COMMUNITY HOSPITAL OF LAGRANGE COUNTY INC: Form 990, tax year 2017
View the entire original 990 at ProPublica ↗
- Organization
- COMMUNITY HOSPITAL OF LAGRANGE COUNTY INC (EIN 20-2401676)
- Tax period
- 2017-01-01 to 2017-12-31
- Filed
- 2018-11-10
- IRS object ID
- 201803149349301100
- Schema version
- 2017v2.3
- 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 K
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2018-11-10T16:26:46-06:00 | ReturnTs |
| Tax Period End | 2017-12-31 | 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 E JEFFERSON BLVD P O 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 | 2017-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 202401676 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | COMMUNITY HOSPITAL OF LAGRANGE COUNTY | BusinessNameLine1Txt |
| Business Name Line2 | INC | BusinessNameLine2Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | COMM | BusinessNameControlTxt |
| Phone | 2603738429 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 207 N TOWNLINE RD | AddressLine1Txt |
| City | LAGRANGE | CityNm |
| State Abbreviation | IN | StateAbbreviationCd |
| ZIP | 46761 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | JEANNE' WICKENS | PersonNm |
| Person Title | PH CFO | PersonTitleTxt |
| Phone | 2603738407 | PhoneNum |
| Signature | 2018-11-10 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | KENNETH J KEBER | PreparerPersonNm |
| PTIN | P00240883 | PTIN |
| Phone | 5742323992 | PhoneNum |
Filing Security Information FilingSecurityInformation
IP Address IPAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| I Pv4 Address | 204.58.171.16 | IPv4AddressTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IP | 2018-11-10 | IPDt |
| IP Tm | 15:25:02 | IPTm |
| IP Timezone | ES | IPTimezoneCd |
| Filing License Type | P | FilingLicenseTypeCd |
| At Submission Creation Device Id | B38744F01C9F8B49338464F7361C640636AC5E7B | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | B38744F01C9F8B49338464F7361C640636AC5E7B | AtSubmissionFilingDeviceId |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2017 | TaxYr |
| Build TS | 2019-02-21 02:37:17Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | MICHAEL J PACKNETT | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 10501 CORPORATE DRIVE | AddressLine1Txt |
| City | FORT WAYNE | CityNm |
| State Abbreviation | IN | StateAbbreviationCd |
| ZIP | 46845 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $42,779,348 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.PARKVIEW.COM; WWW.PARKVIEWFOUNDATIONS.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 2005 | FormationYr |
| Legal Domicile State | IN | LegalDomicileStateCd |
| Activity Or Mission | AS A COMMUNITY OWNED, NOT-FOR-PROFIT ORGANIZATION, COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC., AN AFFILIATE OF PARKVIEW HEALTH SYSTEM, INC., IS DEDICATED TO IMPROVING YOUR HEALTH AND INSPIRING YOUR WELL-BEING. | ActivityOrMissionDesc |
| Voting Members Governing Body | 12 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 7 | VotingMembersIndependentCnt |
| Total Employee | 220 | TotalEmployeeCnt |
| Total Volunteers | 25 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $74,337 | PYContributionsGrantsAmt |
| CY Contributions Grants | $110,332 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $37,407,710 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $42,376,784 | CYProgramServiceRevenueAmt |
| PY Investment Income | $11,383 | PYInvestmentIncomeAmt |
| CY Investment Income | -$4,674 | CYInvestmentIncomeAmt |
| PY Other Revenue | $246,148 | PYOtherRevenueAmt |
| CY Other Revenue | $220,439 | CYOtherRevenueAmt |
| PY Total Revenue | $37,739,578 | PYTotalRevenueAmt |
| CY Total Revenue | $42,702,881 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $63,029 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $45,652 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $12,537,865 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $13,077,596 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $42,680 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $22,002,922 | PYOtherExpensesAmt |
| CY Other Expenses | $27,069,112 | CYOtherExpensesAmt |
| PY Total Expenses | $34,603,816 | PYTotalExpensesAmt |
| CY Total Expenses | $40,192,360 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $3,135,762 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $2,510,521 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $27,199,140 | TotalAssetsBOYAmt |
| Total Assets EOY | $26,162,922 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $29,710,538 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $28,606,950 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | -$2,511,398 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | -$2,444,028 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | AS A COMMUNITY OWNED, NOT-FOR-PROFIT ORGANIZATION, COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC., AN AFFILIATE OF PARKVIEW HEALTH SYSTEM, INC., IS DEDICATED TO IMPROVING YOUR HEALTH AND INSPIRING YOUR WELL-BEING. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $33,678,086 | ExpenseAmt |
| Grant | $45,652 | GrantAmt |
| Revenue | $42,376,784 | RevenueAmt |
| Desc | COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC., D.B.A. PARKVIEW LAGRANGE HOSPITAL EXISTS FOR ONE PURPOSE: TO IMPROVE THE HEALTH OF THE COMMUNITIES WE SERVE. COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC. GIVES BACK TO THE COMMUNITY IN THE FORM OF IMPROVED FACILITIES, FREE AND DISCOUNTED CARE, EDUCATION AND OUTREACH PROGRAMS, VOLUNTEERISM AND MUCH MORE. USING INFORMATION FROM THE TRIANNUAL COMMUNITY HEALTH NEEDS ASSESSMENT, COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC., ALIGNS ITS OUTREACH PROGRAMS TO PRIORITIZE AND ADDRESS THE COMMUNITY'S NEEDS. SOME EXAMPLES INCLUDE:(SEE SCHEDULE O FOR CONTINUATION)-FINANCIAL ASSISTANCE-PRIMARY HEALTH CARE / ACCESS -HEALTH SCREENING AND PREVENTION-DISEASE MANAGEMENT-CONTRIBUTIONS TOWARD AND PARTICIPATION IN ECONOMIC DEVELOPMENT ACTIVITIESCOMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC., D.B.A. PARKVIEW LAGRANGE HOSPITAL, IS A 25-BED CRITICAL ACCESS FACILITY THAT PROVIDES ACUTE-CARE SERVICES TO THE PEOPLE OF LAGRANGE COUNTY AND THE SURROUNDING AREA. THE VISION OF HOSPITAL LEADERSHIP HAS CONTINUED TO FOCUS ON EXPANDING ACCESS TO HEALTHCARE SERVICES AND HELPING TO IMPROVE THE HEALTH STATUS OF THOSE WHO LIVE AND WORK IN THE COMMUNITIES IT SERVES. AMONG THE SERVICES PROVIDED AT THE HOSPITAL ARE:-EMERGENCY CARE-INPATIENT MEDICAL/SURGICAL CARE-ELECTRONIC INTENSIVE CARE UNIT PROVIDING 24/7 ACCESS TO BOARD CERTIFIED INTENSIVE CARE SPECIALISTS-AMBULATORY AND INPATIENT SURGERY-ENDOSCOPY-ORTHOPEDIC SURGERY-INTENSIVE OUTPATIENT BEHAVIORAL HEALTH PROGRAM FOR SENIORS-OBSTETRICS/GYNECOLOGY SERVICES-OUTPATIENT AND INPATIENT REHABILITATION-ADVANCED, DIGITAL DIAGNOSTIC IMAGINGTHE 17,300 SQUARE FOOT MEDICAL OFFICE PLAZA ADJACENT TO THE HOSPITAL HAS ALLOWED FOR EXPANSION OF FULL-TIME AND VISITING MEDICAL SPECIALISTS, MAKING THESE SERVICES AVAILABLE LOCALLY. SPECIALTY MEDICAL SERVICES INCLUDE:-ON-SITE ONCOLOGY AND HEMATOLOGY -CARDIOLOGY-COLON AND RECTAL SURGERY-GENERAL SURGERY-GYNECOLOGY-INFERTILITY-OBSTETRICS-ORTHOPEDIC SURGERY-PODIATRY-PULMONOLOGY-UROLOGYFINANCIAL ASSISTANCE:COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC.'S MISSION INCLUDES CARING FOR PATIENTS WHO DO NOT HAVE THE MEANS TO MEET THEIR FINANCIAL OBLIGATIONS. THE HOSPITAL PLACES ITS PRIORITY ON PROVIDING THE NECESSARY CARE FOR EACH PATIENT, NOT ON THE PATIENT'S FINANCIAL ABILITY TO PAY FOR THEIR MEDICAL EXPENSES.PRIMARY HEALTH CARE / ACCESS:COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC. PROVIDES CLINICAL STAFF AND SUPPORT TO TARGETED POPULATIONS WITHIN LAGRANGE COUNTY, INCLUDING:-A MEDICAL DIRECTOR TO PROVIDE SUPPORT FOR THE LAGRANGE COUNTY SHERIFF'S DEPARTMENT AND INMATES IN THE COUNTY JAIL.-A FULL-TIME ATHLETIC TRAINER IS PROVIDED, IN PARTNERSHIP WITH LAKELAND SCHOOL CORPORATION, TO MEET THE ON-SITE NEEDS OF STUDENT ATHLETES.-A FULL-TIME ATHLETIC TRAINER IS PROVIDED, IN PARTNERSHIP WITH LAKELAND SCHOOL CORPORATION, TO MEET THE ON-SITE NEEDS OF STUDENT ATHLETES.-A FULL TIME PLAIN CHURCH COORDINATOR SERVES AS A SINGLE POINT OF ACCESS FOR AMISH, MENNONITE AND OTHER PLAIN CHURCH MEMBERS WHO HAVE QUESTIONS ABOUT THE HEALTHCARE SERVICES AVAILABLE WITHIN THE PARKVIEW HEALTH SYSTEM. WHETHER THE QUESTION CONCERNS THE APPROXIMATE COST OF A PROCEDURE, THE SCHEDULING OF A DIAGNOSTIC TEST, OR A BILLING QUESTION, THE PLAIN CHURCH COORDINATOR ASSISTS INDIVIDUALS AND FAMILIES BY OBTAINING AN ANSWER.-A PARTNERSHIP WITH THE LAGRANGE COUNTY COUNCIL ON AGING (COA) TO ASSIST WITH OPERATIONAL SUPPORT FOR THE COA'S TRANSPORTATION SERVICES TO ALL RESIDENTS OF LAGRANGE COUNTY. NEARLY HALF OF THE TRIPS THE COA PROVIDES ARE TO A PHYSICIAN FOR A CHECK-UP OR TO THE HOSPITAL FOR A TEST OR TREATMENT. TRANSPORTATION PROVIDED BY THE COA'S LCAT SERVICE IS FREE TO SENIORS RESIDING IN LAGRANGE COUNTY. HEALTH SCREENING, PREVENTION, AND DISEASE MANAGEMENT: COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC. PROVIDES FREE AND LOW COST SERVICES, HEALTH SCREENINGS AND EDUCATION TO DIVERSE POPULATIONS IN OUR SERVICE AREA. THESE INCLUDE: -VOUCHERS REDEEMABLE FOR NINE MONTHS OF PRENATAL VITAMINS HAVE ALSO BEEN MADE AVAILABLE TO WOMEN THROUGH THE BIRTH PLANNER AT COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC., LAGRANGE COUNTY PRIMARY CARE PHYSICIANS AND OBSTETRICIANS, THE LAGRANGE COUNTY HEALTH DEPARTMENT, AND WIC. VOUCHERS ARE REDEEMABLE AT LOCAL PHARMACIES WHO THEN SUBMIT THEM TO THE HOSPITAL FOR REIMBURSEMENT THROUGH COMMUNITY HEALTH IMPROVEMENT FUNDS.-DIABETES SUPPORT GROUP - THIS MONTHLY GROUP IS TAUGHT BY A DIABETES EDUCATOR/PHARMACIST AND IS FREE AND OPEN TO ANY WHOSE LIVES ARE AFFECTED BY DIABETES. THE GROUP OFFERS EDUCATIONAL PROGRAMS ON MEDICATION MANAGEMENT, NUTRITION, NEUROPATHY, ETC., IN ADDITION TO OPEN DIALOGUE ABOUT ANY ISSUES SPECIFIC TO MEMBERS OF THE GROUP-SURVIVING LOSS BY SUICIDE SUPPORT GROUP - MEETING MONTHLY, THIS SUPPORT GROUP PROVIDES A COMPASSIONATE, HEALING ENVIRONMENT FOR ADULTS WHOSE LIVES HAVE BEEN AFFECTED BY THE LOSS OF A LOVED ONE DUE TO SUICIDE.-WELLNESS ON THE ROAD EVENTS BRINGS FREE AND LOW COST SCREENINGS OUT INTO THE COMMUNITY, IMPROVING ACCESS TO THESE SERVICES. AMONG THE SCREENINGS OFFERED ARE LOW COST BLOOD TESTS, HEARING SCREENINGS, BALANCE ASSESSMENTS AND MORE.-HEALTH BOOTHS ARE PROVIDED AT LOCAL COMMUNITY EVENTS AND OFFER ACTIVITIES AND EDUCATION DESIGNED TO HELP PARTICIPANTS LIVE A HEALTHIER LIFE STYLE. INFORMATION PROVIDED INCLUDED EDUCATIONAL MATERIAL AND HEALTH TIPS ALIGNED TO THE SPECIFIC EVENT'S TARGET POPULATION, INCLUDING WOMEN, SENIORS, YOUNG FAMILIES, ETC. | Desc |
| Total Program Service Expenses | $33,678,086 | 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 |
| Temp Or Permanent Endowments | 0 | TempOrPermanentEndowmentsInd |
| 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 | Yes (1) | TaxExemptBondsInd |
| Invest Tax Exempt Bonds | 0 | InvestTaxExemptBondsInd |
| Escrow Account | 0 | EscrowAccountInd |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuerInd |
| 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 With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| 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 | 0 | RelatedOrganizationCtrlEntInd |
| 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 | 36 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 220 | 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 | Yes (1) | QuidProQuoContributionsInd |
| Quid Pro Quo Contri Discl | Yes (1) | QuidProQuoContriDisclInd |
| 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 |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 12 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 7 | IndependentVotingMemberCnt |
| Family Or Business Rln | Yes (1) | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | Yes (1) | 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 | 2603738407 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 10501 CORPORATE DRIVE | AddressLine1Txt |
| City | FORT WAYNE | CityNm |
| State Abbreviation | IN | StateAbbreviationCd |
| ZIP | 46845 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (21 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 |
|---|---|---|---|---|---|---|---|---|---|---|
| JORDI DISLER | ||||||||||
| DIRECTOR/LGHOS PRESIDENT | 40.00 | 0.00 | Yes (X) | Yes (X) | $225,477 | $0 | $73,874 | |||
| MICHAEL PACKNETT | ||||||||||
| DIRECTOR/PH PRESIDENT & CEO | 1.00 | 56.00 | Yes (X) | Yes (X) | $0 | $1,599,863 | $735,183 | |||
| SHELBY COOPER | ||||||||||
| DIRECTOR/PH PHYSICIAN | 1.00 | 40.00 | Yes (X) | $11,856 | $241,323 | $22,185 | ||||
| LOREN HELMUTH | ||||||||||
| DIRECTOR/PH PHYSICIAN | 1.00 | 40.00 | Yes (X) | $17,235 | $579,874 | $44,920 | ||||
| MICHAEL MELLINGER | ||||||||||
| DIRECTOR/POHCI PHYSICIAN | 1.00 | 4.00 | Yes (X) | $1,500 | $16,570 | $0 | ||||
| ROBERT BOND | ||||||||||
| DIRECTOR | 1.00 | 0.00 | Yes (X) | $4,750 | $0 | $0 | ||||
| STEVEN CHRISTNER | ||||||||||
| DIRECTOR | 1.00 | 0.00 | Yes (X) | $4,500 | $0 | $0 | ||||
| KEVIN LAMBRIGHT | ||||||||||
| DIRECTOR/CHAIR | 1.00 | 2.00 | Yes (X) | $5,000 | $5,616 | $0 | ||||
| DENNIS LEHMAN | ||||||||||
| DIRECTOR/TREASURER | 1.00 | 0.00 | Yes (X) | $4,750 | $0 | $0 | ||||
| SHERRYL RHINESMITH | ||||||||||
| DIRECTOR/VICE CHAIR | 1.00 | 0.00 | Yes (X) | $4,750 | $0 | $0 | ||||
| JOE URBANSKI | ||||||||||
| DIRECTOR | 1.00 | 0.00 | Yes (X) | $3,250 | $0 | $0 | ||||
| PAUL YODER | ||||||||||
| DIRECTOR | 1.00 | 0.00 | Yes (X) | $4,750 | $0 | $0 | ||||
| JEANNE' WICKENS | ||||||||||
| PH CHIEF FINANCIAL OFFICER | 1.00 | 56.00 | Yes (X) | $0 | $701,132 | $135,403 | ||||
| JARED BEASLEY | ||||||||||
| LGHOS VP PATIENT CARE | 40.00 | 0.00 | $154,778 | $0 | $28,662 | Yes (X) | ||||
| BRENDA ARMENTROUT | ||||||||||
| LGHOS MGR PHARMACY | 40.00 | 0.00 | $165,496 | $0 | $26,151 | Yes (X) | ||||
| ROBERT BLOOMFIELD | ||||||||||
| LGHOS MGR SUPPORT SERVICE | 40.00 | 0.00 | $117,116 | $0 | $29,307 | Yes (X) | ||||
| MARY WRIGHT | ||||||||||
| LGHOS RN | 40.00 | 15.00 | $79,907 | $34,873 | $17,337 | Yes (X) | ||||
| ROSS ROBISON | ||||||||||
| LGHOS PHARMACIST | 35.00 | 0.00 | $109,436 | $0 | $21,689 | Yes (X) | ||||
| TREVOR FRY | ||||||||||
| LGHOS MGR ER | 40.00 | 0.00 | $108,496 | $0 | $30,991 | Yes (X) | ||||
| STANTON RISSER | ||||||||||
| FORMER OFFICER/PH VP PARTIAL YEAR | 0.00 | 40.00 | $0 | $157,067 | $17,632 | Yes (X) | ||||
| MICHAEL BROWNING | ||||||||||
| FORMER OFFICER | 0.00 | 0.00 | $0 | $277,686 | $0 | Yes (X) | ||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,023,047 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $3,614,004 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $1,183,334 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 9 | 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 |
|---|---|---|---|---|---|
| PROFESSIONAL EMERGENCY PHYSICIANS INC | |||||
| PO BOX 12949 | FORT WAYNE | IN | 46866 | PHYSICIANS | $1,600,593 |
| PARKVIEW HOSPITAL INC | |||||
| 11109 PARKVIEW PLAZA DRIVE | FORT WAYNE | IN | 46845 | LABORATORY SERVICES | $1,017,624 |
| GREAT LAKES ANESTHESIA PC | |||||
| 500 N NAPPANEE ST STE 11-B | ELKHART | IN | 46514 | ANESTHESIOLOGISTS | $845,263 |
| NORTHEAST INTERNAL MEDICINE ASSOC INC | |||||
| 2500 N DETROIT STREET | LAGRANGE | IN | 46761 | HOSPITALISTS | $350,632 |
| FOCUSONE SOLUTIONS LLC | |||||
| 13609 CALIFORNIA STREET | OMAHA | NE | 68154 | NURSES | $217,840 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 5 | CntrctRcvdGreaterThan100KCnt |
| Fundraising | $9,440 | FundraisingAmt |
| Related Organizations | $56,214 | RelatedOrganizationsAmt |
| Government Grants | $4,573 | GovernmentGrantsAmt |
| All Other Contributions | $40,105 | AllOtherContributionsAmt |
| Noncash Contributions | $880 | NoncashContributionsAmt |
| Total Contributions | $110,332 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (5 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| NET PATIENT SERVICE | 622000 | $41,355,740 | $41,355,740 |
| PHARMACY | 446110 | $615,400 | $615,400 |
| EMS SUBSIDY | 900099 | $349,000 | $349,000 |
| INTERUNIT RENT | 531120 | $30,931 | $30,931 |
| SPEECH THERAPY | 621300 | $11,425 | $11,425 |
Total Oth Program Service Rev TotalOthProgramServiceRevGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $14,288 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $14,288 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $42,376,784 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,547 | TotalRevenueColumnAmt |
| Exclusion | $1,547 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $14,185 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $66,751 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | -$52,566 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$52,566 | TotalRevenueColumnAmt |
| Exclusion | -$52,566 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $600 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $6,821 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | -$6,221 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$6,221 | TotalRevenueColumnAmt |
| Exclusion | -$6,221 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fundraising Gross Income | $2,178 | FundraisingGrossIncomeAmt |
| Contri Rpt Fundraising Event | $9,440 | ContriRptFundraisingEventAmt |
| Fundraising Direct Expenses | $2,895 | FundraisingDirectExpensesAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$717 | TotalRevenueColumnAmt |
| Exclusion | -$717 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | ExclusionExclusionAmt |
|---|---|---|---|
| CAFETERIA REVENUE | 722210 | $259,894 | $259,894 |
| GIFT SHOP REVENUE | 453220 | $13,828 | $13,828 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $273,722 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $42,702,881 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $42,376,784 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $215,765 | 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 | $44,282 | TotalAmt |
| Program Services | $44,282 | ProgramServicesAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,370 | TotalAmt |
| Program Services | $1,370 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $547,468 | TotalAmt |
| Management And General | $547,468 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $9,432,672 | TotalAmt |
| Program Services | $9,377,445 | ProgramServicesAmt |
| Management And General | $25,633 | ManagementAndGeneralAmt |
| Fundraising | $29,594 | FundraisingAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,097,456 | TotalAmt |
| Program Services | $3,083,708 | ProgramServicesAmt |
| Management And General | $3,660 | ManagementAndGeneralAmt |
| Fundraising | $10,088 | FundraisingAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,304,232 | TotalAmt |
| Program Services | $4,589,677 | ProgramServicesAmt |
| Management And General | $713,956 | ManagementAndGeneralAmt |
| Fundraising | $599 | FundraisingAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,881 | TotalAmt |
| Program Services | $2,754 | ProgramServicesAmt |
| Management And General | $127 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,122,999 | TotalAmt |
| Program Services | $1,055,124 | ProgramServicesAmt |
| Management And General | $67,635 | ManagementAndGeneralAmt |
| Fundraising | $240 | FundraisingAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $652,286 | TotalAmt |
| Program Services | $642,051 | ProgramServicesAmt |
| Management And General | $10,235 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $53,215 | TotalAmt |
| Program Services | $33,705 | ProgramServicesAmt |
| Management And General | $18,388 | ManagementAndGeneralAmt |
| Fundraising | $1,122 | FundraisingAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $16,398 | TotalAmt |
| Program Services | $6,076 | ProgramServicesAmt |
| Management And General | $9,285 | ManagementAndGeneralAmt |
| Fundraising | $1,037 | FundraisingAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $281,935 | TotalAmt |
| Program Services | $281,935 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,662,391 | TotalAmt |
| Program Services | $1,651,262 | ProgramServicesAmt |
| Management And General | $11,129 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $96,741 | TotalAmt |
| Program Services | $96,741 | ProgramServicesAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| BAD DEBT | $5,075,862 | $5,075,862 | |
| CORP SERVICE ALLOCATION | $5,016,000 | $5,016,000 | |
| MEDICAL SUPPLIES | $4,055,321 | $4,055,321 | |
| PH SUBSIDY | $3,665,345 | $3,665,345 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $63,506 | TotalAmt |
| Program Services | $15,428 | ProgramServicesAmt |
| Management And General | $48,078 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $40,192,360 | TotalAmt |
| Program Services | $33,678,086 | ProgramServicesAmt |
| Management And General | $6,471,594 | ManagementAndGeneralAmt |
| Fundraising | $42,680 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,676 | BOYAmt |
| EOY | $1,675 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $38,443 | BOYAmt |
| EOY | $71,360 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,584 | BOYAmt |
| EOY | $1,028 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,518,967 | BOYAmt |
| EOY | $4,626,726 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $331,673 | BOYAmt |
| EOY | $291,508 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $17,166 | BOYAmt |
| EOY | $19,066 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $32,696,022 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $16,557,571 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $17,231,878 | BOYAmt |
| EOY | $16,138,451 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,011,241 | BOYAmt |
| EOY | $5,011,241 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $46,512 | BOYAmt |
| EOY | $1,867 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $27,199,140 | BOYAmt |
| EOY | $26,162,922 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,052,307 | BOYAmt |
| EOY | $1,680,860 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $18,683,453 | BOYAmt |
| EOY | $17,860,779 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $144,535 | BOYAmt |
| EOY | $114,092 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,830,243 | BOYAmt |
| EOY | $8,951,219 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $29,710,538 | BOYAmt |
| EOY | $28,606,950 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -$2,511,398 | BOYAmt |
| EOY | -$2,444,028 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -$2,511,398 | BOYAmt |
| EOY | -$2,444,028 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $27,199,140 | BOYAmt |
| EOY | $26,162,922 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $2,510,521 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | -$2,443,151 | 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 | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
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 | $3,954 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $3,954 | 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 | REPRESENTS THE PORTION OF THE DUES PAID TO INDIANA HOSPITAL AND HEALTH ASSOCIATION, AMERICAN HOSPITAL ASSOCIATION, NATIONAL RURAL HEALTH ASSOCIATION AND VARIOUS PROFESSIONAL ASSOCIATIONS USED FOR LOBBYING ACTIVITIES. | ExplanationTxt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $320,702 | OtherCostOrOtherBasisAmt |
| Book Value | $320,702 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $13,534,008 | OtherCostOrOtherBasisAmt |
| Depreciation | $3,744,926 | DepreciationAmt |
| Book Value | $9,789,082 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $29,098 | OtherCostOrOtherBasisAmt |
| Depreciation | $29,098 | DepreciationAmt |
| Book Value | $0 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $16,839,494 | OtherCostOrOtherBasisAmt |
| Depreciation | $11,650,469 | DepreciationAmt |
| Book Value | $5,189,025 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,972,720 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,133,078 | DepreciationAmt |
| Book Value | $839,642 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $16,138,451 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (3 entries)
| DescDesc | AmtAmt |
|---|---|
| DUE TO/FROM INTERUNIT | $2,443,816 |
| EST MEDICARE/MEDICAID SETTLEMENTS | $611,162 |
| NOTE PAYABLE TO PH | $5,896,241 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $8,951,219 | 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): PAGE 15 OF ATTACHED FINANCIAL STATEMENTS. 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, 2017 AND 2016, THERE ARE NO UNRECOGNIZED TAX BENEFITS RESULTING FROM UNCERTAIN TAX POSITIONS. FORMS 990 AND 990T FILED BY THE CORPORATION AND ITS TAX-EXEMPT AFFILIATED ENTITIES ARE SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE UP TO THREE YEARS FROM THE EXTENDED DUE DATE OF EACH RETURN. FORMS 990 AND 990T FILED BY THE CORPORATION AND ITS TAX-EXEMPT AFFILIATED ENTITIES ARE NO LONGER SUBJECT TO EXAMINATION FOR THE YEAR 2013 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 | 0 | FPGReferenceDiscountedCareInd |
| 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 | $573,845 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $573,845 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01630 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,410,182 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $208,160 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,202,022 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.06270 | TotalExpensePct |
Unreimbursed Costs UnreimbursedCostsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,168,383 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $941,366 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,227,017 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.03490 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $5,152,410 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,149,526 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $4,002,884 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.11390 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $96,575 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,730 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $93,845 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00270 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $517 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $517 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $47,603 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $47,603 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00140 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $144,695 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,730 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $141,965 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00410 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $5,297,105 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,152,256 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $4,144,849 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.11800 | TotalExpensePct |
Economic Development EconomicDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $10,000 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $10,000 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00030 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $10,000 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $10,000 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00030 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $5,075,862 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $73,111 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $7,991,602 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $7,005,717 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | $985,885 | 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 | COMMUNITY HOSPITAL OF LAGRANGE COUNTY | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 207 N TOWNLINE RD | AddressLine1Txt |
| City | LAGRANGE | CityNm |
| State Abbreviation | IN | StateAbbreviationCd |
| ZIP | 46761 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | WWW.PARKVIEW.COM | WebsiteAddressTxt |
| State License | 14-005085-1 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | COMMUNITY HOSPITAL OF LAGRANGE COUNTY | 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 | 16 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | Yes (1) | 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 | WWW.PARKVIEW.COM/LOCALHEALTHNEEDS | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 16 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | 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 |
| 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 | Yes (X) | LookBackMedicareInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| COMMUNITY HOSPITAL OF LAGRANGE COUNTY | PART V, SECTION B, LINE 5: PARKVIEW HEALTH SYSTEM, INC. INCLUDING COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC. CONDUCTED ITS LAST COMMUNITY HEALTH NEEDS ASSESSMENT IN 2016. OVER THE COURSE OF ADMINISTERING THIS COMMUNITY HEALTH NEEDS ASSESSMENT, THE INDIANA PARTNERSHIP FOR HEALTH COMMUNITIES (IN-PHC) RESEARCH TEAM WORKED TO ENSURE THAT THE NEEDS OF THE MEDICALLY UNDERSERVED, LOW-INCOME AND MINORITY POPULATIONS WERE TAKEN INTO ACCOUNT. THE 2016 COMMUNITY HEALTH NEEDS ASSESSMENT USED THREE SOURCES OF PRIMARY DATA: 1) A PHONE SURVEY OF THE COMMUNITY CONDUCTED ON BEHALF OF COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC. AND THE INDIANA PARTNERSHIP FOR HEALTHY COMMUNITIES (IN-PHC) BY THE EAGLETON CENTER FOR PUBLIC INTEREST POLLING (A CENTER OF RUTGERS UNIVERSITY) COMPLETED IN MARCH 2016; 2) AN ONLINE SURVEY DEVELOPED BY THE IN-PHC AND DISTRIBUTED BY THE HOSPITAL TO AREA PROVIDERS INCLUDING PUBLIC HEALTH OFFICIALS, OTHER HEALTHCARE PROFESSIONALS AND VARIOUS SOCIAL SERVICE ORGANIZATIONS THAT SPECIALIZE IN AIDING VULNERABLE POPULATIONS COMPLETED IN JUNE 2016; AND 3) FOCUS GROUPS WITH SPECIFIC VULNERABLE POPULATIONS, INCLUDING THE HISPANIC/LATINO AND AFRICAN AMERICAN POPULATIONS WERE CONDUCTED BY IN-PHC IN ALLEN, NOBLE AND KOSCIUSKO COUNTIES. FOR THE AMISH COMMUNITY IN LAGRANGE COUNTY, A WRITTEN SURVEY WAS DISTRIBUTED THROUGH COMMUNITY LEADERS. FOCUS GROUP AND WRITTEN SURVEY DATA COLLECTION WAS COMPLETED IN THE SUMMER OF 2016.CONDUENT'S HEALTHY COMMUNITIES INSTITUTE (HCI) DATA BASE WAS USED TO ACCESS SECONDARY DATA FOR THE SEVEN-COUNTY AREA. STATE AND NATIONAL DATA WAS OBTAINED THROUGH THE CENTERS FOR DISEASE CONTROL AND PREVENTION, COUNTY HEALTH RANKINGS, HEALTH INDICATORS WAREHOUSE, INDIANA STATE DEPARTMENT OF HEALTH, INDIANA UNIVERSITY CENTER FOR HEALTH POLICY AND THE U.S. CENSUS BUREAU. |
| COMMUNITY HOSPITAL OF LAGRANGE COUNTY | PART V, SECTION B, LINE 6A: PARKVIEW HOSPITAL, INC. (EIN 35-0868085); COMMUNITY HOSPITAL OF NOBLE COUNTY, INC. (EIN 35-2087092); HUNTINGTON MEMORIAL HOSPITAL, INC. (EIN 35-1970706); WHITLEY MEMORIAL HOSPITAL, INC. (EIN 35-1967665); PARKVIEW WABASH HOSPITAL, INC. (EIN 47-1753440) AND ORTHOPAEDIC HOSPITAL AT PARKVIEW NORTH, LLC (EIN 26-0143823). |
| COMMUNITY HOSPITAL OF LAGRANGE COUNTY | PART V, SECTION B, LINE 6B: PARKVIEW HEALTH SYSTEM, INC.(EIN 35-1972384); INDIANA PARTNERSHIP FOR HEALTHY COMMUNITIES (A PARTNERSHIP BETWEEN THE INDIANA UNIVERSITY RICHARD M. FAIRBANKS SCHOOL OF PUBLIC HEALTH AND THE POLIS CENTER AT IUPUI) AND CONDUENT HEALTHY COMMUNITIES INSTITUTE. |
| COMMUNITY HOSPITAL OF LAGRANGE COUNTY | PART V, SECTION B, LINE 11: SIGNIFICANT HEALTH NEEDS BEING ADDRESSED:OBESITY/HEALTHY LIFESTYLES: COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC. CONTINUES ITS PARTNERSHIP WITH COLE FAMILY CENTER YMCA TO ADDRESS THE OBESITY AND THE NEED FOR PHYSICAL ACTIVITY THROUGH THE OPERATION OF SATELLITE GROUP WELLNESS EXERCISE CLASSES. PLANTING HEALTHY SEEDS, A CURRICULUM FOR 3RD AND 4TH GRADERS, IS A NEW PROGRAM THAT COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC. IS WORKING WITH THE SCHOOLS TO IMPLEMENT IN LAGRANGE COUNTY. PLANTING HEALTHY SEEDS IS THE PROGRAM THE HOSPITAL WILL BE REPORTING ON. MENTAL HEALTH:WITH DEATHS BY SUICIDE IN LAGRANGE COUNTY NEARLY DOUBLING EACH YEAR SINCE 2015, THE NEED FOR SUICIDE PREVENTION ON A BROAD SCALE WAS IDENTIFIED AS A HIGH PRIORITY. WITH ASSISTANCE FROM PARKVIEW BEHAVIORAL HEALTH, AN EVIDENCE-BASED SUICIDE PREVENTION STRATEGY KNOWN AS QUESTION, PERSUADE AND REFER (QPR) WAS SELECTED AS THE TOOL TO BE USED IN TRAINING A BROAD SPECTRUM OF ADULTS IN LAGRANGE COUNTY. A SELECTED GROUP OF HOSPITAL EMPLOYEES, COMMUNITY MEMBERS, AND A PPG PHYSICIAN REPRESENTATIVE WERE TRAINED AS TRAINERS. IN JUNE OF 2017, THESE LOCAL QPR INSTRUCTORS BEGAN PROVIDING THIS LIFE SAVING TRAINING FREE OF CHARGE TO THE COMMUNITY. BY THE END OF 2017, COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC. HAD PROVIDED QPR GATE KEEPER TRAINING TO OVER 300 PEOPLE IN LAGRANGE COUNTY. THOSE TRAINED INCLUDED SCHOOL TEACHERS, COMMUNITY GROUPS, CHURCHES, HOSPITAL EMPLOYEES, OUR HOSPITAL BOARD OF DIRECTORS, AND MANY MORE GROUPS. PARKVIEW LAGRANGE WILL CONTINUE THESE EFFORTS INTO 2018 WITH ONGOING COWORKER AND COMMUNITY TRAINING SESSIONS. IN 2017, COMMUNITY HOSPITAL OF LAGRANGE'S QPR TEAM ESTABLISHED A PEER-LED SUPPORT GROUP FOR THOSE IMPACTED BY THE LOSS OF A LOVED ONE BY SUICIDE.IN ADDITION, COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC. PARTNERS WITH THE THREE PUBLIC SCHOOL CORPORATIONS IN LAGRANGE COUNTY TO ADDRESS MENTAL HEALTH. THE HOSPITAL PROVIDES A LICENSED MENTAL HEALTH COUNSELOR TO THE SCHOOLS FOR FOUR HOURS EACH WEEK.OTHER HEALTH NEEDS NOT BEING ADDRESSED:-TOBACCO USE/SMOKING - PARKVIEW HEALTH IS A SOURCE OF SMOKING CESSATION PROGRAMS AND OPERATES A TOBACCO FREE CAMPUS. -DIABETES, CARDIOVASCULAR DISEASE AND CANCER - WHILE COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC. DID NOT SELECT THESE CHRONIC DISEASES AS TOP HEALTH PRIORITIES, OUR INTENT IS TO HELP TO PREVENT AND REDUCE THE PRESENCE OF CHRONIC CONDITIONS LIKE THE AFOREMENTIONED DISEASES BY ADDRESSING OBESITY THROUGH NUTRITION EDUCATION, INCREASED ACCESS TO HEALTHY FOODS, ACTIVE LIVING PROGRAMS AND EDUCATION ON OTHER HEALTHY LIFESTYLE HABITS. -DRUGS AND ALCOHOL ABUSE AND ADDICTION - ONE OF COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC.'S HEALTH PRIORITIES IS MENTAL HEALTH. MANY INDIVIDUALS BEING ASSISTED AND REFERRED THROUGH PARKVIEW BEHAVIORAL HEALTH CARE NAVIGATION PROGRAM ARE AFFECTED BY DRUG AND ALCOHOL ABUSE, AS WELL AS ADDICTION. COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC. BELIEVES THIS NEEDS TO BE AN INTEGRAL PART OF THE MENTAL HEALTH INITIATIVE WHICH MEANS IT WILL BE ADDRESSED AS PART OF THE COMMUNITY RESPONSE. IN ADDITION, BOWEN CENTER AND NORTHEASTERN CENTER ARE ALSO ADDRESSING DRUG AND ALCOHOL ADDICTION THROUGH THE SERVICES THEIR RESPECTIVE ORGANIZATIONS ARE PROVIDING IN THE LOCAL COMMUNITY. -MATERNAL CHILD AND INFANT HEALTH - COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC. CONTINUES TO PARTNER WITH THE LAGRANGE COUNTY HEALTH DEPARTMENT & WIC DEPARTMENT THROUGH THE BREAST FEEDING SUPPORT GROUP OFFERING SUPPORT AND GUIDANCE TO BREAST FEEDING MOMS. -HEALTHCARE COST AND ACCESS: AS PART OF PARKVIEW HEALTH'S STRATEGIC PLAN, COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC. CONTINUES ITS EFFORTS TO RECRUIT FAMILY PRACTICE AND SPECIALTY PHYSICIANS TO LAGRANGE COUNTY. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 2 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| 1 - PARKVIEW LAGRANGE EMS - CENTRAL | ||||
| 0982 N 00 EW | LAGRANGE | IN | 46761 | AMBULANCE SERVICE |
| 2 - PARKVIEW LAGRANGE EMS - WEST | ||||
| 8175 W US 20 | SHIPSHEWANA | IN | 46565 | AMBULANCE SERVICE |
Supplemental Information Detail SupplementalInformationDetail (17 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 6A: | THE RELATED ENTITIES OF PARKVIEW HEALTH SYSTEM, INC. (EIN 35-1972384); PARKVIEW HOSPITAL, INC. (EIN 35-0868085); COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC. (EIN 20-2401676); COMMUNITY HOSPITAL OF NOBLE COUNTY, INC. (EIN 35-2087092); HUNTINGTON MEMORIAL HOSPITAL, INC. (EIN 35-1970706); WHITLEY MEMORIAL HOSPITAL, INC. (EIN 35-1967665) AND PARKVIEW WABASH HOSPITAL, INC. (EIN 47-1753440) PREPARED A COMBINED REPORT TO THE COMMUNITY DETAILING COMMUNITY BENEFIT PROGRAMS AND SERVICES. |
| PART I, LINE 7: | PART I, LINE 7ATHE FINANCIAL ASSISTANCE COST REPORTED ON LINE 7A IS CALCULATED UNDER THE COST TO CHARGE RATIO METHODOLOGY. UNDER THIS METHOD, THE FINANCIAL ASSISTANCE CHARGES FOREGONE ARE MULTIPLIED BY THE RATIO OF COST TO CHARGES TO DETERMINE THE COST OF SERVICES RENDERED.PART I, LINE 7BCOMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC. ACCEPTS ALL MEDICAID, MEDICAID MANAGED CARE, AND OUT-OF-STATE MEDICAID PATIENTS WITH THE KNOWLEDGE THAT THERE MAY BE SHORTFALLS. INTERNAL REVENUE SERVICE (IRS) REVENUE RULING 69-545 IMPLIES THAT TREATING MEDICAID PATIENTS IS A COMMUNITY BENEFIT. IRS REVENUE RULING 69-545, WHICH ESTABLISHED THE COMMUNITY BENEFIT STANDARD FOR NONPROFIT HOSPITALS, STATES THAT IF A HOSPITAL SERVES PATIENTS WITH GOVERNMENTAL HEALTH BENEFITS, INCLUDING MEDICAID, THEN THIS IS AN INDICATION THAT THE HOSPITAL OPERATES TO PROMOTE THE HEALTH OF THE COMMUNITY. THE UNREIMBURSED MEDICAID COST REPORTED ON LINE 7B IS CALCULATED UNDER THE COST TO CHARGE RATIO METHODOLOGY. UNDER THIS METHOD, THE MEDICAID CHARGES ARE MULTIPLIED BY THE RATIO OF COST TO CHARGES TO DETERMINE THE COST OF MEDICAID SERVICES RENDERED. THEN, THE COST OF MEDICAID SERVICES RENDERED IS DEDUCTED FROM THE REIMBURSEMENT RECEIVED FOR MEDICAID PATIENTS TO ARRIVE AT A GAIN/(LOSS) RELATIVE TO THESE PATIENTS.PART I, LINE 7CCOMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC. ACCEPTS ALL MEANS-TESTED PATIENTS FROM THE HEALTHY INDIANA PLAN (HIP) WITH THE KNOWLEDGE THAT THERE MAY BE SHORTFALLS. INTERNAL REVENUE SERVICE (IRS) REVENUE RULING 69-545 IMPLIES THAT TREATING MEANS-TESTED PATIENTS IS A COMMUNITY BENEFIT. IRS REVENUE RULING 69-545, WHICH ESTABLISHED THE COMMUNITY BENEFIT STANDARD FOR NONPROFIT HOSPITALS, STATES THAT IF A HOSPITAL SERVES PATIENTS WITH GOVERNMENTAL HEALTH BENEFITS, INCLUDING HIP, THEN THIS IS AN INDICATION THAT THE HOSPITAL OPERATES TO PROMOTE THE HEALTH OF THE COMMUNITY. THE UNREIMBURSED HIP COST REPORTED ON LINE 7C IS CALCULATED UNDER THE COST TO CHARGE RATIO METHODOLOGY. UNDER THIS METHOD, THE HIP CHARGES ARE MULTIPLIED BY THE RATIO OF COST TO CHARGES TO DETERMINE THE COST OF HIP SERVICES RENDERED. THEN, THE COST OF HIP SERVICES RENDERED IS DEDUCTED FROM THE REIMBURSEMENT RECEIVED FOR HIP PATIENTS TO ARRIVE AT A GAIN/(LOSS) RELATIVE TO THESE PATIENTS.PART I, LINE 7EAMOUNTS PRESENTED ARE BASED ON ACTUAL SPEND FOR THOSE SERVICES AND BENEFITS PROVIDED DEEMED TO IMPROVE THE HEALTH OF THE COMMUNITIES IN WHICH WE SERVE AND CONFORM WITH THE MISSION OF OUR EXEMPT PURPOSE.PART I, LINE 7FAMOUNTS PRESENTED ARE BASED UPON ACTUAL SPEND AND ARE IN CONFORMITY WITH AGREED UPON COMMITMENTS WITH THE VARIOUS EDUCATIONAL PROGRAMS.PART I, LINE 7IIN KEEPING WITH OUR MISSION AND COMMITMENT TO THE COMMUNITIES IN WHICH WE SERVE, COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC. CONTINUES ITS TRADITION OF CONTRIBUTING TO NUMEROUS ORGANIZATIONS ON BOTH AN AS-NEEDED BASIS AND NEGOTIATED BASIS. AMOUNTS PRESENTED REPRESENT ACTUAL SPEND TO ORGANIZATIONS THROUGHOUT OUR COMMUNITIES. |
| PART I, LN 7 COL(F): | PERCENT OF TOTAL EXPENSECOMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC. EXCLUDED $5,075,862 OF BAD DEBT 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.COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC., D.B.A. PARKVIEW LAGRANGE HOSPITAL, PROVIDES SUPPORT FOR LOCAL ECONOMIC DEVELOPMENT PROGRAMS. THESE EFFORTS ARE ALIGNED OF THE HEALTH SYSTEM'S STRATEGIC INVOLVEMENT IN THE NORTHEAST INDIANA REGIONAL PARTNERSHIP'S VISION 2020, AN INITIATIVE DESIGNED TO TRANSFORM NORTHEAST INDIANA INTO A TOP GLOBAL COMPETITOR BY FOCUSING ON A COMMON MISSION TO DEVELOP, ATTRACT AND RETAIN TALENT. VISION 2020'S PRIORITIES ARE TIED TO EDUCATION/WORKFORCE, BUSINESS CLIMATE, ENTREPRENEURSHIP, INFRASTRUCTURE AND QUALITY OF LIFE FOR THE ELEVEN-COUNTY REGION IN NORTHEAST INDIANA. PROMOTION OF ECONOMIC DEVELOPMENT IN LAGRANGE COUNTY IS A PART OF A COLLECTIVE PLAN TO IMPROVE THE QUALITY OF LIFE AND ULTIMATELY THE OVERALL HEALTH AND WELL-BEING OF THE COMMUNITY.COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC. SUPPORTS ECONOMIC DEVELOPMENT IN THE COUNTY THROUGH THE FOLLOWING INITIATIVES:- GRANT SUPPORT FOR KEY AGENCIES IN LAGRANGE COUNTY, INCLUDING THE ECONOMIC DEVELOPMENT CORPORATION- SPONSORSHIP OF INTERNSHIPS AND JOB-SHADOWING PROGRAMS FOR STUDENTS FROM LOCAL HIGH SCHOOLS AND AREA COLLEGES PLANNING TO PURSUE A CAREER IN THE HEALTHCARE RELATED FIELD- ACTIVE REPRESENTATION BY COMMUNITY HOSPITAL OF LAGRANGE COUNTY LEADERSHIP ON THE BOARDS OF NEARLY FORTY COMMUNITY NON-PROFIT AND CIVIC AGENCIES IN LAGRANGE COUNTY AND THE SURROUNDING AREA, INCLUDING:4H CLUB OF LAGRANGE COUNTYAMERICAN MEDICAL TECHNOLOGIST INDIANA STATE BOARD MEMBERBOARD PRESIDENT FOR DEKALB CENTRAL SCHOOLSCHURCH OF GOD GOVERNANCE BOARDCOMMUNITY CORRECTIONS LAGRANGE COUNTYCOMMUNITY IMPROVEMENT LEAGUE OF STROH - TRUSTEE FORMED COMMITTEECOUNCIL ON AGING BOARD MEMBERDEPUTY CORONER, LAGRANGEDRUG FREE LAGRANGE COUNTY TASKFORCEHABITAT FOR HUMANITY BOARD OF DIRECTORS MEMBERHOWE VOLUNTEER FIRE DEPARTMENTIMPACT - HEATH OCCUPATIONS EDUCATION ADVISORY COMMITTEEINSTRUCTOR FOR ONLINE BUSINESS CLASSESJUNIOR ACHIEVEMENT BOARD, LAGRANGE COUNTYLAGRANGE COUNTY CHAMBER OF COMMERCE BOARD OF DIRECTORSLAGRANGE COUNTY COMMISSIONERLAGRANGE COUNTY COMMUNITY FOUNDATION BOARD OF DIRECTORSLAGRANGE COUNTY ECONOMIC DEVELOPMENT CORPORATION BOARD OF DIRECTORSLAGRANGE COUNTY HEALTH BOARD MEMBERLAGRANGE COUNTY JUDICIAL COMMITTEELAGRANGE COUNTY PARK BOARDLAGRANGE COUNTY REGIONAL UTILITY DISTRICTLAGRANGE COUNTY TRAILS COMMITTEELAGRANGE/NOBLE JOINT DRAINAGE BOARDMEMBER OF PRAIRIE HEIGHTS FFA ALUMNIMERIDIAN SUN LODGE #76, PART OF THE FREE MASONSMIDDLEBURY FOOD PANTRYNEW LEAVES ADVISOR - NEW COMMITTEE IN LAGRANGE COUNTY TO FACILITATE AND COORDINATE COMMUNITY RESOURCESNORTHEAST INDIANA SOLID WASTE DISTRICT BOARDPARKVIEW LAGRANGE HOSPITAL ADOPT-A-HIGHWAY PROGRAMPERSONNEL ADVISORY COMMITTEEPURDUE EXTENSION OFFICE WELLNESS COMMITTEE, LAGRANGE COUNTYQPR INSTRUCTORREMC MEMBER ADVISORY COMMITTEESURVIVING LOSS BY SUICIDE - FOUNDER AND SUPPORTER OF LAGRANGE COUNTY SUICIDE SUPPORT GROUPUNITED FUND BOARDYOUTH FOR CHRIST SUPPORTER IN ALLEN AND LAGRANGE COUNTIES, HELPED FACILITATE PROGRAMMING IN LAGRANGE COUNTY |
| PART III, LINE 2: | THE AMOUNT REPORTED IS CONSISTENT WITH THE AMOUNT REPORTED ON THE ORGANIZATION'S AUDITED FINANCIAL STATEMENTS UNDER THE GENERALLY ACCEPTED ACCOUNTING STANDARDS.DISCOUNTS AND PAYMENTS ON PATIENT ACCOUNTS (BAD DEBT RECOVERIES) ARE FACTORED INTO THE ALLOWANCE FOR BAD DEBT ESTIMATION PROCESS. |
| PART III, LINE 3: | COSTING METHODOLOGY USED:UNCOLLECTIBLE PATIENT ACCOUNTS ARE CHARGED AGAINST THE PROVISION FOR BAD DEBT IN ACCORDANCE WITH THE POLICIES OF COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC. HOWEVER, DURING THE COLLECTION PROCESS THERE IS A CONTINUOUS EFFORT TO DETERMINE IF THE PATIENT QUALIFIES FOR FINANCIAL ASSISTANCE. THEREFORE, ONCE AN UNCOLLECTIBLE ACCOUNT HAS BEEN CHARGED OFF AND IT IS DETERMINED THROUGH THE COLLECTION PROCESS THAT THE PATIENT QUALIFIES FOR FINANCIAL ASSISTANCE, THE UNCOLLECTIBLE ACCOUNT IS RECLASSIFIED TO CHARITY CARE AND ALL COLLECTION EFFORTS CEASE. PATIENTS ARE ELIGIBLE TO APPLY FOR FINANCIAL ASSISTANCE AT ANY TIME, INCLUDING PATIENTS WHOSE ACCOUNTS HAVE BEEN PLACED IN A BAD DEBT AGENCY. THE AMOUNT REFLECTED ON LINE 3 WAS CALCULATED BY TOTALING THE ACCOUNTS PREVIOUSLY WRITTEN OFF TO BAD DEBT AND PLACED WITH A COLLECTION AGENCY, BUT SUBSEQUENTLY RECLASSIFIED AS CHARITY CARE DURING THE TAX YEAR. THE ACCOUNTS WERE RECLASSIFIED AS CHARITY CARE DUE TO THE FACT THAT PATIENTS APPLIED FOR, AND WERE APPROVED FOR, FINANCIAL ASSISTANCE AFTER THE ACCOUNTS WERE PLACED WITH A BAD DEBT AGENCY. |
| PART III, LINE 4: | BAD DEBT EXPENSE - PARKVIEW HEALTH SYSTEM, INC. AND SUBSIDIARIES - NOTES TO THE CONSOLIDATED FINANCIAL STATEMENTSTEXT OF THE FOOTNOTE TO THE ORGANIZATION'S FINANCIAL STATEMENTS THAT DESCRIBES BAD DEBT EXPENSE OR THE PAGE NUMBER ON WHICH THIS FOOTNOTE IS CONTAINED IN THE ATTACHED FINANCIAL STATEMENTS:PAGE 12 OF ATTACHED FINANCIAL STATEMENTS. |
| PART III, LINE 8: | COMMUNITY BENEFIT & METHODOLOGY FOR DETERMINING MEDICARE COSTSSUBSTANTIAL SHORTFALLS TYPICALLY ARISE FROM PAYMENTS THAT ARE LESS THAN THE COST TO PROVIDE THE CARE OR SERVICES AND DO NOT INCLUDE ANY AMOUNTS RELATING TO INEFFICIENT OR POOR MANAGEMENT. COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC. ACCEPTS ALL MEDICARE PATIENTS, AS REFLECTED ON THE YEAR-END MEDICARE COST REPORT, WITH THE KNOWLEDGE THAT THERE MAY BE SHORTFALLS. INTERNAL REVENUE SERVICE (IRS) REVENUE RULING 69-545 IMPLIES THAT TREATING MEDICARE PATIENTS IS A COMMUNITY BENEFIT. IRS REVENUE RULING 69-545, WHICH ESTABLISHED THE COMMUNITY BENEFIT STANDARD FOR NONPROFIT HOSPITALS, STATES THAT IF A HOSPITAL SERVES PATIENTS WITH GOVERNMENTAL HEALTH BENEFITS, INCLUDING MEDICARE, THEN THIS IS AN INDICATION THAT THE HOSPITAL OPERATES TO PROMOTE THE HEALTH OF THE COMMUNITY. HOWEVER, MEDICARE PAYMENTS REPRESENT A PROXY OF COST CALLED THE "UPPER PAYMENT LIMIT." IT HAS HISTORICALLY BEEN ASSUMED THAT UPPER PAYMENT LIMIT PAYMENTS DO NOT GENERATE A SHORTFALL. AS A RESULT, COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC. HAS TAKEN THE POSITION NOT TO INCLUDE THE MEDICARE SHORTFALLS OR SURPLUSES AS PART OF COMMUNITY BENEFIT. COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC. RECOGNIZES THAT THE SHORTFALL OR SURPLUS FROM MEDICARE DOES NOT INCLUDE THE COSTS AND REVENUES ASSOCIATED WITH MEDICARE ADVANTAGE PATIENTS. AS SUCH, THE TOTAL SHORTFALL OR SURPLUS OF MEDICARE IS UNDERSTATED DUE TO THE COSTS AND REVENUES ASSOCIATED WITH MEDICARE ADVANTAGE PATIENTS NOT BEING INCLUDED IN THE COMMUNITY BENEFIT DETERMINATION. |
| PART III, LINE 9B: | IF THE PATIENT CANNOT PAY IN FULL, THE OPTION OF A LOW INTEREST LOAN IS AVAILABLE WITH THE SAME DISCOUNT OFFERED FOR CASH PAYMENTS AS LONG AS THE LOAN IS ARRANGED WITHIN 30 DAYS OF THE FIRST GUARANTOR STATEMENT. IF THE PATIENT DEFAULTS ON THE LOAN, THE DISCOUNT WILL BE REVERSED AND THE PATIENT'S ACCOUNT WILL BE PLACED IN A COLLECTION AGENCY.INTEREST-FREE PAYMENTS WITH PAY-OUT NOT TO EXCEED TWELVE (12) MONTHS ARE AVAILABLE. THE MINIMUM MONTHLY PAYMENT IS $25.FINANCIAL ASSISTANCE MAY BE AVAILABLE FOR THOSE PATIENTS WHO CANNOT PAY THEIR BILL. THOSE OPTIONS ARE GOVERNMENTAL ASSISTANCE OR FREE CARE THROUGH THE HOSPITAL FINANCIAL ASSISTANCE PROGRAM. THE HEALTH SYSTEM FINANCIAL ASSISTANCE POLICY IS AVAILABLE ON PARKVIEW.COM OR BY VISITING ANY HOSPITAL CASHIER OFFICE OR BY CALLING PATIENT ACCOUNTING AT 260.266.6700 OR TOLL FREE 855.814.0012. A PATIENT MAY APPLY FOR FINANCIAL ASSISTANCE ANYTIME DURING THE APPLICATION PERIOD. FAILURE TO MAKE ARRANGEMENTS AS LISTED ABOVE OR FAILURE TO APPLY FOR AND RECEIVE APPROVAL UNDER THE FINANCIAL ASSISTANCE POLICY MAY RESULT IN THE ACCOUNT BEING PLACED IN A COLLECTION AGENCY DUE TO NON-PAYMENT. THE COLLECTION AGENCY MAY REPORT THE ACCOUNT TO ONE OR ALL THREE CREDIT REPORTING AGENCIES WHICH MAY ULTIMATELY ADVERSELY AFFECT THE PATIENT'S CREDIT SCORE. ADDITIONALLY, THE COLLECTION AGENCY MAY SUE AND OBTAIN A JUDGMENT AGAINST THE PATIENT FOR NON-PAYMENT. THESE ACTIONS WILL NOT OCCUR UNTIL 120 DAYS AFTER THE PATIENT IS SENT THEIR FIRST FOLLOW-UP STATEMENT INDICATING THE AMOUNT THEY OWE.A PATIENT MAY APPLY FOR FINANCIAL ASSISTANCE AT ANY TIME DURING THE APPLICATION PERIOD, EVEN THOUGH THEY HAVE BEEN PLACED IN A COLLECTION AGENCY. IF THE PATIENT WAS SENT THEIR FIRST NOTICE ON THE ACCOUNT FOR WHICH THEY ARE APPLYING FOR FREE CARE BETWEEN 120 DAYS AND THE END OF THE APPLICATION PERIOD, THE ACTIONS ABOVE WILL BE SUSPENDED UNTIL THE FREE CARE APPLICATION ELIGIBILITY IS DETERMINED. |
| PART VI, LINE 2: | DESCRIBE HOW THE ORGANIZATION ASSESSES THE HEALTH CARE NEEDS OF THE COMMUNITIES IT SERVES, IN ADDITION TO ANY CHNAS REPORTED IN PART V, SECTION B.IN ADDITION TO IDENTIFYING HEALTH NEEDS THROUGH THE TRIENNIAL COMMUNITY HEALTH NEEDS ASSESSMENT, COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC. IDENTIFIES AND VERIFIES COMMUNITY HEALTH NEEDS THROUGH THE FOLLOWING:-OTHER COMMUNITY NEEDS ASSESSMENTS CONDUCTED BY LOCAL ORGANIZATIONS-USE OF CONDUENT'S HEALTHY COMMUNITIES INSTITUTE SECONDARY DATA PLATFORM -OBSERVATIONS BY HEALTHCARE PROFESSIONALS WHO WORK WITH VULNERABLE POPULATIONS-SPECIFIC REQUESTS PROMPTED BY OTHER PROFESSIONALS IN THE COMMUNITYHOSPITAL REPRESENTATIVES MAINTAIN ON-GOING RELATIONSHIPS THROUGHOUT THE COMMUNITY AND MEET REGULARLY WITH ORGANIZATIONS THAT SHARE THE MISSION OF IMPROVING THE HEALTH AND INSPIRING THE WELL-BEING OF THE COMMUNITY WE SERVE. |
| PART VI, LINE 3: | DESCRIBE HOW THE ORGANIZATION INFORMS AND EDUCATES PATIENTS AND PERSONS WHO MAY BE BILLED FOR PATIENT CARE ABOUT THEIR ELIGIBILITY FOR ASSISTANCE UNDER FEDERAL, STATE OR LOCAL GOVERNMENT PROGRAMS OR UNDER THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY.SIGNAGE AND BROCHURES ARE POSTED AND AVAILABLE AT ALL HOSPITAL POINTS OF REGISTRATION AND IN THE EMERGENCY DEPARTMENT. PATIENTS ARE OFFERED PLAIN LANGUAGE SUMMARIES OF THE FINANCIAL ASSISTANCE POLICY DURING THE REGISTRATION PROCESS AND IN EACH FOLLOW UP STATEMENT SENT TO THE PATIENT. PATIENT STATEMENTS WILL INDICATE HOW A PATIENT CAN OBTAIN FINANCIAL ASSISTANCE APPLICATIONS AND WHO THEY CAN CONTACT FOR ASSISTANCE. |
| PART VI, LINE 4: | DESCRIBE THE COMMUNITY THE ORGANIZATION SERVES, TAKING INTO ACCOUNT THE GEOGRAPHIC AREA AND DEMOGRAPHIC CONSTITUENTS IT SERVES.COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC., PRIMARILY SERVES THE LAGRANGE COUNTY COMMUNITIES OF LAGRANGE, SHIPSHEWANA, WOLCOTTVILLE, HOWE, AND TOPEKA. AS THE ONLY HOSPITAL IN THIS COUNTY, COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC., ALSO SERVES, TO A LIMITED EXTENT, SURROUNDING COMMUNITIES IN ELKHART COUNTY, IN, AND CASS, ST. JOSEPH, AND BRANCH COUNTIES, MI.IN 2017, THE POPULATION OF LAGRANGE COUNTY WAS APPROXIMATELY 39,303. ACCORDING TO STATSINDIANA.EDU, 96% OF THE RESIDENTS ARE CAUCASIAN (NON-HISPANIC) AND 4% HISPANIC. PLAIN CHURCH RESIDENTS, INCLUDING MEMBERS OF THE AMISH COMMUNITY, MAKE UP NEARLY 44% OF THE POPULATION OF LAGRANGE COUNTY. FOR THE MEMBERS OF THESE FAITH-BASED COMMUNITIES, TRAVEL IS BY HORSE AND BUGGY OR BICYCLE; COMMUNICATIONS ARE EITHER FACE-TO-FACE OR THROUGH THE USE OF A COMMUNITY-OWNED, CENTRALLY LOCATED PHONE. THE MEDIAN INCOME IN LAGRANGE COUNTY IS $60,402 WITH AN UNEMPLOYMENT RATE HOLDING STEADY AT 3.4% |
| 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.).COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC.'S BOARD OF DIRECTORS IS COMPOSED OF MEMBERS, OF WHICH SUBSTANTIALLY ALL ARE INDEPENDENT COMMUNITY MEMBERS. A MAJORITY OF THE BOARD RESIDES IN COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC.'S PRIMARY SERVICE AREA. COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC. ALSO EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN THE COMMUNITY. PEOPLE THROUGHOUT THE COMMUNITY CAN COUNT ON COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC. TO BE STANDING BY WITH EMERGENCY CARE 24 HOURS A DAY, 365 DAYS A YEAR. THE EMERGENCY DEPARTMENT IS STAFFED WITH BOARD-CERTIFIED EMERGENCY CARE PHYSICIANS AND A NURSING STAFF THAT IS TRAINED AND EXPERIENCED IN EMERGENCY CARE. FURTHERMORE, NO PATIENT IS EVER DENIED TREATMENT, REGARDLESS OF THEIR ABILITY TO PAY.COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC. GIVES BACK TO THE COMMUNITY IN THE FORM OF IMPROVED FACILITIES, EDUCATION AND OUTREACH PROGRAMS, FREE AND DISCOUNTED CARE, VOLUNTEERISM AND MUCH MORE. THE FOLLOWING ARE SOME OF THE WAYS COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC. IS REACHING OUT TO MAKE OUR NEIGHBORHOODS AND COMMUNITIES HEALTHIER:PATIENT & FAMILY ADVISORY COUNCIL: IN 2017, COMMUNITY HOSPITAL OF LAGRANGE COUNTY CONTINUED ITS PARTNERSHIP WITH PATIENTS AND PATIENT FAMILY MEMBERS THROUGH THE HOSPITAL'S PATIENT & FAMILY ADVISORY COUNCIL. THE PFAC MEMBERS PROVIDED FEEDBACK ABOUT PROCESSES AND COMMUNICATION OPPORTUNITIES THAT WOULD IMPROVE THAT PATIENT EXPERIENCE. A COUPLE OF AREAS IMPACTED BY THE PFAC'S INVOLVEMENT DURING 2017 WERE:-A DISCUSSION RELATED TO THE IMPLEMENTATION OF A "PAIN & COMFORT MENU" TO HELP PATIENTS AND CARE PROVIDERS BETTER COMMUNICATE AND ADDRESS CONCERNS RELATED TO PAIN AND PAIN MANAGEMENT.THE COMMUNITY HEALTH IMPROVEMENT (CHI) INITIATIVE OF COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC. IS A PROGRAM THAT PROVIDES GRANT SUPPORT FOR COMMUNITY HEALTH INITIATIVES DELIVERED BY NOT-FOR-PROFIT COMMUNITY ORGANIZATIONS THAT SHARE THE HOSPITAL'S MISSION TO ENCOURAGE HEALTHIER LIFESTYLES AMONG THE CITIZENS OF LAGRANGE COUNTY. THE FOLLOWING WERE AMONG THE CHI INITIATIVES FUNDED IN 2017:MENTAL HEALTH:WITH DEATHS BY SUICIDE IN LAGRANGE COUNTY NEARLY DOUBLING EACH YEAR SINCE 2015, THE NEED FOR SUICIDE PREVENTION ON A BROAD SCALE WAS IDENTIFIED AS A HIGH PRIORITY. WITH ASSISTANCE FROM PARKVIEW BEHAVIORAL HEALTH, AN EVIDENCE-BASED SUICIDE PREVENTION STRATEGY KNOWN AS QUESTION, PERSUADE AND REFER (QPR) WAS SELECTED AS THE TOOL TO BE USED IN TRAINING A BROAD SPECTRUM OF ADULTS IN LAGRANGE COUNTY. CHI FUNDING WAS USED TO PURCHASE QPR TRAINING MATERIALS THAT WERE MADE AVAILABLE, FREE OF CHARGE, TO ADULTS IN THE COMMUNITY THAT WERE TRAINED IN QPR. A SELECTED GROUP OF HOSPITAL EMPLOYEES, COMMUNITY MEMBERS, AND A PPG PHYSICIAN REPRESENTATIVE WERE TRAINED AS TRAINERS. IN JUNE OF 2017, THESE LOCAL QPR INSTRUCTORS BEGAN PROVIDING THIS LIFE SAVING TRAINING FREE OF CHARGE TO THE COMMUNITY. BY THE END OF THE YEAR, COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC. HAD PROVIDED QPR GATE KEEPER TRAINING TO OVER 300 PEOPLE IN LAGRANGE COUNTY. THOSE TRAINED INCLUDED SCHOOL TEACHERS, COMMUNITY GROUPS, CHURCHES, HOSPITAL EMPLOYEES, OUR HOSPITAL BOARD OF DIRECTORS, AND MANY MORE GROUPS. PARKVIEW LAGRANGE WILL CONTINUE THESE EFFORTS INTO 2018 WITH ONGOING COWORKER AND COMMUNITY TRAINING SESSIONS. IN 2017, COMMUNITY HOSPITAL OF LAGRANGE'S QPR TEAM ESTABLISHED A PEER-LED SUPPORT GROUP FOR THOSE IMPACTED BY THE LOSS OF A LOVED ONE BY SUICIDE.IN ADDITION, COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC. PARTNERS WITH THE THREE PUBLIC SCHOOL CORPORATIONS IN LAGRANGE COUNTY TO ADDRESS MENTAL HEALTH. THE HOSPITAL PROVIDES A LICENSED MENTAL HEALTH COUNSELOR TO THE SCHOOLS FOR FOUR HOURS EACH WEEK.OBESITY:-THE HOSPITAL CONTINUED ITS PARTNERSHIP WITH COLE FAMILY CENTER YMCA IN 2017, TO FACILITATE ACCESS TO GROUP WELLNESS ACTIVITIES IN LAGRANGE COUNTY AT A YMCA SATELLITE SITE IN SILVEUS INSURANCE'S LOWER LEVEL IN LAGRANGE. HEALTH AND SAFETY:-HEALTH AND SAFETY DAY CAMP IS SPONSORED BY THE HOSPITAL IN PARTNERSHIP WITH LAGRANGE COUNTY'S THREE PUBLIC SCHOOL DISTRICTS, THE SHERRIFF'S DEPARTMENT OF LAGRANGE COUNTY AND OTHER IMPORTANT AGENCIES WITHIN THE COUNTY. SAFETY DAY CAMP IS HOSTED AT EACH ELEMENTARY SCHOOL FOR ALL THE SCHOOL'S FOURTH GRADE STUDENTS AND PROVIDES THEM WITH INTERACTIVE EDUCATION ABOUT A VARIETY OF COMMON SAFETY TOPICS. DURING 2017, THE HEALTH AND SAFETY DAY CAMP REACHED OVER 500 FOURTH GRADE STUDENTS.-DURING 2017 COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC., USED CHI FUNDING TO COMPLETE ITS GOAL OF PROVIDING AUTOMATED EXTERNAL DEFIBRILLATORS (AEDS) FOR THE COUNTY'S FIRST RESPONDERS' VEHICLES. -EXPECTANT MOTHERS IN THE FIRST TRIMESTER OF THEIR PREGNANCY WERE PROVIDED WITH ACCESS TO FREE PRENATAL VITAMINS THROUGH A CHI INITIATIVE AND PARTNERSHIPS WITH PHARMACIES IN LAGRANGE COUNTY. VOUCHERS FOR THE VITAMINS COULD BE PICKED UP THROUGH THE WOMAN'S LAGRANGE COUNTY PRIMARY CARE PHYSICIAN, THROUGH PARKVIEW LAGRANGE HOSPITAL'S BIRTH PLANNER OR THE COMPASSION PREGNANCY CENTER IN LAGRANGE COUNTY.ACCESS:-THE HOSPITAL CONTINUED ITS PARTNERSHIP WITH THE LAGRANGE COUNTY COUNCIL ON AGING (COA) TO ASSIST WITH OPERATIONAL SUPPORT FOR THE COA'S SERVICES TO SENIORS. THE COA PROVIDES A TRANSPORTATION PROGRAM, HOMEMAKER SERVICES, A FOOD PANTRY AND MUCH MORE IN THEIR EFFORTS TO HELP SENIORS IN LAGRANGE COUNTY REMAIN INDEPENDENT IN THE HOMES OF THEIR CHOICE FOR AS LONG AS POSSIBLE. NEARLY HALF OF THE TRIPS THE COA OFFERS TO SENIORS ARE TO THEIR PHYSICIANS FOR CHECK-UPS OR TO THE HOSPITAL FOR TESTS OR TREATMENTS. HOMEMAKER SERVICES HELP WITH DAY-TO-DAY TASKS THAT, IN MANY CASES, COULD PUT THE SENIOR AT RISK OF A FALL OR OTHER INJURY. |
| 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.; AS WELL AS 60 PERCENT OWNERSHIP IN THE JOINT VENTURE OF ORTHOPAEDIC HOSPITAL AT PARKVIEW NORTH, LLC. PARKVIEW CONTRIBUTES TO THE SUCCESS OF THE REGION BY EFFECTIVELY MANAGING ITS FACILITIES, EFFICIENTLY PROVIDING AND DELIVERING ITS SERVICES, AND SUPPORTING LOCAL BUSINESSES AND ACTIVITIES. PARKVIEW SEEKS TO CREATE ALIGNMENT OPPORTUNITIES TO DELIVER COMPREHENSIVE HIGH-QUALITY CARE THAT BENEFIT PATIENTS, PHYSICIANS, CO-WORKERS AND COMMUNITIES. EACH HOSPITAL ENTITY ENGAGES IN COMMUNITY OUTREACH CUSTOMIZED TO MEET THE UNIQUE NEEDS OF THEIR RESPECTIVE COMMUNITIES. AFFILIATE HOSPITALS WORK TOGETHER AND SHARE PROGRAMMING AND MESSAGING WHERE COMMON COMMUNITY HEALTH ISSUES ARE IDENTIFIED. FROM THE LIST OF HEALTH ISSUES IN THE SEVEN-COUNTY AREA, THE HEALTH PRIORITY OF OBESITY/HEALTHY LIFESTYLE PROMOTION AND EDUCATION INCLUDING GOOD NUTRITION, ACCESS TO AND CONSUMPTION OF HEALTHY FOODS AND AN ACTIVE LIFESTYLE WAS SELECTED BY ALL AFFILIATE HOSPITALS. PARKVIEW PRIDES ITSELF IN NOT ONLY OFFERING THE HIGHEST LEVEL OF CARE TO ITS PATIENTS, BUT ALSO IN PROVIDING AN EXCELLENT WORKPLACE FOR ITS PHYSICIANS, NURSES AND STAFF. PARKVIEW'S MISSION AND VISION IS AS FOLLOWS: AS A COMMUNITY OWNED, NOT-FOR-PROFIT ORGANIZATION, PARKVIEW HEALTH IS DEDICATED TO IMPROVING YOUR HEALTH AND INSPIRING YOUR WELL-BEING BY: 1) TAILORING A PERSONALIZED HEALTH JOURNEY TO ACHIEVE YOUR UNIQUE GOALS, 2) DEMONSTRATING WORLD-CLASS TEAMWORK AS WE PARTNER WITH YOU ALONG THAT JOURNEY 3) PROVIDING THE EXCELLENCE, INNOVATION AND VALUE YOU SEEK IN TERMS OF CONVENIENCE, COMPASSION, SERVICE, COST AND QUALITY. PARKVIEW BELIEVES THAT THE COMMUNITIES IT SERVES SHOULD ALL HAVE THE PEACE OF MIND THAT COMES WITH ACCESS TO COMPASSIONATE, HIGH-QUALITY HEALTHCARE, REGARDLESS OF WHETHER THE CARE IS DELIVERED IN A RURAL OR URBAN SETTING. |
| PART VI, LINE 7, REPORTS FILED WITH STATES | IN |
| PART VI, LINE 7: | A COPY OF FORM 990, SCHEDULE H IS FILED WITH THE INDIANA STATE DEPARTMENT OF HEALTH. |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (1) | GrantRecordsMaintainedInd |
Recipient Table RecipientTable (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | Recipient EINRecipientEIN | IRC SectionIRCSectionDesc | Non Cash AssistanceNonCashAssistanceAmt | Purpose Of GrantPurposeOfGrantTxt |
|---|---|---|---|---|---|---|---|
| PARKVIEW HOSPITAL INC | |||||||
| 11109 PARKVIEW PLAZA DRIVE | FORT WAYNE | IN | 46845 | 350868085 | 501 ( C ) 3 | $13,500 | HOME HEALTH & HOSPICE PROGRAM FOR SERVICE AREA OF COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC. |
| LAGRANGE COUNTY ECONOMIC DEVELOPMENT | |||||||
| 304 N TOWNLINE ROAD | LAGRANGE | IN | 46764 | 800309463 | 501 ( C ) 3 | $10,000 | BUSINESS DEVELOPMENT AND EMPLOYMENT PROGRAMS |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 2 | 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) |
|---|---|---|
| Travel For Companions | Yes (X) | TravelForCompanionsInd |
| Written Policy Ref T And E Expnss | Yes (1) | WrittenPolicyRefTAndEExpnssInd |
| Substantiation Required | Yes (1) | SubstantiationRequiredInd |
| 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 (9 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| JORDI DISLER | ||||||||||||||
| DIRECTOR/LGHOS PRESIDENT | $177,691 | $0 | $38,281 | $0 | $9,505 | $0 | $52,851 | $0 | $21,023 | $0 | $299,351 | $0 | $8,501 | $0 |
| MICHAEL PACKNETT | ||||||||||||||
| DIRECTOR/PH PRESIDENT & CEO | $0 | $1,029,197 | $0 | $337,969 | $0 | $232,697 | $0 | $702,543 | $0 | $32,640 | $0 | $2,335,046 | $0 | $0 |
| SHELBY COOPER | ||||||||||||||
| DIRECTOR/PH PHYSICIAN | $11,856 | $225,665 | $0 | $0 | $0 | $15,658 | $0 | $0 | $1,039 | $21,146 | $12,895 | $262,469 | $0 | $0 |
| LOREN HELMUTH | ||||||||||||||
| DIRECTOR/PH PHYSICIAN | $17,235 | $505,519 | $0 | $51,084 | $0 | $23,271 | $546 | $18,354 | $751 | $25,269 | $18,532 | $623,497 | $0 | $0 |
| JEANNE' WICKENS | ||||||||||||||
| PH CHIEF FINANCIAL OFFICER | $0 | $597,900 | $0 | $82,480 | $0 | $20,752 | $0 | $103,150 | $0 | $32,253 | $0 | $836,535 | $0 | $0 |
| JARED BEASLEY | ||||||||||||||
| LGHOS VP PATIENT CARE | $139,106 | $0 | $15,229 | $0 | $443 | $0 | $17,320 | $0 | $11,342 | $0 | $183,440 | $0 | $0 | $0 |
| BRENDA ARMENTROUT | ||||||||||||||
| LGHOS MGR PHARMACY | $150,582 | $0 | $12,942 | $0 | $1,972 | $0 | $14,835 | $0 | $11,316 | $0 | $191,647 | $0 | $0 | $0 |
| STANTON RISSER | ||||||||||||||
| FORMER OFFICER/PH VP PARTIAL YEAR | $0 | $87,858 | $0 | $37,484 | $0 | $31,725 | $0 | $4,409 | $0 | $13,223 | $0 | $174,699 | $0 | $10,507 |
| MICHAEL BROWNING | ||||||||||||||
| FORMER OFFICER | $0 | $0 | $0 | $0 | $0 | $277,686 | $0 | $0 | $0 | $0 | $0 | $277,686 | $0 | $277,686 |
Supplemental Information Detail SupplementalInformationDetail (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 1A | TRAVEL FOR COMPANIONS- TAXABLE EXPENSE REIMBURSEMENT FOR FAMILY MEMBER PAID TO: JORDI DISLER $113 |
| PART I, LINE 3 | RELATED ORGANIZATION, PARKVIEW HEALTH SYSTEM, INC., USES THE FOLLOWING TO ESTABLISH THE COMPENSATION OF COMMUNITY HOSPITAL LAGRANGE COUNTY, INC.'S CEO/EXECUTIVE DIRECTOR: COMPENSATION COMMITTEE OF RELATED ORGANIZATION PARKVIEW HEALTH SYSTEM, INC. INDEPENDENT COMPENSATION CONSULTANT FORM 990 OF OTHER ORGANIZATIONS COMPENSATION SURVEY OR STUDY APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE OF RELATED ORGANIZATION PARKVIEW HEALTH SYSTEM, INC. |
| PART I, LINE 4B | SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN PAYMENTS TAXABLE - MICHAEL BROWNING $277,686; JORDI DISLER $8,501; STANTON RISSER $10,507 PARTICIPANTS DEFERRED - 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. BENEFITS EARNED UNDER THE PLANS WILL FUND THE EMPLOYEES' EVENTUAL RETIREMENT BENEFIT. THESE BENEFITS ARE PROVIDED IN EXCHANGE FOR ALL OF THE EMPLOYEES' YEARS OF SERVICE TO THE ORGANIZATION, AND THE COST OF THE BENEFITS MAY VARY FROM YEAR TO YEAR. 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. JARED BEASLEY $15,340; JORDI DISLER $29,750; MICHAEL PACKNETT $678,243; JEANNE' WICKENS $97,750 |
| 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 K IRS990ScheduleK
Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
Issuer Name IssuerName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | INDIANA HEALTH AND EDUCATIONAL FACILITY FINANCING AUTHORITY | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Issuer EIN | 351611409 | BondIssuerEIN |
| CUSIP | 45479RCF2 | CUSIPNum |
| Bond Issued | 2007-03-15 | BondIssuedDt |
| Issue Price | $24,930,000 | IssuePriceAmt |
| Purpose | SEE PART VI | PurposeDesc |
| Defeased | 0 | DefeasedInd |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuerInd |
| Pool Financing | 0 | PoolFinancingInd |
Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Retired | $6,960,000 | RetiredAmt |
| Total Proceeds | $25,930,446 | TotalProceedsAmt |
| Capitalized Interest | $1,074,006 | CapitalizedInterestAmt |
| Issuance Costs From Proceeds | $208,535 | IssuanceCostsFromProceedsAmt |
| Credit Enhancement | $154,519 | CreditEnhancementAmt |
| Capital Expenditures | $24,493,386 | CapitalExpendituresAmt |
| Substantial Completion | 2008 | SubstantialCompletionYr |
| Current Refunding | 0 | CurrentRefundingInd |
| Advance Refunding | 0 | AdvanceRefundingInd |
| Final Allocation Made | Yes (1) | FinalAllocationMadeInd |
| Adequate Books And Rec Maint | Yes (1) | AdequateBooksAndRecMaintInd |
Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Owning Bond Financed Property | 0 | OwningBondFinancedPropertyInd |
| Any Lease Arrangements | Yes (1) | AnyLeaseArrangementsInd |
| Mgmt Contract Bond Fincd Prop | Yes (1) | MgmtContractBondFincdPropInd |
| Engage Bond Counsel Contracts | Yes (1) | EngageBondCounselContractsInd |
| Any Research Agreements | 0 | AnyResearchAgreementsInd |
| Private Bus Use By Others | 0.00000 | PrivateBusUseByOthersPct |
| Total Private Business Use | 0.00000 | TotalPrivateBusinessUsePct |
| Bond Iss Meet Prvt Sec Pymt Test | 0 | BondIssMeetPrvtSecPymtTestInd |
| Change In Use Bond Financed Prop | 0 | ChangeInUseBondFinancedPropInd |
| Procs Nonqualified Bond Remdtd | Yes (1) | ProcsNonqualifiedBondRemdtdInd |
Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Form8038 T Filed | 0 | Form8038TFiledInd |
| Rebate Not Due Yet | 0 | RebateNotDueYetInd |
| Exception To Rebate | 0 | ExceptionToRebateInd |
| No Rebate Due | Yes (1) | NoRebateDueInd |
| Variable Rate Issue | Yes (1) | VariableRateIssueInd |
| Hedge Identified In Bks And Rec | 0 | HedgeIdentifiedInBksAndRecInd |
| Gross Proceeds Invested In GIC | 0 | GrossProceedsInvestedInGICInd |
| Gross Proceeds Invested | 0 | GrossProceedsInvestedInd |
| Written Proc To Monitor Reqs | Yes (1) | WrittenProcToMonitorReqsInd |
Procedures Corrective Action ProceduresCorrectiveActionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Procedures Corrective Action | Yes (1) | ProceduresCorrectiveActionInd |
Supplemental Information Detail SupplementalInformationDetail (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| SCHEDULE K, PART I,A,F: | CONSTRUCTION OF NEW HOSPITAL FACILITY FOR COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC. IN LAGRANGE, INDIANA |
| SCHEDULE K, PART II,3,A: | THIS AMOUNT INCLUDES INTEREST OF $1,000,446. EARNED ON PROJECT, COST OF ISSUANCE AND CAPITALIZED INTEREST FUNDS. |
| SCHEDULE K, PART III, LINES 4-6: | AS PART OF OUR EFFORTS TO MONITOR AND ENSURE THAT THERE IS NO PRIVATE USE AT OUR BOND FINANCED FACILITIES, WE CONTRIBUTE EQUITY TO FINANCE A PORTION OF OUR NEW MONEY PROJECTS. |
| SCHEDULE K, PART III, LINE 7: | THE BOND IS NOT A PRIVATE ACTIVITY BOND BECAUSE IT DOES NOT MEET THE PRIVATE BUSINESS USE TEST. |
| SCHEDULE K, PART IV, COLUMN A, LINE 2C: | REBATE COMPUTATION WAS PERFORMED ON APRIL 13, 2010. |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (14 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, COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC., EIN 20-2401676. 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, 2017 WAS 571. THE TOTAL NUMBER OF EMPLOYEES REPORTED ON FORM W-3 AND FILED BY THE COMMON PAYING AGENT, PH, FOR THE YEAR ENDED DECEMBER 31, 2017 WAS 12,715. FOR PURPOSES OF COMPLETING FORM 990, PART V, LINE 1A AND 2A, THE NUMBER REPORTED FOR THE COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC. WAS 36 AND 220 RESPECTIVELY. |
| FORM 990, PART VI, SECTION A, LINE 1 | THE EXECUTIVE COMMITTEE IS COMPRISED OF MEMBERS FROM THE ORGANIZATION'S BOARD OF DIRECTORS AND MAY ACT ON BEHALF OF THE ORGANIZATION IN ANY MATTER WHEN THE BOARD IS NOT IN SESSION, REPORTING TO THE BOARD FOR ITS RATIFICATION OF ITS ACTIONS. USE OF THE EXECUTIVE COMMITTEE IS INFREQUENT AND TYPICALLY MEETS ONLY WHEN IT IS IMPRACTICAL TO GET THE FULL BOARD TOGETHER FOR A SPECIAL BOARD MEETING. |
| FORM 990, PART VI, SECTION A, LINE 2 | DIRECTORS KEVIN LAMBRIGHT AND JOE URBANSKI HAVE A BUSINESS RELATIONSHIP. |
| FORM 990, PART VI, SECTION A, LINE 4 | DURING 2017, THE FOLLOWING SIGNIFICANT CHANGES WERE MADE TO THE BYLAWS OF COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC.: ARTICLE I - CORPORATION, SECTION 2 - MISSION STATEMENT IS AS FOLLOWS: AS A COMMUNITY OWNED, NOT-FOR-PROFIT ORGANIZATION, PARKVIEW LAGRANGE HOSPITAL, AN AFFILIATE OF PARKVIEW HEALTH SYSTEM, INC., IS DEDICATED TO IMPROVING YOUR HEALTH AND INSPIRING YOUR WELL-BEING. |
| 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 COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC. WITH CERTAIN RESERVED POWERS. |
| FORM 990, PART VI, SECTION A, LINE 7A | THE CORPORATE MEMBER, PARKVIEW HEALTH SYSTEM, INC. EIN 35-1972384, SHALL HAVE THE FOLLOWING RESERVED POWERS: (I) APPOINT AND REMOVE, WITH OR WITHOUT CAUSE, MEMBERS OF THE BOARD SUBJECT TO THE COMPOSITION REQUIREMENTS REGARDING COMMUNITY AND PHYSICIAN REPRESENTATION SET FORTH IN ARTICLE V, SECTION 2; (II) APPOINT AND REMOVE, WITH OR WITHOUT CAUSE, THE CHAIR AND VICE CHAIR OF THE BOARD AND THE PRESIDENT OF THE CORPORATION; (III) APPROVE AND/OR REQUIRE THE ADOPTION OF AMENDMENTS TO THE ARTICLES OF INCORPORATION OR BYLAWS OF THE CORPORATION OR ANY SUBSIDIARY OR AFFILIATE OF THE CORPORATION; (IV) APPROVE AND/OR REQUIRE THE ESTABLISHMENT, ACQUISITION, DIVESTITURE, DISSOLUTION, CLOSURE, MERGER, CONSOLIDATION, CHANGE IN CORPORATE MEMBERSHIP, AFFILIATION OR CORPORATE REORGANIZATION OF THE CORPORATION OR ANY SUBSIDIARY OR AFFILIATE OF THE CORPORATION; (V) APPROVE AND ADOPT THE STRATEGIC PLAN AND ANY AMENDMENTS THERETO FOR THE CORPORATION AND ANY SUBSIDIARY OR AFFILIATE OF THE CORPORATION; (VI) APPROVE AND/OR REQUIRE THE INCURRENCE OF ANY DEBT, INCLUDING THE ISSUANCE OF ANY BONDS, PROPOSED BY THE CORPORATION OR ANY SUBSIDIARY OR AFFILIATE OF THE CORPORATION IN EXCESS OF LIMITS SPECIFIED IN THE POLICY OF THE CORPORATE MEMBER; (VII) APPROVE AND/OR REQUIRE THE APPROVAL OF CONTRACTS OR LOANS OBLIGATING THE CORPORATION TO EXPEND OR REPAY AN AMOUNT IN EXCESS OF LIMITS SPECIFIED IN THE POLICY OF THE CORPORATE MEMBER; (VIII) APPROVE AND/OR REQUIRE THE SALE, LEASE, EXCHANGE, MORTGAGE, PLEDGE, TRANSFER, ENCUMBRANCE OR OTHER DISPOSITION OF PROPERTY AND ASSETS OF THE CORPORATION IN EXCESS OF LIMITS SPECIFIED IN THE POLICY OF THE CORPORATE MEMBER; (IX) APPROVE AND ADOPT THE CAPITAL BUDGET, OPERATING BUDGET, FINANCIAL PLANS AND ANY AMENDMENTS THERETO FOR THE CORPORATION AND ANY SUBSIDIARY OR AFFILIATE OF THE CORPORATION; (X) APPROVE AND/OR REQUIRE THE ADOPTION OF A MANAGED CARE POLICY FOR THE CORPORATION AND ANY SUBSIDIARY OR AFFILIATE OF THE CORPORATION, INCLUDING NETWORK PARTICIPATION, PARTICIPATION IN ANY MANAGED CARE AGREEMENT AND PARTICIPATION IN ANY OTHER HEALTH CARE SERVICE ARRANGEMENTS; (XI) APPOINT AND REMOVE AUDITORS, ATTORNEYS AND OTHER PROFESSIONAL ADVISORS FOR THE CORPORATION AND ANY SUBSIDIARY OR AFFILIATE OF THE CORPORATION; (XII) DEVELOP, APPROVE AND/OR REQUIRE THE ADOPTION OF MEDICAL STAFF QUALITY ASSURANCE STANDARDS, UTILIZATION REVIEW STANDARDS, CRITERIA, POLICIES AND PROCEDURES FOR THE CORPORATION AND ANY SUBSIDIARY OR AFFILIATE OF THE CORPORATION; (XIII) APPROVE AND/OR REQUIRE THE ADOPTION OF ANY ACTION TO CHANGE THE CORPORATION FROM A GENERAL, ACUTE CARE COMMUNITY HOSPITAL OR TO CLOSE THE CORPORATION'S CURRENT LOCATION; (XIV) APPROVE EACH ANNUAL LIST OF PROPOSED DONORS AND AMOUNTS OF DONATIONS OR GRANTS NOT INCLUDED IN THE ANNUAL BUDGET, AND MAKE PROPOSALS TO DEVIATE THEREFROM THROUGHOUT EACH YEAR IN EXCESS OF LIMITS SPECIFIED IN THE POLICY OF THE CORPORATE MEMBER; AND (XV) APPROVE AND/OR REQUIRE THE ADOPTION OF ANY ACTION THAT IS INCONSISTENT WITH THE POLICY OF THE CORPORATE MEMBER. |
| FORM 990, PART VI, SECTION A, LINE 7B | SEE SCHEDULE O EXPLANATION FOR FORM 990, PART VI, SECTION A, LINE 7A |
| FORM 990, PART VI, SECTION B, LINE 11B | PURSUANT TO PARKVIEW HEALTH SYSTEM INC.'S BYLAWS, THE SYSTEM AUDIT COMMITTEE MAY ACT ON BEHALF OF THE CORPORATION TO PROVIDE REVIEW OF THE CORPORATION AND ITS SUBSIDIARY CORPORATIONS' FORM 990 FILINGS. COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC. IS A SUBSIDIARY CORPORATION OF PARKVIEW HEALTH SYSTEM, INC. AN ELECTRONIC COPY OF THE ORGANIZATION'S FINAL FORM 990 (INCLUDING REQUIRED SCHEDULES) WAS PROVIDED TO EACH VOTING MEMBER OF THE ORGANIZATION'S GOVERNING BODY, PRIOR TO FILING WITH THE IRS. ON OCTOBER 10, 2018, THE SYSTEM AUDIT COMMITTEE REVIEWED THE FORM 990 AS ULTIMATELY FILED WITH THE IRS. THIS REVIEW INCLUDED A PRESENTATION BY THE ORGANIZATION'S TAX PREPARER TO HIGHLIGHT THE SIGNIFICANT AREAS ON THE FORM 990 AND SUPPLEMENTAL SCHEDULES. |
| FORM 990, PART VI, SECTION B, LINE 12C | AS DESCRIBED IN ARTICLE IX SECTION 6, OF THE PARKVIEW HEALTH SYSTEM, INC. (PH) BYLAWS, PH ADOPTED PH'S COMPLIANCE POLICY FOR THE ORGANIZATION AND ITS NOT-FOR-PROFIT RELATED ORGANIZATIONS (AND AS LIKEWISE NOTED IN THEIR BYLAWS) WHEN ADDRESSING CONFLICTS OR POTENTIAL CONFLICTS OF INTEREST. THIS COMPLIANCE POLICY (COMPLIANCE POLICY #14) REQUIRES THAT EACH BOARD MEMBER, BOARD COMMITTEE MEMBER, AND KEY MANAGEMENT PERSONNEL MUST ANNUALLY COMPLETE A CONFLICT OF INTEREST FORM. THIS INFORMATION IS PROVIDED TO THE CHAIRMAN OF THE BOARD (FOR BOARD AND BOARD COMMITTEE MEMBERS) AND TO SENIOR MANAGEMENT (FOR KEY MANAGEMENT PERSONNEL). IN ADDITION, AS TO THE CONDUCT OF BOARD MEETINGS, THE FOLLOWING PROCESS IS FOLLOWED: "WHENEVER A PH OR PH AFFILIATE BOARD OR BOARD COMMITTEE IS CONSIDERING A TRANSACTION OR ARRANGEMENT WITH AN ORGANIZATION, ENTITY OR INDIVIDUAL IN WHICH A PERSON COVERED BY THIS POLICY HAS A FINANCIAL OR CONFLICTING INTEREST, THE FOLLOWING SHALL OCCUR: 1. THE INTERESTED PERSON MUST DISCLOSE THE FINANCIAL OR CONFLICTING INTEREST AND ALL MATERIAL FACTS TO THE PH OR PH AFFILIATE BOARD OR BOARD COMMITTEE; 2. THE INTERESTED PERSON WITH THAT FINANCIAL OR CONFLICTING INTEREST MAY MAKE A PRESENTATION AT THE BOARD OR BOARD COMMITTEE MEETING REGARDING THE TRANSACTION OR ARRANGEMENT HOWEVER, HE/SHE SHALL LEAVE THE MEETING DURING THE DISCUSSION OF, AND THE VOTE ON, THE TRANSACTION OR ARRANGEMENT THAT RESULTS IN THE FINANCIAL OR CONFLICTING INTEREST; AND 3. THE PH OR PH AFFILIATE BOARD OR BOARD COMMITTEE MUST APPROVE THE TRANSACTION OR ARRANGEMENT BY A MAJORITY VOTE OF THE BOARD MEMBERS PRESENT AT A MEETING THAT HAS A QUORUM, NOT INCLUDING THE VOTE OF THE INTERESTED PERSON. THE INTERESTED PERSON MAY NOT VOTE ON THE MATTER. A. UPON THE REQUEST OF PH OR PH AFFILIATE BOARD OR BOARD COMMITTEE, THE MATTER MAY BE DELEGATED TO THE PH COMPLIANCE COMMITTEE FOR EVALUATION, RECOMMENDATION AND/OR DETERMINATION. 4. WHENEVER A FINANCIAL OR CONFLICTING INTEREST IS ADDRESSED BY A PH OR PH AFFILIATE BOARD, NOTICE SHALL BE GIVEN TO THE PH COMPLIANCE OFFICER / GENERAL COUNSEL." |
| FORM 990, PART VI, SECTION B, LINE 15 | LINES 15A AND 15B ARE ANSWERED NO IN ACCORDANCE WITH THE IRS INSTRUCTIONS. TO THE EXTENT THAT THE ORGANIZATION HAS VICE PRESIDENT OR ABOVE, THE COMPENSATION COMMITTEE OF RELATED ORGANIZATION, PARKVIEW HEALTH SYSTEM, INC., DETERMINES THE COMPENSATION OF THE CEO, OFFICERS, AND KEY EMPLOYEES. |
| FORM 990, PART VI, SECTION C, LINE 19 | COPIES OF THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. |
| FORM 990, PART IX, LINE 11G | OTHER: PROGRAM SERVICE EXPENSES 2,080,434. MANAGEMENT AND GENERAL EXPENSES 53,343. FUNDRAISING EXPENSES 599. TOTAL EXPENSES 2,134,376. PHYSICIAN PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 2,509,243. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,509,243. CONTRACTED MEDICAL SERVICES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 374,323. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 374,323. COLLECTION EXPENSE: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 286,290. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 286,290. |
| 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: | CURRENT YEAR EARNINGS TRANSFERRED TO PARENT -2,443,537. ASSET TRANSFERS/ADJUSTMENTS 393. DOUBTFUL PLEDGE EXPENSE -7. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (7 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 | |||||||||||
| 10501 CORPORATE DRIVE | FORT WAYNE | IN | 46845 | 351972384 | HEALTH CARE | IN | 501(C)(3) | LINE 12C, III-FI | N/A | 0 | |
| 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 | |
| PARKVIEW OCCUPATIONAL HEALTH CENTERS INC | |||||||||||
| 10501 CORPORATE DRIVE | FORT WAYNE | IN | 46845 | 352064353 | OCCUP HEALTH | IN | 501(C)(3) | LINE 3 | 0 | PARKVIEW HEALTH SYSTEM 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 | |
| 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 | |
| HUNTINGTON MEMORIAL HOSPITAL INC | |||||||||||
| 2001 STULTS ROAD | HUNTINGTON | IN | 46750 | 351970706 | HOSPITAL CARE | IN | 501(C)(3) | LINE 3 | 0 | PARKVIEW HEALTH SYSTEM 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 | |
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (3 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Direct Controlling NADirectControllingNACd | Predominant Income TypePredominantIncomeTypeTxt | Disproportionate AllocationsDisproportionateAllocationsInd | General Or Managing PartnerGeneralOrManagingPartnerInd |
|---|---|---|---|---|---|---|---|---|---|---|
| ORTHOPAEDIC HOSPITAL AT PARKVIEW NORTH LLC | ||||||||||
| 10501 CORPORATE DRIVE | FORT WAYNE | IN | 46845 | 260143823 | ORTHO HOSPITAL | IN | N/A | N/A | 0 | 0 |
| FOUNDATION SURGERY AFFILIATE OF FORT WAYNE LLC | ||||||||||
| 8004 CARNEGIE BLVD | FORT WAYNE | IN | 46804 | 201394120 | SURGICAL SERVICES | IN | N/A | N/A | 0 | 0 |
| MANAGED CARE SERVICES LLC | ||||||||||
| 10501 CORPORATE DRIVE | FORT WAYNE | IN | 46845 | 351996535 | HEALTH PLAN ADMIN | IN | N/A | N/A | 0 | 0 |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Direct Controlling NADirectControllingNACd | Entity TypeEntityTypeTxt | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|
| 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 | Yes (1) | 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 | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | Yes (1) | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (1) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | 0 | 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 | 0 | TransferFromOtherOrgInd |