Department of the Treasury Internal Revenue Service
Public Charity Status and Public Support
Complete if the organization is a section 501(c)(3) organization or a section
4947(a)(1) nonexempt charitable trust.
Attach to Form 990 or Form 990-EZ. See separate instructions.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
Adventist Rehabilitation Hospital of Maryland
Employer identification number
20-1486678
Part I
Reason for Public Charity Status
(All organizations must complete this part.) See instructions
The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)
1
2
3
4
5
section 170(b)(1)(A)(iv). (Complete Part II.)
6
7
8
9
receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of
its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses
acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)
10
11
e
By checking this box, I certify that the organization is not controlled directly or indirectly by one or more disqualified persons other than foundation managers and other than one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2).
f
If the organization received a written determination from the IRS that it is a Type I, Type II or Type III supporting organization, check this box
..................................................
g
Since August 17, 2006, has the organization accepted any gift or contribution from any of the following persons?
(i) a person who directly or indirectly controls, either alone or together with persons described in (ii)
Yes
No
and (iii) below, the governing body of the the supported organization?
................
11g(i)
(ii)
a family member of a person described in (i) above?
......................
11g(ii)
(iii)
a 35% controlled entity of a person described in (i) or (ii) above?
................
11g(iii)
h
Provide the following information about the supported organization(s).
(i) Name of supported organization
(ii) EIN
(iii) Type of organization (described on lines 1- 9 above or IRC section (see instructions))
(iv) Is the organization in col. (i) listed in your governing document?
(v) Did you notify the organization in col. (i) of your support?
(vi) Is the organization in col. (i) organized in the U.S.?
(vii) Amount of support?
Yes
No
Yes
No
Yes
No
Total
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 2
Part II
Support Schedule for Organizations Described in IRC 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi) (Complete only if you checked the box on line 5, 7, or 8 of Part I or if the
organization failed to qualify under Part III. If the organization fails to
qualify under the tests listed below, please complete Part III.)
Section A. Public Support
Calendar year(or fiscal year beginning in)
(a) 2006
(b) 2007
(c) 2008
(d) 2009
(e) 2010
(f) Total
1
Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....
2
Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......
3
The value of services or facilities furnished by a governmental unit to the organization without charge..
4
Total. Add lines 1 through 3..
5
The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included
on line 1 that exceeds 2% of the amount shown on line 11, column (f)..
6
Public Support. Subtract line 5 from line 4.
Section B. Total Support
Calendar year(or fiscal year beginning in)
(a) 2006
(b) 2007
(c) 2008
(d) 2009
(e) 2010
(f) Total
7
Amounts from line 4..
8
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
9
Net income from unrelated business activities, whether or not the business is regularly carried on..
10
Other income. (Explain in Part IV.) Do not include gain or loss from the sale of capital assets..
11
Total support (Add lines 7 through 10).
12
Gross receipts from related activities, etc. (See instructions.)
..................
12
13
First Five Years
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here..........................................
Section C. Computation of Public Support Percentage
14
Public Support Percentage for 2010 (line 6 column (f) divided by line 11 column (f))
.........
14
15
Public Support Percentage for 2009 Schedule A, Part II, line 14
...............
15
16a
33 1/3% support test—2010.
If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization
......................
b
33 1/3% support test—2009.
If the organization did not check the box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization
.....................
17a
10%-facts-and-circumstances test—2010.
If the organization did not check a box on line 13, 16a, or 16b and line 14
is 10% or more, and if the organization meets the "facts and circumstances" test, check this box and stop here. Explain
in Part IV how the organization meets the "facts and circumstances" test. The organization qualifies as a publicly supported
organization
..................................................
b
10%-facts-and-circumstances test—2009.
If the organization did not check a box on line 13, 16a, 16b, or 17a and line
15 is 10% or more, and if the organization meets the "facts and circumstances" test, check this box and stop here.
Explain in Part IV how the organization meets the "facts and circumstances" test. The organization qualifies as a publicly supported organization
..............................................
18
Private Foundation
If the organization did not check a box on line 13, 16a, 16b, 17a or 17b, check this box and see
instructions
...................................................
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 3
Part III
Support Schedule for Organizations Described in IRC 509(a)(2) (Complete only if you checked the box on line 9 of Part I or if the organization
failed to qualify under Part II. If the organization fails to qualify under
the tests listed below, please complete Part II.)
