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 202401676 COMMUNITY HOSPITAL OF LAGRANGE COUNTY INC COMM 2603738429 207 N TOWNLINE RD LAGRANGE IN 467611325 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 PARKVIEW LAGRANGE HOSPITAL MICHAEL J PACKNETT 1450 PRODUCTION RD FORT WAYNE IN 468081167 42615004 0 X WWW.PARKVIEW.COM X 2005 IN IMPROVE HEALTH & PROVIDE QUALITY HEALTH SERVICES TO ALL WHO ENTRUST THEIR CARE TO US. 13 8 202 14 0 0 5951611 1170811 33966116 41164589 79 -6820 139986 263625 40057792 42592205 408134 59971 0 0 13950902 14682536 0 0 3810 23423047 22770303 37782083 37512810 2275709 5079395 26635293 31981138 19817845 20059687 6817448 11921451 X COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC. WORKS TO IMPROVE THE HEALTH OF OUR COMMUNITIES AND PROVIDES QUALITY HEALTH SERVICES TO ALL WHO ENTRUST THEIR CARE TO US. 0 0 30531378 59971 41164589 AS A COMMUNITY-OWNED, NOT FOR PROFIT ORGANIZATION, COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC. IS DEDICATED TO IMPROVING THE HEALTH AND INSPIRING THE WELL-BEING IN THE COMMUNITIES WE SERVE. COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC. GIVES BACK TO THE COMMUNITY IN THE FORM OF IMPROVED FACILITIES, FREE AND DISCOUNTED CARE, EDUCATION AND OUTREACH PROGRAMS, VOLUNTEERISM AND MUCH MORE. USING INFORMATION FROM THE TRIENNIAL COMMUNITY HEALTH NEEDS ASSESSMENT, COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC. ALIGNS ITS OUTREACH PROGRAMS TO PRIORITIZE AND ADDRESS THE COMMUNITY'S NEEDS. (SEE SCHEDULE O FOR CONTINUATION)FOLLOWING ARE SOME OF THE WAYS COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC. IS REACHING OUT TO MAKE OUR NEIGHBORHOODS AND COMMUNITIES HEALTHIER:-FINANCIAL ASSISTANCE-COMMUNITY HEALTH IMPROVEMENT INITIATIVES-PRIMARY HEALTH CARE /ACCESS -MEDICATION ASSISTANCE PROGRAM (MAP)-HEALTH SCREENINGS AND PREVENTION-DISEASE MANAGEMENT-CONTRIBUTIONS TOWARD AND PARTICIPATION IN ECONOMIC DEVELOPMENT ACTIVITIESFINANCIAL ASSISTANCE:COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC.'S MISSION INCLUDES CARING FOR PATIENTS WHO DO NOT HAVE THE MEANS TO MEET THEIR FINANCIAL OBLIGATIONS. THE HOSPITAL PLACES ITS PRIORITY ON PROVIDING THE NECESSARY CARE FOR EACH PATIENT, NOT ON THE PATIENT'S FINANCIAL ABILITY TO PAY FOR THEIR MEDICAL SERVICES.COMMUNITY HEALTH IMPROVEMENT INITIATIVES:THE PURPOSE OF COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC.'S COMMUNITY HEALTH IMPROVEMENT PROGRAM IS TO FUND COMMUNITY HEALTH IMPROVEMENT EFFORTS WITHIN THE SERVICE AREA OF COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC. THE HOSPITAL SETS ASIDE A PORTION OF ITS NET INCOME ANNUALLY TO FUND COMMUNITY HEALTH INITIATIVES AND PARTNERS WITH COMMUNITY ORGANIZATIONS TO ENCOURAGE HEALTHIER LIFESTYLES AMONG THE CITIZENS OF NORTHEAST INDIANA. SOME OF THESE INITIATIVES AND PROGRAMS ARE HIGHLIGHTED BELOW.COMMUNITY HEALTH IMPROVEMENT MANAGER: THE COMMUNITY HEALTH IMPROVEMENT MANAGER IS INSTRUMENTAL IN THE IMPLEMENTATION OF KEY STRATEGIES AS IDENTIFIED BY OUR HOSPITAL'S COMMUNITY HEALTH NEEDS ASSESSMENT - MENTAL HEALTH/SUBSTANCE USE/SUICIDE, OBESITY, AND CHILD HEALTH (CHILD ABUSE & NEGLECT AND CHILDCARE). COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC.'S COMMUNITY HEALTH IMPROVEMENT MANAGER PARTNERS WITH VARIOUS COMMUNITY ORGANIZATIONS AND NON-PROFITS TO BENEFIT THE OVERALL COMMUNITY. THE COMMUNITY HEALTH IMPROVEMENT MANAGER IS INVOLVED WITH MONTHLY COMMUNITY LEADERSHIP MEETINGS. THESE LEADERSHIP MEETINGS BRING COMMUNITY PARTNERS AND STAKEHOLDERS FROM ACROSS LAGRANGE COUNTY TOGETHER TO COLLABORATE ON COMMUNITY NEEDS INCLUDING BUT NOT LIMITED TO OVERALL HEALTH, EDUCATION, AND ECONOMY. THE GROUP COLLABORATES TO MEET COMMUNITY NEEDS TOGETHER AND ELIMINATES EACH ORGANIZATION WORKING ON THEIR OWN TOWARDS THE SAME ISSUES. THE COMMUNITY HEALTH IMPROVEMENT MANAGER IS ALSO INVOLVED IN VARIOUS OTHER COALITIONS AND COMMUNITY PARTNERSHIPS SUCH AS COUNCIL FOR A DRUG FREE LAGRANGE, FOCUS LAGRANGE, LAGRANGE COUNTY CHAMBER OF COMMERCE, LAGRANGE COUNTY TOGETHER, AND NORTHEAST INDIANA FARM TO SCHOOL. THE COMMUNITY HEALTH IMPROVEMENT MANAGER IDENTIFIES, DEVELOPS, IMPLEMENTS, AND EVALUATES ALL COMMUNITY HEALTH PROGRAMS OFFERED THROUGH THE HOSPITAL. COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC. IS ONE OF THE LARGEST EMPLOYERS IN LAGRANGE COUNTY AND BELIEVES STRONGLY IN GIVING BACK TO THE COMMUNITY IT SERVES. THE HOSPITAL NOT ONLY SPONSORS ITS OWN EVENTS AND OUTREACH PROGRAMS EACH YEAR, BUT ALSO TAKES AN ACTIVE ROLE IN NUMEROUS OTHER LOCALLY SPONSORED HEALTH EVENTS, EDUCATION, AND COMMUNITY EVENTS. THE MANAGEMENT AND CO-WORKERS PARTICIPATE IN VOLUNTEER ACTIVITIES THROUGHOUT THE YEAR TO IMPROVE THE HEALTH AND WELL-BEING OF OUR COMMUNITY.TO ASSIST IN HEALTH EDUCATION IN OUR SCHOOL DISTRICTS, FUNDS ARE PROVIDED TO MCMILLEN HEALTH TO PROVIDE EVIDENCE-BASED EDUCATION AROUND THE TOP HEALTH PRIORITIES IDENTIFIED IN THE TRIENNIAL COMMUNITY HEALTH NEEDS ASSESSMENT, WHICH ARE MENTAL HEALTH / SUBSTANCE USE / SUICIDE, OBESITY, AND CHILD ABUSE & NEGLECT.BOOMERANG BACKPACK / BLESSINGS IN A BACKPACK: FUNDING IS PROVIDED TO THE LAGRANGE COUNTY CHAMBER OF COMMERCE TO SUPPORT STUDENTS IN OUR COUNTY SCHOOL DISTRICTS WHO NEED ACCESS TO FOOD OVER THE WEEKENDS WHEN SCHOOL IS NOT IN SESSION. STUDENTS ARE IDENTIFIED