TY 2015 Form 990

(A) Name and business address	(B) Description of services	(C) Compensation
TREAT AMERICA FOOD SERVICES 8500 SHAWNEE MISSION PARKWAY MERRIAM,KS66202	DIETARY SERVICES	1,033,770
CERNER CORPORATION 2800 ROCKCREEK PARKWAY KANSAS CITY,MO64117	COMPUTER SERVICES	769,017
INDIANA UNIVERSITY HEALTH INC 2201 RELIABLE PARKWAY CHICAGO,IL60685	LAB, PHYSICIAN SERVICES	746,049
UNIVERSITY OF PHYSIATRIC ASSOCIATES 541 N CLINICAL DRIVE CL 626 INDIANAPOLIS,IN462025111	PHYSICIAN SERVICES	431,007
INDIANA UNIVERSITY PURDUE UNIVERSITY DEPT 78920 PO BOX 78000 DETROIT,MI482780920	PHYSICIAN SERVICES	236,521
2 Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization 5

- TIN:

SCHEDULE A
(Form 990 or 990EZ)

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.
right arrow

Attach to Form 990 or Form 990-EZ.
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Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public
Inspection

Name of the organization

Rehabilitation Hospital of Indiana Inc

Employer identification number

35-1786005

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.)

A church, convention of churches, or association of churches described in section 170(b)(1)(A)(i).

A school described in section 170(b)(1)(A)(ii). (Attach Schedule E (Form 990 or 990-EZ))

A hospital or a cooperative hospital service organization described in section 170(b)(1)(A)(iii).

A medical research organization operated in conjunction with a hospital described in section 170(b)(1)(A)(iii). Enter the hospital's name, city, and state:

An organization operated for the benefit of a college or university owned or operated by a governmental unit described in section 170(b)(1)(A)(iv). (Complete Part II.)

A federal, state, or local government or governmental unit described in section 170(b)(1)(A)(v).

An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in section 170(b)(1)(A)(vi). (Complete Part II.)

A community trust described in section 170(b)(1)(A)(vi). (Complete Part II.)

An organization that normally receives: (1) more than 331/3% of its support from contributions, membership fees, and gross 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.)

An organization organized and operated exclusively to test for public safety. See section 509(a)(4).

An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). See section 509(a)(3). Check the box in lines 11a through 11d that describes the type of supporting organization and complete lines 11e, 11f, and 11g.

Type I. A supporting organization operated, supervised, or controlled by its supported organization(s), typically by giving the supported organization(s) the power to regularly appoint or elect a majority of the directors or trustees of the supporting organization. You must complete Part IV, Sections A and B.

Type II. A supporting organization supervised or controlled in connection with its supported organization(s), by having control or management of the supporting organization vested in the same persons that control or manage the supported organization(s). You must complete Part IV, Sections A and C.

Type III functionally integrated. A supporting organization operated in connection with, and functionally integrated with, its supported organization(s) (see instructions). You must complete Part IV, Sections A, D, and E.

Type III non-functionally integrated. A supporting organization operated in connection with its supported organization(s) that is not functionally integrated. The organization generally must satisfy a distribution requirement and an attentiveness requirement (see instructions). You must complete Part IV, Sections A and D, and Part V.

Check this box if the organization received a written determination from the IRS that it is a Type I, Type II, Type III functionally integrated, or Type III non-functionally integrated supporting organization.

Enter the number of supported organizations ..............

Provide the following information about the supported organization(s).

(i)Name of supported organization	(ii) EIN	(iv) Is the organization listed in your governing document?		(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)
(i)Name of supported organization	(ii) EIN	Yes	No	(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)


Total

For Paperwork Reduction Act Notice, see the Instructions for
Form 990 or 990-EZ.

Cat. No. 11285F

Schedule A (Form 990 or 990-EZ) 2015

Page 2

Part II

Support Schedule for Organizations Described in Sections 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) 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.

Section B. Total Support

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.

Gross receipts from related activities, etc. (see instructions) ..................

First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization, check this box and stop here........................................ right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2015 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2014 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2015. 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 ....................... right arrow

33 1/3% support test—2014. If the organization did not check a 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 ..................... right arrow

17a

10%-facts-and-circumstances test—2015. 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 VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported
organization ..................................................... right arrow

10%-facts-and-circumstances test—2014. 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 VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly
supported organization ................................................ right arrow

Private foundation. If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions ..................................................... right arrow

Schedule A (Form 990 or 990-EZ) 2015

Page 3

Part III

Support Schedule for Organizations Described in Section 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) 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.)

Section B. Total Support

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.)..

First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization,
check this box and stop here............................................. right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2015 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2014 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2015 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2014 Schedule A, Part III, line 17 .............

19a

331/3% support tests—2015. 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 ....... right arrow

33 1/3% support tests—2014. 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 .... right arrow

Private foundation. If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions .... right arrow

Schedule A (Form 990 or 990-EZ) 2015

Page 4

Part IV

Supporting Organizations

(Complete only if you checked a box on line 11 of Part I. If you checked 11a of Part I, complete Sections A and B. If you checked 11b of Part I, complete Sections A and C. If you checked 11c of Part I, complete Sections A, D, and E. If you checked 11d of Part I, complete Sections A and D, and complete Part V.)

Section A. All Supporting Organizations

Yes

Are all of the organization’s supported organizations listed by name in the organization’s governing documents?
If "No," describe in Part VI how the supported organizations are designated. If designated by class or purpose,
describe the designation. If historic and continuing relationship, explain.

Did the organization have any supported organization that does not have an IRS determination of status under section 509(a)(1) or (2)? If "Yes," explain in Part VI how the organization determined that the supported organization was described in section 509(a)(1) or (2).

Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yes," answer (b) and (c) below.

Did the organization confirm that each supported organization qualified under section 501(c)(4), (5), or (6) and satisfied the public support tests under section 509(a)(2)? If "Yes," describe in Part VI when and how the organization made the determination.

Did the organization ensure that all support to such organizations was used exclusively for section 170(c)(2)(B) purposes? If "Yes," explain in Part VI what controls the organization put in place to ensure such use.

Was any supported organization not organized in the United States ("foreign supported organization")? If “Yes” and if you checked 11a or 11b in Part I, answer (b) and (c) below.

Did the organization have ultimate control and discretion in deciding whether to make grants to the foreign supported organization? If “Yes,” describe in Part VI how the organization had such control and discretion despite being controlled or supervised by or in connection with its supported organizations.

Did the organization support any foreign supported organization that does not have an IRS determination under sections 501(c)(3) and 509(a)(1) or (2)? If “Yes,” explain in Part VI what controls the organization used to ensure that all support to the foreign supported organization was used exclusively for section 170(c)(2)(B) purposes.

Did the organization add, substitute, or remove any supported organizations during the tax year? If “Yes,” answer (b) and (c) below (if applicable). Also, provide detail in Part VI, including (i) the names and EIN numbers of the supported organizations added, substituted, or removed; (ii) the reasons for each such action; (iii) the authority under the organization's organizing document authorizing such action; and (iv) how the action was accomplished (such as by amendment to the organizing document).

Type I or Type II only. Was any added or substituted supported organization part of a class already designated in the organization's organizing document?

Substitutions only. Was the substitution the result of an event beyond the organization's control?

Did the organization provide support (whether in the form of grants or the provision of services or facilities) to anyone other than (i) its supported organizations, (ii) individuals that are part of the charitable class benefited by one or more of its supported organizations, or (iii) other supporting organizations that also support or benefit one or more of the filing organization’s supported organizations? If “Yes,” provide detail in Part VI.

Did the organization provide a grant, loan, compensation, or other similar payment to a substantial contributor (defined in section 4958(c)(3)(C)), a family member of a substantial contributor, or a 35% controlled entity with regard to a substantial contributor? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ) .

Did the organization make a loan to a disqualified person (as defined in section 4958) not described in line 7? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ).

Was the organization controlled directly or indirectly at any time during the tax year by one or more disqualified persons as defined in section 4946 (other than foundation managers and organizations described in section 509(a)(1) or (2))? If “Yes,” provide detail in Part VI.

Did one or more disqualified persons (as defined in line 9a) hold a controlling interest in any entity in which the supporting organization had an interest? If “Yes,” provide detail in Part VI.

Did a disqualified person (as defined in line 9a) have an ownership interest in, or derive any personal benefit from, assets in which the supporting organization also had an interest? If “Yes,” provide detail in Part VI.

10a

Was the organization subject to the excess business holdings rules of section 4943 because of section 4943(f) (regarding certain Type II supporting organizations, and all Type III non-functionally integrated supporting organizations)? If “Yes,” answer line 10b below.

10a

Did the organization have any excess business holdings in the tax year? (Use Schedule C, Form 4720, to determine whether the organization had excess business holdings).

10b

Schedule A (Form 990 or 990-EZ) 2015

Page 5

Part IV

Supporting Organizations (continued)

Yes

Has the organization accepted a gift or contribution from any of the following persons?

A person who directly or indirectly controls, either alone or together with persons described in (b) and (c) below, the governing body of a supported organization?

11a

A family member of a person described in (a) above?

11b

A 35% controlled entity of a person described in (a) or (b) above? If “Yes” to a, b, or c, provide detail in Part VI.

11c

Section B. Type I Supporting Organizations

Yes

Did the directors, trustees, or membership of one or more supported organizations have the power to regularly appoint or elect at least a majority of the organization’s directors or trustees at all times during the tax year? If “No,” describe in Part VI how the supported organization(s) effectively operated, supervised, or controlled the organization’s activities. If the organization had more than one supported organization, describe how the powers to appoint and/or remove directors or trustees were allocated among the supported organizations and what conditions or restrictions, if any, applied to such powers during the tax year.

Did the organization operate for the benefit of any supported organization other than the supported organization(s) that operated, supervised, or controlled the supporting organization? If “Yes,” explain in Part VI how providing such benefit carried out the purposes of the supported organization(s) that operated, supervised or controlled the supporting organization.

Section C. Type II Supporting Organizations

Yes

Were a majority of the organization’s directors or trustees during the tax year also a majority of the directors or trustees of each of the organization’s supported organization(s)? If “No,” describe in Part VI how control or management of the supporting organization was vested in the same persons that controlled or managed the supported organization(s).

Section D. All Type III Supporting Organizations

Yes

Did the organization provide to each of its supported organizations, by the last day of the fifth month of the organization’s tax year, (i) a written notice describing the type and amount of support provided during the prior tax year, (ii) a copy of the Form 990 that was most recently filed as of the date of notification, and (iii) copies of the organization’s governing documents in effect on the date of notification, to the extent not previously provided?

Were any of the organization’s officers, directors, or trustees either (i) appointed or elected by the supported organization(s) or (ii) serving on the governing body of a supported organization? If "No," explain in Part VI how the organization maintained a close and continuous working relationship with the supported organization(s).

By reason of the relationship described in (2), did the organization’s supported organizations have a significant voice in the organization’s investment policies and in directing the use of the organization’s income or assets at all times during the tax year? If "Yes," describe in Part VI the role the organization’s supported organizations played in this regard.

Section E. Type III Functionally-Integrated Supporting Organizations

Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions):

The organization satisfied the Activities Test. Complete line 2 below.

The organization is the parent of each of its supported organizations. Complete line 3 below.

The organization supported a governmental entity. Describe in Part VI how you supported a government entity (see instructions)

Activities Test. Answer (a) and (b) below.

Yes

Did substantially all of the organization’s activities during the tax year directly further the exempt purposes of the supported organization(s) to which the organization was responsive? If "Yes," then in Part VI identify those supported organizations and explain how these activities directly furthered their exempt purposes, how the organization was responsive to those supported organizations, and how the organization determined that these activities constituted substantially all of its activities.

Did the activities described in (a) constitute activities that, but for the organization’s involvement, one or more of the organization’s supported organization(s) would have been engaged in? If "Yes," explain in Part VI the reasons for the organization’s position that its supported organization(s) would have engaged in these activities but for the organization’s involvement.

Parent of Supported Organizations. Answer (a) and (b) below.

Did the organization have the power to regularly appoint or elect a majority of the officers, directors, or trustees of each of the supported organizations? Provide details in Part VI.

Did the organization exercise a substantial degree of direction over the policies, programs and activities of each of its supported organizations? If "Yes," describe in Part VI. the role played by the organization in this regard.

Schedule A (Form 990 or 990-EZ) 2015

Page 6

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations

Check here if the organization satisfied the Integral Part Test as a qualifying trust on Nov. 20, 1970. See instructions. All other Type III non-functionally integrated supporting organizations must complete Sections A through E.

