COMMUNITY LTC INC: Form 990, tax year 2016

View the entire original 990 at ProPublica ↗

Organization
COMMUNITY LTC INC (EIN 35-1877441)
Tax period
2016-01-01 to 2016-12-31
Filed
2017-11-13
IRS object ID
201723179349305557
Schema version
2016v3.0
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Return2017-11-13T12:13:44-08:00ReturnTs
Tax Period End2016-12-31TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1GORDON & GORDON PCBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line19850 N 950 EAddressLine1Txt
CityBROWNSBURGCityNm
State AbbreviationINStateAbbreviationCd
ZIP46112ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2016-01-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN351877441EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1Community LTC IncBusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlCOMMBusinessNameControlTxt
Phone7652982532PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line11030 South Scatterfield RdAddressLine1Txt
CityAndersonCityNm
State AbbreviationINStateAbbreviationCd
ZIP46012ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonDIANA SMITHPersonNm
Person TitleDIRECTOR OF FINANCEPersonTitleTxt
Phone7652982532PhoneNum
Signature2017-11-08SignatureDt
Discuss With Paid PreparerYes (true)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonDON M GATLIN CPAPreparerPersonNm
Phone3178525292PhoneNum
Preparation2017-11-09PreparationDt
Self EmployedYes (X)SelfEmployedInd

Filing Security Information FilingSecurityInformation

IP Address IPAddress

FieldValueIRS element (for citing)
I Pv4 Address174.231.14.242IPv4AddressTxt
FieldValueIRS element (for citing)
IP2017-11-13IPDt
IP Tm12:13:10IPTm
IP TimezonePSIPTimezoneCd
Filing License TypePFilingLicenseTypeCd
At Submission Creation Device IdC2B05DEBF0568CB039060EDD10E0E692C28F8476AtSubmissionCreationDeviceId
At Submission Filing Device Id14F13AE1DC94D78EA276C2313ECD7A131D4F82BBAtSubmissionFilingDeviceId
FieldValueIRS element (for citing)
Tax2016TaxYr
Build TS2017-02-10 21:41:12ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Address ChangeYes (X)AddressChangeInd

