2011-11-11T08:56:11-06:00 2010-12-31 CASKEY & DAILY PC 4745 STATESMEN DRIVE SUITE C INDIANAPOLIS IN 46250 990 2010-01-01 351069822 COMMUNITY HOSPITAL OF ANDERSON AND MADISON COUNTY INC COMM 7652984242 1515 NORTH MADISON AVENUE ANDERSON IN 460113453 JOHN B HARRIS 7652984242 2011-11-08 true JAMES A CASKEY CPA CFP 3175852647 2011-11-11 2010 2016-03-07 17:11:31Z WILLIAM C VANNESS II MD 1515 NORTH MADISON AVENUE ANDERSON IN 460113453 134195692 false X WWW.COMMUNITYANDERSON.COM X 1961 IN THE MISSION OF COMMUNITY HOSPITAL OF ANDERSON AND MADISON COUNTY, INC. IS TO SERVICE THE MEDICAL, HEALTH AND HUMAN SERVICE NEEDS OF THE PEOPLE IN ANDERSON, MADISON COUNTY, AND CONTIGUOUS COUNTIES WITH COMPASSION, DIGNITY, RESPECT, AND EXCELLENCE. SERVICE, ALTHOUGH FOCUSED ON INJURY, ILLNESS, AND DISEASE, WILL ALSO EMBRACE PREVENTION, EDUCATION, AND ALTERNATIVE SYSTEMS OF HEALTH CARE DELIVERY. COMMUNITY HOSPITALS OF ANDERSON AND MADISON COUNTY, INC. OFFERS STATE-OF-THE-ART SERVICES TO EXCEED THE NEEDS OF OUR PATIENTS. FROM BASIC MEDICAL SERVICES SUCH AS THE EMERGENCY DEPARTMENT AND OUR NEW GENERATIONS BIRTH PLACE, TO THE SUPPORT OF OUR BREAST HEALTH SPECIALIST AND DIABETES CARE CENTER EDUCATORS, WE ADD THAT SPECIAL TOUCH TO ANTICIPATE YOUR NEEDS BEFORE YOU ASK. OUR STAFF MAKES EVERY EFFORT TO PROVIDE AN EFFECTIVE AND EFFICIENT HEALTH CARE DELIVERY SYSTEM. 18 15 1253 179 0 0 116035719 119663238 549220 9904 4229408 4451716 120814347 124124858 64615 64375 0 65163131 62300450 0 0 51565277 60300440 116793023 122665265 4021324 1459593 105041467 108413543 33006990 31163437 72034477 77250106 X THE MISSION OF COMMUNITY HOSPITAL OF ANDERSON AND MADISON COUNTY, INC. IS TO SERVICE THE MEDICAL, HEALTH AND HUMAN SERVICE NEEDS OF THE PEOPLE IN ANDERSON, MADISON COUNTY, AND CONTIGUOUS COUNTIES WITH COMPASSION, DIGNITY, RESPECT, AND EXCELLENCE. SERVICE, ALTHOUGH FOCUSED ON INJURY, ILLNESS, AND DISEASE, WILL ALSO EMBRACE PREVENTION, EDUCATION, AND ALTERNATIVE SYSTEMS OF HEALTH CARE DELIVERY. COMMUNITY HOSPITALS OF ANDERSON AND MADISON COUNTY, INC. OFFERS STATE-OF-THE-ART SERVICES TO EXCEED THE NEEDS OF OUR PATIENTS. FROM BASIC MEDICAL SERVICES SUCH AS THE EMERGENCY DEPARTMENT AND OUR NEW GENERATIONS BIRTH PLACE, TO THE SUPPORT OF OUR BREAST HEALTH SPECIALIST AND DIABETES CARE CENTER EDUCATORS, WE ADD THAT SPECIAL TOUCH TO ANTICIPATE YOUR NEEDS BEFORE YOU ASK. OUR STAFF MAKES EVERY EFFORT TO PROVIDE AN EFFECTIVE AND EFFICIENT HEALTH CARE DELIVERY SYSTEM. false false 113408443 119663238 COMMUNITY HOSPITAL OF ANDERSON AND MADISON COUNTY, INC. ("CHA") IS AN ACUTE CARE MEDICAL FACILITY WITH 137 STAFFED BEDS (EXCLUDING NURSERY). IN 2010, THERE WERE 6,456 ADMISSIONS, 6,845 SURGERIES PERFORMED, 931 BIRTHS WITH A TOTAL OF 177,368 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. 64375 64375 COMMUNITY HOSPITAL OF ANDERSON AND MADISON COUNTY, INC. CONTRIBUTED TO A FEW LOCAL CHARITABLE ORGANIZATIONS. THE LARGEST DONATIONS ARE LISTED ON SCHEDULE I. 113472818 true false false false false false false false false false true false false false true false false true false false false false false false false false true false true false true false false false false false false false true false false false false false true true true false false true 105 0 true 1253 true false false false false false false false false false false X 18 15 true false false false true true true true true false false false true true true false true true true true false IN X JOHN B HARRIS 7652985125 1515 N MADISON AVENUE ANDERSON IN 46011 X BRYAN A MILLS 5.00 X 0 1065810 288164 WILLIAM C VANNESS II MD 40.00 X X 450710 0 71528 DAVID A SHAPIRO MD 5.00 X 12900 276096 32614 D BENJAMIN MCCURDY MD 5.00 X 1200 0 0 LARRY BLANKENSHIP MD 5.00 X 150 0 0 MICHAEL L BAKER 5.00 X X 0 0 0 DENNIS CARROLL 5.00 X X 0 0 0 MARIAN DUNNICHAY 