PARKVIEW OCCUPATIONAL HEALTH CENTERS INC: Form 990, tax year 2016
View the entire original 990 at ProPublica ↗
- Organization
- PARKVIEW OCCUPATIONAL HEALTH CENTERS INC (EIN 35-2064353)
- Tax period
- 2016-01-01 to 2016-12-31
- Filed
- 2017-11-12
- IRS object ID
- 201723169349300232
- Schema version
- 2016v3.0
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2017-11-12T15:17:44-06:00 | ReturnTs |
| Tax Period End | 2016-12-31 | 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 HORWATH LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 330 E JEFFERSON BLVD PO BOX 7 | AddressLine1Txt |
| City | SOUTH BEND | CityNm |
| State Abbreviation | IN | StateAbbreviationCd |
| ZIP | 466240007 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2016-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 352064353 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PARKVIEW OCCUPATIONAL HEALTH | BusinessNameLine1Txt |
| Business Name Line2 | CENTERS INC | BusinessNameLine2Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | PARK | BusinessNameControlTxt |
| Phone | 2603738429 | 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 |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | JEANNE' WICKENS | PersonNm |
| Person Title | PH CFO | PersonTitleTxt |
| Phone | 2603738407 | PhoneNum |
| Signature | 2017-11-12 | 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 |
| Self Employed | Yes (X) | SelfEmployedInd |
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 | 2017-11-12 | IPDt |
| IP Tm | 15:50:32 | IPTm |
| IP Timezone | ES | IPTimezoneCd |
| Filing License Type | P | FilingLicenseTypeCd |
| At Submission Creation Device Id | BD78C0151F32BCCEC501E79B474C54CD1328F117 | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | BD78C0151F32BCCEC501E79B474C54CD1328F117 | AtSubmissionFilingDeviceId |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2016 | TaxYr |
| Build TS | 2017-02-10 21:41:12Z | 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 | $10,729,591 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.PARKVIEW.COM | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1998 | FormationYr |
| Legal Domicile State | IN | LegalDomicileStateCd |
| Activity Or Mission | DELIVER OCCUPATIONAL HEALTH CARE SERVICES AND PROMOTE GENERAL HEALTH OF COMMUNITY. | ActivityOrMissionDesc |
| Voting Members Governing Body | 3 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 2 | VotingMembersIndependentCnt |
| Total Employee | 142 | TotalEmployeeCnt |
| Total Volunteers | 0 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $16,415 | PYContributionsGrantsAmt |
| CY Contributions Grants | $10,060 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $10,502,446 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $10,718,531 | CYProgramServiceRevenueAmt |
| PY Investment Income | $0 | PYInvestmentIncomeAmt |
| CY Investment Income | $1,000 | CYInvestmentIncomeAmt |
| PY Other Revenue | $0 | PYOtherRevenueAmt |
| CY Other Revenue | $0 | CYOtherRevenueAmt |
| PY Total Revenue | $10,518,861 | PYTotalRevenueAmt |
| CY Total Revenue | $10,729,591 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $6,819,589 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $7,669,132 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $3,697,169 | PYOtherExpensesAmt |
| CY Other Expenses | $3,720,888 | CYOtherExpensesAmt |
| PY Total Expenses | $10,516,758 | PYTotalExpensesAmt |
| CY Total Expenses | $11,390,020 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $2,103 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$660,429 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $5,320,835 | TotalAssetsBOYAmt |
| Total Assets EOY | $4,617,268 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $373,430 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $330,292 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $4,947,405 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $4,286,976 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | DELIVER OCCUPATIONAL HEALTH CARE SERVICES IN A TIMELY, EFFICIENT, COST-EFFECTIVE MANNER AND PROMOTE THE GENERAL HEALTH OF THE COMMUNITY BY PROVIDING EDUCATIONAL AND WELLNESS PROGRAMS TO EMPLOYEE PATIENTS AND EMPLOYER CLIENTS. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $10,871,286 | ExpenseAmt |
| Revenue | $10,718,531 | RevenueAmt |
| Desc | PARKVIEW OCCUPATIONAL HEALTH CENTERS, INC. (POHCI) PROVIDES A FULL RANGE OF OCCUPATIONAL HEALTH SERVICES IN PREVENTION, TREATMENT, AND REHABILITATION. THESE SERVICES ARE DELIVERED WITH AN EMPHASIS ON COST CONTAINMENT THROUGH EARLY INTERVENTION AND EXPERT CASE MANAGEMENT. EMPLOYEE ASSISTANCE PROGRAMS (EAP) AND WORKSITE WELLNESS SERVICES ARE ALSO AVAILABLE.POHCI PERFORMS A WIDE VARIETY OF PRE-PLACEMENT PHYSICAL EXAMINATIONS FOR A WIDE CROSS SECTION OF THE NORTHEAST INDIANA AREA BUSINESS COMMUNITY. THESE EXAMINATIONS ARE SPECIFIC TO THE JOB FOR WHICH THE INDIVIDUAL IS BEING CONSIDERED, AND WITH THE ADVENT OF THE AMERICANS(SEE SCHEDULE O FOR CONTINUATION)WITH DISABILITIES ACT (ADA), ARE MATCHING POTENTIAL JOB APPLICANTS WITH THE ESSENTIAL FUNCTIONS OF THEIR JOBS. THIS ASSISTANCE IS CRITICAL TO EMPLOYERS AS THEY COMPLY WITH ADA. THE ORGANIZATION ALSO OFFERS A NATIONALLY CERTIFIED DRUG SCREEN PROGRAM, WHICH IS OPERATED IN COMPLIANCE WITH GUIDELINES ESTABLISHED BY THE NATIONAL INSTITUTE FOR DRUG ABUSE. FURTHER, THE ORGANIZATION PROVIDES ON-SITE MEDICAL MONITORING EXAMINATION PROTOCOL DEVELOPMENT, E. G., ASSISTING COMPANIES WITH THEIR COMPLIANCE UNDER OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION GUIDELINES, ERGONOMIC COMPLIANCE ASSISTANCE, AND ASSISTANCE IN COMPLIANCE WITH THE AMERICANS WITH DISABILITIES ACT REASONABLE ACCOMMODATION GUIDELINES. ADDITIONALLY, THE ORGANIZATION PROVIDES INDUSTRIAL HYGIENE SERVICES TO ASSIST IN ANALYZING NOISE LEVELS, INDOOR AIR QUALITY, AND OTHER MANDATED SURVEILLANCE PROGRAMS UNDER THE AUTHORIZATION OF THE OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION.POHCI'S CLINICS ARE EQUIPPED TO CONDUCT INJURY CARE, PHYSICAL EXAMINATIONS, AND THE FOLLOWING ANCILLARY SERVICES: X-RAY, COLLECTION OF SPECIMENS FOR LABORATORY ANALYSIS, PULMONARY FUNCTION TESTING, AUDIOMETRY, ELECTROCARDIOGRAMS (EKG), AND VISION SCREENING.POHCI SPECIALIZES IN THE TREATMENT OF WORKERS' COMPENSATION INJURIES AND OFFERS PHYSICIAN REFERRALS COMPLIMENTARY TO THE SPECIALIZED TREATMENT OF AN INJURY, SUCH AS HAND SURGERY, NEUROLOGY, AND OPHTHALMOLOGY, AS WELL AS IN-HOUSE PHARMACY SERVICES. THE CONCEPT OF THE ORGANIZATION'S TREATMENT PLAN IS CENTERED AROUND THE EARLY INTERVENTION/EARLY TO WORK CONCEPT. THROUGH EARLY INTERVENTION AND A VARIETY OF TREATMENT AND REHABILITATIVE MODALITIES, PATIENTS ARE ASSURED THE MOST EXPEDITIOUS RETURN TO WORK, THUS SAVING THE EMPLOYERS TREMENDOUS EXPENSE IN LOST PRODUCTIVITY, OVERTIME, TRAINING COSTS, ETC.POHCI PROVIDES PHYSICAL THERAPY ON-SITE AT THE CENTRAL, NORTH AND SOUTH LOCATIONS. POHCI HAS PARTNERED WITH PARKVIEW HOSPITALS PHYSICAL THERAPY DEPARTMENTS IN OTHER AREAS OF THE REGION. THE THERAPISTS ARE TRAINED IN REHABILITATION OF WORK RELATED INJURIES AND ARE SUPERVISED BY THE ORGANIZATION'S OCCUPATIONAL HEALTH PHYSICIANS. THE FOCUS OF THE THERAPIST IS TO RETURN THE INJURED WORKER TO THE JOB. DURING PHYSICAL THERAPY REHABILITATION, THE INJURED WORKER IS TAUGHT PROPER LIFTING TECHNIQUES TO AVOID RE-INJURY. THE OCCUPATIONAL THERAPY DEPARTMENT SPECIALIZES IN HAND REHABILITATION, UTILIZING VARIOUS EXERCISES AND SPLINTS THAT ASSIST IN EXPEDITING THE RECOVERY PROCESS.POHCI ALSO PROVIDES A COMPREHENSIVE WORK CONDITIONING PROGRAM, WHICH OPERATES WITHIN A WORK SIMULATION ENVIRONMENT, THUS ASSISTING THE INDIVIDUAL WITH BUILDING A PHYSICAL TOLERANCE LEVEL IN ORDER TO RETURN TO WORK IN A FULLY REHABILITATED CONDITION, IF AT ALL POSSIBLE.POHCI IS COMMITTED TO COST CONTAINMENT FOR ITS EMPLOYER CLIENTS AND/OR THEIR INSURANCE CARRIERS. SINCE THE ORGANIZATION SPECIALIZES IN OCCUPATIONAL HEALTH, APPROXIMATELY NINETY-NINE PERCENT (99%) OF THE FEES FOR ALL CASES ARE PAID EITHER THROUGH THE EMPLOYERS' WORKERS' COMPENSATION INSURANCE OR DIRECTLY BY THE EMPLOYERS. | Desc |
| Total Program Service Expenses | $10,871,286 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | 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 | Yes (1) | ReportOtherAssetsInd |
| Report Other Liabilities | 0 | 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 | 0 | OperateHospitalInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | Yes (1) | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | Yes (1) | 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 | 10 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 142 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 3 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 2 | IndependentVotingMemberCnt |
| Family Or Business Rln | Yes (1) | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (1) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | 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 (11 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| LISA SCHANBACHER | ||||||||
| DIRECTOR/POHCI VP | 20.00 | 20.00 | Yes (X) | $140,448 | $76,019 | $69,860 | ||
| MARJORIE HINER | ||||||||
| DIRECTOR/CHAIR | 1.00 | 1.00 | Yes (X) | $500 | $0 | $0 | ||
| DENISE LEMMON | ||||||||
| DIRECTOR/SECRETARY/TREASURER | 1.00 | 1.00 | Yes (X) | $500 | $0 | $0 | ||
| MICHAEL PACKNETT | ||||||||
| PH PRESIDENT & CEO | 1.00 | 56.00 | $0 | $2,067,010 | $712,544 | Yes (X) | ||
| JEANNE' WICKENS | ||||||||
| PH CHIEF FINANCIAL OFFICER | 1.00 | 56.00 | $0 | $372,369 | $79,329 | Yes (X) | ||
| STANTON RISSER | ||||||||
| INTERIM PH CFO - PARTIAL YEAR/PH VP | 1.00 | 56.00 | $0 | $318,160 | $67,612 | Yes (X) | ||
| RAFID KAKEL | ||||||||
| POHCI PHYSICIAN | 40.00 | 0.00 | $181,299 | $0 | $17,538 | Yes (X) | ||
| GREGORY KNISS | ||||||||
| POHCI PHYSICIAN | 40.00 | 0.00 | $162,027 | $0 | $38,838 | Yes (X) | ||
| DIANE CASEY | ||||||||
| POHCI DIR OCC HEALTH | 40.00 | 0.00 | $134,172 | $0 | $26,727 | Yes (X) | ||
| MARCY PRATT | ||||||||
| POHCI OCC HEALTH NP | 41.00 | 8.00 | $103,234 | $27,122 | $12,285 | Yes (X) | ||
| OMOTAYO FAWIBE | ||||||||
| POHCI PHYSICIAN | 40.00 | 0.00 | $125,745 | $0 | $11,008 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $847,925 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $2,860,680 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $1,035,741 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 9 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (3 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| QUEST DIAGNOSTICS | |||||
| PO BOX 740709 | ATLANTA | GA | 30374 | LABORATORY SERVICES | $494,584 |
| PARKVIEW PROFESSIONAL PROGRAMS INC | |||||
| 10501 CORPORATE DRIVE | FORT WAYNE | IN | 46845 | LABORATORY SERVICES | $443,735 |
| CHG COMPANIES | |||||
| PO BOX 972651 | DALLAS | TX | 75397 | PHYSICIANS | $152,725 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 3 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $100 | RelatedOrganizationsAmt |
| All Other Contributions | $9,960 | AllOtherContributionsAmt |
| Total Contributions | $10,060 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| PATIENT SERVICE | 621400 | $9,808,999 | $9,808,999 |
| EMPLOYEE ASSISTANCE | 900099 | $909,532 | $909,532 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $10,718,531 | TotalProgramServiceRevenueAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $1,000 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $0 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $1,000 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,000 | TotalRevenueColumnAmt |
| Exclusion | $1,000 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $10,729,591 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $10,718,531 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $1,000 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $186,774 | TotalAmt |
| Management And General | $186,774 | ManagementAndGeneralAmt |
Comp Disqual Persons CompDisqualPersonsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $70,285 | TotalAmt |
| Program Services | $70,285 | ProgramServicesAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,690,913 | TotalAmt |
| Program Services | $5,690,913 | ProgramServicesAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,721,160 | TotalAmt |
| Program Services | $1,721,160 | ProgramServicesAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,499,004 | TotalAmt |
| Program Services | $1,434,309 | ProgramServicesAmt |
| Management And General | $64,695 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,057 | TotalAmt |
| Program Services | $3,057 | ProgramServicesAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $297,453 | TotalAmt |
| Program Services | $239,162 | ProgramServicesAmt |
| Management And General | $58,291 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $34,168 | TotalAmt |
| Program Services | $2,428 | ProgramServicesAmt |
| Management And General | $31,740 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $802,908 | TotalAmt |
| Program Services | $791,389 | ProgramServicesAmt |
| Management And General | $11,519 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $82,957 | TotalAmt |
| Program Services | $72,504 | ProgramServicesAmt |
| Management And General | $10,453 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $18,019 | TotalAmt |
| Program Services | $8,173 | ProgramServicesAmt |
| Management And General | $9,846 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $136,066 | TotalAmt |
| Program Services | $136,066 | ProgramServicesAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $146,348 | TotalAmt |
| Program Services | $10,270 | ProgramServicesAmt |
| Management And General | $136,078 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| MEDICAL SUPPLIES | $632,428 | $632,428 | |
| BAD DEBT | $45,997 | $45,997 | |
| DUES & SUBSCRIPTIONS | $8,724 | $5,013 | $3,711 |
| LICENSES | $7,065 | $2,179 | $4,886 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,694 | TotalAmt |
| Program Services | $5,953 | ProgramServicesAmt |
| Management And General | $741 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $11,390,020 | TotalAmt |
| Program Services | $10,871,286 | ProgramServicesAmt |
| Management And General | $518,734 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $450 | BOYAmt |
| EOY | $500 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,473,383 | BOYAmt |
| EOY | $1,304,873 | EOYAmt |
Receivables From Officers Etc ReceivablesFromOfficersEtcGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $129,368 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,369 | BOYAmt |
| EOY | $100,042 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $2,316,027 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $1,403,761 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $853,691 | BOYAmt |
| EOY | $912,266 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,990,942 | BOYAmt |
| EOY | $2,170,219 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,320,835 | BOYAmt |
| EOY | $4,617,268 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $373,430 | BOYAmt |
| EOY | $330,292 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $373,430 | BOYAmt |
| EOY | $330,292 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,947,405 | BOYAmt |
| EOY | $4,286,976 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,947,405 | BOYAmt |
| EOY | $4,286,976 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,320,835 | BOYAmt |
| EOY | $4,617,268 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | -$660,429 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $0 | 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 |
Form990 Schedule A Part VI Form990ScheduleAPartVIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | FORM 990, SCHEDULE A, PART 1, LINE 3: | FormAndLineReferenceDesc |
| Explanation | EXPLANATION OF CHARITY STATUS PURSUANT TO THE IRS DETERMINATION LETTER DATED SEPTEMBER 1, 1999, THE ORGANIZATION IS RECOGNIZED AS EXEMPT UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. THE ORGANIZATION IS DESCRIBED IN SECTION(S) 509(A)(1) AND 170(B(1)(A)(III) AS A HOSPITAL OR A COOPERATIVE HOSPITAL SERVICE ORGANIZATION. PARKVIEW OCCUPATIONAL HEALTH CENTER, INC.'S ORIGINAL APPLICATION FOR RECOGNITION OF EXEMPTION (FORM 1023) STATES THE FOLLOWING: "THE CORPORATION WILL NOT BE A HOSPITAL BUT WILL OPERATE OUTPATIENT CLINICS. THE CORPORATION OPERATES FOR THE PURPOSE OF TREATING WORKERS' COMPENSATION INJURIES AND ILLNESSES IN THE FORT WAYNE METROPOLITAN AREA. IT WILL NOT BE AN EMERGENCY ROOM AS FORMALLY DEFINED. IT WILL BE DESIGNED TO TREAT MINOR EMERGENCIES THAT OCCUR IN THE WORK PLACE THAT ARE COVERED UNDER WORKERS' COMPENSATION LAWS. AS AN AFFILIATE OF PARKVIEW HEALTH SYSTEMS, INC., ALL CHARITY PATIENTS WILL BE REFERRED AND TREATED WITHIN THE PARKVIEW SYSTEM IF SUCH PATIENTS SO CHOOSE." | ExplanationTxt |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule D IRS990ScheduleD
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $603,226 | OtherCostOrOtherBasisAmt |
| Depreciation | $140,352 | DepreciationAmt |
| Book Value | $462,874 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $405,247 | OtherCostOrOtherBasisAmt |
| Depreciation | $400,803 | DepreciationAmt |
| Book Value | $4,444 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,276,590 | OtherCostOrOtherBasisAmt |
| Depreciation | $851,263 | DepreciationAmt |
| Book Value | $425,327 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $30,964 | OtherCostOrOtherBasisAmt |
| Depreciation | $11,343 | DepreciationAmt |
| Book Value | $19,621 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $912,266 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | DUE TO/FROM INTERUNIT | Desc |
| Book Value | $2,170,219 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $2,170,219 | TotalBookValueOtherAssetsAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART X, LINE 2: | FormAndLineReferenceDesc |
| Explanation | PARKVIEW HEALTH SYSTEM, INC. AND SUBSIDIARIES - NOTES TO THE CONSOLIDATED FINANCIAL STATEMENTS TEXT OF THE FOOTNOTE TO THE ORGANIZATION'S FINANCIAL STATEMENTS THAT DESCRIBES THE LIABILITY FOR UNCERTAIN TAX POSITIONS UNDER FIN 48 (ASC 740): INCOME TAXES: THE INTERNAL REVENUE SERVICE HAS DETERMINED THAT THE CORPORATION AND CERTAIN AFFILIATED ENTITIES ARE TAX-EXEMPT ORGANIZATIONS AS DEFINED IN SECTION 501(C)3 OF THE INTERNAL REVENUE CODE. CERTAIN SUBSIDIARIES OF THE CORPORATION ARE TAXABLE ENTITIES, THE TAX EXPENSE AND LIABILITIES OF WHICH ARE NOT MATERIAL TO THE CONSOLIDATED FINANCIAL STATEMENTS. THE CORPORATION AND ITS TAX-EXEMPT AFFILIATED ENTITIES EACH FILE A FORM 990 (RETURN OF ORGANIZATION EXEMPT FROM INCOME TAX) ANNUALLY. WHEN THESE RETURNS ARE FILED, IT IS HIGHLY CERTAIN THAT SOME POSITIONS TAKEN WOULD BE SUSTAINED UPON EXAMINATION BY THE TAXING AUTHORITIES, WHILE OTHERS ARE SUBJECT TO UNCERTAINTY ABOUT THE MERITS OF THE POSITION TAKEN OR THE AMOUNT OF THE POSITION THAT WOULD ULTIMATELY BE SUSTAINED. EXAMPLES OF TAX POSITIONS COMMON TO HEALTH SYSTEMS INCLUDE SUCH MATTERS AS THE TAX-EXEMPT STATUS OF EACH ENTITY, THE CONTINUED TAX-EXEMPT STATUS OF BONDS, THE NATURE, CHARACTERIZATION AND TAXABILITY OF JOINT VENTURE INCOME, AND VARIOUS POSITIONS RELATING TO POTENTIAL SOURCES OF UNRELATED BUSINESS TAXABLE INCOME (REPORTED ON FORM 990T). AS OF DECEMBER 31, 2016 AND 2015, 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 2012 AND PRIOR. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Idemnification Gross Up Pmts | Yes (X) | IdemnificationGrossUpPmtsInd |
| Personal Services | Yes (X) | PersonalServicesInd |
| 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 (7 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| LISA SCHANBACHER | ||||||||||||||
| DIRECTOR/POHCI VP | $76,019 | $76,019 | $46,277 | $0 | $18,152 | $0 | $27,241 | $14,745 | $18,085 | $9,789 | $185,774 | $100,553 | $16,766 | $0 |
| MICHAEL PACKNETT | ||||||||||||||
| PH PRESIDENT & CEO | $0 | $999,068 | $0 | $525,000 | $0 | $542,942 | $0 | $669,350 | $0 | $43,194 | $0 | $2,779,554 | $0 | $419,516 |
| JEANNE' WICKENS | ||||||||||||||
| PH CHIEF FINANCIAL OFFICER | $0 | $329,339 | $0 | $15,000 | $0 | $28,030 | $0 | $60,171 | $0 | $19,158 | $0 | $451,698 | $0 | $0 |
| STANTON RISSER | ||||||||||||||
| INTERIM PH CFO - PARTIAL YEAR/PH VP | $0 | $193,037 | $0 | $116,196 | $0 | $8,927 | $0 | $40,555 | $0 | $27,057 | $0 | $385,772 | $0 | $6,041 |
| RAFID KAKEL | ||||||||||||||
| POHCI PHYSICIAN | $155,556 | $0 | $25,000 | $0 | $743 | $0 | $0 | $0 | $17,538 | $0 | $198,837 | $0 | $0 | $0 |
| GREGORY KNISS | ||||||||||||||
| POHCI PHYSICIAN | $157,171 | $0 | $0 | $0 | $4,856 | $0 | $19,281 | $0 | $19,557 | $0 | $200,865 | $0 | $0 | $0 |
| DIANE CASEY | ||||||||||||||
| POHCI DIR OCC HEALTH | $108,331 | $0 | $24,653 | $0 | $1,188 | $0 | $8,230 | $0 | $18,497 | $0 | $160,899 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 1A | TAX INDEMNIFICATION AND GROSS-UP PAYMENTS - TAX ON TAXABLE GIFT CERTIFICATE PAID TO: LISA SCHANBACHER $68 PERSONAL SERVICES - TAXABLE ALLOWANCE FOR FINANCIAL PLANNING PAID TO: RAFID KAKEL $165; GREGORY KNISS $500 |
| PART I, LINE 3 | RELATED ORGANIZATION, PARKVIEW HEALTH SYSTEM, INC., USES THE FOLLOWING TO ESTABLISH THE COMPENSATION OF PARKVIEW OCCUPATIONAL HEALTH CENTERS, INC.'S CEO/EXECUTIVE DIRECTOR: COMPENSATION COMMITTEE OF RELATED ORGANIZATION PARKVIEW HEALTH SYSTEM, INC. INDEPENDENT COMPENSATION CONSULTANT 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 PACKNETT $419,516; STANTON RISSER $6,041; LISA SCHANBACHER $16,766 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. MICHAEL PACKNETT $645,500; STANTON RISSER $22,005; LISA SCHANBACHER $18,202; JEANNE' WICKENS $57,021 |
| 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 L IRS990ScheduleL
Loans Btwn Org Interested Prsn LoansBtwnOrgInterestedPrsnGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | OMOTAYO FAWIBE | PersonNm |
| Relationship With Org | HIGHEST COMPENSATED EMPLOYEE | RelationshipWithOrgTxt |
| Loan Purpose | EDUCATION LOAN | LoanPurposeTxt |
| Loan From Organization | Yes (X) | LoanFromOrganizationInd |
| Original Principal | $150,000 | OriginalPrincipalAmt |
| Balance Due | $129,368 | BalanceDueAmt |
| Default | 0 | DefaultInd |
| Board Or Committee Approval | Yes (1) | BoardOrCommitteeApprovalInd |
| Written Agreement | Yes (1) | WrittenAgreementInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Balance Due | $129,368 | TotalBalanceDueAmt |
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp (2 entries)
| Relationship DescriptionRelationshipDescriptionTxt | TransactionTransactionAmt | TransactionTransactionDesc | Sharing Of RevenuesSharingOfRevenuesInd |
|---|---|---|---|
| NICHOLAS BRAND | |||
| FAMILY MEMBER OF DIRECTOR LISA SCHANBACHER | $36,862 | EMPLOYEE NICHOLAS BRAND RECEIVED COMPENSATION FROM PARKVIEW OCCUPATIONAL HEALTH CENTERS, INC. | 0 |
| ALEXANDRA BRAND | |||
| FAMILY MEMBER OF DIRECTOR LISA SCHANBACHER | $33,423 | EMPLOYEE ALEXANDRA BRAND RECEIVED COMPENSATION FROM PARKVIEW OCCUPATIONAL HEALTH CENTERS, INC. | 0 |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (11 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART V, LINES 1A AND 2A: | PARKVIEW HEALTH SYSTEM, INC. (PH), EIN 35-1972384, IS THE COMMON PAYING AGENT FOR THE FILING ORGANIZATION, PARKVIEW OCCUPATIONAL HEALTH CENTERS, INC., EIN 35-2064353. 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, 2016 WAS 573. THE TOTAL NUMBER OF EMPLOYEES REPORTED ON FORM W-3 AND FILED BY THE COMMON PAYING AGENT, PH, FOR THE YEAR ENDED DECEMBER 31, 2016 WAS 12,046. FOR PURPOSES OF COMPLETING FORM 990, PART V, LINE 1A AND 2A, THE NUMBER REPORTED FOR THE PARKVIEW OCCUPATIONAL HEALTH CENTERS, INC. WAS 10 AND 142 RESPECTIVELY. |
| FORM 990, PART VI, SECTION A, LINE 2 | DIRECTOR LISA SCHANBACHER AND OFFICER STANTON RISSER HAVE A BUSINESS RELATIONSHIP AS DIRECTORS ON THE BOARD OF A RELATED ENTITY. DIRECTOR LISA SCHANBACHER AND OFFICER JEANNE' WICKENS HAVE A BUSINESS RELATIONSHIP AS DIRECTORS ON THE BOARD OF A RELATED ENTITY. |
| FORM 990, PART VI, SECTION A, LINE 6 | THE ORGANIZATION IS ORGANIZED AS A NOT-FOR-PROFIT CORPORATION. PURSUANT TO THE ORGANIZATION'S GOVERNING DOCUMENTS, PARKVIEW HEALTH SYSTEM, INC. EIN 35-1972384 IS THE SOLE MEMBER OF PARKVIEW OCCUPATIONAL HEALTH CENTERS, INC. WITH CERTAIN RESERVED POWERS. |
| FORM 990, PART VI, SECTION A, LINE 7A | THE CORPORATE MEMBER, PARKVIEW HEALTH SYSTEM, INC. EIN 35-1972384, SHALL HAVE THE FOLLOWING RESERVED POWERS AS DEFINED IN THE NETWORK AGREEMENT: 1. THE BOARD OF DIRECTORS SHALL BE COMPRISED OF THREE (3) DIRECTORS. EACH DIRECTOR SHALL BE ELECTED BY THE SOLE MEMBER OF THE CORPORATION AT THE ANNUAL MEETING OF THE MEMBERSHIP. 2. THE CONFLICT OF INTEREST POLICY OF THE SOLE MEMBER OF THE CORPORATION, WHICH HAS BEEN APPROVED BY THE SYSTEM-WIDE CORPORATE COMPLIANCE COMMITTEE AND APPROVED BY THE SOLE MEMBER OF THE CORPORATION, SHALL APPLY TO THE CORPORATION. THIS CONFLICT OF INTEREST POLICY CAN ONLY BE AMENDED UPON THE APPROVAL OF THE BOARD OF DIRECTORS OF THE SOLE MEMBER OF THE CORPORATION. 3. IT SHALL BE THE GENERAL RULE THAT THE EMPLOYMENT OF IMMEDIATE FAMILY MEMBERS (MOTHER, FATHER, SISTER, BROTHER, SON, DAUGHTER OR SPOUSE) OF DIRECTORS AND EXECUTIVE MANAGEMENT STAFF SHALL BE PERMITTED AS AUTHORIZED BY THE PERSONNEL POLICIES OF THE CORPORATION AND THE SOLE MEMBER OF THE CORPORATION. |
| FORM 990, PART VI, SECTION A, LINE 7B | SEE SCHEDULE O EXPLANATION FOR FORM 990, PART VI, SECTION A, LINE 7A |
| FORM 990, PART VI, SECTION B, LINE 11B | PURSUANT TO PARKVIEW HEALTH SYSTEM INC.'S BYLAWS, THE SYSTEM AUDIT COMMITTEE MAY ACT ON BEHALF OF THE CORPORATION TO PROVIDE REVIEW OF THE CORPORATION AND ITS SUBSIDIARY CORPORATIONS' FORM 990 FILINGS. PARKVIEW OCCUPATIONAL HEALTH CENTERS, 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 25, 2017, 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 | REGARDING LINES 15A AND 15B, TO THE EXTENT THAT THE ORGANIZATION HAS VICE PRESIDENT OR ABOVE, THE ORGANIZATION USED A PROCESS FOR DETERMINING COMPENSATION OF THE CEO, OFFICERS, AND KEY EMPLOYEES. THE PROCESS INCLUDES CONSULTATIONS WITH AN INDEPENDENT COMPENSATION ADVISOR AND THE REVIEW OF APPROPRIATE COMPARABILITY DATA; REVIEW AND APPROVAL BY THE COMPENSATION COMMITTEE OF THE GOVERNING BODY CONSISTING OF MEMBERS WHO DO NOT HAVE A CONFLICT OF INTEREST CONCERNING THE COMPENSATION; AND CONTEMPORANEOUS DOCUMENTATION AND RECORDKEEPING WITH RESPECT TO DELIBERATIONS AND DECISIONS REGARDING THE COMPENSATION ARRANGEMENTS. IN 2016, THE BOARD OF PARKVIEW HEALTH SYSTEM, INC. REVIEWED AND APPROVED ALL EXECUTIVE COMPENSATION, BENEFITS AND PERQUISITES FOR THE 2016 COMPENSATION PACKAGE, PURSUANT TO THE PARKVIEW HEALTH BYLAWS. THE COMPENSATION PACKAGE WAS APPROVED BY A MAJORITY OF INDEPENDENT BOARD MEMBERS. PARKVIEW'S INDEPENDENT CONSULTANT PREPARES A COMPETITIVE COMPENSATION ANALYSIS USING DATA FROM MULTIPLE PUBLISHED SURVEYS PREPARED BY INDEPENDENT FIRMS FOR POSITIONS THAT ARE FUNCTIONALLY COMPARABLE IN SIMILAR-SIZED HEALTH SYSTEMS AND HOSPITAL ORGANIZATIONS ON BOTH A REGIONAL AND NATIONAL BASIS. THE INDEPENDENT CONSULTANT PROVIDES A STATEMENT OF REASONABLENESS OF THE COMPENSATION PROVIDED TO THE CEO AS WELL AS ALL EXECUTIVES AT THE VICE PRESIDENT LEVEL AND ABOVE. ALL DATA IS SHARED WITH THE BOARD OF DIRECTORS. THE BOARD APPROVES ANY CHANGES IN COMPENSATION FOR THE CEO AND HIS DIRECT REPORTS. APPROVAL IS ALSO PROVIDED FOR THE SALARY BUDGET FOR THE ENTIRE ORGANIZATION. THE BOARD REVIEWS AND APPROVES THE PLAN DOCUMENTS FOR THE MANAGEMENT INCENTIVE COMPENSATION PLAN (MICP) AND THE PHYSICIAN AND PROVIDER INCENTIVE COMPENSATION PLAN (PICP). OFFICES OR POSITIONS REVIEWED AT THE 2016 MEETING: PRESIDENT AND CHIEF EXECUTIVE OFFICER PARKVIEW HEALTH EXECUTIVE VICE PRESIDENT CHIEF PHYSICIAN EXECUTIVE CHIEF OPERATING OFFICER PARKVIEW HEALTH CHIEF EXPERIENCE OFFICER PHYSICIAN EXECUTIVE OFFICER PARKVIEW PHYSICIANS GROUP PRESIDENT PARKVIEW REGIONAL MEDICAL CENTER AND AFFILIATES CHIEF CLINICAL INTEGRATION OFFICER CHIEF FINANCIAL OFFICER CHIEF INFORMATION OFFICER SENIOR VICE PRESIDENT GENERAL COUNSEL SENIOR VICE PRESIDENT CHIEF OPERATING OFFICER PARKVIEW PHYSICIANS GROUP CHIEF QUALITY AND SAFETY OFFICER SENIOR VICE PRESIDENT REVENUE CYCLE AND PAYOR STRATEGIES CHIEF HUMAN RESOURCES OFFICER CHIEF NURSING EXECUTIVE SENIOR VICE PRESIDENT STRATEGIC INITIATIVES CHIEF ACADEMIC AND RESEARCH OFFICER CHIEF MEDICAL INFORMATICS OFFICER CHIEF MEDICAL OFFICER PARKVIEW PHYSICIANS GROUP MEDICAL DIRECTOR COMMUNITY HOSPITALS MEDICAL DIRECTOR INTEGRATION AND DEVELOPMENT CHIEF OPERATING OFFICER - RANDALLIA CHIEF NURSING OFFICER - PARKVIEW REGIONAL MEDICAL CENTER AND AFFILIATES PRESIDENT - PARKVIEW CANCER CENTER SENIOR VICE PRESIDENT CHIEF OPERATING OFFICER SERVICE LINE LEADER BEHAVIORAL HEALTH SENIOR VICE PRESIDENT CHIEF OPERATING OFFICER SERVICE LINE LEADER ORTHO SENIOR VICE PRESIDENT CHIEF OPERATING OFFICER SERVICE LINE LEADER HEART INSTITUTE SENIOR VICE PRESIDENT CHIEF OPERATING OFFICER SERVICE LINE LEADER CANCER INSTITUTE SENIOR VICE PRESIDENT SERVICE LINE LEADER SENIOR VICE PRESIDENT DELIVERY SYSTEM INTEGRATION SENIOR VICE PRESIDENT FACILITY DESIGN AND OVERSIGHT SENIOR VICE PRESIDENT HEALTH AND WELL-BEING SENIOR VICE PRESIDENT PARKVIEW PHYSICIANS GROUP OPERATIONS DEPLOYMENT SENIOR VICE PRESIDENT SUPPLY AND SUPPORT SERVICES PRESIDENT COMMUNITY HOSPITALS VICE PRESIDENT CLINICAL INTEGRATION VICE PRESIDENT CONSTRUCTION VICE PRESIDENT EMPLOYEE STRATEGIES VICE PRESIDENT FINANCE VICE PRESIDENT MARKETING/COMMUNICATIONS/COMMUNITY RELATIONS VICE PRESIDENT NURSING RANDALLIA VICE PRESIDENT OPERATIONS - CANCER INSTITUTE VICE PRESIDENT PATIENT CARE SERVICES COMMUNITY HOSPITALS VICE PRESIDENT PARKVIEW PHYSICIANS GROUP FINANCE VICE PRESIDENT PARKVIEW PHYSICIANS GROUP PHYSICIAN PRACTICES VICE PRESIDENT STRATEGY AND BUSINESS DEVELOPMENT VICE PRESIDENT SURGICAL SERVICES PARKVIEW REGIONAL MEDICAL CENTER AND AFFILIATES VICE PRESIDENT CLINICAL OPERATIONS - PARKVIEW PHYSICIANS GROUP VICE PRESIDENT INFORMATION SECURITY VICE PRESIDENT INTERNAL AUDIT VICE PRESIDENT TECHNOLOGY VICE PRESIDENT PATIENT CARE SERVICES - COMMUNITY HOSPITALS |
| 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 | ANCILLARY MEDICAL: PROGRAM SERVICE EXPENSES 135,984. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 135,984. LAB: PROGRAM SERVICE EXPENSES 884,389. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 884,389. CLEANING: PROGRAM SERVICE EXPENSES 73,321. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 73,321. PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 40,691. MANAGEMENT AND GENERAL EXPENSES 450. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 41,141. PHYSICIAN PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 152,725. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 152,725. COLLECTION: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 15,394. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 15,394. OTHER: PROGRAM SERVICE EXPENSES 147,199. MANAGEMENT AND GENERAL EXPENSES 48,851. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 196,050. |
| 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. |
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 | |
| 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 | |
| COMMUNITY HOSPITAL OF LAGRANGE COUNTY INC | |||||||||||
| 207 N TOWNLINE ROAD | LAGRANGE | IN | 46761 | 202401676 | HOSPITAL CARE | IN | 501(C)(3) | LINE 3 | 0 | PARKVIEW HEALTH SYSTEM INC | |
| COMMUNITY HOSPITAL OF NOBLE COUNTY INC | |||||||||||
| 401 SAWYER ROAD | KENDALLVILLE | IN | 46755 | 352087092 | HOSPITAL CARE | IN | 501(C)(3) | LINE 3 | 0 | PARKVIEW HEALTH SYSTEM INC | |
| WHITLEY MEMORIAL HOSPITAL INC | |||||||||||
| 1260 EAST 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 | |||||||||||
| 710 N EAST ST | 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 | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (1) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | Yes (1) | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | 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 | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |