STRATEGY STUDIO / NONPROFIT PEOPLE SEARCH

COMMUNITY HOSPITALS OF INDIANA INC: Form 990, tax year 2014

View the entire original 990 at ProPublica ↗

Organization
COMMUNITY HOSPITALS OF INDIANA INC (EIN 35-1088640)
Tax period
2014-01-01 to 2014-12-31
Filed
2015-11-13
IRS object ID
201543179349301244
Schema version
2014v5.0
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Return2015-11-13T07:56:21-06:00ReturnTs
Tax Period End2014-12-31TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN352032768PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1CASKEY & DAILY PCBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line14745 STATESMEN DRIVE SUITE CAddressLine1Txt
CityINDIANAPOLISCityNm
State AbbreviationINStateAbbreviationCd
ZIP46250ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2014-01-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN351088640EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1COMMUNITY HOSPITAL SOUTH INCBusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlCOMMBusinessNameControlTxt
Phone3178877112PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line11402 E COUNTY LINE ROAD SOUTHAddressLine1Txt
CityINDIANAPOLISCityNm
State AbbreviationINStateAbbreviationCd
ZIP46227ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonANTHONY LENNENPersonNm
Person TitlePRESIDENTPersonTitleTxt
Phone3178877112PhoneNum
Signature2015-10-20SignatureDt
Discuss With Paid PreparerYes (true)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonJAMES A CASKEY CPA CFPPreparerPersonNm
PTINP00172185PTIN
Phone3175852647PhoneNum
Preparation2015-11-13PreparationDt
FieldValueIRS element (for citing)
Tax2014TaxYr
Build TS2016-04-25 22:37:26ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerANTHONY LENNENPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line11402 E COUNTY LINE ROAD SOUTHAddressLine1Txt
CityINDIANAPOLISCityNm
State AbbreviationINStateAbbreviationCd
ZIP46227ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$212,978,874GrossReceiptsAmt
Group Return For AffiliatesfalseGroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website AddressWWW.ECOMMUNITY.COMWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1989FormationYr
Legal Domicile StateINLegalDomicileStateCd
Activity Or MissionCOMMUNITY HOSPITAL SOUTH,INC. ("CHS") IS A 501(C)(3) CORPORATION SERVING THE HEALTH RELATED NEEDS OF THE CITIZENS OF THE INDIANAPOLIS METROPOLITAN AREA AND CENTRAL INDIANA. CHS OPERATES A GENERAL ACUTE CARE HOSPITAL AND PROVIDES INPATIENT, OUTPATIENT, EMERGENCY AND AMBULATORY HEALTH CARE SERVICES TO ALL PATIENTS REGARDLESS OF THEIR ABILITY TO PAY.ActivityOrMissionDesc
Voting Members Governing Body13VotingMembersGoverningBodyCnt
Voting Members Independent8VotingMembersIndependentCnt
Total Employee1111TotalEmployeeCnt
Total Volunteers328TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
PY Contributions Grants$332,858PYContributionsGrantsAmt
CY Contributions Grants$23,174CYContributionsGrantsAmt
PY Program Service Revenue$184,713,350PYProgramServiceRevenueAmt
CY Program Service Revenue$207,776,030CYProgramServiceRevenueAmt
PY Investment Income$1,700PYInvestmentIncomeAmt
CY Investment Income$31,750CYInvestmentIncomeAmt
PY Other Revenue$5,185,511PYOtherRevenueAmt
CY Other Revenue$5,146,956CYOtherRevenueAmt
PY Total Revenue$190,233,419PYTotalRevenueAmt
CY Total Revenue$212,977,910CYTotalRevenueAmt
CY Grants And Similar Paid$0CYGrantsAndSimilarPaidAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$63,386,405PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$60,304,232CYSalariesCompEmpBnftPaidAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$92,401,363PYOtherExpensesAmt
CY Other Expenses$97,046,933CYOtherExpensesAmt
PY Total Expenses$155,787,768PYTotalExpensesAmt
CY Total Expenses$157,351,165CYTotalExpensesAmt
PY Revenues Less Expenses$34,445,651PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$55,626,745CYRevenuesLessExpensesAmt
Total Assets BOY$263,787,589TotalAssetsBOYAmt
Total Assets EOY$320,328,890TotalAssetsEOYAmt
Total Liabilities BOY$4,734,262TotalLiabilitiesBOYAmt
Total Liabilities EOY$5,648,818TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$259,053,327NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$314,680,072NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part IIIYes (X)InfoInScheduleOPartIIIInd
MissionCOMMUNITY HOSPITAL SOUTH,INC. ("CHS") IS A 501(C)(3) CORPORATION SERVING THE HEALTH RELATED NEEDS OF THE CITIZENS OF THE INDIANAPOLIS METROPOLITAN AREA AND CENTRAL INDIANA. CHS OPERATES A GENERAL ACUTE CARE HOSPITAL AND PROVIDES INPATIENT, OUTPATIENT, EMERGENCY AND AMBULATORY HEALTH CARE SERVICES TO ALL PATIENTS REGARDLESS OF THEIR ABILITY TO PAY.MissionDesc
Significant New Program SrvcfalseSignificantNewProgramSrvcInd
Significant ChangefalseSignificantChangeInd
Expense$99,496,096ExpenseAmt
Revenue$212,922,986RevenueAmt
DescCOMMUNITY HOSPITAL SOUTH ("CHS") IS AN ACUTE CARE HOSPITAL IN INDIANAPOLIS, INDIANA WITH 158 LICENSED BEDS. IN 2014, CHS SERVED 8,595 INPATIENTS FOR A TOTAL OF 30,830 INPATIENT DAYS OF SERVICE. CHS ALSO PROVIDED 128,051 OUTPATIENT VISITS, WHICH INCLUDED 47,151 EMERGENCY VISITS. COMMUNITY HOSPITAL SOUTH OFFERS MANY PATIENT FOCUSED HEALTHCARE SERVICES THAT INCLUDE WOMEN AND CHILDREN SERVICES, PEDIATRICS, ONCOLOGY, NEUROSCIENCES, ORTHOPEDICS, JOINT REPLACEMENT, BREAST CARE SERVICES, SURGERY SERVICES, REHABILITATION SERVICES, HEALTH PROMOTION SERVICES, AND EMERGENCY SERVICES.Desc
Total Program Service Expenses$99,496,096TotalProgramServiceExpensesAmt
Described In Section501c3Yes (true)DescribedInSection501c3Ind
Schedule B RequiredYes (true)ScheduleBRequiredInd
Political Campaign ActyfalsePoliticalCampaignActyInd
Lobbying ActivitiesfalseLobbyingActivitiesInd
Subject To Proxy TaxfalseSubjectToProxyTaxInd
Donor Advised FundfalseDonorAdvisedFundInd
Conservation EasementsfalseConservationEasementsInd
Collections Of ArtfalseCollectionsOfArtInd
Credit CounselingfalseCreditCounselingInd
Temp Or Permanent EndowmentsfalseTempOrPermanentEndowmentsInd
Report Land Building EquipmentYes (true)ReportLandBuildingEquipmentInd
Report Investments Other SecfalseReportInvestmentsOtherSecInd
Report Program Related InvstfalseReportProgramRelatedInvstInd
Report Other AssetsYes (true)ReportOtherAssetsInd
Report Other LiabilitiesfalseReportOtherLiabilitiesInd
Include FIN48 FootnotefalseIncludeFIN48FootnoteInd
Independent Audit Fincl StmtfalseIndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtYes (true)ConsolidatedAuditFinclStmtInd
School OperatingfalseSchoolOperatingInd
Foreign OfficefalseForeignOfficeInd
Foreign ActivitiesfalseForeignActivitiesInd
More Than5000 K To OrgfalseMoreThan5000KToOrgInd
More Than5000 K To IndividualsfalseMoreThan5000KToIndividualsInd
Professional FundraisingfalseProfessionalFundraisingInd
Fundraising ActivitiesfalseFundraisingActivitiesInd
Gaming ActivitiesfalseGamingActivitiesInd
Operate HospitalYes (true)OperateHospitalInd
Audited Financial Stmt AttYes (true)AuditedFinancialStmtAttInd
Grants To OrganizationsfalseGrantsToOrganizationsInd
Grants To IndividualsfalseGrantsToIndividualsInd
Schedule J RequiredYes (true)ScheduleJRequiredInd
Tax Exempt BondsfalseTaxExemptBondsInd
Engaged In Excess Benefit TransfalseEngagedInExcessBenefitTransInd
PY Excess Benefit TransfalsePYExcessBenefitTransInd
Loan OutstandingfalseLoanOutstandingInd
Grant To Related PersonfalseGrantToRelatedPersonInd
Business Rln With Org MemfalseBusinessRlnWithOrgMemInd
Business Rln With Fam MemfalseBusinessRlnWithFamMemInd
Business Rln With Officer EntYes (true)BusinessRlnWithOfficerEntInd
Deductible Non Cash ContrifalseDeductibleNonCashContriInd
Deductible Art ContributionfalseDeductibleArtContributionInd
Terminate OperationsfalseTerminateOperationsInd
Partial LiquidationfalsePartialLiquidationInd
Disregarded EntityfalseDisregardedEntityInd
Related EntityYes (true)RelatedEntityInd
Related Organization Ctrl EntYes (true)RelatedOrganizationCtrlEntInd
Transaction With Control EntYes (true)TransactionWithControlEntInd
Trnsfr Exmpt Non Chrtbl Rltd OrgfalseTrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted PrtshpfalseActivitiesConductedPrtshpInd
Schedule O RequiredYes (true)ScheduleORequiredInd
Info In Schedule O Part VYes (X)InfoInScheduleOPartVInd
IRP Document60IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (true)BackupWthldComplianceInd
Employee1111EmployeeCnt
Employment Tax Returns FiledYes (true)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over LimitfalseUnrelatedBusIncmOverLimitInd
Foreign Financial AccountfalseForeignFinancialAccountInd
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTransInd
Taxable Party NotificationfalseTaxablePartyNotificationInd
Nondeductible ContributionsfalseNondeductibleContributionsInd
Quid Pro Quo ContributionsfalseQuidProQuoContributionsInd
Form8282 Property Disposed OffalseForm8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft CntrctfalseRcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft CntrctfalsePayPremiumsPrsnlBnftCntrctInd
Indoor Tanning ServicesfalseIndoorTanningServicesInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members13GoverningBodyVotingMembersCnt
Independent Voting Member8IndependentVotingMemberCnt
Family Or Business RlnYes (true)FamilyOrBusinessRlnInd
Delegation Of Mgmt DutiesYes (true)DelegationOfMgmtDutiesInd
Change To Org DocumentsfalseChangeToOrgDocumentsInd
Material Diversion Or MisusefalseMaterialDiversionOrMisuseInd
Members Or StockholdersYes (true)MembersOrStockholdersInd
Election Of Board MembersYes (true)ElectionOfBoardMembersInd
Decisions Subject To ApprovaYes (true)DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (true)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (true)MinutesOfCommitteesInd
Officer Mailing AddressfalseOfficerMailingAddressInd
Local ChaptersfalseLocalChaptersInd
Form990 Provided To Gvrn BodyfalseForm990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (true)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (true)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (true)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (true)WhistleblowerPolicyInd
Document Retention PolicyYes (true)DocumentRetentionPolicyInd
Compensation Process CEOfalseCompensationProcessCEOInd
Compensation Process OtherfalseCompensationProcessOtherInd
Investment In Joint VenturefalseInvestmentInJointVentureInd
States Where Copy Of Return Is FldINStatesWhereCopyOfReturnIsFldCd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

