2016-11-15T09:30:36-06:00 2015-12-31 352032768 CASKEY & DAILY PC 4745 STATESMEN DRIVE SUITE C INDIANAPOLIS IN 46250 990 2015-01-01 350983617 COMMUNITY HEALTH NETWORK INC COMM 3176210395 7330 SHADELAND STATION SUITE 200 INDIANAPOLIS IN 46256 JOSEPH M KESSLER EVP CHIEF FIN OFFR 3173555822 2016-11-01 true JAMES A CASKEY CPA CFP P00172185 3175852647 2016-11-15 2015 2017-02-10 21:41:12Z BRYAN A MILLS 7330 SHADELAND STATION SUITE 200 INDIANAPOLIS IN 46256 1175840052 false X WWW.ECOMMUNITY.COM X 1952 IN COMMUNITY HEALTH NETWORK, INC. ("CHNW") IS A 501(C)(3) CORPORATION SERVING THE HEALTH RELATED NEEDS OF THE CITIZENS OF THE INDIANAPOLIS METROPOLITAN AREA AND CENTRAL INDIANA. CHNW OPERATES THREE GENERAL ACUTE CARE HOSPITALS AND PROVIDES INPATIENT, OUTPATIENT, EMERGENCY AND AMBULATORY HEALTH CARE SERVICES TO ALL PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. CHNW'S MISSION IS TO: A) PROMOTE THE HEALTH OF THE RESIDENTS OF CENTRAL INDIANA BY PROMOTING, SUPPORTING AND FURTHERING THE CHARITABLE PURPOSES OF: COMMUNITY HOSPITAL SOUTH, INC., COMMUNITY HOSPITAL OF ANDERSON AND MADISON COUNTY, INC., COMMUNITY LTC, INC., AND COMMUNITY HOME HEALTH SERVICES, INC. (COLLECTIVELY, THE "SUPPORTED ORGANIZATIONS"), AND THEIR RESPECTIVE SUBSIDIARIES AND AFFILIATES, TO CONSIDER, COORDINATE, AND FACILITATE THE ALIGNMENT OF INITIATIVES WITHIN THE COMMUNITY HEALTH NETWORK ("NETWORK"). B) SERVE AS THE PARENT OF THE NETWORK, AN INTEGRATED DELIVERY SYSTEM, AND EXERCISE COMMON SUPERVISION AND CONTROL OVER THE NETWO 14 11 7318 559 4897657 3560861 11184189 12874097 837485287 1042479006 16120084 16046546 48582437 39715633 913371997 1111115282 0 0 359469687 419790376 0 0 346971986 437576383 706441673 857366759 206930324 253748523 2033853045 2362803528 936902966 1168628132 1096950079 1194175396 X COMMUNITY HEALTH NETWORK, INC. ("CHNW") IS A 501(C)(3) CORPORATION SERVING THE HEALTH RELATED NEEDS OF THE CITIZENS OF THE INDIANAPOLIS METROPOLITAN AREA AND CENTRAL INDIANA. CHNW OPERATES THREE GENERAL ACUTE CARE HOSPITALS AND PROVIDES INPATIENT, OUTPATIENT, EMERGENCY AND AMBULATORY HEALTH CARE SERVICES TO ALL PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. CHNW'S MISSION IS TO: A) PROMOTE THE HEALTH OF THE RESIDENTS OF CENTRAL INDIANA BY PROMOTING, SUPPORTING AND FURTHERING THE CHARITABLE PURPOSES OF: COMMUNITY HOSPITAL SOUTH, INC., COMMUNITY HOSPITAL OF ANDERSON AND MADISON COUNTY, INC., COMMUNITY LTC, INC., AND COMMUNITY HOME HEALTH SERVICES, INC. (COLLECTIVELY, THE "SUPPORTED ORGANIZATIONS"), AND THEIR RESPECTIVE SUBSIDIARIES AND AFFILIATES, TO CONSIDER, COORDINATE, AND FACILITATE THE ALIGNMENT OF INITIATIVES WITHIN THE COMMUNITY HEALTH NETWORK ("NETWORK"). B) SERVE AS THE PARENT OF THE NETWORK, AN INTEGRATED DELIVERY SYSTEM, AND EXERCISE COMMON SUPERVISION AND CONTROL OVER THE NETWO false false 498455482 1075227665 COMMUNITY HEALTH NETWORK, INC. OPERATES THREE ACUTE CARE FULL SERVICE HOSPITALS IN INDIANAPOLIS, INDIANA WITH 1,085 LICENSED BEDS. IN 2015, THE HOSPITALS SERVED 32,542 INPATIENTS FOR A TOTAL OF 144,464 INPATIENT DAYS OF SERVICE. THE HOSPITALS ALSO PROVIDED 1,227,382 OUTPATIENT VISITS, WHICH INCLUDED 152,533 EMERGENCY VISITS AND 607,593 MENTAL HEALTH VISITS. THE HOSPITALS OFFER MANY PATIENT FOCUSED HEALTHCARE SERVICES THAT INCLUDE WOMEN AND CHILDREN SERVICES, PEDIATRICS, ONCOLOGY, MENTAL HEALTH SERVICES, NEUROSCIENCES, ORTHOPEDICS, JOINT REPLACEMENT, BREAST CARE SERVICES, SURGERY SERVICES, REHABILITATION SERVICES, HEALTH PROMOTION SERVICES, EMERGENCY SERVICES, AND TRAINING AND EDUCATION FOR HEALTH CARE PROFESSIONALS. 34617057 1550564 COMMUNITY HEALTH NETWORK, INC. PROVIDES SHARED SERVICES TO THE ORGANIZATIONS COLLECTIVELY REFERRED TO AS THE COMMUNITY HEALTH NETWORK. THESE SERVICES INCLUDE FINANCE AND ACCOUNTING, MATERIALS MANAGEMENT, PATIENT ACCOUNTING, TRANSCRIPTION SERVICES, MEDICAL RECORDS, LEGAL, HUMAN RESOURCES, INFORMATION TECHNOLOGY, AND BUSINESS DEVELOPMENT. 533072539 true true false true false false false false false false true false true true true false false true false false false false false false false false true true false false true true false false false false false false false false false false false false false false false true true true false false true X 377 0 true 7318 true true true true false false false false false false false false X 14 11 true false false false false false false true true false false false true true true true true true true true false IN X JOSEPH M KESSLER 3176210395 7330 SHADELAND STATION SUITE 200 INDIANAPOLIS IN 46256 BRYAN A MILLS DIRECTOR/PRE 45.00 15.00 X X 1185136 0 127327 HANY HADDAD MD DIRECTOR 2.00 53.00 X 0 523272 34276 KENNETH SHAVER MD DIRECTOR 2.00 53.00 X 0 274306 50392 JASON BECKER DIRECTOR 2.00 4.00 X 0 0 0 KATHRYN G BETLEY DIRECTOR 2.00 4.00 X 0 0 0 BRUCE F KING DIRECTOR 2.00 4.00 X 0 0 0 JEFFREY MOSSLER MD DIRECTOR 2.00 4.00 X 0 0 0 MICHAEL PETERSON CHAIRMAN 2.00 4.00 X X 0 0 0 STEVEN R PLUMP DIRECTOR 2.00 5.00 X 0 0 0 JAY RICKER DIRECTOR 2.00 5.00 X 0 0 0 YVONNEE SHAHEEN SECRETARY 2.00 4.00 X X 0 0 0 KRISTIN T SHERMAN TREASURER 2.00 4.00 X X 0 0 0 CHARLES E STALEY DIRECTOR 2.00 5.00 X 0 0 0 RUSSELL SWAN JR VICE CHAIRMA 2.00 4.00 X X 0 0 0 BRIAN K WILLIAMS DIRECTOR 2.00 4.00 X 0 0 0 TIMOTHY HOBBS MD EVP CHIEF PH 46.00 4.00 X 655467 0 119949 JASON FAHRLANDER EVP ACUTE CA 50.00 0.00 X 618329 0 97173 KYLE FISHER EVP STRTGY & 15.00 35.00 X 0 582840 105914 JOSEPH M KESSLER EVP CHIEF FI 48.00 2.00 X 563487 0 99951 SCOTT TEFFETELLER PRES EAST RE 50.00 X 468566 0 89974 ANTHONY JAVORKA EVP PRES AMB 5.00 45.00 X 0 463922 88039 RONALD THIEME EVP CHF KNOW 50.00 X 460128 0 67316 KATHLEEN KRUSIE PRES NORTH R 50.00 X 226705 0 22639 FRANK COVINGTON MD MEDICAL DIRE 50.00 X 753385 0 62297 DAVID WILLIAMS DO PRES WEST RE 0.00 50.00 X 584863 0 83626 WESLEY WONG MD CHIEF PHY IN 50.00 X 549593 0 93543 KAREN ANN LLOYD EVP GENERAL 50.00 X 531717 0 132606 ANTHONY LENNEN PRES SOUTH R 0.00 50.00 X 529775 0 88502 HOLLY A MILLARD FORMER INTER 49.00 1.00 X 388382 0 73262 JEFFERY KIRKHAM FORMER KEY E 46.00 4.00 X 380387 0 126313 7895920 1844340 1563099 373 true true false MID AMERICA CLINICAL LABS 2560 NORTH SHADELAND AVENUE INDIANAPOLIS IN 46219 LAB SERVICES 17953505 ARAMARK 12483 COLLECTION CENTER DRIVE CHICAGO IL 60673 CLINICAL ENGNRG 12288153 GRANT THORNTON LLP 33562 TREASURY CENTER CHICAGO IL 606943500 CONSULTING 11926473 MEYER AND NAJEM INC 11787 LANTERN ROAD NO 100 FISHERS IN 46038 CONSTRUCTN MGMT 6770192 EPIC SYSTEMS CORPORATION PO BOX 88314 MILWAUKEE WI 53288 SOFTWARE MAINT 5905038 395 3164427 9709670 12874097 PATIENT SERVICES 622110 1037942360 1037942360 RENT 531120 4536646 4536646 1042479006 13760120 13760120 62699826 4311370 61822458 2902312 877368 1409058 2286426 2286426 EQUITY INVESTMENT INCOME 900003 19445281 19445281 JMH MANAGEMENT 900099 4200000 4200000 MANAGED CARE FEES 900099 3039118 3039118 13031234 11814824 697657 518753 39715633 1111115282 1076778229 4897657 16565299 4802147 4802147 968344 968344 324143315 207603304 116540011 23633104 6367565 17265539 43733513 27516890 16216623 22509953 14849090 7660863 3357792 11118 3346674 6466897 21412 6445485 57388 57388 214538 214538 63469948 35283952 28185996 7033964 3684811 3349153 20905640 9719795 11185845 28561489 579770 27981719 36459545 22940148 13519397 2584558 864212 1720346 509721 226131 283590 19912932 19912932 46334918 13149483 33185435 4820430 90977 4729453 MEDICAL SUPPLIES 160770225 160770225 HAF PROGRAM FEES 26930330 26930330 RECRUITMENT 2259808 45872 2213936 CORP SPONS/DEV 2163893 43925 2119968 4762367 2373529 2388838 857366759 533072539 324294220 0 95898731 93059634 113839166 150133721 152511 3396445 11778728 12378737 10423071 177777517 1060154331 632195788 430170359 427958543 448682469 423753121 457196669 157922330 46053785 61736556 419657556 854686924 2033853045 2362803528 75857243 138183220 530901082 514796631 50990441 43438764 279154200 472209517 936902966 1168628132 X 1096950079 1194175396 1096950079 1194175396 2033853045 2362803528 X 253748523 -39818044 -116705162 X false true X true true true X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false true false false false true 20321 true 139883 false false 160204 false SCHEDULE C, PART II-B, LINE 1 LINE 1F - A PORTION OF THE DUES COMMUNITY HEALTH NETWORK, INC. ("CHNW") PAID TO THE INDIANA HOSPITAL ASSOCIATION IS ATTRIBUTABLE TO LOBBYING. LINE 1G - COMMUNITY HEALTH NETWORK, INC. RETAINS A LOBBYIST TO DISCUSS AND WORK WITH LEGISLATORS ON THE IMPACT OF PROPOSED LEGISLATION AND TO PROACTIVELY SUPPORT LEGISLATION THAT FURTHERS THE MISSION AND GOALS OF THE NETWORK. IN ADDITION, ONE EMPLOYEE OF CHNW ASSISTS WITH LOBBYING ACTIVITIES. 6500115 6500115 578520264 254652082 323868182 22846418 10867843 11978575 444733083 359529830 85203253 7554451 7146033 408418 427958543 CLOSELY-HELD EQUITY INTERESTS 157922330 C 157922330 DUE FROM AFFILIATED ENTITIES 696198557 FUNDS HELD BY TRUSTEE 137467943 OTHER RECEIVABLES 15632803 THIRD PARTY RECEIVABLE 4166736 OTHER ASSETS 1220885 854686924 UNDERFUNDED PENSION FAS 158 254187531 TAXABLE REVENUE BOND 200149181 OTHER LT LIABILITY 9256997 THIRD PARTY SETTLEMENTS 8615808 472209517 true true X true X true X true true false true true 4609 4341539 4341539 0.00500 88379 164741601 153703316 11038285 0.01290 92988 169083140 153703316 15379824 0.01790 20 2 17076357 508620 16567737 0.01930 10 20513533 5226934 15286599 0.01780 2 7170413 688790 6481623 0.00760 2 2097518 245897 1851621 0.00220 39 247995 247995 0.00030 73 2 47105816 6670241 40435575 0.04720 73 92990 216188956 160373557 55815399 0.06510 1 66110 66110 0.00010 2 100602 46027 54575 0.00010 1 6 99 99 5 12 5625531 687928 4937603 0.00570 1 1733528 54270 1679258 0.00200 10 18 7525870 788225 6737645 0.00790 true 17290164 12504009 186429551 198353362 -11923811 X true true COMMUNITY IMAGING PROVIDE MEDICAL IMAGING SERVICES 0.50000 0.50000 EAST CAMPUS SURG CTR PROVIDE OUTPATIENT SURGERY SERVICES 0.51000 0.49000 HAMILTON SURGERY CTR PROVIDE OUTPATIENT SURGERY SERVICES 0.11000 0.49000 INDPLS ENDOSCOPY CTR PROVIDE MEDICAL SERVICES 0.19000 0.49000 NORTHPOINT PEDIATRIC PROVIDE PHYSICIANS SERVICES 0.51000 0.49000 SOUTH CAMPUS SURG CT PROVIDE OUTPATIENT SURGERY SERVICES 0.06000 0.45000 3 1 COMMUNITY HOSPITAL NORTH 7150 CLEARVISTA DRIVE INDIANAPOLIS IN 46256 WWW.ECOMMUNITY.COM 15-011437-1 X X X X A 2 INDIANA HEART HOSPITAL LLC 8075 N SHADELAND AVENUE SUITE 33 INDIANAPOLIS IN 46250 WWW.ECOMMUNITY.COM 15-03312-1 X X X X A 3 COMMUNITY HOSPITAL EAST 1500 NORTH RITTER AVENUE INDIANAPOLIS IN 46219 WWW.ECOMMUNITY.COM 15-005068-1 X X X X A A 123 false false true X X X X X X X X X X 15 true true true true X SEE PART V, SECTION C X SEE PART V, SECTION C X true 15 false true false true X 200.000000000000 300.000000000000 X X X X