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COMMUNITY HOSPITAL OF NOBLE COUNTY INC: Form 990, tax year 2019

View the entire original 990 at ProPublica ↗

Organization
COMMUNITY HOSPITAL OF NOBLE COUNTY INC (EIN 35-2087092)
Tax period
2019-01-01 to 2019-12-31
Filed
2021-03-12
IRS object ID
202100719349301325
Schema version
2019v5.2
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 ReturnHeader

FieldValueIRS element (for citing)
Return2021-03-12T15:47:41-06:00ReturnTs
Tax Period End2019-12-31TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN350921680PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1CROWE LLPBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line1330 E JEFFERSON BLVD P O BOX 7AddressLine1Txt
CitySOUTH BENDCityNm
State AbbreviationINStateAbbreviationCd
ZIP466240007ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2019-01-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN352087092EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1COMMUNITY HOSPITAL OF NOBLE COUNTY INCBusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlCOMMBusinessNameControlTxt
Phone2603738429PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1401 SAWYER RDAddressLine1Txt
CityKENDALLVILLECityNm
State AbbreviationINStateAbbreviationCd
ZIP46755ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonJEANNE' WICKENSPersonNm
Person TitlePH CFOPersonTitleTxt
Phone2602669313PhoneNum
Signature2021-03-12SignatureDt
Discuss With Paid PreparerYes (1)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonBRITTNEY KOCAJPreparerPersonNm
PTINP01320603PTIN
Phone5742323992PhoneNum
FieldValueIRS element (for citing)
Tax2019TaxYr
Build TS2022-09-23 18:48:47ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Amended ReturnYes (X)AmendedReturnInd
Principal OfficerMICHAEL J PACKNETTPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line110501 CORPORATE DRIVEAddressLine1Txt
CityFORT WAYNECityNm
State AbbreviationINStateAbbreviationCd
ZIP46845ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$71,922,352GrossReceiptsAmt
Group Return For Affiliates0GroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website AddressWWW.PARKVIEW.COMWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1999FormationYr
Legal Domicile StateINLegalDomicileStateCd
Activity Or MissionCOMMUNITY HOSPITAL OF NOBLE COUNTY, INC. WORKS TO IMPROVE THE HEALTH OF OUR COMMUNITIES AND PROVIDES QUALITY HEALTH SERVICES TO ALL WHO ENTRUST THEIR CARE TO US.ActivityOrMissionDesc
Voting Members Governing Body11VotingMembersGoverningBodyCnt
Voting Members Independent6VotingMembersIndependentCnt
Total Employee333TotalEmployeeCnt
Total Volunteers52TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$173,765PYContributionsGrantsAmt
CY Contributions Grants$220,123CYContributionsGrantsAmt
PY Program Service Revenue$72,930,854PYProgramServiceRevenueAmt
CY Program Service Revenue$71,483,329CYProgramServiceRevenueAmt
PY Investment Income$1,967PYInvestmentIncomeAmt
CY Investment Income-$30,383CYInvestmentIncomeAmt
PY Other Revenue$159,047PYOtherRevenueAmt
CY Other Revenue$172,894CYOtherRevenueAmt
PY Total Revenue$73,265,633PYTotalRevenueAmt
CY Total Revenue$71,845,963CYTotalRevenueAmt
PY Grants And Similar Paid$211,062PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$195,461CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$19,255,124PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$19,720,783CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$202,863CYTotalFundraisingExpenseAmt
PY Other Expenses$41,713,780PYOtherExpensesAmt
CY Other Expenses$44,574,141CYOtherExpensesAmt
PY Total Expenses$61,179,966PYTotalExpensesAmt
CY Total Expenses$64,490,385CYTotalExpensesAmt
PY Revenues Less Expenses$12,085,667PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$7,355,578CYRevenuesLessExpensesAmt
Total Assets BOY$18,315,061TotalAssetsBOYAmt
Total Assets EOY$24,073,117TotalAssetsEOYAmt
Total Liabilities BOY$4,927,194TotalLiabilitiesBOYAmt
Total Liabilities EOY$3,340,409TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$13,387,867NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$20,732,708NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part IIIYes (X)InfoInScheduleOPartIIIInd
MissionCOMMUNITY HOSPITAL OF NOBLE COUNTY, 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 Srvc0SignificantNewProgramSrvcInd
Significant Change0SignificantChangeInd
Expense$53,182,074ExpenseAmt
Grant$195,461GrantAmt
Revenue$71,483,329RevenueAmt
DescCOMMUNITY HOSPITAL OF NOBLE COUNTY, INC. COMMUNITY HEALTH IMPROVEMENT:AS A NOT-FOR-PROFIT HOSPITAL, WE FOCUS ON OUR MISSION TO IMPROVE THE HEALTH OF THE COMMUNITIES WE SERVE AND TO PROVIDE A PERSONALIZED WELLNESS JOURNEY. COMMUNITY HOSPITAL OF NOBLE COUNTY, INC. EXISTS FOR ONE PURPOSE - TO IMPROVE THE HEALTH OF OUR COMMUNITIES. COMMUNITY HOSPITAL OF NOBLE COUNTY, INC. GIVES BACK TO THE COMMUNITY IN THE FORM OF IMPROVED FACILITIES, EDUCATION AND OUTREACH PROGRAMS, FREE AND DISCOUNTED CARE, VOLUNTEERISM AND MUCH MORE. PARKVIEW CONDUCTS A COMMUNITY HEALTH ASSESSMENT ON A REGULAR BASIS TO IDENTIFY HEALTH NEEDS(SEE SCHEDULE FOR CONTINUATION)WITHIN NORTHEAST INDIANA, PARTICULARLY, IN THE FIVE COUNTIES IN WHICH OUR HOSPITALS EXIST. THE FOLLOWING ARE SOME OF THE WAYS COMMUNITY HOSPITAL OF NOBLE COUNTY, INC. IS REACHING OUT TO MAKE OUR NEIGHBORHOODS AND COMMUNITIES HEALTHIER:-FINANCIAL ASSISTANCE-COMMUNITY HEALTH IMPROVEMENT INITIATIVES-PRIMARY HEALTH CARE /ACCESS-HEALTH SCREENINGS AND PREVENTION-DISEASE MANAGEMENT-HEALTH EDUCATIONFINANCIAL ASSISTANCE:COMMUNITY HOSPITAL OF NOBLE COUNTY, INC.'S MISSION INCLUDES CARING FOR PEOPLE WHO DO NOT HAVE THE MEANS TO MEET THEIR FINANCIAL OBLIGATIONS. THE HOSPITAL PLACES ITS PRIORITY ON PROVIDING THE NECESSARY CARE, NOT ON THE PATIENT'S ABILITY TO PAY FOR THEIR MEDICAL EXPENSES.COMMUNITY HEALTH IMPROVEMENT INITIATIVES:THE PURPOSE OF COMMUNITY HOSPITAL OF NOBLE COUNTY, INC.'S COMMUNITY HEALTH IMPROVEMENT PROGRAM IS TO FUND COMMUNITY HEALTH IMPROVEMENT EFFORTS WITHIN THE SERVICE AREA OF COMMUNITY HOSPITAL OF NOBLE COUNTY, INC. THE HOSPITAL SETS ASIDE A PORTION OF ITS NET INCOME ANNUALLY TO FUND COMMUNITY HEALTH INITIATIVES AND PARTNERS WITH COMMUNITY ORGANIZATIONS TO ENCOURAGE HEALTHIER LIFESTYLES AMONG THE CITIZENS OF NORTHEAST INDIANA. SOME OF THESE INITIATIVES AND PROGRAMS ARE HIGHLIGHTED BELOW.CENTER FOR HEALTHY LIVING SUPPORTED BY THE CENTER FOR HEALTHY LIVING SUPERVISOR: COMMUNITY HOSPITAL OF NOBLE COUNTY, INC. OFFERS A WELLNESS FACILITY WHERE THE COMMUNITY CAN ACCESS FITNESS CLASSES, COOKING DEMONSTRATIONS, DIABETES EDUCATION, HEALTH BEHAVIOR CHANGE PROGRAMS, REDUCED COST BLOOD DRAWS, HEALING ARTS AND PROFESSIONAL LECTURES ON HEALTH/WELLNESS. THE CENTER FOR HEALTHY LIVING'S SUPERVISOR IS INSTRUMENTAL IN THE IMPLEMENTATION OF KEY STRATEGIES AS IDENTIFIED BY OUR COMMUNITY HEALTH NEEDS ASSESSMENT - OBESITY, TOBACCO CESSATION, AND DRUG ABUSE AT THE CENTER FOR HEALTHY LIVING - PARKVIEW NOBLE. ALL PROGRAMS AND SERVICES ARE OFFERED FREE, AT LOWER COST, OR SCHOLARSHIPS ARE PROVIDED; AS NO ONE IS TURNED AWAY FOR INABILITY TO PAY. A SENIOR CLUB IS ALSO OFFERED TARGETING THE ELDERLY POPULATION FOR SOCIAL INTERACTION, EDUCATIONAL OPPORTUNITIES VITAL TO MAINTAINING AN ACTIVE LIFESTYLE THROUGH HEALTHY AGING. MANY OF THE PROGRAMS TARGETED OBESITY AND OVERALL WELLNESS. THE SUPERVISOR CONTINUES TO PROMOTE AND MANAGE THE MY BEST HEALTH PROGRAM TO SUPPORT THE OBESITY INITIATIVE TO IMPROVE BMI, WEIGHT, AND RISK FOR CHRONIC DISEASE FOR THOSE IN NOBLE COUNTY. CENTER FOR HEALTHY LIVING NURSE NAVIGATOR: COMMUNITY HOSPITAL OF NOBLE COUNTY, INC.'S NURSE NAVIGATOR WORKS WITH THE COUNTY SCHOOL DISTRICTS, PAROCHIAL AND PRIVATE SCHOOLS, THE NOBLE COUNTY HEALTH DEPARTMENT AS WELL AS WITH THE COMMUNITY AT LARGE TO PROVIDE HEALTH EDUCATION AND SCREENING PROGRAMS. THE GOAL IS TO IMPROVE HEALTH ACCESS, RESOURCES AND EDUCATION TO THE CITIZENS OF COMMUNITY HOSPITAL OF NOBLE COUNTY, INC.'S COMMUNITY. THIS INCLUDES WORKING WITH THE COUNTY HEALTH DEPARTMENT TO PROVIDE VISION SCREENINGS TO HELP ASSURE THAT STUDENTS ARE ABLE TO PERFORM AT THEIR BEST AT SCHOOL. MULTIPLE EDUCATION PROGRAMS ARE PRESENTED, FROM ASTHMA EDUCATION, TOBACCO EDUCATION, NUTRITION, AND BABYSITTING SKILLS, TO CPR AMONG MANY OTHER HEALTH RELATED TOPICS FOR SCHOOL AGE CHILDREN. THE NURSE NAVIGATOR IS ALSO INSTRUMENTAL IN IMPLEMENTATION OF TEENAGE PREGNANCY PROGRAMS, TOBACCO CESSATION, AND DRUG ABUSE EDUCATION PROGRAMS IN NOBLE COUNTY. COMMUNITY PARTNERSHIPS: COMMUNITY HOSPITAL OF NOBLE COUNTY, INC. INVESTS IN KEY ORGANIZATIONS (HEALTH PARTNERS) THAT ENCOURAGE HEALTHIER LIFESTYLES AMONG THE CITIZENS OF NOBLE COUNTY AND NORTHEAST INDIANA. WE PARTNER WITH THE COLE FAMILY CENTER YMCA ON MULTIPLE PROJECTS TO ENCOURAGE HEALTHIER LIFESTYLES AND NOBLE TRAILS TO FUND WALKING AND BIKING TRAIL DEVELOPMENT. TO ASSIST THOSE LESS FORTUNATE, WE SUPPORT COMMON GRACE, NOBLE HOUSE AND LOCAL FOOD PANTRIES. WE ALSO PARTNER WITH THE NOBLE COUNTY HEALTH DEPARTMENT TO PROVIDE IMMUNIZATIONS TO CHILDREN WHO OTHERWISE COULD NOT ACCESS THEM. TO ENCOURAGE HIGHER PAYING JOBS AND ECONOMIC IMPROVEMENT, WE PARTNER WITH THE NOBLE COUNTY ECONOMIC DEVELOPMENT CORPORATION. FUNDS ARE PROVIDED FOR LIFE AND FAMILY SERVICES' BABE PROGRAM & HEALTHIER MOMS AND BABIES TO ENCOURAGE PRE-NATAL VISITS, WELL BABY VISITS AND EDUCATION FOR PARENTS. TO ASSIST IN HEALTH EDUCATION IN OUR SCHOOL DISTRICTS, FUNDS ARE PROVIDED TO MCMILLEN HEALTH TO PROVIDE EVIDENCE-BASED EDUCATION OVER OBESITY, TOBACCO USE, DRUG USE, AND PREGNANCY TO AREA SCHOOLS. OTHER PARTNERS ACTIVE IN ADDRESSING MEDICAL ISSUES INCLUDE DRUG FREE NOBLE COUNTY AND ACTIVATE NOBLE COUNTY. ACTIVATE NOBLE COUNTY: THIS ORGANIZATION IS A TRUE COMMUNITY PARTNERSHIP WITH MANY ORGANIZATIONS INCLUDING COMMUNITY HOSPITAL OF NOBLE COUNTY, INC., THE COLE FAMILY CENTER YMCA, EAST NOBLE SCHOOL SYSTEM, PARKS AND RECREATION AND LOCAL GOVERNMENT. THE MISSION IS "TO IMPROVE THE HEALTH AND WELLNESS OF NOBLE COUNTY BY INCREASING OPPORTUNITIES FOR HEALTHY EATING AND ACTIVE LIVING." THE GROUP HAS BEEN THE CENTRAL PARTNERSHIP TO ESTABLISH COMMUNITY GOALS AROUND THE COMMUNITY HEALTH NEEDS ESTABLISHED FROM OUR ASSESSMENT: OBESITY, SMOKING CESSATION, AND DRUG ABUSE. THE GROUP MEETS MONTHLY WORKING COLLABORATIVELY TO ESTABLISH PROGRAMS, GUIDELINES AND TO MAKE IMPROVEMENTS TO KEY METRICS FROM THE ASSESSMENT PLAN AND HAS ESTABLISHED A WEBSITE AND SOCIAL MEDIA PLATFORMS TO INCREASE ENGAGEMENT AND ACTION AMONG THE COMMUNITY. THE HOSPITAL IS CURRENTLY WORKING WITH ACTIVATE NOBLE COUNTY IN MAKING NOBLE COUNTY MORE WALKING AND BICYCLE FRIENDLY. ACTIVATE NOBLE COUNTY ALSO IS AN INSTRUMENTAL PART IN POLICY CHANGE IN NOBLE COUNTY. THE GROUP HAS STARTED CONVERSATION AND GAINED MOMENTUM AROUND WALKABILITY AND BIKE ABILITY IN NOBLE COUNTY. THE GROUP LED THE EFFORT FOR BOTH PARKLETS AND WAYFINDING SIGNS TO BE INSTALLED IN ONE OF NOBLE COUNTY'S DOWNTOWNS TO PROVIDE A DESTINATION THAT ENCOURAGES WALKING AND GATHERING. PRIMARY HEALTH CARE/ACCESS:MEDICATION ASSISTANCE PROGRAM (MAP): COMMUNITY HOSPITAL OF NOBLE COUNTY, INC. MAINTAINS A MEDICATION ASSISTANCE PROGRAM FOR NOBLE COUNTY RESIDENTS. MAP PARTNERS WITH PATIENTS, PHYSICIANS, PHARMACEUTICAL COMPANIES, LOCAL PHARMACIES, AND DONORS TO PROVIDE MEDICATION ASSISTANCE AT LITTLE OR NO COST FOR QUALIFIED INDIVIDUALS. EMERGENCY VOUCHERS FOR ACUTE MEDICATION NEEDS ARE REDEEMED AT LOCAL PHARMACIES. LONG-TERM MEDICATION HELP IS PROVIDED THROUGH CONNECTING CLIENTS WITH PHARMACEUTICAL ASSISTANCE PROGRAMS (PAP).HEALTH SCREENING AND DISEASE PREVENTION AND MANAGEMENT:HEALTH FAIRS AND SCREENINGS: COMMUNITY HOSPITAL OF NOBLE COUNTY, INC. PARTICIPATES IN NUMEROUS HEALTH FAIRS AND ACTIVITIES THROUGHOUT THE YEAR DESIGNED TO PROVIDE HEALTH EDUCATION, HEALTH SCREENINGS FOR DISEASE PREVENTION, AND TO PROMOTE HEALTHY LIFESTYLES. THE HOSPITAL ALSO PROVIDES SUPPORT GROUPS TO ASSIST PATIENTS AND FAMILIES IN MANAGING DISEASE. ESTABLISHING HEALTHY LIFESTYLES AND PROMOTING SAFETY: COMMUNITY HOSPITAL OF NOBLE COUNTY, INC. SUPPORTS VARIOUS PROGRAMS THAT ENCOURAGE CHILDREN TO ESTABLISH HEALTHY EATING AND SAFETY HABITS TO HELP PREVENT DISEASE LATER IN LIFE. PROGRAMS INCLUDE KID CITY, BIKE RODEO, AND PARTICIPATION AT THE NOBLE COUNTY FAIR. ANOTHER PROGRAM MAINTAINED BY THE COMMUNITY HOSPITAL OF NOBLE COUNTY IS EMS HOUSE CALLS, GEARED TOWARD ASSESSING A COMMUNITY MEMBER'S HOME FOR HEALTH RISK AND TO DECREASE RISKS OF INJURY.Desc
Total Program Service Expenses$53,182,074TotalProgramServiceExpensesAmt
Described In Section501c3Yes (1)DescribedInSection501c3Ind
Schedule B RequiredYes (1)ScheduleBRequiredInd
Political Campaign Acty0PoliticalCampaignActyInd
Lobbying ActivitiesYes (1)LobbyingActivitiesInd
Subject To Proxy Tax0SubjectToProxyTaxInd
Donor Advised Fund0DonorAdvisedFundInd
Conservation Easements0ConservationEasementsInd
Collections Of Art0CollectionsOfArtInd
Credit Counseling0CreditCounselingInd
Donor Rstr Or Quasi EndowmentsYes (1)DonorRstrOrQuasiEndowmentsInd
Report Land Building EquipmentYes (1)ReportLandBuildingEquipmentInd
Report Investments Other Sec0ReportInvestmentsOtherSecInd
Report Program Related Invst0ReportProgramRelatedInvstInd
Report Other AssetsYes (1)ReportOtherAssetsInd
Report Other LiabilitiesYes (1)ReportOtherLiabilitiesInd
Include FIN48 FootnoteYes (1)IncludeFIN48FootnoteInd
Independent Audit Fincl Stmt0IndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtYes (1)ConsolidatedAuditFinclStmtInd
School Operating0SchoolOperatingInd
Foreign Office0ForeignOfficeInd
Foreign Activities0ForeignActivitiesInd
More Than5000 K To Org0MoreThan5000KToOrgInd
More Than5000 K To Individuals0MoreThan5000KToIndividualsInd
Professional Fundraising0ProfessionalFundraisingInd
Fundraising Activities0FundraisingActivitiesInd
Gaming Activities0GamingActivitiesInd
Operate HospitalYes (1)OperateHospitalInd
Audited Financial Stmt AttYes (1)AuditedFinancialStmtAttInd
Grants To OrganizationsYes (1)GrantsToOrganizationsInd
Grants To Individuals0GrantsToIndividualsInd
Schedule J RequiredYes (1)ScheduleJRequiredInd
Tax Exempt Bonds0TaxExemptBondsInd
Engaged In Excess Benefit Trans0EngagedInExcessBenefitTransInd
PY Excess Benefit Trans0PYExcessBenefitTransInd
Loan Outstanding0LoanOutstandingInd
Grant To Related Person0GrantToRelatedPersonInd
Business Rln With Org Mem0BusinessRlnWithOrgMemInd
Business Rln With Fam Mem0BusinessRlnWithFamMemInd
Business Rln With35 Ctrl Ent0BusinessRlnWith35CtrlEntInd
Deductible Non Cash Contri0DeductibleNonCashContriInd
Deductible Art Contribution0DeductibleArtContributionInd
Terminate Operations0TerminateOperationsInd
Partial Liquidation0PartialLiquidationInd
Disregarded Entity0DisregardedEntityInd
Related EntityYes (1)RelatedEntityInd
Related Organization Ctrl EntYes (1)RelatedOrganizationCtrlEntInd
Transaction With Control EntYes (1)TransactionWithControlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org0TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp0ActivitiesConductedPrtshpInd
Schedule O RequiredYes (1)ScheduleORequiredInd
Info In Schedule O Part VYes (X)InfoInScheduleOPartVInd
IRP Document41IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (1)BackupWthldComplianceInd
Employee333EmployeeCnt
Employment Tax Returns FiledYes (1)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over Limit0UnrelatedBusIncmOverLimitInd
Foreign Financial Account0ForeignFinancialAccountInd
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTransInd
Taxable Party Notification0TaxablePartyNotificationInd
Nondeductible Contributions0NondeductibleContributionsInd
Quid Pro Quo Contributions0QuidProQuoContributionsInd
Form8282 Property Disposed Of0Form8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft Cntrct0RcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft Cntrct0PayPremiumsPrsnlBnftCntrctInd
Indoor Tanning Services0IndoorTanningServicesInd
Subj To Tax Rmnrtn Ex Prcht Pymt0SubjToTaxRmnrtnExPrchtPymtInd
Subject To Excs Tax Net Invst Inc0SubjectToExcsTaxNetInvstIncInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members11GoverningBodyVotingMembersCnt
Independent Voting Member6IndependentVotingMemberCnt
Family Or Business Rln0FamilyOrBusinessRlnInd
Delegation Of Mgmt Duties0DelegationOfMgmtDutiesInd
Change To Org Documents0ChangeToOrgDocumentsInd
Material Diversion Or Misuse0MaterialDiversionOrMisuseInd
Members Or StockholdersYes (1)MembersOrStockholdersInd
Election Of Board MembersYes (1)ElectionOfBoardMembersInd
Decisions Subject To ApprovaYes (1)DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (1)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (1)MinutesOfCommitteesInd
Officer Mailing Address0OfficerMailingAddressInd
Local Chapters0LocalChaptersInd
Form990 Provided To Gvrn BodyYes (1)Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (1)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (1)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (1)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (1)WhistleblowerPolicyInd
Document Retention PolicyYes (1)DocumentRetentionPolicyInd
Compensation Process CEO0CompensationProcessCEOInd
Compensation Process Other0CompensationProcessOtherInd
Investment In Joint Venture0InvestmentInJointVentureInd
States Where Copy Of Return Is FldINStatesWhereCopyOfReturnIsFldCd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1JEANNE' WICKENSBusinessNameLine1Txt
FieldValueIRS element (for citing)
Phone2602669313PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line110501 CORPORATE DRIVEAddressLine1Txt
CityFORT WAYNECityNm
State AbbreviationINStateAbbreviationCd
ZIP46845ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (20 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtFormer Ofcr Director TrusteeFormerOfcrDirectorTrusteeIndKey EmployeeKeyEmployeeIndHighest Compensated EmployeeHighestCompensatedEmployeeInd
MICHAEL PACKNETT
DIRECTOR/PH PRESIDENT & CEO1.0056.00Yes (X)Yes (X)$0$3,051,353$797,690
JEANNE' WICKENS
PH CHIEF FINANCIAL OFFICER1.0056.00Yes (X)$0$843,129$327,919
CHRISTOPHER FRAZIER
DIRECTOR/PH PHYSICIAN1.0041.00Yes (X)$4,418$454,297$60,745
RONNIE SLOAN
DIRECTOR/PH PHYSICIAN6.0043.00Yes (X)$16,590$365,491$58,416
LISA LANE
DIRECTOR/PH PHYSICIAN1.0042.00Yes (X)$13,237$344,305$62,923
GARY ADKINS
DIRECTOR/NBHOS PRESIDENT40.001.00Yes (X)Yes (X)$238,107$0$79,589
CATHERINE BYRD
FORMER KEY EMPLOYEE0.00$211,450$0$0Yes (X)
ERIN GOLDSBERRY
NBHOS VP PATIENT CARE36.004.00$152,336$13,208$39,400Yes (X)
KELLY BALYEAT
NBHOS MGR PHARMACY40.00$162,703$0$40,637Yes (X)
JULIE DESPER
NBHOS MGR REHAB20.0020.00$67,560$58,067$47,833Yes (X)
HEATHER ANTAL
NBHOS MGR NURSING SVCS40.00$114,315$0$44,451Yes (X)
RICHARD LARIMORE
NBHOS MGR SUPPORT SVCS40.00$121,913$0$21,698Yes (X)
LISA STREBIG
NBHOS PARAMEDIC60.009.00$93,836$19,476$26,206Yes (X)
GEORGE BENNETT
DIRECTOR/TREASURER1.00Yes (X)$4,750$0$0
ROBERT KIRSCH
DIRECTOR1.00Yes (X)$4,750$0$0
THOMAS LEEDY
DIRECTOR/VICE CHAIR1.00Yes (X)$4,500$0$0
JOSHUA VARGAS
DIRECTOR-PARTIAL YEAR1.00Yes (X)$4,500$0$0
JARROD RAMER
DIRECTOR1.00Yes (X)$3,250$0$0
BETH MUNK
DIRECTOR/SECRETARY1.00Yes (X)$3,000$0$0
BRIAN DECAMP
DIRECTOR/CHAIR1.001.00Yes (X)$0$0$0
FieldValueIRS element (for citing)
Total Reportable Comp From Org$1,221,215TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$5,149,326TotReportableCompRltdOrgAmt
Total Other Compensation$1,607,507TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K14IndivRcvdGreaterThan100KCnt
Former Ofcr Employees ListedYes (1)FormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (1)TotalCompGreaterThan150KInd
Compensation From Other Srcs0CompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (5 entries)

Address Line1ContractorAddress/USAddress/AddressLine1TxtCityContractorAddress/USAddress/CityNmState AbbreviationContractorAddress/USAddress/StateAbbreviationCdZIPContractorAddress/USAddress/ZIPCdServicesServicesDescCompensationCompensationAmt
PARKVIEW HOSPITAL INC
11109 PARKVIEW PLAZA DRIVEFORT WAYNEIN46845LABORATORY SERVICES$2,552,314
CLINICAL COLLEAGUES INC
PO BOX 824246PHILADELPHIAPA19182ANESTHESIOLOGISTS$1,191,254
HEALOGICS WOUND CARE & HYPERBARIC SERVIC
PO BOX 551187JACKSONVILLEFL32255MEDICAL SERVICES$553,091
FOCUSONE SOLUTIONS LLC
13609 CALIFORNIA STREETOMAHANE68154NURSES$541,316
NORTHEAST INTERNAL MEDICINE ASSOC INC
2500 N DETROIT STLAGRANGEIN46761HOSPITALISTS$376,192
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K10CntrctRcvdGreaterThan100KCnt
Related Organizations$208,960RelatedOrganizationsAmt
Government Grants$11,163GovernmentGrantsAmt
Noncash Contributions$2,940NoncashContributionsAmt
Total Contributions$220,123TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (5 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
NET PATIENT SERVICE622000$70,948,346$70,948,346
EMS SUBSIDY900099$297,314$297,314
INTERUNIT RENT531120$114,005$114,005
PHARMACY446110$54,214$54,214
HEALTH FAIR900099$40,445$40,445

Total Oth Program Service Rev TotalOthProgramServiceRevGrp

FieldValueIRS element (for citing)
Total Revenue Column$29,005TotalRevenueColumnAmt
Related Or Exempt Func Income$29,005RelatedOrExemptFuncIncomeAmt
FieldValueIRS element (for citing)
Total Program Service Revenue$71,483,329TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$1,148TotalRevenueColumnAmt
Exclusion$1,148ExclusionAmt

Gross Rents GrossRentsGrp

FieldValueIRS element (for citing)
Real$21,868RealAmt

Less Rental Expenses LessRentalExpensesGrp

FieldValueIRS element (for citing)
Real$44,858RealAmt

Rental Income Or Loss RentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Real-$22,990RealAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column-$22,990TotalRevenueColumnAmt
Exclusion-$22,990ExclusionAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

FieldValueIRS element (for citing)
Other$31,531OtherAmt

Gain Or Loss GainOrLossGrp

FieldValueIRS element (for citing)
Other-$31,531OtherAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

FieldValueIRS element (for citing)
Total Revenue Column-$31,531TotalRevenueColumnAmt
Exclusion-$31,531ExclusionAmt

Other Revenue Misc OtherRevenueMiscGrp (2 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtExclusionExclusionAmt
CAFETERIA SALES722210$157,370$157,370
GIFT SHOP453220$38,514$38,514
FieldValueIRS element (for citing)
Other Revenue Total$195,884OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$71,845,963TotalRevenueColumnAmt
Related Or Exempt Func Income$71,483,329RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$142,511ExclusionAmt
FieldValueIRS element (for citing)
Info In Schedule O Part IXYes (X)InfoInScheduleOPartIXInd

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

FieldValueIRS element (for citing)
Total$195,461TotalAmt
Program Services$195,461ProgramServicesAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$570,733TotalAmt
Management And General$570,733ManagementAndGeneralAmt

Comp Disqual Persons CompDisqualPersonsGrp

FieldValueIRS element (for citing)
Total$211,450TotalAmt
Management And General$211,450ManagementAndGeneralAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$13,925,478TotalAmt
Program Services$13,925,478ProgramServicesAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$5,013,122TotalAmt
Program Services$5,013,122ProgramServicesAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$7,302,561TotalAmt
Program Services$6,424,945ProgramServicesAmt
Management And General$877,616ManagementAndGeneralAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$3,493TotalAmt
Program Services$3,343ProgramServicesAmt
Management And General$150ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$1,391,281TotalAmt
Program Services$1,223,249ProgramServicesAmt
Management And General$168,032ManagementAndGeneralAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$9,283TotalAmt
Program Services$9,283ProgramServicesAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$2,337,887TotalAmt
Program Services$2,336,909ProgramServicesAmt
Management And General$978ManagementAndGeneralAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$28,122TotalAmt
Program Services$21,252ProgramServicesAmt
Management And General$6,870ManagementAndGeneralAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$14,801TotalAmt
Program Services$11,444ProgramServicesAmt
Management And General$3,357ManagementAndGeneralAmt

Interest InterestGrp

FieldValueIRS element (for citing)
Total$8,664TotalAmt
Program Services$8,664ProgramServicesAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$1,308,273TotalAmt
Program Services$1,302,506ProgramServicesAmt
Management And General$5,767ManagementAndGeneralAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$177,980TotalAmt
Program Services$177,980ProgramServicesAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtManagement And GeneralManagementAndGeneralAmtProgram ServicesProgramServicesAmt
FEDERAL & STATE INCOME$252$252
CORP SERVICE ALLOCATION$9,192,144$9,192,144
PH CLINICAL SUPPORT$8,689,395$8,689,395
BAD DEBT$7,822,225$7,822,225

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$6,287,780TotalAmt
Program Services$6,016,818ProgramServicesAmt
Management And General$68,099ManagementAndGeneralAmt
Fundraising$202,863FundraisingAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$64,490,385TotalAmt
Program Services$53,182,074ProgramServicesAmt
Management And General$11,105,448ManagementAndGeneralAmt
Fundraising$202,863FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$1,645BOYAmt
EOY$7,952EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$8,785,451BOYAmt
EOY$8,856,536EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

FieldValueIRS element (for citing)
BOY$597,051BOYAmt
EOY$430,222EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$32,355BOYAmt
EOY$40,806EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$19,642,560LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$12,181,590LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$7,641,990BOYAmt
EOY$7,460,970EOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

FieldValueIRS element (for citing)
BOY$5,000BOYAmt
EOY$5,000EOYAmt

Intangible Assets IntangibleAssetsGrp

FieldValueIRS element (for citing)
BOY$840,505BOYAmt
EOY$840,505EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$411,064BOYAmt
EOY$6,431,126EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$18,315,061BOYAmt
EOY$24,073,117EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$2,304,322BOYAmt
EOY$2,583,182EOYAmt

Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp

FieldValueIRS element (for citing)
BOY$256,582BOYAmt
EOY$343,117EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$2,366,290BOYAmt
EOY$414,110EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$4,927,194BOYAmt
EOY$3,340,409EOYAmt
FieldValueIRS element (for citing)
Organization Follows FASB117Yes (X)OrganizationFollowsFASB117Ind

No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp

FieldValueIRS element (for citing)
BOY$13,387,867BOYAmt
EOY$20,732,708EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$13,387,867BOYAmt
EOY$20,732,708EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$18,315,061BOYAmt
EOY$24,073,117EOYAmt
FieldValueIRS element (for citing)
Info In Schedule O Part XIYes (X)InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss$7,355,578ReconcilationRevenueExpnssAmt
Other Changes In Net Assets-$10,737OtherChangesInNetAssetsAmt
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or Review0AccountantCompileOrReviewInd
FS AuditedYes (1)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Consolidated Basis Fincl StmtYes (X)ConsolidatedBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (1)AuditCommitteeInd
Federal Grant Audit Required0FederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
HospitalYes (X)HospitalInd

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

FieldValueIRS element (for citing)
ContributorRESTRICTEDContributorNum

Contributor Business Name ContributorBusinessName

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor US Address ContributorUSAddress

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Total ContributionsRESTRICTEDTotalContributionsAmt

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Volunteers0VolunteersInd
Paid Staff Or Management0PaidStaffOrManagementInd
Media Advertisements0MediaAdvertisementsInd
Mailings Members0MailingsMembersInd
Publications Or Broadcast0PublicationsOrBroadcastInd
Grants Other Organizations0GrantsOtherOrganizationsInd
Direct Contact Legislators0DirectContactLegislatorsInd
Rallies Demonstrations0RalliesDemonstrationsInd
Other ActivitiesYes (1)OtherActivitiesInd
Other Activities$4,668OtherActivitiesAmt
Total Lobbying Expenditures$4,668TotalLobbyingExpendituresAmt
Not Described Section501c30NotDescribedSection501c3Ind

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePART II-B, LINE 1:FormAndLineReferenceDesc
ExplanationREPRESENTS 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

CY Endwmt Fund CYEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$126,071BeginningYearBalanceAmt
Investment Earnings Or Losses$4,080InvestmentEarningsOrLossesAmt
End Year Balance$130,151EndYearBalanceAmt

CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$122,487BeginningYearBalanceAmt
Investment Earnings Or Losses$3,584InvestmentEarningsOrLossesAmt
End Year Balance$126,071EndYearBalanceAmt

CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$113,496BeginningYearBalanceAmt
Investment Earnings Or Losses$8,991InvestmentEarningsOrLossesAmt
End Year Balance$122,487EndYearBalanceAmt

CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$97,757BeginningYearBalanceAmt
Contributions$11,500ContributionsAmt
Investment Earnings Or Losses$4,239InvestmentEarningsOrLossesAmt
End Year Balance$113,496EndYearBalanceAmt

CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$93,447BeginningYearBalanceAmt
Investment Earnings Or Losses$4,310InvestmentEarningsOrLossesAmt
End Year Balance$97,757EndYearBalanceAmt
FieldValueIRS element (for citing)
Board Designated Balance EOY1.00000BoardDesignatedBalanceEOYPct
Prmnnt Endowment Balance EOY0.00000PrmnntEndowmentBalanceEOYPct
Term Endowment Balance EOY0.00000TermEndowmentBalanceEOYPct
Endowments Held Unrelated Org0EndowmentsHeldUnrelatedOrgInd
Endowments Held Related OrgYes (1)EndowmentsHeldRelatedOrgInd
Related Org List Sch RYes (1)RelatedOrgListSchRInd

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$3,922,018OtherCostOrOtherBasisAmt
Depreciation$1,854,924DepreciationAmt
Book Value$2,067,094BookValueAmt

Leasehold Improvements LeaseholdImprovementsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$63,781OtherCostOrOtherBasisAmt
Depreciation$32,142DepreciationAmt
Book Value$31,639BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$14,901,369OtherCostOrOtherBasisAmt
Depreciation$9,768,507DepreciationAmt
Book Value$5,132,862BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$755,392OtherCostOrOtherBasisAmt
Depreciation$526,017DepreciationAmt
Book Value$229,375BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$7,460,970TotalBookValueLandBuildingsAmt

Other Assets Org OtherAssetsOrgGrp (3 entries)

DescDescBook ValueBookValueAmt
EST 3RD PARTY SETTLEMENTS$87,573
EST MEDICARE/MEDICAID SETTLEMENTS$414,110
DUE TO/FROM INTERUNIT$5,929,443
FieldValueIRS element (for citing)
Total Book Value Other Assets$6,431,126TotalBookValueOtherAssetsAmt

Other Liabilities Org OtherLiabilitiesOrgGrp

FieldValueIRS element (for citing)
DescEST 3RD PARTY SETTLEMENTSDesc
Amt$414,110Amt
FieldValueIRS element (for citing)
Total Liability$414,110TotalLiabilityAmt
Footnote TextYes (X)FootnoteTextInd

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
PART V, LINE 4:TO SUPPORT HOSPITAL BUILDING NEEDS FOR COMMUNITY HOSPITAL OF NOBLE COUNTY, INC.
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, 2019 AND 2018, THERE ARE NO UNRECOGNIZED TAX BENEFITS RESULTING FROM UNCERTAIN TAX POSITIONS. FORMS 990 AND 990T FILED BY THE CORPORATION AND ITS TAX-EXEMPT AFFILIATED ENTITIES ARE SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE UP TO THREE YEARS FROM THE EXTENDED DUE DATE OF EACH RETURN. FORMS 990 AND 990T FILED BY THE CORPORATION AND ITS TAX-EXEMPT AFFILIATED ENTITIES ARE NO LONGER SUBJECT TO EXAMINATION FOR THE YEAR 2015 AND PRIOR.

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Financial Assistance PolicyYes (1)FinancialAssistancePolicyInd
Written PolicyYes (1)WrittenPolicyInd
All Hospitals PolicyYes (X)AllHospitalsPolicyInd
FPG Reference Free CareYes (1)FPGReferenceFreeCareInd
Percent200Yes (X)Percent200Ind
FPG Reference Discounted Care0FPGReferenceDiscountedCareInd
Free Care Medically IndigentYes (1)FreeCareMedicallyIndigentInd
Financial Assistance BudgetYes (1)FinancialAssistanceBudgetInd
Expenses Exceed BudgetYes (1)ExpensesExceedBudgetInd
Unable To Provide Care0UnableToProvideCareInd
Annual Community Bnft ReportYes (1)AnnualCommunityBnftReportInd
Report Publically AvailableYes (1)ReportPublicallyAvailableInd

Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp

FieldValueIRS element (for citing)
Total Community Benefit Expns$1,205,218TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$0DirectOffsettingRevenueAmt
Net Community Benefit Expns$1,205,218NetCommunityBenefitExpnsAmt
Total Expense0.02130TotalExpensePct

Unreimbursed Medicaid UnreimbursedMedicaidGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$5,502,157TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$3,307,862DirectOffsettingRevenueAmt
Net Community Benefit Expns$2,194,295NetCommunityBenefitExpnsAmt
Total Expense0.03870TotalExpensePct

Unreimbursed Costs UnreimbursedCostsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$5,085,589TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$3,805,485DirectOffsettingRevenueAmt
Net Community Benefit Expns$1,280,104NetCommunityBenefitExpnsAmt
Total Expense0.02260TotalExpensePct

Total Financial Assistance Typ TotalFinancialAssistanceTyp

FieldValueIRS element (for citing)
Total Community Benefit Expns$11,792,964TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$7,113,347DirectOffsettingRevenueAmt
Net Community Benefit Expns$4,679,617NetCommunityBenefitExpnsAmt
Total Expense0.08260TotalExpensePct

Community Health Services CommunityHealthServicesGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$176,404TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$12,068DirectOffsettingRevenueAmt
Net Community Benefit Expns$164,336NetCommunityBenefitExpnsAmt
Total Expense0.00290TotalExpensePct

Cash And In Kind Contributions CashAndInKindContributionsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$151,768TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$0DirectOffsettingRevenueAmt
Net Community Benefit Expns$151,768NetCommunityBenefitExpnsAmt
Total Expense0.00270TotalExpensePct

Total Other Benefits TotalOtherBenefitsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$328,172TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$12,068DirectOffsettingRevenueAmt
Net Community Benefit Expns$316,104NetCommunityBenefitExpnsAmt
Total Expense0.00560TotalExpensePct

Total Community Benefits TotalCommunityBenefitsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$12,121,136TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$7,125,415DirectOffsettingRevenueAmt
Net Community Benefit Expns$4,995,721NetCommunityBenefitExpnsAmt
Total Expense0.08820TotalExpensePct

Economic Development EconomicDevelopmentGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$5,000TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$0DirectOffsettingRevenueAmt
Net Community Benefit Expns$5,000NetCommunityBenefitExpnsAmt
Total Expense0.00010TotalExpensePct

Workforce Development WorkforceDevelopmentGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$21,840TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$0DirectOffsettingRevenueAmt
Net Community Benefit Expns$21,840NetCommunityBenefitExpnsAmt
Total Expense0.00040TotalExpensePct

Total Communtity Building Acty TotalCommuntityBuildingActyGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$26,840TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$26,840NetCommunityBenefitExpnsAmt
Total Expense0.00050TotalExpensePct
FieldValueIRS element (for citing)
Bad Debt Expense ReportedYes (1)BadDebtExpenseReportedInd
Bad Debt Expense$7,822,225BadDebtExpenseAmt
Bad Debt Expense Attributable$37,303BadDebtExpenseAttributableAmt
Reimbursed By Medicare$10,560,999ReimbursedByMedicareAmt
Cost Of Care Reimbursed By Medcr$10,402,665CostOfCareReimbursedByMedcrAmt
Medicare Surplus Or Shortfall$158,334MedicareSurplusOrShortfallAmt

Costing Methodology Used CostingMethodologyUsedGrp

FieldValueIRS element (for citing)
Cost To Charge RatioYes (X)CostToChargeRatioInd
FieldValueIRS element (for citing)
Written Debt Collection PolicyYes (1)WrittenDebtCollectionPolicyInd
Financial Assistance PrvsnYes (1)FinancialAssistancePrvsnInd
Hospital Facilities1HospitalFacilitiesCnt

Hospital Facilities HospitalFacilitiesGrp

FieldValueIRS element (for citing)
Facility1FacilityNum

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1COMMUNITY HOSPITAL OF NOBLE COUNTY INCBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line1401 SAWYER RDAddressLine1Txt
CityKENDALLVILLECityNm
State AbbreviationINStateAbbreviationCd
ZIP46755ZIPCd
FieldValueIRS element (for citing)
Website AddressWWW.PARKVIEW.COMWebsiteAddressTxt
State License14-002434-1StateLicenseNum
Licensed HospitalYes (X)LicensedHospitalInd
General Medical And SurgicalYes (X)GeneralMedicalAndSurgicalInd
Emergency Room24 HrsYes (X)EmergencyRoom24HrsInd

Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1COMMUNITY HOSPITAL OF NOBLE COUNTY INCBusinessNameLine1Txt
FieldValueIRS element (for citing)
Facility1FacilityNum
First Licensed CY Or PY0FirstLicensedCYOrPYInd
Tax Exempt Hospital CY Or PY0TaxExemptHospitalCYOrPYInd
CHNA ConductedYes (1)CHNAConductedInd
Community DefinitionYes (X)CommunityDefinitionInd
Community DemographicsYes (X)CommunityDemographicsInd
Existing ResourcesYes (X)ExistingResourcesInd
How Data ObtainedYes (X)HowDataObtainedInd
Community Health NeedsYes (X)CommunityHealthNeedsInd
Other Health IssuesYes (X)OtherHealthIssuesInd
Community Hlth Needs Id ProcessYes (X)CommunityHlthNeedsIdProcessInd
Consulting ProcessYes (X)ConsultingProcessInd
Prior CHNA ImpactYes (X)PriorCHNAImpactInd
CHNA Conducted19CHNAConductedYr
Take Into Account Others InputYes (1)TakeIntoAccountOthersInputInd
CHNA Conducted With Other FcltsYes (1)CHNAConductedWithOtherFcltsInd
CHNA Conducted With Non FcltsYes (1)CHNAConductedWithNonFcltsInd
CHNA Report Widely AvailableYes (1)CHNAReportWidelyAvailableInd
Rpt Available On Own WebsiteYes (X)RptAvailableOnOwnWebsiteInd
Own Website URLHTTPS://WWW.PARKVIEW.COM/LOCALHEALTHNEEDSOwnWebsiteURLTxt
Paper Copy Public InspectionYes (X)PaperCopyPublicInspectionInd
Implementation Strategy AdoptYes (1)ImplementationStrategyAdoptInd
Implementation Strategy Adpt19ImplementationStrategyAdptYr
Strategy Posted WebsiteYes (1)StrategyPostedWebsiteInd
Strategy Website URLHTTPS://WWW.PARKVIEW.COM/LOCALHEALTHNEEDSStrategyWebsiteURLTxt
Organization Incur Excise Tax0OrganizationIncurExciseTaxInd
Elig Criteria ExplainedYes (1)EligCriteriaExplainedInd
FPG Family Incm Lmt Free DscntYes (X)FPGFamilyIncmLmtFreeDscntInd
FPG Family Incm Lmt Free Care200.000000000000FPGFamilyIncmLmtFreeCarePct
Asset Level CriteriaYes (X)AssetLevelCriteriaInd
Medical Indigency CriteriaYes (X)MedicalIndigencyCriteriaInd
Insurance Status CriteriaYes (X)InsuranceStatusCriteriaInd
Underinsurance Stat CriteriaYes (X)UnderinsuranceStatCriteriaInd
Residency CriteriaYes (X)ResidencyCriteriaInd
Explained BasisYes (1)ExplainedBasisInd
App Financial Asst ExplnYes (1)AppFinancialAsstExplnInd
Described InfoYes (X)DescribedInfoInd
Described Suprt DocYes (X)DescribedSuprtDocInd
Provided Hospital ContactYes (X)ProvidedHospitalContactInd
Includes Publicity MeasuresYes (1)IncludesPublicityMeasuresInd
FAP Available On WebsiteYes (X)FAPAvailableOnWebsiteInd
FAP Available On Website URLHTTPS://WWW.PARKVIEW.COM/PATIENTS-VISITORS/FINANCIAL-ASSISTANCEFAPAvailableOnWebsiteURLTxt
FAP App Available On WebsiteYes (X)FAPAppAvailableOnWebsiteInd
FAP App Available On Website URLHTTPS://WWW.PARKVIEW.COM/PATIENTS-VISITORS/FINANCIAL-ASSISTANCEFAPAppAvailableOnWebsiteURLTxt
FAP Summary On WebsiteYes (X)FAPSummaryOnWebsiteInd
FAP Summary On Website URLHTTPS://WWW.PARKVIEW.COM/PATIENTS-VISITORS/FINANCIAL-ASSISTANCEFAPSummaryOnWebsiteURLTxt
FAP Avlbl On Request No ChargeYes (X)FAPAvlblOnRequestNoChargeInd
FAP App Avlbl On Request No ChrgYes (X)FAPAppAvlblOnRequestNoChrgInd
FAP Sum Avlbl On Request No ChrgYes (X)FAPSumAvlblOnRequestNoChrgInd
Notified FAP Copy Bill DisplayYes (X)NotifiedFAPCopyBillDisplayInd
Communtity Notified FAPYes (X)CommuntityNotifiedFAPInd
FAP TranslatedYes (X)FAPTranslatedInd
FAP Actions On NonpaymentYes (1)FAPActionsOnNonpaymentInd
Permit No ActionsYes (X)PermitNoActionsInd
Collection Activities0CollectionActivitiesInd
Provided Written NoticeYes (X)ProvidedWrittenNoticeInd
Made Effort Orally NotifyYes (X)MadeEffortOrallyNotifyInd
Processed FAP ApplicationYes (X)ProcessedFAPApplicationInd
Made Presumptive Elig DetermYes (X)MadePresumptiveEligDetermInd
Nondis Emergency Care PolicyYes (1)NondisEmergencyCarePolicyInd
Look Back MedicareYes (X)LookBackMedicareInd
Amounts Generally Billed0AmountsGenerallyBilledInd
Gross Charges0GrossChargesInd

Supplemental Information SupplementalInformationGrp (5 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
COMMUNITY HOSPITAL OF NOBLE COUNTY, 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, COMMUNITY HOSPITAL OF NOBLE COUNTY, 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 WERE CONSIDERED.IN GATHERING QUALITATIVE COMMUNITY INPUT, COMMUNITY HOSPITAL OF NOBLE COUNTY, 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 SYSTEMS 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.IN ADDITION TO DATA COLLECTION, COMMUNITY HOSPITAL OF NOBLE COUNTY, INC. TURNED TO THE COMMUNITY AND PARTNERING ORGANIZATIONS WHEN SELECTING AND PRIORITIZING NOBLE 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.AS A CONTINUATION OF THE PRIORITIZATION PROCESS, COMMUNITY HOSPITAL OF NOBLE COUNTY, INC FORMED AN INTERNAL, MULTI-DISCIPLINARY ADVISORY COUNCIL TO SELECT ADDITIONAL HEALTH PRIORITIES FOR COMMUNITY HOSPTIAL OF NOBLE COUNTY, INC. THIS GROUP OF STAKEHOLDERS MET AND DISCUSSED THE RESULTS OF THE CHNA. AFTER A THOUGHTFUL REVIEW OF THE DATA AND EXTENSIVE DISCUSSION, THE ADVISORY COMMITTEE SELECTED OBESITY AS OUR SECOND PRIORITY.COMMUNITY HOSPITAL OF NOBLE COUNTY ALSO HELD A COMMUNITY SESSION TO SHARE THE NOBLE COUNTY CHNA RESULTS AND TO GATHER FEEDBACK FROM LOCAL NON-PROFIT AND PUBLIC HEALTH ORGANIZATIONS. ADDITIONALLY, THE TOP TWO HEALTH PRIORITIES WERE PRESENTED TO AND ADOPTED BY COMMUNITY HOSPITAL OF NOBLE COUNTY, INC'S HOSPITAL BOARD OF DIRECTORS.
COMMUNITY HOSPITAL OF NOBLE COUNTY, 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); WHITLEY MEMORIAL HOSPITAL, INC. (EIN 35-1967665); PARKVIEW WABASH HOSPITAL, INC. (EIN 47-1753440) AND ORTHOPAEDIC HOSPITAL AT PARKVIEW NORTH, LLC (EIN 26-0143823).
COMMUNITY HOSPITAL OF NOBLE COUNTY, 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.
COMMUNITY HOSPITAL OF NOBLE COUNTY, 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:OBESITY: COMMUNITY HOSPITAL OF NOBLE COUNTY, INC. IS BOLSTERING ITS EFFORTS IN AREAS DEEMED TO BE THE HIGHEST IMPACT FOR OBESITY PREVENTION. THESE INCLUDE THE FOLLOWING: 1) WORKING TO INCREASE ACCESS TO FRESH, AFFORDABLE AND LOCALLY GROWN (WHEN POSSIBLE) FOOD; 2) INCREASING CONSUMPTION OF FRESH PRODUCE; 3) OFFERING CURRICULUM TO ELEMENTARY SCHOOLS FOR PHYSICAL ACTIVITY AND NUTRITION; 4) PREVENTIVE HEALTH AND SKILL-BUILDING CLASSES FOR FAMILIES AND INDIVIDUALS AND 5) PROVIDER DIRECTED WELLNESS RESOURCES INCLUDING REFERRALS TO MY BEST HEALTH, HEALTH BEHAVIOR CHANGE PROGRAM. ACTIONS TO ADDRESS THE ISSUE OF OBESITY CENTER AROUND AND INCLUDE THE FOLLOWING PROGRAMS: 1) MY BEST HEALTH, HEALTH BEHAVIOR CHANGE PROGRAM; 2) CENTER FOR HEALTHY LIVING PHYSICAL FITNESS CLASSES; 3) ACTIVATE NOBLE COUNTY FARM STANDS; 4) DIABETES WORKSHOPS AND SUPPORT GROUPS; 5) COOKING DEMONSTRATIONS AND 6) EMERGENCY FOOD BAGS.TOBACCO USE: COMMUNITY HOSPITAL OF NOBLE COUNTY, INC. IS BOLSTERING ITS EFFORTS IN AREAS DEEMED TO BE THE HIGHEST IMPACT FOR TOBACCO USE. THESE INCLUDE THE FOLLOWING: 1) PROVIDE EDUCATION IN THE SCHOOL SYSTEMS FOR PREVENTION OF TOBACCO USE 2) OFFER FREEDOM FROM SMOKING (TOBACCO CESSATION PROGRAM) FOR FREE TO ALL PARTICIPANTS 3) PROVIDE FINANCIAL ASSISTANCE FOR MEDICATION TO HELP WITH TOBACCO CESSATION 4) OFFER FREEDOM FROM SMOKING IN MULTIPLE AREAS OF THE COUNTY. DRUG USE: COMMUNITY HOSPITAL OF NOBLE COUNTY, INC. IS REINFORCING ITS EFFORTS IN AREAS DEEMED TO BE THE HIGHEST IMPACT FOR DRUG USE. THESE INCLUDE THE FOLLOWING: 1) PROVIDE EDUCATION IN THE SCHOOL SYSTEMS FOR PREVENTION OF DRUG USE; 2) PROVIDE LECTURES TO THE COMMUNITY ABOUT THE EFFECTS OF DRUG USE AND 3) PROVIDE A BASE OF REFERRALS TO APPROPRIATE RESOURCES FOR THOSE IN NEED.OTHER HEALTH NEEDS NOT BEING ADDRESSED:-DIABETES - COMMUNITY HOSPITAL OF NOBLE COUNTY, INC. CURRENTLY ALREADY HAS A DIABETES EDUCATOR ON STAFF AND FREE WORKSHOPS AND SUPPORT GROUPS OFFERED TO THE COMMUNITY. THE COLE FAMILY CENTER YMCA ALSO PROVIDES A DIABETES PREVENTION PROGRAM. REGISTERED DIETICIANS ARE ON STAFF TO PROVIDE CONSULTATIONS FOR THOSE DIAGNOSED WITH DIABETES. -MATERNAL/INFANT/CHILD HEALTH - A BIRTH PLANNER ON STAFF TEACHES SAFE SLEEP CLASSES FOR EXPECTING PARENTS AND LIFE AND FAMILY SERVICES & HEALTHIER MOMS AND BABIES ALREADY OFFER WORKSHOPS AND EDUCATION FOR THE UNDERSERVED POPULATIONS. THE BIRTH PLANNER, OB SUPERVISORS, AND LIFE AND FAMILY SERVICES ALSO PARTNER TO OFFER A MOM TO BE SUPPORT GROUP TO INSPIRE AND ENCOURAGE ALL MOMS ESPECIALLY YOUNG MOMS ACROSS THE COUNTY. -CARDIOVASCULAR DISEASE - THE SIZE OF THE HEALTH PROBLEM WAS LOWER IN RANKING THAN THE THREE HEALTH NEEDS IDENTIFIED. -CANCER - THE SIZE OF THE HEALTH PROBLEM WAS LOWER IN RANKING THAN THE THREE HEALTH NEEDS IDENTIFIED. -HEALTH CARE ACCESS - COST AND QUALITY - COMMUNITY HOSPITAL OF NOBLE COUNTY, INC. CURRENTLY OFFERS MEDICATION ASSISTANCE, CHARITY CARE, FINANCIAL ASSISTANCE WITH HOSPITAL BILLS, AND TRANSPORTATION FOR THE UNDERSERVED POPULATION TO ACCESS HEALTH CARE. -MENTAL HEALTH - THE CENTER FOR HEALTHY LIVING OFFERS CLASSES FOR STRESS REDUCTION AS WELL AS A HEALING ARTS SERIES. PARKVIEW BEHAVIORAL HEALTH IS INVOLVED IN THE NOBLE COUNTY COMMUNITY TO BRIEFLY PROVIDE THERAPY AND RESOURCES FOR THOSE WITH IMMEDIATE MENTAL HEALTH NEEDS. THE NORTHEASTERN CENTER AND BOWEN CENTER ARE ALREADY IN EXISTENCE TO PROVIDE BOTH INPATIENT AND OUTPATIENT MENTAL HEALTH SERVICES IN NOBLE COUNTY. NEW HOPE CLUBHOUSE IS A SELF-HELP PROGRAM FOR MEN AND WOMEN RECOVERING FROM MENTAL ILLNESS WHICH PROMOTES RECOVERY THROUGH WORK, RELATIONSHIPS, AND THE OPPORTUNITY TO BECOME PART OF THE COMMUNITY. -ASTHMA - THIS NEED RANKED TOO LOW OVERALL ON THE HANLON SCORES BY INDICATOR AND WAS NOT CHOSEN. -AGING - THIS NEED RANKED TOO LOW OVERALL ON THE HANLON SCORES BY INDICATOR AND WAS NOT CHOSEN.
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.

Supplemental Information Detail SupplementalInformationDetail (17 entries)

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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) 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 7BCOMMUNITY HOSPITAL OF NOBLE COUNTY, 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 7CCOMMUNITY HOSPITAL OF NOBLE COUNTY, INC. ACCEPTS ALL CERTAIN MEANS-TESTED PATIENTS FROM THE HEALTHY INDIANA PLAN (HIP) WITH THE KNOWLEDGE THAT THERE MAY BE SHORTFALLS. INTERNAL REVENUE SERVICE (IRS) REVENUE RULING 69-545 IMPLIES THAT TREATING MEANS-TESTED PATIENTS IS A COMMUNITY BENEFIT. IRS REVENUE RULING 69-545, WHICH ESTABLISHED THE COMMUNITY BENEFIT STANDARD FOR NONPROFIT HOSPITALS, STATES THAT IF A HOSPITAL SERVES PATIENTS WITH GOVERNMENTAL HEALTH BENEFITS, INCLUDING HIP, THEN THIS IS AN INDICATION THAT THE HOSPITAL OPERATES TO PROMOTE THE HEALTH OF THE COMMUNITY. THE UNREIMBURSED HIP COST REPORTED ON LINE 7C IS CALCULATED UNDER THE COST TO CHARGE RATIO METHODOLOGY. UNDER THIS METHOD, THE HIP CHARGES ARE MULTIPLIED BY THE RATIO OF COST TO CHARGES TO DETERMINE THE COST OF HIP SERVICES RENDERED. THEN, THE COST OF HIP SERVICES RENDERED IS DEDUCTED FROM THE REIMBURSEMENT RECEIVED FOR HIP PATIENTS TO ARRIVE AT A GAIN/(LOSS) RELATIVE TO THESE PATIENTS.PART I, LINE 7EAMOUNTS PRESENTED ARE BASED ON ACTUAL SPEND FOR THOSE SERVICES AND BENEFITS PROVIDED DEEMED TO IMPROVE THE HEALTH OF THE COMMUNITIES IN WHICH WE SERVE AND CONFORM WITH THE MISSION OF OUR EXEMPT PURPOSE.PART I, LINE 7IIN KEEPING WITH OUR MISSION AND COMMITMENT TO THE COMMUNITIES IN WHICH WE SERVE, COMMUNITY HOSPITAL OF NOBLE COUNTY, 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 EXPENSECOMMUNITY HOSPITAL OF NOBLE COUNTY, INC. EXCLUDED $7,822,225 OF BAD DEBT EXPENSE.
PART II, COMMUNITY BUILDING ACTIVITIES:DESCRIBE HOW THE ORGANIZATION'S COMMUNITY BUILDING ACTIVITIES, AS REPORTED, PROMOTE THE HEALTH OF THE COMMUNITIES THE ORGANIZATION SERVES.HEALTH RESOURCES & SERVICES ADMINISTRATION (HRSA), IS AN AGENCY OF THE U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES. HRSA DEVELOPS SHORTAGE DESIGNATION CRITERIA AND USES THEM TO DECIDE WHETHER OR NOT A GEOGRAPHIC AREA, POPULATION GROUP OR FACILITY IS A HEALTH PROFESSIONAL SHORTAGE AREA (HPSA) OR A MEDICALLY UNDERSERVED AREA OR POPULATION (MUA/P). HRSA HAS DESIGNATED NOBLE COUNTY AS A GEOGRAPHIC HPSA IN PRIMARY CARE, AND THE NORTHEASTERN CATCHMENT AREA 18 IN NOBLE COUNTY AS A GEOGRAPHIC HPSA IN MENTAL HEALTH. AS SUCH, COMMUNITY HOSPITAL OF NOBLE COUNTY, INC. PROVIDES SUPPORT FOR LOCAL ECONOMIC DEVELOPMENT PROGRAMS. THESE EFFORTS ARE ALIGNED WITH OF THE HEALTH SYSTEM'S STRATEGIC INVOLVEMENT IN THE NORTHEAST INDIANA REGIONAL PARTNERSHIP'S VISION 2020, 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 2020'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 DEVELOPMENT IN NOBLE 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. COMMUNITY HOSPITAL OF NOBLE COUNTY, INC. HAS A STRONG COMMITMENT TO SUPPORTING AND ENHANCING THE VITALITY OF OUR COMMUNITY. COMMUNITY HOSPITAL OF NOBLE COUNTY, INC. INVESTS IN PROJECTS THAT HELP TO IMPROVE THE HEALTH AND INSPIRE THE WELL-BEING OF THE COMMUNITY. COMMUNITY HOSPITAL OF NOBLE COUNTY, INC. PARTNERS WITH NOBLE COUNTY ECONOMIC DEVELOPMENT TO CONTINUE TO SUPPORT NOBLE COUNTY AS A TOP PLACE TO LIVE, WORK AND PLAY. COMMUNITY HOSPITAL OF NOBLE COUNTY, INC. ALSO SUPPORTS PHYSICIAN RECRUITMENT ACTIVITIES TO ASSIST IN TIMELY RESPONSE TO PATIENT CARE NEEDS IN THE COMMUNITY. THESE RECRUITMENT ACTIVITIES ARE BASED ON RESULTS OF A PERIODIC PHYSICIAN NEEDS ASSESSMENT. COMMUNITY HOSPITAL OF NOBLE COUNTY, INC. DEVELOPED A PHYSICIAN RECRUITMENT PLAN TO ADDRESS POTENTIAL GAPS IN PATIENT COVERAGE. COMMUNITY HOSPITAL OF NOBLE COUNTY, INC. STRIVES TO BRING THE BEST INTEGRATED, QUALITY, COST EFFECTIVE CARE AND INNOVATIVE TECHNOLOGY TO OUR COMMUNITIES. IN DOING SO, WE FOCUS OUR EFFORTS ON RECRUITING AND AN EXCEPTIONAL TEAM OF PHYSICIANS. PARKVIEW NOBLE CENTER FOR HEALTHY LIVING IS FULLY IMPLEMENTED WITH AN EMPHASIS ON HEALTH NEEDS SUCH AS REDUCTION IN THE OBESITY RATE, SMOKING CESSATION CLASSES AND DRUG ABUSE REDUCTION IN NOBLE COUNTY. EXERCISE CLASSES, NUTRITIONAL TALKS AND SUPPORT GROUPS HELP AREA RESIDENTS IMPROVE THEIR HEALTH AND SENSE OF WELL-BEING. IN ADDITION, FREE AND REDUCED - COST SCREENINGS ARE OFFERED ON A REGULAR BASIS.EVERY MEMBER OF COMMUNITY HOSPITAL OF NOBLE COUNTY, INC.'S HEALTHCARE TEAM IS RESPONSIBLE FOR NURTURING AN ENVIRONMENT OF EXCELLENCE AS THE BEST PLACE FOR CO-WORKERS TO WORK, PHYSICIANS TO PRACTICE MEDICINE, AND PATIENTS TO RECEIVE CARE. WE ARE COMMITTED TO PROVIDING EXCELLENT CUSTOMER SERVICE TO ALL PEOPLE. WE KNOW HOW IMPORTANT CLINICAL, SERVICE AND OPERATIONAL EXCELLENCE IS TO THE SUCCESS OF COMMUNITY HOSPITAL OF NOBLE COUNTY, INC., AND WE RECOGNIZE HOW IMPORTANT OUR SUCCESS IS TO THE COMMUNITY.
PART III, LINE 2:BAD DEBT ON THE ORGANIZATION'S AUDITED FINANCIAL STATEMENTS UNDER GENERALLY ACCEPTED ACCOUNTING STANDARDS IS REPORTED IN ACCORDANCE WITH ASU 2014-09 AND HEALTHCARE FINANCIAL MANAGEMENT ASSOCIATION STATEMENT 15. TEXT OF THE FOOTNOTE TO THE ORGANIZATION'S FINANCIAL STATEMENTS THAT DESCRIBES ACCOUNTING FOR BAD DEBT EXPENSE IS CONTAINED IN THE ATTACHED FINANCIAL STATEMENTS AT PAGES 13 AND 25 - 29.
PART III, LINE 3:COSTING METHODOLOGY USED:UNCOLLECTIBLE PATIENT ACCOUNTS ARE CHARGED AGAINST THE PROVISION FOR BAD DEBT IN ACCORDANCE WITH THE POLICIES OF COMMUNITY HOSPITAL OF NOBLE COUNTY, INC. HOWEVER, DURING THE COLLECTION PROCESS THERE IS A CONTINUOUS EFFORT TO DETERMINE IF THE PATIENT QUALIFIES FOR FINANCIAL ASSISTANCE. THEREFORE, ONCE AN UNCOLLECTIBLE ACCOUNT HAS BEEN CHARGED OFF AND IT IS DETERMINED THROUGH THE COLLECTION PROCESS THAT THE PATIENT QUALIFIES FOR FINANCIAL ASSISTANCE, THE UNCOLLECTIBLE ACCOUNT IS RECLASSIFIED TO CHARITY CARE AND ALL COLLECTION EFFORTS CEASE. PATIENTS ARE ELIGIBLE TO APPLY FOR FINANCIAL ASSISTANCE AT ANY TIME, INCLUDING PATIENTS WHOSE ACCOUNTS HAVE BEEN PLACED IN A BAD DEBT AGENCY. THE AMOUNT REFLECTED ON LINE 3 WAS CALCULATED BY TOTALING THE ACCOUNTS PREVIOUSLY WRITTEN OFF TO BAD DEBT AND PLACED WITH A COLLECTION AGENCY, BUT SUBSEQUENTLY RECLASSIFIED AS CHARITY CARE DURING THE TAX YEAR. THE ACCOUNTS WERE RECLASSIFIED AS CHARITY CARE DUE TO THE FACT THAT PATIENTS APPLIED FOR, AND WERE APPROVED FOR, FINANCIAL ASSISTANCE AFTER THE ACCOUNTS WERE PLACED WITH A BAD DEBT AGENCY.
PART III, LINE 4:BAD DEBT EXPENSE - PARKVIEW HEALTH SYSTEM, INC. AND SUBSIDIARIES - NOTES TO THE CONSOLIDATED FINANCIAL STATEMENTSTEXT OF THE FOOTNOTE TO THE ORGANIZATION'S FINANCIAL STATEMENTS THAT DESCRIBES BAD DEBT EXPENSE OR THE PAGE NUMBER ON WHICH THIS FOOTNOTE IS CONTAINED IN THE ATTACHED FINANCIAL STATEMENTS:PAGES 13 AND 25 - 29 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. COMMUNITY HOSPITAL OF NOBLE COUNTY, 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, COMMUNITY HOSPITAL OF NOBLE COUNTY, INC. HAS TAKEN THE POSITION NOT TO INCLUDE THE MEDICARE SHORTFALLS OR SURPLUSES AS PART OF COMMUNITY BENEFIT. COMMUNITY HOSPITAL OF NOBLE COUNTY, 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:IF THE PATIENT CANNOT PAY IN FULL, THE OPTION OF A LOW INTEREST LOAN IS AVAILABLE WITH THE SAME DISCOUNT OFFERED FOR CASH PAYMENTS AS LONG AS THE LOAN IS ARRANGED WITHIN 30 DAYS OF THE FIRST GUARANTOR STATEMENT. IF THE PATIENT DEFAULTS ON THE LOAN, THE DISCOUNT WILL BE REVERSED AND THE PATIENT'S ACCOUNT WILL BE PLACED IN A COLLECTION AGENCY.INTEREST-FREE PAYMENTS WITH PAY-OUT NOT TO EXCEED THIRTY-SIX (36) MONTHS ARE AVAILABLE. THE MINIMUM MONTHLY PAYMENT IS $25.FINANCIAL ASSISTANCE MAY BE AVAILABLE FOR THOSE PATIENTS WHO CANNOT PAY THEIR BILL. THOSE OPTIONS ARE GOVERNMENTAL ASSISTANCE OR FREE CARE THROUGH THE HOSPITAL FINANCIAL ASSISTANCE PROGRAM. THE HEALTH SYSTEM FINANCIAL ASSISTANCE POLICY IS AVAILABLE ON PARKVIEW.COM OR BY VISITING ANY HOSPITAL CASHIER OFFICE OR BY CALLING PATIENT ACCOUNTING AT 260.266.6700 OR TOLL FREE 855.814.0012. A PATIENT MAY APPLY FOR FINANCIAL ASSISTANCE ANYTIME DURING THE APPLICATION PERIOD. FAILURE TO MAKE ARRANGEMENTS AS LISTED ABOVE OR FAILURE TO APPLY FOR AND RECEIVE APPROVAL UNDER THE FINANCIAL ASSISTANCE POLICY MAY RESULT IN THE ACCOUNT BEING PLACED IN A COLLECTION AGENCY DUE TO NON-PAYMENT. THE COLLECTION AGENCY MAY REPORT THE ACCOUNT TO ONE OR ALL THREE CREDIT REPORTING AGENCIES WHICH MAY ULTIMATELY ADVERSELY AFFECT THE PATIENT'S CREDIT SCORE. ADDITIONALLY, THE COLLECTION AGENCY MAY SUE AND OBTAIN A JUDGMENT AGAINST THE PATIENT FOR NON-PAYMENT. THESE ACTIONS WILL NOT OCCUR UNTIL 120 DAYS AFTER THE PATIENT IS SENT THEIR FIRST FOLLOW-UP STATEMENT INDICATING THE AMOUNT THEY OWE.A PATIENT MAY APPLY FOR FINANCIAL ASSISTANCE AT ANY TIME DURING THE APPLICATION PERIOD, EVEN THOUGH THEY HAVE BEEN PLACED IN A COLLECTION AGENCY. IF THE PATIENT WAS SENT THEIR FIRST NOTICE ON THE ACCOUNT FOR WHICH THEY ARE APPLYING FOR FREE CARE BETWEEN 120 DAYS AND THE END OF THE APPLICATION PERIOD, THE ACTIONS ABOVE WILL BE SUSPENDED UNTIL THE FREE CARE APPLICATION ELIGIBILITY IS DETERMINED.
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, COMMUNITY HOSPITAL OF NOBLE COUNTY, INC. ASSESSES THE HEALTH CARE NEEDS OF THE COMMUNITY IT SERVES THROUGH PRIMARY AND SECONDARY DATA ANALYSIS, WORKING WITH THE ORGANIZATION'S COMMUNITY PARTNERS, AND ITS FRONTLINE STAFF. COMMUNITY HOSPITAL OF NOBLE COUNTY, INC. IDENTIFIES AND VERIFIES COMMUNITY HEALTH NEEDS THROUGH THE FOLLOWING:- HCI SECONDARY DATA ANALYSIS- OBSERVATIONS FROM FRONTLINE STAFF WORKING WITH VULNERABLE POPULATIONS (I.E., COMMUNITY NURSES AND COMMUNITY HEALTH WORKER'S- REVIEW OF COMMUNITY NEEDS ASSESSMENTS CONDUCTED BY LOCAL ORGANIZATIONS (I.E., UNITED WAY, BRIGHTPOINT, ETC.)- PARKVIEW LEADERSHIP'S SERVICE ON HEALTH-RELATED AND SOCIAL SERVICE COMMUNITY BOARDSKEY 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.COMMUNITY HOSPITAL OF NOBLE COUNTY, INC. PRIMARILY SERVES THE NOBLE COUNTY COMMUNITIES OF KENDALLVILLE, LIGONIER, AVILLA, ALBION, ROME CITY, CROMWELL, AND WOLCOTTVILLE. AS THE ONLY HOSPITAL IN THIS COUNTY, COMMUNITY HOSPITAL OF NOBLE COUNTY, INC. ALSO SERVES, TO A LIMITED EXTENT, OTHER SURROUNDING COMMUNITIES. ACCORDING TO THE U.S. CENSUS BUREAU, NOBLE COUNTY HAS APPROXIMATELY 47,744 RESIDENTS, PRIMARILY CAUCASIAN. HISPANICS OR LATINOS MAKE UP APPROXIMATELY 10.5% OF NOBLE COUNTY RESIDENTS. ACCORDING TO PARKVIEW'S 2019 COMMUNITY HEALTH NEEDS ASSESSMENT, THE MEDIAN INCOME IN NOBLE COUNTY IS $52,393 AND HAS A POVERTY RATE OF 9.3%. THE MAKE-UP OF EMPLOYMENT IS HEAVILY MANUFACTURING, FOLLOWED BY HEALTH CARE AND SOCIAL ASSISTANCE JOBS. 9.2% OF NOBLE COUNTY RESIDENTS ARE UNINSURED AND THE UNEMPLOYMENT RATE IS 5.7%.
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 MAJORITY OF THE COMMUNITY HOSPITAL OF NOBLE COUNTY, INC. BOARD OF DIRECTORS IS COMPRISED OF INDEPENDENT COMMUNITY MEMBERS WHO RESIDE IN HOSPITAL'S PRIMARY SERVICE AREA. COMMUNITY HOSPITAL OF NOBLE COUNTY, INC. ALSO EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN THE COMMUNITY. PEOPLE THROUGHOUT THE COMMUNITY CAN COUNT ON COMMUNITY HOSPITAL OF NOBLE COUNTY, 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. IN ADDITION, AN AFTER-HOURS CLINIC IS STAFFED BY LOCAL PHYSICIANS FROM 8:00 A.M. - 8:00 P.M. DAILY AND 8:00 A.M. TO 2:00 P.M. ON THE WEEKENDS. FURTHERMORE, NO PATIENT IS EVER DENIED TREATMENT, REGARDLESS OF THEIR ABILITY TO PAY. ADDITIONALLY, COMMUNITY HOSPITAL OF NOBLE COUNTY, INC. ANNUALLY FUNDS COMMUNITY HEALTH IMPROVEMENT INITIATIVES AND PARTNERS WITH COMMUNITY ORGANIZATIONS TO ENCOURAGE HEALTHIER LIFESTYLES AMONG THE CITIZENS OF NORTHEAST INDIANA. KEY PROJECTS AND AREAS OF FOCUS FUNDED THROUGH THE COMMUNITY HEALTH IMPROVEMENT INITIATIVE AND OTHER HOSPITAL FUNDS INCLUDE: -EDUCATION: COMMUNITY HOSPITAL OF NOBLE COUNTY, INC. IS TAKING THE LEAD IN PARTNERING WITH SCHOOLS FOR HEALTH OCCUPATION EDUCATION PROGRAMS, CAREER PATHWAYS PROGRAMS, COMMUNITY SCHOOL NURSE PROGRAMS, AND HEALTH FAIRS AT SCHOOLS FOR STUDENTS AND STAFF. -COMMUNITY PARTNERSHIPS: COMMUNITY HOSPITAL OF NOBLE COUNTY, INC. INVESTS IN KEY ORGANIZATIONS (HEALTH PARTNERS) THAT ENCOURAGE HEALTHIER LIFESTYLES AMONG THE CITIZENS OF NOBLE COUNTY AND NORTHEAST INDIANA. WE PARTNER WITH THE COLE FAMILY CENTER YMCA ON MULTIPLE PROJECTS TO ENCOURAGE HEALTHIER LIFESTYLES AND NOBLE TRAILS TO FUND WALKING AND BIKING TRAIL DEVELOPMENT. TO ASSIST THOSE LESS FORTUNATE, WE SUPPORT COMMON GRACE, NOBLE HOUSE AND LOCAL FOOD PANTRIES. TO ENCOURAGE HIGHER PAYING JOBS AND ECONOMIC IMPROVEMENT, WE PARTNER WITH THE NOBLE COUNTY ECONOMIC DEVELOPMENT CORPORATION. WE PARTNER WITH THE NOBLE COUNTY HEALTH DEPARTMENT TO PROVIDE IMMUNIZATIONS TO CHILDREN WHO COULD OTHERWISE NOT ACCESS THEM. FUNDS ARE PROVIDED FOR LIFE AND FAMILY SERVICES' BABE PROGRAM & HEALTHIER MOMS AND BABIES TO ENCOURAGE PRE-NATAL VISITS, WELL BABY VISITS AND EDUCATION FOR YOUNG PARENTS. OTHER PARTNERS ACTIVE IN ADDRESSING MEDICAL ISSUES INCLUDE DRUG FREE NOBLE COUNTY, ACTIVATE NOBLE COUNTY, AND MCMILLEN HEALTH. -ACTIVATE NOBLE COUNTY: A TRUE COMMUNITY PARTNERSHIP BETWEEN COMMUNITY HOSPITAL OF NOBLE COUNTY, INC. AND MANY AREA ORGANIZATIONS, INCLUDING THE LOCAL YMCA. THE MISSION IS "TO IMPROVE THE HEALTH AND WELLNESS OF NOBLE COUNTY BY INCREASING OPPORTUNITIES FOR HEALTHY EATING AND ACTIVE LIVING." HE GROUP HAS BEEN THE CENTRAL PARTNERSHIP TO ESTABLISH COMMUNITY GOALS AROUND THE COMMUNITY HEALTH NEEDS ESTABLISHED FROM OUR ASSESSMENT: OBESITY, SMOKING CESSATION AND TEEN-AGE PREGNANCY. THE GROUP MEETS MONTHLY WORKING COLLABORATIVELY TO ESTABLISH PROGRAMS, GUIDELINES AND MAKE IMPROVEMENTS TO KEY METRICS FROM THE ASSESSMENT PLAN. -MEDICATION ASSISTANCE PROGRAM (MAP): COMMUNITY HOSPITAL OF NOBLE COUNTY, INC. IMPLEMENTED A MEDICATION ASSISTANCE PROGRAM FOR NOBLE COUNTY RESIDENTS IN 2006 AND HAS EXPERIENCED STEADY GROWTH SINCE ITS INCEPTION. MAP PARTNERS ALONG WITH PATIENTS, PHYSICIANS, PHARMACEUTICAL COMPANIES, LOCAL PHARMACIES, AND DONORS PROVIDE MEDICATION ASSISTANCE AT LITTLE OR NO COST FOR QUALIFIED INDIVIDUALS. EMERGENCY VOUCHERS FOR ACUTE MEDICATION NEEDS ARE REDEEMED AT LOCAL PHARMACIES. LONG-TERM MEDICATION HELP IS PROVIDED BY CONNECTING PATIENTS WITH PHARMACEUTICAL ASSISTANCE PROGRAMS (PAP). -HEALTH FAIRS AND SCREENINGS: COMMUNITY HOSPITAL OF NOBLE COUNTY, INC. PARTICIPATES IN NUMEROUS HEALTH FAIRS AND ACTIVITIES THROUGHOUT THE YEAR THAT ARE DESIGNED TO PROVIDE HEALTH EDUCATION, HEALTH SCREENINGS FOR DISEASE PREVENTION, AND THE PROMOTION OF HEALTHY LIFESTYLES. THE HOSPITAL ALSO PROVIDES SUPPORT GROUPS TO ASSIST PATIENTS AND FAMILIES IN MANAGING DISEASE. -ESTABLISHING HEALTHY LIFESTYLES AND PROMOTING SAFETY AMONG CHILDREN: COMMUNITY HOSPITAL OF NOBLE COUNTY, INC. SUPPORTS VARIOUS PROGRAMS THAT ENCOURAGE CHILDREN TO ESTABLISH HEALTHY EATING AND SAFETY HABITS TO PREVENT DISEASE LATER IN LIFE. PROGRAMS INCLUDE KID CITY AND A BIKE RODEO.
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.; 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 YOUR HEALTH AND INSPIRING YOUR 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.EACH HOSPITAL ENTITY ENGAGES IN COMMUNITY OUTREACH ACTIVITIES 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 THE SEVEN-COUNTY AREA, 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 WITH A BOARD OF DIRECTORS THAT 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 ALWAYS 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 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 STATESIN
PART VI, LINE 7:A COPY OF FORM 990, SCHEDULE H IS FILED WITH THE INDIANA STATE DEPARTMENT OF HEALTH.

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Grant Records MaintainedYes (1)GrantRecordsMaintainedInd

Recipient Table RecipientTable (8 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdRecipient EINRecipientEINIRC SectionIRCSectionDescCash GrantCashGrantAmtPurpose Of GrantPurposeOfGrantTxt
MCMILLEN FOUNDATION INC
600 JIM KELLY BLVDFORT WAYNEIN46816356021003501(C)(3)$60,000HEALTH EDUCATION PROGRAMS
COLE CENTER FAMILY YMCA - KENDALLVILLE
P O BOX 233KENDALLVILLEIN46755237077600501(C)(3)$29,000HEALTH AND WELLNESS PROGRAMS
LIFE AND FAMILY SERVICES INC
201 SOUTH PARK AVEKENDALLVILLEIN46755311164090501(C)(3)$20,500BABE PROGRAM
FORT WAYNE MEDICAL SOCIETY FOUNDATION INC
700 BROADWAY STE 316FORT WAYNEIN46802356049685501(C)(3)$18,000HEALTHIER MOMS AND BABIES PROGRAM
COMMUNITY HOSPITAL OF NOBLE COUNTY FOUNDATION INC
401 SAWYER RDKENDALLVILLEIN46755352089183501(C)(3)$10,819OPERATIONS
DRUG FREE NOBLE COUNTY INC
2090 S SR 9 SUITE EALBIONIN46701352135869501(C)(3)$10,000PROGRAMS TO REDUCE THE USE AND ABUSE OF ALCOHOL, TOBACCO AND OTHER DRUGS
NOBLE HOUSE INC
205 EAST HIGHLANDALBIONIN46701351883761501(C)(3)$10,000EMERGENCY ASSISTANCE AND REFERRALS TO FAMILIES
NOBLE TRAILS INC
P O BOX 654ROME CITYIN46784800856444501(C)(3)$10,000PROGRAMS TO PROMOTE PHYSICAL ACTIVITY
FieldValueIRS element (for citing)
Total501c3 Org8Total501c3OrgCnt
Total Other Org0TotalOtherOrgCnt

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePART I, LINE 2:FormAndLineReferenceDesc
ExplanationCOMMUNITY 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

FieldValueIRS element (for citing)
Travel For CompanionsYes (X)TravelForCompanionsInd
Written Policy Ref T And E ExpnssYes (1)WrittenPolicyRefTAndEExpnssInd
Substantiation RequiredYes (1)SubstantiationRequiredInd
Severance Payment0SeverancePaymentInd
Supplemental Nonqual Rtr PlanYes (1)SupplementalNonqualRtrPlanInd
Equity Based Comp Arrngm0EquityBasedCompArrngmInd
Comp Based On Revenue Of Flng Org0CompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related Orgs0CompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng Org0CompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd Orgs0CompBsdNetEarnsRltdOrgsInd
Any Non Fixed PaymentsYes (1)AnyNonFixedPaymentsInd
Initial Contract Exception0InitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (11 entries)

TitleTitleTxtBase Compensation Filing OrgBaseCompensationFilingOrgAmtCompensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmtBonus Filing OrganizationBonusFilingOrganizationAmountBonus Related OrganizationsBonusRelatedOrganizationsAmtOther Compensation Filing OrgOtherCompensationFilingOrgAmtOther Compensation Rltd OrgsOtherCompensationRltdOrgsAmtDeferred Compensation Flng OrgDeferredCompensationFlngOrgAmtDeferred Comp Rltd OrgsDeferredCompRltdOrgsAmtNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmtNontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmtTotal Compensation Filing OrgTotalCompensationFilingOrgAmtTotal Compensation Rltd OrgsTotalCompensationRltdOrgsAmtComp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmtComp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
MICHAEL PACKNETT
DIRECTOR/PH PRESIDENT & CEO$0$1,115,831$0$248,595$0$1,686,927$0$758,944$0$38,746$0$3,849,043$0$1,637,768
JEANNE' WICKENS
PH CHIEF FINANCIAL OFFICER$0$689,476$0$131,971$0$21,682$0$295,719$0$32,200$0$1,171,048$0$0
CHRISTOPHER FRAZIER
DIRECTOR/PH PHYSICIAN$4,418$354,770$0$77,383$0$22,144$243$24,957$342$35,203$5,003$514,457$0$0
RONNIE SLOAN
DIRECTOR/PH PHYSICIAN$16,590$289,751$0$51,697$0$24,043$1,337$29,463$1,199$26,417$19,126$421,371$0$0
LISA LANE
DIRECTOR/PH PHYSICIAN$13,237$269,180$0$53,483$0$21,642$1,140$29,660$1,189$30,934$15,566$404,899$0$0
GARY ADKINS
DIRECTOR/NBHOS PRESIDENT$204,993$0$31,495$0$1,619$0$52,088$0$27,501$0$317,696$0$0$0
CATHERINE BYRD
FORMER KEY EMPLOYEE$0$0$0$0$211,450$0$0$0$0$0$211,450$0$211,450$0
ERIN GOLDSBERRY
NBHOS VP PATIENT CARE$133,149$13,169$18,791$0$396$39$8,349$724$27,907$2,420$188,592$16,352$0$0
KELLY BALYEAT
NBHOS MGR PHARMACY$152,311$0$10,122$0$270$0$11,928$0$28,709$0$203,340$0$0$0
JULIE DESPER
NBHOS MGR REHAB$58,777$57,894$8,608$0$175$173$8,467$7,277$17,257$14,832$93,284$80,176$0$0
HEATHER ANTAL
NBHOS MGR NURSING SVCS$105,679$0$7,615$0$1,021$0$12,603$0$31,848$0$158,766$0$0$0

Supplemental Information Detail SupplementalInformationDetail (4 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
PART I, LINE 1ATRAVEL FOR COMPANIONS - TAXABLE EXPENSE REIMBURSEMENT FOR FAMILY MEMBER PAID TO: GARY ADKINS $7;
PART I, LINE 3RELATED ORGANIZATION, PARKVIEW HEALTH SYSTEM, INC., USES THE FOLLOWING TO ESTABLISH THE COMPENSATION OF COMMUNITY HOSPITAL OF NOBLE COUNTY, 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 4BSUPPLEMENTAL 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): CATHERINE BYRD $211,450; MICHAEL PACKNETT $1,637,768; 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 $1,637,768 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: GARY ADKINS $35,109; MICHAEL PACKNETT $733,744; JEANNE' WICKENS $281,719;
PART I, LINE 7MANAGEMENT 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 (13 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
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, COMMUNITY HOSPITAL OF NOBLE COUNTY, INC., EIN 35-2087092. 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, 2019 WAS 524. THE TOTAL NUMBER OF EMPLOYEES REPORTED ON FORM W-3 AND FILED BY THE COMMON PAYING AGENT, PH, FOR THE YEAR ENDED DECEMBER 31, 2019 WAS 15,019. FOR PURPOSES OF COMPLETING FORM 990, PART V, LINE 1A AND 2A, THE NUMBER REPORTED FOR THE COMMUNITY HOSPITAL OF NOBLE COUNTY, INC. WAS 41 AND 333 RESPECTIVELY.
FORM 990, PART VI, SECTION A, LINE 1THE 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 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. IN NO EVENT SHALL THE MEMBERS OF THE EXECUTIVE COMMITTEE EXCEED EIGHT (8) PEOPLE. 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 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 6THE 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 COMMUNITY HOSPITAL OF NOBLE COUNTY, INC. WITH CERTAIN RESERVED POWERS.
FORM 990, PART VI, SECTION A, LINE 7ATHE CORPORATE MEMBER, PARKVIEW HEALTH SYSTEM, INC. EIN 35-1972384, SHALL HAVE THE FOLLOWING RESERVED POWERS (I) APPOINT 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 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, 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 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 7BSEE SCHEDULE O EXPLANATION FOR FORM 990, PART VI, SECTION A, LINE 7A
FORM 990, PART VI, SECTION B, LINE 11BPURSUANT 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. COMMUNITY HOSPITAL OF NOBLE COUNTY, INC. IS A SUBSIDIARY CORPORATION OF PARKVIEW HEALTH SYSTEM, INC. AN ELECTRONIC COPY OF THE ORGANIZATION'S FINAL FORM 990 (INCLUDING REQUIRED SCHEDULES) WAS PROVIDED TO EACH VOTING MEMBER OF THE ORGANIZATION'S GOVERNING BODY, PRIOR TO FILING WITH THE IRS. ON OCTOBER 6, 2020, 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 12CAS 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 15LINES 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 19COPIES OF THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST.
FORM 990, PART IX, LINE 11GOTHER: PROGRAM SERVICE EXPENSES 1,998,990. MANAGEMENT AND GENERAL EXPENSES 2,262. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,001,252. PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 1,191,254. MANAGEMENT AND GENERAL EXPENSES 404,000. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,595,254. COLLECTION SERVICES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 471,354. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 471,354. LABORATORY SERVICES: PROGRAM SERVICE EXPENSES 2,552,314. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,552,314. TEMPORARY HELP: PROGRAM SERVICE EXPENSES 682,387. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 682,387.
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 -10,737.
FORM 990, BOX B - AMENDED RETURNTHE AMENDED RETURN REPORTS A CHANGE TO PART VII, SECTION A AND SCHEDULE J, PART II FOR MICHAEL PACKNETT'S DEFERRED COMPENSATION ONLY. ON THE ORIGINALLY FILED RETURN, THE DEFERRED COMPENSATION FOR MICHAEL PACKNETT WAS INCORRECTLY REPORTED (AT PART VII, SECTION A AND AT SCHEDULE J, PART II, COLUMN (C) OF $2,854,466). THE AMENDED FORM 990 SHOWS THE CORRECT 2019 DEFERRAL OF $758,944.

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (12 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdExempt Code SectionExemptCodeSectionTxtPublic Charity StatusPublicCharityStatusTxtDirect Controlling NADirectControllingNACdControlled OrganizationControlledOrganizationIndBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Txt
PARKVIEW HEALTH SYSTEM INC
10501 CORPORATE DRIVEFORT WAYNEIN46845351972384HEALTH CAREIN501(C)(3)LINE 12C, III-FIN/A0
COMMUNITY HOSPITAL OF NOBLE COUNTY FOUNDATION INC
401 SAWYER ROADKENDALLVILLEIN46755352089183FUND MGMTIN501(C)(3)LINE 12A, IYes (1)COMMUNITY HOSPITAL OF NOBLE COUNTY INC
THE COMMUNITY LEARNING CENTER INC
PO BOX 98 401 E DIAMOND STKENDALLVILLEIN46755834223782ECONOMIC & COMMUNITY DEVELOPMENTIN501(C)(3)LINE 12A, IN/A0
PARKVIEW OCCUPATIONAL HEALTH CENTERS INC
10501 CORPORATE DRIVEFORT WAYNEIN46845352064353OCCUP HEALTHIN501(C)(3)LINE 30PARKVIEW HEALTH SYSTEM INC
PARKVIEW HOSPITAL INC
11109 PARKVIEW PLAZA DRIVEFORT WAYNEIN46845350868085HOSPITAL CAREIN501(C)(3)LINE 30PARKVIEW HEALTH SYSTEM INC
COMMUNITY HOSPITAL OF LAGRANGE COUNTY INC
207 N TOWNLINE ROADLAGRANGEIN46761202401676HOSPITAL CAREIN501(C)(3)LINE 30PARKVIEW HEALTH SYSTEM INC
WHITLEY MEMORIAL HOSPITAL INC
1260 E STATE ROAD 205COLUMBIA CITYIN46725351967665HOSPITAL CAREIN501(C)(3)LINE 30PARKVIEW HEALTH SYSTEM INC
HUNTINGTON MEMORIAL HOSPITAL INC
2001 STULTS ROADHUNTINGTONIN46750351970706HOSPITAL CAREIN501(C)(3)LINE 30PARKVIEW HEALTH SYSTEM INC
PARKVIEW WABASH HOSPITAL INC
10 JOHN KISSINGER DRIVEWABASHIN46992471753440HOSPITAL CAREIN501(C)(3)LINE 30PARKVIEW HEALTH SYSTEM INC
PARK CENTER INC
909 EAST STATE BLVDFORT WAYNEIN46805351135451COMPREHENSIVE MENTAL HEALTH CENTERIN501(C)(3)LINE 100PARKVIEW HEALTH SYSTEM INC
PARK CENTER HOLDINGS INC
909 EAST STATE BLVDFORT WAYNEIN46805843684074TO SUPPORT PARK CENTER, INC.IN501(C)(3)LINE 12B, II0PARKVIEW HEALTH SYSTEM INC
DEKALB MEMORIAL HOSPITAL INC
1316 EAST SEVENTH STREETAUBURNIN46706351064295HOSPITAL CAREIN501(C)(3)LINE 30PARKVIEW HEALTH SYSTEM INC

Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (2 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdDirect Controlling NADirectControllingNACdPredominant Income TypePredominantIncomeTypeTxtDisproportionate AllocationsDisproportionateAllocationsIndGeneral Or Managing PartnerGeneralOrManagingPartnerInd
ORTHOPAEDIC HOSPITAL AT PARKVIEW NORTH LLC
10501 CORPORATE DRIVEFORT WAYNEIN46845260143823ORTHO HOSPITALINN/AN/A00
MANAGED CARE SERVICES LLC
10501 CORPORATE DRIVEFORT WAYNEIN46845351996535HEALTH PLAN ADMININN/AN/A00

Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (2 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdDirect Controlling NADirectControllingNACdEntity TypeEntityTypeTxtControlled OrganizationControlledOrganizationInd
MIDWEST COMMUNITY HEALTH ASSOCIATES INC
442 W HIGH STREETBRYANOH43506341045870PHYSICIANSOHN/AC0
WOODLAND PLAZA MEDICAL PARK CONDO ASSOC INC
202 W BERRY ST SUITE 800FORT WAYNEIN46802352058340CONDO MANAGEMENTINN/AC0
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts Rylts0ReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth OrgYes (1)GiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth OrgYes (1)GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth Org0LoansOrGuaranteesFromOthOrgInd
Div Related Organization0DivRelatedOrganizationInd
Asset Sale To Other Org0AssetSaleToOtherOrgInd
Asset Purchase From Other Org0AssetPurchaseFromOtherOrgInd
Asset Exchange0AssetExchangeInd
Rental Of Facilities To Oth OrgYes (1)RentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth OrgYes (1)RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth OrgYes (1)PerformOfServicesForOthOrgInd
Perform Of Services By Other OrgYes (1)PerformOfServicesByOtherOrgInd
Sharing Of FacilitiesYes (1)SharingOfFacilitiesInd
Paid Employees SharingYes (1)PaidEmployeesSharingInd
Reimbursement Paid To Other OrgYes (1)ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other OrgYes (1)ReimbursementPaidByOtherOrgInd
Transfer To Other OrgYes (1)TransferToOtherOrgInd
Transfer From Other OrgYes (1)TransferFromOtherOrgInd

Transactions Related Org TransactionsRelatedOrgGrp (2 entries)

Transaction TypeTransactionTypeTxtInvolvedInvolvedAmtMethod Of Amount DeterminationMethodOfAmountDeterminationTxt
COMMUNITY HOSPITAL OF NOBLE COUNTY FOUNDATION INC
C$208,960PART VII SUPPLEMENTAL INFORMATION
COMMUNITY HOSPITAL OF NOBLE COUNTY FOUNDATION INC
M$202,863PART VII SUPPLEMENTAL INFORMATION

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferenceSCHEDULE R, PART V, LINE 2, COLUMN (C):FormAndLineReferenceDesc
ExplanationTHE 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