INDIANAPOLIS OSTEOPATHIC HOSPITAL: Form 990, tax year 2014
View the entire original 990 at ProPublica ↗
- Organization
- INDIANAPOLIS OSTEOPATHIC HOSPITAL (EIN 35-1094734)
- Tax period
- 2014-01-01 to 2014-12-31
- Filed
- 2015-11-13
- IRS object ID
- 201533179349301768
- Schema version
- 2014v5.0
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule D
- Schedule H
- Schedule J
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2015-11-13T08:09:48-06:00 | ReturnTs |
| Tax Period End | 2014-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 352032768 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CASKEY & DAILY PC | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 4745 STATESMEN DRIVE SUITE C | AddressLine1Txt |
| City | INDIANAPOLIS | CityNm |
| State Abbreviation | IN | StateAbbreviationCd |
| ZIP | 46250 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2014-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 351094734 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | INDIANAPOLIS OSTEOPATHIC HOSPITAL | BusinessNameLine1Txt |
| Business Name Line2 | INC | BusinessNameLine2Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | INDI | BusinessNameControlTxt |
| Phone | 3179208439 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3630 GUION ROAD | AddressLine1Txt |
| City | INDIANAPOLIS | CityNm |
| State Abbreviation | IN | StateAbbreviationCd |
| ZIP | 46222 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | DAVID C WILLIAMS DO | PersonNm |
| Person Title | CEO | PersonTitleTxt |
| Phone | 3179208439 | PhoneNum |
| Signature | 2015-10-20 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | JAMES A CASKEY CPA CFP | PreparerPersonNm |
| PTIN | P00172185 | PTIN |
| Phone | 3175852647 | PhoneNum |
| Preparation | 2015-11-13 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2014 | TaxYr |
| Build TS | 2016-04-25 22:37:26Z | BuildTS |
Form 990 IRS990
Doing Business As Name DoingBusinessAsName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | COMMUNITY WESTVIEW HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | DAVID C WILLIAMS DO | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3630 GUION ROAD | AddressLine1Txt |
| City | INDIANAPOLIS | CityNm |
| State Abbreviation | IN | StateAbbreviationCd |
| ZIP | 46222 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $46,946,745 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.WESTVIEWHOSPITAL.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1961 | FormationYr |
| Legal Domicile State | IN | LegalDomicileStateCd |
| Activity Or Mission | TO PROVIDE QUALITY HEALTHCARE TO THE CENTRAL INDIANA COMMUNITY - REGARDLESS OF THEIR ABILITY TO PAY - WITH FACILITIES, SUPPORT AND GROWTH FOR THE OSTEOPATHIC PROFESSION THROUGH OUR INTERN/RESIDENT EDUCATION PROGRAMS, INCREASED PHYSICIAN PRACTICES, PRESENCE AND EXPERTISE. | ActivityOrMissionDesc |
| Voting Members Governing Body | 13 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 8 | VotingMembersIndependentCnt |
| Total Employee | 536 | TotalEmployeeCnt |
| Total Volunteers | 42 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| PY Contributions Grants | $96,778 | PYContributionsGrantsAmt |
| CY Contributions Grants | $55,150 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $59,756,666 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $45,380,681 | CYProgramServiceRevenueAmt |
| PY Investment Income | -$402,805 | PYInvestmentIncomeAmt |
| CY Investment Income | -$131,502 | CYInvestmentIncomeAmt |
| PY Other Revenue | $1,914,599 | PYOtherRevenueAmt |
| CY Other Revenue | $1,282,586 | CYOtherRevenueAmt |
| PY Total Revenue | $61,365,238 | PYTotalRevenueAmt |
| CY Total Revenue | $46,586,915 | CYTotalRevenueAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $41,580,182 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $27,229,048 | CYSalariesCompEmpBnftPaidAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $31,859,999 | PYOtherExpensesAmt |
| CY Other Expenses | $25,551,010 | CYOtherExpensesAmt |
| PY Total Expenses | $73,440,181 | PYTotalExpensesAmt |
| CY Total Expenses | $52,780,058 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$12,074,943 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$6,193,143 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $53,056,959 | TotalAssetsBOYAmt |
| Total Assets EOY | $39,357,955 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $29,197,698 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $21,691,837 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $23,859,261 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $17,666,118 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | TO PROVIDE QUALITY HEALTHCARE TO THE CENTRAL INDIANA COMMUNITY - REGARDLESS OF THEIR ABILITY TO PAY - WITH FACILITIES, SUPPORT AND GROWTH FOR THE OSTEOPATHIC PROFESSION THROUGH OUR INTERN/RESIDENT EDUCATION PROGRAMS, INCREASED PHYSICIAN PRACTICES, PRESENCE AND EXPERTISE. | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | Yes (true) | SignificantChangeInd |
| Expense | $30,675,893 | ExpenseAmt |
| Revenue | $40,992,634 | RevenueAmt |
| Desc | AT INDIANAPOLIS OSTEOPATHIC HOSPITAL, INC. ("IOH") OUR OSTEOPATHIC PHILOSOPHY OF CARE MEANS WE TREAT YOU AS A WHOLE PERSON AND ASSESS YOUR ENTIRE LIFESTYLE. THE HOSPITAL OFFERS AN ARRAY OF SERVICES ON THE WESTSIDE OF INDIANAPOLIS, INDIANA, INCLUDING A 24-HOUR EMERGENCY ROOM, INTENSIVE ACUTE CARE NURSING UNITS, SURGICAL SERVICES, IMAGING SERVICES, LABORATORY SERVICES, CANCER CARE, CARDIOPULMONARY REHABILITATION, SLEEP LAB, RENAL/DIALYSIS SERVICES, INPATIENT AND OUTPATIENT REHABILITATION SERVICES, AND GERIATRIC PSYCHIATRIC CARE. THE HOSPITAL OFFERS A FULL RANGE OF DIAGNOSTIC, TREATMENT, MEDICAL AND SURGICAL SERVICES WITH A MEDICAL STAFF COMPRISED OF OVER 30 MEDICAL AND SURGICAL SPECIALTIES. THE HOSPITAL SERVED 961 INPATIENTS AND PROVIDED 85,287 OUTPATIENT VISITS, WHICH INCLUDED 10,660 EMERGENCY VISITS. THE IOH SURGERY DEPARTMENT PERFORMED 2,989 SURGERIES IN 2014. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $10,771,393 | ExpenseAmt |
| Revenue | $5,501,745 | RevenueAmt |
| Desc | PHYSICIAN CLINICS - IN ADDITION TO THE HOSPITAL SERVICES THAT IOH PROVIDES, THE HOSPITAL ALSO PROVIDED SPECIALTY AND PRIMARY CARE IN ITS CLINICS. WITHIN THE CLINIC SITES, 24,988 ENCOUNTERS WERE ACCOMPLISHED IN 2014 BEFORE THE RESTRUCTURING WHEN THE PHYSICIAN PRACTICES WERE MOVED TO COMMUNITY PHYSICIAN NETWORK, INC., A RELATED TAX-EXEMPT ORGANIZATION. | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expenses | $41,447,286 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (true) | ScheduleBRequiredInd |
| Political Campaign Acty | false | PoliticalCampaignActyInd |
| Lobbying Activities | false | LobbyingActivitiesInd |
| Subject To Proxy Tax | false | SubjectToProxyTaxInd |
| Donor Advised Fund | false | DonorAdvisedFundInd |
| Conservation Easements | false | ConservationEasementsInd |
| Collections Of Art | false | CollectionsOfArtInd |
| Credit Counseling | false | CreditCounselingInd |
| Temp Or Permanent Endowments | false | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (true) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | false | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | Yes (true) | ReportProgramRelatedInvstInd |
| Report Other Assets | false | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (true) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | false | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | false | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (true) | ConsolidatedAuditFinclStmtInd |
| School Operating | false | SchoolOperatingInd |
| Foreign Office | false | ForeignOfficeInd |
| Foreign Activities | false | ForeignActivitiesInd |
| More Than5000 K To Org | false | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividualsInd |
| Professional Fundraising | false | ProfessionalFundraisingInd |
| Fundraising Activities | false | FundraisingActivitiesInd |
| Gaming Activities | false | GamingActivitiesInd |
| Operate Hospital | Yes (true) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (true) | AuditedFinancialStmtAttInd |
| Grants To Organizations | false | GrantsToOrganizationsInd |
| Grants To Individuals | false | GrantsToIndividualsInd |
| Schedule J Required | Yes (true) | ScheduleJRequiredInd |
| Tax Exempt Bonds | false | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | false | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | false | PYExcessBenefitTransInd |
| Loan Outstanding | false | LoanOutstandingInd |
| Grant To Related Person | false | GrantToRelatedPersonInd |
| Business Rln With Org Mem | false | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | false | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | Yes (true) | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | false | DeductibleNonCashContriInd |
| Deductible Art Contribution | false | DeductibleArtContributionInd |
| Terminate Operations | false | TerminateOperationsInd |
| Partial Liquidation | false | PartialLiquidationInd |
| Disregarded Entity | false | DisregardedEntityInd |
| Related Entity | Yes (true) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (true) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | Yes (true) | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | false | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | false | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (true) | ScheduleORequiredInd |
| Info In Schedule O Part V | Yes (X) | InfoInScheduleOPartVInd |
| IRP Document | 52 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (true) | BackupWthldComplianceInd |
| Employee | 536 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (true) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | false | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | false | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | false | TaxablePartyNotificationInd |
| Nondeductible Contributions | false | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | false | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | false | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | false | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | false | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 13 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 8 | IndependentVotingMemberCnt |
| Family Or Business Rln | Yes (true) | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | Yes (true) | DelegationOfMgmtDutiesInd |
| Change To Org Documents | Yes (true) | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (true) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (true) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (true) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (true) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (true) | MinutesOfCommitteesInd |
| Officer Mailing Address | false | OfficerMailingAddressInd |
| Local Chapters | false | LocalChaptersInd |
| Form990 Provided To Gvrn Body | false | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (true) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (true) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (true) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (true) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (true) | DocumentRetentionPolicyInd |
| Compensation Process CEO | false | CompensationProcessCEOInd |
| Compensation Process Other | false | CompensationProcessOtherInd |
| Investment In Joint Venture | Yes (true) | InvestmentInJointVentureInd |
| Written Policy Or Procedure | false | WrittenPolicyOrProcedureInd |
| States Where Copy Of Return Is Fld | IN | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | BRIAN MCCONNELL | PersonNm |
| Phone | 3173554212 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 8180 CLEARVISTA PWKY 200 | AddressLine1Txt |
| City | INDIANAPOLIS | CityNm |
| State Abbreviation | IN | StateAbbreviationCd |
| ZIP | 46256 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (31 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd | Former Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd |
|---|---|---|---|---|---|---|---|---|---|
| BRYAN A MILLS | |||||||||
| DIRECTOR | 1.00 | 59.00 | Yes (X) | $0 | $965,396 | $311,390 | |||
| HANY HADDAD MD | |||||||||
| DIRECTOR | 1.00 | 54.00 | Yes (X) | $0 | $524,569 | $33,822 | |||
| DAVID C WILLIAMS DO | |||||||||
| DIR THRU 01/ | 45.00 | 10.00 | Yes (X) | $0 | $440,107 | $196,034 | Yes (X) | ||
| DAVID HARRISON DO | |||||||||
| DIRECTOR THR | 11.00 | 30.00 | Yes (X) | $105,672 | $317,017 | $37,243 | |||
| ALLAN ARKUSH DO | |||||||||
| DIRECTOR THR | 11.00 | 30.00 | Yes (X) | $99,719 | $299,155 | $17,374 | |||
| KENNETH SHAVER MD | |||||||||
| DIRECTOR | 1.00 | 54.00 | Yes (X) | $0 | $262,895 | $102,407 | |||
| LISA RICHTER DO | |||||||||
| DIRECTOR THR | 11.00 | 30.00 | Yes (X) | $65,380 | $196,142 | $15,600 | |||
| CINDY BROWN DO | |||||||||
| VICE CHR THR | 11.00 | 30.00 | Yes (X) | $40,739 | $122,215 | $18,004 | Yes (X) | ||
| ROBERT BEHNING | |||||||||
| DIRECTOR THR | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| ANDREW CARDIMEN | |||||||||
| SEC/TREAS TH | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | ||
| PAUL EVANS DO | |||||||||
| DIRECTOR THR | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| MARIA WILEY | |||||||||
| CHAIRMAN THR | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | ||
| KATHRYN G BETLEY | |||||||||
| DIRECTOR | 1.00 | 5.00 | Yes (X) | $0 | $0 | $0 | |||
| BRUCE F KING | |||||||||
| DIRECTOR | 1.00 | 5.00 | Yes (X) | $0 | $0 | $0 | |||
| JEFFREY MOSSLER MD | |||||||||
| DIRECTOR | 1.00 | 5.00 | Yes (X) | $0 | $0 | $0 | |||
| MICHAEL PETERSON | |||||||||
| CHAIRMAN | 1.00 | 5.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | ||
| STEVEN R PLUMP | |||||||||
| DIRECTOR | 1.00 | 5.00 | Yes (X) | $0 | $0 | $0 | |||
| YVONNE SHAHEEN | |||||||||
| SECRETARY | 1.00 | 5.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | ||
| KRISTIN T SHERMAN | |||||||||
| TREASURER | 1.00 | 5.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | ||
| CHARLES E STALEY | |||||||||
| DIRECTOR | 1.00 | 5.00 | Yes (X) | $0 | $0 | $0 | |||
| RUSSELL SWAN JR | |||||||||
| VICE CHAIRMA | 1.00 | 5.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | ||
| BRIAN K WILLIAMS | |||||||||
| DIRECTOR | 1.00 | 5.00 | Yes (X) | $0 | $0 | $0 | |||
| DOUG PENLEY | |||||||||
| COO | 45.00 | $176,310 | $0 | $85,764 | Yes (X) | ||||
| DEBORAH LEE | |||||||||
| CNO | 45.00 | $147,352 | $0 | $50,698 | Yes (X) | ||||
| ELIZABETH HALL | |||||||||
| DIRECTOR OF | 45.00 | $92,570 | $0 | $42,548 | Yes (X) | ||||
| ROBERT MURRAY DO | |||||||||
| PHYSICIAN | 11.25 | 33.75 | $88,393 | $265,177 | $21,317 | Yes (X) | |||
| THOMAS SOUTHERN MD | |||||||||
| PHYSICIAN | 11.25 | 33.75 | $84,142 | $252,426 | $5,090 | Yes (X) | |||
| STEWART BROWN DO | |||||||||
| PHYSICIAN | 11.25 | 33.75 | $80,084 | $240,251 | $54,244 | Yes (X) | |||
| YOUNG PARK DO | |||||||||
| PHYSICIAN | 11.25 | 33.75 | $61,402 | $184,204 | $42,744 | Yes (X) | |||
| DANNIEL G VLAHOVICH DO | |||||||||
| PHYSICIAN | 11.25 | 33.75 | $60,618 | $181,854 | $24,367 | Yes (X) | |||
| JON ANDERSON | |||||||||
| FORMER CEO | $147,707 | $0 | $0 | Yes (X) | |||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,250,088 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $4,251,408 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $1,058,646 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 22 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | Yes (true) | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (true) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| MID AMERICA CLINICAL LAB | |||||
| 2560 N SHADELAND AVENUE | INDIANAPOLIS | IN | 46219 | LAB SERVICES | $1,750,344 |
| EMCARE | |||||
| 7032 COLLECTION CENTER DRIVE | CHICAGO | IL | 60693 | STAFFING | $977,664 |
| SUBURBAN HEALTH ORGANIZATION | |||||
| 2647 WATERFRONT PKWY E DR SUITE 300 | INDIANAPOLIS | IN | 46214 | PHY RECRUITMENT | $682,508 |
| WESTVIEW ANESTHESIA GROUP | |||||
| 8736 SANTANA LANE | INDIANAPOLIS | IN | 46278 | MEDICAL | $549,000 |
| ACCELECARE WOUND CENTERS INC | |||||
| PO BOX 671242 | DALLAS | TX | 752671242 | MEDICAL | $469,205 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 17 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $55,150 | RelatedOrganizationsAmt |
| Total Contributions | $55,150 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (4 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| PATIENT REVENUE | 622110 | $40,288,824 | $40,288,824 |
| PHYSICIAN CLINICS | 900099 | $4,368,415 | $4,368,415 |
| PHYSICIAN CLINIC ADMIN FEES | 900099 | $364,488 | $364,488 |
| RENT - RELATED PURPOSE | 531120 | $358,954 | $358,954 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $45,380,681 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $53,441 | TotalRevenueColumnAmt |
| Exclusion | $53,441 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $174,887 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $359,830 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | -$184,943 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$184,943 | TotalRevenueColumnAmt |
| Exclusion | -$184,943 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt | ExclusionExclusionAmt |
|---|---|---|---|---|
| ELECTRONIC MED RCRD INCENTIVE | 900099 | $750,772 | $750,772 | |
| EXPENSE REIMBURSEMENT | 900099 | $172,614 | $172,614 | |
| CAFETERIA SALES | 722514 | $168,888 | $168,888 |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $190,312 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $190,312 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $1,282,586 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $46,586,915 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $46,494,379 | RelatedOrExemptFuncIncomeAmt |
| Exclusion | $37,386 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $928,808 | TotalAmt |
| Program Services | $333,566 | ProgramServicesAmt |
| Management And General | $595,242 | ManagementAndGeneralAmt |
Comp Disqual Persons CompDisqualPersonsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $147,707 | TotalAmt |
| Management And General | $147,707 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $20,824,840 | TotalAmt |
| Program Services | $17,524,830 | ProgramServicesAmt |
| Management And General | $3,300,010 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,084,140 | TotalAmt |
| Program Services | $791,422 | ProgramServicesAmt |
| Management And General | $292,718 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,747,971 | TotalAmt |
| Program Services | $2,240,699 | ProgramServicesAmt |
| Management And General | $507,272 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,495,582 | TotalAmt |
| Program Services | $1,305,979 | ProgramServicesAmt |
| Management And General | $189,603 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $25,937 | TotalAmt |
| Management And General | $25,937 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $52,050 | TotalAmt |
| Management And General | $52,050 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,479,886 | TotalAmt |
| Program Services | $6,130,683 | ProgramServicesAmt |
| Management And General | $2,349,203 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $281,671 | TotalAmt |
| Program Services | $197,588 | ProgramServicesAmt |
| Management And General | $84,083 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,451,280 | TotalAmt |
| Program Services | $982,390 | ProgramServicesAmt |
| Management And General | $468,890 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $190,862 | TotalAmt |
| Program Services | $43,364 | ProgramServicesAmt |
| Management And General | $147,498 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,680,145 | TotalAmt |
| Program Services | $2,185,394 | ProgramServicesAmt |
| Management And General | $494,751 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $69,642 | TotalAmt |
| Program Services | $59,539 | ProgramServicesAmt |
| Management And General | $10,103 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $24,556 | TotalAmt |
| Program Services | $22,243 | ProgramServicesAmt |
| Management And General | $2,313 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $72,278 | TotalAmt |
| Management And General | $72,278 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,850,078 | TotalAmt |
| Program Services | $188,564 | ProgramServicesAmt |
| Management And General | $1,661,514 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $504,634 | TotalAmt |
| Program Services | $174,035 | ProgramServicesAmt |
| Management And General | $330,599 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| MEDICAL SUPPLIES | $6,917,244 | $6,917,244 | |
| HOSPITAL ASSESSMENT FEE | $2,256,203 | $2,256,203 | |
| DUES & SUBSCRIPTIONS | $322,699 | $9,061 | $313,638 |
| PHYSICIAN DEVELOPMENT | $201,265 | $45,727 | $155,538 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $170,580 | TotalAmt |
| Program Services | $38,755 | ProgramServicesAmt |
| Management And General | $131,825 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $52,780,058 | TotalAmt |
| Program Services | $41,447,286 | ProgramServicesAmt |
| Management And General | $11,332,772 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,413,502 | BOYAmt |
| EOY | $4,356,429 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,513,953 | BOYAmt |
| EOY | $4,846,537 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,794,187 | BOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $614,464 | BOYAmt |
| EOY | $516,230 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $81,757 | BOYAmt |
| EOY | $70,848 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $26,164,978 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $5,278,490 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $23,223,540 | BOYAmt |
| EOY | $20,886,488 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,073,668 | BOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,279,314 | BOYAmt |
| EOY | $7,069,300 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $421,094 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,062,574 | BOYAmt |
| EOY | $1,191,029 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $53,056,959 | BOYAmt |
| EOY | $39,357,955 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,321,296 | BOYAmt |
| EOY | $3,875,398 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,679,831 | BOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $17,196,571 | BOYAmt |
| EOY | $17,816,439 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $29,197,698 | BOYAmt |
| EOY | $21,691,837 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $23,859,261 | BOYAmt |
| EOY | $17,666,118 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $23,859,261 | BOYAmt |
| EOY | $17,666,118 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $53,056,959 | BOYAmt |
| EOY | $39,357,955 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | -$6,193,143 | ReconcilationRevenueExpnssAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | false | AccountantCompileOrReviewInd |
| FS Audited | Yes (true) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (true) | AuditCommitteeInd |
| Federal Grant Audit Required | false | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,710,000 | OtherCostOrOtherBasisAmt |
| Book Value | $1,710,000 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $16,449,452 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,505,302 | DepreciationAmt |
| Book Value | $14,944,150 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $238,405 | OtherCostOrOtherBasisAmt |
| Depreciation | $43,439 | DepreciationAmt |
| Book Value | $194,966 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $7,617,121 | OtherCostOrOtherBasisAmt |
| Depreciation | $3,729,749 | DepreciationAmt |
| Book Value | $3,887,372 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $150,000 | OtherCostOrOtherBasisAmt |
| Book Value | $150,000 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $20,886,488 | TotalBookValueLandBuildingsAmt |
Invst Program Related Org InvstProgramRelatedOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | INVESTMENT IN AFFILIATES | Desc |
| Book Value | $7,069,300 | BookValueAmt |
| Method Valuation | C | MethodValuationCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Program Rltd | $7,069,300 | TotalBookValueProgramRltdAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (3 entries)
| DescDesc | AmtAmt |
|---|---|
| DUE TO AFFILIATES | $17,320,012 |
| CAPITAL LEASE | $309,443 |
| THIRD PARTY SETTLEMENTS | $186,984 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $17,816,439 | TotalLiabilityAmt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (true) | FinancialAssistancePolicyInd |
| Written Policy | Yes (true) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (true) | FPGReferenceFreeCareInd |
| Percent200 | Yes (X) | Percent200Ind |
| FPG Reference Discounted Care | Yes (true) | FPGReferenceDiscountedCareInd |
| Percent300 | Yes (X) | Percent300Ind |
| Free Care Medically Indigent | Yes (true) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (true) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | false | ExpensesExceedBudgetInd |
| Annual Community Bnft Report | Yes (true) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (true) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 248 | PersonsServedCnt |
| Total Community Benefit Expns | $278,684 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $278,684 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00530 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 4329 | PersonsServedCnt |
| Total Community Benefit Expns | $7,395,739 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,252,449 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $4,143,290 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.07850 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 4577 | PersonsServedCnt |
| Total Community Benefit Expns | $7,674,423 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,252,449 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $4,421,974 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.08380 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 2 | ActivitiesOrProgramsCnt |
| Total Community Benefit Expns | $1,890,615 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $497,514 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,393,101 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02640 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 2 | ActivitiesOrProgramsCnt |
| Total Community Benefit Expns | $1,890,615 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $497,514 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,393,101 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02640 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 2 | ActivitiesOrProgramsCnt |
| Persons Served | 4577 | PersonsServedCnt |
| Total Community Benefit Expns | $9,565,038 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,749,963 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $5,815,075 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.11020 | TotalExpensePct |
Workforce Development WorkforceDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 1 | ActivitiesOrProgramsCnt |
| Total Community Benefit Expns | $12,508 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $12,508 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00020 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 1 | ActivitiesOrProgramsCnt |
| Total Community Benefit Expns | $12,508 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $12,508 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00020 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (true) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $2,509,756 | BadDebtExpenseAmt |
| Reimbursed By Medicare | $7,980,731 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $10,590,962 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$2,610,231 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (true) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (true) | FinancialAssistancePrvsnInd |
Management Co And Jnt Ventures ManagementCoAndJntVenturesGrp
Entity Name EntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | NORTHWEST SURG CTR | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Primary Activities | SURGERY | PrimaryActivitiesTxt |
| Org Profit Or Ownership | 0.20000 | OrgProfitOrOwnershipPct |
| Physicians Profit Or Ownership | 0.43000 | PhysiciansProfitOrOwnershipPct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WESTVIEW HOSPITAL | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3630 GUION ROAD | AddressLine1Txt |
| City | INDIANAPOLIS | CityNm |
