COMMUNITY HOSPITAL ANDERSON FOUNDATION INC: Form 990, tax year 2015

View the entire original 990 at ProPublica ↗

Organization
COMMUNITY HOSPITAL ANDERSON FOUNDATION INC (EIN 86-1053152)
Tax period
2015-01-01 to 2015-12-31
Filed
2016-11-15
IRS object ID
201623209349302567
Schema version
2015v2.1
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)
Return2016-11-15T08:22:53-06:00ReturnTs
Tax Period End2015-12-31TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN352032768PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1CASKEY & DAILY PCBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line14745 STATESMEN DRIVE SUITE CAddressLine1Txt
CityINDIANAPOLISCityNm
State AbbreviationINStateAbbreviationCd
ZIP46250ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2015-01-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN861053152EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1COMMUNITY HOSPITAL ANDERSON FDNBusinessNameLine1Txt
Business Name Line2INCBusinessNameLine2Txt
FieldValueIRS element (for citing)
Business Name ControlCOMMBusinessNameControlTxt
Phone7652985133PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line11515 N MADISON AVENUEAddressLine1Txt
CityANDERSONCityNm
State AbbreviationINStateAbbreviationCd
ZIP46011ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonTOM BANNONPersonNm
Person TitleCHF FND OFF JUNE-DECPersonTitleTxt
Phone7652985133PhoneNum
Signature2016-10-31SignatureDt
Discuss With Paid PreparerYes (true)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonJAMES A CASKEY CPA CFPPreparerPersonNm
PTINP00172185PTIN
Phone3175852647PhoneNum
Preparation2016-11-15PreparationDt
FieldValueIRS element (for citing)
Tax2015TaxYr
Build TS2017-02-10 21:41:12ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerTOM BANNONPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line11515 N MADISON STREETAddressLine1Txt
CityANDERSONCityNm
State AbbreviationINStateAbbreviationCd
ZIP46011ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$1,388,914GrossReceiptsAmt
Group Return For AffiliatesfalseGroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website AddressWWW.COMMUNITYANDERSON.COMWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation2001FormationYr
Legal Domicile StateINLegalDomicileStateCd
Activity Or MissionCOMMUNITY HOSPITAL ANDERSON FOUNDATION, INC. IS ENGAGED IN FUND RAISING ACTIVITIES TO ACQUIRE MONIES TO FURTHER THE PURPOSES AND MISSION OF COMMUNITY HOSPITAL OF ANDERSON AND MADISON COUNTY, INC. IN PROVIDING QUALITY MEDICAL CARE AND TREATMENT TO CITIZENS OF ANDERSON AND MADISON COUNTY, INDIANA.ActivityOrMissionDesc
Voting Members Governing Body14VotingMembersGoverningBodyCnt
Voting Members Independent12VotingMembersIndependentCnt
Total Employee2TotalEmployeeCnt
Total Volunteers14TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
PY Contributions Grants$633,374PYContributionsGrantsAmt
CY Contributions Grants$697,550CYContributionsGrantsAmt
CY Program Service Revenue$0CYProgramServiceRevenueAmt
PY Investment Income$150,307PYInvestmentIncomeAmt
CY Investment Income$146,050CYInvestmentIncomeAmt
PY Other Revenue$16,630PYOtherRevenueAmt
CY Other Revenue$3,011CYOtherRevenueAmt
PY Total Revenue$800,311PYTotalRevenueAmt
CY Total Revenue$846,611CYTotalRevenueAmt
PY Grants And Similar Paid$889,774PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$647,588CYGrantsAndSimilarPaidAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$181,767PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$211,091CYSalariesCompEmpBnftPaidAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$137,247PYOtherExpensesAmt
CY Other Expenses$141,367CYOtherExpensesAmt
PY Total Expenses$1,208,788PYTotalExpensesAmt
CY Total Expenses$1,000,046CYTotalExpensesAmt
PY Revenues Less Expenses-$408,477PYRevenuesLessExpensesAmt
CY Revenues Less Expenses-$153,435CYRevenuesLessExpensesAmt
Total Assets BOY$3,501,630TotalAssetsBOYAmt
Total Assets EOY$3,005,860TotalAssetsEOYAmt
Total Liabilities BOY$48,265TotalLiabilitiesBOYAmt
Total Liabilities EOY$69,036TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$3,453,365NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$2,936,824NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part IIIYes (X)InfoInScheduleOPartIIIInd
MissionCOMMUNITY HOSPITAL ANDERSON FOUNDATION, INC. IS ENGAGED IN FUND RAISING ACTIVITIES TO ACQUIRE MONIES TO FURTHER THE PURPOSES AND MISSION OF COMMUNITY HOSPITAL OF ANDERSON AND MADISON COUNTY, INC. IN PROVIDING QUALITY MEDICAL CARE AND TREATMENT TO CITIZENS OF ANDERSON AND MADISON COUNTY, INDIANA.MissionDesc
Significant New Program SrvcfalseSignificantNewProgramSrvcInd
Significant ChangefalseSignificantChangeInd
Expense$602,213ExpenseAmt
Grant$588,863GrantAmt
DescA) PROVIDE CAPITAL IMPROVEMENTS & MEDICAL EQUIPMENT FOR USE BY COMMUNITY HOSPITAL OF ANDERSON AND MADISON COUNTY, INC. AND B) PROVIDE PROGRAMS DESIGNED TO EDUCATE THE PATIENTS OF COMMUNITY HOSPITAL OF ANDERSON AND MADISON COUNTY, INC. CONCERNING THEIR HEALTH NEEDS AND AVAILABLE MEDICAL TREATMENT.Desc

Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp

FieldValueIRS element (for citing)
Expense$85,729ExpenseAmt
DescPROVIDE FINANCIAL ASSISTANCE TO COMMUNITY HOSPITAL ANDERSON EMPLOYEES THROUGH THE HEALTHCARE EMPLOYEES LOAN PROGRAM.Desc

Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp

FieldValueIRS element (for citing)
Expense$10,000ExpenseAmt
Grant$10,000GrantAmt
DescPROVIDE SCHOLARSHIPS AND EDUCATION ASSISTANCE TO COMMUNITY HOSPITAL ANDERSON EMPLOYEES.Desc

Prog Srvc Accom Acty Other ProgSrvcAccomActyOtherGrp

FieldValueIRS element (for citing)
Expense$48,725ExpenseAmt
Grant$48,725GrantAmt
DescPROVIDED FUNDS TO SUPPORT ANDERSON COMMUNITY.Desc
FieldValueIRS element (for citing)
Total Other Prog Srvc Expense$48,725TotalOtherProgSrvcExpenseAmt
Total Other Prog Srvc Grant$48,725TotalOtherProgSrvcGrantAmt
Total Program Service Expenses$746,667TotalProgramServiceExpensesAmt
Described In Section501c3Yes (true)DescribedInSection501c3Ind
Schedule B RequiredYes (true)ScheduleBRequiredInd
Political Campaign ActyfalsePoliticalCampaignActyInd
Lobbying ActivitiesfalseLobbyingActivitiesInd
Subject To Proxy TaxfalseSubjectToProxyTaxInd
Donor Advised FundYes (true)DonorAdvisedFundInd
Conservation EasementsfalseConservationEasementsInd
Collections Of ArtfalseCollectionsOfArtInd
Credit CounselingfalseCreditCounselingInd
Temp Or Permanent EndowmentsYes (true)TempOrPermanentEndowmentsInd
Report Land Building EquipmentfalseReportLandBuildingEquipmentInd
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 ActivitiesYes (true)FundraisingActivitiesInd
Gaming ActivitiesfalseGamingActivitiesInd
Operate HospitalfalseOperateHospitalInd
Grants To OrganizationsYes (true)GrantsToOrganizationsInd
Grants To IndividualsYes (true)GrantsToIndividualsInd
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 EntYes (true)RelatedOrganizationCtrlEntInd
Transaction With Control EntfalseTransactionWithControlEntInd
Trnsfr Exmpt Non Chrtbl Rltd OrgfalseTrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted PrtshpfalseActivitiesConductedPrtshpInd
Schedule O RequiredYes (true)ScheduleORequiredInd
IRP Document6IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (true)BackupWthldComplianceInd
Employee2EmployeeCnt
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
DAF Excess Business HoldingsfalseDAFExcessBusinessHoldingsInd
Taxable DistributionsfalseTaxableDistributionsInd
Distribution To DonorfalseDistributionToDonorInd
Indoor Tanning ServicesfalseIndoorTanningServicesInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members14GoverningBodyVotingMembersCnt
Independent Voting Member12IndependentVotingMemberCnt
Family Or Business RlnfalseFamilyOrBusinessRlnInd
Delegation Of Mgmt DutiesfalseDelegationOfMgmtDutiesInd
Change To Org DocumentsfalseChangeToOrgDocumentsInd
Material Diversion Or MisusefalseMaterialDiversionOrMisuseInd
Members Or StockholdersYes (true)MembersOrStockholdersInd
Election Of Board MembersYes (true)ElectionOfBoardMembersInd
Decisions Subject To ApprovaYes (true)DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (true)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (true)MinutesOfCommitteesInd
Officer Mailing AddressfalseOfficerMailingAddressInd
Local ChaptersfalseLocalChaptersInd
Form990 Provided To Gvrn BodyfalseForm990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (true)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (true)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (true)RegularMonitoringEnfrcInd
Whistleblower PolicyfalseWhistleblowerPolicyInd
Document Retention PolicyYes (true)DocumentRetentionPolicyInd
Compensation Process CEOfalseCompensationProcessCEOInd
Compensation Process OtherfalseCompensationProcessOtherInd
Investment In Joint VenturefalseInvestmentInJointVentureInd
States Where Copy Of Return Is FldINStatesWhereCopyOfReturnIsFldCd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

FieldValueIRS element (for citing)
PersonTOM BANNONPersonNm
Phone7652985414PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line11515 N MADISON AVENUEAddressLine1Txt
CityANDERSONCityNm
State AbbreviationINStateAbbreviationCd
ZIP46011ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (16 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtOfficerOfficerInd
CHARLIE WILLIAMS MD
DIRECTOR3.0040.00Yes (X)$0$312,345$52,154
SUSAN DURBIN
DIRECTOR3.0040.00Yes (X)$0$136,451$10,664
TIM ALFORD DDO
DIRECTOR3.000.00Yes (X)$0$0$0
SHARON ANTRIM
DIRECTOR3.000.00Yes (X)$0$0$0
JONATHON COOK
DIRECTOR3.000.00Yes (X)$0$0$0
DANA DONAHUE
CHAIRMAN3.000.00Yes (X)$0$0$0Yes (X)
BETH ERSKINE
SECRETARY3.000.00Yes (X)$0$0$0Yes (X)
MIKE MONTGOMERY
DIRECTOR3.000.00Yes (X)$0$0$0
MERRELLEN ROBINSON
DIRECTOR3.000.00Yes (X)$0$0$0
PAM SHOOT
DIRECTOR3.000.00Yes (X)$0$0$0
JADA SPARKS
DIRECTOR3.000.00Yes (X)$0$0$0
TONY THANAS
VICE CHAIRMA3.000.00Yes (X)$0$0$0Yes (X)
BILL WATSON
DIRECTOR3.000.00Yes (X)$0$0$0
GEORGEANN WHITWORTH
TREASURER3.000.00Yes (X)$0$0$0Yes (X)
KEITH TRENT
CHF FDN OFF31.0012.00$62,305$26,702$13,058Yes (X)
TOM BANNON
CHF FND OFF31.0012.00$47,980$20,563$29,150Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$110,285TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$496,061TotReportableCompRltdOrgAmt
Total Other Compensation$105,026TotalOtherCompensationAmt
Former Ofcr Employees ListedfalseFormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (true)TotalCompGreaterThan150KInd
Compensation From Other SrcsfalseCompensationFromOtherSrcsInd
Fundraising$44,986FundraisingAmt
Related Organizations$600RelatedOrganizationsAmt
Government Grants$28,017GovernmentGrantsAmt
All Other Contributions$623,947AllOtherContributionsAmt
Total Contributions$697,550TotalContributionsAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$92,268TotalRevenueColumnAmt
Exclusion$92,268ExclusionAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

