2012-03-05T08:24:53-06:00 2011-09-30 BLUE & CO LLC ONE AMERICAN SQUARE 2200 INDIANAPOLIS IN 46282 990 2010-10-01 350593390 DEACONESS HOSPITAL INC DEAC 8124502370 600 MARY STREET EVANSVILLE IN 47747 SHAWN MCCOY 8124502370 2012-03-05 1 ANGELA L ZIRKELBACH CPA 3176334705 2010 2016-02-24 21:20:13Z SHAWN MCCOY 600 MARY STREET EVANSVILLE IN 47747 587152577 0 X WWW.DEACONESS.COM X 1895 IN PROVIDE QUALITY HEALTH CARE SERVICES WITH A COMPASSIONATE AND CARING SPIRIT CONTINUE TO SCH O TO PERSONS, FAMILIES AND COMMUNITIES OF THE TRI-STATE. 17 9 5419 117 8658993 28948 1809153 1557790 487028074 501428355 4920579 6874717 34195826 40944570 527953632 550805432 215303 270222 0 0 225824244 232797203 0 0 369517 257674542 267994072 483714089 501061497 44239543 49743935 734618250 756476184 361198226 359697615 373420024 396778569 X SEE SCHEDULE O. 0 0 157158579 0 307222085 PATIENT SERVICE REVENUE. SEE SCHEDULE O. 304562246 0 184297424 CHARITY CARE/SUBSIDIZED CARE. SEE SCHEDULE O. 15858968 0 9908846 GRADUATE MEDICAL EDUCATION, MEDICAL EDUCATION AND COMMUNITY BENEFIT. SEE SCHEDULE O. 270222 270222 22865964 OTHER PROGRAM SERVICE REVENUE CONSISTS OF DEACONESS HOSPITAL'S INCOMEFROM THE INVESTMENT IN JOINT VENTURES. OTHER PROGRAM SERVICE EXPENSESCONSISTED OF COMMUNITY BENEFIT GRANTS/ASSISTANCE. 270222 270222 22865964 477850015 1 1 0 1 0 0 0 0 0 1 1 0 0 0 1 1 0 1 0 0 0 0 0 0 1 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 1 1 1 0 0 1 366 0 1 5419 1 1 1 0 0 0 0 1 1 0 0 0 0 0 0 0 X 17 9 0 0 0 0 1 1 0 1 1 1 0 1 1 1 1 1 1 1 1 1 1 IN X JOHN L ZABROWSKI 8124503467 600 MARY STREET EVANSVILLE IN 47747 X LINDA E WHITE 70.00 X X 409381 288612 199407 JEROME A BENKERT JR 5.00 X 5200 0 0 STEVEN T TITZER CPA 5.00 X 6600 0 0 JOHN ENGELBRECHT 5.00 X 7200 0 0 ROBERT G JONES 5.00 X 3400 0 0 BRUCE ADYE MD 5.00 X 9333 0 0 IRA G BOOTS 5.00 X 4800 0 0 STEVEN A CHURCH 5.00 X 4600 0 0 REV DR JOSEPH FRACCARO 5.00 X 5200 0 0 DR H RAY HOOPS 5.00 X 6600 0 0 DAVID A KOEHLER JR MD 5.00 X 21400 176722 10575 MATTHEW R LEE MD 5.00 X 7400 0 0 WILLIAM PENLAND MD 5.00 X 8000 0 0 RUSTON L STOLTZ MD 5.00 X 6708 298575 13541 BRUCE STALLINGS 5.00 X 7600 0 0 ROBERT B WRIGHT 5.00 X 9400 0 0 DANIEL W WHITEHEAD MD 5.00 X 6000 0 0 RICHARD M STIVERS 60.00 X 359324 242208 59177 CHERYL A WATHEN 60.00 X 222002 35266 53876 HARRY L SMITH JR 50.00 X 596687 5600 146897 SHAWN W MCCOY 50.00 X 331974 5800 96886 JAMES R PORTER MD 50.00 X 358309 0 94039 CHERONA J HAJEWSKI 50.00 X 300643 0 79362 BRUCE E EPMEIER 50.00 X 221415 0 64876 LARRY F PILE 50.00 X 216058 0 24468 RICHARD B PERRY 50.00 X 167415 0 39275 JOYCE A THOMAS 50.00 X 166437 0 38737 JOHN L ZABROWSKI 50.00 X 152002 600 36304 REBECCA L MALOTTE 50.00 X 150514 0 55559 VENKATESH R MADADI 50.00 X 734736 0 31924 RAJESH J PATEL MD 50.00 X 690645 0 35745 NIRMAL JOSHI MD 50.00 X 677983 0 32089 AYMAN ELFAR MD 50.00 X 585086 0 27841 LAWRENCE C KILINSKI JR MD 50.00 X 541730 0 34387 7001782 1053383 1174965 182 0 1 0 BOVIS LEND LEASE INC 1801 W END AVE SUITE 600 NASHVILLE TN 37203 BUILDING CONTRACTOR 38595550 EVANSVILLE SURGERY CENTER ASSOC LLC 520 MARY STREET EVANSVILLE IN 47710 SURGICAL SERVICES 30578896 EPIC SYSTEMS CORPORATION PO BOX 88314 MILWAUKEE WI 53288 SOFTWARE/ CONSULTING 6457604 ARUP LABORATORIES PO BOX 27964 SALT LAKE CITY UT 84127 LABORATORY 2151272 WINK CONSTRUCTION INC 4007 E EICHEL AVE EVANSVILLE IN 47716 BUILDING CONTRACTOR 2067297 74 216383 170968 1170439 7961 1557790 NET PATIENT REVENUE 900099 501428355 501428355 501428355 6830797 6830797 217 217 6611143 2859705 3751438 3751438 3751438 33064065 375700 32410179 985883 653886 -610183 43703 43703 39640 216383 91378 -51738 -51738 INVESTMENT IN JOINT VE 900099 22865964 22865964 LABORATORY SALES 621500 8258335 8258335 OTHER HOSPITAL SERVICE 900099 5719913 5719913 400658 400658 37244870 550805432 524294319 8658993 16294330 270222 270222 5222083 5222083 175160446 170169552 4756502 234392 14031570 12818090 1213480 25681945 24178658 1503287 12701159 12003160 697999 789509 379971 409538 116539 116539 30132 30132 294990 283801 11189 55753567 54225886 1519891 7790 1255243 195470 1059773 93132215 92232058 852057 48100 8098960 7011601 1087359 16883721 15467609 1416112 687983 586613 100988 382 869648 685987 183661 9065847 9065847 30695739 28858583 1836845 311 3950360 3934143 16217 PROVISION FOR BAD DEBT 26914235 26914235 EQUIP RENTAL/MAINTENANC 12200725 12066398 134327 AGENCY COLLECTION FEES 6034020 6034020 MISCELLANEOUS 642680 473268 105999 63413 DUES & SUBSCRIPTIONS 577959 278644 295375 3940 501061497 477850015 22841965 369517 45404178 47488383 103136210 110821835 5359268 4376580 4844936 4629844 688014101 353492266 325111997 334521835 192039805 195636448 31252043 31470720 15940119 15522009 11529694 12008530 734618250 756476184 55207479 50602508 224161915 219065919 19721 81809111 90029188 361198226 359697615 X 365289535 388425141 3424795 3304070 4705694 5049358 373420024 396778569 734618250 756476184 X 49743935 -26385390 X X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 30132 30132 0 EXPLANATION OF OTHER LOBBYING ACTIVITIES: PART II-B, LINE 1I: LOBBYING EXPENDITURES CONSISTED OF A PORTION OF MEMBERSHIP DUES TO PROFESSIONAL ORGANIZATIONS IN WHICH DEACONESS HOSPITAL AND ITS EMPLOYEES ARE MEMBERS. THE LOBBYING PORTION OF THE DUES IS NOTED ON THE MEMBERSHIP APPLICATION OR BILLING STATEMENT. 8130489 1293267 294514 7052 1048880 308910 8353428 7433786 1683536 281910 192998 790792 284953 8130489 7797671 931781 337059 329950 1014396 288387 7433778 0.69000 0.31000 0.00000 0 0 10268530 10268530 412984109 199127298 213856811 197148694 154364968 42783726 67612768 67612768 334521835 ACCRUED PENSION/ACCRUED SICK 69251860 TAXABLE BOND- SERIES 1999B 10200000 CAPITAL LEASE OBLIGATIONS 6572522 ESTIMATED THIRD PARTY SETTLEMENTS 4004806 90029188 DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: THE DEACONESS HOSPITAL FOUNDATION UTILIZES ENDOWMENT FUNDS TO SUPPORT AND BENEFIT THE MISSION OF DEACONESS HOSPITAL. SPECIFICALLY, ENDOWMENT FUNDS ARE USED TO HELP SUPPORT ACTIVITIES OR PROJECTS THAT HELP TO PROVIDE QUALITY HEALTHCARE SERVICES WITH A COMPASSIONATE AND CARING SPIRIT TO PERSONS, FAMILIES, AND COMMUNITIES OF THE TRI-STATE. 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 VII AND IX ARE NOT COMPLETED DUE TO THE TOTAL OF EACH LINE BEING LESS THAN 5% OF THE TOTAL ASSETS LISTED ON PART X, LINE 16. 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. DH PARTY OF YR 153125 130625 22500 1000 8095 34582 DH CLASSIC 102898 85758 17140 17670 16863 13168 0 256023 216383 39640 18670 24958 47750 91378 -51738 1 1 X 1 X 300.000000000000 1 X 1 1 1 0 1 1 24814686 24814686 0.04770 52475514 17314788 35160726 0.06760 77290200 17314788 59975412 0.11530 813331 83718 729613 0.00140 3899792 1444783 2455009 0.00470 8963481 7049451 1914030 0.00370 834835 339059 495776 0.00100 14511439 8917011 5594428 0.01080 91801639 26231799 65569840 0.12610 193 193 0.00000 6655 6655 0.00000 15122 15122 0.00000 1200 1200 0.00000 4526 4526 0.00000 405 405 0.00000 40590 14005 26585 0.00010 68691 14005 54686 0.00010 1 8426847 127727071 145399292 -17672221 X 1 1 3 1 DEACONESS HOSPITAL INC

