WHITLEY MEMORIAL HOSPITAL INC: Form 990, tax year 2016
View the entire original 990 at ProPublica ↗
- Organization
- WHITLEY MEMORIAL HOSPITAL INC (EIN 35-1967665)
- Tax period
- 2016-01-01 to 2016-12-31
- Filed
- 2017-11-12
- IRS object ID
- 201743169349300824
- Schema version
- 2016v3.0
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule H
- Schedule I
- Schedule J
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2017-11-12T15:17:44-06:00 | ReturnTs |
| Tax Period End | 2016-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 350921680 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CROWE HORWATH LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 330 E JEFFERSON BLVD P O BOX 7 | AddressLine1Txt |
| City | SOUTH BEND | CityNm |
| State Abbreviation | IN | StateAbbreviationCd |
| ZIP | 466240007 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2016-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 351967665 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WHITLEY MEMORIAL HOSPITAL INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | WHIT | BusinessNameControlTxt |
| Phone | 2603738429 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1260 EAST STATE ROAD 205 | AddressLine1Txt |
| City | COLUMBIA CITY | CityNm |
| State Abbreviation | IN | StateAbbreviationCd |
| ZIP | 46725 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | JEANNE' WICKENS | PersonNm |
| Person Title | PH CFO | PersonTitleTxt |
| Phone | 2603738407 | PhoneNum |
| Signature | 2017-11-12 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | KENNETH J KEBER | PreparerPersonNm |
| PTIN | P00240883 | PTIN |
| Phone | 5742323992 | PhoneNum |
| Self Employed | Yes (X) | SelfEmployedInd |
Filing Security Information FilingSecurityInformation
IP Address IPAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| I Pv4 Address | 204.58.171.16 | IPv4AddressTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IP | 2017-11-12 | IPDt |
| IP Tm | 16:01:35 | IPTm |
| IP Timezone | ES | IPTimezoneCd |
| Filing License Type | P | FilingLicenseTypeCd |
| At Submission Creation Device Id | BD78C0151F32BCCEC501E79B474C54CD1328F117 | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | BD78C0151F32BCCEC501E79B474C54CD1328F117 | AtSubmissionFilingDeviceId |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2016 | TaxYr |
| Build TS | 2017-02-10 21:41:12Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | MICHAEL J PACKNETT | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 10501 CORPORATE DRIVE | AddressLine1Txt |
| City | FORT WAYNE | CityNm |
| State Abbreviation | IN | StateAbbreviationCd |
| ZIP | 46845 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $85,621,335 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.PARKVIEW.COM | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1995 | FormationYr |
| Legal Domicile State | IN | LegalDomicileStateCd |
| Activity Or Mission | WHITLEY MEMORIAL HOSPITAL, INC. WORKS TO IMPROVE THE HEALTH OF OUR COMMUNITIES AND PROVIDES QUALITY HEALTH SERVICES TO ALL WHO ENTRUST THEIR CARE TO US. | ActivityOrMissionDesc |
| Voting Members Governing Body | 13 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 9 | VotingMembersIndependentCnt |
| Total Employee | 379 | TotalEmployeeCnt |
| Total Volunteers | 33 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $215,596 | PYContributionsGrantsAmt |
| CY Contributions Grants | $200,319 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $57,905,195 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $72,958,461 | CYProgramServiceRevenueAmt |
| PY Investment Income | $952,681 | PYInvestmentIncomeAmt |
| CY Investment Income | $1,460,514 | CYInvestmentIncomeAmt |
| PY Other Revenue | $68,275 | PYOtherRevenueAmt |
| CY Other Revenue | $73,818 | CYOtherRevenueAmt |
| PY Total Revenue | $59,141,747 | PYTotalRevenueAmt |
| CY Total Revenue | $74,693,112 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $225,443 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $217,613 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $17,014,860 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $21,637,743 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $33,590,546 | PYOtherExpensesAmt |
| CY Other Expenses | $43,936,143 | CYOtherExpensesAmt |
| PY Total Expenses | $50,830,849 | PYTotalExpensesAmt |
| CY Total Expenses | $65,791,499 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $8,310,898 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $8,901,613 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $74,481,664 | TotalAssetsBOYAmt |
| Total Assets EOY | $94,855,104 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $38,671,803 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $12,997,465 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $35,809,861 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $81,857,639 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | WHITLEY MEMORIAL HOSPITAL, INC. WORKS TO IMPROVE THE HEALTH OF OUR COMMUNITIES AND PROVIDES QUALITY HEALTH SERVICES TO ALL WHO ENTRUST THEIR CARE TO US. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $55,419,386 | ExpenseAmt |
| Grant | $217,613 | GrantAmt |
| Revenue | $72,958,461 | RevenueAmt |
| Desc | AS A COMMUNITY PARTNER AND NOT-FOR-PROFIT ORGANIZATION, WHITLEY MEMORIAL HOSPITAL, INC. - A MEMBER OF PARKVIEW HEALTH - IS DEDICATED TO IMPROVING YOUR HEALTH AND INSPIRING YOUR WELL-BEING BY TAILORING A PERSONALIZED HEALTH JOURNEY TO ACHIEVE YOUR UNIQUE GOALS. BY DEMONSTRATING WORLD-CLASS TEAMWORK, WE PARTNER WITH YOU ALONG THAT JOURNEY AND PROVIDE THE EXCELLENCE, INNOVATION AND VALUE YOU SEEK IN TERMS OF CONVENIENCE, COMPASSION, SERVICE, COST AND QUALITY. WHITLEY MEMORIAL HOSPITAL, INC. IS KEEPING PACE WITH THE RAPIDLY CHANGING HEALTHCARE INDUSTRY BY INCORPORATING NEW TECHNOLOGY AND THE LATEST DIAGNOSTIC AND TREATMENT PROCEDURES WHILE CONTINUALLY SEEKING(SEE SCHEDULE O FOR CONTINUATION)WAYS TO GIVE BACK TO THE COMMUNITY WE SERVE. OUR CORE VALUES ARE DISPLAYED THROUGH OUR MANY COMMUNITY EDUCATION AND OUTREACH PROGRAMS AS WELL AS OUR CHARITY CARE SERVICES AND THE VOLUNTEERISM OF OUR EMPLOYEES. TO FURTHER ADDRESS THE SPECIFIC NEEDS OF THE COMMUNITY, PARKVIEW HEALTH ROUTINELY SPONSORS A PROFESSIONALLY ADMINISTERED COMMUNITY HEALTH NEEDS ASSESSMENT TO IDENTIFY HEALTH NEEDS WITHIN NORTHEAST INDIANA, PARTICULARLY, THE SEVEN COUNTIES IN WHICH HOSPITALS EXIST. THE FOLLOWING ARE SOME OF THE WAYS WHITLEY MEMORIAL HOSPITAL, 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 SCREENING/PREVENTION AND DISEASE MANAGEMENT-EDUCATIONAL AND SUPPORT PROGRAMS-SENIOR CLUB-VOLUNTEER PROGRAM/STAFF VOLUNTEERISM-EMS SERVICES -STAFF FITNESS CENTERFINANCIAL ASSISTANCE:WHITLEY MEMORIAL HOSPITAL, INC.'S MISSION INCLUDES CARING FOR PEOPLE WHO DO NOT HAVE THE MEANS TO MEET THEIR FINANCIAL OBLIGATIONS. A FINANCIAL COUNSELOR IS AVAILABLE TO ASSIST PATIENTS IN NAVIGATING THIS PROCESS. THE HOSPITAL'S HIGHEST PRIORITY IS PROVIDING NECESSARY CARE FOR THE PATIENT, NOT THE PATIENT'S ABILITY TO PAY FOR HIS/HER MEDICAL EXPENSES. COMMUNITY HEALTH IMPROVEMENT INITIATIVES:WHITLEY MEMORIAL HOSPITAL, INC.'S COMMUNITY HEALTH IMPROVEMENT PROGRAM WAS ESTABLISHED TO HELP FUND COMMUNITY HEALTH IMPROVEMENT EFFORTS WITHIN WHITLEY MEMORIAL HOSPITAL'S SERVICE AREA. THE HOSPITAL SETS ASIDE UP TO 10 PERCENT OF ITS NET INCOME ANNUALLY TO FUND COMMUNITY HEALTH INITIATIVES. BY PARTNERING WITH COMMUNITY ORGANIZATIONS, THESE FUNDS ARE USED TO ENCOURAGE HEALTHIER LIFESTYLES AMONG THE CITIZENS OF WHITLEY COUNTY AND KOSCIUSKO COUNTY WITH A SPECIAL EMPHASIS ON ADDRESSING THE HEALTH ISSUES IDENTIFIED IN THE COMMUNITY HEALTH NEEDS ASSESSMENT. WHITLEY MEMORIAL HOSPITAL, INC. INVESTS IN KEY ORGANIZATIONS THAT PROMOTE THE HEALTH AND WELL-BEING OF FAMILIES, CHILDREN, AND INDIVIDUALS OF THE COMMUNITIES SERVED. PRIMARY HEALTH CARE/ACCESS:WHITLEY MEMORIAL HOSPITAL, INC. FEATURES 30 BEDS WITH ALL PRIVATE ROOMS. EMERGENCY MEDICAL CARE, OBSTETRIC CARE AND A MEDICAL-SURGICAL UNIT ARE AVAILABLE AS WELL AS LAB, MULTIPLE MODALITY IMAGING, SURGICAL SERVICES, SLEEP DISORDERS LAB, OUTPATIENT INFUSION CENTER AND PHYSICAL REHABILITATION INCLUDING MASSAGE THERAPY. AN ATTACHED MEDICAL OFFICE BUILDING PROVIDES CONVENIENT, EASY ACCESS FOR PATIENTS TO RECEIVE CARE FROM FAMILY AND SPECIALTY PHYSICIANS. IN 2016, A 90,000 SQUARE FOOT OUTPATIENT FACILITY WAS OPENED IN WARSAW, INDIANA, TO PROVIDE EXCELLENT CARE FOR KOSCIUSKO COUNTY. PARKVIEW WARSAW SERVICES INCLUDE A FREE-STANDING EMERGENCY DEPARTMENT WITH TEN ROOMS, TWO OF WHICH ARE EQUIPPED FOR TRAUMA PATIENTS. THERE IS AN IMAGING DEPARTMENT WHICH PROVIDES DIAGNOSTIC RADIOLOGY, MAGNETIC RESONANCE (MR), COMPUTED TOMOGRAPHY (CT), ULTRASOUND, 3-D DIGITAL MAMMOGRAPHY AND DEXA BONE DENSITY SCANNING SERVICES. THE FACILITY ALSO INCLUDES LABORATORY, PHYSICAL REHABILITATION AND MASSAGE THERAPY AS WELL AS PRIMARY CARE AND SPECIALTY PHYSICIAN OFFICES. SHELL SPACE ON THE THIRD FLOOR PROVIDES AREA FOR GROWTH OF SERVICES IN THE FUTURE. PARKVIEW WARSAW OPERATES UNDER THE WHITLEY MEMORIAL HOSPITAL, INC. TAX ID AND PROVIDER NUMBERS.MEDICATION ASSISTANCE PROGRAM (MAP):BY PARTNERING WITH, PHYSICIANS, PHARMACEUTICAL COMPANIES, LOCAL PHARMACIES, AND DONORS, WHITLEY MEMORIAL HOSPITAL IS ABLE TO PROVIDE MEDICATION ASSISTANCE AT LITTLE OR NO COST FOR QUALIFIED INDIVIDUALS. EMERGENCY VOUCHERS FOR ACUTE MEDICATION NEEDS ARE REDEEMED AT LOCAL PHARMACIES. LONG-TERM MEDICATION HELP IS PROVIDED TO PATIENTS BY CONNECTING THEM WITH PHARMACEUTICAL ASSISTANCE PROGRAMS (PAP).HEALTH SCREENING/PREVENTION AND DISEASE MANAGEMENT:WHITLEY MEMORIAL HOSPITAL, INC. PARTICIPATES IN HEALTH FAIRS AND MANY OTHER ACTIVITIES THROUGHOUT THE YEAR TO PROVIDE HEALTH EDUCATION, HEALTH SCREENINGS FOR DISEASE PREVENTION AND TO PROMOTE HEALTHY LIFESTYLES AND WELL-BEING. THE HOSPITAL ALSO PROVIDES SUPPORT GROUPS TO ASSIST PATIENTS AND FAMILIES IN MANAGING DISEASE: -HEARTBEATS HEALTH FAIR, THE HOSPITAL'S OWN HEALTH FAIR, INCLUDES MULTIPLE HEALTH SCREENINGS AND HEALTH AND PREVENTION EDUCATION FOR ADULTS OF THE COMMUNITY. THIS EVENT DRAWS IN SEVERAL HUNDRED COMMUNITY MEMBERS EACH YEAR.-IHSAA PHYSICALS ARE PERFORMED FOR LOCAL JUNIOR AND SENIOR HIGH SCHOOL STUDENT ATHLETES. -WHITLEY MEMORIAL HOSPITAL, INC.'S BIRTH PLANNER AND LACTATION CONSULTANT CONDUCT BREASTFEEDING EDUCATION AND A SUPPORT GROUP FOR NEW MOMS. LAMAZE CLASSES ARE ALSO AVAILABLE TO PARENTS-TO-BE. -WHITLEY MEMORIAL HOSPITAL, INC. AND THE WHITLEY COUNTY COMMUNITY FOUNDATION PARTNER TOGETHER TO PROVIDE FREE MAMMOGRAPHY SCREENING TO WOMEN WHO ARE UNINSURED OR UNDERINSURED. THROUGH THE WOMEN'S GIVING CIRCLE, A FUND OF THE WHITLEY COUNTY COMMUNITY FOUNDATION, VOUCHERS ARE GIVEN TO WOMEN WHO ARE UNINSURED OR UNDERINSURED AND CAN BE REDEEMED AT THE HOSPITAL FOR MAMMOGRAMS.-WHITLEY MEMORIAL HOSPITAL, INC. PROVIDES FIRST RESPONDER AND ADVANCED EMT COURSES.-HEART SMART CT SCANS ARE OFFERED FOR A MINIMAL OUT-OF-POCKET FEE. THE SCAN IS A SIMPLE, NON-INVASIVE TEST THAT CAN DETECT CORONARY ARTERY DISEASE IT ITS EARLY STAGES. LUNG SCANS ARE AVAILABLE AS WELL FOR SMOKERS CONSIDERED TO BE "AT-RISK". THE TEST INVOLVES A LOW DOSE CT TO ASSIST IN DIAGNOSING EARLY STAGE LUNG CANCER.-WHITLEY MEMORIAL HOSPITAL, INC. IS DEDICATED TO THE WELL-BEING OF ITS CO-WORKERS ALONG WITH ITS PATIENTS. A FITNESS CENTER IS AVAILABLE 24/7 WITH A VARIETY OF EXERCISE AND STRENGTH TRAINING EQUIPMENT FOR ALL STAFF TO ENJOY. RECUMBENT BIKES ARE AVAILABLE WITHIN SEVERAL DEPARTMENTS AS WELL. EDUCATIONAL AND SUPPORT PROGRAMS:NUMEROUS OTHER EDUCATIONAL AND SUPPORT OPPORTUNITIES ARE AVAILABLE FOR THE PUBLIC SUCH AS CARDIO-PULMONARY REHAB SUPPORT, DIABETES SUPPORT, NUTRITION CLASSES, WEIGHT LOSS SUPPORT, ON-SITE SEASONAL FARMER'S MARKET AND SMOKING CESSATION CLASSES. CO-WORKERS, ALSO, VOLUNTEER THEIR TIME TO STAFF THE BOOTHS AT THE WHITLEY COUNTY AND KOSCIUSKO COUNTY 4-H FAIRS OFFERING EDUCATIONAL MATERIALS, BLOOD PRESSURE CHECKS AND A PRIVATE LACTATION AREA. WHITLEY MEMORIAL HOSPITAL, INC. WORKS WITH LOCAL HIGH SCHOOLS TO PROVIDE OPPORTUNITIES FOR STUDENTS TO BE INTERNS IN A VARIETY OF SETTINGS, ALLOWING THEM TO EXPLORE CAREERS IN CLINICAL AND NON-CLINICAL HOSPITAL ENVIRONMENTS. THE HOSPITAL ALSO OFFERS AN ANNUAL KID'S FAIR WHICH INCLUDES PARTICIPATION FROM OTHER LOCAL NON-PROFIT ORGANIZATIONS AS WELL AS A BICYCLE HELMET GIVE-AWAY TO PROMOTE BICYCLE SAFETY. A CHAPLAINCY PROGRAM WAS STARTED IN 2016 TO PROVIDE SPIRITUAL SUPPORT FOR PATIENTS AND THEIR FAMILIES.SENIOR CLUB: THE WHITLEY MEMORIAL HOSPITAL, INC. SENIOR CLUB PROVIDES EDUCATIONAL OPPORTUNITIES FOR LOCAL SENIORS TO LEARN MORE ABOUT THEIR HEALTH. MEETINGS FEATURE GUEST SPEAKERS, AND INCLUDE A SIMPLE EXERCISE SEGMENT AND GIVING MEMBERS THE OPPORTUNITY TO CHECK THEIR WEIGHT AND BLOOD PRESSURE. THESE EVENTS ARE HELD 10 TIMES PER YEAR. VOLUNTEER PROGRAM/STAFF VOLUNTEERISM:THE VOLUNTEER PROGRAM AT WHITLEY MEMORIAL HOSPITAL, INC. HAS APPROXIMATELY 30 VOLUNTEERS WHO FUNCTION TO ASSIST PATIENTS, PROVIDE DIRECTIONS, WORK IN THE GIFT SHOP, BAKE COOKIES FOR INPATIENTS AND ASSIST STAFF. THE MANAGEMENT AND EMPLOYEES OF PARKVIEW WHITLEY PARTICIPATE IN NUMEROUS VOLUNTEER ACTIVITIES THROUGHOUT THE COMMUNITY TO IMPROVE THE HEALTH AND WELL-BEING OF THE COMMUNITY. THEY PARTICIPATE IN THE LOCAL DAY OF CARING, THE MULTI COUNTY MEDICAL OUTREACH CLINIC, JUNIOR ACHIEVEMENT PROGRAMS AT LOCAL SCHOOLS AND THE SALVATION ARMY BELL RINGING. EMS SERVICES:WHITLEY MEMORIAL HOSPITAL, INC. MANAGES AND OPERATES EMS SERVICES FOR WHITLEY COUNTY WITH DEDICATED AMBULANCES AVAILABLE FOR EMERGENCY DISPATCH 24 HOURS, 7 DAYS PER WEEK. STAFFED AMBULANCES ALSO PROVIDE EMERGENCY MEDICAL SERVICES COVERAGE FOR LOCAL FOOTBALL GAMES, THE WHITLEY COUNTY 4-H FAIR AND OTHER AREA COMMUNITY FAIRS. THEY ALSO PARTICIPATE IN LOCAL OPERATION PROM EVENTS AND FIRE TRAINING BURNS. | Desc |
| Total Program Service Expenses | $55,419,386 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (1) | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Temp Or Permanent Endowments | 0 | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (1) | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | Yes (1) | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | Yes (1) | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (1) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | Yes (1) | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| Info In Schedule O Part V | Yes (X) | InfoInScheduleOPartVInd |
| IRP Document | 44 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 379 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 13 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 9 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | Yes (1) | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (1) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | IN | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | JEANNE' WICKENS | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 2603738407 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 10501 CORPORATE DRIVE | AddressLine1Txt |
| City | FORT WAYNE | CityNm |
| State Abbreviation | IN | StateAbbreviationCd |
| ZIP | 46845 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (21 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Key EmployeeKeyEmployeeInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|---|
| SCOTT GABRIEL | |||||||||
| DIRECTOR/WMHOS PRESIDENT | 40.00 | 1.00 | Yes (X) | Yes (X) | $254,127 | $0 | $77,772 | ||
| MICHAEL PACKNETT | |||||||||
| DIRECTOR/PH PRESIDENT & CEO | 1.00 | 56.00 | Yes (X) | Yes (X) | $0 | $2,067,010 | $712,544 | ||
| REBECCA CASE | |||||||||
| DIRECTOR/PH PHYSICIAN | 1.00 | 40.00 | Yes (X) | $17,577 | $257,176 | $58,975 | |||
| JAMES STAPEL | |||||||||
| DIRECTOR/PH PHYSICIAN | 1.00 | 32.00 | Yes (X) | $0 | $414,372 | $96,303 | |||
| SHAWN ELLIS | |||||||||
| DIRECTOR | 1.00 | 0.00 | Yes (X) | $4,750 | $0 | $0 | |||
| KATHERINE FLECK | |||||||||
| DIRECTOR/SECRETARY/TREASURER | 1.00 | 0.00 | Yes (X) | $4,750 | $0 | $0 | |||
| TIM GRISSOM | |||||||||
| DIRECTOR/CHAIR | 1.00 | 1.00 | Yes (X) | $14,750 | $7,250 | $0 | |||
| JIM HEUER | |||||||||
| DIRECTOR/VICE CHAIR | 1.00 | 1.00 | Yes (X) | $1,750 | $5,250 | $0 | |||
| JOSEPH KESSIE | |||||||||
| DIRECTOR | 1.00 | 0.00 | Yes (X) | $4,000 | $0 | $0 | |||
| GEORGE SCHRUMPF | |||||||||
| DIRECTOR | 1.00 | 0.00 | Yes (X) | $4,750 | $0 | $0 | |||
| DAVID SMITH | |||||||||
| DIRECTOR | 1.00 | 0.00 | Yes (X) | $4,750 | $0 | $0 | |||
| BRAD VOELZ | |||||||||
| DIRECTOR | 1.00 | 0.00 | Yes (X) | $3,000 | $0 | $0 | |||
| JANE WEAR | |||||||||
| DIRECTOR | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| JEANNE' WICKENS | |||||||||
| PH CHIEF FINANCIAL OFFICER | 1.00 | 56.00 | Yes (X) | $0 | $372,369 | $79,329 | |||
| STANTON RISSER | |||||||||
| INTERIM PH CFO - PARTIAL YEAR/PH VP | 1.00 | 56.00 | Yes (X) | $0 | $318,160 | $67,612 | |||
| BRIDGET DOLOHANTY-JOHNSON | |||||||||
| WMHOS VP PATIENT CARE | 40.00 | 0.00 | $201,722 | $0 | $36,236 | Yes (X) | |||
| AMANDA KNOWLES | |||||||||
| WMHOS MGR PHARMACY | 40.00 | 0.00 | $161,177 | $0 | $34,785 | Yes (X) | |||
| JEFFREY ROCKETT | |||||||||
| WMHOS DIR OPERATIONS | 40.00 | 0.00 | $143,893 | $0 | $25,596 | Yes (X) | |||
| WAYNE ENGDAHL | |||||||||
| WMHOS PHARMACIST | 48.00 | 4.00 | $128,445 | $5,386 | $19,951 | Yes (X) | |||
| BENJAMIN MAGGARD | |||||||||
| WMHOS PHARMACIST | 36.00 | 14.00 | $100,963 | $30,498 | $32,244 | Yes (X) | |||
| LEA BARNES | |||||||||
| WMHOS MGR NURSING SERVICES | 40.00 | 0.00 | $117,331 | $0 | $26,379 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,167,735 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $3,477,471 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $1,267,726 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 14 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| PARKVIEW HOSPITAL INC | |||||
| 11109 PARKVIEW PLAZA DRIVE | FORT WAYNE | IN | 46845 | LABORATORY SERVICES | $2,526,928 |
| PROFESSIONAL EMERGENCY PHYSICIANS | |||||
| PO BOX 12949 | FORT WAYNE | IN | 46866 | PHYSICIANS | $1,068,506 |
| GREAT LAKES ANESTHESIA PC | |||||
| 500 N NAPPANEE ST STE 11-B | ELKHART | IN | 46514 | ANESTHESIOLOGISTS | $664,498 |
| NORTHEAST INTERNAL MEDICINE ASSOC INC | |||||
| 2500 N DETROIT STREET | LAGRANGE | IN | 46761 | HOSPITALISTS | $320,408 |
| HOSPITAL LAUNDRY SERVICES INC | |||||
| 3322 CAVALIER DRIVE | FORT WAYNE | IN | 46808 | LAUNDRY SERVICES | $154,634 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 8 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $195,240 | RelatedOrganizationsAmt |
| Government Grants | $5,079 | GovernmentGrantsAmt |
| Total Contributions | $200,319 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (5 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| NET PATIENT REVENUE | 622000 | $70,935,526 | $70,935,526 |
| PHARMACY | 446110 | $936,961 | $936,961 |
| INTERUNIT RENT | 531120 | $561,172 | $561,172 |
| EMS SUBSIDY | 621610 | $340,000 | $340,000 |
| REHAB REVENUE | 900099 | $108,459 | $108,459 |
Total Oth Program Service Rev TotalOthProgramServiceRevGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $76,343 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $76,343 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $72,958,461 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,008,718 | TotalRevenueColumnAmt |
| Exclusion | $1,008,718 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $40,544 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $181,046 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | -$140,502 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$140,502 | TotalRevenueColumnAmt |
| Exclusion | -$140,502 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $11,161,318 | SecuritiesAmt |
| Other | $37,655 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $10,747,177 | SecuritiesAmt |
| Other | $0 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $414,141 | SecuritiesAmt |
| Other | $37,655 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $451,796 | TotalRevenueColumnAmt |
| Exclusion | $451,796 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | ExclusionExclusionAmt |
|---|---|---|---|
| CAFETERIA REVENUE | 722210 | $182,530 | $182,530 |
| GIFT SHOP REVENUE | 453220 | $31,790 | $31,790 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $214,320 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $74,693,112 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $72,958,461 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $1,534,332 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $217,613 | TotalAmt |
| Program Services | $217,613 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $633,707 | TotalAmt |
| Management And General | $633,707 | ManagementAndGeneralAmt |
Comp Disqual Persons CompDisqualPersonsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $34,888 | TotalAmt |
| Program Services | $34,888 | ProgramServicesAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $15,868,869 | TotalAmt |
| Program Services | $15,868,869 | ProgramServicesAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,100,279 | TotalAmt |
| Program Services | $5,100,279 | ProgramServicesAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $60,500 | TotalAmt |
| Management And General | $60,500 | ManagementAndGeneralAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $126,822 | TotalAmt |
| Management And General | $126,822 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,342,866 | TotalAmt |
| Program Services | $5,533,445 | ProgramServicesAmt |
| Management And General | $809,421 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $46,339 | TotalAmt |
| Program Services | $29,133 | ProgramServicesAmt |
| Management And General | $17,206 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,747,300 | TotalAmt |
| Program Services | $2,637,783 | ProgramServicesAmt |
| Management And General | $109,517 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,815,243 | TotalAmt |
| Program Services | $3,789,842 | ProgramServicesAmt |
| Management And General | $25,401 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $76,609 | TotalAmt |
| Program Services | $49,485 | ProgramServicesAmt |
| Management And General | $27,124 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $37,965 | TotalAmt |
| Program Services | $215 | ProgramServicesAmt |
| Management And General | $37,750 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $104,518 | TotalAmt |
| Program Services | $104,518 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,364,184 | TotalAmt |
| Program Services | $2,362,411 | ProgramServicesAmt |
| Management And General | $1,773 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $129,732 | TotalAmt |
| Program Services | $95,619 | ProgramServicesAmt |
| Management And General | $34,113 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| BAD DEBT | $9,581,057 | $9,581,057 | |
| CORP SERVICE ALLOCATION | $8,417,000 | $8,417,000 | |
| MEDICAL SUPPLIES | $5,231,152 | $5,231,152 | |
| PH SUBSIDY | $4,674,018 | $4,674,018 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $180,838 | TotalAmt |
| Program Services | $109,059 | ProgramServicesAmt |
| Management And General | $71,779 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $65,791,499 | TotalAmt |
| Program Services | $55,419,386 | ProgramServicesAmt |
| Management And General | $10,372,113 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,800 | BOYAmt |
| EOY | $3,100 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $365,332 | BOYAmt |
