FURP.ORG / PUBLIC DATA EXPLORER

COMMUNITY HOSPITAL OF ANDERSON- MADISON COUNTY INC: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization
COMMUNITY HOSPITAL OF ANDERSON- MADISON COUNTY INC (EIN 35-1069822)
Tax period
2011-01-01 to 2011-12-31
Filed
2012-11-12
IRS object ID
201203179349300545
Schema version
2011v1.2
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 ReturnHeader

FieldValueIRS element (for citing)
Timestamp2012-11-12T09:11:53-06:00Timestamp
Tax Period End Date2011-12-31TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1CASKEY & DAILY PCBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line14745 STATESMEN DRIVE SUITE CAddressLine1
CityINDIANAPOLISCity
StateINState
ZIP Code46250ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2011-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN351069822EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1COMMUNITY HOSPITAL OF ANDERSON ANDBusinessNameLine1
Business Name Line2MADISON COUNTY INCBusinessNameLine2
FieldValueIRS element (for citing)
Name ControlCOMMNameControl
Phone7652984242Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line11515 NORTH MADISON AVENUEAddressLine1
CityANDERSONCity
StateINState
ZIP Code460113453ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameJOHN B HARRISName
TitleVP OF FINANCE/CFOTitle
Phone7652984242Phone
Date Signed2012-11-07DateSigned
Authorize Third PartytrueAuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameJAMES A CASKEY CPA CFPName
Phone3175852647Phone
Date Prepared2012-11-07DatePrepared
FieldValueIRS element (for citing)
Tax Year2011TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonWILLIAM C VANNESS II MDNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line11515 NORTH MADISON AVENUEAddressLine1
CityANDERSONCity
StateINState
ZIP Code460113453ZIPCode
FieldValueIRS element (for citing)
Gross Receipts118068064GrossReceipts
Group Return For AffiliatesfalseGroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.COMMUNITYANDERSON.COMWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1961YearFormation
State Legal DomicileINStateLegalDomicile
Activity Or Mission DescriptionTHE 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.ActivityOrMissionDescription
Nbr Voting Members Governing Body18NbrVotingMembersGoverningBody
Nbr Independent Voting Members14NbrIndependentVotingMembers
Total Nbr Employees1299TotalNbrEmployees
Total Nbr Volunteers211TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Contributions Grants Current Year297960ContributionsGrantsCurrentYear
Program Service Revenue Prior Year119663238ProgramServiceRevenuePriorYear
Program Service Revenue CY104162452ProgramServiceRevenueCY
Investment Income Prior Year9904InvestmentIncomePriorYear
Investment Income Current Year753424InvestmentIncomeCurrentYear
Other Revenue Prior Year4451716OtherRevenuePriorYear
Other Revenue Current Year6407267OtherRevenueCurrentYear
Total Revenue Prior Year124124858TotalRevenuePriorYear
Total Revenue Current Year111621103TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year64375GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY85700GrantsAndSimilarAmntsCY
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year62300450SalariesEtcPriorYear
Salaries Etc Current Year64034402SalariesEtcCurrentYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year60300440OtherExpensePriorYear
Other Expenses Current Year42221650OtherExpensesCurrentYear
Total Expenses Prior Year122665265TotalExpensesPriorYear
Total Expenses Current Year106341752TotalExpensesCurrentYear
Revenues Less Expenses Prior Year1459593RevenuesLessExpensesPriorYear
Revenues Less Expenses CY5279351RevenuesLessExpensesCY
Total Assets BOY108413543TotalAssetsBOY
Total Assets EOY112831542TotalAssetsEOY
Total Liabilities BOY31163437TotalLiabilitiesBOY
Total Liabilities EOY31598958TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY77250106NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY81232584NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionTHE 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.MissionDescription
Significant New Program ServicesfalseSignificantNewProgramServices
Significant ChangefalseSignificantChange
Expense97730759Expense
Revenue104162452Revenue
DescriptionCOMMUNITY HOSPITAL OF ANDERSON AND MADISON COUNTY, INC. ("CHA") IS AN ACUTE CARE MEDICAL FACILITY WITH 137 STAFFED BEDS (EXCLUDING NURSERY). IN 2011, THERE WERE 6,216 ADMISSIONS, 6,781 SURGERIES PERFORMED, 881 BIRTHS WITH A TOTAL OF OVER 180,000 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.Description

