2011-05-12T11:45:34-05:00 2010-06-30 JOHNSON HICKEY & MURCHISON PC 651 E 4TH ST STE 200 CHATTANOOGA TN 37403 990 2009-07-01 621220402 SISKIN HOSPITAL FOR PHYSICAL REHABILITATION INC SISK 4236341200 ONE SISKIN PLAZA CHATTANOOGA TN 37403 ROBERT P MAIN 4236341200 2011-05-11 JOEL D SUSMAN 4237560052 2011-05-11 2009 2016-02-24 21:20:13Z ROBERT MAIN CEO ONE SISKIN PLAZA CHATTANOOGA TN 37403 31086238 false X WWW.SISKINREHAB.ORG X REHABILITATION HEALTH CARE 16 15 464 20 0 47576 521001 23916195 26848865 1252759 2201491 1564303 1076016 26780833 30647373 0 0 16974113 17028717 0 22954 9495483 9419746 26469596 26448463 311237 4198910 76903547 80739904 37891981 37869275 39011566 42870629 REHABILITATION HEALTH CARE false false 8989677 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. 4213868 THE HOSPITAL PROVIDED 89,987 INPATIENT UNITS OF INPATIENT AND 79,773 UNITS OF OUTPATIENT PHYSICAL THERAPY SERVICE DURING FYE 6/30/10. 1912434 THE HOSPITAL PROVIDED 57,201 INPATIENT UNITS AND 15,059 OUTPATIENT UNITS OF OCCUPATIONAL THERAPY SERVICE DURING THE FYE 06/30/10. 4780934 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 4780934 19896913 true true false true false false false false true true true false false false false false false false true false true false false true true false false false false false false false false false false false false false false false true false false false true 20 0 true 464 true false false false false false false false false false 16 15 false false false false false false false true true false false true true true true true true true true false TN X X CAROL ARNHART 4236341200 ONE SISKIN PLAZA CHATTANOOGA TN 37403 ROBERT P MAIN 50.00 X X 462795 0 32569 W CHARLES A STERNBERGH JR MD 1.00 X X 0 0 0 LAWENCE M RICHEY 1.00 X X 0 0 0 THOMAS KINSER 1.00 X 0 0 0 JAMES W CECIL 1.00 X 0 0 0 ROSE E DECOSIMO CPA 1.00 X 0 0 0 CLAIRE BINDER 1.00 X 0 0 0 R PHILLIP BURNS MD 1.00 X 0 0 0 FREDERICK W OBEAR PHD 1.00 X 0 0 0 JO ANN YATES 1.00 X 0 0 0 JUDITH BRITIAN 1.00 X X 0 0 0 JOHN F BOXELL MD 1.00 X 0 0 0 RICHARD L BROWN JR EDD 1.00 X 0 0 0 MARSHAL D MIZE 1.00 X 0 0 0 WILLIAM C MATHENY CPA 1.00 X 0 0 0 ROBERT O BEST 1.00 X 0 0 0 LINDA K LIND 50.00 X 284187 0 17586 LINDA A KNIGHT 40.00 X 179574 0 4349 CAROL E ARNHART 50.00 X 76173 0 3856 TOD CAIN 40.00 X 109044 0 2259 JAMES D RYMER 40.00 X 108664 0 2267 1220437 62886 6 false true false 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 8 521001 521001 NET PATIENT REVENUE 26848865 26848865 26848865 2535637 2535637 198172 198172 198172 198172 334146 -334146 -334146 -334146 249380 104719 144661 144661 LIFEFITNESS SERVICES 427371 427371 CAFETERIA SALES 167606 167606 MISCELLANEOUS REVENUE 52074 52074 86132 86132 733183 30647373 27446074 2680298 854324 854324 13109902 10526234 2583668 521646 393217 128429 1455609 1097238 358371 1087236 819558 267678 127500 77494 50006 50580 30743 19837 1411484 857900 553584 2996 1821 1175 444921 412578 23012 9331 1334714 811239 523475 76334 46396 29938 75983 46182 29801 1273254 891278 381976 1649162 1154414 494748 248604 174023 74581 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 96872 58879 37993 26448463 19896913 6528596 22954 320286 22039 7530876 6929164 1113907 682971 4149962 4138658 1339222 469499 103206 115187 224199 220634 44552673 21385072 24423619 23167601 23840739 29067923 3644359 3632047 10213172 12294181 76903547 80739904 2670423 3041989 5923 10109 33390700 32300158 1824935 2517019 37891981 37869275 X 38831319 42711471 180247 159158 39011566 42870629 76903547 80739904 X false true true X X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false false true 1849 false false false 1849 false false false false false SCHEDULE C, PART II-B, LINE 1I PORTION OF HOSPITAL MEMBERSHIP DUES THAT ARE USED FOR LOBBYING false false false false false false false 7130934 1954220 9085154 7958122 -827188 7130934 1.00000 true false false 260000 260000 27468378 7800159 19668219 14554585 11968072 2586513 2269710 1616841 652869 23167601 BOARD DESIGNATED FUNDS 11915661 BOND ISSUE & DEFERRED FINANCING COST 281141 ESTIMATED THIRD PARTY SETTLEMENTS 92781 DEPOSITS 4598 12294181 SWAP AGREEMENT - LIABILITY 2517019 2517019 30647373 26448463 4198910 -339846 -339846 3859064 30307527 68376 68376 30239151 408222 408222 30647373 26448463 26448463 26448463 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 GOLF CLASSIC 132642 132642 46369 8863 5461 3454 POSSIBILITIES L 116738 116738 522 12980 14389 12681 249380 249380 46369 9385 18441 14389 16135 104719 144661 true true true X true X false true true false true true 221085 221085 0.00840 663083 278664 384419 0.01450 884168 278664 605504 0.02290 738160 327651 410509 0.01550 46827 46827 0.00180 34820 34820 0.00130 819807 327651 492156 0.01860 1703975 606315 1097660 0.04150 false 419170 17415557 13432991 3982566 X false 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 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. X true false X X X X false false false false false false false false false 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 OTHER ADDITIONAL INFORMATION SCHEDULE J, PART III 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. THE HEALTH EDUCATIONAL AND HOUSING 521298872 2005-07-28 12000000 HOSPITAL ADDITION AN false false THE HEALTH EDUCATIONAL AND HOUSING 521298872 162410CH5 2007-05-24 17145000 REFUNDING OF 1990 B false false 11025158 42007 10983151 2006 false false true true 15775000 213194 15561806 2007 true false true true false false false false false true false false false false false true false false false false false false false true true BANK OF AMERICA 21.0 false false false 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 LIFEFITNESS LLC ONE SISKIN PLAZA CHATTANOOGA TN 37403 621668121 HEALTHCARE TN 501 3 N/A false false false false false false false false false false false false false true false true false false LIFEFITNESS P 724436 LIFEFITNESS N 471585