DEACONESS SPECIALTY PHYSICIANS INC: Form 990, tax year 2020
View the entire original 990 at ProPublica ↗
- Organization
- DEACONESS SPECIALTY PHYSICIANS INC (EIN 82-4503095)
- Tax period
- 2020-10-01 to 2021-09-30
- Filed
- 2022-08-15
- IRS object ID
- 202222279349301202
- Schema version
- 2020v4.2
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2022-08-15T07:39:52-05:00 | ReturnTs |
| Tax Period End | 2021-09-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 351178661 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BLUE & CO LLC | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 500 N MERIDIAN ST SUITE 200 | AddressLine1Txt |
| City | INDIANAPOLIS | CityNm |
| State Abbreviation | IN | StateAbbreviationCd |
| ZIP | 46204 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2020-10-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 824503095 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DEACONESS SPECIALTY PHYSICIANS INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | DEAC | BusinessNameControlTxt |
| Phone | 8124503296 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 600 MARY STREET | AddressLine1Txt |
| City | EVANSVILLE | CityNm |
| State Abbreviation | IN | StateAbbreviationCd |
| ZIP | 47747 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | CHERYL WATHEN | PersonNm |
| Person Title | SECRETARY/TREASURER | PersonTitleTxt |
| Phone | 8124503296 | PhoneNum |
| Signature | 2022-08-15 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | CHERYL | PersonFirstNm |
| Person Last | WATHEN | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | CARRIE A MERRILL CPA | PreparerPersonNm |
| PTIN | P00832283 | PTIN |
| Phone | 3176334705 | PhoneNum |
| Preparation | 2022-08-15 | PreparationDt |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 2 | TrustedCustomerCd |
| Authentication Assurance Level | AAL1 | AuthenticationAssuranceLevelCd |
| Identity Assurance Level | IAL1 | IdentityAssuranceLevelCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2020 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | CHERYL WATHEN | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 600 MARY STREET | AddressLine1Txt |
| City | EVANSVILLE | CityNm |
| State Abbreviation | IN | StateAbbreviationCd |
| ZIP | 47747 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $18,046,667 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.DEACONESS.COM | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 2018 | FormationYr |
| Legal Domicile State | IN | LegalDomicileStateCd |
| Activity Or Mission | SEE SCHEDULE O | ActivityOrMissionDesc |
| Voting Members Governing Body | 3 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 0 | VotingMembersIndependentCnt |
| Total Employee | 135 | TotalEmployeeCnt |
| Total Volunteers | 0 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $469,464 | PYContributionsGrantsAmt |
| CY Contributions Grants | $0 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $15,745,860 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $18,045,326 | CYProgramServiceRevenueAmt |
| PY Investment Income | -$5,580 | PYInvestmentIncomeAmt |
| CY Investment Income | $1,341 | CYInvestmentIncomeAmt |
| PY Other Revenue | $0 | PYOtherRevenueAmt |
| CY Other Revenue | $0 | CYOtherRevenueAmt |
| PY Total Revenue | $16,209,744 | PYTotalRevenueAmt |
| CY Total Revenue | $18,046,667 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $25,237,527 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $25,946,100 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $5,040,937 | PYOtherExpensesAmt |
| CY Other Expenses | $3,896,387 | CYOtherExpensesAmt |
| PY Total Expenses | $30,278,464 | PYTotalExpensesAmt |
