2017-02-15T15:35:12-06:00 2016-09-30 351178661 Blue & Co LLC 500 N Meridian St Suite 200 Indianapolis IN 46204 990 2015-10-01 350593390 Deaconess Hospital Inc DEAC 8124503296 600 Mary Street Evansville IN 47747 Shawn W McCoy Chief Administrative Officer 8124503296 2017-02-13 1 Carrie A Merrill CPA P00832283 3176334705 2017-02-10 2015 2021-01-29 14:40:06Z SHAWN W MCCOY CAO 600 Mary Street Evansville IN 47747 953444378 0 X www.deaconess.com X 1895 IN PROVIDE QUALITY HEALTH CARE SERVICES WITH A COMPASSIONATE AND CARING SPIRIT CONTINUE TO SCH O TO PERSONS, FAMILIES AND COMMUNITIES OF THE TRI-STATE. 18 11 5667 158 13030443 0 1644867 2030190 665781752 683619698 17303274 16188212 62063963 69611307 746793856 771449407 837277 1150755 0 0 277414878 301561936 0 0 450982 318504910 358007989 596757065 660720680 150036791 110728727 1080917664 1238423966 387504210 457277189 693413454 781146777 X See Schedule O. 0 0 142924563 0 366519211 Patient Service Revenue. See schedule o. 438795659 0 314792638 Charity Care/Subsidized Care. See Schedule O. 13707405 0 2307849 GRADUATE MEDICAL EDUCATION, MEDICAL EDUCATION AND COMMUNITY BENEFIT. SEE SCHEDULE O. 1150755 1150755 37431239 1150755 1150755 37431239 596578382 1 1 0 1 0 0 0 0 0 1 1 0 0 0 1 1 0 1 0 0 0 0 0 0 1 0 1 1 1 0 1 1 0 1 0 0 0 0 0 1 1 1 1 0 0 0 1 1 1 1 0 0 1 314 0 1 5667 1 1 1 0 0 0 0 1 1 0 0 0 0 X 18 11 0 0 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 1 1 1 1 IN X Cheryl A Wathen 8124503296 600 Mary Street Evansville IN 47747 Linda White President/ CEO 30.00 35.00 X X 1302624 377647 246346 Steven Titzer Chairman 5.00 10.00 X 0 0 0 Daniel Hermann Vice Chairman 5.00 5.00 X 0 0 0 John Engelbrecht Treasurer 5.00 5.00 X 0 0 0 Bruce Stallings Secretary 5.00 5.00 X 0 0 0 Bruce Adye MD Director 5.00 5.00 X 0 0 0 Maqbool Ahmed MD Director 5.00 55.00 X 0 1057702 56030 Jerome Benkert Jr Director 5.00 5.00 X 0 0 0 dr Linda Bennett Director 5.00 5.00 X 0 0 0 steven Church Director 5.00 5.00 X 0 0 0 lisa Collins Director 5.00 5.00 X 0 0 0 rev Dr Joseph Fraccaro Director 5.00 5.00 X 0 0 0 Robert Keller Director (10/1-4/25/16) 5.00 5.00 X 0 0 0 David Koehler MD Director (10/1-10/31/15) 5.00 10.00 X 20928 44110 0 Mathias Kolleck II director 50.00 5.00 X 393431 5200 42352 Barry Phillips MD Director 5.00 55.00 X 10220 438674 34428 Sharon Reed Walker Director 5.00 5.00 X 0 0 0 David Ryon MD Director 50.00 5.00 X 486475 4600 41747 Jonathan Weinzapfel Director 5.00 5.00 X 0 0 0 Daniel WHITEHEAD MD Director 5.00 5.00 X 0 0 0 Shawn McCoy Chief Administrative Officer 50.00 10.00 X 847480 7400 169269 Cheryl Wathen Chief Financial Officer 30.00 35.00 X 424339 221086 154318 James Porter MD Chief Medical Officer 50.00 10.00 X 696559 3200 158980 Cherona Hajewski Chief Nursing Officer 50.00 0.00 X 431326 0 117468 Kathy Schenk HR Director 50.00 0.00 X 150877 0 36230 Lynn Lingafelter Vice President of Operations 50.00 0.00 X 345594 0 93010 Marc Florence Vice President 50.00 5.00 X 237549 0 55095 Kenneth Dicken Controller, Director Finance 50.00 0.00 X 230326 2800 25851 Richard Perry Controller 50.00 0.00 X 205700 0 27329 Carolyn Morton Pharmacy Director 50.00 0.00 X 182038 0 42160 LARRY PILE Attorney 25.00 0.00 X 230105 0 39974 Venkatesh Madadi MD ANESTHESIOLOGIST 50.00 0.00 X 766676 0 50841 Nirmal Joshi MD Anesthesiologist 50.00 0.00 X 714905 0 43028 Rajesh Patel MD Anesthesiologist 50.00 0.00 X 643075 0 42728 Dan Vardi MD Physician 50.00 0.00 X 635030 0 38773 Candido Guiao MD Anesthesiologist 50.00 0.00 X 587904 0 36459 G William Kennedy Former HR Director 0.00 0.00 X 146425 0 11310 9689586 2162419 1563726 257 1 1 0 EVANSVILLE SURGERY CENTER PO Box 2185 Evansville IN 47728 Surgical Services 27843423 Progressive Health Indiana LLC 150 N Rosenberger Ave evansville IN 47712 Physical Therapy 15041058 Tri-State Radiation Oncology 1500 Rosecrans Avenue Ste 400 Manhattan Beach CA 90266 Oncology Services 7835019 Evolent Health LLC 800 glebe rd Suite 500 Arlington VA 22203 consulting services 7128097 CH Garmong Son Inc 3050 Poplar St Terre Haute IN 47803 construction services 5691487 73 392100 156674 1481416 37640 2030190 Net patient Revenue 900099 683619698 683619698 683619698 14367824 14367824 8354208 3186222 5167986 5167986 5167986 179890527 569288 178454358 185069 1436169 384219 1820388 1820388 43480 392100 169322 -125842 -125842 INVESTMENT IN JOINT VENTURES 900099 34401889 34401889 Other Hospital Services 900099 14072012 14072012 Laboratory Sales 621500 12275945 12275945 3819317 3029350 754498 35469 64569163 771449407 721050937 13030443 35337837 X 1150755 1150755 6545521 6545521 226893330 215606578 11004005 282747 15317197 14605872 690579 20746 37009911 36649676 360235 15795977 14680232 1097968 17777 2649263 1780109 869154 241018 241018 15646 15646 623718 600317 23401 94444947 73852288 20565405 27254 1126864 104716 1022148 12190397 10378015 1770632 41750 11284865 9329496 1955369 18357895 16791337 1566558 950112 818828 131284 1177155 838581 330811 7763 6964472 6964472 38418814 35581201 2837613 3724512 2434997 1289515 Medical/Surgical Suppli 112337570 112337570 Medicaid Assessment Fee 19733745 19733745 Equip Rental/Maintenanc 13712879 12892975 819904 Agency Collection Fees 7496726 5036340 2460386 12557391 5010599 7517248 29544 660720680 596578382 63691316 450982 84938943 54287091 108500680 121891403 1203431 1665608 6858270 7135745 7028211 13654386 793330825 461979172 312970967 331351653 479595643 625302549 36965695 41295362 16289093 18509986 26566731 23330183 1080917664 1238423966 72745847 68514028 258765 1540466 206636701 202156996 107862897 185065699 387504210 457277189 X 687470484 774015950 4149539 5297883 1793431 1832944 693413454 781146777 1080917664 1238423966 X 110728727 33469891 -56465295 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 15646 15646 0 Part II-B, Line 1: LOBBYING EXPENDITURES CONSISTED OF A PORTION OF MEMBERSHIP DUES TO PROFESSIONAL ORGANIZATIONS IN WHICH DEACONESS HOSPITAL AND ITS EMPLOYEES ARE MEMBERS. THE LOBBYING PORTION OF THE DUES IS NOTED ON THE MEMBERSHIP APPLICATION OR BILLING STATEMENT. 