5.00 X 0 0 0 WILLIAM HOBBS 5.00 X 0 0 0 MARY JAMERSON 5.00 X X 0 0 0 MICHAEL KIRBY 5.00 X 0 0 0 ARTHUR J LEAK 5.00 X 0 0 0 MARY JO LEE 5.00 X 0 0 0 RICHARD MOUSTY 5.00 X 0 0 0 ROBERT J PENSEC 5.00 X X 0 0 0 JOSEPH PORCARO MD 5.00 X 0 0 0 LEROY A QUASHIE 5.00 X 0 0 0 CHARLES STALEY 5.00 X 0 0 0 SHIRLEY J WEATHERLY 5.00 X 0 0 0 JOHN B HARRIS 40.00 X 227007 0 47733 TAHIR ALI NAQVI MD 40.00 X 1598593 0 929723 RYAN HINDS MD 40.00 X 340957 0 17703 JARED ANDERSON MD 40.00 X 336138 0 26680 VIRGIL LOGHIN MD 40.00 X 299534 0 14292 LEE ANN MCDANIEL 40.00 X 284432 0 35783 ELIZABETH S THARP 40.00 X 191617 0 36257 LISA HALSTEAD 40.00 X 183425 0 52763 3926663 1341906 1553240 49 true true false WR DUNKIN & SON INC 2409 W 18TH STREET ANDERSON IN 46018 CONSTRUCTION 786403 SOUTH BEND MEDICAL FOUNDATION INC 530 N LAFAYETTE BLVD SOUTH BEND IN 466011098 LABORATORY SRV 602185 UNITED HOSPITAL SERVICES LLC 9948 PARK DAVIS DRIVE INDIANAPOLIS IN 46235 LINEN SERVICES 518451 UROLOGY ASSOCIATES LLC 2525 W UNIVERSITY SUITE 504 MUNCIE IN 47304 MED/PHY GUAR 439313 WHITE RIVER ANESTHESIA LLC 1135 CORAL SPRINGS DRIVE CICERO IN 460349216 MED/PHY GUAR 438520 26 PATIENT CARE SERVICE 900099 118528028 118528028 CLINICAL RESEARCH 541700 729406 729406 JOINT VENTURES 621400 405804 405804 119663238 728319 728319 2731588 2731588 2731588 2731588 9033210 319209 10070834 -1037624 319209 -718415 -718415 CAFETERIA SALES 722210 574647 574647 RADIOLOGY SERVICES 621500 122935 122935 TELECOMMUNICATIONS 517000 105677 105677 916869 916869 1720128 124124858 120703042 3421816 64375 64375 811228 14250 796978 49252161 44852216 4399945 2615158 2343687 271471 6340706 5682497 658209 3281197 2940586 340611 441894 418223 23671 267726 253384 14342 9481136 8973250 507886 152643 144466 8177 23241049 21896213 1344836 207899 196762 11137 5196267 4917913 278354 247981 234697 13284 1247787 1180945 66842 6670274 6312960 357314 445555 421687 23868 BAD DEBT EXPENSE 11290401 11290401 PHYSICIAN RECRUITMENT 844050 798836 45214 PROPERTY TAX 347968 329328 18640 DUES & SUBSCRIPTIONS 193173 182825 10348 EMPLOYEE RECRUITMENT 17465 16529 936 7172 6788 384 122665265 113472818 9192447 0 7739317 8201874 20043355 20962932 488015 1944344 2585041 260894 143746 124529178 82514414 43158130 42014764 29148575 32599214 2746852 1417957 105041467 108413543 10339563 9682910 18760000 17195000 3100000 3100000 807427 1185527 33006990 31163437 X 72034477 77250106 72034477 77250106 105041467 108413543 X 1459593 3756036 X false true true X false X false false false false false false false false false false 5956988 5956988 62782333 42794780 19987553 53900987 38211198 15689789 1888870 1508436 380434 42014764 DUE TO AFFILIATES 725994 ESTIMATED THIRD PARTY SETTLEMENTS 459533 1185527 true true true X true X true true true false true true 5076 2145030 2145030 0.01930 12776997 6406804 6370193 0.05720 5076 14922027 6406804 8515223 0.07650 36 9069 5793 5793 1 127 37 9196 5793 5793 37 14272 14927820 6406804 8521016 0.07650 1 6 9 234 60902 60902 1 300 11 540 60902 60902 true 3618801 36759096 39471499 -2712403 X true true COMM ENDOSCOPY CTR ENDOSCOPY CENTER 0.41000 0.49000 MADISON MED ASSOC REAL ESTATE 0.30000 0.30000 1 1 COMM HOSP OF ANDERSON & MADISON CTY

1515 NORTH MADISON AVENUE ANDERSON IN 46011

