2026-08-17T17:47:38-05:00 2025-09-30 351178661 BLUE & CO LLC 500 N MERIDIAN ST SUITE 200 INDIANAPOLIS IN 46204 990 2024-10-01 352062016 DEACONESS WOMEN'S HOSPITAL OF SOUTHERN INDIANA LLC DEAC 5125363090 4199 GATEWAY BLVD NEWBURGH IN 47630 ALLISON INGLER CAO 5125363090 2026-08-17 1 0 EMILIE M KNIERIEM CPA P01330194 3176334705 2026-08-15 2024 2025-03-06 01:10:19Z ALLISON INGLER 4199 GATEWAY BLVD NEWBURGH IN 47630 153788033 0 X SEE SCHEDULE O X 2023 IN IT IS THE MISSION OF THE WOMEN'S HOSPITAL TO PROVIDE A FULL RANGE OF HIGH-QUALITY, CONVENIENT, PERSONALIZED AND COST EFFECTIVE HEALTH CARE SERVICES TO THE WOMEN AND INFANTS IN OUR COMMUNITY. WE STRIVE TO ACHIEVE EXCELLENCE AND LEADERSHIP IN HUMANISTIC FAMILY CENTERED CARE THROUGH EDUCATION, CREATIVE PRACTICE AND RESEARCH. WE RECOGNIZE THAT OUR MOST IMPORTANT ASSET IS OUR STAFF AND THEIR COMMITTED AND CARING ATTITUDE. THEREFORE, IT IS OUR GOAL TO CREATE AN ATMOSPHERE THAT ENHANCES PROFESSIONAL DEVELOPMENT, EFFECTIVE INTERACTION AND EDUCATIONAL OPPORTUNITIES, AND PROMOTES PRIDE IN THE WORK PLACE. 4 0 863 0 0 0 309224 562828 134639078 151863832 115595 66551 1602711 1209100 136666608 153702311 73457 92720 0 0 66448000 69648414 0 0 0 55946689 62836073 122468146 132577207 14198462 21125104 286344674 292566666 48801821 33898709 237542853 258667957 X IT IS THE MISSION OF THE WOMEN'S HOSPITAL TO PROVIDE A FULL RANGE OF HIGH-QUALITY, CONVENIENT, PERSONALIZED AND COST EFFECTIVE HEALTH CARE SERVICES TO THE WOMEN AND INFANTS IN OUR COMMUNITY. WE STRIVE TO ACHIEVE EXCELLENCE AND LEADERSHIP IN HUMANISTIC FAMILY CENTERED CARE THROUGH EDUCATION, CREATIVE PRACTICE AND RESEARCH. WE RECOGNIZE THAT OUR MOST IMPORTANT ASSET IS OUR STAFF AND THEIR COMMITTED AND CARING ATTITUDE. THEREFORE, IT IS OUR GOAL TO CREATE AN ATMOSPHERE THAT ENHANCES PROFESSIONAL DEVELOPMENT, EFFECTIVE INTERACTION AND EDUCATIONAL OPPORTUNITIES, AND PROMOTES PRIDE IN THE WORK PLACE. 0 0 117623381 92720 152051729 THE WOMEN'S HOSPITAL IS DEDICATED TO THE SPECIFIC HEALTH CARE NEEDS OF WOMEN AND BABIES. OUR TEAM OF HIGHLY-SKILLED PHYSICIANS AND STAFF MEMBERS IS COMMITTED TO PROVIDING COMPASSIONATE, HIGH-QUALITY CARE IN A FAMILY-CENTERED ENVIRONMENT. 117623381 1 1 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 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 65 0 1 863 1 0 0 0 0 0 0 0 0 0 0 0 0 X 4 0 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 1 1 IN X CHERYL WATHEN 8124503296 600 MARY STREET EVANSVILLE IN 47747 X LINDA WHITE CHAIRMAN 5.00 50.00 X X 0 296521 26372 CHERYL WATHEN SECRETARY/TREASURER 5.00 50.00 X X 0 988864 194519 SHAWN MCCOY CEO OF DEACONESS HOSPITAL 5.00 56.00 X 0 2016238 361449 JAMES PORTER MD PRESIDENT OF DEACONESS HOSPITAL 5.00 56.00 X 0 1073178 187360 CHRISTINA M RYAN CHIEF EXECUTIVE OFFICER 50.00 0.00 X 762850 0 30475 ALLISON INGLER CAO 50.00 0.00 X 247893 135214 31620 CLAYTON FITZPATRICK CMO 50.00 0.00 X 977929 0 35126 BARTON STAAT MD PHYSICIAN 50.00 0.00 X 925530 0 53361 DANIEL GRIFFIN MD PHYSICIAN 50.00 0.00 X 558110 0 51135 KARENROSE MARTINEZ MD PHYSICIAN 50.00 0.00 X 849451 0 48159 SAMER SCHUMAN MD PHYSICIAN 50.00 0.00 X 1653175 98426 17477 SPENCER KUPER MD PHYSICIAN 50.00 0.00 X 1114443 0 51834 7089381 4608441 1088887 87 0 1 0 TRI STATE ANESTHESIA 1210 HOING RD EVANSVILLE IN 47725 ANESTHESIA SERVICES 5365300 PROGRESSIVE HEALTH OF INDIANA 150 N ROSENBERGER AVE EVANSVILLE IN 47712 PHYSICAL THERAPY SERVICES 2796952 WEATHERBY LOCUMS INC PO BOX 972633 DALLAS TX 753972633 PHYSICIAN SERVICES 783532 