2015-11-13T08:30:03-06:00 2014-12-31 352032768 CASKEY & DAILY PC 4745 STATESMEN DRIVE SUITE C INDIANAPOLIS IN 46250 990 2014-01-01 351069822 COMMUNITY HOSPITAL OF ANDERSON AND MADISON COUNTY INC COMM 7652985125 1515 NORTH MADISON AVENUE ANDERSON IN 460113453 JOHN B HARRIS VP OF FINANCE/CFO 7652985125 2015-11-10 true JAMES A CASKEY CPA CFP P00172185 3175852647 2015-11-13 2014 2016-03-07 17:11:31Z ELIZABETH S THARP 1515 NORTH MADISON AVENUE ANDERSON IN 460113453 168493095 false X WWW.COMMUNITYANDERSON.COM X 1961 IN DEEPLY COMMITTED TO THE COMMUNITIES WE SERVE, WE ENHANCE HEALTH AND WELL- BEING. TO SIMPLY DELIVER AN EXCEPTIONAL EXPERIENCE - WITH EVERY LIFE WE TOUCH. 17 13 1222 135 0 752259 763723 136921901 151949741 3471502 1543091 2169180 991027 143314842 155247582 235302 248641 0 71490150 72052753 0 0 53808753 56914073 125534205 129215467 17780637 26032115 167718997 189039034 31177114 26430866 136541883 162608168 DEEPLY COMMITTED TO THE COMMUNITIES WE SERVE, WE ENHANCE HEALTH AND WELL- BEING. TO SIMPLY DELIVER AN EXCEPTIONAL EXPERIENCE - WITH EVERY LIFE WE TOUCH. false false 120003434 152227539 COMMUNITY HOSPITAL OF ANDERSON AND MADISON COUNTY, INC. ("CHA") IS AN ACUTE CARE MEDICAL FACILITY WITH 137 STAFFED BEDS (EXCLUDING NURSERY). IN 2014, THERE WERE 5,754 ADMISSIONS, 6,978 SURGERIES PERFORMED, 823 BIRTHS WITH A TOTAL OF OVER 190,000 PATIENTS SERVED IN ALL DISCIPLINES. CHA PARTICIPATES IN MEDICARE, MEDICAID, CHAMPUS, TRICARE, AND/OR OTHER GOVERNMENT-SPONSORED HEALTH CARE PROGRAMS. WE PROVIDE AN EMERGENCY ROOM THAT IS OPEN TO ALL PERSONS REGARDLESS OF ABILITY TO PAY. OUR STAFF MAKES EVERY EFFORT TO PROVIDE AN EFFECTIVE AND EFFICIENT HEALTH CARE DELIVERY SYSTEM. FINALLY, WE HAVE A GOVERNING BODY IN WHICH INDEPENDENT PERSONS REPRESENTATIVE OF THE COMMUNITY COMPRISE THE MAJORITY. 248641 248641 COMMUNITY HOSPITAL OF ANDERSON AND MADISON COUNTY, INC. CONTRIBUTED TO A FEW LOCAL CHARITABLE ORGANIZATIONS. THE LARGEST DONATIONS ARE LISTED ON SCHEDULE I. 120252075 true true false false false false false false false false true false false false true false false true false false false false false false false false true true true false true false false false false false false false true false false false false false true true true false false true 125 0 true 1222 true false false false false false false false false false false X 17 13 true false false false true true true true true false false false true true true true true true true true false IN X JOHN B HARRIS 7652985125 1515 N MADISON AVENUE ANDERSON IN 46011 BRYAN A MILLS DIRECTOR 2.00 58.00 X 0 965396 311390 ELIZABETH S THARP DIRECTOR & P 50.00 0.00 X X 473508 0 166178 TROY ABBOTT MD DIRECTOR 2.00 50.00 X 19500 245285 120887 D BENJAMIN MCCURDY MD DIRECTOR 43.85 0.00 X 126633 0 15878 DAVID SHAPIRO MD DIRECTOR 2.00 40.00 X 0 21122 43638 LARRY L BLANKENSHIP MD DIRECTOR 2.00 0.00 X 0 0 0 MARIAN DUNNICHAY DIRECTOR 2.00 0.00 X 0 0 0 JULIE HETTINGA DIRECTOR 2.00 0.00 X 0 0 0 MARY JAMERSON VICE CHAIRMA 2.00 0.00 X X 0 0 0 JOHN KANE TREASURER 2.00 0.00 X X 0 0 0 ARTHUR J LEAK DIRECTOR 2.00 0.00 X 0 0 0 MARY JO LEE DIRECTOR 2.00 0.00 X 0 0 0 RICK MOORE DIRECTOR 2.00 