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 351088640 COMMUNITY HOSPITAL SOUTH INC COMM 3173555822 1402 E COUNTY LINE ROAD SOUTH INDIANAPOLIS IN 46227 JEFFERY KIRKHAM 3173555822 2012-11-07 true JAMES A CASKEY CPA CFP 3175852647 2012-11-06 2011 2016-02-24 21:20:13Z MICHAEL C BLANCHET 7330 SHADELAND STATION SUITE 200 INDIANAPOLIS IN 46256 159537145 false X WWW.ECOMMUNITY.COM X 1989 IN COMMUNITY HOSPITAL SOUTH, INC. ("CHS") IS A 501(C)(3) CORPORATION SERVING THE HEALTH RELATED NEEDS OF THE CITIZENS OF THE INDIANAPOLIS METROPOLITAN AREA AND CENTRAL INDIANA. CHS OPERATES A GENERAL ACUTE CARE HOSPITAL AND PROVIDES INPATIENT, OUTPATIENT, EMERGENCY AND AMBULATORY HEALTH CARE SERVICES TO ALL PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. 3 2 918 185 0 206191 65077 138800062 152973513 -49627 0 5023344 6498555 143979970 159537145 0 0 44980643 52901211 0 0 87830563 83592561 132811206 136493772 11168764 23043373 184350314 206686035 5856021 5148369 178494293 201537666 X COMMUNITY HOSPITAL SOUTH, INC. ("CHS") IS A 501(C)(3) CORPORATION SERVING THE HEALTH RELATED NEEDS OF THE CITIZENS OF THE INDIANAPOLIS METROPOLITAN AREA AND CENTRAL INDIANA. CHS OPERATES A GENERAL ACUTE CARE HOSPITAL AND PROVIDES INPATIENT, OUTPATIENT, EMERGENCY AND AMBULATORY HEALTH CARE SERVICES TO ALL PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. false false 88836373 152973513 COMMUNITY HOSPITAL SOUTH ("CHS") IS AN ACUTE CARE HOSPITAL IN INDIANAPOLIS, INDIANA WITH 150 LICENSED BEDS. IN 2011, CHS SERVED 8,206 INPATIENTS FOR A TOTAL OF 29,651 INPATIENT DAYS OF SERVICE. CHS ALSO PROVIDED 75,052 OUTPATIENT VISITS, WHICH EXCLUDED 36,773 EMERGENCY VISITS. COMMUNITY HOSPITAL SOUTH OFFERS MANY PATIENT FOCUSED HEALTHCARE SERVICES THAT INCLUDE WOMEN AND CHILDREN SERVICES, PEDIATRICS, ONCOLOGY, NEUROSCIENCES, ORTHOPEDICS, JOINT REPLACEMENT, BREAST CARE SERVICES, SURGERY SERVICES, REHABILITATION SERVICES, HEALTH PROMOTION SERVICES, AND EMERGENCY SERVICES. 88836373 true true false false false false false false false false true false false true false false false true false false false false false false false false true true false false true false false false false false false false true false false false false false true true true false false true 53 0 true 918 true false false false false false false false false false false X 3 2 true true false false true true true true true false false false true true true true true true false false IN X JEFFERY KIRKHAM 3173555822 1500 N RITTER AVENUE INDIANAPOLIS IN 46219 X MICHAEL C BLANCHET 10.00 X X 0 500069 350826 STEVEN R PLUMP 5.00 X X 0 0 0 KRISTIN T SHERMAN 5.00 X X 0 0 0 TONY LENNEN 50.00 X 328925 0 133178 JEFFERY KIRKHAM 10.00 X 0 271324 274763 SUSAN LOTTICH MD 50.00 X 679622 0 145132 ERIN ZUSAN MD 50.00 X 363398 0 72054 RANDALL LEE MD 50.00 X 254556 0 83838 SHERYL KING MD 50.00 X 222580 0 46827 WILLIAM JONES 45.00 X 204169 0 40419 CHARLES SALAZAR MD 0.00 X 0 639252 24793 2053250 1410645 1171830 25 true true false 65077 65077 