	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

Check here if the current year is the organization's first as a non-functionally-integrated Type III supporting organization (see instructions)

Schedule A (Form 990 or 990-EZ) 2015

Page 7

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations (continued)

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
2 Underdistributions, if any, for years prior to 2015 (reasonable cause required--see instructions)
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)
6 Remaining underdistributions for 2015. Subtract lines 3h and 4b from line 1 (if amount greater than zero, see instructions)
7 Excess distributions carryover to 2016. Add lines 3j and 4c.
8 Breakdown of line 7:
a
b
c Excess from 2013.......
d From 2014.......
e From 2015.......

Schedule A (Form 990 or 990-EZ) (2015)

Schedule A (Form 990 or 990-EZ) 2015

Page 8

Part VI

Supplemental Information. Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; Part III, line 12; Part IV, Section A, lines 1, 2, 3b, 3c, 4b, 4c, 5a, 6, 9a, 9b, 9c, 11a, 11b, and 11c; Part IV, Section B, lines 1 and 2; Part IV, Section C, line 1; Part IV, Section D, lines 2 and 3; Part IV, Section E, lines 1c, 2a, 2b, 3a and 3b; Part V, line 1; Part V, Section B, line 1e; Part V Section D, lines 5, 6, and 8; and Part V, Section E, lines 2, 5, and 6. Also complete this part for any additional information. (See instructions).

Facts And Circumstances Test

Return Reference	Explanation

Schedule A (Form 990 or 990-EZ) 2015

Additional Data

Software ID:	15000238
Software Version:	2015v2.1

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SCHEDULE C
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Political Campaign and Lobbying Activities

For Organizations Exempt From Income Tax Under section 501(c) and section 527
SchCMd Bullet

Complete if the organization is described below. SchCMd Bullet

Attach to Form 990 or Form 990-EZ.
SchCMd Bullet

Information about Schedule C (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public
Inspection

If the organization answered "Yes" on Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
Round Bullet

Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
Round Bullet

Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
Round Bullet

Section 527 organizations: Complete Part I-A only.
If the organization answered "Yes" on Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
Round Bullet

Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)): Complete Part II-A. Do not complete Part II-B.
Round Bullet

Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered "Yes" on Form 990, Part IV, Line 5 (Proxy Tax) (see separate instructions) or Form 990-EZ, Part V, line 35c (Proxy Tax) (see separate instructions), then
Round Bullet

Section 501(c)(4), (5), or (6) organizations: Complete Part III.

Name of the organization

Rehabilitation Hospital of Indiana Inc

Employer identification number

35-1786005

Part I-A

Complete if the organization is exempt under section 501(c) or is a section 527 organization.

Provide a description of the organization’s direct and indirect political campaign activities in Part IV.

Political expenditures ...................................................................................................................... SchCMd Bullet

Volunteer hours .............................................................................................................................

Part I-B

Complete if the organization is exempt under section 501(c)(3).

Enter the amount of any excise tax incurred by the organization under section 4955 ................................ SchCMd Bullet

Enter the amount of any excise tax incurred by organization managers under section 4955 ....................... SchCMd Bullet

If the organization incurred a section 4955 tax, did it file Form 4720 for this year? .........................................

Yes No

Was a correction made? ......................................................................................................................

Yes No

If "Yes," describe in Part IV.

Part I-C

Complete if the organization is exempt under section 501(c), except section 501(c)(3).

Enter the amount directly expended by the filing organization for section 527 exempt function activities ..... SchCMd Bullet

Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt function activities ............................................................................................................................ SchCMd Bullet

Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, line 17b........... SchCMd Bullet

Did the filing organization file Form 1120-POL for this year? ...................................................................

Yes No

Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing
organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.

(a) Name	(b) Address	(c) EIN	(d) Amount paid from filing organization's funds. If none, enter -0-.	(e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.
1
2
3
4
5
6

For Paperwork Reduction Act Notice, see the instructions for Form 990 or 990-EZ.

Cat. No. 50084S

Schedule C (Form 990 or 990-EZ) 2015

Page 2

Part II-A

Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).

A Check SchCMd Bullet

if the filing organization belongs to an affiliated group (and list in Part IV each affiliated group member's name, address, EIN, expenses, and share of excess lobbying expenditures).
B Check SchCMd Bullet

if the filing organization checked box A and "limited control" provisions apply.

Limits on Lobbying Expenditures (The term "expenditures" means amounts paid or incurred.)		(b) Affiliated group totals
1a	Total lobbying expenditures to influence public opinion (grass roots lobbying) ...............................................
b	Total lobbying expenditures to influence a legislative body (direct lobbying) ...........................................
c	Total lobbying expenditures (add lines 1a and 1b) .......................................................................
d	Other exempt purpose expenditures .........................................................................................
e	Total exempt purpose expenditures (add lines 1c and 1d) ....................................................................
f	Lobbying nontaxable amount. Enter the amount from the following table in both columns.
	If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:
	Not over $500,00020% of the amount on line 1e.
	Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.
	Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.
	Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.
	Over $17,000,000$1,000,000.

g	Grassroots nontaxable amount (enter 25% of line 1f) ..........................................................................
h	Subtract line 1g from line 1a. If zero or less, enter -0-. ..........................................................................
i	Subtract line 1f from line 1c. If zero or less, enter -0-. ...........................................................................
j	If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting section 4911 tax for this year? ..............................................................................................................	Yes No

4-Year Averaging Period Under section 501(h) (Some organizations that made a section 501(h) election do not have to complete all of the five columns below. See the separate instructions for lines 2a through 2f.)
Lobbying Expenditures During 4-Year Averaging Period
	Calendar year (or fiscal year beginning in)	(a) 2012	(b) 2013	(c) 2014	(d) 2015	(e) Total

2a	Lobbying nontaxable amount

b	Lobbying ceiling amount (150% of line 2a, column(e))

c	Total lobbying expenditures

d	Grassroots nontaxable amount

e	Grassroots ceiling amount (150% of line 2d, column (e))

f	Grassroots lobbying expenditures

Schedule C (Form 990 or 990-EZ) 2015

Page 3

Part II-B

Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).

For each "Yes" response on lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.

(a)

Yes

(b)

Amount

During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:

Volunteers? ...........................................................................................................

Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ........

Media advertisements? ...................................................................................................

Mailings to members, legislators, or the public? .............................................................................

Publications, or published or broadcast statements? ...........................................................

Grants to other organizations for lobbying purposes? ..........................................................

Direct contact with legislators, their staffs, government officials, or a legislative body? .......................

Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ..................

Other activities? ...................................................................................................................

Yes

3,635

Total. Add lines 1c through 1i ....................................................................................................

3,635

Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....

If "Yes," enter the amount of any tax incurred under section 4912 ...........................................

If "Yes," enter the amount of any tax incurred by organization managers under section 4912 ...................

If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? ........................

Part III-A

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).

Yes

Were substantially all (90% or more) dues received nondeductible by members? ...............................................

Did the organization make only in-house lobbying expenditures of $2,000 or less? ............................................

Did the organization agree to carry over lobbying and political expenditures from the prior year? .................................

Part III-B

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) and if either (a) BOTH Part III-A, lines 1 and 2, are answered "No" OR (b) Part III-A, line 3, is answered “Yes."

Dues, assessments and similar amounts from members ......................................................................

Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political expenses for which the section 527(f) tax was paid).

Current year .............................................................................................................................

Carryover from last year ............................................................................................................

Total ...........................................................................................................................................

Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .

If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ......................................................................................................................

Taxable amount of lobbying and political expenditures (see instructions) .........................................

Part IV

Supplemental Information

Provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, line 5; Part II-A (affiliated group list); Part II-A, lines 1 and 2 (see instructions), and Part ll-B, line 1. Also, complete this part for any additional information.

Return Reference	Explanation
Schedule C, Part II-B, Line 1i Description of the Activities reported on lines 1A through 1I	Line 1I Represents the portion of membership association dues allocated to lobbying activities by the respective association.

Schedule C (Form 990 or 990EZ) 2015

Additional Data

Software ID:	15000238
Software Version:	2015v2.1

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

Complete if the organization answered "Yes," on Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b.
SchDMd Bullet

Attach to Form 990.
Information about Schedule D (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public Inspection

Name of the organization

Rehabilitation Hospital of Indiana Inc

Employer identification number

35-1786005

Part I

Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" on Form 990, Part IV, line 6.

			(a) Donor advised funds	(b) Funds and other accounts

1	Total number at end of year ....
2	Aggregate value of contributions to (during year)
3	Aggregate value of grants from (during year)
4	Aggregate value at end of year ....

Did the organization inform all donors and donor advisors in writing that the assets held in donor advised
funds are the organization's property, subject to the organization's exclusive legal control? ...........

Yes No

Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be
used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ............................

Yes No

Part II

Conservation Easements. Complete if the organization answered "Yes" on Form 990, Part IV, line 7.

Purpose(s) of conservation easements held by the organization (check all that apply).

Preservation of land for public use (e.g., recreation or education) Preservation of an historically important land area

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.


a	Total number of conservation easements ......................	2a
b	Total acreage restricted by conservation easements ....................	2b
c	Number of conservation easements on a certified historic structure included in (a) .....	2c
d	Number of conservation easements included in (c) acquired after 8/17/06, and not on a historic structure listed in the National Register ...	2d

Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during the
tax year SchDMd Bullet

Number of states where property subject to conservation easement is located SchDMd Bullet

Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and enforcement of the conservation easements it holds? ............

Yes No

Staff and volunteer hours devoted to monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

Amount of expenses incurred in monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(B)(i) and section 170(h)(4)(B)(ii)? .............................

Yes No

In Part XIII, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" on Form 990, Part IV, line 8.

If the organization elected, as permitted under SFAS 116 (ASC 958), not to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide, in Part XIII, the text of the footnote to its financial statements that describes these items.

If the organization elected, as permitted under SFAS 116 (ASC 958), to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide the following amounts relating to these items:

(i)

Revenue included on Form 990, Part VIII, line 1 ......................... SchDMd Bullet

(ii)

Assets included in Form 990, Part X ............................... SchDMd Bullet

If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under SFAS 116 (ASC 958) relating to these items:

Revenue included on Form 990, Part VIII, line 1 .......................... SchDMd Bullet

Assets included in Form 990, Part X ............................... SchDMd Bullet

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 52283D

Schedule D (Form 990) 2015

Page 2

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)

Using the organization’s acquisition, accession, and other records, check any of the following that are a significant use of its collection items (check all that apply):

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.

During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?...

Yes No

Part IV

Escrow and Custodial Arrangements. Complete if the organization answered "Yes" on Form 990, Part IV, line 9, or reported an amount on Form 990, Part X, line 21.

Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................

Yes No


b	If "Yes," explain the arrangement in Part XIII and complete the following table:		Amount
c	Beginning balance .............................	1c
d	Additions during the year ............................	1d
e	Distributions during the year ..........................	1e
f	Ending balance ................................	1f

Did the organization include an amount on Form 990, Part X, line 21, for escrow or custodial account liability?

Yes No

If "Yes," explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII ........

Part V

Endowment Funds. Complete if the organization answered "Yes" on Form 990, Part IV, line 10.

		(a)Current year	(b)Prior year	(c)Two years back	(d)Three years back	(e)Four years back

1a	Beginning of year balance ....
b	Contributions ...
c	Net investment earnings, gains, and losses
d	Grants or scholarships ...
e	Other expenditures for facilities and programs ...
f	Administrative expenses ....
g	End of year balance ......

Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:

Board designated or quasi-endowment SchDMd Bullet

Permanent endowment SchDMd Bullet

Temporarily restricted endowment SchDMd Bullet

The percentages on lines 2a, 2b, and 2c should equal 100%.

Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes

(i) unrelated organizations .................

3a(i)

(ii) related organizations .................

3a(ii)

If "Yes" on 3a(ii), are the related organizations listed as required on Schedule R? .........

Describe in Part XIII the intended uses of the organization's endowment funds.

Part VI

Land, Buildings, and Equipment.
Complete if the organization answered 'Yes' on Form 990, Part IV, line 11a. See Form 990, Part X, line 10.

Description of property		(a) Cost or other basis (investment)	(b)Cost or other basis (other)	(c) Accumulated depreciation	(d) Book value

1a	Land ...	602,474	2,210,845		2,813,319
b	Buildings		15,095,871	11,488,938	3,606,933
c	Leasehold improvements
d	Equipment ...		14,380,260	9,726,800	4,653,460
e	Other ...		423,588		423,588
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..					11,497,300

Schedule D (Form 990) 2015

Page 3

Part VII

InvestmentsOther Securities. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11b. See Form 990, Part X, line 12.

