WHITLEY MEMORIAL HOSPITAL INC: Form 990, tax year 2021
View the entire original 990 at ProPublica ↗
- Organization
- WHITLEY MEMORIAL HOSPITAL INC (EIN 35-1967665)
- Tax period
- 2021-01-01 to 2021-12-31
- Filed
- 2022-11-02
- IRS object ID
- 202213069349303061
- Schema version
- 2021v4.2
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule H
- Schedule I
- Schedule J
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2022-11-02T17:35:31-05:00 | ReturnTs |
| Tax Period End | 2021-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 350921680 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CROWE LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 330 E JEFFERSON BLVD P O BOX 7 | AddressLine1Txt |
| City | SOUTH BEND | CityNm |
| State Abbreviation | IN | StateAbbreviationCd |
| ZIP | 466240007 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2021-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 351967665 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WHITLEY MEMORIAL HOSPITAL INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | WHIT | BusinessNameControlTxt |
| Phone | 2603738429 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1260 E STATE ROAD 205 | AddressLine1Txt |
| City | COLUMBIA CITY | CityNm |
| State Abbreviation | IN | StateAbbreviationCd |
| ZIP | 467259492 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | JEANNE' WICKENS | PersonNm |
| Person Title | PH CFO | PersonTitleTxt |
| Phone | 2602669313 | PhoneNum |
| Signature | 2022-11-02 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | JEANNE | PersonFirstNm |
| Person Last | WICKENS | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | BRITTNEY KOCAJ | PreparerPersonNm |
| PTIN | P01320603 | PTIN |
| Phone | 5742323992 | PhoneNum |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 3 | TrustedCustomerCd |
| Authentication Assurance Level | AAL1 | AuthenticationAssuranceLevelCd |
| Identity Assurance Level | IAL1 | IdentityAssuranceLevelCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2021 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
Doing Business As Name DoingBusinessAsName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PARKVIEW WHITLEY HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | MICHAEL J PACKNETT | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1450 PRODUCTION RD | AddressLine1Txt |
| City | FORT WAYNE | CityNm |
| State Abbreviation | IN | StateAbbreviationCd |
| ZIP | 468081167 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $240,356,033 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.PARKVIEW.COM | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1995 | FormationYr |
| Legal Domicile State | IN | LegalDomicileStateCd |
| Activity Or Mission | IMPROVE HEALTH & PROVIDE QUALITY HEALTH SERVICES TO ALL WHO ENTRUST THEIR CARE TO US. | ActivityOrMissionDesc |
| Voting Members Governing Body | 13 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 8 | VotingMembersIndependentCnt |
| Total Employee | 429 | TotalEmployeeCnt |
| Total Volunteers | 26 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $2,517,715 | PYContributionsGrantsAmt |
| CY Contributions Grants | $2,121,936 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $82,678,875 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $96,531,269 | CYProgramServiceRevenueAmt |
| PY Investment Income | $2,752,957 | PYInvestmentIncomeAmt |
| CY Investment Income | $4,621,231 | CYInvestmentIncomeAmt |
| PY Other Revenue | $48,741 | PYOtherRevenueAmt |
| CY Other Revenue | $177,467 | CYOtherRevenueAmt |
| PY Total Revenue | $87,998,288 | PYTotalRevenueAmt |
| CY Total Revenue | $103,451,903 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $85,321 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $70,448 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $25,244,502 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $26,824,011 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $88,794 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $53,465,107 | PYOtherExpensesAmt |
| CY Other Expenses | $54,205,595 | CYOtherExpensesAmt |
| PY Total Expenses | $78,794,930 | PYTotalExpensesAmt |
| CY Total Expenses | $81,100,054 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $9,203,358 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $22,351,849 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $128,120,921 | TotalAssetsBOYAmt |
| Total Assets EOY | $159,376,222 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $17,625,128 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $23,565,490 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $110,495,793 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $135,810,732 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | WHITLEY MEMORIAL HOSPITAL, INC. WORKS TO IMPROVE THE HEALTH OF OUR COMMUNITIES AND PROVIDES QUALITY HEALTH SERVICES TO ALL WHO ENTRUST THEIR CARE TO US. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $62,690,554 | ExpenseAmt |
| Grant | $70,448 | GrantAmt |
| Revenue | $96,531,269 | RevenueAmt |
| Desc | WHITLEY MEMORIAL HOSPITAL, INC. IS A MEMBER OF PARKVIEW HEALTH. THE LEGAL ENTITY INCLUDES THE FULL-SERVICE HOSPITAL IN WHITLEY COUNTY AND AN OUTPATIENT SERVICES FACILITY, PARKVIEW WARSAW, IN KOSCIUSKO COUNTY. WE ARE DEDICATED TO IMPROVING AND INSPIRING THE HEALTH OF THE COMMUNITY. WE ACCOMPLISH THIS THROUGH DELIVERING WORLD-CLASS TEAMWORK AND EXCELLENT CARE. WE PARTNER WITH PATIENTS AND OTHER COMMUNITY ORGANIZATIONS TO TAILOR PERSONALIZED HEALTH JOURNEYS. EXCELLENCE, INNOVATION AND VALUE ARE IMPORTANT TO OUR PATIENTS AND TO US. OUR CARE IS DELIVERED WHILE ALWAYS KEEPING IN MIND CONVENIENCE, COMPASSION AND EXCELLENCE BOTH IN COST AND IN QUALITY. WE DEVELOP AND VALUE RELATIONSHIPS WITH OUR PATIENTS AND OUR COMMUNITY. (SEE SCHEDULE O FOR CONTINUATION)WHITLEY MEMORIAL HOSPITAL, INC. IS A MAGNET DESIGNATED HOSPITAL. WIDELY CONSIDERED THE HIGHEST RECOGNITION FOR NURSING EXCELLENCE, MAGNET DESIGNATION IS ACHIEVED BY ONLY 8.9% OF U.S. HOSPITALS AND RECOGNIZES MEASURABLE, POSITIVE PATIENT OUTCOMES AND HIGH SATISFACTION LEVELS. MAGNET DESIGNATION IS GRANTED BY THE AMERICAN NURSES CREDENTIALING CENTER'S (ANCC) MAGNET RECOGNITION PROGRAM, WHICH ENSURES THAT RIGOROUS STANDARDS FOR NURSING EXCELLENCE ARE MET. TO MAINTAIN MAGNET RECOGNITION, A HOSPITAL MUST CONTINUE TO MEET THE HIGH STANDARDS SET BY THE ANCC. ACCORDING TO THE ANCC, MAGNET DESIGNATION INDICATES AN ORGANIZATION PROVIDES A CULTURE IN WHICH NURSES CAN FLOURISH AS PROFESSIONALS. THESE SELECT ENTITIES PLACE AN EMPHASIS ON PROVIDING THEIR NURSING TEAMS WITH THE PROFESSIONAL AUTONOMY TO MAKE CLINICAL DECISIONS AT PATIENT BEDSIDES. THEY ALSO INVOLVE NURSES IN DECISIONS REGARDING THE PATIENT CARE ENVIRONMENT, AS WELL AS ENABLE MORE INTERDISCIPLINARY COLLABORATIONS WITH OTHER TEAM MEMBERS.WHITLEY MEMORIAL HOSPITAL, INC. ALSO MAINTAINS THE DESIGNATION OF BEING A BABY FRIENDLY ORGANIZATION AS AWARDED BY BABY-FRIENDLY USA. THIS IS A 5-YEAR DESIGNATION, AND EACH YEAR THE HOSPITAL IS ASSIGNED QUALITY AUDITS TO COMPLETE AND SUBMIT TO MAINTAIN OUR DESIGNATION. THE AWARD RECOGNIZES A COMMITMENT TO IMPROVING THE HEALTH OF BABIES BY PROVIDING EDUCATION ON THE POSITIVE EFFECTS OF BREAST FEEDING. THE DESIGNATION WAS AWARDED AFTER SEVERAL CRITERIA WERE MET, INCLUDING AN ONSITE SURVEY, DEMONSTRATING THAT POLICIES AND PROCESSES WERE IN PLACE TO HELP EDUCATE AND PROMOTE SAFE FEEDING PRACTICES TO ALL MOTHERS WHO GIVE BIRTH AT THE LOCATION. THERE WERE 389 BIRTHS AT WHITLEY MEMORIAL HOSPITAL, INC. IN 2021.WHITLEY MEMORIAL HOSPITAL, INC. WAS RECOGNIZED AS AN INSPIRE HOSPITAL OF DISTINCTION FOR 2021 BY THE INDIANA HOSPITAL ASSOCIATION, IN PARTNERSHIP WITH GOVERNOR ERIC HOLCOMB AND STATE HEALTH COMMISSIONER KRIS BOX, FACOG, FOR ITS EXCELLENCE IN CARING FOR MOTHERS AND BABIES, HAVING IMPLEMENTED BEST PRACTICES IN KEY AREAS THAT ARE DRIVERS OF INFANT AND MATERNAL HEALTH.WHITLEY MEMORIAL HOSPITAL, INC. WAS NAMED ONE OF THE NATION'S 100 TOP HOSPITALS BY IBM WATSON HEALTH IN 2021 FOR THE SMALL COMMUNITY HOSPITAL CATEGORY. THE WATSON HEALTH 100 TOP HOSPITALS STUDY IDENTIFIES THE TOP-PERFORMING HOSPITALS IN THE UNITED STATES USING A BALANCED SCORECARD OF CLINICAL, OPERATIONAL AND FINANCIAL METRICS DERIVED FROM PUBLIC DATA. CRITERIA USED RANGE FROM PATIENT QUALITY MEASURES TO FINANCIAL STABILITY OF THE INSTITUTION.WHITLEY MEMORIAL HOSPITAL, INC. INTRODUCED ROBOTICS SURGICAL TECHNOLOGY FOR USE IN HERNIA AND GALL BLADDER CASES IN 2019. IN JANUARY 2021, ROBOTIC GYNECOLOGICAL SURGERY SERVICES WERE ADDED. THIS MINIMALLY INVASIVE APPROACH IS ASSOCIATED WITH REDUCED RECOVERY TIME AND A DECREASED RISK OF COMPLICATIONS FOR PATIENTS WHO QUALIFY FOR PROCEDURES UTILIZING THIS TECHNOLOGY. THERE WERE 90 GYNECOLOGICAL ROBOTIC SURGERY CASES DURING THE YEAR AND 170 GENERAL SURGERY CASES OR 15% OF TOTAL SURGICAL PROCEDURES.TWO IMPORTANT IMAGING TESTS ARE OFFERED TO THE PUBLIC FOR A REASONABLE OUT-OF-POCKET COST. THE HEART SMART CT SCAN IS A SIMPLE, NON-INVASIVE TEST THAT CAN DETECT CORONARY ARTERY DISEASE IN ITS EARLY STAGES. THERE WERE 687 SCANS PERFORMED IN 2021 BETWEEN WHITLEY AND WARSAW LOCATIONS AT A MINIMAL OUT-OF-POCKET FEE. LUNG SCANS ARE AVAILABLE AS WELL FOR THOSE INDIVIDUALS CONSIDERED TO BE "AT-RISK". A TOTAL OF 386 INDIVIDUALS UTILIZED THAT SERVICE. THE TEST INVOLVES A LOW DOSE CT TO ASSIST IN DIAGNOSING EARLY-STAGE LUNG CANCER.WHITLEY MEMORIAL HOSPITAL, INC.'S MISSION INCLUDES CARING FOR PEOPLE WHO DO NOT HAVE THE MEANS TO MEET THEIR FINANCIAL OBLIGATIONS. A FINANCIAL COUNSELOR IS AVAILABLE TO ASSIST PATIENTS IN NAVIGATING THIS PROCESS. THE HOSPITAL PRIORITIZES OUR RESPONSIBILITY TO DELIVER EXCELLENT, NECESSARY CARE TO THE PATIENT, NOT THE PATIENT'S ABILITY TO PAY FOR HIS/HER MEDICAL EXPENSES. THE PATIENT AND FAMILY ADVISORY COUNCIL (PFAC) IS A FORUM THAT ENABLES PATIENTS AND FAMILIES TO HAVE DIRECT INPUT AND INFLUENCE ON THE POLICIES, PROGRAMS, AND PRACTICES OF WHITLEY MEMORIAL HOSPITAL, INC. THE COUNCIL INCLUDES COMMUNITY MEMBERS FROM BOTH WHITLEY AND KOSCIUSKO COUNTIES AND HELPS THE HOSPITAL LEADERS TO UNDERSTAND THE PULSE OF THE COMMUNITY AND GUIDE DECISIONS THAT ENSURE THE COMMUNITY MEMBERS FELT SAFE WHEN COMING TO THE HOSPITAL. LONG WAIT TIMES AND VISITATION CHALLENGES WERE OTHER EXAMPLES OF TOPICS DISCUSSED. MEETINGS WERE LIMITED IN 2021 DUE TO COVID-19 BUT THE INTENT IS TO RETURN TO REGULAR MEETINGS IN 2022. WHITLEY MEMORIAL HOSPITAL, INC.'S CORE VALUES ARE DISPLAYED THROUGH MANY COMMUNITY EDUCATION AND OUTREACH PROGRAMS, AS WELL AS OUR CHARITY CARE SERVICES AND THE VOLUNTEERISM OF OUR EMPLOYEES. TO FURTHER ADDRESS THE SPECIFIC NEEDS OF THE COMMUNITY, PARKVIEW HEALTH ROUTINELY SPONSORS A PROFESSIONALLY ADMINISTERED COMMUNITY HEALTH NEEDS ASSESSMENT TO IDENTIFY HEALTH NEEDS WITHIN NORTHEAST INDIANA, PARTICULARLY, THE SEVEN COUNTIES IN WHICH PARKVIEW HOSPITALS ARE LOCATED. COMMUNITY HEALTH IMPROVEMENT INITIATIVES:WHITLEY MEMORIAL HOSPITAL, INC.'S COMMUNITY HEALTH IMPROVEMENT PROGRAM WAS ESTABLISHED TO HELP FUND COMMUNITY HEALTH IMPROVEMENT EFFORTS WITHIN WHITLEY MEMORIAL HOSPITAL'S SERVICE AREA. BY PARTNERING WITH COMMUNITY ORGANIZATIONS, THESE FUNDS ARE USED TO ENCOURAGE HEALTHIER LIFESTYLES AMONG THE CITIZENS OF WHITLEY COUNTY AND KOSCIUSKO COUNTY WITH A SPECIAL EMPHASIS ON ADDRESSING THE HEALTH ISSUES IDENTIFIED IN THE COMMUNITY HEALTH NEEDS ASSESSMENT. IN 2019, WHITLEY MEMORIAL COMPLETED A NEW COMMUNITY HEALTH NEEDS ASSESSMENT, AND THIS DATA WAS USED AS A BASIS FOR IDENTIFYING KEY COMMUNITY PARTNERSHIPS AND FUNDING FOR THE YEARS OF 2020-2022. WHITLEY MEMORIAL HOSPITAL, INC. INVESTS IN KEY ORGANIZATIONS THAT PROMOTE THE HEALTH AND WELL-BEING OF FAMILIES, CHILDREN, AND INDIVIDUALS OF THE COMMUNITIES THAT IT SERVES. PRIMARY HEALTH CARE/ACCESS:WHITLEY MEMORIAL HOSPITAL, INC. FEATURES 30 BEDS WITH ALL PRIVATE ROOMS. EMERGENCY MEDICAL CARE, OBSTETRIC, MEDICAL-SURGICAL, AND CONSTANT CARE UNITS ARE AVAILABLE AS WELL AS LABORATORY, MULTIPLE MODALITY IMAGING, SURGICAL SERVICES, ANTICOAGULATION UNIT, DIABETES EDUCATION AND OUTPATIENT INFUSION. AN ATTACHED MEDICAL OFFICE BUILDING PROVIDES CONVENIENT, EASY ACCESS FOR PATIENTS TO RECEIVE CARE FROM FAMILY AND SPECIALTY PHYSICIANS, AS WELL AS DIAGNOSTIC IMAGING SERVICES, SLEEP DISORDERS LAB AND PHYSICAL, OCCUPATIONAL, SPEECH AND CARDIAC REHABILITATION. WHITLEY MEMORIAL HOSPITAL, INC. MANAGES AND OPERATES EMS SERVICES FOR WHITLEY COUNTY WITH DEDICATED AMBULANCES AVAILABLE FOR EMERGENCY DISPATCH 24 HOURS, 7 DAYS PER WEEK. THERE WERE 5,971 EMS RUNS AND 4,133 PATIENT TRANSPORTS DURING 2021. EMS SERVICE WAS ON STANDBY FOR THE WHITLEY COUNTY HEALTH DEPARTMENT COVID-19 VACCINATION CLINIC AS WELL IN CASE OF EMERGENCY MEDICAL NEEDS.PARKVIEW WARSAW SERVICES INCLUDE A FREE-STANDING EMERGENCY DEPARTMENT WITH NINE ROOMS, TWO OF WHICH ARE EQUIPPED FOR TRAUMA PATIENTS. THE FACILITY ALSO PROVIDES A MULTI-MODALITY IMAGING DEPARTMENT, LABORATORY, OUTPATIENT PHYSICAL AND OCCUPATIONAL REHABILITATION AND ANTICOAGULATION CLINIC, AS WELL AS PRIMARY CARE AND SPECIALTY PHYSICIAN OFFICES. CONTINUED GROWTH OF SERVICES FOR KOSCIUSKO COUNTY HAS BEEN PLANNED SINCE THE CURRENT FACILITY OPENED IN 2016. APPROVAL WAS GIVEN BY PARKVIEW HEALTH BOARD OF DIRECTORS IN JANUARY 2020 FOR EXPANSION, BUT THE PROJECT WAS PUT ON HOLD DUE TO COVID-19. IN JUNE 2021, THE GREEN LIGHT WAS GIVEN TO MOVE FORWARD, AND GROUND WAS BROKEN IN NOVEMBER 2021. EXPANSION OF THE CURRENT FACILITY WILL ADD 88,000 SQUARE FEET FOR AN INPATIENT MEDICAL/SURGICAL UNIT, SURGICAL SERVICES, CANCER SERVICES, NON-CANCER IV INFUSION, SLEEP DISORDERS LABORATORY AND CARDIAC REHABILITATION. EMERGENCY DEPARTMENT RENOVATION WILL ADD 3 ROOMS AND LABORATORY WILL BE EXPANDED TO INCLUDE BLOOD BANK AND MORE TESTING SPACE. CAFETERIA AND PHARMACY SERVICES WILL BE ADDED AS WELL. SHELL SPACE ON THE THIRD FLOOR OF THE EXISTING STRUCTURE REMAINS FOR FUTURE NEEDS. THE HOSPITAL IS EXCITED TO OFFER FULL-SERVICE HOSPITAL CARE TO THE KOSCIUSKO COUNTY COMMUNITY MID-2023. | Desc |
| Total Program Service Expenses | $62,690,554 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (1) | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | 0 | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (1) | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | Yes (1) | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | 0 | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (1) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | Yes (1) | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| Info In Schedule O Part V | Yes (X) | InfoInScheduleOPartVInd |
| IRP Document | 29 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 429 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 13 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 8 | IndependentVotingMemberCnt |
| Family Or Business Rln | Yes (1) | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (1) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | 0 | CompensationProcessCEOInd |
| Compensation Process Other | 0 | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | IN | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | JEANNE' WICKENS | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 2602669313 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1450 PRODUCTION RD | AddressLine1Txt |
| City | FORT WAYNE | CityNm |
| State Abbreviation | IN | StateAbbreviationCd |
| ZIP | 468081167 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (22 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Key EmployeeKeyEmployeeInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd | Former Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd |
|---|---|---|---|---|---|---|---|---|---|---|
| MICHAEL PACKNETT | ||||||||||
| DIRECTOR/PH PRESIDENT & CEO | 0.00 | 40.00 | Yes (X) | Yes (X) | $0 | $2,037,606 | $326,073 | |||
| LISA HATCHER | ||||||||||
| DIRECTOR/PH PHYSICIAN | 0.00 | 40.00 | Yes (X) | $18,146 | $452,112 | $47,561 | ||||
| SCOTT GABRIEL | ||||||||||
| DIRECTOR/WMHOS PRESIDENT | 40.00 | 0.00 | Yes (X) | Yes (X) | $298,175 | $0 | $97,318 | |||
| DAVID LIEB | ||||||||||
| DIRECTOR | 1.00 | 0.00 | Yes (X) | $12,000 | $0 | $0 | ||||
| JAMES STAPEL | ||||||||||
| DIRECTOR/CHAIR/PH PHYSICIAN | 1.00 | 2.00 | Yes (X) | Yes (X) | $1,433 | $22,480 | $2,151 | |||
| JIM HEUER | ||||||||||
| DIRECTOR | 1.00 | 1.00 | Yes (X) | $4,500 | $0 | $0 | ||||
| SHAWN ELLIS | ||||||||||
| DIRECTOR/SECRETARY/TREASURER | 1.00 | 0.00 | Yes (X) | Yes (X) | $4,500 | $0 | $0 | |||
| JOSEPH KESSIE | ||||||||||
| DIRECTOR | 1.00 | 0.00 | Yes (X) | $4,250 | $0 | $0 | ||||
| GEORGE SCHRUMPF | ||||||||||
| DIRECTOR | 1.00 | 0.00 | Yes (X) | $4,000 | $0 | $0 | ||||
| DAVID SMITH | ||||||||||
| DIRECTOR | 1.00 | 1.00 | Yes (X) | $4,500 | $0 | $0 | ||||
| BRAD VOELZ | ||||||||||
| DIRECTOR/VICE CHAIR | 1.00 | 0.00 | Yes (X) | Yes (X) | $4,500 | $0 | $0 | |||
| LAURA MCDERMOTT | ||||||||||
| DIRECTOR | 1.00 | 0.00 | Yes (X) | $4,250 | $0 | $0 | ||||
| JANE WEAR | ||||||||||
| DIRECTOR | 1.00 | 0.00 | Yes (X) | $4,250 | $0 | $0 | ||||
| JEANNE' WICKENS | ||||||||||
| PH CHIEF FINANCIAL OFFICER | 0.00 | 40.00 | Yes (X) | $0 | $1,059,636 | $349,980 | ||||
| JEFFREY ROCKETT | ||||||||||
| WMHOS VP OUTPATIENT SVCS | 40.00 | 0.00 | $202,675 | $0 | $40,120 | Yes (X) | ||||
| ASHLEY WIRGES | ||||||||||
| WMHOS VP PATIENT CARE | 40.00 | 0.00 | $167,006 | $0 | $35,943 | Yes (X) | ||||
| AMANDA KNOWLES | ||||||||||
| WMHOS MGR PHARMACY | 40.00 | 0.00 | $182,507 | $0 | $45,193 | Yes (X) | ||||
| BENJAMIN MAGGARD | ||||||||||
| WMHOS PHARMACIST | 38.00 | 2.00 | $146,003 | $2,425 | $42,961 | Yes (X) | ||||
| PETER TALATI | ||||||||||
| WMHOS MGR REHAB | 40.00 | 0.00 | $139,056 | $0 | $34,053 | Yes (X) | ||||
| CHARLES JINKS | ||||||||||
| WMHOS PHARMACIST | 38.00 | 2.00 | $131,036 | $3,200 | $40,746 | Yes (X) | ||||
| BLAKE MAGGART | ||||||||||
| WMHOS NURSE LEAD | 39.00 | 1.00 | $132,837 | $915 | $27,233 | Yes (X) | ||||
| BRIDGET DOLOHANTY-JOHNSON | ||||||||||
| FORMER KEY EMPLOYEE | 0.00 | 0.00 | $356,219 | $0 | $0 | Yes (X) | ||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,821,843 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $3,578,374 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $1,089,332 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 27 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | Yes (1) | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| PARKVIEW HOSPITAL INC | |||||
| 11109 PARKVIEW PLAZA DR | FORT WAYNE | IN | 46845 | LABORATORY SERVICES | $3,578,874 |
| CLINICAL COLLEAGUES INC | |||||
| PO BOX 824246 | PHILADELPHIA | PA | 19182 | ANESTHESIOLOGISTS | $983,425 |
| PROFESSIONAL EMERGENCY PHYSICIANS INC | |||||
| 3640 NEW VISION DR SUITE A | FORT WAYNE | IN | 46845 | PHYSICIANS | $971,400 |
| FOCUSONE SOLUTIONS LLC | |||||
| 13609 CALIFORNIA ST | OMAHA | NE | 68154 | MEDICAL PERSONNEL | $609,961 |
| NORTHEAST INTERNAL MEDICINE ASSOC INC | |||||
| 2500 N DETROIT ST | LAGRANGE | IN | 46761 | HOSPITALISTS | $411,796 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 11 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $58,330 | RelatedOrganizationsAmt |
| Government Grants | $2,063,606 | GovernmentGrantsAmt |
| Total Contributions | $2,121,936 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (5 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| NET PATIENT REVENUE | 622000 | $95,094,378 | $95,094,378 |
| INTERUNIT RENT | 531120 | $1,006,948 | $1,006,948 |
| EMS SUBSIDY | 621910 | $250,000 | $250,000 |
| PHARMACY | 446110 | $120,838 | $120,838 |
| MASSAGE THERAPY CLINIC | 621990 | $55,640 | $55,640 |
Total Oth Program Service Rev TotalOthProgramServiceRevGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $3,465 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $3,465 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $96,531,269 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $979,979 | TotalRevenueColumnAmt |
| Exclusion | $979,979 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $39,847 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $150,391 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | -$110,544 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$110,544 | TotalRevenueColumnAmt |
| Exclusion | -$110,544 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $140,369,991 | SecuritiesAmt |
| Other | $25,000 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $136,753,739 | SecuritiesAmt |
| Other | $0 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $3,616,252 | SecuritiesAmt |
| Other | $25,000 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $3,641,252 | TotalRevenueColumnAmt |
| Exclusion | $3,641,252 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | ExclusionExclusionAmt |
|---|---|---|---|
| CAFETERIA REVENUE | 722514 | $278,714 | $278,714 |
| GIFT SHOP REVENUE | 453220 | $9,297 | $9,297 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $288,011 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $103,451,903 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $96,531,269 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $4,798,698 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $70,448 | TotalAmt |
| Program Services | $70,448 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,265,749 | TotalAmt |
| Management And General | $1,265,749 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $19,479,958 | TotalAmt |
| Program Services | $19,479,958 | ProgramServicesAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,078,304 | TotalAmt |
| Program Services | $6,078,304 | ProgramServicesAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $110,361 | TotalAmt |
| Management And General | $110,361 | ManagementAndGeneralAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $173,732 | TotalAmt |
| Management And General | $173,732 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,641,958 | TotalAmt |
| Program Services | $6,779,431 | ProgramServicesAmt |
| Management And General | $1,862,527 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,418,346 | TotalAmt |
| Program Services | $1,356,024 | ProgramServicesAmt |
| Management And General | $62,322 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,615 | TotalAmt |
| Program Services | $6,615 | ProgramServicesAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,064,994 | TotalAmt |
| Program Services | $4,037,228 | ProgramServicesAmt |
| Management And General | $27,766 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $14,838 | TotalAmt |
| Program Services | $12,822 | ProgramServicesAmt |
| Management And General | $2,016 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,187 | TotalAmt |
| Program Services | $5,187 | ProgramServicesAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $119,151 | TotalAmt |
| Program Services | $119,151 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,835,979 | TotalAmt |
| Program Services | $2,834,246 | ProgramServicesAmt |
| Management And General | $1,733 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $157,432 | TotalAmt |
| Program Services | $109,757 | ProgramServicesAmt |
| Management And General | $47,675 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Management And GeneralManagementAndGeneralAmt | Program ServicesProgramServicesAmt |
|---|---|---|---|
| CORP SERVICE ALLOCATION | $14,707,210 | $14,707,210 | |
| MEDICAL SUPPLIES | $9,036,556 | $9,036,556 | |
| PH CLINICAL SUPPORT | $8,881,644 | $8,881,644 | |
| HOSPITAL ASSESSMENT FEE | $3,803,934 | $3,803,934 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $227,658 | TotalAmt |
| Program Services | $79,249 | ProgramServicesAmt |
| Management And General | $59,615 | ManagementAndGeneralAmt |
| Fundraising | $88,794 | FundraisingAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $81,100,054 | TotalAmt |
| Program Services | $62,690,554 | ProgramServicesAmt |
| Management And General | $18,320,706 | ManagementAndGeneralAmt |
| Fundraising | $88,794 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,448 | BOYAmt |
| EOY | $3,448 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,359 | BOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $252,916 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $12,273,225 | BOYAmt |
| EOY | $15,725,497 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $716,022 | BOYAmt |
| EOY | $539,929 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $110,042 | BOYAmt |
| EOY | $110,699 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $43,832,575 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $20,324,821 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $21,348,116 | BOYAmt |
| EOY | $23,507,754 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $66,085,810 | BOYAmt |
| EOY | $73,230,823 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $27,573,899 | BOYAmt |
| EOY | $46,005,156 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $128,120,921 | BOYAmt |
| EOY | $159,376,222 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,857,586 | BOYAmt |
| EOY | $4,949,250 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,849,174 | BOYAmt |
| EOY | $2,458,570 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,806,500 | BOYAmt |
| EOY | $2,806,500 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,111,868 | BOYAmt |
| EOY | $13,351,170 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $17,625,128 | BOYAmt |
| EOY | $23,565,490 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $110,495,793 | BOYAmt |
| EOY | $135,810,732 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $110,495,793 | BOYAmt |
| EOY | $135,810,732 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $128,120,921 | BOYAmt |
| EOY | $159,376,222 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $22,351,849 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $2,722,513 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $240,577 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | Yes (1) | FederalGrantAuditRequiredInd |
| Federal Grant Audit Performed | Yes (1) | FederalGrantAuditPerformedInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | VolunteersInd |
| Paid Staff Or Management | 0 | PaidStaffOrManagementInd |
| Media Advertisements | 0 | MediaAdvertisementsInd |
| Mailings Members | 0 | MailingsMembersInd |
| Publications Or Broadcast | 0 | PublicationsOrBroadcastInd |
| Grants Other Organizations | 0 | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | 0 | DirectContactLegislatorsInd |
| Rallies Demonstrations | 0 | RalliesDemonstrationsInd |
| Other Activities | Yes (1) | OtherActivitiesInd |
| Other Activities | $5,822 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $5,822 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | 0 | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART II-B, LINE 1: | FormAndLineReferenceDesc |
| Explanation | REPRESENTS THE PORTION OF THE DUES PAID TO INDIANA HOSPITAL AND HEALTH ASSOCIATION, AMERICAN HOSPITAL ASSOCIATION AND VARIOUS PROFESSIONAL ASSOCIATIONS USED FOR LOBBYING ACTIVITIES. | ExplanationTxt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $260,483 | OtherCostOrOtherBasisAmt |
| Book Value | $260,483 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $14,853,613 | OtherCostOrOtherBasisAmt |
| Depreciation | $3,233,711 | DepreciationAmt |
| Book Value | $11,619,902 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $48,824 | OtherCostOrOtherBasisAmt |
| Depreciation | $48,824 | DepreciationAmt |
| Book Value | $0 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $22,553,084 | OtherCostOrOtherBasisAmt |
| Depreciation | $15,869,254 | DepreciationAmt |
| Book Value | $6,683,830 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $6,116,571 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,173,032 | DepreciationAmt |
| Book Value | $4,943,539 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $23,507,754 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp (3 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| DUE TO/FROM INTERUNIT | $43,360,034 |
| EMS SUBSIDY | $200,000 |
| RIGHT OF USE ASSETS | $2,445,122 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $46,005,156 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (4 entries)
| DescDesc | AmtAmt |
|---|---|
| NOTE PAYABLE TO PH | $6,893,500 |
| EST MEDICARE/MEDICAID SETTLEMENTS | $2,419,367 |
| EST 3RD PARTY SETTLEMENTS | $1,588,359 |
| LEASE LIABILITY | $2,449,944 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $13,351,170 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART X, LINE 2: | FormAndLineReferenceDesc |
| Explanation | PARKVIEW HEALTH SYSTEM, INC. AND SUBSIDIARIES - NOTES TO THE CONSOLIDATED FINANCIAL STATEMENTS TEXT OF THE FOOTNOTE TO THE ORGANIZATION'S FINANCIAL STATEMENTS THAT DESCRIBES THE LIABILITY FOR UNCERTAIN TAX POSITIONS UNDER FIN 48 (ASC 740): INCOME TAXES: THE INTERNAL REVENUE SERVICE HAS DETERMINED THAT THE CORPORATION AND CERTAIN AFFILIATED ENTITIES ARE TAX-EXEMPT ORGANIZATIONS AS DEFINED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. CERTAIN SUBSIDIARIES OF THE CORPORATION ARE TAXABLE ENTITIES, THE TAX EXPENSE AND LIABILITIES OF WHICH ARE NOT MATERIAL TO THE CONSOLIDATED FINANCIAL STATEMENTS. THE CORPORATION AND ITS TAX-EXEMPT AFFILIATED ENTITIES EACH FILE A FORM 990 (RETURN OF ORGANIZATION EXEMPT FROM INCOME TAX) ANNUALLY. WHEN THESE RETURNS ARE FILED, IT IS HIGHLY CERTAIN THAT SOME POSITIONS TAKEN WOULD BE SUSTAINED UPON EXAMINATION BY THE TAXING AUTHORITIES, WHILE OTHERS ARE SUBJECT TO UNCERTAINTY ABOUT THE MERITS OF THE POSITION TAKEN OR THE AMOUNT OF THE POSITION THAT WOULD ULTIMATELY BE SUSTAINED. EXAMPLES OF TAX POSITIONS COMMON TO HEALTH SYSTEMS INCLUDE SUCH MATTERS AS THE TAX-EXEMPT STATUS OF EACH ENTITY, THE CONTINUED TAX-EXEMPT STATUS OF BONDS, THE NATURE, CHARACTERIZATION AND TAXABILITY OF JOINT VENTURE INCOME, AND VARIOUS POSITIONS RELATING TO POTENTIAL SOURCES OF UNRELATED BUSINESS TAXABLE INCOME (REPORTED ON FORM 990T). AS OF DECEMBER 31, 2021 AND 2020, THERE ARE NO UNRECOGNIZED TAX BENEFITS RESULTING FROM UNCERTAIN TAX POSITIONS. FORMS 990 AND 990T FILED BY THE CORPORATION AND ITS TAX-EXEMPT AFFILIATED ENTITIES ARE SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE UP TO THREE YEARS FROM THE EXTENDED DUE DATE OF EACH RETURN. FORMS 990 AND 990T FILED BY THE CORPORATION AND ITS TAX-EXEMPT AFFILIATED ENTITIES ARE GENERALLY NO LONGER SUBJECT TO EXAMINATION FOR THE YEAR 2017 AND PRIOR. | ExplanationTxt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent200 | Yes (X) | Percent200Ind |
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
| Percent250 | Yes (X) | Percent250Ind |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | 0 | ExpensesExceedBudgetInd |
| Annual Community Bnft Report | Yes (1) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (1) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $916,094 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $916,094 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01270 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $6,970,409 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $5,182,412 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,787,997 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02480 | TotalExpensePct |
Unreimbursed Costs UnreimbursedCostsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $10,673,208 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $7,073,707 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $3,599,501 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.04980 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $18,559,711 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $12,256,119 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $6,303,592 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.08730 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $86,970 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $7,060 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $79,910 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00110 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $144,041 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $144,041 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00200 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $9,805,580 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $5,414,261 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $4,391,319 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.06080 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $101,132 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $101,132 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00140 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $10,137,723 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $5,421,321 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $4,716,402 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.06530 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $28,697,434 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $17,677,440 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $11,019,994 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.15260 | TotalExpensePct |
Economic Development EconomicDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,500 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $1,500 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,500 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $1,500 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $0 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $0 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $10,006,138 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $9,930,278 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | $75,860 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WHITLEY MEMORIAL HOSPITAL INC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1260 E STATE ROAD 205 | AddressLine1Txt |
| City | COLUMBIA CITY | CityNm |
| State Abbreviation | IN | StateAbbreviationCd |
| ZIP | 46725 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | WWW.PARKVIEW.COM | WebsiteAddressTxt |
| State License | 14-005090-1 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WHITLEY MEMORIAL HOSPITAL INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | 0 | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Prior CHNA Impact | Yes (X) | PriorCHNAImpactInd |
| CHNA Conducted | 19 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | Yes (1) | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | Yes (1) | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | HTTPS://WWW.PARKVIEW.COM/LOCALHEALTHNEEDS | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 19 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | HTTPS://WWW.PARKVIEW.COM/LOCALHEALTHNEEDS | StrategyWebsiteURLTxt |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 200.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 250.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Residency Criteria | Yes (X) | ResidencyCriteriaInd |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | HTTPS://WWW.PARKVIEW.COM/PATIENTS-VISITORS/FINANCIAL-ASSISTANCE | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | HTTPS://WWW.PARKVIEW.COM/PATIENTS-VISITORS/FINANCIAL-ASSISTANCE | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | HTTPS://WWW.PARKVIEW.COM/PATIENTS-VISITORS/FINANCIAL-ASSISTANCE | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| Notified FAP Copy Bill Display | Yes (X) | NotifiedFAPCopyBillDisplayInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| FAP Translated | Yes (X) | FAPTranslatedInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| Provided Written Notice | Yes (X) | ProvidedWrittenNoticeInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Made Presumptive Elig Determ | Yes (X) | MadePresumptiveEligDetermInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Look Back Medicare Private | Yes (X) | LookBackMedicarePrivateInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| WHITLEY MEMORIAL HOSPITAL, INC. | PART V, SECTION B, LINE 5: DESCRIBE HOW THE HOSPITAL FACILITY TOOK INTO ACCOUNT INPUT FROM PERSONS WHO REPRESENT THE COMMUNITY, AND IDENTIFY THE PERSONS THE HOSPITAL FACILITY CONSULTED:WHEN CONDUCTING ITS 2019 CHNA, PARKVIEW HEALTH SYSTEM, INC. (INCLUDING WHITLEY MEMORIAL HOSPITAL, INC.) AND THE INDIANA PARTNERSHIP FOR HEALTHY COMMUNITIES (IN-PHC) RESEARCH TEAM WERE DILIGENT IN ENSURING THE INPUT FROM PERSONS REPRESENTING THE BROADER INTERESTS OF THE COMMUNITY'S VULNERABLE POPULATIONS.IN GATHERING QUALITATIVE COMMUNITY INPUT, PARKVIEW HEALTH SYSTEM, INC. (INCLUDING WHITLEY MEMORIAL HOSPITAL, INC.) AND ITS RESEARCH PARTNERS OBTAINED THE FOLLOWING: 1) PRIMARY DATA COLLECTED VIA AN ONLINE SURVEY OF PARKVIEW HEALTH SYSTEM, INC. HEALTHCARE PROVIDERS (E.G., PHYSICIANS, NURSES, SOCIAL WORKERS, ETC.). ADDITIONALLY, THE HEALTH SYSTEM'S CHNA RESEARCH PARTNERS CONDUCTED A SURVEY OF THE COMMUNITY RESIDENTS IN EACH PARKVIEW HEALTH COUNTY. 2) SECONDARY DATA WAS GATHERED FROM CONDUENT'S HEALTHY COMMUNITIES INSTITUTE (HCI) DATABASE AND OTHER LOCAL AND NATIONAL AGENCIES. TO SUPPLEMENT THESE DATA, A FOCUS GROUP WAS CONDUCTED WITH HISPANIC COMMUNITY MEMBERS IN KOSCIUSKO. IN ADDITION TO DATA COLLECTION, WHITLEY MEMORIAL HOSPITAL, INC. TURNED TO THE COMMUNITY AND PARTNERING ORGANIZATIONS WHEN SELECTING AND PRIORITIZING WHITLEY COUNTY'S HEALTH NEEDS. IN DOING SO, A MODIFIED HANLON METHOD PRIORITIZED HEALTH CONCERNS FOR PARKVIEW HEALTH HOSPITAL COMMUNITIES. THIS METHOD, ALSO KNOWN AS THE BASIC PRIORITY RATING SYSTEM (BPRS) 2.0, IS RECOMMENDED BY THE NATIONAL ASSOCIATION OF COUNTY AND CITY HEALTH OFFICIALS (NACCHO) FOR PRIORITIZING COMMUNITY HEALTH NEEDS (GUIDE-TO-PRIORITIZATION-TECHNIQUES.PDF, N.D.). ALTHOUGH COMPLEX TO IMPLEMENT, IT IS USEFUL WHEN THE DESIRED OUTCOME IS AN OBJECTIVELY SELECTED LIST. EXPLICIT IDENTIFICATION OF FACTORS MUST BE CONSIDERED TO SET PRIORITIES WHICH ENABLES A TRANSPARENT AND REPLICABLE PROCESS. PRIORITY SCORES ARE CALCULATED BASED ON THE SIZE OF THE HEALTH PROBLEM, SERIOUSNESS OF THE HEALTH PROBLEM AND THE AVAILABILITY OF EFFECTIVE HEALTH INTERVENTIONS.THE INDIANA PARTNERSHIP FOR HEALTHY COMMUNITIES PRESENTED AN OVERVIEW OF THE REGIONAL CHNA FINDINGS ON JULY 16, 2019, TO ATTENDEES REPRESENTING THE PARKVIEW HEALTH SYSTEM. IN TOTAL, OVER 60 INDIVIDUALS PARTICIPATED IN THE PRIORITIZATION PROCESS, INCLUDING REPRESENTATIVES FROM HOSPITAL SERVICE LINES, COMMUNITY HOSPITALS, HEALTHCARE PROVIDERS/PHYSICIANS, EXECUTIVE LEADERSHIP TEAM, COMMUNITY HEALTH AND HOSPITAL BOARD OF DIRECTORS. AFTER A THOROUGH REVIEW OF THE DATA AND CONSIDERABLE DISCUSSION, THE GROUP USED AN ELECTRONIC VOTING SYSTEM TO RANK THE VARIOUS HEALTH NEEDS IDENTIFIED IN THE CHNA. ULTIMATELY, THE GROUP VOTED ON SUBSTANCE USE DISORDER/MENTAL HEALTH AS THE SHARED HEALTH PRIORITY ACROSS THE HEALTH SYSTEM.ADDITIONALLY, WHITLEY MEMORIAL HOSPITAL, INC. CHOSE TO CONTINUE THE FOCUS ON OBESITY TO KEEP THE MOMENTUM GOING WITH THIS INITIATIVE. THE BOARD-DRIVEN COMMUNITY HEALTH IMPROVEMENT COMMITTEE AGREED WITH THIS DIRECTION. |
| WHITLEY MEMORIAL HOSPITAL, INC. | PART V, SECTION B, LINE 6A: THE HOSPITAL FACILITY'S CHNA WAS CONDUCTED WITH THE FOLLOWING HOSPITAL FACILITIES:PARKVIEW HOSPITAL, INC. (EIN 35-0868085); COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC. (EIN 20-2401676); HUNTINGTON MEMORIAL HOSPITAL, INC. (EIN 35-1970706); COMMUNITY HOSPITAL OF NOBLE COUNTY, INC. (EIN 35-2087092); PARKVIEW WABASH HOSPITAL, INC. (EIN 47-1753440) AND ORTHOPAEDIC HOSPITAL AT PARKVIEW NORTH, LLC (EIN 26-0143823). |
| WHITLEY MEMORIAL HOSPITAL, INC. | PART V, SECTION B, LINE 6B: THE HOSPITAL FACILITY'S CHNA WAS ALSO CONDUCTED WITH THE FOLLOWING ORGANIZATIONS OTHER THAN HOSPITAL FACILITIES:PARKVIEW HEALTH, INC. (EIN 35-1972384); INDIANA PARTNERSHIP FOR HEALTHY COMMUNITIES (A PARTNERSHIP BETWEEN THE INDIANA UNIVERSITY RICHARD M. FAIRBANKS SCHOOL OF PUBLIC HEALTH AND THE POLIS CENTER AT IUPUI) AND CONDUENT HEALTHY COMMUNITIES INSTITUTE. |
| WHITLEY MEMORIAL HOSPITAL, INC. | PART V, SECTION B, LINE 11: DESCRIBE HOW THE HOSPITAL FACILITY IS ADDRESSING THE SIGNIFICANT NEEDS IDENTIFIED IN ITS MOST RECENTLY CONDUCTED CHNA AND ANY SUCH NEEDS THAT ARE NOT BEING ADDRESSED TOGETHER WITH THE REASONS WHY SUCH NEEDS ARE NOT BEING ADDRESSED:SIGNIFICANT HEALTH NEEDS BEING ADDRESSED:DRUG AND ALCOHOL ABUSE AND ADDICTION -- WHITLEY MEMORIAL HOSPITAL, INC. WORKS CLOSELY WITH COMMUNITY PARTNERS TO ADDRESS ADDICTIONS AND MENTAL HEALTH. THEY WORK WITH PARKVIEW BEHAVIORAL HEALTH TO ASSIST WITH PATIENT AND COMMUNITY MENTAL HEALTH NEEDS. WHITLEY COUNTY HAS A VERY LIMITED NUMBER OF MENTAL HEALTH RESOURCES AND SUBSTANCE ABUSE FACILITIES, AND THIS POSES CHALLENGES IN PARTNERSHIP CAPABILITIES. TO HELP ADDRESS AND PREVENT SUBSTANCE ABUSE ISSUES IN THE COMMUNITY, IN 2020 THE HOSPITAL PARTNERED WITH THE LARGEST SCHOOL SYSTEM IN THE COUNTY TO PROVIDE FUNDING FOR ADDITIONAL MENTAL HEALTH SERVICES FOR STUDENTS. UNFORTUNATELY, COVID PREVENTED THE SCHOOL SYSTEM FROM BEING ABLE TO PUT THOSE DOLLARS INTO ACTION FOR QUITE SOME TIME. THEIR PLAN IS TO UTILIZE THOSE FUNDS IN 2022. IN 2021 THE HOSPITAL ALSO PARTNERED WITH MISSION 25, A LOCAL TRANSITIONAL HOUSING FACILITY THAT NOT ONLY HELPS THOSE THAT ARE HOMELESS BUT HELPS THEM TO GAIN THE TOOLS THEY NEED TO LIVE ON THEIR OWN. ASSISTING WITH JOBS, MENTAL HEALTH AND ADDICTIONS OBSTACLES AND EDUCATION ON NUTRITION, MONEY MANAGEMENT AND SO MUCH MORE. IN 2021, 92% OF THEIR RESIDENTS RECEIVED INDIVIDUAL OR GROUP THERAPY. 73% OF THOSE SERVED AND ASSESSED HAD A SUBSTANCE ABUSE DISORDER DIAGNOSIS AND MAINTAINED THEIR RECOVERY. MENTAL HEALTH -- MENTAL HEALTH IS OFTEN CLOSELY TIED TO ALCOHOL AND DRUG ABUSE AND, IN MANY INSTANCES, SUBSTANCE ABUSE STEMS FROM AN UNDERLYING MENTAL HEALTH CONDITION. BECAUSE OF THE DIRECT CORRELATION BETWEEN THE TWO, WHITLEY MEMORIAL HOSPITAL, INC. BELIEVES THEIR PARTNERSHIP OF PROVIDING MENTAL HEALTH RESOURCES TO COMMUNITY HIGH SCHOOL STUDENTS WILL HELP ADDRESS BOTH ISSUES. PLEASE SEE ABOVE NARRATIVE REGARDING THIS HEALTH NEED. THE HOSPITAL ALSO PARTNERS WITH THE CENTER FOR WHITLEY COUNTY YOUTH, A LOCAL ORGANIZATION THAT PROVIDES MEALS, ACTIVITIES AND SUPPORT FOR THE TEEN POPULATION IN ALL THREE COUNTY SCHOOLS. THEY SERVE HEALTHY SNACKS AFTER SCHOOL AND BALANCED DINNERS. HAVING ADULT MENTORS WHO PROVIDE POSITIVE REINFORCEMENT AND GUIDE THEM IN MAKING POSITIVE CHOICES MAKES A HUGE DIFFERENCE FOR THESE AT-RISK STUDENTS. IN 2021 THE CENTER SERVED 650 STUDENTS, WHICH WAS A 66% INCREASE OVER 2020. THE STUDENTS ARE SURVEYED TWICE ANNUALLY AND IN THE FALL 2021 SURVEY 86% FELT VALUED AND APPRECIATED BY OTHERS. OBESITY -- WHITLEY MEMORIAL HOSPITAL, INC. WILL SERVE AS A COMMUNITY LEADER PARTNERING WITH OTHER KEY COMMUNITY ORGANIZATIONS TO PROMOTE A CULTURE OF HEALTHY DECISIONS THAT INCLUDES ACTIVE LIVING AND HEALTHY EATING. THE HOSPITAL CONTINUES TO BUILD RELATIONSHIPS WITH ORGANIZATIONS THAT SERVE CHILDREN AND OR UNDERSERVED POPULATIONS. WE ALSO FOCUS ON OPPORTUNITIES FOR COMMUNITY MEMBERS TO BETTER MONITOR THEIR HEALTH WITH LOW-COST OR NO-COST EDUCATIONAL AND SCREENING EVENTS. IN 2021, FINANCIAL SUPPORT WAS GIVEN TO THE DIABETES PREVENTION PROGRAM (DPP) AT THE PARKVIEW WARSAW YMCA. THIS EVIDENCE-BASED PROGRAM WORKS WITH INDIVIDUALS THAT ARE AT RISK FOR DIABETES. THIS PROGRAM HELPS ADULTS LOSE 5-7% OF THEIR BODY WEIGHT THROUGH HEALTHIER EATING AND INCREASED PHYSICAL ACTIVITY. WHITLEY MEMORIAL HOSPITAL, INC. ALSO PARTNERED WITH A LOCAL ORGANIZATION, ONE COMMUNITY, THAT OFFERS FREE LUNCHES AND ACTIVITIES TO SOUTH WHITLEY SCHOOL-AGE CHILDREN IN THE SUMMER. MANY OF THE CHILDREN IN THE PROGRAM ARE HOME ALONE THROUGHOUT THE DAY. THE KIDS CONNECT PROGRAM PROVIDES THEM WITH A MEAL, FUN AND, MOST IMPORTANTLY, POSITIVE ROLE MODELS. EATING A HEALTHY MEAL AND GETTING EXERCISE HELPS THEM ON THEIR PATH TO BEING HEALTHY ADULTS. IN 2021, THE KIDS CONNECT PROGRAM SERVED 823 MEALS TO LOCAL CHILDREN. THERE WERE 57 PARTICIPANTS AND 95% OF THOSE STAYED FOR THE DAILY ACTIVITIES THAT PROVIDE PHYSICAL ACTIVITY AND SOCIAL INTERACTIONS. WHITLEY MEMORIAL HOSPITAL, INC. PROVIDED LUNCHES FOR TROY CENTER SCHOOL AT NO COST TO ENSURE NUTRITIOUS MEALS ARE AVAILABLE TO EACH STUDENT THROUGH THE SPRING OF 2021. TROY CENTER IS AN ACCREDITED, INDEPENDENT ALTERNATIVE SCHOOL HELPING STUDENTS GAIN AN EDUCATION AND EARN A DIPLOMA AT THEIR OWN PACE, PROVIDING AN EDUCATIONAL OPTION FOR THOSE WHOSE LEARNING/BEHAVIORAL NEEDS WERE NOT BEING MET IN A TRADITIONAL SCHOOL SETTING. FOR THE 2021-2022 SCHOOL YEAR, A COMMUNITY HEALTH IMPROVEMENT GRANT WAS AWARDED IN LIEU OF THE FREE MEAL PROGRAM. WHITLEY MEMORIAL HOSPITAL, INC. SUPPORTED THE WHITLEY COUNTY FARMERS MARKET. THE DOWNTOWN COLUMBIA CITY SATURDAY MARKETS PROVIDE LOCALLY GROWN FRESH FRUITS AND VEGETABLES IN SEASON FOR SALE TO THE COMMUNITY EVERY SATURDAY. THE FARMERS MARKET ACCEPTS SNAP AND WIC AS PAYMENT, WHICH IS VERY BENEFICIAL TO LOW-INCOME FAMILIES IN THE COMMUNITY. TO FURTHER INCREASE ACCESS TO FRESH, HEALTHY PRODUCE TO THE COMMUNITY, WHITLEY MEMORIAL HOSPITAL, INC., ALSO, HOSTS A MID-WEEK FARMERS' MARKET ON ITS CAMPUS DURING THE SUMMER, GENERALLY JULY-SEPTEMBER. A WEIGHT LOSS SUPPORT GROUP WAS OFFERED BY WHITLEY MEMORIAL HOSPITAL, INC. FOR THE PUBLIC AND INCLUDED 70 PARTICIPANTS THROUGHOUT THE YEAR. THIS PROGRAM HAS BEEN IN PLACE FOR MANY YEARS AND HAS BEEN QUITE SUCCESSFUL.CARDIOVASCULAR DISEASE -- WHITLEY MEMORIAL HOSPITAL, INC. OFFERS THREE CHECK-UP DAYS PER YEAR TO HELP PATIENTS MONITOR SUCH THINGS AS CHOLESTEROL LEVELS, BLOOD PRESSURE AND OTHER CARDIOVASCULAR FACTORS. THIS EVENT PROVIDED REDUCED-FEE LABORATORY TESTING FOR 203 COMMUNITY MEMBERS IN 2021. IN ADDITION, THE PARKVIEW WARSAW CENTER FOR HEALTHY LIVING COORDINATED TWO EVENTS DURING THE YEAR AT THE PARKVIEW WARSAW YMCA WITH 94 PARTICIPANTS. THESE EVENTS ARE WELL KNOWN IN THE COMMUNITY AND OFFER A VALUABLE SERVICE, ESPECIALLY TO THOSE WHO ARE UNINSURED OR UNDER-INSURED. ADDITIONALLY, THE HOSPITAL'S OUTPATIENT THERAPY DEPARTMENT PROVIDES AN EXCELLENT CARDIAC REHABILITATION PROGRAM TO HELP PATIENTS REGAIN THEIR STRENGTH AND QUALITY OF LIFE AFTER A CARDIAC EVENT OR SURGERY. DURING 2021, THE PROGRAM IMPACTED 160 PATIENTS.MULTI-COUNTY MEDICAL OUTREACH CLINIC RECEIVES IN-KIND LAB SERVICES THROUGH WHITLEY MEMORIAL HOSPITAL, INC. TO SERVE THE NEEDS OF THEIR UNINSURED PATIENTS. THEY ALSO RECEIVE IN-KIND SPACE FROM PARKVIEW HEALTH SYSTEM TO OPERATE THEIR FREE MEDICAL CLINIC. MATERNAL/CHILD HEALTH -- IN WHITLEY COUNTY, HEALTH INDICATORS HAVE SHOWN AN INCREASED NUMBER OF CHILD ABUSE AND NEGLECT CASES IN THE COMMUNITY. WE FEEL STRONGLY THAT THIS MAY BE DIRECTLY TIED TO THE MENTAL HEALTH AND ADDICTIONS INDICATOR, AND THUS MAY BE IMPACTED DIRECTLY BY THE FOCUS ON THOSE AREAS. WE PARTNER WITH BEDS & BRITCHES (BABE) WHICH IS A COUPON -BASED INCENTIVE PROGRAM THAT ALLOWS PARENTS TO PURCHASE ITEMS FOR THEIR YOUNGSTERS. BY TAKING CHILDREN TO THEIR DOCTOR, OR DENTIST OR LIBRARY, FOR EXAMPLE, THEY ARE ABLE TO PURCHASE CLOTHING, CAR SEATS, DIAPERS AND MUCH MORE. THEY ALSO OFFER MOMS GROUPS AND MANY EDUCATIONAL OPPORTUNITIES FOR PARENTS. COUPON REDEMPTION INCREASED FROM 4,470 IN 2020 TO 8,201 IN 2021. WHITLEY MEMORIAL HOSPITAL, INC. SERVES AS A COMMUNITY LEADER PARTNERING WITH OTHER KEY COMMUNITY ORGANIZATIONS TO PROMOTE A CULTURE OF HEALTHY DECISIONS THAT PROMOTE THE SAFETY AND WELL-BEING OF INFANTS AND CHILDREN BEFORE AND AFTER THEIR BIRTH. THE HOSPITAL WILL CONTINUE TO ESTABLISH NEW PROGRAMS AND FOSTER EXISTING PROGRAMS AND RELATIONSHIPS WITH OTHER ORGANIZATIONS. THE FAMILY BIRTHING CENTER CURRENTLY OFFERS LAMAZE CHILDBIRTH EDUCATION, BREASTFEEDING CLASSES AND A BREASTFEEDING SUPPORT GROUP FOR NEW MOTHERS. ADDITIONALLY, CERTIFIED CO-WORKERS PROVIDE INFANT CAR SEAT SAFETY INSPECTIONS AND INSTRUCTION TO PARENTS AT VARIOUS COMMUNITY LOCATIONS THROUGHOUT THE YEAR TO SHOW THE CORRECT INSTALLATION AND USE OF CAR SEATS FOR PROMOTION OF CHILD SAFETY. SIXTY-FIVE FAMILIES TOOK ADVANTAGE OF THIS TRAINING. WHITLEY MEMORIAL HOSPITAL, INC. PROVIDED SUPPORT TO A PROGRAM CALLED LAUNCHPAD (FORMERLY CHILDCARE COALITION). LAUNCHPAD IS A CHILD CARE AND EARLY LEARNING COALITION ESTABLISHED IN 2018 UNDER THE KOSCIUSKO CHAMBER OF COMMERCE. THE COALITION WAS FORMED TO INCREASE CAPACITY AND ACCESS TO HIGH-QUALITY CHILD CARE AND EARLY LEARNING FOR KOSCIUSKO COUNTY FAMILIES. IN REGARD TO WOMEN'S HEALTH, WHITLEY MEMORIAL HOSPITAL, INC., AND THE WHITLEY COUNTY COMMUNITY FOUNDATION PARTNER TOGETHER TO PROVIDE FREE MAMMOGRAPHY SCREENING TO WOMEN WHO ARE UNINSURED OR UNDERINSURED. THROUGH THE WOMEN'S GIVING CIRCLE, A FUND OF THE WHITLEY COUNTY COMMUNITY FOUNDATION, VOUCHERS ARE GIVEN TO WOMEN WHO ARE UNINSURED OR UNDERINSURED WHICH CAN BE REDEEMED AT THE HOSPITAL FOR MAMMOGRAMS. (SEE PART V, SECTION B, LINE 11 CONT'D: FOR CONTINUATION OF NARRATIVE) |
| PART V, SECTION B, LINE 3E: | THE SIGNIFICANT HEALTH NEEDS ARE A PRIORITIZED DESCRIPTION OF THE SIGNIFICANT HEALTH NEEDS OF THE COMMUNITY AND IDENTIFIED THROUGH THE CHNA. |
| PART V, SECTION B, LINE 11 CONT'D: | OTHER HEALTH NEEDS NOT BEING ADDRESSED:TOBACCO USE -- WHITLEY MEMORIAL HOSPITAL, INC. PROVIDES INFORMATION, CLASSES AND MATERIALS TO THOSE PATIENTS WHO WISH TO ADDRESS THIS BEHAVIOR. IN WHITLEY COUNTY, THERE ARE NOT CURRENTLY ANY ORGANIZATIONS WITH PROGRAMS SPECIFICALLY DESIGNED TO ADDRESS TOBACCO USE. KOSCIUSKO COUNTY HAS A PROGRAM AND THEY ARE WORKING DILIGENTLY TO MAINTAIN EFFECTIVE PROGRAMMING THAT HAS CONSISTENT RESULTS FOR EXPECTANT MOMS AND AREA STUDENTS. AGING-ALZHEIMER'S DISEASE -- THIS AREA OF CONCERN IS NEW ON OUR "TOP TEN" LIST OF CONCERNS. HOWEVER, WITH AN AGING POPULATION, ITS APPEARANCE IS NOT SURPRISING. WHITLEY MEMORIAL HOSPITAL, INC. WILL CONTINUE TO WORK WITH ORGANIZATIONS FOCUSED ON SERVING OUR SENIOR POPULATION. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | 1 - PWH EMS | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1250 E STATE ROAD 205 | AddressLine1Txt |
| City | COLUMBIA CITY | CityNm |
| State Abbreviation | IN | StateAbbreviationCd |
| ZIP | 46725 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | AMBULANCE SERVICES | FacilityTxt |
Supplemental Information Detail SupplementalInformationDetail (17 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 3C: | EQUITY IN A HOME OTHER THAN THE PATIENT OR GUARANTOR'S PRIMARY RESIDENCE. |
| PART I, LINE 6A: | THE RELATED ENTITIES OF PARKVIEW HEALTH SYSTEM, INC. (EIN 35-1972384); PARKVIEW HOSPITAL, INC. (EIN 35-0868085); COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC. (EIN 20-2401676); COMMUNITY HOSPITAL OF NOBLE COUNTY, INC. (EIN 35-2087092); HUNTINGTON MEMORIAL HOSPITAL, INC. (EIN 35-1970706); WHITLEY MEMORIAL HOSPITAL, INC. (EIN 35-1967665); DEKALB MEMORIAL HOSPITAL, INC. (EIN 35-1064295; PARK CENTER, INC. (EIN 35-1135451); AND PARKVIEW WABASH HOSPITAL, INC. (EIN 47-1753440) PREPARED A COMBINED REPORT TO THE COMMUNITY DETAILING COMMUNITY BENEFIT PROGRAMS AND SERVICES. |
| PART I, LINE 7: | PART I, LINE 7ATHE FINANCIAL ASSISTANCE COST REPORTED ON LINE 7A IS CALCULATED UNDER THE COST TO CHARGE RATIO METHODOLOGY. UNDER THIS METHOD, THE FINANCIAL ASSISTANCE CHARGES FOREGONE ARE MULTIPLIED BY THE RATIO OF COST TO CHARGES TO DETERMINE THE COST OF SERVICES RENDERED.PART I, LINE 7BWHITLEY MEMORIAL HOSPITAL, INC. ACCEPTS ALL MEDICAID, MEDICAID MANAGED CARE, AND OUT-OF-STATE MEDICAID PATIENTS WITH THE KNOWLEDGE THAT THERE MAY BE SHORTFALLS. INTERNAL REVENUE SERVICE (IRS) REVENUE RULING 69-545 IMPLIES THAT TREATING MEDICAID PATIENTS IS A COMMUNITY BENEFIT. IRS REVENUE RULING 69-545, WHICH ESTABLISHED THE COMMUNITY BENEFIT STANDARD FOR NONPROFIT HOSPITALS, STATES THAT IF A HOSPITAL SERVES PATIENTS WITH GOVERNMENTAL HEALTH BENEFITS, INCLUDING MEDICAID, THEN THIS IS AN INDICATION THAT THE HOSPITAL OPERATES TO PROMOTE THE HEALTH OF THE COMMUNITY. THE UNREIMBURSED MEDICAID COST REPORTED ON LINE 7B IS CALCULATED UNDER THE COST TO CHARGE RATIO METHODOLOGY. UNDER THIS METHOD, THE MEDICAID CHARGES ARE MULTIPLIED BY THE RATIO OF COST TO CHARGES TO DETERMINE THE COST OF MEDICAID SERVICES RENDERED. THEN, THE COST OF MEDICAID SERVICES RENDERED IS DEDUCTED FROM THE REIMBURSEMENT RECEIVED FOR MEDICAID PATIENTS TO ARRIVE AT A GAIN/(LOSS) RELATIVE TO THESE PATIENTS.PART I, LINE 7CWHITLEY MEMORIAL HOSPITAL, INC. ACCEPTS ALL MEANS-TESTED PATIENTS FROM THE HEALTHY INDIANA PLAN (HIP) WITH THE KNOWLEDGE THAT THERE MAY BE SHORTFALLS. INTERNAL REVENUE SERVICE (IRS) REVENUE RULING 69-545 IMPLIES THAT TREATING MEANS-TESTED PATIENTS IS A COMMUNITY BENEFIT. IRS REVENUE RULING 69-545, WHICH ESTABLISHED THE COMMUNITY BENEFIT STANDARD FOR NONPROFIT HOSPITALS, STATES THAT IF A HOSPITAL SERVES PATIENTS WITH GOVERNMENTAL HEALTH BENEFITS, INCLUDING HIP, THEN THIS IS AN INDICATION THAT THE HOSPITAL OPERATES TO PROMOTE THE HEALTH OF THE COMMUNITY. THE UNREIMBURSED HIP COST REPORTED ON LINE 7C IS CALCULATED UNDER THE COST TO CHARGE RATIO METHODOLOGY. UNDER THIS METHOD, THE HIP CHARGES ARE MULTIPLIED BY THE RATIO OF COST TO CHARGES TO DETERMINE THE COST OF HIP SERVICES RENDERED. THEN, THE COST OF HIP SERVICES RENDERED IS DEDUCTED FROM THE REIMBURSEMENT RECEIVED FOR HIP PATIENTS TO ARRIVE AT A GAIN/(LOSS) RELATIVE TO THESE PATIENTS.PART I, LINE 7EAMOUNTS PRESENTED ARE BASED ON ACTUAL SPEND FOR THOSE SERVICES AND BENEFITS PROVIDED DEEMED TO IMPROVE THE HEALTH OF THE COMMUNITIES IN WHICH WE SERVE AND CONFORM WITH THE MISSION OF OUR EXEMPT PURPOSE.PART I, LINE 7FAMOUNTS PRESENTED ARE BASED UPON ACTUAL SPEND AND ARE IN CONFORMITY WITH AGREED UPON COMMITMENTS WITH THE VARIOUS EDUCATIONAL PROGRAMS.PART I, LINE 7GAMOUNTS PRESENTED DO NOT INCLUDE ANY COSTS ASSOCIATED WITH PHYSICIAN CLINICS.PART I, LINE 7IIN KEEPING WITH OUR MISSION AND COMMITMENT TO THE COMMUNITIES IN WHICH WE SERVE, WHITLEY MEMORIAL HOSPITAL, INC. CONTINUES ITS TRADITION OF CONTRIBUTING TO NUMEROUS ORGANIZATIONS ON BOTH AN AS-NEEDED BASIS AND NEGOTIATED BASIS. AMOUNTS PRESENTED REPRESENT ACTUAL SPEND TO ORGANIZATIONS THROUGHOUT OUR COMMUNITIES. |
| PART I, LN 7 COL(F): | PERCENT OF TOTAL EXPENSEWHITLEY MEMORIAL HOSPITAL, INC. EXCLUDED $8,881,645 OF PH CLINICAL SUPPORT EXPENSE. |
| PART II, COMMUNITY BUILDING ACTIVITIES: | DESCRIBE HOW THE ORGANIZATION'S COMMUNITY BUILDING ACTIVITIES, AS REPORTED, PROMOTES THE HEALTH OF THE COMMUNITIES THE ORGANIZATION SERVES.WHITLEY MEMORIAL HOSPITAL, INC. PROVIDES SUPPORT FOR LOCAL ECONOMIC DEVELOPMENT PROGRAMS. THESE EFFORTS ARE ALIGNED WITH THE HEALTH SYSTEM'S STRATEGIC INVOLVEMENT IN THE NORTHEAST INDIANA REGIONAL PARTNERSHIP'S VISION 2030, A REGIONAL INITIATIVE DESIGNED TO TRANSFORM NORTHEAST INDIANA INTO A TOP GLOBAL COMPETITOR BY FOCUSING ON A COMMON MISSION TO DEVELOP, ATTRACT AND RETAIN TALENT. VISION 2030'S REGIONAL PRIORITIES ARE TIED TO EDUCATION/WORKFORCE, BUSINESS CLIMATE, ENTREPRENEURSHIP, INFRASTRUCTURE, AND QUALITY OF LIFE FOR THE ELEVEN-COUNTY REGION IN NORTHEAST INDIANA. PROMOTION OF ECONOMIC AND LEADERSHIP DEVELOPMENT IN WHITLEY COUNTY AND KOSCIUSKO COUNTY IS A PART OF A COLLECTIVE PLAN TO IMPROVE THE QUALITY OF LIFE AND ULTIMATELY THE OVERALL HEALTH AND WELL-BEING OF THE COMMUNITY. |
| PART III, LINE 2: | FOR FINANCIAL STATEMENT PURPOSES, THE ORGANIZATION HAS ADOPTED ACCOUNTING STANDARDS UPDATE NO. 2014-09 (TOPIC 606). IMPLICIT PRICE CONCESSIONS INCLUDES BAD DEBTS. THEREFORE, BAD DEBTS ARE INCLUDED IN NET PATIENT REVENUE IN ACCORDANCE WITH HEALTHCARE FINANCIAL MANAGEMENT ASSOCIATION STATEMENT NO. 15 AND BAD DEBT EXPENSE IS NOT SEPARATELY REPORTED AS AN EXPENSE. |
| PART III, LINE 4: | BAD DEBT EXPENSE - PARKVIEW HEALTH SYSTEM, INC. AND SUBSIDIARIES - NOTES TO THE CONSOLIDATED FINANCIAL STATEMENTSTEXT OF THE FOOTNOTE TO THE ORGANIZATION'S FINANCIAL STATEMENTS THAT DESCRIBES BAD DEBT EXPENSE OR THE PAGE NUMBER ON WHICH THIS FOOTNOTE IS CONTAINED IN THE ATTACHED FINANCIAL STATEMENTS:PAGES 12 AND 23 - 26 OF ATTACHED FINANCIAL STATEMENTS. |
| PART III, LINE 8: | COMMUNITY BENEFIT & METHODOLOGY FOR DETERMINING MEDICARE COSTSSUBSTANTIAL SHORTFALLS TYPICALLY ARISE FROM PAYMENTS THAT ARE LESS THAN THE COST TO PROVIDE THE CARE OR SERVICES AND DO NOT INCLUDE ANY AMOUNTS RELATING TO INEFFICIENT OR POOR MANAGEMENT. WHITLEY MEMORIAL HOSPITAL, INC. ACCEPTS ALL MEDICARE PATIENTS, AS REFLECTED ON THE YEAR-END MEDICARE COST REPORT, WITH THE KNOWLEDGE THAT THERE MAY BE SHORTFALLS. INTERNAL REVENUE SERVICE (IRS) REVENUE RULING 69-545 IMPLIES THAT TREATING MEDICARE PATIENTS IS A COMMUNITY BENEFIT. IRS REVENUE RULING 69-545, WHICH ESTABLISHED THE COMMUNITY BENEFIT STANDARD FOR NONPROFIT HOSPITALS, STATES THAT IF A HOSPITAL SERVES PATIENTS WITH GOVERNMENTAL HEALTH BENEFITS, INCLUDING MEDICARE, THEN THIS IS AN INDICATION THAT THE HOSPITAL OPERATES TO PROMOTE THE HEALTH OF THE COMMUNITY. HOWEVER, MEDICARE PAYMENTS REPRESENT A PROXY OF COST CALLED THE "UPPER PAYMENT LIMIT." IT HAS HISTORICALLY BEEN ASSUMED THAT UPPER PAYMENT LIMIT PAYMENTS DO NOT GENERATE A SHORTFALL. AS A RESULT, WHITLEY MEMORIAL HOSPITAL, INC. HAS TAKEN THE POSITION NOT TO INCLUDE THE MEDICARE SHORTFALLS OR SURPLUSES AS PART OF COMMUNITY BENEFIT. WHITLEY MEMORIAL HOSPITAL, INC. RECOGNIZES THAT THE SHORTFALL OR SURPLUS FROM MEDICARE DOES NOT INCLUDE THE COSTS AND REVENUES ASSOCIATED WITH MEDICARE ADVANTAGE PATIENTS. AS SUCH, THE TOTAL SHORTFALL OR SURPLUS OF MEDICARE IS UNDERSTATED DUE TO THE COSTS AND REVENUES ASSOCIATED WITH MEDICARE ADVANTAGE PATIENTS NOT BEING INCLUDED IN THE COMMUNITY BENEFIT DETERMINATION. |
| PART III, LINE 9B: | A PATIENT'S FAILURE TO MAKE PAYMENT ARRANGEMENTS THROUGH VARIOUS AVAILABLE PAYMENT OPTIONS OR FAILURE TO APPLY FOR AND RECEIVE APPROVAL UNDER THE FINANCIAL ASSISTANCE POLICY MAY RESULT IN THE ACCOUNT BEING REFERRED TO A COLLECTION AGENCY DUE TO NON-PAYMENT. THE COLLECTION AGENCY MAY REPORT THE ACCOUNT TO ONE OR ALL THREE CREDIT REPORTING AGENCIES, WHICH MAY ADVERSELY AFFECT THE PATIENT'S CREDIT SCORE.A PATIENT MAY APPLY FOR FINANCIAL ASSISTANCE AT ANY TIME DURING THE APPLICATION PERIOD, EVEN IF THE ACCOUNT HAS BEEN PLACED WITH A COLLECTION AGENCY. IF AN INDIVIDUAL SUBMITS A COMPLETE FINANCIAL ASSISTANCE APPLICATION DURING THE APPLICATION PERIOD, AND PARKVIEW HEALTH DETERMINES THE INDIVIDUAL IS ELIGIBLE FOR FINANCIAL ASSISTANCE, THEN PARKVIEW HEALTH WILL TAKE ALL REASONABLE AVAILABLE MEASURES TO REVERSE ANY EXTRAORDINARY COLLECTION ACTION (EXCEPT FOR A SALE OF DEBT) TAKEN AGAINST THE INDIVIDUAL TO OBTAIN PAYMENT FOR THE CARE. ALSO, IF AN INDIVIDUAL SUBMITS AN INCOMPLETE FINANCIAL ASSISTANCE APPLICATION DURING THE APPLICATION PERIOD, PARKVIEW WILL SUSPEND ANY EXTRAORDINARY COLLECTION ACTIONS AGAINST THE INDIVIDUAL (WITH RESPECT TO CHARGES TO WHICH THE FINANCIAL ASSISTANCE APPLICATION UNDER REVIEW RELATES) UNTIL THE FINANCIAL ASSISTANCE APPLICATION HAS BEEN PROCESSED AND AN ELIGIBILITY DECISION RENDERED. |
| PART VI, LINE 2: | DESCRIBE HOW THE ORGANIZATION ASSESSES THE HEALTH CARE NEEDS OF THE COMMUNITIES IT SERVES, IN ADDITION TO ANY CHNAS REPORTED IN PART V, SECTION B.IN ADDITION TO COMPLETING A COMMUNITY HEALTH NEEDS ASSESSMENT ON A TRIENNIAL BASIS, WHITLEY MEMORIAL HOSPITAL, INC. ASSESSES THE HEALTHCARE NEEDS OF THE COMMUNITY IT SERVES THROUGH PRIMARY AND SECONDARY DATA ANALYSIS, WORKING WITH THE ORGANIZATION'S COMMUNITY PARTNERS, AND ITS FRONTLINE STAFF. WHITLEY MEMORIAL HOSPITAL, INC. IDENTIFIES AND VERIFIES COMMUNITY HEALTH NEEDS THROUGH THE FOLLOWING:- HEALTHY COMMUNITIES INSTITUTE (HCI) SECONDARY DATA ANALYSIS- OBSERVATIONS AND DATA COLLECTED FROM FRONTLINE STAFF WORKING WITH VULNERABLE POPULATIONS (I.E., COMMUNITY NURSES AND COMMUNITY HEALTH WORKERS)- REVIEW OF COMMUNITY NEEDS ASSESSMENTS CONDUCTED BY LOCAL ORGANIZATIONS (I.E., UNITED WAY, BRIGHTPOINT, ETC.)- PARKVIEW LEADERS SERVING ON HEALTH-RELATED AND SOCIAL SERVICE BOARDS OF DIRECTORS IN THE COMMUNITY- OTHER PUBLIC HEALTH DATABASES (E.G. COMMUNITY COMMONS, COUNTY HEALTH RANKINGS)KEY HOSPITAL REPRESENTATIVES MAINTAIN ON-GOING RELATIONSHIPS THROUGHOUT THE COMMUNITY AND MEET REGULARLY WITH ORGANIZATIONS THAT SHARE THE MISSION OF IMPROVING THE HEALTH AND INSPIRING THE WELL-BEING OF THE COMMUNITY WE SERVE. |
| PART VI, LINE 3: | DESCRIBE HOW THE ORGANIZATION INFORMS AND EDUCATES PATIENTS AND PERSONS WHO MAY BE BILLED FOR PATIENT CARE ABOUT THEIR ELIGIBILITY FOR ASSISTANCE UNDER FEDERAL, STATE OR LOCAL GOVERNMENT PROGRAMS OR UNDER THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY.SIGNAGE AND BROCHURES ARE POSTED AND AVAILABLE AT ALL HOSPITAL POINTS OF REGISTRATION AND IN THE EMERGENCY DEPARTMENT. PATIENTS ARE OFFERED PLAIN LANGUAGE SUMMARIES OF THE FINANCIAL ASSISTANCE POLICY DURING THE REGISTRATION PROCESS AND IN EACH FOLLOW UP STATEMENT SENT TO THE PATIENT. PATIENT STATEMENTS WILL INDICATE HOW A PATIENT CAN OBTAIN FINANCIAL ASSISTANCE APPLICATIONS AND WHO THEY CAN CONTACT FOR ASSISTANCE. |
| PART VI, LINE 4: | DESCRIBE THE COMMUNITY THE ORGANIZATION SERVES, TAKING INTO ACCOUNT THE GEOGRAPHIC AREA AND DEMOGRAPHIC CONSTITUENTS IT SERVES.WHITLEY MEMORIAL HOSPITAL, INC., A MEMBER OF PARKVIEW HEALTH SYSTEM, INC., HAS TWO LOCATIONS. PARKVIEW WHITLEY HOSPITAL IS A FULL-SERVICE HOSPITAL WITH MEDICAL/SURGICAL, CONSTANT CARE AND OBSTETRICS INPATIENT UNITS. PARKVIEW WARSAW OPERATES AS A HOSPITAL OUTPATIENT DEPARTMENT (HOD) UNDER THE WHITLEY MEMORIAL HOSPITAL, INC. TAX ID AND PROVIDER NUMBERS. PARKVIEW WARSAW FEATURES A FREE-STANDING EMERGENCY DEPARTMENT WITH MULTI-MODALITY IMAGING, LABORATORY AND PHYSICAL REHABILITATION COUPLED WITH SUITES FOR PRIMARY CARE OFFICES AND SPECIALTY PHYSICIAN CLINICS. THESE FACILITIES PRIMARILY SERVICE WHITLEY AND KOSCIUSKO COUNTIES INCLUDING THE COMMUNITIES OF COLUMBIA CITY, CHURUBUSCO, LARWILL, SOUTH WHITLEY, PIERCETON, WARSAW, AND WINONA LAKE. ACCORDING TO CONDUENT HEALTHY COMMUNITIES INSTITUTE (2019), WHITLEY COUNTY HAD APPROXIMATELY 33,964 RESIDENTS, PRIMARILY IDENTIFYING AS WHITE (NOT HISPANIC OR LATINO) (95.3%), IN 2021. THE MEDIAN HOUSEHOLD INCOME WAS $64,992 (2016-2020). THE WHITLEY COUNTY UNEMPLOYMENT WAS 1.8% OF THE CIVILIAN LABOR FORCE. EMPLOYMENT IN THE COUNTY IS MOSTLY RELATED TO MANUFACTURING. ADDITIONALLY, 9.6% OF PEOPLE WERE LIVING BELOW THE POVERTY LEVEL (2016-2020). ACCORDING TO COUNTY HEALTH RANKINGS (2019), 9% OF PEOPLE DID NOT HAVE HEALTH INSURANCE.ACCORDING TO CONDUENT HEALTHY COMMUNITIES INSTITUTE (2019), KOSCIUSKO COUNTY HAD APPROXIMATELY 79,456 RESIDENTS, WITH THE MAJORITY OF THE POPULATION IDENTIFYING AS WHITE (NOT HISPANIC OR LATINO) (95.2%) AND APPROXIMATELY 8.2% OF THE POPULATION HISPANIC OR LATINO ETHNICITY. THE UNEMPLOYMENT RATE WAS 2.1% (2022). MANUFACTURING, HEAVILY WEIGHTED IN THE ORTHOPEDICS INDUSTRY, AND HEALTH SERVICES MAKE UP THE MAJORITY OF EMPLOYMENT IN THE COUNTY. THE MEDIAN HOUSEHOLD INCOME WAS $62,789 (2016-2020). ALSO, 9.3% OF PEOPLE WERE LIVING BELOW THE POVERTY LEVEL (2016-2020). ACCORDING TO COUNTY HEALTH RANKINGS (2019), 13% OF PEOPLE DID NOT HAVE HEALTH INSURANCE. ACCORDING TO THE INDIANA HOSPITAL ASSOCIATION DIMENSIONS DATABASE, WHITLEY MEMORIAL HOSPITAL, INC. FACILITIES IN WHITLEY COUNTY HAD 16.3% OF INPATIENT DISCHARGES THAT WERE MEDICAID PATIENTS AND 3% WERE SELF-PAY. FOR OUTPATIENT PROCEDURES, 12.9% WERE MEDICAID PATIENTS, AND 2.3% PERCENT WERE SELF-PAY (2021). ACCORDING TO THE INDIANA HOSPITAL ASSOCIATION DIMENSIONS DATABASE, WHITLEY MEMORIAL HOSPITAL, INC. FACILITIES IN KOSCIUSKO COUNTY HAD 25.7% OF INPATIENT DISCHARGES THAT WERE MEDICAID PATIENTS AND 5.1% WERE SELF-PAY. FOR OUTPATIENT PROCEDURES, 23.5% WERE MEDICAID PATIENTS, AND 2.3% PERCENT WERE SELF-PAY (2021). HEALTH RESOURCES AND SERVICES ADMINISTRATION (HRSA), AN AGENCY OF THE U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, DEVELOPS SHORTAGE DESIGNATION CRITERIA INTENDED TO IDENTIFY A GEOGRAPHIC AREA, POPULATION GROUP OR FACILITY AS A HEALTH PROFESSIONAL SHORTAGE AREA (HPSA) OR A MEDICALLY UNDERSERVED AREA OR POPULATION (MUA/P). 1) COUNTIES: HUNTINGTON, KOSCIUSKO, MARSHALL, WABASH AND WHITLEY COUNTYDISCIPLINE: MENTAL HEALTHHPSA ID: 7186918305HPSA NAME: MENTAL HEALTH CATCHMENT AREA 28 - WARSAWDESIGNATION TYPE: GEOGRAPHIC HPSAHPSA FTE SHORT: 11.02HPSA SCORE: 17STATUS: DESIGNATEDRURAL STATUS: PARTIALLY RURAL |
| PART VI, LINE 5: | PROVIDE ANY OTHER INFORMATION IMPORTANT TO DESCRIBING HOW THE ORGANIZATION'S HOSPITAL FACILITIES OR OTHER HEALTH CARE FACILITIES FURTHER ITS EXEMPT PURPOSE BY PROMOTING THE HEALTH OF THE COMMUNITY (E.G. OPEN MEDICAL STAFF, COMMUNITY BOARD, USE OF SURPLUS FUNDS, ETC.).WHITLEY MEMORIAL HOSPITAL, INC.'S BOARD OF DIRECTORS IS COMPRISED OF INDEPENDENT COMMUNITY MEMBERS FROM WHITLEY AND KOSCIUSKO COUNTIES ALONG WITH THE HOSPITAL PRESIDENT AND MEDICAL STAFF PRESIDENT. THE HOSPITAL EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN THE COMMUNITY. PEOPLE THROUGHOUT THE COMMUNITY CAN COUNT ON WHITLEY MEMORIAL HOSPITAL, INC., TO BE AVAILABLE WITH EMERGENCY CARE 24 HOURS A DAY, 365 DAYS A YEAR. THE EMERGENCY DEPARTMENTS BOTH IN WHITLEY COUNTY AND KOSCIUSKO COUNTY ARE STAFFED WITH BOARD-CERTIFIED EMERGENCY CARE PHYSICIANS AND A NURSING STAFF THAT IS TRAINED AND EXPERIENCED IN EMERGENCY CARE. FURTHERMORE, NO PATIENT IS EVER DENIED TREATMENT, REGARDLESS OF THEIR ABILITY TO PAY. THE HOSPITAL IN WHITLEY COUNTY FEATURES 30 PRIVATE ROOMS, IN A 96,000 SQUARE FOOT FACILITY LOCATED ON 42 ACRES. EMERGENCY MEDICAL CARE, OBSTETRIC, MEDICAL-SURGICAL AND CONSTANT CARE UNITS ARE AVAILABLE AS WELL AS LABORATORY, MULTIPLE MODALITY IMAGING, SURGICAL SERVICES, ANTICOAGULATION UNIT, DIABETES EDUCATION AND OUTPATIENT INFUSION. AN ATTACHED MEDICAL OFFICE BUILDING PROVIDES CONVENIENT, EASY ACCESS FOR PATIENTS TO RECEIVE CARE FROM FAMILY AND SPECIALTY PHYSICIANS, AS WELL AS DIAGNOSTIC IMAGING SERVICES, SLEEP DISORDERS LAB AND PHYSICAL, OCCUPATIONAL, SPEECH AND CARDIAC REHABILITATION. PARKVIEW WARSAW IN KOSCIUSKO COUNTY IS A 90,000 SQUARE FOOT FACILITY FEATURING NINE EMERGENCY ROOM BEDS INCLUDING TWO THAT ARE EQUIPPED FOR TRAUMA PATIENTS. THE WARSAW FACILITY IS A HOSPITAL OUTPATIENT DEPARTMENT (HOD) UNDER WHITLEY MEMORIAL HOSPITAL, INC.'S TAX IDENTIFICATION AND PROVIDER NUMBERS. THE FACILITY INCLUDES MULTI-MODALITY IMAGING, LABORATORY, PHYSICAL AND OCCUPATIONAL REHABILITATION AND ANTI-COAGULATION CLINIC AS WELL AS PRIMARY CARE AND SPECIALTY PHYSICIAN OFFICES. EMERGENCY PATIENTS WHO REQUIRE A HIGHER LEVEL OF CARE ARE TRANSPORTED TO WHITLEY MEMORIAL HOSPITAL, INC. OR TO TERTIARY CARE FACILITIES IN ALLEN COUNTY. EXPANSION OF THE CURRENT FACILITY IS CURRENTLY UNDERWAY AND WILL ADD 88,000 SQUARE FEET FOR AN INPATIENT MEDICAL/SURGICAL UNIT, SURGICAL SERVICES, CANCER SERVICES, NON-CANCER IV INFUSION, SLEEP DISORDERS LABORATORY AND CARDIAC REHABILITATION. WHITLEY MEMORIAL HOSPITAL, INC. IS EXCITED TO OFFER FULL-SERVICE HOSPITAL CARE TO THE KOSCIUSKO COUNTY COMMUNITY MID-2023.AS A COMMUNITY PARTNER AND NOT-FOR-PROFIT ORGANIZATION, WHITLEY MEMORIAL HOSPITAL, INC., IS DEDICATED TO IMPROVING HEALTH AND INSPIRING WELL-BEING BY TAILORING A PERSONALIZED HEALTH JOURNEY TO ACHIEVE INDIVIDUAL UNIQUE GOALS. BY DEMONSTRATING WORLD-CLASS TEAMWORK, THE HOSPITAL PARTNERS WITH COMMUNITY MEMBERS ALONG THAT JOURNEY AND PROVIDES THE EXCELLENCE, INNOVATION AND VALUE PATIENTS SEEK IN TERMS OF CONVENIENCE, COMPASSION, SERVICE, COST AND QUALITY. WHITLEY MEMORIAL HOSPITAL, INC. CONSISTENTLY EARNS HIGH METRICS IN PUBLICLY REPORTED QUALITY MEASURES AS WELL AS THE PATIENTS' PERCEPTION OF CARE. MAGNET HOSPITAL STATUS WAS EARNED IN 2017 FROM THE AMERICAN NURSES CREDENTIALING CENTERS, DEMONSTRATING THE BEST PRACTICES AND CULTURE INCORPORATED AT OUR FACILITY TO CONSISTENTLY PROVIDE THE HIGHEST QUALITY OF CARE TO ALL PATIENTS. BABY-FRIENDLY DESIGNATION WAS ACHIEVED IN 2018 FROM UNICEF AND A WORLD HEALTH ORGANIZATION INITIATIVE, RECOGNIZING A COMMITMENT TO HEALTHY BABIES THROUGH SUPPORT AND PROMOTION OF BREASTFEEDING INITIATIVES. THE HOSPITAL CONTINUES TO COMPLY WITH THOSE REQUIREMENTS IN ITS DEDICATION AND STRONG BELIEF IN THE BENEFITS OF BREASTFEEDING FOR HEALTHY CHILDREN IN THE COMMUNITY. WHITLEY MEMORIAL HOSPITAL, INC.'S COMMUNITY HEALTH IMPROVEMENT PROGRAM FUNDS HEALTH IMPROVEMENT EFFORTS WITHIN THE SERVICE AREA OF WHITLEY MEMORIAL HOSPITAL, INC. THE HOSPITAL SETS ASIDE FUNDS ANNUALLY DESIGNATED FOR PARTNERSHIP WITH COMMUNITY ORGANIZATIONS TO ENCOURAGE HEALTHIER LIFESTYLES AMONG THE CITIZENS OF NORTHEAST INDIANA. WHITLEY MEMORIAL HOSPITAL, INC. INVESTS IN KEY ORGANIZATIONS THAT PROMOTE THE HEALTH AND WELLNESS OF FAMILIES, CHILDREN, AND INDIVIDUALS OF WHITLEY AND KOSCIUSKO COUNTIES. KEY PROJECTS AND AREAS OF FOCUS FUNDED THROUGH THE COMMUNITY HEALTH IMPROVEMENT INITIATIVES ARE INCLUDED IN SCHEDULE H, PART V, SETCTION B, LINE 11.WHITLEY MEMORIAL HOSPITAL, INC.'S MISSION INCLUDES CARING FOR PEOPLE WHO DO NOT HAVE THE MEANS TO MEET THEIR FINANCIAL OBLIGATIONS. A FINANCIAL COUNSELOR IS AVAILABLE TO ASSIST PATIENTS NAVIGATING THIS PROCESS. THE HOSPITAL PRIORITIZES OUR RESPONSIBILITY TO PROVIDE EXCELLENT, NECESSARY CARE TO ALL PATIENTS, NOT THE PATIENT'S ABILITY TO PAY FOR MEDICAL EXPENSES. WHITLEY MEMORIAL HOSPITAL, INC. MANAGES AND OPERATES EMS SERVICES FOR WHITLEY COUNTY WITH DEDICATED AMBULANCES AVAILABLE FOR EMERGENCY DISPATCH 24 HOURS, 7 DAYS PER WEEK. THERE WERE 5,971 EMS RUNS AND 4,133 PATIENT TRANSPORTS DURING 2021. ALTHOUGH ADDITIONAL ACTIVITIES WERE MINIMAL DURING 2021 A RESULT OF THE COVID-19 PANDEMIC, STAFFED AMBULANCES WERE ALSO AVAILABLE TO PROVIDE EMERGENCY MEDICAL SERVICES COVERAGE FOR LOCAL FOOTBALL GAMES AND OTHER AREA COMMUNITY EVENTS. EMS STAFF FACILITATE EMT CLASSES FOR LOCAL HIGH SCHOOL STUDENTS, TRAINING FOR FIRST RESPONDERS AND PROVIDE CPR TRAINING IN THE COMMUNITY. AMBULANCES WERE ON STAND-BY OR STATIONED WITHIN CLOSE PROXIMITY OF THE WHITLEY COUNTY HEALTH DEPARTMENT DURING COVID-19 VACCINATION CLINIC HOURS DURING 2021.WHITLEY MEMORIAL HOSPITAL, INC. SUPPORTS A MEDICATION ASSISTANCE PROGRAM (MAP) WHICH PARTNERS WITH PATIENTS, PHYSICIANS, PHARMACEUTICAL COMPANIES, LOCAL PHARMACIES, AND DONORS TO PROVIDE MEDICATION ASSISTANCE AT LITTLE OR NO COST FOR QUALIFIED INDIVIDUALS IN WHITLEY COUNTY. EMERGENCY VOUCHERS FOR ACUTE MEDICATION NEEDS ARE REDEEMED AT THE HOSPITAL PHARMACY. THIRTY-ONE INDIVIDUALS UTILIZED THE SERVICE IN 2021. LONG-TERM MEDICATION HELP IS PROVIDED BY CONNECTING PATIENTS WITH PHARMACEUTICAL ASSISTANCE PROGRAMS (PAP). WHITLEY MEMORIAL HOSPITAL, INC. WORKS WITH LOCAL HIGH SCHOOLS TO PROVIDE INTERNSHIP OPPORTUNITIES FOR STUDENTS IN A VARIETY OF SETTINGS, ALLOWING THEM TO EXPLORE CAREERS IN CLINICAL AND NON-CLINICAL HOSPITAL ENVIRONMENTS. THERE WAS LIMITED PARTICIPATION IN 2021 DUE TO COVID-19 RESTRICTIONS BUT FIVE INDIVIDUALS WERE ABLE TO BENEFIT FROM THE PROGRAM. IN 2021, WHITLEY MEMORIAL HOSPITAL, INC. PARTNERED WITH THE CITY OF WARSAW AND K21 FOUNDATION ON COVID-19 VACCINATION EDUCATION AND ACCESS TO KOSCIUSKO COUNTY RESIDENTS. AS PART OF THIS PARTNERSHIP, THE HOSPITAL SPONSORED AND PARTICIPATED IN A COMMUNITY EDUCATIONAL VIDEO ABOUT THE IMPORTANCE OF VACCINATION THROUGH THE KOSCIUSKO CHAMBER OF COMMERCE. IN ADDITION, A LOCATION AND PLANS FOR A SECOND VACCINATION SITE WERE DEFINED.THE HOSPITAL, ALSO, PARTNERED WITH WHITLEY COUNTY HEALTH DEPARTMENT TO ORGANIZE AND HELP STAFF A VACCINATION CLINIC. HOSPITAL LEADERS VOLUNTEERED THEIR TIME FOR A TOTAL OF 372 HOURS. |
| PART VI, LINE 6: | IF THE ORGANIZATION IS PART OF AN AFFILIATED HEALTH CARE SYSTEM, DESCRIBE THE RESPECTIVE ROLES OF THE ORGANIZATION AND ITS AFFILIATES IN PROMOTING THE HEALTH OF THE COMMUNITIES SERVED.PARKVIEW HEALTH SYSTEM, INC. (PARKVIEW), A HEALTHCARE SYSTEM SERVING NORTHEAST INDIANA AND NORTHWEST OHIO THROUGH OUR HOSPITALS AND PHYSICIAN CLINICS, INCLUDES THE NOT-FOR-PROFIT HOSPITALS OF PARKVIEW HOSPITAL, INC.; COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC.; COMMUNITY HOSPITAL OF NOBLE COUNTY, INC.; DEKALB MEMORIAL HOSPITAL, INC.; HUNTINGTON MEMORIAL HOSPITAL, INC.; PARKVIEW WABASH HOSPITAL, INC.; WHITLEY MEMORIAL HOSPITAL, INC.; PARK CENTER, INC.; AS WELL AS 60 PERCENT OWNERSHIP IN THE JOINT VENTURE OF ORTHOPEDIC HOSPITAL AT PARKVIEW NORTH, LLC.EACH HOSPITAL ENTITY ENGAGES IN COMMUNITY OUTREACH ACTIVITIES AND SUPPORTS THEIR RESPECTIVE COUNTY THROUGH INVESTMENTS OF COMMUNITY HEALTH IMPROVEMENT FUNDING AND PROGRAMMING CUSTOMIZED TO MEET THE UNIQUE HEALTH NEEDS OF THEIR RESPECTIVE COMMUNITIES. AFFILIATE HOSPITALS ALSO WORK TOGETHER AND SHARE PROGRAMMING AND MESSAGING WHERE COMMON COMMUNITY HEALTH ISSUES ARE IDENTIFIED. FROM THE LIST OF HEALTH ISSUES IDENTIFIED IN NORTHEAST INDIANA AS PART OF THE 2019 COMMUNITY HEALTH NEEDS ASSESSMENT, THE HEALTH PRIORITY OF SUBSTANCE USE DISORDER/MENTAL HEALTH PROMOTION WAS SELECTED BY ALL AFFILIATE HOSPITALS.AFFILIATE HOSPITALS EACH HAVE A LOCAL BOARD OF DIRECTORS. PARKVIEW HEALTH SYSTEM, INC. ALSO ENGAGES A BOARD OF DIRECTORS, WHICH CONSISTS OF REPRESENTATION FROM EACH OF THE AFFILIATE HOSPITAL BOARDS AND UP TO 15 AT-LARGE PHYSICIANS OR COMMUNITY LEADERS. MOST OF THE BOARD OF DIRECTORS SHALL, AT ALL TIMES, BE CONSIDERED TO BE INDEPENDENT AS DEFINED BY THE INTERNAL REVENUE SERVICE.PARKVIEW CONTRIBUTES TO THE OVERALL SUCCESS OF THE REGION THROUGH SIGNIFICANT INVOLVEMENT IN THE COMMUNITIES WE SERVE. BY DEVELOPING VARIOUS PARTNERSHIPS AND ALIGNMENTS WITH DIFFERENT SECTORS AND ORGANIZATIONS, PARKVIEW HELPS TO PROMOTE THE ECONOMY, QUALITY OF LIFE AND HEALTH/WELL-BEING ACROSS THE REGION. WITH A CONSISTENT FOCUS ON OUR MISSION AND VISION, WE WORK TO PROVIDE THE BEST CARE TO EVERY PERSON, EVERY DAY IN OUR FACILITIES WHILE SERVING AS GOOD STEWARDS OF SURPLUS FUNDS IN AN EFFORT TO POSITIVELY IMPACT COMMUNITY HEALTH STATUS. |
| PART VI, LINE 7, REPORTS FILED WITH STATES | IN |
| PART VI, LINE 7 CONT'D: | A COPY OF FORM 990, SCHEDULE H IS FILED WITH THE INDIANA STATE DEPARTMENT OF HEALTH. |
| PART V, SECTION B, LINE 19: | DISCLOSURE STATEMENT FOR CORRECTION SECTION 501(R) OMISSIONS, ERRORS AND OTHER FAILURES PURSUANT TO INTERNAL REVENUE SERVICE REVENUE PROCEDURE 2015-21. IN JANUARY AND FEBRUARY 2021, THE ORGANIZATION'S INTERNAL AUDIT DEPARTMENT PERFORMED A COMPREHENSIVE REVIEW OF ALL APPLICABLE POLICIES AND PRACTICES UNDER SECTION 501(R) OF THE INTERNAL REVENUE CODE AND THE TREASURY REGULATIONS ISSUED THEREUNDER. THE AUDIT PERIOD WAS AUGUST 1, 2020, THROUGH DECEMBER 31, 2020. AS A RESULT OF THE AUDIT, MINOR POLICY CHANGES WERE MADE, AND MINOR PROCEDURAL CHANGES RELATED TO SECTION 501(R) COMPLIANCE WERE IMPLEMENTED.ALSO, IT WAS DETERMINED THAT 128 PATIENT ACCOUNTS WERE PRESUMPTIVELY DETERMINED TO BE ELIGIBLE FOR LESS-THAN-100% FINANCIAL ASSISTANCE, WERE NOT NOTIFIED REGARDING THE WAY TO APPLY FOR MORE GENEROUS ASSISTANCE UNDER THE FAP AND WERE INADVERTENTLY SUBJECT TO ADVERSE CREDIT REPORTING. THE ADVERSE CREDIT REPORTING, HOWEVER, WAS IMMEDIATELY REMOVED IN MAY 2021. IN ADDITION TO THE FINANCIAL ASSISTANCE NOTIFICATION ON ALL PATIENT STATEMENTS, THE HOSPITAL FACILITY INSTITUTED PROCEDURES TO PROVIDE WRITTEN NOTICE TO PATIENTS WHO RECEIVE PARTIAL PRESUMPTIVE FINANCIAL ASSISTANCE THAT INFORMS THE INDIVIDUAL REGARDING THE BASIS FOR THE PRESUMPTIVE FAP ELIGIBILITY DETERMINATION AND THE WAY TO APPLY FOR MORE GENEROUS ASSISTANCE DURING THE APPLICATION PERIOD. |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (1) | GrantRecordsMaintainedInd |
Recipient Table RecipientTable (5 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | Recipient EINRecipientEIN | IRC SectionIRCSectionDesc | Cash GrantCashGrantAmt | Non Cash AssistanceNonCashAssistanceAmt | Purpose Of GrantPurposeOfGrantTxt |
|---|---|---|---|---|---|---|---|---|
| INTERFAITH MISSION INC | ||||||||
| 500 WEST BUSINESS 30 | COLUMBIA CITY | IN | 46725 | 352071824 | 501(C)(3) | $15,000 | $0 | PROGRAMS TO PROVIDE SHELTER AND ASSISTANCE TO THE HOMELESS |
| KOSCIUSKO COMMUNITY YMCA INC | ||||||||
| 1305 MARINERS DR | WARSAW | IN | 46582 | 351068182 | 501(C)(3) | $14,000 | $0 | PROGRAMS THAT BUILD A HEALTHY SPIRIT, MIND AND BODY FOR ALL |
| TROY CENTER INC | ||||||||
| 1911 EAST BUSINESS 30 | COLUMBIA CITY | IN | 46725 | 460656583 | 501(C)(3) | $13,000 | $0 | PROGRAMS TO PROVIDE YOUTH IN NORTHEAST INDIANA WITH THE EDUCATION, TOOLS AND SUPPORT NECESSARY FOR SUCCESS |
| CENTER FOR WHITLEY COUNTY YOUTH INC | ||||||||
| 201 W MARKET STREET | COLUMBIA CITY | IN | 46725 | 205993971 | 501(C)(3) | $11,000 | $0 | AFTER-SCHOOL AND SUMMER PROGRAMMING FOR ADOLESCENTS INCLUDING PHYSICAL ACTIVITIES AND EDUCATION |
| BABE BEDS AND BRITCHES ETC | ||||||||
| 533 N LINE ROAD | COLUMBIA CITY | IN | 46725 | 351130532 | 501(C)(3) | $10,000 | $0 | PROGRAMS FOR PREGNANT WOMEN AND FAMILIES TO BENEFIT HEALTH AND WELL BEING OF INFANTS AND YOUNG CHIILDREN |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 5 | Total501c3OrgCnt |
| Total Other Org | 0 | TotalOtherOrgCnt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 2: | FormAndLineReferenceDesc |
| Explanation | COMMUNITY HEALTH IMPROVEMENT FUNDING PARTNER ORGANIZATIONS ARE REQUIRED TO SUBMIT AN ANNUAL PROGRESS REPORT RELATED TO PROGRAM FUNDING. PARTNER ORGANIZATIONS ARE REQUIRED TO RE-APPLY FOR FUNDING ON AN ANNUAL BASIS. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (1) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | Yes (1) | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (12 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| MICHAEL PACKNETT | ||||||||||||||
| DIRECTOR/PH PRESIDENT & CEO | $0 | $1,220,966 | $0 | $259,085 | $0 | $557,555 | $0 | $292,805 | $0 | $33,268 | $0 | $2,363,679 | $0 | $507,042 |
| JEANNE' WICKENS | ||||||||||||||
| PH CHIEF FINANCIAL OFFICER | $0 | $770,820 | $0 | $142,288 | $0 | $146,528 | $0 | $320,169 | $0 | $29,811 | $0 | $1,409,616 | $0 | $124,406 |
| LISA HATCHER | ||||||||||||||
| DIRECTOR/PH PHYSICIAN | $18,146 | $397,945 | $0 | $42,285 | $0 | $11,882 | $1,231 | $30,669 | $604 | $15,057 | $19,981 | $497,838 | $0 | $0 |
| SCOTT GABRIEL | ||||||||||||||
| DIRECTOR/WMHOS PRESIDENT | $221,028 | $0 | $35,047 | $0 | $42,100 | $0 | $62,016 | $0 | $35,302 | $0 | $395,493 | $0 | $40,348 | $0 |
| BRIDGET DOLOHANTY-JOHNSON | ||||||||||||||
| FORMER KEY EMPLOYEE | $0 | $0 | $0 | $0 | $356,219 | $0 | $0 | $0 | $0 | $0 | $356,219 | $0 | $356,219 | $0 |
| JEFFREY ROCKETT | ||||||||||||||
| WMHOS VP OUTPATIENT SVCS | $167,763 | $0 | $21,696 | $0 | $13,216 | $0 | $14,366 | $0 | $25,754 | $0 | $242,795 | $0 | $0 | $0 |
| AMANDA KNOWLES | ||||||||||||||
| WMHOS MGR PHARMACY | $170,626 | $0 | $11,581 | $0 | $300 | $0 | $20,633 | $0 | $24,560 | $0 | $227,700 | $0 | $0 | $0 |
| ASHLEY WIRGES | ||||||||||||||
| WMHOS VP PATIENT CARE | $141,749 | $0 | $18,554 | $0 | $6,703 | $0 | $5,131 | $0 | $30,812 | $0 | $202,949 | $0 | $0 | $0 |
| BENJAMIN MAGGARD | ||||||||||||||
| WMHOS PHARMACIST | $142,596 | $2,422 | $3,248 | $0 | $159 | $3 | $13,520 | $224 | $28,740 | $477 | $188,263 | $3,126 | $0 | $0 |
| CHARLES JINKS | ||||||||||||||
| WMHOS PHARMACIST | $127,159 | $3,182 | $3,155 | $0 | $722 | $18 | $16,349 | $399 | $23,426 | $572 | $170,811 | $4,171 | $0 | $0 |
| PETER TALATI | ||||||||||||||
| WMHOS MGR REHAB | $122,132 | $0 | $8,570 | $0 | $8,354 | $0 | $12,697 | $0 | $21,356 | $0 | $173,109 | $0 | $0 | $0 |
| BLAKE MAGGART | ||||||||||||||
| WMHOS NURSE LEAD | $115,809 | $915 | $8,250 | $0 | $8,778 | $0 | $6,707 | $46 | $20,340 | $140 | $159,884 | $1,101 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 3 | RELATED ORGANIZATION, PARKVIEW HEALTH SYSTEM, INC., USES THE FOLLOWING TO ESTABLISH THE COMPENSATION OF WHITLEY MEMORIAL HOSPITAL, INC.'S CEO/EXECUTIVE DIRECTOR: COMPENSATION COMMITTEE OF RELATED ORGANIZATION PARKVIEW HEALTH SYSTEM, INC. INDEPENDENT COMPENSATION CONSULTANT FORM 990 OF OTHER ORGANIZATIONS COMPENSATION SURVEY OR STUDY APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE OF RELATED ORGANIZATION PARKVIEW HEALTH SYSTEM, INC. |
| PART I, LINE 4B | SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN PAYMENTS THE FOLLOWING INDIVIDUALS PARTICIPATE IN SUPPLEMENTAL NONQUALIFIED DEFERRED COMPENSATION PLANS. BENEFITS EARNED UNDER THE PLANS WILL FUND THE EMPLOYEES' EVENTUAL RETIREMENT BENEFIT. THESE BENEFITS ARE PROVIDED IN EXCHANGE FOR THE EMPLOYEES' YEARS OF SERVICE TO THE ORGANIZATION AND THE AMOUNT OF THE BENEFITS MAY VARY FROM YEAR TO YEAR. THE FOLLOWING INDIVIDUALS VESTED IN A PORTION OF THEIR DEFERRED COMPENSATION PLANS, WHICH IS TREATED AS TAXABLE INCOME TO THE INDIVIDUALS AT THE TIME OF VESTING. THESE AMOUNTS ARE REPORTED IN SCHEDULE J, PART II, COLUMN (B)(III): BRIDGET DOLOHANTY-JOHNSON $356,219; SCOTT GABRIEL $40,348; MICHAEL PACKNETT $507,042; JEANNE' WICKENS $124,406 AMOUNTS LISTED ABOVE THAT HAVE BEEN REPORTED AS DEFERRED COMPENSATION ON PRIOR FORM 990 WILL ALSO BE REFLECTED IN SCHEDULE J, PART II, COLUMN (F). FOR EXAMPLE, THE AMOUNT OF $507,042 REPORTED AS REQUIRED FOR MR. PACKNETT WAS A RESULT OF THE VESTING OF SUCH AMOUNT UNDER THE TERMS OF THE RESPECTIVE PLANS. HOWEVER, THESE AMOUNTS WERE PREVIOUSLY REPORTED IN MR. PACKNETT'S DEFERRED COMPENSATION OVER MORE THAN 10 YEARS AS THE AMOUNTS WERE DEFERRED UNDER THE PLANS. AS SUCH, THE AMOUNT REPORTED IN SCHEDULE J, PART II, COLUMN (F) IS AN INDICATION OF AMOUNTS THAT HAVE BEEN REPORTED TWICE, ONCE AS A DEFERRAL AND ONCE AS VESTED. THE FOLLOWING INDIVIDUALS HAVE AN AMOUNT INCLUDED IN SCHEDULE J, PART II, COLUMN (C) FOR AN AMOUNT EARNED BUT NOT YET VESTED UNDER ONE OF PARKVIEW'S DEFERRED COMPENSATION PLANS. THE AMOUNTS ARE AT RISK AND WILL NOT BE PAID UNLESS AND UNTIL EACH EMPLOYEE HAS PROVIDED SUBSTANTIAL FUTURE SERVICES TO THE ORGANIZATION. BENEFITS UNDER THE PLANS VEST AT THE TIME SET FORTH IN THE PLAN DOCUMENTS AND ARE FORFEITED IF THE EMPLOYEES TERMINATE EMPLOYMENT BEFORE SATISFYING THOSE PLAN CONDITIONS. DEFERRALS REPORTED IN SCHEDULE J, PART II, COLUMN (C) INCLUDE: SCOTT GABRIEL $38,303; MICHAEL PACKNETT $260,905; JEANNE' WICKENS $299,869 |
| PART I, LINE 7 | MANAGEMENT INCENTIVE COMPENSATION PLAN (MICP) AND PHYSICIAN AND PROVIDER INCENTIVE COMPENSATION PLAN (PICP) ARE ANNUAL INCENTIVE PROGRAMS. SYSTEM GOALS ARE APPROVED BY THE BOARD. AT CONCLUSION OF THE PLAN YEAR, RESULTS ARE SHARED WITH THE BOARD AND THE EXECUTIVE COMMITTEE OF THE BOARD APPROVES FINAL PAYMENT. |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (14 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART III, LINE 4A CONT'D FROM ABOVE: | HEALTH SCREENING/PREVENTION AND DISEASE MANAGEMENT: WHITLEY MEMORIAL HOSPITAL, INC. PARTICIPATES IN MANY ACTIVITIES THROUGHOUT THE YEAR TO PROVIDE HEALTH EDUCATION, HEALTH SCREENINGS FOR DISEASE PREVENTION AND TO PROMOTE HEALTHY LIFESTYLES AND WELL-BEING. THE HOSPITAL ALSO PROVIDES SUPPORT GROUPS TO ASSIST PATIENTS AND FAMILIES IN MANAGING DISEASE. WHITLEY MEMORIAL HOSPITAL, INC. IS DEDICATED TO THE WELL-BEING OF ITS CO-WORKERS ALONG WITH ITS PATIENTS AS THEY ARE VALUABLE MEMBERS OF OUR COMMUNITY. A FITNESS CENTER IS AVAILABLE 24/7 WITH A VARIETY OF EXERCISE AND STRENGTH TRAINING EQUIPMENT FOR ALL STAFF TO UTILIZE AND RECUMBENT BIKES ARE AVAILABLE IN SOME DEPARTMENTS. AN OUTDOOR WALKING/BIKING TRAIL CIRCLES THE HOSPITAL PROPERTY AND IS USED BY STAFF AND COMMUNITY MEMBERS FOR WALKING, BIKING, AND SKATING. THE WARSAW FACILITY HAS THE CONVENIENCE OF BEING LOCATED NEXT TO THE PARKVIEW WARSAW YMCA WHICH ALSO INCLUDES THE PARKVIEW WARSAW CENTER FOR HEALTHY LIVING. THE CENTER OFFERS A VARIETY OF CLASSES/PROGRAMS TO EMPLOYEES AS WELL AS THE COMMUNITY. THESE PROGRAMS IN KOSCIUSKO COUNTY CONTINUED TO BE MOSTLY VIRTUAL IN 2021 DUE TO COVID-19 BUT MORE THAN 2100 INDIVIDUALS TOOK ADVANTAGE OF THE OFFERINGS. OTHER EDUCATIONAL AND SUPPORT OPPORTUNITIES ARE AVAILABLE FOR THE PUBLIC AT WHITLEY MEMORIAL HOSPITAL, INC. WHILE OFFERINGS WERE LIMITED DUE TO COVID-19, THE WEIGHT LOSS SUPPORT GROUP AND ON-SITE SEASONAL FARMER'S MARKET WERE AVAILABLE. IN ADDITION, THE FAMILY BIRTHING CENTER OFFERS LAMAZE CHILDBIRTH EDUCATION, BREASTFEEDING CLASSES, AND A BREASTFEEDING SUPPORT GROUP FOR NEW MOTHERS AS WELL AS POST-PARTUM DEPRESSION SUPPORT. OTHER PROGRAMS SUCH AS LIVE NUTRITION CLASSES HAVE BEEN IMPACTED BY COVID-19 BUT THERE ARE HOPES FOR BRINGING THEM BACK IN THE FUTURE. A CHAPLAINCY PROGRAM PROVIDES SPIRITUAL SUPPORT FOR PATIENTS AND THEIR FAMILIES. WHILE NOT A FULL-TIME POSITION AT THE FACILITY, THE CHAPLAIN IS AVAILABLE BY REQUEST IN TIMES OF PATIENT NEED OR TO COMFORT FAMILIES DURING DIFFICULT HEALTHCARE DECISIONS AND OUTCOMES. THE SUPPORT PROVIDED IS BENEFICIAL TO THE STAFF AS WELL FROM BOTH THE PERSONAL AND CAREGIVER PERSPECTIVE. VOLUNTEER PROGRAM/STAFF VOLUNTEERISM: THE VOLUNTEER PROGRAM AT WHITLEY MEMORIAL HOSPITAL, INC. HAS APPROXIMATELY 25 VOLUNTEERS WHO FUNCTION TO ASSIST PATIENTS, PROVIDE DIRECTIONS, WORK IN THE GIFT SHOP, AND ASSIST STAFF. THESE VOLUNTEERS PROVIDED 1230 HOURS IN OUR FACILITY IN 2021. THIS IS A VALUABLE SERVICE TO OUR PATIENTS AND STAFF AND THOSE WHO VOLUNTEER. THE VAST MAJORITY OF THE HOSPITAL VOLUNTEERS ARE RETIRED INDIVIDUALS WHO WISH TO GIVE BACK TO THEIR COMMUNITY. ONCE AGAIN, COVID-19 PROMPTED CHANGE IN THIS AREA AS WELL. VOLUNTEER SERVICE WAS SUSPENDED UNTIL AUGUST 2021 AND MANY OPTED TO WAIT FOR COVID NUMBERS TO GO DOWN FURTHER TO RETURN TO SERVICE. THE MANAGEMENT AND EMPLOYEES OF WHITLEY MEMORIAL HOSPITAL, INC. TYPICALLY PARTICIPATE IN NUMEROUS VOLUNTEER ACTIVITIES THROUGHOUT THE AREA TO IMPROVE THE HEALTH AND WELL-BEING OF THE COMMUNITY. UNFORTUNATELY, COVID-19 LIMITED THE OPPORTUNITIES FOR BOTH 2020 AND 2021. CO-WORKERS TRADITIONALLY VOLUNTEERED THEIR TIME IN COMMUNITY EVENTS SUCH AS STAFFING THE BOOTHS AT THE WHITLEY COUNTY AND KOSCIUSKO COUNTY 4-H FAIRS. IN 2021, HOWEVER, MOST EVENTS AND PROGRAMS WERE EITHER CANCELED OR HOSPITAL ADMINISTRATION CHOSE NOT TO PARTICIPATE TO REDUCE THE POTENTIAL SPREAD OF THE VIRUS. DEPARTMENT MANAGERS ALSO WORK WITH LOCAL HIGH SCHOOLS TO PROVIDE STUDENT INTERNSHIPS IN A VARIETY OF SETTINGS, ALLOWING THEM TO EXPLORE CAREERS IN CLINICAL AND NON-CLINICAL HOSPITAL ENVIRONMENTS. THERE WAS LIMITED PARTICIPATION FOR 2021 BUT FIVE INDIVIDUALS WERE ABLE TO BENEFIT FROM THE PROGRAM. LOCAL COVID-19 RELATED SUPPORT: IN 2021, WHITLEY MEMORIAL HOSPITAL, INC. PARTNERED WITH THE CITY OF WARSAW AND K21 FOUNDATION ON COVID-19 VACCINATION EDUCATION AND ACCESS TO KOSCIUSKO COUNTY RESIDENTS. AS PART OF THIS PARTNERSHIP, THE HOSPITAL SPONSORED AND PARTICIPATED IN A COMMUNITY EDUCATIONAL VIDEO ABOUT THE IMPORTANCE OF VACCINATION THROUGH THE KOSCIUSKO CHAMBER OF COMMERCE. IN ADDITION, A LOCATION AND PLANS FOR A SECOND VACCINATION SITE WERE DEFINED. WHITLEY MEMORIAL HOSPITAL, INC., ALSO, PARTNERED WITH WHITLEY COUNTY HEALTH DEPARTMENT TO ORGANIZE AND HELP STAFF A VACCINATION CLINIC. HOSPITAL LEADERS VOLUNTEERED THEIR TIME FOR A TOTAL OF 372 HOURS. EMS STAFFED AMBULANCES WERE ON STANDBY OR STATIONED NEARBY DURING CLINIC HOURS IN CASE OF EMERGENCY CARE NEEDS. |
| FORM 990, PART V, LINES 1A AND 2A: | PARKVIEW HEALTH SYSTEM, INC. (PH), EIN 35-1972384, IS THE COMMON PAYING AGENT FOR THE FILING ORGANIZATION, WHITLEY MEMORIAL HOSPITAL, INC., EIN 35-1967665. THEREFORE, ALL APPLICABLE IRS TAX FILINGS, INCLUDING FORMS 1099, 1096, W-2 AND W-3 ARE REPORTED AND FILED BY PH. THE TOTAL NUMBER REPORTED IN BOX 3 OF FORM 1096 AND FILED BY THE COMMON PAYING AGENT, PH, FOR THE YEAR ENDED DECEMBER 31, 2021 WAS 593. THE TOTAL NUMBER OF EMPLOYEES REPORTED ON FORM W-3 AND FILED BY THE COMMON PAYING AGENT, PH, FOR THE YEAR ENDED DECEMBER 31, 2021 WAS 16,240. FOR PURPOSES OF COMPLETING FORM 990, PART V, LINE 1A AND 2A, THE NUMBER REPORTED FOR THE WHITLEY MEMORIAL HOSPITAL, INC. WAS 29 AND 429 RESPECTIVELY. |
| FORM 990, PART VI, SECTION A, LINE 1A | THE EXECUTIVE COMMITTEE SHALL BE COMPOSED OF THE OFFICERS OF THE BOARD, THE PRESIDENT OF THE CORPORATION, THE PRESIDENT/CEO OF THE CORPORATE MEMBER OR HIS/HER DESIGNEE, THE CURRENT PRESIDENT OF THE MEDICAL STAFF AND SUCH OTHER PERSONS AS IDENTIFIED BY THE CHAIR OF THE BOARD, EACH OF WHOM SHALL BE ENTITLED TO VOTE. THE EXECUTIVE COMMITTEE MAY ACT ON BEHALF OF THE CORPORATION IN ANY MATTER WHEN THE BOARD IS NOT IN SESSION, REPORTING TO THE BOARD FOR RATIFICATION OF ITS ACTION. THE CHAIR OF THE BOARD SHALL SERVE AS CHAIR OF THE EXECUTIVE COMMITTEE. |
| FORM 990, PART VI, SECTION A, LINE 2 | DIRECTOR/OFFICER MICHAEL PACKNETT AND OFFICER JEANNE' WICKENS HAVE BUSINESS RELATIONSHIPS AS OFFICERS OF RELATED ENTITIES. |
| FORM 990, PART VI, SECTION A, LINE 6 | THE ORGANIZATION IS ORGANIZED AS A NOT-FOR-PROFIT CORPORATION. PURSUANT TO THE ORGANIZATION'S GOVERNING DOCUMENTS, PARKVIEW HEALTH SYSTEM, INC. EIN 35-1972384 IS THE SOLE MEMBER OF WHITLEY MEMORIAL HOSPITAL, INC. WITH CERTAIN RESERVED POWERS. |
| FORM 990, PART VI, SECTION A, LINE 7A | THE CORPORATE MEMBER, PARKVIEW HEALTH SYSTEM, INC. EIN 35-1972384, SHALL HAVE THE FOLLOWING RESERVED POWERS AS DEFINED IN THE NETWORK AGREEMENT: (A) APPOINT DIRECTORS (INCLUDING APPOINTMENTS TO FILL A VACANCY) AND INITIATE THE REMOVAL AND REMOVE ANY DIRECTOR OF THE CORPORATION, WITH CAUSE, PROVIDED CONSIDERATION IS GIVEN TO RECOMMENDATIONS OF THE BOARD REGARDING SUCH APPOINTMENT OR REMOVAL, IF ANY ARE SO MADE; (B) APPOINT (INCLUDING APPOINTMENTS TO FILL A VACANCY) AND INITIATE THE REMOVAL AND REMOVE THE PRESIDENT OF THE CORPORATION, WITH OR WITHOUT CAUSE, PROVIDED CONSIDERATION IS GIVEN TO RECOMMENDATIONS OF THE BOARD REGARDING SUCH APPOINTMENT OR REMOVAL, IF ANY ARE SO MADE; (C) APPROVE AND ADOPT THE STRATEGIC PLAN FOR THE CORPORATION AND ITS AFFILIATES, INCLUDING ANY INDIVIDUAL INITIATIVES OR ARRANGEMENTS, SUCH AS A NEW SERVICE OR CONTRACTUAL ARRANGEMENT, DEEMED BY THE CORPORATE MEMBER TO BE OF STRATEGIC IMPORTANCE TO THE CORPORATION OR ITS AFFILIATES AND DIRECT AND MONITOR COMPLIANCE WITH SUCH PLANS, INITIATIVES AND ARRANGEMENTS; (D) APPROVE AND ADOPT THE CAPITAL AND OPERATING BUDGETS OF THE CORPORATION AND ITS AFFILIATES; (E) APPROVE THE INCURRENCE OF ANY DEBT PROPOSED BY THE CORPORATION, INCLUDING THE ISSUANCE OF BONDS, BY THE CORPORATION AND ITS AFFILIATES AND REQUIRE THE INCURRENCE OF DEBT BY THE CORPORATION AND ITS AFFILIATES; (F) APPROVE THE TRANSFER OF ASSETS BY THE CORPORATION AND ITS AFFILIATES, INCLUDING TRANSFERS OF REAL PROPERTY, PERSONAL PROPERTY, CASH, STOCK OR OTHER TANGIBLE OR INTANGIBLE ASSETS, UNLESS OTHERWISE IDENTIFIED IN PREVIOUSLY APPROVED STRATEGIC PLANS, INITIATIVES, ARRANGEMENTS OR BUDGETS. (G) REQUIRE AND DIRECT THE TRANSFER OF ASSETS BY THE CORPORATION OR ITS AFFILIATES, PROVIDED THAT APPROVAL OF THE BOARD IS ALSO REQUIRED IF THE TRANSFER INVOLVES A TRANSFER OR SALE OF SUBSTANTIALLY ALL OF THE ASSETS OF THE CORPORATION OR WOULD PREVENT THE CORPORATION FROM OPERATING AN ACUTE CARE HOSPITAL IN THE COMMUNITY. FOR PURPOSES OF THIS SECTION, BOARD APPROVAL SHALL NOT BE REQUIRED FOR PARTICIPATION IN A MASTER TRUST INDENTURE, POOLED FINANCING OR ANY OTHER KIND OF DEBT INSTRUMENT, BORROWING OR GUARANTY OBLIGATING CORPORATION ASSETS; (H) APPROVE PARTICIPATION (INCLUDING THE EXERCISE OF RENEWAL OPTIONS) BY THE CORPORATION AND ITS AFFILIATES IN NETWORKS, AFFILIATIONS, JOINT VENTURES, PARTNERSHIPS, MERGERS OR ACQUISITIONS AND REQUIRE PARTICIPATION BY THE CORPORATION AND ITS AFFILIATES IN SUCH ARRANGEMENTS; (I) APPROVE DECISIONS OF THE CORPORATION AND ITS AFFILIATES TO PARTICIPATE (INCLUDING THE EXERCISE OF RENEWAL OPTIONS) IN MANAGED CARE OR OTHER HEALTH CARE SERVICE PURCHASING ARRANGEMENTS AND REQUIRE PARTICIPATION BY THE CORPORATION AND ITS AFFILIATES IN SUCH HEALTH CARE SERVICE PURCHASING ARRANGEMENTS; (J) DEVELOP AND REQUIRE ADOPTION OF MINIMUM MEDICAL STAFF QUALITY ASSURANCE AND UTILIZATION REVIEW STANDARDS, CRITERIA AND PROCEDURES FOR THE CORPORATION AND ITS AFFILIATES IN CONSULTATION WITH THE CORPORATION; (K) APPROVE ANY ACTION OF THE CORPORATION OR AN AFFILIATE TO CHANGE THE HOSPITAL FROM A GENERAL, ACUTE CARE COMMUNITY HOSPITAL OR TO CLOSE THE HOSPITAL; AND (L) APPROVE ANY AMENDMENT TO THE BYLAWS OR THE ARTICLES OF INCORPORATION OF THE CORPORATION, AND THE ARTICLES AND BYLAWS OF ANY NEWLY CREATED AFFILIATE AND REQUIRE AMENDMENT OF THESE GOVERNING DOCUMENTS AS NECESSARY OR ADVISABLE TO RESOLVE SIGNIFICANT ETHICAL ISSUES; TO MAINTAIN JOINT COMMISSION ACCREDITATION, TAX-EXEMPT STATUS, PARTICIPATION IN MEDICARE/MEDICAID OR TO PREVENT SIGNIFICANT ADVERSE LEGAL OR FINANCIAL EFFECTS TO THE CORPORATION OR SYSTEM, EXCEPT THAT THERE CAN BE NO AMENDMENT TO THE RESERVED POWERS LISTED IN SECTIONS (G) AND (K) OF THIS EXHIBIT A OR THE REQUIREMENT THAT ELECTED DIRECTORS BE REPRESENTATIVES OF WHITLEY COUNTY, AS DESCRIBED IN ARTICLE V, SECTIONS 2 AND 10 OF THESE BYLAWS WITHOUT THE CONSENT OF THE CORPORATION. THE CORPORATE MEMBER SHALL DEVELOP POLICIES FOR THE IMPLEMENTATION OF THE RESERVED POWERS, INCLUDING MATERIALITY POLICIES REGARDING MATTERS SUBJECT TO REVIEW. |
| FORM 990, PART VI, SECTION A, LINE 7B | SEE SCHEDULE O EXPLANATION FOR FORM 990, PART VI, SECTION A, LINE 7A |
| FORM 990, PART VI, SECTION B, LINE 11B | PURSUANT TO PARKVIEW HEALTH SYSTEM INC.'S BYLAWS, THE SYSTEM AUDIT COMMITTEE MAY ACT ON BEHALF OF THE CORPORATION TO PROVIDE REVIEW OF THE CORPORATION AND ITS SUBSIDIARY CORPORATIONS' FORM 990 FILINGS. WHITLEY MEMORIAL HOSPITAL, INC. IS A SUBSIDIARY CORPORATION OF PARKVIEW HEALTH SYSTEM, INC. AN ELECTRONIC COPY OF THE ORGANIZATION'S FINAL FORM 990 (INCLUDING SUPPLEMENTAL SCHEDULES) WAS PROVIDED TO EACH VOTING MEMBER OF THE ORGANIZATION'S GOVERNING BODY AND THE SYSTEM AUDIT COMMITTEE, PRIOR TO FILING WITH THE IRS. ON OCTOBER 26, 2022, THE SYSTEM AUDIT COMMITTEE REVIEWED THE FORM 990 AS ULTIMATELY FILED WITH THE IRS. THIS REVIEW INCLUDED A PRESENTATION BY THE ORGANIZATION'S TAX PREPARER TO HIGHLIGHT THE SIGNIFICANT AREAS ON THE FORM 990 AND SUPPLEMENTAL SCHEDULES. |
| FORM 990, PART VI, SECTION B, LINE 12C | AS DESCRIBED IN ARTICLE IX SECTION 6, OF THE PARKVIEW HEALTH SYSTEM, INC. (PH) BYLAWS, PH ADOPTED PH'S COMPLIANCE POLICY FOR THE ORGANIZATION AND ITS NOT-FOR-PROFIT RELATED ORGANIZATIONS (AND AS LIKEWISE NOTED IN THEIR BYLAWS) WHEN ADDRESSING CONFLICTS OR POTENTIAL CONFLICTS OF INTEREST. THIS COMPLIANCE POLICY (COMPLIANCE POLICY #14) REQUIRES THAT EACH BOARD MEMBER, BOARD COMMITTEE MEMBER, AND KEY MANAGEMENT PERSONNEL MUST ANNUALLY COMPLETE A CONFLICT OF INTEREST FORM. THIS INFORMATION IS PROVIDED TO THE CHAIRMAN OF THE BOARD (FOR BOARD AND BOARD COMMITTEE MEMBERS) AND TO SENIOR MANAGEMENT (FOR KEY MANAGEMENT PERSONNEL). IN ADDITION, AS TO THE CONDUCT OF BOARD MEETINGS, THE FOLLOWING PROCESS IS FOLLOWED: "WHENEVER A PH OR PH AFFILIATE BOARD OR BOARD COMMITTEE IS CONSIDERING A TRANSACTION OR ARRANGEMENT WITH AN ORGANIZATION, ENTITY OR INDIVIDUAL IN WHICH A PERSON COVERED BY THIS POLICY HAS A FINANCIAL OR CONFLICTING INTEREST, THE FOLLOWING SHALL OCCUR: 1. THE INTERESTED PERSON MUST DISCLOSE THE FINANCIAL OR CONFLICTING INTEREST AND ALL MATERIAL FACTS TO THE PH OR PH AFFILIATE BOARD OR BOARD COMMITTEE; 2. THE INTERESTED PERSON WITH THAT FINANCIAL OR CONFLICTING INTEREST MAY MAKE A PRESENTATION AT THE BOARD OR BOARD COMMITTEE MEETING REGARDING THE TRANSACTION OR ARRANGEMENT HOWEVER, HE/SHE SHALL LEAVE THE MEETING DURING THE DISCUSSION OF, AND THE VOTE ON, THE TRANSACTION OR ARRANGEMENT THAT RESULTS IN THE FINANCIAL OR CONFLICTING INTEREST; AND 3. THE PH OR PH AFFILIATE BOARD OR BOARD COMMITTEE MUST APPROVE THE TRANSACTION OR ARRANGEMENT BY A MAJORITY VOTE OF THE BOARD MEMBERS PRESENT AT A MEETING THAT HAS A QUORUM, NOT INCLUDING THE VOTE OF THE INTERESTED PERSON. THE INTERESTED PERSON MAY NOT VOTE ON THE MATTER. A. UPON THE REQUEST OF PH OR PH AFFILIATE BOARD OR BOARD COMMITTEE, THE MATTER MAY BE DELEGATED TO THE PH COMPLIANCE COMMITTEE FOR EVALUATION, RECOMMENDATION AND/OR DETERMINATION. 4. WHENEVER A FINANCIAL OR CONFLICTING INTEREST IS ADDRESSED BY A PH OR PH AFFILIATE BOARD, NOTICE SHALL BE GIVEN TO THE PH COMPLIANCE OFFICER / GENERAL COUNSEL." |
| FORM 990, PART VI, SECTION B, LINE 15 | LINES 15A AND 15B ARE ANSWERED NO IN ACCORDANCE WITH THE IRS INSTRUCTIONS. TO THE EXTENT THAT THE ORGANIZATION HAS VICE PRESIDENT OR ABOVE, THE COMPENSATION COMMITTEE OF RELATED ORGANIZATION, PARKVIEW HEALTH SYSTEM, INC., DETERMINES THE COMPENSATION OF THE CEO, OFFICERS, AND KEY EMPLOYEES. |
| FORM 990, PART VI, SECTION C, LINE 19 | COPIES OF THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. |
| FORM 990, PART IX, LINE 11G | OTHER: PROGRAM SERVICE EXPENSES 1,107,367. MANAGEMENT AND GENERAL EXPENSES 110,054. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,217,421. MEDICAL PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 2,093,190. MANAGEMENT AND GENERAL EXPENSES 1,300,325. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,393,515. LABORATORY SERVICES: PROGRAM SERVICE EXPENSES 3,578,874. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,578,874. COLLECTION EXPENSE: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 452,148. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 452,148. |
| FORM 990, PART IX, LINES 5-10: | PARKVIEW HEALTH SYSTEM, INC., EIN 35-1972384, SERVES AS THE COMMON PAYING AGENT FOR ALL TAX-EXEMPT ORGANIZATIONS OF THE SYSTEM. SALARIES AND WAGES OF EMPLOYEES WORKING FOR THESE ORGANIZATIONS ARE CHARGED DIRECTLY TO THE ORGANIZATIONS IN WHICH THEY WORK. THE ACTUAL EXPENSES FOR PAYROLL TAXES, EMPLOYEE BENEFITS, AND PENSION PLAN CONTRIBUTIONS ARE REFLECTED ON THE BOOKS OF PARKVIEW HEALTH SYSTEM, INC. FOR FINANCIAL REPORTING PURPOSES. TO ACCOUNT FOR BENEFIT COSTS ON THE BOOKS OF THE OTHER TAX EXEMPT ORGANIZATIONS, AN ALLOCATION METHODOLOGY IS UTILIZED TO CHARGE THESE ORGANIZATIONS WITH AN ESTIMATE OF THE OVERALL COSTS, REFERRED TO AS A "BENEFIT ALLOCATION" FROM PARKVIEW HEALTH SYSTEM, INC. THE ALLOCATION DOES NOT DISTINGUISH BETWEEN THE COSTS OF THE VARIOUS COMPONENTS (I.E. PAYROLL TAXES, EMPLOYEE BENEFITS, AND PENSION PLAN CONTRIBUTIONS). THEREFORE, FOR PURPOSES OF THE FORM 990, PART IX, THE TOTAL BENEFIT ALLOCATION FOR THE EMPLOYEES' SALARIES AND WAGES REPORTED ON LINE 7 IS REFLECTED ON LINE 9 AND NOT ALLOCATED BETWEEN LINES 8 OR 10. FOR PURPOSES OF THE FORM 990, PART IX, LINES 5 AND 6 REFLECT COMPENSATION AND BENEFIT AMOUNTS REPORTED IN PART VII. |
| FORM 990, PART XI, LINE 9: | ASSET TRANSFERS/ADJUSTMENTS 240,577. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (25 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Direct Controlling NADirectControllingNACd | Controlled OrganizationControlledOrganizationInd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt |
|---|---|---|---|---|---|---|---|---|---|---|---|
| PARKVIEW HEALTH SYSTEM INC | |||||||||||
| 1450 PRODUCTION RD | FORT WAYNE | IN | 468081167 | 351972384 | HEALTH CARE | IN | 501(C)(3) | LINE 12C, III-FI | N/A | 0 | |
| WHITLEY MEMORIAL HOSPITAL FOUNDATION INC | |||||||||||
| 1260 E STATE ROAD 205 | COLUMBIA CITY | IN | 467259492 | 311190239 | FUND MGMT | IN | 501(C)(3) | LINE 12A, I | Yes (1) | WHITLEY MEMORIAL HOSPITAL INC | |
| PARKVIEW HOSPITAL INC | |||||||||||
| 11109 PARKVIEW PLAZA DR | FORT WAYNE | IN | 468451701 | 350868085 | HOSPITAL CARE | IN | 501(C)(3) | LINE 3 | 0 | PARKVIEW HEALTH SYSTEM INC | |
| PARKVIEW FOUNDATION INC | |||||||||||
| 3844 NEW VISION DR | FORT WAYNE | IN | 468451724 | 237220589 | FUND MGMT | IN | 501(C)(3) | LINE 12A, I | 0 | PARKVIEW HOSPITAL INC | |
| DEKALB MEMORIAL HOSPITAL INC | |||||||||||
| 1316 E 7TH ST | AUBURN | IN | 467062515 | 351064295 | HOSPITAL CARE | IN | 501(C)(3) | LINE 3 | 0 | PARKVIEW HEALTH SYSTEM INC | |
| PARKVIEW DEKALB HOSPITAL FOUNDATION INC | |||||||||||
| 1316 E 7TH ST | AUBURN | IN | 467062515 | 351064295 | FUND MGMT | IN | 501(C)(3) | LINE 12A, I | 0 | DEKALB MEMORIAL HOSPITAL INC | |
| HUNTINGTON MEMORIAL HOSPITAL INC | |||||||||||
| 2001 STULTS RD | HUNTINGTON | IN | 467501291 | 351970706 | HOSPITAL CARE | IN | 501(C)(3) | LINE 3 | 0 | PARKVIEW HEALTH SYSTEM INC | |
| PARKVIEW HUNTINGTON HOSPITAL FOUNDATION INC | |||||||||||
| 2001 STULTS RD | HUNTINGTON | IN | 467501291 | 320012095 | FUND MGMT | IN | 501(C)(3) | LINE 12A, I | 0 | HUNTINGTON MEMORIAL HOSPITAL INC | |
| COMMUNITY HOSPITAL OF LAGRANGE COUNTY INC | |||||||||||
| 207 N TOWNLINE RD | LAGRANGE | IN | 467611325 | 202401676 | HOSPITAL CARE | IN | 501(C)(3) | LINE 3 | 0 | PARKVIEW HEALTH SYSTEM INC | |
| PARKVIEW LAGRANGE HOSPITAL FOUNDATION INC | |||||||||||
| 207 N TOWNLINE RD | LAGRANGE | IN | 467611325 | 833347115 | FUND MGMT | IN | 501(C)(3) | LINE 12A, I | 0 | COMMUNITY HOSPITAL OF LAGRANGE COUNTY INC | |
| COMMUNITY HOSPITAL OF NOBLE COUNTY INC | |||||||||||
| 401 N SAWYER RD | KENDALLVILLE | IN | 467552568 | 352087092 | HOSPITAL CARE | IN | 501(C)(3) | LINE 3 | 0 | PARKVIEW HEALTH SYSTEM INC | |
| COMMUNITY HOSPITAL OF NOBLE COUNTY FOUNDATION INC | |||||||||||
| 401 N SAWYER RD | KENDALLVILLE | IN | 467552568 | 352089183 | FUND MGMT | IN | 501(C)(3) | LINE 12A, I | 0 | COMMUNITY HOSPITAL OF NOBLE COUNTY INC | |
| PARKVIEW WABASH HOSPITAL INC | |||||||||||
| 10 JOHN KISSINGER DR | WABASH | IN | 469921648 | 471753440 | HOSPITAL CARE | IN | 501(C)(3) | LINE 3 | 0 | PARKVIEW HEALTH SYSTEM INC | |
| PARKVIEW WABASH HOSPITAL FOUNDATION INC | |||||||||||
| 10 JOHN KISSINGER DR | WABASH | IN | 469921648 | 351921445 | FUND MGMT | IN | 501(C)(3) | LINE 12A, I | 0 | PARKVIEW WABASH HOSPITAL INC | |
| MIDWEST COMMUNITY HEALTH ASSOCIATES INC | |||||||||||
| 442 W HIGH ST | BRYAN | OH | 435061681 | 341045870 | PHYSICIANS | OH | 501(C)(3) | LINE 3 | 0 | PARKVIEW HEALTH SYSTEM INC | |
| PARKVIEW OCCUPATIONAL HEALTH CENTERS INC | |||||||||||
| 1450 PRODUCTION RD | FORT WAYNE | IN | 468081167 | 352064353 | OCCUPATIONAL HEALTH | IN | 501(C)(3) | LINE 3 | 0 | PARKVIEW HEALTH SYSTEM INC | |
| PARK CENTER INC | |||||||||||
| 909 E STATE BLVD | FORT WAYNE | IN | 468053404 | 351135451 | COMPREHENSIVE MENTAL HEALTH CENTER | IN | 501(C)(3) | LINE 10 | 0 | PARKVIEW HEALTH SYSTEM INC | |
| PARK CENTER HOLDINGS INC | |||||||||||
| 909 E STATE BLVD | FORT WAYNE | IN | 468053404 | 843684074 | TO SUPPORT PARK CENTER INC | IN | 501(C)(3) | LINE 12D, III-O | 0 | PARKVIEW HEALTH SYSTEM INC | |
| OUABACHE VILLAGE INC | |||||||||||
| 909 E STATE BLVD | FORT WAYNE | IN | 468053404 | 020731922 | PROVIDE HOUSING TO HANDICAPPED INDIVIDUALS | IN | 501(C)(3) | LINE 10 | 0 | PARK CENTER INC | |
| RICHARDVILLE APARTMENTS INC | |||||||||||
| 909 E STATE BLVD | FORT WAYNE | IN | 468053404 | 050543940 | PROVIDE HOUSING TO HANDICAPPED INDIVIDUALS | IN | 501(C)(3) | LINE 10 | 0 | PARK CENTER INC | |
| RICHARDVILLE APARTMENTS II INC | |||||||||||
| 909 E STATE BLVD | FORT WAYNE | IN | 468053404 | 861077255 | PROVIDE HOUSING TO HANDICAPPED INDIVIDUALS | IN | 501(C)(3) | LINE 10 | 0 | PARK CENTER INC | |
| SEDDLEMEYER APARTMENTS INC | |||||||||||
| 909 E STATE BLVD | FORT WAYNE | IN | 468053404 | 352067590 | PROVIDE HOUSING TO HANDICAPPED INDIVIDUALS | IN | 501(C)(3) | LINE 10 | 0 | PARK CENTER INC | |
| WAYNEDALE APARTMENTS INC | |||||||||||
| 909 E STATE BLVD | FORT WAYNE | IN | 468053404 | 351972197 | PROVIDE HOUSING TO HANDICAPPED INDIVIDUALS | IN | 501(C)(3) | LINE 10 | 0 | PARK CENTER INC | |
| WAYNEDALE II APARTMENTS INC | |||||||||||
| 909 E STATE BLVD | FORT WAYNE | IN | 468053404 | 223972135 | PROVIDE HOUSING TO HANDICAPPED INDIVIDUALS | IN | 501(C)(3) | LINE 10 | 0 | PARK CENTER INC | |
| WOODSIDE APARTMENTS INC | |||||||||||
| 909 E STATE BLVD | FORT WAYNE | IN | 468053404 | 351937426 | PROVIDE HOUSING TO HANDICAPPED INDIVIDUALS | IN | 501(C)(3) | LINE 10 | 0 | PARK CENTER INC | |
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Direct Controlling NADirectControllingNACd | Predominant Income TypePredominantIncomeTypeTxt | Disproportionate AllocationsDisproportionateAllocationsInd | General Or Managing PartnerGeneralOrManagingPartnerInd |
|---|---|---|---|---|---|---|---|---|---|---|
| ORTHOPAEDIC HOSPITAL AT PARKVIEW NORTH LLC | ||||||||||
| 1450 PRODUCTION RD | FORT WAYNE | IN | 468081167 | 260143823 | ORTHOPAEDIC HOSPITAL | IN | N/A | N/A | 0 | 0 |
| MANAGED CARE SERVICES LLC | ||||||||||
| 1450 PRODUCTION RD | FORT WAYNE | IN | 468081167 | 351996535 | HEALTH PLAN ADMINISTRATION | IN | N/A | N/A | 0 | 0 |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Direct Controlling NADirectControllingNACd | Entity TypeEntityTypeTxt | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|
| PARKVIEW PROFESSIONAL PROGRAMS INC | |||||||||
| 1450 PRODUCTION RD | FORT WAYNE | IN | 468081167 | 351668888 | REFERENCE LAB | IN | N/A | C | 0 |
| WOODLAND PLAZA MEDICAL PARK CONDO ASSOC INC | |||||||||
| 202 W BERRY ST | FORT WAYNE | IN | 468022273 | 352058340 | PROPERTY OWNERS ASSOCIATION | IN | N/A | C | 0 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | Yes (1) | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (1) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | Yes (1) | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | Yes (1) | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | Yes (1) | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | Yes (1) | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (1) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (1) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (1) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (1) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | Yes (1) | TransferToOtherOrgInd |
| Transfer From Other Org | Yes (1) | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (2 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt |
|---|---|---|
| WHITLEY MEMORIAL HOSPITAL FOUNDATION INC | ||
| C | $58,330 | PART VII SUPPLEMENTAL INFORMATION |
| WHITLEY MEMORIAL HOSPITAL FOUNDATION INC | ||
| M | $88,794 | PART VII SUPPLEMENTAL INFORMATION |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE R, PART V, LINE 2, COLUMN (C): | FormAndLineReferenceDesc |
| Explanation | THE AMOUNTS REPORTED AS TRANSACTIONS WITH RELATED ORGANIZATIONS ARE CONSISTENT WITH THE AMOUNTS REPORTED ON THE ORGANIZATION'S AUDITED FINANCIAL STATEMENTS UNDER THE GENERALLY ACCEPTED ACCOUNTING STANDARDS DEPENDING ON THE TYPE OF TRANSACTION INVOLVED. | ExplanationTxt |