PATIENT REVENUE 900099 152973513 152973513 152973513 EHR INCENTIVE PAYMENTS 900099 2283408 2283408 LEASED EQUIPMENT 532420 2096971 2096971 LAB REVENUE 621500 546439 546439 1571737 1571737 6498555 159537145 159472068 462103 462103 41514740 33697219 7817521 1158577 1158577 6902893 5541348 1361545 2862898 2329677 533221 35525618 9624981 25900637 750 197 553 32051667 30838745 1212922 618802 192428 426374 2772600 2225725 546875 52627 31957 20670 14284 9141 5143 2514248 2514248 9856711 4285373 5571338 7017 7017 CORPORATE DEVELOPMENT 65054 20230 44824 DUES & SUBSCRIPTIONS 44494 17992 26502 SECURITY EQUIPM & EXP 38163 11868 26295 RECRUITMENT EXPENSE 22844 7104 15740 7682 2388 5294 136493772 88836373 47657399 0 3350 2425 23520126 24399806 2468269 2632225 216010550 85377379 127940404 130633171 30418165 49018408 184350314 206686035 5847635 5148369 8386 5856021 5148369 X 178494293 201537666 178494293 201537666 184350314 206686035 23043373 X false true true X false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false false false 497000 497000 156167108 31893015 124274093 1521995 501791 1020204 55063569 51359596 3703973 2760878 1622977 1137901 130633171 DUE FROM AFFLIATED ENTITIES 48866307 THIRD PARTY RECEIVABLE 152101 49018408 true true true X true X true true false true true 7750 3933939 3933939 0.02880 11900 11926732 5624267 6302465 0.04620 19650 15860671 5624267 10236404 0.07500 7 2849409 2849409 0.02090 3 213677 61607 152070 0.00110 1 314206 314206 0.00230 11 3377292 61607 3315685 0.02430 11 19650 19237963 5685874 13552089 0.09930 true 3121060 38244154 43427294 -5183140 X true true NONE 1 1 COMMUNITY HOSPITAL SOUTH

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X X X X COMMUNITY HOSPITAL SOUTH 1 true X X X X X X X X X X 11 true true true X X X X X X X X X X X X false true true 200.0 true 300.0 true X X true true X X X X X true X X false true X false false 7 COMMUNITY REGIONAL CANCER CENTER

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HEALTH CARE COMM HEART & VASCULAR CV TESTING

1402 E COUNTY LINE ROAD 2200 INDIANAPOLIS IN 46227

HEALTH CARE COMMUNITY IMAGING CENTER

333 E COUNTY LINE ROAD SUITE A GREENWOOD IN 46143

DIAGNOSTIC CENTER CHS SLEEP DISORDERS CENTER

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REHABILITATION REHAB & SPORTS MEDICINE

1340 E COUNTY LINE ROAD U INDIANAPOLIS IN 46227

REHABILITATION CENTER FOR WOMEN'S HEALTH

533 E COUNTY LINE ROAD 101 GREENWOOD IN 46143

HEALTH CARE RELATED ORGANIZATION INFORMATION PART I LINE 6A A COMMUNITY BENEFIT REPORT IS COMPLETED FOR THE COMMUNITY HEALTH NETWORK AS A WHOLE COMMUNITY HOSPITAL SOUTH INC IS INCLUDED WITHIN THE NETWORK COMMUNITY BENEFIT REPORT COSTING METHODOLOGY EXPLANATION PART I LINE 7 A COST TO CHARGE RATIO WAS UTILIZED TO DETERMINE COSTS FOR LINES A THROUGH C IN THE TABLE THE COST TO CHARGE RATIO WAS DERIVED FROM WORKSHEET 2 LINES E THROUGH I OF THE TABLE ARE BASED ON ACTUAL INCURRED EXPENSES PART I LINE 7G SUBSIDIZED HEALTH SERVICES EXPLANATION SUBSIDIZED HEALTH SERVICES WERE NOT REPORTED FOR COMMUNITY HOSPITAL SOUTH INC COMMUNITY BUILDING ACTIVITIES PART II COMMUNITY BUILDING ACTIVITIES ARE DISCUSSED WITHIN THE ATTACHED COMMUNITY BENEFIT REPORT BAD DEBT EXPENSE EXPLANATION PART III LINE 4 THE COST TO CHARGE RATIO UTILIZED FOR PURPOSES OF REPORTING BAD DEBT COSTS WAS DERIVED FROM WORKSHEET 2 AND IS BASED ON THE ORGANIZATIONS AUDITED FINANCIAL STATEMENTS COMMUNITY HOSPITAL SOUTH INC UTILIZES AN AUTOMATED SOFTWARE SOLUTION TO ASSIST IN DETERMINING PATIENTS ELIGIBLE FOR FREE CARE AS A RESULT OF THE IMPLEMENTATION OF THIS AUTOMATED SOLUTION THERE IS VERY LITTLE BAD DEBT RECORDED FOR PATIENTS WHO WOULD BE ELIGIBLE FOR FREE CARE UNDER THE NETWORK POLICY THE AUDITED FINANCIAL STATEMENTS CONTAIN THE FOLLOWING TEXT WITHIN THE FOOTNOTES TO DESCRIBE BAD DEBT EXPENSE THE NETWORKS ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS 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 EXPLANATION PART III LINE 8 PER THE 990 INSTRUCTIONS THE MEDICARE COST REPORT WAS UTILIZED TO DETERMINE THE MEDICARE SHORTFALL HOWEVER THE MEDICARE COST REPORT IS NOT REFLECTIVE OF ALL COSTS ASSOCIATED WITH MEDICARE PROGRAMS SUCH AS PHYSICIAN SERVICES AND SERVICES BILLED VIA FREE STANDING CLINICS FURTHER THE MEDICARE COST REPORT EXCLUDES REVENUES AND COSTS OF MEDICARE PART C AND D THE MEDICARE SHORTFALL ATTRIBUTED TO THOSE AREAS NOT INCLUDED ON THE MEDICARE COST REPORT IS 2814088 AS SUCH THE TOTAL MEDICARE SHORTFALL FOR ALL MEDICARE PROGRAMS IS 7997228 MEDICARE SHORTFALLS SHOULD BE CONSIDERED AS COMMUNITY BENEFIT BECAUSE MEDICARE REPRESENTS 3598 OF THE OVERALL PAYER MIX FOR COMMUNITY HOSPITAL SOUTH INC COLLECTION PRACTICES EXPLANATION PART III LINE 9B SEE ATTACHED FINANCIAL ASSISTANCE POLICY ADDITIONAL INFORMATION PART VI PART VI ITEMS 2 THROUGH 5 ARE DISCUSSED WITHIN THE ATTACHED COMMUNITY BENEFIT REPORT FOR A COPY OF THIS REPORT PLEASE CONTACT HOLLY MILLARD AT 317 3555860 PART VI ITEM 6 AFFILIATED HEALTH CARE SYSTEM COMMUNITY HOSPITAL SOUTH INC CHS IS PART OF AN AFFILIATED HEALTH CARE SYSTEM SEE THE ATTACHED IRS 990 SCHEDULE H SUPPLEMENTAL INFORMATION REPORT FOR HOW CHS IS INVOLVED IN PROMOTING THE HEALTH OF THE COMMUNITY IT SERVES PART VI ITEM 7 STATE FILING OF COMMUNITY BENEFIT REPORT INDIANA COMMUNITY HOSPITAL SOUTH LINE NUMBER 1 PART V LINE 1J PART V LINE 1J SEE ATTACHED IRS 990 SCHEDULE H SUPPLEMENTAL INFORMATION REPORT COMMUNITY HOSPITAL SOUTH LINE NUMBER 1 PART V LINE 3 PART V LINE 3 SEE ATTACHED IRS 990 SCHEDULE H SUPPLEMENTAL INFORMATION REPORT COMMUNITY HOSPITAL SOUTH LINE NUMBER 1 PART V LINE 4 PART V LINE 4 SEE ATTACHED IRS 990 SCHEDULE H SUPPLEMENTAL INFORMATION REPORT COMMUNITY HOSPITAL SOUTH LINE NUMBER 1 PART V LINE 5C PART V LINE 5C SEE ATTACHED IRS 990 SCHEDULE H SUPPLEMENTAL INFORMATION REPORT COMMUNITY HOSPITAL SOUTH LINE NUMBER 1 PART V LINE 6I PART V LINE 6I SEE ATTACHED IRS 990 SCHEDULE H SUPPLEMENTAL INFORMATION REPORT COMMUNITY HOSPITAL SOUTH LINE NUMBER 1 PART V LINE 7 PART V LINE 7 SEE ATTACHED IRS 