COMMUNITY HOSPITAL OF ANDERSON- MADISON COUNTY INC: Form 990, tax year 2013
View the entire original 990 at ProPublica ↗
- Organization
- COMMUNITY HOSPITAL OF ANDERSON- MADISON COUNTY INC (EIN 35-1069822)
- Tax period
- 2013-01-01 to 2013-12-31
- Filed
- 2014-11-12
- IRS object ID
- 201413169349302726
- 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
- Form 990
- Schedule A
- Schedule B
- Schedule D
- Schedule H
- Schedule I
- Schedule J
- Schedule L
- Schedule M
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2014-11-12T12:42:20-06:00 | ReturnTs |
| Tax Period End | 2013-12-31 | 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 | BusinessNameLine1 |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 4745 STATESMEN DRIVE SUITE C | AddressLine1 |
| City | INDIANAPOLIS | City |
| State | IN | State |
| ZIP Code | 46250 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2013-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 351069822 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | COMMUNITY HOSPITAL OF ANDERSON AND | BusinessNameLine1 |
| Business Name Line2 | MADISON COUNTY INC | BusinessNameLine2 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | COMM | BusinessNameControlTxt |
| Phone | 7652984242 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1515 NORTH MADISON AVENUE | AddressLine1 |
| City | ANDERSON | City |
| State | IN | State |
| ZIP Code | 460113453 | ZIPCode |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | JOHN B HARRIS | PersonNm |
| Person Title | VP OF FINANCE/CFO | PersonTitleTxt |
| Phone | 7652984242 | PhoneNum |
| Signature | 2014-10-30 | 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 | 2014-11-12 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2013 | TaxYr |
| Build TS | 2015-11-30 17:44:51Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | ELIZABETH S THARP | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1515 NORTH MADISON AVENUE | AddressLine1 |
| City | ANDERSON | City |
| State | IN | State |
| ZIP Code | 460113453 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $160,039,266 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.COMMUNITYANDERSON.COM | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1961 | FormationYr |
| Legal Domicile State | IN | LegalDomicileStateCd |
| Activity Or Mission | THE MISSION OF COMMUNITY HOSPITAL OF ANDERSON AND MADISON COUNTY, INC. IS TO SERVICE THE MEDICAL, HEALTH AND HUMAN SERVICE NEEDS OF THE PEOPLE IN ANDERSON, MADISON COUNTY, AND CONTIGUOUS COUNTIES WITH COMPASSION, DIGNITY, RESPECT, AND EXCELLENCE. SERVICE, ALTHOUGH FOCUSED ON INJURY, ILLNESS, AND DISEASE, WILL ALSO EMBRACE PREVENTION, EDUCATION, AND ALTERNATIVE SYSTEMS OF HEALTH CARE DELIVERY. COMMUNITY HOSPITALS OF ANDERSON AND MADISON COUNTY, INC. OFFERS STATE-OF-THE-ART SERVICES TO EXCEED THE NEEDS OF OUR PATIENTS. FROM BASIC MEDICAL SERVICES SUCH AS THE EMERGENCY DEPARTMENT AND OUR NEW GENERATIONS BIRTH PLACE, TO THE SUPPORT OF OUR BREAST HEALTH SPECIALIST AND DIABETES CARE CENTER EDUCATORS, WE ADD THAT SPECIAL TOUCH TO ANTICIPATE YOUR NEEDS BEFORE YOU ASK. OUR STAFF MAKES EVERY EFFORT TO PROVIDE AN EFFECTIVE AND EFFICIENT HEALTH CARE DELIVERY SYSTEM. | ActivityOrMissionDesc |
| Voting Members Governing Body | 18 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 13 | VotingMembersIndependentCnt |
| Total Employee | 1194 | TotalEmployeeCnt |
| Total Volunteers | 157 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| PY Contributions Grants | $524,818 | PYContributionsGrantsAmt |
| CY Contributions Grants | $752,259 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $147,261,019 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $136,921,901 | CYProgramServiceRevenueAmt |
| PY Investment Income | $4,696,687 | PYInvestmentIncomeAmt |
| CY Investment Income | $3,471,502 | CYInvestmentIncomeAmt |
| PY Other Revenue | $1,950,891 | PYOtherRevenueAmt |
| CY Other Revenue | $2,169,180 | CYOtherRevenueAmt |
| PY Total Revenue | $154,433,415 | PYTotalRevenueAmt |
| CY Total Revenue | $143,314,842 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $116,820 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $235,302 | CYGrantsAndSimilarPaidAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $68,645,124 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $71,490,150 | CYSalariesCompEmpBnftPaidAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $50,838,213 | PYOtherExpensesAmt |
| CY Other Expenses | $53,808,753 | CYOtherExpensesAmt |
| PY Total Expenses | $119,600,157 | PYTotalExpensesAmt |
| CY Total Expenses | $125,534,205 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $34,833,258 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $17,780,637 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $142,954,048 | TotalAssetsBOYAmt |
| Total Assets EOY | $167,718,997 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $26,645,497 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $31,177,114 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $116,308,551 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $136,541,883 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | THE MISSION OF COMMUNITY HOSPITAL OF ANDERSON AND MADISON COUNTY, INC. IS TO SERVICE THE MEDICAL, HEALTH AND HUMAN SERVICE NEEDS OF THE PEOPLE IN ANDERSON, MADISON COUNTY, AND CONTIGUOUS COUNTIES WITH COMPASSION, DIGNITY, RESPECT, AND EXCELLENCE. SERVICE, ALTHOUGH FOCUSED ON INJURY, ILLNESS, AND DISEASE, WILL ALSO EMBRACE PREVENTION, EDUCATION, AND ALTERNATIVE SYSTEMS OF HEALTH CARE DELIVERY. COMMUNITY HOSPITALS OF ANDERSON AND MADISON COUNTY, INC. OFFERS STATE-OF-THE-ART SERVICES TO EXCEED THE NEEDS OF OUR PATIENTS. FROM BASIC MEDICAL SERVICES SUCH AS THE EMERGENCY DEPARTMENT AND OUR NEW GENERATIONS BIRTH PLACE, TO THE SUPPORT OF OUR BREAST HEALTH SPECIALIST AND DIABETES CARE CENTER EDUCATORS, WE ADD THAT SPECIAL TOUCH TO ANTICIPATE YOUR NEEDS BEFORE YOU ASK. OUR STAFF MAKES EVERY EFFORT TO PROVIDE AN EFFECTIVE AND EFFICIENT HEALTH CARE DELIVERY SYSTEM. | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $116,763,935 | ExpenseAmt |
| Revenue | $138,435,645 | RevenueAmt |
| Desc | COMMUNITY HOSPITAL OF ANDERSON AND MADISON COUNTY, INC. ("CHA") IS AN ACUTE CARE MEDICAL FACILITY WITH 137 STAFFED BEDS (EXCLUDING NURSERY). IN 2013, THERE WERE 6,117 ADMISSIONS, 7,229 SURGERIES PERFORMED, 854 BIRTHS WITH A TOTAL OF OVER 190,000 PATIENTS SERVED IN ALL DISCIPLINES. CHA PARTICIPATES IN MEDICARE, MEDICAID, CHAMPUS, TRICARE, AND/OR OTHER GOVERNMENT-SPONSORED HEALTH CARE PROGRAMS. WE PROVIDE AN EMERGENCY ROOM THAT IS OPEN TO ALL PERSONS REGARDLESS OF ABILITY TO PAY. OUR STAFF MAKES EVERY EFFORT TO PROVIDE AN EFFECTIVE AND EFFICIENT HEALTH CARE DELIVERY SYSTEM. FINALLY, WE HAVE A GOVERNING BODY IN WHICH INDEPENDENT PERSONS REPRESENTATIVE OF THE COMMUNITY COMPRISE THE MAJORITY. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $235,302 | ExpenseAmt |
| Grant | $235,302 | GrantAmt |
| Desc | COMMUNITY HOSPITAL OF ANDERSON AND MADISON COUNTY, INC. CONTRIBUTED TO A FEW LOCAL CHARITABLE ORGANIZATIONS. THE LARGEST DONATIONS ARE LISTED ON SCHEDULE I. | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expenses | $116,999,237 | 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 | false | 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 | Yes (true) | 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 | Yes (true) | 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 |