FieldValueIRS element (for citing)
PersonBRIAN MCCONNELLPersonNm
Phone3173554212PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line18180 CLEARVISTA PKWY 200AddressLine1Txt
CityINDIANAPOLISCityNm
State AbbreviationINStateAbbreviationCd
ZIP46256ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (22 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtOfficerOfficerIndKey EmployeeKeyEmployeeIndHighest Compensated EmployeeHighestCompensatedEmployeeIndFormer Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd
BRYAN A MILLS
DIRECTOR1.0059.00Yes (X)$0$965,396$311,390
HANY HADDAD MD
DIRECTOR1.0054.00Yes (X)$0$524,569$33,822
KENNETH SHAVER MD
DIRECTOR1.0054.00Yes (X)$0$262,895$102,407
KATHRYN G BETLEY
DIRECTOR1.005.00Yes (X)$0$0$0
BRUCE F KING
DIRECTOR1.005.00Yes (X)$0$0$0
JEFFREY MOSSLER MD
DIRECTOR1.005.00Yes (X)$0$0$0
MICHAEL PETERSON
CHAIRMAN1.005.00Yes (X)$0$0$0Yes (X)
STEVEN PLUMP
DIRECTOR1.005.00Yes (X)$0$0$0
YVONNEE SHAHEEN
SECRETARY1.005.00Yes (X)$0$0$0Yes (X)
KRISTEN SHERMAN
TREASURER1.005.00Yes (X)$0$0$0Yes (X)
CHARLES E STALEY
DIRECTOR1.005.00Yes (X)$0$0$0
RUSSELL SWAN JR
VICE CHAIRMA1.005.00Yes (X)$0$0$0Yes (X)
BRIAN K WILLIAMS
DIRECTOR1.005.00Yes (X)$0$0$0
ANTHONY LENNEN
PRESIDENT50.00$429,693$0$161,210Yes (X)
JEFFREY KIRKHAM
CFO CLINICAL55.00$0$307,749$354,482Yes (X)
SARAH KNISELY-KING
COO/CHF NURS50.00$227,966$0$49,313Yes (X)
RANDALL LEE MD
VP CLINICAL45.00$287,829$0$104,465Yes (X)
CRISTINA BOSWELL
PHYSICIST45.00$139,724$0$20,138Yes (X)
SANDRA LEMON
SITE CLINICA45.00$133,280$0$32,202Yes (X)
NATHAN GWINNUP
CLINICAL PHA45.00$130,189$0$33,421Yes (X)
REGINA WARD
EXEC DIR ONC45.00$127,362$0$49,598Yes (X)
MICHAEL C BLANCHET
FORMER COO -0.00$0$313,808$264,991Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$1,476,043TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$2,374,417TotReportableCompRltdOrgAmt
Total Other Compensation$1,517,439TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K29IndivRcvdGreaterThan100KCnt
Former Ofcr Employees ListedYes (true)FormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (true)TotalCompGreaterThan150KInd
Compensation From Other SrcsfalseCompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (5 entries)

Address Line1ContractorAddress/USAddress/AddressLine1TxtCityContractorAddress/USAddress/CityNmState AbbreviationContractorAddress/USAddress/StateAbbreviationCdZIPContractorAddress/USAddress/ZIPCdServicesServicesDescCompensationCompensationAmt
INPATIENT SERVICES OF INDIANA
7032 COLLECTION CENTER DRIVECHICAGOIL60693HOSPITALISTS$2,438,442
ROLLINS CONSTRUCTION CO LLC
3024 N RIDGEVIEW DRIVEINDIANAPOLISIN46226CONSTRUCTION$695,153
ARAMARK
25271 NETWORK PLACECHICAGOIL606731252DIETARY MGMT$554,481
INDPLS GASTROENTEROLOGY & HEPATOLOGY
8051 S EMERSON AVENUEINDIANAPOLISIN46237MEDICAL$415,250
UROLOGY OF INDIANA LLC
679 E COUNTY LINE ROADGREENWOODIN46143MEDICAL$392,839
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K57CntrctRcvdGreaterThan100KCnt
Related Organizations$23,174RelatedOrganizationsAmt
Total Contributions$23,174TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (5 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
PATIENT REVENUE622110$206,855,107$206,855,107
RADIOLOGY900099$301,152$301,152
JOHNSON MEMORIAL REVENUE621500$230,802$230,802
MEDICAL STAFF SERVICES900099$193,637$193,637
RENT531120$146,760$146,760

Total Oth Program Service Rev TotalOthProgramServiceRevGrp

FieldValueIRS element (for citing)
Total Revenue Column$48,572TotalRevenueColumnAmt
Related Or Exempt Func Income$48,572RelatedOrExemptFuncIncomeAmt
FieldValueIRS element (for citing)
Total Program Service Revenue$207,776,030TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$32,714TotalRevenueColumnAmt
Exclusion$32,714ExclusionAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

FieldValueIRS element (for citing)
Other$964OtherAmt

Gain Or Loss GainOrLossGrp

FieldValueIRS element (for citing)
Other-$964OtherAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

FieldValueIRS element (for citing)
Total Revenue Column-$964TotalRevenueColumnAmt
Exclusion-$964ExclusionAmt

Other Revenue Misc OtherRevenueMiscGrp (3 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
LEASED EQUIPMENT532420$3,055,915$3,055,915
EHR INCENTIVE PAYMENTS900099$1,034,506$1,034,506
EQUITY INVESTMENT INCOME900003$727,890$727,890

Miscellaneous Revenue MiscellaneousRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$328,645TotalRevenueColumnAmt
Related Or Exempt Func Income$328,645RelatedOrExemptFuncIncomeAmt
FieldValueIRS element (for citing)
Other Revenue Total$5,146,956OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$212,977,910TotalRevenueColumnAmt
Related Or Exempt Func Income$212,922,986RelatedOrExemptFuncIncomeAmt
Exclusion$31,750ExclusionAmt
FieldValueIRS element (for citing)
Info In Schedule O Part IXYes (X)InfoInScheduleOPartIXInd

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$868,182TotalAmt
Management And General$868,182ManagementAndGeneralAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$44,923,269TotalAmt
Program Services$34,710,106ProgramServicesAmt
Management And General$10,213,163ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$2,818,079TotalAmt
Program Services$974,607ProgramServicesAmt
Management And General$1,843,472ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$8,445,543TotalAmt
Program Services$6,401,756ProgramServicesAmt
Management And General$2,043,787ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$3,249,159TotalAmt
Program Services$2,495,576ProgramServicesAmt
Management And General$753,583ManagementAndGeneralAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$306TotalAmt
Management And General$306ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$36,729,041TotalAmt
Program Services$10,167,385ProgramServicesAmt
Management And General$26,561,656ManagementAndGeneralAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$10,877TotalAmt
Program Services$10,877ProgramServicesAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$4,269,160TotalAmt
Program Services$2,681,824ProgramServicesAmt
Management And General$1,587,336ManagementAndGeneralAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$429,173TotalAmt
Program Services$221,484ProgramServicesAmt
Management And General$207,689ManagementAndGeneralAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$2,180,363TotalAmt
Program Services$1,652,724ProgramServicesAmt
Management And General$527,639ManagementAndGeneralAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$57,151TotalAmt
Program Services$26,039ProgramServicesAmt
Management And General$31,112ManagementAndGeneralAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$30,807TotalAmt
Program Services$21,345ProgramServicesAmt
Management And General$9,462ManagementAndGeneralAmt

Interest InterestGrp

FieldValueIRS element (for citing)
Total$6,403,563TotalAmt
Management And General$6,403,563ManagementAndGeneralAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$11,209,688TotalAmt
Program Services$4,491,318ProgramServicesAmt
Management And General$6,718,370ManagementAndGeneralAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$3,976TotalAmt
Management And General$3,976ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmt
MEDICAL SUPPLIES$27,887,027$27,887,027
HAF PROGRAM FEES$7,719,393$7,719,393
DUES & SUBSCRIPTIONS$49,536$123$49,413
CORPORATE DEVELOPMENT$46,088$23,785$22,303

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$20,784TotalAmt
Program Services$10,727ProgramServicesAmt
Management And General$10,057ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$157,351,165TotalAmt
Program Services$99,496,096ProgramServicesAmt
Management And General$57,855,069ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$2,675BOYAmt
EOY$2,675EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$23,158,667BOYAmt
EOY$26,244,276EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

FieldValueIRS element (for citing)
BOY$2,646,391BOYAmt
EOY$2,670,100EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$236,588,597LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$106,361,532LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$129,519,576BOYAmt
EOY$130,227,065EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$108,460,280BOYAmt
EOY$161,184,774EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$263,787,589BOYAmt
EOY$320,328,890EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$4,616,294BOYAmt
EOY$5,648,818EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$117,968BOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$4,734,262BOYAmt
EOY$5,648,818EOYAmt
FieldValueIRS element (for citing)
Organization Follows SFAS117Yes (X)OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

FieldValueIRS element (for citing)
BOY$259,053,327BOYAmt
EOY$314,680,072EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$259,053,327BOYAmt
EOY$314,680,072EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$263,787,589BOYAmt
EOY$320,328,890EOYAmt
FieldValueIRS element (for citing)
Reconcilation Revenue Expnss$55,626,745ReconcilationRevenueExpnssAmt
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or ReviewfalseAccountantCompileOrReviewInd
FS AuditedYes (true)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Consolidated Basis Fincl StmtYes (X)ConsolidatedBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (true)AuditCommitteeInd
Federal Grant Audit RequiredfalseFederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
HospitalYes (X)HospitalInd

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

FieldValueIRS element (for citing)
ContributorRESTRICTEDContributorNum

Contributor Business Name ContributorBusinessName

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor US Address ContributorUSAddress

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Total ContributionsRESTRICTEDTotalContributionsAmt

Schedule D IRS990ScheduleD

Land LandGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$497,000OtherCostOrOtherBasisAmt
Book Value$497,000BookValueAmt

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$171,260,619OtherCostOrOtherBasisAmt
Depreciation$44,043,488DepreciationAmt
Book Value$127,217,131BookValueAmt

Leasehold Improvements LeaseholdImprovementsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$1,527,876OtherCostOrOtherBasisAmt
Depreciation$930,174DepreciationAmt
Book Value$597,702BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$60,527,224OtherCostOrOtherBasisAmt
Depreciation$59,524,216DepreciationAmt
Book Value$1,003,008BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$2,775,878OtherCostOrOtherBasisAmt
Depreciation$1,863,654DepreciationAmt
Book Value$912,224BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$130,227,065TotalBookValueLandBuildingsAmt

Other Assets Org OtherAssetsOrgGrp (2 entries)

DescDescBook ValueBookValueAmt
DUE FROM AFFLIATED ENTITIES$161,021,233
THIRD PARTY RECEIVABLE$163,541
FieldValueIRS element (for citing)
Total Book Value Other Assets$161,184,774TotalBookValueOtherAssetsAmt

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Financial Assistance PolicyYes (true)FinancialAssistancePolicyInd
Written PolicyYes (true)WrittenPolicyInd
All Hospitals PolicyYes (X)AllHospitalsPolicyInd
FPG Reference Free CareYes (true)FPGReferenceFreeCareInd
Percent200Yes (X)Percent200Ind
FPG Reference Discounted CareYes (true)FPGReferenceDiscountedCareInd
Percent300Yes (X)Percent300Ind
Free Care Medically IndigentYes (true)FreeCareMedicallyIndigentInd
Financial Assistance BudgetYes (true)FinancialAssistanceBudgetInd
Expenses Exceed BudgetfalseExpensesExceedBudgetInd
Annual Community Bnft ReportYes (true)AnnualCommunityBnftReportInd
Report Publically AvailableYes (true)ReportPublicallyAvailableInd

Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp

FieldValueIRS element (for citing)
Persons Served3271PersonsServedCnt
Total Community Benefit Expns$1,236,585TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$1,236,585NetCommunityBenefitExpnsAmt
Total Expense0.00790TotalExpensePct

Unreimbursed Medicaid UnreimbursedMedicaidGrp

FieldValueIRS element (for citing)
Persons Served16076PersonsServedCnt
Total Community Benefit Expns$23,000,367TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$14,779,734DirectOffsettingRevenueAmt
Net Community Benefit Expns$8,220,633NetCommunityBenefitExpnsAmt
Total Expense0.05220TotalExpensePct

Total Financial Assistance Typ TotalFinancialAssistanceTyp

FieldValueIRS element (for citing)
Persons Served19347PersonsServedCnt
Total Community Benefit Expns$24,236,952TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$14,779,734DirectOffsettingRevenueAmt
Net Community Benefit Expns$9,457,218NetCommunityBenefitExpnsAmt
Total Expense0.06010TotalExpensePct

Community Health Services CommunityHealthServicesGrp

FieldValueIRS element (for citing)
Activities Or Programs9ActivitiesOrProgramsCnt
Total Community Benefit Expns$3,284,605TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$3,284,605NetCommunityBenefitExpnsAmt
Total Expense0.02090TotalExpensePct

Health Professions Education HealthProfessionsEducationGrp

FieldValueIRS element (for citing)
Activities Or Programs3ActivitiesOrProgramsCnt
Total Community Benefit Expns$483,527TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$108,202DirectOffsettingRevenueAmt
Net Community Benefit Expns$375,325NetCommunityBenefitExpnsAmt
Total Expense0.00240TotalExpensePct

Research ResearchGrp

FieldValueIRS element (for citing)
Activities Or Programs1ActivitiesOrProgramsCnt
Total Community Benefit Expns$247,306TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$247,306NetCommunityBenefitExpnsAmt
Total Expense0.00150TotalExpensePct

Total Other Benefits TotalOtherBenefitsGrp

FieldValueIRS element (for citing)
Activities Or Programs13ActivitiesOrProgramsCnt
Total Community Benefit Expns$4,015,438TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$108,202DirectOffsettingRevenueAmt
Net Community Benefit Expns$3,907,236NetCommunityBenefitExpnsAmt
Total Expense0.02480TotalExpensePct

Total Community Benefits TotalCommunityBenefitsGrp

FieldValueIRS element (for citing)
Activities Or Programs13ActivitiesOrProgramsCnt
Persons Served19347PersonsServedCnt
Total Community Benefit Expns$28,252,390TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$14,887,936DirectOffsettingRevenueAmt
Net Community Benefit Expns$13,364,454NetCommunityBenefitExpnsAmt
Total Expense0.08490TotalExpensePct
FieldValueIRS element (for citing)
Bad Debt Expense ReportedYes (true)BadDebtExpenseReportedInd
Bad Debt Expense$6,222,751BadDebtExpenseAmt
Bad Debt Expense Attributable$4,398,141BadDebtExpenseAttributableAmt
Reimbursed By Medicare$38,963,544ReimbursedByMedicareAmt
Cost Of Care Reimbursed By Medcr$41,993,953CostOfCareReimbursedByMedcrAmt
Medicare Surplus Or Shortfall-$3,030,409MedicareSurplusOrShortfallAmt

Costing Methodology Used CostingMethodologyUsedGrp

FieldValueIRS element (for citing)
Cost To Charge RatioYes (X)CostToChargeRatioInd
FieldValueIRS element (for citing)
Written Debt Collection PolicyYes (true)WrittenDebtCollectionPolicyInd
Financial Assistance PrvsnYes (true)FinancialAssistancePrvsnInd

Management Co And Jnt Ventures ManagementCoAndJntVenturesGrp

Entity Name EntityName

FieldValueIRS element (for citing)
Business Name Line1NONEBusinessNameLine1Txt
FieldValueIRS element (for citing)
Hospital Facilities1HospitalFacilitiesCnt

Hospital Facilities HospitalFacilitiesGrp

FieldValueIRS element (for citing)
Facility1FacilityNum

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1COMMUNITY HOSPITAL SOUTHBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line11402 E COUNTY LINE ROAD SOUTHAddressLine1Txt
CityINDIANAPOLISCityNm
State AbbreviationINStateAbbreviationCd
ZIP46227ZIPCd
FieldValueIRS element (for citing)
Website AddressWWW.ECOMMUNITY.COMWebsiteAddressTxt
State License14-005109-1StateLicenseNum
Licensed HospitalYes (X)LicensedHospitalInd
General Medical And SurgicalYes (X)GeneralMedicalAndSurgicalInd
Teaching HospitalYes (X)TeachingHospitalInd
Emergency Room24 HrsYes (X)EmergencyRoom24HrsInd

Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1COMMUNITY HOSPITAL SOUTHBusinessNameLine1Txt
FieldValueIRS element (for citing)
Facility1FacilityNum
First Licensed CY Or PYfalseFirstLicensedCYOrPYInd
Tax Exempt Hospital CY Or PYfalseTaxExemptHospitalCYOrPYInd
CHNA ConductedYes (true)CHNAConductedInd
Community DefinitionYes (X)CommunityDefinitionInd
Community DemographicsYes (X)CommunityDemographicsInd
Existing ResourcesYes (X)ExistingResourcesInd
How Data ObtainedYes (X)HowDataObtainedInd
Community Health NeedsYes (X)CommunityHealthNeedsInd
Other Health IssuesYes (X)OtherHealthIssuesInd
Community Hlth Needs Id ProcessYes (X)CommunityHlthNeedsIdProcessInd
Consulting ProcessYes (X)ConsultingProcessInd
Information GapsYes (X)InformationGapsInd
OtherYes (X)OtherInd
CHNA Conducted12CHNAConductedYr
Take Into Account Others InputYes (true)TakeIntoAccountOthersInputInd
CHNA Conducted With Other FcltsYes (true)CHNAConductedWithOtherFcltsInd
CHNA Conducted With Non FcltsfalseCHNAConductedWithNonFcltsInd
CHNA Report Widely AvailableYes (true)CHNAReportWidelyAvailableInd
Rpt Available On Own WebsiteYes (X)RptAvailableOnOwnWebsiteInd
Own Website URLSEE PART V, SECTION COwnWebsiteURLTxt
Other WebsiteYes (X)OtherWebsiteInd
Other Website URLSEE PART V, SECTION COtherWebsiteURLTxt
Paper Copy Public InspectionYes (X)PaperCopyPublicInspectionInd
Implementation Strategy AdoptYes (true)ImplementationStrategyAdoptInd
Implementation Strategy Adpt13ImplementationStrategyAdptYr
Strategy Posted WebsitefalseStrategyPostedWebsiteInd
Strategy AttachedYes (true)StrategyAttachedInd
Organization Incur Excise TaxfalseOrganizationIncurExciseTaxInd
Elig Criteria ExplainedYes (true)EligCriteriaExplainedInd
FPG Family Incm Lmt Free DscntYes (X)FPGFamilyIncmLmtFreeDscntInd
FPG Family Incm Lmt Free Care200.000000000000FPGFamilyIncmLmtFreeCarePct
FPG Family Incm Lmt Dscnt Care300.000000000000FPGFamilyIncmLmtDscntCarePct
Medical Indigency CriteriaYes (X)MedicalIndigencyCriteriaInd
Insurance Status CriteriaYes (X)InsuranceStatusCriteriaInd
Underinsurance Stat CriteriaYes (X)UnderinsuranceStatCriteriaInd
Residency CriteriaYes (X)ResidencyCriteriaInd
Other CriteriaYes (X)OtherCriteriaInd
Explained BasisYes (true)ExplainedBasisInd
App Financial Asst ExplnYes (true)AppFinancialAsstExplnInd
Described InfoYes (X)DescribedInfoInd
Described Suprt DocYes (X)DescribedSuprtDocInd
Provided Hospital ContactYes (X)ProvidedHospitalContactInd
Includes Publicity MeasuresYes (true)IncludesPublicityMeasuresInd
FAP Available On WebsiteYes (X)FAPAvailableOnWebsiteInd
FAP Summary On WebsiteYes (X)FAPSummaryOnWebsiteInd
FAP Avlbl On Request No ChargeYes (X)FAPAvlblOnRequestNoChargeInd
FAP App Avlbl On Request No ChrgYes (X)FAPAppAvlblOnRequestNoChrgInd
FAP Sum Avlbl On Request No ChrgYes (X)FAPSumAvlblOnRequestNoChrgInd
FAP Notice DisplayedYes (X)FAPNoticeDisplayedInd
Other PublicityYes (X)OtherPublicityInd
FAP Actions On NonpaymentYes (true)FAPActionsOnNonpaymentInd
Permit No ActionsYes (X)PermitNoActionsInd
Collection ActivitiesYes (true)CollectionActivitiesInd
FAP Notified Upon AdmissionYes (X)FAPNotifiedUponAdmissionInd
FAP Notified Before DischargeYes (X)FAPNotifiedBeforeDischargeInd
FAP Notified All PatientsYes (X)FAPNotifiedAllPatientsInd
Documented Elig DeterminationYes (X)DocumentedEligDeterminationInd
Nondis Emergency Care PolicyYes (true)NondisEmergencyCarePolicyInd
Other Method UsedYes (X)OtherMethodUsedInd
Amounts Generally BilledfalseAmountsGenerallyBilledInd
Gross ChargesfalseGrossChargesInd

Supplemental Information SupplementalInformationGrp (7 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FACILITY 1, COMMUNITY HOSPITAL SOUTH - PART V, LINE 5SEE ATTACHED IRS 990 SCHEDULE H SUPPLEMENTAL INFORMATION REPORT FOR PERSONS CONSULTED AND HOW INPUT FROM THESE PERSONS WAS TAKEN INTO ACCOUNT.
FACILITY 1, COMMUNITY HOSPITAL SOUTH - PART V, LINE 6ATHE CHNA FOR COMMUNITY HOSPITAL SOUTH, INC. WAS A JOINT PROCESS AMONG ALL OF THE COMMUNITY HEALTH NETWORK HOSPITALS WHICH INCLUDES: COMMUNITY HEALTH NETWORK, INC. (NORTH & EAST), COMMUNITY HOSPITAL SOUTH, INC., COMMUNITY HOSPITAL OF ANDERSON AND MADISON COUNTY, INC., COMMUNITY HOWARD REGIONAL HEALTH, INC., INDIANA HEART HOSPITAL, LLC, AND INDIANAPOLIS OSTEOPATHIC HOSPITAL, INC.
FACILITY 1, COMMUNITY HOSPITAL SOUTH - PART V, LINE 7DWWW.ECOMMUNITY.COM/S/COMMUNITY-BENEFIT/COMMUNITY-HEALTH-NEEDS FACILITY 1, COMMUNITY HOSPITAL SOUTH - PART V, LINE 7B WWW.COMMUNITYANDERSON.COM/ABOUTUS/COMMUNITYNEEDSASSESSMENT.ASP FACILITY 1, COMMUNITY HOSPITAL SOUTH - PART V, LINE 10A THE IMPLEMENTATION STRATEGY IS IN THE CHNA REPORT FOUND AT WWW.ECOMMUNITY.COM/ABOUTUS/CARE.ASPX
FACILITY 1, COMMUNITY HOSPITAL SOUTH - PART V, LINE 11SEE ATTACHED IRS 990 SCHEDULE H SUPPLEMENTAL INFORMATION REPORT FOR HOW THE HOSPITAL IS ADDRESSING THE SIGNIFICANT COMMUNITY HEALTH NEEDS.
FACILITY 1, COMMUNITY HOSPITAL SOUTH - PART V, LINE 13HOTHER CRITERIA INCLUDE MEDICAID/MEDICARE AND STATE REGULATION
FACILITY 1, COMMUNITY HOSPITAL SOUTH - PART V, LINE 16ITHE POLICY IS REFERENCED ON THE BILL.
FACILITY 1, COMMUNITY HOSPITAL SOUTH - PART V, LINE 22DTHE UNINSURED DISCOUNT WAS DETERMINED UTILIZING THE NETWORK'S TOP COMMERICIAL PAYORS. UNINSURED DISCOUNTS REPRESENT A STANDARD DISCOUNT ON CHARGES AS IT RELATES TO PATIENTS WHO HAVE NO INSURANCE COVERAGE.
FieldValueIRS element (for citing)
Facility7FacilityNum

Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp

Oth Hlth Care Fclts OthHlthCareFcltsGrp (7 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdFacilityFacilityTxt
COMMUNITY REGIONAL CANCER CENTER
1550 E COUNTY LINE ROAD SUITE 325INDIANAPOLISIN46227HEALTH CARE
COMM HEART & VASCULAR CV TESTING
1402 E COUNTY LINE ROAD 2200INDIANAPOLISIN46227HEALTH CARE
COMMUNITY IMAGING CENTER
333 E COUNTY LINE ROAD SUITE AGREENWOODIN46143DIAGNOSTIC CENTER
CHS SLEEP DISORDERS CENTER
333 E COUNTY LINE ROAD SUITE DGREENWOODIN46143HEALTH CARE
REHAB & SPORTS MEDICINE
98 SOUTHPARK BLVDGREENWOODIN46143REHABILITATION
REHAB & SPORTS MEDICINE
1340 E COUNTY LINE ROAD UINDIANAPOLISIN46227REHABILITATION
CENTER FOR WOMEN'S HEALTH
533 E COUNTY LINE ROAD 101GREENWOODIN46143HEALTH CARE

