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Nonprofiteer
← COMMUNITY HOSPITAL OF NOBLE COUNTY INC

Form 990 for tax year 2022

Filed by COMMUNITY HOSPITAL OF NOBLE COUNTY INC.

Totals

Total revenue
$67,835,153
Total expenses
$64,240,198
Contributions and grants received
$284,356
Grants paid
$17,309
Program service revenue
$67,333,593
Investment income
-$5,273
Other revenue
$222,477
Total assets, end of year
$52,798,533
Total liabilities, end of year
$5,541,940
Net assets or fund balances, end of year
$47,256,593
Program services expenses (Part IX)
$52,208,609
Management and general expenses
$11,958,539
Fundraising expenses
$73,050
Program service expenses (Part III)
$52,208,609

Program services were 81.3% of total expenses calculated — Part IX's program-services column over total expenses, both as filed.

Line items

Every line the filer filed in Parts VIII, IX and X, as filed and in filed order. Blank columns are left out, and the lines are not forced to add up to the totals above.

Revenue

Part VIII, the statement of revenue.

  • 1d · Related organizations

    $27,833

  • 1e · Government grants (contributions)

    $256,523

  • 1g · Noncash contributions included above

    $290

  • 2a · Program service revenue: NET PATIENT SERVICE

    total $66,521,545 · related or exempt $66,521,545

  • 2b · Program service revenue: EMS SUBSIDY

    total $595,278 · related or exempt $595,278

  • 2c · Program service revenue: INTERUNIT RENT

    total $120,982 · related or exempt $120,982

  • 2d · Program service revenue: PHARMACY

    total $48,051 · related or exempt $48,051

  • 2e · Program service revenue: HEALTH FAIR

    total $43,255 · related or exempt $43,255

  • 2f · All other program service revenue

    total $4,482 · related or exempt $4,482

  • 6a · Gross rents

    real property $23,083

  • 6b · Less rental expenses

    real property $46,377

  • 6c · Rental income or loss

    real property -$23,294

  • 6d · Net rental income or loss

    total -$23,294 · excluded -$23,294

  • 7b · Less cost or other basis and sales expenses

    other assets $5,273

  • 7c · Gain or loss

    other assets -$5,273

  • 7d · Net gain or loss

    total -$5,273 · excluded -$5,273

  • 11a · Other revenue: CAFETERIA SALES

    total $230,735 · excluded $230,735

  • 11b · Other revenue: GIFT SHOP

    total $15,036 · excluded $15,036

  • 11e · Other revenue, total

    $245,771

Functional expenses

Part IX, the statement of functional expenses.

  • 1 · Grants to domestic organizations and governments

    total $17,309 · program services $17,309

  • 5 · Compensation of officers, directors and key employees

    total $745,986 · management and general $745,986

  • 7 · Other salaries and wages

    total $17,960,399 · program services $17,960,399

  • 9 · Other employee benefits

    total $6,081,896 · program services $6,081,896

  • 11g · Fees: other

    total $7,796,940 · program services $6,995,488 · management and general $801,452

  • 12 · Advertising and promotion

    total $948 · program services $749 · management and general $199

  • 13 · Office expenses

    total $1,456,430 · program services $1,339,101 · management and general $117,329

  • 14 · Information technology

    total $27,400 · program services $27,400

  • 16 · Occupancy

    total $2,206,021 · program services $2,203,946 · management and general $2,075

  • 17 · Travel

    total $9,550 · program services $8,702 · management and general $848

  • 19 · Conferences, conventions and meetings

    total $10,614 · program services $8,697 · management and general $1,917

  • 20 · Interest

    total $7,199 · program services $7,199

  • 22 · Depreciation, depletion and amortization

    total $1,423,126 · program services $1,412,499 · management and general $10,627

  • 23 · Insurance

    total $139,626 · program services $139,626

  • 24a · Other expenses: CORP SERVICE ALLOCATION

    total $10,227,087 · management and general $10,227,087

  • 24b · Other expenses: PH CLINICAL SUPPORT

    total $7,128,906 · program services $7,128,906

  • 24c · Other expenses: MEDICAL SUPPLIES

    total $5,933,132 · program services $5,933,132

  • 24d · Other expenses: HOSPITAL ASSESSMENT FEE

    total $2,834,517 · program services $2,834,517

  • 24e · All other expenses

    total $233,112 · program services $109,043 · management and general $51,019 · fundraising $73,050

Balance sheet

Part X, book values.

  • 1 · Cash, non-interest-bearing

    beginning of year $19,563 · end of year $27,568

  • 3 · Pledges and grants receivable

    beginning of year $252,916 · end of year $0

  • 4 · Accounts receivable

    beginning of year $11,934,957 · end of year $8,813,163

  • 8 · Inventories for sale or use

    beginning of year $360,886 · end of year $363,477

  • 9 · Prepaid expenses and deferred charges

    beginning of year $17,170 · end of year $5,971

  • 10a · Land, buildings and equipment: cost or other basis

    $18,947,691

  • 10b · Land, buildings and equipment: accumulated depreciation

    $14,148,226

  • 10c · Land, buildings and equipment, net

    beginning of year $4,632,945 · end of year $4,799,465

  • 15 · Other assets

    beginning of year $35,241,222 · end of year $38,788,889

  • 17 · Accounts payable and accrued expenses

    beginning of year $2,094,188 · end of year $2,336,516

  • 19 · Deferred revenue

    beginning of year $3,177,783 · end of year $0

  • 25 · Other liabilities

    beginning of year $3,920,461 · end of year $3,205,424

  • 27 · Net assets without donor restrictions

    beginning of year $43,267,227 · end of year $47,256,593

Mission and programs · 2022

Mission

COMMUNITY HOSPITAL OF NOBLE COUNTY, INC. WORKS TO IMPROVE THE HEALTH OF OUR COMMUNITIES AND PROVIDES QUALITY HEALTH SERVICES TO ALL WHO ENTRUST THEIR CARE TO US.

Activities or mission (Part I)

IMPROVE HEALTH & PROVIDE QUALITY HEALTH SERVICES TO ALL WHO ENTRUST THEIR CARE TO US.

