2024-11-06T07:22:49-06:00 2023-12-31 351178661 BLUE & CO LLC 500 N MERIDIAN ST SUITE 200 INDIANAPOLIS IN 46204 990 2023-01-01 208226797 CENTRAL INDIANA HEALTH ASSOCIATION INC CENT 7654858100 2605 NORTH LEBANON ST LEBANON IN 46052 KELLY BRAVERMAN PRESIDENT 7654858100 2024-11-05 1 1 EMILIE M KNIERIEM CPA P01330194 3176334705 2024-11-01 2023 2024-10-15 13:58:12Z KELLY BRAVERMAN 2605 NORTH LEBANON ST LEBANON IN 46052 2335466 0 X N/A X 2008 IN TO OPERATE EXCLUSIVELY FOR THE BENEFIT OF AND CARRYING OUT THE PURPOSES OF WITHAM MEMORIAL HOSPITAL. 6 5 0 5 0 0 0 0 64123 58000 1512005 2090748 98938 120724 1675066 2269472 511278 464361 0 0 34657 30225 0 0 0 192846 190127 738781 684713 936285 1584759 82165859 87788957 2062218 1509923 80103641 86279034 TO OPERATE EXCLUSIVELY FOR THE BENEFIT OF AND CARRYING OUT THE PURPOSES OF WITHAM MEMORIAL HOSPITAL. 0 0 555189 464361 59244 PROVIDE HEALTH CARE SERVICES, INCLUDING MANAGEMENT AND CONSULTING SERVICES, BELOW ACTUAL FAIR MARKET VALUE TO SECTION 501(C)(3) TAX-EXEMPT ORGANIZATIONS INCLUDING WITHAM HOSPITAL FURTHERING THE PURPOSES AND GOALS OF THE ORGANIZATIONS, IN PROVIDING HEALTH CARE AND HEALTH EDUCATION.ADMINISTERING, MANAGING, DIRECTING, AND CONSULTING REGARDING HOSPITAL, MEDICAL AND HEALTH CARE SERVICES, HEALTH CARE PRODUCTS, EQUIPMENT, PERSONNEL, FACILITIES AND FINANCES. PROMOTING AND ENCOURAGE AN INFORMED UNDERSTANDING AND UTILIZATION OF HOSPITAL, MEDICAL AND HEALTH CARE SERVICES, PRODUCTS, EQUIPMENT, PERSONNEL, FACILITIES AND FINANCES. PROVIDING PROFESSIONAL, PRACTICAL, CONTINUING AND OTHER EDUCATIONAL PROGRAMS AND SERVICES FOR PERSONS SERVING IN THE HEALTH CARE FIELD AND TO INFORM THE PUBLIC REGARDING HEALTH CARE ISSUES. 555189 1 0 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 8 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 X 6 5 0 0 0 0 0 0 0 1 0 0 0 0 1 1 1 1 1 0 0 0 IN X ANGELA FALL 7654858100 2605 NORTH LEBANON ST LEBANON IN 46052 JACK JONES CHAIRMAN 2.00 4.00 X X 0 6000 0 JOHN BRAND VICE CHAIRMAN 2.00 2.00 X X 0 6000 0 REV C ARCHIBALD HAWKINS SECRETARY 2.00 4.00 X X 0 6000 0 BRETT BAYSTON MEMBER 2.00 0.00 X 0 6000 0 ANDREA CASTETTER MEMBER 2.00 0.00 X 0 6000 0 KELLY BRAVERMAN PRESIDENT 2.00 42.00 X X 0 584110 0 MARGARET MCFRYE VICE CHAIRMAN PARTIAL TERM 2.00 2.00 X X 0 0 0 NANCY MORTON SECRETARY PARTIAL TERM 2.00 2.00 X X 0 0 0 BEVERLY NEWHART TREASURER PARTIAL TERM 2.00 2.00 X X 0 0 0 0 614110 0 0 0 1 0 0 PROGRAM REVENUE 621110 58000 58000 58000 1989696 1989696 147567 28087 119480 119480 119480 138959 37907 101052 101052 101052 1244 1244 1244 2269472 59244 0 2210228 464361 464361 30225 30225 58000 58000 1850 1850 12618 12618 69259 69259 415 415 12670 12670 13303 13303 LICENSE FEES 12050 12050 MEALS 4017 4017 RECRUITING SERVICES 274 274 5671 5671 684713 555189 129524 0 2260044 1731872 14149 30184 20777048 1209684 19578218 19567364 60311732 66459537 1716 0 82165859 87788957 168389 131954 1884000 1377000 9829 969 2062218 1509923 X 80103641 86279034 80103641 86279034 82165859 87788957 X 1584759 4090634 500000 X 0 1 X 0 0 X X 1 WITHAM HEALTH SERVICES INC 351151208 3 1 487630 0 1 487630 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 19503033 19503033 1274015 1209684 64331 19567364 DUE TO WITHAM 969 969 X PART X, LINE 2: ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE HOSPITAL (AND ITS AFFILIATES) AND RECOGNIZE A TAX LIABILITY IF THE HOSPITAL HAS TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY VARIOUS FEDERAL AND STATE TAXING AUTHORITIES. MANAGEMENT HAS ANALYZED THE TAX POSITIONS TAKEN BY THE HOSPITAL AND HAS CONCLUDED THAT AS OF DECEMBER 31, 2023 AND 2022, THERE ARE NO UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY OR DISCLOSURE IN THE ACCOMPANYING FINANCIAL STATEMENTS. THE HOSPITAL IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. PART XI AND XII, RECONCILIATION THE ORGANIZATION IS PART OF CONSOLIDATED AUDITED FINANCIAL STATEMENTS AND PARTS XI AND XII ARE NOT REQUIRED. 0 WESTERN BOONE COMMUNITY SCHOOLS 1201 N STATE ROAD 75 THORNTOWN IN 46071 N/A - GOV'T 91667 0 SPONSORSHIP TRADERS POINT CHRISTIAN HIGH SCHOOL 5608 WHITESTOWN PKWY WHITESTOWN IN 46075 352004115 501C3 91667 0 SPONSORSHIP LEBANON COMMUNITY SCHOOL 1810 N GRANT STREET LEBANON IN 46052 N/A - GOV'T 91667 0 SPONSORSHIP BOONE COUNTY 4-H CLUB 1300 E 100 S LEBANON IN 46052 351068869 501C3 91667 0 SPONSORSHIP LITTLE LEAGUE BASEBALL INC 2119 DALE CT LEBANON IN 46052 814278509 501C3 16667 0 SPONSORSHIP MARIAN UNIVERSITY 3200 COLD SPRING ROAD INDIANAPOLIS IN 46222 350868175 501C3 9167 0 SPONSORSHIP ZIONSVILLE YOUTH SOCCER PO BOX 5041 ZIONSVILLE IN 46077 351859070 501C3 22917 0 SPONSORSHIP FRANKFORT COMMUNITY SCHOOL 2400 E WABASH ST FRANKFORT IN 46041 N/A - GOV'T 13750 0 SPONSORSHIP WITHAM FAMILY YMCA - BOONE COUNTY 2791 N LEBANON ST LEBANON IN 46052 350868211 501C3 14000 0 SPONSORSHIP BOONE COUNTY TENNIS CENTER 4560 S 875 E ZIONSVILLE IN 460778831 455321042 501C7 15000 0 SPONSORSHIP 9 1 PART I, LINE 2: ALL GRANTS ARE PROVIDED TO 501(C)(3) PUBLIC CHARITIES OR SCHOOL DISTRICTS FOR GENERAL SUPPORT. THE ORGANIZATION DOES NOT MONITOR THE USE OF THESE FUNDS BY THESE PUBLIC CHARITIES AND SCHOOL DISTRICTS. 0 0 0 0 0 0 0 0 0 KELLY BRAVERMAN PRESIDENT 0 529600 0 31200 0 23310 0 0 0 0 0 584110 0 0 SCH J, PART I AND II, RELATED PARTY COMPENSATION: ALL COMPENSATION REPORTED ON SCHEDULE J WAS PAID BY RELATED ORGANIZATION, WITHAM HEALTH SERVICES, INC. ALL POLICIES RELATING TO THE COMPENSATION FOR INDIVIDUALS LISTED ON SCHEDULE J ARE POLICIES OF THE RELATED ORGANIZATION AND NOT CENTRAL INDIANA HEALTH ASSOCIATION, THE FILING ORGANIZATION. LINE 1A: THE FILING ORGANIZATION DID NOT PROVIDE ANY ITEMS LISTED. LINE 1B AND 2: NOT APPLICABLE. LINE 3: THE ORGANIZATION'S METHOD FOR ESTABLISHING COMPENSATION IS DETERMINED BY APPROVAL FROM THE BOARD OF DIRECTORS, WHICH IS COMPLETED BY THE RELATED ORGANIZATION, WITHAM HEALTH SERVICES. PART II, LINE (1), COLUMN (B) AND (D): THE COMPENSATION REPORTED DURING THE CURRENT YEAR DOES NOT RELATE TO SERVING AS A BOARD MEMBER FOR CENTRAL INDIANA HEALTH ASSOCIATION, INC. FORM 990, PART VI, SECTION A, LINE 8B THE GOVERNING BODY DOES NOT HAVE ANY SUBCOMMITTEE WITH THE AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY. FORM 990, PART VI, SECTION B, LINE 11B THE PROCESS OF REVIEWING THE FORM 990 ENTAILS A DETAILED REVIEW OF THE FORM 990 BY THE HOSPITAL REPRESENTATIVE/ WITHAM HEALTH SERVICES' CFO. THE FINAL FORM 990 INCLUDING REQUESTED SCHEDULES, AS FILED WITH THE IRS, ARE PROVIDED TO EACH VOTING MEMBER OF THE ORGANIZATION'S GOVERNING BODY UPON REQUEST. FORM 990, PART VI, SECTION B, LINE 12C THE PURPOSE OF THE CONFLICT OF INTEREST POLICY IS TO PROTECT THE ORGANIZATION'S INTEREST WHEN IT IS CONTEMPLATING ENTERING INTO A TRANSACTION OR ARRANGEMENT THAT MIGHT BENEFIT THE PRIVATE INTEREST OF AN OFFICER OR TRUSTEE OF THE ORGANIZATION OR MIGHT RESULT IN A POSSIBLE EXCESS BENEFIT TRANSACTION. THE POLICY IS INTENDED TO SUPPLEMENT, BUT NOT REPLACE, ANY APPLICABLE STATE AND FEDERAL LAWS GOVERNING CONFLICT OF INTEREST APPLICABLE TO NON-PROFIT AND CHARITABLE ORGANIZATION. INTERESTED PERSONS MUST DISCLOSE ANY ACTUAL OR POSSIBLE CONFLICT OF INTEREST TO THE BOARD. WHEN ACTUAL OR POTENTIAL CONFLICT OF INTEREST ISSUES ARE DISCUSSED OR VOTED ON THE INTERESTED PERSON ABSTAINS FROM THESE ACTIVITIES. TO ENSURE THAT THE CORPORATION OPERATES IN A MANNER CONSISTENT WITH ITS CHARITABLE PURPOSES AND THAT IT DOES NOT ENGAGE IN ACTIVITIES THAT COULD JEOPARDIZE ITS TAX-EXEMPT STATUS, PERIODIC REVIEWS OF POTENTIAL CONFLICTS OF INTERESTS ARE CONDUCTED. THE PERIODIC REVIEWS, AT A MINIMUM, INCLUDE THE FOLLOWING SUBJECTS: (A) WHETHER COMPENSATION ARRANGEMENTS AND BENEFITS ARE REASONABLE, BASED ON COMPETENT SURVEY INFORMATION, AND THE RESULT OF ARM'S LENGTH BARGAINING; AND (B) WHETHER PARTNERSHIPS, JOINT VENTURES, AND ARRANGEMENTS WITH MANAGEMENT ORGANIZATIONS CONFORM TO WRITTEN POLICIES, ARE PROPERLY RECORDED, REFLECT REASONABLE INVESTMENT OR PAYMENTS FOR GOODS AND SERVICES, FURTHER THE CORPORATION'S CHARITABLE PURPOSES AND DO NOT RESULT IN INUREMENT, IMPERMISSIBLE PRIVATE BENEFIT OR IN AN EXCESS BENEFIT TRANSACTION. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION DOES MAKE THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, OR FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XI, LINE 9: NET ASSET TRANSFER 500,000. WITHAM HEALTH SERVICES INC 2605 N LEBANON ST LEBANON IN 46052 351151208 HOSPITAL IN 501(C)(3) LINE 3 N/A 0 WITHAM HEALTH SERVICES FOUNDATION INC 2705 NORTH LEBANON ST LEBANON IN 46052 311072162 FUNDRAISING IN 501(C)(3) LINE 12B, II N/A 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1