Attach to Form 990 or Form 990-EZ.
Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
| (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 listed in your governing document? | (v) Amount of monetary support (see instructions) | (vi) Amount of other support (see instructions) | |
|---|---|---|---|---|---|---|
| Yes | No | |||||
| Total | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (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. | ||||||
Calendar year
(or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (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. Do not include gain or loss from the sale of capital assets (Explain in Part VI.).. | ||||||
| 11 | Total support Add lines 7 through 10. | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (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.) | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (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 VI.) .. | ||||||
| 13 | Total support. (Add lines 9, 10c, 11, and 12.).. | ||||||
| Section A - Adjusted Net Income | (A) Prior Year |
(B) Current Year (optional) |
||||
| 1 | Net short-term capital gain | 1 | ||||
| 2 | Recoveries of prior-year distributions | 2 | ||||
| 3 | Other gross income (see instructions) | 3 | ||||
| 4 | Add lines 1 through 3 | 4 | ||||
| 5 | Depreciation and depletion | 5 | ||||
| 6 | Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions) | 6 | ||||
| 7 | Other expenses (see instructions) | 7 | ||||
| 8 | Adjusted Net Income (subtract lines 5, 6 and 7 from line 4) | 8 | ||||
| Section B - Minimum Asset Amount | (A) Prior Year |
(B) Current Year (optional) |
||||
| 1 | Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year): | 1 | ||||
| a | Average monthly value of securities | 1a | ||||
| b | Average monthly cash balances | 1b | ||||
| c | Fair market value of other non-exempt-use assets | 1c | ||||
| d | Total (add lines 1a, 1b, and 1c) | 1d | ||||
| e | Discount claimed for blockage or other factors (explain in detail in Part VI): | |||||
| 2 | Acquisition indebtedness applicable to non-exempt use assets | 2 | ||||
| 3 | Subtract line 2 from line 1d | 3 | ||||
| 4 | Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount, see instructions). | 4 | ||||
| 5 | Net value of non-exempt-use assets (subtract line 4 from line 3) | 5 | ||||
| 6 | Multiply line 5 by .035 | 6 | ||||
| 7 | Recoveries of prior-year distributions | 7 | ||||
| 8 | Minimum Asset Amount (add line 7 to line 6) | 8 | ||||
| Section C - Distributable Amount | Current Year | |||||
| 1 | Adjusted net income for prior year (from Section A, line 8, Column A) | 1 | ||||
| 2 | Enter 85% of line 1 | 2 | ||||
| 3 | Minimum asset amount for prior year (from Section B, line 8, Column A) | 3 | ||||
| 4 | Enter greater of line 2 or line 3 | 4 | ||||
| 5 | Income tax imposed in prior year | 5 | ||||
| 6 | Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions) | 6 | ||||
| 7 | Check here if the current year is the organization's first as a non-functionally-integrated Type III supporting organization (see instructions) | |||||
| Section D - Distributions | Current Year | |
|---|---|---|
| 1 Amounts paid to supported organizations to accomplish exempt purposes | ||
|
2
Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity |
||
| 3 Administrative expenses paid to accomplish exempt purposes of supported organizations | ||
| 4 Amounts paid to acquire exempt-use assets | ||
| 5 Qualified set-aside amounts (prior IRS approval required) | ||
| 6 Other distributions (describe in Part VI). See instructions | ||
| 7Total annual distributions. Add lines 1 through 6. | ||
|
8
Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions |
||
| 9 Distributable amount for 2014 from Section C, line 6 | ||
| 10 Line 8 amount divided by Line 9 amount | ||
| Section E - Distribution Allocations (see instructions) |
(i) Excess Distributions |
(ii) Underdistributions Pre-2014 |
(iii) Distributable Amount for 2014 |
|
|---|---|---|---|---|
|
1
Distributable amount for 2014 from Section C, line 6 |
||||
|
2
Underdistributions, if any, for years prior to 2014 (reasonable cause required--see instructions) |
||||
| 3 Excess distributions carryover, if any, to 2014: | ||||
| a From 2009.......X | ||||
| b From 2010.......X | ||||
| c From 2011.......X | ||||
| d From 2012.......X | ||||
| e From 2013....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2014 distributable amount | ||||
|
i
Carryover from 2009 not applied (see instructions) |
||||
| j Remainder. Subtract lines 3g, 3h, and 3i from 3f. | ||||
| 4Distributions for 2014 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2014 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from 4. | ||||
|
5
Remaining underdistributions for years prior to 2014, if any. Subtract lines 3g and 4a from line 2 (if amount greater than zero, see instructions) |
||||
|
6
Remaining underdistributions for 2014. Subtract lines 3h and 4b from line 1 (if amount greater than zero, see instructions) |
||||
|
7 Excess distributions carryover to 2015. Add lines 3j and 4c. |
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| 8 Breakdown of line 7: | ||||
| a From 2010.......X | ||||
| b From 2011.......X | ||||
| c From 2012.......X | ||||
| d From 2013....... | ||||
| e From 2014....... | ||||
| Facts And Circumstances Test |
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| Return Reference | Explanation |
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| Software Version: |
Attach to Form 990 or 990-EZ.
Information about Schedule O (Form 990 or 990-EZ) and its instructions is at| Return Reference | Explanation |
|---|---|
| FORM 990, PART III, LINE 4A | PROGRAM SERVICE ACCOMPLISHMENTS: san juan regional rehabilitation hospital (sjrrh) is a free-standing 16 bed, inpatient rehabilitation facility. sjrrh was founded as a joint venture in 1989 and became a tax-exempt hospital in 1996. sjrrh is the only licensed acute rehabilitation hospital in the four corners area and serves patients in colorado, utah, arizona and new mexico. sjrrh treats patients with acute and chronic rehabilitation needs regardless of the patient's ability to pay. approximately 240 patients are treated annually. this includes many conditions such as stroke, spinal cord injuries, brain injuries, amputations and other orthopedic injuries, to name a few. at sjrrh, patients relearn and practice life skills so they can return home as soon as possible. stroke, accident, or illness can rob a person of their independence and self-reliance in an instant if the loss is severe enough. the person's only hope of regaining the ability to work, play and live their life independently is by receiving the highest level of rehabilitation possible. sjrrh provides that hope. at sjrrh, a rehabilitation team, made up of a specialist physician, physical, occupational, and speech therapists, rehabilitation nurses, and a case manager designs a personalized plan for the patient. that rehabilitation plan is based on the patient's unique circumstances-their condition, their goals and their lifestyle. sjrrh is active in providing information to the community on fall protection, healthy lifestyles and injury prevention. this is done through health fairs, open houses and the stroke support group. |
| Form 990, Part VI, Section A, Line 6 | MEMBERS: SAN JUAN REGIONAL MEDICAL CENTER, A TAX-EXEMPT ORGANIZATION, IS THE SOLE CORPORATE MEMBER OF SAN JUAN REGIONAL REHABILITATION HOSPITAL. |
| Form 990, Part VI, Section A, Line 7a | Members who can elect members of the governing body: SAN JUAN REGIONAL MEDICAL CENTER, AS THE SOLE CORPORATE MEMBER OF SAN JUAN REGIONAL REHABILITATION HOSPITAL (SJRRH), HAS THE RIGHT TO AUTHORIZE OR APPROVE THE ELECTION OF ANY BOARD MEMBER OR OFFICER OF SJRRH. |
| Form 990, Part VI, Section A, Line 7b | Decisions of governing body subject to approval by members: San juan regional medical center, as the sole corporate member of san juan regional rehabilitation hospital, has the following reserved powers: a) adopt or approve any annual or long-term capital or operating budget of the corporation, b) incur any obligation, not provided for in an annual or long-term capital or operating budget approved by the member, where the amount involved exceeds $50,000 per item or $100,000 in aggregate, c) authorize or approve any sale, mortgage or other disposition of all or substantially all of the corporation's assets, d) authorize or approve sale, conveyance, mortgage, disposition or acquisition of real estate, e) authorize or approve any new, or any change to existing, long-term or master institutional plans of the corporation, f) authorize or approve any plan or agreement of merger or consolidation of the corporation with or into another entity, or any change or transfer of control or membership of the corporation, g) set the compensation of corporation officers and physician employees of the corporation, h) adopt a plan of or authorize a petition for dissolution, liquidation, bankruptcy or reorganization of the corporation, i) authorize or approve organization, formation or acquisition of any subsidiary or affiliate of the corporation, including any corporation, association, partnership, trust, joint venture or other entity directly or indirectly controlling, controlled by or under common control with the corporation, j) authorize or approve any debt instrument, note, pledge or guaranty with a term in excess of one year, k) authorize or approve the corporation's appointment of, or the corporation's contract with, the president and chief executive officer of the corporation, or l) authorize or approve any amendment, repeal, restatement, or revision of the articles of organization or by laws of the corporation |
| Form 990, Part VI, Section B, line 11b | Process to Review the Form 990: THE FORM 990 IS PREPARED BY AN OUTSIDE ACCOUNTING FIRM BASED ON DATA PROVIDED BY MANAGEMENT. A DRAFT COPY OF THE 990 IS PROVIDED TO MANAGEMENT FOR REVIEW. A MEETING IS CONDUCTED BY THE ACCOUNTING FIRM TO REVIEW THE RETURN IN DETAIL. ANY QUESTIONS ARE ADDRESSED AND ANY NECESSARY CHANGES ARE MADE TO THE RETURN. THE FINAL DRAFT OF THE FORM 990 IS PROVIDED TO EACH BOARD MEMBER PRIOR TO FILING ALONG WITH A BRIEF EDUCATION SESSION CONDUCTED BY THE ACCOUNTING FIRM TO DISCUSS THE HIGHLIGHTS OF THE FORM. |
| Form 990, Part VI, Section B, line 12c | Process for Monitoring Compliance with Conflict of Interest Policy: The conflict of interest policy is distributed on a yearly basis to the board of directors and Managers at san juan regional rehabilitation hospital. it is required to be filled out and then reviewed by the executive director and the board in order to find out if any conflicts or potential conflicts exist. any identified conflicts have to be reported to the compliance officer who then reviews and determines if the conflict constitutes breach of employment and may lead to disciplinary action. |
| Form 990, Part VI, Section B, line 15a | Describe process for determining compensation: THE BOARD OF DIRECTORS FOR SAN JUAN REGIONAL MEDICAL CENTER, THE SOLE MEMBER OF SAN JUAN REGIONAL REHABILITATION HOSPITAL (SJRRH), USES THE FOLLOWING COMPARABLE DATA WHEN DETERMINING THE COMPENSATION FOR THE TOP MANAGEMENT OFFICIAL OF SJRRH. REGIONAl/LOCAL AREA NOT-FOR-PROFIT HEALTHCARE ORGANIZATIONS OF COMPARABLE SIZE, NATIONAL NOT-FOR-PROFIT HEALTHCARE ORGANIZATIONS OF COMPARABLE SIZE, AND OTHER RELEVANT COMPARATORS (EG, FOR PROFIT HEALTHCARE AND/OR GENERAL INDUSTRY ORGANIZATIONS) OF COMPARABLE SIZE AND COMPLEXITY, ONLY WHEN COMPETITIVE CIRCUMSTANCES WARRANT THESE MARKETS. ADDITIONALLY, THE BOARD BIANNUALLY HAS AN OUTSIDE FIRM COMPARE THE CEO'S COMPENSATION WITH OTHER HEALTHCARE ORGANIZATIONS TO REMAIN COMPETITIVE. THE PROCESS WAS LAST COMPLETED ON JULY 10, 2015. THE PROCESS IS DOCUMENTED IN THE BOARD MINUTES WHEN PRESENTED TO THE INDIVIDUALS. THE PROCESS IS DOCUMENTED WITHIN THE BOARD MINUTES. NO OTHER OFFICERS ARE COMPENSATED AND THERE ARE NO KEY EMPLOYEES, THEREFORE, LINE 15B IS ANSWERED NO. |
| Form 990, Part VI, Section C, line 19 | Governing Documents Available to the Public: SAN JUAN REGIONAL REHABILITATION HOSPITAL MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. |
| FORM 990 PART IX LINE 11G | DESCRIPTION:CONTRACT SERVICES TOTAL FEES:445099 |
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