TY 2020 Form 990

(A) Name and title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)	(E) Reportable compensation from related organizations (W-2/1099-MISC)	(F) Estimated amount of other compensation from the organization and related organizations
(1) MICHAEL PACKNETT...................................................................... PH PRESIDENT & CEO	0.00 ................. 40.00	X	X			0	2,048,421	1,656,853
(2) MICHELLE HARRISON...................................................................... DIRECTOR/PH PHYSICIAN	0.00 ................. 40.00	X				17,782	576,711	59,109
(3) LISA HATCHER...................................................................... DIRECTOR/PH PHYSICIAN	0.00 ................. 40.00	X				13,346	486,988	46,841
(4) SCOTT GABRIEL...................................................................... DIRECTOR/WMHOS PRESIDENT	40.00 ................. 0.00	X	X			309,421	0	97,803
(5) JAMES STAPEL...................................................................... DIRECTOR/CHAIR/PH PHYSICIAN	1.00 ................. 6.00	X	X			1,000	53,915	0
(6) JIM HEUER...................................................................... DIRECTOR	1.00 ................. 1.00	X				5,250	1,310	0
(7) SHAWN ELLIS...................................................................... DIRECTOR/SECRETARY/TREASURER	1.00 ................. 0.00	X	X			4,750	0	0
(8) JOSEPH KESSIE...................................................................... DIRECTOR	1.00 ................. 0.00	X				4,750	0	0
(9) GEORGE SCHRUMPF...................................................................... DIRECTOR	1.00 ................. 0.00	X				4,750	0	0
(10) DAVID SMITH...................................................................... DIRECTOR	1.00 ................. 1.00	X				4,750	0	0
(11) BRAD VOELZ...................................................................... DIRECTOR/VICE CHAIR	1.00 ................. 0.00	X	X			4,750	0	0
(12) LAURA MCDERMOTT...................................................................... DIRECTOR	1.00 ................. 0.00	X				4,500	0	0
(13) JANE WEAR...................................................................... DIRECTOR	1.00 ................. 0.00	X				4,500	0	0
(14) JEANNE' WICKENS...................................................................... PH CHIEF FINANCIAL OFFICER	0.00 ................. 40.00		X			0	1,084,552	339,895
(15) JEFFREY ROCKETT...................................................................... WMHOS VP OUTPATIENT SVCS	40.00 ................. 0.00			X		202,832	0	40,006
(16) AMANDA KNOWLES...................................................................... WMHOS MGR PHARMACY	40.00 ................. 0.00				X	181,023	0	51,687
(17) BENJAMIN MAGGARD...................................................................... WMHOS PHARMACIST	40.00 ................. 0.00				X	136,530	3,540	39,307

(A) Name and business address	(B) Description of services	(C) Compensation
PARKVIEW HOSPITAL INC 11109 PARKVIEW PLAZA DRIVE FORT WAYNE,IN46845	LABORATORY SERVICES	3,010,056
PROFESSIONAL EMERGENCY PHYSICIANS INC PO BOX 12949 FORT WAYNE,IN46866	PHYSICIANS	1,300,313
CLINICAL COLLEAGUES INC PO BOX 824246 PHILADELPHIA,PA19182	ANESTHESIOLOGISTS	982,699
NORTHEAST INTERNAL MEDICINE ASSOC INC 2500 N DETROIT STREET LAGRANGE,IN46761	HOSPITALISTS	404,000
FOCUSONE SOLUTIONS LLC 13609 CALIFORNIA STREET OMAHA,NE68154	NURSES	179,155
2 Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization 11

- TIN:

SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service

Public Charity Status and Public Support

Complete if the organization is a section 501(c)(3) organization or a section 4947(a)(1) nonexempt charitable trust.
right arrow

Attach to Form 990 or Form 990-EZ.
right arrow

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2020

Open to Public
Inspection

Name of the organization

WHITLEY MEMORIAL HOSPITAL INC

Employer identification number

35-1967665

Part I

Reason for Public Charity Status (All organizations must complete this part.) See instructions.

The organization is not a private foundation because it is: (For lines 1 through 12, check only one box.)

A church, convention of churches, or association of churches described in section 170(b)(1)(A)(i).

A school described in section 170(b)(1)(A)(ii). (Attach Schedule E (Form 990 or 990-EZ).)

A hospital or a cooperative hospital service organization described in section 170(b)(1)(A)(iii).

A medical research organization operated in conjunction with a hospital described in section 170(b)(1)(A)(iii). Enter the hospital's name, city, and state:

An organization operated for the benefit of a college or university owned or operated by a governmental unit described in section 170(b)(1)(A)(iv). (Complete Part II.)

A federal, state, or local government or governmental unit described in section 170(b)(1)(A)(v).

An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in section 170(b)(1)(A)(vi). (Complete Part II.)

A community trust described in section 170(b)(1)(A)(vi). (Complete Part II.)

An agricultural research organization described in 170(b)(1)(A)(ix) operated in conjunction with a land-grant college or university or a non-land grant college of agriculture. See instructions. Enter the name, city, and state of the college or university:

An organization that normally receives: (1) more than 331/3% of its support from contributions, membership fees, and gross receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)

An organization organized and operated exclusively to test for public safety. See section 509(a)(4).

An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). See section 509(a)(3). Check the box in lines 12a through 12d that describes the type of supporting organization and complete lines 12e, 12f, and 12g.

Type I. A supporting organization operated, supervised, or controlled by its supported organization(s), typically by giving the supported organization(s) the power to regularly appoint or elect a majority of the directors or trustees of the supporting organization. You must complete Part IV, Sections A and B.

Type II. A supporting organization supervised or controlled in connection with its supported organization(s), by having control or management of the supporting organization vested in the same persons that control or manage the supported organization(s). You must complete Part IV, Sections A and C.

Type III functionally integrated. A supporting organization operated in connection with, and functionally integrated with, its supported organization(s) (see instructions). You must complete Part IV, Sections A, D, and E.

Type III non-functionally integrated. A supporting organization operated in connection with its supported organization(s) that is not functionally integrated. The organization generally must satisfy a distribution requirement and an attentiveness requirement (see instructions). You must complete Part IV, Sections A and D, and Part V.

Check this box if the organization received a written determination from the IRS that it is a Type I, Type II, Type III functionally integrated, or Type III non-functionally integrated supporting organization.

Enter the number of supported organizations ...............................

Provide the following information about the supported organization(s).

(i) Name of supported organization	(ii) EIN	(iv) Is the organization listed in your governing document?		(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)
(i) Name of supported organization	(ii) EIN	Yes	No	(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)


Total

For Paperwork Reduction Act Notice, see the Instructions for
Form 990 or 990-EZ.

Cat. No. 11285F

Schedule A (Form 990 or 990-EZ) 2020

Page 2

Part II

Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization failed to qualify under the tests listed below, please complete Part III.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2016	(b) 2017	(c) 2018	(d) 2019	(e) 2020	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") ..
2	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf....
3	The value of services or facilities furnished by a governmental unit to the organization without charge..
4	Total. Add lines 1 through 3
5	The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f)..
6	Public support. Subtract line 5 from line 4.

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2016	(b) 2017	(c) 2018	(d) 2019	(e) 2020	(f) Total
7	Amounts from line 4..
8	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...
9	Net income from unrelated business activities, whether or not the business is regularly carried on..
10	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.)..
11	Total support. Add lines 7 through 10

Gross receipts from related activities, etc. (see instructions) ..................

First 5 years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization, check this box and stop here........................................ right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2020 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2019 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2020. If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization ....................... right arrow

33 1/3% support test—2019. If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization ..................... right arrow

17a

10%-facts-and-circumstances test—2020. If the organization did not check a box on line 13, 16a, or 16b, and line 14
is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here. Explain
in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported
organization ..................................................... right arrow

10%-facts-and-circumstances test—2019. If the organization did not check a box on line 13, 16a, 16b, or 17a, and line
15 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here.
Explain in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly
supported organization ................................................ right arrow

Private foundation. If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions ..................................................... right arrow

Schedule A (Form 990 or 990-EZ) 2020

Page 3

Part III

Support Schedule for Organizations Described in Section 509(a)(2)
(Complete only if you checked the box on line 10 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2016	(b) 2017	(c) 2018	(d) 2019	(e) 2020	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
2	Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose
3	Gross receipts from activities that are not an unrelated trade or business under section 513 .....
4	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
5	The value of services or facilities furnished by a governmental unit to the organization without charge
6	Total. Add lines 1 through 5
7a	Amounts included on lines 1, 2, and 3 received from disqualified persons
b	Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.
c	Add lines 7a and 7b..
8	Public support. (Subtract line 7c from line 6.)

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2016	(b) 2017	(c) 2018	(d) 2019	(e) 2020	(f) Total
9	Amounts from line 6...
10a	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
b	Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c	Add lines 10a and 10b.
11	Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
12	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.) ..
13	Total support. (Add lines 9, 10c, 11, and 12.)..

First 5 years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization,
check this box and stop here............................................. right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2020 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2019 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2020 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2019 Schedule A, Part III, line 17 .............

19a

331/3% support tests—2020. If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization ....... right arrow

33 1/3% support tests—2019. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization .... right arrow

Private foundation. If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions .... right arrow

Schedule A (Form 990 or 990-EZ) 2020

Page 4

Part IV

Supporting Organizations

(Complete only if you checked a box on line 12 of Part I. If you checked box 12a, of Part I, complete Sections A and B. If you checked box 12b, of Part I, complete Sections A and C. If you checked box 12c, of Part I, complete Sections A, D, and E. If you checked box12d, of Part I, complete Sections A and D, and complete Part V.)

Section A. All Supporting Organizations

Yes

Are all of the organization’s supported organizations listed by name in the organization’s governing documents?
If "No," describe in Part VI how the supported organizations are designated. If designated by class or purpose,
describe the designation. If historic and continuing relationship, explain.

Did the organization have any supported organization that does not have an IRS determination of status under section 509(a)(1) or (2)? If "Yes," explain in Part VI how the organization determined that the supported organization was described in section 509(a)(1) or (2).

Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yes," answer lines 3b and 3c below.

Did the organization confirm that each supported organization qualified under section 501(c)(4), (5), or (6) and satisfied the public support tests under section 509(a)(2)? If "Yes," describe in Part VI when and how the organization made the determination.

Did the organization ensure that all support to such organizations was used exclusively for section 170(c)(2)(B) purposes? If "Yes," explain in Part VI what controls the organization put in place to ensure such use.

Was any supported organization not organized in the United States ("foreign supported organization")? If “Yes” and if you checked box 12a or 12b in Part I, answer lines 4b and 4c below.

Did the organization have ultimate control and discretion in deciding whether to make grants to the foreign supported organization? If “Yes,” describe in Part VI how the organization had such control and discretion despite being controlled or supervised by or in connection with its supported organizations.

Did the organization support any foreign supported organization that does not have an IRS determination under sections 501(c)(3) and 509(a)(1) or (2)? If “Yes,” explain in Part VI what controls the organization used to ensure that all support to the foreign supported organization was used exclusively for section 170(c)(2)(B) purposes.

Did the organization add, substitute, or remove any supported organizations during the tax year? If “Yes,” answer lines 5b and 5c below (if applicable). Also, provide detail in Part VI, including (i) the names and EIN numbers of the supported organizations added, substituted, or removed; (ii) the reasons for each such action; (iii) the authority under the organization's organizing document authorizing such action; and (iv) how the action was accomplished (such as by amendment to the organizing document).

Type I or Type II only. Was any added or substituted supported organization part of a class already designated in the organization's organizing document?

Substitutions only. Was the substitution the result of an event beyond the organization's control?

Did the organization provide support (whether in the form of grants or the provision of services or facilities) to anyone other than (i) its supported organizations, (ii) individuals that are part of the charitable class benefited by one or more of its supported organizations, or (iii) other supporting organizations that also support or benefit one or more of the filing organization’s supported organizations? If “Yes,” provide detail in Part VI.

Did the organization provide a grant, loan, compensation, or other similar payment to a substantial contributor (defined in section 4958(c)(3)(C)), a family member of a substantial contributor, or a 35% controlled entity with regard to a substantial contributor? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ) .

Did the organization make a loan to a disqualified person (as defined in section 4958) not described in line 7? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ).

Was the organization controlled directly or indirectly at any time during the tax year by one or more disqualified persons, as defined in section 4946 (other than foundation managers and organizations described in section 509(a)(1) or (2))? If “Yes,” provide detail in Part VI.

Did one or more disqualified persons (as defined in line 9a) hold a controlling interest in any entity in which the supporting organization had an interest? If “Yes,” provide detail in Part VI.

Did a disqualified person (as defined in line 9a) have an ownership interest in, or derive any personal benefit from, assets in which the supporting organization also had an interest? If “Yes,” provide detail in Part VI.

10a

Was the organization subject to the excess business holdings rules of section 4943 because of section 4943(f) (regarding certain Type II supporting organizations, and all Type III non-functionally integrated supporting organizations)? If “Yes,” answer line 10b below.

10a

Did the organization have any excess business holdings in the tax year? (Use Schedule C, Form 4720, to determine whether the organization had excess business holdings).

10b

Schedule A (Form 990 or 990-EZ) 2020

Page 5

Part IV

Supporting Organizations (continued)

Yes

Has the organization accepted a gift or contribution from any of the following persons?

A person who directly or indirectly controls, either alone or together with persons described in lines 11b and 11c below, the governing body of a supported organization?

11a

A family member of a person described in 11a above?

11b

A 35% controlled entity of a person described in line 11a or 11b above? If “Yes” to 11a, 11b, or 11c, provide detail in Part VI.

11c

Section B. Type I Supporting Organizations

Yes

Did the officers, directors, trustees, or membership of one or more supported organizations have the power to regularly appoint or elect at least a majority of the organization’s directors or trustees at all times during the tax year? If “No,” describe in Part VI how the supported organization(s) effectively operated, supervised, or controlled the organization’s activities. If the organization had more than one supported organization, describe how the powers to appoint and/or remove directors or trustees were allocated among the supported organizations and what conditions or restrictions, if any, applied to such powers during the tax year.

Did the organization operate for the benefit of any supported organization other than the supported organization(s) that operated, supervised, or controlled the supporting organization? If “Yes,” explain in Part VI how providing such benefit carried out the purposes of the supported organization(s) that operated, supervised or controlled the supporting organization.

Section C. Type II Supporting Organizations

Yes

Were a majority of the organization’s directors or trustees during the tax year also a majority of the directors or trustees of each of the organization’s supported organization(s)? If “No,” describe in Part VI how control or management of the supporting organization was vested in the same persons that controlled or managed the supported organization(s).

Section D. All Type III Supporting Organizations

Yes

Did the organization provide to each of its supported organizations, by the last day of the fifth month of the organization’s tax year, (i) a written notice describing the type and amount of support provided during the prior tax year, (ii) a copy of the Form 990 that was most recently filed as of the date of notification, and (iii) copies of the organization’s governing documents in effect on the date of notification, to the extent not previously provided?

Were any of the organization’s officers, directors, or trustees either (i) appointed or elected by the supported organization(s) or (ii) serving on the governing body of a supported organization? If "No," explain in Part VI how the organization maintained a close and continuous working relationship with the supported organization(s).

By reason of the relationship described in line 2 above, did the organization’s supported organizations have a significant voice in the organization’s investment policies and in directing the use of the organization’s income or assets at all times during the tax year? If "Yes," describe in Part VI the role the organization’s supported organizations played in this regard.

Section E. Type III Functionally-Integrated Supporting Organizations

Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions):

The organization satisfied the Activities Test. Complete line 2 below.

The organization is the parent of each of its supported organizations. Complete line 3 below.

The organization supported a governmental entity. Describe in Part VI how you supported a government entity (see instructions)

Activities Test. Answer lines 2a and 2b below.

Yes

Did substantially all of the organization’s activities during the tax year directly further the exempt purposes of the supported organization(s) to which the organization was responsive? If "Yes," then in Part VI identify those supported organizations and explain how these activities directly furthered their exempt purposes, how the organization was responsive to those supported organizations, and how the organization determined that these activities constituted substantially all of its activities.

Did the activities described in line 2a, above constitute activities that, but for the organization’s involvement, one or more of the organization’s supported organization(s) would have been engaged in? If "Yes," explain in Part VI the reasons for the organization’s position that its supported organization(s) would have engaged in these activities but for the organization’s involvement.

Parent of Supported Organizations. Answer lines 3a and 3b below.

Did the organization have the power to regularly appoint or elect a majority of the officers, directors, or trustees of each of the supported organizations?If "Yes" or "No", provide details in Part VI.

Did the organization exercise a substantial degree of direction over the policies, programs and activities of each of its supported organizations? If "Yes," describe in Part VI. the role played by the organization in this regard.

Schedule A (Form 990 or 990-EZ) 2020

Page 6

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations

Check here if the organization satisfied the Integral Part Test as a qualifying trust on Nov. 20, 1970 (explain in Part VI). See instructions. All other Type III non-functionally integrated supporting organizations must complete Sections A through E.

	Section A - Adjusted Net Income		(A) Prior Year	(B) Current Year (optional)
1	Net short-term capital gain	1
2	Recoveries of prior-year distributions	2
3	Other gross income (see instructions)	3
4	Add lines 1 through 3	4
5	Depreciation and depletion	5
6	Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions)	6
7	Other expenses (see instructions)	7
8	Adjusted Net Income (subtract lines 5, 6 and 7 from line 4)	8

	Section B - Minimum Asset Amount		(A) Prior Year	(B) Current Year (optional)
1	Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year):	1
a	Average monthly value of securities	1a
b	Average monthly cash balances	1b
c	Fair market value of other non-exempt-use assets	1c
d	Total (add lines 1a, 1b, and 1c)	1d
e	Discount claimed for blockage or other factors (explain in detail in Part VI):
2	Acquisition indebtedness applicable to non-exempt use assets	2
3	Subtract line 2 from line 1d	3
4	Cash deemed held for exempt use. Enter 0.015 of line 3 (for greater amount, see instructions).	4
5	Net value of non-exempt-use assets (subtract line 4 from line 3)	5
6	Multiply line 5 by 0.035	6
7	Recoveries of prior-year distributions	7
8	Minimum Asset Amount (add line 7 to line 6)	8

	Section C - Distributable Amount		Current Year
1	Adjusted net income for prior year (from Section A, line 8, Column A)	1
2	Enter 85% of line 1	2
3	Minimum asset amount for prior year (from Section B, line 8, Column A)	3
4	Enter greater of line 2 or line 3	4
5	Income tax imposed in prior year	5
6	Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions)	6

Check here if the current year is the organization's first as a non-functionally-integrated Type III supporting organization (see instructions)

Schedule A (Form 990 or 990-EZ) 2020

Page 7

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations(continued)

Section D - Distributions		Current Year
1 Amounts paid to supported organizations to accomplish exempt purposes	1
2 Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity	2
3 Administrative expenses paid to accomplish exempt purposes of supported organizations	3
4 Amounts paid to acquire exempt-use assets	4
5 Qualified set-aside amounts (prior IRS approval required - provide details in Part VI)	5
6 Other distributions (describe in Part VI). See instructions	6
7Total annual distributions. Add lines 1 through 6.	7
8 Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions	8
9 Distributable amount for 2020 from Section C, line 6	9
10 Line 8 amount divided by Line 9 amount	10

Section E - Distribution Allocations (see instructions)		(i) Excess Distributions	(ii) Underdistributions Pre-2020	(iii) Distributable Amount for 2020
1 Distributable amount for 2020 from Section C, line 6
2 Underdistributions, if any, for years prior to 2019 (reasonable cause required-- explain in Part VI). See instructions.
3 Excess distributions carryover, if any, to 2020:
a From 2015.......
b From 2016.......
c From 2017.......
d From 2018.......
e From 2019.......
fTotal of lines 3a through e
g Applied to underdistributions of prior years
h Applied to 2020 distributable amount
i Carryover from 2015 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from line 3f.
4Distributions for 2020 from Section D, line 7:
$
a Applied to underdistributions of prior years
b Applied to 2020 distributable amount
c Remainder. Subtract lines 4a and 4b from line 4.
5 Remaining underdistributions for years prior to 2020, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions.
6 Remaining underdistributions for 2020. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions.
7 Excess distributions carryover to 2021. Add lines 3j and 4c.
8 Breakdown of line 7:
a Excess from 2016.....
b Excess from 2017.....
c Excess from 2018.....
d Excess from 2019.....
e Excess from 2020.....

Schedule A (Form 990 or 990-EZ) (2020)

Schedule A (Form 990 or 990-EZ) 2020

Page 8

Part VI

Supplemental Information. Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; Part III, line 12; Part IV, Section A, lines 1, 2, 3b, 3c, 4b, 4c, 5a, 6, 9a, 9b, 9c, 11a, 11b, and 11c; Part IV, Section B, lines 1 and 2; Part IV, Section C, line 1; Part IV, Section D, lines 2 and 3; Part IV, Section E, lines 1c, 2a, 2b, 3a and 3b; Part V, line 1; Part V, Section B, line 1e; Part V Section D, lines 5, 6, and 8; and Part V, Section E, lines 2, 5, and 6. Also complete this part for any additional information. (See instructions).

Facts And Circumstances Test

Return Reference	Explanation

Schedule A (Form 990 or 990-EZ) 2020

Additional Data

Software ID:
Software Version:

- TIN:

Schedule B
(Form 990, 990-EZ,
or 990-PF)

Department of the Treasury
Internal Revenue Service

Schedule of Contributors

Attach to Form 990, 990-EZ, or 990-PF.

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2020

Name of the organization

WHITLEY MEMORIAL HOSPITAL INC

Employer identification number

35-1967665

Organization type (check one):

Filers of:

Section:

Form 990 or 990-EZ

501(c)( ) (enter number) organization

4947(a)(1) nonexempt charitable trust not treated as a private foundation

527 political organization

Form 990-PF

501(c)(3) exempt private foundation

4947(a)(1) nonexempt charitable trust treated as a private foundation

501(c)(3) taxable private foundation

Check if your organization is covered by the General Rule or a Special Rule.
Note: Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.

General Rule

For an organization filing Form 990, 990-EZ, or 990-PF that received, during the year, contributions totaling $5,000 or more (in money or other property) from any one contributor. Complete Parts I and II. See instructions for determining a contributor's total contributions.

Special Rules

For an organization described in section 501(c)(3) filing Form 990 or 990-EZ that met the 33¹/3% support test of the regulations
under sections 509(a)(1) and 170(b)(1)(A)(vi), that checked Schedule A (Form 990 or 990-EZ), Part II, line 13, 16a, or 16b, and that received from any one contributor, during the year, total contributions of the greater of (1) $5,000 or (2) 2% of the amount on (i) Form 990, Part VIII, line 1h, or (ii) Form 990-EZ, line 1. Complete Parts I and II.

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, total contributions of more than $1,000 exclusively for religious, charitable, scientific, literary, or educational purposes, or for the prevention of cruelty to children or animals. Complete Parts I, II, and III.

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, contributions exclusively for religious, charitable, etc., purposes, but no such contributions totaled more than $1,000. If this box is checked, enter here the total contributions that were received during the year for an exclusively religious, charitable, etc., purpose. Don't complete any of the parts unless the General Rule applies to this organization because it received nonexclusively religious, charitable, etc., contributions totaling $5,000 or more during the year ......... Arrow Bullet

Caution: An organization that isn't covered by the General Rule and/or the Special Rules doesn't file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2, of its Form 990; or check the box on line H of its Form 990-EZ
or on its Form 990PF, Part I, line 2, to certify that it doesn't meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).

For Paperwork Reduction Act Notice, see the Instructions
for Form 990, 990-EZ, or 990-PF.

Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2020)

Schedule B (Form 990, 990-EZ, or 990-PF) (2020) Page 2

Name of organization WHITLEY MEMORIAL HOSPITAL INC

Part I Contributors	Contributors (see instructions). Use duplicate copies of Part I if additional space is needed.
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
RESTRICTED	,	$ RESTRICTED	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2020)

Schedule B (Form 990, 990-EZ, or 990-PF) (2020)

Page 3

Name of organization WHITLEY MEMORIAL HOSPITAL INC		Employer identification number 35-1967665

Part II	Noncash Property (see instructions). Use duplicate copies of Part II if additional space is needed.
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
Schedule B (Form 990, 990-EZ, or 990-PF) (2020)

Schedule B (Form 990, 990-EZ, or 990-PF) (2020)

Page 4


Name of organization WHITLEY MEMORIAL HOSPITAL INC			Employer identification number 35-1967665
Part III Exclusively religious, charitable, etc., contributions to organizations described in section 501(c)(7), (8), or (10) that total more than $1,000 for the year from any one contributor. Complete columns (a) through (e) and the following line entry. For organizations completing Part III, enter the total of exclusively religious, charitable, etc., contributions of $1,000 or less for the year. (Enter this information once. See instructions.) $ Use duplicate copies of Part III if additional space is needed.

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

Schedule B (Form 990, 990-EZ, or 990-PF) (2020)

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE C
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Political Campaign and Lobbying Activities

For Organizations Exempt From Income Tax Under section 501(c) and section 527

SchCMd Bullet

Complete if the organization is described below. SchCMd Bullet

Attach to Form 990 or Form 990-EZ.
SchCMd Bullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2020

Open to Public
Inspection

If the organization answered "Yes" on Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
Round Bullet

Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
Round Bullet

Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
Round Bullet

Section 527 organizations: Complete Part I-A only.
If the organization answered "Yes" on Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
Round Bullet

Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)): Complete Part II-A. Do not complete Part II-B.
Round Bullet

Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered "Yes" on Form 990, Part IV, Line 5 (Proxy Tax) (see separate instructions) or Form 990-EZ, Part V, line 35c (Proxy Tax) (see separate instructions), then
Round Bullet

Section 501(c)(4), (5), or (6) organizations: Complete Part III.

Name of the organization

WHITLEY MEMORIAL HOSPITAL INC

Employer identification number

35-1967665

Part I-A

Complete if the organization is exempt under section 501(c) or is a section 527 organization.

Provide a description of the organization’s direct and indirect political campaign activities in Part IV (see instructions for definition of “political campaign activities")

Political campaign activity expenditures (see instructions) .................................................................... SchCMd Bullet

Volunteer hours for political campaign activities (see instructions) ..................................................................

Part I-B

Complete if the organization is exempt under section 501(c)(3).

Enter the amount of any excise tax incurred by the organization under section 4955 ................................ SchCMd Bullet

Enter the amount of any excise tax incurred by organization managers under section 4955 ....................... SchCMd Bullet

If the organization incurred a section 4955 tax, did it file Form 4720 for this year? .........................................

Yes No

Was a correction made? ......................................................................................................................

Yes No

If "Yes," describe in Part IV.

Part I-C

Complete if the organization is exempt under section 501(c), except section 501(c)(3).

Enter the amount directly expended by the filing organization for section 527 exempt function activities ..... SchCMd Bullet

Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt function activities ............................................................................................................................ SchCMd Bullet

Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, line 17b........... SchCMd Bullet

Did the filing organization file Form 1120-POL for this year? ...................................................................

Yes No

Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing
organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.

(a) Name	(b) Address	(c) EIN	(d) Amount paid from filing organization's funds. If none, enter -0-.	(e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.
1
2
3
4
5
6

For Paperwork Reduction Act Notice, see the instructions for Form 990 or 990-EZ.

Cat. No. 50084S

Schedule C (Form 990 or 990-EZ) 2020

Page 2

Part II-A

Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).

A Check SchCMd Bullet

if the filing organization belongs to an affiliated group (and list in Part IV each affiliated group member's name, address, EIN, expenses, and share of excess lobbying expenditures).
B Check SchCMd Bullet

if the filing organization checked box A and "limited control" provisions apply.

Limits on Lobbying Expenditures (The term "expenditures" means amounts paid or incurred.)		(b) Affiliated group totals
1a	Total lobbying expenditures to influence public opinion (grass roots lobbying) ......................
b	Total lobbying expenditures to influence a legislative body (direct lobbying) ........................
c	Total lobbying expenditures (add lines 1a and 1b) ............................................................
d	Other exempt purpose expenditures ...............................................................................
e	Total exempt purpose expenditures (add lines 1c and 1d) ..................................................
f	Lobbying nontaxable amount. Enter the amount from the following table in both columns.
	If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:
	Not over $500,00020% of the amount on line 1e.
	Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.
	Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.
	Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.
	Over $17,000,000$1,000,000.

g	Grassroots nontaxable amount (enter 25% of line 1f) .................................................
h	Subtract line 1g from line 1a. If zero or less, enter -0-. ................................................
i	Subtract line 1f from line 1c. If zero or less, enter -0-. ................................................
j	If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting section 4911 tax for this year? ...................................................................................................................	Yes No

4-Year Averaging Period Under Section 501(h) (Some organizations that made a section 501(h) election do not have to complete all of the five columns below. See the separate instructions for lines 2a through 2f.)
Lobbying Expenditures During 4-Year Averaging Period
	Calendar year (or fiscal year beginning in)	(a) 2017	(b) 2018	(c) 2019	(d) 2020	(e) Total

2a	Lobbying nontaxable amount

b	Lobbying ceiling amount (150% of line 2a, column(e))

c	Total lobbying expenditures

d	Grassroots nontaxable amount

e	Grassroots ceiling amount (150% of line 2d, column (e))

f	Grassroots lobbying expenditures

Schedule C (Form 990 or 990-EZ) 2020

Page 3

Part II-B

Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).

For each "Yes" response on lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.

(a)

Yes|No

(b)

Amount

During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:

Volunteers? ...........................................................................................................

Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ........

Media advertisements? ...................................................................................................

Mailings to members, legislators, or the public? .............................................................................

Publications, or published or broadcast statements? ...........................................................

Grants to other organizations for lobbying purposes? ..........................................................

Direct contact with legislators, their staffs, government officials, or a legislative body? .......................

Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ..................

Other activities? ...................................................................................................................

Yes

5,342

Total. Add lines 1c through 1i ....................................................................................................

5,342

Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....

If "Yes," enter the amount of any tax incurred under section 4912 ...........................................

If "Yes," enter the amount of any tax incurred by organization managers under section 4912 ...................

If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? ........................

Part III-A

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).

Yes

Were substantially all (90% or more) dues received nondeductible by members? ...............................................

Did the organization make only in-house lobbying expenditures of $2,000 or less? ............................................

Did the organization agree to carry over lobbying and political expenditures from the prior year? .................................

Part III-B

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) and if either (a) BOTH Part III-A, lines 1 and 2, are answered "No" OR (b) Part III-A, line 3, is answered “Yes."

Dues, assessments and similar amounts from members ......................................................................

Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political expenses for which the section 527(f) tax was paid).

Current year .............................................................................................................................

Carryover from last year ............................................................................................................

Total ...........................................................................................................................................

Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .

If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ......................................................................................................................

Taxable amount of lobbying and political expenditures (see instructions) .........................................

Part IV

Supplemental Information

Provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, line 5; Part II-A (affiliated group list); Part II-A, lines 1 and 2 (see instructions), and Part ll-B, line 1. Also, complete this part for any additional information.

Return Reference	Explanation
PART II-B, LINE 1:	REPRESENTS THE PORTION OF THE DUES PAID TO INDIANA HOSPITAL AND HEALTH ASSOCIATION, AMERICAN HOSPITAL ASSOCIATION AND VARIOUS PROFESSIONAL ASSOCIATIONS USED FOR LOBBYING ACTIVITIES.

Schedule C (Form 990 or 990EZ) 2020

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

Complete if the organization answered "Yes," on Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b.
SchDMd Bullet

Attach to Form 990.
SchDMd Bullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2020

Open to Public Inspection

Name of the organization

WHITLEY MEMORIAL HOSPITAL INC

Employer identification number

35-1967665

Part I

Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" on Form 990, Part IV, line 6.

		(a) Donor advised funds	(b) Funds and other accounts
1	Total number at end of year .........
2	Aggregate value of contributions to (during year)
3	Aggregate value of grants from (during year)
4	Aggregate value at end of year ........

Did the organization inform all donors and donor advisors in writing that the assets held in donor advised funds are the organization’s property, subject to the organization’s exclusive legal control? ............

Yes No

Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ...................................

Yes No

Part II

Conservation Easements.
Complete if the organization answered "Yes" on Form 990, Part IV, line 7.

Purpose(s) of conservation easements held by the organization (check all that apply).

Preservation of land for public use (e.g., recreation or education) Preservation of an historically important land area

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.


a	Total number of conservation easements ......................	2a
b	Total acreage restricted by conservation easements ....................	2b
c	Number of conservation easements on a certified historic structure included in (a) .....	2c
d	Number of conservation easements included in (c) acquired after 7/25/06, and not on a historic structure listed in the National Register ...	2d

Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during the
tax year SchDMd Bullet

Number of states where property subject to conservation easement is located SchDMd Bullet

Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and enforcement of the conservation easements it holds? ............

Yes No

Staff and volunteer hours devoted to monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

Amount of expenses incurred in monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(B)(i) and section 170(h)(4)(B)(ii)? .............................

Yes No

In Part XIII, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" on Form 990, Part IV, line 8.

If the organization elected, as permitted under FASB ASC 958, not to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide, in Part XIII, the text of the footnote to its financial statements that describes these items.

If the organization elected, as permitted under FASB ASC 958, to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide the following amounts relating to these items:

(i)

Revenue included on Form 990, Part VIII, line 1 ......................... SchDMd Bullet

(ii)

Assets included in Form 990, Part X ............................... SchDMd Bullet

If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under FASB ASC 958 relating to these items:

Revenue included on Form 990, Part VIII, line 1 .......................... SchDMd Bullet

Assets included in Form 990, Part X ............................... SchDMd Bullet

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 52283D

Schedule D (Form 990) 2020

Page 2

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)

Using the organization’s acquisition, accession, and other records, check any of the following that are a significant use of its collection items (check all that apply):

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.

During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?...

Yes No

Part IV

Escrow and Custodial Arrangements. Complete if the organization answered "Yes" on Form 990, Part IV, line 9, or reported an amount on Form 990, Part X, line 21.

Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................

Yes No


b	If "Yes," explain the arrangement in Part XIII and complete the following table:		Amount
c	Beginning balance .............................	1c
d	Additions during the year ............................	1d
e	Distributions during the year ..........................	1e
f	Ending balance ................................	1f

Did the organization include an amount on Form 990, Part X, line 21, for escrow or custodial account liability? ...

Yes No

If "Yes," explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII ....

Part V

Endowment Funds.
Complete if the organization answered "Yes" on Form 990, Part IV, line 10.

		(a) Current year	(b) Prior year	(c) Two years back	(d) Three years back	(e) Four years back

1a	Beginning of year balance ....
b	Contributions ...
c	Net investment earnings, gains, and losses
d	Grants or scholarships ...
e	Other expenditures for facilities and programs ...
f	Administrative expenses ....
g	End of year balance ......

Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:

Board designated or quasi-endowment SchDMd Bullet

Permanent endowment SchDMd Bullet

Term endowment SchDMd Bullet

The percentages on lines 2a, 2b, and 2c should equal 100%.

Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes

(i) Unrelated organizations .......................

3a(i)

(ii) Related organizations .......................

3a(ii)

If "Yes" on 3a(ii), are the related organizations listed as required on Schedule R? .........

Describe in Part XIII the intended uses of the organization's endowment funds.

Part VI

Land, Buildings, and Equipment.
Complete if the organization answered "Yes" on Form 990, Part IV, line 11a. See Form 990, Part X, line 10.

Description of property		(a) Cost or other basis (investment)	(b) Cost or other basis (other)	(c) Accumulated depreciation	(d) Book value

1a	Land .....	260,483		260,483
b	Buildings ....	14,853,613	2,795,704	12,057,909
c	Leasehold improvements	48,824	48,824	0
d	Equipment ....	23,323,643	15,848,506	7,475,137
e	Other .....	2,537,776	983,189	1,554,587
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..				21,348,116

Schedule D (Form 990) 2020

Page 3

Part VII

Investments - Other Securities.
Complete if the organization answered "Yes" on Form 990, Part IV, line 11b. See Form 990, Part X, line 12.

(a) Description of security or category (including name of security)	(b) Book value	(c) Method of valuation: Cost or end-of-year market value
(1) Financial derivatives.........
(2) Closely-held equity interests........
(3)Other
(B)
(C)
(D)
(E)
(F)
(G)
(H)
(I)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)

Part VIII

Investments - Program Related. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11c. See Form 990, Part X, line 13.

(a) Description of investment	(b) Book value	(c) Method of valuation: Cost or end-of-year market value

(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)

Part IX

Other Assets.
Complete if the organization answered 'Yes' on Form 990, Part IV, line 11d. See Form 990, Part X, line 15.

(a) Description				(b) Book value
(1)DUE TO/FROM INTERUNIT				27,408,598
(2)EMS SUBSIDY				75,000
(3)RIGHT OF USE ASSETS				90,301
(4)
(5)
(6)
(7)
(8)
(9)
(10)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........				27,573,899

Part X

Other Liabilities.
Complete if the organization answered 'Yes' on Form 990, Part IV, line 11e or 11f. See Form 990, Part X, line 25.

1.(a) Description of liability	(b) Book value
(1) Federal income taxes
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	8,111,868
2. Liability for uncertain tax positions. In Part XIII, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC 740). Check here if the text of the footnote has been provided in Part XIII

Schedule D (Form 990) 2020

Page 4

Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total revenue, gains, and other support per audited financial statements .......		1
2	Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a	Net unrealized gains (losses) on investments ....	2a
b	Donated services and use of facilities .........	2b
c	Recoveries of prior year grants ...........	2c
d	Other (Describe in Part XIII.) ............	2d
e	Add lines 2a through 2d .....................		2e
3	Subtract line 2e from line 1..................		3
4	Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b .	4a
b	Other (Describe in Part XIII.) ...........	4b
c	Add lines 4a and 4b....................		4c
5	Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ......		5

Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total expenses and losses per audited financial statements ...........		1
2	Amounts included on line 1 but not on Form 990, Part IX, line 25:
a	Donated services and use of facilities .........	2a
b	Prior year adjustments ............	2b
c	Other losses ................	2c
d	Other (Describe in Part XIII.) ............	2d
e	Add lines 2a through 2d....................		2e
3	Subtract line 2e from line 1...................		3
4	Amounts included on Form 990, Part IX, line 25, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b ..	4a
b	Other (Describe in Part XIII.) ............	4b
c	Add lines 4a and 4b.....................		4c
5	Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ......		5

Part XIII

Supplemental Information

Provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b; Part V, line 4; Part X, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.

Return Reference

Explanation

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, 2020 AND 2019, 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 2016 AND PRIOR.

Schedule D (Form 990) 2020

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE H
(Form 990)

Department of the Treasury
Internal Revenue Service

Hospitals

Complete if the organization answered "Yes" on Form 990, Part IV, question 20.
MediumBullet

Attach to Form 990.
MediumBullet

Go to www.irs.gov/Form990EZ for instructions and the latest information.

OMB No. 1545-0047

2020

Open to Public Inspection

Name of the organization

WHITLEY MEMORIAL HOSPITAL INC

Employer identification number

35-1967665

Part I

Financial Assistance and Certain Other Community Benefits at Cost

Yes

Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a . . . .

Yes

If "Yes," was it a written policy? ......................

Yes

If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.

Applied uniformly to all hospital facilities Applied uniformly to most hospital facilities Generally tailored to individual hospital facilities

Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.

Did the organization use Federal Poverty Guidelines (FPG) as a factor in determining eligibility for providing free care?

If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:

Yes

100% 150% 200% Other %

Did the organization use FPG as a factor in determining eligibility for providing discounted care? If "Yes," indicate

which of the following was the family income limit for eligibility for discounted care: . . . . . . . .

Yes

200% 250% 300% 350% 400% Other %

If the organization used factors other than FPG in determining eligibility, describe in Part VI the criteria used for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, as a factor in determining eligibility for free or discounted care.

Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? . . . . . . . . . . . . .

Yes

Did the organization budget amounts for free or discounted care provided under its financial assistance policy during
the tax year? . . . . . . . . . . . . . . . . . . . . . . .

Yes

If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? . . . . . .

If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care? . . . . . . . . . . . . .

Did the organization prepare a community benefit report during the tax year? . . . . . . . . .

Yes

If "Yes," did the organization make it available to the public? . . . . . . . . . . . . .

Yes

Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.

Financial Assistance and Certain Other Community Benefits at Cost

Financial Assistance and Means-Tested Government Programs		(c) Total community benefit expense	(d) Direct offsetting revenue	(e) Net community benefit expense	(f) Percent of total expense
a	Financial Assistance at cost (from Worksheet 1) . . .	1,096,513	0	1,096,513	1.600 %
b	Medicaid (from Worksheet 3, column a) . . . . .	6,694,871	2,651,900	4,042,971	5.910 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) . .	8,803,645	4,832,811	3,970,834	5.800 %
d	Total Financial Assistance and Means-Tested Government Programs . . . . .	16,595,029	7,484,711	9,110,318	13.310 %
Other Benefits
e	Community health improvement services and community benefit operations (from Worksheet 4).	94,927	14,239	80,688	0.120 %
f	Health professions education (from Worksheet 5) . . .	1,200	0	1,200	0 %
g	Subsidized health services (from Worksheet 6) . . . .
h	Research (from Worksheet 7) .
i	Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .	92,238	0	92,238	0.130 %
j	Total. Other Benefits . .	188,365	14,239	174,126	0.250 %
k	Total. Add lines 7d and 7j .	16,783,394	7,498,950	9,284,444	13.560 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2020

Schedule H (Form 990) 2020

Page

Part II

Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.

		(c) Total community building expense	(d) Direct offsetting revenue	(e) Net community building expense	(f) Percent of total expense
1	Physical improvements and housing
2	Economic development	1,650	0	1,650	0 %
3	Community support
4	Environmental improvements
5	Leadership development and training for community members	1,000	0	1,000	0 %
6	Coalition building
7	Community health improvement advocacy
8	Workforce development	25,000	0	25,000	0.040 %
9	Other
10	Total	27,650		27,650	0.040 %

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

Did the organization report bad debt expense in accordance with Healthcare Financial Management Association Statement No. 15? ..........................

Yes

Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......

Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy. Explain in Part VI the methodology used by the organization to estimate this amount and the rationale, if any, for including this portion of bad debt as community benefit. ......

41,732

Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.

Section B. Medicare

Enter total revenue received from Medicare (including DSH and IME).....

8,728,525

Enter Medicare allowable costs of care relating to payments on line 5.....

9,915,358

Subtract line 6 from line 5. This is the surplus (or shortfall)........

-1,186,833

Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:

Cost accounting system Cost to charge ratio Other

Section C. Collection Practices

Did the organization have a written debt collection policy during the tax year? ..........

Yes

If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year
contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI .........................

Yes

Part IV

Management Companies and Joint Ventures(owned 10% or more by officers, directors, trustees, key employees, and physicians—see instructions)

(a) Name of entity	(b) Description of primary activity of entity	(c) Organization's profit % or stock ownership %	(d) Officers, directors, trustees, or key employees' profit % or stock ownership %	(e) Physicians' profit % or stock ownership %
1
2
3
4
5
6
7
8
9
10
11
12
13

Schedule H (Form 990) 2020

Page

Part VFacility Information

Section A. Hospital Facilities (list in order of size from largest to smallest—see instructions)How many hospital facilities did the organization operate during the tax year?1Name, address, primary website address, and state license number (and if a group return, the name and EIN of the subordinate hospital organization that operates the hospital facility)
1	WHITLEY MEMORIAL HOSPITAL INC 1260 E STATE ROAD 205 COLUMBIA CITY,IN46725 WWW.PARKVIEW.COM 14-005090-1	X	X	X

Schedule H (Form 990) 2020

Page 4

Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)

	WHITLEY MEMORIAL HOSPITAL INC
Name of hospital facility or letter of facility reporting group

Line number of hospital facility, or line numbers of hospital facilities in a facility
reporting group (from Part V, Section A):

Yes

Community Health Needs Assessment

Was the hospital facility first licensed, registered, or similarly recognized by a state as a hospital facility in the current tax year or the immediately preceding tax year?........................

Was the hospital facility acquired or placed into service as a tax-exempt hospital in the current tax year or the immediately preceding tax year? If “Yes,” provide details of the acquisition in Section C...............

During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 12......................

Yes

If "Yes," indicate what the CHNA report describes (check all that apply):

A definition of the community served by the hospital facility

Demographics of the community

Existing health care facilities and resources within the community that are available to respond to the health needs of the community

How data was obtained

The significant health needs of the community

Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups

The process for identifying and prioritizing community health needs and services to meet the community health needs

The process for consulting with persons representing the community’s interests

The impact of any actions taken to address the significant health needs identified in the hospital facility's prior CHNA(s)

Other (describe in Section C)

Indicate the tax year the hospital facility last conducted a CHNA: 20 19

In conducting its most recent CHNA, did the hospital facility take into account input from persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If "Yes," describe in Section C how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted .................

Yes

6 a

Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Section C..................................

Yes

Was the hospital facility’s CHNA conducted with one or more organizations other than hospital facilities?” If “Yes,” list the other organizations in Section C. ............................

Yes

Did the hospital facility make its CHNA report widely available to the public?..............

Yes

If "Yes," indicate how the CHNA report was made widely available (check all that apply):

Hospital facility’s website (list url): HTTPS://WWW.PARKVIEW.COM/LOCALHEALTHNEEDS

Other website (list url):

Made a paper copy available for public inspection without charge at the hospital facility

Other (describe in Section C)

Did the hospital facility adopt an implementation strategy to meet the significant community health needs
identified through its most recently conducted CHNA? If "No," skip to line 11. ..............

Yes

Indicate the tax year the hospital facility last adopted an implementation strategy: 20 19

Is the hospital facility's most recently adopted implementation strategy posted on a website?.........

Yes

If "Yes" (list url): HTTPS://WWW.PARKVIEW.COM/LOCALHEALTHNEEDS

If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ......

10b

Describe in Section C how the hospital facility is addressing the significant needs identified in its most recently conducted CHNA and any such needs that are not being addressed together with the reasons why such needs are not being addressed.

12a

Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)?...............................

12a

If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........

12b

If "Yes" on line 12b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $

Schedule H (Form 990) 2020

Page 5

Part VFacility Information (continued)

Financial Assistance Policy (FAP)

	WHITLEY MEMORIAL HOSPITAL INC
Name of hospital facility or letter of facility reporting group

Yes

Did the hospital facility have in place during the tax year a written financial assistance policy that:

Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care?

Yes

If “Yes,” indicate the eligibility criteria explained in the FAP:

Federal poverty guidelines (FPG), with FPG family income limit for eligibility for free care of 200.000000000000%
and FPG family income limit for eligibility for discounted care of 250.000000000000%

Income level other than FPG (describe in Section C)

Asset level

Medical indigency

Insurance status

Underinsurance discount

Residency

Other (describe in Section C)

Explained the basis for calculating amounts charged to patients?.................

Yes

Explained the method for applying for financial assistance?...................

Yes

If “Yes,” indicate how the hospital facility’s FAP or FAP application form (including accompanying instructions) explained the method for applying for financial assistance (check all that apply):

Described the information the hospital facility may require an individual to provide as part of his or her application

Described the supporting documentation the hospital facility may require an individual to submit as part of his or
her application

Provided the contact information of hospital facility staff who can provide an individual with information about the
FAP and FAP application process

Provided the contact information of nonprofit organizations or government agencies that may be sources of
assistance with FAP applications

Other (describe in Section C)

Was widely publicized within the community served by the hospital facility?........

Yes

If "Yes," indicate how the hospital facility publicized the policy (check all that apply):

The FAP was widely available on a website (list url):

HTTPS://WWW.PARKVIEW.COM/PATIENTS-VISITORS/FINANCIAL-ASSISTANCE

The FAP application form was widely available on a website (list url):

HTTPS://WWW.PARKVIEW.COM/PATIENTS-VISITORS/FINANCIAL-ASSISTANCE

A plain language summary of the FAP was widely available on a website (list url):
HTTPS://WWW.PARKVIEW.COM/PATIENTS-VISITORS/FINANCIAL-ASSISTANCE

The FAP was available upon request and without charge (in public locations in the hospital facility and by mail)

The FAP application form was available upon request and without charge (in public locations in the hospital facility
and by mail)

A plain language summary of the FAP was available upon request and without charge (in public locations in the
hospital facility and by mail)

Individuals were notified about the FAP by being offered a paper copy of the plain language summary of the FAP, by
receiving a conspicuous written notice about the FAP on their billing statements, and via conspicuous public displays or
other measures reasonably calculated to attract patients' attention

Notified members of the community who are most likely to require financial assistance about availability of the FAP

The FAP, FAP application form, and plain language summary of the FAP were translated into the primary language(s)
spoken by LEP populations

Other (describe in Section C)

Schedule H (Form 990) 2020

Page 6

Part VFacility Information (continued)

Billing and Collections

	WHITLEY MEMORIAL HOSPITAL INC
Name of hospital facility or letter of facility reporting group

Yes

Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained all of the actions the hospital facility or other authorized party may take upon nonpayment?..................................

