2017-08-14T22:37:10-05:00 2016-09-30 351178661 Blue & Co LLC 500 N Meridian St Suite 200 Indianapolis IN 46204 990 2015-10-01 351064295 DeKalb Memorial Hospital Inc DEKA 2609254600 1316 East Seventh Street Auburn IN 46706 Bret Claghorn CPA CFO 2609254600 2017-08-11 1 Amber Kocher CPA P01286298 3176334705 2017-08-11 2015 2021-01-29 14:40:06Z DeKalb Health Craig Polkow 1316 East Seventh Street Auburn IN 46706 70347217 0 X www.dekalbhealth.com X 1964 IN To provide acute, subacute and outpatient medical services to rural northeastern Indiana. 14 14 772 36 74638 0 1006504 694935 60695036 64101584 772705 150226 722920 921369 63197165 65868114 314565 239834 0 0 34257538 34975286 0 0 0 27937706 30727255 62509809 65942375 687356 -74261 68964946 65770755 21183481 17167537 47781465 48603218 X Promote, Preserve, Restore Health 0 0 57944022 239834 64667800 THE 56 INPATIENT BED HOSPITAL OPERATES IN A RURAL AREA. FOR FISCAL YEAR ENDED SEPTEMBER 30, 2016, THE TOTAL NUMBER OF ADMISSIONS WAS 2,176. THE TOTAL NUMBER OF EMERGENCY ROOM VISITS WAS 18,005. THE HOSPITAL PROVIDES CHARITY CARE TO PATIENTS WHO MEET CERTAIN CRITERIA UNDER ITS CHARITY CARE POLICY. THE HOSPITAL DOES NOT PURSUE COLLECTION OF AMOUNTS DETERMINED TO BE CHARITY CARE WHICH WAS APPROXIMATELY $695,000 FOR THE YEAR. AT DEKALB HEALTH, OUR INVESTMENTS IN STATE-OF-THE-ART FACILITIES AND PARTNERSHIPS WITH TOP FAMILY PHYSICIANS AND SPECIALTY GROUPS MEAN THAT YOU NEVER HAVE TO LOOK PAST DEKALB COUNTY FOR THE VERY BEST CARE. OUR COMMITMENT IS ALSO REFLECTED IN OUR INVESTMENTS OF TIME, TALENTS, AND RESOURCES IN LOCAL SCHOOLS, BUSINESSES, CHARITABLE ORGANIZATIONS AND OTHER WORTHY CAUSES TO HELP ENSURE A HEALTHIER COMMUNITY. WE'RE PROUD TO BE YOUR NEIGHBOR, AND YOU CAN BE SURE WE'LL BE HERE, TAKING CARE OF YOU FOR GENERATIONS TO COME.THANKS TO THE VISION OF OUR LEADERSHIP, DEKALB HEALTH HAS TAKEN NUMEROUS STEPS FORWARD. WHILE MANY OF OUR MILESTONES ARE IN PLAIN SIGHT SUCH AS THE NEW ER, EICU, REGISTRATION AREA, IMAGING, LABORATORY, AND RESPIRATORY CENTERS; MANY OF OUR ACHIEVEMENTS ARE BEHIND THE SCENES. WE HAVE FORGED NEW PARTNERSHIPS WITH PHYSICIAN GROUPS, SO THAT PEOPLE IN OUR REGION NOW HAVE ACCESS TO ALMOST EVERY MEDICAL SPECIALTY RIGHT HERE ON OUR CAMPUS. We have also made significant INVESTMENTS IN NEW TECHNOLOGY, SUCH AS A STATE-OF-THE-ART MONITORING SYSTEM FOR CRITICALLY ILL PATIENTS AND THE MOVE TO ELECTRONIC MEDICAL RECORDS. MOST IMPORTANTLY, OUR PEOPLE CONTINUE TO DISTINGUISH THEMSELVES AS THE MOST COMPASSIONATE CAREGIVERS YOU'LL FIND ANYWHERE, AND WE CONTINUE TO DONATE TIME AND RESOURCES IN SUPPORT OF SCHOOLS, BUSINESSES, AND ORGANIZATIONS TO ENSURE A STRONG, HEALTHY COMMUNITY. AT DEKALB HEALTH, WE HAVE REARMED OUR COMMITMENT TO BEING YOUR INDEPENDENT, NOT-FOR-PROFIT COMMUNITY HOSPITAL. WITH EVERY NEW INVESTMENT, WE'RE BRINGING WORLD-CLASS HEALTHCARE HOME TO YOU.[continue on schedule O][Continue program service accomplishments from page 2] WE CELEBRATE THE UNIQUE BOND THAT EXISTS BETWEEN THE HOSPITAL AND ITS COMMUNITY. OURS IS A RICH HERITAGE OF INDEPENDENCE, DETERMINATION AND A COMMITMENT TO TAKING CARE OF THE INDIVIDUALS AND FAMILIES WE SERVE. 57944022 1 1 0 1 0 0 0 0 0 1 1 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 126 0 1 772 1 1 1 0 0 0 0 0 0 0 0 0 X 14 14 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 IN X Bret Claghorn 2609254600 1316 E 7th Street Auburn IN 46706 Mark Fogt Chairperson 1.00 0.00 X X 0 0 0 Douglas Morrow OD Vice Chairperson 1.00 0.00 X X 0 0 0 Beth Freidenberger Secretary 1.00 0.00 X X 0 0 0 Robert Menzie Past Chairman 1.00 0.00 X X 0 0 0 Richard Allen Director 1.00 0.00 X 0 0 0 Trina Chapman-Smith Director 1.00 0.00 X 0 0 0 Kassy Davis director 1.00 0.00 X 0 0 0 Caroline Derrow DDS Director 1.00 0.00 X 0 0 0 Matt Fetter director 1.00 0.00 X 0 0 0 Jason Hanna MD director 1.00 0.00 X 0 0 0 Tom Hartman director 1.00 0.00 X 0 0 0 Scott Pflughoeft director 1.00 0.00 X 0 0 0 Carrie Raver Director 1.00 0.00 X 0 0 0 Trent Stuckey director 1.00 0.00 X 0 0 0 Dennis Stockdale Director term end Sep'16 1.00 0.00 X 0 0 0 Craig Polkow CEO 40.00 0.00 X 105532 0 9743 Bret Claghorn CFO 40.00 0.00 X 38608 0 2391 Emilio Vazquez CMO 40.00 0.00 X 308528 0 6974 Philip Chase Physician 40.00 0.00 X 406382 0 39533 Bret Kueber Physician 40.00 0.00 X 342851 0 51396 Richard Toupin Physician 40.00 0.00 X 326488 0 33337 James Ingram Physician 40.00 0.00 X 305724 0 36320 Scott Armstrong Physician 40.00 0.00 X 290649 0 30189 FRED PRICE Former CEO 40.00 0.00 X 230976 0 2856 2355738 0 212739 26 1 1 0 Fetters Construction 5417 Co Rd 427 Auburn IN 46706 Construction Services 3178488 Signature Construction by Mike 500 North Street Suite 3 Auburn IN 46706 Construction Services 1051907 Rehabcare Group East Inc PO Box 502096 St Louis MO 63150 Rehabilitation Services 832623 Associated Anesthesiologists 5734 Coventry Lane Fort Wayne IN 46804 Physician Services 771790 McKesson Technologies Inc PO Box 98347 Chicago IL 60693 Technological Services 682932 16 460600 234335 694935 Patient Service Revenue 623990 58797060 58797060 Pharmacare 621500 4500423 4500423 Financial Services 900099 488880 488880 Cafeteria Sales 722320 315221 244641 70580 64101584 565452 565452 589812 12300 577512 577512 577512 4051577 4188269 278534 -136692 -278534 -415226 -415226 Cleaning 812300 2421 2421 LAUNDRY 812300 1637 1637 339799 59284 280515 343857 65868114 64667800 74638 430741 239834 239834 656164 273507 382657 26675071 24540315 2134756 102470 102470 5698015 5335771 362244 1843566 1695009 148557 185174 127824 57350 74764 17696 57068 130016 130016 29031 29031 5548213 4736858 811355 426796 34560 392236 1942990 1536534 406456 1652789 1511508 141281 1447387 359465 1087922 162510 152677 9833 54966 44759 10207 541801 541801 4937367 4504012 433355 679776 250 679526 Medical Supplies 10513188 10513188 HAF Assessment Fee 1379690 1379690 License, Accred Fee & M 510784 440475 70309 Collection Fees 226243 226106 137 283770 273984 9786 65942375 57944022 7998353 0 65743 1049131 8047115 8139058 23816 16237 1596794 1267616 692293 581417 87532246 48840788 40831186 38691458 17575039 15497164 460600 132960 68074 68964946 65770755 5894031 5798600 13946391 10894121 1343059 474816 21183481 17167537 X 47294299 48603218 487166 0 47781465 48603218 68964946 65770755 X -74261 1024851 -128837 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 7017 7017 0 Part II-B, Line 1: THE HOSPITAL PAID MEMBERSHIP DUES TO INDIANA HOSPITAL ASSOCIATION "IHA AND AMERICAN HOSPITAL ASSOCIATION "AHA" IN ADDITION TO INDIANA ASSOCIATION FOR HOME & HOSPICE CARE "IAHHC". IHA ATTRIBUTED 5.05% ($1,340); AHA ATTRIBUTED 23.98% ($5,286); AND IAHHC ATTRIBUTED 12% ($391) OF THE DUES TO LOBBYING EXPENSES TO TOTAL $7,017 ABOVE. 487166 487166 1020856 1051118 1584808 487166 1817 1057216 38177 1020856 108890 33375 34016 106432 1817 112897 76699 80706 108890 0.00000 0.00000 0.00000 0 0 393118 393118 62897893 31405565 31492328 24010916 17435223 6575693 230319 230319 38691458 Estimated Third Party Settlement 474816 474816 PART X, LINE 2 FIN 48 FOOTNOTE: NOT APPLICABLE. THE AUDITED FINANCIAL STATEMENTS DID NOT INCLUDE A FOOTNOTE REGARDING UNCERTAIN TAX POSITIONS UNDER FIN 48. HOWEVER, MANAGEMENT HAS EVALUTAED THE INCOME TAX POSITIONS UNDER THIS GUIDANCE AND BASED ON REVIEW, MANAGEMENT HAS NOT IDENTIFIED ANY MATERIAL UNCERTAIN TAX POSITIONS TO BE REPORTED OR DISCLOSED ON THE AUDITED FINANCIAL STATEMENTS ENDING SEPTEMBER 30, 2016. 1 1 1 X 1 X 1 1 0 1 1 304313 304313 0.00460 10343289 5791934 4551355 0.06900 10647602 5791934 4855668 0.07360 110580 110580 0.00170 25000 25000 0.00040 6933 6933 0.00010 142513 142513 0.00220 10790115 5791934 4998181 0.07580 230841 230841 0.00350 5185 5185 0.00010 15749 15749 0.00020 3088 3088 0.00000 254863 254863 0.00380 1 6508801 8150625 10611044 -2460419 X 1 1 1 1 DEKALB MEMORIAL HOSPITAL 1316 E 7th Street Auburn IN 46706 www.dekalbhealth.com 17-005041-1 X X X DEKALB MEMORIAL HOSPITAL INC 1 0 0 1 X X X X X X X X X 15 1 0 1 1 X https://www.dekalbhealth.com/clientuploads/directory/Linked_pdfs/CHNA-2016% X 1 15 1 https://www.dekalbhealth.com/clientuploads/directory/Linked_pdfs/CHNA-2016% 0 0 1 X 200.000000000000 350.000000000000 X X X X X 1 1 X X X 1 X https://www.dekalbhealth.com/clientuploads/directory/Linked_pdfs/financial- X https://www.dekalbhealth.com/clientuploads/directory/Linked_pdfs/financial- X https://www.dekalbhealth.com/clientuploads/directory/Linked_pdfs/Plain-Lang X X X X X 1 0 X X X X 1 X 0 0 DEKALB MEMORIAL HOSPITAL, INC. Part V, Section B, Line 5: THE HOSPITAL FACILITY TOOK INTO ACCOUNT INPUT FROM PERSONS WHO REPRESENT THE COMMUNITY THROUGH COMMUNITY