| CY Total Expenses | $29,842,487 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$14,068,720 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$11,795,820 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $7,248,115 | TotalAssetsBOYAmt |
| Total Assets EOY | $8,399,720 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $7,792,478 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $7,882,490 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | -$544,363 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $517,230 | NetAssetsOrFundBalancesEOYAmt |
| Mission | SEE SCHEDULE O | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $25,859,462 | ExpenseAmt |
| Revenue | $18,045,326 | RevenueAmt |
| Desc | PATIENT SERVICE REVENUE - DEACONESS SPECIALTY PHYSICIANS(DSP) IS A MAJOR SOURCE OF MEDICAL SERVICE WITH THE EXPERTISE OF HEART CARE. DEACONESS SPECIALTY PHYSICIANS EMPLOYS 19 PHYSICIANS, 19 MID-LEVEL PROVIDERS, AND 84 FULL TIME NURSING AND ADMINISTRATIVE FULL TIME EQUIVALENTS. DEACONESS SPECIALTY PHYSICIANS SERVES A 25-COUNTY TRISTATE AREA IN SOUTHWESTERN INDIANA, WESTERN KENTUCKY, AND SOUTHEASTERN ILLINOIS. DSP AND ITS FACILITIES HAVE LOCATIONS IN EVANSVILLE, NEWBURGH, PRINCETON, VINCENNES, AND JASPER IN INDIANA. DSP AND ITS FACILITIES ALSO HAS LOCATIONS IN HENDERSON AND OWENSBORO IN KENTUCKY AND RURAL UNDERSERVED COMMUNITIES OF CARMI, ELDORADO, FAIRFIELD, MCLEANSBORO, OLNEY, AND MT. CARMEL IN ILLINOIS. THE LOCATIONS SERVED 169,061 PATIENT VISITS FROM OCTOBER 1, 2020 THROUGH SEPTEMBER 30, 2021. | Desc |
| Total Program Service Expenses | $25,859,462 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | 0 | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (1) | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | 0 | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (1) | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | 0 | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 13 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 135 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 3 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 0 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (1) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | IN | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | KYLE DILLMAN | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 8124507399 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 600 MARY STREET | AddressLine1Txt |
| City | EVANSVILLE | CityNm |
| State Abbreviation | IN | StateAbbreviationCd |
| ZIP | 47747 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (8 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| BRADLEY SCHEU | ||||||||
| CHAIRMAN | 3.00 | 52.00 | Yes (X) | Yes (X) | $0 | $572,301 | $54,497 | |
| LYNN LINGAFELTER | ||||||||
| VICE CHAIR PERSON | 3.00 | 52.00 | Yes (X) | Yes (X) | $51,352 | $676,851 | $147,424 | |
| CHERYL WATHEN | ||||||||
| SECRETARY/TREASURER | 1.00 | 55.00 | Yes (X) | Yes (X) | $0 | $790,019 | $179,947 | |
| LEE WAGMEISTER | ||||||||
| PHYSICIAN | 50.00 | 0.00 | $1,258,494 | $0 | $32,082 | Yes (X) | ||
| HOANG TRAN | ||||||||
| PHYSICIAN | 50.00 | 0.00 | $1,247,361 | $0 | $18,579 | Yes (X) | ||
| CHANDRASHEKAR KUMBAR | ||||||||
| PHYSICIAN | 50.00 | 0.00 | $1,221,088 | $0 | $21,325 | Yes (X) | ||
| JAMES NEAHRING | ||||||||
| PHYSICIAN | 50.00 | 0.00 | $1,192,084 | $0 | $34,825 | Yes (X) | ||
| NATHAN J REED | ||||||||
| PHYSICIAN | 50.00 | 0.00 | $1,075,997 | $0 | $9,690 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $6,046,376 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $2,039,171 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $498,369 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 33 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (3 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| KEY CONSTRUCTION CO INC | |||||
| PO BOX 6313 | EVANSVILLE | IN | 47719 | SERVICES | $337,155 |