Section A. Public Support
Calendar year(or fiscal year beginning in)
(a) 2006
(b) 2007
(c) 2008
(d) 2009
(e) 2010
(f) Total
1
Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
2
Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose......
3
Gross receipts from activities that are not an unrelated trade or business under section 513..
4
Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
5
The value of services or facilities furnished by a governmental unit to the organization without charge..
6
Total. Add lines 1 through 5.
7a
Amounts included on lines 1, 2, and 3 received from disqualified persons...
b
Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.
c
Add lines 7a and 7b..
8
Public Support (Subtract line 7c from line 6.)
Section B. Total Support
Calendar year (or fiscal year beginning in)
(a) 2006
(b) 2007
(c) 2008
(d) 2009
(e) 2010
(f) Total
9
Amounts from line 6...
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c
Add lines 10a and 10b.
11
Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
12
Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)
13
Total support (Add lines 9, 10c, 11 and 12.).
14
First Five Years
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here.............................................
Section C. Computation of Public Support Percentage
15
Public Support Percentage for 2010 (line 8 column (f) divided by line 13 column (f))
.........
15
16
Public support percentage from 2009 Schedule A, Part III, line 15
...............
16
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2010 (line 10c column (f) divided by line 13 column (f))
......
17
18
Investment income percentage from 2009 Schedule A, Part III, line 17
.............
18
19a
33 1/3% support tests—2010.
If the organization did not check the box on line 14, and line 15 is more than 33 1/3% and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
..........
b
33 1/3% support tests—2009.
If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
....
20
Private Foundation
If the organization did not check a box on line 14, 19a or 19b, check this box and see instructions
.....
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 4
Part IV
Supplemental Information.
Supplemental Information. Complete this part to provide the explanation required by Part II, line 10; Part II, line 17a or 17b; or Part III, line 12. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
Explanation
Schedule A (Form 990 or 990-EZ) 2010
Additional Data
Software ID:
10000105
Software Version:
2010v3.2
-
TIN:
SCHEDULE O (Form 990 or 990-EZ)
Department of the Treasury Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ
Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
Attach to Form 990 or 990-EZ.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
Adventist Rehabilitation Hospital of Maryland
Employer identification number
20-1486678
Identifier
Return Reference
Explanation
Form 990, Part VI, Line 19
Form 990, Part VI, Line 19: Other Organization Documents Publicly Available
The governing documents, conflict of interest policy and financial statements, are available to the public upon request.General ExplanationEmployees of any of the Adventist HealthCare Inc. and affiliated Tax Exempt entities in the state of Maryland (including Adventist Home Health Services, Inc) are paid through a common paymaster, Adventist HealthCare, Inc. and are reported on its Form 941. Salary and benefit expenses reported on their respective returns are actual charges related to the employees working on the specific tax exempt entity.Compensation included regular base salary, bonus, paid time off cash out, taxable relocation allowance, holiday gift, retroactive compensation adjustment, bereavement leave, education, and withdrawal of deferred compensation, as applicable. The same and non-additive compensation and employment benefit plan contribution amounts were also disclosed in the Adventist HealthCare Inc.'s related entities returns.Vendors payment for any of the Adventist HealthCare, Inc. and related entities in the State of Maryland are made through a common paymaster, Adventist HealthCare, Inc.
Form 990, Part VI, Line 15b
Form 990, Part VI, Line 15b: Compensation Review and Approval Process for Officers and Key Employees
When setting officers and or key employees compensation, the organization fully complies with the procedural safeguards embedded in the IRS regulations. Executive compensation is entirely set by a committee of the Board of Trustees of Adventist HealthCare, Inc. In setting compensation, the governing board committee relies upon market comparability data provided by an independent outside compensation consultant. To ensure reasonableness, compensation is set at the 50th percentile of the natural market
Form 990, Part VI, Line 12c
Form 990, Part VI, Line 12c: Explanation of Monitoring and Enforcement of Conflicts
Pursuant to the organizations conflict of interest policy, each facility board member, officer, director and any employee in a position that requires coordination and/or negotiation with contractors or supplies, is required on an annual basis to disclose any business or financial relationship outside of the organization. Compliance with policy is monitored and enforced by the Human Resources Department, Corporate Integrity Department and the Legal Department.
