Attach to Form 990 or Form 990-EZ.
Go to
www.irs.gov/Form990 for instructions and the latest information.
| (i) Name of supported organization | (ii) EIN | (iii) Type of organization (described on lines 1- 10 above (see instructions)) | (iv) Is the organization listed in your governing document? | (v) Amount of monetary support (see instructions) | (vi) Amount of other support (see instructions) | |
|---|---|---|---|---|---|---|
| Yes | No | |||||
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Total |
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Calendar year
(or fiscal year beginning in)
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(a) 2017 | (b) 2018 | (c) 2019 | (d) 2020 | (e) 2021 | (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. | ||||||
Calendar year
(or fiscal year beginning in)
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(a) 2017 | (b) 2018 | (c) 2019 | (d) 2020 | (e) 2021 | (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 | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2017 | (b) 2018 | (c) 2019 | (d) 2020 | (e) 2021 | (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.) | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2017 | (b) 2018 | (c) 2019 | (d) 2020 | (e) 2021 | (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 on 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.).. | ||||||
| Section A - Adjusted Net Income | (A) Prior Year |
(B) Current Year (optional) |
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| 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) |
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| 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): |
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| 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 | ||||
| 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 2021 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-2021 |
(iii) Distributable Amount for 2021 |
|
|---|---|---|---|---|
| 1 Distributable amount for 2021 from Section C, line 6 | ||||
|
2
Underdistributions, if any, for years prior to 2021 (reasonable cause required-- explain in Part VI). See instructions. |
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| 3 Excess distributions carryover, if any, to 2021: | ||||
| a From 2016....... | ||||
| b From 2017....... | ||||
| c From 2018....... | ||||
| d From 2019....... | ||||
| e From 2020....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2021 distributable amount | ||||
|
i
Carryover from 2016 not applied (see instructions) |
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| j Remainder. Subtract lines 3g, 3h, and 3i from line 3f. | ||||
| 4Distributions for 2021 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2021 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from line 4. | ||||
|
5
Remaining underdistributions for years prior to 2021, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions. |
