DEACONESS CLINIC INC: Form 990, tax year 2010
View the entire original 990 at ProPublica ↗
- Organization
- DEACONESS CLINIC INC (EIN 26-3083364)
- Tax period
- 2010-10-01 to 2011-09-30
- Filed
- 2012-03-05
- IRS object ID
- 201220659349300307
- Schema version
- 2010v3.4
- 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 | 2012-03-05T08:22:05-06:00 | Timestamp |
| Tax Period End Date | 2011-09-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
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 | 2010-10-01 | 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 | 8124502370 | 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 | DAVID D CHRISTESON | Name |
| Title | CPAO | Title |
| Phone | 8124502370 | Phone |
| Date Signed | 2012-03-05 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | ANGELA L ZIRKELBACH CPA | Name |
| Phone | 3176334705 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2010 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | DAVID D CHRISTESON MD | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 600 MARY STREET | AddressLine1 |
| City | EVANSVILLE | City |
| State | IN | State |
| ZIP Code | 47747 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 52277158 | 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 | PROVIDE HEALTH CARE AND HEALTH-RELATED EDUCATION FOR THE BENEFIT OF THE COMMUNITY IN A SYSTEMATIC, INTEGRATED AND COORDINATED FASHION WITH DEACONESS HOSPITAL AND ALL OTHER DEACONESS HEALTH SYSTEM AFFILIATES. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 14 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 1 | NbrIndependentVotingMembers |
| Total Nbr Employees | 625 | TotalNbrEmployees |
| Total Nbr Volunteers | 0 | TotalNbrVolunteers |
| Total Gross UBI | 63188 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 9539 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 0 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 0 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 48105216 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 51908995 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 3154 | InvestmentIncomePriorYear |
| Investment Income Current Year | 3154 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 39864 | OtherRevenuePriorYear |
| Other Revenue Current Year | 71995 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 48148234 | TotalRevenuePriorYear |
| Total Revenue Current Year | 51984144 | 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 | 47392400 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 49264601 | 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 | 21526026 | OtherExpensePriorYear |
| Other Expenses Current Year | 21731493 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 68918426 | TotalExpensesPriorYear |
| Total Expenses Current Year | 70996094 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | -20770192 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | -19011950 | RevenuesLessExpensesCY |
| Total Assets BOY | 12242500 | TotalAssetsBOY |
| Total Assets EOY | 14642852 | TotalAssetsEOY |
| Total Liabilities BOY | 7766003 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 11344785 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 4476497 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 3298067 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| 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 INCLUDE (AMONG OTHERS):TO DELIVER HEALTH CARE TO THE PUBLIC;TO CARRY OUT SCIENTIFIC RESEARCH AND RESEARCH PROJECTS IN THE PUBLIC INTEREST IN THE FIELDS OF MEDICAL SCIENCES, MEDICAL ECONOMICS,PUBLIC HEALTH, SOCIOLOGY, AND RELATED AREAS;TO IMPROVE AND DEVELOP THE CAPABILITIES OF INDIVIDUALS AND INSTITUTIONS STUDYING, TEACHING, AND PRACTICING MEDICINE AND OTHER HEALTH OCCUPATIONS;TO PROVIDE HEALTH CARE 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. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 60750914 | Expense |
| Grants | 0 | Grants |
| Revenue | 49957118 | Revenue |
| Description | PATIENT SERVICES REVENUE-DEACONESS CLINIC IS A MAJOR SOURCE OF MEDICAL SERVICES WHICH ENCOMPASSES A BROAD SPECTRUM OF EXPERTISE, REPRESENTING MORE THAN 19 MEDICAL AND SURGICAL SPECIALTIES. DEACONESS CLINIC EMPLOYS 91 PHYSICIANS, 21 MIDLEVEL PROVIDERS AND 335 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 404,267 PATIENT VISITS FROM OCTOBER 1, 2010 THROUGH SEPTEMBER 2011. | Description |
Activity2 Activity2
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 1530665 | Expense |
| Grants | 0 | Grants |
| Revenue | 1951877 | Revenue |
| Description | THE RESEARCH INSTITUTE OF DEACONESS CLINIC ASSISTS DEACONESS CLINIC'S NEARLY 100 PHYSICIANS, AS WELL AS OTHER PHYSICIANS IN THE COMMUNITY IN GAINING ACCESS TO LEADING EDGE MEDICAL SCIENCE AND NEW TREATMENTS FOR ACUTE AND CHRONIC ILLNESSES. THE INSTITUTE WAS AWARDED 50 NEW CLINICAL RESEARCH GRANTS THIS YEAR TO STUDY INVESTIGATIONAL TREATMENTS ACROSS 11 FIELDS OF MEDICINE INCLUDING HEART DISEASE, CANCER, DIABETES, UROLOGICAL DISORDERS, DEPRESSION, ARTHRITIC CONDITIONS, AND DERMATOLOGICAL DISORDERS. THE NEW RESEARCH GRANTS PROVIDED TREATMENT OPPORTUNITIES AND PREVENTATIVE HEALTH SERVICES FOR UP TO 737 PATIENTS. IN ALL, THE NEWLY AWARDED GRANTS THIS YEAR TOTALED $5.3 MILLION TO COVER THE COSTS ASSOCIATED WITH THE CONDUCT OF THE CLINICAL TRIALS WITHIN THE REGION. 501 PATIENTS WERE ENROLLED INTO CLINICAL TRIALS THROUGHOUT THE YEAR, RESULTING IN 4,468 RESEARCH RELATED PATIENT VISITS. THE RESEARCH INSTITUTE ALSO SUCCESSFULLY COMPLETED AN INSPECTION BY THE FOOD AND DRUG ADMINISTRATION. IN ADDITION, RESEARCH CONDUCTED BY THE RESEARCH INSTITUTE AND SELECTED DEACONESS INVESTIGATORS RECEIVED NATIONAL RECOGNITION THROUGH PUBLICATION IN THE JOURNAL OF NEONATOLOGY, AND THE JOURNAL OF NEUROUROLOGY AND URODYNAMICS DURING FISCAL YEAR 2011. | Description |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expense | 62281579 | 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 | 1 | 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 |
| Transaction Related Entity | 0 | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 100 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 625 | 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 | 1 | 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 | 8124502370 | 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 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | X | InfoInScheduleOPartVII |
Form990 Part VII Section A Form990PartVIISectionA (22 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Highest Compensated EmployeeHighestCompensatedEmployee | FormerFormer |
|---|---|---|---|---|---|---|---|---|
| ROBERT WRIGHT | ||||||||
| CHAIRMAN | 5.00 | X | X | 2800 | 9400 | 0 | ||
| MOHAMMED ALLAW MD | ||||||||
| DIRECTOR | 50.00 | X | 378856 | 26033 | 34882 | |||
| AMANDA E BOHLEBER MD | ||||||||
| DIRECTOR | 50.00 | X | 216018 | 12450 | 0 | |||
| GARY ERDY MD | ||||||||
| DIRECTOR | 50.00 | X | 332767 | 0 | 38174 | |||
| JAMES GUTMANN MD | ||||||||
| DIRECTOR | 50.00 | X | 281304 | 0 | 36917 | |||
| ROBERT KAYLOR | ||||||||
| DIRECTOR | 50.00 | X | 278247 | 0 | 19574 | |||
| GARY KEEPS MD | ||||||||
| DIRECTOR | 50.00 | X | 342203 | 0 | 32445 | |||
| ANNE MCLAUGHLIN MD | ||||||||
| DIRECTOR | 50.00 | X | 723772 | 0 | 30392 | |||
| BARRY PHILLIPS MD | ||||||||
| DIRECTOR | 50.00 | X | 364418 | 4770 | 32118 | |||
| BRUCE SCHNEIDER MD | ||||||||
| DIRECTOR | 50.00 | X | 1190839 | 1600 | 39620 | |||
| RUSTON STOLTZ MD | ||||||||
| DIRECTOR | 50.00 | X | 298575 | 2708 | 13541 | |||
| W ALLEN WHITE MD | ||||||||
| DIRECTOR | 50.00 | X | 259747 | 0 | 49317 | |||
| LINDA WHITE | ||||||||
| DIRECTOR | 70.00 | X | 0 | 697993 | 199407 | |||
| DAVID CHRISTESON MD | ||||||||
| CPAO | 50.00 | X | X | 427427 | 0 | 55433 | ||
| RICHARD STIVERS | ||||||||
| SEC/TREAS. TERM FEB2010 | 60.00 | X | X | 0 | 601532 | 59177 | ||
| CHERYL WATHEN | ||||||||
| SEC/TREAS. BEG.MAR2010 | 60.00 | X | X | 0 | 257268 | 53876 | ||
| MAQBOOL AHMED MD | ||||||||
| MD | 50.00 | 1655066 | 0 | 33542 | X | |||
| DANIEL SHIREY MD | ||||||||
| MD | 50.00 | 1277948 | 0 | 24971 | X | |||
| PAUL SIAMI MD | ||||||||
| MD | 50.00 | 958012 | 0 | 35705 | X | |||
| ANVITA SINHA MD | ||||||||
| MD | 50.00 | 805825 | 0 | 19426 | X | |||
| JEFFREY MOORE MD | ||||||||
| MD | 50.00 | 738435 | 0 | 46140 | X | |||
| THOMAS W DAVIDSON | ||||||||
| FORMER OFFICER | 50.00 | 255434 | 0 | 262112 | X | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 10787693 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 1613754 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 1116769 | TotalOtherCompensation |
| Number Individuals GT100 K | 92 | NumberIndividualsGT100K |
| Formers Listed | 1 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (4 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| BILL DUNBAR & ASSOCIATES LLC | |||||
| 2601 FORTUNE CIRCLE EAST | INDIANAPOLIS | IN | 46241 | CONSULTING | 413512 |
| DANCO CONSTRUCTION | |||||
| 3201 INTERSTATE DRIVE | EVANSVILLE | IN | 47715 | CONSTRUCTION | 315120 |
| TRI-STATE ENT | |||||
| 350 W COLUMBIA ST | EVANSVILLE | IN | 47710 | MEDICAL | 157400 |
| JE SHEKELL | |||||
| 424 W TENNESSEE ST | EVANSVILLE | IN | 47710 | SERVICE CONTRACT | 122316 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 4 | NumberOfContractorsGT100K |
Program Service Revenue ProgramServiceRevenue (2 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| NET PATIENT REVENUE | 621110 | 49957118 | 49957118 |
| NET RESEARCH REVENUE | 621110 | 1951877 | 1951877 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 51908995 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 3154 | TotalRevenueColumn |
| Exclusion | $3,154 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 301821 | Real |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 293014 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 8807 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 8807 | TotalRevenueColumn |
| Exclusion | $8,807 | ExclusionAmount |
Other Revenue Misc OtherRevenueMisc
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | SKIN CARE PRODUCTS | Description |
| Business Code | 621110 | BusinessCode |
| Total Revenue Column | 63188 | TotalRevenueColumn |
| Unrelated Business Revenue | 63188 | UnrelatedBusinessRevenue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 63188 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 51984144 | TotalRevenueColumn |
| Related Or Exempt Function Income | 51908995 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 63188 | UnrelatedBusinessRevenue |
| Exclusion | $11,961 | ExclusionAmount |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 5669252 | Total |
| Program Services | 5119221 | ProgramServices |
| Management And General | 550031 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 36131513 | Total |
| Program Services | 34344960 | ProgramServices |
| Management And General | 1786553 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2826850 | Total |
| Program Services | 2820970 | ProgramServices |
| Management And General | 5880 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1852072 | Total |
| Program Services | 1493472 | ProgramServices |
| Management And General | 358600 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2784914 | Total |
| Program Services | 2567974 | ProgramServices |
| Management And General | 216940 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 316295 | Total |
| Management And General | 316295 | ManagementAndGeneral |
Fees For Services Lobbying FeesForServicesLobbying
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 20137 | Total |
| Management And General | 20137 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4853695 | Total |
| Program Services | 573161 | ProgramServices |
| Management And General | 4280534 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 699012 | Total |
