2019-11-11T15:04:50-06:00 2018-12-31 350921680 CROWE LLP 330 E JEFFERSON BLVD PO BOX 7 SOUTH BEND IN 466240007 990 2018-01-01 237220589 PARKVIEW FOUNDATION INC PARK 2603738429 10622 PARKVIEW PLAZA DRIVE FORT WAYNE IN 46845 JEANNE' WICKENS PH CFO 2602669313 2019-11-11 1 KENNETH J KEBER P00240883 5742323992 204.58.171.16 2019-11-11 15:56:24 ES P B38744F01C9F8B49338464F7361C640636AC5E7B B38744F01C9F8B49338464F7361C640636AC5E7B 2018 2020-03-31 21:24:44Z MICHAEL J PACKNETT 10501 CORPORATE DRIVE FORT WAYNE IN 46845 473807188 0 X WWW.PARKVIEWFOUNDATIONS.ORG X 1972 IN TO SERVE AS THE PRIMARY FUNDRAISING ENTITY FOR PARKVIEW HOSPITAL, INC. 16 10 17 115 0 0 3582690 5162723 0 0 673779 319824 -3829 -24712 4252640 5457835 1573700 905984 0 0 1059441 1295393 167975 308670 1218624 529835 540356 3330951 3050403 921689 2407432 12300363 13783797 522051 241310 11778312 13542487 X TO SERVE AS THE PRIMARY FUNDRAISING ENTITY FOR PARKVIEW HOSPITAL, INC. FUNDS ARE USED FOR THE CONTINUED IMPROVEMENT OF THE HOSPITAL'S FACILITIES, EQUIPMENT, PROGRAMS & SERVICES IN ACCORDANCE WITH THE NEEDS OF THE COMMUNITY WHERE THE HOSPITAL IS LOCATED. 0 0 1175057 905984 AT PARKVIEW HEALTH SYSTEM, INC. WE MAINTAIN FOUNDATIONS FOR EACH OF OUR HOSPITALS. THESE NONPROFIT ORGANIZATIONS PROVIDE PHILANTHROPIC SUPPORT FOR OUR MISSION OF PROVIDING QUALITY HEALTH SERVICES TO ALL WHO ENTRUST THEIR CARE TO PARKVIEW. WE ALSO STRIVE TO IMPROVE THE HEALTH OF THE COMMUNITIES THAT WE SERVE.THE STAFF AT PARKVIEW FOUNDATION, INC. BUILDS RELATIONSHIPS THAT FOSTER GIFT GIVING FOR THE BENEFIT OF OUR PATIENTS AND THEIR FAMILY MEMBERS, CAREGIVERS, HOSPITAL PROGRAMS AND SERVICES, AND FOR EQUIPMENT. THESE RELATIONSHIPS ARE MADE WITH PARKVIEW HOSPITAL, INC. CO-WORKERS, PHYSICIANS, VENDORS, PATIENT FAMILIES, AND THE COMMUNITY AT LARGE. IN (SEE SCHEDULE O FOR CONTINUATION)AN IMPORTANT WAY, THE PARKVIEW FOUNDATION, INC. IS COMPOSED OF A COLLECTION OF INDIVIDUAL DONORS WHO SEE PARKVIEW HOSPITAL, INC. AS AN AGENT FOR SAVING AND CHANGING LIVES. MOREOVER, THEY VIEW PARKVIEW FOUNDATION, INC. AS A VEHICLE FOR TRANSFORMING LIVES, CHANGING COMMUNITIES, AND PROVIDING HOPE.EACH GIFT RECEIVED BY PARKVIEW FOUNDATION, INC. IS EITHER IMMEDIATELY SPENT, OR SET ASIDE, FOR THE BENEFIT OF PARKVIEW HOSPITAL, INC. ALL GIFTS, FROM THOSE MADE BY EMPLOYEES, INDIVIDUALS, OR OUTSIDE ORGANIZATIONS ARE GREATLY APPRECIATED.IN 2018, THESE GIFTS WERE TRANSFORMED INTO MANY NEW IMPROVEMENTS FOR PATIENT CARE. THE FOLLOWING ARE A FEW EXAMPLES OF PARKVIEW FOUNDATION, INC. PROVIDING FUNDING TO PARKVIEW HOSPITAL, INC. FOR VARIOUS HOSPITAL PROGRAMS, SERVICES, EQUIPMENT AND IMPROVEMENTS:EMPLOYEE EMERGENCY ASSISTANCE PROGRAM:-GROCERY GIFT CARDS TO SUPPORT EMERGENCY EMPLOYEE ASSISTANCE NEEDSPARKVIEW CANCER INSTITUTE:-GENETIC RESEARCH COUNSELING FOR CANCER PATIENTS-CANCER PATIENT SUPPLIES, SUCH AS WIGS AND ACCESSORIES, NUTRITIONAL SUPPLIES, PATIENT EDUCATION BINDERS AND MATERIALPEDIATRICS UNIT:-FIVE DVD PLAYERS AND BRACKETS FOR PEDIATRIC ROOMSREHAB OUTPATIENT: -MINDCAP TRAINING COURSE - PEDS REHAB