Form 990, Part VI, Line 11
Form 990, Part VI, Line 11: Form 990 Review Process
The Board of Trustees of Adventist Rehabilitation Hospital of Maryland are made up of the executives and officers from Adventist Healthcare Inc. Adventist Healthcare Inc. (AHC) and its controlled entities subscribe to the same policies and procedures of AHC, which are subjected to the approval by its board of trustees.The executive management of AHC reviewed all controlled entities' From 990 prior to filing with IRS.
Form 990, Part VI, Line 7a
Form 990, Part VI, Line 7a: How Members or Shareholders Elect Governing Body
The Board of Trustees of Adventist Healthcare, Inc. appoints the members of Adventist Rehabilitation Hospital of Maryland governing body.
Form 990, Part VI, Line 6
Form 990, Part VI, Line 6: Explanation of Classes of Members or Shareholder
Adventist HealthCare, Inc. is the sole corporate member of Adventist Rehabilitation Hospital of Maryland, Inc. with the authority to approve its Board membership.
Client Note 1 - Page 2 - Part III, 4a.Adventist Rehabilitation Hospital of Maryland, a separate legal entity managed by Adventist Healthcare Executive Team, is the first and only acute rehabilitation hospital in Montgomery County, MD., that offers comprehensive rehabilitation programs for traumatic brain injuries, spinal cord injuries, strokes, amputation, orthopedic injuries and surgeries, sports-related injuries, work-related injuries, cardiopulmonary conditions, and neurological disorders.We believe that rehabilitation is all about helping our patients set their goals and reach them. Expert care teams working side-by-side with patients, using innovative therapies, state-of-the-art equipment and ground-breaking technology combine to offer new ways to heal. Adventist Rehabilitation Hospital is built around our patients and leads the way back to life from stroke, brain injury, spinal cord injury, amputation and trauma. Every day, we celebrate patient advances, big and small.We have recently upgraded our services through the addition of an accessible van, rehabilitation equipment (such as power wheel chairs or light/sport wheel chairs) a car simulator for practice car transfers and sleeper chairs. Adventist Rehab has locations in Rockville and Takoma Park with outpatient services in Rockville and Silver Spring.Adventist Rehab offers specialized inpatient and outpatient treatment for persons with functional limitations, caring for patients 18 and older and, under special circumstances, emancipated minors. Our many rehabilitation programs and services include:Acute Inpatient Rehabilitation Spinal Cord Injury Amputee Program Stroke Brain Injury Orthopedic ProgramsOrthopedic Rehabilitation Prosthetics & Orthotics Outpatient ServicesDriver Rehabilitation Program Lymphedema Therapy Joint Replacement Program Seating & Mobility Clinic Lee Silverman Voice Treatment (LSVT) Speech Language & Swallowing Therapy Adventist Rehabilitation Hospital of Maryland is the only hospital in the D.C. metropolitan area and the third in the nation to earn a specialty accreditation in amputee rehabilitation from the Commission on Accreditation of Rehabilitation Facilities (CARF) International. CARF introduced its amputee specialty standards in July 2007 with input from the Amputee Coalition of America (ACA), Veterans Health Administration, Department of Defense, American Academy of Orthotists & Prosthetists, and persons with limb loss. The standards, which became effective in January 2008, require accredited amputee programs to provide a holistic, interdisciplinary team approach to care and to offer post-care assistance in transitioning back to the community.Our Acute Inpatient Rehabilitation Program is run by a team of rehabilitation experts who will guide you along a practical and personal treatment program focused on increasing self-reliance and gaining independence. The team is led by a physiatrist, a medical doctor who specializes in physical rehabilitation. We provide specialized rehabilitation nursing 24 hours a day, seven days a week. Therapy services include physical therapy, occupational therapy, speech language pathology, and recreational therapy.The Spinal Cord Injury Program addresses both Traumatic Spinal Cord Injuries result from a fall or some kind of accident, and Non-Traumatic Spinal Cord Injuries that result from a stroke and disruption to the spinal cord, tumor on spinal cord, or infection. Again, a team approach to put together an Interdisciplinary Plan of Care helps the patient on the road to recovery.Adventist Rehabilitation's Amputee Program utilizes an interdisciplinary team approach to help post-amputee patients to adjust physically and psychologically after the loss of a limb and resume active and productive lives. Individuals may be treated as inpatients or outpatients, depending on their personal needs. Patients work to improve strength, coordination and endurance and also learn proper wound care. When ready, our patients are prescribed prosthetic devices that are both functional and comfortable to wear. Once tined with a new limb, the patient learns to use the prosthesis with confidence and to incorporate it into daily life.The interdisciplinary team approach of the Brain Injury Program at Adventist Rehab addresses traumatic brain injuries caused by an external physical force, such as a car accident, fall, sports or workplace injuries, etc.; as well as acquired brain injuries caused by internal trauma to the brain, such as tumors, blood clots, seizures, infections, etc. Each of these types of brain injuries may result in impairment of physical, cognitive, behavioral, and/or emotional capabilities. Rehabilitation following a brain injury is very complex because of the need to address multiple areas of deficit, including physical impairments, functional deficiencies (such as difficulty walking or dressing), behavioral difficulties, emotional consequences and social or interpersonal limitations. Often, significant cognitive deficits, such as limited attention span or poor memory, underlie and exacerbate these problems. Patients in our Brain Injury Program receive intensive, integrated rehabilitation designed to maximize their recovery. Team members, including a neuropsychologist, meet at least once a week to discuss goals, progress and treatment strategies.Other programs offered include a Stroke Program for recovering stroke patients to take part in an intensive course of integrated therapy and medical management. The objective is to restore movement, improve speech, teach self care and home care skills and improve cognitive and memory functions. Stroke patients and their families will be guided through a patient-focused, comprehensive, and outcome-oriented stroke program by a caring, competent team of healthcare professionals. The Orthopedic Rehabilitation Program is designed for those who have undergone a total hip or knee replacement or have sustained trauma to bones or joints. The program focuses on helping patients regain their strength, mobility, endurance and range of motion.The Driver Rehabilitation Program determines whether it is safe for the client to continue driving following an injury/illness or age related changes. A driving program may include a clinical evaluation which includes an assessment of vision, visual perception, cognition, reaction time, and motor skills related to driving. It may also include a behind-the-wheel evaluation, in addition to training conducted by an Occupational Therapist who specializes in driving rehabilitation.Our certified Lymphedema Therapists provide a complete decongestive treatment approach for people suffering from lymph edema. This involves a specialized massage technique called manual lymph drainage (MLD), skin and nail care, compression bandaging and garments, remedial exercise and self-care training. The goal of our program is to help individuals reduce increase volume resulting from lymph edema, restore mobility, improve cosmesis, prevent infection, and improve their quality of life.A Joint Replacement Program at Adventist Rehabilitation Center helps patients to achieve goals for optimal results. One of the important critical factors for successful outcomes following knee or hip replacement for patients is for patients to diligently follow the physical rehabilitation process. Adventist Rehab provides both the support and resources for a positive outcome.Lee Silverman Voice Treatment (LSVT)-certified speech language pathologists at Adventist Rehabilitation Center can complete a comprehensive assessment to determine candidacy for LSVT. LSVT is a highly effective intensive speech therapy program designed for Parkinson's patients. LSVT is designed to improve speech and voice function. The therapy targets vocal loudness in order to trigger improved function and coordination across the various subsystems of speech. LSVT combines motor retraining with sensory re-training to elicit maximum outcomes. The treatment regimen includes emphasis on patient education and carryover of gains to daily communication environments. The LSVT protocol involves four 1-hour therapy sessions per week for 4 weeks.Adventist Rehabilitation Hospital is built around our patients and leads the way back to life from stroke, brain injury, spinal cord injury, amputation and trauma. Expert care teams working side-by-side with patients, using innovative therapies, state-of-the-art equipment and ground-breaking technology combine to offer new ways to heal. As a nonprofit organization, Adventist Rehabilitation Hospital depends on this support and dollar for dollar, every donation makes a difference by helping us maintain outstanding programs and services and keep pace with the latest advances in technology and equipment for rehabilitative care.Schedule J Additional InformationCOMPENSATION DEFINED. THE COMPENSATION REPORTED FOR THE EMPLOYEES SET FORTH ON SCHEDULE J IS COMPRISED OF THE FOLLOWING:**BASE COMPENSATION -
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.