(a) Description of security or category (including name of security)	(b)Book value	(c)Method of valuation: Cost or end-of-year market value
(1)Financial derivatives
(2)Closely-held equity interests
(3)Other
(A)
(B)
(C)
(D)
(E)
(F)
(G)
(H)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)

Part VIII

InvestmentsProgram Related. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11c. See Form 990, Part X, line 13.

(a) Description of investment	(b) Book value	(c) Method of valuation: Cost or end-of-year market value

(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)

Part IX

Other Assets. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11d. See Form 990, Part X, line 15.

(a) Description				(b) Book value

(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........

Part X

Other Liabilities. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11e or 11f. See Form 990, Part X, line 25.

1.(a) Description of liability	(b) Book value
(1) Federal income taxes
Estimated Third-party settlements	25,188
Interest Rate Swap Liability	724,745
Capital Lease Obligation	31,477
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	781,410
2. Liability for uncertain tax positions. In Part XIII, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC 740). Check here if the text of the footnote has been provided in Part XIII

Schedule D (Form 990) 2015

Page 4

Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total revenue, gains, and other support per audited financial statements .......			1	39,575,340
2	Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a	Net unrealized gains (losses) on investments ....	2a
b	Donated services and use of facilities .........	2b
c	Recoveries of prior year grants ...........	2c
d	Other (Describe in Part XIII.) ............	2d	197,231
e	Add lines 2a through 2d .....................			2e	197,231
3	Subtract line 2e from line 1..................			3	39,378,109
4	Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b .	4a
b	Other (Describe in Part XIII.) ...........	4b	0
c	Add lines 4a and 4b....................			4c	0
5	Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ......			5	39,378,109

Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total expenses and losses per audited financial statements ...........			1	37,602,693
2	Amounts included on line 1 but not on Form 990, Part IX, line 25:
a	Donated services and use of facilities .........	2a
b	Prior year adjustments ............	2b
c	Other losses ................	2c
d	Other (Describe in Part XIII.) ............	2d	0
e	Add lines 2a through 2d....................			2e	0
3	Subtract line 2e from line 1...................			3	37,602,693
4	Amounts included on Form 990, Part IX, line 25, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b ..	4a
b	Other (Describe in Part XIII.) ............	4b	0
c	Add lines 4a and 4b.....................			4c	0
5	Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ......			5	37,602,693

Part XIII

Supplemental Information

Provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b;
Part V, line 4; Part X, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.

Return Reference

Explanation

Schedule D, Part X, Line 2 FIN 48 (ASC 740) footnote

THE HOSPITAL IS A NOT-FOR-PROFIT CORPORATION PURSUANT TO SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND IS EXEMPT FROM INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A). ACCORDINGLY, NO PROVISION FOR INCOME TAXES IS REQUIRED FOR THE HOSPITAL IN THE CONSOLIDATED FINANCIAL STATEMENTS. A tax position is recognized as a benefit only if it is "more likely than not" that the tax position would be sustained in a tax examination, with a tax examination being presumed to occur. The amount recognized is the largest amount of tax benefit that is greater than 50% likely of being realized on examination. For tax positions not meeting the "more likely than not" test, no tax benefit is recorded. The Hospital does not expect the total amount of unrecognized tax positions to significantly change in the next 12 months. The Hospital would recognize interest and/or penalties related to income tax matters in income tax expense. The Hospital has no amounts accrued for interest or penalties as of December 31, 2015 and 2014.

Schedule D, Part XI, Line 2(d) Other revenues in audited financial statements not in form 990

CHANGE IN INTEREST RATE SWAP - 197231

Schedule D (Form 990) 2015

Additional Data

Software ID:	15000238
Software Version:	2015v2.1

- TIN:

SCHEDULE H
(Form 990)

Department of the Treasury
Internal Revenue Service

Hospitals

Complete if the organization answered "Yes" on Form 990, Part IV, question 20.
MediumBullet

Attach to Form 990.
MediumBullet

Information about Schedule H (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public Inspection

Name of the organization

Rehabilitation Hospital of Indiana Inc

Employer identification number

35-1786005

Part I

Financial Assistance and Certain Other Community Benefits at Cost

Yes

Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a . . . .

Yes

If "Yes," was it a written policy? ......................

Yes

If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.

Applied uniformly to all hospital facilities Applied uniformly to most hospital facilities Generally tailored to individual hospital facilities

Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.

Did the organization use Federal Poverty Guidelines (FPG) as a factor in determining eligibility for providing free care?

If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:

Yes

100% 150% 200% Other %

Did the organization use FPG as a factor in determining eligibility for providing discounted care? If "Yes," indicate

which of the following was the family income limit for eligibility for discounted care: . . . . . . . .

Yes

200% 250% 300% 350% 400% Other %

If the organization used factors other than FPG in determining eligibility, describe in Part VI the criteria used for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, as a factor in determining eligibility for free or discounted care.

Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? . . . . . . . . . . . . .

Yes

Did the organization budget amounts for free or discounted care provided under its financial assistance policy during
the tax year? . . . . . . . . . . . . . . . . . . . . . . .

Yes

If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? . . . . . .

If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care? . . . . . . . . . . . . .

Did the organization prepare a community benefit report during the tax year? . . . . . . . . .

Yes

If "Yes," did the organization make it available to the public? . . . . . . . . . . . . .

Yes

Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.

Financial Assistance and Certain Other Community Benefits at Cost

Financial Assistance and Means-Tested Government Programs		(a) Number of activities or programs (optional)	(b) Persons served (optional)	(c) Total community benefit expense	(d) Direct offsetting revenue	(e) Net community benefit expense	(f) Percent of total expense
a	Financial Assistance at cost (from Worksheet 1) . . .			204,838	0	204,838	0.56 %
b	Medicaid (from Worksheet 3, column a) . . . . .			4,726,708	1,455,811	3,270,897	8.95 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) . .			0	0	0	0 %
d	Total Financial Assistance and Means-Tested Government Programs . . . . .	0	0	4,931,546	1,455,811	3,475,735	9.51 %
Other Benefits
e	Community health improvement services and community benefit operations (from Worksheet 4).			62,044	11,445	50,599	0.14 %
f	Health professions education (from Worksheet 5) . . .			243,699	111,321	132,378	0.36 %
g	Subsidized health services (from Worksheet 6) . . . .			0	0	0	0 %
h	Research (from Worksheet 7) .			113,342	0	113,342	0.31 %
i	Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .			3,900	0	3,900	0.01 %
j	Total. Other Benefits . .	0	0	422,985	122,766	300,219	0.82 %
k	Total. Add lines 7d and 7j .	0	0	5,354,531	1,578,577	3,775,954	10.33 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2015

Schedule H (Form 990) 2015

Page

Part II

Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.

		(a) Number of activities or programs (optional)	(b) Persons served (optional)	(c) Total community building expense	(d) Direct offsetting revenue
1	Physical improvements and housing
2	Economic development
3	Community support
4	Environmental improvements
5	Leadership development and training for community members
6	Coalition building
7	Community health improvement advocacy
8	Workforce development
9	Other
10	Total	0	0	0	0

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

Did the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................

Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......

1,065,506

Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy. Explain in Part VI the methodology used by the organization to estimate this amount and the rationale, if any, for including this portion of bad debt as community benefit. ......

Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.

Section B. Medicare

Enter total revenue received from Medicare (including DSH and IME).....

12,496,245

Enter Medicare allowable costs of care relating to payments on line 5.....

13,188,637

Subtract line 6 from line 5. This is the surplus (or shortfall)........

-692,392

Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:

Cost accounting system Cost to charge ratio Other

Section C. Collection Practices

Did the organization have a written debt collection policy during the tax year? ..........

Yes

If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year
contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI .........................

Yes

Part IV

Management Companies and Joint Ventures(owned 10% or more by officers, directors, trustees, key employees, and physicians—see instructions)

(a) Name of entity	(b) Description of primary activity of entity	(c) Organization's profit % or stock ownership %	(d) Officers, directors, trustees, or key employees' profit % or stock ownership %	(e) Physicians' profit % or stock ownership %
1
2
3
4
5
6
7
8
9
10
11
12
13

Schedule H (Form 990) 2015

Page

Part VFacility Information

Section A. Hospital Facilities (list in order of size from largest to smallest—see instructions) How many hospital facilities did the organization operate during the tax year?1 Name, address, primary website address, and state license number (and if a group return, the name and EIN of the subordinate hospital organization that operates the hospital facility)				Other (Describe)
1	REHABILITATION HOSPITAL OF INDIANA 4141 Shore Drive Indianapolis,IN46254 www.rhin.com 13-005971-1	X	X	Acute Rehabilitation

Schedule H (Form 990) 2015

Page 4

Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)

	REHABILITATION HOSPITAL OF INDIANA
Name of hospital facility or letter of facility reporting group

Line number of hospital facility, or line numbers of hospital facilities in a facility
reporting group (from Part V, Section A):

Yes

Community Health Needs Assessment

Was the hospital facility first licensed, registered, or similarly recognized by a state as a hospital facility in the current tax year or the immediately preceding tax year?........................

Was the hospital facility acquired or placed into service as a tax-exempt hospital in the current tax year or the immediately preceding tax year? If “Yes,” provide details of the acquisition in Section C...............

During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 12......................

Yes

If "Yes," indicate what the CHNA report describes (check all that apply):

A definition of the community served by the hospital facility

Demographics of the community

Existing health care facilities and resources within the community that are available to respond to the health needs of the community

How data was obtained

The significant health needs of the community

Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups

The process for identifying and prioritizing community health needs and services to meet the community health needs

The process for consulting with persons representing the community’s interests

Information gaps that limit the hospital facility’s ability to assess the community’s health needs

Other (describe in Section C)

Indicate the tax year the hospital facility last conducted a CHNA: 20 15

In conducting its most recent CHNA, did the hospital facility take into account input from persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If "Yes," describe in Section C how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted .................

Yes

6 a

Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Section C..................................

Yes

Was the hospital facility’s CHNA conducted with one or more organizations other than hospital facilities?” If “Yes,” list the other organizations in Section C. ............................

Did the hospital facility make its CHNA report widely available to the public?..............

Yes

If "Yes," indicate how the CHNA report was made widely available (check all that apply):

Hospital facility’s website (list url): http://rhin.com/wp-content/files_mf/2015communityhealthneedsassessment.pdf

Other website (list url):

Made a paper copy available for public inspection without charge at the hospital facility

Other (describe in Section C)

Did the hospital facility adopt an implementation strategy to meet the significant community health needs
identified through its most recently conducted CHNA? If "No," skip to line 11. ..............

Yes

Indicate the tax year the hospital facility last adopted an implementation strategy: 20 15

Is the hospital facility's most recently adopted implementation strategy posted on a website?.........

Yes

If "Yes" (list url): http://rhin.com/wp-content/files_mf/20162018rhiimplementationstrategies.pdf

If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ......

10b

Describe in Section C how the hospital facility is addressing the significant needs identified in its most recently conducted CHNA and any such needs that are not being addressed together with the reasons why such needs are not being addressed.

12a

Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)?...............................

12a

If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........

12b

If "Yes" on line 12b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $

Schedule H (Form 990) 2015

Page 5

Part VFacility Information (continued)

Financial Assistance Policy (FAP)

	REHABILITATION HOSPITAL OF INDIANA
Name of hospital facility or letter of facility reporting group

Yes

Did the hospital facility have in place during the tax year a written financial assistance policy that:

Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care?

Yes

If “Yes,” indicate the eligibility criteria explained in the FAP:

Federal poverty guidelines (FPG), with FPG family income limit for eligibility for free care of 200.0% and FPG family income limit for eligibility for discounted care of 400.0%

Income level other than FPG (describe in Section C)

Asset level

Medical indigency

Insurance status

Underinsurance discount

Residency

Other (describe in Section C)

Explained the basis for calculating amounts charged to patients?.................

Yes

Explained the method for applying for financial assistance?...................

Yes

If “Yes,” indicate how the hospital facility’s FAP or FAP application form (including accompanying instructions) explained the method for applying for financial assistance (check all that apply):

Described the information the hospital facility may require an individual to provide as part of his or her application

Described the supporting documentation the hospital facility may require an individual to submit as part of his or
her application

Provided the contact information of hospital facility staff who can provide an individual with information about the
FAP and FAP application process

Provided the contact information of nonprofit organizations or government agencies that may be sources of
assistance with FAP applications

Other (describe in Section C)

Included measures to publicize the policy within the community served by the hospital facility?........

Yes

If "Yes," indicate how the hospital facility publicized the policy (check all that apply):

The FAP was widely available on a website (list url):

http://rhin.com/wp-content/uploads/2012/12/PFS-Financail-Assistance-Poliy-3-06.pdf

The FAP application form was widely available on a website (list url):

http://rhin.com/wp-content/uploads/2012/12/PFS-Financail-Assistance-Poliy-3-06.pdf

A plain language summary of the FAP was widely available on a website (list url):
http://rhin.com/wp-content/uploads/2012/12/PFS-Financail-Assistance-Poliy-3-06.pdf

The FAP was available upon request and without charge (in public locations in the hospital facility and by mail)

The FAP application form was available upon request and without charge (in public locations in the hospital facility
and by mail)

A plain language summary of the FAP was available upon request and without charge (in public locations in the
hospital facility and by mail)

Notice of availability of the FAP was conspicuously displayed throughout the hospital facility

Notified members of the community who are most likely to require financial assistance about availability of the FAP

Other (describe in Section C)

Billing and Collections

Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained all of the actions the hospital facility or other authorized party may take upon non-payment?..................................

Yes

Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

None of these actions or other similar actions were permitted

Schedule H (Form 990) 2015

Page 6

Part VFacility Information (continued)

	REHABILITATION HOSPITAL OF INDIANA
Name of hospital facility or letter of facility reporting group

Yes

Did the hospital facility or other authorized party perform any of the following actions during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP?............

If "Yes," check all actions in which the hospital facility or a third party engaged:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 19. (check all that apply):

Notified individuals of the financial assistance policy on admission

Notified individuals of the financial assistance policy prior to discharge

Notified individuals of the financial assistance policy in communications with the individuals regarding the individuals’ bills

Documented its determination of whether individuals were eligible for financial assistance under the hospital facility’s financial assistance policy

Other (describe in Section C)

None of these efforts were made

Policy Relating to Emergency Medical Care

Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that required the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?..................

If "No," indicate why:

The hospital facility did not provide care for any emergency medical conditions

The hospital facility’s policy was not in writing

The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Section C)

Other (describe in Section C)

Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)

Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.

The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that
can be charged

The hospital facility used the average of its three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged

The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged

Other (describe in Section C)

During the tax year, did the hospital facility charge any FAP-eligible individual to whom the hospital facility provided emergency or other medically necessary services more than the amounts generally billed to individuals who had insurance covering such care? ...............................

If "Yes," explain in Section C.

During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? ...........................

If "Yes," explain in Section C.

Schedule H (Form 990) 2015

Page 7

Part V

Facility Information (continued)

Section C. Supplemental Information for Part V, Section B. Provide descriptions required for Part V, Section B, lines 2, 3j, 5, 6a, 6b, 7d, 11, 13b, 13h, 15e, 16i, 18d, 19d, 20e, 21c, 21d, 22d, 23, and 24. If applicable, provide separate descriptions for each hospital facility in a facility reporting group, designated by facility reporting group letter and hospital facility line number from Part V, Section A (“A, 1,” “A, 4,” “B, 2,” “B, 3,” etc.) and name of hospital facility.
Form and Line Reference	Explanation
Schedule H, Part V, Section B, Line 5 Facility , 1	Facility , 1 - REHABILITATION HOSPITAL OF INDIANA, INC.. 2012 CHNA. The approach to gathering qualitative data for the CHNA consisted of a multicomponent approach to identify and verify community health needs. This included hosting multiple one and a half hour to two hour community conversation focus groups with public health officials and community leaders to discuss the healthcare needs of the service area as well as surveying the community at large. Local leaders with a stake in the Marion County community's health were invited to attend focus group sessions held at IU Health affiliate hospitals to discuss the needs. Attendees who participated in the focus groups are listed below: Cynthia Stone, Associate Professor IU School of Public Health Orion Bell, President & CEO CICOA Aging and In-Home Solutions Paul Pfaff, Director IU Health Enrollment Center Molly Chavers, Executive Director, Indy Hub Chuck Brandenburg, Director of Special Projects and Grants, United Way Stacey Chappell, Health Promotions Coordinator, HealthNet Dr. Larry Reed, Director, IU Health Riley Hospital Trauma Katie Jones Director, Violence Prevention Program, Indiana State Department of Health Morgan McGill, Director, Office of Women's Health Dr. Jay Gladden, Dean, IUPUI School of Physical Education and Tourism Management Mary McKee, Director, Public Health Practice, Marion County Public Health Department Joanne Pope, Manager, After School and Summer Programs, Indy Parks Jenny Boyts, Community Coordinator, Challenge Foundation Academy Charlie Schlegal, Principal, Challenge Foundation Academy 2015 CHNA. To identify community health needs, IU Health/RHI collected comments and surveyed residents of the community at large through a web-based site and utilizing paper copies accessible at clinics and other settings, with special emphasis to garner input from low income, uninsured, or minority groups. Additionally, a two-hour focus group consisting of public health officials and representatives of medically underserved groups was conducted on May 15th, 2015 at Saint Paul Episcopal Church. Focus group facilitators sent email invites, mailed letters and made follow up telephone calls, paying special attention to including organizations that represent the interest of low-income, minority and uninsured individuals. Attendees who participated in the focus group include key stakeholders representing: * All Senior Citizens Connect * Anthem * Clinical Translational Sciences Institute * Coburn Place * Community Alliance of the Far Eastside * Community Health Network * Domestic Violence Network * Families First * Father and Families * Immigrant Welcome Center * Indianapolis Housing * Julian Center * Life's TouchHome Health * Mapleton-Fall Creek Development Corporation * Marion County Public Health Department * Marion County Prosecutor's Office * Martindale Brightwood Community Development Corporation * Phalen Leadership Academies * Repucare Incorporated * St. Francis Hospital * St. Vincent Hospital * Survivors of Violence IU Health/RHI representatives compiled the survey results, health indicator data and focus group priorities and, implementing the Hanlon Method, identified the top five needs.
Schedule H, Part V, Section B, Line 6a Facility , 1	Facility , 1 - REHABILITATION HOSPITAL OF INDIANA, INC.. THE 2012 CHNA WAS CONDUCTED WITH INDIANA UNIVERSITY HEALTH. The 2015 Community Health Needs Assessment (CHNA) was conducted as a collaborative effort involving RHI, IU Health, Community Health Network, Franciscan Alliance and St. Vincent Health.
Schedule H, Part V, Section B, Line 21 Facility , 1	Facility , 1 - REHABILITATION HOSPITAL OF INDIANA, INC.. RHI is not a general acute care hospital/facility nor is RHI equipped to provide care to patients with urgent care needs. RHI is a specialty provider of rehabilitation services such as Physical, Occupational and Speech Therapy.
Schedule H, Part V, Section B, Line 22 Facility , 1	Facility , 1 - REHABILITATON HOSPITAL OF INDIANA, INC.. THE HOSPITAL LIMITS THE AMOUNTS CHARGED TO FAP ELIGIBLE INDIVIDUALS. FAP ELIGIBLE INDIVIDUALS WILL NOT BE CHARGED MORE THAN THE AMOUNTS GENERALLY BILLED (AGB) TO THOSE INDIVIDUALS WHO DO HAVE INSURANCE. THE AGB IS CALCULATED BASED ON THE LOOK-BACK METHOD FOR PAYERS INCLUDING MEDICARE FEE FOR SERVICES ALONG WITH ALL PRIVATE HEALTH INSURERS.

Schedule H (Form 990) 2015

Page 8

Part VFacility Information (continued)

Section D. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility (list in order of size, from largest to smallest) How many non-hospital health care facilities did the organization operate during the tax year?0
Name and address		Type of Facility (describe)
1
2
3
4
5
6
7
8
9
10

Schedule H (Form 990) 2015

Page 9

Part VI

Supplemental Information

Provide the following information.

1	Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II and Part III, lines 2, 3, 4, 8 and 9b.
2	Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any CHNAs reported in Part V, Section B.
3	Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4	Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5	Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6	Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7	State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.