6660917 50 445045 238574 6867438 6749437 1327 -39488 50341 18 6660917 6119408 3639 662188 35798 6749437 5544426 1890 611864 38483 289 6119408 8353428 6871 541295 3357168 5544426 0.14000 0.86000 0.00000 0 0 1800662 13444419 15245081 18659207 502832573 299137355 222354425 222163513 162841817 59321696 34430451 34430451 331351653 Accrued Retirement Benefits 117840012 Estimated Third Party Settlements 5821249 TAXABLE BOND- SERIES 2012C 4560000 Capital Lease Obligations 628933 Related Organization Payables 3215505 Taxable Bond- Series 2016 53000000 185065699 X Part V, Line 4: TEMPORARILY RESTRICTED NET ASSETS INCLUDE THOSE ASSETS WHOSE USE BY THE SYSTEM HAS BEEN TEMPORARILY LIMITED PRIMARY FOR CAPITAL PROJECTS OR A SPECIFIED TIME PERIOD OR PURPOSE. TEMPORARILY RESTRICTED NET ASSETS HAVE BEEN RESTRICTED FOR USE IN PATIENT MEDICAL CARE, EDUCATION AND SCHOLARSHIPS, CAPITAL PROJECTS, AND OTHER SYSTEM SUPPORT. PERMANENTLY RESTRICTED NET ASSETS ARE CONTRIBUTED WITH DONOR RESTRICTIONS REQUIRING THEY BE HELD IN PERPETUITY WITH INCOME USED TO SUPPORT THE SYSTEM'S ACTIVITIES. PERMANENTLY RESTRICTED NET ASSETS INCLUDE BENEFICIAL INTEREST IN TRUSTS AND OTHER PERMANENT RESTRICTIONS. Part X, Line 2: accounting principles generally accepted in the united states of america require management to evaluate tax positions taken by 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, 2016 and 2015, 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 taking jurisdictions; however, there are currently no audits for any tax periods in progess. Part VII and IX: Sections are not required as the totals for each line are less than 5% of the total assets listed on Form 990, part X, line 16. PART XI AND XII: SECTIONS ARE NOT REQUIRED AS THE ORGANIZATION IS PART OF A CONSOLIDATED FINANCIAL STATEMENT. THE CONSOLIDATED FINANCIAL STATEMENT IS AUDITED BY AN INDEPENDENT ACCOUNTING FIRM AND IS PREPARED IN ACCORDANCE WITH GENERALLY ACCEPTED ACCOUNTING PRINCIPLES. DH Party of Yr 204800 177300 27500 27272 48540 9550 6504 DH Classic 230780 214800 15980 34452 669 32203 5692 4440 0 435580 392100 43480 34452 27941 80743 15242 10944 169322 -125842 1 1 X 1 X 1 X 1 1 0 1 1 11317066 11317066 0.01560 121745825 96870198 24875627 0.03420 133062891 96870198 36192693 0.04980 790278 790278 0.00110 7145974 2328151 4817823 0.00660 2712760 372970 2339790 0.00320 1934135 23038 1911097 0.00260 12583147 2724159 9858988 0.01350 145646038 99594357 46051681 0.06330 2251 2251 0.00000 27238 27238 0.00000 13633 13633 0.00000 6300 6300 0.00000 13983 13983 0.00000 74946 16674 58272 0.00010 138351 16674 121677 0.00010 1 6569954 150945812 167606353 -16660541 X 1 1 3 1 DEACONESS HOSPITAL INC 600 Mary Street Evansville IN 47747 www.deaconess.com 15-005074-1 X X X X 2 Deaconess Gateway Hospital 4011 Gateway Blvd Newburgh IN 47630 www.deaconess.com 15-005074-1 X X X X 3 DEACONESS CROSS POINTE 7200 E Indiana Street evansville IN 47715 www.deaconess.com 15-005074-1 X DEACONESS HOSPITAL INC 1 0 0 1 X X X X X X X X X 15 1 1 1 1 X http://www.deaconess.com/CHNA 1 15 1 http://www.healthyswin.org/ 0 0 1 X 200.000000000000 400.000000000000 X X 1 1 X X X X 1 X 1 X 0 X X X 1 X 0 0 DEACONESS GATEWAY HOSPITAL 2 0 0 1 X X X X X X X X X 15 1 1 1 1 X http://www.deaconess.com/CHNA X 1 15 1 http://www.healthyswin.org/ 0 0 1 X 200.000000000000 400.000000000000 X X 1 1 X X X X 1 X 1 X 0 X X X 1 X 0 0 DEACONESS CROSS POINTE 3 0 0 1 X X X X X X X X X 15 1 1 1 1 X http://www.deaconess.com/CHNA X 1 15 1 http://www.healthyswin.org/ 0 0 1 X 200.000000000000 400.000000000000 X X 1 1 X X X X 1 X 1 X 0 X X X 1 X 0 0 DEACONESS HOSPITAL, INC. Part V, Section B, Line 5: DESCRIPTION OF COMMUNITY INPUT:Teams from Deaconess Health System, St. Mary's Health, ECHO Community Health Care, Vanderburgh County Health Department, United Way of Southwest Indiana, and the Welborn Baptist Foundation planned for and executed a second Community Health Needs Assessment in 2015. With assistance from Healthy Communities Institute (HCI), data was gathered in May and June 2015 through 12 focus groups and 17 "key informant interviews." Representation included social service agencies, education, law enforcement, public service, business and industry, government, non-profit organizations, and healthcare related organizations from both Vanderburgh County and Warrick County. The secondary data used in this assessment was obtained and analyzed from the HCI Data Platform which includes a comprehensive dashboard of over 100 community health and quality of life indicators covering over 20 topic areas. Indicator values for each county were compared to other counties in Indiana and nationwide to score health topics and compare relative areas of need. Other considerations for health areas of need included trends over time, Healthy People 2020 targets, and disparities by age, gender, and race/ethnicity.Primary and secondary data were evaluated and synthesized to identify the significant community health needs in each county. These needs were assessed and prioritized taking into consideration the ability to impact change, the opportunity to intervene at a prevention level, the magnitude of the health issue, and whether or not it addresses underserved and vulnerable populations. Behavioral Health (including substance abuse, tobacco use, and mental health) and Exercise, Nutrition, and Weight were two health needs identified for both Vanderburgh and Warrick County. Maternal-child health was also selected as an identified health need for Vanderburgh County and Cancer (specifically breast and prostate) was identified for Warrick County. A work group composed of people and organizations directly involved with each identified health need has been established. These groups are in the process of selecting specific goals for their topic area and will spend the next three years collectively working toward those goals. Our collaborative also created a public website called HealthySWIN to share not only our CHNA data but all publicly reportable data relevant to the identified health needs in our community. It can be found at www.healthyswin.org. A public presentation was held on June 22, 2016 at a local library to review the 2013-2015 CHNA successes and challenges as well as reveal the results from the 2015 CHNA. Our priority areas for each county were shared at this time. DEACONESS GATEWAY HOSPITAL Part V, Section B, Line 5: Description of Community Input is reported the same as Deaconess Hospital, Inc. (Hospital Facility #1). DEACONESS CROSS POINTE Part V, Section B, Line 5: DESCRIPTION OF COMMUNITY INPUT is reported the same as Deaconess Hospital, Inc. (Hospital Facility #1). DEACONESS HOSPITAL, INC. Part V, Section B, Line 6a: Other Hospital Facilities CHNA was conducted with:Deaconess Gateway HospitalDeaconess Cross PointeSt. Mary's Health DEACONESS GATEWAY HOSPITAL Part V, Section B, Line 6a: Other Hospital Facilities CHNA was conducted is reported the same as Deaconess Hospital, Inc. (Hospital Facility #1). DEACONESS CROSS POINTE Part V, Section B, Line 6a: Other Hospital Facilities CHNA was conducted with is reported the same as Deaconess Hospital, Inc. (Hospital Facility #1). DEACONESS HOSPITAL, INC. Part V, Section B, Line 6b: Other organizations CHNA was conducted with:ECHO Community Health CareUnited Way of Southwest IndianaWelborn Baptist FoundationVanderburgh County Health Department DEACONESS GATEWAY HOSPITAL Part V, Section B, Line 6b: Other organizations CHNA was conducted is reported the same as Deaconess Hospital, Inc. (Hospital Facility #1). DEACONESS CROSS POINTE Part V, Section B, Line 6b: Other organizations CHNA was conducted is reported the same as Deaconess Hospital, Inc. (Hospital Facility #1). DEACONESS HOSPITAL, INC. Part V, Section B, Line 7d: The CHNA is made widely available on the hospital's website:The hospital community health needs assessment is located at http://www.deaconess.com/CHNA. DEACONESS GATEWAY HOSPITAL Part V, Section B, Line 7d: The CHNA is made widely available on the hospital's website: The hospital community