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← COMMUNITY HOSPITAL OF NOBLE COUNTY FOUNDATION INC

Form 990 for tax year 2022

Filed by COMMUNITY HOSPITAL OF NOBLE COUNTY FOUNDATION INC.

Totals

Total revenue
$176,662
Total expenses
$162,234
Contributions and grants received
$66,267
Grants paid
$89,833
Program service revenue
$73,050
Investment income
$37,345
Other revenue
$0
Total assets, end of year
$2,296,900
Total liabilities, end of year
$1,000
Net assets or fund balances, end of year
$2,295,900
Program services expenses (Part IX)
$90,934
Management and general expenses
$70,655
Fundraising expenses
$645
Program service expenses (Part III)
$90,934

Program services were 56.1% 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

    $1,811

  • 1e · Government grants (contributions)

    $50

  • 1f · All other contributions, gifts and grants

    $64,406

  • 1g · Noncash contributions included above

    $290

  • 2a · Program service revenue: FNDRSNG SER ALLOCATION

    total $73,050 · related or exempt $73,050

  • 3 · Investment income

    total $31,315 · excluded $31,315

  • 7a · Gross sales of assets other than inventory

    securities $6,720,835

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

    securities $6,714,805

  • 7c · Gain or loss

    securities $6,030

  • 7d · Net gain or loss

    total $6,030 · excluded $6,030

Functional expenses

Part IX, the statement of functional expenses.

  • 1 · Grants to domestic organizations and governments

    total $87,833 · program services $87,833

  • 2 · Grants to domestic individuals

    total $2,000 · program services $2,000

  • 7 · Other salaries and wages

    total $1,648 · program services $741 · management and general $577 · fundraising $330

  • 9 · Other employee benefits

    total $578 · program services $260 · management and general $202 · fundraising $116

  • 11f · Fees: investment management

    total $4,894 · management and general $4,894

  • 13 · Office expenses

    total $520 · program services $81 · management and general $281 · fundraising $158

  • 17 · Travel

    total $48 · program services $12 · management and general $29 · fundraising $7

  • 22 · Depreciation, depletion and amortization

    total $75 · program services $7 · management and general $34 · fundraising $34

  • 24a · Other expenses: CORPORATE SERVICE ALLOC

    total $64,638 · management and general $64,638

Balance sheet

Part X, book values.

  • 2 · Savings and temporary cash investments

    beginning of year $42,083 · end of year $14,235

  • 3 · Pledges and grants receivable

    beginning of year $11,042 · end of year $4,900

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

    $17,277

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

    $17,165

  • 10c · Land, buildings and equipment, net

    beginning of year $187 · end of year $112

  • 11 · Investments: publicly traded securities

    beginning of year $2,022,593 · end of year $1,696,146

  • 15 · Other assets

    beginning of year $488,384 · end of year $581,507

  • 17 · Accounts payable and accrued expenses

    beginning of year $72 · end of year $1,000

  • 27 · Net assets without donor restrictions

    beginning of year $1,694,027 · end of year $1,487,372

  • 28 · Net assets with donor restrictions

    beginning of year $870,190 · end of year $808,528

Mission and programs · 2022

Mission

TO SERVE AS THE PRIMARY FUNDRAISING ENTITY FOR COMMUNITY HOSPITAL OF NOBLE COUNTY, INC. FUNDS ARE USED FOR THE CONTINUED IMPROVEMENT OF THE HOSPITAL'S FACILITIES, EQUIPMENT, PROGRAMS & SERVICES IN ACCORDANCE WITH THE NEEDS OF THE COMMUNITY WHERE THE HOSPITAL IS LOCATED.

Activities or mission (Part I)

TO SERVE AS THE PRIMARY FUNDRAISING ENTITY FOR COMMUNITY HOSPITAL OF NOBLE COUNTY, INC.

  • THE MISSION OF THE PARKVIEW FOUNDATIONS IS TO INSPIRE THE GENEROUS SPIRIT OF OUR COMMUNITY THAT BRINGS GIFTS OF HEALING AND COMFORT TO EVERYONE PARKVIEW SERVES.THE COMMUNITY HOSPITAL OF NOBLE COUNTY FOUNDATION, INC., D.B.A. PARKVIEW NOBLE FOUNDATION, ADHERES TO THIS MISSION. THE FOUNDATION RAISES FUNDS TO SUPPORT NEW PROGRAMS AND SERVICES, EDUCATIONAL NEEDS, AND INNOVATIVE TECHNOLOGY FOR THE COMMUNITY HOSPITAL OF NOBLE COUNTY, INC., D.B.A. PARKVIEW NOBLE HOSPITAL, WITH THE ULTIMATE GOAL OF ENABLING THIS COMMUNITY HOSPITAL TO PROVIDE THE "ABOVE AND BEYOND" CARE AND SERVICES THAT WOULD NOT BE POSSIBLE WITHOUT THE SUPPORT OF PARKVIEW NOBLE FOUNDATION DONORS. (SEE SCHEDULE O FOR CONTINUATION)THE GIFTS RECEIVED IN 2022 BY PARKVIEW NOBLE FOUNDATION WERE DESIGNATED TO TEMPORARILY RESTRICTED OR UNRESTRICTED FUNDS, ACCORDING TO DONOR WISHES, AND WERE USED FOR A NUMBER OF MISSION-DRIVEN PURPOSES THAT TOUCHED THE LIVES OF PARKVIEW NOBLE HOSPITAL PATIENTS AND THEIR FAMILIES IN NUMEROUS WAYS. THE FOLLOWING ARE EXAMPLES OF PARKVIEW NOBLE FOUNDATION PROVIDING FUNDING TO PARKVIEW NOBLE HOSPITAL FOR VARIOUS HOSPITAL PROGRAMS, SERVICES, EQUIPMENT, AND IMPROVEMENTS:-THE SPECIAL TOUCH FUND PROVIDED A TENS/NMES UNIT FOR A PATIENT WHO SUFFERED CVA. THIS DEVICE IS BASICALLY AN E-STIM UNIT THAT WILL HELP RETRAIN MUSCLES IN THE ARM AND HAND OUTSIDE OF THERAPY. THIS EQUIPMENT WAS NOT COVERED UNDER THE PATIENT'S INSURANCE AND WAS NEEDED TO HELP WITH RECOVERY. THE SPECIAL TOUCH FUND ALSO PROVIDED A SPECIAL CHAIR FOR A PATIENT WITH COPD AND CHF. THIS CHAIR WILL ALLOW THE PATIENT TO BREATHE EASIER.-THE CO-WORKER EMERGENCY FUND ASSISTED CO-WORKERS FACING EMERGENCIES SUCH AS A HEALTH EMERGENCY, DOMESTIC VIOLENCE OR OTHER LIFE CRISIS. THIS FUND PROVIDED PAYMENTS FOR RENT, UTILITIES AND ADDRESSED FOOD INSECURITY.-THE NURSING EDUCATION FUND PROVIDED CERTIFICATION TRAINING FOR THREE NURSES PURSUING ADVANCED TRAINING AND EDUCATION IN SPECIALTY AREAS.-SCHOLARSHIP FUNDS PROVIDED TEAM MEMBERS FINANCIAL ASSISTANCE AS THEY PURSUED THEIR NURSING/MEDICAL CAREER.-MEDICATION ASSISTANCE PROGRAM PROVIDED PATIENTS WITH HELP PAYING FOR PRESCRIPTIONS NECESSARY FOR DISCHARGE.-DIABETES EDUCATION SUPPLIES FOR PATIENTS.-THE FAMILY BIRTHING CENTER WAS PROVIDED NEW LABOR GUIDES AND BIRTHING POSTERS FOR PATIENT EDUCATION. THEY WERE ALSO PROVIDED WITH PACK N PLAY FITTED CRIBS FOR PATIENT USE.-THE FOUNDATION FUNDED SERVICES PROVIDED BY PARKVIEW HOME HEALTH AND HOSPICE TO NOBLE COUNTY RESIDENTS. THESE SERVICES INCLUDED MASSAGES FOR PATIENTS, EDUCATIONAL MATERIALS AND BEREAVEMENT GROUPS ASSISTED FAMILIES FACING GRIEF AND LOSS.-THE GREATEST NEED FUND PROVIDED EQUIPMENT AND EDUCATION FOR PATIENTS IN 2022. SOME ITEMS THAT WERE PROVIDED INCLUDE SHOWER CHAIRS FOR THE MEDICAL/SURGICAL UNIT, BLANKET WARMER FOR THE WOUND CLINIC, FURNITURE FOR THE ATU CLINIC, REMOTE CONTROLS FOR VISUALLY IMPAIRED PATIENTS, KNEE ROLLERS FOR WOUND CLINIC, AND A DRY NEEDLING TRAINING COURSE.

