2022-11-02T17:35:31-05:00 2021-12-31 350921680 CROWE LLP 330 EAST JEFFERSON BLVD PO BOX 7 SOUTH BEND IN 466240007 990 2021-01-01 351064295 DEKALB MEMORIAL HOSPITAL INC DEKA 2603738429 1316 E 7TH ST AUBURN IN 467062515 JEANNE' WICKENS PH CFO 2602669313 2022-11-02 1 JEANNE WICKENS 999009999 BRITTNEY KOCAJ P01320603 5742323992 3 AAL1 IAL1 2021 2022-09-23 18:48:47Z X PARKVIEW DEKALB HOSPITAL MICHAEL J PACKNETT 1450 PRODUCTION RD FORT WAYNE IN 468081167 128600529 0 X WWW.PARKVIEW.COM X 1964 IN IMPROVE HEALTH & PROVIDE QUALITY HEALTH SERVICES TO ALL WHO ENTRUST THEIR CARE TO US. 12 9 392 23 4354062 0 3094828 2211343 58118268 73430673 1020304 1692292 -41930 322540 62191470 77656848 49306 29104 0 0 22629624 23610380 0 0 24437 38215026 42295374 60893956 65934858 1297514 11721990 66142458 71850103 16083196 9059668 50059262 62790435 X DEKALB MEMORIAL HOSPITAL, INC. WORKS TO IMPROVE THE HEALTH OF OUR COMMUNITIES AND PROVIDES QUALITY HEALTH SERVICES TO ALL WHO ENTRUST THEIR CARE TO US. 0 0 55908090 29104 69076611 THE 57 INPATIENT BED HOSPITAL OPERATES IN A RURAL AREA. FOR FISCAL PERIOD JANUARY 1, 2021, TO DECEMBER 31, 2021, THE TOTAL NUMBER OF ADMISSIONS WERE 1,668. THE TOTAL NUMBER OF EMERGENCY ROOM VISITS WERE 18,410. THE HOSPITAL PROVIDES CHARITY CARE TO PATIENTS WHO MEET CERTAIN CRITERIA UNDER ITS CHARITY CARE POLICY. THE HOSPITAL DOES NOT PURSUE COLLECTION OF AMOUNTS DETERMINED TO BE CHARITY CARE. AT DEKALB MEMORIAL HOSPITAL, INC., OUR INVESTMENTS IN STATE-OF-THE-ART FACILITIES AND PARTNERSHIPS WITH TOP FAMILY PHYSICIANS AND SPECIALTY GROUPS MEAN THAT YOU NEVER HAVE TO LOOK PAST DEKALB COUNTY FOR THE VERY BEST CARE. (SEE SCHEDULE O FOR CONTINUATION)OUR COMMITMENT IS ALSO REFLECTED IN OUR INVESTMENTS OF TIME, TALENTS, AND RESOURCES IN LOCAL SCHOOLS, BUSINESSES, CHARITABLE ORGANIZATIONS, AND OTHER WORTHY CAUSES TO HELP ENSURE A HEALTHIER COMMUNITY. WE ARE PROUD TO BE YOUR NEIGHBOR, AND YOU CAN BE SURE WE WILL BE HERE, TAKING CARE OF YOU FOR GENERATIONS TO COME.THANKS TO THE VISION OF OUR LEADERSHIP, DEKALB MEMORIAL HOSPITAL, INC. HAS TAKEN NUMEROUS STEPS FORWARD. WE HAVE FORGED NEW PARTNERSHIPS WITH PARKVIEW HEALTH ALONG WITH PHYSICIAN GROUPS, SO THAT PEOPLE IN OUR REGION NOW HAVE ACCESS TO ALMOST EVERY MEDICAL SPECIALTY RIGHT HERE ON OUR CAMPUS.WE HAVE ALSO MADE SIGNIFICANT INVESTMENTS IN NEW TECHNOLOGY, SUCH AS A STATE-OF-THE-ART MONITORING SYSTEM FOR CRITICALLY ILL PATIENTS. THE HOSPITAL HAS INVESTED IN AN INNOVATIVE INFANT SECURITY MONITORING SYSTEM AS WELL AS A NEW PATIENT CALL LIGHT SYSTEM THAT INCLUDES RF TECHNOLOGY. DURING THE PANDEMIC, THE FACILITY INVESTED IN ADDITIONAL SAFETY BARRIERS THROUGHOUT THE HOSPITAL TO KEEP PATIENTS AND COWORKERS SAFE. THE FACILITY EXPANDED NEGATIVE PRESSURE ROOMS IN ORDER TO PROVIDE THE SAFEST CARE FOR COVID-19 PATIENTS. THE HOSPITAL ALSO EXPANDED ITS EMERGENCY DEPARTMENT TO PROVIDE ADDITIONAL SAFE SPACE TO TREAT PATIENTS NEEDING CARE DURING THE PANDEMIC. MOST IMPORTANTLY, OUR PEOPLE CONTINUE TO DISTINGUISH THEMSELVES AS THE MOST COMPASSIONATE CAREGIVERS YOU WILL FIND ANYWHERE, AND WE CONTINUE TO DONATE TIME AND RESOURCES IN SUPPORT OF SCHOOLS, BUSINESSES, AND ORGANIZATIONS TO ENSURE A STRONG, HEALTHY COMMUNITY. AT DEKALB MEMORIAL HOSPITAL, INC., WE HAVE REARMED OUR COMMITMENT TO BEING YOUR NOT-FOR-PROFIT COMMUNITY HOSPITAL. WITH EVERY NEW INVESTMENT, WE ARE BRINGING WORLD-CLASS HEALTHCARE HOME TO YOU.WE CELEBRATE THE UNIQUE BOND THAT EXISTS BETWEEN THE HOSPITAL AND ITS COMMUNITY. OURS IS A RICH HERITAGE OF HIGH QUALITY, DETERMINATION AND A COMMITMENT TO TAKING CARE OF THE INDIVIDUALS AND FAMILIES WE SERVE AND WE SUPPORT THE FOLLOWING INITIATIVES IN THE COMMUNITY: AUBURN WATERLOO TRAIL SYSTEM, HOOSIERS FEEDING THE HUNGRY, HEARTEN HOUSE FOR SUBSTANCE ABUSE AND RECOVERY, CHILDREN'S FIRE SAFETY EDUCATION MATERIAL THROUGH THE BUTLER FIRE DEPARTMENT, HEALTH CARE SERVICES FOR UNINSURED AND UNDERINSURED THROUGH ST. MARTIN'S HEALTH CARE CLINIC AND IN-KIND DONATIONS FOR BICYCLE HELMET INITIATIVES FOR THE JAM CENTER AND THE GREATER GARRETT GROUP. WE ALSO SUPPORTED THE WOMEN'S CARE CENTER BY PROVIDING PRENATAL VITAMINS AND INFANT SUPPLIES AND FLU VACCINES THROUGH THE DEKALB COUNTY HEALTH DEPARTMENT. 55908090 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 X 37 0 1 392 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 12 9 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 IN X JEANNE' WICKENS 2602669313 1450 PRODUCTION RD FORT WAYNE IN 468081167 MICHAEL PACKNETT DIRECTOR/PH PRESIDENT & CEO 0.00 40.00 X X 0 2037606 326073 THOMAS MASON DIRECTOR/PH PHYSICIAN 0.00 40.00 X 0 367470 67766 NATASHA EICHER DIRECTOR/DMHOS PRESIDENT 40.00 0.00 X X 276208 0 92834 DOUGLAS MORROW DIRECTOR/CHAIR 1.00 1.00 X X 6250 1500 0 THOMAS HARTMAN DIRECTOR 1.00 0.00 X 4250 0 0 MICHAEL TULLIS DIRECTOR 1.00 0.00 X 4500 0 0 BRYAN NUGEN DIRECTOR/SECRETARY/TREASURER 1.00 0.00 X X 4500 0 0 TRENTON STUCKEY DIRECTOR 1.00 0.00 X 4250 0 0 TRINA CHAPMAN-SMITH DIRECTOR 1.00 0.00 X 3750 0 0 SCOTT PFLUGHOEFT DIRECTOR/VICE CHAIR 1.00 0.00 X X 7750 0 0 TYLER JOHNSON DIRECTOR 1.00 0.00 X 10000 0 0 CLARAMARY WINEBRENNER DIRECTOR 1.00 0.00 X 3250 0 0 JEANNE' WICKENS PH CHIEF FINANCIAL OFFICER 0.00 40.00 X 0 1059636 349980 KARRA HEGGEN DMHOS VP PATIENT CARE SVCS 40.00 0.00 X 236856 0 25052 JENNIFER SINGER DMHOS HOUSE SPV 32.00 8.00 X 111401 14081 19405 JACOB CLENDENEN DMHOS PHARMACIST 40.00 0.00 X 152394 0 35754 LON KEYES DMHOS PHARMACY MGR 40.00 0.00 X 170901 0 21687 BETHANY HEILEMAN DMHOS PHARMACIST 40.00 0.00 X 126337 1234 41242 ANTHONY STUMP DMHOS MGR REHAB 40.00 0.00 X 129590 0 38732 BRET CLAGHORN FORMER OFFICER/CURRENT PH VP 0.00 40.00 X 0 214449 48128 1252187 3695976 1066653 18 1 1 0 PARKVIEW HOSPITAL INC 11109 PARKVIEW PLAZA DR FORT WAYNE IN 46845 LABORATORY SERVICES 3046831 FOCUSONE SOLUTIONS LLC 13609 CALIFORNIA STREET OMAHA NE 68154 MEDICAL PERSONNEL 1066133 PROLINK HEALTHCARE 4600 MONTGOMERY ROAD SUITE 300 CINCINNATI OH 45212 MEDICAL PERSONNEL 790199 ASSOCIATED ANESTHESIOLOGISTS OF FORT WAY 10315 DAWSON CREEK BLVD SUITE A/B FORT WAYNE IN 46825 ANESTHESIOLOGISTS 655340 NORTHEAST INTERNAL MEDICINE ASSOC INC 2500 N DETROIT STREET LAGRANGE IN 46761 HOSPITALISTS 325796 8 19137 2168620 23586 491 2211343 NET PATIENT SERVICE REVENUE 622000 66697389 66697389 PHARMACY 446110 5305590 951528 4354062 INTERUNIT RENT 531120 1101686 1101686 EMS SUBSIDY 621910 250000 250000 HEALTH/DISEASE EDUCATION CLASSES 621990 73152 73152 2856 2856 73430673 363374 363374 255174 240144 15030 15030 15030 52032455 50691980 11557 1340475 -11557 1328918 1328918 CAFETERIA REVENUE 722514 307510 307510 307510 77656848 69076611 4354062 2014832 X 29104 29104 679450 679450 17563450 17563450 5367480 5367480 64399 64399 7785534 7605717 179817 15900 15900 1977410 1669021 308389 4272 4272 1658697 1650017 8680 5915 5571 344 9110 9110 276192 276192 1793804 1790485 3319 107606 88094 19512 FEDERAL & STATE INCOME -2627 -2627 MEDICAL SUPPLIES 10582072 10582072 CORP SERVICE ALLOCATION 8650528 8650528 PH CLINICAL SUPPORT 5842514 5842514 3524048 3411718 87893 24437 65934858 55908090 10002331 24437 2950 2950 5163223 84481 252916 9431926 11397992 1580489 880016 168027 52449 32492031 4874604 27096816 27617427 22397084 25045603 301943 6516269 66142458 71850103 2664455 3826250 3885767 2867511 8043302 0 1489672 2365907 16083196 9059668 X 50059262 62790435 50059262 62790435 66142458 71850103 11721990 1009183 0 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 3526 3526 0 PART II-B, LINE 1: OTHER ACTIVITIES - REPRESENTS THE PORTION OF THE DUES PAID TO INDIANA HOSPITAL AND HEALTH ASSOCIATION, AMERICAN HOSPITAL ASSOCIATION AND VARIOUS PROFESSIONAL ASSOCIATIONS USED FOR LOBBYING ACTIVITIES. 2496000 2496000 24380378 2630025 21750353 9290 5768 3522 4494782 2238811 2255971 1111581 1111581 27617427 DUE TO/FROM INTERUNIT 5645241 EST MEDICARE/MEDICAID SETTLEMENTS 397065 RIGHT OF USE ASSETS 473963 6516269 LEASE LIABILITY 616156 EST 3RD PARTY SETTLEMENTS 1749751 2365907 X PART X, LINE 2: PARKVIEW HEALTH SYSTEM, INC. AND SUBSIDIARIES - NOTES TO THE CONSOLIDATED FINANCIAL STATEMENTS TEXT OF THE FOOTNOTE TO THE ORGANIZATION'S FINANCIAL STATEMENTS THAT DESCRIBES THE LIABILITY FOR UNCERTAIN TAX POSITIONS UNDER FIN 48 (ASC 740): 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. 1 1 X 1 X 1 X 1 1 1 0 1 1 882405 0 882405 0.01470 5791613 4137987 1653626 0.02750 7649839 5714785 1935054 0.03220 14323857 9852772 4471085 0.07440 53276 0 53276 0.00090 146730 0 146730 0.00240 6214270 4470944 1743326 0.02900 60203 0 60203 0.00100 6474479 4470944 2003535 0.03330 20798336 14323716 6474620 0.10770 1000 1000 0.00000 1000 1000 0.00000 1 0 0 7361222 8651972 -1290750 X 1 1 1 1 DEKALB MEMORIAL HOSPITAL INC 1316 EAST SEVENTH STREET AUBURN IN 46706 WWW.PARKVIEW.COM 20-005041-1 X X X DEKALB MEMORIAL HOSPITAL INC 1 0 0 1 X X X X X X X X X 19 1 0 1 1 X HTTPS://WWW.PARKVIEW.COM/LOCALHEALTHNEEDS X 1 19 1 HTTPS://WWW.PARKVIEW.COM/LOCALHEALTHNEEDS 0 1 X 200.000000000000 250.000000000000 X X X X X 1 1 X X X 1 X HTTPS://WWW.PARKVIEW.COM/PATIENTS-VISITORS/FINANCIAL-ASSISTANCE X HTTPS://WWW.PARKVIEW.COM/PATIENTS-VISITORS/FINANCIAL-ASSISTANCE X HTTPS://WWW.PARKVIEW.COM/PATIENTS-VISITORS/FINANCIAL-ASSISTANCE X X X X X X 1 X 0 X X X X 1 X 0 0 DEKALB 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:DEKALB MEMORIAL HOSPITAL, INC. TOOK INTO ACCOUNT INPUT FROM PERSONS WHO REPRESENT THE COMMUNITY THROUGH COMMUNITY FOCUS GROUPS IN DEKALB COUNTY, AND FEEDBACK COLLECTED FROM KEY CONSTITUENTS.BEGINNING IN JANUARY 2019, THE DIRECTOR OF COMMUNITY OUTREACH HELD TWO COMMUNITY FORUMS WITH INDIVIDUALS FROM THE DEKALB MEMORIAL HOSPITAL, INC. TEAM, COMMUNITY-BASED ORGANIZATIONS, SOCIAL SERVICE LEADERS AND INDIVIDUAL STAKEHOLDERS WITHIN THE COMMUNITY. ALL OF THESE INDIVIDUALS WERE STRATEGICALLY SELECTED BECAUSE OF THEIR VAST UNDERSTANDING OF THE COMMUNITY AND OVERALL INVOLVEMENT IN VARIOUS AREAS THAT IMPACT HEALTH ACROSS DEMOGRAPHICS. WE HELD FOCUS GROUP CONVERSATIONS TO HEAR 'REAL-WORLD' STORIES ABOUT THE IMPACT OF HEALTH IN OUR COMMUNITY AND EXPLORE PRACTICAL SOLUTIONS.THE FOLLOWING ORGANIZATIONS WERE IN ATTENDANCE AT THE COMMUNITY FORUMS:- UNITED WAY OF DEKALB COUNTY- LOCAL LIBRARIES- THE BOWEN CENTER- EASTSIDE JR./SR. HIGH SCHOOL NURSE- GARRETT-KEYSER BUTLER SCHOOL SUPERINTENDENT- ST. MARTIN'S CLINIC- DEKALB COUNTY SHERIFF'S DEPARTMENT- GARRETT CITY POLICE DEPARTMENT- DEKALB COUNTY ECONOMIC DEVELOPMENT- WATERLOO TOWN MANAGER- CHILDREN'S FIRST CENTER- THE JAM CENTER- THE DEKALB COUNTY COUNCIL ON AGING- DEKALB HOSPITAL, INC. ADDITIONALLY, THROUGHOUT THE YEAR, FEEDBACK IS RECEIVED ON HOW THE HOSPITAL CAN SUPPORT HEALTH NEEDS THROUGHOUT THE COMMUNITY. DEKALB 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:THE ASSESSMENT WAS NOT CONDUCTED WITH OTHER HOSPITALS, BUT WAS PART OF A COLLABORATIVE EFFORT WITH DEKALB COUNTY HEALTH DEPARTMENT AND IPFW CENTER FOR SOCIAL RESEARCH AND THE COMMUNITY FOCUS GROUPS. DEKALB 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:DUE TO THE COVID 19 PANDEMIC, THERE WERE LIMITED RESOURCES IN 2021. HOWEVER, WE WERE ABLE TO PARTNER WITH THESE COMMUNITY ORGANIZATIONS TO SUPPORT SAFETY AND HEALTHY LIFESTYLES IN THE COMMUNITY: THE JUDY A. MORRILL RECREATION CENTER (JAM), DEKALB COMMUNITY IMPACT CORPORATION (THE HEARTEN HOUSE GOSPEL RESCUE MISSION), ST. MARTIN'S CLINIC, UNITED WAY OF DEKALB COUNTY, SERENITY HOUSE, LIGHTHOUSE MONTESSORI EDUCATION CENTER, JUNIOR ACHIEVEMENT OF NORTHERN INDIANA (DEKALB COUNTY EAST CENTER & DEKALB COUNTY - GARRETT AND BUTLER YOUTH EVANGELISTIC ASSOCIATION INC (THE FILLING STATION YOUTH CENTER).OUR MOST RECENT ASSESSMENT, DONE IN 2019, REVEALED SEVERAL AREAS OF NEED IN DEKALB COUNTY IMPROVED ACCESS FOR VACCINATIONS:THE HOSPITAL WORKED CLOSELY WITH THE DEKALB COUNTY HEALTH DEPARTMENT TO PROVIDE COVID-19 VACCINES TO DEKALB COUNTY RESIDENTS. THE HOSPITAL PROVIDED EMERGENCY MEDICAL SUPPORT (EMS) DURING THE HOURS OF OPERATION OF THE DEKALB COUNTY COVID-19 VACCINE CLINIC. THE HOSPITAL ALSO SUPPORTED THE PARKVIEW HEALTH SYSTEM COVID-19 VACCINE CLINIC THROUGHOUT 2021. ACCESS TO MENTAL HEALTH:THE HOSPITAL SUPPORTS ST. MARTIN'S HEALTHCARE WHO PROVIDES MENTAL HEALTH COUNSELING TO UNINSURED AND UNDERINSURED PATIENTS IN THE COUNTY. THE HOSPITAL HAS ALSO PARTNERED WITH COMMUNITY GROUPS TO COLLABORATE ON WAYS TO SUPPORT COMMUNITY MEMBERS IN A MENTAL HEALTH CRISIS.SUPPORT THE ALICE (ASSET LIMITED CONSTRAINED EMPLOYED) POPULATION:THE HOSPITAL CONTINUES TO SUPPORT THE UNITED WAY OF DEKALB COUNTY WHOSE PRIMARY FOCUS IS IN SUPPORT OF THE ALICE POPULATION. BOTH MONETARY AND BOARD MEMBER REPRESENTATION WERE MADE TO THE UNITED WAY. SUPPORT INCLUDES: FUNDING TO PROVIDE PROGRAMMING SUCH AS FOOD PANTRIES, EMERGENCY HOUSING ASSISTANCE AND CONNECTING PEOPLE TO AND ACCESSSING RESOURCES THROUGHOUT THE COMMUNITY. ANOTHER WAY THE HOSPITAL SUPPORTS IS THROUGH THE PHARMACARE RETAIL PHARMACY. ENHANCED SERVICES ARE OFFERED TO FOLKS WITHIN DEKALB COUNTY FOR PRESCRIPTION PILL PACKING AND DELIVERY SERVICE. BOTH SERVICES ARE OFFERED FOR NO FEE TO THE RESIDENT. THE GOAL IS TO ENSURE ALL PEOPLE IN THE COUNTY HAVE ACCESS TO THEIR MEDICATIONS IN A SAFE AND TIMELY MANNER.SUPPORT SUSBANCE ABUSE DISORDER:THE HOSPITAL HAS PARTNERED WITH BOTH HEARTEN HOUSE AND SERENITY HOUSE TO PROVIDE SUPPORT OF THEIR MISSION IN OVERCOMING SUBSTANCE ABUSE DISORDERS. THE HOSPITAL PROVIDES MONETARY DONATIONS IN SUPPORT OF THIS VULNERABLE POPULATION. THE HOSPITAL LEADERSHIP ALSO SITS ON COMMUNITY COLLABORATION COMMITTEES NOT ONLY IN SUPPORT OF THESE GROUPS BUT ALSO IN SUPPORT OF MINIMIZING THE STIGMA THESE GROUPS BATTLE.SUPPORT CHILDHOOD DEVELOPMENT:THE HOSPITAL HAS PARTNERED WITH LIGHTHOUSE MONTESSORI SCHOOL TO BRING EARLY LEARNING TO THE ASHLEY, INDIANA COMMUNITY. THIS AREA WAS IDENTIFIED AS A CHILDCARE/EARLY LEARNING DESERT IN THE COUNTY. BY SUPPORTING THIS ORGANIZATION, WE ARE NOW ABLE TO PROVIDE A SAFE PLACE FOR CHILDREN TO LEARN AND DEVELOP. 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.AN AMENDMENT TO THE CHNA WAS ADOPTED THAT FURTHER DESCRIBES THE PROCESSES USED TO IDENTIFY AND PRIORITIZE THE HEALTH NEEDS AND THE RESOURCES THAT ASSIST IN MEETING THOSE NEEDS FOR DEKALB COUNTY. 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 7BDEKALB 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 7CDEKALB 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, DEKALB 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 EXPENSEDEKALB MEMORIAL HOSPITAL, INC. EXCLUDED $5,842,514 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.THE HOSPITAL PARTNERED WITH DEKALB COUNTY ECONOMIC DEVELOPMENT IN THE PLANNING AND IMPLEMENTATION OF A COUNTY-WIDE HOUSING STRATEGIC PLAN. THE HOSPITAL ALSO PARTNERED WITH THE DEKALB CHAMBER PARTNERSHIP BY MEETING WITH THE CURRENT COHORT OF DEKALB LEADS STUDENTS. THESE STUDENTS ARE THE FUTURE GENERATION OF LEADERS IN THE COUNTY. THE HOSPITAL RECOGNIZES THE IMPORTANCE OF THESE PARTNERSHIPS FOR THE CONTINUED GROWTH IN THE COUNTY. 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. DEKALB 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, DEKALB MEMORIAL HOSPITAL, INC. HAS TAKEN THE POSITION NOT TO INCLUDE THE MEDICARE SHORTFALLS OR SURPLUSES AS PART OF COMMUNITY BENEFIT. DEKALB 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.THE HOSPITAL ASSESSES THE HEALTH CARE NEEDS OF THE COMMUNITY THROUGH PERIODIC FOCUS GROUP MEETINGS WHICH ARE PREPARED EVERY 3 YEARS TO ASSESS THE NEEDS OF THE COMMUNITY. THESE FOCUS GROUPS INCLUDE INPUT FROM INDIVIDUALS, HEALTH PROFESSIONALS, GOVERNMENTAL HEALTH CARE OFFICIALS AS WELL AS REPRESENTATIVES FROM DEKALB MEMORIAL HOSPITAL, INC. THE SURVEY SOLICITS INPUT ON THE CURRENT HEALTH CARE NEEDS OF THE COMMUNITY. THESE NEEDS AND CONCERNS ARE EVALUATED AND APPROPRIATE PLANS ARE PUT INTO ACTION TO DEAL WITH THE MOST PRESSING ISSUES.HOSPITAL LEADERS MEET REGULARLY WITH COMMUNITY ORGANIZATIONS TO ENSURE APPROPRIATE FOCUS OF HEALTH CARE NEEDS ARE MET EACH YEAR. THROUGH THE FEEDBACK OF COMMUNITY PARTNERS, THE HOSPITAL CAN REDISTRIBUTE RESOURCES AND FUNDS BASED ON THE NEEDS IN THE COMMUNITY. 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.DEKALB MEMORIAL HOSPITAL, INC, IS THE SOLE COMMUNITY HOSPITAL LOCATED IN DEKALB COUNTY, SERVING DEKALB, PORTIONS OF STEUBEN, LAGRANGE, NOBLE, AND ALLEN COUNTIES, IN ADDITION TO SEVERAL BORDER TOWNS OF HICKSVILLE AND EDGERTON IN NORTHWEST OHIO. ACCORDING TO CONDUENT HEALTHY COMMUNITIES INSTITUTE (2019) THE PRIMARY SERVICE AREA POPULATION OF DEKALB MEMORIAL HOSPITAL IS APPROXIMATELY 43,475 WITH APPROXIMATELY 94.9% RECORDED AS WHITE (NOT HISPANIC OR LATINO) (2019). DEKALB HAS SEEN AN INCREASE IN THE UNINSURED AND UNDERINSURED WITH A REPORTED NUMBER OF 11% OF RESIDENTS LIVING BELOW THE POVERTY LEVEL (2016-2020). THE PERCENTAGE OF UNINSURED WITHIN THE AREA SERVED BY DEKALB MEMORIAL HOSPITAL IS 9% (COUNTY HEALTH RANKINGS (2019). THE DEMOGRAPHIC AREA SERVED BY DEKALB MEMORIAL HOSPITAL, INC. IS MADE UP OF A MEDIAN HOUSEHOLD INCOME OF APPROXIMATELY $58,415, THE MEDIAN AGE IS 38.3 AND CONTAINS PRIMARILY A BLUE COLLAR AND AGRICULTURAL WORKFORCE (CONDUENT, 2016-2020). ACCORDING TO THE INDIANA HOSPITAL ASSOCIATION DIMENSIONS DATABASE, DEKALB MEMORIAL HOSPITAL, INC. HAD 19.4% OF INPATIENT DISCHARGES THAT WERE MEDICAID PATIENTS AND 2.9% WERE SELF-PAY. FOR OUTPATIENT PROCEDURES, 19.2% WERE MEDICAID PATIENTS, AND 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). HRSA HAS DESIGNATED THE FOLLOWING:1) COUNTIES: DEKALB, LAGRANGE, NOBLE AND STEUBEN COUNTYDISCIPLINE: MENTAL HEALTHHPSA ID: 7186175063HPSA NAME: NORTHEASTERN CATCHMENT AREA 18DESIGNATION TYPE: GEOGRAPHIC HPSAHPSA FTE SHORT: 7.03HPSA SCORE: 17STATUS: DESIGNATEDRURAL STATUS: 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.).THE DEKALB MEMORIAL HOSPITAL, INC., BOARD OF DIRECTORS COMPRISES INDEPENDENT COMMUNITY MEMBERS WHO RESIDE IN THE HOSPITAL'S PRIMARY SERVICE AREA. THE HOSPITAL ALSO EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN THE COMMUNITY. DURING THE LAST TWO YEARS OF THE COVID PANDEMIC, THE HOSPITAL SUPPORTED THE COMMUNITY THROUGH EDUCATING THE COMMUNITY REGARDING THE VIRUS AS WELL AS PARTICIPATED IN THE LOCAL COUNTY HEALTH DEPARTMENT COVID VACCINE CLINIC.PEOPLE THROUGHOUT THE COMMUNITY CAN COUNT ON DEKALB MEMORIAL HOSPITAL, INC., TO BE STANDING BY WITH EMERGENCY CARE 24 HOURS A DAY, 365 DAYS A YEAR. THE EMERGENCY DEPARTMENT IS STAFFED WITH BOARD-CERTIFIED EMERGENCY CARE PHYSICIANS AND A NURSING STAFF THAT IS TRAINED AND EXPERIENCED IN EMERGENCY CARE. FURTHERMORE, NO PATIENT IS EVER DENIED TREATMENT, REGARDLESS OF THEIR ABILITY TO PAY. THE ORGANIZATION FURTHERS ITS EXEMPT STATUS BY PROMOTING THE HEALTH OF THE COMMUNITY THROUGH THE USE OF SURPLUS FUNDS TO PROVIDE HIGH QUALITY HEALTHCARE SERVICES TO THE CITIZENS RESIDING IN ITS SERVICE AREA, PARTNERSHIPS WITH LOCAL BUSINESSES TO ENCOURAGE HEALTHY LIFESTYLES, AS WELL AS PROVIDED EDUCATIONAL RESOURCES THRU DIFFERENT MEDIA FORUMS. IN ADDITION, MANY OF THE HOSPITAL'S MANAGERS AND STAFF DONATE THEIR TIME TO SUPPORT ST. MARTIN'S HEALTHCARE CLINIC (FOR UNINSURED) AS WELL AS SERVE ON THE BOARD OF THE UNITED WAY, COMMUNITY FOUNDATION OF DEKALB COUNTY, ST. MARTIN'S HEALTHCARE CLINIC AND SERVE AS A LUNCH BUDDY AT A LOCAL ELEMENTARY SCHOOL THROUGH BIG BROTHER BIG SISTERS OF NORTHEAST INDIANA. 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.; PARK CENTER, INC.; PARKVIEW WABASH HOSPITAL, INC.; WHITLEY MEMORIAL HOSPITAL, INC.; HUNTINGTON MEMORIAL HOSPITAL, INC.; DEKALB MEMORIAL HOSPITAL, INC.; AS WELL AS 60 PERCENT OWNERSHIP IN THE JOINT VENTURE OF ORTHOPEDIC HOSPITAL AT PARKVIEW NORTH, LLC.THE CORPORATE MISSION AND VISION IS AS FOLLOWS: AS A COMMUNITY OWNED, NOT-FOR-PROFIT ORGANIZATION, PARKVIEW HEALTH IS DEDICATED TO IMPROVING INDIVIDUALS' HEALTH AND INSPIRING WELL-BEING BY: 1) TAILORING A PERSONALIZED HEALTH JOURNEY TO ACHIEVE YOUR UNIQUE GOALS, 2) DEMONSTRATING WORLD-CLASS TEAMWORK AS WE PARTNER WITH YOU ALONG THAT JOURNEY 3) PROVIDING THE EXCELLENCE, INNOVATION AND VALUE YOU SEEK IN TERMS OF CONVENIENCE, COMPASSION, SERVICE, COST AND QUALITY 4)"EXCELLENT CARE, EVERY PERSON, EVERY DAY". 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 BENEFIT 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 WITHIN OUR FACILITIES WHILE SERVING AS GOOD STEWARDS OF SURPLUS FUNDS IN OUR EFFORTS 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 87 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. 1 GARRETT COMMUNITY CENTER INC 1200 E HOUSTON STREET GARRETT IN 46738 352010882 501(C)(3) 9996 0 PROGRAMS TO CELEBRATE AND STRENGTHEN THE VIBRANT COMMUNITY BY CONNECTING PEOPLE AND ORGANIZATIONS THROUGH ACTIVITIES THAT IMPROVE THE QUALITY OF LIFE FOR THE GREATER GARRETT INDIANA AREA. 1 0 PART I, LINE 2: COMMUNITY HEALTH IMPROVEMENT FUNDING PARTNER ORGANIZATIONS ARE REQUIRED TO SUBMIT AN ANNUAL PROGRESS REPORT RELATED TO PROGRAM FUNDING. PARTNER ORGANIZATIONS ARE REQUIRED TO RE-APPLY FOR FUNDING ON AN ANNUAL BASIS. 0 1 0 0 0 0 0 1 0 MICHAEL PACKNETT DIRECTOR/PH PRESIDENT & CEO 0 1220966 0 259085 0 557555 0 292805 0 33268 0 2363679 0 507042 JEANNE' WICKENS PH CHIEF FINANCIAL OFFICER 0 770820 0 142288 0 146528 0 320169 0 29811 0 1409616 0 124406 THOMAS MASON DIRECTOR/PH PHYSICIAN 0 345681 0 1250 0 20539 0 31900 0 35866 0 435236 0 0 NATASHA EICHER DIRECTOR/DMHOS PRESIDENT 213314 0 36708 0 26186 0 59531 0 33303 0 369042 0 5884 0 BRET CLAGHORN FORMER OFFICER/CURRENT PH VP 0 187279 0 24086 0 3084 0 15363 0 32765 0 262577 0 0 KARRA HEGGEN DMHOS VP PATIENT CARE SVCS 188548 0 25970 0 22338 0 11741 0 13311 0 261908 0 0 0 LON KEYES DMHOS PHARMACY MGR 152320 0 10252 0 8329 0 10239 0 11448 0 192588 0 0 0 JACOB CLENDENEN DMHOS PHARMACIST 148874 0 3250 0 270 0 6330 0 29424 0 188148 0 0 0 BETHANY HEILEMAN DMHOS PHARMACIST 122936 1232 3250 0 151 2 11771 115 29072 284 167180 1633 0 0 ANTHONY STUMP DMHOS MGR REHAB 120277 0 6820 0 2493 0 9286 0 29446 0 168322 0 0 0 PART I, LINE 3 RELATED ORGANIZATION, PARKVIEW HEALTH SYSTEM, INC., USES THE FOLLOWING TO ESTABLISH THE COMPENSATION OF DEKALB 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): NATASHA EICHER $5,884; 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: NATASHA EICHER $40,185; 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. 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, DEKALB MEMORIAL HOSPITAL, INC., EIN 35-1064295. 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 DEKALB MEMORIAL HOSPITAL, INC. WAS 37 AND 392 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/CHIEF EXECUTIVE OFFICER OF THE CORPORATE MEMBER OR HIS/HER DESIGNEE, THE CURRENT CHIEF OF THE MEDICAL STAFF, AND SUCH OTHER PERSONS AS IDENTIFIED BY THE CHAIR OF THE BOARD, EACH OF WHOM SHALL BE ENTITLED TO VOTE. IN NO EVENT SHALL THE MEMBERS OF THE EXECUTIVE COMMITTEE EXCEED EIGHT (8) PEOPLE. THE EXECUTIVE COMMITTEE MAY ACT ON BEHALF OF THE CORPORATION AS THE PLANNING COMMITTEE AND IN ANY OTHER MATTER WHEN THE BOARD IS NOT IN SESSION, REPORTING TO THE BOARD FOR ITS RATIFICATION OF ITS ACTION. THE CHAIR OF THE BOARD SHALL SERVE AS CHAIR OF THE EXECUTIVE COMMITTEE. MEETINGS OF THE EXECUTIVE COMMITTEE MAY BE CALLED BY THE CHAIR OR BY THREE (3) MEMBERS. 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 DEKALB 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: (I) APPOINT (INCLUDING TO FILL A VACANCY) AND REMOVE, WITH OR WITHOUT CAUSE, MEMBERS OF THE BOARD SUBJECT TO THE COMPOSITION REQUIREMENTS REGARDING COMMUNITY AND PHYSICIAN REPRESENTATION SET FORTH IN ARTICLE V, SECTION 2; (II) APPOINT (INCLUDING TO FILL A VACANCY) AND REMOVE, WITH OR WITHOUT CAUSE, THE CHAIR AND VICE CHAIR OF THE BOARD AND THE PRESIDENT OF THE CORPORATION; (III) APPROVE AND/OR REQUIRE THE ADOPTION OF AMENDMENTS TO THE ARTICLES OF INCORPORATION OR BYLAWS OF THE CORPORATION OR ANY SUBSIDIARY OR AFFILIATE OF THE CORPORATION; (IV) APPROVE AND/OR REQUIRE THE ESTABLISHMENT, ACQUISITION, DIVESTITURE, DISSOLUTION, CLOSURE, MERGER, CONSOLIDATION, CHANGE IN CORPORATE MEMBERSHIP, JOINT VENTURE, PARTNERSHIP, AFFILIATION OR CORPORATE REORGANIZATION OF THE CORPORATION OR ANY SUBSIDIARY OR AFFILIATE OF THE CORPORATION; (V) APPROVE AND ADOPT THE STRATEGIC PLAN AND ANY AMENDMENTS THERETO, INCLUDING ANY INDIVIDUAL INITIATIVES OR ARRANGEMENTS, SUCH AS A NEW SERVICE OR CONTRACTUAL ARRANGEMENT DEEMED BY THE CORPORATE MEMBER TO BE OF STRATEGIC IMPORTANCE FOR THE CORPORATION AND ANY SUBSIDIARY OR AFFILIATE OF THE CORPORATION, FOR THE CORPORATION AND ANY SUBSIDIARY OR AFFILIATE OF THE CORPORATION; (VI) APPROVE AND/OR REQUIRE THE INCURRENCE OF ANY DEBT, INCLUDING THE ISSUANCE OF ANY BONDS, PROPOSED BY THE CORPORATION OR ANY SUBSIDIARY OR AFFILIATE OF THE CORPORATION IN EXCESS OF LIMITS SPECIFIED IN THE POLICY OF THE CORPORATE MEMBER; (VII) APPROVE AND/OR REQUIRE THE APPROVAL OF CONTRACTS OR LOANS OBLIGATING THE CORPORATION TO EXPEND OR REPAY AN AMOUNT IN EXCESS OF LIMITS SPECIFIED IN THE POLICY OF THE CORPORATE MEMBER; (VIII) APPROVE AND/OR REQUIRE THE SALE, LEASE, EXCHANGE, MORTGAGE, PLEDGE, TRANSFER, ENCUMBRANCE OR OTHER DISPOSITION OF PROPERTY AND ASSETS OF THE CORPORATION IN EXCESS OF LIMITS SPECIFIED IN THE POLICY OF THE CORPORATE MEMBER; (IX) APPROVE AND ADOPT THE CAPITAL BUDGET, OPERATING BUDGET, FINANCIAL PLANS AND ANY AMENDMENTS THERETO FOR THE CORPORATION AND ANY SUBSIDIARY OR AFFILIATE OF THE CORPORATION; (X) APPROVE AND/OR REQUIRE THE ADOPTION OF A MANAGED CARE POLICY FOR THE CORPORATION AND ANY SUBSIDIARY OR AFFILIATE OF THE CORPORATION, INCLUDING NETWORK PARTICIPATION, PARTICIPATION IN ANY MANAGED CARE AGREEMENT AND PARTICIPATION IN ANY OTHER HEALTH CARE SERVICE ARRANGEMENTS; (XI) APPOINT AND REMOVE AUDITORS, ATTORNEYS AND OTHER PROFESSIONAL ADVISORS FOR THE CORPORATION AND ANY SUBSIDIARY OR AFFILIATE OF THE CORPORATION; (XII) DEVELOP, APPROVE AND/OR REQUIRE THE ADOPTION OF MEDICAL STAFF QUALITY ASSURANCE STANDARDS, UTILIZATION REVIEW STANDARDS, CRITERIA, POLICIES AND PROCEDURES FOR THE CORPORATION AND ANY SUBSIDIARY OR AFFILIATE OF THE CORPORATION; (XIII) APPROVE AND/OR REQUIRE THE ADOPTION OF ANY ACTION TO CHANGE THE CORPORATION FROM A GENERAL, ACUTE CARE COMMUNITY HOSPITAL OR TO CLOSE THE CORPORATION'S CURRENT LOCATION; (XIV) APPROVE EACH ANNUAL LIST OF PROPOSED DONORS AND AMOUNTS OF DONATIONS OR GRANTS NOT INCLUDED IN THE ANNUAL BUDGET, AND MAKE PROPOSALS TO DEVIATE THEREFROM THROUGHOUT EACH YEAR IN EXCESS OF LIMITS SPECIFIED IN THE POLICY OF THE CORPORATE MEMBER; AND (XV) APPROVE AND/OR REQUIRE THE ADOPTION OF ANY ACTION THAT IS INCONSISTENT WITH THE POLICY OF THE CORPORATE MEMBER. FORM 990, PART VI, SECTION A, LINE 7B SEE SCHEDULE O EXPLANATION FOR FORM 990, PART VI, SECTION A, LINE 7A FORM 990, PART VI, SECTION B, LINE 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. DEKALB MEMORIAL HOSPITAL, INC. IS A SUBSIDIARY CORPORATION OF PARKVIEW HEALTH SYSTEM, INC. AN ELECTRONIC COPY OF THE ORGANIZATION'S FINAL FORM 990 (INCLUDING REQUIRED SCHEDULES) WAS PROVIDED TO EACH VOTING MEMBER OF THE ORGANIZATION'S GOVERNING BODY 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 1,406,739. MANAGEMENT AND GENERAL EXPENSES 96,563. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,503,302. MEDICAL PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 3,152,147. MANAGEMENT AND GENERAL EXPENSES 29,098. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,181,245. LAB SERVICES: PROGRAM SERVICE EXPENSES 3,046,831. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,046,831. COLLECTION EXPENSE: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 54,156. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 54,156. 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. 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