efile Public Visual Render
ObjectId: 202223149349305372 - Submission: 2022-11-10
TIN: 35-0983617
SCHEDULE R
(Form 990)
Department of the Treasury
Internal Revenue Service
Related Organizations and Unrelated Partnerships
Complete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
Attach to Form 990.
Go to
www.irs.gov/Form990
for instructions and the latest information.
OMB No. 1545-0047
20
21
Open to Public Inspection
Name of the organization
COMMUNITY HEALTH NETWORK INC
Employer identification number
35-0983617
Part I
Identification of Disregarded Entities.
Complete if the organization answered "Yes" on Form 990, Part IV, line 33.
(a)
Name, address, and EIN (if applicable) of disregarded entity
(b)
Primary activity
(c)
Legal domicile (state
or foreign country)
(d)
Total income
(e)
End-of-year assets
(f)
Direct controlling
entity
(1)
COMMUNITY LAUNCHPAD LLC
7330 SHADELAND STATION SUITE 200
INDIANAPOLIS
,
IN
46256
82-2682038
INNOVATION
IN
144,226
7,672,631
CHNW
(2)
INDIANA PROHEALTH NETWORK LLC
7330 SHADELAND STATION SUITE 200
INDIANAPOLIS
,
IN
46256
82-3980148
MANAGED CARE
IN
95,684
8,580,154
CHNW
Part II
Identification of Related Tax-Exempt Organizations.
Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.
(a)
Name, address, and EIN of related organization
(b)
Primary activity
(c)
Legal domicile (state
or foreign country)
(d)
Exempt Code section
(e)
Public charity status
(if section 501(c)(3))
(f)
Direct controlling
entity
(g)
Section 512(b)(13) controlled entity?
Yes
No
(1)
COMMUNITY HEALTH NETWORK FOUNDATION
7330 SHADELAND STATION SUITE 100
INDIANAPOLIS
,
IN
46256
51-0181688
SUPPORT
IN
501(C)(3)
LINE 12B, II
CHNW
Yes
(2)
COMMUNITY HOME HEALTH SERVICES INC
9894 EAST 121ST STREET
FISHERS
,
IN
46037
35-0953467
HEALTH CARE
IN
501(C)(3)
LINE 10
CHNW
Yes
(3)
COMM HOSP OF ANDERSON & MADISON CTY
1515 NORTH MADISON AVENUE
ANDERSON
,
IN
46011
35-1069822
HOSPITAL
IN
501(C)(3)
LINE 3
CHNW
Yes
(4)
COMMUNITY HOSP ANDERSON FDN INC
1515 NORTH MADISON AVENUE
ANDERSON
,
IN
46011
86-1053152
SUPPORT
IN
501(C)(3)
LINE 12A, I
CHA
Yes
(5)
COMMUNITY HOSPITAL SOUTH INC
1402 E COUNTY LINE ROAD SOUTH
INDIANAPOLIS
,
IN
46227
35-1088640
HOSPITAL
IN
501(C)(3)
LINE 3
CHNW
Yes
(6)
COMMUNITY HOWARD REGIONAL HEALTH
3500 S LAFOUNTAIN STREET
KOKOMO
,
IN
46902
35-1865344
HOSPITAL
IN
501(C)(3)
LINE 3
CHNW
Yes
(7)
COMM HOWARD REGIONAL HEALTH FDN
PO BOX 9011
KOKOMO
,
IN
46904
23-7309596
SUPPORT
IN
501(C)(3)
LINE 7
N/A
No
(8)
COMMUNITY PHYSICIANS OF IN INC
7240 SHADELAND STATION SUITE 200
INDIANAPOLIS
,
IN
46256
20-5392766
PHYSICIAN SERVICES
IN
501(C)(3)
LINE 10
CHNW
Yes
(9)
FAIRBANKS HOSPITAL INC
8102 CLEARVISTA PARKWAY
INDIANAPOLIS
,
IN
46256
35-0811197
HOSPITAL
IN
501(C)(3)
LINE 3
CHNW
Yes
(10)
INDIANA HEALTH INFO EXCHANGE INC
846 N SENATE AVENUE
INDIANAPOLIS
,
IN
46202
36-4550324
INFO
IN
501(C)(3)
LINE 12A, I
N/A
No
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2021
Page 2
Schedule R (Form 990) 2021
Page
2
Part III
Identification of Related Organizations Taxable as a Partnership.
Complete if the organization answered "Yes" on Form 990, Part IV, line 34, because it had one or more related organizations treated as a partnership during the tax year.
