2022-08-15T07:39:52-05:00 2021-09-30 351178661 BLUE & CO LLC 500 N MERIDIAN ST SUITE 200 INDIANAPOLIS IN 46204 990 2020-10-01 824503095 DEACONESS SPECIALTY PHYSICIANS INC DEAC 8124503296 600 MARY STREET EVANSVILLE IN 47747 CHERYL WATHEN SECRETARY/TREASURER 8124503296 2022-08-15 1 CHERYL WATHEN 999009999 CARRIE A MERRILL CPA P00832283 3176334705 2022-08-15 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z CHERYL WATHEN 600 MARY STREET EVANSVILLE IN 47747 18046667 0 X WWW.DEACONESS.COM X 2018 IN SEE SCHEDULE O 3 0 135 0 0 0 469464 0 15745860 18045326 -5580 1341 0 0 16209744 18046667 0 0 0 0 25237527 25946100 0 0 0 5040937 3896387 30278464 29842487 -14068720 -11795820 7248115 8399720 7792478 7882490 -544363 517230 SEE SCHEDULE O 0 0 25859462 18045326 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. 25859462 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 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 13 0 1 135 1 0 0 0 0 0 0 0 0 0 0 0 0 X 3 0 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 IN X KYLE DILLMAN 8124507399 600 MARY STREET EVANSVILLE IN 47747 BRADLEY SCHEU CHAIRMAN 3.00 52.00 X X 0 572301 54497 LYNN LINGAFELTER VICE CHAIR PERSON 3.00 52.00 X X 51352 676851 147424 CHERYL WATHEN SECRETARY/TREASURER 1.00 55.00 X X 0 790019 179947 LEE WAGMEISTER PHYSICIAN 50.00 0.00 X 1258494 0 32082 HOANG TRAN PHYSICIAN 50.00 0.00 X 1247361 0 18579 CHANDRASHEKAR KUMBAR PHYSICIAN 50.00 0.00 X 1221088 0 21325 JAMES NEAHRING PHYSICIAN 50.00 0.00 X 1192084 0 34825 NATHAN J REED PHYSICIAN 50.00 0.00 X 1075997 0 9690 6046376 2039171 498369 33 0 1 0 KEY CONSTRUCTION CO INC PO BOX 6313 EVANSVILLE IN 47719 SERVICES 337155 MARLON JORDAN 5966 MEDINAH DR EVANSVILLE IN 47630 PHYSICIAN SERVICES 274826 WEATHERBY LOCUMS INC PO BOX 972633 DALLAS TX 753972633 PHYSICIAN SERVICES 179328 3 NET PATIENT REVENUE 621110 18045326 18045326 18045326 1341 1341 18046667 18045326 0 1341 72983 69473 3510 22670435 21450354 1220081 1008425 918145 90280 1221340 1111999 109341 972917 885816 87101 608718 608718 1497 1497 1542250 1542250 38566 35657 2909 121572 119210 2362 187688 173262 14426 602095 602095 20069 14503 5566 67557 63980 3577 336294 174419 161875 370081 240549 129532 29842487 25859462 3983025 0 1724999 1349167 150000 291841 85641 99078 1374230 339605 1204144 1034625 961168 835798 3122163 4789211 7248115 8399720 5235557 5635722 2556921 2246768 7792478 7882490 X -544363 517230 -544363 517230 7248115 8399720 X -11795820 12857413 X X 0 1 X 1 0 X SCHEDULE A, LINE 3: 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. 0 0 0 0 0 0 0 0 1 1497 1497 0 PART II-B, LINE 1: 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. 695038 58614 636424 679192 280991 398201 1034625 DUE FROM RELATED PARTIES 2077158 OTHER RECEIVABLES 14640 RIGHT OF USE 2697413 4789211 CAPITAL LEASE OBLIGATION 2246768 2246768 X 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. X X X X X X 0 1 0 0 0 0 0 0 0 BRADLEY SCHEU CHAIRMAN 0 354827 0 184764 0 32710 0 20434 0 34063 0 626798 0 0 LYNN LINGAFELTER VICE CHAIR PERSON 51352 468988 0 132157 0 75706 18605 98560 3026 27233 72983 802644 0 66902 CHERYL WATHEN SECRETARY/TREASURER 0 537700 0 139230 0 113089 0 140101 0 39846 0 969966 0 100563 LEE WAGMEISTER PHYSICIAN 1218428 0 37834 0 2232 0 8646 0 23436 0 1290576 0 0 0 HOANG TRAN PHYSICIAN 1187464 0 58038 0 1859 0 8646 0 9933 0 1265940 0 0 0 CHANDRASHEKAR KUMBAR PHYSICIAN 1121775 0 97351 0 1962 0 8646 0 12679 0 1242413 0 0 0 JAMES NEAHRING PHYSICIAN 1146018 0 43024 0 3042 0 8646 0 26179 0 1226909 0 0 0 NATHAN J REED PHYSICIAN 954552 0 120185 0 1260 0 8646 0 1044 0 1085687 0 0 0 PART I, LINE 4B 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. 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. 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 DEACONESS HEALTH SYSTEM INC 0 DEACONESS CLINIC INC 600 MARY STREET EVANSVILLE IN 47747 263083364 HEALTHCARE IN 501(C)(3) LINE 3 DEACONESS HEALTH SYSTEM INC 0 DEACONESS REGIONAL HEALTHCARE SERVICES ILLINOIS INC 600 MARY STREET EVANSVILLE IN 47747 810693478 HEALTHCARE IL 501(C)(3) LINE 10 DEACONESS HEALTH SYSTEM INC 0 DEACONESS VNA PLUS LLC 610 E WALNUT ST EVANSVILLE IN 47713 465223267 HEALTHCARE IN 501(C)(3) LINE 10 DEACONESS HEALTH SYSTEM INC 0 DEACONESS HEALTH KENTUCKY INC 600 MARY STREET EVANSVILLE IN 47747 830966826 HEALTHCARE IN 501(C)(3) LINE 10 DEACONESS HEALTH SYSTEM INC 0 METHODIST HEALTH INC PO BOX 48 HENDERSON KY 42419 610461753 HEALTHCARE KY 501(C)(3) LINE 3 DEACONESS HEALTH SYSTEM INC 0 DEACONESS GIBSON HOSPITAL 1808 SHERMAN DR PRINCETON IN 47670 350877575 HEALTHCARE IN 501(C)(3) LINE 3 DEACONESS HEALTH SYSTEM INC 0 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 DEACONESS GIBSON HOSPITAL 0 HEALTHCARE RESOURCE SOLUTIONS LLC 600 MARY STREET EVANSVILLE IN 47747 833275390 HEALTHCARE IN N/A 0 0 0 0 1 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0