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FAIRBANKS HOSPITAL INC: Form 990, tax year 2010

View the entire original 990 at ProPublica ↗

Organization
FAIRBANKS HOSPITAL INC (EIN 35-0811197)
Tax period
2010-07-01 to 2011-06-30
Filed
2012-03-06
IRS object ID
201200669349301385
Schema version
2010v3.4
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2012-03-06T16:58:08-06:00Timestamp
Tax Period End Date2011-06-30TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1BLUE & CO LLCBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1ONE AMERICAN SQUARE 2200AddressLine1
CityINDIANAPOLISCity
StateINState
ZIP Code46282ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2010-07-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN350811197EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1FAIRBANKS HOSPITAL INCBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlFAIRNameControl
Phone3178498222Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line18102 CLEARVISTA PARKWAYAddressLine1
CityINDIANAPOLISCity
StateINState
ZIP Code46256ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameHELENE M CROSSName
TitlePRESIDENT & CEOTitle
Phone3178498222Phone
Date Signed2012-03-05DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameANGELA L ZIRKELBACH CPAName
Phone3176334705Phone
FieldValueIRS element (for citing)
Tax Year2010TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonHELENE M CROSSNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line18102 CLEARVISTA PARKWAYAddressLine1
CityINDIANAPOLISCity
StateINState
ZIP Code46256ZIPCode
FieldValueIRS element (for citing)
Gross Receipts21091965GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.FAIRBANKSCD.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1946YearFormation
State Legal DomicileINStateLegalDomicile
Activity Or Mission DescriptionNONPROFIT ORGANIZATION FOCUSED ON RECOVERY FROM ALCOHOL AND OTHER DRUG PROBLEMS.ActivityOrMissionDescription
Nbr Voting Members Governing Body16NbrVotingMembersGoverningBody
Nbr Independent Voting Members15NbrIndependentVotingMembers
Total Nbr Employees345TotalNbrEmployees
Total Nbr Volunteers150TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year2014741ContributionsGrantsPriorYear
Contributions Grants Current Year1477877ContributionsGrantsCurrentYear
Program Service Revenue Prior Year16331698ProgramServiceRevenuePriorYear
Program Service Revenue CY17941741ProgramServiceRevenueCY
Investment Income Prior Year-45083InvestmentIncomePriorYear
Investment Income Current Year48120InvestmentIncomeCurrentYear
Other Revenue Prior Year1303760OtherRevenuePriorYear
Other Revenue Current Year1515422OtherRevenueCurrentYear
Total Revenue Prior Year19605116TotalRevenuePriorYear
Total Revenue Current Year20983160TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year0GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year11283624SalariesEtcPriorYear
Salaries Etc Current Year12441605SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year153577TotalFundrsngExpCurrentYear
Other Expense Prior Year6396557OtherExpensePriorYear
Other Expenses Current Year7077184OtherExpensesCurrentYear
Total Expenses Prior Year17680181TotalExpensesPriorYear
Total Expenses Current Year19518789TotalExpensesCurrentYear
Revenues Less Expenses Prior Year1924935RevenuesLessExpensesPriorYear
Revenues Less Expenses CY1464371RevenuesLessExpensesCY
Total Assets BOY22221301TotalAssetsBOY
Total Assets EOY23359682TotalAssetsEOY
Total Liabilities BOY1808198TotalLiabilitiesBOY
Total Liabilities EOY1741631TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY20413103NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY21618051NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionFAIRBANKS 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 Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense8257276Expense
Revenue9497949Revenue
DescriptionADULT 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 8,082 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 3,615 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 1,161 ADULT RESIDENTIAL PATIENT DAYS.Description

Activity2 Activity2

FieldValueIRS element (for citing)
Expense2062038Expense
Revenue2371863Revenue
DescriptionADOLESCENT 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 324 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 707 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 4,818 ADOLESCENT RESIDENTIAL PATIENT DAYS.Description

Activity3 Activity3

FieldValueIRS element (for citing)
Expense3075341Expense
Revenue3537418Revenue
DescriptionADULT 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 6,636 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 12,130 IOP VISITS.Description

