2022-11-02T17:35:31-05:00 2021-12-31 350921680 CROWE LLP 330 E JEFFERSON BLVD P O BOX 7 SOUTH BEND IN 466240007 990 2021-01-01 471753440 PARKVIEW WABASH HOSPITAL INC PARK 2603738429 10 JOHN KISSINGER DR WABASH IN 469921648 JEANNE' WICKENS PH CFO 2602669313 2022-11-02 1 JEANNE WICKENS 999009999 BRITTNEY KOCAJ P01320603 5742323992 3 AAL1 IAL1 2021 2022-09-23 18:48:47Z MICHAEL J PACKNETT 1450 PRODUCTION RD FORT WAYNE IN 468081167 66391854 0 X WWW.PARKVIEW.COM X 2014 IN IMPROVE HEALTH & PROVIDE QUALITY HEALTH SERVICES TO ALL WHO ENTRUST THEIR CARE TO US. 11 7 245 26 0 0 378861 1988183 57045871 64104929 -125272 -49994 175737 247379 57475197 66290497 68650 76540 0 0 16314324 17024363 0 0 89092 39335599 39344613 55718573 56445516 1756624 9844981 49924392 48953118 68766938 57952497 -18842546 -8999379 X PARKVIEW WABASH HOSPITAL, INC. WORKS TO IMPROVE THE HEALTH OF OUR COMMUNITIES AND PROVIDES QUALITY HEALTH SERVICES TO ALL WHO ENTRUST THEIR CARE TO US. 0 0 47671736 76540 64104929 PARKVIEW WABASH HOSPITAL, INC., IS A NOT-FOR-PROFIT, CRITICAL ACCESS FACILITY. PARKVIEW WABASH HOSPITAL, INC., IS FULLY ACCREDITED BY THE JOINT COMMISSION. BOTH A MEDICAL-SURGICAL UNIT AND A CONSTANT CARE UNIT ARE AVAILABLE, AS WELL AS LAB, IMAGING, SURGICAL AND EMERGENCY SERVICES, ONCOLOGY, CARDIAC REHAB, PHYSICAL THERAPY, SENIOR BEHAVIORAL HEALTH, MEDICATION ASSISTED TREATMENT PROGRAM FOR SUBSTANCE ABUSE AND INTENSIVE OUTPATIENT THERAPY, AND AN IN-HOUSE SLEEP LAB. PATIENTS HAVE ACCESS TO 14 PARKVIEW PHYSICIANS GROUP PRIMARY CARE AND SPECIALTY PROVIDERS AND MORE THAN 20 VISITING SPECIALISTS.(SEE SCHEDULE O FOR CONTINUATION)PARKVIEW WABASH HOSPITAL, INC. IS A MAGNET DESIGNATED HOSPITAL. WIDELY CONSIDERED THE HIGHEST RECOGNITION FOR NURSING EXCELLENCE, MAGNET DESIGNATION IS ACHIEVED BY ONLY 8.9% OF U.S. HOSPITALS AND RECOGNIZES MEASURABLE, POSITIVE PATIENT OUTCOMES AND HIGH SATISFACTION LEVELS. MAGNET DESIGNATION IS GRANTED BY THE AMERICAN NURSES CREDENTIALING CENTER'S (ANCC) MAGNET RECOGNITION PROGRAM, WHICH ENSURES THAT RIGOROUS STANDARDS FOR NURSING EXCELLENCE ARE MET. TO MAINTAIN MAGNET RECOGNITION, A HOSPITAL MUST CONTINUE TO MEET THE HIGH STANDARDS SET BY THE ANCC. ACCORDING TO THE ANCC, MAGNET DESIGNATION INDICATES AN ORGANIZATION PROVIDES A CULTURE IN WHICH NURSES CAN FLOURISH AS PROFESSIONALS. THESE SELECT ENTITIES PLACE AN EMPHASIS ON PROVIDING THEIR NURSING TEAMS WITH THE PROFESSIONAL AUTONOMY TO MAKE CLINICAL DECISIONS AT PATIENT BEDSIDES. THEY ALSO INVOLVE NURSES IN DECISIONS REGARDING THE PATIENT CARE ENVIRONMENT, AS WELL AS ENABLE MORE INTERDISCIPLINARY COLLABORATIONS WITH OTHER TEAM MEMBERS.PARKVIEW WABASH HOSPITAL, INC. WAS RECOGNIZED AS AN INSPIRE HOSPITAL OF DISTINCTION FOR 2021 BY THE INDIANA HOSPITAL ASSOCIATION, IN PARTNERSHIP WITH GOVERNOR ERIC HOLCOMB AND STATE HEALTH COMMISSIONER KRIS BOX, FACOG, FOR ITS EXCELLENCE IN CARING FOR MOTHERS AND BABIES, HAVING IMPLEMENTED BEST PRACTICES IN KEY AREAS THAT ARE DRIVERS OF INFANT AND MATERNAL HEALTH.THE PATIENT AND FAMILY ADVISORY COUNCIL (PFAC) IS A FORUM THAT ENABLES PATIENTS AND/OR FAMILY MEMBERS OF A PATIENT TO HAVE DIRECT INPUT AND INFLUENCE ON PROGRAMS AND PRACTICES OF PARKVIEW WABASH HOSPITAL, INC. THE COUNCIL INCLUDES COMMUNITY MEMBERS FROM WABASH COUNTY AND HELPS THE HOSPITAL LEADERS TO UNDERSTAND THE PULSE OF THE COMMUNITY AND GUIDE DECISIONS THAT ENSURE COMMUNITY MEMBERS' PERSPECTIVES AND IDEAS ARE REPRESENTED. ONLY TWO MEETINGS WERE HELD IN 2021 DUE TO COVID-19 BUT THE INTENT IS TO RETURN TO REGULAR, BI-MONTHLY MEETINGS IN 2022.A GROUP OF MEN AND WOMEN MAKE UP AN ACTIVE VOLUNTEER PROGRAM AT PARKVIEW WABASH HOSPITAL, INC. THEY WELCOME VISITORS AT BOTH THE MAIN ENTRANCE AND EMERGENCY ROOM ENTRANCE, AS WELL AS OPERATE THE HOSPITAL GIFT SHOP. THE VOLUNTEERS TAKE PEOPLE TO THEIR DESTINATIONS, GREET VISITORS AND PATIENTS, ANSWER QUESTIONS, AND ASSIST OUR CO-WORKERS WITH SMALL TASKS.FINANCIAL ASSISTANCE:PARKVIEW WABASH HOSPITAL, INC. IS COMMITTED TO MAKING MEDICALLY NECESSARY HEALTHCARE ACCESSIBLE TO PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. PATIENTS WHOSE FAMILY INCOME DOES NOT EXCEED TWICE THE FEDERAL POVERTY GUIDELINES MAY BE ELIGIBLE FOR FINANCIAL ASSISTANCE. A FINANCIAL COUNSELOR IS AVAILABLE TO HELP PATIENTS NAVIGATING THIS PROCESS.COMMUNITY OUTREACH:PARKVIEW WABASH HOSPITAL, INC. IS ONE OF THE LARGEST EMPLOYERS IN WABASH COUNTY AND BELIEVES STRONGLY IN GIVING BACK TO THE COMMUNITY IT SERVES. TYPICALLY, THE HOSPITAL WILL SPONSOR A VARIETY OF ITS OWN EVENTS AND OUTREACH PROGRAMS THROUGHOUT THE YEAR, AS WELL AS TAKE AN ACTIVE ROLE IN NUMEROUS OTHER HEALTH FAIRS, FESTIVALS, EDUCATION, PARADES, AND COMMUNITY EVENTS. UNFORTUNATELY, MANY OF THESE ACTIVITIES AND EVENTS WERE CANCELLED IN 2021. THE ONLY HOSPITAL SPONSORED COMMUNITY HEALTH EVENT WAS A CHECK-UP DAY IN JUNE. DISCOUNTED LAB WORK WAS OFFERED TO MORE THAN 50 AREA RESIDENTS. ADDITIONALLY, THE MANAGEMENT AND CO-WORKERS OF PARKVIEW WABASH HOSPITAL, INC. WERE ABLE TO PARTICIPATE IN A FEW VOLUNTEER ACTIVITIES DURING THE YEAR TO IMPROVE THE HEALTH AND WELL-BEING OF OUR COMMUNITY. THOSE INCLUDED THE DAM TO DAM CENTURY BIKE RIDE, BLESSINGS IN A BACKPACK MEAL PACKING, AND BLOOD DRIVES. COVID-19 SPECIFIC INITIATIVES:-IN LATE DECEMBER 2020, THE CITY OF WABASH ASKED PARKVIEW WABASH HOSPITAL, INC. TO ASSIST THEM IN OPENING A COVID-19 VACCINE CLINIC. THAT PARTNERSHIP CONTINUED THROUGH MAY 2021 AND INCLUDED A MOVE TO A LARGER FACILITY. PARKVIEW WABASH HOSPITAL, INC. LEADERS AND CO-WORKERS WERE THE PRIMARY VOLUNTEERS AT THE CLINIC. THIRTY-ONE CO-WORKERS CONTRIBUTED APPROXIMATELY 925 HOURS TO THE CLINIC'S SUCCESS. NEARLY 10,300 VACCINATIONS WERE GIVEN.-IN ANOTHER EFFORT TO SERVE OUR COMMUNITY DURING THE PANDEMIC, WE OFFERED FREE SPACE TO THE INDIANA STATE DEPARTMENT OF HEALTH TO PROVIDE A COVID-19 TESTING SITE. THE SITE WAS OPEN 12 HOURS PER DAY, SIX DAYS PER WEEK. THE SITE WAS OPEN FROM JAN. THRU APRIL WITH 1,099 TESTS PERFORMED AT NO COST TO THE PATIENT.WITH OUR COMMUNITY HEALTH PARTNERS PROGRAM, PARKVIEW WABASH HOSPITAL, INC. INVESTS IN KEY ORGANIZATIONS THAT PROMOTE THE HEALTHY LIFESTYLE CHOICES AND WELL-BEING OF INDIVIDUALS, CHILDREN, AND FAMILIES OF WABASH. IN THE CALENDAR YEAR 2021, THE HOSPITAL SELECTED COMMUNITY AGENCIES OR ORGANIZATIONS TO SUPPORT AND COLLABORATE IN ADDRESSING OUR FOCUS AREAS OF MENTAL HEALTH/ADDICTIONS AND OBESITY. SAMPLES OF THOSE PROJECTS INCLUDE:- LIKING FOR BIKING - THIS HOUR-LONG BIKE RIDE OFFERED EVERY SATURDAY FROM MAY THROUGH EARLY SEPTEMBER IS LED BY THE ROCK CITY BIKE CLUB AND VISIT WABASH COUNTY. IT IS FOR ALL AGES AND ABILITIES OF BIKE RIDERS AND MEANT TO ENCOURAGE PHYSICAL ACTIVITY IN ALL. RIDERS CAN RIDE FOR AS LONG AS THEY LIKE AND AT THEIR OWN PACE, WITH THE END GOAL BEING TO INCREASE BOTH BY THE END OF THE EVENT. THIS WAS ANOTHER ACTIVITY THAT CONTINUED IN 2021, DUE TO IT BEING AN OUTDOORS AND SOCIALLY DISTANCED. THE HOSPITAL PARTNERED WITH THE PROGRAM TO OFFER FREE BLOOD PRESSURE CHECKS FOR THIS GROUP ON TWO DIFFERENT SATURDAYS.- BABY & ME TOBACCO FREE - THE PERCENT OF PREGNANT WOMEN IN INDIANA WHO SMOKE WHILE PREGNANT IS ONE OF THE HIGHEST IN THE COUNTRY AT 22.5%. THERE WERE 58 BIRTHS AFFECTED IN WABASH COUNTY BY SMOKING IN 2021. PARKVIEW WABASH HOSPITAL, INC. CHOSE TO PARTNER WITH THE LOCAL TOBACCO FREE COALITION TO OFFER THE NATIONAL BABY & ME TOBACCO FREE PROGRAM.