COMMUNITY HOSPITAL ANDERSON FOUNDATION INC: Form 990, tax year 2013
View the entire original 990 at ProPublica ↗
- Organization
- COMMUNITY HOSPITAL ANDERSON FOUNDATION INC (EIN 86-1053152)
- Tax period
- 2013-01-01 to 2013-12-31
- Filed
- 2014-11-12
- IRS object ID
- 201413169349303331
- 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 G
- Schedule I
- Schedule J
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2014-11-12T13:03:56-06:00 | 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 | 861053152 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | COMMUNITY HOSPITAL ANDERSON FDN | BusinessNameLine1 |
| Business Name Line2 | INC | BusinessNameLine2 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | COMM | BusinessNameControlTxt |
| Phone | 7652985133 | 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 |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | KEITH TRENT | PersonNm |
| Person Title | CHIEF FOUNDATION OFFICER | PersonTitleTxt |
| Phone | 7652985133 | 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 | KEITH TRENT | PrincipalOfficerNm |
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 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $1,894,580 | 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 | 2001 | FormationYr |
| Legal Domicile State | IN | LegalDomicileStateCd |
| Activity Or Mission | COMMUNITY HOSPITAL ANDERSON FOUNDATION, INC. IS ENGAGED IN FUND RAISING ACTIVITIES TO ACQUIRE MONIES TO FURTHER THE PURPOSES AND MISSION OF COMMUNITY HOSPITAL OF ANDERSON AND MADISON COUNTY, INC. IN PROVIDING QUALITY MEDICAL CARE AND TREATMENT TO CITIZENS OF ANDERSON AND MADISON COUNTY, INDIANA. | ActivityOrMissionDesc |
| Voting Members Governing Body | 15 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 14 | VotingMembersIndependentCnt |
| Total Employee | 2 | TotalEmployeeCnt |
| Total Volunteers | 99 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| PY Contributions Grants | $581,896 | PYContributionsGrantsAmt |
| CY Contributions Grants | $628,616 | CYContributionsGrantsAmt |
| CY Program Service Revenue | $0 | CYProgramServiceRevenueAmt |
| PY Investment Income | $487,184 | PYInvestmentIncomeAmt |
| CY Investment Income | $244,771 | CYInvestmentIncomeAmt |
| PY Other Revenue | -$6,640 | PYOtherRevenueAmt |
| CY Other Revenue | $10,203 | CYOtherRevenueAmt |
| PY Total Revenue | $1,062,440 | PYTotalRevenueAmt |
| CY Total Revenue | $883,590 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $556,465 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $611,256 | CYGrantsAndSimilarPaidAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $172,911 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $168,796 | CYSalariesCompEmpBnftPaidAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $104,168 | PYOtherExpensesAmt |
| CY Other Expenses | $147,306 | CYOtherExpensesAmt |
| PY Total Expenses | $833,544 | PYTotalExpensesAmt |
| CY Total Expenses | $927,358 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $228,896 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$43,768 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $3,903,969 | TotalAssetsBOYAmt |
| Total Assets EOY | $3,911,933 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $144,683 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $43,748 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $3,759,286 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $3,868,185 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | COMMUNITY HOSPITAL ANDERSON FOUNDATION, INC. IS ENGAGED IN FUND RAISING ACTIVITIES TO ACQUIRE MONIES TO FURTHER THE PURPOSES AND MISSION OF COMMUNITY HOSPITAL OF ANDERSON AND MADISON COUNTY, INC. IN PROVIDING QUALITY MEDICAL CARE AND TREATMENT TO CITIZENS OF ANDERSON AND MADISON COUNTY, INDIANA. | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $561,259 | ExpenseAmt |
| Grant | $542,259 | GrantAmt |