Activity Other ActivityOther

FieldValueIRS element (for citing)
Expense2720857Expense
Revenue3129671Revenue
DescriptionADOLESCENT OUTPATIENTS SERVICES PROGRAM SERVED 1,257 PHP VISITS AND 3,068 IOP VISITS DURING THE CURRENT FISCAL YEAR. ADULT HALFWAY HOUSE SERVED 1,529 PATIENT DAYS AND ADOLESCENT TLC/HOUSE PROGRAM SERVED 1,809 PATIENT DAYS DURING THE CURRENT FISCAL YEAR. FAIRBANKS HOSPITAL PROVIDED 216 OUTPATIENT COUNSELING SESSIONS, PROVIDED 3,201 PATIENT DAYS AT LAVERNA LODGE, AND PROVIDED 29,656 PATIENT DAYS AT SUPPORTED LIVING FACILITIES DURING THE CURRENT FISCAL YEAR.Description
FieldValueIRS element (for citing)
Total Of Other Program Service Exp2720857TotalOfOtherProgramServiceExp
Total Of Other Program Service Rev3129671TotalOfOtherProgramServiceRev
Total Program Service Expense16115512TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities0LobbyingActivities
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments1TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets0ReportOtherAssets
Report Other Liabilities1ReportOtherLiabilities
Report Fin48 Footnote1ReportFin48Footnote
Independent Audit Financial Stmt0IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt1ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities1FundraisingActivities
Gaming0Gaming
Hospital1Hospital
Financial Stmt Attached1FinancialStmtAttached
Grants To Organizations0GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds0TaxExemptBonds
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp1OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity1RelatedOrgControlledEntity
Transaction Related Entity0TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With109628NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees345NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions1QuidProQuoContributions
Quid Pro Quo Disclosure1QuidProQuoDisclosure
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members16NbrVotingGoverningBodyMembers
Number Independent Voting Members15NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders0MembersOrStockholders
Election Of Board Members0ElectionOfBoardMembers
Decisions Subject To Approval0DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other0CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
States Where Copy Of Return Is FiledINStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonBARBARA ELLIOTT CFONamePerson
Telephone Number3175729450TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line18102 CLEARVISTA PARKWAYAddressLine1
CityINDIANAPOLISCity
StateINState
ZIP Code46256ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (20 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationHighest Compensated EmployeeHighestCompensatedEmployee
PHYLLIS LAND USHER
CHAIRMAN1.00XX000
RICHARD COLLINS
VICE CHAIRMAN1.00XX000
THOMAS CRAIG
TREASURER1.00XX000
LEAH MANNWEILER
SECRETARY1.00XX000
FARAZ ABBASI
BOARD MEMBER1.00X000
THOMAS CARROLL
BOARD MEMBER1.00X000
LUKE KENLEY
BOARD MEMBER1.00X000
PEGGY MAGEE
BOARD MEMBER1.00X000
MARNI MCKINNEY
BOARD MEMBER1.00X000
DOROTHY MAY
BOARD MEMBER1.00X000
MALCOLM POWNALL
BOARD MEMBER1.00X000
CHRISTOPHER STACK MD
BOARD MEMBER1.00X000
KARL STOUT
BOARD MEMBER1.00X000
JAMES TERRY JR
BOARD MEMBER1.00X000
JANE WARDLE
BOARD MEMBER1.00X000
HELENE CROSS
PRESIDENT/CEO40.00XX212905031868
BARBARA ELLIOTT
CFO40.00X116067030728
TIMOTHY KELLY
MEDICAL DIRECTOR32.00X189391019606
CYNTHIA LEIGH
COO40.00X125716016433
AARON WHITMAN
PHYSICIAN/PSYCHIATRIST32.00113904023090X
FieldValueIRS element (for citing)
Total Reportable Comp From Org757983TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation121725TotalOtherCompensation
Number Individuals GT100 K5NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
FOOD MANAGEMENT SERVICES INC
11770 HAYNES BRIDGE ROADALPHARETTAGA30009FOOD SERVICES MGMT364663
PROGRESSIVE HOMECARE SERVICES
8930 BASH STREETINDIANAPOLISIN46256PHARMACY SERVICES249687
SOUTH BEND MEDICAL FOUNDATION
630 N LAFAYETTE BLVDSOUTH BENDIN46601REFERRAL LAB SERVICE235950
SEQUEST TECHNOLOGIES INC
801 WARRENVILLE ROADLISLEIL60532SOFTWARE PROG/SUPPORT228565
COMMUNITY HEALTH NETWORK
1500 N RITTER AVENUEINDIANAPOLISIN46219IT SERVICES153384
FieldValueIRS element (for citing)
Number Of Contractors GT100 K5NumberOfContractorsGT100K
Fundraising Events86004FundraisingEvents
All Other Contributions1391873AllOtherContributions
Total Contributions1477877TotalContributions

Program Service Revenue ProgramServiceRevenue

FieldValueIRS element (for citing)
DescriptionPATIENT SERVICE REVENUDescription
Business Code621300BusinessCode
Total Revenue Column17941741TotalRevenueColumn
Related Or Exempt Function Income17941741RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Program Service Revenue17941741TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column48120TotalRevenueColumn
Exclusion$48,120ExclusionAmount

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real144600Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real144600Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column144600TotalRevenueColumn
Exclusion$144,600ExclusionAmount
FieldValueIRS element (for citing)
Gross Income Fundraising Events60881GrossIncomeFundraisingEvents
Cntrbtns Rprtd Fundraising Events86004CntrbtnsRprtdFundraisingEvents
Fundraising Direct Expenses108805FundraisingDirectExpenses

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column-47924TotalRevenueColumn
Exclusion-$47,924ExclusionAmount

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnExclusionExclusionAmountRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
OTHER REVENUE900099746234$746,234
OUTSIDE COUNSELING SER624100573452573452
GIFT SHOP REVENUE45322077352$77,352

Miscellaneous Revenue MiscellaneousRevenue

FieldValueIRS element (for citing)
Total Revenue Column21708TotalRevenueColumn
Related Or Exempt Function Income21708RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Other Revenue1418746TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column20983160TotalRevenueColumn
Related Or Exempt Function Income18536901RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$968,382ExclusionAmount

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total713702Total
Program Services313384ProgramServices
Management And General400318ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total8929253Total
Program Services7532084ProgramServices
Management And General1301239ManagementAndGeneral
Fundraising95930Fundraising

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total253994Total
Program Services205735ProgramServices
Management And General45719ManagementAndGeneral
Fundraising2540Fundraising

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total1848394Total
Program Services1498829ProgramServices
Management And General331263ManagementAndGeneral
Fundraising18302Fundraising

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total696262Total
Program Services563972ProgramServices
Management And General125327ManagementAndGeneral
Fundraising6963Fundraising

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total88430Total
Management And General88430ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total53037Total
Management And General53037ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total1668646Total
Program Services1125870ProgramServices
Management And General531434ManagementAndGeneral
Fundraising11342Fundraising

Advertising Advertising

FieldValueIRS element (for citing)
Total362994Total
Program Services352244ProgramServices
Management And General9649ManagementAndGeneral
Fundraising1101Fundraising

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total136168Total
Program Services89361ProgramServices
Management And General45673ManagementAndGeneral
Fundraising1134Fundraising

Occupancy Occupancy

FieldValueIRS element (for citing)
Total928074Total
Program Services880701ProgramServices
Management And General47373ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total60440Total
Program Services59015ProgramServices
Management And General885ManagementAndGeneral
Fundraising540Fundraising

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total56862Total
Program Services34576ProgramServices
Management And General19268ManagementAndGeneral
Fundraising3018Fundraising

Interest Interest

FieldValueIRS element (for citing)
Total5626Total
Program Services5626ProgramServices

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total783761Total
Program Services735186ProgramServices
Management And General48575ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total218100Total
Program Services163585ProgramServices
Management And General53643ManagementAndGeneral
Fundraising872Fundraising

Other Expenses OtherExpenses (5 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneralFundraisingFundraising
BAD DEBT17197801719780
SUPPLIES62910761823610358513
MISCELLANEOUS183845557211246833441
PRINTING AND PUBLICATIO81257749524415864
EQUIPMENT MAINTENANCE A64521609153606

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total36536Total
Program Services25740ProgramServices
Management And General8779ManagementAndGeneral
Fundraising2017Fundraising

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total19518789Total
Program Services16115512ProgramServices
Management And General3249700ManagementAndGeneral
Fundraising153577Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY631252BOY
EOY1218361EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY5636887BOY
EOY6292465EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
BOY248104BOY
EOY178252EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY3317315BOY
EOY3291075EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY270019BOY
EOY390638EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis19147361LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec7628738LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY11770609BOY
EOY11518623EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY347115BOY
EOY470268EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY22221301BOY
EOY23359682EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY1548529BOY
EOY1547936EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY132443BOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY127226BOY
EOY193695EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY1808198BOY
EOY1741631EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY20131123BOY
EOY21419669EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY281980BOY
EOY198382EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY20413103BOY
EOY21618051EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY22221301BOY
EOY23359682EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses1464371ReconcilationRevenueExpenses
Reconcilation Other Changes-259423ReconcilationOtherChanges
Info In Schedule O Part XIIXInfoInScheduleOPartXII
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement ConsolidatedXFinancialStatementConsolidated
Federal Grant Audit Required1FederalGrantAuditRequired
Federal Grant Audit Performed1FederalGrantAuditPerformed

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Hospital170b1 AiiiXHospital170b1Aiii

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule D IRS990ScheduleD

Current Year CurrentYear

FieldValueIRS element (for citing)
Beginning Of Year Balance892895BeginningOfYearBalance
Contributions391777Contributions
Investment Earnings Or Losses5733InvestmentEarningsOrLosses
Other Expenditures417023OtherExpenditures
End Of Year Balance873382EndOfYearBalance

Current Year Minus1 Year CurrentYearMinus1Year

FieldValueIRS element (for citing)
Beginning Of Year Balance979700BeginningOfYearBalance
Contributions732482Contributions
Investment Earnings Or Losses47932InvestmentEarningsOrLosses
Other Expenditures867219OtherExpenditures
End Of Year Balance892895EndOfYearBalance

Current Year Minus2 Years CurrentYearMinus2Years

FieldValueIRS element (for citing)
Beginning Of Year Balance424006BeginningOfYearBalance
Contributions1288061Contributions
Investment Earnings Or Losses67990InvestmentEarningsOrLosses
Other Expenditures800357OtherExpenditures
End Of Year Balance979700EndOfYearBalance
FieldValueIRS element (for citing)
Board Designated EOY Balance0.77290BoardDesignatedEOYBalance
Permanent Endowment EOY Balance0.00000PermanentEndowmentEOYBalance
Term Endowment EOY Balance0.22710TermEndowmentEOYBalance
Endowments Held By Unrelated Orgs0EndowmentsHeldByUnrelatedOrgs
Endowments Held By Related Orgs0EndowmentsHeldByRelatedOrgs

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis605017OtherCostOrOtherBasis
Book Value605017BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis12653276OtherCostOrOtherBasis
Depreciation4253364Depreciation
Book Value8399912BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis5652213OtherCostOrOtherBasis
Depreciation3375374Depreciation
Book Value2276839BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis236855OtherCostOrOtherBasis
Book Value236855BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings11518623TotalOfBookValueLandBuildings

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
DescriptionESTIMATED THIRD PARTY SETTLEMENTSDescription
Amount$193,695Amount
FieldValueIRS element (for citing)
Total Of Amounts193695TotalOfAmounts
Total Revenue20983160TotalRevenue
Total Expenses19518789TotalExpenses
Excess Or Deficit For Year1464371ExcessOrDeficitForYear
Other-$259,423OtherAmount
Total Adjustments-259423TotalAdjustments
Excess Or Deficit Per FS1204948ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt21091965TotRevenueEtcAuditedFinclStmt
Other Revenues108805OtherRevenues
Revenue Not Rptd F990108805RevenueNotRptdF990
Revenue Subtotal20983160RevenueSubtotal
Revenue Not Rptd On Fin Stmt0RevenueNotRptdOnFinStmt
Total Revenue Per Form99020983160TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt19627594TotExpensesEtcAuditedFinclStmt
Other Expenses Included108805OtherExpensesIncluded
Expenses Not Rptd F990108805ExpensesNotRptdF990
Expenses Subtotal19518789ExpensesSubtotal
Expenses Not Rptd On Fin Stmt0ExpensesNotRptdOnFinStmt
Total Expenses Per Form99019518789TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (5 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
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: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, 2011 AND 2010, 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 8 - OTHER ADJUSTMENTS:NET ASSET TRANSFER TO RELATED PARTY -259,423.
PART XII, LINE 2D - OTHER ADJUSTMENTS:FUNDRAISING EVENT EXPENSES 108,805.
PART XIII, LINE 2D - OTHER ADJUSTMENTS:FUNDRAISING EVENT EXPENSES 108,805.