WOMEN'S HEALTH CARE PC 4199 GATEWAY BLVD STE 2500 NEWBURGH IN 47630 PHYSICIAN SERVICES 623221 TOTAL MSP LLC 221 W COLLEGE AVE APPLETON WI 54911 STAFFING 240110 10 366340 196488 562828 PATIENT SERVICE REVENUE 621110 151863832 151863832 151863832 66551 66551 203089 85722 117367 117367 117367 CAFETERIA REVENUE 900099 596795 596795 LOBBY/GIFT SHOP REVENUE 459420 253289 253289 WOMEN'S RESOURCE / LACTATION SHOP 456110 38052 38052 203597 187897 15700 1091733 153702311 152051729 0 1087754 X 92720 92720 1265339 1143393 121946 55063867 49757118 5306749 9693403 8283004 1410399 3625805 3248962 376843 14130 13009 1121 67735 62360 5375 24715336 22754178 1961158 2634384 2360583 273801 449 402 47 7072838 4359803 2713035 276781 248014 28767 114522 67470 47052 1811399 1233275 578124 1117228 1001110 116118 MEDICAL SUPPLIES 9002531 8925078 77453 LABORATORY FEES 7385018 6617466 767552 MEDICAL HOSPITAL ASSESS 7115024 6375534 739490 REPAIRS AND MAINTENANCE 1491596 1064577 427019 17102 15325 1777 132577207 117623381 14953826 0 28972117 12208142 20030429 28320869 621433 728110 794523 623160 1162919 32062184 25548646 6474196 6513538 199551960 199223416 29900016 43786512 286344674 292566666 19610362 10637161 2411498 973175 26779961 22288373 48801821 33898709 X 237542853 258667957 237542853 258667957 286344674 292566666 21125104 0 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 12860 12860 0 PART II-B, LINE 1: LOBBYING EXPENDITURES CONSISTED OF A PORTION OF MEMBERSHIP DUES TO PROFESSIONAL ORGANIZATIONS IN WHICH DEACONESS WOMEN'S HOSPITAL AND ITS EMPLOYEES ARE MEMBERS. THE LOBBYING PORTION OF THE DUES IS NOTED ON THE MEMBERSHIP APPLICATION OR BILLING STATEMENT. 9069455 5106328 3963127 22992729 20442318 2550411 6513538 RIGHT OF USE ASSETS 21540063 THIRD PARTY PAYOR SETTLEMENT 2410698 INTERCOMPANY RECEIVABLES 19835751 43786512 RIGHT OF USE LIABILITIES 21923484 DEFERRED COMPENSATION 364889 22288373 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, 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 1556362 1556362 0.01170 39129719 40876682 0 0.00000 40686081 40876682 1556362 0.01170 162012 162012 0.00120 987336 987336 0.00740 78429 78429 0.00060 1227777 1227777 0.00920 41913858 40876682 2784139 0.02090 1 4235915 8037195 13386248 -5349053 X 1 1 1 BOSTON IVF FERTILITY SERVICES AT THE WOMEN'S HOSPITAL HEALTHCARE 0.50000 1 1 DEACONESS WOMEN'S HOSPITAL 4199 GATEWAY BLVD NEWBURGH IN 47630 WWW.DEACONESS.COM 25-002855-1 X DEACONESS WOMEN'S HOSPITAL 1 0 0 1 X X X X X X X X X 24 1 1 1 1 X HTTP://WWW.DEACONESS.COM/CHNA X 1 24 1 HTTP://WWW.DEACONESS.COM/CHNA 0 1 X 200.000000000000 350.000000000000 X X X X 1 1 X X X X 1 X SEE PART V X SEE PART V X SEE PART V X X X X X X X 1 X 0 X X X X 1 X 0 0 DEACONESS WOMEN'S HOSPITAL PART V, SECTION B, LINE 5: THREE APPROACHES WERE USED TO COLLECT PRIMARY AND SECONDARY DATA. DIEHL CONSULTING GROUP (DCG) WAS CONTRACTED TO PROVIDE SUPPORT FOR THESE METHODS. THIS INCLUDED COMPILING EXISTING SECONDARY DATA, ADMINISTERING STAKEHOLDER SURVEYS, AND CONDUCTING FOCUS GROUPS. DCG ANALYZED AND SUMMARIZED DATA FROM THESE METHODS AND ASSISTED IN THE PRIORITIZATION AND FINAL REPORTING PROCESS. METHODS ARE SUMMARIZED BELOW AND FURTHER DETAILED IN EACH OF THE RESPECTIVE RESULTS SECTIONS OF THIS REPORT AND APPENDIX A. TO SUPPORT PRIORITIZATION, A SYNTHESIS OF KEY FINDINGS FROM DATA COLLECTION PROCESSES WAS PRESENTED AND SUMMARY DOCUMENTS PRODUCED TO GUIDE DISCUSSION (APPENDIX D). SECONDARY DATA SOURCES WERE REVIEWED TO BETTER UNDERSTAND THE HEALTH