2022-08-15T07:35:41-05:00 2021-09-30 351178661 BLUE & CO LLC 500 N MERIDIAN ST SUITE 200 INDIANAPOLIS IN 46204 990 2020-10-01 810693478 DEACONESS REGIONAL HEALTHCARE SERVICES ILLINOIS INC DEAC 8124502220 600 MARY ST EVANSVILLE IN 47747 MARC J FLORENCE PRESIDENT 8124502220 2022-08-15 1 MARC FLORENCE 999009999 CARRIE A MERRILL CPA P00832283 3176334705 2022-08-15 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z MARC J FLORENCE 600 MARY ST EVANSVILLE IN 47747 3229843 0 X WWW.DEACONESS.COM X 2015 IL DEACONESS REGIONAL HEALTHCARE SERVICES ILLINOIS, INC. PROVIDES HEALTHCARE RELATED SERVICES FOR RURAL AND CRITICAL ACCESS HOSPITALS. THE MAIN AREAS THAT ARE FOCUSED ON ARE HEALTHCARE MANAGEMENT SERVICES, EMERGENCY DEPARTMENT STAFFING, EQUIPMENT LEASING, AND SPECIALTY PHYSICIAN OUTREACH CLINICS TO UNDERSERVED AREAS. THE SERVICES PROVIDED GENERATE A LOSS TO THE CORPORATION. THESE SERVICES ARE PROVIDED TO BENEFIT UNDERSERVED COMMUNITIES AND HOSPITALS AND ALLOW FOR IMPROVED HEALTHCARE DELIVERY IN SOUTHEASTERN ILLINOIS. 3 0 48 0 0 0 64678 0 1793105 3229072 331 771 0 0 1858114 3229843 0 0 0 0 2744551 2826094 0 0 0 15887 -102557 2760438 2723537 -902324 506306 2362772 3115277 1184767 625095 1178005 2490182 X DEACONESS REGIONAL HEALTHCARE SERVICES ILLINOIS, INC. PROVIDES HEALTHCARE RELATED SERVICES FOR RURAL AND CRITICAL ACCESS HOSPITALS. THE MAIN AREAS THAT ARE FOCUSED ON ARE HEALTHCARE MANAGEMENT SERVICES, EMERGENCY DEPARTMENT STAFFING, EQUIPMENT LEASING, AND SPECIALTY PHYSICIAN OUTREACH CLINICS TO UNDERSERVED AREAS. THE SERVICES PROVIDED GENERATE A LOSS TO THE CORPORATION. THESE SERVICES ARE PROVIDED TO BENEFIT UNDERSERVED COMMUNITIES AND HOSPITALS AND ALLOW FOR IMPROVED HEALTHCARE DELIVERY IN SOUTHEASTERN ILLINOIS. 0 0 507948 1403851 DEACONESS REGIONAL HEALTHCARE SERVICES ILLINOIS, INC., IS A CORPORATION ORGANIZED EXCLUSIVELY FOR CHARITABLE, EDUCATIONAL, AND SCIENTIFIC PURPOSES FOR THE DELIVERY OF QUALITY, COST-EFFECTIVE HEALTH CARE AND MEDICAL SERVICES TO THE PUBLIC, AND CONDUCTING OTHER ACTIVITIES DESIGNED TO PROMOTE THE HEALTH CARE NEEDS AND WELFARE OF RURAL AND UNDERSERVED COMMUNITIES. 1807058 1825221 TRANSCARE MEDICAL TRANSPORT AND LOGISTICS, LLC, FACILITATES PATIENT TRANSPORTS BETWEEN AND AMONG HEALTH CARE FACILITIES IN SOUTHERN ILLINOIS, SOUTHERN INDIANA, AND WESTERN KENTUCKY TO FACILITATE BETTER QUALITY, MORE EFFICIENT DELIVERY OF HEALTH CARE SERVICES TO PATIENTS IN THE REGION; WHILE ALSO DEVELOPING AND ENGAGING IN THE PROVISION OF MANAGEMENT SOLUTIONS FOR COUNTY-OWNED EMERGENCY MEDICAL SERVICES PROVIDERS WITH THE GOAL OF DECREASING COSTS AND IMPROVING SERVICES TO COMMUNITIES. 2315006 1 0 0 0 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 10 0 1 48 1 0 0 0 0 0 0 0 0 0 0 0 0 X 3 0 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 IL X CHERYL A WATHEN 8124503296 600 MARY STREET EVANSVILLE IN 47747 MARC J FLORENCE PRESIDENT 3.00 55.00 X 73545 436801 114628 LYNN LINGAFELTER SECRETARY 1.00 54.00 X 0 728204 147424 AUTUMN LINK DIRECTOR 3.00 52.00 X 0 164910 41854 ALISA COLEMAN CEO FERRELL HOSPITAL 50.00 0.00 X 346505 0 35301 DONALD ROBBINS CEO LAWRENCE COUNTY HOSPITAL 50.00 0.00 X 228319 0 32534 LARRY SPOUR CFO LAWRENCE COUNTY HOSPITAL 50.00 0.00 X 159920 0 27289 808289 1329915 399030 3 0 1 0 MERCY AMBULANCE OF EVANSVILLE PO BOX 84139 DALLAS TX 75284 DISPATCH FOR AMBULANCES 133183 1 NET PATIENT REVENUE 621110 1702374 1702374 CONTRACT REVENUE 900099 1526698 1526698 3229072 771 771 3229843 3229072 0 771 808289 687046 121243 1638766 1392951 245815 48248 41011 7237 158231 134496 23735 172560 146676 25884 51025 43371 7654 344151 292528 51623 408246 347009 61237 135204 114923 20281 EXPENSE RECOVERY -1094629 -930435 -164194 53446 45430 8016 2723537 2315006 408531 0 66633 10113 579487 345050 128445 81052 2227013 437539 508420 1789474 1079787 889588 2362772 3115277 161139 352256 1023628 272839 1184767 625095 X 1178005 2490182 1178005 2490182 2362772 3115277 X 506306 805871 X X 0 1 X 1 0 X 64678 64678 1150661 2138348 2201530 1793105 3229072 10512716 1150661 2138348 2201530 1857783 3229072 10577394 0 0 0 10577394 165 1554 331 771 2821 165 1554 331 771 2821 1150661 2138513 2203084 1858114 3229843 10580215 0.99970 0.99970 0.00030 0.00030 X 241167 241167 940343 437539 502804 1045503 1045503 1789474 INVESTMENT IN LAWRENCE CO HOSPITAL 656166 OTHER RECEIVABLES 233422 889588 DUE TO DEACONESS HOSPITAL 272839 272839 X PART X, LINE 2: ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE SYSTEM AND RECOGNIZE A TAX LIABILITY IF THE SYSTEM HAS TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY VARIOUS FEDERAL AND STATE TAXING AUTHORITIES. MANAGEMENT HAS ANALYZED THE TAX POSITIONS TAKEN BY THE SYSTEM AND HAS CONCLUDED THAT AS OF SEPTEMBER 30, 2021 AND 2020, THERE ARE NO UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY OR DISCLOSURE IN THE ACCOMPANYING CONSOLIDATED FINANCIAL STATEMENTS. THE SYSTEM IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. X X X X X 0 1 0 0 0 1 1 0 0 MARC J FLORENCE PRESIDENT 73545 294480 0 94867 0 47454 13590 65303 7147 28588 94282 530692 0 43602 LYNN LINGAFELTER SECRETARY 0 520341 0 132157 0 75706 0 117165 0 30259 0 875628 0 66902 AUTUMN LINK DIRECTOR 0 137907 0 25032 0 1971 0 10525 0 31329 0 206764 0 0 ALISA COLEMAN CEO FERRELL HOSPITAL 288224 0 55507 0 2774 0 15486 0 19815 0 381806 0 0 0 DONALD ROBBINS CEO LAWRENCE COUNTY HOSPITAL 226943 0 0 0 1376 0 6549 0 25985 0 260853 0 0 0 LARRY SPOUR CFO LAWRENCE COUNTY HOSPITAL 144798 0 0 0 15122 0 3838 0 23451 0 187209 0 0 0 PART I, LINE 4B SEVERANCE, NONQUALIFIED, AND EQUITY-BASED PAYMENTS: SEVERANCE NONQUALIFIED EQUITY-BASED MARC J. FLORENCE $ -0- $ 19,500 $ -0- LYNN LINGAFELTER 0 19,500 0 PART I, 4B: LYNN LINGAFELTER: SUPPLEMENTAL ACCUMULATION ACCOUNT CONTRIBUTIONS OF $93,097. SUPPLEMENTAL ACCUMULATION ACCOUNT PAYOUT OF $66,902. MARC J. FLORENCE: SUPPLEMENTAL ACCUMULATION ACCOUNT CONTRIBUTIONS OF $59,054. SUPPLEMENTAL ACCUMULATION ACCOUNT PAYOUT OF $43,602. PART I, LINE 6 BONUSES FOR KEY EMPLOYEES ARE DEPENDENT ON THE HEALTH SYSTEM REACHING CERTAIN STRATEGIC GOALS AS IT RELATES TO QUALITY AND SAFETY, POPULATION HEALTH, FINANCIAL STRENGTH, ACCESS TO CARE, REGIONAL PARTNERSHIPS, AND HEALTH. THESE GOALS ARE ESTABLISHED PRIOR TO THE FISCAL YEAR AND APPROVED BY THE COMPENSATION COMMITTEE OF THE BOARD. FORM 990, PART VI, SECTION A, LINE 6 CLASS OF MEMBERS OR STOCKHOLDERS: DEACONESS HEALTH SYSTEM, INC., A TAX EXAMPT 501(C)(3) ORGANIZATION, IS THE SOLE CORPORATE MEMBER OF DEACONESS REGIONAL HEALTHCARE SERVICES ILLINOIS, INC. FORM 990, PART VI, SECTION A, LINE 7A ELECTION OF MEMBERS AND THEIR RIGHTS: DEACONESS HEALTH SYSTEM, INC. HAS THE POWER TO APPOINT EACH PERSON ON THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION A, LINE 7B GOVERNANCE DECISIONS: DEACONESS HEALTH SYSTEM MAY APPOINT OR REMOVE THE CORPORATION'S DIRECTORS AS WELL AS THE CORPORATION'S SECRETARY AND TREASURER. FORM 990, PART VI, SECTION B, LINE 11B THE PROCESS THAT DEACONESS REGIONAL HEALTHCARE SERVICES ILLINOIS, INC. UTILIZES TO PRESENT THE FORM 990 TO ITS GOVERNING BODY PRIOR TO FILING IS TO PRESENT THE FORM 990 TO THE CFO AND CEO OF THE ORGANIZATION FOR REVIEW. AFTER THIS REVIEW IS PERFORMED AND ALL QUESTIONS ARE ANSWERED, THE FORM 990 IS PRESENTED TO THE BOARD OF DIRECTORS OF DIRECTORS AT THE BOARD MEETING PRIOR TO THE FILING DATE OF THE FORM 990. ANY ADDITIONAL QUESTIONS ARE ANSWERED AND THE FINAL FILING IS THEN COMPLETED. FORM 990, PART VI, SECTION B, LINE 12C CONFLICT OF INTEREST REVIEW AND COMPLIANCE ACTIVITIES ARE CONDUCTED THROUGHOUT THE YEAR UNDER DIRECTION OF DEACONESS HOSPITAL'S CORPORATE COMPLIANCE OFFICER. UPON APPOINTMENT AND, ANNUALLY THEREAFTER, OFFICERS, DIRECTORS, TRUSTEES, AND KEY EMPLOYEES, ALSO KNOWN AS INTERESTED PERSONS, ARE REQUIRED TO COMPLETE "THE CONFLICTS OF INTEREST QUESTIONNAIRE AND/OR "THE DISCLOSURE QUESTIONNAIRE". THESE DOCUMENTS SERVE TO ENSURE INTERESTED PERSONS OR COMMITTEE MEMBERS WITH BOARD-DELEGATED POWERS HAVE AN APPROPRIATE AND TIMELY MANNER IN WHICH TO DISCLOSE ANY POTENTIAL CONFLICTS. CONFLICTS ARE CONSIDERED WITH RESPECT TO OUTSIDE INTEREST, INVESTMENTS, OUTSIDE ACTIVITIES, AND BUSINESS INTERESTS AMONG THE INTERESTED PERSONS AS WELL AS THEIR FAMILY MEMBERS. ON A PERIODIC BASIS, REVIEWS OCCUR TO ENSURE THE CORPORATION OPERATES IN A MANNER CONSISTENT WITH ITS CHARITABLE PURPOSE. SUBJECTS THAT ARE REVIEWED ON A PERIODIC BASIS INCLUDE COMPENSATION, PHYSICIAN RELATIONSHIPS, PARTNERSHIP AND JOINT VENTURE ARRANGEMENTS. FORM 990, PART VI, SECTION B, LINE 15 COMPENSATION FOR TOP OFFICIALS AND OTHER OFFICERS: SALARIES AND BENEFITS OF OFFICERS AT DEACONESS REGIONAL HEALTHCARE SERVICES ILLINOIS ARE APPROVED BY THE DEACONESS HEALTH SYSTEM COMPENSATION COMMITTEE. DEACONESS HEALTHCARE SERVICES ILLINOIS BOARD CAN ONLY MAKE RECOMMENDATION TO THE DEACONESS HEALTH SYSTEM COMPENSATION COMMITTEE. THE COMPENSATION COMMITTEE IS APPOINTED BY THE BOARD OF DIRECTORS OF DEACONESS HEALTH SYSTEM INC. AND MUST MEET THE INDEPENDENCE REQUIREMENTS OF THE SEC. THE COMMITTEE HAS THE POWER AND AUTHORITY TO: 1. ANNUALLY REVIEW, APPROVE, AND RECOMMEND TO THE BOARD OF DIRECTORS FOR ITS FINAL APPROVAL FOR THE VICE PRESIDENT AND EACH OTHER EXECUTIVE OFFICERS ALL ELEMENTS OF EXECUTIVE COMPENSATION. 2. MONITOR BROADLY THE STRUCTURE, PHILOSOPHY OR COMPETITIVENESS OF THE SYSTEM'S GENERAL HIRING OR COMPENSATION PRACTICES. 3. OVERSEE THE ESTABLISHMENT AND ADMINISTRATION OF THE COMPANY'S BROAD-BASED BENEFIT PLANS AND PROGRAMS. 4. REVIEW OR APPROVE SIGNIFICANT AMENDMENTS OR CHANGES TO THE PLANS AND PROGRAMS. 5. RETAIN AND TERMINATE ANY COMPENSATION CONSULTANT TO BE USED TO ASSIST IN THE EVALUATION OF DIRECTOR, VICE PRESIDENT OR EXECUTIVE OFFICE COMPENSATION. 6. SOLE AUTHORITY TO APPROVE THE CONSULTANT'S FEES AND OTHER RETENTION TERMS. 7. OBTAIN ADVICE AND ASSISTANCE FROM INTERNAL OR EXTERNAL LEGAL, ACCOUNTING OR OTHER ADVISORS. 8. APPROVE ALL PHYSICIAN AND PHYSICIAN-RELATED CONTRACTS. 9. MAKE REGULAR REPORTS TO THE BOARD. FORM 990, PART VI, SECTION C, LINE 19 DEACONESS REGIONAL HEALTHCARE SERVICES ILLINOIS, INC.'S GOVERNING DOCUMENTS ARE AVAILABLE FOR PUBLIC INSPECTION UPON REQUEST. FORM 990, PART XI, LINE 9: CAPITAL TRANSFER FROM DEACONESS HEALTH SYSTEMS 805,871. FORM 990, PART XII, LINE 2C, OVERSIGHT OF AUDIT: THE BOARD OF DIRECTORS ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF THE FINANCIAL STATEMENTS AND SELECTION OF THE INDEPENDENT ACCOUNTANT. DEACONESS REGIONAL HEALTHCARE NETWORK ILLINOIS LLC 600 MARY STREET EVANSVILLE IN 47747 611775943 HEALTHCARE IL 1103096 2773226 DEACONESS REGIONAL HEALTHCARE SERVICES ILLNOIS INC TRANSCARE MEDICAL TRANSPORT AND LOGISTICS LLC 600 MARY STREET EVANSVILLE IN 47747 810932015 MEDICAL TRANSPORT/AMBULANCE SERVICE IL 1825221 871998 DEACONESS REGIONAL HEALTHCARE SERVICES ILLINOIS INC DEACONESS HOSPITAL INC 600 MARY STREET EVANSVILLE IN 47747 350593390 HEALTHCARE IN 501(C)(3) LINE 3 DEACONESS HEALTH SYSTEM INC 0 DEACONESS HEALTH SYSTEM INC 600 MARY STREET EVANSVILLE IN 47747 351532889 HEALTHCARE IN 501(C)(3) LINE 12A, I N/A 0 DEACONESS CLINIC INC 421 CHESTNUT STREET EVANSVILLE IN 47713 263083364 HEALTHCARE IN 501(C)(3) LINE 3 DEACONESS HEALTH SYSTEM INC 0 DEACONESS VNA PLUS 610 E WALNUT ST EVANSVILLE IN 47713 465223267 HEALTHCARE IN 501(C)(3) LINE 10 DEACONESS HEALTH SYSTEM INC 0 DEACONESS SPECIALTY PHYSICIANS INC 600 MARY STREET EVANSVILLE IN 47747 824503095 HEALTHCARE IN 501(C)(3) LINE 3 DEACONESS HEALTH SYSTEM INC 0 DEACONESS HEALTH KENTUCKY INC 600 MARY STREET EVANSVILLE IN 47747 830966826 HEALTHCARE KY 501(C)(3) LINE 10 DEACONESS HEALTH SYSTEM INC 0 METHODIST HEALTH INC PO BOX 48 HENDERSON KY 42419 610461753 HEALTHCARE KY 501(C)(3) LINE 3 DEACONESS HEALTH SYSTEM INC 0 DEACONESS GIBSON HOSPITAL 1808 SHERMAN DRIVE PRINCETON IN 47670 350877575 HEALTHCARE IN 501(C)(3) LINE 3 DEACONESS HEALTH SYSTEM INC 0 HENDERSON REGIONAL HOSPITAL FOUNDATION 1305 NORTH ELM ST HENDERSON KY 42420 610944432 SUPPORT METHODIST HEALTH KY 501(C)(3) LINE 10 N/A 0 UNION COUNTY METHODIST HOSPITAL FOUNDATION 4604 US HWY 60 WEST MORGANFIELD KY 42437 611230297 SUPPORT METHODIST HEALTH KY 501(C)(3) LINE 10 N/A 0 GIBSON GENERAL HEALTH FOUNDATION INC 1808 SHERMAN DRIVE PRINCETON IN 47670 350950175 SUPPORT DEACONESS GIBSON HOSPITAL IN 501(C)(3) LINE 12A, I DEACONESS GIBSON HOSPITAL 0 HEALTHCARE RESOURCE SOLUTIONS LLC 600 MARY STREET EVANSVILLE IN 47747 833275390 HEALTHCARE IN N/A 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 DEACONESS HEALTH SYSTEM INC C 805871 COST