THROUGH THE SCHOOLS AS AT RISK OF HUNGER. PRIMARY HEALTH CARE / ACCESS:COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC. PROVIDES CLINICAL STAFF AND SUPPORT TO TARGETED POPULATIONS WITHIN LAGRANGE COUNTY, INCLUDING:-A PART TIME PLAIN CHURCH COORDINATOR WHO SERVES AS A RESOURCE FOR AMISH, MENNONITE AND OTHER PLAIN CHURCH MEMBERS TO ADDRESS QUESTIONS RELATED TO HEALTHCARE SERVICES AVAILABLE WITHIN THE PARKVIEW HEALTH SYSTEM, DETERMINING THE APPROXIMATE COST OF A PROCEDURE, SCHEDULING OF A DIAGNOSTIC TEST, OR A BILLING QUESTION. THE PLAIN CHURCH COORDINATOR ASSISTS INDIVIDUALS AND FAMILIES BY OBTAINING AN ANSWER TO THE QUESTIONS THIS COMMUNITY HAS RELATED TO SEEKING HEALTHCARE FROM PARKVIEW.IN 2021, COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC., AFFORDED 45 EXPECTANT PARENTS THE OPPORTUNITY TO ATTEND BIRTH PLANNING CLASSES BY A REGISTERED NURSE WHO IS A CERTIFIED LACTATION CONSULTANT. THE CLASSES PROVIDE ANSWERS TO ANY QUESTIONS AN EXPECTANT MOTHER MAY HAVE; IN ADDITION, OTHER RESOURCES ARE AVAILABLE AT APPOINTMENTS WITH THE HOSPITAL'S BIRTH PLANNER. PRENATAL CLASSES WERE PROVIDED TO 46 INDIVIDUALS. ADDITIONAL SUPPORT ONCE A BABY IS BORN INCLUDES BREASTFEEDING, WHICH WAS PROVIDED TO 88 INDIVIDUALS, AND SAFE SLEEP CLASSES, WHICH WAS PROVIDED TO EIGHT PEOPLE. MEDICATION ASSISTANCE PROGRAMS (MAP):COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC. MAINTAINS A MEDICATION ASSISTANCE PROGRAM FOR LAGRANGE COUNTY RESIDENTS. MAP PARTNERS WITH PATIENTS, PHYSICIANS, PHARMACEUTICAL COMPANIES, AND DONORS TO PROVIDE MEDICATION ASSISTANCE AT LITTLE OR NO COST FOR QUALIFIED INDIVIDUALS. FOR ACUTE MEDICATION NEEDS, MEDICATIONS ARE PROVIDED BY PARKVIEW PHARMACY AT NO COST TO THE PATIENT. LONG-TERM MEDICATION HELP IS PROVIDED THROUGH CONNECTING CLIENTS WITH PHARMACEUTICAL ASSISTANCE PROGRAMS (PAP) AND COPAY ASSISTANCE PROGRAMS. HEALTH SCREENING, PREVENTION, AND DISEASE MANAGEMENT: COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC. PROVIDES FREE AND LOW-COST SERVICES, HEALTH SCREENINGS AND EDUCATION TO DIVERSE POPULATIONS IN OUR SERVICE AREA. THESE INCLUDE: -COMMUNITY CHECK-UP DAYS. COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC. CONTINUED TO FACE COVID PANDEMIC SHUTDOWNS AND SOCIAL DISTANCING GUIDELINES. THE HOSPITAL WAS ABLE TO HOLD ONE SOCIALLY DISTANCED CHECK-UP DAY EVENT TO PROVIDE LOW-COST BLOOD TESTS TO THE COMMUNITY SERVING 36 PEOPLE. -VOUCHERS REDEEMABLE FOR NINE MONTHS OF PRENATAL VITAMINS. THESE ARE MADE AVAILABLE TO WOMEN THROUGH THE HOSPITAL BIRTH PLANNER, LAGRANGE COUNTY PRIMARY CARE PHYSICIANS AND OBSTETRICIANS, THE LAGRANGE COUNTY HEALTH DEPARTMENT, AND WIC. VOUCHERS ARE REDEEMABLE AT LOCAL PHARMACIES WHO THEN SUBMIT THEM TO THE HOSPITAL FOR REIMBURSEMENT THROUGH COMMUNITY HEALTH IMPROVEMENT FUNDS.-QPR TRAINING IS OFFERED MONTHLY TO CO-WORKERS OF COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC. AND TO LAGRANGE COUNTY COMMUNITY MEMBERS. THIS SUICIDE PREVENTION TRAINING PREPARES ATTENDEES TO IDENTIFY WARNING SIGNS AND INTERVENE IN HOPES OF PREVENTING SUICIDE COMPLETION. IN 2021, DUE TO THE COVID-19 PANDEMIC, THESE TRAININGS WERE HELD VIRTUALLY. THE HOSPITAL WAS ABLE TO PROVIDE TRAINING TO 106 PEOPLE. OVER 558 HOURS OF STAFF TIME WAS SPENT IN 2021 AT THE COUNTY COVID VACCINE CLINIC, ADMINISTERING VACCINES AND PROVIDING INFORMATION TO DISCOURAGE THE DISEASE SPREAD OF COVID-19.ECONOMIC DEVELOPMENT:ECONOMIC DEVELOPMENT CORPORATION - COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC. PROVIDES FUNDING TO THE LAGRANGE COUNTY ECONOMIC DEVELOPMENT CORPORATION (EDC) TO SUPPORT THEIR EFFORTS IN DEVELOPING BUSINESS RETENTION AND EXPANSION, BUSINESS ATTRACTION, ENTREPRENEURIAL DEVELOPMENT, AND TO ENCOURAGE HIGHER PAYING JOBS AND ECONOMIC IMPROVEMENT IN OVERALL QUALITY OF LIFE. THE EDC CONTRIBUTES TO FURTHERING ACCESS IN OUR COUNTY BY INVESTING IN AREAS THAT CONTRIBUTE TO A THRIVING COMMUNITY, SUCH AS HOUSING AND AIDING BUSINESSES IN IDENTIFYING BUILDING SITES. THE EDC ALSO INVESTS IN AREAS THAT IMPACT OBESITY AND MATERNAL/INFANT/CHILD HEALTH BY SUPPORTING THE LAUNCH LAGRANGE STUDENT ENTREPRENEURIAL COMPETITION AND LAGRANGE COUNTY TRAILS. IN ADDITION, COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC. IS PART OF THE LAGRANGE COUNTY EARLY LEARNING COALITION. LAGRANGE COUNTY IS CONSIDERED A CHILDCARE DESERT BECAUSE THERE ARE NOT ENOUGH CERTIFIED CHILDCARE PROVIDERS BASED ON OUR COUNTY'S POPULATION. REPRESENTATIVES FROM THE HOSPITAL COLLABORATE WITH KEY STAKEHOLDERS AND HR REPRESENTATIVES FROM COUNTY BUSINESSES TO WORK TOGETHER TOWARDS INCREASING THE NUMBER OF CERTIFIED CHILDCARE PROVIDERS FOR LAGRANGE COUNTY. 