  • AS A NOT-FOR-PROFIT HOSPITAL, WE FOCUS ON OUR MISSION TO IMPROVE THE HEALTH OF THE COMMUNITIES WE SERVE AND TO PROVIDE A PERSONALIZED WELLNESS JOURNEY. COMMUNITY HOSPITAL OF NOBLE COUNTY, INC. EXISTS FOR ONE PURPOSE - TO IMPROVE THE HEALTH OF OUR COMMUNITIES. COMMUNITY HOSPITAL OF NOBLE COUNTY, INC. GIVES BACK TO THE COMMUNITY IN THE FORM OF IMPROVED FACILITIES, EDUCATION AND OUTREACH PROGRAMS, FREE AND DISCOUNTED CARE, VOLUNTEERISM AND MUCH MORE. PARKVIEW CONDUCTS A COMMUNITY HEALTH NEEDS ASSESSMENT ON A REGULAR BASIS TO IDENTIFY HEALTH NEEDS WITHIN NORTHEAST INDIANA, PARTICULARLY, IN THE FIVE COUNTIES IN WHICH OUR HOSPITALS EXIST.(SEE SCHEDULE O FOR CONTINUATION)THE FOLLOWING ARE SOME OF THE WAYS COMMUNITY HOSPITAL OF NOBLE COUNTY, INC. IS REACHING OUT TO MAKE OUR NEIGHBORHOODS AND COMMUNITIES HEALTHIER:-FINANCIAL ASSISTANCE-COMMUNITY HEALTH IMPROVEMENT INITIATIVES-PRIMARY HEALTHCARE /ACCESS-HEALTH SCREENINGS AND PREVENTION-DISEASE MANAGEMENT-HEALTH EDUCATIONFINANCIAL ASSISTANCE:COMMUNITY HOSPITAL OF NOBLE COUNTY, INC.'S MISSION INCLUDES CARING FOR PEOPLE WHO DO NOT HAVE THE MEANS TO MEET THEIR FINANCIAL OBLIGATIONS. THE HOSPITAL PLACES ITS PRIORITY ON PROVIDING THE NECESSARY CARE, NOT ON THE PATIENT'S ABILITY TO PAY FOR THEIR MEDICAL EXPENSES.COMMUNITY HEALTH IMPROVEMENT INITIATIVES:THE PURPOSE OF COMMUNITY HOSPITAL OF NOBLE COUNTY, INC.'S COMMUNITY HEALTH IMPROVEMENT PROGRAM IS TO FUND COMMUNITY HEALTH IMPROVEMENT EFFORTS WITHIN THE SERVICE AREA OF COMMUNITY HOSPITAL OF NOBLE COUNTY, INC. THE HOSPITAL SETS ASIDE A PORTION OF ITS NET INCOME ANNUALLY TO FUND COMMUNITY HEALTH INITIATIVES AND PARTNERS WITH COMMUNITY ORGANIZATIONS TO ENCOURAGE HEALTHIER LIFESTYLES AMONG THE CITIZENS OF NORTHEAST INDIANA. SOME OF THESE INITIATIVES AND PROGRAMS ARE HIGHLIGHTED BELOW.CENTER FOR HEALTHY LIVING SUPPORTED BY THE COMMUNITY HEALTH IMPROVEMENT MANAGER: COMMUNITY HOSPITAL OF NOBLE COUNTY, INC. OFFERS A CENTER FOR HEALTHY LIVING WHERE THE COMMUNITY CAN ACCESS COOKING DEMONSTRATIONS, DIABETES EDUCATION, HEALTH BEHAVIOR CHANGE PROGRAMS, REDUCED COST BLOOD DRAWS, AND PROFESSIONAL LECTURES ON HEALTH/WELLNESS. THE COMMUNITY HEALTH IMPROVEMENT MANAGER IS INSTRUMENTAL IN THE IMPLEMENTATION OF KEY STRATEGIES AS IDENTIFIED BY OUR COMMUNITY HEALTH NEEDS ASSESSMENT - OBESITY, MENTAL HEALTH AND DRUG ABUSE AT THE PARKVIEW NOBLE CENTER FOR HEALTHY LIVING - COMMUNITY LEARNING CENTER LOCATION. ALL PROGRAMS AND SERVICES ARE OFFERED FREE, AT LOWER COST, OR SCHOLARSHIPS ARE PROVIDED; NO ONE IS TURNED AWAY FOR INABILITY TO PAY. MANY OF THE PROGRAMS TARGETED OBESITY AND OVERALL WELLNESS. THE MANAGER CONTINUES TO PROMOTE AND MANAGE THE MY BEST HEALTH PROGRAM WHICH HAS THE GOAL TO PREVENT, ARREST AND REVERSE CHRONIC DISEASE SUCH AS OBESITY. COMMUNITY HEALTH IMPROVEMENT MANAGER: COMMUNITY HOSPITAL OF NOBLE COUNTY, INC.'S COMMUNITY HEALTH IMPROVEMENT MANAGER PARTNERS WITH VARIOUS COMMUNITY ORGANIZATIONS AND NON-PROFITS TO BENEFIT THE OVERALL COMMUNITY. THE COMMUNITY HEALTH IMPROVEMENT MANAGER IS INVOLVED WITH MONTHLY COMMUNITY LEARNING CENTER LEADERSHIP MEETINGS. THESE LEADERSHIP MEETINGS BRING VARIOUS LEADERS ACROSS THE COUNTY TOGETHER TO COLLABORATE ON COMMUNITY NEEDS INCLUDING BUT NOT LIMITED TO OVERALL HEALTH, EDUCATION AND ECONOMY. THE GROUP COLLABORATES TO MEET COMMUNITY NEEDS TOGETHER AND ELIMINATES EACH ORGANIZATION WORKING ON THEIR OWN TOWARDS THE SAME ISSUE. THE COMMUNITY HEALTH IMPROVEMENT MANAGER IS ALSO INVOLVED IN VARIOUS OTHER COALITIONS AND COMMUNITY PARTNERSHIPS SUCH AS THRIVE BY 5, WORKING TOWARDS INCREASING CHILDCARE SPACES IN NOBLE COUNTY; ACTIVATE NOBLE COUNTY, WORKING TO INCREASE ACCESS TO EXERCISE OPPORTUNITIES AND REDUCE FOOD INSECURITY; NOBLE COUNTY SUICIDE PREVENTION BOARD AND COALITION, WORKING TO REDUCE SUICIDE RATES IN NOBLE COUNTY; NOBLE COUNTY MENTAL HEALTH COLLABORATIVE, WORKING TO BECOME A CERTIFIED CRISIS INTERVENTION TEAM AND IDENTIFY OPPORTUNITIES TO BETTER SERVE OUR COMMUNITY ACROSS MULTIPLE INTERCEPTS OF CRIMINAL JUSTICE SYSTEMS AND