Form and Line Reference	Explanation
Schedule H, Part V, Section B, Line 11 HOW THE HOSPITAL IS ADDRESSING THE SIGNIFICANT NEEDS IN CHNA	REHABILITATION HOSPITAL OF INDIANA ACTIVITIES TO ADDRESS PRIORITIES Rehabilitation Hospital of Indiana provides various avenues to assist community residents in improving their health knowledge and care. In addition, Rehabilitation Hospital of Indiana partners with other community organizations in healthcare, wellness, outreach, and other services to address our communities' health needs. Among the many programs focused on priority areas identified, we list a few examples here that take Rehabilitation Hospital of Indiana beyond the clinic walls and into the community. Access to healthcare As part of our ongoing focus on providing patients, caregivers and the community with educational tools and resources for better health and wellness, RHI hosts an annual "Health and Wellness Fair". This event is held in May to spotlight National Stroke Awareness Month, increasing awareness and assisting individuals to better understand the signs and symptoms of stroke. Individual screenings including glucose testing, cholesterol, BMI, blood pressure and balance/flexibility screenings are performed with results provided for use in follow-up with the individual's health care provider. RHI partners with IU Health to participate in the INShape Indiana Black and Minority Health Fair. As part of our involvement, we provide health screenings, education and resources that help community participants attain, maintain and live a healthy lifestyle and reduce their risk of chronic diseases. RHI partners with a number of local hospital and health care providers to co-sponsor the "Strike Out Stroke" events. RHI participated in IU Health's "Veggies and Vaccines" by administering free flu vaccinations to community residents at Churchman Woods Apartments on the south side of Indianapolis. Through this partnership, RHI is able to deliver on its goal of improving access to healthcare services to vulnerable populations in underserved areas within Marion County. Obesity prevention RHI collaborates with IU Health, IPS school officials, and several local organizations on the IUH Day of Service. The focus of this day is on building better health by improving public assets that encourage healthy living and obesity prevention. Volunteers spend the day working at Jonathan Jennings Elementary School #109 to improve grounds and install new fitness areas. IN 2015 RHI revitalized a quarter mile fitness track and enhanced the school grounds, positively impacting the needs of our community by increasing access of places to get physically fit. Prior year RHI volunteer activities include enhancing Marion County community park assets, thereby making recreation more appealing and exercise at these parks safer. RHI Sports Program's annual water ski clinic is a two day program held at Morse Reservoir. This clinic provides individuals with physical disabilities the opportunity to participate in the thrilling sport of water skiing, helping to increase the participants' overall physical fitness and self-confidence while decreasing feelings of isolation and helplessness. RHI partnered with IU Health and IPS to provide free sports physicals to low income students at Arsenal Tech High School, allowing them to be physically active and able to participate in organized sports. Behavioral health In collaboration with Mental Health of America Greater Indianapolis, RHI sponsored Mental Health First Aid scholarships for Marion County government employees and non-for-profit case managers and staff. Scholarship recipients received training to recognize the potential risk factors and warning signs for a range of mental health problems, and how to provide guidance for those undergoing crisis to receive the necessary resources, support and treatments to achieve recovery.
Schedule H, Part I, Line 7 Bad Debt Expense excluded from financial assistance calculation	1065506
Schedule H, Part I, Line 7 Costing Methodology used to calculate financial assistance	THE COST TO CHARGE RATIO BASED ON WORKSHEET 2 WAS USED TO CALCULATE THE AMOUNTS REPORTED ON LINES A-D. LINES E-J ARE REPORTED BASED ON ACTUAL COSTS INCURRED.
Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amount	The provision for bad debts is based upon management's assessment of historical and expected collections of accounts receivable considering business and economic conditions, trends in health care coverage, and other collection indicators. Accounts receivable are written off and charged to the provision for bad debts after collection efforts have been made in accordance with the Hospital's policies. Recoveries are treated as a reduction to the provision for bad debts. Accounts receivable are reduced by an allowance for doubtful accounts. Periodically, management assesses the adequacy of the allowance for uncollectible accounts based upon historical write-off experience by major payor category. Data about the major payor sources of revenue is analyzed to establish an appropriate allowance for uncollectible receivables and provision for bad debts. For receivables associated with services provided to patients who have third-party coverage, contractually due amounts are analyzed and compared to actual cash collected over time to enhance the quality of the estimate of the allowance for doubtful accounts and the provision for bad debts (for example, for expected uncollectible deductibles and co-payments on accounts for which the third-party payor has not yet paid, or for payers who are known to be having financial difficulties that make the realization of amounts due unlikely). For receivables associated with self-pay patients (which includes both patients without insurance and patients with deductible and co payment balances due for which third-party coverage exists for part of the bill), a significant allowance for doubtful accounts is recorded on the basis of historical experience, which indicates that many patients are unable or unwilling to pay the portion of their bill for which they are financially responsible. An estimate of the difference between contracted rates and amounts actually collected, after all reasonable collection efforts have been exhausted, is charged to the provision for bad debts and credited to the allowance for doubtful accounts.
Schedule H, Part III, Line 3 Bad Debt Expense Methodology	The organization does not report any portion of bad debt as community benefit and chooses not to estimate for purposes of Part III, Section A, Line 3 the amount of bad debt attributable to patients that may be eligible under the organization's financial assistance policy.
Schedule H, Part III, Line 4 Bad debt expense - financial statement footnote	Footnote to the Audited Financial Statement. Allowances for Doubtful Accounts: The provision for bad debts is based upon management's assessment of historical and expected collections of accounts receivable considering business and economic conditions, trends in health care coverage, and other collection indicators. Accounts receivable are written off and charged to the provision for bad debts after collection efforts have been made in accordance with the Hospital's policies. Recoveries are treated as a reduction to the provision for bad debts. Accounts receivable are reduced by an allowance for doubtful accounts. Periodically, management assesses the adequacy of the allowance for uncollectible accounts based upon historical write-off experience by major payer category. Data about the major payer sources of revenue is analyzed to establish an appropriate allowance for uncollectible receivables and provision for bad debts. For receivables associated with services provided to patients who have third-party coverage, contractually due amounts are analyzed and compared to actual cash collected over time to enhance the quality of the estimate of the allowance for doubtful accounts provision for bad debts. For receivables associated with self-pay patients (which includes both patients without insurance and patients with deductible and co payment balances due for which third-party coverage exists for part of the bill), a significant allowance for doubtful accounts is recorded on the basis of historical experience, which indicates that many patients are unable or unwilling to pay the portion of their bill for which they are financially responsible. An estimate of the difference between contracted rates and amounts actually collected, after all reasonable collection efforts have been exhausted, is charged to the provision for bad debts and credited to the allowance for doubtful accounts.
Schedule H, Part III, Line 8 Community benefit & methodology for determining medicare costs	Any cost incurred for treatment of a patient in which the total amount of revenue was not collected, is reported as a shortfall. By continuing to treat patient eligible for Medicare, hospitals alleviate the federal government's burden for directly providing medical services. The shortfall is due to continued cuts in Medicare reimbursement while RHI continues to invest in state-of the-art equipment and facilities to meet the challenging healthcare needs of the community. Medicare allowable costs were determined based on the cost to charge ratio from the FY 2015 Medicare cost report.
Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance	The Hospital's collection policy contains provisions on practices to be followed for patients who are known to qualify for financial assistance. The collection policy states that RHI will not engage in extraordinary collection actions before making reasonable efforts to determine whether a patient is eligible for assistance under RHI's Financial Assistance Policy.
Schedule H, Part V, Section B, Line 16a FAP website	- REHABILITATION HOSPITAL OF INDIANA: Line 16a URL: http://rhin.com/wp-content/uploads/2012/12/PFS-Financail-Assistance-Poliy-3-06.pdf;
Schedule H, Part V, Section B, Line 16b FAP Application website	- REHABILITATION HOSPITAL OF INDIANA: Line 16b URL: http://rhin.com/wp-content/uploads/2012/12/PFS-Financail-Assistance-Poliy-3-06.pdf;
Schedule H, Part V, Section B, Line 16c FAP plain language summary website	- REHABILITATION HOSPITAL OF INDIANA: Line 16c URL: http://rhin.com/wp-content/uploads/2012/12/PFS-Financail-Assistance-Poliy-3-06.pdf;
Schedule H, Part VI, Line 2 Needs assessment	Describe how the organization assesses the health care needs of the communities it serves, in addition to any CHNAs reported in Part V, Section B: 2012 CHNA: RHI completed the Community Health Needs Assessment in conjunction with our majority owner/member hospital (Indiana University Health). RHI's Primary Service Area (PSA) is Marion County. The areas of need that were identified from this PSA by the Needs Assessment were : Obesity, Access to Care, Mental Health, Prenatal Care and Tobacco Use. RHI determined that we could impact 3 of these areas of need. The three areas chosen by RHI were: Obesity, Access to Care and Mental Health Needs. The implementation strategy is a plan which addresses how RHI will contribute to each of these three community health needs. RHI also evaluates the hospital's accessibility on an annual basis via an Annual Accessibility Study. This plan includes actions to further the intent of creating accessible facilities, programs and communities for persons with disabilities. In addition, RHI attempts to address the needs of people with disabilities through treatment programs and services, community programming and community awareness. The plan was developed with input from persons served, support group input, clinical outcomes data, satisfaction surveys, RHI personnel using suggestions and input from community involvement and other stakeholders. 2015 CHNA: The 2015 Community Health Needs Assessment (CHNA) was conducted as a collaborative effort involving RHI, IU Health, Community Health Network, Franciscan Alliance and St. Vincent Health. In order to identify the community's leading health needs, both quantitative and qualitative data was utilized. Quantitative analyses assessed the health needs of the population through data abstraction. This data was supplemented with qualitative information to provide a full picture of the community's health and health needs. For this CHNA, qualitative data were gathered from responses collected online and through the distribution of hard copy surveys to members of the public, and a focus group with health leaders and public health experts. The Hanlon Method was utilized to set priorities and RHI utilized the rankings along with the Hospital's ability to impact change to select the below community health needs as priority areas: 1. Access to Healthcare 2. Nutrition and Healthy Weight 3. Behavioral Health and Substance Abuse 4. Community Revitalization These four community health needs are identified in RHI's Implementation Strategy and the hospital is committed to addressing these identified needs during the course of 2016-2018.
Schedule H, Part VI, Line 3 Patient education of eligibility for assistance	Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization's financial assistance policy: Patients are informed about financial assistance before admissions by the clinical liaison. This occurs when the patient is at the general acute care hospital before transferring to RHI. Patients are also informed of financial assistance with signage that is located throughout hospital. The patient is informed during registration by the admissions representative and a summary of the financial assistance policy is included in each admission packet. During the patient's stay, the discharge planner will work with the patient in completing the financial assistance application. Patients are informed again of financial assistance during the discharge process by the discharge planners. The discharge planners will continue to work with the patients after discharge, if the situation requires. Patients receive a summary of the FAP with all statements. RHI also mails a summary of the policy along with a financial assistance application to any uninsured patient that has a balance on his/her account. RHI also publicizes its FAP on the hospital web site. RHI provides representatives to assist patients with the financial assistance process Monday through Friday from 8am to 5pm.
Schedule H, Part VI, Line 4 Community information	Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves: RHI serves adolescents through adults with physical and cognitive disabilities primarily from 100-mile radius of RHI but catchment area normally includes all 92 Indiana counties and surrounding states. RHI offers services for inpatient for 91 beds and 3 outpatient locations. One location is located within the hospital and two offices conveniently located at separate locations. RHI's core services are structured through specialized units. By doing so, a rehabilitative environment is created that fosters progressive leadership, innovation and quality that will lead to preeminent patient care and outcomes. RHI's main services include but not limited to Stroke Rehabilitation, Brain and Spinal Cord injury, Multiple Trauma Rehabilitation and Orthopedic Rehabilitation. This section identifies the community assessed by IU Health/RHI. The community where Rehabilitation Hospital of Indiana is located. The secondary service area (SSA) is comprised of eight counties contiguous to Marion County and consisting of 1% or more of RHI's inpatient population. 57 remaining counties throughout Indiana make up the reminder of the community's total service area. In 2013, Rehabilitation Hospital of Indiana PSA included 567 discharges and its SSA, 354 discharges. The community was defined based on the geographic origins of Rehabilitation Hospital of Indiana. Of the hospital's inpatient discharges, approximately 47% originated from the PSA and 30% from the SSA (source RHI). Rehabilitation Hospital of Indiana is located in Marion County, in central Indiana. Marion County includes ZIP codes within the towns of Beech Grove, Indianapolis, Lawrence, Southport, and Speedway plus portions of Plainfield, which extends into Hendricks County. Based on the Census Bureau data for 2012, Marion County's population is 911,296 and 54% are female. The county's population estimates by race are 59.5% White non-Hispanic, 26.4% Black non-Hispanic, 9.3% Hispanic or Latino, 2.0% Asian, 0.5% American Indian or Alaska Native, and 2.2% persons reporting two or more races. Marion County has relatively moderate levels of educational attainment. Among adults age 25 and up, 81.6% in the county have a high school diploma or equivalent. A small share, 5.6%, has an associate's degree and 21% have some college but no degree. Just over one-quarter of adults over 25 (25.4%) have a bachelor's degree or higher. Within the entire service area, the total population for the PSA is 911,296 and the total population for surrounding counties 945,491, for a combined total of 1,856,797.
Schedule H, Part VI, Line 5 Promotion of community health	Provide any other information important to describing how the organization's hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.): RHI continues to forge positive relationships with all referral sources to identify access challenges and improvement. RHI also provides monthly support groups for patients and families including a Stroke Support Group held on the main campus; a Brain Injury Support Group on the main campus and at NRC; and a Stroke Care Givers Support Group on the main campus. RHI provides the support groups with a meeting room, one staff member's time and refreshments at no cost to the patients and families attending. There are two Stroke Support Groups offered at RHI. One group is to teach individuals recovering from a stroke coping skills. The second Stroke Support Group is to provide training to families and loved ones of the recovering stroke patient. The groups meet monthly on the main hospital campus. The Brain Injury Support Group teaches survivors of brain injury and their family and caregivers through pertinent situations, goal setting and providing information about return to work. Apart from the monthly meetings, social gatherings meet to decrease social loneliness and increase support in the community. RHI believes support groups provide its attendees with coping skills while promoting the health of the community it serves. The support groups encourage the communication among victims and/or family members with those who have sustained a similar injury and have returned to the community. RHI also provided an aquatics wellness program for individuals within the community. This program benefits members of the community such as individuals with arthritis and women during pregnancy. The water allows them to exercise under conditions that they normally would not be able to exercise. This program collects a small fee to offset a small portion of the cost of the program. Every Tuesday and Thursday evenings, RHI offers a Community Fitness Program by making the therapy gym available to all members of the community that have a physical disability. RHI recognizes that an individual with physical disability needs to continue a healthy life style by exercising which may require the need of specialized equipment. One or two RHI volunteers who are licensed therapists supervise the Community Fitness Program. RHI staff volunteers their time to provide supervision for the program, which is at no cost to the attendees. RHI recognizes that medical rehabilitation is a complex, interdisciplinary system of inpatient and outpatient therapies that is part of more complex system that includes emergent and acute care following catastrophic illness or injury as well as networks that provide long-term services and support. This system and its components provide opportunities for a broad diversity of applied research studies. The targets of current research at RHI range from interventions to reduce disability to a way to better measure rehabilitation effectiveness to leading edge methods to evaluate patients and maximize their outcomes. An Overview of the Research RHI conducts includes Identifying medications that enhance recovery following brain injury; Identifying commonly prescribed medications following brain injury that may have adverse effects on recovery; Evaluating the effectiveness of group therapy for patients and families to improve coping skills ; Improving return to work rates by developing networks of community services; Studying outcomes (community reintegration, well-being, and life satisfaction). As we continue to grow as a rehabilitation hospital and leader in medicine and research development, RHI invites physicians to contact us about patients that could be eligible for rehabilitation and participation in our studies and medical advancement. The partnership between RHI and physicians is important in the continual effort to support and provide the best care for the patient. RHI has made various donations throughout the year to groups supporting the needs of the community.
Schedule H, Part VI, Line 6 Affiliated health care system	RHI is owned by two major health systems, Indiana University Health (IUH) and St. Vincent Health. IUH is the majority owner of RHI. RHI works primarily with the IUH system on various activities to address the community needs.
Schedule H, Part VI, Line 7 State filing of community benefit report	IN

Schedule H (Form 990) 2015

Additional Data

Software ID:	15000238
Software Version:	2015v2.1

- TIN:

Schedule J
(Form 990)

Department of the Treasury
Internal Revenue Service

Compensation Information

For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet

Complete if the organization answered "Yes" on Form 990, Part IV, line 23.
SchJMediumBullet

Attach to Form 990.
SchJMediumBullet

Information about Schedule J (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public Inspection

Name of the organization

Rehabilitation Hospital of Indiana Inc

Employer identification number

35-1786005

Part I

Questions Regarding Compensation

Yes

Check the appropiate box(es) if the organization provided any of the following to or for a person listed on Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.