0.00 X 0 0 0 MARIE MORRIS DIRECTOR 2.00 0.00 X 0 0 0 BILL O'NEAL PHD DIRECTOR 2.00 0.00 X 0 0 0 JAY B RICKER SECRETARY 2.00 0.00 X X 0 0 0 CHARLES STALEY CHAIRMAN 2.00 0.00 X X 0 0 0 DANA STUART DIRECTOR 2.00 0.00 X 0 0 0 JOHN B HARRIS VP OF FINANC 50.00 0.00 X 286743 0 148622 TAHIR ALI NAQVI MD PHYSICIAN 50.00 0.00 X 1798786 0 36636 NIGHAT TAHIR MD PHYSICIAN 50.00 0.00 X 454578 0 212223 LEE ANN MCDANIEL CRNA 50.00 0.00 X 349168 0 74133 LISA HALSTEAD VP PROF & AM 50.00 0.00 X 313365 0 112558 CAROL WHITESEL VP PATIENT C 50.00 0.00 X 212119 0 81714 4034400 1231803 1323857 58 false true false WR DUNKIN & SON INC 2911 ENTERPRISE DRIVE ANDERSON IN 46013 CONSTRUCTION 6181314 SOUTH BEND MEDICAL FOUNDATION INC 530 N LAFAYETTE BLVD SOUTH BEND IN 466011098 LABORATORY SRV 633243 ACCELECARE WOUND CENTERS INC SKYLINE TOWER 10900 NE 4TH STREET BELLEVUE WA 98004 MANAGEMENT FEES 632699 ALDERSON COMMERCIAL GROUP 425 W SOUTH SUITE 100 INDIANAPOLIS IN 46225 CONSTRUCTION 509261 EXECUTIVE HEALTH RESOURCES 15 CAMPUS BOULEVARD SUITE 200 NEWTOWN SQUARE PA 19073 MANAGEMENT FEES 469631 32 763723 763723 PATIENT CARE SERVICE 900099 147453455 147453455 RENTAL INCOME - RELATED 531120 3103055 3103055 CLINICAL RESEARCH 541700 820931 820931 JOINT VENTURES 621400 572300 572300 151949741 2260097 2260097 12528338 169 13021641 223872 -493303 -223703 -717006 -717006 CAFETERIA SALES 722514 708582 708582 TELECOMMUNICATIONS 900099 82078 82078 ESPRESSO TO GO INCOME 900099 52876 52876 147491 147491 991027 155247582 152179310 2304549 248641 248641 1052809 146133 906676 55163719 50123659 5040060 3144268 2810792 333476 8804039 7870297 933742 3887918 3475572 412346 29229 27902 1327 296851 283375 13476 63808 63808 6593934 6287951 305983 121207 115704 5503 1944736 1856449 88287 891106 850652 40454 7152118 6827429 324689 182728 174433 8295 412016 393311 18705 7348677 7015064 333613 725606 692665 32941 MEDICAL SUPPLIES 25463649 25463649 HAF PROGRAM FEES 3485413 3485413 RENOVATION EXPENSE 1731656 1653043 78613 DUES & SUBSCRIPTIONS 273043 260647 12396 198296 189294 9002 129215467 120252075 8963392 0 24996587 27045279 26574802 23076262 2325316 2347680 267924 64929 134984194 78326058 51410855 56658136 61309252 78003856 834261 1842892 167718997 189039034 18067177 14678529 11695471 10082167 1414466 1670170 31177114 26430866 X 136541883 162608168 136541883 162608168 167718997 189039034 26032115 34170 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 6188988 6188988 62814083 32180375 30633708 64041894 44325653 19716241 1939229 1820030 119199 56658136 ESTIMATED THIRD PARTY SETTLEMENTS 1058224 DUE TO AFFILIATES 611946 1670170 true true X true X true X true true true false true true 7648 7025324 1521269 5504055 0.04260 18772498 6976697 11795801 0.09130 7648 25797822 8497966 17299856 0.13390 32 13264 47425 500 46925 0.00040 1 60 1 1200 7776 7776 34 14524 55201 500 54701 0.00040 34 22172 25853023 8498466 17354557 0.13420 2 6646 1 25 1 150 500 500 4 6821 500 500 true 11648130 53900244 61693717 -7793473 X true true COMM ENDOSCOPY CTR ENDOSCOPY CENTER 0.41000 0.49000 MADISON MED ASSOC REAL ESTATE 0.30000 0.30000 1 1 COMM HOSP OF ANDERSON & MADISON CTY 1515 NORTH