SURVEYS SENT TO HOUSEHOLDS IN DEKALB COUNTY, PROVIDER SURVEYS SENT, AND FEEDBACK COLLECTED FROM KEY CONSTITUENTS. DEKALB MEMORIAL HOSPITAL, INC. Part V, Section B, Line 6b: The assessment was not conducted with other hospitals, but was part of a collaborative effort with DeKalb County Health Dept and IPFW Center for Social Research. DEKALB MEMORIAL HOSPITAL, INC. Part V, Section B, Line 7d: THE COMMUNITY HEALTH NEEDS ASSESSMENT IS AVAILABLE AT WWW.DEKALBHEALTH.COM located UNDER the drop down menu "COMMUNITY", or by following this URL: https://www.dekalbhealth.com/clientuploads/directory/Linked_pdfs/CHNA-2016%20executive-summary.pdf DEKALB MEMORIAL HOSPITAL, INC. Part V, Section B, Line 16i: FAP: https://www.dekalbhealth.com/clientuploads/directory/Linked_pdfs/financial-assistance-policy.pdfFAP Application: https://www.dekalbhealth.com/clientuploads/directory/Linked_pdfs/financial-assistance-application.pdfFAP Plain Language Summary: https://www.dekalbhealth.com/clientuploads/directory/Linked_pdfs/Plain-Language-Summary_web.pdf Part I, Line 3c: THE ORGANIZATION USES THE FEDERAL POVERTY GUIDELINES WHEN DETERMINING ELIGIBILITY FOR DISCOUNTED CARE BETWEEN 200% AND 350% OF THE FEDERAL POVERTY LIMIT (FPL) AS FOLLOWS: PATIENTS WITH INCOME BETWEEN 200% AND 250% OF THE FPL ARE ELIGIBLE FOR A 75% WRITE-OFF; PATIENTS WITH INCOME BETWEEN 250% AND 300% OF THE FPL ARE ELIGIBLE FOR A 50% WRITE-OFF; and PATIENTS WITH INCOME BETWEEN 300% AND 350% OF THE FPT ARE ELIGIBLE FOR A 30% WRITE-OFF. Part II, Community Building Activities: COMMUNITY BUILDING ACTIVITIES.THE HOSPITAL GIVES BACK THROUGH FINANCIAL AND EDUCATIONAL EFFORTS AND THROUGH VOLUNTEERING, AWARENESS INITIATIVES AND SUPPORT GROUPS. SOME OF THE MANY COMMUNITY EDUCATION PROGRAMS FOR CHILDREN AND ADULTS INCLUDE: PRENATAL EDUCATION, ACLS, CPR, AND FIRST AID TRAINING, DIABETES EDUCATION, SMOKING CESSATION AND WEIGHT MANAGEMENT. SOME OF THE COMMUNITY OUTREACH ACTIVITIES INCLUDE INVOLVEMENT IN: COMMUNITY AND WORKPLACE HEALTH & WELLNESS FAIRS, PRESENTATIONS TO COMMUNITY GROUPS, SPORTS PHYSICALS, ORGAN DONATION, and EMS STANDBY FOR MULTIPLE PUBLIC EVENTS. MANY OF THE PROGRAMS FINANCIALLY SUPPORTED PROVIDE INCREASED OPPORTUNITIES TO HELP PARTICIPANTS BE PHYSICALLY ACTIVE AND HEALTHY. Part III, Line 4: THE TEXT TO THE AUDITED FINANCIAL STATEMENT FOOTNOTE DESCRIBING BAD DEBT EXPENSE AND ITS PRESENTATION IS INCLUDED IN FOOTNOTE 1 "PATIENT ACCOUNTS RECEIVABLE" ON PAGES 8. Part III, Line 8: THE SOURCE USED TO DETERMINE THE AMOUNT OF MEDICARE ALLOWABLE COSTS REPORTED FOR PART III, SECTION B, MEDICARE HAS BEEN PROVIDED FROM THE YEAR ENDED SEPTEMBER 30, 2016: HOSPITAL STATEMENT OF REIMBURSABLE COST Part III, Line 9b: THE HOSPITAL'S COLLECTION PRACTICES FOR THOSE QUALIFYING FOR FINANCIAL ASSISTANCE INCLUDE: (1) DESIGNATING THE ACCOUNTS QUALIFYING FOR FINANCIAL ASSISTANCE IN THE ACCOUNTS RECEIVABLE SYSTEM AS CHARITY CARE; (2)EXCLUDING THE ACCOUNTS FROM BAD DEBT WRITE OFFS; AND (3) EXCLUDING THE ACCOUNTS FROM BEING REPORTED TO ANY COLLECTION AGENCIES. Part VI, Line 2: Assessing Community Need.The hospital assesses the health care needs of the community through Periodic focus group surveys by outside consultants which are prepared every 3 years to assess the needs of the community. These surveys include input from individuals, health professionals, governmental health care officials as well as representatives from Dekalb Hospital. The survey solicits input on the health care needs including obesity, preventive medicine, vaccinations, cardiovascular, etc. These needs and concerns are evaluated and appropriate plans are put into action to deal with the most pressing issues. Customer satisfaction surveys are also used to identify unmet healthcare needs of the community.Recently, In the Fall of 2015, IPFW Center for Social Research finalized and reported on the Community Health Needs Assessment they conducted on behalf of the DeKalb County Health Department and DeKalb Health. This survey is a tool the Hospital is using as one of the key componenets for community outreach strategies. This survey in addition to feeback received from key constituents i.e. The United Way of DeKalb County, Community Foundation of DeKalb County, Children First Center, Purdue Extension Office, Schools, physician offices, hospital department managers, and others helped to identify the health care needs of the community. Part VI, Line 3: Patient Education of Assistance Eligibility.Patients are provided information regarding the charity care policies when admitted to DeKalb Hospital. Financial aid guidelines are also included with the billing statements. Signs outlining the financial aid policies and applications are also located in numerous areas throughout the hospital. All non-insured patients are strongly encouraged to meet with a financial counselor to review all options available to them including medicare, medicaid, charity care, loan and payment programs. Dekalb hospital staff willingly assist patients with qualification criteria and completion of applications for such programs, where applicable. Part VI, Line 4: Community Description.DEKALB MEMORIAL HOSPITAL IS THE SOLE COMMUNITY HOSPITAL LOCATED IN DEKALB COUNTY, SERVING DEKALB, PORTIONS OF STEUBEN, LAGRANGE, NOBLE, AND ALLEN COUNTIES IN ADDITION TO SEVERAL BORDER TOWNS OF HICKSVILLE AND EDGERTON IN NORTHWEST OHIO. THE Primary Service area POPULATION OF DEKALB MEMORIAL HOSPITAL IS APPROXIMATELY 42,000 WITH APPROXIMATELY 98% RECORDED AS WHITE. DEKALB HAS SEEN AN INCREASE IN THE UNINSURED AND UNDERINSURED WITH A REPORTED AMOUNT OF 12.1% OF RESIDENTS LIVING BELOW THE POVERTY LEVEL. THE DEMOGRAPHIC AREA SERVED BY DEKALB MEMORIAL HOSPITAL IS MADE UP OF A MEDIAN HOUSEHOLD INCOME OF