health needs assessment is located at http://www.deaconess.com/CHNA. DEACONESS CROSS POINTE Part V, Section B, Line 7d: The CHNA IS MADE WIDELY AVAILABLE ON THE HOSPITAL'S WEBSITE: THE HOSPITAL COMMUNITY HEALTH NEEDS ASSESSMENT IS LOCATED AT HTTP://WWW.DEACONESS.COM/CHNA. DEACONESS HOSPITAL, INC. Part V, Section B, Line 11: As part of our agreement with the CHNA collaborative, Deaconess will focus time and resources for three years on creating positive change in the four identified topic areas from our 2015/2016 Community Health Needs Assessment. Our "scorecard" at the end of the 2013-2015 CHNA showed improvement in the overall health of the community, a decrease in the number of adult smokers, some progress with adult obesity, and an improvement in poor mental health days.Actions taken in the final year of our original CHNA include:Tobacco Report- We partnered with the Vanderburgh County Health Department to create and sustain the Baby and Me Tobacco Free Program. At the one-year mark, 118 women had participated in the program with 21 women in the post stage, 53 women actively participating, and 13 partners participating with the woman. We had 44 women drop out of the program giving us a 63 percent success rate. Deaconess referred 29 of the participants to the program. Obesity Report- Deaconess partnered with all of the Indiana District 10 hospitals to create "Healthy Baby Steps." This community education and resource campaign encourages women to do three things - get early prenatal care, stop smoking, and take a prenatal vitamin. This initiative followed the Vanderburgh County Health Department's sharing of statistics showing 60 percent of all fetal/infant deaths (in Vand. Co.) had mothers who were at an unhealthy weight (17% were overweight, 26% were obese, and 17% were morbidly obese). - Continuation of Healthier U Walks. For 12 Saturdays in April through June, individuals meet each week at a different park or walking trail to walk from 9-10am. The program encourages exercise but also provides people with the opportunity to explore new places to walk with the safety of a "tour guide and a group to walk with. We also have a service line attend each walk. This gives participants the opportunity to ask about heart care, cancer, women's health, pediatrics, etc.- Deaconess Hospital and the West Side Nut Club collaborated for a 4th year to provide a "Wise Choice" Fall Festival munchie map. The Fall Festival in Evansville (Vanderburgh County) has been said to be the second largest street festival next to Mardi Gras and draws over 200,000 individuals each year. The festival is known for their deep fried and other unhealthy options. The Wise Choice map features food items that are low calorie, low fat, and low sodium.- Continuation of a summer/fall farmers' market at both Deaconess Hospital locations and our downtown clinic. Continued participation in the Downtown Farmers' Market by providing healthy recipes, health information, and other service line related tests and information each week at the market. In 2015, we also participated in the Historic Newburgh Farmers' Market, the New Harmony Farmers' Market, and the Franklin Street Bazaar. - Our already robust employee wellness program was further enhanced with the addition of a Health Reimbursement Account. Employees now have a monetary incentive to get active and meet their fitness goals. Substance Abuse and Mental Health Report- The Healthcare Leadership Council honored Deaconess and St. Mary's with a Wellness Frontier Award for its Youth Mental Health First Aid Training, Project AWARE. Project AWARE was developed in 2015 with the goal of increasing awareness of mental health and substance abuse issues among school age youth. The Healthcare Leadership Council created the Wellness Frontiers Award to recognize health and wellness best practices and programs in communities and organizations across the nation. Winners are organizations developing and activating cost-effective, measurable community programs promoting wellness and disease prevention. DEACONESS GATEWAY HOSPITAL Part V, Section B, Line 11: How the Significant needs are being addressed is reported the same as Deaconess Hospital, Inc. (Hospital Facility #1). DEACONESS CROSS POINTE Part V, Section B, Line 11: How the Significant needs are being addressed is reported the same as Deaconess Hospital, Inc. (Hospital Facility #1). DEACONESS HOSPITAL, INC. Part V, Section B, Line 15e: Med Assist is available to Deaconess Health System patients to assist with applying for Medicaid or Exchange products. DEACONESS GATEWAY HOSPITAL Part V, Section B, Line 15e: Other method used for applying for financial assistance is the same as Deaconess Hospital, Inc. (Hospital Facility #1). DEACONESS CROSS POINTE Part V, Section B, Line 15e: Other method used for applying for financial assistance is the same as Deaconess Hospital, Inc. (Hospital Facility #1). DEACONESS HOSPITAL, INC. Part V, Section B, Line 16i: OTHER METHOD USED TO PUBLICIZE THE FINANCIAL ASSISTANCE POLICY: DEACONESS HOSPITAL SEEKS OUT THE PATIENTS THAT ARE SELF-PAY AND INTERVIEWS THESE PATIENTS WHILE THEY ARE IN THE FACILITY. THE FINANCIAL ASSISTANCE POLICY IS PROMOTED TO PATIENTS. DEACONESS HOSPITAL SEEKS OUT THOSE PATIENTS THAT WOULD QUALIFY FOR THE FINANCIAL ASSISTANCE POLICY. COLLECTABILITY SCORING IS ALSO COMPLETED AND ALLOWANCES ARE MADE BASED UPON THESE SCORES. DEACONESS HOSPITAL FOR FISCAL YEAR 16 IMPACTED THE LIVES OF MORE THAN 9,400 MEMBERS OF OUR COMMUNITY BY HELPING THEM OBTAIN INSURANCE OR PROVIDE ASSISTANCE FOR THE UNDERINSURED. DEACONESS GATEWAY HOSPITAL Part V, Section B, Line 16i: Other method used to publicize the financial assistance policy is reported the same as Deaconess Hospital, Inc. (Hospital Facility #1). DEACONESS CROSS POINTE Part V, Section B, Line 16i: OTHER METHOD USED TO PUBLICIZE THE FINANCIAL ASSISTANCE POLICY is reported the same as Deaconess Hospital, Inc. (Hospital Facility #1). DEACONESS HOSPITAL, INC. Part V, Section B, Line 22d: Deaconess uses a weighted average of medicare and managed care discounts. DEACONESS GATEWAY HOSPITAL Part V, Section B, Line 22d: Deaconess uses a weighted average of medicare and managed care discounts. DEACONESS CROSS POINTE Part V, Section B, Line 22d: Deaconess uses a weighted average of medicare and managed care discounts. 38 1 - DEACONESS PROCEDURE CENTER 421 Chestnut street Evansville IN 47713 Outpatient Services 2 - Deaconess Hospital Physical Medicine 520 Mary Street Suite 280 Evansville IN 47747 Outpatient Services 3 - Deaconess Chemotherapy Infusion Ctr 4055 Gateway Blvd Suite 1200 Newburgh IN 47630 Outpatient Services 4 - Deaconess Clinic Gateway Reg Lab 4233 Gateway Blvd Newburgh IN 47630 Diagnostic Center 5 - Deaconess Comprehensive Pain Ctr & Prog 4600 W Lloyd Expressway Evansville IN 47712 Outpatient Services 6 - Deaconess Hospital Infusion Svcs 421 Chestnut street Evansville IN 47713 Outpatient Services 7 - Deaconess Hospital Physical Medicine 10455 Orthopaedic Drive Newburgh IN 47630 Outpatient Services 8 - Deaconess Comprehensive Pain Ctr-Gateway 4099 Gateway Blvd Newburgh IN 47630 Outpatient Services 9 - Chancellor Center for Oncology 4055 Gateway Blvd Newburgh IN 47630 Outpatient Services 10 - Deaconess Sleep Lab 350 W Columbia Street Suite 210 Evansville IN 47710 Outpatient Services 11 - Deaconess Sleep Lab 350 W Columbia Street Suite LL-10 Evansville IN 47710 Diagnostic Center 12 - Deaconess Hospital Breast Center 520 Mary Street Suite 140 Evansville IN 47710 Diagnostic Center 13 - Deaconess Clinic West Reg Lab Radiology 545 S Boehne Camp Road Evansville IN 47712 Outpatient Physician Clinic 14 - Deaconess Clinic Princeton Radiology Srv 685 Vail Street Princeton IN 47670 Outpatient Physician Clinic 15 - Deaconess Wound Care Center 350 W Columbia Street Suite 350 Evansville IN 47710 Outpatient Services 16 - Deaconess Anticoagulation Clinic 4107 Gateway Blvd Newburgh IN 47630 Outpatient Services 17 - Mt Vernon Medical Center Lab & Radiology 1900 W Fourth Street MT Vernon IN 47620 Diagnostic Center 18 - Midwest Radiologic Imaging 10455 Orthopaedic Drive Newburgh IN 47630 Diagnostic Center 19 - Midwest Radiological Imaging 4087 Gateway Blvd Newburgh IN 47630 Diagnostic Center 20 - Deaconess Regional Laboratory 4133 Gateway Blvd Suite 110 Newburgh IN 47630 Diagnostic Center 21 - Deaconess Riley Children's Specialty Ctr 4133 Gateway Blvd Newburgh IN 47630 Outpatient Physician Clinic 22 - Deaconess Riley Speciality Ctr OP 4121 Gateway Blvd Newburgh IN 47630 Outpatient Physician Clinic 23 - Deaconess Primary Care for Seniors 4498 First Avenue Evansville IN 47710 Outpatient Physician Clinic 24 - Deaconess Primary Care for Seniors 1750 Oak Hill Road Evansville IN 47710 Outpatient Physician Clinic 25 - Deaconess Diabetes Center - Education 421 Chestnut street Evansville IN 47713 Outpatient Services 26 - Deaconess Pre-admission testing 520 Mary Street Suite 330 Evansville IN 47747 Diagnostic Center 27 - Deaconess Gateway Gastroenterology 4133 Gateway Blvd Newburgh IN 47630 Outpatient Physician Clinic 28 - Deaconess Weight Loss Solutions 310 W Iowa Street Evansville IN 47710 Outpatient Physician Clinic 29 - Deaconess Hospital Mammography & Imaging 421 Chestnut street Evansville IN 47713 Diagnostic Center 30 - Deaconess Regional Laboratory 4494 N First Avenue Evansville IN 47710 Diagnostic Center 31 - Deaconess Regional Laboratory 421 Chesnut Street Evansville IN 47713 Diagnostic Center 32 - Deaconess Regional laboratory 1204 W Williams Street Oakland City IN 47660 Diagnostic Center 33 - Deaconess Cross Pointe Outpatient Clinic 445 Cross Pointe Blvd Evansville IN 47715 Outpatient Physician Clinic 34 - deaconess cross pointe 7200 E indiana evansville IN 47715 Outpatient Physician Clinic 35 - deaconess radiology lab & Radiology 8600 north kentucky avenue evansville IN 47725 Diagnostic Center 36 - Deaconess Family Medicine Residency 415 W Columbia St Suite 110 Evansville IN 47710 Outpatient Physician Clinic 37 - Deaconess Sleep Center-East 7307 E Columbia St Evansville IN 47715 Diagnostic Center 38 - Deaconess Hospital Physical Medicine 4600 W Lloyd Expressway Suite B Evansville IN 47715 Outpatient services Part I, Line 6a: Deaconess Hospital prepares an annual community benefit report. The report is made available in the following ways:1. Mailed to all the major employers in the tri-state area.2. An advertisement is placed in the Sunday paper of the Evansville Courier and Press.3. Is made available on the Deaconess website at http://www.deaconess.com/Careers/For-Our-Employees/ Our-Community/Community-Benefit.aspx Part I, Line 7: A cost to charge ratio was used for most of the calculations for the table. IRS Instruction's Worksheet 2 was used for this calculation. We did not use the cost to charge ratio for line 7G as it was not relevant to these services. The actual cost from our costing system was used when available. The cost to charge ratio for each service type was used to estimate cost when not available from our internal costing system. Part I, Line 7g: SUBSIDIZED HEALTH SERVICES ATTRIBUTED TO PHYSICIAN CLINICS HAVE A COST OF $422,576. THESE CLINICS ARE OPERATED AS A BENEFIT TO THE COMMUNITY. Part I, Ln 7 Col(f): The Bad Debt expense is not included on form 990, part IX, line 25, column (a) due to early adoption of accounting standards update (ASU) 2011-07, Healthcare entities (Topic 954). Part II, Community Building Activities: Population Health - Deaconess developed and manages the only comprehensive population health initiative in the region. Current hospital partners include Methodist Hospital (KY), Gibson General Hospital, Good Samaritan Hospital, Memorial Hospital and Health Care Center, Wabash General Hospital, Fairfield Memorial Hospital, and Ferrell Hospital Foundation.In FY15-16, we launched the OneCare Specialist Council to foster efficient, optimal referral relationships. We expanded our care programs to include Catastrophic Care and Advanced Illness Care. Due to our infrastructure and experience, the Deaconess ACO was selected as a Care Management delegation pilot site by Anthem and selected to participate in the Next Generation ACO Model.Increased Childhood ImmunizationFor 2016, the Indiana State Department of Health Immunization Program analyzed immunization rates for completion of the 4:3:1:3:3:1:4 series (4 doses of DTaP, 3 doses of IPV, 1 dose of MMR, 3 doses of Hib, 3 doses of Hep B, 1 dose of varicella and 4 doses of PCV). The average immunization rate in Indiana was 60% for completion of the 4:3:1:3:3:1:4 series at 19-35 months. Nearly 70% of the counties were at or above the rate of 60%, with a median (or midpoint) of 64.5%. Vanderburgh County's rate was 71%. That is a vast improvement from our 52% completion rate in 2014 and our 67% completion rate in 2015. The positive momentum is thanks to an immunization task force created by the Vanderburgh County Health Department. Deaconess had heavy participation in the work of the task force.HeartSaver Program - The Heart Hospital and Deaconess Foundation, thru a program called HeartSaver, continue to collaborate on installing automated external defibrillators (AEDs) in Tri-State schools, churches, organizations and community gathering facilities. As of September 2016, the committee has raised enough money and placed 85 AEDs. Homeless Connect and Community First Health FairDeaconess continued to provide on-site services at two community events intended to increase access to health care for the homeless, near homeless, and those living in poverty. Services include blood pressure checks, blood sugar screenings, prostate checks (DRE and blood test), mammograms, immunizations, connecting people with needed services. Mobile Breast CenterThe 40 ft. coach travelled throughout the tri-state area providing mammograms to women where they live and work. Grant dollars are available for immediate use for women with no or inadequate insurance needing a mammogram. In FY15-16, Deaconess sponsored programs and activities for 180 organizations, contributing more than $1.3 million. (Disease-Related Organization or Event - $94,666.02; Service Provider - $328,374.00; Medical-Related Organization - $305,757.75; School Donations - $214,189.23; Public Service Organizations - $3,800.00; Economic Development - $193,750.00; Other Groups - $194,904.70) All of that money stayed in our service area to improve the health and safety of the community.Trauma Education - Deaconess Trauma Services and the Business Development Group increased the amount of time and resources devoted to educating EMS personnel and other first responders in the region. This includes pre-hospital training and building relationships with tri-state EMS groups. Health Science Institute - We held the 26th annual Health Science Institute, a hands-on summer program for high school students interested in the medical profession. The students spend two weeks living in dorm-style housing at the hospital while learning about all facets of patient care. Suicide Prevention - Members of our mental health hospital travel around the region to provide suicide prevention training to schools, churches, non-profit groups, etc.Deaconess also provides free and reduced care within our hospital buildings. Through our Medication Assistance Program, our Family Practice Residency Clinic, and community health screenings, area residents can access the high quality healthcare they need in convenient locations and at a price they can afford. Part III, Line 4: THE FOOTNOTE DESCRIBING BAD DEBT EXPENSES IS INCLUDED IN THE ATTACHED AUDITED FINANCIAL STATEMENTS UNDER FOOTNOTE "CHARITY CARE, COMMUNITY BENEFIT AND ASSISTANCE TO THE UNINSURED" STARTING ON PAGE 11 AND "PATIENT ACCOUNTS RECEIVABLE AND NET PATIENT SERVICE REVENUE" STARTING ON PAGE 12. Part III, Line 8: THE SOURCE USED TO DETERMINE THE AMOUNT OF MEDICARE REVENUE AND ALLOWABLE COSTS REPORTED FOR PART III, SECTION B, LINE 8: THE MEDICARE TOTAL REVENUE AND ALLOWABLE COSTS WERE ACTUAL BASED UPON THE 2014 MEDICARE COST REPORT. THE MEDICARE SHORTFALL FOR DEACONESS HOSPITAL IS TREATED AS COMMUNITY BENEFIT DUE TO THE HOSPITAL PROVIDING CARE TO MEDICARE PATIENTS AT LESS THAN THE ALLOWABLE MEDICARE COSTS. Part III, Line 9b: DEACONESS HOSPITAL MAKES A DISTINCTION BETWEEN CHARITY AND BAD DEBT. IN DETERMINING AN INDIVIDUAL OR FAMILY'S ABILITY TO PAY, DEACONESS HOSPITAL EVALUATES WHETHER OR NOT THE RESPONSIBLE PARTY HAS SUFFICIENT RESOURCES FOR PAYMENT. IF AN INDIVIDUAL IS DETERMINED TO NOT HAVE SUFFICIENT RESOURCES TO PAY, THEY WILL BE CONSIDERED ELIGIBLE FOR CHARITY CARE AND WILL NOT BE PROCESSED THROUGH EITHER INTERNAL OR EXTERNAL COLLECTIONS. ACCOUNTS OF CHARITY CARE PATIENTS WHO ARE UNABLE TO PAY DO NOT RESULT IN BAD DEBT AND ARE NOT COLLECTED UPON. Part VI, Line 2: NEEDS ASSESSMENT PROCESS: IN ADDITION TO THE CHNA REPORTED IN PART V, SECTION B DEACONESS HOSPITAL UTILIZES A VARIETY OF SOURCES TO GATHER DATA ON LOCAL HEALTH CARE NEEDS. A MAJOR SOURCE IS THE 7-COUNTY HEALTH SURVEY CONDUCTED BY WELBORN BAPTIST FOUNDATION. DEACONESS ALSO USES DATA FROM THE UNITED WAY OF SOUTHWESTERN INDIANA'S COMPREHENSIVE NEEDS ASSESSMENT, COUNTY HEALTH RANKINGS WEBSITE, INDIANA STATE DEPARTMENT OF HEALTH, CENTERS FOR DISEASE CONTROL AND PREVENTION, NATIONAL CENTER FOR HEALTH STATISTICS, AND THE U.S. CENSUS BUREAU. ADDITIONAL INFORMATION COMES THROUGH THE HOSPITAL'S INTERACTION WITH LOCAL SERVICE PROVIDERS AND OTHER NON-PROFIT ORGANIZATIONS. Part VI, Line 3: Patient Education of Eligibility for Assistance: Deaconess Hospital utilizes financial counselors to educate, inform and assist patients and families in understanding their financial obligation, ability to qualify for financial assistance through Deaconess Hospital's financial assistance program and payment options. Specifically, financial counselors staff the emergency department, registration areas, cashier area, as well as, float among inpatient areas to ensure each and every patient requiring assistance is reached. In addition to the personal and individualized counseling provided by the financial counselors, various forms of media are distributed throughout Deaconess Hospital explaining the financial assistance process. Additionally, policies for financial assistance are posted widely throughout Deaconess Hospital and on the internet at www.deaconess.com. http://www.deaconess.com/DeaconessHospital/Business-Office/Financial-Assistance.aspx Part VI, Line 4: Deaconess defines its community as all people living in Vanderburgh and Warrick Counties at any time during the year.Vanderburgh County - According to the 2015 County Health Rankings, Vanderburgh County ranks 78th out of 92 Indiana counties for health outcomes. Vanderburgh County's population is similar to the statewide population, with 85.6% of the population being White, 9% Black/African American, 1.2% Asian, and the remainder being of Other or 2 or More Races. There are also fewer Hispanic/Latinos, at 2.7% of the population. Approximately 10.5% of families are living in poverty, which is slightly lower than the state. The median household income for Vanderburgh County at $44,396 is about $5,000 lower than the state overall. HCI's SocioNeeds Index identified the zip codes of 47708 and 47713 as having the greatest socioeconomic need. Warrick County - According to the 2015 County Health Rankings, Warrick County ranks 30th out of 92 Indiana counties in overall health outcomes. Warrick County demographics are similar to those of the overall Indiana state population, with about 2% less 18-24 year olds and 1.5% more 65 and older. Less than 6% of Warrick County residents are non-white or Caucasian. The median household income is about $66,500 annually which is about $17,500 more than that of the state median, and roughly 6.6% of Warrick County families are living in poverty, which is lower than the state. HCI's SocioNeeds Index identified the zip codes of 47523 and 47637 as having the greatest socioeconomic need. Part VI, Line 5: OTHER IMPORTANT COMMUNITY HEALTH PROMOTION:A MAJORITY OF ORGANIZATION'S GOVERNING BODY IS INDEPENDENT AND COMPRISED OF PERSONS WHO RESIDED IN THE ORGANIZATION'S PRIMARY SERVICE AREA; EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN ITS COMMUNITY; AND APPLIES SURPLUS FUNDS TO IMPROVEMENTS IN PATIENT CARE. Part VI, Line 6: Affiliated Health Care System:Deaconess Hospital works in concert with Deaconess Health System and Deaconess Clinic to provide healthcare services with a compassionate and caring spirit to persons, families and communities of the tri-state. Deaconess Health System works to increase access to healthcare services within our community through Deaconess Hospital and Deaconess Clinic. Deaconess Hospital is a medical institution dedicated to providing quality patient care with unrelenting attention to clinical excellence, patient safety and an unparalleled passion and commitment to assure the very best healthcare for the patients served. Deaconess clinic provides excellent primary and multi-specialty healthcare in a personalized fashion with a dedicated focus to serve the