2021-11-07T10:46:53-06:00 2020-12-31 350921680 CROWE LLP 330 E JEFFERSON BLVD P O BOX 7 SOUTH BEND IN 466240007 990 2020-01-01 471753440 PARKVIEW WABASH HOSPITAL INC PARK 2603738429 10 JOHN KISSINGER DRIVE WABASH IN 46992 JEANNE' WICKENS PH CFO 2602669313 2021-11-05 1 JEANNE WICKENS 999009999 BRITTNEY KOCAJ P01320603 5742323992 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z MICHAEL J PACKNETT 1450 PRODUCTION RD FORT WAYNE IN 46808 57600548 0 X WWW.PARKVIEW.COM X 2014 IN PARKVIEW WABASH HOSPITAL, INC. WORKS TO IMPROVE THE HEALTH OF OUR COMMUNITIES AND PROVIDES QUALITY HEALTH SERVICES TO ALL WHO ENTRUST THEIR CARE TO US. 12 8 231 44 0 0 322676 378861 55243146 57045871 5710 -125272 255290 175737 55826822 57475197 66111 68650 0 0 15907057 16314324 0 0 109080 43891119 39335599 59864287 55718573 -4037465 1756624 52040954 49924392 72085909 68766938 -20044955 -18842546 X PARKVIEW WABASH HOSPITAL, INC. WORKS TO IMPROVE THE HEALTH OF OUR COMMUNITIES AND PROVIDES QUALITY HEALTH SERVICES TO ALL WHO ENTRUST THEIR CARE TO US. 0 0 46608778 68650 57045871 PARKVIEW WABASH HOSPITAL, INC. IS A NOT-FOR-PROFIT, CRITICAL ACCESS FACILITY. PARKVIEW WABASH HOSPITAL, INC. IS FULLY ACCREDITED BY THE JOINT COMMISSION. BOTH A MEDICAL-SURGICAL UNIT AND A CONSTANT CARE UNIT ARE AVAILABLE, AS WELL AS LAB, IMAGING, SURGICAL AND EMERGENCY SERVICES, ONCOLOGY, CARDIAC REHAB, PHYSICAL THERAPY, SENIOR BEHAVIORAL HEALTH AND AN IN-HOUSE SLEEP LAB. PATIENTS HAVE ACCESS TO 10 PARKVIEW PHYSICIANS GROUP PRIMARY CARE AND SPECIALTY PROVIDERS AND MORE THAN 20 VISITING SPECIALISTS. A GROUP OF MEN AND WOMEN MAKE UP AN ACTIVE VOLUNTEER PROGRAM AT PARKVIEW WABASH HOSPITAL, INC. THEY WELCOME VISITORS AT BOTH THE MAIN(SEE SCHEDULE O FOR CONTINUATION)ENTRANCE, EMERGENCY ROOM ENTRANCE, AND MEDICAL OFFICE BUILDING ENTRANCE. THE VOLUNTEERS TAKE PEOPLE TO THEIR DESTINATIONS, GREET VISITORS AND PATIENTS, ANSWER QUESTIONS AND RUN OUR GIFT SHOP.FINANCIAL ASSISTANCE:PARKVIEW WABASH HOSPITAL, INC. IS COMMITTED TO MAKING MEDICALLY NECESSARY HEALTHCARE ACCESSIBLE TO PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. PATIENTS WHOSE FAMILY INCOME DOES NOT EXCEED TWICE THE FEDERAL POVERTY GUIDELINES MAY BE ELIGIBLE FOR FINANCIAL ASSISTANCE. A FINANCIAL COUNSELOR IS AVAILABLE TO HELP PATIENTS NAVIGATING THIS PROCESS.COMMUNITY OUTREACH:PARKVIEW WABASH HOSPITAL, INC. IS ONE OF THE LARGEST EMPLOYERS IN WABASH COUNTY AND BELIEVES STRONGLY IN GIVING BACK TO THE COMMUNITY IT SERVES. THE HOSPITAL NOT ONLY SPONSORS ITS OWN EVENTS AND OUTREACH PROGRAMS EACH YEAR, BUT ALSO TAKES AN ACTIVE ROLE IN NUMEROUS OTHER HEALTH FAIRS, FESTIVALS, EDUCATION, PARADES, AND COMMUNITY EVENTS. THE MANAGEMENT AND CO-WORKERS OF PARKVIEW WABASH HOSPITAL, INC. PARTICIPATE IN VOLUNTEER ACTIVITIES THROUGHOUT THE YEAR TO IMPROVE THE HEALTH AND WELL-BEING OF OUR COMMUNITY. UNFORTUNATELY, MANY OF THESE ACTIVITIES AND EVENTS WERE CANCELLED IN 2020.WITH OUR COMMUNITY HEALTH PARTNERS PROGRAM, PARKVIEW WABASH HOSPITAL, INC. INVESTS IN KEY ORGANIZATIONS THAT PROMOTE THE HEALTHY LIFESTYLE CHOICES AND WELL-BEING OF INDIVIDUALS, CHILDREN, AND FAMILIES OF WABASH. IN THE CALENDAR YEAR 2020, THE HOSPITAL SELECTED COMMUNITY AGENCIES OR ORGANIZATIONS TO SUPPORT AND COLLABORATE IN ADDRESSING OUR FOCUS AREAS OF OBESITY AND MATERNAL CHILD HEALTH. SAMPLINGS OF THOSE PROJECTS INCLUDE:LIKING FOR BIKING - THIS HOUR-LONG BIKE RIDE OFFERED EVERY SATURDAY FROM MAY THROUGH EARLY SEPTEMBER IS LED BY THE ROCK CITY BIKE CLUB AND VISIT WABASH COUNTY. IT IS FOR ALL AGES AND ABILITIES OF BIKE RIDERS AND MEANT TO ENCOURAGE PHYSICAL ACTIVITY IN ALL. RIDERS CAN RIDE FOR AS LONG AS THEY LIKE AND AT THEIR OWN PACE, WITH THE END GOAL BEING TO INCREASE BOTH BY THE END OF THE EVENT. THIS WAS ONE ACTIVITY THAT CONTINUE IN 2020, DUE TO IT BEING AN OUTDOORS AND SOCIALLY DISTANCED. PARTICIPANTS STATED THEY WERE GRATEFUL TO BE ACTIVE AND WITH OTHERS DURING THE STRESSFUL YEAR.BABY & ME TOBACCO FREE - THE PERCENT OF WABASH COUNTY WOMEN WHO SMOKE WHILE PREGNANT IS ONE OF THE HIGHEST IN THE STATE AT 26.3%. PARKVIEW WABASH HOSPITAL, INC. CHOSE TO PARTNER WITH THE LOCAL TOBACCO FREE COALITION TO OFFER THE NATIONAL BABY & ME TOBACCO FREE PROGRAM.BLESSINGS IN A BACKPACK -- THIS PROGRAM PROVIDED STUDENTS KINDERGARTEN THROUGH 6TH GRADE WITH FOOD ITEMS TO HELP THEM AND THEIR FAMILIES OVER THE WEEKENDS. TO QUALIFY, STUDENTS MUST BE ON FREE OR REDUCED LUNCH.COACHING PROGRAM - THE WABASH COUNTY YMCA PROVIDES A ROBUST COACHING PROGRAM TO THEIR MEMBERS. WITH THE ASSISTANCE OF A COMMUNITY HEALTH PARTNERSHIP WITH PWB, THEY ARE ABLE TO OFFER THE PROGRAM TO THEIR LOW-INCOME MEMBERS AT NO COST. ALL REPORTED AN IMPROVEMENT IN THEIR OVERALL WELL-BEING.PRIMARY HEALTH CARE ACCESS: PARKVIEW WABASH HOSPITAL, INC. PROVIDES SUPPORT TO 85 HOPE, WABASH COUNTY'S FREE HEALTH CLINIC, BY OFFERING 100% CHARITY TO ALL OF THEIR PATIENTS. 46608778 1 1 0 1 0 0 0 0 0 1 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 X 31 0 1 231 1 0 0 0 0 0 0 0 0 0 0 0 0 X 12 8 1 0 1 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 IN X JEANNE' WICKENS 2602669313 1450 PRODUCTION RD FORT WAYNE IN 46808 MICHAEL PACKNETT PH PRESIDENT & CEO 0.00 40.00 X X 0 2048421 1656853 DOUGLAS SPARKS DIRECTOR/PH PHYSICIAN 0.00 40.00 X 26568 506344 67549 MARILYN CUSTER-MITCHELL DIRECTOR/WBHOS PRESIDENT 40.00 0.00 X X 335966 0 97755 WILLIAM RAUH DIRECTOR 1.00 0.00 X 12000 0 0 HOWARD HALDERMAN DIRECTOR/CHAIR 1.00 1.00 X X 6750 3199 0 KEVIN BOWMAN DIRECTOR 1.00 0.00 X 4750 0 0 JASON CALLAHAN DIRECTOR/VICE CHAIR 1.00 0.00 X X 4750 0 0 KELLY STOUFFER DIRECTOR/SECRETARY/TREASURER 1.00 0.00 X X 4750 0 0 KENT TERRILL DIRECTOR 1.00 0.00 X 4500 0 0 ROGER CROMER DIRECTOR 1.00 1.00 X 4250 0 0 PATTY GRANT DIRECTOR 1.00 0.00 X 4250 0 0 PARKER BEAUCHAMP DIRECTOR 1.00 0.00 X 2500 0 0 JEANNE' WICKENS PH CHIEF FINANCIAL OFFICER 0.00 40.00 X 0 1084552 339895 CATHY WOLFE WBHOS VP PATIENT CARE 40.00 0.00 X 201502 0 39404 SHERRY SCHOENING WBHOS MGR REHAB 40.00 0.00 X 135580 0 47504 LISA KROH WBHOS PHARMACIST 40.00 0.00 X 147539 0 17197 PAULA OPHEIM WBHOS MGR PHARMACY 40.00 0.00 X 107998 26989 20695 REBECCA MEREDITH WBHOS PHARMACIST 40.00 0.00 X 122083 0 29879 CYNTHIA PETERS WBHOS MGR RADIOLOGY 40.00 0.00 X 118272 0 26943 1244008 3669505 2343674 22 0 1 0 PARKVIEW HEALTH SYSTEM INC 10501 