MADISON AVENUE ANDERSON IN 46011 SEE PART V, SECTION C 14-005100-1 X X X SEE PART VI, ADD'L INFORMATION COMM HOSP OF ANDERSON & MADISON CTY 1 false false true X X X X X X X X X X 12 true true false true X SEE PART V, SECTION C X SEE PART V, SECTION C X true 13 false true false true X 200.000000000000 300.000000000000 X X X X X true true X X X true X X X X X X X true X true X X X X true X false false FACILITY 1, COMM HOSP OF ANDERSON & MADISON CTY - 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. FACILITY 1, COMM HOSP OF ANDERSON & MADISON CTY - PART V, LINE 6A THE CHNA FOR COMMUNITY HOSPITAL OF ANDERSON AND MADISON COUNTY, INC., WAS A JOINT PROCESS AMONG ALL OF THE COMMUNITY HEALTH NETWORK HOSPITALS WHICH INCLUDES: COMMUNITY HEALTH NETWORK, INC. (NORTH & EAST), COMMUNITY HOSPITAL SOUTH, INC., COMMUNITY HOSPITAL OF ANDERSON AND MADISON COUNTY, INC., COMMUNITY HOWARD REGIONAL HEALTH, INC., INDIANA HEART HOSPITAL, LLC, AND INDIANAPOLIS OSTEOPATHIC HOSPITAL, INC. FACILITY 1, COMM HOSP OF ANDERSON & MADISON CTY - PART V, LINE 7D WWW.ECOMMUNITY.COM/S/COMMUNITY-BENEFIT/COMMUNITY-HEALTH-NEEDS FACILITY 1, COMM HOSP OF ANDERSON & MADISON CTY - PART V, LINE 7B WWW.COMMUNITYANDERSON.COM/ABOUTUS/COMMUNITYNEEDSASSESSMENT.ASP FACILITY 1, COMM HOSP OF ANDERSON & MADISON CTY - PART V, LINE 10A THE IMPLEMENTATION STRATEGY IS IN THE CHNA REPORT FOUND AT WWW.ECOMMUNITY.COM/ABOUTUS/CARE.ASPX FACILITY 1, COMM HOSP OF ANDERSON & MADISON CTY - PART V, LINE 11 SEE ATTACHED IRS 990 SCHEDULE H SUPPLEMENTAL INFORMATION REPORT FOR HOW THE HOSPITAL IS ADDRESSING THE SIGNIFICANT COMMUNITY HEALTH NEEDS. FACILITY 1, COMM HOSP OF ANDERSON & MADISON CTY - PART V, LINE 16C WWW.COMMUNITYANDERSON.COM/BILLING/FINANCIAL_ASSISTANCE.ASP FACILITY 1, COMM HOSP OF ANDERSON & MADISON CTY - PART V, LINE 13H OTHER CRITERIA INCLUDE MEDICAID/MEDICARE AND STATE REGULATION FACILITY 1, COMM HOSP OF ANDERSON & MADISON CTY - PART V, LINE 16I CHA PUBLICIZES THE FACT THAT WE HAVE FINANCIAL ASSISTANCE AVAILABLE FOR THOSE WHO CANNOT PAY FOR HEALTHCARE. SIGNS ARE POSTED THROUGHOUT THE HOSPITAL (INCLUDING ER, THE ADMITTING OFFICE, AND THE PATIENT ACCOUNTS OFFICE) LETTING PEOPLE KNOW WE HAVE ASSISTANCE AVAILABLE. INFORMATION IS ALSO INCLUDED IN THE ADMISSION PACKET AS WELL AS ON THE CONSENT FORMS AND BILLS. OUR POLICY IS ALSO POSTED ON OUR WEBSITE. WE HAVE DEDICATED AN ENTIRE PAGE ON OUR WEBSITE TO THOSE WITHOUT INSURANCE. FACILITY 1, COMM HOSP OF ANDERSON & MADISON CTY - PART V, LINE 22D THE HOSPITAL CHARGES ALL PATIENTS THE SAME PRICE REGARDLESS OF INSURANCE, ABILITY TO PAY, AGE, RACE, GENDER OR NATIONAL ORIGIN. THE UNINSURED DISCOUNT WAS DETERMINED UTILIZING THE HOSPITAL'S TOP COMMERCIAL PAYORS. UNINSURED DISCOUNTS REPRESENT A STANDARD DISCOUNT ON CHARGES AS IT RELATES TO PATIENTS WHO HAVE NO INSURANCE COVERAGE. PART I, LINE 6A - RELATED ORGANIZATION INFORMATION A COMMUNITY BENEFIT REPORT IS COMPLETED FOR THE COMMUNITY HEALTH NETWORK INCLUDING COMMUNITY HOSPITAL OF ANDERSON AND MADISON COUNTY, INC. ("CHA") AND OTHER TAX-EXEMPT AFFILIATES OF THE NETWORK. PART I, LINE 7 - COSTING METHODOLOGY 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 990 SCHEDULE H SUPPLEMENTAL INFORMATION REPORT WHICH INCLUDES INFORMATION FOR COMMUNITY HOSPITAL OF ANDERSON AND MADISON COUNTY, INC. 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. COMMUNITY HOSPITAL OF ANDERSON AND MADISON COUNTY, INC., UTILIZES AN AUTOMATED SOFTWARE SOLUTION TO ASSIST IN DETERMINING PATIENTS ELIGIBLE FOR FREE CARE. AS A RESULT OF THE IMPLEMENTATION OF THIS AUTOMATED SOLUTION, THERE IS VERY LITTLE BAD DEBT RECORDED FOR PATIENTS WHO WOULD BE ELIGIBLE FOR FREE CARE UNDER THE HOSPITAL'S POLICY. PATIENTS WITHOUT INSURANCE COVERAGE ARE ELIGIBLE FOR A 40% UNINSURED DISCOUNT. IF PATIENTS PAY THEIR BILL IN FULL WITHIN 30 DAYS OF RECEIVING IT, THEY ARE ELIGIBLE FOR AN ADDITIONAL 10% DISCOUNT. UNCOLLECTIBLE ACCOUNTS ARE WRITTEN OFF AGAINST ALLOWANCE FOR DOUBTFUL ACCOUNTS AFTER EXHAUSTING COLLECTION EFFORTS. BAD DEBT EXPENSE REPRESENTS THE AMOUNT OF UNCOLLECTIBLE ACCOUNTS RECEIVABLE WRITTEN OFF. PART III, LINE 4 - BAD DEBT EXPENSE EXPLANATION CHA DOES NOT HAVE INDIVIDUALLY AUDITED FINANCIAL STATEMENTS. ITS FINANCIAL RESULTS ARE INCLUDED IN THE CONSOLIDATED FINANCIAL STATEMENTS OF COMMUNITY HEALTH NETWORK, INC. AND AFFILIATES. THE NETWORK AUDITED FINANCIAL STATEMENTS CONTAIN THE FOLLOWING TEXT WITHIN THE FOOTNOTES TO DESCRIBE BAD DEBT EXPENSE: THE NETWORK'S 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. 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 AND CHARITY 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, 2014 AND 2013, RESPECTIVELY: THIRD PARTY PAYORS SELF-PAY TOTAL ALL PAYORS 2014 PATIENT SERVICE REVENUE(NET OF CONTRACTUAL ALLOWANCES AND DISCOUNTS) 1,846,217 142,537 1,988,754 ========== ======== ========== 2013 PATIENT SERVICE REVENUE(NET OF CONTRACTUAL ALLOWANCES AND DISCOUNTS) 1,666,086 94,024 1,760,110 ========== ======= ========== 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 15,657000 AND 83,731000 FOR THE YEARS ENDED DECEMBER 31, 2014 AND 2013, RESPECTIVELY. CHARITY CARE COST WAS ESTIMATED ON THE APPLICATION OF THE ASSOCIATED COST-TO-CHARGE RATIOS. THE REDUCTION IN CHARITY CARE AND OFFSETTING INCREASE IN THE ALLOWANCE FOR DOUBTFUL ACCOUNTS ARE REFLECTIONS OF CHANGES THE NETWORK MADE TO ITS CHARITY CARE POLICY EFFECTIVE JANUARY 1, 2014, WHICH PRIMARILY INCLUDE BEING MORE RESTRICTIVE TO PROVIDE CARE TO INDIVIDUALS WHO RESIDE IN THE NETWORK'S SERVICE AREA. FURTHER, BEGINNING IN JANUARY 2014, MORE PATIENTS WERE COVERED UNDER HEALTH EXCHANGE PROGRAMS MANDATED BY THE AFFORDABLE HEALTH CARE ACT. 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 85,581000 AND 91,705000 FOR THE YEARS ENDED DECEMBER 31, 2014 AND 2013, RESPECTIVELY. EXPENSE FOR FEES RELATED TO THE HAF PROGRAM WAS 48,683000 AND 59,757000 FOR THE YEARS ENDED DECEMBER 31, 2014 AND 2013, RESPECTIVELY. THE HAF PROGRAM RUNS ON AN ANNUAL CYCLE FROM JULY 1 TO JUNE 30 AND WAS ORIGINALLY EFFECTIVE UNTIL JUNE 30, 2013. THE PROGRAM WAS RENEWED ON MARCH 21, 2014 WITH A RETROACTIVE EFFECTIVE DATE OF JULY 1, 2013, AND IS EFFECTIVE UNTIL JUNE 30, 2017. AS A RESULT OF THE RETROACTIVE APPLICATION, THE NETWORK ACCRUED BOTH THE ESTIMATED REIMBURSEMENT AND EXPENSE FOR THE PERIOD JULY 1, 2013 THROUGH DECEMBER 31, 