SISKIN HOSPITAL FOR PHYSICAL REHABILITATION: Form 990, tax year 2009
View the entire original 990 at ProPublica ↗
- Organization
- SISKIN HOSPITAL FOR PHYSICAL REHABILITATION (EIN 62-1220402)
- Tax period
- 2009-07-01 to 2010-06-30
- Filed
- 2011-05-12
- IRS object ID
- 201141329349301349
- Schema version
- 2009v1.7
- 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 K
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2011-05-12T11:45:34-05:00 | Timestamp |
| Tax Period End Date | 2010-06-30 | 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 | 2009-07-01 | 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 | BusinessNameLine1 |
| Business Name Line2 | REHABILITATION INC | BusinessNameLine2 |
| 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 | ROBERT P MAIN | Name |
| Title | PRESIDENT, CEO | Title |
| Phone | 4236341200 | Phone |
| Date Signed | 2011-05-11 | DateSigned |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | JOEL D SUSMAN | Name |
| Phone | 4237560052 | Phone |
| Date Prepared | 2011-05-11 | DatePrepared |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2009 | 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 CEO | 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 | 31086238 | GrossReceipts |
| Group Return For Affiliates | false | GroupReturnForAffiliates |
| Organization501c | X | Organization501c |
| Web Site | WWW.SISKINREHAB.ORG | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| 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 |
| Contributions Grants Prior Year | 47576 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 521001 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 23916195 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 26848865 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 1252759 | InvestmentIncomePriorYear |
| Investment Income Current Year | 2201491 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 1564303 | OtherRevenuePriorYear |
| Other Revenue Current Year | 1076016 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 26780833 | TotalRevenuePriorYear |
| Total Revenue Current Year | 30647373 | TotalRevenueCurrentYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 16974113 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 17028717 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 22954 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 9495483 | OtherExpensePriorYear |
| Other Expenses Current Year | 9419746 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 26469596 | TotalExpensesPriorYear |
| Total Expenses Current Year | 26448463 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 311237 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 4198910 | RevenuesLessExpensesCY |
| Total Assets BOY | 76903547 | TotalAssetsBOY |
| Total Assets EOY | 80739904 | TotalAssetsEOY |
| Total Liabilities BOY | 37891981 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 37869275 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 39011566 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 42870629 | NetAssetsOrFundBalancesEOY |
| Mission Description | REHABILITATION HEALTH CARE | MissionDescription |
| Significant New Program Services | false | SignificantNewProgramServices |
| Significant Change | false | SignificantChange |
| Expense | 8989677 | Expense |
| Description | DURING THE FYE 06/30/10 THE HOSPITAL PROVIDED QUALITY ADULT AND PEDIATRIC NURSING SERVICES FOR ALL CATEGORIES OF PATIENTS. 17,116 INPATIENT SERVICE DAYS AND 9,258 SUBACUTE SERVICE DAYS WERE PROVIDED DURING THIS PERIOD. | Description |
Activity2 Activity2
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 4213868 | Expense |
| Description | THE HOSPITAL PROVIDED 89,987 INPATIENT UNITS OF INPATIENT AND 79,773 UNITS OF OUTPATIENT PHYSICAL THERAPY SERVICE DURING FYE 6/30/10. | Description |
Activity3 Activity3
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 1912434 | Expense |
| Description | THE HOSPITAL PROVIDED 57,201 INPATIENT UNITS AND 15,059 OUTPATIENT UNITS OF OCCUPATIONAL THERAPY SERVICE DURING THE FYE 06/30/10. | Description |
Activity Other ActivityOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 4780934 | Expense |
| Description | THE HOSPITAL PROVIDED 16,465 INPATIENT UNITS AND 2,788 OUTPATIENT UNITS OF SPEECH THERAPY FOR THE FYE 06/30/10 AND ALL OTHER HOSPITAL SERVICES PROVIDED BY SISKIN | Description |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Other Program Service Exp | 4780934 | TotalOfOtherProgramServiceExp |
| Total Program Service Expense | 19896913 | TotalProgramServiceExpense |
| Described In501 C3 | true | DescribedIn501C3 |
| Schedule B Required | true | ScheduleBRequired |
| Political Activities | false | PoliticalActivities |
| Lobbying Activities | true | LobbyingActivities |
| Donor Advised Funds | false | DonorAdvisedFunds |
| Conservation Easements | false | ConservationEasements |
| Collections Of Art | false | CollectionsOfArt |
| Credit Counseling | false | CreditCounseling |