HEALTHCARE, AND VARIOUS OTHERS. THE COMMUNITY HEALTH IMPROVEMENT MANAGER ALSO IDENTIFIES, DEVELOPS, IMPLEMENTS AND EVALUATES ALL COMMUNITY PROGRAMS OFFERED THROUGH THE CENTER FOR HEALTHY LIVING, INCLUDING NUTRITION EDUCATION, HEALTH SCREENINGS AND VARIOUS OTHER ACTIVITIES. COMMUNITY PARTNERSHIPS: COMMUNITY HOSPITAL OF NOBLE COUNTY, INC. INVESTS IN VARIOUS WAYS IN KEY ORGANIZATIONS (HEALTH PARTNERS) THAT ENCOURAGE HEALTHIER LIFESTYLES AMONG THE CITIZENS OF NOBLE COUNTY AND NORTHEAST INDIANA. WE PARTNER WITH THE COLE CENTER FAMILY YMCA ON MULTIPLE PROJECTS TO ENCOURAGE HEALTHIER LIFESTYLES INCLUDING SCHOLARSHIPS TO THE YMCA AND A BLOOD PRESSURE SELF-MONITORING PROGRAM. TO ASSIST THOSE LESS FORTUNATE, WE SUPPORT ST. MARTIN'S HEALTHCARE AND NOBLE HOUSE MINISTRIES. WE ALSO PARTNER WITH THE NOBLE COUNTY HEALTH DEPARTMENT TO PROVIDE IMMUNIZATIONS TO CHILDREN WHO OTHERWISE COULD NOT ACCESS THEM. TO ENCOURAGE HIGHER PAYING JOBS AND ECONOMIC IMPROVEMENT, WE PARTNER WITH THE NOBLE COUNTY ECONOMIC DEVELOPMENT CORPORATION. TO ASSIST IN HEALTH EDUCATION IN OUR SCHOOL DISTRICTS, WE PARTNER WITH MCMILLEN HEALTH TO PROVIDE EVIDENCE-BASED EDUCATION OVER OBESITY, TOBACCO USE, DRUG USE AND MENTAL HEALTH TO AREA SCHOOLS. OTHER PARTNERS ACTIVE IN ADDRESSING MEDICAL ISSUES INCLUDE ACTIVATE NOBLE COUNTY AND THE COMMUNITY LEARNING CENTER. ACTIVATE NOBLE COUNTY: THIS ORGANIZATION IS A TRUE COMMUNITY PARTNERSHIP WITH MANY ORGANIZATIONS INCLUDING COMMUNITY HOSPITAL OF NOBLE COUNTY, INC., THE COLE CENTER FAMILY YMCA, COMMUNITY LEARNING CENTER, PARKS AND RECREATION AND LOCAL GOVERNMENT. THE MISSION IS "TO IMPROVE THE HEALTH AND WELLNESS OF NOBLE COUNTY BY INCREASING OPPORTUNITIES FOR HEALTHY EATING AND ACTIVE LIVING." THE GROUP HAS BEEN THE CENTRAL PARTNERSHIP TO ESTABLISH COMMUNITY GOALS AROUND THE COMMUNITY HEALTH NEEDS ESTABLISHED FROM OUR ASSESSMENT: MENTAL HEALTH/DRUG ABUSE AND OBESITY. THE GROUP MEETS MONTHLY WORKING COLLABORATIVELY TO ESTABLISH PROGRAMS, GUIDELINES AND TO MAKE IMPROVEMENTS TO KEY METRICS FROM THE ASSESSMENT PLAN AND HAS ESTABLISHED SOCIAL MEDIA PLATFORMS TO INCREASE ENGAGEMENT AND ACTION AMONG THE COMMUNITY. ACTIVATE NOBLE COUNTY ALSO IS AN INSTRUMENTAL PART IN POLICY CHANGE IN NOBLE COUNTY. THE GROUP HAS STARTED CONVERSATION AND GAINED MOMENTUM AROUND WALKABILITY AND BIKE ABILITY IN NOBLE COUNTY. THE GROUP LED THE EFFORT FOR PARKLETS TO BE INSTALLED IN ONE OF NOBLE COUNTY'S DOWNTOWNS TO PROVIDE A DESTINATION THAT ENCOURAGES WALKING. THE GROUP ALSO GROWS AND MAINTAINS A COMMUNITY GARDEN WITH THE COMMUNITY LEARNING CENTER TO HELP INCREASE ACCESS TO FRESH, AFFORDABLE PRODUCE. PRIMARY HEALTHCARE/ACCESS:MEDICATION ASSISTANCE PROGRAM (MAP): COMMUNITY HOSPITAL OF NOBLE COUNTY, INC. MAINTAINS A MEDICATION ASSISTANCE PROGRAM FOR NOBLE COUNTY RESIDENTS. MAP PARTNERS WITH PATIENTS, PHYSICIANS, PHARMACEUTICAL COMPANIES, AND DONORS TO PROVIDE MEDICATION ASSISTANCE AT LITTLE OR NO COST FOR QUALIFIED INDIVIDUALS. FOR ACUTE MEDICATION NEEDS, MEDICATIONS ARE PROVIDED BY PARKVIEW PHARMACY AT NO COST TO THE PATIENT. LONG-TERM MEDICATION HELP IS PROVIDED THROUGH CONNECTING CLIENTS WITH PHARMACEUTICAL ASSISTANCE PROGRAMS (PAP) AND COPAY ASSISTANCE PROGRAMS. HEALTH SCREENING AND DISEASE PREVENTION AND MANAGEMENT:HEALTH SCREENINGS AND SUPPORT GROUPS: COMMUNITY HOSPITAL OF NOBLE COUNTY, INC. OFFERS NUMEROUS HEALTH SCREENINGS THROUGHOUT THE YEAR THAT ARE DESIGNED TO PROVIDE HEALTH SCREENINGS FOR DISEASE PREVENTION AT A REDUCED COST AND THE PROMOTION OF HEALTHY LIFESTYLES. THE HOSPITAL ALSO PROVIDES SUPPORT GROUPS FOR INDIVIDUALS WHO EXPERIENCE DIABETES, PARKINSON'S AND STROKE TO ASSIST PATIENTS AND FAMILIES IN MANAGING DISEASE.COMMUNITY HOSPITAL OF NOBLE COUNTY, INC. RECEIVED THE FOLLOWING AWARDS IN 2022 FOR THEIR DEDICATED WORK TO THE PATIENTS AND COMMUNITY THEY SERVE: -THE CHARTIS CENTER FOR RURAL HEALTH PERFORMANCE LEADERSHIP AWARD-IHA INSPIRE HOSPITAL OF DISTINCTION -LEAPFROG A-FORTUNE/MERATIVE 100 TOP HOSPITALS (NO. 5 SMALL COMMUNITY HOSPITAL IN THE COUNTRY)

    Expenses $52,208,609 · Grants $17,309 · Revenue $67,333,593

As filed on the 2022 return. The filer continues this part on Schedule O, which is not shown here.

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

  • MYCAL MANSFIELD

    DIRECTOR/PH PHYSICIAN

    Total calculated
    $575,802
    From this org
    $7,803
    From related orgs
    $502,222
    Other
    $65,777
    Hours/week
    0 + 40 related

    Schedule J breakdown matched by us

    Base
    $7,803 + $382,718 related
    Bonus
    $0 + $94,514 related
    Other
    $0 + $24,990 related
    Deferred
    $420 + $27,030 related
    Nontaxable benefits
    $586 + $37,741 related
    Filer's total
    $8,809 + $566,993 related

  • ELIZABETH HERBER

    DIRECTOR/PH PHYSICIAN

    Total calculated
    $465,614
    From this org
    $11,898
    From related orgs
    $412,218
    Other
    $41,498
    Hours/week
    0 + 40 related

    Schedule J breakdown matched by us

    Base
    $11,898 + $405,130 related
    Bonus
    $0 + $750 related
    Other
    $0 + $6,338 related
    Deferred
    $599 + $20,751 related
    Nontaxable benefits
    $565 + $19,583 related
    Filer's total
    $13,062 + $452,552 related

  • GARY ADKINS

    DIRECTOR/NBHOS PRESIDENT

    Total calculated
    $465,522
    From this org
    $376,298
    From related orgs
    $0
    Other
    $89,224
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $225,609
    Bonus
    $87,378
    Other
    $63,311
    Deferred
    $59,715
    Nontaxable benefits
    $29,509
    Filer's total
    $465,522

  • DOUGLAS SCOTT

    DIRECTOR

    Total calculated
    $20,200
    From this org
    $20,200
    From related orgs
    $0
    Other
    $0
    Hours/week
    1

  • THOMAS LEEDY

    DIRECTOR/TREASURER

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

  • GEORGE BENNETT

    DIRECTOR/CHAIR

    Total calculated
    $9,500
    From this org
    $6,750
    From related orgs
    $2,750
    Other
    $0
    Hours/week
    1 + 1 related

  • CHRISTOPHER FOUGHT

    DIRECTOR

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

  • SUSAN JANSEN

    DIRECTOR

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

  • JARROD RAMER

    DIRECTOR/SECRETARY

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

  • GARY GATMAN

    DIRECTOR/VICE CHAIR

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

  • KARA WARRENER

    DIRECTOR

    Total calculated
    $4,750
    From this org
    $4,750
    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

  • ERIN GOLDSBERRY

    NBHOS VP PAT CARE/PVHOS VP PAT CARE

    Total calculated
    $276,753
    From this org
    $173,813
    From related orgs
    $58,690
    Other
    $44,250
    Hours/week
    31 + 9 related

    Schedule J breakdown matched by us

    Base
    $124,291 + $42,797 related
    Bonus
    $49,106 + $15,750 related
    Other
    $416 + $143 related
    Deferred
    $9,555 + $3,226 related
    Nontaxable benefits
    $23,525 + $7,944 related
    Filer's total
    $206,893 + $69,860 related

  • KELLY BALYEAT

    NBHOS MGR PHARMACY

    Total calculated
    $243,669
    From this org
    $199,289
    From related orgs
    $0
    Other
    $44,380
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $171,628
    Bonus
    $27,295
    Other
    $366
    Deferred
    $14,532
    Nontaxable benefits
    $29,848
    Filer's total
    $243,669

  • JENNIFER PERKINS

    NBHOS HOUSE SPV

    Total calculated
    $199,658
    From this org
    $155,527
    From related orgs
    $0
    Other
    $44,131
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $154,777
    Bonus
    $750
    Other
    $0
    Deferred
    $19,603
    Nontaxable benefits
    $24,528
    Filer's total
    $199,658

  • GARY HEIMAN

    NBHOS PARAMEDIC

    Total calculated
    $172,067
    From this org
    $140,859
    From related orgs
    $8,227
    Other
    $22,981
    Hours/week
    38 + 2 related

    Schedule J breakdown matched by us

    Base
    $139,105 + $8,168 related
    Bonus
    $750
    Other
    $1,004 + $59 related
    Deferred
    $6,265 + $366 related
    Nontaxable benefits
    $15,448 + $902 related
    Filer's total
    $162,572 + $9,495 related

  • RICHARD LARIMORE

    NBHOS MGR SUPPORT SVCS

    Total calculated
    $171,501
    From this org
    $148,701
    From related orgs
    $0
    Other
    $22,800
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $127,237
    Bonus
    $19,821
    Other
    $1,643
    Deferred
    $10,370
    Nontaxable benefits
    $12,430
    Filer's total
    $171,501

  • JULIE DESPER

    NBHOS MGR REHAB

    Total calculated
    $188,412
    From this org
    $131,314
    From related orgs
    $12,992
    Other
    $44,106
    Hours/week
    36 + 4 related

    Schedule J breakdown matched by us

    Base
    $110,937 + $12,932 related
    Bonus
    $19,863
    Other
    $514 + $60 related
    Deferred
    $16,298 + $1,613 related
    Nontaxable benefits
    $23,837 + $2,358 related
    Filer's total
    $171,449 + $16,963 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 $59,976; 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: GARY ADKINS $38,365; MICHAEL PACKNETT $268,732; 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

No itemized grants to organizations 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
9 November 2023
IRS schema version
2022v5.0
Source object
202313139349305071

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