| MARLON JORDAN | |||||
| 5966 MEDINAH DR | EVANSVILLE | IN | 47630 | PHYSICIAN SERVICES | $274,826 |
| WEATHERBY LOCUMS INC | |||||
| PO BOX 972633 | DALLAS | TX | 753972633 | PHYSICIAN SERVICES | $179,328 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 3 | CntrctRcvdGreaterThan100KCnt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | NET PATIENT REVENUE | Desc |
| Business | 621110 | BusinessCd |
| Total Revenue Column | $18,045,326 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $18,045,326 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $18,045,326 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,341 | TotalRevenueColumnAmt |
| Exclusion | $1,341 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $18,046,667 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $18,045,326 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $1,341 | ExclusionAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $72,983 | TotalAmt |
| Program Services | $69,473 | ProgramServicesAmt |
| Management And General | $3,510 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $22,670,435 | TotalAmt |
| Program Services | $21,450,354 | ProgramServicesAmt |
| Management And General | $1,220,081 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,008,425 | TotalAmt |
| Program Services | $918,145 | ProgramServicesAmt |
| Management And General | $90,280 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,221,340 | TotalAmt |
| Program Services | $1,111,999 | ProgramServicesAmt |
| Management And General | $109,341 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $972,917 | TotalAmt |
| Program Services | $885,816 | ProgramServicesAmt |
| Management And General | $87,101 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $608,718 | TotalAmt |
| Management And General | $608,718 | ManagementAndGeneralAmt |
Fees For Services Lobbying FeesForServicesLobbyingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,497 | TotalAmt |
| Management And General | $1,497 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,542,250 | TotalAmt |
| Management And General | $1,542,250 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $38,566 | TotalAmt |
| Program Services | $35,657 | ProgramServicesAmt |
| Management And General | $2,909 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $121,572 | TotalAmt |
| Program Services | $119,210 | ProgramServicesAmt |
| Management And General | $2,362 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $187,688 | TotalAmt |
| Program Services | $173,262 | ProgramServicesAmt |
| Management And General | $14,426 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $602,095 | TotalAmt |
| Program Services | $602,095 | ProgramServicesAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $20,069 | TotalAmt |
| Program Services | $14,503 | ProgramServicesAmt |
| Management And General | $5,566 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $67,557 | TotalAmt |
| Program Services | $63,980 | ProgramServicesAmt |
| Management And General | $3,577 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $336,294 | TotalAmt |
| Program Services | $174,419 | ProgramServicesAmt |
| Management And General | $161,875 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $370,081 | TotalAmt |
| Program Services | $240,549 | ProgramServicesAmt |
| Management And General | $129,532 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $29,842,487 | TotalAmt |
| Program Services | $25,859,462 | ProgramServicesAmt |
| Management And General | $3,983,025 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,724,999 | BOYAmt |
| EOY | $1,349,167 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $150,000 | BOYAmt |
| EOY | $291,841 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $85,641 | BOYAmt |
