2011-05-12T14:00:27-05:00 2010-06-30 JOHNSON HICKEY & MURCHISON PC 651 E 4TH ST STE 200 CHATTANOOGA TN 37403 990 2009-07-01 620544855 SWEETWATER HOSPITAL ASSOCIATION SWEE 8652138200 304 CHURCH STREET SWEETWATER TN 37874 SCOTT BOWMAN 8652138200 2011-04-25 1 Joel D Susman 4237560052 2009 2016-02-24 21:20:13Z SCOTT BOWMAN 304 CHURCH STREET SWEETWATER TN 37874 47420176 0 X www.sweetwater.org X 1934 TN THE MISSION OF THE SWEETWATER HOSPITAL ASSOCIATION IS TO PROMOTE HEALTHY LIFESTYLES AND TO PROVIDE THE HIGHEST QUALITY PRIMARY HEALTH CARE TO THE REGION AT THE LOWEST POSSIBLE COST. 13 12 525 38 0 0 1276 3866 44354802 46870959 276431 143334 468984 402017 45101493 47420176 0 0 16795903 17951069 0 0 24951697 26159347 41747600 44110416 3353893 3309760 40344706 43696561 2416760 2458855 37927946 41237706 THE MISSION OF THE SWEETWATER HOSPITAL ASSOCIATION IS TO PROMOTE HEALTHY LIFESTYLES AND TO PROVIDE THE HIGHEST QUALITY PRIMARY HEALTHCARE TO THE REGION AT THE LOWEST POSSIBLE COST. 0 0 6996692 20520058 PROVIDED FOR 264,689 LABORATORY TESTS DURING THE FISCAL YEAR ENDING 6/30/10. 3977475 11665232 PROVIDED FOR 21,741 EMERGENCY ROOM VISITS DURING THE FISCAL YEAR ENDING 6/30/2010 7840615 22995139 PROVIDED FOR 57,358 X-RAY PROCEDURES DURING THE FISCAL YEAR ENDING 6/30/10 17639494 51733518 PROVIDED FOR 34,875 OF CLINIC SERVICE VISITS DURING THE FISCAL YEAR ENDING 6/30/10. ALL OTHER SERVICES INCLUDE PHARMACY, ROUTINE CARE, OPERATING ROOM, MEDICAL SUPPLIES, THERAPY, HOME HEALTHCARE, LABOR AND DELIVERY. LESS CONTRACTUAL ADUSTMENTS AND POLICY DISCOUNTS -60042988 CONTRACTUAL ADJUSTMENTS AND POLICY DISCOUNTS 17639494 -8309470 36454276 1 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 28 0 1 525 1 0 0 0 0 0 0 0 0 0 0 0 13 12 0 0 0 0 0 0 0 1 1 0 0 1 1 1 0 1 1 1 1 0 TN X X SWEETWATER HOSPITAL ASSOCIATION 8652138200 304 CHURCH STREET SWEETWATER TN 37874 SCOTT BOWMAN 40.00 X X 172272 0 19722 DAVID VESTAL 1.00 X 0 0 0 DR THOMAS EVANS 1.00 X 0 0 0 DRJOE LITTLE 1.00 X 0 0 0 DOUG WARREN 1.00 X 0 0 0 RICK BETTIS 1.00 X 0 0 0 BARBARA WATSON 1.00 X 0 0 0 PEGGY WHITE 1.00 X 0 0 0 JON CARSON III 1.00 X 0 0 0 DR KENYA KOZAWA 1.00 X 1258564 0 0 DR KEN ARCHER 1.00 X 0 0 0 JIM FAIRWEATHER 1.00 X 0 0 0 GARY KIMSEY 1.00 X 0 0 0 DEBBIE J THOMPSON 38.00 X 126685 0 14280 PATTI N THOMPSON 38.00 X 115572 0 15504 ROGER EVANS 38.00 X 117371 0 6419 ANDREA B HENRY 38.00 X 109214 0 2212 1899678 0 58137 6 0 1 0 KEN KOZAWA I MD PC 132 FAIRLANE CIRCLE SWEETWATER TN 37874 PHYSICIAN SERVICES 1258564 CPSI PO BOX 850309 MOBILE AL 366850309 COMPUTER SUPPORT 562133 COUILLARD & ASSOCIATES 9413 WOODBY HOLLOW DRIVE CHATTANOOGA TN 37421 PHYSICIAN SERVICES 508250 ERIC POSTON 114 OLD ATHENS PIKE SWEETWATER TN 37874 PHYSICIAN SERVICES 417673 SYED M AMER MD 300 RIVERS EDGE DRIVE LOUDON TN 37774 PHYSICIAN SERVICES 410472 16 3866 3866 NET PATIENT REVENUE 621990 46870959 46870959 46870959 143334 143334 MISCELLANEOUS INCOME 900099 203456 203456 CAFETERIA SALES 900099 141409 141409 MEDICAL RECORDS TRANSC 900099 37398 37398 19754 19754 402017 47420176 46870959 0 545351 338318 338318 15297628 12224736 3072892 425412 339958 85454 769387 614837 154550 1120324 895280 225044 35399 35399 33000 33000 1863650 1489292 374358 260379 208076 52303 745831 596013 149818 85451 68286 17165 22576 22576 2919967 2339478 580489 322340 257590 64750 BAD DEBT 7433119 7433119 SUPPLIES 6265678 5007068 1258610 FEES AND REGISTRATIONS 5856821 4680339 1176482 LAUNDRY 137382 137382 COLLECTION EXPENSE 103685 103685 74069 59137 14932 44110416 36454276 7656140 0 1579579 2513777 10420251 11480520 5645581 6725182 510911 592589 767410 882898 125456 117728 45468160 25129742 20370841 20338418 924677 1045449 40344706 43696561 2112639 2297867 304121 160988 2416760 2458855 X 37927946 41237706 37927946 41237706 40344706 43696561 X 0 1 1 X 0 X 1060329 1060329 20040303 9929059 10111244 21909172 15200683 6708489 2458356 2458356 20338418 47420176 44110416 3309760 0 3309760 47420176 0 47420176 0 47420176 44110416 0 44110416 0 44110416 1 1 0 1 X 0 0 0 0 2858 2858 0.00010 4000 4000 0.00010 14737 14737 0.00040 21595 21595 0.00060 21595 21595 0.00060 1 7433119 6747352 11814148 11102571 711577 X 1 1 SWEETWATER HOSPITAL ASSOCIATION

304 WRIGHT ST SWEETWATER TN 37874

X X X SWEETWATER HOSPITAL HOME HEALTH

304 WRIGHT ST SWEETWATER TN 37874

HOME HEALTH Part III, Line 4: THE ASSOCIATION ACCEPTS PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. A PATIENT IS CLASSIFIED AS A CHARITY PATIENT WHEN NO PAYMENT IS ANTICIPATED. IN ASSESSING A PATIENT'S ABILITY TO PAY, THE ASSOCIATION USES POVERTY GUIDELINES PUBLISHED BY THE FEDERAL GOVERNMENT FOR MONROE COUNTY. WHEN INCURRED CHARGES ARE SIGNIFICANT COMPARED TO THE PATIENT'S INCOME LEVEL, THE ASSOCIATION MAY CHOOSE TO QUALIFY THE SERVICES AS CHARITY CARE. CHARITY CARE CHARGES ARE NOT INCLUDED IN NET PATIENT SERVICE REVENUE. Part III, Line 9b: FOR PATIENTS NOT ELIGIBLE FOR FINANCIAL ASSISTANCE, IT IS THE POLICY OF SWEETWATER HOSPITAL ASSOCIATION TO PERMIT PATIENTS, WHERE ELIGIBLE TO MAKE REGULAR PAYMENTS ON A MONTHLY BASIS. SWEETWATER HOSPITAL ASSOCIATION DOES UTILIZE EXTERNAL COLLECTION FIRMS FOR DEBT COLLECTION AS NEEDED X X X 0 0 0 0 0 0 0 0 0 SCOTT BOWMAN 172272 0 0 0 0 0 17235 0 2487 0 191994 0 198084 0 DR KENYA KOZAWA 1258564 0 0 0 0 0 0 0 0 0 1258564 0 1270759 0 Form 990, Part VI, Section B, line 11 MANAGEMENT WILL REVIEW THIS RETURN BEFORE IT IS FILED Form 990, Part VI, Section B, line 15 TOP OFFICIALS ARE APPROVED BY THE BOARD OF DIRECTORS. COMPENSATION FOR OFFICERS USE INDUSTRY STANDARDS, AND COMPENSATION COMMITTEE. Form 990, Part VI, Section C, line 19 DOCUMENTS ARE MADE AVAILABLE UPON REQUEST Form 990, Part VII Contact Addresses for Officers, Directors, Etc DR, KENYA KOZAWA - 132 FAIRLANE CIRCLE, SWEETWATER, TN 37874. 990 PART IV OFFICER COMPENSATION COMPENSATION FOR DR. KOWAZA WAS FOR THE PHYSICIAN SERVICES RENDERED BY HIS P.C. IDEAL RENTAL COMPANY INC 304 WRIGHT ST SWEETWATER TN 37874 620933728 REAL ESTATE TN C -3151 21048 1.00000 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0