY, THE ASSOCIATION USES POVERTY GUIDELINES PUBLISHED BY THE FEDERAL GOVERNMENT FOR MONROE COUNTY. WHEN INCURRED CHARGES ARE SIGNIFICANT COMPARED TO THE PATIENT'S INCOME LEVEL, THE ASSOCIATION MAY CHOOSE TO QUALIFY THE SERVICES AS CHARITY CARE. CHARITY CARE CHARGES ARE NOT INCLUDED IN NET PATIENT SERVICE REVENUE.FOOTNOTE IN FINANCIALS:PROVISION FOR BAD DEBTSTHE ASSOCIATION RECOGNIZES PATIENT SERVICE REVENUE ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD PARTY PAYER COVERAGE ON THE BASIS OF CONTRACTUAL RATES FOR THE SERVICES RENDERED. FOR UNINSURED PATIENTS THAT DO NOT QUALIFY FOR CHARITY CARE, THE ASSOCIATION RECOGNIZES REVENUE ON THE BASIS OF ITS STANDARD RATES FOR SERVICES PROVIDED (OR ON THE BASIS OF DISCOUNTED RATES, IF NEGOTIATED OR PROVIDED BY THE POLICY). ON THE BASIS OF HISTORICAL EXPERIENCE, A SIGNIFICANT PORTION OF THE ASSOCIATION'S UNINSURED PATIENTS WILL BE UNABLE OR UNWILLING TO PAY FOR THE SERVICES PROVIDED. THUS, THE ASSOCIATION RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS RELATED TO UNINSURED PATIENTS IN THE PERIOD THE SERVICES ARE PROVIDED. BAD DEBT AS A RESULT OF NONPAYMENT OR REDUCED PAYMENT PROVIDES A COMMUNITY BENEFIT TO THOSE WHO ARE UNABLE TO PAY FOR MEDICAL CARE. PART III, LINE 8: THE COST TO CHARGE RATIO WAS USED TO DETERMINE THE MEDICARE ALLOWABLE COSTS. THE EXCESS OF THE COST OVER REVENUE PROVIDES A BENEFIT TO THOSE IN THE COMMUNITY REGARDLESS OF THEIR ABILITY TO PAY FOR SERVICES. PART III, LINE 9B: FOR PATIENTS NOT ELIGIBLE FOR FINANCIAL ASSISTANCE, IT IS THE POLICY OF SWEETWATER HOSPITAL ASSOCIATION TO PERMIT PATIENTS, WHERE ELIGIBLE TO MAKE REGULAR PAYMENTS ON A MONTHLY BASIS. SWEETWATER HOSPITAL ASSOCIATION DOES UTILIZE EXTERNAL COLLECTION FIRMS FOR DEBT COLLECTION AS NEEDED SWEETWATER HOSPITAL ASSOCIATION PART V, SECTION B, LINE 3: 1. A REVIEW OF EXISTING DATA ALREADY AVAILABLE IN THE COMMUNITY, REGION AND STATE.2. AN IN PERSON SURVEY OF 300 COUNTY RESIDENTS (SURVEYED WHILE AT SWEETWATER HOSPITAL ASSOCIATION INCLUDING PATIENTS, FAMILY AND VISITORS3. A CONVENIENCE SURVEY OF KNOWLEDGEABLE KEY COMMUNITY INFORMANT GROUPS WHICH INCLUDED PHYSICIANS,MONROE COUNTY PRINCIPALS, AND OTHER COMMUNITY LEADERS. SWEETWATER HOSPITAL ASSOCIATION PART V, SECTION B, LINE 10: THE HOSPITAL DOES NOT PROVIDE FREE CARE. SWEETWATER HOSPITAL ASSOCIATION PART V, SECTION B, LINE 20D: DISCOUNTED 70% OF GROSS CHARGES PART VI, LINE 2: SWEETWATER HOSPITAL ASSESSED THE HEALTH NEEDS OF THE COMMUNITY SERVED BY A REVIEW OF THE EXISTING DATA ALREADY AVAILABLE IN THE COMMUNITY, REGION AND STATE. A SURVEY OF 300 PERSONS WAS CONDUCTED WHILE THEY WERE AT THE HOSPITAL. THIS SURVEY INCLUDED PATIENTS, FAMILY AND VISITORS. A SURVEY WAS ALSO CONDUCTED OF FIFTEEN KNOWLEDGEABLE KEY COMMUNITY INFORMANT GROUPS. KEY INDIVIDUALS WERE ASKED TO RESPOND TO 13 OPEN ENDED QUESTIONS ABOUT THE HEALTH STATUS OF THE COUNTY. THE TOP THREE COMMUNITY HEALTH NEEDS WERE IDENTIFIED AS (1) NUTRITION AND OBESITY (2)AFTER HOURS ACCESS TO CARE (3)SUBSTANCE ABUSE PART VI, LINE 3: PATIENTS ARE