COMMUNITY HOSPITAL OF LAGRANGE COUNTY INC: Form 990, tax year 2015

View the entire original 990 at ProPublica ↗

Organization: COMMUNITY HOSPITAL OF LAGRANGE COUNTY INC (EIN 20-2401676)
Tax period: 2015-01-01 to 2015-12-31
Filed: 2016-11-10
IRS object ID: 201643159349304364
Schema version: 2015v2.1
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 K
Schedule O
Schedule R

Return header ReturnHeader

Field	Value	IRS element (for citing)
Return	2016-11-10T17:09:14-06:00	ReturnTs
Tax Period End	2015-12-31	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	2015-01-01	TaxPeriodBeginDt

Filer Filer

Field	Value	IRS element (for citing)
EIN	202401676	EIN

Business Name BusinessName

Field	Value	IRS element (for citing)
Business Name Line1	COMMUNITY HOSPITAL OF LAGRANGE COUNTY	BusinessNameLine1Txt
Business Name Line2	INC	BusinessNameLine2Txt

Field	Value	IRS element (for citing)
Business Name Control	COMM	BusinessNameControlTxt
Phone	2603738429	PhoneNum

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	207 N TOWNLINE RD	AddressLine1Txt
City	LAGRANGE	CityNm
State Abbreviation	IN	StateAbbreviationCd
ZIP	46761	ZIPCd

Business Officer BusinessOfficerGrp

Field	Value	IRS element (for citing)
Person	JEANNE' WICKENS	PersonNm
Person Title	PH SVP & CFO	PersonTitleTxt
Phone	2603738407	PhoneNum
Signature	2016-11-10	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

Field	Value	IRS element (for citing)
Tax	2015	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	$35,586,400	GrossReceiptsAmt
Group Return For Affiliates	0	GroupReturnForAffiliatesInd
Organization501c3	Yes (X)	Organization501c3Ind
Website Address	WWW.PARKVIEW.COM; WWW.PARKVIEWFOUNDATIONS.ORG	WebsiteAddressTxt
Type Of Organization Corp	Yes (X)	TypeOfOrganizationCorpInd
Formation	2005	FormationYr
Legal Domicile State	IN	LegalDomicileStateCd
Activity Or Mission	COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC. WORKS TO IMPROVE THE HEALTH OF OUR COMMUNITIES AND PROVIDES QUALITY HEALTH SERVICES TO ALL WHO ENTRUST THEIR CARE TO US.	ActivityOrMissionDesc
Voting Members Governing Body	11	VotingMembersGoverningBodyCnt
Voting Members Independent	6	VotingMembersIndependentCnt
Total Employee	231	TotalEmployeeCnt
Total Volunteers	35	TotalVolunteersCnt
Total Gross UBI	$0	TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm	$0	NetUnrelatedBusTxblIncmAmt
PY Contributions Grants	$45,846	PYContributionsGrantsAmt
CY Contributions Grants	$50,521	CYContributionsGrantsAmt
PY Program Service Revenue	$33,914,909	PYProgramServiceRevenueAmt
CY Program Service Revenue	$35,268,909	CYProgramServiceRevenueAmt
PY Investment Income	$0	PYInvestmentIncomeAmt
CY Investment Income	$845	CYInvestmentIncomeAmt
PY Other Revenue	$188,206	PYOtherRevenueAmt
CY Other Revenue	$237,933	CYOtherRevenueAmt
PY Total Revenue	$34,148,961	PYTotalRevenueAmt
CY Total Revenue	$35,558,208	CYTotalRevenueAmt
PY Grants And Similar Paid	$51,888	PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid	$100,827	CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members	$0	PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members	$0	CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid	$11,348,139	PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid	$12,072,302	CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns	$0	PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns	$0	CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense	$30,271	CYTotalFundraisingExpenseAmt
PY Other Expenses	$20,147,876	PYOtherExpensesAmt
CY Other Expenses	$21,686,298	CYOtherExpensesAmt
PY Total Expenses	$31,547,903	PYTotalExpensesAmt
CY Total Expenses	$33,859,427	CYTotalExpensesAmt
PY Revenues Less Expenses	$2,601,058	PYRevenuesLessExpensesAmt
CY Revenues Less Expenses	$1,698,781	CYRevenuesLessExpensesAmt
Total Assets BOY	$27,575,139	TotalAssetsBOYAmt
Total Assets EOY	$26,693,136	TotalAssetsEOYAmt
Total Liabilities BOY	$30,086,537	TotalLiabilitiesBOYAmt
Total Liabilities EOY	$29,204,534	TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY	-$2,511,398	NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY	-$2,511,398	NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part III	Yes (X)	InfoInScheduleOPartIIIInd
Mission	COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC. WORKS TO IMPROVE THE HEALTH OF OUR COMMUNITIES AND PROVIDES QUALITY HEALTH SERVICES TO ALL WHO ENTRUST THEIR CARE TO US.	MissionDesc
Significant New Program Srvc	0	SignificantNewProgramSrvcInd
Significant Change	0	SignificantChangeInd
Expense	$27,571,359	ExpenseAmt
Grant	$100,827	GrantAmt
Revenue	$35,268,909	RevenueAmt
Desc	AS A NOT-FOR-PROFIT HOSPITAL, WE TAKE OUR MISSION TO HEART. COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC., D.B.A. PARKVIEW LAGRANGE HOSPITAL, EXISTS FOR ONE PURPOSE - TO IMPROVE THE HEALTH OF THE COMMUNITIES WE SERVE. COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC. GIVES BACK TO THE COMMUNITY IN THE FORM OF IMPROVED FACILITIES, EDUCATION AND OUTREACH PROGRAMS, FREE AND DISCOUNTED CARE, VOLUNTEERISM AND MUCH MORE. THE FOLLOWING ARE SOME OF THE WAYS COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC. IS REACHING OUT TO MAKE OUR NEIGHBORHOODS AND COMMUNITIES HEALTHIER:-FINANCIAL ASSISTANCE-PRIMARY HEALTH CARE / ACCESS (SEE SCHEDULE O FOR CONTINUATION)-HEALTH SCREENING AND PREVENTION-DISEASE MANAGEMENT-CONTRIBUTIONS TOWARD AND PARTICIPATION IN ECONOMIC DEVELOPMENT ACTIVITIESCOMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC. IS A 25-BED CRITICAL ACCESS FACILITY THAT PROVIDES ACUTE-CARE SERVICES TO THE PEOPLE OF LAGRANGE COUNTY AND THE SURROUNDING AREA. THE VISION OF HOSPITAL LEADERSHIP HAS CONTINUED TO FOCUS ON EXPANDING ACCESS TO HEALTHCARE SERVICES AND HELPING TO IMPROVE THE HEALTH STATUS OF THOSE WHO LIVE AND WORK IN THE COMMUNITIES IT SERVES. AMONG THE SERVICES PROVIDED AT THE HOSPITAL ARE:-EMERGENCY CARE-INPATIENT MEDICAL/SURGICAL CARE-ELECTRONIC INTENSIVE CARE UNIT PROVIDING 24/7 ACCESS TO BOARD CERTIFIED INTENSIVE CARE SPECIALISTS-AMBULATORY AND INPATIENT SURGERY-ENDOSCOPY-ORTHOPEDIC SURGERY-INTENSIVE OUTPATIENT BEHAVIORAL HEALTH PROGRAM FOR SENIORS-OBSTETRICS/GYNECOLOGY SERVICES-OUTPATIENT AND INPATIENT REHABILITATION-ADVANCED, DIGITAL DIAGNOSTIC IMAGINGTHE ADDITION OF A 17,300 SQUARE FOOT MEDICAL OFFICE BUILDING ON ITS CAMPUS IN 2013 HAS ALLOWED FOR EXPANSION OF FULL-TIME AND VISITING MEDICAL SPECIALISTS, MAKING THESE SERVICES AVAILABLE LOCALLY FOR THE COMMUNITY. SPECIALTY MEDICAL SERVICES INCLUDE:-ON-SITE ONCOLOGY AND HEMATOLOGY SERVICES-CARDIOLOGY-COLON AND RECTAL SURGERY-GENERAL SURGERY-GYNECOLOGY-ORTHOPEDIC SURGERY-PRENATAL GENETIC COUNSELING-PODIATRY-UROLOGY FINANCIAL ASSISTANCE:COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC.'S MISSION INCLUDES CARING FOR PATIENTS WHO DO NOT HAVE THE MEANS TO MEET THEIR FINANCIAL OBLIGATIONS. THE HOSPITAL PLACES ITS PRIORITY ON PROVIDING THE NECESSARY CARE, NOT ON THE PATIENT'S FINANCIAL ABILITY TO PAY FOR THEIR MEDICAL EXPENSES.PRIMARY HEALTH CARE / ACCESS:COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC. PROVIDES CLINICAL STAFF AND SUPPORT TO TARGETED POPULATIONS WITHIN LAGRANGE COUNTY, INCLUDING:-A FULL-TIME PLAIN CHURCH COORDINATOR SERVES AS A SINGLE POINT OF ACCESS FOR AMISH, MENNONITE AND OTHER PLAIN CHURCH MEMBERS WHO HAVE QUESTIONS ABOUT THE HEALTHCARE SERVICES AVAILABLE WITHIN THE PARKVIEW HEALTH SYSTEM. WHETHER THE QUESTION CONCERNS THE APPROXIMATE COST OF A PROCEDURE, THE SCHEDULING OF A DIAGNOSTIC TEST, OR A BILLING QUESTION, THE PLAIN CHURCH COORDINATOR ASSISTS INDIVIDUALS AND FAMILIES BY OBTAINING AN ANSWER.-A MEDICAL DIRECTOR TO PROVIDE SUPPORT FOR THE LAGRANGE COUNTY SHERIFF'S DEPARTMENT AND INMATES IN THE COUNTY JAIL.-A FULL-TIME ATHLETIC TRAINER IS PROVIDED, IN PARTNERSHIP WITH LAKELAND HIGH SCHOOL, TO MEET THE ON-SITE NEEDS OF STUDENT ATHLETES.-SUPPORT FOR THE KENNY BURKETT CLINIC WHICH PROVIDES FREE MEDICAL SERVICES TO RESIDENTS OF LAGRANGE COUNTY WHO ARE UNABLE TO PAY FOR SERVICES. SUPPORT INCLUDES FREE RADIOLOGY DIAGNOSTICS AND LABORATORY TESTING.-A PARTNERSHIP WITH THE LAGRANGE COUNTY COUNCIL ON AGING TO ASSIST WITH OPERATIONAL SUPPORT FOR THE COA'S TRANSPORTATION SERVICES TO ALL RESIDENTS OF LAGRANGE COUNTY. NEARLY HALF OF THE TRIPS THE COA PROVIDES ARE TO A PHYSICIAN FOR A CHECK-UP OR TO THE HOSPITAL FOR A TEST OR TREATMENT. TRANSPORTATION PROVIDED BY THE COA'S LCAT SERVICE IS FREE TO SENIORS RESIDING IN LAGRANGE COUNTY. HOMEMAKER SERVICES HELP WITH DAY-TO-DAY TASKS THAT, IN MANY CASES, COULD PUT THE SENIOR AT RISK OF A FALL OR OTHER INJURY.HEALTH SCREENING AND PREVENTION AND DISEASE MANAGEMENT:COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC. PROVIDES FREE AND LOW COST HEALTH SCREENINGS AND EDUCATION TO DIVERSE POPULATIONS IN OUR SERVICE AREA: -WELLNESS ON THE ROAD EVENTS BRINGS FREE AND LOW COST SCREENINGS OUT INTO THE COMMUNITY, IMPROVING ACCESS TO THESE SERVICES. AMONG THE SCREENINGS OFFERED ARE LOW COST BLOOD TESTS, HEARING SCREENINGS, MAMMOGRAMS AND MORE.-PARKVIEW LAGRANGE SENIOR CLUB PROVIDES HEALTH EDUCATION PROGRAMS AND ACTIVITIES TO IMPROVE THE HEALTH AND WELL-BEING OF SENIORS THROUGHOUT LAGRANGE COUNTY. TOPICS INCLUDE HEART DISEASE, FALL PREVENTION, CANCER, ETC.-HEALTH BOOTHS ARE PROVIDED AT LOCAL COMMUNITY EVENTS AND OFFER ACTIVITIES AND EDUCATION DESIGNED TO HELP PARTICIPANTS LIVE A HEALTHIER LIFE STYLE. INFORMATION PROVIDED INCLUDES CAR SEAT SAFETY, NUTRITION TIPS FOR ALL AGES, THE IMPORTANCE OF EXERCISE AND ACTIVITY IN IMPROVING AND MAINTAINING GOOD HEALTH, ETC.-PRE-PARTICIPATION PHYSICALS FOR STUDENT HIGH SCHOOL AND MIDDLE SCHOOL ATHLETES FROM ALL SCHOOL DISTRICTS IN LAGRANGE COUNTY. THIS ANNUAL EVENT PROVIDES SCREENINGS THAT MEET THE IHSAA REQUIREMENTS FOR STUDENT ATHLETES INCLUDING HEIGHT, WEIGHT, VISION, BLOOD PRESSURE, EKG, AND A PHYSICAL EXAM WITH A PHYSICIAN, ETC.-DIABETES SUPPORT GROUP - THIS MONTHLY GROUP TAUGHT BY A CERTIFIED DIABETES EDUCATOR AND IS FREE AND OPEN TO ANY WHOSE LIVES ARE AFFECTED BY DIABETES. THE GROUP OFFERS EDUCATIONAL PROGRAMS ON MEDICATION MANAGEMENT, NUTRITION, NEUROPATHY, ETC., IN ADDITION TO OPEN DIALOGUE ABOUT ANY ISSUES SPECIFIC TO MEMBERS OF THE GROUP.-COMMUNITY HARVEST FOOD BANK & THE LAGRANGE FOOD & CLOTHES BASKET PROVIDING FOOD AND OTHER ESSENTIALS TO THOSE WHO NEED THEM MOST.-"HEALTHY VIEW" COMMUNITY NEWSLETTER IS MAILED TO ALL HOUSEHOLDS IN LAGRANGE COUNTY. THE PUBLICATION OFFERS HEALTH INFORMATION ON LEADING TOPICS OF INTEREST INCLUDING CANCER, HEART DISEASE, DIABETES, AND MORE.	Desc
Total Program Service Expenses	$27,571,359	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	0	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	Yes (1)	TaxExemptBondsInd
Invest Tax Exempt Bonds	0	InvestTaxExemptBondsInd
Escrow Account	0	EscrowAccountInd
On Behalf Of Issuer	0	OnBehalfOfIssuerInd
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	0	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	0	RelatedOrganizationCtrlEntInd
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	31	IRPDocumentCnt
IRP Document W2 G	0	IRPDocumentW2GCnt
Backup Wthld Compliance	Yes (1)	BackupWthldComplianceInd
Employee	231	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	Yes (1)	QuidProQuoContributionsInd
Quid Pro Quo Contri Discl	Yes (1)	QuidProQuoContriDisclInd
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	11	GoverningBodyVotingMembersCnt
Independent Voting Member	6	IndependentVotingMemberCnt
Family Or Business Rln	Yes (1)	FamilyOrBusinessRlnInd
Delegation Of Mgmt Duties	0	DelegationOfMgmtDutiesInd
Change To Org Documents	0	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 (19 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
ROBERT MYERS
DIRECTOR/LGHOS PRESIDENT	40.00	0.00	Yes (X)	Yes (X)	$275,635	$0	$67,356
MICHAEL PACKNETT
DIRECTOR/PH PRESIDENT & CEO	1.00	56.00	Yes (X)	Yes (X)	$0	$1,472,327	$673,379
LOREN HELMUTH
DIRECTOR/PH PHYSICIAN	1.00	40.00	Yes (X)		$11,374	$456,142	$43,714
MICHAEL MELLINGER
DIRECTOR/POHCI PHYSICIAN	1.00	9.00	Yes (X)		$3,250	$38,830	$0
RHONDA SHARP
DIRECTOR/PH PHYSICIAN	1.00	40.00	Yes (X)		$18,000	$250,296	$33,503
KEVIN LAMBRIGHT
DIRECTOR/CHAIR	1.00	1.00	Yes (X)		$6,750	$2,250	$0
DENNIS LEHMAN
DIRECTOR/TREASURER	1.00	0.00	Yes (X)		$4,750	$0	$0
JOE PIERCE
DIRECTOR	1.00	1.00	Yes (X)		$4,500	$1,250	$0
JOHN PRICE
DIRECTOR/VICE CHAIR	1.00	1.00	Yes (X)		$4,750	$1,750	$0
SHERRYL RHINESMITH
DIRECTOR	1.00	0.00	Yes (X)		$4,750	$0	$0
PAUL YODER
DIRECTOR	1.00	0.00	Yes (X)		$3,250	$0	$0
MICHAEL BROWNING
PH SVP & CFO - PARTIAL YEAR	1.00	56.00		Yes (X)	$0	$590,899	$70,288
STANTON RISSER
INTERIM PH CFO	1.00	56.00		Yes (X)	$0	$277,183	$60,834
JORDI DISLER
LGHOS VP PATIENT CARE	40.00	0.00			$188,843	$0	$51,464	Yes (X)
BRENDA ARMENTROUT
LGHOS MGR PHARMACY	40.00	0.00			$163,034	$0	$22,889		Yes (X)
ROBERT BLOOMFIELD
LGHOS MGR SUPPORT SERVICE	27.00	10.00			$96,826	$25,817	$26,453		Yes (X)
MICHAEL CHARLIER
LGHOS MGR REHAB	40.00	0.00			$107,619	$0	$28,339		Yes (X)
TREVOR FRY
LGHOS MGR ER	40.00	0.00			$106,522	$0	$27,770		Yes (X)
BRUCE CONEY
LGHOS MGR EMS	40.00	0.00			$100,880	$0	$17,113		Yes (X)

