FAIRBANKS HOSPITAL INC: Form 990, tax year 2012
View the entire original 990 at ProPublica ↗
- Organization
- FAIRBANKS HOSPITAL INC (EIN 35-0811197)
- Tax period
- 2012-07-01 to 2013-06-30
- Filed
- 2013-12-23
- IRS object ID
- 201333579349300628
- Schema version
- 2012v2.1
- 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 D
- Schedule G
- Schedule H
- Schedule J
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2013-12-23T13:32:17-06:00 | Timestamp |
| Tax Period End Date | 2013-06-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 351178661 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BLUE & CO LLC | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | ONE AMERICAN SQUARE 2200 | AddressLine1 |
| City | INDIANAPOLIS | City |
| State | IN | State |
| ZIP Code | 46282 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2012-07-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 350811197 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | FAIRBANKS HOSPITAL INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | FAIR | NameControl |
| Phone | 3178498222 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 8102 CLEARVISTA PARKWAY | AddressLine1 |
| City | INDIANAPOLIS | City |
| State | IN | State |
| ZIP Code | 46256 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | MARK MONSON | Name |
| Title | CEO | Title |
| Phone | 3178498222 | Phone |
| Date Signed | 2013-12-20 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | AMBER KOCHER CPA | Name |
| PTIN | P01286298 | PTIN |
| Phone | 3176334705 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2012 | TaxYear |
| Build TS | 2015-11-30 17:44:51Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | MARK MONSON | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 8102 CLEARVISTA PARKWAY | AddressLine1 |
| City | INDIANAPOLIS | City |
| State | IN | State |
| ZIP Code | 46256 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 22571143 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.FAIRBANKSCD.ORG | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1946 | YearFormation |
| State Legal Domicile | IN | StateLegalDomicile |
| Activity Or Mission Description | NONPROFIT ORGANIZATION FOCUSED ON RECOVERY FROM ALCOHOL AND OTHER DRUG PROBLEMS. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 17 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 16 | NbrIndependentVotingMembers |
| Total Nbr Employees | 350 | TotalNbrEmployees |
| Total Nbr Volunteers | 150 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 1165001 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 3079335 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 19017562 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 17927665 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 23325 | InvestmentIncomePriorYear |
| Investment Income Current Year | 31015 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 1718986 | OtherRevenuePriorYear |
| Other Revenue Current Year | 1452082 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 21924874 | TotalRevenuePriorYear |
| Total Revenue Current Year | 22490097 | 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 | 13165601 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 13568081 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 184965 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 8114830 | OtherExpensePriorYear |
| Other Expenses Current Year | 5792382 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 21280431 | TotalExpensesPriorYear |
| Total Expenses Current Year | 19360463 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 644443 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 3129634 | RevenuesLessExpensesCY |
| Total Assets BOY | 23666521 | TotalAssetsBOY |
| Total Assets EOY | 26743154 | TotalAssetsEOY |
| Total Liabilities BOY | 1674854 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 1900664 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 21991667 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 24842490 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | FAIRBANKS IS A NONPROFIT ORGANIZATION FOCUSED ON RECOVERY FROM ALCOHOL AND OTHER DRUG PROBLEMS, SERVING AS A RESOURCE TO IMPROVE THE WELL-BEING OF INDIVIDUALS, FAMILIES AND COMMUNITIES BY OFFERING HOPE AND SUPPORT THROUGH ITS PROGRAMS AND SERVICES. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 8150420 | Expense |
| Grants | 0 | Grants |
| Revenue | 9513987 | Revenue |
| Description | ADULT INPATIENT SERVICES CONSISTING OF DETOXIFICATION, REHABILITATION AND RESIDENTIAL SERVICES. THE DETOXIFICATION PHASE IS A MEDICALLY MANAGED LEVEL OF CARE WHERE THE EXTENT OF THE PATIENT'S ADDICTION IS DETERMINED AND THE PHYSICAL AND PSYCHOLOGICAL IMPACT OF THAT ADDICTION IS ASSESSED AND THE APPROPRIATE TREATMENT COURSE IS INITIATED. FOR THE CURRENT FISCAL YEAR, FAIRBANKS HOSPITAL HAD 8,744 ADULT DETOX PATIENT DAYS.THE REHABILITATION PHASE OCCURS WHEN FURTHER INPATIENT STABILIZATION/TREATMENT IS NEEDED AND REQUIRES CONTINUED MEDICAL SUPERVISION. THE TREATMENT PROCESS IS MULTI-DISCIPLINARY AND GROUP ORIENTED. FOR THE CURRENT FISCAL YEAR, THE HOSPITAL HAD 3,388 ADULT REHAB PATIENT DAYS. THE RESIDENTIAL PROGRAM IS FOR THE PATIENT WHO REQUIRES A RESTRICTIVE ENVIRONMENT TO ABSTAIN FROM USING BUT WHO IS MEDICALLY STABLE. THE PATIENT PARTICIPATES IN NO LESS THAN FOUR HOURS OF THERAPY DAILY AND NURSING CARE IS PROVIDED, IF NEEDED. FOR THE CURRENT FISCAL YEAR, THE HOSPITAL HAD 1,444 ADULT RESIDENTIAL PATIENT DAYS. | Description |
Activity2 Activity2
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 3484371 | Expense |
| Grants | 0 | Grants |
| Revenue | 4067307 | Revenue |
| Description | ADULT OUTPATIENT SERVICES PROGRAM CONSISTING OF PARTIAL HOSPITALIZATION (PHP) AND INTENSIVE OUTPATIENT PROGRAM (IOP). THE PHP PROGRAM IS SIX TO SEVEN HOURS PER DAY MONDAY THROUGH FRIDAY AND IS A MULTI-DISCIPLINARY AND GROUP ORIENTED TREATMENT PROGRAM. IT WILL CONTAIN EVALUATION AND EDUCATION. IT ALLOWS THE PATIENT TO EXPERIENCE LIFE ON THE "OUTSIDE" WHILE BEING INVOLVED IN A VERY INTENSE LEVEL OF TREATMENT. FOR THE CURRENT FISCAL YEAR, THE HOSPITAL HAD 7,893 PHP VISITS.IOP IS AVAILABLE TO THOSE WHOSE ADDICTION IS NOT SO SEVERE AS TO REQUIRE INPATIENT OR PHP SERVICES. THE PATIENTS MUST DEMONSTRATE THE ABILITY TO REMAIN DRUG-FREE DURING THE ENTIRE TREATMENT COURSE AND INDICATE A WILLINGNESS TO BECOME INVOLVED IN A 12-STEP PROGRAM. IOP PATIENTS GENERALLY MEET FOR THREE HOURS, THREE TIMES PER WEEK. IOP OFFERS EDUCATION AND GROUP THERAPY. FOR THE CURRENT FISCAL YEAR, THE HOSPITAL HAD 12,763 VISITS. | Description |