| Term Or Permanent Endowments | true | TermOrPermanentEndowments |
| Balance Sheet Amounts Reported | true | BalanceSheetAmountsReported |
| Independent Audit Financial Stmt | true | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | false | ConsolidatedAuditFinancialStmt |
| School | false | School |
| Foreign Office | false | ForeignOffice |
| Foreign Activities | false | ForeignActivities |
| More Than5000 K To Organizations | false | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividuals |
| Professional Fundraising | false | ProfessionalFundraising |
| Fundraising Activities | true | FundraisingActivities |
| Gaming | false | Gaming |
| Hospital | true | Hospital |
| Grants To Organizations | false | GrantsToOrganizations |
| Grants To Individuals | false | GrantsToIndividuals |
| Schedule J Required | true | ScheduleJRequired |
| Tax Exempt Bonds | true | TaxExemptBonds |
| Invest Tax Exempt Bonds | false | InvestTaxExemptBonds |
| Escrow Account | false | EscrowAccount |
| On Behalf Of Issuer | false | OnBehalfOfIssuer |
| Excess Benefit Transaction | false | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | false | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | false | LoanToOfficerOrDQP |
| Grant To Related Person | false | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | false | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | false | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | false | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | false | DeductibleNonCashContributions |
| Deductible Contributions Of Art | false | DeductibleContributionsOfArt |
| Terminated | false | Terminated |
| Partial Liquidation | false | PartialLiquidation |
| Disregarded Entity | false | DisregardedEntity |
| Related Entity | true | RelatedEntity |
| Related Org Controlled Entity | false | RelatedOrgControlledEntity |
| Transfers To Exempt Non Chrtbl Org | false | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | false | ActivitiesConductedPartnership |
| Schedule O Required | true | ScheduleORequired |
| Number Forms Transmitted With1096 | 20 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | true | ComplianceWithBackupWitholding |
| Number Of Employees | 464 | NumberOfEmployees |
| Employment Tax Returns Filed | true | EmploymentTaxReturnsFiled |
| Unrelated Business Income | false | UnrelatedBusinessIncome |
| Foreign Financial Account | false | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTrans |
| Taxable Party Notification | false | TaxablePartyNotification |
| Non Deductible Contributions | false | NonDeductibleContributions |
| Quid Pro Quo Contributions | false | QuidProQuoContributions |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | false | FundsToPayPremiums |
| Premiums Paid | false | PremiumsPaid |
| Nbr Voting Governing Body Members | 16 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 15 | NumberIndependentVotingMembers |
| Family Or Business Relationship | false | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | false | DelegationOfManagementDuties |
| Changes To Organizing Docs | false | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuse |
| Members Or Stockholders | false | MembersOrStockholders |
| Election Of Board Members | false | ElectionOfBoardMembers |
| Decisions Subject To Approval | false | DecisionsSubjectToApproval |
| Minutes Of Governing Body | true | MinutesOfGoverningBody |
| Minutes Of Committees | true | MinutesOfCommittees |
| Officer Mailing Address | false | OfficerMailingAddress |
| Local Chapters | false | LocalChapters |
| Form990 Provided To Governing Body | true | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | true | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | true | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | true | RegularMonitoringEnforcement |
| Whistleblower Policy | true | WhistleblowerPolicy |
| Document Retention Policy | true | DocumentRetentionPolicy |
| Compensation Process CEO | true | CompensationProcessCEO |
| Compensation Process Other | true | CompensationProcessOther |
| Investment In Joint Venture | false | 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 CE | 50.00 | X | X | 462795 | 0 | 32569 | |
| W CHARLES A STERNBERGH JR MD | |||||||
| CHAIR | 1.00 | X | X | 0 | 0 | 0 | |
| LAWENCE M RICHEY | |||||||
| TREASURER | 1.00 | X | X | 0 | 0 | 0 | |
| THOMAS KINSER | |||||||
| BOARD MEMBER | 1.00 | 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 BINDER | |||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| R PHILLIP BURNS MD | |||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| FREDERICK W OBEAR PHD | |||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| JO ANN YATES | |||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| JUDITH BRITIAN | |||||||
| VICE CHAIR | 1.00 | X | X | 0 | 0 | 0 | |
| JOHN F BOXELL MD | |||||||