Schedule G IRS990ScheduleG

Events Information EventsInformation

FieldValueIRS element (for citing)
Name Of Event1CIRCLE OF HOPE DINNERNameOfEvent1
Gross Receipts Event1124867GrossReceiptsEvent1
Charitable Contributions Event170986CharitableContributionsEvent1
Gross Revenue Event153881GrossRevenueEvent1
Rent Facility Costs Event17804RentFacilityCostsEvent1
Food And Beverage Event133932FoodAndBeverageEvent1
Entertainment Event122933EntertainmentEvent1
Other Direct Expenses Event132714OtherDirectExpensesEvent1
Name Of Event2ALUMNI GOLF OUTINGNameOfEvent2
Gross Receipts Event222018GrossReceiptsEvent2
Charitable Contributions Event215018CharitableContributionsEvent2
Gross Revenue Event27000GrossRevenueEvent2
Non Cash Prizes Event21491NonCashPrizesEvent2
Rent Facility Costs Event26289RentFacilityCostsEvent2
Food And Beverage Event2110FoodAndBeverageEvent2
Other Direct Expenses Event23532OtherDirectExpensesEvent2
Gross Receipts Total146885GrossReceiptsTotal
Charitable Contributions Total86004CharitableContributionsTotal
Gross Revenue Total Events60881GrossRevenueTotalEvents
Non Cash Prizes Total Events1491NonCashPrizesTotalEvents
Rent Facility Costs Total Events14093RentFacilityCostsTotalEvents
Food And Beverage Total Events34042FoodAndBeverageTotalEvents
Entertainment Total Events22933EntertainmentTotalEvents
Other Direct Expenses Total Events36246OtherDirectExpensesTotalEvents
Direct Expense Summary Events108805DirectExpenseSummaryEvents
Net Income Summary-47924NetIncomeSummary

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Charity Care Policy1CharityCarePolicy
Written Policy1WrittenPolicy
FPG Reference Free Care0FPGReferenceFreeCare
FPG Reference Discounted Care1FPGReferenceDiscountedCare
Pcent250XPcent250
Free Disc Care Medically Indigent0FreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity Care1AmountsBudgetedForCharityCare
Expenses Exceeded Budget1ExpensesExceededBudget
Unable To Provide Care0UnableToProvideCare
Annual Community Benefit Report1AnnualCommunityBenefitReport
Report Publically Available0ReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Total Community Benefit Expense1042704TotalCommunityBenefitExpense
Net Community Benefit Expense1042704NetCommunityBenefitExpense
Percent Of Total Expense0.05860PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Total Community Benefit Expense40611TotalCommunityBenefitExpense
Direct Offsetting Revenue9628DirectOffsettingRevenue
Net Community Benefit Expense30983NetCommunityBenefitExpense
Percent Of Total Expense0.00170PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Total Community Benefit Expense1083315TotalCommunityBenefitExpense
Direct Offsetting Revenue9628DirectOffsettingRevenue
Net Community Benefit Expense1073687NetCommunityBenefitExpense
Percent Of Total Expense0.06030PercentOfTotalExpense

Community Health Services CommunityHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense565791TotalCommunityBenefitExpense
Direct Offsetting Revenue4462DirectOffsettingRevenue
Net Community Benefit Expense561329NetCommunityBenefitExpense
Percent Of Total Expense0.03150PercentOfTotalExpense

Health Professions Education HealthProfessionsEducation

FieldValueIRS element (for citing)
Total Community Benefit Expense47708TotalCommunityBenefitExpense
Net Community Benefit Expense47708NetCommunityBenefitExpense
Percent Of Total Expense0.00270PercentOfTotalExpense

Subsidized Health Services SubsidizedHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense1300153TotalCommunityBenefitExpense
Net Community Benefit Expense1300153NetCommunityBenefitExpense
Percent Of Total Expense0.07300PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense1913652TotalCommunityBenefitExpense
Direct Offsetting Revenue4462DirectOffsettingRevenue
Net Community Benefit Expense1909190NetCommunityBenefitExpense
Percent Of Total Expense0.10720PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense2996967TotalCommunityBenefitExpense
Direct Offsetting Revenue14090DirectOffsettingRevenue
Net Community Benefit Expense2982877NetCommunityBenefitExpense
Percent Of Total Expense0.16750PercentOfTotalExpense
FieldValueIRS element (for citing)
Bad Debt Expense Reported1BadDebtExpenseReported
Bad Debt Expense$848,880BadDebtExpenseAmount
Amount Attributable To0AmountAttributableTo
Amount Reimbursed By Medicare1825860AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare1608244CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall217616MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

FieldValueIRS element (for citing)
Cost To Charge RatioXCostToChargeRatio
FieldValueIRS element (for citing)
Written Debt Collection Policy1WrittenDebtCollectionPolicy
Provision For Charity Care1ProvisionForCharityCare
Number Of Hospital Facilities1NumberOfHospitalFacilities

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA

FieldValueIRS element (for citing)
Facility Number1FacilityNumber

Name Name

FieldValueIRS element (for citing)
Business Name Line1FAIRBANKS HOPSITALBusinessNameLine1

Address Address

FieldValueIRS element (for citing)
Address Line18102 CLEARVISTA PARKWAYAddressLine1
CityINDIANAPOLISCity
StateINState
ZIP Code46256ZIPCode
FieldValueIRS element (for citing)
Licensed HospitalXLicensedHospital

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1NOT REQUIREDBusinessNameLine1
FieldValueIRS element (for citing)
Hospital Facility Number1HospitalFacilityNumber

Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC

FieldValueIRS element (for citing)
Number Of Other Facilities3NumberOfOtherFacilities

Other Facilities OtherFacilities (3 entries)

Address Line1Address/AddressLine1CityAddress/CityStateAddress/StateZIP CodeAddress/ZIPCodeFacility TypeFacilityType
LAVERNA LODGE
8102 CLEARVISTA PARKWAYINDIANAPOLISIN46256DRUG & ALCOHOL RESIDENTIAL REHAB
SUPPORTED LIVING PROGRAM
8102 CLEARVISTA PARKWAYINDIANAPOLISIN46256ADULT HALFWAY HOUSE & DRUG & ALCOHOL SUPPORTED LIVING
KOKOMO OUTPATIENT CENTER
210 W WALNUT STREETKOKOMOIN46901OUTPATIENT CENTER

Form990 Schedule H Part VI Form990ScheduleHPartVI (12 entries)

ExplanationExplanation
PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 1719780.
PART II: NONE NOTED.
PART III, LINE 4: NO FOOTNOTE WAS NOTED ON THE AUDITED FINANCIAL STATEMENTS DESCRIBING BAD DEBT EXPENSE. BAD DEBTS AT COST ARE CALCULATED BY USING THE RATIO OF COST TO CHARGES.
PART III, LINE 8: MEDICARE ALLOWABLE COSTS ARE CALCULATED BY USING THE RATIO OF COST TO CHARGES.
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 DISCOVERED AS BEING IN A FINANCIAL POSITION OF 250% FEDERAL POVERTY LEVEL, THE ACCOUNT WILL BE RECLASSED AS CHARITY CARE.
FAIRBANKS DOES NOT FILE A COMMUNITY BENEFIT REPORT FOR THE PUBLIC AT THIS TIME BUT IT DOES MAINTAIN AN INTERNAL REPORT THAT COULD BE REVIEWED UPON REQUEST.
FACILITY INFORMATION: ADDRESSES FOR LAVERNA LODGE AND SUPPORTED LIVING PROGRAM HAVE BEEN OMITTED TO PROTECT THE PRIVACY OF THE PATIENTS RECEIVING CARE AT THOSE LOCATIONS.
PART VI, LINE 2: FAIRBANKS PARTICIPATES IN THE DEVELOPMENT OF THE COMMUNITY ASSESSMENT PROCESS, WHICH IS HEADED UP BY UNITED WAY OF CENTRAL INDIANA. THE ORGANIZATION USES INFORMATION/DEMOGRAPHICS RELATED TO THE SUBSTANCE ABUSE FIELD TO HELP GUIDE THE GROWTH AND DEVELOPMENT. CHARLOTTE PONTIUS, DIRECTOR OF PROGRAM DEVELOPMENT AND OUTREACH, WAS THE CHAIRMAN OF THE DRUG FREE MARION COUNTY BOARD IN FISCAL YEAR 2011. DRUG FREE MARION COUNTY HAS A COMPREHENSIVE COMMUNITY PLAN WHICH SERVES AS A BLUEPRINT REGARDING COMMUNITY PROBLEMS AND SOLUTIONS ASSOCIATED WITH ALCOHOL, TOBACOO, AND OTHER DRUGS IN THE AREAS OF PREVENTION, TREATMENT AND CRIMINAL JUSTICE.
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.
PART VI, LINE 4: FOR THE FISCAL YEAR ENDED JUNE 30, 2011, 19,414 PERSONS WERE SERVED; 60% FROM UNITED WAY OF CENTRAL INDIANA COUNTIES, 25% SURROUNDING COUNTIES, 13% REMAINING INDIANA COUNTIES, AND 2% OUT OF STATE.
PART VI, LINE 6: 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 7: N/A

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Compensation CommitteeXCompensationCommittee
Independent ConsultantXIndependentConsultant
Written Employment ContractXWrittenEmploymentContract
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan0SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org1CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs0CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments0AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (2 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
HELENE CROSS
172905040000000122430196250244773000
TIMOTHY KELLY
1820660732500000196060208997000

Form990 Schedule J Part III Form990ScheduleJPartIII

FieldValueIRS element (for citing)
Return ReferencePART I, LINE 6ReturnReference
ExplanationMANAGEMENT AND STAFF INCENTIVE PROGRAM FOR FY 11 STAFF INCENTIVE: STAFF INCENTIVE PAYOUT WAS CALCULATED BASED ON AN OPERATING MARGIN PERCENTAGE RANGE BETWEEN 5-10%. THESE MONIES WERE THEN ALLOCATED ON A PER SHARE BASIS BASED ON THE NUMBER OF HOURS WORKED. THE INCENTIVE PAYOUT OCCURRED IN AUGUST 2011. MANAGEMENT INCENTIVE: FOR FISCAL YEAR ENDED JUNE 30, 2011, MANAGEMENT INCENTIVE WAS A FLAT AMOUNT BY POSITION AND DEPENDENT ON MEETING AN OPERATING MARGIN PERCENTAGE. IN ADDITION, THE INCENTIVE PAYMENT WAS CONTINGENT ON OBTAINING SPECIFIC ORGANIZATIONAL GOALS.Explanation

Schedule L IRS990ScheduleL

Form990 Schedule L Part IV Form990ScheduleLPartIV (3 entries)