| IRP Document | 137 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (true) | BackupWthldComplianceInd |
| Employee | 1194 | 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 | 18 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 13 | IndependentVotingMemberCnt |
| Family Or Business Rln | Yes (true) | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | false | DelegationOfMgmtDutiesInd |
| Change To Org Documents | false | 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 | Yes (true) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (true) | 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 | JOHN B HARRIS | PersonNm |
| Phone | 7652985125 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1515 N MADISON AVENUE | AddressLine1 |
| City | ANDERSON | City |
| State | IN | State |
| ZIP Code | 46011 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionAGrp (30 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 | 2.00 | 58.00 | Yes (X) | $0 | $1,133,983 | $121,280 | |||
| ELIZABETH S THARP | |||||||||
| DIRECTOR & P | 50.00 | Yes (X) | $310,527 | $0 | $134,194 | Yes (X) | |||
| TROY ABBOTT MD | |||||||||
| DIRECTOR | 2.00 | 50.00 | Yes (X) | $4,500 | $237,694 | $36,900 | |||
| DAVID A SHAPIRO MD | |||||||||
| DIRECTOR | 2.00 | 40.00 | Yes (X) | $0 | $238,707 | $77,595 | |||
| D BENJAMIN MCCURDY MD | |||||||||
| DIRECTOR | 28.54 | Yes (X) | $46,200 | $0 | $0 | ||||
| LARRY L BLANKENSHIP MD | |||||||||
| DIRECTOR | 2.00 | Yes (X) | $0 | $0 | $0 | ||||
| DENNIS CARROLL | |||||||||
| DIRECTOR | 2.00 | Yes (X) | $0 | $0 | $0 | ||||
| MARIAN DUNNICHAY | |||||||||
| DIRECTOR | 2.00 | Yes (X) | $0 | $0 | $0 | ||||
| JULIE HETTINGA | |||||||||
| DIRECTOR | 2.00 | Yes (X) | $0 | $0 | $0 | ||||
| WILLIAM HOBBS | |||||||||
| DIRECTOR | 2.00 | Yes (X) | $0 | $0 | $0 | ||||
| MARY JAMERSON | |||||||||
| TREASURER | 2.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |||
| JOHN KANE | |||||||||
| DIRECTOR | 2.00 | Yes (X) | $0 | $0 | $0 | ||||
| MICHAEL KIRBY | |||||||||
| DIRECTOR | 2.00 | Yes (X) | $0 | $0 | $0 | ||||
| ARTHUR J LEAK | |||||||||
| DIRECTOR | 2.00 | Yes (X) | $0 | $0 | $0 | ||||
| MARY JO LEE | |||||||||
| DIRECTOR | 2.00 | Yes (X) | $0 | $0 | $0 | ||||
| MARIE MORRIS | |||||||||
| DIRECTOR | 2.00 | Yes (X) | $0 | $0 | $0 | ||||
| RICK MOORE | |||||||||
| DIRECTOR | 2.00 | Yes (X) | $0 | $0 | $0 | ||||
| RICHARD MOUSTY | |||||||||
| DIRECTOR | 2.00 | Yes (X) | $0 | $0 | $0 | ||||
| BILL O'NEAL PHD | |||||||||
| DIRECTOR | 2.00 | Yes (X) | $0 | $0 | $0 | ||||
| JOSEPH PORCARO MD | |||||||||
| DIRECTOR | 2.00 | Yes (X) | $0 | $0 | $0 | ||||
| JAY B RICKER | |||||||||
| SECRETARY | 2.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |||
| CHARLES STALEY | |||||||||
| CHAIRMAN | 2.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |||
| DANA STUART | |||||||||
| VICE CHAIRMA | 2.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |||
| JOHN B HARRIS | |||||||||
| VP OF FINANC | 50.00 | $258,597 | $0 | $98,467 | Yes (X) | ||||
| TAHIR ALI NAQVI MD | |||||||||
| PHYSICIAN | 50.00 | $1,471,766 | $0 | $597,918 | Yes (X) | ||||
| NIGHAT TAHIR MD | |||||||||
| PHYSICIAN | 50.00 | $451,472 | $0 | $141,718 | Yes (X) | ||||
| RYAN HINDS MD | |||||||||
| ANESTHESIOLO | 50.00 | $357,300 | $0 | $40,472 | Yes (X) | ||||
| JARED ANDERSON MD | |||||||||
| ANESTHESIOLO | 50.00 | $345,420 | $0 | $47,822 | Yes (X) | ||||
| VIRGIL LOGHIN MD | |||||||||
| ANESTHESIOLO | 50.00 | $342,798 | $0 | $28,694 | Yes (X) | ||||
| WILLIAM C VANNESS II MD | |||||||||
| FORMER CEO | $215,910 | $0 | $2,306 | Yes (X) | |||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $3,804,490 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $1,610,384 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $1,327,366 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 48 | 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/AddressLine1 | CityContractorAddress/USAddress/City | StateContractorAddress/USAddress/State | ZIP CodeContractorAddress/USAddress/ZIPCode | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| WR DUNKIN & SON INC | |||||
| 2911 ENTERPRISE DRIVE | ANDERSON | IN | 46011 | CONSTRUCTION | $7,034,826 |
| WHITE RIVER ANESTHESIA LLC | |||||
| 1135 CORAL SPRINGS DRIVE | CICERO | IN | 460349216 | MED/PHY GUAR | $830,091 |
| SOUTH BEND MEDICAL FOUNDATION INC | |||||
| 530 N LAFAYETTE BLVD | SOUTH BEND | IN | 466011098 | LABORATORY SRV | $663,904 |
| EXECUTIVE HEALTH RESOURCES | |||||
| 15 CAMPUS BOULEVARD SUITE 200 | NEWTOWN SQUARE | PA | 19073 | MANAGEMENT FEES | $549,515 |
| ACCELECARE WOUND CENTERS INC | |||||
| SKYLINE TOWER 10900 NE 4TH STREET | BELLEVUE | WA | 98004 | MANAGEMENT FEES | $535,207 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 23 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $542,259 | RelatedOrganizationsAmt |
| All Other Contributions | $210,000 | AllOtherContributionsAmt |
| Noncash Contributions | $210,000 | NoncashContributionsAmt |
| Total Contributions | $752,259 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (4 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| PATIENT CARE SERVICE | 622110 | $132,831,876 | $132,831,876 |
| RENTAL INCOME - RELATED | 531120 | $3,112,604 | $3,112,604 |
| CLINICAL RESEARCH | 541700 | $508,587 | $508,587 |
| JOINT VENTURES | 621400 | $468,834 | $468,834 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $136,921,901 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,883,336 | TotalRevenueColumnAmt |
| Exclusion | $1,883,336 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $18,311,499 | SecuritiesAmt |
| Other | $1,091 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $16,724,424 | SecuritiesAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $1,587,075 | SecuritiesAmt |
| Other | $1,091 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,588,166 | TotalRevenueColumnAmt |
| Exclusion | $1,588,166 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt | ExclusionExclusionAmt |
|---|---|---|---|---|
| EHR INCENTIVE PAYMENTS | 900099 | $1,204,246 | $1,204,246 | |
| CAFETERIA SALES | 722514 | $655,436 | $655,436 | |
| TELECOMMUNICATIONS | 900099 | $92,862 | $92,862 |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $216,636 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $216,636 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $2,169,180 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $143,314,842 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $138,435,645 | RelatedOrExemptFuncIncomeAmt |
| Exclusion | $4,126,938 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $235,302 | TotalAmt |
| Program Services | $235,302 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $852,485 | TotalAmt |
| Program Services | $50,700 | ProgramServicesAmt |
| Management And General | $801,785 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $54,051,694 | TotalAmt |
| Program Services | $49,371,525 | ProgramServicesAmt |
| Management And General | $4,680,169 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,676,800 | TotalAmt |
| Program Services | $2,409,286 | ProgramServicesAmt |
| Management And General | $267,514 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $10,115,288 | TotalAmt |
| Program Services | $9,104,385 | ProgramServicesAmt |
| Management And General | $1,010,903 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,793,883 | TotalAmt |
| Program Services | $3,414,729 | ProgramServicesAmt |
| Management And General | $379,154 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $187,214 | TotalAmt |
| Program Services | $177,680 | ProgramServicesAmt |
| Management And General | $9,534 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $376,862 | TotalAmt |
| Program Services | $357,670 | ProgramServicesAmt |
| Management And General | $19,192 | ManagementAndGeneralAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $50,015 | TotalAmt |
| Management And General | $50,015 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,331,635 | TotalAmt |
| Program Services | $7,902,491 | ProgramServicesAmt |
| Management And General | $429,144 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $120,034 | TotalAmt |
| Program Services | $113,921 | ProgramServicesAmt |
| Management And General | $6,113 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,502,439 | TotalAmt |
| Program Services | $1,425,925 | ProgramServicesAmt |
| Management And General | $76,514 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $304,676 | TotalAmt |
| Program Services | $289,160 | ProgramServicesAmt |
| Management And General | $15,516 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,075,182 | TotalAmt |
| Program Services | $6,714,865 | ProgramServicesAmt |
| Management And General | $360,317 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $180,382 | TotalAmt |
| Program Services | $171,196 | ProgramServicesAmt |
| Management And General | $9,186 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $455,763 | TotalAmt |
| Program Services | $432,552 | ProgramServicesAmt |
| Management And General | $23,211 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,896,914 | TotalAmt |
| Program Services | $6,545,675 | ProgramServicesAmt |
| Management And General | $351,239 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $502,657 | TotalAmt |
| Program Services | $477,058 | ProgramServicesAmt |
| Management And General | $25,599 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| MEDICAL SUPPLIES | $21,046,647 | $21,046,647 | |
| HAF PROGRAM FEES | $6,388,333 | $6,388,333 | |
| DUES & SUBSCRIPTIONS | $245,679 | $233,167 | $12,512 |
| PROPERTY TAX | $124,721 | $118,369 | $6,352 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $19,600 | TotalAmt |
| Program Services | $18,601 | ProgramServicesAmt |
| Management And General | $999 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $125,534,205 | TotalAmt |
| Program Services | $116,999,237 | ProgramServicesAmt |
| Management And General | $8,534,968 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $25,034,733 | BOYAmt |
| EOY | $24,996,587 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $24,078,695 | BOYAmt |
| EOY | $26,574,802 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $453,189 | BOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,114,271 | BOYAmt |
| EOY | $2,325,316 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $141,962 | BOYAmt |
| EOY | $267,924 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $128,965,768 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $77,554,913 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $44,211,760 | BOYAmt |
| EOY | $51,410,855 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $44,487,582 | BOYAmt |
| EOY | $61,309,252 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,431,856 | BOYAmt |
| EOY | $834,261 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $142,954,048 | BOYAmt |
| EOY | $167,718,997 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $12,619,505 | BOYAmt |
| EOY | $18,067,177 | EOYAmt |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $12,905,449 | BOYAmt |
| EOY | $11,695,471 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,120,543 | BOYAmt |
| EOY | $1,414,466 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $26,645,497 | BOYAmt |
| EOY | $31,177,114 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $116,308,551 | BOYAmt |
| EOY | $136,541,883 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $116,308,551 | BOYAmt |
| EOY | $136,541,883 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $142,954,048 | BOYAmt |
| EOY | $167,718,997 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $17,780,637 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $2,452,695 | NetUnrlzdGainsLossesInvstAmt |
| 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 | $6,188,988 | OtherCostOrOtherBasisAmt |
| Book Value | $6,188,988 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $56,467,667 | OtherCostOrOtherBasisAmt |
| Depreciation | $30,326,573 | DepreciationAmt |
| Book Value | $26,141,094 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $64,400,384 | OtherCostOrOtherBasisAmt |
| Depreciation | $45,463,607 | DepreciationAmt |
| Book Value | $18,936,777 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,908,729 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,764,733 | DepreciationAmt |
| Book Value | $143,996 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $51,410,855 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)
| DescDesc | AmtAmt |
|---|---|
| DUE TO AFFILIATES | $777,300 |
| ESTIMATED THIRD PARTY SETTLEMENTS | $637,166 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $1,414,466 | 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 | Yes (true) | ExpensesExceedBudgetInd |
| Unable To Provide Care | false | UnableToProvideCareInd |
| 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 | 9336 | PersonsServedCnt |
| Total Community Benefit Expns | $10,481,623 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,832,056 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $6,649,567 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.05300 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $20,986,158 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $12,961,056 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $8,025,102 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.06390 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 9336 | PersonsServedCnt |
| Total Community Benefit Expns | $31,467,781 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $16,793,112 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $14,674,669 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.11690 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 51 | ActivitiesOrProgramsCnt |
| Persons Served | 20344 | PersonsServedCnt |
| Total Community Benefit Expns | $38,780 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $38,780 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00030 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 3 | ActivitiesOrProgramsCnt |
| Persons Served | 96 | PersonsServedCnt |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 2 | ActivitiesOrProgramsCnt |
