2021-11-07T10:46:53-06:00 2020-12-31 350921680 CROWE LLP 330 EAST JEFFERSON BLVD PO BOX 7 SOUTH BEND IN 466240007 990 2020-01-01 351064295 DEKALB MEMORIAL HOSPITAL INC DEKA 2603738429 1316 EAST SEVENTH STREET AUBURN IN 46706 JEANNE' WICKENS PH CFO 2602669313 2021-11-05 1 JEANNE WICKENS 999009999 BRITTNEY KOCAJ P01320603 5742323992 3 AAL1 IAL1 2020 2022-09-23 18:48:47Z PARKVIEW DEKALB HOSPITAL MICHAEL J PACKNETT 1450 PRODUCTION RD FORT WAYNE IN 46808 90256275 0 X WWW.PARKVIEW.COM X 1964 IN 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. 11 8 417 24 0 0 0 3094828 15267965 58118268 1786801 1020304 1829516 -41930 18884282 62191470 2517499 49306 0 0 5474934 22629624 0 0 83631 6722514 38215026 14714947 60893956 4169335 1297514 63742332 66142458 16511307 16083196 47231025 50059262 X DEKALB MEMORIAL HOSPITAL, INC. WORKS TO IMPROVE THE HEALTH OF OUR COMMUNITIES AND PROVIDES QUALITY HEALTH SERVICES TO ALL WHO ENTRUST THEIR CARE TO US. 0 0 49288661 49306 58118268 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. 49288661 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 X 40 0 1 417 1 0 0 0 0 0 0 0 0 0 0 0 0 X 11 8 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 IN X JEANNE' WICKENS 2602669313 1450 PRODUCTION RD FORT WAYNE IN 46808 MICHAEL PACKNETT DIRECTOR/PH PRESIDENT & CEO 0.00 40.00 X X 0 2048421 1656853 ROBERT BURTON DIRECTOR/PH PHYSICIAN 0.00 40.00 X 0 339357 53085 NATASHA EICHER DIRECTOR/DMHOS PRESIDENT 40.00 0.00 X X 241899 0 91566 DOUGLAS MORROW DIRECTOR/CHAIR 1.00 1.00 X X 7000 1750 0 THOMAS HARTMAN DIRECTOR 1.00 0.00 X 4500 0 0 THOMAS MASON DIRECTOR 1.00 0.00 X 4500 0 0 MICHAEL TULLIS DIRECTOR 1.00 0.00 X 4500 0 0 BETH FREIDENBERGER DIRECTOR/PARTIAL YEAR 1.00 0.00 X 4500 0 0 BRYAN NUGEN DIRECTOR 1.00 0.00 X 4500 0 0 TRENTON STUCKEY DIRECTOR 1.00 0.00 X 3500 0 0 TRINA CHAPMAN-SMITH DIRECTOR 1.00 0.00 X 2750 0 0 SCOTT PFLUGHOEFT DIRECTOR/SECRETARY/TREASURER 1.00 0.00 X X 1250 0 0 JEANNE' WICKENS PH CHIEF FINANCIAL OFFICER 0.00 40.00 X 0 1084552 339895 KARRA HEGGEN DMHOS VP PAT CARE SVCS 40.00 0.00 X 208111 0 23517 DOUGLAS CRANE DMHOS PHARMACY SPV 40.00 0.00 X 145776 0 36380 JACOB CLENDENEN DMHOS PHARMACIST 40.00 0.00 X 139025 0 34724 LON KEYES DMHOS PHARMACY MGR 40.00 0.00 X 150605 0 20403 BETHANY HEILEMAN DMHOS PHARMACIST 40.00 0.00 X 122498 0 40741 ANTHONY STUMP DMHOS MGR REHAB 29.00 11.00 X 88086 29360 39430 BRET CLAGHORN FORMER OFFICER/CURRENT PH VP 0.00 40.00 X 0 183034 47506 PHILIP CHASE FORMER HC/CURRENT PH PHYSICIAN 0.00 40.00 X 0 449625 52449 JAMES INGRAM FORMER HC/CURRENT PH PHYSICIAN 0.00 40.00 X 0 407618 54927 PAUL REXROTH FORMER HC/CURRENT PH PHYSICIAN 0.00 40.00 X 0 257864 50799 1133000 4801581 2542275 10 1 1 0 PARKVIEW HOSPITAL INC 11109 PARKVIEW PLAZA DRIVE FORT WAYNE IN 46845 LABORATORY SERVICES 1976501 ASSOCIATED ANESTHESIOLOGISTS OF FORT WAY 10315 DAWSON CREEK BLVD SUITE A/B FORT WAYNE IN 46825 ANESTHESIOLOGISTS 789797 FOCUSONE SOLUTIONS LLC 13609 CALIFORNIA STREET OMAHA NE 68154 MEDICAL PERSONNEL 400680 NORTHEAST INTERNAL MEDICINE ASSOC INC 2500 N DETROIT STREET LAGRANGE IN 46761 HOSPITALISTS 318750 HOSPITAL LAUNDRY SERVICES INC 3322 CAVALIER DRIVE FORT WAYNE IN 46808 LAUNDRY SERVICES 168290 7 32178 3062650 395 3094828 NET PATIENT SERVICE REVENUE 622000 51295237 51295237 PHARMACY 446110 6159553 6159553 INTERUNIT RENT 531120 366273 366273 EMS SUBSIDY 621910 200000 200000 REBATES 900099 85353 85353 11852 11852 58118268 382987 382987 384328 642454 -258126 -258126 -258126 28056868 2800 27411799 10552 645069 -7752 637317 637317 CAFETERIA REVENUE 722210 216196 216196 216196 62191470 58118268 0 978374 X 49306 49306 602093 602093 16433049 16433049 5594482 5594482 42640 42640 55171 55171 5576355 5166062 410293 20906 19985 921 1872199 1590697 281502 119 119 1103306 1096264 7042 20769 19152 1617 6342 6123 219 30075 30075 1897833 1878230 19603 238436 203219 35217 MEDICAL SUPPLIES 10445019 10445019 CORP SERVICE ALLOCATION 10007872 10007872 PH CLINICAL SUPPORT 3385350 3385350 HOSPITAL ASSESSMENT FEE 3261527 3261527 251107 110002 57474 83631 60893956 49288661 11521664 83631 4766847 2950 19971290 5163223 8989716 9431926 1630569 1580489 323073 168027 30185785 3088969 27972424 27096816 22397084 88413 301943 63742332 66142458 2931050 2664455 3885767 10123970 8043302 3456287 1489672 16511307 16083196 X 47231025 50059262 47231025 50059262 63742332 66142458 X 1297514 1459032 71691 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 6438 6438 0 PART II-B, LINE 1: OTHER ACTIVITIES - REPRESENTS THE PORTION OF THE DUES PAID TO INDIANA HOSPITAL AND HEALTH ASSOCIATION, AMERICAN HOSPITAL ASSOCIATION AND VARIOUS PROFESSIONAL ASSOCIATIONS USED FOR LOBBYING ACTIVITIES. 2496000 2496000 24158752 1444246 22714506 9290 3204 6086 3303075 1641519 1661556 218668 218668 27096816 LEASE LIABILITY 338440 EST 3RD PARTY SETTLEMENTS 829432 DUE TO/FROM INTERUNIT 217800 RESERVE FOR MALPRACTICE 104000 1489672 X PART X, LINE 2: PARKVIEW HEALTH SYSTEM, INC. AND SUBSIDIARIES - NOTES TO THE CONSOLIDATED FINANCIAL STATEMENTS TEXT OF THE FOOTNOTE TO THE ORGANIZATION'S FINANCIAL STATEMENTS THAT DESCRIBES THE LIABILITY FOR UNCERTAIN TAX POSITIONS UNDER FIN 48 (ASC 740): INCOME TAXES: THE INTERNAL REVENUE SERVICE HAS DETERMINED THAT THE CORPORATION AND CERTAIN AFFILIATED ENTITIES ARE TAX-EXEMPT ORGANIZATIONS AS DEFINED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. CERTAIN SUBSIDIARIES OF THE CORPORATION ARE TAXABLE ENTITIES, THE TAX EXPENSE AND LIABILITIES OF WHICH ARE NOT MATERIAL TO THE CONSOLIDATED FINANCIAL STATEMENTS. THE CORPORATION AND ITS TAX-EXEMPT AFFILIATED ENTITIES EACH FILE A FORM 990 (RETURN OF ORGANIZATION EXEMPT FROM INCOME TAX) ANNUALLY. WHEN THESE RETURNS ARE FILED, IT IS HIGHLY CERTAIN THAT SOME POSITIONS TAKEN WOULD BE SUSTAINED UPON EXAMINATION BY THE TAXING AUTHORITIES, WHILE OTHERS ARE SUBJECT TO UNCERTAINTY ABOUT THE MERITS OF THE POSITION TAKEN OR THE AMOUNT OF THE POSITION THAT WOULD ULTIMATELY BE SUSTAINED. EXAMPLES OF TAX POSITIONS COMMON TO HEALTH SYSTEMS INCLUDE SUCH MATTERS AS THE TAX-EXEMPT STATUS OF EACH ENTITY, THE CONTINUED TAX-EXEMPT STATUS OF BONDS, THE NATURE, CHARACTERIZATION AND TAXABILITY OF JOINT VENTURE INCOME, AND VARIOUS POSITIONS RELATING TO POTENTIAL SOURCES OF UNRELATED BUSINESS TAXABLE INCOME (REPORTED ON FORM 990T). AS OF DECEMBER 31, 2020 AND 2019, THERE ARE NO UNRECOGNIZED TAX BENEFITS RESULTING FROM UNCERTAIN TAX POSITIONS. FORMS 990 AND 990T FILED BY THE CORPORATION AND ITS TAX-EXEMPT AFFILIATED ENTITIES ARE SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE UP TO THREE YEARS FROM THE EXTENDED DUE DATE OF EACH RETURN. FORMS 990 AND 990T FILED BY THE CORPORATION AND ITS TAX-EXEMPT AFFILIATED ENTITIES ARE GENERALLY NO LONGER SUBJECT TO EXAMINATION FOR THE YEAR 2016 AND PRIOR. 1 1 X 1 X 1 X 1 1 1 0 1 1 948911 0 948911 0.01650 5258164 2627726 2630438 0.04570 5592146 3713886 1878260 0.03270 11799221 6341612 5457609 0.09490 52833 0 52833 0.00090 75392 0 75392 0.00130 128225 128225 0.00220 11927446 6341612 5585834 0.09710 800 0 800 0.00000 25000 0 25000 0.00040 25800 25800 0.00040 1 0 12727 7966898 8770838 -803940 X 1 1 1 1 DEKALB MEMORIAL HOSPITAL INC 1316 EAST SEVENTH STREET AUBURN IN 46706 WWW.PARKVIEW.COM 20-005041-1 X X X DEKALB MEMORIAL HOSPITAL INC 1 0 0 1 X X X X X X X X X 19 1 0 1 1 X HTTPS://WWW.PARKVIEW.COM/LOCALHEALTHNEEDS X 1 19 1 HTTPS://WWW.PARKVIEW.COM/LOCALHEALTHNEEDS 0 1 X 200.000000000000 250.000000000000 X X X X X 1 1 X X X 1 X HTTPS://WWW.PARKVIEW.COM/PATIENTS-VISITORS/FINANCIAL-ASSISTANCE X HTTPS://WWW.PARKVIEW.COM/PATIENTS-VISITORS/FINANCIAL-ASSISTANCE X HTTPS://WWW.PARKVIEW.COM/PATIENTS-VISITORS/FINANCIAL-ASSISTANCE X X X X X X 1 X 0 X X X X 1 X 0 0 DEKALB MEMORIAL HOSPITAL, INC. PART V, SECTION B, LINE 5: DESCRIBE HOW THE HOSPITAL FACILITY TOOK INTO ACCOUNT INPUT FROM PERSONS WHO REPRESENT THE COMMUNITY, AND IDENTIFY THE PERSONS THE HOSPITAL FACILITY CONSULTED: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. 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. 1 DEKALB COUNTY COMMUNITY FOUNDATION INC P O BOX 111 700 S MAIN STREET AUBURN IN 46706 351992897 501(C)(3) 15000 PROGRAMS TO IMPROVE LIFE IN DEKALB COUNTY GARRETT COMMUNITY CENTER INC 1200 E HOUSTON STREET GARRETT IN 46738 352010882 501(C)(3) 10996 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) 10524 PROGRAM SERVICES 3 0 PART I, LINE 2: COMMUNITY HEALTH IMPROVEMENT FUNDING PARTNER ORGANIZATIONS ARE REQUIRED TO SUBMIT AN ANNUAL PROGRESS REPORT RELATED TO PROGRAM FUNDING. PARTNER ORGANIZATIONS ARE REQUIRED TO RE-APPLY FOR FUNDING ON AN ANNUAL BASIS. 0 1 0 0 0 0 0 1 0 MICHAEL PACKNETT DIRECTOR/PH PRESIDENT & CEO 0 1193402 0 487482 0 367537 0 1624548 0 32305 0 3705274 0 319527 JEANNE' WICKENS PH CHIEF FINANCIAL OFFICER 0 750792 0 262181 0 71579 0 309952 0 29943 0 1424447 0 49457 PHILIP CHASE FORMER HC/CURRENT PH PHYSICIAN 0 347940 0 74329 0 27356 0 19950 0 32499 0 502074 0 0 JAMES INGRAM FORMER HC/CURRENT PH PHYSICIAN 0 285848 0 97252 0 24518 0 19950 0 34977 0 462545 0 0 ROBERT BURTON DIRECTOR/PH PHYSICIAN 0 243348 0 71192 0 24817 0 19950 0 33135 0 392442 0 0 NATASHA EICHER DIRECTOR/DMHOS PRESIDENT 220611 0 1000 0 20288 0 56407 0 35159 0 333465 0 0 0 PAUL REXROTH FORMER HC/CURRENT PH PHYSICIAN 0 195994 0 34514 0 27356 0 18071 0 32728 0 308663 0 0 KARRA HEGGEN DMHOS VP PAT CARE SVCS 184773 0 1000 0 22338 0 10304 0 13213 0 231628 0 0 0 BRET CLAGHORN FORMER OFFICER/CURRENT PH VP 0 181415 0 1000 0 619 0 13275 0 34231 0 230540 0 0 DOUGLAS CRANE DMHOS PHARMACY SPV 142832 0 1000 0 1944 0 13379 0 23001 0 182156 0 0 0 JACOB CLENDENEN DMHOS PHARMACIST 137845 0 1000 0 180 0 2918 0 31806 0 173749 0 0 0 LON KEYES DMHOS PHARMACY MGR 148322 0 1000 0 1283 0 9022 0 11381 0 171008 0 0 0 BETHANY HEILEMAN DMHOS PHARMACIST 121351 0 1000 0 147 0 11430 0 29311 0 163239 0 0 0 ANTHONY STUMP DMHOS MGR REHAB 84706 28360 1000 1000 2380 0 6410 2137 23163 7720 117659 39217 0 0 PART I, LINE 3 RELATED ORGANIZATION, PARKVIEW HEALTH SYSTEM, INC., USES THE FOLLOWING TO ESTABLISH THE COMPENSATION OF DEKALB MEMORIAL HOSPITAL, INC.'S CEO/EXECUTIVE DIRECTOR: COMPENSATION COMMITTEE OF RELATED ORGANIZATION PARKVIEW HEALTH SYSTEM, INC. INDEPENDENT COMPENSATION CONSULTANT FORM 990 OF OTHER ORGANIZATIONS COMPENSATION SURVEY OR STUDY APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE OF RELATED ORGANIZATION PARKVIEW HEALTH SYSTEM, INC. PART I, LINE 4B SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN PAYMENTS THE FOLLOWING INDIVIDUALS PARTICIPATE IN SUPPLEMENTAL NONQUALIFIED DEFERRED COMPENSATION PLANS. BENEFITS EARNED UNDER THE PLANS WILL FUND THE EMPLOYEES' EVENTUAL RETIREMENT BENEFIT. THESE BENEFITS ARE PROVIDED IN EXCHANGE FOR THE EMPLOYEES' YEARS OF SERVICE TO THE ORGANIZATION AND THE AMOUNT OF THE BENEFITS MAY VARY FROM YEAR TO YEAR. THE FOLLOWING INDIVIDUALS VESTED IN A PORTION OF THEIR DEFERRED COMPENSATION PLANS, WHICH IS TREATED AS TAXABLE INCOME TO THE INDIVIDUALS AT THE TIME OF VESTING. THESE AMOUNTS ARE REPORTED IN SCHEDULE J, PART II, COLUMN (B)(III): 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. 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. DEKALB MEMORIAL PHARMACARE LLC 1316 EAST SEVENTH STREET AUBURN IN 46706 273514342 PHARMACY IN 6146039 1636558 DEKALB MEMORIAL HOSPITAL INC 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 DEKALB MEMORIAL HOSPITAL INC 1 COMMUNITY HOSPITAL OF LAGRANGE COUNTY INC 207 N TOWNLINE ROAD LAGRANGE IN 46761 202401676 HOSPITAL CARE IN 501(C)(3) LINE 3 PARKVIEW HEALTH SYSTEM INC 0 COMMUNITY HOSPITAL OF NOBLE COUNTY FOUNDATION INC 401 SAWYER ROAD KENDALLVILLE IN 46755 352089183 FUND MGMT IN 501(C)(3) LINE 12A, I COMMUNITY HOSPITAL OF NOBLE COUNTY INC 0 COMMUNITY HOSPITAL OF NOBLE COUNTY INC 401 SAWYER ROAD KENDALLVILLE IN 46755 352087092 HOSPITAL CARE IN 501(C)(3) LINE 3 PARKVIEW HEALTH SYSTEM INC 0 HUNTINGTON MEMORIAL HOSPITAL INC 2001 STULTS ROAD HUNTINGTON IN 46750 351970706 HOSPITAL CARE IN 501(C)(3) LINE 3 PARKVIEW HEALTH SYSTEM INC 0 MIDWEST COMMUNITY HEALTH ASSOCIATES INC 442 W HIGH STREET BRYAN OH 43506 341045870 PHYSICIANS OH 501(C)(3) LINE 3 PARKVIEW HEALTH SYSTEM INC 0 PARK CENTER HOLDINGS INC 909 EAST STATE BLVD FORT WAYNE IN 46805 843684074 TO SUPPORT PARK CENTER, INC. IN 501(C)(3) LINE 12D, III-O PARKVIEW HEALTH SYSTEM INC 0 PARK CENTER INC 909 EAST STATE BLVD FORT WAYNE IN 46805 351135451 COMPREHENSIVE MENTAL HEALTH CENTER IN 501(C)(3) LINE 10 PARKVIEW HEALTH SYSTEM INC 0 PARKVIEW FOUNDATION INC 3844 NEW VISION DR FORT WAYNE IN 46845 237220589 FUND MGMT IN 501(C)(3) LINE 12A, I PARKVIEW HOSPITAL INC 0 PARKVIEW HOSPITAL INC 11109 PARKVIEW PLAZA DRIVE FORT WAYNE IN 46845 350868085 HOSPITAL CARE IN 501(C)(3) LINE 3 PARKVIEW HEALTH SYSTEM INC 0 PARKVIEW HUNTINGTON HOSPITAL FOUNDATION INC 2001 STULTS ROAD HUNTINGTON IN 46750 320012095 FUND MGMT IN 501(C)(3) LINE 12A, I HUNTINGTON MEMORIAL HOSPITAL INC 0 PARKVIEW LAGRANGE HOSPITAL FOUNDATION INC 207 N TOWNLINE ROAD LAGRANGE IN 46761 833347115 FUND MGMT IN 501(C)(3) LINE 12A, I COMMUNITY HOSPITAL OF LAGRANGE COUNTY INC 0 PARKVIEW OCCUPATIONAL HEALTH CENTERS INC 1450 PRODUCTION RD FORT WAYNE IN 46808 352064353 OCCUPATIONAL HEALTH IN 501(C)(3) LINE 3 PARKVIEW HEALTH SYSTEM INC 0 PARKVIEW WABASH HOSPITAL FOUNDATION INC 10 JOHN KISSINGER DRIVE WABASH IN 46992 351921445 FUND MGMT IN 501(C)(3) LINE 12A, I PARKVIEW WABASH HOSPITAL INC 0 PARKVIEW WABASH HOSPITAL INC 10 JOHN KISSINGER DRIVE WABASH IN 46992 471753440 HOSPITAL CARE IN 501(C)(3) LINE 3 PARKVIEW HEALTH SYSTEM INC 0 WHITLEY MEMORIAL HOSPITAL FOUNDATION INC 1260 E STATE ROAD 205 COLUMBIA CITY IN 46725 311190239 FUND MGMT IN 501(C)(3) LINE 12A, I WHITLEY MEMORIAL HOSPITAL INC 0 WHITLEY MEMORIAL HOSPITAL INC 1260 E STATE ROAD 205 COLUMBIA CITY IN 46725 351967665 HOSPITAL CARE IN 501(C)(3) LINE 3 PARKVIEW HEALTH SYSTEM INC 0 ORTHOPAEDIC HOSPITAL AT PARKVIEW NORTH LLC 1450 PRODUCTION RD FORT WAYNE IN 46808 260143823 ORTHO HOSPITAL IN N/A 0 0 MANAGED CARE SERVICES LLC 1450 PRODUCTION RD FORT WAYNE IN 46808 351996535 HEALTH PLAN ADMIN IN N/A 0 0 PARKVIEW PROFESSIONAL PROGRAMS INC 1450 PRODUCTION RD FORT WAYNE IN 46808 351668888 REFERENCE LAB IN N/A C 0 MIDWEST COMMUNITY HEALTH ASSOCIATES INC 442 W HIGH STREET BRYAN OH 43506 341045870 PHYSICIANS OH N/A C 0 WOODLAND PLAZA MEDICAL PARK CONDO ASSOC INC 202 W BERRY ST SUITE 800 FORT WAYNE IN 46802 352058340 CONDO MANAGEMENT IN N/A C 0 0 1 1 0 0 0 0 0 0 1 1 1 1 1 1 1 1 1 1 PARKVIEW DEKALB HOSPITAL FOUNDATION INC M 83631 PART VII SUPPLEMENTAL INFORMATION SCHEDULE R, PART V, LINE 2, COLUMN (C): THE AMOUNTS REPORTED AS TRANSACTIONS WITH RELATED ORGANIZATIONS ARE CONSISTENT WITH THE AMOUNTS REPORTED ON THE ORGANIZATION'S AUDITED FINANCIAL STATEMENTS UNDER THE GENERALLY ACCEPTED ACCOUNTING STANDARDS DEPENDING ON THE TYPE OF TRANSACTION INVOLVED.