2013-11-13T13:05:21-06:00 2012-12-31 CASKEY & DAILY PC 4745 STATESMEN DRIVE SUITE C INDIANAPOLIS IN 46250 990 2012-01-01 351069822 COMMUNITY HOSPITAL OF ANDERSON AND MADISON COUNTY INC COMM 7652984242 1515 NORTH MADISON AVENUE ANDERSON IN 460113453 JOHN B HARRIS 7652984242 2013-10-31 true JAMES A CASKEY CPA CFP 3175852647 2013-11-13 2012 2016-02-24 21:20:13Z ELIZABETH S THARP 1515 NORTH MADISON AVENUE ANDERSON IN 460113453 212126700 false X WWW.COMMUNITYANDERSON.COM X 1961 IN 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. 19 14 1338 198 0 297960 524818 104162452 147261019 753424 4696687 6407267 1950891 111621103 154433415 85700 116820 0 64034402 68645124 0 0 42221650 50838213 106341752 119600157 5279351 34833258 112831542 142954048 31598958 26645497 81232584 116308551 X 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. false false 110657826 147261019 COMMUNITY HOSPITAL OF ANDERSON AND MADISON COUNTY, INC. ("CHA") IS AN ACUTE CARE MEDICAL FACILITY WITH 137 STAFFED BEDS (EXCLUDING NURSERY). IN 2012, THERE WERE 6,015 ADMISSIONS, 6,952 SURGERIES PERFORMED, 810 BIRTHS WITH A TOTAL OF OVER 185,000 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. 116820 116820 COMMUNITY HOSPITAL OF ANDERSON AND MADISON COUNTY, INC. CONTRIBUTED TO A FEW LOCAL CHARITABLE ORGANIZATIONS. THE LARGEST DONATIONS ARE LISTED ON SCHEDULE I. 110774646 true true false false false false false false false false true false false false true false false true false false false false false false false false true true true false true false false false false false false false true false false false false false true true true false false true 99 0 true 1338 true false false false false false false false false false false X 19 14 true false false false true true true true true false false false true true true false true true true true false IN X JOHN B HARRIS 7652985125 1515 N MADISON AVENUE ANDERSON IN 46011 BRYAN A MILLS 2.00 55.00 X 0 1113224 178029 WILLIAM C VANNESS II MD 50.00 X X 558216 0 211000 DAVID A SHAPIRO MD 2.00 40.00 X 0 313974 55836 ELIZABETH S THARP 50.00 X X 250392 0 44355 D BENJAMIN MCCURDY MD 2.00 X 40150 0 0 LARRY L BLANKENSHIP MD 2.00 X 0 0 0 DENNIS CARROLL 2.00 X X 0 0 0 MARIAN DUNNICHAY 2.00 X 0 0 0 WILLIAM HOBBS 2.00 X 0 0 0 MARY JAMERSON 2.00 X 0 0 0 JOHN KANE 2.00 X 0 0 0 MICHAEL KIRBY 2.00 X 0 0 0 ARTHUR J LEAK 2.00 X 0 0 0 MARY JO LEE 2.00 X 0 0 0 MARIE MORRIS 2.00 X 0 0 0 RICHARD MOUSTY 2.00 X X 0 0 0 JOSEPH PORCARO MD 2.00 X 0 0 0 JAY B RICKER 2.00 X 0 0 0 CHARLES STALEY 2.00 X 0 0 0 DANA STUART 2.00 X X 0 0 0 JOHN B HARRIS 50.00 X 247862 0 132660 TAHIR ALI NAQVI MD 50.00 X 2145369 0 665781 NIGHAT TAHIR MD 50.00 X 475815 0 256246 RYAN HINDS MD 50.00 X 359006 0 26618 JARED ANDERSON MD 50.00 X 346522 0 33514 LEE ANN MCDANIEL RN CRNA 50.00 X 320838 0 54542 4744170 1427198 1658581 49 false true false WR DUNKIN & SON INC 2911 ENTERPRISE DRIVE ANDERSON IN 46011 CONSTRUCTION 2931272 WHITE RIVER ANESTHESIA LLC 1135 CORAL SPRINGS DRIVE CICERO IN 460349216 MED/PHY GUAR 832489 SOUTH BEND MEDICAL FOUNDATION INC 530 N LAFAYETTE BLVD SOUTH BEND IN 466011098 LABORATORY SRV 767679 ACCELECARE WOUND CENTERS INC SKYLINE TOWER 10900 NE 4TH STREET BELLEVUE WA 98004 MANAGEMENT FEES 627386 K R MONTGOMERY & ASSOCIATES 1020 JACKSON STREET ANDERSON IN 46016 ARCHITECT FEES 617231 23 524818 524818 PATIENT CARE SERVICE 622110 143306686 143306686 RENTAL INCOME - RELATED 531120 2905841 2905841 JOINT VENTURES 621400 572537 572537 CLINICAL RESEARCH 541700 475955 475955 147261019 1564610 1564610 60825362 57665104 28181 3160258 -28181 3132077 3132077 EHR INCENTIVE PAYMENTS 900099 865653 865653 CAFETERIA SALES 722514 619357 619357 INFO TECHNOLOGY 900099 170715 170715 295166 192670 102496 1950891 154433415 148490057 5418540 116820 116820 1180746 1180746 53046146 48439673 4606473 1219121 1089014 130107 9542144 8523784 1018360 3656967 3266687 390280 284630 269569 15061 602001 570146 31855 141604 141604 8186921 7753713 433208 137904 130607 7297 1420403 1345244 75159 372231 352535 19696 6137996 5813206 324790 149249 141352 7897 1159758 1098390 61368 5851462 5541834 309628 622852 589894 32958 MEDICAL SUPPLIES 17984043 17984043 HAF PROGRAM FEES 7049693 7049693 DUES & SUBSCRIPTIONS 234543 222132 12411 PROPERTY TAX 212812 201551 11261 290111 274759 15352 119600157 110774646 8825511 0 14719411 25034733 20331610 24078695 470924 453189 2105640 2114271 200219 141962 116245035 72033275 41117636 44211760 31944816 44487582 1941286 2431856 112831542 142954048 11549840 12619505 15520000 3100000 12905449 1429118 1120543 31598958 26645497 X 81232584 116308551 81232584 116308551 112831542 142954048 34833258 242709 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 5976988 5976988 49630459 28901311 20729148 58748718 41449269 17299449 1888870 1682695 206175 44211760 ESTIMATED THIRD PARTY SETTLEMENTS 875977 DUE TO AFFILIATES 244566 1120543 true true true X true X true true true false true true 7812 3526278 3526278 0.02950 20381847 20423933 -42086 7812 23908125 20423933 3484192 0.02910 8 5341 8811 8811 0.00010 1 1100 16328 16328 0.00010 9 6441 25139 25139 0.00020 9 14253 23933264 20423933 3509331 0.02930 4 7368 1469 1469 4 7368 1469 1469 true 2737805 45266624 55531833 -10265209 X true true COMM ENDOSCOPY CTR ENDOSCOPY CENTER 0.41000 0.49000 MADISON MED ASSOC REAL ESTATE 0.30000 0.30000 1 1 COMM HOSP OF ANDERSON & MADISON CTY

1515 NORTH MADISON AVENUE ANDERSON IN 46011

WWWCOMMUNITYANDERSONCOM X X X SEE ADDITIONAL INFORMATION COMM HOSP OF ANDERSON & MADISON CTY 1 true X X X X X X X X X X 12 true true true X X X X X X X X X X X false false true true 200.0 true 300.0 true X X X X true true X X true false true X false false RELATED ORGANIZATION INFORMATION PART I LINE 6A 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 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 PART I LINE 7K FINANCIAL ASSISTANCE AND CERTAIN OTHER COMMUNITY BENEFITS CHA EXPERIENCED A LARGE DECREASE IN NET COMMUNITY BENEFIT EXPENSE DUE TO THE IMPACT OF THE IMPLEMENTATION OF THE HOSPITAL ASSESSMENT FEE HAF PROGRAM THE HAF PROGRAM SIGNIFICANTLY REDUCED THE LEVEL OF MEDICAID SHORTFALL IN ADDITION CHA RECEIVED DISPROPORTIONATE SHARE HOSPITAL FUNDING COMMUNITY BUILDING ACTIVITIES PART II SEE ATTACHED IRS 990 SCHEDULE H SUPPLEMENTAL INFORMATION REPORT WHICH INCLUDES INFORMATION FOR COMMUNITY HOSPITAL OF ANDERSON AND MADISON COUNTY INC 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 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 HOSPITALS POLICY PATIENTS WITHOUT INSURANCE COVERAGE ARE ELIGIBLE FOR A 10 UNINSURED DISCOUNT IF PATIENTS PAY THEIR BILL IN FULL WITHIN 30 DAYS OF RECEIVING IT THEY ARE ELIGIBLE FOR AN ADDITIONAL 20 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 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 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 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 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 DETERMINED 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 PARTS C AND D MEDICARE SHORTFALLS SHOULD BE CONSIDERED AS COMMUNITY BENEFIT BECAUSE MEDICARE REPRESENTS 4937 OF THE OVERALL PAYER MIX FOR COMMUNITY HOSPITAL OF ANDERSON AND MADISON COUNTY INC COLLECTION PRACTICES EXPLANATION PART III LINE 9B 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 VI PART V FACILITY INFORMATION OTHER CHA IS AN ACUTE CARE MEDICAL FACILITY WITH 137 STAFFED BEDS IN 2012 THERE WERE 6015 ADMISSIONS WITH AN AVERAGE LENGTH OF STAY OF 367 DAYS THERE WERE 30675 EMERGENCY ROOM CASES RESPONDED TO IN OUR 24HOURSEVEN DAY A WEEK EMERGENCY ROOM 625 OF THE BIRTHS IN MADISON COUNTY WERE DELIVERED AT CHA FOR A TOTAL OF 810 BIRTHS IN 2012 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 COMM HOSP OF ANDERSON MADISON CTY LINE NUMBER 1 PART V LINE 3 PART V LINE 3 SEE ATTACHED IRS 990 SCHEDULE H SUPPLEMENTAL INFORMATION REPORT COMM HOSP OF ANDERSON MADISON CTY LINE NUMBER 1 PART V LINE 4 PART V LINE 4 SEE ATTACHED IRS 990 SCHEDULE H SUPPLEMENTAL INFORMATION REPORT COMM HOSP OF ANDERSON MADISON CTY LINE NUMBER 1 PART V LINE 5C PART V LINE 5C SEE ATTACHED IRS 990 SCHEDULE H SUPPLEMENTAL INFORMATION REPORT COMM HOSP OF ANDERSON MADISON CTY LINE NUMBER 1 PART V LINE 7 PART V LINE 7 SEE ATTACHED IRS 990 SCHEDULE H SUPPLEMENTAL INFORMATION REPORT COMM HOSP OF ANDERSON MADISON CTY LINE NUMBER 1 PART V LINE 14G PART V LINE 14G WHILE CHA DOES NOT PUBLICIZE THE ENTIRE FINANCIAL ASSISTANCE POLICY WE DO PUBLICIZE THE FACT THAT WE HAVE ASSISTANCE AVAILABLE WE HAVE DEDICATED AN ENTIRE PAGE ON OUR WEBSITE TO THOSE WITHOUT INSURANCE 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 COMM HOSP OF ANDERSON MADISON CTY LINE NUMBER 1 PART V LINE 20D PART V LINE 20D THE HOSPITAL CHARGES ALL PATIENTS THE SAME PRICE REGARDLESS OF INSURANCE ABILITY TO PAY AGE RACE GENDER OR NATIONAL ORIGIN true ALTERNATIVES INC PO BOX 1302 ANDERSON IN 46015 310986769 501C3 6500 GENERAL SUPPORT ANDERSON POLICE DEPARTMENT 1040 MAIN STREET ANDERSON IN 46016 356000939 GOV 15000 K-9 FUND ANDERSON SYMPHONY ORCHESTRA 1124 MERIDIAN PLAZA ANDERSON IN 46015 310940546 501C3 7370 GENERAL SUPPORT HEALTH & HOSPITAL CORP OF MARION CO 3838 N RURAL STREET 8TH FLOOR INDIANAPOLIS IN 46205 356005697 GOV 10000 GENERAL SUPPORT MADISON COUNTY COMMUNITY FOUNDATION 33 W 10TH STREET SUITE 600 ANDERSON IN 46016 351859959 501C3 30000 SPONSOR KINDERG CAMP MADISON PARK CHURCH OF GOD 1932 E 53RD STREET ANDERSON IN 46013 356005926 501C3 12950 SPONSOR A CHR CAROL UNITED WAY OF MADISON COUNTY INC 1201 E 5TH STREET SUITE 1019 ANDERSON IN 46015 351052350 501C3 15000 GENERAL SUPPORT 7 PROCEDURES FOR MONITORING THE USE OF GRANT FUNDS INSIDE THE UNITED STATES SCHEDULE I, PAGE 1, PART I, LINE 2 THE CONTRIBUTIONS TO VARIOUS LOCAL CHARITABLE ORGANIZATIONS WERE UNRESTRICTED DONATIONS. X false true X X X X X false true false false false false false true false BRYAN A MILLS 821612 272000 19612 148211 29818 1291253 264000 WILLIAM C VANNESS II MD 328684 130034 99498 196620 14380 769216 130034 DAVID A SHAPIRO MD 282407 31567 35111 20725 369810 ELIZABETH S THARP 201536 41590 7266 41739 2616 294747 JOHN B HARRIS 191617 46649 9596 111231 21429 380522 46649 TAHIR ALI NAQVI MD 691859 1379494 74016 635763 30018 2811150 1003700 NIGHAT TAHIR MD 231518 243600 697 225240 31006 732061 62500 RYAN HINDS MD 333643 25363 7500 19118 385624 JARED ANDERSON MD 316095 30427 7500 26014 380036 LEE ANN MCDANIEL RN CRNA 315043 4992 803 28528 26014 375380 FRINGE OR EXPENSE EXPLANATION SCHEDULE J, PAGE 1, PART I, LINE 1A THE CEO OF COMMUNITY HOSPITAL OF ANDERSON AND MADISON COUNTY, INC. ("CHA") WAS PROVIDED SOCIAL CLUB DUES AS APPROVED BY THE CHA COMPENSATION COMMITTEE. THIS WAS NOT TAXABLE COMPENSATION. WRITTEN REIMBURSEMENT POLICY EXPLANATION SCHEDULE J, PAGE 1, PART I, LINE 1B THE CHA BOARD OF DIRECTORS BELIEVES IT IS VITAL FOR THE CEO TO BE ACTIVE IN THE LOCAL COMMUNITY SOCIAL AND SERVICE ORGANIZATIONS. THE HOSPITAL PAYS THE ANNUAL DUES FOR THE CEO'S PARTICIPATION. THE DUES ARE APPROVED BY THE CHA COMPENSATION COMMITTEE. ANY PERSONAL EXPENSES BEYOND THE DUES ARE PAID FOR BY THE CEO AS THEY ARE INCURRED. OTHER ADDITIONAL INFORMATION SCHEDULE J, PART III 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 2012. 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. VISIONARY ENTERPRISES INC SHARE BD MEMBER 16315679 HLTH INSUR/PLAN FEES false ORGANIZATION'S MISSION 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. ADDITIONAL INFORMATION FORM 990, PART VI FORM 990, PART VI, LINE 2 - RELATED PARTY INFORMATION AMONG OFFICERS MANY OF CHA'S DIRECTORS, OFFICERS, AND KEY EMPLOYEES SERVE IN AN EXECUTIVE ROLE FOR OTHER TAX-EXEMPT AND TAXABLE AFFILIATES THROUGHOUT THE NETWORK. SPECIFICALLY, THE FOLLOWING DIRECTORS SERVE AS DIRECTORS AND/OR OFFICERS OF THE FOLLOWING ORGANIZATIONS: DENNIS CARROLL - COMMUNITY HEALTH NETWORK, INC. - COMMUNITY HOME HEALTH SERVICES, INC. - COMMUNITY HOSPITAL SOUTH, INC. - INDIANA HEART HOSPITAL, LLC BRYAN A. MILLS - COMMUNITY HEALTH NETWORK, INC. - COMMUNITY HEALTH NETWORK FOUNDATION, INC. - COMMUNITY HEALTH SERVICES OF INDIANA, INC. - COMMUNITY HOME HEALTH SERVICES, INC. - COMMUNITY HOSPITAL SOUTH, INC. - COMMUNITY PHYSICIANS OF INDIANA, INC. - COMMUNITY WESTVIEW HOSPITAL, INC. - INDIANA HEART HOSPITAL, LLC - VISIONARY ENTERPRISES, INC. MANAGEMENT DELEGATED 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. CLASSES OF MEMBERS OR STOCKHOLDERS 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). ELECTION OF MEMBERS AND THEIR RIGHTS 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. DECISIONS SUBJECT TO APPROVAL OF MEMBERS 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. ORGANIZATION'S PROCESS USED TO REVIEW FORM 990 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. ENFORCEMENT OF CONFLICTS POLICY 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, PART VI, LINE 13 - WRITTEN WHISTLEBLOWER POLICY WHILE NO FORMAL WRITTEN POLICY EXISTS, CHA'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." COMPENSATION PROCESS FOR TOP OFFICIAL 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. COMPENSATION PROCESS FOR OFFICERS 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 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) 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.COM. D) COMMUNITY HEALTH NETWORK, INC. AND AFFILIATES PROVIDE ANY DOCUMENT OPEN TO PUBLIC INSPECTION UPON REQUEST. 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