FieldValueIRS element (for citing)
Securities$567,846SecuritiesAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

FieldValueIRS element (for citing)
Securities$514,064SecuritiesAmt

Gain Or Loss GainOrLossGrp

FieldValueIRS element (for citing)
Securities$53,782SecuritiesAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

FieldValueIRS element (for citing)
Total Revenue Column$53,782TotalRevenueColumnAmt
Exclusion$53,782ExclusionAmt
FieldValueIRS element (for citing)
Fundraising Gross Income$31,250FundraisingGrossIncomeAmt
Contri Rpt Fundraising Event$44,986ContriRptFundraisingEventAmt
Fundraising Direct Expenses$28,239FundraisingDirectExpensesAmt

Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp

FieldValueIRS element (for citing)
Total Revenue Column$3,011TotalRevenueColumnAmt
Exclusion$3,011ExclusionAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$846,611TotalRevenueColumnAmt
Exclusion$149,061ExclusionAmt

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

FieldValueIRS element (for citing)
Total$637,588TotalAmt
Program Services$637,588ProgramServicesAmt

Grants To Domestic Individuals GrantsToDomesticIndividualsGrp

FieldValueIRS element (for citing)
Total$10,000TotalAmt
Program Services$10,000ProgramServicesAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$110,285TotalAmt
Management And General$110,285ManagementAndGeneralAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$86,155TotalAmt
Management And General$86,155ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$600TotalAmt
Management And General$600ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$14,051TotalAmt
Management And General$14,051ManagementAndGeneralAmt

Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp

FieldValueIRS element (for citing)
Total$4,344TotalAmt
Management And General$4,344ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$18,844TotalAmt
Management And General$18,844ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$12,752TotalAmt
Management And General$12,752ManagementAndGeneralAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$5,272TotalAmt
Management And General$5,272ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (3 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmt
"HELP" LOANS$85,729$85,729
ANNUITY PAYMENTS$13,350$13,350
DUES & LICENSES$1,076$1,076

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$1,000,046TotalAmt
Program Services$746,667ProgramServicesAmt
Management And General$253,379ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$57,077BOYAmt
EOY$330,123EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

FieldValueIRS element (for citing)
BOY$3,444,553BOYAmt
EOY$2,675,737EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$3,501,630BOYAmt
EOY$3,005,860EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$4,618BOYAmt
EOY$1,662EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$43,647BOYAmt
EOY$67,374EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$48,265BOYAmt
EOY$69,036EOYAmt
FieldValueIRS element (for citing)
Organization Follows SFAS117Yes (X)OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

FieldValueIRS element (for citing)
BOY$3,453,365BOYAmt
EOY$2,936,824EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$3,453,365BOYAmt
EOY$2,936,824EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$3,501,630BOYAmt
EOY$3,005,860EOYAmt
FieldValueIRS element (for citing)
Reconcilation Revenue Expnss-$153,435ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst-$363,106NetUnrlzdGainsLossesInvstAmt
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)
Supporting Organization509a3Yes (X)SupportingOrganization509a3Ind
Supporting Org Type1Yes (X)SupportingOrgType1Ind
Supported Organizations1SupportedOrganizationsCnt

Supported Org Information SupportedOrgInformationGrp

Supported Organization Name SupportedOrganizationName

FieldValueIRS element (for citing)
Business Name Line1COMMUNITY HOSP OF ANDERSON & MADISON COUNTY INCBusinessNameLine1Txt
FieldValueIRS element (for citing)
EIN351069822EIN
Organization Type3OrganizationTypeCd
Governing Document ListedYes (true)GoverningDocumentListedInd
Support$588,863SupportAmt
Other Support$0OtherSupportAmt
FieldValueIRS element (for citing)
Supported Organizations Total1SupportedOrganizationsTotalCnt
Support Sum$588,863SupportSumAmt
Other Support Sum$0OtherSupportSumAmt

Gifts Grants Contri Rcvd170 GiftsGrantsContriRcvd170Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$464,916CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$581,896CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$628,616CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$633,374CurrentTaxYearMinus1YearAmt
Current Tax Year$697,550CurrentTaxYearAmt
Total$3,006,352TotalAmt

Total Calendar Year170 TotalCalendarYear170Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$464,916CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$581,896CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$628,616CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$633,374CurrentTaxYearMinus1YearAmt
Current Tax Year$697,550CurrentTaxYearAmt
Total$3,006,352TotalAmt
FieldValueIRS element (for citing)
Substantial Contributors Tot$23,057SubstantialContributorsTotAmt
Public Support Total170$2,983,295PublicSupportTotal170Amt

Gross Investment Income170 GrossInvestmentIncome170Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$137,695CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$146,874CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$120,958CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$120,804CurrentTaxYearMinus1YearAmt
Current Tax Year$92,268CurrentTaxYearAmt
Total$618,599TotalAmt

Other Income170 OtherIncome170Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$13,595CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$24,585CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$36,250CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$42,500CurrentTaxYearMinus1YearAmt
Current Tax Year$30,250CurrentTaxYearAmt
Total$147,180TotalAmt
FieldValueIRS element (for citing)
Total Support$3,772,131TotalSupportAmt
Public Support CY1700.79090PublicSupportCY170Pct
Public Support PY1700.78370PublicSupportPY170Pct
Thirty Thr Pct Suprt Tests CY170Yes (X)ThirtyThrPctSuprtTestsCY170Ind

Form990 Sch A Supporting Org Form990SchASupportingOrgGrp

FieldValueIRS element (for citing)
Listed By Name Governing DocfalseListedByNameGoverningDocInd
Suprt Org No IRS DeterminationfalseSuprtOrgNoIRSDeterminationInd
Supported Org Section C456falseSupportedOrgSectionC456Ind
Supported Org Not Organized USfalseSupportedOrgNotOrganizedUSInd
Organization Change Suprt OrgfalseOrganizationChangeSuprtOrgInd
Support Non Supported OrgYes (true)SupportNonSupportedOrgInd
Payment Substantial ContribtrfalsePaymentSubstantialContribtrInd
Loan Disqualified PersonfalseLoanDisqualifiedPersonInd
Controlled Disqualified PrsnfalseControlledDisqualifiedPrsnInd
Disqualified Prsn Controll IntfalseDisqualifiedPrsnControllIntInd
Disqualified Prsn Ownr IntfalseDisqualifiedPrsnOwnrIntInd
Excess Business Holdings RulesfalseExcessBusinessHoldingsRulesInd
Contribution ControllerfalseContributionControllerInd
Contribution FamilyfalseContributionFamilyInd
Contribution35 ControlledfalseContribution35ControlledInd

Form990 Sch A Type1 Suprt Org Form990SchAType1SuprtOrgGrp

FieldValueIRS element (for citing)
Power Appoint Majority Dir TrstYes (true)PowerAppointMajorityDirTrstInd
Operate Benefit Non Suprt OrgfalseOperateBenefitNonSuprtOrgInd

Form990 Schedule A Part VI Form990ScheduleAPartVIGrp (2 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
PART IV, SECTION A, LINE 1COMMUNITY HOSPITAL ANDERSON FOUNDATION, INC. ("CHAF") ARTICLES OF INCORPORATION PROVIDE THAT IT MAY BENEFIT A CLASS OF NONPROFIT CORPORATIONS, THE MAJORITY OF WHOSE DIRECTORS ARE ELECTED BY COMMUNITY HOSPITAL OF ANDERSON AND MADISON COUNTY, INC. ("CHA"). PART IV, LINE 6 - DESCRIPTION OF SUPPORT TO EXTERNAL ENTITY CHAF MADE SMALL GRANTS TO ORGANIZATIONS THAT WERE NOT LISTED BY NAME OR CLASS IN ITS ARTICLES OF INCORPORATION. HOWEVER, THE NAMED SUPPORTED ORGANIZATION, CHA, BENEFITTED DIRECTLY FROM THE GRANTS TO THESE ORGANIZATIONS BECAUSE THE INDIVIDUAL MEMBERS OF THE CHARITABLE CLASS BENEFITTED BY THE GRANTS WERE ALSO MEMBERS OF THE CHARITABLE CLASS SERVED BY CHA, THE NAMED SUPPORTED ORGANIZATION.
SUPPLEMENTAL INFORMATIONPART II, LINE 10 - OTHER INCOME GROSS RECEIPTS FROM FUNDRAISING ACTIVITIES

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

FieldValueIRS element (for citing)
ContributorRESTRICTEDContributorNum

Contributor Business Name ContributorBusinessName

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor US Address ContributorUSAddress

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Total ContributionsRESTRICTEDTotalContributionsAmt

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Donor Advised Funds Held1DonorAdvisedFundsHeldCnt
Donor Advised Funds Contri$7,938DonorAdvisedFundsContriAmt
Donor Advised Funds Grants$1,911DonorAdvisedFundsGrantsAmt
Donor Advised Funds Vl EOY$27,000DonorAdvisedFundsVlEOYAmt
Disclosed Org Leg CtrlfalseDisclosedOrgLegCtrlInd
Disclosed For Charitable PrpsfalseDisclosedForCharitablePrpsInd

CY Endwmt Fund CYEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$3,316,173BeginningYearBalanceAmt
Investment Earnings Or Losses-$210,113InvestmentEarningsOrLossesAmt
Other Expenditures$513,249OtherExpendituresAmt
Administrative Expenses$4,237AdministrativeExpensesAmt
End Year Balance$2,588,574EndYearBalanceAmt

CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$3,703,867BeginningYearBalanceAmt
Investment Earnings Or Losses$158,732InvestmentEarningsOrLossesAmt
Grants Or Scholarships$20,251GrantsOrScholarshipsAmt
Other Expenditures$522,400OtherExpendituresAmt
Administrative Expenses$3,775AdministrativeExpensesAmt
End Year Balance$3,316,173EndYearBalanceAmt

CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$3,623,023BeginningYearBalanceAmt
Investment Earnings Or Losses$383,381InvestmentEarningsOrLossesAmt
Grants Or Scholarships$32,000GrantsOrScholarshipsAmt
Other Expenditures$268,000OtherExpendituresAmt
Administrative Expenses$2,537AdministrativeExpensesAmt
End Year Balance$3,703,867EndYearBalanceAmt

CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$3,358,695BeginningYearBalanceAmt
Investment Earnings Or Losses$542,321InvestmentEarningsOrLossesAmt
Grants Or Scholarships$20,079GrantsOrScholarshipsAmt
Other Expenditures$247,921OtherExpendituresAmt
Administrative Expenses$9,993AdministrativeExpensesAmt
End Year Balance$3,623,023EndYearBalanceAmt

CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$3,438,442BeginningYearBalanceAmt
Investment Earnings Or Losses-$66,313InvestmentEarningsOrLossesAmt
Administrative Expenses$13,434AdministrativeExpensesAmt
End Year Balance$3,358,695EndYearBalanceAmt
FieldValueIRS element (for citing)
Board Designated Balance EOY0.96710BoardDesignatedBalanceEOYPct
Prmnnt Endowment Balance EOY0.03290PrmnntEndowmentBalanceEOYPct
Endowments Held Unrelated OrgfalseEndowmentsHeldUnrelatedOrgInd
Endowments Held Related OrgfalseEndowmentsHeldRelatedOrgInd