X X X SEE ADDITIONAL INFORMATION COMM HOSP OF ANDERSON & MADISON CTY 1 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 7 COLUMN F PERCENT OF TOTAL EXPENSE 11290401 WAS REMOVED FROM THE TOTAL EXPENSES REPORTED ON FORM 990 PART IX LINE 25 RELATED TO BAD DEBT EXPENSES COMMUNITY BUILDING ACTIVITIES PART II SEE ATTACHED COMMUNITY BENEFIT REPORT BAD DEBT EXPENSE EXPLANATION PART III LINE 4 BAD DEBT EXPENSE REPRESENTS THE AMOUNT OF UNCOLLECTIBLE ACCOUNTS RECEIVABLE WRITTEN OFF AFTER EXHAUSTING COLLECTION EFFORTS THE COST TO CHARGE RATIO WAS USED TO DETERMINE THE COST FACTOR IN THIS CALCULATION 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 EXCLUDING CHA THE NETWORK OFFERS A 30 DISCOUNT TO UNINSURED PATIENTS THIS DISCOUNT IS RECORDED IN OTHER ALLOWANCEADJUSTMENTS WHICH ARE NETTED AGAINST NET PATIENT SERVICE REVENUE RETROACTIVE ADJUSTMENTS ARE ACCRUED ON AN ESTIMATED BASIS IN THE PERIOD THE RELATED SERVICES ARE RENDERED AND AJDUSTED IN FUTURE PERIODS AS FINAL SETTLEMENTS ARE DETERMINED 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 CHARITY CARE INCLUDES THE AMOUNT OF CHARGES FORGONE FOR SERVICES AND SUPPLIES FURNISHED UNDER ITS CHARITY CARE POLICY AND WAS 69641000 AND 76215000 FOR THE YEARS ENDED DECEMBER 31 2010 AND 2009 RESPECTIVELY 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 AT COMMUNITY HOSPITAL OF ANDERSON AND MADISON COUNTY INC 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 ANY SUBSEQUENT RECOVERIES ARE RECORDED AGAINST THE PROVISION OF BAD DEBTS 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 SERVICES AND CLINICS MEDICARE SHORTFALLS SHOULD BE CONSIDERED AS COMMUNITY BENEFIT BECAUSE MEDICARE REPRESENTS 4967 OF THE OVERALL PAYER MIX FOR THIS ORGANIZATION COLLECTION PRACTICES EXPLANATION PART III LINE 9B IF A PATIENT IS DETERMINED TO BE ELIGIBLE FOR HARDSHIP DURING THE COLLECTION PROCESS COLLECTION EFFORTS ARE STOPPED AND HARDSHIP IS GIVEN PART VI LINES 2 THROUGH 7 NEEDS ASSESSMENT PART VI CHA MONITORS THE COMMUNITYS USE OF OUR FACILITY AND CONSISTENTLY ADDS NEW SERVICES BASED ON WHAT WE HAVE SEEN AS A NEED IN OUR COMMUNITY FOR EXAMPLE WE HAVE A GROWING HISPANIC POPULATION IN OUR COMMUNITY MANY OF WHOM SPEAK LITTLE TO NO ENGLISH A LARGE NUMBER OF THESE PATIENTS USE OUR PREGNANCY PLUS WOMENS CLINIC WE HAVE SINCE EMPLOYED A FULL TIME SPANISH INTERPRETER IN THIS DEPARTMENT WHO IS ALSO ONCALL TO THE REST OF THE HOSPITAL THIS MAKES IT MUCH EASIER FOR THESE PATIENTS TO RECEIVE OUR HEALTH CARE SERVICES IN THEIR OWN LANGUAGE CHA ALSO RESPONDS TO HEALTH CARE REQUESTS FROM THE COMMUNITY ORGANIZATIONS AND COMPANIES WILL OFTEN REQUEST SPEAKERS INFORMATION ON HEALTH CONDITIONS AND SERVICES ANDOR HEALTH CARE SCREENINGS CHA WILL EITHER PROVIDE THESE FOR THAT ORGANIZATION OR DIRECT THEM TO WHERE THEY CAN RECEIVE THEM INFORMATION ON HOW TO REQUEST THESE SERVICES IS AVAILABLE ON OUR WEBSITE WWWCOMMUNITYANDERSONCOM PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE PART VI ALL PATIENTS WITHOUT INSURANCE ARE SCREENED AT THE TIME OF REGISTRATION FOR ELIGIBILITY IN THE HEALTHY INDIANA PLAN IN AN EFFORT TO SCREEN 100 OF SELFPAY PATIENTS FOR POTENTIAL CHARITY CARE ELIGIBILITY COMMUNITY HOSPITAL UTILIZES DATA FROM TRUSTED THIRDPARTY VENDORS TO AUTOMATICALLY ESTIMATE THE FINANCIAL CONDITION OF EACH PATIENT THIS DATA IS COLLECTED FROM MULTIPLE SOURCES USING MULTIPLE METHODOLOGIES INCLUDING PREDICTIVE MODELING TO MAXIMIZE THE ACCURACY OF THESE FINANCIAL ESTIMATES TO ACCOMPLISH THESE TASKS COMMUNITY HOSPITAL USES TECHNOLOGY FROM VISION FINANCIAL HEADQUARTERED IN LAPORTE IN THIS TECHNOLOGY ENABLES COMMUNITY HOSPITAL TO AUTOMATICALLY GATHER FINANCIAL AND DEMOGRAPHIC INFORMATION FOR EACH PATIENT FROM THIRDPARTY DATA VENDORS INCLUDING EQUIFAX INC THIS PROVIDES AN ESTIMATION OF HOUSEHOLD SIZE AND INCOME REQUIRED TO CALCULATE FEDERAL POVERTY LEVEL VISION FINANCIAL AGGREGATES CENSUS INFORMATION PUBLIC RECORDS AND SELFREPORTED INFORMATION TO ESTIMATE THE FINANCIAL CONDITIONS OF CONSUMER HOUSEHOLDS EQUIFAX INC USES A DIFFERENT METHODOLOGY BASED ON AVAILABLE CREDIT BALANCES AND MONTHLY CREDIT OBLIGATIONS TO ESTIMATE INCOME AND HOUSEHOLD SIZE EACH OF THESE DATA VENDORS USE SOPHISTICATED PREDICTIVE MODELING TECHNIQUES TO INCREASE THE ACCURACY OF THESE ESTIMATES BASED ON MILLIONS OF HISTORICAL RECORDS ON A WEEKLY BASIS ALL SELF PAY ACCOUNTS WITH BALANCES DUE FROM THE PATIENT INPATIENT AND OUTPATIENT ARE CHECKED AGAINST THESE THIRDPARTY DATABASES AUTOMATICALLY AND SEGMENTED BASED ON FEDERAL POVERTY LEVEL AND THE GUIDELINES OF COMMUNITY HOSPITAL FINANCIAL ASSISTANCE PROGRAM THIS APPROACH IS CONSISTENTLY APPLIED LEVERAGING AUTOMATED ANALYTICS TECHNOLOGY IN AN UNBIASED FASHION TO ALL ACCOUNTS PATIENTS WHO ARE VERY LIKELY TO QUALIFY FOR FINANCIAL ASSISTANCE BASED ON THIRDPARTY FEDERAL POVERTY LEVEL ESTIMATES RECEIVE A CHARITY CARE ADJUSTMENT ACCORDING TO COMMUNITY HOSPITAL CHARITY CARE GUIDELINES PATIENTS AT HIGHER FEDERAL POVERTY LEVEL THRESHOLDS HAVE THE OPPORTUNITY TO COMPLETE A FINANCIAL ASSISTANCE APPLICATION AND MEET WITH A FINANCIAL COUNSELOR TO DETERMINE PAYMENT AND ASSISTANCE OPTIONS THIS APPROACH ENABLES COMMUNITY HOSPITAL TO EFFICIENTLY SERVE THE COMMUNITY WHILE USING A CONSISTENT APPROACH TO IDENTIFYING ALL PATIENTS WITH A NEED FOR FINANCIAL ASSISTANCE ALSO WE NO LONGER PHONE PEOPLE OFFERING THEM ASSISTANCE WITH HEALTHY INDIANA PLAN SINCE THERE WAS A WAITING LIST COMMUNITY INFORMATION PART VI CHA SERVES CITIZENS OF MADISON COUNTY INDIANA AS WELL AS OTHERS WITHIN THE SURROUNDING COUNTIES ACCORDING TO THE 2010 CENSUS MADISON COUNTY HAD A TOTAL POPULATION OF 132285 APPROXIMATELY 22 OF THE POPULATION WAS UNDER THE AGE OF 18 9 WAS AGE 18 TO 24 13 AGES 25 TO 34 27 FROM AGE 35 TO 54 13 AGES 55 TO 64 AND 16 WERE 65 YEARS OF AGE OR OLDER THE AVERAGE HOUSEHOLD INCOME IN MADISON COUNTY IN 2010 WAS 55936 COMPARED TO THE US AVERAGE OF 71071 THE COUNTY UNEMPLOYMENT RATE WAS 95 WHICH WAS HIGHER THAN THE US AVERAGE THE PAYER MIX OF PATIENTS SERVED IN 2010 WAS 60 GOVERNMENT PAYERS MEDICAREMEDICAID 34 COMMERCIAL INSURANCES AND 6 WITH NO INSURANCE THE RACIAL MAKEUP OF THE COUNTY WAS ABOUT 87 WHITE 8 AFRICAN AMERICAN 3 HISPANIC AND 2 OTHER RACES HISTORICALLY A LARGE PORTION OF RESIDENTS IN THE AREA WERE EMPLOYED BY GENERAL MOTORS AND OTHER FACTORIES HOWEVER IN RECENT YEARS MANY OF THE FACTORIES HAVE CLOSED NEW EMPLOYERS HAVE MOVED TO THE AREA IN RECENT YEARS INCLUDING NESTLE AND OTHER ORGANIZATIONS HEALTH OF COMMUNITY IN RELATION TO EXEMPT PURPOSE PART VI SEE NEEDS ASSESSMENT ABOVE AFFILIATED HEALTH CARE INFORMATION PART VI SEE ATTACHED COMMUNITY BENEFIT REPORT LIST OF STATES WHERE COMMUNITY BENEFIT REPORT IS FILED PART VI INDIANA ADDITIONAL INFORMATION PART VI PART V FACILITY INFORMATION OTHER CHA IS AN ACUTE CARE MEDICAL FACILITY WITH 137 STAFFED BEDS IN 2010 THERE WERE 6456 ADMISSIONS WITH AN AVERAGE LENGTH OF STAY OF 358 DAYS THERE WERE 30223 EMERGENCY ROOM CASES RESPONDED TO IN OUR 24HOURSEVEN DAY A WEEK EMERGENCY ROOM 68 OF THE BIRTHS IN MADISON COUNTY WERE DELIVERED AT CHA FOR A TOTAL OF 931 BIRTHS IN 2010 true CITY OF ANDERSON PARKS DEPARTMENT 1611 CHASE STREET ANDERSON IN 46016 356000939 GOV 15675 GENERAL SUPPORT COMMUNITY HOSPITAL ANDERSON FDN 1515 N MADISON AVENUE ANDERSON IN 46011 861053152 3 5200 GENERAL SUPPORT HEALTH & HOSPITAL CORP OF MARION CO 3838 N RURAL STREET 8TH FLOOR INDIANAPOLIS IN 46205 356005697 GOV 10000 GENERAL SUPPORT SECOND HARVEST FOOD BANK 6621 N OLD STATE ROAD 3 MUNCIE IN 47303 311111795 3 8000 GENERAL SUPPORT UNITED WAY OF MADISON COUNTY INC 1201 E 5TH STREET SUITE 1019 ANDERSON IN 46015 351052350 3 10500 GENERAL SUPPORT 3 2 PROCEDURES FOR MONITORING THE USE OF GRANT FUNDS INSIDE THE UNITED STATES SCHEDULE I, PAGE 1, PART I, LINE 2 THE CONTRIBUTIONS TO VARIOUS LOCAL CHARITABLE ORGANIZATIONS WERE UNRESTRICTED DONATIONS. X X X X false true true false false false false true false BRYAN A MILLS 751056 295514 19240 264294 23870 1353974 WILLIAM C VANNESS II MD 317676 111640 21394 58481 13047 522238 20263 DAVID A SHAPIRO MD 12900 250636 25460 10986 21628 12900 308710 JOHN B HARRIS 170855 31684 24468 27092 20641 274740 TAHIR ALI NAQVI MD 547741 998483 52369 904350 25373 2528316 RYAN HINDS MD 315368 25589 17703 358660 JARED ANDERSON MD 315344 20794 7350 19330 362818 VIRGIL LOGHIN MD 296359 3175 4552 9740 313826 LEE ANN MCDANIEL 280404 3328 700 9370 26413 320215 ELIZABETH S THARP 156537 28374 6706 22754 13503 227874 LISA HALSTEAD 152800 29029 1596 22918 29845 236188 SEVERANCE, NONQUALIFIED, AND EQUITY-BASED PAYMENTS SCHEDULE J, PAGE 1, PART I, LINE 4 BRYAN A. MILLS 0 0 295,514 OTHER ADDITIONAL INFORMATION SCHEDULE J, PART III PART I, LINE 4B SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN BRYAN A. MILLS PARTICIPATES IN A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN THROUGH HIS EMPLOYER, COMMUNITY BUSINESS INNOVATIONS, INC. MR. MILLS RECEIVED AN AWARD OF 100,000 TOWARDS THE PLAN, BUT DID NOT RECEIVE A PAYMENT FROM THE PLAN IN 2010. PART I, LINE 4C PERFORMANCE-BASED COMPENSATION ARRANGEMENT BRYAN A. MILLS PARTICIPATED IN TWO PERFORMANCE BASED PLANS WITH COMMUNITY BUSINESS INNOVATIONS, INC. AND VISIONARY ENTERPRISES, INC. DURING 2010, MR. MILLS RECEIVED A PAYOUT OF 295,514 FROM ONE PLAN. MR. MILLS RECEIVED AN AWARD OF 139,794 FROM THE OTHER PLAN, BUT DID NOT RECEIVE A PAYMENT FROM THAT PLAN IN 2010. PART I, LINE 7 - NON-FIXED PAYMENTS PROVIDED DR. NAQVI IS 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 NETWORK 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 IS UPDATED ANNUALLY AND DOCUMENTED AS A FORMAL PLAN. THE PARAMETERS CONTAINED IN THE PROGRAM REQUIRE THE APPROVAL OF CHA'S EXECUTIVE COMPENSATION COMMITTEE WHICH IS COMPRISED OF EXTERNAL BOARD MEMBERS. THE INCENTIVE PROGRAM IS BASED ON ORGANIZATIONAL PERFORMANCE AS WELL AS INDIVIDUAL PERFORMANCE. INDIANA PROHEALTH NETWORK INC SHARE BD MEMBER 12024802 HLTH INSUR/PLAN FEES false ORGANIZATION'S MISSION FORM 990 - ORGANIZATION'S MISSION THE MISSION OF COMMUNITY HOSPITAL OF ANDERSON AND MADISON COUNTY, INC. IS TO SERVICE THE MEDICAL, HEALTH AND HUMAN SERVICE NEEDS OF THE PEOPLE IN ANDERSON, MADISON COUNTY, AND CONTIGUOUS COUNTIES WITH COMPASSION, DIGNITY, RESPECT, AND EXCELLENCE. SERVICE, ALTHOUGH FOCUSED ON INJURY, ILLNESS, AND DISEASE, WILL ALSO EMBRACE PREVENTION, EDUCATION, AND ALTERNATIVE SYSTEMS OF HEALTH CARE DELIVERY. COMMUNITY HOSPITALS OF ANDERSON AND MADISON COUNTY, INC. OFFERS STATE-OF-THE-ART SERVICES TO EXCEED THE NEEDS OF OUR PATIENTS. FROM BASIC MEDICAL SERVICES SUCH AS THE EMERGENCY DEPARTMENT AND OUR NEW GENERATIONS BIRTH PLACE, TO THE SUPPORT OF OUR BREAST HEALTH SPECIALIST AND DIABETES CARE CENTER EDUCATORS, WE ADD THAT SPECIAL TOUCH TO ANTICIPATE YOUR NEEDS BEFORE YOU ASK. OUR STAFF MAKES EVERY EFFORT TO PROVIDE AN EFFECTIVE AND EFFICIENT HEALTH CARE DELIVERY SYSTEM. ADDITIONAL INFORMATION FORM 990, PART VI FORM 990, PART VI, LINE 2 - RELATED PARTY INFORMATION AMONG OFFICERS MANY OF CHA'S DIRECTORS, OFFICERS, AND KEY EMPLOYEES SERVE IN AN EXECUTIVE ROLE FOR OTHER TAX-EXEMPT AND TAXABLE AFFILIATES THROUGHOUT THE NETWORK. SPECIFICALLY, THE FOLLOWING DIRECTORS SERVE AS DIRECTORS AND/OR OFFICERS OF THE FOLLOWING ORGANIZATIONS: MICHAEL L. BAKER - COMMUNITY HEALTH NETWORK, INC. BRYAN A. MILLS - COMMUNITY BUSINESS INNOVATIONS, INC. - COMMUNITY HEALTH NETWORK, INC. - COMMUNITY HEALTH NETWORK FOUNDATION, INC. - COMMUNITY HOME HEALTH SERVICES, INC. - COMMUNITY PHYSICIANS OF INDIANA, INC. - INDIANA PROHEALTH NETWORK, INC. - THE INDIANA HEART HOSPITAL, LLC - VISIONARY ENTERPRISES, INC. DAVID A. SHAPIRO, M.D. - COMMUNITY PHYSICIANS OF INDIANA, INC. WILLIAM C. VANNESS II, M.D. - COMMUNITY BUSINESS INNOVATIONS, INC. MANAGEMENT DELEGATED FORM 990, PAGE 6, PART VI, LINE 3 THROUGH AN AFFILIATION AGREEMENT EFFECTIVE SEPTEMBER 1, 1996, CHA'S BOARD OF TRUSTEES RETAINS CONTROL OVER MANAGEMENT DUTIES FOR CHA. HOWEVER, FOR THE FOLLOWING GOVERNANCE ITEMS, CHA 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 STOCKHOLDERS FORM 990, PAGE 6, PART VI, LINE 