2013-05-09T12:46:34-05:00 2012-06-30 621046406 JOHNSON HICKEY & MURCHISON PC 651 E 4TH ST STE 200 CHATTANOOGA TN 37403 990 2011-07-01 620544855 SWEETWATER HOSPITAL ASSOCIATION SWEE 8652138200 304 CHURCH STREET SWEETWATER TN 37874 SCOTT BOWMAN 8652138200 2013-05-08 1 JOEL D SUSMAN P00577620 4237560052 2011 2016-02-25 16:41:14Z SCOTT BOWMAN 304 CHURCH STREET SWEETWATER TN 37874 57025741 0 X WWW.SWEETWATER.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 12 544 24 0 0 16836 2075 46963962 56452948 99572 122502 437754 447967 47518124 57025492 0 0 0 0 18416771 19732694 0 0 0 26598517 28428976 45015288 48161670 2502836 8863822 46741897 56017648 3001355 3413284 43740542 52604364 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 5459078 7775170 PROVIDED FOR 286,972 LABORATORY TESTS DURING THE FISCAL YEAR ENDING 6/30/12 11073083 15770996 PROVIDED FOR 20,485 EMERGENCY ROOM VISITS DURING THE FISCAL YEAR ENDING 6/30/2012 8551827 12180062 PROVIDED FOR 61,316 X-RAY PROCEDURES DURING THE FISCAL YEAR ENDING 6/30/12 14866929 21174438 ALL OTHER SERVICES INCLUDE PHARMACY, ROUTINE CARE, OPERATING ROOM, MEDICAL SUPPLIES, THERAPY, HOME HEALTHCARE, LABOR AND DELIVERY. LESS CONTRACTUAL ADUSTMENTS AND POLICY DISCOUNTS 14866929 21174438 39950917 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 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 26 0 1 544 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 0 1 1 1 1 0 TN X SWEETWATER HOSPITAL ASSOCIATION 8652138200 304 CHURCH STREET SWEETWATER TN 37874 X SCOTT BOWMAN 40.00 X X 209214 0 11404 DR THOMAS EVANS 1.00 X 351810 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 1239819 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 154896 0 6196 PATTI N THOMPSON 38.00 X 138388 0 5536 ROGER EVANS 38.00 X 112565 0 4502 ANDREA B HENRY 38.00 X 132042 0 5282 2338734 0 32920 7 0 1 0 KEN KOZAWA I MD PC 132 FAIRLANE CIRCLE SWEETWATER TN 37874 PHYSICIAN SERVICES 1239819 CPSI PO BOX 850309 MOBILE AL 366850309 COMPUTER SUPPORT 884690 COUILLARD & ASSOCIATES 9413 WOODBY HOLLOW DRIVE CHATTANOOGA TN 37421 PHYSICIAN SERVICES 547000 CHRISTOPHER BOWMAN MD PC 424 FAIRLANE DRIVE SWEETWATER TN 37874 PHYSICIAN SERVICES 414589 ERIC POSTON MD 12108 ASHTON COURT KNOXVILLE TN 37934 PHYSICIAN SERVICES 412187 22 2075 2075 NET PATIENT REVENUE 621990 56452948 56452948 56452948 122751 122751 249 -249 -249 -249 MISCELLANEOUS INCOME 900099 223198 223198 CAFETERIA SALES 900099 157763 157763 MEDICAL RECORDS TRANSC 900099 48052 48052 18954 18954 447967 57025492 56900666 0 122751 391700 391700 16146443 12937627 3208816 463427 371329 92098 1545368 1238254 307114 1185756 950108 235648 15749 15749 37275 37275 1920423 1538773 381650 154312 123645 30667 760503 609367 151136 95665 76653 19012 143899 143899 2959840 2371424 588416 260567 208784 51783 BAD DEBT 8985976 8985976 SUPPLIES 6676030 5349289 1326741 FEES AND REGISTRATIONS 6022971 4826014 1196957 LAUNDRY 156047 156047 239719 207627 32092 48161670 39950917 8210753 0 3197707 3190265 13180200 20391658 5788466 7174296 667735 636271 928696 818178 114408 111836 52850677 30438392 21700190 22412285 1164495 1282859 46741897 56017648 2454121 2969002 547234 444282 3001355 3413284 X 43740542 52604364 43740542 52604364 46741897 56017648 8863822 0 X 0 1 1 X 0 X 1496323 1496323 20589338 11478601 9110737 25258156 18959791 6298365 5506860 5506860 22412285 57025492 48161670 8863822 8863822 57025492 0 57025492 0 57025492 48161670 0 48161670 0 48161670 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: 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 2012 AND 2011. THE ASSOCIATION'S FORM 990, RETURN OF ORGANIZATION EXEMPT FROM INCOME TAX, FOR THE YEARS 2009, 2010,2011 AND 2012 ARE SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE, GENERALLY FOR THREE YEARS AFTER THEY ARE FILED. 1 1 0 1 X 100.000000000000 0 0 0 3008859 3008859 0.07680 3008859 3008859 0.07680 9455 9455 0.00020 9279 9279 0.00020 3000 3000 0.00010 21734 21734 0.00050 3030593 3030593 0.07730 1 8985976 8317657 11155364 11257532 -102168 X 1 1 1 1 SWEETWATER HOSPITAL ASSOCIATION

304 WRIGHT ST SWEETWATER TN 37874

X X X SWEETWATER HOSPITAL ASSOCIATION 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 1 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 $ 8985976. 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. 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 19D: DISCOUNTED 70% OF GROSS CHARGES X X X 0 0 0 0 0 0 0 0 0 SCOTT BOWMAN 209214 0 0 0 0 0 8368 0 3036 0 220618 0 0 0 DR THOMAS EVANS 351810 0 0 0 0 0 0 0 0 0 351810 0 0 0 DR KENYA KOZAWA 1239819 0 0 0 0 0 0 0 0 0 1239819 0 0 0 DEBBIE J THOMPSON 154896 0 0 0 0 0 6196 0 0 0 161092 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 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. IDEAL RENTAL COMPANY INC 304 WRIGHT ST SWEETWATER TN 37874 620933728 REAL ESTATE TN C -3416 20517 1.00000 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0