2020-11-05T08:18:27-06:00 2019-12-31 352123203 KSM BUSINESS SERVICES INC PO BOX 40857 INDIANAPOLIS IN 462400857 990 2019-01-01 351069822 COMMUNITY HOSPITAL OF ANDERSON AND MADISON COUNTY INC COMM 7652985125 1515 NORTH MADISON AVENUE ANDERSON IN 460113453 ELIZABETH S THARP MBA BSN RN PRESIDENT & CEO 7652985125 2020-10-27 1 CASSE TATE P01271193 3175802000 2020-10-27 64.132.79.18 2020-10-27 18:27:10 ED P C13238888B5CA0FD418F0CCA23B587B24FEAB329 58675E87C6136183E5EB75D403EB29D58B6B1823 2019 2021-01-29 14:40:06Z ELIZABETH S THARP MBA B 1515 NORTH MADISON AVENUE ANDERSON IN 460113453 215589403 0 X WWW.COMMUNITYANDERSON.COM X 1961 IN DEEPLY COMMITTED TO THE COMMUNITIES WE SERVE, WE ENHANCE HEALTH AND WELL-BEING. TO SIMPLY DELIVER AN EXCEPTIONAL EXPERIENCE - WITH EVERY LIFE WE TOUCH. 13 9 1345 117 0 0 346274 437155 201674226 204630176 6265566 7751544 1239084 1206313 209525150 214025188 370297 12248115 0 0 90001457 88942639 0 0 0 81522035 123019094 171893789 224209848 37631361 -10184660 307261619 328184932 21393104 24461777 285868515 303723155 DEEPLY COMMITTED TO THE COMMUNITIES WE SERVE, WE ENHANCE HEALTH AND WELL-BEING. TO SIMPLY DELIVER AN EXCEPTIONAL EXPERIENCE - WITH EVERY LIFE WE TOUCH. 0 0 194239386 204803575 COMMUNITY HOSPITAL OF ANDERSON AND MADISON COUNTY, INC. ("CHA") IS AN ACUTE CARE MEDICAL FACILITY WITH 140 STAFFED BEDS (EXCLUDING NURSERY). IN 2019, THERE WERE 6,656 ADMISSIONS, 8,639 SURGERIES PERFORMED, 768 BIRTHS WITH A TOTAL OF 242,437 PATIENTS SERVED IN ALL DISCIPLINES. CHA PARTICIPATES IN MEDICARE, MEDICAID, CHAMPUS, TRICARE, AND/OR OTHER GOVERNMENT-SPONSORED HEALTH CARE PROGRAMS. WE PROVIDE AN EMERGENCY ROOM THAT IS OPEN TO ALL PERSONS REGARDLESS OF ABILITY TO PAY. OUR STAFF MAKES EVERY EFFORT TO PROVIDE AN EFFECTIVE AND EFFICIENT HEALTH CARE DELIVERY SYSTEM. FINALLY, WE HAVE A GOVERNING BODY IN WHICH INDEPENDENT PERSONS REPRESENTATIVE OF THE COMMUNITY COMPRISE THE MAJORITY. 12248115 12248115 COMMUNITY HOSPITAL OF ANDERSON AND MADISON COUNTY, INC. CONTRIBUTED TO SEVERAL CHARITABLE ORGANIZATIONS. THE LARGEST DONATIONS ARE LISTED ON SCHEDULE I. N/A 206487501 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 1 1 1 0 0 1 169 0 1 1345 1 0 0 0 0 0 0 0 0 0 0 0 0 X 13 9 1 1 1 0 1 1 1 1 1 0 0 0 1 1 1 1 1 1 1 1 0 IN X BRIAN MCCONNELL 3173554212 8180 CLEARVISTA PARKWAY SUITE 200 INDIANAPOLIS IN 46256 X JAMES CALLAHAN MD DIRECTOR 2.00 48.00 X 0 1801778 46303 JASON FAHRLANDER DIRECTOR 2.00 48.00 X 0 800681 186051 CAROL WHITESEL VP PATIENT CARE/CNO 50.00 0.00 X 807139 0 21830 ELIZABETH S THARP MBA BSN RN PRESIDENT & CEO 47.00 3.00 X X 687474 0 95327 MICHAEL HARPE VP HUMAN RESOURCES 50.00 0.00 X 742776 0 31013 NIGHAT TAHIR MD PHYSICIAN 50.00 0.00 X 497307 0 31464 JOHN B HARRIS VP OF FINANCE & CFO 47.00 3.00 X 452178 0 64770 LEE ANN MCDANIEL CRNA 50.00 0.00 X 458159 0 28132 SHERRY SIDWELL COO/VP INTEGRATED SERVICES 50.00 0.00 X 380460 0 48203 KENNETH SHAVER MD SVP CHIEF PHYSICIAN EXECUTIVE 2.00 48.00 X 0 302285 65964 CLIFFORD BEYLER SENIOR GENERAL COUNSEL 50.00 0.00 X 261791 0 35346 THOMAS SHORT MD DIRECTOR 2.00 0.00 X 12000 0 0 TROY ABBOTT MD DIRECTOR 2.00 0.00 X 0 0 0 JULIE HETTINGA SECRETARY 2.00 0.00 X X 0 0 0 JASON JAMERSON DIRECTOR 2.00 0.00 X 0 0 0 JOHN KANE TREASURER 2.00 0.00 X X 0 0 0 ARTHUR J LEAK CHAIRMAN 2.00 5.00 X X 0 0 0 RICK MOORE DIRECTOR 2.00 0.00 X 0 0 0 MARIE MORRIS PHD VICE CHAIRMAN 2.00 0.00 X X 0 0 0 BILL O'NEAL PHD DIRECTOR 2.00 0.00 X 0 0 0 JAY B RICKER DIRECTOR 2.00 0.00 X 0 0 0 4299284 2904744 654403 79 0 1 0 WR DUNKIN & SON INC 2409 W 18TH STREET ANDERSON IN 46016 CONSTRUCTION SERVICES 2243926 ACCELECARE WOUND CENTER INC SKYLINE TWR 10900 NE 4TH ST 1920 BELIEVUE WA 98004 MEDICAL SERVICES 690782 SOUTH BEND MEDICAL FOUNDATION INC 530 N LAFAYETTE BLVD SOUTH BEND IN 466011098 LABORATORY SERVICES 676693 EPCHA PC 12953 PUBLISHERS DRIVE FISHERS IN 47360 MEDICAL SERVICES 662269 OPTUMINSIGHT 3797 MOMENTUM PLACE CHICAGO IL 606898337 MEDICAL SERVICES 617593 37 352136 85019 437155 PATIENT CARE SERVICE 622110 186327827 186327827 ONCOLOGY SERVICES 622110 13666456 13666456 RENTAL INCOME - RELATED 531120 2605583 2605583 JOINT VENTURES 621400 1370144 1370144 CLINICAL RESEARCH 541700 660166 660166 204630176 5388403 5388403 1406758 2520598 1283911 280304 122847 2240294 2363141 2363141 CAFETERIA SALES 722514 943439 943439 TELECOMMUNICATIONS EXP REIMBURSEM 900099 108704 108704 ESPRESSO TO GO 722515 89475 89475 64695 64695 1206313 214025188 204803575 0 8784458 X 12248115 12248115 1740412 12000 1728412 68081782 60685672 7396110 3556758 3091953 464805 10746492 9342116 1404376 4817195 4187673 629522 75598 70238 5360 4422 4108 314 158889 158889 57456019 53382311 4073708 144477 134233 10244 4199399 3901656 297743 367946 341858 26088 9196590 8544540 652050 271773 252504 19269 9871 9171 700 104143 96759 7384 8679177 8063812 615365 1115231 1036160 79071 MEDICAL SUPPLIES 31318687 31318687 HAF PROGRAM FEES 7759835 7759835 RENOVATION EXPENSES 1505514 1398771 106743 DUES & SUBSCRIPTIONS 334068 310382 23686 317455 294947 22508 224209848 206487501 17722347 0 35893198 19896546 32292541 25825956 3159324 3051097 277486 1032147 164465771 101910999 66066309 62554772 167492333 212445585 2080428 3378829 307261619 328184932 15476031 10288575 3628951 2015647 2288122 12157555 21393104 24461777 X 285868515 303723155 285868515 303723155 307261619 328184932 -10184660 28142328 -103028 0 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 6403988 6403988 77460002 41838426 35621576 1311533 240989 1070544 77301014 57991138 19309876 1989234 1840446 148788 62554772 ESTIMATED THIRD PARTY SETTLEMENTS 1095654 DUE TO AFFILIATES 9391820 RIGHT-OF-USE OPERATING LIABILITIES 1670081 12157555 1 1 X 1 X 1 X 1 1 0 1 1 7105 1951671 107651 1844020 0.00820 36355087 26091877 10263210 0.04580 0 0 7105 38306758 26199528 12107230 0.05400 32 25112 171271 500 170771 0.00080 2 1100 514108 0 514108 0.00230 34 26212 685379 500 684879 0.00310 34 33317 38992137 26200028 12792109 0.05710 1 7398299 0 70283719 87995540 -17711821 X 1 1 1 COMM ENDOSCOPY CTR ENDOSCOPY CENTER 0.41000 0.00000 0.49000 1 1 COMM HOSP OF ANDERSON & MADISON CTY 1515 NORTH MADISON AVENUE ANDERSON IN 46011 WWW.COMMUNITYANDERSON.COM 19-005100-1 X X X SEE PART V, ADD'L INFORMATION COMM HOSP OF ANDERSON & MADISON CTY 1 0 0 1 X X X X X X X X X 18 1 1 1 1 X SEE PART V, SECTION C X 1 18 1 SEE PART V, SECTION C 0 1 X 200.000000000000 300.000000000000 X X X X X 1 1 X X X 1 X SEE PART V, SECTION C X SEE PART V, SECTION C X SEE PART V, SECTION C X X X X X X X 1 X 0 X X X X 1 X 0 0 PART V, SECTION A: PART V, SECTION B, LINE 7A:HTTPS://WWW.ECOMMUNITY.COM/COMMUNITY-BENEFIT/ARCHIVED-REPORTSPART V, SECTION B, LINE 10A:HTTPS://WWW.ECOMMUNITY.COM/COMMUNITY-BENEFIT/ARCHIVED-REPORTSPART V, SECTION A - FACILITY INFORMATIONCHA IS AN ACUTE CARE MEDICAL FACILITY WITH 134 STAFFED BEDS. IN 2019, THERE WERE 6,656 ADMISSIONS WITH AN AVERAGE LENGTH OF STAY OF 3.89 DAYS. THERE WERE 35,783 EMERGENCY ROOM CASES RESPONDED TO IN OUR 24-HOUR/SEVEN DAY A WEEK EMERGENCY ROOM. 65% OF THE BIRTHS IN MADISON COUNTY WERE DELIVERED AT CHA FOR A TOTAL OF 768 BIRTHS IN 2019. COMM HOSP OF ANDERSON & MADISON CTY PART V, SECTION B, LINE 5: IN 2018, COMMUNITY HEALTH NETWORK CONDUCTED A CHNA TO UNDERSTAND THE GREATEST HEALTH NEEDS IN THE COMMUNITIES SERVED BY OUR HOSPITALS. THIS ASSESSMENT WAS LARGE IN PART A JOINT PROCESS AMONG FOUR INDIANA HEALTH SYSTEMS: COMMUNITY HEALTH NETWORK, IU HEALTH, ST. FRANCIS ALLIANCE, AND ST. VINCENT. COMBINED, THESE ARE THE LARGEST HEALTH SYSTEMS IN INDIANA. THROUGH THIS COLLABORATIVE PARTNERSHIP, COMMUNITY HEALTH DATA WAS COLLECTED IN THREE WAYS:1. SECONDARY DATA COLLECTION: DATA ON HEALTH AND WELLNESS ISSUES WAS COLLECTED. SOURCES INCLUDE COUNTY HEALTH RANKINGS, CENSUS BUREAU DATA, VARIOUS REPORTS FROM THE INDIANA STATE DEPARTMENT OF HEALTH, AND OTHER NATIONAL REPORTS. INDIANA INDICATORS, COMMUNITY COMMONS, AND HEALTHY COMMUNITIES INSTITUTE DATA MANAGEMENT SYSTEMS ALSO CONTRIBUTED TO THE SECONDARY DATA USED. SOURCES OF THE SECONDARY DATA ARE IDENTIFIED THROUGHOUT THE COMMUNITY BENEFITS REPORT.2. COMMUNITY HEALTH SURVEY: A CORE OF 20 MANDATORY QUESTIONS BASED ON PERCEPTION OF COMMUNITY AND PERSONAL NEEDS WERE CREATED. IN ADDITION, PROFESSIONALS ASSIGNED TO EACH COUNTY WORKED WITH ESTABLISHED COMMUNITY HEALTH COLLABORATIVES, LOCAL HOSPITALS, AND THE LOCAL HEALTH DEPARTMENT TO DEVELOP VOLUNTARY COMMUNITY HEALTH NEEDS ASSESSMENT TO CREATE 9 QUESTIONS SPECIFIC TO THE COUNTY. THIS RESULTED IN A SURVEY WITH 20 TO 29 QUESTIONS, DEPENDENT ON THE RESPONDENT'S COUNTY OF RESIDENCE. THE SURVEY WAS DISTRIBUTED ELECTRONICALLY AND ON PAPER. IN ADDITION TO THE QUANTITATIVE DATA, FREE TEXT RESPONSES WERE CODED AND CALCULATED TO PROVIDE FURTHER CLARIFICATION OF THE QUANTITATIVE DATA.3. FOCUS GROUPS: IN ADDITION TO THE SURVEY THE PARTNERSHIP HOSTED FOCUS GROUPS THAT INCLUDED 15-60 COMMUNITY LEADERS FROM GOVERNMENTAL PUBLIC HEALTH, HEALTH CARE, SOCIAL SERVICE AGENCIES, RELATED NONPROFITS, CIVIC ORGANIZATIONS, AND GRASSROOTS/NEIGHBORHOOD ORGANIZATIONS. IN LARGER FOCUS GROUPS, SUB-GROUPS WERE UTILIZED TO GIVE ALL PARTICPANTS A VOICE. EACH FOCUS GROUP DETERMINED THE TOP FOUR TO SIX HEALTH NEEDS IN THE COMMUNITY; POTENTIAL RESOURCES OR PARTNERS; AND SOME