NEEDS AND SOCIAL, ECONOMIC, AND DEMOGRAPHIC CHARACTERISTICS OF THOSE LIVING IN THE SERVICE AREA. SOURCES INCLUDED (A) THE 2025 VERSION OF COUNTY HEALTH RANKINGS & ROADMAPS, (B) THE INDIANA STATE DEPARTMENT OF HEALTH, (C) THE U.S. CENSUS, (D) THE WELBORN BAPTIST FOUNDATION 2025 GREATER EVANSVILLE HEALTH SURVEY, AND (E) OTHER LOCAL DATA SOURCES PROVIDED BY COMMUNITY PARTNERS.STAKEHOLDER SURVEYS WERE ADMINISTERED TO GATHER INSIGHTS INTO THE HEALTH ISSUES IMPACTING THE COMMUNITY. PARTICIPANTS WERE PROVIDED A LIST OF SIXTEEN (16) HEALTH ISSUES, AS WELL AS AN OPPORTUNITY TO WRITE IN OTHER ISSUES NOT INCLUDED ON THE LIST. PARTICIPANTS SELECTED FIVE (5) ISSUES THEY CONSIDERED TO BE HIGHEST PRIORITY NEEDS IN THE COUNTY. RESPONDENTS THEN RANKED THE FIVE (5) ISSUES BASED ON PRIORITY. FOR EACH ISSUE IDENTIFIED, RESPONDENTS WERE THEN ASKED TO PROVIDE FEEDBACK ON THE PERCEIVED TREND OF THE ISSUE SINCE 2021, AN OPTIONAL NARRATIVE RESPONSE SPECIFIC TO ANY PROGRESS MADE SINCE 2021, AND THE ADEQUACY OF RESOURCES DEVOTED TO ADDRESSING THE ISSUE. RESPONDENTS WERE ALSO ASKED TO SELECT UP TO THREE (3) OF THE GREATEST BARRIERS IN ADDRESSING THIS HEALTH ISSUE IN THIS COUNTY BASED ON A LIST OF EIGHTEEN (18) SOCIAL DETERMINANTS OF HEALTH. RESPONDENTS COULD ALSO INSERT BARRIERS NOT LISTED. IN TOTAL, 132 PARTICIPANTS PROVIDED SURVEY FEEDBACK.STAKEHOLDER FOCUS GROUPS WERE CONDUCTED VIRTUALLY WITH 78 PARTICIPANTS ACROSS 16 GROUPS REPRESENTING MEDICAL/HEALTHCARE ORGANIZATIONS AS WELL AS ORGANIZATIONS WITH UNIQUE PERSPECTIVES ON PUBLIC SERVICE, NONPROFIT SERVICES, CHILD/YOUTH DEVELOPMENT, HEALTH EQUITY, AND BUSINESS/ECONOMIC DEVELOPMENT (APPENDIX B). FOCUS GROUPS EXPANDED ON INFORMATION COLLECTED THROUGH THE SURVEYS BY PROVIDING ADDITIONAL INSIGHT INTO THE HIGHEST RANKED PRIORITY NEEDS IDENTIFIED.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). DEACONESS WOMEN'S HOSPITAL PART V, SECTION B, LINE 6A: BOTH HEALTH SYSTEMS IN VANDERBURGH AND WARRICK COUNTY WORKED TOGETHER TO ADMINISTER THE SAME CHNA SURVEY TO RESIDENTS IN BOTH COUNTIES. PARTICIPATING HEALTH SYSTEMS (IN ADDITION TO DEACONESS HEALTH SYSTEM) INCLUDED ASCENSION/ST. VINCENT. DEACONESS WOMEN'S HOSPITAL PART V, SECTION B, LINE 6B: 2024 CHNA CONDUCTED COLLABORATIVELY BY DEACONESS HEALTH SYSTEM, ASCENSION ST. VINCENT EVANSVILLE HOSPITAL, ECHO COMMUNITY HEALTHCARE, VANDERBURGH COUNTY HEALTH DEPARTMENT, UNITED WAY OF SOUTHWESTERN INDIANA, AND THE WELBORN BAPTIST FOUNDATION. DEACONESS WOMEN'S HOSPITAL PART V, SECTION B, LINE 11: THE WOMEN'S HOSPITAL ADDRESSES THE HEALTH NEEDS IDENTIFIED IN THE 2024 WARRICK COUNTY COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA). THE FOUR PRIORITY NEEDS IDENTIFIED THROUGH THAT PROCESS ARE: BEHAVIORAL HEALTH (INCLUDING MENTAL HEALTH AND SUBSTANCE USE/MISUSE); AGING POPULATIONS; ACCESS TO CARE (WITH EMPHASIS ON LIMITED TRANSPORTATION OPTIONS); AND OUTREACH AND ADVOCACY (INCLUDING FAMILY AWARENESS AND SUPPORT AROUND HEALTHY LIVING). THE WOMEN'S HOSPITAL'S IMPLEMENTATION ACTIVITIES DURING FY25 (OCTOBER 1, 2024 SEPTEMBER 30, 2025) ARE DESCRIBED BELOW BY PRIORITY AREA.PRIORITY 1: BEHAVIORAL HEALTH (INCLUDING MENTAL HEALTH AND SUBSTANCE USE/MISUSE)BEHAVIORAL HEALTH WAS THE TOP-RANKED PRIORITY IN THE 2024 CHNA, WITH PARTICULAR CONCERN FOR PREGNANT PATIENTS AND FAMILIES AFFECTED BY SUBSTANCE USE DISORDERS AND A RECOGNIZED ABSENCE OF PEDIATRIC SUBSTANCE USE TREATMENT IN THE COUNTY.-THE WOMEN'S HOSPITAL OPERATED A PERINATAL SUPPORT PROGRAM, A MULTIDISCIPLINARY CONSULT PROGRAM PROVIDING ASSESSMENT, CARE COORDINATION, AND WRAPAROUND SUPPORT TO PREGNANT PATIENTS AND FAMILIES AFFECTED BY SUBSTANCE USE DISORDERS. DURING FY25, THE PROGRAM CONDUCTED 12 CONSULTS, WITH FAMILIES RECEIVING PACK-AND-PLAY EQUIPMENT, TRANSPORTATION SUPPORT, AND REFERRALS TO COMMUNITY PROGRAMS AND HOME VISITING SERVICES.-THE PROGRAM ALSO DELIVERED 475 ADDITIONAL ENCOUNTERS VIA PHONE AND IN-PERSON VISITS, CONNECTING FAMILIES TO COMMUNITY RESOURCES, HOME VISITING PROGRAMS, AND PERINATAL SUPPORT UNIT CONSULT REFERRALS BEYOND THE FORMAL CONSULT PROCESS.-IN PARTNERSHIP WITH VOLUNTEERS OF AMERICA, COMMUNITY EDUCATORS FROM THE WOMEN'S HOSPITAL PROVIDED 14 EDUCATIONAL CLASSES TO 159 ATTENDEES ENROLLED IN A RESIDENTIAL SUBSTANCE USE DISORDER TREATMENT PROGRAM. CLASS TOPICS INCLUDED SAFE SLEEP, CAR SEAT SAFETY, INFANT CPR, AND SELF-CARE.PRIORITY 2: AGING POPULATIONSTHE 2024 CHNA IDENTIFIED AGING ADULTS AS A GROWING AND UNDERSERVED POPULATION IN WARRICK COUNTY, WITH PARTICULAR GAPS IN TRANSPORTATION, ASSISTED LIVING AVAILABILITY, AND SOCIAL CONNECTION.-NO SPECIFIC ACTIVITIES DIRECTED AT AGING POPULATIONS WERE CONDUCTED BY THE WOMEN'S HOSPITAL DURING FY25, CONSISTENT WITH THE HOSPITAL'S MISSION FOCUS ON WOMEN'S AND CHILDREN'S HEALTH. THIS POPULATION IS MORE DIRECTLY ADDRESSED THROUGH OTHER CHNA PARTNER IMPLEMENTATION STRATEGIES.PRIORITY 3: ACCESS TO CARE (WITH EMPHASIS ON LIMITED TRANSPORTATION OPTIONS)THE 2024 CHNA IDENTIFIED TRANSPORTATION AS A PROMINENT BARRIER TO CARE, PARTICULARLY FOR RURAL RESIDENTS, PREGNANT PATIENTS, AND FAMILIES WITH YOUNG CHILDREN.-THE WOMEN'S HOSPITAL LAUNCHED THE RONALD MCDONALD CARE MOBILE, A MOBILE HEALTH UNIT SERVING THE EVANSVILLE COMMUNITY. THE PROGRAM ONBOARDED IN OCTOBER 2024, RECEIVED THE VEHICLE IN JANUARY 2025, COMPLETED A SOFT LAUNCH IN APRIL 2025, AND BEGAN FULL CARE DELIVERY INCLUDING REGISTERED NURSING, SOCIAL WORK, AND DRIVER SERVICES IN AUGUST 2025.-DURING FY25, THE CARE MOBILE OPERATED 19 DAYS AND COMPLETED 156 PATIENT ENCOUNTERS, DIRECTLY ADDRESSING THE ACCESS GAP IDENTIFIED IN THE CHNA BY BRINGING CARE TO UNDERSERVED COMMUNITY MEMBERS RATHER THAN REQUIRING THEM TO NAVIGATE TRANSPORTATION BARRIERS.-THE RONALD MCDONALD CARE MOBILE TEAM LED A COMMUNITY ADVISORY MEETING ON A BI-MONTHLY BASIS, WITH APPROXIMATELY 30 ATTENDEES PER MEETING, TO COORDINATE COMMUNITY PARTNERSHIPS SUPPORTING MATERNAL-CHILD HEALTH ACCESS ACROSS THE REGION.PRIORITY 4: OUTREACH AND ADVOCACY (INCLUDING FAMILY AWARENESS AND SUPPORT AROUND HEALTHY LIVING)THE 2024 CHNA IDENTIFIED AWARENESS AND EDUCATION AS A CRITICAL CROSS-CUTTING NEED, WITH PARENTS AND FAMILIES SPECIFICALLY IDENTIFIED AS NEEDING CONNECTION TO COMMUNITY SUPPORTS AROUND PRENATAL CARE, SAFE SLEEP, NUTRITION, AND SUBSTANCE USE PREVENTION.-ON FEBRUARY 18, 2025, A CARE MOBILE TEAM MEMBER PRESENTED AT THE VANDERBURGH HEALTH DEPARTMENT INFANT MORTALITY SUMMIT, WITH THREE ADDITIONAL TEAM MEMBERS PROVIDING OUTREACH, REACHING AN ESTIMATED 150 INDIVIDUALS.-ON MARCH 1, 2025, THREE CARE MOBILE TEAM MEMBERS CONDUCTED BLOOD PRESSURE SCREENINGS AND HYPERTENSION EDUCATION AT A COMMUNITY EVENT, REACHING AN ESTIMATED 50 ATTENDEES.-ON JUNE 7, 2025, TWO TEAM MEMBERS PROVIDED BLOOD PRESSURE SCREENINGS AT THE JUNETEENTH CELEBRATION, REACHING AN ESTIMATED 100 INDIVIDUALS AND SUPPORTING AWARENESS OF HYPERTENSION AND PATHWAYS TO PROVIDER CARE.-THE WOMEN'S HOSPITAL MAINTAINED ACTIVE MEMBERSHIP IN THE VANDERBURGH COUNTY COMMUNITY ACTION TEAM (VCAT), WITH SIX TEAM MEMBERS PARTICIPATING IN BI-MONTHLY MEETINGS TO COORDINATE STRATEGIES SUPPORTING CHILDBEARING FAMILIES ACROSS THE REGION.-A TEAM MEMBER SERVED AS AN ADVISORY BOARD MEMBER AND LED THE HEALTHCARE WORK GROUP FOR THE IMMIGRANT WELCOME AND RESOURCE CENTER, CONVENING MONTHLY MEETINGS AND QUARTERLY FULL BOARD SESSIONS. DURING FY25, THE TEAM SUPPORTED A BACK TO SCHOOL BASH REACHING APPROXIMATELY 100 FAMILIES AND A BABY SHOWER EVENT REACHING APPROXIMATELY 50 FAMILIES WITH PREGNANCY AND NEWBORN CARE RESOURCES.-COMMUNITY EDUCATORS PROVIDED 8 CLASSES TO 26 ATTENDEES AT LOCAL ORGANIZATIONS SERVING LOW-INCOME FAMILIES, ALONG WITH 3 ADDITIONAL OUTREACH OPPORTUNITIES REACHING AN ESTIMATED 100 INDIVIDUALS.-ON JULY 12, 2025, A TEAM MEMBER PROVIDED SAFE SLEEP EDUCATION TO 8 FAMILIES WITH INFANTS UNDER ONE YEAR, DISTRIBUTING SLEEP SACKS TO REINFORCE SAFE INFANT SLEEP PRACTICES.-ON SEPTEMBER 27, 2025, TWO TEAM MEMBERS PARTICIPATED IN A GRASSROOTS INFANT MORTALITY EVENT, PROVIDING COMMUNITY EDUCATION TO AN ESTIMATED 30 INDIVIDUALS. DEACONESS WOMEN'S HOSPITAL PART V, SECTION B, LINE 15E: WELL FUND IS AVAILABLE TO DEACONESS HEALTH SYSTEM PATIENTS TO ASSIST WITH APPLYING FOR MEDICAID OR EXCHANGE PRODUCTS. DEACONESS WOMEN'S HOSPITAL PART V, SECTION B, LINE 16J: OTHER METHOD USED TO PUBLICIZE THE FINANCIAL ASSISTANCE POLICY: DEACONESS WOMEN'S 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 WOMEN'S 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. PART I, LINE 6A: DEACONESS HOSPITAL PREPARES AN ANNUAL COMMUNITY BENEFIT REPORT. THE REPORT IS MADE AVAILABLE ON THE DEACONESS WEBSITE AT HTTP://WWW.DEACONESS.COM/CHNA 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: $987,336 OF LOSSES FROM RURAL HEALTH CLINICS OPERATED BY DEACONESS WOMEN'S HOSPITAL OF SOUTHER INDIANA ARE INCLUDED IN SUBSIDIZED HEALTH SERVICES. PART I, LN 7 COL(F): BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING PERCENTAGE IN THIS COLUMN IS $0.00. PART III, LINE 2: THE SYSTEM ESTIMATES THE TRANSACTION PRICE FOR PATIENTS WITH DEDUCTIBLES AND COINSURANCE AND FROM THOSE WHO ARE UNINSURED BASED ON HISTORICAL EXPERIENCE AND CURRENT MARKET CONDITIONS. THE INITIAL ESTIMATE OF THE TRANSACTION PRICE IS DETERMINED BY REDUCING THE STANDARD CHARGE BY ANY CONTRACTUAL ADJUSTMENTS, DISCOUNTS, AND IMPLICIT PRICE CONCESSIONS. SUBSEQUENT CHANGES TO THE ESTIMATE OF THE TRANSACTION PRICE ARE GENERALLY RECORDED AS ADJUSTMENTS TO NET PATIENT SERVICE REVENUE IN THE PERIOD OF THE CHANGE. SUBSEQUENT CHANGES THAT ARE SIGNIFICANT AND DETERMINED TO BE THE RESULT OF AN ADVERSE CHANGE IN THE PATIENT'S ABILITY TO PAY, DETERMINED ON A PORTFOLIO BASIS, ARE RECORDED AS BAD DEBT EXPENSE. CONSISTENT WITH THE SYSTEM'S MISSION, CARE IS PROVIDED TO PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. THEREFORE, THE SYSTEM HAS DETERMINED IT HAS PROVIDED IMPLICIT PRICE CONCESSIONS TO UNINSURED PATIENTS AND PATIENTS WITH OTHER UNINSURED BALANCES. THE IMPLICIT PRICE CONCESSIONS INCLUDED IN ESTIMATING THE TRANSACTION PRICE REPRESENT THE DIFFERENCE BETWEEN AMOUNTS BILLED TO PATIENTS AND THE AMOUNTS THE SYSTEM EXPECTS TO COLLECT BASED ON ITS COLLECTION HISTORY WITH THOSE PATIENTS. PART III, LINE 3: DEACONESS WOMEN'S 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 EXPENSE IS INCLUDED IN THE ATTACHED AUDITED FINANCIAL STATEMENTS UNDER FOOTNOTE. THE "PATIENT ACCOUNTS RECEIVABLE" ON PAGE 12 AND "CHARITY CARE, COMMUNITY BENEFIT AND ASSISTANCE TO THE UNINSURED" STARTING ON PAGE 13 IN THE AFS. 