DEACONESS CLINIC INC: Form 990, tax year 2013
View the entire original 990 at ProPublica ↗
- Organization
- DEACONESS CLINIC INC (EIN 26-3083364)
- Tax period
- 2013-10-01 to 2014-09-30
- Filed
- 2015-02-13
- IRS object ID
- 201520449349300917
- Schema version
- 2013v4.0
- 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 | 2015-02-13T08:44:51-06:00 | ReturnTs |
| Tax Period End | 2014-09-30 | 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 | BusinessNameLine1 |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | ONE AMERICAN SQUARE 2200 | AddressLine1 |
| City | INDIANAPOLIS | City |
| State | IN | State |
| ZIP Code | 46282 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2013-10-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 263083364 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DEACONESS CLINIC INC | BusinessNameLine1 |
| 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 | AddressLine1 |
| City | EVANSVILLE | City |
| State | IN | State |
| ZIP Code | 47747 | ZIPCode |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | ALLEN WHITE MD | PersonNm |
| Person Title | VICE PRESIDENT | PersonTitleTxt |
| Phone | 8124503296 | PhoneNum |
| Signature | 2015-02-12 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | AMBER KOCHER CPA | PreparerPersonNm |
| PTIN | P01286298 | PTIN |
| Phone | 3176334705 | PhoneNum |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2013 | TaxYr |
| Build TS | 2016-02-25 16:41:14Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | ALLEN WHITE MD | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 421 CHESTNUT STREET | AddressLine1 |
| City | EVANSVILLE | City |
| State | IN | State |
| ZIP Code | 47713 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $69,230,291 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | DEACONESS.COM | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 2008 | FormationYr |
| Legal Domicile State | IN | LegalDomicileStateCd |
| Activity Or Mission | DEACONESS CLINIC WAS ORGANIZED EXCLUSIVELY FOR CHARITABLE, EDUCATION, AND SCIENTIFIC PROGRAM PURPOSES WITHIN THE MEANING OF SECTION 501(C)(3) OF THE IRS CODE WHICH INCLUDES (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 AREA;TO IMPROVE AND DEVELOP THE CAPABILITIES OF INDIVIDUALS AND INSTITUTIONS STUDYING, TEACHING, AND PRACTICING MEDICINE AND OTHER HEALTH OCCUPATIONS;TO PROVIDE HEALTH CARE 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. | ActivityOrMissionDesc |
| Voting Members Governing Body | 15 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 1 | VotingMembersIndependentCnt |
| Total Employee | 731 | TotalEmployeeCnt |
| Total Volunteers | 0 | TotalVolunteersCnt |
| Total Gross UBI | $21,236 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $2,051 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $0 | PYContributionsGrantsAmt |
| CY Contributions Grants | $0 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $59,283,657 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $67,686,525 | CYProgramServiceRevenueAmt |
| PY Investment Income | $168,505 | PYInvestmentIncomeAmt |
| CY Investment Income | $286 | CYInvestmentIncomeAmt |
| PY Other Revenue | $1,393,775 | PYOtherRevenueAmt |
| CY Other Revenue | $1,254,264 | CYOtherRevenueAmt |
| PY Total Revenue | $60,845,937 | PYTotalRevenueAmt |
| CY Total Revenue | $68,941,075 | 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 | $57,652,941 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $63,703,642 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $23,091,586 | PYOtherExpensesAmt |
| CY Other Expenses | $24,337,198 | CYOtherExpensesAmt |
| PY Total Expenses | $80,744,527 | PYTotalExpensesAmt |
| CY Total Expenses | $88,040,840 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$19,898,590 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$19,099,765 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $13,273,456 | TotalAssetsBOYAmt |
| Total Assets EOY | $12,822,491 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $9,513,361 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $10,976,961 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $3,760,095 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $1,845,530 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | NONE | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $76,431,614 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $66,020,928 | RevenueAmt |
| Desc | PATIENT SERVICES REVENUE-DEACONESS CLINIC IS A MAJOR SOURCE OF MEDICAL SERVICES WHICH ENCOMPASSES A BROAD SPECTRUM OF EXPERTISE, REPRESENTING MORE THAN 20 MEDICAL AND SURGICAL SPECIALTIES. DEACONESS CLINIC EMPLOYS 98 PHYSICIANS, 38 MIDLEVEL PROVIDERS AND 429 FULL TIME NURSING AND ADMINISTRATIVE FULL TIME EQUIVALENTS. DEACONESS CLINIC SERVES A 26-COUNTY TRI-STATE AREA IN SOUTHWESTERN INDIANA, WESTERN KENTUCKY, AND SOUTHEASTERN ILLINOIS. THE CLINIC AND ITS FACILITIES HAVE LOCATIONS IN EVANSVILLE, NEWBURGH, MT. VERNON, PETERSBURG, FT. BRANCH, PRINCETON, OAKLAND CITY, AND REO IN INDIANA. THE CLINIC ALSO HAS LOCATIONS IN HENDERSON AND MORGANFIELD, KENTUCKY. THE CLINICS SERVED 517,161 PATIENT VISITS FROM OCTOBER 1, 2013 THROUGH SEPTEMBER 2014. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $1,699,541 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $1,665,597 | RevenueAmt |
| Desc | THE RESEARCH INSTITUTE OF DEACONESS CLINIC ASSISTS DEACONESS CLINIC'S MORE THAN 100+ PHYSICIANS, AS WELL AS OTHER PHYSICIANS THROUGHOUT THE COMMUNITY IN GAINING ACCESS TO LEADING EDGE MEDICAL SCIENCE AND NEW TREATMENTS FOR ACUTE AND CHRONIC ILLNESSES. THE INSTITUTE WAS AWARDED 26 NEW AND EXPANDED CLINICAL RESEARCH GRANTS THIS YEAR TO STUDY INVESTIGATIONAL DRUGS AND DEVICES ACROSS 10 FIELDS OF MEDICINE INCLUDING, BUT NOT LIMITED TO, NEW TREATMENTS FOR ASTHMA, OBESITY IN PATIENTS WITH CARDIOVASCULAR RISK FACTORS, DISLIPIDEMIA, ONYCHOMYCOSIS, CHRONIC BACK PAIN, GOUT, OVERACTIVE BLADDER, ACTINIC KERATOSIS, AND DIABETES. THE NEW RESEARCH GRANTS PROVIDED TREATMENT OPPORTUNITES AND PREVENTATIVE HEALTH SERVICES FOR UP TO 362 PATIENTS. IN ALL, THE NEWLLY AWARDED GRANTS THIS YEAR TOTALED $4.1 MILLION TO COVER THE COSTS [CONTINUATION FROM PAGE 2] ASSOCIATED WITH THE CONDUCT OF THE CLINICAL TRIALS WITHIN THE REGION. MORE THAN 270 PATIENTS WERE ENROLLED INTO CLINICAL TRIALS THROUGHOUT THE YEAR, RESULTING IN 3,477 RESEARCH RELATED PATIENT VISITS. THE RESEARCH INSTITUTE ALSO COMPLETED RESEARCH ON AN INVESTIGATOR-INITIATED RESEARCH PROJECT STUDYING THE LONG TERM EFFICACY OF HISTERLIN ABDOMINAL IMPLANTS IN PATIENTS WITH PROSTATE CANCER. THE RESULTS AND MANUSCRIPT WERE PUBLISHED IN THE JOURNAL OF PROSTATE CANCER. THE INSTITUTE OVERSAW THE TRAINING OF EIGHT NEW CLINICAL INVESTIGATORS IN 2014, INCLUDING THEIR RESEARCH CERTIFICATIONS IN GOOD CLINICAL PRACTICE AND THE PROTECTION OF HUMAN SUBJECTS. | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expenses | $78,131,155 | 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 |
| Temp Or Permanent Endowments | 0 | TempOrPermanentEndowmentsInd |
| 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 | 0 | 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 With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| 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 | 101 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 731 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | Yes (1) | UnrelatedBusIncmOverLimitInd |
