2011-05-13T15:09:30-04:00 2010-09-30 BKD LLP 200 E Main St Suite 700 Fort Wayne IN 46802 990 2009-10-01 351064295 DEKALB MEMORIAL HOSPITAL INC DEKA 2609254600 1316 EAST SEVENTH STREET AUBURN IN 46706 PAM CAVACINI 2609254600 2011-05-10 true Joyce A Dulworth 2604604000 2009 2016-02-24 21:20:13Z KIRK RAY 1316 EAST SEVENTH STREET AUBURN IN 46706 65404093 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 11 522 52 67310 10713 359773 866110 41559790 43590342 -487366 1148394 -447937 672196 40984260 46277042 16500 17000 0 22880937 23521058 0 0 0 20139518 20102761 43036955 43640819 -2052695 2636223 59414193 60174910 13829453 12183175 45584740 47991735 DEKALB MEMORIAL HOSPITAL WAS ESTABLISHED TO PROVIDE A VARIETY OF ACUTE, SUBACUTE AND OUTPATIENT MEDICAL SERVICES TO THE RESIDENTS OF NORTHEASTERN INDIANA. THE HOSPITAL PROVIDES INPATIENT AND OUTPATIENT HEALTHCARE GENERALLY TO THE RESIDENTS OF DEKALB COUNTY, INDIANA AND CONTIGUOUS COUNTIES. THE HOSPITAL ALSO PROVIDES CHARITY CARE TO PATIENTS. false false 39373481 17000 43807531 THE 47 BED HOSPITAL OPERATES IN A RURAL AREA. FOR FISCAL YEAR ENDED SEPTEMBER 30, 2010 THE TOTAL NUMBER OF ADMISSIONS WAS 2,458. THE TOTAL NUMBER OF EMERGENCY ROOM VISITS WAS 15,809. THE TOTAL NUMBER OF EMERGENCY MEDICAL SERVICES TRIPS WAS 3,668. THE TOTAL NUMBER OF HOME HEALTH CARE VISITS WAS 4,956. 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. FOR FISCAL YEAR ENDED SEPTEMBER 30, 2010, THE CHARGE FOREGONE FOR CHARITY CARE WAS $831,680. 39373481 true true false true false false false false false true true false false false false false false false true false true false true true true false true false false false false false true false false false false false false false true false false false true 42 0 522 true true true false false false false true true false false false 12 11 false false false false true true true true true false false true true true true true true true false true false IN X PAM CAVACINI 2609254600 1316 E 7TH STREET AUBURN IN 46706 FRANK CAPRINO 1.0 X X 0 0 0 MARK MILLETT 1.0 X X 0 0 0 DEB LINSTROMBERG 1.0 X X 0 0 0 RICHARD ALLEN 1.0 X 0 0 0 ANGIE LOCKWOOD 1.0 X 0 0 0 ALAN MIDDLETON 1.0 X 0 0 0 WENDY OBERLIN 1.0 X 0 0 0 DON WALLACE 1.0 X 0 0 0 RON DICKE 1.0 X 0 0 0 STACY HEFTY 1.0 X 0 0 0 MITCHELL TRAVIS 1.0 X 0 0 0 JEFF JUSTICE 1.0 X 0 0 0 KIRK RAY - HIRED 11162009 40.0 X 14546 0 0 PAMELA CAVACINI 40.0 X 126399 0 8357 EMILIO VAZQUEZ 40.0 X 191014 0 14888 BRET KUEBER 40.0 X 153683 0 12606 NICHOLAS FINLEY 40.0 X 144381 0 12006 JOSEPH PUTMAN 40.0 X 154982 0 13406 LEANN PIXLEY 40.0 X 141686 0 11451 JACK M COREY 0.0 X 283064 0 11120 1209755 0 83834 12 true true false INSIGHT HEALTH CORP PO BOX 847689 DALLAS TX 752847689 SCAN SERVICES 594077 NORTHEAST ANESTHESIA PARTNERS 601 WASHINGTON AVE STE 390 NEWPORT KY 41071 ANESTHESIA SERVICES 444970 SOUTH BEND MEDICAL FOUNDATION 530 NORTH LAFAYETTE BLVD SOUTH BEND IN 46602 REFERENCE LAB 602724 ALLIED MEDICAL SERVICES 6444 MONROE STREET STE B SYLVANIA OH 43560 RT SERVICES 423256 THEREX PO BOX 2121 MEMPHIS TN 38159 PT & OT SERVICES 468399 8 20923 225936 619251 866110 PATIENT SERVICE REVENUE 900099 43080908 43080908 CAFETERIA SALES 900099 281383 223702 57681 DRUGS & SUPPLIES 900099 206123 206123 LAB - NON PATIENT REVENUE 621500 21928 21928 43590342 414690 414690 168 168 0 664917 257039 407878 407878 407878 19573453 19500 18855735 3682 717718 15818 733536 15818 717718 6232 20923 10595 -4363 -4363 0 0 OTHER REVENUE 900099 268681 259052 9629 268681 46277042 43807531 67310 1536091 0 17000 17000 0 0 295119 295119 0 17158919 15892114 1266805 1221607 1164640 56967 3593272 3423820 169452 1252141 1191909 60232 118995 117600 1395 28356 5724 22632 79631 79631 5069 5069 0 20000 20000 3617229 3445344 171885 296320 2207 294113 5306716 5061421 245295 1121464 1068287 53177 0 805615 690612 115003 197275 183091 14184 0 30670 21047 9623 390463 390463 0 3523183 3059270 463913 495439 495439 BAD DEBT 3267541 3267541 RECRUITMENT 189794 189794 COLLECTION FEES 224661 224661 LICENSE, ACCRED FEES & MISC 384340 146730 237610 43640819 39373481 4267338 0 4924797 6369522 1508748 1266677 8197446 7552453 485150 522359 461550 363595 63060132 32769573 31463092 30290559 11664089 13157617 709321 652128 59414193 60174910 4656004 4465230 8801642 7698353 370000 0 1807 19592 13829453 12183175 X 44898880 47907517 685860 84218 45584740 47991735 59414193 60174910 X false true true X false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false true 5069 false 5069 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 23.76 PERCENT OF DUES ($3,607) AND IHA IS 5.45 PERCENT OF DUES ($1,267). IAHHC FOR HHC AND HOSPICE IS 12 PERCENT OF DUES ($173) AND SOCIETY OF DIAGNOSTIC MEDICAL SONOGRAPHY IS 15 PERCENT OF DUES ($22). 220118 220118 43754344 18881006 24873338 0 0 0 16758015 12502716 4255299 2327655 1385851 941804 30290559 0 CAPITAL LEASE OBLIGATIONS 19592 19592 46277042 43640819 2636223 372412 372412 3008635 46917088 372412 267634 640046 46277042 46277042 43908453 267634 267634 43640819 43640819 FORM 990, SCHEDULE D FIN 48: MANAGEMENT HAS EVALUATED THEIR INCOME TAX POSITIONS UNDER THE GUIDANCE INCLUDED IN ASC 740. BASED ON THEIR REVIEW, MANAGEMENT HAS NOT IDENTIFIED ANY MATERIAL UNCERTIAN TAX POSITIONS TO BE RECORDED OR DISCLOSED IN THE FINANCIAL STATEMENTS. FORM 990, SCHEDULE D PART XII, LINE 2D: THIS AMOUNT REPRESENTS RENTAL EXPENSES OF ($257,039) AND DIRECT EXPENSES RELATED TO FUNDRAISING EVENTS OF ($10,595). PART XIII, LINE 2D: THIS AMOUNT REPRESENTS RENTAL EXPENSES OF ($257,039) AND DIRECT EXPENSES RELATED TO FUNDRAISING EVENTS OF ($10,595). GOLF OUTING 27155 20923 6232 1280 3757 4869 689 0 27155 20923 6232 1280 3757 4869 689 10595 -4363 true true true X true X false true true false true true 358288 358288 0.00880 4682533 2206486 2476047 0.06090 5040821 2206486 2834335 0.06970 299608 299608 299608 299608 5340429 2206486 3133943 0.06970 true 1539862 153986 9383294 15006981 -5623687 X true true REDIMED AT DEKALB OCCUPATIONAL HEALTH 0.50000 0.00000 0.00000 DEKALB MEMORIAL HOSPITAL

1316 E 7TH STREET AUBURN IN 46706

X X X DEKALB MEMORIAL HOSPITAL USES FEDERAL POVERTY GUIDELINES TO DETERMINE ELIGIBILITY FOR PROVIDING DISCOUNTED CARE. 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. Medicare shortfall is not treated as community benefit. The methodology uses the department cost to charge ratio generated by the Medicare cost report. 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. 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 health care needs of the community. 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. 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. 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 Standy by 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. The Hospital operates a 24-hour emergency room open to all persons regardless of ability to pay and participates in all Government sponsored health programs including Medicare, Medicaid, Champus and all other State programs resulting in up to 40% of the cost of care being absorbed by the Hospital. Total Charity, Community Benefit, Uncompensated Care and Bad Debt at cost totaled over $10,600,000 for fiscal year 2010. The Hospital has an open medical staff with priveleges available to all qualified physicians in the area and participates as a clinical experience site for nurses and other medical para-professionals. The governing body consists of independent persons representative of the community served by the hospital and are nominated and selected by a sub-committee of the Board. Surplus funds are invested back into capital improvements to the hospital, technology, and retention and recruitment of qualified staff. true SCHOLARSHIPS 17 17000 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 true false false false false false false false false EMILIO VAZQUEZ 190207 0 0 0 807 0 12171 0 2717 0 205902 0 0 0 BRET KUEBER 153346 0 0 0 337 0 10155 0 2451 0 166289 0 0 0 NICHOLAS FINLEY 130261 0 13907 0 213 0 10035 0 1971 0 156387 0 0 0 JOSEPH PUTMAN 141692 0 13031 0 259 0 10828 0 2578 0 168388 0 0 0 LEANN PIXLEY 132587 0 8709 0 390 0 9743 0 1708 0 153137 0 0 0 JACK M COREY 140896 0 0 0 142168 0 9385 0 1735 0 294184 0 0 0 FORM 990, SCHEDULE J LINE 1: SOCIAL CLUB DUES ARE PROVIDED TO THE CEO SOLELY FOR BUSINESS PURPOSES. LINE 4: JACK COREY RECEIVED $75,807 FOR SEVERENCE PAY IN FY 2010. HOSPITAL AUTHORITY OF DEKALB COUNTY INDIANA 351064295 240732BQ9 2006-12-29 2725000 CONSTRUCTION false false HOSPITAL AUTHORITY OF DEKALB COUNTY INDIANA 351064295 240732BLO 2006-12-29 9275000 CONSTRUCTION false false 2725000 750000 47500 2011 true false true true 9354438 927500 147500 9000000 2011 false false true true false false false false true 0.00000 0.00000 0.00000 true false false false false true 0.00000 0.00000 0.00000 true false false false false false false false false false false false false 0 AUBURN RADIOLOGY PC OWNED>35% BY BOARD MEMBER 55000 AFTER HOURS COVERAGE 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. REDIMED DEKALB LLC 7950 W JEFFERSON BLVD FORT WAYNE IN 468044160 352046411 OCC HEALTH IN RELATED -42921 55599 false false false false false false false false false false false false false false false false false false false false