Other Liabilities Org OtherLiabilitiesOrgGrp

FieldValueIRS element (for citing)
DescDUE TO AFFILIATESDesc
Amt$67,374Amt
FieldValueIRS element (for citing)
Total Liability$67,374TotalLiabilityAmt

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferenceSCHEDULE D, PAGE 2, PART V, LINE 4FormAndLineReferenceDesc
ExplanationTHE INTENDED USES OF THE ENDOWMENT FUNDS ARE TO PROVIDE EQUIPMENT FOR COMMUNITY HOSPITAL OF ANDERSON AND MADISON COUNTY, INC. ("CHA") AND THE SURROUNDING COMMUNITY. THE FOUNDATION ALSO PROVIDES SCHOLARSHIPS AND OTHER EDUCATIONAL SUPPORT.ExplanationTxt

Schedule G IRS990ScheduleG

Fundraising Event Information FundraisingEventInformationGrp

FieldValueIRS element (for citing)
Event1CHEFS BOY R WEEvent1Nm
Gross Receipts Event1$62,052GrossReceiptsEvent1Amt
Charitable Contri Event1$30,802CharitableContriEvent1Amt
Gross Revenue Event1$31,250GrossRevenueEvent1Amt
Rent Facility Costs Event1$14,185RentFacilityCostsEvent1Amt
Other Direct Expenses Event1$7,684OtherDirectExpensesEvent1Amt
Event2GOLF OUTINGEvent2Nm
Gross Receipts Event2$14,184GrossReceiptsEvent2Amt
Charitable Contri Event2$14,184CharitableContriEvent2Amt
Cash Prizes Event2$1,175CashPrizesEvent2Amt
Food And Beverage Event2$79FoodAndBeverageEvent2Amt
Other Direct Expenses Event2$5,116OtherDirectExpensesEvent2Amt
Gross Receipts Total$76,236GrossReceiptsTotalAmt
Charitable Contributions Tot$44,986CharitableContributionsTotAmt
Gross Revenue Total Events$31,250GrossRevenueTotalEventsAmt
Cash Prizes Total Events$1,175CashPrizesTotalEventsAmt
Rent Fclty Costs Total Events$14,185RentFcltyCostsTotalEventsAmt
Food And Beverage Total Events$79FoodAndBeverageTotalEventsAmt
Oth Direct Expnss Total Events$12,800OthDirectExpnssTotalEventsAmt
Direct Expense Summary Events$28,239DirectExpenseSummaryEventsAmt
Net Income Summary$3,011NetIncomeSummaryAmt

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Grant Records MaintainedYes (true)GrantRecordsMaintainedInd

Recipient Table RecipientTable (5 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdRecipient EINRecipientEINIRC SectionIRCSectionDescCash GrantCashGrantAmtPurpose Of GrantPurposeOfGrantTxt
COMM HOSP OF ANDERSON & MADISON CTY
1515 NORTH MADISON AVENUEANDERSONIN46011351069822501C3$588,863PURCHASE EQUIP/OTHER
ALZHEIMER'S ASSOC OF GREATER IN
50 EAST 91ST STREET SUITE 100INDIANAPOLISIN46240351747836501C3$8,264GENERAL SUPPORT
OPERATION WARM
6 DICKINSON DRIVECHADDS FORDPA19317383663310501C3$7,000COATS FOR KIDS
PROJECT LIFESAVER
PO BOX 3163ANDERSONIN46018273127977501C3$9,988GENERAL SUPPORT
SECOND HARVEST FOOD BANK
6621 N OLD SR 3MUNCIEIN47303311111795501C3$13,789GENERAL SUPPORT
FieldValueIRS element (for citing)
Total501c3 Org5Total501c3OrgCnt

Grants Other Asst To Indiv In US GrantsOtherAsstToIndivInUSGrp

FieldValueIRS element (for citing)
Grant TypeSCHOLARSHIPSGrantTypeTxt
Recipient4RecipientCnt
Cash Grant$10,000CashGrantAmt

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferenceSCHEDULE I, PAGE 1, PART I, LINE 2FormAndLineReferenceDesc
ExplanationSCHOLARSHIPS ARE PAID DIRECTLY TO THE UNIVERSITY FOR A STUDENT IN THE MEDICAL OR NURSING FIELD OF STUDY. TRANSCRIPTS ARE REQUIRED FROM THE SCHOLARSHIP RECIPIENTS AT THE END OF EACH SEMESTER.ExplanationTxt

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Club Dues Or FeesYes (X)ClubDuesOrFeesInd
Written Policy Ref T And E ExpnssYes (true)WrittenPolicyRefTAndEExpnssInd
Substantiation RequiredYes (true)SubstantiationRequiredInd
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 PaymentsYes (true)AnyNonFixedPaymentsInd
Initial Contract ExceptionfalseInitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp

FieldValueIRS element (for citing)
PersonCHARLIE WILLIAMS MDPersonNm
TitleDIRECTORTitleTxt
Compensation Based On Rltd Orgs$280,559CompensationBasedOnRltdOrgsAmt
Bonus Related Organizations$10,270BonusRelatedOrganizationsAmt
Other Compensation Rltd Orgs$21,516OtherCompensationRltdOrgsAmt
Deferred Comp Rltd Orgs$25,676DeferredCompRltdOrgsAmt
Nontaxable Benefits Rltd Orgs$26,478NontaxableBenefitsRltdOrgsAmt
Total Compensation Rltd Orgs$364,499TotalCompensationRltdOrgsAmt
Comp Report Prior990 Rltd Orgs$10,270CompReportPrior990RltdOrgsAmt

