2013-11-11T09:08:41-06:00 2012-12-31 350921680 CROWE HORWATH LLP 330 E JEFFERSON BLVD P O BOX 7 SOUTH BEND IN 466240007 990 2012-01-01 351972384 PARKVIEW HEALTH SYSTEM INC PARK 2603738407 10501 CORPORATE DRIVE FORT WAYNE IN 46845 MICHAEL P BROWNING 2603738407 2013-11-11 1 KENNETH J KEBER P00240883 5742323992 2012 2016-02-24 21:20:13Z MICHAEL PACKNETT 10501 CORPORATE DRIVE FORT WAYNE IN 46845 711154937 0 X WWW.PARKVIEW.COM X 1995 IN PARKVIEW HEALTH SYSTEM, INC. WORKS TO IMPROVE THE HEALTH OF OUR COMMUNITIES AND PROVIDES QUALITY HEALTH SERVICES TO ALL WHO ENTRUST THEIR CARE TO US. 16 10 2797 23 1696576 -246376 115235 29971 280644128 318993582 10709491 19489993 -1366097 81715 290102757 338595261 1392161 3955121 0 0 209821417 211518223 0 0 0 114306580 153985020 325520158 369458364 -35417401 -30863103 1179955138 1205898438 828533839 742806076 351421299 463092362 X PARKVIEW HEALTH SYSTEM, INC. WORKS TO IMPROVE THE HEALTH OF OUR COMMUNITIES AND PROVIDES QUALITY HEALTH SERVICES TO ALL WHO ENTRUST THEIR CARE TO US. 0 0 357508188 3955121 317072271 PARKVIEW HEALTH SYSTEM, INC. SUPPORTS THE FOLLOWING HOSPITALS: PARKVIEW HOSPITAL, INC.; HUNTINGTON MEMORIAL HOSPITAL, INC.; COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC.; COMMUNITY HOSPITAL OF NOBLE COUNTY, INC.; AND WHITLEY MEMORIAL HOSPITAL, INC. IN ADDITION, PARKVIEW HEALTH SYSTEM, INC. IS A 60% OWNER IN THE PARTNERSHIP OF THE ORTHOPAEDIC HOSPITAL AT PARKVIEW NORTH, LLC. IMPROVING THE HEALTH OF THE COMMUNITY IS A FUNDAMENTAL PART OF PARKVIEW HEALTH SYSTEM, INC.'S MISSION. AS A NOT-FOR-PROFIT, COMMUNITY-BASED ORGANIZATION, PARKVIEW HEALTH SYSTEM, INC. REINVESTS ITS FUNDS AND OTHER RESOURCES IN COMMUNITY SERVICES AND HOSPITAL PROGRAMS DESIGNED TO IMPROVE THE HEALTH AND WELL-BEING OF RESIDENTS IN THE AREAS WHERE PARKVIEW HEALTH SYSTEM, INC. HOSPITALS ARE LOCATED.TO GUIDE US IN THIS ENDEAVOR, PARKVIEW HEALTH SYSTEM, INC. ROUTINELY SPONSORS A COMMUNITY HEALTH NEEDS ASSESSMENT. IN ADDITION, PARKVIEW HEALTH SYSTEM, INC. REVIEWS TREND AND TREATMENT ANALYSIS DATA ON AN ONGOING BASIS. DATA OBTAINED FROM THESE STUDIES ARE USED IN PARKVIEW HEALTH SYSTEM, INC.'S STRATEGIC PLANNING PROCESS TO IDENTIFY AND SET PRIORITIES FOR CRITICAL HEALTH INITIATIVES IN THE COMMUNITIES PARKVIEW HEALTH SYSTEM, INC. SERVES.PARKVIEW HEALTH SYSTEM, INC. EMPLOYS 298 PRIMARY AND SPECIALTY CARE PHYSICIANS AS PART OF PARKVIEW PHYSICIANS' GROUP. THESE PHYSICIANS, ALONG WITH 49 NON-PHYSICIAN PROVIDERS, PROVIDE CARE TO RESIDENTS THROUGHOUT NORTHEAST INDIANA AND NORTHWEST OHIO REGARDLESS OF THEIR ABILITY TO PAY FOR THOSE SERVICES. PARKVIEW HEALTH EMPLOYS TWO FULL TIME PHYSICIAN RECRUITERS WHOSE TIME IS DEVOTED SOLELY TO RECRUITING PHYSICIANS. ALL PHYSICIAN RECRUITMENT ACTIVITY IS BASED ON A PHYSICIAN NEEDS ASSESSMENT AND THE OVERSIGHT OF THE COMPLIANCE COMMITTEE OF THE BOARD OF DIRECTORS TO ENSURE THAT WE FOLLOW THE GUIDELINES SET FORTH BY THE FEDERAL GOVERNMENT. ON AVERAGE, 25 TO 40 NEW PHYSICIANS ARE RECRUITED EACH YEAR.PARKVIEW HEALTH SYSTEM, INC. PROVIDES SIGNIFICANT FUNDING TO LOCAL UNIVERSITIES TO PROMOTE AND SUPPORT THEIR NURSING PROGRAMS FOR THE EDUCATION AND DEVELOPMENT OF STUDENTS FOR THE NURSING PROFESSION. PARKVIEW HEALTH SYSTEM, INC. HAS PARTNERSHIPS WITH THE NURSING DEPARTMENTS AT INDIANA UNIVERSITY/ PURDUE UNIVERSITY FORT WAYNE AND THE UNIVERSITY OF SAINT FRANCIS TO PROVIDE FINANCIAL ASSISTANCE FOR SCHOLARSHIPS AS WELL AS OPERATIONAL, CAPITAL, AND MARKETING SUPPORT. IN ADDITION, PARKVIEW HEALTH SYSTEM, INC. IS A SIGNIFICANT CONTRIBUTOR TO THE NORTHEAST INDIANA ECONOMIC DEVELOPMENT COUNCIL TO PROMOTE THE ECONOMIC VITALITY OF THIS AREA. PARKVIEW HEALTH SYSTEM, INC. HAS PLAYED A KEY ROLE IN THE REGION'S VISION 20/20 INITIATIVE GEARED TOWARD THE DEVELOPMENT OF STRATEGIES IMPERATIVE TO THE REGION'S FUTURE ECONOMIC GROWTH AND VITALITY. 357508188 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 1 1 0 0 1 X 260 0 1 2797 1 1 1 1 DA IT NO SW SZ BR GR HU ID MY PL PO SF 0 0 0 0 0 0 0 0 0 X 16 10 0 0 1 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 1 IN X MICHAEL P BROWNING 2603738407 10501 CORPORATE DRIVE FORT WAYNE IN 46845 X MICHAEL PACKNETT 40.00 16.00 X X 1149762 0 166973 RAYMOND DUSMAN 40.00 0.00 X 720414 0 46574 DUANE HOUGENDOBLER 40.00 0.00 X 705100 0 50958 MITCHELL STUCKY 40.00 0.00 X 387589 0 81581 MICHAEL AXEL 1.00 1.00 X 2500 6750 0 JANET CHRZAN 1.00 0.00 X 8500 0 0 BRIAN EMERICK 1.00 1.00 X 2250 6250 0 DAVID HAIST 1.00 1.00 X 1500 3000 0 THOMAS KARST 1.00 1.00 X 1750 6250 0 THOMAS KIMBROUGH 1.00 1.00 X 1000 6000 0 MICHAEL LEE 1.00 0.00 X 5500 0 0 JOHN PRICE 1.00 1.00 X 3250 6750 0 LARRY ROWLAND 40.00 4.00 X 330750 0 0 CHARLES SCHRIMPER 1.00 0.00 X 10250 0 0 WIL SMITH 1.00 1.00 X 3000 3750 0 THOMAS WALSH 1.00 0.00 X 8500 0 0 MICHAEL BROWNING 40.00 16.00 X 608926 0 75200 JEFFREY BROOKES 1.00 40.00 X 109049 265960 57011 CATHERINE WILCOX 40.00 0.00 X 389791 0 61955 JAMES STAPEL 40.00 0.00 X 378771 0 77363 RONALD DOUBLE 40.00 0.00 X 359906 0 66731 DEBRA WILLIAMS 40.00 0.00 X 343690 0 48962 RICK HENVEY 40.00 0.00 X 372812 0 57266 JILL OSTREM 40.00 0.00 X 307952 0 52103 RAMESH BHAT 40.00 1.00 X 852989 48558 39498 SAILAJA BLACKMON 40.00 0.00 X 866695 0 43574 DAVID SCHLEINKOFER 40.00 0.00 X 740661 0 47874 DAVID CLARK 40.00 0.00 X 766553 0 31998 EDWARD SCHULTZ 40.00 0.00 X 770871 0 36727 STANTON RISSER 40.00 0.00 X 132531 0 27053 JAMES HAUGUEL 40.00 0.00 X 255674 0 44455 JAMES WITMER 40.00 0.00 X 271376 0 51216 10869862 353268 1165072 318 1 1 0 MAXIT HEALTHCARE LLC P O BOX 2589 FORT WAYNE IN 46801 CONSULTANTS 1300131 MCGLADREY & PULLEN LLP 5155 PAYSPHERE CIRCLE CHICAGO IL 60674 CONSULTANTS 691202 ERNST & YOUNG US LLP P O BOX 96550 CHICAGO IL 60693 CPA FIRM 499097 PROPHET ONE SOLUTIONS LLC 101 WEST 103RD STREET INDIANAPOLIS IN 46290 CONSULTANTS 456993 TM TRANSCRIPTION SERVICE 3377 S 250 W ALBION IN 46701 TRANSCRIPTION 358396 21 29971 29971 CORP SER ALLOCATION 561000 118307357 118307357 NET PATIENT SERVICE 621110 114630942 114630942 PH SUBSIDY 561499 45704420 45704420 ORTHOPAEDIC HOSPITAL AT PARKVIEW 621110 18628187 18628187 INTERUNIT RENT 532000 9160214 9160214 12562462 10445566 2116896 318993582 5858063 5858063 183522 183522 1969410 2545212 -575802 -575802 -420320 -155482 381151613 2311259 368178000 1836464 12973613 474795 13448408 13448408 CAFETERIA REVENUE 722100 461932 461932 MISCELLANEOUS 900099 195585 195585 657517 338595261 317072271 1696576 19796443 X 3955121 3955121 7014756 7014756 169731719 169731719 7524391 7524391 27247357 27247357 868379 868379 580000 580000 72414 72414 992517 992517 19388879 17644421 1744458 3091308 3070620 20688 9386496 8717027 669469 27667858 27667858 12781153 12778726 2427 976816 779911 196905 579936 438282 141654 20781963 20781963 24511645 24500231 11414 2323179 2304886 18293 UBI TAXES & REFUNDS -403406 -403406 BAD DEBT 10338698 10338698 BOND REFINANCING LOSS 6862635 6862635 MEDICAL SUPPLIES 6474694 6474694 6709856 5572261 1137595 369458364 357508188 11950176 0 23508 23875 16833579 63864294 19503014 14819898 12758705 13970305 1832224 3287295 10431936 11872934 473820458 190112808 732724616 283707650 337456836 274629166 31667444 27259916 12917337 29672921 3805939 482790184 1179955138 1205898438 88546682 75051612 146512 812547 569215990 565540203 15137891 21158136 155486764 80243578 828533839 742806076 X 351421299 463092362 351421299 463092362 1179955138 1205898438 X -30863103 15735566 126798600 X 0 1 X 1 0 X X X 0 0 0 PARKVIEW HOSPITAL INC 350868085 3 1 1 1 90582136 HUNTINGTON MEMORIAL HOSPITAL INC 351970706 3 1 1 1 7371000 WHITLEY MEMORIAL HOSPITAL INC 351967665 3 1 1 1 6420000 COMMUNITY HOSPITAL OF NOBLE COUNTY INC 352089183 3 1 1 1 7686000 COMMUNITY HOSPITAL OF LAGRANGE COUNTY INC 202401676 3 1 1 1 4776000 5 116835136 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 1 72414 0 1 2700 75114 0 EXPLANATION OF LOBBYING ACTIVITIES: PART II-B, LINE 1: A PORTION OF THE DUES PAID TO REGIONAL CHAMBER OF NORTHEAST INDIANA WERE USED FOR LOBBYING ACTIVITIES. 19940440 26268469 46208909 170913954 47175264 123738690 8037800 3012739 5025061 229481811 133733247 95748564 19177984 6191558 12986426 283707650 DUE TO/FROM INTERUNIT 479100668 PREPAID FINANCING COSTS 2742944 MISCELLANEOUS 946572 482790184 ACC RETIREMENTS COST 69946772 RESERVE FOR SIGNATURE CARE 4959158 RESERVE FOR MALPRACTICE 5259971 MISCELLANEOUS 77677 80243578 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 TRANSFER OF PROPERTY TO A FOREIGN CORPORATION: FORM 990, PART IV, LINE 1: PARKVIEW HEALTH SYSTEM, INC. OWNS AN INTEREST IN A DOMESTIC PARTNERSHIP THAT TRANSFERRED CASH TO FOREIGN CORPORATIONS DURING THE REPORTING PERIOD. PARKVIEW HEALTH SYSTEM, INC. HAS FILED ALL REQUIRED FORMS 926 AS PROVIDED IN THE FOOTNOTES TO THE PARTNERSHIP SCHEDULE K-1. THEREFORE, PART IV, LINE 1 HAS BEEN ANSWERED AS "YES" TO REFLECT TRANSACTIONS NOTED. 1 1 X 1 X 0 1 1 1 0 0 49880 49880 0.00010 1659322 843672 815650 0.00230 577495 182765 394730 0.00110 2286697 1026437 1260260 0.00350 145427 3500 141927 0.00040 415125 415125 0.00120 1893690 1893690 0.00530 2454242 3500 2450742 0.00690 4740939 1029937 3711002 0.01040 869739 869739 0.00240 1223334 1223334 0.00340 953784 953784 0.00270 3046857 3046857 0.00850 1 10763238 30615 5120851 7018504 -1897653 X 1 1 1 IMAGING SERVICES HOLDING COMPANY LLC HOLDING COMPANY 0.50000 0.50000 2 ORTHOPAEDIC HOSPITAL AT PARKVIEW NORTH LLC ORTHOPAEDIC HOSPITAL 0.60000 0.40000 3 PREMIER SURGERY CENTER LLC SURGERY CENTER 0.50000 0.50000 1 1 ORTHOPAEDIC HOSPITAL AT PARKVIEW NORTH

11119 PARKVIEW PLAZA DRIVE FORT WAYNE IN 46845

X X X ORTHOPAEDIC HOSPITAL AT PARKVIEW NORTH 1 1 1 200.000000000000 0 0 1 1 X 1 0 1 X 0 0 90 PARKVIEW PHYSICIANS GROUP

11108 PARKVIEW CIRCLE FORT WAYNE IN 46845

PHYSICIAN OFFICE PARKVIEW PHYSICIANS GROUP

3909 NEW VISION DRIVE FORT WAYNE IN 46845

PHYSICIAN OFFICE PARKVIEW PHYSICIANS GROUP

11123 PARKVIEW PLAZA DR SUITE 101 FORT WAYNE IN 46845

PHYSICIAN OFFICE PARKVIEW PHYSICIANS GROUP

1515 HOBSON ROAD FORT WAYNE IN 46805

PHYSICIAN OFFICE PARKVIEW PHYSICIANS GROUP

11141 PARKVIEW PLAZA DR SUITE 320 FORT WAYNE IN 46845

PHYSICIAN OFFICE PREMIER SURGERY CENTER LLC

1333 MAYCREST DRIVE FORT WAYNE IN 46805

SURGERY CENTER PARKVIEW PHYSICIANS GROUP

104 NICHOLAS PLACE AVILLA IN 46710

PHYSICIAN OFFICE PARKVIEW PHYSICIANS GROUP

1331 MINNICH ROAD NEW HAVEN IN 46774

PHYSICIAN OFFICE PARKVIEW PHYSICIANS GROUP

1270 EAST STATE ROAD 205 SUITE 210 COLUMBIA CITY IN 46725

PHYSICIAN OFFICE PARKVIEW PHYSICIANS GROUP

2710 LAKE AVENUE FORT WAYNE IN 46805

PHYSICIAN OFFICE FOUNDATION SURGERY AFF OF FT WAYNE LLC

8004 CARNEGIE BLVD FORT WAYNE IN 46804

SURGERY CENTER PARKVIEW PHYSICIANS GROUP

2708 GUILFORD STREET HUNTINGTON IN 46750

PHYSICIAN OFFICE PARKVIEW PHYSICIANS GROUP

11123 PARKVIEW PLAZA DR SUITE 106 FORT WAYNE IN 46845

PHYSICIAN OFFICE PARKVIEW PHYSICIANS GROUP

11104 PARKVIEW CIRCLE SUITE 320 FORT WAYNE IN 46845

PHYSICIAN OFFICE PARKVIEW PHYSICIANS GROUP

326 SAWYER ROAD KENDALLVILLE IN 46755

PHYSICIAN OFFICE PARKVIEW PHYSICIANS GROUP

1720 BEACON ST FORT WAYNE IN 46805

PHYSICIAN OFFICE IMAGING SYSTEMS HOLDINGS LLC

3707 NEW VISION DRIVE FORT WAYNE IN 46845

IMAGING SERVICES PARKVIEW PHYSICIANS GROUP

10515 ILLINOIS ROAD FORT WAYNE IN 46814

PHYSICIAN OFFICE PARKVIEW PHYSICIANS GROUP

2003 STULTS ROAD SUITE 100 HUNTINGTON IN 46750

PHYSICIAN OFFICE PARKVIEW PHYSICIANS GROUP

6130 TRIER ROAD FORT WAYNE IN 46815

PHYSICIAN OFFICE PARKVIEW PHYSICIANS GROUP

1818 CAREW ST SUITE 260 FORT WAYNE IN 46805

PHYSICIAN OFFICE PARKVIEW PHYSICIANS GROUP

4665 STATE ROAD 5 SOUTH WHITLEY IN 46787

PHYSICIAN OFFICE PARKVIEW PHYSICIANS GROUP

5104 N CLINTON FORT WAYNE IN 46825

PHYSICIAN OFFICE PARKVIEW PHYSICIANS GROUP

11104 PARKVIEW CIRCLE DRIVE SUITE 310 FORT WAYNE IN 46845

PHYSICIAN OFFICE PARKVIEW PHYSICIANS GROUP

2003 STULTS ROAD SUITE 105 HUNTINGTON IN 46750

PHYSICIAN OFFICE PARKVIEW PHYSICIANS GROUP

6108 MAPLECREST ROAD FORT WAYNE IN 46835

PHYSICIAN OFFICE PARKVIEW PHYSICIANS GROUP

207 N TOWNLINE ROAD SUITE 104 LAGRANGE IN 46761

PHYSICIAN OFFICE PARKVIEW PHYSICIANS GROUP

2402 LAKE AVENUE FORT WAYNE IN 46805

PHYSICIAN OFFICE PARKVIEW PHYSICIANS GROUP

15707 OLD LIMA RD HUNTERTOWN IN 46748

PHYSICIAN OFFICE PARKVIEW PHYSICIANS GROUP

13430 MAIN ST GRABILL IN 46741

PHYSICIAN OFFICE PARKVIEW PHYSICIANS GROUP

1464 LINCOLNWAY SOUTH LIGONIER IN 46767

PHYSICIAN OFFICE PARKVIEW PHYSICIANS GROUP

885 W CONNEXION WAY SUITE 200A COLUMBIA CITY IN 46725

PHYSICIAN OFFICE PARKVIEW PHYSICIANS GROUP

1270 EAST STATE ROAD 205 SUITE 150 COLUMBIA CITY IN 46725

PHYSICIAN OFFICE PARKVIEW PHYSICIANS GROUP

3030 LAKE AVENUE SUITE 27 FORT WAYNE IN 46805

PHYSICIAN OFFICE PARKVIEW PHYSICIANS GROUP

1316 EAST 7TH STREET SUITE 3 AUBURN IN 46706

PHYSICIAN OFFICE PARKVIEW PHYSICIANS GROUP

1314 EAST 7TH STREET SUITE 103 AUBURN IN 46706

PHYSICIAN OFFICE NORTHEAST INDIANA CANCER CENTER LLC

516 E MAUMEE STREET ANGOLA IN 46703

MEDICAL SERVICES PARKVIEW PHYSICIANS GROUP

1270 EAST STATE ROAD 205 SUITE 240 COLUMBIA CITY IN 46725

PHYSICIAN OFFICE PARKVIEW PHYSICIANS GROUP

1844 IDA RED ROAD KENDALLVILLE IN 46755

PHYSICIAN OFFICE PARKVIEW PHYSICIANS GROUP

2231 CAREW ST FORT WAYNE IN 46805

PHYSICIAN OFFICE PARKVIEW PHYSICIANS GROUP

2500 E BELLEFONTAINE RD HAMILTON IN 46742

PHYSICIAN OFFICE PARKVIEW PHYSICIANS GROUP

2600 N DETROIT ST SR 9 LAGRANGE IN 46761

PHYSICIAN OFFICE PARKVIEW PHYSICIANS GROUP

11108 PARKVIEW CIRCLE SUITE 5100 FORT WAYNE IN 46845

PHYSICIAN OFFICE PARKVIEW PHYSICIANS GROUP

US HWY 30 WEST 5 MATCHETT DR PIERCETON IN 46562

PHYSICIAN OFFICE PARKVIEW PHYSICIANS GROUP

8028 CARNEGIE BLVD SUITE 600 FORT WAYNE IN 46804

PHYSICIAN OFFICE PARKVIEW PHYSICIANS GROUP

2003 STULTS ROAD SUITE 210 HUNTINGTON IN 46750

PHYSICIAN OFFICE PARKVIEW PHYSICIANS GROUP

11123 PARKVIEW PLAZA DR SUITE 204 FORT WAYNE IN 46845

PHYSICIAN OFFICE PARKVIEW PHYSICIANS GROUP

8175 WEST US 20 SHIPSHEWANA IN 46565

PHYSICIAN OFFICE PARKVIEW PHYSICIANS GROUP

2300 DUBOIS DR WARSAW IN 46580

PHYSICIAN OFFICE PARKVIEW PHYSICIANS GROUP

11104 PARKVIEW CIRCLE SUITE 410 FORT WAYNE IN 46845

PHYSICIAN OFFICE PARKVIEW PHYSICIANS GROUP

4084 NORTH US HWY 33 CHURUBUSCO IN 46723

PHYSICIAN OFFICE PARKVIEW PHYSICIANS GROUP

11141 PARKVIEW PLAZA DRIVE SUITE 310 FORT WAYNE IN 46845

PHYSICIAN OFFICE PARKVIEW PHYSICIANS GROUP

4666 W JEFFERSON BLVD SUITE 140 FORT WAYNE IN 46804

PHYSICIAN OFFICE PARKVIEW PHYSICIANS GROUP

3217 LAKE AVENUE FORT WAYNE IN 46805

PHYSICIAN OFFICE PARKVIEW PHYSICIANS GROUP

817 TRAIL RIDGE ROAD ALBION IN 46701

PHYSICIAN OFFICE PARKVIEW PHYSICIANS GROUP

420 SAWYER ROAD PO BOX 99 KENDALLVILLE IN 46755

PHYSICIAN OFFICE PARKVIEW PHYSICIANS GROUP

2510 E DUPONT ROAD SUITE 200 FORT WAYNE IN 46825

PHYSICIAN OFFICE PARKVIEW PHYSICIANS GROUP

301 E MAUMEE ST ANGOLA IN 46703

PHYSICIAN OFFICE PARKVIEW PHYSICIANS GROUP

1270 EAST STATE ROAD 205 SUITE 140 COLUMBIA CITY IN 46725

PHYSICIAN OFFICE PARKVIEW PHYSICIANS GROUP

577 GEIGER DRIVE SUITE C ROANOKE IN 46783

PHYSICIAN OFFICE PARKVIEW PHYSICIANS GROUP

8028 CARNEGIE BLVD SUITE 400 FORT WAYNE IN 46804

PHYSICIAN OFFICE PARKVIEW PHYSICIANS GROUP

512 NORTH PROFESSIONAL WAY KENDALLVILLE IN 46755

PHYSICIAN OFFICE PARKVIEW PHYSICIANS GROUP

306 E MAUMEE ST SUITE 2 ANGOLA IN 46703

PHYSICIAN OFFICE PARKVIEW PHYSICIANS GROUP

1818 CAREW ST SUITE 240 FORT WAYNE IN 46805

PHYSICIAN OFFICE PARKVIEW PHYSICIANS GROUP

714 W HARCOURT ROAD ANGOLA IN 46703

PHYSICIAN OFFICE PARKVIEW PHYSICIANS GROUP

2003 STULTS ROAD SUITE 215 HUNTINGTON IN 46750

PHYSICIAN OFFICE PARKVIEW PHYSICIANS GROUP

306 E MAUMEE ST SUITE 8 ANGOLA IN 46703

PHYSICIAN OFFICE PARKVIEW PHYSICIANS GROUP

3303 TRIER ROAD SUITE 1 FORT WAYNE IN 46815

PHYSICIAN OFFICE PARKVIEW PHYSICIANS GROUP

1818 CAREW STREET SUITE 260 FORT WAYNE IN 46805

PHYSICIAN OFFICE PARKVIEW PHYSICIANS GROUP

410 EAST MITCHELL STREET KENDALLVILLE IN 46755

PHYSICIAN OFFICE PARKVIEW PHYSICIANS GROUP

3974 NEW VISION DRIVE FORT WAYNE IN 46845

PHYSICIAN OFFICE PARKVIEW PHYSICIANS GROUP

11123 PARKVIEW PLAZA DR SUITE 102 FORT WAYNE IN 46845

PHYSICIAN OFFICE PARKVIEW PHYSICIANS GROUP

344 N MAIN STREET COLUMBIA CITY IN 46725

PHYSICIAN OFFICE PARKVIEW PHYSICIANS GROUP

401 SAWYER ROAD SUITE B KENDALLVILLE IN 46755

PHYSICIAN OFFICE PARKVIEW PHYSICIANS GROUP

1270 EAST STATE ROAD 205 SUITE 120 COLUMBIA CITY IN 46725

PHYSICIAN OFFICE PARKVIEW PHYSICIANS GROUP

8607 TEMPLE DR FORT WAYNE IN 46809

PHYSICIAN OFFICE PARKVIEW PHYSICIANS GROUP

207 N TOWNLINE ROAD SUITE 101 LAGRANGE IN 46761

PHYSICIAN OFFICE PARKVIEW PHYSICIANS GROUP

213 FAIRVIEW BLVD KENDALLVILLE IN 46755

PHYSICIAN OFFICE PARKVIEW PHYSICIANS GROUP

112 SOUTH MAIN STREET MILFORD IN 46542

PHYSICIAN OFFICE PARKVIEW PHYSICIANS GROUP

11123 PARKVIEW PLAZA DR SUITE 203 FORT WAYNE IN 46845

PHYSICIAN OFFICE PARKVIEW PHYSICIANS GROUP

11141 PARKVIEW PLAZA DR SUITE 210 FORT WAYNE IN 46845

PHYSICIAN OFFICE PARKVIEW PHYSICIANS GROUP

207 NORTH TOWNLINE ROAD LAGRANGE IN 46761

PHYSICIAN OFFICE PARKVIEW PHYSICIANS GROUP

4084 NORTH US HWY 33 CHURUBUSCO IN 46723

PHYSICIAN OFFICE PARKVIEW PHYSICIANS GROUP

1818 CAREW STREET SUITE 260 SUITE 260 FORT WAYNE IN 46805

PHYSICIAN OFFICE PARKVIEW PHYSICIANS GROUP

11115 PARKVIEW PLAZA DR FORT WAYNE IN 46845

PHYSICIAN OFFICE PARKVIEW PHYSICIANS GROUP

1234 E DUPONT ROAD SUITE 5 FORT WAYNE IN 46825

PHYSICIAN OFFICE PARKVIEW PHYSICIANS GROUP

306 E MAUMEE ST SUITE 1 ANGOLA IN 46703

PHYSICIAN OFFICE PARKVIEW PHYSICIANS GROUP

442 WEST HIGH STREET BRYAN OH 43506

PHYSICIAN OFFICE PARKVIEW PHYSICIANS GROUP

121 WESTFIELD DRIVE ARCHBOLD OH 43502

PHYSICIAN OFFICE PARKVIEW PHYSICIANS GROUP

11109 PARKVIEW PLAZA DR FORT WAYNE IN 46845

PHYSICIAN OFFICE PART I, LINE 3C: ELIGIBILITY CRITERIA FOR FREE OR DISCOUNTED CAREPARKVIEW HEALTH SYSTEM, 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 7APARKVIEW HEALTH SYSTEM, INC. IS COMMITTED TO PROVIDING CHARITY CARE TO PATIENTS UNABLE TO MEET THEIR FINANCIAL OBLIGATIONS. IT IS FURTHERMORE THE POLICY OF PARKVIEW HEALTH SYSTEM, 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 7BPARKVIEW HEALTH SYSTEM, 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 7CPARKVIEW HEALTH SYSTEM, INC. ACCEPTS ALL CERTAIN 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, PARKVIEW HEALTH SYSTEM, 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 PARKVIEW HEALTH SYSTEM, INC. INCLUDED NO COSTS ATTRIBUTABLE TO A PHYSICIAN CLINIC AS SUBSIDIZED HEALTH SERVICES. PART I, L7 COL(F): PERCENT OF TOTAL EXPENSESPARKVIEW HEALTH SYSTEM, INC. EXCLUDED $10,338,698 OF BAD DEBT EXPENSE. PART II: DESCRIBE HOW THE ORGANIZATION'S COMMUNITY BUILDING ACTIVITIES, AS REPORTED, PROMOTE THE HEALTH OF THE COMMUNITIES THE ORGANIZATION SERVES.PARKVIEW HEALTH SYSTEM, INC. HAS A STRONG COMMITMENT TO THE VITALITY OF THE LOCAL COMMUNITY AND TO THE NORTHEAST INDIANA REGION AND INVESTS IN ENHANCING VARIOUS ASPECTS OF THE COMMUNITY THAT CONTRIBUTE TO IMPROVED HEALTH OF THE COMMUNITY. PHYSICIAN RECRUITMENT:PARKVIEW HEALTH SYSTEM, INC. SUPPORTS PHYSICIAN RECRUITMENT ACTIVITIES TO ASSIST IN TIMELY RESPONSE TO PATIENT CARE NEEDS IN THE COMMUNITY. THESE RECRUITMENT ACTIVITIES ARE BASED ON THE RESULTS OF A PERIODIC PHYSICIAN NEEDS ASSESSMENT. PARKVIEW HEALTH SYSTEM, INC. DEVELOPS A PHYSICIAN RECRUITMENT PLAN TO ADDRESS POTENTIAL GAPS IN PATIENT COVERAGE. PARKVIEW HEALTH SYSTEM, INC. STRIVES TO BRING THE BEST INTEGRATED, QUALITY, AND COST EFFECTIVE CARE AND INNOVATIVE TECHNOLOGY TO OUR COMMUNITIES. IN DOING SO, WE FOCUS OUR EFFORTS ON RECRUITING AN EXCEPTIONAL TEAM OF PHYSICIANS. EVERY MEMBER OF PARKVIEW HEALTH SYSTEM, 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 PARKVIEW HEALTH SYSTEM, INC., AND WE RECOGNIZE HOW IMPORTANT OUR SUCCESS IS TO THE COMMUNITY.PHYSICAL IMPROVEMENTS:THE PARKVIEW NORTH FAMILY PARK IS A RECREATIONAL PARK AREA OPEN TO THE PUBLIC AND LOCATED ON THE NORTH CAMPUS, WHICH IS THE HOME OF THE NEW PARKVIEW REGIONAL MEDICAL CENTER (OPENED IN MARCH, 2012). PARKVIEW HEALTH SYSTEM, INC. MAKES THE PARK AVAILABLE TO THE GENERAL PUBLIC AND MAINTAINS THE PROPERTY TO ENHANCE THE COMMUNITY AND PROMOTE PHYSICAL ACTIVITY.ECONOMIC DEVELOPMENT:PARKVIEW HEALTH SYSTEM, INC. FOSTERS ECONOMIC DEVELOPMENT IN SEVERAL WAYS. PARKVIEW HEALTH SYSTEM, INC. HAS PLAYED A KEY ROLE IN THE NORTHEAST INDIANA REGIONAL MARKETING PARTNERSHIP'S "NEI=ROI" CAMPAIGN TO MARKET NORTHEAST INDIANA ON A GLOBAL BASIS. PARKVIEW HEALTH SYSTEM, INC. MADE A MULTI-YEAR PLEDGE TO THE CAMPAIGN AND ISSUED AN ANNUAL CHALLENGE FOR MATCHING FUNDS FROM AREA BUSINESSES. THE "VISION 20/20" INITIATIVE (DISCUSSED IN LINE 4), DESIGNED TO ENGAGE ALL CITIZENS IN THE DEVELOPMENT OF THE REGION, IS AN EXTENSION OF THE NORTHEAST INDIANA REGIONAL MARKETING PARTNERSHIP EFFORTS. MIKE PACKNETT, PRESIDENT AND CEO OF PARKVIEW HEALTH, SERVES AS CO-CHAIR OF THE VISION 20/20 INITIATIVE, LEADING A GROUP OF COMMUNITY REPRESENTATIVES FROM ACROSS BUSINESS, EDUCATION, GOVERNMENT AND FOUNDATION SECTORS TO DEVELOP A COMPELLING AND ACTIONABLE VISION FOR THE TEN-COUNTY NORTHEAST INDIANA REGION. COMPLETION OF THE FIRST PHASE OF VISION 20/20 HAS REVEALED A CLEAR, UNIFYING VISION FOR THE FUTURE, SHARED REGIONAL PRIORITIES AND ACCOUNTABILITY, PLANS WITH SPECIFIC STRATEGIES AND TACTICS, AND AN ATTITUDE OF PASSION AND URGENCY TO SEE THE VISION TO ACTION. VISION 20/20 ANNOUNCED PRIORITIES TIED TO EDUCATION, BUSINESS CLIMATE, ENTREPRENEURSHIP AND INFRASTRUCTURE FOR THE TEN-COUNTY REGION IN NORTHEAST INDIANA. THE SOCIAL DETERMINANTS OF HEALTH AND COMMUNITY HEALTH STATUS ARE AN IMPORTANT COMPONENT OF THE VISION. IN ADDITION, PARKVIEW HEALTH SYSTEM, INC. CONTINUES TO SUPPORT THE REGIONAL CHAMBER OF NORTHEAST INDIANA. MULTI-YEAR SUPPORT IS PROVIDED TO THE FORT WAYNE REDEVELOPMENT COMMISSION FOR A LOCAL BASEBALL STADIUM LOCATED IN DOWNTOWN FORT WAYNE AS PART OF AN EFFORT TO BRING RENEWED ECONOMIC VITALITY TO THE DOWNTOWN AREA AND THEREBY ENHANCING THE COMMUNITY AS A WHOLE. THE BASEBALL FIELD IS THE CENTERPIECE OF OTHER SIGNIFICANT PROJECTS TOWARD THE GOAL OF DOWNTOWN REVITALIZATION. IN ADDITION, IT SERVES AS A VENUE FOR PROVIDING PREVENTATIVE HEALTH AND SAFETY EDUCATION TO THE COMMUNITY. WORKFORCE DEVELOPMENT:PARKVIEW HEALTH SYSTEM, 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. PARKVIEW HEALTH SYSTEM, INC. DEVELOPS A PHYSICIAN RECRUITMENT PLAN TO ADDRESS POTENTIAL GAPS IN PATIENT COVERAGE. IN ADDITION, PARKVIEW HEALTH SYSTEM, INC. PROMOTES CAREERS IN HEALTHCARE THROUGH STUDENT JOB SHADOWING OPPORTUNITIES AND INTERNSHIP PROGRAMS IN VARIOUS AREAS THROUGHOUT THE ORGANIZATION. PART III, LINE 4: BAD DEBT EXPENSE - FINANCIAL STATEMENT FOOTNOTETEXT OF THE FOOTNOTE TO THE ORGANIZATION'S FINANCIAL STATEMENTS THAT DESCRIBES BAD DEBT EXPENSE:PAGE 15 OF AUDITED FINANCIAL STATEMENTS. COSTING METHODOLOGY USED:UNCOLLECTIBLE PATIENT ACCOUNTS ARE CHARGED AGAINST THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS IN ACCORDANCE WITH THE POLICIES OF PARKVIEW HEALTH SYSTEM, INC. HOWEVER, DURING THE COLLECTION PROCESS THERE IS A CONTINUOUS EFFORT TO DETERMINE IF THE PATIENT QUALIFIES FOR CHARITY. THEREFORE, ONCE AN UNCOLLECTIBLE ACCOUNT HAS BEEN CHARGED OFF AND IT IS DETERMINED THROUGH THE COLLECTION PROCESS THAT THE PATIENT QUALIFIES FOR CHARITY CARE, THE UNCOLLECTIBLE ACCOUNT IS RECLASSIFIED TO CHARITY AND ALL COLLECTION EFFORTS CEASE. PATIENTS ARE ELIGIBLE TO APPLY FOR FREE 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 FREE CARE DURING THE 2012 CALENDAR YEAR. THE ACCOUNTS WERE RECLASSIFIED AS FREE CARE DUE TO THE FACT THAT PATIENTS APPLIED FOR, AND WERE APPROVED FOR, FREE CARE AFTER THE ACCOUNTS WERE PLACED WITH A BAD DEBT AGENCY. PARKVIEW HEALTH SYSTEM, INC. PROVIDES HEALTH CARE SERVICES THROUGH VARIOUS PROGRAMS THAT ARE DESIGNED, AMONG OTHER THINGS, TO ENHANCE THE HEALTH OF THE COMMUNITY AND IMPROVE THE HEALTH OF AT-RISK POPULATIONS. IN ADDITION, PARKVIEW HEALTH SYSTEM, INC. PROVIDES SERVICES INTENDED TO BENEFIT THE POOR AND UNDERSERVED, INCLUDING THOSE PERSONS WHO CANNOT AFFORD HEALTH INSURANCE DUE TO INADEQUATE RESOURCES OR WHO ARE UNINSURED OR UNDERINSURED. 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. PARKVIEW HEALTH SYSTEM, 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, PARKVIEW HEALTH SYSTEM, INC. HAS TAKEN THE POSITION NOT TO INCLUDE THE MEDICARE SHORTFALLS OR SURPLUSES AS PART OF COMMUNITY BENEFIT. PARKVIEW HEALTH SYSTEM, INC. RECOGNIZES THAT THE SHORTFALL OR SUPLUS 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. ORTHOPAEDIC HOSPITAL AT PARKVIEW NORTH, PART V, SECTION B, LINE 11: ELIGIBILITY CRITERIA FOR FREE OR DISCOUNTED CAREORTHOPAEDIC HOSPITAL AT PARKVIEW NORTH, LLC 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. ORTHOPAEDIC HOSPITAL AT PARKVIEW NORTH, PART V, SECTION B, LINE 20D: 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. PART VI, LINE 2: DESCRIBE HOW THE ORGANIZATION ASSESSES THE HEALTH CARE NEEDS OF THE COMMUNITIES IT SERVES.PARKVIEW HEALTH SYSTEM, INC., ALONG WITH ITS SYSTEM HOSPITALS AND IN CONJUNCTION WITH THE ALLEN COUNTY - FORT WAYNE HEALTH DEPARTMENT, IS CURRENTLY CONDUCTING A COMMUNITY HEALTH NEEDS ASSESSMENT FOR THE FIVE-COUNTY SERVICE AREA IN WHICH PARKVIEW HOSPITALS RESIDE. IN ADDITION, PARKVIEW HEALTH SYSTEM, INC. HAS PARTNERED WITH INDIANA UNIVERSITY/PURDUE UNIVERSITY FORT WAYNES (IPFW) SOCIAL RESEARCH DEPARTMENT AND PURDUE UNIVERSITY HEALTHCARE ADVISORS TO COMPLETE MUCH OF THE FIELD WORK. IPFW IS CONDUCTING THE RANDOM COMMUNITY MEMBER SURVEY TO OBTAIN PRIMARY DATA. PURDUE UNIVERSITY IS ASSISTING WITH SURVEYING PUBLIC HEALTH AND OTHER HEALTH CARE PROFESSIONALS, PROVIDING SECONDARY DATA RESEARCH AND DATA ANALYSIS. PARKVIEW HEALTH SYSTEM, INC. PLANS TO FINALIZE THE COMMUNITY HEALTH NEEDS ASSESSMENT AND THE IMPLEMENTATION STRATEGY TO ADDRESS IDENTIFIED HEALTH NEEDS DURING 2013. THE INFORMATION FROM THIS SURVEY IS PROVING TO BE A 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. PARKVIEW HEALTH SYSTEM, INC. REPRESENTATIVES HAVE RELATIONSHIPS THROUGHOUT OUR COMMUNITIES AND MEET REGULARLY WITH VARIOUS ORGANIZATIONS THAT SHARE OUR MISSION OF IMPROVING THE HEALTH OF THESE COMMUNITIES. 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 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 PARKVIEW HEALTH SYSTEM, INC.'S WEBSITE (WWW.PARKVIEW.COM) CONTAINS INFORMATION ON HOW TO CONTACT THE PATIENT ACCOUNTING DEPARTMENT FOR PAYMENT OPTIONS OR FREE CARE ELIGIBILITY.-ALL UNINSURED OR UNDERINSURED PATIENTS WHO ARE INPATIENT OR OBSERVATION STATUS ARE VISITED BY FINANCIAL COUNSELORS. THE FINANCIAL COUNSELORS PROVIDE PAYMENT OPTIONS, INCLUDING SCREENING FOR THE APPLICABILITY OF GOVERNMENT ASSISTANCE, AS WELL AS OFFERING FREE CARE APPLICATIONS TO PATIENTS WHO CANNOT AFFORD TO PAY THEIR BILLS.-OUTBOUND PHONE CALLS ARE MADE TO PATIENTS TO SET UP PAYMENT ARRANGEMENTS. IF A PATIENT CANNOT MAKE PAYMENT ON THEIR ACCOUNT, THEY WILL BE SCREENED FOR THE APPLICABILITY OF GOVERNMENT ASSISTANCE. ADDITIONALLY, FREE CARE APPLICATIONS WILL BE OFFERED TO PATIENTS WHO CANNOT AFFORD TO PAY THEIR BILLS.-IF A PATIENT'S ACCOUNT IS PLACED WITH A COLLECTION AGENCY, THE AGENCY IS INSTRUCTED TO SCREEN FOR FREE CARE IF THE PATIENT EXPRESSES THEIR INABILITY TO PAY. PART VI, LINE 4: DESCRIBE THE COMMUNITY THE ORGANIZATION SERVES, TAKING INTO ACCOUNT THE GEOGRAPHIC AREA AND DEMOGRAPHIC CONSTITUENTS IT SERVES.PARKVIEW HEALTH SYSTEM, INC. SERVES NORTHEAST INDIANA AND NORTHWEST OHIO AND OPERATES FACILITIES AND MEDICAL PRACTICES IN ALLEN, DEKALB, HUNTINGTON, KOSCIUSKO, LAGRANGE, NOBLE, STEUBEN, AND WHITLEY COUNTIES, AS WELL AS IN COMMUNITIES IN VARIOUS NORTHWEST OHIO COUNTIES. ALLEN COUNTY IS CONSIDERED THE URBAN AREA AMONGST THE OTHER RURAL COUNTIES AND REPRESENTS 69.7% OF THE TOTAL POPULATION OF THE 5-COUNTY AREA. HOSPITAL FACILITIES ARE LOCATED IN ALLEN, HUNTINGTON, LAGRANGE, NOBLE AND WHITLEY COUNTIES. 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.).PARKVIEW HEALTH SYSTEM, INC.'S BOARD OF DIRECTORS IS COMPOSED OF MEMBERS OF WHICH SUBSTANTIALLY ALL ARE INDEPENDENT COMMUNITY MEMBERS. A MAJORITY OF THE BOARD RESIDES IN PARKVIEW HEALTH SYSTEM, INC.'S PRIMARY SERVICE AREA. PARKVIEW HEALTH SYSTEM, INC., AS PARENT OF THE SYSTEM'S VARIOUS HOSPITALS AND PHYSICIAN PRACTICES, SERVES IN AN OVERSIGHT CAPACITY TO FORM AN INTEGRATED HEALTHCARE DELIVERY SYSTEM. IN DOING SO, ALL OF OUR HEALTHCARE FACILITIES ARE EFFICIENTLY SUPPORTED WITH CENTRALIZED, COST-EFFECTIVE ADMINISTRATIVE SUPPORT AND GUIDANCE TO FORM A COMPLETE AND COMPREHENSIVE CARE DELIVERY SYSTEM FOR THE REGION. BY ITSELF AND THROUGH ITS MEMBER HOSPITALS AND ORGANIZATIONS, PARKVIEW HEALTH SYSTEM, INC. SERVES TO MEET ITS MISSION TO ITS COMMUNITIES BY PERIODICALLY ASSESSING THE NEEDS OF THE REGION AND OFFERING THE SERVICES NECESSARY FOR A SAFER AND HEALTHIER POPULATION. AS A TESTAMENT TO OUR COMMITMENT TO THE PEOPLE OF OUR COMMUNITIES, PARKVIEW HEALTH SYSTEM, INC. IS PROUD TO FEATURE THE NEW PARKVIEW REGIONAL MEDICAL CENTER ON OUR NORTH CAMPUS, WHICH OPENED IN MARCH 2012. THE NEW CENTER OFFERS THE LATEST IN CARE DESIGN AND STATE OF THE ART EQUIPMENT AND CLINICAL CAPABILITIES. DATA OBTAINED THROUGH PERIODIC COMMUNITY HEALTH ASSESSMENTS, PHYSICIAN SURVEYS, AND TREND AND TREATMENT ANALYSIS IS UTILIZED IN PARKVIEW HEALTH SYSTEM, INC.'S STRATEGIC PLANNING PROCESS IN IDENTIFYING COMMUNITY HEALTH NEEDS. AS A RESULT OF THIS STRATEGIC PLANNING PROCESS, PARKVIEW HEALTH SYSTEM, INC. HAS ESTABLISHED SEVERAL PRIORITY AREAS. THESE PRIORITY AREAS ARE ALIGNED WITH PARKVIEW HEALTH SYSTEM, INC.'S MISSION, VISION, AND GOALS, AND HELP DIRECT THE TYPES OF HEALTH INITIATIVES THAT THE HEALTH SYSTEM UNDERTAKES. PRIORITY AREAS INCLUDE THE FOLLOWING:PRIMARY HEALTH CARE/ACCESS TO HEALTH CARE:-ADDITIONAL RECRUITMENT AND TRAINING OF PRIMARY CARE PHYSICIANS FOR THE COMMUNITY-EXPANSION OF PRIMARY CARE ACCESS AND NON-TRADITIONAL HOURS OF PRACTICE-CONTINUED SUPPORT OF PROGRAMS PROVIDING PRIMARY CARE TO THE UNINSURED-PROGRAMS TO INCREASE DISTRIBUTION OF FREE MEDICATIONS TO THE POOR-PROMOTION OF HEALTH CAREERS, PARTICULARLY THOSE IN WHICH THE COMMUNITY IS EXPERIENCING A CURRENT SHORTAGE OF HEALTH CARE PROFESSIONALS-SUPPORT FOR ACTIVITIES WHICH INCREASE THE AFFORDABILITY AND ACCESSIBILITY OF HEALTH INSURANCE TO THE UNINSUREDHEALTH SCREENING AND PREVENTION:-CANCER SCREENING PROGRAMS, PARTICULARLY MAMMOGRAM AND PROSTATE SCREENING-TOBACCO CESSATION PROGRAMS-INJURY PREVENTION FOR YOUNG PEOPLE-DIABETES EDUCATION AND SCREENING-CARDIOVASCULAR DISEASE EDUCATION AND SCREENING-PROGRAMS TO REDUCE DANGEROUS DRIVINGDISEASE MANAGEMENT:-CARDIOVASCULAR DISEASE -CANCER-MENTAL ILLNESSES-TRAUMA AND ORTHOPAEDIC AILMENTS-WOMEN'S AND CHILDREN'S MEDICINE WITH AN EMPHASIS ON CHILDREN'S ASTHMA-DIABETES AND OBESITY HEALTH INNOVATION, EDUCATION, AND RESEARCH AND DEVELOPMENT:-ENHANCING HEALTH CARE EDUCATION, MEDICAL RESEARCH, AND TECHNOLOGY-PROMOTING ECONOMIC AND OTHER DEVELOPMENT OF THE COMMUNITY PARKVIEW HEALTH SYSTEM, INC., AS THE PARENT ORGANIZATION AND THROUGH ITS MEMBER HOSPITALS, ANNUALLY FUNDS LOCAL COMMUNITY HEALTH IMPROVEMENT EFFORTS. THESE FUNDS ARE USED TO SUPPORT HEALTH-RELATED, COMMUNITY-BASED PROGRAMS, PROJECTS AND ORGANIZATIONS. FUNDS ARE ALSO USED TO SUPPORT COMMUNITY OUTREACH PROGRAMS AND HEALTH INITIATIVES. THE EMPHASIS WITH THESE PROJECTS CONTINUES TO BE ON IMPROVING THE HEALTH OF THE COMMUNITIES WE SERVE WHICH ALIGNS WITH OUR ESTABLISHED MISSION. (CONTINUED RESPONSE IS LOCATED IMMEDIATELY AFTER THE FOLLOWING SECTION OF PART VI, LINE 6): 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 AND NORTHWEST OHIO THROUGH OUR HOSPITALS AND PHYSICIAN CLINICS, INCLUDES THE NOT-FOR-PROFIT HOSPITALS OF PARKVIEW HOSPITAL, INC., COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC., COMMUNITY HOSPITAL OF NOBLE COUNTY, INC., 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 THE REGION BY EFFICIENTLY OPERATING ITS FACILITIES, DELIVERING HIGH QUALITY HEALTHCARE SERVICES TO ITS PATIENTS, AND PROVIDING SUPPORT TO LOCAL BUSINESSES AND ACTIVITIES. PARKVIEW HEALTH SYSTEM, INC. SEEKS TO CREATE ALIGNMENT OPPORTUNITIES TO DELIVER COMPREHENSIVE HIGH-QUALITY CARE THAT BENEFITS ITS PATIENTS, PHYSICIANS, CO-WORKERS, AND COMMUNITIES.PARKVIEW HEALTH SYSTEM, INC. 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 HIGH QUALITY HEALTH SERVICES TO ALL WHO ENTRUST THEIR CARE TO US AND 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. PROMOTION OF COMMUNITY HEALTH: PART VI, LINE 5 CONTINUED: CONTINUED RESPONSE TO THE FOLLOWING: 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.)PARKVIEW HEALTH SYSTEM, INC., THROUGH THE HOSPITALS OF PARKVIEW HOSPITAL, INC., PROVIDES A COMMUNITY-BASED NURSING PROGRAM THAT PROVIDES SUPPORT AND EDUCATION TO THOUSANDS OF CHILDREN AND THEIR FAMILIES EACH YEAR IN SCHOOL SYSTEMS THROUGHOUT THE REGION. OTHER PARKVIEW HOSPITAL, INC. OUTREACH PROGRAMS INCLUDE MEDICATION ASSISTANCE, MOBILE MAMMOGRAPHY, NUTRITION EDUCATION AND TRAUMA INJURY PREVENTION EDUCATION. PARKVIEW HOSPITAL, INC. IS PROUD TO FEATURE THE NEW PARKVIEW REGIONAL MEDICAL CENTER ON ITS NORTH CAMPUS, WHICH OPENED IN MARCH 2012, REPRESENTING A SIGNIFICANT INVESTMENT IN THE LOCAL COMMUNITY AND THE NORTHEAST INDIANA REGION. THE CENTER BLENDS THE LATEST MEDICAL TECHNOLOGY WITH THE BEST POSSIBLE PATIENT-CENTERED CARE AND PROVIDES GREATER ACCESS TO HEALTHCARE FOR THE ENTIRE REGION. ALSO PART OF PARKVIEW HOSPITAL, INC., A HOSPITAL FACILITY AND CAMPUS LOCATED IN NORTH CENTRAL FORT WAYNE (PARKVIEW RANDALLIA HOSPITAL) WILL RECEIVE AN UPGRADE AND REMAIN A VITAL PART OF THE LOCAL NEIGHBORHOOD. IN ADDITION, PARKVIEW HOSPITAL, INC. IS PARTNERING WITH THE LIFE SCIENCE AND RESEARCH CONSORTIUM OF NORTHEAST INDIANA TO CREATE A CAMPUS FOR ACADEMIC PROGRAMS AND RESEARCH TIED TO BEHAVIORAL HEALTH, REHABILITATION, AND SENIOR CARE. 1 PARKVIEW FOUNDATION INC 2200 RANDALLIA DRIVE FORT WAYNE IN 46805 237220589 501 ( C ) 3 675772 OPERATING FUNDS COMMUNITY HOSPITAL OF LAGRANGE COUNTY INC 207 N TOWNLINE RD LAGRANGE IN 46761 202401676 501 ( C ) 3 30705 OPERATING FUNDS COMMUNITY HOSPITAL OF NOBLE COUNTY FOUNDATION INC 401 SAWYER ROAD KENDALLVILLE IN 46755 352089183 501 ( C ) 3 45000 OPERATING FUNDS WHITLEY MEMORIAL HOSPITAL FOUNDATION INC 1260 EAST STATE ROAD 205 COLUMBIA CITY IN 46725 311190239 501 ( C ) 3 50000 OPERATING FUNDS PARKVIEW HUNTINGTON FOUNDATION INC 2001 STULTS ROAD HUNTINGTON IN 46750 320012095 501 ( C ) 3 40000 OPERATING FUNDS UNIVERSITY OF SAINT FRANCIS 2701 SPRING STREET FORT WAYNE IN 46806 350886846 501 ( C ) 3 1150000 SUPPORT FOR SCHOOL FORT WAYNE CHILDRENS ZOO 3411 SHERMAN BLVD FORT WAYNE IN 46808 356068234 501 ( C ) 3 502200 PROGRAMS & OPERATING FUNDS COMMUNITY HARVEST FOOD BANK OF NORTHEAST INDIANA P O BOX 10967 FORT WAYNE IN 46855 311100607 501 ( C ) 3 305000 OPERATING FUNDS FRIENDS OF THE LINCOLN COLLECTION OF INDIANA INC P O BOX 11083 FORT WAYNE IN 46855 352101025 501 ( C ) 3 250000 OPERATING FUNDS IPFW 2101 EAST COLISEUM BLVD FORT WAYNE IN 46805 356033698 501 ( C ) 3 161000 SUPPORT FOR SCHOOL CITY OF FORT WAYNE REDEVELOPMENT COMMISSION ONE EAST MAIN STREET FORT WAYNE IN 46802 GOVT ORG 150000 CAPITAL MAINTENANCE & IMPROVEMENT FUND - PARKVIEW FIELD FORT WAYNE ECONOMIC DEVELOPMENT ALLIANCE INC 111 W WAYNE STREET FORT WAYNE IN 46802 351787258 501 ( C ) 3 100000 OPERATING FUNDS INDIANA STATE CHAMBER OF COMMERCE FOUNDATION INC P O BOX 44926 INDIANAPOLIS IN 46244 311010164 501 ( C ) 3 75000 OPERATING FUNDS RONALD MCDONALD HOUSE CHARITIES OF NORTHEAST INDIANA 2200 RANDALLIA DRIVE FORT WAYNE IN 46805 351950376 501 ( C ) 3 47447 PROGRAMS & OPERATING FUNDS ERINS HOUSE 3811 ILLINOIS ROAD SUITE 205 FORT WAYNE IN 46804 351884264 501 ( C ) 3 35500 PROGRAMS & OPERATING FUNDS FORT WAYNE PHILHARMONIC ORCHESTRA INC 4901 FULLER DR FORT WAYNE IN 46835 350791163 501 ( C ) 3 35000 OPERATING FUNDS SCIENCE CENTRAL 1950 N CLINTON FORT WAYNE IN 46805 311032583 501 ( C ) 3 33333 PROGRAMS & OPERATING FUNDS TURNSTONE CENTER FOR DISABLED CHILDREN AND ADULTS 3320 N CLINTON FORT WAYNE IN 46805 350913541 501 ( C ) 3 30250 FITNESS & WELLNESS PROGRAMS STEUBEN COUNTY COMMUNITY FOUNDATION 5009 E US HIGHWAY 20 ANGOLA IN 46703 351857065 501 ( C ) 3 20000 OPERATING FUNDS AMERICAN HEART ASSOCIATION 6100 WEST 96TH STREET INDIANAPOLIS IN 46278 135613797 501 ( C ) 3 10000 PROGRAMS & OPERATING FUNDS VERA BRADLEY FOUNDATION FOR BREAST CANCER P O BOX 80201 FORT WAYNE IN 46898 352058177 501 ( C ) 3 10000 SUPPORT FOR RESEARCH MATTHEW 25 HEALTH CLINIC 413 E JEFFERSON BLVD FORT WAYNE IN 46802 351484951 501 ( C ) 3 7750 PROGRAMS & OPERATING FUNDS NATIONAL KIDNEY FOUNDATION OF INDIANA INC 5800 FAIRFIELD AVE SUITE 122 FORT WAYNE IN 46807 351180274 501 ( C ) 3 6000 PROGRAMS & OPERATING FUNDS CAMERON HOSPITAL FOUNDATION 416 E MAUMEE ST ANGOLA IN 46703 351722087 501 ( C ) 3 5050 PROGRAMS & OPERATING FUNDS 24 0 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, 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. X X X X X 0 1 0 0 0 0 0 1 0 MICHAEL PACKNETT 740193 0 389731 0 19838 0 154794 0 12179 0 1316735 0 0 0 RAYMOND DUSMAN 593621 0 108120 0 18673 0 27500 0 19074 0 766988 0 0 0 DUANE HOUGENDOBLER 604849 0 97159 0 3092 0 27500 0 23458 0 756058 0 0 0 MITCHELL STUCKY 325639 0 59112 0 2838 0 65850 0 15731 0 469170 0 0 0 LARRY ROWLAND 330750 0 0 0 0 0 0 0 0 0 330750 0 0 0 MICHAEL BROWNING 409616 0 181320 0 17990 0 51645 0 23555 0 684126 0 0 0 JEFFREY BROOKES 17816 265960 73780 0 17453 0 13388 32653 3190 7780 125627 306393 0 14615 CATHERINE WILCOX 275343 0 94510 0 19938 0 48306 0 13649 0 451746 0 0 0 JAMES STAPEL 263396 0 79255 0 36120 0 61752 0 15611 0 456134 0 14714 0 RONALD DOUBLE 287397 0 71519 0 990 0 60090 0 6641 0 426637 0 0 0 DEBRA WILLIAMS 259795 0 68342 0 15553 0 40874 0 8088 0 392652 0 13985 0 RICK HENVEY 282700 0 75267 0 14845 0 38781 0 18485 0 430078 0 14185 0 JILL OSTREM 261604 0 45358 0 990 0 33740 0 18363 0 360055 0 0 0 RAMESH BHAT 766656 48558 81977 0 4356 0 27500 0 11998 0 892487 48558 0 0 SAILAJA BLACKMON 766734 0 98445 0 1516 0 17500 0 26074 0 910269 0 0 0 DAVID SCHLEINKOFER 593577 0 116116 0 30968 0 27500 0 20374 0 788535 0 0 0 DAVID CLARK 698668 0 65960 0 1925 0 20000 0 11998 0 798551 0 0 0 EDWARD SCHULTZ 688059 0 60158 0 22654 0 27500 0 9227 0 807598 0 0 0 STANTON RISSER 109732 0 22335 0 464 0 9419 0 17634 0 159584 0 0 0 JAMES HAUGUEL 186574 0 56150 0 12950 0 38747 0 5708 0 300129 0 11539 0 JAMES WITMER 197059 0 58433 0 15884 0 38262 0 12954 0 322592 0 11495 0 PART I, LINE 4B SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN PAYMENTS TAXABLE - JEFFREY BROOKES $14,615; JAMES HAUGUEL $11,539; RICK HENVEY $14,185; JAMES STAPEL $14,714: DEBRA WILLIAMS $13,985; JAMES WITMER $11,494 PARTICIPANTS DEFERRED - JEFFREY BROOKES $31,041; MICHAEL BROWNING $46,020; RONALD DOUBLE $30,090; JAMES HAUGUEL $21,735; RICK HENVEY $28,781; JILL OSTREM $30,680; MICHAEL PACKNETT $137,294; JAMES STAPEL $31,752; MITCHELL STUCKY $38,350; CATHERINE WILCOX $33,306; DEBRA WILLIAMS $28,373; JAMES WITMER $23,262 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. A INDIANA FINANCE AUTHORITY 351602316 45471ABQ4 2009-08-27 264703254 SEE PART VI 0 0 0 B INDIANA FINANCE AUTHORITY 351602316 45471AAS1 2009-08-27 223665000 SEE PART VI 0 0 0 C INDIANA FINANCE AUTHORITY 351602316 NONEAVAIL 2010-05-04 28000000 SEE PART VI 0 0 0 D INDIANA FINANCE AUTHORITY 351062316 45471AHR6 2012-05-24 94631826 SEE PART VI 0 0 0 A 24805000 37335000 264704689 3451766 261252923 2009 1 0 1 1 B 223915573 1367866 193601 149086870 73267236 2011 1 0 1 1 C 28000000 155500 27844500 2011 0 0 1 1 D 94631826 1096522 93535305 2012 1 1 1 1 A 0 1 1 1 1 1 0.00000 0.00000 0.00000 1 0 1 B 0 1 1 1 1 1 0.00000 0.00000 0.00000 1 0 1 C 0 1 1 1 1 1 0.00000 0.00000 0.00000 1 0 1 D 0 1 1 1 1 1 0.00000 0.00000 0.00000 1 0 1 A 0 1 0 0 0 0 0 0 1 B 0 0 0 1 1 1 WELLS FARGO & PNC 20.000000000000 0 0 0 0 1 C 0 1 0 0 1 0 0 0 1 D 0 1 0 0 0 0 0 0 1 A 1 B 1 C 1 D 1 SCHEDULE K PART IV, ARBITRAGE, LINE 2C DATE REBATE COMPUTATION PERFORMED ISSUER NAME: INDIANA FINANCE AUTHORITY DATE THE REBATE COMPUTATION WAS PERFORMED: 12/08/2011 SCHEDULE K, PART I,A,F: DESCRIPTION OF PURPOSE: SERIES 2009A - 1) PARTIALLY REFUNDED OUTSTANDING 2005 SERIES BOND ISSUE 2) PARTIALLY REFUNDED OUTSTANDING BONDS FOR 2001 SERIES BOND ISSUE SCHEDULE K, PART I,B,F: DESCRIPTION OF PURPOSE: SERIES 2009BCD - 1) NEW MONEY FOR CONSTRUCTION OF NEW HOSPITAL IN FORT WAYNE, IN 2) FULLY REFUNDED BALANCE OF OUTSTANDING 2005 SERIES BONDS SCHEDULE K, PART I,C,F: DESCRIPTION OF PURPOSE: SERIES 2010 - NEW MONEY FOR CONSTRUCTION OF NEW PARKVIEW WHITLEY HOSPITAL FACILITY IN COLUMBIA CITY, IN SCHEDULE K, PART I,D,F: DESCRIPTION OF PURPOSE: SERIES 2012 - 1) PARTIALLY REFUNDED OUTSTANDING 2009A SERIES BOND ISSUE 2) FULLY REFUNDED OUTSTANDING BONDS FOR 1998 SERIES BOND ISSUE SCHEDULE K, PART I,C,E: ISSUE PRICE: ORIGINAL $30,000,000 ISSUE PRICE REDUCED TO $28,000,000 DUE TO CONSTRUCTION DRAW BOND AND ONLY $28,000,000 ACTUALLY DRAWN. SCHEDULE K, PART II,3,A: TOTAL PROCEEDS ON ISSUE: THIS AMOUNT INCLUDES INTEREST EARNED ON PROJECT AND/OR COST OF ISSUANCE FUNDS. SCHEDULE K, PART II,3,B: TOTAL PROCEEDS ON ISSUE: THIS AMOUNT INCLUDES INTEREST EARNED ON PROJECT AND/OR COST OF ISSUANCE FUNDS. SCHEDULE K, PART II,3,C: TOTAL PROCEEDS ON ISSUE: THIS IS A CONSTRUCTION DRAW BOND AND THEREFORE NO INTEREST WILL BE EARNED ON ANY PROJECT FUNDS. SCHEDULE K, PART III, LINES 4-6: PRIVATE BENEFIT USE: PARKVIEW HEALTH SYSTEM, INC. CLOSELY MONITORS THE LEVEL OF PRIVATE USE AT OUR BOND FINANCED FACILITIES. THE LEVEL OF EQUITY PROVIDED BY PARKVIEW HEALTH SYSTEM, INC. FOR THIS FACILITY IS MORE THAN SUFFICIENT TO COVER THE LOW LEVEL OF PRIVATE USE OCCURING WITHIN THE FACILITY CONSTRUCTED IN PART WITH BOND FINANCING. SCHEDULE K, PART III, LINE 7: PRIVATE SECURITY OR PAYMENT TEST: THE BONDS ARE NOT PRIVATE ACTIVITY BONDS BECAUSE THEY DO NOT MEET THE PRIVATE BUSINESS USE TEST. FCFP LLC ENTITY OF WHICH DIRECTOR MITCHELL STUCKY OWNED A GREATER THAN 5% INTEREST 710268 RENTAL OF PROPERTY TO PARKVIEW HEALTH SYSTEM, INC. - TRANSACTIONS WERE ENTERED INTO AT ARM'S LENGTH. ADDITIONALLY, DIRECTOR MITCHELL STUCKY DOES NOT PARTICIPATE IN THE DISCUSSIONS/DECISION TO LEASE PROPERTY OR THE LEASE TERMS AND PAYMENTS. 0 NORTHEAST ORTHOPAEDIC HOSPITAL INVESTORS LLC ENTITY OF WHICH DIRECTOR MICHAEL LEE OWNED A GREATER THAN 5% INTEREST 21198333 PARKVIEW HEALTH SYSTEM, INC. AND NORTHEAST ORTHOPAEDIC HOSPITAL INVESTORS, LLC ARE BOTH MEMBERS IN THE JOINT VENTURE OF ORTHOPAEDIC HOSPITAL AT PARKVIEW NORTH, LLC. THE TOTAL AMOUNT INVESTED BY PARKVIEW HEALTH SYSTEM, INC. IN THE JOINT VENTURE AS OF 12/31/2012 IS $21,198,333. 0 FORM 990, PART VI, SECTION A, LINE 1 THE EXECUTIVE COMMITTEE SHALL BE COMPOSED OF THE CHAIR OF THE BOARD, VICE CHAIR OF THE BOARD, THE PRESIDENT AND CHIEF EXECUTIVE OFFICER, TREASURER AND SECRETARY OF THE CORPORATION AND AT LEAST ONE DIRECTOR WHO IS AN EX-OFFICIO VOTING MEMBER OF THE BOARD AND SUCH OTHER DIRECTORS AS ARE DESIGNATED BY THE CHAIR OF THE BOARD. THE EXECUTIVE COMMITTEE MAY ACT AS THE EXECUTIVE COMPENSATION COMMITTEE FOR THE CORPORATION. AT THE DISCRETION OF THE CHAIR, OTHERS MAY BE INVITED TO PARTICIPATE IN EXECUTIVE COMMITTEE MEETINGS WITHOUT VOTE. THE CHAIR OF THE BOARD SHALL SERVE AS CHAIR OF THE EXECUTIVE COMMITTEE. THE EXECUTIVE COMMITTEE MAY ACT ON BEHALF OF THE CORPORATION IN ANY MATTER WHEN THE BOARD IS NOT IN SESSION. IN ADDITION, THE COMMITTEE SHALL PERFORM ALL RESPONSIBILITIES DELEGATED TO IT BY THE BOARD. THE EXECUTIVE COMMITTEE MAY SERVE AS THE EXECUTIVE COMPENSATION COMMITTEE FOR THE CORPORATION AND ALL OF ITS ENTITIES, AS DETERMINED BY THE CHAIR OF THE BOARD, AT WHICH TIME, THE EXECUTIVE COMPENSATION COMMITTEE SHALL ESTABLISH THE COMPENSATION FOR ALL KEY MANAGEMENT PERSONNEL, PURSUANT TO THE STANDARDS OF CONDUCT RELATING TO EXECUTIVE COMPENSATION. NO INTERESTED PERSON MAY SERVE ON THE EXECUTIVE COMPENSATION COMMITTEE. NO OTHER BOARD OR COMMITTEE CAN APPROVE EXECUTIVE COMPENSATION ARRANGEMENTS. THE EXECUTIVE COMMITTEE SHALL ANNUALLY RECEIVE, REVIEW AND MAKE RECOMMENDATIONS ON ENTITY BOARDS AND SHALL SUBMIT RECOMMENDATIONS FOR ALL SYSTEM BOARD APPOINTMENTS. FORM 990, PART VI, SECTION A, LINE 4 DURING 2012, THE FOLLOWING CHANGES WERE MADE TO THE BYLAWS OF PARKVIEW HEALTH SYSTEM, INC.: ARTICLE IV, SECTION 9 IS AS FOLLOWS: THE CHAIR, REGARDLESS OF TENURE OF BOARD MEMBERSHIP AND THE RESTRICTIONS OF ELIGIBILITY SET FORTH IN THIS ARTICLE, MAY BE SUCCESSIVELY ELECTED FOR NO MORE THAN FIVE (5) ONE-YEAR TERMS, WHERE CONSECUTIVE SERVICE AS THE CHAIR IS DETERMINED TO BE APPROPRIATE FOR ORGANIZATIONAL EFFECTIVENESS. NOTWITHSTANDING THE FOREGOING AND IN LIGHT OF SIGNIFICANT CAPITAL IMPROVEMENTS INVESTED BY THE CORPORATION WITH RESPECT TO NEW AND EXPANDED HOSPITAL FACILITIES AND INFORMATION TECHNOLOGY INFRASTRUCTURE, AND FOR THE PURPOSE OF MAINTAINING CONTINUITY OF LEADERSHIP FROM THE CONSTRUCTION THROUGH OPERATIONAL IMPLEMENTATION, FOR THE YEARS 2013 AND 2014 ONLY, THE CHAIR MAY BE SUCCESSIVELY ELECTD FOR UP TO SEVEN (7) ONE-YEAR TERMS. AFTER SERVICE AS CHAIR, THE CHAIR SHALL NOT BE ELIGIBLE FOR RE-ELECTION TO THE SAME POSITION UNTIL EXPIRATION OF THREE (3) INTERVENING YEARS. IF A CHAIR'S NORMAL TERM AS A DIRECTOR EXPIRES WHILE SERVING AS THE CHAIR, AND IF HE/SHE IS NOMINATED FOR REELECTION AS CHAIR, IN ORDER TO SERVE AS CHAIR, HE/SHE WILL BE RE-ELECTED TO THE BOARD FOR AN ADDITIONAL YEAR BEYOND THEIR TERM AS CHAIR, SECTION 3 OF THIS ARTICLE NOTWITHSTANDING. ARTICLE VI, SECTION 4 (A) IS AS FOLLOWS: THE EXECUTIVE COMMITTEE SHALL BE COMPOSED OF THE CHAIR OF THE BOARD, VICE CHAIR OF THE BOARD, THE PRESIDENT AND CHIEF EXECUTIVE OFFICER, TREASURER AND SECRETARY OF THE CORPORATION AND AT LEAST ONE DIRECTOR WHO IS AN EX-OFFICIO VOTING MEMBER OF THE BOARD AND SUCH OTHER DIRECTORS AS ARE DESIGNATED BY THE CHAIR OF THE BOARD. THE EXECUTIVE COMMITTEE MAY ACT AS THE EXECUTIVE COMPENSATION COMMITTEE FOR THE CORPORATION. AT THE DISCRETION OF THE CHAIR, OTHERS MAY BE INVITED TO PARTICIPATE IN EXECUTIVE COMMITTEE MEETINGS WITHOUT VOTE. THE CHAIR OF THE BOARD SHALL SERVE AS CHAIR OF THE EXECUTIVE COMMITTEE. ARTICLE VI, SECTION 4 (B) IS AS FOLLOWS: THE EXECUTIVE COMMITTEE MAY ACT ON BEHALF OF THE CORPORATION IN ANY MATTER WHEN THE BOARD IS NOT IN SESSION. IN ADDITION, THE COMMITTEE SHALL PERFORM ALL RESPONSIBILITIES DELEGATED TO IT BY THE BOARD. THE EXECUTIVE COMMITTEE MAY SERVE AS THE EXECUTIVE COMPENSATION COMMITTEE FOR THE CORPORATION AND ALL OF ITS ENTITIES, AS DETERMINED BY THE CHAIR OF THE BOARD, AT WHICH TIME, THE EXECUTIVE COMPENSATION COMMITTEE SHALL ESTABLISH THE COMPENSATION FOR ALL KEY MANAGEMENT PERSONNEL, PURSUANT TO THE STANDARDS OF CONDUCT RELATING TO EXECUTIVE COMPENSATION. NO INTERESTED PERSON MAY SERVE ON THE EXECUTIVE COMPENSATION COMMITTEE. NO OTHER BOARD OR COMMITTEE CAN APPROVE EXECUTIVE COMPENSATION ARRANGEMENTS. THE EXECUTIVE COMMITTEE SHALL ANNUALLY RECEIVE, REVIEW AND MAKE RECOMMENDATIONS ON ENTITY BOARDS AND SHALL SUBMIT RECOMMENDATIONS FOR ALL SYSTEM BOARD APPOINTMENTS. FORM 990, PART VI, SECTION B, LINE 11 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 AND THE SYSTEM AUDIT COMMITTEE, 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. COMMON PAYING AGENT FOR FILING ORGANIZATION 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 AS WELL AS RELATED ENTITIES. 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 PARKVIEW HEALTH SYSTEM, INC. WAS 260 AND 2,797 RESPECTIVELY. AS REFLECTED IN PART VII, SECTION B, 21 INDEPENDENT CONTRACTORS RECEIVED MORE THAN $100,000 IN COMPENSATION FOR SERVICES FROM PARKVIEW HEALTH SYSTEM, INC. SALARIES AND WAGES, OTHER EMPLOYEE BENEFITS AND PAYROLL TAXES 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. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 9: ASSET ADJUSTMENT TRANSFERS -1,660,760. BOOK/TAX DIFF FROM K-1'S 2,028,634. CURRENT YEAR EARNINGS TRANSFERRED FROM 501( C )3'S 131,136,016. AMORTIZE BOND SWAP OCI 42,600. ADJUST OCI FOR PENSION -4,747,890. 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616920 184644 0 1 0.51000 MANAGED CARE SERVICES LLC 2200 RANDALLIA DRIVE FORT WAYNE IN 46805 351996535 HEALTH PLAN ADMIN IN PARKVIEW HEALTH SYSTEM INC RELATED 840106 5799389 0 1 0.90000 PARKVIEW IMAGING HUNTINGTON LLC 10501 CORPORATE DRIVE FORT WAYNE IN 46845 208651460 EQUIPMENT LEASING IN HUNTINGTON MEMORIAL HOSPITAL INC RELATED 289960 200392 0 0 PARKVIEW PROFESSIONAL PROGRAMS INC 2200 RANDALLIA DRIVE FORT WAYNE IN 46805 351668888 REFERENCE LAB IN PARKVIEW HOSPITAL INC C 16366851 5570270 0 MIDWEST COMMUNITY HEALTH ASSOCIATES INC 442 W HIGH STREET BRYAN OH 43506 341045870 PHYSICIANS OH PARKVIEW HEALTH SYSTEM INC C 33782908 7368808 1.00000 0 1 1 1 1 0 0 0 0 0 1 1 1 0 0 0 0 1 0 1 HUNTINGTON MEMORIAL HOSPITAL INC A 1292972 PART VII SUPPLEMENTAL INFORMATION COMMUNITY HOSPITAL OF NOBLE COUNTY INC A 1376759 PART VII SUPPLEMENTAL INFORMATION PARKVIEW OCCUPATIONAL HEALTH CENTERS INC A 105267 PART VII SUPPLEMENTAL INFORMATION PARKVIEW HOSPITAL INC A 1706198 PART VII SUPPLEMENTAL INFORMATION 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1553787 PART VII SUPPLEMENTAL INFORMATION METHOD USED TO DETERMINE VALUE 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.