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← COMMUNITY HOSPITAL OF NOBLE COUNTY INC

Form 990 for tax year 2023

Filed by COMMUNITY HOSPITAL OF NOBLE COUNTY INC.

Totals

Total revenue
$75,588,691
Total expenses
$67,082,561
Contributions and grants received
$708,707
Grants paid
$34,004
Program service revenue
not reported
Investment income
not reported
Other revenue
not reported
Total assets, end of year
not reported
Total liabilities, end of year
not reported
Net assets or fund balances, end of year
not reported
Program services expenses (Part IX)
$54,117,235
Management and general expenses
$12,965,326
Fundraising expenses
$0
Program service expenses (Part III)
$54,117,235

Program services were 80.7% of total expenses calculated — Part IX's program-services column over total expenses, both as filed.

Listed in Part VII

  • MYCAL MANSFIELD

    DIRECTOR/PH PHYSICIAN

    Total calculated
    $583,105
    From this org
    $7,545
    From related orgs
    $506,713
    Other
    $68,847
    Hours/week
    1 + 39 related

    Schedule J breakdown matched by us

    Base
    $7,545 + $405,380 related
    Bonus
    $0 + $73,343 related
    Other
    $0 + $27,990 related
    Deferred
    $436 + $29,264 related
    Nontaxable benefits
    $574 + $38,573 related
    Filer's total
    $8,555 + $574,550 related

  • ELIZABETH HERBER

    DIRECTOR/PH PHYSICIAN

    Total calculated
    $489,213
    From this org
    $11,955
    From related orgs
    $437,438
    Other
    $39,820
    Hours/week
    1 + 39 related

    Schedule J breakdown matched by us

    Base
    $11,955 + $416,831 related
    Bonus
    $0
    Other
    $0 + $20,607 related
    Deferred
    $615 + $22,485 related
    Nontaxable benefits
    $445 + $16,275 related
    Filer's total
    $13,015 + $476,198 related

  • GARY ADKINS

    DIRECTOR/PARTIAL YR/MARKET PRESIDENT

    Total calculated
    $283,567
    From this org
    $204,743
    From related orgs
    $51,681
    Other
    $27,143
    Hours/week
    26 + 14 related

    Schedule J breakdown matched by us

    Base
    $118,091 + $51,681 related
    Bonus
    $47,584
    Other
    $39,068
    Deferred
    $5,320 + $1,344 related
    Nontaxable benefits
    $16,352 + $4,127 related
    Filer's total
    $226,415 + $57,152 related

  • JORDI DISLER

    DIRECTOR/MARKET PRESIDENT

    Total calculated
    $455,165
    From this org
    $95,143
    From related orgs
    $246,106
    Other
    $113,916
    Hours/week
    14 + 26 related

    Schedule J breakdown matched by us

    Base
    $94,878 + $164,643 related
    Bonus
    $0 + $45,941 related
    Other
    $265 + $35,522 related
    Deferred
    $23,702 + $61,310 related
    Nontaxable benefits
    $8,059 + $20,845 related
    Filer's total
    $126,904 + $328,261 related

  • DOUGLAS SCOTT

    DIRECTOR/NBHOS CONTRACTED PHYSICIAN

    Total calculated
    $16,500
    From this org
    $16,500
    From related orgs
    $0
    Other
    $0
    Hours/week
    1

  • THOMAS LEEDY

    DIRECTOR/TREASURER

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

  • CHRISTOPHER FOUGHT

    DIRECTOR

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

  • SUSAN JANSEN

    DIRECTOR/SECRETARY

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

  • CASEY MYERS

    DIRECTOR

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

  • JARROD RAMER

    DIRECTOR/VICE CHAIR

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

  • GARY GATMAN

    DIRECTOR/CHAIR

    Total calculated
    $7,000
    From this org
    $5,000
    From related orgs
    $2,000
    Other
    $0
    Hours/week
    1 + 1 related

  • KARA WARRENER

    DIRECTOR

    Total calculated
    $4,250
    From this org
    $4,250
    From related orgs
    $0
    Other
    $0
    Hours/week
    1

  • GREG JOHNSON

    DIRECTOR/REGIONAL MARKET PRESIDENT

    Total calculated
    $1,077,497
    From this org
    $0
    From related orgs
    $888,491
    Other
    $189,006
    Hours/week
    1 + 39 related

    Schedule J breakdown matched by us

    Base
    $0 + $681,591 related
    Bonus
    $0 + $112,796 related
    Other
    $0 + $94,104 related
    Deferred
    $0 + $155,300 related
    Nontaxable benefits
    $0 + $33,706 related
    Filer's total
    $0 + $1,077,497 related

  • JEANNE' WICKENS

    PH CHIEF FINANCIAL OFFICER

    Total calculated
    $2,443,396
    From this org
    $0
    From related orgs
    $2,165,508
    Other
    $277,888
    Hours/week
    1 + 39 related

    Schedule J breakdown matched by us

    Base
    $0 + $834,975 related
    Bonus
    $0 + $187,034 related
    Other
    $0 + $1,143,499 related
    Deferred
    $0 + $239,228 related
    Nontaxable benefits
    $0 + $38,660 related
    Filer's total
    $0 + $2,443,396 related

  • HEATHER STANLEY

    NBHOS VP PATIENT CARE SVCS

    Total calculated
    $226,219
    From this org
    $183,612
    From related orgs
    $0
    Other
    $42,607
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $162,356
    Bonus
    $9,368
    Other
    $11,888
    Deferred
    $17,402
    Nontaxable benefits
    $25,205
    Filer's total
    $226,219

  • KELLY BALYEAT

    NBHOS MGR PHARMACY

    Total calculated
    $258,675
    From this org
    $209,675
    From related orgs
    $0
    Other
    $49,000
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $193,497
    Bonus
    $14,908
    Other
    $1,270
    Deferred
    $19,604
    Nontaxable benefits
    $29,396
    Filer's total
    $258,675

  • JENNIFER PERKINS

    NBHOS HOUSE SPV

    Total calculated
    $206,768
    From this org
    $162,288
    From related orgs
    $0
    Other
    $44,480
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $161,553
    Bonus
    $485
    Other
    $250
    Deferred
    $20,270
    Nontaxable benefits
    $24,210
    Filer's total
    $206,768

  • GARY HEIMAN

    NBHOS PARAMEDIC

    Total calculated
    $169,093
    From this org
    $119,073
    From related orgs
    $27,164
    Other
    $22,856
    Hours/week
    36 + 4 related

    Schedule J breakdown matched by us

    Base
    $116,383 + $27,164 related
    Bonus
    $500
    Other
    $2,190
    Deferred
    $5,439 + $1,241 related
    Nontaxable benefits
    $13,171 + $3,005 related
    Filer's total
    $137,683 + $31,410 related

  • JULIE DESPER

    NBHOS MGR REHAB

    Total calculated
    $185,349
    From this org
    $129,741
    From related orgs
    $12,908
    Other
    $42,700
    Hours/week
    36 + 4 related

    Schedule J breakdown matched by us

    Base
    $118,450 + $12,908 related
    Bonus
    $9,939
    Other
    $1,352
    Deferred
    $16,012 + $1,593 related
    Nontaxable benefits
    $22,824 + $2,271 related
    Filer's total
    $168,577 + $16,772 related

  • HEATHER ANTAL

    NBHOS MGR NURSING SVCS

    Total calculated
    $185,525
    From this org
    $142,041
    From related orgs
    $0
    Other
    $43,484
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $125,800
    Bonus
    $14,612
    Other
    $1,629
    Deferred
    $17,643
    Nontaxable benefits
    $25,841
    Filer's total
    $185,525

  • MICHAEL PACKNETT

    FORMER OFFICER/RETIRED PH CEO

    Total calculated
    $5,063,462
    From this org
    $0
    From related orgs
    $5,034,209
    Other
    $29,253
    Hours/week
    0

    Schedule J breakdown matched by us

    Base
    $0 + $66,747 related
    Bonus
    $0 + $351,881 related
    Other
    $0 + $4,615,581 related
    Deferred
    $0 + $26,400 related
    Nontaxable benefits
    $0 + $2,853 related
    Filer's total
    $0 + $5,063,462 related

  • ERIN GOLDSBERRY

    FORMER KEY EMPLOYEE/CURRENT PVHOS VP

    Total calculated
    $262,591
    From this org
    $0
    From related orgs
    $224,478
    Other
    $38,113
    Hours/week
    0 + 40 related

    Schedule J breakdown matched by us

    Base
    $0 + $194,352 related
    Bonus
    $0 + $28,500 related
    Other
    $0 + $1,626 related
    Deferred
    $0 + $12,723 related
    Nontaxable benefits
    $0 + $25,390 related
    Filer's total
    $0 + $262,591 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

  • 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 3
RELATED ORGANIZATION, PARKVIEW HEALTH SYSTEM, INC., USES THE FOLLOWING TO ESTABLISH THE COMPENSATION OF COMMUNITY HOSPITAL OF NOBLE COUNTY, 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): GARY ADKINS $35,945; JORDI DISLER $33,035; 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: JORDI DISLER $ 47,600; 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.

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
2023
Filed
5 November 2024
IRS schema version
2023v5.1
Source object
202403109349301995

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