TEAMPARKVIEW BEHAVIORAL HEALTH:-CHRISTMAS ITEMS FOR PATIENTS-STAFF TRAINING TO HELP PATIENTS WHO STRUGGLE WITH GRIEF, PANIC, PHOBIA, SUBSTANCE ABUSETRAINING & EDUCATION:-TRAUMA SYMPOSIUM - FIVE EMPLOYEES-COMMUNICATIONS TRAINING COURSE - THREE EMPLOYEES-MIND CAP TRAINING COURSE - SPEECH PATHOLOGISTSUPPORTIVE CARE:-SAPPHIRE PUMPS FOR END-OF-LIFE HOSPICE CARE PATIENTSEQUIPMENT:-USCAN BLADDER SCANNER TABLET SYSTEM FOR POST-ACUTE CONTINUING CARE & INPATIENT REHABFRANCINE'S FRIENDS MOBILE MAMMOGRAPHY:-SCREENING MAMMOGRAMS-DIAGNOSTIC EXAMS AND SERVICESSPECIAL TOUCH FUND:-PRESCRIPTION ASSISTANCE-INFANT CAR SEAT PROGRAM-WHEELCHAIR RAMPNEW LIFE CENTER:-INFANT MEMORY BOXES FOR FAMILIES WITH PERINATAL LOSSPEDIATRIC PULMONARY FUND: -AIRWAY MANAGEMENT STAFF COMPLIANCE TRAINING FLIGHT PROGRAM:-STRYKER POWER LOAD COT SYSTEM FOR SAMARITAN FLIGHT SERVICES PARKVIEW HOSPICE PROGRAM:-TWO SMART TV FOR INFUSION AREA-PATIENT PILLBOXES MISSION & COMMUNITY OUTREACH:-PATIENT EDUCATION FOLDERS-I-SPEAK TRANSLATION BOOKLETS TO ASSIST WITH COMMUNICATION BETWEEN PATIENT AND STAFF-MAGNETS FOR PATIENTS REGARDING SEPSIS EDUCATIONPARKVIEW HEART INSTITUTE:-ZOLL LIFE VESTS WEARABLE DEFIBRILLATORS FOR FIRST MONTH OF WEAR-ECMO CONFERENCE - 6 PEOPLE ATTENDED. RECEIVED ELSO PATHWAYS TO EXCELLENCE AWARD AT CONFERENCE RESPIRATORY CARE EDUCATION:-AIM HIGH CONFERENCE SPEAKERMCHA COMMUNITIES - OHIO:-DIAGNOSTIC MAMMOGRAPHY SERVICES SIMULATION LAB:-TWO SIMULATION MANIKINS WITH WARRANTIESOTHER CAPITAL PURCHASES: -OUTDOOR SCULPTURE -GEO MACHINE 1175057 1 1 0 1 0 0 0 0 0 1 1 0 0 0 1 1 0 1 0 0 0 0 0 1 1 0 0 1 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 1 X 10 1 1 17 1 0 0 0 0 0 1 1 0 0 0 0 0 0 X 16 10 1 0 1 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 IN X JEANNE' WICKENS 2602669313 10501 CORPORATE DRIVE FORT WAYNE IN 46845 TIMOTHY MCELWEE DIRECTOR/SEC/TREAS/SVP FOUNDATIONS 40.00 5.00 X 315283 0 77638 BENJAMIN MILES DIRECTOR/PVHOS PRESIDENT 1.00 40.00 X 0 655188 140126 JAMES DOZIER DIRECTOR/PH PHYSICIAN 1.00 40.00 X 0 1256882 24503 JAMES EDLUND DIRECTOR/CHAIR/PH PHYSICIAN 1.00 40.00 X 0 382727 25379 ROBERT GODLEY DIRECTOR/PH PHYSICIAN 1.00 40.00 X 0 537753 62858 MICHAEL GRABOWSKI DIRECTOR/PH PHYSICIAN 1.00 42.00 X 0 881384 62737 MIKE ALTENDORF DIRECTOR 1.00 1.00 X 0 1000 0 MADELEINE BAKER DIRECTOR 1.00 0.00 X 0 0 0 IAN BOYCE DIRECTOR 1.00 1.00 X 0 4514 0 DANIEL GARMAN DIRECTOR 1.00 1.00 X 0 1326 0 TRACIE MARTIN DIRECTOR 1.00 0.00 X 0 0 0 BETH REGEDANZ DIRECTOR 1.00 0.00 X 0 0 0 CHRISTINE RUPP DIRECTOR 1.00 0.00 X 0 0 0 ALEX SMITH DIRECTOR 1.00 0.00 X 0 0 0 W THOMAS SMITH DIRECTOR 1.00 0.00 X 0 0 0 SUSAN TRENT DIRECTOR 1.00 0.00 X 0 0 0 MICHAEL PACKNETT PH PRESIDENT & CEO 1.00 56.00 X 0 1447044 759330 JEANNE' WICKENS PH CHIEF FINANCIAL OFFICER 1.00 56.00 X 0 869537 314918 TRACY BOSTWICK WBFND COMM HOSP FND DIR 0.00 40.00 X 28558 88500 35687 LIZABETH STEIN PVFND DIR LEADERSHIP GIFTS 40.00 40.00 X 54639 53881 26417 398480 6179736 1529593 3 0 1 0 GRENZEBACH GLIER & ASSOCIATES INC 200 S MICHIGAN AVENUE SUITE 2100 CHICAGO IL 