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 ACTUAL BASED UPON THE 2024 MEDICARE COST REPORT. PART III, LINE 9B: DEACONESS WOMEN'S 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. PART VI, LINE 2: DEACONESS UTILIZES A VARIETY OF SOURCES TO GATHER DATA ON LOCAL HEALTH CARE NEEDS. WE USE DATA FROM THE UNITED WAY OF SOUTHWESTERN INDIANA'S COMPREHENSIVE NEEDS ASSESSMENT, WELBORN BAPTIST FOUNDATION'S GREATER EVANSVILLE HEALTH SURVEY, 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 FROM OUR OWN ELECTRONIC MEDICAL RECORD SYSTEM AND THROUGH OUR INTERACTION WITH LOCAL SERVICE PROVIDERS AND OTHER NON-PROFIT ORGANIZATIONS. THAT INCLUDES "PROMISE ZONE" INITIATIVES THAT KEEP US AWARE OF CHANGING NEEDS IN OUR MOST DISENFRANCHISED POPULATION. 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 VANDERBURGH AND WARRICK COUNTIES IN INDIANA ANY TIME DURING THE YEAR.VANDERBURGH COUNTY VANDERBURGH COUNTY IS MARGINALLY LESS DIVERSE THAN MUCH OF INDIANA IN TERMS OF RACIAL AND ETHNIC CHARACTERISTICS, HAVING SLIGHTLY MORE FEMALES THAN MALES, WITH THE MAJORITY OF INDIVIDUALS LIVING IN AREAS CONSIDERED URBAN. VANDERBURGH COUNTY'S POPULATION OF 179,908 PERSONS IS SIMILAR TO THE STATEWIDE POPULATION, WITH ABOUT 82.1% OF THE POPULATION BEING WHITE, 9.7% BLACK/AFRICAN AMERICAN, 1.4% ASIAN, AND THE REMAINDER BEING OF OTHER OR 2 OR MORE RACES. HOWEVER, VANDERBURGH COUNTY REPORTS A 3.6% HISPANIC POPULATION COMPARED TO 8.4% FOR THE STATE. WARRICK COUNTY - WARRICK COUNTY HAS LESS DIVERSITY THAN VANDERBURGH COUNTY AND THE STATE OF INDIANA. MORE THAN 90% OF PEOPLE THERE IDENTIFY AS WHITE COMPARED TO 78.5% FOR INDIANA. ONLY 2.1% OF THE POPULATION IS LISTED AS BLACK/AFRICAN AMERICAN AND 2.3% AS HISPANIC. THAT'S COMPARED TO STATE AVERAGES OF 9.7% AND 8.4% RESPECTIVELY. PART VI, LINE 5: DEACONESS PROMOTED SERVICES AND INFORMATION THAT HELPED US ADDRESS THE GREATEST HEALTH NEEDS OF THE COMMUNITY AS DEFINED BY OUR MOST RECENT CHNA, AS WELL AS ENCOURAGE PEOPLE TO GET THE PREVENTIVE SCREENINGS THEY NEED.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 9/29/2025COMMUNITY EVENTSOCTOBER 6-12, 2024 HEALTHY EATING MESSAGES WITH WISE CHOICE AT THE FALL FESTIVAL.OCTOBER 6-12, 2024 SNUGGLE STATION AND FIRST AID AT FALL FESTIVALFEBRUARY 5, 2025 BABYPALOOZAAPRIL 3, 2025 HOMELESS CONNECT (SCREENING BOOTH)APRIL 12, 2025 - BABYPALOOZAAPRIL 26, 2025 CANCER SURVIVOR HOPEFESTMAY 17, 2025 HEART WALKJUNE 8, 2025 CANCER PATHWAYS SURVIVOR'S DAYJUNE 14, 2025 COLON SCREENING FOR LIFE 5KJUNE 28, 2025 WELLNESS SUPER SATURDAY AT EVANSVILLE MUSEUMJULY 2, 2025 BABYPALOOZAJULY 10, 2025 75 AEDS DISTRIBUTED TO COMMUNITY ORGANIZATIONSJULY 12, 2025 DESTINATION WELLNESS AT CHILDREN'S MUSEUM OF EVANSVILLEJULY 20-26, 2025 SNUGGLE STATION AND FIRST AID AT VANDERBURGH COUNTY FAIRAUGUST 5, 2025 NATIONAL NIGHT OUTAUGUST 8, 2025 NIGHT MARKETSEPTEMBER 12, 2025 NIGHT MARKETOCTOBER 18, 2025 - BABYPALOOZAOCTOBER 25, 2025 WALK-THRU BOONOVEMBER 2, 2025 TRI-STATE MS WALKMEDICATION ASSISTANCE AND FAMILY MEDICINE RESIDENCY CLINICDEACONESS PROVIDES FREE AND REDUCED CARE WITHIN OUR HOSPITAL BUILDINGS. THROUGH OUR MEDICATION ASSISTANCE PROGRAM (MAP) AND OUR FAMILY PRACTICE RESIDENCY CLINIC, PATIENTS CAN ACCESS THE HIGH-QUALITY HEALTH CARE THEY NEED IN CONVENIENT LOCATIONS AND AT A PRICE THEY CAN AFFORD. SIMILARLY, THE MAP FOR THE DEACONESS CENTRAL REGION, INCLUDING DEACONESS MIDTOWN, DEACONESS WOMEN'S HOSPITAL AND DEACONESS GATEWAY HOSPITAL, PROVIDED 9,398 PATIENTS WITH $63,880,398.82 IN MEDICATION PAYMENT ASSISTANCE.BEHAVIORAL HEALTH AND SUICIDE