2017-08-09T08:16:43-05:00 2016-09-30 273858252 DEAN DORTON ALLEN FORD PLLC 106 W VINE STREET SUITE 600 LEXINGTON KY 40507 990 2015-10-01 350877575 GIBSON GENERAL HOSPITAL INC GIBS 8123853401 1808 SHERMAN DRIVE PRINCETON IN 47670 EMMETT C SCHUSTER CEO 8123853401 2017-08-08 1 LEIGH MCKEE P00169845 8592552341 2015 2021-01-29 14:40:06Z EMMETT C SCHUSTER 1808 SHERMAN DRIVE PRINCETON IN 47670 33917144 0 X WWW.GIBSONGENERAL.COM X 1941 IN TO PROVIDE HIGH QUALITY, PATIENT-CENTERED, COST-EFFECTIVE CARE FOR PEOPLE IN THE COMMUNITY. 16 15 430 54 0 0 87755 111233 34349394 33111853 226562 351120 457321 342938 35121032 33917144 0 0 0 0 18014317 18255806 0 0 0 17486310 15836238 35500627 34092044 -379595 -174900 21739217 20555925 11818988 10599013 9920229 9956912 THE MISSION OF GIBSON GENERAL HOSPITAL AND THE SKILLED NURSING FACILITY IS TO PROVIDE HIGH QUALITY, PATIENT-CENTERED, COST-EFFECTIVE CARE FOR PEOPLE IN OUR COMMUNITY. 0 0 29576099 33128496 THE HOSPITAL'S MISSION IS TO PROVIDE HIGH QUALITY AND COST-EFFECTIVE HEALTHCARE, WHICH INCLUDES PATIENT, OUTPATIENT, AND EMERGENCY CARE SERVICES TO THE RESIDENTS OF THE SURROUNDING TRI-STATE AREA. ALL EXPENSES RELATE TO COSTS ASSOCIATED WITH PROVIDING THESE SERVICES, AND MAINLY INCLUDE SALARIES AND WAGES TO STAFF AND SUPPLIES COST. THERE WERE 365 ADMISSIONS AND 32,046 VISITS DURING THE YEAR. 29576099 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 1 64 0 1 430 1 0 0 0 0 0 0 0 0 0 0 X 16 15 0 1 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 1 1 0 IN X THE ORGANIZATION 8123853401 1808 SHERMAN DRIVE PRINCETON IN 47670 MICHAEL GREEN BOARD MEMBER 2.00 X 0 0 0 ROBERT GIBSON JR BOARD CHAIRMAN 2.00 X 0 0 0 MARION JOCHIM BOARD VICE-CHAIR 2.00 X 0 0 0 DONALD J HAUKE BOARD MEMBER 2.00 X 0 0 0 MIKE WOOD SECRETARY 2.00 X 0 0 0 DR KRISHNA MURTHY CHIEF OF STAFF 2.00 X 0 0 0 GEORGE ANKENBRAND BOARD MEMBER 2.00 X 0 0 0 GEORGE A BALLARD BOARD MEMBER 2.00 X 0 0 0 DR HM BREWSTER BOARD MEMBER 2.00 X 0 0 0 BRAD SCHMITT BOARD MEMBER 2.00 X 0 0 0 LARRY JOHNSON BOARD MEMBER 2.00 X 0 0 0 J ROBERT KINKLE SECOND VICE-CHAIR 2.00 X 0 0 0 DR MS KRISHNA BOARD MEMBER 2.00 X 0 0 0 STEPHEN LANKFORD BOARD MEMBER 2.00 X 0 0 0 SHERRI SMITH BOARD MEMBER 2.00 X 0 0 0 SUSAN STRAUB TREASURER 2.00 X 0 0 0 RON HARRINGTON CHIEF FINANCIAL OFFICER 42.31 X 128854 0 3097 EMMETT C SCHUSTER CHIEF EXECUTIVE OFFICER 42.31 X 219575 0 13440 LORI PHILLIPS CHIEF NURSING OFFICER 40.00 X 145523 0 4145 JIM CHILDERS CHIEF FINANCIAL OFFICER 42.31 X 0 0 0 DORIS A BEST PHYSICIAN 40.00 X 208352 0 8455 RICHARD M