COMMUNITY HOWARD REGIONAL HEALTH FOUNDATION INC: Form 990, tax year 2021
View the entire original 990 at ProPublica ↗
- Organization
- COMMUNITY HOWARD REGIONAL HEALTH FOUNDATION INC (EIN 23-7309596)
- Tax period
- 2021-01-01 to 2021-12-31
- Filed
- 2022-11-10
- IRS object ID
- 202223149349303772
- Schema version
- 2021v4.2
- 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
- Form 990
- Schedule A
- Schedule B
- Schedule D
- Schedule G
- Schedule I
- Schedule J
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2022-11-10T11:55:25-06:00 | ReturnTs |
| Tax Period End | 2021-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 352123203 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | KSM BUSINESS SERVICES INC | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 40857 | AddressLine1Txt |
| City | INDIANAPOLIS | CityNm |
| State Abbreviation | IN | StateAbbreviationCd |
| ZIP | 46240 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2021-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 237309596 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | COMMUNITY HOWARD REGIONAL | BusinessNameLine1Txt |
| Business Name Line2 | HEALTH FOUNDATION INC | BusinessNameLine2Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | COMM | BusinessNameControlTxt |
| Phone | 7654538458 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 9011 | AddressLine1Txt |
| City | KOKOMO | CityNm |
| State Abbreviation | IN | StateAbbreviationCd |
| ZIP | 469049011 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | RHONDA EASTMAN | PersonNm |
| Person Title | FOUNDATION DIRECTOR | PersonTitleTxt |
| Phone | 7654538458 | PhoneNum |
| Signature | 2022-10-25 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | RHONDA | PersonFirstNm |
| Person Last | EASTMAN | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | CASSE TATE | PreparerPersonNm |
| PTIN | P01271193 | PTIN |
| Phone | 3175802000 | PhoneNum |
| Preparation | 2022-10-24 | PreparationDt |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 3 | TrustedCustomerCd |
| Authentication Assurance Level | AAL1 | AuthenticationAssuranceLevelCd |
| Identity Assurance Level | IAL1 | IdentityAssuranceLevelCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2021 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | RHONDA EASTMAN | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 9011 | AddressLine1Txt |
| City | KOKOMO | CityNm |
| State Abbreviation | IN | StateAbbreviationCd |
| ZIP | 469049011 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $474,634 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.ECOMMUNITY.COM/FOUNDATION-HOWARD | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1958 | FormationYr |
| Legal Domicile State | IN | LegalDomicileStateCd |
| Activity Or Mission | TO IMPROVE THE QUALITY AND AVAILABILITY OF HEALTHCARE PROVIDED TO ALL PERSONS SERVED BY COMMUNITY HOWARD REGIONAL HEALTH. | ActivityOrMissionDesc |
| Voting Members Governing Body | 16 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 14 | VotingMembersIndependentCnt |
| Total Employee | 1 | TotalEmployeeCnt |
| Total Volunteers | 17 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $190,739 | PYContributionsGrantsAmt |
| CY Contributions Grants | $142,699 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $0 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $0 | CYProgramServiceRevenueAmt |
| PY Investment Income | $231,918 | PYInvestmentIncomeAmt |
| CY Investment Income | $301,950 | CYInvestmentIncomeAmt |
| PY Other Revenue | $7,114 | PYOtherRevenueAmt |
| CY Other Revenue | $20,567 | CYOtherRevenueAmt |
| PY Total Revenue | $429,771 | PYTotalRevenueAmt |
| CY Total Revenue | $465,216 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $141,483 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $442,720 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $24,540 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $25,846 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $1,041 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $42,672 | PYOtherExpensesAmt |
| CY Other Expenses | $36,797 | CYOtherExpensesAmt |
| PY Total Expenses | $208,695 | PYTotalExpensesAmt |
| CY Total Expenses | $505,363 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $221,076 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$40,147 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $5,159,026 | TotalAssetsBOYAmt |
| Total Assets EOY | $5,271,227 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $49,099 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $8,515 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $5,109,927 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $5,262,712 | NetAssetsOrFundBalancesEOYAmt |
| Mission | TO IMPROVE THE QUALITY AND AVAILABILITY OF HEALTHCARE PROVIDED TO ALL PERSONS SERVED BY COMMUNITY HOWARD REGIONAL HEALTH. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $416,771 | ExpenseAmt |
| Grant | $416,771 | GrantAmt |
| Desc | 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. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $25,949 | ExpenseAmt |
| Grant | $25,949 | GrantAmt |
| Desc | TO PROVIDE SCHOLARSHIPS TO STUDENTS PURSUING DEGREES AND CERTIFICATES IN HEALTH CARE PROFESSIONS. | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expenses | $442,720 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | Yes (1) | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | 0 | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | 0 | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | Yes (1) | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | Yes (1) | GrantsToOrganizationsInd |
| Grants To Individuals | Yes (1) | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | 0 | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| Info In Schedule O Part V | Yes (X) | InfoInScheduleOPartVInd |
| IRP Document | 0 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 1 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | Yes (1) | QuidProQuoContributionsInd |
| Quid Pro Quo Contri Discl | Yes (1) | QuidProQuoContriDisclInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 16 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 14 | IndependentVotingMemberCnt |
| Family Or Business Rln | Yes (1) | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 0 | MembersOrStockholdersInd |
| Election Of Board Members | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | 0 | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | 0 | WhistleblowerPolicyInd |
| Document Retention Policy | 0 | DocumentRetentionPolicyInd |
| Compensation Process CEO | 0 | CompensationProcessCEOInd |
| Compensation Process Other | 0 | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | IN | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BRIAN MCCONNELL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 3173554212 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 8180 CLEARVISTA PKWY SUITE 200 | AddressLine1Txt |
| City | INDIANAPOLIS | CityNm |
| State Abbreviation | IN | StateAbbreviationCd |
| ZIP | 46256 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (18 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd |
|---|---|---|---|---|---|---|---|
| CLIFF EVANS DO | |||||||
| DIRECTOR | 1.00 | 50.00 | Yes (X) | $0 | $775,915 | $62,139 | |
| JOSEPH T HOOPER | |||||||
| PRESIDENT-HOWARD REGION THR 12-26 | 2.00 | 48.00 | $0 | $469,190 | $35,788 | Yes (X) | |
| STEPHANIE COLLINS | |||||||
| DIRECTOR | 1.00 | 40.00 | Yes (X) | $0 | $110,022 | $1,000 | |
| RHONDA EASTMAN | |||||||
| FOUNDATION DIRECTOR | 40.00 | 0.00 | $0 | $73,271 | $36,093 | Yes (X) | |
| JEFF CARDWELL | |||||||
| DIRECTOR | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| RICK FILIP | |||||||
| DIRECTOR | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| ALAN GIRTON | |||||||
| DIRECTOR | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| PAT HIMELICK | |||||||
| DIRECTOR | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| CORBIN KING | |||||||
| DIRECTOR | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| CATHY KUENZLI | |||||||
| PRESIDENT | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | Yes (X) |
| GREG MCCARTY | |||||||
| DIRECTOR MARCH-DEC 2021 | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| JEFF MCCOMMAS | |||||||
| DIRECTOR | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| TONYA NEWHOUSE | |||||||
| DIRECTOR | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| BRIAN PIER | |||||||
| TREASURER/2ND VP | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | Yes (X) |
| GREG SULLIVAN | |||||||
| 1ST VICE PRESIDENT | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | Yes (X) |
| MATT TATE | |||||||
| DIRECTOR | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| CATHY VALCKE | |||||||
| DIRECTOR | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| ALAN WARNER | |||||||
| DIRECTOR | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $0 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $1,428,398 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $135,020 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 0 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
| Cntrct Rcvd Greater Than100 K | 0 | CntrctRcvdGreaterThan100KCnt |
| Fundraising | $13,181 | FundraisingAmt |
| All Other Contributions | $129,518 | AllOtherContributionsAmt |
| Total Contributions | $142,699 | TotalContributionsAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $95,697 | TotalRevenueColumnAmt |
| Exclusion | $95,697 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $206,253 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $0 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $206,253 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $206,253 | TotalRevenueColumnAmt |
| Exclusion | $206,253 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fundraising Gross Income | $29,985 | FundraisingGrossIncomeAmt |
| Contri Rpt Fundraising Event | $13,181 | ContriRptFundraisingEventAmt |
| Fundraising Direct Expenses | $9,418 | FundraisingDirectExpensesAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $20,567 | TotalRevenueColumnAmt |
| Exclusion | $20,567 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $465,216 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $0 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $322,517 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $416,771 | TotalAmt |
| Program Services | $416,771 | ProgramServicesAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $25,949 | TotalAmt |
| Program Services | $25,949 | ProgramServicesAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $24,010 | TotalAmt |
| Management And General | $24,010 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,836 | TotalAmt |
| Management And General | $1,836 | ManagementAndGeneralAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $30,443 | TotalAmt |
| Management And General | $30,443 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $46 | TotalAmt |
| Management And General | $46 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,432 | TotalAmt |
| Management And General | $2,432 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (3 entries)
| DescDesc | TotalTotalAmt | Management And GeneralManagementAndGeneralAmt | FundraisingFundraisingAmt |
|---|---|---|---|
| BOOKS & SUBSCRIPTIONS | $1,481 | $1,481 | |
| MEALS | $1,354 | $1,354 | |
| FUNDRAISING | $1,041 | $1,041 |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $505,363 | TotalAmt |
| Program Services | $442,720 | ProgramServicesAmt |
| Management And General | $61,602 | ManagementAndGeneralAmt |
| Fundraising | $1,041 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $157,891 | BOYAmt |
| EOY | $120,406 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $933,518 | BOYAmt |
| EOY | $479,616 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,967,675 | BOYAmt |
| EOY | $4,564,071 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $99,942 | BOYAmt |
| EOY | $107,134 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,159,026 | BOYAmt |
| EOY | $5,271,227 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $49,099 | BOYAmt |
| EOY | $8,515 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $49,099 | BOYAmt |
| EOY | $8,515 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,247,936 | BOYAmt |