600 MARY STREET EVANSVILLE IN 47747

X X X X 2 DEACONESS GATEWAY HOSPITAL

4011 GATEWAY BLVD NEWBURGH IN 47630

X X X X 3 DEACONESS CROSS POINTE

7200 E INDIANA STREET EVANSVILLE IN 47715

X DEACONESS HOSPITAL INC 1 1 1 300.000000000000 1 300.000000000000 1 X X X X X 1 1 X X X X 1 X X X 1 X X X X X X 1 X 0 0 DEACONESS GATEWAY HOSPITAL 2 1 1 300.000000000000 1 300.000000000000 1 X X X X X 1 1 X X X X 1 X X X 1 X X X X X X 1 0 0 DEACONESS CROSS POINTE 3 1 1 300.000000000000 1 300.000000000000 1 X X X X X 1 1 X X X X 1 X X X 1 X X X X X X 1 0 0 47 DEACONESS PROCEDURE CENTER

421 CHESTNUT STREET EVANSVILLE IN 47713

OUTPATIENT SERVICES DEACONESS HOSPITAL PHYSICAL MEDICINE

520 MARY STREET SUITE 260 EVANSVILLE IN 47747

OUTPATIENT SERVICES DEACONESS CHEMOTHERAPY INFUSION CTR

4055 GATEWAY BLVD SUITE 1200 NEWBURGH IN 47630

OUTPATIENT SERVICES DEACONESS CLINIC GATEWAY

4233 GATEWAY BLVD NEWBURGH IN 17630

DIAGNOSTIC CENTER DEACONESS COMPREHENSIVE PAIN CTR & PROG

4600 W LLOYD EXPRESSWAY EVANSVILLE IN 47712

OUTPATIENT SERVICES DEACONESS HOSPITAL INFUSION SVCS

421 CHESTNUT STREET EVANSVILLE IN 47713

OUTPATIENT SERVICES DEACONESS HOSPITAL PHYSICAL MEDICINE

10455 ORTHOPAEDIC DRIVE NEWBURGH IN 47630

OUTPATIENT SERVICES DEACONESS CRITICAL CARE GROUP

519 HARRIET STREET EVANSVILLE IN 47747

OUTPATIENT PHYSICIAN CLINIC DEACONESS COMPREHENSIVE PAIN CTR-GATEWAY

4099 GATEWAY BLVD NEWBURGH IN 47630

OUTPATIENT SERVICES CHANCELLOR CENTER FOR ONCOLOGY

4055 GATEWAY BLVD NEWBURGH IN 47630

OUTPATIENT SERVICES DEACONESS OHIO VALLEY HOSPICE

701 GARFIELD STREET EVANSVILLE IN 47747

HOSPICE DEACONESS SLEEP LAP

350 W COLUMBIA STREET SUITE 210 EVANSVILLE IN 47710

OUTPATIENT SERVICES DEACONESS HOSPITAL SLEEP LAB

350 W COLUMBIA STREET SUITE LL-10 EVANSVILLE IN 47710

DIAGNOSTIC CENTER DEACONESS HOSPITAL BREAST CENTER

520 MARY STREET SUITE 140 EVANSVILLE IN 47710

DIAGNOSTIC CENTER DEACONESS HOME CARE

701 GARFIELD STREET EVANSVILLE IN 47747

HOME HEALTH AGENCY DEACONESS CLINIC WEST

545 S BOEHNE CAMP ROAD EVANSVILLE IN 47712

OUTPATIENT PHYSICIAN CLINIC DEACONESS CLINIC PRINCETON MED OFC BLDG

685 VAIL STREET PRINCETON IN 47670

OUTPATIENT PHYSICIAN CLINIC DEACONESS COMP CENTER

329 W COLUMBIA STREET EVANSVILLE IN 47710

OUTPATIENT PHYSICIAN CLINIC DEACONESS FAMILY PRACTICE CENTER

515 READ STREET EVANSVILLE IN 47710

OUTPATIENT PHYSICIAN CLINIC DEACONESS MEC MEDICAL CENTER

3844 FIRST AVENUE EVANSVILLE IN 47710

OUTPATIENT PHYSICIAN CLINIC DEACONESS URGENT CARECOMP CARE

10455 ORTHOPAEDIC DRIVE EVANSVILLE IN 47630

OUTPATIENT PHYSICIAN CLINIC DEACONESS WOUND CARE CENTER

611 HARRIET STREET SUITE 501 EVANSVILLE IN 47710

OUTPATIENT SERVICES DEACONESS ANTICOAGULATION CLINIC

4107 GATEWAY BLVD NEWBURGH IN 47710

OUTPATIENT SERVICES USI STUDENT HEALTH CENTER

8600 UNIVERSITY BLVD EVANSVILLE IN 47712

OUTPATIENT PHYSICIAN CLINIC MT VERNON MEDICAL CENTER

1900 W FOURTH STREET MT VERNON IN 47620

DIAGNOSTIC CENTER MIDWEST RADIOLOGIC IMAGING

10455 ORTHOPAEDIC DRIVE NEWBURGH IN 47630

DIAGNOSTIC CENTER MIDWEST RADIOLOGICAL IMAGING

4087 GATEWAY BLVD NEWBURGH IN 47630

DIAGNOSTIC CENTER DOCTOR'S PLAZA X-RAY

611 HARRIET STREET EVANSVILLE IN 47710

DIAGNOSTIC CENTER DEACONESS REGIONAL LABORATORY

611 HARRIET STREET SUITE 102 EVANSVILLE IN 47710

DIAGNOSTIC CENTER DEACONESS RILEY CHILDREN'S SPECIALTY CTR

4133 GATEWAY BLVD NEWBURGH IN 47630

OUTPATIENT PHYSICIAN CLINIC DEACONESS RILEY SPECIALITY CTR OP

4121 GATEWAY BLVD NEWBURGH IN 47630

OUTPATIENT PHYSICIAN CLINIC DEACONESS PRIMARY CARE FOR SENIORS

4498 FIRST AVENUE EVANSVILLE IN 47710

OUTPATIENT PHYSICIAN CLINIC DEACONESS PRIMARY CARE FOR SENIORS

1750 OAK HILL ROAD EVANSVILLE IN 47711

OUTPATIENT PHYSICIAN CLINIC DEACONESS FAMILY MEDICINE

611 HARRIET STREET SUITE 504 EVANSVILLE IN 47710

OUTPATIENT PHYSICIAN CLINIC DEACONESS DIABETES CENTER - EDUCATION

421 CHESTNUT STREET EVANSVILLE IN 47713

OUTPATIENT SERVICES DEACONESS PRE-ADMISSION TESTING

520 MARY STREET SUITE 330 EVANSVILLE IN 47747

DIAGNOSTIC CENTER DEACONESS GATEWAY GASTROENTEROLOGY

4133 GATEWAY BLVD NEWBURGH IN 47630

OUTPATIENT PHYSICIAN CLINIC DEACONESS WEIGHT LOSS SOLUTIONS

310 W IOWA STREET EVANSVILLE IN 47710

OUTPATIENT PHYSICIAN CLINIC DEACONESS HOSPITAL MAMMOGRAPHY & IMAGING

421 CHESTNUT STREET EVANSVILLE IN 47713

DIAGNOSTIC CENTER DEACONESS REGIONAL LABORATORY

4494 N FIRST AVENUE EVANSVILLE IN 47710

DIAGNOSTIC CENTER DEACONESS REGIONAL LABORATORY

4133 GATEWAY BLVD SUITE 110 NEWBURGH IN 47630

DIAGNOSTIC CENTER DEACONESS REGIONAL LABORATORY

421 CHESTNUT STREET EVANSVILLE IN 47713

DIAGNOSTIC CENTER DEACONESS CROSS POINTE-PRINCETON

1808 SHERMAN DRIVE RM 2208 PRINCETON IN 47670

OUTPATIENT PHYSICIAN CLINIC DEACONESS CROSS POINTE-ROCKPORT

2792 N US HIGHWAY 231 ROCKPORT IN 47635

OUTPATIENT PHYSICIAN CLINIC DEACONESS CROSS POINTE-OWENSBORO

920 FREDERICA STREET SUITE 1003 OWENSBORO KY 42301

OUTPATIENT PHYSICIAN CLINIC DEACONESS CROSS POINTE-HENDERSON

209 N ELM STREET HENDERSON KY 42420

OUTPATIENT PHYSICIAN CLINIC DEACONESS CROSS POINTE OUTPATIENT CLINIC

445 CROSS POINTE BLVD EVANSVILLE IN 47715

OUTPATIENT PHYSICIAN CLINIC PART I, LINE 6A: DEACONESS HOSPITAL PREPARES A SEPARATE COMMUNITY BENEFIT REPORT. PART I, LINE 7: A COST TO CHARGE RATIO WAS USED FOR MOST OF THE CALCULATIONS FOR THE TABLE. IRS INSTRUCTION'S WORKSHEET 2 WAS USED FOR THIS CALCULATION. WE DID NOT USE THE COST TO CHARGE RATIO FOR LINE 7G AS IT WAS NOT RELEVANT TO THESE SERVICES. THE ACTUAL COST FROM OUR COSTING SYSTEM WAS USED WHEN AVAILABLE. THE COST TO CHARGE RATIO FOR EACH SERVICE TYPE WAS USED TO ESTIMATE COST WHEN NOT AVAILABLE FROM OUR INTERNAL COSTING SYSTEM. PART I, LINE 7G: SUBSIDIZED HEALTH SERVICES ATTRIBUTED TO PHYSICIAN CLINICS HAVE A COST OF $322,750. PART I, L7 COL(F): BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING PERCENTAGE IN THIS COLUMN IS $26,914,235. PART II: DEACONESS HOSPITAL AND ITS RELATED ORGANIZATIONS PARTICIPATE IN VARIOUS COMMUNITY BUILDING ACTIVITIES. DEACONESS CROSS POINTE IS A MEMBER OF THE SUICIDE PREVENTION COALITION. DEACONESS CROSS POINTE OFFERS A VARIETY OF FREE SUICIDE AWARENESS AND PREVENTION PROGRAMS TO HELP REDUCE THE INCIDENCE OF SUICIDE IN THE TRI-STATE. DEACONESS HOSPITAL SPONSORS THE HEALTH SCIENCE INSTITUTE WHICH ALLOWS HIGH SCHOOL STUDENTS TO EXPERIENCE FIRSTHAND THE WONDERS OF MEDICINE AND MEDICAL RESEARCH THROUGH SEMINARS, CLINICAL EXPERIENCES, AND DEMONSTRATIONS. INTERACTION WITH LEADING HEALTH CARE PROFESSIONALS BROADENS STUDENTS' KNOWLEDGE OF MEDICAL CARE AND CAREER OPPORTUNITIES IN HEALTH CARE AND HEALTH SCIENCES. STUDENTS FROM SOUTHWESTERN INDIANA HIGH SCHOOLS ARE CHOSEN TO PARTICIPATE. DEACONESS LEADERS AND ADMINISTRATORS SERVE AS BOARD MEMBERS ON LOCAL UNIVERSITY BOARDS. THEY SERVE ON EDUCATIONAL PLANNING COMMITTEES AND DETERMINE THE EDUCATIONAL NEEDS OF STUDENTS AND BUSINESSES IN THE COMMUNITY. PART III, LINE 4: SECTION A. BAD DEBT EXPENSE. LINE 2 FOOTNOTE TO ORGANIZATION'S FINANCIAL STATEMENTS THAT DESCRIBES BAD DEBT EXPENSE: MANAGEMENT ESTIMATES AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS RECEIVABLE BASED ON AN EVALUATION OF HISTORICAL LOSSES, CURRENT ECONOMIC CONDITIONS, AND OTHER FACTORS UNIQUE TO THE SYSTEM'S CUSTOMER BASE. PART III, LINE 8: THE SOURCE USED TO DETERMINE THE AMOUNT OF MEDICARE REVENUE AND ALLOWABLE COSTS REPORTED FOR PART III, SECTION B, MEDICARE WERE ESTIMATED BASED UPON THE 2010 MEDICARE COST REPORT AND THE 2011 CONTRACTUAL MODEL FOR EXPECTED REIMBURSEMENT. THE MEDICARE SHORTFALL FOR DEACONESS HOSPITAL IS TREATED AS COMMUNITY BENEFIT DUE TO THE HOSPITAL PROVIDING CARE TO MEDICARE PATIENTS AT LESS THAN THE ALLOWABLE MEDICARE COSTS. PART III, LINE 9B: DEACONESS HOSPITAL MAKES A DISTICTION BETWEEN CHARITY AND BAD DEBT. IN DETERMINING AN INDIVIDUAL OR FAMILY'S ABILITY TO PAY, DEACONESS HOSPITAL EVALUATES WHETHER OR NOT THE RESPONSIBLE PARTY HAS SUFFICIENT RESOURCES FOR PAYMENT. IF AN INDIVIDUAL IS DETERMINED TO NOT HAVE SUFFICIENT RESOURCES TO PAY, THEY WILL BE CONSIDERED ELIGIBLE FOR CHARITY CARE AND WILL NOT BE PROCESSED THROUGH EITHER INTERNAL OR EXTERNAL COLLECTIONS. ACCOUNTS OF CHARITY CARE PATIENTS WHO ARE UNABLE TO PAY DO NOT RESULT IN BAD DEBT AND ARE NOT COLLECTED UPON. DEACONESS HOSPITAL, INC. PART V, SECTION B, LINE 13G: DEACONESS HOSPITAL SEEKS OUT THE PATIENTS THAT ARE SELF-PAY AND INTERVIEWS THESE PATIENTS WHILE THEY ARE IN THE FACILITY. THE FINANCIAL ASSISTANCE POLICY IS PROMOTED TO PATIENTS. DEACONESS HOSPITAL SEEKS OUT THOSE PATIENTS THAT WOULD QUALIFY FOR THE FINANCIAL ASSISTANCE POLICY. COLLECTABILITY SCORING IS ALSO COMPLETED AND ALLOWANCES ARE MADE BASED UPON THESE SCORES. DEACONESS GATEWAY HOSPITAL PART V, SECTION B, LINE 13G: DEACONESS HOSPITAL SEEKS OUT THE PATIENTS THAT ARE SELF-PAY AND INTERVIEWS THESE PATIENTS WHILE THEY ARE IN THE FACILITY. THE FINANCIAL ASSISTANCE POLICY IS PROMOTED TO PATIENTS. DEACONESS HOSPITAL SEEKS OUT THOSE PATIENTS THAT WOULD QUALIFY FOR THE FINANCIAL ASSISTANCE POLICY. COLLECTABILITY SCORING IS ALSO COMPLETED AND ALLOWANCES ARE MADE BASED UPON THESE SCORES. DEACONESS CROSS POINTE PART V, SECTION B, LINE 13G: DEACONESS HOSPITAL SEEKS OUT THE PATIENTS THAT ARE SELF-PAY AND INTERVIEWS THESE PATIENTS WHILE THEY ARE IN THE FACILITY. THE FINANCIAL ASSISTANCE POLICY IS PROMOTED TO PATIENTS. DEACONESS HOSPITAL SEEKS OUT THOSE PATIENTS THAT WOULD QUALIFY FOR THE FINANCIAL ASSISTANCE POLICY. COLLECTABILITY SCORING IS ALSO COMPLETED AND ALLOWANCES ARE MADE BASED UPON THESE SCORES. DEACONESS HOSPITAL, INC. PART V, SECTION B, LINE 19D: DEACONESS HOSPITAL OFFERS A 35% DISCOUNT TO INDIVIDUALS WHO DO NOT HAVE INSURANCE AND RECEIVE EMERGENCY OR OTHER MEDICALLY NECESSARY CARE. THIS DISCOUNT APPROXIMATES AN AVERAGE OF ALL CONTRACTED DISCOUNTS. DEACONESS GATEWAY HOSPITAL PART V, SECTION B, LINE 19D: DEACONESS HOSPITAL OFFERS A 35% DISCOUNT TO INDIVIDUALS WHO DO NOT HAVE INSURANCE AND RECEIVE EMERGENCY OR OTHER MEDICALLY NECESSARY CARE. THIS DISCOUNT APPROXIMATES AN AVERAGE OF ALL CONTRACTED DISCOUNTS. DEACONESS CROSS POINTE PART V, SECTION B, LINE 19D: DEACONESS HOSPITAL OFFERS A 35% DISCOUNT TO INDIVIDUALS WHO DO NOT HAVE INSURANCE AND RECEIVE EMERGENCY OR OTHER MEDICALLY NECESSARY CARE. THIS DISCOUNT APPROXIMATES AN AVERAGE OF ALL CONTRACTED DISCOUNTS. PART VI, LINE 2: DEACONESS HOSPITAL'S COMMUNITY BENEFIT COMMITTEE GATHERS AND ANALYZES HOSPITAL AND COMMUNITY DATA TO INDICATE COMMUNITY NEEDS. THE COMMITTEE USES A DYNAMIC, ONGOING PROCESS TO INCLUDE A REVEIW OF PREVIOUS OR CURRENT ASSESMENTS BY OTHER COMMUNITY GROUPS, PRESENTATIONS MADE BY OUTSIDE GROUPS SOLICITING DEACONESS' INVOLVEMENT IN COMMUNITY INITIATIVES, REVIEW OF HEALTH AND DEMOGRAPHIC INFORMATION OF INPATIENTS AND OUTPATIENTS, AND ANALYSIS OF INFORMATION FROM OUTSIDE ORGANIZATIONS AND INTERNAL RECORDS TO IDENTIFY TRENDS AND AREAS OF CONCERN REQUIRING ATTENTION. PART VI, LINE 3: DEACONESS HOSPITAL UTILIZES FINANCIAL COUNSELORS TO EDUCATE, INFORM AND ASSIST PATIENTS AND FAMILIES IN UNDERSTANDING THEIR FINANCIAL OBLIGATION, ABILITY TO QUALIFY FOR FINANCIAL ASSISTANCE THROUGH DEACONESS HOSPITAL'S FINANCIAL ASSISTANCE PROGRAM AND PAYMENT OPTIONS. SPECIFICALLY, FINANCIAL COUNSELORS STAFF THE EMERGENCY DEPARTMENT, REGISTRATION AREAS, CASHIER AREA, AS WELL AS FLOAT AMONG INPATIENT AREAS TO ENSURE EACH AND EVERY PATIENT REQUIRING ASSISTANCE IS REACHED. IN ADDITION TO THE PERSONAL AND INDIVIDUALIZED COUNSELING PROVIDED BY THE COUNSELORS, VARIOUS FORMS OF MEDIA ARE DISTRIBUTED THROUGHOUT DEACONESS HOSPITAL EXPLAINING THE FINANCIAL ASSISTANCE PROCESS. ADDITIONALLY, POLICIES FOR FINANCIAL ASSISTANCE ARE POSTED WIDELY THROUGHOUT DEACONESS HOSPITAL AND ON THE INTERNET AT WWW.DEACONESS.COM. PART VI, LINE 4: DEACONESS HOSPITAL IS A MAJOR REFERRAL CENTER FOR A 25-COUNTY TRI-STATE AREA IN SOUTHWESTERN INDIANA, WESTERN KENTUCKY AND SOUTHEASTERN ILLINIOS. THE HOSPITAL AND ITS FACILITIES ARE LOCATED ON FOUR CAMPUSES WHICH INCLUDE THE MAIN 28-ACRE CAMPUS ON THE NEAR NORTH SIDE OF EVANSVILLE IN VANDERBURGH COUNTY, THE 63-ACRE GATEWAY CAMPUS IS LOCATED IN WARRICK COUNTY ON THE EASTERN BORDER OF VANDERBURGH COUNTY, AND TWO OTHER EASTSIDE EVANSVILLE LOCATIONS FOR PSYCHIATRIC BEHAVIORAL SERVICES AND REHABILITATION SERVICES. THE HOSPITAL OPERATES A MAIN CAMPUS WITH A TOTAL OF 323 BEDS CONSISTING OF 24 INTENSIVE CARE BEDS, 26 CARDIAC INTENSIVE CARE BEDS, 66 CARDIAC BEDS, 23 ONCOLOGY/PULMONOLOGY BEDS, 61 ORTHOPAEDIC/ NEUROLOGICAL BEDS, 5 PEDIATRIC TRAUMA BEDS, 18 MENTAL HEALTH BEDS, 96 MEDICAL/ SURGICAL BEDS AND 4 HOSPICE BEDS. IN ADDITION, THE HOSPITAL PROVIDES A FULL-ARRAY OF COMPREHENSIVE OUTPATIENT AND AMBULATORY SERVICES ON ITS MAIN CAMPUS AND OTHER SPECIFIC SERVICES AT MULTIPLE SITES WITHIN ITS PRIMARY AND SECONDARY SERVICE AREAS. THE HOSPITAL OPERATES THE 158 BED DEACONESS GATEWAY HOSPITAL WHICH WAS OPENED IN JANUARY 2006, ON THE GATEWAY CAMPUS CONSISTING OF 13 ADULT INTENSIVE CARE BEDS, 17 PEDIATRIC AND