2013-11-13T13:10:24-06:00 2012-12-31 CASKEY & DAILY PC 4745 STATESMEN DRIVE SUITE C INDIANAPOLIS IN 46250 990 2012-01-01 351088640 COMMUNITY HOSPITAL SOUTH INC COMM 3173555822 1402 E COUNTY LINE ROAD SOUTH INDIANAPOLIS IN 46227 JEFFERY KIRKHAM 3173555822 2013-10-31 true JAMES A CASKEY CPA CFP 3175852647 2013-11-13 2012 2016-03-07 17:11:31Z THOMAS P FISCHER 7330 SHADELAND STATION SUITE 200 INDIANAPOLIS IN 46256 174521269 false X WWW.ECOMMUNITY.COM X 1989 IN COMMUNITY HOSPITAL SOUTH,INC. ("CHS") IS A 501(C)(3) CORPORATION SERVING THE HEALTH RELATED NEEDS OF THE CITIZENS OF THE INDIANAPOLIS METROPOLITAN AREA AND CENTRAL INDIANA. CHS OPERATES A GENERAL ACUTE CARE HOSPITAL AND PROVIDES INPATIENT, OUTPATIENT, EMERGENCY AND AMBULATORY HEALTH CARE SERVICES TO ALL PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. 14 11 1016 188 0 65077 33707 152973513 169858075 15764 6498555 4609561 159537145 174517107 0 0 52901211 61207331 0 0 83592561 90239766 136493772 151447097 23043373 23070010 206686035 230047350 5148369 5439674 201537666 224607676 X COMMUNITY HOSPITAL SOUTH,INC. ("CHS") IS A 501(C)(3) CORPORATION SERVING THE HEALTH RELATED NEEDS OF THE CITIZENS OF THE INDIANAPOLIS METROPOLITAN AREA AND CENTRAL INDIANA. CHS OPERATES A GENERAL ACUTE CARE HOSPITAL AND PROVIDES INPATIENT, OUTPATIENT, EMERGENCY AND AMBULATORY HEALTH CARE SERVICES TO ALL PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. false false 103224845 169858075 COMMUNITY HOSPITAL SOUTH ("CHS") IS AN ACUTE CARE HOSPITAL IN INDIANAPOLIS, INDIANA WITH 150 LICENSED BEDS. IN 2012, CHS SERVED 8,356 INPATIENTS FOR A TOTAL OF 29,154 INPATIENT DAYS OF SERVICE. CHS ALSO PROVIDED 116,989 OUTPATIENT VISITS, WHICH EXCLUDED 41,429 EMERGENCY VISITS. COMMUNITY HOSPITAL SOUTH OFFERS MANY PATIENT FOCUSED HEALTHCARE SERVICES THAT INCLUDE WOMEN AND CHILDREN SERVICES, PEDIATRICS, ONCOLOGY, NEUROSCIENCES, ORTHOPEDICS, JOINT REPLACEMENT, BREAST CARE SERVICES, SURGERY SERVICES, REHABILITATION SERVICES, HEALTH PROMOTION SERVICES, AND EMERGENCY SERVICES. 103224845 true true false false false false false false false false true false false true true false false true false false false false false false false false true true false false true false false false false false false false true false false false false false true true true false false true X 0 0 true 1016 true false false false false false false false false false false X 14 11 true true true false true true true true true false false false true true true true true true true false IN X JEFFERY KIRKHAM 3173555822 1500 N RITTER AVENUE INDIANAPOLIS IN 46219 BRYAN A MILLS 2.00 55.00 X 0 1113224 178029 HANY HADDAD MD 2.00 40.00 X 0 619485 139495 KENNETH SHAVER MD 2.00 40.00 X 0 274586 54259 KATHRYN G BETLEY 2.00 X X 0 0 0 DENNIS CARROLL 2.00 X 0 0 0 CAREY LIKENS 2.00 X 0 0 0 JAMES MOREY 2.00 X 0 0 0 JEFFREY MOSSLER MD 2.00 X 0 0 0 MICHAEL PETERSON 2.00 X X 0 0 0 STEVEN PLUMP 2.00 X 0 0 0 YVONNEE SHAHEEN 2.00 X X 0 0 0 KRISTEN SHERMAN 2.00 X X 0 0 0 RUSSELL SWAN JR 2.00 X 0 0 0 RONALD THIEME 2.00 X 0 0 0 MICHAEL C BLANCHET 50.00 X 0 691026 894883 ANTHONY LENNEN 50.00 X 415693 0 84884 JEFFERY KIRKHAM 55.00 X 0 373872 420954 SHERYL KING MD 45.00 X 424591 0 64665 RANDALL LEE MD 45.00 X 351348 0 15000 KERRY SAWIN 45.00 X 206736 