| EOY | $294,332 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,537,081 | BOYAmt |
| EOY | $7,570,046 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $214,164 | BOYAmt |
| EOY | $343,813 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $35,871 | BOYAmt |
| EOY | $38,216 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $39,744,724 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $10,928,095 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $21,241,823 | BOYAmt |
| EOY | $28,816,629 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $45,696,792 | BOYAmt |
| EOY | $49,038,585 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $388,801 | BOYAmt |
| EOY | $8,750,383 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $74,481,664 | BOYAmt |
| EOY | $94,855,104 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,129,685 | BOYAmt |
| EOY | $3,001,729 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,936,488 | BOYAmt |
| EOY | $3,043,751 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $30,605,630 | BOYAmt |
| EOY | $6,951,985 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $38,671,803 | BOYAmt |
| EOY | $12,997,465 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $35,809,861 | BOYAmt |
| EOY | $81,857,639 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $35,809,861 | BOYAmt |
| EOY | $81,857,639 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $74,481,664 | BOYAmt |
| EOY | $94,855,104 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $8,901,613 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $2,046,352 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $35,099,813 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | VolunteersInd |
| Paid Staff Or Management | 0 | PaidStaffOrManagementInd |
| Media Advertisements | 0 | MediaAdvertisementsInd |
| Mailings Members | 0 | MailingsMembersInd |
| Publications Or Broadcast | 0 | PublicationsOrBroadcastInd |
| Grants Other Organizations | 0 | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | 0 | DirectContactLegislatorsInd |
| Rallies Demonstrations | 0 | RalliesDemonstrationsInd |
| Other Activities | Yes (1) | OtherActivitiesInd |
| Other Activities | $3,752 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $3,752 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | 0 | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART II-B, LINE 1: | FormAndLineReferenceDesc |
| Explanation | REPRESENTS THE PORTION OF THE DUES PAID TO INDIANA HOSPITAL AND HEALTH ASSOCIATION AND AMERICAN HOSPITAL ASSOCIATION USED FOR LOBBYING ACTIVITIES. | ExplanationTxt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $260,483 | OtherCostOrOtherBasisAmt |
| Book Value | $260,483 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $14,588,065 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,070,629 | DepreciationAmt |
| Book Value | $13,517,436 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $48,824 | OtherCostOrOtherBasisAmt |
| Depreciation | $48,824 | DepreciationAmt |
| Book Value | $0 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $22,277,987 | OtherCostOrOtherBasisAmt |
| Depreciation | $9,578,555 | DepreciationAmt |
| Book Value | $12,699,432 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $2,569,365 | OtherCostOrOtherBasisAmt |
| Depreciation | $230,087 | DepreciationAmt |
| Book Value | $2,339,278 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $28,816,629 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp (2 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| EST 3RD PARTY SETTLEMENTS | $116,906 |
| DUE TO/FROM INTERUNIT | $8,633,477 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $8,750,383 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)
| DescDesc | AmtAmt |
|---|---|
| NOTE PAYABLE TO PH | $6,893,500 |
| EST MEDICARE/MEDICAID SETTLEMENTS | $58,485 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $6,951,985 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART X, LINE 2: | FormAndLineReferenceDesc |
| Explanation | 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): PAGE 16 OF ATTACHED FINANCIAL STATEMENTS. 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, 2016 AND 2015, 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 2012 AND PRIOR. | ExplanationTxt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent200 | Yes (X) | Percent200Ind |
| FPG Reference Discounted Care | 0 | FPGReferenceDiscountedCareInd |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | 0 | ExpensesExceedBudgetInd |
| Annual Community Bnft Report | Yes (1) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (1) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $777,962 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $777,962 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01380 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $4,746,327 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,995,932 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,750,395 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.04890 | TotalExpensePct |
Unreimbursed Costs UnreimbursedCostsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $5,559,477 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,526,346 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,033,131 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.03620 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $11,083,766 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $5,522,278 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $5,561,488 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.09890 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $181,985 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $49,167 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $132,818 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00240 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $25,411 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $25,411 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00050 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $137,856 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $8,120 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $129,736 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00230 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $345,252 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $57,287 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $287,965 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00520 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $11,429,018 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $5,579,565 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $5,849,453 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.10410 | TotalExpensePct |
Economic Development EconomicDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $11,475 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $11,475 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00020 | TotalExpensePct |
Leadership Development LeadershipDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,450 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $1,450 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Workforce Development WorkforceDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $25,000 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $25,000 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00040 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $37,925 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $37,925 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00060 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $9,581,057 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $125,607 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $6,406,108 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $8,526,617 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$2,120,509 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WHITLEY MEMORIAL HOSPITAL INC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1260 E STATE ROAD 205 | AddressLine1Txt |
| City | COLUMBIA CITY | CityNm |
| State Abbreviation | IN | StateAbbreviationCd |
| ZIP | 46725 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | WWW.PARKVIEW.COM | WebsiteAddressTxt |
| State License | 14-005090-1 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WHITLEY MEMORIAL HOSPITAL INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | 0 | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Prior CHNA Impact | Yes (X) | PriorCHNAImpactInd |
| CHNA Conducted | 16 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | Yes (1) | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | Yes (1) | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | WWW.PARKVIEW.COM/LOCALHEALTHNEEDS | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 16 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | WWW.PARKVIEW.COM/LOCALHEALTHNEEDS | StrategyWebsiteURLTxt |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 200.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Residency Criteria | Yes (X) | ResidencyCriteriaInd |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | WWW.PARKVIEW.COM | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | WWW.PARKVIEW.COM | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | WWW.PARKVIEW.COM | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| Notified FAP Copy Bill Display | Yes (X) | NotifiedFAPCopyBillDisplayInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| FAP Translated | Yes (X) | FAPTranslatedInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| Provided Written Notice | Yes (X) | ProvidedWrittenNoticeInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Made Presumptive Elig Determ | Yes (X) | MadePresumptiveEligDetermInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Look Back Medicare | Yes (X) | LookBackMedicareInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| WHITLEY MEMORIAL HOSPITAL, INC. | PART V, SECTION B, LINE 5: THE RESEARCH TEAM WORKED TO ENSURE THAT THE NEEDS OF THE MEDICALLY UNDERSERVED, LOW-INCOME AND MINORITY POPULATIONS WERE TAKEN INTO ACCOUNT DURING THE COURSE OF THE COMMUNITY HEALTH NEEDS ASSESSMENT. THE SURVEY SAMPLE WAS STRATIFIED TO ENSURE THAT POPULATION SUBSETS WERE REPRESENTED ACCURATELY. SURVEYING OF PUBLIC HEALTH OFFICIALS, OTHER HEALTHCARE PROFESSIONALS AND VARIOUS SOCIAL SERVICE ORGANIZATIONS THAT SPECIALIZE IN AIDING VULNERABLE POPULATIONS IN THE SEVEN-COUNTY AREA WAS ALSO CONDUCTED. ADDITIONALLY, THE ASSESSMENT TEAM CONDUCTED TARGETED FOCUS GROUPS WITH POTENTIALLY VULNERABLE POPULATIONS, INCLUDING THE HISPANIC/LATINO AND AFRICAN AMERICAN POPULATIONS. THE AMISH POPULATION WAS RANDOMLY SURVEYED THROUGH A WRITTEN SURVEY. INFORMATION GAINED THROUGH FOCUS GROUPS AND WRITTEN SURVEYS HELPED TO GAIN INSIGHT INTO THE HEALTH NEEDS AND PERCEPTIONS OF THESE SUB-POPULATION GROUPS TO BETTER UNDERSTAND KEY PUBLIC HEALTH AND HEALTHCARE ISSUES. |
| WHITLEY MEMORIAL HOSPITAL, INC. | PART V, SECTION B, LINE 6A: PARKVIEW HOSPITAL, INC. (EIN 35-0868085); COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC. (EIN 20-2401676); HUNTINGTON MEMORIAL HOSPITAL, INC. (EIN 35-1970706); COMMUNITY HOSPITAL OF NOBLE COUNTY, INC. (EIN 35-2087092); PARKVIEW WABASH HOSPITAL, INC. (EIN 47-1753440) AND ORTHOPAEDIC HOSPITAL AT PARKVIEW NORTH, LLC (EIN 26-0143823). |
| WHITLEY MEMORIAL HOSPITAL, INC. | PART V, SECTION B, LINE 6B: PARKVIEW HEALTH, INC. (EIN 35-1972384); INDIANA PARTNERSHIP FOR HEALTHY COMMUNITIES (A PARTNERSHIP BETWEEN THE INDIANA UNIVERSITY RICHARD M. FAIRBANKS SCHOOL OF PUBLIC HEALTH AND THE POLIS CENTER AT IUPUI) AND CONDUENT HEALTHY COMMUNITIES INSTITUTE. |
| WHITLEY MEMORIAL HOSPITAL, INC. | PART V, SECTION B, LINE 11: SIGNIFICANT HEALTH NEEDS BEING ADDRESSED:OBESITY -- PARKVIEW WHITLEY HOSPITAL WILL SERVE AS A COMMUNITY LEADER PARTNERING WITH OTHER KEY COMMUNITY ORGANIZATIONS TO PROMOTE A CULTURE OF HEALTHY DECISIONS THAT PROMOTE THE SAFETY AND WELL-BEING OF INFANTS AND CHILDREN BEFORE AND AFTER THEIR BIRTH. PARKVIEW WHITLEY HOSPITAL WILL CONTINUE TO ESTABLISH NEW AND FOSTER EXISTING PROGRAMS AND RELATIONSHIPS WITH OTHER ORGANIZATIONS. WE AIM AT PARTNERING WITH ORGANIZATIONS THAT ARE WORKING WITH CHILDREN AND OR UNDERSERVED POPULATIONS. WE ALSO FOCUS ON OPPORTUNITIES FOR COMMUNITY MEMBERS TO MONITOR THEIR HEALTH BETTER WITH LOW-COST OR NO-COST EDUCATIONAL AND SCREENING EVENTS.MATERNAL/CHILD HEALTH -- PARKVIEW WHITLEY HOSPITAL WILL SERVE AS A COMMUNITY LEADER PARTNERING WITH OTHER KEY COMMUNITY ORGANIZATIONS TO PROMOTE A CULTURE OF HEALTHY DECISIONS THAT PROMOTE THE SAFETY AND WELL-BEING OF INFANTS AND CHILDREN BEFORE AND AFTER THEIR BIRTH. PARKVIEW WHITLEY HOSPITAL WILL CONTINUE TO ESTABLISH NEW AND FOSTER EXISTING PROGRAMS AND RELATIONSHIPS WITH OTHER ORGANIZATIONS. WE AIM AT PARTNERING WITH ORGANIZATIONS THAT ARE WORKING WITH CHILDREN AND OR UNDERSERVED POPULATIONS.OTHER HEALTH NEEDS NOT BEING ADDRESSED:ACCESS TO CARE: CANI UTILIZES SPACE IN ONE OF THE PARKVIEW WHITLEY BUILDINGS IN WHITLEY COUNTY; THE SPACE IS PROVIDED IN-KIND IN ORDER TO HELP THEM WITH THEIR BOTTOM LINE SO THAT THEY CAN FOCUS ON PROVIDING RESOURCES TO THOSE IN NEED. ACCESS TO CARE: MULTI COUNTY MEDICAL OUTREACH CLINIC --THE FREE CLINIC OPERATES IN SPACE THAT IS PROVIDED TO THIS NON-PROFIT ORGANIZATION TO SERVE THE UNDER/UNINSURED RESIDENTS OF THIS AREA. PARKVIEW WHITLEY HOSPITAL PROVIDES FREE LAB SERVICES TO THE PATIENTS THAT HAVE AN ORDER FROM THE CLINIC. PARKVIEW WHITLEY HOSPITAL ALSO HAS STAFF THAT WORK AT THE CLINIC ON A REGULAR BASIS. TOBACCO USE: THIS IS BEING ADDRESSED IN KOSCIUSKO COUNTY BY COLLABORATING WITH AND PROVIDING FUNDING FOR THE TOBACCO COALITION TO HAVE PROGRAMS IN THE SCHOOLS AND PROGRAMS FOR EXPECTANT MOMS. OUR GOAL IS TO BE ABLE TO REPLICATE SIMILAR PROGRAMS IN WHITLEY COUNTY. DIABETES: WHILE ADDRESSING OBESITY ISSUES IN OUR COMMUNITIES, WE WILL MOST LIKELY HAVE AN IMPACT ON DIABETES AND DIABETES MANAGEMENT. ALTHOUGH NOT A FOCUS AREA, WE HAVE DIABETES EDUCATION IN BOTH COUNTIES AND PLAN TO CONTINUE THESE PROGRAMS. CANCER: A LIMITED AMOUNT OF FUNDING HAS BEEN DISTRIBUTED TO CANCER SERVICES IN ALLEN COUNTY, AS THEY SERVE MANY PATIENTS IN WHITLEY COUNTY. CARDIOVASCULAR DISEASE: WITH AN EMPHASIS ON OBESITY WE WILL BE INDIRECTLY ADDRESSING CARDIOVASCULAR DISEASE. MAINTAINING A PROPER DIET AND REGULAR EXERCISE IS CERTAINLY BENEFICIAL FOR CARDIOVASCULAR HEALTH. OUR QUARTERLY CHECK-UP DAYS HELP PATIENTS TO MONITOR SUCH THINGS AS CHOLESTEROL LEVELS, BLOOD PRESSURE AND OTHERS. OUR REHAB DEPARTMENT HAS AN EXCELLENT CARDIAC REHAB PROGRAM FOR PATIENTS AND ALLOWS THEM TO CONTINUE FOR AS LONG AS THEY LIKE AFTER GRADUATION, FOR A SMALL FEE. THIS IS AN ESPECIALLY GOOD OPPORTUNITY FOR THOSE WHO ARE UNABLE TO AFFORD OR ARE INTIMIDATED BY LOCAL FITNESS CENTERS. DRUG AND ALCOHOL ABUSE AND ADDICTION: ALTHOUGH NOT A CHOSEN PRIORITY, DRUG AND ALCOHOL ABUSE IS CERTAINLY AN AREA THAT WE KEEP A WATCHFUL EYE ON, AND WE WILL CONTINUE TO DO SO. IF WE SEE A SIGNIFICANT SHIFT IN THESE ISSUES, WE WILL BE ON BOARD WITH THE COMMUNITY TO ADDRESS THESE NEEDS. MENTAL HEALTH: MENTAL HEALTH IS OFTEN TIED TO ALCOHOL AND DRUG ABUSE AND WE WORK WITH PARKVIEW BEHAVIORAL HEALTH TO KEEP THIS PULSE ON THE MENTAL HEALTH OF OUR COMMUNITY. CHRONIC KIDNEY DISEASE: THE INDICATORS SHOW THIS AS AN AREA OF CONCERN IN KOSCIUSKO COUNTY, BUT NOT IN WHITLEY. IT RANKED 11TH OUT OF THE 12 INDICATORS. THUS, WE ARE NOT PRIORITIZING THIS AT THIS TIME. ASTHMA: THE INDICATORS SHOW THIS AS AN AREA OF CONCERN IN KOSCIUSKO COUNTY, BUT NOT IN WHITLEY. IT RANKED 12TH OUT OF THE 12 INDICATORS. THUS, WE ARE NOT PRIORITIZING THIS AT THIS TIME. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 8 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (8 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| 1 - PWH EMS | ||||
| 1250 E STATE ROAD 205 | COLUMBIA CITY | IN | 46725 | AMBULANCE SERVICES |
| 2 - PWH PHYSICAL REHAB | ||||
| 1270 E STATE ROAD 205 | COLUMBIA CITY | IN | 46725 | REHABILITATION SERVICES |
| 3 - PWH LABORATORY MEDICAL OFFICE PLAZA | ||||
| 1270 E STATE ROAD 205 | COLUMBIA CITY | IN | 46725 | LABORATORY SERVICES |
| 4 - PWH RADIOLOGY MEDICAL OFFICE PLAZA | ||||
| 1270 E STATE ROAD 205 | COLUMBIA CITY | IN | 46725 | DIAGNOSTIC RADIOLOGY SERVICES |
| 5 - PWH SLEEP LAB | ||||
| 1270 E STATE ROAD 205 | COLUMBIA CITY | IN | 46725 | SLEEP LAB SERVICES |
| 6 - SOUTH WHITLEY RADIOLOGY | ||||
| 4665 STATE ROAD 5 | SOUTH WHITLEY | IN | 46787 | DIAGNOSTIC RADIOLOGY SERVICES |
| 7 - PWH CARDIO-PUL REHAB | ||||
| 1270 E STATE ROAD 205 | COLUMBIA CITY | IN | 46725 | CARDIAC & PULMONARY REHAB SERVICES |
| 8 - PARKVIEW WARSAW MEDICAL COMPLEX | ||||
| 1355 MARINERS DRIVE | WARSAW | IN | 46582 | EMERGENCY, RADIOLOGY, LABORATORY, PHYS REHAB SERVICES |
Supplemental Information Detail SupplementalInformationDetail (17 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 3C: | EQUITY IN A HOME OTHER THAN THE PATIENT OR GUARANTOR'S PRIMARY RESIDENCE. |
| PART I, LINE 7: | PART I, LINE 7AWHITLEY MEMORIAL HOSPITAL, INC. IS COMMITTED TO PROVIDING FINANCIAL ASSISTANCE TO PATIENTS UNABLE TO MEET THEIR FINANCIAL OBLIGATIONS. IT IS FURTHERMORE THE POLICY OF WHITLEY MEMORIAL HOSPITAL, INC. NOT TO WITHHOLD OR DENY ANY REQUIRED MEDICAL CARE AS A RESULT OF A PATIENT'S FINANCIAL INABILITY TO PAY HIS/HER MEDICAL EXPENSES.THE 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 7BWHITLEY MEMORIAL HOSPITAL, INC. ACCEPTS ALL MEDICAID, MEDICAID MANAGED CARE, AND OUT-OF-STATE MEDICAID PATIENTS WITH THE KNOWLEDGE THAT THERE MAY BE SHORTFALLS. INTERNAL REVENUE SERVICE (IRS) REVENUE RULING 69-545 IMPLIES THAT TREATING MEDICAID PATIENTS IS A COMMUNITY BENEFIT. IRS REVENUE RULING 69-545, WHICH ESTABLISHED THE COMMUNITY BENEFIT STANDARD FOR NONPROFIT HOSPITALS, STATES THAT IF A HOSPITAL SERVES PATIENTS WITH GOVERNMENTAL HEALTH BENEFITS, INCLUDING MEDICAID, THEN THIS IS AN INDICATION THAT THE HOSPITAL OPERATES TO PROMOTE THE HEALTH OF THE COMMUNITY. THE UNREIMBURSED MEDICAID COST REPORTED ON LINE 7B IS CALCULATED UNDER THE COST TO CHARGE RATIO METHODOLOGY. UNDER THIS METHOD, THE MEDICAID CHARGES ARE MULTIPLIED BY THE RATIO OF COST TO CHARGES TO DETERMINE THE COST OF MEDICAID SERVICES RENDERED. THEN, THE COST OF MEDICAID SERVICES RENDERED IS DEDUCTED FROM THE REIMBURSEMENT RECEIVED FOR MEDICAID PATIENTS TO ARRIVE AT A GAIN/(LOSS) RELATIVE TO THESE PATIENTS.PART I, LINE 7CWHITLEY MEMORIAL HOSPITAL, 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 7IIN KEEPING WITH OUR MISSION AND COMMITMENT TO THE COMMUNITIES IN WHICH WE SERVE, WHITLEY MEMORIAL HOSPITAL, INC. CONTINUES ITS TRADITION OF CONTRIBUTING TO NUMEROUS ORGANIZATIONS ON BOTH AN AS-NEEDED BASIS AND NEGOTIATED BASIS. AMOUNTS PRESENTED REPRESENT ACTUAL SPEND TO ORGANIZATIONS THROUGHOUT OUR COMMUNITIES. |
| PART I, LN 7 COL(F): | PERCENT OF TOTAL EXPENSEWHITLEY MEMORIAL HOSPITAL, INC. EXCLUDED $9,581,057 OF BAD DEBT 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.HEALTH RESOURCES & SERVICES ADMINISTRATION (HRSA), IS AN AGENCY OF THE U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES. HRSA DEVELOPS SHORTAGE DESIGNATION CRITERIA AND USES THEM TO DECIDE WHETHER OR NOT A GEOGRAPHIC AREA, POPULATION GROUP OR FACILITY IS A HEALTH PROFESSIONAL SHORTAGE AREA (HPSA) OR A MEDICALLY UNDERSERVED AREA OR POPULATION (MUA/P). HRSA HAS DESIGNATED WHITLEY COUNTY AS A HSPA IN PRIMARY CARE AND MENTAL HEALTH. HRSA HAS DESIGNATED KOSCIUSKO COUNTY AS A HSPA IN MENTAL HEALTH. HRSA HAS DESIGNATED THE CITY OF WARSAW, WHICH IS LOCATED IN KOSCIUSKO COUNTY, AS A MUA/P.AS SUCH, WHITLEY MEMORIAL HOSPITAL, INC. PROVIDES SUPPORT FOR LOCAL ECONOMIC DEVELOPMENT PROGRAMS. THESE EFFORTS ARE ALIGNED WITH OF THE HEALTH SYSTEM'S STRATEGIC INVOLVEMENT IN THE NORTHEAST INDIANA REGIONAL PARTNERSHIP'S VISION 2020, A REGIONAL INITIATIVE DESIGNED TO TRANSFORM NORTHEAST INDIANA INTO A TOP GLOBAL COMPETITOR BY FOCUSING ON A COMMON MISSION TO DEVELOP, ATTRACT AND RETAIN TALENT. VISION 2020'S REGIONAL PRIORITIES ARE TIED TO EDUCATION/WORKFORCE, BUSINESS CLIMATE, ENTREPRENEURSHIP, INFRASTRUCTURE AND QUALITY OF LIFE FOR THE ELEVEN-COUNTY REGION IN NORTHEAST INDIANA. PROMOTION OF ECONOMIC DEVELOPMENT IN WHITLEY COUNTY AND KOSCIUSKO COUNTY IS A PART OF A COLLECTIVE PLAN TO IMPROVE THE QUALITY OF LIFE AND ULTIMATELY THE OVERALL HEALTH AND WELL-BEING OF THE COMMUNITY. WHITLEY MEMORIAL HOSPITAL, INC. ALSO SUPPORTS LEADERSHIP DEVELOPMENT IN THE COMMUNITY IN CONJUNCTION WITH ECONOMIC DEVELOPMENT EFFORTS TO HELP TO IMPROVE THE QUALITY OF LIFE IN WHITLEY COUNTY AND KOSCIUSKO COUNTY. STRONG LEADERS PLAY A KEY ROLE IN BUILDING THRIVING COMMUNITIES. ADDITIONALLY, WHITLEY MEMORIAL HOSPITAL, INC. SUPPORTS PHYSICIAN RECRUITMENT ACTIVITIES TO ASSIST IN TIMELY RESPONSE TO PATIENT CARE NEEDS IN THE COMMUNITY. THESE RECRUITMENT ACTIVITIES ARE BASED ON RESULTS OF A PERIODIC PHYSICIAN NEEDS ASSESSMENT. WHITLEY MEMORIAL HOSPITAL, INC. DEVELOPS A PHYSICIAN RECRUITMENT PLAN TO ADDRESS POTENTIAL GAPS IN PATIENT COVERAGE. WHITLEY MEMORIAL HOSPITAL, INC. STRIVES TO BRING THE BEST INTEGRATED, QUALITY, AND COST EFFECTIVE CARE AND INNOVATIVE TECHNOLOGY TO OUR COMMUNITIES. IN DOING SO, WE FOCUS OUR EFFORTS ON RECRUITING AN EXCEPTIONAL TEAM OF PHYSICIANS THAT ARE THE RIGHT FIT FOR THE COMMUNITY.EVERY MEMBER OF WHITLEY MEMORIAL HOSPITAL, INC.'S HEALTHCARE TEAM IS RESPONSIBLE FOR NURTURING AN ENVIRONMENT OF EXCELLENCE AS THE BEST PLACE FOR CO-WORKERS TO WORK, PHYSICIANS TO PRACTICE MEDICINE, AND PATIENTS TO RECEIVE CARE. WE ARE COMMITTED TO PROVIDING EXCELLENT CUSTOMER SERVICE TO ALL PEOPLE. WE KNOW HOW IMPORTANT CLINICAL, SERVICE AND OPERATIONAL EXCELLENCE IS TO THE SUCCESS OF WHITLEY MEMORIAL HOSPITAL, INC., AND WE RECOGNIZE HOW IMPORTANT OUR SUCCESS IS TO THE COMMUNITY. AN EXAMPLE OF OUR DEDICATION TO QUALITY CARE IS USING PRIMARILY EIGHT (8) HOUR SHIFTS FOR INPATIENT NURSING STAFF VS. 12 HOUR SHIFTS THAT ARE COMMON WITHIN THE INDUSTRY. WE ARE ALSO COMMITTED TO PROVIDING OPPORTUNITIES TO OUR NURSING STAFF TO FURTHER THEIR EDUCATION AND ENCOURAGING ALL NURSING STAFF TO PURSUE AT LEAST A BACHELOR'S LEVEL OF NURSING EDUCATION. |
| PART III, LINE 2: | THE AMOUNT REPORTED IS CONSISTENT WITH THE AMOUNT REPORTED ON THE ORGANIZATION'S AUDITED FINANCIAL STATEMENTS UNDER THE GENERALLY ACCEPTED ACCOUNTING STANDARDS.DISCOUNTS AND PAYMENTS ON PATIENT ACCOUNTS (BAD DEBT RECOVERIES) ARE FACTORED INTO THE ALLOWANCE FOR BAD DEBT ESTIMATION PROCESS. |
| PART III, LINE 3: | COSTING METHODOLOGY USED:UNCOLLECTIBLE PATIENT ACCOUNTS ARE CHARGED AGAINST THE PROVISION FOR BAD DEBT IN ACCORDANCE WITH THE POLICIES OF WHITLEY MEMORIAL HOSPITAL, INC. HOWEVER, DURING THE COLLECTION PROCESS THERE IS A CONTINUOUS EFFORT TO DETERMINE IF THE PATIENT QUALIFIES FOR FINANCIAL ASSISTANCE. THEREFORE, ONCE AN UNCOLLECTIBLE ACCOUNT HAS BEEN CHARGED OFF AND IT IS DETERMINED THROUGH THE COLLECTION PROCESS THAT THE PATIENT QUALIFIES FOR FINANCIAL ASSISTANCE, THE UNCOLLECTIBLE ACCOUNT IS RECLASSIFIED TO CHARITY CARE AND ALL COLLECTION EFFORTS CEASE. PATIENTS ARE ELIGIBLE TO APPLY FOR FINANCIAL ASSISTANCE AT ANY TIME, INCLUDING PATIENTS WHOSE ACCOUNTS HAVE BEEN PLACED IN A BAD DEBT AGENCY. THE AMOUNT REFLECTED ON LINE 3 WAS CALCULATED BY TOTALING THE ACCOUNTS PREVIOUSLY WRITTEN OFF TO BAD DEBT AND PLACED WITH A COLLECTION AGENCY, BUT SUBSEQUENTLY RECLASSIFIED AS CHARITY CARE DURING THE TAX YEAR. THE ACCOUNTS WERE RECLASSIFIED AS CHARITY CARE DUE TO THE FACT THAT PATIENTS APPLIED FOR, AND WERE APPROVED FOR, FINANCIAL ASSISTANCE AFTER THE ACCOUNTS WERE PLACED WITH A BAD DEBT AGENCY. |