| EOY | $4,202,934 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $861,991 | BOYAmt |
| EOY | $1,059,778 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,109,927 | BOYAmt |
| EOY | $5,262,712 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,159,026 | BOYAmt |
| EOY | $5,271,227 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | -$40,147 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $192,932 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Organization170 | Yes (X) | PublicOrganization170Ind |
Gifts Grants Contri Rcvd170 GiftsGrantsContriRcvd170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $180,895 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $225,224 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $194,893 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $190,739 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $142,699 | CurrentTaxYearAmt |
| Total | $934,450 | TotalAmt |
Total Calendar Year170 TotalCalendarYear170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $180,895 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $225,224 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $194,893 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $190,739 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $142,699 | CurrentTaxYearAmt |
| Total | $934,450 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Substantial Contributors Tot | $55,900 | SubstantialContributorsTotAmt |
| Public Support Total170 | $878,550 | PublicSupportTotal170Amt |
Gross Investment Income170 GrossInvestmentIncome170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $78,861 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $100,363 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $90,715 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $90,614 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $95,697 | CurrentTaxYearAmt |
| Total | $456,250 | TotalAmt |
Other Income170 OtherIncome170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $17,725 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $13,860 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $22,340 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $11,375 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $29,985 | CurrentTaxYearAmt |
| Total | $95,285 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Support | $1,485,985 | TotalSupportAmt |
| Public Support CY170 | 0.59120 | PublicSupportCY170Pct |
| Public Support PY170 | 0.62120 | PublicSupportPY170Pct |
| Thirty Thr Pct Suprt Tests CY170 | Yes (X) | ThirtyThrPctSuprtTestsCY170Ind |
Form990 Schedule A Part VI Form990ScheduleAPartVIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: | FormAndLineReferenceDesc |
| Explanation | FUNDRAISING ACTIVITY - 2017 AMOUNT: $ 17,725. 2018 AMOUNT: $ 13,860. 2019 AMOUNT: $ 22,340. 2020 AMOUNT: $ 11,375. 2021 AMOUNT: $ 29,985. | ExplanationTxt |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule D IRS990ScheduleD
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $99,942 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $11,770 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $3,543 | GrantsOrScholarshipsAmt |
| Administrative Expenses | $1,035 | AdministrativeExpensesAmt |
| End Year Balance | $107,134 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $93,684 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $10,685 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $3,537 | GrantsOrScholarshipsAmt |
| Administrative Expenses | $890 | AdministrativeExpensesAmt |
| End Year Balance | $99,942 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $83,147 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $14,893 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $3,458 | GrantsOrScholarshipsAmt |
| Administrative Expenses | $898 | AdministrativeExpensesAmt |
| End Year Balance | $93,684 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $91,895 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | -$4,457 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $3,416 | GrantsOrScholarshipsAmt |
