2012-11-12T12:31:10-06:00 2011-12-31 CASKEY & DAILY PC 4745 STATESMEN DRIVE SUITE C INDIANAPOLIS IN 46250 990 2011-01-01 861053152 COMMUNITY HOSPITAL ANDERSON FDN INC COMM 7652985133 1515 N MADISON AVENUE ANDERSON IN 46011 KEITH TRENT 7652985133 2012-11-07 true JAMES A CASKEY CPA CFP 3175852647 2012-11-07 2011 2016-02-24 21:20:13Z KEITH TRENT 1515 N MADISON AVENUE ANDERSON IN 46011 1196620 false X WWW.COMMUNITYANDERSON.COM X 2001 IN 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. 15 14 2 0 480908 464916 0 -36099 59280 6171 444809 530367 8000 446967 0 157555 146658 0 0 710263 100687 875818 694312 -431009 -163945 3770941 3588833 14704 124912 3756237 3463921 X 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. false false 442077 440967 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. 26481 PROVIDE FINANCIAL ASSISTANCE TO COMMUNITY HOSPITAL ANDERSON EMPLOYEES THROUGH THE HEALTHCARE EMPLOYEES LOAN PROGRAM. 6000 6000 PROVIDE SCHOLARSHIPS AND EDUCATION ASSISTANCE TO COMMUNITY HOSPITAL ANDERSON EMPLOYEES. 474558 true true false false false false false false false true false false false false true false false true false false false false false false false false false true true true false false false false false false false false false false false false false true true false false false true 8 0 true 2 true false false false false false true true false false false false false X 15 14 false false false false true true true true true false false true true true true false true true false false IN X KEITH TRENT 7652985414 1515 N MADISON AVENUE ANDERSON IN 46011 PATRICIA WOODS 5.00 X 0 97127 10216 SHARON ANTRIM 5.00 X 0 0 0 DOUG BANNING 5.00 X X 0 0 0 ROGER BROCKMAN MD 5.00 X 0 0 0 BRIAN DONAHUE 5.00 X 0 0 0 CRAIG DUNKIN 5.00 X 0 0 0 MARSHA MUSTIN 5.00 X 0 0 0 WILLIAM O'NEAL PHD 5.00 X X 0 0 0 QUINN RICKER 5.00 X 0 0 0 JACK ROBINSON 5.00 X X 0 0 0 JR ROSENCRANS 5.00 X 0 0 0 PAM SHOOT 5.00 X 0 0 0 TONY THANAS 5.00 X 0 0 0 GEORGEANN WHITWORTH 5.00 X 0 0 0 BETTY WILLIAMS 5.00 X X 0 0 0 KEITH TRENT 45.00 X 91093 22773 58050 91093 119900 68266 false true false 33303 431613 464916 137695 137695 580414 658829 -78415 -78415 -78415 13595 7424 6171 6171 530367 65451 440967 440967 6000 6000 91093 91093 44948 44948 342 342 10275 10275 4510 4510 14612 14612 39897 39897 493 493 8511 8511 569 569 "HELP" LOANS 26481 26481 DUES & LICENSES 4504 4504 DONOR MEETINGS 1110 1110 694312 474558 219754 0 165762 86706 3605179 3502127 3770941 3588833 14704 2369 122543 14704 124912 X 3756237 3463921 3756237 3463921 3770941 3588833 X -163945 -128371 X false true true X false X X X false false false COMMUNITY HOSP OF ANDERSON & MADISON COUNTY INC 351069822 3 false false false 440967 1 440967 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false 3438442 -66313 13434 3358695 3435272 404254 81823 305450 13811 3438442 2930191 5000 793869 30987 250250 12551 3435272 3744020 457384 -1144762 89235 20999 16217 2930191 0.73000 0.27000 false false false DUE TO AFFILIATES 122543 122543 INTENDED USES FOR ENDOWMENT FUNDS SCHEDULE D, PAGE 2, PART V, LINE 4 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. true COMM HOSP OF ANDERSON & MADISON CTY 1515 NORTH MADISON AVENUE ANDERSON IN 46011 351069822 501 440967 PURCHASE EQUIP/OTHER 1 SCHOLARSHIPS 6 6000 PROCEDURES FOR MONITORING THE USE OF GRANT FUNDS INSIDE THE UNITED STATES SCHEDULE I, PAGE 1, PART I, LINE 2 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. X true true false false false false false false false true false KEITH TRENT 82907 20727 6728 1682 1458 364 33650 8412 12790 3198 137533 34383 FRINGE OR EXPENSE EXPLANATION 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. RELATED ORG METHODS USED FOR COMPENSATION EXPLANATION 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. NON-FIXED PAYMENTS PROVIDED 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. ORGANIZATION'S MISSION 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. CLASSES OF MEMBERS OR STOCKHOLDERS 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. ELECTION OF MEMBERS AND THEIR RIGHTS 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. DECISIONS SUBJECT TO APPROVAL OF MEMBERS 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. 