2023-11-10T08:34:15-06:00 2022-12-31 352123203 KSM BUSINESS SERVICES INC PO BOX 40857 INDIANAPOLIS IN 46240 990 2022-01-01 205392766 COMMUNITY PHYSICIANS OF INDIANA INC COMM 3176218064 7240 SHADELAND STATION 200 INDIANAPOLIS IN 46256 JOHN KUNZER MD MMM PRESIDENT 3173555961 2023-11-08 1 JOHN KUNZER MD MMM 999009999 0 CASSE TATE P01271193 3175802000 2023-11-01 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z COMMUNITY PHYSICIAN NETWORK JOHN KUNZER MD MMM 7240 SHADELAND STATION 200 INDIANAPOLIS IN 46256 403923583 0 X WWW.ECOMMUNITY.COM X 2006 IN COMMUNITY PHYSICIANS OF INDIANA, INC. ("CPI") IS A PHYSICIAN-LED NONPROFIT CORPORATION, PART OF AN INTEGRATED HEALTH CARE NETWORK, WHICH SERVES AS THE LEADER IN PROVIDING COMPASSIONATE, QUALITY, COST-EFFECTIVE HEALTH CARE SERVICES TO HELP PEOPLE ACHIEVE AND MAINTAIN OPTIMAL HEALTH IN THE COMMUNITY WE SERVE. 14 3 4739 3 1600 540 8643012 14628700 362447354 385259571 3827889 390407 3217276 3254563 378135531 403533241 0 0 0 0 606050045 616336923 0 0 0 143368444 240190893 749418489 856527816 -371282958 -452994575 101048784 102291255 2750840572 71578251 -2649791788 30713004 X SEE SCHEDULE O COMMUNITY PHYSICIANS OF INDIANA, INC. IS A PHYSICIAN-LED NONPROFIT CORPORATION, PART OF AN INTEGRATED HEALTH CARE NETWORK, WHICH SERVES AS THE LEADER IN PROVIDING COMPASSIONATE, QUALITY, COST-EFFECTIVE HEALTH CARE SERVICES TO HELP PEOPLE ACHIEVE AND MAINTAIN OPTIMAL HEALTH IN THE COMMUNITY WE SERVE. 0 0 703845588 388512534 COMMUNITY PHYSICIANS OF INDIANA, INC. ("CPI") IS A PHYSICIAN GOVERNED GROUP THAT IS PART OF A PATIENT-CENTERED, INTEGRATED HEALTH CARE NETWORK WHICH WILL, THROUGH CONTINUOUS QUALITY IMPROVEMENT, CONSISTENTLY PROVIDE A BETTER EXPERIENCE FOR PATIENTS, EMPLOYEES, PHYSICIANS, AND PAYERS. CPI INTENDS TO BE RECOGNIZED AS THE PRIMARY CARE AND SPECIALTY CARE GROUP PRACTICE IN CENTRAL INDIANA, SETTING BENCHMARK STANDARDS IN PHYSICIAN LOYALTY, QUALITY, SERVICE, AND COST PERFORMANCE. IN 2022, CPI HAD 2,955,751 PATIENT VISITS. N/A N/A 703845588 1 1 0 0 0 0 0 0 0 0 1 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 X 0 0 1 4739 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 14 3 1 1 0 0 1 1 1 1 1 0 0 0 1 1 1 1 1 0 0 0 IN X BRIAN MCCONNELL 3173554212 8180 CLEARVISTA PARKWAY SUITE 200 INDIANAPOLIS IN 46256 X BRYAN MILLS DIRECTOR 2.00 58.00 X 0 2112016 421466 RAMARAO YELETI MD DIRECTOR 2.00 58.00 X 0 1289408 189888 MICHAEL ROBERTSON MD DIRECTOR 50.00 0.00 X 949953 0 49650 JOHN KUNZER MD MMM PRESIDENT 48.00 2.00 X X 826941 0 136967 ERNEST ASAMOAH MD DIRECTOR 50.00 0.00 X 619265 0 42526 ANNETTE MOORE MD TREASURER/SECRETARY 52.00 3.00 X X 609897 0 18300 STEVE O'NEIL MD DIRECTOR 50.00 0.00 X 516772 0 51566 ANTHONY SANDERS MD VICE CHAIRPERSON 50.00 0.00 X X 533437 0 55184 ROBERT GOULET MD DIRECTOR THROUGH JUNE 2022 50.00 0.00 X 150455 0 14641 STEPHANIE MACKE DO CHAIRPERSON 50.00 0.00 X X 505276 0 5038 BARB WINNINGHAM DNP NP CNM DIRECTOR 50.00 0.00 X 213968 0 37575 MICHAEL ALLEY DIRECTOR 2.00 0.00 X 0 0 0 BP HOUSE MD DIRECTOR 2.00 0.00 X 0 0 0 MIKE LANGELLIER DIRECTOR 2.00 0.00 X 0 0 0 MAUREEN SAMPSON MD DIRECTOR 50.00 0.00 X 596271 0 54292 KATHY KRUSIE CHIEF ADMINISTRATIVE OFFICER 40.00 10.00 X 0 620654 58512 JASON LANDIS VP - FINANCE 10.00 40.00 X 0 296468 28363 JAMES CALLAHAN MD PHYSICIAN 48.00 2.00 X 2083072 0 52110 RAJESH MALLELA MD PHYSICIAN 50.00 0.00 X 2086918 0 55184 SHAHERYAR ANSARI MD PHYSICIAN 50.00 0.00 X 2091514 0 51475 SAKKAPOL ONGWIJITWAT MD PHYSICIAN 50.00 0.00 X 1718393 0 55042 NITESH GADEELA MD PHYSICIAN 50.00 0.00 X 1720734 0 18877 ROBIN LEDYARD MD FORMER INTERIM PRESIDENT 0.00 50.00 X 0 648036 49209 15222866 4966582 1445865 1218 1 1 0 IU HEALTH PHYSICIANS 2568 RELIABLE PARKWAY CHICAGO IL 60686 SUPPORT AGREEMENTS 3341489 OTOLARYNGOLOGY ASSOCIATES LLC 9002 N MERIDIAN ST 222 INDIANAPOLIS IN 46202 MEDICAL GROUP 2350924 CORNERSTONE MEDICAL CONSTRUCTION LLC 8902 N MERIDIAN ST 205 INDPLS IN 46260 CONSTRUCTION 2004755 WURSTER CONSTRUCTION COMPANY INC 8463 CASTLEWOOD DR INDIANAPOLIS IN 46250 CONSTRUCTION 1398416 ALDERSON COMMERCIAL GROUP INC 425 W SOUTH ST 100 INDIANAPOLIS IN 46225 CONSTRUCTION 1178074 37 X 5257921 9370779 14628700 PATIENT SERVICES 621110 381246152 381246152 CARE MANAGEMENT FEES 541900 3881257 3881257 RENTAL INCOME 531120 117192 117192 PHYSICIAN FEES 541900 14970 14970 385259571 399304 399304 8897 -8897 -8897 -8897 238209 381445 -143236 -144836 1600 CORPORATE HEALTH PROMOTIONS 541990 3385441 3385441 PURCHASE DISCOUNT 900099 12358 12358 3397799 403533241 388512534 1600 390407 X 5987974 5024066 963908 515801952 508351813 7450139 20745474 20410946 334528 48583806 47314879 1268927 25217717 24811072 406645 24000 24000 140541625 140541625 613656 544223 69433 6221346 5849918 371428 202015 179158 22857 36086454 35046637 1039817 372873 349031 23842 2013297 2013297 5374108 5304893 69215 8313927 8302948 10979 MEDICAL SUPPLIES 39180006 39180006 DUES, LICENSES, SUBSCRP 833855 800084 33771 MEALS & ENTERTAINMENT 225773 200228 25545 RECRUITMENT 157338 139536 17802 30620 22853 7767 856527816 703845588 152682228 0 18630 18940 29252191 31878970 19529322 17636363 1793610 1662575 78185509 