PREVENTIONSTAFF FROM DEACONESS CROSS POINTE EDUCATED THOUSANDS OF PEOPLE IN THE SURROUNDING COMMUNITY ABOUT BEHAVIORAL HEALTH, RELATED RESOURCES, AND SUICIDE PREVENTION.LOCAL SPONSORSHIPSAS 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: DEACONESS WOMEN'S HOSPITAL OF SOUTHERN INDIANA 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 YOUTH INC OF SOUTHERN INDIANA PO BOX 994 NEWBURGH IN 47729 351809333 501C3 20000 0 GRANT TO SUPPORT MISSION DEACONESS HOSPITAL 600 MARY ST EVANSVILLE IN 47747 350593390 501C3 12250 0 GRANT TO SUPPORT MISSION IVY TECH FOUNDATION 50 W FALL CREEK PKWY NORTH DRIVE INDIANAPOLIS IN 46208 237073977 501C3 10000 0 PLEDGE FOR BARBARA HILTON SCHOOL OF NURSING TRI-STATE AREA TENNIS ASSOCIATION INC 5428 DAVIS LANT DR EVANSVILLE IN 47715 800028117 501C3 10000 0 GRANT TO SUPPORT MISSION EVANSVILLE BOYS & GIRLS CLUB PO BOX 6311 EVANSVILLE IN 47719 351007558 501C3 8800 0 GRANT TO SUPPORT MISSION RONALD MCDONALD HOUSE 3540 WASHINGTON AVENUE EVANSVILLE IN 47714 351748468 501C3 8333 0 GRANT TO SUPPORT MISSION 5 PART I, LINE 2: DEACONESS WOMEN'S HOSPITAL OF SOUTHERN INDIANA CONFIRMS ALL RECIPIENTS OF FUNDS ARE ORGANIZATIONS WHOSE GOALS COINCIDE WITH DEACONESS WOMEN'S HOSPITAL'S MISSION OF PROVIDING A FULL RANGE OF HIGH-QUALITY, CONVENIENT, PERSONALIZED, AND COST-EFFECTIVE HEALTH CARE SERVICES TO THE WOMEN AND INFANTS IN OUR COMMUNITY. THE ORGANIZATIONS PROVIDE NEEDED SERVICES TO OUR COMMUNITY TO IMPROVE HEALTH AND WELLNESS FOR THE CITIZENS IN THE SURROUNDING AREA. X 0 0 0 1 0 0 0 1 0 1 0 SHAWN MCCOY CEO OF DEACONESS HOSPITAL 0 1238547 0 457318 0 320373 0 316483 0 44966 0 2377687 0 313370 SAMER SCHUMAN MD PHYSICIAN 858704 0 793645 0 826 98426 16075 0 1402 0 1670652 98426 0 0 JAMES PORTER MD PRESIDENT OF DEACONESS HOSPITAL 0 682862 0 213203 0 177113 0 160685 0 26675 0 1260538 0 173122 CHERYL WATHEN SECRETARY/TREASURER 0 660905 0 178364 0 149595 0 148420 0 46099 0 1183383 0 143448 SPENCER KUPER MD PHYSICIAN 620046 0 481135 0 13262 0 16075 0 35759 0 1166277 0 0 0 CLAYTON FITZPATRICK CMO 834747 0 141271 0 1911 0 12075 0 23051 0 1013055 0 0 0 BARTON STAAT MD PHYSICIAN 604777 0 303477 0 17276 0 16075 0 37286 0 978891 0 0 0 KARENROSE MARTINEZ MD PHYSICIAN 629209 0 218557 0 1685 0 16075 0 32084 0 897610 0 0 0 CHRISTINA M RYAN CHIEF EXECUTIVE OFFICER 488276 0 161864 0 112710 0 12075 0 18400 0 793325 0 107415 0 DANIEL GRIFFIN MD PHYSICIAN 462759 0 93800 0 1551 0 16075 0 35060 0 609245 0 0 0 ALLISON INGLER CAO 210806 114985 36142 19714 945 515 8752 4774 11708 6386 268353 146374 0 0 LINDA WHITE CHAIRMAN 0 236224 0 56706 0 3591 0 14871 0 11501 0 322893 0 0 PART I, LINE 1A SOCIAL CLUB DUES ARE PAID FOR LINDA WHITE AND SHAWN MCCOY FOR ORGANIZATION BUSINESS ONLY. ANY PERSONAL USE OF THE CLUB MUST BE PAID BY THE EMPLOYEES. 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 SEVERANCE, NONQUALIFIED, AND EQUITY-BASED PAYMENTS: NONQUALIFIED: LINDA WHITE $23,000 SHAWN MCCOY $23,000 JAMES PORTER $23,000 CHERYL WATHEN $23,000 SAMER SCHUMAN $23,000 PART 1, 4B: SHAWN MCCOY: SUPPLEMENTAL ACCUMULATION ACCOUNT CONTRIBUTIONS OF $ 304,408 SUPPLEMENTAL ACCUMULATION ACCOUNT PAYOUT OF $ 313,370 JAMES PORTER: SUPPLEMENTAL ACCUMULATION ACCOUNT CONTRIBUTIONS OF $148,610 SUPPLEMENTAL ACCUMULATION ACCOUNT PAYOUT OF $173,122 CHERYL WATHEN: SUPPLEMENTAL ACCUMULATION ACCOUNT CONTRIBUTIONS OF $136,345 SUPPLEMENTAL ACCUMULATION ACCOUNT PAYOUT OF $143,448 CHRISTINA M. RYAN SUPPLEMENTAL ACCUMULATION ACCOUNT PAYOUT OF $107,415 PART I, LINE 6 INCENTIVE COMPENSATION