2013 IN ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS ON THE DECEMBER 31, 2013 BALANCE SHEET. THE CONSOLIDATED BALANCE SHEET AT DECEMBER 31, 2013 INCLUDES 46,036000 AND 35,240000 IN ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS RECEIVABLE AND PAYABLE, RESPECTIVELY, RELATED TO THE HAF PROGRAM. THE CONSOLIDATED BALANCE SHEET AT DECEMBER 31, 2014 INCLUDES LESS THAN ONE MONTH OF HAF ACTIVITY, OR 700000 AND 1,600000 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 PARTS C AND D. MEDICARE SHORTFALLS SHOULD BE CONSIDERED AS COMMUNITY BENEFIT BECAUSE MEDICARE REPRESENTS 49.04% OF THE OVERALL PAYER MIX FOR COMMUNITY HOSPITAL OF ANDERSON AND MADISON COUNTY, INC. PART III, LINE 9B - COLLECTION PRACTICES EXPLANATION IF A PATIENT IS DETERMINED TO BE ELIGIBLE FOR HARDSHIP DURING THE COLLECTION PROCESS, COLLECTION EFFORTS ARE STOPPED AND HARDSHIP IS GIVEN. ADDITIONAL INFORMATION PART V - FACILITY INFORMATION, SECTION A - OTHER CHA IS AN ACUTE CARE MEDICAL FACILITY WITH 137 STAFFED BEDS. IN 2014, THERE WERE 5,754 ADMISSIONS WITH AN AVERAGE LENGTH OF STAY OF 3.67 DAYS. THERE WERE 31,368 EMERGENCY ROOM CASES RESPONDED TO IN OUR 24-HOUR/SEVEN DAY A WEEK EMERGENCY ROOM. 62.8% OF THE BIRTHS IN MADISON COUNTY WERE DELIVERED AT CHA FOR A TOTAL OF 823 BIRTHS IN 2014. PART VI, ITEMS 2 THROUGH 5 ARE DISCUSSED WITHIN THE ATTACHED COMMUNITY BENEFIT REPORT. PART VI, ITEM 6 - AFFILIATED HEALTH CARE SYSTEM CHA IS PART OF AN AFFILIATED HEALTH CARE SYSTEM. SEE THE ATTACHED IRS 990 SCHEDULE H SUPPLEMENTAL INFORMATION REPORT FOR HOW CHA IS INVOLVED IN PROMOTING THE HEALTH OF THE COMMUNITY IT SERVES. PART VI, ITEM 7 - STATE FILING OF COMMUNITY BENEFIT REPORT INDIANA true ALTERNATIVES INC PO BOX 1302 ANDERSON IN 46015 310986769 501C3 11500 GENERAL SUPPORT ANDERSON IMPACT CENTER 630 NICHOL AVENUE ANDERSON IN 46016 900521040 501C3 25000 GENERAL SUPPORT ANDERSON SYMPHONY ORCHESTRA 1124 MERIDIAN PLAZA ANDERSON IN 46015 310940546 501C3 6250 GENERAL SUPPORT ANDERSON UNIVERSITY 1303 E 5TH STREET ANDERSON IN 46012 350867954 501C3 11000 SCHOOL OF NURSING COMMUNITY HEALTH NETWORK FOUNDATION 7240 SHADELAND STATION SUITE 125 INDIANAPOLIS IN 46256 510181688 501C3 11000 GENERAL SUPPORT FIRST UNITED METHODIST CHURCH 1215 JACKSON STREET ANDERSON IN 46016 350874263 501C3 13261 BUDDY BAG PROGRAM HEALTH & HOSPITAL CORP OF MARION CO 3838 N RURAL STREET 8TH FLOOR INDIANAPOLIS IN 46205 356005697 GOV 10000 GENERAL SUPPORT IVY TECH FOUNDATION 345 S HIGH STREET MUNCIE IN 47305 237073977 501C3 15000 ANDERSON EXPANSION MADISON COUNTY COMMUNITY FOUNDATION 33 W 10TH STREET SUITE 600 ANDERSON IN 46016 351859959 501C3 33300 GENERAL SUPPORT MADISON COUNTY FIREFIGHTERS FOUNDATION INC 824 W 3RD STREET ANDERSON IN 46016 272136389 501C3 7800 GENERAL SUPPORT MADISON PARK CHURCH OF GOD 1932 E 53RD STREET ANDERSON IN 46013 356005926 501C3 8000 SPONSOR A CHR CAROL PARAMOUNT HERITAGE FOUNDATION INC 1124 MERIDIAN PLAZA ANDERSON IN 46015 351774217 501C3 12950 GENERAL SUPPORT SECOND HARVEST FOOD BANK OF EAST CENTRAL INDIANA 6621 N OLD SR 3 MUNCIE IN 47303 311111795 501C3 8600 GENERAL SUPPORT SOUTH MADISON COMMUNITY FOUNDATION 233 S MAIN STREET PENDLETON IN 46064 351839759 501C3 8000 GENERAL SUPPORT THE CROSSING NATIONAL INC 2930 S NAPPANEE STREET ELKHART IN 46517 260588186 501C3 12500 GENERAL SUPPORT UNITED WAY OF MADISON COUNTY INC 1201 E 5TH STREET SUITE 1019 ANDERSON IN 46015 351052350 501C3 13000 GENERAL SUPPORT 16 SCHEDULE I, PAGE 1, PART I, LINE 2 THE CONTRIBUTIONS TO VARIOUS LOCAL CHARITABLE ORGANIZATIONS WERE UNRESTRICTED DONATIONS. X X X X X false true false false false false false true false BRYAN A MILLS DIRECTOR 899084 46200 20112 286605 24785 1276786 46200 ELIZABETH S THARP DIRECTOR & PRES/CEO 318810 152404 2294 164107 2071 639686 113404 TROY ABBOTT MD DIRECTOR 19500 232160 13125 105235 15652 19500 366172 JOHN B HARRIS VP OF FINANCE & CFO 211039 58251 17453 130200 18422 435365 58251 TAHIR ALI NAQVI MD PHYSICIAN 947675 801492 49619 10400 26236 1835422 547600 NIGHAT TAHIR MD PHYSICIAN 247432 206340 806 185720 26503 666801 91400 LEE ANN MCDANIEL CRNA 333133 4992 11043 49817 24316 423301 LISA HALSTEAD VP PROF & AMBUL SRV 249337 48387 15641 85746 26812 425923 CAROL WHITESEL VP PATIENT CARE/CNO 163002 34633 14484 71450 10264 293833 SCHEDULE J, PART III PART I, LINE 4B SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN BRYAN A. MILLS PARTICIPATED IN A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN THROUGH HIS EMPLOYER, COMMUNITY HEALTH NETWORK, INC. MR. MILLS DID NOT RECEIVE A PAYMENT FROM THE PLAN IN 2014. PART I, LINE 7 - NON-FIXED PAYMENTS PROVIDED DR. NAQVI AND DR. TAHIR ARE ELIGIBLE FOR AN INCENTIVE PAYMENT BASED ON PRODUCTIVITY. CHA DEVELOPED ITS COMPENSATION PLAN IN CONJUNCTION WITH AN INDEPENDENT COMPENSATION CONSULTANT. IN ADDITION, THE PLAN WAS APPROVED BY THE CHA EXECUTIVE COMPENSATION COMMITTEE, COMPOSED OF INDEPENDENT OUTSIDE DIRECTORS. IN ADOPTING ITS INCENTIVE BASED COMPENSATION PLAN, CHA (TOGETHER WITH ITS INDEPENDENT COMPENSATION CONSULTANT, ITS EXTERNAL LEGAL COUNSEL, AND THE NETWORK EXECUTIVE COMPENSATION COMMITTEE) CONSIDERED AND APPLIED THE PROVISIONS OF CODE SECTION 4958 AND THE CORRESPONDING TREASURY REGULATIONS TO ENSURE THAT ITS COMPENSATION DECISIONS REFLECT ARMS LENGTH, FAIR MARKET TERMS. CERTAIN INDIVIDUALS OF THE LEADERSHIP TEAM PARTICIPATE IN A SENIOR LEADERSHIP INCENTIVE PROGRAM. THE PROGRAM WAS ADOPTED BY CHA'S EXECUTIVE COMPENSATION COMMITTEE, AND IS INTENDED TO INFLUENCE OUTSTANDING PERFORMANCE BY THE SENIOR LEADERS, AS MEASURED AGAINST BOTH ORGANIZATIONAL AND INDIVIDUAL PERFORMANCE. THE PROGRAM IS REVIEWED ANNUALLY BY THE EXECUTIVE COMPENSATION COMMITTEE, WHICH IS COMPOSED OF EXTERNAL BOARD MEMBERS. THE INCENTIVE COMPENSATION THAT IS AWARDED IS INCLUDED IN TOTAL COMPENSATION TO THE EXECUTIVE. THE TOTAL COMPENSATION (INCLUDING ANY PAYMENTS UNDER THE PROGRAM) IS SUBJECT TO THE REVIEW AND APPROVAL OF THE EXECUTIVE COMPENSATION COMMITTEE AND INDEPENDENT COMPENSATION CONSULTANT, IN CONSIDERATION OF CODE SECTION 4958 (AND THE CORRESPONDING TREASURY REGULATIONS) TO ENSURE THAT IT REFLECTS ARMS LENGTH, FAIR MARKET TERMS. VISIONARY ENTERPRISES INC SHARE BD MEMBER 15025625 HLTH INSUR/PLAN FEES false FORM 990, PART VI FORM 990, PART VI, LINE 2 - RELATED PARTY INFORMATION AMONG OFFICERS CHARLES STALEY SERVED