Form990


Department of the TreasuryInternal Revenue Service
Return of Organization Exempt From Income Tax
Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except private foundations)
Do not enter social security numbers on this form as it may be made public.
Go to www.irs.gov/Form990 for instructions and the latest information.
OMB No. 1545-0047
2023
Open to Public Inspection
A For the 2023 calendar year, or tax year beginning 01-01-2023 , and ending 12-31-2023
BCheck if applicable:
CName of organization
WHITLEY MEMORIAL HOSPITAL INC
 
 
Doing business as
PARKVIEW WHITLEY HOSPITAL
 
Number and street (or P.O. box if mail is not delivered to street address)
1260 E STATE ROAD 205
 
Room/suite
City or town, state or province, country, and ZIP or foreign postal code
COLUMBIA CITY, IN467259492
D Employer identification number

35-1967665
E Telephone number

G Gross receipts $ 148,515,302
F Name and address of principal officer:
GREG JOHNSON
1450 PRODUCTION RD
FORT WAYNE,IN468081167
I
Tax-exempt status: (   ) (insert no.) or
J
Website:
WWW.PARKVIEW.COM
H(a)
Is this a group return for
subordinates?
H(b)
Are all subordinates
included?
If "No," attach a list. See instructions.
H(c)
Group exemption number  
K Form of organization:  
L Year of formation: 1995
M State of legal domicile: IN
Part I
Summary
Activities  & Governance 1 Briefly describe the organization’s mission or most significant activities: IMPROVE HEALTH & PROVIDE 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 9
5 Total number of individuals employed in calendar year 2023 (Part V, line 2a) ...... 5 481
6 Total number of volunteers (estimate if necessary) ............. 6 12
7a Total unrelated business revenue from Part VIII, column (C), line 12 ........ 7a 0
b Net unrelated business taxable income from Form 990-T, Part I, line 11 ......... 7b 0
Revenues Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) ......... 289,048 153,431
9 Program service revenue (Part VIII, line 2g) ......... 90,226,373 103,069,517
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... 4,114,656 763,078
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 173,834 127,939
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12) 94,803,911 104,113,965
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )... 44,328 45,381
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) 30,442,951 32,701,101
16a Professional fundraising fees (Part IX, column (A), line 11e) ..... 0 0
b Total fundraising expenses (Part IX, column (D), line 25) 0    
17 Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e).... 55,772,781 59,608,821
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 86,260,060 92,355,303
19 Revenue less expenses. Subtract line 18 from line 12....... 8,543,851 11,758,662
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............. 133,949,774 175,491,247
21 Total liabilities (Part X, line 26)............. 11,111,070 35,079,496
22 Net assets or fund balances. Subtract line 21 from line 20..... 122,838,704 140,411,751
Part II
Signature Block
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge.
Sign Here
Signature of officer Date
Type or print name and title
Paid Preparer Use Only
Print/Type preparer's name
Preparer's signature
Date
PTIN
Firm's name

Firm's EIN
Firm's address



Phone no.
May the IRS discuss this return with the preparer shown above? See Instructions. ..........
For Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 11282Y Form 990 (2023)
Form 990 (2023)
Page 2
Part III
Statement of Program Service Accomplishments
Check if Schedule O contains a response or note to any line in this Part III..............
1
Briefly describe the organization’s mission: 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
Did the organization undertake any significant program services during the year which were not listed on
the prior Form 990 or 990-EZ? .....................
If "Yes," describe these new services on Schedule O.
3
Did the organization cease conducting, or make significant changes in how it conducts, any program
services? ...........................
If "Yes," describe these changes on Schedule O.
4
Describe the organization’s program service accomplishments for each of its three largest program services, as measured by expenses. Section 501(c)(3) and 501(c)(4) organizations are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.
4a (Code:   ) (Expenses $ 73,166,185 including grants of $ 45,381 ) (Revenue $ 103,069,517 )
WHITLEY MEMORIAL HOSPITAL, INC. IS A MEMBER OF PARKVIEW HEALTH. THE LEGAL ENTITY INCLUDES THE FULL-SERVICE HOSPITAL IN WHITLEY COUNTY AND AN OUTPATIENT SERVICES FACILITY, PARKVIEW WARSAW, IN KOSCIUSKO COUNTY, DEDICATED TO IMPROVING AND INSPIRING THE HEALTH OF THE COMMUNITY. THIS IS ACCOMPLISHED 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 RELATIONSHIPS WITH OUR PATIENTS AND OUR COMMUNITY.(SEE SCHEDULE O FOR CONTINUATION)SERVICES OFFERED:THE HOSPITAL IN WHITLEY COUNTY FEATURES 26 PRIVATE ROOMS AND 4 CCU BEDS, IN A 96,000 SQUARE FOOT FACILITY LOCATED ON 42 ACRES. IN ADDITION TO THE SERVICES BELOW THERE IS A CHAPEL, FULL-SERVICE CAFETERIA, GIFT SHOP AND PUBLIC WALKING PATH AROUND THE CAMPUS. EMERGENCY MEDICAL CARE 24 HOURS A DAY, 365 DAYS A YEAR WITH BOARD CERTIFIED EMERGENCY CARE PHYSICIANS AND A NURSING STAFF THAT IS TRAINED AND EXPERIENCED IN EMERGENCY CARE. THERE ARE NINE EMERGENCY ROOM BEDS INCLUDING TWO THAT ARE EQUIPPED FOR TRAUMA PATIENTS AT WHITLEY MEMORIAL HOSPITAL, INC. AND 8 EMERGENCY AND 2 TRAUMA BEDS AT PARKVIEW WARSAW. THERE WERE 15,282 PATIENTS TREATED IN THE WHITLEY EMERGENCY ROOM IN 2023 AND 14,773 AT PARKVIEW WARSAW. NO PATIENT IS EVER DENIED TREATMENT, REGARDLESS OF THEIR ABILITY TO PAY.EMS: WHITLEY MEMORIAL HOSPITAL, INC. PROVIDES EMERGENCY MEDICAL SERVICES IN THREE LOCAL COMMUNITIES; ONE NEW STATE-OF-THE-ART EMS VEHICLE WAS PURCHASED IN 2023. MEDICAL/SURGICAL ROOMS: THERE ARE 18 PRIVATE MED-SURG BEDS AND 4 CCU ROOMS AT WHITLEY MEMORIAL HOSPITAL, INC. IN ADDITION, THERE ARE 3 "SWING" BEDS THAT CAN BE USED FOR MED-SURG OR FOR OBSTETRIC ROOMS THAT ALLOW US TO SHIFT TO MEET THE NEEDS OF PATIENTS BASED ON THE CURRENT CENSUS.OBSTETRICS: THERE ARE FIVE PRIVATE LABOR/DELIVERY/REECOVERY AND POSTPARTUM ROOMS. THERE WERE 326 BIRTHS IN 2023 AT WHITLEY MEMORIAL HOSPITAL, INC. SURGERY: THERE ARE THREE LARGE SURGICAL SUITES WITH STATE-OF-THE-ART EQUIPMENT, INCLUDING DA VINCI MINIMALLY INVASIVE ROBOTIC TECHNOLOGY. WHITLEY MEMORIAL HOSPITAL, INC. HAD 323 ROBOTIC SURGERIES IN 2023, WHICH IS 32% OF TOTAL SURGERIES PERFORMED. THERE WERE 134 ROBOTIC GYNECOLOGICAL SURGERIES PERFORMED IN 2023. THERE WAS A TOTAL OF 1,397 SURGERIES IN 2023.PARKVIEW WARSAW IS UNDERGOING AN EXPANSION AND WILL BEGIN OFFERING SURGICAL SERVICES IN 2024.DIAGNOSTIC IMAGING: MRI, CT, NUCLEAR MEDICINE, ULTRASOUND, FLUOROSCOPY AND BONE DENSITY, AND DIGITAL 3D MAMMOGRAPHY AS WELL AS HEART SMART CT SCANS AND ROUTINE RADIOLOGY ARE AVAILABLE AT BOTH LOCATIONS.SLEEP DISORDERS LAB: FOR THE DIAGNOSIS AND TREATMENT OF SLEEP-RELATED DISORDERS. THERE WERE 168 SLEEP STUDIES PERFORMED IN THE SLEEP LAB AT WHITLEY MEMORIAL HOSPITAL, INC. IN 2023. OUTPATIENT LAB SERVICES: IN-HOUSE TESTING OF COAGULATION, URINALYSIS, HEMATOLOGY BLOOD GAS AND CHEMISTRY TESTS; THERE ARE CERTIFIED CLINICAL LABORATORY SCIENTISTS ON STAFF 24 HOURS A DAY AT BOTH LOCATIONS.REHABILITATION SERVICES: PHYSICAL, OCCUPATIONAL AND SPEECH THERAPY, CARDIAC AND PULMONARY REHAB AT BOTH LOCATIONS. OTHER: CARDIO-PULMONARY SERVICES, DIABETES EDUCATION, OUTPATIENT INFUSION AND ANTICOAGULATION CLINIC ARE ALSO OFFERED.PARKVIEW WARSAW IS UNDER CONSTRUCTION TO ADD INPATIENT, CCU, OBSTETRICAL SERVICES, AND CANCER TREATMENTS IN 2024. THERE IS SPACE FOR PHYSICIANS AT BOTH LOCATIONS TO PROVIDE CONVENIENT, EASY ACCESS FOR PATIENTS TO RECEIVE CARE FROM FAMILY AND SPECIALTY PHYSICIANS.TWO IMPORTANT IMAGING TESTS ARE OFFERED TO THE PUBLIC FOR A REASONABLE OUT-OF-POCKET COST. THE HEARTSMART CT SCAN IS A SIMPLE, NON-INVASIVE TEST THAT CAN DETECT CORONARY ARTERY DISEASE IN ITS EARLY STAGES. THERE WERE 931 SCANS PERFORMED IN 2023 TOTAL AT 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 568 INDIVIDUALS UTILIZED THAT SERVICE. THE TEST INVOLVES A LOW DOSE CT TO ASSIST IN DIAGNOSING EARLY-STAGE LUNG CANCER.FINANCIAL POLICY:WHITLEY MEMORIAL HOSPITAL, INC. IS COMMITTED TO MAKING HEALTHCARE ACCESSIBLE TO THOSE WHO NEED IT, REGARDLESS OF THEIR HEALTH STATUS OR ABILITY TO PAY. WITH OUR FINANCIAL ASSISTANCE, PATIENTS CAN RECEIVE THE PARKVIEW CARE THEY EXPECT - NO MATTER WHAT FINANCIAL OBSTACLES THEY MIGHT FACE. OUR FINANCIAL ASSISTANCE SERVICES INCLUDE USING FAIR AND CONSISTENT BILLING AND COLLECTION PRACTICES, INCLUDING CHARITABLE CARE AND FINANCIAL ASSISTANCE POLICIES AND A STANDARD APPLICATION PROCESS; AND PROVIDING EMERGENCY CARE, REGARDLESS OF ABILITY TO PAY.ANY PATIENT EXPERIENCING FINANCIAL HARDSHIP CAN REACH OUR SINGLE BILLING OFFICE TO DISCUSS OPTIONS AT 260-266-6700 OR TOLL-FREE AT 855-814-0012.COMMUNITY BENEFIT: WHITLEY MEMORIAL HOSPITAL, INC. COMMUNITY HEALTH IMPROVEMENT PROGRAM WAS ESTABLISHED TO HELP FUND COMMUNITY HEALTH IMPROVEMENT EFFORTS WITHIN WHITLEY MEMORIAL HOSPITAL INC.'S SERVICE AREA. WHITLEY MEMORIAL HOSPITAL, INC. INVESTS IN KEY ORGANIZATIONS THAT PROMOTE THE HEALTH AND WELL-BEING OF FAMILIES, CHILDREN AND INDIVIDUALS OF THE COMMUNITIES THAT IT SERVES. COMMITMENT TO IMPROVING HEALTH AND INSPIRING WELL-BEING EXTENDS BEYOND THE HOSPITAL WALLS AND THROUGHOUT OUR COMMUNITY. THROUGH PARKVIEW'S COMMUNITY HEALTH IMPROVEMENT (CHI) PROGRAM, WHITLEY MEMORIAL HOSPITAL, INC. COLLABORATES WITH OTHERS INSIDE AND OUTSIDE THE HEALTH SYSTEM WHO SHARE PARKVIEW'S MISSION AND VALUES. FUNDED BY A PERCENTAGE OF PARKVIEW'S NET OPERATING SURPLUS, CHI STRATEGICALLY REINVESTS DOLLARS INTO COMMUNITY ORGANIZATIONS AND INITIATIVES THAT ADDRESS THE GREATEST HEALTH NEEDS OUTLINED BY THE HOSPITALS MOST RECENT TRIENNIAL COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA). BASED ON THE 2022 CHNA RESULTS, THE TOP THREE HEALTH CONCERNS FOR WHITLEY MEMORIAL HOSPITAL, INC. ARE MENTAL HEALTH, SUBSTANCE ABUSE AND OBESITY (FOOD INSECURITY).DESIGNATIONS/ACHIEVEMENTS:FOR THE FOURTH YEAR IN A ROW, WHITLEY MEMORIAL HOSPITAL, INC. WAS RECOGNIZED AS AN INSPIRE HOSPITAL OF DISTINCTION FOR 2023 BY THE INDIANA HOSPITAL ASSOCIATION, FOR ITS EXCELLENCE IN CARING FOR MOTHERS AND BABIES, HAVING IMPLEMENTED BEST PRACTICES IN FOUR OR FIVE OF SIX KEY AREAS OF INFANT SAFE SLEEP, BREASTFEEDING, TOBACCO PREVENTION AND CESSATION, PERINATAL SUBSTANCE USE, AIM PATIENT SAFETY BUNDLES: OBSTETRIC HEMORRHAGE AND MATERNAL HYPERTENSION. WHITLEY MEMORIAL HOSPITAL, INC. ALSO RECEIVED NATIONAL SAFE SLEEP HOSPITAL CERTIFICATION: CERTIFIED SAFE SLEEP LEADER. THE CRIBS FOR KIDS' SAFE SLEEP CERTIFICATION PROGRAM RECOGNIZES HOSPITALS AND HOSPITAL SYSTEMS FOR THEIR COMMITMENT TO INFANT SAFE SLEEP. IN 2023, WHITLEY MEMORIAL HOSPITAL, INC. WAS AWARDED THE JOINT COMMISSION'S GOLD SEAL OF APPROVAL AND THE AMERICAN STROKE ASSOCIATION'S HEART-CHECK MARK FOR PRIMARY STROKE CERTIFICATION. IN ADDITION, THE PARKVIEW WARSAW FACILITY WAS AWARDED THE JOINT COMMISSION'S GOLD SEAL OF APPROVAL AND THE AMERICAN STROKE ASSOCIATION'S HEART-CHECK MARK FOR ACUTE STROKE READY CERTIFICATION. THIS CERTIFICATION IS FOR HOSPITALS OR EMERGENCY CENTERS WITH A DEDICATED, STROKE-FOCUSED PROGRAM SERVING THE COMMUNITY. WHITLEY MEMORIAL HOSPITAL, INC. WAS AWARDED A VIZIENT TOP COMMUNITY HOSPITAL RECOGNITION WHICH RECOGNIZES PARTICIPATING HEALTHCARE ORGANIZATIONS THROUGH THE VIZIENT QUALITY AND ACCOUNTABILITY STUDY THAT MEASURES QUALITY OF PATIENT CARE IN SAFETY, MORTALITY, EFFECTIVENESS, EFFICIENCY, PATIENT CENTEREDNESS AND EQUITY. WHITLEY MEMORIAL HOSPITAL, INC. RANKED 22 OF 333 IN THE COMMUNITY HOSPITAL COHORT.WHITLEY MEMORIAL HOSPITAL, INC. RECEIVED A GRADE OF "A" IN BOTH SPRING AND FALL OF 2023. THIS IS AN IMPROVEMENT OF "B" IN THE SAME TIMEFRAME IN 2022. THE HOSPITAL SAFETY GRADE IS A PUBLIC SERVICE PROVIDED BY THE LEAPFROG GROUP, AN INDEPENDENT NONPROFIT ORGANIZATION COMMITTED TO DRIVING QUALITY, SAFETY AND TRANSPARENCY IN HEALTHCARE.
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 expenses73,166,185
Form 990 (2023)
Form 990 (2023)
Page 3
Part IV
Checklist of Required Schedules
Yes
No
1
Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If "Yes," complete Schedule AClick to see attachment
List of Attached Documents:
// Content
.....................
1
Yes
 
2
Is the organization required to complete Schedule B, Schedule of Contributors? See instructions. Click to see attachment
List of Attached Documents:
// Content
...
2
Yes
 
3
Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for public office? If "Yes," complete Schedule C, Part IClick to see attachment
List of Attached Documents:
// Content
.............
3
 
No
4
Section 501(c)(3) organizations. Did the organization engage in lobbying activities, or have a section 501(h) election in effect during the tax year? If "Yes," complete Schedule C, Part IIClick to see attachment
List of Attached Documents:
// Content
.........
4
Yes
 
5
Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues, assessments, or similar amounts as defined in Rev. Proc. 98-19? If "Yes," complete Schedule C, Part IIIClick to see attachment
List of Attached Documents:
// Content
..
5
 
No
6
Did the organization maintain any donor advised funds or any similar funds or accounts for which donors have the right to provide advice on the distribution or investment of amounts in such funds or accounts? If "Yes," complete Schedule D, Part IClick to see attachment
List of Attached Documents:
// Content
.........................
6
 
No
7
Did the organization receive or hold a conservation easement, including easements to preserve open space,
the environment, historic land areas, or historic structures? If "Yes," complete Schedule D, Part IIClick to see attachment
List of Attached Documents:
// Content
....
7
 
No
8
Did the organization maintain collections of works of art, historical treasures, or other similar assets? If "Yes,"
complete Schedule D,
Part IIIClick to see attachment
List of Attached Documents:
// Content
..............
8
 