| Persons Served | 600 | PersonsServedCnt |
| Total Community Benefit Expns | $2,325 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $2,325 | NetCommunityBenefitExpnsAmt |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 1 | ActivitiesOrProgramsCnt |
| Persons Served | 1300 | PersonsServedCnt |
| Total Community Benefit Expns | $2,560 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $2,560 | NetCommunityBenefitExpnsAmt |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 57 | ActivitiesOrProgramsCnt |
| Persons Served | 22340 | PersonsServedCnt |
| Total Community Benefit Expns | $43,665 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $43,665 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00030 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 57 | ActivitiesOrProgramsCnt |
| Persons Served | 31676 | PersonsServedCnt |
| Total Community Benefit Expns | $31,511,446 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $16,793,112 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $14,718,334 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.11720 | TotalExpensePct |
Community Support CommunitySupportGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 3 | ActivitiesOrProgramsCnt |
| Persons Served | 7779 | PersonsServedCnt |
| Total Community Benefit Expns | $136 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $136 | NetCommunityBenefitExpnsAmt |
Coalition Building CoalitionBuildingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 1 | ActivitiesOrProgramsCnt |
| Persons Served | 82 | PersonsServedCnt |
Health Improvement Advocacy HealthImprovementAdvocacyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 1 | ActivitiesOrProgramsCnt |
| Persons Served | 15 | PersonsServedCnt |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 5 | ActivitiesOrProgramsCnt |
| Persons Served | 7876 | PersonsServedCnt |
| Total Community Benefit Expns | $136 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $136 | NetCommunityBenefitExpnsAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (true) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $9,676,855 | BadDebtExpenseAmt |
| Reimbursed By Medicare | $48,350,538 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $60,275,768 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$11,925,230 | 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 (2 entries)
| Primary ActivitiesPrimaryActivitiesTxt | Org Profit Or OwnershipOrgProfitOrOwnershipPct | Physicians Profit Or OwnershipPhysiciansProfitOrOwnershipPct |
|---|---|---|
| COMM ENDOSCOPY CTR | ||
| ENDOSCOPY CENTER | 0.41000 | 0.49000 |
| MADISON MED ASSOC | ||
| REAL ESTATE | 0.30000 | 0.30000 |
| 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 | COMM HOSP OF ANDERSON & MADISON CTY | BusinessNameLine1 |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1515 NORTH MADISON AVENUE | AddressLine1 |
| City | ANDERSON | City |
| State | IN | State |
| ZIP Code | 46011 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | WWW.COMMUNITYANDERSON.COM | WebsiteAddressTxt |
| State License | 13-005100-1 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
| Other | SEE ADDITIONAL INFORMATION | OtherDesc |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | COMM HOSP OF ANDERSON & MADISON CTY | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| 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 Report Widely Available | Yes (true) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | WWW.COMMUNITYANDERSON.COM | OwnWebsiteURLTxt |
| Other Website | Yes (X) | OtherWebsiteInd |
| Other Website URL | WWW.ECOMMUNITY.COM | OtherWebsiteURLTxt |
| Rpt Available Upon Request | Yes (X) | RptAvailableUponRequestInd |
| Rpt Available Thru Other Method | Yes (X) | RptAvailableThruOtherMethodInd |
| Adopt Implementation Strategy | Yes (X) | AdoptImplementationStrategyInd |
| Exec Implementation Strategy | Yes (X) | ExecImplementationStrategyInd |
| Develop Community Wide Plan | Yes (X) | DevelopCommunityWidePlanInd |
| Exec Community Wide Plan | Yes (X) | ExecCommunityWidePlanInd |
| Include Operational Plan | Yes (X) | IncludeOperationalPlanInd |
| Adopt Budget | Yes (X) | AdoptBudgetInd |
| Prioritize Health Needs | Yes (X) | PrioritizeHealthNeedsInd |
| Prioritize Services | Yes (X) | PrioritizeServicesInd |
| All Needs Addressed | false | AllNeedsAddressedInd |
| Organization Incur Excise Tax | false | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (true) | EligCriteriaExplainedInd |
| FPG Used Deter Elig Free Care | Yes (true) | FPGUsedDeterEligFreeCareInd |
| FPG Family Incm Lmt Free Care | 200.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Used Determ Elig Dscnt Care | Yes (true) | FPGUsedDetermEligDscntCareInd |
| FPG Family Incm Lmt Dscnt Care | 300.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Explained Basis | Yes (true) | ExplainedBasisInd |
| Income Level | Yes (X) | IncomeLevelInd |
| Asset Level | Yes (X) | AssetLevelInd |
| Medical Indigency | Yes (X) | MedicalIndigencyInd |
| Uninsured Discount | Yes (X) | UninsuredDiscountInd |
| App Financial Asst Expln | Yes (true) | AppFinancialAsstExplnInd |
| Includes Publicity Measures | Yes (true) | IncludesPublicityMeasuresInd |
| Available On Request | Yes (X) | AvailableOnRequestInd |
| Other Publicity | Yes (X) | OtherPublicityInd |
| FAP Actions On Nonpayment | Yes (true) | FAPActionsOnNonpaymentInd |
| Collection Activities | false | 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, COMM HOSP OF ANDERSON & MADISON CTY - PART V, LINE 3 | SEE ATTACHED IRS 990 SCHEDULE H SUPPLEMENTAL INFORMATION REPORT |
| FACILITY 1, COMM HOSP OF ANDERSON & MADISON CTY - PART V, LINE 4 | SEE ATTACHED IRS 990 SCHEDULE H SUPPLEMENTAL INFORMATION REPORT |
| FACILITY 1, COMM HOSP OF ANDERSON & MADISON CTY - PART V, LINE 5C | SEE ATTACHED IRS 990 SCHEDULE H SUPPLEMENTAL INFORMATION REPORT |
| FACILITY 1, COMM HOSP OF ANDERSON & MADISON CTY - PART V, LINE 7 | SEE ATTACHED IRS 990 SCHEDULE H SUPPLEMENTAL INFORMATION REPORT |
| FACILITY 1, COMM HOSP OF ANDERSON & MADISON CTY - PART V, LINE 14G | CHA PUBLICIZES THE FACT THAT WE HAVE FINANCIAL ASSISTANCE AVAILABLE FOR THOSE WHO CANNOT PAY FOR HEALTHCARE. SIGNS ARE POSTED THROUGHOUT THE HOSPITAL (INCLUDING ER, THE ADMITTING OFFICE, AND THE PATIENT ACCOUNTS OFFICE) LETTING PEOPLE KNOW WE HAVE ASSISTANCE AVAILABLE. INFORMATION IS ALSO INCLUDED IN THE ADMISSION PACKET AS WELL AS ON THE CONSENT FORMS AND BILLS. OUR POLICY IS ALSO POSTED ON OUR WEBSITE. WE HAVE DEDICATED AN ENTIRE PAGE ON OUR WEBSITE TO THOSE WITHOUT INSURANCE. |
| FACILITY 1, COMM HOSP OF ANDERSON & MADISON CTY - PART V, LINE 20D | THE HOSPITAL CHARGES ALL PATIENTS THE SAME PRICE REGARDLESS OF INSURANCE, ABILITY TO PAY, AGE, RACE, GENDER OR NATIONAL ORIGIN. THE UNINSURED DISCOUNT WAS DETERMINED UTILIZING THE HOSPITAL'S TOP COMMERCIAL PAYORS. UNINSURED DISCOUNTS REPRESENT A STANDARD DISCOUNT ON CHARGES AS IT RELATES TO PATIENTS WHO HAVE NO INSURANCE COVERAGE. |
Supplemental Information Detail SupplementalInformationDetail (7 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 6A - RELATED ORGANIZATION INFORMATION | A COMMUNITY BENEFIT REPORT IS COMPLETED FOR THE COMMUNITY HEALTH NETWORK AS A WHOLE. COMMUNITY HOSPITAL OF ANDERSON AND MADISON COUNTY, INC. ("CHA") IS INCLUDED WITHIN THE NETWORK COMMUNITY BENEFIT REPORT. |
