2026-08-17T17:48:23-05:00 2025-09-30 351178661 BLUE & CO LLC 500 N MERIDIAN ST SUITE 200 INDIANAPOLIS IN 46204 990 2024-10-01 350877575 GIBSON GENERAL HOSPITAL GIBS 8123853401 1808 SHERMAN DRIVE PRINCETON IN 47670 SHANE HAYES CAO 8123853401 2026-08-17 1 1 EMILIE M KNIERIEM CPA P01330194 3176334705 2026-08-15 2024 2025-03-06 01:10:19Z DEACONESS GIBSON HOSPITAL SHANE HAYES 1808 SHERMAN DRIVE PRINCETON IN 47670 62268282 0 X SEE SCHEDULE O X 1941 IN TO PROVIDE HIGH QUALITY, PATIENT-CENTERED, COST-EFFECTIVE CARE FOR PEOPLE IN THE COMMUNITY. 14 9 259 30 0 0 0 0 57293340 60958086 2073456 969209 329752 274704 59696548 62201999 0 22200 0 0 17443161 22277403 0 0 0 26427365 26127542 43870526 48427145 15826022 13774854 74276673 82574568 17462559 11985600 56814114 70588968 THE MISSION OF GIBSON GENERAL HOSPITAL AND THE SKILLED NURSING FACILITY IS TO PROVIDE HIGH QUALITY, PATIENT-CENTERED, COST-EFFECTIVE CARE FOR PEOPLE IN OUR COMMUNITY. 0 0 37731579 22200 60989357 THE HOSPITAL'S MISSION IS TO PROVIDE HIGH QUALITY AND COST-EFFECTIVE HEALTHCARE, WHICH INCLUDES PATIENT, OUTPATIENT, AND EMERGENCY CARE SERVICES TO THE RESIDENTS OF THE SURROUNDING TRI-STATE AREA. ALL EXPENSES RELATE TO COSTS ASSOCIATED WITH PROVIDING THESE SERVICES, AND MAINLY INCLUDE SALARIES AND WAGES TO STAFF AND SUPPLIES COST. THERE WERE 582 ADMISSIONS AND 50,309 VISITS DURING THE YEAR. 37731579 1 0 0 1 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 50 0 1 259 1 0 0 0 0 0 0 0 0 0 0 0 0 X 14 9 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 IN X CHERYL A WATHEN 8124503296 600 MARY STREET EVANSVILLE IN 47747 X SUSAN STRAUB CHAIR 1.00 0.00 X X 0 1200 0 DEREK MCGRAW VICE CHAIR 40.00 0.00 X X 74232 0 2874 STEPHEN LANKFORD SECRETARY 1.00 0.00 X X 0 0 0 GEORGE A BALLARD TREASURER 1.00 0.00 X X 0 0 0 DR DAVID PURDOM CHIEF OF STAFF (END 12/2024) 40.00 0.00 X X 345760 0 50399 JENNIFER BARTLEY BOARD MEMBER 1.00 0.00 X 0 0 0 HENRY BREWSTER BOARD MEMBER 1.00 0.00 X 0 0 0 MARC JARED FLORENCE BOARD MEMBER 5.00 60.00 X 0 753379 153958 BOB GIBSON BOARD MEMBER 1.00 0.00 X 0 0 0 STEVEN IVY BOARD MEMBER 5.00 50.00 X 0 380818 48672 LYNN LINGAFELTER BOARD MEMBER 5.00 61.00 X 0 1072961 198379 DUSTIN PRIESTLY BOARD MEMBER 1.00 0.00 X 0 0 0 GREG WRIGHT BOARD MEMBER 50.00 0.00 X 192643 0 26868 MARION JOCHIM BOARD MEMBER (BEG 01/2025) 1.00 0.00 X 0 0 0 DR ADRIAN CARTER CHIEF OF STAFF (BEG 01/2025) 5.00 50.00 X X 0 273451 27196 LOIS MORGAN CAO (END 12/2024) 50.00 0.00 X 262392 0 35629 SHANE C HAYES CNO (PARTIAL YEAR)/CAO 50.00 0.00 X 137410 0 36453 LYNDSI DUNN CNO (BEG 03/2025) 40.00 0.00 X 113413 0 4311 COREY POTTS CRNA 40.00 0.00 X 284607 0 42315 BETH N MCGRAW LEAD MULTI-MODALITY TECH 40.00 0.00 X 148067 0 7696 MARILYN HARPER RN 40.00 0.00 X 149854 0 29411 TAMMY WARMACK DIRECTOR NURSING DEPT CAH 40.00 0.00 X 122279 0 14449 ASHLEY SMITH PHYSICIAN 40.00 0.00 X 926925 0 26995 2757582 2481809 705605 20 0 1 0 PROGRESSIVE HEALTH OF INDIANA 150 N ROSENBERGER EVANSVILLE IN 47710 THERAPY SERVICES 2265053 GREAT LAKES EMERGENCY PHYSICIANS PLLC 1602 AVENUE Q LUBBOCK TX 794014732 MEDICAL PROFESSIONAL FEES 1373914 TOTAL MSP LLC 221 W COLLEGE AVE FLOOR 2 APPLETON WI 54911 STAFFING 962678 TRI-STATE GASTROENTEROLOGY PC PO BOX 5068 EVANSVILLE IN 47716 MEDICAL PROFESSIONAL FEES 529667 INTEGRIUS LLC 501 MAIN ST SUITE 305 EVANSVILLE IN 477353646 MEDICAL PROFESSIONAL FEES 435988 8 PATIENT SERVICE REVENU 622110 60958086 60958086 60958086 969209 969209 157035 66283 90752 90752 90752 CAFETERIA REVENUE 900099 152681 152681 AMBULANCE DRUG CHARGES 900099 12771 12771 CPR CARD REVENUE 900099 6413 6413 12087 12087 183952 62201999 60989357 0 1212642 X 22200 22200 565956 565956 17789065 15031061 2758004 518194 421853 96341 2228784 1229791 998993 1175404 971595 203809 6800 5353 1447 141794 141794 11958779 9414708 2544071 51930 206 51724 460429 337764 122665 4123118 1998146 2124972 24323 21363 2960 47895 47895 335983 252316 83667 1764609 1325186 439423 431013 57294 373719 MEDICAL & DRUG SUPPLIES 5264652 5216694 47958 MEDICAID ASSESSMENT FEE 1026966 1026966 DUES & SUBSCRIPTIONS 127191 84278 42913 LICENSES AND FEES 53016 35129 17887 309044 231781 77263 48427145 37731579 10695566 0 25358714 23604513 1627504 1680110 6886267 6918401 391135 551743 336348 212403 22055760 9574044 13296123 12481716 26380582 37125682 74276673 82574568 6244703 3191197 8842952 8242735 2374904 551668 17462559 11985600 X 56814114 70588968 56814114 70588968 74276673 82574568 13774854 0 X 0 1 X 1 1 1 X 0 0 0 0 0 0 0 0 1 7544 7544 0 PART II-B, LINE 1: THE HOSPITAL PAID MEMBERSHIP DUES TO INDIANA HOSPITAL ASSOCATION "IHA AND THE AMERICAN HOSPITAL ASSOCIATION "AHA" IN FYE 2025. IHA ATTRIBUTED 19.01% OF THE TOTAL DUES TO LOBBYING EXPENSES. AHA ATTRIBUTED 36% OF THE TOTAL DUES TO LOBBYING EXPENSES. 