| Form990 T Filed | Yes (1) | Form990TFiledInd |
| 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 |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 15 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 1 | 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 | 0 | CompensationProcessOtherInd |
| Investment In Joint Venture | Yes (1) | InvestmentInJointVentureInd |
| Written Policy Or Procedure | Yes (1) | WrittenPolicyOrProcedureInd |
| 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 | RICHARD PERRY | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 8124503296 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 600 MARY STREET | AddressLine1 |
| City | EVANSVILLE | City |
| State | IN | State |
| ZIP Code | 47747 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionAGrp (22 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 | Key EmployeeKeyEmployeeInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|---|
| STEPHEN TITZER | |||||||||
| CHAIRMAN | 5.00 | 10.00 | Yes (X) | Yes (X) | $1,600 | $0 | $0 | ||
| CHERYL WATHEN | |||||||||
| SECRETARY/TREASURER | 5.00 | 60.00 | Yes (X) | Yes (X) | $0 | $482,422 | $131,610 | ||
| MOHAMMED ALLAW MD | |||||||||
| DIRECTOR | 50.00 | 5.00 | Yes (X) | $376,014 | $6,608 | $32,319 | |||
| AAMANDA BOHLEBER MD | |||||||||
| DIRECTOR | 50.00 | 0.00 | Yes (X) | $270,833 | $0 | $18,452 | |||
| GARY KEEPES MD | |||||||||
| DIRECTOR | 50.00 | 0.00 | Yes (X) | $363,659 | $0 | $30,549 | |||
| DAVID KOEHLER MD | |||||||||
| DIRECTOR | 30.00 | 30.00 | Yes (X) | $181,149 | $116,743 | $18,452 | |||
| ANNE MCLAUGHLIN MD | |||||||||
| DIRECTOR | 50.00 | 0.00 | Yes (X) | $707,226 | $0 | $38,773 | |||
| BARRY PHILLIPS MD | |||||||||
| DIRECTOR | 50.00 | 2.00 | Yes (X) | $416,924 | $4,410 | $31,971 | |||
| JAMES PORTER | |||||||||
| DIRECTOR | 5.00 | 55.00 | Yes (X) | $0 | $609,835 | $135,412 | |||
| BRUCE SCHNEIDER MD | |||||||||
| DIRECTOR | 50.00 | 0.00 | Yes (X) | $1,412,529 | $0 | $45,188 | |||
| YOUSSEF SIAGE MD | |||||||||
| DIRECTOR | 50.00 | 0.00 | Yes (X) | $315,436 | $0 | $34,942 | |||
| RUSTON STOLTZ MD | |||||||||
| DIRECTOR | 50.00 | 10.00 | Yes (X) | $315,174 | $11,075 | $47,897 | |||
| FREDERICK WALLISCH | |||||||||
| DIRECTOR | 50.00 | 0.00 | Yes (X) | $257,737 | $0 | $43,934 | |||
| LINDA WHITE | |||||||||
| DIRECTOR | 5.00 | 65.00 | Yes (X) | $0 | $1,339,707 | $242,339 | |||
| DAVID CHRISTESON MD | |||||||||
| DIRECTOR/ FORMER CPAO | 50.00 | 0.00 | Yes (X) | $415,661 | $0 | $62,679 | |||
| W ALLEN WHITE MD | |||||||||
| NON-VOTING DIRECT/ VICE PRESIDENT | 50.00 | 0.00 | Yes (X) | Yes (X) | $342,468 | $0 | $51,998 | ||
| JULIE DINGMAN | |||||||||
| PRACTICE DIRECTOR | 50.00 | 0.00 | $152,538 | $0 | $27,670 | Yes (X) | |||
| MAQBOOL AHMED MD | |||||||||
| MD | 50.00 | 0.00 | $1,062,028 | $0 | $36,008 | Yes (X) | |||
| PAUL SIAMI MD | |||||||||
| MD | 50.00 | 0.00 | $945,902 | $0 | $37,411 | Yes (X) | |||
| JEFFREY MOORE MD | |||||||||
| MD | 50.00 | 0.00 | $805,727 | $0 | $44,169 | Yes (X) | |||
| CHRISTOPHER BRADEN MD | |||||||||
| MD | 50.00 | 2.00 | $786,455 | $594 | $39,808 | Yes (X) | |||
| ANVITA SINHA MD | |||||||||
| MD | 50.00 | 0.00 | $772,539 | $0 | $26,212 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $9,901,599 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $2,571,394 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $1,177,793 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 111 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1 | CityContractorAddress/USAddress/City | StateContractorAddress/USAddress/State | ZIP CodeContractorAddress/USAddress/ZIPCode | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| DANCO CONSTRUCTION | |||||
| 3201 INTERSTATE DRIVE | EVANSVILLE | IN | 47715 | CONSTRUCTION | $838,194 |
| WINK CONSTRUCTION | |||||
| 4001 E EICHEL AVE | EVANSVILLE | IN | 47716 | CONSTRUCTION | $477,339 |
| M TOLL INC | |||||
| PO BOX 8142 | EVANSVILLE | IN | 47716 | CLEANING SERVICE | $321,887 |
| WEATHERBY LOCUMS INC | |||||
| PO BOX 972633 | DALLAS | TX | 75397 | MEDICAL SERVICE | $220,895 |
| THE ADVISORY BOARD COMPANY | |||||
| PO BOX 79461 | BALTIMORE | MD | 21279 | CONSULTING | $153,580 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 8 | CntrctRcvdGreaterThan100KCnt |
Program Service Revenue ProgramServiceRevenueGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| NET PATIENT REVENUE | 621110 | $66,020,928 | $66,020,928 |
| NET RESEARCH REVENUE | 621110 | $1,665,597 | $1,665,597 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $67,686,525 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $286 | TotalRevenueColumnAmt |
| Exclusion | $286 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $317,976 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $289,216 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $28,760 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $28,760 | TotalRevenueColumnAmt |
| Exclusion | $28,760 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | ExclusionExclusionAmt | Unrelated Business RevenueUnrelatedBusinessRevenueAmt |
|---|---|---|---|---|
| CMS MEANINGFUL USE | 900099 | $778,850 | $778,850 | |
| USI CAPITATION | 900099 | $425,418 | $425,418 | |
| SKIN CARE PRODUCTS | 621110 | $21,236 | $21,236 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $1,225,504 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $68,941,075 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $67,686,525 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $21,236 | UnrelatedBusinessRevenueAmt |
| Exclusion | $1,233,314 | ExclusionAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,854,733 | TotalAmt |
| Program Services | $5,399,460 | ProgramServicesAmt |
| Management And General | $455,273 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $47,931,856 | TotalAmt |
| Program Services | $44,617,691 | ProgramServicesAmt |
| Management And General | $3,314,165 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,170,380 | TotalAmt |
| Program Services | $2,924,771 | ProgramServicesAmt |
| Management And General | $245,609 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,191,276 | TotalAmt |
| Program Services | $3,866,579 | ProgramServicesAmt |
| Management And General | $324,697 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,555,397 | TotalAmt |
| Program Services | $2,357,431 | ProgramServicesAmt |
| Management And General | $197,966 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $341,562 | TotalAmt |
| Management And General | $341,562 | ManagementAndGeneralAmt |
Fees For Services Lobbying FeesForServicesLobbyingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $20,735 | TotalAmt |
| Management And General | $20,735 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,582,825 | TotalAmt |
| Program Services | $2,339,473 | ProgramServicesAmt |
| Management And General | $4,243,352 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $550,383 | TotalAmt |
| Program Services | $427,470 | ProgramServicesAmt |
| Management And General | $122,913 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,980,133 | TotalAmt |
| Program Services | $5,902,527 | ProgramServicesAmt |
| Management And General | $77,606 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $64,772 | TotalAmt |
| Program Services | $26,412 | ProgramServicesAmt |
| Management And General | $38,360 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,576,296 | TotalAmt |
| Program Services | $8,505,134 | ProgramServicesAmt |
| Management And General | $71,162 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $86,571 | TotalAmt |
| Program Services | $71,901 | ProgramServicesAmt |
| Management And General | $14,670 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $470,247 | TotalAmt |
| Program Services | $318,402 | ProgramServicesAmt |
| Management And General | $151,845 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $747,741 | TotalAmt |
| Program Services | $725,549 | ProgramServicesAmt |
| Management And General | $22,192 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $915,933 | TotalAmt |
| Program Services | $648,355 | ProgramServicesAmt |
| Management And General | $267,578 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $88,040,840 | TotalAmt |
| Program Services | $78,131,155 | ProgramServicesAmt |
| Management And General | $9,909,685 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $32,568 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,333,226 | BOYAmt |
| EOY | $7,711,765 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $439,148 | BOYAmt |
| EOY | $449,883 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $9,584,868 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $5,649,682 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,911,965 | BOYAmt |
| EOY | $3,935,186 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,589,117 | BOYAmt |
| EOY | $693,089 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $13,273,456 | BOYAmt |
| EOY | $12,822,491 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,513,361 | BOYAmt |
| EOY | $10,976,961 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,513,361 | BOYAmt |
| EOY | $10,976,961 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,760,095 | BOYAmt |
| EOY | $1,845,530 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,760,095 | BOYAmt |
| EOY | $1,845,530 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $13,273,456 | BOYAmt |
| EOY | $12,822,491 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | -$19,099,765 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $17,185,200 | 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 IV Form990ScheduleAPartIVGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE A, LINE 3: | FormAndLineReferenceDesc |
| Explanation | DEACONESS CLINIC 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 CLINIC 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 | $20,735 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $20,735 | 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 CLINIC 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 | $3,349,412 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,641,588 | DepreciationAmt |
| Book Value | $1,707,824 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $6,203,120 | OtherCostOrOtherBasisAmt |
| Depreciation | $4,008,094 | DepreciationAmt |
| Book Value | $2,195,026 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $32,336 | OtherCostOrOtherBasisAmt |
| Book Value | $32,336 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $3,935,186 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp (3 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| DUE FROM RELATED ORGANIZATION | $455,841 |
| INVESTMENTS IN JOINT VENTURES | $97,818 |
| INTANGIBLES | $139,430 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $693,089 | TotalBookValueOtherAssetsAmt |
| 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 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, 2014 AND 2013, 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. |
| 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) |
|---|---|---|
| Club Dues Or Fees | Yes (X) | ClubDuesOrFeesInd |
| Written Policy Ref T And E Expnss | Yes (1) | WrittenPolicyRefTAndEExpnssInd |
| Substantiation Required | Yes (1) | SubstantiationRequiredInd |
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Independent Consultant | Yes (X) | IndependentConsultantInd |
| Form990 Of Other Organizations | Yes (X) | Form990OfOtherOrganizationsInd |
| 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 (21 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| CHERYL WATHEN | ||||||||||||||
| SECRETARY/TREASURER | $0 | $356,123 | $0 | $112,354 | $0 | $13,945 | $0 | $88,574 | $0 | $43,036 | $0 | $614,032 | $0 | $0 |
| MOHAMMED ALLAW MD | ||||||||||||||
| DIRECTOR | $322,238 | $0 | $51,880 | $0 | $1,896 | $6,608 | $10,357 | $0 | $21,962 | $0 | $408,333 | $6,608 | $0 | $0 |
| AAMANDA BOHLEBER MD | ||||||||||||||
| DIRECTOR | $257,308 | $0 | $12,805 | $0 | $720 | $0 | $18,009 | $0 | $443 | $0 | $289,285 | $0 | $0 | $0 |
| GARY KEEPES MD | ||||||||||||||
| DIRECTOR | $304,294 | $0 | $57,763 | $0 | $1,602 | $0 | $9,736 | $0 | $20,813 | $0 | $394,208 | $0 | $0 | $0 |
| DAVID KOEHLER MD | ||||||||||||||
| DIRECTOR | $158,944 | $92,775 | $21,485 | $17,368 | $720 | $6,600 | $18,009 | $0 | $443 | $0 | $199,601 | $116,743 | $0 | $0 |
| ANNE MCLAUGHLIN MD | ||||||||||||||
| DIRECTOR | $646,195 | $0 | $59,135 | $0 | $1,896 | $0 | $14,046 | $0 | $24,727 | $0 | $745,999 | $0 | $0 | $0 |
| BARRY PHILLIPS MD | ||||||||||||||
| DIRECTOR | $359,298 | $0 | $55,730 | $0 | $1,896 | $4,410 | $9,573 | $0 | $22,398 | $0 | $448,895 | $4,410 | $0 | $0 |
| JAMES PORTER | ||||||||||||||
| DIRECTOR | $0 | $398,080 | $0 | $118,197 | $0 | $93,558 | $0 | $106,099 | $0 | $29,313 | $0 | $745,247 | $0 | $88,062 |
| BRUCE SCHNEIDER MD | ||||||||||||||
| DIRECTOR | $1,367,618 | $0 | $43,897 | $0 | $1,014 | $0 | $23,226 | $0 | $21,962 | $0 | $1,457,717 | $0 | $0 | $0 |
| YOUSSEF SIAGE MD | ||||||||||||||
| DIRECTOR | $231,365 | $0 | $82,175 | $0 | $1,896 | $0 | $14,046 | $0 | $20,896 | $0 | $350,378 | $0 | $0 | $0 |
| RUSTON STOLTZ MD | ||||||||||||||
| DIRECTOR | $274,007 | $0 | $39,474 | $0 | $1,693 | $11,075 | $25,935 | $0 | $21,962 | $0 | $363,071 | $11,075 | $0 | $0 |
| FREDERICK WALLISCH | ||||||||||||||
| DIRECTOR | $245,596 | $0 | $10,245 | $0 | $1,896 | $0 | $21,972 | $0 | $21,962 | $0 | $301,671 | $0 | $0 | $0 |
| LINDA WHITE | ||||||||||||||
| DIRECTOR | $0 | $721,151 | $0 | $294,599 | $0 | $323,957 | $0 | $221,244 | $0 | $21,095 | $0 | $1,582,046 | $0 | $308,155 |
| DAVID CHRISTESON MD | ||||||||||||||
| DIRECTOR/ FORMER CPAO | $329,644 | $0 | $84,121 | $0 | $1,896 | $0 | $39,290 | $0 | $23,389 | $0 | $478,340 | $0 | $0 | $0 |
| W ALLEN WHITE MD | ||||||||||||||
| NON-VOTING DIRECT/ VICE PRESIDENT | $292,530 | $0 | $48,924 | $0 | $1,014 | $0 | $29,235 | $0 | $22,763 | $0 | $394,466 | $0 | $0 | $0 |
| JULIE DINGMAN | ||||||||||||||
| PRACTICE DIRECTOR | $130,616 | $0 | $20,990 | $0 | $932 | $0 | $13,532 | $0 | $14,138 | $0 | $180,208 | $0 | $0 | $0 |
| MAQBOOL AHMED MD | ||||||||||||||
| MD | $882,586 | $0 | $177,546 | $0 | $1,896 | $0 | $14,046 | $0 | $21,962 | $0 | $1,098,036 | $0 | $0 | $0 |
| PAUL SIAMI MD | ||||||||||||||
| MD | $859,251 | $0 | $85,931 | $0 | $720 | $0 | $21,973 | $0 | $15,438 | $0 | $983,313 | $0 | $0 | $0 |
| JEFFREY MOORE MD | ||||||||||||||
| MD | $772,565 | $0 | $31,266 | $0 | $1,896 | $0 | $24,625 | $0 | $19,544 | $0 | $849,896 | $0 | $0 | $0 |
| CHRISTOPHER BRADEN MD | ||||||||||||||
| MD | $750,949 | $0 | $33,814 | $0 | $1,692 | $594 | $14,046 | $0 | $25,762 | $0 | $826,263 | $594 | $0 | $0 |
| ANVITA SINHA MD | ||||||||||||||
| MD | $767,696 | $0 | $4,123 | $0 | $720 | $0 | $18,126 | $0 | $8,086 | $0 | $798,751 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 1A | SOCIAL CLUB DUES ARE PAID FOR LINDA WHITE FOR ORGANIZATION BUSINESS ONLY. ANY PERSONAL USE OF THE CLUB MUST BE PAID BY THE EMPLOYEE. |
| PART I, LINE 4B | SEVERANCE, NONQUALIFIED, AND EQUITY-BASED PAYMENTS: SEVERANCE NONQUALIFIED EQUITY-BASED CHERYL WATHEN $ -0- $17,500 -0- DAVID CHRISTESON, MD 0 17,500 0 GARY KEEPES, MD 0 17,500 0 DAVID KOEHLER, MD 0 17,500 0 ANNE MCLAUGHLIN, MD 0 17,500 0 YOUSSEF SIAGE, MD 0 17,500 0 RUSTON STOLTZ, MD 0 17,500 0 LINDA WHITE 0 17,500 0 W. ALLEN WHITE, MD 0 17,500 0 MAQBOOL AHMED, MD 0 17,500 0 PAUL SIAMI, MD 0 17,500 0 JEFFREY MOORE, MD 0 17,500 0 SEVERANCE NONQUALIFIED EQUITY-BASED (CONT.) JAMES R. PORTER $ -0- $17,500 $ -0- PART 1, LINE 4B: CHERYL WATHEN: SUPPLEMENTAL ACCUMULATION ACCOUNT CONTRIBUTIONS OF $73,274. JAMES PORTER: SUPPLEMENTAL ACCUMULATION ACCOUNT CONTRIBUTIONS OF $90,799. SUPPLEMENTAL ACCUMULATION ACCOUNT PAYOUT OF $88,062. LINDA WHITE: SUPPLEMENTAL ACCUMULATION ACCOUNT CONTRIBUTIONS OF $205,955. SUPPLEMENTAL ACCUMULATION ACCOUNT PAYOUT OF $308,155. |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (9 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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 CLINIC, INC. |
| FORM 990, PART VI, SECTION A, LINE 7A | ELECTION OF MEMBERS AND THEIR RIGHTS: DEACONESS HEALTH SYSTEM, INC. MUST APPROVE THE SELECTED DEACONESS CLINIC VICE PRESIDENT, FORMALLY KNOWN AS CHIEF PHYSICIAN ADMINISTRATIVE OFFICER (CPAO). |
| FORM 990, PART VI, SECTION A, LINE 7B | GOVERNANCE DECISIONS: APPOINTMENT OF THE VICE PRESIDENT, FORMALLY KNOWN AS CHIEF PHYSICIAN ADMINISTRATIVE OFFICER (CPAO), REQUIRES APPROVAL OF THE SOLE CORPORATE MEMBER; AND, CHANGES TO THE PHYSICIAN COMPENSATION PLAN REQUIRES THE APPROVAL OF THE SOLE CORPORATE MEMBER THROUGH ITS COMPENSATION COMMITTEE WHICH IS COMPRISED OF INDEPENDENT MEMBERS OF THE DEACONESS HEALTH SYSTEM BOARD. |
| FORM 990, PART VI, SECTION B, LINE 11 | THE PROCESS THAT DEACONESS CLINIC UTILIZES TO PRESENT THE FORM 990 TO ITS GOVERNING BODY PRIOR TO FILING IS TO PRESENT THE FORM 990 TO THE 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 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 CLINIC 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 15A | COMPENSATION FOR TOP OFFICIALS AND OTHER OFFICERS: SALARIES AND BENEFITS OF OFFICERS AND PHYSICIANS AT DEACONESS CLINIC ARE APPROVED BY THE DEACONESS HEALTH SYSTEM COMPENSATION COMMITTEE. DEACONESS CLINIC BOARD CAN ONLY MAKE RECOMMENDATION 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 CPAO 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, CPAO 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 CLINIC'S ARTICLES OF INCORPORATION ARE AVAILABLE ON THE SECRETARY OF STATE'S WEBSITE. AS REQUIRED BY LAW, DEACONESS CLINIC 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 17,185,200. |
| 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 (2 entries)
| Address Line1USAddress/AddressLine1 | CityUSAddress/City | StateUSAddress/State | ZIP CodeUSAddress/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Direct Controlling NADirectControllingNACd | Controlled OrganizationControlledOrganizationInd | Business Name Line1DirectControllingEntityName/BusinessNameLine1 |
|---|---|---|---|---|---|---|---|---|---|---|---|
| DEACONESS HEALTH SYSTEM INC | |||||||||||
| 600 MARY STREET | EVANSVILLE | IN | 47747 | 351532889 | HEALTHCARE | IN | 501(C)(3) | LINE 11A, 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 | |
| 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 |