CLARK PHYSICIAN 41.54 X 205007 0 17783 KWABENA OWUSU-DEKYI PHYSICIAN 40.77 X 175292 0 13898 COREY A POTTS CRNA 40.00 X 232041 0 12987 STEPHEN R SHOEMAKER PHYSICIAN 43.10 X 226176 0 10617 1540820 0 84422 8 0 1 0 THOMAS JOSEPH MD 1808 SHERMAN DRIVE PRINCETON IN 47670 MEDICAL PRO FEES 585640 BLAKE TITZER 12011 PROSPECT COURT EVANSVILLE IN 47720 MEDICAL PRO FEES 374542 PHILOMINA THURUTHUMALY MD 1707 BRENTWOOD DRIVE PRINCETON IN 47670 MEDICAL PRO FEES 243750 ALLIANT MANAGEMENT SERVICES 12800 B MERIDIAN ST SUITE 400 CARMEL IN 46032 HOSPITAL MANAGEMENT 144661 MEDICAL STAFFING SOLUTIONS LLC 9700 HWY 57 NORTH SUITE A EVANSVILLE IN 47725 HOSPITAL STAFFING 142358 6 75583 35650 111233 PATIENT SERVICE 621400 33111853 33111853 33111853 137253 137253 169614 0 169614 169614 169614 213867 0 213867 213867 213867 CAFETERIA SALES 722210 156681 156681 MISCELLANEOUS INCOME 900099 16643 16643 173324 33917144 33128496 0 677415 X 501472 451325 50147 13615767 12254190 1361577 164825 110433 54392 2990095 2332274 657821 983647 885282 98365 112347 112347 8399 8399 4872101 4246752 625349 203540 203540 88586 86814 1772 666412 546458 119954 115809 81066 34743 244291 232076 12215 1253796 1191106 62690 331586 189004 142582 BAD DEBT 2889599 2889599 SUPPLIES 2382840 2118624 264216 REPAIRS & MAINTENANCE 903314 632320 270994 DUES & SUBSCRIPTIONS 710133 497093 213040 1053485 831683 221802 34092044 29576099 4515945 0 277238 1112783 1000000 1003961 3679146 3399288 439566 453251 816213 756580 174946 273611 34873224 23507731 12078250 11365493 3221927 2144017 51931 46941 21739217 20555925 2479739 2488341 29417 69297 7469980 6714094 1839852 1327281 11818988 10599013 X 9868298 9909971 51931 46941 9920229 9956912 21739217 20555925 X -174900 211583 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 421244 421244 19903821 11222558 8681263 14241503 12114688 2126815 306656 170485 136171 11365493 1 1 X 1 X 1 X 280.000000000000 1 1 1 0 1 1 381723 381723 0.01120 4914843 1063675 3851168 0.11300 5296566 1063675 4232891 0.12420 3707 1610 2097 0.00010 1500 1500 0.00000 3763 3763 0.00010 8970 1610 7360 0.00020 5305536 1065285 4240251 0.12440 1 2880350 7855876 8023889 -168013 X 1 1 1 1 GIBSON GENERAL HOSPITAL INC 1808 SHERMAN DRIVE PRINCETON IN 47670 X X X X GIBSON GENERAL HOSPITAL INC 1 0 0 1 X X X X X X X X 15 1 0 0 1 X WWW.GIBSONGENERAL.COM X 1 15 0 1 0 1 X 100.000000000000 280.000000000000 1 1 X X X 1 X X 1 0 X X X 1 X 0 0 GIBSON GENERAL HOSPITAL INC PART V, SECTION B, LINE 5: INPUT WAS GATHERED AND ANALYZED FROM INDIVIDUALS THAT REPRESENT