Field	Value	IRS element (for citing)
Total Reportable Comp From Org	$1,100,733	TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org	$3,116,744	TotReportableCompRltdOrgAmt
Total Other Compensation	$1,123,102	TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K	7	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
PROFESSIONAL EMERGENCY PHYSICIANS INC
PO BOX 12949	FORT WAYNE	IN	46866	PHYSICIANS	$1,581,382
PARKVIEW HOSPITAL INC
11109 PARKVIEW PLAZA DRIVE	FORT WAYNE	IN	46845	LABORATORY SERVICES	$816,685
GREAT LAKES ANESTHESIA PC
500 N NAPPANEE ST STE 11-B	ELKHART	IN	46514	ANESTHESIOLOGISTS	$679,373
MED SOLUTIONS TEMP STAFFING
1010 N 102ND STREET SUITE 300	OMAHA	NE	68114	NURSES	$187,107
NORTHEAST INTERNAL MEDICINE ASSOC INC
2500 N DETROIT ST	LAGRANGE	IN	46761	HOSPITALISTS	$155,361

Field	Value	IRS element (for citing)
Cntrct Rcvd Greater Than100 K	5	CntrctRcvdGreaterThan100KCnt
Federated Campaigns	$674	FederatedCampaignsAmt
Fundraising	$11,175	FundraisingAmt
Government Grants	$12,338	GovernmentGrantsAmt
All Other Contributions	$26,334	AllOtherContributionsAmt
Noncash Contributions	$423	NoncashContributionsAmt
Total Contributions	$50,521	TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (5 entries)

DescDesc	BusinessBusinessCd	Total Revenue ColumnTotalRevenueColumnAmt	Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
NET PATIENT SERVICE	622000	$34,579,657	$34,579,657
EMS SUBSIDY	900099	$349,000	$349,000
PHARMACY	446110	$251,544	$251,544
POHCI MEDICAL SERVICES	621990	$57,550	$57,550
INTERUNIT RENT	531120	$18,461	$18,461

Total Oth Program Service Rev TotalOthProgramServiceRevGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$12,697	TotalRevenueColumnAmt
Related Or Exempt Func Income	$12,697	RelatedOrExemptFuncIncomeAmt

Field	Value	IRS element (for citing)
Total Program Service Revenue	$35,268,909	TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$833	TotalRevenueColumnAmt
Exclusion	$833	ExclusionAmt

Gross Rents GrossRentsGrp

Field	Value	IRS element (for citing)
Real	$14,035	RealAmt

Less Rental Expenses LessRentalExpensesGrp

Field	Value	IRS element (for citing)
Real	$25,760	RealAmt

Rental Income Or Loss RentalIncomeOrLossGrp

Field	Value	IRS element (for citing)
Real	-$11,725	RealAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

Field	Value	IRS element (for citing)
Total Revenue Column	-$11,725	TotalRevenueColumnAmt
Exclusion	-$11,725	ExclusionAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

Field	Value	IRS element (for citing)
Other	$12	OtherAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

Field	Value	IRS element (for citing)
Other	$0	OtherAmt

Gain Or Loss GainOrLossGrp

Field	Value	IRS element (for citing)
Other	$12	OtherAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$12	TotalRevenueColumnAmt
Exclusion	$12	ExclusionAmt

Field	Value	IRS element (for citing)
Fundraising Gross Income	$3,203	FundraisingGrossIncomeAmt
Contri Rpt Fundraising Event	$11,175	ContriRptFundraisingEventAmt
Fundraising Direct Expenses	$2,432	FundraisingDirectExpensesAmt

Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$771	TotalRevenueColumnAmt
Exclusion	$771	ExclusionAmt

Other Revenue Misc OtherRevenueMiscGrp (2 entries)

DescDesc	BusinessBusinessCd	Total Revenue ColumnTotalRevenueColumnAmt	ExclusionExclusionAmt
CAFETERIA REVENUE	722210	$235,295	$235,295
GIFT SHOP REVENUE	453220	$13,592	$13,592

Field	Value	IRS element (for citing)
Other Revenue Total	$248,887	OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$35,558,208	TotalRevenueColumnAmt
Related Or Exempt Func Income	$35,268,909	RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue	$0	UnrelatedBusinessRevenueAmt
Exclusion	$238,778	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	$99,615	TotalAmt
Program Services	$99,615	ProgramServicesAmt

Grants To Domestic Individuals GrantsToDomesticIndividualsGrp

Field	Value	IRS element (for citing)
Total	$1,212	TotalAmt
Program Services	$1,212	ProgramServicesAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

Field	Value	IRS element (for citing)
Total	$647,983	TotalAmt
Management And General	$647,983	ManagementAndGeneralAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

Field	Value	IRS element (for citing)
Total	$8,756,272	TotalAmt
Program Services	$8,734,994	ProgramServicesAmt
Fundraising	$21,278	FundraisingAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

Field	Value	IRS element (for citing)
Total	$2,668,047	TotalAmt
Program Services	$2,661,323	ProgramServicesAmt
Fundraising	$6,724	FundraisingAmt

Fees For Services Other FeesForServicesOtherGrp

Field	Value	IRS element (for citing)
Total	$4,546,427	TotalAmt
Program Services	$4,096,649	ProgramServicesAmt
Management And General	$449,778	ManagementAndGeneralAmt

Advertising AdvertisingGrp

Field	Value	IRS element (for citing)
Total	$3,829	TotalAmt
Program Services	$3,329	ProgramServicesAmt
Management And General	$500	ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

Field	Value	IRS element (for citing)
Total	$966,928	TotalAmt
Program Services	$890,133	ProgramServicesAmt
Management And General	$76,711	ManagementAndGeneralAmt
Fundraising	$84	FundraisingAmt

Occupancy OccupancyGrp

Field	Value	IRS element (for citing)
Total	$587,802	TotalAmt
Program Services	$577,917	ProgramServicesAmt
Management And General	$9,885	ManagementAndGeneralAmt

Travel TravelGrp

Field	Value	IRS element (for citing)
Total	$57,273	TotalAmt
Program Services	$36,577	ProgramServicesAmt
Management And General	$19,503	ManagementAndGeneralAmt
Fundraising	$1,193	FundraisingAmt

Conferences Meetings ConferencesMeetingsGrp

Field	Value	IRS element (for citing)
Total	$22,031	TotalAmt
Program Services	$6,160	ProgramServicesAmt
Management And General	$14,896	ManagementAndGeneralAmt
Fundraising	$975	FundraisingAmt

Interest InterestGrp

Field	Value	IRS element (for citing)
Total	$134,837	TotalAmt
Program Services	$134,837	ProgramServicesAmt

Depreciation Depletion DepreciationDepletionGrp

Field	Value	IRS element (for citing)
Total	$1,487,361	TotalAmt
Program Services	$1,476,232	ProgramServicesAmt
Management And General	$11,129	ManagementAndGeneralAmt

Insurance InsuranceGrp

Field	Value	IRS element (for citing)
Total	$82,460	TotalAmt
Program Services	$82,460	ProgramServicesAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDesc	TotalTotalAmt	Management And GeneralManagementAndGeneralAmt	Program ServicesProgramServicesAmt
CORP SERVICE ALLOCATION	$5,000,000	$5,000,000
BAD DEBT	$4,434,778		$4,434,778
MEDICAL SUPPLIES	$2,382,551		$2,382,551
PH SUBSIDY	$1,938,170		$1,938,170

All Other Expenses AllOtherExpensesGrp

Field	Value	IRS element (for citing)
Total	$41,851	TotalAmt
Program Services	$14,422	ProgramServicesAmt
Management And General	$27,412	ManagementAndGeneralAmt
Fundraising	$17	FundraisingAmt

Total Functional Expenses TotalFunctionalExpensesGrp

Field	Value	IRS element (for citing)
Total	$33,859,427	TotalAmt
Program Services	$27,571,359	ProgramServicesAmt
Management And General	$6,257,797	ManagementAndGeneralAmt
Fundraising	$30,271	FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

Field	Value	IRS element (for citing)
BOY	$1,725	BOYAmt
EOY	$1,575	EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

Field	Value	IRS element (for citing)
BOY	$493	BOYAmt
EOY	$930	EOYAmt

Pledges And Grants Receivable PledgesAndGrantsReceivableGrp

Field	Value	IRS element (for citing)
BOY	$6,241	BOYAmt
EOY	$32	EOYAmt

Accounts Receivable AccountsReceivableGrp

Field	Value	IRS element (for citing)
BOY	$4,397,286	BOYAmt
EOY	$4,326,471	EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

Field	Value	IRS element (for citing)
BOY	$239,648	BOYAmt
EOY	$263,617	EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

Field	Value	IRS element (for citing)
BOY	$11,836	BOYAmt
EOY	$18,394	EOYAmt

Field	Value	IRS element (for citing)
Land Bldg Equip Cost Or Other Bss	$30,996,491	LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec	$14,062,167	LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

Field	Value	IRS element (for citing)
BOY	$17,820,095	BOYAmt
EOY	$16,934,324	EOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

Field	Value	IRS element (for citing)
BOY	$1,071	BOYAmt
EOY	$0	EOYAmt

Intangible Assets IntangibleAssetsGrp

Field	Value	IRS element (for citing)
BOY	$5,011,241	BOYAmt
EOY	$5,011,241	EOYAmt

Other Assets Total OtherAssetsTotalGrp

Field	Value	IRS element (for citing)
BOY	$85,503	BOYAmt
EOY	$136,552	EOYAmt

Total Assets TotalAssetsGrp

Field	Value	IRS element (for citing)
BOY	$27,575,139	BOYAmt
EOY	$26,693,136	EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

Field	Value	IRS element (for citing)
BOY	$971,137	BOYAmt
EOY	$1,161,704	EOYAmt

Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$20,342,267	BOYAmt
EOY	$19,574,388	EOYAmt

Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp

Field	Value	IRS element (for citing)
BOY	$142,549	BOYAmt
EOY	$95,578	EOYAmt

Other Liabilities OtherLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$8,630,584	BOYAmt
EOY	$8,372,864	EOYAmt

Total Liabilities TotalLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$30,086,537	BOYAmt
EOY	$29,204,534	EOYAmt

Field	Value	IRS element (for citing)
Organization Follows SFAS117	Yes (X)	OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	-$2,511,398	BOYAmt
EOY	-$2,511,398	EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

Field	Value	IRS element (for citing)
BOY	-$2,511,398	BOYAmt
EOY	-$2,511,398	EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

Field	Value	IRS element (for citing)
BOY	$27,575,139	BOYAmt
EOY	$26,693,136	EOYAmt

Field	Value	IRS element (for citing)
Info In Schedule O Part XI	Yes (X)	InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss	$1,698,781	ReconcilationRevenueExpnssAmt
Other Changes In Net Assets	-$1,698,781	OtherChangesInNetAssetsAmt
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	$2,907	OtherActivitiesAmt
Total Lobbying Expenditures	$2,907	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, AMERICAN HOSPITAL ASSOCIATION AND NATIONAL RURAL HEALTH ASSOCIATION USED FOR LOBBYING ACTIVITIES.	ExplanationTxt

Schedule D IRS990ScheduleD

Land LandGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$282,529	OtherCostOrOtherBasisAmt
Book Value	$282,529	BookValueAmt

Buildings BuildingsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$13,429,858	OtherCostOrOtherBasisAmt
Depreciation	$2,914,508	DepreciationAmt
Book Value	$10,515,350	BookValueAmt

Leasehold Improvements LeaseholdImprovementsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$29,098	OtherCostOrOtherBasisAmt
Depreciation	$26,545	DepreciationAmt
Book Value	$2,553	BookValueAmt

Equipment EquipmentGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$15,282,286	OtherCostOrOtherBasisAmt
Depreciation	$10,153,907	DepreciationAmt
Book Value	$5,128,379	BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$1,972,720	OtherCostOrOtherBasisAmt
Depreciation	$967,207	DepreciationAmt
Book Value	$1,005,513	BookValueAmt

Field	Value	IRS element (for citing)
Total Book Value Land Buildings	$16,934,324	TotalBookValueLandBuildingsAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (3 entries)

DescDesc	AmtAmt
DUE TO/FROM INTERUNIT	$1,188,703
EST MEDICARE/MEDICAID SETTLEMENTS	$587,920
NOTE PAYABLE TO PH	$6,596,241

Field	Value	IRS element (for citing)
Total Liability	$8,372,864	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, 2015 AND 2014, 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 2011 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	Yes (1)	ExpensesExceedBudgetInd
Unable To Provide Care	0	UnableToProvideCareInd
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	$468,699	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$468,699	NetCommunityBenefitExpnsAmt
Total Expense	0.01590	TotalExpensePct

Unreimbursed Medicaid UnreimbursedMedicaidGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$1,993,037	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$886,628	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$1,106,409	NetCommunityBenefitExpnsAmt
Total Expense	0.03760	TotalExpensePct

Unreimbursed Costs UnreimbursedCostsGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$1,058,239	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$514,484	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$543,755	NetCommunityBenefitExpnsAmt
Total Expense	0.01850	TotalExpensePct

Total Financial Assistance Typ TotalFinancialAssistanceTyp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$3,519,975	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$1,401,112	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$2,118,863	NetCommunityBenefitExpnsAmt
Total Expense	0.07200	TotalExpensePct

Community Health Services CommunityHealthServicesGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$41,159	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$6,685	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$34,474	NetCommunityBenefitExpnsAmt
Total Expense	0.00120	TotalExpensePct

Cash And In Kind Contributions CashAndInKindContributionsGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$75,178	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$75,178	NetCommunityBenefitExpnsAmt
Total Expense	0.00260	TotalExpensePct

Total Other Benefits TotalOtherBenefitsGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$116,337	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$6,685	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$109,652	NetCommunityBenefitExpnsAmt
Total Expense	0.00380	TotalExpensePct

Total Community Benefits TotalCommunityBenefitsGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$3,636,312	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$1,407,797	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$2,228,515	NetCommunityBenefitExpnsAmt
Total Expense	0.07580	TotalExpensePct

Economic Development EconomicDevelopmentGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$10,000	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$0	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$10,000	NetCommunityBenefitExpnsAmt
Total Expense	0.00030	TotalExpensePct

Workforce Development WorkforceDevelopmentGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$41,957	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$0	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$41,957	NetCommunityBenefitExpnsAmt
Total Expense	0.00140	TotalExpensePct

Total Communtity Building Acty TotalCommuntityBuildingActyGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$51,957	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$51,957	NetCommunityBenefitExpnsAmt
Total Expense	0.00170	TotalExpensePct

Field	Value	IRS element (for citing)
Bad Debt Expense Reported	Yes (1)	BadDebtExpenseReportedInd
Bad Debt Expense	$4,434,778	BadDebtExpenseAmt
Bad Debt Expense Attributable	$109,936	BadDebtExpenseAttributableAmt
Reimbursed By Medicare	$7,493,693	ReimbursedByMedicareAmt
Cost Of Care Reimbursed By Medcr	$6,214,304	CostOfCareReimbursedByMedcrAmt
Medicare Surplus Or Shortfall	$1,279,389	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	COMMUNITY HOSPITAL OF LAGRANGE COUNTY	BusinessNameLine1Txt

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	207 N TOWNLINE RD	AddressLine1Txt
City	LAGRANGE	CityNm
State Abbreviation	IN	StateAbbreviationCd
ZIP	46761	ZIPCd

Field	Value	IRS element (for citing)
Website Address	WWW.PARKVIEW.COM	WebsiteAddressTxt
State License	14-005085-1	StateLicenseNum
Licensed Hospital	Yes (X)	LicensedHospitalInd
General Medical And Surgical	Yes (X)	GeneralMedicalAndSurgicalInd
Critical Access Hospital	Yes (X)	CriticalAccessHospitalInd
Emergency Room24 Hrs	Yes (X)	EmergencyRoom24HrsInd

Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp

Hospital Facility Name HospitalFacilityName

Field	Value	IRS element (for citing)
Business Name Line1	COMMUNITY HOSPITAL OF LAGRANGE COUNTY	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
CHNA Conducted	13	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	13	ImplementationStrategyAdptYr
Strategy Posted Website	Yes (1)	StrategyPostedWebsiteInd
Strategy Website URL	WWW.PARKVIEW.COM/LOCALHEALTHNEEDS	StrategyWebsiteURLTxt
Strategy Attached	0	StrategyAttachedInd
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
Explained Basis	0	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
Other Publicity	Yes (X)	OtherPublicityInd
FAP Actions On Nonpayment	Yes (1)	FAPActionsOnNonpaymentInd
Permit No Actions	Yes (X)	PermitNoActionsInd
Collection Activities	0	CollectionActivitiesInd
FAP Notified Upon Admission	Yes (X)	FAPNotifiedUponAdmissionInd
FAP Notified Before Discharge	Yes (X)	FAPNotifiedBeforeDischargeInd
FAP Notified All Patients	Yes (X)	FAPNotifiedAllPatientsInd
Documented Elig Determination	Yes (X)	DocumentedEligDeterminationInd
Nondis Emergency Care Policy	Yes (1)	NondisEmergencyCarePolicyInd
Other Method Used	Yes (X)	OtherMethodUsedInd
Amounts Generally Billed	0	AmountsGenerallyBilledInd
Gross Charges	0	GrossChargesInd