Supplemental Information Detail SupplementalInformationDetail (6 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
PART I, LINE 6A - RELATED ORGANIZATION INFORMATIONA COMMUNITY BENEFIT REPORT IS COMPLETED FOR THE COMMUNITY HEALTH NETWORK INCLUDING COMMUNITY HOSPITAL SOUTH, INC. AND OTHER TAX-EXEMPT AFFILIATES OF THE NETWORK.
PART I, LINE 7 - COSTING METHODOLOGY EXPLANATIONA 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 II - COMMUNITY BUILDING ACTIVITIES SEE ATTACHED IRS SCHEDULE H SUPPLEMENTAL INFORMATION REPORT
PART III, LINE 2 - BAD DEBT EXPENSE METHODOLOGYTHE COST TO CHARGE RATIO UTILIZED FOR PURPOSES OF REPORTING BAD DEBT COSTS WAS DERIVED FROM WORKSHEET 2 AND IS BASED ON THE ORGANIZATION'S AUDITED FINANCIAL STATEMENTS. PART III, LINE 3 - BAD DEBT EXPENSE, PATIENTS ELIBIBLE FOR ASSISTANCE THE ESTIMATED AMOUNT OF THE ORGANIZATION'S BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY WAS CALCULATED UTILIZING THE HISTORICAL LEVEL OF PATIENTS THAT WERE DETERMINED AS ELIGIBLE FOR FINANCIAL ASSISTANCE BASED ON A PRESUMPTIVE ELIBIBILITY PROCESS AND APPLYING THIS RATIO TO THE REPORTED BAD DEBT EXPENSE ON THE FINANCIAL STATEMENTS. PART III, LINE 4 - BAD DEBT EXPENSE EXPLANATION THE AUDITED FINANCIAL STATEMENTS CONTAIN THE FOLLOWING TEXT WITHIN THE FOOTNOTES TO DESCRIBE BAD DEBT EXPENSE: THE NETWORK'S ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND CONTRACTUAL ADJUSTMENTS. IN EVALUATING THE COLLECTABILITY OF ACCOUNTS RECEIVABLE, THE NETWORK ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR CONTRACTUAL ADJUSTMENTS AND PROVISION FOR BAD DEBTS. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD PARTY COVERAGE, THE NETWORK ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR CONTRACTUAL ADJUSTMENTS. FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS, INCLUDING PATIENT DEDUCTIBLES AND CO- INSURANCE, THE NETWORK RECORDS A PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS ADJUSTED THROUGH THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. CERTAIN ACCOUNTS THAT ARE SENT TO COLLECTION COMPANIES REMAIN AS ACCOUNTS RECEIVABLE ON THE BALANCE SHEET. THESE ACCOUNTS ARE NOT WRITTEN OFF UNLESS RETURNED FROM THE COLLECTION COMPANY. HOWEVER, THEY ARE FULLY RESERVED WITHIN THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. THE NETWORK RECOGNIZES PATIENT SERVICE REVENUE ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY PAYOR COVERAGE ON THE BASIS OF CONTRACTUAL RATES FOR THE SERVICES RENDERED. FOR UNINSURED PATIENTS THAT DO NOT QUALIFY FOR CHARITY CARE, THE NETWORK RECOGNIZES REVENUE ON THE BASIS OF ITS STANDARD RATES FOR SERVICES PROVIDED OR ON THE BASIS OF DISCOUNTED RATES IF IN ACCORDANCE WITH POLICY. ON THE BASIS OF HISTORICAL EXPERIENCE, A PORTION OF THE NETWORK'S UNINSURED PATIENTS WILL BE UNABLE OR UNWILLING TO PAY FOR THE SERVICES PROVIDED. THUS, THE NETWORK RECORDS A PROVISION FOR BAD DEBTS AND CHARITY RELATED TO UNINSURED PATIENTS IN THE PERIOD THE SERVICES ARE PROVIDED. PATIENT SERVICE REVENUE, NET OF CONTRACTUAL ALLOWANCES AND DISCOUNTS RECOGNIZED IN THE PERIOD FROM THESE MAJOR PAYOR SOURCES, IS AS FOLLOWS FOR THE YEARS ENDED DECEMBER 31, 2014 AND 2013, RESPECTIVELY: THIRD PARTY PAYORS SELF-PAY TOTAL ALL PAYORS 2014 PATIENT SERVICE REVENUE(NET OF CONTRACTUAL ALLOWANCES AND DISCOUNTS) 1,846,217 142,537 1,988,754 ========== ======== ========== 2013 PATIENT SERVICE REVENUE(NET OF CONTRACTUAL ALLOWANCES AND DISCOUNTS) 1,666,086 94,024 1,760,110 ========== ======= ========== THE NETWORK MAINTAINS RECORDS TO IDENTIFY AND MONITOR THE LEVEL OF CHARITY CARE IT PROVIDES. THE NETWORK PROVIDES 100% CHARITY CARE TO PATIENTS WHOSE INCOME LEVEL IS BELOW 200% OF THE FEDERAL POVERTY LEVEL. PATIENTS WITH INCOME LEVELS RANGING FROM 200% - 300% OF THE CURRENT YEAR'S FEDERAL POVERTY LEVEL WILL QUALIFY FOR PARTIAL ASSISTANCE DETERMINED BY A SLIDING SCALE. THE NETWORK USES COST AS THE MEASUREMENT BASIS FOR CHARITY CARE DISCLOSURE PURPOSES WITH THE COST BEING IDENTIFIED AS THE DIRECT AND INDIRECT COSTS OF PROVIDING THE CHARITY CARE. CHARITY CARE AT COST WAS 15,657000 AND 83,731000 FOR THE YEARS ENDED DECEMBER 31, 2014 AND 2013, RESPECTIVELY. CHARITY CARE COST WAS ESTIMATED ON THE APPLICATION OF THE ASSOCIATED COST-TO-CHARGE RATIOS. THE REDUCTION IN CHARITY CARE AND OFFSETTING INCREASE IN THE ALLOWANCE FOR DOUBTFUL ACCOUNTS ARE REFLECTIONS OF CHANGES THE NETWORK MADE TO ITS CHARITY CARE POLICY EFFECTIVE JANUARY 1, 2014, WHICH PRIMARILY INCLUDED BEING MORE RESTRICTIVE TO PROVIDE CARE TO INDIVIDUALS WHO RESIDE IN THE NETWORKS SERVICE AREA. FURTHER, BEGINNING IN JANUARY 2014, MORE PATIENTS WERE COVERED UNDER HEALTH EXCHANGE PROGRAMS MANDATED BY THE AFFORDABLE HEALTH CARE ACT. BEGINNING JUNE 2012, THE STATE OF INDIANA OFFERED VOLUNTARY PARTICIPATION IN THE STATE OF INDIANA'S HOSPITAL ASSESSMENT FEE ("HAF") PROGRAM. THE STATE OF INDIANA IMPLEMENTED THIS PROGRAM TO UTILIZE SUPPLEMENTAL REIMBURSEMENT PROGRAMS FOR THE PURPOSE OF PROVIDING REIMBURSEMENT TO PROVIDERS TO OFFSET A PORTION OF THE COST OF PROVIDING CARE TO MEDICAID AND INDIGENT PATIENTS. THIS PROGRAM IS DESIGNED WITH INPUT FROM CENTERS FOR MEDICARE AND MEDICAID SERVICES AND IS FUNDED WITH A COMBINATION OF STATE AND FEDERAL RESOURCES, INCLUDING FEES OR TAXES LEVIED ON THE PROVIDERS. THE NETWORK RECOGNIZES REVENUES AND RELATED FEES ASSOCIATED WITH THE HAF PROGRAM IN THE PERIOD IN WHICH AMOUNTS ARE ESTIMABLE AND COLLECTION OR PAYMENT IS REASONABLY ASSURED. REIMBURSEMENT UNDER THE PROGRAM IS REFLECTED WITHIN NET PATIENT SERVICE REVENUE AND THE FEES PAID FOR PARTICIPATION IN THE HAF PROGRAM ARE RECORDED IN SUPPLIES AND OTHER EXPENSES WITHIN THE CONSOLIDATED STATEMENT OF OPERATIONS AND CHANGES IN NET ASSETS. THE FEES AND REIMBURSEMENTS ARE SETTLED MONTHLY. REVENUE RECOGNIZED RELATED TO THE HAF PROGRAM WAS 85,581000 AND 91,705000 FOR THE YEARS ENDED DECEMBER 31, 2014 AND 2013, RESPECTIVELY. EXPENSE FOR FEES RELATED TO THE HAF PROGRAM WAS 48,683000 AND 59,757000 FOR THE YEARS ENDED DECEMBER 31, 2014 AND 2013, RESPECTIVELY. THE HAF PROGRAM RUNS ON AN ANNUAL CYCLE FROM JULY 1 TO JUNE 30 AND WAS ORIGINALLY EFFECTIVE UNTIL JUNE 30, 2013. THE PROGRAM WAS RENEWED ON MARCH 21, 2014 WITH A RETROACTIVE EFFECTIVE DATE OF JULY 1, 2013, AND IS EFFECTIVE UNTIL JUNE 30, 2017. AS A RESULT OF THE RETROACTIVE APPLICATION, THE NETWORK ACCRUED BOTH THE ESTIMATED REIMBURSEMENT AND EXPENSE FOR THE PERIOD JULY 1, 2013 THROUGH DECEMBER 31, 2013 IN ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS ON THE DECEMBER 31, 2013 BALANCE SHEET. THE CONSOLIDATED BALANCE SHEET AT DECEMBER 31, 2013 INCLUDES 46,036000 AND 35,240000 IN ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS RECEIVABLE AND PAYABLE, RESPECTIVELY, RELATED TO THE HAF PROGRAM. THE CONSOLIDATED BALANCE SHEET AT DECEMBER 31, 2014 INCLUDES LESS THAN ONE MONTH OF HAF ACTIVITY, OR 700000 AND 1,600000 IN ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS RECEIVABLE AND PAYABLE, RESPECTIVELY, RELATED TO THE HAF PROGRAM. 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 WRITTEN-OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS AFTER EXHAUSTING COLLECTION EFFORTS. ANY SUBSEQUENT RECOVERIES ARE RECORDED AGAINST THE PROVISION FOR BAD DEBTS.
PART III, LINE 8 - MEDICARE EXPLANATIONPER THE 990 INSTRUCTIONS, THE MEDICARE COST REPORT WAS UTILIZED TO DETERMINE THE MEDICARE SHORTFALL. MEDICARE REPRESENTS 41.61% OF THE OVERALL PAYER MIX FOR COMMUNITY HOSPITAL SOUTH, INC.
PART III, LINE 9B - COLLECTION PRACTICES EXPLANATIONSEE ATTACHED FINANCIAL ASSISTANCE POLICY.
ADDITIONAL INFORMATIONPART VI, ITEMS 2 THROUGH 5 ARE DISCUSSED WITHIN THE ATTACHED COMMUNITY BENEFIT REPORT. FOR A COPY OF THIS REPORT, PLEASE CONTACT HOLLY MILLARD AT (317) 355-5860. PART VI, ITEM 6 - AFFILIATED HEALTH CARE SYSTEM COMMUNITY HOSPITAL SOUTH, INC. ("CHS") IS PART OF AN AFFILIATED HEALTH CARE SYSTEM. SEE THE ATTACHED IRS 990 SCHEDULE H SUPPLEMENTAL INFORMATION REPORT FOR HOW CHS IS INVOLVED IN PROMOTING THE HEALTH OF THE COMMUNITY IT SERVES. PART VI, ITEM 7 - STATE FILING OF COMMUNITY BENEFIT REPORT INDIANA

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Severance PaymentYes (true)SeverancePaymentInd
Supplemental Nonqual Rtr PlanYes (true)SupplementalNonqualRtrPlanInd
Equity Based Comp ArrngmfalseEquityBasedCompArrngmInd
Comp Based On Revenue Of Flng OrgfalseCompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related OrgsfalseCompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng OrgfalseCompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd OrgsfalseCompBsdNetEarnsRltdOrgsInd
Any Non Fixed PaymentsYes (true)AnyNonFixedPaymentsInd
Initial Contract ExceptionfalseInitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (12 entries)

TitleTitleTxtCompensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmtBonus Related OrganizationsBonusRelatedOrganizationsAmtOther Compensation Rltd OrgsOtherCompensationRltdOrgsAmtDeferred Comp Rltd OrgsDeferredCompRltdOrgsAmtNontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmtTotal Compensation Rltd OrgsTotalCompensationRltdOrgsAmtComp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmtBase Compensation Filing OrgBaseCompensationFilingOrgAmtBonus Filing OrganizationBonusFilingOrganizationAmountOther Compensation Filing OrgOtherCompensationFilingOrgAmtDeferred Compensation Flng OrgDeferredCompensationFlngOrgAmtNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmtTotal Compensation Filing OrgTotalCompensationFilingOrgAmtComp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt
BRYAN A MILLS
DIRECTOR$899,084$46,200$20,112$286,605$24,785$1,276,786$46,200
HANY HADDAD MD
DIRECTOR$505,548$19,021$15,600$18,222$558,391
KENNETH SHAVER MD
DIRECTOR$194,289$68,606$86,073$16,334$365,302
ANTHONY LENNEN
PRESIDENT$390,302$20,919$18,472$136,475$24,735$590,903$20,919
JEFFREY KIRKHAM
CFO CLINICAL ENTERPR$293,123$12,999$1,627$329,903$24,579$662,231$12,999
SARAH KNISELY-KING
COO/CHF NURS EXEC$219,002$7,782$1,182$49,313$277,279$7,782
RANDALL LEE MD
VP CLINICAL PERFORMN$256,876$11,956$18,997$96,843$7,622$392,294$11,956
CRISTINA BOSWELL
PHYSICIST$139,022$702$20,138$159,862
SANDRA LEMON
SITE CLINICAL COORDN$128,207$250$4,823$24,016$8,186$165,482
NATHAN GWINNUP
CLINICAL PHARMACIST$123,475$250$6,464$9,545$23,876$163,610
REGINA WARD
EXEC DIR ONCOLOGY$121,848$5,000$514$37,128$12,470$176,960
MICHAEL C BLANCHET
FORMER COO - CHNW$313,808$264,991$578,799$274,000

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
SCHEDULE J, PAGE 1, PART I, LINE 4MICHAEL C. BLANCHET 274,000 0 0
SCHEDULE J, PART IIIPART I, LINE 3 - RELATED ORG METHODS USED FOR COMPENSATION EXPLANATION COMMUNITY HOSPITAL SOUTH, INC. ("CHS") CEO/EXECUTIVE DIRECTOR IS PAID BY COMMUNITY HEALTH NETWORK, INC. ("CHNW"), A RELATED 501(C)(3) ORGANIZATION. CHNW USES THE FOLLOWING IN DETERMINING THE CEO'S COMPENSATION: 1) COMPENSATION COMMITTEE, 2) INDEPENDENT COMPENSATION CONSULTANT, 3) COMPENSATION SURVEY OR STUDY, AND 4) APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. PART I, LINE 4B - SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN BRYAN A. MILLS PARTICIPATED IN A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN THROUGH HIS EMPLOYER, CHNW. DURING 2014, MR. MILLS DID NOT RECEIVE A PAYMENT FROM SUCH PLAN. PART I, LINE 7 - NON-FIXED PAYMENTS PROVIDED COMMUNITY HOSPITAL SOUTH, INC., PARTICIPATES IN THE NETWORK'S SENIOR LEADERSHIP INCENTIVE PROGRAM. CERTAIN INDIVIDUALS OF THE LEADERSHIP TEAM PARTICIPATE IN THIS PROGRAM. THE PROGRAM WAS ADOPTED BY THE EXECUTIVE COMPENSATION COMMITTEE, AND IS INTENDED TO INFLUENCE OUTSTANDING PERFORMANCE BY THE SENIOR LEADERS, AS MEASURED AGAINST BOTH ORGANIZATIONAL AND INDIVIDUAL PERFORMANCE. THE PROGRAM IS REVIEWED ANNUALLY BY THE EXECUTIVE COMPENSATION COMMITTEE, WHICH IS COMPOSED ENTIRELY OF INDEPENDENT COMMUNITY MEMBERS. THE INCENTIVE COMPENSATION THAT IS AWARDED IS INCLUDED IN TOTAL COMPENSATION TO THE EXECUTIVE. THE TOTAL COMPENSATION (INCLUDING ANY PAYMENTS UNDER THE PROGRAM) IS SUBJECT TO THE REVIEW AND APPROVAL OF THE EXECUTIVE COMPENSATION COMMITTEE AND INDEPENDENT COMPENSATION CONSULTANT, IN CONSIDERATION OF CODE SECTION 4958 (AND THE CORRESPONDING TREASURY REGULATIONS) TO ENSURE THAT IT REFLECTS ARMS LENGTH, FAIR MARKET TERMS.

Schedule L IRS990ScheduleL

Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp

Name Of Interested NameOfInterested

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1VISIONARY ENTERPRISES INCBusinessNameLine1Txt
FieldValueIRS element (for citing)
Relationship DescriptionSHARE BD MEMBERRelationshipDescriptionTxt
Transaction$1,695,673TransactionAmt
TransactionHLTH & PHARM/MGMTTransactionDesc
Sharing Of RevenuesfalseSharingOfRevenuesInd