PAYMENTS MADE BY THE ORGANIZATION ARE BASED ON THE SUCCESSFUL ACHIEVEMENT OF ESTABLISHED INPATIENT SATISFACTION MEASURES, OUTPATIENT SATISFACTION MEASURES, COMPLIANCE WITH PUBLICLY REPORTED QUALITY INDICATORS, OPERATING MARGIN TARGETS, AS WELL AS OTHER TECHNICAL, PERSONAL, AND FUNCTIONAL GOALS OF THE ORGANIZATION AND ITS AFFILIATED ENTITIES. DEACONESS WOMEN'S HOSPITAL'S INCENTIVE COMPENSATION PROGRAMS ARE DESIGNED TO REWARD BEHAVIORS THAT BALANCE PATIENT NEEDS WITH THE EFFICIENT DELIVERY OF CARE, HELPING TO ENSURE THE BEST POSSIBLE PATIENT OUTCOMES. 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/THE-WOMENS-HOSPITAL FORM 990, PART VI, SECTION A, LINE 6 DEACONESS HEALTH SYSTEM AND DEACONESS HOSPITAL ARE THE MEMBERS OF DEACONESS WOMEN'S HOSPITAL OF SOUTHERN INDIANA. FORM 990, PART VI, SECTION A, LINE 7A THE BUSINESS, PROPERTY AND OPERATIONS AND AFFAIRS OF THE COMPANY SHALL BE MANAGED AND ALL POWERS OF THE COMPANY SHALL BE EXERCISED BY A BOARD OF MANAGERS APPOINTED BY THE MEMBERS OF THE COMPANY, WITH EACH MEMBER APPOINTING AN EQUAL NUMBER OF MANAGERS. MANAGERS SHALL NOT BE SUBJECT TO PERIODIC ELECTIONS AND SHALL SERVE UNTIL HIS OR HER SUCCESSOR IS APPOINTED OR UNTIL HE OR SHE IS REMOVED BY THE MEMBER ENTITLED TO DESIGNATE SUCH MANAGER. FORM 990, PART VI, SECTION A, LINE 7B MEMBERS SHALL HAVE THE RIGHT TO VOTE ON THOSE MATTERS SUBMITTED TO THE MEMBERS FOR APPROVAL. ALL ACTIONS ON WHICH THE MEMBERS ARE ENTITLED TO VOTE SHALL BE APPROVED OR AUTHORIZED BY THE HOLDERS OF A MAJORITY OF THE PERCENTAGE INTERESTS IN THE COMPANY. FORM 990, PART VI, SECTION B, LINE 11B THE IRS FORM 990 IS PRESENTED TO DH CFO AND CEO OF THE ORGANIZATION FOR REVIEW. AFTER THIS REVIEW AND ALL QUESTIONS HAVE BEEN ANSWERED, THE FORM 990 IS PRESENTED TO THE BOARD OF DIRECTORS OF DEACONESS HEALTH SYSTEM PRIOR TO FILING. ANY ADDITIONAL QUESTIONS ARE ANSWERED AND THE FILING OF THE FORM IS COMPLETED. FORM 990, PART VI, SECTION B, LINE 12C CONFLICT OF INTEREST REVIEW AND COMPLIANCE ACTIVITIES ARE CONDUCTED THROUGHOUT THE YEAR UNDER THE DIRECTION OF DEACONESS HEALTH'S CORPORATE COMPLIANCE OFFICER. UPON APPOINTMENT AND ANNUALLY THEREAFTER, OFFICERS, TRUSTEES, DIRECTORS, AND KEY EMPLOYEES, ALSO KNOWN AS INTERESTED PERSONS ARE REQUIRED TO COMPLETE THE CONFLICTS OF INTEREST AND/OR THE DISCLOSURE QUESTIONNAIRE. THESE DOCUMENTS SERVE TO ENSURE INTERESTED PERSONS 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 BASES. REVIEWS OCCUR TO ENSURE THE ORGANIZATION 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 WOMEN'S HOSPITAL UTILIZES THE DEACONESS HEALTH 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 OF DEACONESS HEALTH 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 OFFICER 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 DEACONESS WOMEN'S HOSPITAL'S ARTICLES OF INCORPORATION ARE ON THE SECRETARY OF STATE'S WEBSITE. DEACONESS WOMEN'S HOSPITAL IS PART OF A CONSOLIDATED FINANCIAL STATEMENT WHICH IS AVAILABLE WITH THE PUBLIC DISCLOSURE COPY OF THE IRS FORM 990. GOVERNING DOCUMENTS, ASIDE FROM THE ARTICLES OF INCORPORATION, AND THE CONFLICT-OF-INTEREST POLICY ARE NOT AVAILABLE FOR PUBLIC INSPECTION. 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. DEACONESS WOMEN'S HOSPITAL OF SOUTHERN INDIANA, LLC 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: PROGRAM SERVICE EXPENSES 22,754,178. MANAGEMENT AND GENERAL EXPENSES 1,961,158. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 24,715,336. 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