Supplemental Information SupplementalInformationGrp (6 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
COMMUNITY HOSPITAL OF LAGRANGE COUNTY	PART V, SECTION B, LINE 5: PARKVIEW 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 BY (1) TAKING STEPS TO STRATIFY THE SAMPLE TO ENSURE THAT POPULATION SUBSETS WERE REPRESENTED ACCURATELY AND RESULTS WOULD BE STATISTICALLY SIGNIFICANT; (2) BY WORKING WITH LOCAL ADVOCACY ORGANIZATIONS WHO SPECIALIZE IN AIDING THESE VARIOUS POPULATIONS IN OUR COMMUNITY. IN ADDITION, PURDUE HEALTHCARE ADVISORS CONDUCTED A SURVEY OF PUBLIC HEALTH, OTHER HEALTHCARE PROFESSIONALS, AND SOCIAL SERVICE AGENCIES THAT SERVE LOW-INCOME POPULATIONS IN LAGRANGE COUNTY TO BETTER UNDERSTAND KEY PUBLIC HEALTH AND HEALTHCARE ISSUES. THE SURVEY CONSISTED OF THE FOLLOWING COMPONENTS: RESPONDENT DEMOGRAPHICS, UNMET NEEDS, HEALTH BEHAVIORS, ENVIRONMENTAL FACTORS, THE GREATEST HEALTH CHALLENGE, BARRIERS TO ACCESSING HEALTHCARE AND UTILIZATION OF EDUCATION AND PREVENTION RESOURCES. THE SURVEY WAS CONDUCTED ELECTRONICALLY USING QUALTRICS, A SECURE ONLINE SURVEY WITHOUT A SYSTEMATIC SAMPLING TECHNIQUE. ALL DATA WAS COLLECTED AND REPORTED IN AGGREGATE.
COMMUNITY HOSPITAL OF LAGRANGE COUNTY	PART V, SECTION B, LINE 6A: PARKVIEW HOSPITAL, INC. (EIN 35-0868085); COMMUNITY HOSPITAL OF NOBLE COUNTY, INC. (EIN 35-2087092); HUNTINGTON MEMORIAL HOSPITAL, INC. (EIN 35-1970706); WHITLEY MEMORIAL HOSPITAL, INC. (EIN 35-1967665) AND ORTHOPAEDIC HOSPITAL AT PARKVIEW NORTH, LLC (EIN 26-0143823).
COMMUNITY HOSPITAL OF LAGRANGE COUNTY	PART V, SECTION B, LINE 6B: PARKVIEW HEALTH SYSTEM, INC.; FORT WAYNE-ALLEN COUNTY DEPARTMENT OF HEALTH; INDIANA UNIVERSITY-PURDUE UNIVERSITY FORT WAYNE CENTER FOR SOCIAL RESEARCH AND PURDUE HEALTHCARE ADVISORS OF PURDUE UNIVERSITY.
COMMUNITY HOSPITAL OF LAGRANGE COUNTY	PART V, SECTION B, LINE 11: OBESITY - COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC. STRIVES TO STRENGTHEN ITS PARTNERSHIPS WITH LOCAL SCHOOLS BY PROVIDING NUTRITIONAL AND WELLNESS PROGRAMMING OPTIONS. THE HOSPITAL ALSO UTILIZES THE PARKVIEW LAGRANGE DIETICIAN TO HELP ENHANCE SCHOOL-BASED NUTRITIONAL PROGRAMMING. COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC. WORKS IN PARTNERSHIP WITH PURDUE EXTENSION, LOCAL CHURCH ORGANIZATIONS AND LOCAL FARMER'S MARKETS TO PROMOTE AND COLLABORATE ON OPPORTUNITIES TO PROVIDE ACCESS TO FRESH FRUITS AND VEGETABLES TO LOW-INCOME/UNDERSERVED RESIDENTS OF LAGRANGE COUNTY. FINALLY, COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC. CONTINUES TO BUILD UPON ITS RELATIONSHIP WITH THE COLE FAMILY CENTER YMCA IN ORDER TO EXPAND GROUP WELLNESS CLASSES AND EXERCISE OFFERINGS IN LAGRANGE COUNTY. PRENATAL CARE AND VACCINE EDUBATION - THE GOAL OF THIS INITIATIVE IS TO EXPLORE METHODOLOGIES WITH MID-WIVES AND MID-LEVEL BIRTHING PROVIDERS IN ORDER TO STANDARDIZE PRENATAL AND VACCINE EDUCATION TO EVERY PREGNANT WOMAN IN LAGRANGE COUNTY REGARDLESS OF WHERE SHE CHOOSES TO DELIVER. EDUCATION WILL HELP ADDRESS THE IMPORTANCE OF INFANT VACCINATIONS IN AN ATTEMPT TO IMPROVE LAGRANGE COUNTY'S ON-TIME VACCINATION RATE AS WELL AS REDUCE THE NUMBER OF "EMERGENCY" C-SECTIONS DUE TO COMPLICATIONS RELATED TO THE COUNTY'S HIGH NUMBER OF NON-HOSPITAL BIRTHS. TRAUMA PREVENTION - COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC.'S EMS IN PARTNERSHIP WITH THE LAGRANGE AMERICAN RED CROSS AND THE LAGRANGE COUNTY SHERIFF'S DEPARTMENT PROVIDE ROAD SAFETY EDUCATION AS PART OF THE LAGRANGE SAFETY CAMP TO ALL FOURTH GRADE STUDENTS WHO ATTEND A LAGRANGE COUNTY PUBLIC SCHOOL. ALL SAFETY CAMP PARTICIPANTS RECEIVE A HIGH-VISIBILITY VEST AS PART OF THE ROAD/BIKE SAFETY EDUCATION PIECE OF THE PROGRAM. COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC. HOSTS AN AMISH SAFETY CAMP WHERE AMISH STUDENTS WHO ATTEND THIS EVENT ALSO RECEIVE HIGH-VISIBILITY SAFETY VESTS. COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC. UTILIZES BILLBOARDS, MEDIA EVENTS AND OTHER PROMOTIONAL MATERIALS AND RELATIONSHIPS TO BUILD AWARENESS OF THE SHARE THE ROAD INITIATIVE. RESOURCES FOR OTHER IDENTIFIED NEEDS NOT DIRECTLY ADDRESSED:TOBACCO USE - TOBACCO FREE NORTHEAST INDIANA IS THE LEAD ORGANIZATION IN THE REGION RELATED TO TOBACCO FREE EFFORTS. THEY PROVIDE INFORMATION ON RESOURCES FOR VARIOUS LOCAL SMOKING CESSATION PROGRAMS AND ADVOCATE FOR NO-SMOKING PUBLIC POLICY.CHLAMYDIA INFECTIONS - THE LAGRANGE COUNTY HEALTH DEPARTMENT MANAGES A PROGRAM TO ADDRESS THIS NEED.TEEN BIRTHS - COMPASSION PREGNANCY CENTER OFFERS PREGNANCY AND RELATIONSHIP RESOURCES AS WELL AS AN INCENTIVE-BASED BABY STORE. BEFORE FIVE AND HEALTHY FAMILIES ARE BOTH WORKING IN THE COUNTY TO ADDRESS TEEN PREGNANCY AND THE BEHAVIORS/DECISIONS THAT CAN LEAD TO AN UNPLANNED PREGNANCY.INFANT MORTALITY - PARKVIEW IS ADDRESSING PRENATAL CARE AS ONE OF THE HEALTH PRIORITIES WHICH HAS A DIRECT EFFECT ON INFANT MORTALITY. THE HEALTH SYSTEM IS ADDRESSING INFANT MORTALITY THROUGH PATIENT CARE PROTOCOL, PRENATAL CARE EDUCATION, SAFE SLEEP EDUCATION, CAR SEAT SAFETY AND CHILD ABUSE PREVENTION. THE HOSPITAL WORKS WITH THE INDIANA STATE DEPARTMENT OF HEALTH AND STATE-WIDE PRENATAL HEALTH ORGANIZATIONS TO ADDRESS INFANT MORTALITY. MENTAL HEALTH - PARKVIEW BEHAVIORAL HEALTH IN PARTNERSHIP WITH THE BOWEN CENTER MENTAL HEALTH CENTER, HAVE A CARE NAVIGATION PROGRAM FOR CHRONICALLY ADDICTED PATIENTS. EXCESSIVE ALCOHOL USE - THE BOWEN CENTER AND NORTHEASTERN CENTER PROVIDE COUNSELING PROGRAMS FOR THOSE NEEDING HELP WITH ALCOHOL DEPENDENCY. ALSO, THE AMISH YOUTH VISION PROJECT PROVIDES ASSISTANCE FOR ALCOHOL AND DRUG RELATED ISSUES AMONGST THE PLAIN CHURCH POPULATION.PRIMARY CARE ACCESS - INCREASING ACCESS TO HEALTHCARE IS A STRATEGIC INITIATIVE FOR THE HEALTH SYSTEM. PARKVIEW CONDUCTS PERIODIC STUDIES TO DETERMINE THE AREAS WHERE PHYSICIANS ARE NEEDED AND RECRUITS PHYSICIANS ACCORDINGLY. LAGRANGE COUNTY HAS A HEALTHCARE SAFETY NET THAT ADDRESSES THE NEEDS OF INDIVIDUALS THAT ARE UNINSURED OR UNDERINSURED. PARTICIPATING ORGANIZATIONS IN THE SAFETY NET INCLUDE THE KENNEY BURKETT CLINIC AND THE COMMUNITY DENTAL CLINIC.
COMMUNITY HOSPITAL OF LAGRANGE COUNTY	PART V, SECTION B, LINE 16I: DURING 2015, POLICY WORDING WAS BEING UPDATED WITH THE INTENT THAT THE ORGANIZATION WOULD BECOME FULLY COMPLIANT WITH 501(R) FINAL REGULATIONS ON 1/1/2016.HOWEVER, THE FOLLOWING DETAILS HOW THE ORGANIZATION CURRENTLY 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:-AT POINT OF REGISTRATION OR SCHEDULING, IF A PATIENT EXPRESSES THEIR INABILITY TO PAY, THE REGISTRAR OR SCHEDULER WILL REFER THE PATIENT TO A FINANCIAL COUNSELOR OR WILL PROVIDE FINANCIAL COUNSELING CONTACT INFORMATION IN THE FORM OF A BUSINESS CARD TO THE PATIENT OUTSIDE OF NORMAL BUSINESS HOURS.-SIGNAGE IN THE EMERGENCY DEPARTMENT AND CASHIER AREAS INFORMS THE PATIENT OF THEIR RIGHT TO RECEIVE CARE REGARDLESS OF THEIR ABILITY TO PAY AND TELLS THEM THEY MAY BE ELIGIBLE FOR GOVERNMENTAL ASSISTANCE.-THE PATIENT'S INITIAL STATEMENT INSTRUCTS THE PATIENT TO CALL THE PATIENT ACCOUNTING DEPARTMENT IF THEY CANNOT PAY IN FULL. THE PATIENT ACCOUNTING CALL CENTER COLLECTORS SCREEN FOR THE APPLICABILITY OF GOVERNMENT ASSISTANCE AND OFFER FREE CARE APPLICATIONS TO PATIENTS WHO CANNOT AFFORD TO PAY THEIR BILLS.-THE ONLINE ACCOUNT MANAGER OF COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC.'S WEBSITE (WWW.PARKVIEW.COM) CONTAINS INFORMATION ON HOW TO CONTACT THE PATIENT ACCOUNTING DEPARTMENT FOR PAYMENT OPTIONS OR FREE CARE ELIGIBILITY.-ALL UNINSURED OR UNDERINSURED PATIENTS WHO ARE INPATIENT OR OBSERVATION STATUS ARE VISITED BY FINANCIAL COUNSELORS. THE FINANCIAL COUNSELORS PROVIDE PAYMENT OPTIONS, INCLUDING SCREENING FOR THE APPLICABILITY OF GOVERNMENT ASSISTANCE, AS WELL AS OFFERING FREE CARE APPLICATIONS TO PATIENTS WHO CANNOT AFFORD TO PAY THEIR BILLS.-OUTBOUND PHONE CALLS ARE MADE TO PATIENTS TO SET UP PAYMENT ARRANGEMENTS. IF A PATIENT CANNOT MAKE PAYMENT ON THEIR ACCOUNT, THEY WILL BE SCREENED FOR THE APPLICABILITY OF GOVERNMENT ASSISTANCE. ADDITIONALLY, FREE CARE APPLICATIONS WILL BE OFFERED TO PATIENTS WHO CANNOT AFFORD TO PAY THEIR BILLS.IF A PATIENT'S ACCOUNT IS PLACED WITH A COLLECTION AGENCY, THE AGENCY IS INSTRUCTED TO SCREEN FOR FREE CARE IF THE PATIENT EXPRESSES THEIR INABILITY TO PAY.
COMMUNITY HOSPITAL OF LAGRANGE COUNTY	PART V, SECTION B, LINE 22D: FULL WRITEOFFS ARE PROVIDED TO PATIENTS WHOSE INCOME FALLS UNDER 200% OF THE FPG. ON CHARITY CARE PATIENTS WITH RESIDUAL SELF-PAY BALANCES AFTER INSURANCE PROCESSED AND PAID OR DENIED THEIR CLAIM, 100% OF THE REMAINING ACCOUNT BALANCE AFTER INSURANCE PAYMENTS AND CONTRACTUAL ADJUSTMENTS IS WRITTEN OFF TO CHARITY CARE.

Field	Value	IRS element (for citing)
Facility	2	FacilityNum

Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp

Oth Hlth Care Fclts OthHlthCareFcltsGrp (2 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	FacilityFacilityTxt
1 - PARKVIEW LAGRANGE EMS - CENTRAL
0982 N 00 EW	LAGRANGE	IN	46761	AMBULANCE SERVICE
2 - PARKVIEW LAGRANGE EMS - WEST
8175 W US 20	SHIPSHEWANA	IN	46565	AMBULANCE SERVICE

Supplemental Information Detail SupplementalInformationDetail (16 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
PART I, LINE 3C:	ELIGIBILITY CRITERIA FOR FREE OR DISCOUNTED CARECOMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC. PROVIDES DISCOUNTED CARE TO UNINSURED PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. IF THE PATIENT ULTIMATELY QUALIFIES FOR CHARITY CARE USING THE 200% FPG, THE REMAINING BALANCE AFTER THE DISCOUNT IS WRITTEN OFF TO CHARITY.
PART I, LINE 7:	PART I, LINE 7ACOMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC. IS COMMITTED TO PROVIDING FINANCIAL ASSISTANCE TO PATIENTS UNABLE TO MEET THEIR FINANCIAL OBLIGATIONS. IT IS FURTHERMORE THE POLICY OF COMMUNITY HOSPITAL OF LAGRANGE COUNTY, 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 FINACIAL ASSISTANCE CHARGES FOREGONE ARE MULTIPLIED BY THE RATIO OF COST TO CHARGES TO DETERMINE THE COST OF SERVICES RENDERED.PART I, LINE 7BCOMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC. ACCEPTS ALL MEDICAID, MEDICAID MANAGED CARE, AND OUT-OF-STATE MEDICAID PATIENTS WITH THE KNOWLEDGE THAT THERE MAY BE SHORTFALLS. INTERNAL REVENUE SERVICE (IRS) REVENUE RULING 69-545 IMPLIES THAT TREATING MEDICAID PATIENTS IS A COMMUNITY BENEFIT. IRS REVENUE RULING 69-545, WHICH ESTABLISHED THE COMMUNITY BENEFIT STANDARD FOR NONPROFIT HOSPITALS, STATES THAT IF A HOSPITAL SERVES PATIENTS WITH GOVERNMENTAL HEALTH BENEFITS, INCLUDING MEDICAID, THEN THIS IS AN INDICATION THAT THE HOSPITAL OPERATES TO PROMOTE THE HEALTH OF THE COMMUNITY. THE UNREIMBURSED MEDICAID COST REPORTED ON LINE 7B IS CALCULATED UNDER THE COST TO CHARGE RATIO METHODOLOGY. UNDER THIS METHOD, THE MEDICAID CHARGES ARE MULTIPLIED BY THE RATIO OF COST TO CHARGES TO DETERMINE THE COST OF MEDICAID SERVICES RENDERED. THEN, THE COST OF MEDICAID SERVICES RENDERED IS DEDUCTED FROM THE REIMBURSEMENT RECEIVED FOR MEDICAID PATIENTS TO ARRIVE AT A GAIN/(LOSS) RELATIVE TO THESE PATIENTS.PART I, LINE 7CCOMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC. ACCEPTS ALL MEANS-TESTED PATIENTS FROM THE HEALTHY INDIANA PLAN (HIP) WITH THE KNOWLEDGE THAT THERE MAY BE SHORTFALLS. INTERNAL REVENUE SERVICE (IRS) REVENUE RULING 69-545 IMPLIES THAT TREATING MEANS-TESTED PATIENTS IS A COMMUNITY BENEFIT. IRS REVENUE RULING 69-545, WHICH ESTABLISHED THE COMMUNITY BENEFIT STANDARD FOR NONPROFIT HOSPITALS, STATES THAT IF A HOSPITAL SERVES PATIENTS WITH GOVERNMENTAL HEALTH BENEFITS, INCLUDING HIP, THEN THIS IS AN INDICATION THAT THE HOSPITAL OPERATES TO PROMOTE THE HEALTH OF THE COMMUNITY. THE UNREIMBURSED HIP COST REPORTED ON LINE 7C IS CALCULATED UNDER THE COST TO CHARGE RATIO METHODOLOGY. UNDER THIS METHOD, THE HIP CHARGES ARE MULTIPLIED BY THE RATIO OF COST TO CHARGES TO DETERMINE THE COST OF HIP SERVICES RENDERED. THEN, THE COST OF HIP SERVICES RENDERED IS DEDUCTED FROM THE REIMBURSEMENT RECEIVED FOR HIP PATIENTS TO ARRIVE AT A GAIN/(LOSS) RELATIVE TO THESE PATIENTS.PART I, LINE 7EAMOUNTS PRESENTED ARE BASED ON ACTUAL SPEND FOR THOSE SERVICES AND BENEFITS PROVIDED DEEMED TO IMPROVE THE HEALTH OF THE COMMUNITIES IN WHICH WE SERVE AND CONFORM WITH THE MISSION OF OUR EXEMPT PURPOSE.PART I, LINE 7IIN KEEPING WITH OUR MISSION AND COMMITMENT TO THE COMMUNITIES IN WHICH WE SERVE, COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC. CONTINUES ITS TRADITION OF CONTRIBUTING TO NUMEROUS ORGANIZATIONS ON BOTH AN AS-NEEDED BASIS AND NEGOTIATED BASIS. AMOUNTS PRESENTED REPRESENT ACTUAL SPEND TO ORGANIZATIONS THROUGHOUT OUR COMMUNITIES.
PART I, LN 7 COL(F):	PERCENT OF TOTAL EXPENSECOMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC. EXCLUDED $4,434,778 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 LAGRANGE COUNTY AS A HSPA IN PRIMARY CARE AND MENTAL HEALTH.AS SUCH, COMMUNITY HOSPITAL OF LAGRANGE COUNTY, 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. COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC. DEVELOPED A PHYSICIAN RECRUITMENT PLAN TO ADDRESS POTENTIAL GAPS IN PATIENT COVERAGE. COMMUNITY HOSPITAL OF LAGRANGE COUNTY, 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. EVERY MEMBER OF COMMUNITY HOSPITAL OF LAGRANGE COUNTY, 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 EXCEPTIONAL CUSTOMER SERVICE TO ALL PEOPLE. WE KNOW HOW IMPORTANT CLINICAL, SERVICE AND OPERATIONAL EXCELLENCE IS TO THE SUCCESS OF COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC., AND WE RECOGNIZE HOW IMPORTANT OUR SUCCESS IS TO THE COMMUNITY.
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 COMMUNITY HOSPITAL OF LAGRANGE COUNTY, 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. COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC. ACCEPTS ALL MEDICARE PATIENTS, AS REFLECTED ON THE YEAR-END MEDICARE COST REPORT, WITH THE KNOWLEDGE THAT THERE MAY BE SHORTFALLS. INTERNAL REVENUE SERVICE (IRS) REVENUE RULING 69-545 IMPLIES THAT TREATING MEDICARE PATIENTS IS A COMMUNITY BENEFIT. IRS REVENUE RULING 69-545, WHICH ESTABLISHED THE COMMUNITY BENEFIT STANDARD FOR NONPROFIT HOSPITALS, STATES THAT IF A HOSPITAL SERVES PATIENTS WITH GOVERNMENTAL HEALTH BENEFITS, INCLUDING MEDICARE, THEN THIS IS AN INDICATION THAT THE HOSPITAL OPERATES TO PROMOTE THE HEALTH OF THE COMMUNITY. HOWEVER, MEDICARE PAYMENTS REPRESENT A PROXY OF COST CALLED THE "UPPER PAYMENT LIMIT." IT HAS HISTORICALLY BEEN ASSUMED THAT UPPER PAYMENT LIMIT PAYMENTS DO NOT GENERATE A SHORTFALL. AS A RESULT, COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC. HAS TAKEN THE POSITION NOT TO INCLUDE THE MEDICARE SHORTFALLS OR SURPLUSES AS PART OF COMMUNITY BENEFIT. COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC. RECOGNIZES THAT THE SHORTFALL OR SURPLUS FROM MEDICARE DOES NOT INCLUDE THE COSTS AND REVENUES ASSOCIATED WITH MEDICARE ADVANTAGE PATIENTS. AS SUCH, THE TOTAL SHORTFALL OR SURPLUS OF MEDICARE IS UNDERSTATED DUE TO THE COSTS AND REVENUES ASSOCIATED WITH MEDICARE ADVANTAGE PATIENTS NOT BEING INCLUDED IN THE COMMUNITY BENEFIT DETERMINATION.
PART III, LINE 9B:	COLLECTION PRACTICES FOR PATIENTS ELIGIBLE FOR CHARITY CARETHE LAST PARAGRAPH OF THE PAYMENT POLICY STATES:"FINANCIAL ASSISTANCE MAY BE AVAILABLE FOR THOSE PATIENTS WHO CANNOT PAY THEIR BILL. THOSE OPTIONS ARE WELFARE ASSISTANCE OR FREE CARE THROUGH THE HOSPITAL CHARITY PROGRAM. (SEE CHARITY CARE POLICY.) PATIENTS WILL BE INSTRUCTED TO CONTACT A COUNSELOR TO DISCUSS THE AVAILABLE OPTIONS."ADDITIONALLY, THERE IS AN ONGOING EFFORT THROUGHOUT THE COLLECTION PROCESS TO SCREEN FOR MEDICAID ELIGIBILITY AND THE NEED FOR PROVIDING CHARITY CARE APPLICATIONS TO PATIENTS. IF A PATIENT MAY BE ELIGIBLE FOR MEDICAID, THE HOSPITAL PROVIDES A SERVICE TO OUR PATIENTS THAT HELPS THEM APPLY FOR MEDICAID WITH THE STATE IN WHICH THEY RESIDE. IF A PATIENT IS APPROVED FOR CHARITY CARE, THEIR ACCOUNT IS WRITTEN OFF AND COLLECTION EFFORTS CEASE.
PART VI, LINE 2:	DESCRIBE HOW THE ORGANIZATION ASSESSES THE HEALTH CARE NEEDS OF THE COMMUNITIES IT SERVES.PARKVIEW HEALTH SYSTEM, INC., INCLUDING COMMUNITY HOSPITAL OF LAGRANGE COUNTY AND IN CONJUNCTION WITH THE ALLEN COUNTY FORT WAYNE HEALTH DEPARTMENT, RECENTLY COMPLETED A COMMUNITY HEALTH NEEDS ASSESSMENT FOR THE FIVE COUNTY SERVICE AREA IN WHICH PARKVIEW HOSPITALS RESIDE. IN ADDITION, PARKVIEW HEALTH SYSTEM, INC. PARTNERED WITH THE TECHNICAL ASSISTANCE PROGRAM OF PURDUE UNIVERSITY AND THE SOCIAL RESEARCH DEPARTMENT OF INDIANA UNIVERSITY PURDUE UNIVERSITY OF FORT WAYNE (IPFW) TO COMPLETE MUCH OF THE FIELD WORK. IPFW CONDUCTED THE COMMUNITY SURVEY, PROVIDED DATA ANALYSIS, AND INCORPORATED SECONDARY DATA INTO THE ASSESSMENT. PURDUE UNIVERSITY ASSISTED WITH THE PUBLIC HEALTH AND OTHER HEALTH CARE PROFESSIONALS SURVEY. PARKVIEW HEALTH SYSTEM, INC. COMMENCED IMPLEMENTATION STRATEGIES IN 2013. THE INFORMATION FROM THE SURVEY HAS PROVEN TO BE A VALUABLE TOOL AS WE CONTINUE TO SEEK AND PRIORITIZE OPPORTUNITIES TO IMPROVE THE HEALTH OF THE COMMUNITIES WE SERVE AND IDENTIFY OPPORTUNITIES FOR COLLABORATION AMONG COMMUNITY ORGANIZATIONS AND LEADERS. COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC. REPRESENTATIVES HAVE RELATIONSHIPS THROUGHOUT THE COMMUNITY AND MEET REGULARLY WITH VARIOUS ORGANIZATIONS THAT SHARE COMMUNITY HOSPITAL OF LAGRANGE COUNTY INC.'S MISSION OF IMPROVING THE HEALTH OF THE COMMUNITIES WE SERVE.
PART VI, LINE 3:	DESCRIBE HOW THE ORGANIZATION INFORMS AND EDUCATES PATIENTS AND PERSONS WHO MAY BE BILLED FOR PATIENT CARE ABOUT THEIR ELIGIBILITY FOR ASSISTANCE UNDER FEDERAL, STATE OR LOCAL GOVERNMENT PROGRAMS OR UNDER THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY.-AT POINT OF REGISTRATION OR SCHEDULING, IF A PATIENT EXPRESSES THEIR INABILITY TO PAY, THE REGISTRAR OR SCHEDULER WILL REFER THE PATIENT TO A FINANCIAL COUNSELOR OR WILL PROVIDE FINANCIAL COUNSELING CONTACT INFORMATION IN THE FORM OF A BUSINESS CARD TO THE PATIENT OUTSIDE OF NORMAL BUSINESS HOURS.-SIGNAGE IN THE EMERGENCY DEPARTMENT AND CASHIER AREAS INFORMS THE PATIENT OF THEIR RIGHT TO RECEIVE CARE REGARDLESS OF THEIR ABILITY TO PAY AND TELLS THEM THEY MAY BE ELIGIBLE FOR GOVERNMENTAL ASSISTANCE.-THE PATIENT'S INITIAL STATEMENT INSTRUCTS THE PATIENT TO CALL THE PATIENT ACCOUNTING DEPARTMENT IF THEY CANNOT PAY IN FULL. THE PATIENT ACCOUNTING CALL CENTER COLLECTORS SCREEN FOR THE APPLICABILITY OF GOVERNMENT ASSISTANCE AND OFFER FREE CARE APPLICATIONS TO PATIENTS WHO CANNOT AFFORD TO PAY THEIR BILLS.-THE ONLINE ACCOUNT MANAGER OF COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC.'S WEBSITE (WWW.PARKVIEW.COM) CONTAINS INFORMATION ON HOW TO CONTACT THE PATIENT ACCOUNTING DEPARTMENT FOR PAYMENT OPTIONS OR FREE CARE ELIGIBILITY.-ALL UNINSURED OR UNDERINSURED PATIENTS WHO ARE INPATIENT OR OBSERVATION STATUS ARE VISITED BY FINANCIAL COUNSELORS. THE FINANCIAL COUNSELORS PROVIDE PAYMENT OPTIONS, INCLUDING SCREENING FOR THE APPLICABILITY OF GOVERNMENT ASSISTANCE, AS WELL AS OFFERING FREE CARE APPLICATIONS TO PATIENTS WHO CANNOT AFFORD TO PAY THEIR BILLS.-OUTBOUND PHONE CALLS ARE MADE TO PATIENTS TO SET UP PAYMENT ARRANGEMENTS. IF A PATIENT CANNOT MAKE PAYMENT ON THEIR ACCOUNT, THEY WILL BE SCREENED FOR THE APPLICABILITY OF GOVERNMENT ASSISTANCE. ADDITIONALLY, FREE CARE APPLICATIONS WILL BE OFFERED TO PATIENTS WHO CANNOT AFFORD TO PAY THEIR BILLS.IF A PATIENT'S ACCOUNT IS PLACED WITH A COLLECTION AGENCY, THE AGENCY IS INSTRUCTED TO SCREEN FOR FREE CARE IF THE PATIENT EXPRESSES THEIR INABILITY TO PAY.
PART VI, LINE 4:	DESCRIBE THE COMMUNITY THE ORGANIZATION SERVES, TAKING INTO ACCOUNT THE GEOGRAPHIC AREA AND DEMOGRAPHIC CONSTITUENTS IT SERVES.COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC. PRIMARILY SERVES THE LAGRANGE COUNTY COMMUNITIES OF LAGRANGE, SHIPSHEWANA, TOPEKA, AND WOLCOTTVILLE. AS THE ONLY HOSPITAL IN THIS COUNTY, COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC. ALSO SERVES, TO A LIMITED EXTENT, SURROUNDING COMMUNITIES. LAGRANGE COUNTY HAS APPROXIMATELY 38,809 RESIDENTS, PRIMARILY CAUCASIAN. THE COUNTY'S UNEMPLOYMENT RATE IS 3.6%. THE MEDIAN INCOME IN LAGRANGE COUNTY IS $52,003. PLAIN CHURCH RESIDENTS, INCLUDING MEMBERS OF THE AMISH COMMUNITY, MAKE UP NEARLY 46% OF THE POPULATION IN LAGRANGE COUNTY. FOR THE MEMBERS OF THESE FAITH-BASED COMMUNITIES, PARTICULARLY THE AMISH, EVERYDAY TRAVEL IS BY HORSE AND BUGGY OR BICYCLE; COMMUNICATIONS ARE FACE-TO-FACE OR THROUGH THE USE OF A COMMUNITY-OWNED, CENTRALLY LOCATED PHONE. LAGRANGE COUNTY ALSO SERVES A LARGE NUMBER OF HISPANIC RESIDENTS, WHICH IS APPROXIMATELY 4.0% OF THE OVERALL POPULATION.
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.).COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC.'S BOARD OF DIRECTORS IS COMPOSED OF MEMBERS, OF WHICH SUBSTANTIALLY ALL ARE INDEPENDENT COMMUNITY MEMBERS. A MAJORITY OF THE BOARD RESIDES IN COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC.'S PRIMARY SERVICE AREA. COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC. ALSO EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN THE COMMUNITY. PEOPLE THROUGHOUT THE COMMUNITY CAN COUNT ON COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC. TO BE STANDING BY WITH EMERGENCY CARE 24 HOURS A DAY, 365 DAYS A YEAR. THE EMERGENCY DEPARTMENT IS STAFFED WITH BOARD-CERTIFIED 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.COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC. GIVES BACK TO THE COMMUNITY IN THE FORM OF IMPROVED FACILITIES, EDUCATION AND OUTREACH PROGRAMS, FREE AND DISCOUNTED CARE, VOLUNTEERISM AND MUCH MORE. THE FOLLOWING ARE SOME OF THE WAYS COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC. IS REACHING OUT TO MAKE OUR NEIGHBORHOODS AND COMMUNITIES HEALTHIER:IN 2014, COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC. IMPLEMENTED A PATIENT AND FAMILY ADVISORY COMMITTEE (PFAC) THAT INCLUDES NINE COMMUNITY MEMBERS, ONE CLINICAL STAFF MEMBER AND A FACILITATOR FROM THE HOSPITAL. COMMUNITY MEMBERS OF THE COMMITTEE WERE DRAWN FROM FORMER PATIENTS WHO HAD RECENTLY RECEIVED CARE AT THE HOSPITAL AND WERE IDENTIFIED BY EITHER THEIR PHYSICIAN, COMMUNITY LEADER OR A HOSPITAL STAFF MEMBER AS SOMEONE WHO COULD PROVIDE VALUABLE INPUT INTO THEIR PATIENT EXPERIENCE. THE COMMITTEE WAS TASKED WITH PROVIDING FEEDBACK ABOUT ISSUES, PROCESSES AND OPPORTUNITIES THAT WOULD IMPROVE A PATIENT'S EXPERIENCE AT THE HOSPITAL. AMONG THE PROJECTS SUGGESTED BY THE PFAC THAT WERE COMPLETED IN 2015 WERE:-PLAIN LANGUAGE PATIENT MEDICATION CARDS WERE DEVELOPED IN COOPERATION WITH THE HOSPITAL'S PHARMACISTS. THE 15 MOST COMMONLY-PRESCRIBED MEDICATIONS WERE SELECTED AND DESCRIPTIONS WRITTEN IN PLAIN LANGUAGE DESCRIBING EACH MEDICINE'S PURPOSE, DOSAGE, SIDE EFFECTS, ETC. THESE DESCRIPTIONS WERE PROVIDED TO PATIENTS AT DISCHARGE, BASED ON WHICH MEDICATIONS HAD BEEN PRESCRIBED, IN AN EFFORT TO MAKE IT EASIER FOR THE PATIENT TO FOLLOW THEIR MEDICATION REGIMEN AT HOME. -A BRIEF, USER-FRIENDLY GUEST GUIDE WAS DEVELOPED TO PROVIDE PATIENTS AND THEIR FAMILY MEMBERS WITH A BRIEF AND ACCESSIBLE SOURCE OF BASIC INFORMATION ABOUT THE HOSPITAL SUCH AS: --"AT YOUR REQUEST" DINING OFFERING A ROOM-SERVICE-LIKE MENU AVAILABLE WHENEVER THE DIETARY DEPARTMENT IS OPEN. THE SERVICE IS STAFFED BY REGISTERED DIETITIANS WHO PROVIDE REAL-TIME EDUCATION FOR PATIENTS WITH DIET RESTRICTIONS.--IMPORTANT CONTACT INFORMATION FOR ANY QUESTIONS OR CONCERNS THE PATIENT MAY HAVE--GIFT SHOP AND TERRACE CAFE HOURS OF OPERATION--END OF LIFE INFORMATION AND HOW TO OBTAIN ADDITIONAL COUNSELING-A SIMPLE CHANGE IN THE SIGNAGE FOR THE PUBLIC RESTROOMS IN THE HOSPITAL'S MAIN LOBBY, MAKING BOTH OF THEM UNISEX. THIS SMALL CHANGE FACILITATED EASE OF ACCESS TO A PUBLIC RESTROOM FOR SEVERAL OF THE HOSPITAL'S WHEELCHAIR BOUND OUTPATIENTS.THROUGH ITS COMMUNITY HEALTH IMPROVEMENT (CHI) INITIATIVES, COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC. ANNUALLY FUNDS COMMUNITY HEALTH INITIATIVES AND PARTNERS WITH COMMUNITY ORGANIZATIONS TO ENCOURAGE HEALTHIER LIFESTYLES AMONG THE CITIZENS OF LAGRANGE COUNTY. THE FOLLOWING WERE AMONG THE CHI INITIATIVES FUNDED IN 2015:-THE HOSPITAL CONTINUED ITS PARTNERSHIP WITH COLE FAMILY CENTER YMCA, ADDING SILVEUS INSURANCE TO THE PARTNERSHIP IN 2015 TO FACILITATE ACCESS TO GROUP WELLNESS ACTIVITIES IN LAGRANGE COUNTY AT A YMCA SATELLITE SITE IN SILVEUS INSURANCE'S LOWER LEVEL IN LAGRANGE. CHI FUNDING WAS USED TO PROVIDE AN EXERCISE GRADE FLOOR FOR THE CLASS AREA, STATIONERY BIKES AND OTHER EQUIPMENT. THE NEW SPACE PERMITTED SIGNIFICANT EXPANSION OF THE EXERCISE PROGRAMS OFFERED THROUGHOUT THE YEAR. -HEALTH AND SAFETY DAY CAMP IS SPONSORED BY THE HOSPITAL IN PARTNERSHIP WITH LAGRANGE COUNTY'S THREE PUBLIC SCHOOL DISTRICTS, THE SHERRIFF'S DEPARTMENT OF LAGRANGE COUNTY AND OTHER IMPORTANT AGENCIES WITHIN THE COUNTY. SAFETY DAY CAMP IS HOSTED AT EACH ELEMENTARY SCHOOL FOR ALL THE SCHOOL'S FOURTH GRADE STUDENTS AND PROVIDES THEM WITH INTERACTIVE EDUCATION ABOUT TOPICS SUCH AS:--BIKE AND ROAD SAFETY - THE HOSPITAL PROVIDES EACH STUDENT WITH A FREE SAFETY VEST--CPR--WATER SAFETY--INTERNET SAFETY AND "STRANGER DANGER"--FIRST AIDDURING 2015, THE HEALTH AND SAFETY DAY CAMP REACHED OVER 500 FOURTH GRADE STUDENTS.-THE HOSPITAL'S CHI FUNDING PROVIDED AUTOMATED EXTERNAL DEFIBRILLATORS (AED) FOR MANY OF THE COUNTY'S FIRST RESPONDERS' VEHICLES. THE HOSPITAL PROVIDED AED'S AND TRAINING ON THEIR USE TO THE STROH FIRE DEPARTMENT, THE WOLCOTTVILLE, TOPEKA AND LAGRANGE TOWN MARSHALLS, AND THE LAGRANGE COUNTY SHERIFF'S DEPARTMENT.-EXPECTANT MOTHERS IN THE FIRST TRIMESTER OF THEIR PREGNANCY WERE PROVIDED WITH ACCESS TO FREE PRENATAL VITAMINS THROUGH A CHI INITIATIVE AND PARTNERSHIPS WITH PHARMACIES IN LAGRANGE COUNTY. VOUCHERS FOR THE VITAMINS COULD BE PICKED UP THROUGH THE WOMAN'S LAGRANGE COUNTY PRIMARY CARE PHYSICIAN, THROUGH PARKVIEW LAGRANGE HOSPITAL'S BIRTH PLANNER OR THE COMPASSION PREGNANCY CENTER IN LAGRANGE COUNTY.-THE HOSPITAL CONTINUED ITS PARTNERSHIP WITH THE LAGRANGE COUNTY COUNCIL ON AGING (COA) TO ASSIST WITH OPERATIONAL SUPPORT FOR THE COA'S SERVICES TO SENIORS. THE COA PROVIDES A TRANSPORTATION PROGRAM, HOMEMAKER SERVICES, A FOOD PANTRY AND MUCH MORE IN THEIR EFFORTS TO HELP SENIORS IN LAGRANGE COUNTY REMAIN INDEPENDENT IN THE HOMES OF THEIR CHOICE FOR AS LONG AS POSSIBLE. NEARLY HALF OF THE TRIPS THE COA OFFERS TO SENIORS ARE TO THEIR PHYSICIANS FOR CHECK-UPS OR TO THE HOSPITAL FOR TESTS OR TREATMENTS. HOMEMAKER SERVICES HELP WITH DAY-TO-DAY TASKS THAT, IN MANY CASES, COULD PUT THE SENIOR AT RISK OF A FALL OR OTHER INJURY. AMISH, MENNONITE AND OTHER PLAIN CHURCH RESIDENTS CONTINUE TO MAKE UP A LARGE PART OF THE POPULATION IN LAGRANGE COUNTY. RECOGNIZING THE DIVERSE CIRCUMSTANCES OF THESE COMMUNITIES, COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC. REPRESENTATIVES CONTINUE TO WORK CLOSELY WITH MEMBERS OF THE PLAIN CHURCH COMMUNITY, HELPING TO IDENTIFY SPECIFIC NEEDS AND DEVELOP SYSTEMS TO ADDRESS THEM. THE HOSPITAL'S PLAIN CHURCH COORDINATOR SERVES AS A SINGLE POINT OF ACCESS FOR AMISH, MENNONITE AND OTHER PLAIN CHURCH MEMBERS WHO HAVE QUESTIONS ABOUT THE AVAILABILITY OF HEALTHCARE SERVICES. WHETHER THE QUESTION CONCERNS THE APPROXIMATE COST OF A PROCEDURE, THE SCHEDULING OF A DIAGNOSTIC TEST, OR A BILLING QUESTION, THE PLAIN CHURCH COORDINATOR WILL ASSIST THE CALLER IN OBTAINING AN ANSWER.COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC. PARTICIPATES IN NUMEROUS HEALTH FAIRS AND ACTIVITIES THROUGHOUT THE YEAR OFFERING FREE AND LOW COST HEALTH SCREENINGS AND INFORMATION TO DIVERSE POPULATIONS IN OUR SERVICE AREA, INCLUDING THE PLAIN CHURCH AND HISPANIC RESIDENTS AND SENIORS WHO RESIDE IN THE COUNTY. THESE EVENTS PROVIDE HEALTH EDUCATION AND SCREENINGS FOR DISEASE PREVENTION AND PROMOTE HEALTHY LIFESTYLES. THE HOSPITAL ALSO PROVIDES SUPPORT GROUPS TO ASSIST PATIENTS AND FAMILIES IN MANAGING DISEASE. THE FOLLOWING ARE INITIATIVES UNDERTAKEN IN 2015:-PARKVIEW LAGRANGE HOSPITAL SENIOR CLUB PROVIDED AREA SENIORS WITH MONTHLY EDUCATIONAL PROGRAMS, SCREENINGS, AND SOCIAL ACTIVITIES THROUGHOUT THE YEAR.-WELLNESS ON THE ROAD (WOTR) BROUGHT LOW COST BLOOD TESTS, DIABETES AND CANCER INFORMATION AND SCREENINGS TO RESIDENTS THROUGHOUT LAGRANGE COUNTY. THESE SCREENING AND EDUCATIONAL EVENTS WERE HELD IN THE TOWNS OF LAGRANGE, HOWE, SHIPSHEWANA, STROH AND TOPEKA.-FREE MONTHLY DIABETES SUPPORT GROUPS PROVIDE DIABETIC PATIENTS AND THEIR FAMILY MEMBERS WITH INFORMATION, EDUCATION AND COUNSELING ABOUT THE MANY ASPECTS OF THIS CHRONIC DISEASE.
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. (PH), A HEALTH CARE SYSTEM SERVING NORTHEAST INDIANA, INCLUDES THE NOT-FOR-PROFIT HOSPITALS OF PARKVIEW HOSPITAL, INC., COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC., COMMUNITY HOSPITAL OF NOBLE COUNTY, INC., WHITLEY MEMORIAL HOSPITAL, INC. AND HUNTINGTON MEMORIAL HOSPITAL, INC. AS WELL AS 60% OWNERSHIP IN THE JOINT VENTURE OF ORTHOPEDIC HOSPITAL AT PARKVIEW NORTH, LLC.PH IS GUIDED BY A MISSION TO IMPROVE THE HEALTH OF THE COMMUNITIES IT SERVES. PH CONTRIBUTES TO THE SUCCESS OF NORTHEAST INDIANA BY EFFICIENTLY OPERATING ITS FACILITIES, DELIVERING HIGH QUALITY HEALTHCARE SERVICES TO ITS PATIENTS, AND PROVIDING SUPPORT TO LOCAL BUSINESSES AND ACTIVITIES. PH SEEKS TO CREATE ALIGNMENT OPPORTUNITIES TO DELIVER COMPREHENSIVE HIGH-QUALITY CARE THAT BENEFITS ITS PATIENTS, COMMUNITIES, PHYSICIANS, AND CO-WORKERS.PH PRIDES ITSELF IN NOT ONLY OFFERING THE HIGHEST LEVEL OF CARE TO ITS PATIENTS BUT ALSO IN PROVIDING A WORKPLACE THAT IS SECOND TO NONE FOR ITS PHYSICIANS, NURSES AND STAFF. PH'S MISSION IS TO PROVIDE QUALITY HEALTH SERVICES TO ALL WHO ENTRUST THEIR CARE TO US AND WILL WORK TO IMPROVE THE HEALTH OF OUR COMMUNITIES. PH BELIEVES THAT THE COMMUNITIES IT SERVES SHOULD ALL HAVE THE PEACE OF MIND THAT COMES WITH ACCESS TO COMPASSIONATE, HIGH-QUALITY HEALTH CARE, 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.

Schedule I IRS990ScheduleI

Field	Value	IRS element (for citing)
Grant Records Maintained	Yes (1)	GrantRecordsMaintainedInd

Recipient Table RecipientTable (7 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	Recipient EINRecipientEIN	IRC SectionIRCSectionDesc	Cash GrantCashGrantAmt	Purpose Of GrantPurposeOfGrantTxt	Non Cash AssistanceNonCashAssistanceAmt	Valuation Method UsedValuationMethodUsedDesc	Non Cash AssistanceNonCashAssistanceDesc
LAGRANGE COUNTY COUNCIL ON AGING
125 FENN ST SUITE 4	LAGRANGE	IN	46761	237455893	501 ( C ) 3	$10,000	MEDICAL TRANSPORTATION
LAGRANGE COUNTY ECONOMIC DEVELOPMENT
304 N TOWNLINE ROAD	LAGRANGE	IN	46764	800309463	501 ( C ) 3	$10,000	BUSINESS DEVELOPMENT PROGRAMS
CANCER SERVICES OF NORTHEAST INDIANA
6316 MUTUAL DRIVE	FORT WAYNE	IN	46825	350965609	501 ( C ) 3	$8,294	CLIENT ADVOCATE PROGRAM RELATED TO CANCER SERVICES FOR LAGRANGE RESIDENTS
COLE CENTER FAMILY YMCA
700 S GARDEN STREET	KENDALLVILLE	IN	46755	237077600	501 ( C ) 3	$7,867	HEALTH & WELLBEING OF LAGRANGE COUNTY RESIDENTS
PARKVIEW HOSPITAL INC
11109 PARKVIEW PLAZA DRIVE	FORT WAYNE	IN	46845	350868085	501 ( C ) 3	$7,200	HOME HEALTH & HOSPICE PROGRAM FOR SERVICE AREA OF COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC.
REASON 4 HOPE INC
PO BOX 174	HOWE	IN	46746	275001634	501 ( C ) 3	$5,010	MENTAL HEALTH ASSISTANCE FOR RESIDENT OF LAGRANGE COUNTY
LAGRANGE COUNTY SHERIFF'S DEPARTMENT
0875 S SR 9	LAGRANGE	IN	46761		GOVT ORG		EMERGENCY RESPONSE	$8,909	FMV	AUTOMATED EXTERNAL DEFIBRILLATOR (AED)

Field	Value	IRS element (for citing)
Total501c3 Org	7	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)
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 (8 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
ROBERT MYERS
DIRECTOR/LGHOS PRESIDENT	$191,503	$0	$72,413	$0	$11,719	$0	$41,336	$0	$26,020	$0	$342,991	$0	$10,221	$0
MICHAEL PACKNETT
DIRECTOR/PH PRESIDENT & CEO	$0	$962,128	$0	$485,625	$0	$24,574	$0	$648,113	$0	$25,266	$0	$2,145,706	$0	$0
LOREN HELMUTH
DIRECTOR/PH PHYSICIAN	$11,374	$382,182	$0	$51,518	$0	$22,442	$451	$18,099	$612	$24,552	$12,437	$498,793	$0	$0
RHONDA SHARP
DIRECTOR/PH PHYSICIAN	$18,000	$166,547	$0	$78,253	$0	$5,496	$1,956	$27,194	$292	$4,061	$20,248	$281,551	$0	$0
MICHAEL BROWNING
PH SVP & CFO - PARTIAL YEAR	$0	$298,622	$0	$196,875	$0	$95,402	$0	$44,088	$0	$26,200	$0	$661,187	$0	$0
STANTON RISSER
INTERIM PH CFO	$0	$179,022	$0	$96,738	$0	$1,423	$0	$37,424	$0	$23,410	$0	$338,017	$0	$0
JORDI DISLER
LGHOS VP PATIENT CARE	$139,177	$0	$42,003	$0	$7,663	$0	$33,194	$0	$18,270	$0	$240,307	$0	$6,979	$0
BRENDA ARMENTROUT
LGHOS MGR PHARMACY	$141,035	$0	$20,811	$0	$1,188	$0	$14,634	$0	$8,255	$0	$185,923	$0	$0	$0

Supplemental Information Detail SupplementalInformationDetail (4 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
PART I, LINE 1A	TAX INDEMNIFICATION AND GROSS-UP PAYMENTS - GIFT CERTIFICATE PAID TO: BRUCE CONEY $61
PART I, LINE 3	RELATED ORGANIZATION, PARKVIEW HEALTH SYSTEM, INC., USES THE FOLLOWING TO ESTABLISH THE COMPENSATION OF COMMUNITY HOSPITAL LAGRANGE COUNTY, INC.'S CEO/EXECUTIVE DIRECTOR: COMPENSATION COMMITTEE (BOARD OF RELATED ORGANIZATION PARKVIEW HEALTH SYSTEM, INC.) INDEPENDENT COMPENSATION CONSULTANT FORM 990 OF OTHER ORGANIZATIONS COMPENSATION SURVEY OR STUDY APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE (BOARD OR RELATED ORGANIZATION PARKVIEW HEALTH SYSTEM, INC.)
PART I, LINE 4B	SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN PAYMENTS TAXABLE - JORDI DISLER $6,979; ROBERT MYERS $10,221 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. MICHAEL BROWNING $36,138; JORDI DISLER $16,522; ROBERT MYERS $22,786; MICHAEL PACKNETT $629,563; STANTON RISSER $20,060
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 IN ADVANCE OF THE PLAN YEAR. AT CONCLUSION OF THE PLAN YEAR, RESULTS ARE SHARED WITH THE BOARD AND THE BOARD APPROVES FINAL PAYMENT.

Schedule K IRS990ScheduleK

Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp

Field	Value	IRS element (for citing)
Bond Reference	A	BondReferenceCd

Issuer Name IssuerName

Field	Value	IRS element (for citing)
Business Name Line1	INDIANA HEALTH AND EDUCATIONAL FACILITY FINANCING AUTHORITY	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Bond Issuer EIN	351611409	BondIssuerEIN
CUSIP	45479RCF2	CUSIPNum
Bond Issued	2007-03-15	BondIssuedDt
Issue Price	$24,930,000	IssuePriceAmt
Purpose	SEE PART VI	PurposeDesc
Defeased	0	DefeasedInd
On Behalf Of Issuer	0	OnBehalfOfIssuerInd
Pool Financing	0	PoolFinancingInd

Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp

Field	Value	IRS element (for citing)
Bond Reference	A	BondReferenceCd
Retired	$5,320,000	RetiredAmt
Total Proceeds	$25,930,446	TotalProceedsAmt
Capitalized Interest	$1,074,006	CapitalizedInterestAmt
Issuance Costs From Proceeds	$208,535	IssuanceCostsFromProceedsAmt
Credit Enhancement	$154,519	CreditEnhancementAmt
Capital Expenditures	$24,493,386	CapitalExpendituresAmt
Substantial Completion	2008	SubstantialCompletionYr
Current Refunding	0	CurrentRefundingInd
Advance Refunding	0	AdvanceRefundingInd
Final Allocation Made	Yes (1)	FinalAllocationMadeInd
Adequate Books And Rec Maint	Yes (1)	AdequateBooksAndRecMaintInd

Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp

Field	Value	IRS element (for citing)
Bond Reference	A	BondReferenceCd
Owning Bond Financed Property	0	OwningBondFinancedPropertyInd
Any Lease Arrangements	Yes (1)	AnyLeaseArrangementsInd
Mgmt Contract Bond Fincd Prop	Yes (1)	MgmtContractBondFincdPropInd
Engage Bond Counsel Contracts	Yes (1)	EngageBondCounselContractsInd
Any Research Agreements	0	AnyResearchAgreementsInd
Private Bus Use By Others	0.00000	PrivateBusUseByOthersPct
Private Bus Concerning UBI	0.00000	PrivateBusConcerningUBIPct
Total Private Business Use	0.00000	TotalPrivateBusinessUsePct
Bond Iss Meet Prvt Sec Pymt Test	Yes (1)	BondIssMeetPrvtSecPymtTestInd
Change In Use Bond Financed Prop	0	ChangeInUseBondFinancedPropInd
Procs Nonqualified Bond Remdtd	Yes (1)	ProcsNonqualifiedBondRemdtdInd

Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp

Field	Value	IRS element (for citing)
Bond Reference	A	BondReferenceCd
Form8038 T Filed	0	Form8038TFiledInd
Rebate Not Due Yet	0	RebateNotDueYetInd
Exception To Rebate	0	ExceptionToRebateInd
No Rebate Due	Yes (1)	NoRebateDueInd
Variable Rate Issue	Yes (1)	VariableRateIssueInd
Hedge Identified In Bks And Rec	0	HedgeIdentifiedInBksAndRecInd
Gross Proceeds Invested In GIC	0	GrossProceedsInvestedInGICInd
Gross Proceeds Invested	0	GrossProceedsInvestedInd
Written Proc To Monitor Reqs	Yes (1)	WrittenProcToMonitorReqsInd

Procedures Corrective Action ProceduresCorrectiveActionGrp

Field	Value	IRS element (for citing)
Bond Reference	A	BondReferenceCd
Procedures Corrective Action	Yes (1)	ProceduresCorrectiveActionInd

Supplemental Information Detail SupplementalInformationDetail (5 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
SCHEDULE K, PART I,A,F:	CONSTRUCTION OF NEW HOSPITAL FACILITY FOR COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC. IN LAGRANGE, INDIANA
SCHEDULE K, PART II,3,A:	THIS AMOUNT INCLUDES INTEREST OF $1,000,446. EARNED ON PROJECT, COST OF ISSUANCE AND CAPITALIZED INTEREST FUNDS.
SCHEDULE K, PART III, LINES 4-6:	AS PART OF OUR EFFORTS TO MONITOR AND ENSURE THAT THERE IS NO PRIVATE USE AT OUR BOND FINANCED FACILITIES, WE CONTRIBUTE EQUITY TO FINANCE A PORTION OF OUR NEW MONEY PROJECTS.
SCHEDULE K, PART III, LINE 7:	THE BOND IS NOT A PRIVATE ACTIVITY BOND BECAUSE IT DOES NOT MEET THE PRIVATE BUSINESS USE TEST.
SCHEDULE K, PART IV, COLUMN A, LINE 2C:	REBATE COMPUTATION WAS PERFORMED ON APRIL 13, 2010.

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, COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC., EIN 20-2401676. THEREFORE, ALL APPLICABLE IRS TAX FILINGS, INCLUDING FORMS 1099, 1096, W-2 AND W-3 ARE REPORTED AND FILED BY PH. THE TOTAL NUMBER REPORTED IN BOX 3 OF FORM 1096 AND FILED BY THE COMMON PAYING AGENT, PH, FOR THE YEAR ENDED DECEMBER 31, 2015 WAS 540. THE TOTAL NUMBER OF EMPLOYEES REPORTED ON FORM W-3 AND FILED BY THE COMMON PAYING AGENT, PH, FOR THE YEAR ENDED DECEMBER 31, 2015 WAS 11,190. FOR PURPOSES OF COMPLETING FORM 990, PART V, LINE 1A AND 2A, THE NUMBER REPORTED FOR THE COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC. WAS 31 AND 231 RESPECTIVELY.
FORM 990, PART VI, SECTION A, LINE 2	DIRECTORS KEVIN LAMBRIGHT AND JOE PIERCE HAVE A BUSINESS RELATIONSHIP.
FORM 990, PART VI, SECTION A, LINE 6	THE ORGANIZATION IS ORGANIZED AS A NOT-FOR-PROFIT CORPORATION. PURSUANT TO THE ORGANIZATION'S GOVERNING DOCUMENTS, PARKVIEW HEALTH SYSTEM, INC. EIN 35-1972384 IS THE SOLE MEMBER OF COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC. WITH CERTAIN RESERVED POWERS.
FORM 990, PART VI, SECTION A, LINE 7A	THE CORPORATE MEMBER, PARKVIEW HEALTH SYSTEM, INC. EIN 35-1972384, SHALL HAVE THE FOLLOWING RESERVED POWERS AS DEFINED IN THE NETWORK AGREEMENT: (A) APPOINT AND REMOVE, WITH OR WITHOUT CAUSE, MEMBERS OF THE BOARD SUBJECT TO THE COMPOSITION REQUIREMENTS REGARDING COMMUNITY AND PHYSICIAN REPRESENTATION SET FORTH IN ARTICLE V, SECTION 2; (B) APPOINT AND REMOVE, WITH OR WITHOUT CAUSE, THE CHAIR AND VICE CHAIR OF THE BOARD AND THE PRESIDENT OF THE CORPORATION; (C) APPROVE AND/OR REQUIRE THE ADOPTION OF AMENDMENTS TO THE ARTICLES OF INCORPORATION OR BYLAWS OF THE CORPORATION OR ANY SUBSIDIARY OR AFFILIATE OF THE CORPORATION; (D) APPROVE AND/OR REQUIRE THE ESTABLISHMENT, ACQUISITION, DIVESTITURE, DISSOLUTION, CLOSURE, MERGER, CONSOLIDATION, CHANGE IN CORPORATE MEMBERSHIP, AFFILIATION OR CORPORATE REORGANIZATION OF THE CORPORATION OR ANY SUBSIDIARY OR AFFILIATE OF THE CORPORATION; (E) APPROVE AND ADOPT THE STRATEGIC PLAN AND ANY AMENDMENTS THERETO FOR THE CORPORATION AND ANY SUBSIDIARY OR AFFILIATE OF THE CORPORATION; (F) APPROVE AND/OR REQUIRE THE INCURRENCE OF ANY DEBT, INCLUDING THE ISSUANCE OF ANY BONDS, PROPOSED BY THE CORPORATION OR ANY SUBSIDIARY OR AFFILIATE OF THE CORPORATION IN EXCESS OF LIMITS SPECIFIED IN THE POLICY OF THE CORPORATE MEMBER; (G) APPROVE AND/OR REQUIRE THE APPROVAL OF CONTRACTS OR LOANS OBLIGATING THE CORPORATION TO EXPEND OR REPAY AN AMOUNT IN EXCESS OF LIMITS SPECIFIED IN THE POLICY OF THE CORPORATE MEMBER; (H) APPROVE AND/OR REQUIRE THE SALE, LEASE, EXCHANGE, MORTGAGE, PLEDGE, TRANSFER, ENCUMBRANCE OR OTHER DISPOSITION OF PROPERTY AND ASSETS OF THE CORPORATION IN EXCESS OF LIMITS SPECIFIED IN THE POLICY OF THE CORPORATE MEMBER; (I) APPROVE AND ADOPT THE CAPITAL BUDGET, OPERATING BUDGET, FINANCIAL PLANS AND ANY AMENDMENTS THERETO FOR THE CORPORATION AND ANY SUBSIDIARY OR AFFILIATE TO THE CORPORATION; (J) APPROVE AND/OR REQUIRE THE ADOPTION OF A MANAGED CARE POLICY FOR THE CORPORATION AND ANY SUBSIDIARY OR AFFILIATE OF THE CORPORATION, INCLUDING NETWORK PARTICIPATION, PARTICIPATION IN ANY MANAGED CARE AGREEMENT AND PARTICIPATION IN ANY OTHER HEALTH CARE SERVICE ARRANGEMENTS; (K) APPOINT AND REMOVE AUDITORS, ATTORNEYS AND OTHER PROFESSIONAL ADVISORS FOR THE CORPORATION AND ANY SUBSIDIARY OR AFFILIATE OF THE CORPORATION; (L) DEVELOP, APPROVE AND/OR REQUIRE THE ADOPTION OF MEDICAL STAFF QUALITY ASSURANCE STANDARDS, UTILIZATION REVIEW STANDARDS, CRITERIA, POLICIES AND PROCEDURES FOR THE CORPORATION AND ANY SUBSIDIARY OR AFFILIATE OF THE CORPORATION; (M) APPROVE AND/OR REQUIRE THE ADOPTION OF ANY ACTION TO CHANGE THE CORPORATION FROM A GENERAL, ACUTE CARE COMMUNITY HOSPITAL OR TO CLOSE THE CORPORATION'S CURRENT LOCATION; (N) APPROVE EACH ANNUAL LIST OF PROPOSED DONEES AND AMOUNTS OF DONATIONS OR GRANTS NOT INCLUDED IN THE ANNUAL BUDGET, AND MAKE PROPOSALS TO DEVIATE THEREFROM THROUGHOUT EACH YEAR IN EXCESS OF LIMITS SPECIFIED IN THE POLICY OF THE CORPORATE MEMBER; AND (O) APPROVE AND/OR REQUIRE THE ADOPTION OF ANY ACTION THAT IS INCONSISTENT WITH THE POLICY OF THE CORPORATE MEMBER.
FORM 990, PART VI, SECTION A, LINE 7B	SEE SCHEDULE O EXPLANATION FOR FORM 990, PART VI, SECTION A, LINE 7A
FORM 990, PART VI, SECTION B, LINE 11	PURSUANT TO PARKVIEW HEALTH SYSTEM INC.'S BYLAWS, THE SYSTEM AUDIT COMMITTEE MAY ACT ON BEHALF OF THE CORPORATION TO PROVIDE REVIEW OF THE CORPORATION AND ITS SUBSIDIARY CORPORATIONS' FORM 990 FILINGS. COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC. IS A SUBSIDIARY CORPORATION OF PARKVIEW HEALTH SYSTEM, INC. AN ELECTRONIC COPY OF THE ORGANIZATION'S FINAL FORM 990 (INCLUDING REQUIRED SCHEDULES) WAS PROVIDED TO EACH VOTING MEMBER OF THE ORGANIZATION'S GOVERNING BODY, PRIOR TO FILING WITH THE IRS. ON OCTOBER 12, 2016, 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; REVIEW, AND APPROVAL BY THE GOVERNING BODY; AND CONTEMPORANEOUS DOCUMENTATION AND RECORDKEEPING WITH RESPECT TO DELIBERATIONS AND DECISIONS REGARDING THE COMPENSATION ARRANGEMENTS. IN 2015, THE BOARD OF PARKVIEW HEALTH SYSTEM, INC. REVIEWED AND APPROVED ALL EXECUTIVE COMPENSATION, BENEFITS AND PERQUISITES FOR THE 2015 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 MERIT BUDGET FOR THE ENTIRE ORGANIZATION. THE BOARD REVIEWS AND APPROVES THE MANAGEMENT INCENTIVE COMPENSATION PLAN (MICP) AND THE PHYSICIAN AND PROVIDER INCENTIVE COMPENSATION PLAN (PICP). OFFICES OR POSITIONS REVIEWED AT THE 2015 MEETING: PRESIDENT AND CHIEF EXECUTIVE OFFICER EXECUTIVE VICE PRESIDENT CHIEF PHYSICIAN OFFICER PRESIDENT COMMUNITY HOSPITAL PHYSICIAN EXECUTIVE OFFICER PARKVIEW PHYSICIANS GROUP SENIOR VICE PRESIDENT CHIEF FINANCIAL OFFICER SENIOR VICE PRESIDENT CHIEF EXPERIENCE OFFICER SENIOR VICE PRESIDENT CHIEF INFORMATION OFFICER SENIOR VICE PRESIDENT CHIEF NURSING EXECUTIVE SENIOR VICE PRESIDENT COO PARKVIEW HEALTH SENIOR VICE PRESIDENT COO PARKVIEW PHYSICIANS GROUP SENIOR VICE PRESIDENT COO PARKVIEW REGIONAL MEDICAL CENTER AND AFFILIATES SENIOR VICE PRESIDENT COO SERVICE LINE LEADER SENIOR VICE PRESIDENT DELIVERY SYSTEM INTEGRATION SENIOR VICE PRESIDENT FACILITY DESIGN AND OVERSIGHT SENIOR VICE PRESIDENT GENERAL COUNSEL SENIOR VICE PRESIDENT HEALTH & WELL-BEING SENIOR VICE PRESIDENT HUMAN RESOURCES SENIOR VICE PRESIDENT REVENUE CYCLE MANAGEMENT SENIOR VICE PRESIDENT SERVICE LINE LEADER SENIOR VICE PRESIDENT STRATEGIC INITIATIVES VICE PRESIDENT CONSTRUCTION VICE PRESIDENT FINANCE VICE PRESIDENT MKTG/COMM/COMMUNITY RELATIONS VICE PRESIDENT NURSING RANDALLIA VICE PRESIDENT PARKVIEW PHYSICIANS GROUP FINANCE VICE PRESIDENT PARKVIEW PHYSICIANS GROUP PHYSICIAN PRACTICES VICE PRESIDENT PATIENT CARE SERVICES COMMUNITY HOSPITAL VICE PRESIDENT RANDALLIA OPERATIONS VICE PRESIDENT STRATEGY AND BUSINESS DEVELOPMENT VICE PRESIDENT SUPPLY CHAIN VICE PRESIDENT SURGICAL AND ANCILLARY SERVICES PRMC AND AFFILIATES MEDICAL DIRECTOR COMMUNITY HOSPITAL MEDICAL DIRECTOR INTEGRATION AND DEVELOPMENT MEDICAL DIRECTOR OF VALUE-BASED SERVICES MEDICAL OFFICER PARKVIEW PHYSICIANS GROUP CHIEF ACADEMIC AND RESEARCH OFFICER CHIEF MEDICAL INFORMATICS OFFICER CHIEF MEDICAL OFFICER PRMC AND AFFILIATES CHIEF NURSING OFFICER PRMC AND AFFILIATES CHIEF QUALITY OFFICER AND SAFETY OFFICER EXECUTIVE DIRECTOR EMPLOYER STRATEGIES
FORM 990, PART VI, SECTION C, LINE 19	COPIES OF THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST.
FORM 990, PART IX, LINE 11G	OTHER: PROGRAM SERVICE EXPENSES 1,772,343. MANAGEMENT AND GENERAL EXPENSES 36,511. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,808,854. PHYSICIAN PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 2,324,306. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,324,306. CONTRACTED MEDICAL SERVICES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 150,000. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 150,000. COLLECTION EXPENSE: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 263,267. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 263,267.
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 -1,698,192. PLEDGE WRITE-OFF -589.

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (7 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 11C, III-FI	N/A	0
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 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
WHITLEY MEMORIAL HOSPITAL INC
1260 E STATE ROAD 205	COLUMBIA CITY	IN	46725	351967665	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
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 (3 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
CAREW MEDICAL PARK PROPERTY OWNERS ASSOCIATION INC
10501 CORPORATE DRIVE	FORT WAYNE	IN	46845	351858650	CONDO MANAGEMENT	IN	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	0	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	0	RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth Org	Yes (1)	PerformOfServicesForOthOrgInd
Perform Of Services By Other Org	Yes (1)	PerformOfServicesByOtherOrgInd
Sharing Of Facilities	0	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	0	TransferFromOtherOrgInd