440800 440800 8337740 2555642 5782098 10632865 7018402 3614463 2644355 2644355 12481716 RIGHT OF USE ASSET 184804 FUNDS HELD BY TRUSTEE 169365 BENEFICIAL INTEREST IN TRUST 2610316 PHYSICIAN 457F 85300 RECEIVABLE FROM AFFILIATE - DHS 34029897 THIRD PARTY RECEIVABLE 46000 37125682 RIGHT OF USE LIABILITIES 466368 PHYSICIAN 457F 85300 551668 X PART X, LINE 2: ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE SYSTEM AND RECOGNIZE A TAX LIABILITY IF 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, 2025 AND 2024, 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 TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. 1 1 X 1 X 1 X 1 1 0 1 1 534803 534803 0.01100 7033479 5386134 1647345 0.03400 7568282 5386134 2182148 0.04500 29051 29051 0.00060 20 28196 28196 0.00060 400436 400436 0.00830 152 525836 525836 0.01090 172 983519 983519 0.02040 172 8551801 5386134 3165667 0.06540 95 3794 3794 0.00010 95 3794 3794 0.00010 1 1215433 0 28146734 22984710 5162024 X 1 1 1 1 GIBSON GENERAL HOSPITAL INC 1808 SHERMAN DRIVE PRINCETON IN 47670 WWW.DEACONESS.COM/DEACONESS-GIBSON-HOS 24-005019-1 X X X X GIBSON GENERAL HOSPITAL INC 0 0 1 X X X X X X X X X 23 1 0 1 1 X WWW.DEACONESS.COM/CHNA X 1 23 1 WWW.DEACONESS.COM/CHNA 0 1 X 200.000000000000 350.000000000000 X X X X 1 1 X X X X 1 X HTTPS://WWW.DEACONESS.COM/PAY-MY-BILL/FINANCIAL-ASSISTANCE X HTTPS://WWW.DEACONESS.COM/PAY-MY-BILL/FINANCIAL-ASSISTANCE X HTTPS://WWW.DEACONESS.COM/PAY-MY-BILL/FINANCIAL-ASSISTANCE X X X X X X X 1 X 0 X X X X 1 X 0 0 GIBSON GENERAL HOSPITAL INC PART V, SECTION B, LINE 5: DEACONESS GIBSON HOSPITAL (DGH), IN CONJUNCTION WITH TULIP TREE FAMILY HEALTH CARE (TTFHC), CONTRACTED WITH THE INDIANA RURAL HEALTH ASSOCIATION (IRHA) TO CONDUCT THE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA). IRHA FIRST IDENTIFIED THE COMMUNITY SERVED BY DGH THROUGH CONVERSATIONS WITH HOSPITAL STAFF. BASED ON A REVIEW OF PATIENT ZIP CODES, HOSPITAL STAFF DEFINED THE COMMUNITY SERVED AS ALL POSTAL CODES WITHIN THE GEOGRAPHIC AREA OF GIBSON COUNTY. TO QUANTIFIABLY DESCRIBE THE COMMUNITY, CENSUS REPORTS WERE PULLED FROM THE UNITED STATES CENSUS BUREAU. QUANTIFIABLE STATISTICS AND REPORTS FOR HEALTH-RELATED COMMUNITY DATA WERE OBTAINED FROM THE U.S. CENSUS BUREAU, INDIANA BUSINESS RESEARCH CENTER, INDIANA UNIVERSITY, ROBERT WOOD JOHNSON COUNTY HEALTH RANKINGS & ROADMAPS, INDIANA DEPARTMENT OF TRANSPORTATION, U.S. BUREAU OF ECONOMIC ANALYSIS, AND INDIANA FAMILY AND SOCIAL SERVICES ADMINISTRATION. THE DATA TABLES AND CITATIONS FOR THESE REPORTS CAN BE VIEWED IN APPENDIX A. ADDITIONAL REPORTS ON CHRONIC DISEASE WERE PULLED FROM THE CENTERS FOR DISEASE CONTROL AND THE INDIANA STATE CANCER REGISTRY. EXCERPTS FROM THESE REPORTS CAN ALSO BE FOUND IN APPENDIX A.NEXT, AN IN-PERSON FOCUS GROUP OF GIBSON COUNTY REPRESENTATIVES WERE ORGANIZED WITH THE HELP OF THE DEACONESS GIBSON HOSPITAL DIRECTOR OF MARKETING AND COMMUNICATION, PAM HIGHT, AND EXECUTIVE DIRECTOR, KRISTINE GEORGES. COMMUNITY LEADERS, COUNTY HEALTH DEPARTMENT REPRESENTATIVES, BUSINESS OWNERS, LOCAL OFFICIALS, HEALTHCARE PROVIDERS, MINORITY LEADERS, CLERGY, STUDENT REPRESENTATIVES, AND ANY OTHER INTERESTED PARTIES WERE INVITED TO ATTEND THE MEETINGS TO DISCUSS THE HEALTH-RELATED NEEDS OF THE COUNTY WITH THE INTENT TO IDENTIFY AREAS OF GREATEST CONCERN. THE LIST OF ALL MEETING ATTENDEES, ALONG WITH THE ORGANIZATIONS THEY REPRESENT, IS IN APPENDIX B. FROM THE INFORMATION OBTAINED IN THE FOCUS GROUPS, A 46-QUESTION SURVEY WAS DEVELOPED TO GAIN THE PERSPECTIVE OF THE INHABITANTS OF THE COMMUNITY (SEE APPENDIX C). QUESTIONS INCLUDED QUERIES ABOUT THE EFFECT OF VARIOUS FACTORS (SUCH AS SUBSTANCE USE, TRANSPORTATION, HOUSING, AND MENTAL HEALTH), AS WELL AS PROBES INTO THE PERCEIVED NEED FOR VARIOUS SERVICES AND FACILITIES IN THE COUNTY. THE SURVEY WAS WIDELY DISSEMINATED TO THE RESIDENTS OF GIBSON COUNTY THROUGH INCLUSION ON THE DEACONESS GIBSON HOSPITAL TE, NEWSLETTERS, AND SOCIAL MEDIA WHERE IT WAS MADE PUBLICLY AVAILABLE ON REDCAP.COM. HARD COPIES OF THE SURVEY WERE MADE AVAILABLE IN VARIOUS WAITING ROOMS AROUND THE COUNTY, AND TWO IRHA STAFF MEMBERS CONDUCTED IN-PERSON POLLING AT THE GIBSON COUNTY FAIR TO REACH PEOPLE WHO WERE UNAWARE OF THE SURVEY OR DID NOT HAVE INTERNET ACCESS TO COMPLETE IT. TO IDENTIFY ALL HEALTHCARE FACILITIES AND RESOURCES THAT ARE CURRENTLY RESPONDING TO THE HEALTHCARE NEEDS OF THE COMMUNITY, IRHA CONTACTED DGH AND TULIP TREE. THE TWO HEALTHCARE ENTITIES WERE ABLE TO PROVIDE A LISTING OF THE FACILITIES AND RESOURCES, INCLUDING BUT NOT LIMITED TO CLINICS, FAMILY PRACTICES, AND NURSING FACILITIES THAT ARE CURRENTLY AVAILABLE WITHIN GIBSON COUNTY. SEE APPENDIX D FOR EXISTING COMMUNITY RESOURCES. THE COMPLETED CHNA WAS THEN PUBLICLY POSTED ON BOTH THE DEACONESS GIBSON HOSPITAL AND TULIP TREE FAMILY HEALTH CARE WEBSITES. HARD COPIES OF THE REPORT ARE AVAILABLE UPON REQUEST.LISTINGS OF THOSE COMMUNITY PARTNERS ARE INCLUDED IN THE APPENDICES SECTION OF THE CHNA REPORT (APPENDIX B) AND ALSO LISTED IN THE PRIORITIZATION PROCESS SECTION AS APPLICABLE (SECTION 6). GIBSON GENERAL HOSPITAL INC PART V, SECTION B, LINE 6B: THE CHNA WAS CONDUCTED IN CONJUNCTION WITH TULIP TREE FAMILY HEALTH CARE AND THE INDIANA RURAL HEALTH ASSOCIATION. GIBSON GENERAL HOSPITAL INC PART V, SECTION B, LINE 11: DEACONESS GIBSON HOSPITAL CONDUCTED ITS MOST RECENT COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) IN 2024, IDENTIFYING FOUR PRIORITY AREAS: TRANSPORTATION, MENTAL HEALTH SERVICES, SUBSTANCE USE/MISUSE, AND ACCESS AND AVAILABILITY. THE FOLLOWING DESCRIBES ACTIONS TAKEN IN 2025 TO ADDRESS THESE NEEDS IN ALIGNMENT WITH THE HOSPITAL'S ADOPTED IMPLEMENTATION STRATEGY.PRIORITY 1: TRANSPORTATIONTHE 2024 CHNA IDENTIFIED TRANSPORTATION AVAILABILITY AND AFFORDABILITY AS A TOP PRIORITY, WITH AVAILABILITY OF PUBLIC TRANSPORTATION RANKING AMONG THE MOST NEGATIVELY RATED FACTORS AFFECTING COMMUNITY HEALTH AND RESIDENTS CITING UNRELIABLE OPTIONS AS A DIRECT BARRIER TO ATTENDING MEDICAL APPOINTMENTS.-CASE MANAGEMENT AND CLINICAL TEAMS CONTINUE TO CONNECT PATIENTS WITH LOCAL TRANSPORTATION RESOURCES TO SUPPORT ACCESS TO FOLLOW-UP CARE AND OUTPATIENT SERVICES, CONSISTENT WITH THE IMPLEMENTATION STRATEGY'S FOCUS ON LINKING PATIENTS WITH AVAILABLE COMMUNITY PROGRAMS.-DEACONESS GIBSON HOSPITAL FACILITATES RIDES THROUGH GARLING MOBILITY FOR PATIENTS WITH TRANSPORTATION BARRIERS, PROVIDING A TANGIBLE OPTION FOR NON-EMERGENCY MEDICAL TRANSPORTATION.-THE HOSPITAL HAS BEGUN WORKING WITH ITS FOUNDATION TO EVALUATE POTENTIAL FUNDING FOR A TRANSPORT VAN IN COLLABORATION WITH TOYOTA, REPRESENTING A NEW INITIATIVE TO DEVELOP A SUSTAINABLE LOCAL TRANSPORTATION SOLUTION FOR GIBSON COUNTY RESIDENTS.PRIORITY 2: MENTAL HEALTH SERVICESTHE 2024 CHNA IDENTIFIED MENTAL HEALTH AVAILABILITY, AFFORDABILITY AND STIGMA AS CRITICAL BARRIERS, WITH ADDITIONAL MENTAL HEALTH SERVICES, AFFORDABLE MENTAL HEALTH CARE AND SUICIDE PREVENTION RANKING AMONG THE TOP FIVE AREAS OF GREATEST NEED IDENTIFIED BY SURVEY RESPONDENTS.-DEACONESS GIBSON HOSPITAL UTILIZES TELE-PSYCHIATRY SERVICES FOR INPATIENT, OUTPATIENT AND EMERGENCY DEPARTMENT PATIENTS, EXPANDING ACCESS TO BEHAVIORAL HEALTH CARE FOR RESIDENTS WHO WOULD OTHERWISE FACE SIGNIFICANT BARRIERS TO IN-PERSON SERVICES.-THE HOSPITAL IS PARTICIPATING IN THE GROW GRANT TO HELP BUILD THE LOCAL MENTAL HEALTH WORKFORCE, DIRECTLY ADDRESSING THE PROVIDER SHORTAGE IDENTIFIED IN THE CHNA AS A ROOT CAUSE OF LIMITED MENTAL HEALTH ACCESS IN GIBSON COUNTY.-GIBSON IS STRENGTHENING PARTNERSHIPS WITH DEACONESS MEMORIAL AND SYSTEM BEHAVIORAL HEALTH RESOURCES TO EXPAND THE CONTINUUM OF MENTAL HEALTH SERVICES AVAILABLE TO GIBSON COUNTY RESIDENTS.-MENTAL HEALTH PROVIDERS HAVE BEEN ENGAGED AT COMMUNITY OUTREACH EVENTS TO INCREASE AWARENESS OF AVAILABLE SERVICES AND REDUCE THE STIGMA IDENTIFIED IN THE CHNA AS A BARRIER TO CARE.PRIORITY 3: SUBSTANCE USE/MISUSETHE 2024 CHNA IDENTIFIED SUBSTANCE USE AND MISUSE AS THE HIGHEST NEGATIVELY RATED FACTOR AFFECTING COMMUNITY HEALTH, WITH SUBSTANCE USE EDUCATION AND SUICIDE PREVENTION AMONG THE TOP AREAS OF GREATEST NEED AND FOCUS GROUP PARTICIPANTS EXPRESSING CONCERN ABOUT USE ACROSS ALL AGE GROUPS INCLUDING YOUTH.-DEACONESS GIBSON HOSPITAL HAS PARTNERED WITH ADDICTION SOLUTIONS TO SUPPORT INDIVIDUALS IN RECOVERY, CONSISTENT WITH THE IMPLEMENTATION STRATEGY'S EMPHASIS ON COLLABORATION WITH TREATMENT FACILITIES AND RECOVERY RESOURCES.-HOSPITAL STAFF HAVE BEEN ACTIVELY CONNECTING WITH LOCAL SCHOOLS TO BUILD RELATIONSHIPS AND ENGAGE STUDENTS IN SUBSTANCE USE PREVENTION AND AWARENESS EFFORTS, WITH A FOCUS ON REACHING YOUTH POPULATIONS IDENTIFIED IN THE CHNA AS PARTICULARLY AT RISK.PRIORITY 4: ACCESS AND AVAILABILITYTHE 2024 CHNA IDENTIFIED SPECIALTY CARE ACCESS AND AVAILABILITY FOR MEDICAID PATIENTS AS A SIGNIFICANT UNMET NEED, WITH COMMUNITY MEMBERS NOTING THAT RESIDENTS FREQUENTLY TRAVEL OUTSIDE GIBSON COUNTY FOR CARE AND THAT PROVIDER AVAILABILITY HAS NOT KEPT PACE WITH THE COUNTY'S GROWING POPULATION.-DEACONESS GIBSON HOSPITAL HAS INCREASED ONCOLOGY COVERAGE, IMPROVING LOCAL ACCESS TO CANCER CARE AND REDUCING THE NEED TO TRAVEL TO REGIONAL CENTERS FOR TREATMENT.-THE HOSPITAL ADDED FULL-TIME CARDIOLOGY COVERAGE, DIRECTLY ADDRESSING THE SPECIALIST ACCESS GAP IDENTIFIED AS A PRESSING COMMUNITY NEED.-EXPANDED GI SERVICES HAVE BEEN IMPLEMENTED TO IMPROVE PATIENT ACCESS TO GASTROENTEROLOGY CARE WITHIN THE COUNTY, CONSISTENT WITH THE IMPLEMENTATION STRATEGY'S FOCUS ON ROTATING SPECIALISTS INTO THE PRINCETON CAMPUS. GIBSON GENERAL HOSPITAL INC PART V, SECTION B, LINE 15E: WELL FUND IS AVAILABLE TO DEACONESS HEALTH SYSTEM PATIENTS TO ASSIST WITH APPLYING FOR MEDICAID OR EXCHANGE PRODUCTS. GIBSON GENERAL HOSPITAL INC PART V, SECTION B, LINE 16J: 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. COLLECTIBILITY SCORING IS ALSO COMPLETED AND ALLOWANCES ARE MADE BASED UPON THESE SCORES. GIBSON GENERAL HOSPITAL, INC.: SCHEDULE H, PART V, LINE 16A:HTTPS://WWW.DEACONESS.COM/PAY-MY-BILL/FINANCIAL-ASSISTANCESCHEDULE H, PART V, LINE 16A:HTTPS://WWW.DEACONESS.COM/PAY-MY-BILL/FINANCIAL-ASSISTANCESCHEDULE H, PART V, LINE 16A:HTTPS://WWW.DEACONESS.COM/PAY-MY-BILL/FINANCIAL-ASSISTANCE 5 1 - STAR ONE REHAB 1808 SHERMAN DRIVE PRINCETON IN 47670 PHYSICAL THERAPY, OCCUPATIONAL THERAPY, SPEECH THERAPY 2 - PHYSICIAN OUTPATIENT CLINICS 1808 SHERMAN DRIVE PRINCETON IN 47670 SUBSIDIZED CARE PHYSICIAN PRACTICES 3 - LIFESTYLES DIABETES CENTER 1808 SHERMAN DRIVE PRINCETON IN 47670 DIABETES EDUCATION COUNSELING 4 - GGH-FAMILY PRACTICE 510 N MAIN ST PRINCETON IN 47670 FAMILY MEDICINE 6 - FORT BRANCH WELLNESS CLINIC 7851 S PROFESSIONAL DR FORT BRANCH IN 47648 FAMILY PRACTICE PART I, LINE 3C: GIBSON GENERAL HOSPITAL USES THE FOLLOWING FACTORS, IN ADDITION TO THE FPG, TO DETERMINE AN INDIVIDUAL'S ELIGIBILITY FOR FINANCIAL ASSISTANCE UNDER THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY: MEDICAL INDIGENCY, INSURANCE STATUS, AND UNDERINSURANCE STATUS. ADDITIONALLY, IF AN INDIVIDUAL IS HOMELESS, DECEASED, RECENTLY FILED FOR OR COMPLETED BANKRUPTCY, OR MEETS SPECIAL CIRCUMSTANCES RELATED TO ABILITY TO PAY, THE INDIVIDUAL MAY BE ELIGIBLE FOR FINANCIAL ASSISTANCE. PART I, LINE 7: THE COSTING METHODOLOGY USED TO CALCULATE THE AMOUNTS REPORTED VARY ACCORDING TO THE INFORMATION REQUESTED AND THE MOST ACCURATE MEANS OF GATHERING THE REQUIRED INFORMATION. THE IRS PROVIDED WORKSHEET NUMBER 2 WAS USED TO CALCULATE A COST TO CHARGE RATIO USING INFORMATION FROM THE ORGANIZATION'S GENERAL LEDGER AND COST REPORTS. THAT RATIO WAS THEN USED IN CONJUNCTION WITH IRS WORKSHEET NUMBER 1 TO CALCULATE THE COST OF FINANCIAL ASSISTANCE PROVIDED AND WORKSHEET NUMBER 3 WAS USED TO CALCULATE UNREIMBURSED MEDICAID AMOUNTS. HEALTH IMPROVEMENT AND COMMUNITY BENEFIT PROGRAMS, HEALTH EDUCATION, AND CONTRIBUTIONS ARE CALCULATED BASED ON ACTUAL COSTS. PART I, LINE 7G: $400,436 OF LOSSES FROM RURAL HEALTH CLINICS OPERATED BY GIBSON GENERAL HOSPITAL ARE INCLUDED IN SUBSIDIZED HEALTH SERVICES. PART II, COMMUNITY BUILDING ACTIVITIES: DEACONESS HOSTED AND ATTEND PUBLIC EVENTS, SUCH AS OUR ANNUAL ORAL, HEAD AND NECK CANCER SCREENINGS; COLON CANCER SCREENINGS, LOW DOSE CT SCREENINGS AND MORE OUTLINED BELOW. ADDITIONALLY, WE CREATED AND DISTRIBUTED WRITTEN AND VISUAL CONTENT THAT ADDRESSED SPECIFIC ISSUES AND HEALTH CONCERNS FOR OUR COMMUNITY.SOCIAL MEDIA POSTS:BREAST CANCER AWARENESS 10/1/2024WISE CHOICE 10/8/2024MENTAL HEALTH AWARENESS 10/10/2024PRIMARY CARE WEEK 10/11/2024GLOBAL HANDWASHING DAY 10/15/2024NATIONAL MAMMOGRAPHY DAY 10/18/2024MEGA BREAST TOUR 10/18/2024BREAST CANCER SURVIVOR TESTIMONY 10/25/2024BREAST CANCER SURVIVOR TESTIMONY 10/31/2024LUNG CANCER AWARENESS 11/1/2024LUNG CANCER SCREENING 11/8/2024WORLD DIABETES DAY 11/14/2024GREAT AMERICAN SMOKEOUT 11/24/2024WORLD AIDS DAY SCREENING 11/22/2024NO SHAVE NOVEMBER 11/22/2024SAFE TOYS AND GIFTS MONTH 12/2/2024SAFESITTER 12/4/2024HAND HYGIENE 12/6/2024ANXIETY 12/6/2024WHOOPING COUGH (PERTUSSIS) VACCINE AWARENESS 12/10/2024WHOOPING COUGH (PERTUSSIS) VACCINE AWARENESS 12/18/2024CROHN'S DISEASE AWARENESS 12/19/2024WHOOPING COUGH (PERTUSSIS) VACCINE AWARENESS 12/23/2024ANXIETY 1/3/2025WINTER STORM PREPAREDNESS 1/5/2025SLEDDING SAFETY 1/10/2025WEIGHT LOSS 1/10/2025HEAD AND NECK CANCER AWARENESS 1/15/2025LUNG DISEASE SUPPORT 1/16/2025FROSTBITE/HYPOTHERMIA AWARENESS 1/20/2025MOBILE MAMMOGRAM 1/29/2025GO RED FOR WOMEN (HEART DISEASE) 1/31/2025GO RED FOR WOMEN (HEART DISEASE) 2/1/2025AMERICAN HEART MONTH 2/3/2025GO RED FOR WOMEN (HEART DISEASE) 2/5/2025GO RED FOR WOMEN (HEART DISEASE) 2/6/2025HEART ATTACK SIGNS AND SYMPTOMS 2/8/2025IMPELLA HEART PUMP 2/11/2025CARDIAC REHAB 2/15/2025WINTER WEATHER SAFETY 2/18/2025NATIONAL CAREGIVERS DAY 2/21/2025COLON CANCER SCREENING 3/3/2025MEDICARE SEMINAR 3/3/2025NATIONAL KIDNEY MONTH 3/6/2025COLON CANCER AWARENESS MONTH 3/6/2025COLONOSCOPY AWARENESS 3/7/2025KIDNEY HEALTH 3/11/2025WORLD KIDNEY DAY / CHRONIC KIDNEY DISEASE 3/13/2025PULMONARY REHAB EDUCATION 3/15/2025FLU SEASON AWARENESS 3/18/2025KIDNEY DISEASE AWARENESS 3/20/2025AMERICAN DIABETES ALERT DAY 3/20/2025KIDNEY HEALTH 3/25/2025COLON CANCER SCREENING 3/26/2025HEAD AND NECK CANCER AWARENESS 4/1/2025HEAD AND NECK CANCER SCREENINGS 4/7/2025HEAD AND NECK CANCER SCREENINGS 4/15/2025STRESS AND ALCOHOL USE 4/18/2025STROKE AWARENESS MONTH 5/1/2025SPOT A STROKE F.A.S.T. 5/2/2025WORLD OVARIAN CANCER DAY 5/8/2025MENTAL HEALTH AND NURSING 5/9/2025SANE EDUCATION 5/9/2025SKIN CANCER AWARENESS 5/14/2025F.A.S.T. EXPERIENCE 5/14/2025STROKE AWARENESS MONTH 5/21/2025MENTAL HEALTH FOR WOMEN 5/22/2025BLOOD DONATION 5/24/2025CANCER SURVIVORSHIP 6/1/2025MEN'S HEALTH AWARENESS MONTH 6/2/2025MEN'S HEALTH AWARENESS MONTH 6/4/2025MEN'S HEALTH AWARENESS MONTH 6/9/2025MEN'S HEALTH AWARENESS MONTH 6/11/2025MEN'S HEALTH AWARENESS MONTH 6/12/2025MEN'S HEALTH AWARENESS MONTH 6/12/2025WORLD BLOOD DONATION DAY 6/14/2025HEAT SAFETY AWARENESS 6/23/2025MEN'S CANCERS 6/24/2025MEN'S HEALTH AWARENESS MONTH 6/27/2025SUMMER SAFETY 6/28/2025MEN'S HEALTH AWARENESS MONTH 6/30/2025FIREWORKS SAFETY 7/2/2025SKIN HEALTH AWARENESS 7/17/2025PEDIATRIC PHYSICAL THERAPY 7/18/2025HEATH SAFETY 7/19/2025BLOOD DONATION 7/21/2025INFANT MORTALITY 7/23/2025UV SAFETY AWARENESS 7/25/2025BACK-TO-SCHOOL HEALTH 7/28/2025PEDIATRIC PHYSICAL THERAPY 7/30/2025BACK-TO-SCHOOL HEALTH 7/30/2025WORLD LUNG CANCER DAY 8/1/2025NATIONAL BREASTFEEDING MONTH 8/16/2025BITE THERAPY 9/4/2025WORLD SEPSIS DAY 9/13/2025TIF PROCEDURE FOR GERD 9/17/2025BLOOD DONATION 9/17/2025BREAST CANCER AWARENESS 9/19/2025PROSTATE CANCER DETECTION 9/23/2025COCHLEAR IMPLANTS 9/26/2025MAMMOGRAMS 9/29/20252025 NUMBER SCREENED:117 ACROSS MULTIPLE EVENTS2025 NUMBERS SCREENED AT EVENTS:SKIN CANCER - 32ORAL, HEAD AND NECK CANCER - 85THE MEDICAL ASSISTANCE PROGRAM FOR DEACONESS GIBSON HOSPITAL PROVIDED PATIENTS WITH NEARLY $3,000 IN ASSISTANCE.LOCAL SPONSORSHIPS AS A SYSTEM IN FY 24-25, DEACONESS SPONSORED PROGRAMS AND ACTIVITIES FOR MORE THAN 170,000 PEOPLE, CONTRIBUTING $2.1 MILLION IN SUPPORT OF CLUBS, GROUPS, SOCIAL SERVICE ORGANIZATIONS, AND OTHERS STRIVING TO MAKE OUR COMMUNITY A BETTER PLACE. PART III, LINE 2: METHODOLOGY USED TO ESTIMATE BAD DEBT: MANAGEMENT ANALYZES THIRD-PARTY PAYOR SOURCES AND MAKES AN ESTIMATE BASED ON AGING OF ACCOUNTS, HISTORICAL LOSSES, CURRENT ECONOMIC CONDITIONS, AND OTHER FACTORS UNIQUE TO ITS SERVICE AREA. ADDITIONALLY, A SIGNIFICANT PROVISION IS ESTIMATED AND RECORDED FOR SELF-PAY PAYMENTS BASED ON PAST EXPERIENCE. PART III, LINE 3: THE HOSPITAL DOES NOT PURSUE COLLECTION AMOUNTS DETERMINED TO QUALIFY AS CHARITY CARE. THESE AMOUNTS ARE NOT REPORTED AS NET PATIENT REVENUE BECAUSE THE HOSPITAL DOES NOT PURSUE COLLECTION OF AMOUNTS DETERMINED TO QUALIFY AS CHARITY CARE. GIBSON GENERAL HOSPITAL DOES NOT ATTRIBUTE ANY BAD DEBT EXPENSE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY (FAP), THEREFORE NO PORTION OF BAD DEBT ATTRIBUTABLE TO FAP-ELIGIBLE INDIVIDUALS IS CONSIDERED A COMMUNITY BENEFIT. PART III, LINE 4: THE FOOTNOTE DESCRIBING BAD DEBT EXPENSES IS INCLUDED IN THE ATTACHED AUDITED FINANCIAL STATEMENTS UNDER FOOTNOTE "CHARITY CARE, COMMUNITY BENEFIT AND ASSISTANCE TO THE UNINSURED" STARTING ON PAGE 13 AND "PATIENT ACCOUNTS RECEIVABLE AND NET PATIENT SERVICE REVENUE" ON PAGES 11-12. PART III, LINE 8: MEDICARE SHORTFALL:THE HOSPITAL IS A CRITICAL ACCESS HOSPITAL AND IS REIMBURSED 101%, LESS 2% SEQUESTRATION, OF MEDICARE ALLOWANCE COSTS FOR INPATIENT SERVICES, SWING BED, AND OUTPATIENT PART B SERVICES. THE REVENUE SHORTFALL IS THE DIFFERENCE BETWEEN THE ALLOWABLE COST FOR THE SKILLED NURSING FACILITY AND THE PPS REIMBURSEMENT ALLOWED FOR THAT SKILLED NURSING FACILITY. THE SOURCE USED TO DETERMINE THE AMOUNT OF MEDICARE ALLOWABLE COSTS REPORTED FOR PART III, SECTION B, MEDICARE HAS BEEN PROVIDED FROM THE YEAR ENDED SEPTEMBER 30, 2025: HOSPITAL STATEMENT OF REIMBURSABLE COST. PART III, LINE 9B: COLLECTION PRACTICES:COLLECTION PRACTICES ARE APPLIED TO ALL PATIENTS AT GIBSON GENERAL HOSPITAL. ONCE PATIENTS RECEIVE SERVICES, THE PATIENTS' ACCOUNTS ARE BILLED TO THE APPROPRIATE INSURANCE COMPANY. ONCE PAYMENT IS RECEIVED FROM THE INSURANCE COMPANY, THE REMAINING BALANCE, IF ANY, BECOMES THE PATIENT'S RESPONSIBILITY. NOTIFICATION OF THE BALANCE DUE IS SENT VIA WRITTEN CORRESPONDENCE. IF THE BALANCE IS NOT PAID AND THE ACCOUNT DOES NOT QUALIFY FOR FINANCIAL ASSISTANCE, THE ACCOUNT IS SENT TO A COLLECTION AGENCY TO CONTINUE EFFORTS TO COLLECT THE REMAINING BALANCE DUE. IF THE BALANCE DUE IS NOT PAID WITHIN A CERTAIN NUMBER OF MONTHS, THE ACCOUNT IS RETURNED TO THE HOSPITAL AND THE ACCOUNT IS WRITTEN OFF AS UNCOLLECTIBLE. PART VI, LINE 2: DEACONESS RELIES HEAVILY ON ITS RELATIONSHIPS WITH COMMUNITY PARTNERS, LIKE TULIP TREE AND OTHERS, AND THE FEEDBACK FROM SAME, TO INFORM OUR CARE PRIORITIES. PART VI, LINE 3: THIS IS LISTED ON OUR WEBSITE AT HTTPS://WWW.DEACONESS.COM/PAY-MY-BILL/FINANCIAL-ASSISTANCE AND IS POSTED IN EVERY CLINIC OFFICE AND FACILITY. PART VI, LINE 4: DEACONESS DEFINES ITS COMMUNITY AS ALL PEOPLE LIVING IN GIBSON COUNTY IN INDIANA ANY TIME DURING THE YEAR.THE UNITED STATES CENSUS BUREAU ESTIMATES THE 2023 POPULATION OF GIBSON COUNTY AT 32,904. FEMALES COMPRISE 49.1% OF THE POPULATION. THE MEDIAN AGE OF THE COUNTY IS 40.3 YEARS OLD. THE MEDIAN HOUSEHOLD INCOME FOR GIBSON COUNTY IS $64,153; AND APPROXIMATELY 9.7% OF THE POPULATION IS LIVING IN POVERTY. THE UNEMPLOYMENT RATE FOR GIBSON COUNTY IS 2.5% AS OF APRIL 2024. UNDERSERVED POPULATIONS GIBSON COUNTY HAS A RELATIVELY HOMOGENOUS RACIAL AND ETHNIC PROFILE. MINORITY POPULATIONS MAKE UP APPROXIMATELY 6.4% OF THE TOTAL INHABITANTS OF GIBSON COUNTY ACCORDING TO 2022 CENSUS DATA ESTIMATES. THE SECOND LARGEST POPULATION AFTER WHITE IS THE BLACK POPULATION, REPRESENTING APPROXIMATELY ONLY 2.6% OF THE OVERALL RESIDENTS. UNFORTUNATELY, DATA REGARDING LANGUAGES SPOKEN IN THE COMMUNITIES WAS SUPPRESSED DUE TO POPULATION THRESHOLD REQUIREMENTS. HOWEVER, REPORTS FROM THE INDIANA DEPARTMENT OF TRANSPORTATION DOES SHOW THAT THE PERCENTAGE OF RESIDENTS THAT SPEAK ENGLISH "LESS THAN VERY WELL" IS ONLY 0.92% IN GIBSON. WHILE THIS IS A LOW PERCENTAGE, IT DOES REPRESENT JUST UNDER 300 PEOPLE WHO MAY NEED LANGUAGE SERVICES TO EFFECTIVELY COMMUNICATE AND RECEIVE INFORMED CARE. PART VI, LINE 5: DEACONESS HOSTED AND ATTEND PUBLIC EVENTS, SUCH AS OUR ANNUAL ORAL, HEAD AND NECK CANCER SCREENINGS; COLON CANCER SCREENINGS, LOW DOSE CT SCREENINGS AND MORE OUTLINED BELOW. ADDITIONALLY, WE CREATED AND DISTRIBUTED WRITTEN AND VISUAL CONTENT THAT ADDRESSED SPECIFIC ISSUES AND HEALTH CONCERNS FOR OUR COMMUNITY. SOCIAL MEDIA POSTS: BREAST CANCER AWARENESS - 10/1/2024 WISE CHOICE - 10/8/2024 MENTAL HEALTH AWARENESS - 10/10/2024 PRIMARY CARE WEEK - 10/11/2024 GLOBAL HANDWASHING DAY - 10/15/2024 NATIONAL MAMMOGRAPHY DAY - 10/18/2024 MEGA BREAST TOUR - 10/18/2024 BREAST CANCER SURVIVOR TESTIMONY - 10/25/2024 BREAST CANCER SURVIVOR TESTIMONY - 10/31/2024 LUNG CANCER AWARENESS - 11/1/2024 LUNG CANCER SCREENING - 11/8/2024 WORLD DIABETES DAY - 11/14/2024 GREAT AMERICAN SMOKEOUT - 11/24/2024 WORLD AIDS DAY SCREENING - 11/22/2024 NO SHAVE NOVEMBER - 11/22/2024 SAFE TOYS AND GIFTS MONTH - 12/2/2024 SAFESITTER - 12/4/2024 HAND HYGIENE - 12/6/2024 ANXIETY - 12/6/2024 WHOOPING COUGH (PERTUSSIS) VACCINE AWARENESS - 12/10/2024 WHOOPING COUGH (PERTUSSIS) VACCINE AWARENESS - 12/18/2024 CROHN'S DISEASE AWARENESS - 12/19/2024 WHOOPING COUGH (PERTUSSIS) VACCINE AWARENESS - 12/23/2024 ANXIETY - 1/3/2025 WINTER STORM PREPAREDNESS - 1/5/2025 SLEDDING SAFETY - 1/10/2025 WEIGHT LOSS - 1/10/2025 HEAD AND NECK CANCER AWARENESS - 1/15/2025 LUNG DISEASE SUPPORT - 1/16/2025 FROSTBITE/HYPOTHERMIA AWARENESS - 1/20/2025 MOBILE MAMMOGRAM - 1/29/2025 GO RED FOR WOMEN (HEART DISEASE) - 1/31/2025 GO RED FOR WOMEN (HEART DISEASE) - 2/1/2025 AMERICAN HEART MONTH - 2/3/2025 GO RED FOR WOMEN (HEART DISEASE) - 2/5/2025 GO RED FOR WOMEN (HEART DISEASE) - 2/6/2025 HEART ATTACK SIGNS AND SYMPTOMS - 2/8/2025 IMPELLA HEART PUMP - 2/11/2025 CARDIAC REHAB - 2/15/2025 WINTER WEATHER SAFETY - 2/18/2025 NATIONAL CAREGIVERS DAY - 2/21/2025 COLON CANCER SCREENING - 3/3/2025 MEDICARE SEMINAR - 3/3/2025 NATIONAL KIDNEY MONTH - 3/6/2025 COLON CANCER AWARENESS MONTH - 3/6/2025 COLONOSCOPY AWARENESS - 3/7/2025 KIDNEY HEALTH - 3/11/2025 WORLD KIDNEY DAY / CHRONIC KIDNEY DISEASE - 3/13/2025 PULMONARY REHAB EDUCATION - 3/15/2025 FLU SEASON AWARENESS - 3/18/2025 KIDNEY DISEASE AWARENESS - 3/20/2025 AMERICAN DIABETES ALERT DAY - 3/20/2025 KIDNEY HEALTH - 3/25/2025 COLON CANCER SCREENING - 3/26/2025 HEAD AND NECK CANCER AWARENESS - 4/1/2025 HEAD AND NECK CANCER SCREENINGS - 4/7/2025 HEAD AND NECK CANCER SCREENINGS - 4/15/2025 STRESS AND ALCOHOL USE - 4/18/2025 STROKE AWARENESS MONTH - 5/1/2025 SPOT A STROKE F.A.S.T. - 5/2/2025 WORLD OVARIAN CANCER DAY - 5/8/2025 MENTAL HEALTH AND NURSING - 5/9/2025 SANE EDUCATION - 5/9/2025 SKIN CANCER AWARENESS - 5/14/2025 F.A.S.T. EXPERIENCE - 5/14/2025 STROKE AWARENESS MONTH - 5/21/2025 MENTAL HEALTH FOR WOMEN - 5/22/2025 BLOOD DONATION - 5/24/2025 CANCER SURVIVORSHIP - 6/1/2025 MEN'S HEALTH AWARENESS MONTH - 6/2/2025 MEN'S HEALTH AWARENESS MONTH - 6/4/2025 MEN'S HEALTH AWARENESS MONTH - 6/9/2025 MEN'S HEALTH AWARENESS MONTH - 6/11/2025 MEN'S HEALTH AWARENESS MONTH - 6/12/2025 MEN'S HEALTH AWARENESS MONTH - 6/12/2025 WORLD BLOOD DONATION DAY - 6/14/2025 HEAT SAFETY AWARENESS - 6/23/2025 MEN'S CANCERS - 6/24/2025 MEN'S HEALTH AWARENESS MONTH - 6/27/2025 SUMMER SAFETY - 6/28/2025 MEN'S HEALTH AWARENESS MONTH - 6/30/2025 FIREWORKS SAFETY - 7/2/2025 SKIN HEALTH AWARENESS - 7/17/2025 PEDIATRIC PHYSICAL THERAPY - 7/18/2025 HEATH SAFETY - 7/19/2025 BLOOD DONATION - 7/21/2025 INFANT MORTALITY - 7/23/2025 UV SAFETY AWARENESS - 7/25/2025 BACK-TO-SCHOOL HEALTH - 7/28/2025 PEDIATRIC PHYSICAL THERAPY - 7/30/2025 BACK-TO-SCHOOL HEALTH - 7/30/2025 WORLD LUNG CANCER DAY - 8/1/2025 NATIONAL BREASTFEEDING MONTH - 8/16/2025 BITE THERAPY - 9/4/2025 WORLD SEPSIS DAY - 9/13/2025 TIF PROCEDURE FOR GERD - 9/17/2025 BLOOD DONATION - 9/17/2025 BREAST CANCER AWARENESS - 9/19/2025 PROSTATE CANCER DETECTION - 9/23/2025 COCHLEAR IMPLANTS - 9/26/2025 MAMMOGRAMS - 9/29/2025 2025 - NUMBER SCREENED 117 ACROSS MULTIPLE EVENTS 2025 NUMBERS SCREENED AT EVENTS SKIN CANCER - 32 ORAL, HEAD AND NECK CANCER - 85 THE MEDICAL ASSISTANCE PROGRAM FOR THE DEACONESS SYSTEM SERVICED 4,105 INDIVIDUALS FOR 7,079 UNIQUE MEDICATIONS/PRESCRIPTIONS PROVIDED AT A TOTAL DOLLAR VALUE OF MORE THAN $102.6 MILLION IN FREE DRUGS TO PATIENTS. AN ADDITIONAL $172,763 IN COPAY/FOUNDATION ASSISTANCE WAS ALSO PROVIDED. LOCAL SPONSORSHIPS AS A SYSTEM IN FY 24-25, DEACONESS SPONSORED PROGRAMS AND ACTIVITIES FOR MORE THAN 170,000 PEOPLE, CONTRIBUTING $2.1 MILLION IN SUPPORT OF CLUBS, GROUPS, SOCIAL SERVICE ORGANIZATIONS, AND OTHERS STRIVING TO MAKE OUR COMMUNITY A BETTER PLACE. PART VI, LINE 6: GIBSON GENERAL HOSPITAL IS AFFILIATED WITH DEACONESS HEALTH SYSTEM, COOPERATING TO PROVIDE HEALTH CARE SERVICES TO THEIR COMMUNITIES. ADDITIONALLY, THE HOSPITAL DOES PARTICIPATE IN SEVERAL COALITIONS AND COOPERATIVES WITH OTHER PROVIDERS AND OFTEN COLLABORATES WITH THE LARGER SYSTEM IN THE EVANSVILLE AREA TO PROVIDE ACCESS TO SERVICES THE HOSPITAL CANNOT PROVIDE SUCH AS CARDIAC AND NEUROLOGICAL SURGERY. PART VI, LINE 7, REPORTS FILED WITH STATES IN 1 SPONSORSHIPS 15 22200 PART I, LINE 2: AT GIBSON, OUR APPROACH TO GRANTS AND SPONSORSHIPS IS CENTERED ON SUPPORTING INITIATIVES THAT BENEFIT THE BROADER COMMUNITY GIVEN WE ARE THE ONLY HOSPITAL IN THE COUNTY. WE PRIORITIZE ORGANIZATIONS AND PROGRAMS WITH A COUNTY-WIDE IMPACT. IN ADDITION, WE REGULARLY SPONSOR EVENTS AFFILIATED WITH OTHER HOSPITAL FOUNDATIONS, PARTICULARLY WHEN THEY SUPPORT OR PARTNER WITH OUR INITIATIVES. WE ALSO CONSISTENTLY PROVIDE SUPPORT TO EACH OF THE THREE LOCAL SCHOOL CORPORATIONS IN THE COUNTY, RECOGNIZING THEIR IMPORTANT ROLE IN OVERALL COMMUNITY HEALTH AND DEVELOPMENT. 0 1 0 0 0 1 1 1 0 LYNN LINGAFELTER BOARD MEMBER 0 694891 0 216135 0 161935 0 162333 0 36046 0 1271340 0 158553 ASHLEY SMITH PHYSICIAN 904409 0 0 0 22516 0 16075 0 10920 0 953920 0 0 0 MARC JARED FLORENCE BOARD MEMBER 0 517418 0 139337 0 96624 0 111246 0 42712 0 907337 0 92724 STEVEN IVY BOARD MEMBER 0 309811 0 69781 0 1226 0 12075 0 36597 0 429490 0 0 DR DAVID PURDOM CHIEF OF STAFF (END 12/2024) 334017 0 0 0 11743 0 16075 0 34324 0 396159 0 0 0 COREY POTTS CRNA 256266 0 27950 0 391 0 10166 0 32149 0 326922 0 0 0 DR ADRIAN CARTER CHIEF OF STAFF (BEG 01/2025) 0 209609 0 61157 0 2685 0 14008 0 13188 0 300647 0 0 LOIS MORGAN CAO (END 12/2024) 211933 0 39678 0 10781 0 10351 0 25278 0 298021 0 0 0 GREG WRIGHT BOARD MEMBER 174660 0 15840 0 2143 0 2260 0 24608 0 219511 0 0 0 MARILYN HARPER RN 126247 0 22801 0 806 0 5377 0 24034 0 179265 0 0 0 SHANE C HAYES CNO (PARTIAL YEAR)/CAO 127923 0 8271 0 1216 0 5012 0 31441 0 173863 0 0 0 BETH N MCGRAW LEAD MULTI-MODALITY TECH 123220 0 2007 0 22840 0 5231 0 2465 0 155763 0 0 0 PART I, LINE 3 THE FOLLOWING METHODS WERE USED BY DEACONESS HEALTH SYSTEM, A RELATED NON-PROFIT ORGANIZATION, TO DETERMINE THE COMPENSATION FOR THE CEO: -COMPENSATION COMMITTEE -INDEPENDENT COMPENSATION CONSULTANT -COMPENSATION STUDY OR SURVEY -APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE PART I, LINE 4B NONQUALIFIED PAYMENTS: MARC J. FLORENCE 23,000 DAVID PURDOM 23,000 LYNN LINGAFELTER 23,000 PART I, 4B: MARC J. FLORENCE: SUPPLEMENTAL ACCUMULATION ACCOUNT CONTRIBUTIONS OF $99,171. SUPPLEMENTAL ACCUMULATION ACCOUNT PAYOUT OF $92,724. LYNN LINGAFELTER: SUPPLEMENTAL ACCUMULATION ACCOUNT CONTRIBUTIONS OF $150,258. SUPPLEMENTAL ACCUMULATION ACCOUNT PAYOUT OF $158,553. PART I, LINE 6 COMPENSATION CONTINGENT UPON NET EARNINGS: INCENTIVE COMPENSATION PAYMENTS MADE BY THE ORGANIZATION 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 OF BOTH THE ORGANIZATION AND RELATED ORGANIZATIONS. GIBSON GENERAL 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. PART I, LINE 7 PHYSICIANS ARE ELIGIBLE FOR INCENTIVE COMPENSATION. THE PHYSICIAN IS COMPENSATED FOR EACH WORK RVU PERFORMED BY A PHYSICIAN IN A CALENDAR YEAR IN EXCESS OF THE PHYSICIAN'S WORK RVU INCENTIVE THRESHOLD FOR THE CALENDAR YEAR MULTIPLIED BY THE INCENTIVE RVU PAYMENT. FORM 990, PART I, LINE J WWW.DEACONESS.COM/INDIANA/DEACONESS-GIBSON-HOSPITAL FORM 990, PART VI, SECTION A, LINE 6 CLASSES OF MEMBERS OR STOCKHOLDERS: DEACONESS HEALTH SYSTEM, INC., A TAX EXEMPT 501(C)(3) ORGANIZATION, IS THE SOLE CORPORATE MEMBER OF GIBSON GENERAL HOSPITAL. FORM 990, PART VI, SECTION A, LINE 7A POWER TO ELECT OR APPOINT: DEACONESS HEALTH SYSTEM, THE SOLE MEMBER OF THE ORGANIZATION, HAS THE POWER TO APPOINT AND REMOVE EACH MEMBER. THE ORGANIZATION GOVERNING DOCUMENTS ALLOWS FOR THE COUNTY COMMISSIONERS OF GIBSON COUNTY, INDIANA TO SELECT ONE (1) MEMBER OF THE BOARD OF TRUSTEES; THREE (3) REPRESENTATIVES FROM THE ORGANIZATION'S SOLE MEMBER; THE MAYOR OF PRINCETON, INDIANA; THE PRESIDENT OF GIBSON GENERAL HOSPITAL FOUNDATION; THE CHIEF OF STAFF OF GIBSON GENERAL HOSPITAL TO SERVE AS EX-OFFICIO MEMBER; AND TWO MEMBERS OF THE MEDICAL COMMUNITY. FORM 990, PART VI, SECTION A, LINE 7B THE FOLLOWING GOVERNANCE DECISIONS ARE RESERVED TO THE SOLE MEMBER OF THE ORGANIZATION, DEACONESS HEALTH SYSTEM. - APPROVAL OF ANNUAL OR LONG-TERM CAPITAL BUDGETS, OPERATING BUDGETS AND STRATEGIC PLANS, OR ANY EXPENDITURE IN EXCESS OF $150,000 NOT INCLUDED IN AN APPROVED BUDGET. - THE SALE OR TRANSFER OF SUBSTANTIALLY ALL OF THE ASSETS OF THE CORPORATION OR OF ANY KEY OPERATIONAL ASSETS. - THE FILING OF BANKRUPTCY OR SIMILAR INSOLVENCY PROCESS WITH RESPECT TO THE CORPORATION. - ANY TRANSFER OF SUBSTANTIAL MANAGEMENT RESPONSIBILITY WITH RESPECT TO THE CORPORATION. - ANY AMENDMENT TO THE CORPORATION'S ARTICLES OF INCORPORATION OR BYLAWS. - ANY BORROWING EQUAL TO OR GREATER THAN $150,000, OR ANY AMENDMENT TO FINANCING OR LOAN DOCUMENTS TO WHICH THE CORPORATION IS A PARTY. - ANY DECISION TO CHANGE THE NAME OF THE HOSPITAL, CHANGE THE HOSPITAL CAMPUS FROM A CRITICAL ACCESS HOSPITAL STATUS, RELOCATE OR SUBSTANTIALLY REDUCE OR TERMINATE SERVICES TO THE COMMUNITY. - ANY DECISION TO REDUCE THE LEVEL OF CHARITABLE SERVICES TO THE COMMUNITY. - ANY DECISION RELATING TO THE TERMINATION OF THE CORPORATION'S EMPLOYEE RETIREMENT PLAN. - ADOPTION OF ANY POLICIES RELATING TO THE OPERATION OF THE BOARD, THE CORPORATION, OR THE HOSPITAL THAT ARE INCONSISTENT WITH POLICIES OF DEACONESS. - ANY OF THE FOREGOING ACTIONS BY THE CORPORATION AS THE OWNER, MEMBER OF ANY OF THE CORPORATION'S SUBSIDIARIES OR AFFILIATES, INCLUDING THE HOSPITAL. FORM 990, PART VI, SECTION B, LINE 11B FORM 990 REVIEW PROCESS: THE PROCESS OF REVIEWING THE FORM 990 INCLUDES A DETAILED REVIEW OF THE FORM AND REQUIRED SCHEDULES BY THE CHIEF FINANCIAL OFFICER AND MANAGEMENT. AFTER THIS REVIEW IS PERFORMED AND ALL QUESTIONS ARE ANSWERED, THE FORM 990 IS PRESENTED TO THE BOARD OF DIRECTORS OF DEACONESS HEALTH SYSTEM 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 CONFLICT OF INTEREST POLICY: THE CONFLICT OF INTEREST POLICY IS INCLUDED WITHIN THE BYLAW OF THE ORGANIZATION AND COVERS ALL BOARD OF TRUSTEES. THE POLICY PROVIDES PROCEDURES TO PREVENT THOSE WITH DUALITY OF INTEREST OR POSSIBLE CONFLICTS OF INTEREST FROM PARTICIPATING IN ANY ACTION THAT COULD PERSONALLY BENEFIT THE INDIVIDUAL TRUSTEE. THE CEO AND/OR BOARD COMPLIANCE OFFICER REVIEW ANNUAL WRITTEN AND SIGNED CONFLICT OF INTEREST STATEMENTS THAT PROVIDE ANY DUALITY OF INTEREST OR POSSIBLE CONFLICTS OF INTEREST DISCLOSED BY ALL BOARD OF TRUSTEES. THE INDIVIDUAL TRUSTEE WILL AGAIN DISCLOSE TO THE BOARD WHEN THE INTEREST BECOMES A MATTER OF BOARD ACTION AND RECUSES HIMSELF OR HERSELF FROM VOTING ON THE RELATED ISSUE. THE BOARD MEETING MINUTES DOCUMENT THE DISCLOSURE MADE, WHO ABSTAINED FROM VOTING, AND THE QUORUM SITUATION. FORM 990, PART VI, SECTION B, LINE 15 COMPENSATION PROCESS: CEO: THE CEO EVALUATION COMMITTEE, CONSISTING OF FOUR INDEPENDENT AND BOARD CHAIR APPOINTMENT TRUSTEE MEMBERS, EVALUATES THE PERFORMANCE OF THE CEO ON AN ANNUAL BASIS AND MAKES COMPENSATION-RELATED RECOMMENDATIONS TO THE BOARD PRIOR TO THE CEO'S ANNUAL REVIEW DATE FOR APPROVAL. THE EVALUATION COMMITTEE USES A COMPENSATION CONSULTANT, COMPENSATION SURVEY, AND COMPARATIVE DATA FROM SIMILAR ORGANIZATIONS TO DETERMINE THE CEO'S COMPENSATION PACKAGE. ALL DELIBERATION AND DECISIONS ARE DOCUMENTED IN THE EVALUATION COMMITTEE'S MINUTES. OFFICERS AND/OR KEY EMPLOYEES: ANNUAL REVIEWS FOR TOP MANAGEMENT OFFICIALS ARE CONDUCTED BY THE CEO. THE COMPENSATION IS ANNUALLY REVIEWED AND APPROVED BY THE BOARD OF TRUSTEES. FORM 990, PART VI, SECTION C, LINE 19 THE HOSPITAL'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON WRITTEN REQUEST AND BOARD OF TRUSTEES APPROVAL. WRITTEN REQUESTS SHOULD BE SENT TO ATTN: JAMES CHILDERS, AT THE ADDRESS LISTED ON PAGE 1 OF THE FORM 990. FORM 990, PART VI, LINE 16B, JOINT VENTURE POLICY: THE ORGANIZATION DOES NOT HAVE A FORMAL WRITTEN POLICY ON EVALUATING PARTICIPATION IN A JOINT VENTURE, HOWEVER, THE ORGANIZATION PERFORMS DUE DILIGENCE AND INVOLVES LEGAL COUNSEL TO REVIEW ANY PARTNERSHIPS ENSURING THAT THE JOINT VENTURE WOULD BE ORGANIZED AND OPERATED IN A MANNER CONSISTENT WITH THE HOSPITAL'S EXEMPT PURPOSE AND STATUS. FORM 990, PART VII & SCHEDULE J, PART II: WE DO NOT USE A COMMON PAYMASTER. ALL SHARED STAFF AND DUAL-OFFICERS ARE PAID AND W-2'D SOLELY BY DHS. GIBSON GENERAL HOSPITAL REPORTS ALL SUCH COMPENSATION AS RELATED ORGANIZATION COMPENSATION IN PART VII COL (E) AND SCHEDULE J ROW (II). THE INTERCOMPANY ALLOCATION AND SUBSIDY ARE REPORTED AS OPERATIONAL TRANSFERS/ALLOCATIONS, NOT AS DIRECT COMPENSATION BY THE SUBSIDIARY. FORM 990, PART IX, LINE 11G PURCHASED SERVICES AND PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 9,414,708. MANAGEMENT AND GENERAL EXPENSES 2,544,071. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 11,958,779. DEACONESS ILLINOIS CLINIC INC 600 MARY STREET EVANSVILLE IN 47747 920574205 HEALTHCARE IL 501(C)(3) LINE 10 DEACONESS HEALTH SYSTEM INC 0 DEACONESS ILLINOIS SPECIALTY CLINIC INC 600 MARY STREET EVANSVILLE IN 47747 920904755 HEALTHCARE IL 501(C)(3) LINE 10 DEACONESS HEALTH SYSTEM INC 0 DEACONESS SPECIALTY PHYSICIANS INC 600 MARY STREET EVANSVILLE IN 47747 824503095 HEALTHCARE IN 501(C)(3) LINE 10 DEACONESS HEALTH SYSTEM INC 0 DEACONESS VNA PLUS LLC 611 HARRIET ST EVANSVILLE IN 47710 465223267 HEALTHCARE IN 501(C)(3) LINE 10 DEACONESS HEALTH SYSTEM INC 0 DEACONESS HEALTH SYSTEM INC 600 MARY STREET EVANSVILLE IN 47747 351532889 HEALTHCARE IN 501(C)(3) LINE 12A, I N/A 0 MEMORIAL HOSPITAL FOUNDATION INC 800 WEST NINTH STREET JASPER IN 47546 351359445 SUPPORT DEACONESS MEMORIAL MEDICAL CENTER, INC. 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