RelationshipRelationshipAmount Of TransactionAmountOfTransactionDescription Of TransactionDescriptionOfTransactionSharing Of RevenuesSharingOfRevenues
RICHARD COLLINS
BOARD MEMBER1977031MR. COLLINS IS AN OFFICER OF TWO COMPANIES ENGAGED IN THE BUSINESS OF HEALTH INSURANCE. FAIRBANKS COULD HAVE POTENTIAL ROUTINE INSURANCE CLAIMS WITH THESE COMPANIES (GOLDEN RULE INSURANCE AND AMERICAN MEDICAL SECURITY INSURANCE). FROM 7.1.2008 TO 1.20.2011, HE WAS SENIOR VP OF PRICING, UNDERWRITING AND HEALTH CARE ECONOMICS FOR UNITEDHEALTHCARE INSURANCE COMPANY (UHIC). FAIRBANKS COULD ALSO HAVE ROUTINE CLAIMS WITH UHIC AND AFFILIATES. FAIRBANKS ALSO PURCHASES EMPLOYEE BENEFITS FROM UHIC. MR. COLLINS HAD DIRECT CONTROL AND RESPONSIBILITY FOR SETTING PRICES ON POLICIES NATIONWIDE. HOWEVER, MR. COLLINS DID NOT TAKE PART IN RATE SETTING ACTIVITY FOR FAIRBANKS AND WILL RECUSE HIMSELF IN THE FUTURE. FAIRBANKS HAS NETWORK CONTRACTS WITH UHIC OR AFFILIATES. MR. COLLINS WAS NOT DIRECTLY INVOLVED IN NEGOTIATING NETWORK FEES OR CONTRACTING ACTIVITIES IN THE MIDWEST REGION. THE TRANSACTION AMOUNT EQUALS THE AMOUNT FAIRBANKS PAID UHIC FOR EMPLOYEE HEALTHCARE PREMIUMS DURING THE YEAR.0
LEAH MANNWEILER
BOARD MEMBER73768MS. MANNWEILER IS A PARTNER WITH THE FIRM OF KRIEG DEVAULT, LLP. THE FIRM PROVIDES LEGAL SERVICES TO FAIRBANKS.0
THOMAS CRAIG
BOARD MEMBER237863MR. CRAIG IS A VICE PRESIDENT AT OLD NATIONAL BANK WITH WHICH FAIRBANKS HAS A FINANCIAL RELATIONSHIP. HOWEVER, MR. CRAIG IS NOT DIRECTLY INVOLVED WITH MANAGING THAT RELATIONSHIP. THE TRANSACTION AMOUNT EQUALS THE AMOUNT FAIRBANKS HOLDS IN INVESTMENTS AT THIS BANK.0

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (6 entries)

IdentifierIdentifierExplanationExplanationReturn ReferenceReturnReference
FORM 990, PART VI, SECTION B, LINE 11THE FORM 990 WAS REVIEWED AND APPROVED BY THE BOARD OF DIRECTORS ON FEBRUARY 29, 2012.
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 12C
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 B, LINE 15A
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 VI, SECTION C, LINE 19
CHANGES IN NET ASSETS OR FUND BALANCES:NET ASSET TRANSFER TO RELATED PARTY -259,423. TOTAL TO FORM 990, PART XI, LINE 5: -259,423.FORM 990, PART XI, LINE 5:
AUDIT OVERSIGHTTHE ORGANIZATION UTILIZES THE AUDIT AND FINANCE COMMITTEE OF THE BOARD OF DIRECTORS TO OVERSEE THE AUDIT PROCEDURES AND SELECTION OF THE INDEPENDENT ACCOUNTING FIRM.FORM 990, PART XI, LINE 2C

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII

Name Of Disregarded Entity NameOfDisregardedEntity

FieldValueIRS element (for citing)
Business Name Line1THE RECOVERY HIGH SCHOOL AT FAIRBANKS INC DBA HOPE ACADEMYBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line18102 CLEARVISTA PARKWAYAddressLine1
CityINDIANAPOLISCity
StateINState
ZIP Code46256ZIPCode
FieldValueIRS element (for citing)
EIN203094377EIN
Primary ActivitiesCHARTER SCHOOLPrimaryActivities
Legal Domicile StateINLegalDomicileState
Exempt Code Section501(C)(3)ExemptCodeSection
Public Charity StatusLINE 2PublicCharityStatus

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1FAIRBANKS HOSPITAL INCBusinessNameLine1
FieldValueIRS element (for citing)
Controlled Org0ControlledOrg
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org1GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org0GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org1LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org0LoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs1RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs0RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs1PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs0PerformOfServicesByOtherOrgs
Sharing Of Facilities1SharingOfFacilities
Sharing Of Paid Employees1SharingOfPaidEmployees
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org1ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org0OtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable (3 entries)

Transaction TypeTransactionTypeAmount InvolvedAmountInvolved
THE RECOVERY HIGH SCHOOL AT FAIRBANKS INC DBA HOPE ACADEMY
B259423
THE RECOVERY HIGH SCHOOL AT FAIRBANKS INC DBA HOPE ACADEMY
D262100
THE RECOVERY HIGH SCHOOL AT FAIRBANKS INC DBA HOPE ACADEMY
I144600