| State Abbreviation | IN | StateAbbreviationCd |
| ZIP | 46222 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | WWW.ECOMMUNITY.COM/WESTVIEW | WebsiteAddressTxt |
| State License | 14-005110-1 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Teaching Hospital | Yes (X) | TeachingHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WESTVIEW HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | false | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | false | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (true) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Information Gaps | Yes (X) | InformationGapsInd |
| Other | Yes (X) | OtherInd |
| CHNA Conducted | 12 | CHNAConductedYr |
| Take Into Account Others Input | Yes (true) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | Yes (true) | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | false | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (true) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | SEE PART V, SECTION C | OwnWebsiteURLTxt |
| Other Website | Yes (X) | OtherWebsiteInd |
| Other Website URL | SEE PART V, SECTION C | OtherWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (true) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 13 | ImplementationStrategyAdptYr |
| Strategy Posted Website | false | StrategyPostedWebsiteInd |
| Strategy Attached | Yes (true) | StrategyAttachedInd |
| Organization Incur Excise Tax | false | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (true) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 200.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 300.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Residency Criteria | Yes (X) | ResidencyCriteriaInd |
| Explained Basis | Yes (true) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (true) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Includes Publicity Measures | Yes (true) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| FAP Notice Displayed | Yes (X) | FAPNoticeDisplayedInd |
| Other Publicity | Yes (X) | OtherPublicityInd |
| FAP Actions On Nonpayment | Yes (true) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | Yes (true) | CollectionActivitiesInd |
| FAP Notified Upon Admission | Yes (X) | FAPNotifiedUponAdmissionInd |
| FAP Notified Before Discharge | Yes (X) | FAPNotifiedBeforeDischargeInd |
| FAP Notified All Patients | Yes (X) | FAPNotifiedAllPatientsInd |
| Documented Elig Determination | Yes (X) | DocumentedEligDeterminationInd |
| Nondis Emergency Care Policy | Yes (true) | NondisEmergencyCarePolicyInd |
| Other Method Used | Yes (X) | OtherMethodUsedInd |
| Amounts Generally Billed | false | AmountsGenerallyBilledInd |
| Gross Charges | false | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FACILITY 1, WESTVIEW HOSPITAL - 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, WESTVIEW HOSPITAL - PART V, LINE 6A | THE CHNA FOR INDIANAPOLIS OSTEOPATHIC HOSPITAL, 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 OSTEPATHIC HOSPITAL, INC. |
| FACILITY 1, WESTVIEW HOSPITAL - PART V, LINE 7D | WWW.ECOMMUNITY.COM/S/COMMUNITY-BENEFIT/COMMUNITY-HEALTH-NEEDS FACILITY 1, WESTVIEW HOSPITAL - PART V, LINE 7B WWW.COMMUNITYANDERSON.COM/ABOUTUS/COMMUNITYNEEDSASSESSMENT.ASP FACILITY 1, WESTVIEW HOSPITAL - PART V, LINE 10A THE IMPLEMENTATION STRATEGY IS IN THE CHNA REPORT FOUND AT WWW.ECOMMUNITY.COM/ABOUTUS/CARE.ASPX |
| FACILITY 1, WESTVIEW HOSPITAL - 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, WESTVIEW HOSPITAL - PART V, LINE 16I | THE POLICY IS REFERENCED ON THE BILL. |
| FACILITY 1, WESTVIEW HOSPITAL - PART V, LINE 22D | THE UNINSURED DISCOUNT WAS DETERMINED UTILIZING THE NETWORK'S TOP COMMERCIAL PAYORS. UNINSURED DISCOUNTS REPRESENT A STANDARD DISCOUNT ON CHARGES AS IT RELATES TO PATIENTS WHO HAVE NO INSURANCE COVERAGE. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 22 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (22 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| STIRLING CENTER FOR OSTEOPATHIC MED | ||||
| 3725 KENTUCKY AVENUE | INDIANAPOLIS | IN | 46241 | PRIMARY CARE CLINIC |
| CENTER FOR INTEGRATED MEDICINE | ||||
| 3660 N GUION ROAD | INDIANAPOLIS | IN | 46222 | PRIMARY CARE CLINIC |
| GLENDALE FAMILY MEDICINE | ||||
| 2620 KESSLER BLVD EAST DRIVE | INDIANAPOLIS | IN | 46220 | PRIMARY CARE CLINIC |
| ROCKVILLE PLAZA FAMILY PRACTICE | ||||
| 101 N GIRLS SCHOOL ROAD | INDIANAPOLIS | IN | 46214 | PRIMARY CARE CLINIC |
| SPEEDWAY FAMILY PHYSICIANS | ||||
| 1426 MAIN STREET | INDIANAPOLIS | IN | 46224 | PRIMARY CARE CLINIC |
| WESTVIEW PRIMARY CARE CENTER - GEO | ||||
| 5471 GEORGETOWN ROAD | INDIANAPOLIS | IN | 46254 | PRIMARY CARE CLINIC |
| WESTVIEW WOMEN'S SPECIALTY CARE CTR | ||||
| 3660 N GUION ROAD | INDIANAPOLIS | IN | 46222 | SPECIALTY CARE CENTER |
| INDIANA GENERAL SURGERY | ||||
| 3630 N GUION ROAD | INDIANAPOLIS | IN | 46222 | SPECIALTY CARE CENTER |
| STARSIAK ORTHOPEDICS AND SPORTS MED | ||||
| 3660 N GUION ROAD | INDIANAPOLIS | IN | 46222 | SPECIALTY CARE CENTER |
| WESTVIEW UROLOGY | ||||
| 3520 GUION ROAD | INDIANAPOLIS | IN | 46222 | SPECIALTY CARE CENTER |
| WESTVIEW BONE AND OMT CLINIC | ||||
| 3660 N GUION ROAD | INDIANAPOLIS | IN | 46222 | SPECIALTY CARE CENTER |
| BROWNSBURG FAMILY MEDICAL | ||||
| 321 E NORTHFIELD DRIVE 100 | BROWNSBURG | IN | 46112 | PRIMARY CARE CLINIC |
| WESTVIEW RADIOLOGISTS | ||||
| 3660 N GUION ROAD | INDIANAPOLIS | IN | 46222 | SPECIALTY CARE CENTER |
| HEALTHPLEX INTERNAL MEDICINE | ||||
| 3660 N GUION ROAD | INDIANAPOLIS | IN | 46222 | PRIMARY CARE CLINIC |
| NORTHWEST FAMILY MEDICINE | ||||
| 7439 WOODLAND DRIVE SUITE 105 | INDIANAPOLIS | IN | 46278 | PRIMARY CARE CLINIC |
| BETHESDA COLON AND RECTAL CENTER | ||||
| 3660 N GUION ROAD | INDIANAPOLIS | IN | 46222 | SPECIALTY CARE CENTER |
| BANTA AND ASSOCIATES | ||||
| 3077 E 98TH STREET SUITE 100 | INDIANAPOLIS | IN | 46280 | SPECIALTY CARE CENTER |
| CTR FOR RHEUMATIC & IMMUNE DISORDER | ||||
| 3660 N GUION ROAD | INDIANAPOLIS | IN | 46222 | SPECIALTY CARE CENTER |
| MANDEL FAMILY PRACTICE | ||||
| 4007 N HIGH SCHOOL ROAD | INDIANAPOLIS | IN | 46254 | PRIMARY CARE CLINIC |
| SOUTHERN PLASTIC & RECONSTRUC SRG | ||||
| 3630 GUION ROAD | INDIANAPOLIS | IN | 46222 | SPECIALTY CARE CENTER |
| WESTVIEW GASTROENTEROLOGY | ||||
| 3520 GUION ROAD | INDIANAPOLIS | IN | 46222 | SPECIALTY CARE CENTER |
| OSTEOPATHIC INTEGRATED MEDICINE | ||||
| 17 MOORE STREET | MOORESVILLE | IN | 46158 | PRIMARY CARE CLINIC |
Supplemental Information Detail SupplementalInformationDetail (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 6A - RELATED ORGANIZATION INFORMATION | A COMMUNITY BENEFIT REPORT IS COMPLETED FOR THE COMMUNITY HEALTH NETWORK INCLUDING INDIANAPOLIS OSTEOPATHIC HOSPITAL, 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 4 - BAD DEBT EXPENSE EXPLANATION THE 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. 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 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 INCLUDED BEING MORE RESTRICTIVE TO PROVIDE CARE TO INDIVIDUALS WHO RESIDE IN THE NETWORKS 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 PART C AND D. THE MEDICARE SHORTFALL ATTRIBUTED TO THOSE AREAS NOT INCLUDED ON THE MEDICARE COST REPORT IS 4,691,505. AS SUCH, THE TOTAL MEDICARE SHORTFALL FOR ALL MEDICARE PROGRAMS IS 7,301,736. MEDICARE SHORTFALLS SHOULD BE CONSIDERED AS COMMUNITY BENEFIT BECAUSE MEDICARE REPRESENTS 42.83% OF THE OVERALL PAYER MIX FOR INDIANAPOLIS OSTEOPATHIC HOSPITAL, 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 COMMUNITY BENEFIT REPORT. FOR A COPY OF THIS REPORT, PLEASE CONTACT HOLLY MILLARD AT (317) 355-5860. PART VI, ITEM 6 - AFFILIATED HEALTH CARE SYSTEM INDIANAPOLIS OSTEOPATHIC HOSPITAL, INC. ("IOH")IS PART OF AN AFFILIATED HEALTH CARE SYSTEM. SEE THE ATTACHED IRS 990 SCHEDULE H SUPPLEMENTAL INFORMATION REPORT FOR HOW IOH IS INVOLVED IN PROMOTING THE HEALTH OF THE COMMUNITY IT SERVES. PART VI, ITEM 7 - STATE FILING OF COMMUNITY BENEFIT REPORT INDIANA |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Club Dues Or Fees | Yes (X) | ClubDuesOrFeesInd |
| Written Policy Ref T And E Expnss | Yes (true) | WrittenPolicyRefTAndEExpnssInd |
| Substantiation Required | false | SubstantiationRequiredInd |
| Severance Payment | Yes (true) | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (true) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | false | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | false | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | false | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | false | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | false | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | Yes (true) | AnyNonFixedPaymentsInd |
| Initial Contract Exception | false | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (16 entries)
| TitleTitleTxt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| BRYAN A MILLS | ||||||||||||||
| DIRECTOR | $899,084 | $46,200 | $20,112 | $286,605 | $24,785 | $1,276,786 | $46,200 | |||||||
| HANY HADDAD MD | ||||||||||||||
| DIRECTOR | $505,548 | $19,021 | $15,600 | $18,222 | $558,391 | |||||||||
| DAVID C WILLIAMS DO | ||||||||||||||
| DIR THRU 01/29 & CEO | $404,649 | $14,174 | $21,284 | $179,700 | $16,334 | $636,141 | $14,174 | |||||||
| DAVID HARRISON DO | ||||||||||||||
| DIRECTOR THRU 01/29 | $270,561 | $46,456 | $11,700 | $16,232 | $344,949 | $90,187 | $15,485 | $3,900 | $5,411 | $114,983 | ||||
| ALLAN ARKUSH DO | ||||||||||||||
| DIRECTOR THRU 01/29 | $293,203 | $5,952 | $13,030 | $312,185 | $97,735 | $1,984 | $4,344 | $104,063 | ||||||
| KENNETH SHAVER MD | ||||||||||||||
| DIRECTOR | $194,289 | $68,606 | $86,073 | $16,334 | $365,302 | |||||||||
| LISA RICHTER DO | ||||||||||||||
| DIRECTOR THRU 01/29 | $131,119 | $65,023 | $11,700 | $207,842 | $43,706 | $21,674 | $3,900 | $69,280 | ||||||
| CINDY BROWN DO | ||||||||||||||
| VICE CHR THRU 01/29 | $107,969 | $14,246 | $6,283 | $7,220 | $135,718 | $35,990 | $4,749 | $2,094 | $2,407 | $45,240 | ||||
| DOUG PENLEY | ||||||||||||||
| COO | $171,386 | $1,222 | $60,462 | $25,302 | $262,074 | $3,702 | $3,702 | |||||||
| DEBORAH LEE | ||||||||||||||
| CNO | $141,245 | $1,380 | $50,698 | $198,050 | $4,727 | $4,727 | ||||||||
| ROBERT MURRAY DO | ||||||||||||||
| PHYSICIAN | $212,087 | $53,090 | $11,700 | $4,288 | $281,165 | $70,696 | $17,697 | $3,900 | $1,429 | $93,722 | ||||
| THOMAS SOUTHERN MD | ||||||||||||||
| PHYSICIAN | $229,637 | $22,789 | $3,817 | $256,243 | $76,546 | $7,596 | $1,273 | $85,415 | ||||||
| STEWART BROWN DO | ||||||||||||||
| PHYSICIAN | $203,321 | $16,537 | $20,393 | $28,238 | $12,445 | $280,934 | $67,774 | $6,797 | $9,412 | $4,149 | $93,645 | $5,513 | ||
| YOUNG PARK DO | ||||||||||||||
| PHYSICIAN | $179,433 | $4,771 | $11,515 | $20,542 | $216,261 | $59,811 | $1,591 | $3,839 | $6,848 | $72,089 | ||||
| DANNIEL G VLAHOVICH DO | ||||||||||||||
| PHYSICIAN | $159,382 | $22,472 | $10,972 | $7,303 | $200,129 | $53,127 | $7,491 | $3,658 | $2,434 | $66,710 | ||||
| JON ANDERSON | ||||||||||||||
| FORMER CEO | $483 | $147,224 | $147,707 | $143,844 | ||||||||||
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| SCHEDULE J, PAGE 1, PART I, LINE 1A | HEALTH CLUB DUES PAID FOR THE CNO ARE INCLUDED IN THE WRITTEN EMPLOYMENT CONTRACT. THE CONTRACT WAS APPROVED BY THE COMPENSATION COMMITTEE AND THE BOARD OF DIRECTORS. THE DUES ARE TREATED AS TAXABLE COMPENSATION. |
| SCHEDULE J, PAGE 1, PART I, LINE 4 | JON ANDERSON 147,018 0 0 |
| SCHEDULE J, PART III | PART I, LINE 3 - RELATED ORG METHODS USED FOR COMPENSATION EXPLANATION INDIANAPOLIS OSTEOPATHIC HOSPITAL, INC. ("IOH") CEO/EXECUTIVE DIRECTOR IS PAID BY COMMUNITY HEALTH NETWORK, INC. ("CHNW"), A RELATED 501(C)(3) ORGANIZATION. CHNW 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 4B - SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN BRYAN A. MILLS PARTICIPATED IN A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN THROUGH HIS EMPLOYER, CHNW. DURING 2014, MR. MILLS DID NOT RECEIVE A PAYMENT FROM THE PLAN. PART I, LINE 7 - NON-FIXED PAYMENTS PROVIDED INDIANAPOLIS OSTEOPATHIC HOSPITAL 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. |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp (2 entries)
| Relationship DescriptionRelationshipDescriptionTxt | TransactionTransactionAmt | TransactionTransactionDesc | Sharing Of RevenuesSharingOfRevenuesInd |
|---|---|---|---|
| AMERIPATH INDIANAPOLIS LLC | |||
| BD MBR = PRES | $300,679 | FEES | false |
| VISIONARY ENTERPRISES INC | |||
| SHR BOARD MBR | $360,455 | RENT EXPENSE | false |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (17 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990 - ORGANIZATION'S MISSION | TO PROVIDE QUALITY HEALTHCARE TO THE CENTRAL INDIANA COMMUNITY - REGARDLESS OF THEIR ABILITY TO PAY - WITH FACILITIES, SUPPORT AND GROWTH FOR THE OSTEOPATHIC PROFESSION THROUGH OUR INTERN/RESIDENT EDUCATION PROGRAMS, INCREASED PHYSICIAN PRACTICES, PRESENCE AND EXPERTISE. |
| FORM 990 | FORM 990, PART I, LINE 4 - INDEPENDENT VOTING MEMBERS INDIANAPOLIS OSTEOPATHIC HOSPITAL, INC. ("IOH") IS AN AFFILIATE OF COMMUNITY HEALTH NETWORK ("THE NETWORK"), AN INTEGRATED HEALTH DELIVERY SYSTEM. IOH IS CONTROLLED BY ITS PARENT, COMMUNITY HEALTH NETWORK, INC. ("CHNW"), THE TAX-EXEMPT PARENT OF THE INTEGRATED HEALTH DELIVERY SYSTEM. IOH'S ARTICLES OF INCORPORATION AND BYLAWS DESIGNATE THE MEMBERS OF THE BOARD OF DIRECTORS OF CHNW TO BE THE DIRECTORS OF IOH. CHNW EXERCISES CONTROL OVER IOH THROUGH A SERIES OF GOVERNANCE RIGHTS: A) CHNW IS THE SOLE MEMBER OF IOH; B) IOH HAS DELEGATED EXCLUSIVE AUTHORITY TO CHNW, ACTING THROUGH CHNW'S BOARD OF DIRECTORS, IN THE FOLLOWING SUBSTANTIVE AREAS: STRATEGIC PLANNING; CAPITAL ACCESS, BUDGETING AND ALLOCATION; AUDIT AND COMPLIANCE; EXECUTIVE COMPENSATION; AND DISPUTE RESOLUTION; C) CHNW MUST APPROVE ANY MODIFICATION, REPEAL, AMENDMENT, OR RESTATEMENT OF IOH'S ARTICLES OF INCORPORATION; AND D) CHNW MUST APPROVE ANY SALE OR DISPOSITION OF SUBSTANTIALLY ALL OF THE ASSETS OF IOH. WITH REGARD TO EXECUTIVE COMPENSATION, CHNW HAS DELEGATED AUTHORITY TO REVIEW AND APPROVE EXECUTIVE COMPENSATION, INCLUDING IOH'S EXECUTIVES, TO A NETWORK EXECUTIVE COMPENSATION COMMITTEE COMPOSED OF INDEPENDENT OUTSIDE DIRECTORS. IN SUM, IOH HAS REMOVED ANY RISK OF INAPPROPRIATE RELATED PARTY TRANSACTIONS BY DELEGATING (THROUGH CHNW) ITS EXECUTIVE COMPENSATION DECISIONS TO A NETWORK EXECUTIVE COMPENSATION COMMITTEE AND ITS CONFLICT OF INTEREST DECISIONS TO A NETWORK AUDIT COMMITTEE, WITH EACH COMMITTEE COMPOSED OF INDEPENDENT OUTSIDE DIRECTORS. |
