2011-11-15T09:31:59-07:00 2010-12-31 990 2010-01-01 310537109 DEACONESS HOSPITAL OF CINCINNATI OH DEAC 5135592100 311 Straight Street Cincinnati OH 452191018 E Anthony Woods 5135592111 2011-11-15 2010 2016-03-07 17:11:31Z E Anthony Woods c/o Deaconess Hospital 311 Straight Street Cincinnati OH 45219 14856577 0 X www.deaconess-healthcare.com X 1888 OH The Deaconess Hospital offers a complete range of inpatient and outpatient medical care from treatment of minor complaints to the diagnosis and management of serious illness, including surgical services, as well as wellness health care. The Deaconess Hospital provides care for individuals meeting certain financial criteria for whom no, or reduced, payment may be anticipated. X 5 2 331 78 1143818 -235913 1968809 1950902 34710583 12905660 62 15 0 0 36679454 14856577 0 0 0 0 23781005 10972826 0 0 0 28443718 18636748 52224723 29609574 -15545269 -14752997 15053718 9811622 29535928 44149330 -14482210 -34337708 X The Deaconess Hospital offers a complete range of inpatient and outpatient medical care from treatment of minor complaints to the diagnosis and management of serious illness, including surgical, as well as wellness health care. The Deaconess Hospital provides care for individuals meeting certain financial criteria for whom no, or reduced, payment may be anticipated. 0 1 23791488 0 11761880 Patient Care: The Deaconess Hospital provided effective health care services with approximately 4,130 inpatient days and 48,500 outpatient visits during 2010. The Deaconess Hospital offers a complete range of inpatient and outpatient medical care form treatment of minor complaints to the diagnosis and management of serious illness, including surgical services, as well as wellness health care. The Deaconess Hospital provided care for indivduals meeting certain financial criteria for whom no, or reduced, payment may be anticipated. The amount of charges forgone for services and supplies furnished under the hospital's charity care policy was approximately $224,309 for 2010. Deaconess Hospital also provided uncompensated care of $13,744,000, which is 56% of gross patient revenue. 0 0 0 23791488 1 1 0 0 0 0 0 0 0 0 1 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0 0 1 1 1 0 0 0 1 0 1 0 0 0 0 1 67 0 1 331 1 1 1 0 0 0 0 0 X 5 2 1 0 0 0 0 0 0 1 1 1 0 1 1 1 1 1 1 1 1 0 OH X Deaconess Hospital of Cincinnati OH c/o Jennifer Simon Accounting Manager 5135592100 311 Straight Street Cincinnati OH 452191018 Lee W Scroggins 0 X 0 0 0 Thomas Schiff 0 X 0 0 0 E Anthony Woods 10.00 X X 0 0 218000 Kay French 0 X 0 0 0 John J Schiff Jr 0 X 0 0 0 David Sirk - One80 Interim Inc 40 X 214338 0 0 Randall K Wolf 40 X X 356950 0 23527 Eric W Schneeberger 40 X X 303605 0 16170 Monica Flynn 40 X X 131880 0 6665 Jane Dresselhaus 40 X 123961 0 0 Michael J Rehn 40 X 118532 0 14008 1249266 0 278370 6 0 1 0 Crothall Facilities Management 955 Chesterbrook Blvd Suite 300 Wayne PA 19087 Housekeeping/Maintenance Services 1257113 Christopher Summe PO Box 75097 Fort Thomas KY 41075 physician services 208794 Millenium Anesthesia 20 Medical Village Dr Suite 208 Edgewood KY 41017 Anesthesiology Services 466631 GE Medical Systems PO Box 96483 Chicago IL 60693 Biomedical services 363869 Morrison Management 5801 Peachtree Dunwoody Rd Atlanta GA 30342 Dietary Services 543741 14 0 0 0 1950902 0 0 0 1950902 Net Patient Service Revenues 622000 9546159 9546159 0 0 Other Hospital Operating Revenue 622000 2215683 2215683 0 0 Ref Lab 621500 1143818 0 1143818 0 0 0 0 0 12905660 15 0 0 15 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 14856577 11761842 1143818 15 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 8212051 7176628 1035423 0 1977394 0 1977394 0 34021 30401 3620 0 749360 616095 133265 0 0 0 0 0 238355 0 238355 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 5666588 5007145 659443 0 325489 292595 32894 0 4051463 3789785 261678 0 447771 0 447771 0 0 0 0 0 1390988 1390988 0 0 5206 1675 3531 0 0 0 0 0 1773 1294 479 0 241565 241565 0 0 0 0 0 0 3460792 3460792 0 0 1077835 159524 918311 0 Collection Fees/Billing Fees 105922 0 105922 0 Bad Debt 1100867 1100867 0 0 Drugs 265082 265082 0 0 Hospital Franchise Fee 257052 257052 0 0 29609574 23791488 5818086 0 0 265684 0 0 2188767 1885169 0 0 0 973778 4459 140574 110546 55808021 49668136 10262614 6139885 64648 64656 0 0 0 1423337 1341223 15053718 9811622 14968551 15417666 12920000 1647377 28731664 29535928 44149330 X -14482210 -34337708 0 0 0 0 -14482210 -34337708 15053718 9811622 X -14752997 -5102501 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 385594 385594 0 17323847 16028609 1295238 0 0 0 0 0 38098580 33639527 4459053 0 0 0 0 6139885 Stop Loss Receivable 1249768 Due from Affiliates 91455 1341223 Accrued LT Insurance 1761274 Due to (from) Affiliates 26970390 28731664 1 1 1 X 1 X 180 1 1 0 1 1 507156 507156 0.017 516159 136497 379662 0.013 0 0 1023315 136497 886818 0.030 4 3433 513839 384534 129305 0.004 669000 669000 0.0225 4 3433 1182839 384534 798305 0.0265 4 3433 2206154 521031 1685123 0.0565 1 1227467 0 3586122 8528181 -4942059 X 1 1 Tristate Healthcare Services Physician Practices 1 0 0 1 1 Deaconess Hospital of Cincinnati Ohio

311 Straight Street Cincinnati OH 45219

X X Urgent Care Center Deaconess Hospital of Cincinnati Ohio 1 SchH_P01_S00_L03c Schedule H, Part I, Line 3c Deaconess Hospital uses Federal Poverty Guidelines to determine eligibility for providing free and discounted care to low income individuals. A sliding scale is used to determine discounted care. If the patient's income is 20% over Federal Poverty Guidelines, the patient pays 20%. The maximum income for a patient to receive discounted care is 80% over FPG, the patient would then pay 80% of their bill. SchH_P01_S00_L07 Schedule H, Part I, Line 7 7a. The cost-to-charge ratio derived from Worksheet 2 was used to calculate the community benefit expense. 7b. The cost-to-charge ratio was used to calculate the community benefit expenses using the methodology from the Medicaid Cost Report. 7e. The community benefit expense was determined using direct expenses associated with the following programs: Lifeline program, Transporation services, and the Hughes High School development program. 7i. The community benefit expense was determined by using the fair market value of supplies and equipment donated to Matthew 25 Ministries. SchH_P01_S00_L072f Schedule H, Part I, Line 7, Column f The bad debt expense that is included on Form 990, part IX, line 25, column (A), but subtracted for purposes of calculated the percentage in this column is $1,100,867. SchH_P01_S00_L07g Schedule H, Part I, Line 7g Not applicable SchH_P03_S0A_L04 Schedule H, Part III, Section A, Line 4 Footnote Charity Care - The Hospital treats patients regardless of their ability to pay. The Hospital also provides care for the individuals meeting certain financial criteria for whom no, or reduced payment, is anticipated. The amount of charges forgone for services and supplies furnished under the Association's charity care policy approximated $224,309 and $427,273 for the years ended December 31,2010 and 2009, respectively. Part III, line 2: The bad debt expense at cost is determined by taking the bad debt expense, which would be the gross charges with appropriate discounts for self pay and other payors, taken a the cost-to-charge ratio determined using Worksheet 2. Part III, line3: The charity care is reported in the contracutal, not in bad debt expense, so none of the bad debt expense is attributable to patients eligible under the organization's charity care policy. SchH_P03_S0B_L08 Schedule H, Part III, Section B, Line 8 The methodology used to determine the Medicare allowable costs reported in the Medicare Cost Report is the cost-to-charge ratio. Approximately eighty percent of the Medicare short fall should consititute a community benefit. The majority of patients Deaconess Hospital serves are in the older adult population. The services include older adult mental health behavoir, articular fibrillation, and general older adult surgical services. SchH_P03_S0C_L09b Schedule H, Part III, Section C, Line 9b Patient Financial Services will attempt collection efforts for up to sixty days after services are rendered. During this period two statements are sent indicating the amount due. These collection efforts include counseling the patient about any government, charity care, or other assistance programs for which they may be eligible. SchH_P06_S00_L02 Schedule H, Part VI, Line 2 Needs Assessment: Deaconess' overall goals are to improve health conditions, increase life spans and positively impact quality of life for community residents. Objectives also include achieving a better balance of health parity among residents and improving access to preventitive services. We rely on a variety of tools and resources to support those goals. Examples include: *Partnering with other local agencies/organizations to strengthen and broaden the organization's outreach capacity in the community: Council on Aging; Association for the Blind; City of Cincinnati Health Department; Cincinnati Eye Institute; etc. *Relationship with the Health Foundation of Greater Cincinnati, an independent foundation dedicated to improving community health and access to healthcare for vulnerable populations in our community. *Consulting with physician groups to identify gaps in service *Interacting directly and routinely with seniors and caregivers to identify common barriers to maintaining independence. *Evaluating opportunities within Deaconess Association's long term care facilities to develop a coordinated plan of care model for residents and caregivers *Facilitating discussions with mental health providers in the community to pormote mutual goals *Utilizing the Health Improvement Collaborative of Greater Cincinnati, which identifies critical health issues through community health status surveys and health indicator reports. Data includes environmental, mortality, behavioral, and utilization measures gleaned from 14 counties in the Tristate area. *Participating in HealthBridge, the largest electronic health information exchange system in the country. *Strategizing based on results of HealthINSIGHTS, annual publication of local health council report covering demographic, economic workforce, access, etc. trends in the Greater Cincinnati membership area. *Studying programs initiated by other hospitals in the nation which illustrate success in responding to the community by satisfying social/basic needs, promoting health lifestyles, improving access/coverage, enhancing quality of life. SchH_P06_S00_L03 Schedule H, Part VI, Line 3 It is the policy of Deaconess Hospital to provide basic medically necessary hospital level services free or at a reduced charge for eligible patients. Eligibility is determined by federal or state program criteria or under hospital-specific standards consistent with the hospital's mission and available financial resources. Upon registration, patients who are determined to be self-pay or without insurance are offereced an application form for charity care. Patients who may qualify for Medicaid will be given instructions on the application proces. Consultation with a patient financial services representative is also made available to patients who need assistance in determining insurance plan coverage, payment options, or financial support eligibility under this policy. Patients are also informed of their rights to receive basic medically necessary hospital services, irrespecitve of income level, through public postings in the hospital and on the bill for services provided to patients. The policy includes language and print specifications to ensure legibility as well as supplemental assistance for those hwo may be reading impaired. A separate policy concerning Deaconess Hospital's Collection Process also addresses follow-up efforts to educate patients on potential eligibility for government assistance, charity care, or payment plan options. SchH_P06_S00_L04 Schedule H, Part VI, Line 4 Community information: *Deaconess Hopsital's service area is composed of urban and suburban communitites. The top 45% of its inpatient adminissions and outpatient visits are derived from 14 zip codes with a total population of 350,000. The average median income in those communities is $34,634, almost 30% of which fall in the bottom 10% of national percentile rankings. Half of those communities fall in the bottom ten percent of national rankings in terms of home ownership. Thirteen additional full-service hospitals serve the Greater Cincinnati community - three of which are located less than two miles from Deaconess Hospital's location. SchH_P06_S00_L05 Schedule H, Part VI, Line 5 Community Health Promotion: Reference Part I, 7 e. & Part II Deaconess has strengthened its focus on community health through programs which support senior independence: * Lifeline - Largest in-home emergency response system in region serving over 1400 seniors and disabled adults. *Student Education - Partner with local high schools to promote healthcare careers; provide clinical education to LPN students; addressed anesthesia convention of PACU LPNs on the the value of professional certification. *Transportation - Free service for patients enrolled in the Hospital's outpatient Older Adult Mental Health Outpatient Program and patients utilizin services the hospital and physician network provide. *Atrial Fib Center - Routine seminars to educate prosepective patients on the Hospital's Atrial Fibrillation/Mini-Maze procedure. Surplus space - Allocate surplus hopsital space to community LTACH provider through rental agreement. Permit university students to utilize parking garage at discounted rate. Additional Information:* All independent members of Deaconess Hospital's Board of Trustees are residents of the hospital's service area. *Deaconess Hospital's Medical Staff is open to all qualified physicians per its Bylaws, Rules & Regulations, Policy on Appointment, and credentialing procedures. *The hospital employs a formal budget process whereby funds are allocated to patient care, continuing medical education, etc. SchH_P06_S00_L06 Schedule H, Part VI, Line 6 Affiliated Health Care System: *Deaconess Hospital is a subsidary of Deaconess Associations, Inc. Active "sister" corporations of the hospital include Deaconess Long Term Care, Inc. and The Deaconess Health Association Fund, Inc. Deaconess Long Term Care (DLTC) engages in a variety of initiatives to benefit the communites they serve (portions of Ohio, Missouri, and Kansas). A sampling of such initiatives includes: -Meals on Wheels sponsorships - Champbers of Commerce, Lions Clubs, Rotary Clubs, Hospice Associations, American Legion, Garden Club, etc. memberships - Council on Aging and state helath associatin memberships - Participation in local health and job fairs - Volunteer services at community senior centers (foot care clinics; bingo; potluck dinners; etc.) and thruough prison ministry - Free health screenings (blood pressure, grip strength, etc.) - Community blood drives - National Nursing Home Week promotions - Donation of surplus or recyclable supplies to Matthew 25 Ministries, Ronald McDonald House, Lions Club, etc. - Participation in walks/contributions to benefit Alzheimer's, Breat Cancer, Heart Association, disaster relief, etc. - Food donations to community pantries - Family adoptions at Christmas - Host sites for community ministry alliances. - Establish mutual volunteer relationships with local churches, Salvation Army, etc. - Align with local crisis intervention and ambulance teams re policy, budgetary concerns, etc. - Coordinate reginal CNA forums - Engages in neighborhood safety activities - Promote interaction between elderly and youth in the community via special events on campuses. - Community education: mental illness, heart disease, careers in long term care, etc. The Deaconess Foundation is the primary vehicle for ensuring that the organization is focused on promoting community health. Through community collaboration "maintaining independent lifestyles for seniors" is the current primary focus of theis Deaconess entity. 'FullLife' seeks practical solutions to the common challenges of aging. ITNGreater Cincinnati is a program that transports seniors and disable adults to appointments and social functions through volunteers. Over 1100 rides were provided in 2010. Vital Signs - A community wide forum sponsored by deaconess which convenes leaders of other healthcare providers and social agencies to discuss specific community needs. Transporation for the elderly and disable was the topic of this annual forum in 2010. The Deaconess Foundation began operating two programs which were once part of the Deaconess Hospital; ActiveLife and the Senior Resource Center. ActiveLife is a senior membership program that sponsors educational programs (examples: nutrition, cardiac care, men's health) geared toward prevention/wellness, health screenings and social events. Senior Resource Center is a library of health-related books, audiovisual materials, Internet access, etc open to the public. Skillsource - The Foundation has established a working relationship with SkillSource, a local company that promotes charitable investment in the livelihoods of the disadvantaged to generate an ongoing return. The philosophies of SkillSource are aslo being applied to highlight the positive effects of corporate clutures based on respect, trust, and uncompormising integrity. SchH_P06_S00_L07 Schedule H, Part VI, Line 7 Not applicable X X X X 0 1 0 0 0 0 0 0 0 E Anthony Woods 0 0 0 0 0 0 0 218000 0 0 0 218000 0 0 David Sirk - One80 Interim Inc 214338 0 0 0 0 0 0 0 0 0 214338 0 0 0 Randall K Wolf 318439 0 42561 0 0 0 0 0 -4050 0 356950 0 0 0 Eric W Schneeberger 298978 0 6561 0 0 0 0 0 -23934 0 281605 0 0 0 SchJ_P01_S00_L04 Schedule J, Part I, Line 4 E. Anthony Woods, Chairman and CEO of Deaconess Associations, Inc. (parent of Deaconess Hospital), and Board Member of Deaconess Hospital, participates in a non-qualified supplemental executive retirement plan. He received distributions of $321,853 from the plan during 2010 that were reported on Form 1099-R. John J & Thomas R Schiff & Co John Schiff and Thomas Schiff are on the board of the Hospital 1268943 provides business insurance 0 Medical equipment 2011-03-10 2225687 Book value of assets using straight-line depreciation method Great American Group LLC Nine Parkway North Suite 300 Deerfield IL 60015 Broker 0 0 0 0 SchN_P02_S00_L01 Schedule N, Part II, Line 1 In December 2010, Deaconess Hospital contracted with Great American Group LLC for them to coordinate the sale of medical equipment that had been used in the Hospital. The assets were written off and the sale was recorded in 2010, although the sale was not final until March 2011. Great American Group was used as the broker and the assets were sold to numerous other individuals and facilities. F990_P03_S00_L03 Form 990, Part III, Line 3 In January 2010, Deaconess Hospital closed its emergency room in deference to the prevalence of duplicate ER services existing with the hospital's immediate service area (4 full-service ER's located within 2 mile radius of Deaconess Hospital). To better accommodate non-emergent cases, Deaconess Hospital opened an Urgent Care Center on its orginal ER site, improving accessibility for such cases, easing the burden of over-utilization of ER services, and providing a more cost effective/appropriate means for addressing non-emergent situations. In October 2010, Deaconess Hospital ceased surgcial services due to under-utilization and financial contraints. No negative impact was imposed on physicians and patients due the accessibility of other provider hospitals. F990_P06_S0A_L02 Form 990, Part VI, Section A, Line 2 Board members John J. Schiff, Jr. and Thomas R. Schiff are brothers, and together operate the John J. & Thomas R. Schiff & Co. Insurance business F990_P06_S0A_L09 Form 990, Part VI, Section A, Line 9 Directors and officers not at Deaconess Hospital, or Deaconess Associations, Inc., can be reached at: Lee W. Scroggins, 7905 Graves Rd., Cincinnati OH 45243; Thomas R. Schiff, 4 Grandin Terrace, Cincinnati, OH 45208; Kay French, 2412 Ingleside Ave., Cincinnati, OH, 45206; John J. Schiff, Jr., 8720 Camargo Rd., Cincinnati OH, 45243. F990_P06_S0B_L11a Form 990, Part VI, Section B, Line 11a Copies of the 990's are provided to the Chairman of the parent company. F990_P06_S0B_L12c Form 990, Part VI, Section B, Line 12c Each manager, officer, and director are given a copy of the Conflict of Interest Policy to review and are required to fill out certification forms, and the forms are reviewed and updated annually. F990_P06_S0B_L15 Form 990, Part VI, Section B, Line 15 Compensation for the Chairman and Officers are reviewed and approved by the Board and the Compensation Committee, which establishes compensation after reviewing comparability data. Compensation of key employees is determined by the top management officials, with the use of comparability data. F990_P06_S0C_L19 Form 990, Part VI, Section C, Line 19 No copies of governing documents, etc., are available to the public, other than those publicly available through the Secretary of State's website, or other similar reporting agencies. F990_P11_S00_L05 Form 990, Part XI, Line 5 There was a decrease in the pension liability of $4,286,435 which is primarilary attributed to the market value of the investments in the plan. Also, there was $816,066 written off for intercompany transfers. Deaconess Associations Inc 311 Straight St Cincinnati OH 45219 311209377 Parent company - provides support OH 501(c)(3) 11c N/A Tristate Health Systems Inc 311 Straight St Cincinnati OH 45219 311385584 provides medical services OH 501(c)(3) 11a N/A Deaconess Health Association Fund Inc 311 Straight St Cincinnati OH 45219 311209378 fund raising OH 501(c)(3) 11b N/A Deaconess Long Term Care Inc 440 Lafayette Ave Cincinnati OH 45220 311391195 Parent company-management-health care services OH 501(c)(3) 11b N/A Tristate Primary Care Inc 311 Straight St Cincinnati OH 45219 320019056 provides medical services OH 501(c)(3) 11a N/A Deaconess Health Care Services 311 Straight St Cincinnati OH 45219 311365388 provides medical services OH 501(c)(3) 11a N/A Deaconess Long Term Care of Ohio Inc 440 Lafayette Ave Cincinnati OH 45220 311394484 health care services OH 501(c)(3) 3 N/A Deaconess Long Term Care of Missouri Inc 440 Lafayette Ave Cincinnati OH 45220 431693036 health care services OH 501(c)(3) 3 N/A Cottingham Retirement Community Inc c/o DLTC - 440 Lafayette Ave Cincinnati OH 45220 311338449 health care services OH 501(c)(3) 11b N/A Ottawa Retirement Plaza Inc c/o DLTC 440 Lafayette Ave Cincinnati OH 45220 481101021 health care services KS 501(c)3 11b Deaconess Long Term Care Inc 0 Ottawa Medical Services Inc c/o DLTC 440 Lafayette Ave Cincinnati OH 45220 481114608 health care services KS 501(c)3 11b Deaconess Long Term Care Inc 0 Ottawa Services LP c/o DLTC 440 Lafayette Ave Cincinnati OH 45220 411159868 owns building KS Ottawa Medical Services Inc Related 0 0 0 0 0 0 1 0 1 0 1 0 0 1 1 0 0 0 0 1 1 1 1 1