Principal Ofcr Business Name PrincipalOfcrBusinessName

FieldValueIRS element (for citing)
Business Name Line1Elizabeth HarpeBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line11030 South Scatterfield RdAddressLine1Txt
CityAndersonCityNm
State AbbreviationINStateAbbreviationCd
ZIP46012ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$13,235,050GrossReceiptsAmt
Group Return For AffiliatesfalseGroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website AddressN/AWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1993FormationYr
Legal Domicile StateINLegalDomicileStateCd
Activity Or MissionTo provide room, board, and nursing care services as well as assisted living services to elderly citizens of Madison and surrounding counties.ActivityOrMissionDesc
Voting Members Governing Body5VotingMembersGoverningBodyCnt
Voting Members Independent2VotingMembersIndependentCnt
Total Employee403TotalEmployeeCnt
Total Volunteers121TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
PY Contributions Grants$16,000PYContributionsGrantsAmt
CY Contributions Grants$0CYContributionsGrantsAmt
PY Program Service Revenue$12,384,807PYProgramServiceRevenueAmt
CY Program Service Revenue$13,226,721CYProgramServiceRevenueAmt
PY Investment Income$174PYInvestmentIncomeAmt
CY Investment Income$119CYInvestmentIncomeAmt
PY Other Revenue$1,866PYOtherRevenueAmt
CY Other Revenue$8,210CYOtherRevenueAmt
PY Total Revenue$12,402,847PYTotalRevenueAmt
CY Total Revenue$13,235,050CYTotalRevenueAmt
CY Grants And Similar Paid$0CYGrantsAndSimilarPaidAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$10,021,127PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$10,756,450CYSalariesCompEmpBnftPaidAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$716,648PYOtherExpensesAmt
CY Other Expenses$624,689CYOtherExpensesAmt
PY Total Expenses$10,737,775PYTotalExpensesAmt
CY Total Expenses$11,381,139CYTotalExpensesAmt
PY Revenues Less Expenses$1,665,072PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$1,853,911CYRevenuesLessExpensesAmt
Total Assets BOY$14,492,182TotalAssetsBOYAmt
Total Assets EOY$15,948,085TotalAssetsEOYAmt
Total Liabilities BOY$1,619,771TotalLiabilitiesBOYAmt
Total Liabilities EOY$1,236,460TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$12,872,411NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$14,711,625NetAssetsOrFundBalancesEOYAmt
MissionTo provide room, board, andMissionDesc
Significant New Program SrvcfalseSignificantNewProgramSrvcInd
Significant ChangefalseSignificantChangeInd
Expense$10,483,555ExpenseAmt
Revenue$13,226,721RevenueAmt
DescCOMMUNITY LONG TERM CARE, INC. ("CLTC") OPERATES 3 NURSING FACILITIES WITH A TOTAL OF 254 LICENSED BEDS OF WHICH 193 ARE LICENSED AS SKILLED NURSING BEDS AND 2 ASSISTED LIVING FACILITIES, ONE OF WHICH PROVIDES SPECIALLIZED SERVICES FOR RESIDENTS WITH ALZHEIMERS. THE FACILITIES PROVIDE LONG TERM NURSING CARE OR ASSISTED LIVING TO AREA RESIDENTS WHO NEED SUCH SERVICES. CLTC PARTICIPATES IN THE MEDICARE, MEDICAID, TRI-CARE, AND/OR OTHER GOVERNMENT SPONSORED HEALTH CARE PROGRAMS AS WELL AS PRIVATE MANAGED CARE AND OTHER HEALTH INSURANCE PROGRAMS. THE STAFF AT CLTC MAKE EVERY EFFORT TO PROVIDE QUALITY SERVICES TO THE RESIDENTS. OUR GOALS ARE TO 1) MEET OR EXCEED EXPECTATIONS, 2) DISPLAY A POSITIVE AND ENERGETIC ATTITUDE, 3) HONOR THE DIGNITY, VALUE AND INVOLVEMENT OF OTHERS, 4) PROVIDE HIGH QUALITY SERVICES AT A REASONABLE COST, AND 5) CONTINOUSLY IMPROVE OUR SERVICES. AND FINALLY, CLTC HAS A GOVERNING BODY WHICH INCLUDES INDEPENDENT MEMBERS OF THE COMMUNITY.Desc
Total Program Service Expenses$10,483,555TotalProgramServiceExpensesAmt
Described In Section501c3Yes (true)DescribedInSection501c3Ind
Schedule B RequiredfalseScheduleBRequiredInd
Political Campaign ActyfalsePoliticalCampaignActyInd
Lobbying ActivitiesfalseLobbyingActivitiesInd
Subject To Proxy TaxfalseSubjectToProxyTaxInd
Donor Advised FundfalseDonorAdvisedFundInd
Conservation EasementsfalseConservationEasementsInd
Collections Of ArtfalseCollectionsOfArtInd
Credit CounselingfalseCreditCounselingInd
Temp Or Permanent EndowmentsfalseTempOrPermanentEndowmentsInd
Report Land Building EquipmentYes (true)ReportLandBuildingEquipmentInd
Report Investments Other SecfalseReportInvestmentsOtherSecInd
Report Program Related InvstfalseReportProgramRelatedInvstInd
Report Other AssetsfalseReportOtherAssetsInd
Report Other LiabilitiesYes (true)ReportOtherLiabilitiesInd
Include FIN48 FootnotefalseIncludeFIN48FootnoteInd
Independent Audit Fincl StmtfalseIndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtYes (true)ConsolidatedAuditFinclStmtInd
School OperatingfalseSchoolOperatingInd
Foreign OfficefalseForeignOfficeInd
Foreign ActivitiesfalseForeignActivitiesInd
More Than5000 K To OrgfalseMoreThan5000KToOrgInd
More Than5000 K To IndividualsfalseMoreThan5000KToIndividualsInd