First-class or charter travel Housing allowance or residence for personal use

Travel for companions Payments for business use of personal residence

Tax idemnification and gross-up payments Health or social club dues or initiation fees

Discretionary spending account Personal services (e.g., maid, chauffeur, chef)

If any of the boxes in line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all of the expenses described above? If "No," complete Part III to explain .........

Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
directors, trustees, officers, including the CEO/Executive Director, regarding the items checked in line 1a? ..

Indicate which, if any, of the following the filing organization used to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

Form 990 of other organizations Approval by the board or compensation committee

During the year, did any person listed on Form 990, Part VII, Section A, line 1a with respect to the filing organization or a related organization:

Receive a severance payment or change-of-control payment? ................

Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........

Participate in, or receive payment from, an equity-based compensation arrangement? .........

If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.

Only 501(c)(3), 501(c)(4), and 501(c)(29) organizations must complete lines 5-9.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:

The organization? ...........................

Any related organization?

If "Yes," on line 5a or 5b, describe in Part III.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:

The organization?

Any related organization? .........................

If "Yes," on line 6a or 6b, describe in Part III.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization provide any non-fixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............

Were any amounts reported on Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III .............................

If "Yes" on line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50053T

Schedule J (Form 990) 2015

Page 2

Part II

Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is needed.

For each individual whose compensation must be reported on Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions, on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.
Note. The sum of columns (B)(i)-(iii) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and (E) amounts for that individual.

(A) Name and Title		(B) Breakdown of W-2 and/or 1099-MISC compensation			(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)	(F) Compensation in column(B) reported as deferred on prior Form 990
(A) Name and Title		(i) Base compensation	(ii) Bonus & incentive compensation	(iii) Other reportable compensation	(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)
1DANIEL WOLOSZYN CEO	(i) (ii)	301,831 ------------- 0	44,715 ------------- 0	12,509 ------------- 0	10,623 ------------- 0	24,587 ------------- 0	394,265 ------------- 0	0 ------------- 0
2MONTE M SPENCE COO	(i) (ii)	180,731 ------------- 0	17,180 ------------- 0	9,903 ------------- 0	6,691 ------------- 0	24,204 ------------- 0	238,709 ------------- 0	0 ------------- 0
3Marjorie Basey CFO	(i) (ii)	142,448 ------------- 0	11,200 ------------- 0	2,868 ------------- 0	4,830 ------------- 0	8,006 ------------- 0	169,352 ------------- 0	0 ------------- 0
4DEBRA CORDES CHIEF NURSING OFFICER	(i) (ii)	143,579 ------------- 0	12,652 ------------- 0	689 ------------- 0	6,063 ------------- 0	0 ------------- 0	162,983 ------------- 0	0 ------------- 0
5LANCE E TREXLER DIR OF NEUROREHAB PSYCHOLOGY	(i) (ii)	155,184 ------------- 0	0 ------------- 0	831 ------------- 0	5,394 ------------- 0	24,587 ------------- 0	185,996 ------------- 0	0 ------------- 0
6GARY SKINNER Director	(i) (ii)	145,540 ------------- 0	0 ------------- 0	2,802 ------------- 0	5,568 ------------- 0	5,811 ------------- 0	159,721 ------------- 0	0 ------------- 0
7MARY ESCALANTE Pharmacist	(i) (ii)	135,166 ------------- 0	0 ------------- 0	2,702 ------------- 0	5,814 ------------- 0	18,173 ------------- 0	161,855 ------------- 0	0 ------------- 0

Schedule J (Form 990) 2015

Page 3

Part III

Supplemental Information

Provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II. Also complete this part for any additional information.

Return Reference	Explanation

Schedule J (Form 990) 2015

Additional Data

Software ID:	15000238
Software Version:	2015v2.1

- TIN:

Schedule K
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Information on Tax Exempt Bonds

Complete if the organization answered "Yes" to Form 990, Part IV, line 24a. Provide descriptions,
explanations, and any additional information in Part VI.
SchKMediumBullet

Attach to Form 990.
SchKMediumBullet

Information about Schedule K (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public
Inspection

Name of the organization
Rehabilitation Hospital of Indiana Inc

Employer identification number
35-1786005

Part I

Bond Issues

(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	(g) Defeased		(h) On behalf of issuer		(i) Pool financing
(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	Yes	No	Yes	No	Yes	No
A	INDIANA FINANCE AUTHORITY	35-1602316	45471AEQ1	11-10-2011	16,420,000	SEE SCHEDULE K PART VI		X		X		X

Part II

Proceeds

	A		B		C		D
	1 Amount of bonds retired ..................	615,000
2 Amount of bonds legally defeased ..............	0
3 Total proceeds of issue ..................	16,420,842
4 Gross proceeds in reserve funds .............	0
5 Capitalized interest from proceeds .............	0
6 Proceeds in refunding escrows ...............	0
7 Issuance costs from proceeds ...............	316,503
8 Credit enhancement from proceeds .............	0
9 Working capital expenditures from proceeds .............	0
10 Capital expenditures from proceeds .............	3,917,537
11 Other spent proceeds .............	11,900,000
12 Other unspent proceeds .............	286,802
13 Year of substantial completion .............
	Yes	No	Yes	No	Yes	No	Yes	No
14 Were the bonds issued as part of a current refunding issue? ....	X
15 Were the bonds issued as part of an advance refunding issue? .....		X
16 Has the final allocation of proceeds been made? ..........		X
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? ..................	X

Part III

Private Business Use

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? .............		X
2 Are there any lease arrangements that may result in private business use of bond-financed property? ...............	X

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50193E

Schedule K (Form 990) 2015

Page 2

Part III

Private Business Use (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
3a Are there any management or service contracts that may result in private business use of bond-financed property? .............	X
b If "Yes" to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property?		X
c Are there any research agreements that may result in private business use of bond-financed property? .............		X
d If "Yes" to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property?
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government ....	0.66 %
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government .........
6 Total of lines 4 and 5 .............	0.66 %
7 Does the bond issue meet the private security or payment test? ...	X
8a Has there been a sale or disposition of any of the bond-financed property to a nongovernmental person other than a 501(c)(3) organization since the bonds were issued?.............		X
b If "Yes" to line 8a, enter the percentage of bond-financed property sold or disposed of. ..
c If "Yes" to line 8a, was any remedial action taken pursuant to Regulations sections 1.141-12 and 1.145-2? .............
9 Has the organization established written procedures to ensure that all nonqualified bonds of the issue are remediated in accordance with the requirements under Regulations sections 1.141-12 and 1.145-2? ........	X

Part IV

Arbitrage

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Has the issuer filed Form 8038-T, Arbitrage Rebate, Yield Reduction and Penalty in Lieu of Arbitrage Rebate? ...		X
2 If "No" to line 1, did the following apply? ....
a Rebate not due yet? .......	X
b Exception to rebate? ........
c No rebate due? .........
If "Yes" to line 2c, provide in Part VI the date the rebate computation was performed ......
3 Is the bond issue a variable rate issue? .....	X
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?		X
b Name of provider ..........
c Term of hedge .........
d Was the hedge superintegrated? ......
e Was the hedge terminated? ........

Schedule K (Form 990) 2015

Page 3

Part IV

Arbitrage (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
5a Were gross proceeds invested in a guaranteed investment contract (GIC)?		X
b Name of provider ..........
c Term of GIC .........
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? ........		X
6 Were any gross proceeds invested beyond an available temporary period?		X
7 Has the organization established written procedures to monitor the requirements of section 148? ...	X

Part V

Procedures To Undertake Corrective Action

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
Has the organization established written procedures to ensure that violations of federal tax requirements are timely identified and corrected through the voluntary closing agreement program if self-remediation is not available under applicable regulations?	X

Part VI

Supplemental Information. Provide additional information for responses to questions on Schedule K (see instructions).

Return Reference	Explanation
Schedule K, Part III, Line 3a Private Business Use	ANY MANAGEMENT AGREEMENTS DO NOT RESULT IN PRIVATE BUSINESS USE.
Schedule K, Part III, Line 2 Private Business Use	The organization leases space to contract physicians and this leased space is included in Part III, Line 4, Private Business Use.
Schedule K, Part II, Line 3 Total proceeds of issue	ISSUE PRICE: $16,420,000 EARNINGS: $842 TOTAL PROCEEDS: $16,420,842 $842 represents interest income
Schedule K, Part III, Line 9 Written Procedures	The organization adopted written procedures in 2014. The organizaiton ensures all nonqualified bonds (if any) of the issue are remediated in accordance with the associated regulations. The organization strives to stay abreast of federal regulations and considers the repercussions of all significant activities which could foreseeably have an impact on the organization's tax exempt bonds and the associated federal tax regulations.
Schedule K, Part I, Column (f) DESCRIPTION OF PURPOSE	THE SERIES 2011 BONDS WERE ISSUED IN ORDER TO PROVIDE FUNDING FOR THE CONSTRUCTION & RENOVATION OF BUILDINGS AND STRUCTURES AND THE PURCHASE OF NEW EQUIPMENT. ADDITIONALLY, THE SERIES 2011 BONDS WERE ISSUED IN ORDER TO REFUND THE SERIES 1990 BONDS. THE SERIES 1990 BONDS WERE ISSUED ON NOVEMBER 1, 1990.

Schedule K (Form 990) 2015

Additional Data

Software ID:	15000238
Software Version:	2015v2.1

- 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 990-EZ or to provide any additional information.
MediumBullet

Attach to Form 990 or 990-EZ.
MediumBullet

Information about Schedule O (Form 990 or 990-EZ) and its instructions is at
www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public
Inspection

Name of the organization

Rehabilitation Hospital of Indiana Inc

Employer identification number

35-1786005

Return Reference	Explanation
Form 990, Part III, Line 1 ORGANIZATION'S MISSION (CONTINUED FROM PART III, LINE 1)	RHI WILL ACHIEVE THIS VISION THROUGH THE FOLLOWING: ACHIEVING IN SUPERIOR PATIENT OUTCOMES; EMBRACING INNOVATIVE TREATMENT METHODS; RECRUITING OUTSTANDING CLINICAL EXPERTISE; TRAINING THE NEXT GENERATION OF REHABILITATION PROFESSIONALS; SEEKING PARTNERSHIPS WITH OTHER COMMUNITY MEMBERS WHO SERVE OUR PATIENT POPULATION; AND PROVIDING A LIFETIME CONTINUUM OF SERVICES FOR OUR PATIENTS. RHI'S VALUES INCLUDE: INTEGRITY: TREATING EACH INDIVIDUAL WITH DIGNITY AND RESPECT; INNOVATION: PIONEERING IN RESEARCH LEADING TO BETTER OUTCOMES; COMPASSION: PROVIDING AN EMPATHETIC AND HEALING ENVIRONMENT; TEAMWORK: EMPOWERING EMPLOYEES; AND SERVICE: PROVIDING COMMUNITY OUTREACH AND ADVOCACY FOR INDIVIDUALS WITH DISABILITIES THROUGH OUR STAFF, PHYSICIANS, AND THE RHI FOUNDATION. RHI OPERATES A 91 BED, FREESTANDING SPECIALTY MEDICAL REHABILITATION HOSPITAL LOCATED IN INDIANAPOLIS, INDIANA. THE HOSPITAL PROVIDES SHORT-TERM, COMPREHENSIVE REHABILITATION SERVICES TO PATIENTS, AND ITS PROGRAMS ARE DESIGNED TO RESTORE PHYSICAL, COGNITIVE AND PSYCHOSOCIAL FUNCTIONS FOLLOWING AN INCIDENT OF ACUTE ILLNESS OR TRAUMA. INPATIENT AND OUTPATIENT THERAPY AND SUPPORT SERVICES PROVIDED BY RHI INCLUDE PHYSICAL AND OCCUPATIONAL THERAPY, SPEECH THERAPY, RECREATIONAL THERAPY, ACTIVITIES OF DAILY LIVING, REHABILITATION NURSING, PSYCHOLOGY, SOCIAL SERVICES AND COGNITIVE RETRAINING, AND SUB ACUTE SERVICES REGARDLESS OF AN INDIVIDUAL'S ABILITY TO PAY. THE HOSPITAL PROVIDES FREE AND/OR DISCOUNTED CARE TO THOSE WHO QUALIFY ACCORDING TO RHI'S POLICY. RHI VERIFIES AND COLLECTS FINANCIAL RESOURCE INFORMATION ON EACH PATIENT IN A MANNER THAT PROTECTS EACH PATIENT'S DIGNITY AND QUALITY OF LIFE. NO PATIENT'S ADMISSION IS DENIED DUE TO A PATIENT'S INABILITY TO SETTLE THEIR ACCOUNT. ANY PATIENT WHO WISHES TO BE CONSIDERED FOR CHARITY CARE FURNISHES THE HOSPITAL WITH THE REQUIRED FINANCIAL DOCUMENTATION WHICH THE HOSPITAL USES TO DETERMINE WHETHER HE/SHE QUALIFIED. PATIENTS WHO APPLY FOR AND ARE ELIGIBLE FOR CHARITY CARE GENERALLY ARE APPROVED DURING THE ADMISSION PROCESS, HOWEVER, A PATIENT CAN APPLY FOR CHARITY AT ANY TIME. MEDICAID ELIGIBILITY IS ALSO EVALUATED PRIOR TO THE ADMISSION PROCESS. IF A PATIENT APPEARS TO BE ELIGIBLE FOR ASSISTANCE UNDER A GOVERNMENTAL PROGRAM SUCH AS MEDICAID, RHI ASSISTS THE PATIENT WITH THIS PROCESS. THE HOSPITAL PROVIDES MANY SUPPORT GROUPS THAT BENEFIT AND PROMOTE THE HEALTH OF THE COMMUNITY IT SERVES. SOME OF THESE GROUPS INCLUDE THE STROKE SURVIVOR SUPPORT GROUP, THE STROKE CAREGIVER SUPPORT GROUP AND THE BRAIN INJURY SUPPORT GROUP, WHICH ALL ENCOURAGE COMMUNICATION BETWEEN PATIENTS AND/OR FAMILY MEMBERS WITH THOSE WHO HAVE SUSTAINED A SIMILAR INJURY AND HAVE RETURNED TO THE COMMUNITY. RHI ALSO OFFERS VOCATIONAL REHABILITATION SUPPORT WHICH PROVIDES SEVERAL SERVICES, AMONG THEM PRE-VOCATIONAL COUNSELING AND CONNECTIONS TO OTHER AGENCIES THAT PROVIDE ASSISTANCE IN RETURNING TO WORK OR SCHOOL. RHI PROVIDES TRANSPORTATION SERVICES TO THOSE RHI OUTPATIENTS THAT NEEDED ASSISTANCE IN GETTING TO AND FROM THEIR THERAPY APPOINTMENTS. RHI ALSO PROVIDES AN AQUATICS WELLNESS PROGRAM FOR INDIVIDUALS WITHIN THE COMMUNITY. RHI ENCOURAGES AND PROMOTES EDUCATION BY OFFERING INTERNS AND MEDICAL RESIDENTS THE OPPORTUNITY TO LEARN THEIR SPECIALIZED INTEREST OF STUDY. MEDICAL RESIDENTS ARE PLACED IN POSITIONS WHERE THEY CAN LEARN AND GROW AS THEY WORK TOWARD COMPLETING THEIR RESIDENCY PROGRAM.
Form 990, Part III, Line 4d Description of other program services	(Expenses $ 2,207,241 including grants of $)(Revenue $ 1,035,393) NEUROPSYCHOLOGY: THE PSYCHOLOGICAL ASPECT OF A PATIENT'S REHABILITATION IS ALSO A VERY IMPORTANT PART OF A PATIENT'S RECOVERY. THE NEUROPSYCHOLOGIST WORKS IN COLLABORATION WITH THE REHABILITATION TEAM TO DESIGN THE APPROPRIATE PROGRAM FOR EACH INDIVIDUAL PATIENT. MOREOVER, THE REHABILITATION NEUROPSYCHOLOGIST HELPS THE PATIENT AND FAMILY COPE WITH THEIR ILLNESS AND DISABILITY THROUGH COUNSELING, THERAPY AND EDUCATION.
Form 990, Part VI, Line 1a Delegate broad authority to a committee	The Executive Committee, if any, shall be comprised of the Officers of the Board of Directors, and the Chief Executive Officer, Ex-Officio. The Chairman of the Executive Committee shall be the Chairman of the Board of Directors. The Executive Committee, if any, shall meet at the times and places as shall be determined by the Chairman. When action is taken by the Executive Committee, the action will be reported to the Board of Directors at its next meeting. The Executive Committee, if any, shall have the power to transact all regular business of the Corporation during the period between meetings so the Board of Directors, subject to any prior limitation imposed by the Board of Directors, except that, in accordance with Indiana law, the Executive Committee, if any, may not authorize distributions or fill vacancies on the Board of Directors or on any committee of the Board of Directors.
Form 990, Part VI, Line 6 Classes of members or stockholders	The Not-for-profit corporations St. Vincent Health, Inc. and MH Healthcare are the corporate members of RHI. There are 2 classes of membership: Class A and Class B. The class A member is St. Vincent Health and the class B member is MH Healthcare.
Form 990, Part VI, Line 7a Members or stockholders electing members of governing body	Each of the corporate members has the right to appoint 50% of the members of the RHI board of Directors. The class A member, St. Vincent Health, has the right to appoint all class A directors; the class B member, MH Healthcare, has the right to appoint all class B directors.
Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders	The following matters require the joint approval of the two corporate members of the Hospital: 1. Approve, interpret and change any statement of mission, philosophy, role and purpose of RHI. 2. Approve and amend bylaws and articles of incorporation. 3. Fix the number of Directors of RHI. The appointment, election or removal of any class A director shall require the approval of the class A member and the appointment, election or removal of any class B director shall require the approval of the class B member. 4. Approve the merger, dissolution, consolidation or reorganization of RHI. 5. Approve the formation of other entities by RHI. 6. Approve the acquisition, sale, lease, transfer or other alienation of property of RHI, other than in the usual and regular course of RHI's business, when such acquisition, sale, lease, transfer or other alienation meets specified financial levels set in accordance with policies established from time to time by the class A and class B members. 7. Approve capital and operating budgets of RHI. 8. Approve debt incurred by RHI which is in excess of such limits as are established by the Class A and Class B Corporate Members. 9. Approve the disposition of the assets of RHI at the time of its dissolution. 10. Establish (i) policy concerning quality of care and services or (ii) policy and procedures concerning finance and resources for RHI, which are inconsistent with policies established by the Class A and Class B Corporate Members. 11. Approve the long-range financial and strategic plans for RHI. 12. Approve an internal auditing program for RHI, which is inconsistent with the internal auditing program established by the Class A and Class B Corporate Members. 13. Appoint or remove the Chief Executive Officer of RHI provided, however, that the Class A and Class B Corporate Members shall confer with the Board of Directors concerning the appointment or removal of the Chief Executive Officer. 14. Approve the policy pertaining to the evaluation of the Chief Executive Officer of RHI. 15. Appoint or remove the Medical Director. 16. Take any action which would be inconsistent with the governing documents or policies of the Class A or Class B Corporate Members.
Form 990, Part VI, Line 11b Review of form 990 by governing body	First, a detailed review of the 990 is performed by management and by the majority owner member organization. Then, the final Form 990 is sent to the entire board prior to filing the return with the IRS.
Form 990, Part VI, Line 12c Conflict of interest policy	Annually, all employees and board members are required to complete a conflict of interest form. The CEO and Chairman of the board review the conflict of interest forms completed by the board members and the Director of Human Resources reviews conflict of interest forms completed by employees. If, during a board meeting, there is an action item that presents a formal conflict, the interested person would be asked to recuse himself/herself from the vote. This recusal would be documented in the minutes. If a key employee discloses a potential conflict, that person is removed from the decision-making process for transactions related to that conflict.
Form 990, Part VI, Line 15a Process to establish compensation of top management official	The salary for the CEO is defined in the written hiring agreement which is approved by the Board of Directors. Annual performance goals are determined and set by the Chair and Vice Chair of the Board of Directors. Salary increases and performance bonuses are determined based upon performance and the attainment of these goals. The tool used to evaluate the CEO's annual performance and pay is based on the accomplishment of these approved goals and objectives. The evaluation of performance and goals is completed by the Chair and Vice Chair of the Board annually and is performed in the Executive Session of the annual board meeting. The Chair and Vice Chair represent both of the member owners of RHI. The evaluation is documented by the Chairman of the Board. In addition, RHI Human Resources obtains a Compensation survey/study annually which is used to evaluate the compensation of RHI staff including the CEO. This process was undertaken in 2012 with the hiring of the CEO was carried forward into 2015.
Form 990, Part VI, Line 15b Process to establish compensation of other employees	The administrative officers' compensation is evaluated annually based on the Hospital's standard performance review system and based on the performance of annual goals. Annual goals for each officer are recommended by the CEO and approved by the Board of Directors. Salary increases and performance bonuses are determined based upon performance and goals. The CEO reviews and evaluates the annual performance of each administrative officer and recommends a performance rating based on the Hospital's standard performance review system. This is documented in the HR/personnel files. The CEO also reviews and evaluates the performance of each officer as it relates to the assigned annual goals. The annual evaluation of performance goals is taken to the Chair and Vice Chair of the Board to review and approve in an executive session of the annual board meeting. This is documented by the Chairman of the Board. In addition, RHI Human Resources obtains a Compensation survey/study annually which is used to evaluate the compensation of RHI staff including the administrative officers.
Form 990, Part VI, Line 19 Required documents available to the public	Financial statements, governing documents, and conflict of interest policies are not required disclosures pursuant to Internal Revenue Code (IRC) Section 6104; these documents are not available to the public at this time.
Form 990, Part XI, Line 9 Other changes in net assets or fund balances	CHANGE IN SWAP FAIR VALUE - 197231;

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2015

Additional Data

Software ID:	15000238
Software Version:	2015v2.1

- TIN:

SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

Complete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
MediumBullet

Attach to Form 990.
MediumBullet

Information about Schedule R (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public Inspection

Name of the organization

Rehabilitation Hospital of Indiana Inc

Employer identification number

35-1786005

Part I

Identification of Disregarded Entities Complete if the organization answered "Yes" on Form 990, Part IV, line 33.

(a) Name, address, and EIN (if applicable) of disregarded entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Total income	(e) End-of-year assets	(f) Direct controlling entity

Part II

Identification of Related Tax-Exempt Organizations Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	(g) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	Yes	No
(1)RHI FOUNDATION INC 4141 SHORE DRIVE INDIANAPOLIS,IN46254 35-1932349	TO SUPPORT REHABILITATION HOSPITAL OF INDIANA	IN	501(c)(3	Type I	REHABILITATION HOSPITAL OF INDIANA INC	Yes

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50135Y

Schedule R (Form 990) 2015

Page 2

Part III

Identification of Related Organizations Taxable as a Partnership Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a partnership during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No

Part IV

Identification of Related Organizations Taxable as a Corporation or Trust Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	(i) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	Yes	No

Schedule R (Form 990) 2015

Page 3

Part V

Transactions With Related Organizations Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35b, or 36.

Note. Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.

Yes

1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?

a Receipt of (i) interest, (ii) annuities, (iii) royalties, or (iv) rent from a controlled entity .....................

b Gift, grant, or capital contribution to related organization(s) ............................

c Gift, grant, or capital contribution from related organization(s) ............................

Yes

d Loans or loan guarantees to or for related organization(s) ............................

e Loans or loan guarantees by related organization(s) ............................

f Dividends from related organization(s) ............................

g Sale of assets to related organization(s) ............................

h Purchase of assets from related organization(s) ............................

i Exchange of assets with related organization(s) ............................

j Lease of facilities, equipment, or other assets to related organization(s) .......................

k Lease of facilities, equipment, or other assets from related organization(s) ......................

l Performance of services or membership or fundraising solicitations for related organization(s) .....................

m Performance of services or membership or fundraising solicitations by related organization(s) .................

n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) ...................

Yes

o Sharing of paid employees with related organization(s) ............................

Yes

p Reimbursement paid to related organization(s) for expenses ............................

q Reimbursement paid by related organization(s) for expenses ............................

r Other transfer of cash or property to related organization(s) ............................

s Other transfer of cash or property from related organization(s) ............................

If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.

(a) Name of related organization	(b) Transaction type (a-s)	(c) Amount involved	(d) Method of determining amount involved
(1) RHI FOUNDATION INC	O	168,968	ALLOCATON
(2) RHI FOUNDATION INC	N	355,183	ALLOCATION

Schedule R (Form 990) 2015

Page 4

Part VI

Unrelated Organizations Taxable as a Partnership Complete if the organization answered "Yes" on Form 990, Part IV, line 37.

Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.

(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(e) Are all partners section 501(c)(3) organizations?		(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?
(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	Yes	No	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No

Schedule R (Form 990) 2015

Page 5

Part VII

Supplemental Information

Provide additional information for responses to questions on Schedule R (see instructions).