0 155657 JOSHUA SALYER DO 45.00 X 205763 0 24724 MARTY HENDERSON CRNA 45.00 X 199108 0 17338 1803239 3072193 2049888 34 false true false MID AMERICA CLINICAL LABS 2560 NORTH SHADELAND AVENUE INDIANAPOLIS IN 46219 LAB SERVICES 3370262 INPATIENT SERVICES OF INDIANA 7032 COLLECTION CENTER DRIVE CHICAGO IL 60693 HOSPITALISTS 2160741 ROLLINS CONSTRUCTION CO LLC 3024 N RIDGEVIEW DRIVE INDIANAPOLIS IN 46226 CONSTRUCTION 1689545 BSA LIFESTRUCTURES INC PO BOX 6069 INDIANAPOLIS IN 462066069 ARCHITECTURAL 847697 ARAMARK 25271 NETWORK PLACE CHICAGO IL 606731252 DIETARY MGMT 515861 69 33707 33707 PATIENT REVENUE 622110 169858075 169858075 169858075 19401 19401 525 4162 -3637 -3637 -3637 LEASED EQUIPMENT 532420 2345395 2345395 EHR INCENTIVE PAYMENTS 900099 675466 675466 EQUITY INVESTMENT INCOME 900003 606809 606809 981891 981891 4609561 174517107 174463999 19401 X 500577 500577 45002077 37146688 7855389 2162593 743534 1419059 10382982 8476283 1906699 3159102 2513008 646094 34545823 10450141 24095682 1195 312 883 4465342 4219926 245416 664122 234731 429391 2237986 1827009 410977 63092 32049 31043 14700 5408 9292 3739852 3739852 10034096 4142108 5891988 10372 10372 MEDICAL SUPPLIES 25601112 24631063 970049 HAF PROGRAM FEES 8777264 8777264 DUES & SUBSCRIPTIONS 61957 17243 44714 SECURITY EQUIPM & EXP 17290 6111 11179 5563 1967 3596 151447097 103224845 48222252 0 2425 2725 24399806 26158334 2632225 2648271 221639359 92693639 130633171 128945720 49018408 72292300 206686035 230047350 5148369 4897728 541946 5148369 5439674 X 201537666 224607676 201537666 224607676 206686035 230047350 23070010 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 497000 497000 158111510 35455294 122656216 1534316 689652 844664 58735655 54845461 3890194 2760878 1703232 1057646 128945720 DUE FROM AFFLIATED ENTITIES 72292300 THIRD PARTY SETTLEMENTS 72292300 THIRD PARTY SETTLEMENT 541946 541946 true true true X true X true true true false true true 9643 6132347 6132347 0.04050 12775 21729801 14419704 7310097 0.04830 22418 27862148 14419704 13442444 0.08880 5 790731 8011 782720 0.00520 2 618489 147355 471134 0.00310 1 330659 330659 0.00220 8 1739879 155366 1584513 0.01050 8 22418 29602027 14575070 15026957 0.09920 true 2671422 35899942 43094517 -7194575 X true true NONE 1 1 COMMUNITY HOSPITAL SOUTH

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REHABILITATION CENTER FOR WOMEN'S HEALTH

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HEALTH CARE RELATED ORGANIZATION INFORMATION PART I LINE 6A A COMMUNITY BENEFIT REPORT IS COMPLETED FOR THE COMMUNITY HEALTH NETWORK AS A WHOLE COMMUNITY HOSPITAL SOUTH INC IS INCLUDED WITHIN THE NETWORK COMMUNITY BENEFIT REPORT COSTING METHODOLOGY EXPLANATION PART I LINE 7 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 BAD DEBT EXPENSE EXPLANATION PART III LINE 4 THE COST TO CHARGE RATIO UTILIZED FOR PURPOSES OF REPORTING BAD DEBT COSTS WAS DERIVED FROM WORKSHEET 2 AND IS BASED ON THE ORGANIZATIONS AUDITED FINANCIAL STATEMENTS COMMUNITY HOSPITAL SOUTH 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 NETWORK POLICY PART III LINE 4 BAD DEBT EXPENSE EXPLANATION THE AUDITED FINANCIAL STATEMENTS CONTAIN THE FOLLOWING TEXT WITHIN THE FOOTNOTES TO DESCRIBE BAD DEBT EXPENSE THE NETWORKS 