ACTIONS/INTERVENTIONS THAT MIGHT WORK BEST.OUSIDE OF THE COLLABORATIVE, COMMUNITY HEALTH NETWORK INVITED KEY PUBLIC HEALTH INFORMANTS TO PROVIDE THEIR INPUT ON COMMUNITY HEALTH NEEDS. THE FOLLOWING INFORMANTS WERE INTERVIEWED: DUANE KRAMBECK-PRINCIPAL OF CHRISTIAN PARK ELEMENTARY SCHOOL IN INDIANAPOLIS PUBLIC SCHOOLS; MARY CONWAY, MSN, RN ADMINISTRATIVE COORDINATOR FOR NURSING SERVICES IN INDIANAPOLIS PUBLIC SCHOOLS; AND RANDY MILLER EXECUTIVE DIRECTOR OF DRUG FREE MARION COUNTY.THESE QUANTITATIVE AND QUALITATIVE DATA COLLECTION MECHANISMS HELPED IDENTIFY COMMUNITY HEALTH NEEDS AND SECONDARY DATA CONFIRMED THE NEEDS PERFORM BELOW STATE AVERAGES. FURTHER REVIEW OF THE HEALTH NEEDS DETERMINED THE EXTENT TO WHICH HEALTH INEQUITIES MAY EXIST AND WHICH SEGMENTS OF THE POPULATION ARE MORE NEGATIVELY IMPACTED. COMM HOSP OF ANDERSON & MADISON CTY PART V, SECTION B, LINE 6A: THE CHNA FOR COMMUNITY HOSPITAL OF ANDERSON AND MADISON COUNTY WAS A JOINT PROCESS AMONG ALL OF THE COMMUNITY HEALTH NETWORK HOSPITALS WHICH INCLUDES: COMMUNITY HEALTH NETWORK, INC. (NORTH, EAST, & INDIANA HEART HOSPITAL, LLC), COMMUNITY HOSPITAL SOUTH, INC., COMMUNITY HOSPITAL OF ANDERSON AND MADISON COUNTY, INC., COMMUNITY HOWARD REGIONAL HEALTH, INC., AND INDIANAPOLIS OSTEOPATHIC HOSPITAL, INC. IN ADDITION, THE HOSPITAL COLLABORATED WITH FRANSISCAN ST. FRANCIS HEALTH, IU HEALTH UNIVERSITY HOSPITAL, AND ST. VINCENT HOSPITAL. COMM HOSP OF ANDERSON & MADISON CTY PART V, SECTION B, LINE 6B: THE CHNA WAS ALSO CONDUCTED WITH HEALTHY COMMUNITIES INSTITUTE.COMM HOSP OF ANDERSON & MADISON CTY:PART V, SECTION B, LINE 11: CHA IS ADDRESSING THE SIGNIFICANT NEEDS OF THE COMMUNITY BASED ON INPUT PROVIDED BY COMMUNITY RESIDENTS, PUBLIC HEALTH PARTNERS, INTERNAL AND EXTERNAL LEADERSHIP WHO PARTICIPATED IN FOCUS GROUPS, STAKEHOLDER INTERVIEWS OR COMPLETED THE CHNA SURVEY THROUGHOUT THE CENTRAL INDIANA REGION.CHNA DATA WAS ANALYZED AND PRIORITIZED USING THESE KEY FACTORS: FEASIBILITY FOR OUR HOSPITALS TO IMPACT CHANGE, HEALTH SYSTEM EXPERTISE IN THE FIELD OF THE ASSESSED NEED, AND THE HOSPITALS ABILITY TO BE THE MOST EFFECTIVE WITH THE RESOURCES AVAILABLE. THE FOUR SIGNIFICANT HEALTH NEEDS IDENTIFIED IN ALL OUR COMMUNITIES WERE: ACCESS TO HEALTHCARE; OBESITY; PEDIATRIC ASTHMA AND COMMUNITY DRIVEN INITIATIVES.A MISSION CENTERED ON HELPING OTHERS IS THE FOUNDATION OF EVERYTHING WE DO AT COMMUNITY HEALTH NETWORK - AND EXTENDS FROM THE CARE WE PROVIDE TO THE COMMUNITIES WE SERVE THROUGH A BROAD SPECTRUM OF COMMUNITY BENEFIT ACTIVITIES OR PROGRAMS. OUR COMMUNITY BENEFIT RESPONDS TO IDENTIFIED COMMUNITY NEEDS AND MEETS AT LEAST ONE OF THE FOLLOWING CRITERIA:1. IMPROVES ACCESS TO HEALTH CARE SERVICES.2. ENHANCES HEALTH OF THE COMMUNITY.3. ADVANCES MEDICAL OR HEALTH KNOWLEDGE.4. RELIEVES OR REDUCES THE BURDEN OF GOVERNMENT OR OTHER COMMUNITY EFFORTS.OUR COMMUNITY BENEFIT IS ORGANIZED IN THREE CATEGORIES:CATEGORY 1: FINANCIAL ASSISTANCE-FREE OR DISCOUNTED HEALTH SERVICES PROVIDED TO PERSONS WHO CANNOT AFFORD TO PAY AND WHO MEET THE ELIGIBILITY CRITERIA OF THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY. FINANCIAL ASSISTANCE IS REPORTED IN TERMS OF COSTS, NOT CHARGES. FINANCIAL ASSISTANCE DOES NOT INCLUDE BAD DEBT. CATEGORY 2: GOVERNMENT-SPONSORED MEANS-TESTED HEALTH CARE - UNPAID COSTS OF PUBLIC PROGRAMS FOR LOW-INCOME PERSONS - THE SHORTFALL CREATED WHEN A FACILITY RECEIVES PAYMENTS THAT ARE LESS THAN THE COST OF CARING FOR PUBLIC PROGRAM BENEFICIARIES. THIS PAYMENT SHORTFALL IS NOT THE SAME AS A CONTRACTUAL ALLOWANCE, WHICH IS THE FULL DIFFERENCE BETWEEN CHARGES AND GOVERNMENT PAYMENTS. CATEGORY 3: COMMUNITY BENEFIT SERVICES - PROGRAMS THAT RESPOND TO AN IDENTIFIED COMMUNITY HEALTH NEED AND ARE DESIGNED TO ACCOMPLISH ONE OR MORE COMMUNITY BENEFIT OBJECTIVES; PROGRAMS AND ACTIVITIES DIRECTED TO OR INCLUDING AT-RISK PERSONS, SUCH AS UNDERINSURED AND UNINSURED PERSONS AND PROGRAMS OFFERED TO THE BROAD COMMUNITY (INCLUDING AT-RISK PERSONS) DESIGNED TO IMPROVE COMMUNITY HEALTH.HIGHLIGHTS FOR COMMUNITY BENEFIT SERVICES THAT ALIGN WITH THE IDENTIFIED NEEDS INCLUDES:ACCESS TO HEALTHCARE:COMMUNITY HEALTH NETWORK SUPPORTS THE JANE PAULEY COMMUNITY HEALTH CENTER WHICH OPENED ITS DOORS IN SEPTEMBER 2009 TO PROVIDE PRIMARY HEALTH SERVICES TO EASTSIDE RESIDENTS, REGARDLESS OF INCOME OR INSURANCE COVERAGE. WITH 16 LOCATIONS, THE CENTER SERVES IN PARTNERSHIP WITH THE METROPOLITAN SCHOOL DISTRICT OF WARREN TOWNSHIP, COMMUNITY HEALTH NETWORK, THE COMMUNITY HEALTH NETWORK FOUNDATION, IU SCHOOL OF DENTISTRY AND HANCOCK REGIONAL HOSPITAL. SERVICES ARE PROVIDED ON A DISCOUNTED BASIS BASED ON THE PATIENT'S HOUSEHOLD INCOME. EASTSIDE INDIANAPOLIS NATIVE AND FORMER NBC NEWS ANCHOR JANE PAULEY LENT HER NAME TO THE FACILITY AS AN ADVOCATE FOR ACCESSIBLE HEALTHCARE SERVICES FOR PEOPLE UNDERSERVED BY TRADITIONAL HEALTHCARE MODELS. THE CENTER OFFERS A FULL RANGE OF SERVICES INCLUDING PRIMARY HEALTHCARE, CASE MANAGEMENT, PRESCRIPTION ASSISTANCE AND BEHAVIORAL HEALTH SERVICES, WHILE ALSO FOCUSING ON THE MANAGEMENT OF CHRONIC DISEASES. THE CENTER IS ABLE TO PROVIDE ALL OF THESE IN BOTH ENGLISH AND SPANISH.COMMUNITY HEALTH NETWORK'S SCHOOL-BASED PROGRAMS COVER A WIDE RANGE OF NEEDS FOR YOUTH ACROSS CENTRAL INDIANA. ONSITE NURSES, THERAPISTS AND PHYSICIANS ADDRESS STUDENTS' NEEDS IN THE SCHOOL AND AFTER-SCHOOL SETTING, HELPING TO ENSURE CONSISTENCY IN CARE AND LESS TIME AWAY FROM THE CLASSROOM OR PLAYING FIELD. THE VAST MAJORITY OF THESE SERVICES, INCLUDING ANY NURSING OR BEHAVIORAL HEALTH SUPPORT, ARE OFFERED FREE OF CHARGE TO SCHOOLS THANKS TO COMMUNITY'S ON-GOING COMMITMENT TO ENHANCING HEALTH FOR FUTURE GENERATIONS.FROM EVERYDAY SCRAPES AND BRUISES ON THE PLAYGROUND TO MANAGING CHRONIC ILLNESSES LIKE ASTHMA AND DIABETES, COMMUNITY NURSES OFFER SUPPORT FOR STUDENTS AT MORE THAN 100 SCHOOLS IN THE COMMUNITIES WE SERVE. THEIR WORK ENSURED A 97.2 PERCENT RETURN TO CLASSROOM RATE FOR STUDENTS WHO CAME TO THEM FOR CARE IN 2018. SPECIFIC SERVICES OFFERED TO STUDENTS INCLUDE:1. MANAGEMENT OF INJURIES REQUIRING FIRST AID;2. MANAGEMENT OF LIFE-THREATENING ALLERGIES, ASTHMA, DIABETES AND SEIZURES;3. MANAGEMENT OF ANY HEALTH CONCERN AND REFERRAL TO APPROPRIATE CARE WHEN NEEDED; AND4. EMERGENCY RESPONSE TO ANY HEALTH-RELATED CONCERN WITHIN THE SCHOOL BUILDING.IN ADDITION, FOR STUDENTS FACING CHRONIC HEALTH CONDITIONS AND ONGOING HEALTH NEEDS, MEDICATIONS PRESCRIBED BY PHYSICIANS ARE ADMINISTERED BY COMMUNITY'S SCHOOL-BASED NURSING STAFF. IN THE INSTANCE OF OCCASIONAL MEDICATION NEEDS, PARENTS FURNISH OVER-THE-COUNTER MEDICATIONS THAT ARE THEN ADMINISTERED BY NURSING STAFF. AND, FOR PREVENTATIVE CARE PURPOSES, NURSING STAFF ADMINISTER FLU VACCINES AT A NUMBER OF LOCAL CHARTER SCHOOLS TO ENSURE THE WELLNESS OF STUDENTS THROUGHOUT THE SCHOOL YEAR.OBESITY (ACCESS TO HEALTHY FOODS):COMMUNITY HEALTH NETWORK TOOK OVER THE DAY-TO-DAY OPERATIONAL MANAGEMENT OF THE CUPBOARD, A FOOD PANTRY THAT SERVES RESIDENTS OF LAWRENCE TOWNSHIP OF INDIANAPOLIS, AND ASSISTS AN ESTIMATED 300 FAMILIES PER WEEK, PROVIDES HEALTHIER FOOD OPTIONS AND HELPS RELIEVE THE STRAIN CAUSED BY FOOD INSECURITY. IN 2018, THE CUPBOARD PROVIDED SERVICES TO APPROXIMATELY 63,133 PERSONS. THE CUPBOARD IS A CLIENT-CHOICE FOOD PANTRY, SERVING RESIDENTS THROUGH PARTNERSHIPS WITH GLEANERS FOOD BANK OF INDIANA, MIDWEST FOOD BANK, AND LOCAL RELIGIOUS INSTITUTIONS AND BUSINESSES. THE FOOD PANTRY IS OPEN WEDNESDAYS FROM 10 A.M. TO 4 P.M. AND 6 P.M. TO 8 P.M., FRIDAYS FROM 10 A.M. TO 4 P.M., AND THE THIRD SATURDAY OF THE MONTH FROM 10 A.M. TO NOON.COMMUNITY HEALTH NETWORK SUPPORTS MANY URBAN FARMING AND FARMERS MARKET INITIATIVES THAT PROVIDE FRESH PRODUCE AND HEALTHY OPTIONS. FARMERS MARKETS ARE FOR EVERYONE. ACCESS TO AFFORDABLE, FRESH, AND HEALTHY WHOLE FOODS IS A CHALLENGE FOR MANY PEOPLE WHO RELY ON FOOD ASSISTANCE PROGRAMS LIKE SNAP THAT HELP LOW-INCOME FAMILIES AND INDIVIDUALS BUY FRESH, INDIANA-GROWN FOOD THAT PROVIDES REAL SUSTENANCE FOR THEMSELVES AND THEIR COMMUNITIES. FOR INSTANCE, COMMUNITY EMPLOYEES ALSO VOLUNTEER AND SUPPORT INDY URBAN ACRES WHICH IS AN ORGANIC FARM THAT DONATES 100% OF THE FRESH FRUITS AND VEGETABLES HARVESTED TO LOCAL FOOD PANTRIES THROUGH A PARTNERSHIP WITH GLEANERS FOOD BANK. SINCE 2011, INDY URBAN ACRES HAS GROWN INTO A MULTI-DISCIPLINARY FARM THAT PROVIDES FOOD EQUALITY FOR LOW-INCOME FAMILIES, EDUCATES THOUSANDS OF YOUTH THROUGH TOURS AND FARM-TO-PLATE WORKSHOPS, PROVIDES COMMUNITY ENGAGEMENT TO THOUSANDS OF VOLUNTEERS AND GROUPS, TEACHES TEENS VALUABLE JOB SKILLS AND HELPS IMPROVE INDY'S FOOD SYSTEM.ASTHMA:OUR PRESIDENT AND CEO, BRYAN MILLS, HAS JOINED WITH A NUMBER OF PARTNERS FROM HEALTHCARE AND THE BUSINESS COMMUNITY - INCLUDING THE INDIANA HOSPITAL ASSOCIATION, THE INDIANA STATE MEDICAL ASSOCIATION AND THE INDIANA CHAMBER OF COMMERCE-TO CREATE A NEW ORGANIZATION KNOWN AS THE ALLIANCE FOR A HEALTHIER INDIANA. IN 2016, THE GROUP ANNOUNCED PLANS TO TACKLE ITS FIRST CHALLENGE: THE HIGH RATE OF TOBACCO USE IN OUR STATE. TOBACCO USE LEADS TO DISEASE AND DISABILITY AND HARMS NEARLY EVERY ORGAN OF THE BODY. IT IS THE LEADING CAUSE OF PREVENTABLE DEATH. RESEARCH AS SHOWN THAT SMOKE FROM CIGARS, CIGARETTES, AND PIPES HARMS YOUR BODY IN MANY WAYS, BUT IT IS ESPECIALLY