(a)
Name, address, and EIN of
related organization
(b)
Primary activity
(c)
Legal
domicile
(state or foreign
country)
(d)
Direct controlling
entity
(e)
Predominant income(related, unrelated, excluded from tax under sections 512-514)
(f)
Share of total income
(g)
Share of end-of-year
assets
(h)
Disproprtionate allocations?
(i)
Code V-UBI
amount in box 20 of
Schedule K-1
(Form 1065)
(j)
General or
managing
partner?
(k)
Percentage
ownership
Yes
No
Yes
No
(1)
CHNJMH VENTURES LLC
6626 E 75TH STREET SUITE 200
INDIANAPOLIS
,
IN
46250
46-2356266
DIAG/REHAB
IN
CHNW
RELATED
196,984
1,848,704
No
No
51.000 %
(2)
COMMUNITY ENDOSCOPY CENTER LLC
1601 N MADISON AVENUE SUITE 300
ANDERSON
,
IN
46011
61-1464136
HEALTH CARE
IN
N/A
No
No
(3)
COMMUNITY HEALTH AT HOME LLC
1700 EDISON DRIVE
MILFORD
,
OH
451502729
83-3536760
HOME CARE
IN
CHNW
RELATED
-367,937
1,209,657
No
No
65.000 %
(4)
COMMUNITY HEALTH NETWORK REHAB HOSP LLC
680 S FOURTH STREET
LOUISVILLE
,
KY
40202
45-3414249
REHAB
IN
CHNW
RELATED
8,415,590
3,456,409
No
Yes
51.000 %
(5)
COMMUNITY HLTH NTWRK REHAB HOSP SOUTH LLC
680 S FOURTH STREET
LOUISVILLE
,
KY
40202
82-1385366
REHAB
IN
CHNW
RELATED
3,528,963
1,804,222
No
Yes
51.000 %
(6)
COMMUNITY HLTH NTWRK REHAB HOSP WEST LLC
330 SEVEN SPRINGS WAY
BRENTWOOD
,
TN
37027
84-5110509
REHAB
IN
CHNW
RELATED
No
Yes
51.000 %
(7)
COMMUNITY IMAGING ASSOCIATES LLC
7340 SHADELAND STATION SUITE 200
INDIANAPOLIS
,
IN
46256
35-2008380
HEALTH CARE
IN
N/A
RELATED
3,681,236
1,416,796
No
No
50.000 %
(8)
EAST CAMPUS SURGERY CENTER LLC
6626 E 75TH STREET SUITE 200
INDIANAPOLIS
,
IN
46250
35-2028517
SURGERY
IN
CHNW
RELATED
5,458,946
6,706,509
No
No
51.000 %
(9)
HAMILTON SURGERY CENTER LLC
6626 E 75TH STREET SUITE 200
INDIANAPOLIS
,
IN
46250
35-2061413
SURGERY
IN
N/A
RELATED
671,389
1,657,758
No
No
11.000 %
(10)
HEALTHBOX CHICAGO II LLC
33 WEST MONROE STREET SUITE 1700
CHICAGO
,
IL
60603
46-3871950
INVESTMENT
IL
N/A
No
No
(11)
HOWARD COMMUNITY SURGERY CTR LLC
3500 S LAFOUNTAIN STREET
KOKOMO
,
IN
46904
35-2118748
SURGERY
IN
N/A
No
No
(12)
INDIANAPOLIS ENDOSCOPY CENTER LLC
8315 E 56TH STREET
INDIANAPOLIS
,
IN
46216
35-2010874
HEALTH CARE
IN
N/A
RELATED
4,123,714
9,081,033
No
No
18.880 %
(13)
MICHIGAN SURGERY INVESTMENT LLC
6626 E 75TH STREET SUITE 200
INDIANAPOLIS
,
IN
46250
32-0147008
SURGERY CENTERS
IN
VEI
UNRELATED
-8,605
No
No
40.000 %
(14)
NORTH CAMPUS OFFICE ASSOCIATES LP
6626 E 75TH STREET SUITE 200
INDIANAPOLIS
,
IN
46250
35-1808625
RENTAL PROP
IN
N/A
No
No
(15)
NORTH CAMPUS SURGERY CENTER LLC
6626 E 75TH STREET SUITE 200
INDIANAPOLIS
,
IN
46250
35-2147088
SURGERY
IN
VEI
RELATED
6,603,648
9,033,481
No
No
49.000 %
(16)
NORTHPOINT PEDIATRICS LLC
8101 CLEARVISTA PARKWAY SUITE 185
INDIANAPOLIS
,
IN
46256
35-1960566
HEALTH CARE
IN
CHNW
RELATED
43,696
307,355
No
No
51.000 %
(17)
NORTHWEST SURGERY CENTER LLC
6626 E 75TH STREET SUITE 200
INDIANAPOLIS
,
IN
46250
20-8754071
SURGERY
IN
VEI
RELATED
29,642
760,639
No
No
20.730 %
(18)
PILLARS HOUSING LP
3500 S LAFOUNTAIN STREET
KOKOMO
,
IN
46902
16-1652671
HOUSING
IN
N/A
No
No
(19)
PRIMARIA HEALTH LLC
7330 SHADELAND STATION SUITE 200
INDIANAPOLIS
,
IN
46256
47-4728937
HEALTH CARE
IN
N/A
RELATED
11,220,450
39,151,929
No
Yes
50.000 %
(20)
SCP INDIANAPOLIS LLC
7430 SHADELAND AVENUE SUITE 100
INDIANAPOLIS
,
IN
46250
46-0639908
SURGERY
IN
N/A
No
No
(21)
SOUTH CAMPUS SURGERY CENTER LLC
1550 EAST COUNTY LINE ROAD
INDIANAPOLIS
,
IN
46227
35-2038072
SURGERY
IN
N/A
RELATED
2,955,066
8,820,756
No
No
16.850 %
Part IV
Identification of Related Organizations Taxable as a Corporation or Trust.
Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.
(a)
Name, address, and EIN of
related organization
(b)
Primary activity
(c)
Legal
domicile
(state or foreign
country)
(d)
Direct controlling
entity
(e)
Type of entity
(C corp, S corp,
or trust)
(f)
Share of total income
(g)
Share of end-of-year
assets
(h)
Percentage
ownership
(i)
Section 512(b)(13) controlled entity?
Yes
No
(1)
CHN ASSURANCE COMPANY LTD
PO BOX 1051GT
GRAND CAYMAN
CJ
98-0418913
SELF INSURANCE
CJ
CHNW
C
22,510,538
100.000 %
Yes
(2)
PILLARS COMMUNITY HOUSING INC
3500 S LAFOUNTAIN STREET
KOKOMO
,
IN
46902
16-1652666
HOUSING
IN
N/A
C
Yes
(3)
VISIONARY ENTERPRISES INC
6626 EAST 75TH STREET SUITE 200
INDIANAPOLIS
,
IN
46250
35-1538433
MANAGEMENT SERVICES
IN
CHNW
C
65,012,336
159,099,100
100.000 %
Yes
(4)
VEI MICHIGAN INC
940 N MAIN STREET
ANN HARBOR
,
MI
48104
30-0097377
MANAGEMENT SERVICES
IN
N/A
C
Yes
(5)
WESTVIEW DELIVERY SYSTEM INC
3630 GUION ROAD
INDIANAPOLIS
,
IN
46222
35-1910292
MANAGEMENT SERVICES
IN
N/A
C
Yes
Schedule R (Form 990) 2021
Page 3
Schedule R (Form 990) 2021
Page
3
Part V
Transactions With Related Organizations.
Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35b, or 36.
Note.
Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.
Yes
No
1
During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?
a
Receipt of
(i)
interest,
(ii)
annuities,
(iii)
royalties, or
(iv)
rent from a controlled entity
.....................
1a
Yes
b
Gift, grant, or capital contribution to related organization(s)
............................
1b
Yes
c
Gift, grant, or capital contribution from related organization(s)
............................
1c
Yes
d
Loans or loan guarantees to or for related organization(s)
............................
1d
No
e
Loans or loan guarantees by related organization(s)
............................
1e
No
f
Dividends from related organization(s)
............................
1f
No
g
Sale of assets to related organization(s)
............................
1g
No
h
Purchase of assets from related organization(s)
............................
1h
No
i
Exchange of assets with related organization(s)
............................
1i
No
j
Lease of facilities, equipment, or other assets to related organization(s)
.......................
1j
Yes
k
Lease of facilities, equipment, or other assets from related organization(s)
......................
1k
Yes
l
Performance of services or membership or fundraising solicitations for related organization(s)
.....................
1l
No
m
Performance of services or membership or fundraising solicitations by related organization(s)
.................
1m
No
n
Sharing of facilities, equipment, mailing lists, or other assets with related organization(s)
...................
1n
No
o
Sharing of paid employees with related organization(s)
............................
1o
No
p
Reimbursement paid to related organization(s) for expenses
............................
1p
Yes
q
Reimbursement paid by related organization(s) for expenses
............................
1q
Yes
r
Other transfer of cash or property to related organization(s)
............................
1r
Yes
s
Other transfer of cash or property from related organization(s)
............................
1s
Yes
2
If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.