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6
Remaining underdistributions for 2021. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions. |
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7 Excess distributions carryover to 2022. Add lines 3j and 4c. |
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| 8 Breakdown of line 7: | ||||
| a Excess from 2017..... | ||||
| b Excess from 2018..... | ||||
| c Excess from 2019..... | ||||
| d Excess from 2020..... | ||||
| e Excess from 2021..... | ||||
| Facts And Circumstances Test |
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| Return Reference | Explanation |
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| Software ID: | |
| Software Version: |
Attach to Form 990 or 990-EZ.
Go to www.irs.gov/Form990 for the latest information.
| Return Reference | Explanation |
|---|---|
| FORM 990, PART III, LINE 4A: | - RECOGNIZED AS AN INSPIRE HOSPITAL OF DISTINCTION FOR 2021 BY THE INDIANA HOSPITAL ASSOCIATION, IN PARTNERSHIP WITH GOVERNOR ERIC HOLCOMB AND STATE HEALTH COMMISSIONER KRIS BOX, FACOG, FOR ITS EXCELLENCE IN CARING FOR MOTHERS AND BABIES, HAVING IMPLEMENTED BEST PRACTICES IN SIX KEY AREAS THAT ARE DRIVERS OF INFANT AND MATERNAL HEALTH - NAMED ONE OF THE NATION'S 100 TOP HOSPITALS BY IBM WATSON HEALTH -- RECEIVED IN 2020 FOR THE SEVENTH TIME - NAMED ONE OF THE TOP 100 RURAL & COMMUNITY HOSPITALS IN THE UNITED STATES BY THE CHARTIS CENTER FOR RURAL HEALTH -- RECEIVED IN 2020 FOR THE THIRD YEAR - NAMED ONE OF THE BEST PLACES TO WORK IN INDIANA BY THE INDIANA CHAMBER OF COMMERCE -- RECEIVED IN 2018 AND 2019 - NAMED ONE OF MODERN HEALTHCARE'S BEST PLACES TO WORK IN HEALTHCARE -- RECEIVED IN 2018 AND 2019 - NAMED ONE OF THE BECKER'S HOSPITAL REVIEW 100 GREAT COMMUNITY HOSPITALS -- RECEIVED IN 2019 FOR THE FIFTH CONSECUTIVE YEAR HOSPITAL SERVICES SERVICES INCLUDE: - FULL-SERVICE, 24-HOUR EMERGENCY DEPARTMENT WITH EIGHT TREATMENT ROOMS, ONE TRAUMA BAY AND A "SAFE ROOM" FOR PATIENTS WHO MAY BE EXPERIENCING A BEHAVIORAL HEALTH CRISIS - TWO SURGICAL SUITES, ONE ENDOSCOPY ROOM, EIGHT PRE-/POST-OP ROOMS AND THREE RECOVERY ROOMS - MEDICAL INFUSION UNIT PROVIDING OUTPATIENT MEDICATIONS, INFUSIONS, TRANSFUSIONS AND CENTRAL LINE CARE UNDER THE SUPERVISION OF A DEDICATED RN - FAMILY BIRTHING CENTER WITH SIX PRIVATE LABOR/DELIVERY/RECOVERY/POSTPARTUM ROOMS - REHABILITATION AND WELLNESS SERVICES INCLUDING ADULT AND PEDIATRIC PHYSICAL AND OCCUPATIONAL THERAPY, SPEECH THERAPY, DIABETES EDUCATION, MEDICAL NUTRITION THERAPY, AND CARDIAC AND PULMONARY REHAB - FULL-SERVICE LAB AND PHARMACY, INCLUDING AN ATU CLINIC FOR PATIENTS TAKING BLOOD THINNERS - A SLEEP DISORDERS LAB OFFERING TWO PATIENT ROOMS FOR OVERNIGHT, ON-SITE SLEEP STUDIES AND INSTRUCTION FOR PATIENTS RECEIVING HOME SLEEP STUDIES - AN OUTPATIENT CENTER FOR WOUND HEALING OFFERING BIOLOGIC AND BIOSYNTHETIC DRESSINGS, GROWTH FACTOR THERAPIES, NEGATIVE PRESSURE