HARMFUL TO THE LUNGS OF A PERSON WITH ASTHMA. TOBACCO SMOKE - INCLUDING SECONDHAND SMOKE - IS ONE OF THE MOST COMMON ASTHMA TRIGGERS. THE ALLIANCE ASKED INDIANA'S STATE LEGISLATURE TO CONSIDER A VARIETY OF MEASURES, INCLUDING HIGHER TOBACCO TAXES, AN INCREASE IN THE SMOKING AGE AND A REPEAL OF THE SMOKERS' BILL OF RIGHTS. COMMUNITY HEALTH NETWORK MADE A MAJOR INVESTMENT OF TIME AND RESOURCES INTO A COMBINED TOBACCO CAMPAIGN THIS YEAR, AND WHILE WE DID NOT GET THE TOBACCO TAX INCREASE WE SOUGHT, WE DID MOVE THE BALL FORWARD ON A TAX AND SECURE A PARTIAL VICTORY ON TOBACCO CESSATION FUNDING. INDIANA LEGISLATORS PROVIDED A 50% INCREASE IN STATE FUNDING FOR TOBACCO CESSATION SERVICES, BRINGING THE ANNUAL TOBACCO CESSATION BUDGET TO $7.5 MILLION. THE NEW ALLIANCE FOR A HEALTHIER INDIANA IS A GREAT EXAMPLE OF HOW WE AT COMMUNITY PARTNER WITH OTHERS TO FURTHER OUR WORK. FROM FOOD INSECURITY TO EDUCATIONAL CHALLENGES TO SUICIDE TO SMOKING AND OTHER ADDICTIONS, WE'RE COMMITTED TO TACKLING SOCIETAL ISSUES THAT AFFECT HEALTH AND QUALITY OF LIFE. COMM HOSP OF ANDERSON & MADISON CTY PART V, SECTION B, LINE 11: COMMUNITY-DRIVEN INITIATIVES:COMMUNITY FARM: LOCATED ON MORE THAN 120 ACRES OF LAND AT THE EDGE OF ANDERSON'S CITY LIMITS, IN 2018 COMMUNITY BECAME THE FIRST HOSPITAL IN THE STATE TO HAVE AN IN-GROUND FARM LOCATED ON ITS CAMPUS. ONE OF COMMUNITY FARM'S GOALS IS TO DISTRIBUTE FRESH PRODUCE TO PATIENTS. THIS INVOLVES WORKING WITH DIETITIANS, PRIMARY CARE PROVIDERS, AND OTHER INTEGRAL STAFF TO IMPLEMENT THE PROCESS OF FARM-TO-TABLE, WHILE ALSO PROVIDING EDUCATION TO HELP PATIENTS LEARN HOW TO EAT HEALTHY. THE FARM TEAM WORKS CLOSELY WITH OUR VOLUNTEERS TO COORDINATE FREE, FRESH FLOWER DELIVERY TO PATIENTS TO HELP BRIGHTEN THEIR HOSPITAL STAY. OPERATION UNDIES: THIS IS AN ANNUAL COMPAIGN CONDUCTED BY COMMUNITY HOSPITAL ANDERSON EMPLOYEES TO WORK TOGETHER TO COLLECT NEW, PACKAGED UNDERWEAR FOR MADISON COUNTY SCHOOL CHILDREN. THE CAMPAIGN BEGAN AS A WAY TO HELP SCHOOL NURSES WITH EMERGENCY SUPPLIES OR WHEN A STUDENT IS IN NEED. IN 2018, THE TEAM WAS ABLE TO COLLECT, SORT, AND DONATE 3,280 PAIRS OF UNDERWEAR, HELPING EVERY ELEMENTARY SCHOOL IN MADISON COUNTY. KEITH TRENT'S COATS OF CARING: SINCE 2001, THIS ANNUAL EVENT HAS GATHERED WINTER GARMENTS FOR THOSE IN NEED, HELPING KEEP RESIDENTS OF MADISON COUNTY WARM. OVER THE YEARS, MORE THAN 16,000 COATS HAVE BEEN DISTRIBUTED, THANKS TO THE CARING HEARTS AT COMMUNITY HOSPITAL ANDERSON AND SUPPORTERS IN THE COMMUNITY. COMMUNITY BIKES: A BICYCLE-SHARING PROGRAM IS OFFERED THAT IS AIMED AT HELPING THOSE FACING ECONMIC ISSUES INCLUDING HOMELESSNESS. THIRTY COMMERCIAL-GRADE BICYCLES ARE PARKED NEAR TRANSITIONAL HOUSING FACILITIES FOR RESIDENTS TO USE THE TWO-WHEELED TRANSPORTATION TO CONNECT WITH JOBS, HEALTHCARE, AND A BRIGHTER FUTURE. HUMAN MILK PROGRAM: COMMUNITY ANDERSON ESTABLISHED A HUMAN MILK PROGRAM TO ENSURE THE BEST RANGE OF OPTIONS FOR NEWBORNS IN OUR CARE. AFFILIATED WITH THE MILK BANK, A NONPROFIT DONOR HUMAN MILK BANK LOCATED IN INDIANAPOLIS, COMMUNITY ANDERSON NOW MAKES PASTEURIZED HUMAN MILK AVAILABLE FOR NEWBORNS. COMMUNITY ANDERSON ALSO SERVES AS A MILK DEPOT, A LOCATION WHERE BREASTFEEDING MOTHERS CAN DROP OFF DONATED MILK.COMMUNITY HEALTH NETWORK, CENTRAL INDIANA'S LARGEST PROVIDER OF BEHAVIORAL HEALTH SERVICES, ANNOUNCED ITS COMMITMENT TO BECOMING THE FIRST HEALTH CARE SYSTEM IN THE COUNTRY TO FULLY IMPLEMENT THE ZERO SUICIDE MODEL, DEVELOPED BY THE NATIONAL ACTION ALLIANCE FOR SUICIDE PREVENTION AND OTHER PARTNERS. AT THE SAME TIME, THE INDIANA DIVISION OF MENTAL HEALTH AND ADDICTION AND COMMUNITY HAVE PARTNERED TO SPEARHEAD THE STATE'S SUICIDE PREVENTION MOVEMENT TO SAVE YOUNG LIVES. WITH AN ASPIRATIONAL GOAL OF ACHIEVING A ZERO PERCENT SUICIDE INCIDENT RATE AMONG PATIENTS IN THE NEXT 10 YEARS, COMMUNITY'S ZERO SUICIDE INITIATIVE AIMS TO SAVE HOOSIER LIVES SPECIFICALLY THROUGH EARLY INTERVENTION AND PREVENTION, THE CONSTRUCTION OF A ROBUST CENTRAL INDIANA CRISIS NETWORK AND THE UTILIZATION OF INNOVATIVE MENTAL HEALTH DIAGNOSTICS AND TREATMENT PROTOCOLS. THE STRATEGY BRINGS CRISIS, TELEMEDICINE AND INTENSIVE CARE COORDINATION SERVICES TO MORE THAN 600 PRIMARY CARE PHYSICIANS, 10 EMERGENCY DEPARTMENTS AND 12 HOSPITALS LOCATED THROUGHOUT THE STATE, REPRESENTING BOTH COMMUNITY FACILITIES AND PARTNER ORGANIZATIONS WHERE COMMUNITY PROVIDES BEHAVIORAL HEALTH SERVICES. AS PART OF THE EFFORT TO COMBAT SUICIDE AMONG YOUNG HOOSIERS, COMMUNITY PROVIDES MENTAL HEALTH AND SUBSTANCE ABUSE SERVICES TO STUDENTS IN THE SCHOOL ENVIRONMENT IN MORE THAN 80 SITES FOR INDIANAPOLIS PUBLIC SCHOOLS AND THE METROPOLITAN SCHOOL DISTRICTS OF LAWRENCE, WARREN, WASHINGTON AND WAYNE TOWNSHIPS. IN ADDITION, COMMUNITY HEALTH NETWORK AND WTHR-TV CHANNEL 13 JOINED FORCES TO LAUNCH HAVE HOPE, A TWO-YEAR PUBLIC SERVICE EFFORT TO RAISE AWARENESS ABOUT SUICIDE IN INDIANA AND TO HELP MORE HOOSIERS GET THE HELP THEY NEED. THE HAVE HOPE EFFORT COMPLEMENTS COMMUNITY'S HAVEHOPE.COM, AN ONLINE SUICIDE PREVENTION RESOURCE FOR TEENAGERS, PARENTS AND EDUCATORS. ONE COMMERCIAL OFFERS STATISTICS TO BUILD AWARENESS OF TEEN SUICIDE IN INDIANA. ANOTHER SHARES A MESSAGE WITH PARENTS, TEACHERS, CAREGIVERS AND LOVED ONES ABOUT THE ROLE THEY PLAY IN SUPPORTING THE CHILDREN AND TEENS IN THEIR LIVES. A THIRD COMMERCIAL THAT HAS ALREADY BEEN ON THE AIR HAS BEEN UPDATED AND WILL CONTINUE AS PART OF THE NEW CAMPAIGN. WTHR NEWS STAFF WILL ALSO READ PUBLIC SERVICE ANNOUNCEMENTS.DURING THE ASSESSMENT PHASE WE IDENTIFIED MANY NEEDS THAT FALL OUTSIDE THE EXPERTISE OF THE HEALTH SYSTEM AND ITS CORE COMPETENCIES. EXAMPLES OF NEEDS IDENTIFIED BUT FALLING OUTSIDE OF THE HEALTH SYSTEM CORE COMPETENCIES INCLUDE LONG COMMUTE TIMES, LACK OF BACHELOR DEGREE ATTAINMENT, AND READING AT GRADE LEVEL. WHILE SOME OF OUR PROGRAMS MAY SYSTEMICALLY IMPROVE NEEDS SUCH AS READING LEVEL OR BACHELOR DEGREE ATTAINMENT, THE PRIORITIZATION PROCESS CRITERIA DICTATES THAT THE HEALTH SYSTEM NARROW ITS FOCUS TO CLINICAL CORE COMPETENCIES. COMMUNITY HOSPITAL OF ANDERSON & MADISON COUNTY - PART V, LINE 16AECOMMUNITY.COM/FINANCIAL-ASSISTANCE-POLICY COMMUNITY HOSPITAL OF ANDERSON & MADISON COUNTY - PART V, LINE 16BECOMMUNITY.COM/FINANCIAL-ASSISTANCE-POLICYCOMMUNITY HOSPITAL OF ANDERSON & MADISON COUNTY - PART V, LINE 16CECOMMUNITY.COM/FINANCIAL-ASSISTANCE-POLICY COMM HOSP OF ANDERSON & MADISON CTY PART V, SECTION B, LINE 16J: CHA PUBLICIZES THE FACT THAT WE HAVE FINANCIAL ASSISTANCE AVAILABLE FOR THOSE WHO CANNOT PAY FOR HEALTHCARE. SIGNS ARE POSTED THROUGHOUT THE HOSPITAL (INCLUDING ER, THE ADMITTING OFFICE, AND THE PATIENT ACCOUNTS OFFICE) LETTING PEOPLE KNOW WE HAVE ASSISTANCE AVAILABLE. OUR CURRENT COMPUTER SYSTEM ALSO PROMPTS ALL PATIENT ACCESS STAFF REGISTERING PATIENTS TO ASK, "WOULD YOU LIKE A COPY OF OUR FINANCIAL ASSISTANCE POLICY?" INFORMATION IS ALSO INCLUDED IN THE ADMISSION PACKET AS WELL AS ON THE CONSENT FORMS AND BILLS IN BOTH ENGLISH AND SPANISH. OUR POLICY IS ALSO POSTED ON OUR WEBSITE. WE HAVE DEDICATED AN ENTIRE PAGE ON OUR WEBSITE TO THOSE WITHOUT INSURANCE. THERE IS ALSO INFORMATION ON OUR BILLING STATEMENTS AND COLLECTION LETTERS INFORMING PATIENTS WE HAVE ASSISTANCE AVAILABLE. IN ADDITION, ALL CUSTOMER SERVICE STAFF AND FINANCIAL COUNSELORS ARE TRAINED TO SCREEN FOR POSSIBLE FINANCIAL ASSISTANCE. PART I, LINE 3C: OTHER INCOME BASED CRITERIA FOR FREE OR DISCOUNTED CARECHA ALSO CONSIDERS THE PATIENT'S MEDICAL INDIGENCY, INSURANCE STATUS, UNDERINSURANCE STATUS, AND RESIDENCY WHEN CONSIDERING THE PATIENT FOR FINANCIAL ASSISTANCE. PART I, LINE 6A: RELATED ORGANIZATION INFORMATIONA COMMUNITY BENEFIT REPORT IS COMPLETED FOR THE COMMUNITY HEALTH NETWORK INCLUDING COMMUNITY HOSPITAL OF ANDERSON AND MADISON COUNTY, INC. ("CHA") AND OTHER TAX-EXEMPT AFFILIATES OF THE NETWORK. PART I, LINE 7: COSTING METHODOLOGY EXPLANATIONA COST TO CHARGE RATIO WAS UTILIZED TO DETERMINE COSTS FOR LINES A THROUGH C IN THE TABLE. THE COST TO CHARGE RATIO WAS DERIVED FROM WORKSHEET 2. LINES E THROUGH I OF THE TABLE ARE BASED ON ACTUAL INCURRED EXPENSES. PART III, LINE 2: BAD DEBT EXPENSE METHODOLOGYTHE COST TO CHARGE RATIO UTILIZED FOR PURPOSES OF REPORTING BAD DEBT COSTS WAS DERIVED FROM WORKSHEET 2 AND IS BASED ON THE ORGANIZATION'S AUDITED FINANCIAL STATEMENTS.ADDITIONALLY, COMMUNITY HEALTH NETWORK ADOPTED A NEW STANDARD RELATED TO REVENUE RECOGNITION AND CODIFIED IN THE FASB ACCOUNTING STANDARDS CODIFICATION ("ASC") AS TOPIC 606 ("ASC 606") IN FISCAL YEAR 2018. BECAUSE OF THE ADOPTION OF THIS STANDARD FROM AN ACCOUNTING PRESENTATION STANDPOINT, THE NETWORK NO LONGER EXPLICITLY REPORTS BAD DEBT EXPENSE ON THE AUDITED FINANCIAL STATEMENTS. HOWEVER, THE NETWORK STILL DOES INCUR A SIGNIFICANT AMOUNT OF ADJUSTMENTS TO PATIENT'S ACCOUNTS FOR THOSE WHO DO NOT PAY THEIR PATIENT BALANCE WHICH RESULTS IN A SIGNIFICANT AND MATERIAL COST TO THE NETWORK. AS SUCH THE NETWORK WILL CONTINUE TO REPORT IN LINE 2 THE AMOUNT OF ADJUSTMENTS RELATED TO ADJUSTMENTS PREVIOUSLY IDENTIFIED AS BAD DEBT. PART III, LINE 3: BAD DEBT EXPENSE, PATIENTS ELIGIBLE FOR ASSISTANCETHE ESTIMATED AMOUNT OF THE ORGANIZATION'S BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATIONS FINANCIAL ASSISTANCE POLICY WAS CALCULATED