6 COMMUNITY 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 RIGHTS FORM 990, PAGE 6, PART VI, LINE 7A CHA'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 MEMBERS FORM 990, PAGE 6, PART VI, LINE 7B CHI, AS THE SOLE MEMBER OF CHA, MUST APPROVE THE FOLLOWING: A) STRATEGIC AND OPERATING PLANS; B) ANNUAL OPERATING AND CAPITAL BUDGETS AND ANY UNBUDGETED CAPITAL EXPENDITURES; C) AMENDMENTS TO THE ARTICLES OR BYLAWS OF THE CORPORATION AND THE BYLAWS OF THE MEDICAL STAFF OF THE CORPORATION, D) APPOINTMENT AND REMOVAL OF THE CHIEF EXECUTIVE OFFICER OF THE CORPORATION; E) UNBUDGETED SALES, LEASES, OR TRANSFERS OF ASSETS ABOVE 500,000, WHICH AMOUNT MAY BE ADJUSTED FROM TIME TO TIME AS AGREED BY THE BOARD OF TRUSTEES AND THE BOARD OF DIRECTORS OF THE MEMBER; F) INCURRENCE OF DEBT OTHER THAN IN THE ORDINARY COURSE OF BUSINESS OR IN ACCORDANCE WITH THE OPERATING PLANS, OPERATING BUDGET, OR CAPITAL BUDGET RECOMMENDED BY THE BOARD OF TRUSTEES AND APPROVED BY THE BOARD OF DIRECTORS OF THE MEMBER; G) CHANGE IN THE MISSION OF THE CORPORATION; H) ELECTION OF NEW MEMBERS OR REAPPOINTMENT OF CURRENT MEMBERS TO THE BOARD OF TRUSTEES; I) PARTICIPATION IN MANAGED CARE AND OTHER NETWORKS OR AFFILIATIONS; AND J) RELOCATION OF PHYSICIANS EMPLOYED BY OR UNDER CONTRACT WITH THE MEMBER TO MADISON COUNTY. ORGANIZATION'S PROCESS USED TO REVIEW FORM 990 FORM 990, PAGE 6, PART VI, LINE 11B THE RETURN IS PREPARED BY AN OUTSIDE, INDEPENDENT ACCOUNTING FIRM AND REVIEWED BY LEGAL COUNSEL. IN ADDITION, ALL SECTIONS OF THE FORM 990 ARE REVIEWED BY THE EXECUTIVE COMMITTEE OF THE CHA BOARD OF TRUSTEES. ENFORCEMENT OF CONFLICTS POLICY FORM 990, PAGE 6, PART VI, LINE 12C CHA HAS ADOPTED A CONFLICT OF INTEREST POLICY APPLICABLE TO ALL EMPLOYEES. THE CONFLICT OF INTEREST POLICY REQUIRES EMPLOYEES SUBMIT A CONFLICT OF INTEREST DISCLOSURE FORM UPON EMPLOYMENT WITH CHA AND ON AN ANNUAL BASIS THEREAFTER. PRIOR TO COMPLETING AND SIGNING THE DISCLOSURE, ALL EMPLOYEES MUST READ AND UNDERSTAND CHA'S CONFLICT OF INTEREST POLICY STATEMENT, WHICH PROVIDES THAT NO CHA EMPLOYEE SHALL MAKE A PROFIT BECAUSE OF HIS OR HER POSITION AT CHA. THE DISCLOSURE REQUIRES EMPLOYEES TO DISCLOSE, IN WRITING, ANY KNOWN FINANCIAL INTEREST THAT THE INDIVIDUAL (TOGETHER WITH THEIR SPOUSE AND FAMILY MEMBERS) HAS IN ANY BUSINESS ENTITY THAT CONDUCTS OR WILL POTENTIALLY CONDUCT BUSINESS WITH CHA. EMPLOYEES ARE ALSO REQUIRED TO IMMEDIATELY DISCLOSE TO THE CHA HUMAN RESOURCES DEPARTMENT ANY SUBSEQUENT CHANGES THAT ARISE MID-YEAR AND WOULD OTHERWISE BE REPORTED ON THE ANNUAL DISCLOSURE STATEMENT. IN ADDITION, THE CHA AMENDED AND RESTATED CODE OF BYLAWS PROVIDES A CONFLICT OF INTEREST POLICY FOR THE CHA BOARD OF TRUSTEES. CHA'S AMENDED AND RESTATED CODE OF BYLAWS REQUIRES ALL BOARD MEMBERS TO DISCLOSE ANY DUALITY OR CONFLICT OF INTEREST TO THE OTHER BOARD MEMBERS. THE DIRECTOR IS PROHIBITED FROM VOTING OR EXERTING ANY PERSONAL INFLUENCE ON ANY ISSUE THAT PRESENTS A CONFLICT OF INTEREST. THE DIRECTOR'S ABSTENTION FROM THE VOTE AND THE DETAILS CONCERNING THE CONFLICT OF INTEREST ARE REPORTED IN THE MEETING'S MINUTES. FORM 990, PART VI, LINE 13 - WRITTEN WHISTLEBLOWER POLICY WHILE NO FORMAL WRITTEN POLICY EXISTS, CHA'S WHISTLEBLOWER APPROACH IS AS FOLLOWS: A) ANNUALLY ALL EMPLOYEES ARE REQUIRED TO COMPLETE MANDATORY NETWORK RESPONSIBILITY AND COMPLIANCE PROGRAM TRAINING ("NRCP"). THIS ELECTRONIC TRAINING INCLUDES A TRAINING SESSION ON HOW TO REPORT CONCERNS AND TO WHOM TO REPORT THE CONCERNS. B) IN THE NETWORK'S NRCP MANUAL WHICH IS AVAILABLE TO ALL EMPLOYEES VIA THE NETWORK'S INTRANET, IT STATES "THE NETWORK REALIZES THE RESPONSIBILITY AND SUPPORTS THE RIGHT OF EVERY INDIVIDUAL TO ADDRESS POTENTIAL VIOLATIONS OF NETWORK POLICIES AND PROCEDURES; LAWS, RULES, AND REGULATIONS; OR ETHICAL STANDARDS IN GOOD FAITH AND TO REQUEST GUIDANCE WITHOUT THE FEAR OF PUNISHMENT OR HARASSMENT FROM OTHERS INCLUDING CO-WORKERS, SUPERVISORS, AND LEADERSHIP. BOTH FEDERAL AND STATE FALSE CLAIMS ACTS PROHIBIT EMPLOYERS FROM RETALIATION AGAINST EMPLOYEES WHO FILE WHISTLEBLOWER ACTIONS. THEREFORE, RETRIBUTION, 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 OFFICIAL FORM 990, PAGE 6, PART VI, LINE 15A CHA HAS A COMPENSATION COMMITTEE COMPOSED OF INDEPENDENT MEMBERS OF ITS BOARD OF DIRECTORS. THE COMPENSATION COMMITTEE IS RESPONSIBLE FOR EVALUATING AND DETERMINING COMPENSATION FOR CHA'S EXECUTIVE PERSONNEL. IN DISCHARGING THESE DUTIES, THE COMPENSATION COMMITTEE APPLIES THE PRINCIPLES OF THE REBUTTABLE PRESUMPTION AS OUTLINED IN CODE SECTION 4958 AND THE CORRESPONDING TREASURY REGULATIONS. MOST NOTABLY, THE COMPENSATION COMMITTEE OBTAINS AND RELIES UPON COMPARABILITY DATA WHEN SETTING COMPENSATION AND CONTEMPORANEOUSLY DOCUMENTS ITS DECISIONS AND THE PROCESS THAT IT EMPLOYS IN WRITING. IN ADDITION, THE COMPENSATION COMMITTEE PERIODICALLY RETAINS AN OUTSIDE COMPENSATION CONSULTANT TO PROVIDE INPUT REGARDING THE APPROPRIATENESS OF CHA'S COMPENSATION DECISIONS. COMPENSATION PROCESS FOR OFFICERS FORM 990, PAGE 6, PART VI, LINE 15B SEE PART VI, LINE 15A ABOVE. FORM 990, PART VI, LINE 16A - JOINT VENTURES SEE SCHEDULE H, PART IV GOVERNING DOCUMENTS DISCLOSURE EXPLANATION FORM 990, PAGE 6, PART VI, LINE 19 A) THE ARTICLES OF INCORPORATION AND CERTIFICATE OF EXISTENCE ARE ON FILE WITH THE INDIANA SECRETARY OF STATE AND ARE AVAILABLE TO THE PUBLIC UPON REQUEST TO THE INDIANA SECRETARY OF STATE OR FREE OF CHARGE ON THE SECRETARY OF STATE'S WEBSITE. B) CHA'S CONFLICT OF INTEREST POLICY IS ATTACHED TO THE FORM 990. 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 INFORMATION FORM 990, PART VII FORM 990, PART VII - AVERAGE HOURS WORKED FOR RELATED ORGANIZATION BRYAN A. MILLS - 40 DAVID A. SHAPIRO, M.D. - 40 OTHER CHANGES IN NET ASSETS EXPLANATION FORM 990, PART XI, LINE 5 INCREASE IN INVESTMENT MARKET VALUE COMMUNITY HOSP ANDERSON FDN INC 1515 NORTH MADISON AVENUE ANDERSON IN 46011 861053152 CHARITY IN 501C3 7 CHA true COMMUNITY LTC INC 1031 MONTICELLO DRIVE ANDERSON IN 46011 351877441 HLTH CARE IN 501C3 9 CHA true COMMUNITY HEALTH NETWORK INC 1500 NORTH RITTER AVENUE INDIANAPOLIS IN 46219 311038302 SUPPORT IN 501C3 11B NA false COMMUNITY BUSINESS INNOVATIONS INC 1500 NORTH RITTER AVENUE INDIANAPOLIS IN 46219 352088279 SUPPORT IN 501C3 11B CHNW false COMMUNITY HEALTH NETWORK FOUNDATION 1500 NORTH RITTER AVENUE INDIANAPOLIS IN 46219 510181688 CHARITY IN 501C3 11B CHNW true COMMUNITY HOME HEALTH SERVICES INC 9894 EAST 121ST STREET FISHERS IN 46037 350953467 HLTH CARE IN 501C3 9 CHNW true COMMUNITY HOSPITALS OF INDIANA INC 1500 NORTH RITTER AVENUE INDIANAPOLIS IN 46219 350983617 HOSPITAL IN 501C3 3 CHNW false COMMUNITY HOSPITAL SOUTH INC 1402 E COUNTY LINE ROAD SOUTH INDIANAPOLIS IN 46227 351088640 HOSPITAL IN 501C3 3 CHI true COMMUNITY PHYSICIANS OF IN INC 7240 SHADELAND STATION SUITE 300 INDIANAPOLIS IN 46256 205392766 PHY SRV IN 501C3 9 CHI true THE INDIANA HEART HOSPITAL LLC 8075 NORTH SHADELAND AVENUE INDIANAPOLIS IN 46250 352123783 HOSPITAL IN 501C3 3 CHI true EAST CAMPUS SURGERY CENTER LLC 7330 SHADELAND STATION SUITE 200 INDIANAPOLIS IN 46256 352028517 SURGERY IN N/A false false IMAGING EQUIPMENT LEASING CO LLC 7330 SHADELAND STATION SUITE 200 INDIANAPOLIS IN 46256 201293154 LEASING IN N/A false false INDIANA SPECIALTY GROUP 7240 SHADELAND STATION SUITE 300 INDIANAPOLIS IN 46256 351976258 HLTH CARE IN N/A false false MICHIGAN SURGERY INVESTMENT LLC 7330 SHADELAND STATION SUITE 200 INDIANAPOLIS IN 46256 320147008 SURG CTRS IN N/A false false NORTH CAMPUS OFFICE ASSOCIATES LP 7330 SHADELAND STATION SUITE 200 INDIANAPOLIS IN 46256 351808625 RNTL PROP IN N/A false false