(a)
Name of related organization
(b)
Transaction
type (a-s)
(c)
Amount involved
(d)
Method of determining amount involved
(1)
CHN ASSURANCE COMPANY LTD
P
9,390,000
BOOK VALUE
(2)
CHNJMH VENTURES LLC
S
554,485
BOOK VALUE
(3)
COMMUNITY HEALTH NETWORK FOUNDATION
C
5,419,336
BOOK VALUE
(4)
COMMUNITY HEALTH NETWORK FOUNDATION
S
2,685,648
BOOK VALUE
(5)
COMMUNITY HEALTH NETWORK FOUNDATION
B
3,956,824
BOOK VALUE
(6)
COMM HEALTH NETWORK REHAB HOSP SOUTH LLC
S
3,040,507
BOOK VALUE
(7)
COMM HEALTH NETWORK REHAB HOSP LLC
S
8,530,543
BOOK VALUE
(8)
COMMUNITY HOME HEALTH SERVICES INC
K
103,800
BOOK VALUE
(9)
COMMUNITY HOME HEALTH SERVICES INC
Q
97,215
BOOK VALUE
(10)
COMMUNITY HOME HEALTH SERVICES INC
R
3,925,301
BOOK VALUE
(11)
COMM HOSP OF ANDERSON & MADISON CTY
K
193,146
BOOK VALUE
(12)
COMM HOSP OF ANDERSON & MADISON CTY
A
698,670
BOOK VALUE
(13)
COMM HOSP OF ANDERSON & MADISON CTY
S
66,694,962
BOOK VALUE
(14)
COMMUNITY HOSPITAL SOUTH INC
A
409,595
BOOK VALUE
(15)
COMMUNITY HOSPITAL SOUTH INC
S
91,407,101
BOOK VALUE
(16)
COMMUNITY HOWARD REGIONAL HLTH INC
S
52,244,077
BOOK VALUE
(17)
COMMUNITY PHYSICIANS OF IN INC
A
14,932,581
BOOK VALUE
(18)
COMMUNITY PHYSICIANS OF IN INC
J
21,032,502
BOOK VALUE
(19)
COMMUNITY PHYSICIANS OF IN INC
R
389,541,673
BOOK VALUE
(20)
EAST CAMPUS SURGERY CENTER LLC
R
120,235
BOOK VALUE
(21)
EAST CAMPUS SURGERY CENTER LLC
S
6,260,846
BOOK VALUE
(22)
FAIRBANKS HOSPITAL INC
R
3,812,780
BOOK VALUE
(23)
HAMILTON SURGERY CENTER LLC
S
620,203
BOOK VALUE
(24)
INDIANAPOLIS ENDOSCOPY CENTER LLP
S
4,166,154
BOOK VALUE
(25)
NORTH CAMPUS SURGERY CENTER LLC
R
65,408
BOOK VALUE
(26)
NORTH CAMPUS SURGERY CENTER LLC
S
12,005,000
BOOK VALUE
(27)
NORTH CAMPUS OFFICE ASSOCIATES LP
S
452,305
BOOK VALUE
(28)
SOUTH CAMPUS SURGERY CENTER LLC
R
53,022
BOOK VALUE
(29)
SOUTH CAMPUS SURGERY CENTER LLC
S
3,917,231
BOOK VALUE
(30)
VISIONARY ENTERPRISES INC
A
14,160,978
BOOK VALUE
(31)
VISIONARY ENTERPRISES INC
K
2,236,484
BOOK VALUE
(32)
VISIONARY ENTERPRISES INC
Q
3,400,173
BOOK VALUE
(33)
VISIONARY ENTERPRISES INC
R
4,861,403
BOOK VALUE
(34)
WESTVIEW DELIVERY SYSTEMS INC
R
619,131
BOOK VALUE
Schedule R (Form 990) 2021
Page 4
Schedule R (Form 990) 2021
Page
4
Part VI
Unrelated Organizations Taxable as a Partnership.
Complete if the organization answered "Yes" on Form 990, Part IV, line 37.
Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.
(a)
Name, address, and EIN of entity
(b)
Primary activity
(c)
Legal domicile
(state or foreign
country)
(d)
Predominant income (related, unrelated, excluded from tax under sections 512-514)
(e)
Are all partners
section
501(c)(3)
organizations?
(f)
Share of total income
(g)
Share of
end-of-year
assets
(h)
Disproprtionate allocations?
(i)
Code V-UBI
amount in box 20
of Schedule K-1
(Form 1065)
(j)
General or
managing
partner?
(k)
Percentage
ownership
Yes
No
Yes
No
Yes
No
Schedule R (Form 990) 2021
Page 5
Schedule R (Form 990) 2021
Page
5
Part VII
Supplemental Information
Provide additional information for responses to questions on Schedule R. See instructions.
Return Reference
Explanation
Schedule R (Form 990) 2021
Additional Data
Software ID:
Software Version: