SISKIN HOSPITAL FOR PHYSICAL REHABILITATION: Form 990, tax year 2010
View the entire original 990 at ProPublica ↗
- Organization
- SISKIN HOSPITAL FOR PHYSICAL REHABILITATION (EIN 62-1220402)
- Tax period
- 2010-07-01 to 2011-06-30
- Filed
- 2012-05-14
- IRS object ID
- 201241359349304289
- Schema version
- 2010v3.4
- 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 G
- Schedule H
- Schedule J
- Schedule O
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2012-05-14T14:23:36-05:00 | Timestamp |
| Tax Period End Date | 2011-06-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | JOHNSON HICKEY & MURCHISON PC | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 651 E 4TH ST STE 200 | AddressLine1 |
| City | CHATTANOOGA | City |
| State | TN | State |
| ZIP Code | 37403 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2010-07-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 621220402 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SISKIN HOSPITAL FOR PHYSICAL REHABILITATION INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | SISK | NameControl |
| Phone | 4236341200 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | ONE SISKIN PLAZA | AddressLine1 |
| City | CHATTANOOGA | City |
| State | TN | State |
| ZIP Code | 37403 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | CAROL ARNHART | Name |
| Title | CFO | Title |
| Phone | 4236341200 | Phone |
| Date Signed | 2012-05-07 | DateSigned |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | JOEL D SUSMAN | Name |
| Phone | 4237560052 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2010 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | ROBERT MAIN | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | ONE SISKIN PLAZA | AddressLine1 |
| City | CHATTANOOGA | City |
| State | TN | State |
| ZIP Code | 37403 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 31416496 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.SISKINREHAB.ORG | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1984 | YearFormation |
| State Legal Domicile | TN | StateLegalDomicile |
| Activity Or Mission Description | REHABILITATION HEALTH CARE | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 16 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 15 | NbrIndependentVotingMembers |
| Total Nbr Employees | 464 | TotalNbrEmployees |
| Total Nbr Volunteers | 20 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 521001 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 351537 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 26848865 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 29199576 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 2201491 | InvestmentIncomePriorYear |
| Investment Income Current Year | 884501 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 1076016 | OtherRevenuePriorYear |
| Other Revenue Current Year | 610284 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 30647373 | TotalRevenuePriorYear |
| Total Revenue Current Year | 31045898 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 0 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 17028717 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 18607210 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 34895 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 9419746 | OtherExpensePriorYear |
| Other Expenses Current Year | 10089675 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 26448463 | TotalExpensesPriorYear |
| Total Expenses Current Year | 28696885 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 4198910 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 2349013 | RevenuesLessExpensesCY |
| Total Assets BOY | 80739904 | TotalAssetsBOY |
| Total Assets EOY | 83788487 | TotalAssetsEOY |
| Total Liabilities BOY | 37869275 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 34649080 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 42870629 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 49139407 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | REHABILITATION HEALTH CARE | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 10048814 | Expense |
| Revenue | 13204051 | Revenue |
| Description | DURING THE FYE 06/30/11 THE HOSPITAL PROVIDED QUALITY ADULT AND PEDIATRIC NURSING SERVICES FOR ALL CATEGORIES OF PATIENTS. 17,681 INPATIENT SERVICE DAYS AND 9,250 SUBACUTE SERVICE DAYS WERE PROVIDED DURING THIS PERIOD. | Description |
Activity2 Activity2
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 4814985 | Expense |
| Revenue | 6326846 | Revenue |
| Description | THE HOSPITAL PROVIDED 94,221 INPATIENT UNITS AND 80,689 OUTPATIENT UNITS OF PHYSICAL THERAPY SERVICE DURING FYE 06/30/11. | Description |
Activity3 Activity3