60604 PROFESSIONAL FUNDRAISING 193458 1 358248 2295152 2509323 50674 5162723 278894 278894 468232056 468191126 40930 40930 40930 119640 358248 157449 -37809 -37809 13875 778 13097 13097 5457835 0 0 295112 X 802729 802729 103255 103255 392921 58938 137522 196461 661467 99222 231512 330733 241005 36150 84352 120503 308670 308670 15800 15800 15368 2619 2628 10121 8403 2101 840 5462 82904 23317 3110 56477 58807 7535 3015 48257 131686 32922 13168 85596 18882 1888 1888 15106 7356 1839 736 4781 1034 1034 280 70 28 182 CORP SERVICE ALLOCATION 162000 162000 DUES & SUBSCRIPTIONS 23180 2318 20862 BANK CHARGES 12166 12166 MISCELLANEOUS 2490 154 123 2213 3050403 1175057 656722 1218624 3275892 2118576 907860 856078 183958 183077 1161 881 8115450 10808262 12300363 13783797 27757 3013 494294 238297 522051 241310 X 6486505 6491838 4464123 6196950 827684 853699 11778312 13542487 12300363 13783797 X 2407432 -636411 -6846 X 0 1 X 1 0 X X 1 PARKVIEW HOSPITAL INC 350868085 3 1 660648 38305 1 660648 38305 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 PART I, LINE 11G, COLUMN VI TOYS, BOOKS, BLANKETS, BABY ITEMS, ETC. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 219 219 0 PART II-B, LINE 1: OTHER ACTIVITIES - REPRESENTS THE PORTION OF DUES PAID TO VARIOUS PROFESSIONAL ASSOCIATIONS USED FOR LOBBYING ACTIVITIES. 6123524 47384 -101047 13436 6056425 6059545 4000 86679 26700 6123524 6008489 225 64680 13849 6059545 5975804 4535 43549 15399 6008489 5977296 39 43003 44534 5975804 0.82550 0.14100 0.03350 0 0 183958 183077 881 881 PVFND-CHARITABLE GIFT ANNUITY 4853 DUE TO/FROM INTERUNIT 233444 238297 X PART V, LINE 4: BOARD DESIGNATED ENDOWMENTS ARE USED TO COVER THE OPERATING EXPENSES OF THE FOUNDATION. PERMANENT ENDOWMENTS ARE USED FOR SCHOLARSHIPS AND CHAPLAINCY SERVICES. 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, 2018 AND 2017, 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 NO LONGER SUBJECT TO EXAMINATION FOR THE YEAR 2014 AND PRIOR. X X X X X X 1 GRENZEBACH GLIER & ASSOCIATES INC 200 S MICHIGAN AVENUE SUITE 2100 CHICAGO IL 60604 DEVELOPMENT & CONSULTATION SERVICES 0 0 193458 -193458 SNF WRITING SOLUTIONS LLC P O BOX 7652 GREENWOOD IN 46142 GRANT WRITING SERVICES 0 0 65337 -65337 CANDACE SCHULER 7022 PALLADIO SQUARE FORT WAYNE IN 46804 GRANT WRITING SERVICES 0 0 36300 -36300 BRAND INNOVATION GROUP LLC 8902 AIRPORT DRIVE SUITE A FORT WAYNE IN 46809 CONSULTATION & PREPARATION OF SOLICITATION MATERIAL 0 0 13575 -13575 308670 -308670 AK AL AR AZ CA CT CO FL GA HI IL IN KS KY MA MD ME MI MN MO MS NC NH NJ NM NY OH OK OR PA RI SC TN UT VA WA WI WV COOKIN' MEN EVENT 222691 147536 75155 10228 14064 50301 GOLF OUTING 188203 148038 40165 2289 30720 11883 25744 1 66994 62674 4320 2000 10220 477888 358248 119640 2289 42948 36167 76045 157449 -37809 SCHEDULE G, PART I, LINE 2B, COLUMN (V) THE TOTAL PAYMENT OF $193,458 TO PROFESSIONAL FUNDRAISER, GRENZEBACH GLIER & ASSOCIATES, INC., CONSISTED OF $181,763 FOR DEVELOPMENT AND CONSULTATION SERVICES, AND $11,695 FOR REIMBURSEMENT OF TRAVEL EXPENSES. THE