PARKVIEW OCCUPATIONAL HEALTH CENTERS INC: Form 990, tax year 2012
View the entire original 990 at ProPublica ↗
- Organization
- PARKVIEW OCCUPATIONAL HEALTH CENTERS INC (EIN 35-2064353)
- Tax period
- 2012-01-01 to 2012-12-31
- Filed
- 2013-11-11
- IRS object ID
- 201313169349301526
- Schema version
- 2012v2.1
- 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 ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2013-11-11T09:08:41-06:00 | Timestamp |
| Tax Period End Date | 2012-12-31 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 350921680 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CROWE HORWATH LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 330 E JEFFERSON BLVD PO BOX 7 | AddressLine1 |
| City | SOUTH BEND | City |
| State | IN | State |
| ZIP Code | 466240007 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2012-01-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 352064353 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PARKVIEW OCCUPATIONAL HEALTH CENTERS INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | PARK | NameControl |
| Phone | 2603738407 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 10501 CORPORATE DRIVE | AddressLine1 |
| City | FORT WAYNE | City |
| State | IN | State |
| ZIP Code | 46845 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | MICHAEL P BROWNING | Name |
| Title | PH SVP & CFO | Title |
| Phone | 2603738407 | Phone |
| Date Signed | 2013-11-11 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | KENNETH J KEBER | Name |
| PTIN | P00240883 | PTIN |
| Phone | 5742323992 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2012 | TaxYear |
| Build TS | 2016-02-25 16:41:14Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Change | X | AddressChange |
| Name Of Principal Officer Person | MICHAEL PACKNETT | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 10501 CORPORATE DRIVE | AddressLine1 |
| City | FORT WAYNE | City |
| State | IN | State |
| ZIP Code | 46845 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 9698405 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.PARKVIEW.COM | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1998 | YearFormation |
| State Legal Domicile | IN | StateLegalDomicile |
| Activity Or Mission Description | DELIVER OCCUPATIONAL HEALTH CARE SERVICES AND PROMOTE GENERAL HEALTH OF COMMUNITY. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 3 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 2 | NbrIndependentVotingMembers |
| Total Nbr Employees | 107 | TotalNbrEmployees |
| Total Nbr Volunteers | 0 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 1428 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 197 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 8626285 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 9698208 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 0 | InvestmentIncomePriorYear |
| Investment Income Current Year | -3443 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 0 | OtherRevenuePriorYear |
| Other Revenue Current Year | 0 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 8627713 | TotalRevenuePriorYear |
| Total Revenue Current Year | 9694962 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 0 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 4841125 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 5369137 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 2997798 | OtherExpensePriorYear |
| Other Expenses Current Year | 3347860 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 7838923 | TotalExpensesPriorYear |
| Total Expenses Current Year | 8716997 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 788790 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 977965 | RevenuesLessExpensesCY |
| Total Assets BOY | 2222998 | TotalAssetsBOY |
| Total Assets EOY | 3217418 | TotalAssetsEOY |
| Total Liabilities BOY | 335172 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 348008 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 1887826 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 2869410 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | DELIVER OCCUPATIONAL HEALTH CARE SERVICES IN A TIMELY, EFFICIENT, COST-EFFECTIVE MANNER AND PROMOTE THE GENERAL HEALTH OF THE COMMUNITY BY PROVIDING EDUCATIONAL AND WELLNESS PROGRAMS TO EMPLOYEE PATIENTS AND EMPLOYER CLIENTS. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 7892193 | Expense |
| Revenue | 9698208 | Revenue |
| Description | PARKVIEW OCCUPATIONAL HEALTH CENTERS, INC. (POHCI) PROVIDES A FULL RANGE OF OCCUPATIONAL HEALTH SERVICES IN PREVENTION, TREATMENT, AND REHABILITATION. EMPLOYEE ASSISTANCE PROGRAMS (EAP) AND WORKSITE WELLNESS SERVICES ARE ALSO AVAILABLE.POHCI PERFORMS A WIDE VARIETY OF PRE-PLACEMENT PHYSICAL EXAMINATIONS FOR A WIDE CROSS SECTION OF THE NORTHEAST INDIANA AREA BUSINESS COMMUNITY. THESE EXAMINATIONS ARE SPECIFIC TO THE JOB FOR WHICH THE INDIVIDUAL IS BEING CONSIDERED, AND WITH THE ADVENT OF THE AMERICANS WITH DISABILITIES ACT (ADA), ARE MATCHING POTENTIAL JOB APPLICANTS WITH THE ESSENTIAL FUNCTIONS OF THEIR JOBS. THIS ASSISTANCE IS CRITICAL TO EMPLOYERS AS THEY COMPLY WITH ADA. THE ORGANIZATION ALSO OFFERS A NATIONALLY CERTIFIED DRUG SCREEN PROGRAM, WHICH IS OPERATED IN COMPLIANCE WITH GUIDELINES ESTABLISHED BY THE NATIONAL INSTITUTE FOR DRUG ABUSE. FURTHER, THE ORGANIZATION PROVIDES ON-SITE MEDICAL MONITORING EXAMINATION PROTOCOL DEVELOPMENT, E. G., ASSISTING COMPANIES WITH THEIR COMPLIANCE UNDER OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION GUIDELINES, ERGONOMIC COMPLIANCE ASSISTANCE, AND ASSISTANCE IN COMPLIANCE WITH THE AMERICANS WITH DISABILITIES ACT REASONABLE ACCOMMODATION GUIDELINES. ADDITIONALLY, THE ORGANIZATION PROVIDES INDUSTRIAL HYGIENE SERVICES TO ASSIST IN ANALYZING NOISE LEVELS, INDOOR AIR QUALITY, AND OTHER MANDATED SURVEILLANCE PROGRAMS UNDER THE AUTHORIZATION OF THE OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION.POHCI SPECIALIZES IN THE TREATMENT OF WORKERS' COMPENSATION INJURIES AND OFFERS PHYSICIAN REFERRALS COMPLIMENTARY TO THE SPECIALIZED TREATMENT OF AN INJURY, SUCH AS HAND SURGERY, NEUROLOGY, AND OPHTHALMOLOGY, AS WELL AS IN-HOUSE PHARMACY SERVICES. THE CONCEPT OF THE ORGANIZATION'S TREATMENT PLAN IS CENTERED AROUND THE EARLY INTERVENTION/EARLY TO WORK CONCEPT. THROUGH EARLY INTERVENTION AND A VARIETY OF TREATMENT AND REHABILITATIVE MODALITIES, PATIENTS ARE ASSURED THE MOST EXPEDITIOUS RETURN TO WORK, THUS SAVING THE EMPLOYERS TREMENDOUS EXPENSE IN LOST PRODUCTIVITY, OVERTIME, TRAINING COSTS, ETC.POHCI PROVIDES PHYSICAL THERAPY ON-SITE AT THE CENTRAL LOCATION. POHCI HAS PARTNERED WITH PARKVIEW HOSPITALS PHYSICAL THERAPY DEPARTMENTS IN OTHER AREAS OF THE REGION. THE THERAPISTS ARE TRAINED IN REHABILITATION OF WORK RELATED INJURIES AND ARE SUPERVISED BY THE ORGANIZATION'S OCCUPATIONAL HEALTH PHYSICIANS. THE FOCUS OF THE THERAPIST IS TO RETURN THE INJURED WORKER TO THE JOB. DURING PHYSICAL THERAPY REHABILITATION, THE INJURED WORKER IS TAUGHT PROPER LIFTING TECHNIQUES TO AVOID RE-INJURY. THE OCCUPATIONAL THERAPY DEPARTMENT SPECIALIZES IN HAND REHABILITATION, UTILIZING VARIOUS EXERCISES AND SPLINTS THAT ASSIST IN EXPEDITING THE RECOVERY PROCESS.POHCI ALSO PROVIDES A COMPREHENSIVE WORK CONDITIONING PROGRAM, WHICH OPERATES WITHIN A WORK SIMULATION ENVIRONMENT, THUS ASSISTING THE INDIVIDUAL WITH BUILDING A PHYSICAL TOLERANCE LEVEL IN ORDER TO RETURN TO WORK IN A FULLY REHABILITATED CONDITION, IF AT ALL POSSIBLE.POHCI MEETS THE OCCUPATIONAL HEALTH CARE NEEDS OF NORTHEAST INDIANA AREA EMPLOYERS IN THE AREAS OF PREVENTION, TREATMENT, AND REHABILITATION. THESE SERVICES ARE DELIVERED WITH AN EMPHASIS ON COST CONTAINMENT THROUGH EARLY INTERVENTION AND EXPERT CASE MANAGEMENT.POHCI'S CLINICS ARE EQUIPPED TO CONDUCT INJURY CARE, PHYSICAL EXAMINATIONS, AND THE FOLLOWING ANCILLARY SERVICES: X-RAY, COLLECTION OF SPECIMENS FOR LABORATORY ANALYSIS, PULMONARY FUNCTION TESTING, AUDIOMETRY, ELECTROCARDIOGRAMS (EKG), AND VISION SCREENING.CERTAIN SERVICES ARE CONTRACTED IN THE TREATMENT COMPONENTS. HAND SURGERY, NEUROLOGY, PHYSIATRY, AND OPHTHALMOLOGY ARE ALL CONTRACTED WITH INDIVIDUAL PHYSICIANS AND/OR SPECIALTY GROUPS WHO PROVIDE THEIR SERVICES TO ASSURE STREAMLINED COMMUNICATION WITH THE PHYSICIAN AND THE EMPLOYER/INSURANCE CARRIER. THESE CONTRACTS REMUNERATE THESE SPECIALISTS ON A FEE FOR SERVICE BASIS.POHCI IS COMMITTED TO COST CONTAINMENT FOR ITS EMPLOYER CLIENTS AND/OR THEIR INSURANCE CARRIERS. SINCE THE ORGANIZATION SPECIALIZES IN OCCUPATIONAL HEALTH, APPROXIMATELY NINETY-NINE PERCENT (99%) OF THE FEES FOR ALL CASES ARE PAID EITHER THROUGH THE EMPLOYERS' WORKERS' COMPENSATION INSURANCE OR DIRECTLY BY THE EMPLOYERS. | Description |
| Total Program Service Expense | 7892193 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 0 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 0 | LobbyingActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 0 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 1 | ReportOtherAssets |
| Report Other Liabilities | 0 | ReportOtherLiabilities |
| Report Fin48 Footnote | 0 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 0 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 1 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 0 | Hospital |
| Grants To Organizations | 0 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 0 | TaxExemptBonds |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 0 | RelatedOrgControlledEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Info In Schedule O Part V | X | InfoInScheduleOPartV |
| Number Forms Transmitted With1096 | 4 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 107 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 0 | UnrelatedBusinessIncome |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 3 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 2 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 1 | MembersOrStockholders |
| Election Of Board Members | 1 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 1 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 1 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| States Where Copy Of Return Is Filed | IN | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MICHAEL P BROWNING | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 2603738407 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 10501 CORPORATE DRIVE | AddressLine1 |
| City | FORT WAYNE | City |
| State | IN | State |
| ZIP Code | 46845 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | X | InfoInScheduleOPartVII |
Form990 Part VII Section A Form990PartVIISectionA (9 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Average Hours Per Week RelatedAverageHoursPerWeekRelated | Individual Trustee Or DirectorIndividualTrusteeOrDirector | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | OfficerOfficer | Highest Compensated EmployeeHighestCompensatedEmployee | FormerFormer |
|---|---|---|---|---|---|---|---|---|---|
| LISA SCHANBACHER | |||||||||
| DIRECTOR/POHCI EXEC DIR | 28.00 | 12.00 | X | 138929 | 39981 | 54232 | |||
| MARJORIE HINER | |||||||||
| DIRECTOR | 1.00 | 1.00 | X | 250 | 1500 | 0 | |||
| DENISE LEMMON | |||||||||
| DIRECTOR | 1.00 | 2.00 | X | 250 | 1500 | 0 | |||
| MICHAEL PACKNETT | |||||||||
| DIRECTOR/PH CEO | 1.00 | 55.00 | 0 | 1149762 | 166973 | X | |||
| MICHAEL BROWNING | |||||||||
| PH SVP & CFO | 1.00 | 55.00 | 0 | 608926 | 75200 | X | |||
| GREGORY KNISS | |||||||||
| POHCI PHYSICIAN | 40.00 | 0.00 | 160430 | 0 | 37371 | X | |||
| HENRY GINDT | |||||||||
| POHCI PHYSICIAN | 40.00 | 0.00 | 112191 | 0 | 4652 | X | |||
| DIANE CASEY | |||||||||
| POHCI DIR OH | 40.00 | 0.00 | 109007 | 0 | 22526 | X | |||
| STANTON RISSER | |||||||||
| FORMER:OFFICER CURRENT:PH | 0.00 | 40.00 | 0 | 132531 | 27053 | X | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 521057 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 1934200 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 388007 | TotalOtherCompensation |
| Number Individuals GT100 K | 4 | NumberIndividualsGT100K |
| Formers Listed | 1 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
| Number Of Contractors GT100 K | 0 | NumberOfContractorsGT100K |
| All Other Contributions | 197 | AllOtherContributions |
| Total Contributions | 197 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (2 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| PATIENT SERVICE | 621400 | 9020938 | 9020938 |
| EMPLOYEE ASSISTANCE | 900099 | 677270 | 677270 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 9698208 | TotalProgramServiceRevenue |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 3443 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | -3443 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -3443 | TotalRevenueColumn |
| Exclusion | -$3,443 | ExclusionAmount |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 9694962 | TotalRevenueColumn |
| Related Or Exempt Function Income | 9698208 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | -$3,443 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | X | InfoInScheduleOPartIX |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 181042 | Total |
| Management And General | 181042 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3944830 | Total |
| Program Services | 3643018 | ProgramServices |
| Management And General | 301812 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1243265 | Total |
| Program Services | 1165353 | ProgramServices |
| Management And General | 77912 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1843221 | Total |
| Program Services | 1668207 | ProgramServices |
| Management And General | 175014 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 214 | Total |
| Program Services | 214 | ProgramServices |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 207672 | Total |
| Program Services | 182124 | ProgramServices |
| Management And General | 25548 | ManagementAndGeneral |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1550 | Total |
| Program Services | 600 | ProgramServices |
| Management And General | 950 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 574676 | Total |
| Program Services | 574390 | ProgramServices |
| Management And General | 286 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 71873 | Total |
| Program Services | 53034 | ProgramServices |
| Management And General | 18839 | ManagementAndGeneral |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 9779 | Total |
| Program Services | 7359 | ProgramServices |
| Management And General | 2420 | ManagementAndGeneral |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 36141 | Total |
| Program Services | 36141 | ProgramServices |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 51880 | Total |
| Program Services | 12097 | ProgramServices |
| Management And General | 39783 | ManagementAndGeneral |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| MEDICAL SUPPLIES | 470131 | 470131 | |
| BAD DEBT | 73649 | 73649 | |
| DUES & SUBSCRIPTIONS | 5621 | 5251 | 370 |
| MISCELLANEOUS | 1453 | 625 | 828 |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 8716997 | Total |
| Program Services | 7892193 | ProgramServices |
| Management And General | 824804 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 200 | BOY |
| EOY | 200 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 20769 | BOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1167421 | BOY |
| EOY | 1338018 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 29253 | BOY |
| EOY | 18918 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 1148310 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 994301 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 180916 | BOY |
| EOY | 154009 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 824439 | BOY |
| EOY | 1706273 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2222998 | BOY |
| EOY | 3217418 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 335172 | BOY |
| EOY | 348008 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 335172 | BOY |
| EOY | 348008 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1887826 | BOY |
| EOY | 2869410 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1887826 | BOY |
| EOY | 2869410 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2222998 | BOY |
| EOY | 3217418 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | 977965 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | 3619 | ReconcilationOtherChanges |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
FS Audited Basis FSAuditedBasis
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | 1 | AuditCommittee |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
| General Explanation | SCHEDULE A, PART IV, SUPPLEMENTAL INFORMATION: FORM 990, SCHEDULE A, PART 1, LINE 3: EXPLANATION OF CHARITY STATUS PURSUANT TO THE IRS DETERMINATION LETTER DATED SEPTEMBER 1, 1999, THE ORGANIZATION IS RECOGNIZED AS EXEMPT UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. THE ORGANIZATION IS DESCRIBED IN SECTION(S) 509(A)(1) AND 170(B(1)(A)(III) AS A HOSPITAL OR A COOPERATIVE HOSPITAL SERVICE ORGANIZATION. PARKVIEW OCCUPATIONAL HEALTH CENTER, INC.'S ORIGINAL APPLICATION FOR RECOGNITION OF EXEMPTION (FORM 1023) STATES THE FOLLOWING: "THE CORPORATION WILL NOT BE A HOSPITAL BUT WILL OPERATE OUTPATIENT CLINICS. THE CORPORATION OPERATES FOR THE PURPOSE OF TREATING WORKERS' COMPENSATION INJURIES AND ILLNESSES IN THE FORT WAYNE METROPOLITAN AREA. IT WILL NOT BE AN EMERGENCY ROOM AS FORMALLY DEFINED. IT WILL BE DESIGNED TO TREAT MINOR EMERGENCIES THAT OCCUR IN THE WORK PLACE THAT ARE COVERED UNDER WORKERS' COMPENSATION LAWS. AS AN AFFILIATE OF PARKVIEW HEALTH SYSTEMS, INC., ALL CHARITY PATIENTS WILL BE REFERRED AND TREATED WITHIN THE PARKVIEW SYSTEM IF SUCH PATIENTS SO CHOOSE." | GeneralExplanation |
Schedule D IRS990ScheduleD
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 19955 | OtherCostOrOtherBasis |
| Depreciation | 11539 | Depreciation |
| Book Value | 8416 | BookValue |
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 399829 | OtherCostOrOtherBasis |
| Depreciation | 389367 | Depreciation |
| Book Value | 10462 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 723322 | OtherCostOrOtherBasis |
| Depreciation | 590359 | Depreciation |
| Book Value | 132963 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 5204 | OtherCostOrOtherBasis |
| Depreciation | 3036 | Depreciation |
| Book Value | 2168 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 154009 | TotalOfBookValueLandBuildings |
Other Assets OtherAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | DUE TO/FROM INTERUNIT | Description |
| Book Value | 1706273 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | 1706273 | TotalBookValueOtherAssets |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 1 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 1 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (5 entries)
| TitleTitle | Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| LISA SCHANBACHER | ||||||||||||||
| DIRECTOR/POHCI EXEC DIR | 93288 | 39981 | 44593 | 0 | 1048 | 0 | 27177 | 7821 | 14936 | 4298 | 181042 | 52100 | 0 | 0 |
| MICHAEL PACKNETT | ||||||||||||||
| DIRECTOR/PH CEO | 0 | 740193 | 0 | 389731 | 0 | 19838 | 0 | 154794 | 0 | 12179 | 0 | 1316735 | 0 | 0 |
| MICHAEL BROWNING | ||||||||||||||
| PH SVP & CFO | 0 | 409616 | 0 | 181320 | 0 | 17990 | 0 | 51645 | 0 | 23555 | 0 | 684126 | 0 | 0 |
| GREGORY KNISS | ||||||||||||||
| POHCI PHYSICIAN | 158244 | 0 | 0 | 0 | 2186 | 0 | 19288 | 0 | 18083 | 0 | 197801 | 0 | 0 | 0 |
| STANTON RISSER | ||||||||||||||
| FORMER:OFFICER CURRENT:PH | 0 | 109732 | 0 | 22335 | 0 | 464 | 0 | 9419 | 0 | 17634 | 0 | 159584 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII (3 entries)
| Return ReferenceReturnReference | ExplanationExplanation |
|---|---|
| PART I, LINE 3 | RELATED ORGANIZATION, PARKVIEW HEALTH SYSTEM, INC., USES THE FOLLOWING TO ESTABLISH THE COMPENSATION OF PARKVIEW OCCUPATIONAL HEALTH CENTERS, 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 - NONE PARTICIPANTS DEFERRED - MICHAEL BROWNING $46,020; MICHAEL PACKNETT $137,294; LISA SCHANBACHER $15,929 |
| 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. |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (11 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| 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 PARKVIEW OCCUPATIONAL HEALTH CENTERS, 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: 1. THE BOARD OF DIRECTORS SHALL BE COMPRISED OF THREE (3) DIRECTORS. EACH DIRECTOR SHALL BE ELECTED BY THE SOLE MEMBER OF THE CORPORATION AT THE ANNUAL MEETING OF THE MEMBERSHIP. 2. THE CONFLICT OF INTEREST POLICY OF THE SOLE MEMBER OF THE CORPORATION, WHICH HAS BEEN APPROVED BY THE SYSTEM-WIDE CORPORATE COMPLIANCE COMMITTEE AND APPROVED BY THE SOLE MEMBER OF THE CORPORATION, SHALL APPLY TO THE CORPORATION. THIS CONFLICT OF INTEREST POLICY CAN ONLY BE AMENDED UPON THE APPROVAL OF THE BOARD OF DIRECTORS OF THE SOLE MEMBER OF THE CORPORATION. 3. IT SHALL BE THE GENERAL RULE THAT THE EMPLOYMENT OF IMMEDIATE FAMILY MEMBERS (MOTHER, FATHER, SISTER, BROTHER, SON, DAUGHTER OR SPOUSE) OF DIRECTORS AND EXECUTIVE MANAGEMENT STAFF SHALL BE PERMITTED AS AUTHORIZED BY THE PERSONNEL POLICIES OF THE CORPORATION AND THE SOLE MEMBER OF THE CORPORATION. | |
| 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. PARKVIEW OCCUPATIONAL HEALTH CENTERS, 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 9, 2013, 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. IN ADDITION, THE FOLLOWING CONSIDERATIONS SHOULD BE MADE: 4. IF APPROPRIATE, THE PH OR PH AFFILIATE BOARD OR BOARD COMMITTEE MAY APPOINT A DISINTERESTED PERSON OR COMMITTEE TO INVESTIGATE ALTERNATIVES TO THE PROPOSED TRANSACTION OR ARRANGEMENT; AND 5. IN ORDER TO APPROVE THE TRANSACTION, THE PH OR PH AFFILIATE BOARD OR BOARD COMMITTEE MUST FIRST FIND, BY A MAJORITY VOTE OF THE DISINTERESTED BOARD MEMBERS, THAT THE PROPOSED TRANSACTION OR ARRANGEMENT IS IN THE BEST INTERESTS OF AND FOR THE BENEFIT OF PH AND/OR PH AFFILIATES AND THE PROPOSED TRANSACTION IS FAIR AND REASONABLE TO PH AND/OR PH AFFILIATES AND, AFTER REASONABLE INVESTIGATION, THAT THE PH AND/OR PH AFFILIATES CANNOT OBTAIN A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT WITH REASONABLE EFFORTS UNDER THE CIRCUMSTANCES." | |
| FORM 990, PART VI, SECTION B, LINE 15 | 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 2012, THE BOARD OF PARKVIEW HEALTH SYSTEM, INC. REVIEWED AND APPROVED ALL EXECUTIVE COMPENSATION, BENEFITS AND PERQUISITES FOR THE 2012 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 2012 MEETING: PRESIDENT AND CHIEF EXECUTIVE OFFICER PRESIDENT PARKVIEW REGIONAL MEDICAL CENTER AND AFFILIATES PHYSICIAN EXECUTIVE OFFICER PARKVIEW PHYSICIANS GROUP SENIOR VICE PRESIDENT CHIEF FINANCIAL OFFICER SENIOR VICE PRESIDENT CHIEF INFORMATION OFFICER SENIOR VICE PRESIDENT COO COMMUNITY HOSPITAL SENIOR VICE PRESIDENT COO PARKVIEW PHYSICIANS GROUP 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 HUMAN RESOURCES 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 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 MEDICAL DIRECTOR COMMUNITY HOSPITAL MEDICAL DIRECTOR HEALTH PLAN SERVICES MEDICAL DIRECTOR PARKVIEW PHYSICIANS GROUP ASSOCIATE MEDICAL DIRECTOR EXECUTIVE DIRECTOR EMPLOYER STRATEGIES CHIEF ADMINISTRATIVE OFFICER CHIEF MEDICAL INFORMATICS OFFICER CORPORATE DIRECTOR MARKETING, COMMUNICATIONS, COMMUNITY RELATIONS | |
| 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 V, LINE 1A, 2A AND PART VII, SECTION B, LINE 2: | PARKVIEW HEALTH SYSTEM, INC. (PH), EIN 35-1972384, IS THE COMMON PAYING AGENT FOR THE FILING ORGANIZATION, PARKVIEW OCCUPATIONAL HEALTH CENTERS, INC., EIN 35-2064353. 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, 2012 WAS 475. THE TOTAL NUMBER OF EMPLOYEES REPORTED ON FORM W-3 AND FILED BY THE COMMON PAYING AGENT, PH, FOR THE YEAR ENDED DECEMBER 31, 2012 WAS 9,435. FOR PURPOSES OF COMPLETING FORM 990, PART V, LINE 1A AND 2A, THE NUMBER REPORTED FOR THE PARKVIEW OCCUPATIONAL HEALTH CENTERS, INC. WAS 4 AND 107 RESPECTIVELY. AS REFLECTED IN PART VII, SECTION B, NO INDEPENDENT CONTRACTORS RECEIVED MORE THAN $100,000 IN COMPENSATION FOR SERVICES FROM PARKVIEW OCCUPATIONAL HEALTH CENTERS, INC. | COMMON PAYING AGENT FOR FILING ORGANIZATION |
| FORM 990, PART IX, LINE 11G | ANCILLARY MEDICAL: PROGRAM SERVICE EXPENSES 917,083. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 917,083. LAB : PROGRAM SERVICE EXPENSES 524,252. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 524,252. PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 45,129. MANAGEMENT AND GENERAL EXPENSES 126,390. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 171,519. COLLECTION: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 29,284. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 29,284. OTHER: PROGRAM SERVICE EXPENSES 181,743. MANAGEMENT AND GENERAL EXPENSES 19,340. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 201,083. | OTHER FEES |
| 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. | SALARIES AND WAGES, OTHER EMPLOYEE BENEFITS AND PAYROLL TAXES |
| FORM 990, PART XI, LINE 9: | ASSET TRANSFERS/ADJUSTMENTS 3,619. | CHANGES IN NET ASSETS OR FUND BALANCES: |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (6 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Direct Controlling Entity NADirectControllingEntityNA | Controlled OrgControlledOrg | Business Name Line1DirectControllingEntityName/BusinessNameLine1 |
|---|---|---|---|---|---|---|---|---|---|---|---|
| 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 | |
| PARKVIEW HOSPITAL INC | |||||||||||
| 11109 PARKVIEW PLAZA DRIVE | FORT WAYNE | IN | 46845 | 350868085 | HOSPITAL CARE | IN | 501(C)(3) | LINE 3 | 0 | PARKVIEW HEALTH SYSTEM INC | |
| COMMUNITY HOSPITAL OF LAGRANGE COUNTY INC | |||||||||||
| 207 N TOWNLINE ROAD | LAGRANGE | IN | 46761 | 202401676 | HOSPITAL CARE | IN | 501(C)(3) | LINE 3 | 0 | PARKVIEW HEALTH SYSTEM INC | |
| 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 | |
| WHITLEY MEMORIAL HOSPITAL INC | |||||||||||
| 1260 EAST 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 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 0 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 0 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| Dividends Related Organization | 0 | DividendsRelatedOrganization |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 0 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 1 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 0 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 0 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 0 | SharingOfFacilities |
| Sharing Of Paid Employees | 0 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 0 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |
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