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 2135793 | Expense |
| Revenue | 2806413 | Revenue |
| Description | THE HOSPITAL PROVIDED 56,399 INPATIENT UNITS AND 16,571 OUTPATIENT UNITS OF OCCUPATIONAL THERAPY SERVICE DURING THE FYE 06/30/11. | Description |
Activity Other ActivityOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 5222461 | Expense |
| Revenue | 7160470 | Revenue |
| Description | ALL OTHER ACHIEVEMENTS - THE HOSPITAL PROVIDED 15,951 INPATIENT UNITS AND 4,477 OUTPATIENT UNITS OF SPEECH THERAPY AND ALL OTHER HOSPITAL SERVICES PROVIDED BY SISKIN. | Description |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Other Program Service Exp | 5222461 | TotalOfOtherProgramServiceExp |
| Total Of Other Program Service Rev | 7160470 | TotalOfOtherProgramServiceRev |
| Total Program Service Expense | 22222053 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 1 | LobbyingActivities |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 1 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 1 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 1 | ReportProgRelInvest |
| Report Other Assets | 1 | ReportOtherAssets |
| Report Other Liabilities | 1 | ReportOtherLiabilities |
| Report Fin48 Footnote | 1 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 1 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 0 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 1 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 1 | Hospital |
| Financial Stmt Attached | 1 | FinancialStmtAttached |
| Grants To Organizations | 0 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 0 | TaxExemptBonds |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 0 | RelatedEntity |
| Related Org Controlled Entity | 0 | RelatedOrgControlledEntity |
| Transaction Related Entity | 0 | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 31 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 464 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 0 | UnrelatedBusinessIncome |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 1 | QuidProQuoContributions |
| Quid Pro Quo Disclosure | 1 | QuidProQuoDisclosure |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 16 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 15 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 0 | MembersOrStockholders |
| Election Of Board Members | 0 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 0 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 1 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| States Where Copy Of Return Is Filed | TN | StatesWhereCopyOfReturnIsFiled |
| Other Website | X | OtherWebsite |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | CAROL ARNHART | NamePerson |
| Telephone Number | 4236341200 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | ONE SISKIN PLAZA | AddressLine1 |
| City | CHATTANOOGA | City |
| State | TN | State |
| ZIP Code | 37403 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (21 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|
| ROBERT P MAIN | |||||||
| PRESIDENT AND CEO | 50.00 | X | X | 432679 | 0 | 106320 | |
| LAWRENCE M RICHEY | |||||||
| TREASURER | 1.00 | X | X | 0 | 0 | 0 | |
| JAMES W CECIL | |||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| ROSE E DECOSIMO CPA | |||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| CLAIRE S BINDER | |||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| R PHILLIP BURNS MD | |||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| ROBERT A MAXWELL MD | |||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| JO ANN YATES | |||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| JUDITH E BRITAIN | |||||||
| VICE CHAIR | 1.00 | X | X | 0 | 0 | 0 | |
| RICHARD L BROWN JR EDD | |||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| MARSHAL D MIZE | |||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| WILLIAM C MATHENEY CPA | |||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| ROBERT O BEST | |||||||
| SECRETARY | 1.00 | X | X | 0 | 0 | 0 | |
| JOHN F BOXELL MD | |||||||
| CHAIRMAN | 1.00 | X | X | 0 | 0 | 0 | |
| HUGH P BROWN MD | |||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| FREDERICK W OBEAR PHD | |||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| LINDA K LIND | |||||||
| SR VICE PRESIDENT/COO | 50.00 | X | 290470 | 0 | 18614 | ||
| CAROL E ARNHART | |||||||
| CONTROLLER CFO | 50.00 | X | 134281 | 0 | 19593 | ||
| TOD CAIN OTRL | |||||||
| ADMINISTRATIVE DIR CLINICAL SERVICES | 40.00 | 115406 | 0 | 18402 | X | ||
| JAMES D RYMER | |||||||
| PHARMACIST | 40.00 | 120754 | 0 | 15512 | X | ||
| HERMAN GRIER | |||||||
| PHARMACIST | 40.00 | 108098 | 0 | 17954 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 1201688 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 196395 | TotalOtherCompensation |
| Number Individuals GT100 K | 6 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| HUMPHREYS & ASSOCIATES CONTRACTORS | |||||
| PO BOX 206 | SODDY DAISY | TN | 37384 | BUILDING RENOVATION | 1078514 |
| ERLANGER MEDICAL CENTER | |||||
| 975 E THIRD STREET | CHATTANOOGA | TN | 37403 | MEDICAL AND DIAGNOSTICS | 841431 |
| MCKESSON | |||||
| PO BOX 409521 | ATLANTA | GA | 30384 | PHARMACEUTICALS | 754594 |
| SODEXHO MARRIOTT SERVICES | |||||
| PO BOX 536922 | ATLANTA | GA | 30353 | FOOD & FOOD SERVICE | 611834 |
| SISKIN SPINE AND REHAB | |||||
| 1 SISKIN PLAZA | CHATTANOOGA | TN | 37403 | MEDICAL DIR SVS | 278333 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 10 | NumberOfContractorsGT100K |
| Fundraising Events | 126806 | FundraisingEvents |
| All Other Contributions | 224731 | AllOtherContributions |
| Total Contributions | 351537 | TotalContributions |
Program Service Revenue ProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | NET PATIENT REVENUE | Description |
| Business Code | 621990 | BusinessCode |
| Total Revenue Column | 29199576 | TotalRevenueColumn |
| Related Or Exempt Function Income | 29199576 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 29199576 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 1132034 | TotalRevenueColumn |
| Exclusion | $1,132,034 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 213712 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 213712 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 213712 | TotalRevenueColumn |
| Related Or Exempt Function Income | 213712 | RelatedOrExemptFunctionIncome |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 247533 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | -247533 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -247533 | TotalRevenueColumn |
| Related Or Exempt Function Income | -247533 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Income Fundraising Events | 187612 | GrossIncomeFundraisingEvents |
| Cntrbtns Rprtd Fundraising Events | 126806 | CntrbtnsRprtdFundraisingEvents |
| Fundraising Direct Expenses | 123065 | FundraisingDirectExpenses |
Net Income From Fundraising Events NetIncomeFromFundraisingEvents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 64547 | TotalRevenueColumn |
| Exclusion | $64,547 | ExclusionAmount |
Other Revenue Misc OtherRevenueMisc (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| CAFETERIA | 621990 | 202370 | 202370 |
| MISCELLANEOUS REVENUE | 621990 | 37932 | 37932 |
| OTHER SERVICES | 621990 | 32739 | 32739 |
Miscellaneous Revenue MiscellaneousRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 58984 | TotalRevenueColumn |
| Related Or Exempt Function Income | 58984 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 332025 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 31045898 | TotalRevenueColumn |
| Related Or Exempt Function Income | 29497780 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $1,196,581 | ExclusionAmount |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1001957 | Total |
| Management And General | 1001957 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 14566253 | Total |
| Program Services | 11735317 | ProgramServices |
| Management And General | 2830936 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 609564 | Total |
| Program Services | 459489 | ProgramServices |
| Management And General | 150075 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1322412 | Total |
| Program Services | 996834 | ProgramServices |
| Management And General | 325578 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1107024 | Total |
| Program Services | 834475 | ProgramServices |
| Management And General | 272549 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 38404 | Total |
| Program Services | 29037 | ProgramServices |
| Management And General | 9367 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 59225 | Total |
| Program Services | 44780 | ProgramServices |
| Management And General | 14445 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1431403 | Total |
| Program Services | 1082284 | ProgramServices |
| Management And General | 349119 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 813 | Total |
| Program Services | 615 | ProgramServices |
| Management And General | 198 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 534293 | Total |
| Program Services | 487759 | ProgramServices |
| Management And General | 31959 | ManagementAndGeneral |
| Fundraising | 14575 | Fundraising |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1641390 | Total |
| Program Services | 1241055 | ProgramServices |
| Management And General | 400335 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 96305 | Total |
| Program Services | 72816 | ProgramServices |
| Management And General | 23489 | ManagementAndGeneral |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 82407 | Total |
| Program Services | 62308 | ProgramServices |
| Management And General | 20099 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1264544 | Total |
| Program Services | 885181 | ProgramServices |
| Management And General | 379363 | ManagementAndGeneral |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1627193 | Total |
| Program Services | 1139035 | ProgramServices |
| Management And General | 488158 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 214688 | Total |
| Program Services | 150282 | ProgramServices |
| Management And General | 64406 | ManagementAndGeneral |
Other Expenses OtherExpenses (5 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral | FundraisingFundraising |
|---|---|---|---|---|
| MEDICAL SUPPLIES & DRUG | 1818940 | 1818940 | ||
| BAD DEBTS | 877347 | 877347 | ||
| OTHER EXPENSES | 122951 | 92964 | 9667 | 20320 |
| OTHER TAXES | 90315 | 68287 | 22028 | |
| EQUIPMENT RENTAL | 87678 | 66293 | 21385 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 101779 | Total |
| Program Services | 76955 | ProgramServices |
| Management And General | 24824 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 28696885 | Total |
| Program Services | 22222053 | ProgramServices |
| Management And General | 6439937 | ManagementAndGeneral |
| Fundraising | 34895 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 22039 | BOY |
| EOY | 84936 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6929164 | BOY |
| EOY | 9295013 | EOY |
Pledges And Grants Receivable PledgesAndGrantsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 682971 | BOY |
| EOY | 435636 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4138658 | BOY |
| EOY | 3505432 | EOY |
Other Notes Loans Receivable Net OtherNotesLoansReceivableNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 469499 | BOY |
| EOY | 348618 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 115187 | BOY |
| EOY | 119226 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 220634 | BOY |
| EOY | 320767 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 46886212 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 22999704 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 23167601 | BOY |
| EOY | 23886508 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 29067923 | BOY |
| EOY | 31390738 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3632047 | BOY |
| EOY | 438656 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 12294181 | BOY |
| EOY | 13962957 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 80739904 | BOY |
| EOY | 83788487 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3041989 | BOY |
| EOY | 2969867 | EOY |
Deferred Revenue DeferredRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 10109 | BOY |
| EOY | 4664 | EOY |
Tax Exempt Bond Liabilities TaxExemptBondLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 32300158 | BOY |
| EOY | 29571184 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2517019 | BOY |
| EOY | 2103365 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 37869275 | BOY |
| EOY | 34649080 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 42711471 | BOY |
| EOY | 48993181 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 159158 | BOY |
| EOY | 146226 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 42870629 | BOY |
| EOY | 49139407 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 80739904 | BOY |
| EOY | 83788487 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | 2349013 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | 3919765 | ReconcilationOtherChanges |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
| Audit Committee | 1 | AuditCommittee |
| Financial Statement Separate | X | FinancialStatementSeparate |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| 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) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | Volunteers |
| Paid Staff Or Management | 0 | PaidStaffOrManagement |
| Media Advertisements | 0 | MediaAdvertisements |
| Mailings Members | 0 | MailingsMembers |
| Publications Or Broadcast | 0 | PublicationsOrBroadcast |
| Grants Other Organizations | 0 | GrantsOtherOrganizations |
| Direct Contact Legislators | 0 | DirectContactLegislators |
| Rallies Demonstrations | 0 | RalliesDemonstrations |
| Other Activities | 1 | OtherActivities |
| Other Activities | $4,477 | OtherActivitiesAmount |
| Total Lobbying Expenditures IIB | 4477 | TotalLobbyingExpendituresIIB |
| Not Described In501c3 | 0 | NotDescribedIn501c3 |
Form990 Schedule C Part IV Form990ScheduleCPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | EXPLANATION OF OTHER LOBBYING ACTIVITIES: | Identifier |
| Return Reference | PART II-B, LINE 1I: | ReturnReference |
| Explanation | PORTION OF HOSPITAL MEMBERSHIP DUES THAT ARE USED FOR LOBBYING. | Explanation |
Schedule D IRS990ScheduleD
Current Year CurrentYear
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 9085153 | BeginningOfYearBalance |
| Investment Earnings Or Losses | 1672467 | InvestmentEarningsOrLosses |
| End Of Year Balance | 10757620 | EndOfYearBalance |
Current Year Minus1 Year CurrentYearMinus1Year
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 7130934 | BeginningOfYearBalance |
| Investment Earnings Or Losses | 1954220 | InvestmentEarningsOrLosses |
| End Of Year Balance | 9085154 | EndOfYearBalance |
Current Year Minus2 Years CurrentYearMinus2Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 7958122 | BeginningOfYearBalance |
| Investment Earnings Or Losses | -827188 | InvestmentEarningsOrLosses |
| End Of Year Balance | 7130934 | EndOfYearBalance |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated EOY Balance | 1.00000 | BoardDesignatedEOYBalance |
| Endowments Held By Unrelated Orgs | 1 | EndowmentsHeldByUnrelatedOrgs |
| Endowments Held By Related Orgs | 0 | EndowmentsHeldByRelatedOrgs |
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 260000 | OtherCostOrOtherBasis |
| Book Value | 260000 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 29209218 | OtherCostOrOtherBasis |
| Depreciation | 7800159 | Depreciation |
| Book Value | 21409059 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 15323768 | OtherCostOrOtherBasis |
| Depreciation | 13543590 | Depreciation |
| Book Value | 1780178 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 2093226 | OtherCostOrOtherBasis |
| Depreciation | 1655955 | Depreciation |
| Book Value | 437271 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 23886508 | TotalOfBookValueLandBuildings |
Other Assets OtherAssets (2 entries)
| DescriptionDescription | Book ValueBookValue |
|---|---|
| BOARD DESIGNATED FUNDS | 13747414 |
| BOND ISSUE & DEFERRED FINANCING COST | 215543 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | 13962957 | TotalBookValueOtherAssets |
Other Liabilities OtherLiabilities (2 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| SWAP AGREEMENT - LIABILITY | $2,090,365 |
| COST SETTLEMENT | $13,000 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 2103365 | TotalOfAmounts |
| Total Revenue | 31045898 | TotalRevenue |
| Total Expenses | 28696885 | TotalExpenses |
| Excess Or Deficit For Year | 2349013 | ExcessOrDeficitForYear |
| Net Unrealized GL On Investments | 3932697 | NetUnrealizedGLOnInvestments |
| Other | -$12,932 | OtherAmount |
| Total Adjustments | 3919765 | TotalAdjustments |
| Excess Or Deficit Per FS | 6268778 | ExcessOrDeficitPerFS |
| Tot Revenue Etc Audited Fincl Stmt | 34965663 | TotRevenueEtcAuditedFinclStmt |
| Net Unrealized Gains Investments | 3932697 | NetUnrealizedGainsInvestments |
| Other Revenues | -12932 | OtherRevenues |
| Revenue Not Rptd F990 | 3919765 | RevenueNotRptdF990 |
| Revenue Subtotal | 31045898 | RevenueSubtotal |
| Revenue Not Rptd On Fin Stmt | 0 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 31045898 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 28696885 | TotExpensesEtcAuditedFinclStmt |
| Expenses Not Rptd F990 | 0 | ExpensesNotRptdF990 |
| Expenses Subtotal | 28696885 | ExpensesSubtotal |
| Expenses Not Rptd On Fin Stmt | 0 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 28696885 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV (2 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: | PART V, LINE 4: | TO PROVIDE RESOURCES FOR VARIOUS ACTIVITIES CONSISTENT WITH THE MISSION OF THE HOSPITAL. |
| DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: | PART X: | THE HOSPITAL IS A NOT-FOR-PROFIT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND IS EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE INTERNAL REVENUE CODE. IN JULY 2006, THE FINANCIAL ACCOUNTING STANDARDS BOARD(FASB) ISSUED ASC 740-10 (FORMERLY KNOW AS FASB INTERPETATION NO.48,(ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES). ASC 740-10 PROVIDES GUIDANCE ON DERECOGNITION OF TAX BENEFITS, CLASSIFICATION ON THE BALANCE SHEET, INTEREST AND PENALTIES, ACCOUNTING IN INTERIM PERIODS, DISCLOSURE AND TRANSITION. THE HOSPITAL ASC 740-10 AS OF JULY 1, 2009. THERE WAS NO IMPACT ON THE HOSPITAL'S FINANCIAL STATEMENTS AS A RESULT OF IMPLEMENTATION OF ASC 740-10. THE HOSPITAL'S FORM 990, RETURN OF ORGANIZATION EXEMPT FROM TAX, FOR THE YEARS 2008 AND BEYOND REMAIN SUBJECT TO EXAMINATION BY THE IRS, GENERALLY FOR THREE YEARS AFTER THEY WERE FILED. |