| Desc | A) PROVIDE CAPITAL IMPROVEMENTS & MEDICAL EQUIPMENT FOR USE BY COMMUNITY HOSPITAL OF ANDERSON AND MADISON COUNTY, INC. AND B) PROVIDE PROGRAMS DESIGNED TO EDUCATE THE PATIENTS OF COMMUNITY HOSPITAL OF ANDERSON AND MADISON COUNTY, INC. CONCERNING THEIR HEALTH NEEDS AND AVAILABLE MEDICAL TREATMENT. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $75,941 | ExpenseAmt |
| Desc | PROVIDE FINANCIAL ASSISTANCE TO COMMUNITY HOSPITAL ANDERSON EMPLOYEES THROUGH THE HEALTHCARE EMPLOYEES LOAN PROGRAM. | Desc |
Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $16,959 | ExpenseAmt |
| Grant | $16,959 | GrantAmt |
| Desc | PROVIDE SCHOLARSHIPS AND EDUCATION ASSISTANCE TO COMMUNITY HOSPITAL ANDERSON EMPLOYEES. | Desc |
Prog Srvc Accom Acty Other ProgSrvcAccomActyOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $66,312 | ExpenseAmt |
| Grant | $52,038 | GrantAmt |
| Desc | PROVIDED FUNDS TO SUPPORT ANDERSON COMMUNITY. | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Prog Srvc Expense | $66,312 | TotalOtherProgSrvcExpenseAmt |
| Total Other Prog Srvc Grant | $52,038 | TotalOtherProgSrvcGrantAmt |
| Total Program Service Expenses | $720,471 | 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 | Yes (true) | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | false | 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 | Yes (true) | FundraisingActivitiesInd |
| Gaming Activities | false | GamingActivitiesInd |
| Operate Hospital | false | OperateHospitalInd |
| Grants To Organizations | Yes (true) | GrantsToOrganizationsInd |
| Grants To Individuals | Yes (true) | 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 | false | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | false | DeductibleNonCashContriInd |
| Deductible Art Contribution | false | DeductibleArtContributionInd |
| Terminate Operations | false | TerminateOperationsInd |
| Partial Liquidation | false | PartialLiquidationInd |
| Disregarded Entity | false | DisregardedEntityInd |
| Related Entity | Yes (true) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (true) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | false | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | false | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | false | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (true) | ScheduleORequiredInd |
| IRP Document | 10 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (true) | BackupWthldComplianceInd |
| Employee | 2 | 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 |
| Excess Business Holdings | false | ExcessBusinessHoldingsInd |
| Indoor Tanning Services | false | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 15 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 14 | IndependentVotingMemberCnt |
| Family Or Business Rln | false | 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 | false | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (true) | DocumentRetentionPolicyInd |
| Compensation Process CEO | false | CompensationProcessCEOInd |
| Compensation Process Other | false | CompensationProcessOtherInd |
| Investment In Joint Venture | false | InvestmentInJointVentureInd |
| 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 | KEITH TRENT | PersonNm |
| Phone | 7652985414 | 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 (16 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 |
|---|---|---|---|---|---|---|---|
| PATRICIA WOODS | |||||||
| DIRECTOR | 3.00 | 40.00 | Yes (X) | $0 | $107,211 | $40,861 | |
| SHARON ANTRIM | |||||||
| DIRECTOR | 3.00 | Yes (X) | $0 | $0 | $0 | ||
| DOUG BANNING | |||||||
| TREASURER | 3.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| TOM BANNON | |||||||
| DIRECTOR | 3.00 | Yes (X) | $0 | $0 | $0 | ||
| ROGER BROCKMAN MD | |||||||
| DIRECTOR | 3.00 | Yes (X) | $0 | $0 | $0 | ||
| BRIAN DONAHUE | |||||||
| DIRECTOR | 3.00 | Yes (X) | $0 | $0 | $0 | ||
| DANA DONAHUE | |||||||
| DIRECTOR | 3.00 | Yes (X) | $0 | $0 | $0 | ||
| CRAIG DUNKIN | |||||||
| DIRECTOR | 3.00 | Yes (X) | $0 | $0 | $0 | ||
| MARSHA MUSTIN | |||||||
| SECRETARY | 3.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| WILLIAM O'NEAL PHD | |||||||
| CHAIRMAN | 3.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| PAM SHOOT | |||||||
| DIRECTOR | 3.00 | Yes (X) | $0 | $0 | $0 | ||
| JADA SPARKS | |||||||
| DIRECTOR | 3.00 | Yes (X) | $0 | $0 | $0 | ||
| TONY THANAS | |||||||
| DIRECTOR | 3.00 | Yes (X) | $0 | $0 | $0 | ||
| GEORGEANN WHITWORTH | |||||||
| DIRECTOR | 3.00 | Yes (X) | $0 | $0 | $0 | ||
| BETTY WILLIAMS | |||||||
| VICE CHAIRMA | 3.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| KEITH TRENT | |||||||
| CHIEF FDN OF | 37.00 | 8.00 | $93,864 | $38,439 | $64,556 | Yes (X) | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $93,864 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $145,650 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $105,417 | TotalOtherCompensationAmt |
| Former Ofcr Employees Listed | false | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (true) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
| Fundraising | $85,094 | FundraisingAmt |
| Related Organizations | $1,000 | RelatedOrganizationsAmt |
| Government Grants | $29,557 | GovernmentGrantsAmt |
| All Other Contributions | $512,965 | AllOtherContributionsAmt |
| Total Contributions | $628,616 | TotalContributionsAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $120,958 | TotalRevenueColumnAmt |
| Exclusion | $120,958 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $1,108,756 | SecuritiesAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $984,943 | SecuritiesAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $123,813 | SecuritiesAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $123,813 | TotalRevenueColumnAmt |
| Exclusion | $123,813 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fundraising Gross Income | $36,250 | FundraisingGrossIncomeAmt |
| Contri Rpt Fundraising Event | $85,094 | ContriRptFundraisingEventAmt |
| Fundraising Direct Expenses | $26,047 | FundraisingDirectExpensesAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $10,203 | TotalRevenueColumnAmt |
| Exclusion | $10,203 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $883,590 | TotalRevenueColumnAmt |
| Exclusion | $254,974 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $594,297 | TotalAmt |
| Program Services | $594,297 | ProgramServicesAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $16,959 | TotalAmt |
| Program Services | $16,959 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $93,864 | TotalAmt |
| Management And General | $93,864 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $64,066 | TotalAmt |
| Management And General | $64,066 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $600 | TotalAmt |
| Management And General | $600 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $10,266 | TotalAmt |
| Management And General | $10,266 | ManagementAndGeneralAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,665 | TotalAmt |
| Management And General | $2,665 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $27,305 | TotalAmt |
| Management And General | $27,305 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $14,274 | TotalAmt |
| Program Services | $14,274 | ProgramServicesAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,153 | TotalAmt |
| Management And General | $7,153 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $171 | TotalAmt |
| Management And General | $171 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| "HELP" LOANS | $75,941 | $75,941 | |
| ANNUITY PAYMENTS | $18,488 | $18,488 | |
| DUES & LICENSES | $797 | $797 | |
| DONOR MEETINGS | $512 | $512 |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $927,358 | TotalAmt |
| Program Services | $720,471 | ProgramServicesAmt |
| Management And General | $206,887 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $138,459 | BOYAmt |
| EOY | $70,269 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,765,510 | BOYAmt |
| EOY | $3,841,664 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,903,969 | BOYAmt |