| BOARD MEMBER | 1.00 | 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 MATHENY CPA | |||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| ROBERT O BEST | |||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| LINDA K LIND | |||||||
| SR.VICE PRES | 50.00 | X | 284187 | 0 | 17586 | ||
| LINDA A KNIGHT | |||||||
| CFO | 40.00 | X | 179574 | 0 | 4349 | ||
| CAROL E ARNHART | |||||||
| CONTROLLER C | 50.00 | X | 76173 | 0 | 3856 | ||
| TOD CAIN | |||||||
| DIR THERAPY | 40.00 | 109044 | 0 | 2259 | X | ||
| JAMES D RYMER | |||||||
| PHARMACIST | 40.00 | 108664 | 0 | 2267 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 1220437 | TotalReportableCompFromOrg |
| Total Other Compensation | 62886 | TotalOtherCompensation |
| Number Individuals GT100 K | 6 | NumberIndividualsGT100K |
| Formers Listed | false | FormersListed |
| Total Comp GT150 K | true | TotalCompGT150K |
| Compensation From Other Sources | false | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| ERLANGER MEDICAL CENTER | |||||
| 975 E THIRD STREET | CHATTANOOGA | TN | 37403 | MEDICAL & DIAG | 860332 |
| SODEXHO MARRIOTT SERVICES | |||||
| PO BOX 536922 | ATLANTA | GA | 30353 | FOOD & FOOD SER | 541941 |
| MCKESSON | |||||
| PO BOX 409521 | ATLANTA | GA | 30384 | PHARMACEUTICALS | 526504 |
| MCKESSON SOLUTIONS | |||||
| PO BOX 98347 | CHICAGO | IL | 60693 | SOFTWARE IMPLET | 349889 |
| SISKIN SPINE & REHAB | |||||
| 1 SISKIN PLAZA | CHATTANOOGA | TN | 37403 | MEDICAL DIR SVS | 275000 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 8 | NumberOfContractorsGT100K |
| All Other Contributions | 521001 | AllOtherContributions |
| Total Contributions | 521001 | TotalContributions |
Program Service Revenue ProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | NET PATIENT REVENUE | Description |
| Total Revenue Column | 26848865 | TotalRevenueColumn |
| Related Or Exempt Function Income | 26848865 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 26848865 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 2535637 | TotalRevenueColumn |
| Exclusion | $2,535,637 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 198172 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 198172 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 198172 | TotalRevenueColumn |
| Related Or Exempt Function Income | 198172 | RelatedOrExemptFunctionIncome |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 334146 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | -334146 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -334146 | TotalRevenueColumn |
| Related Or Exempt Function Income | -334146 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Income Fundraising Events | 249380 | GrossIncomeFundraisingEvents |
| Fundraising Direct Expenses | 104719 | FundraisingDirectExpenses |
Net Income From Fundraising Events NetIncomeFromFundraisingEvents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 144661 | TotalRevenueColumn |
| Exclusion | $144,661 | ExclusionAmount |
Other Revenue Misc OtherRevenueMisc (3 entries)
| DescriptionDescription | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|
| LIFEFITNESS SERVICES | 427371 | 427371 |
| CAFETERIA SALES | 167606 | 167606 |
| MISCELLANEOUS REVENUE | 52074 | 52074 |
Miscellaneous Revenue MiscellaneousRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 86132 | TotalRevenueColumn |
| Related Or Exempt Function Income | 86132 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 733183 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 30647373 | TotalRevenueColumn |
| Related Or Exempt Function Income | 27446074 | RelatedOrExemptFunctionIncome |
| Exclusion | $2,680,298 | ExclusionAmount |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 854324 | Total |
| Management And General | 854324 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 13109902 | Total |
| Program Services | 10526234 | ProgramServices |
| Management And General | 2583668 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 521646 | Total |
| Program Services | 393217 | ProgramServices |
| Management And General | 128429 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1455609 | Total |
| Program Services | 1097238 | ProgramServices |
| Management And General | 358371 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1087236 | Total |
| Program Services | 819558 | ProgramServices |
| Management And General | 267678 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 127500 | Total |
| Program Services | 77494 | ProgramServices |
| Management And General | 50006 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 50580 | Total |
| Program Services | 30743 | ProgramServices |
| Management And General | 19837 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1411484 | Total |
| Program Services | 857900 | ProgramServices |
| Management And General | 553584 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2996 | Total |
| Program Services | 1821 | ProgramServices |
| Management And General | 1175 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 444921 | Total |
| Program Services | 412578 | ProgramServices |
| Management And General | 23012 | ManagementAndGeneral |
| Fundraising | 9331 | Fundraising |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1334714 | Total |
| Program Services | 811239 | ProgramServices |
| Management And General | 523475 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 76334 | Total |
| Program Services | 46396 | ProgramServices |
| Management And General | 29938 | ManagementAndGeneral |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 75983 | Total |
| Program Services | 46182 | ProgramServices |
| Management And General | 29801 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1273254 | Total |
| Program Services | 891278 | ProgramServices |
| Management And General | 381976 | ManagementAndGeneral |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1649162 | Total |
| Program Services | 1154414 | ProgramServices |
| Management And General | 494748 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 248604 | Total |
| Program Services | 174023 | ProgramServices |
| Management And General | 74581 | ManagementAndGeneral |
Other Expenses OtherExpenses (5 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral | FundraisingFundraising |
|---|---|---|---|---|
| MEDICAL SUPPLIES & DRUGS | 1715467 | 1715467 | ||
| BAD DEBTS | 581374 | 581374 | ||
| OTHER EXPENSES | 144898 | 88069 | 43206 | 13623 |
| EQUIPMENT RENTAL AND LEAS | 93434 | 56789 | 36645 | |
| MISC. TAXES | 92169 | 56020 | 36149 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 96872 | Total |
| Program Services | 58879 | ProgramServices |
| Management And General | 37993 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 26448463 | Total |
| Program Services | 19896913 | ProgramServices |
| Management And General | 6528596 | ManagementAndGeneral |
| Fundraising | 22954 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 320286 | BOY |
| EOY | 22039 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 7530876 | BOY |
| EOY | 6929164 | EOY |
Pledges And Grants Receivable PledgesAndGrantsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1113907 | BOY |
| EOY | 682971 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4149962 | BOY |
| EOY | 4138658 | EOY |
Other Notes Loans Receivable Net OtherNotesLoansReceivableNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1339222 | BOY |
| EOY | 469499 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 103206 | BOY |
| EOY | 115187 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 224199 | BOY |
| EOY | 220634 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 44552673 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 21385072 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 24423619 | BOY |
| EOY | 23167601 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 23840739 | BOY |
| EOY | 29067923 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3644359 | BOY |
| EOY | 3632047 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 10213172 | BOY |
| EOY | 12294181 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 76903547 | BOY |
| EOY | 80739904 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2670423 | BOY |
| EOY | 3041989 | EOY |
Deferred Revenue DeferredRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5923 | BOY |
| EOY | 10109 | EOY |
Tax Exempt Bond Liabilities TaxExemptBondLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 33390700 | BOY |
| EOY | 32300158 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1824935 | BOY |
| EOY | 2517019 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 37891981 | BOY |
| EOY | 37869275 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 38831319 | BOY |
| EOY | 42711471 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 180247 | BOY |
| EOY | 159158 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 39011566 | BOY |
| EOY | 42870629 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 76903547 | BOY |
| EOY | 80739904 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | false | AccountantCompileOrReview |
| FS Audited | true | FSAudited |
| Audit Committee | true | AuditCommittee |
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
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) |
|---|---|---|
| Form4720 Filed4955 Tax | false | Form4720Filed4955Tax |
| Correction Made | false | CorrectionMade |
| Form1120 Pol Filed | false | Form1120PolFiled |
| Form4720 Filed | false | Form4720Filed |
| Volunteers | false | Volunteers |
| Paid Staff Or Management | false | PaidStaffOrManagement |
| Media Advertisements | false | MediaAdvertisements |
| Mailings Members | false | MailingsMembers |
| Publications Or Broadcast | false | PublicationsOrBroadcast |
| Grants Other Organizations | true | GrantsOtherOrganizations |
| Grants Other Organizations | $1,849 | GrantsOtherOrganizationsAmount |
| Direct Contact Legislators | false | DirectContactLegislators |
| Rallies Demonstrations | false | RalliesDemonstrations |