Return Reference	Explanation

Schedule R (Form 990) 2015

Additional Data

Software ID:	15000238
Software Version:	2015v2.1

1	Briefly describe the organization’s mission or most significant activities: The primary focus of the Rehabilitation Hospital of Indiana is to deliver acute inpatient and outpatient rehabilitation services to the residents of Central Indiana regardless of their ability to pay. The cost of financial assistance and community benefit provided in 2014 = $2.2 million.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	4
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	4
5	Total number of individuals employed in calendar year 2015 (Part V, line 2a) ......	5	504
6	Total number of volunteers (estimate if necessary) .............	6	68
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	0
b	Net unrelated business taxable income from Form 990-T, line 34 .........	7b	0

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	50,199	750
9	Program service revenue (Part VIII, line 2g) .........	36,957,093	39,225,411
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	10,057	17,863
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	135,443	134,085
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	37,152,792	39,378,109
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...		0
14	Benefits paid to or for members (Part IX, column (A), line 4).....		0
15	Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10)	24,237,481	24,463,604
16a	Professional fundraising fees (Part IX, column (A), line 11e) .....		0
b	Total fundraising expenses (Part IX, column (D), line 25) 0
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	11,824,878	13,139,089
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	36,062,359	37,602,693
19	Revenue less expenses. Subtract line 18 from line 12.......	1,090,433	1,775,416
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	30,924,254	31,109,338
21	Total liabilities (Part X, line 26).............	23,572,649	21,785,086
22	Net assets or fund balances. Subtract line 21 from line 20.....	7,351,605	9,324,252

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 11,107,872 including grants of $ ) (Revenue $ 16,117,927 )
	THERAPY SERVICES: THERAPY IS A KEY COMPONENT OF A PATIENT'S RECOVERY AND INCLUDES PHYSICAL, OCCUPATIONAL, SPEECH, AND RECREATIONAL THERAPY. THE THERAPY PROGRAM'S PURPOSE IS TO DEVELOP A COMPREHENSIVE PLAN TO HELP PATIENTS BECOME INDEPENDENTLY CAPABLE IN THEIR EVERYDAY LIVES. ADDITIONALLY, THE OVERALL GOAL IS TO HELP BUILD STRENGTH AND ENDURANCE BY USING VARIOUS TECHNIQUES AND SPECIALIZED EQUIPMENT.

4b	(Code: ) (Expenses $ 10,811,491 including grants of $ ) (Revenue $ 16,136,678 )
	REHABILITATION NURSING: REHABILITATION NURSES WORK TO REINFORCE HEALING TECHNIQUES BY ENCOURAGING PATIENTS TO PRACTICE WHAT THEY LEARN IN THERAPY. THE NURSES AT REHABILITATION HOSPITAL, INC. HAVE A STRONG BACKGROUND IN MEDICAL-SURGICAL NURSING AND MANY HAVE HAD EXTENSIVE EXPERIENCE IN THE CRITICAL CARE AND ACUTE REHAB SETTING.

4c	(Code: ) (Expenses $ 6,785,062 including grants of $ ) (Revenue $ 6,069,498 )
	OTHER PROGRAMS INCLUDE:ANCILLARY SERVICES WHICH CONSISTS OF LAB, EKG, RADIOLOGY, PHARMACY, CENTRAL SUPPLIES, NUTRITION, RESPIRATORY THERAPY, MEDICAL SERVICES (CLINICS), AND DIETARY SERVICES. OUR INTERNS & MEDICAL RESIDENTS PROGRAM REPRESENTS AN EDUCATIONAL PROGRAM TO TRAIN MEDICAL RESIDENTS IN THE ACUTE REHAB SETTING.

	(Code: ) (Expenses $ 2,207,241 including grants of $ ) (Revenue $ 1,035,393 )
	NEUROPSYCHOLOGY: THE PSYCHOLOGICAL ASPECT OF A PATIENT'S REHABILITATION IS ALSO A VERY IMPORTANT PART OF A PATIENT'S RECOVERY. THE NEUROPSYCHOLOGIST WORKS IN COLLABORATION WITH THE REHABILITATION TEAM TO DESIGN THE APPROPRIATE PROGRAM FOR EACH INDIVIDUAL PATIENT. MOREOVER, THE REHABILITATION NEUROPSYCHOLOGIST HELPS THE PATIENT AND FAMILY COPE WITH THEIR ILLNESS AND DISABILITY THROUGH COUNSELING, THERAPY AND EDUCATION.

4d	Other program services (Describe in Schedule O.)
	(Expenses $ 2,207,241 including grants of $ ) (Revenue $ 1,035,393 )
4e	Total program service expenses30,911,666

(A) Name and Title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)			(D) Reportable compensation from the organization (W- 2/1099-MISC)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)	(F) Estimated amount of other compensation from the organization and related organizations
(A) Name and Title
(1) RAYAN NAGY CHAIRMAN	1.0 .................	X	X		0	0	0
(2) CHERYL HARMON VICE CHAIR (PREVIOUSLY TREASURER)	1.0 .................	X	X		0	0	0
(3) DAWN DAVIDSON VICE CHAIR (TERM ENDED APRIL 2015)	1.0 .................	X	X		0	0	0
(4) MICHAEL NIEMEIER BOARD MEMBER (TERM ENDED IN JUNE 2015)	1.0 .................	X			0	0	0
(5) JONATHAN CURTRIGHT BOARD MEMBER	1.0 .................	X			0	0	0
(6) MIKE MULLINS BOARD MEMBER	1.0 .................	X			0	0	0
(7) DANIEL WOLOSZYN CEO	40.0 .................		X		359,055	0	35,210
(8) MONTE M SPENCE COO	40.0 .................		X		207,814	0	30,895
(9) Marjorie Basey CFO	40.0 .................		X		156,516	0	12,836
(10) DEBRA CORDES CHIEF NURSING OFFICER	40.0 .................			X	156,920	0	6,063
(11) LANCE E TREXLER DIR OF NEUROREHAB PSYCHOLOGY	40.0 .................			X	156,015	0	29,981
(12) GARY SKINNER Director	40.0 .................			X	148,342	0	11,379
(13) MARY ESCALANTE Pharmacist	40.0 .................			X	137,868	0	23,987
(14) JONI BROWN Exec Dir Human Resources	40.0 .................			X	125,967	0	14,516

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	1,448,497	0	164,867

1a	Federated campaigns..		1a
b	Membership dues..		1b
c	Fundraising events..		1c
d	Related organizations		1d	750
e	Government grants (contributions)		1e

f	All other contributions, gifts, grants, and similar amounts not included above		1f

g	Noncash contributions included in lines 1a-1f:$
h Total.Add lines 1a-1f.......		750

			Business Code
2a	NET PATIENT SERVICE REVENUE	621300	37,912,450	37,912,450
b	MANAGEMENT FEE	621110	1,299,594	1,299,594
c	PHARMACY REVENUE	621300	3,186	3,186
d	RENT RELATED TO EXEMPTION	531120	10,181	10,181
e
f	All other program service revenue.			0	0	0	0
g Total.Add lines 2a–2f.....			39,225,411

3 Investment income (including dividends, interest, and othersimilar amounts) ..........			17,934			17,934
4 Income from investment of tax-exempt bond proceeds
5 Royalties...........
		(ii) Personal	(i) Real
6a	Gross rents
b	Less: rental expenses
c	Rental income or (loss)	0	0
d	Net rental income or (loss)......
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory	0
b	Less: cost or other basis and sales expenses	71
c	Gain or (loss)	-71	0
d	Net gain or (loss).....			-71			-71
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ....
	a
b	Less: direct expenses ...b
c	Net income or (loss) from fundraising events..
9a	Gross income from gaming activities. See Part IV, line 19 ...
	a
b	Less: direct expenses ...b
c	Net income or (loss) from gaming activities..
10a	Gross sales of inventory, less returns and allowances ..
	a
b	Less: cost of goods sold ..b
c	Net income or (loss) from sales of inventory..
Business Code			Miscellaneous Revenue
11a	CAFETERIA & VENDING		722210	126,714	126,714
b	REBATE REVENUE		900099	1,043	1,043
c	PHYSICIAN SERVICES		900099	6,328	6,328
d	All other revenue ....			0	0	0	0
e	Total. Add lines 11a–11d ......			134,085
12	Total revenue. See Instructions......			39,378,109	39,359,496	0	17,863

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21
2	Grants and other assistance to individuals in the United States. See Part IV, line 22
3	Grants and other assistance to governments, organizations, and individuals outside the United States. See Part IV, lines 15 and 16
4	Benefits paid to or for members
5	Compensation of current officers, directors, trustees, and key employees ....	1,216,728		1,216,728
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ....
7	Other salaries and wages	17,331,339	16,276,392	1,054,947
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	497,224	402,694	94,530
9	Other employee benefits .......	3,956,161	3,323,175	632,986
10	Payroll taxes ...........	1,462,152	1,242,829	219,323
11	Fees for services (non-employees):
a	Management ......
b	Legal .........	31,703	5,260	26,443
c	Accounting ...........	3,046	2,498	548
d	Lobbying ...........
e	Professional fundraising services. See Part IV, line 17
f	Investment management fees ......
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	2,949,434	560,392	2,389,042	0
12	Advertising and promotion ....	121,779	22,528	99,251
13	Office expenses .......	899,316	728,446	170,870
14	Information technology ......	1,068,727	865,669	203,058
15	Royalties ..
16	Occupancy ...........	2,447,435	2,307,931	139,504
17	Travel ............	184,607	157,836	26,771
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .
19	Conferences, conventions, and meetings ....	34,823	28,244	6,579
20	Interest ...........	347,440	281,426	66,014
21	Payments to affiliates .......
22	Depreciation, depletion, and amortization ..	1,475,543	1,195,190	280,353
23	Insurance ...	268,031	229,351	38,680
24	Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a	NURSING SUPPLIES	2,119,648	2,119,648
b	BAD DEBT	1,065,506	1,065,506
c	MEMBERSHIP DUES	122,051	96,651	25,400
d
e	All other expenses	0	0	0	0
25	Total functional expenses. Add lines 1 through 24e	37,602,693	30,911,666	6,691,027	0
26	Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here if following SOP 98-2 (ASC 958-720).

1	Cash–non-interest-bearing ........			2,714	1	2,714
2	Savings and temporary cash investments .........			7,558,144	2	8,097,827
3	Pledges and grants receivable, net ......				3
4	Accounts receivable, net .............			6,129,559	4	6,470,861
5	Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of Schedule L
					5	0
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing employers and sponsoring organizations of section 501(c)(9) voluntary employees' beneficiary organizations (see instructions) Complete Part II of Schedule L
					6	0
7	Notes and loans receivable, net ....				7
8	Inventories for sale or use ........			267,660	8	228,165
9	Prepaid expenses and deferred charges ......			991,132	9	747,149
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	32,713,038
b	Less: accumulated depreciation	10b	21,215,738	11,754,377	10c	11,497,300
11	Investments—publicly traded securities .			3,004,270	11	3,000,601
12	Investments—other securities. See Part IV, line 11 .....			0	12
13	Investments—program-related. See Part IV, line 11 ..			0	13
14	Intangible assets ...............				14
15	Other assets. See Part IV, line 11 ...........			1,216,398	15	1,064,721
16	Total assets. Add lines 1 through 15 (must equal line 34)...			30,924,254	16	31,109,338

17	Accounts payable and accrued expenses .....	4,209,693	17	3,638,676
18	Grants payable ...		18
19	Deferred revenue .........		19
20	Tax-exempt bond liabilities .........	14,980,000	20	14,365,000
21	Escrow or custodial account liability. Complete Part IV of Schedule D		21
22	Loans and other payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
	persons. Complete Part II of Schedule L..		22
23	Secured mortgages and notes payable to unrelated third parties ..		23
24	Unsecured notes and loans payable to unrelated third parties ..	3,000,000	24	3,000,000
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D	1,382,956	25	781,410
26	Total liabilities. Add lines 17 through 25..	23,572,649	26	21,785,086

	Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets	7,351,605	27	9,324,252
28	Temporarily restricted net assets ...........		28
29	Permanently restricted net assets		29
	Organizations that do not follow SFAS 117 (ASC 958), check here and complete lines 30 through 34.
30	Capital stock or trust principal, or current funds .....		30
31	Paid-in or capital surplus, or land, building or equipment fund ...		31
32	Retained earnings, endowment, accumulated income, or other funds		32
33	Total net assets or fund balances ...........	7,351,605	33	9,324,252
34	Total liabilities and net assets/fund balances ........	30,924,254	34	31,109,338