THE BROAD INTERESTS OF THE COMMUNITY, INCLUDING THOSE WITH SPECIAL KNOWLEDGE OF OR EXPERTISE IN THE HEALTHCARE INDUSTRY, DURING THE COURSE OF PREPARING THE COMMUNITY HEALTH NEEDS ASSESSMENT. GIBSON GENERAL HOSPITAL INC PART V, SECTION B, LINE 11: NEEDS WERE IDENTIFIED AFTER REVIEW OF THE SURVEY GIVEN. THE HOSPITAL IS PRIORITIZING THE ITEMS FROM THE COMMUNITY INPUT AND EVALUATING THE RESOURCES NEEDED TO ADDRESS THE TOP COMMUNITY NEEDS. OBESITY AND ASSISTED LIVING ARE TWO AREAS THAT THE HOSPITAL DOES NOT HAVE THE RESOURCES CURRENTLY TO MEET THE COMMUNITY CONCERNS AND NEEDS IDENTIFIED IN ITS MOST RECENTLY CONDUCTED CHNA.PLEASE SEE THE ATTACHED IMPLEMENTATION POLICY TO SEE HOW THE HOSPITAL IS ADDRESSING THE SIGNIFICANT NEEDS IDENTIFIED IN ITS MOST RECENTLY CONDUCTED CHNA. 5 1 - STAR ONE REHAB 1808 SHERMAN DRIVE PRINCETON IN 47670 PHYSICAL THERAPY, OCCUPATIONAL THERAPY, SPEECH THERAPY 2 - PHYSICIAN OUTPATIENT CLINICS 1808 SHERMAN DRIVE PRINCETON IN 47670 SUBSIDIZED CARE PHYSICIAN PRACTICES 3 - HOPE HOUSE 1808 SHERMAN DRIVE PRINCETON IN 47670 GERIATRIC CONSULTING MEDICATION MANAGEMENT 4 - LIFESTYLES DIABETES CENTER 1808 SHERMAN DRIVE PRINCETON IN 47670 DIABETES EDUCATION COUNSELING 5 - GGH - SKILLED NURSING FACILITY 1808 SHERMAN DRIVE PRINCETON IN 47670 SKILLED NURSING REHAB CENTER SCHEDULE H GIBSON GENERAL HOSPITAL, INC. (GGH) IS A NOT-FOR-PROFIT 501(C)(3) CORPORATION OPERATING A 25-BED CRITICAL ACCESS HOSPITAL WITH AN ATTACHED 45-BED SKILLED NURSING FACILITY LOCATED IN PRINCETON, INDIANA. THE HOSPITAL HAS BEEN IN THE COMMUNITY SINCE 1907, AND MOVED TO ITS CURRENT LOCATION IN 1962.THE ACUTE-CARE FACILITY HOUSES PHYSICIAN PRACTICES, INCLUDING FAMILY MEDICINE, GENERAL SURGERY AND ORTHOPEDIC SURGERY; OUTPATIENT CLINICS, SUCH AS A OCCUPATIONAL MEDICINE CLINIC, PAIN MANAGEMENT CENTER, SLEEP DIAGNOSTICS CENTER, AND A SPECIALTY CLINIC THAT HOUSES ROTATING SPECIALISTS, INCLUDING ALLERGY/IMMUNOLOGY, CARDIOLOGY, GASTROENTEROLOGY, GYNECOLOGY, OPHTHALMOLOGY, OTOLARYNGOLOGY, PSYCHOLOGY AND UROLOGY; A HOME HEALTH AGENCY; AND A 45-BED SKILLED NURSING FACILITY.OFF-SITE FACILITIES INCLUDE ONE FAMILY MEDICINE CLINIC, LOCATED 1.5 MILES AWAY IN DOWNTOWN PRINCETON, AND ONE FAMILY MEDICINE CLINIC AND AN OUTPATIENT REHABILITATION OFFICE LOCATED 10 MILES FROM THE HOSPITAL OFF HWY. 41 IN FORT BRANCH, INDIANA. IN ADDITION TO THE FAMILY MEDICINE CLINIC IN FORT BRANCH, THE HOSPITAL ALSO OPERATES A BRANCH OF ITS REHABILITATION AND SPORTS THERAPY SERVICES IN THE SAME OFFICE COMPLEX.IN ADDITION TO THE SERVICES MENTIONED