UTILIZING THE HISTORICAL LEVEL OF PATIENTS THAT WERE DETERMINED AS ELIGIBLE FOR FINANCIAL ASSISTANCE BASED ON A PRESUMPTIVE ELIGIBILITY PROCESS AND APPLYING THIS RATIO TO THE REPORTED BAD DEBT EXPENSE ON THE FINANCIAL STATEMENTS. BAD DEBT SHOULD BE COUNTED AS COMMUNITY BENEFIT AS THIS IS A COST THAT THE NETWORK INCURS AND IS NOT REIMBURSED. FURTHER IT IS ESTIMATED A SIGNIFICANT PORTION OF BAD DEBT RELATES TO THE ACTUAL CHARITY OR LOW INCOME PATIENTS BUTH THEY HAVE NOT APPLIED FOR FINANCIAL ASSISTANCE.PART III, LINE 4:THE AUDITED FINANCIAL STATEMENTS CONTAIN THE FOLLOWING WITHIN THE FOOTNOTES:PATIENT ACCOUNTS RECEIVABLE AT DECEMBER 31, 2019 AND 2018, ARE REPORTED AT THE AMOUNTS THAT REFLECTS THE CONSIDERATION WHICH THE NETWORK EXPECTS TO BE ENTITLED IN EXCHANGE FOR PROVIDIDNG PATIENT CARE, AS FURTHER DESCRIBED IN NOTE 2. THE COLLECTION OF OUTSTANDING RECEIVABLES FOR MEDICARE, MEDICAID, MANAGED CARE AND COMMERCIAL INSURANCE PAYERS, AND PATIENTS IS THE NETWORK'S PRIMARY SOURCE OF CASH AND IS CRITICAL TO THE NETWORK'S OPERATING PERFORMANCE. THE PRIMARY COLLECTION RISKS RELATE TO UNINSURED PATIENT ACCOUNTS AND PATIENT ACCOUNTS FOR WHICH THE PRIMARY INSURANCE CARRIER HAS PAID THE AMOUNTS COVERED BY THE APPLICABLE AGREEMENT, BUT PATIENT RESPONSIBILITY AMOUNTS (DEDUCTIBLES AND COINSURANCE) REMAIN OUTSTANDING. THE NETWORK GRANTS CREDIT WITHOUT COLLATERAL TO ITS PATIENTS, MOST OF WHOM ARE LOCAL RESIDENTS AND ARE INSURED UNDER THIRD-PARTY PAYER AGREEMENTS. THE CONCENTRATION OF NET RECEIVABLES BY PAYER CLASS FOR BOTH PATIENTS AND THIRD-PARTY PAYERS AT DECEMBER 31, 2019 AND 2018 IS AS FOLLOWS. NET RECEIVABLE FOR PATIENTS INCLUDES UNINSURED BALANCES WHICH ARE THE RESPONSIBILITY OF THE PATIENT ASSOCIATED WITH THIRD-PARTY PAYERS LISTED BELOW: 2019 2018MEDICARE 21% 23%MEDICAID 11% 11%MANAGED CARE AND COMMERCIAL INSURANCE 55% 53%PATIENTS 13% 13% 100% 100%CHARITY CARETHE NETWORK MAINTAINS RECORDS TO IDENTIFY AND MONITOR THE LEVEL OF CHARITY CARE IT PROVIDES. THE NETWORK PROVIDES 100% CHARITY CARE TO PATIENTS WHOSE INCOME LEVEL IS EQUAL TO OR BELOW 200% OF THE FEDERAL POVERTY LINE. PATIENTS WITH INCOME LEVELS RANGING FROM 200%-300% OF THE CURRENT YEAR'S FEDERAL POVERTY LEVEL WILL QUALIFY FOR PARTIAL ASSISTANCE DETERMINED BY A SLIDING SCALE. THE NETWORK USES COST AS THE MEASUREMENT BASIS FOR CHARITY CARE DISCLOSURE PURPOSES WITH THE COST BEING IDENTIFIED AS THE DIRECT AND INDIRECT COSTS OF PROVIDING THE CHARITY CARE. CHARITY CARE AT COST WAS $11,870(000) AND $10,719(000) FOR THE YEARS ENDED DECEMBER 31, 2019 AND 2018, RESPECTIVELY. CHARITY CARE COST WAS ESTIMATED ON THE APPLICATION OF THE ASSOCIATED COST-TO-CHARGE RATIOS.PATIENT SERVICE REVENUETHE NETWORK'S REVENUES GENERALLY RELATE TO CONTRACTS WITH PATIENTS IN WHICH THE NETWORK'S PERFORMANCE OBLIGATIONS ARE TO PROVIDE HEALTH CARE SERVICES TO THE PATIENTS. PATIENT SERVICE REVENUE IS REPORTED AT THE AMOUNT THAT REFLECTS THE CONSIDERATION TO WHICH THE NETWORK EXPECTS TO BE ENTITLED IN EXCHANGE FOR PROVIDING PATIENT CARE. THESE AMOUNTS ARE DUE FROM PATIENTS AND THIRD-PARTY PAYERS (INCLUDING GOVERNMENT PROGRAMS AND MANAGED CARE AND COMMERCIAL INSURANCE COMPANIES), AND INCLUDE VARIABLE CONSIDERATION FOR RETROACTIVE REVENUE ADJUSTMENTS DUE TO SETTLEMENT OF AUDITS, REVIEWS, AND INVESTIGATIONS. GENERALLY, THE NETWORK BILLS THE PATIENTS AND THIRD-PARTY PAYERS SEVERAL DAYS AFTER THE SERVICES ARE PERFORMED OR THE PATIENT IS DISCHARGED FROM THE FACILITY. REVENUE IS RECOGNIZED AS PERFORMANCE OBLIGATIONS ARE SATISFIED. THE NETWORK DETERMINES THE TRANSACTION PRICE BASED ON STANDARD CHARGES, REDUCED BY CONTRACTUAL ADJUSTMENTS PROVIDED TO THIRD-PARTY PAYERS, DISCOUNTS PROVIDED TO UNINSURED PATIENTS IN ACCORDANCE WITH THE NETWORK'S POLICY, AND IMPLICIT PRICE CONCESSIONS.PERFORMANCE OBLIGATIONS ARE DETERMINED BASED ON THE NATURE OF THE SERVICES PROVIDED BY THE NETWORK. REVENUE FOR PERFORMANCE OBLIGATIONS SATISFIED OVER TIME IS RECOGNIZED BASED ON ACTUAL CHARGES INCURRED IN RELATION TO TOTAL EXPECTED OR ACTUAL CHARGES. THE NETWORK BELIEVES THAT THIS METHOD PROVIDES A FAITHFUL DEPICTION OF THE TRANSFER OF SERVICES OVER THE TERM OF THE PERFORMANCE OBLIGATION BASED ON THE INPUTS NEEDED TO SATISFY THE OBLIGATION. GENERALLY, PERFORMANCE OBLIGATIONS SATISFIED OVER TIME RELATE TO PATIENTS IN OUR HOSPITALS RECEIVING INPATIENT ACUTE CARE SERVICES. THE NETWORK MEASURES THE PERFORMANCE OBLIGATION FROM ADMISSION INTO THE HOSPITAL TO THE POINT WHEN IT IS NO LONGER REQUIRED TO PROVIDE SERVICES TO THAT PATIENT, WHICH IS GENERALLY AT THE TIME OF DISCHARGE. REVENUE FOR PERFORMANCE OBLIGATIONS SATISFIED AT A POINT IN TIME, WHICH INCLUDES OUTPATIENT SERVICES, IS GENERALLY RECOGNIZED WHEN SERVICES ARE PROVIDED TO OUR PATIENTS AND THE NETWORK DOES NOT BELIEVE IT IS REQUIRED TO PROVIDE ADDITIONAL SERVICES TO THE PATIENT.BECAUSE ALL OF ITS PERFORMANCE OBLIGATIONS RELATE TO CONTRACTS WITH A DURATION OF LESS THAN ONE YEAR, THE NETWORK HAS ELECTED TO APPLY THE OPTIONAL EXEMPTION PROVIDED IN FASB ASC 606-10-50-14A AND, THEREFORE, IS NOT REQUIRED TO DISCLOSE THE AGGREGATE AMOUNT OF THE TRANSACTION PRICE ALLOCATED TO PERFORMANCE OBLIGATIONS THAT ARE UNSATISFIED OR PARTIALLY UNSATISFIED AT THE END OF THE REPORTING PERIOD. THE UNSATISFIED OR PARTIALLY UNSATISFIED PERFORMANCE OBLIGATIONS REFERRED TO PREVIOUSLY ARE PRIMARILY RELATED TO INPATIENT ACUTE CARE SERVICES AT THE END OF THE REPORTING PERIOD. THE PERFORMANCE OBLIGATIONS FOR THESE CONTRACTS ARE GENERALLY COMPLETED WHEN THE PATIENTS ARE DISCHARGED, WHICH GENERALLY OCCURS WITHIN DAYS OR WEEKS OF THE END OF THE REPORTING PERIOD.THE NETWORK DETERMINES ITS ESTIMATES OF CONTRACTUAL ADJUSTMENTS AND DISCOUNTS BASED ON CONTRACTUAL AGREEMENTS, ITS DISCOUNT POLICIES, AND HISTORICAL EXPERIENCE. MANAGEMENT CONTINUALLY REVIEWS THE CONTRACTUAL ESTIMATION PROCESS TO CONSIDER AND INCORPORATE UPDATES TO LAWS AND REGULATIONS AND THE FREQUENT CHANGES IN MANAGED CARE CONTRACTUAL TERMS RESULTING FROM CONTRACT RENEGOTIATIONS AND RENEWALS. ESTIMATES OF CONTRACTUAL ADJUSTMENTS UNDER MANAGED CARE AND COMMERCIAL INSURANCE PLANS ARE BASED UPON THE PAYMENT TERMS SPECIFIED IN THE RELATED CONTRACTUAL AGREEMENTS. THE PAYMENT ARRANGEMENTS WITH THIRD-PARTY PAYERS PROVIDE FOR PAYMENTS TO THE NETWORK AT AMOUNTS DIFFERENT FROM ITS ESTABLISHED RATES. GENERALLY, PATIENTS WHO ARE COVERED BY THIRD-PARTY PAYERS ARE RESPONSIBLE FOR RELATED DEDUCTIBLES AND COINSURANCE, WHICH VARY IN AMOUNT. THE NETWORK ALSO PROVIDES SERVICES TO UNINSURED PATIENTS, AND OFFERS THOSE UNINSURED PATIENTS A DISCOUNT, EITHER BY POLICY OR LAW, FROM STANDARD CHARGES. THE INITIAL ESTIMATE OF THE TRANSACTION PRICE IS DETERMINED BY REDUCING THE STANDARD CHARGE BY ANY CONTRACTUAL ADJUSTMENTS, DISCOUNTS, AND IMPLICIT PRICE CONCESSIONS. FOR THE YEARS ENDED DECEMBER 31, 2019 AND 2018, ESTIMATED IMPLICIT PRICE CONCESSIONS OF $564,440(000) AND $583,943(000), RESPECTIVELY, WERE RECORDED TO ADJUST REVENUES TO THE ESTIMATED AMOUNTS COLLECTIBLE.ESTIMATED IMPLICIT PRICE CONCESSIONS ARE RECORDED FOR ALL UNINSURED ACCOUNTS, WHICH INCLUDES UNINSURED PATIENTS AND UNINSURED COINSURANCE AND DEDUCTIBLE AMOUNTS FOR PATIENTS WHO HAVE HEALTH CARE COVERAGE, REGARDLESS OF THE AGING OF THOSE ACCOUNTS. THE ESTIMATES FOR IMPLICIT PRICE CONCESSIONS ARE BASED UPON MANAGEMENT'S ASSESSMENT OF HISTORICAL WRITE-OFFS AND EXPECTED NET COLLECTIONS, BUSINESS AND ECONOMIC CONDITIONS, TRENDS IN FEDERAL, STATE AND PRIVATE EMPLOYER HEALTH CARE COVERAGE AND OTHER COLLECTION INDICATORS. MANAGEMENT RELIES ON THE RESULTS OF DETAILED REVIEWS OF HISTORICAL WRITE-OFFS AND COLLECTIONS AS A PRIMARY SOURCE OF INFORMATION IN ESTIMATING THE COLLECTABILITY OF OUR ACCOUNTS RECEIVABLE. THE NETWORK PERFORMS A HINDSIGHT ANALYSIS QUARTERLY, UTILIZING HISTORICAL ACCOUNTS RECEIVABLE COLLECTION AND WRITE-OFF DATA. THE NETWORK BELIEVES ITS QUARTERLY UPDATES TO THE ESTIMATED IMPLICIT PRICE CONCESSION AMOUNTS AT EACH OF ITS HOSPITAL FACILITIES PROVIDE REASONABLE VALUATION ESTIMATES OF THE NETWORK'S REVENUES AND ACCOUNTS RECEIVABLE. PART III, LINE 4: BEGINNING JUNE 2012, THE STATE OF INDIANA OFFERED VOLUNTARY PARTICIPATION IN THE STATE OF INDIANA'S HAF PROGRAM. THE STATE OF INDIANA IMPLEMENTED THIS PROGRAM TO UTILIZE SUPPLEMENTAL REIMBURSEMENT PROGRAMS FOR THE PURPOSE OF PROVIDING REIMBURSEMENT TO PROVIDERS TO OFFSET A PORTION OF THE COST OF PROVIDING CARE TO MEDICAID AND INDIGENT PATIENTS. THIS PROGRAM IS DESIGNED WITH INPUT FROM CMS AND IS FUNDED WITH A COMBINATION OF STATE AND FEDERAL RESOURCES, INCLUDING FEES OR TAXES LEVIED ON THE PROVIDERS.REIMBURSEMENT UNDER THE PROGRAM IS REFLECTED WITHIN PATIENT SERVICE REVENUE AND THE FEES PAID FOR PARTICIPATION IN THE HAF PROGRAM ARE RECORDED IN SUPPLIES AND OTHER EXPENSES WITHIN THE CONSOLIDATED STATEMENTS OF OPERATIONS AND CHANGES IN NET ASSETS. THE FEES AND REIMBURSEMENTS ARE SETTLED MONTHLY. REVENUE RECOGNIZED RELATED TO THE HAF PROGRAM WAS $198,105(000) AND $135,510(000) FOR THE YEARS ENDED DECEMBER 31, 2019 AND 2018, RESPECTIVELY. EXPENSE FOR FEES RELATED TO THE HAF PROGRAM WAS $83,600(000) AND $66,236(000) FOR THE YEARS ENDED DECEMBER 31, 2019 AND 2018, RESPECTIVELY.THE HAF PROGRAM RUNS ON AN ANNUAL CYCLE FROM JULY 1 TO JUNE 30 AND IS EFFECTIVE UNTIL JUNE 30, 2021. THE CONSOLIDATED BALANCE