| EOY | $3,911,933 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,006 | BOYAmt |
| EOY | $688 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $143,677 | BOYAmt |
| EOY | $43,060 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $144,683 | BOYAmt |
| EOY | $43,748 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,759,286 | BOYAmt |
| EOY | $3,868,185 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,759,286 | BOYAmt |
| EOY | $3,868,185 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,903,969 | BOYAmt |
| EOY | $3,911,933 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | -$43,768 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $152,667 | 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) |
|---|---|---|
| Supporting Organization509a3 | Yes (X) | SupportingOrganization509a3Ind |
| Supporting Org Type1 | Yes (X) | SupportingOrgType1Ind |
| Certification | Yes (X) | CertificationInd |
| Contribution Controller | false | ContributionControllerInd |
| Contribution Family | false | ContributionFamilyInd |
| Contribution35 Controlled | false | Contribution35ControlledInd |
Supported Org Information SupportedOrgInformationGrp
Supported Organization Name SupportedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | COMMUNITY HOSP OF ANDERSON & MADISON COUNTY INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 351069822 | EIN |
| Organization Type | 3 | OrganizationTypeDesc |
| Governing Document Listed | Yes (true) | GoverningDocumentListedInd |
| Supported Org Notified | false | SupportedOrgNotifiedInd |
| US Organized | false | USOrganizedInd |
| Support | $542,259 | SupportAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Supported Organizations Total | 1 | SupportedOrganizationsTotalCnt |
| Support Sum | $542,259 | SupportSumAmt |
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
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $3,623,023 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $383,381 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $32,000 | GrantsOrScholarshipsAmt |
| Other Expenditures | $268,000 | OtherExpendituresAmt |
| Administrative Expenses | $2,537 | AdministrativeExpensesAmt |
| End Year Balance | $3,703,867 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $3,358,695 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $542,321 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $20,079 | GrantsOrScholarshipsAmt |
| Other Expenditures | $247,921 | OtherExpendituresAmt |
| Administrative Expenses | $9,993 | AdministrativeExpensesAmt |
| End Year Balance | $3,623,023 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $3,438,442 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | -$66,313 | InvestmentEarningsOrLossesAmt |
| Administrative Expenses | $13,434 | AdministrativeExpensesAmt |
| End Year Balance | $3,358,695 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $3,435,272 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $404,254 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $81,823 | GrantsOrScholarshipsAmt |
| Other Expenditures | $305,450 | OtherExpendituresAmt |
| Administrative Expenses | $13,811 | AdministrativeExpensesAmt |
| End Year Balance | $3,438,442 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $2,930,191 | BeginningYearBalanceAmt |
| Contributions | $5,000 | ContributionsAmt |
| Investment Earnings Or Losses | $793,869 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $30,987 | GrantsOrScholarshipsAmt |
| Other Expenditures | $250,250 | OtherExpendituresAmt |
| Administrative Expenses | $12,551 | AdministrativeExpensesAmt |
| End Year Balance | $3,435,272 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated Balance EOY | 0.73120 | BoardDesignatedBalanceEOYPct |
| Prmnnt Endowment Balance EOY | 0.26880 | PrmnntEndowmentBalanceEOYPct |
| Endowments Held Unrelated Org | false | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | false | EndowmentsHeldRelatedOrgInd |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | DUE TO AFFILIATES | Desc |