community with excellent, timely and compassionate patient care.Part VI, line 7, list of states receiving community benefit report: Indiana 1 American Heart Association 7272 Greenville Ave Dallas TX 75231 135613797 501(c)(3) 7500 General Support American red cross 29 s stockwell rd Evansville IN 47714 530196605 501(c)(3) 10000 General Support Easter seals rehabilitation center 3701 Bellemeade Ave Evansville IN 47714 351087526 501(c)(3) 38925 General Support & Capital Campaign Echo Community Health Care 315 Mulberry Street Evansville IN 47713 351791786 501(c)(3) 30000 Family Practce - Multicultural Clinic Economic Development Coalition of Southwestern Indiana 318 Main Street Suite 400 Evansville IN 47708 320152563 501(c)(6) 25000 One Region-One Economy-One Voice Campaign Evansville Area Community of Churches 713 N 2nd Ave Evansville IN 47710 350886837 501(c)(3) 12000 Food for Food Pantries Evansville Vanderburgh School Corp 1 SE Ninth Street Evansville IN 47708 351071682 501(c)(3) 19990 classroom supplies Evansville-Vanderburgh County Convention & Visitors Commission Sports Compl 4300 Heckel Road Evansville IN 47711 472582515 501(c)(3) 50000 Support Health Trail Ivy Tech Foundation 3501 N 1st Avenue Evansville IN 47710 237073977 501(c)(3) 33200 general support & Scholarships Junior Achievement of SW Indiana 431 E Diamond Avenue Evansville IN 47711 356048156 501(c)(3) 20000 Adopt a school program & General Support Komen Greater Evansville Affiliate 4424 Vogel Rd Ste 205 Evansville IN 47715 752844632 501(c)(3) 15000 general support Marian university 3200 cold spring road Indianapolis IN 462221997 350868175 501(c)(3) 25000 D.O. Program Scholarships OTHERS 5000 146785 General Support Ronald McDonald House Charities of the Ohio Valley 3540 Washington Avenue Evansville IN 477140136 351748468 501(c)(3) 14850 General Support Tri-State Food Bank 801 E Michigan Street Evansville IN 477115631 351539870 501(c)(3) 15000 General Support United Caring Shelters 324 NW Sixth Street Evansville IN 47708 351892153 501(c)(3) 76196 123 Cost Medical Supplies Homeless Medical Respite & General Support United Way of Southwestern Indiana PO Box 18 Evansville IN 477010018 350868069 501(c)(3) 20200 general support University of Evansville 1800 Lincoln Avenue Evansville IN 47722 350868074 501(c)(3) 35333 Start-Up Fund for Physician Assistant Program & General Support UNIVERSITY OF SOUTHERN INDIANA Foundation 8600 University Boulevard Evansville IN 47712 237042320 501(c)(3) 47800 General Support YMCA of SW Indiana Inc 222 NW 6th St Evansville IN 47708 350869074 501(c)(3) 32833 General Support Youth First 3420 East Morgan Ave Ste A Evansville IN 47715 352050168 501(c)(3) 9667 General Support YWCA 118 Vine st Evansville IN 47708 350869075 501(c)(3) 35000 General Support Ark Crisis Child Care Center 415 Lincoln Ave Evansville IN 47713 351553918 501(c)(3) 9000 General Support Aurora Inc 1100 Lincoln Avenue PO Box 74 Evansville IN 47701 351759576 501(c)(3) 10300 Homeless Outreach Children's Museum of Evansville 22 SE 5th Street Evansville IN 47701 351951848 501(c)(3) 25000 Capital Campaign Alliance Initiatives Fund 5000 E Virginia St Evansville IN 47715 352116083 501(c)(3) 250000 Graduate Medical Education Consortium Community Patient Safety Coalition 13113 Browning Road Evansville IN 47725 611646052 501(c)(3) 18752 General Support Evansville-Area Trails Coalition Inc PO Box 5644 Evansville IN 47716 271556835 501(c)(3) 21000 General Support Four Rivers Resource Services Inc dba Ride Solution PO Box 367 1001 E Main St Washington IN 47501 351665140 501(c)(3) 10000 General Support Henderson Community College 2660 S Green Street Henderson KY 42420 616035281 501(c)(3) 11600 Scholarships & general Support American Cancer Society 5250 Vogel Rd Suite A Evansville IN 47715 131788491 501(c)(3) 10000 General Support Evansville Regional Business Committee Inc One Vectren Square Evansville IN 47708 030408032 501(c)(3) 10000 General Support Evansville Parks Foundation Inc PO Box 3112 Evansville IN 47730 351520591 501(c)(3) 6400 Capital & General Support Juvenile Diabetes Research Foundation 10401 N Meridian Street Suite 150 Indianapolis IN 46290 231907729 501(c)(3) 15000 General Support Leadership Evansville PO Box 2449 Evansville IN 47728 310883858 501(c)(3) 6300 General Support WNIN Tri-State Public Media 405 Carpenter Street Evansville IN 47705 351307165 501(c)(3) 27000 General Support & Capital Campaign 34 1 Part I, Line 2: DEACONESS HOSPITAL CONFIRMS ALL RECIPIENTS OF FUNDS ARE ORGANIZATIONS WHOSE GOALS COINCIDE WITH DEACONESS' MISSION OF PROVIDING QUALITY HEALTH CARE WITH A COMPASSIONATE AND CARING SPIRIT. THE ORGANIZATIONS PROVIDE NEEDED SERVICES TO OUR COMMUNITY TO IMPROVE HEALTH AND WELLNESS FOR THE CITIZENS IN THE SURROUNDING AREA. X 1 1 X X X X X 1 1 0 0 0 0 1 0 0 Linda White President/ CEO 369071 371647 345622 0 587931 6000 127413 107537 5698 5698 1435735 490882 0 0 Maqbool Ahmed MD Director 0 887205 0 167851 0 2646 0 33007 0 23023 0 1113732 0 0 Mathias Kolleck II director 236826 0 89273 0 67332 5200 22820 0 19532 0 435783 5200 0 0 Barry Phillips MD Director 0 350349 0 86233 10220 2092 0 13314 0 21114 10220 473102 0 0 David Ryon MD Director 344289 0 100786 0 41400 4600 18830 0 22917 0 528222 4600 0 0 Shawn McCoy Chief Administrative Officer 478982 0 188026 0 180472 7400 139281 0 29988 0 1016749 7400 0 0 Cheryl Wathen Chief Financial Officer 204639 213086 139468 0 80232 8000 72829 48299 16595 16595 513763 285980 0 0 James Porter MD Chief Medical Officer 455118 0 149633 0 91808 3200 131243 0 27737 0 855539 3200 0 0 Cherona Hajewski Chief Nursing Officer 285993 0 96633 0 48700 0 91618 0 25850 0 548794 0 0 0 Kathy Schenk HR Director 124868 0 24704 0 1305 0 13400 0 22830 0 187107 0 0 0 Lynn Lingafelter Vice President of Operations 258354 0 85849 0 1391 0 86198 0 6812 0 438604 0 0 0 Marc Florence Vice President 199043 0 37400 0 1106 0 32816 0 22279 0 292644 0 0 0 Kenneth Dicken Controller, Director Finance 192256 0 36629 0 1441 2800 3006 0 22845 0 256177 2800 0 0 Richard Perry Controller 172855 0 32194 0 651 0 18453 0 8876 0 233029 0 0 0 Carolyn Morton Pharmacy Director 151624 0 29119 0 1295 0 14809 0 27351 0 224198 0 0 0 LARRY PILE Attorney 191173 0 35183 0 3749 0 22277 0 17697 0 270079 0 0 0 Venkatesh Madadi MD ANESTHESIOLOGIST 717257 0 0 0 49419 0 28245 0 22596 0 817517 0 0 0 Nirmal Joshi MD Anesthesiologist 551462 0 103385 0 60058 0 18705 0 24323 0 757933 0 0 0 Rajesh Patel MD Anesthesiologist 607074 0 0 0 36001 0 18163 0 24565 0 685803 0 0 0 Dan Vardi MD Physician 348324 0 231939 0 54767 0 24130 0 14643 0 673803 0 0 0 Candido Guiao MD Anesthesiologist 546363 0 0 0 41541 0 14590 0 21869 0 624363 0 0 0 G William Kennedy Former HR Director 92502 0 13013 0 40910 0 8888 0 2422 0 157735 0 0 0 Part I, Line 1a Social club dues are paid for Linda White and Shawn McCoy for organization business only. Any personal use of the club must be paid by the employees. Part I, Lines 4a-b SEVERANCE, NONQUALIFIED, AND EQUITY-BASED PAYMENTS: SEVERANCE NONQUALIFIED EQUITY-BASED LINDA