| Other Activities | false | OtherActivities |
| Total Lobbying Expenditures IIB | 1849 | TotalLobbyingExpendituresIIB |
| Not Described In501c3 | false | NotDescribedIn501c3 |
| Form4720 Filed4912 Tax | false | Form4720Filed4912Tax |
| Substantially All Dues Nondeduct | false | SubstantiallyAllDuesNondeduct |
| Only In House Lobbying | false | OnlyInHouseLobbying |
| Agree To Carryover Prior Year | false | AgreeToCarryoverPriorYear |
Form990 Schedule C Part IV Form990ScheduleCPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Reference | SCHEDULE C, PART II-B, LINE 1I | ReturnReference |
| Explanation | PORTION OF HOSPITAL MEMBERSHIP DUES THAT ARE USED FOR LOBBYING | Explanation |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Disclosed Orgs Legal Control | false | DisclosedOrgsLegalControl |
| Disclosed For Charitable Purposes | false | DisclosedForCharitablePurposes |
| Written Policy Monitoring | false | WrittenPolicyMonitoring |
| Sect170h Requirements Satisfied | false | Sect170hRequirementsSatisfied |
| Solicited Assets For Sale | false | SolicitedAssetsForSale |
| Agent Trustee Etc | false | AgentTrusteeEtc |
| Included On FS | false | IncludedOnFS |
Current Year CurrentYear
| 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 Minus1 Year CurrentYearMinus1Year
| 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 | true | EndowmentsHeldByUnrelatedOrgs |
| Endowments Held By Related Orgs | false | EndowmentsHeldByRelatedOrgs |
| Are Related Orgs Listed Schedule R | false | AreRelatedOrgsListedScheduleR |
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 | 27468378 | OtherCostOrOtherBasis |
| Depreciation | 7800159 | Depreciation |
| Book Value | 19668219 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 14554585 | OtherCostOrOtherBasis |
| Depreciation | 11968072 | Depreciation |
| Book Value | 2586513 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 2269710 | OtherCostOrOtherBasis |
| Depreciation | 1616841 | Depreciation |
| Book Value | 652869 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 23167601 | TotalOfBookValueLandBuildings |
Other Assets OtherAssets (4 entries)
| DescriptionDescription | Book ValueBookValue |
|---|---|
| BOARD DESIGNATED FUNDS | 11915661 |
| BOND ISSUE & DEFERRED FINANCING COST | 281141 |
| ESTIMATED THIRD PARTY SETTLEMENTS | 92781 |
| DEPOSITS | 4598 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | 12294181 | TotalBookValueOtherAssets |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | SWAP AGREEMENT - LIABILITY | Description |
| Amount | $2,517,019 | Amount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 2517019 | TotalOfAmounts |
| Total Revenue | 30647373 | TotalRevenue |
| Total Expenses | 26448463 | TotalExpenses |
| Excess Or Deficit For Year | 4198910 | ExcessOrDeficitForYear |
| Other | -$339,846 | OtherAmount |
| Total Adjustments | -339846 | TotalAdjustments |
| Excess Or Deficit Per FS | 3859064 | ExcessOrDeficitPerFS |
| Tot Revenue Etc Audited Fincl Stmt | 30307527 | TotRevenueEtcAuditedFinclStmt |
| Other Revenues | 68376 | OtherRevenues |
| Revenue Not Rptd F990 | 68376 | RevenueNotRptdF990 |
| Revenue Subtotal | 30239151 | RevenueSubtotal |
| Other Revenues Not Included | 408222 | OtherRevenuesNotIncluded |
| Revenue Not Rptd On Fin Stmt | 408222 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 30647373 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 26448463 | TotExpensesEtcAuditedFinclStmt |
| Expenses Subtotal | 26448463 | ExpensesSubtotal |
| Total Expenses Per Form990 | 26448463 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV (4 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| INTENDED USES FOR ENDOWMENT FUNDS | SCHEDULE D, PAGE 2, PART V, LINE 4 | TO PROVIDE RESOURCES FOR VARIOUS ACTIVITIES CONSISTENT WITH THE MISSION OF THE HOSPITAL |
| RECONCILIATION OF CHANGES - OTHER | SCHEDULE D, PAGE 4, PART XI, LINE 8 | UNREALIZED LOSS ON INTEREST RATE SWAP AGREEMENT -692,085 UNREALIZED GAIN ON OTHER THAN TRADING SECURITIES 781,547 TEMPORARILY RESTRICTED NET ASSETS -21,086 CONTRIBUTIONS INCLUDED ON RETURN NOT ON FINANCIALS -408,222 |
| REVENUE AMOUNTS INCLUDED IN FINANCIALS - OTHER | SCHEDULE D, PAGE 4, PART XII, LINE 2D | UNREALIZED LOSS ON INTEREST RATE SWAP AGREEMENT -692,085 UNREALIZED GAIN ON OTHER THAN TRADING SECURITIES 781,547 TEMPORARILY RESTRICTED NET ASSETS -21,086 |
| REVENUE AMOUNTS INCLUDED ON RETURN - OTHER | SCHEDULE D, PAGE 4, PART XII, LINE 4B | CONTRIBUTIONS INCLUDED ON RETURN NOT ON FINANCIALS 408,222 |
Schedule G IRS990ScheduleG
Events Information EventsInformation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Event1 | GOLF CLASSIC | NameOfEvent1 |
| Gross Receipts Event1 | 132642 | GrossReceiptsEvent1 |
| Gross Revenue Event1 | 132642 | GrossRevenueEvent1 |
| Non Cash Prizes Event1 | 46369 | NonCashPrizesEvent1 |
| Rent Facility Costs Event1 | 8863 | RentFacilityCostsEvent1 |
| Food And Beverage Event1 | 5461 | FoodAndBeverageEvent1 |
| Other Direct Expenses Event1 | 3454 | OtherDirectExpensesEvent1 |
| Name Of Event2 | POSSIBILITIES L | NameOfEvent2 |
| Gross Receipts Event2 | 116738 | GrossReceiptsEvent2 |
| Gross Revenue Event2 | 116738 | GrossRevenueEvent2 |
| Rent Facility Costs Event2 | 522 | RentFacilityCostsEvent2 |
| Food And Beverage Event2 | 12980 | FoodAndBeverageEvent2 |
| Entertainment Event2 | 14389 | EntertainmentEvent2 |
| Other Direct Expenses Event2 | 12681 | OtherDirectExpensesEvent2 |
| Gross Receipts Total | 249380 | GrossReceiptsTotal |
| Gross Revenue Total Events | 249380 | GrossRevenueTotalEvents |
| Non Cash Prizes Total Events | 46369 | NonCashPrizesTotalEvents |
| Rent Facility Costs Total Events | 9385 | RentFacilityCostsTotalEvents |
| Food And Beverage Total Events | 18441 | FoodAndBeverageTotalEvents |
| Entertainment Total Events | 14389 | EntertainmentTotalEvents |
| Other Direct Expenses Total Events | 16135 | OtherDirectExpensesTotalEvents |
| Direct Expense Summary Events | 104719 | DirectExpenseSummaryEvents |
| Net Income Summary | 144661 | NetIncomeSummary |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | true | CharityCarePolicy |
| Written Policy | true | WrittenPolicy |
| FPG Reference Free Care | true | FPGReferenceFreeCare |
| Pcent200 | X | Pcent200 |
| FPG Reference Discounted Care | true | FPGReferenceDiscountedCare |
| Pcent200 D | X | Pcent200D |
| Free Disc Care Medically Indigent | false | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | true | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | true | ExpensesExceededBudget |
| Unable To Provide Care | false | UnableToProvideCare |
| Annual Community Benefit Report | true | AnnualCommunityBenefitReport |
| Report Publically Available | true | ReportPublicallyAvailable |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 221085 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 221085 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00840 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 663083 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 278664 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 384419 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01450 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 884168 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 278664 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 605504 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.02290 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 738160 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 327651 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 410509 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01550 | PercentOfTotalExpense |
Health Professions Education HealthProfessionsEducation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 46827 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 46827 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00180 | PercentOfTotalExpense |
Cash And In Kind Contributions CashAndInKindContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 34820 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 34820 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00130 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 819807 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 327651 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 492156 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01860 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 1703975 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 606315 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1097660 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.04150 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | false | BadDebtExpenseReported |
| Bad Debt Expense | $419,170 | BadDebtExpenseAmount |
| Amount Reimbursed By Medicare | 17415557 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 13432991 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | 3982566 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | X | Other |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | false | WrittenDebtCollectionPolicy |
Form990 Schedule H Part V Form990ScheduleHPartV (7 entries)
| Business Name Line2Name/BusinessNameLine2 | Address Line1Address/AddressLine1 | CityAddress/City | StateAddress/State | ZIP CodeAddress/ZIPCode | Research FacilityResearchFacility |
|---|---|---|---|---|---|
| SISKIN HOSPITAL FOR PHYSICAL | |||||
| REHABILITATION | 1 SISKIN PLAZA | CHATTANOOGA | TN | 37403 | |
| SISKIN HOSPITAL SUBACUTE UNIT | |||||
| 1 SISKIN PLAZA | CHATTANOOGA | TN | 37403 | X | |
| SISKIN HOSPITAL FOR PHYSICAL | |||||
| REHABILITATION | 1755 GUNBARREL SUITE 206 | CHATTANOOGA | TN | 37421 | X |
| SISKIN HOSPITAL FOR PHYSICAL | |||||
| REHABILITATION | 3820 KEITH STREET | CLEVELAND | TN | 37312 | X |
| SISKIN HOSPITAL FOR PHYSICAL | |||||
| REHABILITATION | 813 RIDGEWAY AVENUE | SIGNAL MOUNTAIN | TN | 37377 | X |
| SISKIN HOSPITAL FOR PHYSICAL | |||||