990 SCHEDULE H SUPPLEMENTAL INFORMATION REPORT COMMUNITY HOSPITAL SOUTH LINE NUMBER 1 PART V LINE 19D PART V LINE 19D THE UNINSURED DISCOUNT WAS DETERMINED UTILIZING THE NETWORKS TOP COMMERICIAL PAYORS PER THE NETWORKS AUDITED FINANCIAL STATEMENTS REGARDING UNINSURED DISCOUNTS COSTS FORGONE FOR SERVICES AND SUPPLIES FURNISHED UNDER THE NETWORKS UNINSURED DISCOUNT POLICY APPROXIMATED 6956000 AND 5417000 FOR THE YEARS ENDED DECEMBER 31 2011 AND 2010 RESPECTIVELY UNINSURED DISCOUNTS REPRESENT A STANDARD DISCOUNT ON CHARGES AS IT RELATES TO PATIENTS WHO HAVE NO INSURANCE COVERAGE UNINSURED DISCOUNT COST WAS DETERMINED BASED ON THE APPLICATION OF THE ASSOCIATED COSTTOCHARGE RATIOS TO CHARGES false false false false false false false true false MICHAEL C BLANCHET 489882 10187 343806 7020 850895 TONY LENNEN 327130 1795 108763 24415 462103 JEFFERY KIRKHAM 269875 1449 252298 22465 546087 SUSAN LOTTICH MD 567660 35479 76483 132380 12752 824754 35479 ERIN ZUSAN MD 334703 28695 49772 22282 435452 RANDALL LEE MD 228830 25000 726 83685 153 338394 SHERYL KING MD 205280 17300 33519 13308 269407 WILLIAM JONES 191949 400 11820 27082 13337 244588 CHARLES SALAZAR MD 637665 1587 24793 664045 RELATED ORG METHODS USED FOR COMPENSATION EXPLANATION SCHEDULE J, PAGE 1, PART I, LINE 3 COMMUNITY HOSPITALS OF INDIANA, INC. ("CHI") CEO/EXECUTIVE DIRECTOR IS PAID BY COMMUNITY HEALTH NETWORK, INC. ("CHNW"), A RELATED 501(C)(3) ORGANIZATION. CHNW USES THE FOLLOWING IN DETERMINING THE CEO'S COMPENSATION: 1) COMPENSATION COMMITTEE, 2) INDEPENDENT COMPENSATION CONSULTANT, 3) COMPENSATION SURVEY OR STUDY, AND 4) APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. NON-FIXED PAYMENTS PROVIDED SCHEDULE J, PAGE 1, PART I, LINE 7 DR. SHERYL KING, DR. SUSAN LOTTICH, AND DR. ERIN ZUSAN ARE ELIGIBLE TO PARTICIPATE IN AN INCENTIVE COMPENSATION PLAN AS OUTLINED IN THEIR EMPLOYMENT AGREEMENT WITH COMMUNITY HOSPITALS OF INDIANA, INC. ("CHI"). CHI IS A TAX-EXEMPT ORGANIZATION AND IT DEVELOPED THE COMPENSATION PLAN IN CONJUNCTION WITH AN INDEPENDENT COMPENSATION CONSULTANT. COMMUNITY HOSPITAL SOUTH, INC., PARTICIPATES IN THE NETWORK'S SENIOR LEADERSHIP INCENTIVE PROGRAM. CERTAIN INDIVIDUALS OF THE LEADERSHIP TEAM PARTICIPATE IN THIS PROGRAM. THE PROGRAM WAS ADOPTED BY THE EXECUTIVE COMPENSATION COMMITTEE, AND IS INTENDED TO INFLUENCE OUTSTANDING PERFORMANCE BY THE SENIOR LEADERS, AS MEASURED AGAINST BOTH ORGANIZATIONAL AND INDIVIDUAL PERFORMANCE. THE PROGRAM IS REVIEWED ANNUALLY BY THE EXECUTIVE COMPENSATION COMMITTEE, WHICH IS COMPOSED ENTIRELY OF INDEPENDENT COMMUNITY MEMBERS. THE INCENTIVE COMPENSATION THAT IS AWARDED IS INCLUDED IN TOTAL COMPENSATION TO THE EXECUTIVE. THE TOTAL COMPENSATION (INCLUDING ANY PAYMENTS UNDER THE PROGRAM) IS SUBJECT TO THE REVIEW AND APPROVAL OF THE EXECUTIVE COMPENSATION COMMITTEE AND INDEPENDENT COMPENSATION CONSULTANT, IN CONSIDERATION OF CODE SECTION 4958 (AND THE CORRESPONDING TREASURY REGULATIONS) TO ENSURE THAT IT REFLECTS ARMS LENGTH, FAIR MARKET TERMS. INDIANA PROHEALTH NETWORK INC SHARE BD MEMBER 4588394 HEALTH & PHARM PLANS false ORGANIZATION'S MISSION FORM 990 - ORGANIZATION'S MISSION COMMUNITY HOSPITAL SOUTH, INC. ("CHS") IS A 501(C)(3) CORPORATION SERVING THE HEALTH RELATED NEEDS OF THE CITIZENS OF THE INDIANAPOLIS METROPOLITAN AREA AND CENTRAL INDIANA. CHS OPERATES A GENERAL ACUTE CARE HOSPITAL AND PROVIDES INPATIENT, OUTPATIENT, EMERGENCY AND AMBULATORY HEALTH CARE SERVICES TO ALL PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. ADDITIONAL INFORMATION FORM 990 FORM 990, PART I, LINE 4 - INDEPENDENT VOTING MEMBERS COMMUNITY HOSPITAL SOUTH, INC. ("CHS") IS AN AFFILIATE OF COMMUNITY HEALTH NETWORK ("THE NETWORK"), AN INTEGRATED HEALTH DELIVERY SYSTEM. CHS IS CONTROLLED BY ITS PARENT, COMMUNITY HOSPITALS OF INDIANA, INC. ("CHI"), A TAX-EXEMPT HOSPITAL. THROUGH CHI, CHS IS ULTIMATELY CONTROLLED BY COMMUNITY HEALTH NETWORK, INC. ("CHNW"), THE TAX-EXEMPT PARENT OF THE INTEGRATED HEALTH DELIVERY SYSTEM. CHI HAS THE FOLLOWING POWERS OVER CHS: A) CHI IS THE SOLE MEMBER OF CHS, B) CHI APPOINTS ALL OF THE MEMBERS OF CHS' BOARD OF DIRECTORS, C) THE CHI AND CHS BOARDS OF DIRECTORS ARE IDENTICAL WITH THE EXCEPTION THAT CHS' BOARD ALSO INCLUDES THE CHS MEDICAL OFFICER, D) CHI AND CHS HAVE IDENTICAL OFFICERS, AND E) CHI HAS THE AUTHORITY TO REMOVE ANY MEMBER OF CHS' BOARD OF DIRECTORS. CHI IS LIKEWISE CONTROLLED BY ITS PARENT, CHNW. CHI HAS EXERCISED ITS CONTROL OVER CHS TO ENSURE THAT CHNW HAS EXCLUSIVE AUTHORITY OVER THE FOLLOWING AFFAIRS OF CHS: STRATEGIC PLANNING; CAPITAL ACCESS, BUDGETING, AND ALLOCATION; AUDIT AND COMPLIANCE; EXECUTIVE COMPENSATION; AND DISPUTE RESOLUTION. WITH REGARD TO EXECUTIVE COMPENSATION, CHNW REVIEWS AND APPROVES EXECUTIVE COMPENSATION, INCLUDING CHS' EXECUTIVES, THROUGH THE DELIBERATIONS OF A NETWORK EXECUTIVE COMPENSATION COMMITTEE COMPOSED OF INDEPENDENT OUTSIDE DIRECTORS. LIKEWISE, CHNW REVIEWS AND MANAGES CHS' CONFLICT OF INTEREST TRANSACTIONS THROUGH THE DELIBERATION OF A NETWORK AUDIT COMMITTEE COMPOSED OF INDEPENDENT OUTSIDE DIRECTORS. FORM 990, PART I, LINE 5 - NUMBER OF EMPLOYEES CHS EMPLOYEES ARE LEASED FROM COMMUNITY HEALTH NETWORK, INC. ADDITIONAL INFORMATION FORM 990, PART VI FORM 990, PART VI, LINE 1B - VOTING MEMBERS THAT ARE INDEPENDENT SEE FORM 990, PART I, LINE 4 REFERENCE ON SCHEDULE O ABOVE FORM 990, PART VI, LINE 2 - RELATED PARTY INFORMATION AMONG OFFICERS MANY OF CHS' DIRECTORS, OFFICERS, AND KEY EMPLOYEES SERVE IN AN EXECUTIVE ROLE FOR OTHER TAX-EXEMPT AND TAXABLE AFFILIATES THROUGHOUT THE NETWORK. ALL CHS' DIRECTORS AND/OR OFFICERS ALSO SERVE AS DIRECTORS AND/OR OFFICERS OF COMMUNITY HOSPITALS OF INDIANA, INC. IN ADDITION, THE DIRECTORS SERVE AS DIRECTORS OF THE FOLLOWING ORGANIZATIONS: MICHAEL C. BLANCHET - COMMUNITY HOME HEALTH SERVICES, INC. - INDIANA PROHEALTH NETWORK, INC. STEVEN R. PLUMP - COMMUNITY HEALTH NETWORK, INC. KRISTIN T. SHERMAN - COMMUNITY HEALTH NETWORK, INC. MANAGEMENT DELEGATED FORM 990, PAGE 6, PART VI, LINE 3 CHS HAS DELEGATED EXCLUSIVE AUTHORITY TO CHNW, ACTING THROUGH CHNW'S BOARD OF DIRECTORS, IN THE FOLLOWING SUBSTANTIVE AREAS: STRATEGIC PLANNING, CAPITAL ACCESS, BUDGETING AND ALLOCATION; AUDIT AND COMPLIANCE; EXECUTIVE COMPENSATION; AND DISPUTE RESOLUTION. CLASSES OF MEMBERS OR STOCKHOLDERS FORM 990, PAGE 6, PART VI, LINE 6 SEE FORM 990, PART I, LINE 4 REFERENCE ON SCHEDULE O ABOVE ELECTION OF MEMBERS AND THEIR RIGHTS FORM 990, PAGE 6, PART VI, LINE 7A SEE FORM 990, PART I, LINE 4 REFERENCE ON SCHEDULE O ABOVE DECISIONS SUBJECT TO APPROVAL OF MEMBERS FORM 990, PAGE 6, PART VI, LINE 7B SEE FORM 990, PART I, LINE 4 REFERENCE ON SCHEDULE O ABOVE ORGANIZATION'S PROCESS USED TO REVIEW FORM 990 FORM 990, PAGE 6, PART VI, LINE 11B AS DISCUSSED IN PART I, LINE 4, CHNW HAS ASSUMED RESPONSIBILITY FOR CHS' AUDIT, COMPLIANCE, AND EXECUTIVE COMPENSATION MATTERS. CHNW'S BOARD OF DIRECTORS HAS DELEGATED AUTHORITY FOR THE REVIEW OF CHS' FORM 990 TO TWO COMMITTEES COMPOSED OF INDEPENDENT OUTSIDE DIRECTORS: A) THE NETWORK EXECUTIVE COMPENSATION COMMITTEE REVIEWED THE COMPENSATION ASPECTS OF CHS' FORM 990, AND B) THE NETWORK FINANCE COMMITTEE REVIEWED THE REMAINDER OF THE CHS' FORM 990. IN ADDITION, CHS' OUTSIDE ACCOUNTING FIRM AND LAW FIRM REVIEWED THE FORM 990 PRIOR TO FILING. CHS AND CHNW UTILIZED THIS PROCESS TO ENSURE THAT CHS' FORM 990 RECEIVED SUBSTANTIVE REVIEW BY DIRECTORS AND PROFESSIONALS WITH SPECIFIC KNOWLEDGE OF CHS' ACTIVITIES AND EXTENSIVE FINANCIAL, ACCOUNTING, AND TAX EXPERTISE. ENFORCEMENT OF CONFLICTS POLICY FORM 990, PAGE 6, PART VI, LINE 12C AS DISCUSSED IN PART I, LINE 4, CHNW HAS ASSUMED RESPONSIBILITY FOR CHS' AUDIT AND COMPLIANCE MATTERS. CHNW HAS ADOPTED A CONFLICT OF INTEREST POLICY THAT APPLIES TO EVERY TAX-EXEMPT ORGANIZATION WITHIN THE NETWORK, INCLUDING CHS. THE CONFLICT OF INTEREST POLICY REQUIRES DIRECTORS, OFFICERS, AND KEY EMPLOYEES TO SUBMIT AN ANNUAL CONFLICT OF INTEREST DISCLOSURE. THE ANNUAL DISCLOSURE REQUIRES DIRECTORS, OFFICERS, AND KEY EMPLOYEES TO DISCLOSE, IN WRITING, ANY KNOWN FINANCIAL INTEREST THAT THE INDIVIDUAL (TOGETHER WITH FAMILY MEMBERS) HAS IN ANY BUSINESS ENTITY THAT TRANSACTS BUSINESS WITH CHS. IN ADDITION, DIRECTORS, OFFICERS, AND KEY EMPLOYEES ARE REQUIRED TO IMMEDIATELY DISCLOSE ANY POSSIBLE CONFLICT OF INTEREST THAT ARISES MID-YEAR IN RELATION TO A PROPOSED TRANSACTION. THE CONFLICT OF INTEREST POLICY REQUIRES THAT ANY INDIVIDUAL WITH A CONFLICT BE RECUSED FROM THE DECISION MAKING PROCESS, THAT INDEPENDENT DIRECTORS OR COMMITTEE MEMBERS DETERMINE THAT THE PROPOSED TRANSACTION IS IN THE BEST INTEREST OF CHS, AND THE TRANSACTION MUST BE APPROVED BY A VOTE OF INDEPENDENT DIRECTORS OR COMMITTEE MEMBERS WITHOUT THE PARTICIPATION OF ANY INTERESTED INDIVIDUAL. THE ANNUAL CONFLICT DISCLOSURE STATEMENTS ARE SUBMITTED TO, AND REVIEWED BY, CHNW'S AUDIT COMMITTEE, COMPOSED OF INDEPENDENT DIRECTORS. IN ADDITION, THE EXECUTIVE STAFF AND GENERAL COUNSEL OF THE NETWORK ARE RESPONSIBLE FOR MONITORING ANY POSSIBLE CONFLICT TRANSACTIONS THAT ARISE AND MANAGING THEM TO ENSURE THAT ALL TRANSACTIONS REPRESENT ARMS LENGTH, FAIR MARKET VALUE TERMS FOR THE BENEFIT OF CHS. COMPENSATION PROCESS FOR TOP OFFICIAL FORM 990, PAGE 6, PART VI, LINE 15A AS DISCUSSED IN PART I, LINE 4, CHNW HAS ASSUMED RESPONSIBILITY FOR CHS' EXECUTIVE COMPENSATION MATTERS. CHNW HAS ADOPTED AN EXECUTIVE COMPENSATION AND INTERMEDIATE SANCTIONS POLICY THAT APPLIES TO CHS. THE PURPOSE OF THE POLICY IS TO ENSURE THAT CHS' COMPENSATION ARRANGEMENTS WITH RELATED PARTIES ARE EVALUATED AND ENTERED AT ARMS LENGTH AND THAT ANY COMPENSATION THAT IS PAID TO A RELATED PARTY IS REASONABLE AND REFLECTS FAIR MARKET VALUE. THIS POLICY ENCOURAGES THE APPLICATION OF THE REBUTTABLE PRESUMPTION STANDARD OF CODE SECTION 4958 AND THE RELATED TREASURY REGULATIONS BY: A) EXCLUDING ANY INTERESTED PARTY FROM THE DECISION MAKING PROCESS, B) REQUIRING DISINTERESTED BOARD OR COMMITTEE MEMBERS TO OBTAIN AND RELY UPON COMPARABILITY DATA WHEN SETTING THE PROPOSED COMPENSATION TERMS, C) REQUIRING APPROVAL OF THE TRANSACTION IN ADVANCE BY DISINTERESTED DIRECTORS OR COMMITTEE MEMBERS, AND D) REQUIRING CONTEMPORANEOUS DOCUMENTATION (I.E. MINUTES) REFLECTING THE DECISION AND THE PROCESS BY WHICH IT WAS MADE. CHNW ALSO DELEGATED AUTHORITY REGARDING CHS' EXECUTIVE COMPENSATION TO A) THE NETWORK EXECUTIVE COMPENSATION COMMITTEE, COMPOSED OF INDEPENDENT OUTSIDE DIRECTORS, WHICH IS RESPONSIBLE FOR APPLYING THE TERMS AND PROCESS OF THE EXECUTIVE COMPENSATION AND INTERMEDIATE SANCTIONS POLICY AS OUTLINED ABOVE, AND B) THE NETWORK VICE PRESIDENT OF HUMAN RESOURCES WHO IS RESPONSIBLE FOR OBTAINING COMPARATIVE SALARY MARKET DATA FOR THE CHIEF EXECUTIVE OFFICER, OFFICERS, AND KEY EMPLOYEES, PERIODICALLY ENGAGING AN INDEPENDENT COMPENSATION CONSULTANT TO ESTABLISH REASONABLE COMPENSATION, AND PROVIDING STAFF SUPPORT TO THE NETWORK EXECUTIVE COMPENSATION COMMITTEE. DURING 2011, THE NETWORK EXECUTIVE COMPENSATION COMMITTEE FOLLOWED THIS PROCESS FOR ALL CHIEF EXECUTIVE OFFICERS FOR ALL NETWORK ENTITIES; THE NETWORK CHIEF FINANCIAL OFFICER; THE NETWORK VICE PRESIDENT OF HUMAN RESOURCES; THE NETWORK VICE PRESIDENT OF MEDICAL AND ACADEMIC AFFAIRS; THE NETWORK VICE PRESIDENT OF LEGAL SERVICES; THE NETWORK CHIEF INFORMATION OFFICER; AND THE VICE PRESIDENT OF BUSINESS DEVELOPMENT AND MARKETING. FOR ALL POSITIONS REPRESENTING MANAGER AND ABOVE, THE CHIEF EXECUTIVE OFFICERS, CHIEF FINANCIAL OFFICERS, AND HUMAN RESOURCES REPRESENTATIVES FOR ALL NETWORK ENTITIES FOLLOWED A PROCESS WHEREBY SALARIES WERE COMPARED AGAINST COMPARATIVE SALARY MARKET DATA. GOVERNING DOCUMENTS DISCLOSURE EXPLANATION FORM 990, PAGE 6, PART VI, LINE 19 A) THE ARTICLES OF INCORPORATION AND CERTIFICATE OF EXISTENCE ARE ON FILE WITH THE INDIANA SECRETARY OF STATE AND ARE AVAILABLE TO THE PUBLIC UPON REQUEST TO THE INDIANA SECRETARY OF STATE OR FREE OF CHARGE ON THE SECRETARY OF STATE'S WEBSITE. B) AS AN AFFILIATE OF CHNW, CHS HAS ADOPTED THE NETWORK CONFLICT OF INTEREST POLICY. WHILE