Professional FundraisingfalseProfessionalFundraisingInd
Fundraising ActivitiesfalseFundraisingActivitiesInd
Gaming ActivitiesfalseGamingActivitiesInd
Operate HospitalfalseOperateHospitalInd
Grants To OrganizationsfalseGrantsToOrganizationsInd
Grants To IndividualsfalseGrantsToIndividualsInd
Schedule J RequiredYes (true)ScheduleJRequiredInd
Tax Exempt BondsfalseTaxExemptBondsInd
Engaged In Excess Benefit TransfalseEngagedInExcessBenefitTransInd
PY Excess Benefit TransfalsePYExcessBenefitTransInd
Loan OutstandingfalseLoanOutstandingInd
Grant To Related PersonfalseGrantToRelatedPersonInd
Business Rln With Org MemfalseBusinessRlnWithOrgMemInd
Business Rln With Fam MemfalseBusinessRlnWithFamMemInd
Business Rln With Officer EntfalseBusinessRlnWithOfficerEntInd
Deductible Non Cash ContrifalseDeductibleNonCashContriInd
Deductible Art ContributionfalseDeductibleArtContributionInd
Terminate OperationsfalseTerminateOperationsInd
Partial LiquidationfalsePartialLiquidationInd
Disregarded EntityfalseDisregardedEntityInd
Related EntityYes (true)RelatedEntityInd
Related Organization Ctrl EntfalseRelatedOrganizationCtrlEntInd
Transaction With Control EntfalseTransactionWithControlEntInd
Activities Conducted PrtshpfalseActivitiesConductedPrtshpInd
Schedule O RequiredYes (true)ScheduleORequiredInd
IRP Document0IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (true)BackupWthldComplianceInd
Employee403EmployeeCnt
Employment Tax Returns FiledYes (true)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over LimitfalseUnrelatedBusIncmOverLimitInd
Foreign Financial AccountfalseForeignFinancialAccountInd
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTransInd
Taxable Party NotificationfalseTaxablePartyNotificationInd
Nondeductible ContributionsfalseNondeductibleContributionsInd
Quid Pro Quo ContributionsfalseQuidProQuoContributionsInd
Form8282 Property Disposed OffalseForm8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft CntrctfalseRcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft CntrctfalsePayPremiumsPrsnlBnftCntrctInd
Indoor Tanning ServicesfalseIndoorTanningServicesInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members5GoverningBodyVotingMembersCnt
Independent Voting Member2IndependentVotingMemberCnt
Family Or Business RlnfalseFamilyOrBusinessRlnInd
Delegation Of Mgmt DutiesfalseDelegationOfMgmtDutiesInd
Change To Org DocumentsfalseChangeToOrgDocumentsInd
Material Diversion Or MisusefalseMaterialDiversionOrMisuseInd
Members Or StockholdersfalseMembersOrStockholdersInd
Election Of Board MembersYes (true)ElectionOfBoardMembersInd
Decisions Subject To ApprovafalseDecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (true)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (true)MinutesOfCommitteesInd
Officer Mailing AddressYes (true)OfficerMailingAddressInd
Local ChaptersfalseLocalChaptersInd
Form990 Provided To Gvrn BodyYes (true)Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (true)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (true)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (true)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (true)WhistleblowerPolicyInd
Document Retention PolicyYes (true)DocumentRetentionPolicyInd
Compensation Process CEOYes (true)CompensationProcessCEOInd
Compensation Process OtherYes (true)CompensationProcessOtherInd
Investment In Joint VenturefalseInvestmentInJointVentureInd
States Where Copy Of Return Is FldINStatesWhereCopyOfReturnIsFldCd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1Diana SmithBusinessNameLine1Txt
FieldValueIRS element (for citing)
Phone7652982532PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line11030 South Scatterfield RdAddressLine1Txt
CityAndersonCityNm
State AbbreviationINStateAbbreviationCd
ZIP46012ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (7 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtOfficerOfficerInd
ELIZABETH THARP
Director & Pres/CEO0.50Yes (X)$0$370,176$110,613
JOHN HARRIS
Secretary/Treasurer0.50Yes (X)$0$358,532$94,626
MARY JO LEE
Chairman0.50Yes (X)$0$0$0
GARLAND ANTRIM
Member-Board of Directors0.50Yes (X)$0$0$0
DR KELLY CHAMBERS
Member-Board of Directors0.50Yes (X)$0$0$0
ELIZABETH HARPE
Director of Senior Services40.00$132,593$0$3,978Yes (X)
DIANA SMITH
Director of Finance40.00$116,142$0$24,503Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$248,735TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$728,708TotReportableCompRltdOrgAmt
Total Other Compensation$233,720TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K2IndivRcvdGreaterThan100KCnt
Former Ofcr Employees ListedfalseFormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (true)TotalCompGreaterThan150KInd
Compensation From Other SrcsfalseCompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (2 entries)

