COMMUNITY LTC INC: Form 990, tax year 2013

View the entire original 990 at ProPublica ↗

Organization
COMMUNITY LTC INC (EIN 35-1877441)
Tax period
2013-01-01 to 2013-12-31
Filed
2014-11-17
IRS object ID
201403219349310565
Schema version
2013v3.1
Source
Download XML · Original 990 at ProPublica

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

Return header ReturnHeader

FieldValueIRS element (for citing)
Return2014-11-17T14:34:36-08:00ReturnTs
Tax Period End2013-12-31TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1GORDON & GORDON PCBusinessNameLine1

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line19850 N 950 EAddressLine1
CityBROWNSBURGCity
StateINState
ZIP Code46112ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2013-01-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN351877441EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1Community LTC IncBusinessNameLine1
FieldValueIRS element (for citing)
Business Name ControlCOMMBusinessNameControlTxt
Phone7652982532PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line11031 Monticello DriveAddressLine1
CityAndersonCity
StateINState
ZIP Code46011ZIPCode

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonDIANA SMITHPersonNm
Person TitleCONTROLLERPersonTitleTxt
Phone7652982532PhoneNum
Signature2014-11-17SignatureDt
Discuss With Paid PreparerYes (true)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonDON M GATLIN CPAPreparerPersonNm
Phone3178525292PhoneNum
Preparation2014-11-17PreparationDt
Self EmployedYes (X)SelfEmployedInd
FieldValueIRS element (for citing)
Tax2013TaxYr
Build TS2015-11-30 17:44:51ZBuildTS

Form 990 IRS990

Principal Ofcr Business Address PrincipalOfcrBusinessAddress

FieldValueIRS element (for citing)
Business Name Line1Betty CrumBusinessNameLine1