| PART I, LINE 7 - COSTING METHODOLOGY EXPLANATION | A COST TO CHARGE RATIO WAS UTILIZED TO DETERMINE COSTS FOR LINES A THROUGH C IN THE TABLE. THE COST TO CHARGE RATIO WAS DERIVED FROM WORKSHEET 2. LINES E THROUGH I OF THE TABLE ARE BASED ON ACTUAL INCURRED EXPENSES. |
| PART II - COMMUNITY BUILDING ACTIVITIES | SEE ATTACHED IRS 990 SCHEDULE H SUPPLEMENTAL INFORMATION REPORT WHICH INCLUDES INFORMATION FOR COMMUNITY HOSPITAL OF ANDERSON AND MADISON COUNTY, INC. |
| PART III, LINE 2 - BAD DEBT EXPENSE METHODOLOGY | THE COST TO CHARGE RATIO UTILIZED FOR PURPOSES OF REPORTING BAD DEBT COSTS WAS DERIVED FROM WORKSHEET 2 AND IS BASED ON THE ORGANIZATION'S AUDITED FINANCIAL STATEMENTS. COMMUNITY HOSPITAL OF ANDERSON AND MADISON COUNTY, INC., UTILIZES AN AUTOMATED SOFTWARE SOLUTION TO ASSIST IN DETERMINING PATIENTS ELIGIBLE FOR FREE CARE. AS A RESULT OF THE IMPLEMENTATION OF THIS AUTOMATED SOLUTION, THERE IS VERY LITTLE BAD DEBT RECORDED FOR PATIENTS WHO WOULD BE ELIGIBLE FOR FREE CARE UNDER THE HOSPITAL'S POLICY. PATIENTS WITHOUT INSURANCE COVERAGE ARE ELIGIBLE FOR A 40% UNINSURED DISCOUNT. IF PATIENTS PAY THEIR BILL IN FULL WITHIN 30 DAYS OF RECEIVING IT, THEY ARE ELIGIBLE FOR AN ADDITIONAL 10% DISCOUNT. UNCOLLECTIBLE ACCOUNTS ARE WRITTEN OFF AGAINST ALLOWANCE FOR DOUBTFUL ACCOUNTS AFTER EXHAUSTING COLLECTION EFFORTS. BAD DEBT EXPENSE REPRESENTS THE AMOUNT OF UNCOLLECTIBLE ACCOUNTS RECEIVABLE WRITTEN OFF. PART III, LINE 4 - BAD DEBT EXPENSE EXPLANATION CHA DOES NOT HAVE INDIVIDUALLY AUDITED FINANCIAL STATEMENTS. ITS FINANCIAL RESULTS ARE INCLUDED IN THE CONSOLIDATED FINANCIAL STATEMENTS OF COMMUNITY HEALTH NETWORK, INC. AND AFFILIATES. THE NETWORK AUDITED FINANCIAL STATEMENTS CONTAIN THE FOLLOWING TEXT WITHIN THE FOOTNOTES TO DESCRIBE BAD DEBT EXPENSE: THE NETWORK'S ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND CONTRACTUAL ADJUSTMENTS. IN EVALUATING THE COLLECTABILITY OF ACCOUNTS RECEIVABLE, THE NETWORK ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR CONTRACTUAL ADJUSTMENTS AND PROVISION FOR BAD DEBTS. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD PARTY COVERAGE, THE NETWORK ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR CONTRACTUAL ADJUSTMENTS. FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS, INCLUDING PATIENT DEDUCTIBLES AND CO- INSURANCE, THE NETWORK RECORDS A PROVISION FOR BAD DEBTS AND CHARITY 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. FOR CHNW, CHS, VEI AND CHVH, 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 ARE FULLY RESERVED WITHIN THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. AS SUCH THE ALLOWANCE FOR DOUBTFUL ACCOUNTS IS SIGNIFICANT FOR ACCOUNTS RECEIVABLE THAT HAVE BEEN FULLY RESERVED. 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, 2013 AND 2012, RESPECTIVELY: THIRD PARTY PAYORS SELF-PAY TOTAL ALL PAYORS 2013 PATIENT SERVICE REVENUE(NET OF CONTRACTUAL ALLOWANCES AND DISCOUNTS) 1,666,086 94,024 1,760,110 ========== ======= ========== 2012 PATIENT SERVICE REVENUE(NET OF CONTRACTUAL ALLOWANCES AND DISCOUNTS) 1,580,962 73,759 1,654,721 ========== ======= ========== 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 83,731000 AND 58,163000 FOR THE YEARS ENDED DECEMBER 31, 2013 AND 2012, RESPECTIVELY. CHARITY CARE COST WAS ESTIMATED ON THE APPLICATION OF THE ASSOCIATED COST-TO-CHARGE RATIOS. BEGINNING JUNE 2012, THE STATE OF INDIANA OFFERED VOLUNTARY PARTICIPATION IN THE STATE OF INDIANA'S HOSPITAL ASSESSMENT FEE ("HAF") PROGRAM, RETROACTIVE TO JULY, 1, 2011. 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. AS A RESULT OF PARTICIPATING IN THE HAF PROGRAM, FOR THE YEAR ENDED DECEMBER 31, 2012, THE NETWORK RECOGNIZED REIMBURSEMENTS OF 78,197000 AND FEES OF 43,453000 RELATED TO THE PERIOD JULY 1, 2011 THROUGH JUNE 30, 2012. 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. 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 SUBSEQUENTLY RENEWED ON MARCH 21, 2014 EFFECTIVE THROUGH JUNE 30, 2017 WITH A RETROACTIVE EFFECTIVE DATE OF JULY 1, 2013. AS A RESULT OF THE RETROACTIVE DATE OF JULY 1, 2013, THE NETWORK HAS 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. ADJUSTMENTS TO THE ALLOWANCE FOR DOUBTFUL ACCOUNTS ARE MADE AFTER THE NETWORK HAS ANALYZED HISTORICAL CASH COLLECTIONS AND CONSIDERED THE IMPACT OF ANY KNOWN MATERIAL EVENTS. UNCOLLECTIBLE ACCOUNTS ARE WRITTEN-OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS AFTER EXHAUSTING COLLECTION EFFORTS. ANY SUBSEQUENT RECOVERIES ARE RECORDED AGAINST THE PROVISION FOR BAD DEBTS. |
| PART III, LINE 8 - MEDICARE EXPLANATION | PER THE 990 INSTRUCTIONS, THE MEDICARE COST REPORT WAS UTILIZED TO DETERMINE THE MEDICARE SHORTFALL. HOWEVER, THE MEDICARE COST REPORT IS NOT REFLECTIVE OF ALL COSTS ASSOCIATED WITH MEDICARE PROGRAMS SUCH AS PHYSICIAN SERVICES AND SERVICES BILLED VIA FREE STANDING CLINICS. FURTHER, THE MEDICARE COST REPORT EXCLUDES REVENUES AND COSTS OF MEDICARE PARTS C AND D. MEDICARE SHORTFALLS SHOULD BE CONSIDERED AS COMMUNITY BENEFIT BECAUSE MEDICARE REPRESENTS 51.82% OF THE OVERALL PAYER MIX FOR COMMUNITY HOSPITAL OF ANDERSON AND MADISON COUNTY, INC. |
| PART III, LINE 9B - COLLECTION PRACTICES EXPLANATION | IF A PATIENT IS DETERMINED TO BE ELIGIBLE FOR HARDSHIP DURING THE COLLECTION PROCESS, COLLECTION EFFORTS ARE STOPPED AND HARDSHIP IS GIVEN. |
| ADDITIONAL INFORMATION | PART V - FACILITY INFORMATION, SECTION A - OTHER CHA IS AN ACUTE CARE MEDICAL FACILITY WITH 137 STAFFED BEDS. IN 2013, THERE WERE 5,572 ADMISSIONS WITH AN AVERAGE LENGTH OF STAY OF 3.70 DAYS. THERE WERE 30,748 EMERGENCY ROOM CASES RESPONDED TO IN OUR 24-HOUR/SEVEN DAY A WEEK EMERGENCY ROOM. 62.5% OF THE BIRTHS IN MADISON COUNTY WERE DELIVERED AT CHA FOR A TOTAL OF 867 BIRTHS IN 2013. PART VI, ITEMS 2 THROUGH 5 ARE DISCUSSED WITHIN THE ATTACHED COMMUNITY BENEFIT REPORT. PART VI, ITEM 6 - AFFILIATED HEALTH CARE SYSTEM CHA IS PART OF AN AFFILIATED HEALTH CARE SYSTEM. SEE THE ATTACHED IRS 990 SCHEDULE H SUPPLEMENTAL INFORMATION REPORT FOR HOW CHA IS INVOLVED IN PROMOTING THE HEALTH OF THE COMMUNITY IT SERVES. PART VI, ITEM 7 - STATE FILING OF COMMUNITY BENEFIT REPORT INDIANA |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (true) | GrantRecordsMaintainedInd |
Recipient Table RecipientTable (11 entries)
| Address Line1USAddress/AddressLine1 | CityUSAddress/City | StateUSAddress/State | ZIP CodeUSAddress/ZIPCode | Recipient EINRecipientEIN | IRC SectionIRCSectionDesc | Cash GrantCashGrantAmt | Purpose Of GrantPurposeOfGrantTxt |
|---|---|---|---|---|---|---|---|
| ALTERNATIVES INC | |||||||
| PO BOX 1302 | ANDERSON | IN | 46015 | 310986769 | 501C3 | $9,000 | GENERAL SUPPORT |
| ANDERSON IMPACT CENTER | |||||||
| 630 NICHOL AVENUE | ANDERSON | IN | 46016 | 900521040 | 501C3 | $50,000 | GENERAL SUPPORT |
| ANDERSON SYMPHONY ORCHESTRA | |||||||
| 1124 MERIDIAN PLAZA | ANDERSON | IN | 46015 | 310940546 | 501C3 | $6,250 | GENERAL SUPPORT |
| COMMUNITY LTC INC | |||||||
| 1031 MONTICELLO DRIVE | ANDERSON | IN | 46011 | 351877441 | 501C3 | $5,546 | NURSE AID COURSE |
| FIRST UNITED METHODIST CHURCH | |||||||
| 1215 JACKSON STREET | ANDERSON | IN | 46016 | 350874263 | 501C3 | $6,990 | BUDDY BAG PROGRAM |