- BLESSINGS IN A BACKPACK -- THIS PROGRAM PROVIDED STUDENTS KINDERGARTEN THROUGH 6TH GRADE WITH FOOD ITEMS TO HELP THEM AND THEIR FAMILIES OVER THE WEEKENDS. TO QUALIFY, STUDENTS MUST BE ON FREE OR REDUCED LUNCH. IN 2021, THE NUMBER ENROLLED IN THE PROGRAM ROSE BY 100, FOR A TOTAL OF 624 CHILDREN.PRIMARY HEALTH CARE ACCESS: PARKVIEW WABASH HOSPITAL, INC. PROVIDES SUPPORT TO 85 HOPE, WABASH COUNTY'S FREE HEALTH CARE CLINIC, BY OFFERING 100% CHARITY CARE TO ALL OF THEIR PATIENTS.AN IMPORTANT IMAGING TEST IS OFFERED TO THE PUBLIC FOR A REASONABLE OUT-OF-POCKET COST. THE HEART SMART CT SCAN IS A SIMPLE, NON-INVASIVE TEST THAT CAN DETECT CORONARY ARTERY DISEASE IN ITS EARLY STAGES. THERE WERE 394 SCANS PERFORMED IN 2021 AT PARKVIEW WABASH HOSPITAL, INC., AT A MINIMAL OUT-OF-POCKET FEE. 47671736 1 1 0 1 0 0 0 0 0 1 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 X 33 0 1 245 1 0 0 0 0 0 0 0 0 0 0 0 0 X 11 7 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 IN X JEANNE' WICKENS 2602669313 1450 PRODUCTION RD FORT WAYNE IN 468081167 MICHAEL PACKNETT PH PRESIDENT & CEO 0.00 40.00 X X 0 2037606 326073 DOUGLAS SPARKS DIRECTOR/PH PHYSICIAN 0.00 40.00 X 25989 481230 67399 MARILYN CUSTER-MITCHELL DIRECTOR/WBHOS PRESIDENT 40.00 0.00 X X 303093 0 98796 WILLIAM RAUH DIRECTOR 1.00 0.00 X 13000 0 0 HOWARD HALDERMAN DIRECTOR/CHAIR 1.00 1.00 X X 6500 3000 0 KEVIN BOWMAN DIRECTOR 1.00 0.00 X 4500 0 0 JASON CALLAHAN DIRECTOR/PARTIAL YR/VICE CHAIR 1.00 0.00 X X 2250 0 0 KELLY STOUFFER DIRECTOR/SECRETARY/TREASURER/VICE CHAIR 1.00 0.00 X X 4500 0 0 KENT TERRILL DIRECTOR 1.00 0.00 X 4250 0 0 ROGER CROMER DIRECTOR 1.00 1.00 X 4500 0 0 PATTY GRANT DIRECTOR 1.00 0.00 X 4000 0 0 PARKER BEAUCHAMP DIRECTOR 1.00 0.00 X 3750 0 0 SARAH LOCHNER DIRECTOR/PARTIAL YR/VICE CHAIR 1.00 0.00 X X 0 0 0 JEANNE' WICKENS PH CHIEF FINANCIAL OFFICER 0.00 40.00 X 0 1059636 349980 CATHY WOLFE WBHOS VP PATIENT CARE 40.00 0.00 X 178027 0 38490 SHERRY SCHOENING WBHOS MGR REHAB 40.00 0.00 X 135407 0 47514 LISA KROH WBHOS PHARMACIST 40.00 0.00 X 151972 0 17700 PAULA OPHEIM WBHOS MGR PHARMACY 40.00 0.00 X 155268 0 23140 GRACE STANLEY WBHOS NURSE PRACTITIONER 40.00 0.00 X 126269 0 22548 JAMI METZGER WBHOS NURSE PRACTITIONER 28.00 12.00 X 114660 44171 46432 1237935 3625643 1038072 28 0 1 0 PARKVIEW HEALTH SYSTEM INC 1450 PRODUCTION RD FORT WAYNE IN 46808 RHC OPERATIONS 6413952 PROFESSIONAL EMERGENCY PHYSICIANS INC 3640 NEW VISION DR SUITE A FORT WAYNE IN 46845 PHYSICIANS 2625540 PARKVIEW HOSPITAL INC 11109 PARKVIEW PLAZA DR FORT WAYNE IN 46845 LABORATORY SERVICES 2123143 NORTHEAST INTERNAL MEDICINE ASSOC INC 2500 N DETROIT ST LAGRANGE IN 46761 HOSPITALISTS 411796 FOCUSONE SOLUTIONS LLC 13609 CALIFORNIA ST OMAHA NE 68154 MEDICAL PERSONNEL 212043 8 72387 1915796 491 1988183 NET PATIENT SERVICE 622000 63859290 63859290 INTERUNIT RENT 531120 150867 150867 PHARMACY 446110 85117 85117 HOME BOUND MEALS 624210 9655 9655 64104929 34191 51363 -17172 -17172 -17172 49994 -49994 -49994 -49994 CAFETERIA SALES 722514 257155 257155 GIFT SHOP 453220 7396 7396 264551 66290497 64104929 0 197385 X 76540 76540 695098 695098 12559877 12559877 3769388 3769388 12960432 12229445 730987 600 600 832872 698181 134691 1801790 1781309 20481 8382 6788 1594 25011 21696 3315 731421 731421 3607426 3600571 6855 98448 48975 49473 CORP SERVICE ALLOCATION 6982783 6982783 MEDICAL SUPPLIES 6041665 6041665 PH CLINICAL SUPPORT 3062685 3062685 HOSPITAL ASSESSMENT FEE 2946425 2946425 244673 96170 59411 89092 56445516 47671736 8684688 89092 1350 1350 1407 252916 10059207 11325975 779557 903764 58414 63090 48106978 13420347 37665169 34686631 1359288 1719392 49924392 48953118 2857594 2424813 4229215 3475488 22739648 21969171 38940481 30083025 68766938 57952497 X -18842546 -8999379 -18842546 -8999379 49924392 48953118 X 9844981 -1814 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 4703 4703 0 PART II-B, LINE 1: OTHER ACTIVITIES - REPRESENTS THE PORTION OF THE DUES PAID TO INDIANA HOSPITAL AND HEALTH ASSOCIATION, AMERICAN HOSPITAL ASSOCIATION, NATIONAL RURAL HEALTH ASSOCIATION AND VARIOUS PROFESSIONAL ASSOCIATIONS USED FOR LOBBYING ACTIVITIES. 1274014 226997 11719 1489292 1220881 100 62212 9179 1274014 846506 300560 87363 1096 12452 1220881 805494 165 51005 502 9656 846506 621519 101080 90165 7270 805494 0.04150 0.63790 0.32060 1 1 1 1208757 1208757 31765378 5608950 26156428 13216255 7083173 6133082 1916588 728224 1188364 34686631 LEASE LIABILITY 1756184 DUE TO/FROM INTERUNIT 21375282 EST MEDICARE/MEDICAID SETTLEMENTS 6170985 EST 3RD PARTY SETTLEMENTS 596975 ACCRUED INTEREST 117520 RHC SETTLEMENTS 66079 30083025 X PART V, LINE 4: ENDOWMENT FUNDS ARE USED FOR THE ORGANIZATION'S PROGRAMS AND OPERATIONS RELATED TO PATIENT-FOCUSED CARE. PART X, LINE 2: PARKVIEW HEALTH SYSTEM, INC. AND SUBSIDIARIES - NOTES TO THE CONSOLIDATED FINANCIAL STATEMENTS TEXT OF THE FOOTNOTE TO THE ORGANIZATION'S FINANCIAL STATEMENTS THAT DESCRIBES THE LIABILITY FOR UNCERTAIN TAX POSITIONS UNDER FIN 48 (ASC 740): INCOME TAXES: THE INTERNAL REVENUE SERVICE HAS DETERMINED THAT THE CORPORATION AND CERTAIN AFFILIATED ENTITIES ARE TAX-EXEMPT ORGANIZATIONS AS DEFINED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. CERTAIN SUBSIDIARIES OF THE CORPORATION ARE TAXABLE ENTITIES, THE TAX EXPENSE AND LIABILITIES OF WHICH ARE NOT MATERIAL TO THE CONSOLIDATED FINANCIAL STATEMENTS. THE CORPORATION AND ITS TAX-EXEMPT AFFILIATED ENTITIES EACH FILE A FORM 990 (RETURN OF ORGANIZATION EXEMPT FROM INCOME TAX) ANNUALLY. WHEN THESE RETURNS ARE FILED, IT IS HIGHLY CERTAIN THAT SOME POSITIONS TAKEN WOULD BE SUSTAINED UPON EXAMINATION BY THE TAXING AUTHORITIES, WHILE OTHERS ARE SUBJECT TO UNCERTAINTY ABOUT THE MERITS OF THE POSITION TAKEN OR THE AMOUNT OF THE POSITION THAT WOULD ULTIMATELY BE SUSTAINED. EXAMPLES OF TAX POSITIONS COMMON TO HEALTH SYSTEMS INCLUDE SUCH MATTERS AS THE TAX-EXEMPT STATUS OF EACH ENTITY, THE CONTINUED TAX-EXEMPT STATUS OF BONDS, THE NATURE, CHARACTERIZATION AND TAXABILITY OF JOINT VENTURE INCOME, AND VARIOUS POSITIONS RELATING TO POTENTIAL SOURCES OF UNRELATED BUSINESS TAXABLE INCOME (REPORTED ON FORM 990T). AS OF DECEMBER 31, 2021 AND 2020, THERE ARE NO UNRECOGNIZED TAX BENEFITS RESULTING FROM UNCERTAIN TAX POSITIONS. FORMS 990 AND 990T FILED BY THE CORPORATION AND ITS TAX-EXEMPT AFFILIATED ENTITIES ARE SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE UP TO THREE YEARS FROM THE EXTENDED DUE DATE OF EACH RETURN. FORMS 990 AND 990T FILED BY THE CORPORATION AND ITS TAX-EXEMPT AFFILIATED ENTITIES ARE GENERALLY NO LONGER SUBJECT TO EXAMINATION FOR THE YEAR 2017 AND PRIOR. 1 1 X 1 X 1 X 1 1 0 1 1 1004019 1004019 0.01880 5080246 3458994 1621252 0.03040 7933655 5116986 2816669 0.05280 14017920 8575980 5441940 0.10200 155735 9711 146024 0.00270 166648 166648 0.00310 3387063 2572022 815041 0.01530 39302 39302 0.00070 3748748 2581733 1167015 0.02180 17766668 11157713 6608955 0.12380 50000 50000 0.00090 50000 50000 0.00090 1 0 0 11723508 12378543 -655035 X 1 1 1 1 PARKVIEW WABASH HOSPITAL INC 10 JOHN KISSINGER DRIVE WABASH IN 46992 WWW.PARKVIEW.COM 16-005094-1 X X X X PARKVIEW WABASH HOSPITAL INC 1 0 0 1 X X X X X X X X X 19 1 1 1 1 X HTTPS://WWW.PARKVIEW.COM/LOCALHEALTHNEEDS X 1 19 1 HTTPS://WWW.PARKVIEW.COM/LOCALHEALTHNEEDS 0 1 X 200.000000000000 250.000000000000 X X X X X 1 1 X X X 1 X HTTPS://WWW.PARKVIEW.COM/PATIENTS-VISITORS/FINANCIAL-ASSISTANCE X HTTPS://WWW.PARKVIEW.COM/PATIENTS-VISITORS/FINANCIAL-ASSISTANCE X HTTPS://WWW.PARKVIEW.COM/PATIENTS-VISITORS/FINANCIAL-ASSISTANCE X X X X X X 1 X 0 X X X X 1 X 0 0 PARKVIEW WABASH HOSPITAL, INC. PART V, SECTION B, LINE 5: DESCRIBE HOW THE HOSPITAL FACILITY TOOK INTO ACCOUNT INPUT FROM PERSONS WHO REPRESENT THE COMMUNITY, AND IDENTIFY THE PERSONS THE HOSPITAL FACILITY CONSULTED:WHEN CONDUCTING ITS 2019 CHNA, PARKVIEW HEALTH SYSTEM, INC., INCLUDING PARKVIEW WABASH HOSPITAL, INC., AND THE INDIANA PARTNERSHIP FOR HEALTHY COMMUNITIES (IN-PHC) RESEARCH TEAM MADE SURE TO GET THE INPUT FROM PERSONS REPRESENTING THE BROADER INTERESTS OF THE COMMUNITY, WHILE ALSO FOCUSING ON THE NEEDS OF VULNERABLE POPULATIONS IN NORTHEAST INDIANA. AREA HEALTH DEPARTMENTS, MEDICAL PROFESSIONALS AND SOCIAL SERVICE AGENCIES THAT PROVIDE SERVICES DIRECTLY TO THE UNDERSERVED IN OUR COMMUNITIES WERE SURVEYED AND TOOK PART IN COMMUNITY HEALTH PLANNING SESSIONS.AS PART OF THE RESEARCH PROCESS, PARKVIEW HEALTH SYSTEM, INC. AND ITS RESEARCH PARTNERS OBTAINED THE FOLLOWING: 1) PRIMARY DATA WAS COLLECTED VIA AN ONLINE SURVEY OF COMMUNITY HEALTHCARE AND SOCIAL SERVICE PROVIDERS (E.G., PHYSICIANS, NURSES, SOCIAL WORKERS, ETC.). ADDITIONALLY, THE HEALTH SYSTEM'S CHNA RESEARCH PARTNERS CONDUCTED A TELEPHONE SURVEY, WHICH INCLUDED COMMUNITY RESIDENTS FROM EACH COUNTY IN THE PARKVIEW HEALTH SERVICE REGION. 2) SECONDARY DATA WAS GATHERED FROM CONDUENT'S HEALTHY COMMUNITIES INSTITUTE (HCI) DATABASE AND OTHER LOCAL AND NATIONAL AGENCIES. TO SUPPLEMENT THESE DATA, A FOCUS GROUP WAS CONDUCTED WITH HISPANIC COMMUNITY MEMBERS IN KOSCIUSKO COUNTY AND A PAPER SURVEY OF THE AMISH COMMUNITY WAS CONDUCTED IN LAGRANGE COUNTY.IN ADDITION TO DATA COLLECTION, PARKVIEW HEALTH SYSTEM, INC. TURNED TO THE COMMUNITY AND PARTNERING ORGANIZATIONS WHEN SELECTING AND PRIORITIZING WABASH COUNTY'S HEALTH NEEDS. AS RECOMMENDED BY THE INDIANA PARTNERSHIP FOR HEALTHY COMMUNITIES, A MODIFIED HANLON METHOD WAS USED TO PRIORITIZE HEALTH CONCERNS FOR PARKVIEW WABASH HOSPITAL. THIS METHOD, ALSO KNOWN AS THE BASIC PRIORITY RATING SYSTEM (BPRS) 2.0, IS RECOMMENDED BY THE NATIONAL ASSOCIATION OF COUNTY AND CITY HEALTH OFFICIALS (NACCHO) FOR PRIORITIZING COMMUNITY HEALTH NEEDS (GUIDE-TO-PRIORITIZATION-TECHNIQUES.PDF, N.D.). ALTHOUGH COMPLEX TO IMPLEMENT, IT IS USEFUL WHEN THE DESIRED OUTCOME IS AN OBJECTIVELY SELECTED LIST. EXPLICIT IDENTIFICATION OF FACTORS MUST BE CONSIDERED TO SET PRIORITIES, THUS ENABLING A TRANSPARENT AND REPLICABLE PROCESS. PRIORITY SCORES ARE CALCULATED BASED ON THE SIZE OF THE HEALTH PROBLEM, SERIOUSNESS OF THE HEALTH PROBLEM AND THE AVAILABILITY OF EFFECTIVE HEALTH INTERVENTIONS. THE FINDINGS WERE PRESENTED AT THE DECEMBER 2019 PARKVIEW WABASH HOSPITAL, INC, BOARD MEETING. AFTER A THOROUGH REVIEW OF THE DATA AND CONSIDERABLE DISCUSSION, THE GROUP USED AN ELECTRONIC VOTING SYSTEM TO RANK THE VARIOUS HEALTH NEEDS IDENTIFIED IN THE CHNA. ULTIMATELY, THE GROUP VOTED ON SUBSTANCE USE DISORDER/MENTAL HEALTH, AS THE TOP HEALTH PRIORITY. THEY VOTED FOR OBESITY RELATED INITIATIVES AS A SECONDARY PRIORITY. PARKVIEW WABASH HOSPITAL, INC. PART V, SECTION B, LINE 6A: THE HOSPITAL FACILITY'S CHNA WAS CONDUCTED WITH THE FOLLOWING HOSPITAL FACILITIES:PARKVIEW HOSPITAL, INC. (EIN 35-0868085); COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC. (EIN 20-2401676); COMMUNITY HOSPITAL OF NOBLE COUNTY, INC. (EIN 35-2087092); HUNTINGTON MEMORIAL HOSPITAL, INC. (EIN 35-1970706); WHITLEY MEMORIAL HOSPITAL, INC. (EIN 35-1967665); AND ORTHOPAEDIC HOSPITAL AT PARKVIEW NORTH, LLC (EIN 26-0143823). PARKVIEW WABASH HOSPITAL, INC. PART V, SECTION B, LINE 6B: THE HOSPITAL FACILITY'S CHNA WAS ALSO CONDUCTED WITH THE FOLLOWING ORGANIZATIONS OTHER THAN HOSPITAL FACILITIES:PARKVIEW HEALTH, INC. (EIN 35-1972384); INDIANA PARTNERSHIP FOR HEALTHY COMMUNITIES (A PARTNERSHIP BETWEEN THE INDIANA UNIVERSITY RICHARD M. FAIRBANKS SCHOOL OF PUBLIC HEALTH AND THE POLIS CENTER AT IUPUI) AND CONDUENT HEALTHY COMMUNITIES INSTITUTE. PARKVIEW WABASH HOSPITAL, INC. PART V, SECTION B, LINE 11: DESCRIBE HOW THE HOSPITAL FACILITY IS ADDRESSING THE SIGNIFICANT NEEDS IDENTIFIED IN ITS MOST RECENTLY CONDUCTED CHNA AND ANY SUCH NEEDS THAT ARE NOT BEING ADDRESSED TOGETHER WITH THE REASONS WHY SUCH NEEDS ARE NOT BEING ADDRESSED:SIGNIFICANT HEALTH NEEDS BEING ADDRESSED:OBESITY -- PARKVIEW WABASH HOSPITAL SUPPORTS PROGRAMS ESTABLISHED TO ADDRESS OBESITY IN WABASH COUNTY. ACTIONS TO ADDRESS THE ISSUE OF OBESITY CENTER AROUND PROGRAMS THAT ENGAGE CHILDREN AND FAMILIES AND INCLUDE THE FOLLOWING PROGRAMS:- WORKED WITH THE CITY OF WABASH TO INCLUDE THE NEARLY HALF MILE WALKING PATH AROUND THE POND ON THE HOSPITAL CAMPUS ON A BROCHURE THAT PROMOTES THE CITY'S TRAILS AND PAVED WALKWAYS AS A WAY TO PROMOTE PHYSICAL ACTIVITY. SIDEWALKS ON WABASH STREET MAKE IT SAFE AND EASY FOR PEOPLE TO CONNECT TO THE CHARLEY CREEK TRAIL, AN ADDITIONAL THREE-QUARTER MILE TRAIL THAT LEADS TO THE MORRET SPORTS COMPLEX.- BLESSINGS IN A BACKPACK WORKS TO COMBAT FOOD INSECURITY BY FEEDING, ON AVERAGE, 600 ELEMENTARY STUDENTS WEEKLY THROUGHOUT 2021. ONE TEACHER STATES "MY STUDENTS ARE SO EXCITED EACH FRIDAY WHEN THEIR BLESSINGS BAGS ARE PASSED OUT." WHEN A STUDENT WAS ASKED WHY THEY WERE EXCITED, THEY SAID "BECAUSE I HAVE FOOD FOR WHEN I AM HUNGRY."- THE HOSPITAL'S "MY WELL-BEING" COMMITTEE PROVIDES RESOURCES FOR CO-WORKERS TO ENABLE THEM TO BE GOOD EXAMPLES FOR THE REST OF THE COMMUNITY.MATERNAL/CHILD HEALTH --- THOUGH PRIMARILY SUSPENDED IN 2021, PARKVIEW WABASH HOSPITAL, INC., DID CONTINUE TO OFFER A MOMS GROUP AND LACTATION VISITS IN THE FOURTH QUARTER. THE PROGRAMS WERE DESIGNED TO REDUCE RISKS AND INCREASE HEALTHY BEHAVIORS AMONG NEWBORNS, AS WELL AS OFFERING SUPPORT TO BOTH FIRST-TIME AND EXPERIENCED MOTHERS. OUR PART-TIME LACTATION CONSULTANT AND BIRTH PLANNER HAD 25 LACTATION VISITS SEPT. - DEC. 2021 AND MET WITH 30 MOMS IN MOMS GROUP FROM OCT.-DEC. 2021. ALL CLASSES ARE OPEN TO THE PUBLIC, REGARDLESS OF WHERE MOM DELIVERED.- SUPPORTED BABE OF WABASH COUNTY. BABE IS AN INCENTIVE-BASED PROGRAM THAT PROMOTES GOOD HEALTH, EDUCATION, AND CONNECTION FOR PARENTS OF CHILDREN AGES BIRTH TO 5 YEARS OLD. DR. RAFAEL NUNEZ, PWB PEDIATRICIAN, AND SHELLY BOONE, NP, CNM, ARE BOTH PARTNERS OF THE PROGRAM. ADDITIONALLY, STAFF MEMBERS PROVIDED EDUCATION ON SUCH TOPICS AS "FEEDING A PICKY EATER AND BREASTFEEDING.OTHER HEALTH NEEDS NOT BEING ADDRESSED: TOBACCO USE - THE TOBACCO FREE COALITION IS THE LEAD ORGANIZATION IN WABASH COUNTY RELATED TO TOBACCO FREE EFFORTS. THE COALITION PROVIDES INFORMATION ON RESOURCES ABOUT LOCAL SMOKING CESSATION PROGRAMS AND ADVOCATES FOR NO-SMOKING PUBLIC POLICY. PARKVIEW WABASH HOSPITAL IS REPRESENTED ON THEIR COALITION BOARD AND ALSO FUNDS THEIR "DON'T START SMOKING" PROGRAM FOR ALL 2ND AND 5TH GRADERS IN THE COUNTY. NEARLY 1200 STUDENTS IN ALL THREE COUNTY SCHOOL DISTRICTS ARE REACHED BY THIS PROGRAM EACH YEAR.THE HOSPITAL ALSO SUPPORTS THEIR BABY AND ME TOBACCO FREE PROGRAM THROUGH A CHI GRANT. IT IS AN INCENTIVE-BASED PROGRAM THAT HELPS EXPECTANT MOMS, AND THEIR PARTNERS, TO QUIT SMOKING. THERE WERE 58 WABASH COUNTY BIRTHS AFFECTED BY SMOKING IN 2021.- THE HOSPITAL IS A TOBACCO FREE CAMPUS. DIABETES, CARDIOVASCULAR DISEASE, AND CANCER - WHILE PARKVIEW WABASH HOSPITAL, INC. DID NOT SELECT THESE CHRONIC DISEASES AS TOP HEALTH PRIORITIES, OUR REGISTERED DIETITIAN IS ALSO A CERTIFIED DIABETIC EDUCATOR. SHE WORKS WITH PATIENTS ON A ONE-ON-ONE BASIS THROUGH PHYSICIAN REFERRAL AND INPATIENT CONSULTS. IN 2021, SHE COUNSELED 67 PATIENTS DIAGNOSED WITH DIABETES.DRUGS/ALCOHOL ABUSE AND ADDICTION - THIS IS NOW THE TOP PRIORITY FOR PARKVIEW WABASH HOSPITAL, INC., AS IDENTIFIED BY THE CHNA. WABASH COUNTY FORMED A DRUG STEERING COMMITTEE IN JULY 2017. PARKVIEW WABASH HOSPITAL, INC. PRESIDENT MARILYN CUSTER-MITCHELL HELPS TO FACILITATE THE MONTHLY MEETINGS. OPENED MEDICATION ASSISTED TREATMENT AND INTENSIVE OUTPATIENT THERAPY PROGRAMS IN LATE 2020. THE PROGRAM GREW SUBSTANTIALLY IN 2021, INCREASING FROM 111 APPOINTMENTS IN JANUARY TO 376 IN DECEMBER. NINETEEN PEOPLE SUCCESSFULLY COMPLETED THE PROGRAM, WHICH CONSISTS OF BOTH GROUP AND INDIVIDUAL COUNSELING.SEXUALLY TRANSMITTED DISEASES (STDS) - THE WABASH COUNTY HEALTH DEPARTMENT IS THE MAIN RESOURCE IN OUR COUNTY FOR INDIVIDUALS WITH THESE NEEDS.CHRONIC KIDNEY DISEASE - PARKVIEW WABASH HOSPITAL, INC. HAS DONE RESEARCH OVER THE YEARS ON THE NEED FOR ADDITIONAL RESOURCES IN THIS AREA. FOR INSTANCE, ALL THREE NATIONAL COMPANIES WHO PROVIDE DIALYSIS HAVE CONDUCTED EVALUATIONS OF THE NEED WITHIN WABASH COUNTY AND DETERMINED IT WAS NOT BENEFICIAL TO BRING DIALYSIS TO WABASH COUNTY. THERE ARE COMPANIES THAT PROVIDE THE SERVICE IN THE COUNTIES NEIGHBORING WABASH. PARKVIEW WABASH HOSPITAL, INC. MET WITH THE LOCAL PUBLIC TRANSIT PROVIDER AND THEY AGREED TO RELAX THEIR "IN-COUNTY" RULE TO TRANSPORT RESIDENTS IN NEED OF MEDICAL CARE IN A NEIGHBORING COUNTY. ASTHMA - WHILE ASTHMA WAS NOT SELECTED AS A TOP HEALTH PRIORITY, 85 HOPE, THE LOCAL FREE CLINIC, PROVIDES ASTHMA EDUCATION TO ITS PATIENTS. THE PROGRAM INCLUDES EDUCATION, INFORMATION, AND STRATEGIES FOR FOLLOW-UP CARE THAT ARE BOTH INEXPENSIVE AND EFFECTIVE. AGING - WABASH COUNTY OFFERS A VIBRANT AND ACTIVE SENIOR CENTER. THE DALLAS WINCHESTER SENIOR CENTER OFFERS MEALS MONDAY THROUGH FRIDAY, PRESCRIPTION ASSISTANCE, A FOOD PANTRY, PUBLIC TRANSPORTATION, SOCIAL EVENTS, PHYSICAL ACTIVITIES, AND CONNECTIONS TO RESOURCES THAT BENEFIT SENIORS IN OUR COMMUNITY. MENTAL HEALTH - AREA RESIDENTS HAVE ACCESS TO A NUMBER OF RESOURCES IN THE COMMUNITY. THE BOWEN CENTER, FRIENDS COUNSELING CENTER AND MENTAL HEALTH AMERICA OF WABASH COUNTY EACH SERVE PEOPLE OF ALL AGES.- THE LIFEBRIDGE SENIOR INTENSIVE OUTPATIENT PROGRAM IS A SPECIALTY MENTAL/BEHAVIORAL PROGRAM DESIGNED TO MEET THE NEEDS OF OLDER ADULTS FOCUSING ON PROVIDING INTENSIVE INDIVIDUAL, FAMILY AND /OR GROUP SERVICES. EACH OF THE INDIVIDUALS ENROLLED IN THE LIFEBRIDGE PROGRAM ATTEND MONTHLY APPOINTMENTS WITH MEDICAL DIRECTOR/PSYCHIATRIST FOR MEDICATION MANAGEMENT AND TREATMENT PLANNING. AT EACH VISIT, INDIVIDUALS ARE SCREENED BY NURSING STAFF FOR VITALS, MEDICATION RECONCILIATION AND ANY MEDICAL CONCERNS ARE IMMEDIATELY COMMUNICATED TO THE INDIVIDUAL'S PRIMARY CARE PHYSICIAN. FAMILY AND SIGNIFICANT OTHERS ARE ENCOURAGED TO PARTICIPATE IN THE TREATMENT PROCESS. LIFEBRIDGE PROVIDES A COHESIVE TREATMENT TEAM TO INCREASE INDIVIDUAL'S MENTAL HEALTH AND PHYSICAL WELL-BEING. PART V, SECTION B, LINE 3E: THE SIGNIFICANT HEALTH NEEDS ARE A PRIORITIZED DESCRIPTION OF THE SIGNIFICANT HEALTH NEEDS OF THE COMMUNITY AND IDENTIFIED THROUGH THE CHNA. PART I, LINE 3C: EQUITY IN A HOME OTHER THAN THE PATIENT OR GUARANTOR'S PRIMARY RESIDENCE. PART I, LINE 6A: THE RELATED ENTITIES OF PARKVIEW HEALTH SYSTEM, INC. (EIN 35-1972384); PARKVIEW HOSPITAL, INC. (EIN 35-0868085); COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC. (EIN 20-2401676); COMMUNITY HOSPITAL OF NOBLE COUNTY, INC. (EIN 35-2087092); HUNTINGTON MEMORIAL HOSPITAL, INC. (EIN 35-1970706); WHITLEY MEMORIAL HOSPITAL, INC. (EIN 35-1967665); DEKALB MEMORIAL HOSPITAL, INC. (EIN 35-1064295; PARK CENTER, INC. (EIN 35-1135451); AND PARKVIEW WABASH HOSPITAL, INC. (EIN 47-1753440) PREPARED A COMBINED REPORT TO THE COMMUNITY DETAILING COMMUNITY BENEFIT PROGRAMS AND SERVICES. PART I, LINE 7: PART I, LINE 7ATHE FINANCIAL ASSISTANCE COST REPORTED ON LINE 7A IS CALCULATED UNDER THE COST TO CHARGE RATIO METHODOLOGY. UNDER THIS METHOD, THE FINANCIAL ASSISTANCE CHARGES FOREGONE ARE MULTIPLIED BY THE RATIO OF COST TO CHARGES TO DETERMINE THE COST OF SERVICES RENDERED.PART I, LINE 7BPARKVIEW WABASH HOSPITAL, INC. ACCEPTS ALL MEDICAID, MEDICAID MANAGED CARE, AND OUT-OF-STATE MEDICAID PATIENTS WITH THE KNOWLEDGE THAT THERE MAY BE SHORTFALLS. INTERNAL REVENUE SERVICE (IRS) REVENUE RULING 69-545 IMPLIES THAT TREATING MEDICAID PATIENTS IS A COMMUNITY BENEFIT. IRS REVENUE RULING 69-545, WHICH ESTABLISHED THE COMMUNITY BENEFIT STANDARD FOR NONPROFIT HOSPITALS, STATES THAT IF A HOSPITAL SERVES PATIENTS WITH GOVERNMENTAL HEALTH BENEFITS, INCLUDING MEDICAID, THEN THIS IS AN INDICATION THAT THE HOSPITAL OPERATES TO PROMOTE THE HEALTH OF THE COMMUNITY. THE UNREIMBURSED MEDICAID COST REPORTED ON LINE 7B IS CALCULATED UNDER THE COST TO CHARGE RATIO METHODOLOGY. UNDER THIS METHOD, THE MEDICAID CHARGES ARE MULTIPLIED BY THE RATIO OF COST TO CHARGES TO DETERMINE THE COST OF MEDICAID SERVICES RENDERED. THEN, THE COST OF MEDICAID SERVICES RENDERED IS DEDUCTED FROM THE REIMBURSEMENT RECEIVED FOR MEDICAID PATIENTS TO ARRIVE AT A GAIN/(LOSS) RELATIVE TO THESE PATIENTS.PART I, LINE 7CPARKVIEW WABASH HOSPITAL, INC. ACCEPTS ALL CERTAIN MEANS-TESTED PATIENTS FROM THE HEALTHY INDIANA PLAN (HIP) WITH THE KNOWLEDGE THAT THERE MAY BE SHORTFALLS. INTERNAL REVENUE SERVICE (IRS) REVENUE RULING 69-545 IMPLIES THAT TREATING MEANS-TESTED PATIENTS IS A COMMUNITY BENEFIT. IRS REVENUE RULING 69-545, WHICH ESTABLISHED THE COMMUNITY BENEFIT STANDARD FOR NONPROFIT HOSPITALS, STATES THAT IF A HOSPITAL SERVES PATIENTS WITH GOVERNMENTAL HEALTH BENEFITS, INCLUDING HIP, THEN THIS IS AN INDICATION THAT THE HOSPITAL OPERATES TO PROMOTE THE HEALTH OF THE COMMUNITY. THE UNREIMBURSED HIP COST REPORTED ON LINE 7C IS CALCULATED UNDER THE COST TO CHARGE RATIO METHODOLOGY. UNDER THIS METHOD, THE HIP CHARGES ARE MULTIPLIED BY THE RATIO OF COST TO CHARGES TO DETERMINE THE COST OF HIP SERVICES RENDERED. THEN, THE COST OF HIP SERVICES RENDERED IS DEDUCTED FROM THE REIMBURSEMENT RECEIVED FOR HIP PATIENTS TO ARRIVE AT A GAIN/(LOSS) RELATIVE TO THESE PATIENTS.PART I, LINE 7EAMOUNTS PRESENTED ARE BASED ON ACTUAL SPEND FOR THOSE SERVICES AND BENEFITS PROVIDED DEEMED TO IMPROVE THE HEALTH OF THE COMMUNITIES IN WHICH WE SERVE AND CONFORM WITH THE MISSION OF OUR EXEMPT PURPOSE.PART I, LINE 7FAMOUNTS PRESENTED ARE BASED UPON ACTUAL SPEND AND ARE IN CONFORMITY WITH AGREED UPON COMMITMENTS WITH THE VARIOUS EDUCATIONAL PROGRAMS.PART I, LINE 7GAMOUNTS PRESENTED DO NOT INCLUDE ANY COSTS ASSOCIATED WITH PHYSICIAN CLINICS.PART I, LINE 7IIN KEEPING WITH OUR MISSION AND COMMITMENT TO THE COMMUNITIES IN WHICH WE SERVE, PARKVIEW WABASH HOSPITAL, INC. CONTINUES ITS TRADITION OF CONTRIBUTING TO NUMEROUS ORGANIZATIONS ON BOTH AN AS-NEEDED BASIS AND NEGOTIATED BASIS. AMOUNTS PRESENTED REPRESENT ACTUAL SPEND TO ORGANIZATIONS THROUGHOUT OUR COMMUNITIES. PART I, LN 7 COL(F): PERCENT OF TOTAL EXPENSEPARKVIEW WABASH HOSPITAL, INC. EXCLUDED $3,062,685 OF PH CLINICAL SUPPORT EXPENSE. PART II, COMMUNITY BUILDING ACTIVITIES: DESCRIBE HOW THE ORGANIZATION'S COMMUNITY BUILDING ACTIVITIES, AS REPORTED, PROMOTE THE HEALTH OF THE COMMUNITIES THE ORGANIZATION SERVES.PARKVIEW WABASH HOSPITAL, INC., PROVIDES SUPPORT FOR LOCAL ECONOMIC DEVELOPMENT PROGRAMS. THESE EFFORTS ARE ALIGNED WITH THE HEALTH SYSTEM'S STRATEGIC INVOLVEMENT IN THE NORTHEAST INDIANA REGIONAL PARTNERSHIP'S VISION 2030, A REGIONAL INITIATIVE DESIGNED TO TRANSFORM NORTHEAST INDIANA INTO A TOP GLOBAL COMPETITOR BY FOCUSING ON A COMMON MISSION TO DEVELOP, ATTRACT AND RETAIN TALENT. VISION 2030'S REGIONAL PRIORITIES ARE TIED TO EDUCATION/WORKFORCE, BUSINESS CLIMATE, ENTREPRENEURSHIP, INFRASTRUCTURE AND QUALITY OF LIFE FOR THE ELEVEN-COUNTY REGION IN NORTHEAST INDIANA. PROMOTION OF ECONOMIC DEVELOPMENT IN WABASH COUNTY IS A PART OF A COLLECTIVE PLAN TO IMPROVE THE QUALITY OF LIFE AND ULTIMATELY THE OVERALL HEALTH AND WELL-BEING OF THE COMMUNITY.PARKVIEW WABASH HOSPITAL, INC., WORKS CLOSELY WITH GROW WABASH COUNTY, THE COUNTY'S ECONOMIC DEVELOPMENT ORGANIZATION AND THE CITY OF WABASH. PARKVIEW WABASH HOSPITAL, INC. PRESIDENT MARILYN CUSTER-MITCHELL SERVES ON THE BOARD FOR GROW WABASH COUNTY AND IS INVOLVED IN COMMUNITY MEETINGS THAT DISCUSS THE OUTLOOK, FUTURE AND PLAN FOR A VIBRANT CITY.PARKVIEW WABASH HOSPITAL, INC. LEADERS SERVE ON LOCAL BOARDS AND COMMITTEES OF NON-PROFIT ORGANIZATIONS. THESE INCLUDE WAYPOINT TRANSITIONAL SHELTER FOR WOMEN, NEW BEGINNINGS TRANSITIONAL SHELTER FOR MEN, COMMUNITY CORRECTIONS, MEALS ON WHEELS, WABASH COUNTY UNITED FUND, WABASH ROTARY CLUB, AND GROW WABASH COUNTY. THE ROLES ARE PERFECT OPPORTUNITIES TO CONNECT WITH THE COMMUNITY AND PROVIDE INSIGHT FROM THE HEALTHCARE PERSPECTIVE RELATED TO LOCAL PROGRAMS AND ISSUES. PART III, LINE 2: FOR FINANCIAL STATEMENT PURPOSES, THE ORGANIZATION HAS ADOPTED ACCOUNTING STANDARDS UPDATE NO. 2014-09 (TOPIC 606). IMPLICIT PRICE CONCESSIONS INCLUDES BAD DEBTS. THEREFORE, BAD DEBTS ARE INCLUDED IN NET PATIENT REVENUE IN ACCORDANCE WITH HEALTHCARE FINANCIAL MANAGEMENT ASSOCIATION STATEMENT NO. 15 AND BAD DEBT EXPENSE IS NOT SEPARATELY REPORTED AS AN EXPENSE. PART III, LINE 4: BAD DEBT EXPENSE - PARKVIEW HEALTH SYSTEM, INC. AND SUBSIDIARIES - NOTES TO THE CONSOLIDATED FINANCIAL STATEMENTSTEXT OF THE FOOTNOTE TO THE ORGANIZATION'S FINANCIAL STATEMENTS THAT DESCRIBES BAD DEBT EXPENSE OR THE PAGE NUMBER ON WHICH THIS FOOTNOTE IS CONTAINED IN THE ATTACHED FINANCIAL STATEMENTS:PAGES 12 AND 23 - 26 OF ATTACHED FINANCIAL STATEMENTS. PART III, LINE 8: COMMUNITY BENEFIT & METHODOLOGY FOR DETERMINING MEDICARE COSTSSUBSTANTIAL SHORTFALLS TYPICALLY ARISE FROM PAYMENTS THAT ARE LESS THAN THE COST TO PROVIDE THE CARE OR SERVICES AND DO NOT INCLUDE ANY AMOUNTS RELATING TO INEFFICIENT OR POOR MANAGEMENT. PARKVIEW WABASH HOSPITAL, INC. ACCEPTS ALL MEDICARE PATIENTS, AS REFLECTED ON THE YEAR-END MEDICARE COST REPORT, WITH THE KNOWLEDGE THAT THERE MAY BE SHORTFALLS. INTERNAL REVENUE SERVICE (IRS) REVENUE RULING 69-545 IMPLIES THAT TREATING MEDICARE PATIENTS IS A COMMUNITY BENEFIT. IRS REVENUE RULING 69-545, WHICH ESTABLISHED THE COMMUNITY BENEFIT STANDARD FOR NONPROFIT HOSPITALS, STATES THAT IF A HOSPITAL SERVES PATIENTS WITH GOVERNMENTAL HEALTH BENEFITS, INCLUDING MEDICARE, THEN THIS IS AN INDICATION THAT THE HOSPITAL OPERATES TO PROMOTE THE HEALTH OF THE COMMUNITY. HOWEVER, MEDICARE PAYMENTS REPRESENT A PROXY OF COST CALLED THE "UPPER PAYMENT LIMIT." IT HAS HISTORICALLY BEEN ASSUMED THAT UPPER PAYMENT LIMIT PAYMENTS DO NOT GENERATE A SHORTFALL. AS A RESULT, PARKVIEW WABASH HOSPITAL, INC. HAS TAKEN THE POSITION NOT TO INCLUDE THE MEDICARE SHORTFALLS OR SURPLUSES AS PART OF COMMUNITY BENEFIT. PARKVIEW WABASH HOSPITAL, INC. RECOGNIZES THAT THE SHORTFALL OR SURPLUS FROM MEDICARE DOES NOT INCLUDE THE COSTS AND REVENUES ASSOCIATED WITH MEDICARE ADVANTAGE PATIENTS. AS SUCH, THE TOTAL SHORTFALL OR SURPLUS OF MEDICARE IS UNDERSTATED DUE TO THE COSTS AND REVENUES ASSOCIATED WITH MEDICARE ADVANTAGE PATIENTS NOT BEING INCLUDED IN THE COMMUNITY BENEFIT DETERMINATION. PART III, LINE 9B: A PATIENT'S FAILURE TO MAKE PAYMENT ARRANGEMENTS THROUGH VARIOUS AVAILABLE PAYMENT OPTIONS OR FAILURE TO APPLY FOR AND RECEIVE APPROVAL UNDER THE FINANCIAL ASSISTANCE POLICY MAY RESULT IN THE ACCOUNT BEING REFERRED TO A COLLECTION AGENCY DUE TO NON-PAYMENT. THE COLLECTION AGENCY MAY REPORT THE ACCOUNT TO ONE OR ALL THREE CREDIT REPORTING AGENCIES, WHICH MAY ADVERSELY AFFECT THE PATIENT'S CREDIT SCORE.A PATIENT MAY APPLY FOR FINANCIAL ASSISTANCE AT ANY TIME DURING THE APPLICATION PERIOD, EVEN IF THE ACCOUNT HAS BEEN PLACED WITH A COLLECTION AGENCY. IF AN INDIVIDUAL SUBMITS A COMPLETE FINANCIAL ASSISTANCE APPLICATION DURING THE APPLICATION PERIOD, AND PARKVIEW HEALTH DETERMINES THE INDIVIDUAL IS ELIGIBLE FOR FINANCIAL ASSISTANCE, THEN PARKVIEW HEALTH WILL TAKE ALL REASONABLE AVAILABLE MEASURES TO REVERSE ANY EXTRAORDINARY COLLECTION ACTION (EXCEPT FOR A SALE OF DEBT) TAKEN AGAINST THE INDIVIDUAL TO OBTAIN PAYMENT FOR THE CARE. ALSO, IF AN INDIVIDUAL SUBMITS AN INCOMPLETE FINANCIAL ASSISTANCE APPLICATION DURING THE APPLICATION PERIOD, PARKVIEW WILL SUSPEND ANY EXTRAORDINARY COLLECTION ACTIONS AGAINST THE INDIVIDUAL (WITH RESPECT TO CHARGES TO WHICH THE FINANCIAL ASSISTANCE APPLICATION UNDER REVIEW RELATES) UNTIL THE FINANCIAL ASSISTANCE APPLICATION HAS BEEN PROCESSED AND AN ELIGIBILITY DECISION RENDERED. PART VI, LINE 2: DESCRIBE HOW THE ORGANIZATION ASSESSES THE HEALTH CARE NEEDS OF THE COMMUNITIES IT SERVES, IN ADDITION TO ANY CHNAS REPORTED IN PART V, SECTION B.IN ADDITION TO COMPLETING A COMMUNITY HEALTH NEEDS ASSESSMENT ON A TRIENNIAL BASIS, PARKVIEW WABASH HOSPITAL, INC. ASSESSES THE HEALTHCARE NEEDS OF THE COMMUNITY IT SERVES THROUGH PRIMARY AND SECONDARY DATA ANALYSIS, WORKING WITH THE ORGANIZATION'S COMMUNITY PARTNERS, AND FRONTLINE STAFF. PARKVIEW WABASH HOSPITAL, INC. IDENTIFIES AND VERIFIES COMMUNITY HEALTH NEEDS THROUGH THE FOLLOWING:1. HEALTHY COMMUNITIES INSTITUTE (HCI) SECONDARY DATA ANALYSIS2. OBSERVATIONS AND DATA COLLECTED FROM FRONTLINE STAFF WORKING WITH VULNERABLE POPULATIONS (I.E., COMMUNITY NURSES AND COMMUNITY HEALTH WORKERS)3. REVIEW OF COMMUNITY NEEDS ASSESSMENTS CONDUCTED BY LOCAL ORGANIZATIONS (I.E., UNITED WAY, BRIGHTPOINT, ETC.) 4. PARKVIEW LEADERS SERVING ON HEALTH-RELATED AND SOCIAL SERVICE BOARDS OF DIRECTORS IN THE COMMUNITY5. OTHER PUBLIC HEALTH DATABASES (E.G. COMMUNITY COMMONS, COUNTY HEALTH RANKINGS) KEY HOSPITAL REPRESENTATIVES MAINTAIN ON-GOING RELATIONSHIPS THROUGHOUT THE COMMUNITY AND MEET REGULARLY WITH ORGANIZATIONS THAT SHARE THE MISSION OF IMPROVING THE HEALTH AND INSPIRING THE WELL-BEING OF THE COMMUNITY WE SERVE. PART VI, LINE 3: DESCRIBE HOW THE ORGANIZATION INFORMS AND EDUCATES PATIENTS AND PERSONS WHO MAY BE BILLED FOR PATIENT CARE ABOUT THEIR ELIGIBILITY FOR ASSISTANCE UNDER FEDERAL, STATE OR LOCAL GOVERNMENT PROGRAMS OR UNDER THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY.SIGNAGE AND BROCHURES ARE POSTED AND AVAILABLE AT ALL HOSPITAL POINTS OF REGISTRATION AND IN THE EMERGENCY DEPARTMENT. PATIENTS ARE OFFERED PLAIN LANGUAGE SUMMARIES OF THE FINANCIAL ASSISTANCE POLICY DURING THE REGISTRATION PROCESS AND IN EACH FOLLOW UP STATEMENT SENT TO THE PATIENT. PATIENT STATEMENTS WILL INDICATE HOW A PATIENT CAN OBTAIN FINANCIAL ASSISTANCE APPLICATIONS AND WHO THEY CAN CONTACT FOR ASSISTANCE. PART VI, LINE 4: DESCRIBE THE COMMUNITY THE ORGANIZATION SERVES, TAKING INTO ACCOUNT THE GEOGRAPHIC AREA AND DEMOGRAPHIC CONSTITUENTS IT SERVES.THE ONLY FULL-SERVICE HOSPITAL IN WABASH COUNTY, PARKVIEW WABASH HOSPITAL, INC., PRIMARILY SERVES THE COMMUNITIES OF WABASH, NORTH MANCHESTER, ROANN, URBANA, LAGRO AND LAFOUNTAIN. TO A LESSER EXTENT, THE HOSPITAL SERVES COMMUNITIES IN SURROUNDING COUNTIES, TO INCLUDE MIAMI COUNTY, SOUTHERN KOSCIUSKO COUNTY AND NORTHERN GRANT COUNTY. ACCORDING TO CONDUENT HEALTHY COMMUNITIES INSTITUTE (2019), POPULATION ESTIMATES FROM SHOW WABASH COUNTY WITH APPROXIMATELY 30,996 RESIDENTS, WITH 94.1% BEING WHITE (NOT HISPANIC OR LATINO) AND 21.3% BEING OLDER THAN 65. THE MEDIAN HOUSEHOLD INCOME IS WABASH COUNTY IS $56,573. FURTHERMORE, 11.5% OF PEOPLE ARE LIVING BELOW THE POVERTY LEVEL (2016-2019), AND IT IS ESTIMATED THAT 2.1% OF WORKERS IN THE CIVILIAN LABOR FORCE ARE UNEMPLOYED (2022).PARKVIEW WABASH HOSPITAL, INC., IS THE 5TH LARGEST EMPLOYER IN THE COUNTY. THE MAKE-UP OF EMPLOYERS IN THE COUNTY IS LARGELY MANUFACTURING, FOLLOWED BY EDUCATION AND HEALTHCARE. ACCORDING TO THE INDIANA HOSPITAL ASSOCIATION DIMENSIONS DATABASE, PARKVIEW WABASH HOSPITAL, INC. FACILITIES HAD 16.5% OF INPATIENT DISCHARGES THAT WERE MEDICAID PATIENTS AND 1.7% WERE SELF-PAY. FOR OUTPATIENT PROCEDURES, 18.7% WERE MEDICAID PATIENTS, AND 2.5% PERCENT WERE SELF-PAY (2021). HEALTH RESOURCES AND SERVICES ADMINISTRATION (HRSA), AN AGENCY OF THE U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, DEVELOPS SHORTAGE DESIGNATION CRITERIA INTENDED TO IDENTIFY A GEOGRAPHIC AREA, POPULATION GROUP OR FACILITY AS A HEALTH PROFESSIONAL SHORTAGE AREA (HPSA) OR A MEDICALLY UNDERSERVED AREA OR POPULATION (MUA/P). 1) COUNTIES: HUNTINGTON, KOSCIUSKO, MARSHALL, WABASH AND WHITLEY COUNTYDISCIPLINE: MENTAL HEALTHHPSA ID: 7186918305HPSA NAME: MENTAL HEALTH CATCHMENT AREA 28 - WARSAWDESIGNATION TYPE: GEOGRAPHIC HPSAHPSA FTE SHORT: 11.02HPSA SCORE: 17STATUS: DESIGNATEDRURAL STATUS: PARTIALLY RURAL PART VI, LINE 5: PROVIDE ANY OTHER INFORMATION IMPORTANT TO DESCRIBING HOW THE ORGANIZATION'S HOSPITAL FACILITIES OR OTHER HEALTH CARE FACILITIES FURTHER ITS EXEMPT PURPOSE BY PROMOTING THE HEALTH OF THE COMMUNITY (EG OPEN MEDICAL STAFF, COMMUNITY BOARD, USE OF SURPLUS FUNDS, ETC.)THE MAJORITY OF THE PARKVIEW WABASH HOSPITAL, INC. BOARD OF DIRECTORS IS COMPRISED OF INDEPENDENT COMMUNITY MEMBERS WHO RESIDE IN THE HOSPITAL'S PRIMARY SERVICE AREA. THE HOSPITAL ALSO EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN THE COMMUNITY.PEOPLE IN OUR SERVICE AREA HAVE ACCESS TO CARE 24 HOURS A DAY, 365 DAYS A YEAR THROUGH PARKVIEW WABASH HOSPITAL, INC.'S EMERGENCY DEPARTMENT (ED). THE ED IS STAFFED WITH BOARD-CERTIFIED EMERGENCY CARE PHYSICIANS, PHYSICIAN ASSISTANTS AND A NURSING STAFF THAT IS TRAINED AND EXPERIENCED IN EMERGENCY CARE. ADDITIONALLY, THE HOSPITAL OFFERS FIRSTCARE, A WALK-IN CLINIC OPEN FROM 8 A.M. TO 8 P.M. MONDAY THROUGH FRIDAY AND 8 A.M. TO 2 P.M. ON SATURDAY AND SUNDAY.FURTHERMORE, NO PATIENT IS EVER DENIED TREATMENT, REGARDLESS OF THEIR ABILITY TO PAY, AND PARKVIEW WABASH HOSPITAL, INC. AND ITS AFFILIATES CONTINUE TO ADAPT TO MEET THE NEEDS OF THE COMMUNITY.OUR CARE IS NOT LIMITED TO THE WALLS OF OUR BUILDING. PARKVIEW WABASH HOSPITAL, INC., IS ACTIVE IN THE COMMUNITY IN A VARIETY OF WAYS.A FEW HIGHLIGHTS INCLUDE:--ONCOLOGY - THE PARKVIEW WABASH HOSPITAL, INC.'S, ONCOLOGY PROGRAM OFFERS CANCER PATIENTS ADVANCED CHEMOTHERAPY TREATMENT CLOSE TO HOME. ADDITIONALLY, THE DEPARTMENT ENCOURAGES SUPPORT BEYOND TREATMENT BY PROVIDING FREE SCREENINGS AND CLINICAL TRIALS. --WABASH COUNTY DRUG STEERING COMMITTEE - COMPRISED OF LOCAL LAW ENFORCEMENT, COURT OFFICIALS, BOWEN CENTER STAFF AND OTHERS, THE DRUG STEERING COMMITTEE WORKS TOGETHER TO ADDRESS THE DRUG PROBLEM IN WABASH COUNTY. PARKVIEW WABASH HOSPITAL, INC., PRESIDENT SERVES AS THE CHAIR OF THE COMMITTEE. THE COMMITTEE IS CURRENTLY LOOKING TO OPEN A WOMEN'S RECOVERY HOME.--UNINSURED ASSISTANCE - PARKVIEW WABASH HOSPITAL, INC., ASSISTS THOSE LESS FORTUNATE BY SUPPORTING 85 HOPE, THE COUNTY'S FREE CLINIC. --ATHLETIC TRAINERS - PARKVIEW WABASH HOSPITAL, INC., EMPLOYS THREE ATHLETIC TRAINERS TO WORK IN THREE WABASH COUNTY HIGH SCHOOLS. THESE TRAINERS SPEND HOURS AT A WIDE VARIETY OF ATHLETIC EVENTS TO ASSIST IF A STUDENT ATHLETE IS INJURED DURING PLAY OR PRACTICE. THEY ARE ALSO AVAILABLE DURING AND AFTER SCHOOL HOURS FOR ATHLETES IN NEED.--HEALTH FAIRS AND SCREENINGS - DUE TO COVID-19, PARKVIEW WABASH HOSPITAL, INC., HOSTED JUST ONE CHECK-UP DAY IN 2021. APPROXIMATELY 50 PEOPLE ATTENDED AND RECEIVED DISCOUNTED LAB WORK.--COVID-19 VACCINATION CLINIC - JOINING THE CITY OF WABASH'S LEAD, PARKVIEW WABASH HOSPITAL, INC., WAS INSTRUMENTAL IN GETTING A COVID VACCINATION CLINIC UP AND RUNNING IN LATE 2020. THAT CLINIC OPERATED THROUGH MAY OF 2021. PARKVIEW WABASH HOSPITAL, INC., LEADERS AND STAFF MEMBERS GAVE SELFLESSLY OF THEIR TIME TO ENSURE THE CLINIC WAS ABLE TO OFFER THE VACCINE TO ANYONE WHO WANTED IT. IN TOTAL, THEY WORKED MORE THAN 900 HOURS IN THE CLINIC, REGISTERING PEOPLE, SCHEDULING SECOND APPOINTMENTS, DIRECTING, AND ANSWERING QUESTIONS, ADMINISTERING THE VACCINE AND MORE.--BLESSINGS IN A BACKPACK - ONE EVENING EACH MONTH DURING THE SCHOOL YEAR, PARKVIEW WABASH HOSPITAL, INC., MANAGERS VOLUNTEER AN EVENING PACKING ABOUT 600 BAGS OF FOOD FOR AREA CHILDREN IN NEED, GRADES KINDERGARTEN THROUGH SIXTH. THE FOOD BAGS ARE INTENDED TO HELP THE FAMILIES GET THROUGH THE WEEKEND.--BRIANNA'S HOPE - THE SECOND THURSDAY OF EVERY MONTH, A TEAM OF PARKVIEW WABASH HOSPITAL, INC., MANAGERS AND STAFF SUPPLY A MEAL FOR AN ADDICTION RECOVERY SUPPORT GROUP. THEY SERVE APPROXIMATELY 25 PEOPLE.EVERY MEMBER OF THE PARKVIEW WABASH HOSPITAL, INC., HEALTHCARE TEAM, REGARDLESS OF THEIR DEPARTMENT, IS RESPONSIBLE FOR NURTURING AN ENVIRONMENT OF EXCELLENCE AS THE PLACE PATIENTS WANT TO RECEIVE CARE, PHYSICIANS WANT TO PRACTICE, AND CO-WORKERS WANT TO WORK. WE UNDERSTAND THAT BY PROVIDING EXCELLENCE IN ALL WE DO, WE NOT ONLY ENSURE THE SUCCESS OF PARKVIEW WABASH HOSPITAL, INC., BUT ALSO FOR THE COMMUNITY WE SERVE. PART VI, LINE 6: IF THE ORGANIZATION IS PART OF AN AFFILIATED HEALTH CARE SYSTEM, DESCRIBE THE RESPECTVE ROLES OF THE ORGANIZATION AND ITS AFFILIATES IN PROMOTING THE HEALTH OF THE COMMUNITIES SERVED.PARKVIEW HEALTH SYSTEM, INC. (PARKVIEW), A HEALTHCARE SYSTEM SERVING NORTHEAST INDIANA AND NORTHWEST OHIO THROUGH OUR HOSPITALS AND PHYSICIAN CLINICS, INCLUDES THE NOT-FOR-PROFIT HOSPITALS OF PARKVIEW HOSPITAL, INC.; COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC.; COMMUNITY HOSPITAL OF NOBLE COUNTY, INC.; DEKALB MEMORIAL HOSPITAL, INC.; HUNTINGTON MEMORIAL HOSPITAL, INC.; PARKVIEW WABASH HOSPITAL, INC.; WHITLEY MEMORIAL HOSPITAL, INC.; PARK CENTER, INC.; AS WELL AS 60 PERCENT OWNERSHIP IN THE JOINT VENTURE OF ORTHOPEDIC HOSPITAL AT PARKVIEW NORTH, LLC. EACH HOSPITAL ENTITY ENGAGES IN COMMUNITY OUTREACH ACTIVITIES AND SUPPORTS THEIR RESPECTIVE COUNTY THROUGH INVESTMENTS OF COMMUNITY HEALTH IMPROVEMENT FUNDING AND PROGRAMMING CUSTOMIZED TO MEET THE UNIQUE HEALTH NEEDS OF THEIR RESPECTIVE COMMUNITIES. AFFILIATE HOSPITALS ALSO WORK TOGETHER AND SHARE PROGRAMMING AND MESSAGING WHERE COMMON COMMUNITY HEALTH ISSUES ARE IDENTIFIED. FROM THE LIST OF HEALTH ISSUES IDENTIFIED IN NORTHEAST INDIANA AS PART OF THE 2019 COMMUNITY HEALTH NEEDS ASSESSMENT, THE HEALTH PRIORITY OF SUBSTANCE USE DISORDER/MENTAL HEALTH PROMOTION WAS SELECTED BY ALL AFFILIATE HOSPITALS.AFFILIATE HOSPITALS EACH HAVE A LOCAL BOARD OF DIRECTORS. PARKVIEW HEALTH SYSTEM, INC. ALSO ENGAGES A BOARD OF DIRECTORS, WHICH CONSISTS OF REPRESENTATION FROM EACH OF THE AFFILIATE HOSPITAL BOARDS AND UP TO 15 AT-LARGE PHYSICIANS OR COMMUNITY LEADERS. MOST OF THE BOARD OF DIRECTORS SHALL, AT ALL TIMES, BE CONSIDERED TO BE INDEPENDENT AS DEFINED BY THE INTERNAL REVENUE SERVICE. PARKVIEW CONTRIBUTES TO THE OVERALL SUCCESS OF THE REGION THROUGH SIGNIFICANT INVOLVEMENT IN THE COMMUNITIES WE SERVE. BY DEVELOPING VARIOUS PARTNERSHIPS AND ALIGNMENTS WITH DIFFERENT SECTORS AND ORGANIZATIONS, PARKVIEW HELPS TO PROMOTE THE ECONOMY, QUALITY OF LIFE AND HEALTH/WELL-BEING ACROSS THE REGION. WITH A CONSISTENT FOCUS ON OUR MISSION AND VISION, WE WORK TO PROVIDE THE BEST CARE TO EVERY PERSON, EVERY DAY IN OUR FACILITIES WHILE SERVING AS GOOD STEWARDS OF SURPLUS FUNDS IN AN EFFORT TO POSITIVELY IMPACT COMMUNITY HEALTH STATUS. PART VI, LINE 7, REPORTS FILED WITH STATES IN PART VI, LINE 7 CONT'D: A COPY OF FORM 990, SCHEDULE H IS FILED WITH THE INDIANA STATE DEPARTMENT OF HEALTH. PART V, SECTION B, LINE 19: DISCLOSURE STATEMENT FOR CORRECTION SECTION 501(R) OMISSIONS, ERRORS AND OTHER FAILURES PURSUANT TO INTERNAL REVENUE SERVICE REVENUE PROCEDURE 2015-21. IN JANUARY AND FEBRUARY 2021, THE ORGANIZATION'S INTERNAL AUDIT DEPARTMENT PERFORMED A COMPREHENSIVE REVIEW OF ALL APPLICABLE POLICIES AND PRACTICES UNDER SECTION 501(R) OF THE INTERNAL REVENUE CODE AND THE TREASURY REGULATIONS ISSUED THEREUNDER. THE AUDIT PERIOD WAS AUGUST 1, 2020, THROUGH DECEMBER 31, 2020. AS A RESULT OF THE AUDIT, MINOR POLICY CHANGES WERE MADE, AND MINOR PROCEDURAL CHANGES RELATED TO SECTION 501(R) COMPLIANCE WERE IMPLEMENTED.ALSO, IT WAS DETERMINED THAT 34 PATIENT ACCOUNTS WERE PRESUMPTIVELY DETERMINED TO BE ELIGIBLE FOR LESS-THAN-100% FINANCIAL ASSISTANCE, WERE NOT NOTIFIED REGARDING THE WAY TO APPLY FOR MORE GENEROUS ASSISTANCE UNDER THE FAP AND WERE INADVERTENTLY SUBJECT TO ADVERSE CREDIT REPORTING. THE ADVERSE CREDIT REPORTING, HOWEVER, WAS IMMEDIATELY REMOVED IN MAY 2021. IN ADDITION TO THE FINANCIAL ASSISTANCE NOTIFICATION ON ALL PATIENT STATEMENTS, THE HOSPITAL FACILITY INSTITUTED PROCEDURES TO PROVIDE WRITTEN NOTICE TO PATIENTS WHO RECEIVE PARTIAL PRESUMPTIVE FINANCIAL ASSISTANCE THAT INFORMS THE INDIVIDUAL REGARDING THE BASIS FOR THE PRESUMPTIVE FAP ELIGIBILITY DETERMINATION AND THE WAY TO APPLY FOR MORE GENEROUS ASSISTANCE DURING THE APPLICATION PERIOD. 1 WABASH COUNTY BUSINESS ALLIANCE FOUNDATION INC 214 S WABASH ST WABASH IN 469923132 351538747 501(C)(3) 50000 0 PROMOTE ECONOMIC DEVELOPMENT & INDUSTRIAL GROWTH IN WABASH COUNTY OTIS R BOWEN CENTER FOR HUMAN SERVICES INC 2621 EAST JEFFERSON ST WARSAW IN 46581 351057889 501(C)(3) 7500 0 WABASH COUNTY TOBACCO FREE COALITION PROGRAMS COMMUNITY FOUNDATION OF WABASH COUNTY INC 105 W 2ND ST 100 NORTH MANCHESTER IN 469621536 356019016 501(C)(3) 6000 0 PROGRAMS TO SERVICE THE CITIZENS OF WABASH COUNTY 3 0 PART I, LINE 2: COMMUNITY HEALTH IMPROVEMENT FUNDING PARTNER ORGANIZATIONS ARE REQUIRED TO SUBMIT AN ANNUAL PROGRESS REPORT RELATED TO PROGRAM FUNDING. PARTNER ORGANIZATIONS ARE REQUIRED TO RE-APPLY FOR FUNDING ON AN ANNUAL BASIS. X 1 1 0 1 0 0 0 0 0 1 0 MICHAEL PACKNETT PH PRESIDENT & CEO 0 1220966 0 259085 0 557555 0 292805 0 33268 0 2363679 0 507042 JEANNE' WICKENS PH CHIEF FINANCIAL OFFICER 0 770820 0 142288 0 146528 0 320169 0 29811 0 1409616 0 124406 DOUGLAS SPARKS DIRECTOR/PH PHYSICIAN 25989 435740 0 18134 0 27356 1634 30266 1819 33680 29442 545176 0 0 MARILYN CUSTER-MITCHELL DIRECTOR/WBHOS PRESIDENT 219012 0 37227 0 46854 0 66009 0 32787 0 401889 0 21975 0 CATHY WOLFE WBHOS VP PATIENT CARE 154380 0 20235 0 3412 0 12645 0 25845 0 216517 0 0 0 JAMI METZGER WBHOS NURSE PRACTITIONER 106132 43878 7650 0 878 293 10676 4113 22843 8800 148179 57084 0 0 SHERRY SCHOENING WBHOS MGR REHAB 124871 0 8833 0 1703 0 15564 0 31950 0 182921 0 0 0 PAULA OPHEIM WBHOS MGR PHARMACY 147117 0 7886 0 265 0 7836 0 15304 0 178408 0 0 0 LISA KROH WBHOS PHARMACIST 147948 0 3250 0 774 0 16632 0 1068 0 169672 0 0 0 PART I, LINE 1A DISCRETIONARY SPENDING ACCOUNT - TAXABLE DISCRETIONARY SPENDING ACCOUNT PAID TO: JAMI METZGER $675; GRACE STANLEY $1,000 PART I, LINE 3 RELATED ORGANIZATION, PARKVIEW HEALTH SYSTEM, INC., USES THE FOLLOWING TO ESTABLISH THE COMPENSATION OF PARKVIEW WASBASH HOSPITAL, INC.'S CEO/EXECUTIVE DIRECTOR: COMPENSATION COMMITTEE OF RELATED ORGANIZATION PARKVIEW HEALTH SYSTEM, INC. INDEPENDENT COMPENSATION CONSULTANT FORM 990 OF OTHER ORGANIZATIONS COMPENSATION SURVEY OR STUDY APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE OF RELATED ORGANIZATION PARKVIEW HEALTH SYSTEM, INC. PART I, LINE 4B SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN PAYMENTS THE FOLLOWING INDIVIDUALS PARTICIPATE IN SUPPLEMENTAL NONQUALIFIED DEFERRED COMPENSATION PLANS. BENEFITS EARNED UNDER THE PLANS WILL FUND THE EMPLOYEES' EVENTUAL RETIREMENT BENEFIT. THESE BENEFITS ARE PROVIDED IN EXCHANGE FOR THE EMPLOYEES' YEARS OF SERVICE TO THE ORGANIZATION AND THE AMOUNT OF THE BENEFITS MAY VARY FROM YEAR TO YEAR. THE FOLLOWING INDIVIDUALS VESTED IN A PORTION OF THEIR DEFERRED COMPENSATION PLANS, WHICH IS TREATED AS TAXABLE INCOME TO THE INDIVIDUALS AT THE TIME OF VESTING. THESE AMOUNTS ARE REPORTED IN SCHEDULE J, PART II, COLUMN (B)(III): MARILYN CUSTER-MITCHELL $21,975; MICHAEL PACKNETT $507,042; JEANNE' WICKENS $124,406 AMOUNTS LISTED ABOVE THAT HAVE BEEN REPORTED AS DEFERRED COMPENSATION ON PRIOR FORM 990 WILL ALSO BE REFLECTED IN SCHEDULE J, PART II, COLUMN (F). FOR EXAMPLE, THE AMOUNT OF $507,042 REPORTED AS REQUIRED FOR MR. PACKNETT WAS A RESULT OF THE VESTING OF SUCH AMOUNT UNDER THE TERMS OF THE RESPECTIVE PLANS. HOWEVER, THESE AMOUNTS WERE PREVIOUSLY REPORTED IN MR. PACKNETT'S DEFERRED COMPENSATION OVER MORE THAN 10 YEARS AS THE AMOUNTS WERE DEFERRED UNDER THE PLANS. AS SUCH, THE AMOUNT REPORTED IN SCHEDULE J, PART II, COLUMN (F) IS AN INDICATION OF AMOUNTS THAT HAVE BEEN REPORTED TWICE, ONCE AS A DEFERRAL AND ONCE AS VESTED. THE FOLLOWING INDIVIDUALS HAVE AN AMOUNT INCLUDED IN SCHEDULE J, PART II, COLUMN (C) FOR AN AMOUNT EARNED BUT NOT YET VESTED UNDER ONE OF PARKVIEW'S DEFERRED COMPENSATION PLANS. THE AMOUNTS ARE AT RISK AND WILL NOT BE PAID UNLESS AND UNTIL EACH EMPLOYEE HAS PROVIDED SUBSTANTIAL FUTURE SERVICES TO THE ORGANIZATION. BENEFITS UNDER THE PLANS VEST AT THE TIME SET FORTH IN THE PLAN DOCUMENTS AND ARE FORFEITED IF THE EMPLOYEES TERMINATE EMPLOYMENT BEFORE SATISFYING THOSE PLAN CONDITIONS. DEFERRALS REPORTED IN SCHEDULE J, PART II, COLUMN (C) INCLUDE: MARILYN CUSTER-MITCHELL $40,773; MICHAEL PACKNETT $260,905; JEANNE' WICKENS $299,869 PART I, LINE 7 MANAGEMENT INCENTIVE COMPENSATION PLAN (MICP) AND PHYSICIAN AND PROVIDER INCENTIVE COMPENSATION PLAN (PICP) ARE ANNUAL INCENTIVE PROGRAMS. SYSTEM GOALS ARE APPROVED BY THE BOARD. AT CONCLUSION OF THE PLAN YEAR, RESULTS ARE SHARED WITH THE BOARD AND THE EXECUTIVE COMMITTEE OF THE BOARD APPROVES FINAL PAYMENT. A INDIANA FINANCE AUTHORITY 351602316 NONEAVAIL 2016-08-17 25000000 SEE PART VI 0 0 0 A 2965000 25247064 25247064 2018 0 0 1 1 A 0 1 0 0 0.00000 0.00000 0.00000 0 0 1 A 0 0 0 1 0 0 0 0 1 A 1 SCHEDULE K, PART I, COLUMN F, LINE A: CONSTRUCTION OF NEW HOSPITAL FACILITY FOR PARKVIEW WABASH HOSPITAL, INC. IN WABASH, INDIANA SCHEDULE K, PART II, COLUMN A, LINE 3: THIS AMOUNT INCLUDES INTEREST OF $247,064. EARNED ON PROJECT FUND. SCHEDULE K, PART III, COLUMN A, LINE 7: BECAUSE PARKVIEW MONITORS THE PRIVATE BUSINESS USE PERCENTAGE FOR EACH BOND ISSUE, TO ENSURE THAT THE PRIVATE BUSINESS USE LIMIT IS NOT EXCEEDED, PARKVIEW DOES NOT CALCULATE THE AMOUNT OF PRIVATE PAYMENTS. SCHEDULE K, PART IV, COLUMN A, LINE 2C: REBATE CALCULATION PERFORMED ON JANUARY 23, 2019. FORM 990, PART V, LINES 1A AND 2A: PARKVIEW HEALTH SYSTEM, INC. (PH), EIN 35-1972384, IS THE COMMON PAYING AGENT FOR THE FILING ORGANIZATION, PARKVIEW WABASH HOSPITAL, INC., EIN 47-1753440. THEREFORE, ALL APPLICABLE IRS TAX FILINGS, INCLUDING FORMS 1099, 1096, W-2 AND W-3 ARE REPORTED AND FILED BY PH. THE TOTAL NUMBER REPORTED IN BOX 3 OF FORM 1096 AND FILED BY THE COMMON PAYING AGENT, PH, FOR THE YEAR ENDED DECEMBER 31, 2021 WAS 593. THE TOTAL NUMBER OF EMPLOYEES REPORTED ON FORM W-3 AND FILED BY THE COMMON PAYING AGENT, PH, FOR THE YEAR ENDED DECEMBER 31, 2021 WAS 16,240. FOR PURPOSES OF COMPLETING FORM 990, PART V, LINE 1A AND 2A, THE NUMBER REPORTED FOR THE PARKVIEW WABASH HOSPITAL, INC. WAS 33 AND 245 RESPECTIVELY. FORM 990, PART VI, SECTION A, LINE 1A THE EXECUTIVE COMMITTEE SHALL BE COMPOSED OF THE OFFICERS OF THE BOARD, THE PRESIDENT OF THE CORPORATION, THE PRESIDENT/CHIEF EXECUTIVE OFFICER OF THE CORPORATE MEMBER OR HIS/HER DESIGNEE, THE CURRENT PRESIDENT OF THE MEDICAL STAFF AND SUCH OTHER PERSONS AS IDENTIFIED BY THE CHAIR OF THE BOARD, EACH OF WHOM SHALL BE ENTITLED TO VOTE. IN NO EVENT SHALL THE MEMBERS OF THE EXECUTIVE COMMITTEE EXCEED EIGHT (8) PEOPLE. THE EXECUTIVE COMMITTEE MAY ACT ON BEHALF OF THE CORPORATION IN ANY MATTER WHEN THE BOARD IS NOT IN SESSION, REPORTING TO THE BOARD FOR ITS RATIFICATION OF ITS ACTION. THE CHAIR OF THE BOARD SHALL SERVE AS CHAIR OF THE EXECUTIVE COMMITTEE. MEETINGS OF THE EXECUTIVE COMMITTEE MAY BE CALLED BY THE CHAIR OR BY THREE (3) MEMBERS. FORM 990, PART VI, SECTION A, LINE 2 DIRECTOR/OFFICER HOWARD HALDERMAN AND DIRECTOR PARKER BEAUCHAMP HAVE A BUSINESS RELATIONSHIP AS DIRECTORS ON THE BOARD OF AN UNRELATED ENTITY. DIRECTOR/OFFICER MICHAEL PACKNETT AND OFFICER JEANNE' WICKENS HAVE BUSINESS RELATIONSHIPS AS OFFICERS OF RELATED ENTITIES. FORM 990, PART VI, SECTION A, LINE 6 THE ORGANIZATION IS ORGANIZED AS A NOT-FOR-PROFIT CORPORATION. PURSUANT TO THE ORGANIZATION'S GOVERNING DOCUMENTS, PARKVIEW HEALTH SYSTEM, INC. EIN 35-1972384 IS THE SOLE MEMBER OF PARKVIEW WABASH HOSPITAL, INC. WITH CERTAIN RESERVED POWERS. FORM 990, PART VI, SECTION A, LINE 7A THE CORPORATE MEMBER, PARKVIEW HEALTH SYSTEM, INC. EIN 35-1972384, SHALL HAVE THE FOLLOWING RESERVED POWERS: (I) APPOINT AND REMOVE, WITH OR WITHOUT CAUSE, MEMBERS OF THE BOARD SUBJECT TO THE COMPOSITION REQUIREMENTS REGARDING COMMUNITY AND PHYSICIAN REPRESENTATION SET FORTH IN ARTICLE V, SECTION 2; (II) APPOINT AND REMOVE, WITH OR WITHOUT CAUSE, THE CHAIR AND VICE CHAIR OF THE BOARD AND THE PRESIDENT OF THE CORPORATION; (III) APPROVE AND/OR REQUIRE THE ADOPTION OF AMENDMENTS TO THE ARTICLES OF INCORPORATION OR BYLAWS OF THE CORPORATION OR ANY SUBSIDIARY OR AFFILIATE OF THE CORPORATION; (IV) APPROVE AND/OR REQUIRE THE ESTABLISHMENT, ACQUISITION, DIVESTITURE, DISSOLUTION, CLOSURE, MERGER, CONSOLIDATION, CHANGE IN CORPORATE MEMBERSHIP, AFFILIATION OR CORPORATE REORGANIZATION OF THE CORPORATION OR ANY SUBSIDIARY OR AFFILIATE OF THE CORPORATION; (V) APPROVE AND ADOPT THE STRATEGIC PLAN AND ANY AMENDMENTS THERETO FOR THE CORPORATION AND ANY SUBSIDIARY OR AFFILIATE OF THE CORPORATION; (VI) APPROVE AND/OR REQUIRE THE INCURRENCE OF ANY DEBT, INCLUDING THE ISSUANCE OF ANY BONDS, PROPOSED BY THE CORPORATION OR ANY SUBSIDIARY OR AFFILIATE OF THE CORPORATION IN EXCESS OF LIMITS SPECIFIED IN THE POLICY OF THE CORPORATE MEMBER; (VII) APPROVE AND/OR REQUIRE THE APPROVAL OF CONTRACTS OR LOANS OBLIGATING THE CORPORATION TO EXPEND OR REPAY AN AMOUNT IN EXCESS OF LIMITS SPECIFIED IN THE POLICY OF THE CORPORATE MEMBER; (VIII) APPROVE AND/OR REQUIRE THE SALE, LEASE, EXCHANGE, MORTGAGE, PLEDGE, TRANSFER, ENCUMBRANCE OR OTHER DISPOSITION OF PROPERTY AND ASSETS OF THE CORPORATION IN EXCESS OF LIMITS SPECIFIED IN THE POLICY OF THE CORPORATE MEMBER; (IX) APPROVE AND ADOPT THE CAPITAL BUDGET, OPERATING BUDGET, FINANCIAL PLANS AND ANY AMENDMENTS THERETO FOR THE CORPORATION AND ANY SUBSIDIARY OR AFFILIATE OF THE CORPORATION; (X) APPROVE AND/OR REQUIRE THE ADOPTION OF A MANAGED CARE POLICY FOR THE CORPORATION AND ANY SUBSIDIARY OR AFFILIATE OF THE CORPORATION, INCLUDING NETWORK PARTICIPATION, PARTICIPATION IN ANY MANAGED CARE AGREEMENT AND PARTICIPATION IN ANY OTHER HEALTH CARE SERVICE ARRANGEMENTS; (XI) APPOINT AND REMOVE AUDITORS, ATTORNEYS AND OTHER PROFESSIONAL ADVISORS FOR THE CORPORATION AND ANY SUBSIDIARY OR AFFILIATE OF THE CORPORATION; (XII) DEVELOP, APPROVE AND/OR REQUIRE THE ADOPTION OF MEDICAL STAFF QUALITY ASSURANCE STANDARDS, UTILIZATION REVIEW STANDARDS, CRITERIA, POLICIES AND PROCEDURES FOR THE CORPORATION AND ANY SUBSIDIARY OR AFFILIATE OF THE CORPORATION; (XIII) APPROVE AND/OR REQUIRE THE ADOPTION OF ANY ACTION TO CHANGE THE CORPORATION FROM A GENERAL, ACUTE CARE COMMUNITY HOSPITAL OR TO CLOSE THE CORPORATION'S CURRENT LOCATION; (XIV) APPROVE EACH ANNUAL LIST OF PROPOSED DONORS AND AMOUNTS OF DONATIONS OR GRANTS NOT INCLUDED IN THE ANNUAL BUDGET, AND MAKE PROPOSALS TO DEVIATE THEREFROM THROUGHOUT EACH YEAR IN EXCESS OF LIMITS SPECIFIED IN THE POLICY OF THE CORPORATE MEMBER; AND (XV) APPROVE AND/OR REQUIRE THE ADOPTION OF ANY ACTION THAT IS INCONSISTENT WITH THE POLICY OF THE CORPORATE MEMBER. FORM 990, PART VI, SECTION A, LINE 7B SEE SCHEDULE O EXPLANATION FOR FORM 990, PART VI, SECTION A, LINE 7A FORM 990, PART VI, SECTION B, LINE 11B PURSUANT TO PARKVIEW HEALTH SYSTEM INC.'S BYLAWS, THE SYSTEM AUDIT COMMITTEE MAY ACT ON BEHALF OF THE CORPORATION TO PROVIDE REVIEW OF THE CORPORATION AND ITS SUBSIDIARY CORPORATIONS' FORM 990 FILINGS. PARKVIEW WABASH HOSPITAL, INC. IS A SUBSIDIARY CORPORATION OF PARKVIEW HEALTH SYSTEM, INC. AN ELECTRONIC COPY OF THE ORGANIZATION'S FINAL FORM 990 (INCLUDING SUPPLEMENTAL SCHEDULES) WAS PROVIDED TO EACH VOTING MEMBER OF THE ORGANIZATION'S GOVERNING BODY AND THE SYSTEM AUDIT COMMITTEE, PRIOR TO FILING WITH THE IRS. ON OCTOBER 26, 2022, THE SYSTEM AUDIT COMMITTEE REVIEWED THE FORM 990 AS ULTIMATELY FILED WITH THE IRS. THIS REVIEW INCLUDED A PRESENTATION BY THE ORGANIZATION'S TAX PREPARER TO HIGHLIGHT THE SIGNIFICANT AREAS ON THE FORM 990 AND SUPPLEMENTAL SCHEDULES. FORM 990, PART VI, SECTION B, LINE 12C AS DESCRIBED IN ARTICLE IX SECTION 6, OF THE PARKVIEW HEALTH SYSTEM, INC. (PH) BYLAWS, PH ADOPTED PH'S COMPLIANCE POLICY FOR THE ORGANIZATION AND ITS NOT-FOR-PROFIT RELATED ORGANIZATIONS (AND AS LIKEWISE NOTED IN THEIR BYLAWS) WHEN ADDRESSING CONFLICTS OR POTENTIAL CONFLICTS OF INTEREST. THIS COMPLIANCE POLICY (COMPLIANCE POLICY #14) REQUIRES THAT EACH BOARD MEMBER, BOARD COMMITTEE MEMBER, AND KEY MANAGEMENT PERSONNEL MUST ANNUALLY COMPLETE A CONFLICT OF INTEREST FORM. THIS INFORMATION IS PROVIDED TO THE CHAIRMAN OF THE BOARD (FOR BOARD AND BOARD COMMITTEE MEMBERS) AND TO SENIOR MANAGEMENT (FOR KEY MANAGEMENT PERSONNEL). IN ADDITION, AS TO THE CONDUCT OF BOARD MEETINGS, THE FOLLOWING PROCESS IS FOLLOWED: "WHENEVER A PH OR PH AFFILIATE BOARD OR BOARD COMMITTEE IS CONSIDERING A TRANSACTION OR ARRANGEMENT WITH AN ORGANIZATION, ENTITY OR INDIVIDUAL IN WHICH A PERSON COVERED BY THIS POLICY HAS A FINANCIAL OR CONFLICTING INTEREST, THE FOLLOWING SHALL OCCUR: 1. THE INTERESTED PERSON MUST DISCLOSE THE FINANCIAL OR CONFLICTING INTEREST AND ALL MATERIAL FACTS TO THE PH OR PH AFFILIATE BOARD OR BOARD COMMITTEE; 2. THE INTERESTED PERSON WITH THAT FINANCIAL OR CONFLICTING INTEREST MAY MAKE A PRESENTATION AT THE BOARD OR BOARD COMMITTEE MEETING REGARDING THE TRANSACTION OR ARRANGEMENT HOWEVER, HE/SHE SHALL LEAVE THE MEETING DURING THE DISCUSSION OF, AND THE VOTE ON, THE TRANSACTION OR ARRANGEMENT THAT RESULTS IN THE FINANCIAL OR CONFLICTING INTEREST; AND 3. THE PH OR PH AFFILIATE BOARD OR BOARD COMMITTEE MUST APPROVE THE TRANSACTION OR ARRANGEMENT BY A MAJORITY VOTE OF THE BOARD MEMBERS PRESENT AT A MEETING THAT HAS A QUORUM, NOT INCLUDING THE VOTE OF THE INTERESTED PERSON. THE INTERESTED PERSON MAY NOT VOTE ON THE MATTER. A. UPON THE REQUEST OF PH OR PH AFFILIATE BOARD OR BOARD COMMITTEE, THE MATTER MAY BE DELEGATED TO THE PH COMPLIANCE COMMITTEE FOR EVALUATION, RECOMMENDATION AND/OR DETERMINATION. 4. WHENEVER A FINANCIAL OR CONFLICTING INTEREST IS ADDRESSED BY A PH OR PH AFFILIATE BOARD, NOTICE SHALL BE GIVEN TO THE PH COMPLIANCE OFFICER / GENERAL COUNSEL." FORM 990, PART VI, SECTION B, LINE 15 LINES 15A AND 15B ARE ANSWERED NO IN ACCORDANCE WITH THE IRS INSTRUCTIONS. TO THE EXTENT THAT THE ORGANIZATION HAS VICE PRESIDENT OR ABOVE, THE COMPENSATION COMMITTEE OF RELATED ORGANIZATION, PARKVIEW HEALTH SYSTEM, INC., DETERMINES THE COMPENSATION OF THE CEO, OFFICERS, AND KEY EMPLOYEES. FORM 990, PART VI, SECTION C, LINE 19 COPIES OF THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. FORM 990, PART IX, LINE 11G OTHER: PROGRAM SERVICE EXPENSES 1,134,437. MANAGEMENT AND GENERAL EXPENSES 67,031. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,201,468. RHC OPERATIONS: PROGRAM SERVICE EXPENSES 6,413,952. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 6,413,952. MEDICAL PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 2,557,913. MANAGEMENT AND GENERAL EXPENSES 404,000. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,961,913. LABORATORY SERVICES: PROGRAM SERVICE EXPENSES 2,123,143. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,123,143. COLLECTIONS: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 259,956. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 259,956. FORM 990, PART IX, LINES 5-10: PARKVIEW HEALTH SYSTEM, INC., EIN 35-1972384, SERVES AS THE COMMON PAYING AGENT FOR ALL TAX-EXEMPT ORGANIZATIONS OF THE SYSTEM. SALARIES AND WAGES OF EMPLOYEES WORKING FOR THESE ORGANIZATIONS ARE CHARGED DIRECTLY TO THE ORGANIZATIONS IN WHICH THEY WORK. THE ACTUAL EXPENSES FOR PAYROLL TAXES, EMPLOYEE BENEFITS, AND PENSION PLAN CONTRIBUTIONS ARE REFLECTED ON THE BOOKS OF PARKVIEW HEALTH SYSTEM, INC. FOR FINANCIAL REPORTING PURPOSES. TO ACCOUNT FOR BENEFIT COSTS ON THE BOOKS OF THE OTHER TAX EXEMPT ORGANIZATIONS, AN ALLOCATION METHODOLOGY IS UTILIZED TO CHARGE THESE ORGANIZATIONS WITH AN ESTIMATE OF THE OVERALL COSTS, REFERRED TO AS A "BENEFIT ALLOCATION" FROM PARKVIEW HEALTH SYSTEM, INC. THE ALLOCATION DOES NOT DISTINGUISH BETWEEN THE COSTS OF THE VARIOUS COMPONENTS (I.E. PAYROLL TAXES, EMPLOYEE BENEFITS, AND PENSION PLAN CONTRIBUTIONS). THEREFORE, FOR PURPOSES OF THE FORM 990, PART IX, THE TOTAL BENEFIT ALLOCATION FOR THE EMPLOYEES' SALARIES AND WAGES REPORTED ON LINE 7 IS REFLECTED ON LINE 9 AND NOT ALLOCATED BETWEEN LINES 8 OR 10. FOR PURPOSES OF THE FORM 990, PART IX, LINES 5 AND 6 REFLECT COMPENSATION AND BENEFIT AMOUNTS REPORTED IN PART VII. FORM 990, PART XI, LINE 9: ASSET TRANSFERS/ADJUSTMENTS -1,814. PARKVIEW HEALTH SYSTEM INC 1450 PRODUCTION RD FORT WAYNE IN 468081167 351972384 HEALTH CARE IN 501(C)(3) LINE 12C, III-FI N/A 0 PARKVIEW WABASH HOSPITAL FOUNDATION INC 10 JOHN KISSINGER DR WABASH IN 469921648 351921445 FUND MGMT IN 501(C)(3) LINE 12A, I PARKVIEW WABASH HOSPITAL INC 1 PARKVIEW HOSPITAL INC 11109 PARKVIEW PLAZA DR FORT WAYNE IN 468451701 350868085 HOSPITAL CARE IN 501(C)(3) LINE 3 PARKVIEW HEALTH SYSTEM INC 0 PARKVIEW FOUNDATION INC 3844 NEW VISION DR FORT WAYNE IN 468451724 237220589 FUND MGMT IN 501(C)(3) LINE 12A, I PARKVIEW HOSPITAL INC 0 DEKALB MEMORIAL HOSPITAL INC 1316 E 7TH ST AUBURN IN 467062515 351064295 HOSPITAL CARE IN 501(C)(3) LINE 3 PARKVIEW HEALTH SYSTEM INC 0 PARKVIEW DEKALB HOSPITAL FOUNDATION INC 1316 E 7TH ST AUBURN IN 467062515 351064295 FUND MGMT IN 501(C)(3) LINE 12A, I DEKALB MEMORIAL HOSPITAL INC 0 HUNTINGTON MEMORIAL HOSPITAL INC 2001 STULTS RD HUNTINGTON IN 467501291 351970706 HOSPITAL CARE IN 501(C)(3) LINE 3 PARKVIEW HEALTH SYSTEM INC 0 PARKVIEW HUNTINGTON HOSPITAL FOUNDATION INC 2001 STULTS RD HUNTINGTON IN 467501291 320012095 FUND MGMT IN 501(C)(3) LINE 12A, I HUNTINGTON MEMORIAL HOSPITAL INC 0 COMMUNITY HOSPITAL OF LAGRANGE COUNTY INC 207 N TOWNLINE RD LAGRANGE IN 467611325 202401676 HOSPITAL CARE IN 501(C)(3) LINE 3 PARKVIEW HEALTH SYSTEM INC 0 PARKVIEW LAGRANGE HOSPITAL FOUNDATION INC 207 N TOWNLINE RD LAGRANGE IN 467611325 833347115 FUND MGMT IN 501(C)(3) LINE 12A, I COMMUNITY HOSPITAL OF LAGRANGE COUNTY INC 0 COMMUNITY HOSPITAL OF NOBLE COUNTY INC 401 N SAWYER RD KENDALLVILLE IN 467552568 352087092 HOSPITAL CARE IN 501(C)(3) LINE 3 PARKVIEW HEALTH SYSTEM INC 0 COMMUNITY HOSPITAL OF NOBLE COUNTY FOUNDATION INC 401 N SAWYER RD KENDALLVILLE IN 467552568 352089183 FUND MGMT IN 501(C)(3) LINE 12A, I COMMUNITY HOSPITAL OF NOBLE COUNTY INC 0 WHITLEY MEMORIAL HOSPITAL INC 1260 E STATE ROAD 205 COLUMBIA CITY IN 467259492 351967665 HOSPITAL CARE IN 501(C)(3) LINE 3 PARKVIEW HEALTH SYSTEM INC 0 WHITLEY MEMORIAL HOSPITAL FOUNDATION INC 1260 E STATE ROAD 205 COLUMBIA CITY IN 467259492 311190239 FUND MGMT IN 501(C)(3) LINE 12A, I WHITLEY MEMORIAL HOSPITAL INC 0 MIDWEST COMMUNITY HEALTH ASSOCIATES INC 442 W HIGH ST BRYAN OH 435061681 341045870 PHYSICIANS OH 501(C)(3) LINE 3 PARKVIEW HEALTH SYSTEM INC 0 PARKVIEW OCCUPATIONAL HEALTH CENTERS INC 1450 PRODUCTION RD FORT WAYNE IN 468081167 352064353 OCCUPATIONAL HEALTH IN 501(C)(3) LINE 3 PARKVIEW HEALTH SYSTEM INC 0 PARK CENTER INC 909 E STATE BLVD FORT WAYNE IN 468053404 351135451 COMPREHENSIVE MENTAL HEALTH CENTER IN 501(C)(3) LINE 10 PARKVIEW HEALTH SYSTEM INC 0 PARK CENTER HOLDINGS INC 909 E STATE BLVD FORT WAYNE IN 468053404 843684074 TO SUPPORT PARK CENTER INC IN 501(C)(3) LINE 12D, III-O PARKVIEW HEALTH SYSTEM INC 0 OUABACHE VILLAGE INC 909 E STATE BLVD FORT WAYNE IN 468053404 020731922 PROVIDE HOUSING TO HANDICAPPED INDIVIDUALS IN 501(C)(3) LINE 10 PARK CENTER INC 0 RICHARDVILLE APARTMENTS INC 909 E STATE BLVD FORT WAYNE IN 468053404 050543940 PROVIDE HOUSING TO HANDICAPPED INDIVIDUALS IN 501(C)(3) LINE 10 PARK CENTER INC 0 RICHARDVILLE APARTMENTS II INC 909 E STATE BLVD FORT WAYNE IN 468053404 861077255 PROVIDE HOUSING TO HANDICAPPED INDIVIDUALS IN 501(C)(3) LINE 10 PARK CENTER INC 0 SEDDLEMEYER APARTMENTS INC 909 E STATE BLVD FORT WAYNE IN 468053404 352067590 PROVIDE HOUSING TO HANDICAPPED INDIVIDUALS IN 501(C)(3) LINE 10 PARK CENTER INC 0 WAYNEDALE APARTMENTS INC 909 E STATE BLVD FORT WAYNE IN 468053404 351972197 PROVIDE HOUSING TO HANDICAPPED INDIVIDUALS IN 501(C)(3) LINE 10 PARK CENTER INC 0 WAYNEDALE II APARTMENTS INC 909 E STATE BLVD FORT WAYNE IN 468053404 223972135 PROVIDE HOUSING TO HANDICAPPED INDIVIDUALS IN 501(C)(3) LINE 10 PARK CENTER INC 0 WOODSIDE APARTMENTS INC 909 E STATE BLVD FORT WAYNE IN 468053404 351937426 PROVIDE HOUSING TO HANDICAPPED INDIVIDUALS IN 501(C)(3) LINE 10 PARK CENTER INC 0 ORTHOPAEDIC HOSPITAL AT PARKVIEW NORTH LLC 1450 PRODUCTION RD FORT WAYNE IN 468081167 260143823 ORTHOPAEDIC HOSPITAL IN N/A N/A 0 0 MANAGED CARE SERVICES LLC 1450 PRODUCTION RD FORT WAYNE IN 468081167 351996535 HEALTH PLAN ADMINISTRATION IN N/A N/A 0 0 PARKVIEW PROFESSIONAL PROGRAMS INC 1450 PRODUCTION RD FORT WAYNE IN 468081167 351668888 REFERENCE LAB IN N/A C 0 WOODLAND PLAZA MEDICAL PARK CONDO ASSOC INC 202 W BERRY ST FORT WAYNE IN 468022273 352058340 PROPERTY OWNERS ASSOCIATION IN N/A C 0 0 1 1 0 0 0 0 0 0 1 1 1 1 1 1 1 1 1 1 PARKVIEW WABASH HOSPITAL FOUNDATION INC C 72387 PART VII SUPPLEMENTAL INFORMATION PARKVIEW WABASH HOSPITAL FOUNDATION INC M 89092 PART VII SUPPLEMENTAL INFORMATION SCHEDULE R, PART V, LINE 2, COLUMN (C): THE AMOUNTS REPORTED AS TRANSACTIONS WITH RELATED ORGANIZATIONS ARE CONSISTENT WITH THE AMOUNTS REPORTED ON THE ORGANIZATION'S AUDITED FINANCIAL STATEMENTS UNDER THE GENERALLY ACCEPTED ACCOUNTING STANDARDS DEPENDING ON THE TYPE OF TRANSACTION INVOLVED.