CORPORATE DRIVE FORT WAYNE IN 46845 RHC OPERATIONS 4882035 PARKVIEW HOSPITAL INC 11109 PARKVIEW PLAZA DRIVE FORT WAYNE IN 46845 LABORATORY SERVICES 1738879 PROFESSIONAL EMERGENCY PHYSICIANS INC 3640 NEW VISION DRIVE SUITE A FORT WAYNE IN 46845 PHYSICIANS 1445774 NORTHEAST INTERNAL MEDICINE ASSOC INC 2500 N DETROIT ST LAGRANGE IN 46761 HOSPITALISTS 437667 BARTON ASSOCIATES INC P O BOX 417844 BOSTON MA 02241 PHYSICIANS 340427 9 150126 228735 378861 NET PATIENT SERVICE 622000 56799962 56799962 INTERUNIT RENT 531120 123592 123592 PHARMACY 446110 110223 110223 HOME BOUND MEALS 624210 11900 11900 DIAGNOSTIC RADIOLOGY 621990 175 175 19 19 57045871 79 79 125351 -125351 -125351 -125351 CAFETERIA SALES 722210 170984 170984 GIFT SHOP 453220 4753 4753 175737 57475197 57045871 0 50465 X 68650 68650 753063 753063 11644554 11644554 3916707 3916707 11568075 10835777 732298 869 734 135 843196 716533 126663 1675083 1649441 25642 25061 22625 2436 9595 6806 2789 760217 760217 3482158 3475303 6855 109557 63187 46370 CORP SERVICE ALLOCATION 7243770 7243770 MEDICAL SUPPLIES 6886917 6886917 PH CLINICAL SUPPORT 4162285 4162285 HOSPITAL ASSESSMENT FEE 2291613 2291613 277203 107429 60694 109080 55718573 46608778 9000715 109080 2330 1350 576573 1407 8645219 10059207 880988 779557 48223 58414 47728691 10063522 40102696 37665169 1784925 1359288 52040954 49924392 1839559 2857594 4229215 23613740 22739648 46632610 38940481 72085909 68766938 X -20044955 -18842546 -20044955 -18842546 52040954 49924392 X 1756624 515 -554730 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 4353 4353 0 PART II-B, LINE 1: OTHER ACTIVITIES - REPRESENTS THE PORTION OF THE DUES PAID TO INDIANA HOSPITAL AND HEALTH ASSOCIATION, AMERICAN HOSPITAL ASSOCIATION, NATIONAL RURAL HEALTH ASSOCIATION AND VARIOUS PROFESSIONAL ASSOCIATIONS USED FOR LOBBYING ACTIVITIES. 1220881 100 62212 9179 1274014 846506 300560 87363 1096 12452 1220881 805494 165 51005 502 9656 846506 621519 101080 90165 7270 805494 603064 21841 3385 621519 0.04850 0.74570 0.20580 1 1 1 1208757 1208757 31765378 4031288 27734090 12814631 5507235 7307396 1939925 524999 1414926 37665169 LEASE LIABILITY 1402780 DUE TO/FROM INTERUNIT 32589015 EST MEDICARE/MEDICAID SETTLEMENTS 4474692 EST 3RD PARTY SETTLEMENTS 352341 ACCRUED INTEREST 121653 38940481 X PART V, LINE 4: ENDOWMENT FUNDS ARE USED FOR THE ORGANIZATION'S PROGRAMS AND OPERATIONS RELATED TO PATIENT-FOCUSED CARE. 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, 2020 AND 2019, THERE ARE NO UNRECOGNIZED TAX BENEFITS RESULTING FROM UNCERTAIN TAX POSITIONS. FORMS 990 AND 990T FILED BY THE CORPORATION AND ITS TAX-EXEMPT AFFILIATED ENTITIES ARE SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE UP TO THREE YEARS FROM THE EXTENDED DUE DATE OF EACH RETURN. FORMS 990 AND 990T FILED BY THE CORPORATION AND ITS TAX-EXEMPT AFFILIATED ENTITIES ARE GENERALLY NO LONGER SUBJECT TO EXAMINATION FOR THE YEAR 2016 AND PRIOR. 1 1 X 1 X 1 X 1 1 0 1 1 1308170 0 1308170 0.02540 5028858 2390190 2638668 0.05120 6490138 3959244 2530894 0.04910 12827166 6349434 6477732 0.12570 59378 0 59378 0.00120 2713 0 2713 0.00010 62091 62091 0.00130 12889257 6349434 6539823 0.12700 25000 25000 0.00050 3380 0 3380 0.00010 28380 28380 0.00060 1 0 12993 12369693 12978740 -609047 X 1 1 1 1 PARKVIEW WABASH HOSPITAL INC 10 JOHN KISSINGER DRIVE WABASH IN 46992 WWW.PARKVIEW.COM 16-005094-1 X X X X PARKVIEW WABASH HOSPITAL INC 1 0 0 1 X X X X X X X X X 19 1 1 1 1 X HTTPS://WWW.PARKVIEW.COM/LOCALHEALTHNEEDS X 1 19 1 HTTPS://WWW.PARKVIEW.COM/LOCALHEALTHNEEDS 0 1 X 200.000000000000 250.000000000000 X X X X X 1 1 X X X 1 X HTTPS://WWW.PARKVIEW.COM/PATIENTS-VISITORS/FINANCIAL-ASSISTANCE X HTTPS://WWW.PARKVIEW.COM/PATIENTS-VISITORS/FINANCIAL-ASSISTANCE X HTTPS://WWW.PARKVIEW.COM/PATIENTS-VISITORS/FINANCIAL-ASSISTANCE X X X X X X 1 X 0 X X X X 1 X 0 0 PARKVIEW WABASH HOSPITAL, INC. PART V, SECTION B, LINE 5: DESCRIBE HOW THE HOSPITAL FACILITY TOOK INTO ACCOUNT INPUT FROM PERSONS WHO REPRESENT THE COMMUNITY, AND IDENTIFY THE PERSONS THE HOSPITAL FACILITY CONSULTED:WHEN CONDUCTING ITS 2019 CHNA, PARKVIEW HEALTH SYSTEM, INC., INCLUDING PARKVIEW WABASH HOSPITAL, INC., AND THE INDIANA PARTNERSHIP FOR HEALTHY COMMUNITIES (IN-PHC) RESEARCH TEAM MADE SURE TO GET THE INPUT FROM PERSONS REPRESENTING THE BROADER INTERESTS OF THE COMMUNITY, WHILE ALSO FOCUSING ON THE NEEDS OF VULNERABLE POPULATIONS IN NORTHEAST INDIANA. AREA HEALTH DEPARTMENTS, MEDICAL PROFESSIONALS AND SOCIAL SERVICE AGENCIES THAT PROVIDE SERVICES DIRECTLY TO THE UNDERSERVED IN OUR COMMUNITIES WERE SURVEYED AND TOOK PART IN COMMUNITY HEALTH PLANNING SESSIONS.AS PART OF THE RESEARCH PROCESS, PARKVIEW HEALTH SYSTEM, INC. AND ITS RESEARCH PARTNERS OBTAINED THE FOLLOWING: 1) PRIMARY DATA WAS COLLECTED VIA AN ONLINE SURVEY OF COMMUNITY HEALTHCARE AND SOCIAL SERVICE PROVIDERS (E.G., PHYSICIANS, NURSES, SOCIAL WORKERS, ETC.). ADDITIONALLY, THE HEALTH SYSTEM'S CHNA RESEARCH PARTNERS CONDUCTED A TELEPHONE SURVEY, WHICH INCLUDED COMMUNITY RESIDENTS FROM EACH COUNTY IN THE PARKVIEW HEALTH SERVICE REGION. 2) SECONDARY DATA WAS GATHERED FROM CONDUENT'S HEALTHY COMMUNITIES INSTITUTE (HCI) DATABASE AND OTHER LOCAL AND NATIONAL AGENCIES.IN ADDITION TO DATA COLLECTION, PARKVIEW HEALTH SYSTEM, INC. TURNED TO THE COMMUNITY AND PARTNERING ORGANIZATIONS WHEN SELECTING AND PRIORITIZING WABASH COUNTY'S HEALTH NEEDS. AS RECOMMENDED BY THE INDIANA PARTNERSHIP FOR HEALTHY COMMUNITIES, A MODIFIED HANLON METHOD WAS USED TO PRIORITIZE HEALTH CONCERNS FOR PARKVIEW WABASH HOSPITAL. 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, THUS ENABLING 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 FINDINGS WERE PRESENTED AT THE DECEMBER 2019 PARKVIEW WABASH HOSPITAL, INC, BOARD MEETING. 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 TOP HEALTH PRIORITY. THEY VOTED FOR OBESITY RELATED INITIATIVES AS A SECONDARY PRIORITY. PARKVIEW WABASH HOSPITAL, INC. PART V, SECTION B, LINE 6A: THE HOSPITAL FACILITY'S CHNA WAS CONDUCTED WITH THE FOLLOWING HOSPITAL FACILITIES:PARKVIEW HOSPITAL, INC. (EIN 35-0868085); COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC. (EIN 20-2401676); COMMUNITY HOSPITAL OF NOBLE COUNTY, INC. (EIN 35-2087092); HUNTINGTON MEMORIAL HOSPITAL, INC. (EIN 35-1970706); WHITLEY MEMORIAL HOSPITAL, INC. (EIN 35-1967665); AND ORTHOPAEDIC HOSPITAL AT PARKVIEW NORTH, LLC (EIN 26-0143823). PARKVIEW WABASH HOSPITAL, INC. PART V, SECTION B, LINE 6B: THE HOSPITAL FACILITY'S CHNA WAS ALSO CONDUCTED WITH THE FOLLOWING ORGANIZATIONS OTHER THAN HOSPITAL FACILITIES:PARKVIEW HEALTH, INC. (EIN 35-1972384); INDIANA PARTNERSHIP FOR HEALTHY COMMUNITIES (A PARTNERSHIP BETWEEN THE INDIANA UNIVERSITY RICHARD M. FAIRBANKS SCHOOL OF PUBLIC HEALTH AND THE POLIS CENTER AT IUPUI) AND CONDUENT HEALTHY COMMUNITIES INSTITUTE. PARKVIEW WABASH HOSPITAL, INC. PART V, SECTION B, LINE 11: DESCRIBE HOW THE HOSPITAL FACILITY IS ADDRESSING THE SIGNIFICANT NEEDS IDENTIFIED IN ITS MOST RECENTLY CONDUCTED CHNA AND ANY SUCH NEEDS THAT ARE NOT BEING ADDRESSED TOGETHER WITH THE REASONS WHY SUCH NEEDS ARE NOT BEING ADDRESSED:SIGNIFICANT HEALTH NEEDS BEING ADDRESSED:OBESITY -- PARKVIEW WABASH HOSPITAL WILL CONTINUE PROGRAMS ESTABLISHED TO ADDRESS OBESITY IN WABASH COUNTY. ACTIONS TO ADDRESS THE ISSUE OF OBESITY CENTER AROUND PROGRAMS THAT ENGAGE CHILDREN AND FAMILIES AND INCLUDE THE FOLLOWING PROGRAMS:- INCORPORATED A NEARLY HALF MILE WALKING PATH AROUND THE POND ON OUR NEW CAMPUS TO PROMOTE PHYSICAL ACTIVITY. PARTNERED WITH THE CITY OF WABASH TO CREATE SIDEWALKS ON WABASH STREET THAT LEAD TO THE WALKING PATH AND IMPROVE THE WALKABILITY OF THE NORTH END OF TOWN.MATERNAL/CHILD HEALTH - - THOUGH SUSPENDED IN EARLY 2020, PARKVIEW WABASH HOSPITAL, INC., OFFERED PROGRAMS DESIGNED TO REDUCE RISKS AND INCREASE HEALTHY BEHAVIORS AMONG PREGNANT WOMEN VIA A PART-TIME LACTATION CONSULTANT AND BIRTH PLANNER JUNE THROUGH DECEMBER. ALL CLASSES ARE OPEN TO THE PUBLIC.- SPONSORED A HAND-WASHING BOOTH AT THE ANNUAL KINDERGARTEN ROUND-UP. TAUGHT MORE THAN 150 CHILDREN AND THEIR FAMILIES THE PROPER WAY TO WASH THEIR HANDS.- SUPPORTED BABE OF WABASH COUNTY AS THEY OPENED A NEW FACILITY. BABE IS AN INCENTIVE-BASED PROGRAM THAT PROMOTES GOOD HEALTH, EDUCATION AND CONNECTION FOR PARENTS OF CHILDREN AGES BIRTH TO 5 YEARS OLD. DR. RAFAEL NUNEZ, PWB PEDIATRICIAN, AND DR. JOHNATHAN LARSEN, PWB OB-GYN, ARE BOTH PARTNERS OF THE PROGRAM.OTHER HEALTH NEEDS NOT BEING ADDRESSED: TOBACCO USE - THE TOBACCO FREE COALITION IS THE LEAD ORGANIZATION IN WABASH COUNTY RELATED TO TOBACCO FREE EFFORTS. THE COALITION PROVIDES INFORMATION ON RESOURCES ABOUT LOCAL SMOKING CESSATION PROGRAMS AND ADVOCATES FOR NO-SMOKING PUBLIC POLICY. PARKVIEW WABASH HOSPITAL IS REPRESENTED ON THEIR COALITION BOARD AND ALSO FUNDS THEIR "DON'T START SMOKING" PROGRAM FOR ALL 2ND AND 5TH GRADERS IN THE COUNTY. CLASSES WERE HALTED AT THE END OF THE SCHOOL YEAR IN 2020, DUE TO COVID. HOWEVER, THE ORGANIZATION CAME BACK STRONG IN THE FALL OF 2020 AND HELD CLASSES EITHER OUTDOORS OR VIRTUALLY. THEY NOT ONLY CONNECTED WITH NEW STUDENTS, BUT THOSE THEM MISSED IN THE SPRING. THE HOSPITAL ALSO SUPPORTS THEIR BABY AND ME TOBACCO FREE PROGRAM THROUGH A CHI GRANT. IT IS AN INCENTIVE-BASED PROGRAM THAT HELPS EXPECTANT MOMS, AND THEIR PARTNERS, TO QUIT SMOKING.- THE HOSPITAL IS ALSO A TOBACCO FREE CAMPUS. DIABETES, CARDIOVASCULAR DISEASE AND CANCER - WHILE PARKVIEW WABASH HOSPITAL, INC. DID NOT SELECT THESE CHRONIC DISEASES AS TOP HEALTH PRIORITIES, OUR REGISTERED DIETITIAN IS ALSO A CERTIFIED DIABETIC EDUCATOR. SHE WORKS WITH PATIENTS ON A ONE-ON-ONE BASIS THROUGH PHYSICIAN REFERRAL AND INPATIENT CONSULTS. DRUGS/ALCOHOL ABUSE AND ADDICTION - THIS IS NOW THE TOP PRIORITY FOR PARKVIEW WABASH HOSPITAL, INC., AS IDENTIFIED BY THE CHNA. WABASH COUNTY FORMED A DRUG STEERING COMMITTEE IN JULY 2017. PARKVIEW WABASH HOSPITAL, INC. PRESIDENT MARILYN CUSTER-MITCHELL HELPS TO FACILITATE THE MONTHLY MEETINGS. OPENED MEDICATION ASSISTED TREATMENT AND INTENSIVE OUTPATIENT THERAPY PROGRAMS.SEXUALLY TRANSMITTED DISEASES (STDS) - THE WABASH COUNTY HEALTH DEPARTMENT IS THE MAIN RESOURCE IN OUR COUNTY FOR INDIVIDUALS WITH THESE NEEDS.CHRONIC KIDNEY DISEASE - PARKVIEW WABASH HOSPITAL, INC. HAS DONE RESEARCH OVER THE YEARS ON THE NEED FOR ADDITIONAL RESOURCES IN THIS AREA. FOR INSTANCE, ALL THREE NATIONAL COMPANIES WHO PROVIDE DIALYSIS HAVE CONDUCTED EVALUATIONS OF THE NEED WITHIN WABASH COUNTY AND DETERMINED IT WAS NOT BENEFICIAL TO BRING DIALYSIS TO WABASH COUNTY. THERE ARE COMPANIES THAT PROVIDE THE SERVICE IN THE COUNTIES NEIGHBORING WABASH. PARKVIEW WABASH HOSPITAL, INC. MET WITH THE LOCAL PUBLIC TRANSIT PROVIDER AND THEY AGREED TO RELAX THEIR "IN-COUNTY" RULE TO TRANSPORT RESIDENTS IN NEED OF MEDICAL CARE IN A NEIGHBORING COUNTY. ASTHMA - WHILE ASTHMA WAS NOT SELECTED AS A TOP HEALTH PRIORITY, 85 HOPE, THE LOCAL FREE CLINIC, PROVIDES ASTHMA EDUCATION TO ITS PATIENTS. THE PROGRAM INCLUDES EDUCATION, INFORMATION, AND STRATEGIES FOR FOLLOW-UP CARE THAT ARE BOTH INEXPENSIVE AND EFFECTIVE. AGING - WABASH COUNTY OFFERS A VIBRANT AND ACTIVE SENIOR CENTER. THE DALLAS WINCHESTER SENIOR CENTER OFFERS MEALS MONDAY THROUGH FRIDAY, PRESCRIPTION ASSISTANCE, A FOOD PANTRY, PUBLIC TRANSPORTATION, SOCIAL EVENTS, PHYSICAL ACTIVITIES AND CONNECTIONS TO RESOURCES THAT BENEFIT SENIORS IN OUR COMMUNITY. MENTAL HEALTH - AREA RESIDENTS HAVE ACCESS TO A NUMBER OF RESOURCES IN THE COMMUNITY. THE BOWEN CENTER, FRIENDS COUNSELING CENTER AND MENTAL HEALTH AMERICA OF WABASH COUNTY EACH SERVE PEOPLE OF ALL AGES.- THE LIFEBRIDGE SENIOR INTENSIVE OUTPATIENT PROGRAM IS A SPECIALTY MENTAL/BEHAVIORAL PROGRAM DESIGNED TO MEET THE NEEDS OF OLDER ADULTS FOCUSING ON PROVIDING INTENSIVE INDIVIDUAL, FAMILY AND /OR GROUP SERVICES. EACH OF THE INDIVIDUALS ENROLLED IN THE LIFEBRIDGE PROGRAM ATTEND MONTHLY APPOINTMENTS WITH MEDICAL DIRECTOR/PSYCHIATRIST FOR MEDICATION MANAGEMENT AND TREATMENT PLANNING. AT EACH VISIT, INDIVIDUALS ARE SCREENED BY NURSING STAFF FOR VITALS, MEDICATION RECONCILIATION AND ANY MEDICAL CONCERNS ARE IMMEDIATELY COMMUNICATED TO THE INDIVIDUAL'S PRIMARY CARE PHYSICIAN. FAMILY AND SIGNIFICANT OTHERS ARE ENCOURAGED TO PARTICIPATE IN THE TREATMENT PROCESS. LIFEBRIDGE PROVIDES A COHESIVE TREATMENT TEAM TO INCREASE INDIVIDUAL'S MENTAL HEALTH AND PHYSICAL WELL-BEING. 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. 5 1 - AUTUMN RIDGE REHABILITATION CENTRE 600 WABASH AVENUE WABASH IN 46992 LAB DRAW SITE 2 - WELLBROOKE OF WABASH V20 JOHN KISSINGER DRIVE WABASH IN 46992 LAB DRAW SITE 3 - MILLERS EAST 1900 ALBER STREET WABASH IN 46992 LAB DRAW SITE 4 - MILLERS WEST 1720 ALBER STREET WABASH IN 46992 LAB DRAW SITE 5 - VERNON MANOR 1955 VERNON STREET WABASH IN 46992 LAB DRAW SITE 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 7BPARKVIEW WABASH HOSPITAL, INC. ACCEPTS ALL MEDICAID, MEDICAID MANAGED CARE, AND OUT-OF-STATE MEDICAID PATIENTS WITH THE KNOWLEDGE THAT THERE MAY BE SHORTFALLS. INTERNAL REVENUE SERVICE (IRS) REVENUE RULING 69-545 IMPLIES THAT TREATING MEDICAID PATIENTS IS A COMMUNITY BENEFIT. IRS REVENUE RULING 69-545, WHICH ESTABLISHED THE COMMUNITY BENEFIT STANDARD FOR NONPROFIT HOSPITALS, STATES THAT IF A HOSPITAL SERVES PATIENTS WITH GOVERNMENTAL HEALTH BENEFITS, INCLUDING MEDICAID, THEN THIS IS AN INDICATION THAT THE HOSPITAL OPERATES TO PROMOTE THE HEALTH OF THE COMMUNITY. THE UNREIMBURSED MEDICAID COST REPORTED ON LINE 7B IS CALCULATED UNDER THE COST TO CHARGE RATIO METHODOLOGY. UNDER THIS METHOD, THE MEDICAID CHARGES ARE MULTIPLIED BY THE RATIO OF COST TO CHARGES TO DETERMINE THE COST OF MEDICAID SERVICES RENDERED. THEN, THE COST OF MEDICAID SERVICES RENDERED IS DEDUCTED FROM THE REIMBURSEMENT RECEIVED FOR MEDICAID PATIENTS TO ARRIVE AT A GAIN/(LOSS) RELATIVE TO THESE PATIENTS.PART I, LINE 7CPARKVIEW WABASH HOSPITAL, 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, PARKVIEW WABASH HOSPITAL, INC. CONTINUES ITS TRADITION OF CONTRIBUTING TO NUMEROUS ORGANIZATIONS ON BOTH AN AS-NEEDED BASIS AND NEGOTIATED BASIS. AMOUNTS PRESENTED REPRESENT ACTUAL SPEND TO ORGANIZATIONS THROUGHOUT OUR COMMUNITIES. PART I, LN 7 COL(F): PERCENT OF TOTAL EXPENSEPARKVIEW WABASH HOSPITAL, INC. EXCLUDED $4,162,285 OF PH CLINICAL SUPPORT 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.PARKVIEW WABASH HOSPITAL, 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 WABASH 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.PARKVIEW WABASH HOSPITAL, INC. WORKS CLOSELY WITH GROW WABASH COUNTY, THE COUNTY'S ECONOMIC DEVELOPMENT ORGANIZATION AND THE CITY OF WABASH. PWB PRESIDENT SERVES ON THE BOARD FOR GROW WABASH COUNTY AND IS INVOLVED IN COMMUNITY MEETINGS THAT DISCUSS THE OUTLOOK, FUTURE AND PLAN FOR A VIBRANT CITY.PARKVIEW WABASH HOSPITAL, 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. PARKVIEW WABASH HOSPITAL, INC. DEVELOPED A PHYSICIAN RECRUITMENT PLAN TO ADDRESS POTENTIAL GAPS IN PATIENT COVERAGE. A FAMILY PRACTICE PHYSICIAN AND PEDIATRICIAN WERE SUCCESSFULLY RECRUITED IN 2020.PARKVIEW WABASH HOSPITAL, INC. STRIVES TO BRING THE BEST INTEGRATED, QUALITY, AND COST-EFFECTIVE CARE AND INNOVATIVE TECHNOLOGY TO OUR COMMUNITIES. IN DOING SO, WE FOCUS OUR EFFORTS ON RECRUITING AN EXCEPTIONAL TEAM OF PHYSICIANS. EVERY MEMBER OF PARKVIEW WABASH HOSPITAL, 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 AN EXCELLENT EXPERIENCE TO ALL PEOPLE. WE KNOW HOW IMPORTANT CLINICAL, SERVICE AND OPERATIONAL EXCELLENCE IS TO THE SUCCESS OF PARKVIEW WABASH HOSPITAL, INC., AND WE RECOGNIZE HOW IMPORTANT OUR SUCCESS IS TO THE COMMUNITY. PART III, LINE 2: FOR FINANCIAL STATEMENT PURPOSES, THE ORGANIZATION HAS ADOPTED ACCOUNTING STANDARDS UPDATE NO. 2014-09 (TOPIC 606). IMPLICIT PRICE CONCESSIONS INCLUDES BAD DEBTS. THEREFORE, BAD DEBTS ARE INCLUDED IN NET PATIENT REVENUE IN ACCORDANCE WITH HEALTHCARE FINANCIAL MANAGEMENT ASSOCIATION STATEMENT NO. 15 AND BAD DEBT EXPENSE IS NOT SEPARATELY REPORTED AS AN EXPENSE. THE AMOUNT REPORTED ON PART III, LINE 3 IS THE ESTIMATED COST OF BAD DEBT ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER PARKVIEW HEALTH SYSTEM'S FINANCIAL ASSISTANCE POLICY ON A GROSS BASIS. PART III, LINE 3: COSTING METHODOLOGY USED:UNCOLLECTIBLE PATIENT ACCOUNTS ARE CHARGED AGAINST THE PROVISION FOR BAD DEBT IN ACCORDANCE WITH THE POLICIES OF PARKVIEW WABASH HOSPITAL, 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 DURING THE APPLICATION PERIOD, INCLUDING PATIENTS WHOSE ACCOUNTS HAVE BEEN PLACED WITH A COLLECTION 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 24 - 27 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. PARKVIEW WABASH HOSPITAL, INC. ACCEPTS ALL MEDICARE PATIENTS, AS REFLECTED ON THE YEAR-END MEDICARE COST REPORT, WITH THE KNOWLEDGE THAT THERE MAY BE SHORTFALLS. INTERNAL REVENUE SERVICE (IRS) REVENUE RULING 69-545 IMPLIES THAT TREATING MEDICARE PATIENTS IS A COMMUNITY BENEFIT. IRS REVENUE RULING 69-545, WHICH ESTABLISHED THE COMMUNITY BENEFIT STANDARD FOR NONPROFIT HOSPITALS, STATES THAT IF A HOSPITAL SERVES PATIENTS WITH GOVERNMENTAL HEALTH BENEFITS, INCLUDING MEDICARE, THEN THIS IS AN INDICATION THAT THE HOSPITAL OPERATES TO PROMOTE THE HEALTH OF THE COMMUNITY. HOWEVER, MEDICARE PAYMENTS REPRESENT A PROXY OF COST CALLED THE "UPPER PAYMENT LIMIT." IT HAS HISTORICALLY BEEN ASSUMED THAT UPPER PAYMENT LIMIT PAYMENTS DO NOT GENERATE A SHORTFALL. AS A RESULT, PARKVIEW WABASH HOSPITAL, INC. HAS TAKEN THE POSITION NOT TO INCLUDE THE MEDICARE SHORTFALLS OR SURPLUSES AS PART OF COMMUNITY BENEFIT. PARKVIEW WABASH HOSPITAL, INC. RECOGNIZES THAT THE SHORTFALL OR SURPLUS FROM MEDICARE DOES NOT INCLUDE THE COSTS AND REVENUES ASSOCIATED WITH MEDICARE ADVANTAGE PATIENTS. AS SUCH, THE TOTAL SHORTFALL OR SURPLUS OF MEDICARE IS UNDERSTATED DUE TO THE COSTS AND REVENUES ASSOCIATED WITH MEDICARE ADVANTAGE PATIENTS NOT BEING INCLUDED IN THE COMMUNITY BENEFIT DETERMINATION. PART III, LINE 9B: 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 WITH 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, PARKVIEW HEALTH SYSTEM, INC. INCLUDING PARKVIEW WABASH HOSPITAL, 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.- DATA COLLECTION FROM COMMUNITY HEALTH WORKERS- HCI SECONDARY DATA- MEETING WITH COMMUNITY PARTNERS- OBSERVATIONS FROM FRONTLINE STAFF WORKING WITH VULNERABLE POPULATIONS- REVIEW OF CHNA CONDUCTED BY LOCAL ORGANIZATIONSHOSPITAL 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.THE ONLY HOSPITAL IN WABASH COUNTY, PARKVIEW WABASH HOSPITAL, INC., PRIMARILY SERVES THE COMMUNITIES OF WABASH, NORTH MANCHESTER, ROANN, URBANA, LAGRO, AND LAFONTAINE. TO A LESSER EXTENT, THE HOSPITAL ALSO SERVES COMMUNITIES IN SURROUNDING COUNTIES.ACCORDING TO DATA USA, 2019 DATA SHOWS WABASH COUNTY HAS APPROXIMATELY 31,389 RESIDENTS, WITH 94.3% BEING CAUCASIAN AND A MEDIAN AGE OF 42.3. THE COUNTY'S UNEMPLOYMENT RATE IS 6.96%. THE MEDIAN HOUSEHOLD INCOME IN WABASH COUNTY IS $54,259, WITH A POVERTY RATE OF 11.5%.PARKVIEW WABASH HOSPITAL, INC., IS THE 5TH LARGEST EMPLOYER IN THE COUNTY. THE MAKE-UP OF EMPLOYERS IN THE COUNTY IS LARGELY MANUFACTURING, FOLLOWED BY EDUCATION AND HEALTHCARE. 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 (EG OPEN MEDICAL STAFF, COMMUNITY BOARD, USE OF SURPLUS FUNDS, ETC.)THE MAJORITY OF THE PARKVIEW WABASH HOSPITAL, INC. BOARD OF DIRECTORS IS COMPRISED OF INDEPENDENT COMMUNITY MEMBERS WHO RESIDE IN THE HOSPITAL'S PRIMARY SERVICE AREA. THE HOSPITAL ALSO EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN THE COMMUNITY.PEOPLE IN OUR SERVICE AREA COMMUNITY HAVE ACCESS TO CARE 24 HOURS A DAY, 365 DAYS A YEAR THROUGH PARKVIEW WABASH HOSPITAL, INC.'S EMERGENCY DEPARTMENT (ED). THE ED IS STAFFED WITH BOARD-CERTIFIED EMERGENCY CARE PHYSICIANS, PHYSICIANS ASSISTANTS AND A NURSING STAFF THAT IS TRAINED AND EXPERIENCED IN EMERGENCY CARE. ADDITIONALLY, THE HOSPITAL OFFERS FIRSTCARE, A WALK-IN CLINIC OPEN FROM 8 A.M. TO 8 P.M. MONDAY THROUGH FRIDAY AND 8 A.M. TO 2 P.M. ON SATURDAYS AND SUNDAYS.OUR CARE IS NOT LIMITED TO THE WALLS OF OUR BUILDING. PARKVIEW WABASH HOSPITAL, INC., OFFERS A WIDE BREADTH OF SERVICES TO ITS RURAL COMMUNITY.A FEW HIGHLIGHTS INCLUDE:--ONCOLOGY - THE PARKVIEW WABASH HOSPITAL, INC.'S, ONCOLOGY PROGRAM OFFERS CANCER PATIENTS ADVANCED CHEMOTHERAPY TREATMENT CLOSE TO HOME. LAST YEAR, WE ADMINISTERED SEVERAL THOUSAND INFUSION TREATMENTS TO INCLUDE CHEMOTHERAPY, INJECTIONS, IV PUSHES, LEVEL PORT FLUSHES AND COMPLEX REGIMES. ADDITIONALLY, THE DEPARTMENT ENCOURAGES SUPPORT BEYOND TREATMENT BY PROVIDING FREE SCREENINGS AND CLINICAL TRIALS. --SURGERY - OUR MEDICAL STAFF OFFERS NOTHING LESS THAN INNOVATIVE AND INDIVIDUALIZED SURGERY OPTIONS THAT ARE RESPONSIVE TO OUR PATIENTS' NEEDS. AT PARKVIEW WABASH HOSPITAL, INC., WE'RE PROUD TO OFFER AN INCREASING NUMBER OF MINIMALLY INVASIVE OPTIONS, WHICH TYPICALLY RESULT IN LESS PAIN, A SHORTER HOSPITAL STAY AND FASTER RECOVERY. SURGICAL SPECIALTIES INCLUDE: ORTHOPEDIC, GENERAL SURGERY, COLO-RECTAL, UROLOGY, GYNECOLOGY, AND PODIATRY.--PHYSICAL, OCCUPATIONAL, SPEECH AND SPORTS MEDICINE - THE REHAB PLACE OF PARKVIEW WABASH HOSPITAL, INC., IS AN EXCELLENT RESOURCE FOR REHABILITATION, INCLUDING PHYSICAL, OCCUPATIONAL, AND SPEECH THERAPY. WE HAVE A TEAM OF HIGHLY-SKILLED HEALTHCARE PROFESSIONALS WHO ARE COMMITTED TO EXCELLENCE AND SERVICE. WE HAVE THE BENEFIT OF EXPERIENCE AND EQUIPMENT THAT RIVALS ANY FACILITY IN THE STATE, TO INCLUDE AQUATIC THERAPY. OUR THERAPY DEPARTMENT IS LOCATED AT OUR LOCAL YMCA. THE PROXIMITY TO THE Y IS A GREAT PARTNERSHIP THAT ALLOWS OUR THERAPISTS TO ENCOURAGE PATIENTS TO CONTINUE THEIR EXERCISE ROUTINES ONCE DISCHARGED FROM OUR CARE.PARKVIEW WABASH HOSPITAL, INC., IS ACTIVE IN THE COMMUNITY WITH A VARIETY OF PARTNERSHIPS TO INCLUDE:--WABASH COUNTY DRUG STEERING COMMITTEE - COMPRISED OF LOCAL LAW ENFORCEMENT, COURT OFFICIALS, BOWEN CENTER STAFF AND OTHERS, THE DRUG STEERING COMMITTEE WORKS TOGETHER TO ADDRESS THE DRUG PROBLEM IN WABASH COUNTY. PARKVIEW WABASH HOSPITAL, INC., PRESIDENT SERVES AS THE CHAIR OF THE COMMITTEE. THE COMMITTEE IS CURRENTLY LOOKING TO OPEN A WOMEN'S RECOVERY HOME.--UNINSURED ASSISTANCE - PARKVIEW WABASH HOSPITAL, INC., ASSISTS THOSE LESS FORTUNATE BY SUPPORTING 85 HOPE, THE COUNTY'S FREE CLINIC. --ATHLETIC TRAINERS - PARKVIEW WABASH HOSPITAL, INC., EMPLOYS THREE ATHLETIC TRAINERS TO WORK IN THREE WABASH COUNTY HIGH SCHOOLS. THESE TRAINERS SPEND HOURS AT A WIDE VARIETY OF ATHLETIC EVENTS TO ASSIST IF A STUDENT ATHLETE IS INJURED DURING PLAY. THEY ARE ALSO AVAILABLE DURING AND AFTER SCHOOL HOURS FOR ATHLETES IN NEED.HEALTH FAIRS AND SCREENINGS: DUE TO COVID-19, PARKVIEW WABASH HOSPITAL, INC., HOSTED JUST ONE CHECK-UP DAYS IN 2020. APPROXIMATELY 75 PEOPLE ATTENDED AND RECEIVED A WIDE VARIETY OF FREE AND DISCOUNTED HEALTH SCREENINGS.COVID-19 VACCINATION CLINIC - JOINING THE CITY OF WABASH'S LEAD, PARKVIEW WABASH HOSPITAL, INC., WAS INSTRUMENTAL IN GETTING A COVID VACCINATION CLINIC UP AND RUNNING IN LATE 2020. MANY OF OUR STAFF MEMBERS GAVE SELFLESSLY OF THEIR TIME TO VOLUNTEER AT THE CLINIC.EVERY MEMBER OF THE PARKVIEW WABASH HOSPITAL, INC., HEALTHCARE TEAM, REGARDLESS OF THEIR DEPARTMENT, IS RESPONSIBLE FOR NURTURING AN ENVIRONMENT OF EXCELLENCE AS THE PLACE PATIENTS WANT TO RECEIVE CARE, PHYSICIANS WANT TO PRACTICE, AND CO-WORKERS WANT TO WORK. WE UNDERSTAND THAT BY PROVIDING EXCELLENCE IN ALL WE DO, WE NOT ONLY INSURE THE SUCCESS OF PARKVIEW WABASH HOSPITAL, INC., BUT ALSO FOR THE COMMUNITY WE SERVE. PART VI, LINE 6: IF THE ORGANIZATION IS PART OF AN AFFILIATED HEALTH CARE SYSTEM, DESCRIBE THE RESPECTVE 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 ORTHOPAEDIC HOSPITAL AT PARKVIEW NORTH, LLC. PARKVIEW CONTRIBUTES TO THE SUCCESS OF THE REGION BY EFFECTIVELY MANAGING ITS FACILITIES, EFFICIENTLY PROVIDING AND DELIVERING ITS SERVICES, AND SUPPORTING LOCAL BUSINESSES AND ACTIVITIES. PARKVIEW SEEKS TO CREATE ALIGNMENT OPPORTUNITIES TO DELIVER COMPREHENSIVE HIGH-QUALITY CARE THAT BENEFIT PATIENTS, PHYSICIANS, CO-WORKERS AND COMMUNITIES. EACH HOSPITAL ENTITY ENGAGES IN COMMUNITY OUTREACH CUSTOMIZED TO MEET THE UNIQUE NEEDS OF THEIR RESPECTIVE COMMUNITIES. AFFILIATE HOSPITALS WORK TOGETHER AND SHARE PROGRAMMING AND MESSAGING WHERE COMMON COMMUNITY HEALTH ISSUES ARE IDENTIFIED. FROM THE LIST OF HEALTH ISSUES IN THE SEVEN-COUNTY AREA, THE HEALTH PRIORITY OF MENTAL HEALTH/ADDICTION WAS SELECTED BY ALL AFFILIATE HOSPITALS. PARKVIEW WABASH HOSPITAL, INC., CHOSE OBESITY AS ITS SECOND PRIORITY.PARKVIEW PRIDES ITSELF IN NOT ONLY OFFERING THE HIGHEST LEVEL OF CARE TO ITS PATIENTS, BUT ALSO IN PROVIDING AN EXCELLENT WORKPLACE FOR ITS PHYSICIANS, NURSES AND STAFF. PARKVIEW'S 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. PARKVIEW BELIEVES THAT THE COMMUNITIES IT SERVES SHOULD ALL HAVE THE PEACE OF MIND THAT COMES WITH ACCESS TO COMPASSIONATE, HIGH-QUALITY HEALTHCARE, REGARDLESS OF WHETHER THE CARE IS DELIVERED IN A RURAL OR URBAN SETTING. PART VI, LINE 7, REPORTS FILED WITH STATES IN PART VI, LINE 7: A COPY OF FORM 990, SCHEDULE H IS FILED WITH THE INDIANA STATE DEPARTMENT OF HEALTH. 1 WABASH COUNTY BUSINESS ALLIANCE FOUNDATION INC 214 SOUTH WABASH STREET WABASH IN 46992 351538747 501(C)(3) 25000 PROMOTE ECONOMIC DEVELOPMENT & INDUSTRIAL GROWTH IN WABASH COUNTY HISTORIC LANDMARKS FOUNDATION OF INDIANA INC 1201 CENTRAL AVENUE INDIANAPOLIS IN 46202 351162873 501(C)(3) 10000 HISTORIC REAL ESTATE PROJECTS OTIS R BOWEN CENTER FOR HUMAN SERVICES INC 2621 EAST JEFFERSON STREET WARSAW IN 46581 351057889 501(C)(3) 9500 WABASH COUNTY TOBACCO FREE COALITION PROGRAMS 3 0 PART I, LINE 2: COMMUNITY HEALTH IMPROVEMENT FUNDING PARTNER ORGANIZATIONS ARE REQUIRED TO SUBMIT AN ANNUAL PROGRESS REPORT RELATED TO PROGRAM FUNDING. PARTNER ORGANIZATIONS ARE REQUIRED TO RE-APPLY FOR FUNDING ON AN ANNUAL BASIS. X 1 1 0 1 0 0 0 0 0 1 0 MICHAEL PACKNETT PH PRESIDENT & CEO 0 1193402 0 487482 0 367537 0 1624548 0 32305 0 3705274 0 319527 JEANNE' WICKENS PH CHIEF FINANCIAL OFFICER 0 750792 0 262181 0 71579 0 309952 0 29943 0 1424447 0 49457 DOUGLAS SPARKS DIRECTOR/PH PHYSICIAN 26568 440057 0 40449 0 25838 1563 29787 1805 34394 29936 570525 0 0 MARILYN CUSTER-MITCHELL DIRECTOR/WBHOS PRESIDENT 223573 0 70421 0 41972 0 65236 0 32519 0 433721 0 17193 0 CATHY WOLFE WBHOS VP PATIENT CARE 151481 0 38249 0 11772 0 13703 0 25701 0 240906 0 8424 0 SHERRY SCHOENING WBHOS MGR REHAB 118662 0 15877 0 1041 0 15586 0 31918 0 183084 0 0 0 LISA KROH WBHOS PHARMACIST 144765 0 2000 0 774 0 16144 0 1053 0 164736 0 0 0 PAULA OPHEIM WBHOS MGR PHARMACY 106829 25975 1000 973 169 41 4368 1092 12189 3046 124555 31127 0 0 REBECCA MEREDITH WBHOS PHARMACIST 119531 0 1937 0 615 0 8735 0 21144 0 151962 0 0 0 PART I, LINE 1A TAX INDEMNIFICATION AND GROSS-UP PAYMENTS - TAX ON TAXABLE GIFT: CYNTHIA PETERS $14 PART I, LINE 3 RELATED ORGANIZATION, PARKVIEW HEALTH SYSTEM, INC., USES THE FOLLOWING TO ESTABLISH THE COMPENSATION OF PARKVIEW WASBASH HOSPITAL, INC.'S CEO/EXECUTIVE DIRECTOR: COMPENSATION COMMITTEE OF RELATED ORGANIZATION PARKVIEW HEALTH SYSTEM, INC. INDEPENDENT COMPENSATION CONSULTANT FORM 990 OF OTHER ORGANIZATIONS COMPENSATION SURVEY OR STUDY APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE OF RELATED ORGANIZATION PARKVIEW HEALTH SYSTEM, INC. PART I, LINE 4B SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN PAYMENTS THE FOLLOWING INDIVIDUALS PARTICIPATE IN SUPPLEMENTAL NONQUALIFIED DEFERRED COMPENSATION PLANS. BENEFITS EARNED UNDER THE PLANS WILL FUND THE EMPLOYEES' EVENTUAL RETIREMENT BENEFIT. THESE BENEFITS ARE PROVIDED IN EXCHANGE FOR THE EMPLOYEES' YEARS OF SERVICE TO THE ORGANIZATION AND THE AMOUNT OF THE BENEFITS MAY VARY FROM YEAR TO YEAR. THE FOLLOWING INDIVIDUALS VESTED IN A PORTION OF THEIR DEFERRED COMPENSATION PLANS, WHICH IS TREATED AS TAXABLE INCOME TO THE INDIVIDUALS AT THE TIME OF VESTING. THESE AMOUNTS ARE REPORTED IN SCHEDULE J, PART II, COLUMN (B)(III): MARILYN CUSTER-MITCHELL $17,193; MICHAEL PACKNETT $319,527; JEANNE' WICKENS $49,457; CATHY WOLFE $8,424 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 $319,527 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: MARILYN CUSTER-MITCHELL $39,586; MICHAEL PACKNETT $1,598,898; JEANNE' WICKENS $290,002 PART I, LINE 7 MANAGEMENT INCENTIVE COMPENSATION PLAN (MICP) AND PHYSICIAN AND PROVIDER INCENTIVE COMPENSATION PLAN (PICP) ARE ANNUAL INCENTIVE PROGRAMS. SYSTEM GOALS ARE APPROVED BY THE BOARD. AT CONCLUSION OF THE PLAN YEAR, RESULTS ARE SHARED WITH THE BOARD AND THE EXECUTIVE COMMITTEE OF THE BOARD APPROVES FINAL PAYMENT. A INDIANA FINANCE AUTHORITY 351602316 NONEAVAIL 2016-08-17 25000000 SEE PART VI 0 0 0 A 2190000 25247064 25247064 2018 0 0 1 1 A 0 1 0 0 0.00000 0.00000 0.00000 0 0 1 A 0 0 0 1 0 0 0 0 1 A 1 SCHEDULE K, PART I, COLUMN F, LINE A: CONSTRUCTION OF NEW HOSPITAL FACILITY FOR PARKVIEW WABASH HOSPITAL, INC. IN WABASH, INDIANA SCHEDULE K, PART II, COLUMN A, LINE 3: THIS AMOUNT INCLUDES INTEREST OF $247,064. EARNED ON PROJECT FUND. SCHEDULE K, PART III, COLUMN A, LINE 7: BECAUSE PARKVIEW MONITORS THE PRIVATE BUSINESS USE PERCENTAGE FOR EACH BOND ISSUE, TO ENSURE THAT THE PRIVATE BUSINESS USE LIMIT IS NOT EXCEEDED, PARKVIEW DOES NOT CALCULATE THE AMOUNT OF PRIVATE PAYMENTS. SCHEDULE K, PART IV, COLUMN A, LINE 2C: REBATE CALCULATION PERFORMED ON JANUARY 23, 2019. 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, PARKVIEW WABASH HOSPITAL, INC., EIN 47-1753440. 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, 2020 WAS 738. THE TOTAL NUMBER OF EMPLOYEES REPORTED ON FORM W-3 AND FILED BY THE COMMON PAYING AGENT, PH, FOR THE YEAR ENDED DECEMBER 31, 2020 WAS 15,150. FOR PURPOSES OF COMPLETING FORM 990, PART V, LINE 1A AND 2A, THE NUMBER REPORTED FOR THE PARKVIEW WABASH HOSPITAL, INC. WAS 31 AND 231 RESPECTIVELY. FORM 990, PART VI, SECTION A, LINE 1 THE EXECUTIVE COMMITTEE SHALL BE COMPOSED OF THE OFFICERS OF THE BOARD, THE PRESIDENT OF THE CORPORATION, THE PRESIDENT/CHIEF EXECUTIVE OFFICER OF THE CORPORATE MEMBER OR HIS/HER DESIGNEE, THE CURRENT 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 2 DIRECTORS HOWARD HALDERMAN AND PARKER BEAUCHAMP HAVE A BUSINESS RELATIONSHIP AS DIRECTORS ON THE BOARD OF AN UNRELATED ENTITY. FORM 990, PART VI, SECTION A, LINE 4 DURING 2020, THE FOLLOWING SIGNIFICANT CHANGES WERE MADE TO THE BYLAWS OF PARKVIEW WABASH HOSPITAL, INC.: ARTICLE IV - MEMBERSHIP, SECTION 1 - CORPORATE MEMBER, IS AS FOLLOWS: THE CORPORATE MEMBER OF THE CORPORATION SHALL BE PARKVIEW HEALTH SYSTEM, INC. (THE "CORPORATE MEMBER", "PH OR "SYSTEM"), AN INDIANA NONPROFIT CORPORATION. IN ADDITION TO THE RIGHTS AND POWERS ACCORDED IT BY LAW, THE CORPORATE MEMBER, UNLESS SPECIFICALLY DELEGATED BY IT, SHALL HAVE THE RESERVED RIGHTS AND POWERS ATTACHED AND INCORPORATED BY REFERENCE AS EXHIBIT A. THE CORPORATE MEMBER SHALL ACT BY EXECUTING AND DELIVERING TO THE CHAIR OF THE BOARD OR PRESIDENT OR THE CHIEF OPERATING OFFICER OF THE CORPORATION A WRITTEN INSTRUMENT WHICH SETS FORTH THE ACTION TAKEN AND THE APPLICABLE CORPORATE AUTHORIZATIONS OR DIRECTIVE FROM THE BOARD OF DIRECTORS OF THE CORPORATE MEMBER. THE ACTION OF THE CORPORATE MEMBER SHALL BE DEEMED TO HAVE BEEN TAKEN ON THE DATES THE WRITTEN INSTRUMENTS ARE SO DELIVERED UNLESS THE WRITTEN INSTRUMENTS PROVIDE OTHERWISE. ARTICLE V - BOARD OF DIRECTORS, SECTION 2 - NUMBER AND CHARACTERISTICS, IS AS FOLLOWS: THE BOARD SHALL BE COMPOSED OF NO MORE THAN TWELVE (12) DIRECTORS, INCLUDING THE FOLLOWING EX OFFICIO DIRECTORS: THE PRESIDENT OF THE CORPORATION; THE PRESIDENT/CHIEF EXECUTIVE OFFICER OF THE CORPORATE MEMBER OR HIS/HER DESIGNEE, THE PRESIDENT OF THE MEDICAL STAFF (AS DEFINED IN ARTICLE IX) AND THE VICE PRESIDENT OF THE MEDICAL STAFF (UNLESS UNABLE TO SERVE, IN WHICH CASE, SUCH PHYSICIAN AS DESIGNATED BY THE MEDICAL STAFF BYLAWS). THE REMAINING APPOINTED DIRECTORS SHALL BE SELECTED FROM AMONG THOSE PERSONS WHO ARE RESIDENTS OF THE SERVICE AREA OF THE CORPORATION (THE "SERVICE AREA") AND WHO HAVE DEMONSTRATED AN ABILITY AND WILLINGNESS TO SERVE EFFECTIVELY IN THE DISCHARGE OF CORPORATE RESPONSIBILITIES AND WHO ARE ABLE AND WILLING TO SERVE AND WHO SATISFY THE CRITERIA FOR BOARD PARTICIPATION. CONSIDERATION SHOULD BE GIVEN TO PROMOTE DIVERSITY ON THE BOARD OF DIRECTORS. A MAJORITY OF THE BOARD OF DIRECTORS SHALL, AT ALL TIMES, BE CONSIDERED TO BE INDEPENDENT AS DEFINED BY THE INTERNAL REVENUE SERVICE. THE BOARD SHALL CONDUCT AN ORIENTATION SESSION FOR ALL NEW DIRECTORS AND CONTINUING EDUCATION SESSIONS REGARDING CURRENT TOPICS IN HEALTH CARE (INCLUDING MECHANISMS FOR DESIGNING, MEASURING, ASSESSING AND IMPROVING HOSPITAL PERFORMANCE) TO ASSIST ALL DIRECTORS IN THE DISCHARGE OF THEIR DUTIES. WHEN VACANCIES ON THE BOARD OCCUR BY REASON OF DEATH, RESIGNATION, REMOVAL OR OTHERWISE, THE NUMBER OF DIRECTORS SHALL BE REDUCED BY SUCH VACANCIES UNTIL QUALIFIED REPLACEMENTS ARE ELECTED, AS SET FORTH IN ARTICLE V, SECTION 4. IT SHALL BE THE DUTY OF DIRECTORS TO ATTEND REGULAR, SPECIAL AND ANNUAL MEETINGS OF THE BOARD. ARTICLE V - BOARD OF DIRECTORS, SECTION 3 - APPOINTMENT AND TERM OF OFFICE, IS AS FOLLOWS: THE APPOINTMENT AND REMOVAL OF DIRECTORS OF THE CORPORATION SHALL BE CONDUCTED IN ACCORDANCE WITH THE RESERVED POWERS OF THE CORPORATE MEMBER, AS THOSE POWERS ARE DESCRIBED IN EXHIBIT A. THE CORPORATE MEMBER SHALL APPOINT AND REMOVE DIRECTORS, PROVIDED THAT IN TAKING SUCH ACTION, THE CORPORATE MEMBER SHALL APPOINT SUCH DIRECTORS FROM A SLATE OF CANDIDATES PROPOSED BY THE CORPORATION'S BOARD OF DIRECTORS. NOTWITHSTANDING THE FOREGOING, THE CORPORATE MEMBER MAY REJECT THE SLATE OF CANDIDATES PROPOSED BY THE CORPORATION'S BOARD OF DIRECTORS AND REQUEST THAT A NEW SLATE OF DIFFERENT CANDIDATES BE PRESENTED UNTIL AN ACCEPTABLE CANDIDATE IS PRESENTED, IF A MAJORITY OF THE CORPORATE MEMBER'S BOARD OF DIRECTORS DETERMINES IN GOOD FAITH THAT THE PROPOSED CANDIDATES DO NOT MEET SYSTEM CRITERIA FOR BOARD MEMBERSHIP. THE CORPORATION'S BOARD SHALL USE ITS BEST EFFORTS TO SUBMIT CANDIDATES TO THE CORPORATE MEMBER AT LEAST SIXTY (60) DAYS PRIOR TO, BUT NO LATER THAN, THE ANNUAL MEETING DATE. THE CORPORATE MEMBER SHALL USE ITS BEST EFFORTS TO ACT WITH RESPECT TO APPROVAL OR APPOINTMENT OF DIRECTORS BY THE ANNUAL MEETING DATE BUT SHALL ACT NO LATER THAN THE NEXT MEETING. IF THE CORPORATE MEMBER FAILS TO ACT WITH RESPECT TO APPROVAL OR APPOINTMENT OF DIRECTORS WITHIN THE TIME FRAME SPECIFIED HEREIN, THEN THE CORPORATE MEMBER SHALL BE GIVEN WRITTEN NOTICE OF THOSE CANDIDATES PROPOSED BY THE BOARD, WHICH CANDIDATES SHALL BE DEEMED APPOINTED AS DIRECTORS. AS TO THOSE DIRECTORS WHO ARE NOT SERVING IN AN EX OFFICIO CAPACITY, THESE DIRECTORS SHALL BE APPOINTED FOR A TERM OF THREE (3) YEARS AND UNTIL A SUCCESSOR HAS BEEN DULY APPOINTED AND QUALIFIED OR UNTIL THEIR EARLIER RESIGNATION, REMOVAL, INCAPACITY OR DEATH. THE BOARD SHALL BE CLASSIFIED IN APPROXIMATELY EQUAL CLASSES OF CLASS 1, CLASS 2 AND CLASS 3. NO APPOINTED DIRECTOR SHALL BE ELIGIBLE FOR APPOINTMENT TO MORE THAN THREE (3) CONSECUTIVE THREE (3) YEAR TERMS. AFTER AN ABSENCE OF ONE (1) YEAR, A PERSON SHALL BECOME ELIGIBLE FOR REAPPOINTMENT TO THE BOARD. TERMS SHALL COMMENCE ON JANUARY 1 OF EACH CALENDAR YEAR. IF A DIRECTOR BEGINS THEIR SERVICE MIDWAY THROUGH THE YEAR (JUNE 30TH) OR AFTER, THE DIRECTOR SHALL NOT BE DEEMED TO HAVE COMMENCED THE FIRST YEAR OF THEIR TERM UNTIL JANUARY 1 OF THE FOLLOWING YEAR. PURSUANT TO THE RESERVED POWERS OF THE CORPORATE MEMBER SET FORTH IN EXHIBIT A, THE CORPORATE MEMBER SHALL HAVE CERTAIN POWERS TO REMOVE, WITH OR WITHOUT CAUSE, MEMBERS OF THE BOARD. FORM 990, PART VI, SECTION A, LINE 6 THE ORGANIZATION IS ORGANIZED AS A NOT-FOR-PROFIT CORPORATION. PURSUANT TO THE ORGANIZATION'S GOVERNING DOCUMENTS, PARKVIEW HEALTH SYSTEM, INC. EIN 35-1972384 IS THE SOLE MEMBER OF PARKVIEW WABASH HOSPITAL, INC. WITH CERTAIN RESERVED POWERS. FORM 990, PART VI, SECTION A, LINE 7A THE CORPORATE MEMBER, PARKVIEW HEALTH SYSTEM, INC. EIN 35-1972384, SHALL HAVE THE FOLLOWING RESERVED POWERS: (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 7B SEE SCHEDULE O EXPLANATION FOR FORM 990, PART VI, SECTION A, LINE 7A FORM 990, PART VI, SECTION B, LINE 11B PURSUANT TO PARKVIEW HEALTH SYSTEM INC.'S BYLAWS, THE SYSTEM AUDIT COMMITTEE MAY ACT ON BEHALF OF THE CORPORATION TO PROVIDE REVIEW OF THE CORPORATION AND ITS SUBSIDIARY CORPORATIONS' FORM 990 FILINGS. PARKVIEW WABASH HOSPITAL, INC. IS A SUBSIDIARY CORPORATION OF PARKVIEW HEALTH SYSTEM, INC. AN ELECTRONIC COPY OF THE ORGANIZATION'S FINAL FORM 990 (INCLUDING SUPPLEMENTAL SCHEDULES) WAS PROVIDED TO EACH VOTING MEMBER OF THE ORGANIZATION'S GOVERNING BODY AND THE SYSTEM AUDIT COMMITTEE, PRIOR TO FILING WITH THE IRS. ON OCTOBER 27, 2021, THE SYSTEM AUDIT COMMITTEE REVIEWED THE FORM 990 AS ULTIMATELY FILED WITH THE IRS. THIS REVIEW INCLUDED A PRESENTATION BY THE ORGANIZATION'S TAX PREPARER TO HIGHLIGHT THE SIGNIFICANT AREAS ON THE FORM 990 AND SUPPLEMENTAL SCHEDULES. FORM 990, PART VI, SECTION B, LINE 12C AS DESCRIBED IN ARTICLE IX SECTION 6, OF THE PARKVIEW HEALTH SYSTEM, INC. (PH) BYLAWS, PH ADOPTED PH'S COMPLIANCE POLICY FOR THE ORGANIZATION AND ITS NOT-FOR-PROFIT RELATED ORGANIZATIONS (AND AS LIKEWISE NOTED IN THEIR BYLAWS) WHEN ADDRESSING CONFLICTS OR POTENTIAL CONFLICTS OF INTEREST. THIS COMPLIANCE POLICY (COMPLIANCE POLICY #14) REQUIRES THAT EACH BOARD MEMBER, BOARD COMMITTEE MEMBER, AND KEY MANAGEMENT PERSONNEL MUST ANNUALLY COMPLETE A CONFLICT OF INTEREST FORM. THIS INFORMATION IS PROVIDED TO THE CHAIRMAN OF THE BOARD (FOR BOARD AND BOARD COMMITTEE MEMBERS) AND TO SENIOR MANAGEMENT (FOR KEY MANAGEMENT PERSONNEL). IN ADDITION, AS TO THE CONDUCT OF BOARD MEETINGS, THE FOLLOWING PROCESS IS FOLLOWED: "WHENEVER A PH OR PH AFFILIATE BOARD OR BOARD COMMITTEE IS CONSIDERING A TRANSACTION OR ARRANGEMENT WITH AN ORGANIZATION, ENTITY OR INDIVIDUAL IN WHICH A PERSON COVERED BY THIS POLICY HAS A FINANCIAL OR CONFLICTING INTEREST, THE FOLLOWING SHALL OCCUR: 1. THE INTERESTED PERSON MUST DISCLOSE THE FINANCIAL OR CONFLICTING INTEREST AND ALL MATERIAL FACTS TO THE PH OR PH AFFILIATE BOARD OR BOARD COMMITTEE; 2. THE INTERESTED PERSON WITH THAT FINANCIAL OR CONFLICTING INTEREST MAY MAKE A PRESENTATION AT THE BOARD OR BOARD COMMITTEE MEETING REGARDING THE TRANSACTION OR ARRANGEMENT HOWEVER, HE/SHE SHALL LEAVE THE MEETING DURING THE DISCUSSION OF, AND THE VOTE ON, THE TRANSACTION OR ARRANGEMENT THAT RESULTS IN THE FINANCIAL OR CONFLICTING INTEREST; AND 3. THE PH OR PH AFFILIATE BOARD OR BOARD COMMITTEE MUST APPROVE THE TRANSACTION OR ARRANGEMENT BY A MAJORITY VOTE OF THE BOARD MEMBERS PRESENT AT A MEETING THAT HAS A QUORUM, NOT INCLUDING THE VOTE OF THE INTERESTED PERSON. THE INTERESTED PERSON MAY NOT VOTE ON THE MATTER. A. UPON THE REQUEST OF PH OR PH AFFILIATE BOARD OR BOARD COMMITTEE, THE MATTER MAY BE DELEGATED TO THE PH COMPLIANCE COMMITTEE FOR EVALUATION, RECOMMENDATION AND/OR DETERMINATION. 4. WHENEVER A FINANCIAL OR CONFLICTING INTEREST IS ADDRESSED BY A PH OR PH AFFILIATE BOARD, NOTICE SHALL BE GIVEN TO THE PH COMPLIANCE OFFICER / GENERAL COUNSEL." FORM 990, PART VI, SECTION B, LINE 15 LINES 15A AND 15B ARE ANSWERED NO IN ACCORDANCE WITH THE IRS INSTRUCTIONS. TO THE EXTENT THAT THE ORGANIZATION HAS VICE PRESIDENT OR ABOVE, THE COMPENSATION COMMITTEE OF RELATED ORGANIZATION, PARKVIEW HEALTH SYSTEM, INC., DETERMINES THE COMPENSATION OF THE CEO, OFFICERS, AND KEY EMPLOYEES. FORM 990, PART VI, SECTION C, LINE 19 COPIES OF THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. FORM 990, PART IX, LINE 11G OTHER: PROGRAM SERVICE EXPENSES 1,272,706. MANAGEMENT AND GENERAL EXPENSES 71,034. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,343,740. RHC OPERATIONS: PROGRAM SERVICE EXPENSES 4,822,501. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,822,501. MEDICAL PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 2,850,237. MANAGEMENT AND GENERAL EXPENSES 404,000. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,254,237. LABORATORY SERVICES: PROGRAM SERVICE EXPENSES 1,738,879. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,738,879. TEMPORARY HELP: PROGRAM SERVICE EXPENSES 151,454. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 151,454. COLLECTIONS: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 257,264. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 257,264. 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 -554,730. PARKVIEW HEALTH SYSTEM INC 1450 PRODUCTION RD FORT WAYNE IN 46808 351972384 HEALTH CARE IN 501(C)(3) LINE 12C, III-FI N/A 0 PARKVIEW WABASH HOSPITAL FOUNDATION INC 10 JOHN KISSINGER DRIVE WABASH IN 46992 351921445 FUND MGMT IN 501(C)(3) LINE 12A, I PARKVIEW WABASH HOSPITAL INC 1 COMMUNITY HOSPITAL OF LAGRANGE COUNTY INC 207 N TOWNLINE ROAD LAGRANGE IN 46761 202401676 HOSPITAL CARE IN 501(C)(3) LINE 3 PARKVIEW HEALTH SYSTEM INC 0 COMMUNITY HOSPITAL OF NOBLE COUNTY FOUNDATION INC 401 SAWYER ROAD KENDALLVILLE IN 46755 352089183 FUND MGMT IN 501(C)(3) LINE 12A, I COMMUNITY HOSPITAL OF NOBLE COUNTY INC 0 COMMUNITY HOSPITAL OF NOBLE COUNTY INC 401 SAWYER ROAD KENDALLVILLE IN 46755 352087092 HOSPITAL CARE IN 501(C)(3) LINE 3 PARKVIEW HEALTH SYSTEM INC 0 DEKALB MEMORIAL HOSPITAL INC 1316 EAST SEVENTH STREET AUBURN IN 46706 351064295 HOSPITAL CARE IN 501(C)(3) LINE 3 PARKVIEW HEALTH SYSTEM INC 0 HUNTINGTON MEMORIAL HOSPITAL INC 2001 STULTS ROAD HUNTINGTON IN 46750 351970706 HOSPITAL CARE IN 501(C)(3) LINE 3 PARKVIEW HEALTH SYSTEM INC 0 MIDWEST COMMUNITY HEALTH ASSOCIATES INC 442 W HIGH STREET BRYAN OH 43506 341045870 PHYSICIANS OH 501(C)(3) LINE 3 PARKVIEW HEALTH SYSTEM INC 0 PARK CENTER HOLDINGS INC 909 EAST STATE BLVD FORT WAYNE IN 46805 843684074 TO SUPPORT PARK CENTER, INC. IN 501(C)(3) LINE 12D, III-O PARKVIEW HEALTH SYSTEM INC 0 PARK CENTER INC 909 EAST STATE BLVD FORT WAYNE IN 46805 351135451 COMPREHENSIVE MENTAL HEALTH CENTER IN 501(C)(3) LINE 10 PARKVIEW HEALTH SYSTEM INC 0 PARKVIEW DEKALB HOSPITAL FOUNDATION INC 1316 EAST SEVENTH STREET AUBURN IN 46706 356047817 FUND MGMT IN 501(C)(3) LINE 12A, I DEKALB MEMORIAL HOSPITAL INC 0 PARKVIEW FOUNDATION INC 3844 NEW VISION DR FORT WAYNE IN 46845 237220589 FUND MGMT IN 501(C)(3) LINE 12A, I PARKVIEW HOSPITAL INC 0 PARKVIEW HOSPITAL INC 11109 PARKVIEW PLAZA DRIVE FORT WAYNE IN 46845 350868085 HOSPITAL CARE IN 501(C)(3) LINE 3 PARKVIEW HEALTH SYSTEM INC 0 PARKVIEW HUNTINGTON HOSPITAL FOUNDATION INC 2001 STULTS ROAD HUNTINGTON IN 46750 320012095 FUND MGMT IN 501(C)(3) LINE 12A, I HUNTINGTON MEMORIAL HOSPITAL INC 0 PARKVIEW LAGRANGE HOSPITAL FOUNDATION INC 207 N TOWNLINE ROAD LAGRANGE IN 46761 833347115 FUND MGMT IN 501(C)(3) LINE 12A, I COMMUNITY HOSPITAL OF LAGRANGE COUNTY INC 0 PARKVIEW OCCUPATIONAL HEALTH CENTERS INC 1450 PRODUCTION RD FORT WAYNE IN 46808 352064353 OCCUPATIONAL HEALTH IN 501(C)(3) LINE 3 PARKVIEW HEALTH SYSTEM INC 0 WHITLEY MEMORIAL HOSPITAL FOUNDATION INC 1260 E STATE ROAD 205 COLUMBIA CITY IN 46725 311190239 FUND MGMT IN 501(C)(3) LINE 12A, I WHITLEY MEMORIAL HOSPITAL INC 0 WHITLEY MEMORIAL HOSPITAL INC 1260 E STATE ROAD 205 COLUMBIA CITY IN 46725 351967665 HOSPITAL CARE IN 501(C)(3) LINE 3 PARKVIEW HEALTH SYSTEM INC 0 ORTHOPAEDIC HOSPITAL AT PARKVIEW NORTH LLC 1450 PRODUCTION RD FORT WAYNE IN 46808 260143823 ORTHO HOSPITAL IN N/A N/A 0 0 MANAGED CARE SERVICES LLC 1450 PRODUCTION RD FORT WAYNE IN 46808 351996535 HEALTH PLAN ADMIN IN N/A N/A 0 0 PARKVIEW PROFESSIONAL PROGRAMS INC 1450 PRODUCTION RD FORT WAYNE IN 46808 351668888 REFERENCE LAB IN N/A C 0 MIDWEST COMMUNITY HEALTH ASSOCIATES INC 442 W HIGH STREET BRYAN OH 43506 341045870 PHYSICIANS OH N/A C 0 WOODLAND PLAZA MEDICAL PARK CONDO ASSOC INC 202 W BERRY ST SUITE 800 FORT WAYNE IN 46802 352058340 CONDO MANAGEMENT IN N/A C 0 0 1 1 0 0 0 0 0 0 1 1 1 1 1 1 1 1 1 1 PARKVIEW WABASH HOSPITAL FOUNDATION INC C 125937 PART VII SUPPLEMENTAL INFORMATION PARKVIEW WABASH HOSPITAL FOUNDATION INC M 109080 PART VII SUPPLEMENTAL INFORMATION SCHEDULE R, PART V, LINE 2, COLUMN (C): THE AMOUNTS REPORTED AS TRANSACTIONS WITH RELATED ORGANIZATIONS ARE CONSISTENT WITH THE AMOUNTS REPORTED ON THE ORGANIZATION'S AUDITED FINANCIAL STATEMENTS UNDER THE GENERALLY ACCEPTED ACCOUNTING STANDARDS DEPENDING ON THE TYPE OF TRANSACTION INVOLVED.