ABOVE, GGH OFFERS A FULL RANGE OF INPATIENT AND OUTPATIENT SERVICES, INCLUDING: ACUTE HOSPITAL CAREBEHAVIORAL HEALTH SERVICES OUTPATIENT MENTAL HEALTH SERVICES EMPLOYEE ASSISTANCE PROGRAM BUSINESS HEALTH SERVICES IME MEDICAL SURVEILLANCE CONTRACTED ON-SITE STAFFING PHYSICAL EXAMS: DEPT. OF TRANSPORTATION, PRE-PLACEMENT, RETURN-TO-WORK, FIT-FOR-DUTY AND EXECUTIVE DRUG & ALCOHOL TESTING SCREENINGS: HEARING, VISION AND SPIROMETRY WORK-RELATED DISABILITY EVALUATIONS CPR/AED/FIRST AID HEPATITIS B AND FLU IMMUNIZATIONS DIAGNOSTIC TESTING: LAB AND X-RAY, RESPIRATOR CLEARANCE & FIT TESTING CARE EMPLOYEE ASSISTANCE PROGRAM WORK CONDITIONING/WORK HARDENING ERGONOMIC ASSESSMENTS: WORKSTATION ANALYSIS, FUNCTIONAL JOB ANALYSIS AND PRE WORK SCREEN DEVELOPMENTCARDIOPULMONARY SERVICES CARDIAC EVENT MONITORING CARDIAC REHABILITATION - PHASES I TO III ECHOCARDIOGRAPHY STRESS TESTING PULMONARY REHABILITATION RESPIRATORY THERAPYDIABETES PROGRAM (LIFESTYLES DIABETES CENTER) DIABETES EDUCATION & MANAGEMENTEMERGENCY ROOMGIBSON HOME HEALTH SERVICES SKILLED NURSING CARE PHYSICAL THERAPY HOME CARE AID OCCUPATIONAL THERAPY SPEECH THERAPY MEDICAL SOCIAL SERVICES GUARDIAN MEDICAL MONITORINGINFUSION THERAPY SERVICES BLOOD PRODUCTS CHEMOTHERAPY IV MEDICATION AND HYDRATIONLABORATORY SERVICESMEDICAL/SURGICAL OUTPATIENT SERVICESMULTI-SPECIALTY HEALTH CENTERNUTRITION COUNSELINGONCOLOGY/HEMATOLOGY SERVICESORTHOPEDIC SERVICESPAIN MANAGEMENT CENTERRADIOLOGY SERVICES DIGITAL MAMMOGRAPHY CT SCAN DXA SCAN BONE DENSITY SCREENING FLUOROSCOPY MRI NUCLEAR MEDICINE ULTRASOUND X-RAYREHABILITATION & THERAPY SERVICES (STAR ONE) ATHLETIC TRAINING BALANCE ASSESSMENT BURN THERAPY ERGONOMIC ASSESSMENT HAND THERAPY OCCUPATIONAL THERAPY PEDIATRIC THERAPY PHYSICAL THERAPY SPEECH THERAPY WOUND CARESKILLED NURSING FACILITY SLEEP DIAGNOSTIC CENTER (OVERNIGHT AND OUTPATIENT TAKE-HOME STUDIES)SURGICAL SERVICES - INPATIENT & OUTPATIENTSWING BED PROGRAMTRI-STATE LAPAROSCOPIC HERNIA CENTERWELLNESS CLINIC PART III, LINE 2: PERCENT OF TOTAL EXPENSE $2,880,350 OF BAD DEBT EXPENSE IS INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN A (TOTAL FUNCTIONAL EXPENSES), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN, SCHEDULE H, PART III, SECTION A, LINE 2. METHODOLOGY USED TO ESTIMATE BAD DEBT ACCOUNTS ARE BILLED TO THE APPROPRIATE INSURANCE AND ONCE PAYMENT IS RECEIVED AND THE BALANCE AMOUNT IS THE PATIENT'S RESPONSIBILITY, THE ACCOUNTS ARE SENT LETTERS FOR THE BALANCE DUE. IF NOT PAID WITHIN 30 DAYS, ACCOUNTS ARE SENT TO COLLECTIONS TO WORK BASED ON LAST NAME ON THE ACCOUNT. IF THE ACCOUNT IS NOT PAID WITHIN 150 DAYS, THE ACCOUNT IS SENT BACK TO THE HOSPITAL AND THEN THE ACCOUNT IS WRITTEN OFF AS UNCOLLECTIBLE. PART III, LINE 8: THE HOSPITAL IS A CRITICAL ACCESS HOSPITAL AND IS REIMBURSED 101%, LESS 2% SEQUESTRATION, OF MEDICARE ALLOWANCE COSTS FOR INPATIENT SERVICES, SWING BED, AND OUTPATIENT PART B SERVICES. THE SEQUESTRATION IS THE REASON FOR THE SHORTFALL. PART III, LINE 9B: COLLECTION PRACTICES ARE APPLIED TO ALL PATIENTS AT GIBSON GENERAL HOSPITAL PRIORITIZING THE ITEMS FROM THE COMMUNITY INPUT AND EVALUATING THE RESOURCES NEEDED TO ADDRESS THE TOP COMMUNITY NEEDS. PART VI, LINE 2: GIBSON COUNTY, INDIANA, IS LOCATED IN SOUTHWESTERN INDIANA, APPROXIMATELY 146 MILES SOUTHWEST OF INDIANAPOLIS AND 25 MILES NORTH OF EVANSVILLE, INDIANA. WITH A POPULATION OF 33,503, GIBSON COUNTY IS THE PRIMARY SERVICE AREA FOR THE HOSPITAL. IN ADDITION, THE HOSPITAL SERVES PATIENTS FROM NEIGHBORING COUNTIES.BETWEEN APRIL AND JULY 2015, THE HOSPITAL PARTNERED WITH THE INDIANA RURAL HEALTH ASSOCIATION (IRHA) TO CONDUCT A COMMUNITY HEALTH NEEDS ASSESSMENT TO IDENTIFY AREAS OF GREATEST NEED IN GIBSON COUNTY. THROUGH THE COLLECTION OF HEALTH DATA AND COMMUNITY INPUT ON THE COUNTY'S ASSETS, VALUES, AND WEAKNESSES WITHIN THE HOSPITAL'S SERVICE AREA, THE FOLLOWING NEEDS WERE IDENTIFIED AS BEING OF THE HIGHEST IMPORTANCE: IDENTIFIED NEEDS: - FITNESS/ACTIVITY - CHRONIC DISEASE PREVENTION/TREATMENT - MENTAL HEALTH SERVICES AVAILABILITY - HEALTHCARE ACCESS AND QUALITY - LIVING CONDITIONS - DRUG AND TOBACCO MISUSE ADDITIONALLY, TO AID GIBSON GENERAL HOSPITAL IN THE CREATION OF AN ACTION PLAN, THE IRHA MADE PRELIMINARY RECOMMENDATIONS FOR DEALING WITH THE DEFINED AREAS OF NEED.RECOMMENDATIONS: FITNESS/ACTIVITY: - EVALUATE OPPORTUNITY TO CREATE WALKING/BIKING PATHS IN COMMUNITY - EXERCISE PROGRAMS INDOORS AND OUTDOORS - WELLNESS PROGRAMS - SCREENINGS FOR BLOOD PRESSURE/HEART RATE AND BMI - COMMUNITY ACTIVITIES - EVENTS IN THE PARK - FAMILY NIGHTS OUT - FAMILY ADVENTURE NIGHTS - MONTHLY FITNESS NEWSLETTER - COUNTY BIGGEST LOSER WITH INCENTIVES CHRONIC DISEASE: - FOCUS EDUCATION ON THE BENEFITS OF SCREENING AND EARLY DETECTION - FOCUS ON EVIDENCE-INFORMED SKILL-BASED PROGRAMS IMPLEMENT SELF-MANAGEMENT INITIATIVES ACCORDING TO IOM RECOMMENDATIONS - HEALTHY EATING AND WEIGHT REGULATION - EXERCISE PROGRAMS MENTAL HEALTH SERVICES AVAILABILITY: - IDENTIFY SERVICES AND PROVIDERS IN GIBSON COUNTY - REFER PATIENTS TO MENTAL HEALTH SERVICES HEALTHCARE ACCESS AND QUALITY: - MARKET AVAILABILITY OF SERVICES AND COST COMPARISONS VS. OTHER COMMUNITIES -IDENTIFY AREAS FOR IMPROVED POLICIES AND PROCEDURES TO ENSURE BEST PRACTICES ARE ACHIEVED AND DOCUMENTED-COLLABORATE WITH PHYSICIANS TO IMPROVE QUALITY AND ACCESS -COMPLETE A MARKET ANALYSIS FOR URGENT CARE FACILITY LIVING CONDITIONS: - FOCUS ON IMPROVING WHAT IS ALREADY IN PLACE - EVALUATE MARKET FOR HEALTH LIVING FACILITY, SUCH AS THE YMCA - EVALUATE OPPORTUNITY OF OUTPATIENT REHAB THROUGH GGH INTO COMMUNITY LIVING DYNAMICDRUGS: - FOCUS ON EDUCATION REGARDING THE EFFECTS OF DRUGS ON HEALTH - PARTNER WITH LOCAL AND STATE AGENCIES TO LEVERAGE DRUG EDUCATION SUPPORT - CREATE A CULTURE OF HEALTH - CREATE PARENT GROUPS - INVOLVE SOCIAL SERVICE AGENCIES - INCREASE SERVICES FOR MENTAL HEALTH NEEDS SEE ATTACHMENT FOR THE HOSPITAL'S IMPLEMENTATION PLAN BASED OFF THESE RECOMMENDATIONS. PART VI, LINE 3: THE HOSPITAL HAS POSTERS IN THE CENTRAL REGISTRATION AND EMERGENCY ROOM WAITING AREA INFORMING PATIENTS THAT WE SEE PATIENTS REGARDLESS OF THEIR ABILITY TO PAY AND ALSO PROVIDE FINANCIAL ASSISTANCE TO UNINSURED AND UNDERINSURED IN COMPLIANCE WITH EMTALA. ALL EMERGENCY ROOM PATIENTS ARE SEEN BY A PRACTITIONER PRIOR TO SOLICITATION OF FINANCIAL ASSISTANCE OR INSURANCE INFORMATION. ALL PATIENTS WHO DO NOT HAVE INSURANCE AND PATIENTS WHO HAVE BALANCES AFTER INSURANCE ARE CONTACTED BY OUR PATIENT FINANCIAL COUNSELOR BY MAIL WITH A FINANCIAL ASSISTANCE APPLICATION. PART VI, LINE 4: THE HOSPITAL'S PRIMARY SERVICE AREA ENCOMPASSES GIBSON COUNTY, INDIANA, SW PIKE COUNTY, AND POSEY COUNTY, INDIANA. GIBSON COUNTY HAS A POPULATION DENSITY OF 66/SQ MILE. SW PIKE COUNTY HAS A POPULATION DENSITY OF 38/SQ MILE. GIBSON GENERAL HOSPITAL HAS TWO LARGE COMPETING HEALTHCARE SYSTEMS 35 MILES TO THE SOUTH. TRADITIONALLY, THE HOSPITAL HAS BEEN RELIED UPON AS A SAFETY NET HOSPITAL FOR OLDER PATIENTS, LOW-INCOME PATIENTS, AND PATIENTS WITH LIMITED MEANS TO TRAVEL TO THE LARGER CITY OF EVANSVILLE, INDIANA. MUCH OF GIBSON COUNTY IS RURAL WITH AGRICULTURE AND COAL MINING AS PRIMARY INDUSTRIES. GIBSON COUNTY DOES ENJOY SOME ECONOMIC BENEFIT FROM TOYOTA MANUFACTURING OF INDIANA. IN ADDITION, APPROXIMATELY 75-80% OF THE HOSPITAL'S PATIENT POPULATION IS FUNDED BY MEDICARE, MEDICAID AND OR OTHER GOVERNMENT SUBSIDIZED PLANS. PART VI, LINE 5: THE HOSPITAL IS INVOLVED IN NUMEROUS COMMUNITY BUILDING ACTIVITIES WHICH PROMOTE THE HEALTH OF THE COMMUNITIES IT SERVES. NUMEROUS COMMUNITY CONCERNS ARE ADDRESSED, INCLUDING HEALTH IMPROVEMENT, EDUCATION, SAFETY, AND