PEDIATRIC INTENSIVE CARE BEDS, 16 NEUROSURGICAL BEDS, 32 ORTHOPAEDIC BEDS, 16 NEURO INTENSIVE CARE BEDS, 32 SURGICAL ONCOLOGY BEDS, AND 32 GENERAL MED/ TELEMETRY BEDS. THE HOSPITAL PROVIDES A FULL ARRAY OF COMPREHENSIVE OUTPATIENT AND AMBULATORY SERVICE ON THE GATEWAY CAMPUS. THE HOSPITAL OWNS AND OPERATES DEACONESS CROSS POINTE, A FREE-STANDING, 60-BED INPATIENT PSYCHIATRIC HOSPITAL LOCATED APPROXIMATELY 7 MILES EAST OF THE MAIN CAMPUS IN EVANSVILLE. ALSO, THE HOSPITAL IS AN OWNER IN THREE JOINT VENTURE HOSPITALS:1. DEACONESS WOMEN'S HOSPITAL OF SOUTHERN INDIANA, LLC D/B/A THE WOMEN'S HOSPITAL, A FREE STANDING SPECIALTY 74-BED WOMEN AND INFANT HOSPITAL LOCATED ON THE GATEWAY CAMPUS.2. HEALTHSOUTH/DEACONESS, LLC D/B/A TRI-STATE REGIONAL REHABILITATION HOSPITAL, A 78-BED INPATIENT ACUTE REHABILITATION HOSPITAL LOCATED APPROXIMATELY 8 MILES TO THE SOUTHEAST OF THE MAIN CAMPUS.3. THE HEART HOSPITAL AT DEACONESS GATEWAY, LLC, A 24-BED CARDIOVASCULAR SPECIALTY HOSPITAL WHICH RESIDES ON THE GATEWAY CAMPUS. THE HOSPITAL PLAYS AN ACTIVE ROLE IN MEDICAL EDUCATION, OPERATING A THREE YEAR FAMILY MEDICINE RESIDENCY PROGRAM AND A POST-GRADUATE PHARMACY RESIDENT PROGRAM, AND SEVERAL UNDERGRADUATE MEDICAL AFFILIATIONS. THE HOSPITAL ALSO PROVIDES CONTINUING MEDICAL EDUCATION PROGRAMS FOR ATTENDING PHYSICIANS, OTHER HEALTH PROFESSIONALS, OTHER ALLIED HEALTH PROGRAMS, AND THE COMMUNITY AT LARGE. THE HOSPITAL, THROUGH ITS RELATED CORPORATIONS, PROVIDES OUTREACH SERVICES TO NURSING HOMES, PHYSICIANS' OFFICES AND SURROUNDING SMALLER HOSPITALS IN ITS SERVICE AREA. PART VI, LINE 6: THE ORGANIZATION FURTHERS ITS EXEMPT PURPOSE BY PROMOTING HEALTH OF THE COMMUNITY INCLUDES: A MAJORITY OF ORGANIZATION'S GOVERNING BODY IS INDEPENDENT AND COMPRISED OF PERSONS WHO RESIDED IN THE ORGANIZATION'S PRIMARY SERVICE AREA; EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN ITS COMMUNITY; AND APPLIES SURPLUS FUNDS TO IMPROVEMENTS IN PATIENT CARE. PART VI, LINE 7: DEACONESS WORKS IN CONCERT WITH DEACONESS HEALTH SYSTEM AND DEACONESS CLINIC TO PROVIDE HEALTHCARE SERVICES WITH A COMPASSIONATE AND CARING SPIRIT TO PERSONS, FAMILIES AND COMMUNITIES OF THE TRI-STATE. DEACONESS HEALTH SYSTEM WORKS TO INCREASE ACCESS TO HEALTHCARE SERVICES WITHIN OUR COMMUNITY THROUGH DEACONESS HOSPITAL AND DEACONESS CLINIC. DEACONESS HOSPITAL IS A MEDICAL INSTITUTION DEDICATED TO PROVIDING QUALITY PATIENT CARE WITH UNRELENTING ATTENTION TO CLINICAL EXCELLENCE, PATIENT SAFETY AND AN UNPARALLELED PASSION AND COMMITMENT TO ASSURE THE VERY BEST HEALTHCARE FOR THE PATIENTS SERVED. DEACONESS CLINIC PROVIDES EXCELLENT PRIMARY AND MULTI-SPECIALTY HEALTHCARE IN A PERSONALIZED FASHION WITH A DEDICATED FOCUS TO SERVE THE COMMUNITY WITH EXCELLENT, TIMELY AND COMPASSIONATE PATIENT CARE. REPORTS FILED WITH STATES PART VI, LINE 7 IN 1 ECONOMIC DEVELOPEMENT COALITION 100 NW 2ND ST 208 EVANSVILLE IN 47737 320152630 3 25000 GENERAL SUPPORT EVANSVILLE KIDNEY ASSOCIATION 1312 PROFESSIONAL BLVD EVANSVILLE IN 47714 260219765 3 20000 GENERAL SUPPORT KOMEN GREATER EVANSVILLE AFFILIATE 4424 VOGEL RD STE 744 EVANSVILLE IN 47708 752844632 3 15000 GENERAL SUPPORT YMCA 118 VINE STREET EVANSVILLE IN 47708 350869075 3 12500 GENERAL SUPPORT YMCA OF SW INDIANA INC 222 NW 6TH ST EVANSVILLE IN 47708 350869074 3 12500 GENERAL SUPPORT EVANSVILLE AREA COMMUNITY CHURCHES 713 N 2ND AVE EVANSVILLE IN 47710 350886837 3 12000 FOOD FOR FOOD PANTRY EVANSVILLE MUSEUM OF ARTS AND SCIENCE 411 SE RIVERSIDE DR EVANSVILLE IN 47713 350874517 3 10000 CAPITAL CAMPAIGN EVANSVILLE REGIONAL BUSINESS ONE VECTREN SQ 744 EVANSVILLE IN 47708 030408032 6 10000 GENERAL SUPPORT MEDIA MINISTRIES DREAM CENTER 16 W MORGAN AVENUE EVANSVILLE IN 47710 352061699 3 10000 CAPITAL CAMPAIGN EVANSVILLE SOCCER CLUB PO BOX 15906 EVANSVILLE IN 47716 352086976 3 10000 GENERAL SUPPORT OTHERS 5000 133222 GENERAL SUPPORT 9 1 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: DEACONESS HOSPITAL CONFIRMS ALL RECIPIENTS OF FUNDS ARE ORGAANIZATIONS WHOSE GOALS COINCIDE WITH DEACONESS' MISSION OF PROVIDING QUALITY HEALTH CARE WITH A COMPASSIONATE AND CARING SPIRIT. THE ORGANIZATIONS PROVIDE NEEDED SERVICES TO OUR COMMUNITY TO IMPROVE HEALTH AND WELLNESS FOR THE CITIZENS IN THE SURROUNDING AREA. X 1 1 X X X X X 1 1 0 0 1 0 0 0 0 LINDA E WHITE 280724 282612 118697 0 