SHEETS AT DECEMBER 31, 2019 AND 2018 INCLUDES LESS THAN ONE MONTH OF HAF ACTIVITY, OR $939[000] AND $1,880[000], RESPECTIVELY, IN ESTIMATED THIRD-PARTY PAYER SETTLEMENTS PAYABLE RELATED TO THE HAF PROGRAM. PART III, LINE 8: MEDICARE EXPLANATIONPER THE 990 INSTRUCTIONS, THE MEDICARE COST REPORT WAS UTILIZED TO DETERMINE THE MEDICARE SHORTFALL. HOWEVER, THE MEDICARE COST REPORT IS NOT REFLECTIVE OF ALL COSTS ASSOCIATED WITH MEDICARE PROGRAMS SUCH AS PHYSICIAN SERVICES AND SERVICES BILLED VIA FREE STANDING CLINICS. FURTHER, THE MEDICARE COST REPORT EXCLUDES REVENUES AND COSTS OF MEDICARE PARTS C AND D. THE MEDICARE COST REPORT IS $6,254,440. AS SUCH, THE TOTAL MEDICARE SHORTFALL FOR ALL MEDICARE PROGRAMS IS $18,876,777. MEDICARE SHORTFALLS SHOULD BE CONSIDERED AS COMMUNITY BENEFIT BECUASE MEDICARE REPRESENTS 54.5% OF THE OVERALL PAYER MIX FOR COMMUNITY HOSPITAL OF ANDERSON AND MADISON COUNTY, INC. PART III, LINE 9B: NOTWITHSTANDING ANY OTHER PROVISION OF ANY OTHER POLICY AT COMMUNITY REGARDING BILLING AND COLLECTION MATTERS, COMMUNITY WILL NOT ENGAGE IN ANY EXTRAORDINARY COLLECTION ACTIONS BEFORE IT MAKES REASONABLE EFFORTS TO DETERMINE WHETHER AN INDIVIDUAL WHO HAS AN UNPAID BILL FROM COMMUNITY IS ELIGIBLE FOR FINANCIAL ASSISTANCE FROM UNDER THIS POLICY. THE ACTIONS COMMUNITY MAY TAKE IN THE EVENT OF NONPAYMENT AND THE PROCESS AND TIME FRAMES FOR TAKING THESE ACTIONS ARE MORE FULLY DESCRIBED IN COMMUNITY'S BILLING AND COLLECTIONS POLICY.PART VI, LINE 2 NEEDS ASSESSMENT:THE IDENTIFICATION OF HEALTH NEEDS FOR CHNW REGIONS WAS CARRIED OUT USING TWO TYPES OF DATA: (1) PRIMARY DATA OBTAINED THROUGH AN ONLINE SURVEY OF CHNW HEALTHCARE PROVIDERS (E.G. PHYSICIANS, NURSES, AND SOCIAL WORKERS) AND A SURVEY OF COMMUNITY RESIDENTS IN EACH CHNW REGION AND (2) SECONDARY DATA FROM THE HEALTHY COMMUNITIES INSTITUTE (HCI) DASHBOARD AND OTHER LOCAL AND NATIONAL AGENCIES (E.G. COUNTY HEALTH RANKINGS). TO SUPPLEMENT THESE DATA AND IDENTIFY POPULATION-SPECIFIC HEALTH NEEDS AMONG COMMUNITY MEMBERS IN THE ANDERSON REGION IN PARTICULAR, FOCUS GROUPS WITH COMMUNITY STAKEHOLDERS WERE CONDUCTED. THESE DATA SOURCES ARE DESCRIBED IN THE FOLLOWING SECTIONS:PRIMARY DATA: THIS ASSESSMENT USED THREE SOURCES OF COMMUNITY INPUT: 1) AN ONLINE SURVEY OF CHNW PROVIDERS; 2) FOCUS GROUPS WITH COMMUNITY STAKEHOLDER ORGANIZATIONS; AND 3) A COMMUNITY SURVEY. IMPORTANTLY, FOCUS GROUPS CONDUCTED FOR THIS CHNA INCLUDED ONE OR MORE REPRESENTATIVES FROM A GOVERNMENTAL HEALTH DEPARTMENT. THE PRIMARY DATA GATHERING AND ANALYSIS PROCESS IS DESCRIBED IN MORE DETAIL BELOW.CHNW PROVIDER SURVEY: AN ONLINE SURVEY OF CHNW HEALTH PROVIDERS WAS CONDUCTED IN APRIL 2018 TO COLLECT CHNW PROVIDER PERCEPTIONS ABOUT WHAT POPULATIONS WERE AT GREATEST SOCIAL/MEDICAL DISADVANTAGE AND WHICH COMMUNITY CIRCUMSTANCES IMPACTING POPULATION HEALTH WERE MOST URGENT. ANY CLINICIAN THAT INTERACTS WITH PATIENTS WAS INVITED TO PARTICIPATE IN THE PROVIDER SURVEY. THE SURVEY WAS DESIGNED BY POLIS AND THE FAIRBANKS SCHOOL OF PUBLIC HEALTH (FSPH) IN PARTNERSHIP WITH CHNW AND IMPLEMENTED USING QUALTRICS, AN ONLINE SURVEY SERVICE. A TOTAL OF 819 CHNW PROVIDERS RESPONDED TO THE SURVEY. SEVEN PERCENT (7%, N=59) OF THOSE NAMED ANDERSON REGION AS THEIR REGION OF PRIMARY PRACTICE OR SERVICE. THE MAJORITY OF THE RESPONDENTS FROM THE ANDERSON REGION WERE A PRIMARY CARE OR SPECIALTY CARE PROVIDER (46% AND 44%, RESPECTIVELY), FOLLOWED BY OTHER, NURSE, AND ADMINISTRATOR (5%, 3%, AND 2%, RESPECTIVELY).FOCUS GROUPS: A FOCUS GROUP WITH COMMUNITY STAKEHOLDER ORGANIZATIONS FROM THE ANDERSON REGION WAS ORGANIZED BY CHNW AND DESIGNED AND CONDUCTED BY FSPH ON MAY 17, 2018. REPRESENTATITVES FROM EIGHTEEN ORGANIZATIONS IN MADISON COUNTY PARTICIPATED IN THE CHNW ANDERSON REGION FOCUS GROUP. A VARIETY OF ORGANIZATION TYPES, INCLUDING SCHOOL SYSTEMS, SOCIAL SERVICES, HEALTHCARE, STATE GOVERNMENT, LAW ENFORCEMENT, AND GOVERNMENTAL PUBLIC HEALTH WERE REPRESENTED IN THE FOCUS GROUPS.FOCUS GROUP PARTICIPANTS WERE ASKED TO INDICATE THE TWO MOST IMPORTANT UNMET NEEDS AFFECTING THE HEALTH OF THEIR COMMUNITY AND THE TWO MOST VULNERABLE POPULATIONS. AT THE END OF THE FOCUS GROUPS, PARTICIPANTS WERE ASKED TO DISCUSS POSSIBLE SOLUTIONS TO ADDRESS THE UNMET NEEDS AMONG THE MOST VULNERABLE POPULATIONS.THE FOLLOWING COMMUNITY STAKEHOLDER ORGANIZATIONS PARTICIPATED IN THE MAY 17, 2018 FOCUS GROUP IN THE ANDERSON REGION:1. ANDERSON IMPACT CENTER2. COMMUNITY HEALTH NETWORK BEHAVIORAL HEALTH3. FRANKTON-LAPEL COMMUNITY SCHOOLS4. COMMUNITY HOSPITAL WOMEN AND CHILDREN HEALTH SERVICES5. EAST CENTRAL INDIANA CASA (COURT APPOINTED SPECIAL ADVOCATES)6. JANE PAULEY COMMUNITY HEALTH CENTERS (THREE IN MADISON COUNTY)7. CHRISTIAN CENTER8. SALVATION ARMY9. LIBERTY CHRISTIAN HIGH SCHOOL10. DOVE HARBOR RESIDENTIAL HOUSING PROGRAM11. MADISON COUNTY HEALTH DEPARTMENT12. COMMUNITY HOSPITAL SEXUAL ASSULT CENTER13. SECOND HARVEST FOOD BANK14. UNITED WAY OF MADISON COUNTY15. OPERATION LOVE MINISTRIES16. MADISON COUNTY SHERIFF'S OFFICE17. MADISON COUNTY COMMUNITY HEALTH CENTER18. INDIANA STATE LEGISLATURE-STATE REPRESENTATIVEKEY INFORMANT INTERVIEWS WERE ALSO CONDUCTED WITH THE STATE OF INDIANA'S TOP HEALTH LEADERS: DIRECTOR OF THE MARION COUNTY PUBLIC HEALTH DEPARTMENT, THE COMMISSIONER FOR THE INDIANA STATE DEPARTMENT OF HEALTH, AND THE FAMILY AND SOCIAL SERVICES ADMINISTRATION.COMMUNITY SURVEY: THE FIVE MAJOR HOSPITAL SYSTEMS IN INDIANAPOLIS REFERRED TO AS THE INDIANAPOLIS HOSPITAL COLLABORATIVE AND INCLUDING CHNW, JOINTLY CONTRACTED THE UNIVERSITY OF EVANSVILLE AND THE INDIANA UNIVERSITY CENTER FOR SURVEY RESEARCH (CSR) TO DESIGN AND CONDUCT A BROAD COMMUNITY SURVEY IN 2018. THIS SURVEY WAS DESIGNED AND CONDUCTED INDEPENDENTLY OF THE CHNA ACTIVITIES CONDUCTED BY POLIS AND FSPH. TWO QUESTIONS FROM THIS SURVEY WERE USED AS MEASURES OF COMMUNITY CONCERN FOR THE CHNW CHNA. ONE QUESTION ASKED RESPONDENTS TO CHOOSE WHAT THEY PERCEIVED AS TOP HEALTH CONCERNS IN THEIR COMMUNITY AND A SECOND QUESTION ASKED RESPONDENTS TO INDICATE HOW IMPORTANT LISTED HEALTH AND COMMUNITY SERVICES WERE FOR THEIR COMMUNITY.AS PART OF THEIR SURVEY EFFORT CSR SELECTED RANDOM ADDRESS-BASED POPULATION SAMPLES FROM EACH OF THE FIVE CHNW REGIONS AND ADMINISTERED A MAIL SURVEY TO THOSE SAMPLES. THE SURVEY RESULTS WERE ALGORITHMICALLY WEIGHTED BY CSR TO CONTROL FOR DIFFERENCES IN THE DEMOGRAPHIC MAKEUP OF SURVEY PARTICIPANTS COMPARED TO THE TOTAL POPULATION OF EACH REGION.IDENTIFICATION OF SIGNIFICANT COMMUNITY HEALTH NEED:COMMUNITY HEALTH NEEDS AND ISSUES PRESENTED IN THIS REPORT WERE CONSIDERED SIGNIFICANT IF THEY WERE IDENTIFIED AS PROBLEMATIC IN TWO OR MORE OF THE PRIMARY AND SECONDARY DATA SOURCES DESCRIBED IN THIS SECTION. FOR EXAMPLE, FOOD INSECURITY WAS MENTIONED AS PROBLEMATIC IN THE PROVIDER SURVEY, IN FOCUS GROUPS, AND IN THE COMMUNITY SURVEY. POVERTY WAS FOUND TO BE ABOVE AVERAGE IN SECONDARY DATA, AND PROVIDERS RESPONDING TO THE PROVIDER SURVEY IDENTIFIED LOW-INCOME/IMPOVERISHED PEOPLE TO BE AT THE "GREATEST DISADVANTAGE" IN THE ANDERSON REGION.DATA LIMITATIONS SECONDARY DATA: ONE OF THE MOST NOTABLE LIMITATIONS OF THE SECONDARY DATA WAS THAT DIFFERENT DATA SOURCES APPLIED DIFFERENT MODELS TO ESTIMATE COMMUNITY HEALTH INDICATORS. SOME INDICATORS WERE BASED ON ADMINISTRATIVE DATA WHILE OTHERS WERE BASED ON SAMPLE SURVEYS. IN ADDITION, SECONDARY DATA WAS SOURCED FROM DIFFERENT DATA YEARS, BASED ON DATA AVAILABILITY. THE YEAR OF THE AVAILABLE DATA RANGED FROM A 2010-2014 FIVE-YEAR AVERAGE IN SOME CASES TO 2018 IN OTHERS.ANOTHER NOTABLE LIMITATION WAS THAT WHEN MORTALITY AND MORBIDITY RATES WERE NOT AVAILABLE, HOSPITALIZATION RATES WERE USED. HOSPITALIZATION RATES ARE AVAILABLE FROM STATE HOSPITAL ASSOCIATIONS AND ARE OFTEN USED AS SURROGATE MEASURES OF COMMUNITY HEALTH NEED. HOSPITALIZATION RATES TYPICALLY ARE BASED ON PATIENT HOME ADDRESS VERSUS TREATMENT LOCATION, WHICH IS APPROPRIATE WHEN ATTEMPTING TO USE THESE RATES TO MEASURE COMMUNITY HEALTH. HOWEVER, A LIMITATION IS THAT HOSPITALIZATION RATES MAY UNDERREPORT THE RATE OF A HEALTH CONDITION BECAUSE HOSPITALIZATION RATES ONLY CAPTURE DATA FROM INDIVIDUALS WHO SEEK HOSPITAL CARE AND DO NOT CAPTURE DATA FROM INDIVIDUALS WHO HAVE THE HEALTH CONDITION BUT DO NOT RECEIVE ASSOCIATED HOSPITAL CARE. ANOTHER LIMITATION IS THAT POPULATIONS WITH CLOSER PROXIMITY TO A HOSPITAL FACILITY MAY BE MORE LIKELY TO SEEK TREATMENT FOR HEALTH CONDITIONS AND, AS SUCH, AREAS WITH A HOSPITAL FACILITY MAY APPEAR TO HAVE POPULATIONS WITH HIGHER RATES OF HEALTH CONDITIONS.ANOTHER LIMITATION WAS THAT THE GEOGRAPHIC LEVEL OF AVAILABLE DATA DID NOT ALWAYS MATCH THE HOSPITAL SERVICE AREA (REGION). CHNW REGIONS WERE DEFINED AS COLLECTIONS OF ZIP CODES BUT NOT ALL DATA ARE AVAILABLE AT THE ZIP CODE LEVEL. IN CASES WHERE ONLY COUNTY-LEVEL DATA WERE AVAILABLE, THE TOTAL POPULATION WITHIN THE INTERSECTIONS OF THE CHNW REGION AND THE COUNTY(IES) WERE USED TO GENERATE WEIGHTED VALUES AND BUILD REGIONAL ESTIMATES.PROVIDER SURVEY: THE PRINCIPAL LIMITATION OF THE PROVIDER SURVEY WAS THAT IT WAS NOT CONDUCTED USING A RANDOM SAMPLING TECHNIQUE AND MAY REFLECT RESPONSE BIAS. THIS MEANS THAT THE RESPONSES WERE NOT NECESSARILY REPRESENTATIVE OF THE FULL POPULATION OF CHNW PROVIDERS. ANOTHER LIMITATION WAS