Schedule G IRS990ScheduleG
Events Information EventsInformation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Event1 | GOLF TOURNAMENT | NameOfEvent1 |
| Gross Receipts Event1 | 155023 | GrossReceiptsEvent1 |
| Charitable Contributions Event1 | 72456 | CharitableContributionsEvent1 |
| Gross Revenue Event1 | 82567 | GrossRevenueEvent1 |
| Non Cash Prizes Event1 | 53485 | NonCashPrizesEvent1 |
| Rent Facility Costs Event1 | 12814 | RentFacilityCostsEvent1 |
| Food And Beverage Event1 | 1684 | FoodAndBeverageEvent1 |
| Other Direct Expenses Event1 | 5465 | OtherDirectExpensesEvent1 |
| Name Of Event2 | POSSIBILITIES | NameOfEvent2 |
| Gross Receipts Event2 | 159395 | GrossReceiptsEvent2 |
| Charitable Contributions Event2 | 54350 | CharitableContributionsEvent2 |
| Gross Revenue Event2 | 105045 | GrossRevenueEvent2 |
| Rent Facility Costs Event2 | 535 | RentFacilityCostsEvent2 |
| Food And Beverage Event2 | 15015 | FoodAndBeverageEvent2 |
| Entertainment Event2 | 16117 | EntertainmentEvent2 |
| Other Direct Expenses Event2 | 17950 | OtherDirectExpensesEvent2 |
| Gross Receipts Total | 314418 | GrossReceiptsTotal |
| Charitable Contributions Total | 126806 | CharitableContributionsTotal |
| Gross Revenue Total Events | 187612 | GrossRevenueTotalEvents |
| Non Cash Prizes Total Events | 53485 | NonCashPrizesTotalEvents |
| Rent Facility Costs Total Events | 13349 | RentFacilityCostsTotalEvents |
| Food And Beverage Total Events | 16699 | FoodAndBeverageTotalEvents |
| Entertainment Total Events | 16117 | EntertainmentTotalEvents |
| Other Direct Expenses Total Events | 23415 | OtherDirectExpensesTotalEvents |
| Direct Expense Summary Events | 123065 | DirectExpenseSummaryEvents |
| Net Income Summary | 64547 | NetIncomeSummary |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | 1 | CharityCarePolicy |
| Written Policy | 1 | WrittenPolicy |
| FPG Reference Free Care | 1 | FPGReferenceFreeCare |
| Pcent200 | X | Pcent200 |
| FPG Reference Discounted Care | 1 | FPGReferenceDiscountedCare |
| Pcent400 | X | Pcent400 |
| Free Disc Care Medically Indigent | 0 | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | 1 | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | 0 | ExpensesExceededBudget |
| Annual Community Benefit Report | 1 | AnnualCommunityBenefitReport |
| Report Publically Available | 1 | ReportPublicallyAvailable |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 242940 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 242940 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00870 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 461699 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 216615 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 245084 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00880 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 704639 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 216615 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 488024 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01750 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 857998 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 365952 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 492046 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01770 | PercentOfTotalExpense |
Health Professions Education HealthProfessionsEducation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 50000 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 50000 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00180 | PercentOfTotalExpense |
Cash And In Kind Contributions CashAndInKindContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 65597 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 65597 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00240 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 973595 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 365952 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 607643 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.02190 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 1678234 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 582567 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1095667 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.03940 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 1 | BadDebtExpenseReported |
| Bad Debt Expense | $679,154 | BadDebtExpenseAmount |
| Amount Reimbursed By Medicare | 18165125 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 14172684 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | 3992441 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | X | CostToChargeRatio |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | 0 | WrittenDebtCollectionPolicy |