AS A DIRECTOR OF COMMUNITY HEALTH NETWORK, INC. ("CHNW") AND BRYAN A. MILLS RECEIVED COMPENSATION FROM CHNW. IN ADDITION, BRYAN A. MILLS SERVED AS A DIRECTOR OF COMMUNITY PHYSICIANS OF INDIANA, INC. ("CPI") AND THE FOLLOWING RECEIVED COMPENSATION FROM CPI: TROY ABBOTT, M.D. FORM 990, PAGE 6, PART VI, LINE 3 THROUGH AN AFFILIATION AGREEMENT EFFECTIVE SEPTEMBER 1, 1996, CHA'S BOARD OF TRUSTEES RETAINS CONTROL OVER MANAGEMENT DUTIES FOR CHA. HOWEVER, FOR THE FOLLOWING GOVERNANCE ITEMS, CHA INITIATES RECOMMENDATIONS TO THE COMMUNITY HEALTH NETWORK, INC. ("CHNW") BOARD OF DIRECTORS FOR ITS APPROVAL OF THE FOLLOWING: A) STRATEGIC AND OPERATING PLANS; B) ANNUAL OPERATING AND CAPITAL BUDGETS AND ANY UNBUDGETED CAPITAL EXPENDITURES; C) AMENDMENTS TO THE ARTICLES OR BYLAWS OF THE CHA BOARD OF TRUSTEES, THE BYLAWS OF THE CHA MEDICAL STAFF, OR TO THE AFFILIATION AGREEMENT; D) APPOINTMENT AND REMOVAL OF THE CHIEF EXECUTIVE OFFICER OF CHA; E) UNBUDGETED SALES, LEASES, OR TRANSFERS OF ASSETS ABOVE 500,000; F) INCURRENCE OF DEBT OTHER THAN IN THE ORDINARY COURSE OF BUSINESS OR IN ACCORDANCE WITH THE OPERATING PLANS, OPERATING BUDGET, OR CAPITAL BUDGET RECOMMENDED BY THE CHA BOARD OF TRUSTEES AND APPROVED BY THE CHNW BOARD OF DIRECTORS; G) CHANGE IN THE MISSION OF CHA; H) ELECTION OF NEW MEMBERS OR REAPPOINTMENT OF CURRENT MEMBERS TO THE CHA BOARD OF TRUSTEES; I) PARTICIPATION IN MANAGED CARE AND OTHER NETWORKS OR AFFILIATIONS; AND J) RELOCATION OF PHYSICIANS EMPLOYED BY OR UNDER CONTRACT WITH CHNW TO MADISON COUNTY. FORM 990, PAGE 6, PART VI, LINE 6 COMMUNITY HEALTH NETWORK, INC. ("CHNW") IS THE SOLE MEMBER OF COMMUNITY HOSPITAL OF ANDERSON AND MADISON COUNTY, INC. ("CHA"). CHNW IS AN EXEMPT ORGANIZATION PURSUANT TO SECTION 501(C)(3). FORM 990, PAGE 6, PART VI, LINE 7A CHA'S BOARD OF TRUSTEES MEMBERSHIP IS DETERMINED AS FOLLOWS: A) CHNW, AS THE SOLE MEMBER OF CHA, SHALL NOMINATE AND ELECT ONE MEMBER OF CHA'S BOARD OF TRUSTEES, B) ONE MEMBER OF THE CHA BOARD OF TRUSTEES SHALL BE THE CHIEF EXECUTIVE OFFICER OF CHA, C) FOUR MEMBERS SHALL BE ACTIVE MEMBERS OF THE CHA MEDICAL STAFF AND SHALL BE NOMINATED AND ELECTED BY THE CHA MEDICAL STAFF, AND RATIFIED BY THE CHA BOARD OF TRUSTEES, D) THE TWELVE REMAINING POSITIONS SHALL BE FILLED BY PERSONS ELECTED BY CHNW'S BOARD OF DIRECTORS, AND E) ADDITIONALLY, THE PRESIDENT OF THE MEDICAL STAFF SHALL SERVE AS AN EX OFFICIO, NONVOTING MEMBER OF THE BOARD OF TRUSTEES. FORM 990, PAGE 6, PART VI, LINE 7B CHNW, AS THE SOLE MEMBER OF CHA, MUST APPROVE THE FOLLOWING: A) STRATEGIC AND OPERATING PLANS; B) ANNUAL OPERATING AND CAPITAL BUDGETS AND ANY UNBUDGETED CAPITAL EXPENDITURES; C) AMENDMENTS TO THE ARTICLES OR BYLAWS OF THE CORPORATION AND THE BYLAWS OF THE MEDICAL STAFF OF THE CORPORATION, D) APPOINTMENT AND REMOVAL OF THE CHIEF EXECUTIVE OFFICER OF THE CORPORATION; E) UNBUDGETED SALES, LEASES, OR TRANSFERS OF ASSETS ABOVE 500,000, WHICH AMOUNT MAY BE ADJUSTED FROM TIME TO TIME AS AGREED BY THE BOARD OF TRUSTEES AND THE BOARD OF DIRECTORS OF THE MEMBER; F) INCURRENCE OF DEBT OTHER THAN IN THE ORDINARY COURSE OF BUSINESS OR IN ACCORDANCE WITH THE OPERATING PLANS, OPERATING BUDGET, OR CAPITAL BUDGET RECOMMENDED BY THE BOARD OF TRUSTEES AND APPROVED BY THE BOARD OF DIRECTORS OF THE MEMBER; G) CHANGE IN THE MISSION OF THE CORPORATION; H) ELECTION OF NEW MEMBERS OR REAPPOINTMENT OF CURRENT MEMBERS TO THE BOARD OF TRUSTEES; I) PARTICIPATION IN MANAGED CARE AND OTHER NETWORKS OR AFFILIATIONS; AND J) RELOCATION OF PHYSICIANS EMPLOYED BY OR UNDER CONTRACT WITH THE MEMBER TO MADISON COUNTY. FORM 990, PAGE 6, PART VI, LINE 11B CHA'S BOARD OF TRUSTEES HAS DELEGATED AUTHORITY FOR THE REVIEW OF CHA'S FORM 990 TO THE EXECUTIVE COMMITTEE. IN ADDITION, CHA'S OUTSIDE ACCOUNTING FIRM AND LAW FIRM REVIEWED THE FORM 990 PRIOR TO FILING. CHA UTILIZED THIS PROCESS TO ENSURE THAT ITS FORM 990 RECEIVED SUBSTANTIVE REVIEW BY PROFESSIONALS WITH SPECIFIC KNOWLEDGE REGARDING CHA'S ACTIVITIES AND EXTENSIVE FINANCIAL, ACCOUNTING, AND TAX EXPERTISE. FORM 990, PAGE 6, PART VI, LINE 12C CHA HAS ADOPTED A CONFLICT OF INTEREST POLICY APPLICABLE TO ALL EMPLOYEES. THE CONFLICT OF INTEREST POLICY REQUIRES EMPLOYEES SUBMIT A CONFLICT OF INTEREST DISCLOSURE FORM UPON EMPLOYMENT WITH CHA AND ON AN ANNUAL BASIS THEREAFTER. PRIOR TO COMPLETING AND SIGNING THE DISCLOSURE, ALL EMPLOYEES MUST READ AND UNDERSTAND CHA'S CONFLICT OF INTEREST POLICY STATEMENT, WHICH PROVIDES THAT NO CHA EMPLOYEE SHALL MAKE A PROFIT BECAUSE OF HIS OR HER POSITION AT CHA. THE DISCLOSURE REQUIRES EMPLOYEES TO DISCLOSE, IN WRITING, ANY KNOWN FINANCIAL INTEREST THAT THE INDIVIDUAL (TOGETHER WITH THEIR SPOUSE AND FAMILY MEMBERS) HAS IN ANY BUSINESS ENTITY THAT CONDUCTS OR WILL POTENTIALLY CONDUCT BUSINESS WITH CHA. EMPLOYEES ARE ALSO REQUIRED TO IMMEDIATELY DISCLOSE TO THE CHA HUMAN RESOURCES DEPARTMENT ANY SUBSEQUENT CHANGES THAT ARISE MID-YEAR AND WOULD OTHERWISE BE REPORTED ON THE ANNUAL DISCLOSURE STATEMENT. IN ADDITION, THE CHA AMENDED AND RESTATED CODE OF BYLAWS PROVIDES A CONFLICT OF INTEREST POLICY FOR THE CHA BOARD OF TRUSTEES. CHA'S AMENDED AND RESTATED CODE OF BYLAWS REQUIRES ALL BOARD MEMBERS TO DISCLOSE ANY DUALITY OR CONFLICT OF INTEREST TO THE OTHER BOARD MEMBERS. THE DIRECTOR IS PROHIBITED FROM VOTING OR EXERTING ANY PERSONAL INFLUENCE ON ANY ISSUE THAT PRESENTS A CONFLICT OF INTEREST. THE DIRECTOR'S ABSTENTION FROM THE VOTE AND THE DETAILS CONCERNING THE CONFLICT OF INTEREST ARE REPORTED IN THE MEETING'S MINUTES. FORM 990, PAGE 6, PART VI, LINE 15A 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 15B SEE PART VI, LINE 15A ABOVE. 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) WHILE NOT AVAILABLE TO THE PUBLIC, CHA'S CONFLICT OF INTEREST POLICY IS DESCRIBED IN PART VI, LINE 12C. C) CHA DOES NOT HAVE INDIVIDUALLY AUDITED FINANCIAL STATEMENTS. ITS FINANCIAL RESULTS ARE INCLUDED IN THE CONSOLIDATED FINANCIAL STATEMENTS OF COMMUNITY HEALTH NETWORK, INC. AND AFFILIATES. AS SUCH, THERE ARE NO INDIVIDUAL FINANCIAL STATEMENTS TO POST. CHA DOES FILE THE 990 TAX RETURN ON AN ANNUAL BASIS WHICH IS AVAILABLE UPON REQUEST AND/OR AVAILABLE ON A DELAYED BASIS ON GUIDESTAR.ORG. D) COMMUNITY HEALTH NETWORK, INC. AND AFFILIATES PROVIDE ANY DOCUMENT OPEN TO PUBLIC INSPECTION UPON REQUEST. 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