2011-02-03T07:32:45-06:00 2010-09-30 ERNST & YOUNG US LLP PO Box 44972 Indianapolis IN 462440972 990 2009-10-01 263083364 Deaconess Clinic Inc DEAC 8124502370 600 Mary Street Evansville IN 47747 David Christeson 2011-02-01 3176817000 2009 2016-02-24 21:20:13Z DAVID D CHRISTESON MD 421 CHESTNUT STREET EVANSVILLE IN 47713 48421774 false X DEACONESS.COM X 2008 IN ATTACHMENT 2 14 1 688 0 41320 0 0 50420500 48105216 0 3154 60821 39864 50481321 48148234 0 0 0 0 45803441 47392400 0 0 0 20731153 21526026 66534594 68918426 -16053273 -20770192 14411906 12242500 7336534 7766003 7075372 4476497 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. The governing body has adopted the preceding Mission Statement. Form 990 - Part I, Line 1 - Organization's Most Significant Activities: 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, int false false 58436528 46419947 Patient Service 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 90 physicians and 365 full time nursing and administrative personnel. 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 386,664 patient visits from October 1, 2009 through September 2010. 1689196 1685269 The Research Institute of Deaconess Clinic assists Deaconess Clinic's 90 physicians in gaining access to leading edge medical science and new treatments for acute and chronic illnesses. The Institute was awarded 53 new clinical research grants this year to study investigational treatments across 12 fields of medicine including heart disease, cancer, diabetes, urological disorders, depression, and pain management. The new research grants will provide treatment opportunities for up to 1,025 patients. In all, the newly awarded grants this year totaled $4.8 million to cover the costs associated with the conduct of the clinical trials within the region. 413 patients were enrolled into clinical trials throughout the year, resulting in 4,839 research related patient visits. The Research Institute also successfully completed 3 inspections by the Food and Drug Administration. In addition, research conducted by the Research Institute and selected Deaconess Clinic Investigators received national recognition through publication in the New England Journal of Medicine, and the Journal of Allergy and Immunology in 2010. 60125724 true false false true false false false false false true false true false false false false false false false false false false false true false false false false false false false false false false false false false true false false false true 76 0 true 688 true true true false false false false false false false false 14 1 false false false false true true true true true true false true true true true true true true true true true IN X RICHARD PERRY 8124502370 600 MARY STREET EVANSVILLE IN 47747 LINDA WHITE 5.0 X 0 2158468 178330 BRUCE SCHNEIDER MD 50.0 X 1492211 0 27556 RICHARD STIVERS 5.0 X 0 996331 53438 ANNE MCLAUGHLIN MD 50.0 X 702331 0 21801 DAVID CHRISTESON MD 50.0 X X 429073 0 45279 MOHAMMED ALLAW MD 50.0 X 408584 0 27070 BARRY PHILLIPS MD 50.0 X 340351 10320 26297 GARY KEEPES MD 50.0 X 344367 0 25292 GARY ERDY MD 50.0 X 326472 0 25073 RUSTON STOLTZ MD 50.0 X 306267 0 7871 ROBERT KAYLOR 50.0 X 260030 0 13999 W ALLEN WHITE MD 50.0 X 250661 0 38473 JAMES GUTMANN MD 50.0 X 239237 0 25185 CHERYL WATHEN 5.0 X X 0 216784 43422 ROBERT WRIGHT 5.0 X X 0 0 0 MAQBOOL AHMED MD 50.0 X 1383103 0 27039 PAUL SIAMI MD 50.0 X 1073678 0 26088 DANIEL SHIREY 50.0 X 804283 0 19215 JEFFREY MOORE MD 50.0 X 723204 0 31669 MAJED KOLEILAT MD 50.0 X 667535 0 23443 THOMAS W DAVIDSON 50.0 X 280011 0 48451 10031398 3381903 734991 83 true true false SPHERIS 13552 COLLECTIONS CENTER DRIVE CHICAGO IL 60693 TRANSCRIPTION 332322 BILL DUNBAR ASSOCIATES LLC 2601 FORTUNE CIRCLE EAST INDIANAPOLIS IN 46241 CONSULTING 270650 TRI-STATE ENT 350 W COLUMBIA ST EVANSVILLE IN 47710 MEDICAL 233200 THE HEART GROUP 415 W COLUMBIA ST EVANSVILLE IN 47710 MEDICAL 209593 ALVEY SIGN CO INC 13100 