2023-11-08T16:02:20-06:00 2022-12-31 350921680 CROWE LLP 401 E LAS OLAS BLVD SUITE 1100 FORT LAUDERDALE FL 33301 990 2022-01-01 311190239 WHITLEY MEMORIAL HOSPITAL FOUNDATION INC WHIT 2603738429 1260 E STATE ROAD 205 COLUMBIA CITY IN 467259492 JEANNE' WICKENS PH CFO 2602669313 2023-11-08 1 JEANNE WICKENS 999009999 1 BRITTNEY KOCAJ P01320603 9542028600 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z RICK HENVEY 1450 PRODUCTION RD FORT WAYNE IN 468081167 1661397 0 X WWW.PARKVIEWFOUNDATIONS.ORG X 1985 IN TO SERVE AS THE PRIMARY FUNDRAISING ENTITY FOR WHITLEY MEMORIAL HOSPITAL, INC. 13 11 0 11 0 0 37177 33843 88794 11719 53084 39094 0 0 179055 84656 62823 92132 0 0 69588 0 0 0 127 11984 10269 144395 102401 34660 -17745 1045272 829487 0 0 1045272 829487 X TO SERVE AS THE PRIMARY FUNDRAISING ENTITY FOR WHITLEY MEMORIAL HOSPITAL, INC. FUNDS ARE USED FOR THE CONTINUED IMPROVEMENT OF THE HOSPITAL'S FACILITIES, EQUIPMENT, PROGRAMS & SERVICES IN ACCORDANCE WITH THE NEEDS OF THE COMMUNITY WHERE THE HOSPITAL IS LOCATED. 0 0 92132 92132 11719 WHITLEY MEMORIAL HOSPITAL FOUNDATION, INC. - A FOUNDATION FOR GIVINGAT PARKVIEW HEALTH SYSTEM, INC., WE MAINTAIN FOUNDATIONS FOR EACH OF OUR HOSPITALS. THESE NONPROFIT ORGANIZATIONS PROVIDE PHILANTHROPIC SUPPORT FOR OUR MISSION OF PROVIDING QUALITY HEALTH SERVICES TO ALL WHO ENTRUST THEIR CARE TO PARKVIEW, AND FOR IMPROVING THE HEALTH OF THE COMMUNITY.WHITLEY MEMORIAL HOSPITAL FOUNDATION, INC. BUILDS RELATIONSHIPS THAT FOSTER GIFT GIVING FOR THE BENEFIT OF OUR PATIENTS AND THEIR FAMILY MEMBERS, CAREGIVERS, HOSPITAL PROGRAMS AND SERVICES, AND EQUIPMENT.(SEE SCHEDULE O FOR CONTINUATION)THESE RELATIONSHIPS ARE MADE WITH WHITLEY MEMORIAL HOSPITAL, INC. CO-WORKERS, PHYSICIANS, VENDORS, PATIENT FAMILIES, OR THE COMMUNITY AT LARGE. IN AN IMPORTANT WAY, WHITLEY MEMORIAL HOSPITAL FOUNDATION, INC. IS A COLLECTION OF INDIVIDUAL DONORS WHO SEE WHITLEY MEMORIAL HOSPITAL, INC. AS AN AGENT FOR SAVING AND CHANGING LIVES - A VEHICLE FOR CREATING HEALTHIER COMMUNITIES FOR GENERATIONS TO COME.EACH GIFT THE WHITLEY MEMORIAL HOSPITAL FOUNDATION, INC. RECEIVES - WHETHER FROM INDIVIDUALS, BUSINESSES, OR FOUNDATIONS - IS GREATLY APPRECIATED, AND IS A VITAL PART OF OUR MISSION TO IMPROVE THE HEALTH OF THE COMMUNITY. IN 2022, THESE GIFTS WERE TRANSFORMED INTO MANY NEW IMPROVEMENTS FOR PATIENT CARE. HERE ARE JUST A FEW EXAMPLES:-PATIENTS WHO NEED MEDICATIONS FOR ACUTE ILLNESSES OR LONG-TERM ASSISTANCE AND CANNOT AFFORD IT NOW HAVE ACCESS TO HELP THROUGH THE MEDICATION ASSISTANCE PROGRAM. COMMUNITY BENEFIT FUNDS PROVIDE A COORDINATOR WHO CONNECTS PATIENTS WITH PHARMACEUTICAL ASSISTANCE PROGRAMS FOR LONG-TERM CARE.-THE GREATEST NEED FUND PROVIDED EQUIPMENT AND SERVICES TO PATIENTS AT PARKVIEW WHITLEY HOSPITAL. SOME OF THOSE ITEMS INCLUDE IPODS FOR THE SURGICAL AND ENDO UNITS, CLOTHING FOR PATIENTS BEING SEEN IN THE EMERGENCY DEPARTMENT, AND MASSAGE THERAPY FOR PATIENTS TO PROMOTE HEALING.-HOSPICE SERVICES WERE PROVIDED TO WHITLEY RESIDENTS. MASSAGES FOR PATIENTS, EDUCATIONAL MATERIALS AND BEREAVEMENT GROUPS ASSISTED FAMILIES FACING GRIEF AND LOSS.-SCHOLARSHIPS WERE AWARDED TO TEAM MEMBERS PURSUING CAREERS IN THE MEDICAL FIELD.- THE WHITLEY MEMORIAL HOSPITAL FOUNDATION, INC. CONTINUED ITS COMMITMENT TO HELP MAINTAIN THE HIGHEST STANDARDS OF TRAINING AND CERTIFICATION OF HOSPITAL CO-WORKERS BY PROVIDING FUNDS FOR EDUCATION. THOSE FRONT-LINE STAFF MEMBERS FROM CLINICAL DEPARTMENTS WERE ABLE TO TAKE ADVANTAGE OF ADVANCED, SPECIALIZED INSTRUCTION, AND SHARED BEST PRACTICES WITH THEIR SUPERVISORS AND CO-WORKERS.-FUNDING PROVIDED FOR A CERTIFIED MASSAGE THERAPIST TO ROUND ON PATIENTS FOR HAND, FOOT, AND SHOULDER MASSAGES DURING THE INDIVIDUAL'S INPATIENT STAY. MASSAGE IS PROVEN TO HELP IN THE HEALING PROCESS.-CLOTHES WERE PROVIDED AT BOTH PARKVIEW WHITLEY HOSPITAL AND PARKVIEW WARSAW TO EMERGENCY ROOM PATIENTS REPLACING DAMAGED OR STAINED CLOTHES FOR WEAR OUT OF THE HOSPITAL UPON DISCHARGE.-FUNDING WAS PROVIDED FOR THE AFTER-HOURS TRANSPORTATION PROGRAM TO PROVIDE QUALIFIED PATIENTS WITH RIDES HOME FROM THE HOSPITAL. THOSE DEMONSTRATING THE INABILITY TO ARRANGE AND PAY FOR THEIR TRANSPORTATION HOME ARE PROVIDED A VOUCHER FOR THE WHITLEY COUNTY COUNCIL ON AGING'S TRANSIT SERVICE.-FUNDS WERE DIRECTED TO THE CO-WORKER EMERGENCY FUND (CEF) WHICH PROVIDES PARKVIEW CO-WORKERS FINANCIAL ASSISTANCE TO HELP THEM OVERCOME TEMPORARY FINANCIAL CRISES. THIS CONFIDENTIAL PROGRAM PROVIDES COUNSELING, ADVICE, AND RESOURCES TO ASSIST IN NAVIGATING EMERGENCIES AND OTHER TRAGIC LIFE EVENTS.A GIFT TO THE WHITLEY MEMORIAL HOSPITAL FOUNDATION, INC. IS PRIMARILY A GIFT TO THE COMMUNITY BECAUSE THE FUNDS ARE USED TO SUPPORT PATIENTS AND PROGRAMS WITH THE ULTIMATE GOAL OF BUILDING A HEALTHIER COMMUNITY FOR GENERATIONS. 92132 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 1 0 1 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 X 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X 13 11 1 0 0 0 1 1 1 1 0 0 0 1 1 1 1 1 1 0 0 0 IN X JEANNE' WICKENS 2602669313 1450 PRODUCTION RD FORT WAYNE IN 468081167 DENA JACQUAY DIRECTOR/PH CHIEF ADMIN OFFICER 0.00 40.00 X X 0 908033 284995 SCOTT GABRIEL DIRECTOR/WMHOS PRESIDENT 0.00 40.00 X 0 396112 105216 DAVID SMITH DIRECTOR 1.00 1.00 X 0 4250 0 LUCAS KONGER DIRECTOR/CHAIR 1.00 0.00 X X 0 0 0 CARI WELLS DIRECTOR 1.00 0.00 X 0 0 0 JIM HEUER DIRECTOR 1.00 1.00 X 0 4000 0 SHAWN ELLIS DIRECTOR 1.00 1.00 X 0 4000 0 JOSEPH KESSIE DIRECTOR 1.00 1.00 X 0 3750 0 GEORGE SCHRUMPF DIRECTOR 1.00 1.00 X 0 4250 0 BRAD VOELZ DIRECTOR 1.00 2.00 X 0 5500 0 LAURA MCDERMOTT DIRECTOR 1.00 1.00 X 0 3750 0 JANE WEAR DIRECTOR 1.00 1.00 X 0 3500 0 BRIDGET DOLOHANTY-JOHNSON DIRECTOR 1.00 1.00 X 0 2750 0 MICHAEL PACKNETT PH PRESIDENT & CEO 0.00 40.00 X 0 2602841 338299 JEANNE' WICKENS PH CHIEF FINANCIAL OFFICER 0.00 40.00 X 0 1264400 357767 BENJAMIN MILES FORMER OFFICER/CURRENT HPS PRESIDENT 0.00 40.00 X 0 582664 6193 0 5789800 1092470 0 1 1 0 0 350 33493 33843 FNDRSNG SER ALLOCATION 561499 11719 11719 11719 37659 37659 1578176 1576741 1435 1435 1435 84656 11719 0 39094 84132 84132 8000 8000 3842 3842 127 127 CORPORATE SERVICE ALLOC 6300 6300 102401 92132 10142 127 69338 2990 5292 0 15561 15561 0 0 429066 403287 541576 423210 1045272 829487 0 0 X 511194 437819 534078 391668 1045272 829487 1045272 829487 X -17745 -126790 -71250 X 0 1 X 1 0 X X 1 WHITLEY MEMORIAL HOSPITAL INC 351967665 3 1 36132 0 1 36132 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 132916 -19398 2000 1672 109846 119559 14356 1000 132916 92069 28490 1000 119559 83378 8691 92069 76217 7161 83378 0.00000 0.23050 0.76950 1 0 15561 15561 0 0 INTEREST IN ASSETS AS WHITLEY COUNTY COMMUNITY FOUNDATION, INC. 139888 DUE TO/FROM INTERUNIT 283322 423210 X PART V, LINE 4: THE GOAL OF THE SCHULTZ ENDOWMENT FUND IS TO CONTINUOUSLY IMPROVE PATIENT CARE AND THE EDUCATION OF LOCAL STAFF MEMBERS. WHITLEY MEMORIAL HOSPITAL, INC. EMPLOYEES APPLY FOR SCHOLARSHIPS FUNDED THROUGH THE SUPPORT OF THIS GENEROUS BEQUEST. 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, 2022 AND 2021, THERE ARE NO UNRECOGNIZED TAX BENEFITS RESULTING FROM UNCERTAIN TAX POSITIONS. FORMS 990 AND 990T FILED BY THE CORPORATION AND ITS TAX-EXEMPT AFFILIATED ENTITIES ARE SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE UP TO THREE YEARS FROM THE EXTENDED DUE DATE OF EACH RETURN. FORMS 990 AND 990T FILED BY THE CORPORATION AND ITS TAX-EXEMPT AFFILIATED ENTITIES ARE GENERALLY NO LONGER SUBJECT TO EXAMINATION FOR THE YEAR 2018 AND PRIOR. 1 PARKVIEW HOSPITAL INC 11109 PARKVIEW PLAZA DR FORT WAYNE IN 468451701 350868085 501(C)(3) 48000 0 HOME HEALTH AND HOSPICE PROGRAM FOR SERVICE AREA OF WHITLEY MEMORIAL HOSPITAL INC WHITLEY MEMORIAL HOSPITAL INC 1260 E STATE ROAD 205 COLUMBIA CITY IN 467259492 351967665 501(C)(3) 36132 0 HOSPITAL PROGRAMS 2 0 SCHOLARSHIPS 5 7000 CO-WORKER EMERGENCY FUND (CEF) 1 1000 PART I, LINE 2: HOSPITAL DEPARTMENTS COMPLETE FUNDING REQUEST FORMS THAT ARE RETURNED TO THE FOUNDATION. UPON COMPLETION OF THE PROJECT, THE DEPARTMENT SUBMITS A REIMBURSEMENT REQUEST ALONG WITH AN ATTACHED PURCHASE ORDER OR RECEIPT FOR SUPPLIES. BASED UPON THE ORGANIZATION'S AUTHORITY TO ACT POLICY, APPROVALS ARE MADE BY THE FOUNDATION DIRECTOR AND FOUNDATION BOARD. PART I, LINE 2 - SCHOLARSHIPS: SCHOLARSHIPS: --SCHULTZ SCHOLARSHIP ALL WHITLEY MEMORIAL HOSPITAL EMPLOYEES AND VOLUNTEERS WHO ARE PURSUING A DEGREE OR CONTINUING EDUCATION AS A NURSE, NURSE'S AIDE OR MEDICAL TECHNOLOGIST ARE ELIGIBLE. CRITERIA FOR SELECTION OF THE WINNER IS BASED ON THE DONOR'S PHILOSOPHY WHICH INCLUDES EMPLOYMENT OR VOLUNTEER HISTORY, EDUCATIONAL BACKGROUND, PERSONAL BACKGROUND, AND FUTURE PERSONAL GOALS. ANNOUNCEMENTS OF THE APPLICATION PROCESS ARE PROVIDED OVER A TWO-MONTH PERIOD. UPON APPLICATION DEADLINE, UNNAMED PACKETS ARE SENT TO THE SELECTION SUBCOMMITTEE OF THE WHITLEY MEMORIAL HOSPITAL FOUNDATION BOARD. THE TOP THREE RANKED CANDIDATES ARE OFFERED A SCHOLARSHIP. UPON RECEIPT OF AN ACCEPTANCE LETTER, THE CANDIDATES ARE PRESENTED TO THE WHITLEY MEMORIAL HOSPITAL FOUNDATION BOARD FOR FINAL APPROVAL AND SIGNATURES. 1. THE APPLICANT MUST WORK OR VOLUNTEER FOR WHITLEY MEMORIAL HOSPITAL IN COLUMBIA CITY. 2. THE CLASSES FUNDED MUST BE OFFERED BY A RECOGNIZED COLLEGE, UNIVERSITY, OR OTHER ACCREDITED INSTITUTION. 3. IF THE FUNDED PARTICIPANT VOLUNTARILY TERMINATES EMPLOYMENT AT THE HOSPITAL WITHIN ONE YEAR OF DEGREE COMPLETION, HE/SHE MUST REIMBURSE THE FOUNDATION 50 PERCENT OF THE FUNDS GRANTED TO THEM WITHIN THE LAST YEAR. 4. ANY PREVIOUS SCHULTZ AWARD RECIPIENT CAN REAPPLY FOR ADDITIONAL FUNDS IN FOLLOWING YEARS. 5. SCHOLARSHIP ELIGIBILITY IS LIMITED TO THOSE WHO OPT TO PURSUE A DEGREE AND/OR CONTINUING EDUCATION AS A NURSE, NURSES' AIDE, OR MEDICAL TECHNOLOGIST. --BEV GOSS NURSING SCHOLARSHIP THE SCHOLARSHIP IS AVAILABLE TO ALL ELIGIBLE CANDIDATES THROUGHOUT WHITLEY MEMORIAL HOSPITAL. CANDIDATES MUST MEET THE FOLLOWING CRITERIA TO BE CONSIDERED FOR THE SCHOLARSHIP: 1. BE ENROLLED IN A B.S. NURSING PROGRAM 2. BE A CO-WORKER OF PARKVIEW FOR A MINIMUM OF TWO (2) YEARS 3. BE AT LEAST A .4 FTE STATUS 4. BE IN GOOD STANDING WITH NO DISCIPLINARY ACTIONS IN THE PREVIOUS THREE (3) YEARS 5. IF APPLYING FOR A SECOND YEAR OF FUNDING, CANDIDATES MUST PROVIDE PROOF THAT HE/SHE COMPLETED THE FIRST YEAR WITH AT LEAST A B AVERAGE OR EQUIVALENT. 6. MUST PROVIDE ONE (1) PROFESSIONAL RECOMMENDATION FROM A SUPERVISOR, COWORKER, OR EDUCATOR --BRIDGET DOLOHANTY-JOHNSON NURSING SCHOLARSHIP THIS SCHOLARSHIP IS AVAILABLE TO ALL ELIGIBLE PARKVIEW WHITLEY CO-WORKERS WHO ARE PURSUING A MASTER'S DEGREE IN NURSING. CANDIDATES MUST MEET THE FOLLOWING CRITERIA TO BE CONSIDERED FOR THE SCHOLARSHIP: 1. BE ENROLLED IN A MASTER'S NURSING PROGRAM 2. BE A CO-WORKER OF PARKVIEW FOR A MINIMUM OF TWO (2) YEARS 3. BE AT LEAST A .4 FTE STATUS 4. BE IN GOOD STANDING WITH NO DISCIPLINARY ACTIONS IN THE PREVIOUS THREE (3) YEARS 5. IF APPLYING FOR A SECOND YEAR OF FUNDING, CANDIDATES MUST PROVIDE PROOF THAT HE/SHE COMPLETED THE FIRST YEAR WITH AT LEAST A B AVERAGE OR EQUIVALENT. 6. MUST PROVIDE ONE (1) PROFESSIONAL RECOMMENDATION FROM A SUPERVISOR, COWORKER, OR EDUCATOR ORGANIZATION'S PROCESS TO APPROVE ALL SCHOLARSHIPS: ALL APPLICATIONS RECEIVED BY THE DUE DATE AND TIME ARE COLLECTED BY THE FOUNDATION DIRECTOR. THE FOUNDATION DIRECTOR THEN SUBMITS ALL APPLICATIONS TO THE SCHOLARSHIP COMMITTEE, COMPRISED OF WHITLEY MEMORIAL HOSPITAL FOUNDATION BOARD MEMBERS. THE SCHOLARSHIP COMMITTEE WILL DISCUSS AND MAKE A RECOMMENDATION OF THOSE TO FUND TO THE WHITLEY MEMORIAL HOSPITAL FOUNDATION BOARD FOR APPROVAL. PART I, LINE 2 - CO-WORKER EMERGENCY FUND (CEF): THE CEF PROVIDES LIMITED FINANCIAL ASSISTANCE FOR PARKVIEW CO-WORKERS FOR SHORT-TERM CRISIS SITUATIONS THAT ARE THE RESULT OF EMERGENCIES OR CATASTROPHIC EVENTS. THE FUNDS ARE USED AS A LAST RESORT FOR BASIC NEEDS SUCH AS FOOD, SHELTER, UTILITIES, ETC. TO BE ELIGIBLE A CO-WORKER MUST: -BE A CO-WORKER OF PARKVIEW FOR A MINIMUM OF 6 MONTHS -BE AT LEAST A .6 FTE STATUS -HAVE NOT RECEIVED MONEY FROM THE FUND IN THE LAST 12 MONTHS OR MORE THAN TWICE DURING LIFETIME OF EMPLOYMENT -COMPLETE AN APPLICATION FORM THE CEF COMMITTEE SHALL: -REVIEW, CONSIDER AND MAKE DECISIONS RELATIVE TO THE CO-WORKER'S APPLICATION FOR ASSISTANCE AND APPROVE A REQUEST BY A MAJORITY OF AFFIRMATIVE VOTES -CONSIST OF AT LEAST FIVE (5) PARKVIEW CO-WORKERS (ONE FROM EVERY PARKVIEW HOSPITAL ENTITY APPOINTED ANNUALLY BY THE CHIEF ADMINISTRATIVE OFFICER ALONG WITH ONE MEMBER EACH FROM EMPLOYEE ASSISTANCE PROGRAM & FOUNDATION) AND WILL INCLUDE BOTH MANAGEMENT AND NON-MANAGEMENT CO-WORKERS -NOT BE AWARE OF THE IDENTITY OF THE CO-WORKER MAKING THE REQUEST 1 1 0 0 0 0 0 0 0 MICHAEL PACKNETT PH PRESIDENT & CEO 0 1330197 0 664677 0 607967 0 302282 0 36017 0 2941140 0 577374 JEANNE' WICKENS PH CHIEF FINANCIAL OFFICER 0 804432 0 363922 0 96046 0 325215 0 32552 0 1622167 0 70644 DENA JACQUAY DIRECTOR/PH CHIEF ADMIN OFFICER 0 648964 0 217050 0 42019 0 239919 0 45076 0 1193028 0 39944 BENJAMIN MILES FORMER OFFICER/CURRENT HPS PRESIDENT 0 64367 0 0 0 518297 0 1948 0 4245 0 588857 0 242356 SCOTT GABRIEL DIRECTOR/WMHOS PRESIDENT 0 230796 0 87776 0 77540 0 66902 0 38314 0 501328 0 75701 PART I, LINE 3 RELATED ORGANIZATION, PARKVIEW HEALTH SYSTEM, INC., USES THE FOLLOWING TO ESTABLISH THE COMPENSATION OF WHITLEY MEMORIAL HOSPITAL FOUNDATION, INC.'S CEO/EXECUTIVE DIRECTOR: COMPENSATION COMMITTEE OF RELATED ORGANIZATION PARKVIEW HEALTH SYSTEM, INC. INDEPENDENT COMPENSATION CONSULTANT FORM 990 OF OTHER ORGANIZATIONS COMPENSATION SURVEY OR STUDY APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE OF RELATED ORGANIZATION PARKVIEW HEALTH SYSTEM, INC. PART I, LINES 4A-B SEVERANCE PAYMENT BENJAMIN MILES $275,656 SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN PAYMENTS THE FOLLOWING INDIVIDUALS PARTICIPATE IN SUPPLEMENTAL NONQUALIFIED DEFERRED COMPENSATION PLANS. BENEFITS EARNED UNDER THE PLANS WILL FUND THE EMPLOYEES' EVENTUAL RETIREMENT BENEFIT. THESE BENEFITS ARE PROVIDED IN EXCHANGE FOR THE EMPLOYEES' YEARS OF SERVICE TO THE ORGANIZATION AND THE AMOUNT OF THE BENEFITS MAY VARY FROM YEAR TO YEAR. THE FOLLOWING INDIVIDUALS VESTED IN A PORTION OF THEIR DEFERRED COMPENSATION PLANS, WHICH IS TREATED AS TAXABLE INCOME TO THE INDIVIDUALS AT THE TIME OF VESTING. THESE AMOUNTS ARE REPORTED IN SCHEDULE J, PART II, COLUMN (B)(III): SCOTT GABRIEL $75,701; DENA JACQUAY $39,944; BENJAMIN MILES $242,356; MICHAEL PACKNETT $577,374; JEANNE' WICKENS $70,644 AMOUNTS LISTED ABOVE THAT HAVE BEEN REPORTED AS DEFERRED COMPENSATION ON PRIOR FORM 990 WILL ALSO BE REFLECTED IN SCHEDULE J, PART II, COLUMN (F). FOR EXAMPLE, THE AMOUNT OF $577,374 REPORTED AS REQUIRED FOR MR. PACKNETT WAS A RESULT OF THE VESTING OF SUCH AMOUNT UNDER THE TERMS OF THE RESPECTIVE PLANS. HOWEVER, THESE AMOUNTS WERE PREVIOUSLY REPORTED IN MR. PACKNETT'S DEFERRED COMPENSATION OVER MORE THAN 10 YEARS AS THE AMOUNTS WERE DEFERRED UNDER THE PLANS. AS SUCH, THE AMOUNT REPORTED IN SCHEDULE J, PART II, COLUMN (F) IS AN INDICATION OF AMOUNTS THAT HAVE BEEN REPORTED TWICE, ONCE AS A DEFERRAL AND ONCE AS VESTED. THE FOLLOWING INDIVIDUALS HAVE AN AMOUNT INCLUDED IN SCHEDULE J, PART II, COLUMN (C) FOR AN AMOUNT EARNED BUT NOT YET VESTED UNDER ONE OF PARKVIEW'S DEFERRED COMPENSATION PLANS. THE AMOUNTS ARE AT RISK AND WILL NOT BE PAID UNLESS AND UNTIL EACH EMPLOYEE HAS PROVIDED SUBSTANTIAL FUTURE SERVICES TO THE ORGANIZATION. BENEFITS UNDER THE PLANS VEST AT THE TIME SET FORTH IN THE PLAN DOCUMENTS AND ARE FORFEITED IF THE EMPLOYEES TERMINATE EMPLOYMENT BEFORE SATISFYING THOSE PLAN CONDITIONS. DEFERRALS REPORTED IN SCHEDULE J, PART II, COLUMN (C) INCLUDE: SCOTT GABRIEL $39,452; DENA JACQUAY $203,319; MICHAEL PACKNETT $268,732; JEANNE' WICKENS $303,865 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, WHITLEY MEMORIAL HOSPITAL FOUNDATION, INC., EIN 31-1190239. 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, 2022 WAS 627. THE TOTAL NUMBER OF EMPLOYEES REPORTED ON FORM W-3 AND FILED BY THE COMMON PAYING AGENT, PH, FOR THE YEAR ENDED DECEMBER 31, 2022 WAS 17,284. FOR PURPOSES OF COMPLETING FORM 990, PART V, LINE 1A AND 2A, THE NUMBER REPORTED FOR THE WHITLEY MEMORIAL HOSPITAL FOUNDATION, INC. WAS 0 AND 0 RESPECTIVELY. FORM 990, PART VI, SECTION A, LINE 2 OFFICERS MICHAEL PACKNETT AND JEANNE' WICKENS HAVE BUSINESS RELATIONSHIPS AS OFFICERS OF RELATED ENTITIES. 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, WHITLEY MEMORIAL HOSPITAL, INC. EIN 35-1967665 IS THE SOLE MEMBER OF WHITLEY MEMORIAL HOSPITAL FOUNDATION, INC. WITH CERTAIN RESERVED POWERS. FORM 990, PART VI, SECTION A, LINE 7A THE CORPORATE MEMBER SHALL HAVE THE FOLLOWING RESERVED POWERS: (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 CHIEF ADMINISTRATIVE OFFICER 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, 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 AND DIRECT AND MONITOR COMPLIANCE WITH SUCH PLANS, INITIATIVES AND ARRANGEMENTS; (D) APPROVE AND ADOPT THE CAPITAL AND OPERATING BUDGETS OF THE CORPORATION; (E) APPROVE THE INCURRENCE OF ANY DEBT PROPOSED BY THE CORPORATION, AND REQUIRE THE INCURRENCE OF DEBT BY THE CORPORATION, WHERE APPROPRIATE; (F) APPROVE THOSE TRANSFERS OF ASSETS BY THE CORPORATION, WHETHER BY SALE OR GIFT, WHERE THE ASSET BEING TRANSFERRED IS AN INTEREST IN REAL PROPERTY OR IS AN OPERATING ASSET OF THE CORPORATION, UNLESS OTHERWISE IDENTIFIED IN PREVIOUSLY APPROVED STRATEGIC PLANS, INITIATIVES, ARRANGEMENTS OR BUDGETS; (G) APPROVE PARTICIPATION (INCLUDING THE EXERCISE OF RENEWAL OPTIONS) BY THE CORPORATION IN NETWORKS, AFFILIATIONS, JOINT VENTURES, PARTNERSHIPS, AND REQUIRE PARTICIPATION BY THE CORPORATION IN SUCH ARRANGEMENTS; (H) APPROVE ANY AMENDMENT TO THE BYLAWS OR THE ARTICLES OF INCORPORATION OF THE CORPORATION, AND REQUIRE AMENDMENT OF THESE GOVERNING DOCUMENTS AS NECESSARY OR ADVISABLE TO RESOLVE SIGNIFICANT ETHICAL ISSUES, TO MAINTAIN TAX-EXEMPT STATUS, OR TO PREVENT SIGNIFICANT, ADVERSE LEGAL OR FINANCIAL EFFECTS TO THE CORPORATION OR THE CORPORATE MEMBER. THE CORPORATE MEMBER SHALL FROM TIME TO TIME DEVELOP POLICIES FOR THE IMPLEMENTATION OF THE RESERVED POWERS. 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 A, LINE 8B AT THE CURRENT TIME NO EXECUTIVE COMMITTEE EXISTS. THE BYLAWS ALLOW FOR SUCH COMMITTEE IN THE FOLLOWING PASSAGE: THE EXECUTIVE COMMITTEE SHALL BE COMPOSED OF THE OFFICERS OF THE BOARD, THE DIRECTOR OF THE CORPORATION, THE CHIEF ADMINISTRATIVE OFFICER OF PARKVIEW FOUNDATION, INC., THE CHIEF OPERATING OFFICER OF THE CORPORATE MEMBER, AND SUCH OTHER PERSONS AS IDENTIFIED BY THE CHAIR, EACH OF WHOM SHALL BE ENTITLED TO VOTE. IN NO EVENT SHALL THE MEMBERS OF THE EXECUTIVE COMMITTEE EXCEED EIGHT (8) PEOPLE. THE EXECUTIVE COMMITTEE MAY ACT ON BEHALF OF THE CORPORATION IN ANY MATTER WHEN THE BOARD IS NOT IN SESSION, REPORTING TO THE BOARD FOR ITS RATIFICATION OF ITS ACTION. THE CHAIR OF THE BOARD SHALL SERVE AS CHAIR OF THE EXECUTIVE COMMITTEE. MEETINGS OF THE EXECUTIVE COMMITTEE MAY BE CALLED BY THE CHAIR OR BY THREE (3) MEMBERS. FORM 990, PART VI, SECTION B, LINE 11B PURSUANT TO PARKVIEW HEALTH SYSTEM INC.'S BYLAWS, THE SYSTEM AUDIT COMMITTEE MAY ACT ON BEHALF OF THE CORPORATION TO PROVIDE REVIEW OF THE CORPORATION AND ITS SUBSIDIARY CORPORATIONS' FORM 990 FILINGS. WHITLEY MEMORIAL HOSPITAL FOUNDATION, 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 24, 2023, THE SYSTEM AUDIT COMMITTEE REVIEWED THE FORM 990 AS ULTIMATELY FILED WITH THE IRS. THIS REVIEW INCLUDED A PRESENTATION BY THE ORGANIZATION'S TAX PREPARER TO HIGHLIGHT THE SIGNIFICANT AREAS ON THE FORM 990 AND SUPPLEMENTAL SCHEDULES. FORM 990, PART VI, SECTION B, LINE 12C AS DESCRIBED IN ARTICLE IX SECTION 6, OF THE PARKVIEW HEALTH SYSTEM, INC. (PH) BYLAWS, PH ADOPTED PH'S COMPLIANCE POLICY FOR THE ORGANIZATION AND ITS NOT-FOR-PROFIT RELATED ORGANIZATIONS (AND AS LIKEWISE NOTED IN THEIR BYLAWS) WHEN ADDRESSING CONFLICTS OR POTENTIAL CONFLICTS OF INTEREST. THIS COMPLIANCE POLICY (COMPLIANCE POLICY #14) REQUIRES THAT EACH BOARD MEMBER, BOARD COMMITTEE MEMBER, AND KEY MANAGEMENT PERSONNEL MUST ANNUALLY COMPLETE A CONFLICT OF INTEREST FORM. THIS INFORMATION IS PROVIDED TO THE CHAIRMAN OF THE BOARD (FOR BOARD AND BOARD COMMITTEE MEMBERS) AND TO SENIOR MANAGEMENT (FOR KEY MANAGEMENT PERSONNEL). IN ADDITION, AS TO THE CONDUCT OF BOARD MEETINGS, THE FOLLOWING PROCESS IS FOLLOWED: "WHENEVER A PH OR PH AFFILIATE BOARD OR BOARD COMMITTEE IS CONSIDERING A TRANSACTION OR ARRANGEMENT WITH AN ORGANIZATION, ENTITY OR INDIVIDUAL IN WHICH A PERSON COVERED BY THIS POLICY HAS A FINANCIAL OR CONFLICTING INTEREST, THE FOLLOWING SHALL OCCUR: 1. THE INTERESTED PERSON MUST DISCLOSE THE FINANCIAL OR CONFLICTING INTEREST AND ALL MATERIAL FACTS TO THE PH OR PH AFFILIATE BOARD OR BOARD COMMITTEE; 2. THE INTERESTED PERSON WITH THAT FINANCIAL OR CONFLICTING INTEREST MAY MAKE A PRESENTATION AT THE BOARD OR BOARD COMMITTEE MEETING REGARDING THE TRANSACTION OR ARRANGEMENT HOWEVER, HE/SHE SHALL LEAVE THE MEETING DURING THE DISCUSSION OF, AND THE VOTE ON, THE TRANSACTION OR ARRANGEMENT THAT RESULTS IN THE FINANCIAL OR CONFLICTING INTEREST; AND 3. THE PH OR PH AFFILIATE BOARD OR BOARD COMMITTEE MUST APPROVE THE TRANSACTION OR ARRANGEMENT BY A MAJORITY VOTE OF THE BOARD MEMBERS PRESENT AT A MEETING THAT HAS A QUORUM, NOT INCLUDING THE VOTE OF THE INTERESTED PERSON. THE INTERESTED PERSON MAY NOT VOTE ON THE MATTER. A. UPON THE REQUEST OF PH OR PH AFFILIATE BOARD OR BOARD COMMITTEE, THE MATTER MAY BE DELEGATED TO THE PH COMPLIANCE COMMITTEE FOR EVALUATION, RECOMMENDATION AND/OR DETERMINATION. 4. WHENEVER A FINANCIAL OR CONFLICTING INTEREST IS ADDRESSED BY A PH OR PH AFFILIATE BOARD, NOTICE SHALL BE GIVEN TO THE PH COMPLIANCE OFFICER / GENERAL COUNSEL." FORM 990, PART VI, SECTION B, LINE 15 LINES 15A AND 15B ARE ANSWERED NO IN ACCORDANCE WITH THE IRS INSTRUCTIONS. TO THE EXTENT THAT THE ORGANIZATION HAS A VICE PRESIDENT OR ABOVE, THE RELATED ORGANIZATION, PARKVIEW HEALTH SYSTEM, INC., HAS A PROCESS IN PLACE FOR DETERMINING COMPENSATION OF THE CEO, OFFICERS, AND KEY EMPLOYEES. THE PROCESS INCLUDES CONSULTATIONS WITH AN INDEPENDENT COMPENSATION ADVISOR AND THE REVIEW OF APPROPRIATE COMPARABILITY DATA; REVIEW AND APPROVAL BY THE COMPENSATION COMMITTEE OF THE GOVERNING BODY CONSISTING OF MEMBERS WHO DO NOT HAVE A CONFLICT OF INTEREST CONCERNING THE COMPENSATION; AND CONTEMPORANEOUS DOCUMENTATION AND RECORDKEEPING WITH RESPECT TO DELIBERATIONS AND DECISIONS REGARDING THE COMPENSATION ARRANGEMENTS. IN 2022, THE COMPENSATION COMMITTEE OF PARKVIEW HEALTH SYSTEM, INC. REVIEWED AND APPROVED ALL EXECUTIVE COMPENSATION, BENEFITS, AND PERQUISITES FOR THE 2022 COMPENSATION PACKAGE, PURSUANT TO THE PARKVIEW HEALTH BYLAWS. THE COMPENSATION PACKAGE WAS APPROVED BY A MAJORITY OF INDEPENDENT COMPENSATION COMMITTEE 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 THEIR DIRECT REPORTS. APPROVAL IS ALSO PROVIDED FOR THE SALARY BUDGET FOR THE ENTIRE ORGANIZATION. THE BOARD REVIEWS AND APPROVES THE PLAN DOCUMENTS FOR THE MANAGEMENT INCENTIVE COMPENSATION PLAN (MICP) AND THE PHYSICIAN AND PROVIDER INCENTIVE COMPENSATION PLAN (PICP). 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 XI, LINE 9: DOUBTFUL PLEDGE EXPENSE -5,292. CORRECTION TO ENDOWMENT -65,958. 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