Activity3 Activity3
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 1419021 | Expense |
| Grants | 0 | Grants |
| Revenue | 1656424 | Revenue |
| Description | ADOLESCENT INPATIENT SERVICES CONSISTING OF DETOXIFICATION, REHABILITATION, AND RESIDENTIAL SERVICES. THE DETOXIFICATION PHASE IS A MEDICALLY MANAGED LEVEL OF CARE WHERE THE EXTENT OF THE PATIENT'S ADDICTION IS DETERMINED AND THE PHYSICAL AND PSYCHOLOGICAL IMPACT OF THAT ADDICTION IS ASSESSED AND THE APPROPRIATE TREATMENT COURSE IS INITIATED. ADOLESCENT GUIDANCE SPECIALISTS ARE MEMBERS OF THE TREATMENT TEAM. DURING THIS PHASE OF CARE, VARIOUS MULTI-DISCIPLINARY EVALUATIONS ARE COMPLETED. FAMILIES AND OTHER SUPPORT INDIVIDUALS (SCHOOL, PROBATION, CASEWORKERS, ETC) ARE INVOLVED. FOR THE CURRENT FISCAL YEAR, FAIRBANKS HOSPITAL HAD 612 ADOLESCENT DETOX PATIENT DAYS.THE ADOLESCENT REHAB PHASE IS FOR PATIENTS NEEDING FURTHER INPATIENT STABILIZATION/TREATMENT AND REQUIRES MEDICAL SUPERVISION. THIS TREATMENT PROCESS IS MULTI-DISCIPLINARY AND GROUP ORIENTED. AN IMPORTANT PART OF THE PROGRAM INCLUDES FAMILY MEMBERS OF THE PATIENT. FOR THE CURRENT FISCAL YEAR, THE HOSPITAL HAD 876 ADOLESCENT REHAB PATIENT DAYS.THE RESIDENTIAL PHASE IS FOR ADOLESCENTS IN NEED OF STABILIZATION AND TREATMENT. TREATMENT IS MULTI-DISCIPLINARY AND GROUP-ORIENTED. ADOLESCENTS RECEIVE INFORMATION ON DEVELOPING SOCIAL SKILLS, COMMUNICATION, HOW TO GAIN INTERNAL CONTROL OVER FEELING, HOW TO DEAL WITH ANGER, HOW TO DEAL WITH PEER PRESSURE, AND OTHER DEVELOPMENT NEEDS. FOR THE CURRENT FISCAL YEAR, THE HOSPITAL HAD 1,997 ADOLESCENT RESIDENTIAL PATIENT DAYS. | Description |
Activity Other ActivityOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 2733599 | Expense |
| Grants | 0 | Grants |
| Revenue | 3190929 | Revenue |
| Description | ADOLESCENT OUTPATIENTS SERVICES PROGRAM SERVED 1,844 PHP VISITS AND 4,196 IOP VISITS DURING THE CURRENT FISCAL YEAR. ADULT HALFWAY HOUSE SERVED 1,273 PATIENT DAYS DURING THE CURRENT FISCAL YEAR. FAIRBANKS HOSPITAL PROVIDED 3,397 PATIENT DAYS AT LAVERNA LODGE AND PROVIDED 32,664 PATIENT DAYS AT SUPPORTED LIVING FACILITIES DURING THE CURRENT FISCAL YEAR. | Description |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Other Program Service Exp | 2733599 | TotalOfOtherProgramServiceExp |
| Total Of Other Program Service Rev | 3190929 | TotalOfOtherProgramServiceRev |
| Total Program Service Expense | 15787411 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 0 | LobbyingActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| 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 | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 0 | ReportOtherAssets |
| Report Other Liabilities | 1 | ReportOtherLiabilities |
| Report Fin48 Footnote | 1 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 0 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 1 | 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 | 1 | RelatedEntity |
| Related Org Controlled Entity | 1 | 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 | 26 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 350 | 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 | 17 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 16 | 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 | 0 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| States Where Copy Of Return Is Filed | IN | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | BARBARA ELLIOTT VICE PRESIDENT AND | NamePerson |
| Telephone Number | 3175729450 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 8102 CLEARVISTA PARKWAY | AddressLine1 |
| City | INDIANAPOLIS | City |
| State | IN | State |
| ZIP Code | 46256 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | X | InfoInScheduleOPartVII |
Form990 Part VII Section A Form990PartVIISectionA (27 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Average Hours Per Week RelatedAverageHoursPerWeekRelated | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|---|
| RICHARD COLLINS | ||||||||
| CHAIRMAN | 1.00 | 0.00 | X | X | 0 | 0 | 0 | |
| THOMAS CRAIG | ||||||||
| TREASURER | 1.00 | 0.00 | X | X | 0 | 0 | 0 | |
| TOM FLOWERS | ||||||||
| SECRETARY/V.CHAIR(ELECTED VC APR'13) | 1.00 | 0.00 | X | X | 0 | 0 | 0 | |
| FARAZ ABBASI | ||||||||
| BOARD MEMBER | 1.00 | 0.00 | X | 0 | 0 | 0 | ||
| TOM EMMERSON | ||||||||
| BOARD MEMBER | 1.00 | 0.00 | X | 0 | 0 | 0 | ||
| JOHN HAYES MD | ||||||||
| BOARD MEMBER | 1.00 | 0.00 | X | 0 | 0 | 0 | ||
| LUKE KENLEY | ||||||||
| BOARD MEMBER | 1.00 | 0.00 | X | 0 | 0 | 0 | ||
| CAROL BROWN LUKEMEYER | ||||||||
| BOARD MEMBER | 1.00 | 0.00 | X | 0 | 0 | 0 | ||
| PEGGY MAGEE | ||||||||
| BOARD MEMBER | 1.00 | 0.00 | X | 0 | 0 | 0 | ||
| KARL STOUT | ||||||||
| BOARD MEMBER | 1.00 | 0.00 | X | 0 | 0 | 0 | ||
| JANE WARDLE | ||||||||
| BOARD MEMBER | 1.00 | 0.00 | X | 0 | 0 | 0 | ||
| PATRICK CARR | ||||||||
| BOARD MEMBER | 1.00 | 0.00 | X | 0 | 0 | 0 | ||
| DAVID CORBITT | ||||||||
| BOARD MEMBER | 1.00 | 0.00 | X | 0 | 0 | 0 | ||
| ANN MERKEL | ||||||||
| BOARD MEMBER | 1.00 | 0.00 | X | 0 | 0 | 0 | ||
| KEVIN MURPHY | ||||||||
| BOARD MEMBER | 1.00 | 0.00 | X | 0 | 0 | 0 | ||
| BEVERLY PITTS | ||||||||
| BOARD MEMBER | 1.00 | 0.00 | X | 0 | 0 | 0 | ||
| LEAH MANNWEILER | ||||||||
| VICE CHAIR - TERM DURING FY | 1.00 | 0.00 | X | X | 0 | 0 | 0 | |
| MARNI MCKINNEY | ||||||||
| BOARD MEMBER - TERM DURING FY | 1.00 | 0.00 | X | 0 | 0 | 0 | ||
| DOROTHY MAY | ||||||||
| BOARD MEMBER - TERM DURING FY | 1.00 | 1.00 | X | 0 | 0 | 0 | ||
| HELENE CROSS | ||||||||
| PRESIDENT/CEO - RETIRED SEPT 2012 | 38.40 | 1.60 | X | 389749 | 0 | 35481 | ||
| MARK MONSON | ||||||||
| PRESIDENT/CEO - BEGINNING SEPT 2012 | 38.40 | 1.60 | X | X | 59207 | 0 | 5618 | |
| BARBARA ELLIOTT | ||||||||
| VICE PRESIDENT AND CFO | 36.00 | 4.00 | X | 116378 | 0 | 29320 | ||
| TIMOTHY KELLY | ||||||||
| MEDICAL DIRECTOR | 32.00 | 0.00 | X | 186898 | 0 | 18485 | ||
| CYNTHIA LEIGH | ||||||||
| COO | 40.00 | 0.00 | X | 130271 | 0 | 714 | ||
| DR DENNIS RHYNE | ||||||||
| PHYSICIAN | 40.00 | 0.00 | 151245 | 0 | 3281 | X | ||
| DR BARBARA DAVIS | ||||||||
| PHYSICIAN | 40.00 | 0.00 | 146326 | 0 | 8356 | X | ||
| SHARON BAKER | ||||||||