THAT RESPONDENTS WERE ASKED TO SELECT FROM PRE-DEFINED LISTS OF DISADVANTAGED POPULATIONS AND POTENTIAL CONCERNS. WHILE THE LIST OF POSSIBLE CONCERNS WAS DEVELOPED BASED ON EXPERT KNOWLEDGE, IT IS POSSIBLE THAT THERE WERE OTHER CONCERNS THAT WERE NOT LISTED.COMMUNITY SURVEY: A GENERAL LIMITATION OF BROAD COMMUNITY SURVEYS IS THAT PARTICIPATION TENDS TO BE GREATER AMONG RETIREES OR THOSE OTHERWISE UNEMPLOYED COMPARED TO YOUNGER, EMPLOYED PERSONS. STATISTICAL WEIGHTING WAS UTILIZED BY THE INDIANA UNIVERSITY CENTER FOR SURVEY RESEARCH (CSR) TO CORRECT FOR THESE AND OTHER DIFFERENCES. PART VI, LINE 2: ANOTHER LIMITATION THAT SHOULD BE NOTED IS THAT THE COMMUNITY SURVEY DEVIATED ENOUGH FROM THE PROVIDER SURVEY AND SECONDARY DATA SO THAT DIRECT COMPARISONS COULD NOT BE DRAWN. FUTURE ITERATIONS OF THE PROVIDER AND THE COMMUNITY SURVEY SHOULD CONTAIN THE SAME LANGUAGE OPTIONS.IMPLEMENTATION STRATEGY TO ADDRESS SIGNIFICANT HEALTH NEEDS THIS IMPLEMENTATION STRATEGY DESCRIBES HOW THE HOSPITAL PLANS TO ADDRESS THE SIGNIFICANT COMMUNITY HEALTH NEEDS IDENTIFIED IN THE 2018 CHNA. THE HOSPITAL REVIEWED THE CHNA FINDINGS AND APPLIED THE FOLLOWING CRITERIA TO DETERMINE THE MOST APPROPRIATE NEEDS FOR THE ANDERSON REGION TO ADDRESS:1. THE EXTENT TO WHICH THE HOSPITAL HAS RESOURCES AND COMPETENCIES TO ADDRESS THE NEED2. THE IMPACT THAT THE HOSPITAL COULD HAVE ON THE NEED (I.E., THE NUMBER OF LIVES THE HOSPITAL CAN IMPACT)3. THE FREQUENCY WITH WHICH STAKEHOLDERS IDENTIFIED THE NEED AS A SIGNIFICANT PRIORITY4. THE EXTENT OF COMMUNITY SUPPORT FOR THE HOSPITAL TO ADDRESS THE ISSUE AND POTENTIAL FOR PARTNERSHIPS TO ADDRESS THE ISSUEBY APPLYING THESE CRITERIA, THE HOSPITAL DETERMINED THAT IT WOULD ADDRESS THE SIGNIFICANT HEALTH NEEDS IDENTIFIED BY Y (FOR YES) IN THE TABLE THAT FOLLOWS. ISSUES IDENTIFIED BY N (FOR NO) REPRESENT ISSUES THAT THE HOSPITAL DOES NOT PLAN TO ADDRESS DURING THE 2019-2021 TIME-PERIOD.SIGNIFICANT HEALTH NEEDS IDENTIFIED IN THE 2018 CHNA INTEND TO ADDRESS1. SOCIAL DETERMINANT OF HEALTH Y2. MENTAL HEALTH Y3. SERVICES FOR SENIORS N4. SUBSTANCE ABUSE (ALCOHOL) Y5. SUBSTANCE ABUSE (OPIOIDS AND OTHER DRUGS) Y6. OBESITY Y7. ACCESS TO HEALTH SERVICES Y8. CHRONIC DISEASE MANAGEMENT Y9. TOBACCO USE Y10. DIABETES YHEALTH NEEDS NOT ADDRESSEDHEALTH NEEDS NOT IDENTIFIED AS A PRIORITY FALL INTO ONE OF THREE CATEGORIES:1. BEYOND THE SCOPE AND CAPACITY OF CHNW SERVICES2. NEEDS FURTHER INTERVENTION, BUT NO PLANS TO EXPAND COMMUNITY BENEFIT SERVICES AT THIS TIME3. RELY ON COMMUNITY PARTNERS TO LEAD EFFORTS WITH EXPERTISE IN THESE AREAS WITH CHNW IN A SUPPORTING ROLETHE NEEDS IDENTIFIED BELOW ARE NOT SPECIFICALLY INCLUDED IN THE HOSPITAL'S IMPLEMENTATION STRATEGY FOR 2019-2021:1. SERVICES FOR SENIORS: ALIGNMENT WITH SIGNIFICANT HEALTH NEEDS OUTLINED IN THE IMPLEMENTATION STRATEGY.2. MATERNAL AND CHILD HEALTH: ALIGNMENT WITH MENTAL HEALTH, SUBSTANCE USE DISORDER, FOOD INSECURITY AND TOBACCO USE.SECONDARY DATA: THE COMMUNITY HEALTH NETWORK COMMUNITY DASHBOARD DEVELOPED BY HCI WAS USED AS A PRIMARY SOURCE OF SECONDARY DATA. THIS DASHBOARD INCLUDES DATA FROM THE INDIANA HOSPITAL ASSOCIATION, AS WELL AS THE INDIANA STATE DEPARTMENT OF HEALTH, NATIONAL CANCER INSTITUTE, CENTERS FOR DISEASE CONTROL AND PREVENTION, CENTERS FOR MEDICAID AND MEDICARE SERVICES, NATIONAL CENTER FOR HIV/AIDS, VIRAL HEPATITIS, STD AND TB PREVENTION, INSTITUTE FOR HEALTH METRICS AND EVALUATION, COUNTY HEALTH RANKINGS, US CENSUS BUREAU, US DEPARTMENT OF AGRICULTURE, AND OTHER SOURCES.ADDITIONAL STATE AND NATIONAL SECONDARY DATA SOURCES WERE ACCESSED BY THE CHNA TEAM FOR MORE RECENT AND GEOGRAPHICALLY SPECIFIC INFORMATION, INCLUDING THE FOLLOWING: AMERICAN LUNG ASSOCIATION, ANNIE E. CASEY FOUNDATION, CENTERS FOR DISEASE CONTROL AND PREVENTION NATIONAL CENTER FOR HIV/AIDS, VIRAL HEPATITIS, STD, AND TB PREVENTION (CDC-NCHHSTP) ATLAS, COUNTY HEALTH RANKINS, FEEDING AMERICA, HEALTH INDICATORS WAREHOUSE, INDIANA STATE DEPARTMENT OF HEALTH (ISDH), INDIANA UNIVERSITY CENTER FOR HEALTH POLICY, SG2, CLARITAS, US CENSUS BUREAU, THE YOUTH RISK BEHAVIOR SURVEILLANCE SYSTEM, PUBLISHED BY THE CENTERS FOR DISEASE CONTROL. PART VI, LINE 3: COMMUNITY WILL UNDERTAKE THE FOLLOWING EFFORTS TO WIDELY PUBLICIZE ITS FINANCIAL ASSISTANCE POLICY:1) WRITTEN NOTIFICATION - A PLAN LANGUAGE SUMMARY WILL BE POSTED IN EACH PATIENT REGISTRATION AND WAITING AREA AND AVAILABLE ONLINE AT ECOMMUNITY.COM. IN THE CASE OF SERVICES RENDERED IN THE HOME, THE FINANCIAL ASSISTANCE SUMMARY WILL BE PROVIDED TO THE RESPONSIBLE PARTY DURING THE FIRST IN-HOME VISIT. ALL PUBLICATIONS AND INFORMATIONAL MATERIALS RELATED TO THE FINANCIAL ASSISTANCE PROGRAM WILL BE TRANSLATED INTO LANGUAGES APPROPRIATE TO THE POPULATION IN THE SERVICE AREA.2) ORAL NOTIFICATION: ALL POINTS OF ACCESS WILL MAKE EVERY EFFORT TO INFORM EACH RESPONSIBLE PARTY ABOUT THE EXISTENCE OF COMMUNITY'S FINANCIAL ASSISTANCE PROGRAM IN THE APPROPRIATE LANGUAGE DURING ANY PRE-ADMISSION, REGISTRATION, ADMISSION OR DISCHARGE PROCESS. ADDITIONALLY, THE POST-SERVICE COLLECTION PROCESS WILL INTEGRATE NOTIFICATION OF THE AVAILABILITY OF ASSISTANCE INTO THE STANDARD PROCESS WHEN COLLECTION EFFORTS FAIL.3) STATEMENT NOTIFICATIONS: STATEMENTS WILL PROVIDE INFORMATION ABOUT THE FINANCIAL ASSISTANCE PROGRAM.4) "ABOUT YOUR BILL: FREQUENTLY ASKED QUESTIONS:" COPIES OF THESE DOCUMENTS WILL BE AVAILABLE IN PATIENT REGISTRATION AREAS, THROUGH THE BUSINESS OFFICES AND PATIENT FINANCIAL COUNSELORS.5) COMMUNITY WILL MAKE REASONABLE EFFORTS TO INFORM AND NOTIFY RESIDENTS OF THE COMMUNITY SERVED ABOUT THE FINANCIAL ASSISTANCE POLICY IN A MANNER REASONABLY CALCULATED TO REACH THOSE MEMBERS OF THE COMMUNITY WHO ARE MOST LIKELY TO REQUIRE FINANCIAL ASSISTANCE. MODES OF DELIVERY OF THIS INFORMATION MAY INCLUDE NEWSLETTERS, BROCHURES AND/OR THE PROVISION OF ONLINE ACCESS. PART VI, LINE 4: COMMUNITY INFORMATION1. THE CURRENT POPULATION IS 128,928. A FIVE-YEAR TREND (2018-2023) SHOWS POPULATION AT 128,6012. WHITES COMPRISED 84.7% OF THE POPULATION, WITH AFRICAN-AMERICANS AT 8.5%, HISPANIC/LATINOS AT 4.0% AND OTHER RACE OR ETHNICITY AT 2.9%3. THE FASTEST GROWING AGE GROUP IS 65+ AT 11%4. THE ANDERSON REGION WILL EXPERIENCE 0.7% DECLINE IN GROWTH BETWEEN 2018-2023.5. THE ANDERSON REGION HAS ONE OF THE LOWEST MEDIAN HOUSEHOLD INCOMES OF $42,819. PART VI, LINE 5: PROMOTION OF COMMUNITY HEALTHA MAJORITY OF COMMUNITY HEALTH NETWORK'S (COMMUNITY) BOARD OF DIRECTORS IS COMPRISED OF INDEPENDENT COMMUNITY MEMBERS WHO RESIDE IN COMMUNITY'S PRIMARY SERVICE AREAS. COMMUNITY EXTENDS MEDICAL PRIVILEGES TO ALL PHYSICIANS WHO MEET THE CREDENTIALING QUALIFICATIONS NECESSARY FOR APPOINTMENT TO ITS MEDICAL STAFF. COMMUNITY DOES NOT DENY APPOINTMENT BASED ON GENDER, RACE, CREED, OR NATIONAL ORIGIN. COMMUNITY, IN COLLABORATION WITH MARIAN UNIVERSITY OSTEOPATHIC SCHOOL OF MEDICINE, TRAINS THE NEXT GENERATION OF PHYSICIANS IN A LEARNING ENVIRONMENT. COMMUNITY APPLIES SURPLUS FUNDS TO IMPROVEMENTS IN PATIENT CARE, MEDICAL EDUCATION, AND RESEARCH. PART VI, LINE 6: AFFILIATED HEALTH CARE SYSTEMCOMMUNITY HOSPITAL OF ANDERSON & MADISON COUNTY, INC. ("CHA") IS PART OF AN AFFILIATED HEALTH CARE SYSTEM. SEE THE ATTACHED IRS 990 SCHEDULE H SUPPLEMENTAL INFORMATION REPORT FOR HOW CHA IS INVOLVED IN PROMOTING THE HEALTH OF THE COMMUNITY IT SERVES. PART VI, ITEM 7 - STATE FILING OF COMMUNITY BENEFIT REPORT INDIANA 1 ANDERSON FIRE DEPARTMENTCITY OF ANDERSON 120 E 8TH STREET ANDERSON IN 46016 356000939 GOV 35000 FIRE SAFETY TRAINING TRAILER ANDERSON IMPACT CENTER 630 NICHOL AVENUE ANDERSON IN 46016 900521040 501(C)(3) 25000 GENERAL SUPPORT COMMUNITY HEALTH NETWORK FOUNDATION 7330 SHADELAND STATION SUITE 100 INDIANAPOLIS IN 46256 510181688 501(C)(3) 12000 GENERAL SUPPORT COMMUNITY HOSPITAL ANDERSON FOUNDATION 1515 N MADISON AVENUE ANDERSON IN 46011 861053152 501(C)(3) 12048839 GENERAL SUPPORT CORPORATION FOR ECONOMIC DEVELOPMENT 739 MAIN STREET ANDERSON IN 46016 351473675 501(C)(3) 15000 GENERAL SUPPORT FIRST UNITED METHODIST CHURCH 1215 JACKSON STREET ANDERSON IN 46016 350874263 501(C)(3) 18775 BUDDY BAGS HEALTH & HOSPITAL CORPORATION OF MARION COUNTY 3838 N RURAL STREET 8TH FLOOR INDIANAPOLIS IN 46205 356005697 GOV 10000 COVERING KIDS AND FAMILIES OPERATION LOVE MINISTRIES 620 E 21ST STREET ANDERSON IN 46015 311114443 501(C)(3) 6000 GENERAL SUPPORT SECOND HARVEST FOOD BANK OF EAST CENTRAL INDIANA 6621 N OLD SR 3 MUNCIE IN 47303 311111795 501(C)(3) 37500 GENERAL SUPPORT UNITED WAY OF MADISON COUNTY 1201 E 5TH STREET SUITE 1019 ANDERSON IN 46015 351052350 501(C)(3) 40000 GENERAL SUPPORT 10 0 PART I, LINE 2: PROCEDURES FOR MONITORING THE USE OF GRANT FUNDS PRIOR TO THE DISBURSEMENT OF ANY GRANT PROCEEDS, CHA ENSURES THAT THE PURPOSE OF THE GRANT IS CONSISTENT WITH CHA'S CHARITABLE PURPOSES. THE TERMS OF ALL GRANTS REQUIRE THAT THE RECIPIENT EXPEND THE FUNDS SOLELY FOR CHARITABLE PURPOSES. X X X X 1 1 0 0 0 0 0 1 0 JAMES CALLAHAN MD DIRECTOR 0 1650738 0 0 0 151040 0 16800 0 29503 0 1848081 0 0 JASON FAHRLANDER DIRECTOR 0 645348 0 128400 0 26933 0 153691 0 32360 0 986732 0 128400 CAROL WHITESEL VP PATIENT CARE/CNO 145063 0 131925 0 530151 0 7112 0 14718 0 828969 0 68327 0 ELIZABETH S THARP MBA BSN RN PRESIDENT & CEO 360946 0 218951 0 107577 0 72701 0 22626 0 782801 0 157449 0 MICHAEL HARPE VP HUMAN RESOURCES 149949 0 115468 0 477359 0 11200 0 19813 0 773789 0 57128 0 NIGHAT TAHIR MD PHYSICIAN 302002 0 194660 0 645 0 9308 0 22156 0 528771 0 82000 0 JOHN B HARRIS VP OF FINANCE & CFO 270123 0 129080 0 52975 0 45626 0 19144 0 516948 0 83178 0 LEE ANN MCDANIEL CRNA 424496 0 1872 0 31791 0 11177 0 16955 0 486291 0 1872 0 SHERRY SIDWELL COO/VP INTEGRATED SERVICES 232820 0 100247 0 47393 0 38589 0 9614 0 428663 0 62445 0 KENNETH SHAVER MD SVP CHIEF PHYSICIAN EXECUTIVE 0 235427 0 50437 0 16421 0 46022 0 19942 0 368249 0 50437 CLIFFORD BEYLER SENIOR GENERAL COUNSEL 217877 0 10267 0 33647 0 25740 0 9606 0 297137 0 0 0 PART I, LINE 4 - SEVERANCE, NONQUALIFIED, AND EQUITY-BASED PAYMENTS MICHAEL HARPE - SEVERANCE: $461,136 CAROL WHITESEL - SEVERANCE: $502,694 PART I, LINE 4B - SUPPLEMENTAL NONQUALIFIED RETIREMENT PLANS COMMUNITY HEALTH NETWORK, INC. RESTORATION PLAN COMMUNITY HEALTH NETWORK, INC. ("COMMUNITY") ADOPTED THIS COMMUNITY HEALTH NETWORK RESTORATION PLAN ("PLAN") AS OF DECEMBER 1, 2017 TO PROVIDE A SUPPLEMENTAL INCOME FOR RETIREMENT UPON VESTING IN THE BENEFITS AS DESCRIBED IN THE PLAN DOCUMENT. THE PLAN IS DESIGNED UNDER CODE SECTION 457(F) AS A "TOP-HAT PLAN" (I.E. AN UNFUNDED DEFERRED COMPENSATION PLAN MAINTAINED FOR A SELECT GROUP OF MANAGEMENT OR HIGHLY COMPENSATED EMPLOYEES PURSUANT TO SECTIONS 201(2), 301(A)(3) AND 401(A)(1) OF THE EMPLOYEE RETIREMENT INCOME SECURITY ACT OF 1974, AS AMENDED ("ERISA"). ELIGIBILITY: INDIVIDUALS WHO HAVE THE TITLE OF PRESIDENT, SENIOR VICE PRESIDENT OR EXECUTIVE VICE PRESIDENT AND WHOSE PLAN COMPENSATION FOR THE APPLICABLE PLAN YEAR EXCEEDS THE ANNUAL COMPENSATION LIMIT UNDER CODE SECTION 401(A)(17), AS ADJUSTED FROM TIME TO TIME. CONTRIBUTIONS: 1. MATCHING CONTRIBUTIONS: IF A PARTICIPANT RECEIVES THE MAXIMUM PERMISSIBLE MATCHING CONTRIBUTION UNDER THE 401(K) PLAN, THEY WILL RECEIVE A MATCHING CONTRIBUTION IN THE PLAN THAT IS EQUAL TO THEIR COMPENSATION THAT IS GREATER THAN THE 401(K) PLAN LIMIT MULTIPLIED BY THE MAXIMUM PERMITTED MATCHING CONTRIBUTION PERCENTAGE IN THE 401(K) PLAN FOR THAT YEAR. 2. NON-ELECTIVE CONTRIBUTIONS: IF A PARTICIPANT RECEIVES A NON-ELECTIVE CONTRIBUTION IN THE 401(K) PLAN, THEY WILL RECEIVE A NON-ELECTIVE CONTRIBUTION IN THE PLAN THAT IS EQUAL TO THEIR COMPENSATION THAT IS GREATER THAN THE 401(K) PLAN LIMIT MULTIPLIED BY THE NON-ELECTIVE CONTRIBUTION PERCENTAGE IN THE 401(K) PLAN FOR THAT YEAR. NOTE THAT NO NON-ELECTIVE CONTRIBUTIONS ARE CURRENTLY BEING MADE TO THE 401(K) PLAN. CONTRIBUTIONS WILL BE CREDITED TO A PARTICIPANT'S ACCOUNT AS SOON AS ADMINISTRATIVELY FEASIBLE FOLLOWING THE END OF THE PLAN YEAR TO WHICH THE CONTRIBUTIONS RELATE. VESTING: A PARTICIPANT WILL BE 100% VESTED IN HIS ACCOUNT UPON THE EARLIEST TO OCCUR OF THE FOLLOWING: 1. ATTAINMENT OF AGE 65 PRIOR TO SEPARATION FROM SERVICE 2. DISABILITY 3. INVOLUNTARY SEPARATION FROM SERVICE FOR A REASON OTHER THAN FOR CAUSE 4. SEPARATION FROM SERVICE FOR GOOD REASON 5. A NONCOMPETITIVE PARTICIPANT'S COMPLIANCE WITH ALL TERMS OF A NONCOMPETING AGREEMENT, OR 6. DEATH FORFEITURES: IF ACCOUNT IS NOT VESTED AS DESCRIBED ABOVE, THE ACCOUNT WILL BE COMPLETELY FORFEITED. AMOUNTS FORFEITED DURING A PLAN YEAR REMAIN A GENERAL ASSET OF COMMUNITY. PART I, LINE 7 - NON-FIXED PAYMENTS PROVIDED DR. TAHIR IS ELIGIBLE FOR AN INCENTIVE PAYMENT BASED ON PRODUCTIVITY. CHA DEVELOPED ITS COMPENSATION PLAN IN CONJUNCTION WITH AN INDEPENDENT COMPENSATION CONSULTANT. IN ADDITION, THE PLAN WAS APPROVED BY THE CHA EXECUTIVE COMPENSATION COMMITTEE, COMPOSED OF INDEPENDENT OUTSIDE DIRECTORS. IN ADOPTING ITS INCENTIVE BASED COMPENSATION PLAN, CHA (TOGETHER WITH ITS INDEPENDENT COMPENSATION CONSULTANT, ITS EXTERNAL LEGAL COUNSEL, AND THE NETWORK EXECUTIVE COMPENSATION COMMITTEE) CONSIDERED AND APPLIED THE PROVISIONS OF CODE SECTION 4958 (AND THE CORRESPONDING TREASURY REGULATIONS) TO ENSURE THAT ITS COMPENSATION DECISIONS REFLECT ARMS LENGTH, FAIR MARKET TERMS. CERTAIN INDIVIDUALS OF THE LEADERSHIP TEAM PARTICIPATE IN A SENIOR LEADERSHIP INCENTIVE PROGRAM. THE PROGRAM WAS ADOPTED BY CHA'S EXECUTIVE COMPENSATION COMMITTEE, AND IS INTENDED TO INFLUENCE OUTSTANDING PERFORMANCE BY THE SENIOR LEADERS, AS MEASURED AGAINST BOTH ORGANIZATIONAL AND INDIVIDUAL PERFORMANCE. THE PROGRAM IS REVIEWED ANNUALLY BY THE EXECUTIVE COMPENSATION COMMITTEE, WHICH IS COMPOSED OF EXTERNAL BOARD MEMBERS. THE INCENTIVE COMPENSATION THAT IS AWARDED IS INCLUDED IN TOTAL COMPENSATION TO THE EXECUTIVE. THE TOTAL COMPENSATION (INCLUDING ANY PAYMENTS UNDER THE PROGRAM) IS SUBJECT TO THE REVIEW AND APPROVAL OF THE EXECUTIVE COMPENSATION COMMITTEE AND INDEPENDENT COMPENSATION CONSULTANT, IN CONSIDERATION OF CODE SECTION 4958 (AND THE CORRESPONDING TREASURY REGULATIONS) TO ENSURE THAT IT REFLECTS ARMS LENGTH, FAIR MARKET TERMS. SAMUEL SHAVER MD DIRECTOR'S SON 171968 WAGES 0 FORM 990, PART VI, SECTION A, LINE 2 RELATED PARTY INFORMATION AMONG OFFICERS JASON FAHRLANDER AND ARTHUR J. LEAK SERVED AS DIRECTORS AND/OR OFFICERS OF COMMUNITY HEALTH NETWORK, INC. JASON FAHRLANDER RECEIVED COMPENSATION FROM COMMUNITY HEALTH NETWORK, INC. FORM 990, PART VI, SECTION A, LINE 3 MANAGEMENT DELEGATED AMENDED AND RESTATED BYLAWS WERE ADOPTED AS OF MAY 9, 2019 AND THE FOLLOWING ACTIONS NOW REQUIRE, IN ADDITION TO THE APPROVAL OR RECOMMENDATION, AS APPLICABLE, OF THE BOARD, WRITTEN APPROVAL OF THE MEMBER: A) AMENDMENT OF ORGANIZATIONAL DOCUMENTS, B) UNBUDGETED INDEBTEDNESS - THE INCURRENCE OF ANY UNBUDGETED LOANS OR OTHER INDEBTEDNESS IN AN AGGREGRATE AMOUNT GREATER THAN $750,000, C) SIGNIFICANT CHANGES - THE FORMATION OF LEGAL ENTITIES, THE SALE, TRANSFER OR SUBSTANTIAL CHANGE IN USE OF ALL OR SUBSTANTIALLY OF ALL THE ASSETS OF THE CORPORATION, OR THE DIVESTURE, DISSOLUTION, CLOSURE, MERGER, CONSOLIDATION OR REORGANIZATION OF THE CORPORATION, D) ASSET ACQUISITIONS AND SALES ABOVE $500,000, E) DISPOSITION OF ASSETS ON DISSOLUTION, F) CAPITAL AND OPERATING BUDGETS, PLANS, OR FORECASTS, G) AUDITORS - THE SELECTION, EVALUATION AND TERMINATION OF THE INDEPENDENT AUDITING FIRM FOR THE CORPORATION, H) CERTAIN COMPENSATION FOR EMPLOYED PHYSICIANS, THE CORPORATION'S PRESIDENT, AND SENIOR ADMINISTRATORS OR LEADERS OF THE CORPORATION OR INDEPENDENT PHYSICIANS PROVIDING SERVICES TO THE CORPORATION, I) CAPITAL IMPROVEMENTS GREATER THAN THE BUDGETED AMOUNT BY $500,000 PER FISCAL YEAR IN THE AGGREGATE, J) STRATEGIC PLANS, K) PRESIDENT'S EMPLOYMENT, AND L) THE LINES OF BUSINESS - COMMENCEMENT OR DISCONTINUATION OF ANY LINE OF BUSINESS OR HEALTHCARE SERVICES TO BE PROVIDED AT THE CORPORATION'S FACILITIES. PRIOR TO MAY 9, 2019, THERE WAS AN AFFILIATION AGREEMENT EFFECTIVE SEPTEMBER 1, 1996, WHEREBY CHA'S BOARD OF TRUSTEES RETAINED CONTROL OVER MANAGEMENT DUTIES FOR CHA. HOWEVER, FOR THE FOLLOWING GOVERNANCE ITEMS, CHA SENT RECOMMENDATIONS TO THE COMMUNITY HEALTH NETWORK, INC. ("CHNW") BOARD OF DIRECTORS FOR ITS APPROVAL OF THE FOLLOWING: A) STRATEGIC AND OPERATING PLANS; B) ANNUAL OPERATING AND CAPITAL BUDGETS AND ANY UNBUDGETED CAPITAL C) AMENDMENTS TO THE ARTICLES OR BYLAWS OF THE CHA BOARD OF TRUSTEES, THE BYLAWS OF THE CHA MEDICAL STAFF, OR TO THE AFFILIATION AGREEMENT; D) APPOINTMENT AND REMOVAL OF THE CHIEF EXECUTIVE OFFICER OF CHA; E) UNBUDGETED SALES, LEASES OR TRANSFERS OF ASSETS ABOVE $500,000; F) INCURRENCE OF DEBT OTHER THAN IN THE ORDINARY COURSE OF BUSINESS OR IN ACCORDANCE WITH THE OPERATING PLANS, OPERATING BUDGET, OR CAPITAL BUDGET RECOMMENDED BY THE CHA BOARD OF TRUSTEES AND APPROVED BY THE CHNW BOARD OF DIRECTORS; G) CHANGE IN THE MISSION OF CHA; H) ELECTION OF NEW MEMBERS OR REAPPOINTMENT OF CURRENT MEMBERS TO THE CHA BOARD OF TRUSTEES; I) PARTICIPATION IN MANAGED CARE AND OTHER NETWORKS OR AFFILIATIONS; AND J) RELOCATION OF PHYSICIANS EMPLOYED BY OR UNDER CONTRACT WITH CHNW TO MADISON COUNTY. THE AFFILIATION AGREEMENT WAS TERMINATED EFFECTIVE JUNE 1, 2019. FORM 990, PART VI, SECTION A, LINE 4 SIGNIFICANT CHANGES TO GOVERNING DOCUMENTS CHA ADOPTED AMENDED AND RESTATED BYLAWS EFFECTIVE MAY 9, 2019. THE COMPOSITION OF THE BOARD OF DIRECTORS WAS CHANGED TO REQUIRE A MINIMUM OF 5 DIRECTORS AND A MAXIMUM OF 13. THE BYLAWS WERE ALSO REVISED TO STATE THAT THE MEMBER, COMMUNITY HEALTH NETWORK, INC., ACTING THROUGH ITS BOARD OF DIRECTORS, SHALL APPOINT AND REMOVE A MAJORITY OF THE DIRECTORS. THE BOARD SHALL HAVE THE RIGHT TO APPOINT AND REMOVE THE REMAINING DIRECTORS. THE QUALIFICATIONS FOR BOARD MEMBERS CHANGED SO THAT AT LEAST TWO-THIRDS OF THE BOARD MEMBERS MUST BE RESIDENTS OF THE COMMUNITY AND AT LEAST A MAJORITY OF THE BOARD MEMBERS MUST NOT BE EMPLOYEES OF THE MEMBER OF THE CORPORATION. THE AMENDED AND RESTATED BYLAWS AS WELL AS AMENDED AND RESTATED ARTICLES OF INCORPORATION REVISED THE BOARD OF TRUSTEES TO BOARD OF DIRECTORS. FORM 990, PART VI, SECTION A, LINE 6 CLASSES OF MEMBERS OR STOCKHOLDERS COMMUNITY HEALTH NETWORK, INC. ("CHNW") IS THE SOLE MEMBER OF COMMUNITY HOSPITAL OF ANDERSON AND MADISON COUNTY, INC. ("CHA"). CHNW IS AN EXEMPT ORGANIZATION PURSUANT TO SECTION 501(C)(3). FORM 990, PART VI, SECTION A, LINE 7A ELECTION OF MEMBERS AND THEIR RIGHTS PRIOR TO MAY 9, 2019 CHA'S BOARD OF TRUSTEES MEMBERSHIP WAS DETERMINED AS FOLLOWS: A) CHNW, AS THE