true true X X X true X ECOMMUNITYCOMSFINANCIALASSISTANCE X ECOMMUNITYCOMSFINANCIALASSISTANCE X X X X X X true X true X X X X true X false false GROUP A, FACILITY 1, COMMUNITY HOSPITAL NORTH - PART V, LINE 5 SEE ATTACHED IRS 990 SCHEDULE H SUPPLEMENTAL INFORMATION REPORT FOR PERSONS CONSULTED AND HOW INPUT FROM THESE PERSONS WAS TAKEN INTO ACCOUNT. GROUP A, FACILITY 1, COMMUNITY HOSPITAL NORTH - PART V, LINE 6A THE CHNA FOR COMMUNITY HOSPITAL NORTH 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 FRANCISCAN ST. FRANCIS HEALTH, IU HEALTH UNIVERSITY HOSPITAL, AND ST. VINCENT HOSPITAL. GROUP A, FACILITY 1, COMMUNITY HOSPITAL NORTH - PART V, LINE 6B HEALTHY COMMUNITIES INSTITUTE GROUP A, FACILITY 1, COMMUNITY HOSPITAL NORTH - PART V, LINE 7D HTTP://WEBAPP.ECOMMUNITY.COM/ABOUTUS/ GROUP A, FACILITY 1, COMMUNITY HOSPITAL NORTH - PART V, LINE 7B WWW.COMMUNITYANDERSON.COM/ABOUTUS/COMMUNITYNEEDSASSESSMENT.ASP GROUP A, FACILITY 1, COMMUNITY HOSPITAL NORTH - PART V, LINE 10A THE IMPLEMENTATION STRATEGY IS IN THE CHNA REPORT FOUND AT WWW.ECOMMUNITY.COM/ABOUTUS/CARE.ASPX GROUP A, FACILITY 1, COMMUNITY HOSPITAL NORTH - PART V, LINE 11 SEE ATTACHED IRS 990 SCHEDULE H SUPPLEMENTAL INFORMATION REPORT FOR HOW THE HOSPITAL IS ADDRESSING THE SIGNIFICANT COMMUNITY HEALTH NEEDS. GROUP A, FACILITY 1, COMMUNITY HOSPITAL NORTH - PART V, LINE 16I THE POLICY IS REFERENCED ON THE BILL. GROUP A, FACILITY 1, COMMUNITY HOSPITAL NORTH - PART V, LINE 22D THE AMOUNT GENERALLY BILLED ("AGB") TO INSURED PATIENTS FOR EMERGENT OR MEDICALLY NECESSARY CARE IS CALCULATED BY REVIEWING TWELVE MONTH CLOSED CLAIM REIMBURSEMENT RATES FOR MEDICARE AND COMMERCIAL INSURANCE. AGB IS UPDATED ANNUALLY. PATIENTS WHO ARE UNINSURED AND DO NOT MEET THE INCOME REQUIREMENTS WILL RECEIVE A DISCOUNT OF 60% ON GROSS CHARGES FOR FACILITY SERVICES, BASED ON AGB AND A DISCOUNT OF 25% ON GROSS CHARGES FOR PROFESSIONAL SERVICES FOR MEDICALLY NECESSARY AND EMERGENCY CARE SERVICES THEY RECEIVE. GROUP A, FACILITY 2, INDIANA HEART HOSPITAL, LLC - PART V, LINE 5 SEE ATTACHED IRS 990 SCHEDULE H SUPPLEMENTAL INFORMATION REPORT FOR PERSONS CONSULTED AND HOW INPUT FROM THESE PERSONS WAS TAKEN INTO ACCOUNT. GROUP A, FACILITY 2, INDIANA HEART HOSPITAL, LLC - PART V, LINE 6A THE CHNA FOR INDIANA HEART HOSPITAL, LLC 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 FRANCISCAN ST. FRANCIS HEALTH, IU HEALTH UNIVERSITY HOSPITAL, AND ST. VINCENT HOSPITAL. GROUP A, FACILITY 2, INDIANA HEART HOSPITAL, LLC - PART V, LINE 6B HEALTHY COMMUNITIES INSTITUTE GROUP A, FACILITY 2, INDIANA HEART HOSPITAL, LLC - PART V, LINE 7D HTTP://WEBAPP.ECOMMUNITY.COM/ABOUTUS/ FACILITY 2, INDIANA HEART HOSPITAL, LLC - PART V, LINE 7B WWW.COMMUNITYANDERSON.COM/ABOUTUS/COMMUNITYNEEDSASSESSMENT.ASP FACILITY 2, INDIANA HEART HOSPITAL, LLC - PART V, LINE 10A THE IMPLEMENTATION STRATEGY IS IN THE CHNA REPORT FOUND AT WWW.ECOMMUNITY.COM/ABOUTUS/CARE.ASPX GROUP A, FACILITY 2, INDIANA HEART HOSPITAL, LLC - PART V, LINE 11 SEE ATTACHED IRS 990 SCHEDULE H SUPPLEMENTAL INFORMATION REPORT FOR HOW THE HOSPITAL IS ADDRESSING THE SIGNIFICANT COMMUNITY HEALTH NEEDS. GROUP A, FACILITY 2, INDIANA HEART HOSPITAL, LLC - PART V, LINE 16I THE POLICY IS REFERENCED ON THE BILL. GROUP A, FACILITY 2, INDIANA HEART HOSPITAL, LLC - PART V, LINE 22D THE AMOUNT GENERALLY BILLED ("AGB") TO INSURED PATIENTS FOR EMERGENT OR MEDICALLY NECESSARY CARE IS CALCULATED BY REVIEWING TWELVE MONTH CLOSED CLAIM REIMBURSEMENT RATES FOR MEDICARE AND COMMERCIAL INSURANCE. AGB IS UPDATED ANNUALLY. PATIENTS WHO ARE UNINSURED AND DO NOT MEET THE INCOME REQUIREMENTS WILL RECEIVE A DISCOUNT OF 60% ON GROSS CHARGES FOR FACILITY SERVICES, BASED ON AGB AND A DISCOUNT OF 25% ON GROSS CHARGES FOR PROFESSIONAL SERVICES FOR MEDICALLY NECESSARY AND EMERGENCY CARE SERVICES THEY RECEIVE. GROUP A, FACILITY 3, COMMUNITY HOSPITAL EAST - PART V, LINE 5 SEE ATTACHED IRS 990 SCHEDULE H SUPPLEMENTAL INFORMATION REPORT FOR PERSONS CONSULTED AND HOW INPUT FROM THESE PERSONS WAS TAKEN INTO ACCOUNT. GROUP A, FACILITY 3, COMMUNITY HOSPITAL EAST - PART V, LINE 6A THE CHNA FOR COMMUNITY HOSPITAL EAST WAS A JOINT PROCESS AMONG ALL OF THE COMMUNITY HEALTH NETWORK HOSPITALS WHICH INCLUDES: COMMUNITY HEALTH NETWORK, INC. (NORTH, EAST, & INDIANA HEARTH 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 FRANCISCAN ST. FRANCIS HEALTH, IU HEALTH UNIVERSITY HOSPITAL, AND ST. VINCENT HOSPITAL. GROUP A, FACILITY 3, COMMUNITY HOSPITAL EAST - PART V, LINE 6B HEALTHY COMMUNITIES INSTITUTE GROUP A, FACILITY 3, COMMUNITY HOSPITAL EAST - PART V, LINE 7D HTTP://WEBAPP.ECOMMUNITY.COM/ABOUTUS/ GROUP A, FACILITY 3, COMMUNITY HOSPITAL EAST - PART V, LINE 7B WWW.COMMUNITYANDERSON.COM/ABOUTUS/COMMUNITYNEEDSASSESSMENT.ASP GROUP A, FACILITY 3, COMMUNITY HOSPITAL EAST - PART V, LINE 10A THE IMPLEMENTATION STRATEGY IS IN THE CHNA REPORT FOUND AT WWW.ECOMMUNITY.COM/ABOUTUS/CARE.ASPX GROUP A, FACILITY 3, COMMUNITY HOSPITAL EAST - PART V, LINE 11 SEE ATTACHED IRS 990 SCHEDULE H SUPPLEMENTAL INFORMATION REPORT FOR HOW THE HOSPITAL IS ADDRESSING THE SIGNIFICANT COMMUNITY HEALTH NEEDS. GROUP A, FACILITY 3, COMMUNITY HOSPITAL EAST - PART V, LINE 16I THE POLICY IS REFERENCED ON THE BILL. GROUP A, FACILITY 3, COMMUNITY HOSPITAL EAST - PART V, LINE 22D THE AMOUNT GENERALLY BILLED ("AGB") TO INSURED PATIENTS FOR EMERGENT OR MEDICALLY NECESSARY CARE IS CALCULATED BY REVIEWING TWELVE MONTH CLOSED CLAIM REIMBURSEMENT RATES FOR MEDICARE AND COMMERCIAL INSURANCE. AGB IS UPDATED ANNUALLY. PATIENTS WHO ARE UNINSURED AND DO NOT MEET THE INCOME REQUIREMENTS WILL RECEIVE A DISCOUNT OF 60% ON GROSS CHARGES FOR FACILITY SERVICES, BASED ON AGB AND A DISCOUNT OF 25% ON GROSS CHARGES FOR PROFESSIONAL SERVICES FOR MEDICALLY NECESSARY AND EMERGENCY CARE SERVICES THEY RECEIVE. 67 COMMUNITY REGIONAL CANCER CENTER 1400 N RITTER AVENUE 340 INDIANAPOLIS IN 46219 HEALTH CARE COMMUNITY IMAGING CENTER NORTH 8181 CLEARVISTA PKWY INDIANAPOLIS IN 46256 HEALTH CARE COMMUNITY BREAST CARE 8040 CLEARVISTA PKWY 290 INDIANAPOLIS IN 46256 HEALTH CARE SLEEP WAKE DISORDERS 7250 CLEARVISTA DRIVE 350 INDIANAPOLIS IN 46256 HEALTH CARE COMMUNITY IMAGING CTR NOBLESVILLE 9669 E 146TH STREET 140 NOBLESVILLE IN 46060 DIAGNOSTIC CENTER CHE SLEEP WAKE DISORDERS 1400 N RITTER AVENUE 481 INDIANAPOLIS IN 46219 HEALTH CARE REHAB & SPORTS MEDICINE 2040 N SHADELAND AVENUE INDIANAPOLIS IN 46219 REHABILITATION MATERNAL FETAL MEDICINE 7120 E CLEARVISTA DRIVE 5900 INDIANAPOLIS IN 46256 HEALTH CARE COMMUNITY NEUROSURGERY 1400 N RITTER AVENUE 231 INDIANAPOLIS IN 46219 HEALTH CARE HRC OP THERAPY 8501 E 56TH STREET 140 INDIANAPOLIS IN 46216 HEALTH CARE REHAB & SPORTS MEDICINE 6922 HILLSDALE COURT INDIANAPOLIS IN 46250 REHABILITATION FAMILY PRACTICE CENTER 10122 E 10TH STREET 100 INDIANAPOLIS IN 46229 HEALTH CARE GALLAHUE ADDICTIONS 2040 N SHADELAND AVENUE SUITE 200 INDIANAPOLIS IN 46219 HEALTH CARE GMHC LAWRENCE OP 6950 HILLSDALE COURT INDIANAPOLIS IN 46250 HEALTH CARE WARREN OP OFFICE 2040 N SHADELAND AVENUE SUITE 200 INDIANAPOLIS IN 46219 HEALTH CARE MEDCHECK CASTLETON 8177 CLEARVISTA PKWY INDIANAPOLIS IN 46256 HEALTH CARE REHAB & SPORTS MEDICINE 13121 OLIO ROAD 140 FISHERS IN 46037 REHABILITATION GALLAHUE MENTAL HEALTH SERVICES 145 GREEN MEADOWS DRIVE GREENFIELD IN 46140 HEALTH CARE GALLAHUE MENTAL HEALTH SERVICES 2040 N SHADELAND AVENUE SUITE 250 INDIANAPOLIS IN 46219 HEALTH CARE COMMUNITY IMAGING CENTER 11911 N MERIDIAN STREET 175 CARMEL IN 46032 DIAGNOSTIC CENTER GALLAHUE MENTAL HEALTH SERVICES 7 E HENDRICKS STREET SHELBYVILLE IN 46176 HEALTH CARE GALLAHUE MENTAL HEALTH SERVICES 2201 HILLCREST DRIVE ANDERSON IN 46012 HEALTH CARE COMMUNITY SPINE CENTER 7120 E CLEARVISTA DRIVE 1500 INDIANAPOLIS IN 46256 HEALTH CARE COMMUNITY GENERAL SURGEONS 1400 N RITTER AVENUE 330 INDIANAPOLIS IN 46219 HEALTH CARE SLEEP WAKE DISORDERS 11911 N MERIDIAN STREET 140 CARMEL IN 46032 HEALTH CARE MEDCHECK CARMEL 1911 N MERIDIAN STREET 150 CARMEL IN 46032 HEALTH CARE MEDCHECK GREENWOOD 1664 W SMITH VALLEY ROAD SUITE B GREENWOOD IN 46142 HEALTH CARE MEDCHECK EAST 1703 N POST ROAD INDIANAPOLIS IN 46219 HEALTH CARE ORTHOPEDIC SURGEONS OF CENTRAL IN 1400 N RITTER AVENUE 510 INDIANAPOLIS IN 46219 HEALTH CARE COMM OCCUPATIONAL HEALTH CENTER 1709 N POST ROAD INDIANAPOLIS IN 46219 HEALTH CARE DAY THERAPY 6950 HILLSDALE COURT INDIANAPOLIS IN 46250 HEALTH CARE COMMUNITY BARIATRICS SURGEONS 7250 CLEARVISTA SUITE 355 INDIANAPOLIS IN 46256 HEALTH CARE FORGE AHEAD CLUBHOUSE 1640 N RITTER AVENUE INDIANAPOLIS IN 46201 HEALTH CARE OUTPATIENT WORK COMP REHAB 1911 N MERIDIAN STREET 170 CARMEL IN 46032 HEALTH CARE WORK COMP REHAB 1713 N POST ROAD INDIANAPOLIS IN 46219 REHABILITATION WORK COMP REHAB 6922 HILLSDALE COURT INDIANAPOLIS IN 46250 REHABILITATION HRC NEUROPSYCH SERVICES 7250 CLEARVISTA DRIVE 327 INDIANAPOLIS IN 46256 HEALTH CARE HRC NEUROPSYCHOLOGY 8501 E 56TH STREET 140 INDIANAPOLIS IN 46216 HEALTH CARE MEDCHECK ANDERSON 1030 S SCATTERFIELD ROAD ANDERSON IN 46012 HEALTH CARE OCCUPATIONAL HEALTH 8177 CLEARVISTA PKWY INDIANAPOLIS IN 46256 HEALTH CARE SHELBYVILLE GROUP HOME 18 E MECHANIC STREET SHELBYVILLE IN 46176 HEALTH CARE NORTH RIVER CROSS ORTHOPEDICS 18051 RIVER ROAD NOBLESVILLE IN 46062 HEALTH CARE COMMUNITY SLEEP SPECIALISTS 7250 CLEARVISTA DRIVE 330 INDIANAPOLIS IN 46256 HEALTH CARE GREENFIELD OCCUPATIONAL HEALTH 124 W MUSKEGAN DRIVE GREENFIELD IN 46140 HEALTH CARE WOMEN'S & CHILDREN'S CARE CENTER 2040 N SHADELAND AVENUE SUITE 300 INDIANAPOLIS IN 46219 HEALTH CARE OLIO ROAD IMAGING CENTER 13121 OLIO ROAD 110 FISHERS IN 46037 DIAGNOSTIC CENTER REHAB & SPORTS MEDICINE 10122 E 10TH STREET 225 INDIANAPOLIS IN 46229 REHABILITATION YOUTH DAY PROGRAM 6950 HILLSDALE COURT INDIANAPOLIS IN 46250 HEALTH CARE COMM REPRODUCTIVE ENDOCRINOLOGY 7250 CLEARVISTA DRIVE SUITE 365 INDIANAPOLIS IN 46256 HEALTH CARE ASSISTED FERTILITY 8040 CLEARVISTA PKWY 510 INDIANAPOLIS IN 46256 HEALTH CARE OCCUPATIONAL HEALTH 1030 S SCATTERFIELD ROAD ANDERSON IN 46012 HEALTH CARE REHAB & SPORTS MEDICINE 11911 N MERIDIAN STREET 170 CARMEL IN 46032 REHABILITATION REHAB & SPORTS MEDICINE 740 W GREEN MEADOWS DRIVE 120 GREENFIELD IN 46140 REHABILITATION COMMUNITY IMAGING CENTER 740 W GREEN MEADOWS DRIVE 120 GREENFIELD IN 46140 DIAGNOSTIC CENTER EVENING THERAPY 6950 HILLSDALE COURT INDIANAPOLIS IN 46250 HEALTH CARE COMMUNITY SLEEP SPECIALISTS 1400 N RITTER AVENUE SUITE 410 INDIANAPOLIS IN 46219 HEALTH CARE MEDCHECK EXPRESS FISHERS 8300 E 96TH STREET FISHERS IN 46038 HEALTH CARE MEDCHECK EXPRESS NOBLESVILLE 16865 CLOVER ROAD NOBLESVILLE IN 46060 HEALTH CARE CHN BARIATRIC SERVICES 7250 CLEARVISTA DRIVE 355 INDIANAPOLIS IN 46256 HEALTH CARE MEDCHECK EXPRESS INDIANAPOLIS 10617 E WASHINGTON STREET INDIANAPOLIS IN 46229 HEALTH CARE LIFECHECK 7250 CLEARVISTA DRIVE 227 INDIANAPOLIS IN 46256 HEALTH CARE BEHAVIORAL MEDICINE 6950 HILLSDALE COURT INDIANAPOLIS IN 46250 HEALTH CARE GMHC OUTPATIENT ADDICTION TREATMENT 145 GREEN MEADOWS DRIVE GREENFIELD IN 46140 HEALTH CARE MEDCHECK NOBLESVILLE 9669 E 146TH STREET 100 NOBLESVILLE IN 46060 HEALTH CARE HOOK REHAB SILP HOME 9716 E 16TH STREET INDIANAPOLIS IN 46229 REHABILITATION BREAST HEALTH NAVIGATORS 1550 E COUNTY LINE ROAD 325 INDIANAPOLIS IN 46227 HEALTH CARE GMHC HANCOCK INTENSIVE ADDICTION TR 145 GREEN MEADOWS DRIVE GREENFIELD IN 46140 HEALTH CARE PART I, LINE 6A - RELATED ORGANIZATION INFORMATION A COMMUNITY BENEFIT REPORT IS COMPLETED FOR THE COMMUNITY HEALTH NETWORK INCLUDING COMMUNITY HEALTH NETWORK, INC. AND OTHER TAX-EXEMPT AFFILIATES OF THE NETWORK. PART I, LINE 7 - COSTING METHODOLOGY EXPLANATION A 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 II COMMUNITY BUILDING ACTIVITIES SEE ATTACHED IRS SCHEDULE H SUPPLEMENTAL INFORMATION REPORT. PART III, LINE 2 - BAD DEBT EXPENSE METHODOLOGY THE 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. PART III, LINE 3 - BAD DEBT EXPENSE, PATIENTS ELIBIBLE FOR ASSISTANCE THE ESTIMATED AMOUNT OF THE ORGANIZATION'S BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY WAS CALCULATED UTILIZING THE HISTORICAL LEVEL OF PATIENTS THAT WERE DETERMINED AS ELIGIBLE FOR FINANCIAL ASSISTANCE BASED ON A PRESUMPTIVE ELIBIBILITY PROCESS AND APPLYING THIS RATIO TO THE REPORTED BAD DEBT EXPENSE ON THE FINANCIAL STATEMENTS. PART III, LINE 4 - BAD DEBT EXPENSE EXPLANATION THE AUDITED FINANCIAL STATEMENTS CONTAIN THE FOLLOWING TEXT WITHIN THE FOOTNOTES TO DESCRIBE BAD DEBT EXPENSE: THE NETWORK'S PATIENT ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND CONTRACTUAL ADJUSTMENTS. IN EVALUATING THE COLLECTABILITY OF ACCOUNTS RECEIVABLE, THE NETWORK ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR CONTRACTUAL ADJUSTMENTS AND PROVISION FOR BAD DEBTS. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD PARTY COVERAGE, THE NETWORK ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR CONTRACTUAL ADJUSTMENTS. FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS, INCLUDING PATIENT DEDUCTIBLES AND CO-INSURANCE, THE NETWORK RECORDS A PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS ADJUSTED THROUGH THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. CERTAIN ACCOUNTS THAT ARE SENT TO COLLECTION COMPANIES REMAIN AS ACCOUNTS RECEIVABLE ON THE BALANCE SHEET. THESE ACCOUNTS ARE NOT WRITTEN OFF UNLESS RETURNED FROM THE COLLECTION COMPANY. HOWEVER, THEY ARE FULLY RESERVED WITHIN THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. THE NETWORK RECOGNIZES PATIENT SERVICE REVENUE ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY PAYOR COVERAGE ON THE BASIS OF CONTRACTUAL RATES FOR THE SERVICES RENDERED. FOR UNINSURED PATIENTS THAT DO NOT QUALIFY FOR CHARITY CARE, THE NETWORK RECOGNIZES REVENUE ON THE BASIS OF ITS STANDARD RATES FOR SERVICES PROVIDED OR ON THE BASIS OF DISCOUNTED RATES IF IN ACCORDANCE WITH POLICY. ON THE BASIS OF HISTORICAL EXPERIENCE, A PORTION OF THE NETWORK'S UNINSURED PATIENTS WILL BE UNABLE OR UNWILLING TO PAY FOR THE SERVICES PROVIDED. THUS, THE NETWORK RECORDS A PROVISION FOR BAD DEBTS RELATED TO UNINSURED PATIENTS IN THE PERIOD THE SERVICES ARE PROVIDED. PATIENT SERVICE REVENUE, NET OF CONTRACTUAL ALLOWANCES AND DISCOUNTS RECOGNIZED IN THE PERIOD FROM THESE MAJOR PAYOR SOURCES, IS AS FOLLOWS FOR THE YEARS ENDED DECEMBER 31, 2015 AND 2014, RESPECTIVELY: THIRD PARTY PAYORS SELF-PAY TOTAL ALL PAYORS 2015 PATIENT SERVICE REVENUE(NET OF CONTRACTUAL ALLOWANCES AND DISCOUNTS) 1,985,324 118,573 2,103,897 ========== ======== ========== 2014 PATIENT SERVICE REVENUE(NET OF CONTRACTUAL ALLOWANCES AND DISCOUNTS) 1,846,217 142,537 1,988,754 ========== ======== ========== THE 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 BELOW 200% OF THE FEDERAL POVERTY LEVEL. 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 10,566000 AND 15,657000 FOR THE YEARS ENDED DECEMBER 31, 2015 AND 2014, RESPECTIVELY. CHARITY CARE COST WAS ESTIMATED ON THE APPLICATION OF THE ASSOCIATED COST-TO-CHARGE RATIOS. THE DECREASE IN CHARITY CARE IS THE RESULT OF MORE PATIENTS BEING COVERED UNDER HEALTH EXCHANGE PROGRAMS MANDATED BY THE AFFORDABLE HEALTH CARE ACT AND THE HEALTHY INDIANA PLAN 2.0. BEGINNING JUNE 2012, THE STATE OF INDIANA OFFERED VOLUNTARY PARTICIPATION IN THE STATE OF INDIANA'S HOSPITAL ASSESSMENT FEE ("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 CENTERS FOR MEDICARE AND MEDICAID SERVICES AND IS FUNDED WITH A COMBINATION OF STATE AND FEDERAL RESOURCES, INCLUDING FEES OR TAXES LEVIED ON THE PROVIDERS. THE NETWORK RECOGNIZES REVENUES AND RELATED FEES ASSOCIATED WITH THE HAF PROGRAM IN THE PERIOD IN WHICH AMOUNTS ARE ESTIMABLE AND COLLECTION OR PAYMENT IS REASONABLY ASSURED. REIMBURSEMENT UNDER THE PROGRAM IS REFLECTED WITHIN NET PATIENT SERVICE REVENUE AND THE FEES PAID FOR PARTICIPATION IN THE HAF PROGRAM ARE RECORDED IN SUPPLIES AND OTHER EXPENSES WITHIN THE CONSOLIDATED STATEMENT OF OPERATIONS AND CHANGES IN NET ASSETS. THE FEES AND REIMBURSEMENTS ARE SETTLED MONTHLY. REVENUE RECOGNIZED RELATED TO THE HAF PROGRAM WAS 71,953000 AND 85,581000 FOR THE YEARS ENDED DECEMBER 31, 2015 AND 2014, RESPECTIVELY. EXPENSE FOR FEES RELATED TO THE HAF PROGRAM WAS 41,044000 AND 48,683000 FOR THE YEARS ENDED DECEMBER 31, 2015 AND 2014, RESPECTIVELY. THE HAF PROGRAM RUNS ON AN ANNUAL CYCLE FROM JULY 1 TO JUNE 30 AND IS EFFECTIVE UNTIL JUNE 30, 2017. THE CONSOLIDATED BALANCE SHEET AT DECEMBER 31, 2015 INCLUDES LESS THAN ONE MONTH OF HAF ACTIVITY, OR 4,202000 AND 7,658000 IN ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS RECEIVABLE AND PAYABLE, RESPECTIVELY, RELATED TO THE HAF PROGRAM. ADJUSTMENTS TO THE ALLOWANCE FOR DOUBTFUL ACCOUNTS ARE MADE AFTER THE NETWORK HAS ANALYZED HISTORICAL CASH COLLECTIONS AND CONSIDERED THE IMPACT OF ANY KNOWN MATERIAL EVENTS. UNCOLLECTIBLE ACCOUNTS ARE WRITTEN-OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS AFTER EXHAUSTING COLLECTION EFFORTS. ANY SUBSEQUENT RECOVERIES ARE RECORDED AGAINST THE PROVISION FOR BAD DEBTS. PART III, LINE 8 - MEDICARE EXPLANATION PER 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 PART C AND D. THE MEDICARE SHORTFALL ATTRIBUTED TO THOSE AREAS NOT INCLUDED ON THE MEDICARE COST REPORT IS 24,223,904. AS SUCH, THE TOTAL MEDICARE SHORTFALL FOR ALL MEDICARE PROGRAMS IS 36,217,599. MEDICARE SHORTFALLS SHOULD BE CONSIDERED AS COMMUNITY BENEFIT BECAUSE MEDICARE REPRESENTS 40.53% OF THE OVERALL PAYER MIX FOR COMMUNITY HEALTH NETWORK, INC. PART III, LINE 9B - COLLECTION PRACTICES EXPLANATION SEE ATTACHED FINANCIAL ASSISTANCE POLICY. ADDITIONAL INFORMATION PART VI, ITEMS 2 THROUGH 5 ARE DISCUSSED WITHIN THE ATTACHED IRS 990 SCHEDULE H SUPPLEMENTAL INFORMATION REPORT. FOR A COPY OF THIS REPORT, PLEASE CONTACT HOLLY MILLARD AT (317) 355-5860. PART VI, ITEM 6 - AFFILIATED HEALTH CARE SYSTEM COMMUNITY HEALTH NETWORK, INC. ("CHNW") IS PART OF AN AFFILIATED HEALTH CARE SYSTEM. SEE THE ATTACHED IRS 990 SCHEDULE H SUPPLEMENTAL INFORMATION REPORT FOR HOW CHNW IS INVOLVED IN PROMOTING THE HEALTH OF THE COMMUNITY IT SERVES. PART VI, ITEM 7 - STATE FILING OF COMMUNITY BENEFIT REPORT INDIANA X X X X false true false true false false false true false BRYAN A MILLS DIRECTOR/PRES & CEO 901429 263340 20367 100308 27019 1312463 263340 HANY HADDAD MD DIRECTOR 504201 19071 15900 18376 557548 KENNETH SHAVER MD DIRECTOR 194445 8983 70878 32916 17476 324698 8983 TIMOTHY HOBBS MD EVP CHIEF PHYSICIAN 530600 104500 20367 100150 19799 775416 104500 JASON FAHRLANDER EVP ACUTE CARE SRV 450769 165300 2260 70246 26927 715502 165300 KYLE FISHER EVP STRTGY & INNOVTN 419253 161500 2087 79750 26164 688754 161500 JOSEPH M KESSLER EVP CHIEF FIN OFFR 490846 70274 2367 72000 27951 663438 70274 SCOTT TEFFETELLER PRES EAST REGION 390600 76000 1966 63350 26624 558540 76000 ANTHONY JAVORKA EVP PRES AMBULATORY 357235 104878 1809 59765 28274 551961 104878 RONALD THIEME EVP CHF KNOWLDG/INFO 342336 116124 1668 41015 26301 527444 KATHLEEN KRUSIE PRES NORTH REGION 141499 85000 206 17758 4881 249344 FRANK COVINGTON MD MEDICAL DIRECTOR 468091 70110 215184 51022 11275 815682 70110 DAVID WILLIAMS DO PRES WEST REGION 403505 161500 19858 66150 17476 668489 161500 WESLEY WONG MD CHIEF PHY INTEGRTN 425303 122550 1740 73590 19953 643136 122550 KAREN ANN LLOYD EVP GENERAL COUNSEL 385037 144400 2280 116847 15759 664323 ANTHONY LENNEN PRES SOUTH REGION 391365 118275 20135 71670 16832 618277 118275 HOLLY A MILLARD FORMER INTERIM CFO 277774 109019 1589 56923 16339 461644 109019 JEFFERY KIRKHAM FORMER KEY EMPLOYEE 293408 85500 1479 100012 26301 506700 85500 SCHEDULE J, PART III PART I, LINE 4B - SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN BRYAN A. MILLS PARTICIPATED IN A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN. DURING 2015, MR. MILLS DID NOT RECEIVE A PAYMENT FROM SUCH PLAN. PART I, LINE 5A - COMPENSATION CONTINGENT UPON REVENUES OF ORGANIZATION DR. FRANK COVINGTON WAS ELIGIBLE TO PARTICIPATE IN CHNW'S INCENTIVE COMPENSATION PLAN. CHNW DEVELOPED ITS COMPENSATION PLAN IN CONJUNCTION WITH AN INDEPENDENT COMPENSATION CONSULTANT. IN ADDITION, THE PLAN WAS APPROVED BY THE NETWORK EXECUTIVE COMPENSATION COMMITTEE, COMPOSED OF INDEPENDENT OUTSIDE DIRECTORS. IN ADOPTING ITS INCENTIVE BASED COMPENSATION PLAN, CHNW (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. PART I, LINE 7 - NON-FIXED PAYMENTS PROVIDED COMMUNITY HEALTH NETWORK, INC., PARTICIPATES IN THE NETWORK'S SENIOR LEADERSHIP INCENTIVE PROGRAM. CERTAIN INDIVIDUALS OF THE LEADERSHIP TEAM PARTICIPATE IN THIS PROGRAM. THE PROGRAM WAS ADOPTED BY THE 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 ENTIRELY OF INDEPENDENT COMMUNITY 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. A INDIANA FINANCE AUTHORITY 351602316 45471AAM4 2009-06-30 100000000 SOUTH HOSP EXPANSION false false false B INDIANA FINANCE AUTHORITY 351602316 45471AKA9 2012-11-27 404346943 SEE PART VI false false false C INDIANA FINANCE AUTHORITY 351602316 2012-11-27 74250000 SEE PART VI false false false A 64420000 100013940 842000 499875 98672065 2010 false false true true B 16150000 404722600 4254900 63063065 250092043 87312592 true true false true C 5005000 74250000 270000 73980000 true false true true A false true true true true true 0.00590 0.00590 true false true B false true true true true true 0.00570 0.00570 true false true C false true true true true true 0.00780 0.00780 true false true A false false true false true false false false true B false true false false false false false true true C false false true false true false false false true A true B true C true SCHEDULE K - PURPOSE OF ISSUE DESCRIPTION INDIANA FINANCE AUTHORITY PART I, LINE B, COLUMN (F) ADVANCE REFUND THE INDIANA HEALTH FACILITY FINANCING AUTHORITY HOSPITAL REVENUE BONDS, SERIES 2005A (COMMUNITY HEALTH NETWORK PROJECT) ISSUED ON MAY 4, 2005; CURRENTLY REFUND THE HOSPITAL AUTHORITY OF MADISON COUNTY HOSPITAL REVENUE REFUNDING BONDS, SERIES 1988A (COMMUNITY HOSPITAL OF ANDERSON PROJECT) ISSUED ON APRIL 21, 1988; CURRENTLY REFUND THE INDIANA HEALTH FACILITY FINANCING AUTHORITY HOSPITAL REVENUE BONDS, SERIES 1992 (COMMUNITY HOSPITALS PROJECT) ISSUED ON JANUARY 14, 1992; CURRENTLY REFUND THE INDIANA HEALTH FACILITY FINANCING AUTHORITY HOSPITAL REVENUE BONDS, SERIES 1993 (COMMUNITY HOSPITAL OF ANDERSON PROJECT) ISSUED ON JUNE 16, 1993; CURRENTLY REFUND THE INDIANA HEALTH FACILITY FINANCING AUTHORITY HOSPITAL REVENUE REFUNDING AND IMPROVEMENT BONDS, SERIES 1995 (COMMUNITY HOSPITALS PROJECT) ISSUED ON JANUARY 4, 1996; CURRENTLY REFUND THE INDIANA HEALTH FACILITY FINANCING AUTHORITY ADJUSTABLE RATE HOSPITAL REVENUE BONDS, SERIES 1997A (COMMUNITY HOSPITALS PROJECT) ISSUED ON AUGUST 7, 1997; CURRENTLY REFUND THE INDIANA HEALTH FACILITY FINANCING AUTHORITY ADJUSTABLE RATE HOSPITAL REVENUE BONDS, SERIES 1997B (COMMUNITY HOSPITALS PROJECT) ISSUED ON AUGUST 7, 1997; CURRENTLY REFUND THE INDIANA HEALTH FACILITY FINANCING AUTHORITY ADJUSTABLE RATE HOSPITAL REVENUE BONDS, SERIES 2005C (COMMUNITY HEALTH NETWORK PROJECT) ON MAY 4, 2005 AND CONSTRUCTION OF A CANCER CENTER AT SOUTH AND NORTH, RENOVATION OF THE EMERGENCY DEPARTMENT AT EAST AND THE CONSTRUCTION OF TWO HYBRID OPERATING SUITES AT COMMUNITY HEART AND VASCULAR HOSPITAL. INDIANA FINANCE AUTHORITY PART I, LINE C, COLUMN (F) CURRENT REFUNDING OF THE INDIANA HEALTH FACILITY FINANCING AUTHORITY ADJUSTABLE RATE HOSPITAL REVENUE BONDS, SERIES 2005B (COMMUNITY HEALTH NETWORK PROJECT) ISSUED ON MAY 4, 2005 AND CURRENT REFUNDING OF THE INDIANA FINANCE AUTHORITY ADJUSTABLE RATE HOSPITAL REVENUE BONDS, SERIES 2009B (COMMUNITY HEALTH NETWORK PROJECT) ISSUED ON JUNE 30, 2009. SCHEDULE K - ADDITIONAL INFORMATION INDIANA FINANCE AUTHORITY PART II, LINE 3, COLUMN A - DIFFERENCES IN ISSUE PRICE EXPLANATION ISSUE PRICE 100,000,000 INTEREST EARNED 13,940 INDIANA FINANCE AUTHORITY PART II, LINE 3, COLUMN B - DIFFERENCES IN ISSUE PRICE EXPLANATION ISSUE PRICE 404,346,943 INTEREST EARNED 375,658 THE HIGHER AMOUNT OF INVESTMENT EARNINGS ACCOUNTED FOR IN PRIOR YEARS WAS DUE TO THE FACT THAT ESCROW EARNINGS WERE INCLUDED. THE ESCROW TERMINATED ON MAY 1, 2015 AND THEREFORE, ESCROW EARNINGS ARE NO LONGER INCLUDED. PART III, LINE 7 COLUMNS A, B, AND C - THE BONDS ARE NOT PRIVATE ACTIVITY BONDS BECAUSE THEY DO NOT MEET THE PRIVATE BUSINESS USE TEST. PART IV, LINE 2C COLUMN A - DATE REBATE COMPUTATION PERFORMED THE 2009A BONDS AND THE 2009B BONDS MET THE 18 MONTH SPENDING EXCEPTION AS OF 12/30/10. PART IV, LINE 2C COLUMN C - DATE REBATE COMPUTATION PERFORMED THE 2012B BONDS MET THE 6 MONTH SPENDING EXCEPTION AS OF 12/31/12. FORM 990 - ORGANIZATION'S MISSION COMMUNITY HEALTH NETWORK, INC. ("CHNW") IS A 501(C)(3) CORPORATION SERVING THE HEALTH RELATED NEEDS OF THE CITIZENS OF THE INDIANAPOLIS METROPOLITAN AREA AND CENTRAL INDIANA. CHNW OPERATES THREE GENERAL ACUTE CARE HOSPITALS AND PROVIDES INPATIENT, OUTPATIENT, EMERGENCY AND AMBULATORY HEALTH CARE SERVICES TO ALL PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. CHNW'S MISSION IS TO: A) PROMOTE THE HEALTH OF THE RESIDENTS OF CENTRAL INDIANA BY PROMOTING, SUPPORTING AND FURTHERING THE CHARITABLE PURPOSES OF: COMMUNITY HOSPITAL SOUTH, INC., COMMUNITY HOSPITAL OF ANDERSON AND MADISON COUNTY, INC., COMMUNITY LTC, INC., AND COMMUNITY HOME HEALTH SERVICES, INC. (COLLECTIVELY, THE "SUPPORTED ORGANIZATIONS"), AND THEIR RESPECTIVE SUBSIDIARIES AND AFFILIATES, TO CONSIDER, COORDINATE, AND FACILITATE THE ALIGNMENT OF INITIATIVES WITHIN THE COMMUNITY HEALTH NETWORK ("NETWORK"). B) SERVE AS THE PARENT OF THE NETWORK, AN INTEGRATED DELIVERY SYSTEM, AND EXERCISE COMMON SUPERVISION AND CONTROL OVER THE NETWORK BY INTEGRATING, COORDINATING, AND MANAGING THE DELIVERY OF CAPITAL, RESOURCES, AND SERVICES THROUGHOUT THE NETWORK. IN FURTHERANCE OF ITS ROLE AS THE PARENT, THE CORPORATION WILL BE RESPONSIBLE FOR CARRYING OUT A NUMBER OF SIGNIFICANT MANAGEMENT, GOVERNANCE, AND OPERATIONAL FUNCTIONS ON BEHALF OF THE ENTIRE NETWORK, THE SUPPORTED ORGANIZATIONS, AND THEIR RESPECTIVE SUBSIDIARIES AND AFFILIATES. FORM 990 FORM 990, PART I, LINE 4 - INDEPENDENT VOTING MEMBERS THE BOARD OF DIRECTORS FOR CHNW IS ALSO THE BOARD OF DIRECTORS FOR THE FOLLOWING ORGANIZATIONS: COMMUNITY HOME HEALTH SERVICES, INC., COMMUNITY HOSPITAL SOUTH, INC., HEALTH INSTITUTE OF INDIANA, INC., AND INDIANAPOLIS OSTEOPATHIC HOSPITAL, INC. WITH REGARD TO EXECUTIVE COMPENSATION, CHNW REVIEWS AND APPROVES EXECUTIVE COMPENSATION THROUGH THE DELIBERATIONS OF THE NETWORK EXECUTIVE COMPENSATION COMMITTEE COMPOSED OF INDEPENDENT OUTSIDE DIRECTORS. LIKEWISE, CHNW REVIEWS AND MANAGES CONFLICT OF INTEREST TRANSACTIONS THROUGH THE DELIBERATIONS OF A NETWORK AUDIT COMMITTEE COMPOSED OF INDEPENDENT OUTSIDE DIRECTORS. FORM 990, PART I, LINE 5 - NUMBER OF EMPLOYEES AS OF JANUARY 1, 2012, CHNW BECAME THE EMPLOYER FOR VARIOUS RELATED ENTITIES. THE TOTAL EMPLOYEES REPORTED ON FORM W-3, TRANSMITTAL OF WAGE AND TAX STATEMENTS FILED FOR 2015 WAS 14,784. FORM 990, PART V FORM 990, PART V, LINE 1A - NUMBER REPORTED IN BOX 3 OF FORM 1096 CHNW FILES 1099 FOR VARIOUS RELATED ENTITIES. THE TOTAL NUMBER REPORTED ON FORM 1096, TRANSMITTAL OF U.S. INFORMATION RETURNS FILED FOR 2015 WAS 377. FORM 990, PART VI FORM 990, PART VI, LINE 2 - RELATED PARTY INFORMATION AMONG OFFICERS THE FOLLOWING DIRECTORS/OFFICERS SERVED AS A DIRECTOR OR OFFICER OF COMMUNITY PHYSICIANS OF INDIANA, INC. ("CPI"): TIMOTHY HOBBS, M.D. ANTHONY JAVORKA BRYAN A. MILLS STEVEN R. PLUMP AND ANTHONY JAVORKA, HANY HADDAD, M.D., AND KENNETH SHAVER, M.D. RECEIVED COMPENSATION FROM CPI. THE FOLLOWING DIRECTORS/OFFICERS SERVED AS DIRECTORS OF VISIONARY ENTERPRISES, INC. ("VEI"), A TAXABLE AFFILIATE OF CHNW: KYLE FISHER BRUCE F. KING BRYAN A. MILLS AND KYLE FISHER RECEIVED COMPENSATION FROM VEI. FORM 990, PAGE 6, PART VI, LINE 11B CHNW HAS DELEGATED AUTHORITY FOR THE REVIEW OF CHNW'S FORM 990 TO TWO COMMITTEES COMPOSED OF INDEPENDENT OUTSIDE DIRECTORS: A) THE NETWORK EXECUTIVE COMPENSATION COMMITTEE REVIEWED THE COMPENSATION ASPECTS OF CHNW'S FORM 990, AND B) THE NETWORK FINANCE COMMITTEE REVIEWED THE REMAINDER OF THE FORM 990. IN ADDITION, CHNW'S OUTSIDE ACCOUNTING FIRM AND LAW FIRM REVIEWED THE FORM 990 PRIOR TO FILING. CHNW UTILIZED THIS PROCESS TO ENSURE THAT ITS FORM 990 RECEIVED SUBSTANTIVE REVIEW BY DIRECTORS AND PROFESSIONALS WITH SPECIFIC KNOWLEDGE OF CHNW'S ACTIVITIES AND EXTENSIVE FINANCIAL, ACCOUNTING, AND TAX EXPERTISE. FORM 990, PAGE 6, PART VI, LINE 12C CHNW HAS DELEGATED AUTHORITY FOR AUDIT AND COMPLIANCE TO THE AUDIT COMMITTEE, WHICH IS COMPOSED OF INDEPENDENT DIRECTORS. THE CONFLICT OF INTEREST POLICY REQUIRES DIRECTORS, OFFICERS, AND KEY EMPLOYEES TO SUBMIT AN ANNUAL CONFLICT OF INTEREST DISCLOSURE. THE ANNUAL DISCLOSURE REQUIRES DIRECTORS, OFFICERS, AND KEY EMPLOYEES TO DISCLOSE, IN WRITING, ANY KNOWN FINANCIAL INTEREST THAT THE INDIVIDUAL (TOGETHER WITH FAMILY MEMBERS) HAS IN ANY BUSINESS ENTITY THAT TRANSACTS BUSINESS WITH CHNW. IN ADDITION, DIRECTORS, OFFICERS, AND KEY EMPLOYEES 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 CHNW, AND THE TRANSACTION MUST BE APPROVED BY A VOTE OF INDEPENDENT DIRECTORS OR COMMITTEE MEMBERS WITHOUT THE PARTICIPATION OF ANY INTERESTED INDIVIDUAL. THE ANNUAL CONFLICT DISCLOSURE STATEMENTS ARE SUBMITTED TO, AND REVIEWED BY, CHNW'S AUDIT COMMITTEE, COMPOSED OF INDEPENDENT DIRECTORS. IN ADDITION, THE EXECUTIVE STAFF AND GENERAL COUNSEL OF THE NETWORK ARE RESPONSIBLE FOR MONITORING ANY POSSIBLE CONFLICT TRANSACTIONS THAT ARISE AND MANAGING THEM TO ENSURE THAT ALL TRANSACTIONS REPRESENT ARMS LENGTH, FAIR MARKET VALUE TERMS FOR THE BENEFIT OF CHNW. FORM 990, PAGE 6, PART VI, LINE 15A CHNW HAS ADOPTED AN EXECUTIVE COMPENSATION AND INTERMEDIATE SANCTIONS POLICY. THE PURPOSE OF THE POLICY IS TO ENSURE THAT CHNW'S COMPENSATION ARRANGEMENTS WITH RELATED PARTIES ARE EVALUATED AND ENTERED AT ARMS LENGTH AND THAT ANY COMPENSATION THAT IS PAID TO A RELATED PARTY IS REASONABLE AND REFLECTS FAIR MARKET VALUE. THIS POLICY ENCOURAGES THE APPLICATION OF THE REBUTTABLE PRESUMPTION STANDARD OF CODE SECTION 4958 AND THE RELATED TREASURY REGULATIONS BY: A) EXCLUDING ANY INTERESTED PARTY FROM THE DECISION MAKING PROCESS, B) REQUIRING DISINTERESTED BOARD OR COMMITTEE MEMBERS TO OBTAIN AND RELY UPON COMPARABILITY DATA WHEN SETTING THE PROPOSED COMPENSATION TERMS, C) REQUIRING APPROVAL OF THE TRANSACTION IN ADVANCE BY DISINTERESTED DIRECTORS OR COMMITTEE MEMBERS, AND D) REQUIRING CONTEMPORANEOUS DOCUMENTATION (I.E. MINUTES) REFLECTING THE DECISION AND THE PROCESS BY WHICH IT WAS MADE. CHNW ALSO DELEGATED AUTHORITY REGARDING CHNW'S EXECUTIVE COMPENSATION TO A) THE NETWORK EXECUTIVE COMPENSATION COMMITTEE, COMPOSED OF INDEPENDENT OUTSIDE DIRECTORS, WHICH IS RESPONSIBLE FOR APPLYING THE TERMS AND PROCESS OF THE EXECUTIVE COMPENSATION AND INTERMEDIATE SANCTIONS POLICY AS OUTLINED ABOVE, AND B) THE NETWORK VICE PRESIDENT OF HUMAN RESOURCES WHO IS RESPONSIBLE FOR OBTAINING COMPARATIVE SALARY MARKET DATA FOR THE CHIEF EXECUTIVE OFFICER, OFFICERS, AND KEY EMPLOYEES, PERIODICALLY ENGAGING AN INDEPENDENT COMPENSATION CONSULTANT TO ESTABLISH REASONABLE COMPENSATION, AND PROVIDING STAFF SUPPORT TO THE NETWORK EXECUTIVE COMPENSATION COMMITTEE. DURING 2015, THE NETWORK EXECUTIVE COMPENSATION COMMITTEE FOLLOWED THIS PROCESS FOR ALL SENIOR EXECUTIVE LEADERS. FORM 990, PAGE 6, PART VI, LINE 15B SALARIES WERE COMPARED AGAINST COMPARATIVE SALARY MARKET DATA FOR ALL POSITIONS REPRESENTING MANAGERS, CHIEF EXECUTIVE OFFICERS, CHIEF FINANCIAL OFFICERS, AND HUMAN RESOURCES REPRESENTATIVES FOR ALL NETWORK ENTITIES. FORM 990, PAGE 6, PART VI, LINE 19 A) 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) CHNW HAS ADOPTED THE NETWORK CONFLICT OF INTEREST POLICY. WHILE THIS POLICY IS NOT AVAILABLE TO THE PUBLIC, THE NETWORK'S DEFINITION OF CONFLICT OF INTEREST AND HOW TO REPORT SUCH AN INCIDENT IS DESCRIBED IN THE NETWORK RESPONSIBILITY AND COMPLIANCE PROGRAM ("NRCP") MANUAL WHICH IS POSTED ON THE NETWORK'S WEBSITE, ECOMMUNITY.COM. THIS MANUAL IS AVAILABLE FOR THE PUBLIC TO REVIEW. C) CHNW DOES NOT HAVE INDIVIDUALLY AUDITED FINANCIAL STATEMENTS. ITS FINANCIAL RESULTS ARE INCLUDED IN THE CONSOLIDATED FINANCIAL STATEMENTS OF CHNW AND AFFILIATES. AS SUCH, THERE ARE NO INDIVIDUAL FINANCIAL STATEMENTS TO POST. CHNW 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. 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