| Amt | $43,060 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $43,060 | TotalLiabilityAmt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE D, PAGE 2, PART V, LINE 4 | FormAndLineReferenceDesc |
| Explanation | THE INTENDED USES OF THE ENDOWMENT FUNDS ARE TO PROVIDE EQUIPMENT FOR COMMUNITY HOSPITAL OF ANDERSON AND MADISON COUNTY, INC. ("CHA") AND THE SURROUNDING COMMUNITY. THE FOUNDATION ALSO PROVIDES SCHOLARSHIPS AND OTHER EDUCATIONAL SUPPORT. | ExplanationTxt |
Schedule G IRS990ScheduleG
Fundraising Event Information FundraisingEventInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Event1 | CHEFS BOY R WE | NameOfEvent1Amt |
| Gross Receipts Event1 | $106,266 | GrossReceiptsEvent1Amt |
| Charitable Contri Event1 | $70,016 | CharitableContriEvent1Amt |
| Gross Revenue Event1 | $36,250 | GrossRevenueEvent1Amt |
| Rent Facility Costs Event1 | $11,946 | RentFacilityCostsEvent1Amt |
| Entertainment Event1 | $350 | EntertainmentEvent1Amt |
| Other Direct Expenses Event1 | $7,244 | OtherDirectExpensesEvent1Amt |
| Name Of Event2 | GOLF OUTING | NameOfEvent2Amt |
| Gross Receipts Event2 | $15,078 | GrossReceiptsEvent2Amt |
| Charitable Contri Event2 | $15,078 | CharitableContriEvent2Amt |
| Cash Prizes Event2 | $775 | CashPrizesEvent2Amt |
| Other Direct Expenses Event2 | $5,732 | OtherDirectExpensesEvent2Amt |
| Gross Receipts Total | $121,344 | GrossReceiptsTotalAmt |
| Charitable Contributions Tot | $85,094 | CharitableContributionsTotAmt |
| Gross Revenue Total Events | $36,250 | GrossRevenueTotalEventsAmt |
| Cash Prizes Total Events | $775 | CashPrizesTotalEventsAmt |
| Rent Fclty Costs Total Events | $11,946 | RentFcltyCostsTotalEventsAmt |
| Entertainment Total Events | $350 | EntertainmentTotalEventsAmt |
| Oth Direct Expnss Total Events | $12,976 | OthDirectExpnssTotalEventsAmt |
| Direct Expense Summary Events | $26,047 | DirectExpenseSummaryEventsAmt |
| Net Income Summary | $10,203 | NetIncomeSummaryAmt |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (true) | GrantRecordsMaintainedInd |
Recipient Table RecipientTable (5 entries)
| Address Line1USAddress/AddressLine1 | CityUSAddress/City | StateUSAddress/State | ZIP CodeUSAddress/ZIPCode | Recipient EINRecipientEIN | IRC SectionIRCSectionDesc | Cash GrantCashGrantAmt | Purpose Of GrantPurposeOfGrantTxt |
|---|---|---|---|---|---|---|---|
| COMM HOSP OF ANDERSON & MADISON CTY | |||||||
| 1515 NORTH MADISON AVENUE | ANDERSON | IN | 46011 | 351069822 | 501C3 | $542,259 | PURCHASE EQUIP/OTHER |
| ALZHEIMER'S ASSOC OF GREATER IN | |||||||
| 50 EAST 91ST STREET SUITE 100 | INDIANAPOLIS | IN | 46240 | 351747836 | 501C3 | $7,676 | GENERAL SUPPORT |
| FRANKTON HIGH SCHOOL | |||||||
| 7916 W 300 N | ANDERSON | IN | 46011 | 351263898 | GOV | $5,500 | GENERAL SUPPORT |
| SOUTH MADISON COMMUNITY SCHOOL CORP | |||||||
| 203 S HERITAGE WAY | PENDLETON | IN | 46064 | 351114508 | GOV | $7,000 | GENERAL SUPPORT |
| ANDERSON COMMUNITY SCHOOL CORP | |||||||
| 1600 HILLCREST AVENUE | ANDERSON | IN | 46011 | 356002149 | GOV | $12,000 | GENERAL SUPPORT |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 5 | Total501c3OrgCnt |
Grants Other Asst To Indiv In US GrantsOtherAsstToIndivInUSGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Type | SCHOLARSHIPS | GrantTypeTxt |
| Recipient | 16 | RecipientCnt |
| Cash Grant | $16,959 | CashGrantAmt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE I, PAGE 1, PART I, LINE 2 | FormAndLineReferenceDesc |
| Explanation | SCHOLARSHIPS ARE PAID DIRECTLY TO THE UNIVERSITY FOR A STUDENT IN THE MEDICAL OR NURSING FIELD OF STUDY. TRANSCRIPTS ARE REQUIRED FROM THE SCHOLARSHIP RECIPIENTS AT THE END OF EACH SEMESTER. FOR DONATIONS TO SCHOOLS, COMMUNITY HOSPITAL ANDERSON FOUNDATION, INC. REQUESTS A REPORT FROM THE SCHOOL ON HOW THE FUNDS WERE SPENT. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Club Dues Or Fees | Yes (X) | ClubDuesOrFeesInd |
| Written Policy Ref T And E Expnss | Yes (true) | WrittenPolicyRefTAndEExpnssInd |