US Address USAddress

FieldValueIRS element (for citing)
Address Line11031 Monticello DriveAddressLine1
CityAndersonCity
StateINState
ZIP Code46011ZIPCode
FieldValueIRS element (for citing)
Gross Receipts$14,052,217GrossReceiptsAmt
Group Return For AffiliatesfalseGroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website AddressN/AWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1993FormationYr
Legal Domicile StateINLegalDomicileStateCd
Activity Or MissionTo provide room, board, and nursing care services to elderly citizens of Madison and surrounding counties.ActivityOrMissionDesc
Voting Members Governing Body5VotingMembersGoverningBodyCnt
Voting Members Independent2VotingMembersIndependentCnt
Total Employee393TotalEmployeeCnt
Total Volunteers110TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
CY Contributions Grants$3,626CYContributionsGrantsAmt
PY Program Service Revenue$15,282,772PYProgramServiceRevenueAmt
CY Program Service Revenue$14,047,582CYProgramServiceRevenueAmt
PY Investment Income$2,505PYInvestmentIncomeAmt
CY Investment Income$152CYInvestmentIncomeAmt
PY Other Revenue$290,771PYOtherRevenueAmt
CY Other Revenue$857CYOtherRevenueAmt
PY Total Revenue$15,576,048PYTotalRevenueAmt
CY Total Revenue$14,052,217CYTotalRevenueAmt
CY Grants And Similar Paid$0CYGrantsAndSimilarPaidAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$8,680,043PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$9,360,329CYSalariesCompEmpBnftPaidAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$6,179,538PYOtherExpensesAmt
CY Other Expenses$1,627,579CYOtherExpensesAmt
PY Total Expenses$14,859,581PYTotalExpensesAmt
CY Total Expenses$10,987,908CYTotalExpensesAmt
PY Revenues Less Expenses$716,467PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$3,064,309CYRevenuesLessExpensesAmt
Total Assets BOY$8,368,385TotalAssetsBOYAmt
Total Assets EOY$10,539,191TotalAssetsEOYAmt
Total Liabilities BOY$3,529,540TotalLiabilitiesBOYAmt
Total Liabilities EOY$2,636,037TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$4,838,845NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$7,903,154NetAssetsOrFundBalancesEOYAmt
MissionTo provide room, board, andMissionDesc
Significant New Program SrvcfalseSignificantNewProgramSrvcInd
Significant ChangefalseSignificantChangeInd
Expense$10,000,950ExpenseAmt
Revenue$14,052,217RevenueAmt
DescCOMMUNITY LONG TERM CARE, INC. ("CLTC") OPERATES 3 NURSING FACILITIES WITH A TOTAL OF 254 LICENSED BEDS OF WHICH 193 ARE LICENSED AS SKILLED NURSING BEDS. THE FACILITIES PROVIDE LONG TERM NURSING CARE TO RESIDENTS WHO NEED SUCH SERVICES. CLTC PARTICIPATES IN THE MEDICARE, MEDICAID, TRI-CARE, AND/OR OTHER GOVERNMENT SPONSORED HEALTH CARE PROGRAMS AS WELL AS PRIVATE MANAGED CARE AND OTHER HEALTH INSURANCE PROGRAMS. THE STAFF AT CLTC MAKE EVERY EFFORT TO PROVIDE QUALITY SERVICES TO THE RESIDENTS. OUR GOALS ARE TO 1) MEET OR EXCEED EXPECTATIONS, 2) DISPLAY A POSITIVE AND ENERGETIC ATTITUDE, 3) HONOR THE DIGNITY, VALUE AND INVOLVEMENT OF OTHERS, 4) PROVIDE HIGH QUALITY SERVICES AT A REASONABLE COST, AND 5) CONTINOUSLY IMPROVE OUR SERVICES. AND FINALLY, CLTC HAS A GOVERNING BODY WHICH INCLUDES INDEPENDENT MEMBERS OF THE COMMUNITY.Desc
Total Program Service Expenses$10,000,950TotalProgramServiceExpensesAmt
Described In Section501c3Yes (true)DescribedInSection501c3Ind
Schedule B RequiredfalseScheduleBRequiredInd
Political Campaign ActyfalsePoliticalCampaignActyInd
Lobbying ActivitiesfalseLobbyingActivitiesInd
Subject To Proxy TaxfalseSubjectToProxyTaxInd
Donor Advised FundfalseDonorAdvisedFundInd
Conservation EasementsfalseConservationEasementsInd
Collections Of ArtfalseCollectionsOfArtInd
Credit CounselingfalseCreditCounselingInd
Temp Or Permanent EndowmentsfalseTempOrPermanentEndowmentsInd
Report Land Building EquipmentYes (true)ReportLandBuildingEquipmentInd
Report Investments Other SecfalseReportInvestmentsOtherSecInd
Report Program Related InvstfalseReportProgramRelatedInvstInd
Report Other AssetsfalseReportOtherAssetsInd
Report Other LiabilitiesYes (true)ReportOtherLiabilitiesInd
Include FIN48 FootnotefalseIncludeFIN48FootnoteInd
Independent Audit Fincl StmtfalseIndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtYes (true)ConsolidatedAuditFinclStmtInd
School OperatingfalseSchoolOperatingInd
Foreign OfficefalseForeignOfficeInd
Foreign ActivitiesfalseForeignActivitiesInd
More Than5000 K To OrgfalseMoreThan5000KToOrgInd
More Than5000 K To IndividualsfalseMoreThan5000KToIndividualsInd
Professional FundraisingfalseProfessionalFundraisingInd
Fundraising ActivitiesfalseFundraisingActivitiesInd
Gaming ActivitiesfalseGamingActivitiesInd
Operate HospitalfalseOperateHospitalInd
Grants To OrganizationsfalseGrantsToOrganizationsInd
Grants To IndividualsfalseGrantsToIndividualsInd
Schedule J RequiredYes (true)ScheduleJRequiredInd
Tax Exempt BondsfalseTaxExemptBondsInd
Engaged In Excess Benefit TransfalseEngagedInExcessBenefitTransInd
PY Excess Benefit TransfalsePYExcessBenefitTransInd
Loan OutstandingfalseLoanOutstandingInd
Grant To Related PersonfalseGrantToRelatedPersonInd
Business Rln With Org MemfalseBusinessRlnWithOrgMemInd
Business Rln With Fam MemfalseBusinessRlnWithFamMemInd
Business Rln With Officer EntfalseBusinessRlnWithOfficerEntInd
Deductible Non Cash ContrifalseDeductibleNonCashContriInd
Deductible Art ContributionfalseDeductibleArtContributionInd
Terminate OperationsfalseTerminateOperationsInd
Partial LiquidationfalsePartialLiquidationInd
Disregarded EntityfalseDisregardedEntityInd
Related EntityYes (true)RelatedEntityInd
Related Organization Ctrl EntfalseRelatedOrganizationCtrlEntInd
Transaction With Control EntfalseTransactionWithControlEntInd
Activities Conducted PrtshpfalseActivitiesConductedPrtshpInd
Schedule O RequiredYes (true)ScheduleORequiredInd
IRP Document0IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (true)BackupWthldComplianceInd
Employee393EmployeeCnt
Employment Tax Returns FiledYes (true)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over LimitfalseUnrelatedBusIncmOverLimitInd
Foreign Financial AccountfalseForeignFinancialAccountInd
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTransInd
Taxable Party NotificationfalseTaxablePartyNotificationInd
Nondeductible ContributionsfalseNondeductibleContributionsInd
Quid Pro Quo ContributionsfalseQuidProQuoContributionsInd
Form8282 Property Disposed OffalseForm8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft CntrctfalseRcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft CntrctfalsePayPremiumsPrsnlBnftCntrctInd
Indoor Tanning ServicesfalseIndoorTanningServicesInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members5GoverningBodyVotingMembersCnt
Independent Voting Member2IndependentVotingMemberCnt
Family Or Business RlnfalseFamilyOrBusinessRlnInd
Delegation Of Mgmt DutiesfalseDelegationOfMgmtDutiesInd
Change To Org DocumentsfalseChangeToOrgDocumentsInd
Material Diversion Or MisusefalseMaterialDiversionOrMisuseInd
Members Or StockholdersfalseMembersOrStockholdersInd
Election Of Board MembersYes (true)ElectionOfBoardMembersInd
Decisions Subject To ApprovafalseDecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (true)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (true)MinutesOfCommitteesInd
Officer Mailing AddressYes (true)OfficerMailingAddressInd
Local ChaptersfalseLocalChaptersInd
Form990 Provided To Gvrn BodyYes (true)Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (true)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (true)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (true)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (true)WhistleblowerPolicyInd
Document Retention PolicyYes (true)DocumentRetentionPolicyInd
Compensation Process CEOYes (true)CompensationProcessCEOInd
Compensation Process OtherYes (true)CompensationProcessOtherInd
Investment In Joint VenturefalseInvestmentInJointVentureInd
States Where Copy Of Return Is FldINStatesWhereCopyOfReturnIsFldCd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1Diana SmithBusinessNameLine1
FieldValueIRS element (for citing)
Phone7652982532PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line11031 MonticelloAddressLine1
CityDrCity
StateINState
ZIP Code46011ZIPCode

