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← PARKVIEW WABASH HOSPITAL FOUNDATION INC

Form 990 for tax year 2022

Filed by PARKVIEW WABASH HOSPITAL FOUNDATION INC.

Totals

Total revenue
$354,316
Total expenses
$131,033
Contributions and grants received
$140,317
Grants paid
$60,205
Program service revenue
$64,409
Investment income
$153,055
Other revenue
-$3,465
Total assets, end of year
$6,072,665
Total liabilities, end of year
$13,762
Net assets or fund balances, end of year
$6,058,903
Program services expenses (Part IX)
$71,991
Management and general expenses
$48,410
Fundraising expenses
$10,632
Program service expenses (Part III)
$71,991

Program services were 54.9% 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.

  • 1c · Fundraising events

    $36,147

  • 1d · Related organizations

    $175

  • 1f · All other contributions, gifts and grants

    $103,995

  • 1g · Noncash contributions included above

    $5,976

  • 2a · Program service revenue: FNDRSNG SER ALLOCATION

    total $64,409 · related or exempt $64,409

  • 3 · Investment income

    total $138,215 · excluded $138,215

  • 7a · Gross sales of assets other than inventory

    securities $16,431,279

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

    securities $16,416,439

  • 7c · Gain or loss

    securities $14,840

  • 7d · Net gain or loss

    total $14,840 · excluded $14,840

  • 8a · Fundraising events: gross income

    $19,301

  • 8a · Fundraising events: contributions included on line 1c

    $36,147

  • 8b · Fundraising events: direct expenses

    $22,766

  • 8c · Net income from fundraising events

    total -$3,465 · excluded -$3,465

Functional expenses

Part IX, the statement of functional expenses.

  • 1 · Grants to domestic organizations and governments

    total $58,275 · program services $58,275

  • 2 · Grants to domestic individuals

    total $1,930 · program services $1,930

  • 5 · Compensation of officers, directors and key employees

    total $37,210 · program services $11,163 · management and general $18,605 · fundraising $7,442

  • 9 · Other employee benefits

    total $965 · program services $289 · management and general $483 · fundraising $193

  • 11f · Fees: investment management

    total $22,509 · management and general $22,509

  • 11g · Fees: other

    total $231 · management and general $231

  • 12 · Advertising and promotion

    total $40 · fundraising $40

  • 13 · Office expenses

    total $3,741 · program services $334 · management and general $450 · fundraising $2,957

  • 24a · Other expenses: CORPORATE SERVICE ALLOC

    total $6,132 · management and general $6,132

Balance sheet

Part X, book values.

  • 2 · Savings and temporary cash investments

    beginning of year $799,853 · end of year $130,379

  • 3 · Pledges and grants receivable

    beginning of year $39,984 · end of year $5,684

  • 11 · Investments: publicly traded securities

    beginning of year $4,579,138 · end of year $4,713,656

  • 15 · Other assets

    beginning of year $1,285,263 · end of year $1,222,946

  • 17 · Accounts payable and accrued expenses

    beginning of year $0 · end of year $13,762

  • 27 · Net assets without donor restrictions

    beginning of year $4,205,943 · end of year $3,727,297

  • 28 · Net assets with donor restrictions

    beginning of year $2,498,295 · end of year $2,331,606

Mission and programs · 2022

Mission

TO SERVE AS THE PRIMARY FUNDRAISING ENTITY FOR PARKVIEW WABASH HOSPITAL, 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 PARKVIEW WABASH HOSPITAL, INC.

  • PARKVIEW WABASH HOSPITAL FOUNDATION, INC. IS A COLLECTION OF INDIVIDUALS, BUSINESS, AND INSTITUTIONAL DONORS WHO RECOGNIZE PARKVIEW WABASH HOSPITAL, INC. AS AN AGENT FOR SAVING AND CHANGING LIVES AND A VEHICLE FOR CREATING HEALTHIER COMMUNITIES FOR GENERATIONS TO COME. EACH GIFT TO PARKVIEW WABASH HOSPITAL FOUNDATION, INC. IS VITAL TO THE HOSPITAL'S MISSION OF IMPROVING THE HEALTH OF THE COMMUNITY. IN 2022, THESE GIFTS WERE USED TO ENHANCE PATIENT CARE AS WELL AS ASSISTED IN PROVIDING EDUCATIONAL OPPORTUNITIES AND SCHOLARSHIPS FOR PWH TEAM MEMBERS.(SEE SCHEDULE O FOR CONTINUATION)THESE ARE SOME NOTABLE WAYS THAT FOUNDATION GIFTS WERE USED IN 2022 TO IMPROVE THE HEALTH OF THE COMMUNITY:EDUCATION AND TRAININGCO-WORKERS AND DEPARTMENTS WHO SEEK TO IMPROVE PATIENT CARE AND TREATMENT THROUGH NEW PROGRAMS OR ENHANCED SKILLS TRAINING ANNUALLY APPROACH THE FOUNDATION FOR SUPPORT. THIS FUND IS USED TO ASSIST OUR DRIVEN AND DETERMINED CO-WORKERS WHO CHOOSE TO GO ABOVE AND BEYOND TO PROVIDE EVEN BETTER CARE FOR OUR PATIENTS. IN 2022, THE FOUNDATION FUNDED TRAINING AND EDUCATION BY SENDING CO-WORKERS TO TWO DIFFERENT CONFERENCES, THE NATIONAL MEDICAL STAFF SERVICES CONFERENCE AND THE NADCP CONFERENCE.HOME HEALTH AND HOSPICEPARKVIEW HOME HEALTH AND HOSPICE RECEIVED FOUNDATION SUPPORT TO ENHANCE PATIENT CARE WHICH MADE IT POSSIBLE FOR THEM TO OFFER PATIENT MASSAGES, AS WELL AS PROVIDING BEREAVEMENT CARE AFTER THE LOSS OF THE PATIENT BY PROVIDING CHAPLAINCY VISITS, FAMILY SUPPORT GROUPS AND BEREAVEMENT MATERIALS FOR LOVED ONES FACING GRIEF AND LOSS.CO-WORKER EMERGENCY FUNDFUNDS WERE DIRECTED TO THE CO-WORKER EMERGENCY FUND WHICH PROVIDES PARKVIEW CO-WORKERS FINANCIAL ASSISTANCE TO HELP THEM OVERCOME TEMPORARY FINANCIAL CRISES. THIS CONFIDENTIAL PROGRAM PROVIDES COUNSELING, ADVICE, AND RESOURCES TO ASSIST IN NAVIGATING EMERGENCIES AND OTHER TRAGIC LIFE EVENTS.SCHOLARSHIPSTHE LEON RIBLEY SCHOLARSHIP PROVIDED ACADEMIC ASSISTANCE FOR TWO STUDENTS ENROLLED IN POST-SECONDARY STUDIES IN HEALTHCARE-RELATED FIELDS.

    Expenses $71,991 · Grants $60,205 · Revenue $64,409

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

  • Debra Potempa

    DIRECTOR/WBHOS PRESIDENT

    Total calculated
    $256,154
    From this org
    $0
    From related orgs
    $217,853
    Other
    $38,301
    Hours/week
    0 + 40 related

    Schedule J breakdown matched by us

    Base
    $0 + $164,199 related
    Bonus
    $0 + $25,750 related
    Other
    $0 + $27,904 related
    Deferred
    $0 + $27,767 related
    Nontaxable benefits
    $0 + $10,534 related
    Filer's total
    $0 + $256,154 related

  • Marilyn Custer-Mitchell

    DIRECTOR-PARTIAL YR/WBHOS PRESIDENT

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

    Schedule J breakdown matched by us

    Base
    $0 + $64,475 related
    Bonus
    $0 + $92,640 related
    Other
    $0 + $43,565 related
    Deferred
    $0 + $5,298 related
    Nontaxable benefits
    $0 + $12,312 related
    Filer's total
    $0 + $218,290 related

  • Cynthia Peters

    DIRECTOR/PH EPIC CARE ANALYST II

    Total calculated
    $134,020
    From this org
    $0
    From related orgs
    $109,719
    Other
    $24,301
    Hours/week
    0 + 40 related

  • Michael Perkins

    DIRECTOR-PARTIAL YR/COM HOSP FND DIR

    Total calculated
    $117,384
    From this org
    $31,438
    From related orgs
    $67,738
    Other
    $18,208
    Hours/week
    20 + 20 related

  • Roger Cromer

    DIRECTOR

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

  • Lance Agness

    DIRECTOR/CHAIR

    Total calculated
    $0
    Hours/week
    1

  • Carol Fenton

    DIRECTOR

    Total calculated
    $0
    Hours/week
    1

  • Mark Frantz

    DIRECTOR

    Total calculated
    $0
    Hours/week
    1

  • Steven Hentgen

    DIRECTOR

    Total calculated
    $0
    Hours/week
    1

  • Kathy Jones

    DIRECTOR/SECRETARY/TREASURER

    Total calculated
    $0
    Hours/week
    1

  • Bill Leonhard

    DIRECTOR

    Total calculated
    $0
    Hours/week
    1

  • Bill Needler

    DIRECTOR/VICE CHAIR

    Total calculated
    $0
    Hours/week
    1

  • George Schneider

    DIRECTOR

    Total calculated
    $0
    Hours/week
    1

  • David Vancamp

    DIRECTOR-PARTIAL YR

    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
  • 7 · Other non-fixed payments

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
  • 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 PARKVIEW WABASH HOSPITAL 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): MARILYN CUSTER-MITCHELL $23,937; 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: DENA JACQUAY $203,319; 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.

  • 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
202343129349304619

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