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Nonprofiteer
← COMMUNITY HOSPITAL OF LAGRANGE COUNTY INC

Form 990 for tax year 2022

Filed by COMMUNITY HOSPITAL OF LAGRANGE COUNTY INC.

Totals

Total revenue
$42,679,297
Total expenses
$39,585,711
Contributions and grants received
$137,175
Grants paid
$39,082
Program service revenue
$42,242,017
Investment income
$2
Other revenue
$300,103
Total assets, end of year
$31,300,442
Total liabilities, end of year
$16,544,351
Net assets or fund balances, end of year
$14,756,091
Program services expenses (Part IX)
$31,592,879
Management and general expenses
$7,980,125
Fundraising expenses
$12,707
Program service expenses (Part III)
$31,592,879

Program services were 79.8% 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

    $755

  • 1e · Government grants (contributions)

    $136,420

  • 1g · Noncash contributions included above

    $240

  • 2a · Program service revenue: NET PATIENT SERVICE

    total $42,134,931 · related or exempt $42,134,931

  • 2b · Program service revenue: INTERUNIT RENT

    total $51,508 · related or exempt $51,508

  • 2c · Program service revenue: PHARMACY

    total $29,414 · related or exempt $29,414

  • 2d · Program service revenue: SPEECH THERAPY

    total $22,371 · related or exempt $22,371

  • 2e · Program service revenue: MEALS ON WHEELS

    total $2,212 · related or exempt $2,212

  • 2f · All other program service revenue

    total $1,581 · related or exempt $1,581

  • 6a · Gross rents

    real property $3,914

  • 6b · Less rental expenses

    real property $14,344

  • 6c · Rental income or loss

    real property -$10,430

  • 6d · Net rental income or loss

    total -$10,430 · excluded -$10,430

  • 7a · Gross sales of assets other than inventory

    other assets $2

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

    other assets $0

  • 7c · Gain or loss

    other assets $2

  • 7d · Net gain or loss

    total $2 · excluded $2

  • 11a · Other revenue: CAFETERIA REVENUE

    total $288,701 · excluded $288,701

  • 11b · Other revenue: GIFT SHOP REVENUE

    total $21,832 · excluded $21,832

  • 11e · Other revenue, total

    $310,533

Functional expenses

Part IX, the statement of functional expenses.

  • 1 · Grants to domestic organizations and governments

    total $39,082 · program services $39,082

  • 5 · Compensation of officers, directors and key employees

    total $884,325 · management and general $884,325

  • 6 · Compensation of disqualified persons

    total $279,674 · program services $279,674

  • 7 · Other salaries and wages

    total $10,181,176 · program services $10,181,176

  • 9 · Other employee benefits

    total $3,557,111 · program services $3,557,111

  • 11g · Fees: other

    total $6,191,429 · program services $5,492,792 · management and general $698,637

  • 12 · Advertising and promotion

    total $416 · program services $416

  • 13 · Office expenses

    total $830,590 · program services $800,612 · management and general $29,978

  • 14 · Information technology

    total $3,944 · program services $3,786 · management and general $158

  • 16 · Occupancy

    total $748,051 · program services $739,308 · management and general $8,743

  • 17 · Travel

    total $11,629 · program services $10,493 · management and general $1,136

  • 19 · Conferences, conventions and meetings

    total $11,371 · program services $5,674 · management and general $5,697

  • 20 · Interest

    total $248,784 · program services $248,784

  • 22 · Depreciation, depletion and amortization

    total $1,519,566 · program services $1,493,666 · management and general $25,900

  • 23 · Insurance

    total $91,954 · program services $91,954

  • 24a · Other expenses: CORP SERVICE ALLOCATION

    total $6,277,377 · management and general $6,277,377

  • 24b · Other expenses: PH CLINICAL SUPPORT

    total $3,522,689 · program services $3,522,689

  • 24c · Other expenses: MEDICAL SUPPLIES

    total $2,749,014 · program services $2,749,014

  • 24d · Other expenses: HOSPITAL ASSESSMENT FEE

    total $2,336,852 · program services $2,336,852

  • 24e · All other expenses

    total $100,677 · program services $39,796 · management and general $48,174 · fundraising $12,707

Balance sheet

Part X, book values.

  • 1 · Cash, non-interest-bearing

    beginning of year $1,757 · end of year $1,757

  • 3 · Pledges and grants receivable

    beginning of year $252,916

  • 4 · Accounts receivable

    beginning of year $7,281,458 · end of year $6,844,664

  • 8 · Inventories for sale or use

    beginning of year $395,706 · end of year $389,198

  • 9 · Prepaid expenses and deferred charges

    beginning of year $8,417 · end of year $4,926

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

    $34,732,907

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

    $22,584,410

  • 10c · Land, buildings and equipment, net

    beginning of year $13,031,916 · end of year $12,148,497

  • 14 · Intangible assets

    beginning of year $5,011,241 · end of year $5,011,241

  • 15 · Other assets

    beginning of year $5,997,727 · end of year $6,900,159

  • 17 · Accounts payable and accrued expenses

    beginning of year $1,980,329 · end of year $1,665,888

  • 19 · Deferred revenue

    beginning of year $1,467,613 · end of year $192,423

  • 20 · Tax-exempt bond liabilities

    beginning of year $14,186,769 · end of year $13,160,114

  • 25 · Other liabilities

    beginning of year $2,424,976 · end of year $1,525,926

  • 27 · Net assets without donor restrictions

    beginning of year $11,921,451 · end of year $14,756,091

Mission and programs · 2022

Mission

COMMUNITY HOSPITAL OF LAGRANGE 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 COMMUNITY-OWNED, NOT FOR PROFIT ORGANIZATION, COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC. IS DEDICATED TO IMPROVING THE HEALTH AND INSPIRING THE WELL-BEING IN THE COMMUNITIES WE SERVE. COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC. GIVES BACK TO THE COMMUNITY IN THE FORM OF IMPROVED FACILITIES, FREE AND DISCOUNTED CARE, EDUCATION AND OUTREACH PROGRAMS, VOLUNTEERISM AND MUCH MORE. USING INFORMATION FROM THE TRIENNIAL COMMUNITY HEALTH NEEDS ASSESSMENT, COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC. ALIGNS ITS OUTREACH PROGRAMS TO PRIORITIZE AND ADDRESS THE COMMUNITY'S NEEDS. (SEE SCHEDULE O FOR CONTINUATION)FOLLOWING ARE SOME OF THE WAYS COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC. IS REACHING OUT TO MAKE OUR NEIGHBORHOODS AND COMMUNITIES HEALTHIER:-FINANCIAL ASSISTANCE-COMMUNITY HEALTH IMPROVEMENT INITIATIVES-PRIMARY HEALTH CARE /ACCESS -MEDICATION ASSISTANCE PROGRAM (MAP)-HEALTH SCREENINGS AND PREVENTION-DISEASE MANAGEMENT-CONTRIBUTIONS TOWARD AND PARTICIPATION IN ECONOMIC DEVELOPMENT ACTIVITIESFINANCIAL ASSISTANCE:COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC.'S MISSION INCLUDES CARING FOR PATIENTS WHO DO NOT HAVE THE MEANS TO MEET THEIR FINANCIAL OBLIGATIONS. THE HOSPITAL PLACES ITS PRIORITY ON PROVIDING THE NECESSARY CARE FOR EACH PATIENT, NOT ON THE PATIENT'S FINANCIAL ABILITY TO PAY FOR THEIR MEDICAL SERVICES.COMMUNITY HEALTH IMPROVEMENT INITIATIVES:THE PURPOSE OF COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC.'S COMMUNITY HEALTH IMPROVEMENT PROGRAM IS TO FUND