| Substantiation Required | Yes (true) | SubstantiationRequiredInd |
| Severance Payment | false | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | false | 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | KEITH TRENT | PersonNm |
| Title | CHIEF FDN OFFICER | TitleTxt |
| Base Compensation Filing Org | $77,669 | BaseCompensationFilingOrgAmt |
| Compensation Based On Rltd Orgs | $33,286 | CompensationBasedOnRltdOrgsAmt |
| Bonus Filing Organization | $15,491 | BonusFilingOrganizationAmount |
| Bonus Related Organizations | $4,851 | BonusRelatedOrganizationsAmt |
| Other Compensation Filing Org | $704 | OtherCompensationFilingOrgAmt |
| Other Compensation Rltd Orgs | $302 | OtherCompensationRltdOrgsAmt |
| Deferred Compensation Flng Org | $30,079 | DeferredCompensationFlngOrgAmt |
| Deferred Comp Rltd Orgs | $12,891 | DeferredCompRltdOrgsAmt |
| Nontaxable Benefits Filing Org | $15,110 | NontaxableBenefitsFilingOrgAmt |
| Nontaxable Benefits Rltd Orgs | $6,476 | NontaxableBenefitsRltdOrgsAmt |
| Total Compensation Filing Org | $139,053 | TotalCompensationFilingOrgAmt |
| Total Compensation Rltd Orgs | $57,806 | TotalCompensationRltdOrgsAmt |
| Comp Report Prior990 Filing Org | $15,491 | CompReportPrior990FilingOrgAmt |
| Comp Report Prior990 Rltd Orgs | $4,851 | CompReportPrior990RltdOrgsAmt |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| SCHEDULE J, PAGE 1, PART I, LINE 1A | THE CHIEF FOUNDATION OFFICER WAS PROVIDED SOCIAL CLUB DUES BY COMMUNITY HOSPITAL ANDERSON FOUNDATION. THIS WAS NOT TAXABLE COMPENSATION. |
| SCHEDULE J, PAGE 1, PART I, LINE 3 | COMMUNITY HOSPITAL ANDERSON FOUNDATION, INC. CEO/EXECUTIVE DIRECTOR IS PAID BY COMMUNITY HOSPITAL OF ANDERSON AND MADISON COUNTY, INC. ("CHA"), A RELATED 501(C)(3) ORGANIZATION. CHA USES THE FOLLOWING IN DETERMINING THE CEO'S COMPENSATION: 1) COMPENSATION COMMITTEE, 2) INDEPENDENT COMPENSATION CONSULTANT, 3) WRITTEN EMPLOYMENT CONTRACT, 4) COMPENSATION SURVEY OR STUDY, AND 5) APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. |
| SCHEDULE J, PAGE 1, PART I, LINE 7 | THE CHIEF FOUNDATION OFFICER PARTICIPATES IN A SENIOR LEADERSHIP INCENTIVE PROGRAM. THE PROGRAM WAS ADOPTED BY THE COMMUNITY HOSPITAL OF ANDERSON AND MADISON COUNTY, INC.'S ("CHA") EXECUTIVE COMPENSATION COMMITTEE, AND IS INTENDED TO INFLUENCE OUTSTANDING PERFORMANCE, AS MEASURED AGAINST BOTH ORGANIZATIONAL AND INDIVIDUAL PERFORMANCE. THE PROGRAM IS REVIEWED ANNUALLY BY CHA'S 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. |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (9 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990 - ORGANIZATION'S MISSION | COMMUNITY HOSPITAL ANDERSON FOUNDATION, INC. IS ENGAGED IN FUND RAISING ACTIVITIES TO ACQUIRE MONIES TO FURTHER THE PURPOSES AND MISSION OF COMMUNITY HOSPITAL OF ANDERSON AND MADISON COUNTY, INC. IN PROVIDING QUALITY MEDICAL CARE AND TREATMENT TO CITIZENS OF ANDERSON AND MADISON COUNTY, INDIANA. |
| FORM 990, PAGE 2, PART III, LINE 4D | PROVIDED FUNDS TO SUPPORT ANDERSON COMMUNITY. |
| FORM 990, PAGE 6, PART VI, LINE 6 | THE MEMBERS CONSIST OF THE BOARD OF DIRECTORS OF COMMUNITY HOSPITAL OF ANDERSON AND MADISON COUNTY, INC. |
| FORM 990, PAGE 6, PART VI, LINE 7A | THE FOUNDATION'S ARTICLES OF INCORPORATION STATE THE "MEMBERS" OF THE FOUNDATION ARE THE BOARD OF TRUSTEES OF COMMUNITY HOSPITAL OF ANDERSON AND MADISON COUNTY, INC. THEY ARE THE ONES WHO OFFICIALLY ELECT FOUNDATION BOARD OF DIRECTORS. THE BY-LAWS ALSO GIVE THE MEMBERS THE RIGHT TO FILL ANY VACANCY AMONG THE DIRECTORS AND THE RIGHT TO REMOVE ANY DIRECTOR. |
| FORM 990, PAGE 6, PART VI, LINE 7B | THE FOUNDATION'S ARTICLES OF INCORPORATION STATE THE "MEMBERS" OF THE FOUNDATION ARE THE BOARD OF TRUSTEES OF COMMUNITY HOSPITAL OF ANDERSON AND MADISON COUNTY, INC. THEY ARE THE ONES WHO OFFICIALLY ELECT THE FOUNDATION BOARD OF DIRECTORS. THE MEMBERS ALSO MUST APPROVE ANY AMENDMENT TO THE ARTICLES OF INCORPORATION. THE FOUNDATION BOARD OF DIRECTORS APPROVE ALL OTHER MATTERS RELATED TO THE FOUNDATION WITHOUT AUTHORIZATION OR APPROVAL OF THE MEMBERS OF THE FOUNDATION. |
| FORM 990, PAGE 6, PART VI, LINE 11B | COMMUNITY HEALTH NETWORK, INC. ("CHNW") HAS ASSUMED RESPONSIBILITY FOR CHAF'S AUDIT AND COMPLIANCE MATTERS. CHNW'S BOARD OF DIRECTORS HAS DELEGATED AUTHORITY FOR THE REVIEW OF CHAF'S FORM 990 TO TWO COMMITTEES COMPOSED OF INDEPENDENT OUTSIDE DIRECTORS: A) THE NETWORK EXECUTIVE COMPENSATION COMMITTEE REVIEWED THE COMPENSATION ASPECTS OF CHAF'S FORM 990, AND B) THE NETWORK FINANCE COMMITTEE REVIEWED THE REMAINDER OF THE FORM 990. IN ADDITION, CHAF'S OUTSIDE ACCOUNTING FIRM AND LAW FIRM REVIEWED THE FORM 990 PRIOR TO FILING. CHAF AND CHNW UTILIZED THIS PROCESS TO ENSURE THAT CHAF'S FORM 990 RECEIVED SUBSTANTIVE REVIEW BY DIRECTORS AND PROFESSIONALS WITH SPECIFIC KNOWLEDGE OF CHAF'S ACTIVITIES AND EXTENSIVE FINANCIAL, ACCOUNTING, AND TAX EXPERTISE. |
| FORM 990, PAGE 6, PART VI, LINE 12C | COMMUNITY HOSPITAL ANDERSON FOUNDATION, INC. MONITORS THE CONFLICT OF INTEREST POLICY BY MAKING SURE THAT THE FOUNDATION BOARD MEMBERS SIGN A CONFLICT OF INTEREST STATEMENT ANNUALLY. THE EXECUTIVE COMMITTEE, WHICH CONSISTS OF THE OFFICERS, WOULD ADDRESS ANY CONFLICTS OF INTEREST. THE ANNUAL DISCLOSURE REQUIRES BOARD MEMBERS TO DISCLOSE, IN WRITING, ANY KNOWN FINANCIAL INTEREST THAT THE INDIVIDUAL (TOGETHER WITH FAMILY MEMBERS) HAS IN ANY BUSINESS ENTITY THAT TRANSACTS BUSINESS WITH CHAF. IN ADDITION, BOARD MEMBERS ARE REQUIRED TO IMMEDIATELY DISCLOSE ANY POSSIBLE CONFLICT OF INTEREST THAT ARISES MID-YEAR IN RELATION TO A PROPOSED TRANSACTION. THE CONFLICT OF INTEREST POLICY REQUIRES THAT ANY INDIVIDUAL WITH A CONFLICT BE RECUSED FROM THE DECISION MAKING PROCESS, THAT INDEPENDENT DIRECTORS OR COMMITTEE MEMBERS DETERMINE THAT THE PROPOSED TRANSACTION IS IN THE BEST INTEREST OF CHAF, AND THE TRANSACTION MUST BE APPROVED BY A VOTE OF INDEPENDENT DIRECTORS OR COMMITTEE MEMBERS WITHOUT THE PARTICIPATION OF ANY INTERESTED INDIVIDUAL. FORM 990, PART VI, LINE 13 - WRITTEN WHISTLEBLOWER POLICY WHILE NO FORMAL WRITTEN POLICY EXISTS, CHAF'S WHISTLEBLOWER APPROACH IS AS FOLLOWS: A) ANNUALLY ALL EMPLOYEES ARE REQUIRED TO COMPLETE MANDATORY NETWORK RESPONSIBILITY AND COMPLIANCE PROGRAM TRAINING ("NRCP"). THIS ELECTRONIC TRAINING INCLUDES A TRAINING SESSION ON HOW TO REPORT CONCERNS AND TO WHOM TO REPORT THE CONCERNS. B) IN THE NETWORK'S NRCP MANUAL WHICH IS AVAILABLE TO ALL EMPLOYEES VIA THE NETWORK'S INTRANET, IT STATES "THE NETWORK REALIZES THE RESPONSIBILITY AND SUPPORTS THE RIGHT OF EVERY INDIVIDUAL TO ADDRESS POTENTIAL VIOLATIONS OF NETWORK POLICIES AND PROCEDURES; LAWS, RULES, AND REGULATIONS; OR ETHICAL STANDARDS IN GOOD FAITH AND TO REQUEST GUIDANCE WITHOUT THE FEAR OF PUNISHMENT OR HARASSMENT FROM OTHERS INCLUDING CO-WORKERS, SUPERVISORS, AND LEADERSHIP. BOTH FEDERAL AND STATE FALSE CLAIMS ACTS PROHIBIT EMPLOYERS FROM RETALIATION AGAINST EMPLOYEES WHO FILE WHISTLEBLOWER ACTIONS. THEREFORE, RETRIBUTION, RETALIATION, OR HARASSMENT OF ANY KIND AGAINST ANY PERSON WHO REQUESTS GUIDANCE OR BRINGS A VIOLATION, REAL OR PERCEIVED, TO LEADERSHIP'S OR THE GOVERNMENT'S ATTENTION IS FORBIDDEN." |
| FORM 990, PAGE 6, PART VI, LINE 15A | COMMUNITY HOSPITAL ANDERSON FOUNDATION, INC. HAS DELEGATED THE AUTHORITY FOR DETERMINING THE COMPENSATION FOR THE FOUNDATION OFFICER TO COMMUNITY HOSPITAL OF ANDERSON AND MADISON COUNTY, INC. ("CHA"). 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 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, THE CONFLICT OF INTEREST POLICY IS DESCRIBED IN PART VI, LINE 12C. C) COMMUNITY HOSPITAL ANDERSON FOUNDATION, INC. 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. COMMUNITY HOSPITAL ANDERSON FOUNDATION, INC. 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 (14 entries)
| Address Line1USAddress/AddressLine1 | CityUSAddress/City | StateUSAddress/State | ZIP CodeUSAddress/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Direct Controlling NADirectControllingNACd | Controlled OrganizationControlledOrganizationInd | Business Name Line1DirectControllingEntityName/BusinessNameLine1 |
|---|---|---|---|---|---|---|---|---|---|---|---|
| COMMUNITY HEALTH NETWORK INC | |||||||||||
| 7330 SHADELAND STATION SUITE 200 | INDIANAPOLIS | IN | 46256 | 350983617 | HOSPITAL | IN | 501C3 | 3 | N/A | false | |
| COMMUNITY HEALTH NETWORK FOUNDATION | |||||||||||
| 7240 SHADELAND STATION SUITE 125 | INDIANAPOLIS | IN | 46256 | 510181688 | CHARITY | IN | 501C3 | 11B | Yes (true) | CHNW | |
| COMMUNITY HLTH SERVICES OF INDIANA | |||||||||||
| 7330 SHADELAND STATION SUITE 200 | INDIANAPOLIS | IN | 46256 | 454817436 | HLTH CARE | IN | 501C3 | 3 | Yes (true) | CHNW | |
| COMMUNITY HOME HEALTH SERVICES INC | |||||||||||
| 9894 EAST 121ST STREET | FISHERS | IN | 46037 | 350953467 | HLTH CARE | IN | 501C3 | 9 | Yes (true) | CHNW | |
| COMM HOSP OF ANDERSON & MADISON CTY | |||||||||||
| 1515 N MADISON AVENUE | ANDERSON | IN | 46011 | 351069822 | HOSPITAL | IN | 501C3 | 3 | false | CHNW | |
| COMMUNITY HOSPITAL SOUTH INC | |||||||||||
| 1402 E COUNTY LINE ROAD SOUTH | INDIANAPOLIS | IN | 46227 | 351088640 | HOSPITAL | IN | 501C3 | 3 | Yes (true) | CHNW | |
| COMMUNITY HOWARD REGIONAL HEALTH | |||||||||||
| 3500 S LAFOUNTAIN STREET | KOKOMO | IN | 46902 | 351865344 | HOSPITAL | IN | 501C3 | 3 | Yes (true) | CHNW | |
| COMM HOWARD REGIONAL HEALTH FDN | |||||||||||
| PO BOX 9011 | KOKOMO | IN | 46904 | 237309596 | SUPPORT | IN | 501C3 | 7 | false | NA | |
| COMMUNITY LTC INC | |||||||||||
| 1031 MONTICELLO DRIVE | ANDERSON | IN | 46011 | 351877441 | HLTH CARE | IN | 501C3 | 9 | Yes (true) | CHA | |
| COMMUNITY PHYSICIANS OF IN INC | |||||||||||
| 7240 SHADELAND STATION SUITE 300 | INDIANAPOLIS | IN | 46256 | 205392766 | PHY SRV | IN | 501C3 | 9 | Yes (true) | CHNW | |
| HEALTH INSTITUTE OF INDIANA INC | |||||||||||
| 3660 GUION ROAD | INDIANAPOLIS | IN | 46222 | 352022402 | FITNESS | IN | 501C3 | 9 | Yes (true) | IOH | |
| INDIANA HEART HOSPITAL LLC | |||||||||||
| 8075 NORTH SHADELAND AVENUE | INDIANAPOLIS | IN | 46250 | 352123783 | HOSPITAL | IN | 501C3 | 3 | Yes (true) | CHNW | |
| INDIANAPOLIS OSTEOPATHIC HOSP INC | |||||||||||
| 3630 GUION ROAD | INDIANAPOLIS | IN | 46222 | 351094734 | HOSPITAL | IN | 501C3 | 3 | Yes (true) | CHNW | |
| WESTVIEW HOSPITAL FOUNDATION INC | |||||||||||
| 3630 GUION ROAD | INDIANAPOLIS | IN | 46222 | 311036451 | SUPPORT | IN | 501C3 | 11A | Yes (true) | IOH | |
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 |
|---|---|---|---|---|---|---|---|---|---|
| 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 LLC | |||||||||
| 1601 N MADISON AVENUE SUITE 300 | ANDERSON | IN | 46011 | 611464136 | HLTH CARE | IN | N/A | false | false |
| 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 SOUTH 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 S LAFOUNTAIN STREET | KOKOMO | IN | 46902 | IN | |||||
| PILLARS COMMUNITY HOUSING INC | |||||||||||||
| 161652666 | HOUSING | N/A | Yes (true) | 3500 S LAFOUNTAIN STREET | KOKOMO | IN | 46902 | IN | |||||
| VISIONARY ENTERPRISES INC | |||||||||||||
| 351538433 | MGMT 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 | |||||||||||||
| 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 | false | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | Yes (true) | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (true) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | false | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | false | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | false | DivRelatedOrganizationInd |
| Asset Sale To Other Org | false | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | false | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | false | AssetExchangeInd |
| Rental Of Facilities To Oth Org | false | 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 | false | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | Yes (true) | TransferToOtherOrgInd |
| Transfer From Other Org | Yes (true) | TransferFromOtherOrgInd |
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