EDUCATED IN THE AVAILABILITY OF FINANCIAL ASSISTANCE THROUGH THE POSTING OF POLICY IN THE REGISTRATION OFFICE, POSTING OF THE POLICY ONLINE, AND REQUEST FROM THEIR PATIENT REPRESENTATIVE. PART VI, LINE 4: MONROE COUNTY IS LOCATED IN THE SOUTHEASTERN PORTION OF THE STATE OF TENNESSEE IN THE FOOTHILLS OF THE SMOKY MOUNTAINS. THE COUNTY HAS A TOTAL AREA OF 653 SQUARE MILES, OF WHICH 635 SQUARE MILES IS LAND AND 18 SQUARE MILES OF IT IS WATER. MONROE COUNTY RANKS AS THE SIXTH LARGEST IN LAND AREA AMOUNG TENNESSEE'S 95 COUNTIES.AS OF THE CENSUS OF 2000 THERE ARE 15,329 HOUSEHOLDS OUT OF WHICH 32.10% HAVE CHILDREN UNDER THE AGE OF 18 LIVING WITH THEM. 59.4% ARE MARRIED COUPLES LIVING TOGETHER. 10% HAVE A FEMALE HOUSEHOLDER WITH NO HUSBAND PRESENT, AND 26.7% ARE NON-FAMILIES. 23.3% OF ALL HOUSEHOLDS ARE MADE UP OF INDIVIDUALS AND 9.4% HAVE SOMEONE LIVING ALONE THAT IS 65 YEARS OF AGE OR OLDER. THE AVERAGE HOUSEHOLD SIZE IS 2.51 AND THE AVERAGE FAMILY SIZE IS 2.94. PART VI, LINE 5: SWEETWATER HOSPITAL ASSOCIATION IS A 59-BED ACUTE CARE NOT-FOR-PROFIT CORPORATION WHICH WAS CHARTERED BY THE STATE OF TENNESSEE IN 1936. IT IS A UNIQUE ORGANIZATION IN THAT NO STOCK HAS EVER BEEN ISSUED, NOR CAN BE ISSUED IN THE FUTURE. SINCE THERE ARE NEITHER OWNERS NOR STOCKHOLDERS, ANY MONEY GENERATED IN EXCESS OF OPERATIONAL FUNDS IS DEDICATED BY LAW AND RESOLUTION OF THE BOARD OF DIRECTORS TO PERPETUAL USE FOR IMPROVING HEALTH CARE DELIVERY TO THE PEOPLE SERVED BY SWEETWATER HOSPITAL ASSOCIATION.SWEETWATER HOSPITAL ASSOCIATION IS LOCATED IN RURAL EAST TENNESSEE AND PROUDLY SERVES PARTS OF MEIGS COUNTY, MCMINN COUNTY, ROANE COUNTY, LOUDON COUNTY, AND MONROE COUNTY. IT IS THE ONLY HOSPITAL LOCATED IN MONROE COUNTY WHICH HAS A POPULATION OF APPROXIMATELY 38,000. X X X 0 0 0 0 0 0 0 0 0 SCOTT BOWMAN 219640 0 0 0 0 0 8731 0 2132 0 230503 0 0 0 DR THOMAS EVANS 326423 0 0 0 0 0 0 0 0 0 326423 0 0 0 DR KENYA KOZAWA 1269017 0 0 0 0 0 0 0 0 0 1269017 0 0 0 DEBBIE J THOMPSON 165326 0 0 0 0 0 6655 0 2132 0 174113 0 0 0 PATTI N THOMPSON 143075 0 0 0 0 0 5711 0 4157 0 152943 0 0 0 FORM 990, PART VI, SECTION B, LINE 11 MANAGEMENT WILL REVIEW THIS RETURN BEFORE IT IS FILED FORM 990, PART VI, SECTION B, LINE 12C POSSIBLE CONFLICT OF INTEREST ARE REQUIRED TO BE DISCLOSED ANNUALLY. FORM 990, PART VI, SECTION B, LINE 15 TOP OFFICIALS ARE APPROVED BY THE BOARD OF DIRECTORS. COMPENSATION FOR OFFICERS USE INDUSTRY STANDARDS, AND COMPENSATION COMMITTEE. FORM 990, PART VI, SECTION C, LINE 19 DOCUMENTS ARE MADE AVAILABLE UPON REQUEST CONTACT ADDRESSES FOR OFFICERS, DIRECTORS, ETC FORM 990, PART VII DR. KENYA KOZAWA - 132 FAIRLANE CIRCLE, SWEETWATER, TN 37874. DR. KOWAZA OFFICER COMPENSATION PART VII SECTION B COMPENSATION FOR DR. KOWAZA WAS FOR THE PHYSICIANS SERVICES RENDERED BY HIS P.C. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 9: SUBSIDIARY EXPENSES -3,759. IDEAL RENTAL COMPANY INC 304 WRIGHT ST SWEETWATER TN 37874 620933728 REAL ESTATE TN C -3759 -33047 1.00000 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0