Address Line1ContractorAddress/USAddress/AddressLine1TxtCityContractorAddress/USAddress/CityNmState AbbreviationContractorAddress/USAddress/StateAbbreviationCdZIPContractorAddress/USAddress/ZIPCdServicesServicesDescCompensationCompensationAmt
Cabinet Crafters
120 S Sheridan StAlexandriaIN46001Custom Cabinets$326,747
M Chaplin & Sons Construction
4532 E 900 NAlexandriaIN46001Construction Work$206,314
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K2CntrctRcvdGreaterThan100KCnt

Program Service Revenue ProgramServiceRevenueGrp

FieldValueIRS element (for citing)
DescProgram Service RevenueDesc
Business623000BusinessCd
Total Revenue Column$13,226,721TotalRevenueColumnAmt
FieldValueIRS element (for citing)
Total Program Service Revenue$13,226,721TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$119TotalRevenueColumnAmt
Exclusion$119ExclusionAmt

Other Revenue Misc OtherRevenueMiscGrp

FieldValueIRS element (for citing)
DescMisc. IncomeDesc
Business623000BusinessCd
Total Revenue Column$8,210TotalRevenueColumnAmt
Exclusion$8,210ExclusionAmt
FieldValueIRS element (for citing)
Other Revenue Total$8,210OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$13,235,050TotalRevenueColumnAmt
Related Or Exempt Func Income$13,226,721RelatedOrExemptFuncIncomeAmt
Exclusion$8,329ExclusionAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$248,735TotalAmt
Program Services$0ProgramServicesAmt
Management And General$248,735ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$8,608,938TotalAmt
Program Services$8,181,736ProgramServicesAmt
Management And General$427,202ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$1,319,726TotalAmt
Program Services$1,214,148ProgramServicesAmt
Management And General$105,578ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$579,051TotalAmt
Program Services$532,727ProgramServicesAmt
Management And General$46,324ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$8TotalAmt
Program Services$0ProgramServicesAmt
Management And General$8ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Interest InterestGrp

FieldValueIRS element (for citing)
Total$56,213TotalAmt
Program Services$56,213ProgramServicesAmt
Management And General$0ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$545,419TotalAmt
Program Services$482,203ProgramServicesAmt
Management And General$63,216ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$375TotalAmt
Program Services$0ProgramServicesAmt
Management And General$375ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$22,674TotalAmt
Program Services$16,528ProgramServicesAmt
Management And General$6,146ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$11,381,139TotalAmt
Program Services$10,483,555ProgramServicesAmt
Management And General$897,584ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$4,684,834BOYAmt
EOY$4,782,645EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$4,784,706BOYAmt
EOY$5,549,651EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$22,815BOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$10,223,407LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$4,607,618LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$4,999,827BOYAmt
EOY$5,615,789EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$14,492,182BOYAmt
EOY$15,948,085EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$180,974BOYAmt
EOY$82,454EOYAmt

Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp

FieldValueIRS element (for citing)
BOY$1,432,229BOYAmt
EOY$1,145,642EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$6,568BOYAmt
EOY$8,364EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$1,619,771BOYAmt
EOY$1,236,460EOYAmt
FieldValueIRS element (for citing)
Organization Follows SFAS117Yes (X)OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