No
9
Did the organization report an amount in Part X, line 21 for escrow or custodial account liability; serve as a custodian for amounts not listed in Part X; or provide credit counseling, debt management, credit repair, or debt negotiation services? If "Yes," complete Schedule D, Part IVClick to see attachment
List of Attached Documents:
// Content
..............
9
 
No
10
Did the organization, directly or through a related organization, hold assets in temporarily restricted endowments, permanent endowments, or quasi endowments? If "Yes," complete Schedule D, Part V......
10
 
No
11
If the organization’s answer to any of the following questions is "Yes," then complete Schedule D, Parts VI, VII, VIII, IX, or X, as applicable.
a
Did the organization report an amount for land, buildings, and equipment in Part X, line 10? If "Yes," complete
Schedule D,
Part VI. Click to see attachment
List of Attached Documents:
// Content
...................
11a
Yes
 
b
Did the organization report an amount for investments—other securities in Part X, line 12 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part VIIClick to see attachment
List of Attached Documents:
// Content
.......
11b
 
No
c
Did the organization report an amount for investments—program related in Part X, line 13 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part VIIIClick to see attachment
List of Attached Documents:
// Content
.......
11c
 
No
d
Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part IXClick to see attachment
List of Attached Documents:
// Content
............
11d
 
No
e
Did the organization report an amount for other liabilities in Part X, line 25? If "Yes," complete Schedule D, Part XClick to see attachment
List of Attached Documents:
// Content
11e
Yes
 
f
Did the organization’s separate or consolidated financial statements for the tax year include a footnote that addresses the organization’s liability for uncertain tax positions under FIN 48 (ASC 740)? If "Yes," complete Schedule D, Part XClick to see attachment
List of Attached Documents:
// Content
11f
Yes
 
12a
Did the organization obtain separate, independent audited financial statements for the tax year? If "Yes," complete
Schedule D, Parts XI and XII
Click to see attachment
List of Attached Documents:
// Content
......................
12a
 
No
b
Was the organization included in consolidated, independent audited financial statements for the tax year? If "Yes," and if the organization answered "No" to line 12a, then completing Schedule D, Parts XI and XII is optional Click to see attachment
List of Attached Documents:
// Content
12b
Yes
 
13
Is the organization a school described in section 170(b)(1)(A)(ii)? If "Yes," complete Schedule E
13
 
No
14a
Did the organization maintain an office, employees, or agents outside of the United States? .....
14a
 
No
b
Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business, investment, and program service activities outside the United States, or aggregate foreign investments valued at $100,000 or more? If "Yes," complete Schedule F, Parts I and IV.........
14b
 
No
15
Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or other assistance to or for any foreign organization? If “Yes,” complete Schedule F, Parts II and IV.....
15
 
No
16
Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or other assistance to or for foreign individuals? If “Yes,” complete Schedule F, Parts III and IV...
16
 
No
17
Did the organization report a total of more than $15,000 of expenses for professional fundraising services on Part IX, column (A), lines 6 and 11e? If "Yes," complete Schedule G, Part I. See instructions. ....
17
 
No
18
Did the organization report more than $15,000 total of fundraising event gross income and contributions on Part VIII, lines 1c and 8a? If "Yes," complete Schedule G, Part II............
18
 
No
19
Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a? If "Yes," complete Schedule G, Part III...................
19
 
No
20a
Did the organization operate one or more hospital facilities? If "Yes," complete Schedule H....Click to see attachment
List of Attached Documents:
// Content
20a
Yes
 
b
If "Yes" to line 20a, did the organization attach a copy of its audited financial statements to this return? Click to see attachment
List of Attached Documents:
// Content
20b
Yes
 
21
Did the organization report more than $5,000 of grants or other assistance to any domestic organization or domestic government on Part IX, column (A), line 1? If “Yes,” complete Schedule I, Parts I and II.....Click to see attachment
List of Attached Documents:
// Content
21
Yes
 
Form 990 (2023)
Form 990 (2023)
Page 4
Part IV
Checklist of Required Schedules (continued)
Yes
No
22
Did the organization report more than $5,000 of grants or other assistance to or for domestic individuals on Part IX, column (A), line 2? If “Yes,” complete Schedule I, Parts I and III........Click to see attachment
List of Attached Documents:
// Content
22
 
No
23
Did the organization answer "Yes" to Part VII, Section A, line 3, 4, or 5, about compensation of the organization’s current and former officers, directors, trustees, key employees, and highest compensated employees? If "Yes," complete Schedule J....................... Click to see attachment
List of Attached Documents:
// Content
23
Yes
 
24a
Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $100,000 as of the last day of the year, that was issued after December 31, 2002? If “Yes,” answer lines 24b through 24d and complete Schedule K. If “No,” go to line 25a...............
24a
 
No
b
Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?...
24b
 
 
c
Did the organization maintain an escrow account other than a refunding escrow at any time during the year
to defease any tax-exempt bonds? ...............
24c
 
 
d
Did the organization act as an "on behalf of" issuer for bonds outstanding at any time during the year?...
24d
 
 
25a
Section 501(c)(3), 501(c)(4), and 501(c)(29) organizations. Did the organization engage in an excess benefit transaction with a disqualified person during the year? If "Yes," complete Schedule L, Part I ....
25a
 
No
b
Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and that the transaction has not been reported on any of the organization’s prior Forms 990 or 990-EZ? If "Yes," complete Schedule L, Part I.......................
25b
 
No
26
Did the organization report any amount on Part X, line 5 or 22 for receivables from or 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? If "Yes," complete Schedule L, Part II...........
26
 
No
27
Did the organization provide a grant or other assistance to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or employee thereof, a grant selection committee member, or to a 35% controlled entity (including an employee thereof) or family member of any of these persons?
If "Yes," complete
Schedule L, Part III.........................
27
 
No
28
Was the organization a party to a business transaction with one of the following parties (see the Schedule L, Part IV instructions for applicable filing thresholds, conditions, and exceptions):
a
A current or former officer, director, trustee, key employee, creator or founder, or substantial contributor? If "Yes," complete Schedule L, Part IV......................
28a
 
No
b
A family member of any individual described in line 28a? If "Yes," complete Schedule L, Part IV.....
28b
 
No
c
A 35% controlled entity of one or more individuals and/or organizations described in line 28a or 28b? If "Yes," complete Schedule L, Part IV.....................
28c
 
No
29
Did the organization receive more than $25,000 in non-cash contributions? If "Yes," complete Schedule M..
29
 
No
30
Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions? If "Yes," complete Schedule M .................
30
 
No
31
Did the organization liquidate, terminate, or dissolve and cease operations? If "Yes," complete Schedule N, Part I
31
 
No
32
Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If "Yes," complete Schedule N, Part II........................
32
 
No
33
Did the organization own 100% of an entity disregarded as separate from the organization under Regulations sections 301.7701-2 and 301.7701-3? If "Yes," complete Schedule R, Part I............Click to see attachment
List of Attached Documents:
// Content
33
 
No
34
Was the organization related to any tax-exempt or taxable entity? If "Yes," complete Schedule R, Part II, III, or IV, and Part V, line 1.........................Click to see attachment
List of Attached Documents:
// Content
34
Yes
 
35a
Did the organization have a controlled entity within the meaning of section 512(b)(13)?
35a
Yes
 
b
If ‘Yes’ to line 35a, did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 512(b)(13)? If "Yes," complete Schedule R, Part V, line 2 ...Click to see attachment
List of Attached Documents:
// Content
35b
Yes
 
36
Section 501(c)(3) organizations. Did the organization make any transfers to an exempt non-charitable related organization? If "Yes," complete Schedule R, Part V, line 2............. Click to see attachment
List of Attached Documents:
// Content
36
 
No
37
Did the organization conduct more than 5% of its activities through an entity that is not a related organization and that is treated as a partnership for federal income tax purposes? If "Yes," complete Schedule R, Part VIClick to see attachment
List of Attached Documents:
// Content
37
 
No
38
Did the organization complete Schedule O and provide explanations on Schedule O for Part VI, lines 11b and 19? Note. All Form 990 filers are required to complete Schedule O. ............
38
Yes
 
Part V
Statements Regarding Other IRS Filings and Tax Compliance
Check if Schedule O contains a response or note to any line in this Part V...........
Yes
No
1a
Enter the number reported in box 3 of Form 1096. Enter -0- if not applicable ..
1a
40
b
Enter the number of Forms W-2G included on line 1a. Enter -0- if not applicable .
1b
0
c
Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming (gambling) winnings to prize winners? ..................
1c
Yes
 
Form 990 (2023)
Form 990 (2023)
Page 5
Part V
Statements Regarding Other IRS Filings and Tax Compliance (continued)
2a
Enter the number of employees reported on Form W-3, Transmittal of Wage and
Tax Statements, filed for the calendar year ending with or within the year covered by this return ..................
2a
481
b
If at least one is reported on line 2a, did the organization file all required federal employment tax returns?
2b
Yes
 
3a
Did the organization have unrelated business gross income of $1,000 or more during the year?...
3a
 
No
b
If “Yes,” has it filed a Form 990-T for this year? If “No” to line 3b, provide an explanation in Schedule O...
3b
 
 
4a
At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a financial account in a foreign country (such as a bank account, securities account, or other financial account)? ..
4a
 
No
b
If "Yes," enter the name of the foreign country:
See instructions for filing requirements for FinCEN Form 114, Report of Foreign Bank and Financial Accounts (FBAR).
5a
Was the organization a party to a prohibited tax shelter transaction at any time during the tax year? ..
5a
 
No
b
Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?
5b
 
No
c
If "Yes," to line 5a or 5b, did the organization file Form 8886-T? ............
5c
 
 
6a
Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization solicit any contributions that were not tax deductible as charitable contributions? ...
6a
 
No
b
If "Yes," did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible? ......................
6b
 
 
7
Organizations that may receive deductible contributions under section 170(c).
a
Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods and services provided to the payor? ....................
7a
 
No
b
If "Yes," did the organization notify the donor of the value of the goods or services provided? .....
7b
 
 
c
Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required to file Form 8282? .........................
7c
 
No
d
If "Yes," indicate the number of Forms 8282 filed during the year ....
7d
 
e
Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?
7e
 
No
f
Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract? ..
7f
 
No
g
If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required? ......................
7g
 
 
h
If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C? ..........................
7h
 
 
8
Sponsoring organizations maintaining donor advised funds. Did a donor advised fund maintained by the sponsoring organization have excess business holdings at any time during the year? ........
8
 
 
9
Sponsoring organizations maintaining donor advised funds.
a
Did the sponsoring organization make any taxable distributions under section 4966?........
9a
 
 
b
Did the sponsoring organization make a distribution to a donor, donor advisor, or related person?...
9b
 
 
10
Section 501(c)(7) organizations. Enter:
a
Initiation fees and capital contributions included on Part VIII, line 12 ...
10a
 
b
Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities
10b
 
11
Section 501(c)(12) organizations. Enter:
a
Gross income from members or shareholders .........
11a
 
b
Gross income from other sources. (Do not net amounts due or paid to other sources against amounts due or received from them.) ..........
11b
 
12a
Section 4947(a)(1) non-exempt charitable trusts. Is the organization filing Form 990 in lieu of Form 1041?
12a
 
 
b
If "Yes," enter the amount of tax-exempt interest received or accrued during the year.
12b
 
13
Section 501(c)(29) qualified nonprofit health insurance issuers.
a
Is the organization licensed to issue qualified health plans in more than one state? .........
Note. See the instructions for additional information the organization must report on Schedule O.
13a
 
 
b
Enter the amount of reserves the organization is required to maintain by the states in which the organization is licensed to issue qualified health plans ....
13b
 
c
Enter the amount of reserves on hand ............
13c
 
14a
Did the organization receive any payments for indoor tanning services during the tax year?.....
14a
 
No
b
If "Yes," has it filed a Form 720 to report these payments? If "No," provide an explanation in Schedule O..
14b
 
 
15
Is the organization subject to the section 4960 tax on payment(s) of more than $1,000,000 in remuneration or excess parachute payment(s) during the year? ....................
If "Yes," see the instructions and file Form 4720, Schedule N.
15
 
No
16
Is the organization an educational institution subject to the section 4968 excise tax on net investment income? ..
If "Yes," complete Form 4720, Schedule O.
16
 
No
17
Section 501(c)(21) organizations. Did the trust, or any disqualified or other person engage in any activities that would result in the imposition of an excise tax under section 4951, 4952, or 4953? ..
If "Yes," complete Form 6069.
17
 
 
Form 990 (2023)
Form 990 (2023)
Page 6
Part VI
Governance, Management, and Disclosure. For each "Yes" response to lines 2 through 7b below, and for a "No" response to lines 8a, 8b, or 10b below, describe the circumstances, processes, or changes in Schedule O. See instructions.
Check if Schedule O contains a response or note to any line in this Part VI..............
Section A. Governing Body and Management
Yes
No
1a
Enter the number of voting members of the governing body at the end of the tax year
1a
13
If there are material differences in voting rights among members of the governing body, or if the governing body delegated broad authority to an executive committee or similar committee, explain in Schedule O.
b
Enter the number of voting members included in line 1a, above, who are independent
1b
9
2
Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any other officer, director, trustee, or key employee? .................
2
 
No
3
Did the organization delegate control over management duties customarily performed by or under the direct supervision of officers, directors or trustees, or key employees to a management company or other person? .
3
 
No
4
Did the organization make any significant changes to its governing documents since the prior Form 990 was filed? .
4
Yes
 
5
Did the organization become aware during the year of a significant diversion of the organization’s assets? .
5
 
No
6
Did the organization have members or stockholders? ................
6
Yes
 
7a
Did the organization have members, stockholders, or other persons who had the power to elect or appoint one or more members of the governing body? ....................
7a
Yes
 
b
Are any governance decisions of the organization reserved to (or subject to approval by) members, stockholders, or persons other than the governing body? ...................
7b
Yes
 
8
Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:
a
The governing body? .......................
8a
Yes
 
b
Each committee with authority to act on behalf of the governing body? ............
8b
Yes
 
9
Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the organization’s mailing address? If "Yes," provide the names and addresses in Schedule O.......
9
 
No
Section B. Policies (This Section B requests information about policies not required by the Internal Revenue Code.)
Yes
No
10a
Did the organization have local chapters, branches, or affiliates? ............
10a
 
No
b
If "Yes," did the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure their operations are consistent with the organization's exempt purposes?
10b
 
 
11a
Has the organization provided a complete copy of this Form 990 to all members of its governing body before filing the form? ............................
11a
Yes
 
b
Describe on Schedule O the process, if any, used by the organization to review this Form 990. .....
12a
Did the organization have a written conflict of interest policy? If "No," go to line 13.......
12a
Yes
 
b
Were officers, directors, or trustees, and key employees required to disclose annually interests that could give rise to conflicts? ..........................
12b
Yes
 
c
Did the organization regularly and consistently monitor and enforce compliance with the policy? If "Yes," describe on Schedule O how this was done...................
12c
Yes
 
13
Did the organization have a written whistleblower policy? ...............
13
Yes
 
14
Did the organization have a written document retention and destruction policy? .........
14
Yes
 
15
Did the process for determining compensation of the following persons include a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision?
a
The organization’s CEO, Executive Director, or top management official ...........
15a
 
No
b
Other officers or key employees of the organization ................
15b
 
No
If "Yes" to line 15a or 15b, describe the process on Schedule O. See instructions.
16a
Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement with a taxable entity during the year? ......................
16a
 
No
b
If "Yes," did the organization follow a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicable federal tax law, and take steps to safeguard the organization’s exempt status with respect to such arrangements? ............
16b
 
 
Section C. Disclosure
17
List the states with which a copy of this Form 990 is required to be filed
IN
18
Section 6104 requires an organization to make its Form 1023 (1024 or 1024-A, if applicable), 990, and 990-T (section 501(c)(3)s only) available for public inspection. Indicate how you made these available. Check all that apply.
19
Describe in Schedule O whether (and if so, how) the organization made its governing documents, conflict of interest policy, and financial statements available to the public during the tax year.
20
State the name, address, and telephone number of the person who possesses the organization's books and records:
STANTON RISSER1450 PRODUCTION RD   FORT WAYNE,IN468081167 (260) 266-9380
Form 990 (2023)
Form 990 (2023)
Page 7
Part VII
Compensation of Officers, Directors,Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors
Check if Schedule O contains a response or note to any line in this Part VII..............
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees
1a Complete this table for all persons required to be listed. Report compensation for the calendar year ending with or within the organization’s tax year.
RoundBullet List all of the organization’s current officers, directors, trustees (whether individuals or organizations), regardless of amount
of compensation. Enter -0- in columns (D), (E), and (F) if no compensation was paid.

RoundBullet List all of the organization’s current key employees, if any. See the instructions for definition of "key employee."
RoundBullet List the organization’s five current highest compensated employees (other than an officer, director, trustee or key employee)
who received reportable compensation (box 5 of Form W-2, box 6 of Form 1099-MISC, and/or box 1 of Form 1099-NEC) of more than $100,000 from the organization and any related organizations.

RoundBullet List all of the organization’s former officers, key employees, or highest compensated employees who received more than $100,000
of reportable compensation from the organization and any related organizations.

RoundBullet List all of the organization’s former directors or trustees that received, in the capacity as a former director or trustee of the
organization, more than $10,000 of reportable compensation from the organization and any related organizations.

See the instructions for the order in which to list the persons above.
Check this box if neither the organization nor any related organization compensated any current officer, director, or trustee.
(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)
(D)
Reportable compensation from the organization (W-2/1099-MISC/1099-NEC)
(E)
Reportable compensation from related organizations (W-2/1099-MISC/1099-NEC)
(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; OfficerInd; Key Employee; Highest compensated employee; FormerOfcrDirectorTrusteeInd;
(1) SVETLANA HAGAN......................................................................
DIRECTOR/PH PHYSICIAN
1.00
.................
39.00
X           10,834 304,582 56,328
(2) SCOTT GABRIEL......................................................................
DIRECTOR/MARKET PRESIDENT
39.00
.................
1.00
X   X       353,558 0 113,469
(3) BRIDGET DOLOHANTY-JOHNSON......................................................................
DIRECTOR/SECRETARY/TREASURER
1.00
.................
1.00
X   X       4,500 0 0
(4) DAVID LIEB......................................................................
DIRECTOR/WMHOS CONTRACTED PHYSICIAN
1.00
.................
1.00
X           18,000 0 0
(5) JIM HEUER......................................................................
DIRECTOR
1.00
.................
1.00
X           4,500 0 0
(6) MARK JOHNSON......................................................................
DIRECTOR
1.00
.................
0.00
X           3,250 0 0
(7) JOSEPH KESSIE......................................................................
DIRECTOR
1.00
.................
1.00
X           3,750 0 0
(8) DJ SIGLER JR......................................................................
DIRECTOR
1.00
.................
0.00
X           3,000 0 0
(9) DAVID SMITH......................................................................
DIRECTOR/VICE CHAIR
1.00
.................
1.00
X   X       4,500 0 0
(10) BRAD VOELZ......................................................................
DIRECTOR/CHAIR
1.00
.................
2.00
X   X       6,250 2,250 0
(11) LAURA MCDERMOTT......................................................................
DIRECTOR
1.00
.................
1.00
X           4,250 0 0
(12) JANE WEAR......................................................................
DIRECTOR
1.00
.................
1.00
X           4,750 0 0
(13) GREG JOHNSON......................................................................
DIRECTOR/REGIONAL MARKET PRESIDENT
1.00
.................
39.00
X   X       0 888,491 189,006
(14) JEANNE' WICKENS......................................................................
PH CHIEF FINANCIAL OFFICER
1.00
.................
39.00
    X       0 2,165,508 277,888
(15) JEFFREY ROCKETT......................................................................
WMHOS VP OUTPATIENT CARE SVCS
40.00
.................
0.00
      X     228,298 0 48,037
(16) ASHLEY WIRGES......................................................................
WMHOS VP PATIENT CARE SVCS
40.00
.................
0.00
      X     185,309 0 43,309
(17) AMANDA KNOWLES......................................................................
WMHOS MGR PHARMACY
40.00
.................
0.00
        X   219,144 0 51,548
Form 990 (2023)
Form 990 (2023)
Page 8
Part VII
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees (continued)
(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)
(D)
Reportable compensation from the organization (W-2/1099-MISC/1099-NEC)
(E)
Reportable compensation from related organizations (W-2/1099-MISC/1099-NEC)
(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; OfficerInd; Key Employee; Highest compensated employee; FormerOfcrDirectorTrusteeInd;
(18) BENJAMIN MAGGARD........................................................................
WMHOS PHARMACIST
37.00
.......................3.00
        X   155,199 5,681 47,110
(19) CHARLES JINKS........................................................................
WMHOS PHARMACIST
37.00
.......................3.00
        X   141,367 5,112 33,577
(20) PETER TALATI........................................................................
WMHOS MGR REHAB
40.00
.......................0.00
        X   142,356 0 39,417
(21) ANGELIA RAMIREZ........................................................................
WMHOS MGR NURSING SVCS
14.00
.......................26.00
        X   46,950 94,291 40,339
(22) MICHAEL PACKNETT........................................................................
FORMER OFFICER/RETIRED PH CEO
0.00
.......................0.00
          X 0 5,034,209 29,253
















1b Sub-Total..............
c Total from continuation sheets to Part VII, Section A..
d Total (add lines 1b and 1c)......... 1,539,765 8,500,124 969,281
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable compensation from the organization 30
Yes
No
3
Did the organization list any former officer, director or trustee, key employee, or highest compensated employee on line 1a? If "Yes," complete Schedule J for such individual ..............
3
Yes
 
4
For any individual listed on line 1a, is the sum of reportable compensation and other compensation from the organization and related organizations greater than $150,000? If "Yes," complete Schedule J for such
individual
...........................
4
Yes
 
5
Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual for services rendered to the organization? If "Yes," complete Schedule J for such person ........
5
 
No
Section B. Independent Contractors
1
Complete this table for your five highest compensated independent contractors that received more than $100,000 of compensation from the organization. Report compensation for the calendar year ending with or within the organization’s tax year.
(A)
Name and business address
(B)
Description of services
(C)
Compensation
PARKVIEW HOSPITAL INC

11109 PARKVIEW PLAZA DR
FORT WAYNE,IN46845
LABORATORY SERVICES 4,297,801
CLINICAL COLLEAGUES INC

PO BOX 824246
PHILADELPHIA,PA19182
ANESTHESIOLOGISTS 1,308,032
FOCUSONE SOLUTIONS LLC

13609 CALIFORNIA ST
OMAHA,NE68154
MEDICAL PERSONNEL 896,786
PROFESSIONAL EMERGENCY PHYSICIANS INC

3640 NEW VISION DR SUITE A
FORT WAYNE,IN46845
PHYSICIANS 659,846
NORTHEAST INTERNAL MEDICINE ASSOC INC

2500 N DETROIT ST
LAGRANGE,IN46761
HOSPITALISTS 404,000
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization 10
Form 990 (2023)
Form 990 (2023)
Page 9
Part VIII
Statement of Revenue
Check if Schedule O contains a response or note to any line in this Part VIII.............
(A)
Total revenue
(B)
Related or
exempt
function
revenue
(C)
Unrelated
business
revenue
(D)
Revenue
excluded from
tax under sections
512 - 514
Contributions, Gifts, Grants, and OtherAmt Similar Amounts 1a Federated campaigns..1a  
b Membership dues..1b  
c Fundraising events..1c  
d Related organizations1d 153,431
e Government grants (contributions)1e  
f All other contributions, gifts, grants, and similar amounts not included above1f  
g Noncash contributions included in lines 1a - 1f:$ 1g  
h Total. Add lines 1a-1f....... 153,431
 Program Service RevenueAmt Business Code
2a NET PATIENT REVENUE 622110 101,552,366 101,552,366    
b INTERUNIT RENT 531120 1,090,425 1,090,425    
c EMS SUBSIDY 621910 275,000 275,000    
d PHARMACY 456110 105,233 105,233    
e MASSAGE THERAPY CLINIC 621990 41,048 41,048    
f All other program service revenue. 5,445 5,445    
g Total. Add lines 2a–2f ..... 103,069,517
 OtherAmtRevenueAmt 3 Investment income (including dividends, interest, and othersimilar amounts) ...... 1,257,332     1,257,332
4 Income from investment of tax-exempt bond proceeds        
5 Royalties...........        
(i) Real (ii) Personal
6a Gross rents 6a 26,196  
b Less: rental expenses 6b 155,081  
c Rental income or (loss) 6c -128,885  
d Net rental income or (loss)....... -128,885     -128,885
(i) Securities (ii) Other
7a Gross amount from sales of assets other than inventory 7a 43,752,002  
b Less: cost or other basis and sales expenses 7b 44,243,149 3,107
c Gain or (loss) 7c -491,147 -3,107
d Net gain or (loss)......... -494,254     -494,254
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..        
 OtherRevenueMiscAmt
Business Code
11a CAFETERIA 722514 246,600     246,600
b GIFT SHOP 459420 10,224     10,224
c            
d All other revenue ....        
e Total. Add lines 11a–11d ...... 256,824
12 Total revenue. See instructions..... 104,113,965 103,069,517 0 891,017
Form 990 (2023)
Form 990 (2023)
Page 10
Part IX
Statement of Functional Expenses
Section 501(c)(3) and 501(c)(4) organizations must complete all columns. All other organizations must complete column (A).Check if Schedule O contains a response or note to any line in this Part IX..............
Do not include amounts reported on lines 6b,
7b, 8b, 9b, and 10b of Part VIII.
(A)
Total expenses
(B)
Program service expenses
(C)
Management and general expenses
(D)
Fundraising
expenses
1 Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21 .... 45,381 45,381
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 ........... 1,041,499   1,041,499  
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........ 23,921,034 23,921,034    
8 Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....        
9 Other employee benefits ....... 7,738,568 7,738,568    
10 Payroll taxes ...........        
11 Fees for services (non-employees):        
a Management ......        
b Legal .........        
c Accounting ...........        
d Lobbying ...........        
e Professional fundraising services. See Part IV, line 17    
f Investment management fees ...... 176,616   176,616  
g Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O) 9,110,089 7,678,358 1,431,731  
12 Advertising and promotion .... 125 125    
13 Office expenses ....... 1,789,990 1,730,026 59,964  
14 Information technology ...... 12,060 11,894 166  
15 Royalties ..        
16 Occupancy ........... 4,579,399 4,540,198 39,201  
17 Travel ............ 24,977 21,347 3,630  
18 Payments of travel or entertainment expenses for any federal, state, or local public officials .        
19 Conferences, conventions, and meetings .... 15,282 7,203 8,079  
20 Interest ........... 14,785 14,785    
21 Payments to affiliates .......        
22 Depreciation, depletion, and amortization .. 1,631,894 1,586,030 45,864  
23 Insurance ... 189,811 131,919 57,892  
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 16,159,142   16,159,142  
b MEDICAL SUPPLIES 10,893,497 10,893,497    
c PH CLINICAL SUPPORT 9,563,208 9,563,208    
d HOSPITAL ASSESSMENT FEE 5,153,167 5,153,167    
e All other expenses 294,779 129,445 165,334  
25 Total functional expenses. Add lines 1 through 24e 92,355,303 73,166,185 19,189,118 0
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).        
Form 990 (2023)
Form 990 (2023)
Page 11
Part X
Balance Sheet
Check if Schedule O contains a response or note to any line in this Part IX..............
(A)
Beginning of year
(B)
End of year
Assets 1 Cash–non-interest-bearing ........ 3,448 1 3,248
2 Savings and temporary cash investments .........   2  
3 Pledges and grants receivable, net ......   3  
4 Accounts receivable, net ............. 11,704,233 4 14,738,675
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 ............ 386,123 8 1,027,721
9 Prepaid expenses and deferred charges ...... 105,556 9 149,763
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 110,819,882
b Less: accumulated depreciation 10b 23,488,871 46,493,890 10c 87,331,011
11 Investments—publicly traded securities . 64,851,724 11 71,256,754
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 ........... 10,404,800 15 984,075
16 Total assets. Add lines 1 through 15 (must equal line 33)... 133,949,774 16 175,491,247
Liabilities 17 Accounts payable and accrued expenses ..... 8,097,386 17 4,811,240
18 Grants payable ...   18  
19 Deferred revenue .........   19  
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 ..   23  
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 3,013,684 25 30,268,256
26 Total liabilities. Add lines 17 through 25.. 11,111,070 26 35,079,496
Net Assets or Fund Balance Organizations that follow FASB ASC 958, check here and complete lines 27, 28, 32, and 33.
27 Net assets without donor restrictions .......... 122,838,704 27 140,411,751
28 Net assets with donor restrictions ...........   28  
Organizations that do not follow FASB ASC 958, check here right arrow 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 ........... 122,838,704 32 140,411,751
33 Total liabilities and net assets/fund balances ........ 133,949,774 33 175,491,247
Form 990 (2023)
Form 990 (2023)
Page 12
Part XI
Reconcilliation of Net Assets
Check if Schedule O contains a response or note to any line in this Part XI..............
1
Total revenue (must equal Part VIII, column (A), line 12) ............
1
104,113,965
2
Total expenses (must equal Part IX, column (A), line 25) ............
2
92,355,303
3
Revenue less expenses. Subtract line 2 from line 1 ..............
3
11,758,662
4
Net assets or fund balances at beginning of year (must equal Part X, line 32, column (A)) ..
4
122,838,704
5
Net unrealized gains (losses) on investments ...............
5
5,815,460
6
Donated services and use of facilities .................
6
 
7
Investment expenses .....................
7
 
8
Prior period adjustments .....................
8
 
9
Other changes in net assets or fund balances (explain in Schedule O) ........
9
-1,075
10
Net assets or fund balances at end of year. Combine lines 3 through 9 (must equal Part X, line 32, column (B))
10
140,411,751
Part XII
Financial Statements and Reporting
Check if Schedule O contains a response or note to any line in this Part XII.............
Yes
No
1
Accounting method used to prepare the Form 990:  
If the organization changed its method of accounting from a prior year or checked "Other," explain on
Schedule O.
2a
Were the organization’s financial statements compiled or reviewed by an independent accountant?
2a
 
No
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were compiled or reviewed on a separate basis, consolidated basis, or both:
b
Were the organization’s financial statements audited by an independent accountant?
2b
Yes
 
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were audited on a separate basis, consolidated basis, or both:
c
If "Yes," to line 2a or 2b, does the organization have a committee that assumes responsibility for oversight of the audit, review, or compilation of its financial statements and selection of an independent accountant?
2c
Yes
 
If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O.
3a
As a result of a federal award, was the organization required to undergo an audit or audits as set forth in the Uniform Guidance, 2 C.F.R. Part 200, Subpart F?
3a
 
No
b
If "Yes," did the organization undergo the required audit or audits? If the organization did not undergo the required audit or audits, explain why in Schedule O and describe any steps taken to undergo such audits.
3b
 
 
Form 990 (2023)
Form 990 (2023)
Additional Data


Software ID:  
Software Version:  
Form 990, Special Condition Description:
Special Condition Description
SCHEDULE A
(Form 990)

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
2023
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.)
1
A church, convention of churches, or association of churches described in section 170(b)(1)(A)(i).
2
A school described in section 170(b)(1)(A)(ii). (Attach Schedule E (Form 990).)
3
A hospital or a cooperative hospital service organization described in section 170(b)(1)(A)(iii).
4
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:

5
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.)
6
A federal, state, or local government or governmental unit described in section 170(b)(1)(A)(v).
7
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.)
8
A community trust described in section 170(b)(1)(A)(vi). (Complete Part II.)
9
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:
10
An organization that normally receives: (1) more than 33 1/3% 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 33 1/3% 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.)
11
12
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 on lines 12a through 12d that describes the type of supporting organization and complete lines 12e, 12f, and 12g.
a
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.
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.
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.
d
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.
e
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.
f
Enter the number of supported organizations ...............................  
g
Provide the following information about the supported organization(s).
(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
Total
 
   
For Paperwork Reduction Act Notice, see the Instructions for
Form 990 or 990-EZ.
Cat. No. 11285F
Schedule A (Form 990) 2023

Schedule A (Form 990) 2023
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) right arrow (a) 2019 (b) 2020 (c) 2021 (d) 2022 (e) 2023 (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) right arrow (a) 2019 (b) 2020 (c) 2021 (d) 2022 (e) 2023 (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  
12
12
 
13
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
14
14
 
15
15
 
16a
33 1/3% support test—2023. 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
b
33 1/3% support test—2022. 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—2023. 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
b
10%-facts-and-circumstances test—2022. 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
18
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) 2023

Schedule A (Form 990) 2023
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) right arrow (a) 2019 (b) 2020 (c) 2021 (d) 2022 (e) 2023 (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) right arrow (a) 2019 (b) 2020 (c) 2021 (d) 2022 (e) 2023 (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.)..            
14
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
15
15
 
16
16
 
Section D. Computation of Investment Income Percentage
17
17
 
18
18
 
19a
33 1/3% support tests-2023. 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
b
33 1/3 % support tests—2022. 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
20
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) 2023

Schedule A (Form 990) 2023
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
No
1
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.
1
 
 
2
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).
2
 
 
3a
Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yes," answer lines 3b and 3c below.
3a
 
 
b
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.
3b
 
 
c
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.
3c
 
 
4a
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.
4a
 
 
b
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.
4b
 
 
c
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.
4c
 
 
5a
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).
5a
 
 
b
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?
5b
 
 
c
Substitutions only. Was the substitution the result of an event beyond the organization's control?
5c
 
 
6
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.
6
 
 
7
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) .
7
 
 
8
Did the organization make a loan to a disqualified person (as defined in section 4958) not described on line 7? If “Yes,” complete Part I of Schedule L (Form 990).
8
 
 
9a
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.
9a
 
 
b
Did one or more disqualified persons (as defined on line 9a) hold a controlling interest in any entity in which the supporting organization had an interest? If “Yes,” provide detail in Part VI.
9b
 
 
c
Did a disqualified person (as defined on 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.
9c
 
 
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
 
 
b
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) 2023

Schedule A (Form 990) 2023
Page 5
Part IV
Supporting Organizations (continued)
Yes
No
11
Has the organization accepted a gift or contribution from any of the following persons?
a
A person who directly or indirectly controls, either alone or together with persons described on lines 11b and 11c below, the governing body of a supported organization?
11a
 
 
b
A family member of a person described on 11a above?
11b
 
 
c
A 35% controlled entity of a person described on 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
No
1
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.
1
 
 
2
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.
2
 
 
Section C. Type II Supporting Organizations
Yes
No
1
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).
1
 
 
Section D. All Type III Supporting Organizations
Yes
No
1
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?
1
 
 
2
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).
2
 
 
3
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.
3
 
 
Section E. Type III Functionally-Integrated Supporting Organizations
1
Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions):
a
b
c
2
Activities Test. Answer lines 2a and 2b below.
Yes
No
a
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.
2a
 
 
b
Did the activities described on 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.
2b
 
 
3
Parent of Supported Organizations. Answer lines 3a and 3b below.
a
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.
3a
 
 
b
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.
3b
 
 
Schedule A (Form 990) 2023

Schedule A (Form 990) 2023
Page 6
Part V
Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations
1
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  
7
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) 2023

Schedule A (Form 990) 2023
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 2023 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-2023
(iii)
Distributable
Amount for 2023
1 Distributable amount for 2023 from Section C, line 6  
2 Underdistributions, if any, for years prior to 2023 (reasonable cause required-- explain in Part VI).
See instructions.
 
3 Excess distributions carryover, if any, to 2023:
a From 2018.......  
b From 2019.......  
c From 2020.......  
d From 2021.......  
e From 2022.......  
fTotal of lines 3a through e  
g Applied to underdistributions of prior years  
h Applied to 2023 distributable amount  
i Carryover from 2018 not applied (see
instructions)
 
j Remainder. Subtract lines 3g, 3h, and 3i from line 3f.  
4Distributions for 2023 from Section D, line 7:
$  
a Applied to underdistributions of prior years  
b Applied to 2023 distributable amount  
c Remainder. Subtract lines 4a and 4b from line 4.  
5 Remaining underdistributions for years prior to
2023, 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 2023. 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 2024. Add lines
3j and 4c.
 
8 Breakdown of line 7:
a Excess from 2019.....  
b Excess from 2020.....  
c Excess from 2021.....  
d Excess from 2022.....  
e Excess from 2023.....  
Schedule A (Form 990) (2023)

Schedule A (Form 990) 2023
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) 2023


Additional Data


Software ID:  
Software Version:  
Schedule B
(Form 990)
Department of the Treasury
Internal Revenue Service
Schedule of Contributors

Arrow Bullet Attach to Form 990, 990-EZ, or 990-PF.
Arrow Bullet Go to www.irs.gov/Form990 for the latest information.
OMB No. 1545-0047
2023
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






Form 990-PF




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
Special Rules
......... 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) (2023)
Schedule B (Form 990) (2023) Page 2
Name of organization
WHITLEY MEMORIAL HOSPITAL INC
 
Employer identification number
35-1967665
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


(Complete Part II for noncash contributions.)
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
 
 
 
 

$  


(Complete Part II for noncash contributions.)
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
 
 
 
 

$  


(Complete Part II for noncash contributions.)
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
 
 
 
 

$  


(Complete Part II for noncash contributions.)
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
 
 
 
 

$  


(Complete Part II for noncash contributions.)
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
 
 
 
 

$  


(Complete Part II for noncash contributions.)
Schedule B (Form 990) (2023)
Schedule B (Form 990) (2023)
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) (2023)
Schedule B (Form 990) (2023)
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 $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet$  
Use duplicate copies of Part III if additional space is needed.
(a)
No. from Part I
(b) Purpose of gift (c) Use 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 (c) Use 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 (c) Use 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 (c) Use 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) (2023)
Additional Data


Software ID:  
Software Version:  
SCHEDULE C
(Form 990)

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

right arrow Complete if the organization is described below. right arrow Attach to Form 990 or Form 990-EZ.
right arrowGo to www.irs.gov/Form990 for instructions and the latest information.
OMB No. 1545-0047
2022
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.

1
Provide a description of the organization’s direct and indirect political campaign activities in Part IV. See instructions for definition of “political campaign activities."

2
Political campaign activity expenditures. See instructions ....................................................................right arrow
$  
3
Volunteer hours for political campaign activities. See instructions ..................................................................
 

Part I-B
Complete if the organization is exempt under section 501(c)(3).
1
Enter the amount of any excise tax incurred by the organization under section 4955 ................................right arrow
$  
2
Enter the amount of any excise tax incurred by organization managers under section 4955 .......................right arrow
$  
3
If the organization incurred a section 4955 tax, did it file Form 4720 for this year? .........................................
4a
Was a correction made? ......................................................................................................................
b
If "Yes," describe in Part IV.
Part I-C
Complete if the organization is exempt under section 501(c), except section 501(c)(3).
1
Enter the amount directly expended by the filing organization for section 527 exempt function activities ..... right arrow
$  
2
Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt function activities ............................................................................................................................right arrow

$  
3
Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, line 17b...........right arrow

$  
4
Did the filing organization file Form 1120-POL for this year? ...................................................................
5
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.
Cat. No. 50084S
Schedule C (Form 990) 2022

Schedule C (Form 990) 2022
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 right arrowexpenses, and share of excess lobbying expenditures).
B Check right arrow
Limits on Lobbying Expenditures
(The term "expenditures" means amounts paid or incurred.)
(a) Filing
organization's
totals
(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? ...................................................................................................................

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) 2019 (b) 2020 (c) 2021 (d) 2022 (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) 2022


Schedule C (Form 990) 2022
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
1
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:
a
Volunteers? ...........................................................................................................
 
No
b
Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ........
 
No
c
Media advertisements? ...................................................................................................
 
No
 
d
Mailings to members, legislators, or the public? .............................................................................
 
No
 
e
Publications, or published or broadcast statements? ...........................................................
 
No
 
f
Grants to other organizations for lobbying purposes? ..........................................................
 
No
 
g
Direct contact with legislators, their staffs, government officials, or a legislative body? .......................
 
No
 
h
Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ..................
 
No
 
i
Other activities? ...................................................................................................................
Yes
 
7,491
j
Total. Add lines 1c through 1i ....................................................................................................
7,491
2a
Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....
 
No
b
If "Yes," enter the amount of any tax incurred under section 4912 ...........................................
 
c
If "Yes," enter the amount of any tax incurred by organization managers under section 4912 ...................
 
d
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
No
1
Were substantially all (90% or more) dues received nondeductible by members? ...............................................
1
 
 
2
Did the organization make only in-house lobbying expenditures of $2,000 or less? ............................................
2
 
 
3
Did the organization agree to carry over lobbying and political expenditures from the prior year? .................................
3
 
 
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."
1
Dues, assessments and similar amounts from members ......................................................................
1
 
2
Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political expenses for which the section 527(f) tax was paid).
a
Current year .............................................................................................................................
2a
 
b
Carryover from last year ............................................................................................................
2b
 
c
Total ...........................................................................................................................................
2c
 
3
Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .
3
 
4
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? ......................................................................................................................
4
 
5
Taxable amount of lobbying and political expenditures. See Instructions .........................................
5
 
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 AND AMERICAN HOSPITAL ASSOCIATION USED FOR LOBBYING ACTIVITIES.
Schedule C (Form 990) 2022


Additional Data


Software ID:  
Software Version:  

SCHEDULE D
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Financial Statements
right arrow 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.
right arrow Attach to Form 990.
right arrow Go to www.irs.gov/Form990 for instructions and the latest information.
OMB No. 1545-0047
2022
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 ........    
5
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? ............
6
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? ...................................
Part II
Conservation Easements.
Complete if the organization answered "Yes" on Form 990, Part IV, line 7.
1
Purpose(s) of conservation easements held by the organization (check all that apply).
2
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.
Held at the End of the 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 July 25, 2006, and not on a historic structure listed in the National Register ... 2d  
3
Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during the
tax year right arrow  
4
Number of states where property subject to conservation easement is located right arrow  
5
Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and enforcement of the conservation easements it holds? ............
6
Staff and volunteer hours devoted to monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
right arrow  
7
Amount of expenses incurred in monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
right arrow $  
8
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)? .............................
9
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.
1a
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.
b
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 .........................right arrow $  
(ii)
Assets included in Form 990, Part X ...............................right arrow $  
2
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:
a
Revenue included on Form 990, Part VIII, line 1 ..........................right arrow $  
b
Assets included in Form 990, Part X ...............................right arrow $  
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 52283D
Schedule D (Form 990) 2022

Schedule D (Form 990) 2022
Page 2
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)
3
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):
a
d
b
e
 
c
4
Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.
5
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?...
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.
1a
Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................
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  
2a
Did the organization include an amount on Form 990, Part X, line 21, for escrow or custodial account liability? ...
b
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 ......          
2
Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:
a
Board designated or quasi-endowment right arrow  
b
Permanent endowment right arrow  
c
Term endowment right arrow  
The percentages on lines 2a, 2b, and 2c should equal 100%.
3a
Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes
No
(i) Unrelated organizations .................
3a(i)
 
 
(ii) Related organizations .................
3a(ii)
 
 
b
If "Yes" on 3a(ii), are the related organizations listed as required on Schedule R? .........
3b
 
 
4
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 .....   616,560 616,560
b Buildings ....   15,117,545 3,981,981 11,135,564
c Leasehold improvements   48,824 48,824 0
d Equipment ....   24,203,852 17,902,563 6,301,289
e Other .....   70,833,101 1,555,503 69,277,598
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..right arrow 87,331,011
Schedule D (Form 990) 2022

Schedule D (Form 990) 2022
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
(A)
(B)
(C)
(D)
(E)
(F)
(G)
(H)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)right arrow  
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
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)right arrow  
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)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........right arrow  
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  
EST MEDICARE/MEDICAID SETTLEMENTS 341,840
EST 3RD PARTY SETTLEMENTS 215,762
LEASE LIABILITY 713,514
DUE TO/FROM INTERUNIT 28,997,140





Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)right arrow 30,268,256
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) 2022

Schedule D (Form 990) 2022
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, 2023 AND 2022, 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 2019 AND PRIOR.
Schedule D (Form 990) 2022


Additional Data


Software ID:  
Software Version:  




SCHEDULE H
(Form 990)
Department of the Treasury
Internal Revenue Service
Hospitals
Medium right arrow Complete if the organization answered "Yes" on Form 990, Part IV, question 20a.
Medium right arrow Attach to Form 990.
Medium right arrow Go to www.irs.gov/Form990EZ for instructions and the latest information.
OMB No. 1545-0047
2023
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
No
1a
Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a . . . .
1a
Yes
 
b
If "Yes," was it a written policy? ......................
1b
Yes
 
2
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.
3
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.
a
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:
3a
Yes
 
%
b
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: . . . . . . . .
3b
Yes
 
%
c
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.
4
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"? . . . . . . . . . . . . .

4

Yes

 
5a
Did the organization budget amounts for free or discounted care provided under its financial assistance policy during
the tax year? . . . . . . . . . . . . . . . . . . . . . . .

5a

Yes

 
b
If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? . . . . . .
5b
Yes
 
c
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? . . . . . . . . . . . . .
5c
 
No
6a
Did the organization prepare a community benefit report during the tax year? . . . . . . . . .
6a
Yes
 
b
If "Yes," did the organization make it available to the public? . . . . . . . . . . . . .
6b
Yes
 
Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.
7
Financial Assistance and Certain Other Community Benefits at Cost
Financial Assistance and
Means-Tested
Government Programs
(a) Number of activities or programs (optional) (b) Persons served (optional) (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) . . .
    1,383,313   1,383,313 1.670 %
b Medicaid (from Worksheet 3, column a) . . . . .     20,065,072 14,633,380 5,431,692 6.560 %
c Costs of other means-tested government programs (from Worksheet 3, column b) . .            
d Total Financial Assistance and Means-Tested Government Programs . . . . .     21,448,385 14,633,380 6,815,005 8.230 %
Other Benefits
e Community health improvement services and community benefit operations (from Worksheet 4).     68,994 4,745 64,249 0.080 %
f Health professions education (from Worksheet 5) . . .     82,452   82,452 0.100 %
g Subsidized health services (from Worksheet 6) . . . .     11,610,709 6,359,156 5,251,553 6.340 %
h Research (from Worksheet 7) .            
i Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .     66,040   66,040 0.080 %
j Total. Other Benefits . .     11,828,195 6,363,901 5,464,294 6.600 %
k Total. Add lines 7d and 7j .     33,276,580 20,997,281 12,279,299 14.830 %
For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2023
Schedule H (Form 990) 2023
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.
(a) Number of activities or programs (optional) (b) Persons served (optional) (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            
3 Community support            
4 Environmental improvements            
5 Leadership development and
training for community members
           
6 Coalition building            
7 Community health improvement advocacy            
8 Workforce development     14,575   14,575 0.020 %
9 Other            
10 Total     14,575   14,575 0.020 %
Part III
Bad Debt, Medicare, & Collection Practices
Section A. Bad Debt Expense
Yes
No
1
Did the organization report bad debt expense in accordance with Healthcare Financial Management Association Statement No. 15? ..........................
1
Yes
 
2
Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......
2
0
3
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. ......
3
0
4
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
5
Enter total revenue received from Medicare (including DSH and IME).....
5
10,032,323
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
11,091,919
7
Subtract line 6 from line 5. This is the surplus (or shortfall)........
7
-1,059,596
8
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:
Section C. Collection Practices
9a
Did the organization have a written debt collection policy during the tax year? ..........
9a
Yes
 
b
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 .........................

9b

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) 2023
Schedule H (Form 990) 2023
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)
Licensed Hospital General Medical and Surgical Children's Hospital Teaching Hospital Critical Access Hospital Research Facility ER-24Hours ER-Other Other (describe) Facility reporting group
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) 2023
Schedule H (Form 990) 2023
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):
1
Yes No
Community Health Needs Assessment
1 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?........................ 1   No
2 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............... 2   No
3 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...................... 3 Yes  
If "Yes," indicate what the CHNA report describes (check all that apply):
a
b
c
d
e
f
g
h
i
j
4 Indicate the tax year the hospital facility last conducted a CHNA: 20 22
5 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 ................. 5 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.................................. 6a Yes  
b 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. ............................ 6b Yes  
7 Did the hospital facility make its CHNA report widely available to the public?.............. 7 Yes  
If "Yes," indicate how the CHNA report was made widely available (check all that apply):
a
b
c
d
8 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. ..............
8 Yes  
9 Indicate the tax year the hospital facility last adopted an implementation strategy: 20 22
10 Is the hospital facility's most recently adopted implementation strategy posted on a website?......... 10 Yes  
a If "Yes" (list url): HTTPS://WWW.PARKVIEW.COM/LOCALHEALTHNEEDS
b If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ...... 10b    
11 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   No
b If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........ 12b    
c 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) 2023
Schedule H (Form 990) 2023
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 No
Did the hospital facility have in place during the tax year a written financial assistance policy that:
13 Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care? 13 Yes  
If “Yes,” indicate the eligibility criteria explained in the FAP:
a
b
c
d
e
f
g
h
14 Explained the basis for calculating amounts charged to patients?................. 14 Yes  
15 Explained the method for applying for financial assistance?................... 15 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):
a
b
c
d
e
16 Was widely publicized within the community served by the hospital facility?........ 16 Yes  
If "Yes," indicate how the hospital facility publicized the policy (check all that apply):
a
SEE PART V, LINES 16A B & C
b
SEE PART V, LINES 16A B & C
c
d
e
f
g
h
i
j
Schedule H (Form 990) 2023
Schedule H (Form 990) 2023
Page 6
Part VFacility Information (continued)

Billing and Collections
WHITLEY MEMORIAL HOSPITAL INC
Name of hospital facility or letter of facility reporting group  
Yes No
17 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?.................................. 17 Yes  
18 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:
a
b
c
d
e
f
19 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?............ 19   No
If "Yes," check all actions in which the hospital facility or a third party engaged:
a
b
c
d
e
20 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):
a
b
c
d
e
f
Policy Relating to Emergency Medical Care
21 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?.................. 21 Yes  
If "No," indicate why:
a
b
c
d
Schedule H (Form 990) 2023
Schedule H (Form 990) 2023
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 No
22 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.
a
b
c
d
23 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? ............................... 23   No
If "Yes," explain in Section C.
24 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? ........................... 24   No
If "Yes," explain in Section C.
Schedule H (Form 990) 2023
Schedule H (Form 990) 2023
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 2022 COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA), PARKVIEW HEALTH SYSTEM, INC., INCLUDING WHITLEY MEMORIAL HOSPITAL, INC., WERE DILIGENT IN ENSURING INPUT FROM PERSONS WHO REPRESENT THE BROAD INTERESTS OF THE COMMUNITY WAS INCLUDED, WHILE ALSO FOCUSING ON THE NEEDS OF VULNERABLE POPULATIONS IN NORTHEAST INDIANA. IN GATHERING COMMUNITY INPUT, PARKVIEW HEALTH SYSTEM, INC., INCLUDING WHITLEY MEMORIAL HOSPITAL, INC., OBTAINED THE FOLLOWING: 1) PRIMARY DATA COLLECTED THROUGH A COMMUNITY SURVEY OF RESIDENTS IN EACH PARKVIEW HEALTH COUNTY, 2) PRIMARY DATA COLLECTED THROUGH AN ONLINE SURVEY OF HEALTHCARE AND SOCIAL SERVICE PROVIDERS IN EACH COUNTY THAT PROVIDE SERVICES DIRECTLY TO THE UNDERSERVED IN OUR COMMUNITIES (E.G., PHYSICIANS, NURSES, SOCIAL WORKERS, ETC.), AND 3) SECONDARY DATA COLLECTED FROM CONDUENT'S HEALTHY COMMUNITIES INSTITUTE (HCI) DATABASE AND OTHER LOCAL AND NATIONAL AGENCIES (E.G., COUNTY HEALTH RANKINGS, INDIANA STATE DEPARTMENT OF HEALTH, ETC.). COMMUNITY MEMBER AND PROVIDER INPUT WAS GATHERED FROM MARCH THROUGH MAY 2022 VIA MULTIPLE RECRUITMENT AND DATA COLLECTION METHODS: 1) E-MAIL TO HEALTHCARE AND SOCIAL SERVICE PROVIDERS WITH AN EMBEDDED ONLINE SURVEY LINK; 2) MAILED PAPER AND E-MAILED ONLINE SURVEYS TO COMMUNITY MEMBERS; 3) PAPER SURVEYS DISTRIBUTED TO INDIVIDUALS, CLINICS OR ORGANIZATIONS SERVING HISPANIC, AMISH, OR PEOPLE OF BURMA POPULATIONS; 4) IN-PERSON RECRUITMENT AT LOCATIONS PROVIDING SERVICES TO LOW-INCOME POPULATIONS IN EACH PARKVIEW HEALTH COUNTY; AND 5) PRESS RELEASE AND SOCIAL MEDIA NOTIFICATIONS WITH A SURVEY LINK. THE SURVEY WAS MADE AVAILABLE IN ENGLISH, SPANISH, AND BURMESE.HISPANIC, AMISH, PEOPLE OF BURMA, AND LOW-INCOME POPULATIONS WERE IDENTIFIED AS VULNERABLE POPULATIONS IN PARKVIEW HEALTH COUNTIES, AND THEREFORE SURVEY DISTRIBUTION AND DATA COLLECTION STRATEGIES INCLUDED FOCUSED EFFORTS TO OBTAIN COMMUNITY INPUT FROM THESE POPULATIONS. IN WHITLEY AND KOSCIUSKO COUNTIES, THIS INCLUDED HISPANIC AND LOW-INCOME POPULATIONS. THE RESEARCH TEAM COORDINATED WITH COMMUNITY HEALTH WORKERS, LOCAL HEALTH DEPARTMENTS, AND KNOWN CONTACTS IN EACH COUNTY TO IDENTIFY LOCATIONS TO SURVEY UNDERREPRESENTED OR VULNERABLE POPULATIONS. IN WHITLEY AND KOSCIUSKO COUNTIES, IN-PERSON TEAMS OF RESEARCH ASSISTANTS CONDUCTED COMMUNITY SURVEY OUTREACH AT THE LOCAL YMCA. REGARDING VULNERABLE POPULATIONS SURVEYED IN WHITLEY COUNTY, 13.3% OF RESPONDENTS REPORTED AN INCOME OF < $35,000 AND 0.5% OF RESPONDENTS IDENTIFIED AS HISPANIC/LATINO. IN KOSCIUSKO COUNTY, 13.6% OF RESPONDENTS REPORTED AN INCOME OF < $35,000 AND 1.0% OF RESPONDENTS IDENTIFIED AS HISPANIC/LATINO. ADDITIONALLY, RESPONDENTS 65 YEARS AND OLDER WERE WELL-REPRESENTED IN BOTH COUNTIES (46.3% IN WHITLEY COUNTY AND 51.8% IN KOSCIUSKO COUNTY). THE PROVIDER SURVEY INCLUDED RESPONSES FROM PHYSICIANS, PHYSICIAN'S ASSISTANTS, NURSE PRACTITIONERS, REGISTERED NURSES, MENTAL/BEHAVIORAL HEALTH PROVIDERS, OTHER HEALTHCARE PROVIDERS, COMMUNITY/SOCIAL SERVICE PROVIDERS, PUBLIC HEALTH/COMMUNITY HEALTH WORKERS, SOCIAL WORKERS/CASE MANAGERS, PUBLIC SECTOR WORKERS, AND EDUCATORS. IN ADDITION TO DATA COLLECTION, WHITLEY MEMORIAL HOSPITAL, INC. COLLABORATED WITH THE COMMUNITY AND PARTNERING ORGANIZATIONS TO SELECT AND PRIORITIZE WHITLEY AND KOSCIUSKO COUNTIES' HEALTH NEEDS. IN DOING SO, A MODIFIED HANLON METHOD WAS EMPLOYED TO PRIORITIZE 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.). THIS METHOD IS PARTICULARLY 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.A PRIORITIZATION SESSION WAS HELD BY PARKVIEW HEALTH SYSTEM, INC. ON AUGUST 22, 2022, TO REVIEW THE FINDINGS FROM THE HEALTH SERVICES AND INFORMATICS RESEARCH GROUP TO ESTABLISH THE SHARED PRIORITY FOR THE SYSTEM. THE TOP PRIORITY OF MENTAL HEALTH WAS CHOSEN BY THE SYSTEM GROUP AND WHITLEY MEMORIAL HOSPITAL, INC. CHOSE TO FOLLOW THIS LEAD. THE INFORMATION FROM THE PRIORITIZATION SESSION WAS SHARED WITH THE PARKVIEW WHITLEY COMMUNITY HEALTH IMPROVEMENT COMMITTEE (CHI) ON SEPTEMBER 2, 2022, TO ESTABLISH ANY ADDITIONAL PRIORITIES. THIS COMMITTEE OVERSEES THE CHI PROCESS AND CONSISTS OF HOSPITAL BOARD AND COMMUNITY MEMBERS. THE COMMITTEE DECIDED TO CONTINUE WITH SUBSTANCE ABUSE AS A SECOND PRIORITY BECAUSE OF THE CLOSE TIES TO MENTAL HEALTH. OBESITY WAS HIGH IN THE CHNA RESULTS, HOWEVER, IT IS VERY BROAD AND DIFFICULT TO TACKLE. THE GROUP FELT THAT WORKING ON ONE ASPECT OF OBESITY COULD BE MORE IMPACTFUL. WITH THAT IN MIND, OBESITY WAS CHOSEN AS A THIRD PRIORITY, WITH A FOCUS ON FOOD INSECURITY. THE THREE PRIORITIES FOR WHITLEY MEMORIAL HOSPITAL, INC. ARE MENTAL HEALTH, SUBSTANCE USE DISORDER AND OBESITY- FOOD INSECURITY. THE PRIORITY SESSION INFORMATION AND CHI COMMITTEE RECOMMENDATIONS WERE PRESENTED TO THE WHITLEY MEMORIAL HOSPITAL, INC. BOARD OF DIRECTORS IN DECEMBER 2022, FOR THEIR APPROVAL. PRIORITIZATION SESSION ATTENDEES REPRESENTED SEVERAL ORGANIZATIONS IN WHITLEY AND KOSCIUSKO COUNTIES: PARKVIEW BOARD, PARKVIEW COMMUNITY HEALTH IMPROVEMENT, PARKVIEW ADMINISTRATION, AND WHITLEY COUNTY CONSOLIDATED SCHOOLS.
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); DEKALB MEMORIAL HOSPITAL, INC. (EIN 35-1064295); 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); PARK CENTER, INC. (EIN 35-1135451) 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 SYSTEM, INC. (EIN 35-1972384), THROUGH PARKVIEW'S HEALTH SERVICES AND INFORMATICS RESEARCH (HSIR) GROUP, DESIGNED AND CONDUCTED BOTH PRIMARY AND SECONDARY DATA COLLECTION AND ANALYSIS ACTIVITIES FOR THE 2022 COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA). HSIR EMPLOYS MULTIPLE RESEARCH STAFF, WHICH INCLUDES PHD PREPARED SCIENTISTS, USER EXPERIENCE SPECIALISTS AND PROJECT MANAGERS. AS A RESEARCH UNIT EMBEDDED IN PARKVIEW, HSIR HAS DEDICATED TIME TO SUPPORT INITIATIVES THAT REQUIRE RESEARCH SKILLS, SUCH AS THE CHNA.
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:SUBSTANCE USE DISORDERS:WHITLEY MEMORIAL HOSPITAL, INC. WORKS CLOSELY WITH COMMUNITY PARTNERS TO ADDRESS ADDICTIONS AND MENTAL HEALTH. 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, THE HOSPITAL HAS PARTNERED WITH MISSION 25, WHICH IS A LOCAL TRANSITIONAL HOUSING FACILITY THAT NOT ONLY HELPS THOSE THAT ARE HOMELESS BUT HELPS THEM TO GAIN THE TOOLS THEY NEED TO LIVE ON THEIR OWN. ASSISTING WITH JOBS, MENTAL HEALTH AND ADDICTION OBSTACLES, NUTRITION EDUCATION, MONEY MANAGEMENT AND SO MUCH MORE. IN 2023, 75% OF ELIGIBLE RESIDENTS RECEIVED UNLIMITED ACCESS TO INDIVIDUALIZED CARE FOR ADDICTIONS AND MENTAL HEALTH ISSUES. 100% OF CHILD CLIENTS SAID THEY WERE BETTER WHEN THEY LEFT THAN WHEN THEY CAME. MENTAL HEALTH:THE HOSPITAL ALSO PARTNERS WITH THE CENTER FOR WHITLEY COUNTY YOUTH, A LOCAL ORGANIZATION THAT PROVIDES MEALS, ACTIVITIES AND SUPPORT FOR THE TEEN POPULATION IN ALL THREE COUNTY SCHOOL SYSTEMS. THEY SERVE HEALTHY SNACKS AFTER SCHOOL AND BALANCED DINNERS. HAVING ADULT MENTORS WHO PROVIDE POSITIVE REINFORCEMENT AND GUIDE THEM IN MAKING POSITIVE CHOICES MAKES A HUGE DIFFERENCE FOR THESE AT-RISK STUDENTS. IN 2023, THE CENTER SERVED 757 STUDENTS, WHICH IS AN EVER-INCREASING NUMBER. THE STUDENTS ARE SURVEYED ANNUALLY AND IN THE MOST RECENT SURVEY 98.9% OF STUDENTS REPORTED THEY FEEL A SENSE OF BELONGING AT THE CENTER. 97.9% AGREED THEY HAVE MADE NEW FRIENDS AT THE CENTER AND 87% OF PARENTS AGREE THAT THE PROGRAMS HELP PREPARE THEIR CHILD FOR FUTURE CHALLENGES. IN WHITLEY COUNTY, HEALTH INDICATORS HAVE SHOWN AN INCREASED NUMBER OF CHILD ABUSE AND NEGLECT CASES IN THE COMMUNITY AND WHITLEY MEMORIAL HOSPITAL, INC. FEELS STRONGLY THAT THIS MAY BE DIRECTLY TIED TO LACK OF MENTAL HEALTH RESOURCES. THEREFORE, WHITLEY MEMORIAL HOSPITAL, INC. PARTNERED WITH BABE, A LOCAL ORGANIZATION THAT WORKS WITH FAMILIES BY INCENTIVIZING POSITIVE BEHAVIORS FOR PARENTS OF CHILDREN THROUGH AGE 5. THE RELATIONSHIPS AND LEARNING OPPORTUNITIES THROUGH THIS PROGRAM ARE A TREMENDOUS BOOST FOR THE MENTAL HEALTH OF PARENTS. THE PARENTS RECEIVE COUPONS FOR ATTENDANCE AT EDUCATIONAL PROGRAMS, GOING TO DOCTOR VISITS, TAKING THEIR CHILD TO THE LIBRARY AND A MULTITUDE OF OTHER POSITIVE PARENTING BEHAVIORS. THESE COUPONS CAN BE REDEEMED FOR DIAPERS, CLOTHING, CAR SEATS ETC. FOR THEIR CHILDREN. THOUSANDS OF DIAPERS ARE DISTRIBUTED ANNUALLY. IN 2023, BABE INCREASED THE NUMBER OF FAMILIES TO 313, FROM 81 THE PREVIOUS YEAR. THEY ALSO INCREASED THE NUMBER OF ATTENDEES AT EVERY ONE OF THEIR CLASS SIZES BY AT LEAST 10% IN 2023. OBESITY:WHITLEY MEMORIAL HOSPITAL, INC. ALSO PARTNERED WITH A LOCAL ORGANIZATION, ONE COMMUNITY, WHICH OFFERS FREE LUNCHES AND ACTIVITIES TO SOUTH WHITLEY SCHOOL-AGE CHILDREN IN THE SUMMER. MANY OF THE CHILDREN IN THE PROGRAM ARE HOME ALONE THROUGHOUT THE DAY. THE KIDS CONNECT PROGRAM PROVIDES THEM WITH A MEAL, FUN AND, MOST IMPORTANTLY, POSITIVE ROLE MODELS. EATING A HEALTHY MEAL AND GETTING EXERCISE HELPS THEM ON THEIR PATH TO BEING HEALTHY ADULTS. IN 2023, THE KIDS CONNECT PROGRAM SERVED 1,040 MEALS TO LOCAL CHILDREN. THERE WERE 89 PARTICIPANTS AND 98% OF THOSE STAYED FOR THE DAILY ACTIVITIES THAT PROVIDE PHYSICAL ACTIVITY AND SOCIAL INTERACTIONS. BY PROVIDING A BALANCED MEAL AND GROUP PHYSICAL ACTIVITIES, THIS PROGRAM IS NOT ONLY BENEFICIAL FOR OBESITY BUT ALSO THE MENTAL HEALTH OF CHILDREN IN THE SOUTH WHITLEY COMMUNITY. THIS PROGRAM CONTINUES TO GROW AND IMPACT THE CHILDREN MENTALLY AND PHYSICALLY. WHITLEY MEMORIAL HOSPITAL, INC. PARTNERED WITH TROY CENTER, ASSISTING THEM WITH MEALS FOR THEIR STUDENTS. 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. CHILDREN WITH EMPTY BELLIES HAVE DIFFICULTY LEARNING AND 75% OF THE STUDENTS WOULD FALL IN THE FREE & REDUCED LUNCH CATEGORY. THEY SERVED 5,760 LUNCHES TO STUDENTS IN 2023, THERE WERE APPROXIMATELY 40 STUDENT LUNCHES DAILY. LUNCH ALWAYS INCLUDED A VEGETABLE AND A FRESH FRUIT OPTION, WHICH MANY OF THE STUDENTS MAY NOT HAVE ACCESS TO OUTSIDE OF SCHOOL.CARDIOVASCULAR DISEASE:WHITLEY MEMORIAL HOSPITAL, INC. OFFERS THREE CHECK-UP DAYS PER YEAR TO HELP PATIENTS MONITOR SUCH THINGS AS CHOLESTEROL LEVELS, BLOOD PRESSURE AND OTHER CARDIOVASCULAR FACTORS. THIS EVENT PROVIDED REDUCED-FEE LABORATORY TESTING FOR 173 COMMUNITY MEMBERS IN 2023. IN ADDITION, THE PARKVIEW WARSAW CENTER FOR HEALTHY LIVING COORDINATED THREE EVENTS DURING THE YEAR AT THE PARKVIEW WARSAW YMCA WITH 94 PARTICIPANTS. THESE EVENTS ARE WELL KNOWN IN THE COMMUNITY AND OFFER A VALUABLE SERVICE, ESPECIALLY TO THOSE WHO ARE UNINSURED OR UNDER-INSURED.MULTI-COUNTY MEDICAL OUTREACH CLINIC IN WHITLEY COUNTY, AND ST. ANTHONYS FREE CLINIC IN KOSCIUSKO COUNTY, RECEIVE IN-KIND LAB SERVICES THROUGH WHITLEY MEMORIAL HOSPITAL, INC. TO SERVE THE NEEDS OF THEIR UNDERINSURED AND UNINSURED PATIENTS. CANCER: 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. WHITLEY MEMORIAL HOSPITAL, INC. SERVES 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. THE HOSPITAL WILL CONTINUE TO ESTABLISH NEW PROGRAMS AND FOSTER EXISTING PROGRAMS AND RELATIONSHIPS WITH OTHER ORGANIZATIONS. THE FAMILY BIRTHING CENTER CURRENTLY OFFERS LAMAZE CHILDBIRTH EDUCATION, BREASTFEEDING CLASSES, BREASTFEEDING SUPPORT GROUP, POST PARTUM DEPRESSION SUPPORT AND SAFE SLEEP CLASSES FOR NEW MOTHERS. ADDITIONALLY, CERTIFIED CO-WORKERS 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. FIFTY-SIX FAMILIES TOOK ADVANTAGE OF THIS TRAINING. ALTHOUGH THE DESIRE WOULD BE TO ADDRESS ALL TOP TEN HEALTH NEEDS, THE REALITY IS THAT PHYSICALLY AND FINANCIALLY THAT IS NOT POSSIBLE. ASTHMA & COPD- BOTH ARE IN THE TOP TEN BUT THE HOSPITAL DID NOT CHOOSE TO FOCUS ON THESE AT THIS TIME. IN 2024 THE HOSPITAL WILL HAVE A PROVIDER IN OUR TIMESHARE THAT SPECIALIZES IN THESE AREAS.KIDNEY DISEASE AND DIABETES ARE ON THE TOP TEN; HOWEVER, THE HOSPITAL IS NOT ABLE TO FOCUS ON THIS AT THIS TIME DUE TO PHYSICAL AND FINANCIAL CONSTRAINTS.
PART V, LINES 16A, 16B AND 16C: HTTPS://WWW.PARKVIEW.COM/PATIENTS-AND-VISITORS/BILLING-AND-INSURANCE/FINANCIAL-ASSISTANCE
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) 2023
Schedule H (Form 990) 2023
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) 2023
Schedule H (Form 990) 2023
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 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); DEKALB MEMORIAL HOSPITAL, INC. (EIN 35-1064295; PARK CENTER, INC. (EIN 35-1135451); 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 (INCLUDING HEALTHY INDIANA PLAN - HIP), 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 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 7GAMOUNTS PRESENTED DO NOT INCLUDE ANY COSTS ASSOCIATED WITH PHYSICIAN CLINICS.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 $9,563,208 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.WORKFORCE DEVELOPMENT: WHITLEY MEMORIAL HOSPITAL, INC. AS PART OF PARKVIEW HEALTH SYSTEM, INC. OFFERS INNOVATIVE LEARNING EXPERIENCES TO HIGH SCHOOL, UNIVERSITY AND ADULT EDUCATION STUDENTS, GRANTING STUDENTS AN OPPORTUNITY TO EXPLORE HEALTHCARE CAREERS AND PURSUE AN ADVANCED EDUCATION. PARKVIEW HAS MORE THAN 150 AFFILIATION AGREEMENTS WITH SCHOOL PARTNERS, WHICH SUPPORT STUDENT LEARNING OPPORTUNITIES AT ALL PARKVIEW FACILITIES. STUDENTS MAY BEGIN TO EXPLORE POTENTIAL CAREER PATHS THROUGH JOB SHADOWS AND OBSERVATIONS AND THEN ADVANCE INTO INTERNSHIPS AND SPECIALTY CLINICALS AS THEY PROGRESS THROUGH THEIR EDUCATION JOURNEY.
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.
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 COSTSWHITLEY MEMORIAL HOSPITAL, INC. BELIEVES THERE ARE SEVERAL REASONS WHY MEDICARE SHORTFALL SHOULD BE TREATED AS COMMUNITY BENEFIT. FIRST, WHILE WHITLEY MEMORIAL HOSPITAL, INC. ACCEPTS ALL MEDICARE PATIENTS, NON-NEGOTIABLE MEDICARE RATES ARE SOMETIMES OUT-OF-LINE WITH THE TRUE COSTS OF TREATING MEDICARE PATIENTS. SECOND, BY CONTINUING TO TREAT PATIENTS ELIGIBLE FOR MEDICARE, HOSPITALS ALLEVIATE THE FEDERAL GOVERNMENT'S BURDEN FOR DIRECTLY PROVIDING MEDICAL SERVICES. THIRD, IRS REVENUE RULING 69-545 STATES THAT IF A HOSPITAL SERVES PATIENTS WITH GOVERNMENT HEALTH BENEFITS, INCLUDING MEDICARE, THEN THIS IS AN INDICATION THAT THE HOSPITAL OPERATES TO PROMOTE THE HEALTH OF THE COMMUNITY.
PART III, LINE 9B: A PATIENT'S FAILURE TO MAKE PAYMENT ARRANGEMENTS THROUGH VARIOUS AVAILABLE PAYMENT OPTIONS OR FAILURE TO APPLY FOR AND RECEIVE APPROVAL UNDER THE FINANCIAL ASSISTANCE POLICY MAY RESULT IN THE ACCOUNT BEING REFERRED TO A COLLECTION AGENCY DUE TO NON-PAYMENT. THE COLLECTION AGENCY MAY REPORT THE ACCOUNT TO ONE OR ALL THREE CREDIT REPORTING AGENCIES, WHICH MAY ADVERSELY AFFECT THE PATIENT'S CREDIT SCORE.A PATIENT MAY APPLY FOR FINANCIAL ASSISTANCE AT ANY TIME DURING THE APPLICATION PERIOD, EVEN IF THE ACCOUNT HAS BEEN PLACED WITH A COLLECTION AGENCY. IF AN INDIVIDUAL SUBMITS A COMPLETE FINANCIAL ASSISTANCE APPLICATION DURING THE APPLICATION PERIOD, AND PARKVIEW HEALTH DETERMINES THE INDIVIDUAL IS ELIGIBLE FOR FINANCIAL ASSISTANCE, THEN PARKVIEW HEALTH WILL TAKE ALL REASONABLE AVAILABLE MEASURES TO REVERSE ANY EXTRAORDINARY COLLECTION ACTION (EXCEPT FOR A SALE OF DEBT) TAKEN AGAINST THE INDIVIDUAL TO OBTAIN PAYMENT FOR THE CARE. ALSO, IF AN INDIVIDUAL SUBMITS AN INCOMPLETE FINANCIAL ASSISTANCE APPLICATION DURING THE APPLICATION PERIOD, PARKVIEW WILL SUSPEND ANY EXTRAORDINARY COLLECTION ACTIONS AGAINST THE INDIVIDUAL (WITH RESPECT TO CHARGES TO WHICH THE FINANCIAL ASSISTANCE APPLICATION UNDER REVIEW RELATES) UNTIL THE FINANCIAL ASSISTANCE APPLICATION HAS BEEN PROCESSED AND AN ELIGIBILITY DECISION RENDERED.
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 COMPLETING A COMMUNITY HEALTH NEEDS ASSESSMENT ON A TRIENNIAL BASIS, WHITLEY MEMORIAL HOSPITAL, INC. ASSESSES THE HEALTHCARE NEEDS OF THE COMMUNITY IT SERVES THROUGH PRIMARY AND SECONDARY DATA ANALYSIS, WORKING WITH THE ORGANIZATION'S COMMUNITY PARTNERS, AND FRONTLINE STAFF. WHITLEY MEMORIAL HOSPITAL, INC. IDENTIFIES AND VERIFIES COMMUNITY HEALTH NEEDS THROUGH THE FOLLOWING:1. HEALTHY COMMUNITIES INSTITUTE (HCI) SECONDARY DATA ANALYSIS2. OBSERVATIONS AND DATA COLLECTED FROM FRONTLINE STAFF WORKING WITH VULNERABLE POPULATIONS (I.E., COMMUNITY NURSES AND COMMUNITY HEALTH WORKERS)3. REVIEW OF COMMUNITY NEEDS ASSESSMENTS CONDUCTED BY LOCAL ORGANIZATIONS (I.E., UNITED WAY, BRIGHTPOINT, ETC.) 4. PARKVIEW LEADERS SERVING ON HEALTH-RELATED AND SOCIAL SERVICE BOARDS OF DIRECTORS IN THE COMMUNITY5. OTHER PUBLIC HEALTH DATABASES (E.G. COMMUNITY COMMONS, COUNTY HEALTH RANKINGS) KEY HOSPITAL 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 SYSTEM, INC., HAS TWO LOCATIONS. WHITLEY MEMORIAL HOSPITAL, INC. IS A FULL-SERVICE HOSPITAL WITH MEDICAL/SURGICAL, CONSTANT CARE AND OBSTETRICS INPATIENT UNITS. PARKVIEW WARSAW OPERATES AS A HOSPITAL OUTPATIENT 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. THESE FACILITIES PRIMARILY SERVICE WHITLEY AND KOSCIUSKO COUNTIES INCLUDING THE COMMUNITIES OF COLUMBIA CITY, CHURUBUSCO, LARWILL, SOUTH WHITLEY, PIERCETON, WARSAW, AND WINONA LAKE. ACCORDING TO CONDUENT HEALTHY COMMUNITIES INSTITUTE (HCI), WHITLEY COUNTY, IS A RURAL AREA WITHIN THE HEALTH SYSTEM'S SERVICE AREA WITH A POPULATION OF 34,627 (2022). IN ADDITION, HCI REPORTS THE MEDIAN HOUSEHOLD INCOME OF WHITLEY COUNTY RESIDENTS IS APPROXIMATELY $73,636 WITH 9.1% LIVING BELOW THE FEDERAL POVERTY LEVEL (2018-2022). APPROXIMATELY 92.7% OF WHITLEY COUNTY RESIDENTS HAVE HEALTH INSURANCE (2021). MEDICAID EXTENDS COVERAGE TO 15.23% OF THE COUNTY'S INSURED POPULATION, AS CONFIRMED BY DATA FROM THE U.S. CENSUS BUREAU'S AMERICAN COMMUNITY SURVEY DATABASE (2022).ACCORDING TO CONDUENT HEALTHY COMMUNITIES INSTITUTE (HCI), KOSCIUSKO COUNTY, IS A RURAL AREA WITHIN THE HEALTH SYSTEM'S SERVICE AREA WITH A POPULATION OF 80,826 (2022). IN ADDITION, HCI REPORTS THE MEDIAN HOUSEHOLD INCOME OF KOSCIUSKO COUNTY RESIDENTS IS APPROXIMATELY $70,945 WITH 8.9% LIVING BELOW THE FEDERAL POVERTY LEVEL (2018-2022). AROUND 88.9% OF KOSCIUSKO COUNTY RESIDENTS HAVE HEALTH INSURANCE (2021). MEDICAID EXTENDS COVERAGE TO 22.82% OF THE COUNTY'S INSURED POPULATION, AS CONFIRMED BY DATA FROM THE U.S. CENSUS BUREAU'S AMERICAN COMMUNITY SURVEY DATABASE (2022).HEALTH RESOURCES AND SERVICES ADMINISTRATION (HRSA), AN AGENCY OF THE U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, DEVELOPS SHORTAGE DESIGNATION CRITERIA INTENDED TO IDENTIFY A GEOGRAPHIC AREA, POPULATION GROUP OR FACILITY AS A HEALTH PROFESSIONAL SHORTAGE AREA (HPSA) OR A MEDICALLY UNDERSERVED AREA OR POPULATION (MUA/P). EACH HPSA DESIGNATION IS GIVEN A SCORE (RANGING FROM 0 TO 26) THAT EXPRESSES THE PRIORITY LEVEL FOR CLINICIAN ASSIGNMENT. MEANING, THE HIGHER THE HPSA SCORE, THE HIGHER THE PRIORITY IS. HRSA HAS DESIGNATED/IDENTIFIED THE FOLLOWING MEDICALLY UNDERSERVED AREAS/POPULATIONS AND HEALTH PROFESSIONAL SHORTAGE AREAS:1) DISCIPLINE: PRIMARY CAREHSPA ID: 1187177279 HPSA NAME: OTIS R BOWEN CENTER FOR HUMAN SERVICES, INC. DESIGNATION TYPE: FEDERALLY QUALIFIED HEALTH CENTER LOOK-ALIKECOUNTY NAME: KOSCIUSKO COUNTYHPSA SCORE: 12 STATUS: DESIGNATEDRURAL STATUS: RURAL2) DISCIPLINE: MENTAL HEALTHHSPA ID: 7188376199HPSA NAME: OTIS R BOWEN CENTER FOR HUMAN SERVICES, INC. DESIGNATION TYPE: FEDERALLY QUALIFIED HEALTH CENTER LOOK-ALIKECOUNTY NAME: KOSCIUSKO COUNTYHPSA SCORE: 14 STATUS: DESIGNATEDRURAL STATUS: RURAL3) DISCIPLINE: MENTAL HEALTHHSPA ID: 7186918305HPSA NAME: MENTAL HEALTH CATCHMENT AREA 28 - WARSAWDESIGNATION TYPE: GEOGRAPHIC HPSACOUNTY NAME: HUNTINGTON, KOSCIUSKO, MARSHALL, WABASH, AND WHITLEY COUNTIESHPSA SCORE: 17 STATUS: DESIGNATEDRURAL STATUS: PARTIALLY RURAL
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. SEEKS TO DELIVER EXCELLENT CARE TO EVERY PATIENT, EVERY DAY. IN DOING SO, THE HOSPITAL HAS DEVELOPED ITS INFRASTRUCTURE, POLICIES, AND PROCEDURES TO ALIGN WITH THIS GOAL. THIS INCLUDES HAVING A BOARD OF DIRECTORS FOR PARKVIEW HOSPITAL, INC. THAT IS COMPRISED OF INDEPENDENT COMMUNITY MEMBERS RESIDING WITHIN THE HOSPITAL'S PRIMARY SERVICE AREA AND EXTENDING MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN THE COMMUNITY. WHILE THESE TWO COMPONENTS ARE CENTRAL IN PROVIDING THE HOSPITAL WITH A STRONG FOUNDATION, IT TAKES A LOT MORE THAN THIS TO MEET THE HOSPITAL'S STANDARD OF DELIVERING EXCELLENT CARE TO EVERY PATIENT, EVERY DAY. ACHIEVING THIS STANDARD OF CARE REQUIRES FURTHERING EDUCATION AND RESEARCH, PARTNERING WITH COMMUNITY ORGANIZATIONS THROUGH COMMUNITY HEALTH, AND ADVANCING HEALTHCARE DELIVERY AND ACCESS. EDUCATION:WHITLEY MEMORIAL HOSPITAL, INC. AS PART OF PARKVIEW HEALTH SYSTEM, INC. OFFERS INNOVATIVE LEARNING EXPERIENCES TO HIGH SCHOOL, UNIVERSITY, AND ADULT EDUCATION STUDENTS, GRANTING STUDENTS THE OPPORTUNITY TO EXPLORE HEALTHCARE CAREERS AND PURSUE AN ADVANCED EDUCATION. PARKVIEW HAS MORE THAN 150 AFFILIATION AGREEMENTS WITH SCHOOL PARTNERS, WHICH SUPPORT STUDENT LEARNING OPPORTUNITIES AT ALL PARKVIEW FACILITIES. STUDENTS MAY BEGIN TO EXPLORE POTENTIAL CAREER PATHS THROUGH JOB SHADOWS AND OBSERVATIONS AND THEN ADVANCE INTO INTERNSHIPS AND SPECIALTY CLINICALS AS THEY PROGRESS THROUGH THEIR EDUCATION JOURNEY. PRIOR TO LAUNCHING THEIR CAREER, STUDENTS CAN ACCESS PARKVIEW'S SPECIALLY DESIGNED WORK-STUDY OPPORTUNITIES THAT HELP THEM BECOME PRACTICE-READY BY GRADUATION.BEYOND THE HOSPITAL WALLS, THE PARKVIEW EDUCATION CENTER (PEC) OFFERS YOUNG PEOPLE, COLLEGE STUDENTS AND PROFESSIONALS A UNIQUE ENVIRONMENT WHERE THEY CAN LEARN TOGETHER UNDER THE SAME ROOF. THIS FACILITY IS THE RESULT OF A COLLABORATION BETWEEN PARKVIEW HEALTH, FORT WAYNE COMMUNITY SCHOOLS (FWCS) AND IVY TECH COMMUNITY COLLEGE. TOGETHER WE ENHANCE THE WAY THAT STUDENTS AND HEALTHCARE PROFESSIONALS LEARN AND WORK TOGETHER. EDUCATORS CAN PARTNER ACROSS THE CONSORTIUM, SHARING NOT ONLY SPACE BUT RESOURCES, TECHNOLOGY, AND BEST PRACTICES. FURTHERMORE, PEC OFFERS BOTH CLASSROOM AND SIMULATED EXPERIENCE OPTIONS FOR STUDENTS AND CURRENT HEALTHCARE PROFESSIONALS. THE CLASSROOMS, LABORATORIES AND COLLABORATIVE SPACES PROVIDE PARTICIPANTS FROM ALL SKILLSETS AND BACKGROUNDS TO GROW TOGETHER. THIS ENABLES HIGH SCHOOL STUDENTS TO DISCOVER POTENTIAL CAREER PATHS, GIVES ADULTS THE CHANCE TO EARN COLLEGE DEGREES AND CERTIFICATIONS, AND GIVES PARKVIEW CO-WORKERS AN OPPORTUNITY TO ENHANCE THEIR SKILLS.THE HEALTH SYSTEM CONTINUES TO ENHANCE HEALTHCARE EDUCATION AND MEDICAL RESEARCH THROUGH INNOVATIVE PARTNERSHIPS WITH LOCAL UNIVERSITIES. THIS INCLUDES THE PARKVIEW MIRRO CENTER FOR RESEARCH AND INNOVATION AND LOCAL UNIVERSITIES WORKING TOGETHER AT THE PARKVIEW REGIONAL MEDICAL CENTER CAMPUS, AS WELL AS DEVELOPMENT OF THE LIFE SCIENCE EDUCATION AND RESEARCH CONSORTIUM ON THE PARKVIEW RANDALLIA CAMPUS. THE CONSORTIUM IS A COLLABORATION BETWEEN THE HOSPITAL, TRINE UNIVERSITY AND HUNTINGTON UNIVERSITY. TOGETHER THEY PRESENT ACADEMIC PROGRAMS AND RESEARCH TIED TO REHABILITATION SERVICES AND SENIOR CARE. IN ADDITION, DOCTORAL PROGRAMS FOR PHYSICAL THERAPY AND OCCUPATIONAL THERAPY ARE OFFERED TO ADDRESS SIGNIFICANT WORKFORCE GAPS AND SPECIALTY CARE ACCESS NEEDS IN THE COMMUNITY.RESEARCH:THE PARKVIEW RESEARCH CENTER (FOUNDED IN 1993) AT THE PARKVIEW MIRRO CENTER FOR RESEARCH AND INNOVATION HAS BROUGHT MORE THAN 800 CLINICAL TRIALS TO PATIENTS AND PROVIDERS FOR NOVEL AND POTENTIALLY LIFE-SAVING TREATMENTS, WITH AN AVERAGE OF 150 OPEN STUDIES AT ANY GIVEN TIME. THE PRIMARY FOCUS AT THE CENTER HAS BEEN PHASE II AND PHASE III SPONSORED CLINICAL TRIALS, WITH TWO-THIRDS OF OUR ACTIVE RESEARCH IN CANCER TREATMENTS. THE PARKVIEW RESEARCH CENTER ALSO PROVIDES ACCESS TO HUMANITARIAN USE DEVICES (HUD) AS WELL AS EXPANDED ACCESS PROGRAMS THAT ALLOW OUR PATIENTS ACCESS TO INVESTIGATIONAL DRUGS AND DEVICES IN LIFE-THREATENING OR SPECIAL CIRCUMSTANCES. THE PARKVIEW RESEARCH CENTER IS UNIQUELY SITUATED TO PARTICIPATE IN COLLABORATIVE RESEARCH EFFORTS WITH LOCAL AND NATIONAL ACADEMIC PARTNERS. ONE OF OUR OLDEST COLLABORATIONS IS WITH THE INDIANA UNIVERSITY SCHOOL OF MEDICINE ON THE STUDENT EDUCATION AND RESEARCH FELLOWSHIP (SERF) PROGRAM (FORMERLY THE MIDWEST ALLIANCE FOR HEALTH EDUCATION). THIS PROGRAM WAS ESTABLISHED MORE THAN 30 YEARS AGO AND CONTINUES TO SERVE THE SURROUNDING REGION. WITHIN THIS FELLOWSHIP PROGRAM, STUDENTS ARE IN RESIDENCE FOR NINE WEEKS, LEARNING ABOUT RESEARCH AND INTERACTING WITH PARKVIEW PHYSICIANS ON ONGOING RESEARCH STUDIES. STUDENTS GAIN BASIC RESEARCH SKILLS AND DISSEMINATE THEIR WORK THROUGH A POSTER OR PODIUM PRESENTATION AT THE END OF THE PROGRAM. IN ADDITION TO TRAINING AND EDUCATION, THE MIRRO CENTER FOR RESEARCH AND INNOVATION ALSO HOUSES THE HEALTH SERVICES AND INFORMATICS RESEARCH GROUP, WHICH IS COMPRISED OF INTERDISCIPLINARY SCIENTISTS, PROJECT MANAGERS AND USER-EXPERIENCE SPECIALISTS. THIS TEAM WORKS ON A BROAD ARRAY OF PROJECTS, INCLUDING INVESTIGATOR-INITIATED RESEARCH, PROGRAM EVALUATION, PILOT STUDIES, COMMUNITY SURVEYS AND USER-EXPERIENCE PROJECTS THAT IMPROVE THE USABILITY OF HEALTHCARE TECHNOLOGIES. EXAMPLES OF THEIR PROJECTS INCLUDE YOUTH MENTAL HEALTH RESEARCH, INNOVATIVE PRACTICE MODEL EVALUATION, SCREENING FOR AND ADDRESSING SOCIAL DETERMINANTS OF HEALTH, AND SUPPORTING PEOPLE LIVING WITH CHRONIC DISEASE. MUCH OF THIS TEAM'S WORK HAS LED TO PUBLICATION IN PEER-REVIEWED JOURNALS, PRESENTATIONS AT TOP-TIER SCIENTIFIC CONFERENCES, AND THE DISSEMINATION OF FINDINGS TO OUR LOCAL PUBLIC HEALTH AND GOVERNMENT OFFICIALS TO INFLUENCE PUBLIC HEALTH POLICY.COMMUNITY HEALTH:WHITLEY MEMORIAL HOSPITAL, INC. IS COMMITTED TO THE INVESTMENT OF TIME AND RESOURCES IN THE PROCESS AND CHALLENGES OF IMPROVING THE HEALTH AND WELL-BEING OF THE COMMUNITY THROUGH ITS COMMUNITY HEALTH IMPROVEMENT (CHI) PROGRAM. THE GOAL OF THE CHI PROGRAM IS TO UTILIZE BEST PRACTICES AND INNOVATIVE METHODS TO IMPROVE THE HEALTH AND WELL-BEING OF OUR COMMUNITY, PARTICULARLY THE UNDERSERVED. WHITLEY MEMORIAL HOSPITAL, INC., SUPPORTS CHI EFFORTS BY COMMITTING A PERCENTAGE OF ITS NET INCOME ANNUALLY. WITH OVERSIGHT BY THE COMMUNITY HEALTH IMPROVEMENT COMMITTEE, CONSISTING OF COMMUNITY LEADERS, MEMBERS OF THE WHITLEY MEMORIAL HOSPITAL, INC. BOARD OF DIRECTORS AND HOSPITAL MANAGEMENT, THESE FUNDS ARE USED TO STRATEGICALLY ADDRESS COMMUNITY HEALTH NEEDS IDENTIFIED BY THE TRIENNIAL COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA). THIS IS ACCOMPLISHED BY BUILDING INNOVATIVE INTERNAL AND EXTERNAL PROGRAMS IN COLLABORATION WITH COMMUNITY PARTNERS THAT ADDRESS IDENTIFIED HEALTH PRIORITIES. IN PARTNERING WITH OTHER ORGANIZATIONS TO IMPROVE THE HEALTH OF OUR COMMUNITY, THE CHI PROGRAM WORKS WITH SEVERAL COMMUNITY PARTNERS TO ADDRESS THE PRIORITIES OUTLINED BY PARKVIEW HEALTH'S MOST RECENT CHNA. ONE COMMUNITY, MULTI COUNTY OUTREACH CLINIC, MISSION 25 KOSCIUSKO COUNTY FREE CLINIC, THE CENTER FOR WHITLEY COUNTY YOUTH, TROY CENTER AND BABE WERE OUR 2023 PARTNER ORGANIZATIONS. OTHER COMMUNITY OUTREACH PROGRAMS INCLUDE MEDICATION ASSISTANCE, HOSTING MOBILE MAMMOGRAPHY SERVICES, AND BLOOD DRIVES. THREE TIMES A YEAR AT EACH FACILITY WE OFFER CHECK-UP DAYS WHICH OFFER DISCOUNTED LAB SERVICES TO THE COMMUNITY. THERE WERE 267 INDIVIDUALS THAT PARTICIPATED IN WHITLEY AND KOSCIUSKO COUNTIES IN 2023.IN ADDITION TO CHI'S PARTNERSHIPS SEEKING TO IMPROVE THE HEALTH AND WELL-BEING OF THE COMMUNITY, PARKVIEW ALSO VALUES AND MAINTAINS UPSTREAM PARTNERSHIPS WITH LOCAL, STATE, AND FEDERAL GOVERNMENT LEADERS TO COLLABORATE ON PUBLIC POLICY THAT PROMOTES A HEALTHIER AND MORE VIBRANT COMMUNITY. PARKVIEW'S KEY ADVOCACY PILLARS INCLUDE REDUCING THE TOTAL COST OF CARE; PROTECTING AND EXPANDING ACCESS TO CARE; IMPROVING COMMUNITY HEALTH AND QUALITY OF PLACE; AND ADVANCING INFRASTRUCTURE, TALENT, RESEARCH, AND INNOVATION.(NARRATIVE CONTINUED AFTER PART VI, LINE 7 CONT'D)
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.; DEKALB MEMORIAL HOSPITAL, INC.; HUNTINGTON MEMORIAL HOSPITAL, INC.; PARK CENTER, INC.; PARKVIEW WABASH HOSPITAL, INC.; WHITLEY MEMORIAL HOSPITAL, INC.; AS WELL AS 60 PERCENT OWNERSHIP IN THE JOINT VENTURE OF ORTHOPAEDIC HOSPITAL AT PARKVIEW NORTH, LLC.EACH HOSPITAL ENTITY ENGAGES IN COMMUNITY OUTREACH ACTIVITIES 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 NORTHEAST INDIANA AS PART OF THE 2022 COMMUNITY HEALTH NEEDS ASSESSMENT, THE HEALTH PRIORITY OF MENTAL HEALTH WAS SELECTED BY ALL AFFILIATE HOSPITALS.AFFILIATE HOSPITALS EACH HAVE A LOCAL BOARD OF DIRECTORS. PARKVIEW HEALTH SYSTEM, INC. ALSO ENGAGES WITH A BOARD OF DIRECTORS THAT 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 ALWAYS BE INDEPENDENT AS DEFINED BY THE INTERNAL REVENUE SERVICE (IRS). 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 AND WELL-BEING ACROSS THE REGION. WITH A CONSISTENT FOCUS ON OUR MISSION AND VISION, WE WORK TO PROVIDE EXCELLENT CARE TO EVERY PERSON, EVERY DAY WITHIN OUR FACILITIES WHILE SERVING AS GOOD STEWARDS OF SURPLUS FUNDS TO POSITIVELY IMPACT COMMUNITY HEALTH STATUS.
PART VI, LINE 7, REPORTS FILED WITH STATES IN
PART VI, LINE 7 CONT'D: A COPY OF FORM 990, SCHEDULE H IS FILED WITH THE INDIANA STATE DEPARTMENT OF HEALTH.
PART VI, SUPPLEMENTAL INFORMATION, LINE 5 CONT'D: CONTINUED FROM ABOVE: 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.).ADVANCING HEALTHCARE DELIVERY AND ACCESS :PARKVIEW CONTINUES TO ADVANCE INNOVATION IN PATIENT ACCESS TO HEALTHCARE SERVICES THROUGH ITS DIGITAL HEALTH AND VIRTUAL CARE TECHNOLOGY. PARKVIEW USES THE ELECTRONIC MEDICAL RECORD (EMR), THIRD PARTIES, AND ADDITIONAL TOOLS TO FACILITATE VIRTUAL CONNECTIONS BETWEEN STAFF MEMBERS, PROVIDERS, AND PATIENTS. THESE CONNECTIONS ENSURE THAT WE CAN CONNECT WITH COMMUNITY HOSPITALS, COMMUNITY PARTNERS, AND PATIENTS TO EXPEDITE CARE THAT MAY HAVE PREVIOUSLY REQUIRED ADDITIONAL STAFFING, PATIENT MOVEMENT AND TRANSPORT, OR DELAYED CARE. ONE OF THE LARGEST PLATFORMS UTILIZED IS THE PATIENT PORTAL, BRANDED AS PARKVIEW'S MYCHART. PARKVIEW MYCHART IS AN EASY-TO-USE TOOL THAT ENABLES PATIENTS TO PLAY AN ACTIVE ROLE IN THEIR HEALTHCARE JOURNEY. IT OFFERS NOT ONLY CONVENIENT AND SECURE ACCESS TO MEDICAL RECORDS BUT ALSO A RANGE OF SERVICES, RESOURCES, AND FEATURES THAT ENHANCE THE PATIENT EXPERIENCE. PATIENTS WHO INTEGRATE MYCHART INTO THEIR EVERYDAY LIFE CAN SAVE TIME ORGANIZING HEALTH AND INSURANCE INFORMATION, COMMUNICATE WITH THEIR PROVIDER OFFICE, VIEW SCHEDULING OPTIONS, AND GAIN A BETTER UNDERSTANDING OF THEIR HEALTH AND WELL-BEING. OVER THE LAST 12 MONTHS, PARKVIEW HEALTH ENGAGED MORE THAN 500,000 PATIENTS THROUGH THE MYCHART PLATFORM, WHO LOGGED INTO THEIR ACCOUNT TO ACTIVELY MANAGE OR PARTICIPATE IN THEIR CARE. PARKVIEW ONDEMAND IS A TELEHEALTH PLATFORM THAT ALLOWS INDIVIDUALS TO CONNECT WITH A PROVIDER 24/7, ANYTIME AND ANYWHERE, THROUGH VIDEO VISITS USING A COMPUTER, TABLET, OR SMARTPHONE. THIS SERVICE ENABLES PROVIDERS TO SEE PATIENTS FOR SIMPLE FOLLOW-UPS, WELLNESS EXAMS, AND NON-EMERGENCY CONDITIONS LIKE COLD AND FLU, ALLERGIES, AND PINK EYE. CONVENIENTLY, PARKVIEW ONDEMAND CAN ALSO SUBMIT PRESCRIPTIONS DIRECTLY TO THE PATIENT'S PHARMACY OF CHOICE WHEN NEEDED.PARKVIEW ALSO OFFERS THE PARKVIEW HEALTH APP, AVAILABLE IN THE GOOGLE AND APPLE APP STORES. THIS APP CONNECTS USERS TO VARIOUS HELPFUL TOOLS DESIGNED TO ENHANCE THE PATIENT'S JOURNEY OR PROVIDE ACCESS TO HEALTH RECORDS. WITH THE APP, USERS CAN START A VIDEO VISIT, SCHEDULE A NEW PATIENT APPOINTMENT WITH A PRIMARY CARE PROVIDER, GET TURN-BY-TURN WAYFINDING INSIDE PARKVIEW REGIONAL MEDICAL CENTER AND PARKVIEW RANDALLIA, AMONG OTHER FEATURES. THE APP ALSO ALLOWS ACCESS TO THE USER'S PARKVIEW MYCHART ACCOUNT.PARKVIEW HAS FOCUSED RECENTLY ON LEVERAGING SOME OF OUR CONNECTIVITY OPTIONS TO CREATE VIRTUAL NURSING AND VIRTUAL SITTING OPTIONS. FOR PATIENTS WHO HAVE MONITORING ORDERS AND REQUIRE CONSTANT SUPERVISION TO MAINTAIN THEIR SAFETY, A TEAM OF TRAINED STAFF MEMBERS CAN MONITOR PATIENTS ACROSS THE HEALTH SYSTEM THROUGH THE CAMERAS. THIS HELPS REDUCE FALLS, ALLOWS FOR QUICK INTERVENTION, AND SCALABLE RESOURCES DURING A TIME OF CHALLENGED LABOR CONSTRAINTS.
Schedule H (Form 990) 2023
Additional Data


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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
2023
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
1
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? ........................
2
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 (e) Amount of non-cash
assistance
(f) Method of valuation
(book, FMV, appraisal,
other)
(g) Description of
noncash assistance
(h) Purpose of grant
or assistance
(1) INTERFAITH MISSION INC
500 WEST BUSINESS 30
COLUMBIA CITY,IN46725
35-2071824 501(C)(3) 15,000 0     PROGRAMS TO PROVIDE SHELTER AND ASSISTANCE TO THE HOMELESS
(2) TROY CENTER INC
1911 EAST BUSINESS 30
COLUMBIA CITY,IN46725
46-0656583 501(C)(3) 10,000 0     WELL-BEING AND MENTAL HEALTH SUPPORT
(3) CENTER FOR WHITLEY COUNTY YOUTH INC
201 W MARKET STREET
COLUMBIA CITY,IN46725
20-5993971 501(C)(3) 8,000 0     AFTER-SCHOOL AND SUMMER PROGRAMMING FOR ADOLESCENTS INCLUDING PHYSICAL ACTIVITIES AND EDUCATION
2
Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image
3
3
Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image
0
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50055P
Schedule I (Form 990) 2023

Schedule I (Form 990) 2023
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) 2023



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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
medium right arrow graphic Complete if the organization answered "Yes" on Form 990, Part IV, line 23.
medium right arrow graphic Attach to Form 990.
medium right arrow graphic Go to www.irs.gov/Form990 for instructions and the latest information.
OMB No. 1545-0047
2023
Open to Public Inspection
Name of the organization
WHITLEY MEMORIAL HOSPITAL INC
 
Employer identification number

35-1967665
Part I
Questions Regarding Compensation
Yes
No
1a
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.
b
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 .....
1b
 
 
2
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? ....
2
 
 
3
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.
4
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:
a
Receive a severance payment or change-of-control payment? .............
4a
 
No
b
Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........
4b
Yes
 
c
Participate in, or receive payment from, an equity-based compensation arrangement? .........
4c
 
No
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.
5
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:
a
The organization? ....................
5a
 
No
b
Any related organization? .......................
5b
 
No
If "Yes," on line 5a or 5b, describe in Part III.
6
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:
a
The organization? ..................
6a
 
No
b
Any related organization? ......................
6b
 
No
If "Yes," on line 6a or 6b, describe in Part III.
7
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 ............
7
Yes
 
8
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 ..........................
8
 
No
9
If "Yes" on line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................
9
 
 
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50053T
Schedule J (Form 990) 2023

Schedule J (Form 990) 2023
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, 1099-MISC compensation, and/or 1099-NEC (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
(i) Base
compensation
(ii) Bonus & incentive
compensation
(iii) Other reportable compensation
1MICHAEL PACKNETT
FORMER OFFICER/RETIRED PH CEO
(i)

(ii)
0
-------------
66,747
0
-------------
351,881
0
-------------
4,615,581
0
-------------
26,400
0
-------------
2,853
0
-------------
5,063,462
0
-------------
4,613,104
2JEANNE' WICKENS
PH CHIEF FINANCIAL OFFICER
(i)

(ii)
0
-------------
834,975
0
-------------
187,034
0
-------------
1,143,499
0
-------------
239,228
0
-------------
38,660
0
-------------
2,443,396
0
-------------
1,101,767
3GREG JOHNSON
DIRECTOR/REGIONAL MARKET PRESIDENT
(i)

(ii)
0
-------------
681,591
0
-------------
112,796
0
-------------
94,104
0
-------------
155,300
0
-------------
33,706
0
-------------
1,077,497
0
-------------
84,817
4SCOTT GABRIEL
DIRECTOR/MARKET PRESIDENT
(i)

(ii)
260,023
-------------
0
44,819
-------------
0
48,716
-------------
0
74,725
-------------
0
38,744
-------------
0
467,027
-------------
0
45,647
-------------
0
5SVETLANA HAGAN
DIRECTOR/PH PHYSICIAN
(i)

(ii)
10,834
-------------
253,312
0
-------------
19,914
0
-------------
31,356
980
-------------
27,549
955
-------------
26,844
12,769
-------------
358,975
0
-------------
0
6JEFFREY ROCKETT
WMHOS VP OUTPATIENT CARE SVCS
(i)

(ii)
198,151
-------------
0
27,114
-------------
0
3,033
-------------
0
20,698
-------------
0
27,339
-------------
0
276,335
-------------
0
0
-------------
0
7AMANDA KNOWLES
WMHOS MGR PHARMACY
(i)

(ii)
202,556
-------------
0
15,388
-------------
0
1,200
-------------
0
24,701
-------------
0
26,847
-------------
0
270,692
-------------
0
0
-------------
0
8ASHLEY WIRGES
WMHOS VP PATIENT CARE SVCS
(i)

(ii)
160,825
-------------
0
22,947
-------------
0
1,537
-------------
0
9,482
-------------
0
33,827
-------------
0
228,618
-------------
0
0
-------------
0
9BENJAMIN MAGGARD
WMHOS PHARMACIST
(i)

(ii)
153,519
-------------
5,681
500
-------------
0
1,180
-------------
0
14,510
-------------
531
30,937
-------------
1,132
200,646
-------------
7,344
0
-------------
0
10PETER TALATI
WMHOS MGR REHAB
(i)

(ii)
130,795
-------------
0
9,959
-------------
0
1,602
-------------
0
13,272
-------------
0
26,145
-------------
0
181,773
-------------
0
0
-------------
0
11ANGELIA RAMIREZ
WMHOS MGR NURSING SVCS
(i)

(ii)
46,603
-------------
83,482
0
-------------
9,772
347
-------------
1,037
5,725
-------------
11,497
7,684
-------------
15,433
60,359
-------------
121,221
0
-------------
0
12CHARLES JINKS
WMHOS PHARMACIST
(i)

(ii)
139,142
-------------
5,112
453
-------------
0
1,772
-------------
0
17,370
-------------
628
15,035
-------------
544
173,772
-------------
6,284
0
-------------
0
Schedule J (Form 990) 2023

Schedule J (Form 990) 2023
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 $45,647; GREG JOHNSON $84,817; MICHAEL PACKNETT $4,613,104; JEANNE' WICKENS $1,101,767 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 $4,613,104 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 $46,487; GREG JOHNSON $119,000; JEANNE' WICKENS $216,128
PART I, LINE 7 THE MANAGEMENT INCENTIVE COMPENSATION PLAN (MICP) AND THE PHYSICIAN AND PROVIDER INCENTIVE COMPENSATION PLAN (PICP) ARE ANNUAL INCENTIVE PROGRAMS. THE COMPENSATION COMMITTEE OF RELATED ORGANIZATION, PARKVIEW HEALTH SYSTEM, INC., REVIEWS AND APPROVES THE PLAN DOCUMENTS FOR MICP AND PICP. AT CONCLUSION OF THE PLAN YEAR, THE PARKVIEW HEALTH SYSTEM, INC. EXECUTIVE COMMITTEE APPROVES FINAL PAYMENT.
Schedule J (Form 990) 2023

Additional Data


Software ID:  
Software Version:  
SCHEDULE O
(Form 990)

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.
Attach to Form 990 or 990-EZ.
Go to www.irs.gov/Form990 for the latest information.
OMB No. 1545-0047
2023
Open to Public
Inspection
Name of the organization
WHITLEY MEMORIAL HOSPITAL INC
 
Employer identification number

35-1967665
Return Reference Explanation
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, 2023 WAS 704. THE TOTAL NUMBER OF EMPLOYEES REPORTED ON FORM W-3 AND FILED BY THE COMMON PAYING AGENT, PH, FOR THE YEAR ENDED DECEMBER 31, 2023 WAS 18,435. FOR PURPOSES OF COMPLETING FORM 990, PART V, LINE 1A AND 2A, THE NUMBER REPORTED FOR THE WHITLEY MEMORIAL HOSPITAL, INC. WAS 40 AND 481 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/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 4 THE FOLLOWING SIGNIFICANT CHANGES WERE MADE TO THE BYLAWS OF WHITLEY MEMORIAL HOSPITAL, INC.: REFERENCES TO THE NETWORK AGREEMENT DATED JUNE 1, 1995, AND CLASS 1, CLASS 2, AND CLASS 3 DIRECTORS WERE REMOVED. ARTICLE V - GOVERNING BODY THE BOARD COMPOSITION CHANGED FROM NO MORE THAN FOURTEEN (14) BOARD MEMBERS AND UP TO TEN (10) BEING COMMUNITY LEADERS TO NO MORE THAN TWENTY (20) BOARD MEMBERS AND UP TO SIXTEEN (16) BEING COMMUNITY LEADERS. ADDITIONALLY, THE BYLAWS WERE UPDATED TO PROVIDE EQUAL REPRESENTATION FROM WHITLEY COUNTY AND KOSCIUSKO COUNTY. ARTICLE XI - MISCELLANEOUS SECTION 2 - QUORUM AND ACTION CONSENT BY THE MAJORITY OF BOARD MEMBERS WAS CHANGED TO CONSENT BY ALL BOARD MEMBERS.
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: (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 COMPLIANCE AND 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 COMPLIANCE AND AUDIT COMMITTEE, PRIOR TO FILING WITH THE IRS. ON OCTOBER 24, 2024, THE SYSTEM COMPLIANCE AND 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 AND AUDIT 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. RELATED ORGANIZATION, PARKVIEW HEALTH SYSTEM, INC., HAS A PROCESS IN PLACE FOR REVIEWING AND APPROVING COMPENSATION OF THE CEO & EVP LEVEL EXECUTIVES. THE PROCESS INCLUDES CONSULTATIONS WITH AN INDEPENDENT COMPENSATION ADVISOR AND THE REVIEW OF APPROPRIATE COMPARABILITY DATA; REVIEW AND APPROVAL BY THE COMPENSATION COMMITTEE OF THE GOVERNING BODY CONSISTING OF MEMBERS WHO DO NOT HAVE A CONFLICT OF INTEREST CONCERNING THE COMPENSATION; AND CONTEMPORANEOUS DOCUMENTATION AND RECORDKEEPING WITH RESPECT TO DELIBERATIONS AND DECISIONS REGARDING THE COMPENSATION ARRANGEMENTS. IN 2023, THE COMPENSATION COMMITTEE OF PARKVIEW HEALTH SYSTEM, INC. REVIEWED AND APPROVED ALL CEO & EVP LEVEL COMPENSATION, BENEFITS, AND PERQUISITES FOR THE 2023 COMPENSATION PACKAGE, PURSUANT TO THE PARKVIEW HEALTH BYLAWS. IN ADDITION, AGGREGATE INFORMATION ON ALL OTHER EXECUTIVE ROLES (OUTSIDE OF THE CEO & EVPS) IS SHARED. THE COMPENSATION PACKAGE OF THE CEO AND EVPS WAS APPROVED BY A MAJORITY OF INDEPENDENT COMPENSATION COMMITTEE MEMBERS. ADDITIONALLY, THE COMPENSATION COMMITTEE REVIEWS AND APPROVES THE PLAN DOCUMENTS FOR THE MANAGEMENT INCENTIVE COMPENSATION PLAN (MICP) AND THE PHYSICIAN AND PROVIDER INCENTIVE COMPENSATION PLAN (PICP). THE BOARD OF PARKVIEW HEALTH SYSTEM, INC. APPROVES ANY CHANGES IN COMPENSATION FOR THE CEO. PARKVIEW'S INDEPENDENT CONSULTANT PREPARES A SUMMARY OF THE EXECUTIVE COMPENSATION PROCESS USING DATA FROM MULTIPLE PUBLISHED SURVEYS PREPARED BY INDEPENDENT FIRMS FOR POSITIONS THAT ARE FUNCTIONALLY COMPARABLE IN SIMILAR-SIZED HEALTH SYSTEMS AND HOSPITAL ORGANIZATIONS ON BOTH A REGIONAL AND NATIONAL BASIS. THE INDEPENDENT CONSULTANT PROVIDES A STATEMENT OF REASONABLENESS OF THE COMPENSATION PROVIDED TO THE CEO AND EVP LEVEL EXECUTIVES.
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.
FORM 990, PART XI, LINE 9: ASSET TRANSFERS/ADJUSTMENTS -1,075.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990) 2023


Additional Data


Software ID:  
Software Version:  
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.
Attach to Form 990.
Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047
2023
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?
Yes No
(1)PARKVIEW HEALTH SYSTEM INC
1450 PRODUCTION RD

FORT WAYNE,IN468081167
35-1972384
HEALTH CARE IN 501(C)(3) LINE 12C, III-FI N/A
 
No
(2)PARKVIEW HEALTH FOUNDATION INC
1450 PRODUCTION RD

FORT WAYNE,IN468081167
92-1994990
FUND MGMT IN 501(C)(3) LINE 7 PARKVIEW HEALTH SYSTEM INC
 
 
No
(3)WHITLEY MEMORIAL HOSPITAL FOUNDATION INC
1260 E STATE ROAD 205

COLUMBIA CITY,IN467259492
31-1190239
FUND MGMT IN 501(C)(3) LINE 12A, I WHITLEY MEMORIAL HOSPITAL INC
 
Yes
 
(4)PARKVIEW HOSPITAL INC
11109 PARKVIEW PLAZA DR

FORT WAYNE,IN468451701
35-0868085
HOSPITAL CARE IN 501(C)(3) LINE 3 PARKVIEW HEALTH SYSTEM INC
 
 
No
(5)PARKVIEW FOUNDATION INC
3844 NEW VISION DR

FORT WAYNE,IN468451724
23-7220589
FUND MGMT IN 501(C)(3) LINE 12A, I PARKVIEW HOSPITAL INC
 
 
No
(6)DEKALB MEMORIAL HOSPITAL INC
1316 E 7TH ST

AUBURN,IN467062515
35-1064295
HOSPITAL CARE IN 501(C)(3) LINE 3 PARKVIEW HEALTH SYSTEM INC
 
 
No
(7)PARKVIEW DEKALB HOSPITAL FOUNDATION INC
1316 E 7TH ST

AUBURN,IN467062515
35-6047817
FUND MGMT IN 501(C)(3) LINE 12A, I DEKALB MEMORIAL HOSPITAL INC
 
 
No
(8)HUNTINGTON MEMORIAL HOSPITAL INC
2001 STULTS RD

HUNTINGTON,IN467501291
35-1970706
HOSPITAL CARE IN 501(C)(3) LINE 3 PARKVIEW HEALTH SYSTEM INC
 
 
No
(9)PARKVIEW HUNTINGTON HOSPITAL FOUNDATION INC
2001 STULTS RD

HUNTINGTON,IN467501291
32-0012095
FUND MGMT IN 501(C)(3) LINE 12A, I HUNTINGTON MEMORIAL HOSPITAL INC
 
 
No
(10)COMMUNITY HOSPITAL OF LAGRANGE COUNTY INC
207 N TOWNLINE RD

LAGRANGE,IN467611325
20-2401676
HOSPITAL CARE IN 501(C)(3) LINE 3 PARKVIEW HEALTH SYSTEM INC
 
 
No
(11)PARKVIEW LAGRANGE HOSPITAL FOUNDATION INC
207 N TOWNLINE RD

LAGRANGE,IN467611325
83-3347115
FUND MGMT IN 501(C)(3) LINE 12A, I COMMUNITY HOSPITAL OF LAGRANGE COUNTY INC
 
 
No
(12)COMMUNITY HOSPITAL OF NOBLE COUNTY INC
401 N SAWYER RD

KENDALLVILLE,IN467552568
35-2087092
HOSPITAL CARE IN 501(C)(3) LINE 3 PARKVIEW HEALTH SYSTEM INC
 
 
No
(13)COMMUNITY HOSPITAL OF NOBLE COUNTY FOUNDATION INC
401 N SAWYER RD

KENDALLVILLE,IN467552568
35-2089183
FUND MGMT IN 501(C)(3) LINE 12A, I COMMUNITY HOSPITAL OF NOBLE COUNTY INC
 
 
No
(14)PARKVIEW WABASH HOSPITAL INC
10 JOHN KISSINGER DR

WABASH,IN469921648
47-1753440
HOSPITAL CARE IN 501(C)(3) LINE 3 PARKVIEW HEALTH SYSTEM INC
 
 
No
(15)PARKVIEW WABASH HOSPITAL FOUNDATION INC
10 JOHN KISSINGER DR

WABASH,IN469921648
35-1921445
FUND MGMT IN 501(C)(3) LINE 12A, I PARKVIEW WABASH HOSPITAL INC
 
 
No
(16)COMMUNITY HOSPITALS AND WELLNESS CENTERS
433 W HIGH ST

BRYAN,OH435061690
34-1048666
HOSPITAL CARE OH 501(C)(3) LINE 3 PARKVIEW HEALTH SYSTEM INC
 
 
No
(17)SHARE FOUNDATION OF COMMUNITY HOSPITALS OF WILLIAMS COUNTY INC
433 W HIGH ST

BRYAN,OH435061690
34-1596175
FUND MGMT OH 501(C)(3) LINE 12B, II COMMUNITY HOSPITALS AND WELLNESS CENTERS
 
 
No
(18)MIDWEST COMMUNITY HEALTH ASSOCIATES INC
442 W HIGH ST

BRYAN,OH435061681
34-1045870
PHYSICIANS OH 501(C)(3) LINE 3 PARKVIEW HEALTH SYSTEM INC
 
 
No
(19)PARKVIEW OCCUPATIONAL HEALTH CENTERS INC
1450 PRODUCTION RD

FORT WAYNE,IN468081167
35-2064353
OCCUPATIONAL HEALTH IN 501(C)(3) LINE 3 PARKVIEW HEALTH SYSTEM INC
 
 
No
(20)PARK CENTER INC
909 E STATE BLVD

FORT WAYNE,IN468053404
35-1135451
COMPREHENSIVE MENTAL HEALTH CENTER IN 501(C)(3) LINE 10 PARKVIEW HEALTH SYSTEM INC
 
 
No
(21)OUABACHE VILLAGE INC
909 E STATE BLVD

FORT WAYNE,IN468053404
02-0731922
PROVIDE HOUSING TO HANDICAPPED INDIVIDUALS IN 501(C)(3) LINE 10 PARK CENTER INC
 
 
No
(22)RICHARDVILLE APARTMENTS INC
909 E STATE BLVD

FORT WAYNE,IN468053404
05-0543940
PROVIDE HOUSING TO HANDICAPPED INDIVIDUALS IN 501(C)(3) LINE 10 PARK CENTER INC
 
 
No
(23)RICHARDVILLE APARTMENTS II INC
909 E STATE BLVD

FORT WAYNE,IN468053404
86-1077255
PROVIDE HOUSING TO HANDICAPPED INDIVIDUALS IN 501(C)(3) LINE 10 PARK CENTER INC
 
 
No
(24)SEDDLEMEYER APARTMENTS INC
909 E STATE BLVD

FORT WAYNE,IN468053404
35-2067590
PROVIDE HOUSING TO HANDICAPPED INDIVIDUALS IN 501(C)(3) LINE 10 PARK CENTER INC
 
 
No
(25)WAYNEDALE APARTMENTS INC
909 E STATE BLVD

FORT WAYNE,IN468053404
35-1972197
PROVIDE HOUSING TO HANDICAPPED INDIVIDUALS IN 501(C)(3) LINE 10 PARK CENTER INC
 
 
No
(26)WAYNEDALE II APARTMENTS INC
909 E STATE BLVD

FORT WAYNE,IN468053404
22-3972135
PROVIDE HOUSING TO HANDICAPPED INDIVIDUALS IN 501(C)(3) LINE 10 PARK CENTER INC
 
 
No
(27)WOODSIDE APARTMENTS INC
909 E STATE BLVD

FORT WAYNE,IN468053404
35-1937426
PROVIDE HOUSING TO HANDICAPPED INDIVIDUALS IN 501(C)(3) LINE 10 PARK CENTER INC
 
 
No
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2023
Schedule R (Form 990) 2023
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


Yes No Yes No
(1) ORTHOPAEDIC HOSPITAL AT PARKVIEW NORTH LLC

1450 PRODUCTION RD
FORT WAYNE,IN468081167
26-0143823
ORTHOPAEDIC HOSPITAL IN N/A
N/A       No     No  
(2) MANAGED CARE SERVICES LLC

1450 PRODUCTION RD
FORT WAYNE,IN468081167
35-1996535
HEALTH PLAN ADMINISTRATION IN N/A
N/A       No     No  
(3) FOUNDATION SURGERY AFFILIATE OF FORT WAYNE LLC

1450 PRODUCTION RD
FORT WAYNE,IN468081167
20-1394120
SURGICAL SERVICES IN N/A
N/A       No     No  
(4) COMMUNITY HOSPITALS AND WELLNESS CENTERS PAIN MANAGEMENT LLC

433 W HIGH ST
BRYAN,OH435061690
46-1084537
MEDICAL SERVICES OH N/A
N/A       No     No  
(5) EXCEL SPORTS GROUP LLC

1450 PRODUCTION RD
FORT WAYNE,IN468081167
92-1435049
SPORTS CAMPS & LEAGUES 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?
Yes No
(1) PARKVIEW PROFESSIONAL PROGRAMS INC

1450 PRODUCTION RD
FORT WAYNE,IN468081167
35-1668888
REFERENCE LAB IN N/A
C         No
(2) WOODLAND PLAZA MEDICAL PARK CONDO ASSOC INC

202 W BERRY ST
FORT WAYNE,IN468022273
35-2058340
PROPERTY OWNERS ASSOCIATION IN N/A
C         No
(3) PARKVIEW HEALTH SYSTEM INC 457(B) PLAN

1450 PRODUCTION RD
FORT WAYNE,IN468081167
35-7048812
TRUST - 457(B) PLAN 003 IN N/A
T         No
(4) PARKVIEW HEALTH SYSTEM SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN

1450 PRODUCTION RD
FORT WAYNE,IN468081167
35-7048813
TRUST - SERP PLAN 004 IN N/A
T         No
(5) PARKVIEW HEALTH SYSTEM INC 457(F) PLAN

1450 PRODUCTION RD
FORT WAYNE,IN468081167
35-7048810
TRUST - 457(F) PLAN 005 IN N/A
T         No
(6) PARKVIEW HEALTH SYSTEM SUPPLEMENTAL

1450 PRODUCTION RD
FORT WAYNE,IN468081167
99-6407150
TRUST - SUPPLEMENTAL PLAN 008 IN N/A
T         No
(7) PARKVIEW HEALTH SYSTEM EVPCEO

1450 PRODUCTION RD
FORT WAYNE,IN468081167
93-6856743
TRUST - EVP/CEO PLAN 009 IN N/A
T         No
Schedule R (Form 990) 2023
Schedule R (Form 990) 2023
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
No
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 .....................
1a
 
No
b Gift, grant, or capital contribution to related organization(s) ............................
1b
Yes
 
c Gift, grant, or capital contribution from related organization(s) ............................
1c
Yes
 
d Loans or loan guarantees to or for related organization(s) ............................
1d
 
No
e Loans or loan guarantees by related organization(s) ............................
1e
 
No
f Dividends from related organization(s) ............................
1f
 
No
g Sale of assets to related organization(s) ............................
1g
 
No
h Purchase of assets from related organization(s) ............................
1h
 
No
i Exchange of assets with related organization(s) ............................
1i
 
No
j Lease of facilities, equipment, or other assets to related organization(s) .......................
1j
Yes
 
k Lease of facilities, equipment, or other assets from related organization(s) ......................
1k
Yes
 
l Performance of services or membership or fundraising solicitations for related organization(s) .....................
1l
Yes
 
m Performance of services or membership or fundraising solicitations by related organization(s) .................
1m
Yes
 
n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) ...................
1n
Yes
 
o Sharing of paid employees with related organization(s) ............................
1o
Yes
 
p Reimbursement paid to related organization(s) for expenses ............................
1p
Yes
 
q Reimbursement paid by related organization(s) for expenses ............................
1q
Yes
 
r Other transfer of cash or property to related organization(s) ............................
1r
Yes
 
s Other transfer of cash or property from related organization(s) ............................
1s
Yes
 
2
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 153,431 PART VII SUPPLEMENTAL INFORMATION





Schedule R (Form 990) 2023
Schedule R (Form 990) 2023
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)
(d)
Predominant income (related, unrelated, excluded from tax under sections 512-514)

(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


Yes No Yes No Yes No






























Schedule R (Form 990) 2023
Schedule R (Form 990) 2023
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 (D): 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) 2023

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