| 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:PAGE 14 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. WHITLEY MEMORIAL HOSPITAL, INC. ACCEPTS ALL MEDICARE PATIENTS, AS REFLECTED ON THE YEAR-END MEDICARE COST REPORT, WITH THE KNOWLEDGE THAT THERE MAY BE SHORTFALLS. INTERNAL REVENUE SERVICE (IRS) REVENUE RULING 69-545 IMPLIES THAT TREATING MEDICARE PATIENTS IS A COMMUNITY BENEFIT. IRS REVENUE RULING 69-545, WHICH ESTABLISHED THE COMMUNITY BENEFIT STANDARD FOR NONPROFIT HOSPITALS, STATES THAT IF A HOSPITAL SERVES PATIENTS WITH GOVERNMENTAL HEALTH BENEFITS, INCLUDING MEDICARE, THEN THIS IS AN INDICATION THAT THE HOSPITAL OPERATES TO PROMOTE THE HEALTH OF THE COMMUNITY. HOWEVER, MEDICARE PAYMENTS REPRESENT A PROXY OF COST CALLED THE "UPPER PAYMENT LIMIT." IT HAS HISTORICALLY BEEN ASSUMED THAT UPPER PAYMENT LIMIT PAYMENTS DO NOT GENERATE A SHORTFALL. AS A RESULT, WHITLEY MEMORIAL HOSPITAL, INC. HAS TAKEN THE POSITION NOT TO INCLUDE THE MEDICARE SHORTFALLS OR SURPLUSES AS PART OF COMMUNITY BENEFIT. WHITLEY MEMORIAL HOSPITAL, INC. RECOGNIZES THAT THE SHORTFALL OR SURPLUS FROM MEDICARE DOES NOT INCLUDE THE COSTS AND REVENUES ASSOCIATED WITH MEDICARE ADVANTAGE PATIENTS. AS SUCH, THE TOTAL SHORTFALL OR SURPLUS OF MEDICARE IS UNDERSTATED DUE TO THE COSTS AND REVENUES ASSOCIATED WITH MEDICARE ADVANTAGE PATIENTS NOT BEING INCLUDED IN THE COMMUNITY BENEFIT DETERMINATION. |
| PART III, LINE 9B: | IF THE PATIENT CANNOT PAY IN FULL, THE OPTION OF A LOW INTEREST LOAN IS AVAILABLE WITH THE SAME DISCOUNT OFFERED FOR CASH PAYMENTS AS LONG AS THE LOAN IS ARRANGED WITHIN 30 DAYS OF THE FIRST GUARANTOR STATEMENT. IF THE PATIENT DEFAULTS ON THE LOAN, THE DISCOUNT WILL BE REVERSED AND THE PATIENT'S ACCOUNT WILL BE PLACED IN A COLLECTION AGENCY.INTEREST-FREE PAYMENTS WITH PAY-OUT NOT TO EXCEED TWELVE (12) MONTHS ARE AVAILABLE. THE MINIMUM MONTHLY PAYMENT IS $25.FINANCIAL ASSISTANCE MAY BE AVAILABLE FOR THOSE PATIENTS WHO CANNOT PAY THEIR BILL. THOSE OPTIONS ARE GOVERNMENTAL ASSISTANCE OR FREE CARE THROUGH THE HOSPITAL FINANCIAL ASSISTANCE PROGRAM. THE HEALTH SYSTEM FINANCIAL ASSISTANCE POLICY IS AVAILABLE ON PARKVIEW.COM OR BY VISITING ANY HOSPITAL CASHIER OFFICE OR BY CALLING PATIENT ACCOUNTING AT 260.373.7770 OR TOLL FREE 855.814.0012. A PATIENT MAY APPLY FOR FINANCIAL ASSISTANCE ANYTIME DURING THE APPLICATION PERIOD. FAILURE TO MAKE ARRANGEMENTS AS LISTED ABOVE OR FAILURE TO APPLY FOR AND RECEIVE APPROVAL UNDER THE FINANCIAL ASSISTANCE POLICY MAY RESULT IN THE ACCOUNT BEING PLACED IN A COLLECTION AGENCY DUE TO NON-PAYMENT. THE COLLECTION AGENCY MAY REPORT THE ACCOUNT TO ONE OR ALL THREE CREDIT REPORTING AGENCIES WHICH MAY ULTIMATELY ADVERSELY AFFECT THE PATIENT'S CREDIT SCORE. ADDITIONALLY, THE COLLECTION AGENCY MAY SUE AND OBTAIN A JUDGMENT AGAINST THE PATIENT FOR NON-PAYMENT. THESE ACTIONS WILL NOT OCCUR UNTIL 120 DAYS AFTER THE PATIENT IS SENT THEIR FIRST FOLLOW-UP STATEMENT INDICATING THE AMOUNT THEY OWE.A PATIENT MAY APPLY FOR FINANCIAL ASSISTANCE AT ANY TIME DURING THE APPLICATION PERIOD, EVEN THOUGH THEY HAVE BEEN PLACED IN A COLLECTION AGENCY. IF THE PATIENT WAS SENT THEIR FIRST NOTICE ON THE ACCOUNT FOR WHICH THEY ARE APPLYING FOR FREE CARE BETWEEN 120 DAYS AND THE END OF THE APPLICATION PERIOD, THE ACTIONS ABOVE WILL BE SUSPENDED UNTIL THE FREE CARE APPLICATION ELIGIBILITY IS DETERMINED. |
| PART VI, LINE 2: | DESCRIBE HOW THE ORGANIZATION ASSESSES THE HEALTH CARE NEEDS OF THE COMMUNITIES IT SERVES.PARKVIEW HEALTH SYSTEM, INC., INCLUDING WHITLEY MEMORIAL HOSPITAL, INC., CONDUCTED A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) FOR THE SEVEN COUNTIES (ALLEN, HUNTINGTON, KOSCIUSKO, LAGRANGE, NOBLE, WABASH AND WHITLEY) WHERE PARKVIEW HAS HOSPITALS. ADDITIONALLY, PARKVIEW HEALTH SYSTEM, INC. PARTNERED WITH THE INDIANA PARTNERSHIP FOR HEALTHY COMMUNITIES (IPHC) TO COMPLETE MUCH OF THE FIELD WORK. IPHC CONDUCTED THE RANDOMLY SELECTED COMMUNITY MEMBER SURVEY TO OBTAIN PRIMARY DATA. THE SURVEY INSTRUMENT USED FOR THIS STUDY WAS LARGELY BASED ON THE CENTERS FOR DISEASE CONTROL AND PREVENTION BEHAVIORAL RISK FACTOR SURVEILLANCE SYSTEM. OUR SURVEY INCLUDED CUSTOMIZED QUESTIONS ADDRESSING GAPS IN INDICATOR DATA RELATIVE TO NATIONAL HEALTH PROMOTION AND DISEASE PREVENTION OBJECTIVES AND OTHER RECOGNIZED HEALTH ISSUES. IPHC ASSISTED WITH SURVEYING PUBLIC HEALTH, OTHER HEALTHCARE PROFESSIONALS, SOCIAL SERVICE AGENCIES AND OTHER COMMUNITY GROUP REPRESENTATIVES. THEY ALSO CONDUCTED SECONDARY DATA RESEARCH, DATA ANALYSIS AND FACILITATED PRIORITIZATION OF IDENTIFIED HEALTH ISSUES. A COLLECTIVE SECONDARY DATA BASE PROVIDED BY CONDUENT HEALTHY COMMUNITIES INSTITUTE WAS ALSO USED TO DETERMINE HEALTH ISSUES FOR EACH COUNTY IN THE SEVEN-COUNTY AREA. OTHER STATE AND NATIONAL SECONDARY SOURCES INCLUDED CENTERS FOR DISEASE CONTROL AND PREVENTION, COUNTY HEALTH RANKINGS, HEALTH INDICATORS WAREHOUSE, INDIANA STATE DEPARTMENT OF HEALTH, INDIANA UNIVERSITY CENTER FOR HEALTH POLICY AND THE US CENSUS BUREAU. CHNA REPORTS WERE PRESENTED TO AND ADOPTED BY THEIR RESPECTIVE HOSPITAL BOARD OF DIRECTORS IN 2016. WHITLEY MEMORIAL HOSPITAL, INC. REPRESENTATIVES MAINTAIN ON-GOING RELATIONSHIPS THROUGHOUT OUR COMMUNITIES AND MEET REGULARLY WITH ORGANIZATIONS THAT SHARE THE MISSION OF IMPROVING THE HEALTH AND INSPIRING THE WELL-BEING OF OUR COMMUNITIES. HEALTH ISSUES IDENTIFIED IN THE SURVEY INCLUDED: OBESITY, TOBACCO USE, MATERNAL/CHILD HEALTH, DIABETES, CARDIOVASCULAR DISEASE, DRUG/ALCOHOL USE, CANCER, STDS, HEALTHCARE ACCESS, MENTAL HEALTH, ASTHMA, AGING AND CHRONIC KIDNEY DISEASE.THE PRIORITIZATION OF HEALTH ISSUES WAS CONDUCTED USING A MODIFIED HANLON METHOD WHICH TAKES INTO ACCOUNT THE SIZE OF THE HEALTH PROBLEM, SERIOUSNESS OF THE HEALTH PROBLEM AND THE EFFECTIVENESS OF INTERVENTIONS. THIS METHOD, CALLED THE BASIC PRIORITY RATING SYSTEM (BPRS) IS RECOMMENDED BY THE NATIONAL ASSOCIATION OF COUNTY AND CITY HEALTH OFFICIALS (NACCHO) FOR THE PURPOSE OF PRIORITIZING COMMUNITY HEALTH NEEDS. FROM THE LIST OF HEALTH ISSUES IDENTIFIED, THREE TOP HEALTH PRIORITIES WERE SELECTED THROUGH APPLYING THE PEARL TEST WHICH IS DESIGNED TO SCREEN OUT IMPRACTICAL OR IMPRACTICABLE INTERVENTIONS BASE ON KEY FEASIBILITY FACTORS. THESE PRIORITIES ARE: 1) OBESITY/HEALTHY LIFESTYLES; 2) MATERNAL/CHILD HEALTH.OTHER WAYS THAT WHITLEY MEMORIAL HOSPITAL, INC. IDENTIFIES OR VERIFIES COMMUNITY HEALTH NEEDS: -OTHER COMMUNITY NEEDS ASSESSMENTS CONDUCTED BY LOCAL ORGANIZATIONS -OBSERVATIONS BY HEALTHCARE PROFESSIONALS WHO WORK WITH VULNERABLE POPULATIONS-SPECIFIC REQUESTS PROMPTED BY OBSERVATION BY OTHER PROFESSIONALS IN THE COMMUNITY |
| 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.WHITLEY MEMORIAL HOSPITAL, INC. PRIMARILY SERVES WHITLEY COUNTY INCLUDING THE COMMUNITIES OF COLUMBIA CITY, CHURUBUSCO, LARWILL, AND SOUTH WHITLEY. EXPANSION INTO KOSCIUSKO COUNTY IN 2016 WITH THE OPENING OF PARKVIEW WARSAW, SERVICES ARE PROVIDED TO MEET THE NEEDS OF WARSAW AND THE SURROUNDING COMMUNITIES IN THAT COUNTY AS WELL. THE NEW FACILITY INCLUDES A FREE-STANDING EMERGENCY DEPARTMENT, MULTI-MODALITY IMAGING, LABORATORY, PHYSICAL REHABILITATION AND MASSAGE THERAPY AS WELL AS PRIMARY CARE AND SPECIALTY PHYSICIAN OFFICES. SHELL SPACE ON THE THIRD FLOOR PROVIDES AREA FOR GROWTH OF SERVICES IN THE FUTURE. WHITLEY COUNTY HAS APPROXIMATELY 33,439 RESIDENTS, PRIMARILY CAUCASIAN. THE MEDIAN HOUSEHOLD INCOME IS $56,142. THE UNEMPLOYMENT RATE IS 3.9%. THE MAJORITY OF THE EMPLOYMENT IN THE COUNTY IS RELATED TO MANUFACTURING, RETAIL SALES AND HEALTHCARE. KOSCIUSKO COUNTY HAS APPROXIMATELY 79,092 RESIDENTS, PRIMARILY CAUCASIAN, AND APPROXIMATELY 8% HISPANIC OR LATINO. THE UNEMPLOYMENT RATE IS 3.7%. MANUFACTURING, HEAVILY WEIGHTED IN THE ORTHOPEDICS INDUSTRY, EDUCATION AND HEALTH SERVICES MAKE UP THE MAJORITY OF EMPLOYMENT IN THE COUNTY. THE MEDIAN HOUSEHOLD INCOME IS $54,147. |
| 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.).WHITLEY MEMORIAL HOSPITAL, INC.'S BOARD OF DIRECTORS IS COMPRISED OF INDEPENDENT COMMUNITY MEMBERS FROM WHITLEY AND KOSCIUSKO COUNTIES ALONG WITH HOSPITAL PRESIDENT AND MEDICAL STAFF PRESIDENT. A MAJORITY OF THE BOARD RESIDES IN WHITLEY MEMORIAL HOSPITAL, INC.'S PRIMARY SERVICE AREA. THE HOSPITAL EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN THE COMMUNITY. PEOPLE THROUGHOUT THE COMMUNITY CAN COUNT ON WHITLEY MEMORIAL HOSPITAL, INC. TO AVAILABLE WITH EMERGENCY CARE 24 HOURS A DAY, 365 DAYS A YEAR. THE EMERGENCY DEPARTMENTS BOTH IN WHITLEY COUNTY AND KOSCIUSKO COUNTY ARE STAFFED WITH BOARD-CERTIFIED EMERGENCY CARE PHYSICIANS AND A NURSING STAFF THAT IS TRAINED AND EXPERIENCED IN EMERGENCY CARE. FURTHERMORE, NO PATIENT IS EVER DENIED TREATMENT, REGARDLESS OF THEIR ABILITY TO PAY. THE HOSPITAL IN WHITLEY COUNTY FEATURES 30 BEDS WITH ALL PRIVATE ROOMS, IN A 96,000 SQUARE FEET FACILITY LOCATED ON 42 ACRES. PARKVIEW WARSAW IN KOSCIUSKO COUNTY IS A 90,000 SQUARE FEET FACILITY FEATURING 10 EMERGENCY ROOM BEDS INCLUDING 2 THAT ARE EQUIPPED FOR TRAUMA PATIENTS. AS A COMMUNITY PARTNER AND NOT-FOR-PROFIT ORGANIZATION, WHITLEY MEMORIAL HOSPITAL, INC., IS DEDICATED TO IMPROVING YOUR HEALTH AND INSPIRING YOUR WELL-BEING BY TAILORING A PERSONALIZED HEALTH JOURNEY TO ACHIEVE YOUR UNIQUE GOALS. BY DEMONSTRATING WORLD-CLASS TEAMWORK, WE PARTNER WITH YOU ALONG THAT JOURNEY AND PROVIDE THE EXCELLENCE, INNOVATION AND VALUE YOU SEEK IN TERMS OF CONVENIENCE, COMPASSION, SERVICE, COST AND QUALITY. WHITLEY MEMORIAL HOSPITAL, INC. IS CONSISTENTLY RATED HIGHLY IN PUBLICALLY REPORTED MEASURES OF CARE AS WELL AS THE PATIENT PERCEPTION OF CARE.THE FOLLOWING LIST DEMONSTRATES SOME OF THE WAYS WHITLEY MEMORIAL HOSPITAL, INC. REACHES OUT TO MAKE OUR COMMUNITIES HEALTHIER: -FINANCIAL ASSISTANCE-COMMUNITY HEALTH IMPROVEMENT INITIATIVES-PRIMARY HEALTH CARE/ACCESS-MEDICATION ASSISTANCE PROGRAM (MAP)-HEALTH SCREENING/PREVENTION AND DISEASE MANAGEMENT-EDUCATIONAL AND SUPPORT PROGRAMS-SENIOR'S CLUB-EMS SERVICES-SPONSORSHIPSFINANCIAL ASSISTANCE:WHITLEY MEMORIAL HOSPITAL, INC.'S MISSION INCLUDES CARING FOR PEOPLE WHO DO NOT HAVE THE MEANS TO MEET THEIR FINANCIAL OBLIGATIONS. A FINANCIAL COUNSELOR IS AVAILABLE TO ASSIST PATIENTS IN NAVIGATING THIS PROCESS. THE HOSPITAL PLACES ITS PRIORITY ON PROVIDING THE NECESSARY CARE, NOT ON THE PATIENT'S ABILITY TO PAY FOR THEIR MEDICAL EXPENSES. COMMUNITY HEALTH IMPROVEMENT:THE PURPOSE OF WHITLEY MEMORIAL HOSPITAL, INC.'S COMMUNITY HEALTH IMPROVEMENT PROGRAM IS TO FUND COMMUNITY HEALTH IMPROVEMENT EFFORTS WITHIN THE SERVICE AREA OF WHITLEY MEMORIAL HOSPITAL, INC. THE HOSPITAL SETS ASIDE UP TO 10 PERCENT 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. WHITLEY MEMORIAL HOSPITAL, INC. INVESTS IN KEY ORGANIZATIONS THAT PROMOTE THE HEALTH AND WELLNESS OF FAMILIES, CHILDREN, AND INDIVIDUALS OF WHITLEY AND KOSCIUSKO COUNTIES. KEY PROJECTS AND AREAS OF FOCUS FUNDED THROUGH THE COMMUNITY HEALTH IMPROVEMENT INITIATIVE AND OTHER HOSPITAL FUNDS INCLUDE: -SUPPORT OF B.A.B.E. OF WHITLEY COUNTY, AN INCENTIVE BASED PROGRAM FOR PREGNANT WOMEN AND FAMILIES, IN AN EFFORT TO DETER THE HIGH INCIDENCE OF LOW-BIRTH WEIGHT BABIES AND TO ENSURE THAT THE CHILDREN ARE GIVEN THE BEST POSSIBLE START IN LIFE. -MULTI-COUNTY MEDICAL OUTREACH CLINIC IS GIVEN IN-KIND LAB SERVICES THROUGH PARKVIEW WHITLEY HOSPITAL TO SERVE THE NEEDS OF THEIR UNINSURED PATIENTS. THEY ALSO RECEIVE IN-KIND SPACE TO OPERATE THEIR CLINIC. -CANI COVERING KIDS AND FAMILIES HELPS PROVIDE RESOURCES TO FAMILIES AND THEIR CHILDREN TO ENSURE THOSE ELIGIBLE FOR HEALTHCARE INSURANCE ARE ENROLLED. THEY UTILIZE IN-KIND SPACE TO OPERATE IN WHITLEY COUNTY.-SUPPORTED THE KOSCIUSKO YOUTH LEAGUE TO PROVIDE HEALTHY SNACKS AND WATER AFTER BASEBALL GAMES RATHER THAN SUGAR SWEETENED FOODS AND BEVERAGES. -SUPPORTED THE CENTER FOR WHITLEY COUNTY YOUTH, A LOCAL YOUTH DEVELOPMENT ORGANIZATION. THEY PROVIDE POSITIVE ROLE MODELS, SNACKS, MEALS AND ACTIVITIES TO AT RISK TEENS TO IMPROVE THEIR HEALTH AND OPPORTUNITIES FOR SUCCESS IN LIFE. -WHITLEY MEMORIAL HOSPITAL, INC. PROVIDED FUNDING TO THE KOSCIUSKO COUNTY TOBACCO FREE COALITION THRU GRACE SCHOOLS INC. FOCUS IS PLACED ON MOTHER AND CHILD WELL-BEING INCLUDING SMOKING CESSATION PROGRAMS.-ONE COMMUNITY PROVIDES LUNCHES AND ENTERTAINMENT/EDUCATIONAL PROGRAMS FOR SOUTH WHITLEY AREA RESIDENTS AND THEY ALSO DELIVER TO SOME SHUT-IN RESIDENTS AS WELL. THE FUNDING FROM COMMUNITY HEALTH IMPROVEMENT DOLLARS IS TO PROVIDE FRESH FRUITS AND VEGETABLES FOR THE LUNCHES. I-+N ADDITION, THE HOSPITAL HAS PROVIDED SPEAKERS FOR THEIR LUNCHEONS TO INCREASE THEIR KNOWLEDGE ON HEALTH RELATED ISSUES. -WHITLEY MEMORIAL HOSPITAL, INC. PROVIDES LUNCHES FOR TROY CENTER SCHOOL AT NO COST TO ENSURE NUTRITIONAL MEALS ARE AVAILABLE TO EACH STUDENT. TROY CENTER IS AN ACCREDITED INDEPENDENT ALTERNATIVE SCHOOL HELPING STUDENTS TO GAIN AN EDUCATION AND EARN A DIPLOMA AT THEIR OWN PACE, PROVIDING AN OPTION FOR ACHIEVEMENT FOR THOSE WHO HAVE FAILED IN TRADITIONAL SCHOOL SETTINGS.PRIMARY HEALTH CARE ACCESS:WHITLEY MEMORIAL HOSPITAL, INC. FEATURES 30 BEDS WITH ALL PRIVATE ROOMS. EMERGENCY MEDICAL CARE, OBSTETRIC CARE AND MEDICAL-SURGICAL UNITS ARE AVAILABLE AS WELL AS LAB, MULTIPLE MODALITIES OF IMAGING SERVICES, SURGICAL SERVICES, PHYSICAL REHABILITATION AS WELL AS CARDIAC/PULMONARY REHABILITATION. AN ATTACHED MEDICAL OFFICE BUILDING PROVIDES CONVENIENT, EASY ACCESS FOR PATIENTS TO RECEIVE CARE FROM FAMILY AND SPECIALTY PHYSICIANS AS WELL AS LABORATORY AND DIAGNOSTIC X-RAY SERVICES.THE PARKVIEW WARSAW FACILITY IN KOSCIUSKO COUNTY INCLUDES A 10 BED FREE-STANDING EMERGENCY DEPARTMENT, MULTI-MODALITY IMAGING, LABORATORY, PHYSICAL REHABILITATION AND MASSAGE THERAPY AS WELL AS PRIMARY CARE AND SPECIALTY PHYSICIAN OFFICES. EMERGENCY PATIENTS WHO REQUIRE A HIGHER LEVEL OF CARE ARE TRANSPORTED TO WHITLEY MEMORIAL HOSPITAL OR TO TERTIARY CARE FACILITIES IN ALLEN COUNTY.MEDICATION ASSISTANCE PROGRAM (MAP):WHITLEY MEMORIAL HOSPITAL, INC. SUPPORTS A MEDICATION ASSISTANCE PROGRAM THAT BEEN VERY SUCCESSFUL SINCE ITS INCEPTION. MAP PARTNERS WITH PATIENTS, PHYSICIANS, PHARMACEUTICAL COMPANIES, LOCAL PHARMACIES, AND DONORS TO PROVIDE MEDICATION ASSISTANCE AT LITTLE OR NO COST FOR QUALIFIED INDIVIDUALS IN WHITLEY COUNTY. EMERGENCY VOUCHERS FOR ACUTE MEDICATION NEEDS ARE REDEEMED AT LOCAL PHARMACIES. LONG-TERM MEDICATION HELP IS PROVIDED THROUGH CONNECTING PATIENTS WITH PHARMACEUTICAL ASSISTANCE PROGRAMS (PAP).HEALTH SCREENING/PREVENTION AND DISEASE MANAGEMENT:WHITLEY MEMORIAL HOSPITAL, INC. PARTICIPATES IN NUMEROUS HEALTH FAIRS AND ACTIVITIES THROUGHOUT THE YEAR TO PROVIDE HEALTH EDUCATION, HEALTH SCREENINGS FOR DISEASE PREVENTION, AND TO PROMOTE HEALTHY LIFESTYLES. THE HOSPITAL ALSO PROVIDES SUPPORT GROUPS TO ASSIST PATIENTS AND FAMILIES IN MANAGING DISEASE. -HEARTBEATS HEALTH FAIR, THE HOSPITAL'S OWN HEALTH FAIR, INCLUDED MULTIPLE HEALTH SCREENINGS AND HEALTH AND PREVENTION EDUCATION FOR ADULTS OF THE COMMUNITY. THIS EVENT PROVIDED LABORATORY TESTING FOR 220 COMMUNITY MEMBERS IN 2016. FRANCINE'S FRIENDS MOBILE MAMMOGRAPHY ALSO CONTINUES TO OFFER MAMMOGRAMS.-IHSAA PHYSICALS WERE PERFORMED FOR LOCAL JUNIOR AND SENIOR HIGH SCHOOL STUDENT ATHLETES IN 2016 AT NO COST. -WHITLEY MEMORIAL HOSPITAL, INC. AND THE WHITLEY COUNTY COMMUNITY FOUNDATION PARTNER TOGETHER TO PROVIDE FREE MAMMOGRAPHY SCREENING TO WOMEN WHO ARE UNINSURED OR UNDERINSURED. THROUGH THE WOMEN'S GIVING CIRCLE, A FUND OF THE WHITLEY COUNTY COMMUNITY FOUNDATION, VOUCHERS ARE GIVEN TO WOMEN WHO ARE UNINSURED OR UNDERINSURED AND CAN BE REDEEMED AT THE HOSPITAL FOR MAMMOGRAMS.-PROVIDED SUPPORT FOR JOE'S KIDS, AN ORGANIZATION WHERE SPECIAL CHILDREN RECEIVE PHYSICAL, OCCUPATIONAL AND SPEECH THERAPY IN ORDER TO HELP THEM REACH THEIR MAXIMAL LEVEL OF INDEPENDENCE IN THE AREAS OF GROSS MOTOR SKILLS AND MOBILITY, FINE MOTOR SKILLS, SENSORY PROCESSING, SELF-CARE, FEEDING AND SWALLOWING AND SPEECH AND LANGUAGE.-WHITLEY MEMORIAL HOSPITAL, INC. PARTNERS WITH THE LOCAL YMCA TO PROVIDE NO COST GROUP EXERCISE AND FITNESS CLASSES TO THEIR EMPLOYEES. ADDITIONAL FITNESS EQUIPMENT IS ALSO PROVIDED TO EMPLOYEES WITHIN OUR FACILITY TO PROMOTE THEIR HEALTH AND FITNESS. (NARRATIVE CONTINUED AFTER PART VI, LINE 7) |
| 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.; PARKVIEW WABASH HOSPITAL, INC.; WHITLEY MEMORIAL HOSPITAL, INC.; HUNTINGTON MEMORIAL HOSPITAL, INC.; AS WELL AS 60 PERCENT OWNERSHIP IN THE JOINT VENTURE OF ORTHOPAEDIC HOSPITAL AT PARKVIEW NORTH, LLC. PARKVIEW CONTRIBUTES TO THE SUCCESS OF THE REGION BY EFFECTIVELY MANAGING ITS FACILITIES, EFFICIENTLY PROVIDING AND DELIVERING ITS SERVICES, AND SUPPORTING LOCAL BUSINESSES AND ACTIVITIES. PARKVIEW SEEKS TO CREATE ALIGNMENT OPPORTUNITIES TO DELIVER COMPREHENSIVE HIGH-QUALITY CARE THAT BENEFIT PATIENTS, PHYSICIANS, CO-WORKERS AND COMMUNITIES. EACH HOSPITAL ENTITY ENGAGES IN COMMUNITY OUTREACH CUSTOMIZED TO MEET THE UNIQUE NEEDS OF THEIR RESPECTIVE COMMUNITIES. AFFILIATE HOSPITALS WORK TOGETHER AND SHARE PROGRAMMING AND MESSAGING WHERE COMMON COMMUNITY HEALTH ISSUES ARE IDENTIFIED. FROM THE LIST OF HEALTH ISSUES IN THE SEVEN-COUNTY AREA, THE HEALTH PRIORITY OF OBESITY/HEALTHY LIFESTYLE PROMOTION AND EDUCATION INCLUDING GOOD NUTRITION, ACCESS TO AND CONSUMPTION OF HEALTHY FOODS AND AN ACTIVE LIFESTYLE WAS SELECTED BY ALL AFFILIATE HOSPITALS. PARKVIEW PRIDES ITSELF IN NOT ONLY OFFERING THE HIGHEST LEVEL OF CARE TO ITS PATIENTS, BUT ALSO IN PROVIDING AN EXCELLENT WORKPLACE FOR ITS PHYSICIANS, NURSES AND STAFF. PARKVIEW'S MISSION AND VISION IS AS FOLLOWS: AS A COMMUNITY OWNED, NOT-FOR-PROFIT ORGANIZATION, PARKVIEW HEALTH IS DEDICATED TO IMPROVING YOUR HEALTH AND INSPIRING YOUR WELL-BEING BY: 1) TAILORING A PERSONALIZED HEALTH JOURNEY TO ACHIEVE YOUR UNIQUE GOALS, 2) DEMONSTRATING WORLD-CLASS TEAMWORK AS WE PARTNER WITH YOU ALONG THAT JOURNEY 3) PROVIDING THE EXCELLENCE, INNOVATION AND VALUE YOU SEEK IN TERMS OF CONVENIENCE, COMPASSION, SERVICE, COST AND QUALITY. PARKVIEW BELIEVES THAT THE COMMUNITIES IT SERVES SHOULD ALL HAVE THE PEACE OF MIND THAT COMES WITH ACCESS TO COMPASSIONATE, HIGH-QUALITY HEALTHCARE, REGARDLESS OF WHETHER THE CARE IS DELIVERED IN A RURAL OR URBAN SETTING. |
| PART VI, LINE 7, REPORTS FILED WITH STATES | IN |
| PART VI, LINE 7: | A COPY OF FORM 990, SCHEDULE H IS FILED WITH THE INDIANA STATE DEPARTMENT OF HEALTH. |
| PART VI, SUPPLEMENTAL INFORMATION, LINE 5 | CONTINUED FROM ABOVE: 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.).-WHITLEY MEMORIAL HOSPITAL, INC. HOSTS THE LOCAL FARMERS MARKET ON THEIR CAMPUS THROUGHOUT THE SUMMER AS WELL AS SPONSORS THE DOWNTOWN COLUMBIA CITY SATURDAY MARKETS WHICH PROVIDE LOCALLY GROWN FRESH FRUITS AND VEGETABLES FOR SALE TO THE COMMUNITY ONE DAY PER WEEK. THE FARMERS MARKET ACCEPTS SNAP, WHICH IS VERY BENEFICIAL TO THE LOW INCOME FAMILIES IN THE COMMUNITY. EDUCATIONAL AND SUPPORT PROGRAMS:NUMEROUS OTHER EDUCATIONAL AND SUPPORT OPPORTUNITIES ARE AVAILABLE FOR THE PUBLIC SUCH AS CARDIO-PULMONARY REHAB SUPPORT, DIABETES SUPPORT, NUTRITION CLASSES, WEIGHT LOSS SUPPORT AND SMOKING CESSATION CLASSES. CO-WORKERS ALSO VOLUNTEER THEIR TIME TO STAFF THE BOOTHS AT THE WHITLEY COUNTY AND KOSCIUSKO COUNTY 4-H FAIRS OFFERING EDUCATIONAL MATERIALS, BLOOD PRESSURE CHECKS AND A PRIVATE LACTATION AREA. WHITLEY MEMORIAL HOSPITAL, INC. WORKS WITH LOCAL HIGH SCHOOLS TO PROVIDE OPPORTUNITIES FOR STUDENTS TO BE INTERNS IN A VARIETY OF SETTINGS, ALLOWING THEM TO EXPLORE CAREERS IN CLINICAL AND NON-CLINICAL HOSPITAL ENVIRONMENTS. THE HOSPITAL ALSO OFFERS AN ANNUAL KID'S FAIR WHICH INCLUDES PARTICIPATION FROM OTHER LOCAL NON-PROFIT ORGANIZATIONS AS WELL AS A BICYCLE HELMET GIVE-AWAY TO PROMOTE BICYCLE SAFETY. A CHAPLAINCY PROGRAM WAS STARTED IN 2016 TO PROVIDE SPIRITUAL SUPPORT FOR PATIENTS AND THEIR FAMILIES.SENIOR CLUB: THE WHITLEY MEMORIAL HOSPITAL, INC. SENIOR CLUB PROVIDES EDUCATIONAL OPPORTUNITIES FOR LOCAL SENIORS TO LEARN MORE ABOUT THEIR HEALTH. MEETINGS FEATURE GUEST SPEAKERS, AND INCLUDE A SIMPLE EXERCISE SEGMENT AND GIVING MEMBERS THE OPPORTUNITY TO CHECK THEIR WEIGHT AND BLOOD PRESSURE. THESE EVENTS ARE HELD 10 TIMES PER YEAR. EMS SERVICES:WHITLEY MEMORIAL HOSPITAL, INC. MANAGES AND OPERATES EMS SERVICES FOR WHITLEY COUNTY WITH DEDICATED AMBULANCES AVAILABLE FOR EMERGENCY DISPATCH 24 HOURS, 7 DAYS PER WEEK. STAFFED AMBULANCES ALSO PROVIDE EMERGENCY MEDICAL SERVICES COVERAGE FOR LOCAL FOOTBALL GAMES, THE WHITLEY COUNTY 4-H FAIR AND OTHER AREA COMMUNITY FAIRS. THEY PARTICIPATE IN LOCAL OPERATION PROM EVENTS AND FIRE TRAINING BURNS AS WELL.SPONSORSHIPS:WHITLEY MEMORIAL HOSPITAL, INC. SPONSORS NUMEROUS LOCAL ORGANIZATIONS EACH YEAR THAT HAVE POSITIVE IMPACTS ON THE COMMUNITIES SERVED. THE FUNDING PROVIDED SUPPORTS EVENTS RELATED TO HEALTHY ACTIVITIES SUCH AS TRIATHLONS OR 5K RACES AS WELL AS TO ORGANIZATIONS WHO ARE DEDICATED TO SERVING SPECIFIC INDIVIDUALS IN NEED. THE SPONSORSHIPS FOR 2016 INCLUDED BIG BROTHERS BIG SISTERS, BOWEN CENTER, CASA OF KOSCIUSKO COUNTY, UNITED WAY, INDIANA CENTER FOR NURSING, JUNIOR ACHIEVEMENT, KOSCIUSKO COMMUNITY YMCA, KOSCIUSKO LEADERSHIP ACADEMY, MARCH OF DIMES, PASSAGES INC., SOUTH WHITLEY YOUTH LEAGUE, VETERANS MARATHON, WHITLEY COUNTY ECONOMIC DEVELOPMENT CORP, WARSAW LITTLE LEAGUE AND WAWASEE KIWANIS CLUB TRIATHLON. |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (1) | GrantRecordsMaintainedInd |
Recipient Table RecipientTable (6 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | Recipient EINRecipientEIN | IRC SectionIRCSectionDesc | Cash GrantCashGrantAmt | Non Cash AssistanceNonCashAssistanceAmt | Valuation Method UsedValuationMethodUsedDesc | Non Cash AssistanceNonCashAssistanceDesc | Purpose Of GrantPurposeOfGrantTxt |
|---|---|---|---|---|---|---|---|---|---|---|
| WHITLEY MEMORIAL HOSPITAL FOUNDATION INC | ||||||||||
| 1260 EAST STATE ROAD 205 | COLUMBIA CITY | IN | 46725 | 311190239 | 501 ( C ) 3 | $103,138 | $1,258 | FMV | FURNITURE | OPERATIONS |
| BABE BEDS AND BRITCHES ETC | ||||||||||
| 533 N LINE ROAD | COLUMBIA CITY | IN | 46725 | 351130532 | 501 ( C ) 3 | $20,000 | TEEN PARENT CHILDCARE CENTER | |||
| GRACE SCHOOLS INC | ||||||||||
| 200 SEMINARY DRIVE | WINONA LAKE | IN | 465901224 | 350868095 | 501 ( C ) 3 | $15,750 | KOS. CO. TOBACCO FREE COALITION - SMOKING CESSATION FOR PREGNANT WOMEN & SPONSORSHIP | |||
| CENTER FOR WHITLEY COUNTY YOUTH INC | ||||||||||
| 201 W MARKET ST | COLUMBIA CITY | IN | 46725 | 205993971 | 501 ( C ) 3 | $11,000 | YOUTH DEVELOPMENT PROGRAMS | |||
| JOE'S KIDS | ||||||||||
| 3540 COMMERCE DRIVE | WARSAW | IN | 46580 | 464095781 | 501 ( C ) 3 | $10,880 | REHABILITATION & DISABILITY SERVICES | |||
| WARSAW LITTLE LEAGUE INC | ||||||||||
| PO BOX 153 | WARSAW | IN | 465810153 | 351859050 | 501 ( C ) 3 | $8,800 | HEALTHY SNACKS FOR PLAYERS | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 6 | Total501c3OrgCnt |
| Total Other Org | 0 | TotalOtherOrgCnt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 2: | FormAndLineReferenceDesc |
| Explanation | 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. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Travel For Companions | Yes (X) | TravelForCompanionsInd |
| Idemnification Gross Up Pmts | Yes (X) | IdemnificationGrossUpPmtsInd |
| Written Policy Ref T And E Expnss | Yes (1) | WrittenPolicyRefTAndEExpnssInd |
| Substantiation Required | Yes (1) | SubstantiationRequiredInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (1) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | Yes (1) | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (11 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| SCOTT GABRIEL | ||||||||||||||
