DEKALB MEMORIAL HOSPITAL INC: Form 990, tax year 2020
View the entire original 990 at ProPublica ↗
- Organization
- DEKALB MEMORIAL HOSPITAL INC (EIN 35-1064295)
- Tax period
- 2020-01-01 to 2020-12-31
- Filed
- 2021-11-07
- IRS object ID
- 202113119349300551
- Schema version
- 2020v4.1
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule H
- Schedule I
- Schedule J
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2021-11-07T10:46:53-06:00 | ReturnTs |
| Tax Period End | 2020-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 350921680 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CROWE LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 330 EAST JEFFERSON BLVD PO BOX 7 | AddressLine1Txt |
| City | SOUTH BEND | CityNm |
| State Abbreviation | IN | StateAbbreviationCd |
| ZIP | 466240007 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2020-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 351064295 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DEKALB MEMORIAL HOSPITAL INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | DEKA | BusinessNameControlTxt |
| Phone | 2603738429 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1316 EAST SEVENTH STREET | AddressLine1Txt |
| City | AUBURN | CityNm |
| State Abbreviation | IN | StateAbbreviationCd |
| ZIP | 46706 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | JEANNE' WICKENS | PersonNm |
| Person Title | PH CFO | PersonTitleTxt |
| Phone | 2602669313 | PhoneNum |
| Signature | 2021-11-05 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | JEANNE | PersonFirstNm |
| Person Last | WICKENS | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | BRITTNEY KOCAJ | PreparerPersonNm |
| PTIN | P01320603 | PTIN |
| Phone | 5742323992 | PhoneNum |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 3 | TrustedCustomerCd |
| Authentication Assurance Level | AAL1 | AuthenticationAssuranceLevelCd |
| Identity Assurance Level | IAL1 | IdentityAssuranceLevelCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2020 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
Doing Business As Name DoingBusinessAsName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PARKVIEW DEKALB HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | MICHAEL J PACKNETT | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1450 PRODUCTION RD | AddressLine1Txt |
| City | FORT WAYNE | CityNm |
| State Abbreviation | IN | StateAbbreviationCd |
| ZIP | 46808 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $90,256,275 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.PARKVIEW.COM | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1964 | FormationYr |
| Legal Domicile State | IN | LegalDomicileStateCd |
| Activity Or Mission | DEKALB MEMORIAL HOSPITAL, INC. WORKS TO IMPROVE THE HEALTH OF OUR COMMUNITIES AND PROVIDES QUALITY HEALTH SERVICES TO ALL WHO ENTRUST THEIR CARE TO US. | ActivityOrMissionDesc |
| Voting Members Governing Body | 11 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 8 | VotingMembersIndependentCnt |
| Total Employee | 417 | TotalEmployeeCnt |
| Total Volunteers | 24 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $0 | PYContributionsGrantsAmt |
| CY Contributions Grants | $3,094,828 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $15,267,965 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $58,118,268 | CYProgramServiceRevenueAmt |
| PY Investment Income | $1,786,801 | PYInvestmentIncomeAmt |
| CY Investment Income | $1,020,304 | CYInvestmentIncomeAmt |
| PY Other Revenue | $1,829,516 | PYOtherRevenueAmt |
| CY Other Revenue | -$41,930 | CYOtherRevenueAmt |
| PY Total Revenue | $18,884,282 | PYTotalRevenueAmt |
| CY Total Revenue | $62,191,470 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $2,517,499 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $49,306 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $5,474,934 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $22,629,624 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $83,631 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $6,722,514 | PYOtherExpensesAmt |
| CY Other Expenses | $38,215,026 | CYOtherExpensesAmt |
| PY Total Expenses | $14,714,947 | PYTotalExpensesAmt |
| CY Total Expenses | $60,893,956 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $4,169,335 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $1,297,514 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $63,742,332 | TotalAssetsBOYAmt |
| Total Assets EOY | $66,142,458 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $16,511,307 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $16,083,196 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $47,231,025 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $50,059,262 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | DEKALB MEMORIAL HOSPITAL, INC. WORKS TO IMPROVE THE HEALTH OF OUR COMMUNITIES AND PROVIDES QUALITY HEALTH SERVICES TO ALL WHO ENTRUST THEIR CARE TO US. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $49,288,661 | ExpenseAmt |
| Grant | $49,306 | GrantAmt |
| Revenue | $58,118,268 | RevenueAmt |
| Desc | THE 57 INPATIENT BED HOSPITAL OPERATES IN A RURAL AREA. FOR FISCAL PERIOD JANUARY 1, 2020 TO DECEMBER 31, 2020. THE TOTAL NUMBER OF ADMISSIONS WERE 1,563 ADMISSIONS. THE TOTAL NUMBER OF EMERGENCY ROOM VISITS WERE 14,917. THE HOSPITAL PROVIDES CHARITY CARE TO PATIENTS WHO MEET CERTAIN CRITERIA UNDER ITS CHARITY CARE POLICY. THE HOSPITAL DOES NOT PURSUE COLLECTION OF AMOUNTS DETERMINED TO BE CHARITY CARE. AT DEKALB MEMORIAL HOSPITAL, INC., OUR INVESTMENTS IN STATE-OF-THE-ART FACILITIES AND PARTNERSHIPS WITH TOP FAMILY PHYSICIANS AND SPECIALTY GROUPS MEAN THAT YOU NEVER HAVE TO LOOK PAST DEKALB COUNTY FOR THE VERY BEST CARE. (SEE SCHEDULE O FOR CONTINUATION) OUR COMMITMENT IS ALSO REFLECTED IN OUR INVESTMENTS OF TIME, TALENTS, AND RESOURCES IN LOCAL SCHOOLS, BUSINESSES, CHARITABLE ORGANIZATIONS AND OTHER WORTHY CAUSES TO HELP ENSURE A HEALTHIER COMMUNITY. WE'RE PROUD TO BE YOUR NEIGHBOR, AND YOU CAN BE SURE WE'LL BE HERE, TAKING CARE OF YOU FOR GENERATIONS TO COME.THANKS TO THE VISION OF OUR LEADERSHIP, DEKALB MEMORIAL HOSPITAL, INC. HAS TAKEN NUMEROUS STEPS FORWARD. WE HAVE FORGED NEW PARTNERSHIPS WITH PARKVIEW HEALTH ALONG WITH PHYSICIAN GROUPS, SO THAT PEOPLE IN OUR REGION NOW HAVE ACCESS TO ALMOST EVERY MEDICAL SPECIALTY RIGHT HERE ON OUR CAMPUS.WE HAVE ALSO MADE SIGNIFICANT INVESTMENTS IN NEW TECHNOLOGY, SUCH AS A STATE-OF-THE-ART MONITORING SYSTEM FOR CRITICALLY ILL PATIENTS. MOST IMPORTANTLY, OUR PEOPLE CONTINUE TO DISTINGUISH THEMSELVES AS THE MOST COMPASSIONATE CAREGIVERS YOU'LL FIND ANYWHERE, AND WE CONTINUE TO DONATE TIME AND RESOURCES IN SUPPORT OF SCHOOLS, BUSINESSES, AND ORGANIZATIONS TO ENSURE A STRONG, HEALTHY COMMUNITY. AT DEKALB MEMORIAL HOSPITAL, INC., WE HAVE REARMED OUR COMMITMENT TO BEING YOUR NOT-FOR-PROFIT COMMUNITY HOSPITAL. WITH EVERY NEW INVESTMENT, WE'RE BRINGING WORLD-CLASS HEALTHCARE HOME TO YOU.WE CELEBRATE THE UNIQUE BOND THAT EXISTS BETWEEN THE HOSPITAL AND ITS COMMUNITY. OURS IS A RICH HERITAGE OF HIGH QUALITY, DETERMINATION AND A COMMITMENT TO TAKING CARE OF THE INDIVIDUALS AND FAMILIES WE SERVE AND WE SUPPORT THE FOLLOWING INITIATIVES IN THE COMMUNITY: AUBURN WATERLOO TRAIL SYSTEM, HOOSIERS FEEDING THE HUNGRY, HEARTEN HOUSE FOR SUBSTANCE ABUSE AND RECOVERY, CHILDREN'S FIRE SAFTETY EDUCATION MATERIAL THROUGH THE BUTLER FIRE DEPARMENT, HEALTH CARE SERVICES FOR UNINSURED AND UNDERINSURED THROUGH ST. MARTIN'S HEALTH CARE CLINIC AND IN KIND DONATIONS FOR BICYCLE HELMET INITITAVES FOR THE JAM CENTER AND THE GREATER GARRETT GROUP. WE ALSO SUPPORTED THE WOMEN'S CARE CENTER BY PROVIDING PRENATAL VITAMINS AND INFANT SUPPLIES AND FLU VACCINES THROUGH THE DEKALB COUNTY HEALTH DEPARTMENT. | Desc |
| Total Program Service Expenses | $49,288,661 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (1) | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | 0 | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | Yes (1) | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | 0 | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (1) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | Yes (1) | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| Info In Schedule O Part V | Yes (X) | InfoInScheduleOPartVInd |
| IRP Document | 40 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 417 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 11 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 8 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (1) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | 0 | CompensationProcessCEOInd |
| Compensation Process Other | 0 | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | IN | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | JEANNE' WICKENS | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 2602669313 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1450 PRODUCTION RD | AddressLine1Txt |
| City | FORT WAYNE | CityNm |
| State Abbreviation | IN | StateAbbreviationCd |
| ZIP | 46808 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (23 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Key EmployeeKeyEmployeeInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd | Former Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd |
|---|---|---|---|---|---|---|---|---|---|---|
| MICHAEL PACKNETT | ||||||||||
| DIRECTOR/PH PRESIDENT & CEO | 0.00 | 40.00 | Yes (X) | Yes (X) | $0 | $2,048,421 | $1,656,853 | |||
| ROBERT BURTON | ||||||||||
| DIRECTOR/PH PHYSICIAN | 0.00 | 40.00 | Yes (X) | $0 | $339,357 | $53,085 | ||||
| NATASHA EICHER | ||||||||||
| DIRECTOR/DMHOS PRESIDENT | 40.00 | 0.00 | Yes (X) | Yes (X) | $241,899 | $0 | $91,566 | |||
| DOUGLAS MORROW | ||||||||||
| DIRECTOR/CHAIR | 1.00 | 1.00 | Yes (X) | Yes (X) | $7,000 | $1,750 | $0 | |||
| THOMAS HARTMAN | ||||||||||
| DIRECTOR | 1.00 | 0.00 | Yes (X) | $4,500 | $0 | $0 | ||||
| THOMAS MASON | ||||||||||
| DIRECTOR | 1.00 | 0.00 | Yes (X) | $4,500 | $0 | $0 | ||||
| MICHAEL TULLIS | ||||||||||
| DIRECTOR | 1.00 | 0.00 | Yes (X) | $4,500 | $0 | $0 | ||||
| BETH FREIDENBERGER | ||||||||||
| DIRECTOR/PARTIAL YEAR | 1.00 | 0.00 | Yes (X) | $4,500 | $0 | $0 | ||||
| BRYAN NUGEN | ||||||||||
| DIRECTOR | 1.00 | 0.00 | Yes (X) | $4,500 | $0 | $0 | ||||
| TRENTON STUCKEY | ||||||||||
| DIRECTOR | 1.00 | 0.00 | Yes (X) | $3,500 | $0 | $0 | ||||
| TRINA CHAPMAN-SMITH | ||||||||||
| DIRECTOR | 1.00 | 0.00 | Yes (X) | $2,750 | $0 | $0 | ||||
| SCOTT PFLUGHOEFT | ||||||||||
| DIRECTOR/SECRETARY/TREASURER | 1.00 | 0.00 | Yes (X) | Yes (X) | $1,250 | $0 | $0 | |||
| JEANNE' WICKENS | ||||||||||
| PH CHIEF FINANCIAL OFFICER | 0.00 | 40.00 | Yes (X) | $0 | $1,084,552 | $339,895 | ||||
| KARRA HEGGEN | ||||||||||
| DMHOS VP PAT CARE SVCS | 40.00 | 0.00 | $208,111 | $0 | $23,517 | Yes (X) | ||||
| DOUGLAS CRANE | ||||||||||
| DMHOS PHARMACY SPV | 40.00 | 0.00 | $145,776 | $0 | $36,380 | Yes (X) | ||||
| JACOB CLENDENEN | ||||||||||
| DMHOS PHARMACIST | 40.00 | 0.00 | $139,025 | $0 | $34,724 | Yes (X) | ||||
| LON KEYES | ||||||||||
| DMHOS PHARMACY MGR | 40.00 | 0.00 | $150,605 | $0 | $20,403 | Yes (X) | ||||
| BETHANY HEILEMAN | ||||||||||
| DMHOS PHARMACIST | 40.00 | 0.00 | $122,498 | $0 | $40,741 | Yes (X) | ||||
| ANTHONY STUMP | ||||||||||
| DMHOS MGR REHAB | 29.00 | 11.00 | $88,086 | $29,360 | $39,430 | Yes (X) | ||||
| BRET CLAGHORN | ||||||||||
| FORMER OFFICER/CURRENT PH VP | 0.00 | 40.00 | $0 | $183,034 | $47,506 | Yes (X) | ||||
| PHILIP CHASE | ||||||||||
| FORMER HC/CURRENT PH PHYSICIAN | 0.00 | 40.00 | $0 | $449,625 | $52,449 | Yes (X) | ||||
| JAMES INGRAM | ||||||||||
| FORMER HC/CURRENT PH PHYSICIAN | 0.00 | 40.00 | $0 | $407,618 | $54,927 | Yes (X) | ||||
| PAUL REXROTH | ||||||||||
| FORMER HC/CURRENT PH PHYSICIAN | 0.00 | 40.00 | $0 | $257,864 | $50,799 | Yes (X) | ||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,133,000 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $4,801,581 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $2,542,275 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 10 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | Yes (1) | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| PARKVIEW HOSPITAL INC | |||||
| 11109 PARKVIEW PLAZA DRIVE | FORT WAYNE | IN | 46845 | LABORATORY SERVICES | $1,976,501 |
| ASSOCIATED ANESTHESIOLOGISTS OF FORT WAY | |||||
| 10315 DAWSON CREEK BLVD SUITE A/B | FORT WAYNE | IN | 46825 | ANESTHESIOLOGISTS | $789,797 |
| FOCUSONE SOLUTIONS LLC | |||||
| 13609 CALIFORNIA STREET | OMAHA | NE | 68154 | MEDICAL PERSONNEL | $400,680 |
| NORTHEAST INTERNAL MEDICINE ASSOC INC | |||||
| 2500 N DETROIT STREET | LAGRANGE | IN | 46761 | HOSPITALISTS | $318,750 |
| HOSPITAL LAUNDRY SERVICES INC | |||||
| 3322 CAVALIER DRIVE | FORT WAYNE | IN | 46808 | LAUNDRY SERVICES | $168,290 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 7 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $32,178 | RelatedOrganizationsAmt |
| Government Grants | $3,062,650 | GovernmentGrantsAmt |
| Noncash Contributions | $395 | NoncashContributionsAmt |
| Total Contributions | $3,094,828 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (5 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| NET PATIENT SERVICE REVENUE | 622000 | $51,295,237 | $51,295,237 |
| PHARMACY | 446110 | $6,159,553 | $6,159,553 |
| INTERUNIT RENT | 531120 | $366,273 | $366,273 |
| EMS SUBSIDY | 621910 | $200,000 | $200,000 |
| REBATES | 900099 | $85,353 | $85,353 |
Total Oth Program Service Rev TotalOthProgramServiceRevGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $11,852 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $11,852 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $58,118,268 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $382,987 | TotalRevenueColumnAmt |
| Exclusion | $382,987 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $384,328 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $642,454 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | -$258,126 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$258,126 | TotalRevenueColumnAmt |
| Exclusion | -$258,126 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $28,056,868 | SecuritiesAmt |
| Other | $2,800 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $27,411,799 | SecuritiesAmt |
| Other | $10,552 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $645,069 | SecuritiesAmt |
| Other | -$7,752 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $637,317 | TotalRevenueColumnAmt |
| Exclusion | $637,317 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | CAFETERIA REVENUE | Desc |
| Business | 722210 | BusinessCd |
| Total Revenue Column | $216,196 | TotalRevenueColumnAmt |
| Exclusion | $216,196 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $216,196 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $62,191,470 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $58,118,268 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $978,374 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $49,306 | TotalAmt |
| Program Services | $49,306 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $602,093 | TotalAmt |
| Management And General | $602,093 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $16,433,049 | TotalAmt |
| Program Services | $16,433,049 | ProgramServicesAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,594,482 | TotalAmt |
| Program Services | $5,594,482 | ProgramServicesAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $42,640 | TotalAmt |