FieldValueIRS element (for citing)
BOY$12,872,411BOYAmt
EOY$14,711,625EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$12,872,411BOYAmt
EOY$14,711,625EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$14,492,182BOYAmt
EOY$15,948,085EOYAmt
FieldValueIRS element (for citing)
Reconcilation Revenue Expnss$1,853,911ReconcilationRevenueExpnssAmt
Prior Period Adjustments-$14,697PriorPeriodAdjustmentsAmt
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or ReviewfalseAccountantCompileOrReviewInd
FS AuditedYes (true)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Consolidated Basis Fincl StmtYes (X)ConsolidatedBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (true)AuditCommitteeInd
Federal Grant Audit RequiredfalseFederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org509a2Yes (X)PubliclySupportedOrg509a2Ind
Public Support Total170$0PublicSupportTotal170Amt

Gross Investment Income170 GrossInvestmentIncome170Grp

FieldValueIRS element (for citing)
Total$0TotalAmt
FieldValueIRS element (for citing)
Public Support CY1700PublicSupportCY170Pct

Gifts Grants Contris Rcvd509 GiftsGrantsContrisRcvd509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus3 Years$3,626CurrentTaxYearMinus3YearsAmt
Total$3,626TotalAmt

Gross Receipts Admissions GrossReceiptsAdmissionsGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$15,282,773CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$14,047,582CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$14,215,973CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$12,384,807CurrentTaxYearMinus1YearAmt
Current Tax Year$13,226,721CurrentTaxYearAmt
Total$69,157,856TotalAmt

Total509 Total509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$15,282,773CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$14,051,208CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$14,215,973CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$12,384,807CurrentTaxYearMinus1YearAmt
Current Tax Year$13,226,721CurrentTaxYearAmt
Total$69,161,482TotalAmt
FieldValueIRS element (for citing)
Public Support Total509$69,161,482PublicSupportTotal509Amt

Gross Investment Income509 GrossInvestmentIncome509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$2,505CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$152CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$197CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$174CurrentTaxYearMinus1YearAmt
Current Tax Year$119CurrentTaxYearAmt
Total$3,147TotalAmt

Investment Income And UBTI InvestmentIncomeAndUBTIGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$2,505CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$152CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$197CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$174CurrentTaxYearMinus1YearAmt
Current Tax Year$119CurrentTaxYearAmt
Total$3,147TotalAmt

Other Income509 OtherIncome509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$290,771CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$858CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$2,881CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$1,866CurrentTaxYearMinus1YearAmt
Current Tax Year$8,210CurrentTaxYearAmt
Total$304,586TotalAmt

Total Support Calendar Year TotalSupportCalendarYearGrp

FieldValueIRS element (for citing)
Total$69,469,215TotalAmt
FieldValueIRS element (for citing)
Public Support CY5090.99560PublicSupportCY509Pct
Public Support PY5090.99520PublicSupportPY509Pct
Investment Income CY0InvestmentIncomeCYPct
Investment Income PY0.00010InvestmentIncomePYPct
Thirty Thr Pct Suprt Tests CY509Yes (X)ThirtyThrPctSuprtTestsCY509Ind

Form990 Schedule A Part VI Form990ScheduleAPartVIGrp

FieldValueIRS element (for citing)
Form And Line ReferencePt III Ln 12FormAndLineReferenceDesc
ExplanationOther Income Part III, Line 12 Description: Other Income 2012: 290771. 2013: 858. 2014: 2881. 2015: 1866. 2016: 8210.ExplanationTxt

Schedule D IRS990ScheduleD

Land LandGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$279,072OtherCostOrOtherBasisAmt
Book Value$279,072BookValueAmt

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$3,742,770OtherCostOrOtherBasisAmt
Depreciation$2,303,125DepreciationAmt
Book Value$1,439,645BookValueAmt

Leasehold Improvements LeaseholdImprovementsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$4,756,180OtherCostOrOtherBasisAmt
Depreciation$1,559,682DepreciationAmt
Book Value$3,196,498BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$1,273,629OtherCostOrOtherBasisAmt
Depreciation$744,811DepreciationAmt
Book Value$528,818BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$171,756OtherCostOrOtherBasisAmt
Book Value$171,756BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$5,615,789TotalBookValueLandBuildingsAmt

Other Liabilities Org OtherLiabilitiesOrgGrp

FieldValueIRS element (for citing)
DescResident FundsDesc
Amt$8,364Amt
FieldValueIRS element (for citing)
Total Liability$8,364TotalLiabilityAmt