| EOY | $99,078 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $1,374,230 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $339,605 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,204,144 | BOYAmt |
| EOY | $1,034,625 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $961,168 | BOYAmt |
| EOY | $835,798 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,122,163 | BOYAmt |
| EOY | $4,789,211 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,248,115 | BOYAmt |
| EOY | $8,399,720 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,235,557 | BOYAmt |
| EOY | $5,635,722 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,556,921 | BOYAmt |
| EOY | $2,246,768 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,792,478 | BOYAmt |
| EOY | $7,882,490 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -$544,363 | BOYAmt |
| EOY | $517,230 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -$544,363 | BOYAmt |
| EOY | $517,230 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,248,115 | BOYAmt |
| EOY | $8,399,720 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | -$11,795,820 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $12,857,413 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Form990 Schedule A Part VI Form990ScheduleAPartVIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE A, LINE 3: | FormAndLineReferenceDesc |
| Explanation | DEACONESS SPECIALTY PHYSICIANS HAS BEEN DETERMINED BY THE IRS TO BE A PUBLIC CHARITY UNDER IRS CODE SECTION 170(B)(1)(A)(III). PER SCHEDULE H INSTRUCTIONS ONLY ORGANIZATIONS THAT OPERATE AT LEAST ONE FACILITY THAT IS, OR IS REQUIRED TO BE, LICENSED, REGISTERED, OR SIMILARILY RECOGNIZED BY A STATE AS A HOSPITAL IS REQUIRED TO COMPLETE THE SCHEDULE. THE COMPANY IS NOT LICENSED AS A HOSPITAL FOR THE STATE OF INDIANA. | ExplanationTxt |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | VolunteersInd |
| Paid Staff Or Management | 0 | PaidStaffOrManagementInd |
| Media Advertisements | 0 | MediaAdvertisementsInd |
| Mailings Members | 0 | MailingsMembersInd |
| Publications Or Broadcast | 0 | PublicationsOrBroadcastInd |
| Grants Other Organizations | 0 | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | 0 | DirectContactLegislatorsInd |
| Rallies Demonstrations | 0 | RalliesDemonstrationsInd |
| Other Activities | Yes (1) | OtherActivitiesInd |
| Other Activities | $1,497 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $1,497 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | 0 | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART II-B, LINE 1: | FormAndLineReferenceDesc |
| Explanation | LOBBYING EXPENDITURES CONSISTED OF A PORTION OF MEMBERSHIP DUES TO PROFESSIONAL ORGANIZATIONS IN WHICH DEACONESS SPECIALTY PHYSICIANS AND ITS EMPLOYEES ARE MEMBERS. THE LOBBYING PORTION OF THE DUES IS NOTED ON THE MEMBERSHIP APPLICATION OR BILLING STATEMENT. | ExplanationTxt |
Schedule D IRS990ScheduleD
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $695,038 | OtherCostOrOtherBasisAmt |
| Depreciation | $58,614 | DepreciationAmt |
| Book Value | $636,424 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $679,192 | OtherCostOrOtherBasisAmt |
| Depreciation | $280,991 | DepreciationAmt |
| Book Value | $398,201 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $1,034,625 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp (3 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| DUE FROM RELATED PARTIES | $2,077,158 |
| OTHER RECEIVABLES | $14,640 |
| RIGHT OF USE | $2,697,413 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $4,789,211 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | CAPITAL LEASE OBLIGATION | Desc |
| Amt | $2,246,768 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $2,246,768 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART X, LINE 2: | ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE COMPANY AND RECOGNIZE A TAX LIABILITY IF THE COMPANY 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 COMPANY AND HAS CONCLUDED THAT AS OF SEPTEMBER 30, 2021 AND 2020, 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 COMPANY IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. |
| PART XI AND XII: | SECTIONS ARE NOT REQUIRED AS THE ORGANIZATION IS PART OF A CONSOLIDATED FINANCIAL STATEMENT. THE CONSOLIDATED FINANCIAL STATEMENT IS AUDITED BY AN INDEPENDENT ACCOUNTING FIRM AND IS PREPARED IN ACCORDANCE WITH GENERALLY ACCEPTED ACCOUNTING PRINCIPLES. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Independent Consultant | Yes (X) | IndependentConsultantInd |
| Form990 Of Other Organizations | Yes (X) | Form990OfOtherOrganizationsInd |
| Written Employment Contract | Yes (X) | WrittenEmploymentContractInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (1) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (8 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| BRADLEY SCHEU | ||||||||||||||
| CHAIRMAN | $0 | $354,827 | $0 | $184,764 | $0 | $32,710 | $0 | $20,434 | $0 | $34,063 | $0 | $626,798 | $0 | $0 |
| LYNN LINGAFELTER | ||||||||||||||
| VICE CHAIR PERSON | $51,352 | $468,988 | $0 | $132,157 | $0 | $75,706 | $18,605 | $98,560 | $3,026 | $27,233 | $72,983 | $802,644 | $0 | $66,902 |
| CHERYL WATHEN | ||||||||||||||
| SECRETARY/TREASURER | $0 | $537,700 | $0 | $139,230 | $0 | $113,089 | $0 | $140,101 | $0 | $39,846 | $0 | $969,966 | $0 | $100,563 |
| LEE WAGMEISTER | ||||||||||||||
| PHYSICIAN | $1,218,428 | $0 | $37,834 | $0 | $2,232 | $0 | $8,646 | $0 | $23,436 | $0 | $1,290,576 | $0 | $0 | $0 |
| HOANG TRAN | ||||||||||||||
| PHYSICIAN | $1,187,464 | $0 | $58,038 | $0 | $1,859 | $0 | $8,646 | $0 | $9,933 | $0 | $1,265,940 | $0 | $0 | $0 |
| CHANDRASHEKAR KUMBAR | ||||||||||||||
| PHYSICIAN | $1,121,775 | $0 | $97,351 | $0 | $1,962 | $0 | $8,646 | $0 | $12,679 | $0 | $1,242,413 | $0 | $0 | $0 |
| JAMES NEAHRING | ||||||||||||||
| PHYSICIAN | $1,146,018 | $0 | $43,024 | $0 | $3,042 | $0 | $8,646 | $0 | $26,179 | $0 | $1,226,909 | $0 | $0 | $0 |
| NATHAN J REED | ||||||||||||||
| PHYSICIAN | $954,552 | $0 | $120,185 | $0 | $1,260 | $0 | $8,646 | $0 | $1,044 | $0 | $1,085,687 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 4B | FormAndLineReferenceDesc |
| Explanation | SEVERANCE, NONQUALIFIED, AND EQUITY-BASED PAYMENTS: SEVERANCE NONQUALIFIED EQUITY-BASED LYNN LINGAFELTER $ -0- $ 19,500 $ -0- BRADLEY SCHEU 0 19,500 0 CHERYL WATHEN 0 19,500 0 LEE WAGMEISTER 0 19,500 0 HOANG TRAN 0 19,500 0 CHANDRASHEKAR KUMBAR 0 19,500 0 NATHAN REED 0 5,528 0 PART I, 4B: LYNN LINGAFELTER: SUPPLEMENTAL ACCUMULATION ACCOUNT CONTRIBUTIONS OF $93,097. SUPPLEMENTAL ACCUMULATION ACCOUNT PAYOUT OF $66,902. BRADLEY SCHEU: SUPPLEMENTAL ACCUMULATION ACCOUNT CONTRIBUTIONS OF $11,788. SUPPLEMENTAL ACCUMULATION ACCOUNT PAYOUT OF $23,441. CHERYL WATHEN: SUPPLEMENTAL ACCUMULATION ACCOUNT CONTRIBUTIONS OF $100,293. SUPPLEMENTAL ACCUMULATION ACCOUNT PAYOUT OF $100,563. | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (10 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART I, LINE 1 AND PART III, LINE 1: ORGANIZATION'S MISSION | DEACONESS SPECIALTY PHYSICIANS WAS ORGANIZED EXCLUSIVELY FOR CHARITABLE, EDUCATION, AND SCIENTIFIC PROGRAM PURPOSES WITHIN THE MEANING OF SECTION 501(C)(3) OF THE IRS CODE, WHICH INCLUDE (AMONG OTHERS): TO DELIVER HEALTH CARE TO THE PUBLIC; TO CARRY OUT SCIENTIFIC RESEARCH AND RESEARCH PROJECTS IN THE PUBLIC INTEREST IN THE FIELDS OF MEDICAL SCIENCES, MEDICAL ECONOMICS, PUBLIC HEALTH, SOCIOLOGY, AND RELATED AREAS; TO IMPROVE AND DEVELOP THE CAPABILITIES OF INDIVIDUALS AND INSTITUTIONS STUDYING, TEACHING, AND