HIGHWAY 57 NORTH EVANSVILLE IN 47725 ADVERTISING 199397 6 0 NET PATIENT REVENUE 621110 46419947 46419947 RESEARCH REVENUE 621110 1685269 1685269 48105216 3154 3154 0 0 272084 273540 -1456 -1456 -1456 0 0 0 0 SKIN CARE PRODUCTS 621110 41320 41320 41320 48148234 48105216 41320 1698 0 0 0 0 5386866 4895568 491298 0 34991093 33510076 1481017 271451 265571 5880 1384964 1215464 169500 5358026 4790724 567302 0 0 402014 402014 18141 18141 0 0 4767485 590682 4176803 828467 393770 434697 4470038 4366630 103408 1587573 1418236 169337 0 6276567 5941814 334753 66534 42432 24102 0 277381 251593 25788 1307 1307 0 851795 748217 103578 971566 672459 299107 BAD DEBT 1003040 1003040 UBI INCOME TAX 4118 4118 68918426 60125724 8792702 0 1264781 0 8657760 7638240 213137 284406 5773177 1705021 4029738 4068156 226140 231698 20350 20000 14411906 12242500 7291051 7766003 45483 0 7336534 7766003 X 7075372 4476497 7075372 4476497 14411906 12242500 X false true true X false X false false false false false false false false true 18141 18141 false SCHEDULE C PART II-B, LINE 1i 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 statements. 2177476 558002 1619474 2794529 1147019 1647510 801172 0 801172 4068156 0 0 X true false X X X X X X false true false false false false false false false LINDA WHITE 0 597519 0 151669 0 1413280 0 161405 0 28335 0 2352208 0 1397694 BRUCE SCHNEIDER MD 1475836 0 14671 0 1704 4200 5714 0 27157 0 1525082 4200 0 0 RICHARD STIVERS 0 404777 0 90267 0 506688 0 37315 0 21439 0 1060486 0 491246 ANNE MCLAUGHLIN MD 691055 0 9335 0 1941 0 2100 0 25017 0 729448 0 0 0 DAVID CHRISTESON MD 341058 0 86074 0 1941 0 25113 0 25482 0 479668 0 0 0 MOHAMMED ALLAW MD 367077 0 40470 0 1037 2163 8855 0 23530 0 440969 2163 0 0 BARRY PHILLIPS MD 299601 0 38809 0 1941 10320 8082 0 23530 0 371963 10320 0 0 GARY KEEPES MD 298973 0 43532 0 1862 0 8501 0 22106 0 374974 0 0 0 GARY ERDY MD 274707 0 50140 0 1625 0 5581 0 24807 0 356860 0 0 0 RUSTON STOLTZ MD 276243 0 29304 0 720 2713 7601 0 5585 0 319453 2713 0 0 ROBERT KAYLOR 247947 0 11178 0 905 0 0 0 19315 0 279345 0 0 0 W ALLEN WHITE MD 230906 0 18730 0 1025 0 22350 0 21439 0 294450 0 0 0 JAMES GUTMANN MD 204194 0 33418 0 1625 0 4403 0 26097 0 269737 0 0 0 CHERYL WATHEN 0 193664 0 21419 0 3901 0 22825 0 25912 0 267721 0 0 MAQBOOL AHMED MD 1324151 0 57011 0 1941 0 2417 0 29937 0 1415457 0 0 0 PAUL SIAMI MD 999341 0 72712 0 1625 0 6646 0 24757 0 1105081 0 0 0 DANIEL SHIREY 803243 0 0 0 1040 0 0 0 24530 0 828813 0 0 0 JEFFREY MOORE MD 678243 0 43020 0 1941 0 7677 0 29307 0 760188 0 0 0 MAJED KOLEILAT MD 654209 0 11385 0 1941 0 2252 0 26506 0 696293 0 0 0 THOMAS W DAVIDSON 255230 0 24061 0 720 0 30236 0 23530 0 333777 0 0 0 PART III- OTHER ADDITIONAL INFORMATION PART 1, 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. SEVERANCE, NONQUALIFIED, & EQUITY-BASED PAYMENTS PART I, LINE 4 SEVERANCE NONQUALIFIED EQUITY-BASED LINDA WHITE 0 16,500 0 RICHARD STIVERS 0 16,500 0 ANNE MCLAUGHLIN, MD 0 16,500 0 DAVID CHRISTESON, MD 0 16,500 0 GARY KEEPES, MD 0 16,500 0 GARY ERDY, MD 0 16,500 0 RUSTON STOLTZ, MD 0 16,500 0 W ALLEN WHITE, MD 0 16,500 0 JAMES GUTMANN, 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 MAJED KOLEILAT, MD 0 16,500 0 Part 1, Line 4B Linda White: Supplemental retirement payout of $1,309,125; contributions made to a supplemental accumulation account of $149,645; supplemental accumulation account payout of $88,569. Richard Stivers: Supplemental retirement payout of $433,225; supplemental accumulation account payout of $58,023. Classes of Members or stockholders Form 990, Part VI, Line 6 Deaconess Clinic Inc has one member which is Deaconess Health System Inc. Election of Members and their rights Form 990, Part VI, Line 7a The System must approve the chosen Deaconess Clinic Chief Physician Administrative Officer (CPAO). Decisions subject to approval of Members Form 990, Part VI, 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. Officers Who Cannot Be Reached Form 990, Part VI, Line 9 Richard Stivers 9901 Browning Road Evansville IN 47725 Organization's process to review form 990 Form Part VI, Line 11A The process that Deaconess Clinic utilizes to present the Form 990 to its governing body prior to filing Form 990. The Form 990 is reviewed by the organization's CEO, CFO, and internal audit department prior to presenting the Form 990 to the Board of Directors at the board meeting prior to the filing date of the Form 990. Any questions are answered and the final filing is then completed. Enforcement of conflicts policy Form 990, Part VI, Line 12c Conflict of Interest review and compliance activities are conducted through out the year under 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 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. Compensation process for top officials Form 990, Part VI, Line 15a Deaconess Clinic utilizes the compensation committee of Deaconess Health System Inc 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, annually review and approve and recommend to the Board of Directors for its final approval for the CPAO and each other executive officer of the System all elements of executive compensation, monitor broadly the structure, philosophy or competitiveness of the system's general hiring or compensation practices, oversee the establishment and administration of the Company's broad-based benefits plans and programs, and review or approve significant amendments or changes to the plans and programs, to retain and terminate any compensation consultant to be used to assist in the evaluation of director, CPAO or executive officer compensation and shall have the sole authority to approve the consultant's fees and other retention terms. The Committee also has the authority to obtain advice and assistance from internal or external legal, accounting or other advisors, to approve all Physician and physician-related contracts and to make regular reports to the Board. Compensation process for Officers Form 990, Part VI, Line 15b Deaconess Clinic utilizes the compensation committee of Deaconess Health System Inc 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, annually review and approve and recommend to the Board of Directors for its final approval for the CPAO and each other executive officer of the System all elements of executive compensation, monitor broadly the structure, philosophy or competitiveness of the system's general hiring or compensation practices, oversee the establishment and administration of the Company's broad-based benefits plans and programs, and review or approve significant amendments or changes to the plans and programs, to retain and terminate any compensation consultant to be used to assist in the evaluation of director, CPAO or executive officer compensation and shall have the sole authority to approve the consultant's fees and other retention terms. The Committee also has the authority to obtain advice and assistance from internal or external legal, accounting or other advisors, to approve all Physician and physician-related contracts and to make regular reports to the Board. Governing Documents Disclosure Explanation Form 990, Part VI, Line 19 Deaconess Clinic does not make its governing documents, conflict of interest or financial statements available to the public. Average hours per week Form 990, Part VII, Section A (B) The average worked hours of Ms. White, Ms. Wathen, and Mr. Stivers reported in column (B) is the portion of their hours reported as 50 hours per week on the Deaconess Hospital, Inc. return. A portion of those 50 hours relates to time devoted to Deaconess Clinic issues and concerns. Additional Information Schedule R, Part V, Section 2(1) Deaconess Health System Inc is the only shareholder of Deaconess Clinic Inc and when needed contributes additional capital so Deaconess Clinic can pay expenses. 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