E. WHITE $ -0- $18,000 $ -0- DAVID A. KOEHLER, JR., MD. 0 18,000 0 SHAWN W. MCCOY 0 18,000 0 JAMES R. PORTER, MD. 0 18,000 0 CHERONA J. HAJEWSKI 0 18,000 0 DAVID L RYON, MD. 0 18,000 0 VENKATESH R. MADADI, MD. 0 18,000 0 RAJESH J. PATEL, MD. 0 18,000 0 NIRMAL JOSHI, M.D. 0 18,000 0 CHERYL A. WATHEN 0 18,000 0 LYNN C. Lingafelter 0 18,000 0 Dan Vardi, M.D. 0 18,000 0 Candido M. Guiao, M.D. $ -0- $12,212 $ -0- G. William Kennedy 27,686 0 0 PART I, 4B: LINDA WHITE: SUPPLEMENTAL ACCUMULATION ACCOUNT CONTRIBUTIONS OF $194,273 SUPPLEMENTAL ACCUMULATION ACCOUNT PAYOUT OF $397,458 SHAWN MCCOY: SUPPLEMENTAL ACCUMULATION ACCOUNT CONTRIBUTIONS OF $118,508 SUPPLEMENTAL ACCUMULATION ACCOUNT PAYOUT OF $177,028 CHERYL WATHEN: SUPPLEMENTAL ACCUMULATION ACCOUNT CONTRIBUTIONS OF $92,071 SUPPLEMENTAL ACCUMULATION ACCOUNT PAYOUT OF $75,769 JAMES PORTER: SUPPLEMENTAL ACCUMULATION ACCOUNT CONTRIBUTIONS OF $102,543 SUPPLEMENTAL ACCUMULATION ACCOUNT PAYOUT OF $90,140 CHERONA HAJEWSKI: SUPPLEMENTAL ACCUMULATION ACCOUNT CONTRIBUTIONS OF $52,186 SUPPLEMENTAL ACCUMULATION ACCOUNT PAYOUT OF $42,188 LYNN LINGAFELTER: SUPPLEMENTAL ACCUMULATION ACCOUNT CONTRIBUTIONS OF $46,407 Marc Florence: SUPPLEMENTAL ACCUMULATION ACCOUNT PAYOUT OF $16,979 Part I, Line 6 RELATED ORG. COMPENSATION CONTINGENT UPON NET EARNINGS INCENTIVE COMPENSATION PAYMENTS ARE BASED UPON SUCCESSFUL ACHIEVEMENT OF ESTABLISHED INPATIENT SATISFACTION MEASURES, OUTPATIENT SATISFACTION MEASURES, COMPLIANCE WITH PUBLICLY REPORTED QUALITY INDICATORS, OPERATING MARGIN AS WELL AS OTHER TECHNICAL AND PERSONAL FUNCTIONAL GOALS. DEACONESS HOSPITAL'S INCENTIVE COMPENSATION PROGRAMS ARE FORMULATED TO REWARD BEHAVIOR THAT BALANCES PATIENT NEEDS AND EFFICIENT DELIVERY OF PATIENT CARE TO ENSURE THE BEST OUTCOMES ARE ACHIEVED. A INDIANA FINANCE AUTHORITY 351602316 45471AES7 2011-12-02 20667197 3/15/99 refunding 0 0 0 B INDIANA FINANCE AUTHORITY 351602316 2012-11-20 13005000 1992 refunding 0 0 0 C INDIANA FINANCE AUTHORITY 351602316 45471ALU4 2013-07-23 40180000 3/29/09 Refunding 0 0 0 D INDIANA FINANCE AUTHORITY-2013a 351602316 45471aky7 2013-03-05 71336168 5/27/04 AND 3/26/09 Refunding 0 0 0 A 4240000 20667197 397197 20270000 1 0 1 1 B 2945000 13005000 103657 12901343 1 0 1 1 C 40180000 180000 40000000 1 0 1 1 D 705000 71336168 729538 70606631 0 1 1 1 A 0 0 0 0 0 0 1 B 0 0 0 0 0 0 1 C 0 1 0 0 0.00000 0.00000 0.00000 0 0 1 D 0 1 0 0 0.00400 0.00400 0 0 1 A 0 1 0 0 0 0 0 0 1 B 0 1 0 0 1 0 0 0 1 C 0 1 0 0 1 0 0 0 1 D 0 1 0 0 0 0 0 0 1 A 1 B 1 C 1 D 1 A INdiana Finance Authority-2013b 351602316 2013-03-05 21440000 5/27/04 Refunding 0 0 0 B IndianA FINANCE AUTHORITY-2015A 351602316 45506DUL7 2015-07-09 49772341 03/26/2009 Refunding 0 0 0 A 2945000 21440000 125000 21315000 1 0 1 1 B 49772341 49170494 601847 0 1 0 1 A 0 1 0 0 0.00700 0.00100 0.00800 0 1 0 1 B 0 1 0 0 0.00000 0.00000 0.00000 0 0 1 A 0 1 0 0 1 1 Fifth Third 16.000000000000 0 0 0 0 1 B 0 1 0 0 0 0 0 0 1 A 1 B 1 Letta Fraccaro Family of BD Mbr 47974 Comp. 0 Misty Adye Family of BD Mbr 20377 Comp. 0 Alex Seibert Family of Officer 88089 Comp. 0 Evansville Radiology PC Common board Member 792886 Mgmt. Srvs. 0 Vectren energy Deliverly common board Member 5552982 Gas/Electricy 0 Elizabeth Voegel family of officer 38468 Comp. 0 Suzanne Seibert family of officer 31778 Comp. 0 Joan McCoy family of officer 19837 Comp. 0 University of Southern Indiana Common board Member 84650 Support 0 Ivy Tech Foundation Common board Member 40500 Donation and Support 0 SCH L, PART IV, ABBREVIATION: BD MBR = board memberComp. = Reportable CompensationSRVS. = Services X Miscellanous 1 27940 Cost X Jewelry 1 9700 Cost 0 0 1 0 Part I, Line 32b: Schedule M - Supplemental Information The number of contributions reported in Column B on Schedule M is the actual number of items received from each contributor. Form 990, Part III, Line 1, Organization's Mission: DEACONESS HOSPITAL PROVIDES QUALITY HEALTHCARE SERVICES WITH A COMPASSIONATE AND CARING SPIRIT TO PERSONS, FAMILIES AND COMMUNITIES OF THE TRI-STATE. AT DEACONESS HOSPITAL, OUR VALUES ARE BASED ON OUR COMMITMENT TO QUALITY. WE DEFINE QUALITY AS THE CONTINUOUS IMPROVEMENT OF SERVICES TO MEET THE NEEDS AND EXCEED THE EXPECTATIONS OF THE CUSTOMERS WE SERVE. OUR VALUES ARE QUALITY IN EVERYTHING WE DO, RESPECT FOR ALL PEOPLE, EFFICIENCY AND EFFECTIVENESS IN THE USE OF RESOURCES, INNOVATION TOWARD CONTINUOUS SYSTEMS IMPROVEMENT, PARTNERSHIP WITH THOSE WE SERVE AND WITH SUPPLIERS, EDUCATION FOR CONTINUOUS GROWTH AND KNOWLEDGE AND PRIDE IN WORKMANSHIP. TO ACCOMPLISH ITS MISSION, DEACONESS HOSPITAL IS COMMITTED TO IMPROVING THE QUALITY OF LIFE FOR THE PEOPLE OF THE TRI-STATE BY DEMONSTRATING EXCELLENCE IN HEALTHCARE SERVICES, PROVIDING ACCESS TO HEALTHCARE, PROVIDING CHARITY CARE TO THOSE IN NEED,PROMOTING HEALTHY LIFESTYLES, OFFERING SPIRITUAL AND PSYCHOLOGICAL SUPPORT, SUPPORTING HEALTH RELATED EDUCATION, AND ADVANCING HEALTH KNOWLEDGE THROUGH RESEARCH. Form 990, Part III, Line 4A PROGRAM SERVICES ACCOMPLISHMENT 1: PATIENT SERVICE REVENUE. DEACONESS HOSPITAL IS A MAJOR REFERRAL CENTER FOR A 26 COUNTY TRI-STATE AREA IN SOUTHWESTERN INDIANA, WESTERN KENTUCKY AND SOUTHEASTERN ILLINOIS. THE HOSPITAL AND ITS FACILITIES ARE LOCATED ON FOUR CAMPUSES WHICH INCLUDE THE MAIN 28-ACRE CAMPUS ON THE NEAR NORTH SIDE OF EVANSVILLE IN VANDERBURGH COUNTY; THE 63-ACRE GATEWAY CAMPUS LOCATED IN WARRICK COUNTY ON THE EASTERN BORDER OF VANDERBURGH COUNTY; AND TWO OTHER EASTSIDE EVANSVILLE LOCATIONS FOR PSYCHIATRIC BEHAVIORAL SERVICES AND REHABILITATION SERVICES. THE HOSPITAL OPERATES A MAIN CAMPUS WITH A TOTAL OF 266 BEDS CONSISTING OF 38 INTENSIVE CARE BEDS, 16 CARDIAC INTENSIVE CARE BEDS, 45 CARDIAC BEDS, 23 ONCOLOGY/ PULMONOLOGY BEDS, 61 ORTHOPAEDIC/ NEUROLOGICAL BEDS, 44 MEDICAL/ SURGICAL BEDS, 39 Medical Renal Beds. IN ADDITION, THE HOSPITAL PROVIDES A FULL-ARRAY OF COMPREHENSIVE OUTPATIENT AND AMBULATORY SERVICES ON ITS MAIN CAMPUS AND OTHER SPECIFIC SERVICES AT MULTIPLE SITES WITHIN ITS PRIMARY AND SECONDARY SERVICE AREAS. THE HOSPITAL OPERATES THE 190 BED DEACONESS GATEWAY HOSPITAL WHICH WAS OPENED IN JANUARY 2006, ON THE GATEWAY CAMPUS CONSISTING OF 13 ADULT INTENSIVE CARE BEDS, 17 PEDIATRIC AND PEDIATRIC INTENSIVE CARE BEDS, 16 NEUROSURGICAL BEDS, 32 ORTHOPAEDIC BEDS, 16 NEURO INTENSIVE CARE BEDS, 32 SURGICAL ONCOLOGY BEDS AND 64 GENERAL MED/ TELEMETRY BEDS. THE HOSPITAL PROVIDES A FULL ARRAY OF COMPREHENSIVE OUTPATIENT AND AMBULATORY SERVICE ON THE GATEWAY CAMPUS. THE HOSPITAL OWNS AND OPERATES DEACONESS CROSS POINTE, A FREE-STANDING, 60 BED INPATIENT PSYCHIATRIC HOSPITAL LOCATED APPROXIMATELY 7 MILES EAST OF THE MAIN CAMPUS IN EVANSVILLE. Form 990, Part III, Line 4B PROGRAM SERVICES ACCOMPLISHMENT 2: CHARITY CARE/ SUBSIDIZED CARE. DEACONESS HOSPITAL MAKES A DISTINCTION BETWEEN CHARITY CARE AND BAD DEBT. IN DETERMINING AN INDIVIDUAL OR FAMILY'S ABILITY TO PAY, DEACONESS HOSPITAL EVALUATES WHETHER OR NOT THE RESPONSIBLE PARTY HAS SUFFICIENT RESOURCES AVAILABLE FOR PAYMENT. IF AN INDIVIDUAL IS DETERMINED TO NOT HAVE SUFFICIENT RESOURCES TO PAY, THEY ARE CONSIDERED ELIGIBLE FOR CHARITY CARE AND WILL NOT BE PROCESSED THROUGH EITHER INTERNAL OR EXTERNAL COLLECTIONS. ACCOUNTS OF CHARITY CARE PATIENTS WHO ARE UNABLE TO PAY DO NOT RESULT IN BAD DEBT AND ARE NOT COLLECTED UPON. DEACONESS HOSPITAL PROVIDES CARE TO PERSONS COVERED BY GOVERNMENTAL PROGRAMS BELOW COST. RECOGNIZING ITS MISSION TO THE COMMUNITY, SERVICES ARE PROVIDED TO BOTH MEDICARE AND MEDICAID PATIENTS. TO THE EXTENT OF REIMBURSEMENT IS BELOW COST, DEACONESS HOSPITAL ABSORBS THESE COSTS IN MEETING ITS MISSION TO THE COMMUNITY. IN SUPPORT OF ITS MISSION, DEACONESS HOSPITAL PROVIDED $11.4 MILLION OF CHARITY CARE AND $20.0 MILLION OF SUBSIDIZED SERVICES TO THE MEDICAID PROGRAM, AND $64.1 MILLION OF SUBSIDIZED SERVICES TO THE MEDICARE PROGRAM. Form 990, Part III, Line 4C PROGRAM SERVICES ACCOMPLISHMENT 3: GRADUATE MEDICAL EDUCATION, MEDICAL EDUCATION & COMMUNITY BENEFITS. DEACONESS HOSPITAL PLAYS AN ACTIVE ROLE IN MEDICAL EDUCATION, OPERATING A THREE YEAR FAMILY MEDICINE RESIDENCY PROGRAM AND A POST-GRADUATE PHARMACY RESIDENCY PROGRAM. DEACONESS HOSPITAL ALSO PROVIDES CONTINUING MEDICAL EDUCATION PROGRAMS FOR ATTENDING PHYSICIANS, OTHER HEALTH PROFESSIONALS, OTHER ALLIED HEALTH PROGRAMS, COMMUNITY HEALTH PROGRAMS AND A CHAPLAIN RESIDENCY PROGRAM. IN ADDITION TO EDUCATIONAL SERVICES, DEACONESS HOSPITAL PROVIDED $11.4 MILLION IN COMMUNITY BENEFIT ACTIVITIES (ALL ON A COST BASIS), SERVING A MINIMUM OF 981,016 PEOPLE WITHIN THE TRI-STATE AREA. Form 990, Part III, Line 4d ALL OTHER ACCOMPLISHMENTS. OTHER PROGRAM SERVICE REVENUE CONSISTS OF DEACONESS HOSPITAL'S INCOME FROM THE INVESTMENT IN JOINT VENTURES. OTHER PROGRAM SERVICE EXPENSES CONSISTED OF COMMUNITY BENEFIT GRANTS/ASSISTANCE. Form 990, Part VI, Section A, line 6 Class of Members or Stockholders: Deaconess Health System, Inc. is the sole corporate member of Deaconess Hospital, Inc. Form 990, Part VI, Section A, line 7a Election of Governing body: The board of directors may elect one or more non-medical staff members of the governing body through an approved election and approval process. The election and approval process for non-medical staff members begins with a recommendation by the governance committee for membership to the Board of Directors. That recommendation is then reviewed and approved by the Board of Directors. Depending on the decision reached by the Board of Directors, membership may or may not be granted to that individual. Medical Staff Executive Council leadership are appointed to Board of Director membership through their position as elected medical staff leaders. Through the election process of the medical staff executive council, their appointment is confirmed and approved. Form 990, Part VI, Section B, line 11 FORM 990 REVIEW PROCESS: THE PROCESS THAT DEACONESS HOSPITAL 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 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 COMPLIANCE WITH CONFLICT OF INTEREST POLICY: CONFLICT OF INTEREST REVIEW AND COMPLIANCE ACTIVITIES ARE CONDUCTED THROUGHOUT THE YEAR UNDER THE 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 DEACONESS HOSPITAL 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: DEACONESS HOSPITAL UTILIZES A COMPENSATION COMMITTEE TO APPROVE EXECUTIVE, DIRECTOR AND PHYSICIAN COMPENSATION AS WELL AS EXECUTIVE AND PHYSICIAN BENEFITS PROGRAMS. THE COMPENSATION COMMITTEE IS APPOINTED BY THE BOARD OF DIRECTORS AND MUST MEET THE INDEPENDENCE REQUIREMENTS OF THE SEC. THE COMMITTEE HAS THE POWER AND AUTHORITY TO: 1. ANNUALLY REVIEW AND APPROVE AND RECOMMEND TO THE BOARD OF DIRECTORS FOR ITS FINAL APPROVAL FOR THE CEO AND EACH OTHER EXECUTIVE OFFICER OF THE SYSTEM 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, CEO 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 GOVERNING DOCUMENTS DISCLOSURE EXPLANATION: DEACONESS HOSPITAL'S ARTICLES OF INCORPORATION ARE AVAILABLE ON THE SECRETARY OF STATE'S WEBSITE. DEACONESS HOSPITAL IS PART OF A CONSOLIDATED FINANCIAL STATEMENT WHICH IS AVAILABLE WITH THE PUBLIC DISCLOSURE COPY OF THE IRS FORM 990. ALSO, AS REQUIRED BY LAW, THE HOSPITAL SUBMITS ITS CONSOLIDATED FINANCIAL STATEMENTS TO THE INDIANA DEPARTMENT OF HEALTH WHICH ARE PUBLISHED ON ITS WEBSITE. GOVERNING DOCUMENTS, ASIDE FROM THE ARTICLES OF INCORPORATION, AND THE CONFLICT OF INTEREST POLICY ARE NOT AVAILABLE FOR PUBLIC INSPECTION. Form 990, Part IX, line 11g professional fees: Program service expenses 60,962,490. Management and general expenses 20,174,693. Fundraising expenses 27,254. Total expenses 81,164,437. professional fees- physicians: Program service expenses 12,889,798. Management and general expenses 390,712. Fundraising expenses 0. Total expenses 13,280,510. Form 990, Part XI, line 9: Change in Pension Liability -29,112,043. Foundation monies granted from Restriction -795,832. Change in General Fund Equity -26,596,934. Change in Beneficial interests in trusts 39,514. 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; AND NO PROCESSES HAVE CHANGED FROM PRIOR YEAR. regional emergency department 600 mary st evansville IN 47710 463509500 healthcare IN 45934 0 Deaconess Hospital Ready Development LLC 600 mary st Evansville IN 47747 472051747 Real Estate IN 0 1658120 Deaconess Hospital Ready Development of Indiana 600 mary st Evansville IN 47747 472040018 Real Estate IN 0 0 Deaconess Hospital Deaconess Health System Inc 600 Mary Street Evansville IN 47747 351532889 Healthcare IN 501(c)(3) Line 11a, I N/A 0 Deaconess Clinic Inc 421 Chesnut Street Evansville IN 47713 263083364 Healthcare IN 501(c)(3) Line 3 Deaconess Health System 0 Deaconess Regional Healthcare Services Illinois Inc 600 Mary Street evansville IN 47747 810693478 healthcare IL 501(c)(3) Line 3 Deaconess Health System 0 DEACONESS HEALTH PLANS LLC 350 W Columbia Suite 400 Evansville IN 47710 383492529 Preferred Provider network IN Deaconess Hospital Related 527166 2082443 0 0 0.95150 Progressive Health of IN LLC 150 N Rosenberger Evansville IN 47712 208480988 Outpatient IN Deaconess Hospital Related 3696489 1776999 0 0 0.51000 Heart Hospital at Deaconess Gateway LLC 4007 Gateway Blvd Newburgh IN 47630 261766835 Hospital DE Deaconess Hospital Related 8033670 13741287 0 0 0.51000 Tri-State Radiation Oncology 1500 rosecrans Avenue manhattan Beach CA 90266 263706834 outpatient DE Deaconess Hospital related 4328566 2687552 0 0 0.51000 MAINSPRING MANAGERS LLC 4011 Gateway Blvd Newburgh IN 47630 464601001 Neurology Services IN Deaconess Hospital Related 974906 841053 0 0 0.51000 VascMed LLC 600 Mary Street Evansville IN 47747 472578168 Vascular Services IN Deaconess Hospital Related 467669 582521 0 0 0.51000 TRI-STATE MEDICAL MANAGEMENT INC 600 Mary Street Evansville IN 47747 351875888 Physician Management IN Deaconess Hospital C 1.00000 1 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 0 0 Heart Hosp at Deac Gateway LLC O 2229780 Heart Hosp at Deac Gateway LLC P 3177283 Deaconess Health Plans LLC Q 141879 Heart Hosp at Deac Gateway LLC Q 5309293 Mainspring Managers LLC Q 177503 VascMed LLC Q 160743