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 PROVISION FOR BAD DEBTS AND PROVISION FOR CHARITY MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYOR SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS 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 SELFPAY PATIENTS INCLUDING PATIENT DEDUCTIBLES AND COINSURANCE 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 CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS FOR CHNW CHS VEI AND CHVH ACCOUNTS THAT ARE SENT TO COLLECTION COMPANIES THE ACCOUNTS 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 THIS COMPONENT OF THE ACCOUNTS RECEIVABLE THE NETWORK RECOGNIZES PATIENT SERVICE REVENUE ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRDPARTY 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 NETWORKS 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 DISCOUNTS AND CHARITY ALLOWANCES RECOGNIZED IN THE PERIOD FROM THESE MAJOR PAYOR SOURCES IS AS FOLLOWS FOR THE YEARS ENDED DECEMBER 31 2012 AND 2011 RESPECTIVELY THIRD PARTY PAYORS SELFPAY TOTAL ALL PAYORS 2012 PATIENT SERVICE REVENUENET OF CONTRACTUAL ALLOWANCES AND DISCOUNTS 1580962 73759 1654721 2011 PATIENT SERVICE REVENUENET OF CONTRACTUAL ALLOWANCES AND DISCOUNTS 1276969 55994 1332963 BEGINNING JUNE 2012 THE STATE OF INDIANA BEGAN OFFERING VOLUNTARY PARTICIPATION IN THE STATE OF INDIANAS HOSPITAL ASSESSMENT FEE HAF PROGRAM THE OFFICE OF MEDICAID PLANNING AND POLICY DEEMED THE PROGRAM TO BE EFFECTIVE RETROACTIVE TO JULY 1 2011 THE HAF PROGRAM RUNS ON AN ANNUAL CYCLE FROM JULY 1 TO JUNE 30 AND IS EFFECTIVE UNTIL JUNE 30 2013 WITH OPTIONS TO RENEW THE PROGRAM THE STATE OF INDIANA IMPLEMENTED THIS PROGRAM TO UTILIZE SUPPLEMENTAL REIMBURSEMENT PROGRAMS FOR THE PURPOSE OF PROVIDING REIMBURSEMENT TO PROVIDERS TO OFFSET A PORTION OF THE COST OF PROVIDING CARE TO MEDICAID AND INDIGENT PATIENTS THIS PROGRAM IS DESIGNED WITH INPUT FROM CENTERS FOR MEDICARE AND MEDICAID SERVICES AND IS FUNDED WITH A COMBINATION OF STATE AND FEDERAL RESOURCES INCLUDING FEES OR TAXES LEVIED ON THE PROVIDERS THE NETWORK RECOGNIZES REVENUES AND RELATED EXPENSES ASSOCIATED WITH THE HAF PROGRAM IN THE PERIOD IN WHICH AMOUNTS ARE ESTIMABLE AND COLLECTION IS REASONABLY ASSURED REIMBURSEMENT UNDER THE PROGRAM IS REFLECTED AS CONTRA CONTRACTUAL ALLOWANCES 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 AS A RESULT OF PARTICIPATING IN THE PROGRAM THE NETWORK RECOGNIZED IN 2012 HAF RETROACTIVE REIMBURSEMENTS OF 78197000 AND PAID RETROACTIVE FEES OF 43453000 RELATED TO THE PERIOD JULY 1 2011 THROUGH JUNE 30 2012 ON AN ONGOING BASIS THE FEES AND REIMBURSEMENTS ARE SETTLED MONTHLY 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 WRITTENOFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS AFTER EXHAUSTING COLLECTION EFFORTS ANY SUBSEQUENT RECOVERIES ARE RECORDED AGAINST THE PROVISION FOR BAD DEBTS THE NETWORK MAINTAINS RECORDS TO IDENTIFY AND MONITOR THE LEVEL OF CHARITY CARE IT PROVIDES THE NETWORK PROVIDES 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 YEARS 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 INCLUDES THE AMOUNT OF COSTS INCURRED FOR SERVICES AND SUPPLIES FURNISHED UNDER THE CHARITY CARE POLICY AND WAS 58163000 AND 26939000 FOR THE YEARS ENDED DECEMBER 31 2012 AND 2011 RESPECTIVELY CHARITY