2016-11-10T17:09:14-06:00 2015-12-31 350921680 CROWE HORWATH LLP 330 E JEFFERSON BLVD PO BOX 7 SOUTH BEND IN 466240007 990 2015-01-01 352064353 PARKVIEW OCCUPATIONAL HEALTH CENTERS INC PARK 2603738429 10501 CORPORATE DRIVE FORT WAYNE IN 46845 JEANNE' WICKENS PH SVP & CFO 2603738407 2016-11-10 1 KENNETH J KEBER P00240883 5742323992 X 2015 2017-02-10 21:41:12Z MICHAEL J PACKNETT 10501 CORPORATE DRIVE FORT WAYNE IN 46845 10518861 0 X WWW.PARKVIEW.COM X 1998 IN DELIVER OCCUPATIONAL HEALTH CARE SERVICES AND PROMOTE GENERAL HEALTH OF COMMUNITY. 3 2 143 0 0 0 16966 16415 11116217 10502446 0 0 0 0 11133183 10518861 0 0 0 0 6081021 6819589 0 0 0 4053500 3697169 10134521 10516758 998662 2103 5216597 5320835 403393 373430 4813204 4947405 X 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. 0 0 10113625 10502446 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 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. 10113625 1 1 0 0 0 0 0 0 0 0 1 0 0 1 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 X 13 0 1 143 1 0 0 0 0 0 0 0 0 0 0 X 3 2 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 IN X JEANNE' WICKENS 2603738407 10501 CORPORATE DRIVE FORT WAYNE IN 46845 LISA SCHANBACHER DIRECTOR/POHCI VP 20.00 20.00 X 127163 73974 61454 MARJORIE HINER DIRECTOR/CHAIR 1.00 0.00 X 500 0 0 DENISE LEMMON DIRECTOR/SECRETARY/TREASURER 1.00 0.00 X 500 0 0 MICHAEL PACKNETT PH PRESIDENT & CEO 1.00 56.00 X 0 1472327 673379 MICHAEL BROWNING PH SVP & CFO - PARTIAL YEAR 1.00 56.00 X 0 590899 70288 STANTON RISSER INTERIM PH CFO 1.00 56.00 X 0 277183 60834 GERRY EASTERDAY POHCI PHYSICIAN 28.00 0.00 X 281220 0 37474 GREGORY KNISS POHCI PHYSICIAN 40.00 0.00 X 162472 0 36338 DIANE CASEY POHCI DIR OH 40.00 0.00 X 129670 0 27496 MARCY PRATT POHCI OH NP 20.00 20.00 X 45708 65487 5540 RUTH WILSON POHCI OH NP 49.00 0.00 X 110147 0 31154 857380 2479870 1003957 7 0 1 0 QUEST DIAGNOSTICS PO BOX 740709 ATLANTA GA 30374 LABORATORY SERVICES 559718 PARKVIEW PROFESSIONAL PROGRAMS INC 10501 CORPORATE DRIVE FORT WAYNE IN 46845 LABORATORY SERVICES 424590 WHITLEY MEMORIAL HOSPITAL INC 1260 EAST STATE ROAD 205 COLUMBIA CITY IN 46725 ANCILLARY MEDICAL SERVICES 112880 CHG COMPANIES PO BOX 972651 DALLAS TX 75397 PHYSICIANS 109443 4 228 16187 16415 PATIENT SERVICE 621400 9748647 9748647 EMPLOYEE ASSISTANCE 900099 753799 753799 10502446 10518861 10502446 0 0 X 167015 167015 5165323 5165323 1487251 1487251 1744182 1675049 69133 6912 6912 260924 209016 51908 705429 704393 1036 80665 75953 4712 26720 16077 10643 109335 109335 100535 5790 94745 MEDICAL SUPPLIES 648675 648675 DUES & SUBSCRIPTIONS 7988 5481 2507 MISCELLANEOUS 5804 4370 1434 10516758 10113625 403133 0 300 450 1348858 1473383 2369 2369 2121385 1267694 748494 853691 3116576 2990942 5216597 5320835 403393 373430 403393 373430 X 4813204 4947405 4813204 4947405 5216597 5320835 X 2103 132098 X 0 1 X 1 0 X FORM 990, SCHEDULE A, PART 1, LINE 3: 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." RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 601505 101304 500201 399829 398946 883 1089087 759198 329889 30964 8246 22718 853691 DUE TO/FROM INTERUNIT 2990942 2990942 X PART X, LINE 2: PARKVIEW HEALTH SYSTEM, INC. AND SUBSIDIARIES - NOTES TO THE CONSOLIDATED FINANCIAL STATEMENTS TEXT OF THE FOOTNOTE TO THE ORGANIZATION'S FINANCIAL STATEMENTS THAT DESCRIBES THE LIABILITY FOR UNCERTAIN TAX POSITIONS UNDER FIN 48 (ASC 740): INCOME TAXES: THE INTERNAL REVENUE SERVICE HAS DETERMINED THAT THE CORPORATION AND CERTAIN AFFILIATED ENTITIES ARE TAX-EXEMPT ORGANIZATIONS AS DEFINED IN SECTION 501(C)3 OF THE INTERNAL REVENUE CODE. CERTAIN SUBSIDIARIES OF THE CORPORATION ARE TAXABLE ENTITIES, THE TAX EXPENSE AND LIABILITIES OF WHICH ARE NOT MATERIAL TO THE CONSOLIDATED FINANCIAL STATEMENTS. THE CORPORATION AND ITS TAX-EXEMPT AFFILIATED ENTITIES EACH FILE A FORM 990 (RETURN OF ORGANIZATION EXEMPT FROM INCOME TAX) ANNUALLY. WHEN THESE RETURNS ARE FILED, IT IS HIGHLY CERTAIN THAT SOME POSITIONS TAKEN WOULD BE SUSTAINED UPON EXAMINATION BY THE TAXING AUTHORITIES, WHILE OTHERS ARE SUBJECT TO UNCERTAINTY ABOUT THE MERITS OF THE POSITION TAKEN OR THE AMOUNT OF THE POSITION THAT WOULD ULTIMATELY BE SUSTAINED. EXAMPLES OF TAX POSITIONS COMMON TO HEALTH SYSTEMS INCLUDE SUCH MATTERS AS THE TAX-EXEMPT STATUS OF EACH ENTITY, THE CONTINUED TAX-EXEMPT STATUS OF BONDS, THE NATURE, CHARACTERIZATION AND TAXABILITY OF JOINT VENTURE INCOME, AND VARIOUS POSITIONS RELATING TO POTENTIAL SOURCES OF UNRELATED BUSINESS TAXABLE INCOME (REPORTED ON FORM 990T). AS OF DECEMBER 31, 2015 AND 2014, 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 2011 AND PRIOR. X X 1 1 0 1 0 0 0 0 0 1 0 LISA SCHANBACHER DIRECTOR/POHCI VP 73974 73974 43823 0 9366 0 23924 13918 14928 8684 166015 96576 8192 0 MICHAEL PACKNETT PH PRESIDENT & CEO 0 962128 0 485625 0 24574 0 648113 0 25266 0 2145706 0 0 MICHAEL BROWNING PH SVP & CFO - PARTIAL YEAR 0 298622 0 196875 0 95402 0 44088 0 26200 0 661187 0 0 STANTON RISSER INTERIM PH CFO 0 179022 0 96738 0 1423 0 37424 0 23410 0 338017 0 0 GERRY EASTERDAY POHCI PHYSICIAN 248134 0 11934 0 21152 0 12588 0 24886 0 318694 0 0 0 GREGORY KNISS POHCI PHYSICIAN 158116 0 0 0 4356 0 19281 0 17057 0 198810 0 0 0 DIANE CASEY POHCI DIR OH 104262 0 23935 0 1473 0 7984 0 19512 0 157166 0 0 0 PART I, LINE 1A TAX INDEMNIFICATION AND GROSS-UP PAYMENTS - GIFT CERTIFICATE PAID TO: DIANE CASEY $35; MARCY PRATT $16 PERSONAL SERVICES TAXABLE ALLOWANCE FOR FINANCIAL PLANNING PAID TO: GERRY EASTERDAY $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 (BOARD 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 (BOARD OF RELATED ORGANIZATION PARKVIEW HEALTH SYSTEM, INC.) PART I, LINE 4B SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN PAYMENTS TAXABLE - LISA SCHANBACHER $8,192 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 BROWNING $36,138; MICHAEL PACKNETT $629,563; STANTON RISSER $20,060; LISA SCHANBACHER $17,237 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 IN ADVANCE OF THE PLAN YEAR. AT CONCLUSION OF THE PLAN YEAR, RESULTS ARE SHARED WITH THE BOARD AND THE BOARD APPROVES FINAL PAYMENT. FORM 990, PART V, LINES 1A AND 2A: PARKVIEW HEALTH SYSTEM, INC. (PH), EIN 35-1972384, IS THE COMMON PAYING AGENT FOR THE FILING ORGANIZATION, 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, 2015 WAS 540. THE TOTAL NUMBER OF EMPLOYEES REPORTED ON FORM W-3 AND FILED BY THE COMMON PAYING AGENT, PH, FOR THE YEAR ENDED DECEMBER 31, 2015 WAS 11,190. FOR PURPOSES OF COMPLETING FORM 990, PART V, LINE 1A AND 2A, THE NUMBER REPORTED FOR THE PARKVIEW OCCUPATIONAL HEALTH CENTERS, INC. WAS 13 AND 143 RESPECTIVELY. 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 11 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 12, 2016, 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; REVIEW, AND APPROVAL BY THE GOVERNING BODY; AND CONTEMPORANEOUS DOCUMENTATION AND RECORDKEEPING WITH RESPECT TO DELIBERATIONS AND DECISIONS REGARDING THE COMPENSATION ARRANGEMENTS. IN 2015, THE BOARD OF PARKVIEW HEALTH SYSTEM, INC. REVIEWED AND APPROVED ALL EXECUTIVE COMPENSATION, BENEFITS AND PERQUISITES FOR THE 2015 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 MERIT BUDGET FOR THE ENTIRE ORGANIZATION. THE BOARD REVIEWS AND APPROVES THE MANAGEMENT INCENTIVE COMPENSATION PLAN (MICP) AND THE PHYSICIAN AND PROVIDER INCENTIVE COMPENSATION PLAN (PICP). OFFICES OR POSITIONS REVIEWED AT THE 2015 MEETING: PRESIDENT AND CHIEF EXECUTIVE OFFICER EXECUTIVE VICE PRESIDENT CHIEF PHYSICIAN OFFICER PRESIDENT COMMUNITY HOSPITAL PHYSICIAN EXECUTIVE OFFICER PARKVIEW PHYSICIANS GROUP SENIOR VICE PRESIDENT CHIEF FINANCIAL OFFICER SENIOR VICE PRESIDENT CHIEF EXPERIENCE OFFICER SENIOR VICE PRESIDENT CHIEF INFORMATION OFFICER SENIOR VICE PRESIDENT CHIEF NURSING EXECUTIVE SENIOR VICE PRESIDENT COO PARKVIEW HEALTH SENIOR VICE PRESIDENT COO PARKVIEW PHYSICIANS GROUP SENIOR VICE PRESIDENT COO PARKVIEW REGIONAL MEDICAL CENTER AND AFFILIATES SENIOR VICE PRESIDENT COO SERVICE LINE LEADER SENIOR VICE PRESIDENT DELIVERY SYSTEM INTEGRATION SENIOR VICE PRESIDENT FACILITY DESIGN AND OVERSIGHT SENIOR VICE PRESIDENT GENERAL COUNSEL SENIOR VICE PRESIDENT HEALTH & WELL-BEING SENIOR VICE PRESIDENT HUMAN RESOURCES SENIOR VICE PRESIDENT REVENUE CYCLE MANAGEMENT SENIOR VICE PRESIDENT SERVICE LINE LEADER SENIOR VICE PRESIDENT STRATEGIC INITIATIVES VICE PRESIDENT CONSTRUCTION VICE PRESIDENT FINANCE VICE PRESIDENT MKTG/COMM/COMMUNITY RELATIONS VICE PRESIDENT NURSING RANDALLIA VICE PRESIDENT PARKVIEW PHYSICIANS GROUP FINANCE VICE PRESIDENT PARKVIEW PHYSICIANS GROUP PHYSICIAN PRACTICES VICE PRESIDENT PATIENT CARE SERVICES COMMUNITY HOSPITAL VICE PRESIDENT RANDALLIA OPERATIONS VICE PRESIDENT STRATEGY AND BUSINESS DEVELOPMENT VICE PRESIDENT SUPPLY CHAIN VICE PRESIDENT SURGICAL AND ANCILLARY SERVICES PRMC AND AFFILIATES MEDICAL DIRECTOR COMMUNITY HOSPITAL MEDICAL DIRECTOR INTEGRATION AND DEVELOPMENT MEDICAL DIRECTOR OF VALUE-BASED SERVICES MEDICAL OFFICER PARKVIEW PHYSICIANS GROUP CHIEF ACADEMIC AND RESEARCH OFFICER CHIEF MEDICAL INFORMATICS OFFICER CHIEF MEDICAL OFFICER PRMC AND AFFILIATES CHIEF NURSING OFFICER PRMC AND AFFILIATES CHIEF QUALITY OFFICER AND SAFETY OFFICER EXECUTIVE DIRECTOR EMPLOYER STRATEGIES 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 393,933. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 393,933. LAB: PROGRAM SERVICE EXPENSES 1,038,087. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,038,087. CLEANING: PROGRAM SERVICE EXPENSES 76,281. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 76,281. PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 40,949. MANAGEMENT AND GENERAL EXPENSES 250. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 41,199. PHYSICIAN PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 112,880. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 112,880. COLLECTION: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 25,056. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 25,056. OTHER: PROGRAM SERVICE EXPENSES 12,919. MANAGEMENT AND GENERAL EXPENSES 43,827. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 56,746. FORM 990, PART IX, LINES 5-10: PARKVIEW HEALTH SYSTEM, INC., EIN 35-1972384, SERVES AS THE COMMON PAYING AGENT FOR ALL TAX-EXEMPT ORGANIZATIONS OF THE SYSTEM. SALARIES AND WAGES OF EMPLOYEES WORKING FOR THESE ORGANIZATIONS ARE CHARGED DIRECTLY TO THE ORGANIZATIONS IN WHICH THEY WORK. THE ACTUAL EXPENSES FOR PAYROLL TAXES, EMPLOYEE BENEFITS, AND PENSION PLAN CONTRIBUTIONS ARE REFLECTED ON THE BOOKS OF PARKVIEW HEALTH SYSTEM, INC. FOR FINANCIAL REPORTING PURPOSES. TO ACCOUNT FOR BENEFIT COSTS ON THE BOOKS OF THE OTHER TAX EXEMPT ORGANIZATIONS, AN ALLOCATION METHODOLOGY IS UTILIZED TO CHARGE THESE ORGANIZATIONS WITH AN ESTIMATE OF THE OVERALL COSTS, REFERRED TO AS A "BENEFIT ALLOCATION" FROM PARKVIEW HEALTH SYSTEM, INC. THE ALLOCATION DOES NOT DISTINGUISH BETWEEN THE COSTS OF THE VARIOUS COMPONENTS (I.E. PAYROLL TAXES, EMPLOYEE BENEFITS, AND PENSION PLAN CONTRIBUTIONS). THEREFORE, FOR PURPOSES OF THE FORM 990, PART IX, THE TOTAL BENEFIT ALLOCATION FOR THE EMPLOYEES' SALARIES AND WAGES REPORTED ON LINE 7 IS REFLECTED ON LINE 9 AND NOT ALLOCATED BETWEEN LINES 8 OR 10. FOR PURPOSES OF THE FORM 990, PART IX, LINES 5 AND 6 REFLECT COMPENSATION AND BENEFIT AMOUNTS REPORTED IN PART VII. FORM 990, PART XI, LINE 9: ASSET TRANSFERS/ADJUSTMENTS 132,098. 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