SOLE MEMBER OF CHA, NOMINATED AND ELECTED ONE MEMBER OF CHA'S BOARD OF TRUSTEES, B) ONE MEMBER OF THE CHA BOARD OF TRUSTEES WAS TO BE THE CHIEF EXECUTIVE OFFICER OF CHA, C) THREE MEMBERS WERE TO BE ACTIVE MEMBERS OF THE CHA MEDICAL STAFF THAT WERE NOMINATED AND ELECTED BY THE CHA MEDICAL STAFF, AND RATIFIED BY THE CHA BOARD OF TRUSTEES, D) THE NINE REMAINING POSITIONS WERE TO BE FILLED BY PERSONS ELECTED BY CHNW'S BOARD OF DIRECTORS, AND E) ADDITIONALLY, THE PRESIDENT OF THE MEDICAL STAFF WAS TO SERVE AS AN EX OFFICIO, NONVOTING MEMBER OF THE BOARD OF TRUSTEES. EFFECTIVE MAY 9, 2019 CHA'S BOARD OF DIRECTORS MEMBERSHIP IS DETERMINED AS FOLLOWS: A) THE BOARD OF DIRECTORS SHOULD HAVE A MINIMUM OF FIVE DIRECTORS AND A MAXIMUM OF THIRTEEN MEMBERS, WITH THE EXACT NUMBER OF DIRECTORS SPECIFIED FROM TIME TO TIME BY RESOLUTION OF THE BOARD. THE MEMBER, CHNW ACTING THROUGH IT'S BOARD OF DIRECTORS, SHALL DIRECTLY APPOINT AND REMOVE A MAJORITY OF THE BOARD. THE BOARD SHALL HAVE THE RIGHT TO APPOINT AND REMOVE THE REMAINING DIRECTORS. B) NO PERSON WHO HAS SERVED AS A BOARD-APPOINTED DIRECTOR SHALL SERVE FOR MORE THAN THREE SUCCESSIVE TERMS. (A PARTIAL TERM SHALL NOT BE REGARDED AS A FULL TERM). C) AT LEAST TWO-THIRDS OF THE MEMBERS OF THE BOARD SHALL BE RESIDENTS OF THE COMMUNITY AND AT LEAST A MAJORITY OF THE BOARD MUST BE RESIDENTS OF THE COMMUNITY WHO ARE NOT EMPLOYEES OF THE MEMBER OR THE CORPORATION. ALL DIRECTORS SHALL COMPLY WITH ALL REQUIREMENTS IMPOSED BY ANY APPLICABLE HEALTH CARE REGULATORY BODY AND SHALL BE SUBJECT TO ALL APPLICABLE SELF-EVALUATION AND QUALIFICATION REQUIREMENTS OF THE MEMBER. FORM 990, PART VI, SECTION A, LINE 7B DECISIONS SUBJECT TO APPROVAL OF MEMBERS PRIOR TO MAY 9, 2019, THE FOLLOWING ITEMS WERE REQUIRED TO BE APPROVED BY CHNW, AS THE SOLE MEMBER OF CHA: A) STRATEGIC AND OPERATING PLANS; B) ANNUAL OPERATING AND CAPITAL BUDGETS AND ANY UNBUDGETED CAPITAL EXPENDITURES; C) AMENDMENTS TO THE ARTICLES OR BYLAWS OF THE CORPORATION AND THE BYLAWS OF THE MEDICAL STAFF OF THE CORPORATION, D) APPOINTMENT AND REMOVAL OF THE CHIEF EXECUTIVE OFFICER OF THE CORPORATION; E) UNBUDGETED SALES, LEASES, OR TRANSFERS OF ASSETS ABOVE $500,000, WHICH AMOUNT MAY BE ADJUSTED FROM TIME TO TIME AS AGREED BY THE BOARD OF TRUSTEES AND THE BOARD OF DIRECTORS OF THE MEMBER, F) INCURRENCE OF DEBT OTHER THAN IN THE ORDINARY COURSE OF BUSINESS OR IN ACCORDANCE WITH THE OPERATING PLANS, OPERATING BUDGET, OR CAPITAL BUDGET RECCOMENDED BY THE BOARD OF TRUSTEES AND APPROVED BY THE BOARD OF DIRECTORS OF THE MEMBER; G) CHANGE IN THE MISSION OF THE CORPORATION; H) ELECTION OF NEW MEMBERS OR REAPPOINTMENT OF CURRENT MEMBERS TO THE BOARD OF TRUSTEES; I) PARTICIPATION IN MANAGED CARE AND OTHER NETWORKS OR AFFILIATIONS; AND J) RELOCATION OF PHYSICIANS EMPLOYED BY OR UNDER CONTRACT WITH THE MEMBER TO MADISON COUNTY.WRITTEN APPROVAL OF THE MEMBER: AMENDED BYLAWS WERE ADOPTED MAY 9, 2019 THAT REQUIRE THE FOLLOWING, IN ADDITION TO THE APPROVAL OR RECOMMENDATION OF THE BOARD, TO HAVE WRITTEN APPROVAL FROM CHNW, THE SOLE MEMBER OF CHA: A) AMENDMENT OF ORGANIZATIONAL DOCUMENTS, B) UNBUDGETED INDEBTEDNESS - THE INCURRENCE OF ANY UNBUDGETED LOANS OR OTHER INDEBTEDNESS IN AN AGGREGRATE AMOUNT GREATER THAN $750,000, C) SIGNIFICANT CHANGES - THE FORMATION OF LEGAL ENTITIES, THE SALE, TRANSFER OR SUBSTANTIAL CHANGE IN USE OF ALL OR SUBSTANTIALLY OF ALL THE ASSETS OF THE CORPORATION, OR THE DIVESTURE, DISSOLUTION, CLOSURE, MERGER, CONSOLIDATION OR REORGANIZATION OF THE CORPORATION, D) ASSET ACQUISITIONS AND SALES ABOVE $500,000, E) DISPOSITION OF ASSETS ON DISSOLUTION, F) CAPITAL AND OPERATING BUDGETS, PLANS, OR FORECASTS, G) AUDITORS - THE SELECTION, EVALUATION AND TERMINATION OF THE INDEPENDENT AUDITING FIRM FOR THE CORPORATION, H) CERTAIN COMPENSATION FOR EMPLOYED PHYSICIANS, THE CORPORATION'S PRESIDENT, AND SENIOR ADMINISTRATORS OR LEADERS OF THE CORPORATION OR INDEPENDENT PHYSICIANS PROVIDING SERVICES TO THE CORPORATION, I) CAPITAL IMPROVEMENTS GREATER THAN THE BUDGETED AMOUNT BY $500,000 PER FISCAL YEAR IN THE AGGREGATE, J) STRATEGIC PLANS, K) PRESIDENT'S EMPLOYMENT, AND L) THE LINES OF BUSINESS - COMMENCEMENT OR DISCONTINUATION OF ANY LINE OF BUSINESS OR HEALTHCARE SERVICES TO BE PROVIDED AT THE CORPORATION'S FACILITIES. FORM 990, PART VI, SECTION B, LINE 11B ORGANIZATION'S PROCESS TO REVIEW FORM 990 CHNW HAS ASSUMED RESPONSIBILITY FOR CHA'S AUDIT, COMPLIANCE, AND EXECUTIVE COMPENSATION MATTERS. CHNW'S BOARD OF DIRECTORS HAS DELEGATED AUTHORITY FOR THE REVIEW OF CHA'S FORM 990 TO TWO COMMITTEES COMPOSED OF INDEPENDENT OUTSIDE DIRECTORS: A) THE NETWORK EXECUTIVE COMPENSATION COMMITTEE REVIEWED THE COMPENSATION ASPECTS OF CHA'S FORM 990, AND B) THE NETWORK FINANCE COMMITTEE REVIEWED THE REMAINDER OF THE CHA'S FORM 990. IN ADDITION, CHA'S OUTSIDE ACCOUNTING FIRM AND LAW FIRM REVIEWED THE FORM 990 PRIOR TO FILING. CHA AND CHNW UTILIZED THIS PROCESS TO ENSURE THAT CHA'S FORM 990 RECEIVED SUBSTANTIVE REVIEW BY DIRECTORS AND PROFESSIONALS WITH SPECIFIC KNOWLEDGE OF CHA'S ACTIVITIES AND EXTENSIVE FINANCIAL, ACCOUNTING, AND TAX EXPERTISE. FORM 990, PART VI, SECTION B, LINE 12C ENFORCEMENT OF CONFLICT OF INTEREST POLICY CHA HAS ADOPTED A CONFLICT OF INTEREST POLICY APPLICABLE TO ALL EMPLOYEES. THE CONFLICT OF INTEREST POLICY REQUIRES EMPLOYEES SUBMIT A CONFLICT OF INTEREST DISCLOSURE FORM UPON EMPLOYMENT WITH CHA AND ON AN ANNUAL BASIS THEREAFTER. PRIOR TO COMPLETING AND SIGNING THE DISCLOSURE, ALL EMPLOYEES MUST READ AND UNDERSTAND CHA'S CONFLICT OF INTEREST POLICY STATEMENT, WHICH PROVIDES THAT NO CHA EMPLOYEE SHALL MAKE A PROFIT BECAUSE OF HIS OR HER POSITION AT CHA. THE DISCLOSURE REQUIRES EMPLOYEES TO DISCLOSE, IN WRITING, ANY KNOWN FINANCIAL INTEREST THAT THE INDIVIDUAL (TOGETHER WITH THEIR SPOUSE AND FAMILY MEMBERS) HAS IN ANY BUSINESS ENTITY THAT CONDUCTS OR WILL POTENTIALLY CONDUCT BUSINESS WITH CHA. EMPLOYEES ARE ALSO REQUIRED TO IMMEDIATELY DISCLOSE TO THE CHA HUMAN RESOURCES DEPARTMENT ANY SUBSEQUENT CHANGES THAT ARISE MID-YEAR AND WOULD OTHERWISE BE REPORTED ON THE ANNUAL DISCLOSURE STATEMENT. IN ADDITION, THE CHA AMENDED AND RESTATED BYLAWS PROVIDES A CONFLICT OF INTEREST POLICY FOR THE CHA BOARD OF DIRECTORS. CHA'S AMENDED AND RESTATED BYLAWS REQUIRES ALL BOARD MEMBERS TO IDENTIFY AND DISCLOSE IN WRITING TO THE CORPORATION, ON AN ANNUAL BASIS, ANY ACTUAL OR POTENTIAL CONFLICTS OF INTEREST WITH THE CORPORATION OF THE MEMBER OR THEIR RESPECTIVE AFFILIATES. FORM 990, PART VI, SECTION B, LINE 15 COMPENSATION PROCESS FOR TOP OFFICIAL CHA HAS A COMPENSATION COMMITTEE COMPOSED OF INDEPENDENT MEMBERS OF ITS BOARD OF DIRECTORS. THE COMPENSATION COMMITTEE IS RESPONSIBLE FOR EVALUATING AND DETERMINING COMPENSATION FOR CHA'S EXECUTIVE PERSONNEL. IN DISCHARGING THESE DUTIES, THE COMPENSATION COMMITTEE APPLIES THE PRINCIPLES OF THE REBUTTABLE PRESUMPTION AS OUTLINED IN CODE SECTION 4958 AND THE CORRESPONDING TREASURY REGULATIONS. MOST NOTABLY, THE COMPENSATION COMMITTEE OBTAINS AND RELIES UPON COMPARABILITY DATA WHEN SETTING COMPENSATION AND CONTEMPORANEOUSLY DOCUMENTS ITS DECISIONS AND THE PROCESS THAT IT EMPLOYS IN WRITING. IN ADDITION, THE COMPENSATION COMMITTEE PERIODICALLY RETAINS AN OUTSIDE COMPENSATION CONSULTANT TO PROVIDE INPUT REGARDING THE APPROPRIATENESS OF CHA'S COMPENSATION DECISIONS. FORM 990, PART VI, LINE 15B - COMPENSATION PROCESS FOR OFFICERS SEE PART VI, LINE 15A ABOVE. FORM 990, PART VI, LINE 16B - JOINT VENTURE PROCEDURE JOINT VENTURE OPERATING AGREEMENTS INVOLVING CHA INCLUDE PROVISIONS TO PROTECT CHA'S TAX-EXEMPT STATUS. EACH AGREEMENT CONTAINS SPECIFIC LANGUAGE RELATED TO THE PROVISION OF HEALTH CARE SERVICES WITH FOCUS ON COMMUNITY HEALTH BENEFIT AND MUST FOLLOW A FORMAL REVIEW PROCESS PRIOR TO CONTRACT EXECUTION. CHA CONTINUALLY ENSURES THAT ITS TAX-EXEMPT STATUS IS PROTECTED BY ACTIVELY PARTICIPATING IN THE GOVERNANCE OF ALL JOINT VENTURES. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS DISCLOSURE EXPLANATION A) THE ARTICLES OF INCORPORATION AND BUSINESS ENTITY REPORT ARE ON FILE WITH THE INDIANA SECRETARY OF STATE AND ARE AVAILABLE TO THE PUBLIC UPON REQUEST TO THE INDIANA SECRETARY OF STATE OR FREE OF CHARGE ON THE SECRETARY OF STATE'S WEBSITE. B) WHILE NOT AVAILABLE TO THE PUBLIC, CHA'S CONFLICT OF INTEREST POLICY IS DESCRIBED IN PART VI, LINE 12C. C) CHA DOES NOT HAVE INDIVIDUALLY AUDITED FINANCIAL STATEMENTS. ITS FINANCIAL RESULTS ARE INCLUDED IN THE CONSOLIDATED FINANCIAL STATEMENTS OF COMMUNITY HEALTH NETWORK, INC. AND AFFILIATES. AS SUCH, THERE ARE NO INDIVIDUAL FINANCIAL STATEMENTS TO POST. CHA DOES FILE THE 990 TAX RETURN ON AN ANNUAL BASIS WHICH IS AVAILABLE UPON REQUEST AND/OR AVAILABLE ON A DELAYED BASIS ON GUIDESTAR.ORG. D) COMMUNITY HEALTH NETWORK, INC. AND AFFILIATES PROVIDE ANY DOCUMENT OPEN TO PUBLIC INSPECTION UPON REQUEST. FORM 990, PART VII - ADDITIONAL INFORMATION PART VII, SECTION B - INDEPENDENT CONTRACTOR DISCLOSURE COMPENSATION TO WR DUNKIN & SON, INC. INCLUDES MATERIAL COSTS. FORM 990, PART IX, LINE 11G PURCHASED SERVICES : PROGRAM SERVICE EXPENSES 53,382,311. MANAGEMENT AND GENERAL EXPENSES 4,073,708. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 57,456,019. 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