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Compensation SurveyYes (X)CompensationSurveyInd
Board Or Committee ApprovalYes (X)BoardOrCommitteeApprovalInd
Severance PaymentfalseSeverancePaymentInd
Supplemental Nonqual Rtr PlanfalseSupplementalNonqualRtrPlanInd
Equity Based Comp ArrngmfalseEquityBasedCompArrngmInd
Comp Based On Revenue Of Flng OrgfalseCompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related OrgsfalseCompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng OrgfalseCompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd OrgsfalseCompBsdNetEarnsRltdOrgsInd
Any Non Fixed PaymentsfalseAnyNonFixedPaymentsInd
Initial Contract ExceptionfalseInitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (2 entries)

Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmtBonus Related OrganizationsBonusRelatedOrganizationsAmtOther Compensation Rltd OrgsOtherCompensationRltdOrgsAmtDeferred Comp Rltd OrgsDeferredCompRltdOrgsAmtNontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmtTotal Compensation Rltd OrgsTotalCompensationRltdOrgsAmtComp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
ELIZABETH THARP
$268,620$38,880$62,676$110,405$208$480,789$32,465
JOHN HARRIS
$244,619$76,920$36,993$68,952$25,674$453,158$76,920

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (57 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Pt VI, Line 7aThree members of the Board of Directors are designated
Pt VI, Line 7adirectors. These designated directors are (1) a member
Pt VI, Line 7aof the Board of Directors, (2) the President and Chief
Pt VI, Line 7aExecutive Officer and (3) the Vice President and Chief
Pt VI, Line 7aFinancial Officer of Community Hospital of Anderson and
Pt VI, Line 7aMadison County, Inc. The remaining two or more directors are
Pt VI, Line 7aindependent members of the community and are elected by the
Pt VI, Line 7aCommunity LTC, Inc. Board of Directors.
Pt VI, Line 12cThe board of directors and key employees are required to
Pt VI, Line 12csign the conflict of interest policy and disclose any
Pt VI, Line 12cconflicts at the beginning of every Board Meeting and
Pt VI, Line 12con an annual basis.
Pt VI, Line 15aTop management compensation of Community Long Term Care
Pt VI, Line 15ais determined by related organization Community Hospital of
Pt VI, Line 15aAnderson and Madison County, Inc.
Pt VI, Line 15aCommunity LTC, Inc. participates in a state and national
Pt VI, Line 15aindustry trade association which conducts an annual wage
Pt VI, Line 15asurvey - this survey is utilized for evaluation of salaries
Pt VI, Line 15aand wages.
Pt VI, Line 15bOther officers compensation of Community Long Term care
Pt VI, Line 15bis determined by related organization Community Hospital of
Pt VI, Line 15bAnderson and Madison County, Inc.
Pt VI, Line 15bCommunity LTC, Inc. participates in a state and national
Pt VI, Line 15bindustry trade association which conducts an annual wage
Pt VI, Line 15bsurvey - this survey is utilized for evaluation of salaries
Pt VI, Line 15band wages.
Pt VI, Line 19A) The articles of incorporation and certificate of
Pt VI, Line 19existence are on file with the Indiana Secretary of State
Pt VI, Line 19and are available to the public upon request to the Indiana
Pt VI, Line 19Secretary of State.
Pt VI, Line 19B) Community LTC, Inc. conflict of interest policy is
Pt VI, Line 19available to the public upon request.
Pt VI, Line 19C) Community LTC, Inc. does not have individually audited
Pt VI, Line 19financial statements. Its financial results are included
Pt VI, Line 19in the consolidated financial statements of Community
Pt VI, Line 19Health Network, Inc. and Affiliates, which are
Pt VI, Line 19audited by an independent accounting firm. As a result there are no
Pt VI, Line 19individual financial statements available to post.
Pt VI, Line 19Community LTC, Inc. does file the Form 990 tax return,
Pt VI, Line 19Medicaid and Medicare Cost Reports with the appropriate
Pt VI, Line 19agencies on an annual basis. The Form 990 tax return is
Pt VI, Line 19available upon request and/or available on a delayed
Pt VI, Line 19basis on GuideStar.com. The Medicaid and Medicare
Pt VI, Line 19Cost Reports are available via Freedom of Information
Pt VI, Line 19Request filed with the applicable agencies.
Pt VI, Line 11bA complete copy of the Form 990 is provided to the members
Pt VI, Line 11bof the board of directors of the organization. The Form 990
Pt VI, Line 11bis reviewed and discussed by the governing body at a meeting
Pt VI, Line 11bbefore finalization and filing.
Form 990, Part VI, Line 9Elizabeth Tharp 1515 N. Madison Ave Anderson IN 46011
Form 990, Part VI, Line 9John Harris 1515 N. Madison Ave Anderson IN 46011
Form 990, Part VI, Line 9Mary Jo Lee P.O. Box 1302 Anderson IN XXX-XX-XXXX
Form 990, Part VI, Line 9Garland Antrim 8562 N 700 W Frankton IN 46044
Form 990, Part VI, Line 9Dr. Kelley Chambers 9739 W. 400N. Noblesville IN 46060
Form 990, Part IX, Line 24eMiscellaneous Expense 4773. 0. 4773. 0.
Form 990, Part IX, Line 24eBank Fees 1373. 0. 1373. 0.
Form 990, Part IX, Line 24eRepairs and maintenance 16528. 16528. 0. 0.