THIS POLICY IS NOT AVAILABLE TO THE PUBLIC, THE NETWORK'S DEFINITION OF CONFLICT OF INTEREST AND HOW TO REPORT SUCH AN INCIDENT IS DESCRIBED IN THE NETWORK RESPONSIBILITY AND COMPLIANCE PROGRAM ("NRCP") MANUAL WHICH IS POSTED ON THE NETWORK'S WEBSITE, ECOMMUNITY.COM. THIS MANUAL IS AVAILABLE FOR THE PUBLIC TO REVIEW. C) CHS DOES NOT HAVE INDIVIDUALLY AUDITED FINANCIAL STATEMENTS. ITS FINANCIAL RESULTS ARE INCLUDED IN THE CONSOLIDATED FINANCIAL STATEMENTS OF CHNW AND AFFILIATES. AS SUCH, THERE ARE NO INDIVIDUAL FINANCIAL STATEMENTS TO POST. CHS DOES FILE THE 990 TAX RETURN ON AN ANNUAL BASIS WHICH IS AVAILABLE UPON REQUEST AND/OR AVAILABLE ON A DELAYED BASIS ON GUIDESTAR.COM. ADDITIONAL INFORMATION FORM 990, PART VII FORM 990, PART VII - AVERAGE HOURS WORKED FOR RELATED ORGANIZATION MICHAEL C. BLANCHET - 50 JEFFERY KIRKHAM - 40 CHARLES SALAZAR, M.D. - 50 COMMUNITY HEALTH NETWORK INC 7330 SHADELAND STATION SUITE 200 INDIANAPOLIS IN 46256 311038302 PARENT IN 501C3 11B NA false COMMUNITY HEALTH NETWORK FOUNDATION 1500 NORTH RITTER AVENUE INDIANAPOLIS IN 46219 510181688 SUPPORT 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 COMM HOSP OF ANDERSON & MADISON CTY 1515 NORTH MADISON AVENUE ANDERSON IN 46011 351069822 HOSPITAL IN 501C3 3 CHI true COMMUNITY HOSP ANDERSON FDN INC 1515 NORTH MADISON AVENUE ANDERSON IN 46011 861053152 SUPPORT IN 501C3 7 CHA true COMMUNITY LTC INC 1031 MONTICELLO DRIVE ANDERSON IN 46011 351877441 HLTH CARE IN 501C3 9 CHA true COMMUNITY HOSPITALS OF INDIANA INC 1500 NORTH RITTER AVENUE INDIANAPOLIS IN 46219 350983617 HOSPITAL IN 501C3 3 CHNW false COMMUNITY PHYSICIANS OF IN INC 7240 SHADELAND STATION SUITE 300 INDIANAPOLIS IN 46256 205392766 PHY SRV IN 501C3 9 CHI true 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 LLC 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 CENTER 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 LLC 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 CENTER 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 SRVS IN N/A VEI MICHIGAN INC 940 N MAIN STREET ANN HARBOR MI 48104 300097377 MGMT SRVS MI N/A VEI-PRO HEALTH INC 7330 SHADLEAND STATION SUITE 200 INDIANAPOLIS IN 46256 454037444 INSURANCE IN N/A WESTVIEW DELIVERY SYSTEM INC 3630 GUION ROAD INDIANAPOLIS IN 46222 351910292 MGMT SRVS 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 SRVS IN N/A VEI MICHIGAN INC 940 N MAIN STREET ANN HARBOR MI 48104 300097377 MGMT SRVS MI N/A VEI-PRO HEALTH INC 7330 SHADLEAND STATION SUITE 200 INDIANAPOLIS IN 46256 454037444 INSURANCE IN N/A WESTVIEW DELIVERY SYSTEM INC 3630 GUION ROAD INDIANAPOLIS IN 46222 351910292 MGMT SRVS IN N/A false false true false false false false false true false false false false false true false true true COMMUNITY HEALTH NETWORK FOUNDATION C 65077 BOOK VALUE COMMUNITY HEALTH NETWORK FOUNDATION Q 65139 BOOK VALUE INDIANA HEART HOSPITAL LLC R 226537 BOOK VALUE INDIANA PROHEALTH NETWORK INC O 3743188 BOOK VALUE INDIANA PROHEALTH NETWORK INC Q 845206 BOOK VALUE