Activity2 Activity2

FieldValueIRS element (for citing)
Expense85700Expense
Grants85700Grants
DescriptionCOMMUNITY HOSPITAL OF ANDERSON AND MADISON COUNTY, INC. CONTRIBUTED TO A FEW LOCAL CHARITABLE ORGANIZATIONS. THE LARGEST DONATIONS ARE LISTED ON SCHEDULE I.Description
FieldValueIRS element (for citing)
Total Program Service Expense97816459TotalProgramServiceExpense
Described In501 C3trueDescribedIn501C3
Schedule B RequiredtrueScheduleBRequired
Political ActivitiesfalsePoliticalActivities
Lobbying ActivitiesfalseLobbyingActivities
Subject To Proxy TaxfalseSubjectToProxyTax
Donor Advised FundsfalseDonorAdvisedFunds
Conservation EasementsfalseConservationEasements
Collections Of ArtfalseCollectionsOfArt
Credit CounselingfalseCreditCounseling
Term Or Permanent EndowmentsfalseTermOrPermanentEndowments
Report Land Bldg EquiptrueReportLandBldgEquip
Report Invest Oth SecuritiesfalseReportInvestOthSecurities
Report Prog Rel InvestfalseReportProgRelInvest
Report Other AssetsfalseReportOtherAssets
Report Other LiabilitiestrueReportOtherLiabilities
Report Fin48 FootnotefalseReportFin48Footnote
Independent Audit Financial StmtfalseIndependentAuditFinancialStmt
Consolidated Audit Financial StmttrueConsolidatedAuditFinancialStmt
SchoolfalseSchool
Foreign OfficefalseForeignOffice
Foreign ActivitiesfalseForeignActivities
More Than5000 K To OrganizationsfalseMoreThan5000KToOrganizations
More Than5000 K To IndividualsfalseMoreThan5000KToIndividuals
Professional FundraisingfalseProfessionalFundraising
Fundraising ActivitiesfalseFundraisingActivities
GamingfalseGaming
HospitaltrueHospital
Financial Stmt AttachedtrueFinancialStmtAttached
Grants To OrganizationstrueGrantsToOrganizations
Grants To IndividualsfalseGrantsToIndividuals
Schedule J RequiredtrueScheduleJRequired
Tax Exempt BondsfalseTaxExemptBonds
Excess Benefit TransactionfalseExcessBenefitTransaction
Prior Excess Benefit TransactionfalsePriorExcessBenefitTransaction
Loan To Officer Or DQPfalseLoanToOfficerOrDQP
Grant To Related PersonfalseGrantToRelatedPerson
Bsnss Rltnshp With OrganizationfalseBsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family MemberfalseBsnssRltnshpThruFamilyMember
Officer Entity With Bsnss RltnshptrueOfficerEntityWithBsnssRltnshp
Deductible Non Cash ContributionsfalseDeductibleNonCashContributions
Deductible Contributions Of ArtfalseDeductibleContributionsOfArt
TerminatedfalseTerminated
Partial LiquidationfalsePartialLiquidation
Disregarded EntityfalseDisregardedEntity
Related EntitytrueRelatedEntity
Related Org Controlled EntitytrueRelatedOrgControlledEntity
Transaction Related EntitytrueTransactionRelatedEntity
Transfers To Exempt Non Chrtbl OrgfalseTransfersToExemptNonChrtblOrg
Activities Conducted PartnershipfalseActivitiesConductedPartnership
Schedule O RequiredtrueScheduleORequired
Number Forms Transmitted With109699NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup WitholdingtrueComplianceWithBackupWitholding
Number Of Employees1299NumberOfEmployees
Employment Tax Returns FiledtrueEmploymentTaxReturnsFiled
Unrelated Business IncomefalseUnrelatedBusinessIncome
Foreign Financial AccountfalseForeignFinancialAccount
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTrans
Taxable Party NotificationfalseTaxablePartyNotification
Non Deductible ContributionsfalseNonDeductibleContributions
Quid Pro Quo ContributionsfalseQuidProQuoContributions
Form8282 Property Disposed OffalseForm8282PropertyDisposedOf
Funds To Pay PremiumsfalseFundsToPayPremiums
Premiums PaidfalsePremiumsPaid
Indoor Tanning ServicesfalseIndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members18NbrVotingGoverningBodyMembers
Number Independent Voting Members14NumberIndependentVotingMembers
Family Or Business RelationshiptrueFamilyOrBusinessRelationship
Delegation Of Management DutiesfalseDelegationOfManagementDuties
Changes To Organizing DocsfalseChangesToOrganizingDocs
Material Diversion Or MisusefalseMaterialDiversionOrMisuse
Members Or StockholderstrueMembersOrStockholders
Election Of Board MemberstrueElectionOfBoardMembers
Decisions Subject To ApprovaltrueDecisionsSubjectToApproval
Minutes Of Governing BodytrueMinutesOfGoverningBody
Minutes Of CommitteestrueMinutesOfCommittees
Officer Mailing AddressfalseOfficerMailingAddress
Local ChaptersfalseLocalChapters
Form990 Provided To Governing BodyfalseForm990ProvidedToGoverningBody
Conflict Of Interest PolicytrueConflictOfInterestPolicy
Annual Disclosure Covered PersonstrueAnnualDisclosureCoveredPersons
Regular Monitoring EnforcementtrueRegularMonitoringEnforcement
Whistleblower PolicyfalseWhistleblowerPolicy
Document Retention PolicytrueDocumentRetentionPolicy
Compensation Process CEOtrueCompensationProcessCEO
Compensation Process OthertrueCompensationProcessOther
Investment In Joint VenturetrueInvestmentInJointVenture
Written Policy Or ProcedurefalseWrittenPolicyOrProcedure
States Where Copy Of Return Is FiledINStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonJOHN B HARRISNamePerson
Telephone Number7652985125TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line11515 N MADISON AVENUEAddressLine1
CityANDERSONCity
StateINState
ZIP Code46011ZIPCode
FieldValueIRS element (for citing)
Info In Schedule O Part VIIXInfoInScheduleOPartVII

Form990 Part VII Section A Form990PartVIISectionA (26 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationOfficerOfficerHighest Compensated EmployeeHighestCompensatedEmployee
BRYAN A MILLS
DIRECTOR5.00X0938491313007
WILLIAM C VANNESS II MD
DIRECTOR & C50.00X3839760184996X
DAVID A SHAPIRO MD
DIRECTOR5.00X030272555767
D BENJAMIN MCCURDY MD
DIRECTOR5.00X2830000
MICHAEL L BAKER
CHAIRMAN5.00X000X
LARRY BLANKENSHIP MD
DIRECTOR5.00X000
DENNIS CARROLL
VICE CHAIRMA5.00X000X
MARIAN DUNNICHAY
DIRECTOR5.00X000
WILLIAM HOBBS
DIRECTOR5.00X000
MARY JAMERSON
SECRETARY5.00X000X
MICHAEL KIRBY
DIRECTOR5.00X000
ARTHUR J LEAK
DIRECTOR5.00X000
MARY JO LEE
DIRECTOR5.00X000
MARIE MORRIS
DIRECTOR5.00X000
RICHARD MOUSTY
DIRECTOR5.00X000
ROBERT J PENSEC
DIRECTOR5.00X000
JOSEPH PORCARO MD
DIRECTOR5.00X000
CHARLES STALEY
DIRECTOR5.00X000
DANA STUART
TREASURER5.00X000X
SHIRLEY J WEATHERLY
DIRECTOR5.00X000
JOHN B HARRIS
VP OF FINANC50.002144700116441X
TAHIR ALI NAQVI MD
PHYSICIAN50.00187891101038806X
NIGHAT TAHIR MD
PHYSICIAN50.00385387095596X
RYAN HINDS MD
ANESTHESIOLO50.00345956022206X
JARED ANDERSON MD
ANESTHESIOLO50.00342120028364X
VIRGIL LOGHIN MD
ANESTHESIOLO50.0031519607350X
FieldValueIRS element (for citing)
Total Reportable Comp From Org3894316TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs1241216TotalReportableCompFrmRltdOrgs
Total Other Compensation1862533TotalOtherCompensation
Number Individuals GT100 K40NumberIndividualsGT100K
Formers ListedfalseFormersListed
Total Comp GT150 KtrueTotalCompGT150K
Compensation From Other SourcesfalseCompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
LEHMAN'S MECHANICAL CONTRACTORS
1023 W 38TH STREETANDERSONIN46013CONSTRUCTION1046681
WR DUNKIN & SON INC
2911 ENTERPRISE DRIVEANDERSONIN46011CONSTRUCTION831004
SOUTH BEND MEDICAL FOUNDATION INC
530 N LAFAYETTE BLVDSOUTH BENDIN466011098LABORATORY SRV729764
WHITE RIVER ANESTHESIA LLC
1135 CORAL SPRINGS DRIVECICEROIN460349216MED/PHY GUAR535380
ACCELECARE WOUND CENTERS INC
SKYLINE TOWER 10900 NE 4TH STREETBELLEVUEWA98004MANAGEMENT FEES495166
FieldValueIRS element (for citing)
Number Of Contractors GT100 K23NumberOfContractorsGT100K
Related Organizations297960RelatedOrganizations
Total Contributions297960TotalContributions

Program Service Revenue ProgramServiceRevenue (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
PATIENT CARE SERVICE900099103142031103142031
CLINICAL RESEARCH541700551647551647
JOINT VENTURES621400468774468774
FieldValueIRS element (for citing)
Total Program Service Revenue104162452TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column1075076TotalRevenueColumn
Exclusion$1,075,076ExclusionAmount

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real2819976Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real2819976Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column2819976TotalRevenueColumn
Exclusion$2,819,976ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities6090690Securities
Other34619Other

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities6446961Securities

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities-356271Securities
Other34619Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column-321652TotalRevenueColumn
Exclusion-$321,652ExclusionAmount

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncomeExclusionExclusionAmount
EHR INCENTIVE PAYMENTS90009923484732348473
CAFETERIA SALES722210655653$655,653
RADIOLOGY SERVICES621500126750126750

Miscellaneous Revenue MiscellaneousRevenue

FieldValueIRS element (for citing)
Total Revenue Column456415TotalRevenueColumn
Related Or Exempt Function Income348698RelatedOrExemptFunctionIncome
Exclusion$107,717ExclusionAmount
FieldValueIRS element (for citing)
Total Other Revenue3587291TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column111621103TotalRevenueColumn
Related Or Exempt Function Income106986373RelatedOrExemptFunctionIncome
Exclusion$4,336,770ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total85700Total
Program Services85700ProgramServices

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total928183Total
Program Services28300ProgramServices
Management And General899883ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total50847991Total
Program Services46741546ProgramServices
Management And General4106445ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total2163599Total
Program Services1954397ProgramServices
Management And General209202ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total6656920Total
Program Services6013251ProgramServices
Management And General643669ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total3437709Total
Program Services3105311ProgramServices
Management And General332398ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total140909Total
Program Services133453ProgramServices
Management And General7456ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total259168Total
Program Services245454ProgramServices
Management And General13714ManagementAndGeneral

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total105117Total
Management And General105117ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total6657732Total
Program Services6305441ProgramServices
Management And General352291ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total222375Total
Program Services210609ProgramServices
Management And General11766ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total19571956Total
Program Services18536313ProgramServices
Management And General1035643ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total347464Total
Program Services329078ProgramServices
Management And General18386ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total5966158Total
Program Services5650461ProgramServices
Management And General315697ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total128480Total
Program Services121682ProgramServices
Management And General6798ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total1132491Total
Program Services1072566ProgramServices
Management And General59925ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total5804148Total
Program Services5497023ProgramServices
Management And General307125ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total693498Total
Program Services656802ProgramServices
Management And General36696ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
PHYSICIAN RECRUITMENT58738755630631081
PROPERTY TAX35060433205218552
DUES & SUBSCRIPTIONS23111921888912230
MISCELLANEOUS FEES1805117096955

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total4993Total
Program Services4729ProgramServices
Management And General264ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total106341752Total
Program Services97816459ProgramServices
Management And General8525293ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY8201874BOY
EOY14719411EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY20962932BOY
EOY20331610EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

FieldValueIRS element (for citing)
BOY488015BOY
EOY470924EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY2585041BOY
EOY2105640EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY143746BOY
EOY200219EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis110328127LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec69210491LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY42014764BOY
EOY41117636EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY32599214BOY
EOY31944816EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY1417957BOY
EOY1941286EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY108413543BOY
EOY112831542EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY9682910BOY
EOY11549840EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY17195000BOY
EOY15520000EOY

Unsecured Notes Loans Payable UnsecuredNotesLoansPayable

FieldValueIRS element (for citing)
BOY3100000BOY
EOY3100000EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY1185527BOY
EOY1429118EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY31163437BOY
EOY31598958EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY77250106BOY
EOY81232584EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY77250106BOY
EOY81232584EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY108413543BOY
EOY112831542EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses5279351ReconcilationRevenueExpenses
Reconcilation Other Changes-1296873ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or ReviewfalseAccountantCompileOrReview
FS AuditedtrueFSAudited
Audit CommitteetrueAuditCommittee
Financial Statement SeparateXFinancialStatementSeparate
Federal Grant Audit RequiredfalseFederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Hospital170b1 AiiiXHospital170b1Aiii

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Disclosed Orgs Legal ControlfalseDisclosedOrgsLegalControl
Disclosed For Charitable PurposesfalseDisclosedForCharitablePurposes
Written Policy MonitoringfalseWrittenPolicyMonitoring
Sect170h Requirements SatisfiedfalseSect170hRequirementsSatisfied
Solicited Assets For SalefalseSolicitedAssetsForSale
Agent Trustee EtcfalseAgentTrusteeEtc
Included On FSfalseIncludedOnFS
Endowments Held By Unrelated OrgsfalseEndowmentsHeldByUnrelatedOrgs
Endowments Held By Related OrgsfalseEndowmentsHeldByRelatedOrgs
Are Related Orgs Listed Schedule RfalseAreRelatedOrgsListedScheduleR

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis5976988OtherCostOrOtherBasis
Book Value5976988BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis46260838OtherCostOrOtherBasis
Depreciation27707634Depreciation
Book Value18553204BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis56201431OtherCostOrOtherBasis
Depreciation39907245Depreciation
Book Value16294186BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis1888870OtherCostOrOtherBasis
Depreciation1595612Depreciation
Book Value293258BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings41117636TotalOfBookValueLandBuildings

Other Liabilities OtherLiabilities (2 entries)

DescriptionDescriptionAmountAmount
DUE TO AFFILIATES$997,946
ESTIMATED THIRD PARTY SETTLEMENTS$431,172
FieldValueIRS element (for citing)
Total Of Amounts1429118TotalOfAmounts

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Charity Care PolicytrueCharityCarePolicy
Written PolicytrueWrittenPolicy
FPG Reference Free CaretrueFPGReferenceFreeCare
Pcent200XPcent200
FPG Reference Discounted CaretrueFPGReferenceDiscountedCare
Pcent300XPcent300
Free Disc Care Medically IndigenttrueFreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity CaretrueAmountsBudgetedForCharityCare
Expenses Exceeded BudgettrueExpensesExceededBudget
Unable To Provide CarefalseUnableToProvideCare
Annual Community Benefit ReporttrueAnnualCommunityBenefitReport
Report Publically AvailabletrueReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Persons Served7352PersonsServed
Total Community Benefit Expense3218565TotalCommunityBenefitExpense
Net Community Benefit Expense3218565NetCommunityBenefitExpense
Percent Of Total Expense0.03030PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Total Community Benefit Expense12901967TotalCommunityBenefitExpense
Direct Offsetting Revenue6099784DirectOffsettingRevenue
Net Community Benefit Expense6802183NetCommunityBenefitExpense
Percent Of Total Expense0.06400PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Persons Served7352PersonsServed
Total Community Benefit Expense16120532TotalCommunityBenefitExpense
Direct Offsetting Revenue6099784DirectOffsettingRevenue
Net Community Benefit Expense10020748NetCommunityBenefitExpense
Percent Of Total Expense0.09420PercentOfTotalExpense

Community Health Services CommunityHealthServices

FieldValueIRS element (for citing)
Number Of Activities Or Programs58NumberOfActivitiesOrPrograms
Persons Served13170PersonsServed
Total Community Benefit Expense16960TotalCommunityBenefitExpense
Net Community Benefit Expense16960NetCommunityBenefitExpense
Percent Of Total Expense0.00020PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Number Of Activities Or Programs58NumberOfActivitiesOrPrograms
Persons Served13170PersonsServed
Total Community Benefit Expense16960TotalCommunityBenefitExpense
Net Community Benefit Expense16960NetCommunityBenefitExpense
Percent Of Total Expense0.00020PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Number Of Activities Or Programs58NumberOfActivitiesOrPrograms
Persons Served20522PersonsServed
Total Community Benefit Expense16137492TotalCommunityBenefitExpense
Direct Offsetting Revenue6099784DirectOffsettingRevenue
Net Community Benefit Expense10037708NetCommunityBenefitExpense
Percent Of Total Expense0.09440PercentOfTotalExpense

Physical Improvements And Housing PhysicalImprovementsAndHousing

FieldValueIRS element (for citing)
Number Of Activities Or Programs1NumberOfActivitiesOrPrograms
Persons Served12PersonsServed

Community Support CommunitySupport

FieldValueIRS element (for citing)
Number Of Activities Or Programs15NumberOfActivitiesOrPrograms
Persons Served602PersonsServed
Total Community Building Expense85579TotalCommunityBuildingExpense
Net Community Building Expense85579NetCommunityBuildingExpense
Percent Of Total Expense0.00080PercentOfTotalExpense

Coalition Building CoalitionBuilding

FieldValueIRS element (for citing)
Number Of Activities Or Programs2NumberOfActivitiesOrPrograms
Persons Served386PersonsServed

Total Total

FieldValueIRS element (for citing)
Number Of Activities Or Programs18NumberOfActivitiesOrPrograms
Persons Served1000PersonsServed
Total Community Building Expense85579TotalCommunityBuildingExpense
Net Community Building Expense85579NetCommunityBuildingExpense
Percent Of Total Expense0.00080PercentOfTotalExpense
FieldValueIRS element (for citing)
Bad Debt Expense ReportedtrueBadDebtExpenseReported
Bad Debt Expense$2,345,649BadDebtExpenseAmount
Amount Reimbursed By Medicare31605864AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare38671662CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall-7065798MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

FieldValueIRS element (for citing)
Cost To Charge RatioXCostToChargeRatio
FieldValueIRS element (for citing)
Written Debt Collection PolicytrueWrittenDebtCollectionPolicy
Provision For Charity CaretrueProvisionForCharityCare

Form990 Schedule H Part IV Form990ScheduleHPartIV (2 entries)

Description Ent Primary ActivityDescriptionEntPrimaryActivityOrganization Profit Or OwnershipOrganizationProfitOrOwnershipPhysicans Profit Or OwnershipPhysicansProfitOrOwnership
COMM ENDOSCOPY CTR
ENDOSCOPY CENTER0.410000.49000
MADISON MED ASSOC
REAL ESTATE0.300000.30000
FieldValueIRS element (for citing)
Number Of Hospital Facilities1NumberOfHospitalFacilities

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA

FieldValueIRS element (for citing)
Facility Number1FacilityNumber

Name Name

FieldValueIRS element (for citing)
Business Name Line1COMM HOSP OF ANDERSON & MADISON CTYBusinessNameLine1

Address Address

FieldValueIRS element (for citing)
Address Line11515 NORTH MADISON AVENUEAddressLine1
CityANDERSONCity
StateINState
ZIP Code46011ZIPCode
FieldValueIRS element (for citing)
Licensed HospitalXLicensedHospital
General Medical And SurgicalXGeneralMedicalAndSurgical
Er24 HoursXEr24Hours
OtherSEE ADDITIONAL INFORMATIONOther

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1COMM HOSP OF ANDERSON & MADISON CTYBusinessNameLine1
FieldValueIRS element (for citing)
Hospital Facility Number1HospitalFacilityNumber
CHNA ConductedtrueCHNAConducted
Community DefinitionXCommunityDefinition
Community DemographicsXCommunityDemographics
Existing ResourcesXExistingResources
How Data ObtainedXHowDataObtained
Community Health NeedsXCommunityHealthNeeds
Other Health IssuesXOtherHealthIssues
Identifying ProcessXIdentifyingProcess
Consulting ProcessXConsultingProcess
Information GapsXInformationGaps
OtherXOther
Needs Assessment Conducted11NeedsAssessmentConducted
Take Into AccounttrueTakeIntoAccount
Other FacilitiestrueOtherFacilities
CHNA Widely AvailabletrueCHNAWidelyAvailable
Own WebsiteXOwnWebsite
On RequestXOnRequest
Other MethodXOtherMethod
Adopt Implement StrategyXAdoptImplementStrategy
Execute Implement StrategyXExecuteImplementStrategy
Develop Community PlanXDevelopCommunityPlan
Participate Community PlanXParticipateCommunityPlan
Include Operational PlansXIncludeOperationalPlans
Adopt BudgetXAdoptBudget
Prioritize Health NeedsXPrioritizeHealthNeeds
Prioritize ServicesXPrioritizeServices
Other Needs AddressedXOtherNeedsAddressed
All Needs AddressedfalseAllNeedsAddressed
Eligibility Criteria ExplainedtrueEligibilityCriteriaExplained
Uses FPG FreetrueUsesFPGFree
FPG Free Percent200.0FPGFreePercent
Uses FPG DiscountedtrueUsesFPGDiscounted
FPG Discount Percent300.0FPGDiscountPercent
Explains BasistrueExplainsBasis
Income LevelXIncomeLevel
Asset LevelXAssetLevel
Medical IndigencyXMedicalIndigency
Explains Application MethodtrueExplainsApplicationMethod
Includes Publicity MeasurestrueIncludesPublicityMeasures
Available On RequestXAvailableOnRequest
Other PublicityXOtherPublicity
Actions On NonpaymenttrueActionsOnNonpayment
Collection ActivitiesfalseCollectionActivities
Nondiscrim Emergency Care PolicytrueNondiscrimEmergencyCarePolicy
Used Other MethodXUsedOtherMethod
Amounts Generally BilledfalseAmountsGenerallyBilled
Gross ChargestrueGrossCharges

Form990 Schedule H Part VI Form990ScheduleHPartVI (16 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
RELATED ORGANIZATION INFORMATIONPART I LINE 6AA 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 EXPLANATIONPART I LINE 7A 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 7G SUBSIDIZED HEALTH SERVICES EXPLANATION SUBSIDIZED HEALTH SERVICES WERE NOT REPORTED FOR CHA
COMMUNITY BUILDING ACTIVITIESPART IISEE ATTACHED IRS 990 SCHEDULE H SUPPLEMENTAL INFORMATION REPORT WHICH INCLUDES INFORMATION FOR COMMUNITY HOSPITAL OF ANDERSON AND MADISON COUNTY INC
BAD DEBT EXPENSE EXPLANATIONPART III LINE 4THE 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 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 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 DOUBTFUL ACCOUNTS 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 DOUBTFUL ACCOUNTS PROVISION FOR BAD DEBTS AND CHARITY FOR EXPECTED UNCOLLECTIBLE DEDUCTIBLES AND COINSURANCES FOR RECEIVABLES ASSOCIATED WITH SELFPAY PATIENTS 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 IHH 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 AS SUCH THE ALLOWANCE FOR DOUBTFUL ACCOUNTS IS SIGNIFICANT FOR THIS COMPONENT OF THE ACCOUNTS RECEIVABLE THE NETWORKS ALLOWANCE FOR DOUBTFUL ACCOUNTS INCREASED BY 956 IN FISCAL YEAR 2011 FROM FISCAL YEAR 2010 THIS INCREASE IS THE RESULT OF ACCOUNTS THAT WERE TRANSFERRED TO THE COLLECTION COMPANY DURING FISCAL YEAR 2011 FOR CHNW CHS VEI AND IHH ACCOUNTS TRANSFERRED TO COLLECTIONS DURING FISCAL YEAR 2011 REPRESENTED 1086 OF THE TOTAL GROSS ACCOUNTS RECEIVABLE IN FISCAL YEAR 2011 WESTVIEW WAS CONSOLIDATED ONTO THE NETWORK FINANCIAL STATEMENTS WHICH ATTRIBUTED TO 2985000 OF THE OVERALL INCREASE FROM FISCAL YEAR 2010 THE NETWORK HAS NOT CHANGED ITS CHARITY CARE OR UNINSURED DISCOUNT POLICIES DURING FISCAL YEARS 2011 OR 2010 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 CHARITY CARE TO PATIENTS WHOSE INCOME LEVEL IS BELOW 200 OF THE FEDERAL POVERTY LEVEL EFFECTIVE JANUARY 1 2010 THE NETWORK EARLY ADOPTED ACCOUNTING STANDARDS UPDATE ASU NO 201023 HEALTH CARE ENTITIES TOPIC 954 MEASURING CHARITY CARE FOR DISCLOSURE AS A RESULT OF ASU NO 201023 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 FORGONE FOR SERVICES AND SUPPLIES FURNISHED UNDER ITS CHARITY CARE POLICY AND WAS 26939000 AND 25693000 FOR THE YEARS ENDED DECEMBER 31 2011 AND 2010 RESPECTIVELY CHARITY CARE COST WAS DETERMINED ON THE APPLICATION OF THE ASSOCIATED COSTTO CHARGE RATIOS
MEDICARE EXPLANATIONPART III LINE 8PER 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 4831 OF THE OVERALL PAYER MIX FOR COMMUNITY HOSPITAL OF ANDERSON AND MADISON COUNTY INC
COLLECTION PRACTICES EXPLANATIONPART III LINE 9BIF A PATIENT IS DETERMINED TO BE ELIGIBLE FOR HARDSHIP DURING THE COLLECTION PROCESS COLLECTION EFFORTS ARE STOPPED AND HARDSHIP IS GIVEN
ADDITIONAL INFORMATIONPART VIPART V FACILITY INFORMATION OTHER CHA IS AN ACUTE CARE MEDICAL FACILITY WITH 137 STAFFED BEDS IN 2011 THERE WERE 6216 ADMISSIONS WITH AN AVERAGE LENGTH OF STAY OF 361 DAYS THERE WERE 29543 EMERGENCY ROOM CASES RESPONDED TO IN OUR 24HOURSEVEN DAY A WEEK EMERGENCY ROOM 66 OF THE BIRTHS IN MADISON COUNTY WERE DELIVERED AT CHA FOR A TOTAL OF 881 BIRTHS IN 2011 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 1JPART V LINE 1JSEE ATTACHED IRS 990 SCHEDULE H SUPPLEMENTAL INFORMATION REPORT
COMM HOSP OF ANDERSON MADISON CTY LINE NUMBER 1 PART V LINE 3PART V LINE 3SEE ATTACHED IRS 990 SCHEDULE H SUPPLEMENTAL INFORMATION REPORT
COMM HOSP OF ANDERSON MADISON CTY LINE NUMBER 1 PART V LINE 4PART V LINE 4SEE ATTACHED IRS 990 SCHEDULE H SUPPLEMENTAL INFORMATION REPORT
COMM HOSP OF ANDERSON MADISON CTY LINE NUMBER 1 PART V LINE 5CPART V LINE 5CSEE ATTACHED IRS 990 SCHEDULE H SUPPLEMENTAL INFORMATION REPORT
COMM HOSP OF ANDERSON MADISON CTY LINE NUMBER 1 PART V LINE 6IPART V LINE 6ISEE ATTACHED IRS 990 SCHEDULE H SUPPLEMENTAL INFORMATION REPORT
COMM HOSP OF ANDERSON MADISON CTY LINE NUMBER 1 PART V LINE 7PART V LINE 7SEE ATTACHED IRS 990 SCHEDULE H SUPPLEMENTAL INFORMATION REPORT
COMM HOSP OF ANDERSON MADISON CTY LINE NUMBER 1 PART V LINE 13GPART V LINE 13GWHILE 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 15 CHA DOES NOT ATTEMPT ANY OF THESE OPTIONS WITHOUT FIRST MAKING REASONABLE EFFORTS TO DETERMINE HARDSHIP ELIGIBILITY
COMM HOSP OF ANDERSON MADISON CTY LINE NUMBER 1 PART V LINE 19DPART V LINE 19DTHE HOSPITAL CHARGES ALL PATIENTS THE SAME PRICE REGARDLESS OF INSURANCE ABILITY TO PAY AGE RACE GENDER OR NATIONAL ORIGIN
COMM HOSP OF ANDERSON MADISON CTY LINE NUMBER 1 PART V LINE 21PART V LINE 21THE HOSPITAL CHARGED FAPELIGIBLE PATIENTS THE SAME AS ANY OTHER PATIENT HOWEVER THE HOSPITAL DID NOT REQUIRE THEM TO PAY THE BILL

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records MaintainedtrueRecordsMaintained

Recipient Table RecipientTable (6 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEIN Of RecipientEINOfRecipientIRC SectionIRCSectionAmount Of Cash GrantAmountOfCashGrantPurpose Of GrantPurposeOfGrant
ALEXANDRIA REDEVELOPMENT COMMISSION
125 N WAYNE STREETALEXANDRAIN46001351061754GOV25000GENERAL SUPPORT
ALTERNATIVES INC
PO BOX 1302ANDERSONIN4601531098676936500GENERAL SUPPORT
ANDERSON SYMPHONY ORCHESTRA
1124 MERIDIAN PLAZAANDERSONIN46015310940546312250GENERAL SUPPORT
HEALTH & HOSPITAL CORP OF MARION CO
3838 N RURAL STREET 8TH FLOORINDIANAPOLISIN46205356005697GOV10000GENERAL SUPPORT
PARAMOUNT HERITAGE FOUNDATION INC
1124 MERIDIAN PLAZAANDERSONIN4601635177421739765GENERAL SUPPORT
UNITED WAY OF MADISON COUNTY INC
1201 E 5TH STREET SUITE 1019ANDERSONIN46015351052350314100GENERAL SUPPORT
FieldValueIRS element (for citing)
Total Nbr Of501 C3 And Govt Grants6TotalNbrOf501C3AndGovtGrants

Form990 Schedule I Part IV Form990ScheduleIPartIV

FieldValueIRS element (for citing)
IdentifierPROCEDURES FOR MONITORING THE USE OF GRANT FUNDS INSIDE THE UNITED STATESIdentifier
Return ReferenceSCHEDULE I, PAGE 1, PART I, LINE 2ReturnReference
ExplanationTHE CONTRIBUTIONS TO VARIOUS LOCAL CHARITABLE ORGANIZATIONS WERE UNRESTRICTED DONATIONS.Explanation

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Club Dues Or FeesXClubDuesOrFees
Written Policy Re T And E ExpensesfalseWrittenPolicyReTAndEExpenses
Substantiation RequiredtrueSubstantiationRequired
Compensation CommitteeXCompensationCommittee
Independent ConsultantXIndependentConsultant
Written Employment ContractXWrittenEmploymentContract
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance PaymentfalseSeverancePayment
Supplemental Nonqual Retire PlantrueSupplementalNonqualRetirePlan
Equity Based Comp ArrangementtrueEquityBasedCompArrangement
Comp Based On Revenue Of Filing OrgfalseCompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related OrgsfalseCompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing OrgfalseCompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate OrgsfalseCompBasedNetEarningsRelateOrgs
Any Non Fixed PaymentstrueAnyNonFixedPayments
Initial Contract ExceptionfalseInitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (9 entries)

Comp Based On Related OrgsCompBasedOnRelatedOrgsBonus Related OrgsBonusRelatedOrgsOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgsBase Compensation Filing OrgBaseCompensationFilingOrgBonus Filing OrgBonusFilingOrgOther Compensation Filing OrgOtherCompensationFilingOrgDeferred Comp Filing OrgDeferredCompFilingOrgNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgTotal Compensation Filing OrgTotalCompensationFilingOrgComp Report Prior990 Filing OrgCompReportPrior990FilingOrg
BRYAN A MILLS
77953013979419167288500245071251498139794
WILLIAM C VANNESS II MD
32614436404214281733541164256897236404
DAVID A SHAPIRO MD
284828178973911016657358492
JOHN B HARRIS
1834281487316169991521728933091114873
TAHIR ALI NAQVI MD
5457871263793693311011050277562917717897000
NIGHAT TAHIR MD
2326401520407076985025746480983
RYAN HINDS MD
32445421502735014856368162
JARED ANDERSON MD
31776224358735021014370484
VIRGIL LOGHIN MD
299530156667350322546

Form990 Schedule J Part III Form990ScheduleJPartIII (4 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
FRINGE OR EXPENSE EXPLANATIONSCHEDULE J, PAGE 1, PART I, LINE 1ATHE 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 EXPLANATIONSCHEDULE J, PAGE 1, PART I, LINE 1BTHE 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.
SEVERANCE, NONQUALIFIED, AND EQUITY-BASED PAYMENTSSCHEDULE J, PAGE 1, PART I, LINE 4BRYAN A. MILLS 0 0 139,794
OTHER ADDITIONAL INFORMATIONSCHEDULE J, PART IIIPART 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 2011. PART I, LINE 4C PERFORMANCE-BASED COMPENSATION ARRANGEMENT BRYAN A. MILLS PARTICIPATED IN A PERFORMANCE BASED PLAN DURING 2010 WITH VISIONARY ENTERPRISES, INC. DURING 2011, MR. MILLS RECEIVED A FINAL PAYOUT OF 139,794 FROM THE PLAN. 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 INDENDEPENDENT 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.

Schedule L IRS990ScheduleL

Form990 Schedule L Part IV Form990ScheduleLPartIV

Name Of Interested Person NameOfInterestedPerson

FieldValueIRS element (for citing)
Name PersonINDIANA PROHEALTH NETWORK INCNamePerson
FieldValueIRS element (for citing)
RelationshipSHARE BD MEMBERRelationship
Amount Of Transaction12275249AmountOfTransaction
Description Of TransactionHLTH INSUR/PLAN FEESDescriptionOfTransaction
Sharing Of RevenuesfalseSharingOfRevenues

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (13 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
ORGANIZATION'S MISSIONFORM 990 - ORGANIZATION'S MISSIONTHE 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 INFORMATIONFORM 990, PART VIFORM 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: MICHAEL L. BAKER - COMMUNITY HEALTH NETWORK, INC. BRYAN A. MILLS - COMMUNITY HEALTH NETWORK, INC. - COMMUNITY HEALTH NETWORK FOUNDATION, INC. - COMMUNITY HOME HEALTH SERVICES, INC. - COMMUNITY PHYSICIANS OF INDIANA, INC. - INDIANA HEART HOSPITAL, LLC - INDIANAPOLIS OSTEOPATHIC HOSPITAL, INC. - INDIANA PROHEALTH NETWORK, INC. - VISIONARY ENTERPRISES, INC. DAVID A. SHAPIRO, M.D. - COMMUNITY PHYSICIANS OF INDIANA, INC.
MANAGEMENT DELEGATEDFORM 990, PAGE 6, PART VI, LINE 3THROUGH 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 INITIATIES RECOMMENDATIONS TO THE COMMUNITY HOSPITALS OF INDIANA, INC. ("CHI") BOARD OF DIRECTORS FOR ITS APPROVAL FOR 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 CHI 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 CHI TO MADISON COUNTY.
CLASSES OF MEMBERS OR STOCKHOLDERSFORM 990, PAGE 6, PART VI, LINE 6COMMUNITY HOSPITALS OF INDIANA, INC. ("CHI") IS THE SOLE MEMBER OF COMMUNITY HOSPITAL OF ANDERSON AND MADISON COUNTY, INC. ("CHA"). CHI IS AN EXEMPT ORGANIZATION PURSUANT TO SECTION 501(C)(3).
ELECTION OF MEMBERS AND THEIR RIGHTSFORM 990, PAGE 6, PART VI, LINE 7ACHA'S BOARD OF TRUSTEES MEMBERSHIP IS DETERMINED AS FOLLOWS: A) CHI, 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 CHI'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 MEMBERSFORM 990, PAGE 6, PART VI, LINE 7BCHI, 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 990FORM 990, PAGE 6, PART VI, LINE 11BTHE 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 POLICYFORM 990, PAGE 6, PART VI, LINE 12CCHA 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, RETAILIATION, 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 OFFICIALFORM 990, PAGE 6, PART VI, LINE 15ACHA 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 OFFICERSFORM 990, PAGE 6, PART VI, LINE 15BSEE PART VI, LINE 15A ABOVE. FORM 990, PART VI, LINE 16A - JOINT VENTURES SEE SCHEDULE H, PART IV
GOVERNING DOCUMENTS DISCLOSURE EXPLANATIONFORM 990, PAGE 6, PART VI, LINE 19A) 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.
ADDITIONAL INFORMATIONFORM 990, PART VIIFORM 990, PART VII - AVERAGE HOURS WORKED FOR RELATED ORGANIZATION BRYAN A. MILLS - 55 DAVID A. SHAPIRO, M.D. - 40
OTHER CHANGES IN NET ASSETS EXPLANATIONFORM 990, PART XI, LINE 5DECREASE IN INVESTMENT MARKET VALUE (1,296,873)

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (12 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Controlled OrgControlledOrg
COMMUNITY HOSP ANDERSON FDN INC
1515 NORTH MADISON AVENUEANDERSONIN46011861053152CHARITYIN501C37CHAtrue
COMMUNITY LTC INC
1031 MONTICELLO DRIVEANDERSONIN46011351877441HLTH CAREIN501C39CHAtrue
COMMUNITY HEALTH NETWORK INC
7330 SHADELAND STATION SUITE 200INDIANAPOLISIN46256311038302SUPPORTIN501C311BNAfalse
COMMUNITY HEALTH NETWORK FOUNDATION
1500 NORTH RITTER AVENUEINDIANAPOLISIN46219510181688CHARITYIN501C311BCHNWtrue
COMMUNITY HOME HEALTH SERVICES INC
9894 EAST 121ST STREETFISHERSIN46037350953467HLTH CAREIN501C39CHNWtrue
COMMUNITY HOSPITALS OF INDIANA INC
1500 NORTH RITTER AVENUEINDIANAPOLISIN46219350983617HOSPITALIN501C33CHNWfalse
COMMUNITY HOSPITAL SOUTH INC
1402 E COUNTY LINE ROAD SOUTHINDIANAPOLISIN46227351088640HOSPITALIN501C33CHItrue
COMMUNITY PHYSICIANS OF IN INC
7240 SHADELAND STATION SUITE 300INDIANAPOLISIN46256205392766PHY SRVIN501C39CHItrue
INDIANA HEART HOSPITAL LLC
8075 NORTH SHADELAND AVENUEINDIANAPOLISIN46250352123783HOSPITALIN501C33CHItrue
INDIANAPOLIS OSTEOPATHIC HOSPITAL
3630 GUION ROADINDIANAPOLISIN46222351094734HOSPITALIN501C33CHNWtrue
WESTVIEW HOSPITAL FOUNDATION INC
3630 GUION ROADINDIANAPOLISIN46222311036451SUPPORTIN501C311BIOHtrue
HEALTH INSTITUTE OF INDIANA INC
3660 GUION ROADINDIANAPOLISIN46222352022402FITNESSIN501C39IOHtrue

Form990 Schedule R Part III Form990ScheduleRPartIII (12 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivityPrimaryActivityLegal Domicile StateLegalDomicileStateDirect Controlling Entity NADirectControllingEntityNADisproportionate AllocationsDisproportionateAllocationsGeneral Or Managing PartnerGeneralOrManagingPartner
EAST CAMPUS SURGERY CENTER LLC
7330 SHADELAND STATION SUITE 200INDIANAPOLISIN46256352028517SURGERYINN/Afalsefalse
INDIANA SPECIALTY GROUP
7240 SHADELAND STATION SUITE 300INDIANAPOLISIN46256351976258HLTH CAREINN/Afalsefalse
MICHIGAN SURGERY INVESTMENT LLC
7330 SHADELAND STATION SUITE 200INDIANAPOLISIN46256320147008SURG CTRSINN/Afalsefalse
NORTH CAMPUS OFFICE ASSOCIATES LP
7330 SHADELAND STATION SUITE 200INDIANAPOLISIN46256351808625RNTL PROPINN/Afalsefalse
NORTH CAMPUS SURGERY CENTERS LLC
7330 SHADELAND STATION SUITE 200INDIANAPOLISIN46256352147088SURGERYINN/Afalsefalse
SURGICARE LLC
2907 MCINTIRE DRIVEBLOOMINGTONIN47403351975122SURGERYINN/Afalsefalse
EAST CAMPUS SURGERY CENTER LLC
7330 SHADELAND STATION SUITE 200INDIANAPOLISIN46256352028517SURGERYINN/Afalsefalse
INDIANA SPECIALTY GROUP
7240 SHADELAND STATION SUITE 300INDIANAPOLISIN46256351976258HLTH CAREINN/Afalsefalse
MICHIGAN SURGERY INVESTMENT LLC
7330 SHADELAND STATION SUITE 200INDIANAPOLISIN46256320147008SURG CTRSINN/Afalsefalse
NORTH CAMPUS OFFICE ASSOCIATES LP
7330 SHADELAND STATION SUITE 200INDIANAPOLISIN46256351808625RNTL PROPINN/Afalsefalse
NORTH CAMPUS SURGERY CENTERS LLC
7330 SHADELAND STATION SUITE 200INDIANAPOLISIN46256352147088SURGERYINN/Afalsefalse
SURGICARE LLC
2907 MCINTIRE DRIVEBLOOMINGTONIN47403351975122SURGERYINN/Afalsefalse

Form990 Schedule R Part IV Form990ScheduleRPartIV (12 entries)

Address Line1AddressForeign/AddressLine1Province Or StateAddressForeign/ProvinceOrStateCountryAddressForeign/CountryEINEINPrimary ActivityPrimaryActivityLegal Domicile Foreign CountryLegalDomicileForeignCountryDirect Controlling Entity NADirectControllingEntityNAAddress Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeLegal Domicile StateLegalDomicileState
CHN ASSURANCE COMPANY LTD
PO BOX 1051GTGRAND CAYMANCJ980418913INSURANCECJN/A
INDIANA PROHEALTH NETWORK INC
351614719INSURANCEN/A8180 CLEARVISTA PARKWAY SUITE 230INDIANAPOLISIN46256IN
VISIONARY ENTERPRISES INC
351538433MGMT SRVCSN/A7330 SHADELAND STATION SUITE 200INDIANAPOLISIN46256IN
VEI MICHIGAN INC
300097377MGMT SRVCSN/A940 N MAIN STREETANN HARBORMI48104MI
VEI-PRO HEALTH INC
454037444INSURANCEN/A7330 SHADELAND STATION SUITE 200INDIANAPOLISIN46256IN
WESTVIEW DELIVERY SYSTEM INC
351910292MGMT SRVCSN/A3630 GUION ROADINDIANAPOLISIN46222IN
CHN ASSURANCE COMPANY LTD
PO BOX 1051GTGRAND CAYMANCJ980418913INSURANCECJN/A
INDIANA PROHEALTH NETWORK INC
351614719INSURANCEN/A8180 CLEARVISTA PARKWAY SUITE 230INDIANAPOLISIN46256IN
VISIONARY ENTERPRISES INC
351538433MGMT SRVCSN/A7330 SHADELAND STATION SUITE 200INDIANAPOLISIN46256IN
VEI MICHIGAN INC
300097377MGMT SRVCSN/A940 N MAIN STREETANN HARBORMI48104MI
VEI-PRO HEALTH INC
454037444INSURANCEN/A7330 SHADELAND STATION SUITE 200INDIANAPOLISIN46256IN
WESTVIEW DELIVERY SYSTEM INC
351910292MGMT SRVCSN/A3630 GUION ROADINDIANAPOLISIN46222IN
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents RoyaltiestrueReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other OrgfalseGiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other OrgfalseGiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other OrgtrueLoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other OrgfalseLoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other OrgfalseSaleOfAssetsToOtherOrg
Purchase Of Assets From Other OrgfalsePurchaseOfAssetsFromOtherOrg
Exchange Of AssetsfalseExchangeOfAssets
Rental Of Facilities To Other OrgstrueRentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other OrgsfalseRentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other OrgsfalsePerformOfServicesForOtherOrgs
Perform Of Services By Other OrgsfalsePerformOfServicesByOtherOrgs
Sharing Of FacilitiesfalseSharingOfFacilities
Sharing Of Paid EmployeesfalseSharingOfPaidEmployees
Reimbursement Paid To Other OrgtrueReimbursementPaidToOtherOrg
Reimbursement Paid By Other OrgtrueReimbursementPaidByOtherOrg
Other Transfer To Other OrgtrueOtherTransferToOtherOrg
Other Transfer From Other OrgtrueOtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable (42 entries)

Transaction TypeTransactionTypeAmount InvolvedAmountInvolvedMethod Of Amt DeterminationMethodOfAmtDetermination
COMMUNITY HOSP ANDERSON FDN INC
C297960BOOK VALUE
COMMUNITY HOSP ANDERSON FDN INC
P146317BOOK VALUE
COMMUNITY LTC INC
A9663BOOK VALUE
COMMUNITY LTC INC
I168806BOOK VALUE
COMMUNITY LTC INC
P534029BOOK VALUE
COMMUNITY LTC INC
R108562BOOK VALUE
COMMUNITY HOME HEALTH SERVICES INC
P85752BOOK VALUE
COMMUNITY PHYSICIANS OF IN INC
A640354BOOK VALUE
COMMUNITY PHYSICIANS OF IN INC
R86405BOOK VALUE
INDIANA HEART HOSPITAL LLC
Q75402BOOK VALUE
INDIANA HEART HOSPITAL LLC
O402684BOOK VALUE
INDIANA PROHEALTH NETWORK INC
O8277707BOOK VALUE
INDIANA PROHEALTH NETWORK INC
P3288780BOOK VALUE
INDIANA PROHEALTH NETWORK INC
Q708762BOOK VALUE
COMMUNITY HOSP ANDERSON FDN INC
C297960BOOK VALUE
COMMUNITY HOSP ANDERSON FDN INC
P146317BOOK VALUE
COMMUNITY LTC INC
A9663BOOK VALUE
COMMUNITY LTC INC
I168806BOOK VALUE
COMMUNITY LTC INC
P534029BOOK VALUE
COMMUNITY LTC INC
R108562BOOK VALUE
COMMUNITY HOME HEALTH SERVICES INC
P85752BOOK VALUE
COMMUNITY PHYSICIANS OF IN INC
A640354BOOK VALUE
COMMUNITY PHYSICIANS OF IN INC
R86405BOOK VALUE
INDIANA HEART HOSPITAL LLC
Q75402BOOK VALUE
INDIANA HEART HOSPITAL LLC
O402684BOOK VALUE
INDIANA PROHEALTH NETWORK INC
O8277707BOOK VALUE
INDIANA PROHEALTH NETWORK INC
P3288780BOOK VALUE
INDIANA PROHEALTH NETWORK INC
Q708762BOOK VALUE
COMMUNITY HOSP ANDERSON FDN INC
C297960BOOK VALUE
COMMUNITY HOSP ANDERSON FDN INC
P146317BOOK VALUE
COMMUNITY LTC INC
A9663BOOK VALUE
COMMUNITY LTC INC
I168806BOOK VALUE
COMMUNITY LTC INC
P534029BOOK VALUE
COMMUNITY LTC INC
R108562BOOK VALUE
COMMUNITY HOME HEALTH SERVICES INC
P85752BOOK VALUE
COMMUNITY PHYSICIANS OF IN INC
A640354BOOK VALUE
COMMUNITY PHYSICIANS OF IN INC
R86405BOOK VALUE
INDIANA HEART HOSPITAL LLC
Q75402BOOK VALUE
INDIANA HEART HOSPITAL LLC
O402684BOOK VALUE
INDIANA PROHEALTH NETWORK INC
O8277707BOOK VALUE
INDIANA PROHEALTH NETWORK INC
P3288780BOOK VALUE
INDIANA PROHEALTH NETWORK INC
Q708762BOOK VALUE