ACCESS TO CARE. THE HOSPITAL ENCOURAGES ITS EMPLOYEES TO SERVE ON COMMUNITY BOARDS AND PARTICIPATE IN HEALTH PROGRAMS THAT PROMOTE BETTER HEALTH AND COMMUNITIES. THE HOSPITAL PARTNERS WITH STATE AND COUNTY-WIDE AGENCIES, INCLUDING SCHOOL CORPORATIONS, EMPLOYERS AND AREA HEALTH PROVIDERS TO PROMOTE HEALTH AND WELLNESS AND PREVENT DISEASE. THESE ACTIVITIES INCLUDE, BUT ARE NOT LIMITED TO:1. OFFERING DISCOUNTED HEART-HEALTH AND BREAST CANCER SCREENINGS FOR WOMEN.2. WORKING WITH SCHOOLS TO PROVIDE EDUCATION ABOUT HEALTH CAREERS, AND HOW EDUCATION IMPACTS FUTURES.3. WORKING WITH SCHOOLS TO OFFER FREE ATHLETIC PHYSICALS.4. WORKING WITH AREA EMPLOYERS ON HEALTH PROMOTION, SCREENING AND WELLNESS OPPORTUNITIES FOR THEIR EMPLOYEES.5. OFFERING A SAFE, CONVENIENT TRICK-OR-TREAT LOCATION FOR AREA CHILDREN.6. SPONSORING VARIOUS EDUCATIONAL GUIDES TO ENSURE HEALTH, SAFETY AND DRUG AWARENESS EDUCATION TAKES PLACE IN AREA SCHOOLS. PART VI, LINE 6: GIBSON GENERAL HOSPITAL IS NOT PART OF AN AFFILIATED HEALTHCARE SYSTEM. THE HOSPITAL DOES PARTICIPATE IN SEVERAL COALITIONS AND COOPERATIVES WITH OTHER PROVIDERS AND OFTEN COLLABORATES WITH THE LARGER SYSTEM IN THE EVANSVILLE AREA TO PROVIDE ACCESS TO SERVICES THE HOSPITAL CANNOT PROVIDE SUCH AS CARDIAC AND NEUROLOGICAL SURGERY. X X X 0 0 0 0 0 0 0 0 0 EMMETT C SCHUSTER CHIEF EXECUTIVE OFFICER 219575 0 0 0 0 0 3624 0 9816 0 233015 0 0 0 DORIS A BEST PHYSICIAN 208352 0 0 0 0 0 4044 0 4411 0 216807 0 0 0 RICHARD M CLARK PHYSICIAN 205007 0 0 0 0 0 4206 0 13577 0 222790 0 0 0 KWABENA OWUSU-DEKYI PHYSICIAN 175292 0 0 0 0 0 3580 0 10318 0 189190 0 0 0 COREY A POTTS CRNA 232041 0 0 0 0 0 4704 0 8283 0 245028 0 0 0 STEPHEN R SHOEMAKER PHYSICIAN 226176 0 0 0 0 0 0 0 10617 0 236793 0 0 0 A CITY OF PRINCETON 356001169 2005-06-01 7100000 CAPITAL IMPROVEMENTS 0 0 0 B CITY OF PRINCETON 356001169 2007-10-01 2096000 ENERGY CONSERVATION PROJECT 0 0 0 C CITY OF PRINCETON 356001169 2008-12-01 2500000 RENOVATIONS - EMERGENCY DEPARTMENT 0 0 0 A 7100000 55566 7044434 2009 0 1 1 1 B 2096000 2096000 2008 0 0 1 1 C 2500000 31500 2468500 2009 0 0 1 1 A 0 0 0 0 0 0 1 B 0 0 0 0 0 0 1 C 0 0 0 0 0 0 1 A 0 0 1 0 1 0 0 0 1 B 0 0 1 0 1 0 0 0 1 C 0 0 1 0 1 0 0 0 1 A 1 B 1 C 1 LEANN COOPER SEE PART V 51751 COMPENSATION PAID BY GGH 0 SCHEDULE L, PART IV, LINE 1B LEANN COOPER IS THE EXECUTIVE DIRECTOR OF GIBSON GENERAL HEALTH FOUNDATION AND IS THE DAUGHTER OF BOARD MEMBER, DR. MICHAEL GREEN. THE HOSPITAL COMPENSATES FOR THE SALARY OF THE EXECUTIVE DIRECTOR OF THE GIBSON GENERAL HEALTH FOUNDATION. FORM 990, PART VI, SECTION A, LINE 3 THE HOSPITAL OBTAINS MANAGEMENT SUPPORT THROUGH ALLIANT MANAGEMENT SERVICES. FORM 990, PART VI, SECTION B, LINE 11 AN OFFICER OF THE BOARD REVIEWS THE 990 ON BEHALF OF THE BOARD OF DIRECTORS BEFORE FILING. FORM 990, PART VI, SECTION B, LINE 12C THE BOARD OF TRUSTEES SIGNS A CONFLICT OF INTEREST STATEMENT ANNUALLY AND THE CEO OR A COMPLIANCE OFFICER REVIEWS THE SIGNED STATEMENTS. ANY BOARD MEMBER WHO HAS A CONFLICT OF INTEREST RECUSES HIMSELF OR HERSELF FROM VOTING ON THE RELATED ISSUE. FORM 990, PART VI, SECTION B, LINE 15 THE CEO OR TOP MANAGEMENT OFFICIAL'S COMPENSATION IS REVIEWED ANNUALLY AND APPROVED BY THE BOARD OF TRUSTEES COMPENSATION COMMITTEE. THE COMMITTEE USES A COMPENSATION CONSULTANT, COMPENSATION SURVEY, AND COMPARATIVE DATA FROM SIMILAR ORGANIZATIONS TO DETERMINE THE CEO'S COMPENSATION. OFFICER COMPENSATION IS REVIEWED ANNUALLY BY THE CEO. COMPENSATION SURVEYS ARE USED IN DETERMINING OFFICER COMPENSATION. FORM 990, PART VI, SECTION C, LINE 19 THE HOSPITAL'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST, AT THE DISCRETION OF THE BOARD OF DIRECTORS AND MANAGEMENT. FORM 990, PART IX, LINE 11G CONTRACTED SERVICES: PROGRAM SERVICE EXPENSES 159,133. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 159,133. PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 1,979,172. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,979,172. PHYSICIAN FEES: PROGRAM SERVICE EXPENSES 2,108,447. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,108,447. CONSULTING FEES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 625,349. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 625,349. FORM 990, PART XI, LINE 9: PAIN MANAGEMENT MINORITY INTEREST -111,907. CHANGE IN BENEFICIAL INTEREST IN ASSETS AT COMMUNITY -4,990. JOINT VENTURE EQUITY - PAIN MANAGEMENT 328,480. FORM 990, PART XII, LINE 2C THE HOSPITAL'S BOARD AND SENIOR MANAGEMENT ASSUME RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT AND THE SELECTION OF THE INDEPENDENT AUDITOR. THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. GIBSON GENERAL HEALTH FOUNDATION INC 1808 SHERMAN DRIVE PRINCETON IN 47670 350950175 PHILANTHROPIC SUPPORT OF THE HOSPITAL IN 501(C)(3) LINE 11D, III-O N/A 0 GIBSON GENERAL HOSPITAL PAIN MANAGEMENT LLC 1808 SHERMAN DRIVE PRINCETON IN 47670 472156126 PAIN MANAGEMENT SERVICES IN GIBSON GENERAL HOSPITAL RELATED 58073 353730 0 0 0.51000 0 0 1 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 GIBSON GENERAL HEALTH FOUNDATION INC C 75583 COST