30531378 1 1 0 1 0 0 0 0 0 0 1 0 0 1 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 1 0 0 0 0 0 0 1 1 0 0 0 1 X 34 0 1 202 1 0 0 0 0 0 0 0 0 0 0 0 0 X 13 8 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 DIRECTOR/PH PRESIDENT & CEO 0.00 40.00 X X 0 2037606 326073 LISA BOOTH DIRECTOR/PH PHYSICIAN 0.00 40.00 X 11364 427869 47017 RHONDA SHARP DIRECTOR/PH PHYSICIAN 16.00 24.00 X 125734 209082 36583 JORDI DISLER DIRECTOR/LGHOS PRESIDENT 40.00 0.00 X X 251050 0 87094 JAMIN YODER DIRECTOR/PH PHYSICIAN 0.00 40.00 X 17626 239100 47565 SHERRYL RHINESMITH DIRECTOR/CHAIR 1.00 1.00 X X 6500 4061 0 STEVEN CHRISTNER DIRECTOR 1.00 0.00 X 4500 0 0 MARK LEU DIRECTOR 1.00 0.00 X 4500 0 0 MICHAEL MELLINGER DIRECTOR 1.00 0.00 X 4500 0 0 BETH THORNBURG DIRECTOR 1.00 0.00 X 4500 0 0 JOE URBANSKI DIRECTOR/VICE CHAIR 1.00 0.00 X X 4250 0 0 ROBERT BOND DIRECTOR 1.00 0.00 X 4500 0 0 PAUL YODER DIRECTOR/SECRETARY/TREASURER 1.00 0.00 X X 4500 0 0 JEANNE' WICKENS PH CHIEF FINANCIAL OFFICER 0.00 40.00 X 0 1059636 349980 TODD KLINEDINST LGHOS VP PATIENT CARE 40.00 0.00 X 177599 0 7241 BRENDA ARMENTROUT LGHOS MGR PHARMACY 40.00 0.00 X 194719 0 32235 ROBERT BLOOMFIELD LGHOS MGR SUPPORT SERVICE 40.00 0.00 X 147067 0 37713 TREVOR FRY LGHOS MGR ER 40.00 0.00 X 131779 0 38051 EMILY PLANT LGHOS MGR IP 40.00 0.00 X 123403 0 31554 MARY LOU WRIGHT LGHOS RN 36.00 4.00 X 118458 11999 22437 1336549 3989353 1063543 20 0 1 0 PROFESSIONAL EMERGENCY PHYSICIANS INC PO BOX 12949 FORT WAYNE IN 46866 PHYSICIANS 2146795 PARKVIEW HOSPITAL INC 11109 PARKVIEW PLAZA DR FORT WAYNE IN 468451701 LABORATORY SERVICES 1188412 CLINICAL COLLEAGUES INC PO BOX 824246 PHILADELPHIA PA 19182 ANESTHESIOLOGISTS 722463 NORTHEAST INTERNAL MEDICINE ASSOC INC 2500 N DETROIT ST LAGRANGE IN 46761 HOSPITALISTS 412300 FOCUSONE SOLUTIONS LLC 13609 CALIFORNIA ST OMAHA NE 68154 MEDICAL PERSONNEL 299186 6 11707 1159104 379 1170811 NET PATIENT SERVICE 622000 40723617 40723617 EMS SUBSIDY 621910 349000 349000 INTERUNIT RENT 531120 50786 50786 PHARMACY 446110 30405 30405 SPEECH THERAPY 621300 10135 10135 646 646 41164589 4990 15979 -10989 -10989 -10989 6820 -6820 -6820 -6820 CAFETERIA REVENUE 722514 244552 244552 GIFT SHOP REVENUE 453220 30062 30062 274614 42592205 41164589 0 256805 X 59971 59971 733679 733679 148410 148410 10576429 10576429 3224018 3224018 6047961 5387510 660451 825492 812764 12728 5705 5547 158 580550 572717 7833 5785 5785 141503 141503 1712394 1686049 26345 80711 80711 CORP SERVICE ALLOCATION 5501835 5501835 PH CLINICAL SUPPORT 3759427 3759427 MEDICAL SUPPLIES 2683991 2683991 HOSPITAL ASSESSMENT FEE 1362568 1362568 62381 23978 34593 3810 37512810 30531378 6977622 3810 1876 1757 252916 5300146 7281458 378717 395706 53928 8417 34892672 21860756 13969133 13031916 5011241 5011241 1920252 5997727 26635293 31981138 1539679 1980329 1986028 1467613 15125741 14186769 1166397 2424976 19817845 20059687 X 6817448 11921451 6817448 11921451 26635293 31981138 X 5079395 24608 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 4005 4005 0 PART II-B, LINE 1: 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. 320702 320702 13577442 5283614 8293828 29098 29098 0 18565886 15148310 3417576 2399544 1399734 999810 13031916 DUE TO/FROM INTERUNIT 5530957 RIGHT OF USE ASSETS 466770 5997727 LEASE LIABILITY 467530 EST MEDICARE/MEDICAID SETTLEMENTS 1286853 EST 3RD PARTY SETTLEMENTS 662126 ACCRUED INTEREST 8467 2424976 X 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 1 0 1 1 861255 861255 0.02550 3270327 1429983 1840344 0.05450 3148031 2251221 896810 0.02660 7279613 3681204 3598409 0.10660 83007 83007 0.00250 7228 7228 0.00020 4205882 2473563 1732319 0.05130 44940 44940 0.00130 4341057 2473563 1867494 0.05530 11620670 6154767 5465903 0.16190 2500 2500 0.00010 2500 2500 0.00010 1 0 0 6314470 6176899 137571 X 1 1 1 1 COMMUNITY HOSPITAL OF LAGRANGE COUNTY 207 N TOWNLINE RD LAGRANGE IN 46761 WWW.PARKVIEW.COM 14-005085-1 X X X X COMMUNITY HOSPITAL OF LAGRANGE COUNTY 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 COMMUNITY HOSPITAL OF LAGRANGE COUNTY 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 COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC., AND THE INDIANA PARTNERSHIP FOR HEALTHY COMMUNITIES (IN-PHC) RESEARCH TEAM MADE SURE TO INVITE 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 LAGRANGE COUNTY'S HEALTH NEEDS. AS RECOMMENDED BY THE INDIANA PARTNERSHIP FOR HEALTHY COMMUNITIES, A MODIFIED HANLON METHOD WAS USED TO PRIORITIZE HEALTH CONCERNS FOR COMMUNITY HOSPITAL OF LAGRANGE COUTNY, INC. 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.FOLLOWING THE PRIMARY DATA COLLECTION THAT WAS CONDUCTED FOR THE 2019 COMMUNITY HEALTH NEEDS ASSESSMENT, INPUT WAS GATHERED FROM THE COMMUNITY MEMBERS WHO SIT ON THE COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC. BOARD OF DIRECTORS AT THEIR SEPTEMBER 2019 MEETING. BASED ON THIS REVIEW AND INPUT, THREE PRIORITIES WERE RECOMMENDED FOR ADDITIONAL EMPHASIS, WHICH ARE: 1) MENTAL HEALTH/SUBSTANCE USE DISORDER, 2) OBESITY, 3) MATERNAL/INFANT/CHILD HEALTH - WITH SPECIFIC FOCUS ON CHILD HEALTH.THIS INFORMATION WAS THEN PRESENTED AT A COMMUNITY MEETING ON NOVEMBER 4, 2019, THAT WAS OPEN TO THE PUBLIC. REPRESENTATIVES FROM THE FOLLOWING ORGANIZATIONS WERE PRESENT: YMCA, LAGRANGE COUNTY COMMUNITY FOUNDATION, BRIGHTPOINT, COMMUNITY HEALTH CLINIC, COMMUNITY DENTAL CLINIC, PLAIN CHURCH GROUP MINISTRY LLC, LAGRANGE COUNTY SHERIFF'S DEPARTMENT, PURDUE EXTENSION, TOPEKA PHARMACY, LAGRANGE COUNTY HEALTH COALITION, LAGRANGE COUNTY HEALTH DEPARTMENT, LAGRANGE COUNTY COMMISSIONER, LAGRANGE COUNTY ECONOMIC DEVELOPMENT AND TC ENERGY. AT THIS COMMUNITY MEETING, A SUMMARY PRESENTATION OF THE 2019 COMMUNITY HEALTH NEEDS ASSESSMENT WAS GIVEN, AND THE THREE PRIORITIES OUTLINED ABOVE WERE SHARED. THOSE PRESENT WERE ASKED TO CONSIDER BECOMING INVOLVED IN COLLABORATIVE GROUPS THAT WERE FORMED, ONE FOR EACH OF THE HEALTH PRIORITIES