2014-11-10T13:03:53-06:00 2013-12-31 350921680 CROWE HORWATH LLP 330 E JEFFERSON BLVD PO BOX 7 SOUTH BEND IN 466240007 990 2013-01-01 350868085 PARKVIEW HOSPITAL INC PARK 2603738407 11109 PARKVIEW PLAZA DRIVE FORT WAYNE IN 468451701 MICHAEL P BROWNING PH SVP & CFO 2603738407 2014-11-10 1 KENNETH J KEBER P00240883 5742323992 X 2013 2015-11-30 17:44:51Z MICHAEL PACKNETT 10501 CORPORATE DRIVE FORT WAYNE IN 46845 826076467 0 X WWW.PARKVIEW.COM X 1941 IN PARKVIEW HOSPITAL, INC. WORKS TO IMPROVE THE HEALTH OF OUR COMMUNITIES AND PROVIDES QUALITY HEALTH SERVICES TO ALL WHO ENTRUST THEIR CARE TO US. 15 9 4893 486 2427641 226178 1142115 924118 737317882 791147267 1135655 571702 9995581 11757423 749591233 804400510 1292622 992170 0 0 231713753 245924812 0 23475 23475 433591855 468842164 666598230 715782621 82993003 88617889 834136664 810112826 517663176 500067676 316473488 310045150 X PARKVIEW HOSPITAL, INC. WORKS TO IMPROVE THE HEALTH OF OUR COMMUNITIES AND PROVIDES QUALITY HEALTH SERVICES TO ALL WHO ENTRUST THEIR CARE TO US. 0 0 595157844 992170 793583248 PARKVIEW HOSPITAL, INC. IS A 412-BED REGIONAL TERTIARY REFERRAL CENTER, AS WELL AS A 154-BED COMMUNITY HOSPITAL AND A 103-BED BEHAVIORAL HEALTH HOSPITAL, LOCATED IN FORT WAYNE, INDIANA. IT IS THE LARGEST HEALTHCARE EMPLOYER IN THE REGION AND IS HOME TO NORTHEAST INDIANA'S FIRST VERIFIED LEVEL II ADULT AND PEDIATRIC TRAUMA CENTER. ADDITIONAL SERVICES INCLUDE THE SAMARITAN FLIGHT AND EMS SERVICES, PARKVIEW HEART INSTITUTE, A CERTIFIED STROKE CENTER, WOMEN'S & CHILDREN'S HOSPITAL, OUTPATIENT SERVICES CENTER AND COMPREHENSIVE CANCER CENTER. AS A NOT-FOR-PROFIT HOSPITAL, WE TAKE OUR MISSION TO HEART. PARKVIEW HOSPITAL, INC. EXISTS FOR ONE PURPOSE - TO IMPROVE THE HEALTH AND WELL-BEING OF OUR COMMUNITIES. SEE SCHEDULE O FOR CONTINUATION 595157844 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 0 0 1 0 0 0 0 0 1 0 0 1 1 1 1 1 0 0 0 0 0 0 1 1 0 0 0 0 0 1 1 1 0 0 1 127 0 1 4893 1 1 1 0 0 0 0 0 0 0 0 0 X 15 9 0 0 1 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 IN X MICHAEL P BROWNING 2603738407 10501 CORPORATE DRIVE FORT WAYNE IN 46845 X SUZANNE EHINGER DIRECTOR/PVHOS PRESIDENT PRMC 40.00 1.00 X X 561597 0 110059 MICHAEL PACKNETT DIRECTOR/PH PRESIDENT & CEO 1.00 55.00 X X 0 1156215 213123 MICHAEL GRABOWSKI DIRECTOR/PVHOS MSO & SLL 8.00 19.00 X 75828 371004 37544 JEFFREY NICKEL DIRECTOR/PVHOS ASST MED DI 7.00 1.00 X 148850 1500 0 STEVE CORONA DIRECTOR 1.00 0.00 X 4250 0 0 THOMAS KIMBROUGH DIRECTOR/CHAIR 1.00 1.00 X 6500 3250 0 DAVID KOHLI DIRECTOR 1.00 0.00 X 4750 0 0 DAVID MICHEL DIRECTOR 1.00 0.00 X 4750 0 0 SHERRI MILLER DIRECTOR/SECRETARY 1.00 0.00 X 4250 0 0 MARILYN MORAN-TOWNSEND DIRECTOR/VICE CHAIR 1.00 0.00 X 4250 0 0 WENDY ROBINSON DIRECTOR 1.00 0.00 X 4250 0 0 CHRISTINE RUPP DIRECTOR/TREASURER 1.00 1.00 X 4500 0 0 DAN STARR DIRECTOR 1.00 0.00 X 4250 0 0 IRENE WALTERS DIRECTOR 1.00 0.00 X 4750 0 0 MICHAEL YURKANIN DIRECTOR 4.00 0.00 X 51264 0 0 MICHAEL BROWNING PH SVP & CFO 1.00 55.00 X 0 622250 119373 CHAD CARPENTER PVHOS COO PARKVIEW HEART I 40.00 0.00 X 239437 0 34566 GREG JOHNSON PVHOS CMO 36.00 4.00 X 305044 79464 75066 JUDITH BOERGER PVHOS SVP 40.00 0.00 X 371526 0 58605 DANIEL GARMAN PVHOS SVP 40.00 0.00 X 289868 0 60997 CHARLES CLARK PVHOS SVP 40.00 0.00 X 227967 0 47847 BENJAMIN MILES PVHOS VP 40.00 0.00 X 201217 0 53175 YUENIAN ZHANG PVHOS CHIEF PHYSICIST 40.00 0.00 X 272174 0 20750 RAE GONTERMAN PVHOS SVP 40.00 0.00 X 201387 0 44240 MICHAEL GERUE PVHOS SVP 40.00 0.00 X 195742 0 61915 THOMAS GUTWEIN PVHOS MEDICAL DIR ECC 24.00 1.00 X 164900 4700 0 CHRISTOPHER JELLISON PVHOS DIR PHARMACY 40.00 0.00 X 161151 0 26222 STANTON RISSER FORMER OFFICER/CURRENT PH DIR 0.00 40.00 X 0 165576 31144 3514452 2403959 994626 119 1 1 0 PREFERRED ANESTHESIA CONSULTANTS PC 3810 NEW VISION DRIVE FORT WAYNE IN 46845 ANESTHESIOLOGISTS 4877887 INDIANA SURGICAL SPECIALISTS LLC 11141 PARKVIEW PLAZA DRIVE SUITE 30 FORT WAYNE IN 46845 PHYSICIANS 1449915 ORTHOPAEDICS NORTHEAST PC 5050 N CLINTON STREET FORT WAYNE IN 46825 PHYSICIANS 825379 ALLIED HOSPITAL PATHOLOGISTS PC 2458 LAKE AVENUE FORT WAYNE IN 46805 PATHOLOGY 646000 MEDICAL SOLUTIONS LLC 9101 WESTERN AVE SUITE 101 OMAHA NE 68114 NURSING SERVICES 503649 12 835161 88957 18114 924118 NET PATIENT SERVICE 622000 756081893 756081893 LAB SERVICES 621500 14897577 14897577 PHARMACY 446110 14725767 14142521 583246 MEANINGFUL USE 900099 3060078 3060078 INTERUNIT RENT 900099 1540338 1540338 841614 441898 399716 791147267 194765 194765 4237238 1906486 2330752 2330752 2330752 19744091 19341081 26073 403010 -26073 376937 376937 336861 402317 -65456 -65456 CAFETERIA & MEALS 722210 3567997 3567997 ORTHO BILLINGS 541900 3548118 2206834 1341284 ORTHO DEF REV/GN SALE 900099 1060508 1060508 1315504 1212109 103395 9492127 804400510 793583248 2427641 7465503 X 966332 966332 25838 25838 2950271 2950271 180214060 178761261 1452799 62760481 62451286 309195 24897 24897 23475 23475 57804 57804 62130642 57599176 4531466 124879 110274 14605 21585994 19196615 2389379 91806 91806 13381339 13034634 346705 1154920 1043423 111497 321517 246766 74751 361386 361386 45317059 44870714 446345 1372291 36787 1335504 CORP SERVICE ALLOCATION 106241498 106241498 MEDICAL SUPPLIES 89178109 89178109 BAD DEBT 77974076 77974076 PH SUBSIDY 44880710 44880710 4643237 4303754 339483 715782621 595157844 120601302 23475 14898 24564 102712927 111571834 449983 1230215 11373072 12712438 1344096 1388058 1002501035 349199565 686472214 653301470 18750691 20452135 6983764 6381225 1543174 1543174 4491845 1507713 834136664 810112826 29167034 28109947 10808047 9739791 8409004 6351629 469279091 455866309 517663176 500067676 X 316473488 310045150 316473488 310045150 834136664 810112826 X 88617889 1036073 -96082300 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 24897 24897 0 PART II-B, LINE 1: REPRESENTS THE PORTION OF THE DUES PAID TO INDIANA HOSPITAL AND HEALTH ASSOCIATION, AMERICAN HOSPITAL ASSOCIATION, INDIANA ASSOCIATION OF HOMES & SERVICES FOR THE AGING, INC. AND AMERICAN ASSOCIATION OF HOMES & SERVICES FOR THE AGING, INC. USED FOR LOBBYING ACTIVITIES. 6760319 6760319 509300378 176178008 333122370 9508702 4221121 5287581 413529261 155752939 257776322 63402375 13047497 50354878 653301470 EST. MEDICARE/MEDICAID SETTLEMENTS 3749963 RESTRICTED FUNDS 507714 PROPERTY SECURITY DEPOSITS 1050 DUE TO/FROM INTERUNIT 451607582 455866309 X X 0 CANDANCE SCHULER 4723 KENTLEY DRIVE FORT WAYNE IN 46845 GRANT WRITING 0 0 23475 -23475 23475 -23475 IN SCHEDULE G, PART I, LINE 2B, COLUMN IV: THE GROSS RECEIPTS ASSOCIATED WITH THE ACTIVITIES OF THE PROFESSIONAL FUNDRAISER ARE NOT READILY ASCERTAINABLE AS THEY WERE NOT DIRECTLY CONNECTED WITH SPECIFIC FUNDRAISING ACTIVITIES. THE PROFESSIONAL FUNDRAISING SERVICES WERE FOR GRANT WRITING. AS SUCH, NO AMOUNTS HAVE BEEN DISCLOSED IN PART I, LINE 2B, COLUMN IV. 1 1 X 1 X 0 1 1 1 0 1 1 11615536 11615536 0.01820 69779791 51670618 18109173 0.02840 3367703 1634188 1733515 0.00270 84763030 53304806 31458224 0.04930 3958307 288060 3670247 0.00580 4891539 2107691 2783848 0.00440 45725085 45725085 0.07170 2184530 215834 1968696 0.00310 1134634 46767 1087867 0.00170 57894095 2658352 55235743 0.08670 142657125 55963158 86693967 0.13600 96180 96180 0.00020 96180 96180 0.00020 1 77974075 4161550 123582112 138506379 -14924267 X 1 1 1 1 PARKVIEW HOSPITAL INC 11109 PARKVIEW PLAZA DRIVE FORT WAYNE IN 46845 WWW.PARKVIEW.COM 14-005020-1 X X X X X PARKVIEW HOSPITAL INC 1 1 X X X X X X X X 13 1 1 1 X WWW.PARKVIEW.COM/LOCALHEALTHNEEDS X X X X X X X 0 0 1 1 200.000000000000 0 0 1 1 X 1 0 X X X X 1 X 0 0 PARKVIEW HOSPITAL, INC. PART V, SECTION B, LINE 3: PARKVIEW WORKED TO ENSURE THAT THE NEEDS OF THE MEDICALLY UNDERSERVED, LOW-INCOME AND MINORITY POPULATIONS WERE TAKEN INTO ACCOUNT DURING THE COURSE OF THE COMMUNITY HEALTH NEEDS ASSESSMENT BY (1) TAKING STEPS TO STRATIFY THE SAMPLE TO ENSURE THAT POPULATION SUBSETS WERE REPRESENTED ACCURATELY AND RESULTS WOULD BE STATISTICALLY SIGNIFICANT; (2) WORKING WITH LOCAL ADVOCACY ORGANIZATIONS WHO SPECIALIZE IN AIDING THESE VARIOUS POPULATIONS IN OUR COMMUNITIES. IN ADDITION, PURDUE HEALTHCARE ADVISORS CONDUCTED A SURVEY OF PUBLIC HEALTH, OTHER HEALTHCARE PROFESSIONALS, AND SOCIAL SERVICE AGENCIES THAT SERVE LOW-INCOME POPULATIONS IN ALLEN, HUNTINGTON, LAGRANGE, NOBLE AND WHITLEY COUNTIES TO BETTER UNDERSTAND KEY PUBLIC HEALTH AND HEALTHCARE ISSUES IN THE FIVE-COUNTY AREA. THE SURVEY CONSISTED OF THE FOLLOWING COMPONENTS: RESPONDENT DEMOGRAPHICS, UNMET NEEDS, HEALTH BEHAVIORS, ENVIRONMENTAL FACTORS, THE GREATEST HEALTH CHALLENGE, BARRIERS TO ACCESSING HEALTHCARE AND UTILIZATION OF EDUCATION AND PREVENTION RESOURCES. THE SURVEY WAS CONDUCTED ELECTRONICALLY USING QUALTRICS, A SECURE ONLINE SURVEY. ALL DATA WAS COLLECTED AND REPORTED IN AGGREGATE. PARKVIEW HOSPITAL, INC. PART V, SECTION B, LINE 4: 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 ORTHOPAEDIC HOSPITAL AT PARKVIEW NORTH, LLC (EIN 26-0143823). PARKVIEW HOSPITAL, INC. PART V, SECTION B, LINE 7: TOBACCO USE - TOBACCO FREE ALLEN COUNTY (TFAC) IS THE LEAD ORGANIZATION IN ALLEN COUNTY RELATED TO TOBACCO FREE EFFORTS. TFAC PROVIDES INFORMATION ON RESOURCES ABOUT LOCAL SMOKING CESSATION PROGRAMS AND ADVOCATES FOR NO-SMOKING PUBLIC POLICY. CHLAMYDIA INFECTIONS - THE FORT WAYNE-ALLEN COUNTY HEALTH DEPARTMENT IN CONJUNCTION WITH MATTHEW 25 HEALTH AND DENTAL CLINIC OPERATES A SEXUALLY TRANSMITTED DISEASE (STD) CLINIC. THE AIDS TASK FORCE OF FORT WAYNE PROVIDES STD PREVENTION EDUCATION TO TEENS AND ADULTS WHICH PARKVIEW SUPPORTS. TEEN BIRTHS - LUTHERAN SOCIAL SERVICES' EDUCATION CREATES HOPE AND OPPORTUNITY (ECHO) PROGRAM PROVIDES ONE-ON-ONE, HOME- AND SCHOOL-BASED CASE MANAGEMENT SERVICES TO PREGNANT AND PARENTING TEENS WITH THE GOAL OF TEENS COMPLETING THEIR HIGH SCHOOL EDUCATION AND SETTING OTHER LIFE GOALS. TWO OTHER LOCAL ORGANIZATIONS PROVIDE PREGNANCY TESTING, EDUCATION AND SERVICES TO PREGNANT WOMEN AND NEW MOMS. INFANT MORTALITY - PARKVIEW IS ADDRESSING PRENATAL CARE AS ONE OF THE THREE TOP HEALTH PRIORITIES WHICH HAS A DIRECT EFFECT ON INFANT MORTALITY. THE HEALTH SYSTEM IS ADDRESSING INFANT MORTALITY THROUGH PATIENT CARE PROTOCOLS, PRENATAL CARE EDUCATION, SAFE SLEEP EDUCATION, CAR SEAT SAFETY AND CHILD ABUSE PREVENTION. THE SYSTEM WORKS WITH LOCAL ORGANIZATIONS, THE INDIANA STATE DEPARTMENT OF HEALTH AND STATE-WIDE PERINATAL HEALTH ORGANIZATIONS TO ADDRESS INFANT MORTALITY. EXCESSIVE ALCOHOL USE - PARKVIEW BEHAVIORAL HEALTH (PBH) WILL BE ADDRESSING MENTAL HEALTH AS A TOP PRIORITY. RELATED TO ALCOHOL ABUSE SPECIFICALLY, PBH PROVIDES DETOXIFICATION SERVICES AND INTENSIVE OUTPATIENT SERVICES. IN ADDITION, PBH PARTNERS WITH LOCAL SUBSTANCE ABUSE PROVIDERS, I.E., COMMUITY MENTAL HEALTH CENTERS, FOR OTHER SERVICES ON THE CONTINUUM OF CARE. THE DRUG AND ALCOHOL CONSORTIUM OF ALLEN COUNTY HAS AS ITS MISSION TO PROVIDE AN EFFECTIVE NETWORK TO COORDINATE RESOURCES AND EFFORTS TO REDUCE AND ERASE ALCOHOL, TOBACCO AND OTHER DRUG (ATOD) ABUSE AND THE PROBLEMS THAT RESULT FROM SUBSTANCE ABUSE IN THE COMMUNITY. THE CONSORTIUM IS MADE UP OF INTERDISCIPLINARY ORGANIZATIONS. PBH HAS REPRESENTATION ON THE CONSORTIUM, CONTRIBUTES TO THE ANNUAL PLANNING PROCESS AND PROVIDES DATA TO THE CONSORTIUM. THERE ARE OTHER LOCAL SUBSTANCE ABUSE PROGRAMS AND TRANSITIONAL LIVING FACILITIES THAT SERVE THIS POPULATION. PRIMARY CARE ACCESS - INCREASING ACCESS TO HEALTHCARE IS A STRATEGIC INITIATIVE FOR THE HEALTH SYSTEM. PARKVIEW CONDUCTS PERIODIC STUDIES TO DETERMINE THE AREAS WHERE PHYSICIANS ARE NEEDED AND RECRUITS PHYSICIANS ACCORDINGLY. ALLEN COUNTY HAS A STRONG HEALTHCARE SAFETY NET THAT ADDRESSES THE NEEDS OF INDIVIDUALS THAT ARE UNINSURED OR UNDERINSURED. PARTICIPATING ORGANIZATIONS IN THE SAFETY NET INCLUDE MATTHEW 25 HEALTH AND DENTAL CLINIC, NEIGHBORHOOD HEALTH CLINICS, BOTH OF WHICH ARE SUPPORTED IN PART BY PARKVIEW HOSPITAL, INC., FORT WAYNE-ALLEN COUNTY HEALTH DEPARTMENT AND OTHER HEALTH ORGANIZATIONS. PARKVIEW HOSPITAL, INC. PART V, SECTION B, LINE 11: PARKVIEW HOSPITAL, INC. PROVIDES DISCOUNTED CARE TO UNINSURED PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. IF THE PATIENT ULTIMATELY QUALIFIES FOR CHARITY CARE USING THE 200% FPG, THE REMAINING BALANCE AFTER THE DISCOUNT IS WRITTEN OFF TO CHARITY. PARKVIEW HOSPITAL, INC. PART V, SECTION B, LINE 14G: POLICY WORDING IS IN THE PROCESS OF BEING UPDATED.HOWEVER, THE FOLLOWING DETAILS HOW THE ORGANIZATION CURRENTLY 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:-AT POINT OF REGISTRATION OR SCHEDULING, IF A PATIENT EXPRESSES THEIR INABILITY TO PAY, THE REGISTRAR OR SCHEDULER WILL REFER THE PATIENT TO A FINANCIAL COUNSELOR OR WILL PROVIDE FINANCIAL COUNSELING CONTACT INFORMATION IN THE FORM OF A BUSINESS CARD TO THE PATIENT OUTSIDE OF NORMAL BUSINESS HOURS.-SIGNAGE IN THE EMERGENCY DEPARTMENT AND CASHIER AREAS INFORMS THE PATIENT OF THEIR RIGHT TO RECEIVE CARE REGARDLESS OF THEIR ABILITY TO PAY AND TELLS THEM THEY MAY BE ELIGIBLE FOR GOVERNMENTAL ASSISTANCE.-THE PATIENT'S INITIAL STATEMENT INSTRUCTS THE PATIENT TO CALL THE PATIENT ACCOUNTING DEPARTMENT IF THEY CANNOT PAY IN FULL. THE PATIENT ACCOUNTING CALL CENTER COLLECTORS SCREEN AND OFFER FREE CARE APPLICATIONS TO PATIENTS WHO CANNOT AFFORD TO PAY THEIR BILLS.-THE ONLINE ACCOUNT MANAGER OF PARKVIEW HOSPITAL, INC.'S WEBSITE (WWW.PARKVIEW.COM) CONTAINS INFORMATION ON HOW TO CONTACT THE PATIENT ACCOUNTING DEPARTMENT FOR PAYMENT OPTIONS OR FREE CARE ELIGIBILITY.-ALL UNINSURED OR UNDERINSURED PATIENTS WHO ARE INPATIENT OR OBSERVATION STATUS ARE VISITED BY FINANCIAL COUNSELORS. THE FINANCIAL COUNSELORS PROVIDE PAYMENT OPTIONS INCLUDING SCREENING FOR FREE CARE AND PROVIDE THE PATIENT WITH FREE CARE APPLICATIONS.-OUTBOUND PHONE CALLS ARE MADE TO PATIENTS TO SET UP PAYMENT ARRANGEMENTS. IF A PATIENT CANNOT MAKE PAYMENT ON THEIR ACCOUNT, THE PATIENT WILL BE SCREENED FOR FREE CARE AND PROVIDED WITH AN APPLICATION TO APPLY FOR FREE CARE.-IF A PATIENT'S ACCOUNT IS PLACED WITH A COLLECTION AGENCY, THE AGENCY IS INSTRUCTED TO SCREEN FOR FREE CARE IF THE PATIENT EXPRESSES THEIR INABILITY TO PAY. PARKVIEW HOSPITAL, INC. PART V, SECTION B, LINE 20D: FULL WRITEOFFS ARE PROVIDED TO PATIENTS WHOSE INCOME FALLS UNDER 200% OF THE FPG. ON CHARITY CARE PATIENTS WITH RESIDUAL SELF-PAY BALANCES AFTER INSURANCE PROCESSED AND PAID OR DENIED THEIR CLAIM, 100% OF THE REMAINING ACCOUNT BALANCE AFTER INSURANCE PAYMENTS AND CONTRACTUAL ADJUSTMENTS IS WRITTEN OFF TO CHARITY CARE. 33 PARKVIEW BEHAVIORAL HEALTH 1720 BEACON STREET FORT WAYNE IN 46805 IP & OP BEHAVIORAL PARKVIEW REGIONAL CANCER CENTER 11141 PARKVIEW PLAZA DR FORT WAYNE IN 46845 ONCOLOGY CENTER PARKVIEW HOME HEALTHCARE 1900 CAREW STREET SUITE 6 FORT WAYNE IN 46805 HOME HEALTH & HOSPICE NEW VISION LAB & AMBULATORY 3909 NEW VISION DRIVE FORT WAYNE IN 46845 IMAGING AND LAB DRAW OUPATIENT SERVICE CENTER OSC 11141 PARKVIEW PLAZA DR SUITE 100 FORT WAYNE IN 46845 OP AMBULATORY PARKVIEW MED PARK 11 OP PHARMACY 11104 PARKVIEW CIRCLE DRIVE FORT WAYNE IN 46845 OP PHARMACY PARKVIEW HOME INFUSION SERVICES 1900 CAREW STREET SUITE 4 FORT WAYNE IN 46805 OP INFUSION PARKVIEW CHILDRENS REHAB CLINIC 1900 CAREW STREET SUITE 2 FORT WAYNE IN 46805 OP REHAB SERVICES PARKVIEW REHAB OP CLINIC 2622 LAKE AVE FORT WAYNE IN 46805 OP REHAB SERVICES CAREW MRI 2110 CAREW STREET FORT WAYNE IN 46825 OP AMBULATORY OP THERAPY PRMC MOB11 11104 PARKVIEW CIRCLE DRIVE SUITE 050 FORT WAYNE IN 46845 OP THERAPY PARKVIEW NEW HAVEN AMBULATORY SITE 1331 MINNICH RD NEW HAVEN IN 46774 OP AMBULATORY, IMAGING AND LAB DRAW PARKVIEW OUTPATIENT CENTER AT INVERNESS 8028 CARNEGIE BLVD SUITE 160 FORT WAYNE IN 46804 IMAGING AND LAB DRAW LIBERTY MILLS LAB 8911 LIBERTY MILLS ROAD FORT WAYNE IN 46804 IMAGING AND LAB DRAW PARKVIEW CYTOGENETICS 11141 PARKVIEW PLAZA DR FORT WAYNE IN 46845 REFERENCE LAB CAREW MEDICAL PARK LAB 1818 CAREW STREET FORT WAYNE IN 46805 LAB DRAW PRMC MOB2 OB-GYN LAB 111123 PARKVIEW PLAZA SUITE 101 FORT WAYNE IN 46845 LAB DRAW PARKVIEW WOODLAND PLAZA AMBULATORY SITE 1234 DUPONT RD FORT WAYNE IN 46845 LAB DRAW PARKVIEW RESEARCH CENTER 3602 NEW VISION DRIVE FORT WAYNE IN 46845 CLINICAL RESEARCH CAREW CENTER OB-GYN LAB 2414 EAST STATE FORT WAYNE IN 46805 LAB DRAW PARKVIEW HEALTH & FITNESS 3000 E STATE BLVD FORT WAYNE IN 46805 HEALTH FITNESS PRMC MOB11 LAB 11104 PARKVIEW CIRCLE FORT WAYNE IN 46845 LAB DRAW LAKE AVE 1 LAB 2710 LAKE AVE FORT WAYNE IN 46805 LAB DRAW PARKVIEW CENTER FOR HEALTHY LIVING 11123 PARKVIEW PLAZA DR FORT WAYNE IN 46845 HEALTH AND WELLNESS HOBSON LAB 1515 HOBSON ROAD FORT WAYNE IN 46805 LAB DRAW WARSAW DUBOIS LAB 2300 DUBOIS AVE WARSAW IN 46580 LAB DRAW NORTH CLINTON LAB 5104 NORTH CLINTON FORT WAYNE IN 46825 LAB DRAW GRABILL MAIN LAB 13430 MAIN ST GRABILL IN 46741 LAB DRAW TRIER 2 LAB 6130 TRIER RD FORT WAYNE IN 46815 LAB DRAW PRMC LAB AT AVILLA 104 NICHOLAS PLACE AVILLA IN 46710 LAB DRAW WAYNEDALE TEMPLE LAB 8607 TEMPLE DRIVE FORT WAYNE IN 46809 LAB DRAW PARKVIEW FAMILY MED SW - DIAG IMAGING 10515 ILLINOIS RD FORT WAYNE IN 46814 OP AMBULATORY SOUTHEAST CLINIC 3350 EAST PAULDING ROAD FORT WAYNE IN 46816 CLINIC PART I, LINE 3C: ELIGIBILITY CRITERIA FOR FREE OR DISCOUNTED CAREPARKVIEW HOSPITAL, INC. PROVIDES DISCOUNTED CARE TO UNINSURED PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. IF THE PATIENT ULTIMATELY QUALIFIES FOR CHARITY CARE USING THE 200% FPG, THE REMAINING BALANCE AFTER THE DISCOUNT IS WRITTEN OFF TO CHARITY. PART I, LINE 7: PART I, LINE 7APARKVIEW HOSPITAL, INC. IS COMMITTED TO PROVIDING CHARITY CARE TO PATIENTS UNABLE TO MEET THEIR FINANCIAL OBLIGATIONS. IT IS FURTHERMORE THE POLICY OF PARKVIEW HOSPITAL, INC. NOT TO WITHHOLD OR DENY ANY REQUIRED MEDICAL CARE AS A RESULT OF A PATIENT'S FINANCIAL INABILITY TO PAY HIS/HER MEDICAL EXPENSES.THE CHARITY CARE COST REPORTED ON LINE 7A IS CALCULATED UNDER THE COST TO CHARGE RATIO METHODOLOGY. UNDER THIS METHOD, THE CHARITY CARE CHARGES FOREGONE ARE MULTIPLIED BY THE RATIO OF COST TO CHARGES TO DETERMINE THE COST OF SERVICES RENDERED.PART I, LINE 7BPARKVIEW HOSPITAL, INC. ACCEPTS ALL MEDICAID, MEDICAID MANAGED CARE, AND OUT-OF-STATE MEDICAID PATIENTS WITH THE KNOWLEDGE THAT THERE MAY BE SHORTFALLS. INTERNAL REVENUE SERVICE (IRS) REVENUE RULING 69-545 IMPLIES THAT TREATING MEDICAID PATIENTS IS A COMMUNITY BENEFIT. IRS REVENUE RULING 69-545, WHICH ESTABLISHED THE COMMUNITY BENEFIT STANDARD FOR NONPROFIT HOSPITALS, STATES THAT IF A HOSPITAL SERVES PATIENTS WITH GOVERNMENTAL HEALTH BENEFITS, INCLUDING MEDICAID, THEN THIS IS AN INDICATION THAT THE HOSPITAL OPERATES TO PROMOTE THE HEALTH OF THE COMMUNITY. THE UNREIMBURSED MEDICAID COST REPORTED ON LINE 7B IS CALCULATED UNDER THE COST TO CHARGE RATIO METHODOLOGY. UNDER THIS METHOD, THE MEDICAID CHARGES ARE MULTIPLIED BY THE RATIO OF COST TO CHARGES TO DETERMINE THE COST OF MEDICAID SERVICES RENDERED. THEN, THE COST OF MEDICAID SERVICES RENDERED IS DEDUCTED FROM THE REIMBURSEMENT RECEIVED FOR MEDICAID PATIENTS TO ARRIVE AT A GAIN/(LOSS) RELATIVE TO THESE PATIENTS.PART I, LINE 7CPARKVIEW HOSPITAL, INC. ACCEPTS ALL CERTAIN 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 7HAMOUNTS PRESENTED REPRESENT ACTUAL SPEND TO SUPPORT THE RESEARCH CONDUCTED BY THE PARKVIEW RESEARCH CENTER. SPEND IS BASED ON THE OPERATING EXPENSES ASSOCIATED WITH RESEARCH ACTIVITIES OVER AND ABOVE GRANTS AND OTHER REVENUE RECEIVED BY THE CENTER. PART I, LINE 7IIN KEEPING WITH OUR MISSION AND COMMITMENT TO THE COMMUNITIES IN WHICH WE SERVE, PARKVIEW HOSPITAL, INC. CONTINUES ITS TRADITION OF CONTRIBUTING TO NUMEROUS ORGANIZATIONS ON BOTH AN AS-NEEDED BASIS AND NEGOTIATED BASIS. AMOUNTS PRESENTED REPRESENT ACTUAL SPEND TO ORGANIZATIONS THROUGHOUT OUR COMMUNITIES. PART I, LINE 7G: SUBSIDIZED HEALTH SERVICES PARKVIEW HOSPITAL, INC. INCLUDED $44,880,710 IN COSTS ATTRIBUTABLE TO PHYSICIAN CLINICS AS SUBSIDIZED HEALTH SERVICES. PART I, LN 7 COL(F): PERCENT OF TOTAL EXPENSESPARKVIEW HOSPITAL, INC. EXCLUDED $77,974,075 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.PARKVIEW HOSPITAL, INC. HAS A STRONG COMMITMENT TO SUPPORTING AND ENHANCING THE VITALITY OF OUR COMMUNITY AND THE NORTHEAST INDIANA REGION. PARKVIEW INVESTS IN PROJECTS THAT HELP TO IMPROVE THE HEALTH AND WELL-BEING OF THE COMMUNITY. ECONOMIC DEVELOPMENT: PARKVIEW HOSPITAL, INC. SUPPORTS CERTAIN ECONOMIC DEVELOPMENT BASED ORGANIZATIONS IN AN EFFORT TO FULFILL PARKVIEW HOSPITAL, INC. STRATEGIC PLAN TO SERVE AS A LEADER IN THE ECONOMIC DEVELOPMENT IN THE NORTHEAST INDIANA REGION. WORKFORCE DEVELOPMENT:IN ADDITION, PARKVIEW HOSPITAL, INC. PROMOTES CAREERS IN HEALTHCARE THROUGH STUDENT JOB SHADOWING OPPORTUNITIES AND INTERNSHIP PROGRAMS DESIGNED FOR HIGH SCHOOL STUDENTS. THESE JOB SHADOWING AND INTERNSHIP PROGRAMS ARE COORDINATED BY EDUCATIONAL SERVICES AND TAKE PLACE THROUGHOUT THE ORGANIZATION, OFFERING STUDENTS A VARIETY OF LEARNING EXPERIENCE OPTIONS. PART III, LINE 4: BAD DEBT EXPENSE - FINANCIAL STATEMENT FOOTNOTETEXT OF THE FOOTNOTE TO THE ORGANIZATION'S FINANCIAL STATEMENTS THAT DESCRIBES BAD DEBT EXPENSE:PAGE 15 OF AUDITED FINANCIAL STATEMENTS.COSTING METHODOLOGY USED:UNCOLLECTIBLE PATIENT ACCOUNTS ARE CHARGED AGAINST THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS IN ACCORDANCE WITH THE POLICIES OF PARKVIEW HOSPITAL, INC. HOWEVER, DURING THE COLLECTION PROCESS THERE IS A CONTINUOUS EFFORT TO DETERMINE IF THE PATIENT QUALIFIES FOR CHARITY. THEREFORE, ONCE AN UNCOLLECTIBLE ACCOUNT HAS BEEN CHARGED OFF AND IT IS DETERMINED THROUGH THE COLLECTION PROCESS THAT THE PATIENT QUALIFIES FOR CHARITY CARE, THE UNCOLLECTIBLE ACCOUNT IS RECLASSIFIED TO CHARITY AND ALL COLLECTION EFFORTS CEASE. PATIENTS ARE ELIGIBLE TO APPLY FOR FREE CARE 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 FREE CARE DURING THE TAX YEAR. THE ACCOUNTS WERE RECLASSIFIED AS FREE CARE DUE TO THE FACT THAT PATIENTS APPLIED FOR, AND WERE APPROVED FOR, FREE CARE AFTER THE ACCOUNTS WERE PLACED WITH A BAD DEBT AGENCY. PARKVIEW HOSPITAL, INC. PROVIDES HEALTH CARE SERVICES THROUGH VARIOUS PROGRAMS THAT ARE DESIGNED, AMONG OTHER THINGS, TO ENHANCE THE HEALTH OF THE COMMUNITY AND IMPROVE THE HEALTH OF AT-RISK POPULATIONS. IN ADDITION, PARKVIEW HOSPITAL, INC. PROVIDES SERVICES INTENDED TO BENEFIT THE POOR AND UNDERSERVED, INCLUDING THOSE PERSONS WHO CANNOT AFFORD HEALTH INSURANCE DUE TO INADEQUATE RESOURCES OR WHO ARE UNINSURED OR UNDERINSURED. 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. PARKVIEW HOSPITAL, INC. ACCEPTS ALL MEDICARE PATIENTS, AS REFLECTED ON THE YEAR-END MEDICARE COST REPORT, WITH THE KNOWLEDGE THAT THERE MAY BE SHORTFALLS. INTERNAL REVENUE SERVICE (IRS) REVENUE RULING 69-545 IMPLIES THAT TREATING MEDICARE PATIENTS IS A COMMUNITY BENEFIT. IRS REVENUE RULING 69-545, WHICH ESTABLISHED THE COMMUNITY BENEFIT STANDARD FOR NONPROFIT HOSPITALS, STATES THAT IF A HOSPITAL SERVES PATIENTS WITH GOVERNMENTAL HEALTH BENEFITS, INCLUDING MEDICARE, THEN THIS IS AN INDICATION THAT THE HOSPITAL OPERATES TO PROMOTE THE HEALTH OF THE COMMUNITY. HOWEVER, MEDICARE PAYMENTS REPRESENT A PROXY OF COST CALLED THE "UPPER PAYMENT LIMIT." IT HAS HISTORICALLY BEEN ASSUMED THAT UPPER PAYMENT LIMIT PAYMENTS DO NOT GENERATE A SHORTFALL. AS A RESULT, PARKVIEW HOSPITAL, INC. HAS TAKEN THE POSITION NOT TO INCLUDE THE MEDICARE SHORTFALLS OR SURPLUSES AS PART OF COMMUNITY BENEFIT. PARKVIEW HOSPITAL, INC. RECOGNIZES THAT THE SHORTFALL OR SUPLUS 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: COLLECTION PRACTICES FOR PATIENTS ELIGIBLE FOR CHARITY CARETHE LAST PARAGRAPH OF THE PAYMENT POLICY STATES:"FINANCIAL ASSISTANCE MAY BE AVAILABLE FOR THOSE PATIENTS WHO CANNOT PAY THEIR BILL. THOSE OPTIONS ARE WELFARE ASSISTANCE OR FREE CARE THROUGH THE HOSPITAL CHARITY PROGRAM. (SEE CHARITY CARE POLICY.) PATIENTS WILL BE INSTRUCTED TO CONTACT A COUNSELOR TO DISCUSS THE AVAILABLE OPTIONS."ADDITIONALLY, THERE IS AN ONGOING EFFORT THROUGHOUT THE COLLECTION PROCESS TO SCREEN FOR MEDICAID ELIGIBILITY AND THE NEED FOR PROVIDING CHARITY CARE APPLICATIONS TO PATIENTS. IF A PATIENT MAY BE ELIGIBLE FOR MEDICAID, THE HOSPITAL PROVIDES A SERVICE TO OUR PATIENTS THAT HELPS THEM APPLY FOR MEDICAID WITH THE STATE IN WHICH THEY RESIDE. IF A PATIENT IS APPROVED FOR CHARITY CARE, THEIR ACCOUNT IS WRITTEN OFF AND COLLECTION EFFORTS CEASE. PART VI, LINE 2: DESCRIBE HOW THE ORGANIZATION ASSESSES THE HEALTH CARE NEEDS OF THE COMMUNITIES IT SERVES.PARKVIEW HEALTH SYSTEM, INC. AND PARKVIEW HOSPITAL, INC. IN CONJUNCTION WITH THE ALLEN COUNTY - FORT WAYNE HEALTH DEPARTMENT AND OTHERS CONDUCTED A COMMUNITY HEALTH NEEDS ASSESSMENT FOR THE FIVE COUNTIES (ALLEN, HUNTINGTON, LAGRANGE, NOBLE AND WHITLEY) WHERE PARKVIEW HAS HOSPITALS. ADDITIONALLY, PARKVIEW HEALTH SYSTEM, INC. PARTNERED WITH THE INDIANA UNIVERSITY/PURDUE UNIVERSITY OF FORT WAYNE'S (IPFW) SOCIAL RESEARCH DEPARTMENT AND PURDUE UNIVERSITY HEALTHCARE ADVISORS TO COMPLETE MUCH OF THE FIELD WORK. IPFW CONDUCTED THE RANDOMLY SELECTED COMMUNITY MEMBER SURVEY TO OBTAIN PRIMARY DATA. THE SURVEY INSTRUMENT USED FOR THIS STUDY WAS LARGELY BASED ON THE CENTERS FOR DISEASE CONTROL AND PREVENTION BEHAVIORAL RISK FACTOR SURVEILLANCE SYSTEM AS WELL AS OTHER PUBLIC HEALTH SURVEYS. OUR SURVEY INCLUDED CUSTOMIZED QUESTIONS ADDRESSING GAPS IN INDICATOR DATA RELATIVE TO NATIONAL HEALTH PROMOTION AND DISEASE PREVENTION OBJECTIVES AND OTHER RECOGNIZED HEALTH ISSUES. PURDUE UNIVERSITY ASSISTED WITH SURVEYING PUBLIC HEALTH, OTHER HEALTHCARE PROFESSIONALS, SOCIAL SERVICE AGENCIES AND OTHER COMMUNITY GROUP REPRESENTATIVES. PURDUE ALSO CONDUCTED SECONDARY DATA RESEARCH, DATA ANALYSIS AND FACILITATED PRIORITIZATION OF IDENTIFIED HEALTH ISSUES. SEVERAL SECONDARY DATA SOURCES WERE USED TO DETERMINE HEALTH ISSUES FOR THE FIVE-COUNTY AREA. THESE RESOURCES INCLUDE THE CENTERS FOR DISEASE CONTROL AND PREVENTION WINNABLE BATTLES, THE INDIANA STATE HEALTH IMPROVEMENT PLAN AND THE INDIANA HEALTH DEPARTMENT DISTRICT 3 HEALTH ASSESSMENTS. IN THE FOURTH QUARTER OF 2013, EACH OF THE FIVE HOSPITALS' BOARD OF DIRECTORS ADOPTED THEIR RESPECTIVE COMMUNITY HEALTH NEEDS ASSESSMENT REPORT AND IMPLEMENTATION STRATEGIES TO ADDRESS IDENTIFIED HEALTH NEEDS. PARKVIEW HOSPITAL, INC. REPRESENTATIVES MAINTAIN ON-GOING RELATIONSHIPS THROUGHOUT OUR COMMUNITIES AND MEET REGULARLY WITH ORGANIZATIONS THAT SHARE OUR MISSION OF IMPROVING THE HEALTH AND WELL-BEING OF OUR COMMUNITIES. HEALTH ISSUES IDENTIFIED IN THE SURVEY INCLUDED: OBESITY, TOBACCO USE, CHLAMYDIA INFECTIONS, TEEN BIRTHS, INFANT MORTALITY, PRENATAL CARE, EXCESSIVE ALCOHOL USE, POOR MENTAL HEALTH AND PRIMARY CARE PHYSICIANS (HEALTH CARE ACCESS). THROUGH A PRIORITIZATION PROCESS USING SPECIFIC CRITERIA, THREE HEALTH PRIORITIES WERE SELECTED. THESE PRIORITIES ARE: 1) OBESITY HEALTHY LIFESTYLE BEHAVIORS PROMOTION AND EDUCATION, 2) PRENATAL CARE PROVIDING VARIOUS INTERVENTIONS TO ENSURE EARLY AND QUALITY PRENATAL CARE AND 3) MENTAL HEALTH USING A MENTAL HEALTH SCREENING TOOL AND IMPROVING ACCESS TO MENTAL HEALTH CARE. 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.-AT POINT OF REGISTRATION OR SCHEDULING, IF A PATIENT EXPRESSES THEIR INABILITY TO PAY, THE REGISTRAR OR SCHEDULER WILL REFER THE PATIENT TO A FINANCIAL COUNSELOR OR WILL PROVIDE FINANCIAL COUNSELING CONTACT INFORMATION IN THE FORM OF A BUSINESS CARD TO THE PATIENT OUTSIDE OF NORMAL BUSINESS HOURS.-SIGNAGE IN THE EMERGENCY DEPARTMENT AND CASHIER AREAS INFORMS THE PATIENT OF THEIR RIGHT TO RECEIVE CARE REGARDLESS OF THEIR ABILITY TO PAY AND TELLS THEM THEY MAY BE ELIGIBLE FOR GOVERNMENTAL ASSISTANCE.-THE PATIENT'S INITIAL STATEMENT INSTRUCTS THE PATIENT TO CALL THE PATIENT ACCOUNTING DEPARTMENT IF THEY CANNOT PAY IN FULL. THE PATIENT ACCOUNTING CALL CENTER COLLECTORS SCREEN AND OFFER FREE CARE APPLICATIONS TO PATIENTS WHO CANNOT AFFORD TO PAY THEIR BILLS.-THE ONLINE ACCOUNT MANAGER OF PARKVIEW HOSPITAL, INC.'S WEBSITE (WWW.PARKVIEW.COM) CONTAINS INFORMATION ON HOW TO CONTACT THE PATIENT ACCOUNTING DEPARTMENT FOR PAYMENT OPTIONS OR FREE CARE ELIGIBILITY.-ALL UNINSURED OR UNDERINSURED PATIENTS WHO ARE INPATIENT OR OBSERVATION STATUS ARE VISITED BY FINANCIAL COUNSELORS. THE FINANCIAL COUNSELORS PROVIDE PAYMENT OPTIONS INCLUDING SCREENING FOR FREE CARE AND PROVIDE THE PATIENT WITH FREE CARE APPLICATIONS.-OUTBOUND PHONE CALLS ARE MADE TO PATIENTS TO SET UP PAYMENT ARRANGEMENTS. IF A PATIENT CANNOT MAKE PAYMENT ON THEIR ACCOUNT, THE PATIENT WILL BE SCREENED FOR FREE CARE AND PROVIDED WITH AN APPLICATION TO APPLY FOR FREE CARE.-IF A PATIENT'S ACCOUNT IS PLACED WITH A COLLECTION AGENCY, THE AGENCY IS INSTRUCTED TO SCREEN FOR FREE CARE IF THE PATIENT EXPRESSES THEIR INABILITY TO PAY. PART VI, LINE 4: DESCRIBE THE COMMUNITY THE ORGANIZATION SERVES, TAKING INTO ACCOUNT THE GEOGRAPHIC AREA AND DEMOGRAPHIC CONSTITUENTS IT SERVES.THE FACILITIES OF PARKVIEW HOSPITAL, INC., CONSISTING OF THE PARKVIEW REGIONAL MEDICAL CENTER, PARKVIEW HOSPITAL RANDALLIA AND PARKVIEW BEHAVIORAL HEALTH ARE LOCATED IN FORT WAYNE, THE PRIMARY URBAN AREA THAT RESIDES IN THE HEALTH SYSTEM'S SERVICE AREA. ACCORDING TO STATS INDIANA 2013, FORT WAYNE REPORTED A POPULATION OF 254,555 AND COMPRISES 70.6% OF THE TOTAL ALLEN COUNTY POPULATION. NEW HAVEN, THE LARGEST TOWN IN THE COUNTY, ACCOUNTS FOR 4.3% OF THE COUNTY POPULATION. PARKVIEW HOSPITAL, INC. WAS THE REGION'S FIRST LEVEL II TRAUMA CENTER AND SERVES THE SURROUNDING COMMUNITIES. THE TOTAL POPULATION IN ALLEN COUNTY IS 363,014, A 2.2% INCREASE SINCE 2010 CENSUS. IN 2012, APPROXIMATELY 15.8% OF THE POPULATION WAS REPORTED TO BE BELOW THE FEDERAL POVERTY LEVEL. THE PER CAPITA PERSONAL (ANNUAL) INCOME WAS $37,371 AND THE MEDIAN HOUSEHOLD INCOME WAS $48,795. AS OF APRIL 2014, THE UNEMPLOYMENT RATE WAS 5.0%. A PORTION OF SOUTHEAST FORT WAYNE IS DESIGNATED AS A MEDICALLY UNDERSERVED AREA (MUA) BY THE FEDERAL GOVERNMENT. THERE IS ONE FEDERALLY QUALIFIED HEALTH CENTER (FQHC) IN ALLEN COUNTY, NEIGHBORHOOD HEALTH CLINIC. IN 2013, PARKVIEW AND THE NEIGHBORHOOD HEALTH CLINIC PARTNERED TO FORM A SATELLITE LOCATION IN SOUTHEAST FORT WAYNE. THIS FACILITY IS NAMED THE PARKVIEW NEIGHBORHOOD HEALTH CLINIC. IN ADDITION TO THE CLINIC, THE FACILITY HOUSES THE PARKVIEW CENTER FOR HEALTHY LIVING SOUTHEAST WHICH WILL PROVIDE HEALTH PREVENTION EDUCATION TO THE LOCAL UNDERSERVED POPULATION. ACCORDING TO TRUVEN HEALTH ANALYTICS, IN 2013, 14.9% OF ALLEN COUNTY RESIDENTS WERE ENROLLED IN MEDICAID AND 12% WERE UNINSURED. FOR PARKVIEW HOSPITAL, INC. FACILITIES IN ALLEN COUNTY, 18.34% OF INPATIENT DISCHARGES WERE MEDICAID PATIENTS AND 9.56% WERE SELF-PAY. FOR OUTPATIENT PROCEDURES, 8.72% WERE MEDICAID PATIENTS AND 4.15% WERE SELF-PAY. 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.).IN AN EFFORT TO BEST MEET PATIENT NEEDS, ALL AREA QUALIFIED PHYSICIANS MAY APPLY FOR PRIVILEGES AT PARKVIEW HOSPITAL, INC. ADDITIONALLY, THE MEDICAL CONTINUING EDUCATION DEPARTMENTS MEDICAL SYMPOSIUMS HELD THROUGHOUT THE YEAR ARE OPEN TO ALL AREA HEALTH CARE PROFESSIONALS. PARKVIEW HOSPITAL, INC.'S BOARD OF DIRECTORS IS COMPRISED OF INDEPENDENT COMMUNITY MEMBERS WHO RESIDE IN PARKVIEW HOSPITAL, INC.'S PRIMARY SERVICE AREA. AS A TESTAMENT TO OUR COMMITMENT TO THE RESIDENTS OF OUR COMMUNITIES, PARKVIEW HOSPITAL, INC. OPENED THE PARKVIEW REGIONAL MEDICAL CENTER ON OUR NORTH CAMPUS IN MARCH 2012. THE CENTER OFFERS THE LATEST IN CARE DESIGN AND STATE OF THE ART EQUIPMENT AND CLINICAL CAPABILITIES. IT BLENDS THE LATEST MEDICAL TECHNOLOGY WITH THE BEST POSSIBLE PATIENT-CENTERED CARE WHILE PROVIDING INCREASED ACCESS TO HEALTHCARE FOR PATIENTS. PARKVIEW HAS PROVIDED CLINICAL RESEARCH SERVICES TO PARKVIEW HEALTH SYSTEM, INC. PHYSICIANS, AND HAS DEVELOPED AREAS OF SPECIALIZATION IN CARDIOLOGY, NEUROLOGY, RADIATION ONCOLOGY, EMERGENCY MEDICINE AND CRITICAL CARE OVER THE PAST 25 YEARS. FACILITY CONSTRUCTION IS CURRENTLY UNDERWAY ON THE MIRRO CENTER FOR RESEARCH AND EDUCATION ON OUR NORTH CAMPUS. THE CENTER WILL BE ABLE TO STUDY DISEASE MANAGEMENT IN A MULTI-PROFESSIONAL SETTING BRINGING TOGETHER PHYSICIANS, PHARMACISTS, NURSES AND HEALTH CARE STAFF. THE NEW CENTER CREATES PROMISE OF SIGNIFICANT ADVANCEMENTS IN CLINICAL RESEARCH AND TRAINING. THROUGH A PARTNERSHIP WITH REGIONAL ACADEMIC INSTITUTIONS, THE CENTER'S GOAL IS TO BECOME AN INNOVATOR IN HEALTH CARE SCIENCES FOR THE REGION. ALSO PART OF PARKVIEW HOSPITAL, INC., THE HOSPITAL FACILITY AND CAMPUS LOCATED IN NORTH CENTRAL FORT WAYNE (PARKVIEW HOSPITAL RANDALLIA) IS IN THE PROCESS OF RECEIVING EXTERNAL RENOVATIONS AND REMAINS A VITAL PART OF THE LOCAL NEIGHBORHOOD. WHILE THIS FACILITY CONTINUES TO PROVIDE COMMUNITY-CENTRIC HEALTH CARE SERVICES, PARKVIEW IS REPOSITIONING THE RANDALLIA CAMPUS AS PART OF A FUTURE USES PLAN PROCESS. AS A PART OF THESE EFFORTS, PARKVIEW HOSPITAL, INC. IS PARTNERING WITH TRINE AND HUNTINGTON UNIVERSITIES TO FORM THE LIFE SCIENCE AND RESEARCH CENTER. THIS CENTER WILL PROVIDE NEW ACADEMIC PROGRAMS AND RESEARCH TIED TO BEHAVIORAL HEALTH, REHABILITATION SERVICES AND SENIOR CARE. PARKVIEW HOSPITAL, INC. PROVIDES EMERGENCY CARE 24 HOURS A DAY, 365 DAYS A YEAR. BECAUSE THE FIRST HOUR AFTER AN EMERGENCY IS THE MOST CRITICAL, PARKVIEW HOSPITAL, INC. ESTABLISHED THE SAMARITAN FLIGHT PROGRAM FOR RAPID AIR TRANSPORT. THE TWO SAMARITAN EMERGENCY RESPONSE HELICOPTERS ARE AVAILABLE FOR DISPATCH 24 HOURS A DAY, WITH A HIGHLY TRAINED CREW AND ADVANCED ON-BOARD TRAUMA TECHNOLOGY. THE EMERGENCY DEPARTMENT IS STAFFED WITH BOARD-CERTIFIED EMERGENCY CARE PHYSICIANS AND A NURSING STAFF THAT IS EXCEPTIONALLY TRAINED AND EXPERIENCED IN EMERGENCY CARE. FURTHERMORE, NO PATIENT IS EVER DENIED TREATMENT, REGARDLESS OF THEIR ABILITY TO PAY. PARKVIEW HOSPITAL, INC.'S EMERGENCY DEPARTMENT ALSO CONNECTS CRITICALLY ILL OR INJURED PATIENTS WITH THE SPECIALIZED CARE THEY NEED THROUGH ACCESS TO THE REGION'S FIRST VERIFIED LEVEL II ADULT AND PEDIATRIC TRAUMA CENTER, THE PARKVIEW HEART INSTITUTE AND HOSPITAL, AND THE CERTIFIED PARKVIEW STANLEY WISSMAN STROKE CENTER. PATIENTS RECEIVING EMERGENCY CARE AT PARKVIEW HOSPITAL, INC. MAY ALSO SEE SPECIALISTS IN ORTHOPEDICS, NEUROSURGERY, PLASTIC SURGERY AND OTHER SPECIALTY AREAS.DATA OBTAINED THROUGH PERIODIC COMMUNITY HEALTH ASSESSMENTS, PHYSICIAN SURVEYS, AND TREND AND TREATMENT ANALYSIS IS UTILIZED IN THE ORGANIZATION'S STRATEGIC PLANNING PROCESS BY IDENTIFYING COMMUNITY HEALTH NEEDS. AS A RESULT OF THIS STRATEGIC PLANNING PROCESS, PARKVIEW HOSPITAL, INC. HAS ESTABLISHED SEVERAL PRIORITY AREAS. THESE PRIORITY AREAS ARE ALIGNED WITH PARKVIEW HOSPITAL, INC.'S MISSION, VISION, AND GOALS AND HELP DIRECT THE TYPES OF HEALTH INITIATIVES THAT THE HOSPITAL UNDERTAKES. PRIORITY AREAS INCLUDE THE FOLLOWING:PRIMARY HEALTH CARE/ACCESS TO HEALTH CARE:-ADDITIONAL RECRUITMENT AND TRAINING OF PRIMARY CARE PHYSICIANS FOR THE COMMUNITY INCLUDING THE ADDITION OF FAMILY PRACTICE PHYSICIANS AT OUR LIBERTY MILLS AND NEW VISION DRIVE LOCATIONS.-EXPANSION OF PRIMARY CARE ACCESS AND NON-TRADITIONAL HOURS OF PRACTICE INCLUDING THE EXPANSION OF WALK-IN CLINIC HOURS AT SEVERAL PARKVIEW PHYSICIAN GROUP OFFICES TO ACCOMMODATE SAME-DAY APPOINTMENTS. -CONTINUED SUPPORT OF PROGRAMS PROVIDING PRIMARY CARE TO THE UNINSURED INCLUDING FINANCIAL SUPPORT TO MATTHEW 25 HEALTH, DENTAL CLINIC NEIGHBORHOOD HEALTH CLINICS AND COMMUNITY TRANSPORTATION NETWORK. -PROGRAMS TO INCREASE DISTRIBUTION OF FREE MEDICATIONS TO THE POOR. EACH HOSPITAL PROVIDES A MEDICATION ASSISTANCE PROGRAM AND MAKES THESE SERVICES AVAILABLE TO THE COMMUNITY. -PROMOTION OF CAREERS IN HEALTHCARE, PARTICULARLY THOSE FUNCTIONS IN WHICH THE COMMUNITY IS EXPERIENCING A CURRENT SHORTAGE OF HEALTH CARE PROFESSIONALS INCLUDING SCHOLARSHIP AND INTERNSHIP PROGRAMS FOR STUDENTS IN A MEDICAL FIELD OF STUDY.-SUPPORT FOR ACTIVITIES WHICH INCREASE THE AFFORDABILITY AND ACCESSIBILITY OF HEALTH INSURANCE TO THE UNINSURED INCLUDING PARTNERSHIP WITH CANI COVERING KIDS AND FAMILIES AND OTHER GROUPS THAT PROVIDE ENROLLMENT ELIGIBILITY SERVICES. HEALTH SCREENING AND PREVENTION:-HEALTHY LIFESTYLE BEHAVIOR PROMOTION AND EDUCATION -CANCER SCREENING PROGRAMS, PARTICULARLY MAMMOGRAM AND PROSTATE SCREENING-TOBACCO CESSATION PROGRAMS ESPECIALLY FOR WOMEN OF CHILDBEARING AGE-INJURY PREVENTION FOR CHILDREN, YOUTH AND SENIORS-DIABETES EDUCATION AND SCREENING-CARDIOVASCULAR DISEASE EDUCATION AND SCREENING-PROGRAMS TO REDUCE DANGEROUS DRIVING-MENTAL HEALTH SCREENINGDISEASE MANAGEMENT:-CARDIOVASCULAR DISEASE -CANCER-MENTAL ILLNESS-TRAUMA AND ORTHOPAEDIC AILMENTS-WOMEN'S AND CHILDREN'S MEDICINE WITH AN EMPHASIS ON PRENATAL CARE AND CHILDREN'S ASTHMA-DIABETES AND OBESITY HEALTH INNOVATION, EDUCATION AND RESEARCH AND DEVELOPMENT:-ENHANCING HEALTH CARE EDUCATION, MEDICAL RESEARCH, AND TECHNOLOGY THROUGH PARTNERSHIPS WITH LOCAL UNIVERSITIES, CONSTRUCTION OF THE MIRRO RESEARCH AND EDUCATION CENTER ON THE NORTH CAMPUS AND DEVELOPMENT OF THE LIFE SCIENCE EDUCATION AND RESEARCH CENTER ON THE RANDALLIA CAMPUS.-PROMOTING ECONOMIC AND OTHER DEVELOPMENT OF THE COMMUNITY THROUGH PROVIDING HIGH-LEVEL LEADERSHIP TO DEVELOP PARTNERSHIPS WITH REGIONAL PARTNER ORGANIZATIONS THAT SHARE COMMON GOALS.-DEVELOPMENT OF A POPULATION HEALTH MANAGEMENT MODEL. PARKVIEW HOSPITAL, INC. ANNUALLY FUNDS COMMUNITY HEALTH IMPROVEMENT EFFORTS THROUGH A COMMITMENT OF UP TO 10% OF ITS NET INCOME. THESE FUNDS ARE USED TO SUPPORT HEALTH-RELATED, COMMUNITY-BASED PROGRAMS, PROJECTS AND ORGANIZATIONS. THESE FUNDS ARE ALSO USED TO SUPPORT A PORTION OF PARKVIEW HOSPITAL, INC.'S COMMUNITY OUTREACH PROGRAMS AND HEALTH INITIATIVES. THE EMPHASIS WITH THESE PROJECTS CONTINUES TO BE ON IMPROVING THE HEALTH AND WELL-BEING OF THE COMMUNITIES WE SERVE.PARKVIEW HOSPITAL, INC. PROVIDES A COMMUNITY-BASED NURSING PROGRAM THAT PROVIDES SUPPORT AND EDUCATION TO THOUSANDS OF CHILDREN AND THEIR FAMILIES EACH YEAR. OTHER PARKVIEW HOSPITAL, INC. OUTREACH PROGRAMS INCLUDE MEDICATION ASSISTANCE, MOBILE MAMMOGRAPHY, NUTRITION EDUCATION AND TRAUMA INJURY PREVENTION. SEVERAL LOCAL HEALTH PARTNERS ASSIST IN ADDRESSING ACCESS TO HEALTH CARE. MATTHEW 25 HEALTH AND DENTAL CLINIC, NEIGHBORHOOD HEALTH CLINIC, SUPER SHOT IMMUNIZATION CLINIC AND CANI COVERING KIDS AND FAMILIES ARE JUST A FEW OF OUR PARTNER ORGANIZATIONS. IN ADDITION, PARKVIEW HOSPITAL, INC. PROVIDES FUNDING TO COMMUNITY TRANSPORTATION NETWORK AS THEY MAY PROVIDE MEDICAL TRANSPORTATION THROUGHOUT THE COMMUNITY. A COMMITTEE OF COMMUNITY LEADERS, MEMBERS OF THE PARKVIEW HOSPITAL, INC. BOARD OF DIRECTORS AND HOSPITAL STAFF REPRESENTATIVES MEET REGULARLY TO ESTABLISH OR AFFIRM FUNDING PRIORITIES FOR PARKVIEW HOSPITAL, INC.'S COMMUNITY HEALTH IMPROVEMENT PROGRAM. PARKVIEW HOSPITAL, INC. PROACTIVELY SEEKS TO BUILD COMMUNITY PARTNERSHIPS AND COLLABORATIONS IN DEVELOPING AND IMPLEMENTING HEALTH INITIATIVES TO MEET IDENTIFIED COMMUNITY HEALTH NEEDS. PARKVIEW HOSPITAL, INC. IS DEDICATED TO THE INVESTMENT OF TIME AND RESOURCES IN THE PROCESS AND CHALLENGES OF IMPROVING THE HEALTH AND WELL-BEING OF THE COMMUNITY. OUR GOAL IS TO UTILIZE BEST PRACTICES AND INNOVATIVE METHODS TO IMPROVE HEALTH STATUS, PARTICULARLY FOR THE UNDERSERVED. 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., WHITLEY MEMORIAL HOSPITAL, INC. AND HUNTINGTON MEMORIAL HOSPITAL, INC., AS WELL AS 60% 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 FIVE-COUNTY AREA, THE HEALTH PRIORITY OF OBESITY OR HEALTHY LIFESTYLE PROMOTION AND EDUCATION INCLUDING GOOD NUTRITION AND PHYSICAL ACTIVITY 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 IS TO PROVIDE QUALITY HEALTH SERVICES TO ALL WHO ENTRUST THEIR CARE TO US AND TO IMPROVE THE HEALTH AND WELL-BEING OF OUR COMMUNITIES. 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. 1 MATTHEW 25 HEALTH CLINIC 413 E JEFFERSON BLVD FORT WAYNE IN 46802 351484951 501 ( C ) 3 283586 HEALTH AND DENTAL CLINIC EARLY CHILDHOOD ALLIANCE INC 3320 FAIRFIELD FORT WAYNE IN 46807 350953465 501 ( C ) 3 235927 PROGRAMS TO IMPROVE THE EDUCATIONAL, HEALTH & EMOTIONAL WELL-BEING OF YOUNG CHILDREN NEIGHBORHOOD HEALTH CLINICS INC 1717 SOUTH CALHOUN STREET FORT WAYNE IN 46802 351922483 501 ( C ) 3 100000 HEALTH CARE SERVICES IHA HOSPITAL ASSISTANCE FOUNDATION INC 1 AMERICAN SQUARE SUITE 1900 INDIANAPOLIS IN 46282 455573749 501 ( C ) 3 50576 PROMOTE A STABLE AND DIVERSE HOSPITAL INFRASTRUCTURE THROUGHOUT INDIANA IPFW 2101 E COLISEUM BLVD FORT WAYNE IN 46805 356002041 501 ( C ) 3 50000 OPERATIONS & TAPESTRY FUNDING CANCER SERVICES OF NORTHEAST INDIANA 6316 MUTUAL DRIVE FORT WAYNE IN 46825 350965609 501 ( C ) 3 45000 OPERATIONS FUNDING & PATIENT ADVOCACY PROGRAMS MIDWEST ALLIANCE FOR HEALTH EDUCATION 1819 CAREW FORT WAYNE IN 46805 351637515 501 ( C ) 3 33000 RESEARCH PROJECTS & INTERNSHIPS TURNSTONE CENTER FOR DISABLED CHILDREN AND ADULTS 3320 N CLINTON FORT WAYNE IN 46805 350913541 501 ( C ) 3 30000 FITNESS AND WELLNESS PROGRAMS UNITED WAY OF ALLEN COUNTY 334 EAST BERRY STREET FORT WAYNE IN 46802 350867932 501 ( C ) 3 25000 LET'S TALK PROGRAM AMERICAN HEART ASSOCIATION 4040 VINELAND DRIVE FORT WAYNE IN 46815 135613797 501 ( C ) 3 15654 PROGRAMS TO REDUCE DEATH CAUSED BY HEART DISEASE & STROKE EASTER SEALS OF NORTHEAST INDIANA INC 4919 COLDWATER ROAD FORT WAYNE IN 46825 350998711 501 ( C ) 3 10150 PROGRAMS TO ASSIST CHILDREN & ADULTS WITH DISABILITIES & SPECIAL NEEDS HEALTH AND HOSP CORP OF MARION COUNTY 3835 NORTH RURAL ST INDIANAPOLIS IN 46205 356005697 501 ( C ) 3 10000 OPERATIONS & ADVOCATE PROGRAMS LEO-CEDARVILLE FOUNDATION INCORPORATED P O BOX 6 LEO IN 46765 454195859 501 ( C ) 3 10000 SPONSORSHIP OF RIVERSIDE GARDENS PROJECT PBS 39 WFWA 2501 E COLISEUM BLVD FORT WAYNE IN 46805 237173906 501 ( C ) 3 6000 SPONSORSHIP OF FOOD FOR THOUGHT - HEALTHY HABITS FOR LIFE VERA BRADLEY FOUNDATION FOR BREAST CANCER PO BOX 80201 FORT WAYNE IN 46898 352058177 501 ( C ) 3 10000 SPONSORSHIP OF RESEARCH EVENT 15 0 FAMILY & CHILDREN ASSISTANCE 540 4053 FMV TOYS, BABY ITEMS, ETC. CAR SEAT DISTRIBUTION PROGRAM 433 21785 FMV CAR SEATS PART I, LINE 2: COMMUNITY HEALTH IMPROVEMENT FUNDING PARTNER ORGANIZATIONS ARE REQUIRED TO SUBMIT AN ANNUAL PROGRESS REPORT RELATED TO PROGRAM FUNDING. PARTNER ORGANIZATIONS ARE REQUIRED TO RE-APPLY FOR FUNDING ON AN ANNUAL BASIS. X 1 1 0 1 0 0 0 0 0 1 0 SUZANNE EHINGER DIRECTOR/PVHOS PRESIDENT PRMC 414020 0 127189 0 20388 0 83700 0 26359 0 671656 0 0 0 MICHAEL PACKNETT DIRECTOR/PH PRESIDENT & CEO 0 812073 0 323754 0 20388 0 187852 0 25271 0 1369338 0 0 MICHAEL GRABOWSKI DIRECTOR/PVHOS MSO & SLL 74083 338045 0 25000 1745 7959 4760 23290 1611 7883 82199 402177 0 0 JEFFREY NICKEL DIRECTOR/PVHOS ASST MED DI 148850 1500 0 0 0 0 0 0 0 0 148850 1500 0 0 MICHAEL BROWNING PH SVP & CFO 0 461450 0 141682 0 19118 0 89278 0 30095 0 741623 0 0 CHAD CARPENTER PVHOS COO PARKVIEW HEART I 166864 0 70114 0 2459 0 20163 0 14403 0 274003 0 0 0 GREG JOHNSON PVHOS CMO 305044 32307 0 44215 0 2942 39338 10247 20215 5266 364597 94977 0 0 JUDITH BOERGER PVHOS SVP 267787 0 81195 0 22544 0 41470 0 17135 0 430131 0 14162 0 DANIEL GARMAN PVHOS SVP 211743 0 64424 0 13701 0 38672 0 22325 0 350865 0 10863 0 CHARLES CLARK PVHOS SVP 169785 0 47312 0 10870 0 33428 0 14419 0 275814 0 8470 0 BENJAMIN MILES PVHOS VP 194816 0 0 0 6401 0 29780 0 23395 0 254392 0 0 0 YUENIAN ZHANG PVHOS CHIEF PHYSICIST 224377 0 46973 0 824 0 5100 0 15650 0 292924 0 0 0 RAE GONTERMAN PVHOS SVP 155386 0 42609 0 3392 0 30068 0 14172 0 245627 0 0 0 MICHAEL GERUE PVHOS SVP 146488 0 39643 0 9611 0 38253 0 23662 0 257657 0 9074 0 THOMAS GUTWEIN PVHOS MEDICAL DIR ECC 164900 4700 0 0 0 0 0 0 0 0 164900 4700 0 0 CHRISTOPHER JELLISON PVHOS DIR PHARMACY 138918 0 21769 0 464 0 9299 0 16923 0 187373 0 0 0 STANTON RISSER FORMER OFFICER/CURRENT PH DIR 0 137621 0 27491 0 464 0 11765 0 19379 0 196720 0 0 PART I, LINE 1A PERSONAL SERVICES TAXABLE ALLOWANCE FOR FINANCIAL PLANNING PAID TO: GREG JOHNSON $500 PART I, LINE 3 RELATED ORGANIZATION, PARKVIEW HEALTH SYSTEM, INC., USES THE FOLLOWING TO ESTABLISH THE COMPENSATION OF PARKVIEW HOSPITAL, 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 - JUDITH BOERGER $14,162; CHARLES CLARK $8,470; DANIEL GARMAN $10,863; MICHAEL GERUE $9,074 PARTICIPANTS DEFERRED - JUDITH BOERGER $31,270; MICHAEL BROWNING $53,100; CHAD CARPENTER $20,163; CHARLES CLARK $19,795; SUZANNE EHINGER $53,100; DANIEL GARMAN $23,372; MICHAEL GERUE $17,456; RAE GONTERMAN $18,068; GREG JOHNSON $21,535; BENJAMIN MILES $23,600; MICHAEL PACKNETT $170,002 PART I, LINE 7 MANAGEMENT INCENTIVE COMPENSATION PLAN (MICP) IS AN ANNUAL INCENTIVE PROGRAM. 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. INDIANA SURGICAL SPECIALISTS LLC ENTITY OF WHICH DIRECTOR MICHAEL GRABOWSKI WAS SERVING AS AN OFFICER 1449915 COMMON PAYMASTER, PARKVIEW HEALTH SYSTEM, INC. EIN 35-1972384, PAID INDIANA SURGICAL SPECIALISTS, LLC FOR CONTRACTED SERVICES. TRANSACTIONS WERE ENTERED INTO AT ARM'S LENGTH. THE CONTRACTED SERVICES INCLUDE: CALL COVERAGE 24/7, MEDICAL DIRECTOR COVERAGE, AND PROFESSIONAL TRAUMA SERVICES PROVIDED TO PARKVIEW HOSPITAL, INC. PATIENTS. INDIANA SURGICAL SPECIALISTS, LLC ASSIGN THEIR BILLINGS AND RECEIPTS TO THE HOSPITAL. COLLECTED AMOUNT OF $390,723 IS NOT REFLECTED ON SCHEDULE L. 0 TRAVIS CARPENTER FAMILY MEMBER OF OFFICER CHAD CARPENTER 33285 TRAVIS CARPENTER RECEIVED COMPENSATION FROM PARKVIEW HOSPITAL, INC. 0 VINCENT CORONA FAMILY MEMBER OF DIRECTOR STEVE CORONA. 11703 VINCENT CORONA RECEIVED COMPENSATION FROM PARKVIEW HOSPITAL, INC. 0 FORM 990, PART III, LINE 4A CONTINUED FROM PAGE 2: PARKVIEW HOSPITAL, INC. GIVES BACK TO THE COMMUNITY IN THE FORM OF IMPROVED FACILITIES, EDUCATION AND OUTREACH PROGRAMS, FREE AND DISCOUNTED CARE, VOLUNTEERISM AND SO MUCH MORE. IN MARCH 2012, THE NEWLY CONSTRUCTED PARKVIEW REGIONAL MEDICAL CENTER OPENED AND REPRESENTS AN INVESTMENT OF OVER $500 MILLION TO PROVIDE STATE-OF-THE-ART CARE AND EXCEPTIONAL SERVICE FOR THOSE THAT ENTRUST THEIR CARE TO US. THROUGH THE PARKVIEW HOSPITAL, INC. COMMUNITY HEALTH IMPROVEMENT FUND, THE HOSPITAL WORKS WITH COMMUNITY PARTNERS IN TAKING A PROACTIVE APPROACH TO IMPROVING SPECIFIC HEALTH-RELATED OUTCOMES. AREAS OF FOCUS INCLUDE PROVIDING INCREASED ACCESS TO HEALTHCARE, HEALTH SCREENINGS AND PREVENTION PROGRAMS, DISEASE MANAGEMENT, AND HEALTH AND HEALTHCARE INNOVATION THROUGH RESEARCH AND DEVELOPMENT. PARKVIEW HOSPITAL, INC., IN CONJUNCTION WITH PARKVIEW HEALTH SYSTEM, INC., COMPLETED A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) IN THE FIVE-COUNTY (ALLEN, HUNTINGTON, LAGRANGE, NOBLE AND WHITLEY COUNTIES) AREA DURING 2013. PARKVIEW PARTNERED WITH THE FORT WAYNE/ALLEN COUNTY HEALTH DEPARTMENT AND OTHER AREA NOT-FOR-PROFIT ORGANIZATIONS THAT HAVE A VESTED INTEREST IN COMMUNITY HEALTH. TO ENSURE THAT THE NEEDS OF THE MEDICALLY UNDERSERVED, LOW-INCOME AND MINORITY POPULATIONS WERE TAKEN INTO ACCOUNT WHEN COLLECTING PRIMARY DATA, STEPS WERE TAKEN TO STRATIFY THE SAMPLE SO THAT POPULATION SUBSETS WERE ACCURATELY REPRESENTED. PARKVIEW ALSO OBTAINED INPUT FROM LOCAL ADVOCACY ORGANIZATIONS THAT SPECIALIZE IN AIDING OUR AREA'S MEDICALLY UNDERSERVED, LOW-INCOME AND MINORITY POPULATIONS. SEVERAL SECONDARY DATA SOURCES WERE ALSO USED TO ASSIST IN IDENTIFYING HEALTH CONCERNS. HEALTH CONCERNS WERE PRIORITIZED USING EIGHT CRITERIA. THE TOP THREE HEALTH PRIORITIES FOR PARKVIEW HOSPITAL, INC. IDENTIFIED INCLUDE THE FOLLOWING: 1) OBESITY, 2) PRENATAL CARE AND 3) MENTAL HEALTH. ALL FIVE HOSPITALS WILL FOCUS ON OBESITY THROUGH COMMUNITY COLLABORATIONS PROMOTING HEALTHY LIFESTYLE CHOICES. THE FOLLOWING ARE SOME OF THE WAYS PARKVIEW HOSPITAL, INC. IS REACHING OUT TO MAKE OUR NEIGHBORHOODS AND COMMUNITIES HEALTHIER: FINANCIAL ASSISTANCE: PARKVIEW HOSPITAL, 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, NOT ON THE PATIENT'S FINANCIAL ABILITY TO PAY FOR THEIR MEDICAL EXPENSES. COMMUNITY HEALTH IMPROVEMENT PROGRAM: THE PURPOSE OF PARKVIEW HOSPITAL, INC.'S COMMUNITY HEALTH IMPROVEMENT PROGRAM IS TO FUND COMMUNITY HEALTH IMPROVEMENT EFFORTS WITHIN ALLEN COUNTY WHERE PARKVIEW HOSPITAL, INC. RESIDES. THE HOSPITAL PROVIDES FUNDING UP TO 10% OF ITS NET INCOME FOR COMMUNITY HEALTH INITIATIVES AND COMMUNITY PARTNER ORGANIZATIONS TO ADDRESS IDENTIFIED HEALTH NEEDS AND TO ENCOURAGE HEALTHIER LIFESTYLES AMONG THE CITIZENS OF ALLEN COUNTY. SEVERAL INITIATIVES AND PROGRAMS ARE HIGHLIGHTED BELOW. COMMUNITY NURSING INITIATIVE: BELIEVING THAT THE KNOWLEDGE AND SKILL OF DEDICATED NURSES HAS GREAT BENEFIT OUTSIDE THE HOSPITAL WALLS, PARKVIEW HOSPITAL, INC. HAS, SINCE 1998, FUNDED A PROGRAM THAT PLACES PARKVIEW NURSES IN STRATEGIC POSITIONS THROUGHOUT THE COMMUNITY. FUNDING SUPPORTS NURSES IN PUBLIC SCHOOLS DEMONSTRATING THE GREATEST HEALTH NEEDS. PARKVIEW NURSES ALSO PROVIDE HEALTHCARE MANAGEMENT EXPERTISE AT CANI HEADSTART PRESCHOOL, SCAN, INC. (STOP CHILD ABUSE AND NEGLECT) AND THE FORT WAYNE WOMEN'S BUREAU TRANSITIONS PROGRAM FOR WOMEN RECOVERING FROM DRUG ABUSE. IN ADDITION, PARKVIEW HOSPITAL, INC. PROVIDES TWO DIABETES SPECIALTY NURSES, AN ASTHMA SPECIALTY NURSE, AND A RESPIRATORY THERAPIST TO IMPROVE THE HEALTH OF CHILDREN IN FORT WAYNE COMMUNITY SCHOOLS, EAST ALLEN COUNTY SCHOOLS AND NORTHWEST ALLEN COUNTY SCHOOLS. THE HEALTH AND WELL-BEING OF FAMILIES: THROUGH VARIOUS PROGRAMS PROVIDED BY COMMUNITY NURSES, REGISTERED DIETITIANS AND OTHER STAFF, PARKVIEW HOSPITAL, INC. DEMONSTRATES ITS COMMITMENT TO THE HEALTH AND WELL-BEING OF AREA FAMILIES. IN 2012, THE HOSPITAL KICKED OFF THE PARKVIEW LIVE PROGRAM PROMOTING THE 8 HEALTHY HABITS TO CHILDREN AND THIER PARENTS. THIS PROGRAM IS A MEDIA CAMPAIGN AS WELL AS AN EDUCATIONAL PROGRAM THAT BRINGS THE MESSAGE OF THE IMPORTANCE OF HEALTHY EATING, REGULAR PHYSICAL ACTIVITY AND HEALTHY ATTITUDES TO THE EVERYDAY LIVES OF FAMILIES IN THE REGION. FRANCINE'S FRIENDS MOBILE MAMMOGRAPHY PROGRAM: IN PARTNERSHIP WITH FRANCINE'S FRIENDS AND THE BREAST DIAGNOSTIC CENTER, PARKVIEW'S COMPREHENSIVE CANCER CENTER ADMINISTERS A MOBILE MAMMOGRAPHY PROGRAM IN ALLEN COUNTY AND THE SURROUNDING AREA. THIS INITIATIVE BEGAN IN DECEMBER OF 2005 AND IS TARGETED TO INCREASE THE NUMBER OF MAMMOGRAMS GIVEN TO WOMEN AGE 40 AND OVER. IN ADDITION, THE PROGRAM PROVIDES FINANCIAL ASSISTANCE TO THOSE WHO DO NOT HAVE THE MEANS TO PAY FOR A MAMMOGRAM. COMMUNITY HEALTH ASSESSMENTS SUBSEQUENT TO THE CREATION OF THIS PROGRAM REVEALED A SIGNIFICANT INCREASE IN SCREENINGS FOR ALLEN COUNTY. MEDICATION ASSISTANCE PROGRAM: PARKVIEW HOSPITAL, INC.'S MEDICATION ASSISTANCE PROGRAM HELPS LOW-INCOME PATIENTS OBTAIN PRESCRIPTION MEDICATIONS UPON DISCHARGE AT REDUCED RATES, AND COMPLIMENTS OTHER LONG-TERM PHARMACEUTICAL ASSISTANCE PROGRAMS TO MEET PATIENTS' HEALTH MAINTENANCE NEEDS. THE PROGRAM ALSO SERVES PATIENTS REFERRED BY PHYSICIAN OFFICES BY PROVIDING ASSISTANCE WITH ENROLLING IN PHARMACEUTICAL ASSISTANCE PROGRAMS. PRIMARY HEALTH CARE ACCESS: IN ADDITION TO PROVIDING A FINANCIAL ASSISTANCE PROGRAM TO THOSE THAT QUALIFY, PARKVIEW HOSPITAL, INC. REACHES OUT TO THE UNDERINSURED, UNINSURED, AND SPECIAL AT-RISK POPULATIONS BY PROVIDING FUNDING FOR LOCAL CLINICS AND SUPPORTING MEDICAL TRANSPORTATION PROGRAMS AS FOLLOWS: MATTHEW 25 HEALTH & DENTAL CLINIC AND NEIGHBORHOOD HEALTH CLINICS: PARKVIEW HOSPITAL, INC. PROVIDES OPERATIONAL SUPPORT FOR MATTHEW 25 HEALTH AND DENTAL CLINIC AND PROVIDES FUNDING FOR LABORATORY SERVICES FOR THEIR PATIENTS. THE HOSPITAL ALSO PROVIDES SUPPORT FOR SERVICES TO THE UNINSURED AND UNDERINSURED AT NEIGHBORHOOD HEALTH CLINICS, INCLUDING THE CLINIC'S DIABETES MANAGEMENT PROGRAM AND IN-KIND STAFF FOR RADIOGRAPHIC IMAGING SERVICES. IN ADDITION, THE HOSPITAL PROVIDES FUNDING FOR MEDICATION ASSISTANCE PROGRAMS AT EACH OF THE AFOREMENTIONED CLINICS. PARKVIEW SUPER SHOT CLINIC: IN ADDITION TO CASH DONATIONS FOR OPERATIONAL SUPPORT, PARKVIEW HOSPITAL, INC. PROVIDES SPACE, UTILITIES, AND BUILDING MAINTENANCE FOR THE PARKVIEW SUPER SHOT CLINIC (CHILDREN'S IMMUNIZATION CLINIC) LOCATED AT PARKVIEW CHILDREN'S SPECIALTY CLINICS IN THE REGIONAL MEDICAL CENTER. COMMUNITY TRANSPORTATION NETWORK: THE HOSPITAL HAS A WORKING RELATIONSHIP WITH, AND PROVIDES FINANCIAL SUPPORT TO, THE COMMUNITY TRANSPORTATION NETWORK (CTN), A NOT-FOR-PROFIT ORGANIZATION THAT PROVIDES AND COORDINATES MEDICAL TRANSPORTATION FOR SENIORS, PERSONS WITH DISABILITIES, LOW-INCOME FAMILIES, YOUTH, AND CHILDREN. PASSENGER ASSISTANCE IS PROVIDED IN A "DOOR-THROUGH-DOOR, ARM-IN-ARM, AND HAND-TO-HAND" FASHION. CTN ADDRESSES TRANSPORTATION ISSUES AS THEY RELATE TO ACCESSING HEALTHCARE FOR OBTAINING AND MAINTAINING GOOD COMMUNITY HEALTH. HEALTH SCREENING AND PREVENTION: PARKVIEW HOSPITAL, INC. HAS A LONG-TERM COMMITMENT TO IMPROVING THE HEALTH OF THE COMMUNITIES WE SERVE THROUGH DISEASE PREVENTION PROGRAMS AND HEALTH EDUCATION. PARKVIEW HOSPITAL, INC. OFFERS 24-HOUR TELEPHONE COUNSELING THROUGH PARKVIEW BEHAVIORAL HEALTH FOR PEOPLE WITH ALCOHOL AND DRUG PROBLEMS, DEPRESSION OR OTHER MENTAL HEALTH CRISES. IN ADDITION, THE HOSPITAL PARTICIPATES IN NUMEROUS HEALTH FAIRS THROUGHOUT THE YEAR TO PROVIDE HEALTH EDUCATION, HEALTH SCREENINGS FOR DISEASE PREVENTION, AND TO PROMOTE HEALTHY LIFESTYLES FOR THE UNDERSERVED POPULATION AND THE COMMUNITY AT LARGE. TRAUMA PREVENTION EDUCATION: PARKVIEW HOSPITAL, INC. IS A LEVEL II TRAUMA CENTER AS VERIFIED BY THE AMERICAN COLLEGE OF SURGEONS. IT IS NOT ONLY PARKVIEW HOSPITAL, INC.'S RESPONSIBILITY TO PROVIDE EMERGENCY CARE, BUT TO ALSO CONDUCT PUBLIC EDUCATION WITH THE GOAL OF REDUCING THE NUMBER OF PREVENTABLE INJURIES IN THE COMMUNITY. TO HELP ACCOMPLISH THIS, THE HOSPITAL SPONSORS A TRAUMA PREVENTION TASK FORCE THAT CONSISTS OF PARKVIEW EMERGENCY AND TRAUMA STAFF, OTHER EMPLOYEES, COMMUNITY-BASED EMERGENCY RESPONSE PROFESSIONALS, AND REPRESENTATIVES FROM THE COMMUNITY. SOME OF THE PROGRAMS INCLUDE: "DON'T DRINK AND DRIVE", "SHARE THE ROAD", TEEN DRIVER SAFETY, "DON'T TEXT AND DRIVE", INFANT CAR SEAT SAFETY AND FALL PREVENTION PROGRAMS. "SHARE THE ROAD" IS A COMMUNITY AWARENESS CAMPAIGN AND EDUCATIONAL PROGRAM TO PROMOTE SAFE PRACTICES FOR MOTORISTS, CYCLISTS, MOTORCYCLISTS, AND HORSE-DRAWN BUGGIES WHILE TRAVELING ON AREA ROADWAYS. FORM 990, PART III, LINE 4A "DON'T DRINK & DRIVE" IS AN EDUCATIONAL PROGRAM GEARED TOWARD TEENS TO WARN THEM ABOUT THE DANGERS OF DRINKING AND DRIVING, MUCH AS "DON'T TEXT & DRIVE" INFORMS TEENS AND ADULTS ABOUT THE DANGERS OF TEXTING AND DRIVING. PARKVIEW HOSPITAL, INC. PARTNERS WITH THE ALLEN COUNTY SHERIFF RESERVES AND THE INDIANA STATE POLICE TO PROVIDE EDUCATION THROUGH COMMUNITY SPEAKING EVENTS, CLASSROOM PRESENTATIONS, AND BILLBOARD AND MEDIA COVERAGE. VIEWED AS A LEADING DISTRACTED DRIVING PREVENTION PROGRAM, STAFF WITH PARKVIEW'S "DON'T TEXT & DRIVE" PROGRAM ATTENDED THE ANNUAL MEETING OF THE INTERNATIONAL TELECOMMUNICATION UNION, AN AGENCY OF THE UNITED NATIONS, IN GENEVA, SWITZERLAND. HEALTH INNOVATION AND RESEARCH: IN AN EFFORT TO PROVIDE THE NEWEST TECHNOLOGIES, PROCEDURES AND MEDICINES TO PATIENTS IN A SHORTER TIME SPAN, PARKVIEW RESEARCH CENTER, IN COOPERATION WITH PHYSICIANS AND HOSPITAL STAFF, OFFERS PATIENTS NEW THERAPIES NOT AVAILABLE OUTSIDE THE INVESTIGATIONAL SETTING. AS THE COMMUNITY LEADER IN MEDICAL RESEARCH FOR THE PAST DECADE, THE CENTER PROVIDES CLINICAL RESEARCH SERVICES TO MORE THAN 500 NORTHEAST INDIANA PHYSICIANS AFFILIATED WITH PARKVIEW. THE CENTER HAS DEVELOPED AREAS OF SPECIALIZATION IN CARDIOLOGY, NEUROLOGY, RADIATION ONCOLOGY, EMERGENCY MEDICINE AND CRITICAL CARE. TO FURTHER PARKVIEW'S COMMITMENT TO MEDICAL RESEARCH, GROUNDBREAKING OF THE MIRRO CENTER FOR RESEARCH AND EDUCATION TOOK PLACE IN OCTOBER 2013. THE CENTER HAS IMPLICATIONS FOR ADVANCEMENTS IN CLINICAL RESEARCH AND EDUCATIONAL OPPORTUNITIES. IT WILL HAVE THE CAPABILITY TO LOOK AT DISEASE MANAGEMENT IN A MULTI-PROFESSIONAL SETTING, BRINGING TOGETHER PHYSICIANS, PHARMACISTS, NURSES AND HEALTH CARE STAFF. THE NEW CENTER WILL ALLOW FORT WAYNE TO BECOME AN INNOVATOR IN THE HEALTH CARE SCIENCES IN PARTNERSHIP WITH REGIONAL ACADEMIC INSTITUTIONS. TRAINING SIMULATION LABS WILL BE OPEN TO HEALTH CARE PROFESSIONALS THROUGHOUT THE REGION. HEALTH CAREERS AND CONTINUING EDUCATION: PARKVIEW HOSPITAL, INC. SUPPORTS MEDICAL AND HEALTH EDUCATION FOR PHYSICIANS, NURSES, PHARMACISTS, AND OTHER CLINICAL PROFESSIONALS THROUGH CONTINUING MEDICAL EDUCATION PROGRAMS. THE HOSPITAL ALSO SUPPORTS PROGRAMS THAT PROMOTE AND EDUCATE AREA YOUTH ABOUT POSSIBLE CAREERS IN HEALTHCARE AND HEALTH-RELATED FIELDS. COMFORT AND SUPPORT: WHILE MANY OF PARKVIEW HOSPITAL, INC.'S COMMUNITY PROGRAMS ARE AIMED AT THE GENERAL PUBLIC, THE HOSPITAL ALSO SPONSORS SUPPORT GROUPS FOR PEOPLE WITH SPECIAL NEEDS. THERE ARE MANY HOSPITAL SUPPORT GROUPS FOR THOSE SUFFERING FROM RESPIRATORY AILMENTS, DIABETES, CANCER, BEHAVIORAL HEALTH, STROKE, AND OTHER HEALTH CONDITIONS. IN ADDITION TO PROVIDING SUPPORT FOR PEOPLE WITH SPECIAL NEEDS, PARKVIEW HOSPITAL, INC. CARES FOR THE WHOLE PERSON, WHICH INCLUDES SPIRITUAL HEALING AS WELL AS PHYSICAL. FULL-TIME CHAPLAINS ARE ON STAFF TO MINISTER TO THE SPIRITUAL NEEDS OF OUR PATIENTS AND THEIR FAMILIES OF ALL FAITHS. WHETHER CELEBRATING THE MIRACLE OF LIFE OR MOURNING THE LOSS OF A LOVED ONE, PARKVIEW HOSPITAL, INC.'S CHAPLAINS ARE AVAILABLE 24 HOURS A DAY. FORM 990, PART VI, SECTION A, LINE 4 DURING 2013, THE FOLLOWING SIGNIFICANT CHANGES WERE MADE TO THE BYLAWS OF PARKVIEW HOSPITAL, INC.: ARTICLE V, SECTION 2 IS AS FOLLOWS: THE BOARD SHALL BE COMPOSED OF NO MORE THAN EIGHTEEN (18) DIRECTORS, INCLUDING THE FOLLOWING EX OFFICIO DIRECTORS: PRESIDENT OF THE CORPORATION, THE PRESIDENT/CHIEF EXECUTIVE OFFICER OF PARKVIEW HEALTH SYSTEM, INC. OR THE DESIGNATED VICE PRESIDENT OF THE CORPORATE MEMBER, THE PRESIDENT OF THE MEDICAL STAFF, THE IMMEDIATE PAST PRESIDENT OF THE MEDICAL STAFF, PRESIDENT-ELECT OF THE MEDICAL STAFF, AND THE SUPERINTENDENT OF THE FORT WAYNE DISTRICT OF THE UNITED METHODIST CHURCH. THE REMAINING APPOINTED DIRECTORS SHALL BE SELECTED FROM AMONG PERSONS WHO ARE RESIDENTS OF THE SERVICE AREA OF THE CORPORATION AND WHO HAVE DEMONSTRATED THEIR ABILITY TO PARTICIPATE EFFECTIVELY IN THE DISCHARGE OF CORPORATE RESPONSIBILITIES AND WHO ARE ABLE AND WILLING TO SERVE AND WHO SATISFY THE CRITERIA FOR BOARD PARTICIPATION. CONSIDERATION SHOULD BE GIVEN TO PROMOTE DIVERSITY ON THE BOARD OF DIRECTORS. A MAJORITY OF THE BOARD OF DIRECTORS SHALL, AT ALL TIMES, BE CONSIDERED TO BE INDEPENDENT AS DEFINED BY THE INTERNAL REVENUE SERVICE. THE BOARD SHALL CONDUCT AN ORIENTATION SESSION FOR ALL NEW DIRECTORS AND CONTINUING EDUCATION SESSIONS REGARDING CURRENT TOPICS IN HEALTH CARE (INCLUDING MECHANISMS FOR DESIGNING, MEASURING, ASSESSING AND IMPROVING HOSPITAL PERFORMANCE) TO ASSIST ALL DIRECTORS IN THE DISCHARGE OF THEIR DUTIES. IT SHALL BE THE DUTY OF DIRECTORS TO ATTEND REGULAR, SPECIAL AND ANNUAL MEETINGS. ARTICLE VIII, SECTION 3 IS AS FOLLOWS: THE BOARD SHALL HAVE THE FOLLOWING STANDING COMMITTEES, WHICH SHALL BE ANNUALLY APPOINTED BY THE CHAIR: (A) EXECUTIVE (B) QUALITY (C) COMMUNITY HEALTH IMPROVEMENT ALL STANDING COMMITTEES SHALL HAVE AS MEMBERS, INDIVIDUALS FROM THE SERVICE AREA OF THE CORPORATION. THE JURISDICTION OF THE STANDING COMMITTEES IS ESSENTIALLY INDICATED BY THEIR DESCRIPTIVE TITLES, IT BEING CONTEMPLATED, HOWEVER, THAT THE BOARD MAY ENLARGE OR CONTRACT THE SCOPE OF SUCH COMMITTEES' AUTHORITY AND POWER AS OCCASIONS DEMAND. SUCH COMMITTEES MAY ACT IN RESPONSE TO THE SUGGESTION OF THE BOARD OR THEY MAY ACT ON THEIR OWN INITIATIVE. THE STUDIES, FINDINGS AND RECOMMENDATIONS OF SUCH COMMITTEES SHALL BE REPORTED TO THE BOARD FOR CONSIDERATION AND ACTION. ARTICLE VIII, SECTION 6 IS AS FOLLOWS: THE COMMUNITY HEALTH IMPROVEMENT COMMITTEE SHALL BE COMPRISED OF THE PRESIDENT OF THE CORPORATION, AT LEAST TWO (2) MEMBERS OF THE BOARD, AND ADDITIONAL MEMBERS AS DESIGNATED BY THE CHAIR OF THE BOARD ON AN ANNUAL BASIS. THE COMMITTEE CHAIR WILL BE APPOINTED BY THE CHAIR OF THE BOARD AND SHALL REPORT RELEVANT INFORMATION AND PROVIDE NECESSARY RECOMMENDATIONS TO THE BOARD ON BEHALF OF THE COMMITTEE. THE COMMUNITY HEALTH IMPROVEMENT COMMITTEE OVERSEES ACTIVITIES RELATED TO COMMUNITY BENEFIT AND COMMUNITY HEALTH IMPROVEMENT. THE PRIMARY DUTIES INCLUDE THE ALLOCATION OF COMMUNITY HEALTH IMPROVEMENT FUNDS WHICH ARE INTENDED TO SUPPORT HEALTH PARTNER ORGANIZATIONS AND COMMUNITY HEALTH OUTREACH PROGRAMS INITIATED BY THE CORPORATION. ARTICLE XI, SECTION 2 IS AS FOLLOWS: A QUORUM FOR THE PURPOSE OF DOING BUSINESS SHALL BE A MAJORITY OF THE MEMBERS OF THE BOARD. A MAJORITY OF ANY STANDING OR SPECIAL COMMITTEE SHALL CONSTITUTE A QUORUM. IF NECESSARY TO CONSTITUTE A QUORUM, A MEMBER CAN BE COUNTED AS PRESENT IF THROUGH MEANS OF TELECOMMUNICATION SAID MEMBER MAY HEAR AND BE HEARD BY ALL OTHER MEMBERS PRESENT AT SUCH MEETINGS. THE ACT OF THE MAJORITY OF THE INDIVIDUALS PRESENT AT A MEETING AT WHICH A QUORUM IS PRESENT SHALL BE THE ACT OF THE BOARD OR COMMITTEE EXCEPT WHERE OTHERWISE PROVIDED BY LAW OR BY THESE BYLAWS. ANY ACTION REQUIRED OR PERMITTED TO BE TAKEN AT ANY MEETING OF THE BOARD (OR OF ANY COMMITTEE THEREOF) MAY BE TAKEN WITHOUT A MEETING BY WAY OF WRITTEN CONSENT TO INCLUDE ELECTRONIC/E-MAIL COMMUNICATION IF SUCH CONSENT IS EXECUTED BY A MAJORITY OF THE MEMBERS OF THE BOARD. AN ELECTRONIC/E-MAIL COMMUNICATION EXPRESSING SUPPORT FOR THE PENDING ACTION SHALL BE COUNTED AS AN EXECUTION OF SUCH CONSENT. ALL ELECTRONIC VOTES OR FAXES SHALL BE MAINTAINED IN THE MINUTE BOOK OF THE CORPORATION. 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 HOSPITAL, INC. WITH CERTAIN RESERVED POWERS. FORM 990, PART VI, SECTION A, LINE 7A THE CORPORATE MEMBER SHALL HAVE THE FOLLOWING RESERVED POWERS AS DEFINED IN THE NETWORK AGREEMENT: (A) APPOINT DIRECTORS (INCLUDING APPOINTMENTS TO FILL A VACANCY) AND INITIATE THE REMOVAL AND REMOVE ANY DIRECTOR OF THE CORPORATION, WITH CAUSE, PROVIDED CONSIDERATION IS GIVEN TO RECOMMENDATIONS OF THE BOARD REGARDING SUCH APPOINTMENT OR REMOVAL, IF ANY ARE SO MADE; (B) APPOINT (INCLUDING APPOINTMENTS TO FILL A VACANCY) AND INITIATE THE REMOVAL AND REMOVE THE PRESIDENT OF THE CORPORATION, WITH OR WITHOUT CAUSE, PROVIDED CONSIDERATION IS GIVEN TO RECOMMENDATIONS OF THE BOARD REGARDING SUCH APPOINTMENT OR REMOVAL, IF ANY ARE SO MADE; (C) APPROVE AND ADOPT THE STRATEGIC PLAN FOR THE CORPORATION AND ITS AFFILIATES, INCLUDING ANY INDIVIDUAL INITIATIVES OR ARRANGEMENTS, SUCH AS A NEW SERVICE OR CONTRACTUAL ARRANGEMENT, DEEMED BY THE CORPORATE MEMBER TO BE OF STRATEGIC IMPORTANCE TO THE CORPORATION OR ITS AFFILIATES AND DIRECT AND MONITOR COMPLIANCE WITH SUCH PLANS, INITIATIVES AND ARRANGEMENTS; (D) UPON RECOMMENDATIONS OF THE CORPORATION, THE CORPORATE MEMBER SHALL APPROVE AND ADOPT THE CAPITAL AND OPERATING BUDGETS OF THE CORPORATION AND ITS AFFILIATES; (E) APPROVE THE INCURRENCE OF ANY DEBT PROPOSED BY THE CORPORATION, INCLUDING THE ISSUANCE OF BONDS BY THE CORPORATION AND ITS AFFILIATES, AND REQUIRE THE INCURRENCE OF DEBT BY THE CORPORATION AND ITS AFFILIATES; (F) APPROVE THE TRANSFER OF ASSETS BY THE CORPORATION AND ITS AFFILIATES, INCLUDING TRANSFERS OF REAL PROPERTY, PERSONAL PROPERTY, CASH, STOCK OR OTHER TANGIBLE OR INTANGIBLE ASSETS, UNLESS OTHERWISE IDENTIFIED IN PREVIOUSLY APPROVED STRATEGIC PLANS, INITIATIVES, ARRANGEMENTS, OR BUDGETS. ANY ASSET TRANSFER OR CAPITAL CONTRIBUTION FROM THE CORPORATION SHALL BE SUBJECT TO ANY AND ALL RESTRICTIONS SET FORTH IN EXHIBIT A-1 OF THE BYLAWS. (G) REQUIRE AND DIRECT TRANSFER OF ASSETS BY THE CORPORATION OR ITS AFFILIATES, PROVIDED THAT APPROVAL OF THE BOARD IS ALSO REQUIRED IF THE TRANSFER INVOLVES A TRANSFER OR SALE OF SUBSTANTIALLY ALL OF THE ASSETS OF THE CORPORATION OR WOULD PREVENT THE CORPORATION FROM OPERATING AN ACUTE CARE HOSPITAL IN THE COMMUNITY. SUCH RIGHT BY THE CORPORATE MEMBER TO DIRECT THE TRANSFER OF ASSETS SHALL NOT INCLUDE ANY TRANSFER WHICH WOULD CAUSE THE CORPORATION TO BE PUT INTO A FINANCIALLY VULNERABLE POSITION AS AN ONGOING CONCERN, NOR SHALL ANY SUCH TRANSFER CAUSE THE CORPORATION TO VIOLATE THE TERMS AND CONDITIONS OF ANY GIFTS, BEQUESTS, BOND COVENANTS, OR RESTRICTIONS SET FORTH IN THIS LIST. FURTHER, FOR PURPOSES OF THIS SECTION, BOARD APPROVAL SHALL NOT BE REQUIRED FOR PARTICIPATION IN A MASTER TRUST INDENTURE, POOLED FINANCING OR ANY OTHER KIND OF DEBT INSTRUMENT, BORROWING OR GUARANTY OBLIGATING CORPORATION ASSETS; (H) APPROVE PARTICIPATION (INCLUDING THE EXERCISE OF RENEWAL OPTIONS) BY THE CORPORATION AND ITS AFFILIATES IN NETWORKS, AFFILIATIONS, JOINT VENTURES, PARTNERSHIPS, MERGERS, OR ACQUISITIONS AND REQUIRE PARTICIPATION BY THE CORPORATION AND ITS AFFILIATES IN SUCH ARRANGEMENTS; (I) APPROVE DECISIONS OF THE CORPORATION AND ITS AFFILIATES TO PARTICIPATE (INCLUDING THE EXERCISE OF RENEWAL OPTIONS) IN MANAGED CARE OR OTHER HEALTH CARE SERVICES PURCHASING ARRANGEMENTS AND REQUIRE PARTICIPATION BY THE CORPORATION AND ITS AFFILIATES IN SUCH HEALTH CARE SERVICE PURCHASING ARRANGEMENTS; (J) DEVELOP AND REQUIRE ADOPTION OF MINIMUM MEDICAL STAFF QUALITY ASSURANCE AND UTILIZATION REVIEW STANDARDS, CRITERIA AND PROCEDURES FOR THE CORPORATION AND ITS AFFILIATES IN CONSULTATION WITH THE CORPORATION; (K) APPROVE ANY ACTION OF THE CORPORATION OR AN AFFILIATE TO CHANGE THE HOSPITAL FROM A GENERAL, ACUTE CARE COMMUNITY HOSPITAL OR TO CLOSE THE HOSPITAL; AND (L) APPROVE ANY AMENDMENT TO THE BYLAWS OR THE ARTICLES OF INCORPORATION OF THE CORPORATION, AND THE ARTICLES AND BYLAWS OF ANY NEWLY CREATED AFFILIATE AND REQUIRE AMENDMENT OF THESE GOVERNING DOCUMENTS AS NECESSARY OR ADVISABLE TO RESOLVE SIGNIFICANT ETHICAL ISSUES, TO MAINTAIN JCAHO ACCREDITATION, TAX-EXEMPT STATUS, PARTICIPATION IN MEDICARE/MEDICAID OR TO PREVENT SIGNIFICANT ADVERSE LEGAL OR FINANCIAL EFFECTS TO THE CORPORATION OR THE SYSTEM, EXCEPT THAT THERE CAN BE NO AMENDMENT TO THE RESERVED POWERS LISTED IN SECTIONS (G) AND (K) OF THIS LIST WITHOUT THE CONSENT OF THE CORPORATION. THE CORPORATE MEMBER SHALL DEVELOP POLICIES FOR THE IMPLEMENTATION OF THE RESERVED POWERS, INCLUDING MATERIALITY POLICIES REGARDING MATTERS SUBJECT TO REVIEW. 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 HOSPITAL, INC. IS A SUBSIDIARY CORPORATION OF PARKVIEW HEALTH SYSTEM, INC. AN ELECTRONIC COPY OF THE ORGANIZATION'S FINAL FORM 990 (INCLUDING REQUIRED SCHEDULES) WAS PROVIDED TO EACH VOTING MEMBER OF THE ORGANIZATION'S GOVERNING BODY, PRIOR TO FILING WITH THE IRS. ON OCTOBER 8, 2014, 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 2013, THE BOARD OF PARKVIEW HEALTH SYSTEM, INC. REVIEWED AND APPROVED ALL EXECUTIVE COMPENSATION, BENEFITS AND PERQUISITES FOR THE 2013 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). OFFICES OR POSITIONS REVIEWED AT THE 2013 MEETING: PRESIDENT AND CHIEF EXECUTIVE OFFICER PRESIDENT PARKVIEW REGIONAL MEDICAL CENTER (PRMC) AND AFFILIATES PRESIDENT COMMUNITY HOSPITAL PHYSICIAN EXECUTIVE OFFICER PARKVIEW PHYSICIANS GROUP SENIOR VICE PRESIDENT CHIEF FINANCIAL OFFICER SENIOR VICE PRESIDENT CHIEF INFORMATION OFFICER SENIOR VICE PRESIDENT COO PARKVIEW HEALTH SENIOR VICE PRESIDENT COO PARKVIEW PHYSICIANS GROUP 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 HUMAN RESOURCES SENIOR VICE PRESIDENT PATIENT CARE SENIOR VICE PRESIDENT SERVICE LINE LEADER SENIOR VICE PRESIDENT STRATEGIC INITIATIVES VICE PRESIDENT CHANGING SPACES CONSTRUCTION PROJECT MANAGEMENT VICE PRESIDENT HUMAN RESOURCES VICE PRESIDENT MKTG/COMM/COMMUNITY RELATIONS VICE PRESIDENT NURSING PRMC 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 PLANNING AND DECISION SUPPORT VICE PRESIDENT RANDALLIA OPERATIONS VICE PRESIDENT REVENUE CYCLE MANAGEMENT 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 HEALTH PLAN SERVICES MEDICAL DIRECTOR PARKVIEW PHYSICIANS GROUP MEDICAL DIRECTOR INTEGRATION AND DEVELOPMENT CHIEF MEDICAL INFORMATICS OFFICER CHIEF MEDICAL OFFICER PRMC AND AFFILIATES 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 V, LINE 1A, 2A AND PART VII, SECTION B, LINE 2: PARKVIEW HEALTH SYSTEM, INC. (PH), EIN 35-1972384, IS THE COMMON PAYING AGENT FOR THE FILING ORGANIZATION, PARKVIEW HOSPITAL, INC., EIN 35-0868085. 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, 2013 WAS 969. THE TOTAL NUMBER OF EMPLOYEES REPORTED ON FORM W-3 AND FILED BY THE COMMON PAYING AGENT, PH, FOR THE YEAR ENDED DECEMBER 31, 2013 WAS 9,926. FOR PURPOSES OF COMPLETING FORM 990, PART V, LINE 1A AND 2A, THE NUMBER REPORTED FOR THE PARKVIEW HOSPITAL, INC. WAS 127 AND 4,893 RESPECTIVELY. AS REFLECTED IN PART VII, SECTION B, 12 INDEPENDENT CONTRACTORS RECEIVED MORE THAN $100,000 IN COMPENSATION FOR SERVICES FROM PARKVIEW HOSPITAL, INC. 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 -1,987,804. CURRENT YEAR EARNINGS TRANSFERRED TO PARENT -93,222,341. INCOME (LOSS) FROM HOSPITAL LAUNDRY SERVICE, INC. -97,132. INCOME (LOSS) FROM PARKVIEW PROFESSIONAL PROGRAMS, INC. -489,632. BOOK/TAX DIFFERENCES K-1'S -285,391. PARKVIEW HEALTH SYSTEM INC 10501 CORPORATE DRIVE FORT WAYNE IN 46845 351972384 HEALTH CARE IN 501(C)(3) LINE 11C, III-FI N/A 0 PARKVIEW FOUNDATION INC 2200 RANDALLIA DRIVE FORT WAYNE IN 46805 237220589 FUND MGMT IN 501(C)(3) LINE 11A, I PARKVIEW HOSPITAL INC 1 PARKVIEW OCCUPATIONAL HEALTH CENTERS INC 10501 CORPORATE DRIVE FORT WAYNE IN 46845 352064353 OCCUP HEALTH IN 501(C)(3) LINE 3 PARKVIEW HEALTH SYSTEM INC 0 COMMUNITY HOSPITAL OF NOBLE COUNTY INC 401 SAWYER ROAD KENDALLVILLE IN 46755 352087092 HOSPITAL CARE IN 501(C)(3) LINE 3 PARKVIEW HEALTH SYSTEM INC 0 COMMUNITY HOSPITAL OF LAGRANGE COUNTY INC 207 N TOWNLINE ROAD LAGRANGE IN 46761 202401676 HOSPITAL CARE IN 501(C)(3) LINE 3 PARKVIEW HEALTH SYSTEM INC 0 WHITLEY MEMORIAL HOSPITAL INC 1260 E STATE ROAD 205 COLUMBIA CITY IN 46725 351967665 HOSPITAL CARE IN 501(C)(3) LINE 3 PARKVIEW HEALTH SYSTEM INC 0 HUNTINGTON MEMORIAL HOSPITAL INC 2001 STULTS ROAD HUNTINGTON IN 46750 351970706 HOSPITAL CARE IN 501(C)(3) LINE 3 PARKVIEW HEALTH SYSTEM INC 0 PARKVIEW PROFESSIONAL PROGRAMS INC 2200 RANDALLIA DRIVE FORT WAYNE IN 46805 351668888 REFERENCE LAB IN PARKVIEW HOSPITAL INC C 12127394 5085913 1.00000 0 1 1 1 0 0 0 0 0 0 1 1 0 0 0 0 1 0 1 0 PARKVIEW FOUNDATION INC A 25263 PART VII SUPPLEMENTAL INFORMATION PARKVIEW FOUNDATION INC C 835161 PART VII SUPPLEMENTAL INFORMATION SCHEDULE R, PART V, LINE 2, COLUMN (C): THE AMOUNTS REPORTED AS TRANSACTIONS WITH RELATED ORGANIZATIONS ARE CONSISTENT WITH THE AMOUNTS REPORTED ON THE ORGANIZATION'S AUDITED FINANCIAL STATEMENTS UNDER THE GENERALLY ACCEPTED ACCOUNTING STANDARDS DEPENDING ON THE TYPE OF TRANSACTION INVOLVED.