CARE COST WAS ESTIMATED ON THE APPLICATION OF THE ASSOCIATED COSTTOCHARGE RATIOS MEDICARE EXPLANATION PART III LINE 8 PER THE 990 INSTRUCTIONS THE MEDICARE COST REPORT WAS UTILIZED TO DETERMINE THE MEDICARE SHORTFALL HOWEVER THE MEDICARE COST REPORT IS NOT REFLECTIVE OF ALL COSTS ASSOCIATED WITH MEDICARE PROGRAMS SUCH AS PHYSICIAN SERVICES AND SERVICES BILLED VIA FREE STANDING CLINICS FURTHER THE MEDICARE COST REPORT EXCLUDES REVENUES AND COSTS OF MEDICARE PART C AND D THE MEDICARE SHORTFALL ATTRIBUTED TO THOSE AREAS NOT INCLUDED ON THE MEDICARE COST REPORT IS 4459065 AS SUCH THE TOTAL MEDICARE SHORTFALL FOR ALL MEDICARE PROGRAMS IS 11653640 MEDICARE SHORTFALLS SHOULD BE CONSIDERED AS COMMUNITY BENEFIT BECAUSE MEDICARE REPRESENTS 4408 OF THE OVERALL PAYER MIX FOR COMMUNITY HOSPITAL SOUTH INC COLLECTION PRACTICES EXPLANATION PART III LINE 9B SEE ATTACHED FINANCIAL ASSISTANCE POLICY ADDITIONAL INFORMATION PART VI PART VI ITEMS 2 THROUGH 5 ARE DISCUSSED WITHIN THE ATTACHED COMMUNITY BENEFIT REPORT FOR A COPY OF THIS REPORT PLEASE CONTACT HOLLY MILLARD AT 317 3555860 PART VI ITEM 6 AFFILIATED HEALTH CARE SYSTEM COMMUNITY HOSPITAL SOUTH INC CHS IS PART OF AN AFFILIATED HEALTH CARE SYSTEM SEE THE ATTACHED IRS 990 SCHEDULE H SUPPLEMENTAL INFORMATION REPORT FOR HOW CHS IS INVOLVED IN PROMOTING THE HEALTH OF THE COMMUNITY IT SERVES PART VI ITEM 7 STATE FILING OF COMMUNITY BENEFIT REPORT INDIANA COMMUNITY HOSPITAL SOUTH LINE NUMBER 1 PART V LINE 3 PART V LINE 3 SEE ATTACHED IRS 990 SCHEDULE H SUPPLEMENTAL INFORMATION REPORT COMMUNITY HOSPITAL SOUTH LINE NUMBER 1 PART V LINE 4 PART V LINE 4 SEE ATTACHED IRS 990 SCHEDULE H SUPPLEMENTAL INFORMATION REPORT COMMUNITY HOSPITAL SOUTH LINE NUMBER 1 PART V LINE 5C PART V LINE 5C SEE ATTACHED IRS 990 SCHEDULE H SUPPLEMENTAL INFORMATION REPORT COMMUNITY HOSPITAL SOUTH LINE NUMBER 1 PART V LINE 7 PART V LINE 7 SEE ATTACHED IRS 990 SCHEDULE H SUPPLEMENTAL INFORMATION REPORT COMMUNITY HOSPITAL SOUTH LINE NUMBER 1 PART V LINE 12H PART V LINE 12H SEE ATTACHED IRS 990 SCHEDULE H SUPPLEMENTAL INFORMATION REPORT COMMUNITY HOSPITAL SOUTH LINE NUMBER 1 PART V LINE 14G PART V LINE 14G THE POLICY IS REFERENCED ON THE BILL COMMUNITY HOSPITAL SOUTH LINE NUMBER 1 PART V LINE 20D PART V LINE 20D THE UNINSURED DISCOUNT WAS DETERMINED UTILIZING THE NETWORKS TOP COMMERICIAL PAYORS UNINSURED DISCOUNTS REPRESENT A STANDARD DISCOUNT ON CHARGES AS IT RELATES TO PATIENTS WHO HAVE NO INSURANCE COVERAGE false true false false false false false true false BRYAN A MILLS 821612 272000 19612 148211 29818 1291253 264000 HANY HADDAD MD 516047 101250 2188 115000 24495 758980 101250 KENNETH SHAVER MD 193480 81106 35212 19047 328845 MICHAEL C BLANCHET 520592 167825 2609 885389 9494 1585909 161700 ANTHONY LENNEN 335327 78516 1850 55752 29132 500577 78516 JEFFERY KIRKHAM 295857 76444 1571 394162 26792 794826 70875 SHERYL KING MD 303536 16442 104613 37500 27165 489256 20000 RANDALL LEE MD 285224 64550 1574 15000 366348 68985 KERRY SAWIN 181081 24628 1027 132749 22908 362393 JOSHUA SALYER DO 196924 7750 1089 15596 9128 230487 MARTY HENDERSON CRNA 197688 600 820 17338 216446 OTHER ADDITIONAL INFORMATION SCHEDULE J, PART III PART I, LINE 3 - RELATED ORG METHODS USED FOR COMPENSATION EXPLANATION COMMUNITY HOSPITAL SOUTH, INC. ("CHS") CEO/EXECUTIVE DIRECTOR IS PAID BY COMMUNITY HEALTH NETWORK, INC. ("CHNW"), A RELATED 501(C)(3) ORGANIZATION. CHNW USES THE FOLLOWING IN DETERMINING THE CEO'S COMPENSATION: 1) COMPENSATION COMMITTEE, 2) INDEPENDENT COMPENSATION CONSULTANT, 3) COMPENSATION SURVEY OR STUDY, AND 4) APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. PART III - OTHER ADDITIONAL INFORMATION PART I, LINE 4B - SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN BRYAN A. MILLS PARTICIPATED IN A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN THROUGH HIS EMPLOYER, CHNW. DURING 2012, MR. MILLS DID NOT RECEIVE A PAYMENT FROM SUCH PLAN. PART I, LINE 7 - NON-FIXED PAYMENTS PROVIDED DR. SHERYL KING AND DR. JOSHUA SALYER ARE ELIGIBLE TO PARTICIPATE IN AN INCENTIVE COMPENSATION PLAN AS OUTLINED IN THEIR EMPLOYMENT AGREEMENTS WITH CHNW. CHNW IS A TAX-EXEMPT ORGANIZATION AND IT DEVELOPED THE COMPENSATION PLAN IN CONJUNCTION WITH AN INDEPENDENT COMPENSATION CONSULTANT. COMMUNITY HOSPITAL SOUTH, INC., PARTICIPATES IN THE NETWORK'S SENIOR LEADERSHIP INCENTIVE PROGRAM. CERTAIN INDIVIDUALS OF THE LEADERSHIP TEAM PARTICIPATE IN THIS PROGRAM. THE PROGRAM WAS ADOPTED BY THE EXECUTIVE COMPENSATION COMMITTEE, AND IS INTENDED TO INFLUENCE OUTSTANDING PERFORMANCE BY THE SENIOR LEADERS, AS MEASURED AGAINST BOTH ORGANIZATIONAL AND INDIVIDUAL PERFORMANCE. THE PROGRAM IS REVIEWED ANNUALLY BY THE EXECUTIVE COMPENSATION COMMITTEE, WHICH IS COMPOSED ENTIRELY OF INDEPENDENT COMMUNITY MEMBERS. THE INCENTIVE COMPENSATION THAT IS AWARDED IS INCLUDED IN TOTAL COMPENSATION TO THE EXECUTIVE. THE TOTAL COMPENSATION (INCLUDING ANY PAYMENTS UNDER THE PROGRAM) IS SUBJECT TO THE REVIEW AND APPROVAL OF THE EXECUTIVE COMPENSATION COMMITTEE AND INDEPENDENT COMPENSATION CONSULTANT, IN CONSIDERATION OF CODE SECTION 4958 (AND THE CORRESPONDING TREASURY REGULATIONS) TO ENSURE THAT IT REFLECTS ARMS LENGTH, FAIR MARKET TERMS. VISIONARY ENTERPRISES INC SHARE BD MEMBER 3368323 HEALTH & PHARM PLANS false ORGANIZATION'S MISSION FORM 990 - ORGANIZATION'S MISSION COMMUNITY HOSPITAL SOUTH,INC. ("CHS") IS A 501(C)(3) CORPORATION SERVING THE HEALTH RELATED NEEDS OF THE CITIZENS OF THE INDIANAPOLIS METROPOLITAN AREA AND CENTRAL INDIANA. CHS OPERATES A GENERAL ACUTE CARE HOSPITAL AND PROVIDES INPATIENT, OUTPATIENT, EMERGENCY AND AMBULATORY HEALTH CARE SERVICES TO ALL PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. ADDITIONAL INFORMATION FORM 990 FORM 990, PART I, LINE 4 - INDEPENDENT VOTING MEMBERS COMMUNITY HOSPITAL SOUTH, INC. ("CHS") IS AN AFFILIATE OF COMMUNITY HEALTH NETWORK ("THE NETWORK"), AN INTEGRATED HEALTH DELIVERY SYSTEM. CHS IS CONTROLLED BY ITS PARENT, COMMUNITY HEALTH NETWORK, INC ("CHNW"), THE TAX- EXEMPT PARENT OF THE INTEGRATED HEALTH DELIVERY SYSTEM. CHS' ARTICLES OF INCORPORATION AND BYLAWS WERE AMENDED EFFECTIVE 12/31/11 TO DESIGNATE THE MEMBERS OF THE BOARD OF DIRECTORS OF CHNW TO BE THE DIRECTORS OF CHS. CHNW EXERCISES CONTROL OVER CHS THROUGH A SERIES OF GOVERANCE RIGHTS: A) CHNW IS THE SOLE MEMBER OF CHS; B) CHS HAS DELEGATED EXCLUSIVE AUTHORITY TO CHNW, ACTING THROUGH CHNW'S BOARD OF DIRECTORS, IN THE FOLLOWING SUBSTANTIVE AREAS: STRATEGIC PLANNING; CAPITAL ACCESS, BUDGETING AND ALLOCATION; AUDIT AND COMPLIANCE; EXECUTIVE COMPENSATION; AND