COMMUNITY HEALTH IMPROVEMENT EFFORTS WITHIN THE SERVICE AREA OF COMMUNITY HOSPITAL OF LAGRANGE 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.COMMUNITY HEALTH IMPROVEMENT MANAGER: THE COMMUNITY HEALTH IMPROVEMENT MANAGER IS INSTRUMENTAL IN THE IMPLEMENTATION OF KEY STRATEGIES AS IDENTIFIED BY OUR HOSPITAL'S COMMUNITY HEALTH NEEDS ASSESSMENT - MENTAL HEALTH, SUBSTANCE USE/ABUSE, SUICIDE, OBESITY AND CHILD ABUSE AND NEGLECT. COMMUNITY HOSPITAL OF LAGRANGE 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 LEADERSHIP MEETINGS. THESE LEADERSHIP MEETINGS BRING COMMUNITY PARTNERS AND STAKEHOLDERS FROM ACROSS LAGRANGE 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 ISSUES. THE COMMUNITY HEALTH IMPROVEMENT MANAGER IS ALSO INVOLVED IN VARIOUS OTHER COALITIONS AND COMMUNITY PARTNERSHIPS SUCH AS COUNCIL FOR A DRUG FREE LAGRANGE, FOCUS LAGRANGE, LAGRANGE COUNTY CHAMBER OF COMMERCE, LAGRANGE COUNTY TOGETHER, AND NORTHEAST INDIANA FARM TO SCHOOL. THE COMMUNITY HEALTH IMPROVEMENT MANAGER IDENTIFIES, DEVELOPS, IMPLEMENTS, AND EVALUATES ALL COMMUNITY HEALTH PROGRAMS OFFERED THROUGH THE HOSPITAL. COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC. IS ONE OF THE LARGEST EMPLOYERS IN LAGRANGE COUNTY AND BELIEVES STRONGLY IN GIVING BACK TO THE COMMUNITY IT SERVES. THE HOSPITAL NOT ONLY SPONSORS ITS OWN EVENTS AND OUTREACH PROGRAMS EACH YEAR, BUT ALSO TAKES AN ACTIVE ROLE IN NUMEROUS OTHER LOCALLY SPONSORED HEALTH EVENTS, EDUCATION, AND COMMUNITY EVENTS. THE MANAGEMENT AND CO-WORKERS PARTICIPATE IN VOLUNTEER ACTIVITIES THROUGHOUT THE YEAR TO IMPROVE THE HEALTH AND WELL-BEING OF OUR COMMUNITY.TO ASSIST IN HEALTH EDUCATION IN OUR SCHOOL DISTRICTS, FUNDS ARE PROVIDED TO MCMILLEN HEALTH TO PROVIDE EVIDENCE-BASED EDUCATION AROUND THE TOP HEALTH PRIORITIES IDENTIFIED IN THE TRIENNIAL COMMUNITY HEALTH NEEDS ASSESSMENT, WHICH ARE MENTAL HEALTH, SUBSTANCE USE/ABUSE, SUICIDE, OBESITY AND CHILD ABUSE AND NEGLECT.BOOMERANG BACKPACK / BLESSINGS IN A BACKPACK: FUNDING IS PROVIDED TO THE LAGRANGE COUNTY CHAMBER OF COMMERCE TO SUPPORT STUDENTS IN OUR COUNTY SCHOOL DISTRICTS WHO NEED ACCESS TO FOOD OVER THE WEEKENDS WHEN SCHOOL IS NOT IN SESSION. STUDENTS ARE IDENTIFIED THROUGH THE SCHOOLS AS AT RISK OF HUNGER. PRIMARY HEALTH CARE / ACCESS:COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC. PROVIDES CLINICAL STAFF AND SUPPORT TO TARGETED POPULATIONS WITHIN LAGRANGE COUNTY, INCLUDING:-A PART-TIME PLAIN CHURCH COORDINATOR WHO SERVES AS A RESOURCE FOR AMISH, MENNONITE AND OTHER PLAIN CHURCH MEMBERS TO ADDRESS QUESTIONS RELATED TO HEALTHCARE SERVICES AVAILABLE WITHIN THE PARKVIEW HEALTH SYSTEM, DETERMINING THE APPROXIMATE COST OF A PROCEDURE, SCHEDULING OF A DIAGNOSTIC TEST, OR A BILLING QUESTION. THE PLAIN CHURCH COORDINATOR ASSISTS INDIVIDUALS AND FAMILIES BY OBTAINING AN ANSWER TO THE QUESTIONS THIS COMMUNITY HAS RELATED TO SEEKING HEALTHCARE FROM PARKVIEW.IN 2022, COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC., AFFORDED 39 EXPECTANT PARENTS THE OPPORTUNITY TO ATTEND BIRTH PLANNING CLASSES BY A REGISTERED NURSE WHO IS A CERTIFIED LACTATION CONSULTANT. THE CLASSES PROVIDE ANSWERS TO ANY QUESTIONS AN EXPECTANT MOTHER MAY HAVE; IN ADDITION, OTHER RESOURCES ARE AVAILABLE AT APPOINTMENTS WITH THE HOSPITAL'S BIRTH PLANNER. PRENATAL CLASSES WERE PROVIDED TO 66 INDIVIDUALS. ADDITIONAL SUPPORT ONCE A BABY IS BORN INCLUDES BREASTFEEDING, WHICH WAS PROVIDED TO 86 INDIVIDUALS, AND SAFE SLEEP CLASSES, WHICH WAS PROVIDED TO SEVEN PEOPLE. MEDICATION ASSISTANCE PROGRAMS (MAP):COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC. MAINTAINS A MEDICATION ASSISTANCE PROGRAM FOR LAGRANGE 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, PREVENTION, AND DISEASE MANAGEMENT: COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC. PROVIDES FREE AND LOW-COST SERVICES, HEALTH SCREENINGS AND EDUCATION TO DIVERSE POPULATIONS IN OUR SERVICE AREA. THESE INCLUDE: -COMMUNITY CHECK-UP DAYS. COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC. PROVIDED LOW-COST BLOOD TESTS TO THE COMMUNITY SERVING 47 PEOPLE. -VOUCHERS REDEEMABLE FOR NINE MONTHS OF PRENATAL VITAMINS. THESE ARE MADE AVAILABLE TO WOMEN THROUGH THE HOSPITAL BIRTH PLANNER, LAGRANGE COUNTY PRIMARY CARE PHYSICIANS AND OBSTETRICIANS, THE LAGRANGE COUNTY HEALTH DEPARTMENT, AND WIC. VOUCHERS ARE REDEEMABLE AT LOCAL PHARMACIES WHO THEN SUBMIT THEM TO THE HOSPITAL FOR REIMBURSEMENT THROUGH COMMUNITY HEALTH IMPROVEMENT FUNDS.-QPR TRAINING IS OFFERED MONTHLY TO CO-WORKERS OF COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC. AND TO LAGRANGE COUNTY COMMUNITY MEMBERS. THIS SUICIDE PREVENTION TRAINING PREPARES ATTENDEES TO IDENTIFY WARNING SIGNS AND INTERVENE IN HOPES OF PREVENTING SUICIDE COMPLETION. IN 2022 THE HOSPITAL WAS ABLE TO PROVIDE TRAINING TO 157 PEOPLE. ECONOMIC DEVELOPMENT:ECONOMIC DEVELOPMENT CORPORATION - COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC. PROVIDES FUNDING TO THE LAGRANGE COUNTY ECONOMIC DEVELOPMENT CORPORATION (EDC) TO SUPPORT THEIR EFFORTS IN DEVELOPING BUSINESS RETENTION AND EXPANSION, BUSINESS ATTRACTION, ENTREPRENEURIAL DEVELOPMENT, AND TO ENCOURAGE HIGHER PAYING JOBS AND ECONOMIC IMPROVEMENT IN OVERALL QUALITY OF LIFE. THE EDC CONTRIBUTES TO FURTHERING ACCESS IN OUR COUNTY BY INVESTING IN AREAS THAT CONTRIBUTE TO A THRIVING COMMUNITY, SUCH AS HOUSING AND AIDING BUSINESSES IN IDENTIFYING BUILDING SITES. THE EDC ALSO INVESTS IN AREAS THAT IMPACT OBESITY AND MATERNAL/INFANT/CHILD HEALTH BY SUPPORTING THE LAUNCH LAGRANGE STUDENT ENTREPRENEURIAL COMPETITION AND LAGRANGE COUNTY TRAILS. IN ADDITION, COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC. IS PART OF THE LAGRANGE COUNTY EARLY LEARNING COALITION. LAGRANGE COUNTY IS CONSIDERED A CHILDCARE DESERT BECAUSE THERE ARE NOT ENOUGH CERTIFIED CHILDCARE PROVIDERS BASED ON OUR COUNTY'S POPULATION. REPRESENTATIVES FROM THE HOSPITAL COLLABORATE WITH KEY STAKEHOLDERS AND HR REPRESENTATIVES FROM COUNTY BUSINESSES TO WORK TOGETHER TOWARDS INCREASING THE NUMBER OF CERTIFIED CHILDCARE PROVIDERS FOR LAGRANGE COUNTY.

    Expenses $31,592,879 · Grants $39,082 · Revenue $42,242,017

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

  • Lisa Booth

    DIRECTOR/PH PHYSICIAN

    Total calculated
    $594,727
    From this org
    $17,120
    From related orgs
    $527,885
    Other
    $49,722
    Hours/week
    0 + 40 related

    Schedule J breakdown matched by us

    Base
    $17,120 + $410,512 related
    Bonus
    $0 + $84,991 related
    Other
    $0 + $32,382 related
    Deferred
    $1,054 + $32,496 related
    Nontaxable benefits
    $508 + $15,664 related
    Filer's total
    $18,682 + $576,045 related

  • Rhonda Sharp

    DIRECTOR/PH PHYSICIAN

    Total calculated
    $398,851
    From this org
    $158,806
    From related orgs
    $201,812
    Other
    $38,233
    Hours/week
    16 + 24 related

    Schedule J breakdown matched by us

    Base
    $158,806 + $163,350 related
    Bonus
    $0 + $32,124 related
    Other
    $0 + $6,338 related
    Deferred
    $14,774 + $18,776 related
    Nontaxable benefits
    $2,062 + $2,621 related
    Filer's total
    $175,642 + $223,209 related

  • Jordi Disler

    DIRECTOR/LGHOS PRESIDENT

    Total calculated
    $406,241
    From this org
    $308,629
    From related orgs
    $0
    Other
    $97,612
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $207,367
    Bonus
    $78,305
    Other
    $22,957
    Deferred
    $70,059
    Nontaxable benefits
    $27,553
    Filer's total
    $406,241

  • Todd Klinedinst

    DIRECTOR/LGHOS VP PATIENT CARE SVCS

    Total calculated
    $226,710
    From this org
    $213,263
    From related orgs
    $0
    Other
    $13,447
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $163,552
    Bonus
    $48,494
    Other
    $1,217
    Deferred
    $10,602
    Nontaxable benefits
    $2,845
    Filer's total
    $226,710

  • Steven Christner

    DIRECTOR/VICE CHAIR

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

  • Daryl Hershberger

    DIRECTOR/CONTRACTED PHYSICIAN

    Total calculated
    $134,924
    From this org
    $134,924
    From related orgs
    $0
    Other
    $0
    Hours/week
    1

  • Mark Leu

    DIRECTOR

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

  • Michael Mellinger

    DIRECTOR

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

  • Trevor Thain

    DIRECTOR

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

  • Beth Thornburg

    DIRECTOR

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

  • Joe Urbanski

    DIRECTOR/CHAIR

    Total calculated
    $8,250
    From this org
    $6,250
    From related orgs
    $2,000
    Other
    $0
    Hours/week
    1 + 1 related

  • Robert Bond

    DIRECTOR

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

  • Paul Yoder

    DIRECTOR/SECRETARY/TREASURER

    Total calculated
    $4,500
    From this org
    $4,500
    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

  • Brenda Armentrout

    LGHOS MGR PHARMACY

    Total calculated
    $253,276
    From this org
    $217,221
    From related orgs
    $0
    Other
    $36,055
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $185,261
    Bonus
    $28,150
    Other
    $3,810
    Deferred
    $23,568
    Nontaxable benefits
    $12,487
    Filer's total
    $253,276

  • Mary Lou Wright

    LGHOS RN

    Total calculated
    $198,158
    From this org
    $88,458
    From related orgs
    $82,692
    Other
    $27,008
    Hours/week
    25 + 15 related

    Schedule J breakdown matched by us

    Base
    $87,417 + $77,434 related
    Bonus
    $750 + $5,000 related
    Other
    $291 + $258 related
    Deferred
    $8,003 + $7,481 related
    Nontaxable benefits
    $5,956 + $5,568 related
    Filer's total
    $102,417 + $95,741 related

  • Robert Bloomfield

    LGHOS MGR SUPPORT SERVICE

    Total calculated
    $191,096
    From this org
    $150,451
    From related orgs
    $0
    Other
    $40,645
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $128,492
    Bonus
    $20,278
    Other
    $1,681
    Deferred
    $16,904
    Nontaxable benefits
    $23,741
    Filer's total
    $191,096

  • Trevor Fry

    LGHOS MGR ER

    Total calculated
    $182,789
    From this org
    $141,840
    From related orgs
    $0
    Other
    $40,949
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $121,963
    Bonus
    $19,511
    Other
    $366
    Deferred
    $16,031
    Nontaxable benefits
    $24,918
    Filer's total
    $182,789

  • Emily Plant

    LGHOS MGR IP

    Total calculated
    $172,739
    From this org
    $138,578
    From related orgs
    $0
    Other
    $34,161
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $118,986
    Bonus
    $19,233
    Other
    $359
    Deferred
    $8,152
    Nontaxable benefits
    $26,009
    Filer's total
    $172,739

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 LAGRANGE 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): JORDI DISLER $21,333; 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: JORDI DISLER $35,158; 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

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
9 November 2023
IRS schema version
2022v5.0
Source object
202333139349305268

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