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. ALL SECTIONS OF THE FORM 990 ARE REVIEWED BY THE EXECUTIVE COMMITTEE OF THE FOUNDATION BOARD OF DIRECTORS. ENFORCEMENT OF CONFLICTS POLICY 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. COMPENSATION PROCESS FOR TOP OFFICIAL FORM 990, PAGE 6, PART VI, LINE 15A THE FOUNDATION OFFICER IS COMPENSATED BY 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. 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, 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 FOUDNATION, 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.COM. OTHER CHANGES IN NET ASSETS EXPLANATION FORM 990, PART XI, LINE 5 DECREASE IN INVESTMENT MARKET VALUE 128,371 COMM HOSP OF ANDERSON & MADISON CTY 1515 N MADISON AVENUE ANDERSON IN 46011 351069822 HOSPITAL IN 501C3 3 CHI false COMMUNITY LTC INC 1031 MONTICELLO DRIVE ANDERSON IN 46011 351877441 HLTH CARE IN 501C3 9 CHA true COMMUNITY HEALTH NETWORK INC 7330 SHADELAND STATION SUITE 200 INDIANAPOLIS IN 46256 311038302 SUPPORT IN 501C3 11B N/A false COMMUNITY HEALTH NETWORK FOUNDATION 1500 NORTH RITTER AVENUE INDIANAPOLIS IN 46219 510181688 CHARITY IN 501C3 11B CHNW true COMMUNITY HOME HEALTH SERVICES INC 9894 EAST 121ST STREET FISHERS IN 46037 350953467 HLTH CARE IN 501C3 9 CHNW true COMMUNITY HOSPITALS OF INDIANA INC 1500 NORTH RITTER AVENUE INDIANAPOLIS IN 46219 350983617 HOSPITAL IN 501C3 3 CHNW false COMMUNITY HOSPITAL SOUTH INC 1402 E COUNTY LINE ROAD SOUTH INDIANAPOLIS IN 46227 351088640 HOSPITAL IN 501C3 3 CHI true COMMUNITY PHYSICIANS OF IN INC 7240 SHADELAND STATION SUITE 300 INDIANAPOLIS IN 46256 205392766 PHY SRV IN 501C3 9 CHI true THE INDIANA HEART HOSPITAL LLC 8075 NORTH SHADELAND AVENUE INDIANAPOLIS IN 46250 352123783 HOSPITAL IN 501C3 3 CHI true INDIANAPOLIS OSTEOPATHIC HOSPITAL 3630 GUION ROAD INDIANAPOLIS IN 46222 351094734 HOSPITAL IN 501C3 3 CHNW true WESTVIEW HOSPITAL FOUNDATION INC 3630 GUION ROAD INDIANAPOLIS IN 46222 311036451 SUPPORT IN 501C3 11B IOH true HEALTH INSTITUTE OF INDIANA INC 3660 GUION ROAD INDIANAPOLIS IN 46222 352022402 FITNESS IN 501C3 9 IOH true EAST CAMPUS SURGERY CENTER LLC 7330 SHADELAND STATION SUITE 200 INDIANAPOLIS IN 46256 352028517 SURGERY IN N/A false false INDIANA SPECIALTY GROUP 7240 SHADELAND STATION SUITE 300 INDIANAPOLIS IN 46256 351976258 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 SURGICARE LLC 2907 MCINTIRE DRIVE BLOOMINGTON IN 47403 351975122 SURGERY 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 INDIANA SPECIALTY GROUP 7240 SHADELAND STATION SUITE 300 INDIANAPOLIS IN 46256 351976258 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 SURGICARE LLC 2907 MCINTIRE DRIVE BLOOMINGTON IN 47403 351975122 SURGERY IN N/A false false CHN ASSURANCE COMPANY LTD PO BOX 1051GT GRAND CAYMAN CJ 980418913 INSURANCE CJ N/A INDIANA PROHEALTH NETWORK INC 8180 CLEARVISTA PARKWAY SUITE 230 INDIANAPOLIS IN 46256 351614719 INSURANCE IN N/A VISIONARY ENTERPRISES INC 7330 SHADELAND STATION SUITE 200 INDIANAPOLIS IN 46256 351538433 MGMT SRVCS IN N/A VEI MICHIGAN INC 940 N MAIN STREET ANN HARBOR MI 48104 300097377 MGMT SRVCS MI N/A VEI-PRO HEALTH INC 7330 SHADELAND STATION SUITE 200 INDIANAPOLIS IN 46256 454037444 INSURANCE IN N/A WESTVIEW DELIVERY SYSTEM 3630 GUION ROAD INDIANAPOLIS IN 46222 351910292 MGMT SRVCS IN N/A CHN ASSURANCE COMPANY LTD PO BOX 1051GT GRAND CAYMAN CJ 980418913 INSURANCE CJ N/A INDIANA PROHEALTH NETWORK INC 8180 CLEARVISTA PARKWAY SUITE 230 INDIANAPOLIS IN 46256 351614719 INSURANCE IN N/A VISIONARY ENTERPRISES INC 7330 SHADELAND STATION SUITE 200 INDIANAPOLIS IN 46256 351538433 MGMT SRVCS IN N/A VEI MICHIGAN INC 940 N MAIN STREET ANN HARBOR MI 48104 300097377 MGMT SRVCS MI N/A VEI-PRO HEALTH INC 7330 SHADELAND STATION SUITE 200 INDIANAPOLIS IN 46256 454037444 INSURANCE IN N/A WESTVIEW DELIVERY SYSTEM 3630 GUION ROAD INDIANAPOLIS IN 46222 351910292 MGMT SRVCS IN N/A false true false false false false false false false false false false false false true false true true