Form990 Part VII Section A Form990PartVIISectionAGrp (9 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtFormer Ofcr Director TrusteeFormerOfcrDirectorTrusteeIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerInd
DR WILLIAM VAN NESS
Former CEO0.50Yes (X)$0$215,910$2,306
JOHN HARRIS
Secretary/Treasurer0.50$0$258,597$98,467Yes (X)
MARY JO LEE
Chairman0.50$0$0$0Yes (X)
SHIRLEY WEATHERLY
Member-Board of Directors0.50$0$0$0Yes (X)
GARLAND ANTRIM
Member-Board of Directors0.50$0$0$0Yes (X)
JEANNE STEWART
Member-Board of Directors0.50$0$0$0Yes (X)
BETTY CRUM
Director of Senior Services40.00$119,980$0$10,156Yes (X)
DIANA SMITH
Director of Finance40.00$76,904$0$23,046Yes (X)
ELIZABETH THARP
Director & Pres/CEO0.50$0$310,527$134,194Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$196,884TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$785,034TotReportableCompRltdOrgAmt
Total Other Compensation$268,169TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K1IndivRcvdGreaterThan100KCnt
Former Ofcr Employees ListedYes (true)FormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (true)TotalCompGreaterThan150KInd
Compensation From Other SrcsfalseCompensationFromOtherSrcsInd
All Other Contributions$3,626AllOtherContributionsAmt
Total Contributions$3,626TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp

FieldValueIRS element (for citing)
DescProgram Service RevenueDesc
Business623110BusinessCd
Total Revenue Column$14,047,582TotalRevenueColumnAmt
FieldValueIRS element (for citing)
Total Program Service Revenue$14,047,582TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$152TotalRevenueColumnAmt

Other Revenue Misc OtherRevenueMiscGrp

FieldValueIRS element (for citing)
DescMisc. IncomeDesc
Business623000BusinessCd
Total Revenue Column$857TotalRevenueColumnAmt
Exclusion$857ExclusionAmt
FieldValueIRS element (for citing)
Other Revenue Total$857OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$14,052,217TotalRevenueColumnAmt
Related Or Exempt Func Income$14,047,734RelatedOrExemptFuncIncomeAmt
Exclusion$857ExclusionAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$196,884TotalAmt
Program Services$0ProgramServicesAmt
Management And General$196,884ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$7,773,538TotalAmt
Program Services$7,291,842ProgramServicesAmt
Management And General$481,696ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$876,812TotalAmt
Program Services$797,899ProgramServicesAmt
Management And General$78,913ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$513,095TotalAmt
Program Services$466,916ProgramServicesAmt
Management And General$46,179ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$17,376TotalAmt
Program Services$0ProgramServicesAmt
Management And General$17,376ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$96,055TotalAmt
Program Services$0ProgramServicesAmt
Management And General$96,055ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$6,816TotalAmt
Program Services$6,816ProgramServicesAmt
Management And General$0ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$724TotalAmt
Program Services$161ProgramServicesAmt
Management And General$563ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$1,462TotalAmt
Program Services$0ProgramServicesAmt
Management And General$1,462ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$371,926TotalAmt
Program Services$369,698ProgramServicesAmt
Management And General$2,228ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$1,259TotalAmt
Program Services$0ProgramServicesAmt
Management And General$1,259ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Interest InterestGrp

FieldValueIRS element (for citing)
Total$99,480TotalAmt
Program Services$99,480ProgramServicesAmt
Management And General$0ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$405,372TotalAmt
Program Services$374,881ProgramServicesAmt
Management And General$30,491ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$28,206TotalAmt
Program Services$1,606ProgramServicesAmt
Management And General$26,600ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Other Expenses OtherExpensesGrp (2 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmtFundraisingFundraisingAmt
Supplies$14,911$14,911$0$0
Raw Food & Supplements$20,940$20,940$0$0

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$563,052TotalAmt
Program Services$555,800ProgramServicesAmt
Management And General$7,252ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$10,987,908TotalAmt
Program Services$10,000,950ProgramServicesAmt
Management And General$986,958ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$1,326,737BOYAmt
EOY$2,077,964EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$2,480,462BOYAmt
EOY$4,208,218EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$102,174BOYAmt
EOY$150,498EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$7,605,319LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$3,502,808LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$4,459,012BOYAmt
EOY$4,102,511EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$8,368,385BOYAmt
EOY$10,539,191EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$181,492BOYAmt
EOY$138,778EOYAmt

Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp

FieldValueIRS element (for citing)
BOY$2,890,702BOYAmt
EOY$2,493,084EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$457,346BOYAmt
EOY$4,175EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$3,529,540BOYAmt
EOY$2,636,037EOYAmt
FieldValueIRS element (for citing)
Organization Follows SFAS117Yes (X)OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

FieldValueIRS element (for citing)
BOY$4,838,845BOYAmt
EOY$7,903,154EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$4,838,845BOYAmt
EOY$7,903,154EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$8,368,385BOYAmt
EOY$10,539,191EOYAmt
FieldValueIRS element (for citing)
Reconcilation Revenue Expnss$3,064,309ReconcilationRevenueExpnssAmt
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or ReviewfalseAccountantCompileOrReviewInd
FS AuditedYes (true)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

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

Schedule A IRS990ScheduleA

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

Gross Investment Income170 GrossInvestmentIncome170Grp

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

Gifts Grants Contris Rcvd509 GiftsGrantsContrisRcvd509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$16,395CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$523CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$235CurrentTaxYearMinus2YearsAmt
Current Tax Year$3,626CurrentTaxYearAmt
Total$20,779TotalAmt

Gross Receipts Admissions GrossReceiptsAdmissionsGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$15,176,487CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$15,205,008CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$16,095,484CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$15,282,773CurrentTaxYearMinus1YearAmt
Current Tax Year$14,047,582CurrentTaxYearAmt
Total$75,807,334TotalAmt

Total509 Total509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$15,192,882CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$15,205,531CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$16,095,719CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$15,282,773CurrentTaxYearMinus1YearAmt
Current Tax Year$14,051,208CurrentTaxYearAmt
Total$75,828,113TotalAmt
FieldValueIRS element (for citing)
Public Support Total509$75,828,113PublicSupportTotal509Amt

Gross Investment Income509 GrossInvestmentIncome509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$4,068CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$2,027CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$2,141CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$2,505CurrentTaxYearMinus1YearAmt
Current Tax Year$152CurrentTaxYearAmt
Total$10,893TotalAmt

Investment Income And UBTI InvestmentIncomeAndUBTIGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$4,068CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$2,027CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$2,141CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$2,505CurrentTaxYearMinus1YearAmt
Current Tax Year$152CurrentTaxYearAmt
Total$10,893TotalAmt

Other Income509 OtherIncome509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$37,155CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$49,861CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$47,433CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$290,771CurrentTaxYearMinus1YearAmt
Current Tax Year$858CurrentTaxYearAmt
Total$426,078TotalAmt

Total Support Calendar Year TotalSupportCalendarYearGrp

FieldValueIRS element (for citing)
Total$76,265,084TotalAmt
FieldValueIRS element (for citing)
Public Support CY5090.99430PublicSupportCY509Pct
Public Support PY5090.99370PublicSupportPY509Pct
Investment Income CY0.00010InvestmentIncomeCYPct
Investment Income PY0.00030InvestmentIncomePYPct
Thirty Thr Pct Suprt Tests CY509Yes (X)ThirtyThrPctSuprtTestsCY509Ind

Form990 Schedule A Part IV Form990ScheduleAPartIVGrp (6 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Pt III Line 12Description: Other Income
Pt III Line 122009: 37155.
Pt III Line 122010: 49861.
Pt III Line 122011: 47433.
Pt III Line 122012: 290771.
Pt III Line 122013: 858.

Schedule D IRS990ScheduleD

Land LandGrp

FieldValueIRS element (for citing)
Investment Cost Or Other Basis$363,072InvestmentCostOrOtherBasisAmt
Book Value$363,072BookValueAmt

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Investment Cost Or Other Basis$3,889,883InvestmentCostOrOtherBasisAmt
Depreciation$1,771,162DepreciationAmt
Book Value$2,118,721BookValueAmt

Leasehold Improvements LeaseholdImprovementsGrp

FieldValueIRS element (for citing)
Investment Cost Or Other Basis$2,205,979InvestmentCostOrOtherBasisAmt
Depreciation$1,048,673DepreciationAmt
Book Value$1,157,306BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Investment Cost Or Other Basis$1,081,669InvestmentCostOrOtherBasisAmt
Depreciation$682,973DepreciationAmt
Book Value$398,696BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

FieldValueIRS element (for citing)
Investment Cost Or Other Basis$64,716InvestmentCostOrOtherBasisAmt
Book Value$64,716BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$4,102,511TotalBookValueLandBuildingsAmt

Other Liabilities Org OtherLiabilitiesOrgGrp

FieldValueIRS element (for citing)
DescResident FundsDesc
Amt$4,175Amt
FieldValueIRS element (for citing)
Total Liability$4,175TotalLiabilityAmt

Schedule J IRS990ScheduleJ

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

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (3 entries)

Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmtBonus Related OrganizationsBonusRelatedOrganizationsAmtOther Compensation Rltd OrgsOtherCompensationRltdOrgsAmtDeferred Comp Rltd OrgsDeferredCompRltdOrgsAmtNontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmtTotal Compensation Rltd OrgsTotalCompensationRltdOrgsAmtComp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
DR WILLIAM VAN NESS
$13,978$189,120$12,812$1,697$612$218,219$189,120
JOHN HARRIS
$197,962$40,380$20,255$76,101$22,366$357,064$40,380
ELIZABETH THARP
$274,695$34,239$1,593$131,254$2,940$444,721$34,239

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (52 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Pt VI, Line 7aThree members of the Board of Directors are designated
Pt VI, Line 7adirectors. These designated directors are (1) the Chairman
Pt VI, Line 7aof the Board of Directors, (2) the President and Chief Executive
Pt VI, Line 7aOfficer and (3)the Vice President and Chief Financial Officer
Pt VI, Line 7aof Community Hospital of Anderson and Madison County, Inc.
Pt VI, Line 7aThe remaining two or more directors are independent members
Pt VI, Line 7aof the community and are elected by the Community LTC,
Pt VI, Line 7aInc. Board of Directors.
Pt VI, Line 12cThe board of directors and key employees are required to sign the conflict
Pt VI, Line 12cof interest policy and disclose any conflicts on an annual basis.
Pt VI, Line 15aTop management compensation of Community Long Term Care
Pt VI, Line 15ais determined by related organization Community Hospital Anderson.
Pt VI, Line 15aCommunity LTC, Inc. participates in a state and national
Pt VI, Line 15aindustry trade association which conducts an annual wage
Pt VI, Line 15asurvey - this survey is utilized for evaluation of salaries and wages.
Pt VI, Line 15bOther officers compensation of Community Long Term Care
Pt VI, Line 15bis determined by related organization Community Hospital Anderson.
Pt VI, Line 15bCommunity LTC, Inc. participates in a state and national
Pt VI, Line 15bindustry trade association which conducts an annual wage
Pt VI, Line 15bsurvey - this survey is utilized for evaluation of salaries and wages.
Pt VI, Line 19A) The articles of incorporation and certificate of existence are
Pt VI, Line 19on file with the Indiana Secretary of State and are available
Pt VI, Line 19to the public upon request to the Indiana Secretary of State.
Pt VI, Line 19B) Community LTC, Inc. conflict of interest policy is available
Pt VI, Line 19to the public upon request.
Pt VI, Line 19C) Community LTC, Inc. does not have individually audited
Form 990, Part VI, Line 9DR. WILLIAM VAN NESS 1515 N. MADISON AVE ANDERSON IN 46011 JOHN HARRIS 1515 N. MADISON AVE ANDERSON IN 46011 MARY JO LEE P.O. BOX 1302 ANDERSON IN XXX-XX-XXXX GARLAND ANTRIM 8562 N 700 W FRANKTON IN 46044 JEANNE STEWART 1831 E TUMBLEWEED LANE ALEXANDRIA IN 46001 ELIZABETH THARP 1515 N. MADISON AVENUE ANDERSON IN 46011
Form 990, Part IX, Line 24fREPAIRS & MAINTENANCE 200510. 200510. 0. DUES & SUBSCRIPTIONS 792. 792. RESIDENT ACTIVITIES BANK FEES 6460. 6460. MISCELLANEOUS EXPENSE 32. 32. BEAUTY & BARBER 34. 34. BAD DEBT 355224. 355224.
Pt VI, Line 19financial statements. Its financial results are included in the
Pt VI, Line 19consolidated financial statements of Community Health Network, Inc.
Pt VI, Line 19and Affiliates. As a result there are no individual financial
Pt VI, Line 19statements available to post. Community LTC, Inc. does file
Pt VI, Line 19the Form 990 tax return, medicaid and Medicare Cost Reports with the
Pt VI, Line 19appropriate agencies on an annual basis. The Form 990 tax
Pt VI, Line 19return is available upon request and/or available on a delayed
Pt VI, Line 19basis on GuideStar.com. The Medicaid and Medicare Cost Reports are available
Pt VI, Line 19via Freedom of Information Request filed with the applicable
Pt VI, Line 19agencies.
Pt VI, Line 11bA complete copy of the Form 990 is provided to the members of the board
Pt VI, Line 11bof directors of the organization. The Form 990 is reviewed and
Pt VI, Line 11bdiscussed by the governing body at a meeting before finalizaton
Pt VI, Line 11band filing.
Pt IV, Line 12Community LTC, Inc. does not have individually audited
PT IV LINE 12financial statements. Its financial results are included
PT IV LINE 12in the consolidated financial statements of Community Health
PT IV LINE 12Network, Inc. and Affiliates, which are audited by an
PT IV LINE 12independent accounting firm.
Pt XII, Line 2a & 2bCommunity LTC, Inc. does not have individually audited
Pt XII, Line 2a & 2bfinancial statements. Its financial results are included
Pt XII, Line 2a & 2bin the consolidated financial statements of Community Health
Pt XII, Line 2a & 2bNetwork, Inc. and Affiliates, which are audited by an
Pt XII, Line 2a & 2bindependent accounting firm.

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (15 entries)

Address Line1USAddress/AddressLine1CityUSAddress/CityStateUSAddress/StateZIP CodeUSAddress/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdExempt Code SectionExemptCodeSectionTxtPublic Charity StatusPublicCharityStatusTxtBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Controlled OrganizationControlledOrganizationInd
Auxiliary of Community Hospital
1515 North Madison AvenueAndersonIN46011356065606SUPPORTIN501C311ANAfalse
Community Hosp Anderson FDN Inc
1515 North Madison AvenueAndersonIN46011861053152CHARITYIN501C311BCHAYes (true)
Community Hosp of Anderson and Madison County Inc
1515 North Madison AvenueAndersonIN46011351069822HOSPITALIN501C33NAfalse
Community Home Health Services Inc
9894 East 121st StreetFishersIN46037350953467HLTH CAREIN501C39CHNWYes (true)
Community Health Network Inc
7330 Shadeland Station Suite 200IndianapolisIN46256350983617HOSPITALIN501C33NAfalse
Community Health Network Foundation
7240 Shadeland Station Suite 125IndianapolisIN46256510181688CHARITYIN501C311BCHNWYes (true)
Community HLTH Services of Indiana
7330 Shadeland Station Suite 200IndianapolisIN46256454817436HLTH CAREIN501C33CHNWYes (true)
Community Hospital South Inc
1402 E County Line Road SouthIndianapolisIN46227351088640HOSPITALIN501C33CHNWYes (true)
Community Physicians of IN Inc
7240 Shadeland Station Suite 300IndianapolisIN46256205392766PHY SRVIN501C39CHNWYes (true)
Health Institute of Indiana Inc
3660 Guion RoadIndianapolisIN46222352022402FITNESSIN501C39IOHYes (true)
Indiana Heart Hospital LLC
8075 North Shadeland AvenueIndianapolisIN46250352123783HOSPITALIN501C33CHNWYes (true)
Indianapolis Osteopathic Hosp Inc
3630 Guion RoadIndianapolisIN46222351094734HOSPITALIN501C33CHNWYes (true)
Westview Hospital Foundation Inc
3630 Guion RoadIndianapolisIN46222311036451SUPPORTIN501C311AIOHYes (true)
Community Howard Regional Health
3500 S Lafountain StreetKokomoIN46902351865344HOSPITALIN501C33CHNWYes (true)
Comm Howard Regional Health FDN
PO Box 9011KokomoIN46904237309596SUPPORTIN501C37NAfalse

Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (17 entries)

Address Line1USAddress/AddressLine1CityUSAddress/CityStateUSAddress/StateZIP CodeUSAddress/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Predominant Income TypePredominantIncomeTypeTxtShare Of Total IncomeShareOfTotalIncomeAmtShare Of EOY AssetsShareOfEOYAssetsAmtDisproportionate AllocationsDisproportionateAllocationsIndGeneral Or Managing PartnerGeneralOrManagingPartnerIndOwnershipOwnershipPct
Brownsburg Office Center 2 LLP
321 E NorthfieldBrownsburgIN46112351929859LEASINGINNANA
Community Endoscopy Center
1601 N Madison Avenue Suite 300AndersonIN46011611464136HLTH CAREINNARelated$500,303$417,006falseYes (true)0.41000
East Campus surgery Center LLC
7330 Shadeland Station Suite 200IndianapolisIN46256352028517SURGERYINNANA
Hamilton Surgery Center LLC
7330 Shadeland Station Suite 200IndianapolisIN46256352061413SURGERYINNANA
Howard Community Surgery CTR LLC
3500 S Lafountain StreetKokomoIN46902352118748SURGERYINNANA
Howard Regional Specialty Care LLC
680 South Fourth StreetLouisvilleKY40202371501021REHABINNANA
Indiana Specialty Group
7240 Shadeland Station Suite 300IndianapolisIN46256351976258HLTH CAREINNANA
Indianapolis Endoscopy Center LLC
7353 E 21st StreetIndianapolisIN46219352010874HLTH CAREINNANA
Michigan Surgery Investment LLC
7330 Shadeland Station Suite 200IndianapolisIN46256320147008SURG CTRSINNANA
North Campus Office Associates LP
7330 Shadeland Station Suite 200IndianapolisIN46256351808625RNTL PROPINNANA
CHNJMH Ventures LLC
7330 Shadeland Station Suite 200IndianapolisIN46256462356266DIAG/REHABINNANA
Comm Health Network Rehab Hosp LLC
7343 Clearvista DriveIndianapolisIN46256453414249REHABINNANA
Northwest Surgery Center LLC
7330 Shadeland Station Suite 200IndianapolisIN46256208754071SURGERYINNANA
Pillars Housing LP
3500 S Lafountain StreetKokomoIN46902161652671HOUSINGINNANA
South Campus Surgery Center LLC
1550 East County Line RoadIndianapolisIN46227352038072SURGERYINNANA
North Campus Surgery Centers LLC
7330 Shadeland Station Suite 200IndianapolisIN46256352147088SURGERYINNANA
Northpoint Pediatrics LLC
8101 Clearvista Parkway Suite 185IndianapolisIN46256351960566HLTH CAREINNANA

Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (6 entries)

Address Line1ForeignAddress/AddressLine1CityForeignAddress/CityCountryForeignAddress/CountryEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile Foreign CountryLegalDomicileForeignCountryCdBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Entity TypeEntityTypeTxtControlled OrganizationControlledOrganizationIndAddress Line1USAddress/AddressLine1CityUSAddress/CityStateUSAddress/StateZIP CodeUSAddress/ZIPCodeLegal Domicile StateLegalDomicileStateCd
CHN Assurance Company LTD
PO Box 1051 GTGrand CaymanCJ980418913INSURANCECJNACYes (true)
Midwest Racquetball Inc
351396016HLTHNACYes (true)3500 South Lafountain StreetKokomoIN46902IN
Pillars Community Housing Inc
161652666HOUSINGNAC3500 South Lafountain StreetKokomoIN46902IN
Visionary Enterprises Inc
351538433MGMT SRVCSNAC6626 East 75th StreetIndianapolisIN46250IN
VEI Michigan Inc
300097377MGMT SRVCSNAC940 N Main StreetAnn HarborMI48104MI
Westview Delivery System Inc
351910292MGMT SRVCSNAC3630 Guion RoadIndianapolisIN46222IN
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts RyltsfalseReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth OrgfalseGiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth OrgfalseGiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other OrgfalseLoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth OrgfalseLoansOrGuaranteesFromOthOrgInd
Div Related OrganizationfalseDivRelatedOrganizationInd
Asset Sale To Other OrgfalseAssetSaleToOtherOrgInd
Asset Purchase From Other OrgfalseAssetPurchaseFromOtherOrgInd
Asset ExchangefalseAssetExchangeInd
Rental Of Facilities To Oth OrgfalseRentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth OrgYes (true)RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth OrgfalsePerformOfServicesForOthOrgInd
Perform Of Services By Other OrgfalsePerformOfServicesByOtherOrgInd
Sharing Of FacilitiesfalseSharingOfFacilitiesInd
Paid Employees SharingfalsePaidEmployeesSharingInd
Reimbursement Paid To Other OrgYes (true)ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other OrgfalseReimbursementPaidByOtherOrgInd
Transfer To Other OrgfalseTransferToOtherOrgInd
Transfer From Other OrgfalseTransferFromOtherOrgInd

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