| DIRECTOR/WMHOS PRESIDENT | $193,406 | $0 | $59,579 | $0 | $1,142 | $0 | $49,907 | $0 | $27,865 | $0 | $331,899 | $0 | $0 | $0 |
| MICHAEL PACKNETT | ||||||||||||||
| DIRECTOR/PH PRESIDENT & CEO | $0 | $999,068 | $0 | $525,000 | $0 | $542,942 | $0 | $669,350 | $0 | $43,194 | $0 | $2,779,554 | $0 | $419,516 |
| REBECCA CASE | ||||||||||||||
| DIRECTOR/PH PHYSICIAN | $17,462 | $213,527 | $0 | $42,246 | $115 | $1,403 | $1,780 | $26,045 | $1,993 | $29,157 | $21,350 | $312,378 | $0 | $0 |
| JAMES STAPEL | ||||||||||||||
| DIRECTOR/PH PHYSICIAN | $0 | $241,284 | $0 | $88,101 | $0 | $84,987 | $0 | $72,589 | $0 | $23,714 | $0 | $510,675 | $0 | $0 |
| JEANNE' WICKENS | ||||||||||||||
| PH CHIEF FINANCIAL OFFICER | $0 | $329,339 | $0 | $15,000 | $0 | $28,030 | $0 | $60,171 | $0 | $19,158 | $0 | $451,698 | $0 | $0 |
| STANTON RISSER | ||||||||||||||
| INTERIM PH CFO - PARTIAL YEAR/PH VP | $0 | $193,037 | $0 | $116,196 | $0 | $8,927 | $0 | $40,555 | $0 | $27,057 | $0 | $385,772 | $0 | $6,041 |
| BRIDGET DOLOHANTY-JOHNSON | ||||||||||||||
| WMHOS VP PATIENT CARE | $161,307 | $0 | $38,163 | $0 | $2,252 | $0 | $23,913 | $0 | $12,323 | $0 | $237,958 | $0 | $0 | $0 |
| AMANDA KNOWLES | ||||||||||||||
| WMHOS MGR PHARMACY | $143,152 | $0 | $17,863 | $0 | $162 | $0 | $11,523 | $0 | $23,262 | $0 | $195,962 | $0 | $0 | $0 |
| JEFFREY ROCKETT | ||||||||||||||
| WMHOS DIR OPERATIONS | $120,602 | $0 | $22,877 | $0 | $414 | $0 | $5,441 | $0 | $20,155 | $0 | $169,489 | $0 | $0 | $0 |
| WAYNE ENGDAHL | ||||||||||||||
| WMHOS PHARMACIST | $124,962 | $5,386 | $1,480 | $0 | $2,003 | $0 | $7,814 | $328 | $11,334 | $475 | $147,593 | $6,189 | $0 | $0 |
| BENJAMIN MAGGARD | ||||||||||||||
| WMHOS PHARMACIST | $94,390 | $30,475 | $6,500 | $0 | $73 | $23 | $7,256 | $2,192 | $17,507 | $5,289 | $125,726 | $37,979 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 1A | TRAVEL FOR COMPANIONS - TAXABLE EXPENSE REIMBURSEMENT FOR FAMILY MEMBER PAID TO: SCOTT GABRIEL $91; TAX INDEMNIFICATION AND GROSS-UP PAYMENTS - TAX ON TAXABLE GIFT CERTIFICATE PAID TO: WAYNE ENGDAHL $179; SCOTT GABRIEL $23 |
| PART I, LINE 3 | RELATED ORGANIZATION, PARKVIEW HEALTH SYSTEM, INC., USES THE FOLLOWING TO ESTABLISH THE COMPENSATION OF WHITLEY MEMORIAL HOSPITAL, INC.'S CEO/EXECUTIVE DIRECTOR: COMPENSATION COMMITTEE OF RELATED ORGANIZATION PARKVIEW HEALTH SYSTEM, INC. INDEPENDENT COMPENSATION CONSULTANT 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 PACKNETT $419,516; STANTON RISSER $6,041; JAMES STAPEL $74,230 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. BRIDGET DOLOHANTY-JOHNSON $18,013; SCOTT GABRIEL $32,411; MICHAEL PACKNETT $645,500; STANTON RISSER $22,005; JAMES STAPEL $40,789; JEANNE' WICKENS $57,021 |
| 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. |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp
Name Of Interested NameOfInterested
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | CHELSEA JOHNSON | PersonNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship Description | FAMILY MEMBER OF KEY EMPLOYEE BRIDGET DOLOHANTY-JOHNSON | RelationshipDescriptionTxt |
| Transaction | $34,888 | TransactionAmt |
| Transaction | EMPLOYEE CHELSEA JOHNSON RECEIVED COMPENSATION FROM WHITLEY MEMORIAL HOSPITAL, INC. | TransactionDesc |
| Sharing Of Revenues | 0 | SharingOfRevenuesInd |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (12 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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, WHITLEY MEMORIAL HOSPITAL, INC., EIN 35-1967665. 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, 2016 WAS 573. THE TOTAL NUMBER OF EMPLOYEES REPORTED ON FORM W-3 AND FILED BY THE COMMON PAYING AGENT, PH, FOR THE YEAR ENDED DECEMBER 31, 2016 WAS 12,046. FOR PURPOSES OF COMPLETING FORM 990, PART V, LINE 1A AND 2A, THE NUMBER REPORTED FOR THE WHITLEY MEMORIAL HOSPITAL, INC. WAS 44 AND 379 RESPECTIVELY. |
| FORM 990, PART VI, SECTION A, LINE 4 | DURING 2016, THE FOLLOWING SIGNIFICANT CHANGES WERE MADE TO THE BYLAWS OF WHITLEY MEMORIAL HOSPITAL, INC.: ARTICLE II - PURPOSES 2 IS AS FOLLOWS: THE CORPORATION IS ORGANIZED AND OPERATED EXCLUSIVELY FOR CHARITABLE, SCIENTIFIC AND EDUCATIONAL PURPOSES AS AN ORGANIZATION EXEMPT FROM FEDERAL INCOME TAX UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE OF 1986, AS IT MAY BE AMENDED FROM TIME TO TIME ("CODE"). IN FURTHERANCE OF THESE PURPOSES, THE CORPORATION SHALL, WITH THE PARTICIPATION AND COOPERATION OF COMMUNITY REPRESENTATIVES, ASSESS THE HEALTH CARE NEEDS OF THE COMMUNITY PERIODICALLY AND IMPLEMENT AND ANNUALLY UPDATE PLANS THAT PROVIDE QUALIFIED OUTREACH SERVICES AND OTHER COMMUNITY BENEFIT-ORIENTED PROGRAMS THAT SATISFY THE HEALTH CARE NEEDS OF INDIGENT PERSONS, MEDICALLY UNDERSERVED AREAS, AND THE COMMUNITY AS A WHOLE. THE CORPORATION'S ACTIVITIES SHALL BE CONDUCTED FOR THE AFORESAID PURPOSES IN SUCH A MANNER THAT NO PART OF ITS NET EARNINGS SHALL INURE TO THE BENEFIT OF ANY MEMBER, DIRECTOR, OFFICER OR INDIVIDUAL, EXCEPT THAT THE CORPORATION SHALL BE AUTHORIZED AND EMPOWERED TO PAY REASONABLE COMPENSATION FOR SERVICES RENDERED AND MAY ALSO MAKE PAYMENTS AND DISTRIBUTIONS IN FURTHERANCE OF ITS CHARITABLE, EDUCATIONAL AND SCIENTIFIC PURPOSES. NOTWITHSTANDING ANY OTHER PROVISION OF THESE BYLAWS, THE CORPORATION SHALL NOT CARRY ON ANY OTHER ACTIVITIES THAT ARE NOT PERMITTED TO BE CARRIED ON (A) BY A CORPORATION EXEMPT FROM FEDERAL INCOME TAX UNDER SECTION 501(C)(3) OF THE CODE, OR (B) BY A CORPORATION, CONTRIBUTIONS TO WHICH ARE DEDUCTIBLE UNDER SECTION 170(C)(2) OF THE CODE. ARTICLE V, SECTION 2 - NUMBER AND CHARACTERISTICS IS AS FOLLOWS: THE BOARD SHALL BE COMPOSED OF NO MORE THAN FOURTEEN (14) DIRECTORS, INCLUDING THE PRESIDENT OF THE CORPORATION OR HIS/HER DESIGNEE, THE PRESIDENT/CEO OF THE CORPORATE MEMBER OR HIS/HER DESIGNEE, THE PRESIDENT AND VICE PRESIDENT OF THE MEDICAL STAFF, WHO SHALL SERVE AS DIRECTORS BY VIRTUE OF THEIR OFFICES; AND UP TO TEN (10) COMMUNITY LEADERS WHO SHALL BE SELECTED FROM THE SERVICE AREA OF THE CORPORATION, PROVIDING THAT NO LESS THAN SIX (6) APPOINTED MEMBERS ARE RESIDENTS OF WHITLEY COUNTY. ALL DIRECTORS SHALL BE SELECTED FROM THOSE PERSONS WHO HAVE DEMONSTRATED AN ABILITY AND WILLINGNESS TO SERVE EFFECTIVELY IN THE DISCHARGE OF THEIR RESPONSIBILITIES. A MAJORITY OF THE BOARD OF DIRECTORS SHALL, AT ALL TIMES, BE CONSIDERED TO BE INDEPENDENT AS DEFINED BY THE INTERNAL REVENUE SERVICE. THE BOARD SHALL CONDUCT AN ORIENTATION SESSION FOR ALL NEW DIRECTORS AND CONTINUING EDUCATION SESSIONS REGARDING CURRENT TOPICS IN HEALTH CARE (INCLUDING MECHANISMS FOR DESIGNING, MEASURING, ASSESSING AND IMPROVING HOSPITAL PERFORMANCE) TO ASSIST ALL DIRECTORS IN THE DISCHARGE OF THEIR DUTIES. IT SHALL BE THE DUTY OF DIRECTORS TO ATTEND REGULAR, SPECIAL AND ANNUAL MEETINGS OF THE BOARD. WHEN VACANCIES ON THE BOARD OCCUR BY REASON OF DEATH, RESIGNATION, OR OTHERWISE, THE NUMBER OF DIRECTORS SHALL BE REDUCED BY SUCH VACANCIES UNTIL QUALIFIED REPLACEMENTS ARE ELECTED, AS SET FORTH IN ARTICLE V, SECTION 4. ARTICLE V, SECTION 8 - NOMINATION PROCESS IS AS FOLLOWS: ANNUALLY, THE NOMINATING COMMITTEE SHALL PRESENT TO THE BOARD, A SLATE OF NOMINEES FOR THE ENSUING YEAR. THE BOARD SHALL SUBSEQUENTLY RECOMMEND TO THE CORPORATE MEMBER A SLATE OF NOMINEES AT LEAST SIXTY (60) DAYS IN ADVANCE OF THE ANNUAL MEETING AS PROVIDED IN ARTICLE V, SECTION 3. THE NOMINATING COMMITTEE SHALL ALSO RECOMMEND A SLATE OF OFFICERS FOR THE ENSUING YEAR. IN THE EVENT THE CORPORATE MEMBER OBJECTS TO ANY SLATE PROPOSED BY THE BOARD, IT MAY REJECT THE SLATE AND REQUEST FROM THE BOARD A NEW SLATE WITH SUCH PROCESS BEING FOLLOWED UNTIL AN ACCEPTABLE SLATE IS PRESENTED TO THE CORPORATE MEMBER. WHERE A REJECTION OF THE SLATE OCCURS, REPRESENTATIVES OF THE PARTIES INVOLVED SHALL INITIALLY MEET INFORMALLY TO DISCUSS WHY THE SLATE WAS REJECTED AND ATTEMPT, THROUGH THIS PROCESS, TO ENSURE, TO THE EXTENT POSSIBLE, THAT THE CANDIDATES PROPOSED ON THE SUCCEEDING SLATE WILL BE ACCEPTED. ARTICLE XI, SECTION 3 - AMENDMENT OF BYLAWS IS AS FOLLOWS: THE BYLAWS MAY BE AMENDED IN THE FOLLOWING MANNER: (A) FIRST, THE PROPOSED AMENDMENT SHALL BE SUBMITTED TO AND APPROVED FOR CONSIDERATION BY A MAJORITY VOTE OF THE BOARD AT WHICH A QUORUM IS IN ATTENDANCE. (B) SUBSEQUENTLY, AT A REGULAR OR SPECIAL MEETING OF THE BOARD, HELD NOT EARLIER THAN THREE (3) WEEKS FROM THE DATE OF THE FIRST MEETING DESCRIBED, THE PROPOSED AMENDMENT SHALL BE SUBMITTED FOR ACTION OF THE BOARD. A VOTE IN PERSON OR IN WRITING OF AT LEAST TWO-THIRDS (2/3) OF THE MEMBERS OF THE ENTIRE BOARD SHALL BE REQUIRED TO ADOPT THE PROPOSED AMENDMENTS. (C) THE AMENDMENT OF THE BYLAWS OF THE CORPORATION SHALL BE SUBJECT TO THE APPROVAL OF THE CORPORATE MEMBER. IN ADDITION, THE CORPORATE MEMBER MAY DIRECT THE BOARD TO ADOPT BYLAW AMENDMENTS NECESSARY OR ADVISABLE TO RESOLVE SIGNIFICANT ETHICAL ISSUES; TO MAINTAIN JOINT COMMISSION ACCREDITATION, TAX-EXEMPT STATUS, PARTICIPATION IN MEDICARE/MEDICAID, TO PREVENT SIGNIFICANT ADVERSE LEGAL OR FINANCIAL EFFECTS TO THE CORPORATION OR THE SYSTEM, OR TO FURTHER THE OPERATION OF THE SYSTEM, AS CONTEMPLATED BY THE NETWORK AGREEMENT, AND EXCEPT AS OTHERWISE SET FORTH IN EXHIBIT A. (D) A MAJORITY OF THE BOARD MAY WAIVE THE PROCEDURAL REQUIREMENTS OF SUBPARAGRAPHS (A) AND (B) ABOVE AND VOTE ON A PROPOSED AMENDMENT AT THE MEETING IN WHICH IT IS INTRODUCED. A VOTE OF AT LEAST TWO-THIRDS (2/3) OF THE ENTIRE BOARD SHALL BE REQUIRED TO ADOPT THE PROPOSED AMENDMENT. THE BYLAWS OF THE CORPORATION SHALL BE REVIEWED AT LEAST EVERY OTHER YEAR. |
| 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 WHITLEY MEMORIAL HOSPITAL, INC. WITH CERTAIN RESERVED POWERS. |
| FORM 990, PART VI, SECTION A, LINE 7A | THE CORPORATE MEMBER, PARKVIEW HEALTH SYSTEM, INC. EIN 35-1972384, SHALL HAVE THE FOLLOWING RESERVED POWERS AS DEFINED IN THE NETWORK AGREEMENT: (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 PRESIDENT 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 AND ITS AFFILIATES, 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 OR ITS AFFILIATES AND DIRECT AND MONITOR COMPLIANCE WITH SUCH PLANS, INITIATIVES AND ARRANGEMENTS; (D) APPROVE AND ADOPT THE CAPITAL AND OPERATING BUDGETS OF THE CORPORATION AND ITS AFFILIATES; (E) APPROVE THE INCURRENCE OF ANY DEBT PROPOSED BY THE CORPORATION, INCLUDING THE ISSUANCE OF BONDS, BY THE CORPORATION AND ITS AFFILIATES AND REQUIRE THE INCURRENCE OF DEBT BY THE CORPORATION AND ITS AFFILIATES; (F) APPROVE THE TRANSFER OF ASSETS BY THE CORPORATION AND ITS AFFILIATES, INCLUDING TRANSFERS OF REAL PROPERTY, PERSONAL PROPERTY, CASH, STOCK OR OTHER TANGIBLE OR INTANGIBLE ASSETS, UNLESS OTHERWISE IDENTIFIED IN PREVIOUSLY APPROVED STRATEGIC PLANS, INITIATIVES, ARRANGEMENTS OR BUDGETS. (G) REQUIRE AND DIRECT THE TRANSFER OF ASSETS BY THE CORPORATION OR ITS AFFILIATES, PROVIDED THAT APPROVAL OF THE BOARD IS ALSO REQUIRED IF THE TRANSFER INVOLVES A TRANSFER OR SALE OF SUBSTANTIALLY ALL OF THE ASSETS OF THE CORPORATION OR WOULD PREVENT THE CORPORATION FROM OPERATING AN ACUTE CARE HOSPITAL IN THE COMMUNITY. FOR PURPOSES OF THIS SECTION, BOARD APPROVAL SHALL NOT BE REQUIRED FOR PARTICIPATION IN A MASTER TRUST INDENTURE, POOLED FINANCING OR ANY OTHER KIND OF DEBT INSTRUMENT, BORROWING OR GUARANTY OBLIGATING CORPORATION ASSETS; (H) APPROVE PARTICIPATION (INCLUDING THE EXERCISE OF RENEWAL OPTIONS) BY THE CORPORATION AND ITS AFFILIATES IN NETWORKS, AFFILIATIONS, JOINT VENTURES, PARTNERSHIPS, MERGERS OR ACQUISITIONS AND REQUIRE PARTICIPATION BY THE CORPORATION AND ITS AFFILIATES IN SUCH ARRANGEMENTS; (I) APPROVE DECISIONS OF THE CORPORATION AND ITS AFFILIATES TO PARTICIPATE (INCLUDING THE EXERCISE OF RENEWAL OPTIONS) IN MANAGED CARE OR OTHER HEALTH CARE SERVICE PURCHASING ARRANGEMENTS AND REQUIRE PARTICIPATION BY THE CORPORATION AND ITS AFFILIATES IN SUCH HEALTH CARE SERVICE PURCHASING ARRANGEMENTS; (J) DEVELOP AND REQUIRE ADOPTION OF MINIMUM MEDICAL STAFF QUALITY ASSURANCE AND UTILIZATION REVIEW STANDARDS, CRITERIA AND PROCEDURES FOR THE CORPORATION AND ITS AFFILIATES IN CONSULTATION WITH THE CORPORATION; (K) APPROVE ANY ACTION OF THE CORPORATION OR AN AFFILIATE TO CHANGE THE HOSPITAL FROM A GENERAL, ACUTE CARE COMMUNITY HOSPITAL OR TO CLOSE THE HOSPITAL; AND (L) APPROVE ANY AMENDMENT TO THE BYLAWS OR THE ARTICLES OF INCORPORATION OF THE CORPORATION, AND THE ARTICLES AND BYLAWS OF ANY NEWLY CREATED AFFILIATE AND REQUIRE AMENDMENT OF THESE GOVERNING DOCUMENTS AS NECESSARY OR ADVISABLE TO RESOLVE SIGNIFICANT ETHICAL ISSUES; TO MAINTAIN JOINT COMMISSION ACCREDITATION, TAX-EXEMPT STATUS, PARTICIPATION IN MEDICARE/MEDICAID OR TO PREVENT SIGNIFICANT ADVERSE LEGAL OR FINANCIAL EFFECTS TO THE CORPORATION OR SYSTEM, EXCEPT THAT THERE CAN BE NO AMENDMENT TO THE RESERVED POWERS LISTED IN SECTIONS (G) AND (K) OF THIS EXHIBIT A OR THE REQUIREMENT THAT ELECTED DIRECTORS BE REPRESENTATIVES OF WHITLEY COUNTY, AS DESCRIBED IN ARTICLE V, SECTIONS 2 AND 10 OF THESE BYLAWS WITHOUT THE CONSENT OF THE CORPORATION. THE CORPORATE MEMBER SHALL DEVELOP POLICIES FOR THE IMPLEMENTATION OF THE RESERVED POWERS, INCLUDING MATERIALITY POLICIES REGARDING MATTERS SUBJECT TO REVIEW. |
| 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. WHITLEY MEMORIAL HOSPITAL, INC. IS A SUBSIDIARY CORPORATION OF PARKVIEW HEALTH SYSTEM, INC. AN ELECTRONIC COPY OF THE ORGANIZATION'S FINAL FORM 990 (INCLUDING SUPPLEMENTAL SCHEDULES) WAS PROVIDED TO EACH VOTING MEMBER OF THE ORGANIZATION'S GOVERNING BODY AND THE SYSTEM AUDIT COMMITTEE, PRIOR TO FILING WITH THE IRS. ON OCTOBER 25, 2017, 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 | REGARDING LINES 15A AND 15B, TO THE EXTENT THAT THE ORGANIZATION HAS VICE PRESIDENT OR ABOVE, THE ORGANIZATION USED A PROCESS FOR DETERMINING COMPENSATION OF THE CEO, OFFICERS, AND KEY EMPLOYEES. THE PROCESS INCLUDES CONSULTATIONS WITH AN INDEPENDENT COMPENSATION ADVISOR AND THE REVIEW OF APPROPRIATE COMPARABILITY DATA; REVIEW AND APPROVAL BY THE COMPENSATION COMMITTEE OF THE GOVERNING BODY CONSISTING OF MEMBERS WHO DO NOT HAVE A CONFLICT OF INTEREST CONCERNING THE COMPENSATION; AND CONTEMPORANEOUS DOCUMENTATION AND RECORDKEEPING WITH RESPECT TO DELIBERATIONS AND DECISIONS REGARDING THE COMPENSATION ARRANGEMENTS. IN 2016, THE BOARD OF PARKVIEW HEALTH SYSTEM, INC. REVIEWED AND APPROVED ALL EXECUTIVE COMPENSATION, BENEFITS AND PERQUISITES FOR THE 2016 COMPENSATION PACKAGE, PURSUANT TO THE PARKVIEW HEALTH BYLAWS. THE COMPENSATION PACKAGE WAS APPROVED BY A MAJORITY OF INDEPENDENT BOARD MEMBERS. PARKVIEW'S INDEPENDENT CONSULTANT PREPARES A COMPETITIVE COMPENSATION ANALYSIS USING DATA FROM MULTIPLE PUBLISHED SURVEYS PREPARED BY INDEPENDENT FIRMS FOR POSITIONS THAT ARE FUNCTIONALLY COMPARABLE IN SIMILAR-SIZED HEALTH SYSTEMS AND HOSPITAL ORGANIZATIONS ON BOTH A REGIONAL AND NATIONAL BASIS. THE INDEPENDENT CONSULTANT PROVIDES A STATEMENT OF REASONABLENESS OF THE COMPENSATION PROVIDED TO THE CEO AS WELL AS ALL EXECUTIVES AT THE VICE PRESIDENT LEVEL AND ABOVE. ALL DATA IS SHARED WITH THE BOARD OF DIRECTORS. THE BOARD APPROVES ANY CHANGES IN COMPENSATION FOR THE CEO AND HIS DIRECT REPORTS. APPROVAL IS ALSO PROVIDED FOR THE SALARY BUDGET FOR THE ENTIRE ORGANIZATION. THE BOARD REVIEWS AND APPROVES THE PLAN DOCUMENTS FOR THE MANAGEMENT INCENTIVE COMPENSATION PLAN (MICP) AND THE PHYSICIAN AND PROVIDER INCENTIVE COMPENSATION PLAN (PICP). OFFICES OR POSITIONS REVIEWED AT THE 2016 MEETING: PRESIDENT AND CHIEF EXECUTIVE OFFICER PARKVIEW HEALTH EXECUTIVE VICE PRESIDENT CHIEF PHYSICIAN EXECUTIVE CHIEF OPERATING OFFICER PARKVIEW HEALTH CHIEF EXPERIENCE OFFICER PHYSICIAN EXECUTIVE OFFICER PARKVIEW PHYSICIANS GROUP PRESIDENT PARKVIEW REGIONAL MEDICAL CENTER AND AFFILIATES CHIEF CLINICAL INTEGRATION OFFICER CHIEF FINANCIAL OFFICER CHIEF INFORMATION OFFICER SENIOR VICE PRESIDENT GENERAL COUNSEL SENIOR VICE PRESIDENT CHIEF OPERATING OFFICER PARKVIEW PHYSICIANS GROUP CHIEF QUALITY AND SAFETY OFFICER SENIOR VICE PRESIDENT REVENUE CYCLE AND PAYOR STRATEGIES CHIEF HUMAN RESOURCES OFFICER CHIEF NURSING EXECUTIVE SENIOR VICE PRESIDENT STRATEGIC INITIATIVES CHIEF ACADEMIC AND RESEARCH OFFICER CHIEF MEDICAL INFORMATICS OFFICER CHIEF MEDICAL OFFICER PARKVIEW PHYSICIANS GROUP MEDICAL DIRECTOR COMMUNITY HOSPITALS MEDICAL DIRECTOR INTEGRATION AND DEVELOPMENT CHIEF OPERATING OFFICER - RANDALLIA CHIEF NURSING OFFICER - PARKVIEW REGIONAL MEDICAL CENTER AND AFFILIATES PRESIDENT - PARKVIEW CANCER CENTER SENIOR VICE PRESIDENT CHIEF OPERATING OFFICER SERVICE LINE LEADER BEHAVIORAL HEALTH SENIOR VICE PRESIDENT CHIEF OPERATING OFFICER SERVICE LINE LEADER ORTHO SENIOR VICE PRESIDENT CHIEF OPERATING OFFICER SERVICE LINE LEADER HEART INSTITUTE SENIOR VICE PRESIDENT CHIEF OPERATING OFFICER SERVICE LINE LEADER CANCER INSTITUTE SENIOR VICE PRESIDENT SERVICE LINE LEADER SENIOR VICE PRESIDENT DELIVERY SYSTEM INTEGRATION SENIOR VICE PRESIDENT FACILITY DESIGN AND OVERSIGHT SENIOR VICE PRESIDENT HEALTH AND WELL-BEING SENIOR VICE PRESIDENT PARKVIEW PHYSICIANS GROUP OPERATIONS DEPLOYMENT SENIOR VICE PRESIDENT SUPPLY AND SUPPORT SERVICES PRESIDENT COMMUNITY HOSPITALS VICE PRESIDENT CLINICAL INTEGRATION VICE PRESIDENT CONSTRUCTION VICE PRESIDENT EMPLOYEE STRATEGIES VICE PRESIDENT FINANCE VICE PRESIDENT MARKETING/COMMUNICATIONS/COMMUNITY RELATIONS VICE PRESIDENT NURSING RANDALLIA VICE PRESIDENT OPERATIONS - CANCER INSTITUTE VICE PRESIDENT PATIENT CARE SERVICES COMMUNITY HOSPITALS VICE PRESIDENT PARKVIEW PHYSICIANS GROUP FINANCE VICE PRESIDENT PARKVIEW PHYSICIANS GROUP PHYSICIAN PRACTICES VICE PRESIDENT STRATEGY AND BUSINESS DEVELOPMENT VICE PRESIDENT SURGICAL SERVICES PARKVIEW REGIONAL MEDICAL CENTER AND AFFILIATES VICE PRESIDENT CLINICAL OPERATIONS - PARKVIEW PHYSICIANS GROUP VICE PRESIDENT INFORMATION SECURITY VICE PRESIDENT INTERNAL AUDIT VICE PRESIDENT TECHNOLOGY VICE PRESIDENT PATIENT CARE SERVICES - COMMUNITY HOSPITALS |
| 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: | CURRENT YEAR EARNINGS TRANSFERRED TO PARENT -13,977,951. CLEAR DUE TO/FROM PARKVIEW WHITLEY LONG TERM CARE 49,070,269. ASSET TRANSFERS/ADJUSTMENTS 7,495. |
| FORM 990, PART XII, LINE 9 | EFFECTIVE DECEMBER 1, 2014, PARKVIEW WHITLEY HOSPITAL DIVESTED THE PARKVIEW WHITLEY LONG TERM CARE OPERATIONS TO AN INDEPENDENT THIRD PARTY. AS PART OF THE DIVESTITURE AGREEMENTS, PARKVIEW WHITLEY LONG TERM CARE MAINTAINED RESPONSIBILITY FOR THE COLLECTION AND PAYMENT OF CERTAIN RECEIVABLES AND LIABILITIES. AS OF MARCH 31, 2016, PARKVIEW WHITLEY HOSPITAL MANAGEMENT DETERMINED THESE ACTIVITIES WERE COMPLETE AND THE DECISION WAS MADE TO CLOSE OUT ACCOUNTS ON THE PARKVIEW WHITLEY LONG TERM CARE BALANCE SHEET. AT THE TIME OF THIS DECISION, THE PARKVIEW WHITLEY LONG TERM CARE BALANCE SHEET WAS COMPRISED OF INTERNAL RECEIVABLES AND LIABILITIES ASSOCIATED WITH OTHER PARKVIEW HEALTH RELATED ENTITIES. THE BALANCE SHEET WAS CLOSED OUT THROUGH THE TRANSFERRING OF NET ASSETS TO AND FROM RELATED PARKVIEW ENTITIES IN SETTLEMENT OF THESE INTERNAL RECEIVABLES AND LIABILITIES. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (8 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Direct Controlling NADirectControllingNACd | Controlled OrganizationControlledOrganizationInd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt |
|---|---|---|---|---|---|---|---|---|---|---|---|
| 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 | |
| WHITLEY MEMORIAL HOSPITAL FOUNDATION INC | |||||||||||
| 1260 E STATE ROAD 205 | COLUMBIA CITY | IN | 46725 | 311190239 | FUND MGMT | IN | 501(C)(3) | LINE 12A, I | Yes (1) | WHITLEY MEMORIAL HOSPITAL INC | |
| PARKVIEW OCCUPATIONAL HEALTH CENTERS INC | |||||||||||
| 10501 CORPORATE DRIVE | FORT WAYNE | IN | 46845 | 352064353 | OCCUP HEALTH | IN | 501(C)(3) | LINE 3 | 0 | PARKVIEW HEALTH SYSTEM INC | |
| PARKVIEW HOSPITAL INC | |||||||||||
| 11109 PARKVIEW PLAZA DRIVE | FORT WAYNE | IN | 46845 | 350868085 | HOSPITAL CARE | IN | 501(C)(3) | LINE 3 | 0 | PARKVIEW HEALTH SYSTEM INC | |
| COMMUNITY HOSPITAL OF LAGRANGE COUNTY INC | |||||||||||
| 207 N TOWNLINE ROAD | LAGRANGE | IN | 46761 | 202401676 | HOSPITAL CARE | IN | 501(C)(3) | LINE 3 | 0 | PARKVIEW HEALTH SYSTEM INC | |
| HUNTINGTON MEMORIAL HOSPITAL INC | |||||||||||
| 2001 STULTS ROAD | HUNTINGTON | IN | 46750 | 351970706 | HOSPITAL CARE | IN | 501(C)(3) | LINE 3 | 0 | PARKVIEW HEALTH SYSTEM INC | |
| COMMUNITY HOSPITAL OF NOBLE COUNTY INC | |||||||||||
| 401 SAWYER ROAD | KENDALLVILLE | IN | 46755 | 352087092 | HOSPITAL CARE | IN | 501(C)(3) | LINE 3 | 0 | PARKVIEW HEALTH SYSTEM INC | |
| PARKVIEW WABASH HOSPITAL INC | |||||||||||
| 710 N EAST ST | WABASH | IN | 46992 | 471753440 | HOSPITAL CARE | IN | 501(C)(3) | LINE 3 | 0 | PARKVIEW HEALTH SYSTEM INC | |
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (3 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Direct Controlling NADirectControllingNACd | Predominant Income TypePredominantIncomeTypeTxt | Disproportionate AllocationsDisproportionateAllocationsInd | General Or Managing PartnerGeneralOrManagingPartnerInd |
|---|---|---|---|---|---|---|---|---|---|---|
| ORTHOPAEDIC HOSPITAL AT PARKVIEW NORTH LLC | ||||||||||
| 10501 CORPORATE DRIVE | FORT WAYNE | IN | 46845 | 260143823 | ORTHO HOSPITAL | IN | N/A | N/A | 0 | 0 |
| FOUNDATION SURGERY AFFILIATE OF FORT WAYNE LLC | ||||||||||
| 8004 CARNEGIE BLVD | FORT WAYNE | IN | 46804 | 201394120 | SURGICAL SERVICES | IN | N/A | N/A | 0 | 0 |
| MANAGED CARE SERVICES LLC | ||||||||||
| 10501 CORPORATE DRIVE | FORT WAYNE | IN | 46845 | 351996535 | HEALTH PLAN ADMIN | IN | N/A | N/A | 0 | 0 |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Direct Controlling NADirectControllingNACd | Entity TypeEntityTypeTxt | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|
| MIDWEST COMMUNITY HEALTH ASSOCIATES INC | |||||||||
| 442 W HIGH STREET | BRYAN | OH | 43506 | 341045870 | PHYSICIANS | OH | N/A | C | 0 |
| WOODLAND PLAZA MEDICAL PARK CONDO ASSOC INC | |||||||||
| 202 W BERRY ST SUITE 800 | FORT WAYNE | IN | 46802 | 352058340 | CONDO MANAGEMENT | IN | N/A | C | 0 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | Yes (1) | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (1) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | Yes (1) | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | Yes (1) | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | Yes (1) | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | Yes (1) | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (1) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (1) | SharingOfFacilitiesInd |
| Paid Employees Sharing | 0 | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (1) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (1) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | Yes (1) | TransferToOtherOrgInd |
| Transfer From Other Org | Yes (1) | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (3 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt |
|---|---|---|
| WHITLEY MEMORIAL HOSPITAL FOUNDATION INC | ||
| B | $104,396 | PART VII SUPPLEMENTAL INFORMATION |
| WHITLEY MEMORIAL HOSPITAL FOUNDATION INC | ||
| C | $195,240 | PART VII SUPPLEMENTAL INFORMATION |
| WHITLEY MEMORIAL HOSPITAL FOUNDATION INC | ||
| R | $94,336 | PART VII SUPPLEMENTAL INFORMATION |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE R, PART V, LINE 2, COLUMN (C): | FormAndLineReferenceDesc |
| Explanation | THE AMOUNTS REPORTED AS TRANSACTIONS WITH RELATED ORGANIZATIONS ARE CONSISTENT WITH THE AMOUNTS REPORTED ON THE ORGANIZATION'S AUDITED FINANCIAL STATEMENTS UNDER THE GENERALLY ACCEPTED ACCOUNTING STANDARDS DEPENDING ON THE TYPE OF TRANSACTION INVOLVED. | ExplanationTxt |
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