| Management And General | $42,640 | ManagementAndGeneralAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $55,171 | TotalAmt |
| Management And General | $55,171 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,576,355 | TotalAmt |
| Program Services | $5,166,062 | ProgramServicesAmt |
| Management And General | $410,293 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $20,906 | TotalAmt |
| Program Services | $19,985 | ProgramServicesAmt |
| Management And General | $921 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,872,199 | TotalAmt |
| Program Services | $1,590,697 | ProgramServicesAmt |
| Management And General | $281,502 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $119 | TotalAmt |
| Program Services | $119 | ProgramServicesAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,103,306 | TotalAmt |
| Program Services | $1,096,264 | ProgramServicesAmt |
| Management And General | $7,042 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $20,769 | TotalAmt |
| Program Services | $19,152 | ProgramServicesAmt |
| Management And General | $1,617 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,342 | TotalAmt |
| Program Services | $6,123 | ProgramServicesAmt |
| Management And General | $219 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $30,075 | TotalAmt |
| Program Services | $30,075 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,897,833 | TotalAmt |
| Program Services | $1,878,230 | ProgramServicesAmt |
| Management And General | $19,603 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $238,436 | TotalAmt |
| Program Services | $203,219 | ProgramServicesAmt |
| Management And General | $35,217 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| MEDICAL SUPPLIES | $10,445,019 | $10,445,019 | |
| CORP SERVICE ALLOCATION | $10,007,872 | $10,007,872 | |
| PH CLINICAL SUPPORT | $3,385,350 | $3,385,350 | |
| HOSPITAL ASSESSMENT FEE | $3,261,527 | $3,261,527 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $251,107 | TotalAmt |
| Program Services | $110,002 | ProgramServicesAmt |
| Management And General | $57,474 | ManagementAndGeneralAmt |
| Fundraising | $83,631 | FundraisingAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $60,893,956 | TotalAmt |
| Program Services | $49,288,661 | ProgramServicesAmt |
| Management And General | $11,521,664 | ManagementAndGeneralAmt |
| Fundraising | $83,631 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,766,847 | BOYAmt |
| EOY | $2,950 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $19,971,290 | BOYAmt |
| EOY | $5,163,223 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,989,716 | BOYAmt |
| EOY | $9,431,926 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,630,569 | BOYAmt |
| EOY | $1,580,489 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $323,073 | BOYAmt |
| EOY | $168,027 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $30,185,785 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $3,088,969 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $27,972,424 | BOYAmt |
| EOY | $27,096,816 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $22,397,084 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $88,413 | BOYAmt |
| EOY | $301,943 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $63,742,332 | BOYAmt |
| EOY | $66,142,458 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,931,050 | BOYAmt |
| EOY | $2,664,455 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $3,885,767 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,123,970 | BOYAmt |
| EOY | $8,043,302 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,456,287 | BOYAmt |
| EOY | $1,489,672 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $16,511,307 | BOYAmt |
| EOY | $16,083,196 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $47,231,025 | BOYAmt |
| EOY | $50,059,262 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $47,231,025 | BOYAmt |
| EOY | $50,059,262 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $63,742,332 | BOYAmt |
| EOY | $66,142,458 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $1,297,514 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $1,459,032 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $71,691 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | Yes (1) | FederalGrantAuditRequiredInd |
| Federal Grant Audit Performed | Yes (1) | FederalGrantAuditPerformedInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | VolunteersInd |
| Paid Staff Or Management | 0 | PaidStaffOrManagementInd |
| Media Advertisements | 0 | MediaAdvertisementsInd |
| Mailings Members | 0 | MailingsMembersInd |
| Publications Or Broadcast | 0 | PublicationsOrBroadcastInd |
| Grants Other Organizations | 0 | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | 0 | DirectContactLegislatorsInd |
| Rallies Demonstrations | 0 | RalliesDemonstrationsInd |
| Other Activities | Yes (1) | OtherActivitiesInd |
| Other Activities | $6,438 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $6,438 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | 0 | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART II-B, LINE 1: | FormAndLineReferenceDesc |
| Explanation | OTHER ACTIVITIES - REPRESENTS THE PORTION OF THE DUES PAID TO INDIANA HOSPITAL AND HEALTH ASSOCIATION, AMERICAN HOSPITAL ASSOCIATION AND VARIOUS PROFESSIONAL ASSOCIATIONS USED FOR LOBBYING ACTIVITIES. | ExplanationTxt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $2,496,000 | OtherCostOrOtherBasisAmt |
| Book Value | $2,496,000 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $24,158,752 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,444,246 | DepreciationAmt |
| Book Value | $22,714,506 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $9,290 | OtherCostOrOtherBasisAmt |
| Depreciation | $3,204 | DepreciationAmt |
| Book Value | $6,086 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $3,303,075 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,641,519 | DepreciationAmt |
| Book Value | $1,661,556 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $218,668 | OtherCostOrOtherBasisAmt |
| Book Value | $218,668 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $27,096,816 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (4 entries)
| DescDesc | AmtAmt |
|---|---|
| LEASE LIABILITY | $338,440 |
| EST 3RD PARTY SETTLEMENTS | $829,432 |
| DUE TO/FROM INTERUNIT | $217,800 |
| RESERVE FOR MALPRACTICE | $104,000 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $1,489,672 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART X, LINE 2: | FormAndLineReferenceDesc |
| Explanation | PARKVIEW HEALTH SYSTEM, INC. AND SUBSIDIARIES - NOTES TO THE CONSOLIDATED FINANCIAL STATEMENTS TEXT OF THE FOOTNOTE TO THE ORGANIZATION'S FINANCIAL STATEMENTS THAT DESCRIBES THE LIABILITY FOR UNCERTAIN TAX POSITIONS UNDER FIN 48 (ASC 740): INCOME TAXES: THE INTERNAL REVENUE SERVICE HAS DETERMINED THAT THE CORPORATION AND CERTAIN AFFILIATED ENTITIES ARE TAX-EXEMPT ORGANIZATIONS AS DEFINED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. CERTAIN SUBSIDIARIES OF THE CORPORATION ARE TAXABLE ENTITIES, THE TAX EXPENSE AND LIABILITIES OF WHICH ARE NOT MATERIAL TO THE CONSOLIDATED FINANCIAL STATEMENTS. THE CORPORATION AND ITS TAX-EXEMPT AFFILIATED ENTITIES EACH FILE A FORM 990 (RETURN OF ORGANIZATION EXEMPT FROM INCOME TAX) ANNUALLY. WHEN THESE RETURNS ARE FILED, IT IS HIGHLY CERTAIN THAT SOME POSITIONS TAKEN WOULD BE SUSTAINED UPON EXAMINATION BY THE TAXING AUTHORITIES, WHILE OTHERS ARE SUBJECT TO UNCERTAINTY ABOUT THE MERITS OF THE POSITION TAKEN OR THE AMOUNT OF THE POSITION THAT WOULD ULTIMATELY BE SUSTAINED. EXAMPLES OF TAX POSITIONS COMMON TO HEALTH SYSTEMS INCLUDE SUCH MATTERS AS THE TAX-EXEMPT STATUS OF EACH ENTITY, THE CONTINUED TAX-EXEMPT STATUS OF BONDS, THE NATURE, CHARACTERIZATION AND TAXABILITY OF JOINT VENTURE INCOME, AND VARIOUS POSITIONS RELATING TO POTENTIAL SOURCES OF UNRELATED BUSINESS TAXABLE INCOME (REPORTED ON FORM 990T). AS OF DECEMBER 31, 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. | ExplanationTxt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent200 | Yes (X) | Percent200Ind |
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
| Percent250 | Yes (X) | Percent250Ind |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | Yes (1) | ExpensesExceedBudgetInd |
| Unable To Provide Care | 0 | UnableToProvideCareInd |
| Annual Community Bnft Report | Yes (1) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (1) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $948,911 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $948,911 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01650 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $5,258,164 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,627,726 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,630,438 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.04570 | TotalExpensePct |
Unreimbursed Costs UnreimbursedCostsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $5,592,146 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,713,886 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,878,260 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.03270 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $11,799,221 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $6,341,612 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $5,457,609 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.09490 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $52,833 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $52,833 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00090 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $75,392 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $75,392 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00130 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $128,225 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $128,225 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00220 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $11,927,446 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $6,341,612 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $5,585,834 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.09710 | TotalExpensePct |
Economic Development EconomicDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $800 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $800 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Workforce Development WorkforceDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $25,000 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $25,000 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00040 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $25,800 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $25,800 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00040 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $0 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $12,727 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $7,966,898 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $8,770,838 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$803,940 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DEKALB MEMORIAL HOSPITAL INC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1316 EAST SEVENTH STREET | AddressLine1Txt |
| City | AUBURN | CityNm |
| State Abbreviation | IN | StateAbbreviationCd |
| ZIP | 46706 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | WWW.PARKVIEW.COM | WebsiteAddressTxt |
| State License | 20-005041-1 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DEKALB MEMORIAL HOSPITAL INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | 0 | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Prior CHNA Impact | Yes (X) | PriorCHNAImpactInd |
| CHNA Conducted | 19 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | 0 | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | Yes (1) | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | HTTPS://WWW.PARKVIEW.COM/LOCALHEALTHNEEDS | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 19 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | HTTPS://WWW.PARKVIEW.COM/LOCALHEALTHNEEDS | StrategyWebsiteURLTxt |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 200.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 250.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Residency Criteria | Yes (X) | ResidencyCriteriaInd |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | HTTPS://WWW.PARKVIEW.COM/PATIENTS-VISITORS/FINANCIAL-ASSISTANCE | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | HTTPS://WWW.PARKVIEW.COM/PATIENTS-VISITORS/FINANCIAL-ASSISTANCE | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | HTTPS://WWW.PARKVIEW.COM/PATIENTS-VISITORS/FINANCIAL-ASSISTANCE | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| Notified FAP Copy Bill Display | Yes (X) | NotifiedFAPCopyBillDisplayInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| FAP Translated | Yes (X) | FAPTranslatedInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| Provided Written Notice | Yes (X) | ProvidedWrittenNoticeInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Made Presumptive Elig Determ | Yes (X) | MadePresumptiveEligDetermInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Look Back Medicare Private | Yes (X) | LookBackMedicarePrivateInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| DEKALB MEMORIAL HOSPITAL, INC. | PART V, SECTION B, LINE 5: DESCRIBE HOW THE HOSPITAL FACILITY TOOK INTO ACCOUNT INPUT FROM PERSONS WHO REPRESENT THE COMMUNITY, AND IDENTIFY THE PERSONS THE HOSPITAL FACILITY CONSULTED:THE HOSPITAL FACILITY TOOK INTO ACCOUNT INPUT FROM PERSONS WHO REPRESENT THE COMMUNITY THROUGH COMMUNITY FOCUS GROUPS IN DEKALB COUNTY, AND FEEDBACK COLLECTED FROM KEY CONSTITUENTS.BEGINNING IN JANUARY 2019, THE DIRECTOR OF COMMUNITY OUTREACH HELD TWO COMMUNITY FORUMS WITH INDIVIDUALS FROM THE DEKALB HOSPITAL, INC. TEAM, COMMUNITY-BASED ORGANIZATION, SOCIAL SERVICE LEADERS AND INDIVIDUAL STAKEHOLDERS WITHIN THE COMMUNITY. ALL OF THESE INDIVIDUALS WERE STRATEGICALLY SELECTED BECAUSE OF THEIR VAST UNDERSTANDING OF THE COMMUNITY AND OVERALL INVOLVEMENT IN VARIOUS AREAS THAT IMPACT HEALTH ACROSS DEMOGRAPHICS. WE HELD FOCUS GROUP CONVERSATIONS TO HEAR 'REAL-WORLD' STORIES ABOUT THE IMPACT OF HEALTH IN OUR COMMUNITY AND EXPLORE PRACTICAL SOLUTIONS.THE FOLLOWING ORGANIZATIONS WERE IN ATTENDANCE AT THE COMMUNITY FORUMS:- UNITED WAY OF DEKALB COUNTY- LOCAL LIBRARIES- THE BOWEN CENTER- EASTSIDE JR./SR. HIGH SCHOOL NURSE- GARRETT-KEYSER BUTLER SCHOOL SUPERINTENDENT- ST. MARTIN'S CLINIC- DEKALB COUNTY SHERIFF'S DEPARTMENT- GARRETT CITY POLICE DEPARTMENT- DEKALB COUNTY ECONOMIC DEVELOPMENT- WATERLOO TOWN MANAGER- CHILDREN'S FIRST CENTER- THE JAM CENTER- THE DEKALB COUNTY COUNCIL ON AGING- DEKALB HOSPITAL, INC. ADDITIONALLY, THROUGHOUT THE YEAR, FEEDBACK IS RECEIVED ON HOW THE HOSPITAL CAN SUPPORT HEALTH NEEDS THROUGHOUT THE COMMUNITY. |
| DEKALB MEMORIAL HOSPITAL, INC. | PART V, SECTION B, LINE 6B: THE HOSPITAL FACILITY'S CHNA WAS ALSO CONDUCTED WITH THE FOLLOWING ORGANIZATIONS OTHER THAN HOSPITAL FACILITIES:THE ASSESSMENT WAS NOT CONDUCTED WITH OTHER HOSPITALS, BUT WAS PART OF A COLLABORATIVE EFFORT WITH DEKALB COUNTY HEALTH DEPARTMENT AND IPFW CENTER FOR SOCIAL RESEARCH AND THE COMMUNITY FOCUS GROUPS. |
| DEKALB MEMORIAL HOSPITAL, INC. | PART V, SECTION B, LINE 11: DESCRIBE HOW THE HOSPITAL FACILITY IS ADDRESSING THE SIGNIFICANT NEEDS IDENTIFIED IN ITS MOST RECENTLY CONDUCTED CHNA AND ANY SUCH NEEDS THAT ARE NOT BEING ADDRESSED TOGETHER WITH THE REASONS WHY SUCH NEEDS ARE NOT BEING ADDRESSED:SIGNIFICANT HEALTH NEEDS BEING ADDRESSED:DUE TO THE COVID 19 PANDEMIC, THERE WERE LIMITED RESOURCES IN 2020 HOWEVER, WE WERE ABLE TO PARTNER WITH THESE COMMUNITY ORGANIATIONS TO SUPPORT SAFETY AND HEALTHY LIFESTYLES IN THE COMMUNITY; THE JUDY A. MORRILL RECREATION CENTER (JAM), HEARTEN HOUSE WOMEN AND CHILDREN'S RESCUE MISSION, ST. MARTIN'S CLINIC, BUTLER FIRE DEPARTMENT, UNITED WAY OF DEKALB COUNTY, CHILDREN FIRST CENTER, HOOSIERS FEEDING THE HUNGRY, SERENITY HOUSE AND DEKALB COUNTY COMMUNITY FOUNDATION. OUR MOST RECENT ASSESSMENT, DONE IN 2019, REVEALED SEVERAL AREAS OF NEED IN DEKALB IMPROVED ACCESS FOR VACCINATIONS:SINCE 2014 DEKALB HEALTH HAS BEEN WORKING WITH THE DEKALB COUNTY HEALTH DEPARTMENT TO PROVIDE FLU VACCINES TO DEKALB COUNTY SCHOOLS. IN ADDITION, WE CONTINUE TO INVEST IN VACCINATIONS FOR THE COMMUNITY BY PROVIDING SHOT CLINICS.REDUCE THE RATE OF OBESITY AND DIABETES:WE CREATED OPPORTUNITIES FOR OUR TEAM TO IMPROVE THEIR PERSONAL HEALTH AND CONTINUE TO PARTNER WITH OUR LOCAL FITNESS CENTERS, YMCA AND THE JAM CENTER TO PROMOTE A HEALTHY LIFESTYLE AND HELP COMBAT OBESITY AND DIABETES IN OUR COMMUNITY. WE ALSO LOOK FORWARD TO WILL CONTINUE TO BE AN ACTIVE SUPPORTER OF A VARIETY OF HEALTH FAIRS AROUND THE COUNTY.SUICIDE AWARENESS AND PREVENTION:WE CONTINUE TO WORK WITH PARTNER AGENCIES AND MENTAL HEALTH PROFESSIONALS TO PROVIDE SERVICES IN OUR COUNTY. WE INTENTIONALLY SUPPORT LOCAL COMMUNITY EVENTS REGARDING SUICIDE AWARENESS AND PREVENTION TO HELP ADDRESS THE PROBLEM OF STIGMA. ADDITIONALLY, WE ARE PLEASED TO HAVE A LONG-TERM RELATIONSHIP WITH THE NORTHEASTERN CENTER IN OUR COMMUNITY AND THE BOWEN CENTER TO HELP OUR RESIDENTS WITH MENTAL HEALTH CONCERNS.WE ALSO ENHANCED OUR PHARMACY ACCESS THROUGH PHARMACARE AND EXPANDED SUPPORT OF ST. MARTIN'S CLINIC WHICH PROVIDES HEALTH CARE TO UNINSURED AND UNDERINSURED INDIVIDUALS IN OUR COUNTY. |
| PART V, SECTION B, LINE 3E: | THE SIGNIFICANT HEALTH NEEDS ARE A PRIORITIZED DESCRIPTION OF THE SIGNIFICANT HEALTH NEEDS OF THE COMMUNITY AND IDENTIFIED THROUGH THE CHNA.AN AMENDMENT TO THE CHNA WAS ADOPTED THAT FURTHER DESCRIBES THE PROCESSES USED TO IDENTIFY AND PRIORITIZE THE HEALTH NEEDS AND THE RESOURCES THAT ASSIST IN MEETING THOSE NEEDS FOR DEKALB COUNTY. |
Supplemental Information Detail SupplementalInformationDetail (16 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 3C: | EQUITY IN A HOME OTHER THAN THE PATIENT OR GUARANTOR'S PRIMARY RESIDENCE. |
| PART I, LINE 7: | PART I, LINE 7ATHE FINANCIAL ASSISTANCE COST REPORTED ON LINE 7A IS CALCULATED UNDER THE COST TO CHARGE RATIO METHODOLOGY. UNDER THIS METHOD, THE FINANCIAL ASSISTANCE CHARGES FOREGONE ARE MULTIPLIED BY THE RATIO OF COST TO CHARGES TO DETERMINE THE COST OF SERVICES RENDERED.PART I, LINE 7BDEKALB MEMORIAL HOSPITAL, INC. ACCEPTS ALL MEDICAID, MEDICAID MANAGED CARE, AND OUT-OF-STATE MEDICAID PATIENTS WITH THE KNOWLEDGE THAT THERE MAY BE SHORTFALLS. INTERNAL REVENUE SERVICE (IRS) REVENUE RULING 69-545 IMPLIES THAT TREATING MEDICAID PATIENTS IS A COMMUNITY BENEFIT. IRS REVENUE RULING 69-545, WHICH ESTABLISHED THE COMMUNITY BENEFIT STANDARD FOR NONPROFIT HOSPITALS, STATES THAT IF A HOSPITAL SERVES PATIENTS WITH GOVERNMENTAL HEALTH BENEFITS, INCLUDING MEDICAID, THEN THIS IS AN INDICATION THAT THE HOSPITAL OPERATES TO PROMOTE THE HEALTH OF THE COMMUNITY. THE UNREIMBURSED MEDICAID COST REPORTED ON LINE 7B IS CALCULATED UNDER THE COST TO CHARGE RATIO METHODOLOGY. UNDER THIS METHOD, THE MEDICAID CHARGES ARE MULTIPLIED BY THE RATIO OF COST TO CHARGES TO DETERMINE THE COST OF MEDICAID SERVICES RENDERED. THEN, THE COST OF MEDICAID SERVICES RENDERED IS DEDUCTED FROM THE REIMBURSEMENT RECEIVED FOR MEDICAID PATIENTS TO ARRIVE AT A GAIN/(LOSS) RELATIVE TO THESE PATIENTS.PART I, LINE 7CDEKALB MEMORIAL HOSPITAL, INC. ACCEPTS ALL MEANS-TESTED PATIENTS FROM THE HEALTHY INDIANA PLAN (HIP) WITH THE KNOWLEDGE THAT THERE MAY BE SHORTFALLS. INTERNAL REVENUE SERVICE (IRS) REVENUE RULING 69-545 IMPLIES THAT TREATING MEANS-TESTED PATIENTS IS A COMMUNITY BENEFIT. IRS REVENUE RULING 69-545, WHICH ESTABLISHED THE COMMUNITY BENEFIT STANDARD FOR NONPROFIT HOSPITALS, STATES THAT IF A HOSPITAL SERVES PATIENTS WITH GOVERNMENTAL HEALTH BENEFITS, INCLUDING HIP, THEN THIS IS AN INDICATION THAT THE HOSPITAL OPERATES TO PROMOTE THE HEALTH OF THE COMMUNITY. THE UNREIMBURSED HIP COST REPORTED ON LINE 7C IS CALCULATED UNDER THE COST TO CHARGE RATIO METHODOLOGY. UNDER THIS METHOD, THE HIP CHARGES ARE MULTIPLIED BY THE RATIO OF COST TO CHARGES TO DETERMINE THE COST OF HIP SERVICES RENDERED. THEN, THE COST OF HIP SERVICES RENDERED IS DEDUCTED FROM THE REIMBURSEMENT RECEIVED FOR HIP PATIENTS TO ARRIVE AT A GAIN/(LOSS) RELATIVE TO THESE PATIENTS.PART I, LINE 7EAMOUNTS PRESENTED ARE BASED ON ACTUAL SPEND FOR THOSE SERVICES AND BENEFITS PROVIDED DEEMED TO IMPROVE THE HEALTH OF THE COMMUNITIES IN WHICH WE SERVE AND CONFORM WITH THE MISSION OF OUR EXEMPT PURPOSE.PART I, LINE 7IIN KEEPING WITH OUR MISSION AND COMMITMENT TO THE COMMUNITIES IN WHICH WE SERVE, DEKALB MEMORIAL HOSPITAL, INC. CONTINUES ITS TRADITION OF CONTRIBUTING TO NUMEROUS ORGANIZATIONS ON BOTH AN AS-NEEDED BASIS AND NEGOTIATED BASIS. AMOUNTS PRESENTED REPRESENT ACTUAL SPEND TO ORGANIZATIONS THROUGHOUT OUR COMMUNITIES. |
| PART I, LN 7 COL(F): | PERCENT OF TOTAL EXPENSEDEKALB MEMORIAL HOSPITAL, INC. EXCLUDED $3,385,350 OF PH CLINICAL SUPPORT EXPENSE. |
| PART II, COMMUNITY BUILDING ACTIVITIES: | DESCRIBE HOW THE ORGANIZATION'S COMMUNITY BUILDING ACTIVITIES, AS REPORTED, PROMOTES THE HEALTH OF THE COMMUNITIES THE ORGANIZATION SERVES.THE HOSPITAL PARTNERS WITH THE DEKALB CHAMBER PARTNERSHIP AND DEKALB COUNTY ECONOMIC DEVELOPMENT TO IMPROVE THE BUSINESS AND DEVELOPMENT EFFORTS WITHIN THE COUNTY. THE HOSPITAL PARTICIPATED AND PARTNERED WITH THE CHAMBER IN LEADERSHIP DEVELOPMENT INITIATIVES ACROSS THE COUNTY. THE HOSPITAL PARTNERED WITH OTHER COMMUNITY LEADERS AND DEKALB COUNTY ECONOMIC DEVELOPMENT TO DEVELOP A PROSPECTUS. THE HOSPITAL HAS ALSO INVESTED IN PHYSICIAN AND ADVANCED PRACTITIONER PROVIDER RECRUITMENT IN MEDICALLY UNDERSERVED AREAS SUCH AS BUTLER INDIANA. THIS INVESTMENT IS ESSENTIAL TO PROVIDE SERVICES TO PATIENTS IN RURAL AREAS OF DEKALB COUNTY. |
| PART III, LINE 2: | FOR FINANCIAL STATEMENT PURPOSES, THE ORGANIZATION HAS ADOPTED ACCOUNTING STANDARDS UPDATE NO. 2014-09 (TOPIC 606). IMPLICIT PRICE CONCESSIONS INCLUDES BAD DEBTS. THEREFORE, BAD DEBTS ARE INCLUDED IN NET PATIENT REVENUE IN ACCORDANCE WITH HEALTHCARE FINANCIAL MANAGEMENT ASSOCIATION STATEMENT NO. 15 AND BAD DEBT EXPENSE IS NOT SEPARATELY REPORTED AS AN EXPENSE. 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 DEKALB MEMORIAL 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. DEKALB MEMORIAL HOSPITAL, INC. ACCEPTS ALL MEDICARE PATIENTS, AS REFLECTED ON THE YEAR-END MEDICARE COST REPORT, WITH THE KNOWLEDGE THAT THERE MAY BE SHORTFALLS. INTERNAL REVENUE SERVICE (IRS) REVENUE RULING 69-545 IMPLIES THAT TREATING MEDICARE PATIENTS IS A COMMUNITY BENEFIT. IRS REVENUE RULING 69-545, WHICH ESTABLISHED THE COMMUNITY BENEFIT STANDARD FOR NONPROFIT HOSPITALS, STATES THAT IF A HOSPITAL SERVES PATIENTS WITH GOVERNMENTAL HEALTH BENEFITS, INCLUDING MEDICARE, THEN THIS IS AN INDICATION THAT THE HOSPITAL OPERATES TO PROMOTE THE HEALTH OF THE COMMUNITY. HOWEVER, MEDICARE PAYMENTS REPRESENT A PROXY OF COST CALLED THE "UPPER PAYMENT LIMIT." IT HAS HISTORICALLY BEEN ASSUMED THAT UPPER PAYMENT LIMIT PAYMENTS DO NOT GENERATE A SHORTFALL. AS A RESULT, DEKALB MEMORIAL HOSPITAL, INC. HAS TAKEN THE POSITION NOT TO INCLUDE THE MEDICARE SHORTFALLS OR SURPLUSES AS PART OF COMMUNITY BENEFIT. DEKALB MEMORIAL HOSPITAL, INC. RECOGNIZES THAT THE SHORTFALL OR SURPLUS FROM MEDICARE DOES NOT INCLUDE THE COSTS AND REVENUES ASSOCIATED WITH MEDICARE ADVANTAGE PATIENTS. AS SUCH, THE TOTAL SHORTFALL OR SURPLUS OF MEDICARE IS UNDERSTATED DUE TO THE COSTS AND REVENUES ASSOCIATED WITH MEDICARE ADVANTAGE PATIENTS NOT BEING INCLUDED IN THE COMMUNITY BENEFIT DETERMINATION. |
| PART III, LINE 9B: | 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.THE HOSPITAL ASSESSES THE HEALTH CARE NEEDS OF THE COMMUNITY THROUGH PERIODIC FOCUS GROUP MEETINGS WHICH ARE PREPARED EVERY 3 YEARS TO ASSESS THE NEEDS OF THE COMMUNITY. THESE FOCUS GROUPS INCLUDE INPUT FROM INDIVIDUALS, HEALTH PROFESSIONALS, GOVERNMENTAL HEALTH CARE OFFICIALS AS WELL AS REPRESENTATIVES FROM DEKALB MEMORIAL HOSPITAL, INC. THE SURVEY SOLICITS INPUT ON THE CURRENT HEALTH CARE NEEDS OF THE COMMUNITY. THESE NEEDS AND CONCERNS ARE EVALUATED AND APPROPRIATE PLANS ARE PUT INTO ACTION TO DEAL WITH THE MOST PRESSING ISSUES.HOSPITAL LEADERS MEET REGULARLY WITH COMMUNITY ORGANIZATIONS TO ENSURE APPROPRIATE FOCUS OF HEALTH CARE NEEDS ARE MET EACH YEAR. THROUGH THE FEEDBACK OF COMMUNITY PARTNERS, THE HOSPITAL CAN REDISTRBUTE RESOURCES AND FUNDS BASED ON THE NEEDS IN THE COMMUNITY. |
| PART VI, LINE 3: | DESCRIBE HOW THE ORGANIZATION INFORMS AND EDUCATES PATIENTS AND PERSONS WHO MAY BE BILLED FOR PATIENT CARE ABOUT THEIR ELIGIBILITY FOR ASSISTANCE UNDER FEDERAL, STATE OR LOCAL GOVERNMENT PROGRAMS OR UNDER THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY.SIGNAGE AND BROCHURES ARE POSTED AND AVAILABLE AT ALL HOSPITAL POINTS OF REGISTRATION AND IN THE EMERGENCY DEPARTMENT. PATIENTS ARE OFFERED PLAIN LANGUAGE SUMMARIES OF THE FINANCIAL ASSISTANCE POLICY DURING THE REGISTRATION PROCESS AND IN EACH FOLLOW UP STATEMENT SENT TO THE PATIENT. PATIENT STATEMENTS WILL INDICATE HOW A PATIENT CAN OBTAIN FINANCIAL ASSISTANCE APPLICATIONS AND WHO THEY CAN CONTACT FOR ASSISTANCE. |
| PART VI, LINE 4: | DESCRIBE THE COMMUNITY THE ORGANIZATION SERVES, TAKING INTO ACCOUNT THE GEOGRAPHIC AREA AND DEMOGRAPHIC CONSTITUENTS IT SERVES.DEKALB MEMORIAL HOSPITAL, INC, IS THE SOLE COMMUNITY HOSPITAL LOCATED IN DEKALB COUNTY, SERVING DEKALB, PORTIONS OF STEUBEN, LAGRANGE, NOBLE, AND ALLEN COUNTIES IN ADDITION TO SEVERAL BORDER TOWNS OF HICKSVILLE AND EDGERTON IN NORTHWEST OHIO, THE PRIMARY SERVICE AREA POPULATION OF DEKALB MEMORIAL HOSPITAL IS APPROXIMATELY 55,064 WITH APPROXIMATELY 97.4% RECORDED AS WHITE. DEKALB HAS SEEN AN INCREASE IN THE UNINSURED AND UNDERINSURED WITH A REPORTED AMOUNT OF 9.5% OF RESIDENTS LIVING BELOW THE POVERTY LEVEL. THE PERCENTAGE OF UNINSURED WITHIN THE AREA SERVED BY DEKALB MEMORIAL HOSPITAL IS 8.1%. THE DEMOGRAPHIC AREA SERVED BY DEKALB MEMORIAL HOSPITAL, INC. IS MADE UP OF A MEDIAN HOUSEHOLD INCOME OF APPROXIMATELY $61,563, THE MEDIAN AGE IS 38.9 AND CONTAINS PRIMARILY A BLUE COLLAR AND AGRICULTURAL WORKFORCE. |
| PART VI, LINE 5: | PROVIDE ANY OTHER INFORMATION IMPORTANT TO DESCRIBING HOW THE ORGANIZATION'S HOSPITAL FACILITIES OR OTHER HEALTH CARE FACILITIES FURTHER ITS EXEMPT PURPOSE BY PROMOTING THE HEALTH OF THE COMMUNITY (E.G. OPEN MEDICAL STAFF, COMMUNITY BOARD, USE OF SURPLUS FUNDS, ETC.).THE DEKALB MEMORIAL HOSPITAL, INC., BOARD OF DIRECTORS COMPRISES INDEPENDENT COMMUNITY MEMBERS WHO RESIDE IN THE HOSPITAL'S PRIMARY SERVICE AREA. THE HOSPITAL ALSO EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN THE COMMUNITY. PEOPLE THROUGHOUT THE COMMUNITY CAN COUNT ON DEKALB MEMORIAL HOSPITAL, INC., TO BE STANDING BY WITH EMERGENCY CARE 24 HOURS A DAY, 365 DAYS A YEAR. THE EMERGENCY DEPARTMENT IS STAFFED WITH BOARD-CERTIFIED EMERGENCY CARE PHYSICIANS AND A NURSING STAFF THAT IS TRAINED AND EXPERIENCED IN EMERGENCY CARE. FURTHERMORE, NO PATIENT IS EVER DENIED TREATMENT, REGARDLESS OF THEIR ABILITY TO PAY. THE ORGANIZATION FURTHERS ITS EXEMPT PURPOSE BY PROMOTING HEALTH OF THE COMMUNITY THROUGH THE FOLLOWING: AN OPEN MEDICAL STAFF, AND THE USE OF SURPLUS FUNDS TO PROVIDE HIGH QUALITY HEALTHCARE SERVICES TO THE CITIZENS RESIDING IN ITS SERVICE AREA, PARTNERSHIPS WITH LOCAL BUSINESSES TO ENCOUARGE HEALTHY LIFESTYLES, AS WELL AS PROVIDED EDUCATIONAL RESOURCES THRU DIFFERENT MEDIA FORUMS. IN ADDITION, MANY OF THE HOSPITAL'S MANAGERS AND STAFF DONATE THEIR TIME TO SUPPORT ST. MARTIN'S HEALTHCARE CLINIC (FOR UNINSURED) AS WELL AS SERVE ON THE BOARD OF THE UNITED WAY, COMMUNITY FOUNDATION OF DEKALB COUNTY, ST. MARTIN'S HEALTHCARE CLINIC AND THE JAM CENTER. |
| 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 4)"EXCELLENT CARE, EVERY PERSON, EVERY DAY". PARKVIEW CONTRIBUTES TO THE OVERALL SUCCESS OF THE REGION THROUGH SIGNIFICANT INVOLVEMENT IN THE COMMUNITIES WE SERVE, BY DEVELOPING VARIOUS PARTNERSHIPS AND ALIGNMENTS WITH DIFFERENT SECTORS AND ORGANIZATIONS, PARKVIEW HELPS TO BENEFIT THE ECONOMY, QUALITY OF LIFE AND HEALTH/WELL-BEING ACROSS THE REGION, WITH A CONSISTENT FOCUS ON OUR MISSION AND VISION, WE WORK TO PROVIDE THE BEST CARE TO EVERY PERSON, EVERY DAY WITHIN OUR FACILITIES WHILE SERVING AS GOOD STEWARDS OF SURPLUS FUNDS IN OUR EFFORTS TO POSITIVELY IMPACT COMMUNITY HEALTH STATUS. |
| PART VI, LINE 7, REPORTS FILED WITH STATES | IN |
| PART VI, LINE 7: | A COPY OF FORM 990, SCHEDULE H IS FILED WITH THE INDIANA STATE DEPARTMENT OF HEALTH. |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (1) | GrantRecordsMaintainedInd |
Recipient Table RecipientTable (3 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | Recipient EINRecipientEIN | IRC SectionIRCSectionDesc | Cash GrantCashGrantAmt | Purpose Of GrantPurposeOfGrantTxt |
|---|---|---|---|---|---|---|---|
| DEKALB COUNTY COMMUNITY FOUNDATION INC | |||||||
| P O BOX 111 700 S MAIN STREET | AUBURN | IN | 46706 | 351992897 | 501(C)(3) | $15,000 | PROGRAMS TO IMPROVE LIFE IN DEKALB COUNTY |
| GARRETT COMMUNITY CENTER INC | |||||||
| 1200 E HOUSTON STREET | GARRETT | IN | 46738 | 352010882 | 501(C)(3) | $10,996 | PROGRAMS TO CELEBRATE AND STRENGTHEN THE VIBRANT COMMUNITY BY CONNECTING PEOPLE AND ORGANIZATIONS THROUGH ACTIVITIES THAT IMPROVE THE QUALITY OF LIFE FOR THE GREATER GARRETT INDIANA AREA |
| PARKVIEW DEKALB HOSPITAL FOUNDATION INC | |||||||
| 1316 EAST SEVENTH STREET | AUBURN | IN | 46845 | 356047817 | 501(C)(3) | $10,524 | PROGRAM SERVICES |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 3 | Total501c3OrgCnt |
| Total Other Org | 0 | TotalOtherOrgCnt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 2: | FormAndLineReferenceDesc |
| Explanation | COMMUNITY HEALTH IMPROVEMENT FUNDING PARTNER ORGANIZATIONS ARE REQUIRED TO SUBMIT AN ANNUAL PROGRESS REPORT RELATED TO PROGRAM FUNDING. PARTNER ORGANIZATIONS ARE REQUIRED TO RE-APPLY FOR FUNDING ON AN ANNUAL BASIS. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (1) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | Yes (1) | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (14 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| MICHAEL PACKNETT | ||||||||||||||
| DIRECTOR/PH PRESIDENT & CEO | $0 | $1,193,402 | $0 | $487,482 | $0 | $367,537 | $0 | $1,624,548 | $0 | $32,305 | $0 | $3,705,274 | $0 | $319,527 |
| JEANNE' WICKENS | ||||||||||||||
| PH CHIEF FINANCIAL OFFICER | $0 | $750,792 | $0 | $262,181 | $0 | $71,579 | $0 | $309,952 | $0 | $29,943 | $0 | $1,424,447 | $0 | $49,457 |
| PHILIP CHASE | ||||||||||||||
| FORMER HC/CURRENT PH PHYSICIAN | $0 | $347,940 | $0 | $74,329 | $0 | $27,356 | $0 | $19,950 | $0 | $32,499 | $0 | $502,074 | $0 | $0 |
| JAMES INGRAM | ||||||||||||||
| FORMER HC/CURRENT PH PHYSICIAN | $0 | $285,848 | $0 | $97,252 | $0 | $24,518 | $0 | $19,950 | $0 | $34,977 | $0 | $462,545 | $0 | $0 |
| ROBERT BURTON | ||||||||||||||
| DIRECTOR/PH PHYSICIAN | $0 | $243,348 | $0 | $71,192 | $0 | $24,817 | $0 | $19,950 | $0 | $33,135 | $0 | $392,442 | $0 | $0 |
| NATASHA EICHER | ||||||||||||||
| DIRECTOR/DMHOS PRESIDENT | $220,611 | $0 | $1,000 | $0 | $20,288 | $0 | $56,407 | $0 | $35,159 | $0 | $333,465 | $0 | $0 | $0 |
| PAUL REXROTH | ||||||||||||||
| FORMER HC/CURRENT PH PHYSICIAN | $0 | $195,994 | $0 | $34,514 | $0 | $27,356 | $0 | $18,071 | $0 | $32,728 | $0 | $308,663 | $0 | $0 |
| KARRA HEGGEN | ||||||||||||||
| DMHOS VP PAT CARE SVCS | $184,773 | $0 | $1,000 | $0 | $22,338 | $0 | $10,304 | $0 | $13,213 | $0 | $231,628 | $0 | $0 | $0 |
| BRET CLAGHORN | ||||||||||||||
| FORMER OFFICER/CURRENT PH VP | $0 | $181,415 | $0 | $1,000 | $0 | $619 | $0 | $13,275 | $0 | $34,231 | $0 | $230,540 | $0 | $0 |
| DOUGLAS CRANE | ||||||||||||||
| DMHOS PHARMACY SPV | $142,832 | $0 | $1,000 | $0 | $1,944 | $0 | $13,379 | $0 | $23,001 | $0 | $182,156 | $0 | $0 | $0 |
| JACOB CLENDENEN | ||||||||||||||
| DMHOS PHARMACIST | $137,845 | $0 | $1,000 | $0 | $180 | $0 | $2,918 | $0 | $31,806 | $0 | $173,749 | $0 | $0 | $0 |
| LON KEYES | ||||||||||||||
| DMHOS PHARMACY MGR | $148,322 | $0 | $1,000 | $0 | $1,283 | $0 | $9,022 | $0 | $11,381 | $0 | $171,008 | $0 | $0 | $0 |
| BETHANY HEILEMAN | ||||||||||||||
| DMHOS PHARMACIST | $121,351 | $0 | $1,000 | $0 | $147 | $0 | $11,430 | $0 | $29,311 | $0 | $163,239 | $0 | $0 | $0 |
| ANTHONY STUMP | ||||||||||||||
| DMHOS MGR REHAB | $84,706 | $28,360 | $1,000 | $1,000 | $2,380 | $0 | $6,410 | $2,137 | $23,163 | $7,720 | $117,659 | $39,217 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 3 | RELATED ORGANIZATION, PARKVIEW HEALTH SYSTEM, INC., USES THE FOLLOWING TO ESTABLISH THE COMPENSATION OF DEKALB MEMORIAL HOSPITAL, INC.'S CEO/EXECUTIVE DIRECTOR: COMPENSATION COMMITTEE OF RELATED ORGANIZATION PARKVIEW HEALTH SYSTEM, INC. INDEPENDENT COMPENSATION CONSULTANT FORM 990 OF OTHER ORGANIZATIONS COMPENSATION SURVEY OR STUDY APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE OF RELATED ORGANIZATION PARKVIEW HEALTH SYSTEM, INC. |
| PART I, LINE 4B | SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN PAYMENTS THE FOLLOWING INDIVIDUALS PARTICIPATE IN SUPPLEMENTAL NONQUALIFIED DEFERRED COMPENSATION PLANS. BENEFITS EARNED UNDER THE PLANS WILL FUND THE EMPLOYEES' EVENTUAL RETIREMENT BENEFIT. THESE BENEFITS ARE PROVIDED IN EXCHANGE FOR THE EMPLOYEES' YEARS OF SERVICE TO THE ORGANIZATION AND THE AMOUNT OF THE BENEFITS MAY VARY FROM YEAR TO YEAR. THE FOLLOWING INDIVIDUALS VESTED IN A PORTION OF THEIR DEFERRED COMPENSATION PLANS, WHICH IS TREATED AS TAXABLE INCOME TO THE INDIVIDUALS AT THE TIME OF VESTING. THESE AMOUNTS ARE REPORTED IN SCHEDULE J, PART II, COLUMN (B)(III): MICHAEL PACKNETT $319,527; JEANNE' WICKENS $49,457 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: NATASHA EICHER $39,015; 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. |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (11 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART V, LINES 1A AND 2A: | PARKVIEW HEALTH SYSTEM, INC.(PH), EIN 35-1972384, IS THE COMMON PAYING AGENT FOR THE FILING ORGANIZATION, DEKALB MEMORIAL HOSPITAL, INC., EIN 35-1064295. THEREFORE, ALL APPLICABLE IRS TAX FILINGS, INCLUDING FORMS 1099, 1096, W-2 AND W-3 ARE REPORTED AND FILED BY PH. THE TOTAL NUMBER REPORTED IN BOX 3 OF FORM 1096 AND FILED BY THE COMMON PAYING AGENT, PH, FOR THE YEAR ENDED DECEMBER 31, 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 DEKALB MEMORIAL HOSPITAL, INC. WAS 40 AND 417 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 CHIEF OF THE MEDICAL STAFF, AND SUCH OTHER PERSONS AS IDENTIFIED BY THE CHAIR OF THE BOARD, EACH OF WHOM SHALL BE ENTITLED TO VOTE. IN NO EVENT SHALL THE MEMBERS OF THE EXECUTIVE COMMITTEE EXCEED EIGHT (8) PEOPLE. THE EXECUTIVE COMMITTEE MAY ACT ON BEHALF OF THE CORPORATION AS THE PLANNING COMMITTEE AND IN ANY OTHER MATTER WHEN THE BOARD IS NOT IN SESSION, REPORTING TO THE BOARD FOR ITS RATIFICATION OF ITS ACTION. THE CHAIR OF THE BOARD SHALL SERVE AS CHAIR OF THE EXECUTIVE COMMITTEE. MEETINGS OF THE EXECUTIVE COMMITTEE MAY BE CALLED BY THE CHAIR OR BY THREE (3) MEMBERS. |
| FORM 990, PART VI, SECTION A, LINE 6 | THE ORGANIZATION IS ORGANIZED AS A NOT-FOR-PROFIT CORPORATION. PURSUANT TO THE ORGANIZATION'S GOVERNING DOCUMENTS, PARKVIEW HEALTH SYSTEM, INC. EIN 35-1972384 IS THE SOLE MEMBER OF DEKALB MEMORIAL HOSPITAL, INC. WITH CERTAIN RESERVED POWERS. |
| FORM 990, PART VI, SECTION A, LINE 7A | THE CORPORATE MEMBER, PARKVIEW HEALTH SYSTEM, INC. EIN 35-1972384, SHALL HAVE THE FOLLOWING RESERVED POWERS AS DEFINED IN THE NETWORK AGREEMENT: (I) APPOINT (INCLUDING TO FILL A VACANCY) AND REMOVE, WITH OR WITHOUT CAUSE, MEMBERS OF THE BOARD SUBJECT TO THE COMPOSITION REQUIREMENTS REGARDING COMMUNITY AND PHYSICIAN REPRESENTATION SET FORTH IN ARTICLE V, SECTION 2; (II) APPOINT (INCLUDING TO FILL A VACANCY) AND REMOVE, WITH OR WITHOUT CAUSE, THE CHAIR AND VICE CHAIR OF THE BOARD AND THE PRESIDENT OF THE CORPORATION; (III) APPROVE AND/OR REQUIRE THE ADOPTION OF AMENDMENTS TO THE ARTICLES OF INCORPORATION OR BYLAWS OF THE CORPORATION OR ANY SUBSIDIARY OR AFFILIATE OF THE CORPORATION; (IV) APPROVE AND/OR REQUIRE THE ESTABLISHMENT, ACQUISITION, DIVESTITURE, DISSOLUTION, CLOSURE, MERGER, CONSOLIDATION, CHANGE IN CORPORATE MEMBERSHIP, JOINT VENTURE, PARTNERSHIP, AFFILIATION OR CORPORATE REORGANIZATION OF THE CORPORATION OR ANY SUBSIDIARY OR AFFILIATE OF THE CORPORATION; (V) APPROVE AND ADOPT THE STRATEGIC PLAN AND ANY AMENDMENTS THERETO, INCLUDING ANY INDIVIDUAL INITIATIVES OR ARRANGEMENTS, SUCH AS A NEW SERVICE OR CONTRACTUAL ARRANGEMENT DEEMED BY THE CORPORATE MEMBER TO BE OF STRATEGIC IMPORTANCE FOR THE CORPORATION AND ANY SUBSIDIARY OR AFFILIATE OF THE CORPORATION, FOR THE CORPORATION AND ANY SUBSIDIARY OR AFFILIATE OF THE CORPORATION; (VI) APPROVE AND/OR REQUIRE THE INCURRENCE OF ANY DEBT, INCLUDING THE ISSUANCE OF ANY BONDS, PROPOSED BY THE CORPORATION OR ANY SUBSIDIARY OR AFFILIATE OF THE CORPORATION IN EXCESS OF LIMITS SPECIFIED IN THE POLICY OF THE CORPORATE MEMBER; (VII) APPROVE AND/OR REQUIRE THE APPROVAL OF CONTRACTS OR LOANS OBLIGATING THE CORPORATION TO EXPEND OR REPAY AN AMOUNT IN EXCESS OF LIMITS SPECIFIED IN THE POLICY OF THE CORPORATE MEMBER; (VIII) APPROVE AND/OR REQUIRE THE SALE, LEASE, EXCHANGE, MORTGAGE, PLEDGE, TRANSFER, ENCUMBRANCE OR OTHER DISPOSITION OF PROPERTY AND ASSETS OF THE CORPORATION IN EXCESS OF LIMITS SPECIFIED IN THE POLICY OF THE CORPORATE MEMBER; (IX) APPROVE AND ADOPT THE CAPITAL BUDGET, OPERATING BUDGET, FINANCIAL PLANS AND ANY AMENDMENTS THERETO FOR THE CORPORATION AND ANY SUBSIDIARY OR AFFILIATE OF THE CORPORATION; (X) APPROVE AND/OR REQUIRE THE ADOPTION OF A MANAGED CARE POLICY FOR THE CORPORATION AND ANY SUBSIDIARY OR AFFILIATE OF THE CORPORATION, INCLUDING NETWORK PARTICIPATION, PARTICIPATION IN ANY MANAGED CARE AGREEMENT AND PARTICIPATION IN ANY OTHER HEALTH CARE SERVICE ARRANGEMENTS; (XI) APPOINT AND REMOVE AUDITORS, ATTORNEYS AND OTHER PROFESSIONAL ADVISORS FOR THE CORPORATION AND ANY SUBSIDIARY OR AFFILIATE OF THE CORPORATION; (XII) DEVELOP, APPROVE AND/OR REQUIRE THE ADOPTION OF MEDICAL STAFF QUALITY ASSURANCE STANDARDS, UTILIZATION REVIEW STANDARDS, CRITERIA, POLICIES AND PROCEDURES FOR THE CORPORATION AND ANY SUBSIDIARY OR AFFILIATE OF THE CORPORATION; (XIII) APPROVE AND/OR REQUIRE THE ADOPTION OF ANY ACTION TO CHANGE THE CORPORATION FROM A GENERAL, ACUTE CARE COMMUNITY HOSPITAL OR TO CLOSE THE CORPORATION'S CURRENT LOCATION; (XIV) APPROVE EACH ANNUAL LIST OF PROPOSED DONORS AND AMOUNTS OF DONATIONS OR GRANTS NOT INCLUDED IN THE ANNUAL BUDGET, AND MAKE PROPOSALS TO DEVIATE THEREFROM THROUGHOUT EACH YEAR IN EXCESS OF LIMITS SPECIFIED IN THE POLICY OF THE CORPORATE MEMBER; AND (XV) APPROVE AND/OR REQUIRE THE ADOPTION OF ANY ACTION THAT IS INCONSISTENT WITH THE POLICY OF THE CORPORATE MEMBER. |
| FORM 990, PART VI, SECTION A, LINE 7B | SEE SCHEDULE O EXPLANATION FOR FORM 990, PART VI, SECTION A, LINE 7A |
| FORM 990, PART VI, SECTION B, LINE 11B | PURSUANT TO PARKVIEW HEALTH SYSTEM INC.'S BYLAWS, THE SYSTEM AUDIT COMMITTEE MAY ACT ON BEHALF OF THE CORPORATION TO PROVIDE REVIEW OF THE CORPORATION AND ITS SUBSIDIARY CORPORATIONS' FORM 990 FILINGS. HUNTINGTON MEMORIAL HOSPITAL, INC. IS A SUBSIDIARY CORPORATION OF PARKVIEW HEALTH SYSTEM, INC. AN ELECTRONIC COPY OF THE ORGANIZATION'S FINAL FORM 990 (INCLUDING REQUIRED SCHEDULES) WAS PROVIDED TO EACH VOTING MEMBER OF THE ORGANIZATION'S GOVERNING BODY AND THE SYSTEM AUDIT COMMITTEE, PRIOR TO FILING WITH THE IRS. ON OCTOBER 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, 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 71,691. |
Schedule R IRS990ScheduleR
Id Disregarded Entities IdDisregardedEntitiesGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DEKALB MEMORIAL PHARMACARE LLC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1316 EAST SEVENTH STREET | AddressLine1Txt |
| City | AUBURN | CityNm |
| State Abbreviation | IN | StateAbbreviationCd |
| ZIP | 46706 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 273514342 | EIN |
| Primary Activities | PHARMACY | PrimaryActivitiesTxt |
| Legal Domicile State | IN | LegalDomicileStateCd |
| Total Income | $6,146,039 | TotalIncomeAmt |
| End Of Year Assets | $1,636,558 | EndOfYearAssetsAmt |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DEKALB MEMORIAL HOSPITAL INC | BusinessNameLine1Txt |
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (18 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Direct Controlling NADirectControllingNACd | Controlled OrganizationControlledOrganizationInd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt |
|---|---|---|---|---|---|---|---|---|---|---|---|
| PARKVIEW HEALTH SYSTEM INC | |||||||||||
| 1450 PRODUCTION RD | FORT WAYNE | IN | 46808 | 351972384 | HEALTH CARE | IN | 501(C)(3) | LINE 12C, III-FI | N/A | 0 | |
| PARKVIEW DEKALB HOSPITAL FOUNDATION INC | |||||||||||
| 1316 EAST SEVENTH STREET | AUBURN | IN | 46706 | 320012095 | FUND MGMT | IN | 501(C)(3) | LINE 12A, I | Yes (1) | DEKALB MEMORIAL HOSPITAL INC | |
| COMMUNITY HOSPITAL OF LAGRANGE COUNTY INC | |||||||||||
| 207 N TOWNLINE ROAD | LAGRANGE | IN | 46761 | 202401676 | HOSPITAL CARE | IN | 501(C)(3) | LINE 3 | 0 | PARKVIEW HEALTH SYSTEM INC | |
| COMMUNITY HOSPITAL OF NOBLE COUNTY FOUNDATION INC | |||||||||||
| 401 SAWYER ROAD | KENDALLVILLE | IN | 46755 | 352089183 | FUND MGMT | IN | 501(C)(3) | LINE 12A, I | 0 | COMMUNITY HOSPITAL OF NOBLE COUNTY INC | |
| COMMUNITY HOSPITAL OF NOBLE COUNTY INC | |||||||||||
| 401 SAWYER ROAD | KENDALLVILLE | IN | 46755 | 352087092 | HOSPITAL CARE | IN | 501(C)(3) | LINE 3 | 0 | PARKVIEW HEALTH SYSTEM INC | |
| HUNTINGTON MEMORIAL HOSPITAL INC | |||||||||||
| 2001 STULTS ROAD | HUNTINGTON | IN | 46750 | 351970706 | HOSPITAL CARE | IN | 501(C)(3) | LINE 3 | 0 | PARKVIEW HEALTH SYSTEM INC | |
| MIDWEST COMMUNITY HEALTH ASSOCIATES INC | |||||||||||
| 442 W HIGH STREET | BRYAN | OH | 43506 | 341045870 | PHYSICIANS | OH | 501(C)(3) | LINE 3 | 0 | PARKVIEW HEALTH SYSTEM INC | |
| 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 | 0 | PARKVIEW HEALTH SYSTEM INC | |
| PARK CENTER INC | |||||||||||
| 909 EAST STATE BLVD | FORT WAYNE | IN | 46805 | 351135451 | COMPREHENSIVE MENTAL HEALTH CENTER | IN | 501(C)(3) | LINE 10 | 0 | PARKVIEW HEALTH SYSTEM INC | |
| PARKVIEW FOUNDATION INC | |||||||||||
| 3844 NEW VISION DR | FORT WAYNE | IN | 46845 | 237220589 | FUND MGMT | IN | 501(C)(3) | LINE 12A, I | 0 | PARKVIEW HOSPITAL INC | |
| PARKVIEW HOSPITAL INC | |||||||||||
| 11109 PARKVIEW PLAZA DRIVE | FORT WAYNE | IN | 46845 | 350868085 | HOSPITAL CARE | IN | 501(C)(3) | LINE 3 | 0 | PARKVIEW HEALTH SYSTEM INC | |
| PARKVIEW HUNTINGTON HOSPITAL FOUNDATION INC | |||||||||||
| 2001 STULTS ROAD | HUNTINGTON | IN | 46750 | 320012095 | FUND MGMT | IN | 501(C)(3) | LINE 12A, I | 0 | HUNTINGTON MEMORIAL HOSPITAL INC | |
| PARKVIEW LAGRANGE HOSPITAL FOUNDATION INC | |||||||||||
| 207 N TOWNLINE ROAD | LAGRANGE | IN | 46761 | 833347115 | FUND MGMT | IN | 501(C)(3) | LINE 12A, I | 0 | COMMUNITY HOSPITAL OF LAGRANGE COUNTY INC | |
| PARKVIEW OCCUPATIONAL HEALTH CENTERS INC | |||||||||||
| 1450 PRODUCTION RD | FORT WAYNE | IN | 46808 | 352064353 | OCCUPATIONAL HEALTH | IN | 501(C)(3) | LINE 3 | 0 | PARKVIEW HEALTH SYSTEM INC | |
| PARKVIEW WABASH HOSPITAL FOUNDATION INC | |||||||||||
| 10 JOHN KISSINGER DRIVE | WABASH | IN | 46992 | 351921445 | FUND MGMT | IN | 501(C)(3) | LINE 12A, I | 0 | PARKVIEW WABASH HOSPITAL INC | |
| PARKVIEW WABASH HOSPITAL INC | |||||||||||
| 10 JOHN KISSINGER DRIVE | WABASH | IN | 46992 | 471753440 | HOSPITAL CARE | IN | 501(C)(3) | LINE 3 | 0 | PARKVIEW HEALTH SYSTEM INC | |
| WHITLEY MEMORIAL HOSPITAL FOUNDATION INC | |||||||||||
| 1260 E STATE ROAD 205 | COLUMBIA CITY | IN | 46725 | 311190239 | FUND MGMT | IN | 501(C)(3) | LINE 12A, I | 0 | WHITLEY MEMORIAL HOSPITAL INC | |
| WHITLEY MEMORIAL HOSPITAL INC | |||||||||||
| 1260 E STATE ROAD 205 | COLUMBIA CITY | IN | 46725 | 351967665 | HOSPITAL CARE | IN | 501(C)(3) | LINE 3 | 0 | PARKVIEW HEALTH SYSTEM INC | |
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Predominant Income TypePredominantIncomeTypeTxt | Disproportionate AllocationsDisproportionateAllocationsInd | General Or Managing PartnerGeneralOrManagingPartnerInd |
|---|---|---|---|---|---|---|---|---|---|
| ORTHOPAEDIC HOSPITAL AT PARKVIEW NORTH LLC | |||||||||
| 1450 PRODUCTION RD | FORT WAYNE | IN | 46808 | 260143823 | ORTHO HOSPITAL | IN | N/A | 0 | 0 |
| MANAGED CARE SERVICES LLC | |||||||||
| 1450 PRODUCTION RD | FORT WAYNE | IN | 46808 | 351996535 | HEALTH PLAN ADMIN | IN | N/A | 0 | 0 |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (3 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Direct Controlling NADirectControllingNACd | Entity TypeEntityTypeTxt | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|
| PARKVIEW PROFESSIONAL PROGRAMS INC | |||||||||
| 1450 PRODUCTION RD | FORT WAYNE | IN | 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 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | Yes (1) | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (1) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | Yes (1) | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | Yes (1) | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | Yes (1) | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (1) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (1) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (1) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (1) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | Yes (1) | TransferToOtherOrgInd |
| Transfer From Other Org | Yes (1) | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp
Other Organization Name OtherOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PARKVIEW DEKALB HOSPITAL FOUNDATION INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Transaction Type | M | TransactionTypeTxt |
| Involved | $83,631 | InvolvedAmt |
| Method Of Amount Determination | PART VII SUPPLEMENTAL INFORMATION | MethodOfAmountDeterminationTxt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE R, PART V, LINE 2, COLUMN (C): | FormAndLineReferenceDesc |
| Explanation | THE AMOUNTS REPORTED AS TRANSACTIONS WITH RELATED ORGANIZATIONS ARE CONSISTENT WITH THE AMOUNTS REPORTED ON THE ORGANIZATION'S AUDITED FINANCIAL STATEMENTS UNDER THE GENERALLY ACCEPTED ACCOUNTING STANDARDS DEPENDING ON THE TYPE OF TRANSACTION INVOLVED. | ExplanationTxt |