| Program Services | 438768 | ProgramServices |
| Management And General | 260244 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4553916 | Total |
| Program Services | 4498630 | ProgramServices |
| Management And General | 55286 | ManagementAndGeneral |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1311495 | Total |
| Program Services | 1212994 | ProgramServices |
| Management And General | 98501 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 6656601 | Total |
| Program Services | 6292476 | ProgramServices |
| Management And General | 364125 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 70229 | Total |
| Program Services | 38151 | ProgramServices |
| Management And General | 32078 | ManagementAndGeneral |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 280707 | Total |
| Program Services | 259092 | ProgramServices |
| Management And General | 21615 | ManagementAndGeneral |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 908920 | Total |
| Program Services | 822209 | ProgramServices |
| Management And General | 86711 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1015976 | Total |
| Program Services | 754991 | ProgramServices |
| Management And General | 260985 | ManagementAndGeneral |
Other Expenses OtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | BAD DEBT | Description |
| Total | 1044510 | Total |
| Program Services | 1044510 | ProgramServices |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 70996094 | Total |
| Program Services | 62281579 | ProgramServices |
| Management And General | 8714515 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 7638240 | BOY |
| EOY | 6312014 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 284406 | BOY |
| EOY | 284365 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 5861757 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 2614697 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4068156 | BOY |
| EOY | 3247060 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 231698 | BOY |
| EOY | 229280 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 20000 | BOY |
| EOY | 4570133 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 12242500 | BOY |
| EOY | 14642852 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 7766003 | BOY |
| EOY | 6774652 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 4570133 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 7766003 | BOY |
| EOY | 11344785 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4476497 | BOY |
| EOY | 3298067 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4476497 | BOY |
| EOY | 3298067 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 12242500 | BOY |
| EOY | 14642852 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | -19011950 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | 17833520 | 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 |
| Audit Committee | 1 | AuditCommittee |
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| 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 | $20,137 | OtherActivitiesAmount |
| Total Lobbying Expenditures IIB | 20137 | TotalLobbyingExpendituresIIB |
| Not Described In501c3 | 0 | NotDescribedIn501c3 |
Form990 Schedule C Part IV Form990ScheduleCPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | EXPLANATION OF OTHER LOBBYING ACTIVITIES: | Identifier |
| Return Reference | PART II-B, LINE 1I: | 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 | 2015119 | OtherCostOrOtherBasis |
| Depreciation | 813060 | Depreciation |
| Book Value | 1202059 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 3678683 | OtherCostOrOtherBasis |
| Depreciation | 1801637 | Depreciation |
| Book Value | 1877046 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 167955 | OtherCostOrOtherBasis |
| Book Value | 167955 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 3247060 | TotalOfBookValueLandBuildings |
Other Assets OtherAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | DUE FROM RELATED PARTY | Description |
| Book Value | 4570133 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | 4570133 | TotalBookValueOtherAssets |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | DUE TO RELATED PARTY | Description |
| Amount | $4,570,133 | Amount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 4570133 | TotalOfAmounts |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV (2 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: | PART X: | 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, 2011 AND 2010, 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, XII, AND XIII ARE NOT REQUIRED AS THE ORGANIZATION IS PART OF A CONSOLIDATED FINANCIAL STATEMENT. THE CONSOLIDATED FINANCIAL STATEMENT IS AUDITED BY AN INDEPENDANT 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 | 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 | 1 | 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 (21 entries)
| 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| MOHAMMED ALLAW MD | |||||||||||||
| 325272 | 0 | 51688 | 0 | 1896 | 26033 | 11485 | 0 | 23397 | 0 | 413738 | 26033 | 0 | 0 |
| AMANDA E BOHLEBER MD | |||||||||||||
| 196402 | 0 | 5108 | 0 | 14508 | 12450 | 0 | 0 | 0 | 0 | 216018 | 12450 | 0 | 0 |
| GARY ERDY MD | |||||||||||||
| 250061 | 0 | 81907 | 0 | 799 | 0 | 13583 | 0 | 24591 | 0 | 370941 | 0 | 0 | 0 |
| JAMES GUTMANN MD | |||||||||||||
| 206350 | 0 | 74234 | 0 | 720 | 0 | 10716 | 0 | 26201 | 0 | 318221 | 0 | 0 | 0 |
| ROBERT KAYLOR | |||||||||||||
| 259170 | 0 | 19077 | 0 | 0 | 0 | 0 | 0 | 19574 | 0 | 297821 | 0 | 0 | 0 |
| GARY KEEPS MD | |||||||||||||
| 293962 | 0 | 46560 | 0 | 1681 | 0 | 9048 | 0 | 23397 | 0 | 374648 | 0 | 0 | 0 |
| ANNE MCLAUGHLIN MD | |||||||||||||
| 703374 | 0 | 18502 | 0 | 1896 | 0 | 4811 | 0 | 25581 | 0 | 754164 | 0 | 0 | 0 |
| BARRY PHILLIPS MD | |||||||||||||
| 318155 | 0 | 44367 | 0 | 1896 | 4770 | 8721 | 0 | 23397 | 0 | 396536 | 4770 | 0 | 0 |
| BRUCE SCHNEIDER MD | |||||||||||||
| 1171487 | 0 | 18417 | 0 | 935 | 1600 | 13403 | 0 | 26217 | 0 | 1230459 | 1600 | 0 | 0 |
| RUSTON STOLTZ MD | |||||||||||||
| 265918 | 0 | 31937 | 0 | 720 | 2708 | 8191 | 0 | 5350 | 0 | 312116 | 2708 | 0 | 0 |
| W ALLEN WHITE MD | |||||||||||||
| 239457 | 0 | 19276 | 0 | 1014 | 0 | 27929 | 0 | 21388 | 0 | 309064 | 0 | 0 | 0 |
| LINDA WHITE | |||||||||||||
| 0 | 563336 | 0 | 118697 | 0 | 15960 | 0 | 169483 | 0 | 29924 | 0 | 897400 | 0 | 258 |
| DAVID CHRISTESON MD | |||||||||||||
| 327584 | 0 | 97947 | 0 | 1896 | 0 | 29341 | 0 | 26092 | 0 | 482860 | 0 | 0 | 0 |
| RICHARD STIVERS | |||||||||||||
| 0 | 65214 | 0 | 49058 | 0 | 487260 | 0 | 39343 | 0 | 19834 | 0 | 660709 | 0 | 91298 |
| CHERYL WATHEN | |||||||||||||
| 0 | 220641 | 0 | 29571 | 0 | 7056 | 0 | 28805 | 0 | 25071 | 0 | 311144 | 0 | 0 |
| MAQBOOL AHMED MD | |||||||||||||
| 1564340 | 0 | 89147 | 0 | 1579 | 0 | 5341 | 0 | 28201 | 0 | 1688608 | 0 | 0 | 0 |
| DANIEL SHIREY MD | |||||||||||||
| 1276772 | 0 | 0 | 0 | 1176 | 0 | 0 | 0 | 24971 | 0 | 1302919 | 0 | 0 | 0 |
| PAUL SIAMI MD | |||||||||||||
| 865332 | 0 | 91960 | 0 | 720 | 0 | 15671 | 0 | 20034 | 0 | 993717 | 0 | 0 | 0 |
| ANVITA SINHA MD | |||||||||||||
| 799546 | 0 | 4677 | 0 | 1602 | 0 | 7156 | 0 | 12270 | 0 | 825251 | 0 | 0 | 0 |
| JEFFREY MOORE MD | |||||||||||||
| 664365 | 0 | 72174 | 0 | 1896 | 0 | 18774 | 0 | 27366 | 0 | 784575 | 0 | 0 | 0 |
| THOMAS W DAVIDSON | |||||||||||||
| 167521 | 0 | 19775 | 0 | 68138 | 0 | 3339 | 0 | 258773 | 0 | 517546 | 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, LINES 4A-B | SEVERANCE, NONQUALIFIED, AND EQUITY-BASED PAYMENTS: SEVERANCE NONQUALIFIED EQUITY-BASED ANNE MCLAUGHLIN, MD $ -0- $16,500 $ -0- LINDA WHITE 0 16,500 0 RICHARD STIVERS 324,538 1,240 0 DAVID CHRISTESON, MD 0 7,758 0 GARY KEEPES, MD 0 16,500 0 RUSTON STOLTZ, MD 0 16,500 0 JAMES GUTMANN, MD 0 16,500 0 W. ALLEN WHITE, MD 0 16,500 0 MAQBOOL AHMED, MD 0 16,500 0 PAUL SIAMI, MD 0 16,500 0 JEFFREY MOORE, MD 0 16,500 0 THOMAS W. DAVIDSON 28,882 0 0 LINDA WHITE: CONTRIBUTIONS MADE TO A SUPPLEMENTAL ACCUMULATION ACCOUNT OF $157,723 SUPPLEMENTAL ACCUMULATION ACCOUNT PAYOUT OF $258 RICHARD STIVERS: SUPPLEMENTAL RETIREMENT PAYMENT OF $51,526 SUPPLEMENTAL ACCUMULATION ACCOUNT PAYOUT OF $39,772 |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (10 entries)