| DIRECTOR OF SUPPORT SERVICES | 40.00 | 0.00 | 102528 | 0 | 7959 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 1282602 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 109214 | TotalOtherCompensation |
| Number Individuals GT100 K | 7 | 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 |
|---|---|---|---|---|---|
| SODEXO INC & AFFILIATES | |||||
| 4880 PAYSPHERE CIRCLE | CHICAGO | IL | 60674 | FOOD SERVICES MGMT | 840989 |
| PROGRESSIVE HOMECARE SERVICES | |||||
| PO BOX 6069-DEPT 178 | INDIANAPOLIS | IN | 46206 | PHARMACY SERVICES | 305785 |
| SOUTH BEND MEDICAL FOUNDATION | |||||
| PO BOX 2030 | MISHAWAKA | IN | 46546 | REFERRAL LAB SERVICE | 279137 |
| FA WILHELM CONSTRUCTION COMPANY | |||||
| PO BOX 516 | INDIANAPOLIS | IN | 46206 | CONSTRUCTION SERVICES | 185605 |
| COMMUNITY HEALTH NETWORK | |||||
| 1500 N RITTER AVENUE | INDIANAPOLIS | IN | 46219 | IT SERVICES | 133894 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 5 | NumberOfContractorsGT100K |
| Fundraising Events | 73497 | FundraisingEvents |
| Government Grants | 307827 | GovernmentGrants |
| All Other Contributions | 2698011 | AllOtherContributions |
| Total Contributions | 3079335 | TotalContributions |
Program Service Revenue ProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | PATIENT SERVICE REVENUE | Description |
| Business Code | 621300 | BusinessCode |
| Total Revenue Column | 17927665 | TotalRevenueColumn |
| Related Or Exempt Function Income | 17927665 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 17927665 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 25515 | TotalRevenueColumn |
| Exclusion | $25,515 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 144600 | Real |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 0 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 144600 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 144600 | TotalRevenueColumn |
| Exclusion | $144,600 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 5500 | Other |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 0 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 5500 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 5500 | TotalRevenueColumn |
| Exclusion | $5,500 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Income Fundraising Events | 32770 | GrossIncomeFundraisingEvents |
| Cntrbtns Rprtd Fundraising Events | 73497 | CntrbtnsRprtdFundraisingEvents |
| Fundraising Direct Expenses | 81046 | FundraisingDirectExpenses |
Net Income From Fundraising Events NetIncomeFromFundraisingEvents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -48276 | TotalRevenueColumn |
| Exclusion | -$48,276 | ExclusionAmount |
Other Revenue Misc OtherRevenueMisc (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | ExclusionExclusionAmount | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|---|
| OTHER REVENUE | 900099 | 790289 | $790,289 | |
| OUTSIDE COUNSELING SERVICES | 624100 | 500982 | 500982 | |
| GIFT SHOP REVENUE | 453220 | 64487 | $64,487 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 1355758 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 22490097 | TotalRevenueColumn |
| Related Or Exempt Function Income | 18428647 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $982,115 | ExclusionAmount |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 526389 | Total |
| Program Services | 193044 | ProgramServices |
| Management And General | 333345 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 9508290 | Total |
| Program Services | 7967215 | ProgramServices |
| Management And General | 1429332 | ManagementAndGeneral |
| Fundraising | 111743 | Fundraising |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 347752 | Total |
| Program Services | 291389 | ProgramServices |
| Management And General | 52276 | ManagementAndGeneral |
| Fundraising | 4087 | Fundraising |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2384358 | Total |
| Program Services | 2001479 | ProgramServices |
| Management And General | 355195 | ManagementAndGeneral |
| Fundraising | 27684 | Fundraising |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 801292 | Total |
| Program Services | 671421 | ProgramServices |
| Management And General | 120454 | ManagementAndGeneral |
| Fundraising | 9417 | Fundraising |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 87148 | Total |
| Management And General | 87148 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 54778 | Total |
| Management And General | 54778 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1783020 | Total |
| Program Services | 1291222 | ProgramServices |
| Management And General | 487354 | ManagementAndGeneral |
| Fundraising | 4444 | Fundraising |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 378978 | Total |
| Program Services | 369490 | ProgramServices |
| Management And General | 9079 | ManagementAndGeneral |
| Fundraising | 409 | Fundraising |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 166012 | Total |
| Program Services | 102127 | ProgramServices |
| Management And General | 63463 | ManagementAndGeneral |
| Fundraising | 422 | Fundraising |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1113613 | Total |
| Program Services | 1060962 | ProgramServices |
| Management And General | 52651 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 58188 | Total |
| Program Services | 55587 | ProgramServices |
| Management And General | 1888 | ManagementAndGeneral |
| Fundraising | 713 | Fundraising |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 55525 | Total |
| Program Services | 32208 | ProgramServices |
| Management And General | 21085 | ManagementAndGeneral |
| Fundraising | 2232 | Fundraising |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 7432 | Total |
| Program Services | 7432 | ProgramServices |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 883700 | Total |
| Program Services | 814793 | ProgramServices |
| Management And General | 68907 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 246822 | Total |
| Program Services | 184783 | ProgramServices |
| Management And General | 60984 | ManagementAndGeneral |
| Fundraising | 1055 | Fundraising |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral | FundraisingFundraising |
|---|---|---|---|---|
| SUPPLIES | 598901 | 582931 | 15410 | 560 |
| EQUIPMENT MAINTENANCE A | 75138 | 63581 | 11557 | 0 |
| PRINTING AND PUBLICATIO | 51224 | 10880 | 32160 | 8184 |
| POSTAGE AND SHIPPING | 30568 | 17488 | 11323 | 1757 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 201335 | Total |
