2013-08-13T13:42:41-05:00 2012-09-30 BKD LLP 200 E Main St Suite 700 Fort Wayne IN 46802 990 2011-10-01 351064295 DEKALB MEMORIAL HOSPITAL INC % AMY CROUCH DEKA 2609254600 1316 EAST SEVENTH STREET AUBURN IN 46706 AMY CROUCH 2013-08-15 true Joyce A Dulworth 2604604000 2011 2016-02-25 16:41:14Z FRED PRICE 1316 EAST SEVENTH STREET AUBURN IN 46706 67242645 false X WWW.DEKALBMEMORIAL.COM X 1964 IN DEKALB MEMORIAL HOSPITAL WAS ESTABLISHED TO PROVIDE A VARIETY OF ACUTE, SUBACUTE AND OUTPATIENT MEDICAL SERVICES TO THE RESIDENTS OF NORTHEASTERN INDIANA. 12 12 591 48 154934 -9326 217959 135233 48010105 59683726 700799 621375 1390736 1326050 50319599 61766384 40000 77646 0 0 25570049 30517482 0 0 24635 24715163 29718274 50325212 60313402 -5613 1452982 63926199 68069935 16854681 17637023 47071518 50432912 X PROMOTE, PRESERVE, RESTORE HEALTH false false 54908173 77646 60384692 THE 47 BED HOSPITAL OPERATES IN A RURAL AREA. FOR FISCAL YEAR ENDED SEPTEMBER 30, 2011, THE TOTAL NUMBER OF ADMISSIONS WAS 2,527. THE TOTAL NUMBER OF EMERGENCY ROOM VISITS WAS 15,197. THE TOTAL NUMBER OF EMERGENCY MEDICAL SERVICES TRIPS WAS 3,578. THE TOTAL NUMBER OF HOME HEALTH CARE VISITS WAS 4,480. 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. 54908173 true true false true false false false false false false true false false false true false false true false false false false false false true false true true true true true true false true false false false false false false false false false false false false true true false false false false true X 60 0 true 591 true true true false false false false true true false false false false X 12 12 false false false false true true true true true false false true true true true true true true false true false IN X AMY CROUCH 2609254600 1316 E 7TH STREET AUBURN IN 46706 X ALAN MIDDLETON 1.0 X X 0 0 0 ROBERT MENZIE 1.0 X X 0 0 0 RICHARD ALLEN 1.0 X X 0 0 0 STACEY HEFTY 1.0 X 0 0 0 DEB LINSTROMBERG 1.0 X 0 0 0 MITCHELL TRAVIS 1.0 X 0 0 0 BRIAN NUGENT 1.0 X 0 0 0 MARK MILLET 1.0 X 0 0 0 JEFF JUSTICE 1.0 X 0 0 0 BETH FREIDENBERGER 1.0 X 0 0 0 MATT FETTER 1.0 X 0 0 0 MARK FOGT 1.0 X 0 0 0 KIRK RAY 40.0 X 281321 0 30766 PAMELA CASSARA 40.0 X 149538 0 13312 AMY CROUCH 40.0 X 7500 0 300 KENNETH CHAFFEE 40.0 X 295315 0 18117 EMILIO VAZQUEZ 40.0 X 246211 0 20825 BRET KUEBER 40.0 X 215117 0 16198 NICHOLAS FINLEY 40.0 X 190495 0 25227 JOSEPH PUTMAN 40.0 X 178013 0 13206 1563510 0 137951 17 false true false ALLIED MEDICAL SERVICES 6444 MONROE ST SYLVANIA OH 43560 RT SERVICES 476065 EMERGENCY PHYSICIANS OF IN PC 4560 SOLUTIONS CENTER CHICAGO IL 60677 PHYSICIAN SERVICES 467137 APRN SLEEP INC 6444 MONROE ST SYLVANIA OH 43560 REFERENCE LAB 241497 