2015-11-06T15:00:54-06:00 2014-12-31 350921680 CROWE HORWATH LLP 330 E JEFFERSON BLVD P O BOX 7 SOUTH BEND IN 466240007 990 2014-01-01 351967665 WHITLEY MEMORIAL HOSPITAL INC WHIT 2603737001 1260 EAST STATE ROAD 205 COLUMBIA CITY IN 46725 MICHAEL J PACKNETT PH CEO 2603737001 2015-11-06 1 KENNETH J KEBER P00240883 5742323992 X 2014 2016-03-07 17:11:31Z MICHAEL J PACKNETT 10501 CORPORATE DRIVE FORT WAYNE IN 46845 81669669 0 X WWW.PARKVIEW.COM X 1995 IN WHITLEY MEMORIAL HOSPITAL, INC. WORKS TO IMPROVE THE HEALTH OF OUR COMMUNITIES AND PROVIDES QUALITY HEALTH SERVICES TO ALL WHO ENTRUST THEIR CARE TO US. 12 8 319 58 31085 -2467 128813 152184 50871132 57535223 1642944 4487766 80634 68119 52723523 62243292 185935 254355 0 0 18005895 19213342 0 0 0 30004023 33283326 48195853 52751023 4527670 9492269 59788358 68661561 35964416 32118733 23823942 36542828 X WHITLEY MEMORIAL HOSPITAL, INC. WORKS TO IMPROVE THE HEALTH OF OUR COMMUNITIES AND PROVIDES QUALITY HEALTH SERVICES TO ALL WHO ENTRUST THEIR CARE TO US. 0 0 43153729 254355 57504138 AS A NOT-FOR-PROFIT HOSPITAL, WE TAKE OUR MISSION SERIOUSLY. WHITLEY MEMORIAL HOSPITAL, INC. EXISTS FOR ONE PURPOSE - TO IMPROVE THE HEALTH OF OUR COMMUNITIES BY BEING THE BEST PLACE FOR EMPLOYEES TO WORK, FOR PHYSICIANS TO TREAT PATIENTS AND FOR PATIENTS TO RECEIVE CARE. WHITLEY MEMORIAL HOSPITAL, INC. GIVES BACK TO THE WHITLEY COUNTY COMMUNITY IN THE FORM OF CONTINUALLY IMPROVING FACILITIES, EDUCATION AND OUTREACH PROGRAMS, FREE AND DISCOUNTED CARE, VOLUNTEERISM AND MUCH MORE. ON A ROUTINE BASIS, PARKVIEW SPONSORS A PROFESSIONALLY ADMINISTERED COMMUNITY HEALTH ASSESSMENT TO IDENTIFY HEALTH NEEDS WITHIN NORTHEAST INDIANA, PARTICULARLY, IN THE FIVE COUNTIES IN WHICH HOSPITALS EXIST. WHITLEY MEMORIAL HOSPITAL, INC. IS KEEPING PACE WITH THE RAPIDLY CHANGING HEALTHCARE INDUSTRY BY INCORPORATING NEW TECHNOLOGY AND THE LATEST DIAGNOSTIC AND TREATMENT PROCEDURES.THE FOLLOWING ARE SOME OF THE WAYS WHITLEY MEMORIAL HOSPITAL, INC. IS REACHING OUT TO MAKE OUR NEIGHBORHOODS AND COMMUNITIES HEALTHIER:-FINANCIAL ASSISTANCE-COMMUNITY HEALTH IMPROVEMENT INITIATIVES-PRIMARY HEALTH CARE / ACCESS-MEDICATION ASSISTANCE PROGRAM (MAP)-HEALTH SCREENING/PREVENTION AND DISEASE MANAGEMENT-SENIOR CLUB-VOLUNTEER PROGRAMFINANCIAL ASSISTANCEWHITLEY MEMORIAL HOSPITAL, INC.'S MISSION INCLUDES CARING FOR PEOPLE WHO DO NOT HAVE THE MEANS TO MEET THEIR FINANCIAL OBLIGATIONS. A FINANCIAL COUNSELOR IS AVAILABLE TO ASSIST PATIENTS IN NAVIGATING THIS PROCESS. THE HOSPITAL PLACES ITS PRIORITY ON PROVIDING THE NECESSARY CARE, NOT ON THE PATIENT'S ABILITY TO PAY FOR THEIR MEDICAL EXPENSES.COMMUNITY HEALTH IMPROVEMENT INITIATIVESTHE PURPOSE OF WHITLEY MEMORIAL HOSPITAL, INC.'S COMMUNITY HEALTH IMPROVEMENT PROGRAM IS TO FUND COMMUNITY HEALTH IMPROVEMENT EFFORTS WITHIN THE SERVICE AREA OF WHITLEY MEMORIAL HOSPITAL, INC. THE HOSPITAL SETS ASIDE UP TO 10 PERCENT OF ITS NET INCOME ANNUALLY TO FUND COMMUNITY HEALTH INITIATIVES AND PARTNERS WITH COMMUNITY ORGANIZATIONS TO ENCOURAGE HEALTHIER LIFESTYLES AMONG THE CITIZENS OF WHITLEY COUNTY. WHITLEY MEMORIAL HOSPITAL, INC. INVESTS IN KEY ORGANIZATIONS THAT PROMOTE THE HEALTH AND WELLNESS OF FAMILIES, CHILDREN, AND INDIVIDUALS OF WHITLEY COUNTY. KEY PROJECTS INCLUDE: -SUPPORT OF B.A.B.E. OF WHITLEY COUNTY, AN INCENTIVE BASED PROGRAM FOR PREGNANT WOMEN AND FAMILIES TO TRY TO DETER THE HIGH INCIDENCE OF LOW-BIRTH WEIGHT BABIES AND TO ENSURE THAT THE CHILDREN ARE GIVEN THE BEST POSSIBLE START IN LIFE. -WOLF LAKE FREE HEALTH CLINIC IS GIVEN IN-KIND LAB SERVICES THROUGH PARKVIEW WHITLEY HOSPITAL TO SERVE THE NEEDS OF THEIR UNINSURED PATIENTS. THE CLINIC WAS ALSO GRANTED FUNDING TO PURCHASE PRESCRIPTION CARDS FOR PATIENTS THAT OTHERWISE MAY NOT BE ABLE TO AFFORD THEIR PRESCRIPTIONS.-CANI COVERING KIDS AND FAMILIES HELPS PROVIDE RESOURCES TO FAMILIES AND THEIR CHILDREN TO ENSURE THOSE ELIGIBLE FOR HEALTHCARE INSURANCE ARE ENROLLED. IN-KIND OFFICE SPACE IS PROVIDED TO HELP THEM INCREASE VISIBILITY WITHIN THE COMMUNITY.-ELEMENTARY 1 MILE- PWH PROVIDED FRESH FRUIT, STRING CHEESE AND WATER TO ELEMENTARY STUDENTS AFTER PARTICIPATION IN A ONE MILE FUN RUN EVENT. PRIMARY HEALTH CARE ACCESSWHITLEY MEMORIAL HOSPITAL, INC. FEATURES 30 BEDS WITH ALL PRIVATE ROOMS. EMERGENCY MEDICAL CARE, OBSTETRIC CARE AND A MEDICAL-SURGICAL UNIT ARE AVAILABLE AS WELL AS LAB, X-RAY AND SURGICAL SERVICES. AN ATTACHED MEDICAL OFFICE BUILDING PROVIDES CONVENIENT, EASY ACCESS FOR PATIENTS TO RECEIVE CARE FROM FAMILY AND SPECIALTY PHYSICIANS.MEDICATION ASSISTANCE PROGRAM (MAP)WHITLEY MEMORIAL HOSPITAL, INC. IMPLEMENTED A MEDICATION ASSISTANCE PROGRAM THAT HAS EXPERIENCED STEADY GROWTH SINCE ITS INCEPTION. MAP PARTNERS WITH PATIENTS, PHYSICIANS, PHARMACEUTICAL COMPANIES, LOCAL PHARMACIES, AND DONORS TO PROVIDE MEDICATION ASSISTANCE AT LITTLE OR NO COST FOR QUALIFIED INDIVIDUALS. EMERGENCY VOUCHERS FOR ACUTE MEDICATION NEEDS ARE REDEEMED AT LOCAL PHARMACIES. LONG-TERM MEDICATION HELP IS PROVIDED THROUGH CONNECTING PATIENTS WITH PHARMACEUTICAL ASSISTANCE PROGRAMS (PAP).HEALTH SCREENING/PREVENTION AND DISEASE MANAGEMENTWHITLEY MEMORIAL HOSPITAL, INC. PARTICIPATES IN NUMEROUS HEALTH FAIRS AND ACTIVITIES THROUGHOUT THE YEAR TO PROVIDE HEALTH EDUCATION, HEALTH SCREENINGS FOR DISEASE PREVENTION, AND TO PROMOTE HEALTHY LIFESTYLES. THE HOSPITAL ALSO PROVIDES SUPPORT GROUPS TO ASSIST PATIENTS AND FAMILIES IN MANAGING DISEASE: -HEARTBEATS HEALTH FAIR, THE HOSPITAL'S OWN HEALTH FAIR, INCLUDES MULTIPLE HEALTH SCREENINGS AND HEALTH AND PREVENTION EDUCATION FOR ADULTS OF THE COMMUNITY. THIS EVENT DRAWS IN SEVERAL HUNDRED COMMUNITY MEMBERS EACH YEAR.-IHSAA PHYSICALS ARE PERFORMED FOR LOCAL JUNIOR AND SENIOR HIGH SCHOOL STUDENT ATHLETES. APPROXIMATELY 350 STUDENTS RECEIVED A PHYSICAL EXAM BY A HEALTHCARE PROVIDER, VISION SCREENING, HEIGHT AND WEIGHT CHECKS, BLOOD PRESSURE AND AN ORTHOPEDIC EXAM.-PARKVIEW WHITLEY BIRTH PLANNER CONDUCTS BREASTFEEDING EDUCATION AND A SUPPORT GROUP FOR NEW MOMS. LAMAZE CLASSES ARE ALSO AVAILABLE TO PARENTS. THE BIRTH PLANNER ALSO CONDUCTED A CRIB GIVE-AWAY TO PROVIDE A SAFE PLACE FOR INFANTS TO SLEEP.-WHITLEY MEMORIAL HOSPITAL, INC. AND THE WHITLEY COUNTY COMMUNITY FOUNDATION PARTNER TOGETHER TO PROVIDE FREE MAMMOGRAPHY SCREENING TO WOMEN WHO ARE UNINSURED OR UNDERINSURED. THROUGH THE WOMEN'S GIVING CIRCLE, A FUND OF THE WHITLEY COUNTY COMMUNITY FOUNDATION, VOUCHERS ARE GIVEN TO WOMEN WHO ARE UNINSURED OR UNDERINSURED AND CAN BE REDEEMED AT THE HOSPITAL FOR MAMMOGRAMS.-WHITLEY MEMORIAL HOSPITAL, INC. PROVIDES FIRST RESPONDER AND ADVANCED EMT COURSES AND AN ANNUAL SUBSIDY TO THE WHITLEY COUNTY EMS PROGRAM.-SENIOR CLUB-THE PWH SENIOR CLUB PROVIDES EDUCATIONAL OPPORTUNITIES FOR LOCAL SENIORS TO LEARN MORE ABOUT THEIR HEALTH. THEY HAVE SPEAKERS, DO SIMPLE EXERCISES, AND HAVE THE OPPORTUNITY TO CHECK THEIR WEIGHT AND BLOOD PRESSURE. THESE EVENTS ARE HELD 10 TIMES PER YEAR. -VOLUNTEER PROGRAM-THE PEH VOLUNTEER PROGRAM HAS APPROXIMATELY 30 VOLUNTEERS TO ASSIST PATIENTS, PROVIDE DIRECTIONS, DELIVER MEALS TO THE HOMEBOUND AND ASSIST STAFF. THE MANAGEMENT AND EMPLOYEES OF PARKVIEW WHITLEY PARTICIPATE IN NUMEROUS VOLUNTEER ACTIVITIES THROUGHOUT THE COMMUNITY TO IMPROVE THE HEALTH AND WELL-BEING OF THE COMMUNITY. THEY PARTICIPATE IN THE LOCAL DAY OF CARING, THE WOLF LAKE FREE HEALTH CLINIC, JUNIOR ACHIEVEMENT PROGRAMS AT LOCAL SCHOOLS AND THE SALVATION ARMY BELL RINGING. NUMEROUS OTHER EDUCATIONAL AND SUPPORT OPPORTUNITIES ARE AVAILABLE FOR THE PUBLIC SUCH AS CARDIO-PULMONARY REHAB SUPPORT, DIABETES SUPPORT, HEALTHY EATING PRESENTATIONS, AND SMOKING CESSATION CLASSES. 43153729 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 1 1 1 0 0 1 X 29 0 1 319 1 1 1 0 0 0 0 0 0 0 0 0 X 12 8 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 IN X STANTON RISSER 2603738403 10501 CORPORATE DRIVE FORT WAYNE IN 46845 SCOTT GABRIEL DIRECTOR/WMHOS PRESIDENT 40.00 1.00 X X 222050 0 58155 MICHAEL PACKNETT PH PRESIDENT & CEO 1.00 55.00 X X 0 1301223 224891 MARK BURKETT DIRECTOR/PH PHYSICIAN 1.00 40.00 X 18043 220617 29196 REBECCA CASE DIRECTOR/PH PHYSICIAN 1.00 40.00 X 14144 266692 44483 SHAWN ELLIS DIRECTOR 1.00 0.00 X 3250 0 0 BRIAN EMERICK DIRECTOR/CHAIR 1.00 1.00 X 7000 3904 0 KATHERINE FLECK DIRECTOR 1.00 0.00 X 4750 0 0 TIM GRISSOM DIRECTOR/VICE CHAIR 1.00 1.00 X 5500 1250 0 JERRY REIFF DIRECTOR 1.00 0.00 X 4500 0 0 NILA REIMER DIRECTOR 1.00 0.00 X 4250 0 0 REX SCHRADER DIRECTOR 1.00 0.00 X 4250 0 0 GEORGE SCHRUMPF DIRECTOR 1.00 0.00 X 3000 0 0 MICHAEL BROWNING PH SVP & CFO 1.00 55.00 X 0 736633 99949 BRIDGET DOLOHANTY-JOHNSON WMHOS VP PATIENT CARE 40.00 0.00 X 179674 0 31171 WAYNE ENGDAHL WMHOS PHARMACIST 48.00 3.00 X 132245 5913 15397 CHRISTOPHER VICE WMHOS MGR PHARMACY 40.00 0.00 X 126699 0 18537 BENJAMIN MAGGARD WMHOS PHARMACIST 8.00 44.00 X 22544 101395 25692 AMANDA KNOWLES WMHOS MGR PHARMACY 33.00 13.00 X 92377 29756 27550 PETER TALATI WMHOS MGR REH-CH 40.00 0.00 X 110908 0 19548 STANTON RISSER FORMER OFFICER/CURRENT PH EMPLOYEE 0.00 40.00 X 0 191833 45994 JOHN MEISTER FORMER OFFICER/CURRENT PH EMPLOYEE 0.00 40.00 X 0 261078 59189 RICK HENVEY FORMER OFFICER/CURRENT PH EMPLOYEE 0.00 40.00 X 0 555049 71844 955184 3675343 771596 9 1 1 0 PARKVIEW HOSPITAL INC 11109 PARKVIEW PLAZA DRIVE FORT WAYNE IN 46845 LABORATORY SERVICES 1420704 GREAT LAKES ANESTHESIA PC 500 N NAPPANEE ST STE 11-B ELKHART IN 46514 ANESTHESIOLOGISTS 627229 HEALTHCARE THERAPY SERVICES INC 1411 W COUNTY LINE ROAD STE A GREENWOOD IN 46142 THERAPY SERVICES 579874 NORTHEAST INDIANA ANESTHESIOLOGY PC 2914 SOUTH REPUBLIC TOLEDO OH 43615 ANESTHESIOLOGISTS 396561 NORTHEAST INTERNAL MEDICINE PC 2500 N DETROIT STREET LAGRANGE IN 46761 PHYSICIANS 218000 7 152184 152184 NET PATIENT REVENUE 622000 54491720 54491720 INDEPENDENT LIVING 621610 889371 889371 PHARMACY 446110 706446 706446 MEANINGFUL USE 900099 652900 652900 EMS SUBSIDY 621610 320000 320000 474786 443701 31085 57535223 728031 728031 59844 161044 -101200 -101200 -101200 20576321 2448747 18718170 547163 1858151 1901584 3759735 3759735 CAFETERIA REVENUE 722210 139442 139442 GIFT SHOP REVENUE 453220 24627 24627 MEDICAL STAFF CREDENTIALING 561499 5250 5250 169319 62243292 57504138 31085 4555885 X 254355 254355 564184 564184 14161355 14041312 120043 4487803 4410550 77253 23500 23500 129670 129670 4911781 3873010 1038771 14880 9759 5121 1472928 1399185 73743 3976870 3969568 7302 50138 27934 22204 35937 9503 26434 11461 11461 1149811 1133606 16205 122142 102151 19991 CORP SERVICE ALLOCATION 7417000 7417000 BAD DEBT 6203189 6203189 MEDICAL SUPPLIES 3970568 3970568 PH SUBSIDY 3671864 3671864 121587 65714 55873 52751023 43153729 9597294 0 2510 1760 9499199 6884514 6789067 208872 196320 17254 22063 12804028 8141604 5729641 4662424 46034903 47414152 2034 2034 908630 74542 59788358 68661561 1421762 1676471 89476 0 272168 9891739 34181010 20550523 35964416 32118733 X 23823942 36542828 23823942 36542828 59788358 68661561 X 9492269 -1081746 4308363 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 6717 6717 0 PART II-B, LINE 1: REPRESENTS THE PORTION OF THE DUES PAID TO INDIANA HOSPITAL AND HEALTH ASSOCIATION AND AMERICAN HOSPITAL ASSOCIATION USED FOR LOBBYING ACTIVITIES. 260976 260976 1119257 627855 491402 48824 46586 2238 11330109 7422301 3907808 44862 44862 0 4662424 RESTRICTED FUNDS 50250 DUE TO/FROM INTERUNIT 20388566 EST MEDICARE/MEDICAID SETTLEMENTS 111707 20550523 X PART X, LINE 2: PARKVIEW HEALTH SYSTEM, INC. AND SUBSIDIARIES - NOTES TO THE CONSOLIDATED FINANCIAL STATEMENTS TEXT OF THE FOOTNOTE TO THE ORGANIZATION'S FINANCIAL STATEMENTS THAT DESCRIBES THE LIABILITY FOR UNCERTAIN TAX POSITIONS UNDER FIN 48 (ASC 740): PAGE 15 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, 2014 AND 2013, 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 2010 AND PRIOR. 1 1 X 1 X 0 1 0 1 1 654353 654353 0.01410 6336708 4243037 2093671 0.04500 548154 313090 235064 0.00500 7539215 4556127 2983088 0.06410 124115 22529 101586 0.00220 20923 20923 0.00040 2618735 2618735 0.05630 58760 58760 0.00130 2822533 22529 2800004 0.06020 10361748 4578656 5783092 0.12430 50000 50000 0.00110 38185 38185 0.00080 88185 88185 0.00190 1 6203189 421258 6202442 7572258 -1369816 X 1 1 1 1 WHITLEY MEMORIAL HOSPITAL INC 1260 E STATE ROAD 205 COLUMBIA CITY IN 46725 WWW.PARKVIEW.COM 14-005090-1 X X X WHITLEY MEMORIAL HOSPITAL INC 1 0 0 1 X X X X X X X X 13 1 1 1 1 X WWW.PARKVIEW.COM/LOCALHEALTHNEEDS X 1 14 1 WWW.PARKVIEW.COM/LOCALHEALTHNEEDS 0 0 1 X 200.000000000000 0 1 X X X 1 X 1 0 X X X X 1 X 0 0 WHITLEY MEMORIAL HOSPITAL, INC. 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 WHITLEY 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. WHITLEY MEMORIAL HOSPITAL, INC. PART V, SECTION B, LINE 6A: PARKVIEW HOSPITAL, INC. (EIN 35-0868085); COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC. (EIN 20-2401676); HUNTINGTON MEMORIAL HOSPITAL, INC. (EIN 35-1970706); COMMUNITY HOSPITAL OF NOBLE COUNTY, INC. (EIN 35-2087092) AND ORTHOPAEDIC HOSPITAL AT PARKVIEW NORTH, LLC (EIN 26-0143823). WHITLEY MEMORIAL HOSPITAL, INC. PART V, SECTION B, LINE 11: CHLAMYDIA INFECTIONS - THE WHITLEY COUNTY HEALTH DEPARTMENT FOCUSES ON SEXUALLY TRANSMITTED DISEASES WITHIN WHITLEY COUNTY. TEEN BIRTHS - WHITLEY COUNTY SCHOOL CORPORATION ALONG WITH CANI PROVIDE PROGRAMS WITHIN THE SCHOOLS TO REDUCE THE NUMBER OF TEEN BIRTHS THROUGH EDUCATION. EXCESSIVE ALCOHOL USE - PARKVIEW BEHAVIORAL HEALTH (PBH) IN PARTNERSHIP WITH THE BOWEN CENTER DEVELOPED A CARE NAVIGATION PROGRAM FOR CHRONICALLY ADDICTED PATIENTS. PARKVIEW WHITLEY HOSPITAL ALSO HOUSES AN INTENSIVE OUTPATIENT PROGRAM FOR EXCESSIVE ALCOHOL USERS. MENTAL HEALTH - PARKVIEW IN ALLEN COUNTY HAS CHOSEN MENTAL HEALTH AS ONE OF ITS THREE HEALTH PRIORITIES AND WILL BE WORKING WITH PARKVIEW BEHAVIORAL HEALTH (PBH). 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. ALSO, THROUGH THE SURVEY, WHITLEY COUNTY HAS SEEN A POSITIVE TREND LINE IN THE MEMBER OF PRIMARY CARE PHYSICIANS. WHITLEY MEMORIAL HOSPITAL, INC. PART V, SECTION B, LINE 16I: POLICY WORDING IS IN THE PROCESS OF BEING UPDATED.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 WHITLEY MEMORIAL HOSPITAL, 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, THE PATIENT 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. WHITLEY MEMORIAL HOSPITAL, INC. 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. 9 THE OAKS DBA PARKVIEW OAKS 413 N WOLF ROAD COLUMBIA CITY IN 46725 SKILLED NURSING FACILITY PWH EMS 1250 E STATE ROAD 205 COLUMBIA CITY IN 46725 AMBULANCE SERVICES PWH PHYSICAL REHAB 1270 E STATE ROAD 205 COLUMBIA CITY IN 46725 REHABILITATION SERVICES OAK POINTE DBA PARKVIEW POINTE 415 N WOLF ROAD COLUMBIA CITY IN 46725 INDEPENDENT LIVING APARTMENTS PWH SLEEP LAB 1270 E STATE ROAD 205 COLUMBIA CITY IN 46725 SLEEP LAB SERVICES SOUTH WHITLEY RADIOLOGY 4665 STATE ROAD 5 SOUTH WHITLEY IN 46787 DIAGNOSTIC RADIOLOGY SERVICES PWH CARDIO-PUL REHAB 1270 E STATE ROAD 205 COLUMBIA CITY IN 46725 CARDIAC & PULMONARY REHAB SERVICES PWH RADIOLOGY MEDICAL OFFICE PLAZA 1270 E STATE ROAD 205 COLUMBIA CITY IN 46725 DIAGNOSTIC RADIOLOGY SERVICES PWH LABORATORY MEDICAL OFFICE PLAZA 1270 E STATE ROAD 205 COLUMBIA CITY IN 46725 LABORATORY SERVICES PART I, LINE 3C: ELIGIBILITY CRITERIA FOR FREE OR DISCOUNTED CAREWHITLEY MEMORIAL HOSPITAL, 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 7AWHITLEY MEMORIAL HOSPITAL, INC. IS COMMITTED TO PROVIDING CHARITY CARE TO PATIENTS UNABLE TO MEET THEIR FINANCIAL OBLIGATIONS. IT IS FURTHERMORE THE POLICY OF WHITLEY MEMORIAL HOSPITAL, INC. NOT TO WITHHOLD OR DENY ANY REQUIRED MEDICAL CARE AS A RESULT OF A PATIENT'S FINANCIAL INABILITY TO PAY HIS/HER MEDICAL EXPENSES.THE CHARITY CARE COST REPORTED ON LINE 7A IS CALCULATED UNDER THE COST TO CHARGE RATIO METHODOLOGY. UNDER THIS METHOD, THE CHARITY CARE CHARGES FOREGONE ARE MULTIPLIED BY THE RATIO OF COST TO CHARGES TO DETERMINE THE COST OF SERVICES RENDERED.PART I, LINE 7BWHITLEY MEMORIAL HOSPITAL, INC. ACCEPTS ALL MEDICAID, MEDICAID MANAGED CARE, AND OUT-OF-STATE MEDICAID PATIENTS WITH THE KNOWLEDGE THAT THERE MAY BE SHORTFALLS. INTERNAL REVENUE SERVICE (IRS) REVENUE RULING 69-545 IMPLIES THAT TREATING MEDICAID PATIENTS IS A COMMUNITY BENEFIT. IRS REVENUE RULING 69-545, WHICH ESTABLISHED THE COMMUNITY BENEFIT STANDARD FOR NONPROFIT HOSPITALS, STATES THAT IF A HOSPITAL SERVES PATIENTS WITH GOVERNMENTAL HEALTH BENEFITS, INCLUDING MEDICAID, THEN THIS IS AN INDICATION THAT THE HOSPITAL OPERATES TO PROMOTE THE HEALTH OF THE COMMUNITY. THE UNREIMBURSED MEDICAID COST REPORTED ON LINE 7B IS CALCULATED UNDER THE COST TO CHARGE RATIO METHODOLOGY. UNDER THIS METHOD, THE MEDICAID CHARGES ARE MULTIPLIED BY THE RATIO OF COST TO CHARGES TO DETERMINE THE COST OF MEDICAID SERVICES RENDERED. THEN, THE COST OF MEDICAID SERVICES RENDERED IS DEDUCTED FROM THE REIMBURSEMENT RECEIVED FOR MEDICAID PATIENTS TO ARRIVE AT A GAIN/(LOSS) RELATIVE TO THESE PATIENTS.PART I, LINE 7CWHITLEY MEMORIAL HOSPITAL, INC. ACCEPTS ALL MEANS-TESTED PATIENTS FROM THE HEALTHY INDIANA PLAN (HIP) WITH THE KNOWLEDGE THAT THERE MAY BE SHORTFALLS. INTERNAL REVENUE SERVICE (IRS) REVENUE RULING 69-545 IMPLIES THAT TREATING MEANS-TESTED PATIENTS IS A COMMUNITY BENEFIT. IRS REVENUE RULING 69-545, WHICH ESTABLISHED THE COMMUNITY BENEFIT STANDARD FOR NONPROFIT HOSPITALS, STATES THAT IF A HOSPITAL SERVES PATIENTS WITH GOVERNMENTAL HEALTH BENEFITS, INCLUDING HIP, THEN THIS IS AN INDICATION THAT THE HOSPITAL OPERATES TO PROMOTE THE HEALTH OF THE COMMUNITY. THE UNREIMBURSED HIP COST REPORTED ON LINE 7C IS CALCULATED UNDER THE COST TO CHARGE RATIO METHODOLOGY. UNDER THIS METHOD, THE HIP CHARGES ARE MULTIPLIED BY THE RATIO OF COST TO CHARGES TO DETERMINE THE COST OF HIP SERVICES RENDERED. THEN, THE COST OF HIP SERVICES RENDERED IS DEDUCTED FROM THE REIMBURSEMENT RECEIVED FOR HIP PATIENTS TO ARRIVE AT A GAIN/(LOSS) RELATIVE TO THESE PATIENTS.PART I, LINE 7EAMOUNTS PRESENTED ARE BASED ON ACTUAL SPEND FOR THOSE SERVICES AND BENEFITS PROVIDED DEEMED TO IMPROVE THE HEALTH OF THE COMMUNITIES IN WHICH WE SERVE AND CONFORM WITH THE MISSION OF OUR EXEMPT PURPOSE.PART I, LINE 7FAMOUNTS PRESENTED ARE BASED UPON ACTUAL SPEND AND ARE IN CONFORMITY WITH AGREED UPON COMMITMENTS WITH THE VARIOUS EDUCATIONAL PROGRAMS.PART I, LINE 7IIN KEEPING WITH OUR MISSION AND COMMITMENT TO THE COMMUNITIES IN WHICH WE SERVE, WHITLEY MEMORIAL HOSPITAL, INC. CONTINUES ITS TRADITION OF CONTRIBUTING TO NUMEROUS ORGANIZATIONS ON BOTH AN AS-NEEDED BASIS AND NEGOTIATED BASIS. AMOUNTS PRESENTED REPRESENT ACTUAL SPEND TO ORGANIZATIONS THROUGHOUT OUR COMMUNITIES. PART I, LINE 7G: SUBSIDIZED HEALTH SERVICES WHITLEY MEMORIAL HOSPITAL, INC. INCLUDED $2,618,735 OF MEDICARE AND MEDICAID SHORTFALLS AND CHARITY CARE CALCULATED UNDER THE COST TO CHARGE RATIO METHODOLOGY ATTRIBUTABLE TO PARKVIEW HEALTH PHYSICIAN CLINICS AS SUBSIDIZED HEALTH SERVICES. PART I, LN 7 COL(F): PERCENT OF TOTAL EXPENSEWHITLEY MEMORIAL HOSPITAL, INC. EXCLUDED $6,203,189 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.WHITLEY MEMORIAL HOSPITAL, INC. SUPPORTS PHYSICIAN RECRUITMENT ACTIVITIES TO ASSIST IN TIMELY RESPONSE TO PATIENT CARE NEEDS IN THE COMMUNITY. THESE RECRUITMENT ACTIVITIES ARE BASED ON RESULTS OF A PERIODIC PHYSICIAN NEEDS ASSESSMENT. WHITLEY MEMORIAL HOSPITAL, INC. DEVELOPS A PHYSICIAN RECRUITMENT PLAN TO ADDRESS POTENTIAL GAPS IN PATIENT COVERAGE. WHITLEY MEMORIAL HOSPITAL, INC. STRIVES TO BRING THE BEST INTEGRATED, QUALITY, AND COST EFFECTIVE CARE AND INNOVATIVE TECHNOLOGY TO OUR COMMUNITIES. IN DOING SO, WE FOCUS OUR EFFORTS ON RECRUITING AN EXCEPTIONAL TEAM OF PHYSICIANS THAT ARE THE RIGHT FIT FOR THE COMMUNITY.EVERY MEMBER OF WHITLEY MEMORIAL HOSPITAL, INC.'S HEALTHCARE TEAM IS RESPONSIBLE FOR NURTURING AN ENVIRONMENT OF EXCELLENCE AS THE BEST PLACE FOR CO-WORKERS TO WORK, PHYSICIANS TO PRACTICE MEDICINE, AND PATIENTS TO RECEIVE CARE. WE ARE COMMITTED TO PROVIDING EXCELLENT CUSTOMER SERVICE TO ALL PEOPLE. WE KNOW HOW IMPORTANT CLINICAL, SERVICE AND OPERATIONAL EXCELLENCE IS TO THE SUCCESS OF WHITLEY MEMORIAL HOSPITAL, INC., AND WE RECOGNIZE HOW IMPORTANT OUR SUCCESS IS TO THE COMMUNITY. AN EXAMPLE OF OUR DEDICATION TO QUALITY CARE IS USING PRIMARILY EIGHT (8) HOUR SHIFTS FOR NURSING STAFF VS. 12 HOUR SHIFTS THAT ARE COMMON WITHIN THE INDUSTRY. WE ARE ALSO COMMITTED TO PROVIDING OPPORTUNITIES TO OUR NURSING STAFF TO FURTHER THEIR EDUCATION AND ENCOURAGING ALL NURSING STAFF TO PURSUE AT LEAST A BACHELOR'S LEVEL OF NURSING EDUCATION. PART III, LINE 2: THE AMOUNT REPORTED IS CONSISTENT WITH THE AMOUNT REPORTED ON THE ORGANIZATION'S AUDITED FINANCIAL STATEMENTS UNDER THE GENERALLY ACCEPTED ACCOUNTING STANDARDS. PART III, LINE 3: COSTING METHODOLOGY USED:UNCOLLECTIBLE PATIENT ACCOUNTS ARE CHARGED AGAINST THE PROVISION FOR BAD DEBT IN ACCORDANCE WITH THE POLICIES OF WHITLEY MEMORIAL HOSPITAL, INC. HOWEVER, DURING THE COLLECTION PROCESS THERE IS A CONTINUOUS EFFORT TO DETERMINE IF THE PATIENT QUALIFIES FOR FINANCIAL ASSISTANCE. THEREFORE, ONCE AN UNCOLLECTIBLE ACCOUNT HAS BEEN CHARGED OFF AND IT IS DETERMINED THROUGH THE COLLECTION PROCESS THAT THE PATIENT QUALIFIES FOR FINANCIAL ASSISTANCE, THE UNCOLLECTIBLE ACCOUNT IS RECLASSIFIED TO CHARITY CARE AND ALL COLLECTION EFFORTS CEASE. PATIENTS ARE ELIGIBLE TO APPLY FOR FINANCIAL ASSISTANCE CARE 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 12 OF ATTACHED FINANCIAL STATEMENTS. PART III, LINE 8: COMMUNITY BENEFIT & METHODOLOGY FOR DETERMINING MEDICARE COSTSSUBSTANTIAL SHORTFALLS TYPICALLY ARISE FROM PAYMENTS THAT ARE LESS THAN THE COST TO PROVIDE THE CARE OR SERVICES AND DO NOT INCLUDE ANY AMOUNTS RELATING TO INEFFICIENT OR POOR MANAGEMENT. WHITLEY MEMORIAL HOSPITAL, INC. ACCEPTS ALL MEDICARE PATIENTS, AS REFLECTED ON THE YEAR-END MEDICARE COST REPORT, WITH THE KNOWLEDGE THAT THERE MAY BE SHORTFALLS. INTERNAL REVENUE SERVICE (IRS) REVENUE RULING 69-545 IMPLIES THAT TREATING MEDICARE PATIENTS IS A COMMUNITY BENEFIT. IRS REVENUE RULING 69-545, WHICH ESTABLISHED THE COMMUNITY BENEFIT STANDARD FOR NONPROFIT HOSPITALS, STATES THAT IF A HOSPITAL SERVES PATIENTS WITH GOVERNMENTAL HEALTH BENEFITS, INCLUDING MEDICARE, THEN THIS IS AN INDICATION THAT THE HOSPITAL OPERATES TO PROMOTE THE HEALTH OF THE COMMUNITY. HOWEVER, MEDICARE PAYMENTS REPRESENT A PROXY OF COST CALLED THE "UPPER PAYMENT LIMIT." IT HAS HISTORICALLY BEEN ASSUMED THAT UPPER PAYMENT LIMIT PAYMENTS DO NOT GENERATE A SHORTFALL. AS A RESULT, WHITLEY MEMORIAL HOSPITAL, INC. HAS TAKEN THE POSITION NOT TO INCLUDE THE MEDICARE SHORTFALLS OR SURPLUSES AS PART OF COMMUNITY BENEFIT. WHITLEY MEMORIAL HOSPITAL, INC. RECOGNIZES THAT THE SHORTFALL OR SURPLUS FROM MEDICARE DOES NOT INCLUDE THE COSTS AND REVENUES ASSOCIATED WITH MEDICARE ADVANTAGE PATIENTS. AS SUCH, THE TOTAL SHORTFALL OR SURPLUS OF MEDICARE IS UNDERSTATED DUE TO THE COSTS AND REVENUES ASSOCIATED WITH MEDICARE ADVANTAGE PATIENTS NOT BEING INCLUDED IN THE COMMUNITY BENEFIT DETERMINATION. PART III, LINE 9B: 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 WHITLEY MEMORIAL HOSPITAL, INC., AND IN CONJUNCTION WITH THE ALLEN COUNTY - FORT WAYNE HEALTH DEPARTMENT, RECENTLY COMPLETED A COMMUNITY HEALTH NEEDS ASSESSMENT FOR THE FIVE COUNTY SERVICE AREAS IN WHICH PARKVIEW HOSPITALS RESIDE. IN ADDITION, PARKVIEW HEALTH SYSTEM, INC. HAS 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 AND 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 THIS SURVEY HAS PROVEN TO BE VALUABLE TOOL AS WE SEEK AND PRIORITIZE OPPORTUNITIES TO IMPROVE THE HEALTH OF THE COMMUNITIES WE SERVE AND IDENTIFY OPPORTUNITIES FOR COLLABORATION AMONG COMMUNITY ORGANIZATIONS AND LEADERS. WHITLEY MEMORIAL HOSPITAL, INC. REPRESENTATIVES HAVE RELATIONSHIPS THROUGHOUT THE COMMUNITY AND MEET REGULARLY WITH VARIOUS ORGANIZATIONS THAT SHARE WHITLEY MEMORIAL HOSPITAL, INC.'S MISSION OF IMPROVING THE HEALTH OF THE COMMUNITIES.ON A ROUTINE BASIS, PARKVIEW SPONSORS A PROFESSIONALLY ADMINISTERED COMMUNITY HEALTH ASSESSMENT TO IDENTIFY HEALTH NEEDS WITHIN NORTHEAST INDIANA, PARTICULARLY, IN THE FIVE COUNTIES IN WHICH HOSPITALS EXIST. WHITLEY MEMORIAL HOSPITAL, INC. IS KEEPING PACE WITH THE RAPIDLY CHANGING HEALTHCARE INDUSTRY BY INCORPORATING NEW TECHNOLOGY AND THE LATEST DIAGNOSTIC AND TREATMENT PROCEDURES. 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 WHITLEY MEMORIAL HOSPITAL, 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, THE PATIENT 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.WHITLEY MEMORIAL HOSPITAL, INC. PRIMARILY SERVES THE WHITLEY COUNTY COMMUNITIES OF COLUMBIA CITY, CHURUBUSCO, LARWILL, AND SOUTH WHITLEY. AS THE ONLY HOSPITAL IN THIS COUNTY, WHITLEY MEMORIAL HOSPITAL, INC. ALSO SERVES, TO A LIMITED EXTENT, OTHER SURROUNDING COMMUNITIES. WHITLEY MEMORIAL HOSPITAL, INC. IS EXPANDING INTO KOSCIUSKO COUNTY TO MEET THE NEEDS OF THAT COMMUNITY AS WELL. THE PLANS INCLUDE AN EMERGENCY ROOM, MEDICAL OFFICE SPACE AND OUTPATIENT SERVICES. WHITLEY COUNTY HAS APPROXIMATELY 33,392 RESIDENTS, PRIMARILY CAUCASIAN. THE MEDIAN INCOME IS $62,200. THE UNEMPLOYMENT RATE IS 5.2%. MANUFACTURING, TRADE, TRANSPORTATION, UTILITIES, EDUCATION AND HEALTH SERVICES MAKE-UP A MAJORITY OF THE EMPLOYMENT IN THE COUNTY. KOSCIUSKO COUNTY HAS APPROXIMATELY 78,564 RESIDENTS, PRIMARILY CAUCASIAN, AND APPROXIMATELY 8% HISPANIC OR LATINO. THE UNEMPLOYMENT RATE IS 4.7%. MANUFACTURING, HEAVILY WEIGHTED IN THE ORTHOPEDICS INDUSTRY, EDUCATION AND HEALTH SERVICES MAKE UP THE MAJORITY OF EMPLOYMENT IN THE COUNTY. PART VI, LINE 5: PROVIDE ANY OTHER INFORMATION IMPORTANT TO DESCRIBING HOW THE ORGANIZATION'S HOSPITAL FACILITIES OR OTHER HEALTH CARE FACILITIES FURTHER ITS EXEMPT PURPOSE BY PROMOTING THE HEALTH OF THE COMMUNITY (E.G. OPEN MEDICAL STAFF, COMMUNITY BOARD, USE OF SURPLUS FUNDS, ETC.).WHITLEY MEMORIAL HOSPITAL, INC.'S BOARD OF DIRECTORS IS COMPRISED OF MEMBERS, THE MAJORITY OF WHICH ARE INDEPENDENT COMMUNITY MEMBERS. A MAJORITY OF THE BOARD RESIDES IN WHITLEY MEMORIAL HOSPITAL, INC.'S PRIMARY SERVICE AREA. WHITLEY MEMORIAL HOSPITAL, INC. ALSO EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN THE COMMUNITY. PEOPLE THROUGHOUT THE COMMUNITY CAN COUNT ON WHITLEY MEMORIAL HOSPITAL, 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. THE HOSPITAL FEATURES 30 BEDS WITH ALL PRIVATE ROOMS, IN A 96,000 SQUARE FOOT FACILITY LOCATED ON 42 ACRES. AS A NOT-FOR-PROFIT HOSPITAL, WE TAKE OUR MISSION SERIOUSLY. WHITLEY MEMORIAL HOSPITAL, INC. EXISTS FOR ONE PURPOSE - TO IMPROVE THE HEALTH OF OUR COMMUNITIES BY BEING THE BEST PLACE FOR EMPLOYEES TO WORK, FOR PHYSICIANS TO TREAT PATIENTS AND FOR PATIENTS TO RECEIVE CARE. WHITLEY MEMORIAL HOSPITAL, INC. GIVES BACK TO THE WHITLEY COUNTY COMMUNITY IN THE FORM OF CONTINUALLY IMPROVING FACILITIES, EDUCATION AND OUTREACH PROGRAMS, FREE AND DISCOUNTED CARE, VOLUNTEERISM AND MUCH MORE. THE FOLLOWING LIST DEMONSTRATES SOME OF THE WAYS WHITLEY MEMORIAL HOSPITAL, INC. REACHES OUT TO MAKE OUR COMMUNITIES HEALTHIER: -FINANCIAL ASSISTANCE-COMMUNITY HEALTH IMPROVEMENT INITIATIVES-PRIMARY HEALTH CARE/ACCESS-MEDICATION ASSISTANCE PROGRAM (MAP)-HEALTH SCREENING/PREVENTION AND DISEASE MANAGEMENTFINANCIAL ASSISTANCE:WHITLEY MEMORIAL HOSPITAL, INC.'S MISSION INCLUDES CARING FOR PEOPLE WHO DO NOT HAVE THE MEANS TO MEET THEIR FINANCIAL OBLIGATIONS. A FINANCIAL COUNSELOR IS AVAILABLE TO ASSIST PATIENTS IN NAVIGATING THIS PROCESS. THE HOSPITAL PLACES ITS PRIORITY ON PROVIDING THE NECESSARY CARE, NOT ON THE PATIENT'S ABILITY TO PAY FOR THEIR MEDICAL EXPENSES. COMMUNITY HEALTH IMPROVEMENT:THE PURPOSE OF WHITLEY MEMORIAL HOSPITAL, INC.'S COMMUNITY HEALTH IMPROVEMENT PROGRAM IS TO FUND COMMUNITY HEALTH IMPROVEMENT EFFORTS WITHIN THE SERVICE AREA OF WHITLEY MEMORIAL HOSPITAL, INC. THE HOSPITAL SETS ASIDE UP TO 10 PERCENT OF ITS NET INCOME ANNUALLY TO FUND COMMUNITY HEALTH INITIATIVES AND PARTNERS WITH COMMUNITY ORGANIZATIONS TO ENCOURAGE HEALTHIER LIFESTYLES AMONG THE CITIZENS OF NORTHEAST INDIANA. WHITLEY MEMORIAL HOSPITAL, INC. INVESTS IN KEY ORGANIZATIONS THAT PROMOTE THE HEALTH AND WELLNESS OF FAMILIES, CHILDREN, AND INDIVIDUALS OF WHITLEY COUNTY. KEY PROJECTS AND AREAS OF FOCUS FUNDED THROUGH THE COMMUNITY HEALTH IMPROVEMENT INITIATIVE AND OTHER HOSPITAL FUNDS INCLUDE: -SUPPORT OF B.A.B.E. OF WHITLEY COUNTY, AN INCENTIVE BASED PROGRAM FOR PREGNANT WOMEN AND FAMILIES TO TRY TO DETER THE HIGH INCIDENCE OF LOW-BIRTH WEIGHT BABIES AND TO ENSURE THAT THE CHILDREN ARE GIVEN THE BEST POSSIBLE START IN LIFE. -WOLF LAKE FREE HEALTH CLINIC IS GIVEN IN-KIND LAB SERVICES THROUGH PARKVIEW WHITLEY HOSPITAL TO SERVE THE NEEDS OF THEIR UNINSURED PATIENTS. THEY ALSO RECEIVE IN-KIND SPACE TO OPERATE THEIR CLINIC. -CANI COVERING KIDS AND FAMILIES HELPS PROVIDE RESOURCES TO FAMILIES AND THEIR CHILDREN TO ENSURE THOSE ELIGIBLE FOR HEALTHCARE INSURANCE ARE ENROLLED. THEY UTILIZE IN-KIND SPACE TO OPERATE IN WHITLEY COUNTY.-SUPPORTED THE LOCAL ELEMENTARY ONE (1) MILE RUN BY PROVIDING WATER, FRESH FRUIT AND CHEESE AS A HEALTHY SNACK ALTERNATIVE AFTER PHYSICAL ACTIVITY. -SUPPORTED THE WHITLEY COUNTY ECONOMIC DEVELOPMENT CORPORATION TO HELP LOCAL BUSINESSES PLAN, BUILD AND EQUIP TO GROW AND THRIVE IN OUR COMMUNITIES. AN ECONOMICALLY HEALTHY COMMUNITY LEADS TO A PHYSICALLY HEALTHY COMMUNITY. PRIMARY HEALTH CARE ACCESS:WHITLEY MEMORIAL HOSPITAL, INC. FEATURES 30 BEDS WITH ALL PRIVATE ROOMS. EMERGENCY MEDICAL CARE, OBSTETRIC CARE AND MEDICAL-SURGICAL UNITS ARE AVAILABLE; AS WELL AS LAB, X-RAY AND SURGICAL SERVICES. AN ATTACHED MEDICAL OFFICE BUILDING PROVIDES CONVENIENT, EASY ACCESS FOR PATIENTS TO RECEIVE CARE FROM FAMILY AND SPECIALTY PHYSICIANS.IN ADDITION, WHITLEY MEMORIAL HOSPITAL, INC. PROVIDES FIRST RESPONDER AND ADVANCED EMT COURSES AND AN ANNUAL SUBSIDY TO THE WHITLEY COUNTY EMS PROGRAM. MEDICATION ASSISTANCE PROGRAM (MAP):WHITLEY MEMORIAL HOSPITAL, INC. SUPPORTS A MEDICATION ASSISTANCE PROGRAM THAT HAS EXPERIENCED STEADY GROWTH SINCE ITS INCEPTION. MAP PARTNERS WITH PATIENTS, PHYSICIANS, PHARMACEUTICAL COMPANIES, LOCAL PHARMACIES, AND DONORS TO PROVIDE MEDICATION ASSISTANCE AT LITTLE OR NO COST FOR QUALIFIED INDIVIDUALS. EMERGENCY VOUCHERS FOR ACUTE MEDICATION NEEDS ARE REDEEMED AT LOCAL PHARMACIES. LONG-TERM MEDICATION HELP IS PROVIDED THROUGH CONNECTING PATIENTS WITH PHARMACEUTICAL ASSISTANCE PROGRAMS (PAP).HEALTH SCREENING/PREVENTION AND DISEASE MANAGEMENT:WHITLEY MEMORIAL HOSPITAL, INC. PARTICIPATES IN NUMEROUS HEALTH FAIRS AND ACTIVITIES THROUGHOUT THE YEAR TO PROVIDE HEALTH EDUCATION, HEALTH SCREENINGS FOR DISEASE PREVENTION, AND TO PROMOTE HEALTHY LIFESTYLES. THE HOSPITAL ALSO PROVIDES SUPPORT GROUPS TO ASSIST PATIENTS AND FAMILIES IN MANAGING DISEASE. -HEARTBEATS HEALTH FAIR, THE HOSPITAL'S OWN HEALTH FAIR, INCLUDES MULTIPLE HEALTH SCREENINGS AND HEALTH AND PREVENTION EDUCATION FOR ADULTS OF THE COMMUNITY. THIS EVENT DRAWS IN SEVERAL HUNDRED COMMUNITY MEMBERS EACH YEAR. FRANCINE'S FRIEND MOBILE MAMMOGRAPHY ALSO CONTINUES TO OFFER MAMMOGRAMS.-IHSAA PHYSICALS ARE PERFORMED FOR LOCAL JUNIOR AND SENIOR HIGH SCHOOL STUDENT ATHLETES. APPROXIMATELY 400 STUDENTS RECEIVED A PHYSICAL EXAM BY A HEALTHCARE PROVIDER, VISION SCREENING, HEIGHT AND WEIGHT CHECKS, BLOOD PRESSURE AND AN ORTHOPEDIC EXAM. -PARKVIEW WHITLEY BIRTH PLANNER CONDUCTS BREASTFEEDING EDUCATION AND A SUPPORT GROUP FOR NEW MOMS. LAMAZE CLASSES ARE ALSO AVAILABLE TO PARENTS. THE BIRTH PLANNER ALSO CONDUCTED A CRIB GIVE-AWAY TO PROVIDE A SAFE PLACE FOR INFANTS TO SLEEP.-WHITLEY MEMORIAL HOSPITAL, INC. AND THE WHITLEY COUNTY COMMUNITY FOUNDATION PARTNER TOGETHER TO PROVIDE FREE MAMMOGRAPHY SCREENING TO WOMEN WHO ARE UNINSURED OR UNDERINSURED. THROUGH THE WOMEN'S GIVING CIRCLE, A FUND OF THE WHITLEY COUNTY COMMUNITY FOUNDATION, VOUCHERS ARE GIVEN TO WOMEN WHO ARE UNINSURED OR UNDERINSURED AND CAN BE REDEEMED AT THE HOSPITAL FOR MAMMOGRAMS.THE MANAGEMENT AND EMPLOYEES OF PARKVIEW WHITLEY HOSPITAL, INC. PARTICIPATE IN NUMEROUS VOLUNTEER ACTIVITIES THROUGHOUT THE COMMUNITY TO IMPROVE THE HEALTH AND WELL-BEING OF THE COMMUNITY. THEY PARTICIPATE IN THE LOCAL DAY OF CARING, THE WOLF LAKE FREE HEALTH CLINIC, JUNIOR ACHIEVEMENT PROGRAMS AT LOCAL SCHOOLS AND THE SALVATION ARMY BELL RINGING, TO NAME A FEW. NUMEROUS OTHER EDUCATIONAL AND SUPPORT OPPORTUNITIES ARE AVAILABLE FOR THE PUBLIC SUCH AS CARDIO PULMONARY REHAB SUPPORT, DIABETES SUPPORT, HEALTHY EATING PRESENTATIONS, AND SMOKING CESSATION CLASSES. -PROVIDING FIRST RESPONDER AND ADVANCED EMT COURSES AND AN ANNUAL SUBSIDY OF THE WHITLEY COUNTY EMS PROGRAM. -IN 2013 WHITLEY MEMORIAL HOSPITAL, INC. INVESTED IN THE HEALTH OF THEIR EMPLOYEES BY CREATING SPACE FOR THEM TO UTILIZE EXERCISE EQUIPMENT RIGHT AT THE WORKPLACE. PROMOTING HEALTHY LIFESTYLES FOR THOSE WITHIN OUR FACILITY AND THE COMMUNITY ARE IMPORTANT TO OUR MISSION.-WHITLEY MEMORIAL HOSPITAL, INC. IS CONSISTENTLY RATED HIGHLY IN PUBLICALLY REPORTED MEASURES OF CARE AS WELL AS THE PATIENT PERCEPTION OF CARE.-PARKVIEW WHITLEY HOSPITAL HOSTED THE LOCAL FARMERS MARKET ON THEIR CAMPUS THROUGHOUT THE SUMMER; PROVIDING LOCALLY GROWN FRESH FRUITS AND VEGETABLES FOR SALE TO THE COMMUNITY. THE FARMERS MARKET ACCEPTS SNAP, WHICH IS VERY BENEFICIAL TO THE LOW INCOME FAMILIES IN THE COMMUNITY.-PARKVIEW WHITLEY CHILDREN'S FAIR PROMOTED BICYCLE SAFETY, FREE HELMETS AND CAR SEAT INSPECTIONS AS WELL AS NUMEROUS OTHER SAFETY AND WELLNESS INFORMATION BOOTHS TO CHILDREN AND PARENTS AS THEY PARTICIPATED IN A WALK AROUND THE HOSPITAL CAMPUS. PART VI, LINE 6: IF THE ORGANIZATION IS PART OF AN AFFILIATED HEALTH CARE SYSTEM, DESCRIBE THE RESPECTIVE ROLES OF THE ORGANIZATION AND ITS AFFILIATES IN PROMOTING THE HEALTH OF THE COMMUNITIES SERVED.PARKVIEW HEALTH SYSTEM, INC. (PARKVIEW), A 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 ORTHOPAEDIC HOSPITAL AT PARKVIEW NORTH, LLC. PARKVIEW IS GUIDED BY A MISSION TO IMPROVE THE HEALTH OF THE COMMUNITIES IT SERVES. PARKVIEW 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. PARKVIEW SEEKS TO CREATE ALIGNMENT OPPORTUNITIES TO DELIVER COMPREHENSIVE HIGH-QUALITY CARE THAT BENEFITS ITS PATIENTS, COMMUNITIES, PHYSICIANS, AND CO-WORKERS.PARKVIEW 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. PARKVIEW'S MISSION IS TO PROVIDE QUALITY HEALTH SERVICES TO ALL WHO ENTRUST THEIR CARE TO US AND WE WILL WORK TO IMPROVE THE HEALTH OF OUR COMMUNITIES. PARKVIEW 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. 1 WHITLEY MEMORIAL HOSPITAL FOUNDATION INC 1260 EAST STATE ROAD 205 COLUMBIA CITY IN 46725 311190239 501 ( C ) 3 112102 OPERATIONS WHITLEY COUNTY ECONOMIC DEVELOPMENT CORP 220 W VAN BUREN ST STE10 COLUMBIA CITY IN 46725 351854496 501 ( C ) 4 50000 EDC INVESTMENT CAMPAIGN COMMUNITY ACTION OF NORTHEAST INDIANA 227 E WASHINGTON BLVD FORT WAYNE IN 46853 351111819 501 ( C ) 3 15000 ASSISTANCE FOR MEDICAID ENROLLMENT BABE BEDS AND BRITCHES ETC 533 N LINE ROAD COLUMBIA CITY IN 46725 351130532 501 ( C ) 3 10000 TEEN PARENT CHILDCARE CENTER 3 1 PART I, LINE 2: COMMUNITY HEALTH IMPROVEMENT FUNDING PARTNER ORGANIZATIONS ARE REQUIRED TO SUBMIT AN ANNUAL PROGRESS REPORT RELATED TO PROGRAM FUNDING. PARTNER ORGANIZATIONS ARE REQUIRED TO RE-APPLY FOR FUNDING ON AN ANNUAL BASIS. 0 1 0 0 0 0 0 1 0 SCOTT GABRIEL DIRECTOR/WMHOS PRESIDENT 183555 0 37852 0 643 0 35382 0 22773 0 280205 0 0 0 MICHAEL PACKNETT PH PRESIDENT & CEO 0 917476 0 361729 0 22018 0 198402 0 26489 0 1526114 0 0 MARK BURKETT DIRECTOR/PH PHYSICIAN 17783 176463 0 41576 260 2578 1108 13553 1099 13436 20250 247606 0 0 REBECCA CASE DIRECTOR/PH PHYSICIAN 14144 221142 0 43474 0 2076 1375 25925 865 16318 16384 308935 0 0 MICHAEL BROWNING PH SVP & CFO 0 515063 0 202344 0 19226 0 72000 0 27949 0 836582 0 0 BRIDGET DOLOHANTY-JOHNSON WMHOS VP PATIENT CARE 151973 0 25630 0 2071 0 22194 0 8977 0 210845 0 0 0 WAYNE ENGDAHL WMHOS PHARMACIST 130087 5879 1400 0 758 34 7947 355 6791 304 146983 6572 0 0 STANTON RISSER FORMER OFFICER/CURRENT PH EMPLOYEE 0 165187 0 25633 0 1013 0 24847 0 21147 0 237827 0 0 JOHN MEISTER FORMER OFFICER/CURRENT PH EMPLOYEE 0 198380 0 58339 0 4359 0 40377 0 18812 0 320267 0 0 RICK HENVEY FORMER OFFICER/CURRENT PH EMPLOYEE 0 443984 0 95062 0 16003 0 47216 0 24628 0 626893 0 14805 PART I, LINE 3 RELATED ORGANIZATION, PARKVIEW HEALTH SYSTEM, INC., USES THE FOLLOWING TO ESTABLISH THE COMPENSATION OF WHITLEY MEMORIAL HOSPITAL, INC.'S CEO/EXECUTIVE DIRECTOR: COMPENSATION COMMITTEE (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 OF RELATED ORGANIZATION PARKVIEW HEALTH SYSTEM, INC.) PART I, LINE 4B SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN PAYMENTS TAXABLE - RICK HENVEY $14,805 PARTICIPANTS DEFERRED - MICHAEL BROWNING $59,000; BRIDGET DOLOHANTY-JOHNSON $16,979; SCOTT GABRIEL $20,060; RICK HENVEY $36,816; JOHN MEISTER $22,593; MICHAEL PACKNETT $180,202; STANTON RISSER $11,702 PART I, LINE 7 MANAGEMENT INCENTIVE COMPENSATION PLAN (MICP) IS AN ANNUAL INCENTIVE PROGRAM. 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. CHELSEA CRESS FAMILY MEMBER OF KEY EMPLOYEE BRIDGET DOLOHANTY-JOHNSON 25655 CHELSEA CRESS RECEIVED COMPENSATION FROM WHITLEY MEMORIAL HOSPITAL, INC. 0 FORM 990, PART V, LINES 1A AND 2A: PARKVIEW HEALTH SYSTEM, INC. (PH), EIN 35-1972384, IS THE COMMON PAYING AGENT FOR THE FILING ORGANIZATION, WHITLEY MEMORIAL HOSPITAL, INC., EIN 35-1967665. THEREFORE, ALL APPLICABLE IRS TAX FILINGS, INCLUDING FORMS 1099, 1096, W-2 AND W-3 ARE REPORTED AND FILED BY PH. THE TOTAL NUMBER REPORTED IN BOX 3 OF FORM 1096 AND FILED BY THE COMMON PAYING AGENT, PH, FOR THE YEAR ENDED DECEMBER 31, 2014 WAS 493. THE TOTAL NUMBER OF EMPLOYEES REPORTED ON FORM W-3 AND FILED BY THE COMMON PAYING AGENT, PH, FOR THE YEAR ENDED DECEMBER 31, 2013 WAS 10,268. FOR PURPOSES OF COMPLETING FORM 990, PART V, LINE 1A AND 2A, THE NUMBER REPORTED FOR THE WHITLEY MEMORIAL HOSPITAL, INC. WAS 29 AND 319 RESPECTIVELY. FORM 990, PART VI, SECTION A, LINE 6 THE ORGANIZATION IS ORGANIZED AS A NOT-FOR-PROFIT CORPORATION. PURSUANT TO THE ORGANIZATION'S GOVERNING DOCUMENTS, PARKVIEW HEALTH SYSTEM, INC. EIN 35-1972384 IS THE SOLE MEMBER OF WHITLEY MEMORIAL HOSPITAL, INC. WITH CERTAIN RESERVED POWERS. FORM 990, PART VI, SECTION A, LINE 7A THE CORPORATE MEMBER, PARKVIEW HEALTH SYSTEM, INC. EIN 35-1972384, SHALL HAVE THE FOLLOWING RESERVED POWERS AS DEFINED IN THE NETWORK AGREEMENT: (A) APPOINT DIRECTORS (INCLUDING APPOINTMENTS TO FILL A VACANCY) AND INITIATE THE REMOVAL AND REMOVE ANY DIRECTOR OF THE CORPORATION, WITH CAUSE, PROVIDED CONSIDERATION IS GIVEN TO RECOMMENDATIONS OF THE BOARD REGARDING SUCH APPOINTMENT OR REMOVAL, IF ANY ARE SO MADE; (B) APPOINT (INCLUDING APPOINTMENTS TO FILL A VACANCY) AND INITIATE THE REMOVAL AND REMOVE THE PRESIDENT OF THE CORPORATION, WITH OR WITHOUT CAUSE, PROVIDED CONSIDERATION IS GIVEN TO RECOMMENDATIONS OF THE BOARD REGARDING SUCH APPOINTMENT OR REMOVAL, IF ANY ARE SO MADE; (C) APPROVE AND ADOPT THE STRATEGIC PLAN FOR THE CORPORATION AND ITS AFFILIATES, INCLUDING ANY INDIVIDUAL INITIATIVES OR ARRANGEMENTS, SUCH AS A NEW SERVICE OR CONTRACTUAL ARRANGEMENT, DEEMED BY THE CORPORATE MEMBER TO BE OF STRATEGIC IMPORTANCE TO THE CORPORATION AND DIRECT AND MONITOR COMPLIANCE WITH SUCH PLANS, INITIATIVES AND ARRANGEMENTS; (D) APPROVE AND ADOPT THE CAPITAL AND OPERATING BUDGETS OF THE CORPORATION AND ITS AFFILIATES; (E) APPROVE THE INCURRENCE OF ANY DEBT PROPOSED BY THE CORPORATION, INCLUDING THE ISSUANCE OF BONDS, BY THE CORPORATION AND ITS AFFILIATES AND REQUIRE THE INCURRENCE OF DEBT BY THE CORPORATION AND ITS AFFILIATES; (F) APPROVE THOSE TRANSFERS OF ASSETS BY THE CORPORATION AND ITS AFFILIATES, INCLUDING TRANSFERS OF REAL PROPERTY, PERSONAL PROPERTY, CASH, STOCK OR OTHER TANGIBLE OR INTANGIBLE ASSETS, UNLESS OTHERWISE IDENTIFIED IN PREVIOUSLY APPROVED STRATEGIC PLANS, INITIATIVES, ARRANGEMENTS, OR BUDGETS; (G) REQUIRE AND DIRECT THE TRANSFER OF ASSETS BY THE CORPORATION OR ITS AFFILIATES, PROVIDED THAT APPROVAL OF THE BOARD IS ALSO REQUIRED IF THE TRANSFER INVOLVES A TRANSFER OR SALE OF SUBSTANTIALLY ALL OF THE ASSETS OF THE CORPORATION OR WOULD PREVENT THE CORPORATION FROM OPERATING AN ACUTE CARE HOSPITAL IN THE COMMUNITY. FURTHER, THE CORPORATE MEMBER COVENANTS NOT TO DIRECT THE TRANSFER OF THE CORPORATION'S REAL ESTATE AND IMPROVEMENTS TRANSFERRED TO THE CORPORATION PURSUANT TO, OR OTHERWISE COVERED BY, THE JOINT ACTION OF THE BOARD OF DIRECTORS OF THE PARKVIEW WHITLEY HOSPITAL, THE WHITLEY COUNTY COMMISSIONERS, AND THE WHITLEY COUNTY COUNCIL WITHOUT THE CONSENT OF THE CORPORATION'S BOARD AND THE COUNTY COMMISSIONERS. FOR PURPOSES OF THIS SECTION, BOARD APPROVAL SHALL NOT BE REQUIRED FOR PARTICIPATION IN A MASTER TRUST INDENTURE, POOLED FINANCING OR ANY OTHER KIND OF DEBT INSTRUMENT, BORROWING OR GUARANTY OBLIGATING CORPORATION ASSETS; (H) APPROVE PARTICIPATION (INCLUDING THE EXERCISE OF RENEWAL OPTIONS) BY THE CORPORATION AND ITS AFFILIATES IN NETWORKS, AFFILIATIONS, JOINT VENTURES, PARTNERSHIPS, MERGERS OR ACQUISITIONS AND REQUIRE PARTICIPATION BY THE CORPORATION AND ITS AFFILIATES IN SUCH ARRANGEMENTS; (I) APPROVE DECISIONS OF THE CORPORATION AND ITS AFFILIATES TO PARTICIPATE (INCLUDING THE EXERCISE OF RENEWAL OPTIONS) IN MANAGED CARE OR OTHER HEALTH CARE SERVICE PURCHASING ARRANGEMENTS AND REQUIRED PARTICIPATION BY THE CORPORATION AND ITS AFFILIATES IN SUCH HEALTH CARE SERVICE PURCHASING ARRANGEMENTS; (J) DEVELOP AND REQUIRE ADOPTION OF MINIMUM MEDICAL STAFF QUALITY ASSURANCE AND UTILIZATION REVIEW STANDARDS, CRITERIA AND PROCEDURES FOR THE CORPORATION AND ITS AFFILIATES IN CONSULTATION WITH THE CORPORATION; (K) APPROVE ANY ACTION OF THE CORPORATION OR AN AFFILIATE TO CHANGE THE HOSPITAL FROM A GENERAL, ACUTE CARE COMMUNITY HOSPITAL OR TO CLOSE THE HOSPITAL; AND (L) APPROVE ANY AMENDMENT TO THE BYLAWS OR THE ARTICLES OF INCORPORATION OF THE CORPORATION, AND THE ARTICLE AND BYLAWS OF ANY NEWLY CREATED AFFILIATE AND REQUIRE AMENDMENT OF THESE GOVERNING DOCUMENTS AS NECESSARY OR ADVISABLE TO RESOLVE SIGNIFICANT ETHICAL ISSUES; TO MAINTAIN JCAHO ACCREDITATION, TAX-EXEMPT STATUS, PARTICIPATION IN MEDICARE/MEDICAID OR TO PREVENT SIGNIFICANT ADVERSE LEGAL OR FINANCIAL EFFECTS TO THE CORPORATION OR SYSTEM, EXCEPT THAT THERE CAN BE NO AMENDMENT TO THE RESERVED POWERS LISTED IN SECTIONS (G) AND (K) OF THIS EXHIBIT A OR THE REQUIREMENT THAT ELECTED DIRECTORS BE REPRESENTATIVE OF WHITLEY COUNTY, AS DESCRIBED IN ARTICLE V, SECTIONS 2 AND 10 OF THESE BYLAWS WITHOUT THE CONSENT OF THE CORPORATION, AND THERE CAN BE NO AMENDMENT TO ARTICLE XI, SECTION 3(E) OF THE BYLAWS WITHOUT THE CONSENT OF THE COUNTY COMMISSIONERS. THE CORPORATE MEMBER SHALL DEVELOP POLICIES FOR THE IMPLEMENTATION OF THE RESERVED POWERS, INCLUDING MATERIALITY POLICIES REGARDING MATTERS SUBJECT TO REVIEW. FORM 990, PART VI, SECTION A, LINE 7B SEE SCHEDULE O EXPLANATION FOR FORM 990, PART VI, SECTION A, LINE 7A FORM 990, PART VI, SECTION B, LINE 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. WHITLEY MEMORIAL HOSPITAL, INC. IS A SUBSIDIARY CORPORATION OF PARKVIEW HEALTH SYSTEM, INC. AN ELECTRONIC COPY OF THE ORGANIZATION'S FINAL FORM 990 (INCLUDING SUPPLEMENTAL SCHEDULES) WAS PROVIDED TO EACH VOTING MEMBER OF THE ORGANIZATION'S GOVERNING BODY AND THE SYSTEM AUDIT COMMITTEE, PRIOR TO FILING WITH THE IRS. ON OCTOBER 7, 2015, 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 2014, THE BOARD OF PARKVIEW HEALTH SYSTEM, INC. REVIEWED AND APPROVED ALL EXECUTIVE COMPENSATION, BENEFITS AND PERQUISITES FOR THE 2014 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). OFFICES OR POSITIONS REVIEWED AT THE 2014 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 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 PATIENT CARE SENIOR VICE PRESIDENT SERVICE LINE LEADER SENIOR VICE PRESIDENT STRATEGIC INITIATIVES VICE PRESIDENT CHANGING SPACES CONSTRUCTION PROJECT MANAGEMENT VICE PRESIDENT HUMAN RESOURCES VICE PRESIDENT MKTG/COMM/COMMUNITY RELATIONS VICE PRESIDENT NURSING PRMC 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 PLANNING AND DECISION SUPPORT VICE PRESIDENT RANDALLIA OPERATIONS VICE PRESIDENT REVENUE CYCLE MANAGEMENT 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 PARKVIEW PHYSICIANS GROUP MEDICAL DIRECTOR INTEGRATION AND DEVELOPMENT CHIEF MEDICAL INFORMATICS OFFICER CHIEF MEDICAL OFFICER PRMC AND AFFILIATES 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, LINES 5-10: PARKVIEW HEALTH SYSTEM, INC., EIN 35-1972384, SERVES AS THE COMMON PAYING AGENT FOR ALL TAX-EXEMPT ORGANIZATIONS OF THE SYSTEM. SALARIES AND WAGES OF EMPLOYEES WORKING FOR THESE ORGANIZATIONS ARE CHARGED DIRECTLY TO THE ORGANIZATIONS IN WHICH THEY WORK. THE ACTUAL EXPENSES FOR PAYROLL TAXES, EMPLOYEE BENEFITS, AND PENSION PLAN CONTRIBUTIONS ARE REFLECTED ON THE BOOKS OF PARKVIEW HEALTH SYSTEM, INC. FOR FINANCIAL REPORTING PURPOSES. TO ACCOUNT FOR BENEFIT COSTS ON THE BOOKS OF THE OTHER TAX EXEMPT ORGANIZATIONS, AN ALLOCATION METHODOLOGY IS UTILIZED TO CHARGE THESE ORGANIZATIONS WITH AN ESTIMATE OF THE OVERALL COSTS, REFERRED TO AS A "BENEFIT ALLOCATION" FROM PARKVIEW HEALTH SYSTEM, INC. THE ALLOCATION DOES NOT DISTINGUISH BETWEEN THE COSTS OF THE VARIOUS COMPONENTS (I.E. PAYROLL TAXES, EMPLOYEE BENEFITS, AND PENSION PLAN CONTRIBUTIONS). THEREFORE, FOR PURPOSES OF THE FORM 990, PART IX, THE TOTAL BENEFIT ALLOCATION FOR THE EMPLOYEES' SALARIES AND WAGES REPORTED ON LINE 7 IS REFLECTED ON LINE 9 AND NOT ALLOCATED BETWEEN LINES 8 OR 10. FOR PURPOSES OF THE FORM 990, PART IX, LINES 5 AND 6 REFLECT COMPENSATION AND BENEFIT AMOUNTS REPORTED IN PART VII. FORM 990, PART XI, LINE 9: ASSET ADJUSTMENTS/TRANSFERS -29,443. CURRENT YEAR EARNINGS TRANSFERRED TO PARENT -7,828,316. INVESTMENT IN WRPLX FOR NMTC 12,166,122. 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 WHITLEY MEMORIAL HOSPITAL FOUNDATION INC 1260 E STATE ROAD 205 COLUMBIA CITY IN 46725 311190239 FUND MGMT IN 501(C)(3) LINE 11A, I WHITLEY MEMORIAL HOSPITAL INC 1 PARKVIEW OCCUPATIONAL HEALTH CENTERS INC 10501 CORPORATE DRIVE FORT WAYNE IN 46845 352064353 OCCUP HEALTH IN 501(C)(3) LINE 3 PARKVIEW HEALTH SYSTEM INC 0 PARKVIEW HOSPITAL INC 11109 PARKVIEW PLAZA DRIVE FORT WAYNE IN 46845 350868085 HOSPITAL CARE IN 501(C)(3) LINE 3 PARKVIEW HEALTH SYSTEM INC 0 COMMUNITY HOSPITAL OF LAGRANGE COUNTY INC 207 N TOWNLINE ROAD LAGRANGE IN 46761 202401676 HOSPITAL CARE IN 501(C)(3) LINE 3 PARKVIEW HEALTH SYSTEM INC 0 HUNTINGTON MEMORIAL HOSPITAL INC 2001 STULTS ROAD HUNTINGTON IN 46750 351970706 HOSPITAL CARE IN 501(C)(3) LINE 3 PARKVIEW HEALTH SYSTEM INC 0 COMMUNITY HOSPITAL OF NOBLE COUNTY INC 401 SAWYER ROAD KENDALLVILLE IN 46755 352087092 HOSPITAL CARE IN 501(C)(3) LINE 3 PARKVIEW HEALTH SYSTEM INC 0 PARKVIEW WABASH HOSPITAL INC 710 N EAST ST WABASH IN 46992 471753440 HOSPITAL CARE - BEGINNING 1/1/2015 IN 501(C)(3) LINE 3 PARKVIEW HEALTH SYSTEM INC 0 ORTHOPAEDIC HOSPITAL AT PARKVIEW NORTH LLC 10501 CORPORATE DRIVE FORT WAYNE IN 46845 260143823 ORTHO HOSPITAL IN PARKVIEW HEALTH SYSTEM INC RELATED 47466142 56284945 0 0 FOUNDATION SURGERY AFFILIATE OF FORT WAYNE LLC 8004 CARNEGIE BLVD FORT WAYNE IN 46804 201394120 SURGICAL SERVICES IN PARKVIEW HEALTH SYSTEM INC RELATED 310434 201875 0 0 MANAGED CARE SERVICES LLC 10501 CORPORATE DRIVE FORT WAYNE IN 46845 351996535 HEALTH PLAN ADMIN IN PARKVIEW HEALTH SYSTEM INC RELATED 2836327 12241084 0 0 MIDWEST COMMUNITY HEALTH ASSOCIATES INC 442 W HIGH STREET BRYAN OH 43506 341045870 PHYSICIANS OH PARKVIEW HEALTH SYSTEM INC C 29489689 2316575 0 0 1 1 0 0 0 0 0 0 1 1 1 1 0 0 1 0 1 0 WHITLEY MEMORIAL HOSPITAL FOUNDATION B 112102 PART VII SUPPLEMENTAL INFORMATION WHITLEY MEMORIAL HOSPITAL FOUNDATION C 152184 PART VII SUPPLEMENTAL INFORMATION SCHEDULE R, PART V, LINE 2, COLUMN (C): THE AMOUNTS REPORTED AS TRANSACTIONS WITH RELATED ORGANIZATIONS ARE CONSISTENT WITH THE AMOUNTS REPORTED ON THE ORGANIZATION'S AUDITED FINANCIAL STATEMENTS UNDER THE GENERALLY ACCEPTED ACCOUNTING STANDARDS DEPENDING ON THE TYPE OF TRANSACTION INVOLVED.