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (14 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990 - ORGANIZATION'S MISSIONCOMMUNITY HOSPITAL SOUTH,INC. ("CHS") IS A 501(C)(3) CORPORATION SERVING THE HEALTH RELATED NEEDS OF THE CITIZENS OF THE INDIANAPOLIS METROPOLITAN AREA AND CENTRAL INDIANA. CHS OPERATES A GENERAL ACUTE CARE HOSPITAL AND PROVIDES INPATIENT, OUTPATIENT, EMERGENCY AND AMBULATORY HEALTH CARE SERVICES TO ALL PATIENTS REGARDLESS OF THEIR ABILITY TO PAY.
FORM 990FORM 990, PART I, LINE 4 - INDEPENDENT VOTING MEMBERS COMMUNITY HOSPITAL SOUTH, INC. ("CHS") IS AN AFFILIATE OF COMMUNITY HEALTH NETWORK ("THE NETWORK"), AN INTEGRATED HEALTH DELIVERY SYSTEM. CHS IS CONTROLLED BY ITS PARENT, COMMUNITY HEALTH NETWORK, INC ("CHNW"), THE TAX- EXEMPT PARENT OF THE INTEGRATED HEALTH DELIVERY SYSTEM. CHS' ARTICLES OF INCORPORATION AND BYLAWS DESIGNATE THE MEMBERS OF THE BOARD OF DIRECTORS OF CHNW TO BE THE DIRECTORS OF CHS. CHNW EXERCISES CONTROL OVER CHS THROUGH A SERIES OF GOVERNANCE RIGHTS: A) CHNW IS THE SOLE MEMBER OF CHS; B) CHS HAS DELEGATED EXCLUSIVE AUTHORITY TO CHNW, ACTING THROUGH CHNW'S BOARD OF DIRECTORS, IN THE FOLLOWING SUBSTANTIVE AREAS: STRATEGIC PLANNING; CAPITAL ACCESS, BUDGETING AND ALLOCATION; AUDIT AND COMPLIANCE; EXECUTIVE COMPENSATION; AND DISPUTE RESOLUTION; C) CHNW MUST APPROVE ANY MODIFICATION, REPEAL, AMENDMENT, OR RESTATEMENT OF CHS' ARTICLES OF INCORPORATION; AND D) CHNW MUST APPROVE ANY SALE OR DISPOSITION OF SUBSTANTIALLY ALL OF THE ASSETS OF CHS. WITH REGARD TO EXECUTIVE COMPENSATION, CHNW HAS DELEGATED AUTHORITY TO REVIEW AND APPROVE EXECUTIVE COMPENSATION, INCLUDING CHS' EXECUTIVES, TO A NETWORK EXECUTIVE COMPENSATION COMMITTEE COMPOSED OF INDEPENDENT OUTSIDE DIRECTORS. IN SUM, CHS HAS REMOVED ANY RISK OF INAPPROPRIATE RELATED PARTY TRANSACTIONS BY DELEGATING (THROUGH CHNW) ITS EXECUTIVE COMPENSATION DECISIONS TO A NETWORK EXECUTIVE COMPENSATION COMMITTEE AND ITS CONFLICT OF INTEREST DECISIONS TO A NETWORK AUDIT COMMITTEE, WITH EACH COMMITTEE COMPOSED OF INDEPENDENT OUTSIDE DIRECTORS. FORM 990, PART I, LINE 5 - NUMBER OF EMPLOYEES CHS EMPLOYEES ARE LEASED FROM COMMUNITY HEALTH NETWORK, INC.
FORM 990, PART VFORM 990, PART V, LINE 1A - BOX 3 OF FORM 1096 FORM 1099S WERE PROCESSED UNDER THE NAME AND FEDERAL IDENTIFICATION NUMBER OF COMMUNITY HEALTH NETWORK, INC.
FORM 990, PART VIFORM 990, PART VI, LINE 1B - VOTING MEMBERS THAT ARE INDEPENDENT SEE FORM 990, PART I, LINE 4 REFERENCE ON SCHEDULE O ABOVE FORM 990, PART VI, LINE 2 - RELATED PARTY INFORMATION AMONG OFFICERS THE BOARD OF DIRECTORS FOR CHS IS ALSO THE BOARD OF DIRECTORS FOR THE FOLLOWING ORGANIZATIONS: COMMUNITY HEALTH NETWORK, INC. COMMUNITY HOME HEALTH SERVICES, INC., HEALTH INSTITUTE OF INDIANA, INC., INDIANA HEART HOSPITAL, LLC, AND INDIANAPOLIS OSTEOPATHIC HOSPITAL, INC. IN ADDITION, JEFFREY KIRKHAM SERVED AS AN OFFICER OF CHNW AND RECEIVED COMPENSATION FROM CHNW. BRYAN A. MILLS ALSO RECEIVED COMPENSATION FROM CHNW. THE FOLLOWING DIRECTORS ALSO SERVED AS A DIRECTOR OF COMMUNITY PHYSICIANS OF INDIANA, INC. ("CPI"): BRYAN A. MILLS JEFFREY A. MOSSLER, M.D. STEVEN R. PLUMP AND KENNETH SHAVER, M.D. AND HANY HADDAD, M.D. RECEIVED COMPENSATION FROM CPI. THE FOLLOWING DIRECTORS SERVED AS DIRECTORS OF COMMUNITY HOSPITAL OF ANDERSON & MADISON COUNTY, INC. ("CHA"): BRYAN A. MILLS CHARLES E. STALEY THE FOLLOWING DIRECTORS/OFFICERS ALSO SERVED AS A DIRECTOR/OFFICER OF COMMUNITY HOWARD REGIONAL HEALTH, INC. ("CHRH"): BRYAN A. MILLS JEFFREY KIRKHAM THE FOLLOWING DIRECTORS SERVED AS DIRECTORS OF VISIONARY ENTERPRISES, INC., A TAXABLE AFFILIATE OF CHNW: BRUCE F. KING BRYAN A. MILLS JEFFREY A. MOSSLER, M.D.
FORM 990, PAGE 6, PART VI, LINE 3CHS HAS DELEGATED EXCLUSIVE AUTHORITY TO CHNW, ACTING THROUGH CHNW'S BOARD OF DIRECTORS, IN THE FOLLOWING SUBSTANTIVE AREAS: STRATEGIC PLANNING, CAPITAL ACCESS, BUDGETING AND ALLOCATION; AUDIT AND COMPLIANCE; EXECUTIVE COMPENSATION; AND DISPUTE RESOLUTION. IN ADDITION, CHNW MUST APPROVE ANY MODIFICATION, REPEAL, AMENDMENT, OR RESTATEMENT OF CHS' ARTICLES OF INCORPORATION. FINALLY, CHNW MUST APPROVE ANY MATERIAL SALE OR DISPOSITION OF THE ASSETS OF CHS.
FORM 990, PAGE 6, PART VI, LINE 6SEE FORM 990, PART I, LINE 4 REFERENCE ON SCHEDULE O ABOVE
FORM 990, PAGE 6, PART VI, LINE 7ASEE FORM 990, PART I, LINE 4 REFERENCE ON SCHEDULE O ABOVE
FORM 990, PAGE 6, PART VI, LINE 7BSEE FORM 990, PART I, LINE 4 REFERENCE ON SCHEDULE O ABOVE
FORM 990, PAGE 6, PART VI, LINE 11BAS DISCUSSED IN PART I, LINE 4, CHNW HAS ASSUMED RESPONSIBILITY FOR CHS' AUDIT, COMPLIANCE, AND EXECUTIVE COMPENSATION MATTERS. CHNW'S BOARD OF DIRECTORS HAS DELEGATED AUTHORITY FOR THE REVIEW OF CHS' FORM 990 TO TWO COMMITTEES COMPOSED OF INDEPENDENT OUTSIDE DIRECTORS: A) THE NETWORK EXECUTIVE COMPENSATION COMMITTEE REVIEWED THE COMPENSATION ASPECTS OF CHS' FORM 990, AND B) THE NETWORK FINANCE COMMITTEE REVIEWED THE REMAINDER OF THE CHS' FORM 990. IN ADDITION, CHS' OUTSIDE ACCOUNTING FIRM AND LAW FIRM REVIEWED THE FORM 990 PRIOR TO FILING. CHS AND CHNW UTILIZED THIS PROCESS TO ENSURE THAT CHS' FORM 990 RECEIVED SUBSTANTIVE REVIEW BY DIRECTORS AND PROFESSIONALS WITH SPECIFIC KNOWLEDGE OF CHS' ACTIVITIES AND EXTENSIVE FINANCIAL, ACCOUNTING, AND TAX EXPERTISE.
FORM 990, PAGE 6, PART VI, LINE 12CAS DISCUSSED IN PART I, LINE 4, CHNW HAS ASSUMED RESPONSIBILITY FOR CHS' AUDIT AND COMPLIANCE MATTERS. CHNW HAS ADOPTED A CONFLICT OF INTEREST POLICY THAT APPLIES TO CHS. THE CONFLICT OF INTEREST POLICY REQUIRES DIRECTORS, OFFICERS, AND KEY EMPLOYEES TO SUBMIT AN ANNUAL CONFLICT OF INTEREST DISCLOSURE. THE ANNUAL DISCLOSURE REQUIRES DIRECTORS, OFFICERS, AND KEY EMPLOYEES TO DISCLOSE, IN WRITING, ANY KNOWN FINANCIAL INTEREST THAT THE INDIVIDUAL (TOGETHER WITH FAMILY MEMBERS) HAS IN ANY BUSINESS ENTITY THAT TRANSACTS BUSINESS WITH CHS. IN ADDITION, DIRECTORS, OFFICERS, AND KEY EMPLOYEES ARE REQUIRED TO IMMEDIATELY DISCLOSE ANY POSSIBLE CONFLICT OF INTEREST THAT ARISES MID-YEAR IN RELATION TO A PROPOSED TRANSACTION. THE CONFLICT OF INTEREST POLICY REQUIRES THAT ANY INDIVIDUAL WITH A CONFLICT BE RECUSED FROM THE DECISION MAKING PROCESS, THAT INDEPENDENT DIRECTORS OR COMMITTEE MEMBERS DETERMINE THAT THE PROPOSED TRANSACTION IS IN THE BEST INTEREST OF CHS, AND THE TRANSACTION MUST BE APPROVED BY A VOTE OF INDEPENDENT DIRECTORS OR COMMITTEE MEMBERS WITHOUT THE PARTICIPATION OF ANY INTERESTED INDIVIDUAL. THE ANNUAL CONFLICT DISCLOSURE STATEMENTS ARE SUBMITTED TO, AND REVIEWED BY, CHNW'S AUDIT COMMITTEE, COMPOSED OF INDEPENDENT DIRECTORS. IN ADDITION, THE EXECUTIVE STAFF AND GENERAL COUNSEL OF THE NETWORK ARE RESPONSIBLE FOR MONITORING ANY POSSIBLE CONFLICT TRANSACTIONS THAT ARISE AND MANAGING THEM TO ENSURE THAT ALL TRANSACTIONS REPRESENT ARMS LENGTH, FAIR MARKET VALUE TERMS FOR THE BENEFIT OF CHS.
FORM 990, PAGE 6, PART VI, LINE 15AAS DISCUSSED IN PART I, LINE 4, CHNW HAS ASSUMED RESPONSIBILITY FOR CHS' EXECUTIVE COMPENSATION MATTERS. CHNW HAS ADOPTED AN EXECUTIVE COMPENSATION AND INTERMEDIATE SANCTIONS POLICY THAT APPLIES TO CHS. THE PURPOSE OF THE POLICY IS TO ENSURE THAT CHS' COMPENSATION ARRANGEMENTS WITH RELATED PARTIES ARE EVALUATED AND ENTERED AT ARMS LENGTH AND THAT ANY COMPENSATION THAT IS PAID TO A RELATED PARTY IS REASONABLE AND REFLECTS FAIR MARKET VALUE. THIS POLICY ENCOURAGES THE APPLICATION OF THE REBUTTABLE PRESUMPTION STANDARD OF CODE SECTION 4958 AND THE RELATED TREASURY REGULATIONS BY: A) EXCLUDING ANY INTERESTED PARTY FROM THE DECISION MAKING PROCESS, B) REQUIRING DISINTERESTED BOARD OR COMMITTEE MEMBERS TO OBTAIN AND RELY UPON COMPARABILITY DATA WHEN SETTING THE PROPOSED COMPENSATION TERMS, C) REQUIRING APPROVAL OF THE TRANSACTION IN ADVANCE BY DISINTERESTED DIRECTORS OR COMMITTEE MEMBERS, AND D) REQUIRING CONTEMPORANEOUS DOCUMENTATION (I.E. MINUTES) REFLECTING THE DECISION AND THE PROCESS BY WHICH IT WAS MADE. CHNW ALSO DELEGATED AUTHORITY REGARDING CHS' EXECUTIVE COMPENSATION TO A) THE NETWORK EXECUTIVE COMPENSATION COMMITTEE, COMPOSED OF INDEPENDENT OUTSIDE DIRECTORS, WHICH IS RESPONSIBLE FOR APPLYING THE TERMS AND PROCESS OF THE EXECUTIVE COMPENSATION AND INTERMEDIATE SANCTIONS POLICY AS OUTLINED ABOVE, AND B) THE NETWORK VICE PRESIDENT OF HUMAN RESOURCES WHO IS RESPONSIBLE FOR OBTAINING COMPARATIVE SALARY MARKET DATA FOR THE CHIEF EXECUTIVE OFFICER, OFFICERS, AND KEY EMPLOYEES, PERIODICALLY ENGAGING AN INDEPENDENT COMPENSATION CONSULTANT TO ESTABLISH REASONABLE COMPENSATION, AND PROVIDING STAFF SUPPORT TO THE NETWORK EXECUTIVE COMPENSATION COMMITTEE. DURING 2014, THE NETWORK EXECUTIVE COMPENSATION COMMITTEE FOLLOWED THIS PROCESS FOR ALL SENIOR EXECUTIVE LEADERS.
FORM 990, PAGE 6, PART VI, LINE 15BSALARIES 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, PAGE 6, PART VI, LINE 19A) THE ARTICLES OF INCORPORATION AND CERTIFICATE OF EXISTENCE ARE ON FILE WITH THE INDIANA SECRETARY OF STATE AND ARE AVAILABLE TO THE PUBLIC UPON REQUEST TO THE INDIANA SECRETARY OF STATE OR FREE OF CHARGE ON THE SECRETARY OF STATE'S WEBSITE. B) AS AN AFFILIATE OF CHNW, CHS HAS ADOPTED THE NETWORK CONFLICT OF INTEREST POLICY. WHILE THIS POLICY IS NOT AVAILABLE TO THE PUBLIC, THE NETWORK'S DEFINITION OF CONFLICT OF INTEREST AND HOW TO REPORT SUCH AN INCIDENT IS DESCRIBED IN THE NETWORK RESPONSIBILITY AND COMPLIANCE PROGRAM ("NRCP") MANUAL WHICH IS POSTED ON THE NETWORK'S WEBSITE, ECOMMUNITY.COM. THIS MANUAL IS AVAILABLE FOR THE PUBLIC TO REVIEW. C) CHS DOES NOT HAVE INDIVIDUALLY AUDITED FINANCIAL STATEMENTS. ITS FINANCIAL RESULTS ARE INCLUDED IN THE CONSOLIDATED FINANCIAL STATEMENTS OF CHNW AND AFFILIATES. AS SUCH, THERE ARE NO INDIVIDUAL FINANCIAL STATEMENTS TO POST. CHS DOES FILE THE 990 TAX RETURN ON AN ANNUAL BASIS WHICH IS AVAILABLE UPON REQUEST AND/OR AVAILABLE ON A DELAYED BASIS ON GUIDESTAR.ORG. D) COMMUNITY HEALTH NETWORK, INC. AND AFFILIATES PROVIDE ANY DOCUMENT OPEN TO PUBLIC INSPECTION UPON REQUEST.
FORM 990, PART IX, LINE 11GPROFESSIONAL MEDICAL FEES 2,912,834 1,356,977 0 PURCHASED SERVICES 7,254,551 25,204,679 0