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (13 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdExempt Code SectionExemptCodeSectionTxtPublic Charity StatusPublicCharityStatusTxtBusiness Name Line1DirectControllingEntityName/BusinessNameLine1TxtControlled OrganizationControlledOrganizationInd
Auxiliary of Community Hospital
1515 North Madison AvenueAndersonIN46011356065606SUPPORTIN501C312ANAfalse
Community Hosp Anderson FDN Inc
1515 North Madison AvenueAndersonIN46011861053152SUPPORTIN501C312ACHAYes (true)
Community Hosp of Anderson and Madison County Inc
1515 North Madison AvenueAndersonIN46011351069822HOSPITALIN501C33NAfalse
Community Home Health Services Inc
9894 East 121st StreetFishersIN46037350953467HLTH CAREIN501C310CHNWYes (true)
Community Health Network Inc
7330 Shadeland Station Suite 200IndianapolisIN46256350983617HOSPITALIN501C33NAfalse
Community Health Network Foundation
7240 Shadeland Station Suite 125IndianapolisIN46256510181688SUPPORTIN501C312BCHNWYes (true)
Community HLTH Services of Indiana
7330 Shadeland Station Suite 200IndianapolisIN46256454817436HLTH CAREIN501C33CHNWYes (true)
Community Hospital South Inc
1402 E County Line Road SouthIndianapolisIN46227351088640HOSPITALIN501C33CHNWYes (true)
Community Physicians of IN Inc
7240 Shadeland Station Suite 300IndianapolisIN46256205392766PHY SRVIN501C310CHNWYes (true)
Health Institute of Indiana Inc
3660 Guion RoadIndianapolisIN46222352022402FITNESSIN501C310CHNWYes (true)
Indianapolis Osteopathic Hosp Inc
3630 Guion RoadIndianapolisIN46222351094734HOSPITALIN501C33CHNWYes (true)
Community Howard Regional Health
3500 S Lafountain StreetKokomoIN46902351865344HOSPITALIN501C33CHNWYes (true)
Comm Howard Regional Health FDN
PO Box 9011KokomoIN46904237309596SUPPORTIN501C37NAfalse

Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (17 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdBusiness Name Line1DirectControllingEntityName/BusinessNameLine1TxtPredominant Income TypePredominantIncomeTypeTxtShare Of Total IncomeShareOfTotalIncomeAmtShare Of EOY AssetsShareOfEOYAssetsAmtDisproportionate AllocationsDisproportionateAllocationsIndGeneral Or Managing PartnerGeneralOrManagingPartnerIndOwnershipOwnershipPct
Brownsburg Office Center 2 LLP
321 E NorthfieldBrownsburgIN46112351929859LEASINGINNANA
Community Endoscopy Center
1601 N Madison Avenue Suite 300AndersonIN46011611464136HLTH CAREINNARelated$867,296$538,215falsefalse0.41000
East Campus surgery Center LLC
7330 Shadeland Station Suite 200IndianapolisIN46256352028517SURGERYINNANA
Hamilton Surgery Center LLC
7330 Shadeland Station Suite 200IndianapolisIN46256352061413SURGERYINNANA
Howard Community Surgery CTR LLC
3500 S Lafountain StreetKokomoIN46902352118748SURGERYINNANA
Howard Regional Specialty Care LLC
680 South Fourth StreetLouisvilleKY40202371501021REHABINNANA
North Campus Surgery Centers LLC
7330 Shadeland Station Suite 200IndianapolisIN46256352147088SURGERYINNANA
Indianapolis Endoscopy Center LLC
7353 E 21st StreetIndianapolisIN46219352010874HLTH CAREINNANA
Michigan Surgery Investment LLC
7330 Shadeland Station Suite 200IndianapolisIN46256320147008SURG CTRSINNANA
North Campus Office Associates LP
7330 Shadeland Station Suite 200IndianapolisIN46256351808625RNTL PROPINNANA
CHNJMH Ventures LLC
7330 Shadeland Station Suite 200IndianapolisIN46256462356266DIAG/REHABINNANA
Comm Health Network Rehab Hosp LLC
7343 Clearvista DriveIndianapolisIN46256453414249REHABINNANA
Northwest Surgery Center LLC
7330 Shadeland Station Suite 200IndianapolisIN46256208754071SURGERYINNANA
Pillars Housing LP
3500 S Lafountain StreetKokomoIN46902161652671HOUSINGINNANA
South Campus Surgery Center LLC
1550 East County Line RoadIndianapolisIN46227352038072SURGERYINNANA
Primaria Health LLC
7330 Shadeland Station Suite 200IndianapolisIN46256474728937CONSULTINGINNANA
Northpoint Pediatrics LLC
8101 Clearvista Parkway Suite 185IndianapolisIN46256351960566HLTH CAREINNANA

Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (5 entries)

Address Line1ForeignAddress/AddressLine1TxtCityForeignAddress/CityNmCountryForeignAddress/CountryCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile Foreign CountryLegalDomicileForeignCountryCdBusiness Name Line1DirectControllingEntityName/BusinessNameLine1TxtEntity TypeEntityTypeTxtControlled OrganizationControlledOrganizationIndAddress Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdLegal Domicile StateLegalDomicileStateCd
CHN Assurance Company LTD
PO Box 1051 GTGrand CaymanCJ980418913INSURANCECJNACYes (true)
Westview Delivery System Inc
351910292MGMT SRVCSNACYes (true)3630 Guion RoadIndianapolisIN46222IN
Pillars Community Housing Inc
161652666HOUSINGNAC3500 South Lafountain StreetKokomoIN46902IN
Visionary Enterprises Inc
351538433MGMT SRVCSNAC6626 East 75th StreetIndianapolisIN46250IN
VEI Michigan Inc
300097377MGMT SRVCSNAC940 N Main StreetAnn HarborMI48104MI
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts RyltsfalseReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth OrgfalseGiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth OrgfalseGiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other OrgfalseLoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth OrgfalseLoansOrGuaranteesFromOthOrgInd
Div Related OrganizationfalseDivRelatedOrganizationInd
Asset Sale To Other OrgfalseAssetSaleToOtherOrgInd
Asset Purchase From Other OrgfalseAssetPurchaseFromOtherOrgInd
Asset ExchangefalseAssetExchangeInd
Rental Of Facilities To Oth OrgfalseRentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth OrgYes (true)RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth OrgfalsePerformOfServicesForOthOrgInd
Perform Of Services By Other OrgfalsePerformOfServicesByOtherOrgInd
Sharing Of FacilitiesfalseSharingOfFacilitiesInd
Paid Employees SharingfalsePaidEmployeesSharingInd
Reimbursement Paid To Other OrgYes (true)ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other OrgfalseReimbursementPaidByOtherOrgInd
Transfer To Other OrgfalseTransferToOtherOrgInd
Transfer From Other OrgfalseTransferFromOtherOrgInd

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