| REHABILITATION | 3309 CUMMINGS HIGHWAY SUITE D | CHATTANOOGA | TN | 37419 | X |
| SISKIN HOSPITAL FOR PHYSICAL | |||||
| REHABILITATION | 628 MORRISON SPRINGS ROAD | CHATTANOOGA | TN | 37415 | X |
Form990 Schedule H Part VI Form990ScheduleHPartVI
| Field | Value | IRS element (for citing) |
|---|---|---|
| General Explanation | PART III LINE 4 - TO DETERMINE THE AMOUNTS REPORTED IN PART III, LINE 2, SISKIN HOSPITAL FOR PHYSICAL REHABILITATION REVIEWS INDIVIDUAL PATIENT ACCOUNTS ON AN ONGOING BASIS TO DETERMINE BAD DEBTS. 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'S 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 - 1 INPATIENT REHABILITATION FACILITY, 1 SKILLED NURSING FACILITY, 5 OUTPATIENT CLINICS. 2 NEEDS ASSESSMENT SISKIN HOSPITAL ASSESSES HEALTH CARE NEEDS 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 LOOKS AT 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. 3 PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE INFORMATION TO INFORM AND EDUCATE PATIENTS REGARDING ASSISTANCE UNDER FEDERAL, STATE OR LOCAL PROGRAMS AND SISKIN HOSPITAL'S POLICIES IS AVAILABLE TO PATIENTS UPON ADMISSION AND IS POSTED IN PATIENT ROOMS. BUSINESS OFFICE REPRESENTATIVES ARE AVAILABLE BEFORE, DURING AND FOLLOWING PATIENT STAYS TO DISCUSS PAYMENT ARRANGEMENTS AND QUESTIONS ABOUT BILLING. FOR INPATIENT AND SUBACUTE REFERRALS, THE HOSPITAL'S NURSE LIASONS ARE THE FIRST POINT OF CONTACT FOR INFORMATION DISSEMINATION TO PROSPECTIVE PATIENTS REGARDING AVAILABILITY OF ASSISTANCE AND ELIGIBILITY AND APPLICATION INFORMATION. 4 COMMUNITY INFORMATION SISKIN HOSPITAL 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 REHAB CONDITIONS. THE POPULATIONS WE SERVE CUT ACROSS ALL ECONOMIC LEVELS. 6 OTHER INFORMATION 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 REENTRY PROGRAMS, VOCATIONAL EVALUATION AND SUPPORTED EMPLOYMENT, DRIVER EVALUATION AND TRAINING, AND ADAPTED SPORTS AND LEISURE SKILLS TRAINING. | GeneralExplanation |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Club Dues Or Fees | X | ClubDuesOrFees |
| Written Policy Re T And E Expenses | true | WrittenPolicyReTAndEExpenses |
| Substantiation Required | false | SubstantiationRequired |
| Compensation Committee | X | CompensationCommittee |
| Written Employment Contract | X | WrittenEmploymentContract |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | false | SeverancePayment |
| Supplemental Nonqual Retire Plan | false | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | false | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | false | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | false | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | false | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | false | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | false | AnyNonFixedPayments |
| Initial Contract Exception | false | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (3 entries)
| Base Compensation Filing OrgBaseCompensationFilingOrg | Bonus Filing OrgBonusFilingOrg | Other Compensation Filing OrgOtherCompensationFilingOrg | Deferred Comp Filing OrgDeferredCompFilingOrg | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Total Compensation Filing OrgTotalCompensationFilingOrg | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg |
|---|---|---|---|---|---|---|
| ROBERT P MAIN | ||||||
| 344369 | 83826 | 34600 | 29014 | 3555 | 495364 | 945609 |
| LINDA K LIND | ||||||
| 238606 | 40781 | 4800 | 14001 | 3585 | 301773 | 294168 |
| LINDA A KNIGHT | ||||||
| 117673 | 21154 | 40747 | 2394 | 1955 | 183923 | 202575 |
Form990 Schedule J Part III Form990ScheduleJPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | OTHER ADDITIONAL INFORMATION | Identifier |
| Return Reference | SCHEDULE J, PART III | ReturnReference |
| Explanation | SISKIN HOSPITAL ENTERED INTO A SPLIT DOLLAR INSURANCE AGREEMENT WITH ROBERT P. MAIN, PRESIDENT AND CEO, ON FEBRUARY 9, 1995. AS PER THE AGREEMENT, SISKIN HOSPITAL WOULD FORGIVE THE DEBT FOR PREMIUMS WHEN ROBERT P. MAIN ATTAINED THE NORMAL RETIREMENT AGE OF 65 YEARS. THE DEBT WAS FORGIVEN AND INCLUDED IN HIS W-2 FOR 2008. THE AMOUNT OF DEBT FORGIVENESS EXPLAINS THE DIFFERENCE IN COMPENSATION REPORTED FOR ROBERT MAIN FOR 2008 TO 2009. | Explanation |
Schedule K IRS990ScheduleK
Form990 Schedule K Part I Form990ScheduleKPartI (2 entries)
| Issuer EINIssuerEIN | Date IssuedDateIssued | Issue PriceIssuePrice | Description Of PurposeDescriptionOfPurpose | DefeasedDefeased | On Behalf Of IssuerOnBehalfOfIssuer | CUSIP NumberCUSIPNumber |
|---|---|---|---|---|---|---|
| THE HEALTH EDUCATIONAL AND HOUSING | ||||||
| 521298872 | 2005-07-28 | 12000000 | HOSPITAL ADDITION AN | false | false | |
| THE HEALTH EDUCATIONAL AND HOUSING | ||||||
| 521298872 | 2007-05-24 | 17145000 | REFUNDING OF 1990 B | false | false | 162410CH5 |
Form990 Schedule K Part II Form990ScheduleKPartII (2 entries)
| Total ProceedsTotalProceeds | Issuance Costs From ProceedsIssuanceCostsFromProceeds | Capital ExpendituresCapitalExpenditures | Year Of Subst CompletionYearOfSubstCompletion | Current RefundingCurrentRefunding | Advance RefundingAdvanceRefunding | Final Allocation MadeFinalAllocationMade | Adequate Books And Recds MaintaindAdequateBooksAndRecdsMaintaind |
|---|---|---|---|---|---|---|---|
| 11025158 | 42007 | 10983151 | 2006 | false | false | true | true |
| 15775000 | 213194 | 15561806 | 2007 | true | false | true | true |
Form990 Schedule K Part III Form990ScheduleKPartIII (2 entries)
| Owning Bond Financed PropertyOwningBondFinancedProperty | Any Lease ArrangementsAnyLeaseArrangements | Mngment Cntrct Bond Financd PrprtyMngmentCntrctBondFinancdPrprty | Any Research AgreementsAnyResearchAgreements | Bond Counsel Routinely EngagedBondCounselRoutinelyEngaged | Post Issuance Compliance ProcdrsPostIssuanceComplianceProcdrs |
|---|---|---|---|---|---|
| false | false | false | false | false | true |
| false | false | false | false | false | true |
Form990 Schedule K Part IV Form990ScheduleKPartIV (2 entries)
| Form8038 T FiledForm8038TFiled | Variable Rate IssueVariableRateIssue | Hedge Identified In Books And RecdsHedgeIdentifiedInBooksAndRecds | Gross Proceeds Invested In GICGrossProceedsInvestedInGIC | Gross Proceeds InvestedGrossProceedsInvested | Exception To RebateExceptionToRebate | Term Of HedgeTermOfHedge |
|---|---|---|---|---|---|---|
| (no name) | ||||||
| false | false | false | false | false | false | |
| BANK OF AMERICA | ||||||
| false | true | true | false | false | false | 21.0 |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (6 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| ALL OTHER ACHIEVEMENTS DESCRIPTION | FORM 990, PAGE 2, PART III, LINE 4D | THE HOSPITAL PROVIDED 16,465 INPATIENT UNITS AND 2,788 OUTPATIENT UNITS OF SPEECH THERAPY FOR THE FYE 06/30/10 AND ALL OTHER HOSPITAL SERVICES PROVIDED BY SISKIN |
| ORGANIZATION'S PROCESS USED TO REVIEW FORM 990 | FORM 990, PAGE 6, PART VI, LINE 11 | THE TAX RETURN WILL BE REVIEWED BY THE AUDIT COMMITTEE BEFORE IT IS FILED. |
| ENFORCEMENT OF CONFLICTS POLICY | FORM 990, PAGE 6, PART VI, LINE 12C | ANNUAL DISCLOSURE |
| COMPENSATION PROCESS FOR TOP OFFICIAL | FORM 990, PAGE 6, PART VI, LINE 15A | 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 U.S. DEPARTMENT OF JUSTICE/FEDERAL TRADE COMMISSION GUIDELINES ON SALARY SURVEYS. THESE DATA ARE FROM NATIONALLY RECOGNIZED FREE-STANDING REHABILITATION HOSPITALS IN THE UNITED STATES. |
| COMPENSATION PROCESS FOR OFFICERS | FORM 990, PAGE 6, PART VI, LINE 15B | 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 ADJUSTMENT 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 U.S. DEPARTMENT OF JUSTICE/FEDERAL TRADE COMMISSION GUIDELINES ON SALARY SURVEYS. THESE DATA ARE FROM NATIONALLY RECOGNIZED FREE-STANDING REHABILITATION HOSPITALS IN THE UNITED STATES. |
| GOVERNING DOCUMENTS DISCLOSURE EXPLANATION | FORM 990, PAGE 6, PART VI, LINE 19 | DOCUMENTS UPON REQUEST |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII
Name Of Disregarded Entity NameOfDisregardedEntity
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | LIFEFITNESS LLC | BusinessNameLine1 |
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 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 621668121 | EIN |
| Primary Activities | HEALTHCARE | PrimaryActivities |
| Legal Domicile State | TN | LegalDomicileState |
| Exempt Code Section | 501 | ExemptCodeSection |
| Public Charity Status | 3 | PublicCharityStatus |
| Direct Controlling Entity NA | N/A | DirectControllingEntityNA |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | false | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | false | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | false | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | false | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | false | LoansOrGuaranteesFromOtherOrg |
| Sale Of Assets To Other Org | false | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | false | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | false | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | false | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | false | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | false | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | false | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | false | SharingOfFacilities |
| Sharing Of Paid Employees | true | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | false | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | true | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | false | OtherTransferToOtherOrg |
| Other Transfer From Other Org | false | OtherTransferFromOtherOrg |
Transactions Related Orgs Table TransactionsRelatedOrgsTable (2 entries)
| Transaction TypeTransactionType | Amount InvolvedAmountInvolved |
|---|---|
| LIFEFITNESS | |
| P | 724436 |
| LIFEFITNESS | |
| N | 471585 |
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