| IdentifierIdentifier | ExplanationExplanation | Return ReferenceReturnReference |
|---|---|---|
| FORM 990, PART VI, SECTION A, LINE 6 | DEACONESS HEALTH SYSTEM, INC. IS THE SOLE CORPORATE MEMBER OF DEACONESS CLINIC, INC. | |
| FORM 990, PART VI, SECTION A, LINE 7A | THE DEACONESS HEALTH SYSTEM, INC. MUST APPROVE THE CHOSEN DEACONESS CLINIC CHIEF PHYSICIAN ADMINISTRATIVE OFFICER (CPAO). | |
| 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 CONTROLLER, CFO AND CEO OF THE ORGANIZATION FOR REVEIW. 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. | |
| 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, AND PARTNERSHIP AND JOINT VENTURE ARRANGEMENTS. | FORM 990, PART VI, SECTION B, LINE 12C | |
| COMPENSATION FOR TOP OFFICIALS AND OTHER OFFICERS: DEACONESS CLINIC UTILIZES A COMPENSATION COMMITTEE TO APPROVE EXECUTIVE, DIRECTOR, AND PHYSICIAN COMPENSATION AS WELL AS EXECUTIVE AND PHYSICIAN BENEFIT PROGRAMS. 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 AND 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 CLINIC'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 B, LINE 15 | |
| DEACONESS CLINIC DOES NOT MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST OR FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC. | FORM 990, PART VI, SECTION C, LINE 19 | |
| AVERAGE HOURS PER WEEK | THE AVERAGE HOURS WORKED PER WEEK INCLUDE RELATED PARTY HOURS FOR MS. WHITE, MS. WATHEN, AND MR. STIVERS. HOURS LISTED IN PART VII RELATE TO TIME DEVOTED TO DEACONESS HEALTH SYSTEM (DHS), DEACONESS CLINIC, INC. (DCI), AND DEACONESS HOSPITAL, INC. (DHI). SEE THE AVERAGE HOURS PER WEEK BELOW: DHS DCI DHI TOTAL MS. WHITE 20 10 40 70 MS. WATHEN 5 5 50 60 MR. STIVERS 5 5 50 60 | FORM 990, PART VII, SECTION A, LINE 1A, COLUMN (B) |
| CHANGES IN NET ASSETS OR FUND BALANCES: | CAPITAL CONTRIBUTION 17,833,520. TOTAL TO FORM 990, PART XI, LINE 5: 17,833,520. | FORM 990, PART XI, LINE 5: |
| 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. | FORM 990, PART XII, LINE 2C |
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 3 | 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 | |
Form990 Schedule R Part III Form990ScheduleRPartIII (5 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivityPrimaryActivity | Legal Domicile StateLegalDomicileState | Direct Controlling Entity NADirectControllingEntityNA |
|---|---|---|---|---|---|---|---|
| DEACONESS HEALTH PLANS | |||||||
| 350 W COLUMBIA SUITE 400 | EVANSVILLE | IN | 47710 | 383492529 | PERF PROV | IN | N/A |
| HEARTCARE HEALTH SYSTEM | |||||||
| 415 W COLUMBIA | EVANSVILLE | IN | 47710 | 352038344 | HEALTHCARE | IN | N/A |
| PROGRESSIVE HLTH IN | |||||||
| 150 N ROSENBERGER | EVANSVILLE | IN | 47712 | 208480988 | OUTPATIENT | IN | N/A |
| HEART HOSPITAL AT DEACONESS GATEWAY | |||||||
| 4007 GATEWAY BLVD | NEWBURGH | IN | 47630 | 261766835 | HOSPITAL | DE | N/A |
| TRI-STATE RADIATION ONCOLOGY | |||||||
| 1500 ROSECRANS AVENUE | MANHATTAN BEACH | CA | 90266 | 263706834 | OUTPATIENT | DE | N/A |
Form990 Schedule R Part IV Form990ScheduleRPartIV
Name Of Related Org NameOfRelatedOrg
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | TRI-STATE MEDICAL MANAGEMENT INC | BusinessNameLine1 |
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 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 351875888 | EIN |
| Primary Activity | PHYSICIAN MANAGEMENT | PrimaryActivity |
| Legal Domicile State | IN | LegalDomicileState |
| Direct Controlling Entity NA | N/A | DirectControllingEntityNA |
| Type Of Entity | C | TypeOfEntity |
| 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 |
| 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 |