| HEALTH & HOSPITAL CORP OF MARION CO | |||||||
| 3838 N RURAL STREET 8TH FLOOR | INDIANAPOLIS | IN | 46205 | 356005697 | GOV | $10,000 | GENERAL SUPPORT |
| MADISON COUNTY COMMUNITY FOUNDATION | |||||||
| 33 W 10TH STREET SUITE 600 | ANDERSON | IN | 46016 | 351859959 | 501C3 | $41,300 | KINDERG CAMP & VAR |
| MADISON PARK CHURCH OF GOD | |||||||
| 1932 E 53RD STREET | ANDERSON | IN | 46013 | 356005926 | 501C3 | $12,500 | SPONSOR A CHR CAROL |
| PARAMOUNT HERITAGE FOUNDATION INC | |||||||
| 1124 MERIDIAN PLAZA | ANDERSON | IN | 46016 | 351774217 | 501C3 | $5,390 | GENERAL SUPPORT |
| SOUTH MADISON COMMUNITY FOUNDATION | |||||||
| 233 S MAIN STREET | PENDLETON | IN | 46064 | 351839769 | 501C3 | $25,000 | MADISON CTY LEGACY |
| UNITED WAY OF MADISON COUNTY INC | |||||||
| 1201 E 5TH STREET SUITE 1019 | ANDERSON | IN | 46015 | 351052350 | 501C3 | $20,000 | GENERAL SUPPORT |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 11 | Total501c3OrgCnt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE I, PAGE 1, PART I, LINE 2 | FormAndLineReferenceDesc |
| Explanation | THE CONTRIBUTIONS TO VARIOUS LOCAL CHARITABLE ORGANIZATIONS WERE UNRESTRICTED DONATIONS. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Independent Consultant | Yes (X) | IndependentConsultantInd |
| Written Employment Contract | Yes (X) | WrittenEmploymentContractInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | false | 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 (11 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 | Bonus Filing OrganizationBonusFilingOrganizationAmount | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| BRYAN A MILLS | ||||||||||||||
| DIRECTOR | $912,524 | $123,211 | $98,248 | $90,730 | $30,550 | $1,255,263 | $123,211 | |||||||
| ELIZABETH S THARP | ||||||||||||||
| DIRECTOR & PRES/CEO | $274,695 | $34,239 | $1,593 | $131,254 | $2,940 | $444,721 | $34,239 | |||||||
| TROY ABBOTT MD | ||||||||||||||
| DIRECTOR | $224,573 | $13,121 | $14,834 | $22,066 | $274,594 | $4,500 | $4,500 | |||||||
| DAVID A SHAPIRO MD | ||||||||||||||
| DIRECTOR | $219,965 | $18,742 | $55,831 | $21,764 | $316,302 | |||||||||
| JOHN B HARRIS | ||||||||||||||
| VP OF FINANCE & CFO | $197,962 | $40,380 | $20,255 | $76,101 | $22,366 | $357,064 | $40,380 | |||||||
| TAHIR ALI NAQVI MD | ||||||||||||||
| PHYSICIAN | $767,713 | $628,263 | $75,790 | $565,450 | $37,460 | $2,069,684 | $628,263 | |||||||
| NIGHAT TAHIR MD | ||||||||||||||
| PHYSICIAN | $232,926 | $217,740 | $806 | $109,250 | $37,460 | $593,190 | $217,740 | |||||||
| RYAN HINDS MD | ||||||||||||||
| ANESTHESIOLOGIST | $330,206 | $27,094 | $17,850 | $22,622 | $397,772 | |||||||||
| JARED ANDERSON MD | ||||||||||||||
| ANESTHESIOLOGIST | $315,909 | $29,511 | $17,850 | $29,972 | $393,242 | |||||||||
| VIRGIL LOGHIN MD | ||||||||||||||
| ANESTHESIOLOGIST | $296,309 | $46,489 | $17,850 | $10,844 | $371,492 | |||||||||
| WILLIAM C VANNESS II MD | ||||||||||||||
| FORMER CEO | $13,978 | $189,120 | $12,812 | $1,694 | $612 | $218,216 | $189,120 | |||||||
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE J, PART III | FormAndLineReferenceDesc |
| Explanation | PART I, LINE 4B SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN BRYAN A. MILLS PARTICIPATED IN A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN THROUGH HIS EMPLOYER, COMMUNITY HEALTH NETWORK, INC. MR. MILLS DID NOT RECEIVE A PAYMENT FROM THE PLAN IN 2013. PART I, LINE 7 - NON-FIXED PAYMENTS PROVIDED DR. NAQVI AND DR. TAHIR ARE ELIGIBLE FOR AN INCENTIVE PAYMENT BASED ON PRODUCTIVITY. CHA DEVELOPED ITS COMPENSATION PLAN IN CONJUNCTION WITH AN INDEPENDENT COMPENSATION CONSULTANT. IN ADDITION, THE PLAN WAS APPROVED BY THE CHA EXECUTIVE COMPENSATION COMMITTEE, COMPOSED OF INDEPENDENT OUTSIDE DIRECTORS. IN ADOPTING ITS INCENTIVE BASED COMPENSATION PLAN, CHA (TOGETHER WITH ITS INDEPENDENT COMPENSATION CONSULTANT, ITS EXTERNAL LEGAL COUNSEL, AND THE NETWORK EXECUTIVE COMPENSATION COMMITTEE) CONSIDERED AND APPLIED THE PROVISIONS OF CODE SECTION 4958 AND THE CORRESPONDING TREASURY REGULATIONS TO ENSURE THAT ITS COMPENSATION DECISIONS REFLECT ARMS LENGTH, FAIR MARKET TERMS. CERTAIN INDIVIDUALS OF THE LEADERSHIP TEAM PARTICIPATE IN A SENIOR LEADERSHIP INCENTIVE PROGRAM. THE PROGRAM WAS ADOPTED BY 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 OF EXTERNAL BOARD MEMBERS. THE INCENTIVE COMPENSATION THAT IS AWARDED IS INCLUDED IN TOTAL COMPENSATION TO THE EXECUTIVE. THE TOTAL COMPENSATION (INCLUDING ANY PAYMENTS UNDER THE PROGRAM) IS SUBJECT TO THE REVIEW AND APPROVAL OF THE EXECUTIVE COMPENSATION COMMITTEE AND INDEPENDENT COMPENSATION CONSULTANT, IN CONSIDERATION OF CODE SECTION 4958 (AND THE CORRESPONDING TREASURY REGULATIONS) TO ENSURE THAT IT REFLECTS ARMS LENGTH, FAIR MARKET TERMS. | ExplanationTxt |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp
Name Of Interested NameOfInterested
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | VISIONARY ENTERPRISES INC | PersonNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship Description | SHARE BD MEMBER | RelationshipDescriptionTxt |
| Transaction | $17,707,057 | TransactionAmt |
| Transaction | HLTH INSUR/PLAN FEES | TransactionDesc |
| Sharing Of Revenues | false | SharingOfRevenuesInd |
Schedule M IRS990ScheduleM
Real Estate Other RealEstateOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Non Cash Checkbox | Yes (X) | NonCashCheckboxInd |
| Contribution | 1 | ContributionCnt |
| Noncash Contributions Rpt F990 | $210,000 | NoncashContributionsRptF990Amt |
| Method Of Determining Revenues | APPRAISAL | MethodOfDeterminingRevenuesTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form8283 Received | 1 | Form8283ReceivedCnt |
| Any Property That Must Be Held | false | AnyPropertyThatMustBeHeldInd |
| Review Process Unusual NC Gifts | false | ReviewProcessUnusualNCGiftsInd |
| Third Parties Used | false | ThirdPartiesUsedInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE M, PAGE 2, PART II | FormAndLineReferenceDesc |
| Explanation | PART I, LINE 17 COLUMN (B) IS THE NUMBER OF CONTRIBUTIONS AS WELL AS THE NUMBER OF ITEMS RECEIVED. | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (11 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990 - ORGANIZATION'S MISSION | THE MISSION OF COMMUNITY HOSPITAL OF ANDERSON AND MADISON COUNTY, INC. IS TO SERVICE THE MEDICAL, HEALTH AND HUMAN SERVICE NEEDS OF THE PEOPLE IN ANDERSON, MADISON COUNTY, AND CONTIGUOUS COUNTIES WITH COMPASSION, DIGNITY, RESPECT, AND EXCELLENCE. SERVICE, ALTHOUGH FOCUSED ON INJURY, ILLNESS, AND DISEASE, WILL ALSO EMBRACE PREVENTION, EDUCATION, AND ALTERNATIVE SYSTEMS OF HEALTH CARE DELIVERY. COMMUNITY HOSPITALS OF ANDERSON AND MADISON COUNTY, INC. OFFERS STATE-OF-THE-ART SERVICES TO EXCEED THE NEEDS OF OUR PATIENTS. FROM BASIC MEDICAL SERVICES SUCH AS THE EMERGENCY DEPARTMENT AND OUR NEW GENERATIONS BIRTH PLACE, TO THE SUPPORT OF OUR BREAST HEALTH SPECIALIST AND DIABETES CARE CENTER EDUCATORS, WE ADD THAT SPECIAL TOUCH TO ANTICIPATE YOUR NEEDS BEFORE YOU ASK. OUR STAFF MAKES EVERY EFFORT TO PROVIDE AN EFFECTIVE AND EFFICIENT HEALTH CARE DELIVERY SYSTEM. |
| FORM 990, PART VI | FORM 990, PART VI, LINE 2 - RELATED PARTY INFORMATION AMONG OFFICERS CHARLES STALEY SERVED AS A DIRECTOR OF COMMUNITY HEALTH NETWORK, INC. ("CHNW") AND BRYAN A. MILLS RECEIVED COMPENSATION FROM CHNW. IN ADDITION, BRYAN A. MILLS SERVED AS A DIRECTOR OF COMMUNITY PHYSICIANS OF INDIANA, INC. ("CPI") AND THE FOLLOWING RECEIVED COMPENSATION FROM CPI: TROY ABBOTT, M.D. DAVID A. SHAPIRO, M.D. |
| FORM 990, PAGE 6, PART VI, LINE 3 | THROUGH AN AFFILIATION AGREEMENT EFFECTIVE SEPTEMBER 1, 1996, CHA'S BOARD OF TRUSTEES RETAINS CONTROL OVER MANAGEMENT DUTIES FOR CHA. HOWEVER, FOR THE FOLLOWING GOVERNANCE ITEMS, CHA INITIATES RECOMMENDATIONS TO THE COMMUNITY HEALTH NETWORK, INC. ("CHNW") BOARD OF DIRECTORS FOR ITS APPROVAL OF THE FOLLOWING: A) STRATEGIC AND OPERATING PLANS; B) ANNUAL OPERATING AND CAPITAL BUDGETS AND ANY UNBUDGETED CAPITAL EXPENDITURES; C) AMENDMENTS TO THE ARTICLES OR BYLAWS OF THE CHA BOARD OF TRUSTEES, THE BYLAWS OF THE CHA MEDICAL STAFF, OR TO THE AFFILIATION AGREEMENT; D) APPOINTMENT AND REMOVAL OF THE CHIEF EXECUTIVE OFFICER OF CHA; E) UNBUDGETED SALES, LEASES, OR TRANSFERS OF ASSETS ABOVE 500,000; F) INCURRENCE OF DEBT OTHER THAN IN THE ORDINARY COURSE OF BUSINESS OR IN ACCORDANCE WITH THE OPERATING PLANS, OPERATING BUDGET, OR CAPITAL BUDGET RECOMMENDED BY THE CHA BOARD OF TRUSTEES AND APPROVED BY THE CHNW BOARD OF DIRECTORS; G) CHANGE IN THE MISSION OF CHA; H) ELECTION OF NEW MEMBERS OR REAPPOINTMENT OF CURRENT MEMBERS TO THE CHA BOARD OF TRUSTEES; I) PARTICIPATION IN MANAGED CARE AND OTHER NETWORKS OR AFFILIATIONS; AND J) RELOCATION OF PHYSICIANS EMPLOYED BY OR UNDER CONTRACT WITH CHNW TO MADISON COUNTY. |
| FORM 990, PAGE 6, PART VI, LINE 6 | COMMUNITY HEALTH NETWORK, INC. ("CHNW") IS THE SOLE MEMBER OF COMMUNITY HOSPITAL OF ANDERSON AND MADISON COUNTY, INC. ("CHA"). CHNW IS AN EXEMPT ORGANIZATION PURSUANT TO SECTION 501(C)(3). |
| FORM 990, PAGE 6, PART VI, LINE 7A | CHA'S BOARD OF TRUSTEES MEMBERSHIP IS DETERMINED AS FOLLOWS: A) CHNW, AS THE SOLE MEMBER OF CHA, SHALL NOMINATE AND ELECT ONE MEMBER OF CHA'S BOARD OF TRUSTEES, B) ONE MEMBER OF THE CHA BOARD OF TRUSTEES SHALL BE THE CHIEF EXECUTIVE OFFICER OF CHA, C) FOUR MEMBERS SHALL BE ACTIVE MEMBERS OF THE CHA MEDICAL STAFF AND SHALL BE NOMINATED AND ELECTED BY THE CHA MEDICAL STAFF, AND RATIFIED BY THE CHA BOARD OF TRUSTEES, D) THE TWELVE REMAINING POSITIONS SHALL BE FILLED BY PERSONS ELECTED BY CHNW'S BOARD OF DIRECTORS, AND E) ADDITIONALLY, THE PRESIDENT OF THE MEDICAL STAFF SHALL SERVE AS AN EX OFFICIO, NONVOTING MEMBER OF THE BOARD OF TRUSTEES. |
| FORM 990, PAGE 6, PART VI, LINE 7B | CHNW, AS THE SOLE MEMBER OF CHA, MUST APPROVE THE FOLLOWING: A) STRATEGIC AND OPERATING PLANS; B) ANNUAL OPERATING AND CAPITAL BUDGETS AND ANY UNBUDGETED CAPITAL EXPENDITURES; C) AMENDMENTS TO THE ARTICLES OR BYLAWS OF THE CORPORATION AND THE BYLAWS OF THE MEDICAL STAFF OF THE CORPORATION, D) APPOINTMENT AND REMOVAL OF THE CHIEF EXECUTIVE OFFICER OF THE CORPORATION; E) UNBUDGETED SALES, LEASES, OR TRANSFERS OF ASSETS ABOVE 500,000, WHICH AMOUNT MAY BE ADJUSTED FROM TIME TO TIME AS AGREED BY THE BOARD OF TRUSTEES AND THE BOARD OF DIRECTORS OF THE MEMBER; F) INCURRENCE OF DEBT OTHER THAN IN THE ORDINARY COURSE OF BUSINESS OR IN ACCORDANCE WITH THE OPERATING PLANS, OPERATING BUDGET, OR CAPITAL BUDGET RECOMMENDED BY THE BOARD OF TRUSTEES AND APPROVED BY THE BOARD OF DIRECTORS OF THE MEMBER; G) CHANGE IN THE MISSION OF THE CORPORATION; H) ELECTION OF NEW MEMBERS OR REAPPOINTMENT OF CURRENT MEMBERS TO THE BOARD OF TRUSTEES; I) PARTICIPATION IN MANAGED CARE AND OTHER NETWORKS OR AFFILIATIONS; AND J) RELOCATION OF PHYSICIANS EMPLOYED BY OR UNDER CONTRACT WITH THE MEMBER TO MADISON COUNTY. |
| FORM 990, PAGE 6, PART VI, LINE 11B | THE RETURN IS PREPARED BY AN OUTSIDE, INDEPENDENT ACCOUNTING FIRM AND REVIEWED BY LEGAL COUNSEL. IN ADDITION, ALL SECTIONS OF THE FORM 990 ARE REVIEWED BY THE EXECUTIVE COMMITTEE OF THE CHA BOARD OF TRUSTEES. |
| FORM 990, PAGE 6, PART VI, LINE 12C | CHA HAS ADOPTED A CONFLICT OF INTEREST POLICY APPLICABLE TO ALL EMPLOYEES. THE CONFLICT OF INTEREST POLICY REQUIRES EMPLOYEES SUBMIT A CONFLICT OF INTEREST DISCLOSURE FORM UPON EMPLOYMENT WITH CHA AND ON AN ANNUAL BASIS THEREAFTER. PRIOR TO COMPLETING AND SIGNING THE DISCLOSURE, ALL EMPLOYEES MUST READ AND UNDERSTAND CHA'S CONFLICT OF INTEREST POLICY STATEMENT, WHICH PROVIDES THAT NO CHA EMPLOYEE SHALL MAKE A PROFIT BECAUSE OF HIS OR HER POSITION AT CHA. THE DISCLOSURE REQUIRES EMPLOYEES TO DISCLOSE, IN WRITING, ANY KNOWN FINANCIAL INTEREST THAT THE INDIVIDUAL (TOGETHER WITH THEIR SPOUSE AND FAMILY MEMBERS) HAS IN ANY BUSINESS ENTITY THAT CONDUCTS OR WILL POTENTIALLY CONDUCT BUSINESS WITH CHA. EMPLOYEES ARE ALSO REQUIRED TO IMMEDIATELY DISCLOSE TO THE CHA HUMAN RESOURCES DEPARTMENT ANY SUBSEQUENT CHANGES THAT ARISE MID-YEAR AND WOULD OTHERWISE BE REPORTED ON THE ANNUAL DISCLOSURE STATEMENT. IN ADDITION, THE CHA AMENDED AND RESTATED CODE OF BYLAWS PROVIDES A CONFLICT OF INTEREST POLICY FOR THE CHA BOARD OF TRUSTEES. CHA'S AMENDED AND RESTATED CODE OF BYLAWS REQUIRES ALL BOARD MEMBERS TO DISCLOSE ANY DUALITY OR CONFLICT OF INTEREST TO THE OTHER BOARD MEMBERS. THE DIRECTOR IS PROHIBITED FROM VOTING OR EXERTING ANY PERSONAL INFLUENCE ON ANY ISSUE THAT PRESENTS A CONFLICT OF INTEREST. THE DIRECTOR'S ABSTENTION FROM THE VOTE AND THE DETAILS CONCERNING THE CONFLICT OF INTEREST ARE REPORTED IN THE MEETING'S MINUTES. |
| FORM 990, PAGE 6, PART VI, LINE 15A | CHA HAS A COMPENSATION COMMITTEE COMPOSED OF INDEPENDENT MEMBERS OF ITS BOARD OF DIRECTORS. THE COMPENSATION COMMITTEE IS RESPONSIBLE FOR EVALUATING AND DETERMINING COMPENSATION FOR CHA'S EXECUTIVE PERSONNEL. IN DISCHARGING THESE DUTIES, THE COMPENSATION COMMITTEE APPLIES THE PRINCIPLES OF THE REBUTTABLE PRESUMPTION AS OUTLINED IN CODE SECTION 4958 AND THE CORRESPONDING TREASURY REGULATIONS. MOST NOTABLY, THE COMPENSATION COMMITTEE OBTAINS AND RELIES UPON COMPARABILITY DATA WHEN SETTING COMPENSATION AND CONTEMPORANEOUSLY DOCUMENTS ITS DECISIONS AND THE PROCESS THAT IT EMPLOYS IN WRITING. IN ADDITION, THE COMPENSATION COMMITTEE PERIODICALLY RETAINS AN OUTSIDE COMPENSATION CONSULTANT TO PROVIDE INPUT REGARDING THE APPROPRIATENESS OF CHA'S COMPENSATION DECISIONS. |
| FORM 990, PAGE 6, PART VI, LINE 15B | SEE PART VI, LINE 15A ABOVE. FORM 990, PART VI, LINE 16A - JOINT VENTURES SEE SCHEDULE H, PART IV |
| FORM 990, PAGE 6, PART VI, LINE 19 | A) THE ARTICLES OF INCORPORATION AND CERTIFICATE OF EXISTENCE ARE ON FILE WITH THE INDIANA SECRETARY OF STATE AND ARE AVAILABLE TO THE PUBLIC UPON REQUEST TO THE INDIANA SECRETARY OF STATE OR FREE OF CHARGE ON THE SECRETARY OF STATE'S WEBSITE. B) WHILE NOT AVAILABLE TO THE PUBLIC, CHA'S CONFLICT OF INTEREST POLICY IS DESCRIBED IN PART VI, LINE 12C. C) CHA DOES NOT HAVE INDIVIDUALLY AUDITED FINANCIAL STATEMENTS. ITS FINANCIAL RESULTS ARE INCLUDED IN THE CONSOLIDATED FINANCIAL STATEMENTS OF COMMUNITY HEALTH NETWORK, INC. AND AFFILIATES. AS SUCH, THERE ARE NO INDIVIDUAL FINANCIAL STATEMENTS TO POST. CHA DOES FILE THE 990 TAX RETURN ON AN ANNUAL BASIS WHICH IS AVAILABLE UPON REQUEST AND/OR AVAILABLE ON A DELAYED BASIS ON GUIDESTAR.ORG. D) COMMUNITY HEALTH NETWORK, INC. AND AFFILIATES PROVIDE ANY DOCUMENT OPEN TO PUBLIC INSPECTION UPON REQUEST. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (15 entries)
| Address Line1USAddress/AddressLine1 | CityUSAddress/City | StateUSAddress/State | ZIP CodeUSAddress/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|---|
| AUXILIARY OF COMMUNITY HOSPITAL | ||||||||||
| 1515 NORTH MADISON AVENUE | ANDERSON | IN | 46011 | 356065606 | SUPPORT | IN | 501C3 | 11A | NA | false |
| COMMUNITY HOSP ANDERSON FDN INC | ||||||||||
| 1515 NORTH MADISON AVENUE | ANDERSON | IN | 46011 | 861053152 | CHARITY | IN | 501C3 | 11A | CHA | Yes (true) |
| COMMUNITY LTC INC | ||||||||||
| 1031 MONTICELLO DRIVE | ANDERSON | IN | 46011 | 351877441 | HLTH CARE | IN | 501C3 | 9 | CHA | Yes (true) |
| COMMUNITY HOME HEALTH SERVICES INC | ||||||||||
| 9894 EAST 121ST STREET | FISHERS | IN | 46037 | 350953467 | HLTH CARE | IN | 501C3 | 9 | CHNW | Yes (true) |
| 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 HOSPITAL SOUTH INC | ||||||||||
| 1402 E COUNTY LINE ROAD SOUTH | INDIANAPOLIS | IN | 46227 | 351088640 | HOSPITAL | IN | 501C3 | 3 | CHNW | 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 | IOH | Yes (true) |
| INDIANA HEART HOSPITAL LLC | ||||||||||
| 8075 NORTH SHADELAND AVENUE | INDIANAPOLIS | IN | 46250 | 352123783 | HOSPITAL | IN | 501C3 | 3 | CHNW | Yes (true) |
| INDIANAPOLIS OSTEOPATHIC HOSP INC | ||||||||||
| 3630 GUION ROAD | INDIANAPOLIS | IN | 46222 | 351094734 | HOSPITAL | IN | 501C3 | 3 | CHNW | Yes (true) |
| WESTVIEW HOSPITAL FOUNDATION INC | ||||||||||
| 3630 GUION ROAD | INDIANAPOLIS | IN | 46222 | 311036451 | SUPPORT | IN | 501C3 | 11A | IOH | 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 |
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (17 entries)
| Address Line1USAddress/AddressLine1 | CityUSAddress/City | StateUSAddress/State | ZIP CodeUSAddress/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Direct Controlling NADirectControllingNACd | Disproportionate AllocationsDisproportionateAllocationsInd | General Or Managing PartnerGeneralOrManagingPartnerInd | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Predominant Income TypePredominantIncomeTypeTxt | Share Of Total IncomeShareOfTotalIncomeAmt | Share Of EOY AssetsShareOfEOYAssetsAmt | OwnershipOwnershipPct |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| BROWNSBURG OFFICE CENTER 2 LLP | ||||||||||||||
| 321 E NORTHFIELD | BROWNSBURG | IN | 46112 | 351929859 | LEASING | IN | N/A | false | false | |||||
| CHNJMH VENTURES LLC | ||||||||||||||
| 7330 SHADELAND STATION SUITE 200 | INDIANAPOLIS | IN | 46256 | 462356266 | DIAG/REHAB | IN | N/A | false | false | |||||
| COMMUNITY ENDOSCOPY CENTER | ||||||||||||||
| 1601 N MADISON AVENUE SUITE 300 | ANDERSON | IN | 46011 | 611464136 | HLTH CARE | IN | false | Yes (true) | NA | RELATED | $500,303 | $417,006 | 0.41000 | |
| COMM HEALTH NETWORK REHAB HOSP LLC | ||||||||||||||
| 7343 CLEARVISTA DRIVE | INDIANAPOLIS | IN | 46256 | 453414249 | REHAB | IN | N/A | false | false | |||||
| EAST CAMPUS SURGERY CENTER LLC | ||||||||||||||
| 7330 SHADELAND STATION SUITE 200 | INDIANAPOLIS | IN | 46256 | 352028517 | SURGERY | IN | N/A | false | false | |||||
| HAMILTON SURGERY CENTER LLC | ||||||||||||||
| 7330 SHADELAND STATION SUITE 200 | INDIANAPOLIS | IN | 46256 | 352061413 | SURGERY | IN | N/A | false | false | |||||
| HOWARD COMMUNITY SURGERY CTR LLC | ||||||||||||||
| 3500 S LAFOUNTAIN STREET | KOKOMO | IN | 46902 | 352118748 | SURGERY | IN | N/A | false | false | |||||
| HOWARD REGIONAL SPECIALTY CARE LLC | ||||||||||||||
| 680 SOUTH FOURTH STREET | LOUISVILLE | KY | 40202 | 371501021 | REHAB | IN | N/A | false | false | |||||
| INDIANA SPECIALTY GROUP | ||||||||||||||
| 7240 SHADELAND STATION SUITE 300 | INDIANAPOLIS | IN | 46256 | 351976258 | HLTH CARE | IN | N/A | false | false | |||||
| INDIANAPOLIS ENDOSCOPY CENTER LLC | ||||||||||||||
| 7353 E 121ST STREET | INDIANAPOLIS | IN | 46219 | 352010874 | HLTH CARE | IN | N/A | false | false | |||||
| MICHIGAN SURGERY INVESTMENT LLC | ||||||||||||||
| 7330 SHADELAND STATION SUITE 200 | INDIANAPOLIS | IN | 46256 | 320147008 | SURG CTRS | IN | N/A | false | false | |||||
| NORTH CAMPUS OFFICE ASSOCIATES LP | ||||||||||||||
| 7330 SHADELAND STATION SUITE 200 | INDIANAPOLIS | IN | 46256 | 351808625 | RNTL PROP | IN | N/A | false | false | |||||
| NORTH CAMPUS SURGERY CENTERS LLC | ||||||||||||||
| 7330 SHADELAND STATION SUITE 200 | INDIANAPOLIS | IN | 46256 | 352147088 | SURGERY | IN | N/A | false | false | |||||
| NORTHPOINT PEDIATRICS LLC | ||||||||||||||
| 8101 CLEARVISTA PARKWAY SUITE 185 | INDIANAPOLIS | IN | 46256 | 351960566 | HLTH CARE | IN | N/A | false | false | |||||
| NORTHWEST SURGERY CENTER LLC | ||||||||||||||
| 7330 SHADELAND STATION SUITE 200 | INDIANAPOLIS | IN | 46256 | 208754071 | SURGERY | IN | N/A | false | false | |||||
| PILLARS HOUSING LP | ||||||||||||||
| 3500 S LAFOUNTAIN STREET | KOKOMO | IN | 46902 | 161652671 | HOUSING | IN | N/A | false | false | |||||
| SOUTH CAMPUS SURGERY CENTER LLC | ||||||||||||||
| 1550 EAST COUNTY LINE ROAD | INDIANAPOLIS | IN | 46227 | 352038072 | SURGERY | IN | N/A | false | false | |||||
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (6 entries)
| Address Line1ForeignAddress/AddressLine1 | CityForeignAddress/City | Province Or StateForeignAddress/ProvinceOrState | CountryForeignAddress/Country | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile Foreign CountryLegalDomicileForeignCountryCd | Direct Controlling NADirectControllingNACd | Controlled OrganizationControlledOrganizationInd | Address Line1USAddress/AddressLine1 | CityUSAddress/City | StateUSAddress/State | ZIP CodeUSAddress/ZIPCode | 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 SOUTH LAFOUNTAIN STREET | KOKOMO | IN | 46902 | IN | |||||
| PILLARS COMMUNITY HOUSING INC | |||||||||||||
| 161652666 | HOUSING | N/A | Yes (true) | 3500 SOUTH LAFOUNTAIN STREET | KOKOMO | IN | 46902 | IN | |||||
| VISIONARY ENTERPRISES INC | |||||||||||||
| 351538433 | MGMT SRVCS | N/A | Yes (true) | 6626 EAST 75TH STREET | INDIANAPOLIS | IN | 46250 | IN | |||||
| VEI MICHIGAN INC | |||||||||||||
| 300097377 | MGMT SRVCS | N/A | Yes (true) | 940 N MAIN STREET | ANN HARBOR | MI | 48104 | MI | |||||
| WESTVIEW DELIVERY SYSTEM INC | |||||||||||||
| 351910292 | MGMT SRVCS | 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 | Yes (true) | 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 | Yes (true) | 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 (13 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt |
|---|---|---|
| COMMUNITY HOSP ANDERSON FDN INC | ||
| C | $542,259 | BOOK VALUE |
| COMMUNITY HOSP ANDERSON FDN INC | ||
| Q | $168,795 | BOOK VALUE |
| COMMUNITY HOSP ANDERSON FDN INC | ||
| R | $86,255 | BOOK VALUE |
| COMMUNITY LTC INC | ||
| A | $16,363 | BOOK VALUE |
| COMMUNITY LTC INC | ||
| J | $337,611 | BOOK VALUE |
| COMMUNITY LTC INC | ||
| Q | $1,255,712 | BOOK VALUE |
| COMMUNITY LTC INC | ||
| S | $100,617 | BOOK VALUE |
| COMMUNITY HOME HEALTH SERVICES INC | ||
| Q | $73,742 | BOOK VALUE |
| COMMUNITY PHYSICIANS OF IN INC | ||
| A | $1,382,947 | BOOK VALUE |
| COMMUNITY PHYSICIANS OF IN INC | ||
| P | $544,083 | BOOK VALUE |
| COMMUNITY PHYSICIANS OF IN INC | ||
| S | $257,242 | BOOK VALUE |
| VISIONARY ENTERPRISES INC | ||
| P | $12,086,389 | BOOK VALUE |
| VISIONARY ENTERPRISES INC | ||
| Q | $5,620,668 | BOOK VALUE |