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferenceSCHEDULE J, PART IIIFormAndLineReferenceDesc
ExplanationPART I, LINE 1A - FRINGE OR EXPENSE EXPLANATION THE CHIEF FOUNDATION OFFICER WAS PROVIDED SOCIAL CLUB DUES BY COMMUNITY HOSPITAL ANDERSON FOUNDATION. THIS WAS NOT TAXABLE COMPENSATION. PART I, LINE 3 - RELATED ORG METHODS USED FOR COMPENSATION EXPLANATION COMMUNITY HOSPITAL ANDERSON FOUNDATION, INC. CEO/EXECUTIVE DIRECTOR IS PAID BY COMMUNITY HOSPITAL OF ANDERSON AND MADISON COUNTY, INC. ("CHA"), A RELATED 501(C)(3) ORGANIZATION. CHA USES THE FOLLOWING IN DETERMINING THE CEO'S COMPENSATION: 1) COMPENSATION COMMITTEE, 2) INDEPENDENT COMPENSATION CONSULTANT, 3) COMPENSATION SURVEY OR STUDY, AND 4) APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE PART I, LINE 7 - NON-FIXED PAYMENTS PROVIDED THE CHIEF FOUNDATION OFFICER PARTICIPATES IN A SENIOR LEADERSHIP INCENTIVE PROGRAM. THE PROGRAM WAS ADOPTED BY THE COMMUNITY HOSPITAL OF ANDERSON AND MADISON COUNTY, INC'S ("CHA") EXECUTIVE COMPENSATION COMMITTEE, AND IS INTENDED TO INFLUENCE OUTSTANDING PERFORMANCE, AS MEASURED AGAINST BOTH ORGANIZATIONAL AND INDIVIDUAL PERFORMANCE. THE PROGRAM IS REVIEWED ANNUALLY BY CHA'S 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 COMPENSATION CONSULTANT, IN CONSIDERATION OF CODE 4958 (AND THE CORRESPONDING TREASURY REGULATIONS) TO ENSURE THAT IT REFLECTS ARMS LENGTH, FAIR MARKET TERMS.ExplanationTxt