PRACTICING MEDICINE AND OTHER HEALTH OCCUPATIONS; TO PROVIDE HEALTH CARE, MEDICAL SERVICES AND HEALTH-RELATED EDUCATION FOR THE BENEFIT OF THE COMMUNITY IN A SYSTEMATIC, INTEGRATED AND COORDINATED FASHION WITH THE DEACONESS HEALTH SYSTEM AND DEACONESS HOSPITAL, INC. AND THEIR AFFILIATES; TO ENGAGE IN THE INSTRUCTION OF THE GENERAL PUBLIC IN THE AREA OF MEDICAL SCIENCE, PUBLIC HEALTH AND HYGIENE AND RELATED INSTRUCTION USEFUL TO THE INDIVIDUAL AND BENEFICIAL TO THE COMMUNITY; TO CONDUCT OTHER ACTIVITIES USEFUL OR APPROPRIATE TO THE ACCOMPLISHMENT OF THE FOREGOING PURPOSES OR AS OTHERWISE PERMITTED BY LAW. |
| 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 DEACONESS SPECIALTY PHYSICIANS, INC. |
| FORM 990, PART VI, SECTION A, LINE 7A | ELECTION OF MEMBERS AND THEIR RIGHTS: DEACONESS HEALTH SYSTEM, INC. MUST APPROVE THE DIRECTORS OF THE CORPORATION. |
| FORM 990, PART VI, SECTION A, LINE 7B | DECISIONS SUBJECT TO APPROVAL OF MEMBERS: APPOINTMENT OF DIRECTORS OF THE CORPORATION REQUIRES APPROVAL OF THE MEMBERS. CHANGES TO PHYSICIANS' COMPENSATION PLAN REQUIRES THE APPROVAL OF THE MEMBERS THROUGH ITS COMPENSATION COMMITTEE, WHICH IS COMPRISED OF INDEPENDENT MEMBERS OF THE DEACONESS HEALTH SYSTEMS BOARD. |
| FORM 990, PART VI, SECTION B, LINE 11B | THE PROCESS THAT DEACONESS SPECIALTY PHYSICIANS UTILIZES TO PRESENT THE FORM 990 TO ITS GOVERNING BODY PRIOR TO FILING IS TO PRESENT THE FORM 990 TO THE CONTROLLER, CFO AND CEO OF THE ORGANIZATION FOR REVIEW. AFTER THIS REVIEW IS PERFORMED AND ALL QUESTIONS ARE ANSWERED, THE FORM 990 IS PRESENTED TO THE BOARD OF DIRECTORS 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 REVIEW AND COMPLIANCE ACTIVITIES ARE CONDUCTED THROUGHOUT THE YEAR UNDER THE DIRECTION OF DEACONESS HOSPITAL'S CORPORATE COMPLIANCE OFFICER. UPON APPOINTMENT, AND ANNUALLY THEREAFTER, OFFICERS, DIRECTORS, TRUSTEES, AND KEY EMPLOYEES, ALSO KNOWN AS INTERESTED PERSONS, ARE REQUIRED TO COMPLETE "THE CONFLICTS OF INTEREST QUESTIONNAIRE AND/OR THE "THE DISCLOSURE QUESTIONNAIRE". THESE DOCUMENTS SERVE TO ENSURE INTERESTED PERSONS OR COMMITTEE MEMBERS WITH BOARD-DELEGATED POWERS HAVE AN APPROPRIATE AND TIMELY MANNER IN WHICH TO DISCLOSE ANY POTENTIAL CONFLICTS. CONFLICTS ARE CONSIDERED WITH RESPECT TO OUTSIDE INTEREST, INVESTMENTS, OUTSIDE ACTIVITIES, AND BUSINESS INTERESTS AMONG THE INTERESTED PERSONS AS WELL AS THEIR FAMILY MEMBERS. ON A PERIODIC BASIS, REVIEWS OCCUR TO ENSURE DEACONESS SPECIALTY PHYSICIANS 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: SALARIES AND BENEFITS OF OFFICERS AND PHYSICIANS AT DEACONESS SPECIALTY PHYSICIANS ARE APPROVED BY THE DEACONESS HEALTH SYSTEM COMPENSATION COMMITTEE. DEACONESS SPECIALTY PHYSICIANS BOARD CAN ONLY MAKE RECOMMENDATIONS TO THE DEACONESS HEALTH SYSTEM COMPENSATION COMMITTEE. THE COMPENSATION COMMITTEE IS APPOINTED BY THE BOARD OF DIRECTORS OF DEACONESS HEALTH SYSTEM INC. AND MUST MEET THE INDEPENDENCE REQUIREMENTS OF THE SEC. THE COMMITTEE HAS THE POWER AND AUTHORITY TO: 1. ANNUALLY REVIEW, APPROVE, AND RECOMMEND TO THE BOARD OF DIRECTORS FOR ITS FINAL APPROVAL FOR THE VICE PRESIDENT AND EACH OTHER EXECUTIVE OFFICERS 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, VICE PRESIDENT OR EXECUTIVE OFFICE COMPENSATION. 6. SOLE AUTHORITY TO APPROVE THE CONSULTANT'S FEES AND OTHER RETENTION TERMS. 7. OBTAIN ADVICE AND ASSISTANCE FROM INTERNAL OR EXTERNAL LEGAL, ACCOUNTING OR OTHER ADVISORS. 8. APPROVE ALL PHYSICIAN AND PHYSICIAN-RELATED CONTRACTS. 9. MAKE REGULAR REPORTS TO THE BOARD. |
| FORM 990, PART VI, SECTION C, LINE 19 | DEACONESS SPECIALTY PHYSICIANS' ARTICLES OF INCORPORATION ARE AVAILABLE ON THE SECRETARY OF STATE'S WEBSITE. AS REQUIRED BY LAW, DEACONESS SPECIALTY PHYSICIANS SUBMITS ITS CONSOLIDATED FINANCIAL STATEMENTS TO THE INDIANA DEPARTMENT OF HEALTH WHICH ARE PUBLISHED ON ITS WEBSITE. GOVERNING DOCUMENTS, ASIDE FROM THE ARTICLES OF INCORPORATION, AND THE CONFLICT OF INTEREST POLICY ARE NOT AVAILABLE FOR PUBLIC INSPECTION. |
| FORM 990, PART XI, LINE 9: | CAPITAL CONTRIBUTED 12,857,413. |
| FORM 990, PART XII, LINE 2C, OVERSIGHT OF AUDIT: | THE BOARD OF DIRECTORS ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF THE FINANCIAL STATEMENTS AND SELECTION OF THE INDEPENDENT ACCOUNTANT; AND NO PROCESSES HAVE CHANGED FROM PRIOR YEAR. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (11 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Direct Controlling NADirectControllingNACd | Controlled OrganizationControlledOrganizationInd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt |
|---|---|---|---|---|---|---|---|---|---|---|---|
| DEACONESS HEALTH SYSTEM INC | |||||||||||
| 600 MARY STREET | EVANSVILLE | IN | 47747 | 351532889 | HEALTHCARE | IN | 501(C)(3) | LINE 12A, I | N/A | 0 | |
| DEACONESS HOSPITAL INC | |||||||||||
| 600 MARY STREET | EVANSVILLE | IN | 47747 | 350593390 | HEALTHCARE | IN | 501(C)(3) | LINE 3 | 0 | DEACONESS HEALTH SYSTEM INC | |
| DEACONESS CLINIC INC | |||||||||||
| 600 MARY STREET | EVANSVILLE | IN | 47747 | 263083364 | HEALTHCARE | IN | 501(C)(3) | LINE 3 | 0 | DEACONESS HEALTH SYSTEM INC | |
| DEACONESS REGIONAL HEALTHCARE SERVICES ILLINOIS INC | |||||||||||
| 600 MARY STREET | EVANSVILLE | IN | 47747 | 810693478 | HEALTHCARE | IL | 501(C)(3) | LINE 10 | 0 | DEACONESS HEALTH SYSTEM INC | |
| DEACONESS VNA PLUS LLC | |||||||||||
| 610 E WALNUT ST | EVANSVILLE | IN | 47713 | 465223267 | HEALTHCARE | IN | 501(C)(3) | LINE 10 | 0 | DEACONESS HEALTH SYSTEM INC | |
| DEACONESS HEALTH KENTUCKY INC | |||||||||||
| 600 MARY STREET | EVANSVILLE | IN | 47747 | 830966826 | HEALTHCARE | IN | 501(C)(3) | LINE 10 | 0 | DEACONESS HEALTH SYSTEM INC | |
| METHODIST HEALTH INC | |||||||||||
| PO BOX 48 | HENDERSON | KY | 42419 | 610461753 | HEALTHCARE | KY | 501(C)(3) | LINE 3 | 0 | DEACONESS HEALTH SYSTEM INC | |
| DEACONESS GIBSON HOSPITAL | |||||||||||
| 1808 SHERMAN DR | PRINCETON | IN | 47670 | 350877575 | HEALTHCARE | IN | 501(C)(3) | LINE 3 | 0 | DEACONESS HEALTH SYSTEM INC | |
| HENDERSON REGIONAL HOSPITAL FOUNDATION | |||||||||||
| 1305 NORTH ELM ST | HENDERSON | KY | 42420 | 610944432 | SUPPORT METHODIST HEALTH | KY | 501(C)(3) | LINE 10 | N/A | 0 | |
| UNION COUNTY METHODIST HOSPITAL FOUNDATION | |||||||||||
| 4604 US HWY 60 WEST | MORGANFIELD | KY | 42437 | 611230297 | SUPPORT METHODIST HEALTH | KY | 501(C)(3) | LINE 10 | N/A | 0 | |
| GIBSON GENERAL HEALTH FOUNDATION INC | |||||||||||
| 1808 SHERMAN DRIVE | PRINCETON | IN | 47670 | 350950175 | SUPPORT DEACONESS GIBSON HOSPITAL | IN | 501(C)(3) | LINE 12A, I | 0 | DEACONESS GIBSON HOSPITAL | |
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp
Related Organization Name RelatedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | HEALTHCARE RESOURCE SOLUTIONS LLC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 600 MARY STREET | AddressLine1Txt |
| City | EVANSVILLE | CityNm |
| State Abbreviation | IN | StateAbbreviationCd |
| ZIP | 47747 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 833275390 | EIN |
| Primary Activities | HEALTHCARE | PrimaryActivitiesTxt |
| Legal Domicile State | IN | LegalDomicileStateCd |
| Direct Controlling NA | N/A | DirectControllingNACd |
| Disproportionate Allocations | 0 | DisproportionateAllocationsInd |
| General Or Managing Partner | 0 | GeneralOrManagingPartnerInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (1) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | Yes (1) | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | 0 | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (1) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |