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Nonprofiteer
← PARKVIEW WABASH HOSPITAL INC

Form 990 for tax year 2022

Filed by PARKVIEW WABASH HOSPITAL INC.

Totals

Total revenue
$62,067,634
Total expenses
$61,598,422
Contributions and grants received
$469,372
Grants paid
$23,310
Program service revenue
$61,325,792
Investment income
$2,387
Other revenue
$270,083
Total assets, end of year
$43,274,746
Total liabilities, end of year
$51,731,175
Net assets or fund balances, end of year
-$8,456,429
Program services expenses (Part IX)
$50,983,315
Management and general expenses
$10,550,698
Fundraising expenses
$64,409
Program service expenses (Part III)
$50,983,315

Program services were 82.8% of total expenses calculated — Part IX's program-services column over total expenses, both as filed.

Listed in Part VII

  • MICHAEL PACKNETT

    DIRECTOR/PH PRESIDENT & CEO

    Total calculated
    $2,941,140
    From this org
    $0
    From related orgs
    $2,602,841
    Other
    $338,299
    Hours/week
    0 + 40 related

    Schedule J breakdown matched by us

    Base
    $0 + $1,330,197 related
    Bonus
    $0 + $664,677 related
    Other
    $0 + $607,967 related
    Deferred
    $0 + $302,282 related
    Nontaxable benefits
    $0 + $36,017 related
    Filer's total
    $0 + $2,941,140 related

  • DOUGLAS SPARKS

    DIRECTOR/PH PHYSICIAN

    Total calculated
    $590,686
    From this org
    $23,437
    From related orgs
    $494,391
    Other
    $72,858
    Hours/week
    0 + 40 related

    Schedule J breakdown matched by us

    Base
    $23,437 + $423,139 related
    Bonus
    $0 + $42,896 related
    Other
    $0 + $28,356 related
    Deferred
    $1,518 + $32,032 related
    Nontaxable benefits
    $1,779 + $37,529 related
    Filer's total
    $26,734 + $563,952 related

  • DEBRA POTEMPA

    DIRECTOR/WBHOS PRESIDENT

    Total calculated
    $256,154
    From this org
    $164,949
    From related orgs
    $52,904
    Other
    $38,301
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $164,199
    Bonus
    $750 + $25,000 related
    Other
    $0 + $27,904 related
    Deferred
    $21,024 + $6,743 related
    Nontaxable benefits
    $7,976 + $2,558 related
    Filer's total
    $193,949 + $62,205 related

  • MARILYN CUSTER-MITCHELL

    DIRECTOR-PARTIAL YR/WBHOS PRESIDENT

    Total calculated
    $218,290
    From this org
    $200,680
    From related orgs
    $0
    Other
    $17,610
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $64,475
    Bonus
    $92,640
    Other
    $43,565
    Deferred
    $5,298
    Nontaxable benefits
    $12,312
    Filer's total
    $218,290

  • WILLIAM RAUH

    DIRECTOR

    Total calculated
    $12,000
    From this org
    $12,000
    From related orgs
    $0
    Other
    $0
    Hours/week
    1

  • HOWARD HALDERMAN

    DIRECTOR/CHAIR

    Total calculated
    $10,500
    From this org
    $7,000
    From related orgs
    $3,500
    Other
    $0
    Hours/week
    1 + 1 related

  • KEVIN BOWMAN

    DIRECTOR/SECRETARY/TREASURER

    Total calculated
    $4,750
    From this org
    $4,750
    From related orgs
    $0
    Other
    $0
    Hours/week
    1

  • KELLY STOUFFER

    DIRECTOR/VICE CHAIR

    Total calculated
    $5,000
    From this org
    $5,000
    From related orgs
    $0
    Other
    $0
    Hours/week
    1

  • KENT TERRILL

    DIRECTOR

    Total calculated
    $4,500
    From this org
    $4,500
    From related orgs
    $0
    Other
    $0
    Hours/week
    1

  • ROGER CROMER

    DIRECTOR

    Total calculated
    $4,500
    From this org
    $4,500
    From related orgs
    $0
    Other
    $0
    Hours/week
    1 + 1 related

  • PATTY GRANT

    DIRECTOR

    Total calculated
    $5,000
    From this org
    $5,000
    From related orgs
    $0
    Other
    $0
    Hours/week
    1

  • PARKER BEAUCHAMP

    DIRECTOR-PARTIAL YR

    Total calculated
    $3,750
    From this org
    $3,750
    From related orgs
    $0
    Other
    $0
    Hours/week
    1

  • BENJAMIN VANDERPOOL

    DIRECTOR

    Total calculated
    $3,250
    From this org
    $3,250
    From related orgs
    $0
    Other
    $0
    Hours/week
    1

  • JEANNE' WICKENS

    PH CHIEF FINANCIAL OFFICER

    Total calculated
    $1,622,167
    From this org
    $0
    From related orgs
    $1,264,400
    Other
    $357,767
    Hours/week
    0 + 40 related

    Schedule J breakdown matched by us

    Base
    $0 + $804,432 related
    Bonus
    $0 + $363,922 related
    Other
    $0 + $96,046 related
    Deferred
    $0 + $325,215 related
    Nontaxable benefits
    $0 + $32,552 related
    Filer's total
    $0 + $1,622,167 related

  • CATHY WOLFE

    WBHOS VP PATIENT CARE SVCS

    Total calculated
    $257,963
    From this org
    $214,527
    From related orgs
    $0
    Other
    $43,436
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $161,304
    Bonus
    $49,637
    Other
    $3,586
    Deferred
    $15,198
    Nontaxable benefits
    $28,238
    Filer's total
    $257,963

  • PAULA OPHEIM

    WBHOS MGR PHARMACY

    Total calculated
    $209,533
    From this org
    $179,785
    From related orgs
    $0
    Other
    $29,748
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $155,595
    Bonus
    $23,920
    Other
    $270
    Deferred
    $12,691
    Nontaxable benefits
    $17,057
    Filer's total
    $209,533

  • JAMI METZGER

    WBHOS NURSE PRACTITIONER

    Total calculated
    $226,506
    From this org
    $177,590
    From related orgs
    $0
    Other
    $48,916
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $158,887
    Bonus
    $17,533
    Other
    $1,170
    Deferred
    $16,314
    Nontaxable benefits
    $32,602
    Filer's total
    $226,506

  • LISA KROH

    WBHOS PHARMACIST

    Total calculated
    $173,852
    From this org
    $155,685
    From related orgs
    $0
    Other
    $18,167
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $154,161
    Bonus
    $750
    Other
    $774
    Deferred
    $17,040
    Nontaxable benefits
    $1,127
    Filer's total
    $173,852

  • GRACE STANLEY

    WBHOS NURSE PRACTITIONER

    Total calculated
    $174,684
    From this org
    $148,922
    From related orgs
    $0
    Other
    $25,762
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $134,396
    Bonus
    $12,386
    Other
    $2,140
    Deferred
    $13,307
    Nontaxable benefits
    $12,455
    Filer's total
    $174,684

  • MELANIE ZOLMAN

    WBHOS NURSE PRACTITIONER

    Total calculated
    $171,725
    From this org
    $148,304
    From related orgs
    $591
    Other
    $22,830
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $128,326 + $591 related
    Bonus
    $12,117
    Other
    $7,861
    Deferred
    $10,380 + $41 related
    Nontaxable benefits
    $12,360 + $49 related
    Filer's total
    $171,044 + $681 related

Compensation is as filed in Part VII: reportable pay from this organization and from related organizations, other compensation, and hours per week. The total, marked calculated, is our sum of the three dollar columns, with a blank column counted as $0; the form itself has no total. On a Form 990-EZ the columns are Part IV's instead, and on a Form 990-PF Part VIII's — compensation, contributions to benefit plans, and expense account — and the total sums those. A Schedule J breakdown is as filed: base pay, bonus, other, deferred compensation and nontaxable benefits from this organization, with any from related organizations beside each, and the filer's own total. It is shown with the Part VII listing of the same name on the same return. The form gives no key between the two, so that pairing is ours, and is marked matched by us.

Schedule J

Answered yes

  • 1a · Discretionary spending account
  • 1b · Written policy on the line-1a expenses
  • 2 · Substantiation required before reimbursing expenses
  • 4b · Supplemental nonqualified retirement plan
  • 7 · Other non-fixed payments

Answered no

  • 4a · Severance or change-of-control payment
  • 4c · Equity-based compensation arrangement
  • 5a · Pay contingent on this organization's revenues
  • 5b · Pay contingent on a related organization's revenues
  • 6a · Pay contingent on this organization's net earnings
  • 6b · Pay contingent on a related organization's net earnings
  • 8 · Paid under the initial-contract exception

The filer's explanations (Part III)

PART I, LINE 1A
DISCRETIONARY SPENDING ACCOUNT - TAXABLE DISCRETIONARY SPENDING ACCOUNT PAID TO: JAMI METZGER $900; GRACE STANLEY $1,000; MELANIE ZOLMAN $908
PART I, LINE 3
RELATED ORGANIZATION, PARKVIEW HEALTH SYSTEM, INC., USES THE FOLLOWING TO ESTABLISH THE COMPENSATION OF PARKVIEW WASBASH 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): MARILYN CUSTER-MITCHELL $23,937; MICHAEL PACKNETT $577,374; JEANNE' WICKENS $70,644 AMOUNTS LISTED ABOVE THAT HAVE BEEN REPORTED AS DEFERRED COMPENSATION ON PRIOR FORM 990 WILL ALSO BE REFLECTED IN SCHEDULE J, PART II, COLUMN (F). FOR EXAMPLE, THE AMOUNT OF $577,374 REPORTED AS REQUIRED FOR MR. PACKNETT WAS A RESULT OF THE VESTING OF SUCH AMOUNT UNDER THE TERMS OF THE RESPECTIVE PLANS. HOWEVER, THESE AMOUNTS WERE PREVIOUSLY REPORTED IN MR. PACKNETT'S DEFERRED COMPENSATION OVER MORE THAN 10 YEARS AS THE AMOUNTS WERE DEFERRED UNDER THE PLANS. AS SUCH, THE AMOUNT REPORTED IN SCHEDULE J, PART II, COLUMN (F) IS AN INDICATION OF AMOUNTS THAT HAVE BEEN REPORTED TWICE, ONCE AS A DEFERRAL AND ONCE AS VESTED. THE FOLLOWING INDIVIDUALS HAVE AN AMOUNT INCLUDED IN SCHEDULE J, PART II, COLUMN (C) FOR AN AMOUNT EARNED BUT NOT YET VESTED UNDER ONE OF PARKVIEW'S DEFERRED COMPENSATION PLANS. THE AMOUNTS ARE AT RISK AND WILL NOT BE PAID UNLESS AND UNTIL EACH EMPLOYEE HAS PROVIDED SUBSTANTIAL FUTURE SERVICES TO THE ORGANIZATION. BENEFITS UNDER THE PLANS VEST AT THE TIME SET FORTH IN THE PLAN DOCUMENTS AND ARE FORFEITED IF THE EMPLOYEES TERMINATE EMPLOYMENT BEFORE SATISFYING THOSE PLAN CONDITIONS. DEFERRALS REPORTED IN SCHEDULE J, PART II, COLUMN (C) INCLUDE: MICHAEL PACKNETT $268,732; DEBRA POTEMPA $27,767; JEANNE' WICKENS $303,865
PART I, LINE 7
MANAGEMENT INCENTIVE COMPENSATION PLAN (MICP) AND PHYSICIAN AND PROVIDER INCENTIVE COMPENSATION PLAN (PICP) ARE ANNUAL INCENTIVE PROGRAMS. SYSTEM GOALS ARE APPROVED BY THE BOARD. AT CONCLUSION OF THE PLAN YEAR, RESULTS ARE SHARED WITH THE BOARD AND THE EXECUTIVE COMMITTEE OF THE BOARD APPROVES FINAL PAYMENT.

Part I's answers as filed. A line not listed was left unanswered; on lines 1a and 3 that means the box was not checked.

Grants on this return

Related organizations on this return

Schedule R Part II: tax-exempt organizations related to the filer by control. It does not record shared board members or money.

Taxable family on this return

Schedule R Parts I, III and IV, as filed. These record ownership and control, not shared board members or money moved.

Related partnerships

Part III: related organizations taxable as a partnership, with the filer's share.

Related corporations and trusts

Part IV: related organizations taxable as a corporation or trust.

Provenance

Return type
form_990
Tax year
2022
Filed
10 November 2023
IRS schema version
2022v5.0
Source object
202313149349304516

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