APPROXIMATELY $46,000, THE MEDIAN AGE IS 38 AND CONTAINS PRIMARILY A BLUE COLLAR AND AGRICULTURAL WORKFORCE. Part VI, Line 5: Community Health Promotion.THE ORGANIZATION FURTHERS ITS EXEMPT PURPOSE BY PROMOTING HEALTH OF THE COMMUNITY THROUGH THE FOLLOWING: AN OPEN MEDICAL STAFF, CORPORATE BOARD MADE UP OF 30 COMMUNITY MEMBERS THAT SELECT THE BOARD OF DIRECTORS, AND THE USE OF SURPLUS FUNDS TO PROVIDE HIGH QUALITY HEALTHCARE SERVICES TO THE CITIZENS RESIDING IN ITS SERVICE AREAIN ADDITION, MANY OF THE HOSPITAL'S MANAGERS AND STAFF DONATE THEIR TIME TO SUPPORT ST. MARTIN'S HEALTHCARE CLINIC (FOR UNINSURED) AS WELL AS SERVE ON UNITED WAY, CHAMBER OF COMMERCE, ECONOMIC DEVELOPMENT BOARDS, AND JUNIOR ACHIEVEMENT. NONPERISHABLE FOOD ITEMS THAT ARE LEFT OVER AFTER THE HEATLHY HALLOWEEN FAIR AND/OR PLAY-LEARN-SOAR ARE DONATED TO A LOCAL FOOD BANK OR BOOMERANG BACKPACK PROGRAM. Part VI, Line 6: Affiliated Health Care System.The organizatnion is not part of an affiliated health care system. Part VI, Line 7, Reports Filed With States IN 1 YMCA 310 N Main Street auburn IN 46706 350868958 501C3 145300 Program Support Fort Wayne Medical Education Program 50 Broadway Fort Wayne IN 46802 356049685 501C3 25150 Program Support Auburn-Cord-Duesenberg Festival Inc PO Box 6019 Auburn IN 46706 237291285 501C4 15000 Program Support United Way of Dekalb COunty PO Box 307 Auburn IN 46706 351065714 501C3 10948 Program Support Erin's House for Grieving Children Inc 5670 YMCA Park Drive West Fort Wayne IN 46835 351884264 501C3 7500 Program Support Dekalb County Fair Association inc PO Box 65 Auburn IN 46706 351697339 501C3 5000 Program Support Dekalb Chamber Partnership 208 S Jackson St Auburn IN 46706 350154290 501C3 5000 Program Support Dekalb County Health Department 220 E Seventh ST Auburn IN 46706 Gov't 25936 Cost Flu Mist Vacines Vaccines for Area School Children 6 2 Part I, Line 2: The amount of assistance listed in Part II are general contributions for general program support. The hospital does not monitor the use of funds once distributed to these organizations. 1 0 0 0 0 0 0 0 0 Emilio Vazquez CMO 300288 0 5590 0 2650 0 6974 0 0 0 315502 0 0 0 Philip Chase Physician 333800 0 70855 0 1727 0 11399 0 28134 0 445915 0 0 0 Bret Kueber Physician 264258 0 72863 0 5730 0 24342 0 27054 0 394247 0 0 0 Richard Toupin Physician 265573 0 59188 0 1727 0 6134 0 27203 0 359825 0 0 0 James Ingram Physician 248551 0 56571 0 602 0 6171 0 30149 0 342044 0 0 0 Scott Armstrong Physician 219470 0 64206 0 6973 0 0 0 30189 0 320838 0 0 0 FRED PRICE Former CEO 230562 0 0 0 414 0 2260 0 596 0 233832 0 0 0 Part I, Line 4a INCLUDED IN COMPENSATION ON schedule J, Part II, LINE 7 ABOVE FOR FORMER CEO, FRED PRICE, IS $182,776 IN SEVERANCE PAYMENTS. Form 990, Part I, Doing Business As: DeKalb Health Dekalb Health Home Care Dekalb Health Hospice Dekalb Health Medical Group Dekalb Health Medical Group - Butler Dekalb Health Medical Group - Garrett Dekalb Health Medical Group - Armstrong Dekalb Health Medical Group - Pediatrics Form 990, Part VI, Section A, line 6 The organization has corporate board members consisting of 30 community members. Form 990, Part VI, Section A, line 7a THE ORANIZATION HAS CORPORATE BOARD MEMBERS CONSISTING OF 30 COMMUNITY MEMBERS. FOURTEEN MEMBERS WERE ELECTED BY THE CORPORATE BOARD AND SERVED AS THE ORGANIZATIONS GOVERNING BODY DURING THE FISCAL YEAR. Form 990, Part VI, Section A, line 7b Nominations and approval for vacancies on the governing board are subject to approval by corporate members. All business decisions of the governing body are ratified by annual resolution of the corporate board. Form 990, Part VI, Section B, line 11 The 990 process includes a detail review by the accounting manager, chief financial officer and Chief Executive Officer. A copy of the Form 990 is provided to the audit and finance committee for review. A report of the committee's review and copy of the Form 990 including requested schedules, as ultimately filed with the IRS, are provided to the board of directors prior to filing with the IRS. Form 990, Part VI, Section B, line 12c THE CONFLICT OF INTEREST Statements ARE COMPLETED ANNUALLY BY ALL BOARD MEMBERS AND STAFF. THE annual STATEMENTS ARE REVIEWED BY THE BOARD Chair. WHEN conducting ORGANIZATION BUSINESS AND a conflict arises, THE BOARD OR STAFF MEMBER involved ABSTAINs FROM VOTING ON RELATED MATTERS. DOCUMENtation on this matter is kept IN THE BOARD MINUTES. Form 990, Part VI, Section B, line 15 AN INDEPENDENT COMPENSATION COMMITTEE, A SUB-COMMITTEE OF THE BOARD, REVIEWS AND APPROVES THE COMPENSATION OF THE CHIEF EXECUTIVE OFFICER, CHIEF FINANCIAL OFFICER AND OTHER KEY EMPLOYEES; THIRD PARTY AND MARKET DATA ARE UTILIZED AS COMPARABLE DATA; AND, DELIBERATION OF THESE DECISIONS ARE DOCUMENTED IN THE COMMITTEE'S MINUTES. Form 990, Part VI, Section C, line 19 THE CONFLICT OF INTEREST POLICY, GOVERNING DOCUMENTS, AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. IN ADDITION, THE ARTICLES OF INCORPORATION CAN BE VIEWED ON THE WEBSITE FOR THE INDIANA SECRETARY OF STATE AND THE MOST CURRENT FINANCIAL STATEMENTS ARE ATTACHED TO THIS FORM 990. Form 990, Part XI, line 9: Change in value of Derivative -115,348. Decrease in investment in Foundation -13,489. Form 990, Part XII, line 2c, Oversight of Audit: The audit committee 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. Dekalb Memorial Pharmacare LLC 1314 E 7th Street Auburn IN 46706 273514342 Retail Pharmacy IN 111118 891076 Dekalb Memorial hospital DEKALB HEALTH FOUNDATION INC 1316 EAST 7TH STREET Auburn IN 46706 356047817 Foundation IN 501(c)3 Line 11 Dekalb memorial Hospital 1 0 0 1 0 0 0 0 0 0 0 0 1 1 1 1 0 0 0 0 Dekalb Health Foundation inc C 460600 fair market value