2025-11-12T10:32:58-06:00 2024-12-31 352123203 KSM BUSINESS SERVICES INC PO BOX 40857 INDIANAPOLIS IN 46240 990 2024-01-01 350811197 FAIRBANKS HOSPITAL INC FAIR 3178498222 8102 CLEARVISTA PARKWAY INDIANAPOLIS IN 46256 JASON FAHRLANDER EVP COO 3176215345 2025-11-06 1 1 CASSE TATE P01271193 3175802000 2025-11-04 2024 2025-03-06 01:10:19Z COMMUNITY FAIRBANKS RECOVERY CTR JASON FAHRLANDER 8102 CLEARVISTA PARKWAY INDIANAPOLIS IN 46256 23830471 0 X //ECOMMUNITY.COM/FAIRBANKS X 1946 IN NONPROFIT ORGANIZATION FOCUSED ON RECOVERY FROM ALCOHOL AND OTHER DRUG PROBLEMS. 14 11 264 173 0 0 819487 921611 22248406 22743433 376 0 151675 165427 23219944 23830471 0 0 0 0 15511893 16551378 0 0 0 7750664 10211635 23262557 26763013 -42613 -2932542 21957950 21659884 157973 110433 21799977 21549451 X FAIRBANKS IS A NONPROFIT ORGANIZATION FOCUSED ON RECOVERY FROM ALCOHOL AND OTHER DRUG PROBLEMS, SERVING AS A RESOURCE TO IMPROVE THE WELL-BEING OF INDIVIDUALS, FAMILIES AND COMMUNITIES BY OFFERING HOPE AND SUPPORT THROUGH ITS PROGRAMS AND SERVICES. 0 0 5391014 9628873 ADULT INPATIENT SERVICES CONSISTING OF DETOXIFICATION AND REHABILIATION SERVICES. THE DETOXIFICATION PHASE IS A MEDICALLY MANAGED LEVEL OF CARE WHERE THE EXTENT OF THE PATIENT'S ADDICTION IS DETERMINED AND THE PHYSICAL AND PSYCHOLOGICAL IMPACT OF THAT ADDICTION IS ASSESSED AND THE APPROPRIATE TREATMENT COURSE IS INITIATED. FOR THE CURRENT YEAR, FAIRBANKS HOSPITAL HAD 7,815 ADULT DETOX PATIENT DAYS.THE REHABILITATION PHASE OCCURS WHEN FURTHER INPATIENT STABILIZATION/TREATMENT IS NEEDED AND REQUIRED CONTINUED MEDICAL SUPERVISION. THE TREATMENT PROCESS IS MULTI-DISCIPLINARY AND GROUP ORIENTED. FOR THE CURRENT YEAR, THE HOSPITAL HAD 254 ADULT REHAB PATIENT DAYS. 1663092 5017943 THE ADULT RESIDENTIAL PROGRAM IS FOR THE PATIENT WHO REQUIRES A RESTRICTIVE ENVIRONMENT TO ABSTAIN FROM USING BUT WHO IS MEDICALLY STABLE. THE PATIENT PARTICIPATES IN NO LESS THAN FOUR HOURS OF THERAPY DAILY AND NURSING CARE IS PROVIDED, IF NEEDED. FOR THE CURRENT YEAR, THE HOSPITAL HAD 10,091 ADULT RESIDENTIAL PATIENT DAYS. 1384774 4538275 ADULT OUTPATIENT SERVICES PROGRAM CONSISTING OF PARTIAL HOSPITALIZATION (PHP) AND INTENSIVE OUTPATIENT PROGRAM (IOP). THE PHP PROGRAM IS SIX TO SEVEN HOURS PER DAY MONDAY THROUGH FRIDAY AND IS A MULTI-DISCIPLINARY AND GROUP ORIENTED TREATMENT PROGRAM. THE PROGRAM CONTAINS EVALUATION AND EDUCATION. IT ALLOWS THE PATIENT TO EXPERIENCE LIFE ON THE "OUTSIDE" WHILE BEING INVOLVED IN A VERY INTENSE LEVEL OF TREATMENT. FOR THE CURRENT YEAR, THE HOSPITAL HAD 2,598 PHP VISITS.IOP IS AVAILABLE TO THOSE WHOSE ADDICTION IS NOT SO SEVERE AS TO REQUIRE INPATIENT OR PHP SERVICES. THE PATIENTS MUST DEMONSTRATE THE ABILITY TO REMAIN DRUG-FREE DURING THE ENTIRE TREATMENT COURSE AND INDICATE A WILLINGNESS TO BECOME INVOLVED IN A 12-STEP PROGRAM. IOP PATIENTS GENERALLY MEET FOR THREE HOURS, THREE TIMES PER WEEK. IOP OFFERS EDUCATION AND GROUP THERAPY. FOR THE CURRENT YEAR, THE HOSPITAL HAD 11,241 VISITS.LEVEL 1 OUTPATIENT - IN ALIGNMENT WITH THE AMERICAN SOCIETY FOR ADDICTION MEDICINE (ASAM), FAIRBANKS CONSIDERS PATIENTS WHOSE SEVERITY OF SUBSTANCE USE IS MILD AND CAUSES MINIMAL INTERRUPTION IN THEIR FUNCTIONING AS BEING BEST SUITED FOR LEVEL 1 OP SERVICES. THESE INDIVIDUALS MAY PRESENT WITH MILD, CO-OCCURRING SUBSTANCE ABUSE AND MENTAL HEALTH AND/OR PHYSICAL HEALTH CONDITIONS. THEY MAY ALREADY BE RECEIVING SERVICES FOR THESE OTHER CO-OCCURING CONDITIONS, BUT NEED MORE EDUCATION, SUPPORT AND TREATMENT FOR ISSUES RELATED TO THEIR SUBSTANCE USE. ADDITIONALLY, LEVEL 1 MAY BE APPROPRIATE FOR INDIVIDUALS WHO ARE NOT INTERESTED IN RECOVERY, BUT ARE MANDATED INTO TREATMENT. THEY MAY OR MAY NOT HAVE COMPLETED AN EDUCATION COURSE, BUT APPEAR TO NEED MORE THAN JUST EDUCATION AS INDICATED BY THEIR USE OR SERVICE HISTORY. INDIVIDUALS WHO NEED MORE THAN JUST EDUCATION TO ENHANCE THEIR MOTIVATION OR TO CREATE AMBIVALENCE MAY ALSO BENEFIT FROM THIS LEVEL OF CARE. AT THE SAME TIME, INDIVIDUALS WHO ARE IN EARLY RECOVERY AND VIEW TREATMENT AS POTENTIALLY HELPFUL AND ARE ENTERING TREATMENT FOR THE FIRST TIME WILL BENEFIT FROM LEVEL 1. PATIENTS IN THIS LEVEL OF CARE MAY BE RECEIVING MEDICATION ASSISTED TREATMENT (MAT) SERVICES AND/OR OTHER THERAPIES DUE TO THEIR SUBSTANCE USE INCLUDING PATIENTS WHO NEED A STEP DOWN FROM IOP WHOM THE TREATMENT TEAM FINDS HAVE CONTINUED THERAPEUTIC NEEDS BEYOND THE SUPPORT OF AN AFTERCARE PROGRAM. FOR THE CURRENT YEAR, THE HOSPITAL HAD 2,589 ADULT LEVEL 1 VISITS. 8978750 3565130 ADOLESCENT OUTPATIENTS SERVICES PROGRAM SERVED 558 IOP VISITS DURING THE CURRENT YEAR. FAIRBNKS HOSPITAL PROVIDED 3,010 PATIENT DAYS AT LAVERNA LODGE FOR MEN AND 13,892 PATIENT DAYS AT RECOVERY HOUSING DURING THE CURRENT YEAR. 8978750 3565130 17417630 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 1 264 1 0 0 0 0 0 0 0 0 0 0 0 0 X 14 11 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 JASON FAHRLANDER DIRECTOR 1.00 54.00 X 0 1304617 564695 GEOFFREY FORTNER MD DIRECTOR 5.00 45.00 X 0 564600 137504 DAWN MOORE DIRECTOR 1.00 49.00 X 0 416136 119882 JASON LANDIS VP-FINANCE 5.00 45.00 X 0 351509 95885 ANDREW SONDERMAN MD PHYSICIAN 40.00 0.00 X 383227 0 40162 JACOB MULINIX MD PHYSICIAN 40.00 0.00 X 368675 0 30302 CATHY BOGGS EXECUTIVE DIRECTOR AND ADMINISTRATOR 40.00 0.00 X 264776 0 76265 DENNIS RHYNE MD PSYCHIATRIST 40.00 0.00 X 257457 0 36859 PEGGY MCCORMICK PATIENT CARE COORDINATOR 40.00 0.00 X 210731 0 27717 GRETCHEN JOHNSON MD PHYSICIAN 40.00 0.00 X 193302 0 42644 PAMELA ANDERSON DIRECTOR 1.00 0.00 X 0 0 0 NORA BAMMANN DIRECTOR 1.00 0.00 X 0 0 0 BILLIE FOUTS VICE CHAIR 1.00 0.00 X X 0 0 0 GREG FULK DIRECTOR 1.00 0.00 X 0 0 0 SWATI GUNALE SECRETARY 1.00 0.00 X X 0 0 0 DAVID HERZOG CHAIR 1.00 0.00 X X 0 0 0 DAVID MOORE MD DIRECTOR 1.00 2.00 X 0 0 0 KYLE MORRIS DIRECTOR 1.00 0.00 X 0 0 0 DIANA MUTZ DIRECTOR 1.00 0.00 X 0 0 0 KATHY OSBORN DIRECTOR 1.00 0.00 X 0 0 0 STEVEN STOLEN DIRECTOR 1.00 0.00 X 0 0 0 1678168 2636862 1171915 19 0 1 0 ARAMARK FOOD SERVICES AND SUPPORT SERVIC 27310 NETWORK PLACE CHICAGO IL 60673 FOOD SERVICE 760596 AMUNDSEN DAVIS LLC 150 N MICHIGAN AVE SUITE 3300 CHICAGO IL 60601 CONSULTING 181934 ELLIS MECHANICAL AND ELECTRICAL 2929 BLUFF ROAD INDIANAPOLIS IN 46225 ELECTRICAL CONTRACTOR 140388 JOHNSON CONTROLS FIRE PROTECTION LP 5920 CASTLEWAY WEST DR INDIANAPOLIS IN 46250 FIRE PROTECTION SERVICES 113814 4 921611 921611 PATIENT SERVICE REVENUE 621300 22743433 22743433 22743433 CAFETERIA REVENUE 722514 78744 78744 GIFT SHOP REVENUE 459420 74829 74829 CONFERENCE ROOM RENT 531110 5872 5872 5982 916 5066 165427 23830471 22750221 0 158639 X 341041 297986 43055 13196204 11530245 1665959 489242 423819 65423 1562884 1365577 197307 962007 841345 120662 7351024 547272 6803752 2515 187 2328 976836 814529 162307 17984 7001 10983 957887 836958 120929 14127 9233 4894 11293 5819 5474 587526 476269 111257 3847 3496 351 MEDICAL EXPENSES 243861 243861 DUES & LICENSES 20662 6649 14013 LICENSING & INSPECTION 12654 3881 8773 MEALS & ENTERTAINMENT 7692 2359 5333 3727 1144 2583 26763013 17417630 9345383 0 1053 1053 3577124 2750965 35833 67833 15278 15967 286 0 18055204 2959819 15460370 15095385 2868006 3728681 21957950 21659884 9949 6176 148024 104257 157973 110433 X 21799977 21549451 21799977 21549451 21957950 21659884 X -2932542 2682016 X 0 1 X 1 0 X SCHEDULE A, PART 1, LINE 3: FAIRBANKS HOSPITAL, INC. IS A PRIVATE MENTAL HEALTH INSTITUTION AND CERTIFIED AS AN ADDICTIONS SERVICE PROVIDER. IT HAS BEEN DETERMINED BY THE IRS TO BE A PUBLIC CHARITY UNDER CODE SECTION 170(B)(1)(A)(III) BECAUSE IT HAS AS A PURPOSE THE PROVISION OF MEDICAL OR HOSPITAL CARE. FAIRBANKS HOSPITAL IS ALSO RECOGNIZED BY THE CENTERS FOR MEDICAID AND MEDICARE AS A HOSPITAL-GENERAL ON FORM 855. HOWEVER, FAIRBANKS HOSPITAL IS NOT REQUIRED TO COMPLETE SCHEDULE H BECAUSE IT IS NOT REQUIRED TO BE, NOR IS IT, LICENSED OR REGISTERED BY THE STATE OF INDIANA AS A "HOSPITAL." CODE SECTION 501(R) AND THE INSTRUCTIONS FOR SCHEDULE H PROVIDE THAT ONLY ORGANIZATIONS THAT OPERATE AT LEAST ONE FACILITY THAT IS, OR IS REQUIRED TO BE, LICENSED, REGISTERED OR SIMILARLY RECOGNIZED BY A STATE AS A HOSPITAL ARE REQUIRED TO COMPLETE SCHEDULE H. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 150000 150000 16552025 2203664 14348361 1216216 694692 521524 136963 61463 75500 15095385 THIRD PARTY SETTLEMENTS 103913 RIGHT-OF-USE ASSETS 41559 DUE FROM AFFILIATED ENTITIES 3583209 3728681 RIGHT-OF-USE LIABILITIES 41558 THIRD PARTY SETTLEMENTS 62594 OTHER CURRENT LIABILITIES 105 104257 0 1 0 0 0 0 0 1 0 JASON FAHRLANDER DIRECTOR 0 765404 0 508209 0 31004 0 530558 0 34137 0 1869312 0 508209 GEOFFREY FORTNER MD DIRECTOR 0 377032 0 116003 0 71565 0 116726 0 20778 0 702104 0 116003 DAWN MOORE DIRECTOR 0 324179 0 90560 0 1397 0 101697 0 18185 0 536018 0 0 JASON LANDIS VP-FINANCE 0 272820 0 77676 0 1013 0 86290 0 9595 0 447394 0 77676 ANDREW SONDERMAN MD PHYSICIAN 292492 0 41764 0 48971 0 20700 0 19462 0 423389 0 41764 0 JACOB MULINIX MD PHYSICIAN 286677 0 0 0 81998 0 20700 0 9602 0 398977 0 0 0 CATHY BOGGS EXECUTIVE DIRECTOR AND ADMINISTRATOR 204568 0 59332 0 876 0 65998 0 10267 0 341041 0 59332 0 DENNIS RHYNE MD PSYCHIATRIST 248841 0 0 0 8616 0 15459 0 21400 0 294316 0 0 0 PEGGY MCCORMICK PATIENT CARE COORDINATOR 209517 0 750 0 464 0 13372 0 14345 0 238448 0 750 0 GRETCHEN JOHNSON MD PHYSICIAN 165180 0 0 0 28122 0 12389 0 32643 0 238334 0 0 0 PART III - OTHER ADDITIONAL INFORMATION PART I, LINE 3 - RELATED ORG METHODS USED FOR COMPENSATION EXPLANATION FAIRBANKS HOSPITAL, INC. ("FBH") 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 PLANS 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. FAIRBANKS HOSPITAL, INC. ("FBH") 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 CONTRIBUTION UNDER THE COMMUNITY HEALTH NETWORK 401(K) RETIREMENT PLAN, THEY WILL RECEIVE A MATCHING CONTRIBUTION IN THE PLAN THAT IS EQUAL TO THEIR COMPENSATION THAT IS GREATER THAN THE 401(K) PLAN LIMIT MULTIPLIED BY THE MAXIMUM PERMITTED MATCHING CONTRIBUTION PERCENTAGE IN THE 401(K) PLAN FOR THAT YEAR. 2. NON-ELECTIVE CONTRIBUTIONS: IF A PARTICIPANT RECEIVES A NON-ELECTIVE CONTRIBUTION IN THE 401(K) PLAN, THEY WILL RECEIVE A NON-ELECTIVE CONTRIBUTION IN THE PLAN THAT IS EQUAL TO THEIR COMPENSATION THAT IS GREATER THAN THE 401(K) PLAN LIMIT MULTIPLIED BY THE NON-ELECTIVE CONTRIBUTION PERCENTAGE IN THE 401(K) PLAN FOR THAT YEAR. NOTE THAT NO NON-ELECTIVE CONTRIBUTIONS ARE CURRENTLY BEING MADE TO THE 401(K) PLAN. CONTRIBUTIONS WILL BE CREDITED TO A PARTICIPANT'S ACCOUNT AS SOON AS ADMINISTRATIVELY FEASIBLE FOLLOWING THE END OF THE PLAN YEAR TO WHICH THE CONTRIBUTIONS RELATE. VESTING: A PARTICIPANT WILL BE 100% VESTED IN HIS ACCOUNT UPON THE EARLIEST TO OCCUR OF THE FOLLOWING: 1. ATTAINMENT OF AGE 65 PRIOR TO SEPARATION FROM SERVICE 2. DISABILITY 3. INVOLUNTARY SEPARATION FROM SERVICE FOR A REASON OTHER THAN FOR CAUSE 4. SEPARATION FROM SERVICE FOR GOOD REASON 5. A NONCOMPETITIVE PARTICIPANT'S COMPLIANCE WITH ALL TERMS OF A NONCOMPETING AGREEMENT, OR 6. DEATH FORFEITURES: IF ACCOUNT IS NOT VESTED AS DESCRIBED ABOVE, THE ACCOUNT WILL BE COMPLETELY FORFEITED. AMOUNTS FORFEITED DURING A PLAN YEAR REMAIN A GENERAL ASSET OF COMMUNITY. PART I, LINE 7 - NON-FIXED PAYMENTS PROVIDED SENIOR LEADERSHIP INCENTIVE PROGRAM FAIRBANKS HOSPITAL, 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 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. FORM 990, PART IV, LINE 22 - GRANTS OR ASSISTANCE FAIRBANKS HOSPITAL, INC. DOES PROVIDE ASSISTANCE TO INDIVIDUALS PURSUANT TO CHNW'S CHARITABLE CARE POLICY, BUT SUCH ASSISTANCE DOES NOT SHOW UP AS AN EXPENDITURE ON THE INCOME AND EXPENSE STATEMENT, THEREFORE THIS QUESTION IS ANSWERED NO. FORM 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 VI, SECTION A, LINE 2 RELATED PARTY INFORMATION AMONG OFFICERS JASON FAHRLANDER SERVED AS AN OFFICER OF COMMUNITY HEALTH NETWORK, INC. ("CHNW"). JASON FAHRLANDER, GEOFFREY FORTNER, JASON LANDIS AND DAWN MOORE ARE ALSO EMPLOYED BY CHNW. FORM 990, PART VI, SECTION A, LINE 3 MANAGEMENT DELEGATED THE FOLLOWING ACTIONS REQUIRE, IN ADDITION TO THE APPROVAL OR RECOMMENDATION OF THE BOARD, WRITTEN APPROVAL FROM COMMUNITY HEALTH NETWORK, INC. ("CHNW"), THE SOLE MEMBER OF FAIRBANKS: A) AMENDMENT OF ORGANIZATIONAL DOCUMENTS, B) UNBUDGETED INDEBTEDNESS - THE INCURRENCE OF ANY UNBUDGETED LOANS OR OTHER INDEBTEDNESS IN AN AGGREGRATE AMOUNT GREATER THAN $500,000, C) SIGNIFICANT CHANGES - THE FORMATION OF LEGAL ENTITIES, THE SALE, TRANSFER OR SUBSTANTIAL CHANGE IN USE OF ALL OR SUBSTANTIALLY OF ALL THE ASSETS OF THE CORPORATION, OR THE DIVESTURE, DISSOLUTION, CLOSURE, MERGER, CONSOLIDATION OR REORGANIZATION OF THE CORPORATION, D) ASSET ACQUISITIONS AND SALES ABOVE $100,000, E) DISPOSITION OF ASSETS ON DISSOLUTION, F) CAPITAL AND OPERATING BUDGETS, PLANS, OR FORECASTS, G) AUDITORS - THE SELECTION, EVALUATION AND TERMINATION OF THE INDEPENDENT AUDITING FIRM FOR THE CORPORATION, H) CERTAIN COMPENSATION FOR EMPLOYED PHYSICIANS, THE CORPORATION'S PRESIDENT, AND SENIOR ADMINISTRATORS OR LEADERS OF THE CORPORATION OR INDEPENDENT PHYSICIANS PROVIDING SERVICES TO THE CORPORATION, I) CAPITAL IMPROVEMENTS GREATER THAN THE BUDGETED AMOUNT BY $100,000 PER FISCAL YEAR IN THE AGGREGATE, J) STRATEGIC PLANS, K) PRESIDENT'S EMPLOYMENT, AND L) THE LINES OF BUSINESS - COMMENCEMENT OR DISCONTINUATION OF ANY LINE OF BUSINESS OR HEALTHCARE SERVICES TO BE PROVIDED AT THE CORPORATION'S FACILITIES. FORM 990, PART VI, SECTION A, LINE 6 CLASSES OF MEMBERS OR STOCKHOLDERS COMMUNITY HEALTH NETWORK, INC. ("CHNW") IS THE SOLE MEMBER OF FAIRBANKS HOSPITAL, INC. CHNW IS AN EXEMPT ORGANIZATION PURSUANT TO SECTION 501(C)(3). FORM 990, PART VI, SECTION A, LINE 7A ELECTION OF MEMBERS AND THEIR RIGHTS CHNW, THE SOLE MEMBER OF FAIRBANKS, DIRECTLY APPOINTS AND REMOVES A MAJORITY OF THE BOARD OF DIRECTORS. THE BOARD CONSISTS OF NO MORE THAN 16 DIRECTORS. ALL DIRECTORS ARE SUBJECT TO ALL APPLICABLE SELF-EVALUATION AND QUALIFICATION REQUIREMENTS OF CHNW. ANY VACANCIES AMONG THE DIRECTORS ARE FILLED BY CHNW. CHNW MAY ALSO REMOVE, WITH OR WITHOUT CAUSE, ANY DIRECTOR. FORM 990, PART VI, SECTION A, LINE 7B DECISIONS SUBJECT TO APPROVAL OF MEMBERS IN ADDITION TO THE APPROVAL OR RECOMMENDATION OF THE BOARD, THE FOLLOWING REQUIRE WRITTEN APPROVAL FROM CHNW, THE SOLE MEMBER OF FAIRBANKS: A) AMENDMENT OF ORGANIZATIONAL DOCUMENTS, B) UNBUDGETED INDEBTEDNESS - THE INCURRENCE OF ANY UNBUDGETED LOANS OR OTHER INDEBTEDNESS IN AN AGGREGRATE AMOUNT GREATER THAN $500,000, C) SIGNIFICANT CHANGES - THE FORMATION OF LEGAL ENTITIES, THE SALE, TRANSFER OR SUBSTANTIAL CHANGE IN USE OF ALL OR SUBSTANTIALLY OF ALL THE ASSETS OF THE CORPORATION, OR THE DIVESTURE, DISSOLUTION, CLOSURE, MERGER, CONSOLIDATION OR REORGANIZATION OF THE CORPORATION, D) ASSET ACQUISITIONS AND SALES ABOVE $100,000, E) DISPOSITION OF ASSETS ON DISSOLUTION, F) CAPITAL AND OPERATING BUDGETS, PLANS, OR FORECASTS, G) AUDITORS - THE SELECTION, EVALUATION AND TERMINATION OF THE INDEPENDENT AUDITING FIRM FOR THE CORPORATION, H) CERTAIN COMPENSATION FOR EMPLOYED PHYSICIANS, THE CORPORATION'S PRESIDENT, AND SENIOR ADMINISTRATORS OR LEADERS OF THE CORPORATION OR INDEPENDENT PHYSICIANS PROVIDING SERVICES TO THE CORPORATION, I) CAPITAL IMPROVEMENTS GREATER THAN THE BUDGETED AMOUNT BY $100,000 PER FISCAL YEAR IN THE AGGREGATE, J) STRATEGIC PLANS, K) PRESIDENT'S EMPLOYMENT, AND L) THE LINES OF BUSINESS - COMMENCEMENT OR DISCONTINUATION OF ANY LINE OF BUSINESS OR HEALTHCARE SERVICES TO BE PROVIDED AT THE CORPORATION'S FACILITIES. FORM 990, PART VI, SECTION B, LINE 11B ORGANIZATION'S PROCESS TO REVIEW FORM 990 CHNW'S BOARD OF DIRECTORS HAS DELEGATED AUTHORITY FOR THE REVIEW OF FAIRBANKS' FORM 990 TO TWO COMMITTEES COMPOSED OF INDEPENDENT OUTSIDE DIRECTORS, INCLUDING SPECIFICALLY THE PREPARATION AND REVIEW OF FAIRBANKS' FORM 990: A) THE NETWORK EXECUTIVE COMPENSATION COMMITTEE REVIEWED THE COMPENSATION ASPECTS OF FAIRBANKS' FORM 990, AND B) THE NETWORK FINANCE COMMITTEE REVIEWED THE REMAINDER OF THE FAIRBANKS' FORM 990. IN ADDITION, FAIRBANKS' OUTSIDE ACCOUNTING FIRM AND LAW FIRM REVIEWED THE FORM 990 PRIOR TO FILING. FAIRBANKS AND CHNW UTILIZED THIS PROCESS TO ENSURE THAT FAIRBANKS' FORM 990 RECEIVED SUBSTANTIVE REVIEW BY DIRECTORS AND PROFESSIONALS WITH SPECIFIC KNOWLEDGE OF FAIRBANKS' ACTIVITIES AND EXTENSIVE FINANCIAL, ACCOUNTING, AND TAX EXPERTISE. FORM 990, PART VI, SECTION B, LINE 12C ENFORCEMENT OF CONFLICTS POLICY FAIRBANKS HAS DELEGATED AUTHORITY FOR AUDIT AND COMPLIANCE TO CHNW. 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 FAIRBANKS. 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 FAIRBANKS, 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 FAIRBANKS. FORM 990, PART VI, SECTION B, LINE 15 COMPENSATION PROCESS FOR TOP OFFICIAL AS A MEMBER OF THE NETWORK, FAIRBANKS IS SUBJECT TO THE EXECUTIVE COMPENSATION PRACTICES AND PROCEDURES OF CHNW, THE NETWORK PARENT. CHNW HAS ADOPTED AN EXECUTIVE COMPENSATION AND INTERMEDIATE SANCTIONS POLICY THAT APPLIES TO FAIRBANKS. THE PURPOSE OF THE POLICY IS TO ENSURE THAT FAIRBANKS' 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 FAIRBANKS' EXECUTIVE COMPENSATION TO A) THE NETWORK EXECUTIVE COMPENSATION COMMITTEE, COMPOSED OF INDEPENDENT OUTSIDE DIRECTORS, WHICH IS RESPONSIBLE FOR APPLYING THE TERMS AND PROCESS OF THE EXECUTIVE COMPENSATION AND INTERMEDIATE SANCTIONS POLICY AS OUTLINED ABOVE, AND B) THE NETWORK CHIEF HUMAN RESOURCES OFFICER WHO IS RESPONSIBLE FOR OBTAINING COMPARATIVE SALARY MARKET DATA FOR THE CHIEF EXECUTIVE OFFICER, OFFICERS, AND KEY EMPLOYEES, ENGAGING AN INDEPENDENT COMPENSATION CONSULTANT TO PROVIDE REASONABLE COMPENSATION ANALYSIS AND/OR CONFIRM THE REASONABLENESS OF COMPENSATION, AND PROVIDING STAFF SUPPORT TO THE NETWORK EXECUTIVE COMPENSATION COMMITTEE. DURING 2024, 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 15A 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 A MEMBER OF THE NETWORK, FAIRBANKS 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 RESPONSBILITY 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) FAIRBANKS 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. FAIRBANKS 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 11G NETWORK EXPENSES: PROGRAM SERVICE EXPENSES 487,416. MANAGEMENT AND GENERAL EXPENSES 6,059,301. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 6,546,717. PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 350. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 350. PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 59,856. MANAGEMENT AND GENERAL EXPENSES 744,101. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 803,957. FORM 990, PART XI, LINE 9: RECLASSIFICATION OF INTERCOMPANY BALANCES 2,682,016. COMM HOSP OF ANDERSON & MADISON COUNTY 1515 NORTH MADISON AVENUE ANDERSON IN 46011 351069822 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 COMMUNITY HEALTH NETWORK FOUNDATION 7330 SHADELAND STATION SUITE 150 INDIANAPOLIS IN 46256 510181688 SUPPORT IN 501(C)(3) LINE 12B, II COMMUNITY HEALTH NETWORK INC 1 COMMUNITY HEALTH NETWORK INC 7330 SHADELAND STATION SUITE 200 INDIANAPOLIS IN 46256 350983617 HOSPITAL IN 501(C)(3) LINE 3 N/A 0 COMMUNITY HOME HEALTH SERVICES INC 9894 EAST 121ST STREET FISHERS IN 46037 350953467 HEALTH CARE IN 501(C)(3) LINE 10 COMMUNITY HEALTH NETWORK INC 1 COMMUNITY HOSP ANDERSON FOUNDATION INC 1515 NORTH MADISON AVENUE ANDERSON IN 46011 861053152 SUPPORT IN 501(C)(3) LINE 12A, I COMM HOSP OF ANDERSON & MADISON COUNTY 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 HOSPITAL WESTFIELD INC 7330 SHADELAND STATION SUITE 200 INDIANAPOLIS IN 46256 331341777 HOSPITAL IN 501(C)(3) LINE 3 COMMUNITY HEALTH NETWORK INC 1 COMMUNITY HOWARD REGIONAL HEALTH INC 3500 S LAFOUNTAIN STREET KOKOMO IN 46902 351865344 HOSPITAL IN 501(C)(3) LINE 3 COMMUNITY HEALTH NETWORK INC 1 COMMUNITY PHYSICIANS OF INDIANA INC 7240 SHADELAND STATION SUITE 200 INDIANAPOLIS IN 46256 205392766 PHYSICIAN SERVICES IN 501(C)(3) LINE 10 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 SURGERY IN N/A 0 0 COMMUNITY HEALTH AT HOME LLC 6281 TRI-RIDGE BLVD LOVELAND OH 45140 833536760 HOME 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 COMMUNITY PHYSICIAN NTWRK CLINICALLY INTEGRATED NTWRK LLC 7330 SHADELAND STATION SUITE 200 INDIANAPOLIS IN 46256 992328589 MANAGEMENT SERVICES 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 SURGERY 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 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 MANAGEMENT SERVICES IN N/A 0 0 SCP INDIANAPOLIS LLC 7430 SHADELAND AVENUE SUITE 100 INDIANAPOLIS IN 46250 460639908 SURGERY 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 1051GT GRAND CAYMAN CJ 980418913 SELF INSURANCE CJ N/A C 0 PILLARS COMMUNITY HOUSING INC 3500 S LAFOUNTAIN STREET KOKOMO IN 46902 161652666 HOUSING IN N/A C 0 VISIONARY ENTERPRISES INC 6626 EAST 75TH STREET SUITE 200 INDIANAPOLIS IN 46250 351538433 MANAGEMENT SERVICES IN N/A C 0 WESTVIEW DELIVERY SYSTEM INC 7330 SHADELAND STATION SUITE 200 INDIANAPOLIS IN 46256 351910292 MANAGEMENT SERVICES IN N/A C 0 0 0 1 0 0 0 0 0 0 0 0 0 1 1 0 1 1 1 1 COMMUNITY HEALTH NETWORK FOUNDATION INC C 921611 BOOK VALUE COMMUNITY PHYSICIANS OF INDIANA INC R 234728 BOOK VALUE