2014-05-10T12:53:42-05:00 2013-09-30 351178661 BLUE & CO LLC ONE AMERICAN SQUARE 2200 INDIANAPOLIS IN 46282 990 2012-10-01 350593390 DEACONESS HOSPITAL INC DEAC 8124503296 600 MARY STREET EVANSVILLE IN 47747 SHAWN MCCOY 8124503296 2014-05-08 1 AMBER KOCHER CPA P01286298 3176334705 2012 2015-11-30 17:44:51Z SHAWN W MCCOY CAO 600 MARY STREET EVANSVILLE IN 47747 749274534 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. 16 10 5493 235 11227601 -19012 1888774 1649475 515082254 531568224 8461947 4987420 51646845 52034431 577079820 590239550 295491 578388 0 0 247753296 255744305 0 0 364666 270678198 268997419 518726985 525320112 58352835 64919438 819821086 869894363 382563647 349588545 437257439 520305818 X SEE SCHEDULE O. 0 0 143852079 316070548 PATIENT SERVICE REVENUE. SEE SCHEDULE O. 338408631 205242013 CHARITY CARE/SUBSIDIZED CARE. SEE SCHEDULE O. 17170574 10255663 GRADUATE MEDICAL EDUCATION, MEDICAL EDUCATION AND COMMUNITY BENEFIT. SEE SCHEDULE O. 578388 578388 26019726 578388 578388 26019726 500009672 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 1 410 0 1 5493 1 1 1 0 0 0 0 1 1 0 0 0 0 0 0 0 0 X 16 10 0 0 0 0 1 1 0 1 1 1 0 1 1 1 1 1 1 1 1 1 1 IN X CHERYL A WATHEN 8124503296 600 MARY STREET EVANSVILLE IN 47747 LINDA E WHITE 40.00 30.00 X X 641386 324241 242168 JEROME A BENKERT JR 5.00 5.00 X 5800 0 0 STEVEN T TITZER CPA 5.00 10.00 X 6000 1200 0 JOHN ENGELBRECHT 5.00 5.00 X 7800 0 0 BRUCE STALLINGS 5.00 5.00 X 7600 0 0 BRUCE ADYE MD 7.00 5.00 X 11000 0 0 STEVEN A CHURCH 5.00 5.00 X 3800 0 0 REV DR JOSEPH FRACCARO 5.00 5.00 X 5000 0 0 DAVID A KOEHLER JR MD 25.00 35.00 X 98015 167939 14420 WILLIAM PENLAND MD 5.00 5.00 X 5000 0 0 ROBERT B WRIGHT 5.00 5.00 X 7400 2000 0 DANIEL W WHITEHEAD MD 5.00 5.00 X 25200 0 0 MATHIAS KOLLECK II 25.00 5.00 X 325208 0 45041 DANIEL HERMANN 5.00 5.00 X 0 0 0 ROBERT KELLER 5.00 5.00 X 0 0 0 SHARON REED WALKER 5.00 5.00 X 0 0 0 SHAWN W MCCOY 50.00 10.00 X 500742 9000 119505 CHERYL A WATHEN 50.00 10.00 X 282777 171300 107341 JAMES R PORTER MD 50.00 5.00 X 526210 2800 131061 CHERONA J HAJEWSKI 50.00 0.00 X 378529 0 83585 BRUCE E EPMEIER 50.00 0.00 X 335237 0 69530 LARRY F PILE 50.00 5.00 X 279611 2205 11732 LYNN C LINGAFELTER 50.00 0.00 X 204897 0 26093 RICHARD B PERRY 50.00 0.00 X 208170 0 30179 JOHN L ZABROWSKI 50.00 10.00 X 207787 3000 40728 JOYCE A THOMAS 50.00 0.00 X 173403 0 49766 REBECCA L MALOTTE 50.00 0.00 X 177273 0 54623 VENKATESH R MADADI 50.00 0.00 X 680818 0 56136 NIRMAL JOSHI MD 50.00 0.00 X 722406 0 60544 RAJESH J PATEL MD 50.00 0.00 X 743257 0 34595 AYMAN ELFAR MD 50.00 0.00 X 593181 0 51830 LAWRENCE C KILINSKI JR MD 50.00 0.00 X 594465 0 53659 HARRY L SMITH JR 0.00 0.00 X 392735 0 43776 8150707 683685 1326312 197 1 1 0 EVANSVILLE SURGERY CENTER PO BOX 2185 EVANSVILLE IN 47728 SURGICAL SERVICES 28732379 WINK CONSTRUCTION INC 4007 E EICHEL AVE EVANSVILLE IN 47716 BUILDING CONTRACTOR 5931732 EPIC SYSTEMS CORPORATION PO BOX 88314 MILWAUKEE WI 53288 SOFTWARE/ CONSULTING 3425048 EVANSVILLE SURGERY ASSOCIATES 520 MARY STREET EVANSVILLE IN 47710 SURGICAL SERVICES 2464881 KAHN DEES DONOVAN & KAHN LLP 501 MAIN STREET EVANSVILLE IN 47735 LAW SERVICES 2434978 60 100941 184708 1363826 370399 1649475 NET PATIENT REVENUE 900099 531568224 531568224 531568224 10164342 10164342 15009 15009 7203557 2909670 4293887 4293887 4293887 150495594 294016 149584881 6396660 910713 -6102644 -5191931 -5191931 48700 100941 143773 -95073 -95073 INVESTMENT IN JOINT VENTURES 900099 26019726 26019726 LABORATORY SALES 621500 10781585 10781585 CMS MEANINGFUL USE 900099 3916943 3916943 7117363 446016 6671347 47835617 590239550 557587950 11227601 19774524 X 578388 578388 5407382 5407382 188093447 183152816 4694730 245901 17286336 15764621 1521715 31592927 29862385 1730542 13364213 12671349 692864 2329465 1550908 778557 94894 94894 32237 32237 410806 393302 17504 56176905 54876547 1274012 26346 1188805 117553 1071252 11119266 10008736 1062501 48029 8379770 7328652 1051118 16534132 15177862 1356270 960228 809362 150866 841465 629264 211096 1105 8603870 8603870 39181434 36713406 2468010 18 1768049 1760454 7595 MEDICAL/SURGICAL SUPPLI 85867759 85818456 49303 MEDICAID ASSESSMENT FEE 14775510 14775510 EQUIP RENTAL/MAINTENANC 12742083 12463055 279028 AGENCY COLLECTION FEES 6262186 6262186 1728555 1084292 618500 25763 525320112 500009672 24945774 364666 54671462 43965528 88496093 79773146 980947 1051175 5592070 5518992 4566672 5393760 740768222 428226748 328708749 312541474 270497387 354838689 33696074 34131516 15522009 15522009 17089623 17158074 819821086 869894363 59087211 60092128 244662 251958 205620955 206158405 117610819 83086054 382563647 349588545 X 432200551 514674469 3293842 3782581 1763046 1848768 437257439 520305818 819821086 869894363 X 64919438 18128941 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 32237 32237 0 EXPLANATION OF LOBBYING ACTIVITIES: 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. 5544426 1890 611864 38483 289 6119408 8353428 6871 541295 3357168 5544426 8130489 1293267 294514 7052 1048880 308910 8353428 7433786 1683536 281910 192998 790792 284953 8130489 7797671 931781 337059 329950 1014396 288379 7433786 0.86000 0.14000 0 0 495397 9854366 10349763 48151381 428755603 240194336 236712648 248898529 188032412 60866117 4612946 4612946 312541474 ACCRUED RETIREMENT BENEFITS 61125664 TAXABLE BOND- SERIES 2012C 8200000 ESTIMATED THIRD PARTY SETTLEMENTS 6224177 TAXABLE BOND-SERIES 2012A 4985000 CAPITAL LEASE OBLIGATIONS 1814482 RELATED ORGANIZATION PAYABLES 736731 83086054 X DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: 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. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: 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, 2013 AND 2012, 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 CLASSIC 124716 100016 24700 39410 18500 15187 3637 DH PARTY OF THE YEAR 24925 925 24000 48029 895 18115 0 149641 100941 48700 39410 66529 16082 21752 143773 -95073 1 1 X 1 X 300.000000000000 1 X 1 1 0 1 1 22872446 22872446 0.03960 73681506 53624066 20057440 0.03470 96553952 53624066 42929886 0.07430 732049 36211 695838 0.00120 4403251 1658288 2744963 0.00480 8961794 6565848 2395946 0.00410 1146998 28933 1118065 0.00190 15244092 8289280 6954812 0.01200 111798044 61913346 49884698 0.08630 1555 1555 0.00000 10946 660 10286 0.00000 1801 1801 0.00000 4000 4000 0.00000 8207 8207 0.00000 935 935 0.00000 64434 16350 48084 0.00010 91878 17010 74868 0.00010 1 40019702 131537693 151926989 -20389296 X 1 1 3 1 DEACONESS HOSPITAL INC

600 MARY STREET EVANSVILLE IN 47747

WWW.DEACONESS.COM X X X X 2 DEACONESS GATEWAY HOSPITAL

4011 GATEWAY BLVD NEWBURGH IN 47630

WWW.DEACONESS.COM X X X X 3 DEACONESS CROSS POINTE

7200 E INDIANA STREET EVANSVILLE IN 47715

WWW.DEACONESS.COM X DEACONESS HOSPITAL INC 1 1 X X X X X X X X X 12 1 1 1 X X X X X X X X X X 1 0 1 1 300.000000000000 1 300.000000000000 1 X X X X X 1 1 X X X 1 0 X X X 1 X 0 0 DEACONESS GATEWAY HOSPITAL 2 1 X X X X X X X X X 12 1 1 1 X X X X X X X X X X 1 0 1 1 300.000000000000 1 300.000000000000 1 X X X X X 1 1 X X X 1 0 X X X 1 X 0 0 DEACONESS CROSS POINTE 3 1 X X X X X X X X X 12 1 1 1 X X X X X X X X X X 1 0 1 1 300.000000000000 1 300.000000000000 1 X X X X X 1 1 X X X 1 0 X X X 1 X 0 0 45 DEACONESS PROCEDURE CENTER

421 CHESTNUT STREET EVANSVILLE IN 47713

OUTPATIENT SERVICES DEACONESS HOSPITAL PHYSICAL MEDICINE

520 MARY STREET SUITE 280 EVANSVILLE IN 47747

OUTPATIENT SERVICES DEACONESS COMPREHENSIVE PAIN CTR & PROG

4600 W LLOYD EXPRESSWAY EVANSVILLE IN 47712

OUTPATIENT SERVICES DEACONESS CHEMOTHERAPY INFUSION CTR

4055 GATEWAY BLVD SUITE 1200 NEWBURGH IN 47630

OUTPATIENT SERVICES DEACONESS HOSPITAL INFUSION SVCS

421 CHESTNUT STREET EVANSVILLE IN 47713

OUTPATIENT SERVICES DEACONESS HOSPITAL PHYSICAL MEDICINE

10455 ORTHOPAEDIC DRIVE NEWBURGH IN 47630

OUTPATIENT SERVICES DEACONESS COMPREHENSIVE PAIN CTR-GATEWAY

4099 GATEWAY BLVD NEWBURGH IN 47630

OUTPATIENT SERVICES DEACONESS CRITICAL CARE GROUP

519 HARRIET STREET EVANSVILLE IN 47747

OUTPATIENT PHYSICIAN CLINIC DEACONESS HOSPITAL BREAST CENTER

520 MARY STREET SUITE 140 EVANSVILLE IN 47710

DIAGNOSTIC CENTER DEACONESS REGIONAL LABORATORY

421 CHESTNUT STREET EVANSVILLE IN 47713

DIAGNOSTIC CENTER DEACONESS HOME CARE

701 GARFIELD STREET EVANSVILLE IN 47747

HOME HEALTH AGENCY CHANCELLOR CENTER FOR ONCOLOGY

4055 GATEWAY BLVD NEWBURGH IN 47630

OUTPATIENT SERVICES DEACONESS SLEEP LAB

350 W COLUMBIA STREET SUITE 210 EVANSVILLE IN 47710

OUTPATIENT SERVICES DEACONESS SLEEP LAB

350 W COLUMBIA STREET SUITE LL-10 EVANSVILLE IN 47710

DIAGNOSTIC CENTER DEACONESS OHIO VALLEY HOSPICE

701 GARFIELD STREET EVANSVILLE IN 47747

HOSPICE DEACONESS REGIONAL LABORATORY

4133 GATEWAY BLVD SUITE 110 NEWBURGH IN 47630

DIAGNOSTIC CENTER THE FAMILY PRACTICE CENTER

515 READ STREET EVANSVILLE IN 47710

OUTPATIENT PHYSICIAN CLINIC DEACONESS WOUND CARE CENTER

611 HARRIET STREET SUITE 501 EVANSVILLE IN 47710

OUTPATIENT SERVICES DEACONESS HOSPITAL MAMMOGRAPHY & IMAGING

421 CHESTNUT STREET EVANSVILLE IN 47713

DIAGNOSTIC CENTER DEACONESS CLINIC GATEWAY REG LAB

4233 GATEWAY BLVD NEWBURGH IN 47630

DIAGNOSTIC CENTER DEACONESS ANTICOAGULATION CLINIC

4107 GATEWAY BLVD NEWBURGH IN 47630

OUTPATIENT SERVICES DEACONESS CLINIC WEST REG LAB RADIOLOGY

545 S BOEHNE CAMP ROAD EVANSVILLE IN 47712

OUTPATIENT PHYSICIAN CLINIC MIDWEST RADIOLOGIC IMAGING

10455 ORTHOPAEDIC DRIVE NEWBURGH IN 47630

DIAGNOSTIC CENTER MIDWEST RADIOLOGICAL IMAGING

4087 GATEWAY BLVD NEWBURGH IN 47630

DIAGNOSTIC CENTER DEACONESS REGIONAL LABORATORY

611 HARRIET STREET SUITE 102 EVANSVILLE IN 47710

DIAGNOSTIC CENTER DEACONESS RILEY CHILDREN'S SPECIALTY CTR

4133 GATEWAY BLVD NEWBURGH IN 47630

OUTPATIENT PHYSICIAN CLINIC DEACONESS RILEY SPECIALITY CTR OP

4121 GATEWAY BLVD NEWBURGH IN 47630

OUTPATIENT PHYSICIAN CLINIC DOCTOR'S PLAZA X-RAY

611 HARRIET STREET EVANSVILLE IN 47710

DIAGNOSTIC CENTER DEACONESS PRIMARY CARE FOR SENIORS

4498 FIRST AVENUE EVANSVILLE IN 47710

OUTPATIENT PHYSICIAN CLINIC DEACONESS REGIONAL LABORATORY

4494 N FIRST AVENUE EVANSVILLE IN 47710

DIAGNOSTIC CENTER DEACONESS CLINIC PRINCETON RADIOLOGY SRV

685 VAIL STREET PRINCETON IN 47670

OUTPATIENT PHYSICIAN CLINIC DEACONESS PRIMARY CARE FOR SENIORS

1750 OAK HILL ROAD EVANSVILLE IN 47710

OUTPATIENT PHYSICIAN CLINIC DEACONESS PRE-ADMISSION TESTING

520 MARY STREET SUITE 330 EVANSVILLE IN 47747

DIAGNOSTIC CENTER MT VERNON MEDICAL CENTER LAB & RADIOLOGY

1900 W FOURTH STREET MT VERNON IN 47620

DIAGNOSTIC CENTER DEACONESS FAMILY MEDICINE

611 HARRIET STREET SUITE 504 EVANSVILLE IN 47710

OUTPATIENT PHYSICIAN CLINIC DEACONESS DIABETES CENTER - EDUCATION

421 CHESTNUT STREET EVANSVILLE IN 47713

OUTPATIENT SERVICES DEACONESS GATEWAY GASTROENTEROLOGY

4133 GATEWAY BLVD NEWBURGH IN 47630

OUTPATIENT PHYSICIAN CLINIC DEACONESS WEIGHT LOSS SOLUTIONS

310 W IOWA STREET EVANSVILLE IN 47710

OUTPATIENT PHYSICIAN CLINIC DEACONESS REGIONAL LABORATORY

1204 W WILLIAMS STREET OAKLAND CITY IN 47660

DIAGNOSTIC CENTER DEACONESS CROSS POINTE-OWENSBORO

920 FREDERICA STREET SUITE 1003 OWENSBORO KY 42301

OUTPATIENT PHYSICIAN CLINIC DEACONESS CROSS POINTE-HENDERSON

209 N ELM STREET HENDERSON KY 42420

OUTPATIENT PHYSICIAN CLINIC DEACONESS CROSS POINTE OUTPATIENT CLINIC

445 CROSS POINTE BLVD EVANSVILLE IN 47715

OUTPATIENT PHYSICIAN CLINIC DEACONESS CROSS POINTE

7200 E INDIANA EVANSVILLE IN 47715

OUTPATIENT PHYSICIAN CLINIC DEACONESS RADIOLOGY LABORATORY- MT PLEA

8600 NORTH KENTUCKY AVENUE EVANSVILLE IN 47725

DIAGNOSTIC CENTER DEACONESS RADIOLOGY SERVICES- MT PLEASA

8600 NORTH KENTUCKY AVENUE EVANSVILLE IN 47725

DIAGNOSTIC CENTER 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 $455,161. THESE CLINICS ARE OPERATED AS A BENEFIT TO THE COMMUNITY. PART I, L7 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:DURING FISCAL YEAR 2014, DEACONESS PROVIDED FINANCIAL SUPPORT TO MORE THAN 100 NON-PROFIT ORGANIZATIONS LOCATED IN OUR THREE-STATE SERVICE AREA. THIS INCLUDES SPONSORSHIP OF WALKS AND RUNS TO RAISE AWARENESS FOR DISEASES AND HEALTH CONDITIONS, DONATIONS TO AREA FOOD PANTRIES, SIGNIFICANT PARTNERSHIPS WITH EVENTS THAT FUND RESEARCH FOR BREAST CANCER AND TYPE 1 DIABETES, AND FUNDING FOR SOCIAL WORKERS SO THEY CAN BE IN THE MIDDLE AND HIGH SCHOOLS WHERE THEIR SERVICES ARE DESPERATELY NEEDED. THE HOSPITAL GAVE EACH TEACHER IN THE DESIGNATED "COMMUNITY BENEFIT SCHOOLS" $100 TO BUSY SUPPLIES FOR THEIR CLASSROOM, TOTALING OF $23,236. THE HOSPITAL ALSO SENT $100 TO EVERY "AFTER PROM" EVENT IN THE REGION TO PROVIDE TEENAGERS WITH A SAFE PLACE TO CELEBRATE FREE FROM DRUGS, ALCOHOL, AND RISKY BEHAVIOR, TOTALING $2,100. DEACONESS PROVIDED 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. DEACONESS PROMOTES HEALTHY LIVING IN THE COMMUNITY THROUGH SEVERAL INITIATIVES INCLUDING:1. HEALTHIER U WORKS: ORGANIZED, OUTDOOR COMMUNITY WALK EVERY MORNING FROM APRIL TO OCTOBER2. WISE CHOICE: VENDORS AT THE ANNUAL FALL FESTIVAL SUBMIT RECIPES TO OUR DIETICIANS. IF THEY MEET CERTAIN NUTRITIONAL REQUIREMENTS, THE VENDOR'S BOOTH GETS A GREEN SIGN TO HANG THAT INDICATES THE SERVE HEALTHY FOOD OPTIONS AT THEIR BOOTH.3. MEN'S HEALTH SERIES: ONCE A MONTH FROM MARCH THROUGH NOVEMBER, MEN IN THE COMMUNITY ARE INVITED TO COME TO THE HOSPITAL, EAT DINNER, AND HEAR A PRESENTATION SPECIFICALLY GEARED TOWARD IMPROVING MEN'S HEALTH.4. COMMUNITY SCREENINGS: EACH, WEEK, REDUCED COST HEALTH SCREENINGS ARE OFFERED AT A DEACONESS CLINIC LOCATION. THE LOCATION ROTATES BETWEEN MULTIPLE STATES AND COUNTIES. 5. MENTAL HEALTH FIRST-AID COURSES: AN EDUCATION PROGRAM THAT HELPS THE PUBLIC IDENTIFIES, UNDERSTAND, AND RESPOND TO SIGNS OF MENTAL ILLNESSES AND SUBSTANCE ABUSE DISORDERS.6. TRAUMA EDUCATION: DEACONESS TRAUMA SERVICES DEVOTES TIME AND RESOURCES TO EDUCATING EMS PERSONNEL AND OTHER FIRST RESPONDERS IN THE REGION. 7. HEALTH SCIENCE INSTITUTE: A HANDS-ON SUMMER PROGRAM FOR HIGH SCHOOL STUDENTS INTERESTED IN THE MEDICAL PROFESSION. 8. SUICIDE PREVENTION: MEMBERS OF OUR MENTAL HEALTH HOSPITAL TRAVEL AROUND THE REGION TO PROVIDE SUICIDE PREVENTION TRAINING TO SCHOOLS, CHURCHES, NON-PROFIT GROUPS, ETC. PART III, LINE 4: SECTION A. FOOTNOTE TO ORGANIZATION'S FINANCIAL STATEMENTS THAT DESCRIBES BAD DEBT EXPENSE: (BELOW IS THE PORTION OF THE AUDITED FINANCIAL STATEMENT FOOTNOTE "PATIENT ACCOUNTS RECEIVABLE, ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS AND NET PATIENT SERVICE REVENUE" RELATED TO BAD DEBTS.)PATIENT ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS BASED ON THE SYSTEM'S EVALUATION OF ITS MAJOR PAYOR SOURCES OF REVENUE, THE AGING OF THE ACCOUNTS, HISTORICAL LOSSES, CURRENT ECONOMIC CONDITIONS, AND OTHER FACTORS UNIQUE TO ITS SERVICE AREA AND THE HEALTHCARE INDUSTRY. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THE MAJOR PAYOR SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE SYSTEM ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS AND A PROVISION FOR BAD DEBTS, IF NECESSARY. FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PAYMENTS THE SYSTEM RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS. 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 ESTIMATED BASED UPON THE 2013 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. DEACONESS HOSPITAL, INC. PART V, SECTION B, LINE 3: DESCRIPTION OF COMMUNITY INPUT:IN 2011, DEACONESS HEALTH SYSTEM JOINED FOUR OTHER LOCAL HEALTH-RELATED ORGANIZATIONS, ECHO COMMUNITY HEALTH CARE, ST. MARY'S MEDICAL CENTER, UNITED WAY, AND WELBORN BAPTIST FOUNDATION, TO PLAN FOR AND ADMINISTER A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA). MEMBERS OF THE DEACONESS COMMUNITY BENEFIT TEAM MET REGULARLY WITH OTHER MEMBERS OF THE COLLABORATIVE TO CREATE A STRATEGY AND TACTICS THAT ADDRESS OUR FOUR IDENTIFIED COMMUNITY HEALTH NEEDS. WE ALSO PARTICIPATED IN FOCUS GROUP SESSIONS WITH 51 BUSINESS, COMMUNITY, AND SOCIAL SERVICE LEADERS AND STRATEGY SESSIONS WITH 42 PROVIDERS AND AGENCIES TO DEVELOP A PLAN THAT WOULD CAUSE POSITIVE CHANGE IN THE OVERALL HEALTH OF OUR POPULATION. ADDITIONALLY, EACH PARTNER CREATED AN ORGANIZATION SPECIFIC PLAN TO ADDRESS THE SAME ISSUES. THE PLANS WERE TRANSCRIBED, PRESENTED AT A PRESS CONFERENCE, AND POSTED ON THE WEBSITE OF EACH PARTNER'S ORGANIZATION. DEACONESS GATEWAY HOSPITAL PART V, SECTION B, LINE 3: DESCRIPTION OF COMMUNITY INPUT:IN 2011, DEACONESS HEALTH SYSTEM JOINED FOUR OTHER LOCAL HEALTH-RELATED ORGANIZATIONS, ECHO COMMUNITY HEALTH CARE, ST. MARY'S MEDICAL CENTER, UNITED WAY, AND WELBORN BAPTIST FOUNDATION, TO PLAN FOR AND ADMINISTER A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA). MEMBERS OF THE DEACONESS COMMUNITY BENEFIT TEAM MET REGULARLY WITH OTHER MEMBERS OF THE COLLABORATIVE TO CREATE A STRATEGY AND TACTICS THAT ADDRESS OUR FOUR IDENTIFIED COMMUNITY HEALTH NEEDS. WE ALSO PARTICIPATED IN FOCUS GROUP SESSIONS WITH 51 BUSINESS, COMMUNITY, AND SOCIAL SERVICE LEADERS AND STRATEGY SESSIONS WITH 42 PROVIDERS AND AGENCIES TO DEVELOP A PLAN THAT WOULD CAUSE POSITIVE CHANGE IN THE OVERALL HEALTH OF OUR POPULATION. ADDITIONALLY, EACH PARTNER CREATED AN ORGANIZATION SPECIFIC PLAN TO ADDRESS THE SAME ISSUES. THE PLANS WERE TRANSCRIBED, PRESENTED AT A PRESS CONFERENCE, AND POSTED ON THE WEBSITE OF EACH PARTNER'S ORGANIZATION. DEACONESS CROSS POINTE PART V, SECTION B, LINE 3: DESCRIPTION OF COMMUNITY INPUT:IN 2011, DEACONESS HEALTH SYSTEM JOINED FOUR OTHER LOCAL HEALTH-RELATED ORGANIZATIONS, ECHO COMMUNITY HEALTH CARE, ST. MARY'S MEDICAL CENTER, UNITED WAY, AND WELBORN BAPTIST FOUNDATION, TO PLAN FOR AND ADMINISTER A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA). MEMBERS OF THE DEACONESS COMMUNITY BENEFIT TEAM MET REGULARLY WITH OTHER MEMBERS OF THE COLLABORATIVE TO CREATE A STRATEGY AND TACTICS THAT ADDRESS OUR FOUR IDENTIFIED COMMUNITY HEALTH NEEDS. WE ALSO PARTICIPATED IN FOCUS GROUP SESSIONS WITH 51 BUSINESS, COMMUNITY, AND SOCIAL SERVICE LEADERS AND STRATEGY SESSIONS WITH 42 PROVIDERS AND AGENCIES TO DEVELOP A PLAN THAT WOULD CAUSE POSITIVE CHANGE IN THE OVERALL HEALTH OF OUR POPULATION. ADDITIONALLY, EACH PARTNER CREATED AN ORGANIZATION SPECIFIC PLAN TO ADDRESS THE SAME ISSUES. THE PLANS WERE TRANSCRIBED, PRESENTED AT A PRESS CONFERENCE, AND POSTED ON THE WEBSITE OF EACH PARTNER'S ORGANIZATION. DEACONESS HOSPITAL, INC. PART V, SECTION B, LINE 4: OTHER HOSPITAL FACILITIES CHNA WAS CONDUCTED WITH:DEACONESS GATEWAY HOSPITALDEACONESS CROSS POINTEST. MARY'S MEDICAL CENTER DEACONESS GATEWAY HOSPITAL PART V, SECTION B, LINE 4: OTHER HOSPITAL FACILITIES CHNA WAS CONDUCTED WITH:DEACONESS HOSPITAL, INC.DEACONESS CROSS POINTEST. MARY'S MEDICAL CENTER DEACONESS CROSS POINTE PART V, SECTION B, LINE 4: OTHER HOSPITAL FACILITIES CHNA WAS CONDUCTED WITH:DEACONESS HOSPITAL, INC.DEACONESS GATEWAY HOSPITALST. MARY'S MEDICAL CENTER DEACONESS HOSPITAL, INC. PART V, SECTION B, LINE 5C: 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 5C: 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 5C: 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 6I: METHOD FOR ADDRESSING NEEDS IDENTIFIED IN CHNA:6A: IN 2011, DEACONESS HEALTH SYSTEM JOINED FOUR OTHER LOCAL HEALTH-RELATED ORGANIZATIONS, ECHO COMMUNITY HEALTH CARE, ST. MARY'S MEDICAL CENTER, UNITED WAY, AND WELBORN BAPTIST FOUNDATION, TO PLAN FOR AND ADMINISTER A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA). REVIEW OF THE ASSESSMENT DATA LED THE TEAM TO IDENTIFY FOUR MAIN ISSUES AT THE CORE OF POOR COMMUNITY HEALTH: TOBACCO USE, OBESITY, SUBSTANCE ABUSE, AND MENTAL HEALTH. THE COLLABORATIVE CREATED A GROUP PLAN OF ACTION TO ADDRESS THE FOUR IDENTIFIED COMMUNITY HEALTH ISSUES. MEETING WITH COMMUNITY PARTNERS AND STAKEHOLDERS GUIDED THE PLANNING PROCESS. ADDITIONALLY, EACH PARTNER CREATED AN ORGANIZATION SPECIFIC PLAN TO ADDRESS THE SAME ISSUES. THE PLANS WERE TRANSCRIBED, PRESENTED AT A PRESS CONFERENCE, AND POSTED ON THE WEBSITE OF EACH PARTNER'S ORGANIZATION.6B: STRATEGIES FOR EACH OF THE FOUR TARGET AREAS WERE CREATED FOR THE COLLABORATIVE AND FOR DEACONESS. SINCE THE HOSPITAL SERVES VANDERBURGH AND WARRICK COUNTIES IN INDIANA, THE STRATEGY FOR DEACONESS INCLUDES TACTICS TO ADDRESS THESE ISSUES IN BOTH COMMUNITIES. AN INTERNAL TEAM LEADER WAS ASSIGNED TO EACH OF THE FOUR TOPIC AREAS AND RESPONSIBLE FOR PUTTING TOGETHER A TEAM AND THEN A PLAN TO CREATE POSITIVE CHANGE IN THE SPECIFIC HEALTH AREA. THE PLANNING PHASE IS COMPLETE AND THE EXECUTION PHASE TAKES PLACE IN TAX YEARS 2013, 2014, 2015.6C: MEMBERS OF THE DEACONESS COMMUNITY BENEFIT TEAM MET REGULARLY WITH OTHER MEMBERS OF THE COLLABORATIVE TO CREATE A STRATEGY AND TACTICS THAT ADDRESS OUR FOUR IDENTIFIED COMMUNITY HEALTH NEEDS. THE BENEFIT TEAM PARTICIPATED IN FOCUS GROUP SESSIONS WITH 51 BUSINESS, COMMUNITY, AND SOCIAL SERVICE LEADERS, AND STRATEGY SESSIONS WITH 42 PROVIDERS AND AGENCIES TO DEVELOP A PLAN THAT WOULD CAUSE POSITIVE CHANGE IN THE OVERALL HEALTH OF OUR POPULATION.6D: THE FIRST STEP IN EXECUTING OUR COMMUNITY HEALTH NEEDS ASSESSMENT IMPLEMENTATION PLAN WAS RELEASING INFORMATION TO THE PUBLIC. A PRESS CONFERENCE WAS HELD JUNE 13, 2013, AT A LOCAL BUSINESS. DURING THE PRESS CONFERENCE, REPRESENTATIVES FROM THE COLLABORATIVE EXPLAINED THE CHNA SURVEY PROCESS, RESULTS, CONTRIBUTIONS OF COMMUNITY PARTNERS, AND THE FOUR HEALTH ISSUES SELECTED AS OUR FOCUS FOR THE NEXT THREE YEARS. FOLLOWING THIS ANNOUNCEMENT, THE COLLABORATIVE SET UP MEETINGS FOR EACH OF THE FOUR HEALTH TOPICS AND INVITED ALL RELEVANT COMMUNITY PARTNERS TO ATTEND. DURING THESE MEETINGS, THE GROUP REVIEWS THE ACTION ITEMS IN THE IMPLEMENTATION PLAN, REPORTS ON THE PROGRESS OF THOSE ITEMS, AND ASKS FOR ASSISTANCE OR ADDITIONAL RESOURCES AS APPROPRIATE. 6G: MEMBERS OF OUR THREE KEY INFORMANT GROUPS (COMMUNITY LEADERS, BUSINESS LEADERS, AND SOCIAL SERVICE AGENCIES) SUBMITTED THEIR TOP 5 HEALTH PRIORITIES FOR THE COMMUNITY. THIS INFORMATION WAS COUPLED WITH THE SURVEY DATA RESULTING IN A LIST OF SEVEN KEY COMMUNITY HEALTH ISSUES. FOLLOWING FURTHER ANALYSIS, THE COLLABORATIVE DECIDED THAT TOBACCO USE, OBESITY, SUBSTANCE ABUSE, AND MENTAL HEALTH ISSUES WERE THE ROOT CAUSES OF MULTIPLE HEALTH CONDITIONS AND HIGHER HEALTH CARE COSTS. BY ADDRESSING THESE FOUR AREAS, THE COLLABORATIVE COULD HAVE THE BIGGEST IMPACT ON THE CURRENT HEALTH CONDITIONS IN OUR COMMUNITIES. 6H:AS PART OF OUR AGREEMENT WITH THE CHNA COLLABORATIVE, DEACONESS WILL FOCUS TIME AND RESOURCES FOR THE NEXT THREE YEARS ON CREATING POSITIVE CHANGE IN THE FOUR IDENTIFIED TOPIC AREAS. DEACONESS OPERATES AN ACCOUNTABLE CARE ORGANIZATION (ACO) CALLED DEACONESS CARE INTEGRATION. THE ACO HOUSES MANY OF THE PROGRAMS WE WILL USED TO ADDRESS OBESITY, TOBACCO USE, MENTAL HEALTH AND SUBSTANCE ABUSE. SPECIFIC SERVICES INCLUDE CERTIFICATION FOR ALL DEACONESS CLINIC LOCATIONS AS PATIENT CENTERED MEDICAL HOMES (PCMH), USE OF HEALTH COACHES IN THE PCMH, REFERRALS TO OUR MEDICATION MANAGEMENT PROGRAM, DIABETES MANAGEMENT PROGRAM, SUBSTANCE ABUSE, AND MENTAL HEALTH SERVICES (DEACONESS OPERATES A BEHAVIORAL HEALTH CLINIC AS WELL AS INPATIENT AND OUTPATIENT MENTAL HEALTH SERVICES.) THE DESIGN OF OUR ACO AND PCMH ENABLES STAFF MEMBERS TO EASILY ADDRESS THE FOUR IDENTIFIED COMMUNITY HEALTH NEEDS DURING ROUTINE OFFICE VISITS. DEACONESS GATEWAY HOSPITAL PART V, SECTION B, LINE 6I: METHOD FOR ADDRESSING NEEDS IDENTIFIED IN CHNA:6A: IN 2011, DEACONESS HEALTH SYSTEM JOINED FOUR OTHER LOCAL HEALTH-RELATED ORGANIZATIONS, ECHO COMMUNITY HEALTH CARE, ST. MARY'S MEDICAL CENTER, UNITED WAY, AND WELBORN BAPTIST FOUNDATION, TO PLAN FOR AND ADMINISTER A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA). REVIEW OF THE ASSESSMENT DATA LED THE TEAM TO IDENTIFY FOUR MAIN ISSUES AT THE CORE OF POOR COMMUNITY HEALTH: TOBACCO USE, OBESITY, SUBSTANCE ABUSE, AND MENTAL HEALTH. THE COLLABORATIVE CREATED A GROUP PLAN OF ACTION TO ADDRESS THE FOUR IDENTIFIED COMMUNITY HEALTH ISSUES. MEETING WITH COMMUNITY PARTNERS AND STAKEHOLDERS GUIDED THE PLANNING PROCESS. ADDITIONALLY, EACH PARTNER CREATED AN ORGANIZATION SPECIFIC PLAN TO ADDRESS THE SAME ISSUES. THE PLANS WERE TRANSCRIBED, PRESENTED AT A PRESS CONFERENCE, AND POSTED ON THE WEBSITE OF EACH PARTNER'S ORGANIZATION.6B: STRATEGIES FOR EACH OF THE FOUR TARGET AREAS WERE CREATED FOR THE COLLABORATIVE AND FOR DEACONESS. SINCE THE HOSPITAL SERVES VANDERBURGH AND WARRICK COUNTIES IN INDIANA, THE STRATEGY FOR DEACONESS INCLUDES TACTICS TO ADDRESS THESE ISSUES IN BOTH COMMUNITIES. AN INTERNAL TEAM LEADER WAS ASSIGNED TO EACH OF THE FOUR TOPIC AREAS AND RESPONSIBLE FOR PUTTING TOGETHER A TEAM AND THEN A PLAN TO CREATE POSITIVE CHANGE IN THE SPECIFIC HEALTH AREA. THE PLANNING PHASE IS COMPLETE AND THE EXECUTION PHASE TAKES PLACE IN TAX YEARS 2013, 2014, 2015.6C: MEMBERS OF THE DEACONESS COMMUNITY BENEFIT TEAM MET REGULARLY WITH OTHER MEMBERS OF THE COLLABORATIVE TO CREATE A STRATEGY AND TACTICS THAT ADDRESS OUR FOUR IDENTIFIED COMMUNITY HEALTH NEEDS. THE BENEFIT TEAM PARTICIPATED IN FOCUS GROUP SESSIONS WITH 51 BUSINESS, COMMUNITY, AND SOCIAL SERVICE LEADERS, AND STRATEGY SESSIONS WITH 42 PROVIDERS AND AGENCIES TO DEVELOP A PLAN THAT WOULD CAUSE POSITIVE CHANGE IN THE OVERALL HEALTH OF OUR POPULATION.6D: THE FIRST STEP IN EXECUTING OUR COMMUNITY HEALTH NEEDS ASSESSMENT IMPLEMENTATION PLAN WAS RELEASING INFORMATION TO THE PUBLIC. A PRESS CONFERENCE WAS HELD JUNE 13, 2013, AT A LOCAL BUSINESS. DURING THE PRESS CONFERENCE, REPRESENTATIVES FROM THE COLLABORATIVE EXPLAINED THE CHNA SURVEY PROCESS, RESULTS, CONTRIBUTIONS OF COMMUNITY PARTNERS, AND THE FOUR HEALTH ISSUES SELECTED AS OUR FOCUS FOR THE NEXT THREE YEARS. FOLLOWING THIS ANNOUNCEMENT, THE COLLABORATIVE SET UP MEETINGS FOR EACH OF THE FOUR HEALTH TOPICS AND INVITED ALL RELEVANT COMMUNITY PARTNERS TO ATTEND. DURING THESE MEETINGS, THE GROUP REVIEWS THE ACTION ITEMS IN THE IMPLEMENTATION PLAN, REPORTS ON THE PROGRESS OF THOSE ITEMS, AND ASKS FOR ASSISTANCE OR ADDITIONAL RESOURCES AS APPROPRIATE. 6G: MEMBERS OF OUR THREE KEY INFORMANT GROUPS (COMMUNITY LEADERS, BUSINESS LEADERS, AND SOCIAL SERVICE AGENCIES) SUBMITTED THEIR TOP 5 HEALTH PRIORITIES FOR THE COMMUNITY. THIS INFORMATION WAS COUPLED WITH THE SURVEY DATA RESULTING IN A LIST OF SEVEN KEY COMMUNITY HEALTH ISSUES. FOLLOWING FURTHER ANALYSIS, THE COLLABORATIVE DECIDED THAT TOBACCO USE, OBESITY, SUBSTANCE ABUSE, AND MENTAL HEALTH ISSUES WERE THE ROOT CAUSES OF MULTIPLE HEALTH CONDITIONS AND HIGHER HEALTH CARE COSTS. BY ADDRESSING THESE FOUR AREAS, THE COLLABORATIVE COULD HAVE THE BIGGEST IMPACT ON THE CURRENT HEALTH CONDITIONS IN OUR COMMUNITIES. 6H:AS PART OF OUR AGREEMENT WITH THE CHNA COLLABORATIVE, DEACONESS WILL FOCUS TIME AND RESOURCES FOR THE NEXT THREE YEARS ON CREATING POSITIVE CHANGE IN THE FOUR IDENTIFIED TOPIC AREAS. DEACONESS OPERATES AN ACCOUNTABLE CARE ORGANIZATION (ACO) CALLED DEACONESS CARE INTEGRATION. THE ACO HOUSES MANY OF THE PROGRAMS WE WILL USED TO ADDRESS OBESITY, TOBACCO USE, MENTAL HEALTH AND SUBSTANCE ABUSE. SPECIFIC SERVICES INCLUDE CERTIFICATION FOR ALL DEACONESS CLINIC LOCATIONS AS PATIENT CENTERED MEDICAL HOMES (PCMH), USE OF HEALTH COACHES IN THE PCMH, REFERRALS TO OUR MEDICATION MANAGEMENT PROGRAM, DIABETES MANAGEMENT PROGRAM, SUBSTANCE ABUSE, AND MENTAL HEALTH SERVICES (DEACONESS OPERATES A BEHAVIORAL HEALTH CLINIC AS WELL AS INPATIENT AND OUTPATIENT MENTAL HEALTH SERVICES.) THE DESIGN OF OUR ACO AND PCMH ENABLES STAFF MEMBERS TO EASILY ADDRESS THE FOUR IDENTIFIED COMMUNITY HEALTH NEEDS DURING ROUTINE OFFICE VISITS. DEACONESS CROSS POINTE PART V, SECTION B, LINE 6I: METHOD FOR ADDRESSING NEEDS IDENTIFIED IN CHNA:6A: IN 2011, DEACONESS HEALTH SYSTEM JOINED FOUR OTHER LOCAL HEALTH-RELATED ORGANIZATIONS, ECHO COMMUNITY HEALTH CARE, ST. MARY'S MEDICAL CENTER, UNITED WAY, AND WELBORN BAPTIST FOUNDATION, TO PLAN FOR AND ADMINISTER A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA). REVIEW OF THE ASSESSMENT DATA LED THE TEAM TO IDENTIFY FOUR MAIN ISSUES AT THE CORE OF POOR COMMUNITY HEALTH: TOBACCO USE, OBESITY, SUBSTANCE ABUSE, AND MENTAL HEALTH. THE COLLABORATIVE CREATED A GROUP PLAN OF ACTION TO ADDRESS THE FOUR IDENTIFIED COMMUNITY HEALTH ISSUES. MEETING WITH COMMUNITY PARTNERS AND STAKEHOLDERS GUIDED THE PLANNING PROCESS. ADDITIONALLY, EACH PARTNER CREATED AN ORGANIZATION SPECIFIC PLAN TO ADDRESS THE SAME ISSUES. THE PLANS WERE TRANSCRIBED, PRESENTED AT A PRESS CONFERENCE, AND POSTED ON THE WEBSITE OF EACH PARTNER'S ORGANIZATION.6B: STRATEGIES FOR EACH OF THE FOUR TARGET AREAS WERE CREATED FOR THE COLLABORATIVE AND FOR DEACONESS. SINCE THE HOSPITAL SERVES VANDERBURGH AND WARRICK COUNTIES IN INDIANA, THE STRATEGY FOR DEACONESS INCLUDES TACTICS TO ADDRESS THESE ISSUES IN BOTH COMMUNITIES. AN INTERNAL TEAM LEADER WAS ASSIGNED TO EACH OF THE FOUR TOPIC AREAS AND RESPONSIBLE FOR PUTTING TOGETHER A TEAM AND THEN A PLAN TO CREATE POSITIVE CHANGE IN THE SPECIFIC HEALTH AREA. THE PLANNING PHASE IS COMPLETE AND THE EXECUTION PHASE TAKES PLACE IN TAX YEARS 2013, 2014, 2015.6C: MEMBERS OF THE DEACONESS COMMUNITY BENEFIT TEAM MET REGULARLY WITH OTHER MEMBERS OF THE COLLABORATIVE TO CREATE A STRATEGY AND TACTICS THAT ADDRESS OUR FOUR IDENTIFIED COMMUNITY HEALTH NEEDS. THE BENEFIT TEAM PARTICIPATED IN FOCUS GROUP SESSIONS WITH 51 BUSINESS, COMMUNITY, AND SOCIAL SERVICE LEADERS, AND STRATEGY SESSIONS WITH 42 PROVIDERS AND AGENCIES TO DEVELOP A PLAN THAT WOULD CAUSE POSITIVE CHANGE IN THE OVERALL HEALTH OF OUR POPULATION.6D: THE FIRST STEP IN EXECUTING OUR COMMUNITY HEALTH NEEDS ASSESSMENT IMPLEMENTATION PLAN WAS RELEASING INFORMATION TO THE PUBLIC. A PRESS CONFERENCE WAS HELD JUNE 13, 2013, AT A LOCAL BUSINESS. DURING THE PRESS CONFERENCE, REPRESENTATIVES FROM THE COLLABORATIVE EXPLAINED THE CHNA SURVEY PROCESS, RESULTS, CONTRIBUTIONS OF COMMUNITY PARTNERS, AND THE FOUR HEALTH ISSUES SELECTED AS OUR FOCUS FOR THE NEXT THREE YEARS. FOLLOWING THIS ANNOUNCEMENT, THE COLLABORATIVE SET UP MEETINGS FOR EACH OF THE FOUR HEALTH TOPICS AND INVITED ALL RELEVANT COMMUNITY PARTNERS TO ATTEND. DURING THESE MEETINGS, THE GROUP REVIEWS THE ACTION ITEMS IN THE IMPLEMENTATION PLAN, REPORTS ON THE PROGRESS OF THOSE ITEMS, AND ASKS FOR ASSISTANCE OR ADDITIONAL RESOURCES AS APPROPRIATE. 6G: MEMBERS OF OUR THREE KEY INFORMANT GROUPS (COMMUNITY LEADERS, BUSINESS LEADERS, AND SOCIAL SERVICE AGENCIES) SUBMITTED THEIR TOP 5 HEALTH PRIORITIES FOR THE COMMUNITY. THIS INFORMATION WAS COUPLED WITH THE SURVEY DATA RESULTING IN A LIST OF SEVEN KEY COMMUNITY HEALTH ISSUES. FOLLOWING FURTHER ANALYSIS, THE COLLABORATIVE DECIDED THAT TOBACCO USE, OBESITY, SUBSTANCE ABUSE, AND MENTAL HEALTH ISSUES WERE THE ROOT CAUSES OF MULTIPLE HEALTH CONDITIONS AND HIGHER HEALTH CARE COSTS. BY ADDRESSING THESE FOUR AREAS, THE COLLABORATIVE COULD HAVE THE BIGGEST IMPACT ON THE CURRENT HEALTH CONDITIONS IN OUR COMMUNITIES. 6H:AS PART OF OUR AGREEMENT WITH THE CHNA COLLABORATIVE, DEACONESS WILL FOCUS TIME AND RESOURCES FOR THE NEXT THREE YEARS ON CREATING POSITIVE CHANGE IN THE FOUR IDENTIFIED TOPIC AREAS. DEACONESS OPERATES AN ACCOUNTABLE CARE ORGANIZATION (ACO) CALLED DEACONESS CARE INTEGRATION. THE ACO HOUSES MANY OF THE PROGRAMS WE WILL USED TO ADDRESS OBESITY, TOBACCO USE, MENTAL HEALTH AND SUBSTANCE ABUSE. SPECIFIC SERVICES INCLUDE CERTIFICATION FOR ALL DEACONESS CLINIC LOCATIONS AS PATIENT CENTERED MEDICAL HOMES (PCMH), USE OF HEALTH COACHES IN THE PCMH, REFERRALS TO OUR MEDICATION MANAGEMENT PROGRAM, DIABETES MANAGEMENT PROGRAM, SUBSTANCE ABUSE, AND MENTAL HEALTH SERVICES (DEACONESS OPERATES A BEHAVIORAL HEALTH CLINIC AS WELL AS INPATIENT AND OUTPATIENT MENTAL HEALTH SERVICES.) THE DESIGN OF OUR ACO AND PCMH ENABLES STAFF MEMBERS TO EASILY ADDRESS THE FOUR IDENTIFIED COMMUNITY HEALTH NEEDS DURING ROUTINE OFFICE VISITS. DEACONESS HOSPITAL, INC. PART V, SECTION B, LINE 14G: 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 GATEWAY HOSPITAL PART V, SECTION B, LINE 14G: 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 CROSS POINTE PART V, SECTION B, LINE 14G: 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, INC. PART V, SECTION B, LINE 20D: DEACONESS USES ITS AVERAGE MANAGED CARE NEGOTIATED DISCOUNT FOR ALL COMMERCIAL PAYERS. DEACONESS GATEWAY HOSPITAL PART V, SECTION B, LINE 20D: DEACONESS USES ITS AVERAGE MANAGED CARE NEGOTIATED DISCOUNT FOR ALL COMMERCIAL PAYERS. DEACONESS CROSS POINTE PART V, SECTION B, LINE 20D: DEACONESS USES ITS AVERAGE MANAGED CARE NEGOTIATED DISCOUNT FOR ALL COMMERCIAL PAYERS. 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. THE COMMITTEE USES A DYNAMIC, ONGOING PROCESS TO INCLUDE A REVIEW OF PREVIOUS OR CURRENT ASSESSMENTS BY OTHER COMMUNITY GROUPS, PRESENTATIONS MADE BY OUTSIDE GROUPS SOLICITING DEACONESS HOSPITAL'S INVOLVEMENT IN COMMUNITY INITIATIVES, REVIEW OF HEALTH AND DEMOGRAPHIC INFORMATION OF INPATIENTS AND OUTPATIENTS, AND ANALYSIS OF INFORMATION FROM OUTSIDE ORGANIZATIONS AND INTERNAL RECORDS TO IDENTIFY TRENDS AND AREAS OF CONCERN REQUIRING ATTENTION. 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: COMMUNITY INFORMATION: DEACONESS HOSPITAL IS A MAJOR REFERRAL CENTER FOR A 25-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 305 BEDS CONSISTING OF 38 INTENSIVE CARE BEDS, 16 CARDIAC INTENSIVE CARE BEDS, 66 CARDIAC BEDS, 23 ONCOLOGY/ PULMONOLOGY BEDS, 61 ORTHOPAEDIC/ NEUROLOGICAL BEDS, 96 MEDICAL/ SURGICAL BEDS AND 5 HOSPICE 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 158 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 32 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. ALSO, THE HOSPITAL IS AN OWNER IN THREE JOINT VENTURE HOSPITALS:1. DEACONESS WOMEN'S HOSPITAL OF SOUTHERN INDIANA, LLC D/B/A THE WOMEN'S HOSPITAL, A FREE STANDING SPECIALTY 74-BED WOMEN'S AND INFANT'S HOSPITAL, LOCATED ON THE GATEWAY CAMPUS.2. HEALTHSOUTH/DEACONESS, LLC D/B/A TRI-STATE REGIONAL REHABILITATION HOSPITAL, A 80-BED INPATIENT ACUTE REHABILITATION HOSPITAL, LOCATED APPROXIMATELY 8 MILES TO THE SOUTHEAST OF THE MAIN CAMPUS.3. THE HEART HOSPITAL AT DEACONESS GATEWAY, LLC, A 24-BED CARDIOVASCULAR SPECIALTY HOSPITAL, RESIDING ON THE GATEWAY CAMPUS. THE HOSPITAL PLAYS AN ACTIVE ROLE IN MEDICAL EDUCATION, OPERATING A THREE YEAR FAMILY MEDICINE RESIDENCY PROGRAM, A POST-GRADUATE PHARMACY RESIDENT PROGRAM, AND SEVERAL UNDERGRADUATE MEDICAL AFFILIATIONS. THE HOSPITAL ALSO PROVIDES CONTINUING MEDICAL EDUCATION PROGRAMS FOR ATTENDING PHYSICIANS, OTHER HEALTH PROFESSIONALS, OTHER ALLIED HEALTH PROGRAMS, AND THE COMMUNITY AT LARGE. THE HOSPITAL, THROUGH ITS RELATED CORPORATIONS, PROVIDES OUTREACH SERVICES TO NURSING HOMES, PHYSICIANS' OFFICES AND SURROUNDING SMALLER HOSPITALS IN ITS SERVICE AREA.VANDERBURGH COUNTY DEMOGRAPHICS INCLUDE:POPULATION: VANDERBURGH COUNTY INCLUDES A POPULATION OF 183,833 PEOPLE, A NUMBER THAT IS EXPECTED TO REMAIN RELATIVELY FLAT OVER THE NEXT 5 YEARS. WITHIN VANDERBURGH, ONE OF THE MOST SIGNIFICANT GROWTH SEGMENTS IS THE 65+ AGE POPULATION, WHERE AN 8.8% INCREASE IS PROJECTED FOR THE 5-YEAR PERIOD BETWEEN 2012 AND 2017. MARKET DIVERSITY: THE EVANSVILLE AREA CONTINUES TO BE A RELATIVELY NON-DIVERSE POPULATION, WITH 86% OF THE POPULATION CHARACTERIZED AS WHITE OR CAUCASIAN ALONE AND 9% OF THE POPULATION CHARACTERIZED AS BLACK OR AFRICAN AMERICAN ALONE.POOR AND VULNERABLE POPULATIONS: ONE OUT OF SEVEN HOUSEHOLDS IN VANDERBURGH (15.1%) EARNS LESS THAN $15,000 ANNUALLY. IT IS ESTIMATED THAT 15.9% OF RESIDENTS ARE UNINSURED, A NUMBER THAT IS PROJECTED TO DECLINE TO 7.5% BY 2017, ASSUMING THAT THE EXPANSION OF MEDICAID TAKES PLACE AS ORIGINALLY SCHEDULED.HEALTH OUTCOMES: BASED ON THE 2012 COUNTY HEALTH RAKINGS, VANDERBURGH COUNTY RANKS 76TH OUT OF 92 INDIANA COUNTIES BASED ON SPECIFIC HEALTH FACTORS AND HEALTH OUTCOMES. IT RANKS 78TH RELATIVE TO ITS PHYSICAL ENVIRONMENT (E.G. AIR POLLUTION). (SOURCE: ROBERT WOODS JOHNSON FOUNDATION, ACCESSED AT WWW.COUNTYHEALTHRANKINGS.ORG). HOUSEHOLD INCOME: THE MEDIAN HOUSEHOLD INCOME IN VANDERBURGH COUNTY IS ESTIMATED AT $38,851 FOR 2012.MEDIAN AGE: THE MEDIAN AGE IN VANDERBURGH DURING 2012 WAS 38 YEARS.WARRICK COUNTY DEMOGRAPHICS INCLUDE:POPULATION: WARRICK COUNTY INCLUDES A POPULATION OF 61,138 PEOPLE, A NUMBER THAT IS EXPECTED TO GROW BY MORE THAN 5% OVER THE NEXT 5 YEARS. WITHIN WARRICK, ONE OF THE MOST SIGNIFICANT GROWTH SEGMENTS IS THE 65+ AGE POPULATION, WHERE A 27.8% INCREASE IS PROJECTED FOR THE 5-YEAR PERIOD BETWEEN 2012 AND 2017. MARKET DIVERSITY: THE WARRICK AREA CONTINUES TO BE A RELATIVELY NON-DIVERSE POPULATION, WITH 95% OF THE POPULATION CHARACTERIZED AS WHITE OR CAUCASIAN ALONE.POOR AND VULNERABLE POPULATIONS: A RELATIVELY AFFLUENT POPULATION, ONLY 8% OF WARRICK'S HOUSEHOLDS EARNS LESS THAN $15,000 ANNUALLY. IT IS ESTIMATED THAT 7% OF RESIDENTS ARE UNINSURED, A NUMBER THAT IS PROJECTED TO DECLINE TO 3% BY 2017, ASSUMING THAT THE EXPANSION OF MEDICAID TAKES PLACE AS ORIGINALLY SCHEDULED.HEALTH OUTCOMES: BASED ON THE 2012 COUNTY HEALTH RAKINGS, WARRICK COUNTY RANKS 11TH OUT OF 92 INDIANA COUNTIES BASED ON SPECIFIC HEALTH FACTORS AND HEALTH OUTCOMES. IT RANKS 85TH BASED ON ITS PHYSICAL ENVIRONMENT (E.G. AIR POLLUTION). HOUSEHOLD INCOME: THE MEDIAN HOUSEHOLD INCOME IN WARRICK COUNTY IS ESTIMATED AT $47,922 FOR 2012.MEDIAN AGE: THE MEDIAN AGE IN WARRICK DURING 2012 WAS 40 YEARS. PART VI, LINE 5: OTHER IMPORTANT COMMUNITY HEALTH PROMOTION:THE ORGANIZATION FURTHERS ITS EXEMPT PURPOSE BY PROMOTING HEALTH OF THE COMMUNITY INCLUDES: 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 GILDA'S CLUB EVANSVILLE INC PO BOX 5134 EVANSVILLE IN 47716 261932741 3 84431 CAPITAL CAMPAIGN EVANSVILLE MUSEUM OF ARTS AND SCIENCE 411 SE RIVERSIDE DR EVANSVILLE IN 47713 350874517 3 41500 CAPITAL CAMPAIGN YMCA OF SW INDIANA INC 222 NW 6TH ST EVANSVILLE IN 47708 350869074 3 26750 GENERAL SUPPORT MARIAN UNIVERSITY 3200 COLD SPRING ROAD INDIANAPOLIS IN 462221997 350868175 3 25000 D.O. SCHOLARSHIP PROGRAM IVY TECH FOUNDATION 3501 N 1ST AVENUE EVANSVILLE IN 47710 237073977 3 24600 GENERAL SUPPORT CHILDREN'S MUSEUM OF EVANSVILLE PO BOX 122 EVANSVILLE IN 477010074 351951848 3 21500 GENERAL SUPPORT JUVENILE DIABETES 10401 N MERIDIAN ST SUITE 150 INDIANAPOLIS IN 46290 231907729 3 15000 GENERAL SUPPORT KOMEN GREATER EVANSVILLE AFFILIATE 4424 VOGEL RD STE 205 EVANSVILLE IN 47715 752844632 3 15000 GENERAL SUPPORT YWCA 118 VINE ST EVANSVILLE IN 47708 350869075 3 12500 GENERAL SUPPORT EVANSVILLE AREA COMMUNITY CHURCHES 713 N 2ND AVE EVANSVILLE IN 47710 350886837 3 12000 FOOD FOR FOOD PANTRY AURORA 1100 LINCOLN AVE PO BOX 74 EVANSVILLE IN 477010074 351759576 3 10000 CAPITAL CAMPAIGN EVANSVILLE SOCCER CLUB PO BOX 15906 EVANSVILLE IN 47716 352086976 3 10000 UNDERSERVED YOUTH HABITAT FOR HUMANITY 1401 N FARES AVENUE EVANSVILLE IN 47711 351602775 3 10000 GENERAL SUPPORT EVANSVILLE KIDNEY ASSOCIATION 1312 PROFESSIONAL BLVD STE 200 EVANSVILLE IN 47714 260219765 3 9224 GENERAL SUPPORT CONGREGATIONS OF ACTING FOR JUSTICE 713 N 2ND AVE EVANSVILLE IN 47710 300051217 3 8000 GENERAL SUPPORT GIRL SCOUTS OF SOUTHWEST INDIANA 223 NW 2ND STREET EVANSVILLE IN 47708 350876380 3 8000 GENERAL SUPPORT UNITED WAY OF SW INDIANA PO BOX 18 EVANSVILLE IN 47701 350868069 3 8000 GENERAL SUPPORT EASTER SEALS REHABILITATION CENTER 3701 BELLEMEADE AVE EVANSVILLE IN 47714 351087526 3 7925 GENERAL SUPPORT AMERICAN CANCER SOCIETY 5250 VOGEL RD SUITE A EVANSVILLE IN 47715 131788491 3 7572 GENERAL SUPPORT KEEP EVANSVILLE BEAUTIFUL 209 MAIN STREET EVANSVILLE IN 47708 351449381 3 6555 GENERAL SUPPORT TOUCH INC 2401 E CHANDLER AVE EVANSVILLE IN 47714 263989768 3 6112 GENERAL SUPPORT AMERICAN RED CROSS 29 S STOCKWELL RD EVANSVILLE IN 47714 530196605 3 5100 GENERAL SUPPORT OTHERS 5000 203619 GENERAL SUPPORT 22 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: DEACONESS HOSPITAL CONFIRMS ALL RECIPIENTS OF FUNDS ARE ORGAANIZATIONS 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 E WHITE 311414 317441 320304 0 9668 6800 138093 83645 10215 10215 789694 418101 0 0 DAVID A KOEHLER JR MD 81606 144298 9709 22921 6700 720 0 13977 0 443 98015 182359 0 0 MATHIAS KOLLECK II 218342 0 54987 0 51879 0 21271 0 23770 0 370249 0 0 0 SHAWN W MCCOY 341560 0 155831 0 3351 9000 92132 0 27373 0 620247 9000 0 0 CHERYL A WATHEN 156046 162500 121875 0 4856 8800 38866 27563 20456 20456 342099 219319 0 0 JAMES R PORTER MD 380503 0 143856 0 1851 2800 104326 0 26735 0 657271 2800 0 0 CHERONA J HAJEWSKI 269058 0 102740 0 6731 0 57616 0 25969 0 462114 0 0 0 BRUCE E EPMEIER 198588 0 75846 0 60803 0 50170 0 19360 0 404767 0 57102 0 LARRY F PILE 94445 0 34453 0 150713 2205 3929 0 7803 0 291343 2205 0 0 LYNN C LINGAFELTER 172162 0 32485 0 250 0 25650 0 443 0 230990 0 0 0 RICHARD B PERRY 144423 0 62616 0 1131 0 13291 0 16888 0 238349 0 0 0 JOHN L ZABROWSKI 172401 0 33855 0 1531 3000 14471 0 26257 0 248515 3000 0 0 JOYCE A THOMAS 142560 0 29232 0 1611 0 26756 0 23010 0 223169 0 0 0 REBECCA L MALOTTE 142470 0 33740 0 1063 0 40360 0 14263 0 231896 0 0 0 VENKATESH R MADADI 631337 0 0 0 49481 0 37116 0 19020 0 736954 0 0 0 NIRMAL JOSHI MD 651704 0 0 0 70702 0 39351 0 21193 0 782950 0 0 0 RAJESH J PATEL MD 699301 0 0 0 43956 0 14412 0 20183 0 777852 0 0 0 AYMAN ELFAR MD 560800 0 0 0 32381 0 32233 0 19597 0 645011 0 0 0 LAWRENCE C KILINSKI JR MD 551067 0 0 0 43398 0 33309 0 20350 0 648124 0 0 0 HARRY L SMITH JR 0 0 0 0 392735 0 23761 0 20015 0 436511 0 19077 0 PART I, LINE 1A SOCIAL CLUB DUES ARE PAID FOR LINDA WHITE, JAMES PORTER 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- $17,000 $ -0- DAVID A. KOEHLER, JR., MD. 0 17,000 0 SHAWN W. MCCOY 0 17,000 0 JAMES R. PORTER, MD. 0 17,000 0 CHERONA J. HAJEWSKI 0 17,000 0 BRUCE E. EPMEIER 0 17,000 0 VENKATESH R. MADADI, MD. 0 17,000 0 RAJESH J. PATEL, MD. 0 17,000 0 LAWRENCE C. KILINSKI, JR., MD. 0 17,000 0 CHERYL A. WATHEN 0 17,000 0 HARRY L. SMITH, JR. 374,762 0 0 PART I, 4B: CONTRIBUTIONS MADE TO A SUPPLEMENTAL ACCUMULATION ACCOUNT LINDA WHITE: $206,738. SHAWN MCCOY: $77,132. CHERYL WATHEN: $51,429. JAMES PORTER: $89,326. BRUCE EPMEIER: $36,184 CHERONA HAJEWSKI: $42,616. HARRY SMITH: $19,077. PAYOUT FROM A SUPPLEMENTAL ACCUMULATION ACCOUNT BRUCE EPMEIER: $57,102. 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 45471AAK8 2009-03-26 55914771 FACILITY CONSTRUCTION 0 0 0 B INDIANA FINANCE AUTHORITY 351602316 45471AFF4 2011-12-02 20667197 3/15/99 REFUNDING 0 0 0 C INDIANA FINANCE AUTHORITY 351602316 2012-11-20 13005000 1992 REFUNDING 0 0 0 D INDIANA FINANCE AUTHORITY 351602316 45471ALU4 2013-07-23 40180000 3/29/09 REFUNDING 0 0 0 A 13440000 55914771 5636806 5733841 828073 43061620 699759 2011 0 0 1 1 B 20667197 397197 20270000 1 0 1 1 C 13005000 103657 12901343 1 0 1 1 D 40180000 180000 40000000 1 0 1 1 A 0 1 0 0 0.00900 0.00900 0 0 1 B 0 0 0 0 0 0 1 C 0 0 0 0 0 0 1 D 0 0 0 0 0.00900 0.00000 0.00900 0 0 1 A 0 1 0 0 0 0 1 TRINITY PLUS 2.000000000000 1 0 1 B 0 0 1 0 0 0 0 1 C 0 1 0 0 0 0 0 0 1 D 0 0 0 0 0 0 0 0 1 A 1 B 1 C 1 D 1 SCHEDULE K, PART II, COLUMN A (WORKSHEET 1), LINE 1 AMOUNT OF BONDS RETIRED: $13,440,000 OF THE ORIGINAL ISSUED PRINCIPAL AMOUNT OF THE 2009A BOND ISSUED 3/26/1999 WAS ADVANCED REFUNDED BY THE 2013A BOND ISSUE. SCHEDULE K, PART II, COLUMN A (WORKSHEET 1), LINE 11 OTHER SPENT PROCEEDS THE OTHER SPENT PROCEEDS ARE THE CURRENT REFUNDING PROCEEDS OF THE BOND ISSUE. SCHEDULE K, PART II, COLUMN A (WORKSHEET 2), LINE 6 PROCEEDS IN REFUNDING ESCROW: THE PROCEEDS IN COLUMN A ON THE 2ND WORKSHEET K WILL BE USED ON 3/1/14 TO REFUND THE 2009A AND 2004A BOND ISSUES. A INDIANA FINANCE AUTHORITY 351602316 45471AKY7 2013-03-05 71336168 5/27/04 AND 3/26/09 REFUNDING 0 0 0 B INDIANA FINANCE AUTHORITY 351602316 2013-03-05 21440000 5/27/04 REFUNDING 0 0 0 A 71336168 70606631 729538 0 1 1 1 B 21440000 125000 21315000 1 0 1 1 A 0 1 0 0 0.00200 0.00000 0.00200 0 0 1 B 0 1 0 0 0.00000 0.00700 0.00700 0 0 1 A 0 1 0 0 0 0 0 0 1 B 0 1 0 0 0 1 FIFTH THIRD 16.000000000000 0 0 0 0 1 A 1 B 1 NANCY KOEHLER FAMILY OF BD MBR 130892 COMP. 0 ANN TORNATTA FAMILY OF BD MBR 109033 COMP. 0 LETTA FRACCARO FAMILY OF BD MBR 50203 COMP. 0 MISTY ADYE FAMILY OF BD MBR 32912 COMP. 0 ALEX SEIBERT FAMILY OF OFFICER 75814 COMP. 0 VECTREN ENERGY DELIVERY COMMON BOARD MEMBER 5110974 GAS/ELECTRIC UTILITY 0 OLD NATIONAL BANK COMMON BOARD MEMBER 1830562 LEASES 0 EVANSVILLE RADIOLOGY PC COMMON BOARD MEMBER 790733 MGMT. SRVS. 0 SOUTH CENTRAL COMMUNICATIONS COMMON BOARD MEMBER 128887 ADVERTISING PROVIDER 0 SCH L, PART IV, ABBREVIATION: BD MBR = BOARD MEMBERCOMP. = REPORTABLE COMPENSATIONSRVS. = SERVICES X 2 47928 COST X 1 290000 FAIR MARKET VALUE X GIFT CERTIFICATES 100 32471 COST 0 1 0 THIRD PARTY USE: 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. ORGANIZATION'S MISSION: FORM 990, PART III, LINE 1 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. PROGRAM SERVICES ACCOMPLISHMENT 1: PATIENT SERVICE REVENUE. FORM 990, PART III, LINE 4A DEACONESS HOSPITAL IS A MAJOR REFERRAL CENTER FOR A 25 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 271 BEDS CONSISTING OF 38 INTENSIVE CARE BEDS, 16 CARDIAC INTENSIVE CARE BEDS, 45 CARDIAC BEDS, 23 ONCOLOGY/ PULMONOLOGY BEDS, 61 ORTHOPAEDIC/ NEUROLOGICAL BEDS, 83 MEDICAL/ SURGICAL BEDS AND 5 HOSPICE 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 158 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 32 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. PROGRAM SERVICES ACCOMPLISHMENT 2: CHARITY CARE/ SUBSIDIZED CARE. FORM 990, PART III, LINE 4B 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 $22.1 MILLION OF CHARITY CARE AND $15.7 MILLION OF SUBSIDIZED SERVICES TO THE MEDICAID PROGRAM, AND $60.5 MILLION OF SUBSIDIZED SERVICES TO THE MEDICARE PROGRAM. PROGRAM SERVICE STATEMENT 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 $6.4 MILLION IN COMMUNITY BENEFIT ACTIVITIES (ALL ON A COST BASIS), SERVING A MINIMUM OF 768,486 PEOPLE WITHIN THE TRI-STATE AREA. ALL OTHER ACCOMPLISHMENTS FORM 990, PART III, LINE 4D 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. CONTACT ADDRESSES FOR OFFICERS, DIRECTORS, ETC FORM 990, PART VII LARRY F PILE - 12035 LONGVIEW LAKE CIRCLE, LAKEWOOD, FL 34211. OTHER FEES FORM 990, PART IX, LINE 11G PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 44,186,677. MANAGEMENT AND GENERAL EXPENSES 1,185,051. FUNDRAISING EXPENSES 26,346. TOTAL EXPENSES 45,398,074. PROFESSIONAL FEES- PHYSICIANS: PROGRAM SERVICE EXPENSES 10,689,870. MANAGEMENT AND GENERAL EXPENSES 88,961. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 10,778,831. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 9: CHANGE IN PENSION LIABILITY 31,884,890. NET UNREALIZED GAIN ON INVESTMENTS 7,547,271. FOUNDATION MONIES GRANTED FROM RESTRICTION -775,678. CAPITAL CONTRIBUTION TO DEACONESS HEALTH SYSTEM -20,613,264. CHANGE IN BENEFICIAL INTERESTS IN TRUSTS 85,722. OVERSIGHT OF AUDIT FORM 990, PART XII, LINE 2C 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. 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