NORTH CAMPUS SURGERY CENTERS LLC 7330 SHADELAND STATION SUITE 200 INDIANAPOLIS IN 46256 352147088 SURGERY IN N/A false false SURGICARE LLC 2907 MCINTIRE DRIVE BLOOMINGTON IN 47403 351975122 SURGERY IN N/A false false EAST CAMPUS SURGERY CENTER LLC 7330 SHADELAND STATION SUITE 200 INDIANAPOLIS IN 46256 352028517 SURGERY IN N/A false false IMAGING EQUIPMENT LEASING CO LLC 7330 SHADELAND STATION SUITE 200 INDIANAPOLIS IN 46256 201293154 LEASING IN N/A false false INDIANA SPECIALTY GROUP 7240 SHADELAND STATION SUITE 300 INDIANAPOLIS IN 46256 351976258 HLTH CARE IN N/A false false MICHIGAN SURGERY INVESTMENT LLC 7330 SHADELAND STATION SUITE 200 INDIANAPOLIS IN 46256 320147008 SURG CTRS IN N/A false false NORTH CAMPUS OFFICE ASSOCIATES LP 7330 SHADELAND STATION SUITE 200 INDIANAPOLIS IN 46256 351808625 RNTL PROP IN N/A false false NORTH CAMPUS SURGERY CENTERS LLC 7330 SHADELAND STATION SUITE 200 INDIANAPOLIS IN 46256 352147088 SURGERY IN N/A false false SURGICARE LLC 2907 MCINTIRE DRIVE BLOOMINGTON IN 47403 351975122 SURGERY IN N/A false false CHN ASSURANCE COMPANY LTD PO BOX 1051GT GRAND CAYMAN CJ 980418913 INSURANCE CJ N/A INDIANA PROHEALTH NETWORK INC 8180 CLEARVISTA PARKWAY SUITE 230 INDIANAPOLIS IN 46256 351614719 INSURANCE IN N/A VISIONARY ENTERPRISES INC 7330 SHADELAND STATION SUITE 200 INDIANAPOLIS IN 46256 351538433 MGMT SRVCS IN N/A VEI MICHIGAN INC 940 N MAIN STREET ANN HARBOR MI 48104 300097377 MGMT SRVCS MI N/A CHN ASSURANCE COMPANY LTD PO BOX 1051GT GRAND CAYMAN CJ 980418913 INSURANCE CJ N/A INDIANA PROHEALTH NETWORK INC 8180 CLEARVISTA PARKWAY SUITE 230 INDIANAPOLIS IN 46256 351614719 INSURANCE IN N/A VISIONARY ENTERPRISES INC 7330 SHADELAND STATION SUITE 200 INDIANAPOLIS IN 46256 351538433 MGMT SRVCS IN N/A VEI MICHIGAN INC 940 N MAIN STREET ANN HARBOR MI 48104 300097377 MGMT SRVCS MI N/A true false false true false false false false true false false false false false true true false true COMMUNITY HOSP ANDERSON FDN INC P 157555 ACTUAL AMOUNT PER BOOKS COMMUNITY HOSP ANDERSON FDN INC R 395667 ACTUAL AMOUNT PER BOOKS COMMUNITY LTC INC A 6644 ACTUAL AMOUNT PER BOOKS COMMUNITY LTC INC D 493544 ACTUAL AMOUNT PER BOOKS COMMUNITY LTC INC I 225074 ACTUAL AMOUNT PER BOOKS COMMUNITY LTC INC P 657088 ACTUAL AMOUNT PER BOOKS COMMUNITY BUSINESS INNOVATIONS INC O 1783285 ACTUAL AMOUNT PER BOOKS COMMUNITY HOME HEALTH SERVICES INC P 108300 ACTUAL AMOUNT PER BOOKS COMMUNITY PHYSICIANS OF IN INC A 651311 ACTUAL AMOUNT PER BOOKS THE INDIANA HEART HOSPITAL LLC O 402689 ACTUAL AMOUNT PER BOOKS INDIANA PROHEALTH NETWORK INC O 7893951 ACTUAL AMOUNT PER BOOKS INDIANA PROHEALTH NETWORK INC P 4130851 ACTUAL AMOUNT PER BOOKS COMMUNITY HOSP ANDERSON FDN INC P 157555 ACTUAL AMOUNT PER BOOKS COMMUNITY HOSP ANDERSON FDN INC R 395667 ACTUAL AMOUNT PER BOOKS COMMUNITY LTC INC A 6644 ACTUAL AMOUNT PER BOOKS COMMUNITY LTC INC D 493544 ACTUAL AMOUNT PER BOOKS COMMUNITY LTC INC I 225074 ACTUAL AMOUNT PER BOOKS COMMUNITY LTC INC P 657088 ACTUAL AMOUNT PER BOOKS COMMUNITY BUSINESS INNOVATIONS INC O 1783285 ACTUAL AMOUNT PER BOOKS COMMUNITY HOME HEALTH SERVICES INC P 108300 ACTUAL AMOUNT PER BOOKS COMMUNITY PHYSICIANS OF IN INC A 651311 ACTUAL AMOUNT PER BOOKS THE INDIANA HEART HOSPITAL LLC O 402689 ACTUAL AMOUNT PER BOOKS INDIANA PROHEALTH NETWORK INC O 7893951 ACTUAL AMOUNT PER BOOKS INDIANA PROHEALTH NETWORK INC P 4130851 ACTUAL AMOUNT PER BOOKS ADDITIONAL INFORMATION SCHEDULE R PART II IDENTIFICATION OF RELATED TAXEXEMPT ORGANIZATIONS COMMUNITY HOSPITAL OF ANDERSON AND MADISON COUNTY INC CHA EIN XXX-XX-XXXX IS AFFILIATED WITH COMMUNITY HOSPITALS OF INDIANA INC CHI EIN XXX-XX-XXXX AND COMMUNITY HEALTH NETWORK INC CHNW EIN XXX-XX-XXXX PURSUANT TO AN AFFILIATION AGREEMENT DATED SEPTEMBER 1 1996 BOTH CHI AND CHNW ARE EXEMPT ORGANIZATIONS PURSUANT TO SECTION 501C3