DISPUTE RESOLUTION; C) CHNW MUST APPROVE ANY MODIFICATION, REPEAL, AMENDMENT, OR RESTATEMENT OF CHS' ARTICLES OF INCORPORATION; AND D) CHNW MUST APPROVE ANY SALE OR DISPOSITION OF SUBSTANTIALLY ALL OF THE ASSETS OF CHS. WITH REGARD TO EXECUTIVE COMPENSATION, CHNW HAS DELEGATED AUTHORITY TO REVIEW AND APPROVE EXECUTIVE COMPENSATION, INCLUDING CHS' EXECUTIVES, TO A NETWORK EXECUTIVE COMPENSATION COMMITTEE COMPOSED OF INDEPENDENT OUTSIDE DIRECTORS. IN SUM, CHS HAS REMOVED ANY RISK OF INAPPROPRIATE RELATED PARTY TRANSACTIONS BY DELEGATING (THROUGH CHNW) ITS EXECUTIVE COMPENSATION DECISIONS TO A NETWORK EXECUTIVE COMPENSATION COMMITTEE AND ITS CONFLICT OF INTEREST DECISIONS TO A NETWORK AUDIT COMMITTEE, WITH EACH COMMITTEE COMPOSED OF INDEPENDENT OUTSIDE DIRECTORS. FORM 990, PART I, LINE 5 - NUMBER OF EMPLOYEES CHS EMPLOYEES ARE LEASED FROM COMMUNITY HEALTH NETWORK, INC. ADDITIONAL INFORMATION FORM 990, PART V FORM 99, PART V, LINE 1A - BOX 3 OF FORM 1096 FORM 1099S WERE PROCESSED UNDER THE NAME AND FEDERAL IDENTIFICATION NUMBER OF COMMUNITY HEALTH NETWORK, INC. ADDITIONAL INFORMATION FORM 990, PART VI FORM 990, PART VI, LINE 1B - VOTING MEMBERS THAT ARE INDEPENDENT SEE FORM 990, PART I, LINE 4 REFERENCE ON SCHEDULE O ABOVE FORM 990, PART VI, LINE 2 - RELATED PARTY INFORMATION AMONG OFFICERS MANY OF CHS' DIRECTORS, OFFICERS, AND KEY EMPLOYEES SERVE IN AN EXECUTIVE ROLE FOR OTHER TAX-EXEMPT AND TAXABLE AFFILIATES THROUGHOUT THE NETWORK. ALL CHS' DIRECTORS AND/OR OFFICERS ALSO SERVE AS DIRECTORS AND/OR OFFICERS OF COMMUNITY HEALTH NETWORK, INC., COMMUNITY HOME HEALTH SERVICES, INC., AND INDIANA HEART HOSPITAL, LLC. IN ADDITION, THE FOLLOWING DIRECTORS SERVE AS DIRECTORS OF THE FOLLOWING ORGANIZATIONS: DENNIS CARROLL - COMMUNITY HOSPITAL OF ANDERSON AND MADISON COUNTY, INC. BRYAN MILLS - COMMUNITY HEALTH NETWORK FOUNDATION, INC. - COMMUNITY HEALTH SERVICES OF INDIANA, INC. - COMMUNITY HOSPITAL OF ANDERSON AND MADISON COUNTY, INC. - COMMUNITY PHYSICIANS OF INDIANA, INC. - COMMUNITY WESTVIEW HOSPITAL, INC. - VISIONARY ENTERPRISES, INC. JEFFREY A. MOSSLER, M.D. - COMMUNITY PHYSICIANS OF INDIANA, INC. - VISIONARY ENTERPRISES, INC. STEVEN PLUMP - COMMUNITY PHYSICIANS OF INDIANA, INC. MANAGEMENT DELEGATED FORM 990, PAGE 6, PART VI, LINE 3 CHS HAS DELEGATED EXCLUSIVE AUTHORITY TO CHNW, ACTING THROUGH CHNW'S BOARD OF DIRECTORS, IN THE FOLLOWING SUBSTANTIVE AREAS: STRATEGIC PLANNING, CAPITAL ACCESS, BUDGETING AND ALLOCATION; AUDIT AND COMPLIANCE; EXECUTIVE COMPENSATION; AND DISPUTE RESOLUTION. SIGNIFICANT CHANGES TO ORGANIZATIONAL DOCUMENTS FORM 990, PAGE 6, PART VI, LINE 4 THE ARTICLES OF INCORPORATION AND BYLAWS WERE AMENDED EFFECTIVE 12/31/11 TO DESIGNATE THE MEMBERS OF THE BOARD OF DIRECTORS OF CHNW TO BE THE DIRECTORS OF CHS. CLASSES OF MEMBERS OR STOCKHOLDERS FORM 990, PAGE 6, PART VI, LINE 6 SEE FORM 990, PART I, LINE 4 REFERENCE ON SCHEDULE O ABOVE ELECTION OF MEMBERS AND THEIR RIGHTS FORM 990, PAGE 6, PART VI, LINE 7A SEE FORM 990, PART I, LINE 4 REFERENCE ON SCHEDULE O ABOVE DECISIONS SUBJECT TO APPROVAL OF MEMBERS FORM 990, PAGE 6, PART VI, LINE 7B SEE FORM 990, PART I, LINE 4 REFERENCE ON SCHEDULE O ABOVE ORGANIZATION'S PROCESS USED TO REVIEW FORM 990 FORM 990, PAGE 6, PART VI, LINE 11B AS DISCUSSED IN PART I, LINE 4, CHNW HAS ASSUMED RESPONSIBILITY FOR CHS' AUDIT, COMPLIANCE, AND EXECUTIVE COMPENSATION MATTERS. CHNW'S BOARD OF DIRECTORS HAS DELEGATED AUTHORITY FOR THE REVIEW OF CHS' FORM 990 TO TWO COMMITTEES COMPOSED OF INDEPENDENT OUTSIDE DIRECTORS: A) THE NETWORK EXECUTIVE COMPENSATION COMMITTEE REVIEWED THE COMPENSATION ASPECTS OF CHS' FORM 990, AND B) THE NETWORK FINANCE COMMITTEE REVIEWED THE REMAINDER OF THE CHS' FORM 990. IN ADDITION, CHS' OUTSIDE ACCOUNTING FIRM AND LAW FIRM REVIEWED THE FORM 990 PRIOR TO FILING. CHS AND CHNW UTILIZED THIS PROCESS TO ENSURE THAT CHS' FORM 990 RECEIVED SUBSTANTIVE REVIEW BY DIRECTORS AND PROFESSIONALS WITH SPECIFIC KNOWLEDGE OF CHS' ACTIVITIES AND EXTENSIVE FINANCIAL, ACCOUNTING, AND TAX EXPERTISE. ENFORCEMENT OF CONFLICTS POLICY FORM 990, PAGE 6, PART VI, LINE 12C AS DISCUSSED IN PART I, LINE 4, CHNW HAS ASSUMED RESPONSIBILITY FOR CHS' AUDIT AND COMPLIANCE MATTERS. CHNW HAS ADOPTED A CONFLICT OF INTEREST POLICY THAT APPLIES TO CHS. THE CONFLICT OF INTEREST POLICY REQUIRES DIRECTORS, OFFICERS, AND KEY EMPLOYEES TO SUBMIT AN ANNUAL CONFLICT OF INTEREST DISCLOSURE. THE ANNUAL DISCLOSURE REQUIRES DIRECTORS, OFFICERS, AND KEY EMPLOYEES TO DISCLOSE, IN WRITING, ANY KNOWN FINANCIAL INTEREST THAT THE INDIVIDUAL (TOGETHER WITH FAMILY MEMBERS) HAS IN ANY BUSINESS ENTITY THAT TRANSACTS BUSINESS WITH CHS. IN ADDITION, DIRECTORS, OFFICERS, AND KEY EMPLOYEES ARE REQUIRED TO IMMEDIATELY DISCLOSE ANY POSSIBLE CONFLICT OF INTEREST THAT ARISES MID-YEAR IN RELATION TO A PROPOSED TRANSACTION. THE CONFLICT OF INTEREST POLICY REQUIRES THAT ANY INDIVIDUAL WITH A CONFLICT BE RECUSED FROM THE DECISION MAKING PROCESS, THAT INDEPENDENT DIRECTORS OR COMMITTEE MEMBERS DETERMINE THAT THE PROPOSED TRANSACTION IS IN THE BEST INTEREST OF CHS, AND THE TRANSACTION MUST BE APPROVED BY A VOTE OF INDEPENDENT DIRECTORS OR COMMITTEE MEMBERS WITHOUT THE PARTICIPATION OF ANY INTERESTED INDIVIDUAL. THE ANNUAL CONFLICT DISCLOSURE STATEMENTS ARE SUBMITTED TO, AND REVIEWED BY, CHNW'S AUDIT COMMITTEE, COMPOSED OF INDEPENDENT DIRECTORS. IN ADDITION, THE EXECUTIVE STAFF AND GENERAL COUNSEL OF THE NETWORK ARE RESPONSIBLE FOR MONITORING ANY POSSIBLE CONFLICT TRANSACTIONS THAT ARISE AND MANAGING THEM TO ENSURE THAT ALL TRANSACTIONS REPRESENT ARMS LENGTH, FAIR MARKET VALUE TERMS FOR THE BENEFIT OF CHS. COMPENSATION PROCESS FOR TOP OFFICIAL FORM 990, PAGE 6, PART VI, LINE 15A AS DISCUSSED IN PART I, LINE 4, CHNW HAS ASSUMED RESPONSIBILITY FOR CHS' EXECUTIVE COMPENSATION MATTERS. CHNW HAS ADOPTED AN EXECUTIVE COMPENSATION AND INTERMEDIATE SANCTIONS POLICY THAT APPLIES TO CHS. THE PURPOSE OF THE POLICY IS TO ENSURE THAT CHS' COMPENSATION ARRANGEMENTS WITH RELATED PARTIES ARE EVALUATED AND ENTERED AT ARMS LENGTH AND THAT ANY COMPENSATION THAT IS PAID TO A RELATED PARTY IS REASONABLE AND REFLECTS FAIR MARKET VALUE. THIS POLICY ENCOURAGES THE APPLICATION OF THE REBUTTABLE PRESUMPTION STANDARD OF CODE SECTION 4958 AND THE RELATED TREASURY REGULATIONS BY: A) EXCLUDING ANY INTERESTED PARTY FROM THE DECISION MAKING PROCESS, B) REQUIRING DISINTERESTED BOARD OR COMMITTEE MEMBERS TO OBTAIN AND RELY UPON COMPARABILITY DATA WHEN SETTING THE PROPOSED COMPENSATION TERMS, C) REQUIRING APPROVAL OF THE TRANSACTION IN ADVANCE BY DISINTERESTED DIRECTORS OR COMMITTEE MEMBERS, AND D) REQUIRING CONTEMPORANEOUS DOCUMENTATION (I.E. MINUTES) REFLECTING THE DECISION AND THE PROCESS BY WHICH IT WAS MADE. CHNW ALSO DELEGATED AUTHORITY REGARDING CHS' EXECUTIVE COMPENSATION TO A) THE NETWORK EXECUTIVE COMPENSATION COMMITTEE, COMPOSED OF INDEPENDENT OUTSIDE DIRECTORS, WHICH IS RESPONSIBLE FOR APPLYING THE TERMS AND PROCESS OF THE EXECUTIVE COMPENSATION AND INTERMEDIATE SANCTIONS POLICY AS OUTLINED ABOVE, AND B) THE NETWORK VICE PRESIDENT OF HUMAN RESOURCES WHO IS RESPONSIBLE FOR OBTAINING COMPARATIVE SALARY MARKET DATA FOR THE CHIEF EXECUTIVE OFFICER, OFFICERS, AND KEY EMPLOYEES, PERIODICALLY ENGAGING AN INDEPENDENT COMPENSATION CONSULTANT TO ESTABLISH REASONABLE COMPENSATION, AND PROVIDING STAFF SUPPORT TO THE NETWORK EXECUTIVE COMPENSATION COMMITTEE. DURING 2012, THE NETWORK EXECUTIVE COMPENSATION COMMITTEE FOLLOWED THIS PROCESS FOR ALL SENIOR EXECUTIVE LEADERS. FOR ALL POSITIONS REPRESENTING MANAGERS, CHIEF EXECUTIVE OFFICERS, CHIEF FINANCIAL OFFICERS, AND HUMAN RESOURCES REPRESENTATIVES FOR ALL NETWORK ENTITIES SALARIES WERE COMPARED AGAINST COMPARATIVE SALARY MARKET DATA. COMPENSATION PROCESS FOR OFFICERS FORM 990, PAGE 6, PART VI, LINE 15B SEE LINE 15A ABOVE GOVERNING DOCUMENTS DISCLOSURE EXPLANATION 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) AS AN AFFILIATE OF CHNW, CHS HAS ADOPTED THE NETWORK CONFLICT OF INTEREST POLICY. WHILE THIS POLICY IS NOT AVAILABLE TO THE PUBLIC, THE NETWORK'S DEFINITION OF CONFLICT OF INTEREST AND HOW TO REPORT SUCH AN INCIDENT IS DESCRIBED IN THE NETWORK RESPONSIBILITY AND COMPLIANCE PROGRAM ("NRCP") MANUAL WHICH IS POSTED ON THE NETWORK'S WEBSITE, ECOMMUNITY.COM. THIS MANUAL IS AVAILABLE FOR THE PUBLIC TO REVIEW. C) CHS DOES NOT HAVE INDIVIDUALLY AUDITED FINANCIAL STATEMENTS. ITS FINANCIAL RESULTS ARE INCLUDED IN THE CONSOLIDATED FINANCIAL STATEMENTS OF CHNW AND AFFILIATES. AS SUCH, THERE ARE NO INDIVIDUAL FINANCIAL STATEMENTS TO POST. CHS DOES FILE THE 990 TAX RETURN ON AN ANNUAL BASIS WHICH IS AVAILABLE UPON REQUEST AND/OR AVAILABLE ON A DELAYED BASIS ON GUIDESTAR.COM. D) COMMUNITY HEALTH NETWORK, INC. AND AFFILIATES PROVIDE ANY DOCUMENT OPEN TO PUBLIC INSPECTION UPON REQUEST. OTHER FEES FOR SERVICES FORM 990, PART IX, LINE 11G PROFESSIONAL MEDICAL FEES 2,478,259 1,497,439 0 PURCHASED SERVICES 7,971,882 22,598,243 0 COMMUNITY HEALTH NETWORK INC 7330 SHADELAND STATION SUITE 200 INDIANAPOLIS IN 46256 350983617 HOSP IN 501C3 3 NA false COMMUNITY HEALTH NETWORK FOUNDATION 7240 SHADELAND STATION SUITE 125 INDIANAPOLIS IN 46256 510181688 SUPPORT IN 501C3 11B CHNW true COMMUNITY HLTH SERVICES OF INDIANA 7330 SHADELAND STATION SUITE 200 INDIANAPOLIS IN 46256 454817436 HLTH CARE IN 501C3 3 CHNW true COMMUNITY HOME HEALTH SERVICES INC 9894 EAST 121ST STREET FISHERS IN 46037 350953467 HLTH CARE IN 501C3 9 CHNW true COMM HOSP OF ANDERSON & MADISON CTY 1515 NORTH MADISON AVENUE ANDERSON IN 46011 351069822 HOSPITAL IN 501C3 3 CHNW true COMMUNITY HOSP ANDERSON FDN INC 1515 NORTH MADISON AVENUE ANDERSON IN 46011 861053152 SUPPORT IN 501C3 7 CHA true COMMUNITY HOWARD REGIONAL HEALTH 3500 S LAFOUNTAIN STREET KOKOMO IN 46902 351865344 IMAG/HOSP IN 501C3 9 CHNW true COMMUNITY 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