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (9 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990 - ORGANIZATION'S MISSIONCOMMUNITY HOSPITAL ANDERSON FOUNDATION, INC. IS ENGAGED IN FUND RAISING ACTIVITIES TO ACQUIRE MONIES TO FURTHER THE PURPOSES AND MISSION OF COMMUNITY HOSPITAL OF ANDERSON AND MADISON COUNTY, INC. IN PROVIDING QUALITY MEDICAL CARE AND TREATMENT TO CITIZENS OF ANDERSON AND MADISON COUNTY, INDIANA.
FORM 990, PAGE 2, PART III, LINE 4DPROVIDED FUNDS TO SUPPORT ANDERSON COMMUNITY.
FORM 990, PAGE 6, PART VI, LINE 6THE MEMBERS CONSIST OF THE BOARD OF DIRECTORS OF COMMUNITY HOSPITAL OF ANDERSON AND MADISON COUNTY, INC.
FORM 990, PAGE 6, PART VI, LINE 7ATHE FOUNDATION'S ARTICLES OF INCORPORATION STATE THE "MEMBERS" OF THE FOUNDATION ARE THE BOARD OF TRUSTEES OF COMMUNITY HOSPITAL OF ANDERSON AND MADISON COUNTY, INC. THEY ARE THE ONES WHO OFFICIALLY ELECT FOUNDATION BOARD OF DIRECTORS. THE BY-LAWS ALSO GIVE THE MEMBERS THE RIGHT TO FILL ANY VACANCY AMONG THE DIRECTORS AND THE RIGHT TO REMOVE ANY DIRECTOR.
FORM 990, PAGE 6, PART VI, LINE 7BTHE FOUNDATION'S ARTICLES OF INCORPORATION STATE THE "MEMBERS" OF THE FOUNDATION ARE THE BOARD OF TRUSTEES OF COMMUNITY HOSPITAL OF ANDERSON AND MADISON COUNTY, INC. THEY ARE THE ONES WHO OFFICIALLY ELECT THE FOUNDATION BOARD OF DIRECTORS. THE MEMBERS ALSO MUST APPROVE ANY AMENDMENT TO THE ARTICLES OF INCORPORATION. THE FOUNDATION BOARD OF DIRECTORS APPROVE ALL OTHER MATTERS RELATED TO THE FOUNDATION WITHOUT AUTHORIZATION OR APPROVAL OF THE MEMBERS OF THE FOUNDATION.
FORM 990, PAGE 6, PART VI, LINE 11BCOMMUNITY HEALTH NETWORK, INC. ("CHNW") HAS ASSUMED RESPONSIBILITY FOR CHAF'S AUDIT AND COMPLIANCE MATTERS. CHNW'S BOARD OF DIRECTORS HAS DELEGATED AUTHORITY FOR THE REVIEW OF CHAF'S FORM 990 TO TWO COMMITTEES COMPOSED OF INDEPENDENT OUTSIDE DIRECTORS: A) THE CHNW EXECUTIVE COMPENSATION COMMITTEE REVIEWED THE COMPENSATION ASPECTS OF CHAF'S FORM 990, AND B) THE CHNW FINANCE COMMITTEE REVIEWED THE REMAINDER OF THE FORM 990. IN ADDITION, CHAF'S OUTSIDE ACCOUNTING FIRM AND LAW FIRM REVIEWED THE FORM 990 PRIOR TO FILING. CHAF AND CHNW UTILIZED THIS PROCESS TO ENSURE THAT CHAF'S FORM 990 RECEIVED SUBSTANTIVE REVIEW BY DIRECTORS AND PROFESSIONALS WITH SPECIFIC KNOWLEDGE OF CHAF'S ACTIVITIES AND EXTENSIVE FINANCIAL, ACCOUNTING, AND TAX EXPERTISE.
FORM 990, PAGE 6, PART VI, LINE 12CCOMMUNITY HOSPITAL ANDERSON FOUNDATION, INC. MONITORS THE CONFLICT OF INTEREST POLICY BY MAKING SURE THAT THE FOUNDATION BOARD MEMBERS SIGN A CONFLICT OF INTEREST STATEMENT ANNUALLY. THE EXECUTIVE COMMITTEE, WHICH CONSISTS OF THE OFFICERS, WOULD ADDRESS ANY CONFLICTS OF INTEREST. THE ANNUAL DISCLOSURE REQUIRES BOARD MEMBERS TO DISCLOSE, IN WRITING, ANY KNOWN FINANCIAL INTEREST THAT THE INDIVIDUAL (TOGETHER WITH FAMILY MEMBERS) HAS IN ANY BUSINESS ENTITY THAT TRANSACTS BUSINESS WITH CHAF. IN ADDITION, BOARD MEMBERS ARE REQUIRED TO IMMEDIATELY DISCLOSE ANY POSSIBLE CONFLICT OF INTEREST THAT ARISES MID-YEAR IN RELATION TO A PROPOSED TRANSACTION. THE CONFLICT OF INTEREST POLICY REQUIRES THAT ANY INDIVIDUAL WITH A CONFLICT BE RECUSED FROM THE DECISION MAKING PROCESS, THAT INDEPENDENT DIRECTORS OR COMMITTEE MEMBERS DETERMINE THAT THE PROPOSED TRANSACTION IS IN THE BEST INTEREST OF CHAF, AND THE TRANSACTION MUST BE APPROVED BY A VOTE OF INDEPENDENT DIRECTORS OR COMMITTEE MEMBERS WITHOUT THE PARTICIPATION OF ANY INTERESTED INDIVIDUAL. FORM 990, PART VI, LINE 13 - WRITTEN WHISTLEBLOWER POLICY WHILE NO FORMAL WRITTEN POLICY EXISTS, CHAF'S WHISTLEBLOWER APPROACH IS AS FOLLOWS: A) ANNUALLY ALL EMPLOYEES ARE REQUIRED TO COMPLETE MANDATORY NETWORK RESPONSIBILITY AND COMPLIANCE PROGRAM TRAINING ("NRCP"). THIS ELECTRONIC TRAINING INCLUDES A TRAINING SESSION ON HOW TO REPORT CONCERNS AND TO WHOM TO REPORT THE CONCERNS. B) IN THE NETWORK'S NRCP MANUAL WHICH IS AVAILABLE TO ALL EMPLOYEES VIA THE NETWORK'S INTRANET, IT STATES "THE NETWORK REALIZES THE RESPONSIBILITY AND SUPPORTS THE RIGHT OF EVERY INDIVIDUAL TO ADDRESS POTENTIAL VIOLATIONS OF NETWORK POLICIES AND PROCEDURES; LAWS, RULES, AND REGULATIONS; OR ETHICAL STANDARDS IN GOOD FAITH AND TO REQUEST GUIDANCE WITHOUT THE FEAR OF PUNISHMENT OR HARASSMENT FROM OTHERS INCLUDING CO-WORKERS, SUPERVISORS, AND LEADERSHIP. BOTH FEDERAL AND STATE FALSE CLAIMS ACTS PROHIBIT EMPLOYERS FROM RETALIATION AGAINST EMPLOYEES WHO FILE WHISTLEBLOWER ACTIONS. THEREFORE, RETRIBUTION, RETALIATION, OR HARASSMENT OF ANY KIND AGAINST ANY PERSON WHO REQUESTS GUIDANCE OR BRINGS A VIOLATION, REAL OR PERCEIVED, TO LEADERSHIP'S OR THE GOVERNMENT'S ATTENTION IS FORBIDDEN."
FORM 990, PAGE 6, PART VI, LINE 15ACOMMUNITY HOSPITAL ANDERSON FOUNDATION, INC. HAS DELEGATED THE AUTHORITY FOR DETERMINING THE COMPENSATION FOR THE FOUNDATION OFFICER TO COMMUNITY HOSPITAL OF ANDERSON AND MADISON COUNTY, INC. ("CHA"). 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, PAGE 6, PART VI, LINE 19A) THE ARTICLES OF INCORPORATION AND CERTIFICATE OF EXISTENCE 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, THE CONFLICT OF INTEREST POLICY IS DESCRIBED IN PART VI, LINE 12C. C) COMMUNITY HOSPITAL ANDERSON FOUNDATION, INC. 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. COMMUNITY HOSPITAL ANDERSON FOUNDATION, INC. 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.

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (12 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdExempt Code SectionExemptCodeSectionTxtPublic Charity StatusPublicCharityStatusTxtDirect Controlling NADirectControllingNACdControlled OrganizationControlledOrganizationIndBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Txt
COMMUNITY HEALTH NETWORK INC
7330 SHADELAND STATION SUITE 200INDIANAPOLISIN46256350983617HOSPITALIN501C33N/Afalse
COMMUNITY HEALTH NETWORK FOUNDATION
7240 SHADELAND STATION SUITE 125INDIANAPOLISIN46256510181688CHARITYIN501C311BYes (true)CHNW
COMMUNITY HLTH SERVICES OF INDIANA
7330 SHADELAND STATION SUITE 200INDIANAPOLISIN46256454817436HLTH CAREIN501C33Yes (true)CHNW
COMMUNITY HOME HEALTH SERVICES INC
9894 EAST 121ST STREETFISHERSIN46037350953467HLTH CAREIN501C39Yes (true)CHNW
COMM HOSP OF ANDERSON & MADISON CTY
1515 N MADISON AVENUEANDERSONIN46011351069822HOSPITALIN501C33falseCHNW
COMMUNITY HOSPITAL SOUTH INC
1402 E COUNTY LINE ROAD SOUTHINDIANAPOLISIN46227351088640HOSPITALIN501C33Yes (true)CHNW
COMMUNITY HOWARD REGIONAL HEALTH
3500 S LAFOUNTAIN STREETKOKOMOIN46902351865344HOSPITALIN501C33Yes (true)CHNW
COMM HOWARD REGIONAL HEALTH FDN
PO BOX 9011KOKOMOIN46904237309596SUPPORTIN501C37falseNA
COMMUNITY LTC INC
1031 MONTICELLO DRIVEANDERSONIN46011351877441HLTH CAREIN501C39Yes (true)CHA
COMMUNITY PHYSICIANS OF IN INC
7240 SHADELAND STATION SUITE 300INDIANAPOLISIN46256205392766PHY SRVIN501C39Yes (true)CHNW
HEALTH INSTITUTE OF INDIANA INC
3660 GUION ROADINDIANAPOLISIN46222352022402FITNESSIN501C39Yes (true)CHNW
INDIANAPOLIS OSTEOPATHIC HOSP INC
3630 GUION ROADINDIANAPOLISIN46222351094734HOSPITALIN501C33Yes (true)CHNW

Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (17 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdDirect Controlling NADirectControllingNACdDisproportionate AllocationsDisproportionateAllocationsIndGeneral Or Managing PartnerGeneralOrManagingPartnerInd
BROWNSBURG OFFICE CENTER 2 LLP
321 E NORTHFIELDBROWNSBURGIN46112351929859LEASINGINN/Afalsefalse
CHNJMH VENTURES LLC
7330 SHADELAND STATION SUITE 200INDIANAPOLISIN46256462356266DIAG/REHABINN/Afalsefalse
COMMUNITY ENDOSCOPY CENTER LLC
1601 N MADISON AVENUE SUITE 300ANDERSONIN46011611464136HLTH CAREINN/Afalsefalse
COMM HEALTH NETWORK REHAB HOSP LLC
7343 CLEARVISTA DRIVEINDIANAPOLISIN46256453414249REHABINN/Afalsefalse
EAST CAMPUS SURGERY CENTER LLC
7330 SHADELAND STATION SUITE 200INDIANAPOLISIN46256352028517SURGERYINN/Afalsefalse
HAMILTON SURGERY CENTER LLC
7330 SHADELAND STATION SUITE 200INDIANAPOLISIN46256352061413SURGERYINN/Afalsefalse
HOWARD COMMUNITY SURGERY CTR LLC
3500 S LAFOUNTAIN STREETKOKOMOIN46902352118748SURGERYINN/Afalsefalse
HOWARD REGIONAL SPECIALTY CARE LLC
680 SOUTH FOURTH STREETLOUISVILLEKY40202371501021REHABINN/Afalsefalse
INDIANAPOLIS ENDOSCOPY CENTER LLC
7353 E 121ST STREETINDIANAPOLISIN46219352010874HLTH CAREINN/Afalsefalse
MICHIGAN SURGERY INVESTMENT LLC
7330 SHADELAND STATION SUITE 200INDIANAPOLISIN46256320147008SURG CTRSINN/Afalsefalse
NORTH CAMPUS OFFICE ASSOCIATES LP
7330 SHADELAND STATION SUITE 200INDIANAPOLISIN46256351808625RNTL PROPINN/Afalsefalse
NORTH CAMPUS SURGERY CENTERS LLC
7330 SHADELAND STATION SUITE 200INDIANAPOLISIN46256352147088SURGERYINN/Afalsefalse
NORTHPOINT PEDIATRICS LLC
8101 CLEARVISTA PARKWAY SUITE 185INDIANAPOLISIN46256351960566HLTH CAREINN/Afalsefalse
NORTHWEST SURGERY CENTER LLC
7330 SHADELAND STATION SUITE 200INDIANAPOLISIN46256208754071SURGERYINN/Afalsefalse
PILLARS HOUSING LP
3500 SOUTH LAFOUNTAIN STREETKOKOMOIN46902161652671HOUSINGINN/Afalsefalse
PRIMARIA HEALTH LLC
7330 SHADELAND STATION SUITE 200INDIANAPOLISIN46256474728937CONSULTINGINN/Afalsefalse
SOUTH CAMPUS SURGERY CENTER LLC
1550 EAST COUNTY LINE ROADINDIANAPOLISIN46227352038072SURGERYINN/Afalsefalse

Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (6 entries)

Address Line1ForeignAddress/AddressLine1TxtCityForeignAddress/CityNmProvince Or StateForeignAddress/ProvinceOrStateNmCountryForeignAddress/CountryCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile Foreign CountryLegalDomicileForeignCountryCdDirect Controlling NADirectControllingNACdControlled OrganizationControlledOrganizationIndAddress Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdLegal Domicile StateLegalDomicileStateCd
CHN ASSURANCE COMPANY LTD
PO BOX 1051GTGRAND CAYMANGRAND CAYMANCJ980418913INSURANCECJN/AYes (true)
MIDWEST RACQUETBALL INC
351396016HEALTHN/AYes (true)3500 S LAFOUNTAIN STREETKOKOMOIN46902IN
PILLARS COMMUNITY HOUSING INC
161652666HOUSINGN/AYes (true)3500 S LAFOUNTAIN STREETKOKOMOIN46902IN
VISIONARY ENTERPRISES INC
351538433MGMT SRVCSN/AYes (true)6626 EAST 75TH STREETINDIANAPOLISIN46250IN
VEI MICHIGAN INC
300097377MGMT SRVCSN/AYes (true)940 N MAIN STREETANN HARBORMI48104MI
WESTVIEW DELIVERY SYSTEM
351910292MGMT SRVCSN/AYes (true)3630 GUION ROADINDIANAPOLISIN46222IN
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts RyltsfalseReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth OrgYes (true)GiftGrntOrCapContriToOthOrgInd
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 OrgfalseRentalOfFcltsFromOthOrgInd
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 OrgYes (true)TransferToOtherOrgInd
Transfer From Other OrgYes (true)TransferFromOtherOrgInd

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