2023-11-08T13:34:41-06:00 2022-12-31 352123203 KSM BUSINESS SERVICES INC PO BOX 40857 INDIANAPOLIS IN 46240 990 2022-01-01 237309596 COMMUNITY HOWARD REGIONAL HEALTH FOUNDATION INC COMM 7654538458 PO BOX 9011 KOKOMO IN 469049011 RHONDA EASTMAN FOUNDATION DIRECTOR 7654538458 2023-11-06 1 RHONDA EASTMAN 999009999 0 CASSE TATE P01271193 3175802000 2023-11-01 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z RHONDA EASTMAN PO BOX 9011 KOKOMO IN 469049011 1806504 0 X WWW.ECOMMUNITY.COM/FOUNDATION-HOWARD X 1958 IN TO IMPROVE THE QUALITY AND AVAILABILITY OF HEALTHCARE PROVIDED TO ALL PERSONS SERVED BY COMMUNITY HOWARD REGIONAL HEALTH. 12 10 1 16 0 0 142699 238157 0 0 301950 198347 20567 15408 465216 451912 442720 438776 0 0 25846 26016 0 0 591 36797 43588 505363 508380 -40147 -56468 5271227 4200965 8515 147 5262712 4200818 TO IMPROVE THE QUALITY AND AVAILABILITY OF HEALTHCARE PROVIDED TO ALL PERSONS SERVED BY COMMUNITY HOWARD REGIONAL HEALTH. 0 0 421588 421588 TO RECEIVE AND MAINTAIN FUNDS FOR THE CONSTRUCTION, FURNISHING, EQUIPPING AND IMPROVEMENT OF THE FACILITIES AND SERVICES OF COMMUNITY HOWARD REGIONAL HEALTH (HOSPITAL). TO PROVIDE FINANCIAL ASSISTANCE FOR THE IMPROVEMENT OF THE HEALTH, SAFETY, AND GENERAL WELFARE AND TO AID IN THE ALLEVIATION OF HUMAN SUFFERING OF ALL PERSONS CONNECTED WITH OR USING THE FACILITIES AND SERVICES OF THE HOSPITAL. 17188 17188 TO PROVIDE SCHOLARSHIPS TO STUDENTS PURSUING DEGREES AND CERTIFICATES IN HEALTH CARE PROFESSIONS. 438776 1 1 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 X 0 0 1 1 1 0 0 0 0 0 1 1 0 0 0 0 0 0 X 12 10 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 0 0 0 0 0 X BRIAN MCCONNELL 3173554212 8180 CLEARVISTA PKWY SUITE 200 INDIANAPOLIS IN 46256 CLIFF EVANS DO DIRECTOR 1.00 50.00 X 0 866880 18300 STEPHANIE COLLINS DIRECTOR 1.00 40.00 X 0 145531 0 RHONDA EASTMAN FOUNDATION DIRECTOR 40.00 0.00 X 0 84493 28589 JEFF CARDWELL DIRECTOR 1.00 0.00 X 0 0 0 JONI DELON DIRECTOR 1.00 0.00 X 0 0 0 RICK FILIP DIRECTOR 1.00 0.00 X 0 0 0 ALAN GIRTON 2ND VICE PRESIDENT 1.00 0.00 X X 0 0 0 PAT HIMELICK DIRECTOR 1.00 0.00 X 0 0 0 CORBIN KING DIRECTOR 1.00 0.00 X 0 0 0 CATHY KUENZLI DIRECTOR 1.00 0.00 X 0 0 0 LORA LACEY DIRECTOR 1.00 0.00 X 0 0 0 GREG MCCARTY TREASURER 1.00 0.00 X X 0 0 0 JEFF MCCOMAS DIRECTOR 1.00 0.00 X 0 0 0 TONYA NEWHOUSE 1ST VICE PRESIDENT 1.00 0.00 X X 0 0 0 BRIAN PIER PRESIDENT 1.00 0.00 X X 0 0 0 GREG SULLIVAN 1ST VP THROUGH MARCH 2022 1.00 0.00 X X 0 0 0 MATT TATE DIRECTOR 1.00 0.00 X 0 0 0 CATHY VALCKE DIRECTOR 1.00 0.00 X 0 0 0 ALAN WARNER DIRECTOR 1.00 0.00 X 0 0 0 0 1096904 46889 0 0 1 0 0 19065 219092 238157 69474 69474 1266119 195836 1333082 0 -66963 195836 128873 128873 36675 19065 21510 15165 15165 HEART SCAN COUPON REVENUE 621500 196 196 BANK ADJUSTMENT 900099 46 46 PURCHASE DISCOUNT 900099 1 1 243 451912 243 0 213512 421588 421588 17188 17188 24140 24140 1876 1876 710 710 35353 35353 3384 3384 MEALS 2030 2030 BOOKS & SUBSCRIPTIONS 1520 1520 FUNDRAISING 591 591 508380 438776 69013 591 120406 56357 479616 441900 4564071 3608578 107134 94130 5271227 4200965 147 8515 0 8515 147 X 4202934 3292077 1059778 908741 5262712 4200818 5271227 4200965 X -56468 -1014743 9317 X 0 1 X 1 0 X 225224 194893 190739 142699 238157 991712 225224 194893 190739 142699 238157 991712 101120 890592 100363 90715 90614 95697 69474 446863 13860 22340 11375 29985 36675 114235 1552810 0.57350 0.59120 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: FUNDRAISING ACTIVITY - 2018 AMOUNT: $ 13,860. 2019 AMOUNT: $ 22,340. 2020 AMOUNT: $ 11,375. 2021 AMOUNT: $ 29,985. 2022 AMOUNT: $ 36,675. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 107134 -14015 3756 897 88466 99942 11770 3543 1035 107134 93684 10685 3537 890 99942 83147 14893 3458 898 93684 91895 -4457 3416 875 83147 0.00000 0.00000 1.00000 1 0 0 PART XIII - SUPPLEMENTAL FINANCIAL INFORMATION THE ENDOWMENT PROVIDES FUNDS FOR SCHOLARSHIPS TO STUDENTS PURSUING DEGREES AND CERTIFICATES IN HEALTH CARE PROFESSIONS. GOLF OUTING 27600 15725 11875 900 1408 2688 547 1116 CHEF'S BASH 20200 20200 123 4000 5500 1443 1 7940 3340 4600 825 2191 158 611 55740 19065 36675 1725 1531 8879 705 5500 3170 21510 15165 1 COMMUNITY HOWARD REGIONAL HEALTH 3500 S LAFOUNTAIN STREET KOKOMO IN 46902 351865344 501C3 421588 0 GENERAL PURPOSE 1 0 SCHOLARSHIPS/EDUC EXPENSE 25 17188 PART I, LINE 2 - PROCEDURES FOR MONITORING THE USE OF GRANT FUNDS COMMUNITY HOWARD REGIONAL HEALTH FOUNDATION, INC. ("CHRHF") ISSUES GRANTS TO OTHER TAX-EXEMPT MEMBERS OF THE COMMUNITY HEALTH NETWORK. PRIOR TO THE DISBURSEMENT OF ANY GRANT PROCEEDS, CHRHF ENSURES THAT THE PURPOSE OF THE GRANT IS CONSISTENT WITH CHRHF'S CHARITABLE PURPOSES AS DEFINED IN CODE SECTION 501(C)(3). THE TERMS OF ALL GRANTS REQUIRE THAT THE RECIPIENT EXPEND THE FUNDS SOLELY FOR CHARITABLE PURPOSES AS DEFINED BY CODE SECTION 501(C)(3). WITH REGARD TO GRANTS TO ORGANIZATIONS WITHIN THE NETWORK, CHRHF DOES NOT REQUIRE PERIODIC REPORTING REGARDING THE USE OF THE GRANT PROCEEDS SINCE ALL NETWORK MEMBERS ARE SUBJECT TO COMMON CONTROL BY A TAX-EXEMPT PARENT ORGANIZATIONS (CHNW). CHRHF ALSO AWARDS ACADEMIC SCHOLARSHIPS AND REIMBURSES EDUCATION EXPENSES TO INDIVIDUALS UNDER THE TERMS OF A WRITTEN SCHOLARSHIP PROGRAM. CHRHF MONITORS THE RECIPIENT'S PROGRESS TOWARDS RECEIPT OF THE INTENDED CERTIFICATE OR DEGREE BY REQUIRING ACADEMIC RECORDS DURING THE SCHOLARSHIP PERIOD. 0 1 0 0 0 0 0 0 0 CLIFF EVANS DO DIRECTOR 0 632722 0 113866 0 120292 0 18300 0 0 0 885180 0 44541 PART I, LINE 3 COMMUNITY HOWARD REGIONAL HEALTH FOUNDATION, INC. ("CHRHF") 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 SURVEY OR STUDY PART I, LINE 4B - SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN COMMUNITY HEALTH NETWORK, INC. RESTORATION PLAN COMMUNITY HEALTH NETWORK, INC. ("COMMUNITY") ADOPTED THIS COMMUNITY HEALTH NETWORK RESTORATION PLAN ("PLAN") AS OF DECEMBER 1, 2017 TO PROVIDE A SUPPLEMENTAL INCOME FOR RETIREMENT UPON VESTING IN THE BENEFITS AS DESCRIBED IN THE PLAN DOCUMENT. COMMUNITY HOWARD REGIONAL HEALTH FOUNDATION, INC. ("CHRHF") IS INCLUDED IN THE PLAN. THE PLAN IS DESIGNED UNDER CODE SECTION 457(F) AS A "TOP-HAT PLAN" (I.E. AN UNFUNDED DEFERRED COMPENSATION PLAN MAINTAINED FOR A SELECT GROUP OF MANAGEMENT OR HIGHLY COMPENSATED EMPLOYEES PURSUANT TO SECTIONS 201(2), 301(A)(3) AND 401(A)(1) OF THE EMPLOYEE RETIREMENT INCOME SECURITY ACT OF 1974, AS AMENDED ("ERISA"). ELIGIBILITY: INDIVIDUALS WHO HAVE THE TITLE OF PRESIDENT, SENIOR VICE PRESIDENT OR EXECUTIVE VICE PRESIDENT AND WHOSE PLAN COMPENSATION FOR THE APPLICABLE PLAN YEAR EXCEEDS THE ANNUAL COMPENSATION LIMITY UNDER CODE SECTION 401(A)(17), AS ADJUSTED FROM TIME TO TIME. CONTRIBUTIONS: 1. MATCHING CONTRIBUTIONS. IF A PARTICIPANT RECEIVES THE MAXIMUM PERMISSIBLE MATCHING CONTRIBUTION UNDER THE COMMUNITY HEALTH NETWORK 401(K) RETIREMENT PLAN, THEY WILL RECEIVE A MATCHING CONTRIBUTION IN THE PLAN THAT IS EQUAL TO THEIR COMPENSATION THAT IS GREATER THAN THE 401(K) PLAN LIMIT MULTIPLIED BY THE MAXIMUM PERMITTED MATCHING CONTRIBUTION PERCENTAGE IN THE 401(K) PLAN FOR THAT YEAR. 2. NON-ELECTIVE CONTRIBUTIONS. IF A PARTICIPANT RECEIVES A NON-ELECTIVE CONTRIBUTION IN THE 401(K) PLAN, THEY WILL RECEIVE A NON-ELECTIVE CONTRIBUTION IN THE PLAN THAT IS EQUAL TO THEIR COMPENSATION THAT IS GREATER THAN THE 401(K) PLAN LIMIT MULTIPLIED BY THE NON-ELECTIVE CONTRIBUTION PERCENTAGE IN THE 401(K) PLAN FOR THAT YEAR. NOTE THAT NO NON-ELECTIVE CONTRIBUTIONS ARE CURRENTLY BEING MADE TO THE 401(K) PLAN. CONTRIBUTIONS WILL BE CREDITED TO A PARTICIPANT'S ACCOUNT AS SOON AS ADMINISTRATIVELY FEASIBLE FOLLOWING THE END OF THE PLAN YEAR TO WHICH THE CONTRIBUTIONS RELATE. VESTING: A PARTICIPANT WILL BE 100% VESTED IN HIS ACCOUNT UPON THE EARLIEST TO OCCUR OF THE FOLLOWING: 1. ATTAINMENT OF AGE 65 PRIOR TO SEPARATION FROM SERVICE 2. DISABILITY 3. INVOLUNTARY SEPARATION FROM SERVICE FOR A REASON OTHER THAN FOR CAUSE 4. SEPARATION FROM SERVICE FOR GOOD REASON 5. A NONCOMPETITIVE PARTICIPANT'S COMPLIANCE WITH ALL TERMS OF A NONCOMPETING AGREEMENT, OR 6. DEATH FORFEITURES: IF ACCOUNT IS NOT VESTED AS DESCRIBED ABOVE, THE ACCOUNT WILL BE COMPLETELY FORFEITED. AMOUNTS FORFEITED. AMOUNTS FORFEITED DURING A PLAN YEAR REMAIN A GENERAL ASSET OF COMMUNITY. 990, PART V, LINE 1A - BOX 3 OF FORM 1096 FORM 1096 WAS PROCESSED UNDER THE NAME AND FEDERAL IDENTIFICATION NUMBER OF COMMUNITY HEALTH NETWORK, INC. FORM 990, PART VI, SECTION B, LINE 11B ORGANIZATION'S PROCESS TO REVIEW FORM 990 THE FINANCE COMMITTEE OF THE GOVERNING BODY REVIEWS THE FORM 990 PRIOR TO ITS SIGNING AND SUBMISSION TO THE INTERNAL REVENUE SERVICE CHRHF IS ALSO USING THE PROCESS ESTABLISHED BY COMMUNITY HEALTH NETWORK, INC. ("CHNW") FOR REVIEWING THE FORM 990. CHNW'S BOARD OF DIRECTORS HAS DELEGATED AUTHORITY FOR THE REVIEW OF CHRHF'S FORM 990 TO TWO COMMITTEES COMPOSED OF INDEPENDENT OUTSIDE DIRECTORS: A) THE NETWORK EXECUTIVE COMPENSATION COMMITTEE REVIEWED THE COMPENSATION ASPECTS OF CHRHF'S FORM 990, AND B) THE NETWORK FINANCE COMMITTEE REVIEWED THE REMAINDER OF THE CHRHF'S FORM 990. IN ADDITION, CHRHF'S OUTSIDE ACCOUNTING FIRM AND LAW FIRM REVIEWED THE FORM 990 PRIOR TO FILING. CHRHF UTILIZED THIS PROCESS TO ENSURE THAT CHRHF'S FORM 990 RECEIVED SUBSTANTIVE REVIEW BY DIRECTORS AND PROFESSIONALS WITH SPECIFIC KNOWLEDGE OF CHRHF'S ACTIVITIES AND EXTENSIVE FINANCIAL, ACCOUNTING, AND TAX EXPERTISE. FORM 990, PART VI, SECTION B, LINE 12C ENFORCEMENT OF CONFLICTS POLICY ALL INTERESTED PERSONS ARE REQUIRED TO DISCLOSE ANY CONFLICTS OF INTEREST, OR POSSIBLE CONFLICTS OF INTEREST THAT MIGHT POTENTIALLY AFFECT THEIR JUDGMENT IN MAKING DECISIONS ON BEHALF OF THE FOUNDATION BY COMPLETING A CONFLICT OF INTEREST DISCLOSURE STATEMENT ANNUALLY. FORM 990, PART VI, SECTION B, LINE 15 FORM 990, PART VI, LINE 15A - COMPENSATION PROCESS FOR TOP OFFICIAL CHRHF HAS DELEGATED AUTHORITY FOR EXECUTIVE COMPENSATION TO CHNW. CHNW HAS ADOPTED AN EXECUTIVE COMPENSATION AND INTERMEDIATE SANCTIONS POLICY THAT APPLIES TO CHRHF. THE PURPOSE OF THE POLICY IS TO ENSURE THAT CHRHF'S 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 CHRHF'S 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 CHIEF HUMAN RESOURCES OFFICER WHO IS RESPONSIBLE FOR OBTAINING COMPARATIVE SALARY MARKET DATA FOR THE CHIEF EXECUTIVE OFFICER, OFFICERS, AND KEY EMPLOYEES, ENGAGING AN INDEPENDENT COMPENSATION CONSULTANT TO PROVIDE REASONABLE COMPENSATION ANALYSIS AND/OR CONFIRM THE REASONABLENESS OF COMPENSATION, AND PROVIDING STAFF SUPPORT TO THE NETWORK EXECUTIVE COMPENSATION COMMITTEE. DURING 2022, THE NETWORK EXECUTIVE COMPENSATION COMMITTEE FOLLOWED THIS PROCESS FOR ALL SENIOR EXECUTIVE LEADERS. FORM 990, PART VI, LINE 15B - COMPENSATION PROCESS FOR OFFICERS SALARIES WERE COMPARED AGAINST COMPARATIVE SALARY MARKET DATA FOR ALL POSITIONS REPRESENTING MANAGERS, CHIEF EXECUTIVE OFFICERS, CHIEF FINANCIAL OFFICERS, AND HUMAN RESOURCES REPRESENTATIVES FOR ALL NETWORK ENTITIES. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS DISCLOSURE EXPLANATION A) THE ARTICLES OF INCORPORATION AND BUSINESS ENTITY REPORT 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) CHRHF'S CONFLICT OF INTEREST POLICY IS AVAILABLE UPON REQUEST. C) CHRHF 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. CHRHF DOES FILE THE 990 TAX RETURN ON AN ANNUAL BASIS WHICH IS AVAILABLE UPON REQUEST AND/OR AVAILABLE ON A DELAYED BASIS ON GUIDESTAR.ORG. D) COMMUNITY HEALTH NETWORK, INC. AND AFFILIATES PROVIDE ANY DOCUMENT OPEN TO PUBLIC INSPECTION UPON REQUEST. FORM 990, PART XI, LINE 9: RECLASSIFICATION OF INTERCOMPANY BALANCES 9,317. 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