| Number Of Hospital Facilities | 1 | NumberOfHospitalFacilities |
Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility Number | 1 | FacilityNumber |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SISKIN HOSPITAL PHYSICAL REHABILITATION | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1 SISKIN PLAZA | AddressLine1 |
| City | CHATTANOOGA | City |
| State | TN | State |
| ZIP Code | 37403 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| Other | INPATIENT REHABILITATION | Other |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SISKIN HOSPITAL PHYSICAL REHABILITATION | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
| Eligibility Criteria Explained | 1 | EligibilityCriteriaExplained |
| Uses FPG Free | 1 | UsesFPGFree |
| FPG Free Percent | 200.000000000000 | FPGFreePercent |
| Uses FPG Discounted | 1 | UsesFPGDiscounted |
| FPG Discount Percent | 400.000000000000 | FPGDiscountPercent |
| Explains Basis | 1 | ExplainsBasis |
| Income Level | X | IncomeLevel |
| Asset Level | X | AssetLevel |
| Insurance Status | X | InsuranceStatus |
| Uninsured Discount | X | UninsuredDiscount |
| Medicaid Medicare | X | MedicaidMedicare |
| State Regulation | X | StateRegulation |
| Explains Application Method | 1 | ExplainsApplicationMethod |
| Includes Publicity Measures | 1 | IncludesPublicityMeasures |
| Posted In Emergency Room | X | PostedInEmergencyRoom |
| Available On Request | X | AvailableOnRequest |
| Actions On Nonpayment | 0 | ActionsOnNonpayment |
| Collection Activities | 1 | CollectionActivities |
| Report To Credit Agency | X | ReportToCreditAgency |
| Notify Upon Admission | X | NotifyUponAdmission |
| Notify Before Discharge | X | NotifyBeforeDischarge |
| Notified All Patients | X | NotifiedAllPatients |
| Documented Determination | X | DocumentedDetermination |
| Nondiscrim Emergency Care Policy | 0 | NondiscrimEmergencyCarePolicy |
| No Emergency Care | X | NoEmergencyCare |
| Used Other Method | X | UsedOtherMethod |
| Amounts Generally Billed | 0 | AmountsGenerallyBilled |
| Gross Charges | 0 | GrossCharges |
Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Other Facilities | 4 | NumberOfOtherFacilities |
Other Facilities OtherFacilities (4 entries)
| Address Line1Address/AddressLine1 | CityAddress/City | StateAddress/State | ZIP CodeAddress/ZIPCode | Facility TypeFacilityType |
|---|---|---|---|---|
| SISKIN HOSPITAL SUBACUTE UNIT | ||||
| 1 SISKIN PLAZA | CHATTANOOGA | TN | 37403 | SKILLED NURSING FACILITY |
| SISKIN HOSPITAL FOR PHYSICAL REHAB | ||||
| 1755 GUNBARREL ROAD SUITE 206 | CHATTANOOGA | TN | 37421 | OUTPATIENT CLINIC |
| SISKIN HOSPITAL FOR PHYSICAL REHAB | ||||
| 3820 KEITH STREET | CLEVELAND | TN | 37312 | OUTPATIENT CLINIC |
| SISKIN HOSPITAL FOR PHYSICAL REHAB | ||||
| 813 RIDGEWAY AVENUE | SIGNAL MOUNTAIN | TN | 37377 | OUTPATIENT CLINIC |
Form990 Schedule H Part VI Form990ScheduleHPartVI (7 entries)
| ExplanationExplanation |
|---|
| 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 $ 877347. |
| PART III, LINE 4: TO DETERMINE THE AMOUNTS REPORTED IN PART III, LINE 2, SISKIN HOSPITAL REVIEWS INDIVIDUAL PATIENT ACCOUNTS ON AN ONGOING BASIS TO DETERMINE BAD DEBTS. THIS BAD DEBT EXPENSE IS REPORTED IN THE FINANCIAL STATEMENTS AT 100% OF PATIENT CHARGES, BUT IS ADJUSTED TO COST USING COST TO CHARGE RATIO TO DETERMINE THE AMOUNT REPORTED ON PART III, LINE 2. BAD DEBT EXPENSE HAS NOT BEEN INCLUDED AS COMMUNITY BENEFIT. NOTE FROM SISKIN HOSPITAL'S AUDITED FINANCIAL STATEMENTS, IN PERTINENT PART:NOTE A - DESCRIPTION OF ORGANIZATION AND SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES...PATIENT RECEIVABLES - FOR PATIENT RECEIVABLES, THE ALLOWANCE FOR DOUBTFUL ACCOUNTS IS BASED ON MANAGEMENT'S ASSESSMENT OF THE COLLECTIBILITY OF SPECIFIC PATIENT ACCOUNTS AND THE AGING OF ACCOUNTS RECEIVABLE. IF THERE IS A DETERIORATION OF A PATIENT'S CREDITWORTHINESS OR ACTUAL DEFAULTS ARE HIGHER THAN HISTORICAL EXPERIENCE, MANAGEMENT'S ESTIMATES OF RECOVERABILITY OF AMOUNTS DUE TO THE HOSPITAL COULD BE ADVERSELY AFFECTED..." |
| PART V, SECTION A: PART V - 1 INPATIENT REHABILITATION FACILITY, 1 SKILLED NURSING FACILITY, 3 OUTPATIENT CLINICS. |
| PART VI, LINE 2: HEALTHCARE NEEDS ARE ASSESSED BY SISKIN HOSPITAL FOR PHYSICAL REHABILITATION THROUGH A VARIETY OF MECHANISMS, INCLUDING SURVEYS OF THOSE SERVED BY OUR PROGRAMS, FOLLOW-UP TELEPHONE CALLS WITH SERVICE USERS, FEEDBACK FROM VARIOUS SUPPORT GROUPS AND THE INPUT GATHERED FROM ANNUAL ACCESSIBILITY PLANNING. THE HOSPITAL ALSO CONSIDERS COMMUNITY NEEDS THROUGH ITS STRATEGIC PLANNING PROCESS, WHERE INPUT IS SOUGHT FROM A VARIETY OF STAKEHOLDERS, INCLUDING COMMUNITY LEADERS, BOARD MEMBERS, OTHER PROVIDERS, EMPLOYEES AND PATIENTS. |
| PART VI, LINE 3: INFORMATION TO INFORM AND EDUCATE PATIENTS REGARDING ASSISTANCE UNDER FEDERAL, STATE OR LOCAL PROGRAMS AND SISKIN HOSPITAL'S POLICIES IS AVAILABLE UPON ADMISSION AND IS POSTED IN PATIENT ROOMS. BUSINESS OFFICE REPRESENTATIVES ARE AVAILABLE BEFORE, DURING AND FOLLOWING PATIENT STAYS TO DISCUSS PAYMENT ARRANGEMENTS,FINANCIAL ASSISTANCE, AND QUESTIONS ABOUT BILLING. FOR INPATIENT AND SUBACUTE REFERRALS, THE HOSPITAL'S NURSE LIAISONS ARE THE FIRST POINT OF CONTACT FOR INFORMATION DISSEMINATION TO PROSPECTIVE PATIENTS REGARDING AVAILABILITY OF ASSISTANCE, ELIGIBILITY CRITERIA AND APPLICATION INFORMATION. |
| PART VI, LINE 4: SISKIN HOSPITAL FOR PHYSICAL REHABILITATION HAS A PRIMARY SERVICE AREA OF 14 COUNTIES IN THE TRI-STATE AREA OF TENNESSEE, GEORGIA AND ALABAMA. THIS INCLUDES URBAN AND RURAL AREAS OF THE CUMBERLAND PLATEAU. SISKIN HOSPITAL OPERATES SATELLITE CLINICS AND PROVIDES FREE SCREENINGS FOR REHABILITATION CONDITIONS. THE POPULATIONS WE SERVE ENCOMPASS ALL ECONOMIC LEVELS. |
| PART VI, LINE 6: SISKIN HOSPITAL IS AN INDEPENDENT, FREE STANDING REHABILITATION HOSPITAL WHICH IS GOVERNED BY A COMMUNITY BOARD. SISKIN HOSPITAL OFFERS A CONTINUUM OF REHABILITATION SERVICES FROM ACUTE INPATIENT REHABILITATION AND SUBACUTE REHABILITATION TO DAY HOSPITAL AND OUTPATIENT REHABILITATION SERVICES. SISKIN HOSPITAL PROVIDES SPEAKERS TO CIVIC GROUPS TO PROVIDE INFORMATION AND EDUCATION ON REHABILITATION NEEDS. IN ADDITION, SISKIN HOSPITAL OFFERS MANY UNFUNDED OR UNDER-FUNDED SERVICES, FOR WHICH IT IS THE SOLE COMMUNITY PROVIDER. SOME OF THESE INCLUDE COMMUNITY RE-ENTRY, VOCATIONAL EVALUATION AND SUPPORTED EMPLOYMENT, DRIVER EVALUATION AND TRAINING, AND ADAPTED SPORTS AND LEISURE SKILLS TRAINING. SISKIN HOSPITAL ALSO PARTICIPATES IN VARIOUS AREA HEALTH FAIRS AND COMMUNITY EVENTS.SISKIN HOSPITAL UNDERSTANDS THE IMPORTANCE OF CAMARADERIE AND ENCOURAGEMENT OUTSIDE THE HOSPITAL SETTING. THE HOSPITAL HOSTS AND OR/SPONSORS SUPPORT GROUPS DESIGNED TO ADDRESS THE SOCIAL, EMOTIONAL, MEDICAL AND LEGAL ISSUES FACING COMMUNITY MEMBERS AND THEIR FAMILIES EXPERIENCING MANY DIFFERENT CONDITIONS. THESE INCLUDE SUPPORT GROUPS FOR AMPUTEES, ADULTS WITH ASSISTANCE DOGS, LYMPHEDEMA, PARKINSON'S DISEASE AND STROKE SURVIVORS/CAREGIVERS. PROGRAMS ARE ALSO SUPPORTED FOR BRAIN INJURIES AND EPILEPSY IN CONJUNCTION WITH THE CHATTANOOGA AREA BRAIN INJURY ASSOCIATION AND THE EPILEPSY FOUNDATION OF SOUTHEAST TENNESSEE. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Club Dues Or Fees | X | ClubDuesOrFees |
| Written Policy Re T And E Expenses | 1 | WrittenPolicyReTAndEExpenses |
| Substantiation Required | 0 | SubstantiationRequired |
| Compensation Committee | X | CompensationCommittee |
| Written Employment Contract | X | WrittenEmploymentContract |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 0 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (3 entries)
| Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| ROBERT P MAIN | |||||||||||||
| 338928 | 0 | 0 | 0 | 93751 | 0 | 102241 | 0 | 4079 | 0 | 538999 | 0 | 495364 | 0 |
| LINDA K LIND | |||||||||||||
| 238700 | 0 | 46970 | 0 | 4800 | 0 | 14535 | 0 | 4079 | 0 | 309084 | 0 | 301773 | 0 |
| CAROL E ARNHART | |||||||||||||
| 110614 | 0 | 19790 | 0 | 3877 | 0 | 7711 | 0 | 11882 | 0 | 153874 | 0 | 80029 | 0 |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (5 entries)
| IdentifierIdentifier | ExplanationExplanation | Return ReferenceReturnReference |
|---|---|---|
| FORM 990, PART VI, SECTION B, LINE 11 | THE TAX RETURN WILL BE REVIEWED BY THE AUDIT COMMITTEE BEFORE IT IS FILED. | |
| ANNUAL DISCLOSURE | FORM 990, PART VI, SECTION B, LINE 12C | |
| COMPENSATION PROCESS FOR TOP OFFICIAL: THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS FUNCTIONS AS THE COMPENSATION COMMITTEE RESPONSIBLE FOR THE PERFORMANCE REVIEW OF THE CHIEF EXECUTIVE OFFICER AND ANY ADJUSTMENTS IN COMPENSATION AND HIS IMMEDIATE SUBORDINATES AT THE EXECUTIVE LEVEL. THE EXECUTIVE COMMITTEE UTILIZES DATA FROM SALARIES AND COMPENSATION PROGRAMS, AND SELECTED BENEFIT PROGRAMS. THESE ARE COMPILED BY THE US DEPARTMENT OF JUSTICE/FEDERAL TRADE COMMISSION GUIDELINES ON SALARY SURVEYS. THESE DATA ARE FROM NATIONALLY RECOGNIZED FREE-STANDING REHABILITATION HOSPITALS IN THE UNITED STATES. | FORM 990, PART VI, SECTION B, LINE 15 | |
| DOCUMENTS UPON REQUEST. | FORM 990, PART VI, SECTION C, LINE 19 | |
| CHANGES IN NET ASSETS OR FUND BALANCES: | NET UNREALIZED GAINS ON INVESTMENTS: 3,932,697. DECREASE IN TEMPORARILY RESTRICTED ASSETS -12,932. TOTAL TO FORM 990, PART XI, LINE 5: 3,919,765. | FORM 990, PART XI, LINE 5: |
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