| Program Services | 69379 | ProgramServices |
| Management And General | 119698 | ManagementAndGeneral |
| Fundraising | 12258 | Fundraising |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 19360463 | Total |
| Program Services | 15787411 | ProgramServices |
| Management And General | 3388087 | ManagementAndGeneral |
| Fundraising | 184965 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1214354 | BOY |
| EOY | 1806354 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6572961 | BOY |
| EOY | 6984631 | EOY |
Pledges And Grants Receivable PledgesAndGrantsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 109968 | BOY |
| EOY | 92363 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3698498 | BOY |
| EOY | 3167912 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 455170 | BOY |
| EOY | 533664 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 22969973 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 9374065 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 11143927 | BOY |
| EOY | 13595908 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 471643 | BOY |
| EOY | 562322 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 23666521 | BOY |
| EOY | 26743154 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1467989 | BOY |
| EOY | 1205997 | EOY |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayable
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 490000 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 206865 | BOY |
| EOY | 204667 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1674854 | BOY |
| EOY | 1900664 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 21742323 | BOY |
| EOY | 24618944 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 249344 | BOY |
| EOY | 223546 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 21991667 | BOY |
| EOY | 24842490 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 23666521 | BOY |
| EOY | 26743154 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | 3129634 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | -278811 | ReconcilationOtherChanges |
| Info In Schedule O Part XII | X | InfoInScheduleOPartXII |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
FS Audited Basis FSAuditedBasis
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | 1 | AuditCommittee |
| Federal Grant Audit Required | 1 | FederalGrantAuditRequired |
| Federal Grant Audit Performed | 1 | FederalGrantAuditPerformed |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
| General Explanation | SCHEDULE A, PART IV, SUPPLEMENTAL INFORMATION: SCHEDULE A, PART I, LINE 3: FAIRBANKS HOSPITAL, INC. HAS BEEN DETERMINED BY THE IRS TO BE A PUBLIC CHARITY UNDER IRS CODE SECTION 170(B)(1)(A)(III). PER SCHEDULE H INSTRUCTIONS ONLY ORGANIZATIONS THAT OPERATE AT LEAST ONE FACILITY THAT IS, OR IS REQUIRED TO BE, LICENSED, REGISTERED, OR SIMILARLY RECOGNIZED BY A STATE AS A HOSPITAL IS REQUIRED TO COMPLETE THIS SCHEDULE. FAIRBANK HOSPITAL, INC. IS A PRIVATE MENTAL HEALTH INSTITUTION AND CERTIFIED AS AN ADDICTIONS SERVICE PROVIDER. FAIRBANKS IS NOT LICENSED BY THE INDIANA STATE DEPARTMENT OF HEALTH AS A HOSPITAL, BUT IS RECOGNIZED BY THE CENTERS FOR MEDICAID AND MEDICARE AS AN ACUTE CARE HOSPITAL. THE COMPLETION OF SCHEDULE H IS NOT REQUIRED; HOWEVER, FAIRBANKS' MANAGEMENT HAS DECIDED TO COMPLETE SCHEDULE H TO PROVIDE INFORMATION TO THE COMMUNITY REGARDING ITS FINANCIAL ASSISTANCE, COMMUNITY BENEFITS, AND FACILITY INFORMATION. | GeneralExplanation |
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 D IRS990ScheduleD
Current Year CurrentYear
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 924344 | BeginningOfYearBalance |
| Contributions | 2368777 | Contributions |
| Other Expenditures | 2394575 | OtherExpenditures |
| End Of Year Balance | 898546 | EndOfYearBalance |
Current Year Minus1 Year CurrentYearMinus1Year
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 873382 | BeginningOfYearBalance |
| Contributions | 440636 | Contributions |
| Investment Earnings Or Losses | 429 | InvestmentEarningsOrLosses |
| Other Expenditures | 390103 | OtherExpenditures |
| End Of Year Balance | 924344 | EndOfYearBalance |
Current Year Minus2 Years CurrentYearMinus2Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 892895 | BeginningOfYearBalance |
| Contributions | 391777 | Contributions |
| Investment Earnings Or Losses | 5733 | InvestmentEarningsOrLosses |
| Other Expenditures | 417023 | OtherExpenditures |
| End Of Year Balance | 873382 | EndOfYearBalance |
Current Year Minus3 Years CurrentYearMinus3Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 979700 | BeginningOfYearBalance |
| Contributions | 732482 | Contributions |
| Investment Earnings Or Losses | 47932 | InvestmentEarningsOrLosses |
| Other Expenditures | 867219 | OtherExpenditures |
| End Of Year Balance | 892895 | EndOfYearBalance |
Current Year Minus4 Years CurrentYearMinus4Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 424006 | BeginningOfYearBalance |
| Contributions | 1288061 | Contributions |
| Investment Earnings Or Losses | 67990 | InvestmentEarningsOrLosses |
| Other Expenditures | 800357 | OtherExpenditures |
| End Of Year Balance | 979700 | EndOfYearBalance |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated EOY Balance | 0.75120 | BoardDesignatedEOYBalance |
| Permanent Endowment EOY Balance | 0.00000 | PermanentEndowmentEOYBalance |
| Term Endowment EOY Balance | 0.24880 | TermEndowmentEOYBalance |
| Endowments Held By Unrelated Orgs | 0 | EndowmentsHeldByUnrelatedOrgs |
| Endowments Held By Related Orgs | 0 | EndowmentsHeldByRelatedOrgs |
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 768446 | OtherCostOrOtherBasis |
| Book Value | 768446 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 12718595 | OtherCostOrOtherBasis |
| Depreciation | 5202254 | Depreciation |
| Book Value | 7516341 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 6184940 | OtherCostOrOtherBasis |
| Depreciation | 4171811 | Depreciation |
| Book Value | 2013129 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 3297992 | OtherCostOrOtherBasis |
| Book Value | 3297992 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 13595908 | TotalOfBookValueLandBuildings |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | ESTIMATED THIRD PARTY SETTLEMENTS | Description |
| Amount | $204,667 | Amount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 204667 | TotalOfAmounts |
| Footnote In Part XIII | X | FootnoteInPartXIII |
| Tot Revenue Etc Audited Fincl Stmt | 22571143 | TotRevenueEtcAuditedFinclStmt |
| Other Revenues | 81046 | OtherRevenues |
| Revenue Not Rptd F990 | 81046 | RevenueNotRptdF990 |
| Revenue Subtotal | 22490097 | RevenueSubtotal |
| Revenue Not Rptd On Fin Stmt | 0 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 22490097 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 19441509 | TotExpensesEtcAuditedFinclStmt |
| Other Expenses Included | 81046 | OtherExpensesIncluded |
| Expenses Not Rptd F990 | 81046 | ExpensesNotRptdF990 |
| Expenses Subtotal | 19360463 | ExpensesSubtotal |
| Expenses Not Rptd On Fin Stmt | 0 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 19360463 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIII Form990ScheduleDPartXIII (4 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: | PART V, LINE 4: | TEMPORARILY RESTRICTED NET ASSETS ARE THOSE ASSETS WHOSE USE HAS BEEN LIMITED BY DONORS FOR A SPECIFIC OPERATING OR CAPITAL PURPOSE. BOARD DESIGNATED FUNDS ARE SET ASIDE BY THE BOARD FOR SPECIFIC PURPOSES INCLUDING CHARITY CARE. |
| DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: | PART X, LINE 2: | ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY FAIRBANKS AND THE SCHOOL AND RECOGNIZE A TAX LIABILITY IF FAIRBANKS OR THE SCHOOL HAS TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY VARIOUS FEDERAL AND STATE TAXING AUTHORITIES. MANAGEMENT HAS ANALYZED THE TAX POSITIONS TAKEN BY FAIRBANKS AND THE SCHOOL, AND HAS CONCLUDED THAT AS OF JUNE 30, 2013 AND 2012, THERE ARE NO UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY OR DISCLOSURE IN THE ACCOMPANYING FINANCIAL STATEMENTS. |
| PART XI, LINE 2D - OTHER ADJUSTMENTS: | FUNDRAISING EVENT EXPENSES 81,046. | |
| PART XII, LINE 2D - OTHER ADJUSTMENTS: | FUNDRAISING EVENT EXPENSES 81,046. |
Schedule G IRS990ScheduleG
Events Information EventsInformation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Event1 | CIRCLE OF HOPE DINNER | NameOfEvent1 |
| Gross Receipts Event1 | 87787 | GrossReceiptsEvent1 |
| Charitable Contributions Event1 | 60877 | CharitableContributionsEvent1 |
| Gross Revenue Event1 | 26910 | GrossRevenueEvent1 |
| Rent Facility Costs Event1 | 7279 | RentFacilityCostsEvent1 |
| Food And Beverage Event1 | 27144 | FoodAndBeverageEvent1 |
| Entertainment Event1 | 10350 | EntertainmentEvent1 |
| Other Direct Expenses Event1 | 26667 | OtherDirectExpensesEvent1 |
| Name Of Event2 | ALUMNI GOLF OUTING | NameOfEvent2 |
| Gross Receipts Event2 | 18480 | GrossReceiptsEvent2 |
| Charitable Contributions Event2 | 12620 | CharitableContributionsEvent2 |
| Gross Revenue Event2 | 5860 | GrossRevenueEvent2 |
| Non Cash Prizes Event2 | 2254 | NonCashPrizesEvent2 |
| Rent Facility Costs Event2 | 5723 | RentFacilityCostsEvent2 |
| Food And Beverage Event2 | 122 | FoodAndBeverageEvent2 |
| Other Direct Expenses Event2 | 1507 | OtherDirectExpensesEvent2 |
| Gross Receipts Total | 106267 | GrossReceiptsTotal |
| Charitable Contributions Total | 73497 | CharitableContributionsTotal |
| Gross Revenue Total Events | 32770 | GrossRevenueTotalEvents |
| Non Cash Prizes Total Events | 2254 | NonCashPrizesTotalEvents |
| Rent Facility Costs Total Events | 13002 | RentFacilityCostsTotalEvents |
| Food And Beverage Total Events | 27266 | FoodAndBeverageTotalEvents |
| Entertainment Total Events | 10350 | EntertainmentTotalEvents |
| Other Direct Expenses Total Events | 28174 | OtherDirectExpensesTotalEvents |
| Direct Expense Summary Events | 81046 | DirectExpenseSummaryEvents |
| Net Income Summary | -48276 | NetIncomeSummary |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | 1 | CharityCarePolicy |
| Written Policy | 1 | WrittenPolicy |
| FPG Reference Free Care | 0 | FPGReferenceFreeCare |
| FPG Reference Discounted Care | 1 | FPGReferenceDiscountedCare |
| Pcent250 | X | Pcent250 |
| 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 | 0 | ReportPublicallyAvailable |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 907632 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 0 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 907632 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.04690 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 39164 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 5031 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 34133 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00180 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 946796 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 5031 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 941765 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.04870 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 784897 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 3600 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 781297 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.04040 | PercentOfTotalExpense |
Health Professions Education HealthProfessionsEducation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 82283 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 82283 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00430 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 867180 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 3600 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 863580 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.04470 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 1813976 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 8631 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1805345 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.09340 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 1 | BadDebtExpenseReported |
| Bad Debt Expense | $1,744,842 | BadDebtExpenseAmount |
| Amount Reimbursed By Medicare | 2234064 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 2338061 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | -103997 | 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 | 1 | WrittenDebtCollectionPolicy |
| Provision For Charity Care | 1 | ProvisionForCharityCare |
| 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 | FAIRBANKS HOSPITAL INC | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 8102 CLEARVISTA PARKWAY | AddressLine1 |
| City | INDIANAPOLIS | City |
| State | IN | State |
| ZIP Code | 46256 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| Other | LICENSED PRIVATE MENTAL HEALTH INSTITUTION | Other |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | FAIRBANKS HOSPITAL INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
| CHNA Conducted | 1 | CHNAConducted |
| Community Definition | X | CommunityDefinition |
| Community Demographics | X | CommunityDemographics |
| Existing Resources | X | ExistingResources |
| How Data Obtained | X | HowDataObtained |
| Community Health Needs | X | CommunityHealthNeeds |
| Other Health Issues | X | OtherHealthIssues |
| Identifying Process | X | IdentifyingProcess |
| Consulting Process | X | ConsultingProcess |
| Take Into Account | 1 | TakeIntoAccount |
| Other Facilities | 0 | OtherFacilities |
| CHNA Widely Available | 1 | CHNAWidelyAvailable |
| Own Website | X | OwnWebsite |
| Adopt Implement Strategy | X | AdoptImplementStrategy |
| Execute Implement Strategy | X | ExecuteImplementStrategy |
| Prioritize Health Needs | X | PrioritizeHealthNeeds |
| Prioritize Services | X | PrioritizeServices |
| All Needs Addressed | 0 | AllNeedsAddressed |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTax |
| Eligibility Criteria Explained | 1 | EligibilityCriteriaExplained |
| Uses FPG Free | 0 | UsesFPGFree |
| Uses FPG Discounted | 1 | UsesFPGDiscounted |
| FPG Discount Percent | 250.000000000000 | FPGDiscountPercent |
| Explains Basis | 1 | ExplainsBasis |
| Income Level | X | IncomeLevel |
| Medical Indigency | X | MedicalIndigency |
| Insurance Status | X | InsuranceStatus |
| Uninsured Discount | X | UninsuredDiscount |
| Medicaid Medicare | X | MedicaidMedicare |
| Explains Application Method | 1 | ExplainsApplicationMethod |
| Includes Publicity Measures | 1 | IncludesPublicityMeasures |
| Posted On Website | X | PostedOnWebsite |
| Posted In Emergency Room | X | PostedInEmergencyRoom |
| Posted In Admission Office | X | PostedInAdmissionOffice |
| Available On Request | X | AvailableOnRequest |
| Actions On Nonpayment | 1 | ActionsOnNonpayment |
| Collection Activities | 0 | CollectionActivities |
| 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 |
|---|---|---|---|---|
| LAVERNA LODGE | ||||
| 8102 CLEARVISTA PARKWAY | INDIANAPOLIS | IN | 46256 | DRUG & ALCOHOL RESIDENTIAL REHAB |
| SUPPORTED LIVING PROGRAM | ||||
| 8102 CLEARVISTA PARKWAY | INDIANAPOLIS | IN | 46256 | ADULT HALFWAY HOUSE & DRUG & ALCOHOL SUPPORTED LIVING |
| KOKOMO ADDICTIONS TREATMENT CENTER | ||||
| 210 W WALNUT STREET STE 258 261 | KOKOMO | IN | 46901 | OUTPATIENT CENTER |
| PLAINFIELD ADDICTIONS TREATMENT FACILITY | ||||
| 6100 CLARKS CREEK RD STE 102 104 | PLAINFIELD | IN | 46168 | OUTPATIENT CENTER |
Form990 Schedule H Part VI Form990ScheduleHPartVI (14 entries)
| ExplanationExplanation | IdentifierIdentifier | Return ReferenceReturnReference |
|---|---|---|
| PART I, LINE 7: FAIRBANKS USES THE IRS WORKSHEETS PROVIDED IN THE INSTRUCTIONS FOR FORM 990, SCHEDULE H TO CALCULATE A SINGLE COST TO CHARGE RATIO WHICH IS APPLIED TO THE CHARGES FOR FINANCIAL ASSISTANCE AND OTHER BENEFITS TO PROVIDE AMOUNTS AT COST. | ||
| PART I, L7 COL(F): EFFECTIVE JULY 1, 2012, FAIRBANKS ADOPTED ACCOUNTING STANDARDS UPDATE (ASU)2011-07, HEALTHCARE ENTITIES (TOPIC 954), "PRESENTATION AND DISCLOSURE OF PATIENT SERVICE REVENUE, PROVISION FOR BAD DEBTS, AND THE ALLOWANCE FOR DOUBTFUL ACCOUNTS FOR CERTAIN HEALTHCARE ENTITIES," WHICH REQUIRES CERTAIN HEALTHCARE ENTITIES TO PRESENT THE PROVISION FOR BAD DEBTS RELATING TO PATIENT SERVICE REVENUE AS A DEDUCTION FROM PATIENT SERVICE REVENUE IN THE CONSOLIDATED STATEMENTS OF OPERATIONS AND CHANGES IN NET ASSETS RATHER THAN AS AN OPERATING EXPENSE. ADOPTION OF THIS STANDARD HAS NO IMPACT ON ITS FINANCIAL POSITION, RESULTS OF OPERATIONS, OR CASH FLOWS. | ||
| PART III, LINE 4: PART III, SECTION A, LINE 2, BAD DEBT EXPENSE METHODOLOGY: THE AMOUNT OF BAD DEBT HAS BEEN PROVIDED FROM THE AUDITED FINANCIAL STATEMENTS. PART III, SECTION A, LINE 3, EXPLANATION FOR RATIONAL FOR INCLUDING OTHER BAD DEBT AMOUNT IN COMMUNITY BENEFIT: NO OTHER BAD DEBT AMOUNTS HAVE BEEN INCLUDED AS COMMUNITY BENEFIT. THE HOSPITAL HAS A DETAILED FINANCIAL ASSISTANCE POLICY WHICH STATES THAT TO PARTICIPATE IN CHARITY CARE, CANDIDATES MUST PROVIDE NECESSARY INFORMATION WITHIN 15 DAYS OF ADMISSION. IN ADDITION, THE HOSPITAL EDUCATES PATIENTS WITH LIMITED ABILITY TO PAY REGARDING FINANCIAL ASSISTANCE. FOR THIS REASON, THE ORGANIZATION BELIEVES IT ACCURATELY CAPTURES ALL CHARITY CARE DEDUCTIONS PROVIDED ACCORDING TO THE FINANCIAL ASSISTANCE POLICY AND THE AMOUNT OF BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S CHARITY CARE POLICY IS NEGLIGIBLE.PART III, SECTION A, LINE 4, BAD DEBT EXPENSE FOOTNOTE TO AUDITED FINANCIAL STATEMENTS: EFFECTIVE JULY 1, 2012, FAIRBANKS ADOPTED ACCOUNTING STANDARDS UPDATE (ASU)2011-07, HEALTHCARE ENTITIES (TOPIC 954), "PRESENTATION AND DISCLOSURE OF PATIENT SERVICE REVENUE, PROVISION FOR BAD DEBTS, AND THE ALLOWANCE FOR DOUBTFUL ACCOUNTS FOR CERTAIN HEALTHCARE ENTITIES," WHICH REQUIRES CERTAIN HEALTHCARE ENTITIES TO PRESENT THE PROVISION FOR BAD DEBTS RELATING TO PATIENT SERVICE REVENUE AS A DEDUCTION FROM PATIENT SERVICE REVENUE IN THE CONSOLIDATED STATEMENTS OF OPERATIONS AND CHANGES IN NET ASSETS RATHER THAN AS AN OPERATING EXPENSE. ASU 2011-07 REQUIRES HEALTHCARE ENTITIES TO PROVIDE ENHANCED DISCLOSURE ABOUT THEIR POLICIES FOR RECOGNIZING REVENUE AND ASSESSING BAD DEBTS, AS WELL AS QUALITATIVE AND QUANTITATIVE INFORMATION ABOUT CHANGES IN THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS. INFORMATION IS PROVIDED IN THE NOTES TO THE FINANCIAL STATEMENT UNDER THE "PATIENT ACCOUNTS RECEIVABLE AND NET PATIENT SERVICE REVENUE" AND "ALLOWANCE FOR DOUBTFUL ACCOUNTS" SECTIONS. REPRINTED BELOW IS THE PORTION OF THE NOTES RELATING TO BAD DEBT EXPENSE INCLUDED IN "ALLOWANCE FOR DOUBTFUL ACCOUNTS" AUDITED FINANCIAL STATEMENT FOOTNOTE."ALLOWANCE FOR DOUBTFUL ACCOUNTS" - PATIENT ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS BASED ON FAIRBANKS' EVALUATION OF ITS MAJOR PAYOR SOURCES OF REVENUE, THE AGING OF THE ACCOUNTS, HISTORICAL LOSSES, CURRENT ECONOMIC CONDITIONS, AND OTHER FACTORS UNIQUE TO ITS SERVICE AREA AND THE HEALTHCARE INDUSTRY. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THE MAJOR PAYOR SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, FAIRBANKS ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS, IF NECESSARY. FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PAYMENTS, WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL, FAIRBANKS RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS.DURING 2013, FAIRBANKS' ALLOWANCE FOR DOUBTFUL ACCOUNTS CHANGED FROM APPROXIMATELY $646,000 TO $886,000. FAIRBANKS ALLOWS FOR ACCOUNTS BASED ON AGING OVER AN ESTABLISHED THRESHOLD. AS OF JUNE 30, 2013, THE ALLOWANCE FOR DOUBTFUL ACCOUNTS OF $886,000 WAS COMPRISED OF $447,000 RESERVED FOR SELF-PAY BALANCES AND $439,000 RESERVED FOR THIRD-PARTY PAYOR BALANCES. AS OF JUNE 30, 2012, THE ALLOWANCE FOR DOUBTFUL ACCOUNTS OF $646,000 WAS COMPRISED OF $498,000 RESERVED FOR SELF-PAY BALANCES AND $148,000 RESERVED FOR THIRD-PARTY PAYOR BALANCES. | ||
| PART III, LINE 8: MEDICARE ALLOWABLE COSTS ARE CALCULATED BY USING THE RATIO OF COST TO CHARGES. THE SOURCE USED TO DETERMINE THE AMOUNT OF MEDICARE ALLOWABLE COSTS REPORTED FOR PART III, SECTION B, MEDICARE HAS BEEN PROVIDED FROM THE YEAR ENDED JUNE 30, 2013: HOSPITAL STATEMENT OF REIMBURSABLE COST. | ||
| PART III, LINE 9B: WHEN AN ACCOUNT IS IDENTIFIED AS UNCOLLECTIBLE, IT BECOMES BAD DEBT. IF THE FINANCIAL POSITION OF THE IDENTIFIED INDIVIDUAL'S ACCOUNT HAS BEEN VERIFIED AS BEING IN A FINANCIAL POSITION OF 250% FEDERAL POVERTY LEVEL, THE ACCOUNT WILL BE RECLASSED AS CHARITY CARE. | ||
| PART V, SECTION B, LINE 3: IN CONDUCTING ITS MOST RECENT CHNA THE HOSPITAL TOOK INTO ACCOUNT INPUT FROM PERSONS WHO REPRESENTED THE COMMUNITY IT SERVED INCLUDING THOSE WITH SPECIAL KNOWLEDGE THROUGH FIVE FOCUS GROUPS. THE GROUPS WERE DETERMINED THROUGH DISCUSSION WITH ACADEMIC AND HEALTHCARE EXPERTS WHO HAVE KNOWLEDGE OF THE SUBSTANCE IMPACTED POPULATION IN THE INDIANAPOLIS METROPOLITAN AREA. THE FIRST GROUP CONSISTED OF ADDICTION SERVICE PROVIDERS FOR LOW INCOME AND MINORITY POPULATIONS; THE SECOND GROUP WAS COMPOSED OF COMMUNITY STAKEHOLDERS FROM THE STATE CRIMINAL JUSTICE DEPARTMENT, TASK FORCE ON DRUG FREE MARION COUNTY, HALFWAY HOUSES, PRIMARY MEDICAL CARE COALITION, AND EMPLOYEE ASSISTANCE PROGRAMS. ADOLESCENTS ATTENDING THE RECOVERY HIGH SCHOOL COMPRISED THE THIRD GROUP; PARENTS OF ADOLESCENTS WHO HAD RECEIVED ADDICTION TREATMENT SERVICES WERE IN THE FOURTH, AND THE FIFTH GROUP CONSISTED OF ADULT PATIENTS WHO HAD SUCCESSFULLY COMPLETED INPATIENT TREATMENT. FOCUS GROUP QUESTIONS INCLUDED IDENTIFICATION OF STRENGTHS AND WEAKNESSES IN THE ADDICTION TREATMENT SYSTEM, BARRIERS TO SERVICES, GAPS IN SERVICES, AND RECOMMENDATIONS FOR THE SYSTEM OF CARE. | FAIRBANKS HOSPITAL, INC | |
| PART V, SECTION B, LINE 6I: FAIRBANKS HOSPITAL COMPLETED THEIR FISCAL YEAR 2013 COMMUNITY NEEDS ASSESSMENT IN JUNE 2013. THE ASSESSMENT CONTAINED NINE STRATEGIES OF WHICH SIX STRATEGIES HAVE BEEN ACCOMPLISHED THROUGH DECEMBER 2013. THE REMAINING STRATEGIES OUR COLLABORATIVE IN NATURE AND REQUIRE COMPREHENSIVE PLANNING. THE GOAL IS TO COMPLETE THE REMAINING THREE STRATEGIES OVER THE NEXT 18 MONTHS. | FAIRBANKS HOSPITAL, INC | |
| PART V, SECTION B, LINE 20D: FAIRBANKS OFFERS A 40% STANDARD DISCOUNT FOR SELF PAY INDIVIDUALS WITHOUT A THIRD PARTY PAYMENT SOURCE OR TO PATIENTS WHO EXHAUST THEIR THIRD PARTY BENEFTIS AND BECOME SELF-PAY; 50% DISCOUNT IS AVAILABLE WITH PROMPT PAY. | FAIRBANKS HOSPITAL, INC | |
| WITH REGARDS TO PART V, SECTION B, LINE 2 THE MOST RECENT COMMUNITY HEALTH NEEDS ASSESSMENT WAS REIVEWED BY THE BOARD ON JUNE 26, 2013 AND MADE AVAILABLE TO THE PUBLIC THROUGH POSTING ON ITS WEBSITE DURING NOVEMBER 2013. | CHNA CONDUCTED | PART V, SECTION B |
| PART VI, LINE 2: FAIRBANKS ENGAGED THE SERVICES OF THE INDIANA UNIVERSITY CENTER FOR HEALTH POLICY TO CONDUCT COMMUNITY FOCUS GROUPS. THE GROUPS WERE DETERMINED THROUGH DISCUSSION WITH ACADEMIC AND HEALTHCARE EXPERTS WHO HAVE KNOWLEDGE OF THE SUBSTANCE IMPACTED POPULATION IN THE INDIANAPOLIS METROPOLITAN AREA. FIVE SEPARATE FOCUS GROUPS WERE DEVELOPED. THE FIRST GROUP CONSISTED OF ADDICTION SERVICE PROVIDERS FOR LOW INCOME AND MINORITY POPULATIONS; THE SECOND GROUP WAS COMPOSED OF COMMUNITY STAKEHOLDERS FROM THE STATE CRIMINAL JUSTICE DEPARTMENT, TASK FORCE ON DRUG FREE MARION COUNTY, HALFWAY HOUSES, PRIMARY MEDICAL CARE COALITION, AND EMPLOYEE ASSISTANCE PROGRAMS. ADOLESCENTS ATTENDING THE RECOVERY HIGH SCHOOL COMPRISED THE THIRD GROUP; PARENTS OF ADOLESCENTS WHO HAD RECEIVED ADDICTION TREATMENT SERVICES WERE IN THE FOURTH, AND THE FIFTH GROUP CONSISTED OF ADULT PATIENTS WHO HAD SUCCESSFULLY COMPLETED INPATIENT TREATMENT. FOCUS GROUP QUESTIONS INCLUDED IDENTIFICATION OF STRENGTHS AND WEAKNESSES IN THE ADDICTION TREATMENT SYSTEM, BARRIERS TO SERVICES, GAPS IN SERVICES, AND RECOMMENDATIONS FOR THE SYSTEM OF CARE. | ||
| PART VI, LINE 3: THOSE INDIVIDUALS SEEKING ADMISSION TO FAIRBANKS HAVE THE OPPORTUNITY TO MEET WITH A FINANCIAL COUNSELOR TO DETERMINE WHAT RESOURCES ARE AVAILABLE. IN ADDITION, AN INFORMATION BOOKLET IS GIVEN TO THE FAMILIES DURING THE ADMISSION PROCESS WHICH NOTES THAT CHARITY CARE IS AVAILABLE. LASTLY, SIGNS ARE VISIBLE TO PATIENTS IN THE ACCESS DEPARTMENT WHERE ADMISSIONS TAKE PLACE. FAIRBANKS USES THE LOCAL MEDICA TO ASSIST IN EDUCATING THE PUBLIC CONCERNING PREVENTION, INTERVENTION AND TREATMENT. ALSO, FAIRBANKS PARTICIPATES IN NATIONAL ALCHOHOL AWARENESS MONTH, RECOVERY MONTH COMMUNITY ACTIVITIES, AND PROVIDES COMMUNITY EDUCATION THROUGH THE SUSAN LI CONFERENCE. | ||
| PART VI, LINE 4: FOR THE FISCAL YEAR ENDED JUNE 30, 2013, 3,460 PERSONS WERE SERVED; 58% FROM UNITED WAY OF CENTRAL INDIANA COUNTIES, 20% SURROUNDING COUNTIES, 21% REMAINING INDIANA COUNTIES, AND 1% OUT OF STATE. | ||
| PART VI, LINE 5: THE ORGANIZATION FURTHERS ITS EXEMPT PURPOSE BY PROMOTING HEALTH OF THE COMMUNITY THROUGH THE FOLLOWING: THE ORGANIZATION'S GOVERNING BODY IS COMPRISED OF A MAJORITY OF INDEPENDENT PERSONS WHO RESIDE IN THE ORGANIZATION'S PRIMARY SERVICE AREA. SURPLUS OF FUNDS WHEN AVAILABLE ARE USED TO IMPROVE THE PATIENT CARE AND MEDICAL EDUCATION OF THE STAFF; AND A PERCENTAGE OF OPERATING INCOME IS RESTRICTED FOR PATIENT SCHOLARSHIP FUNDS. FAIRBANKS USES THE LOCAL MEDIA TO ASSIST IN EDUCATING THE PUBLIC CONCERNING PREVENTION, INTERVENTION AND TREATMENT. THE ORGANIZATION ALSO PARTICIPATES IN NATIONAL ALCOHOL AWARENESS MONTH, RECOVERY MONTH COMMUNITY ACTIVITIES AND PROVIDES COMMUNITY EDUCATION THROUGH THE SUSAN LI CONFERENCE. | ||
| PART VI, LINE 6: N/A - ORGANIZATION IS NOT PART OF AN AFFILIATED HEALTH CARE SYSTEM. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | X | CompensationCommittee |
| Independent Consultant | X | IndependentConsultant |
| 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 (4 entries)
| TitleTitle | 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| HELENE CROSS | ||||||||||||||
| PRESIDENT/CEO - RETIRED SEPT 2012 | 158262 | 0 | 231487 | 0 | 0 | 0 | 21496 | 0 | 13985 | 0 | 425230 | 0 | 0 | 0 |
| TIMOTHY KELLY | ||||||||||||||
| MEDICAL DIRECTOR | 186898 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 18485 | 0 | 205383 | 0 | 0 | 0 |
| DR DENNIS RHYNE | ||||||||||||||
| PHYSICIAN | 151245 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 3281 | 0 | 154526 | 0 | 0 | 0 |
| DR BARBARA DAVIS | ||||||||||||||
| PHYSICIAN | 146326 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 8356 | 0 | 154682 | 0 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | SUPPLEMENTAL INFORMATION | Identifier |
| Return Reference | PART III | ReturnReference |
| Explanation | MS. HELEN CROSS IS COMPENSATED FROM FAIRBANKS HOSPITAL, INC. FOR HER DUTIES AS PRESIDENT/ CEO OF THE HOSPITAL. A PORTION OF EHR COMPENSATION RECEIVED FROM FAIRBANKS HOSPITAL, INC. IS ALLOCATED TO HOPE ACADEMY FOR DUTIES PROVIDED. FOR FY 13, 4% OF MS. CROSS' HOURS (83 HOURS ANNUALLY) OR SALARIES AND BENEFITS TOTALING $17,009 ARE ALLOCATED TO HOPE ACADEMY. | Explanation |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (7 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| FORM 990, PART VI, SECTION B, LINE 11 | THE PROCESS OF REVIEWING THE FORM 990 INCLUDES A DETAILED REVIEW OF THE FORM 990 AND REQUIRED SCHEDULES BY THE CHIEF EXECUTIVE OFFICER, CHIEF FINANCIAL OFFICER, AND BOARD FINANCE COMMITTEE. EACH VOTING MEMBER OF THE GOVERNING BODY REVIEWS AND APPROVES THE FORM 990 AT THE BOARD OF DIRECTOR MEETING WHICH TOOK PLACE FOR THE 2012 TAX RETURN ON DECEMBER 18, 2013. | |
| FORM 990, PART VI, SECTION B, LINE 12C | THE BOARD MEMBERS MUST COMPLETE A CONFLICT OF INTEREST FORM ANNUALLY. BOARD MEMBERS WHO HAVE A POTENTIAL FOR CONFLICT MUST RECUSE THEMSELVES FROM VOTING ON SUBJECTS THAT MIGHT POSE A CONFLICT. THE CORPORATE COMPLIANCE OFFICER REVIEWS ANY POTENTIAL CONFLICTS THAT ARE REPORTED. | |
| FORM 990, PART VI, SECTION B, LINE 15A | ALL CURRENT MEMBERS OF THE BOARD OF DIRECTORS ARE GIVEN A WRITTEN EVALUATION FORM TO RATE THE CEO. ALL INFORMATION IS THEN COMPILED IN A FINAL REPORT AND PRESENTED BY THE BOARD CHAIR TO THE CEO. FOR COMPENSATION, WE COMPILE DATA PROVIDED BY OUR INDEPENDENT AUDITORS FROM THE INDIANA HOSPITAL ASSOCIATION, OTHER MENTAL HEALTH PROVIDERS, AND NAATP (NATIONAL ASSOCIATION OF ADDICTION TREATMENT PROVIDERS) TO ENSURE THE SALARY IS COMPETITIVE AND REASONABLE. MEMBERS OF THE EXECUTIVE COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS MEET TO DISCUSS AND REVIEW THE DATA AND MAKE A FINAL DECISION REGARDING COMPENSATION THAT IS THEN REVIEWED AND APPROVED BY THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS. | |
| FORM 990, PART VI, SECTION C, LINE 19 | SUMMARY FINANCIAL INFORMATION IS AVAILABLE ON THE ORGANIZATION'S WEBSITE, REPORTED IN THE ANNUAL REPORTS. DETAILED FINANCIAL INFORMATION, GOVERNING DOCUMENTS, AND CONFLICT OF INTEREST POLICY IS AVAILABLE TO THE PUBLIC UPON REQUEST. | |
| FORM 990, PART VII, SECTION A, LINE 1A | MS. HELENE CROSS AND MR. MARK MONSON ARE COMPENSATED FROM FAIRBANKS HOSPITAL, INC. FOR THEIR DUTIES AS PRESIDENT/CEO OF THE HOSPITAL. A PORTION OF THEIR COMPENSATION RECEIVED FROM FAIRBANKS HOSPITAL, INC. IS ALLOCATED TO HOPE ACADEMY FOR DUTIES PROVIDED. FOR FY 13, 4% OF MS. CROSS AND MR. MONSON'S HOURS (83 HOURS ANNUALLY) OR SALARIES AND BENEFITS TOTALING $17,009 AND $2,593, RESPECTIVELY, ARE ALLOCATED TO HOPE ACADEMY. MS. RACHELLE GARDNER IS COMPENSATED FROM FAIRBANKS HOSPITAL, INC. FOR FY 13, 30% OF HER HOURS (624 HOURS ANNUALLY) OR SALARIES AND BENEFITS TOTALING $32,327 ARE ALLOCATED TO HOPE ACADEMY. MS. BARBARA ELLIOTT IS COMPENSATED FROM FAIRBANKS HOSPITAL, INC. FOR FY 13, 10% OF HER HOURS (208 HOURS ANNUALLY) OR SALARIES AND BENEFITS TOTALING $14,570 ARE ALLOCATED TO HOPE ACADEMY. | RELATED ORGANIZATION HOURS |
| FORM 990, PART XI, LINE 9: | NET ASSETS TRANSFERRED TO HOPE ACADEMY -278,811. | CHANGES IN NET ASSETS OR FUND BALANCES: |
| FORM 990, PART XI, LINE 2C | THE ORGANIZATION UTILIZES THE AUDIT AND FINANCE COMMITTEE OF THE BOARD OF DIRECTORS TO OVERSEE THE AUDIT PROCEDURES AND SELECTION OF THE INDEPENDENT ACCOUNTING FIRM. | AUDIT OVERSIGHT |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII
Name Of Disregarded Entity NameOfDisregardedEntity
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | THE RECOVERY HIGH SCHOOL AT FAIRBANKS INC DBA HOPE ACADEMY | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 8102 CLEARVISTA PARKWAY | AddressLine1 |
| City | INDIANAPOLIS | City |
| State | IN | State |
| ZIP Code | 46256 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 203094377 | EIN |
| Primary Activities | CHARTER SCHOOL | PrimaryActivities |
| Legal Domicile State | IN | LegalDomicileState |
| Exempt Code Section | 501(C)(3) | ExemptCodeSection |
| Public Charity Status | LINE 2 | PublicCharityStatus |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | FAIRBANKS HOSPITAL INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Controlled Org | 1 | ControlledOrg |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 1 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 0 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 1 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| Dividends Related Organization | 0 | DividendsRelatedOrganization |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 1 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 0 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 1 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 0 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 1 | SharingOfFacilities |
| Sharing Of Paid Employees | 1 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 1 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 0 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |
Transactions Related Orgs Table TransactionsRelatedOrgsTable (3 entries)
| Transaction TypeTransactionType | Amount InvolvedAmountInvolved | Method Of Amt DeterminationMethodOfAmtDetermination |
|---|---|---|
| THE RECOVERY HIGH SCHOOL AT FAIRBANKS INC DBA HOPE ACADEMY | ||
| B | 278811 | COST |
| THE RECOVERY HIGH SCHOOL AT FAIRBANKS INC DBA HOPE ACADEMY | ||
| D | 405340 | COST |
| THE RECOVERY HIGH SCHOOL AT FAIRBANKS INC DBA HOPE ACADEMY | ||
| J | 144600 | COST |