DEACONESS CLINIC INC: Form 990, tax year 2012
View the entire original 990 at ProPublica ↗
- Organization
- DEACONESS CLINIC INC (EIN 26-3083364)
- Tax period
- 2012-10-01 to 2013-09-30
- Filed
- 2014-05-10
- IRS object ID
- 201411309349300206
- Schema version
- 2012v2.1
- 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) |
|---|---|---|
| Timestamp | 2014-05-10T12:53:42-05:00 | Timestamp |
| Tax Period End Date | 2013-09-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 351178661 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BLUE & CO LLC | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| 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 | ReturnType |
| Tax Period Begin Date | 2012-10-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 263083364 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DEACONESS CLINIC INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | DEAC | NameControl |
| Phone | 8124503296 | Phone |
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 |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | ALLEN WHITE MD | Name |
| Title | CPAO | Title |
| Phone | 8124503296 | Phone |
| Date Signed | 2014-05-08 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | AMBER KOCHER CPA | Name |
| PTIN | P01286298 | PTIN |
| Phone | 3176334705 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2012 | TaxYear |
| Build TS | 2015-11-30 17:44:51Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | ALLEN WHITE MD | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| 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 | 61262128 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | DEACONESS.COM | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 2008 | YearFormation |
| State Legal Domicile | IN | StateLegalDomicile |
| Activity Or Mission Description | 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 AREAS;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. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 14 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 1 | NbrIndependentVotingMembers |
| Total Nbr Employees | 653 | TotalNbrEmployees |
| Total Nbr Volunteers | 0 | TotalNbrVolunteers |
| Total Gross UBI | 43748 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 3279 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 0 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 0 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 53813247 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 59283657 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 0 | InvestmentIncomePriorYear |
| Investment Income Current Year | 168505 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 1879933 | OtherRevenuePriorYear |
| Other Revenue Current Year | 1393775 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 55693180 | TotalRevenuePriorYear |
| Total Revenue Current Year | 60845937 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 0 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 52308474 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 57652941 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 21441281 | OtherExpensePriorYear |
| Other Expenses Current Year | 23091586 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 73749755 | TotalExpensesPriorYear |
| Total Expenses Current Year | 80744527 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | -18056575 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | -19898590 | RevenuesLessExpensesCY |
| Total Assets BOY | 11950468 | TotalAssetsBOY |
| Total Assets EOY | 13273456 | TotalAssetsEOY |
| Total Liabilities BOY | 8905046 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 9513361 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 3045422 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 3760095 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | NONE | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 71484601 | Expense |
| Revenue | 57281525 | Revenue |
| Description | 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 95 PHYSICIANS, 27 MIDLEVEL PROVIDERS AND 396 FULL TIME NURSING AND ADMINISTRATIVE FULL TIME EQUIVALENTS. DEACONESS CLINIC SERVES A 25-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 482,288 PATIENT VISITS FROM OCTOBER 1, 2012 THROUGH SEPTEMBER 2013. | Description |
Activity2 Activity2
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 1603670 | Expense |
| Revenue | 2002132 | Revenue |
| Description | 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 37 NEW AND EXPANDED CLINICAL RESEARCH GRANTS THIS YEAR TO STUDY INVESTIGATIONAL DRUGS AND DEVICES ACROSS 12 FIELDS OF MEDICINE INCLUDING NEW TREATMENTS FOR AUTISM, OBESITY, OSTEOPOROSIS, BLADDER CANCER,DIABETIC FOOT ULCERS, COPD, DEPRESSION, CAROTID STENTING, AND NUMEROUS CARDIAC IMPLANTABLE DEVICES. THE NEW RESEARCH GRANTS PROVIDED TREATMENT OPPORTUNITES AND PREVENTATIVE HEALTH SERVICES FOR UP TO 514 PATIENTS. IN ALL, THE NEWLLY AWARDED GRANTS THIS YEAR TOTALED $6.9 MILLION TO COVER THE COSTS 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 3,121 RESEARCH RELATED PATIENT VISITS. THE RESEARCH INSTITUTE ALSO CONTINUED THE EXPLORATION OF A NUMBER OF INVESTIGATOR INITIATED RESEARCH PROJECTS IN SUPPORT OF MEDICAL ADVANCEMENTS INCLUDING: ALLERGENIC FOOD SUPPLEMENT FOR INFANTS; THE EFFECTIVENESS OF DOWN TITRATION OF A NEW MEDICATION FOR URTICARIA; THE EARLY DETECTION OF BLADDER CANCER; A PAIN TREATMENT OF CARPAL TUNNEL PAIN; AND THE LONG TERM EFFICACY OF HISTERLIN ABDOMINAL IMPLANTS IN PATIENTS WITH PROSTATE CANCER. THE INSTITUTE OVERSAW THE TRAINING OF SEVEN NEW CLINICAL INVESTIGATORS IN 2013, INCLUDING THEIR RESEARCH CERTIFICATION THROUGH THE NATIONAL INSTITUTE OF HEALTH IN GOOD CLINICAL PRACTICE AND THE PROTECTION OF HUMAN SUBJECTS. | Description |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expense | 73088271 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 0 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 1 | LobbyingActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 0 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 1 | ReportOtherAssets |
| Report Other Liabilities | 0 | ReportOtherLiabilities |
| Report Fin48 Footnote | 1 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 0 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 1 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 0 | Hospital |
| Grants To Organizations | 0 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 0 | TaxExemptBonds |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 0 | RelatedOrgControlledEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 89 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 653 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 1 | UnrelatedBusinessIncome |
| Form990-T Filed | 1 | Form990-TFiled |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 14 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 1 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 1 | MembersOrStockholders |
| Election Of Board Members | 1 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 1 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 1 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 0 | CompensationProcessOther |
| Investment In Joint Venture | 1 | InvestmentInJointVenture |
| Written Policy Or Procedure | 1 | WrittenPolicyOrProcedure |
| States Where Copy Of Return Is Filed | IN | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RICHARD PERRY | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 8124503296 | TelephoneNumber |
Address US AddressUS
| 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 Form990PartVIISectionA (24 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Average Hours Per Week RelatedAverageHoursPerWeekRelated | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Key EmployeeKeyEmployee | Highest Compensated EmployeeHighestCompensatedEmployee | FormerFormer |
|---|---|---|---|---|---|---|---|---|---|---|
| STEPHEN TITZER | ||||||||||
| CHAIRMAN | 5.00 | 10.00 | X | X | 1200 | 6000 | 0 | |||
| CHERYL WATHEN | ||||||||||
| SECRETARY/TREASURER | 5.00 | 55.00 | X | X | 0 | 454077 | 107341 | |||
| DAVID CHRISTESON MD | ||||||||||
| CPAO | 50.00 | 0.00 | X | X | 427911 | 0 | 59348 | |||
| MOHAMMED ALLAW MD | ||||||||||
| DIRECTOR | 50.00 | 5.00 | X | 352751 | 22519 | 31160 | ||||
| AMANDA E BOHLEBER MD | ||||||||||
| DIRECTOR | 50.00 | 0.00 | X | 248327 | 0 | 13814 | ||||
| GARY KEEPES MD | ||||||||||
| DIRECTOR | 50.00 | 0.00 | X | 346192 | 0 | 29781 | ||||
| DAVID KOEHLER MD | ||||||||||
| DIRECTOR | 30.00 | 20.00 | X | 167939 | 98015 | 14420 | ||||
| ANNE MCLAUGHLIN MD | ||||||||||
| DIRECTOR | 50.00 | 0.00 | X | 659918 | 0 | 49650 | ||||
| BARRY PHILLIPS MD | ||||||||||
| DIRECTOR | 50.00 | 2.00 | X | 409102 | 5400 | 30334 | ||||
| BRUCE SCHNEIDER MD | ||||||||||
| DIRECTOR | 50.00 | 0.00 | X | 1129611 | 0 | 90510 | ||||
| YOUSSEF SIAGE MD | ||||||||||
| DIRECTOR | 50.00 | 0.00 | X | 296274 | 0 | 27433 | ||||
| RUSTON STOLTZ MD | ||||||||||
| DIRECTOR | 50.00 | 9.00 | X | 289826 | 10300 | 39110 | ||||
| FREDERICK WALLISCH | ||||||||||
| DIRECTOR | 50.00 | 0.00 | X | 237594 | 0 | 34371 | ||||
| LINDA WHITE | ||||||||||
| DIRECTOR | 10.00 | 60.00 | X | 0 | 965628 | 242168 | ||||
| W ALLEN WHITE MD | ||||||||||
| NON-VOTING DIRECTOR | 50.00 | 0.00 | X | 329226 | 0 | 50949 | ||||
| JULIE DINGMAN | ||||||||||
| OPERATIONS ADMINISTRATOR | 50.00 | 0.00 | 152491 | 0 | 18672 | X | ||||
| MAQBOOL AHMED MD | ||||||||||
| MD | 50.00 | 0.00 | 1017256 | 0 | 58860 | X | ||||
| PAUL SIAMI MD | ||||||||||
| MD | 50.00 | 0.00 | 1009400 | 0 | 36686 | X | ||||
| JEFFREY MOORE MD | ||||||||||
| MD | 50.00 | 0.00 | 780385 | 0 | 45878 | X | ||||
| MAJED KOLEILAT MD | ||||||||||
| MD | 50.00 | 0.00 | 760151 | 0 | 54091 | X | ||||
| ANVITA SINHA MD | ||||||||||
| MD | 50.00 | 0.00 | 760818 | 0 | 53063 | X | ||||
| GARY ERDY MD | ||||||||||
| FORMER DIRECTOR | 50.00 | 0.00 | 119182 | 0 | 19827 | X | ||||
| JAMES GUTMANN MD | ||||||||||
| FORMER DIRECTOR | 50.00 | 0.00 | 278610 | 0 | 43900 | X | ||||
| ROBERT KAYLOR | ||||||||||
| FORMER DIRECTOR | 50.00 | 0.00 | 284782 | 0 | 14739 | X | ||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 10058946 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 1561939 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 1166105 | TotalOtherCompensation |
| Number Individuals GT100 K | 96 | NumberIndividualsGT100K |
| Formers Listed | 1 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| WINK CONSTRUCTION | |||||
| 4001 E EICHEL AVE | EVANSVILLE | IN | 47716 | CONSTRUCTION | 297529 |
| WEATHERBY LOCUMS INC | |||||
| PO BOX 972633 | DALLAS | TX | 75397 | MEDICAL SERVICE | 246170 |
| THREE I DESIGN | |||||
| 2425 W INDIANA STREET | EVANSVILLE | IN | 47712 | ENGINEERING | 245625 |
| THE ADVISORY BOARD COMPANY | |||||
| PO BOX 79461 | BALTIMORE | MD | 21279 | CONSULTING | 121754 |
| RICHARD RIEDFORD MD | |||||
| 9921 OGELSBY DRIVE | EVANSVILLE | IN | 47720 | MEDICAL SERVICE | 104957 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 5 | NumberOfContractorsGT100K |
Program Service Revenue ProgramServiceRevenue (2 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| NET PATIENT REVENUE | 621110 | 57281525 | 57281525 |
| NET RESEARCH REVENUE | 621110 | 2002132 | 2002132 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 59283657 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 9461 | TotalRevenueColumn |
| Exclusion | $9,461 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 309334 | Real |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 293961 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 15373 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 15373 | TotalRevenueColumn |
| Exclusion | $15,373 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 281274 | Securities |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 122230 | Securities |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 159044 | Securities |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 159044 | TotalRevenueColumn |
| Exclusion | $159,044 | ExclusionAmount |
Other Revenue Misc OtherRevenueMisc (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | ExclusionExclusionAmount | Unrelated Business RevenueUnrelatedBusinessRevenue |
|---|---|---|---|---|
| CMS MEANINGFUL USE | 900099 | 1026000 | $1,026,000 | |
| USI CAPITATION | 900099 | 308654 | $308,654 | |
| SKIN CARE PRODUCTS | 621110 | 43748 | 43748 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 1378402 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 60845937 | TotalRevenueColumn |
| Related Or Exempt Function Income | 59283657 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 43748 | UnrelatedBusinessRevenue |
| Exclusion | $1,518,532 | ExclusionAmount |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 6196046 | Total |
| Program Services | 5705392 | ProgramServices |
| Management And General | 490654 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 42611177 | Total |
| Program Services | 40683433 | ProgramServices |
| Management And General | 1927744 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3868292 | Total |
| Program Services | 3659070 | ProgramServices |
| Management And General | 209222 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2679524 | Total |
| Program Services | 2534598 | ProgramServices |
| Management And General | 144926 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2297902 | Total |
| Program Services | 2173617 | ProgramServices |
| Management And General | 124285 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 298760 | Total |
| Program Services | 47747 | ProgramServices |
| Management And General | 251013 | ManagementAndGeneral |
Fees For Services Lobbying FeesForServicesLobbying
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 22122 | Total |
| Management And General | 22122 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 5402167 | Total |
| Program Services | 1900503 | ProgramServices |
| Management And General | 3501664 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 797906 | Total |
| Program Services | 505036 | ProgramServices |
| Management And General | 292870 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4796876 | Total |
| Program Services | 4690657 | ProgramServices |
| Management And General | 106219 | ManagementAndGeneral |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1343757 | Total |
| Program Services | 1283079 | ProgramServices |
| Management And General | 60678 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 7726807 | Total |
| Program Services | 7582658 | ProgramServices |
| Management And General | 144149 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 110020 | Total |
| Program Services | 102820 | ProgramServices |
| Management And General | 7200 | ManagementAndGeneral |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 460379 | Total |
| Program Services | 298514 | ProgramServices |
| Management And General | 161865 | ManagementAndGeneral |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1202349 | Total |
| Program Services | 1140154 | ProgramServices |
| Management And General | 62195 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 930443 | Total |
| Program Services | 780993 | ProgramServices |
| Management And General | 149450 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 80744527 | Total |
| Program Services | 73088271 | ProgramServices |
| Management And General | 7656256 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6865103 | BOY |
| EOY | 7333226 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 428929 | BOY |
| EOY | 439148 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 8813999 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 4902034 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3476492 | BOY |
| EOY | 3911965 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 122230 | BOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1057714 | BOY |
| EOY | 1589117 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 11950468 | BOY |
| EOY | 13273456 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 8905046 | BOY |
| EOY | 9513361 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 8905046 | BOY |
| EOY | 9513361 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3045422 | BOY |
| EOY | 3760095 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3045422 | BOY |
| EOY | 3760095 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 11950468 | BOY |
| EOY | 13273456 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | -19898590 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | 20613263 | ReconcilationOtherChanges |
| Info In Schedule O Part XII | X | InfoInScheduleOPartXII |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
FS Audited Basis FSAuditedBasis
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | 1 | AuditCommittee |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
| General Explanation | SCHEDULE A, PART IV, SUPPLEMENTAL INFORMATION: SCHEDULE A, LINE 3: 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 SIMILARLY 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. | GeneralExplanation |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | Volunteers |
| Paid Staff Or Management | 0 | PaidStaffOrManagement |
| Media Advertisements | 0 | MediaAdvertisements |
| Mailings Members | 0 | MailingsMembers |
| Publications Or Broadcast | 0 | PublicationsOrBroadcast |
| Grants Other Organizations | 0 | GrantsOtherOrganizations |
| Direct Contact Legislators | 0 | DirectContactLegislators |
| Rallies Demonstrations | 0 | RalliesDemonstrations |
| Other Activities | 1 | OtherActivities |
| Other Activities | $22,122 | OtherActivitiesAmount |
| Total Lobbying Expenditures IIB | 22122 | TotalLobbyingExpendituresIIB |
| Not Described In501c3 | 0 | NotDescribedIn501c3 |
Form990 Schedule C Part IV Form990ScheduleCPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | EXPLANATION OF LOBBYING ACTIVITIES: | Identifier |
| Return Reference | PART II-B, LINE 1: | ReturnReference |
| 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. | Explanation |
Schedule D IRS990ScheduleD
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 2848792 | OtherCostOrOtherBasis |
| Depreciation | 1452820 | Depreciation |
| Book Value | 1395972 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 5748305 | OtherCostOrOtherBasis |
| Depreciation | 3449214 | Depreciation |
| Book Value | 2299091 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 216902 | OtherCostOrOtherBasis |
| Book Value | 216902 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 3911965 | TotalOfBookValueLandBuildings |
Other Assets OtherAssets (3 entries)
| DescriptionDescription | Book ValueBookValue |
|---|---|
| DUE FROM RELATED ORGANIZATION | 1442439 |
| INVESTMENTS IN JOINT VENTURES | 97818 |
| INTANGIBLES | 48860 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | 1589117 | TotalBookValueOtherAssets |
| Footnote In Part XIII | X | FootnoteInPartXIII |
Form990 Schedule D Part XIII Form990ScheduleDPartXIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: | Identifier |
| Return Reference | PART X, LINE 2: | ReturnReference |
| Explanation | 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, 2013 AND 2012, 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. | Explanation |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Club Dues Or Fees | X | ClubDuesOrFees |
| Written Policy Re T And E Expenses | 1 | WrittenPolicyReTAndEExpenses |
| Substantiation Required | 1 | SubstantiationRequired |
| Compensation Committee | X | CompensationCommittee |
| Independent Consultant | X | IndependentConsultant |
| Form990 Of Other Organizations | X | Form990OfOtherOrganizations |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 1 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (23 entries)
| TitleTitle | Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| CHERYL WATHEN | ||||||||||||||
| SECRETARY/TREASURER | 0 | 318546 | 0 | 121875 | 0 | 13656 | 0 | 66429 | 0 | 40912 | 0 | 561418 | 0 | 0 |
| DAVID CHRISTESON MD | ||||||||||||||
| CPAO | 328661 | 0 | 97399 | 0 | 1851 | 0 | 37888 | 0 | 21460 | 0 | 487259 | 0 | 0 | 0 |
| MOHAMMED ALLAW MD | ||||||||||||||
| DIRECTOR | 303687 | 0 | 47213 | 0 | 1851 | 22519 | 11217 | 0 | 19943 | 0 | 383911 | 22519 | 0 | 0 |
| AMANDA E BOHLEBER MD | ||||||||||||||
| DIRECTOR | 238237 | 0 | 9370 | 0 | 720 | 0 | 13371 | 0 | 443 | 0 | 262141 | 0 | 0 | 0 |
| GARY KEEPES MD | ||||||||||||||
| DIRECTOR | 288789 | 0 | 55835 | 0 | 1568 | 0 | 10761 | 0 | 19020 | 0 | 375973 | 0 | 0 | 0 |
| DAVID KOEHLER MD | ||||||||||||||
| DIRECTOR | 167939 | 98015 | 0 | 0 | 0 | 0 | 14420 | 0 | 0 | 0 | 182359 | 98015 | 0 | 0 |
| ANNE MCLAUGHLIN MD | ||||||||||||||
| DIRECTOR | 608507 | 0 | 49560 | 0 | 1851 | 0 | 29205 | 0 | 20445 | 0 | 709568 | 0 | 0 | 0 |
| BARRY PHILLIPS MD | ||||||||||||||
| DIRECTOR | 350010 | 0 | 57241 | 0 | 1851 | 5400 | 10391 | 0 | 19943 | 0 | 439436 | 5400 | 0 | 0 |
| BRUCE SCHNEIDER MD | ||||||||||||||
| DIRECTOR | 1094244 | 0 | 34364 | 0 | 1003 | 0 | 70567 | 0 | 19943 | 0 | 1220121 | 0 | 0 | 0 |
| YOUSSEF SIAGE MD | ||||||||||||||
| DIRECTOR | 232059 | 0 | 62364 | 0 | 1851 | 0 | 13170 | 0 | 14263 | 0 | 323707 | 0 | 0 | 0 |
| RUSTON STOLTZ MD | ||||||||||||||
| DIRECTOR | 249249 | 0 | 38726 | 0 | 1851 | 10300 | 19167 | 0 | 19943 | 0 | 328936 | 10300 | 0 | 0 |
| FREDERICK WALLISCH | ||||||||||||||
| DIRECTOR | 225720 | 0 | 10023 | 0 | 1851 | 0 | 14428 | 0 | 19943 | 0 | 271965 | 0 | 0 | 0 |
| LINDA WHITE | ||||||||||||||
| DIRECTOR | 0 | 628856 | 0 | 320304 | 0 | 16468 | 0 | 221738 | 0 | 20430 | 0 | 1207796 | 0 | 0 |
| W ALLEN WHITE MD | ||||||||||||||
| NON-VOTING DIRECTOR | 271913 | 0 | 56310 | 0 | 1003 | 0 | 30529 | 0 | 20420 | 0 | 380175 | 0 | 0 | 0 |
| JULIE DINGMAN | ||||||||||||||
| OPERATIONS ADMINISTRATOR | 128237 | 0 | 23774 | 0 | 480 | 0 | 17190 | 0 | 1482 | 0 | 171163 | 0 | 0 | 0 |
| MAQBOOL AHMED MD | ||||||||||||||
| MD | 842183 | 0 | 173222 | 0 | 1851 | 0 | 38917 | 0 | 19943 | 0 | 1076116 | 0 | 0 | 0 |
| PAUL SIAMI MD | ||||||||||||||
| MD | 917462 | 0 | 90574 | 0 | 1364 | 0 | 21181 | 0 | 15505 | 0 | 1046086 | 0 | 0 | 0 |
| JEFFREY MOORE MD | ||||||||||||||
| MD | 686482 | 0 | 92052 | 0 | 1851 | 0 | 22485 | 0 | 23393 | 0 | 826263 | 0 | 0 | 0 |
| MAJED KOLEILAT MD | ||||||||||||||
| MD | 690421 | 0 | 67880 | 0 | 1850 | 0 | 32321 | 0 | 21770 | 0 | 814242 | 0 | 0 | 0 |
| ANVITA SINHA MD | ||||||||||||||
| MD | 755169 | 0 | 4929 | 0 | 720 | 0 | 45725 | 0 | 7338 | 0 | 813881 | 0 | 0 | 0 |
| GARY ERDY MD | ||||||||||||||
| FORMER DIRECTOR | 109133 | 0 | 9041 | 0 | 1008 | 0 | 9711 | 0 | 10116 | 0 | 139009 | 0 | 0 | 0 |
| JAMES GUTMANN MD | ||||||||||||||
| FORMER DIRECTOR | 188618 | 0 | 89001 | 0 | 991 | 0 | 22735 | 0 | 21165 | 0 | 322510 | 0 | 0 | 0 |
| ROBERT KAYLOR | ||||||||||||||
| FORMER DIRECTOR | 243059 | 0 | 41508 | 0 | 215 | 0 | 0 | 0 | 14739 | 0 | 299521 | 0 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)
| Return ReferenceReturnReference | ExplanationExplanation |
|---|---|
| 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- $17,000 -0- DAVID CHRISTESON, MD 0 17,000 0 GARY KEEPES, MD 0 17,000 0 DAVID KOEHLER, MD 0 17,000 0 ANNE MCLAUGHLIN, MD 0 17,000 0 YOUSSEF SIAGE, MD 0 17,000 0 RUSTON STOLTZ, MD 0 17,000 0 LINDA WHITE 0 17,000 0 W. ALLEN WHITE, MD 0 17,000 0 MAQBOOL AHMED, MD 0 17,000 0 PAUL SIAMI, MD 0 17,000 0 JEFFREY MOORE, MD 0 17,000 0 MAJED KOLEILAT, MD 0 17,000 0 SEVERANCE NONQUALIFIED EQUITY-BASED (CONT.) GARY ERDY, MD $ -0- $11,551 $ -0- PART 1, LINE 4B: CHERYL WATHEN: SUPPLEMENTAL ACCUMULATION ACCOUNT CONTRIBUTIONS OF $51,429. LINDA WHITE: SUPPLEMENTAL ACCUMULATION ACCOUNT CONTRIBUTIONS OF $206,738. |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (10 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| 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 THE DEACONESS HEALTH SYSTEM, INC. MUST APPROVE THE CHOSEN DEACONESS CLINIC CHIEF PHYSICIAN ADMINISTRATIVE OFFICER | |
| FORM 990, PART VI, SECTION A, LINE 7B | APPOINTMENT OF CHIEF PHYSICIAN ADMINISTRATIVE OFFICER (CPAO) REQUIRES APPROVAL OF THE MEMBER. CHANGES TO PHYSICIAN COMPENSATION PLAN REQUIRES THE APPROVAL OF THE 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. | |
| OFFICERS WHO CANNOT BE REACHED: GARY ERDY, MD 1045 APT C SEACOVE CIRCLE LONDON, OH 43140 | ||
| 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 20,613,263. | CHANGES IN NET ASSETS OR FUND BALANCES: |
| FORM 990, PART XII, LINE 2C | 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. | OVERSIGHT OF AUDIT |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (2 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Direct Controlling Entity NADirectControllingEntityNA | Controlled OrgControlledOrg | 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 Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 0 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 1 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| Dividends Related Organization | 0 | DividendsRelatedOrganization |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 0 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 1 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 0 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 0 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 0 | SharingOfFacilities |
| Sharing Of Paid Employees | 0 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 1 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 0 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |