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 (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) 2011 | (b) 2012 | (c) 2013 | (d) 2014 | (e) 2015 | (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) 2011 | (b) 2012 | (c) 2013 | (d) 2014 | (e) 2015 | (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) 2011 | (b) 2012 | (c) 2013 | (d) 2014 | (e) 2015 | (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) 2011 | (b) 2012 | (c) 2013 | (d) 2014 | (e) 2015 | (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 | ||||
| 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 2015 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-2015 |
(iii) Distributable Amount for 2015 |
|
|---|---|---|---|---|
|
1
Distributable amount for 2015 from Section C, line 6 |
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|
2
Underdistributions, if any, for years prior to 2015 (reasonable cause required--see instructions) |
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| 3 Excess distributions carryover, if any, to 2015: | ||||
| a | ||||
| b | ||||
| c | ||||
| d From 2013....... | ||||
| e From 2014....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2015 distributable amount | ||||
|
i
Carryover from 2010 not applied (see instructions) |
||||
| j Remainder. Subtract lines 3g, 3h, and 3i from 3f. | ||||
| 4Distributions for 2015 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2015 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from 4. | ||||
|
5
Remaining underdistributions for years prior to 2015, if any. Subtract lines 3g and 4a from line 2 (if amount greater than zero, see instructions) |
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|
6
Remaining underdistributions for 2015. Subtract lines 3h and 4b from line 1 (if amount greater than zero, see instructions) |
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|
7 Excess distributions carryover to 2016. Add lines 3j and 4c. |
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| 8 Breakdown of line 7: | ||||
| a | ||||
| b | ||||
| c Excess from 2013....... | ||||
| d From 2014....... | ||||
| e From 2015....... | ||||
| Facts And Circumstances Test |
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| Return Reference | Explanation |
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| Software ID: | |
| 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 | BROOKS TAKES GREAT PRIDE IN THE QUALITY CARE WE OFFER OUR PATIENTS EACH YEAR AS ILLUSTRATED IN OUR CLINICAL OUTCOMES AND PATIENT SATISFACTION SCORES. IN 2012: - OVERALL, BROOKS PATIENTS HAVE A SHORTER STAY AT THE HOSPITAL AND RETURN BACK TO THEIR LIVES AND BACK HOME AFTER TREATMENT.** - 95.3% OF PATIENTS RESPONDED POSITIVELY TO THE QUESTION, LIKELIHOOD OF RECOMMENDING BROOKS".* - BROOKS RETURNS 75% OF PATIENTS BACK TO THEIR HOMES, WHICH IS MORE THAN OTHER REHABILITATION HOSPITALS NATIONALLY.** - PATIENTS ARE ADMITTED FASTER AND CAN BEGIN THE REHABILITATION PROCESS SOONER AT BROOKS THAN IN OTHER REHABILITATION HOSPITALS ACROSS THE NATION.** SOURCES: * PATIENT SATISFACTION AS MEASURED BY THE PRESS GANEY PATIENT SATISFACTION SURVEY 1/12-12/12. ** OUTCOMES DATA FROM E-REHABDATA 1/12-12/12. BROOKS REHABILITATION HAS CONTINUED TO INCREASE THE AMOUNT OF FREE CARE TO CHARITY, UNDERINSURED, AND UNINSURED PATIENTS EACH YEAR. IN 2012, BROOKS PROVIDED $2,079,388 OF FREE CARE AT COST IN THE HOSPITAL, WHICH WAS EQUIVALENT TO 1,661 PATIENT DAYS. CHARITY CARE AND OTHER FREE CARE PROVIDED TO OUTPATIENTS' VISITS WERE EQUIVALENT TO $652,438 IN COSTS. BROOKS ALSO PROVIDED CARE TO MEDICAID PATIENTS IN THE HOSPITAL AND OUTPATIENT CLINICS. THERE WERE 1,912 MEDICAID DAYS PROVIDED IN 2012, INCLUDING 3,249 MEDICAID HMO DAYS. SINCE THE MEDICAID PROGRAM REIMBURSES AT A RATE SIGNIFICANTLY BELOW THE COST OF CARE, THERE WAS A NET LOSS TO BROOKS IN PROVIDING THIS CARE OF $538,075. |
| FORM 990, PART VI, SECTION A, LINE 2 | BOARD MEMBERS LYNNE SNEED AND GARY W. SNEED HAVE A FAMILY RELATIONSHIP. |
| FORM 990, PART VI, SECTION A, LINE 6 | THE SOLE MEMBER OF THE ORGANIZATION IS GENESIS HEALTH, INC. (DOING BUSINESS AS BROOKS HEALTH SYSTEM), A FLORIDA NOT-FOR-PROFIT CORPORATION. |
| FORM 990, PART VI, SECTION A, LINE 7A | THE BOARD SHALL BE COMPOSED OF AT LEAST FIVE DIRECTORS. DIRECTORS SHALL BE SELECTED FOR THEIR ABILITY TO PARTICIPATE EFFECTIVELY IN FULFILLING THE BOARD'S RESPONSIBILITY AND WITH THE PURPOSE AND INTENT OF PROVIDING A BOARD OF DIRECTORS THAT IS REPRESENTATIVE OF THE MAJOR SEGMENTS OF THE COMMUNITY SERVICED BY THE HOSPITAL. THE DIRECTORS OF THE ORGANIZATION SHALL BE DESIGNATED BY THE SOLE MEMBER OF THE ORGANIZATION AND SHALL SERVE FOR TERMS OF TWO YEARS. ONE HALF OF THE DIRECTORS SHALL BE DESIGNATED EACH YEAR. AT LEAST ONE DIRECTOR SHALL BE A PHYSICIAN AND AT LEAST TWO DIRECTORS SHALL BE LAYMEN. |
| FORM 990, PART VI, SECTION A, LINE 7B | THE BOARD OF DIRECTORS SHALL NOT, WITHOUT PRIOR APPROVAL OF THE SOLE MEMBER OF THE ORGANIZATION: - APPROVE ANY ANNUAL OR LONG-TERM CAPITAL AND OPERATIONAL BUDGETS OR ANY CHANGES THEREIN EXCEEDING FIVE PERCENT OF THE TOTAL ORIGINAL BUDGET - APPROVE ANY NEW, OR ANY CHANGES TO EXISTING LONG-TERM OR MASTER INSTITUTIONAL PLANS OF THE ORGANIZATION - ENGAGE IN, OR ENTER INTO ANY AGREEMENT PROVIDING FOR, ANY TRANSACTION REQUIRING A CERTIFICATE OF NEED - APPROVE A PLAN OF DISSOLUTION OF THE ORGANIZATION - AGREE TO ANY CONTRACT OR ENGAGE IN ANY TRANSACTION WHERE THE AMOUNT INVOLVED EXCEEDS $100,000 - APPROVE A PLAN OF MERGER OR CONSOLIDATION OF THE ORGANIZATION WITH ANOTHER ORGANIZATION - ORGANIZE OR ACQUIRE, OR AUTHORIZE OR APPROVE THE ORGANIZATION OR ACQUISITION OF, ANY SUBSIDIARY OR AFFILIATE OF THE ORGANIZATION |
| FORM 990, PART VI, SECTION B, LINE 11 | THE FORM 990 WAS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM WITH THE GUIDANCE AND ASSISTANCE OF MANAGEMENT. THE FORM WAS REVIEWED INTERNALLY AND THEN PRESENTED TO THE AUDIT COMMITTEE FOR REVIEW. THE AUDIT COMMITTEE THEN PREPARED A SUMMARY THAT WAS PRESENTED TO THE BOARD OF DIRECTORS ALONG WITH THE FORM 990 PRIOR TO FILING. |
| FORM 990, PART VI, SECTION B, LINE 12C | EACH YEAR BOARD MEMBERS ARE REQUIRED TO COMPLETE A FORM THAT WILL DISCLOSE ANY RELATIONSHIPS THAT MAY CREATE A CONFLICT OF INTEREST. THE FORMS ARE REVIEWED BY MANAGEMENT AND ANY CONCERNS ARE REFERRED TO THE BOARD IF NECESSARY. |
| FORM 990, PART VI, SECTION B, LINE 15 | GENESIS REHABILITATION HOSPITAL USES AN OUTSIDE CONSULTANT FOR ALL OFFICER, EXECUTIVE, AND TOP MANAGEMENT OFFICIAL COMPENSATION DECISIONS. THE COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS MUST APPROVE ANY AND ALL DECISIONS REGARDING EXECUTIVE PAY. |
| FORM 990, PART VI, SECTION C, LINE 18 | THE ORGANIZATION'S FORM 990 IS AVAILABLE UPON REQUEST. ADDITIONALLY, RECENT FILINGS OF THE FORM ARE AVAILABLE ON GUIDESTAR.ORG. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION'S GOVERNING DOCUMENTS, FINANCIAL STATEMENTS, AND CONFLICT OF INTEREST POLICY ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. |
| FORM 990, PART VII, LINE 1: | BOARD MEMBER TREVOR PARIS, MD WAS COMPENSATED BY PHYSICAL MEDICINE SPECIALISTS, A RELATED ORGANIZATION, FOR MEDICAL SERVICES PERFORMED FOR THE ORGANIZATION. |
| FORM 990, PART VIII, LINES 3 AND 4: | AMOUNTS PRESENTED ON LINE 3 AND LINE 4 ARE AN ALLOCATION OF INVESTMENT INCOME BASED ON INVESTMENTS HELD BY THE SOLE MEMBER. |
| FORM 990, PART IX, LINE 11G | CONSULTING: PROGRAM SERVICE EXPENSES 41,423. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 41,423. OTHER PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 12,004,673. MANAGEMENT AND GENERAL EXPENSES 101,461. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 12,106,134. |
| FORM 990, PART X, LINE 20: TAX EXEMPT BONDS: | THE ORGANIZATION REPORTS ON ITS BALANCE SHEET AN ALLOCATION OF TAX-EXEMPT BOND LIABILITIES FROM A SERIES 2007 ISSUE REPORTED IN FULL ON THE SCHEDULE K OF GENESIS HEALTH, INC., THE ORGANIZATION'S CORPORATE PARENT AND SOLE MEMBER. THE ORGANIZATION ALSO REPORTS ON ITS BALANCE SHEET AN ALLOCATION OF TAX-EXEMPT BOND LIABILITIES FROM A SERIES 2010 ISSUE REPORTED IN FULL ON THE SCHEDULE K OF BROOKS HOME CARE ADVANTAGE, A RELATED ORGANIZATION. |
| FORM 990, PART XI, LINE 9: | NET LOSS ON SWAP VALUATION 841,521. |
| FORM 990, PART XII, LINE 2C: | THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. |
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