52582280 24442846 25603229 84047 52223 25928138 25438955 101048784 102291255 42695862 4114895 611641 2707533069 67463356 2750840572 71578251 X -2649791788 30713004 -2649791788 30713004 101048784 102291255 X -452994575 3133499367 X 0 1 X 1 1 1 X 1150534 695969 7597396 8643012 14628700 32715611 313222992 338983889 301122023 365970492 388887581 1708186977 314373526 339679858 308719419 374613504 403516281 1740902588 0 0 0 1740902588 542921 384458 334978 468260 399304 2129921 542921 384458 334978 468260 399304 2129921 3424 1538 977 1794 1600 9333 314919871 340065854 309055374 375083558 403917185 1743041842 0.99880 0.99890 0.00120 0.00110 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 131948 21005 110943 46243794 27217104 19026690 31691313 25262628 6428685 118454 81543 36911 25603229 RIGHT OF USE OPERATING ASSETS 25438955 25438955 GUARANTEE LIABILITY 210793 RIGHT OF USE OPERATING LIABILITIES 25894099 DUE TO AFFILIATES 41358464 67463356 0 1 0 0 0 0 0 1 0 BRYAN MILLS DIRECTOR 0 1357500 0 731897 0 22619 0 393904 0 27562 0 2533482 0 731897 SHAHERYAR ANSARI MD PHYSICIAN 1662095 0 232325 0 197094 0 18300 0 33560 0 2143374 0 232325 0 RAJESH MALLELA MD PHYSICIAN 1640111 0 241183 0 205624 0 18300 0 36884 0 2142102 0 241183 0 JAMES CALLAHAN MD PHYSICIAN 1739801 0 134577 0 208694 0 18300 0 33810 0 2135182 0 134577 0 SAKKAPOL ONGWIJITWAT MD PHYSICIAN 1431437 0 214763 0 72193 0 18300 0 36742 0 1773435 0 214763 0 NITESH GADEELA MD PHYSICIAN 1418357 0 202855 0 99522 0 18300 0 577 0 1739611 0 0 0 RAMARAO YELETI MD DIRECTOR 0 799781 0 344549 0 145078 0 154168 0 35720 0 1479296 0 344549 MICHAEL ROBERTSON MD DIRECTOR 757510 0 124041 0 68402 0 18300 0 33862 0 1002115 0 124041 0 JOHN KUNZER MD MMM PRESIDENT 561088 0 237234 0 28619 0 105201 0 31766 0 963908 0 237234 0 ROBIN LEDYARD MD FORMER INTERIM PRESIDENT 0 497686 0 127731 0 22619 0 38850 0 10359 0 697245 0 127731 KATHY KRUSIE CHIEF ADMINISTRATIVE OFFICER 0 474864 0 123173 0 22617 0 37634 0 20878 0 679166 0 123173 ERNEST ASAMOAH MD DIRECTOR 536254 0 77318 0 5693 0 18300 0 24226 0 661791 0 77318 0 MAUREEN SAMPSON MD DIRECTOR 385174 0 45503 0 165594 0 18300 0 38503 0 653074 0 38064 0 ANNETTE MOORE MD TREASURER/SECRETARY 562262 0 0 0 47635 0 18300 0 0 0 628197 0 0 0 ANTHONY SANDERS MD VICE CHAIRPERSON 384804 0 58244 0 90389 0 18300 0 39396 0 591133 0 58244 0 STEVE O'NEIL MD DIRECTOR 410720 0 71038 0 35014 0 18300 0 33266 0 568338 0 71038 0 STEPHANIE MACKE DO CHAIRPERSON 464539 0 33148 0 7589 0 5038 0 0 0 510314 0 33148 0 JASON LANDIS VP - FINANCE 0 249655 0 45751 0 1062 0 18016 0 10347 0 324831 0 45751 BARB WINNINGHAM DNP NP CNM DIRECTOR 178829 0 34125 0 1014 0 13168 0 24407 0 251543 0 34125 0 ROBERT GOULET MD DIRECTOR THROUGH JUNE 2022 150133 0 0 0 322 0 8990 0 5651 0 165096 0 0 0 PART I, LINE 3 - RELATED ORG METHODS USED FOR COMPENSATION EXPLANATION COMMUNITY PHYSICIANS OF INDIANA, INC. ("CPI") CEO/EXECUTIVE DIRECTOR'S COMPENSATION IS DETERMINED 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 COMMUNITY HEALTH NETWORK, INC. SECTION 457(F) PLAN COMMUNITY HEALTH NETWORK, INC. ("COMMUNITY") ADOPTED THIS COMMUNITY HEALTH NETWORK, INC. SECTION 457(F) PLAN ("PLAN") AS OF JANUARY 1, 2016 TO PROVIDE A SUPPLEMENTAL INCOME FOR RETIREMENT UPON VESTING IN THE BENEFIT AS DESCRIBED IN THE PLAN DOCUMENT. COMMUNITY PHYSICIANS OF INDIANA, INC. ("CPI") IS INCLUDED IN THE PLAN. THE PLAN IS INTENDED TO BE EXEMPT FROM THE REQUIREMENTS OF CODE SECTION 409A AS A SHORT-TERM DEFERRAL PROGRAM DESCRIBED UNDER TREAS. REG. 1.409A-1 (B)(4). 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 DESIGNATED BY THE BOARD OF DIRECTORS OF COMMUNITY HEALTH NETWORK, INC. CONTRIBUTIONS: ANNUALLY FROM 2021 TO 2025 COMMUNITY WILL CREDIT A CONTRIBUTION TO A PARTICIPANT'S ACCOUNT IN AN AMOUNT EQUAL TO TEN PERCENT OF THEIR BASE COMPENSATION AS DEFINED IN THE PARTICIPANT'S EMPLOYMENT AGREEMENT WITH COMMUNITY. VESTING: SINGLE VESTING METHOD ELECTED BY THE EMPLOYER, IN ITS DISCRETION, FOR EACH PARTICIPANT, WHICH APPLIES TO ALL EMPLOYER CONTRIBUTION CREDITS. UNLESS VESTED OR FORFEITED EARLIER, THE ENTIRE ACCOUNT SHALL VEST ON JANUARY 1, 2026. IN ADDITION, A PARTICIPANT'S ENTIRE ACCOUNT SHALL VEST ON THE PARTICIPANT'S DEATH, AN INVOLUNTARY TERMINATION OF THE PARTICIPANT'S EMPLOYMENT WITHOUT CAUSE (AS REASONABLY DETERMINED BY THE EMPLOYER), THE PARTICIPANT'S DISABILITY (AS DEFINED BY THE SOCIAL SECURITY ADMINISTRATION), OR THE PARTICIPANT'S VOLUNTARY TERMINATION FOR GOOD REASON. FORFEITURE: IF ACCOUNT IS NOT VESTED AS DESCRIBED ABOVE, THE ACCOUNT WILL BE COMPLETELY FORFEITED. AMOUNTS FORFEITED DURING A PLAN YEAR REMAIN A GENERAL ASSET OF COMMUNITY. 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 PHYSICIANS OF INDIANA, INC. ("CPI") 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 LIMIT UNDER CODE SECTION 401(A)(17), AS ADJUSTED FROM TIME TO TIME. CONTRIBUTIONS: 1. MATCHING CONTRIBUTIONS: IF A PARTICIPANT RECEIVES THE MAXIMUM PERMISSIBLE MATCHING CONTRIBUION 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 DURING A PLAN YEAR REMAIN A GENERAL ASSET OF COMMUNITY. PART I, LINE 7 - NON-FIXED PAYMENTS PROVIDED CPI 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 ORGANIZATIONAL 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 ARM'S LENGTH, FAIR MARKET TERMS. LONG TERM INCENTIVE PLAN CHNW DEVELOPED ITS COMPENSATION PLAN IN CONJUNCTION WITH AN INDEPENDENT COMPENSATION CONSULTANT. IN ADDITION, THE PLAN WAS APPROVED BY THE NETWORK EXECUTIVE COMPENSATION COMMITTEE, COMPOSED OF INDEPENDENT OUTSIDE DIRECTORS. IN ADOPTING ITS INCENTIVE BASED COMPENSATION PLAN, CHNW (TOGETHER WITH ITS INDEPENDENT COMPENSATION CONSULTANT, ITS EXTERNAL LEGAL COUNSEL, AND THE NETWORK EXECUTIVE COMPENSATION COMMITTEE) CONSIDERED AND APPLIED THE PROVISIONS OF CODE SECTION 4958 AND THE CORRESPONDING TREASURY REGULATIONS TO ENSURE THAT ITS COMPENSATION DECISIONS REFLECT ARM'S LENGTH, FAIR MARKET TERMS. FORM 990 - ADDITIONAL INFORMATION FORM 990, PART I, LINE 4 - INDEPENDENT VOTING MEMBERS COMMUNITY PHYSICIANS OF INDIANA, INC. ("CPI") IS AN AFFILIATE OF COMMUNITY HEALTH NETWORK ("THE NETWORK"), AN INTEGRATED HEALTH DELIVERY SYSTEM. CPI IS CONTROLLED BY ITS PARENT, COMMUNITY HEALTH NETWORK, INC. ("CHNW"), A TAX-EXEMPT HOSPITAL. CHNW HAS THE FOLLOWING POWERS OVER CPI: A) CHNW IS THE SOLE MEMBER OF CPI, B) CHNW APPOINTS ALL OF THE MEMBERS OF CPI'S BOARD OF DIRECTORS, C) CHNW HAS THE AUTHORITY TO REMOVE ANY MEMBERS OF CPI'S BOARD OF DIRECTORS, D) CHNW MUST APPROVE ANY MODIFICATION, REPEAL, AMENDMENT, OR RESTATEMENT OF CPI'S ARTICLES OF INCORPORATION, AND E) CHNW MUST APPROVE ANY SALE OF SUBSTANTIALLY ALL OF CPI'S ASSETS. CHNW HAS EXERCISED ITS CONTROL OVER CPI TO ENSURE THAT CHNW HAS EXCLUSIVE AUTHORITY OVER THE FOLLOWING AFFAIRS OF CPI: STRATEGIC PLANNING, CAPITAL ACCESS, BUDGETING AND ALLOCATION, AUDIT AND COMPLIANCE, EXECUTIVE COMPENSATION, AND DISPUTE RESOLUTION. WITH REGARD TO EXECUTIVE COMPENSATION, CHNW REVIEWS AND APPROVES EXECUTIVE COMPENSATION, INCLUDING CPI'S EXECUTIVES, THROUGH THE DELIBERATIONS OF A NETWORK EXECUTIVE COMPENSATION COMMITTEE COMPOSED OF INDEPENDENT OUTSIDE DIRECTORS. LIKEWISE, CHNW REVIEWS AND MANAGES CPI'S CONFLICT OF INTEREST TRANSACTIONS THROUGH THE DELIBERATIONS OF A NETWORK AUDIT COMMITTEE COMPOSED OF INDEPENDENT OUTSIDE DIRECTORS. IN SUM, CPI IS CONTROLLED BY CHNW. CPI HAS DELEGATED SUBSTANTIAL AUTHORITY REGARDING ITS GOVERNANCE AND MANAGEMENT TO CHNW. THE MAJORITY OF THE BOARD MEMBERS FOR CHNW ARE INDEPENDENT OUTSIDE DIRECTORS. FORM 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 V, LINE 1A - BOX 3 OF FORM 1096 FORM 1099'S WERE PROCESSED UNDER THE NAME AND FEDERAL IDENTIFICATION NUMBER OF COMMUNITY HEALTH NETWORK, INC. FORM 990, PART V, LINE 2A - NUMBER OF EMPLOYEES CPI EMPLOYEES ARE LEASED FROM COMMUNITY HEALTH NETWORK, INC. FORM 990, PART VI, SECTION A, LINE 2 RELATED PARTY INFORMATION AMONG OFFICERS THE FOLLOWING DIRECTORS SERVED AS A DIRECTOR OR OFFICER OF COMMUNITY HEALTH NETWORK, INC. ("CHNW"): JOHN KUNZER, M.D., M.M.M. BRYAN A. MILLS ANNETTE MOORE, M.D. RAMARAO YELETI, M.D. AND THE FOLLOWING ARE EMPLOYED BY CHNW: KATHY KRUSIE JASON LANDIS BRYAN A. MILLS RAMARAO YELETI, M.D. FORM 990, PART VI, SECTION A, LINE 3 MANAGEMENT DELEGATED CPI DELEGATED AUTHORITY IN ITS ARTICLES OF INCORPORATION TO CHNW IN THE FOLLOWING SUBSTANTIVE AREAS: STRATEGIC PLANNING, CAPITAL ACCESS, BUDGETING AND ALLOCATION; AUDIT AND COMPLIEANCE; EXECUTIVE COMPENSATION; AND DISPUTE RESOLUTION. CPI DELEGATED THESE AUTHORITIES TO ITS PARENT, CHNW, TO ENSURE THAT CPI'S ACTIVITIES WERE INTEGRATED INTO THE BROADER CHARITABLE EFFORTS OF THE NETWORK. FORM 990, PART VI, SECTION A, LINE 6 CLASSES OF MEMBERS OR STOCKHOLDERS CHNW IS THE SOLE MEMBER OF CPI. FORM 990, PART VI, SECTION A, LINE 7A ELECTION OF MEMBERS AND THEIR RIGHTS CHNW, ACTING THROUGH ITS BOARD OF DIRECTORS, HAS THE AUTHORITY TO APPOINT THE MEMBERS OF THE BOARD OF DIRECTORS OF CPI. FORM 990, PART VI, SECTION A, LINE 7B DECISIONS SUBJECT TO APPROVAL OF MEMBERS THE FOLLOWING GOVERNANCE DECISIONS REQUIRE THE APPROVAL OF CHNW, ACTING THROUGH ITS BOARD OF DIRECTORS: 1) ANY MATERIAL SALE OR OTHER DISPOSITION OF THE ASSETS OF CPI; AND 2) THE MODIFICATION, REPEAL, AMENDMENT, OR RESTATEMENT OF THE ARTICLES OF INCORPORATION. FORM 990, PART VI, SECTION B, LINE 11B ORGANIZATIONS PROCESS TO REVIEW FORM 990 AS DISCUSSED IN PART I, LINE 4, CHNW HAS ASSUMED RESPONSIBILITY FOR CPI'S, AUDIT, COMPLIANCE, FINANCE AND EXECUTIVE COMPENSATION MATTERS, INCLUDING SPECIFICALLY THE PREPARATION AND REVIEW OF CPI'S FORM 990. CHNW'S BOARD OF DIRECTORS HAS DELEGATED AUTHORITY FOR THE REVIEW OF CPI'S FORM 990 TO TWO COMMITTEES COMPOSED OF INDEPENDENT OUTSIDE DIRECTORS: A) THE NETWORK EXECUTIVE COMPENSATION COMMITTEE REVIEWED THE COMPENSATION ASPECTS OF CPI'S FORM 990, AND B) THE NETWORK FINANCE COMMITTEE REVIEWED THE REMAINDER OF CPI'S FORM 990. IN ADDITION, CPI'S OUTSIDE ACCOUNTING FIRM AND LAW FIRM REVIEWED THE FORM 990 PRIOR TO FILING. CPI AND CHNW UTILIZED THIS PROCESS TO ENSURE THAT CPI'S FORM 990 RECEIVED SUBSTANTIVE REVIEW BY DIRECTORS AND PROFESSIONALS WITH SPECIFIC KNOWLEDGE OF CPI'S ACTIVITIES AND EXTENSIVE FINANCIAL, ACCOUNTING, AND TAX EXPERTISE. FORM 990, PART VI, SECTION B, LINE 12C ENFORCEMENT OF CONFLICTS POLICY AS DISCUSSED IN PART I, LINE 4, CHNW HAS ASSUMED RESPONSIBILTY FOR CPI'S AUDIT AND COMPLIANCE MATTERS. CHNW HAS ADOPTED A CONFLICT OF INTEREST POLICY THAT APPLIES TO CPI. 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 CPI. 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 CPI, 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 CPI. FORM 990, PART VI, LINE 15A - COMPENSATION PROCESS FOR TOP OFFICIAL AS DISCUSSED IN PART I, LINE 4, CHNW HAS ASSUMED RESPONSIBILITY FOR CPI'S EXECUTIVE COMPENSATION MATTERS. CHNW HAS ADOPTED AN EXECUTIVE COMPENSATION AND INTERMEDIATE SANCTIONS POLICY THAT APPLIES TO CPI. THE PURPOSE OF THE POLICY IS TO ENSURE THAT CPI'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 CPI'S EXECUTIVE COMPENSATION TO A) THE NEWTORK EXECUTIVE COMPENSATION COMMITTEE, COMPOSED OF INDEPENDENT OUTSIDE DIRECTORS, WHICH IS RESPONSIBLE FOR APPLYING THE TERMS AND PROCESS OF THE EXECUTIVE COMPENSATION AND INTERMEDIATE SANCTIONS POLICY AS OUTLINED ABOVE, AND B) THE NETWORK CHIEF HUMAN RESOURCES OFFICER WHO IS RESPONSIBLE FOR OBTAINING COMPARATIVE SALARY MARKET DATA FOR THE CHIEF EXECUTIVE OFFICER, OFFICERS AND KEY EMPLOYEES, ENGAGING AN INDEPENDENT COMPENSATION CONSULTANT TO PROVIDE REASONABLE COMPENSATION ANALYSIS AND/OR CONFIRM THE REASONABLENESS OF COMPENSATION, AND PROVIDING STAFF SUPPORT TO THE NETWORK EXECUTIVE COMPENSATION COMMITTEE. DURING 2022, THE NETWORK EXECUTIVE COMPENSATION COMMITTEE FOLLOWED THIS PROCESS FOR ALL SENIOR EXECUTIVE LEADERS. FORM 990, PART VI, LINE 15B - COMPENSATION PROCESS FOR OFFICERS SEE LINE 15 A ABOVE 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) AS AN AFFILIATE OF CHNW, CPI HAS ADOPTED THE NETWORK CONFLICT OF INTEREST POLICY. WHILE THIS POLICY IS NOT AVAILABLE TO THE PUBLIC, THE NETWORK'S DEFINITION OF A 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) CPI 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. CPI 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 VII, SECTION B - INDEPENDENT CONTRACTOR DISCLOSURE COMPENSATION TO CORNERSTONE MEDICAL CONSTRUCTION LLC, WURSTER CONSTRUCTION COMPANY INC., AND ALDERSON COMMERCIAL GROUP INC. INCLUDES MATERIAL COSTS. PART VIII, LINE 1E - GOVERNMENT GRANTS CPI RECEIVED PROVIDER RELIEF FUNDS OF $9,370,779 IN 2022 PURSUANT TO THE CARES ACT. FORM 990, PART IX, LINE 11G PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 33,601,194. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 33,601,194. NETWORK EXPENSES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 106,940,431. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 106,940,431. FORM 990, PART XI, LINE 9: RECLASSIFICATION OF INTERCOMPANY BALANCE 3,133,499,367. 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 FDN 7330 SHADELAND STATION SUITE 100 INDIANAPOLIS IN 46256 510181688 SUPPORT IN 501(C)(3) LINE 12B, II COMMUNITY HEALTH NETWORK INC 1 COMMUNITY HOME HLTH SERV INC 9894 EAST 121ST STREET FISHERS IN 46037 350953467 HEALTH CARE IN 501(C)(3) LINE 10 COMMUNITY HEALTH NETWORK INC 1 COMM HOSP OF ANDERSON & MADISON CTY 1515 NORTH MADISON AVENUE ANDERSON IN 46011 351069822 HOSPITAL IN 501(C)(3) LINE 3 COMMUNITY HEALTH NETWORK INC 1 COMMUNITY HOSP ANDERSON FDN INC 1515 NORTH MADISON AVENUE ANDERSON IN 46011 861053152 SUPPORT IN 501(C)(3) LINE 12A, I COMM HOSP OF ANDERSON & MADISON CTY 1 COMMUNITY HOSPITAL SOUTH INC 1402 E COUNTY LINE ROAD SOUTH INDIANAPOLIS IN 46227 351088640 HOSPITAL IN 501(C)(3) LINE 3 COMMUNITY HEALTH NETWORK INC 1 COMMUNITY HOWARD REGIONAL HEALTH 3500 S LAFOUNTAIN STREET KOKOMO IN 46902 351865344 HOSPITAL IN 501(C)(3) LINE 3 COMMUNITY HEALTH NETWORK INC 1 COMM HOWARD REGIONAL HEALTH FDN PO BOX 9011 KOKOMO IN 46904 237309596 SUPPORT IN 501(C)(3) LINE 7 N/A 0 FAIRBANKS HOSPITAL INC 8102 CLEARVISTA PARKWAY INDIANAPOLIS IN 46256 350811197 HOSPITAL IN 501(C)(3) LINE 3 COMMUNITY HEALTH NETWORK INC 1 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 LLP 8315 E 56TH STREET INDIANAPOLIS IN 46216 352010874 HEALTH CARE 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 CHN ASSURANCE COMPANY LTD PO BOX 1051 GT GRAND CAYMAN CJ 980418913 SELF INSURANCE CJ N/A C 1 PILLARS COMMUNITY HOUSING INC 3500 S LAFOUNTAIN STREET KOKOMO IN 46902 161652666 HOUSING IN N/A C 1 VISIONARY ENTERPRISES INC 6626 EAST 75TH STREET SUITE 200 INDIANAPOLIS IN 46250 351538433 MANAGEMENT SERVICES IN N/A C 1 WESTVIEW DELIVERY SYSTEM INC 3630 GUION ROAD INDIANAPOLIS IN 46222 351910292 MANAGEMENT SERVICES IN COMMUNITY PHYSICIANS OF INDIANA INC C 138287 1.00000 1 1 0 1 0 0 0 0 0 0 1 1 0 0 0 0 1 1 1 1 COMMUNITY HEALTH NETWORK FOUNDATION C 5257921 BOOK VALUE COMMUNITY HEALTH NETWORK FOUNDATION R 231392 BOOK VALUE COMM HOSP OF ANDERSON & MADISON CTY K 1520302 BOOK VALUE COMM HOSP OF ANDERSON & MADISON CTY R 1854050 BOOK VALUE COMMUNITY HOSPITAL SOUTH INC K 721464 BOOK VALUE COMMUNITY HOSPITAL SOUTH INC R 4701733 BOOK VALUE COMMUNITY HOWARD REGIONAL HEALTH K 873229 BOOK VALUE COMMUNITY HOWARD REGIONAL HEALTH R 3643460 BOOK VALUE NORTH CAMPUS OFFICE ASSOCIATES LP S 732648 BOOK VALUE VISIONARY ENTERPRISES INC K 4312311 BOOK VALUE VISIONARY ENTERPRISES INC S 3863218 BOOK VALUE WESTVIEW DELIVERY SYSTEM S 1009284 BOOK VALUE