Yes

Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Deferring, denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

None of these actions or other similar actions were permitted

Did the hospital facility or other authorized party perform any of the following actions during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP?............

If "Yes," check all actions in which the hospital facility or a third party engaged:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Deferring , denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 19. (check all that apply):

Provided a written notice about upcoming ECAs (Extraordinary Collection Action) and a plain language summary of the
FAP at least 30 days before initiating those ECAs (if not, describe in Section C)

Made a reasonable effort to orally notify individuals about the FAP and FAP application process (if not, describe in
Section C)

Processed incomplete and complete FAP applications (if not, describe in Section C)

Made presumptive eligibility determinations (if not, describe in Section C)

Other (describe in Section C)

None of these efforts were made

Policy Relating to Emergency Medical Care

Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that required the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?..................

Yes

If "No," indicate why:

The hospital facility did not provide care for any emergency medical conditions

The hospital facility’s policy was not in writing

The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Section C)

Other (describe in Section C)

Schedule H (Form 990) 2020

Page 7

Part VFacility Information (continued)

Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)

	WHITLEY MEMORIAL HOSPITAL INC
Name of hospital facility or letter of facility reporting group

Yes

Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.

The hospital facility used a look-back method based on claims allowed by Medicare fee-for-service during a prior 12-month period

The hospital facility used a look-back method based on claims allowed by Medicare fee-for-service and all private health insurers that pay claims to the hospital facility during a prior 12-month period

The hospital facility used a look-back method based on claims allowed by Medicaid, either alone or in combination with
Medicare fee-for-service and all private health insurers that pay claims to the hospital facility during a prior 12-month
period

The hospital facility used a prospective Medicare or Medicaid method

During the tax year, did the hospital facility charge any FAP-eligible individual to whom the hospital facility provided emergency or other medically necessary services more than the amounts generally billed to individuals who had insurance covering such care? ...............................

If "Yes," explain in Section C.

During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? ...........................

If "Yes," explain in Section C.

Schedule H (Form 990) 2020

Page 8

Part V

Facility Information (continued)

Section C. Supplemental Information for Part V, Section B. Provide descriptions required for Part V, Section B, lines 2, 3j, 5, 6a, 6b, 7d, 11, 13b, 13h, 15e, 16j, 18e, 19e, 20a, 20b, 20c, 20d, 20e, 21c, 21d, 23, and 24. If applicable, provide separate descriptions for each hospital facility in a facility reporting group, designated by facility reporting group letter and hospital facility line number from Part V, Section A (“A, 1,” “A, 4,” “B, 2,” “B, 3,” etc.) and name of hospital facility.
Form and Line Reference	Explanation
WHITLEY MEMORIAL HOSPITAL, INC.	PART V, SECTION B, LINE 5: DESCRIBE HOW THE HOSPITAL FACILITY TOOK INTO ACCOUNT INPUT FROM PERSONS WHO REPRESENT THE COMMUNITY, AND IDENTIFY THE PERSONS THE HOSPITAL FACILITY CONSULTED:WHEN CONDUCTING ITS 2019 CHNA, PARKVIEW HOSPITAL, INC. AND THE INDIANA PARTNERSHIP FOR HEALTHY COMMUNITIES (IN-PHC) RESEARCH TEAM WERE DILIGENT IN ENSURING THE INPUT FROM PERSONS REPRESENTING THE BROADER INTERESTS OF THE COMMUNITY'S VULNERABLE POPULATIONS WERE CONSIDERED. IN GATHERING QUALITATIVE COMMUNITY INPUT, PARKVIEW HOSPITAL, INC. AND ITS RESEARCH PARTNERS OBTAINED THE FOLLOWING: 1) PRIMARY DATA COLLECTED VIA AN ONLINE SURVEY OF PARKVIEW HEALTH SYSTEM, INC. HEALTHCARE PROVIDERS (E.G., PHYSICIANS, NURSES, SOCIAL WORKERS, ETC.). ADDITIONALLY, THE HEALTH SYSTEMS CHNA RESEARCH PARTNERS CONDUCTED A SURVEY OF THE COMMUNITY RESIDENTS IN EACH PARKVIEW HEALTH COUNTY. 2) SECONDARY DATA WAS GATHERED FROM CONDUENT'S HEALTHY COMMUNITIES INSTITUTE (HCI) DATABASE AND OTHER LOCAL AND NATIONAL AGENCIES. TO SUPPLEMENT THESE DATA, A FOCUS GROUP WAS CONDUCTED WITH HISPANIC COMMUNITY MEMBERS IN KOSCIUSKO COUNTY AND A PAPER SURVEY OF THE AMISH COMMUNITY WAS CONDUCTED IN LAGRANGE COUNTY.IN ADDITION TO DATA COLLECTION, PARKVIEW HOSPITAL, INC. TURNED TO THE COMMUNITY AND PARTNERING ORGANIZATIONS WHEN SELECTING AND PRIORITIZING ALLEN COUNTY'S HEALTH NEEDS. IN DOING SO, A MODIFIED HANLON METHOD PRIORITIZED HEALTH CONCERNS FOR PARKVIEW HEALTH HOSPITAL COMMUNITIES. THIS METHOD, ALSO KNOWN AS THE BASIC PRIORITY RATING SYSTEM (BPRS) 2.0, IS RECOMMENDED BY THE NATIONAL ASSOCIATION OF COUNTY AND CITY HEALTH OFFICIALS (NACCHO) FOR PRIORITIZING COMMUNITY HEALTH NEEDS (GUIDE-TO-PRIORITIZATION-TECHNIQUES.PDF, N.D.). ALTHOUGH COMPLEX TO IMPLEMENT, IT IS USEFUL WHEN THE DESIRED OUTCOME IS AN OBJECTIVELY SELECTED LIST. EXPLICIT IDENTIFICATION OF FACTORS MUST BE CONSIDERED TO SET PRIORITIES WHICH ENABLES A TRANSPARENT AND REPLICABLE PROCESS. PRIORITY SCORES ARE CALCULATED BASED ON THE SIZE OF THE HEALTH PROBLEM, SERIOUSNESS OF THE HEALTH PROBLEM AND THE AVAILABILITY OF EFFECTIVE HEALTH INTERVENTIONS. THE INDIANA PARTNERSHIP FOR HEALTHY COMMUNITIES PRESENTED AN OVERVIEW OF THE REGIONAL CHNA FINDINGS ON JULY 16, 2019, TO ATTENDEES REPRESENTING THE PARKVIEW HEALTH SYSTEM. IN TOTAL, OVER 60 INDIVIDUALS PARTICIPATED IN THE PRIORITIZATION PROCESS, INCLUDING REPRESENTATIVES FROM HOSPITAL SERVICE LINES, COMMUNITY HOSPITALS, HEALTHCARE PROVIDERS/PHYSICIANS, EXECUTIVE LEADERSHIP TEAM, COMMUNITY HEALTH AND HOSPITAL BOARD OF DIRECTORS. AFTER A THOROUGH REVIEW OF THE DATA AND CONSIDERABLE DISCUSSION, THE GROUP USED AN ELECTRONIC VOTING SYSTEM TO RANK THE VARIOUS HEALTH NEEDS IDENTIFIED IN THE CHNA. ULTIMATELY, THE GROUP VOTED ON SUBSTANCE USE DISORDER/MENTAL HEALTH AS THE SHARED HEALTH PRIORITY ACROSS THE HEALTH SYSTEM.ADDITIONALLY, PARKVIEW WHITLEY HOSPITAL CHOSE TO CONTINUE THE FOCUS ON OBESITY TO KEEP THE MOMENTUM GOING WITH THIS INITIATIVE. THE BOARD-DRIVEN COMMUNITY HEALTH IMPROVEMENT COMMITTEE AGREED WITH THIS DIRECTION.
WHITLEY MEMORIAL HOSPITAL, INC.	PART V, SECTION B, LINE 6A: THE HOSPITAL FACILITY'S CHNA WAS CONDUCTED WITH THE FOLLOWING HOSPITAL FACILITIES:PARKVIEW HOSPITAL, INC. (EIN 35-0868085); COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC. (EIN 20-2401676); HUNTINGTON MEMORIAL HOSPITAL, INC. (EIN 35-1970706); COMMUNITY HOSPITAL OF NOBLE COUNTY, INC. (EIN 35-2087092); PARKVIEW WABASH HOSPITAL, INC. (EIN 47-1753440) AND ORTHOPAEDIC HOSPITAL AT PARKVIEW NORTH, LLC (EIN 26-0143823).
WHITLEY MEMORIAL HOSPITAL, INC.	PART V, SECTION B, LINE 6B: THE HOSPITAL FACILITY'S CHNA WAS ALSO CONDUCTED WITH THE FOLLOWING ORGANIZATIONS OTHER THAN HOSPITAL FACILITIES:PARKVIEW HEALTH, INC. (EIN 35-1972384); INDIANA PARTNERSHIP FOR HEALTHY COMMUNITIES (A PARTNERSHIP BETWEEN THE INDIANA UNIVERSITY RICHARD M. FAIRBANKS SCHOOL OF PUBLIC HEALTH AND THE POLIS CENTER AT IUPUI) AND CONDUENT HEALTHY COMMUNITIES INSTITUTE.
WHITLEY MEMORIAL HOSPITAL, INC.	PART V, SECTION B, LINE 11: DESCRIBE HOW THE HOSPITAL FACILITY IS ADDRESSING THE SIGNIFICANT NEEDS IDENTIFIED IN ITS MOST RECENTLY CONDUCTED CHNA AND ANY SUCH NEEDS THAT ARE NOT BEING ADDRESSED TOGETHER WITH THE REASONS WHY SUCH NEEDS ARE NOT BEING ADDRESSED:SIGNIFICANT HEALTH NEEDS BEING ADDRESSED:DRUG AND ALCOHOL ABUSE AND ADDICTION -- PARKVIEW WHITLEY HOSPITAL WORKS CLOSELY WITH COMMUNITY PARTNERS TO ADDRESS ADDICTIONS AND MENTAL HEALTH. WE WORK WITH PARKVIEW BEHAVIORAL HEALTH TO ASSIST WITH PATIENT AND COMMUNITY MENTAL HEALTH NEEDS. WHITLEY COUNTY HAS A VERY LIMITED NUMBER OF MENTAL HEALTH RESOURCES AND SUBSTANCE ABUSE FACILITIES, AND THIS POSES CHALLENGES IN PARTNERSHIP CAPABILITIES. TO HELP ADDRESS AND PREVENT SUBSTANCE ABUSE ISSUES IN THE COMMUNITY, WE PARTNERED WITH THE LARGEST SCHOOL SYSTEM IN THE COUNTY IN 2020 TO PROVIDE FUNDING FOR ADDITIONAL MENTAL HEALTH SERVICES FOR STUDENTS. MENTAL HEALTH -- MENTAL HEALTH IS OFTEN CLOSELY TIED TO ALCOHOL AND DRUG ABUSE AND, IN MANY INSTANCES, SUBSTANCE ABUSE STEMS FROM AN UNDERLYING MENTAL HEALTH CONDITION. BECAUSE OF THE DIRECT CORRELATION BETWEEN THE TWO, PARKVIEW WHITLEY HOSPITAL BELIEVES OUR PARTNERSHIP PROVIDING MENTAL HEALTH RESOURCES TO COMMUNITY HIGH SCHOOL STUDENTS WILL HELP ADDRESS BOTH ISSUES. PLEASE SEE ABOVE NARRATIVE REGARDING THIS HEALTH NEED. OBESITY -- PARKVIEW WHITLEY HOSPITAL WILL SERVE AS A COMMUNITY LEADER PARTNERING WITH OTHER KEY COMMUNITY ORGANIZATIONS TO PROMOTE A CULTURE OF HEALTHY DECISIONS THAT INCLUDES ACTIVE LIVING AND HEALTHY EATING. PARKVIEW WHITLEY HOSPITAL WILL CONTINUE TO ESTABLISH NEW PROGRAMS WHILE FOSTERING EXISTING PROGRAMS AND RELATIONSHIPS WITH OTHER ORGANIZATIONS. WE STRIVE TO PARTNER WITH ORGANIZATIONS THAT SERVE CHILDREN AND OR UNDERSERVED POPULATIONS. WE ALSO FOCUS ON OPPORTUNITIES FOR COMMUNITY MEMBERS TO BETTER MONITOR THEIR HEALTH WITH LOW-COST OR NO-COST EDUCATIONAL AND SCREENING EVENTS.OTHER HEALTH NEEDS NOT BEING ADDRESSED:TOBACCO USE -- PARKVIEW WHITLEY HOSPITAL PROVIDES INFORMATION, CLASSES AND MATERIALS TO THOSE PATIENTS WHO WISH TO ADDRESS THIS BEHAVIOR. IN WHITLEY COUNTY, THERE ARE NOT CURRENTLY ANY ORGANIZATIONS WITH PROGRAMS SPECIFICALLY DESIGNED TO ADDRESS TOBACCO USE. KOSCIUSKO COUNTY HAS A PROGRAM AND THEY ARE WORKING DILIGENTLY TO MAINTAIN EFFECTIVE PROGRAMMING THAT HAS CONSISTENT RESULTS FOR EXPECTANT MOMS AND PREVENTION PROGRAMS FOR AREA STUDENTS. DIABETES -- IN AN EFFORT TO ADDRESS OBESITY AND RELATED ISSUES IN OUR COMMUNITIES, WE WILL MOST LIKELY HAVE AN IMPACT THROUGH OUR DIABETES SUPPORT AND MANAGEMENT PROGRAMS. ALTHOUGH NOT A FOCUS AREA, WE PROVIDE DIABETES EDUCATION IN BOTH COUNTIES AND PLAN TO CONTINUE THESE PROGRAMS AS A MEANS OF REDUCING OVERALL OBESITY AND POSITIVELY IMPACTING COMMUNITY HEALTH. CARDIOVASCULAR DISEASE -- PARKVIEW WHITLEY HOSPITAL OFFERS THREE CHECK-UP DAYS PER YEAR TO HELP PATIENTS MONITOR SUCH THINGS AS CHOLESTEROL LEVELS, BLOOD PRESSURE AND OTHER CARDIOVASCULAR FACTORS. ADDITIONALLY, OUR OUTPATIENT THERAPY DEPARTMENT PROVIDES AN EXCELLENT CARDIAC REHABILITATION PROGRAM TO HELP PATIENTS REGAIN THEIR STRENGTH AND QUALITY OF LIFE AFTER A CARDIAC EVENT OR SURGERY.MATERNAL/CHILD HEALTH -- IN WHITLEY COUNTY, HEALTH INDICATORS HAVE SHOWN AN INCREASED NUMBER OF CHILD ABUSE AND NEGLECT CASES IN THE COMMUNITY. WE FEEL STRONGLY THAT THIS MAY BE DIRECTLY TIED TO THE MENTAL HEALTH AND ADDICTIONS INDICATOR, AND THUS MAY BE IMPACTED DIRECTLY BY THE FOCUS ON THOSE AREAS. PARKVIEW WHITLEY HOSPITAL WILL SERVE AS A COMMUNITY LEADER PARTNERING WITH OTHER KEY COMMUNITY ORGANIZATIONS TO PROMOTE A CULTURE OF HEALTHY DECISIONS THAT PROMOTE THE SAFETY AND WELL-BEING OF INFANTS AND CHILDREN BEFORE AND AFTER THEIR BIRTH. PARKVIEW WHITLEY HOSPITAL WILL CONTINUE TO ESTABLISH NEW PROGRAMS AND FOSTER EXISTING PROGRAMS AND RELATIONSHIPS WITH OTHER ORGANIZATIONS. WE AIM TO PARTNER WITH ORGANIZATIONS THAT POSITIVELY IMPACT CHILDREN AND/OR UNDERSERVED POPULATIONS.AGING-ALZHEIMER'S DISEASE -- THIS AREA OF CONCERN IS NEW ON OUR "TOP TEN" LIST OF CONCERNS. HOWEVER, WITH AN AGING POPULATION, ITS APPEARANCE IS NOT SURPRISING. PARKVIEW WHITLEY WILL CONTINUE TO WORK WITH ORGANIZATIONS FOCUSED ON SERVING OUR SENIOR POPULATION.
PART V, SECTION B, LINE 3E:	THE SIGNIFICANT HEALTH NEEDS ARE A PRIORITIZED DESCRIPTION OF THE SIGNIFICANT HEALTH NEEDS OF THE COMMUNITY AND IDENTIFIED THROUGH THE CHNA.

Schedule H (Form 990) 2020

Page 9

Part VFacility Information (continued)

Section D. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility (list in order of size, from largest to smallest) How many non-hospital health care facilities did the organization operate during the tax year?1
Name and address		Type of Facility (describe)
1	1 - PWH EMS 1250 E STATE ROAD 205 COLUMBIA CITY,IN46725	AMBULANCE SERVICES
2
3
4
5
6
7
8
9
10

Schedule H (Form 990) 2020

Page 10

Part VI

Supplemental Information

Provide the following information.

1	Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II and Part III, lines 2, 3, 4, 8 and 9b.
2	Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any CHNAs reported in Part V, Section B.
3	Patient education of eligibility for assistance. 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.
4	Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5	Promotion of community health. 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.).
6	Affiliated health care system. 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.
7	State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.

Form and Line Reference	Explanation
PART I, LINE 3C:	EQUITY IN A HOME OTHER THAN THE PATIENT OR GUARANTOR'S PRIMARY RESIDENCE.
PART I, LINE 6A:	THE RELATED ENTITIES OF PARKVIEW HEALTH SYSTEM, INC. (EIN 35-1972384); PARKVIEW HOSPITAL, INC. (EIN 35-0868085); COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC. (EIN 20-2401676); COMMUNITY HOSPITAL OF NOBLE COUNTY, INC. (EIN 35-2087092); HUNTINGTON MEMORIAL HOSPITAL, INC. (EIN 35-1970706); WHITLEY MEMORIAL HOSPITAL, INC. (EIN 35-1967665) AND PARKVIEW WABASH HOSPITAL, INC. (EIN 47-1753440) PREPARED A COMBINED REPORT TO THE COMMUNITY DETAILING COMMUNITY BENEFIT PROGRAMS AND SERVICES.
PART I, LINE 7:	PART I, LINE 7ATHE FINANCIAL ASSISTANCE COST REPORTED ON LINE 7A IS CALCULATED UNDER THE COST TO CHARGE RATIO METHODOLOGY. UNDER THIS METHOD, THE FINANCIAL ASSISTANCE CHARGES FOREGONE ARE MULTIPLIED BY THE RATIO OF COST TO CHARGES TO DETERMINE THE COST OF SERVICES RENDERED.PART I, LINE 7BWHITLEY MEMORIAL 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 7CWHITLEY MEMORIAL HOSPITAL, INC. ACCEPTS ALL MEANS-TESTED PATIENTS FROM THE HEALTHY INDIANA PLAN (HIP) WITH THE KNOWLEDGE THAT THERE MAY BE SHORTFALLS. INTERNAL REVENUE SERVICE (IRS) REVENUE RULING 69-545 IMPLIES THAT TREATING MEANS-TESTED PATIENTS IS A COMMUNITY BENEFIT. IRS REVENUE RULING 69-545, WHICH ESTABLISHED THE COMMUNITY BENEFIT STANDARD FOR NONPROFIT HOSPITALS, STATES THAT IF A HOSPITAL SERVES PATIENTS WITH GOVERNMENTAL HEALTH BENEFITS, INCLUDING HIP, THEN THIS IS AN INDICATION THAT THE HOSPITAL OPERATES TO PROMOTE THE HEALTH OF THE COMMUNITY. THE UNREIMBURSED HIP COST REPORTED ON LINE 7C IS CALCULATED UNDER THE COST TO CHARGE RATIO METHODOLOGY. UNDER THIS METHOD, THE HIP CHARGES ARE MULTIPLIED BY THE RATIO OF COST TO CHARGES TO DETERMINE THE COST OF HIP SERVICES RENDERED. THEN, THE COST OF HIP SERVICES RENDERED IS DEDUCTED FROM THE REIMBURSEMENT RECEIVED FOR HIP PATIENTS TO ARRIVE AT A GAIN/(LOSS) RELATIVE TO THESE PATIENTS.PART I, LINE 7EAMOUNTS PRESENTED ARE BASED ON ACTUAL SPEND FOR THOSE SERVICES AND BENEFITS PROVIDED DEEMED TO IMPROVE THE HEALTH OF THE COMMUNITIES IN WHICH WE SERVE AND CONFORM WITH THE MISSION OF OUR EXEMPT PURPOSE.PART I, LINE 7FAMOUNTS PRESENTED ARE BASED UPON ACTUAL SPEND AND ARE IN CONFORMITY WITH AGREED UPON COMMITMENTS WITH THE VARIOUS EDUCATIONAL PROGRAMS.PART I, LINE 7IIN KEEPING WITH OUR MISSION AND COMMITMENT TO THE COMMUNITIES IN WHICH WE SERVE, WHITLEY MEMORIAL 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, LN 7 COL(F):	PERCENT OF TOTAL EXPENSEWHITLEY MEMORIAL HOSPITAL, INC. EXCLUDED $10,334,676 OF PH CLINICAL SUPPORT 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.HEALTH RESOURCES & SERVICES ADMINISTRATION (HRSA), IS AN AGENCY OF THE U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES. HRSA DEVELOPS SHORTAGE DESIGNATION CRITERIA AND USES THEM TO DETERMINE IF A GEOGRAPHIC AREA, POPULATION GROUP OR FACILITY IS A HEALTH PROFESSIONAL SHORTAGE AREA (HPSA) OR A MEDICALLY UNDERSERVED AREA OR POPULATION (MUA/P). HRSA HAS DESIGNATED THE WARSAW MENTAL HEALTH CATCHMENT AREA 28 IN WHITLEY COUNTY AND KOSCIUSKO COUNTY AS A HPSA IN MENTAL HEALTH. HRSA HAS DESIGNATED THE LOW INCOME - WARSAW SERVICE AREA LOCATED IN KOSCIUSKO COUNTY, AS A MUP.AS SUCH, WHITLEY MEMORIAL HOSPITAL, INC. PROVIDES SUPPORT FOR LOCAL ECONOMIC DEVELOPMENT PROGRAMS. THESE EFFORTS ARE ALIGNED WITH THE HEALTH SYSTEM'S STRATEGIC INVOLVEMENT IN THE NORTHEAST INDIANA REGIONAL PARTNERSHIP'S VISION 2030, A REGIONAL INITIATIVE DESIGNED TO TRANSFORM NORTHEAST INDIANA INTO A TOP GLOBAL COMPETITOR BY FOCUSING ON A COMMON MISSION TO DEVELOP, ATTRACT AND RETAIN TALENT. VISION 2030'S REGIONAL PRIORITIES ARE TIED TO EDUCATION/WORKFORCE, BUSINESS CLIMATE, ENTREPRENEURSHIP, INFRASTRUCTURE AND QUALITY OF LIFE FOR THE ELEVEN-COUNTY REGION IN NORTHEAST INDIANA. PROMOTION OF ECONOMIC AND LEADERSHIP DEVELOPMENT IN WHITLEY COUNTY AND KOSCIUSKO COUNTY IS A PART OF A COLLECTIVE PLAN TO IMPROVE THE QUALITY OF LIFE AND ULTIMATELY THE OVERALL HEALTH AND WELL-BEING OF THE COMMUNITY. EVERY MEMBER OF WHITLEY MEMORIAL HOSPITAL, INC.'S HEALTHCARE TEAM IS RESPONSIBLE FOR NURTURING AN ENVIRONMENT OF EXCELLENCE THAT PROVIDES THE BEST PLACE FOR CO-WORKERS TO WORK, PHYSICIANS TO PRACTICE MEDICINE, AND PATIENTS TO RECEIVE CARE. WE ARE COMMITTED TO PROVIDING EXCELLENT CUSTOMER SERVICE TO ALL PEOPLE. WE KNOW HOW IMPORTANT CLINICAL SERVICE AND OPERATIONAL EXCELLENCE IS TO THE SUCCESS OF WHITLEY MEMORIAL HOSPITAL, INC., AND WE RECOGNIZE HOW IMPORTANT OUR SUCCESS IS TO THE COMMUNITY. WE ARE ALSO COMMITTED TO PROVIDING OPPORTUNITIES TO OUR NURSING STAFF TO FURTHER THEIR EDUCATION AND ENCOURAGE ALL NURSING STAFF TO PURSUE, AT MINIMUM, A BACHELOR'S DEGREE IN NURSING. RELATED TO DIRECT HEALTHCARE, WHITLEY MEMORIAL HOSPITAL, INC. SUPPORTS PHYSICIAN RECRUITMENT ACTIVITIES TO ENSURE OUR ABILITY TO RESPOND TO PATIENT CARE NEEDS IN THE COMMUNITY. THESE RECRUITMENT ACTIVITIES ARE BASED ON THE RESULTS OF A PERIODIC PHYSICIAN NEEDS ASSESSMENT. WHITLEY MEMORIAL HOSPITAL, INC. DEVELOPS A PHYSICIAN RECRUITMENT PLAN TO PROACTIVELY ADDRESS POTENTIAL GAPS IN PATIENT COVERAGE WHILE STRIVING TO BRING THE BEST INTEGRATED, QUALITY, AND COST-EFFECTIVE CARE AND INNOVATIVE TECHNOLOGY TO OUR COMMUNITIES. IN DOING SO, WE FOCUS OUR EFFORTS ON RECRUITING AN EXCEPTIONAL TEAM OF PHYSICIANS THAT ARE THE RIGHT FIT FOR THE COMMUNITY.WHITLEY MEMORIAL HOSPITAL, INC. HAS OPENED ITS FACILITIES TO STUDENTS ENROLLED IN JOB SHADOWING OR INTERNSHIP PROGRAMS IN THEIR HIGH SCHOOLS OR COLLEGES FOR MANY YEARS. NURSING STAFF AND OTHER CLINICAL COWORKERS ARE EAGER TO SHARE THEIR EXPERIENCES WITH THOSE WHO MAY BE INTERESTED IN PURSUING HEALTHCARE CAREERS WHILE PROVIDING INSIGHT INTO THE REAL-LIFE CLINICAL SETTING. THE PROGRAM WAS STARTED IN EARLY 2020 BUT HAD TO BE DISCONTINUED DUE TO COVID-19 PANDEMIC RESTRICTIONS.WHITLEY MEMORIAL HOSPITAL, INC. FOCUSED ON COMMUNITY YOUTH AS WELL THROUGH A CONTRIBUTION TO THE KOSCIUSKO YOUTH LEADERSHIP ACADEMY (KYLA). THE INITIATIVE IS AN OFFSHOOT OF AN ADULT PROGRAM GEARED TOWARDS UPCOMING LEADERS IN THE ADULT WORKFORCE IN KOSCIUSKO COUNTY. SIMILAR IN MISSION, KYLA WAS FORMED TO ENCOURAGE THE GROWTH, EDUCATION, TRAINING AND MOTIVATION OF FUTURE LEADERS TO MEET THE CHALLENGES OF DEVELOPMENT AND EXPANSION IN KOSCIUSKO COUNTY. WHITLEY MEMORIAL HOSPITAL, INC. HAS TRADITIONALLY PROVIDED COMMUNITY BUILDING SUPPORT THROUGH PARTICIPATION IN LOCAL EVENTS SUCH AS GOLF OUTINGS SPONSORED BY COMMUNITY NON-PROFIT ORGANIZATIONS, HOWEVER, COVID-19 IMPACTED THE NUMBER OF EVENTS IN 2020. SEVERAL DONATIONS AND SPONSORSHIPS WERE MADE IN LIEU OF IN-PERSON PARTICIPATION AND INCLUDED WARSAW EDUCATION FOUNDATION QUIZ BOWL, UNITED WAY OF KOSCIUSKO COUNTY 100 WOMEN WHO CARE, KOSCIUSKO CHAMBER OF COMMERCE GOLF OUTING, KOSCIUSKO COUNTY COMMUNITY FAIR AND BABE (BEDS AND BRITCHES) MINI GOLF EVENT.WHITLEY MEMORIAL HOSPITAL, INC. LEADERS SERVE ON LOCAL BOARDS AND COMMITTEES OF NON-PROFIT ORGANIZATIONS. THESE INCLUDE MISSION 25 HOMELESS SHELTER, PASSAGES INC. ORGANIZATION FOR MENTALLY CHALLENGED INDIVIDUALS, JOE'S KIDS WHICH PROVIDES PHYSICAL, OCCUPATIONAL AND SPEECH THERAPY TO CHILDREN IN NEED, PARKVIEW WARSAW YMCA AND KOSCIUSKO CHAMBER OF COMMERCE. THE ROLES ARE PERFECT OPPORTUNITIES TO CONNECT WITH THE COMMUNITY AND PROVIDE INSIGHT FROM THE HEALTHCARE PERSPECTIVE RELATED TO LOCAL PROGRAMS AND ISSUES.
PART III, LINE 2:	FOR FINANCIAL STATEMENT PURPOSES, THE ORGANIZATION HAS ADOPTED ACCOUNTING STANDARDS UPDATE NO. 2014-09 (TOPIC 606). IMPLICIT PRICE CONCESSIONS INCLUDES BAD DEBTS. THEREFORE, BAD DEBTS ARE INCLUDED IN NET PATIENT REVENUE IN ACCORDANCE WITH HEALTHCARE FINANCIAL MANAGEMENT ASSOCIATION STATEMENT NO. 15 AND BAD DEBT EXPENSE IS NOT SEPARATELY REPORTED AS AN EXPENSE. THE AMOUNT REPORTED ON PART III, LINE 3 IS THE ESTIMATED COST OF BAD DEBT ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER PARKVIEW HEALTH SYSTEM'S FINANCIAL ASSISTANCE POLICY ON A GROSS BASIS.
PART III, LINE 3:	COSTING METHODOLOGY USED:UNCOLLECTIBLE PATIENT ACCOUNTS ARE CHARGED AGAINST THE PROVISION FOR BAD DEBT IN ACCORDANCE WITH THE POLICIES OF WHITLEY MEMORIAL HOSPITAL, INC. HOWEVER, DURING THE COLLECTION PROCESS THERE IS A CONTINUOUS EFFORT TO DETERMINE IF THE PATIENT QUALIFIES FOR FINANCIAL ASSISTANCE. THEREFORE, ONCE AN UNCOLLECTIBLE ACCOUNT HAS BEEN CHARGED OFF AND IT IS DETERMINED THROUGH THE COLLECTION PROCESS THAT THE PATIENT QUALIFIES FOR FINANCIAL ASSISTANCE, THE UNCOLLECTIBLE ACCOUNT IS RECLASSIFIED TO CHARITY CARE AND ALL COLLECTION EFFORTS CEASE. PATIENTS ARE ELIGIBLE TO APPLY FOR FINANCIAL ASSISTANCE AT ANY TIME DURING THE APPLICATION PERIOD, INCLUDING PATIENTS WHOSE ACCOUNTS HAVE BEEN PLACED WITH A COLLECTION AGENCY. THE AMOUNT REFLECTED ON LINE 3 WAS CALCULATED BY TOTALING THE ACCOUNTS PREVIOUSLY WRITTEN OFF TO BAD DEBT AND PLACED WITH A COLLECTION AGENCY, BUT SUBSEQUENTLY RECLASSIFIED AS CHARITY CARE DURING THE TAX YEAR. THE ACCOUNTS WERE RECLASSIFIED AS CHARITY CARE DUE TO THE FACT THAT PATIENTS APPLIED FOR, AND WERE APPROVED FOR, FINANCIAL ASSISTANCE AFTER THE ACCOUNTS WERE PLACED WITH A BAD DEBT AGENCY.
PART III, LINE 4:	BAD DEBT EXPENSE - PARKVIEW HEALTH SYSTEM, INC. AND SUBSIDIARIES - NOTES TO THE CONSOLIDATED FINANCIAL STATEMENTSTEXT OF THE FOOTNOTE TO THE ORGANIZATION'S FINANCIAL STATEMENTS THAT DESCRIBES BAD DEBT EXPENSE OR THE PAGE NUMBER ON WHICH THIS FOOTNOTE IS CONTAINED IN THE ATTACHED FINANCIAL STATEMENTS:PAGES 13 AND 24 - 27 OF ATTACHED FINANCIAL STATEMENTS.
PART III, LINE 8:	COMMUNITY BENEFIT & METHODOLOGY FOR DETERMINING MEDICARE COSTSSUBSTANTIAL SHORTFALLS TYPICALLY ARISE FROM PAYMENTS THAT ARE LESS THAN THE COST TO PROVIDE THE CARE OR SERVICES AND DO NOT INCLUDE ANY AMOUNTS RELATING TO INEFFICIENT OR POOR MANAGEMENT. WHITLEY MEMORIAL 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, WHITLEY MEMORIAL HOSPITAL, INC. HAS TAKEN THE POSITION NOT TO INCLUDE THE MEDICARE SHORTFALLS OR SURPLUSES AS PART OF COMMUNITY BENEFIT. WHITLEY MEMORIAL HOSPITAL, INC. RECOGNIZES THAT THE SHORTFALL OR SURPLUS FROM MEDICARE DOES NOT INCLUDE THE COSTS AND REVENUES ASSOCIATED WITH MEDICARE ADVANTAGE PATIENTS. AS SUCH, THE TOTAL SHORTFALL OR SURPLUS OF MEDICARE IS UNDERSTATED DUE TO THE COSTS AND REVENUES ASSOCIATED WITH MEDICARE ADVANTAGE PATIENTS NOT BEING INCLUDED IN THE COMMUNITY BENEFIT DETERMINATION.
PART III, LINE 9B:	IF THE PATIENT CANNOT PAY IN FULL, THE OPTION OF A LOW INTEREST LOAN IS AVAILABLE WITH THE SAME DISCOUNT OFFERED FOR CASH PAYMENTS AS LONG AS THE LOAN IS ARRANGED WITHIN 30 DAYS OF THE FIRST GUARANTOR STATEMENT. IF THE PATIENT DEFAULTS ON THE LOAN, THE DISCOUNT WILL BE REVERSED AND THE PATIENT'S ACCOUNT WILL BE PLACED IN A COLLECTION AGENCY.INTEREST-FREE PAYMENTS WITH PAY-OUT NOT TO EXCEED THIRTY-SIX (36) MONTHS ARE AVAILABLE. THE MINIMUM MONTHLY PAYMENT IS $25.FINANCIAL ASSISTANCE MAY BE AVAILABLE FOR THOSE PATIENTS WHO CANNOT PAY THEIR BILL. THOSE OPTIONS ARE GOVERNMENTAL ASSISTANCE OR FREE CARE THROUGH THE HOSPITAL FINANCIAL ASSISTANCE PROGRAM. THE HEALTH SYSTEM FINANCIAL ASSISTANCE POLICY IS AVAILABLE ON PARKVIEW.COM OR BY VISITING ANY HOSPITAL CASHIER OFFICE OR BY CALLING PATIENT ACCOUNTING AT 260.266.6700 OR TOLL FREE 855.814.0012. A PATIENT MAY APPLY FOR FINANCIAL ASSISTANCE ANYTIME DURING THE APPLICATION PERIOD. FAILURE TO MAKE ARRANGEMENTS AS LISTED ABOVE OR FAILURE TO APPLY FOR AND RECEIVE APPROVAL UNDER THE FINANCIAL ASSISTANCE POLICY MAY RESULT IN THE ACCOUNT BEING PLACED IN A COLLECTION AGENCY DUE TO NON-PAYMENT. THE COLLECTION AGENCY MAY REPORT THE ACCOUNT TO ONE OR ALL THREE CREDIT REPORTING AGENCIES WHICH MAY ULTIMATELY ADVERSELY AFFECT THE PATIENT'S CREDIT SCORE. ADDITIONALLY, THE COLLECTION AGENCY MAY SUE AND OBTAIN A JUDGMENT AGAINST THE PATIENT FOR NON-PAYMENT. THESE ACTIONS WILL NOT OCCUR UNTIL 120 DAYS AFTER THE PATIENT IS SENT THEIR FIRST FOLLOW-UP STATEMENT INDICATING THE AMOUNT THEY OWE.A PATIENT MAY APPLY FOR FINANCIAL ASSISTANCE AT ANY TIME DURING THE APPLICATION PERIOD, EVEN THOUGH THEY HAVE BEEN PLACED WITH A COLLECTION AGENCY. IF THE PATIENT WAS SENT THEIR FIRST NOTICE ON THE ACCOUNT FOR WHICH THEY ARE APPLYING FOR FREE CARE BETWEEN 120 DAYS AND THE END OF THE APPLICATION PERIOD, THE ACTIONS ABOVE WILL BE SUSPENDED UNTIL THE FREE CARE APPLICATION ELIGIBILITY IS DETERMINED.
PART VI, LINE 2:	DESCRIBE HOW THE ORGANIZATION ASSESSES THE HEALTH CARE NEEDS OF THE COMMUNITIES IT SERVES, IN ADDITION TO ANY CHNAS REPORTED IN PART V, SECTION B.IN ADDITION TO IDENTIFYING HEALTH NEEDS THROUGH THE TRIENNIAL COMMUNITY HEALTH NEEDS ASSESSMENT, WHITLEY MEMORIAL HOSPITAL, INC. IDENTIFIES AND VERIFIES COMMUNITY HEALTH NEEDS THROUGH THE FOLLOWING:- OTHER COMMUNITY NEEDS ASSESSMENTS CONDUCTED BY LOCAL ORGANIZATIONS- USE OF CONDUENT'S HEALTHY COMMUNITIES INSTITUTE SECONDARY DATA PLATFORM- OBSERVATIONS BY HEALTHCARE PROFESSIONALS WHO WORK WITH VULNERABLE POPULATIONS- SPECIFIC REQUESTS PROMPTED BY OTHER PROFESSIONALS IN THE COMMUNITYHOSPITAL REPRESENTATIVES MAINTAIN ON-GOING RELATIONSHIPS THROUGHOUT THE COMMUNITY AND MEET REGULARLY WITH ORGANIZATIONS THAT SHARE THE MISSION OF IMPROVING THE HEALTH AND INSPIRING THE WELL-BEING OF THE COMMUNITY WE SERVE.
PART VI, LINE 3:	DESCRIBE HOW THE ORGANIZATION INFORMS AND EDUCATES PATIENTS AND PERSONS WHO MAY BE BILLED FOR PATIENT CARE ABOUT THEIR ELIGIBILITY FOR ASSISTANCE UNDER FEDERAL, STATE OR LOCAL GOVERNMENT PROGRAMS OR UNDER THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY.SIGNAGE AND BROCHURES ARE POSTED AND AVAILABLE AT ALL HOSPITAL POINTS OF REGISTRATION AND IN THE EMERGENCY DEPARTMENT. PATIENTS ARE OFFERED PLAIN LANGUAGE SUMMARIES OF THE FINANCIAL ASSISTANCE POLICY DURING THE REGISTRATION PROCESS AND IN EACH FOLLOW UP STATEMENT SENT TO THE PATIENT. PATIENT STATEMENTS WILL INDICATE HOW A PATIENT CAN OBTAIN FINANCIAL ASSISTANCE APPLICATIONS AND WHO THEY CAN CONTACT FOR ASSISTANCE.
PART VI, LINE 4:	DESCRIBE THE COMMUNITY THE ORGANIZATION SERVES, TAKING INTO ACCOUNT THE GEOGRAPHIC AREA AND DEMOGRAPHIC CONSTITUENTS IT SERVES.WHITLEY MEMORIAL HOSPITAL, INC., A MEMBER OF PARKVIEW HEALTH SYSTEMS, INC., HAS TWO LOCATIONS. PARKVIEW WHITLEY HOSPITAL IS A FULL-SERVICE HOSPITAL WITH MEDICAL/SURGICAL AND OBSTETRICS INPATIENT UNITS. PARKVIEW WARSAW OPERATES AS A HOSPITAL OPERATED DEPARTMENT (HOD) UNDER THE WHITLEY MEMORIAL HOSPITAL, INC. TAX ID AND PROVIDER NUMBERS. PARKVIEW WARSAW FEATURES A FREE-STANDING EMERGENCY DEPARTMENT WITH MULTI-MODALITY IMAGING, LABORATORY AND PHYSICAL REHABILITATION COUPLED WITH SUITES FOR PRIMARY CARE OFFICES AND SPECIALTY PHYSICIAN CLINICS. THE FACILITIES PRIMARILY SERVICE WHITLEY AND KOSCIUSKO COUNTIES INCLUDING THE COMMUNITIES OF COLUMBIA CITY, CHURUBUSCO, LARWILL, AND SOUTH WHITLEY, PIERCETON, WARSAW, AND WINONA LAKE. WHITLEY COUNTY HAD APPROXIMATELY 33,292 RESIDENTS, PRIMARILY IDENTIFYING AS CAUCASIAN, IN 2020. THE MEDIAN HOUSEHOLD INCOME WAS $61,741. THE 2020 UNEMPLOYMENT RATE REACHED A HIGH OF 17.6% IN APRIL, RELATED TO THE COVID-19 PANDEMIC'S IMPACT ON BUSINESSES, AND DECREASED TO A MORE TYPICAL RATE OF 2.9% IN DECEMBER. EMPLOYMENT IN THE COUNTY IS MOSTLY RELATED TO MANUFACTURING, RETAIL AND HEALTHCARE. KOSCIUSKO COUNTY HAD APPROXIMATELY 77,358 RESIDENTS IN 2020, WITH THE MAJORITY OF THE POPULATION IDENTIFYING AS CAUCASIAN AND APPROXIMATELY 8.2% OF THE POPULATION HISPANIC OR LATINO ETHNICITY. THE UNEMPLOYMENT RATE IN APRIL 2020 WAS 19.2% BUT DROPPED DOWN TO 3.3% BY END OF THE YEAR. MANUFACTURING, HEAVILY WEIGHTED IN THE ORTHOPEDICS INDUSTRY, AND HEALTH SERVICES MAKE UP THE MAJORITY OF EMPLOYMENT IN THE COUNTY. THE 2020 MEDIAN HOUSEHOLD INCOME WAS $61,366.
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.).WHITLEY MEMORIAL HOSPITAL, INC.'S BOARD OF DIRECTORS IS COMPRISED OF INDEPENDENT COMMUNITY MEMBERS FROM WHITLEY AND KOSCIUSKO COUNTIES ALONG WITH THE HOSPITAL PRESIDENT AND MEDICAL STAFF PRESIDENT. THE HOSPITAL EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN THE COMMUNITY. PEOPLE THROUGHOUT THE COMMUNITY CAN COUNT ON WHITLEY MEMORIAL HOSPITAL, INC., TO BE AVAILABLE WITH EMERGENCY CARE 24 HOURS A DAY, 365 DAYS A YEAR. THE EMERGENCY DEPARTMENTS BOTH IN WHITLEY COUNTY AND KOSCIUSKO COUNTY ARE STAFFED WITH BOARD-CERTIFIED EMERGENCY CARE PHYSICIANS AND A NURSING STAFF THAT IS TRAINED AND EXPERIENCED IN EMERGENCY CARE. FURTHERMORE, NO PATIENT IS EVER DENIED TREATMENT, REGARDLESS OF THEIR ABILITY TO PAY. THE HOSPITAL IN WHITLEY COUNTY FEATURES 30 PRIVATE ROOMS, IN A 96,000 SQUARE FOOT FACILITY LOCATED ON 42 ACRES. PARKVIEW WARSAW IN KOSCIUSKO COUNTY IS A 90,000 SQUARE FOOT FACILITY FEATURING 9 EMERGENCY ROOM BEDS INCLUDING 2 THAT ARE EQUIPPED FOR TRAUMA PATIENTS. THE WARSAW FACILITY IS A HOSPITAL OUTPATIENT DEPARTMENT (HOD) UNDER WHITLEY MEMORIAL HOSPITAL, INC.'S TAX IDENTIFICATION AND PROVIDER NUMBERS.AS A COMMUNITY PARTNER AND NOT-FOR-PROFIT ORGANIZATION, WHITLEY MEMORIAL HOSPITAL, INC., IS DEDICATED TO IMPROVING YOUR HEALTH AND INSPIRING YOUR WELL-BEING BY TAILORING A PERSONALIZED HEALTH JOURNEY TO ACHIEVE YOUR UNIQUE GOALS. BY DEMONSTRATING WORLD-CLASS TEAMWORK, WE PARTNER WITH YOU ALONG THAT JOURNEY AND PROVIDE THE EXCELLENCE, INNOVATION AND VALUE YOU SEEK IN TERMS OF CONVENIENCE, COMPASSION, SERVICE, COST AND QUALITY. WHITLEY MEMORIAL HOSPITAL, INC. CONSISTENTLY EARNS HIGH METRICS IN PUBLICLY REPORTED QUALITY MEASURES AS WELL AS THE PATIENTS' PERCEPTION OF CARE. MAGNET HOSPITAL ACCREDITATION WAS EARNED IN 2017 FROM THE AMERICAN NURSES CREDENTIALING CENTERS, DEMONSTRATING THE BEST PRACTICES AND CULTURE THAT INCORPORATED AT OUR FACILITY TO CONSISTENTLY PROVIDE THE HIGHEST QUALITY OF CARE TO ALL PATIENTS. BABY-FRIENDLY DESIGNATION WAS ACHIEVED IN 2018 FROM UNICEF AND WORLD HEALTH ORGANIZATION INITIATIVE, RECOGNIZING A COMMITMENT TO HEALTHY BABIES THROUGH SUPPORT AND PROMOTION OF BREASTFEEDING INITIATIVES. THE HOSPITAL CONTINUES TO COMPLY WITH THOSE REQUIREMENTS IN ITS DEDICATION AND STRONG BELIEF IN THE BENEFITS OF BREASTFEEDING FOR HEALTHY CHILDREN IN THE COMMUNITY. THE FOLLOWING LIST DEMONSTRATES SOME OF THE WAYS WHITLEY MEMORIAL HOSPITAL, INC., REACHES OUT TO MAKE OUR COMMUNITIES HEALTHIER: -COMMUNITY HEALTH IMPROVEMENT INITIATIVES-COMMUNITY NURSE PROGRAM-PRIMARY HEALTH CARE/ACCESS-FINANCIAL ASSISTANCE-EMS SERVICES-MEDICATION ASSISTANCE PROGRAM (MAP)-HEALTH SCREENING/PREVENTION AND DISEASE MANAGEMENT-EDUCATIONAL AND SUPPORT PROGRAMS-SPONSORSHIPSCOMMUNITY HEALTH IMPROVEMENT INITIATIVES:THE PURPOSE OF WHITLEY MEMORIAL HOSPITAL, INC.'S COMMUNITY HEALTH IMPROVEMENT PROGRAM IS TO FUND COMMUNITY HEALTH IMPROVEMENT EFFORTS WITHIN THE SERVICE AREA OF WHITLEY MEMORIAL HOSPITAL, INC. THE HOSPITAL SETS ASIDE UP TO 10 PERCENT OF ITS NET INCOME ANNUALLY TO FUND COMMUNITY HEALTH INITIATIVES AND PARTNERS WITH COMMUNITY ORGANIZATIONS TO ENCOURAGE HEALTHIER LIFESTYLES AMONG THE CITIZENS OF NORTHEAST INDIANA. WHITLEY MEMORIAL HOSPITAL, INC. INVESTS IN KEY ORGANIZATIONS THAT PROMOTE THE HEALTH AND WELLNESS OF FAMILIES, CHILDREN, AND INDIVIDUALS OF WHITLEY AND KOSCIUSKO COUNTIES. KEY PROJECTS AND AREAS OF FOCUS FUNDED THROUGH THE COMMUNITY HEALTH IMPROVEMENT INITIATIVE AND OTHER HOSPITAL FUNDS INCLUDE:-SUPPORTED B.A.B.E. OF WHITLEY COUNTY, AN INCENTIVE-BASED PROGRAM FOR PREGNANT WOMEN AND FAMILIES, TO DETER THE HIGH INCIDENCE OF LOW-BIRTH WEIGHT BABIES AND TO ENSURE THAT THE CHILDREN ARE GIVEN THE BEST POSSIBLE START IN LIFE. -INTERFAITH MISSION (NOW MISSION 25) IS A MEN'S AND WOMEN'S TRANSITIONAL SHELTER THAT EDUCATES AS WELL AS HOUSES THE HOMELESS, PROVIDING SKILLS AND SUPPORT TO BE ABLE TO LIVE INDEPENDENTLY. THEY TEACH PARENTING, COOKING, NUTRITION CLASSES, AND COLLABORATE WITH OTHER SERVICES IN THE COMMUNITY FOR THEIR CLIENTS. -MULTI-COUNTY MEDICAL OUTREACH CLINIC RECEIVES IN-KIND LAB SERVICES THROUGH PARKVIEW WHITLEY HOSPITAL TO SERVE THE NEEDS OF THEIR UNINSURED PATIENTS. THEY ALSO RECEIVE IN-KIND SPACE TO OPERATE THEIR FREE MEDICAL CLINIC. -WHITLEY COUNTY FARMERS MARKET SPONSORS THE DOWNTOWN COLUMBIA CITY SATURDAY MARKETS WHICH PROVIDE LOCALLY GROWN, FRESH FRUITS AND VEGETABLES FOR SALE TO THE COMMUNITY EVERY SATURDAY SEASONALLY. THE FARMERS MARKET ACCEPTS SNAP AND WIC AS PAYMENT, WHICH IS VERY BENEFICIAL TO LOW-INCOME FAMILIES IN THE COMMUNITY. TO FURTHER INCREASE ACCESS TO FRESH, HEALTHY PRODUCE TO THE COMMUNITY, PARKVIEW WHITLEY HOSTS A MID-WEEK FARMERS' MARKET ON ITS CAMPUS DURING THE SUMMER, GENERALLY JULY-SEPTEMBER. -THE CENTER FOR WHITLEY COUNTY YOUTH, A LOCAL YOUTH DEVELOPMENT ORGANIZATION PROVIDES POSITIVE ROLE MODELS, SNACKS, MEALS AND ACTIVITIES TO AT-RISK TEENS TO IMPROVE THEIR HEALTH AND INCREASE OPPORTUNITIES FOR SUCCESS IN LIFE. -WHITLEY MEMORIAL HOSPITAL, INC. PROVIDES LUNCHES FOR TROY CENTER SCHOOL AT NO COST TO ENSURE NUTRITIOUS MEALS ARE AVAILABLE TO EACH STUDENT. TROY CENTER IS AN ACCREDITED, INDEPENDENT ALTERNATIVE SCHOOL HELPING STUDENTS GAIN AN EDUCATION AND EARN A DIPLOMA AT THEIR OWN PACE, PROVIDING AN EDUCATIONAL OPTION FOR THOSE WHOSE LEARNING/BEHAVIORAL NEEDS WERE NOT BEING MET IN A TRADITIONAL SCHOOL SETTING.-SUPPORTED ONE COMMUNITY, A LOCAL ORGANIZATION, WITH A NEW PROGRAM CALLED KIDS CONNECT, WHICH PROVIDES FREE SUMMER LUNCH AND ACTIVITY PROGRAM TO CHILDREN IN THE SOUTH WHITLEY AREA OF WHITLEY COUNTY DURING THE SUMMER. -WHITLEY MEMORIAL HOSPITAL, INC., PARTNERED WITH PARKVIEW BEHAVIORAL HEALTH AND THE MENTAL HEALTH PROGRAM OF THE LOCAL SCHOOL SYSTEM, WHITLEY COUNTY CONSOLIDATED SCHOOLS, TO PROVIDE ADDITIONAL RESOURCES FOR STUDENTS IN NEED OR IN CRISIS. -KOSCIUSKO COMMUNITY YMCA DIABETES PREVENTION PROGRAM WAS SUPPORTED TO HELP PEOPLE THAT ARE AT RISK FOR BECOMING DIABETIC.-COMMUNITY NURSE PROGRAM:WHITLEY MEMORIAL HOSPITAL, INC. DEVELOPED A NEW COMMUNITY HEALTH NURSE PROGRAM IN 2019. THE PROGRAM INCLUDED THE CREATION OF A NEW COMMUNITY HEALTH NURSE POSITION, WHOSE ROLE WAS TO IDENTIFY THE HEALTH AND WELLBEING NEEDS OF THE UNDERSERVED WITHIN A COMMUNITY. THEIR FOCUS WAS TO IMPROVE THE HEALTH, QUALITY OF LIFE, AND WELLNESS OF THE COMMUNITY BY PROVIDING EDUCATION, SCREENINGS, AND ADDITIONAL RESOURCES. WHITLEY MEMORIAL HOSPITAL, INC.'S COMMUNITY HEALTH NURSE DEVELOPED STRATEGIES AND PROGRAMS TO PROMOTE HEALTH AND DISEASE PREVENTION IN A RANGE OF POPULATIONS INCLUDING THE ELDERLY, SCHOOL AGE CHILDREN, AND RESIDENTS IN LOCAL HOMELESS SHELTERS. THE ROLE ALSO DEVELOPED INTERVENTIONS TARGETED TO THESE POPULATIONS AND THEIR SOCIAL DETERMINANTS OF HEALTH. UNFORTUNATELY, DURING MARCH 2020, THE COMMUNITY HEALTH NURSE WAS REDEPLOYED TO THE HOSPITAL'S INPATIENT UNIT DUE TO COVID-19 PATIENT NEEDS AND BECAUSE OF SOCIAL DISTANCING RESTRICTIONS WITHIN THE COMMUNITY. THE POSITION HAD NOT BEEN REINSTATED BY END OF 2020.-FINANCIAL ASSISTANCE:WHITLEY MEMORIAL HOSPITAL, INC.'S MISSION INCLUDES CARING FOR PEOPLE WHO DO NOT HAVE THE MEANS TO MEET THEIR FINANCIAL OBLIGATIONS. A FINANCIAL COUNSELOR IS AVAILABLE TO ASSIST PATIENTS NAVIGATING THIS PROCESS. THE HOSPITAL PRIORITIZES OUR RESPONSIBILITY TO PROVIDE EXCELLENT, NECESSARY CARE TO ALL PATIENTS, NOT THE PATIENT'S ABILITY TO PAY FOR MEDICAL EXPENSES. -PRIMARY HEALTH CARE ACCESS:WHITLEY MEMORIAL HOSPITAL, INC. FEATURES 30 BEDS WITH ALL PRIVATE ROOMS. EMERGENCY MEDICAL CARE, OBSTETRIC CARE AND MEDICAL-SURGICAL UNITS ARE AVAILABLE AS WELL AS LABORATORY, MULTIPLE MODALITIES OF IMAGING, SURGICAL AND GASTRO-INTESTINAL ENDOSCOPIC SERVICES, SLEEP DISORDER LAB, IV INFUSION SERVICES, PHYSICAL REHABILITATION, CARDIAC/PULMONARY REHABILITATION AND MASSAGE THERAPY. AN ATTACHED MEDICAL OFFICE BUILDING PROVIDES CONVENIENT, EASY ACCESS FOR PATIENTS TO RECEIVE CARE FROM FAMILY AND SPECIALTY PHYSICIANS AS WELL AS LABORATORY, DIAGNOSTIC IMAGING SERVICES AND A SLEEP DISORDER LAB.THE PARKVIEW WARSAW FACILITY IN KOSCIUSKO COUNTY INCLUDES A 9-BED FREE-STANDING EMERGENCY DEPARTMENT, MULTI-MODALITY IMAGING, LABORATORY, PHYSICAL AND OCCUPATIONAL REHABILITATION AND ANTI-COAGULATION CLINIC AS WELL AS PRIMARY CARE AND SPECIALTY PHYSICIAN OFFICES. EMERGENCY PATIENTS WHO REQUIRE A HIGHER LEVEL OF CARE ARE TRANSPORTED TO WHITLEY MEMORIAL HOSPITAL, INC. OR TO TERTIARY CARE FACILITIES IN ALLEN COUNTY.(SEE END OF SCHEDULE O FOR CONTINUATION)
PART VI, LINE 6:	IF THE ORGANIZATION IS PART OF AN AFFILIATED HEALTH CARE SYSTEM, DESCRIBE THE RESPECTIVE ROLES OF THE ORGANIZATION AND ITS AFFILIATES IN PROMOTING THE HEALTH OF THE COMMUNITIES SERVED.PARKVIEW HEALTH SYSTEM, INC. (PARKVIEW), A HEALTHCARE SYSTEM SERVING NORTHEAST INDIANA AND NORTHWEST OHIO THROUGH OUR HOSPITALS AND PHYSICIAN CLINICS, INCLUDES THE NOT-FOR-PROFIT HOSPITALS OF PARKVIEW HOSPITAL, INC.: COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC.; COMMUNITY HOSPITAL OF NOBLE COUNTY, INC.; PARKVIEW WABASH HOSPITAL, INC.; WHITLEY MEMORIAL HOSPITAL, INC.; HUNTINGTON MEMORIAL HOSPITAL, INC.; DEKALB MEMORIAL HOSPITAL, INC.; AS WELL AS 60 PERCENT OWNERSHIP IN THE JOINT VENTURE OF ORTHOPEDIC HOSPITAL AT PARKVIEW NORTH, LLC.THE CORPORATE MISSION AND VISION IS AS FOLLOWS: AS A COMMUNITY OWNED, NOT-FOR-PROFIT ORGANIZATION, PARKVIEW HEALTH IS DEDICATED TO IMPROVING YOUR HEALTH AND INSPIRING YOUR WELL-BEING BY: 1) TAILORING A PERSONALIZED HEALTH JOURNEY TO ACHIEVE YOUR UNIQUE GOALS, 2) DEMONSTRATING WORLD-CLASS TEAMWORK AS WE PARTNER WITH YOU ALONG THAT JOURNEY AND 3) PROVIDING THE EXCELLENCE, INNOVATION AND VALUE YOU SEEK IN TERMS OF CONVENIENCE, COMPASSION, SERVICE, COST AND QUALITY.EACH HOSPITAL ENTITY ENGAGES IN COMMUNITY OUTREACH ACTIVITIES AND SUPPORTS THEIR RESPECTIVE COUNTY THROUGH INVESTMENTS OF COMMUNITY HEALTH IMPROVEMENT DOLLARS AND PROGRAMMING CUSTOMIZED TO MEET THE UNIQUE HEALTH NEEDS OF THEIR RESPECTIVE COMMUNITIES. AFFILIATE HOSPITALS ALSO WORK TOGETHER AND SHARE PROGRAMMING AND MESSAGING WHERE COMMON COMMUNITY HEALTH ISSUES ARE IDENTIFIED. FROM THE LIST OF HEALTH ISSUES IDENTIFIED IN THE SIX-COUNTY AREA AS PART OF THE 2019 COMMUNITY HEALTH NEEDS ASSESSMENT, THE HEALTH PRIORITY OF SUBSTANCE USE DISORDER/MENTAL HEALTH PROMOTION WAS SELECTED BY ALL AFFILIATE HOSPITALS.AFFILIATE HOSPITALS EACH HAVE A LOCAL BOARD OF DIRECTORS. PARKVIEW HEALTH SYSTEM, INC. ALSO ENGAGES A BOARD OF DIRECTORS, WHICH CONSISTS OF REPRESENTATION FROM EACH OF THE AFFILIATE HOSPITAL BOARDS AND UP TO 15 AT-LARGE PHYSICIANS OR COMMUNITY LEADERS. MOST OF THE BOARD OF DIRECTORS SHALL AT ALL TIMES BE CONSIDERED TO BE INDEPENDENT AS DEFINED BY THE INTERNAL REVENUE SERVICE. PARKVIEW CONTRIBUTES TO THE OVERALL SUCCESS OF THE REGION THROUGH SIGNIFICANT INVOLVEMENT IN THE COMMUNITIES WE SERVE. BY DEVELOPING VARIOUS PARTNERSHIPS AND ALIGNMENTS WITH DIFFERENT SECTORS AND ORGANIZATIONS, PARKVIEW HELPS TO BENEFIT THE ECONOMY, QUALITY OF LIFE AND HEALTH/WELL-BEING ACROSS THE REGION. WITH A CONSISTENT FOCUS ON OUR MISSION AND VISION, WE WORK TO PROVIDE THE BEST CARE TO EVERY PERSON, EVERY DAY WITHIN OUR FACILITIES WHILE SERVING AS GOOD STEWARDS OF SURPLUS FUNDS IN OUR EFFORTS TO POSITIVELY IMPACT COMMUNITY HEALTH STATUS.
PART VI, LINE 7, REPORTS FILED WITH STATES	IN
PART VI, LINE 7:	A COPY OF FORM 990, SCHEDULE H IS FILED WITH THE INDIANA STATE DEPARTMENT OF HEALTH.

Schedule H (Form 990) 2020

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Schedule I
(Form 990)

Department of the Treasury
Internal Revenue Service

Grants and Other Assistance to Organizations,
Governments and Individuals in the United States

Complete if the organization answered "Yes," on Form 990, Part IV, line 21 or 22.
lBullet

Attach to Form 990.
lBullet

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2020

Open to Public
Inspection

Name of the organization
WHITLEY MEMORIAL HOSPITAL INC

Employer identification number
35-1967665

Part I

General Information on Grants and Assistance

Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ........................

Yes No

Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.

Part II

Grants and Other Assistance to Domestic Organizations and Domestic Governments. Complete if the organization answered "Yes" on Form 990, Part IV, line 21, for any recipient

that received more than $5,000. Part II can be duplicated if additional space is needed.

(a) Name and address of organization or government	(b) EIN	(c) IRC section (if applicable)	(d) Amount of cash grant	(h) Purpose of grant or assistance
(1) WHITLEY COUNTY CONSOLIDATED SCHOOLS 107 N WALNUT COLUMBIA CITY,IN46725	35-1800881	GOVT ORG	30,000	MENTAL HEALTH SERVICES FOR STUDENTS
(2) INTERFAITH MISSION INC 500 WEST BUSINESS 30 COLUMBIA CITY,IN46725	35-2071824	501(C)(3)	15,000	PROGRAMS TO PROVIDE SHELTER AND ASSISTANCE TO THE HOMELESS
(3) BABE BEDS AND BRITCHES ETC 533 N LINE ROAD COLUMBIA CITY,IN46725	35-1130532	501(C)(3)	10,150	PROGRAMS FOR PREGNANT WOMEN AND FAMILIES TO BENEFIT HEALTH AND WELL BEING OF INFANTS AND YOUNG CHIILDREN
(4) CENTER FOR WHITLEY COUNTY YOUTH INC 201 W MARKET STREET COLUMBIA CITY,IN46725	20-5993971	501(C)(3)	9,500	AFTER-SCHOOL & SUMMER PROGRAMMING FOR ADOLESCENTS INCLUDING PHYSICAL ACTIVITIES & EDUCATION

Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image

Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50055P

Schedule I (Form 990) 2020

Page 2

Part III

Grants and Other Assistance to Domestic Individuals. Complete if the organization answered "Yes" on Form 990, Part IV, line 22.
Part III can be duplicated if additional space is needed.

(a) Type of grant or assistance	(b) Number of recipients	(c) Amount of cash grant	(d) Amount of noncash assistance	(e) Method of valuation (book, FMV, appraisal, other)	(f) Description of noncash assistance
(1)
(2)
(3)
(4)
(5)
(6)
(7)

Part IV

Supplemental Information. Provide the information required in Part I, line 2; Part III, column (b); and any other additional information.

Return Reference	Explanation
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.

Schedule I (Form 990) 2020

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Schedule J
(Form 990)

Department of the Treasury
Internal Revenue Service

Compensation Information

For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
Graphic Arrow

Complete if the organization answered "Yes" on Form 990, Part IV, line 23.
Graphic Arrow

Attach to Form 990.
Graphic Arrow

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2020

Open to Public Inspection

Name of the organization

WHITLEY MEMORIAL HOSPITAL INC

Employer identification number

35-1967665

Part I

Questions Regarding Compensation

Yes

Check the appropiate box(es) if the organization provided any of the following to or for a person listed on Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.

First-class or charter travel Housing allowance or residence for personal use

Travel for companions Payments for business use of personal residence

Tax idemnification and gross-up payments Health or social club dues or initiation fees

Discretionary spending account Personal services (e.g., maid, chauffeur, chef)

If any of the boxes on Line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all of the expenses described above? If "No," complete Part III to explain .....

Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
directors, trustees, officers, including the CEO/Executive Director, regarding the items checked on Line 1a? ....

Indicate which, if any, of the following the filing organization used to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

Form 990 of other organizations Approval by the board or compensation committee

During the year, did any person listed on Form 990, Part VII, Section A, line 1a, with respect to the filing organization or a related organization:

Receive a severance payment or change-of-control payment? .............

Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........

Yes

Participate in, or receive payment from, an equity-based compensation arrangement? .........

If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.

Only 501(c)(3), 501(c)(4), and 501(c)(29) organizations must complete lines 5-9.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:

The organization? ....................

Any related organization? .......................

If "Yes," on line 5a or 5b, describe in Part III.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:

The organization? ..................

Any related organization? ......................

If "Yes," on line 6a or 6b, describe in Part III.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization provide any nonfixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............

Yes

Were any amounts reported on Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III ..........................

If "Yes" on line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50053T

Schedule J (Form 990) 2020

Page 2

Part II

Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is needed.

For each individual whose compensation must be reported on Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions, on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.
Note. The sum of columns (B)(i)-(iii) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and (E) amounts for that individual.

(A) Name and Title		(B) Breakdown of W-2 and/or 1099-MISC compensation			(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)	(F) Compensation in column (B) reported as deferred on prior Form 990
(A) Name and Title		(i) Base compensation	(ii) Bonus & incentive compensation	(iii) Other reportable compensation	(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)
1MICHAEL PACKNETT PH PRESIDENT & CEO	(i) (ii)	0 ------------- 1,193,402	0 ------------- 487,482	0 ------------- 367,537	0 ------------- 1,624,548	0 ------------- 32,305	0 ------------- 3,705,274	0 ------------- 319,527
2JEANNE' WICKENS PH CHIEF FINANCIAL OFFICER	(i) (ii)	0 ------------- 750,792	0 ------------- 262,181	0 ------------- 71,579	0 ------------- 309,952	0 ------------- 29,943	0 ------------- 1,424,447	0 ------------- 49,457
3MICHELLE HARRISON DIRECTOR/PH PHYSICIAN	(i) (ii)	17,782 ------------- 474,507	0 ------------- 97,186	0 ------------- 5,018	767 ------------- 24,883	1,001 ------------- 32,458	19,550 ------------- 634,052	0 ------------- 0
4LISA HATCHER DIRECTOR/PH PHYSICIAN	(i) (ii)	13,346 ------------- 382,935	0 ------------- 92,171	0 ------------- 11,882	836 ------------- 30,514	413 ------------- 15,078	14,595 ------------- 532,580	0 ------------- 0
5SCOTT GABRIEL DIRECTOR/WMHOS PRESIDENT	(i) (ii)	232,934 ------------- 0	58,558 ------------- 0	17,929 ------------- 0	62,837 ------------- 0	34,966 ------------- 0	407,224 ------------- 0	16,210 ------------- 0
6JEFFREY ROCKETT WMHOS VP OUTPATIENT SVCS	(i) (ii)	164,641 ------------- 0	35,820 ------------- 0	2,371 ------------- 0	14,381 ------------- 0	25,625 ------------- 0	242,838 ------------- 0	0 ------------- 0
7AMANDA KNOWLES WMHOS MGR PHARMACY	(i) (ii)	161,962 ------------- 0	18,761 ------------- 0	300 ------------- 0	17,115 ------------- 0	34,572 ------------- 0	232,710 ------------- 0	0 ------------- 0
8BENJAMIN MAGGARD WMHOS PHARMACIST	(i) (ii)	134,372 ------------- 3,536	2,000 ------------- 0	158 ------------- 4	9,849 ------------- 255	28,465 ------------- 738	174,844 ------------- 4,533	0 ------------- 0
9ASHLEY WIRGES WMHOS VP PATIENT CARE	(i) (ii)	139,107 ------------- 0	1,000 ------------- 0	411 ------------- 0	1,018 ------------- 0	30,652 ------------- 0	172,188 ------------- 0	0 ------------- 0
10CHARLES JINKS WMHOS PHARMACIST	(i) (ii)	120,896 ------------- 3,685	1,913 ------------- 0	725 ------------- 22	15,439 ------------- 463	23,229 ------------- 697	162,202 ------------- 4,867	0 ------------- 0
11PETER TALATI WMHOS MGR REHAB	(i) (ii)	118,881 ------------- 0	13,585 ------------- 0	349 ------------- 0	9,453 ------------- 0	21,294 ------------- 0	163,562 ------------- 0	0 ------------- 0

Schedule J (Form 990) 2020

Page 3

Part III

Supplemental Information

Provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II. Also complete this part for any additional information.

Return Reference	Explanation
PART I, LINE 3	RELATED ORGANIZATION, PARKVIEW HEALTH SYSTEM, INC., USES THE FOLLOWING TO ESTABLISH THE COMPENSATION OF WHITLEY MEMORIAL HOSPITAL, INC.'S CEO/EXECUTIVE DIRECTOR: COMPENSATION COMMITTEE OF RELATED ORGANIZATION PARKVIEW HEALTH SYSTEM, INC. INDEPENDENT COMPENSATION CONSULTANT FORM 990 OF OTHER ORGANIZATIONS COMPENSATION SURVEY OR STUDY APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE OF RELATED ORGANIZATION PARKVIEW HEALTH SYSTEM, INC.
PART I, LINE 4B	SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN PAYMENTS 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 $16,210; MICHAEL PACKNETT $319,527; JEANNE' WICKENS $49,457 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 $319,527 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 $37,187; MICHAEL PACKNETT $1,598,898; JEANNE' WICKENS $290,002
PART I, LINE 7	MANAGEMENT INCENTIVE COMPENSATION PLAN (MICP) AND PHYSICIAN AND PROVIDER INCENTIVE COMPENSATION PLAN (PICP) ARE ANNUAL INCENTIVE PROGRAMS. SYSTEM GOALS ARE APPROVED BY THE BOARD. AT CONCLUSION OF THE PLAN YEAR, RESULTS ARE SHARED WITH THE BOARD AND THE EXECUTIVE COMMITTEE OF THE BOARD APPROVES FINAL PAYMENT.

Schedule J (Form 990) 2020

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or 990-EZ or to provide any additional information.
MediumBullet

Attach to Form 990 or 990-EZ.
MediumBullet

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2020

Open to Public
Inspection

Name of the organization

WHITLEY MEMORIAL HOSPITAL INC

Employer identification number

35-1967665

Return Reference	Explanation
PART III, LINE 4A CONT'D FROM ABOVE:	PARKVIEW WARSAW SERVICES INCLUDE A FREE-STANDING EMERGENCY DEPARTMENT WITH NINE ROOMS, TWO OF WHICH ARE EQUIPPED FOR TRAUMA PATIENTS. THE FACILITY ALSO PROVIDES A MULTI-MODALITY IMAGING DEPARTMENT, LABORATORY, OUTPATIENT PHYSICAL AND OCCUPATIONAL REHABILITATION AND ANTICOAGULATION CLINIC, AS WELL AS PRIMARY CARE AND SPECIALTY PHYSICIAN OFFICES. SHELL SPACE ON THE THIRD FLOOR PROVIDES AN AREA FOR GROWTH OF SERVICES IN THE FUTURE. MEDICATION ASSISTANCE PROGRAM (MAP): BY PARTNERING WITH PHYSICIANS, PHARMACEUTICAL COMPANIES, LOCAL PHARMACIES, AND DONORS, WHITLEY MEMORIAL HOSPITAL, INC. PROVIDES MEDICATION ASSISTANCE AT LITTLE OR NO COST TO QUALIFIED INDIVIDUALS. EMERGENCY VOUCHERS FOR ACUTE MEDICATION NEEDS ARE REDEEMED AT THE HOSPITAL PHARMACY. LONG-TERM MEDICATION HELP IS PROVIDED TO PATIENTS BY CONNECTING THEM WITH PHARMACEUTICAL ASSISTANCE PROGRAMS (PAP). HEALTH SCREENING/PREVENTION AND DISEASE MANAGEMENT: WHITLEY MEMORIAL HOSPITAL, INC. PARTICIPATES MANY ACTIVITIES THROUGHOUT THE YEAR TO PROVIDE HEALTH EDUCATION, HEALTH SCREENINGS FOR DISEASE PREVENTION AND TO PROMOTE HEALTHY LIFESTYLES AND WELL-BEING. THE HOSPITAL ALSO PROVIDES SUPPORT GROUPS TO ASSIST PATIENTS AND FAMILIES IN MANAGING DISEASE: -CHECK-UP DAYS, WHICH PROVIDE LOW COST LABORATORY SCREENINGS TO THE PUBLIC, WERE PLANNED TO BE HOSTED THREE TIMES IN 2020, ON-SITE AT THE HOSPITAL. HOWEVER, THE COVID19 OUTBREAK FORCED SOME CHANGES TO THOSE PLANS. THE EVENT IN APRIL WAS CANCELED COMPLETELY. IN AUGUST, THE FACILITY OFFERED A RESCHEDULED EVENT AND THEN HOSTED ANOTHER IN SEPTEMBER BECAUSE DEMAND WAS SO HIGH. IN DECEMBER, THE SCREENING EVENT WAS HELD AT THE LOCAL YMCA DUE TO SUCH A HIGH CENSUS OF COVID PATIENTS AT THE HOSPITAL. THERE WERE 155 PARTICIPANTS IN 2020. THESE EVENTS ARE WELL KNOWN IN THE COMMUNITY AND OFFER A VALUABLE SERVICE, ESPECIALLY TO THOSE WHO ARE UNINSURED OR UNDER-INSURED. -WHITLEY MEMORIAL HOSPITAL, INC. AND THE WHITLEY COUNTY COMMUNITY FOUNDATION PARTNER TOGETHER TO PROVIDE FREE MAMMOGRAPHY SCREENING TO WOMEN WHO ARE UNINSURED OR UNDERINSURED. THROUGH THE WOMEN'S GIVING CIRCLE, A FUND OF THE WHITLEY COUNTY COMMUNITY FOUNDATION, VOUCHERS ARE GIVEN TO THOSE WHO QUALIFY AND CAN BE REDEEMED AT THE HOSPITAL FOR MAMMOGRAMS. -TWO IMAGING TESTS ARE OFFERED TO THE PUBLIC FOR A REASONABLE OUT-OF-POCKET COST. THE HEART SMART CT SCAN IS A SIMPLE, NON-INVASIVE TEST THAT CAN DETECT CORONARY ARTERY DISEASE IN ITS EARLY STAGES. THERE WERE 615 SCANS PERFORMED IN 2020 BETWEEN WHITLEY AND WARSAW LOCATIONS AT A MINIMAL OUT-OF-POCKET FEE. LUNG SCANS ARE AVAILABLE AS WELL FOR THOSE INDIVIDUALS CONSIDERED TO BE "AT-RISK". A TOTAL OF 295 INDIVIDUALS UTILIZED THAT SERVICE. THE TEST INVOLVES A LOW DOSE CT TO ASSIST IN DIAGNOSING EARLY-STAGE LUNG CANCER. -WHITLEY MEMORIAL HOSPITAL, INC. IS DEDICATED TO THE WELL-BEING OF ITS CO-WORKERS ALONG WITH ITS PATIENTS AS THEY ARE VALUABLE MEMBERS OF OUR COMMUNITY. A FITNESS CENTER IS AVAILABLE 24/7 WITH A VARIETY OF EXERCISE AND STRENGTH TRAINING EQUIPMENT FOR ALL STAFF TO UTILIZE. RECUMBENT BIKES ARE AVAILABLE WITHIN SEVERAL DEPARTMENTS AS WELL. AN OUTDOOR WALKING/BIKING TRAIL CIRCLES THE HOSPITAL PROPERTY AND IS USED BY STAFF AND COMMUNITY MEMBERS FOR WALKING, BIKING AND SKATING. THE WARSAW FACILITY HAS THE CONVENIENCE OF BEING LOCATED NEXT TO THE KOSCIUSKO COUNTY YMCA WHICH ALSO INCLUDES THE PARKVIEW WARSAW CENTER FOR HEALTHY LIVING. THE CENTER OFFERS A VARIETY OF CLASSES/PROGRAMS TO EMPLOYEES AS WELL AS THE COMMUNITY. THESE PROGRAMS HAVE BEEN ALMOST ENTIRELY VIRTUAL IN 2020 DUE TO COVID. -IN 2020, PARKVIEW WARSAW PARTNERED WITH KOSCIUSKO COUNTY AND THE CITY OF WARSAW TO PROVIDE FREE COVID-19 TESTING TO KOSCIUSKO COUNTY RESIDENTS. THIS PARTNERSHIP WAS FUNDED BY CARES ACT MONIES RECEIVED BY THE CITY AND COUNTY. A DRIVE-THRU COLLECTION AND ABBREVIATED REGISTRATION PROCESS WERE DEVELOPED FOR THIS INITIATIVE. PARKVIEW WARSAW WORKED WITH THE KOSCIUSKO HEALTH DEPARTMENT TO CONNECT RESULTS DIRECTLY TO THE KCHD THROUGH A SECURE PORTAL, FOR TIMELY REPORTING. EDUCATIONAL AND SUPPORT PROGRAMS: NUMEROUS OTHER EDUCATIONAL AND SUPPORT OPPORTUNITIES ARE AVAILABLE FOR THE PUBLIC ON-SITE AT THE WHITLEY MEMORIAL HOSPITAL, INC. SUCH AS DIABETES SUPPORT, NUTRITION CLASSES, WEIGHT LOSS SUPPORT AND ON-SITE SEASONAL FARMER'S MARKET. THE FAMILY BIRTHING CENTER OFFERS THEIR LAMAZE CHILDBIRTH EDUCATION, BREASTFEEDING CLASS AND BREASTFEEDING SUPPORT GROUP FOR NEW MOTHERS. THOSE EVENTS WERE HELD VIRTUALLY FROM MARCH THROUGH DECEMBER 2020 BUT REACHED NEARLY 200 PARTICIPANTS. WHITLEY MEMORIAL HOSPITAL, INC.'S FAMILY BIRTHING CENTER COWORKERS PROVIDE INFANT CAR SEAT SAFETY INSPECTIONS AND INSTRUCTION TO PARENTS THROUGHOUT THE YEAR TO SHOW THE CORRECT INSTALLATION AND USE OF CAR SEATS TO PROMOTE CHILD SAFETY IN VEHICLES. THE EVENTS WERE HELD AT VARIOUS LOCATIONS IN THE COMMUNITY. A CHAPLAINCY PROGRAM PROVIDES SPIRITUAL SUPPORT FOR PATIENTS AND THEIR FAMILIES. WHILE NOT A FULL-TIME POSITION AT THE FACILITY, THE CHAPLAIN IS AVAILABLE BY REQUEST IN TIMES OF PATIENT NEED OR TO COMFORT FAMILIES DURING DIFFICULT HEALTHCARE DECISIONS AND OUTCOMES. THE SUPPORT PROVIDED IS BENEFICIAL TO THE STAFF AS WELL FROM BOTH THE PERSONAL AND CAREGIVER PERSPECTIVE. VOLUNTEER PROGRAM/STAFF VOLUNTEERISM: THE VOLUNTEER PROGRAM AT WHITLEY MEMORIAL HOSPITAL, INC. HAS APPROXIMATELY 30 VOLUNTEERS WHO FUNCTION TO ASSIST PATIENTS, PROVIDE DIRECTIONS, WORK IN THE GIFT SHOP AND ASSIST STAFF. THESE VOLUNTEERS PROVIDED 1057 HOURS IN OUR FACILITY IN 2020. THIS IS A VALUABLE SERVICE TO OUR PATIENTS AND STAFF AND THOSE WHO VOLUNTEER. THE VAST MAJORITY OF THE HOSPITAL VOLUNTEERS ARE RETIRED INDIVIDUALS WHO WISH TO GIVE BACK TO THEIR COMMUNITY. ONCE AGAIN, COVID PROMPTED CHANGE IN THIS AREA AS WELL. VOLUNTEER SERVICE WAS SUSPENDED IN MARCH OF 2020 IN AN EFFORT TO KEEP VOLUNTEERS SAFE. THERE IS A PLAN TO BRING THEM BACK TO SERVICE IN 2021. THE MANAGEMENT AND EMPLOYEES OF WHITLEY MEMORIAL HOSPITAL, INC. ALSO TYPICALLY PARTICIPATE IN NUMEROUS VOLUNTEER ACTIVITIES THROUGHOUT THE AREA TO IMPROVE THE HEALTH AND WELL-BEING OF THE COMMUNITY. THESE ACTIVITIES INCLUDE PARTICIPATION IN THE LOCAL UNITED WAY DAY OF CARING, THE MULTI COUNTY MEDICAL OUTREACH CLINIC, JUNIOR ACHIEVEMENT PROGRAMS AT LOCAL SCHOOLS AND THE SALVATION ARMY BELL RINGING DURING THE HOLIDAY SEASON. CO-WORKERS TRADITIONALLY VOLUNTEER THEIR TIME IN A VARIETY OF COMMUNITY EVENTS INCLUDING STAFFING THE BOOTHS AT THE WHITLEY COUNTY AND KOSCIUSKO COUNTY 4-H FAIRS. DEPARTMENT MANAGERS ALSO WORK WITH LOCAL HIGH SCHOOLS TO PROVIDE STUDENT INTERNSHIPS IN A VARIETY OF SETTINGS, ALLOWING THEM TO EXPLORE CAREERS IN CLINICAL AND NON-CLINICAL HOSPITAL ENVIRONMENTS. IN 2020, HOWEVER, MOST EVENTS AND PROGRAMS WERE EITHER CANCELED DUE TO COVID-19 OR HOSPITAL ADMINISTRATION CHOSE NOT TO PARTICIPATE IN ORDER TO REDUCE THE POTENTIAL SPREAD OF THE VIRUS. EMS SERVICES: WHITLEY MEMORIAL HOSPITAL, INC. MANAGES AND OPERATES EMS SERVICES FOR WHITLEY COUNTY WITH DEDICATED AMBULANCES AVAILABLE FOR EMERGENCY DISPATCH 24 HOURS, 7 DAYS PER WEEK. THERE WERE 5,710 EMS RUNS AND 4,294 PATIENT TRANSPORTS DURING 2020. ALTHOUGH ADDITIONAL ACTIVITIES WERE MINIMAL DURING 2020 AS A RESULT OF THE COVID-19 PANDEMIC, STAFFED AMBULANCES WERE AVAILABLE TO PROVIDE EMERGENCY MEDICAL SERVICES COVERAGE FOR LOCAL FOOTBALL GAMES AND OTHER AREA COMMUNITY EVENTS AS WELL AS FACILITATE TRAINING FOR FIRST RESPONDERS IN THE COMMUNITY. WHEELCHAIR DONATION: IN 2020, WHITLEY MEMORIAL HOSPITAL, INC. DONATED FIVE WHEELCHAIRS TO THE LATIN AMERICAN MISSION BOARD (LAMB). LAMB IS A CHURCH BASED AND CHURCH OPERATED MISSION BOARD DEDICATED TO REACHING PEOPLE IN LATIN AMERICAN COUNTRIES. THE WHEELCHAIRS WILL BE DISTRIBUTED TO THOSE IN NEED. PARKVIEW HEALTH SYSTEM, INC. COVID-19 SPECIFIC INITIATIVES: THE YEAR OF 2020 PRESENTED PARKVIEW HEALTH SYSTEM, INC. WITH MANY NEW CHALLENGES WITH THE SPREAD OF COVID-19 THROUGHOUT THE UNITED STATES. HOWEVER, DUE TO THE HEALTH SYSTEM'S GROWTH AND PREPAREDNESS FOR SUCH TRYING TIMES, PARKVIEW WAS ABLE TO STEP UP AND OFFER MANY ADDITIONAL RESOURCES TO THE COMMUNITY WHILE PROVIDING CARE TO A LARGE INFLUX OF COVID-19 PATIENTS. THE FOLLOWING IS A TIMELINE OUTLINING THE EXTENSIVE EFFORTS MADE POSSIBLE BY THE DEDICATED STAFF OF PARKVIEW HEALTH SYSTEM, INC. AND ITS PARTNERS IN THE COMMUNITY IN 2020: APRIL 17, 2020 - ADDED A FREE COVID-19 SYMPTOM CHECKER TO PARKVIEW.COM. THE INTERACTIVE TOOL ALLOWS PATIENTS TO COMPLETE A SELF-ASSESSMENT AND BE DIRECTED TO APPROPRIATE CARE. PATIENTS CAN ACCESS THIS TOOL AT PARKVIEW.COM/COVID19SYMPTOMCHECKER.
PART III, LINE 4A, CONT'D FROM ABOVE:	APRIL 22, 2020 - PARKVIEW COMMUNITY NURSING AND THE PARKVIEW COMMUNITY GREENHOUSE AND LEARNING KITCHEN PARTNERED TOGETHER TO PROVIDE FRESH PRODUCE FOR MOMS IN THE BREASTFEEDING SUPPORT GROUP, AS WELL AS FAMILIES AT VINCENT VILLAGE, MOMS PARTICIPATING IN THE SAFETY PIN GRANT AND RESIDENTS AT BEACON HEIGHTS. IN ALL, PARKVIEW WAS ABLE TO PROVIDE OVER 65 BAGS OF PRODUCE FROM BOTH THE PARKVIEW COMMUNITY GREENHOUSE AND THE FORT WAYNE FARMER'S MARKET TO FAMILIES IN NEED. THIS PROGRAM HAS HELPED TO PROVIDE ACCESS TO NUTRITIOUS FOODS WITHOUT POTENTIALLY EXPOSING MOM AND BABY TO UNNECESSARY OUTSIDE CONTACT. MAY 11, 2020 - IN PARTNERSHIP WITH GREATER FORT WAYNE, INC. AND NORTHEAST REGIONAL PARTNERSHIP, LEADERS AND PHYSICIANS FROM PARKVIEW HEALTH SYSTEM, INC. WERE ABLE TO DEVELOP A WEBINAR THAT PROVIDED A "ROADMAP TO REOPENING" FOR BUSINESS LEADERS AND INDIVIDUALS/CO-WORKERS. THE WEBINAR INCLUDED ADVICE FOR RETURNING TO WORK AND COMMUNITY LIFE SAFELY. IN ADDITION TO THE WEBINAR, PARKVIEW PUBLISHED THE BUSINESS CONNECT DASHBOARD WHERE LOCAL BUSINESS LEADERS CAN LOCATE MORE INFORMATION ABOUT REOPENING SAFELY AND OTHER ADDITIONAL RESOURCES. JULY 24, 2020 - PRODUCED A FREE WEBINAR OFFERING GUIDANCE TO PARENTS FOR SAFELY RETURNING CHILDREN TO SCHOOL. THE WEBINAR INCLUDED INFORMATION ABOUT: - THE CURRENT STATE OF THE COVID-19 PANDEMIC IN NORTHEAST INDIANA. - HOW IN-PERSON EDUCATION PLAYS A ROLE IN THE OVERALL HEALTH OF CHILDREN. - WHY SCHOOLS ARE INTRODUCING NEW SAFETY MEASURES. - WHAT STUDENTS MIGHT EXPECT TO SEE OR EXPERIENCE. - HOW YOU CAN SUPPORT YOUR CHILDREN AND EDUCATORS AS THEY NAVIGATE THE YEAR AHEAD. SEPTEMBER 9, 2020 - IN PARTNERSHIP WITH THE STATE OF INDIANA, PARKVIEW HEALTH SYSTEM, INC. OBTAINED A NEW ROCHE COBAS MACHINE THAT WILL REDUCE THE TURNAROUND TIME FOR COVID-19 DIAGNOSTIC TESTS IN THE REGION. THE NEW EQUIPMENT WAS INSTALLED IN THE LAB AT PARKVIEW REGIONAL MEDICAL CENTER AND WILL ALLOW THE HEALTH SYSTEM TO PROCESS A HIGH VOLUME OF COVID-19 POLYMERASE CHAIN REACTION (PCR) TESTS, WITH MOST RESULTS AVAILABLE IN LESS THAN 24 HOURS. THE SHORTER TURNAROUND TIME WILL BENEFIT THE REGION IN SEVERAL WAYS: - PROVIDERS MAY MAKE BETTER INFORMED CARE DECISIONS AND IMPLEMENT CARE PLANS SOONER. - PATIENTS WILL KNOW SOONER IF THEY NEED TO REMAIN QUARANTINED OR ISOLATED. - CONTACT TRACERS MAY IDENTIFY THOSE WHO MAY HAVE BEEN EXPOSED FASTER. NOVEMBER 5, 2020 - PARKVIEW HEALTH SYSTEM, INC. IN PARTNERSHIP WITH THE INDIANA UNIVERSITY RICHARD M. FAIRBANKS SCHOOL OF PUBLIC HEALTH AT IUPUI, INDIANA UNIVERSITY SCHOOL OF MEDICINE AND THE REGENSTRIEF INSTITUTE BEGAN COMMUNICATING CLINICAL GUIDANCE AND EXPERTISE IN A NEW PROGRAM DESIGNED TO SUPPORT INDIANA NURSING HOMES WITH OPERATIONAL ISSUES RELATED TO COVID-19. PARKVIEW SERVED AS A VIRTUAL TRAINING CENTER FOR THE NEW STATEWIDE PROGRAM, AS PART OF THE NATIONAL NURSING HOME COVID-19 ACTION NETWORK, USING THE PROJECT ECHO (EXTENSION FOR COMMUNITY HEALTHCARE OUTCOMES) MODEL. DECEMBER 14, 2020 - AS A PILOT SITE FOR THE INDIANA DEPARTMENT OF HEALTH (IDOH) COVID-19 VACCINE DISTRIBUTION PLAN, PARKVIEW HEALTH PREPARED TO BEGIN VACCINATING THE FIRST GROUP OF ELIGIBLE HEALTHCARE WORKERS. IN DOING SO, AN EXTENSIVE EFFORT WAS MADE TO PLAN AND DEVELOP A VACCINE CLINIC AT THE PARKVIEW MIRRO CENTER FOR RESEARCH AND INNOVATION. THE PARKVIEW MIRRO CENTER VACCINE CLINIC HAS FOUR SCREENING STATIONS, 10 REGISTRATION STATIONS, 10 VACCINATION STATIONS, AND A POST-VACCINATION WAITING AREA THAT CAN ACCOMMODATE UP TO 120 PEOPLE WHO ARE WAITING THE REQUIRED 15 MINUTES TO MONITOR FOR SYMPTOMS.
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, INC., EIN 35-1967665. 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, 2020 WAS 738. THE TOTAL NUMBER OF EMPLOYEES REPORTED ON FORM W-3 AND FILED BY THE COMMON PAYING AGENT, PH, FOR THE YEAR ENDED DECEMBER 31, 2020 WAS 15,150. FOR PURPOSES OF COMPLETING FORM 990, PART V, LINE 1A AND 2A, THE NUMBER REPORTED FOR THE WHITLEY MEMORIAL HOSPITAL, INC. WAS 33 AND 406 RESPECTIVELY.
FORM 990, PART VI, SECTION A, LINE 1	THE EXECUTIVE COMMITTEE SHALL BE COMPOSED OF THE OFFICERS OF THE BOARD, THE PRESIDENT OF THE CORPORATION, THE PRESIDENT/CEO OF THE CORPORATE MEMBER OR HIS/HER DESIGNEE, THE CURRENT PRESIDENT OF THE MEDICAL STAFF AND SUCH OTHER PERSONS AS IDENTIFIED BY THE CHAIR OF THE BOARD, EACH OF WHOM SHALL BE ENTITLED TO VOTE. 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 RATIFICATION OF ITS ACTION. THE CHAIR OF THE BOARD SHALL SERVE AS CHAIR OF THE EXECUTIVE COMMITTEE.
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 WHITLEY MEMORIAL HOSPITAL, INC. WITH CERTAIN RESERVED POWERS.
FORM 990, PART VI, SECTION A, LINE 7A	THE CORPORATE MEMBER, PARKVIEW HEALTH SYSTEM, INC. EIN 35-1972384, SHALL HAVE THE FOLLOWING RESERVED POWERS AS DEFINED IN THE NETWORK AGREEMENT: (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) 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. (G) REQUIRE AND DIRECT THE 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. 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 SERVICE 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 JOINT COMMISSION ACCREDITATION, TAX-EXEMPT STATUS, PARTICIPATION IN MEDICARE/MEDICAID OR TO PREVENT SIGNIFICANT ADVERSE LEGAL OR FINANCIAL EFFECTS TO THE CORPORATION OR SYSTEM, EXCEPT THAT THERE CAN BE NO AMENDMENT TO THE RESERVED POWERS LISTED IN SECTIONS (G) AND (K) OF THIS EXHIBIT A OR THE REQUIREMENT THAT ELECTED DIRECTORS BE REPRESENTATIVES OF WHITLEY COUNTY, AS DESCRIBED IN ARTICLE V, SECTIONS 2 AND 10 OF THESE BYLAWS 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 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, INC. IS A SUBSIDIARY CORPORATION OF PARKVIEW HEALTH SYSTEM, INC. AN ELECTRONIC COPY OF THE ORGANIZATION'S FINAL FORM 990 (INCLUDING SUPPLEMENTAL SCHEDULES) WAS PROVIDED TO EACH VOTING MEMBER OF THE ORGANIZATION'S GOVERNING BODY AND THE SYSTEM AUDIT COMMITTEE, PRIOR TO FILING WITH THE IRS. ON OCTOBER 27, 2021, THE SYSTEM AUDIT COMMITTEE REVIEWED THE FORM 990 AS ULTIMATELY FILED WITH THE IRS. THIS REVIEW INCLUDED A PRESENTATION BY THE ORGANIZATION'S TAX PREPARER TO HIGHLIGHT THE SIGNIFICANT AREAS ON THE FORM 990 AND SUPPLEMENTAL SCHEDULES.
FORM 990, PART VI, SECTION B, LINE 12C	AS DESCRIBED IN ARTICLE IX SECTION 6, OF THE PARKVIEW HEALTH SYSTEM, INC. (PH) BYLAWS, PH ADOPTED PH'S COMPLIANCE POLICY FOR THE ORGANIZATION AND ITS NOT-FOR-PROFIT RELATED ORGANIZATIONS (AND AS LIKEWISE NOTED IN THEIR BYLAWS) WHEN ADDRESSING CONFLICTS OR POTENTIAL CONFLICTS OF INTEREST. THIS COMPLIANCE POLICY (COMPLIANCE POLICY #14) REQUIRES THAT EACH BOARD MEMBER, BOARD COMMITTEE MEMBER, AND KEY MANAGEMENT PERSONNEL MUST ANNUALLY COMPLETE A CONFLICT OF INTEREST FORM. THIS INFORMATION IS PROVIDED TO THE CHAIRMAN OF THE BOARD (FOR BOARD AND BOARD COMMITTEE MEMBERS) AND TO SENIOR MANAGEMENT (FOR KEY MANAGEMENT PERSONNEL). IN ADDITION, AS TO THE CONDUCT OF BOARD MEETINGS, THE FOLLOWING PROCESS IS FOLLOWED: "WHENEVER A PH OR PH AFFILIATE BOARD OR BOARD COMMITTEE IS CONSIDERING A TRANSACTION OR ARRANGEMENT WITH AN ORGANIZATION, ENTITY OR INDIVIDUAL IN WHICH A PERSON COVERED BY THIS POLICY HAS A FINANCIAL OR CONFLICTING INTEREST, THE FOLLOWING SHALL OCCUR: 1. THE INTERESTED PERSON MUST DISCLOSE THE FINANCIAL OR CONFLICTING INTEREST AND ALL MATERIAL FACTS TO THE PH OR PH AFFILIATE BOARD OR BOARD COMMITTEE; 2. THE INTERESTED PERSON WITH THAT FINANCIAL OR CONFLICTING INTEREST MAY MAKE A PRESENTATION AT THE BOARD OR BOARD COMMITTEE MEETING REGARDING THE TRANSACTION OR ARRANGEMENT HOWEVER, HE/SHE SHALL LEAVE THE MEETING DURING THE DISCUSSION OF, AND THE VOTE ON, THE TRANSACTION OR ARRANGEMENT THAT RESULTS IN THE FINANCIAL OR CONFLICTING INTEREST; AND 3. THE PH OR PH AFFILIATE BOARD OR BOARD COMMITTEE MUST APPROVE THE TRANSACTION OR ARRANGEMENT BY A MAJORITY VOTE OF THE BOARD MEMBERS PRESENT AT A MEETING THAT HAS A QUORUM, NOT INCLUDING THE VOTE OF THE INTERESTED PERSON. THE INTERESTED PERSON MAY NOT VOTE ON THE MATTER. A. UPON THE REQUEST OF PH OR PH AFFILIATE BOARD OR BOARD COMMITTEE, THE MATTER MAY BE DELEGATED TO THE PH COMPLIANCE COMMITTEE FOR EVALUATION, RECOMMENDATION AND/OR DETERMINATION. 4. WHENEVER A FINANCIAL OR CONFLICTING INTEREST IS ADDRESSED BY A PH OR PH AFFILIATE BOARD, NOTICE SHALL BE GIVEN TO THE PH COMPLIANCE OFFICER / GENERAL COUNSEL."
FORM 990, PART VI, SECTION B, LINE 15	LINES 15A AND 15B ARE ANSWERED NO IN ACCORDANCE WITH THE IRS INSTRUCTIONS. TO THE EXTENT THAT THE ORGANIZATION HAS VICE PRESIDENT OR ABOVE, THE COMPENSATION COMMITTEE OF RELATED ORGANIZATION, PARKVIEW HEALTH SYSTEM, INC., DETERMINES THE COMPENSATION OF THE CEO, OFFICERS, AND KEY EMPLOYEES.
FORM 990, PART VI, SECTION C, LINE 19	COPIES OF THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST.
FORM 990, PART IX, LINES 5-10:	PARKVIEW HEALTH SYSTEM, INC., EIN 35-1972384, SERVES AS THE COMMON PAYING AGENT FOR ALL TAX-EXEMPT ORGANIZATIONS OF THE SYSTEM. SALARIES AND WAGES OF EMPLOYEES WORKING FOR THESE ORGANIZATIONS ARE CHARGED DIRECTLY TO THE ORGANIZATIONS IN WHICH THEY WORK. THE ACTUAL EXPENSES FOR PAYROLL TAXES, EMPLOYEE BENEFITS, AND PENSION PLAN CONTRIBUTIONS ARE REFLECTED ON THE BOOKS OF PARKVIEW HEALTH SYSTEM, INC. FOR FINANCIAL REPORTING PURPOSES. TO ACCOUNT FOR BENEFIT COSTS ON THE BOOKS OF THE OTHER TAX EXEMPT ORGANIZATIONS, AN ALLOCATION METHODOLOGY IS UTILIZED TO CHARGE THESE ORGANIZATIONS WITH AN ESTIMATE OF THE OVERALL COSTS, REFERRED TO AS A "BENEFIT ALLOCATION" FROM PARKVIEW HEALTH SYSTEM, INC. THE ALLOCATION DOES NOT DISTINGUISH BETWEEN THE COSTS OF THE VARIOUS COMPONENTS (I.E. PAYROLL TAXES, EMPLOYEE BENEFITS, AND PENSION PLAN CONTRIBUTIONS). THEREFORE, FOR PURPOSES OF THE FORM 990, PART IX, THE TOTAL BENEFIT ALLOCATION FOR THE EMPLOYEES' SALARIES AND WAGES REPORTED ON LINE 7 IS REFLECTED ON LINE 9 AND NOT ALLOCATED BETWEEN LINES 8 OR 10. FOR PURPOSES OF THE FORM 990, PART IX, LINES 5 AND 6 REFLECT COMPENSATION AND BENEFIT AMOUNTS REPORTED IN PART VII.
SCHEDULE H, PART VI, SUPPLEMENTAL INFORMATION, LINE 5, CONT'D:	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.). EMS SERVICES: WHITLEY MEMORIAL HOSPITAL, INC. MANAGES AND OPERATES EMS SERVICES FOR WHITLEY COUNTY WITH DEDICATED AMBULANCES AVAILABLE FOR EMERGENCY DISPATCH 24 HOURS, 7 DAYS PER WEEK. THERE WERE 5,710 EMS RUNS AND 4,294 PATIENT TRANSPORTS DURING 2020. ALTHOUGH ADDITIONAL ACTIVITIES WERE MINIMAL DURING 2020 A RESULT OF THE COVID-19 PANDEMIC, STAFFED AMBULANCES WERE ALSO AVAILABLE TO PROVIDE EMERGENCY MEDICAL SERVICES COVERAGE FOR LOCAL FOOTBALL GAMES AND OTHER AREA COMMUNITY EVENTS. EMS STAFF FACILITATE EMT CLASSES FOR LOCAL HIGH SCHOOL STUDENTS AND TRAINING FOR FIRST RESPONDERS AND PROVIDE CPR TRAINING IN THE COMMUNITY. MEDICATION ASSISTANCE PROGRAM (MAP): WHITLEY MEMORIAL HOSPITAL, INC. SUPPORTS A MEDICATION ASSISTANCE PROGRAM (MAP) WHICH PARTNERS WITH PATIENTS, PHYSICIANS, PHARMACEUTICAL COMPANIES, LOCAL PHARMACIES, AND DONORS TO PROVIDE MEDICATION ASSISTANCE AT LITTLE OR NO COST FOR QUALIFIED INDIVIDUALS IN WHITLEY COUNTY. EMERGENCY VOUCHERS FOR ACUTE MEDICATION NEEDS ARE REDEEMED AT LOCAL PHARMACIES. LONG-TERM MEDICATION HELP IS PROVIDED BY CONNECTING PATIENTS WITH PHARMACEUTICAL ASSISTANCE PROGRAMS (PAP). -HEALTH SCREENING/PREVENTION AND DISEASE MANAGEMENT: WHITLEY MEMORIAL HOSPITAL, INC. TYPICALLY PARTICIPATES IN HEALTH FAIRS AND ACTIVITIES THROUGHOUT THE YEAR TO PROVIDE HEALTH EDUCATION, HEALTH SCREENINGS FOR DISEASE PREVENTION, AND TO PROMOTE HEALTHY LIFESTYLES. HOWEVER, THESE INITIATIVES WERE LIMITED IN 2020 A RESULT OF COVID-19. THE HOSPITAL ALSO PROVIDES SUPPORT GROUPS TO ASSIST PATIENTS AND FAMILIES IN MANAGING DISEASE. -WELLNESS CHECK UP DAYS INCLUDED MULTIPLE HEALTH SCREENINGS AS WELL AS HEALTH AND PREVENTION EDUCATION FOR ADULTS OF THE COMMUNITY. THIS EVENT PROVIDED REDUCED-FEE LABORATORY TESTING FOR 278 COMMUNITY MEMBERS IN 2020. FRANCINE'S FRIENDS MOBILE MAMMOGRAPHY ALSO CONTINUED TO OFFER FREE OR REDUCED COST MAMMOGRAMS TO WOMEN IN THE COMMUNITY WHO QUALIFY FOR THE SERVICE. -WHITLEY MEMORIAL HOSPITAL, INC., AND THE WHITLEY COUNTY COMMUNITY FOUNDATION PARTNER TOGETHER TO PROVIDE FREE MAMMOGRAPHY SCREENING TO WOMEN WHO ARE UNINSURED OR UNDERINSURED. THROUGH THE WOMEN'S GIVING CIRCLE, A FUND OF THE WHITLEY COUNTY COMMUNITY FOUNDATION, VOUCHERS ARE GIVEN TO WOMEN WHO ARE UNINSURED OR UNDERINSURED WHICH CAN BE REDEEMED AT THE HOSPITAL FOR MAMMOGRAMS. -EDUCATIONAL AND SUPPORT PROGRAMS: NUMEROUS OTHER EDUCATIONAL AND SUPPORT OPPORTUNITIES ARE AVAILABLE FOR THE PUBLIC SUCH AS CARDIO-PULMONARY DISEASE SUPPORT, DIABETES SUPPORT, NUTRITION CLASSES AND WEIGHT LOSS SUPPORT. THE FAMILY BIRTHING CENTER OFFERS LAMAZE BIRTHING CLASSES ALONG WITH BREAST FEEDING CLASSES AND SUPPORT GROUPS. MANY OF THESE ACTIVITIES WERE VIRTUAL IN 2020. WHITLEY MEMORIAL HOSPITAL, INC. WORKS WITH LOCAL HIGH SCHOOLS TO PROVIDE INTERNSHIP OPPORTUNITIES FOR STUDENTS IN A VARIETY OF SETTINGS, ALLOWING THEM TO EXPLORE CAREERS IN CLINICAL AND NON-CLINICAL HOSPITAL ENVIRONMENTS. A CHAPLAINCY PROGRAM PROVIDES SPIRITUAL SUPPORT FOR PATIENTS AND THEIR FAMILIES. COWORKERS PROVIDE INFANT CAR SEAT SAFETY INSPECTIONS AND INSTRUCTION TO PARENTS AT VARIOUS COMMUNITY LOCATIONS THROUGHOUT THE YEAR TO SHOW THE CORRECT INSTALLATION AND USE OF CAR SEATS FOR PROMOTION OF CHILD SAFETY. SPONSORSHIPS: WHITLEY MEMORIAL HOSPITAL, INC., SPONSORS NUMEROUS LOCAL ORGANIZATIONS IN WHITLEY AND KOSCIUSKO COUNTIES EACH YEAR THAT HAVE POSITIVE IMPACTS ON THE COMMUNITIES SERVED. THE FUNDING PROVIDED SUPPORTS EVENTS RELATED TO HEALTHY ACTIVITIES SUCH AS TRIATHLONS OR 5K RACES AS WELL AS TO ORGANIZATIONS WHO ARE DEDICATED TO SERVING SPECIFIC INDIVIDUALS IN NEED. THE ORGANIZATIONS AWARDED SPONSORSHIP DOLLARS FOR 2020 INCLUDED THE BEAMAN HOME SHELTER, UNITED WAY, FORT WAYNE MEDICAL EDUCATION PROGRAM, JUNIOR ACHIEVEMENT, KATE'S KART, KOSCIUSKO COMMUNITY YMCA, KOSCIUSKO YOUTH LEADERSHIP ACADEMY, WARSAW EDUCATION FOUNDATION, SOUTH WHITLEY YOUTH LEAGUE, PASSAGES INC. AND KOSCIUSKO COMMUNITY FAIR. OTHER DONATIONS OF SNACKS OR WATER PROVIDED SUPPORT FOR VARIOUS EVENTS THROUGHOUT THE YEAR. THE YEAR OF 2020 PRESENTED PARKVIEW HEALTH SYSTEM, INC. WITH MANY NEW CHALLENGES WITH THE SPREAD OF COVID-19 THROUGHOUT THE UNITED STATES. HOWEVER, DUE TO THE HEALTH SYSTEM'S GROWTH AND PREPAREDNESS FOR SUCH TRYING TIMES, PARKVIEW WAS ABLE TO QUICKLY RESPOND AND OFFER MANY ADDITIONAL RESOURCES TO THE COMMUNITY IN ADDITION TO PROVIDING CARE TO A LARGE INFLUX OF COVID-19 PATIENTS. THE FOLLOWING IS A TIMELINE OUTLINING THE EXTENSIVE EFFORTS MADE POSSIBLE BY THE DEDICATED STAFF OF PARKVIEW HEALTH SYSTEM, INC., AND ITS PARTNERS IN THE COMMUNITY IN 2020: APRIL 17, 2020 - PARKVIEW ADDED A FREE COVID-19 SYMPTOM CHECKER TO PARKVIEW.COM. THE INTERACTIVE TOOL ALLOWS PATIENTS TO COMPLETE A SELF-ASSESSMENT AND BE DIRECTED TO APPROPRIATE CARE. PATIENTS CAN ACCESS THIS TOOL AT PARKVIEW.COM/COVID19SYMPTOMCHECKER. APRIL 22, 2020 - PARKVIEW COMMUNITY NURSING AND THE PARKVIEW COMMUNITY GREENHOUSE AND LEARNING KITCHEN PARTNERED TOGETHER TO PROVIDE FRESH PRODUCE FOR MOMS IN THE BREASTFEEDING SUPPORT GROUP, AS WELL AS FAMILIES AT VINCENT VILLAGE, MOMS PARTICIPATING IN THE SAFETY PIN GRANT AND RESIDENTS AT BEACON HEIGHTS. IN ALL, PARKVIEW WAS ABLE TO PROVIDE OVER 65 BAGS OF PRODUCE FROM BOTH THE PARKVIEW COMMUNITY GREENHOUSE AND THE FORT WAYNE FARMER'S MARKET TO FAMILIES IN NEED. THIS PROGRAM HAS HELPED TO PROVIDE ACCESS TO NUTRITIOUS FOODS WITHOUT POTENTIALLY EXPOSING MOM AND BABY TO UNNECESSARY OUTSIDE CONTACT. MAY 11, 2020 - IN PARTNERSHIP WITH GREATER FORT WAYNE, INC. AND NORTHEAST REGIONAL PARTNERSHIP, LEADERS AND PHYSICIANS FROM PARKVIEW HEALTH SYSTEM, INC. WERE ABLE TO DEVELOP A WEBINAR THAT PROVIDED A "ROADMAP TO REOPENING" FOR BUSINESS LEADERS AND INDIVIDUALS/CO-WORKERS. THE WEBINAR FORWARDS ADVICE FOR RETURNING TO WORK AND COMMUNITY LIFE SAFELY. IN ADDITION TO THE WEBINAR, PARKVIEW PUBLISHED THE BUSINESS CONNECT DASHBOARD WHERE LOCAL BUSINESS LEADERS COULD LOCATE MORE INFORMATION ABOUT REOPENING SAFELY AND OTHER ADDITIONAL RECOURSES. JULY 24, 2020 - PRODUCED A FREE WEBINAR OFFERING GUIDANCE TO PARENTS FOR SAFELY RETURNING CHILDREN TO SCHOOL. THE WEBINAR INCLUDED INFORMATION ABOUT: -THE CURRENT STATE OF THE COVID-19 PANDEMIC IN NORTHEAST INDIANA. -HOW IN-PERSON EDUCATION PLAYS A ROLE IN THE OVERALL HEALTH OF CHILDREN. -WHY SCHOOLS ARE INTRODUCING NEW SAFETY MEASURES. -WHAT STUDENTS MIGHT EXPECT TO SEE OR EXPERIENCE. -HOW YOU CAN SUPPORT YOUR CHILDREN AND EDUCATORS AS THEY NAVIGATE THE YEAR AHEAD. SEPTEMBER 9, 2020 - IN PARTNERSHIP WITH THE STATE OF INDIANA, PARKVIEW HEALTH SYSTEM, INC. OBTAINED A NEW ROCHE COBAS MACHINE THAT WILL REDUCE THE TURNAROUND TIME FOR COVID-19 DIAGNOSTIC TESTS IN THE REGION. THE NEW EQUIPMENT WAS INSTALLED IN THE LAB AT PARKVIEW REGIONAL MEDICAL CENTER AND WILL ALLOW THE HEALTH SYSTEM TO PROCESS A HIGH VOLUME OF COVID-19 POLYMERASE CHAIN REACTION (PCR) TESTS, WITH MOST RESULTS AVAILABLE IN LESS THAN 24 HOURS. THE SHORTER TURNAROUND TIME WILL BENEFIT THE REGION IN SEVERAL WAYS: -PROVIDERS MAY MAKE BETTER INFORMED CARE DECISIONS AND IMPLEMENT CARE PLANS SOONER. -PATIENTS WILL KNOW SOONER IF THEY NEED TO REMAIN QUARANTINED OR ISOLATED. -CONTACT TRACERS MAY IDENTIFY THOSE WHO MAY HAVE BEEN EXPOSED FASTER. NOVEMBER 5, 2020 - PARKVIEW HEALTH SYSTEM, INC., IN PARTNERSHIP WITH THE INDIANA UNIVERSITY RICHARD M. FAIRBANKS SCHOOL OF PUBLIC HEALTH AT IUPUI, INDIANA UNIVERSITY SCHOOL OF MEDICINE, AND THE REGENSTRIEF INSTITUTE BEGAN COMMUNICATING CLINICAL GUIDANCE AND EXPERTISE IN A NEW PROGRAM DESIGNED TO SUPPORT INDIANA NURSING HOMES WITH OPERATIONAL ISSUES RELATED TO COVID-19. PARKVIEW SERVED AS A VIRTUAL TRAINING CENTER FOR THE NEW STATEWIDE PROGRAM, AS PART OF THE NATIONAL NURSING HOME COVID-19 ACTION NETWORK, USING THE PROJECT ECHO (EXTENSION FOR COMMUNITY HEALTHCARE OUTCOMES) MODEL. DECEMBER 14, 2020 - AS A PILOT SITE FOR THE INDIANA DEPARTMENT OF HEALTH (IDOH) COVID-19 VACCINE DISTRIBUTION PLAN, PARKVIEW HEALTH PREPARED TO BEGIN VACCINATING THE FIRST GROUP OF ELIGIBLE HEALTHCARE WORKERS. IN DOING SO, AN EXTENSIVE EFFORT WAS MADE TO PLAN AND DEVELOP A VACCINE CLINIC AT THE PARKVIEW MIRRO CENTER FOR RESEARCH AND INNOVATION. THE PARKVIEW MIRRO CENTER VACCINE CLINIC HAS FOUR SCREENING STATIONS, 10 REGISTRATION STATIONS, 10 VACCINATION STATIONS, AND A POST-VACCINATION WAITING AREA THAT CAN ACCOMMODATE UP TO 120 PEOPLE WHO ARE WAITING THE REQUIRED 15 MINUTES TO MONITOR FOR SYMPTOMS.

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2020

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

Complete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
MediumBullet

Attach to Form 990.
MediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2020

Open to Public Inspection

Name of the organization

WHITLEY MEMORIAL HOSPITAL INC

Employer identification number

35-1967665

Part I

Identification of Disregarded Entities. Complete if the organization answered "Yes" on Form 990, Part IV, line 33.

(a) Name, address, and EIN (if applicable) of disregarded entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Total income	(e) End-of-year assets	(f) Direct controlling entity

Part II

Identification of Related Tax-Exempt Organizations. Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	(g) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	Yes	No
(1)PARKVIEW HEALTH SYSTEM INC 1450 PRODUCTION RD FORT WAYNE,IN46808 35-1972384	HEALTH CARE	IN	501(C)(3)	LINE 12C, III-FI	N/A		No
(2)WHITLEY MEMORIAL HOSPITAL FOUNDATION INC 1260 E STATE ROAD 205 COLUMBIA CITY,IN46725 31-1190239	FUND MGMT	IN	501(C)(3)	LINE 12A, I	WHITLEY MEMORIAL HOSPITAL INC	Yes
(3)COMMUNITY HOSPITAL OF LAGRANGE COUNTY INC 207 N TOWNLINE ROAD LAGRANGE,IN46761 20-2401676	HOSPITAL CARE	IN	501(C)(3)	LINE 3	PARKVIEW HEALTH SYSTEM INC		No
(4)COMMUNITY HOSPITAL OF NOBLE COUNTY FOUNDATION INC 401 SAWYER ROAD KENDALLVILLE,IN46755 35-2089183	FUND MGMT	IN	501(C)(3)	LINE 12A, I	COMMUNITY HOSPITAL OF NOBLE COUNTY INC		No
(5)COMMUNITY HOSPITAL OF NOBLE COUNTY INC 401 SAWYER ROAD KENDALLVILLE,IN46755 35-2087092	HOSPITAL CARE	IN	501(C)(3)	LINE 3	PARKVIEW HEALTH SYSTEM INC		No
(6)DEKALB MEMORIAL HOSPITAL INC 1316 EAST SEVENTH STREET AUBURN,IN46706 35-1064295	HOSPITAL CARE	IN	501(C)(3)	LINE 3	PARKVIEW HEALTH SYSTEM INC		No
(7)HUNTINGTON MEMORIAL HOSPITAL INC 2001 STULTS ROAD HUNTINGTON,IN46750 35-1970706	HOSPITAL CARE	IN	501(C)(3)	LINE 3	PARKVIEW HEALTH SYSTEM INC		No
(8)MIDWEST COMMUNITY HEALTH ASSOCIATES INC 442 W HIGH STREET BRYAN,OH43506 34-1045870	PHYSICIANS	OH	501(C)(3)	LINE 3	PARKVIEW HEALTH SYSTEM INC		No
(9)PARK CENTER HOLDINGS INC 909 EAST STATE BLVD FORT WAYNE,IN46805 84-3684074	TO SUPPORT PARK CENTER, INC.	IN	501(C)(3)	LINE 12D, III-O	PARKVIEW HEALTH SYSTEM INC		No
(10)PARK CENTER INC 909 EAST STATE BLVD FORT WAYNE,IN46805 35-1135451	COMPREHENSIVE MENTAL HEALTH CENTER	IN	501(C)(3)	LINE 10	PARKVIEW HEALTH SYSTEM INC		No
(11)PARKVIEW DEKALB HOSPITAL FOUNDATION INC 1316 EAST SEVENTH STREET AUBURN,IN46706 35-6047817	FUND MGMT	IN	501(C)(3)	LINE 12A, I	DEKALB MEMORIAL HOSPITAL INC		No
(12)PARKVIEW FOUNDATION INC 3844 NEW VISION DR FORT WAYNE,IN46845 23-7220589	FUND MGMT	IN	501(C)(3)	LINE 12A, I	PARKVIEW HOSPITAL INC		No
(13)PARKVIEW HOSPITAL INC 11109 PARKVIEW PLAZA DRIVE FORT WAYNE,IN46845 35-0868085	HOSPITAL CARE	IN	501(C)(3)	LINE 3	PARKVIEW HEALTH SYSTEM INC		No
(14)PARKVIEW HUNTINGTON HOSPITAL FOUNDATION INC 2001 STULTS ROAD HUNTINGTON,IN46750 32-0012095	FUND MGMT	IN	501(C)(3)	LINE 12A, I	HUNTINGTON MEMORIAL HOSPITAL INC		No
(15)PARKVIEW LAGRANGE HOSPITAL FOUNDATION INC 207 N TOWNLINE ROAD LAGRANGE,IN46761 83-3347115	FUND MGMT	IN	501(C)(3)	LINE 12A, I	COMMUNITY HOSPITAL OF LAGRANGE COUNTY INC		No
(16)PARKVIEW OCCUPATIONAL HEALTH CENTERS INC 1450 PRODUCTION RD FORT WAYNE,IN46808 35-2064353	OCCUPATIONAL HEALTH	IN	501(C)(3)	LINE 3	PARKVIEW HEALTH SYSTEM INC		No
(17)PARKVIEW WABASH HOSPITAL FOUNDATION INC 10 JOHN KISSINGER DRIVE WABASH,IN46992 35-1921445	FUND MGMT	IN	501(C)(3)	LINE 12A, I	PARKVIEW WABASH HOSPITAL INC		No
(18)PARKVIEW WABASH HOSPITAL INC 10 JOHN KISSINGER DRIVE WABASH,IN46992 47-1753440	HOSPITAL CARE	IN	501(C)(3)	LINE 3	PARKVIEW HEALTH SYSTEM INC		No

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50135Y

Schedule R (Form 990) 2020

Page 2

Part III

Identification of Related Organizations Taxable as a Partnership. Complete if the organization answered "Yes" on Form 990, Part IV, line 34, because it had one or more related organizations treated as a partnership during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Predominant income(related, unrelated, excluded from tax under sections 512-514)	(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?		(k) Percentage ownership
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity		(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No	(k) Percentage ownership
(1) ORTHOPAEDIC HOSPITAL AT PARKVIEW NORTH LLC 1450 PRODUCTION RD FORT WAYNE,IN46808 26-0143823	ORTHO HOSPITAL	IN	N/A	N/A				No			No
(2) MANAGED CARE SERVICES LLC 1450 PRODUCTION RD FORT WAYNE,IN46808 35-1996535	HEALTH PLAN ADMIN	IN	N/A	N/A				No			No

Part IV

Identification of Related Organizations Taxable as a Corporation or Trust. Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	(h) Percentage ownership	(i) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	(h) Percentage ownership	Yes	No
(1) PARKVIEW PROFESSIONAL PROGRAMS INC 1450 PRODUCTION RD FORT WAYNE,IN46808 35-1668888	REFERENCE LAB	IN	N/A	C					No
(2) MIDWEST COMMUNITY HEALTH ASSOCIATES INC 442 W HIGH STREET BRYAN,OH43506 34-1045870	PHYSICIANS	OH	N/A	C					No
(3) WOODLAND PLAZA MEDICAL PARK CONDO ASSOC INC 202 W BERRY ST SUITE 800 FORT WAYNE,IN46802 35-2058340	CONDO MANAGEMENT	IN	N/A	C					No

Schedule R (Form 990) 2020

Page 3

Part V

Transactions With Related Organizations. Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35b, or 36.

Note. Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.

Yes

1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?

a Receipt of (i) interest, (ii) annuities, (iii) royalties, or (iv) rent from a controlled entity .....................

b Gift, grant, or capital contribution to related organization(s) ............................

Yes

c Gift, grant, or capital contribution from related organization(s) ............................

Yes

d Loans or loan guarantees to or for related organization(s) ............................

e Loans or loan guarantees by related organization(s) ............................

Yes

f Dividends from related organization(s) ............................

g Sale of assets to related organization(s) ............................

h Purchase of assets from related organization(s) ............................

i Exchange of assets with related organization(s) ............................

j Lease of facilities, equipment, or other assets to related organization(s) .......................

Yes

k Lease of facilities, equipment, or other assets from related organization(s) ......................

Yes

l Performance of services or membership or fundraising solicitations for related organization(s) .....................

Yes

m Performance of services or membership or fundraising solicitations by related organization(s) .................

Yes

n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) ...................

Yes

o Sharing of paid employees with related organization(s) ............................

Yes

p Reimbursement paid to related organization(s) for expenses ............................

Yes

q Reimbursement paid by related organization(s) for expenses ............................

Yes

r Other transfer of cash or property to related organization(s) ............................

Yes

s Other transfer of cash or property from related organization(s) ............................

Yes

If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.

(a) Name of related organization	(b) Transaction type (a-s)	(c) Amount involved	(d) Method of determining amount involved
(1) WHITLEY MEMORIAL HOSPITAL FOUNDATION INC	C	79,714	PART VII SUPPLEMENTAL INFORMATION
(2) WHITLEY MEMORIAL HOSPITAL FOUNDATION INC	M	160,389	PART VII SUPPLEMENTAL INFORMATION

Schedule R (Form 990) 2020

Page 4

Part VI

Unrelated Organizations Taxable as a Partnership. Complete if the organization answered "Yes" on Form 990, Part IV, line 37.

Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.

(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(e) Are all partners section 501(c)(3) organizations?		(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?		(k) Percentage ownership
(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	Yes	No	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No	(k) Percentage ownership

Schedule R (Form 990) 2020

Page 5

Part VII

Supplemental Information

Provide additional information for responses to questions on Schedule R. See instructions.

Return Reference	Explanation
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.

Schedule R (Form 990) 2020

Additional Data

Software ID:
Software Version:

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	184,803	2,517,715
9	Program service revenue (Part VIII, line 2g) .........	95,004,286	82,678,875
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	1,891,284	2,752,957
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	150,851	48,741
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	97,231,224	87,998,288
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	86,061	85,321
14	Benefits paid to or for members (Part IX, column (A), line 4).....	0	0
15	Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10)	25,180,318	25,244,502
16a	Professional fundraising fees (Part IX, column (A), line 11e) .....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 160,389
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	60,287,299	53,465,107
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	85,553,678	78,794,930
19	Revenue less expenses. Subtract line 18 from line 12.......	11,677,546	9,203,358
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	109,761,803	128,120,921
21	Total liabilities (Part X, line 26).............	12,405,455	17,625,128
22	Net assets or fund balances. Subtract line 21 from line 20.....	97,356,348	110,495,793

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 59,834,358 including grants of $ 85,321 ) (Revenue $ 82,678,875 )
	WHITLEY MEMORIAL HOSPITAL, INC. IS A MEMBER OF PARKVIEW HEALTH. WE ARE DEDICATED TO IMPROVING AND INSPIRING THE HEALTH OF THE COMMUNITY. WE ACCOMPLISH THIS THROUGH DELIVERING WORLD-CLASS TEAMWORK AND EXCELLENT CARE. WE PARTNER WITH PATIENTS AND OTHER COMMUNITY ORGANIZATIONS TO TAILOR PERSONALIZED HEALTH JOURNEYS. EXCELLENCE, INNOVATION AND VALUE ARE IMPORTANT TO OUR PATIENTS AND TO US. OUR CARE IS DELIVERED WHILE ALWAYS KEEPING IN MIND CONVENIENCE, COMPASSION AND EXCELLENCE BOTH IN COST AND IN QUALITY. WE DEVELOP AND VALUE THE RELATIONSHIPS WE FORM WITH OUR PATIENTS AND OUR COMMUNITY. (SEE SCHEDULE O FOR CONTINUATION)WHITLEY MEMORIAL HOSPITAL, INC. IS A MAGNET DESIGNATED HOSPITAL. WIDELY CONSIDERED THE HIGHEST RECOGNITION FOR NURSING EXCELLENCE, MAGNET DESIGNATION IS ACHIEVED BY ONLY 8% OF U.S. HOSPITALS AND RECOGNIZES MEASURABLE, POSITIVE PATIENT OUTCOMES AND HIGH SATISFACTION LEVELS. MAGNET DESIGNATION IS GRANTED BY THE AMERICAN NURSES CREDENTIALING CENTER'S (ANCC) MAGNET RECOGNITION PROGRAM, WHICH ENSURES THAT RIGOROUS STANDARDS FOR NURSING EXCELLENCE ARE MET. TO MAINTAIN MAGNET RECOGNITION, A HOSPITAL MUST CONTINUE TO MEET THE HIGH STANDARDS SET BY THE ANCC. ACCORDING TO THE ANCC, MAGNET DESIGNATION INDICATES AN ORGANIZATION PROVIDES A CULTURE IN WHICH NURSES CAN FLOURISH AS PROFESSIONALS. THESE SELECT ENTITIES PLACE AN EMPHASIS ON PROVIDING THEIR NURSING TEAMS WITH THE PROFESSIONAL AUTONOMY TO MAKE CLINICAL DECISIONS AT PATIENT BEDSIDES. THEY ALSO INVOLVE NURSES IN DECISIONS REGARDING THE PATIENT CARE ENVIRONMENT, AS WELL AS ENABLE MORE INTERDISCIPLINARY COLLABORATIONS WITH OTHER TEAM MEMBERS.WHITLEY MEMORIAL HOSPITAL, INC. MAINTAINS THE DESIGNATION OF BEING A BABY FRIENDLY ORGANIZATION AS AWARDED BY BABY-FRIENDLY USA. THIS IS A 5-YEAR DESIGNATION, AND EACH YEAR WE ARE ASSIGNED QUALITY AUDITS TO COMPLETE AND SUBMIT TO MAINTAIN OUR DESIGNATION. THE AWARD RECOGNIZES A COMMITMENT TO IMPROVING THE HEALTH OF BABIES BY PROVIDING EDUCATION ON THE POSITIVE EFFECTS OF BREAST FEEDING. THE DESIGNATION WAS AWARDED AFTER SEVERAL CRITERIA WERE MET, INCLUDING AN ONSITE SURVEY, DEMONSTRATING THAT POLICIES AND PROCESSES WERE IN PLACE TO HELP EDUCATE AND PROMOTE SAFE FEEDING PRACTICES TO ALL MOTHERS WHO GIVE BIRTH AT THE LOCATION. THERE WERE 394 BIRTHS AT WHITLEY MEMORIAL HOSPITAL, INC. IN 2020.WHITLEY MEMORIAL HOSPITAL, INC. IS KEEPING PACE WITH THE RAPIDLY CHANGING HEALTHCARE INDUSTRY BY INCORPORATING NEW TECHNOLOGY AND THE LATEST DIAGNOSTIC AND TREATMENT PROCEDURES, WHILE CONTINUALLY SEEKING WAYS TO GIVE BACK TO THE COMMUNITY WE SERVE. ONE SUCH EXAMPLE IS THE TOMOGRAPHIC 3D DIGITAL MAMMOGRAPHY EQUIPMENT UTILIZED FOR SCREENING AND DIAGNOSTIC PROCEDURES. THIS ADVANCED MAMMOGRAPHY TECHNOLOGY IS CONSIDERED THE NEW STANDARD OF CARE AND HAS BEEN SHOWN TO HELP REDUCE THE NUMBER OF FOLLOW-UP SCANS REQUIRED. WHITLEY AND WARSAW LOCATIONS SAW 7567 WOMEN UTILIZE THIS EQUIPMENT IN 2020. IN ADDITION, ROBOTICS TECHNOLOGY HAS BECOME ROUTINE FOR ELIGIBLE HERNIA AND GALL BLADDER CASES. THIS MINIMALLY INVASIVE SURGICAL APPROACH IS ASSOCIATED WITH GREATLY REDUCED RECOVERY TIME AND A DECREASED RISK OF COMPLICATIONS FOR PATIENTS WHO QUALIFY FOR PROCEDURES UTILIZING THIS TECHNOLOGY. THERE WERE 187 ROBOTIC GENERAL SURGERY CASES DURING THE YEAR 2020. IN ADDITION, GYNECOLOGICAL SURGERIES WERE ADDED TO THE ROBOTICS CASELOAD IN DECEMBER.THE PATIENT AND FAMILY ADVISORY COUNCIL (PFAC) IS A FORUM THAT ENABLES PATIENTS AND FAMILIES TO HAVE DIRECT INPUT AND INFLUENCE ON THE POLICIES, PROGRAMS, AND PRACTICES OF WHITLEY MEMORIAL HOSPITAL, INC. THE PATIENT AND FAMILY ADVISORY COUNCIL IS UTILIZED IN THE DEVELOPMENT AND PLANNING OF PROGRAMS THAT IMPACT THE CARE AND SERVICES RECEIVED AT WHITLEY. WHILE THERE WAS LIMITED ACTIVITY IN 2020 DUE TO COVID-19 RESTRICTIONS, THE COUNCIL IS ACTIVE AGAIN IN 2021. WHITLEY MEMORIAL HOSPITAL, INC.'S FOCUS ON WORLD CLASS QUALITY AND SAFETY IS THE BASIS OF ITS QUALITY SAFETY INFECTION PREVENTION (QSI) TEAM. DEPARTMENTS ASSIGN A CO-WORKER TO BE A MEMBER OF THE TEAM. THE AGENT WILL ATTEND ONE MEETING A MONTH TO REVIEW TOPICS IN QUALITY, SAFETY AND INFECTION PREVENTION. IT IS AN OPPORTUNITY TO REVIEW WHY CHANGE IN HEALTHCARE CAN BE DIFFICULT, BUT MOST IMPORTANTLY, WHY IT IS CRUCIAL AND NECESSARY. IT ALL ALLOWS THE AGENT TO IDENTIFY OPPORTUNITIES FOR IMPROVEMENT IN THEIR OWN DEPARTMENTS AND UNDERSTAND HOW THOSE CHANGES CAN POSITIVELY IMPACT OUR FACILITY'S OUTCOMES. BEING A PART OF THE QSI AGENT PROGRAM GIVES THE CO-WORKER SPECIFIC SKILLS TO USE TO IMPROVE PATIENT AND CO-WORKER SAFETY AND EFFECTIVENESS. THIS PROGRAM ALSO BUILDS TEAMWORK AND COMMUNICATION THAT ENHANCE THE SAFETY OF ANYONE WHO WALKS THROUGH WHITLEY MEMORIAL HOSPITAL, INC.'S DOORS.OUR CORE VALUES ARE DISPLAYED THROUGH OUR MANY COMMUNITY EDUCATION AND OUTREACH PROGRAMS, AS WELL AS OUR CHARITY CARE SERVICES AND THE VOLUNTEERISM OF OUR EMPLOYEES. TO FURTHER ADDRESS THE SPECIFIC NEEDS OF THE COMMUNITY, PARKVIEW HEALTH ROUTINELY SPONSORS A PROFESSIONALLY ADMINISTERED COMMUNITY HEALTH NEEDS ASSESSMENT TO IDENTIFY HEALTH NEEDS WITHIN NORTHEAST INDIANA, PARTICULARLY, THE SEVEN COUNTIES IN WHICH PARKVIEW HOSPITALS ARE LOCATED. THE FOLLOWING ARE SOME OF THE WAYS WHITLEY MEMORIAL HOSPITAL, INC. IS REACHING OUT TO MAKE OUR NEIGHBORHOODS AND COMMUNITIES HEALTHIER:-FINANCIAL ASSISTANCE-COMMUNITY HEALTH IMPROVEMENT INITIATIVES-COMMUNITY HEALTH NURSE PROGRAM-PRIMARY HEALTH CARE/ACCESS-MEDICATION ASSISTANCE PROGRAM (MAP)-HEALTH SCREENING/PREVENTION AND DISEASE MANAGEMENT-EDUCATIONAL AND SUPPORT PROGRAMS-VOLUNTEER PROGRAM/STAFF VOLUNTEERISM-EMS SERVICES -WHEELCHAIR DONATION-PARKVIEW HEALTH SYSTEM, INC. COVID-19 SPECIFIC INITIATIVESFINANCIAL ASSISTANCE:WHITLEY MEMORIAL HOSPITAL, INC.'S MISSION INCLUDES CARING FOR PEOPLE WHO DO NOT HAVE THE MEANS TO MEET THEIR FINANCIAL OBLIGATIONS. A FINANCIAL COUNSELOR IS AVAILABLE TO ASSIST PATIENTS IN NAVIGATING THIS PROCESS. THE HOSPITAL PRIORITIZES OUR RESPONSIBILITY TO DELIVER EXCELLENT, NECESSARY CARE TO THE PATIENT, NOT THE PATIENT'S ABILITY TO PAY FOR HIS/HER MEDICAL EXPENSES. COMMUNITY HEALTH IMPROVEMENT INITIATIVES:WHITLEY MEMORIAL HOSPITAL, INC.'S COMMUNITY HEALTH IMPROVEMENT PROGRAM WAS ESTABLISHED TO HELP FUND COMMUNITY HEALTH IMPROVEMENT EFFORTS WITHIN WHITLEY MEMORIAL HOSPITAL'S SERVICE AREA. THE HOSPITAL SETS ASIDE UP TO 10 PERCENT OF ITS NET INCOME ANNUALLY TO FUND COMMUNITY HEALTH INITIATIVES. BY PARTNERING WITH COMMUNITY ORGANIZATIONS, THESE FUNDS ARE USED TO ENCOURAGE HEALTHIER LIFESTYLES AMONG THE CITIZENS OF WHITLEY COUNTY AND KOSCIUSKO COUNTY WITH A SPECIAL EMPHASIS ON ADDRESSING THE HEALTH ISSUES IDENTIFIED IN THE COMMUNITY HEALTH NEEDS ASSESSMENT. IN 2019, WHITLEY MEMORIAL COMPLETED A NEW COMMUNITY HEALTH NEEDS ASSESSMENT, AND THIS DATA WAS USED AS A BASIS FOR IDENTIFYING KEY COMMUNITY PARTNERSHIPS AND FUNDING FOR THE YEARS OF 2020-2022. WHITLEY MEMORIAL HOSPITAL, INC. INVESTS IN KEY ORGANIZATIONS THAT PROMOTE THE HEALTH AND WELL-BEING OF FAMILIES, CHILDREN, AND INDIVIDUALS OF THE COMMUNITIES IT SERVES. COMMUNITY HEALTH NURSE PROGRAM:WHITLEY MEMORIAL HOSPITAL, INC. DEVELOPED A NEW COMMUNITY HEALTH NURSE PROGRAM IN 2019. THE PROGRAM INCLUDED THE CREATION OF A NEW COMMUNITY HEALTH NURSE POSITION, WHOSE ROLE WAS TO IDENTIFY THE HEALTH AND WELLBEING NEEDS OF THE UNDERSERVED WITHIN A COMMUNITY. THEIR FOCUS WAS TO IMPROVE THE HEALTH, QUALITY OF LIFE, AND WELLNESS OF THE COMMUNITY BY PROVIDING EDUCATION, SCREENINGS, AND AVAILABLE RESOURCES. WHITLEY MEMORIAL HOSPITAL, INC.'S COMMUNITY HEALTH NURSE DEVELOPED STRATEGIES AND PROGRAMS TO PROMOTE HEALTH AND DISEASE PREVENTION IN A RANGE OF POPULATIONS INCLUDING THE ELDERLY, SCHOOL AGE CHILDREN, AND RESIDENTS IN LOCAL HOMELESS SHELTERS. THE ROLE ALSO DEVELOPED INTERVENTIONS TARGETED TO THESE POPULATIONS AND THEIR SOCIAL DETERMINANTS OF HEALTH. UNFORTUNATELY, DURING MARCH 2020, THE COMMUNITY HEALTH NURSE WAS REDEPLOYED TO THE HOSPITAL'S INPATIENT UNIT DUE TO COVID-19 PATIENT NEEDS AND BECAUSE OF SOCIAL DISTANCING RESTRICTIONS WITHIN THE COMMUNITY. THE POSITION HAD NOT BEEN REINSTATED BY END OF 2020.PRIMARY HEALTH CARE/ACCESS:WHITLEY MEMORIAL HOSPITAL, INC. FEATURES 30 BEDS WITH ALL PRIVATE ROOMS. EMERGENCY MEDICAL CARE, OBSTETRIC CARE AND A MEDICAL-SURGICAL UNIT ARE AVAILABLE AS WELL AS LABORATORY, MULTIPLE MODALITY IMAGING, SURGICAL SERVICES AND OUTPATIENT INFUSION. AN ATTACHED MEDICAL OFFICE BUILDING PROVIDES CONVENIENT, EASY ACCESS FOR PATIENTS TO RECEIVE CARE FROM FAMILY AND SPECIALTY PHYSICIANS, AS WELL AS DIAGNOSTIC IMAGING SERVICES, SLEEP DISORDERS LAB AND PHYSICAL, OCCUPATIONAL, SPEECH AND CARDIAC REHABILITATION.

4b	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4c	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4d	Other program services (Describe in Schedule O.)
	(Expenses $ including grants of $ ) (Revenue $ )
4e	Total program service expenses59,834,358

(A) Name and title	(B) Average hours per week (list any hours for related organizations below dotted line)		(D) Reportable compensation from the organization (W-2/1099-MISC)	(E) Reportable compensation from related organizations (W-2/1099-MISC)	(F) Estimated amount of other compensation from the organization and related organizations
(A) Name and title
(18) ASHLEY WIRGES........................................................................ WMHOS VP PATIENT CARE	40.00 .......................0.00	X	140,518	0	31,670
(19) CHARLES JINKS........................................................................ WMHOS PHARMACIST	40.00 .......................0.00	X	123,534	3,707	39,828
(20) PETER TALATI........................................................................ WMHOS MGR REHAB	40.00 .......................0.00	X	132,815	0	30,747

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	1,296,801	4,259,144	2,433,746

1	Briefly describe the organization’s mission or most significant activities: WHITLEY MEMORIAL HOSPITAL, INC. WORKS TO IMPROVE THE HEALTH OF OUR COMMUNITIES AND PROVIDES QUALITY HEALTH SERVICES TO ALL WHO ENTRUST THEIR CARE TO US.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	13
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	8
5	Total number of individuals employed in calendar year 2020 (Part V, line 2a) ......	5	406
6	Total number of volunteers (estimate if necessary) .............	6	28
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	0
b	Net unrelated business taxable income from Form 990-T, line 39 .........	7b	0

1a	Federated campaigns..		1a
b	Membership dues..		1b
c	Fundraising events..		1c
d	Related organizations		1d	120,946
e	Government grants (contributions)		1e	2,396,769

f	All other contributions, gifts, grants, and similar amounts not included above		1f

g	Noncash contributions included in lines 1a - 1f:$		1g

h Total. Add lines 1a-1f.......		2,517,715

		Business Code
2a	NET PATIENT REVENUE	622000	81,191,454	81,191,454
b	INTERUNIT RENT	531120	987,099	987,099
c	EMS SUBSIDY	621910	250,000	250,000
d	PHARMACY	446110	203,595	203,595
e	REHAB REVENUE	621990	45,021	45,021
f	All other program service revenue.		1,706	1,706
g	Total. Add lines 2a–2f .....		82,678,875

3 Investment income (including dividends, interest, and othersimilar amounts) ......			1,012,730			1,012,730
4 Income from investment of tax-exempt bond proceeds
5 Royalties...........
		(ii) Personal	(i) Real
6a	Gross rents		47,921	6a
b	Less: rental expenses		158,670	6b
c	Rental income or (loss)		-110,749	6c
d	Net rental income or (loss).......			-110,749			-110,749
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory		75,690,109	7a
b	Less: cost or other basis and sales expenses		73,949,882	7b
c	Gain or (loss)		1,740,227	7c
d	Net gain or (loss).........			1,740,227			1,740,227
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ....
			8a
b	Less: direct expenses ...		8b
c	Net income or (loss) from fundraising events..
9a	Gross income from gaming activities. See Part IV, line 19 ...
			9a
b	Less: direct expenses ...		9b
c	Net income or (loss) from gaming activities..
10a	Gross sales of inventory, less returns and allowances ..
			10a
b	Less: cost of goods sold ..		10b
c	Net income or (loss) from sales of inventory..
Business Code			Miscellaneous Revenue
11a	CAFETERIA REVENUE		722210	153,525			153,525
b	GIFT SHOP REVENUE		453220	5,965			5,965
c
d	All other revenue ....
e	Total. Add lines 11a–11d ......			159,490
12	Total revenue. See instructions.....			87,998,288	82,678,875	0	2,801,698

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21 ....	85,321	85,321
2	Grants and other assistance to domestic individuals. See Part IV, line 22 ...........
3	Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See Part IV, lines 15 and 16. .............
4	Benefits paid to or for members .......
5	Compensation of current officers, directors, trustees, and key employees ...........	723,207		723,207
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .........
7	Other salaries and wages........	18,268,239	18,268,239
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....
9	Other employee benefits .......	6,253,056	6,253,056
10	Payroll taxes ...........
11	Fees for services (non-employees):
a	Management ......
b	Legal .........	3,530		3,530
c	Accounting ...........	60,500		60,500
d	Lobbying ...........
e	Professional fundraising services. See Part IV, line 17
f	Investment management fees ......	148,836		148,836
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	7,584,056	5,527,512	2,056,544
12	Advertising and promotion ....	6,887	2,425	4,462
13	Office expenses .......	1,260,631	1,178,448	82,183
14	Information technology ......	415	415
15	Royalties ..
16	Occupancy ...........	3,953,345	3,937,246	16,099
17	Travel ............	27,155	20,690	6,465
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .
19	Conferences, conventions, and meetings ....	6,702	4,545	2,157
20	Interest ...........	100,096	100,096
21	Payments to affiliates .......
22	Depreciation, depletion, and amortization ..	2,918,605	2,916,832	1,773
23	Insurance ...	186,043	141,458	44,585
24	Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a	CORP SERVICE ALLOCATION	15,572,719		15,572,719
b	PH CLINICAL SUPPORT	10,334,676	10,334,676
c	MEDICAL SUPPLIES	7,870,221	7,870,221
d	HOSPITAL ASSESSMENT FEE	3,114,582	3,114,582
e	All other expenses	316,108	78,596	77,123	160,389
25	Total functional expenses. Add lines 1 through 24e	78,794,930	59,834,358	18,800,183	160,389
26	Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here if following SOP 98-2 (ASC 958-720).

1	Cash–non-interest-bearing ........			3,448	1	3,448
2	Savings and temporary cash investments .........			81,332	2	10,359
3	Pledges and grants receivable, net ......				3
4	Accounts receivable, net .............			12,206,876	4	12,273,225
5	Loans and other receivables from any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .......
					5
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), and persons described in section 4958(c)(3)(B) ...
					6
7	Notes and loans receivable, net ...........				7
8	Inventories for sale or use ............			526,020	8	716,022
9	Prepaid expenses and deferred charges ......			69,294	9	110,042
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	41,024,339
b	Less: accumulated depreciation	10b	19,676,223	23,622,995	10c	21,348,116
11	Investments—publicly traded securities .			59,581,236	11	66,085,810
12	Investments—other securities. See Part IV, line 11 .....				12
13	Investments—program-related. See Part IV, line 11 ..				13
14	Intangible assets ...............				14
15	Other assets. See Part IV, line 11 ...........			13,670,602	15	27,573,899
16	Total assets. Add lines 1 through 15 (must equal line 33)...			109,761,803	16	128,120,921

17	Accounts payable and accrued expenses .....	2,521,775	17	2,857,586
18	Grants payable ...		18
19	Deferred revenue .........		19	3,849,174
20	Tax-exempt bond liabilities .........		20
21	Escrow or custodial account liability. Complete Part IV of Schedule D		21
22	Loans and other payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .........
			22
23	Secured mortgages and notes payable to unrelated third parties ..	2,806,500	23	2,806,500
24	Unsecured notes and loans payable to unrelated third parties ..		24
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17 - 24). Complete Part X of Schedule D	7,077,180	25	8,111,868
26	Total liabilities. Add lines 17 through 25..	12,405,455	26	17,625,128

	Organizations that follow FASB ASC 958, check here and complete lines 27, 28, 32, and 33.
27	Net assets without donor restrictions ..........	97,356,348	27	110,495,793
28	Net assets with donor restrictions ...........		28
	Organizations that do not follow FASB ASC 958, check here and complete lines 29 through 33.
29	Capital stock or trust principal, or current funds .....		29
30	Paid-in or capital surplus, or land, building or equipment fund ...		30
31	Retained earnings, endowment, accumulated income, or other funds		31
32	Total net assets or fund balances ...........	97,356,348	32	110,495,793
33	Total liabilities and net assets/fund balances ........	109,761,803	33	128,120,921