THERAPY, DEBRIDEMENT AND HYPERBARIC OXYGEN THERAPY - DIAGNOSTIC IMAGING SERVICES: 3D MAMMOGRAPHY, 3D AND 4D ULTRASOUND, CT SCAN, MRI, NUCLEAR MEDICINE, DEXA SCAN, EKG, EEG AND CARDIOPULMONARY PROCEDURES, VASCULAR SCREENING AND FLUOROSCOPY - ON-SITE CLINIC HOUSING SPECIALTY PHYSICIANS WHO TRAVEL TO HUNTINGTON ON SCHEDULED DAYS TO ACCOMMODATE THE NEEDS OF PATIENTS FOR CONSULTATIONS, FOLLOW-UP VISITS AND/OR PROCEDURES IN A NUMBER OF MEDICAL SPECIALTIES - PRIMARY CARE AND SPECIALTY SERVICES ON THE HOSPITAL CAMPUS AND IN NEARBY LOCATIONS COMMUNITY-FOCUSED AS A NOT-FOR-PROFIT HOSPITAL, MISSION IS CENTRAL TO HOW THE STAFF DELIVERS CARE. HUNTINGTON MEMORIAL HOSPITAL, INC., EXISTS TO IMPROVE THE HEALTH AND INSPIRE THE WELL-BEING OF SURROUNDING COMMUNITIES. HUNTINGTON MEMORIAL HOSPITAL, INC., SUPPORTS THE NEEDS OF PEOPLE IN HUNTINGTON COUNTY WITH CERTIFIED NURSING STAFF, HEALTH EDUCATION AND OUTREACH PROGRAMS, AND FREE AND DISCOUNTED MEDICAL CARE. THE FIVE PROGRAMS LISTED HERE DEMONSTRATE SOME OF THE WAYS IN WHICH HUNTINGTON MEMORIAL HOSPITAL, INC., REACHES OUT TO NEIGHBORHOODS AND HELPS AREA RESIDENTS CREATE HEALTHIER LIVES. FINANCIAL ASSISTANCE HUNTINGTON MEMORIAL HOSPITAL, INC., IS COMMITTED TO MAKING MEDICALLY NECESSARY HEALTHCARE ACCESSIBLE TO PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. PATIENTS WHOSE FAMILY INCOME DOES NOT EXCEED TWICE THE FEDERAL POVERTY GUIDELINES MAY BE ELIGIBLE FOR FINANCIAL ASSISTANCE. THE PATIENT ACCESS TEAM INFORMS PATIENTS OF THE FINANCIAL ASSISTANCE POLICY AS PART OF THE REGISTRATION PROCESS. THE HOSPITAL COMMITS TO PROVIDING THE BEST POSSIBLE CARE TO ALL. COMMUNITY HEALTH IMPROVEMENT INITIATIVES THE PURPOSE OF HUNTINGTON MEMORIAL HOSPITAL, INC.'S COMMUNITY HEALTH IMPROVEMENT PROGRAM IS TO FUND COMMUNITY HEALTH IMPROVEMENT EFFORTS WITHIN THE HOSPITAL'S SERVICE AREA. THE HOSPITAL SETS ASIDE FUNDS ANNUALLY TO SUPPORT PROGRAMS OF SELECTED COMMUNITY HEALTH PARTNERS THAT ALIGN WITH HEALTH PRIORITIES IDENTIFIED PERIODICALLY BY THE COMMUNITY HEALTH NEEDS ASSESSMENT. WITH ITS COMMUNITY HEALTH PARTNERS PROGRAM, HUNTINGTON MEMORIAL HOSPITAL, INC., INVESTS IN PROGRAMMING BY KEY ORGANIZATIONS THAT PROMOTE THE HEALTHY LIFESTYLE CHOICES AND WELL-BEING OF INDIVIDUALS, CHILDREN, AND FAMILIES OF HUNTINGTON COUNTY. IN CALENDAR YEAR 2021, THE HOSPITAL SELECTED 10 COMMUNITY AGENCIES OR ORGANIZATIONS WITH WHICH TO COLLABORATE IN ADDRESSING FOCUS AREAS: SUBSTANCE USE DISORDER/MENTAL HEALTH AND OBESITY. PRIMARY HEALTH CARE/ACCESS HUNTINGTON MEMORIAL HOSPITAL, INC., COLLABORATES WITH PARKVIEW PHYSICIANS GROUP (PPG) TO PROVIDE THE MEDICAL COVERAGE NEEDED FOR THE COMMUNITY. IF AN INDIVIDUAL DOES NOT HAVE A LOCAL PRIMARY CARE PHYSICIAN, THEY ARE PROVIDED WITH A LIST OF THE LOCAL PHYSICIANS AND THEIR CONTACT NUMBERS. MATTHEW 25 HEALTH AND CARE, BASED IN FORT WAYNE, HAS A SATELLITE OFFICE IN THE HUNTINGTON COMMUNITY TO WHICH PPG OFFICES AND THE HOSPITAL CAN REFER PEOPLE WHO DO NOT HAVE HEALTH INSURANCE. IN ADDITION, THE HOSPITAL PROVIDES SUPPORT FOR THE HUNTINGTON MEDICATION ASSISTANCE PROGRAM, WHICH ASSISTS THOSE WHO QUALIFY IN OBTAINING MEDICAL SUPPLIES AND PRESCRIPTION MEDICATIONS AT NO OR LOW COST. THE PROGRAM ALSO HELPS PATIENTS ENROLL IN PHARMACEUTICAL ASSISTANCE PROGRAMS. HEALTH SCREENING AND PREVENTION HUNTINGTON MEMORIAL HOSPITAL, INC., HISTORICALLY PARTICIPATED IN COMMUNITY HEALTH FAIRS AND ACTIVITIES THROUGHOUT THE YEAR TO PROVIDE HEALTH EDUCATION AND SCREENINGS FOR DISEASE PREVENTION, AND TO PROMOTE HEALTHY LIFESTYLES, BUT 2021 ONCE AGAIN CHALLENGED THESE ENDEAVORS WITH PANDEMIC SHUTDOWNS AND SOCIAL DISTANCING GUIDELINES. HUNTINGTON MEMORIAL HOSPITAL, INC., WAS ABLE TO COLLABORATE WITH PARKVIEW CENTER FOR HEALTHY LIVING TO SAFELY PROVIDE FOUR SOCIALLY DISTANCED, MASK-REQUIRED "CHECK-UP DAY" EVENTS TO PROVIDE REDUCED-COST LABORATORY WORK TO AREA RESIDENTS. ALMOST 200 HOURS OF STAFF TIME WAS SPENT IN 2021 AT OUR HUNTINGTON COUNTY COVID VACCINE CLINIC, ADMINISTERING VACCINES AND PROVIDING INFORMATION TO DISCOURAGE THE DISEASE SPREAD. HUNTINGTON MEMORIAL HOSPITAL, INC.'S EMERGENCY MANAGEMENT SERVICES (EMS) ALSO PLAY A VITAL ROLE IN THE COMMUNITY WITH REGARD TO HEALTH PREVENTION SERVICES. FORTY-FOUR HOURS WERE DEVOTED TO CPR AND AED TRAINING TO GROUPS INCLUDING CITY AND COUNTY POLICE AND FIRE AND HUNTINGTON UNIVERSITY NURSING STUDENTS. TWO HOURS WERE DEVOTED TO PEER SUPPORT TRAINING TO THE MT. ETNA FIRE DEPARTMENT AND AN ADDITIONAL TWO HOURS FOR SAMARITAN SCENE SAFETY TRAINING. SIXTY HOURS WERE SPENT FOR A FIRST RESPONDER CLASS FOR HUNTINGTON COUNTY. A SAFE PROM PROGRAM TOOK ONE HOUR. STOP THE BLEED CLASS FOR CITY AND COUNTY POLICE INVOLVED FOUR HOURS OF STAFF TIME. AN AMBULANCE REVIEW WITH MARKLE FIRE DEPARTMENT TOOK TWO HOURS, AND A PRESENTATION FOR COUNTY SCHOOL NURSES ABOUT FIRST-AID TRAINING ALSO INVOLVED TWO HOURS OF TIME. COMMUNITY NURSING HUNTINGTON MEMORIAL HOSPITAL, INC., AFFORDED 284 EXPECTANT PARENTS THE OPPORTUNITY TO ATTEND CHILDBIRTH CLASSES (IN PERSON OR VIRTUALLY) BY A REGISTERED NURSE WHO IS A CERTIFIED LACTATION CONSULTANT. THE CLASSES PROVIDE ANSWERS TO ANY QUESTIONS AN EXPECTANT MOTHER MAY HAVE; IN ADDITION, OTHER RESOURCES ARE AVAILABLE AT APPOINTMENTS WITH THE HOSPITAL'S BIRTH PLANNER. SOME 604 INDIVIDUALS ATTENDED BIRTH PLANNING APPOINTMENTS LAST YEAR (MAINLY VIRTUALLY). ADDITIONAL SUPPORT ONCE A BABY IS BORN INCLUDES THE BREASTFEEDING MOMS GROUP; EVERY WEDNESDAY, THE HOSPITAL LACTATION CONSULTANT PROVIDES WEIGHT CHECKS FOR INFANTS AND ANSWERS ANY QUESTIONS THE MOTHERS HAVE. THIS GROUP HELPED 80 MOMS, BABIES AND SIBLINGS IN 2021. VIRTUAL BREASTFEEDING CLASSES REACHED 192 SOON-TO-BE PARENTS. ANOTHER VIRTUAL COURSE ABOUT PARENTING AND BABY CARE REACHED 162 INDIVIDUALS IN 2021. |
| FORM 990, PART III, LINE 4A CONT'D FROM ABOVE: | THE HOSPITAL'S EXTERNAL PARTNER WIC PROVIDES FOOD VOUCHERS FOR PREGNANT MOTHERS AND INFANTS IN NEED. EXPECTANT PARENTS ALSO HAVE THE OPPORTUNITY, THROUGH YOUTH SERVICES BUREAU (YSB) OF HUNTINGTON COUNTY, TO RECEIVE INCENTIVES SUCH AS CAR SEATS AND SAFETY ITEMS BY PARTICIPATING IN HEALTHY ACTIVITIES (WIC PRENATAL CLASSES, IMMUNIZATIONS, MENTAL HEALTH SERVICES, ETC.). AS PART OF YSB'S "ON YOUR WAY UP" PROGRAM, 19 CAR SEATS WERE DISTRIBUTED, AND PROPER INSTALLATION INSTRUCTIONS WERE PROVIDED, IN 2021. ALSO IN 2021, PARKVIEW PHYSICIANS GROUP PHYSICIANS AND HUNTINGTON MEMORIAL HOSPITAL, INC., CO-WORKERS WHO IDENTIFIED A NEED FOR SMOKING CESSATION AID REFERRED PATIENTS TO APPROPRIATE RESOURCES. DURING HOSPITAL ADMISSIONS, PATIENTS ARE ASKED SCREENING QUESTIONS REGARDING TOBACCO USE AND OFFERED HELP. THE TRANSITIONAL CARE NURSE PROVIDES RESOURCES INCLUDING THE 1-800-QUIT-NOW PAMPHLET AND ENCOURAGES THEM TO CALL THE PHONE NUMBER PROVIDED. THIS PROGRAM PROVIDES NICOTINE PATCHES AND GUM FREE OF CHARGE FOR THOSE WHO QUALIFY. PREVIOUSLY, THE PARKVIEW HUNTINGTON FAMILY YMCA OFFERED SMOKING CESSATION CLASSES, BUT THOSE WERE DISCONTINUED IN LATE 2016. HUNTINGTON MEMORIAL HOSPITAL, INC., IDENTIFIED THIS GAP IN SERVICES AND ENABLED ONE OF ITS REGISTERED NURSES TO BECOME CERTIFIED IN THE AMERICAN LUNG ASSOCIATION'S FREEDOM FROM SMOKING PROGRAM. IN-PERSON CLASSES CEASED IN 2020 DUE TO COVID, BUT VIRTUAL CLASSES ARE BEING OFFERED AND ENCOURAGED. HUNTINGTON MEMORIAL HOSPITAL, INC., STRIVES TO BE A RESPONSIBLE CORPORATE CITIZEN AND TO CONTRIBUTE IN MEANINGFUL WAYS TO THE HEALTH AND WELL-BEING OF INDIVIDUALS AND ALL OF HUNTINGTON COUNTY. |
| 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, HUNTINGTON MEMORIAL HOSPITAL, INC., EIN 35-1970706. 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, 2021 WAS 593. THE TOTAL NUMBER OF EMPLOYEES REPORTED ON FORM W-3 AND FILED BY THE COMMON PAYING AGENT, PH, FOR THE YEAR ENDED DECEMBER 31, 2021 WAS 16,240. FOR PURPOSES OF COMPLETING FORM 990, PART V, LINE 1A AND 2A, THE NUMBER REPORTED FOR THE HUNTINGTON MEMORIAL HOSPITAL, INC. WAS 28 AND 335. RESPECTIVELY. |
| FORM 990, PART VI, SECTION A, LINE 1A | THE EXECUTIVE COMMITTEE SHALL BE COMPOSED OF THE OFFICERS OF THE BOARD, THE PRESIDENT OF THE CORPORATION, THE PRESIDENT/CHIEF EXECUTIVE OFFICER OF THE CORPORATE MEMBER OR HIS/HER DESIGNEE, THE CURRENT CHIEF OF THE MEDICAL STAFF, AND SUCH OTHER PERSONS AS IDENTIFIED BY THE CHAIR OF THE BOARD, EACH OF WHOM SHALL BE ENTITLED TO VOTE. IN NO EVENT SHALL THE MEMBERS OF THE EXECUTIVE COMMITTEE EXCEED EIGHT (8) PEOPLE. THE EXECUTIVE COMMITTEE MAY ACT ON BEHALF OF THE CORPORATION AS THE PLANNING COMMITTEE AND IN ANY OTHER MATTER WHEN THE BOARD IS NOT IN SESSION, REPORTING TO THE BOARD FOR ITS RATIFICATION OF ITS ACTION. THE CHAIR OF THE BOARD SHALL SERVE AS CHAIR OF THE EXECUTIVE COMMITTEE. MEETINGS OF THE EXECUTIVE COMMITTEE MAY BE CALLED BY THE CHAIR OR BY THREE (3) MEMBERS. |
| FORM 990, PART VI, SECTION A, LINE 2 | DIRECTOR/OFFICER MICHAEL PACKNETT AND OFFICER JEANNE' WICKENS HAVE BUSINESS RELATIONSHIPS AS OFFICERS OF RELATED ENTITIES. |
| FORM 990, PART VI, SECTION A, LINE 6 | THE ORGANIZATION IS ORGANIZED AS A NOT-FOR-PROFIT CORPORATION. PURSUANT TO THE ORGANIZATION'S GOVERNING DOCUMENTS, PARKVIEW HEALTH SYSTEM, INC. EIN 35-1972384 IS THE SOLE MEMBER OF HUNTINGTON 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'S 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 JCAHO 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 LIST OR THE REQUIREMENT THAT APPOINTED DIRECTORS CAN BE REPRESENTATIVES OF HUNTINGTON COUNTY, AS DESCRIBED IN ARTICLE V, SECTIONS 2 AND 10 OF 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. HUNTINGTON MEMORIAL HOSPITAL, INC. IS A SUBSIDIARY CORPORATION OF PARKVIEW HEALTH SYSTEM, INC. AN ELECTRONIC COPY OF THE ORGANIZATION'S FINAL FORM 990 (INCLUDING REQUIRED SCHEDULES) WAS PROVIDED TO EACH VOTING MEMBER OF THE ORGANIZATION'S GOVERNING BODY AND THE SYSTEM AUDIT COMMITTEE, PRIOR TO FILING WITH THE IRS. ON OCTOBER 26, 2022, 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, LINE 11G | OTHER: PROGRAM SERVICE EXPENSES 1,321,922. MANAGEMENT AND GENERAL EXPENSES 68,524. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,390,446. MEDICAL PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 2,030,176. MANAGEMENT AND GENERAL EXPENSES 404,000. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,434,176. LABORATORY SERVICES: PROGRAM SERVICE EXPENSES 2,594,799. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,594,799. COLLECTION EXPENSE: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 298,926. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 298,926. |
| FORM 990, PART IX, LINES 5-10: | PARKVIEW HEALTH SYSTEM, INC., EIN 35-1972384, SERVES AS THE COMMON PAYING AGENT FOR ALL TAX-EXEMPT ORGANIZATIONS OF THE SYSTEM. SALARIES AND WAGES OF EMPLOYEES WORKING FOR THESE ORGANIZATIONS ARE CHARGED DIRECTLY TO THE ORGANIZATIONS IN WHICH THEY WORK. THE ACTUAL EXPENSES FOR PAYROLL TAXES, EMPLOYEE BENEFITS, AND PENSION PLAN CONTRIBUTIONS ARE REFLECTED ON THE BOOKS OF PARKVIEW HEALTH SYSTEM, INC. FOR FINANCIAL REPORTING PURPOSES. TO ACCOUNT FOR BENEFIT COSTS ON THE BOOKS OF THE OTHER TAX EXEMPT ORGANIZATIONS, AN ALLOCATION METHODOLOGY IS UTILIZED TO CHARGE THESE ORGANIZATIONS WITH AN ESTIMATE OF THE OVERALL COSTS, REFERRED TO AS A "BENEFIT ALLOCATION" FROM PARKVIEW HEALTH SYSTEM, INC. THE ALLOCATION DOES NOT DISTINGUISH BETWEEN THE COSTS OF THE VARIOUS COMPONENTS (I.E. PAYROLL TAXES, EMPLOYEE BENEFITS, AND PENSION PLAN CONTRIBUTIONS). THEREFORE, FOR PURPOSES OF THE FORM 990, PART IX, THE TOTAL BENEFIT ALLOCATION FOR THE EMPLOYEES' SALARIES AND WAGES REPORTED ON LINE 7 IS REFLECTED ON LINE 9 AND NOT ALLOCATED BETWEEN LINES 8 OR 10. FOR PURPOSES OF THE FORM 990, PART IX, LINES 5 AND 6 REFLECT COMPENSATION AND BENEFIT AMOUNTS REPORTED IN PART VII. |
| FORM 990, PART XI, LINE 9: | ASSET TRANSFERS/ADJUSTMENTS 216,535. |
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