PSI SUPPLY CHAIN SOLUTIONS LLC 5050 BRADENTEN AVE DUBLIN OH 43017 SUPPLY SERVICES 187594 BKD LLP 200 E MAIN STREET SUITE 700 FORT WAYNE IN 46802 ACCOUNTING SERVICES 183876 6 31993 103240 135233 PATIENT SERVICE REVENUE 900099 52847956 52847956 CAFETERIA SALES 900099 284758 213704 71054 DRUGS & SUPPLIES 900099 169244 169244 LAB - NON PATIENT REVENUE 621500 35246 35246 PHARMACARE 621500 3927480 3846040 81440 2419042 2419042 59683726 434220 434220 162 162 0 711720 237180 474540 474540 474540 5412878 5225885 186993 186993 186993 8806 31993 13196 -4390 -4390 0 0 OTHER REVENUE 900099 855900 853460 2440 855900 61766384 60384692 154934 1091525 57646 57646 20000 20000 0 0 395665 395665 0 22707202 20665138 2025074 16990 947252 861999 84590 663 4740041 4313437 423286 3318 1727322 1571863 154250 1209 108632 108632 46548 1848 44700 94629 94629 4936 4936 0 0 5128183 4689812 438371 307372 2314 305058 5540089 5200640 337408 2041 1153077 1099171 53906 0 1034056 959389 74667 289398 258594 30390 414 0 54468 35058 19410 453184 453184 0 4140062 3767456 372606 584120 531549 52571 BAD DEBT 4525485 4525485 RECRUITMENT 91498 91498 COLLECTION FEES 284754 284754 LICENSE, ACCRED FEES & MISC 650004 272425 377579 5227779 5227779 60313402 54908173 5380594 24635 2050 2750 4223983 1235665 0 0 7159342 7325062 0 0 0 0 0 0 903158 1324144 779746 1040979 79633399 39275626 36986222 40357773 12948021 15392864 0 0 0 0 0 0 923677 1390698 63926199 68069935 4833222 6077934 0 0 0 0 6550065 5351775 0 0 0 0 5317493 3763376 0 0 153901 2443938 16854681 17637023 X 46958621 50324022 112897 108890 0 0 47071518 50432912 63926199 68069935 X 1452982 1908412 X false true true X false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false true 5112 false 5112 false false FORM 990, SCHEDULE C LINE 1H: WE CONTRIBUTE TO A NATIONAL AND STATE HOSPITAL ASSOCIATION AND A HHC & HOSPITAL ASSOCIATION WITH A PERCENT GOING TOWARDS LOBBYING. AHA IS 24.42 PERCENT OF DUES ($3,820). IHA IS 5.29 PERCENT OF DUES ($1,116). IAHHC FOR HHC AND HOSPICE IS 12 PERCENT OF DUES (176). 393118 393118 53782651 22515722 31266929 23277251 15266159 8011092 2180379 1493745 686634 40357773 0 CAPITAL LEASE OBLIGATIONS 2443938 2443938 61766384 60313402 1452982 1908412 1908412 3361394 63925172 1908412 250376 2158788 61766384 61766384 60563778 250376 250376 60313402 60313402 FORM 990, SCHEDULE D ASC 740: MANAGEMENT HAS EVALUATED THEIR INCOME TAX POSITIONS UNDER THE GUIDANCE INCLUDED IN ASC 740. BASED ON THEIR REVIEW, MANAGEMENT HAS NOT IDENTIFIED ANY MATERIAL UNCERTAIN TAX POSITIONS TO BE RECORDED OR DISCLOSED IN THE FINANCIAL STATEMENTS. FORM 990, SCHEDULE D PART XII, LINE 2D RENTAL EXPENSE $237,180 SPECIAL EVENT EXPENSE 13,196 TOTAL: $250,376 PART XIII, LINE 2D RENTAL EXPENSE $237,180 SPECIAL EVENT EXPENSE 13,196 TOTAL: $250,376 GOLF OUTING 40799 31993 8806 2194 3872 5270 1860 0 40799 31993 8806 2194 3872 5270 1860 13196 -4390 true true true X true X true true false true true 537157 537157 0.00960 8948075 3109785 5838290 0.10470 9485232 3109785 6375447 0.11430 318253 318253 0.00570 318253 318253 0.00570 9803485 3109785 6693700 0.12000 true 5157065 515707 6503495 8339191 -1835696 X true true 1 1 DEKALB MEMORIAL HOSPITAL

1316 E 7TH STREET AUBURN IN 46706

X X X DEKALB MEMORIAL HOSPITAL 1 true true 150. true 300. true X X X X X X true true X X X X X X true false true X false false PART III, LINE 4A ACCOUNTS ARE CONSIDERED DELINQUENT AND SUBSEQUENTLY WRITTEN OFF AS BAD DEBTS BASED ON INDIVIDUAL CREDIT EVALUATION AND SPECIFIC CIRCUMSTANCES OF THE ACCOUNT. AN AGGREGATE COST TO CHARGE RATIO WAS USED TO PROVIDE BAD DEBT AT COST. THE ESTIMATED AMOUNT OF THE HOSPITAL'S BAD DEBT EXPENSE (AT COST) ATTRIBUTABLE TO PATIENTS THAT MIGHT HAVE BEEN ELIGIBLE UNDER THE HOSPITAL'S CHARITY CARE POLICY WAS DETERMINED BY COMPUTING A PERCENTAGE OF DOLLAR AMOUNT TOTALS OF ACCOUNTS APPROVED FOR ASSISTANCE TO TOTAL APPLICATIONS AND THEN APPLIED THE PERCENTAGE TO THE APPLICATIONS THAT WERE DENIED DUE TO INCOMPLETE INFORMATION TO COME UP WITH AN ESTIMATE OF WHAT WOULD HAVE QUALIFIED IF THE INFORMATION HAD BEEN RECEIVED. THE RATIONALE BEING THAT HAD THE INFORMATION BEEN RECEIVED,THOSE ACCOUNTS WOULD HAVE BEEN APPROVED. PART III, LINE 8A MEDICARE SHORTFALL IS NOT TREATED AS COMMUNITY BENEFIT. THE METHODOLOGY USES THE DEPARTMENT COST TO CHARGE RATIO GENERATED BY THE MEDICARE COST REPORT. PART III, LINE 9B ACCOUNTS QUALIFYING FOR CHARITY CARE OR FINANCIAL ASSISTANCE ARE DESIGNATED AS SUCH IN THE ACCOUNTS RECEIVABLE SYSTEM AND ARE NOT WRITTEN OFF TO BAD DEBT OR SENT TO A COLLECTION AGENCY. PART V, SECTION B, LINE 13 THE STATEMENT REGARDING AVAILABLE ASSISTANCE IS POSTED IN THE FOLLOWING AREAS OF THE HOSPITAL, BUT NOT THE ENTIRE POLICY: HOSPITAL FACILITY'S EMERGENCY ROOMS OR WAITING ROOMS HOSPITAL FACILITY'S ADMISSIONS OFFICES NEEDS ASSESSMENT PERIODIC FOCUS GROUP SURVEYS BY OUTSIDE CONSULTANTS ARE PREPARED EVERY 3-5 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. PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE UPON ADMITTANCE TO DEKALB HOSPITAL, PATIENTS ARE PROVIDED INFORMATION REGARDING THE CHARITY CARE POLICIES. 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. COMMUNITY INFORMATION DEKALB MEMORIAL HOSPITAL IS THE SOLE COMMUNITY HOSPITAL LOCATED IN DEKALB COUNTY, SERVING DEKALB, PORTIONS OF STEUBEN, NOBLE AND ALLEN COUNTIES AND THE TOWNS OF HICKSVILLE AND EDGERTON IN NORTHWEST OHIO. THE POPULATION OF DEKALB MEMORIAL HOSPITAL'S PRIMARY SERVICE AREA IS APPROXIMATELY 42,000 AND POPULATION GROWTH HAS REMAINED AT 3-4% ANNUALLY. DUE TO THE 2008 ECONOMIC DOWNTURN, DEKALB HAS SEEN AN INCREASE IN THE UNINSURED AND UNDERINSURED AND QUALIFIES FOR DISPROPORTIONATE SHARE PAYMENT ON THE MEDICARE COST REPORT DUE TO THE LARGER THAN NORMAL SHARE OF MEDICAID PATIENT VOLUME SERVED BY THE HOSPITAL. THE DEMOGRAPHIC AREA SERVED BY DEKALB MEMORIAL HOSPITAL IS MADE UP OF A MEDIAN HOUSEHOLD INCOME OF APPROXIMATELY $45,000, THE MEDIAN AGE IS 40 AND CONTAINS PRIMARILY A BLUE COLLAR AND AGRICULTURAL WORKFORCE. PROMOTION OF COMMUNITY HEALTH THE HOSPITAL GIVES BACK FINANCIALLY, EDUCATIONALLY, AND THROUGH VOLUNTEERISM, 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, ROTARY PRESENTATIONS, BACK TO SCHOOL SPORTS PHYSICALS, GRIEF CARE, HEART CARE AND ORGAN DONATION DISCUSSION SERIES, SHOTS FOR TOTS, UNITED WAY DAY OF CARING,PROVIDING EMS STANDBY FOR 20+ COMMUNITY EVENTS AND DISASTER PREPAREDNESS. ADDITIONALLY, THE HOSPITAL PROVIDES FINANCIAL DONATIONS TO OVER 50 NON-PROFIT ORGANIZATIONS IN THE COMMUNITY TOTALING OVER $100,000 ANNUALLY. true NORTHEAST INDIANA REGIONAL PARTNERSHIP 200 E MAIN STREET SUITE 910 FORT WAYNE IN 46802 351984702 501(c)(6) 10000 PROGRAM SUPPORT DEKALB COUNTY ECONOMIC DEVELOPMENT PARTNERSHIP 4483 COUNTY ROAD 19 SUITE C AUBURN IN 46706 364577514 501(C)(3) 10000 COMMUNITY SUPPORT FORT WAYNE MEDICAL EDUCATION PROGRAM 50 BROADWAY SUITE 250 FORT WAYNE IN 46802 356049685 501(C)(3) 25000 PROGRAM SUPPORT JUDY A MORRILL CENTER 1200 E HOUSTON STREET GARRETT IN 46738 352010882 501(C)(3) 12646 FMV 4 TREADMILLS FITNESS PROGRAM 3 1 SCHOLARSHIPS 18 20000 FORM 990, SCHEDULE I THE SCHOLARSHIPS ARE GRANTED TO DEKALB COUNTY STUDENTS PURSUING HEALTHCARE COURSES. THERE IS NO DISCRIMINATION BASED ON RACE, RELIGION, OR SEX IN AWARDING ANY OF THE SCHOLARSHIPS. X true true X X X X false false false false false false false false false KIRK RAY 242602 0 38719 0 0 0 26520 0 4246 0 312087 0 0 0 PAMELA CASSARA 149538 0 0 0 0 0 7543 0 5769 0 162850 0 0 0 KENNETH CHAFFEE 295315 0 0 0 0 0 12654 0 5463 0 313432 0 0 0 EMILIO VAZQUEZ 203317 0 42894 0 0 0 18473 0 2352 0 267036 0 0 0 BRET KUEBER 187252 0 27865 0 0 0 15343 0 855 0 231315 0 0 0 NICHOLAS FINLEY 162073 0 28422 0 0 0 22629 0 2598 0 215722 0 0 0 JOSEPH PUTMAN 174097 0 3916 0 0 0 9009 0 4197 0 191219 0 0 0 FORM 990, SCHEDULE J LINE 1: SOCIAL CLUB DUES ARE PROVIDED TO THE CEO SOLELY FOR BUSINESS PURPOSES. HOSPITAL AUTHORITY OF DEKALB COUNTY INDIANA 351064295 240732bq9 2006-12-29 2725000 CONSTRUCTION false false false HOSPITAL AUTHORITY OF DEKALB COUNTY INDIANA 351064295 240732BLC 2006-12-29 9275000 CONSTRUCTION false false false 2725000 0 2725000 750000 0 0 47553 0 0 0 0 0 2011 true false true true 0 0 9354438 927500 0 0 149931 0 0 9000000 0 0 2011 false false true true false false false false true 0 true false false false false true 0 true false false false 0 false 0 false false false false false 0 false 0 false false FORM 990, PART VI LINE 6: THE ORGANIZATION HAS A CORPORATE BOARD MEETING CONSISTING OF 30 COMMUNITY MEMBERS. TWELVE MEMBERS OF THE CORPORATE BOARD ARE ELECTED AND SERVE AS THE ORGANIZATION'S GOVERNING BOARD OF DIRECTORS. FORM 990, PART VI LINE 7A: THE ORGANIZATION HAS A CORPORATE BOARD MEETING CONSISTING OF 30 COMMUNITY MEMBERS. TWELVE MEMBERS OF THE CORPORATE BOARD ARE ELECTED AND SERVE AS THE ORGANIZATIONS GOVERNING BOARD OF DIRECTORS. FORM 990, PART VI LINE 7B: NOMINATIONS AND APPROVAL FOR VACANCIES ON THE GOVERNING BOARD ARE SUBJECT TO APPROVAL BY CORPORATE MEMBERS. ALL BUSINESS DECISIONS OF THE BOARD OF DIRECTORS ARE RATIFIED BY ANNUAL RESOLUTION OF THE CORPORATE BOARD. FORM 990, PART VI LINE 11B: THE FORM 990 IS PREPARED BY AN OUTSIDE CPA FIRM AND REVIEWED BY THE CHIEF FINANCIAL OFFICER AFTER WHICH IT IS PROVIDED TO THE BOARD OF DIRECTORS PRIOR TO FILING WITH THE IRS. FORM 990, PART VI LINE 12C: The conflict of interest policies are completed annually by all board members and staff. The policy statements are reviewed annually by the board of directors. When organization business is being conducted and there is a conflict, the board or staff members abstain from voting on related matters. This is documented in the board minutes. FORM 990, PART VI LINE 15A: THE COMPENSATION COMMITTEE, A SUB-COMMITTEE OF THE BOARD, IS INVOLVED IN DETERMINING THE COMPENSATION OF THE CEO UTILIZING THIRD PARTY AND MARKET DATA. FORM 990, PART VI LINE 19: THE CONFLICT OF INTEREST STATEMENTS AND GOVERNING DOCUMENTS ARE KEPT WITH THE EXECUTIVE SECRETARY AND ARE AVAILABLE TO BE VIEWED WHEN REQUESTED. THE FINANCIAL STATEMENTS ARE KEPT IN THE FINANCE AREA AND ARE ALSO AVAILABLE UPON REQUEST. FORM 990, PART VII SECTION A, LINE 1A A COMMON PAYMASTER IS USED BY DEKALB MEMORIAL HOSPITAL AND DEKALB HEALTH FOUNDATION. DEKALB HEALTH FOUNDATION CONTRACTED EMPLOYEES ARE PAID THROUGH THE COMMON PAYMASTER. FORM 990, PART XI LINE 5 UNREALIZED GAIN ON TRADING SECURITIES $1,908,412 LOSS ON EQUITY INVESTEE (10,491) TOTAL: $1,897,921 DEKALB MEMORIAL PHARMACARE LLC 1314 E 7TH STREET AUBURN IN 46706 273514342 RETAIL PHARM IN 3927480 591961 NA REDIMED DEKALB LLC 7950 W JEFFERSON BLVD FORT WAYNE IN 468044160 352046411 OCC HEALTH IN RELATED -23175 67722 false false 0.50000 false false true false false false false false false false false false false false false false false false