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (14 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdExempt Code SectionExemptCodeSectionTxtPublic Charity StatusPublicCharityStatusTxtBusiness Name Line1DirectControllingEntityName/BusinessNameLine1TxtControlled OrganizationControlledOrganizationInd
COMMUNITY HEALTH NETWORK INC
7330 SHADELAND STATION SUITE 200INDIANAPOLISIN46256350983617HOSPIN501C33NAfalse
COMMUNITY HEALTH NETWORK FOUNDATION
7240 SHADELAND STATION SUITE 125INDIANAPOLISIN46256510181688SUPPORTIN501C311BCHNWYes (true)
COMMUNITY HLTH SERVICES OF INDIANA
7330 SHADELAND STATION SUITE 200INDIANAPOLISIN46256454817436HLTH CAREIN501C33CHNWYes (true)
COMMUNITY HOME HEALTH SERVICES INC
9894 EAST 121ST STREETFISHERSIN46037350953467HLTH CAREIN501C39CHNWYes (true)
COMM HOSP OF ANDERSON & MADISON CTY
1515 NORTH MADISON AVENUEANDERSONIN46011351069822HOSPITALIN501C33CHNWYes (true)
COMMUNITY HOSP ANDERSON FDN INC
1515 NORTH MADISON AVENUEANDERSONIN46011861053152SUPPORTIN501C311ACHAYes (true)
COMMUNITY HOWARD REGIONAL HEALTH
3500 S LAFOUNTAIN STREETKOKOMOIN46902351865344HOSPITALIN501C33CHNWYes (true)
COMM HOWARD REGIONAL HEALTH FDN
PO BOX 9011KOKOMOIN46904237309596SUPPORTIN501C37NAfalse
COMMUNITY LTC INC
1031 MONTICELLO DRIVEANDERSONIN46011351877441HLTH CAREIN501C39CHAYes (true)
COMMUNITY PHYSICIANS OF IN INC
7240 SHADELAND STATION SUITE 300INDIANAPOLISIN46256205392766PHY SRVIN501C39CHNWYes (true)
HEALTH INSTITUTE OF INDIANA INC
3660 GUION ROADINDIANAPOLISIN46222352022402FITNESSIN501C39CHNWYes (true)
INDIANA HEART HOSPITAL LLC
8075 NORTH SHADELAND AVENUEINDIANAPOLISIN46250352123783HOSPITALIN501C33CHNWYes (true)
INDIANAPOLIS OSTEOPATHIC HOSP INC
3630 GUION ROADINDIANAPOLISIN46222351094734HOSPITALIN501C33CHNWYes (true)
WESTVIEW HOSPITAL FOUNDATION INC
3630 GUION ROADINDIANAPOLISIN46222311036451SUPPORTIN501C311AIOHYes (true)

Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (17 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdDirect Controlling NADirectControllingNACdDisproportionate AllocationsDisproportionateAllocationsIndGeneral Or Managing PartnerGeneralOrManagingPartnerInd
BROWNSBURG OFFICE CENTER 2 LLP
321 E NORTHFIELDBROWNSBURGIN46112351929859LEASINGINN/Afalsefalse
CHNJMH VENTURES LLC
7330 SHADELAND STATION SUITE 200INDIANAPOLISIN46256462356266DIAG/REHABINN/Afalsefalse
COMMUNITY ENDOSCOPY CENTER LLC
1601 N MADISON AVENUE SUITE 300ANDERSONIN46011611464136HLTH CAREINN/Afalsefalse
COMM HEALTH NETWORK REHAB HOSP LLC
7343 CLEARVISTA DRIVEINDIANAPOLISIN46256453414249REHABINN/Afalsefalse
EAST CAMPUS SURGERY CENTER LLC
7330 SHADELAND STATION SUITE 200INDIANAPOLISIN46256352028517SURGERYINN/Afalsefalse
HAMILTON SURGERY CENTER LLC
7330 SHADELAND STATION SUITE 200INDIANAPOLISIN46256352061413SURGERYINN/Afalsefalse
HOWARD COMMUNITY SURGERY CTR LLC
3500 S LAFOUNTAIN STREETKOKOMOIN46902352118748SURGERYINN/Afalsefalse
HOWARD REGIONAL SPECIALTY CARE LLC
680 SOUTH FOURTH STREETLOUISVILLEKY40202371501021REHABINN/Afalsefalse
INDIANA SPECIALTY GROUP LLC
7240 SHADELAND STATION SUITE 300INDIANAPOLISIN46256351976258HLTH CAREINN/Afalsefalse
INDIANAPOLIS ENDOSCOPY CENTER LLC
7353 E 121ST STREETINDIANAPOLISIN46219352010874HLTH CAREINN/Afalsefalse
MICHIGAN SURGERY INVESTMENT LLC
7330 SHADELAND STATION SUITE 200INDIANAPOLISIN46256320147008SURG CTRSINN/Afalsefalse
NORTH CAMPUS OFFICE ASSOCIATES LP
7330 SHADELAND STATION SUITE 200INDIANAPOLISIN46256351808625RNTL PROPINN/Afalsefalse
NORTH CAMPUS SURGERY CENTER LLC
7330 SHADELAND STATION SUITE 200INDIANAPOLISIN46256352147088SURGERYINN/Afalsefalse
NORTHPOINT PEDIATRICS LLC
8101 CLEARVISTA PARKWAY SUITE 185INDIANAPOLISIN46256351960566HLTH CAREINN/Afalsefalse
NORTHWEST SURGERY CENTER LLC
7330 SHADELAND STATION SUITE 200INDIANAPOLISIN46256208754071SURGERYINN/Afalsefalse
PILLARS HOUSING LP
3500 S LAFOUNTAIN STREETKOKOMOIN46902161652671HOUSINGINN/Afalsefalse
SOUTH CAMPUS SURGERY CENTER LLC
1550 EAST COUNTY LINE ROADINDIANAPOLISIN46227352038072SURGERYINN/Afalsefalse

Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (6 entries)

Address Line1ForeignAddress/AddressLine1TxtCityForeignAddress/CityNmProvince Or StateForeignAddress/ProvinceOrStateNmCountryForeignAddress/CountryCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile Foreign CountryLegalDomicileForeignCountryCdDirect Controlling NADirectControllingNACdControlled OrganizationControlledOrganizationIndAddress Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdLegal Domicile StateLegalDomicileStateCd
CHN ASSURANCE COMPANY LTD
PO BOX 1051GTGRAND CAYMANGRAND CAYMANCJ980418913INSURANCECJN/AYes (true)
MIDWEST RACQUETBALL INC
351396016HLTHN/AYes (true)3500 S LAFOUNTAIN STREETKOKOMOIN46902IN
PILLARS COMMUNITY HOUSING INC
161652666HOUSINGN/AYes (true)3500 S LAFOUNTAIN STREETKOKOMOIN46902IN
VISIONARY ENTERPRISES INC
351538433MGMT SRVSN/AYes (true)6626 EAST 75TH STREETINDIANAPOLISIN46250IN
VEI MICHIGAN INC
300097377MGMT SRVSN/AYes (true)940 N MAIN STREETANN HARBORMI48104MI
WESTVIEW DELIVERY SYSTEM INC
351910292MGMT SRVSN/AYes (true)3630 GUION ROADINDIANAPOLISIN46222IN
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts RyltsfalseReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth OrgfalseGiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth OrgYes (true)GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other OrgfalseLoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth OrgfalseLoansOrGuaranteesFromOthOrgInd
Div Related OrganizationfalseDivRelatedOrganizationInd
Asset Sale To Other OrgfalseAssetSaleToOtherOrgInd
Asset Purchase From Other OrgfalseAssetPurchaseFromOtherOrgInd
Asset ExchangefalseAssetExchangeInd
Rental Of Facilities To Oth OrgYes (true)RentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth OrgYes (true)RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth OrgfalsePerformOfServicesForOthOrgInd
Perform Of Services By Other OrgfalsePerformOfServicesByOtherOrgInd
Sharing Of FacilitiesfalseSharingOfFacilitiesInd
Paid Employees SharingfalsePaidEmployeesSharingInd
Reimbursement Paid To Other OrgYes (true)ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other OrgfalseReimbursementPaidByOtherOrgInd
Transfer To Other OrgYes (true)TransferToOtherOrgInd
Transfer From Other OrgYes (true)TransferFromOtherOrgInd

Transactions Related Org TransactionsRelatedOrgGrp (3 entries)

Transaction TypeTransactionTypeTxtInvolvedInvolvedAmtMethod Of Amount DeterminationMethodOfAmountDeterminationTxt
COMMUNITY PHYSICIANS OF INDIANA INC
R$736,289BOOK VALUE
VISIONARY ENTERPRISESINC
K$118,501BOOK VALUE
VISIONARY ENTERPRISESINC
P$1,577,172BOOK VALUE