    Expenses $90,934 · Grants $89,833 · Revenue $73,050

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

Listed in Part VII

  • Dena Jacquay

    DIRECTOR/PH CHIEF ADMIN OFFICER

    Total calculated
    $1,193,028
    From this org
    $0
    From related orgs
    $908,033
    Other
    $284,995
    Hours/week
    0 + 40 related

    Schedule J breakdown matched by us

    Base
    $0 + $648,964 related
    Bonus
    $0 + $217,050 related
    Other
    $0 + $42,019 related
    Deferred
    $0 + $239,919 related
    Nontaxable benefits
    $0 + $45,076 related
    Filer's total
    $0 + $1,193,028 related

  • Gary Adkins

    DIRECTOR/NBHOS PRESIDENT

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

    Schedule J breakdown matched by us

    Base
    $0 + $225,609 related
    Bonus
    $0 + $87,378 related
    Other
    $0 + $63,311 related
    Deferred
    $0 + $59,715 related
    Nontaxable benefits
    $0 + $29,509 related
    Filer's total
    $0 + $465,522 related

  • Erin Goldsberry

    DIRECTOR-PARTIAL YR/PVHOS VP PAT SVR

    Total calculated
    $276,753
    From this org
    $0
    From related orgs
    $232,503
    Other
    $44,250
    Hours/week
    0 + 40 related

    Schedule J breakdown matched by us

    Base
    $0 + $167,088 related
    Bonus
    $0 + $64,856 related
    Other
    $0 + $559 related
    Deferred
    $0 + $12,781 related
    Nontaxable benefits
    $0 + $31,469 related
    Filer's total
    $0 + $276,753 related

  • Becky Drerup

    DIRECTOR/PH NURSE PRACTITIONER

    Total calculated
    $20,979
    From this org
    $0
    From related orgs
    $20,979
    Other
    $0
    Hours/week
    0 + 5 related

  • Denise Lemmon

    DIRECTOR/CHAIR

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

  • Lori Blackburn

    DIRECTOR

    Total calculated
    $0
    Hours/week
    1

  • Jason Blume

    DIRECTOR

    Total calculated
    $0
    Hours/week
    1

  • Debra Hockley

    DIRECTOR

    Total calculated
    $0
    Hours/week
    1

  • Vickie Irwin

    DIRECTOR

    Total calculated
    $0
    Hours/week
    1

  • Amy Leedy

    DIRECTOR/SECRETARY/TREASURER

    Total calculated
    $0
    Hours/week
    1

  • Jean Ness

    DIRECTOR/VICE CHAIR

    Total calculated
    $0
    Hours/week
    1

  • Gabriela Ruvalcaba

    DIRECTOR

    Total calculated
    $0
    Hours/week
    1

  • Michael Packnett

    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

  • 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

  • Benjamin Miles

    FORMER OFFICER/CURRENT HPS PRESIDENT

    Total calculated
    $588,857
    From this org
    $0
    From related orgs
    $582,664
    Other
    $6,193
    Hours/week
    0 + 40 related

    Schedule J breakdown matched by us

    Base
    $0 + $64,367 related
    Bonus
    $0
    Other
    $0 + $518,297 related
    Deferred
    $0 + $1,948 related
    Nontaxable benefits
    $0 + $4,245 related
    Filer's total
    $0 + $588,857 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

  • 4a · Severance or change-of-control payment
  • 4b · Supplemental nonqualified retirement plan

Answered no

  • 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
  • 7 · Other non-fixed payments
  • 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 FOUNDATION, 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, LINES 4A-B
SEVERANCE PAYMENT BENJAMIN MILES $275,656 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; DENA JACQUAY $39,944; BENJAMIN MILES $242,356; 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; DENA JACQUAY $203,319; MICHAEL PACKNETT $268,732; JEANNE' WICKENS $303,865

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.

  • ORTHOPAEDIC HOSPITAL AT PARKVIEW NORTH LLC

    N/A · ORTHOPAEDIC HOSPITAL · IN

  • MANAGED CARE SERVICES LLC

    N/A · HEALTH PLAN ADMINISTRATION · IN

  • FOUNDATION SURGERY AFFILIATE OF FORT WAYNE LLC

    N/A · SURGICAL SERVICES · IN

Related corporations and trusts

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

  • PARKVIEW PROFESSIONAL PROGRAMS INC

    C · REFERENCE LAB · IN

  • WOODLAND PLAZA MEDICAL PARK CONDO ASSOC INC

    C · PROPERTY OWNERS ASSOCIATION · IN

Provenance

Return type
form_990
Tax year
2022
Filed
8 November 2023
IRS schema version
2022v5.0
Source object
202323129349304592

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