9960 6000 108846 60637 14962 14962 533189 364211 258 0 DAVID A KOEHLER JR MD 0 152046 0 23881 21400 795 0 5415 0 5160 21400 187297 0 0 RUSTON L STOLTZ MD 0 265918 0 31937 6708 720 0 8191 0 5350 6708 312116 0 0 RICHARD M STIVERS 32607 32607 49058 0 277659 209601 39343 0 9917 9917 408584 252125 91297 0 CHERYL A WATHEN 190775 29866 29571 0 1656 5400 28805 0 16410 8661 267217 43927 0 0 HARRY L SMITH JR 407891 0 74396 0 114400 5600 113732 0 33165 0 743584 5600 109394 0 SHAWN W MCCOY 278019 0 50559 0 3396 5800 72192 0 24694 0 428860 5800 0 0 JAMES R PORTER MD 309738 0 46675 0 1896 0 71625 0 22414 0 452348 0 0 0 CHERONA J HAJEWSKI 256935 0 39000 0 4708 0 54828 0 24534 0 380005 0 0 0 BRUCE E EPMEIER 189228 0 28791 0 3396 0 46391 0 18485 0 286291 0 0 0 LARRY F PILE 184618 0 30078 0 1362 0 5286 0 19182 0 240526 0 0 0 RICHARD B PERRY 131907 0 34332 0 1176 0 13397 0 25878 0 206690 0 0 0 JOYCE A THOMAS 150799 0 15598 0 40 0 30977 0 7760 0 205174 0 0 0 JOHN L ZABROWSKI 132440 0 19031 0 531 600 7449 0 28855 0 188306 600 0 0 REBECCA L MALOTTE 131274 0 19002 0 238 0 37487 0 18072 0 206073 0 0 0 VENKATESH R MADADI 669660 0 0 0 65076 0 10536 0 21388 0 766660 0 0 0 RAJESH J PATEL MD 640978 0 0 0 49667 0 11724 0 24021 0 726390 0 0 0 NIRMAL JOSHI MD 614050 0 0 0 63933 0 6092 0 25997 0 710072 0 0 0 AYMAN ELFAR MD 538160 0 0 0 46926 0 6453 0 21388 0 612927 0 0 0 LAWRENCE C KILINSKI JR MD 482448 0 0 0 59282 0 12342 0 22045 0 576117 0 0 0 PART I, LINE 1A SOCIAL CLUB DUES ARE PAID FOR LINDA WHITE AND HARRY SMITH FOR ORGANIZATION BUSINESS ONLY. ANY PERSONAL USE OF THE CLUB MUST BE PAID BY THE EMPLOYEES. PART I, LINES 4A-B SEVERANCE, NONQUALIFIED, AND EQUITY-BASED PAYMENTS: SEVERANCE NONQUALIFIED EQUITY-BASED LINDA E. WHITE $ -0- $16,500 $ -0- RUSTON L. STOLTZ, MD. 0 16,500 0 RICHARD M. STIVERS 324,538 1,240 0 HARRY L. SMITH, JR. 0 16,500 0 SHAWN W. MCCOY 0 16,500 0 JAMES R. PORTER, MD. 0 16,500 0 CHERONA J. HAJEWSKI 0 16,500 0 BRUCE E. EPMEIER 0 16,500 0 VENKATESH R. MADADI 0 16,500 0 RAJESH J. PATEL, MD. 0 16,500 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 HARRY SMITH: CONTRIBUTIONS MADE TO SUPPLEMENTAL ACCUMULATION ACCOUNT OF $101,972 SUPPLEMENTAL ACCUMULATION ACCOUNT PAYOUT OF $109,394 SHAWN MCCOY: SUPPLEMENTAL ACCUMULATION ACCOUNT CONTRIBUTIONS OF $60,432 JAMES PORTER: SUPPLEMENTAL ACCUMULATION ACCOUNT CONTRIBUTIONS OF $59,865 CHERONA HAJEWSKI: SUPPLEMENTAL ACCUMULATION ACCOUNT CONTRIBUTIONS OF $43,068 BRUCE EPMEIER: SUPPLEMENTAL ACCUMULATION ACCOUNT CONTRIBUTIONS OF $36,947 PART I, LINE 5 INCENTIVE COMPENSATION PAYMENTS ARE BASED UPON SUCCESSFUL ACHIEVEMENT OF ESTABLISHED INPATIENT SATISFACTION MEASURES, OUTPATIENT SATISFACTION MEASURES, COMPLIANCE WITH PUBLICLY REPORTED QUALITY INDICATORS, OPERATING MARGIN AS WELL AS OTHER TECHNICAL AND PERSONAL FUNCTIONAL GOALS. DEACONESS HOSPITAL'S INCENTIVE COMPENSATION PROGRAMS ARE FORMULATED TO REWARD BEHAVIOR THAT BALANCES PATIENT NEEDS AND EFFICIENT DELIVERY OF PATIENT CARE TO ENSURE THE BEST OUTCOMES ARE ACHIEVED. INDIANA FINANCE AUTHORITY 351602316 45471AAJI 2009-03-26 55914771 FACILITY CONSTRUCTION 0 0 0 INDIANA FINANCE AUTHORITY 351602316 45471AAG7 2009-03-26 40000000 FACILITY CONSTRUCTION 0 0 0 INDIANA HLTH FACILITY FINANCING AUTHORITY 351611409 4547977Y1 2004-05-27 55371597 FACILITY CONSTRUCTION 0 0 0 INDIANA HLTH FACILITY FINANCING AUTHORITY 351611409 4547978A2 2004-05-27 25000000 FACILITY CONSTRUCTION 0 0 0 55914771 12025077 825245 43064449 2011 0 0 1 1 40000000 2672335 399807 60789 36867068 2011 0 0 1 1 55581965 5255622 611421 2187409 47527513 2006 0 0 1 1 25000000 161203 161281 24677516 2006 0 0 1 1 0 1 0 0 1 0.00000 0.01590 0.01590 1 0 1 0 0 1 0.00000 0.01000 0.01000 1 0 1 0 0 1 0.00000 0.01100 0.01100 1 0 1 0 0 1 0.00000 0.01760 0.01760 1 1 0 0 1 TRINITY PLUS 2.000000000000 1 0 1 1 1 0 1 CREDIT AGRICOLE 2.000000000000 1 0 1 1 0 0 0 0 1 1 1 0 0 0 1 VECTREN ENERGY DELIVERY COMMON BOARD MEMBER 5762004 GAS/ ELECTRIC UTILITY 0 SOUTH CENTRAL COMMUNICATIONS COMMON BD MBR 164685 ADVERTISING PROVIDER 0 EVANSVILLE RADIOLOGY PC COMMON BD MBR 728657 MANAGEMENT SERVICES 0 MISTY ADYE FAMILY OF BD MBR 33369 COMPENSATION 0 LETTA FRACCARO FAMILY OF BD MBR 47071 COMPENSATION 0 ANN TORNATTA FAMILY OF BD MBR 97933 COMPENSATION 0 NANCY KOEHLER FAMILY OF BD MBR 116306 COMPENSATION 0 ALEX SEIBERT FAMILY OF OFFICER 71606 COMPENSATION 0 SHERRI MCCOY FAMILY OF OFFICER 22938 COMPENSATION 0 ORGANIZATION'S MISSION FORM 990, PART III, LINE 1 DEACONESS HOSPITAL PROVIDES QUALITY HEALTHCARE SERVICES WITH A COMPASSIONATE AND CARING SPIRIT TO PERSONS, FAMILIES AND COMMUNITIES OF THE TRI-STATE. AT DEACONESS HOSPITAL, OUR VALUES ARE BASED ON OUR COMMITMENT TO QUALITY. WE DEFINE QUALITY AS THE CONTINUOUS IMPROVEMENT OF SERVICES TO MEET THE NEEDS AND EXCEED THE EXPECTATIONS OF THE CUSTOMERS WE SERVE. OUR VALUES ARE QUALITY IN EVERYTHING WE DO, RESPECT FOR ALL PEOPLE, EFFICIENCY AND EFFECTIVENESS IN THE USE OF RESOURCES, INNOVATION TOWARD CONTINUOUS SYSTEMS IMPROVEMENT, PARTNERSHIP WITH THOSE WE SERVE AND WITH SUPPLIERS, EDUCATION FOR CONTINUOUS GROWTH AND KNOWLEDGE AND PRIDE IN WORKMANSHIP. TO ACCOMPLISH ITS MISSION, DEACONESS HOSPITAL IS COMMITTED TO IMPROVING THE QUALITY OF LIFE FOR THE PEOPLE OF THE TRI-STATE BY DEMONSTRATING EXCELLENCE IN HEALTHCARE SERVICES, PROVIDING ACCESS TO HEALTHCARE, PROVIDING CHARITY CARE TO THOSE IN NEED,PROMOTING HEALTHLY LIFESTYLES, OFFERING SPIRITUAL AND PSYCHOLOGICAL SUPPORT, SUPPORTING HEALTH RELATED EDUCATION, AND ADVANCING HEALTH KNOWLEDGE THROUGH RESEARCH. PROGRAM SERVICES ACCOMPLISHMENT 1: PATIENT SERVICE REVENUE FORM 990, PART III, LINE 4A DEACONESS HOSPITAL IS A MAJOR REFERRAL CENTER FOR A 25 COUNTY TRI-STATE AREA IN SOUTHWESTERN INDIANA, WESTERN KENTUCKY AND SOUTHEASTERN ILLINIOS. THE HOSPITAL AND ITS FACILITIES ARE LOCATED ON FOUR CAMPUSES WHICH INCLUDE THE MAIN 28-ACRE CAMPUS ON THE NEAR NORTH SIDE OF EVANSVILLE IN VANDERBURGH COUNTY, THE 63-ACRE GATEWAY CAMPUS IS LOCATED IN WARRICK COUNTY ON THE EASTERN BORDER OF VANDERBURGH COUNTY, AND TWO OTHER EASTSIDE EVANSVILLE LOCATIONS FOR PSYCHIATRIC BEHAVIORAL SERVICES AND REHABILITATION SERVICES. THE HOSPITAL OPERATES A MAIN CAMPUS WITH A TOTAL OF 323 BEDS CONSISTING OF 24 INTENSIVE CARE BED, 26 CARDIAC INTENSIVE CARE BEDS, 66 CARDIAC BEDS, 23 ONCOLOGY/PULMONOLOGY BEDS, 61 ORTHOPAEDIC/NEUROLOGICAL BEDS, 5 PEDIATRIC TRAUMA BEDS, 18 MENTAL HEALTH BEDS, 96 MEDICAL/SURGICAL BEDS AND 4 HOSPICE BEDS. IN ADDITION, THE HOSPITAL PROVIDES A FULL-ARRAY OF COMPREHENSIVE OUTPATIENT AND AMBULATORY SERVICES ON ITS MAIN CAMPUS AND OTHER SPECIFIC SERVICES AT MULTIPLE SITES WITHIN ITS PRIMARY AND SECONDARY SERVICE AREAS. THE HOSPITAL OPERATES THE 158 BED DEACONESS GATEWAY HOSPITAL WHICH WAS OPENED IN JANUARY 2006, ON THE GATEWAY CAMPUS CONSISTING OF 13 ADULT INTENSIVE CARE BEDS, 17 PEDIATRIC AND PEDIATRIC INTENSIVE CARE BEDS, 16NEUROSURGICAL BEDS, 32 ORTHOPAEDIC BEDS, 16 NEURO INTENSIVE CARE BEDS, 32 SURGICAL ONCOLOGY BEDS AND 32 GENERAL MED/ TELEMETRY BEDS. THE HOSPITAL PROVIDES A FULL ARRAY OF COMPREHENSIVE OUTPATIENT AND AMBULATORY SERVICE ON THE GATEWAY CAMPUS. THE HOSPITAL OWNS AND OPERATES DEACONESS CROSS POINTE, A FREE-STANDING, 60 BED INPATIENT PSYCHIATRIC HOSPITAL LOCATED APPROXIMATELY 7 MILES EAST OF THE MAIN CAMPUS IN EVANSVILLE. PROGRAM SERVICES ACCOMPLISHMENT 2: CHARITY CARE/ SUBSIDIZED CARE: FORM 990, PART III, LINE 4B DECONESS HOSPITAL MAKES A DISTINCTION BETWEEN CHARITY CARE AND BAD DEBT. IN DETERMINING AN INDIVIDUAL OR FAMILIY'S ABILITY TO PAY, DEACONESS HOSPITAL EVALUATES WHETHER OR NOT THE RESPONSIBLE PARTY HAS SUFFICIENT RESOURCES AVAILABLE FOR PAYMENT. IF AN INDIVIDUAL IS DETERMINED TO NOT HAVE SUFFICIENT RESOURCES TO PAY, THEY ARE CONSIDERED ELIGIBLE FOR CHARITY CARE AND WILL NOT BE PROCESSED THROUGH INTERNAL OR EXTERNAL COLLECTIONS. ACCOUNTS OF CHARITY CARE PATIENTS WHO ARE UNABLE TO PAY DO NOT RESULT IN BAD DEBT AND ARE NOT COLLECTED UPON. DEACONESS HOSPITAL PROVIDES CARE TO PERSONS COVERED BY GOVENMENTAL PROGRAMS BELOW COST. RECOGNIZING ITS MISSION TO THE COMMUNITY, SERVICES ARE PROVIDED TO BOTH MEDICARE AND MEDICAID PATIENTS. TO THE EXTENT OF REIMBURSEMENT IS BELOW COST, DEACONESS HOSPITAL ABSORBS THESE COSTS IN MEETING ITS MISSION TO THE COMMUNITY. IN SUPPORT OF ITS MISSION, DEACONESS HOSPITAL PROVIDED $26 MILLION OF CHARITY CARE & $37.8 MILLION OF SUBSIDIZED SERVICES TO THE MEDICAID PROGRAM, AND $33.6 OF SUBSIDIZED SERVICES TO THE MEDICARE PROGRAM. PROGRAM SERVICES ACCOMPLISHMENT 3: MEDICAL EDUCATION & COMMUNITY BENEFITS FORM 990, PART III, LINE 4C DEACONESS HOSPITAL PLAYS AN ACTIVE ROLE IN MEDICAL EDUCATION, OPERATING A THREE YEAR FAMILY MEDICINE RESIDENCY PROGRAM AND A POST-GRADUATE PHARMACY RESIDENT PROGRAM. DEACONESS HOSPITAL ALSO PROVIDES CONTINUING MEDICAL EDUCATION PROGRAMS FOR ATTENDING PHYSICIANS, OTHER HEALTH PROFESSIONALS, OTHER ALLIED HEALTH PROGRAMS, COMMUNITY HEALTH PROGRAMS AND A CHAPLAIN RESIDENCY PROGRAM. IN ADDITION TO EDUCATIONAL SERVICES, DEACONESS HOSPITAL PROVIDES $5.5 MILLION IN COMMUNITY BENEFIT ACTIVITIES (ALL ON A COST BASIS), SERVING A MINIMUM OF 626,389 PEOPLE WITHIN THE TRI-STATE AREA. FORM 990, PART VI, SECTION A, LINE 6 DEACONESS HEALTH SYSTEM, INC. IS THE SOLE CORPORATE MEMBER OF DEACONESS HOSPITAL, INC. FORM 990, PART VI, SECTION A, LINE 7A THE BOARD OF DIRECTORS MAY ELECT ONE OR MORE NON-MEDICAL STAFF MEMBERS OF THE GOVERNING BODY THROUGH AN APPROVED ELECTION AND APPROVAL PROCESS. THE ELECTION AND APPROVAL PROCESS FOR NON-MEDICAL STAFF MEMBERS BEGINS WITH A RECCOMENDATION BY THE GOVERNANCE COMMITTEE FOR MEMBERSHIP TO THE BOARD OF DIRECTORS. THAT RECCOMENDATION IS THEN REVEIWED AND APPROVED BY THE BOARD OF DIRECTORS. DEPENDING ON THE DECISION REACHED BY THE BOARD OF DIRECTORS, MEMBERSHIP MAY OR MAY NOT BE GRANTED TO THAT INDIVIDUAL. MEDICAL STAFF EXECUTIVE COUNCIL LEADERSHIP ARE APPOINTED TO BOARD OF DIRECTOR MEMBERSHIP THROUGH THEIR POSITION AS ELECTED MEDICAL STAFF LEADERS. THROUGH THE ELECTION PROCESS OF THE MEDICAL STAFF EXECUTIVE COUNCIL, THEIR APPOINTMENT IS CONFIRMED AND APPROVED. FORM 990, PART VI, SECTION B, LINE 11 THE PROCESS THAT DEACONESS HOSPITAL 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. 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 HOSPITAL 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 15 COMPENSATION FOR TOP OFFICIALS AND OTHER OFFICERS: DEACONESS 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 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 CEO AND EACH OTHER EXECUTIVE OFFICER OF THE SYSTEM 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, CEO 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 18 DEACONESS DOES NOT MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTERST POLICY OR FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC. FORM 990, PART VI, SECTION C, LINE 19 DEACONESS HOSPITAL DOES NOT MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY OR FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC. CONTACT ADDRESSES FOR OFFICERS, DIRECTORS, ETC FORM 990, PART VII RICHARD M STIVERS - 9901 BROWNING ROAD, EVANSVILLE, IN 47630. HARRY L SMITH, JR - 916 WOODRIDGE COURT, NEWBURGH, IN 47630. AVERAGE HOURS PER WEEK FORM 990, PART VII, SECTION A, LINE 1A, COLUMN (B) 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 CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -3,563,788. CHANGE IN PENSION LIABILITY -3,997,955. CAPITAL CONTRIBUTION TO DEACONESS HEALTH SYSTEM -17,833,520. CAPITAL CONTRIBUTION FROM DEACONESS FOUNDATION 200,000. FOUNDATION MONIES RELEASED FROM RESTRICTION -1,190,127. TOTAL TO FORM 990, PART XI, LINE 5: -26,385,390. OVERSIGHT OF AUDIT 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. DEACONESS HEALTH SYSTEM INC 600 MARY STREET EVANSVILLE IN 47747 351532889 HEALTHCARE IN 501(C)(3) LINE 11A, I N/A 0 DEACONESS CLINIC INC 421 CHESNUT STREET EVANSVILLE IN 47713 263083364 HEALTHCARE IN 501(C)(3) LINE 3 DEACONESS HEALTH SYSTEM 0 DEACONESS HEALTH PLANS 350 W COLUMBIA SUITE 400 EVANSVILLE IN 47710 383492529 PERF PROV IN N/A RELATED 503475 2165183 0 0 0.93000 HEARTCARE HEALTH SYSTEM 415 W COLUMBIA EVANSVILLE IN 47710 352038344 HEALTHCARE IN N/A RELATED -365329 74980 0 0 0.70000 PROGRESSIVE HLTH IN 150 N ROSENBERGER EVANSVILLE IN 47712 208480988 OUTPATIENT IN N/A RELATED 1643528 1105739 0 0 0.51000 HEART HOSPITAL AT DEACONESS GATEWAY 4007 GATEWAY BLVD NEWBURGH IN 47630 261766835 HOSPITAL DE N/A RELATED 2726392 6808578 0 0 0.51000 TRI-STATE RADIATION ONCOLOGY 1500 ROSECRANS AVENUE MANHATTAN BEACH CA 90266 263706834 OUTPATIENT DE N/A RELATED 1878002 3069727 0 0 0.51000 TRI-STATE MEDICAL MANAGEMENT INC 600 MARY STREET EVANSVILLE IN 47747 351875888 PHYSICIAN MANAGEMENT IN N/A C 1.00000 0 1 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 0 DEACONESS HEALTH PLANS LLC I 55358 HEART HOSP AT DEAC GATEWAY LLC N 7767054 HEART HOSP AT DEAC GATEWAY LLC O 2274096 HEART HOSP AT DEAC GATEWAY LLC P 5408156 DEACONESS HEALTH PLANS LLC P 169229