| FORM 990, PAGE 2, PART III, LINE 3 | IN 2014, THE PHYSICIAN PRACTICES WERE MOVED TO COMMUNITY PHYSICIAN NETWORK, INC., A RELATED TAX-EXEMPT ORGANIZATION. |
| FORM 990, PAGE 2, PART III, LINE 4A | 10,660 EMERGENCY VISITS. THE IOH SURGERY DEPARTMENT PERFORMED 2,989 SURGERIES IN 2014. |
| FORM 990, PART V | FORM 990, PART V, LINE 1A - BOX 3 OF FORM 1096 FORM 1099S WERE PROCESSED UNDER THE NAME AND FEDERAL IDENTIFICATION NUMBER OF COMMUNITY HEALTH NETWORK, INC. |
| FORM 990, PART VI | FORM 990, PART VI, LINE 2 - RELATED PARTY INFORMATION AMONG OFFICERS THE BOARD OF DIRECTORS FOR IOH IS ALSO THE BOARD OF DIRECTORS FOR THE FOLLOWING ORGANIZATIONS: COMMUNITY HEALTH NETWORK, INC. COMMUNITY HOME HEALTH SERVICES, INC., COMMUNITY HOSPITAL SOUTH, INC. HEALTH INSTITUTE OF INDIANA, INC., AND INDIANA HEART HOSPITAL, LLC IN ADDITION, BRYAN MILLS RECEIVED COMPENSATION FROM COMMUNITY HEALTH NETWORK, ("CHNW"). THE FOLLOWING DIRECTORS ALSO SERVED AS A DIRECTOR OF COMMUNITY PHYSICIANS OF INDIANA, INC. ("CPI"): BRYAN A. MILLS JEFFREY A. MOSSLER, M.D. STEVEN R. PLUMP AND KENNETH SHAVER, M.D. AND HANY HADDAD, M.D. RECEIVED COMPENSATION FROM CPI. THE FOLLOWING DIRECTORS SERVED AS DIRECTORS OF COMMUNITY HOSPITAL OF ANDERSON & MADISON COUNTY, INC. ("CHA"): BRYAN A. MILLS CHARLES E. STALEY THE FOLLOWING DIRECTORS SERVED AS DIRECTORS OF VISIONARY ENTERPRISES, INC., A TAXABLE AFFILIATE OF CHNW: BRUCE F. KING BRYAN A. MILLS JEFFREY A. MOSSLER, M.D. |
| FORM 990, PAGE 6, PART VI, LINE 3 | EFFECTIVE JANUARY 30, 2014, IOH DELEGATED EXCLUSIVE AUTHORITY TO CHNW (THE SOLE MEMBER), ACTING THROUGH CHNW'S BOARD OF DIRECTORS, IN THE FOLLOWING SUBSTANTIVE AREAS: STRATEGIC PLANNING, CAPITAL ACCESS, BUDGETING AND ALLOCATION; AUDIT AND COMPLIANCE; NETWORK COMPENSATION; AND DISPUTE RESOLUTION. IN ADDITION, CHNW MUST APPROVE ANY MODIFICATION, REPEAL, AMENDMENT, OR RESTATEMENT OF IOH'S ARTICLES OF INCORPORATION. FINALLY, CHNW MUST APPROVE ANY MATERIAL SALE OR DISPOSITION OF THE ASSETS OF IOH. |
| FORM 990, PAGE 6, PART VI, LINE 4 | IOH AMENDED ITS ARTICLES OF INCORPORATION TO BETTER DEFINE THE CHARITABLE PURPOSES SUPPORTED WITHIN THE MEANING OF SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE OF 1986, AS AMENDED. THE AMENDED ARTICLES OF INCORPORATION ALSO CHANGED THE COMPOSITION OF THE BOARD OF DIRECTORS TO DESIGNATE THE BOARD AS THE MEMBERS OF THE BOARD OF DIRECTORS OF COMMUNITY HEALTH NETWORK, INC., A 501(C)(3) ORGANIZATION. |
| FORM 990, PAGE 6, PART VI, LINE 6 | CHNW IS THE SOLE MEMBER OF IOH. CHNW IS AN EXEMPT ORGANIZATION PURSUANT TO SECTION 501(C)(3). |
| FORM 990, PAGE 6, PART VI, LINE 7A | PRIOR TO JANUARY 30, 2014, THE BOARD OF DIRECTORS WAS TO CONSIST OF TEN (10) DIRECTORS, AT LEAST 1/2 OF WHOM WERE COMMUNITY BUSINESS AND CIVIC LEADERS SELECTED FROM THE COMMUNITY AT LARGE. ONE DIRECTOR WAS APPOINTED BY CHNW, AS THE SOLE MEMBER OF IOH. THE OTHER DIRECTORS WERE ELECTED BY THE BOARD OF DIRECTORS FROM A SLATE OF CANDIDATES RECOMMENDED BY IOH'S NOMINATING COMMITTEE. EFFECTIVE JANUARY 30, 2014, THE AMENDED AND RESTATED ARTICLES OF INCORPORATION DESIGNATED THE BOARD OF DIRECTORS AS THE MEMBERS OF THE BOARD OF DIRECTORS OF CHNW. |
| FORM 990, PAGE 6, PART VI, LINE 7B | SEE FORM 990, PART VI, SECTION A, LINE 3 |
| FORM 990, PAGE 6, PART VI, LINE 11B | IOH IS AN AFFILIATE OF COMMUNITY HEALTH NETWORK ("THE NETWORK"), AN INTEGRATED HEALTH DELIVERY SYSTEM. IOH HAS DELEGATED AUTHORITY FOR THE REVIEW OF THE FORM 990 TO TWO COMMITTEES COMPOSED OF INDEPENDENT OUTSIDE DIRECTORS: A) THE NETWORK EXECUTIVE COMPENSATION COMMITTEE REVIEWED THE COMPENSATION ASPECTS OF IOH'S FORM 990, AND B) THE NETWORK FINANCE COMMITTEE REVIEWED THE REMAINDER OF THE FORM 990. IN ADDITION, IOH'S BOARD OF DIRECTORS AND THE NETWORK'S OUTSIDE ACCOUNTING FIRM AND LAW FIRM REVIEWED THE FORM 990 PRIOR TO FILING. IOH UTILIZED THIS PROCESS TO ENSURE THAT IOH'S FORM 990 RECEIVED SUBSTANTIVE REVIEW BY DIRECTORS AND PROFESSIONALS WITH SPECIFIC KNOWLEDGE OF IOH'S ACTIVITIES AND EXTENSIVE FINANCIAL, ACCOUNTING, AND TAX EXPERTISE. |
| FORM 990, PAGE 6, PART VI, LINE 12C | CHNW HAS ASSUMED RESPONSIBILITY FOR IOH'S AUDIT AND COMPLIANCE MATTERS. CHNW HAS ADOPTED A CONFLICT OF INTEREST POLICY THAT APPLIES TO IOH. 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 IOH. 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 IOH, 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 IOH. |
| FORM 990, PAGE 6, PART VI, LINE 15A | CHNW ASSUMED RESPONSIBILITY FOR IOH'S EXECUTIVE COMPENSATION MATTERS. 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 IOH'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 2014, THE NETWORK EXECUTIVE COMPENSATION COMMITTEE FOLLOWED THIS PROCESS FOR ALL SENIOR EXECUTIVE LEADERS. |
| FORM 990, PAGE 6, PART VI, LINE 15B | SEE 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) IOH DOES NOT MAKE ITS CONFLICT OF INTEREST POLICY AVAILABLE TO THE PUBLIC. C) IOH 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. IOH DOES FILE THE 990 TAX RETURN ON AN ANNUAL BASIS WHICH IS AVAILABLE UPON REQUEST AND/OR AVAILABLE ON A DELAYED BASIS ON GUIDESTAR.ORG. D) COMMUNITY HEALTH NETWORK, INC. AND AFFILIATES PROVIDE ANY DOCUMENT OPEN TO PUBLIC INSPECTION UPON REQUEST. |
| FORM 990, PART IX, LINE 11G | PURCHASED SERVICES 746,305 57,887 0 SERVICE EXPENSE 5,384,378 2,291,316 0 |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (14 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|---|
| COMMUNITY HEALTH NETWORK INC | ||||||||||
| 7330 SHADELAND STATION SUITE 200 | INDIANAPOLIS | IN | 46256 | 350983617 | HOSPITAL | IN | 501C3 | 3 | NA | false |
| COMMUNITY HEALTH NETWORK FOUNDATION | ||||||||||
| 7240 SHADELAND STATION SUITE 125 | INDIANAPOLIS | IN | 46256 | 510181688 | CHARITY | IN | 501C3 | 11B | CHNW | Yes (true) |
| COMMUNITY HLTH SERVICES OF INDIANA | ||||||||||
| 7330 SHADELAND STATION SUITE 200 | INDIANAPOLIS | IN | 46256 | 454817436 | HLTH CARE | IN | 501C3 | 3 | CHNW | Yes (true) |
| COMMUNITY HOME HEALTH SERVICES INC | ||||||||||
| 9894 EAST 121ST STREET | FISHERS | IN | 46037 | 350953467 | HLTH CARE | IN | 501C3 | 9 | CHNW | Yes (true) |
| COMM HOSP OF ANDERSON & MADISON CTY | ||||||||||
| 1515 NORTH MADISON AVENUE | ANDERSON | IN | 46011 | 351069822 | HOSPITAL | IN | 501C3 | 3 | CHNW | Yes (true) |
| COMMUNITY HOSP ANDERSON FDN INC | ||||||||||
| 1515 NORTH MADISON AVENUE | ANDERSON | IN | 46011 | 861053152 | SUPPORT | IN | 501C3 | 11A | CHA | Yes (true) |
| COMMUNITY HOSPITAL SOUTH INC | ||||||||||
| 1402 E COUNTY LINE ROAD SOUTH | INDIANAPOLIS | IN | 46227 | 351088640 | HOSPITAL | IN | 501C3 | 3 | CHNW | Yes (true) |
| COMMUNITY HOWARD REGIONAL HEALTH | ||||||||||
| 3500 S LAFOUNTAIN STREET | KOKOMO | IN | 46902 | 351865344 | HOSPITAL | IN | 501C3 | 3 | CHNW | Yes (true) |
| COMM HOWARD REGIONAL HEALTH FDN | ||||||||||
| PO BOX 9011 | KOKOMO | IN | 46904 | 237309596 | SUPPORT | IN | 501C3 | 7 | NA | false |
| COMMUNITY LTC INC | ||||||||||
| 1031 MONTICELLO DRIVE | ANDERSON | IN | 46011 | 351877441 | HLTH CARE | IN | 501C3 | 9 | CHA | Yes (true) |
| COMMUNITY PHYSICIANS OF IN INC | ||||||||||