| Administrative Expenses | $875 | AdministrativeExpensesAmt |
| End Year Balance | $83,147 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $156,184 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | -$60,000 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $3,404 | GrantsOrScholarshipsAmt |
| Administrative Expenses | $885 | AdministrativeExpensesAmt |
| End Year Balance | $91,895 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated Balance EOY | 0.00000 | BoardDesignatedBalanceEOYPct |
| Prmnnt Endowment Balance EOY | 0.00000 | PrmnntEndowmentBalanceEOYPct |
| Term Endowment Balance EOY | 1.00000 | TermEndowmentBalanceEOYPct |
| Endowments Held Unrelated Org | Yes (1) | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | 0 | EndowmentsHeldRelatedOrgInd |
| Total Book Value Land Buildings | $0 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)
| DescDesc | AmtAmt |
|---|---|
| DUE TO AFFILIATES | $4,015 |
| LIABILITY UNDER TRUST AGREEMENT | $4,500 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $8,515 | TotalLiabilityAmt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART XIII - SUPPLEMENTAL FINANCIAL INFORMATION | FormAndLineReferenceDesc |
| Explanation | THE ENDOWMENT PROVIDES FUNDS FOR SCHOLARSHIPS TO STUDENTS PURSUING DEGREES AND CERTIFICATES IN HEALTH CARE PROFESSIONS. | ExplanationTxt |
Schedule G IRS990ScheduleG
Fundraising Event Information FundraisingEventInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Event1 | GOLF OUTING | Event1Nm |
| Gross Receipts Event1 | $24,681 | GrossReceiptsEvent1Amt |
| Charitable Contri Event1 | $13,181 | CharitableContriEvent1Amt |
| Gross Revenue Event1 | $11,500 | GrossRevenueEvent1Amt |
| Cash Prizes Event1 | $900 | CashPrizesEvent1Amt |
| Non Cash Prizes Event1 | $419 | NonCashPrizesEvent1Amt |
| Rent Facility Costs Event1 | $2,984 | RentFacilityCostsEvent1Amt |
| Food And Beverage Event1 | $550 | FoodAndBeverageEvent1Amt |
| Other Direct Expenses Event1 | $710 | OtherDirectExpensesEvent1Amt |
| Event2 | CHEF'S BASH | Event2Nm |
| Gross Receipts Event2 | $18,485 | GrossReceiptsEvent2Amt |
| Gross Revenue Event2 | $18,485 | GrossRevenueEvent2Amt |
| Non Cash Prizes Event2 | $712 | NonCashPrizesEvent2Amt |
| Entertainment Event2 | $2,000 | EntertainmentEvent2Amt |
| Other Direct Expenses Event2 | $1,143 | OtherDirectExpensesEvent2Amt |
| Gross Receipts Total | $43,166 | GrossReceiptsTotalAmt |
| Charitable Contributions Tot | $13,181 | CharitableContributionsTotAmt |
| Gross Revenue Total Events | $29,985 | GrossRevenueTotalEventsAmt |
| Cash Prizes Total Events | $900 | CashPrizesTotalEventsAmt |
| Non Cash Prizes Total Events | $1,131 | NonCashPrizesTotalEventsAmt |
| Rent Fclty Costs Total Events | $2,984 | RentFcltyCostsTotalEventsAmt |
| Food And Beverage Total Events | $550 | FoodAndBeverageTotalEventsAmt |
| Entertainment Total Events | $2,000 | EntertainmentTotalEventsAmt |
| Oth Direct Expnss Total Events | $1,853 | OthDirectExpnssTotalEventsAmt |
| Direct Expense Summary Events | $9,418 | DirectExpenseSummaryEventsAmt |
| Net Income Summary | $20,567 | NetIncomeSummaryAmt |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (1) | GrantRecordsMaintainedInd |
Recipient Table RecipientTable
Recipient Business Name RecipientBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | COMMUNITY HOWARD REGIONAL HEALTH | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3500 S LAFOUNTAIN STREET | AddressLine1Txt |
| City | KOKOMO | CityNm |
| State Abbreviation | IN | StateAbbreviationCd |
| ZIP | 46902 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Recipient EIN | 351865344 | RecipientEIN |
| IRC Section | 501C3 | IRCSectionDesc |
| Cash Grant | $416,771 | CashGrantAmt |
| Non Cash Assistance | $0 | NonCashAssistanceAmt |
| Purpose Of Grant | GENERAL PURPOSE | PurposeOfGrantTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 1 | Total501c3OrgCnt |
| Total Other Org | 0 | TotalOtherOrgCnt |
Grants Other Asst To Indiv In US GrantsOtherAsstToIndivInUSGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Type | SCHOLARSHIPS/EDUC EXPENSE | GrantTypeTxt |
| Recipient | 28 | RecipientCnt |
| Cash Grant | $25,949 | CashGrantAmt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 2 - PROCEDURES FOR MONITORING THE USE OF GRANT FUNDS | FormAndLineReferenceDesc |
| Explanation | 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. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (1) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (2 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| CLIFF EVANS DO | ||||||||||||||
| DIRECTOR | $0 | $702,331 | $0 | $14,500 | $0 | $59,084 | $0 | $61,941 | $0 | $198 | $0 | $838,054 | $0 | $14,500 |
| JOSEPH T HOOPER | ||||||||||||||
| PRESIDENT-HOWARD REGION THR 12-26 | $0 | $407,181 | $0 | $40,000 | $0 | $22,009 | $0 | $17,400 | $0 | $18,388 | $0 | $504,978 | $0 | $40,000 |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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 | JOSEPH HOOPER SEVERANCE: 0 NONQUALIFIED: $21,859 EQUITY-BASED: 0 |
| 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. |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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 A, LINE 2 | RELATED PARTY INFORMATION AMONG OFFICERS JOSEPH T. HOOPER IS AN OFFICER OF COMMUNITY HOWARD REGIONAL HEALTH, INC. AND HE AND RHONDA EASTMAN RECEIVED COMPENSATION FROM COMMUNITY HOWARD REGIONAL HEALTH, 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 VICE PRESIDENT OF HUMAN RESOURCES 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 2021, 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. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (9 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Direct Controlling NADirectControllingNACd | Controlled OrganizationControlledOrganizationInd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt |
|---|---|---|---|---|---|---|---|---|---|---|---|
| COMMUNITY HEALTH NETWORK INC | |||||||||||
| 7330 SHADELAND STATION SUITE 200 | INDIANAPOLIS | IN | 46256 | 350983617 | HOSPITAL | IN | 501(C)(3) | LINE 3 | N/A | 0 | |
| COMMUNITY HEALTH NETWORK FOUNDATION | |||||||||||
| 7330 SHADELAND STATION SUITE 100 | INDIANAPOLIS | IN | 46256 | 510181688 | SUPPORT | IN | 501(C)(3) | LINE 12B, II | 0 | CHNW | |
| COMMUNITY HOME HEALTH SERVICES INC | |||||||||||
| 9894 EAST 121ST STREET | FISHERS | IN | 46037 | 350953467 | HEALTH CARE | IN | 501(C)(3) | LINE 10 | 0 | CHNW | |
| COMM HOSP OF ANDERSON & MADISON CTY | |||||||||||
| 1515 NORTH MADISON AVENUE | ANDERSON | IN | 46011 | 351069822 | HOSPITAL | IN | 501(C)(3) | LINE 3 | 0 | CHNW | |
| COMMUNITY HOSP ANDERSON FDN INC | |||||||||||
| 1515 NORTH MADISON AVENUE | ANDERSON | IN | 46011 | 861053152 | SUPPORT | IN | 501(C)(3) | LINE 12A, I | 0 | CHA | |
| COMMUNITY HOSPITAL SOUTH INC | |||||||||||
| 1402 EAST COUNTY LINE ROAD SOUTH | INDIANAPOLIS | IN | 46227 | 351088640 | HOSPITAL | IN | 501(C)(3) | LINE 3 | 0 | CHNW | |
| COMMUNITY HOWARD REGIONAL HEALTH | |||||||||||
| 3500 S LAFOUNTAIN STREET | KOKOMO | IN | 46902 | 351865344 | HOSPITAL | IN | 501(C)(3) | LINE 3 | 0 | CHNW | |
| COMMUNITY PHYSICIANS OF IN INC | |||||||||||
| 7240 SHADELAND STATION SUITE 200 | INDIANAPOLIS | IN | 46256 | 205392766 | PHYSICIAN SERVICES | IN | 501(C)(3) | LINE 10 | 0 | CHNW | |
| FAIRBANKS HOSPITAL INC | |||||||||||
| 8102 CLEARVISTA PARKWAY | INDIANAPOLIS | IN | 46256 | 350811197 | HOSPITAL | IN | 501(C)(3) | LINE 3 | 0 | CHNW | |
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (20 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Direct Controlling NADirectControllingNACd | Disproportionate AllocationsDisproportionateAllocationsInd | General Or Managing PartnerGeneralOrManagingPartnerInd |
|---|---|---|---|---|---|---|---|---|---|
| CHNJMH VENTURES LLC | |||||||||
| 6626 E 75TH STREET SUITE 200 | INDIANAPOLIS | IN | 46250 | 462356266 | DIAG/REHAB | IN | N/A | 0 | 0 |
| COMMUNITY ENDOSCOPY CENTER LLC | |||||||||
| 1601 N MADISON AVENUE SUITE 300 | ANDERSON | IN | 46011 | 611464136 | HEALTH CARE | IN | N/A | 0 | 0 |
| COMMUNITY HEALTH AT HOME LLC | |||||||||
| 1700 EDISON DRIVE | MILFORD | OH | 451502729 | 833536760 | HEALTH CARE | IN | N/A | 0 | 0 |
| COMMUNITY HEALTH NETWORK REHAB HOSP LLC | |||||||||
| 680 S FOURTH STREET | LOUISVILLE | KY | 40202 | 453414249 | REHAB | IN | N/A | 0 | 0 |
| COMMUNITY HEALTH NTWRK REHAB HOSP SOUTH LLC | |||||||||
| 680 S FOURTH STREET | LOUISVILLE | KY | 40202 | 821385366 | REHAB | IN | N/A | 0 | 0 |
| COMMUNITY HEALTH NTWRK REHAB HOSP WEST LLC | |||||||||
| 330 SEVEN SPRINGS WAY | BRENTWOOD | TN | 37027 | 845110509 | REHAB | IN | N/A | 0 | 0 |
| EAST CAMPUS SURGERY CENTER LLC | |||||||||
| 6626 E 75TH STREET SUITE 200 | INDIANAPOLIS | IN | 46250 | 352028517 | SURGERY | IN | N/A | 0 | 0 |
| HAMILTON SURGERY CENTER LLC | |||||||||
| 6626 E 75TH STREET SUITE 200 | INDIANAPOLIS | IN | 46250 | 352061413 | SURGERY | IN | N/A | 0 | 0 |
| HEALTHBOX CHICAGO II LLC | |||||||||
| 33 WEST MONROE STREET SUITE 1700 | CHICAGO | IL | 60603 | 463871950 | INVESTMENT | IL | N/A | 0 | 0 |
| HOWARD COMMUNITY SURGERY CTR LLC | |||||||||
| 3500 S LAFOUNTAIN STREET | KOKOMO | IN | 46902 | 352118748 | SURGERY | IN | N/A | 0 | 0 |
| INDIANAPOLIS ENDOSCOPY CENTER LLC | |||||||||
| 8315 E 56TH STREET | INDIANAPOLIS | IN | 46216 | 352010874 | HEALTH CARE | IN | N/A | 0 | 0 |
| MICHIGAN SURGERY INVESTMENT LLC | |||||||||
| 6626 E 75TH STREET SUITE 200 | INDIANAPOLIS | IN | 46250 | 320147008 | SURGERY CENTERS | IN | N/A | 0 | 0 |
| NORTH CAMPUS OFFICE ASSOCIATES LP | |||||||||
| 6626 E 75TH STREET SUITE 200 | INDIANAPOLIS | IN | 46250 | 351808625 | RENTAL PROPERTY | IN | N/A | 0 | 0 |
| NORTH CAMPUS SURGERY CENTER LLC | |||||||||
| 6626 E 75TH STREET SUITE 200 | INDIANAPOLIS | IN | 46250 | 352147088 | SURGERY | IN | N/A | 0 | 0 |
| NORTHPOINT PEDIATRICS LLC | |||||||||
| 8101 CLEARVISTA PARKWAY SUITE 185 | INDIANAPOLIS | IN | 46256 | 351960566 | HEALTH CARE | IN | N/A | 0 | 0 |
| NORTHWEST SURGERY CENTER LLC | |||||||||
| 6626 E 75TH STREET SUITE 200 | INDIANAPOLIS | IN | 46250 | 208754071 | SURGERY | IN | N/A | 0 | 0 |
| PILLARS HOUSING LP | |||||||||
| 3500 S LAFOUNTAIN STREET | KOKOMO | IN | 46902 | 161652671 | HOUSING | IN | N/A | 0 | 0 |
| PRIMARIA HEALTH LLC | |||||||||
| 9365 COUNSELORS ROW SUITE 210 | INDIANAPOLIS | IN | 46240 | 474728937 | CONSULTING | IN | N/A | 0 | 0 |
| SCP INDIANAPOLIS LLC | |||||||||
| 7430 SHADELAND AVENUE SUITE 100 | INDIANAPOLIS | IN | 46250 | 460639908 | HEALTH CARE | IN | N/A | 0 | 0 |
| SOUTH CAMPUS SURGERY CENTER LLC | |||||||||
| 1550 EAST COUNTY LINE ROAD | INDIANAPOLIS | IN | 46227 | 352038072 | SURGERY | IN | N/A | 0 | 0 |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (5 entries)
| Address Line1ForeignAddress/AddressLine1Txt | CityForeignAddress/CityNm | CountryForeignAddress/CountryCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile Foreign CountryLegalDomicileForeignCountryCd | Direct Controlling NADirectControllingNACd | Entity TypeEntityTypeTxt | Controlled OrganizationControlledOrganizationInd | Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | Legal Domicile StateLegalDomicileStateCd |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| CHN ASSURANCE COMPANY LTD | |||||||||||||
| PO BOX 1051GT | GRAND CAYMAN | CJ | 980418913 | SELF INSURANCE | CJ | N/A | C | 0 | |||||
| PILLARS COMMUNITY HOUSING INC | |||||||||||||
| 161652666 | HOUSING | N/A | C | 0 | 3500 S LAFOUNTAIN STREET | KOKOMO | IN | 46902 | IN | ||||
| VISIONARY ENTERPRISES INC | |||||||||||||
| 351538433 | MANAGEMENT SERVICES | N/A | C | 0 | 6626 E 75TH STREET SUITE 200 | INDIANAPOLIS | IN | 46250 | IN | ||||
| VEI MICHIGAN INC | |||||||||||||
| 300097377 | MANAGEMENT SERVICES | N/A | C | 0 | 940 N MAIN STREET | ANN HARBOR | MI | 48104 | MI | ||||
| WESTVIEW DELIVERY SYSTEM INC | |||||||||||||
| 351910292 | MANAGEMENT SERVICES | N/A | C | 0 | 3630 GUION ROAD | INDIANAPOLIS | IN | 46222 | IN | ||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | Yes (1) | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (1) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (1) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (1) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (1) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | Yes (1) | TransferToOtherOrgInd |
| Transfer From Other Org | Yes (1) | TransferFromOtherOrgInd |