IDENTIFIED.IN 2021, COLLABORATIVE GROUPS, INCLUDING THE COMMUNITY STAKEHOLDERS IDENTIFIED ABOVE, FOR EACH OF THE THREE HEALTH PRIORITIES MET REGULARLY TO REVIEW ADDITIONAL DATA SOURCES, DEVELOP AN IMPLEMENTATION STRATEGY, AND BEGIN TO DEVELOP TACTICS TO ROLL OUT AND MEASURE UNTIL THE NEXT COMMUNITY HEALTH NEEDS ASSESSMENT IS CONDUCTED IN 2022. COMMUNITY HOSPITAL OF LAGRANGE COUNTY 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 NOBLE COUNTY, INC. (EIN 35-2087092); HUNTINGTON MEMORIAL HOSPITAL, INC. (EIN 35-1970706); WHITLEY MEMORIAL HOSPITAL, INC. (EIN 35-1967665); PARKVIEW WABASH HOSPITAL, INC. (EIN 47-1753440) AND ORTHOPAEDIC HOSPITAL AT PARKVIEW NORTH, LLC (EIN 26-0143823). COMMUNITY HOSPITAL OF LAGRANGE COUNTY PART V, SECTION B, LINE 6B: THE HOSPITAL FACILITY'S CHNA WAS ALSO CONDUCTED WITH THE FOLLOWING ORGANIZATIONS OTHER THAN HOSPITAL FACILITIES:PARKVIEW HEALTH SYSTEM, 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. COMMUNITY HOSPITAL OF LAGRANGE COUNTY 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:MENTAL HEALTH:A COLLABORATIVE GROUP WAS FORMED IN 2019 TO BRING KEY STAKEHOLDERS FROM THE LAGRANGE COUNTY COMMUNITY TOGETHER TO ADDRESS MENTAL HEALTH/SUBSTANCE USE DISORDER. THIS WAS IDENTIFIED AS THE TOP NEED IN OUR REGION BASED ON RESULTS FROM THE 2019 COMMUNITY HEALTH NEEDS ASSESSMENT, MEASURING THE PERCENT OF THE POPULATION WITH FREQUENT MENTAL DISTRESS. IN 2021, THE COLLABORATIVE GROUP MEETING FREQUENCY AND EFFORTS WERE IMPACTED BY COVID-19, HOWEVER, THE MENTAL HEALTH/SUBSTANCE USE COLLABORATIVE MADE PROGRESS IN THE FOLLOWING AREAS:-DISSEMINATED DRUG DISPOSAL BAGS TO INDIVIDUALS AND ORGANIZATIONS THROUGHOUT LAGRANGE COUNTY. THESE BAGS CAN SAFELY BE USED TO DEACTIVATE PILLS, LIQUID, OR PATCHES AND HELP TO REDUCE THE LIKELIHOOD OF PRESCRIPTION DRUG ABUSE. THESE BAGS WERE PLACED THROUGHOUT LAGRANGE COUNTY IN KEY LOCATIONS, SOME OF WHICH ARE: LAGRANGE COUNTY SHERIFF'S DEPARTMENT, LAGRANGE COUNTY SCHOOL SYSTEMS, AND LAGRANGE COUNTY AMBULANCE VEHICLES.-PARTNERED WITH MCMILLEN HEALTH TO PROVIDE EDUCATION TO YOUTH IN LAGRANGE COUNTY SCHOOLS AROUND PEER PRESSURE, TEACHING REFUSAL SKILLS, EDUCATION ON OPIOIDS AND EFFECTS ON THE NERVOUS SYSTEM, THE BRAIN AND THE BODY.-UTILIZED SHIP FUNDING TO HAVE THREE ADDITIONAL INDIVIDUALS TRAINED SO THEY CAN EXPAND THE TEAM THAT TEACHES QPR GATEKEEPER SUICIDE PREVENTION CURRICULUM. WITH ASSISTANCE FROM PARKVIEW BEHAVIORAL HEALTH INSTITUTE, AN EVIDENCE-BASED SUICIDE PREVENTION STRATEGY KNOWN AS QUESTION, PERSUADE AND REFER (QPR) IS OFFERED AS A FREE TRAINING PROGRAM TO EQUIP PARTICIPANTS TO RECOGNIZE THE WARNING SIGNS OF SUICIDE AND HOW TO TAKE STEPS TO INTERVENE. SINCE BEING IMPLEMENTED IN 2017, OVER 1,040 PEOPLE HAVE RECEIVED THIS EDUCATION, WITH 106 PEOPLE BEING TRAINED IN 2021. THE GOAL OF THIS PROGRAM IS TO REDUCE THE NUMBER OF SUICIDE ATTEMPTS AND COMPLETIONS IN LAGRANGE COUNTY. PARKVIEW BEHAVIORAL HEALTH IS INVOLVED IN THE LAGRANGE COUNTY COMMUNITY TO PROVIDE THERAPY AND RESOURCES FOR THOSE WITH IMMEDIATE MENTAL HEALTH NEEDS. 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. SINCE ITS INCEPTION IN 2014 AT COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC., THE PROGRAM HAS PROVIDED OVER 13,000 HOURS OF DIRECT COUNSELING SERVICES TO INDIVIDUALS IN LAGRANGE, STEUBEN AND NOBLE COUNTIES, WITH 2,251 HOURS BEING PROVIDED TO 49 PATIENTS IN 2021. IN ADDITION, EACH OF THE INDIVIDUALS ENROLLED IN THE LIFEBRIDGE PROGRAM ATTEND MONTHLY APPOINTMENTS WITH THE 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.OBESITY: A COLLABORATIVE GROUP WAS FORMED IN 2019 TO BRING KEY STAKEHOLDERS FROM THE LAGRANGE COUNTY COMMUNITY TOGETHER TO ADDRESS OBESITY. THIS WAS IDENTIFIED AS A TOP NEED IN OUR COUNTY BASED ON RESULTS FROM THE 2019 COMMUNITY HEALTH NEEDS ASSESSMENT. THIS GROUP IS WORKING WITH COMMUNITY PARTNERS TO PROVIDE PUBLIC EDUCATION ON WHY IT IS IMPORTANT TO BE HEALTHY, WHY INDIVIDUALS SHOULD INCREASE ACTIVITY/FITNESS, AND INCREASING NUTRITION EDUCATION AND ACCESS TO HEALTHY FOODS. THE GOAL OF THIS COLLABORATIVE GROUP IS TO SEE A REDUCTION IN THE NUMBER OF OBESE AND OVERWEIGHT INDIVIDUALS IN THE COUNTY. IN 2021, THE COLLABORATIVE GROUP MEETING FREQUENCY AND EFFORTS WERE IMPACTED BY COVID-19, HOWEVER, THE OBESITY COLLABORATIVE MADE PROGRESS IN THE FOLLOWING AREAS:-LAGRANGE COUNTY COMMUNITY MEMBERS WERE ENCOURAGED TO PARTICIPATE IN THE GREAT APPLE CRUNCH FOR THE MONTH OF OCTOBER 2021 BY TAKING PHOTOS OF THEMSELVES BITING INTO AN APPLE AND POSTING IT ON SOCIAL MEDIA. THE INTENT WAS TO RAISE AWARENESS TO THE BENEFITS OF MAKING HEALTHIER FOOD CHOICES. BECAUSE LAGRANGE COUNTY HAS A SIGNIFICANT PLAIN CHURCH/AMISH POPULATION, A CHALLENGE WAS PUT OUT TO AMISH SCHOOLS TO SUBMIT AN ORIGINAL RECIPE OR ESSAY ON THE APPLE. STUDENTS IN GRADES K - 8 SUBMITTED 46 ENTRIES. THREE RANDOM WINNERS WERE SELECTED TO RECEIVE WELLNESS BUNDLES FOR THEIR SCHOOL CLASSROOM. -THE HOSPITAL IMPLEMENTED A FOOD PHARMACY PROGRAM IN 2018 TO REDUCE THE NEGATIVE EFFECTS (HEALTH AND ECONOMIC) OF OBESITY, AND RELATED CHRONIC DISEASES, SUCH AS DIABETES, THROUGH EDUCATION AND HEALTHY EATING PRACTICES. PATIENTS MUST BE REFERRED BY THEIR DOCTOR, HAVE TYPE 2 DIABETES, AND A BMI>30 TO PARTICIPATE. THIS FREE 6-MONTH PROGRAM BRINGS CLASS PARTICIPANTS TOGETHER MONTHLY TO LEARN HOW TO EAT AND SHOP HEALTHIER, COOK HEALTHIER, MANAGE MEDICATION, AND MORE. SINCE STARTING, PARTICIPANTS HAVE SEEN AN AVERAGE IMPROVEMENT IN A1C LEVELS OF 1.7, AND AN AVERAGE WEIGHT REDUCTION OF 5.2 LBS., AND IMPROVEMENTS IN CHOLESTEROL AND BLOOD PRESSURE MEASUREMENTS. IN 2021, CLASSES HAD TO BE SUSPENDED DUE TO COVID-19. -THE HOSPITAL PARTNERS WITH THE COLE CENTER FAMILY YMCA TO INCREASE PHYSICAL ACTIVITY BY OFFERING GROUP EXERCISE CLASSES IN LAGRANGE COUNTY. THESE GROUP CLASSES ALSO OFFER A CLOSE-KNIT COMMUNITY TO PARTICIPANTS AS THEY DEVELOP FRIENDSHIPS THROUGH REGULAR ATTENDANCE, WHICH POSITIVELY IMPACTS THEIR MENTAL HEALTH AND WELL-BEING. IN 2021, CLASSES WERE SUSPENDED DUE TO COVID-19. -PARTNERED WITH LAGRANGE COUNTY TRAILS TO EXPAND ACCESS TO THE CURRENT TRAIL SYSTEM THROUGHOUT LAGRANGE COUNTY.-PARTNERED WITH MCMILLEN HEALTH TO PROVIDE EDUCATION TO YOUTH IN LAGRANGE COUNTY SCHOOLS ON THE FOLLOWING TOPICS: MEDIA INFLUENCE ON JUNK FOOD CONSUMPTION, HARMFUL EFFECTS OF FAD DIETS, ANOREXIA, BULIMIA, OBESITY, EDUCATION ON BASIC FOOD GUIDELINES, INCLUDING READING FOOD LABELS, UNDERSTANDING FITNESS FACTS, AND LEARNING ABOUT PREVENTATIVE HEALTH CHOICES.PARTNERED WITH PARKVIEW WELL-BEING TEAM AND NORTHEAST INDIANA FARM-TO-SCHOOL TO PROVIDE HARVEST OF THE MONTH TASTE TESTS TO 4,289 STUDENTS THROUGH THE LAGRANGE COUNTY SCHOOLS. KIDS WERE INVITED TO TRY FRUITS AND VEGETABLES THEY WOULD NOT HAVE OTHERWISE, AND ALSO HAD EDUCATION ON THE PRODUCE TIED INTO THE TEACHER'S EDUCATION CIRICULUUM. 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. WELL-BEING GO-BAGS WERE IMPLEMENTED IN EACH DEPARTMENT TO OFFER STAFF TOOLS AND EDUCATION FOR MENTAL HEALTH AND WELL-BEING, INCREASING ACTIVITY, AND MAKING BETTER NUTRITION CHOICES. OVER 219 STAFF WERE SURVEYED AND 97% STATED THEY FOUND THE GO-BAG HELPFUL; 99% SAID THEY WOULD USE THE GO-BAG AGAIN.MATERNAL/INFANT/CHILD HEALTH:A COLLABORATIVE GROUP WAS FORMED IN 2019 TO BRING KEY STAKEHOLDERS FROM THE LAGRANGE COUNTY COMMUNITY TOGETHER TO ADDRESS MATERNAL/INFANT/CHILD HEALTH. BASED ON RESULTS FROM THE 2019 COMMUNITY HEALTH NEEDS ASSESSMENT, CHILD HEALTH WAS IDENTIFIED AS A TOP NEED IN LAGRANGE COUNTY, EMPHASIZING CHILD ABUSE & NEGLECT AND CHILDCARE. THE GOAL OF THIS COLLABORATIVE GROUP IS TO SEE AN INCREASE IN THE NUMBER OF REFERRALS FOR PARENTAL SUPPORT, WHICH SHOULD RESULT IN A REDUCTION OF CASES OF CHILD ABUSE & NEGLECT, AND TO INCREASE THE NUMBER OF CERTIFIED CHILDCARE PROVIDERS IN LAGRANGE COUNTY. IN 2021, THE COLLABORATIVE GROUP MEETING FREQUENCY AND EFFORTS WERE IMPACTED BY COVID-19. -PARTNERED WITH MCMILLEN HEALTH TO PROVIDE EDUCATION TO YOUTH IN LAGRANGE COUNTY SCHOOLS ON THE FOLLOWING TOPICS: SOCIAL AND EMOTIONAL SKILLS, BEING THE BOSS OF THEIR BODY, HOW TO IDENTIFY A TRUSTED ADULT, INAPPROPRIATE TOUCH, BULLYING, STAYING SAFE ONLINE, WARNING SIGNS OF SUICIDE, AND HOW TO IDENTIFY AN ABUSIVE RELATIONSHIP WHILE DATING.COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC. OFFERED PROGRAMS DESIGNED TO REDUCE RISKS AND INCREASE HEALTHY BEHAVIORS AMONG PREGNANT WOMEN VIA A LACTATION CONSULTANT / BIRTH PLANNER. CLASSES ARE OPEN TO THE PUBLIC REGARDLESS OF WHETHER OR NOT THEY DELIVER AT THIS HOSPITAL.(SEE PART V, SECTION B, LINE 11 CONT'D: FOR CONTINUATION OF NARRATIVE) 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 V, SECTION B, LINE 11 CONT'D: OTHER HEALTH NEEDS NOT BEING ADDRESSED:-AGING - AGING AND IN-HOME SERVICES OF NORTHEAST INDIANA (AIHS) SERVES OLDER ADULTS, PERSONS WITH DISABILITIES AND THEIR CAREGIVERS IN NINE COUNTIES IN NORTHEAST INDIANA. THIS NOT-FOR-PROFIT, COMMUNITY-BASED ORGANIZATION IS A FEDERAL AND STATE DESIGNATED AREA AGENCY ON AGING AND AN AGING AND DISABILITY RESOURCE CENTER WHICH PROVIDES A STREAMLINED ACCESS TO INFORMATION, CARE OPTIONS, SHORT-TERM CASE MANAGEMENT AND BENEFITS ENROLLMENT ACROSS A SPECTRUM OF LONG-TERM CARE SERVICES. THROUGH THE CARE TRANSITIONS PROGRAM, AIHS PARTNERS WITH PARKVIEW HEALTH TO REDUCE MEDICARE READMISSIONS. IN ADDITION, THE AGENCY SERVES AS THE INITIAL COORDINATOR AND FISCAL AGENT FOR HONORING CHOICES INDIANA, WHICH IS AN INITIATIVE COMMITTED TO PROMOTING AND SUSTAINING ADVANCE CARE PLANNING (ACP) ACROSS THE STATE TO ENSURE INDIVIDUALS' FUTURE HEALTH CARE PREFERENCES ARE DISCUSSED, DOCUMENTED, AND HONORED. THROUGH HONORING CHOICES, PARKVIEW AND AIHS WORK TOGETHER TO TRAIN ACP FACILITATORS, PROMOTE BEST PRACTICE AND INCREASE PUBLIC AWARENESS ABOUT THE VALUE OF DISCUSSING HEALTH CARE DECISION MAKING IN ADVANCE OF MEDICAL CRISIS.-CARDIOVASCULAR DISEASE & DIABETES - WHILE WE ARE NOT ADDRESSING THIS NEED SPECIFICALLY, WE WILL BE ADDRESSING OBESITY. MANY OF OUR OUTREACH INITIATIVES TO ADDRESS OR PREVENT OBESITY WILL IMPACT BOTH THESE AREAS IN THAT INTERVENTIONS ARE SIMILAR FOR THESE HEALTH ISSUES.-TOBACCO USE - THE HOSPITAL IS A TOBACCO FREE CAMPUS AND OFFERS FREE CLASSES QUARTERLY TO COMMUNITY MEMBERS. THIS IS A SEVEN-WEEK, EIGHT-SESSION CLASS SERIES THAT PROVIDES SUPPORT AND EDUCATION TO HELP PEOPLE GET TOBACCO FREE. THESE CLASSES WERE OFFERED VIRTUALLY IN 2021 DUE TO THE COVID-19 PANDEMIC. 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 7BCOMMUNITY HOSPITAL OF LAGRANGE COUNTY, 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 7CCOMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC. ACCEPTS ALL 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, COMMUNITY HOSPITAL OF LAGRANGE COUNTY, 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 EXPENSECOMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC. EXCLUDED $3,759,427 OF PH CLINICAL SUPPORT EXPENSE. PART II, COMMUNITY BUILDING ACTIVITIES: DESCRIBE HOW THE ORGANIZATION'S COMMUNITY BUILDING ACTIVITIES, AS REPORTED, PROMOTES THE HEALTH OF THE COMMUNITIES THE ORGANIZATION SERVES.COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC. HAS A STRONG COMMITMENT TO SUPPORTING AND ENHANCING THE VITALITY OF OUR COMMUNITY, AND AS SUCH INVESTS IN PROJECTS THAT HELP TO IMPROVE THE HEALTH AND INSPIRE THE WELL-BEING OF THE COMMUNITY. COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC. PARTNERS WITH THE LAGRANGE COUNTY ECONOMIC DEVELOPMENT CORPORATION (LCEDC) TO CONTINUE TO SUPPORT LAGRANGE COUNTY AS A TOP PLACE TO LIVE, WORK AND PLAY. A FEW EXAMPLES OF PARTNERSHIP WITH LCEDC INCLUDE WORKING WITH A NEWLY FOUNDED COALITION CALLED THE LAGRANGE COUNTY EARLY LEARNING COALITION TO INCREASE ACCESS TO QUALITY EARLY LEARNING /CHILDCARE PROGRAMS IN LAGRANGE COUNTY. COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC. IS ALSO A FINANCIAL SPONSOR FOR EDC INFRASTRUCTURE, HOUSING DEVELOPMENT, AND QUALITY OF LIFE/GROWTH IN THE COUNTY. COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC. HAS ACTIVE REPRESENTATION BY LEADERSHIP ON THE BOARDS OF NEARLY 30 COMMUNITY NON-PROFIT AND CIVIC AGENCIES THROUGHOUT LAGRANGE COUNTY AND THE SURROUNDING AREA. 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. COMMUNITY HOSPITAL OF LAGRANGE COUNTY, 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, COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC. HAS TAKEN THE POSITION NOT TO INCLUDE THE MEDICARE SHORTFALLS OR SURPLUSES AS PART OF COMMUNITY BENEFIT. COMMUNITY HOSPITAL OF LAGRANGE COUNTY, 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 HEALTH SYSTEM, INC., INCLUDING COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC., ASSESSES THE HEALTHCARE NEEDS OF THE COMMUNITY IT SERVES THROUGH PRIMARY AND SECONDARY DATA ANALYSIS, WORKING WITH THE ORGANIZATION'S COMMUNITY PARTNERS, AND ITS FRONTLINE STAFF. PARKVIEW HEALTH SYSTEM, 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.COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC., PRIMARILY SERVES THE LAGRANGE COUNTY COMMUNITIES OF HOWE, LAGRANGE, SHIPSHEWANA, STROH, TOPEKA, AND WOLCOTTVILLE INDIANA. AS THE ONLY HOSPITAL IN THIS COUNTY, COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC., ALSO SERVES, TO A LIMITED EXTENT, SURROUNDING COMMUNITIES IN THE EASTERN PORTION OF ELKHART COUNTY, INDIANA, THE WESTERN PORTION OF STEUBEN COUNTY, INDIANA, AND SOME OF THE SOUTHERN PORTIONS OF CASS, ST. JOSEPH, AND BRANCH COUNTIES IN MICHIGAN.ACCORDING TO THE U.S. CENSUS BUREAU AND STATSAMERICA.ORG, AS OF JULY 21, 2021, POPULATION ESTIMATES SHOW LAGRANGE COUNTY HAS APPROXIMATELY 40,524 RESIDENTS. OF THOSE, 97.8% ARE WHITE, 4.4% ARE HISPANIC OR LATINO, AND .6% ARE BLACK OR AFRICAN AMERICAN. THE MEDIAN HOUSEHOLD INCOME IN 2020 DOLLARS WAS $69,331. THE PERCENTAGE OF THE POPULATION LIVING IN POVERTY IS 8.8%. THE ANNUAL AVERAGE UNEMPLOYMENT RATE AS OF 2021 IS 2%. ACCORDING TO COUNTYHEALTHRANKINGS.ORG (2019), APPROXIMATELY 28% OF THE POPULATION IN LAGRANGE COUNTY ARE UNINSURED.ACCORDING TO THE LAGRANGE COUNTY ECONOMIC DEVELOPMENT CORPORATION, PLAIN CHURCH RESIDENTS, INCLUDING MEMBERS OF THE AMISH COMMUNITY, MAKE UP APPROXIMATELY 44% OF THE TOTAL POPULATION OF LAGRANGE COUNTY. FOR THE MEMBERS OF THESE FAITH-BASED COMMUNITIES, TRAVEL IS BY HORSE AND BUGGY OR BICYCLE; COMMUNICATIONS ARE PRIMARILY FACE-TO-FACE OR THROUGH THE USE OF MULTI-FAMILY CENTRALIZED PARTY LINE TELEPHONE BOOTHS.THE MAKE-UP OF EMPLOYMENT IS HEAVILY MANUFACTURING, FOLLOWED BY HEALTHCARE AND EDUCATION. ACCORDING TO IHA DIMENSIONS DATABASE INPATIENT (2021) % BY PAYER SHOWS MEDICAID IS 14.7% (119/809), AND SELF-PAY IS 2.3% (19/809); OUTPATIENT % BY PAYER SHOWS MEDICAID IS 17.2% (4,761/27,686), AND SELF-PAY IS 4.2% (1,163/27,686).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). HRSA HAS DESIGNATED THE FOLLOWING:1) COUNTIES: DEKALB, LAGRANGE, NOBLE AND STEUBEN COUNTYDISCIPLINE: MENTAL HEALTHHPSA ID: 7186175063HPSA NAME: NORTHEASTERN CATCHMENT AREA 18DESIGNATION TYPE: GEOGRAPHIC HPSA 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 (E.G. OPEN MEDICAL STAFF, COMMUNITY BOARD, USE OF SURPLUS FUNDS, ETC.).THE MAJORITY OF THE COMMUNITY HOSPITAL OF LAGRANGE COUNTY, 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 THROUGHOUT THE COMMUNITY CAN COUNT ON COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC. TO BE STANDING BY WITH EMERGENCY CARE 24 HOURS A DAY, 365 DAYS A YEAR. THE EMERGENCY DEPARTMENT IS STAFFED WITH BOARD-CERTIFIED PHYSICIANS AND A NURSING STAFF THAT IS TRAINED AND CERTIFIED IN EMERGENCY CARE. FURTHERMORE, NO PATIENT IS EVER DENIED TREATMENT, REGARDLESS OF THEIR ABILITY TO PAY AND COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC. AND ITS AFFILIATES CONTINUE TO ADAPT TO MEET THE NEEDS OF THE COMMUNITY.COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC. GIVES BACK TO THE COMMUNITY IN THE FORM OF IMPROVED FACILITIES, EDUCATION AND OUTREACH PROGRAMS, FREE AND DISCOUNTED CARE, VOLUNTEERISM AND MUCH MORE. THE FOLLOWING ARE SOME OF THE WAYS COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC. IS REACHING OUT TO MAKE OUR NEIGHBORHOODS AND COMMUNITIES HEALTHIER:-EDUCATION: COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC. IS TAKING THE LEAD IN PARTNERING WITH SCHOOLS FOR HEALTH OCCUPATION EDUCATION PROGRAMS, CAREER PATHWAYS PROGRAMS, PREVENTIVE EDUCATION, AND SCREENINGS FOR STUDENTS.COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC. PARTNERED WITH TOPEKA PHARMACY AND SUPERSHOT TO PROVIDE FREE FLU AND COVID-19 VACCINES AND BOOSTERS TO OVER 300 PEOPLE. - MEDICATION ASSISTANCE PROGRAM (MAP): COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC. MAINTAINS A MEDICATION ASSISTANCE PROGRAM FOR LAGRANGE COUNTY RESIDENTS. MAP PARTNERS WITH PATIENTS, PHYSICIANS, PHARMACEUTICAL COMPANIES, AND DONORS TO PROVIDE MEDICATION ASSISTANCE AT LITTLE OR NO COST FOR QUALIFIED INDIVIDUALS. FOR ACUTE MEDICATION NEEDS, MEDICATIONS ARE PROVIDED BY PARKVIEW PHARMACY AT NO COST TO THE PATIENT. LONG-TERM MEDICATION HELP IS PROVIDED THROUGH CONNECTING CLIENTS WITH PHARMACEUTICAL ASSISTANCE PROGRAMS (PAP) AND COPAY ASSISTANCE PROGRAMS. OVER 290 PATIENTS WERE SERVED THROUGH THIS PROGRAM IN 2021.-COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC. TEAM MEMBERS SERVED OVER 200 HOURS ON PROJECTS AND ADVISORY BODIES FOR THE FOLLOWING: COMMUNITY IMPROVEMENT LEAGUE OF STROH, LAGRANGE COUNTY COUNCIL ON AGING, LAGRANGE COUNTY CORONER'S OFFICE, COUNCIL FOR A DRUG FREE LAGRANGE, HOWE VOLUNTEER FIRE DEPARTMENT, IMPACT - HEATH OCCUPATIONS EDUCATION ADVISORY COMMITTEE, LAGRANGE COUNTY COMMISSIONER, LAGRANGE COUNTY EARLY LEARNING COALITION, LAGRANGE COUNTY ECONOMIC DEVELOPMENT CORPORATION, LAGRANGE COUNTY HEALTH DEPARTMENT, LAGRANGE COUNTY HOUSING PROJECT, LAGRANGE COUNTY REGIONAL UTILITY DISTRICT, LAGRANGE/NOBLE JOINT DRAINAGE BOARD, AND REMC ADVISORY COMMITTEE.THE COMMUNITY HEALTH IMPROVEMENT COMMITTEE (CHIC) OF COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC. IS A PROGRAM THAT PROVIDES GRANT SUPPORT FOR COMMUNITY HEALTH INITIATIVES DELIVERED BY NOT-FOR-PROFIT COMMUNITY ORGANIZATIONS THAT SHARE THE HOSPITAL'S MISSION TO ENCOURAGE HEALTHIER LIFESTYLES AMONG THE CITIZENS OF LAGRANGE COUNTY AND PROVIDE SERVICES THAT ARE NOT AVAILABLE THROUGH THE HOSPITAL. FUNDS ARE AWARDED BASED ON THE TOP NEEDS THAT WERE IDENTIFIED FOR LAGRANGE COUNTY THROUGH THE MOST RECENT COMMUNITY HEALTH NEEDS ASSESSMENT. THE FOLLOWING CHIC INITIATIVES WERE SUPPORTED THROUGH HEALTH PARTNERS WHO ALIGN WITH THE TOP COMMUNITY HEALTH NEEDS IDENTIFIED FOR LAGRANGE COUNTY AND NORTHEAST INDIANA. FUNDED PROGRAMS PROVIDING SUPPORT TO LAGRANGE COUNTY PATIENTS IN 2021 INCLUDED:-BRIGHTPOINT - SUPPORT WAS PROVIDED TO ASSIST WITH OBTAINING HEALTHCARE COVERAGE FOR CHILDREN AND THEIR FAMILIES. -CANCER SERVICES OF NORTHEAST INDIANA - SUPPORT WAS PROVIDED TO ASSIST PATIENTS WITH HEALTHCARE SUPPLIES NOT COVERED BY INSURANCE, FOR EDUCATION RELATED TO WELLNESS AND HEALTHY LIFESTYLE PRACTICES.-LAGRANGE COUNTY ECONOMIC DEVELOPMENT CORPORATION - SUPPORT WAS PROVIDED TO ASSIST WITH EFFORTS AROUND ACCESS TO HOUSING AND INCREASING CAPACITY FOR CERTIFIED EARLY LEARNING PROGRAMS AND CHILDCARE.LAGRANGE COUNTY EARLY LEARNING COALITION - SUPPORT WAS PROVIDED TO HELP WITH PLACEMENT OF EARLY LEARNING/CHILDCARE CENTERS IN LAGRANGE COUNTY.THE FARM PLACE - SUPPORT WAS PROVIDED TO HELP WITH OPERATIONS OF THEIR FAITH-BASED PROGRAM TO PROVIDE A SAFE, NURTURING, AND RESTORATIVE PLACE FOR CHILDREN IN NEED THROUGH ANIMAL COMPANIONSHIP AND OTHER THERAPEUTIC METHODS. WOLCOTTVILLE POLICE DEPARTMENT - SUPPORT WAS PROVIDED TO ENSURE ENHANCED SAFETY WHEN OFFICERS ARE RESPONDING TO CRIME SCENES AND NEED PROPER MASK PROTECTION AND CLOTHING PROTECTION TO REDUCE THE RISK OF THEIR SAFETY. LAGRANGE COUNTY TRAILS - SUPPORT WAS PROVIDED TO INCREASE THE WALKABILITY AND BICYCLING ACROSS OUR COUNTY IN ADDITION TO THE ENHANCED SAFETY IT PROVIDES AS MANY USE THE TRAIL SYSTEM TO COMMUNITE TO WORK.-MCMILLEN HEALTH - SUPPORT WAS PROVIDED TO BRING EDUCATION AND PROGRAMMING ON MENTAL HEALTH/SUBSTANCE USE, OBESITY AND WELLNESS, AND CHILD ABUSE & NEGLECT TO STUDENTS AT THE THREE PUBLIC SCHOOL SYSTEMS IN LAGRANGE COUNTY.-LAGRANGE COUNTY SHERIFF'S DEPARTMENT - AED'S WERE PLACED TO SUPPORT SAFETY EFFORTS. -LAGRANGE COUNTY PARKS DEPARTMENT - AED'S WERE PLACED TO SUPPORT SAFETY EFFORTS.PATIENT & FAMILY ADVISORY COUNCIL (PFAC): IN 2021, COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC. CONTINUED ITS PARTNERSHIP WITH PATIENTS AND PATIENT FAMILY MEMBERS THROUGH THE HOSPITAL'S PFAC. THE PFAC MEMBERS PROVIDED FEEDBACK ABOUT PROCESSES AND COMMUNICATION OPPORTUNITIES THAT WOULD IMPROVE QUALITY AND THE PATIENT EXPERIENCE. AREAS IMPACTED BY THE PFAC'S INVOLVEMENT DURING 2021 WERE:-PROVIDING INPUT AND FEEDBACK REGARDING THE HOSPITAL'S VISITOR RESTRICTION PROCESS AND COMMUNICATION AS A RESULT OF THE COVID-19 PANDEMIC.-PROVIDING INPUT AND FEEDBACK ON HOW MANDATORY MASKING IS VIEWED FROM THE PLAIN CHURCH/AMISH PERSPECTIVE AND THE GENERAL POPULATION, AND HOW IT IMPACTS THE COMMUNICATION PROCESS BETWEEN CAREGIVERS, PATIENTS & FAMILY/SUPPORT MEMBERS. PART VI, LINE 6: IF THE ORGANIZATION IS PART OF AN AFFILIATED HEALTH CARE SYSTEM, DESCRIBE THE RESPECTIVE 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.; PARK CENTER, INC.; PARKVIEW WABASH HOSPITAL, INC.; WHITLEY MEMORIAL HOSPITAL, 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 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 WITH A BOARD OF DIRECTORS THAT 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 ALWAYS BE INDEPENDENT AS DEFINED BY THE INTERNAL REVENUE SERVICE (IRS).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 BENEFIT 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 WITHIN OUR FACILITIES WHILE SERVING AS GOOD STEWARDS OF SURPLUS FUNDS 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 66 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 PARKVIEW LAGRANGE HOSPITAL FOUNDATION INC 207 N TOWNLINE RD LAGRANGE IN 467611325 833347115 501(C)(3) 19969 0 SCHOLARSHIPS THE FARM PLACE INC P O BOX 76 LAGRANGE IN 46761 814767776 501(C)(3) 10000 0 PROGRAMS TO PROVIDE A SAFE, NURTURING AND RESTORATIVE PLACE FOR CHILDREN IN NEED THROUGH THERAPEUTIC ANIMAL COMPANIONSHIP AND OTHER METHODS LAGRANGE COUNTY COMMUNITY FOUNDATION INC 0045 N 250 W LAGRANGE IN 46761 351834679 501(C)(3) 10000 0 LAGRANGE COUNTY EARLY LEARNING COALITION FUND 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. 0 1 0 0 0 0 0 1 0 MICHAEL PACKNETT DIRECTOR/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 LISA BOOTH DIRECTOR/PH PHYSICIAN 11364 362617 0 33870 0 31382 825 31075 391 14726 12580 473670 0 0 RHONDA SHARP DIRECTOR/PH PHYSICIAN 125734 188602 0 13680 0 6800 11980 19920 1759 2924 139473 231926 0 0 JORDI DISLER DIRECTOR/LGHOS PRESIDENT 199041 0 31368 0 20641 0 62327 0 24767 0 338144 0 19094 0 JAMIN YODER DIRECTOR/PH PHYSICIAN 17626 201705 0 33235 0 4160 1074 14569 2192 29730 20892 283399 0 0 BRENDA ARMENTROUT LGHOS MGR PHARMACY 175192 0 11581 0 7946 0 21088 0 11147 0 226954 0 0 0 TODD KLINEDINST LGHOS VP PATIENT CARE 156649 0 19791 0 1159 0 4411 0 2830 0 184840 0 0 0 ROBERT BLOOMFIELD LGHOS MGR SUPPORT SERVICE 127544 0 8794 0 10729 0 16364 0 21349 0 184780 0 0 0 TREVOR FRY LGHOS MGR ER 116136 0 8324 0 7319 0 14939 0 23112 0 169830 0 0 0 EMILY PLANT LGHOS MGR IP 109590 0 7887 0 5926 0 7550 0 24004 0 154957 0 0 0 MARY LOU WRIGHT LGHOS RN 102039 11999 13250 0 3169 0 10658 1079 9716 984 138832 14062 0 0 PART I, LINE 3 RELATED ORGANIZATION, PARKVIEW HEALTH SYSTEM, INC., USES THE FOLLOWING TO ESTABLISH THE COMPENSATION OF COMMUNITY HOSPITAL LAGRANGE COUNTY, 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): JORDI DISLER $19,094; 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: JORDI DISLER $34,134; 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 HEALTH AND EDUCATIONAL FACILITY FINANCING AUTHORITY 351611409 45479RCF2 2007-03-15 24930000 SEE PART VI 0 0 0 A 10690000 25930446 1074006 208535 154519 24493386 2008 0 0 1 1 A 0 1 1 1 0 0.00000 0.00000 0.00000 0 0 1 A 0 0 0 1 1 0 0 0 1 A 1 SCHEDULE K, PART I, COLUMN F, LINE A: CONSTRUCTION OF NEW HOSPITAL FACILITY FOR COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC. IN LAGRANGE, INDIANA SCHEDULE K, PART II, COLUMN A, LINE 3: THIS AMOUNT INCLUDES INTEREST OF $1,000,446. EARNED ON PROJECT, COST OF ISSUANCE AND CAPITALIZED INTEREST FUNDS. SCHEDULE K, PART III, COLUMN A, LINES 4-6: AS PART OF OUR EFFORTS TO MONITOR AND ENSURE THAT THERE IS NO PRIVATE USE AT OUR BOND FINANCED FACILITIES, WE CONTRIBUTE EQUITY TO FINANCE A PORTION OF OUR NEW MONEY PROJECTS. 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 COMPUTATION PERFORMED ON APRIL 13, 2010. LYNNELLE MILLER FAMILY MEMBER OF DIRECTOR LISA BOOTH 148410 EMPLOYEE LYNNELLE MILLER RECEIVED COMPENSATION (INCLUDING TAXABLE AND NONTAXABLE FRINGE BENEFITS TREATED AS COMPENSATION) FROM COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC. 0 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, COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC., EIN 20-2401676. 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 COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC. WAS 34 AND 202 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 DIRECTORS/OFFICERS JORDI DISLER AND JOE URBANSKI HAVE A BUSINESS RELATIONSHIP. 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 COMMUNITY HOSPITAL OF LAGRANGE COUNTY, 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. COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC. IS A SUBSIDIARY CORPORATION OF PARKVIEW HEALTH SYSTEM, INC. AN ELECTRONIC COPY OF THE ORGANIZATION'S FINAL FORM 990 (INCLUDING REQUIRED SCHEDULES) WAS PROVIDED TO EACH VOTING MEMBER OF THE ORGANIZATION'S GOVERNING BODY, 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 585,710. MANAGEMENT AND GENERAL EXPENSES 37,432. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 623,142. MEDICAL PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 3,613,388. MANAGEMENT AND GENERAL EXPENSES 392,169. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,005,557. LAB SERVICES: PROGRAM SERVICE EXPENSES 1,188,412. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,188,412. COLLECTION EXPENSE: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 230,850. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 230,850. 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 24,608. 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