| 7240 SHADELAND STATION SUITE 300 | INDIANAPOLIS | IN | 46256 | 205392766 | PHY SRV | IN | 501C3 | 9 | CHNW | Yes (true) |
| HEALTH INSTITUTE OF INDIANA INC | ||||||||||
| 3660 GUION ROAD | INDIANAPOLIS | IN | 46222 | 352022402 | FITNESS | IN | 501C3 | 9 | CHNW | Yes (true) |
| INDIANA HEART HOSPITAL LLC | ||||||||||
| 8075 NORTH SHADELAND AVENUE | INDIANAPOLIS | IN | 46250 | 352123783 | HOSPITAL | IN | 501C3 | 3 | CHNW | Yes (true) |
| WESVIEW HOSPITAL FOUNDATION INC | ||||||||||
| 3630 GUION ROAD | INDIANAPOLIS | IN | 46222 | 311036451 | SUPPORT | IN | 501C3 | 11A | IOH | Yes (true) |
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (17 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Predominant Income TypePredominantIncomeTypeTxt | Share Of Total IncomeShareOfTotalIncomeAmt | Share Of EOY AssetsShareOfEOYAssetsAmt | Disproportionate AllocationsDisproportionateAllocationsInd | General Or Managing PartnerGeneralOrManagingPartnerInd | OwnershipOwnershipPct | Direct Controlling NADirectControllingNACd |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| BROWNSBURG OFFICE CENTER 2 LLP | ||||||||||||||
| 321 E NORTHFIELD | BROWNSBURG | IN | 46112 | 351929859 | LEASING | IN | CWH | RELATED | $5,397 | $119,695 | false | Yes (true) | 0.05000 | |
| CHNJMH VENTURES LLC | ||||||||||||||
| 7330 SHADELAND STATION SUITE 200 | INDIANAPOLIS | IN | 46256 | 462356266 | DIAG/REHAB | IN | false | false | N/A | |||||
| COMMUNITY ENDOSCOPY CENTER LLC | ||||||||||||||
| 1601 N MADISON AVENUE SUITE 300 | ANDERSON | IN | 46011 | 611464136 | HLTH CARE | IN | false | false | N/A | |||||
| COMM HEALTH NETWORK REHAB HOSP LLC | ||||||||||||||
| 7343 CLEARVISTA DRIVE | INDIANAPOLIS | IN | 46256 | 453414249 | REHAB | IN | false | false | N/A | |||||
| EAST CAMPUS SURGERY CENTER LLC | ||||||||||||||
| 7330 SHADELAND STATION SUITE 200 | INDIANAPOLIS | IN | 46256 | 352028517 | SURGERY | IN | false | false | N/A | |||||
| HAMILTON SURGERY CENTER LLC | ||||||||||||||
| 7330 SHADELAND STATION SUITE 200 | INDIANAPOLIS | IN | 46256 | 352061413 | SURGERY | IN | false | false | N/A | |||||
| HOWARD COMMUNITY SURGERY CTR LLC | ||||||||||||||
| 3500 S LAFOUNTAIN STREET | KOKOMO | IN | 46902 | 352118748 | SURGERY | IN | false | false | N/A | |||||
| HOWARD REGIONAL SPECIALTY CARE LLC | ||||||||||||||
| 680 SOUTH FOURTH STREET | LOUISVILLE | KY | 40202 | 371501021 | REHAB | IN | false | false | N/A | |||||
| INDIANA SPECIALTY GROUP LLC | ||||||||||||||
| 7240 SHADELAND STATION SUITE 300 | INDIANAPOLIS | IN | 46256 | 351976258 | HLTH CARE | IN | false | false | N/A | |||||
| INDIANAPOLIS ENDOSCOPY CENTER LLC | ||||||||||||||
| 7353 E 21ST STREET | INDIANAPOLIS | IN | 46219 | 352010874 | HLTH CARE | IN | false | false | N/A | |||||
| MICHIGAN SURGERY INVESTMENT LLC | ||||||||||||||
| 7330 SHADELAND STATION SUITE 200 | INDIANAPOLIS | IN | 46256 | 320147008 | SURG CTRS | IN | false | false | N/A | |||||
| NORTH CAMPUS OFFICE ASSOCIATES LP | ||||||||||||||
| 7330 SHADELAND STATION SUITE 200 | INDIANAPOLIS | IN | 46256 | 351808625 | RNTL PROP | IN | false | false | N/A | |||||
| NORTH CAMPUS SURGERY CENTER LLC | ||||||||||||||
| 7330 SHADELAND STATION SUITE 200 | INDIANAPOLIS | IN | 46256 | 352147088 | SURGERY | IN | false | false | N/A | |||||
| NORTHPOINT PEDIATRICS LLC | ||||||||||||||
| 8101 CLEARVISTA PARKWAY SUITE 185 | INDIANAPOLIS | IN | 46256 | 351960566 | HLTH CARE | IN | false | false | N/A | |||||
| NORTHWEST SURGERY CENTER LLC | ||||||||||||||
| 7330 SHADELAND STATION SUITE 200 | INDIANAPOLIS | IN | 46256 | 208754071 | SURGERY | IN | NA | RELATED | $100,234 | $273,019 | false | Yes (true) | 0.20000 | |
| PILLARS HOUSING LP | ||||||||||||||
| 3500 S LAFOUNTAIN STREET | KOKOMO | IN | 46902 | 161652671 | HOUSING | IN | false | false | N/A | |||||
| SOUTH CAMPUS SURGERY CENTER LLC | ||||||||||||||
| 1550 EAST COUNTY LINE ROAD | INDIANAPOLIS | IN | 46227 | 352038072 | SURGERY | IN | false | false | N/A | |||||
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (6 entries)
| Address Line1ForeignAddress/AddressLine1Txt | CityForeignAddress/CityNm | Province Or StateForeignAddress/ProvinceOrStateNm | CountryForeignAddress/CountryCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile Foreign CountryLegalDomicileForeignCountryCd | Direct Controlling NADirectControllingNACd | Controlled OrganizationControlledOrganizationInd | Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | Legal Domicile StateLegalDomicileStateCd |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| CHN ASSURANCE COMPANY LTD | |||||||||||||
| PO BOX 1051GT | GRAND CAYMAN | GRAND CAYMAN | CJ | 980418913 | INSURANCE | CJ | N/A | Yes (true) | |||||
| MIDWEST RACQUETBALL INC | |||||||||||||
| 351396016 | HLTH | N/A | Yes (true) | 3500 S LAFOUNTAIN STREET | KOKOMO | IN | 46902 | IN | |||||
| PILLARS COMMUNITY HOUSING INC | |||||||||||||
| 161652666 | HOUSING | N/A | Yes (true) | 3500 S LAFOUNTAIN STREET | KOKOMO | IN | 46902 | IN | |||||
| VISIONARY ENTERPRISES INC | |||||||||||||
| 351538433 | MGMT SRVS | N/A | Yes (true) | 6626 EAST 75TH STREET | INDIANAPOLIS | IN | 46250 | IN | |||||
| VEI MICHIGAN INC | |||||||||||||
| 300097377 | MGMT SRVS | N/A | Yes (true) | 940 N MAIN STREET | ANN HARBOR | MI | 48104 | IN | |||||
| WESTVIEW DELIVERY SYSTEM INC | |||||||||||||
| 351910292 | MGMT SRVS | N/A | Yes (true) | 3630 GUION ROAD | INDIANAPOLIS | IN | 46222 | IN | |||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | Yes (true) | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | Yes (true) | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (true) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | false | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | false | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | false | DivRelatedOrganizationInd |
| Asset Sale To Other Org | false | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | false | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | false | AssetExchangeInd |
| Rental Of Facilities To Oth Org | Yes (true) | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | false | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | false | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | false | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | false | SharingOfFacilitiesInd |
| Paid Employees Sharing | false | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | false | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (true) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | Yes (true) | TransferToOtherOrgInd |
| Transfer From Other Org | Yes (true) | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (8 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt |
|---|---|---|
| COMMUNITY PHYSICIANS OF IN INC | ||
| S | $512,259 | BOOK VALUE |
| HEALTH INSTITUTE OF INDIANA INC | ||
| A | $86,694 | BOOK VALUE |
| HEALTH INSTITUTE OF INDIANA INC | ||
| J | $424,269 | BOOK VALUE |
| HEALTH INSTITUTE OF INDIANA INC | ||
| Q | $172,614 | BOOK VALUE |
| HEALTH INSTITUTE OF INDIANA INC | ||
| R | $4,786,938 | BOOK VALUE |
| HEALTH INSTITUTE OF INDIANA INC | ||
| S | $4,794,187 | BOOK VALUE |
| VISIONARY ENTERPRISES INC | ||
| J | $360,455 | BOOK VALUE |
| WESTVIEW DELIVERY SYSTEM INC | ||
| R | $237,237 | BOOK VALUE |