TOTAL PAYMENT OF $65,337 TO PROFESSIONAL FUNDRAISER, SNF WRITING SOLUTIONS, LLC, CONSISTED OF $62,739 FOR GRANT WRITING AND COORDINATING SERVICES, AND $2,598 FOR REIMBURSEMENT OF TRAVEL EXPENSES. SCHEDULE G, PART I, LINE 2B, COLUMN IV: GROSS RECEIPTS FROM ACTIVITY: THE GROSS RECEIPTS ASSOCIATED WITH THE ACTIVITIES OF THE PROFESSIONAL FUNDRAISERS ARE NOT READILY ASCERTAINABLE AS THE GRANT WRITING, COORDINATING, DEVELOPMENT AND CONSULTATION SERVICES WERE RENDERED ON BEHALF OF MULTIPLE PARKVIEW ORGANIZATIONS AND WERE NOT DIRECTLY CONNECTED WITH SPECIFIC FUNDRAISING ACTIVITIES. AS SUCH, NO AMOUNTS HAVE BEEN DISCLOSED IN PART I, LINE 2B, COLUMN IV. 1 PARKVIEW HEALTH SYSTEM INC 10501 CORPORATE DRIVE FORT WAYNE IN 46845 351972384 501(C)(3) 85157 N/A N/A SYSTEM PROGRAMS PARKVIEW HOSPITAL INC 11109 PARKVIEW PLAZA DRIVE FORT WAYNE IN 46845 350868085 501(C)(3) 660648 38305 OTHER TOYS, BOOKS, BLANKETS, BABY ITEMS, ETC. HOSPITAL PROGRAMS PARKVIEW OCCUPATIONAL HEALTH CENTERS INC 10501 CORPORATE DRIVE FORT WAYNE IN 46845 352064353 501(C)(3) 18500 N/A N/A EMPLOYEE EMERGENCY ASSISTANCE PROGRAM CLASSES 3 0 EMPLOYEE EMERGENCY ASSISTANCE FUND 114 76255 SCHOLARSHIPS 26 27000 PART I, LINE 2: HOSPITAL FUNDING: HOSPITAL DEPARTMENTS COMPLETE FUNDING REQUEST FORMS THAT ARE RETURNED TO THE FOUNDATION. UPON COMPLETION OF THE PROJECT, THE DEPARTMENT SUBMITS A REIMBURSEMENT REQUEST ALONG WITH AN ATTACHED PURCHASE ORDER OR RECEIPT FOR SUPPLIES. BASED UPON THE ORGANIZATION'S AUTHORITY TO ACT POLICY, APPROVALS ARE MADE BY THE FOUNDATION DIRECTOR AND FOUNDATION BOARD. EMPLOYEE EMERGENCY ASSISTANCE FUND (EEAF): THE EEAF PROVIDES LIMITED FINANCIAL ASSISTANCE FOR PARKVIEW EMPLOYEES FOR SHORT-TERM CRISIS SITUATIONS THAT ARE THE RESULT OF EMERGENCIES OR CATASTROPHIC EVENTS. THE FUNDS ARE USED AS A LAST RESORT FOR BASIC NEEDS SUCH AS FOOD, SHELTER, UTILITIES, ETC. TO BE ELIGIBLE AN EMPLOYEE MUST: -BE AN EMPLOYEE OF PARKVIEW FOR A MINIMUM OF 6 MONTHS -BE AT LEAST A .5 FTE STATUS -HAVE NOT RECEIVED MONEY FROM THE FUND IN THE LAST 24 MONTHS -COMPLETE AN APPLICATION FORM THE EEAF COMMITTEE SHALL: -REVIEW, CONSIDER AND MAKE DECISIONS RELATIVE TO THE EMPLOYEE'S APPLICATION FOR ASSISTANCE AND APPROVE A REQUEST BY A MAJORITY OF AFFIRMATIVE VOTES -CONSIST OF BETWEEN FIVE (5) AND ELEVEN (11) PARKVIEW EMPLOYEES REPRESENTING A CROSS SECTION OF THE EMPLOYEE COMMUNITY AND WILL INCLUDE BOTH MANAGEMENT AND NON-MANAGEMENT EMPLOYEES -BE APPOINTED BY THE FOUNDATION DIRECTOR -NOT BE AWARE OF THE IDENTITY OF THE EMPLOYEE MAKING THE REQUEST SCHOLARSHIPS: 1) ROLLAND SCHOLARSHIP -APPLICANTS MUST BE A HIGH SCHOOL SENIOR PREPARING TO ENTER THE SCHOOL OF NURSING AT THE UNIVERSITY OF SAINT FRANCIS OR INDIANA UNIVERSITY-PURDUE UNIVERSITY AT FORT WAYNE WITH THE INTENT OF COMPLETING AN R.N. PROGRAM OF STUDY. -APPLICANTS MUST RESIDE IN ALLEN, DEKALB, NOBLE, WHITLEY, HUNTINGTON, WELLS OR ADAMS COUNTY. -APPLICANTS MUST SHOW ACADEMIC ABILITY, AS EVIDENCED BY A "B" AVERAGE OR BETTER ON THE HIGH SCHOOL TRANSCRIPT AND EXHIBIT SOME FINANCIAL NEED, AS EVIDENCED BY THE STATEMENT OF FINANCIAL CHALLENGES. ONE SCHOLARSHIP WILL BE AWARDED ANNUALLY AND IS RENEWABLE FOR UP TO THREE ADDITIONAL YEARS, PROVIDED THE STUDENT MAINTAINS A "B" AVERAGE OR BETTER AND IS MAKING PROGRESS, AS DEFINED BY UNIVERSITY STANDARDS, TOWARD COMPLETION OF THE R.N. DEGREE. APPLICATIONS ARE AVAILABLE AT LOCAL HIGH SCHOOLS. THE EXECUTIVE DIRECTOR OF THE FOUNDATION MEETS WITH MEMBERS OF THE ROLLAND FAMILY TO REVIEW QUALIFIED APPLICANTS' INFORMATION. THE FAMILY MAKES THE FINAL DECISION. 2) SUE JOHNSON SCHOLARSHIP THE SCHOLARSHIP IS AVAILABLE TO ALL ELIGIBLE CANDIDATES SYSTEM-WIDE. CANDIDATES MUST MEET THE FOLLOWING CRITERIA IN ORDER TO BE CONSIDERED FOR THE SCHOLARSHIP: -BE ENROLLED IN A B.S. NURSING PROGRAM -HAVE AT LEAST TWO (2) YEARS OF SERVICE WITH PARKVIEW -HAVE A FTE STATUS OF .4 OR HIGHER -BE IN GOOD STANDING WITH NO DISCIPLINARY ACTIONS IN THE PREVIOUS TWO (2) YEARS -IF APPLYING FOR A SECOND YEAR OF FUNDING, CANDIDATES MUST PROVIDE PROOF THAT HE/SHE COMPLETED THE FIRST YEAR WITH AT LEAST A "B" AVERAGE OR EQUIVALENT. -MUST PROVIDE ONE (1) PROFESSIONAL RECOMMENDATION FROM A SUPERVISOR, COWORKER, OR EDUCATOR QUALIFIED APPLICANTS' INFORMATION IS REVIEWED BY A PANEL CONSISTING OF SVP PATIENT CARE, MANAGER CLINICAL STAFF DEVELOPMENT, AND A FOUNDATION STAFF MEMBER. 3) DARLENE TIELKER MEMORIAL SCHOLARSHIP AVAILABLE TO GRADUATING HIGH SCHOOL SENIORS THROUGHOUT NORTHEAST IN OR PARKVIEW COWORKERS SYSTEM WIDE. CRITERIA FOR HIGH SCHOOL STUDENTS: THE SCHOLARSHIP IS AVAILABLE TO ALL HIGH SCHOOL SENIORS OR PARKVIEW COWORKERS PURSUING AN ADVANCED DEGREE IN NURSING. CANDIDATES MUST MEET THE FOLLOWING CRITERIA IN ORDER TO BE CONSIDERED FOR THE SCHOLARSHIP: -MUST BE ACCEPTED TO AND PLANNING TO ATTEND INDIANA UNIVERSITY-PURDUE UNIVERSITY AT FORT WAYNE. -MUST BE ACCEPTED TO B.S. NURSING PROGRAM AT INDIANA-PURDUE UNIVERSITY AT FORT WAYNE. -CARRY A CUMULATIVE G.P.A. OF AT LEAST "B" (OR EQUIVALENT) -PROVIDE PROOF OF FINANCIAL NEED -PROVIDE TWO (2) RECOMMENDATIONS FROM A TEACHER, AN EMPLOYER, A CHURCH OR COMMUNITY LEADER, AN EXTRACURRICULAR COACH OR MENTOR CRITERIA FOR PARKVIEW COWORKERS: THE SCHOLARSHIP IS AVAILABLE TO ALL ELIGIBLE PARKVIEW COWORKERS SYSTEM-WIDE WHO ARE PURSUING A BACHELOR'S DEGREE IN NURSING AT INDIANA-PURDUE FORT WAYNE. CANDIDATES MUST MEET THE FOLLOWING CRITERIA IN ORDER TO BE CONSIDERED FOR THE SCHOLARSHIP: -BE ACCEPTED TO AND PLANNING TO ATTEND THE B.S. NURSING PROGRAM AT INDIANA-PURDUE UNIVERSITY AT FORT WAYNE. -HAVE AT LEAST 2 YEARS OF SERVICE WITH PARKVIEW -BE IN GOOD STANDING WITH NO DISCIPLINARY ACTIONS IN THE PREVIOUS TWO (2) YEARS -PROVIDE PROOF OF FINANCIAL NEED -MUST PROVIDE TWO (2) RECOMMENDATIONS, ONE OF WHICH MUST BE FROM A SUPERVISOR, COWORKER, OR EDUCATOR. QUALIFIED APPLICANTS' INFORMATION IS REVIEWED BY DR. TIELKER AND HIS CHILDREN, AND THEY CHOOSE THE RECIPIENT BASED ON WHOM THEY FEEL BEST EXEMPLIFIED DARLENE TIELKER'S TRAITS AS A PERSON AND A NURSE. 4) CATHY E. HARRIS GOOD SAMARITAN SCHOLARSHIP THE SCHOLARSHIP WILL PROVIDE A TOTAL OF $2,000 A YEAR AT THE BEGINNING OF THE SCHOOL YEAR, DISTRIBUTED AMONGST THE RECIPIENTS. THOSE PURSUING BASIC EMT WILL BE ELIGIBLE FOR $300, ADVANCED EMT $700, AND PARAMEDIC $1,000. THE SCHOLARSHIP DOLLARS, WHICH WILL BE DISTRIBUTED DIRECTLY TO THE SCHOOL OR PROGRAM, MAY BE USED TOWARD TUITION AND/OR BOOKS. THE SCHOLARSHIP IS AVAILABLE TO ALL ELIGIBLE CANDIDATES OF NORTHEAST INDIANA AND NORTHWEST OHIO. CANDIDATES MUST MEET THE FOLLOWING CRITERIA IN ORDER TO BE CONSIDERED FOR THE SCHOLARSHIP: -ACCEPTED INTO OR ENROLLED INTO A EMT, ADVANCED EMT, OR PARAMEDIC PROGRAM -HAVE AT LEAST ONE (1) YEAR OF SERVICE WITH PARKVIEW HEALTH -BE IN GOOD STANDING WITH NO DISCIPLINARY ACTIONS IN THE PREVIOUS YEAR -MUST PROVIDE ONE (1) PROFESSIONAL RECOMMENDATION FROM A SUPERVISOR, COWORKER, OR EDUCATOR QUALIFIED APPLICANTS' INFORMATION IS REVIEWED BY A PANEL CONSISTING OF PARKVIEW SENIOR STAFF. 5) DR. JAMES E. ALBRIGHT PARKVIEW SPORTS MEDICINE EXCELLENCE SCHOLARSHIP THE SCHOLARSHIP HONORS REMARKABLE SENIOR STUDENT ATHLETES. THESE ATHLETES ARE NOMINATED BY THEIR ATHLETIC TRAINERS - AND SELECTED BY THE SCHOLARSHIP REVIEW COMMITTEE - BASED ON THE FOLLOWING CRITERIA: -EXCEL ACADEMICALLY -MAKE A POSITIVE IMPACT ON THEIR COMMUNITY -DEMONSTRATE EXCEPTIONAL LEADERSHIP SKILLS -EXHIBIT OUTSTANDING ATHLETIC ABILITY THEY RECEIVE FUNDING FOR FOUR YEARS, BASED ON THE FOLLOWING SCHEDULE: YEAR 1: $1,000 YEAR 2: $750 YEAR 3: $500 YEAR 4: $250 6) DR. DARRYL R. SMITH MED-TECH SCHOLARSHIP TWO $1,000 SCHOLARSHIPS WILL BE AWARDED EACH YEAR. ONE TO THE PARKVIEW MED-TECH STUDENT WITH THE HIGHEST GRADE POINT AVERAGE AND THE OTHER TO THE PARKVIEW MED-TECH STUDENT WITH THE GREATEST FINANCIAL NEED. QUALIFIED APPLICANTS' INFORMATION IS REVIEWED BY A PANEL CONSISTING OF PARKVIEW MED-TECH SENIOR STAFF. THE PANEL WILL INFORM THE FOUNDATION OF THE SELECTED RECIPIENTS AND THE FOUNDATION WILL INFORM DR. AND MRS. SMITH OF THE SCHOLARSHIP RECIPIENTS, INCLUDING BIOGRAPHICAL INFORMATION ABOUT THE AWARDEES. X X 1 1 0 1 0 0 0 0 0 1 0 TIMOTHY MCELWEE DIRECTOR/SEC/TREAS/SVP FOUNDATIONS 232938 0 57807 0 24538 0 49375 0 28263 0 392921 0 0 0 BENJAMIN MILES DIRECTOR/PVHOS PRESIDENT 0 507288 0 111879 0 36021 0 104242 0 35884 0 795314 0 31782 JAMES DOZIER DIRECTOR/PH PHYSICIAN 0 1235544 0 0 0 21338 0 5500 0 19003 0 1281385 0 0 JAMES EDLUND DIRECTOR/CHAIR/PH PHYSICIAN 0 299735 0 69396 0 13596 0 8250 0 17129 0 408106 0 0 ROBERT GODLEY DIRECTOR/PH PHYSICIAN 0 453826 0 49099 0 34828 0 30250 0 32608 0 600611 0 0 MICHAEL GRABOWSKI DIRECTOR/PH PHYSICIAN 0 715192 0 128267 0 37925 0 30250 0 32487 0 944121 0 17796 MICHAEL PACKNETT PH PRESIDENT & CEO 0 1060073 0 345323 0 41648 0 723342 0 35988 0 2206374 0 0 JEANNE' WICKENS PH CHIEF FINANCIAL OFFICER 0 642848 0 176468 0 50221 0 284505 0 30413 0 1184455 0 28885 TRACY BOSTWICK WBFND COMM HOSP FND DIR 28434 75860 0 12308 124 332 3228 10004 5478 16977 37264 115481 0 0 PART I, LINE 1A TRAVEL FOR COMPANIONS - TAXABLE EXPENSE REIMBURSEMENT FOR FAMILY MEMBER PAID TO: TIMOTHY MCELWEE $357 NON-TAXABLE MANDATORY ANNUAL MEDICAL PHYSICAL PAID FOR: TIMOTHY MCELWEE $4,012 PART I, LINE 3 RELATED ORGANIZATION, PARKVIEW HEALTH SYSTEM, INC., USES THE FOLLOWING TO ESTABLISH THE COMPENSATION OF PARKVIEW FOUNDATION, 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 TAXABLE - MICHAEL GRABOWSKI $17,796; BENJAMIN MILES $31,782; JEANNE' WICKENS $28,885 PARTICIPANTS DEFERRED - 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. BENEFITS EARNED UNDER THE PLANS WILL FUND THE EMPLOYEES' EVENTUAL RETIREMENT BENEFIT. THESE BENEFITS ARE PROVIDED IN EXCHANGE FOR ALL OF THE EMPLOYEES' YEARS OF SERVICE TO THE ORGANIZATION, AND THE COST OF THE BENEFITS MAY VARY FROM YEAR TO YEAR. 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. BENJAMIN MILES $84,992; TIMOTHY MCELWEE $42,500; MICHAEL PACKNETT $698,592; JEANNE' WICKENS $274,192 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. X TOYS, BOOKS, BLANKETS, BABY ITEMS, ETC. 17 38305 ESTIMATED VALUE X EVENT ITEMS 35 12369 ESTIMATED VALUE 0 1 0 PART I, COLUMN (B): THE ORGANIZATION USED NUMBER OF CONTRIBUTORS FOR LINES 25 & 26. FORM 990, PART V, LINES 1A, 1B AND 2A: PARKVIEW HEALTH SYSTEM, INC. (PH), EIN 35-1972384 IS THE COMMON PAYING AGENT FOR THE FILING ORGANIZATION, PARKVIEW FOUNDATION, INC., EIN 23-7220589. 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, 2018 WAS 568. THE TOTAL NUMBER OF EMPLOYEES REPORTED ON FORM W-3 AND FILED BY THE COMMON PAYING AGENT, PH, FOR THE YEAR ENDED DECEMBER 31, 2018 WAS 13,593. FOR PURPOSES OF COMPLETING FORM 990, PART V, LINE 1A, 1B, AND 2A, THE NUMBER REPORTED FOR THE PARKVIEW FOUNDATION, INC. WAS 10 AND 17 RESPECTIVELY. OF THE 10 REPORTED ON PART V, LINE 1A, PARKVIEW FOUNDATION, INC. DIRECTLY FILED 2 FORMS 1099-R TO REPORT ANNUITIES EARNED BY A PROGRAM OWNED AND FUNDS HELD BY PARKVIEW FOUNDATION, INC. FORM 990, PART VI, SECTION A, LINE 1 THE EXECUTIVE COMMITTEE SHALL BE COMPOSED OF THE OFFICERS OF THE BOARD, THE CHIEF ADMINISTRATIVE OFFICER OF THE CORPORATION, THE PRESIDENT AND CHIEF EXECUTIVE OFFICER OF PARKVIEW HEALTH OR HIS/HER DESIGNEE, AND THE PRESIDENT OR CHIEF OPERATING OFFICER OF THE CORPORATE MEMBER, AND SUCH OTHER PERSONS AS IDENTIFIED BY THE CHAIR, 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 OFFICER JEANNE' WICKENS AND DIRECTORS MICHAEL GRABOWSKI AND BENJAMIN MILES HAVE A BUSINESS RELATIONSHIP AS DIRECTORS ON THE BOARD OF A RELATED ENTITY. FORM 990, PART VI, SECTION A, LINE 4 DURING 2018, THE FOLLOWING SIGNIFICANT CHANGE WAS MADE TO THE BYLAWS OF PARKVIEW FOUNDATION, INC.: ARTICLE IX - COMMITTEES OF THE BOARD OF DIRECTORS, SECTION 9 - VOLUNTEERS WAS ADDED TO ALLOW THE BOARD TO AUTHORIZE VOLUNTEERS AND OTHER COMMITTEE MEMBERS TO ASSIST IN FACILITATING GAMING ACTIVITES AND IS AS FOLLOWS: THE FOUNDATION BOARD MAY AUTHORIZE VOLUNTEERS AND OTHER COMMITTEE MEMBERS TO ASSIST IN FACILITATING GAMING ACTIVITIES, SUCH AS THE SALE OF RAFFLE TICKETS, ON BEHALF OF THE PARKVIEW HOSPITAL FOUNDATION. HOWEVER, SUCH VOLUNTEERS AND COMMITTEE MEMBERS SHALL HAVE NO VOTING RIGHTS AND ARE NOT PERMITTED TO PARTICIPATE IN PARKVIEW HOSPITAL FOUNDATION BOARD MEETINGS. 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 HOSPITAL, INC. EIN 35-0868085 IS THE SOLE MEMBER OF PARKVIEW FOUNDATION, INC. WITH CERTAIN RESERVED POWERS. FORM 990, PART VI, SECTION A, LINE 7A THE CORPORATE MEMBER SHALL HAVE THE FOLLOWING RESERVED POWERS: (A) APPOINT DIRECTORS (INCLUDING APPOINTMENTS TO FILL A VACANCY) AND INITIATE THE REMOVAL AND REMOVE ANY DIRECTOR OF THE CORPORATION, WITH CAUSE, PROVIDED CONSIDERATION IS GIVEN TO RECOMMENDATIONS OF THE BOARD REGARDING SUCH APPOINTMENT OR REMOVAL, IF ANY ARE SO MADE; (B) APPOINT (INCLUDING APPOINTMENTS TO FILL A VACANCY) AND INITIATE THE REMOVAL AND REMOVE THE CHIEF ADMINISTRATIVE OFFICER OF THE CORPORATION, WITH OR WITHOUT CAUSE, PROVIDED CONSIDERATION IS GIVEN TO RECOMMENDATIONS OF THE BOARD REGARDING SUCH APPOINTMENT OR REMOVAL, IF ANY ARE SO MADE; (C) APPROVE AND ADOPT THE STRATEGIC PLAN FOR THE CORPORATION, INCLUDING ANY INDIVIDUAL INITIATIVES OR ARRANGEMENTS, SUCH AS A NEW SERVICE OR CONTRACTUAL ARRANGEMENT, DEEMED BY THE CORPORATE MEMBER TO BE OF STRATEGIC IMPORTANCE TO THE CORPORATION AND DIRECT AND MONITOR COMPLIANCE WITH SUCH PLANS, INITIATIVES AND ARRANGEMENTS; (D) APPROVE AND ADOPT THE CAPITAL AND OPERATING BUDGETS OF THE CORPORATION; (E) APPROVE THE INCURRENCE OF ANY DEBT PROPOSED BY THE CORPORATION, AND REQUIRE THE INCURRENCE OF DEBT BY THE CORPORATION, WHERE APPROPRIATE; (F) APPROVE THOSE TRANSFERS OF ASSETS BY THE CORPORATION, WHETHER BY SALE OR GIFT, WHERE THE ASSET BEING TRANSFERRED IS AN INTEREST IN REAL PROPERTY OR IS AN OPERATING ASSET OF THE CORPORATION, UNLESS OTHERWISE IDENTIFIED IN PREVIOUSLY APPROVED STRATEGIC PLANS, INITIATIVES, ARRANGEMENTS OR BUDGETS; (G) APPROVE PARTICIPATION (INCLUDING THE EXERCISE OF RENEWAL OPTIONS) BY THE CORPORATION IN NETWORKS, AFFILIATIONS, JOINT VENTURES, AND PARTNERSHIPS, AND REQUIRE PARTICIPATION BY THE CORPORATION IN SUCH ARRANGEMENTS; (H) APPROVE ANY AMENDMENT TO THE BYLAWS OR THE ARTICLES OF INCORPORATION OF THE CORPORATION, AND REQUIRE AMENDMENT OF THESE GOVERNING DOCUMENTS AS NECESSARY OR ADVISABLE TO RESOLVE SIGNIFICANT ETHICAL ISSUES, TO MAINTAIN TAX-EXEMPT STATUS, OR TO PREVENT SIGNIFICANT ADVERSE LEGAL OR FINANCIAL EFFECTS TO THE CORPORATION OR THE CORPORATE MEMBER. THE CORPORATE MEMBER SHALL FROM TIME TO TIME DEVELOP POLICIES FOR THE IMPLEMENTATION OF THE RESERVED POWERS. 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 FOUNDATION, 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 2, 2019, 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, 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: DOUBTFUL PLEDGE EXPENSE -6,846. PARKVIEW HEALTH SYSTEM INC 10501 CORPORATE DRIVE FORT WAYNE IN 46845 351972384 HEALTH CARE IN 501(C)(3) LINE 12C, III-FI N/A 0 PARKVIEW HOSPITAL INC 11109 PARKVIEW PLAZA DRIVE FORT WAYNE IN 46845 350868086 HOSPITAL CARE IN 501(C)(3) LINE 3 PARKVIEW HEALTH SYSTEM INC 0 PARKVIEW PROFESSIONAL PROGRAMS INC 10501 CORPORATE DRIVE FORT WAYNE IN 46845 351668888 REFERENCE LAB IN N/A C 0 0 1 1 0 0 0 0 0 0 0 1 0 1 0 1 0 0 0 0