TY 2017 Form 990

(A) Name and title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)	(E) Reportable compensation from related organizations (W-2/1099-MISC)
(1) SHAWN MCCOY...................................................................... CEO OF DEACONESS HEALTH SYSTEM	40.00 ................. 25.00	X	X	903,313	183,000	196,397
(2) LINDA WHITE...................................................................... CEO EMERITA	30.00 ................. 25.00	X	X	1,086,245	200,679	53,542
(3) DANIEL HERMANN...................................................................... CHAIRMAN	5.00 ................. 5.00	X		0	0	0
(4) SHARON REED WALKER...................................................................... SECRETARY	5.00 ................. 5.00	X		0	0	0
(5) JOHN ENGELBRECHT...................................................................... TREASURER	5.00 ................. 5.00	X		0	0	0
(6) BRUCE ADYE MD...................................................................... DIRECTOR	5.00 ................. 5.00	X		6,060	0	0
(7) MAQBOOL AHMED MD...................................................................... DIRECTOR	5.00 ................. 55.00	X		720	913,121	43,152
(8) DR LINDA BENNETT...................................................................... DIRECTOR	5.00 ................. 5.00	X		0	0	0
(9) STEVEN CHURCH...................................................................... DIRECTOR	5.00 ................. 5.00	X		0	0	0
(10) REV DR JOSEPH FRACCARO...................................................................... DIRECTOR	5.00 ................. 5.00	X		0	0	0
(11) TERI HOLLANDER ALBIN...................................................................... DIRECTOR	5.00 ................. 5.00	X		0	0	0
(12) ANTHONY KAISER MD...................................................................... DIRECTOR	5.00 ................. 5.00	X		15,175	0	0
(13) MATHIAS KOLLECK II MD...................................................................... DIRECTOR	50.00 ................. 5.00	X		448,740	5,600	51,863
(14) BARRY PHILLIPS MD...................................................................... DIRECTOR	5.00 ................. 55.00	X		7,200	444,088	40,554
(15) JAMES RYAN III...................................................................... DIRECTOR	5.00 ................. 5.00	X		0	0	0
(16) DAVID RYON MD...................................................................... DIRECTOR	50.00 ................. 5.00	X		462,093	8,030	47,443
(17) ERIC SCHACH...................................................................... DIRECTOR	5.00 ................. 5.00	X		0	0	0

(A) Name and title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)	(E) Reportable compensation from related organizations (W-2/1099-MISC)	(F) Estimated amount of other compensation from the organization and related organizations
(18) STEPHEN TITZER CPA........................................................................ DIRECTOR	5.00 .......................10.00	X					0	0	0
(19) JONATHAN WEINZAPFEL........................................................................ DIRECTOR	5.00 .......................5.00	X					0	0	0
(20) LISA COLLINS........................................................................ SECRETARY (10/1/17-03/18/18)	5.00 .......................5.00	X					0	0	0
(21) CHERYL WATHEN........................................................................ CHIEF FINANCIAL OFFICER	25.00 .......................35.00		X				487,084	246,471	158,975
(22) JAMES PORTER MD........................................................................ PRESIDENT OF DEACONESS HEALTH SYSTEM	45.00 .......................5.00		X				827,006	2,000	167,121
(23) CHERONA HAJEWSKI........................................................................ CHIEF NURSING OFFICER	50.00 .......................0.00		X				576,438	0	104,912
(24) LYNN LINGAFELTER........................................................................ CHIEF OPERATION OFFICER	50.00 .......................10.00		X				479,173	1,200	96,756
(25) HERMAN BLANTON MD........................................................................ CHIEF MEDICAL OFFICER	50.00 .......................5.00		X				419,360	0	87,411
(26) MARC FLORENCE........................................................................ VICE PRESIDENT	45.00 .......................15.00			X			299,717	0	81,892
(27) KATHY SCHENK........................................................................ HR DIRECTOR	50.00 .......................0.00			X			154,435	0	30,812
(28) KENNETH DICKEN........................................................................ CONTROLLER, DIRECTOR FINANCE	50.00 .......................10.00			X			228,549	2,400	37,712
(29) RICHARD PERRY........................................................................ CONTROLLER, PHYSICIAN PRACTICE MGMT.	50.00 .......................0.00			X			203,848	0	23,551
(30) CAROLYN MORTON........................................................................ PHARMACY AND LAB DIRECTOR	50.00 .......................0.00			X			199,979	0	43,219
(31) SUSAN BRUMLEY........................................................................ IMAGING AND CARDIOVASCULAR DIRECTOR	50.00 .......................0.00			X			156,568	0	32,879
(32) VENKATESH MADADI MD........................................................................ ANESTHESIOLOGIST	50.00 .......................0.00				X		898,965	0	53,293
(33) NIRMAL JOSHI MD........................................................................ ANESTHESIOLOGIST	50.00 .......................0.00				X		796,065	0	48,087
(34) KISHWAR NAZ MD........................................................................ ANESTHESIOLOGIST	50.00 .......................0.00				X		778,744	0	34,689
(35) SHIVON ABDULLAH MD........................................................................ ANESTHESIOLOGIST	50.00 .......................0.00				X		765,896	0	39,395
(36) RAJESH PATEL MD........................................................................ ANESTHESIOLOGIST	50.00 .......................0.00				X		705,831	0	51,039
(37) LARRY PILE........................................................................ FORMER HR DIRECTOR	25.00 .......................0.00					X	197,144	0	27,247

(A) Name and business address	(B) Description of services	(C) Compensation
BARTON MALOW COMPANY 26500 AMERICAN DR SOUTHFIELD,MI48034	CONSTRUCTION SERVICES	103,435,183
EVANSVILLE SURGERY CENTER PO BOX 2185 EVANSVILLE,IN47728	SURGICAL SERVICES	26,237,141
EVOLENT HEALTH LLC 800 GLEBE RD SUITE 500 ARLINGTON,VA22203	CONSULTING SERVICES	14,878,857
PROGRESSIVE HEALTH INDIANA LLC 150 N ROSENBERGER AVE EVANSVILLE,IN47712	PHYSICAL THERAPY	14,004,177
ORTHOALIGN LLC 4011 GATEWAY BLVD NEWBURGH,IN47630	MEDICAL SERVICES	10,674,249
2 Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization 82

- TIN:

SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service

Public Charity Status and Public Support

Complete if the organization is a section 501(c)(3) organization or a section 4947(a)(1) nonexempt charitable trust.
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Attach to Form 990 or Form 990-EZ.
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Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public
Inspection

Name of the organization

DEACONESS HOSPITAL INC

Employer identification number

35-0593390

Part I

Reason for Public Charity Status (All organizations must complete this part.) See instructions.

The organization is not a private foundation because it is: (For lines 1 through 12, check only one box.)

A church, convention of churches, or association of churches described in section 170(b)(1)(A)(i).

A school described in section 170(b)(1)(A)(ii). (Attach Schedule E (Form 990 or 990-EZ).)

A hospital or a cooperative hospital service organization described in section 170(b)(1)(A)(iii).

A medical research organization operated in conjunction with a hospital described in section 170(b)(1)(A)(iii). Enter the hospital's name, city, and state:

An organization operated for the benefit of a college or university owned or operated by a governmental unit described in section 170(b)(1)(A)(iv). (Complete Part II.)

A federal, state, or local government or governmental unit described in section 170(b)(1)(A)(v).

An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in section 170(b)(1)(A)(vi). (Complete Part II.)

A community trust described in section 170(b)(1)(A)(vi). (Complete Part II.)

An agricultural research organization described in 170(b)(1)(A)(ix) operated in conjunction with a land-grant college or university or a non-land grant college of agriculture. See instructions. Enter the name, city, and state of the college or university:

An organization that normally receives: (1) more than 331/3% of its support from contributions, membership fees, and gross receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)

An organization organized and operated exclusively to test for public safety. See section 509(a)(4).

An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). See section 509(a)(3). Check the box in lines 12a through 12d that describes the type of supporting organization and complete lines 12e, 12f, and 12g.

Type I. A supporting organization operated, supervised, or controlled by its supported organization(s), typically by giving the supported organization(s) the power to regularly appoint or elect a majority of the directors or trustees of the supporting organization. You must complete Part IV, Sections A and B.

Type II. A supporting organization supervised or controlled in connection with its supported organization(s), by having control or management of the supporting organization vested in the same persons that control or manage the supported organization(s). You must complete Part IV, Sections A and C.

Type III functionally integrated. A supporting organization operated in connection with, and functionally integrated with, its supported organization(s) (see instructions). You must complete Part IV, Sections A, D, and E.

Type III non-functionally integrated. A supporting organization operated in connection with its supported organization(s) that is not functionally integrated. The organization generally must satisfy a distribution requirement and an attentiveness requirement (see instructions). You must complete Part IV, Sections A and D, and Part V.

Check this box if the organization received a written determination from the IRS that it is a Type I, Type II, Type III functionally integrated, or Type III non-functionally integrated supporting organization.

Enter the number of supported organizations ...............................

Provide the following information about the supported organization(s).

(i) Name of supported organization	(ii) EIN	(iv) Is the organization listed in your governing document?		(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)
(i) Name of supported organization	(ii) EIN	Yes	No	(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)


Total

For Paperwork Reduction Act Notice, see the Instructions for
Form 990 or 990-EZ.

Cat. No. 11285F

Schedule A (Form 990 or 990-EZ) 2019

Page 2

Part II

Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization failed to qualify under the tests listed below, please complete Part III.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2015	(b) 2016	(c) 2017	(d) 2018	(e) 2019	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") ..
2	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf....
3	The value of services or facilities furnished by a governmental unit to the organization without charge..
4	Total. Add lines 1 through 3
5	The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f)..
6	Public support. Subtract line 5 from line 4.

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2015	(b) 2016	(c) 2017	(d) 2018	(e) 2019	(f) Total
7	Amounts from line 4..
8	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...
9	Net income from unrelated business activities, whether or not the business is regularly carried on..
10	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.)..
11	Total support. Add lines 7 through 10

Gross receipts from related activities, etc. (see instructions) ..................

First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization, check this box and stop here........................................ right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2019 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2018 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2019. If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization ....................... right arrow

33 1/3% support test—2018. If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization ..................... right arrow

17a

10%-facts-and-circumstances test—2019. If the organization did not check a box on line 13, 16a, or 16b, and line 14
is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here. Explain
in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported
organization ..................................................... right arrow

10%-facts-and-circumstances test—2018. If the organization did not check a box on line 13, 16a, 16b, or 17a, and line
15 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here.
Explain in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly
supported organization ................................................ right arrow

Private foundation. If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions ..................................................... right arrow

Schedule A (Form 990 or 990-EZ) 2019

Page 3

Part III

Support Schedule for Organizations Described in Section 509(a)(2)
(Complete only if you checked the box on line 10 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2015	(b) 2016	(c) 2017	(d) 2018	(e) 2019	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
2	Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose
3	Gross receipts from activities that are not an unrelated trade or business under section 513 .....
4	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
5	The value of services or facilities furnished by a governmental unit to the organization without charge
6	Total. Add lines 1 through 5
7a	Amounts included on lines 1, 2, and 3 received from disqualified persons
b	Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.
c	Add lines 7a and 7b..
8	Public support. (Subtract line 7c from line 6.)

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2015	(b) 2016	(c) 2017	(d) 2018	(e) 2019	(f) Total
9	Amounts from line 6...
10a	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
b	Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c	Add lines 10a and 10b.
11	Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
12	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.) ..
13	Total support. (Add lines 9, 10c, 11, and 12.)..

First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization,
check this box and stop here............................................. right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2019 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2018 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2019 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2018 Schedule A, Part III, line 17 .............

19a

331/3% support tests—2019. If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization ....... right arrow

33 1/3% support tests—2018. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization .... right arrow

Private foundation. If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions .... right arrow

Schedule A (Form 990 or 990-EZ) 2019

Page 4

Part IV

Supporting Organizations

(Complete only if you checked a box on line 12 of Part I. If you checked 12a of Part I, complete Sections A and B. If you checked 12b of Part I, complete Sections A and C. If you checked 12c of Part I, complete Sections A, D, and E. If you checked 12d of Part I, complete Sections A and D, and complete Part V.)

Section A. All Supporting Organizations

Yes

Are all of the organization’s supported organizations listed by name in the organization’s governing documents?
If "No," describe in Part VI how the supported organizations are designated. If designated by class or purpose,
describe the designation. If historic and continuing relationship, explain.

Did the organization have any supported organization that does not have an IRS determination of status under section 509(a)(1) or (2)? If "Yes," explain in Part VI how the organization determined that the supported organization was described in section 509(a)(1) or (2).

Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yes," answer (b) and (c) below.

Did the organization confirm that each supported organization qualified under section 501(c)(4), (5), or (6) and satisfied the public support tests under section 509(a)(2)? If "Yes," describe in Part VI when and how the organization made the determination.

Did the organization ensure that all support to such organizations was used exclusively for section 170(c)(2)(B) purposes? If "Yes," explain in Part VI what controls the organization put in place to ensure such use.

Was any supported organization not organized in the United States ("foreign supported organization")? If “Yes” and if you checked 12a or 12b in Part I, answer (b) and (c) below.

Did the organization have ultimate control and discretion in deciding whether to make grants to the foreign supported organization? If “Yes,” describe in Part VI how the organization had such control and discretion despite being controlled or supervised by or in connection with its supported organizations.

Did the organization support any foreign supported organization that does not have an IRS determination under sections 501(c)(3) and 509(a)(1) or (2)? If “Yes,” explain in Part VI what controls the organization used to ensure that all support to the foreign supported organization was used exclusively for section 170(c)(2)(B) purposes.

Did the organization add, substitute, or remove any supported organizations during the tax year? If “Yes,” answer (b) and (c) below (if applicable). Also, provide detail in Part VI, including (i) the names and EIN numbers of the supported organizations added, substituted, or removed; (ii) the reasons for each such action; (iii) the authority under the organization's organizing document authorizing such action; and (iv) how the action was accomplished (such as by amendment to the organizing document).

Type I or Type II only. Was any added or substituted supported organization part of a class already designated in the organization's organizing document?

Substitutions only. Was the substitution the result of an event beyond the organization's control?

Did the organization provide support (whether in the form of grants or the provision of services or facilities) to anyone other than (i) its supported organizations, (ii) individuals that are part of the charitable class benefited by one or more of its supported organizations, or (iii) other supporting organizations that also support or benefit one or more of the filing organization’s supported organizations? If “Yes,” provide detail in Part VI.

Did the organization provide a grant, loan, compensation, or other similar payment to a substantial contributor (defined in section 4958(c)(3)(C)), a family member of a substantial contributor, or a 35% controlled entity with regard to a substantial contributor? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ) .

Did the organization make a loan to a disqualified person (as defined in section 4958) not described in line 7? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ).

Was the organization controlled directly or indirectly at any time during the tax year by one or more disqualified persons as defined in section 4946 (other than foundation managers and organizations described in section 509(a)(1) or (2))? If “Yes,” provide detail in Part VI.

Did one or more disqualified persons (as defined in line 9a) hold a controlling interest in any entity in which the supporting organization had an interest? If “Yes,” provide detail in Part VI.

Did a disqualified person (as defined in line 9a) have an ownership interest in, or derive any personal benefit from, assets in which the supporting organization also had an interest? If “Yes,” provide detail in Part VI.

10a

Was the organization subject to the excess business holdings rules of section 4943 because of section 4943(f) (regarding certain Type II supporting organizations, and all Type III non-functionally integrated supporting organizations)? If “Yes,” answer line 10b below.

10a

Did the organization have any excess business holdings in the tax year? (Use Schedule C, Form 4720, to determine whether the organization had excess business holdings).

10b

Schedule A (Form 990 or 990-EZ) 2019

Page 5

Part IV

Supporting Organizations (continued)

Yes

Has the organization accepted a gift or contribution from any of the following persons?

A person who directly or indirectly controls, either alone or together with persons described in (b) and (c) below, the governing body of a supported organization?

11a

A family member of a person described in (a) above?

11b

A 35% controlled entity of a person described in (a) or (b) above? If “Yes” to a, b, or c, provide detail in Part VI.

11c

Section B. Type I Supporting Organizations

Yes

Did the directors, trustees, or membership of one or more supported organizations have the power to regularly appoint or elect at least a majority of the organization’s directors or trustees at all times during the tax year? If “No,” describe in Part VI how the supported organization(s) effectively operated, supervised, or controlled the organization’s activities. If the organization had more than one supported organization, describe how the powers to appoint and/or remove directors or trustees were allocated among the supported organizations and what conditions or restrictions, if any, applied to such powers during the tax year.

Did the organization operate for the benefit of any supported organization other than the supported organization(s) that operated, supervised, or controlled the supporting organization? If “Yes,” explain in Part VI how providing such benefit carried out the purposes of the supported organization(s) that operated, supervised or controlled the supporting organization.

Section C. Type II Supporting Organizations

Yes

Were a majority of the organization’s directors or trustees during the tax year also a majority of the directors or trustees of each of the organization’s supported organization(s)? If “No,” describe in Part VI how control or management of the supporting organization was vested in the same persons that controlled or managed the supported organization(s).

Section D. All Type III Supporting Organizations

Yes

Did the organization provide to each of its supported organizations, by the last day of the fifth month of the organization’s tax year, (i) a written notice describing the type and amount of support provided during the prior tax year, (ii) a copy of the Form 990 that was most recently filed as of the date of notification, and (iii) copies of the organization’s governing documents in effect on the date of notification, to the extent not previously provided?

Were any of the organization’s officers, directors, or trustees either (i) appointed or elected by the supported organization(s) or (ii) serving on the governing body of a supported organization? If "No," explain in Part VI how the organization maintained a close and continuous working relationship with the supported organization(s).

By reason of the relationship described in (2), did the organization’s supported organizations have a significant voice in the organization’s investment policies and in directing the use of the organization’s income or assets at all times during the tax year? If "Yes," describe in Part VI the role the organization’s supported organizations played in this regard.

Section E. Type III Functionally-Integrated Supporting Organizations

Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions):

The organization satisfied the Activities Test. Complete line 2 below.

The organization is the parent of each of its supported organizations. Complete line 3 below.

The organization supported a governmental entity. Describe in Part VI how you supported a government entity (see instructions)

Activities Test. Answer (a) and (b) below.

Yes

Did substantially all of the organization’s activities during the tax year directly further the exempt purposes of the supported organization(s) to which the organization was responsive? If "Yes," then in Part VI identify those supported organizations and explain how these activities directly furthered their exempt purposes, how the organization was responsive to those supported organizations, and how the organization determined that these activities constituted substantially all of its activities.

Did the activities described in (a) constitute activities that, but for the organization’s involvement, one or more of the organization’s supported organization(s) would have been engaged in? If "Yes," explain in Part VI the reasons for the organization’s position that its supported organization(s) would have engaged in these activities but for the organization’s involvement.

Parent of Supported Organizations. Answer (a) and (b) below.

Did the organization have the power to regularly appoint or elect a majority of the officers, directors, or trustees of each of the supported organizations? Provide details in Part VI.

Did the organization exercise a substantial degree of direction over the policies, programs and activities of each of its supported organizations? If "Yes," describe in Part VI. the role played by the organization in this regard.

Schedule A (Form 990 or 990-EZ) 2019

Page 6

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations

Check here if the organization satisfied the Integral Part Test as a qualifying trust on Nov. 20, 1970 (explain in Part VI). See instructions. All other Type III non-functionally integrated supporting organizations must complete Sections A through E.

	Section A - Adjusted Net Income		(A) Prior Year	(B) Current Year (optional)
1	Net short-term capital gain	1
2	Recoveries of prior-year distributions	2
3	Other gross income (see instructions)	3
4	Add lines 1 through 3	4
5	Depreciation and depletion	5
6	Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions)	6
7	Other expenses (see instructions)	7
8	Adjusted Net Income (subtract lines 5, 6 and 7 from line 4)	8

	Section B - Minimum Asset Amount		(A) Prior Year	(B) Current Year (optional)
1	Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year):	1
a	Average monthly value of securities	1a
b	Average monthly cash balances	1b
c	Fair market value of other non-exempt-use assets	1c
d	Total (add lines 1a, 1b, and 1c)	1d
e	Discount claimed for blockage or other factors (explain in detail in Part VI):
2	Acquisition indebtedness applicable to non-exempt use assets	2
3	Subtract line 2 from line 1d	3
4	Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount, see instructions).	4
5	Net value of non-exempt-use assets (subtract line 4 from line 3)	5
6	Multiply line 5 by .035	6
7	Recoveries of prior-year distributions	7
8	Minimum Asset Amount (add line 7 to line 6)	8

	Section C - Distributable Amount		Current Year
1	Adjusted net income for prior year (from Section A, line 8, Column A)	1
2	Enter 85% of line 1	2
3	Minimum asset amount for prior year (from Section B, line 8, Column A)	3
4	Enter greater of line 2 or line 3	4
5	Income tax imposed in prior year	5
6	Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions)	6

Check here if the current year is the organization's first as a non-functionally-integrated Type III supporting organization (see instructions)

Schedule A (Form 990 or 990-EZ) 2019

Page 7

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations(continued)

Section D - Distributions		Current Year
1 Amounts paid to supported organizations to accomplish exempt purposes
2 Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity
3 Administrative expenses paid to accomplish exempt purposes of supported organizations
4 Amounts paid to acquire exempt-use assets
5 Qualified set-aside amounts (prior IRS approval required)
6 Other distributions (describe in Part VI). See instructions
7Total annual distributions. Add lines 1 through 6.
8 Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions
9 Distributable amount for 2019 from Section C, line 6
10 Line 8 amount divided by Line 9 amount

Section E - Distribution Allocations (see instructions)		(i) Excess Distributions	(ii) Underdistributions Pre-2019	(iii) Distributable Amount for 2019
1 Distributable amount for 2019 from Section C, line 6
2 Underdistributions, if any, for years prior to 2019 (reasonable cause required-- explain in Part VI). See instructions.
3 Excess distributions carryover, if any, to 2019:
a From 2014.......
b From 2015.......
c From 2016.......
d From 2017.......
e From 2018.......
fTotal of lines 3a through e
g Applied to underdistributions of prior years
h Applied to 2019 distributable amount
i Carryover from 2014 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from 3f.
4Distributions for 2019 from Section D, line 7:
$
a Applied to underdistributions of prior years
b Applied to 2019 distributable amount
c Remainder. Subtract lines 4a and 4b from 4.
5 Remaining underdistributions for years prior to 2019, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions.
6 Remaining underdistributions for 2019. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions.
7 Excess distributions carryover to 2020. Add lines 3j and 4c.
8 Breakdown of line 7:
a Excess from 2015.....
b Excess from 2016.....
c Excess from 2017.....
d Excess from 2018.....
e Excess from 2019.....

Schedule A (Form 990 or 990-EZ) (2019)

Schedule A (Form 990 or 990-EZ) 2019

Page 8

Part VI

Supplemental Information. Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; Part III, line 12; Part IV, Section A, lines 1, 2, 3b, 3c, 4b, 4c, 5a, 6, 9a, 9b, 9c, 11a, 11b, and 11c; Part IV, Section B, lines 1 and 2; Part IV, Section C, line 1; Part IV, Section D, lines 2 and 3; Part IV, Section E, lines 1c, 2a, 2b, 3a and 3b; Part V, line 1; Part V, Section B, line 1e; Part V Section D, lines 5, 6, and 8; and Part V, Section E, lines 2, 5, and 6. Also complete this part for any additional information. (See instructions).

Facts And Circumstances Test

Return Reference	Explanation

Schedule A (Form 990 or 990-EZ) 2019

Additional Data

Software ID:
Software Version:

- TIN:

Schedule B
(Form 990, 990-EZ,
or 990-PF)

Department of the Treasury
Internal Revenue Service

Schedule of Contributors

Attach to Form 990, 990-EZ, or 990-PF.

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2019

Name of the organization

DEACONESS HOSPITAL INC

Employer identification number

35-0593390

Organization type (check one):

Filers of:

Section:

Form 990 or 990-EZ

501(c)( ) (enter number) organization

4947(a)(1) nonexempt charitable trust not treated as a private foundation

527 political organization

Form 990-PF

501(c)(3) exempt private foundation

4947(a)(1) nonexempt charitable trust treated as a private foundation

501(c)(3) taxable private foundation

Check if your organization is covered by the General Rule or a Special Rule.
Note: Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.

General Rule

For an organization filing Form 990, 990-EZ, or 990-PF that received, during the year, contributions totaling $5,000 or more (in money or other property) from any one contributor. Complete Parts I and II. See instructions for determining a contributor's total contributions.

Special Rules

For an organization described in section 501(c)(3) filing Form 990 or 990-EZ that met the 33¹/3% support test of the regulations
under sections 509(a)(1) and 170(b)(1)(A)(vi), that checked Schedule A (Form 990 or 990-EZ), Part II, line 13, 16a, or 16b, and that received from any one contributor, during the year, total contributions of the greater of (1) $5,000 or (2) 2% of the amount on (i) Form 990, Part VIII, line 1h, or (ii) Form 990-EZ, line 1. Complete Parts I and II.

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, total contributions of more than $1,000 exclusively for religious, charitable, scientific, literary, or educational purposes, or for the prevention of cruelty to children or animals. Complete Parts I, II, and III.

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, contributions exclusively for religious, charitable, etc., purposes, but no such contributions totaled more than $1,000. If this box is checked, enter here the total contributions that were received during the year for an exclusively religious, charitable, etc., purpose. Don't complete any of the parts unless the General Rule applies to this organization because it received nonexclusively religious, charitable, etc., contributions totaling $5,000 or more during the year ......... Arrow Bullet

Caution: An organization that isn't covered by the General Rule and/or the Special Rules doesn't file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2, of its Form 990; or check the box on line H of its Form 990-EZ
or on its Form 990PF, Part I, line 2, to certify that it doesn't meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).

For Paperwork Reduction Act Notice, see the Instructions
for Form 990, 990-EZ, or 990-PF.

Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2019)

Schedule B (Form 990, 990-EZ, or 990-PF) (2019) Page 2

Name of organization DEACONESS HOSPITAL INC

Part I Contributors	Contributors (see instructions). Use duplicate copies of Part I if additional space is needed.
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2019)

Schedule B (Form 990, 990-EZ, or 990-PF) (2019)

Page 3

Name of organization DEACONESS HOSPITAL INC		Employer identification number 35-0593390

Part II	Noncash Property (see instructions). Use duplicate copies of Part II if additional space is needed.
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
Schedule B (Form 990, 990-EZ, or 990-PF) (2019)

Schedule B (Form 990, 990-EZ, or 990-PF) (2019)

Page 4


Name of organization DEACONESS HOSPITAL INC			Employer identification number 35-0593390
Part III Exclusively religious, charitable, etc., contributions to organizations described in section 501(c)(7), (8), or (10) that total more than $1,000 for the year from any one contributor. Complete columns (a) through (e) and the following line entry. For organizations completing Part III, enter the total of exclusively religious, charitable, etc., contributions of $1,000 or less for the year. (Enter this information once. See instructions.) $ Use duplicate copies of Part III if additional space is needed.

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

Schedule B (Form 990, 990-EZ, or 990-PF) (2019)

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE C
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Political Campaign and Lobbying Activities

For Organizations Exempt From Income Tax Under section 501(c) and section 527

SchCMd Bullet

Complete if the organization is described below. SchCMd Bullet

Attach to Form 990 or Form 990-EZ.
SchCMd Bullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public
Inspection

If the organization answered "Yes" on Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
Round Bullet

Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
Round Bullet

Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
Round Bullet

Section 527 organizations: Complete Part I-A only.
If the organization answered "Yes" on Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
Round Bullet

Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)): Complete Part II-A. Do not complete Part II-B.
Round Bullet

Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered "Yes" on Form 990, Part IV, Line 5 (Proxy Tax) (see separate instructions) or Form 990-EZ, Part V, line 35c (Proxy Tax) (see separate instructions), then
Round Bullet

Section 501(c)(4), (5), or (6) organizations: Complete Part III.

Name of the organization

DEACONESS HOSPITAL INC

Employer identification number

35-0593390

Part I-A

Complete if the organization is exempt under section 501(c) or is a section 527 organization.

Provide a description of the organization’s direct and indirect political campaign activities in Part IV (see instructions for definition of “political campaign activities")

Political campaign activity expenditures (see instructions) .................................................................... SchCMd Bullet

Volunteer hours for political campaign activities (see instructions) ..................................................................

Part I-B

Complete if the organization is exempt under section 501(c)(3).

Enter the amount of any excise tax incurred by the organization under section 4955 ................................ SchCMd Bullet

Enter the amount of any excise tax incurred by organization managers under section 4955 ....................... SchCMd Bullet

If the organization incurred a section 4955 tax, did it file Form 4720 for this year? .........................................

Yes No

Was a correction made? ......................................................................................................................

Yes No

If "Yes," describe in Part IV.

Part I-C

Complete if the organization is exempt under section 501(c), except section 501(c)(3).

Enter the amount directly expended by the filing organization for section 527 exempt function activities ..... SchCMd Bullet

Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt function activities ............................................................................................................................ SchCMd Bullet

Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, line 17b........... SchCMd Bullet

Did the filing organization file Form 1120-POL for this year? ...................................................................

Yes No

Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing
organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.

(a) Name	(b) Address	(c) EIN	(d) Amount paid from filing organization's funds. If none, enter -0-.	(e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.
1
2
3
4
5
6

For Paperwork Reduction Act Notice, see the instructions for Form 990 or 990-EZ.

Cat. No. 50084S

Schedule C (Form 990 or 990-EZ) 2019

Page 2

Part II-A

Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).

A Check SchCMd Bullet

if the filing organization belongs to an affiliated group (and list in Part IV each affiliated group member's name, address, EIN, expenses, and share of excess lobbying expenditures).
B Check SchCMd Bullet

if the filing organization checked box A and "limited control" provisions apply.

Limits on Lobbying Expenditures (The term "expenditures" means amounts paid or incurred.)		(b) Affiliated group totals
1a	Total lobbying expenditures to influence public opinion (grass roots lobbying) ......................
b	Total lobbying expenditures to influence a legislative body (direct lobbying) ........................
c	Total lobbying expenditures (add lines 1a and 1b) ............................................................
d	Other exempt purpose expenditures ...............................................................................
e	Total exempt purpose expenditures (add lines 1c and 1d) ..................................................
f	Lobbying nontaxable amount. Enter the amount from the following table in both columns.
	If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:
	Not over $500,00020% of the amount on line 1e.
	Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.
	Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.
	Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.
	Over $17,000,000$1,000,000.

g	Grassroots nontaxable amount (enter 25% of line 1f) .................................................
h	Subtract line 1g from line 1a. If zero or less, enter -0-. ................................................
i	Subtract line 1f from line 1c. If zero or less, enter -0-. ................................................
j	If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting section 4911 tax for this year? ...................................................................................................................	Yes No

4-Year Averaging Period Under Section 501(h) (Some organizations that made a section 501(h) election do not have to complete all of the five columns below. See the separate instructions for lines 2a through 2f.)
Lobbying Expenditures During 4-Year Averaging Period
	Calendar year (or fiscal year beginning in)	(a) 2016	(b) 2017	(c) 2018	(d) 2019	(e) Total

2a	Lobbying nontaxable amount

b	Lobbying ceiling amount (150% of line 2a, column(e))

c	Total lobbying expenditures

d	Grassroots nontaxable amount

e	Grassroots ceiling amount (150% of line 2d, column (e))

f	Grassroots lobbying expenditures

Schedule C (Form 990 or 990-EZ) 2019

Page 3

Part II-B

Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).

For each "Yes" response on lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.

(a)

Yes|No

(b)

Amount

During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:

Volunteers? ...........................................................................................................

Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ........

Media advertisements? ...................................................................................................

Mailings to members, legislators, or the public? .............................................................................

Publications, or published or broadcast statements? ...........................................................

Grants to other organizations for lobbying purposes? ..........................................................

Direct contact with legislators, their staffs, government officials, or a legislative body? .......................

Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ..................

Other activities? ...................................................................................................................

Yes

49,398

Total. Add lines 1c through 1i ....................................................................................................

49,398

Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....

If "Yes," enter the amount of any tax incurred under section 4912 ...........................................

If "Yes," enter the amount of any tax incurred by organization managers under section 4912 ...................

If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? ........................

Part III-A

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).

Yes

Were substantially all (90% or more) dues received nondeductible by members? ...............................................

Did the organization make only in-house lobbying expenditures of $2,000 or less? ............................................

Did the organization agree to carry over lobbying and political expenditures from the prior year? .................................

Part III-B

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) and if either (a) BOTH Part III-A, lines 1 and 2, are answered "No" OR (b) Part III-A, line 3, is answered “Yes."

Dues, assessments and similar amounts from members ......................................................................

Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political expenses for which the section 527(f) tax was paid).

Current year .............................................................................................................................

Carryover from last year ............................................................................................................

Total ...........................................................................................................................................

Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .

If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ......................................................................................................................

Taxable amount of lobbying and political expenditures (see instructions) .........................................

Part IV

Supplemental Information

Provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, line 5; Part II-A (affiliated group list); Part II-A, lines 1 and 2 (see instructions), and Part ll-B, line 1. Also, complete this part for any additional information.

Return Reference	Explanation
PART II-B, LINE 1:	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.

Schedule C (Form 990 or 990EZ) 2019

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

Complete if the organization answered "Yes," on Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b.
SchDMd Bullet

Attach to Form 990.
SchDMd Bullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization

DEACONESS HOSPITAL INC

Employer identification number

35-0593390

Part I

Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" on Form 990, Part IV, line 6.

		(a) Donor advised funds	(b) Funds and other accounts
1	Total number at end of year .........
2	Aggregate value of contributions to (during year)
3	Aggregate value of grants from (during year)
4	Aggregate value at end of year ........

Did the organization inform all donors and donor advisors in writing that the assets held in donor advised funds are the organization’s property, subject to the organization’s exclusive legal control? ............

Yes No

Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ...................................

Yes No

Part II

Conservation Easements.
Complete if the organization answered "Yes" on Form 990, Part IV, line 7.

Purpose(s) of conservation easements held by the organization (check all that apply).

Preservation of land for public use (e.g., recreation or education) Preservation of an historically important land area

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.


a	Total number of conservation easements ......................	2a
b	Total acreage restricted by conservation easements ....................	2b
c	Number of conservation easements on a certified historic structure included in (a) .....	2c
d	Number of conservation easements included in (c) acquired after 7/25/06, and not on a historic structure listed in the National Register ...	2d

Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during the
tax year SchDMd Bullet

Number of states where property subject to conservation easement is located SchDMd Bullet

Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and enforcement of the conservation easements it holds? ............

Yes No

Staff and volunteer hours devoted to monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

Amount of expenses incurred in monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(B)(i) and section 170(h)(4)(B)(ii)? .............................

Yes No

In Part XIII, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" on Form 990, Part IV, line 8.

If the organization elected, as permitted under FASB ASC 958, not to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide, in Part XIII, the text of the footnote to its financial statements that describes these items.

If the organization elected, as permitted under FASB ASC 958, to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide the following amounts relating to these items:

(i)

Revenue included on Form 990, Part VIII, line 1 ......................... SchDMd Bullet

(ii)

Assets included in Form 990, Part X ............................... SchDMd Bullet

If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under FASB ASC 958 relating to these items:

Revenue included on Form 990, Part VIII, line 1 .......................... SchDMd Bullet

Assets included in Form 990, Part X ............................... SchDMd Bullet

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 52283D

Schedule D (Form 990) 2019

Page 2

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)

Using the organization’s acquisition, accession, and other records, check any of the following that are a significant use of its collection items (check all that apply):

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.

During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?...

Yes No

Part IV

Escrow and Custodial Arrangements. Complete if the organization answered "Yes" on Form 990, Part IV, line 9, or reported an amount on Form 990, Part X, line 21.

Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................

Yes No


b	If "Yes," explain the arrangement in Part XIII and complete the following table:		Amount
c	Beginning balance .............................	1c
d	Additions during the year ............................	1d
e	Distributions during the year ..........................	1e
f	Ending balance ................................	1f

Did the organization include an amount on Form 990, Part X, line 21, for escrow or custodial account liability? ...

Yes No

If "Yes," explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII ....

Part V

Endowment Funds.
Complete if the organization answered "Yes" on Form 990, Part IV, line 10.

		(a) Current year	(b) Prior year	(c) Two years back	(d) Three years back	(e) Four years back

1a	Beginning of year balance ....	7,389,906	6,877,438	6,660,917	6,749,437	6,119,408
b	Contributions ...	120	1,200	50	1,327	3,639
c	Net investment earnings, gains, and losses	606,614	705,719	445,045	-39,488	662,188
d	Grants or scholarships ...
e	Other expenditures for facilities and programs ...	82,600	194,451	228,574	50,341	35,798
f	Administrative expenses ....				18
g	End of year balance ......	7,914,040	7,389,906	6,877,438	6,660,917	6,749,437

Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:

Board designated or quasi-endowment SchDMd Bullet

13.000 %

Permanent endowment SchDMd Bullet

87.000 %

Term endowment SchDMd Bullet

0 %

The percentages on lines 2a, 2b, and 2c should equal 100%.

Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes

(i) Unrelated organizations .................

3a(i)

(ii) Related organizations .................

3a(ii)

If "Yes" on 3a(ii), are the related organizations listed as required on Schedule R? .........

Describe in Part XIII the intended uses of the organization's endowment funds.

Part VI

Land, Buildings, and Equipment.
Complete if the organization answered "Yes" on Form 990, Part IV, line 11a. See Form 990, Part X, line 10.

Description of property		(a) Cost or other basis (investment)	(b) Cost or other basis (other)	(c) Accumulated depreciation	(d) Book value

1a	Land .....	2,347,245	14,434,107		16,781,352
b	Buildings ....	52,284,953	678,834,627	351,630,651	379,488,929
c	Leasehold improvements
d	Equipment ....		289,663,287	212,810,106	76,853,181
e	Other .....		36,890,346		36,890,346
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..					510,013,808

Schedule D (Form 990) 2019

Page 3

Part VII

InvestmentsOther Securities.
Complete if the organization answered "Yes" on Form 990, Part IV, line 11b. See Form 990, Part X, line 12.

(a) Description of security or category (including name of security)	(b) Book value	(c) Method of valuation: Cost or end-of-year market value
(1) Financial derivatives.........
(2) Closely-held equity interests........
(3)Other
(B)
(C)
(D)
(E)
(F)
(G)
(H)
(I)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)

Part VIII

InvestmentsProgram Related. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11c. See Form 990, Part X, line 13.

(a) Description of investment	(b) Book value	(c) Method of valuation: Cost or end-of-year market value

(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)

Part IX

Other Assets.
Complete if the organization answered 'Yes' on Form 990, Part IV, line 11d. See Form 990, Part X, line 15.

(a) Description				(b) Book value

(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........

Part X

Other Liabilities.
Complete if the organization answered 'Yes' on Form 990, Part IV, line 11e or 11f. See Form 990, Part X, line 25.

1.(a) Description of liability	(b) Book value
(1) Federal income taxes
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	126,369,866
2. Liability for uncertain tax positions. In Part XIII, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC 740). Check here if the text of the footnote has been provided in Part XIII

Schedule D (Form 990) 2019

Page 4

Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total revenue, gains, and other support per audited financial statements .......		1
2	Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a	Net unrealized gains (losses) on investments ....	2a
b	Donated services and use of facilities .........	2b
c	Recoveries of prior year grants ...........	2c
d	Other (Describe in Part XIII.) ............	2d
e	Add lines 2a through 2d .....................		2e
3	Subtract line 2e from line 1..................		3
4	Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b .	4a
b	Other (Describe in Part XIII.) ...........	4b
c	Add lines 4a and 4b....................		4c
5	Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ......		5

Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total expenses and losses per audited financial statements ...........		1
2	Amounts included on line 1 but not on Form 990, Part IX, line 25:
a	Donated services and use of facilities .........	2a
b	Prior year adjustments ............	2b
c	Other losses ................	2c
d	Other (Describe in Part XIII.) ............	2d
e	Add lines 2a through 2d....................		2e
3	Subtract line 2e from line 1...................		3
4	Amounts included on Form 990, Part IX, line 25, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b ..	4a
b	Other (Describe in Part XIII.) ............	4b
c	Add lines 4a and 4b.....................		4c
5	Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ......		5

Part XIII

Supplemental Information

Provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b; Part V, line 4; Part X, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.

Return Reference	Explanation
PART V, LINE 4:	TEMPORARILY RESTRICTED NET ASSETS INCLUDE THOSE ASSETS WHOSE USE BY THE SYSTEM HAS BEEN TEMPORARILY LIMITED PRIMARILY FOR CAPITAL PROJECTS OR A SPECIFIED TIME PERIOD OR PURPOSE. TEMPORARILY RESTRICTED NET ASSETS HAVE BEEN RESTRICTED FOR USE IN PATIENT MEDICAL CARE, EDUCATION AND SCHOLARSHIPS, CAPITAL PROJECTS, AND OTHER SYSTEM SUPPORT. PERMANENTLY RESTRICTED NET ASSETS ARE CONTRIBUTED WITH DONOR RESTRICTIONS REQUIRING THEY BE HELD IN PERPETUITY WITH INCOME USED TO SUPPORT THE SYSTEM'S ACTIVITIES. PERMANENTLY RESTRICTED NET ASSETS INCLUDE BENEFICIAL INTEREST IN TRUSTS AND OTHER PERMANENT RESTRICTIONS.
PART X, LINE 2:	ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE COMPANY AND RECOGNIZE A TAX LIABILITY IF THE COMPANY 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 COMPANY AND HAS CONCLUDED THAT AS OF SEPTEMBER 30, 2018 AND 2017, 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 COMPANY IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS.
PART VII AND IX:	SECTIONS ARE NOT REQUIRED AS THE TOTALS FOR EACH LINE ARE LESS THAN 5% OF THE TOTAL ASSETS LISTED ON FORM 990, PART X, LINE 16.
PART XI AND XII:	SECTIONS ARE NOT REQUIRED AS THE ORGANIZATION IS PART OF A CONSOLIDATED FINANCIAL STATEMENT. THE CONSOLIDATED FINANCIAL STATEMENT IS AUDITED BY AN INDEPENDENT ACCOUNTING FIRM AND IS PREPARED IN ACCORDANCE WITH GENERALLY ACCEPTED ACCOUNTING PRINCIPLES.

Schedule D (Form 990) 2019

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE G (Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Supplemental Information Regarding
Fundraising or Gaming Activities

Complete if the organization answered "Yes" on Form 990, Part IV, lines 17, 18, or 19, or if the organization entered more than $15,000 on Form 990-EZ, line 6a. right arrow

Attach to Form 990 or Form 990-EZ.
right arrow

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization
DEACONESS HOSPITAL INC

Employer identification number

35-0593390

Part I

Fundraising Activities.Complete if the organization answered "Yes" on Form 990, Part IV, line 17.

Form 990-EZ filers are not required to complete this part.

Indicate whether the organization raised funds through any of the following activities. Check all that apply.

a	Mail solicitations	e	Solicitation of non-government grants
b	Internet and email solicitations	f	Solicitation of government grants
c	Phone solicitations	g	Special fundraising events
d	In-person solicitations

Did the organization have a written or oral agreement with any individual (including officers, directors, trustees

or key employees listed in Form 990, Part VII) or entity in connection with professional fundraising services?

YesNo

If "Yes," list the 10 highest paid individuals or entities (fundraisers) pursuant to agreements under which the fundraiser is
to be compensated at least $5,000 by the organization.

(i) Name and address of individual or entity (fundraiser)	(iii) Did fundraiser have custody or control of contributions?
	Yes	No










Total . . . . . . . . . . . . . . . . . . . .

List all states in which the organization is registered or licensed to solicit contributions or has been notified it is exempt from registration or licensing.

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 50083H

Schedule G (Form 990 or 990-EZ) 2019

Page 2

Part II

Fundraising Events. Complete if the organization answered "Yes" on Form 990, Part IV, line 18, or reported more than $15,000 of fundraising event contributions and gross income on Form 990-EZ, lines 1 and 6b. List events with gross receipts greater than $5,000.

		(a) Event #1 DH PARTY OF YR (event type)	(b) Event #2 DH CLASSIC (event type)	(d) Total events (add col. (a) through col. (c))
1	Gross receipts . . . . .	239,250	226,688	465,938
2	Less: Contributions . . . .	116,225	195,368	311,593
3	Gross income (line 1 minus line 2) . . . . . .	123,025	31,320	154,345

4	Cash prizes . . . . .
5	Noncash prizes . . . .		38,534	38,534
6	Rent/facility costs . . . .	35,758	30,333	66,091
7	Food and beverages . . .	62,051		62,051
8	Entertainment . . . .	16,320	4,938	21,258
9	Other direct expenses . . .	4,845	3,064	7,909
10	Direct expense summary. Add lines 4 through 9 in column (d) . . . . . . . . . .			195,843
11	Net income summary. Subtract line 10 from line 3, column (d). . . . . . . . . .			-41,498

Part III

Gaming. Complete if the organization answered "Yes" on Form 990, Part IV, line 19, or reported more than $15,000 on Form 990-EZ, line 6a.

		(a) Bingo	(b) Pull tabs/Instant bingo/progressive bingo	(c) Other gaming	(d) Total gaming (add col.(a) through col.(c))
1	Gross revenue . . . . .

2	Cash prizes . . . . .
3	Noncash prizes . . . .
4	Rent/facility costs . . . .
5	Other direct expenses . . .

Volunteer labor . . . .

	Yes %
	No

	Yes %
	No

	Yes %
	No

Direct expense summary. Add lines 2 through 5 in column (d) . . . . . . . . . . right arrow

Net gaming income summary. Subtract line 7 from line 1, column (d). . . . . . . . . right arrow

Enter the state(s) in which the organization conducts gaming activities:

Is the organization licensed to conduct gaming activities in each of these states? . . . . . . . .

YesNo

If "No," explain:

10a

Were any of the organization's gaming licenses revoked, suspended or terminated during the tax year? . . .

YesNo

If "Yes," explain:

Schedule G (Form 990 or 990-EZ) 2019

Page 3

Does the organization conduct gaming activities with nonmembers? . . . . . . . . . . .

YesNo

Is the organization a grantor, beneficiary or trustee of a trust or a member of a partnership or other entity

formed to administer charitable gaming? . . . . . . . . . . . . . . . . .

YesNo

Indicate the percentage of gaming activity conducted in:

The organization's facility . . . . . . . . . . . . . . . . . .

13a

An outside facility . . . . . . . . . . . . . . . . . . . .

13b

Enter the name and address of the person who prepares the organization's gaming/special events books and records:

Name

Address

15a

Does the organization have a contract with a third party from whom the organization receives gaming

revenue? . . . . . . . . . . . . . . . . . . . . . . . .

YesNo

If "Yes," enter the amount of gaming revenue received by the organization right arrow

$ and the

amount of gaming revenue retained by the third party right arrow

$ .

If "Yes," enter name and address of the third party:

Name

Address

Gaming manager information:

Name

Gaming manager compensation right arrow

Description of services provided right arrow

Director/officer Employee Independent contractor

Mandatory distributions:

Is the organization required under state law to make charitable distributions from the gaming proceeds to

retain the state gaming license? . . . . . . . . . . . . . . . . . . .

YesNo

Enter the amount of distributions required under state law distributed to other exempt organizations or spent

in the organization's own exempt activities during the tax year right arrow

Part IV

Supplemental Information. Provide the explanations required by Part I, line 2b, columns (iii) and (v); and Part III, lines 9, 9b, 10b, 15b, 15c, 16, and 17b, as applicable. Also provide any additional information. See instructions.

Return Reference	Explanation

Schedule G (Form 990 or 990-EZ) 2019

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE H
(Form 990)

Department of the Treasury
Internal Revenue Service

Hospitals

Complete if the organization answered "Yes" on Form 990, Part IV, question 20.
MediumBullet

Attach to Form 990.
MediumBullet

Go to www.irs.gov/Form990EZ for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization

DEACONESS HOSPITAL INC

Employer identification number

35-0593390

Part I

Financial Assistance and Certain Other Community Benefits at Cost

Yes

Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a . . . .

Yes

If "Yes," was it a written policy? ......................

Yes

If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.

Applied uniformly to all hospital facilities Applied uniformly to most hospital facilities Generally tailored to individual hospital facilities

Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.

Did the organization use Federal Poverty Guidelines (FPG) as a factor in determining eligibility for providing free care?

If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:

Yes

100% 150% 200% Other %

Did the organization use FPG as a factor in determining eligibility for providing discounted care? If "Yes," indicate

which of the following was the family income limit for eligibility for discounted care: . . . . . . . .

Yes

200% 250% 300% 350% 400% Other %

If the organization used factors other than FPG in determining eligibility, describe in Part VI the criteria used for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, as a factor in determining eligibility for free or discounted care.

Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? . . . . . . . . . . . . .

Yes

Did the organization budget amounts for free or discounted care provided under its financial assistance policy during
the tax year? . . . . . . . . . . . . . . . . . . . . . . .

Yes

If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? . . . . . .

If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care? . . . . . . . . . . . . .

Did the organization prepare a community benefit report during the tax year? . . . . . . . . .

Yes

If "Yes," did the organization make it available to the public? . . . . . . . . . . . . .

Yes

Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.

Financial Assistance and Certain Other Community Benefits at Cost

Financial Assistance and Means-Tested Government Programs		(c) Total community benefit expense	(d) Direct offsetting revenue	(e) Net community benefit expense	(f) Percent of total expense
a	Financial Assistance at cost (from Worksheet 1) . . .	15,603,093		15,603,093	2.000 %
b	Medicaid (from Worksheet 3, column a) . . . . .	141,766,005	105,793,397	35,972,608	4.600 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) . .
d	Total Financial Assistance and Means-Tested Government Programs . . . . .	157,369,098	105,793,397	51,575,701	6.600 %
Other Benefits
e	Community health improvement services and community benefit operations (from Worksheet 4).	897,204		897,204	0.110 %
f	Health professions education (from Worksheet 5) . . .	7,632,400	2,367,250	5,265,150	0.670 %
g	Subsidized health services (from Worksheet 6) . . . .	596,405	194,717	401,688	0.050 %
h	Research (from Worksheet 7) .
i	Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .	2,063,738	33,119	2,030,619	0.260 %
j	Total. Other Benefits . .	11,189,747	2,595,086	8,594,661	1.090 %
k	Total. Add lines 7d and 7j .	168,558,845	108,388,483	60,170,362	7.690 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2019

Schedule H (Form 990) 2019

Page

Part II

Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.

		(c) Total community building expense	(d) Direct offsetting revenue	(e) Net community building expense	(f) Percent of total expense
1	Physical improvements and housing	1,380		1,380	0 %
2	Economic development	11,524		11,524	0 %
3	Community support	32,096		32,096	0 %
4	Environmental improvements
5	Leadership development and training for community members	3,941		3,941	0 %
6	Coalition building
7	Community health improvement advocacy
8	Workforce development	76,011	18,550	57,461	0.010 %
9	Other
10	Total	124,952	18,550	106,402	0.010 %

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

Did the organization report bad debt expense in accordance with Healthcare Financial Management Association Statement No. 15? ..........................

Yes

Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......

11,245,205

Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy. Explain in Part VI the methodology used by the organization to estimate this amount and the rationale, if any, for including this portion of bad debt as community benefit. ......

Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.

Section B. Medicare

Enter total revenue received from Medicare (including DSH and IME).....

191,552,676

Enter Medicare allowable costs of care relating to payments on line 5.....

212,311,819

Subtract line 6 from line 5. This is the surplus (or shortfall)........

-20,759,143

Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:

Cost accounting system Cost to charge ratio Other

Section C. Collection Practices

Did the organization have a written debt collection policy during the tax year? ..........

Yes

If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year
contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI .........................

Yes

Part IV

Management Companies and Joint Ventures(owned 10% or more by officers, directors, trustees, key employees, and physicians—see instructions)

(a) Name of entity	(b) Description of primary activity of entity	(c) Organization's profit % or stock ownership %	(d) Officers, directors, trustees, or key employees' profit % or stock ownership %	(e) Physicians' profit % or stock ownership %
1
2
3
4
5
6
7
8
9
10
11
12
13

Schedule H (Form 990) 2019

Page

Part VFacility Information

Section A. Hospital Facilities (list in order of size from largest to smallest—see instructions)How many hospital facilities did the organization operate during the tax year?4Name, address, primary website address, and state license number (and if a group return, the name and EIN of the subordinate hospital organization that operates the hospital facility)
1	DEACONESS HOSPITAL INC 600 MARY STREET EVANSVILLE,IN47747 WWW.DEACONESS.COM 19-005074-1	X	X	X	X
2	DEACONESS GATEWAY HOSPITAL 4011 GATEWAY BLVD NEWBURGH,IN47630 WWW.DEACONESS.COM 19-005074-1	X	X	X	X
3	DEACONESS CROSS POINTE 7200 E INDIANA STREET EVANSVILLE,IN47715 WWW.DEACONESS.COM 19-005074-1	X
4	THE HEART HOSPITAL 4007 GATEWAY BLVD NEWBURGH,IN47630 WWW.DEACONESS.COM 18-011772-1	X

Schedule H (Form 990) 2019

Page 4

Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)

	DEACONESS HOSPITAL INC
Name of hospital facility or letter of facility reporting group

Line number of hospital facility, or line numbers of hospital facilities in a facility
reporting group (from Part V, Section A):

Yes

Community Health Needs Assessment

Was the hospital facility first licensed, registered, or similarly recognized by a state as a hospital facility in the current tax year or the immediately preceding tax year?........................

Was the hospital facility acquired or placed into service as a tax-exempt hospital in the current tax year or the immediately preceding tax year? If “Yes,” provide details of the acquisition in Section C...............

During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 12......................

Yes

If "Yes," indicate what the CHNA report describes (check all that apply):

A definition of the community served by the hospital facility

Demographics of the community

Existing health care facilities and resources within the community that are available to respond to the health needs of the community

How data was obtained

The significant health needs of the community

Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups

The process for identifying and prioritizing community health needs and services to meet the community health needs

The process for consulting with persons representing the community’s interests

The impact of any actions taken to address the significant health needs identified in the hospital facility's prior CHNA(s)

Other (describe in Section C)

Indicate the tax year the hospital facility last conducted a CHNA: 20 15

In conducting its most recent CHNA, did the hospital facility take into account input from persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If "Yes," describe in Section C how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted .................

Yes

6 a

Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Section C..................................

Yes

Was the hospital facility’s CHNA conducted with one or more organizations other than hospital facilities?” If “Yes,” list the other organizations in Section C. ............................

Yes

Did the hospital facility make its CHNA report widely available to the public?..............

Yes

If "Yes," indicate how the CHNA report was made widely available (check all that apply):

Hospital facility’s website (list url): HTTP://WWW.DEACONESS.COM/CHNA

Other website (list url):

Made a paper copy available for public inspection without charge at the hospital facility

Other (describe in Section C)

Did the hospital facility adopt an implementation strategy to meet the significant community health needs
identified through its most recently conducted CHNA? If "No," skip to line 11. ..............

Yes

Indicate the tax year the hospital facility last adopted an implementation strategy: 20 15

Is the hospital facility's most recently adopted implementation strategy posted on a website?.........

Yes

If "Yes" (list url): HTTP://WWW.DEACONESS.COM/CHNA

If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ......

10b

Describe in Section C how the hospital facility is addressing the significant needs identified in its most recently conducted CHNA and any such needs that are not being addressed together with the reasons why such needs are not being addressed.

12a

Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)?...............................

12a

If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........

12b

If "Yes" on line 12b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $

Schedule H (Form 990) 2019

Page 5

Part VFacility Information (continued)

Financial Assistance Policy (FAP)

	DEACONESS HOSPITAL INC
Name of hospital facility or letter of facility reporting group

Yes

Did the hospital facility have in place during the tax year a written financial assistance policy that:

Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care?

Yes

If “Yes,” indicate the eligibility criteria explained in the FAP:

Federal poverty guidelines (FPG), with FPG family income limit for eligibility for free care of 200.000000000000%
and FPG family income limit for eligibility for discounted care of 400.000000000000%

Income level other than FPG (describe in Section C)

Asset level

Medical indigency

Insurance status

Underinsurance discount

Residency

Other (describe in Section C)

Explained the basis for calculating amounts charged to patients?.................

Yes

Explained the method for applying for financial assistance?...................

Yes

If “Yes,” indicate how the hospital facility’s FAP or FAP application form (including accompanying instructions) explained the method for applying for financial assistance (check all that apply):

Described the information the hospital facility may require an individual to provide as part of his or her application

Described the supporting documentation the hospital facility may require an individual to submit as part of his or
her application

Provided the contact information of hospital facility staff who can provide an individual with information about the
FAP and FAP application process

Provided the contact information of nonprofit organizations or government agencies that may be sources of
assistance with FAP applications

Other (describe in Section C)

Was widely publicized within the community served by the hospital facility?........

Yes

If "Yes," indicate how the hospital facility publicized the policy (check all that apply):

The FAP was widely available on a website (list url):

SEE PART V

The FAP application form was widely available on a website (list url):

SEE PART V

A plain language summary of the FAP was widely available on a website (list url):
SEE PART V

The FAP was available upon request and without charge (in public locations in the hospital facility and by mail)

The FAP application form was available upon request and without charge (in public locations in the hospital facility
and by mail)

A plain language summary of the FAP was available upon request and without charge (in public locations in the
hospital facility and by mail)

Individuals were notified about the FAP by being offered a paper copy of the plain language summary of the FAP, by
receiving a conspicuous written notice about the FAP on their billing statements, and via conspicuous public displays or
other measures reasonably calculated to attract patients' attention

Notified members of the community who are most likely to require financial assistance about availability of the FAP

The FAP, FAP application form, and plain language summary of the FAP were translated into the primary language(s)
spoken by LEP populations

Other (describe in Section C)

Schedule H (Form 990) 2019

Page 6

Part VFacility Information (continued)

Billing and Collections

	DEACONESS HOSPITAL INC
Name of hospital facility or letter of facility reporting group

Yes

Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained all of the actions the hospital facility or other authorized party may take upon nonpayment?..................................

Yes

Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Deferring, denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

None of these actions or other similar actions were permitted

Did the hospital facility or other authorized party perform any of the following actions during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP?............

If "Yes," check all actions in which the hospital facility or a third party engaged:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Deferring , denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 19. (check all that apply):

Provided a written notice about upcoming ECAs (Extraordinary Collection Action) and a plain language summary of the
FAP at least 30 days before initiating those ECAs (if not, describe in Section C)

Made a reasonable effort to orally notify individuals about the FAP and FAP application process (if not, describe in
Section C)

Processed incomplete and complete FAP applications (if not, describe in Section C)

Made presumptive eligibility determinations (if not, describe in Section C)

Other (describe in Section C)

None of these efforts were made

Policy Relating to Emergency Medical Care

Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that required the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?..................

Yes

If "No," indicate why:

The hospital facility did not provide care for any emergency medical conditions

The hospital facility’s policy was not in writing

The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Section C)

Other (describe in Section C)

Schedule H (Form 990) 2019

Page 7

Part VFacility Information (continued)

Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)

	DEACONESS HOSPITAL INC
Name of hospital facility or letter of facility reporting group

Yes

Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.

The hospital facility used a look-back method based on claims allowed by Medicare fee-for-service during a prior 12-month period

The hospital facility used a look-back method based on claims allowed by Medicare fee-for-service and all private health insurers that pay claims to the hospital facility during a prior 12-month period

The hospital facility used a look-back method based on claims allowed by Medicaid, either alone or in combination with
Medicare fee-for-service and all private health insurers that pay claims to the hospital facility during a prior 12-month
period

The hospital facility used a prospective Medicare or Medicaid method

During the tax year, did the hospital facility charge any FAP-eligible individual to whom the hospital facility provided emergency or other medically necessary services more than the amounts generally billed to individuals who had insurance covering such care? ...............................

If "Yes," explain in Section C.

During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? ...........................

If "Yes," explain in Section C.

Schedule H (Form 990) 2019

Page 4

Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)

	DEACONESS GATEWAY HOSPITAL
Name of hospital facility or letter of facility reporting group

Line number of hospital facility, or line numbers of hospital facilities in a facility
reporting group (from Part V, Section A):

Yes

Community Health Needs Assessment

Was the hospital facility first licensed, registered, or similarly recognized by a state as a hospital facility in the current tax year or the immediately preceding tax year?........................

During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 12......................

Yes

If "Yes," indicate what the CHNA report describes (check all that apply):

A definition of the community served by the hospital facility

Demographics of the community

Existing health care facilities and resources within the community that are available to respond to the health needs of the community

How data was obtained

The significant health needs of the community

Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups

The process for identifying and prioritizing community health needs and services to meet the community health needs

The process for consulting with persons representing the community’s interests

The impact of any actions taken to address the significant health needs identified in the hospital facility's prior CHNA(s)

Other (describe in Section C)

Indicate the tax year the hospital facility last conducted a CHNA: 20 15

Yes

6 a

Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Section C..................................

Yes

Was the hospital facility’s CHNA conducted with one or more organizations other than hospital facilities?” If “Yes,” list the other organizations in Section C. ............................

Yes

Did the hospital facility make its CHNA report widely available to the public?..............

Yes

If "Yes," indicate how the CHNA report was made widely available (check all that apply):

Hospital facility’s website (list url): HTTP://WWW.DEACONESS.COM/CHNA

Other website (list url):

Made a paper copy available for public inspection without charge at the hospital facility

Other (describe in Section C)

Did the hospital facility adopt an implementation strategy to meet the significant community health needs
identified through its most recently conducted CHNA? If "No," skip to line 11. ..............

Yes

Indicate the tax year the hospital facility last adopted an implementation strategy: 20 15

Is the hospital facility's most recently adopted implementation strategy posted on a website?.........

Yes

If "Yes" (list url): HTTP://WWW.DEACONESS.COM/CHNA

If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ......

10b

12a

Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)?...............................

12a

If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........

12b

If "Yes" on line 12b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $

Schedule H (Form 990) 2019

Page 5

Part VFacility Information (continued)

Financial Assistance Policy (FAP)

	DEACONESS GATEWAY HOSPITAL
Name of hospital facility or letter of facility reporting group

Yes

Did the hospital facility have in place during the tax year a written financial assistance policy that:

Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care?

Yes

If “Yes,” indicate the eligibility criteria explained in the FAP:

Federal poverty guidelines (FPG), with FPG family income limit for eligibility for free care of 200.000000000000%
and FPG family income limit for eligibility for discounted care of 400.000000000000%

Income level other than FPG (describe in Section C)

Asset level

Medical indigency

Insurance status

Underinsurance discount

Residency

Other (describe in Section C)

Explained the basis for calculating amounts charged to patients?.................

Yes

Explained the method for applying for financial assistance?...................

Yes

Described the information the hospital facility may require an individual to provide as part of his or her application

Described the supporting documentation the hospital facility may require an individual to submit as part of his or
her application

Provided the contact information of hospital facility staff who can provide an individual with information about the
FAP and FAP application process

Provided the contact information of nonprofit organizations or government agencies that may be sources of
assistance with FAP applications

Other (describe in Section C)

Was widely publicized within the community served by the hospital facility?........

Yes

If "Yes," indicate how the hospital facility publicized the policy (check all that apply):

The FAP was widely available on a website (list url):

SEE PART V

The FAP application form was widely available on a website (list url):

SEE PART V

A plain language summary of the FAP was widely available on a website (list url):
SEE PART V

The FAP was available upon request and without charge (in public locations in the hospital facility and by mail)

The FAP application form was available upon request and without charge (in public locations in the hospital facility
and by mail)

A plain language summary of the FAP was available upon request and without charge (in public locations in the
hospital facility and by mail)

Notified members of the community who are most likely to require financial assistance about availability of the FAP

The FAP, FAP application form, and plain language summary of the FAP were translated into the primary language(s)
spoken by LEP populations

Other (describe in Section C)

Schedule H (Form 990) 2019

Page 6

Part VFacility Information (continued)

Billing and Collections

	DEACONESS GATEWAY HOSPITAL
Name of hospital facility or letter of facility reporting group

Yes

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Deferring, denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

None of these actions or other similar actions were permitted

If "Yes," check all actions in which the hospital facility or a third party engaged:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Deferring , denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 19. (check all that apply):

Provided a written notice about upcoming ECAs (Extraordinary Collection Action) and a plain language summary of the
FAP at least 30 days before initiating those ECAs (if not, describe in Section C)

Made a reasonable effort to orally notify individuals about the FAP and FAP application process (if not, describe in
Section C)

Processed incomplete and complete FAP applications (if not, describe in Section C)

Made presumptive eligibility determinations (if not, describe in Section C)

Other (describe in Section C)

None of these efforts were made

Policy Relating to Emergency Medical Care

Yes

If "No," indicate why:

The hospital facility did not provide care for any emergency medical conditions

The hospital facility’s policy was not in writing

The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Section C)

Other (describe in Section C)

Schedule H (Form 990) 2019

Page 7

Part VFacility Information (continued)

Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)

	DEACONESS GATEWAY HOSPITAL
Name of hospital facility or letter of facility reporting group

Yes

Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.

The hospital facility used a look-back method based on claims allowed by Medicare fee-for-service during a prior 12-month period

The hospital facility used a prospective Medicare or Medicaid method

If "Yes," explain in Section C.

During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? ...........................

If "Yes," explain in Section C.

Schedule H (Form 990) 2019

Page 4

Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)

	DEACONESS CROSS POINTE
Name of hospital facility or letter of facility reporting group

Line number of hospital facility, or line numbers of hospital facilities in a facility
reporting group (from Part V, Section A):

Yes

Community Health Needs Assessment

Was the hospital facility first licensed, registered, or similarly recognized by a state as a hospital facility in the current tax year or the immediately preceding tax year?........................

During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 12......................

Yes

If "Yes," indicate what the CHNA report describes (check all that apply):

A definition of the community served by the hospital facility

Demographics of the community

Existing health care facilities and resources within the community that are available to respond to the health needs of the community

How data was obtained

The significant health needs of the community

Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups

The process for identifying and prioritizing community health needs and services to meet the community health needs

The process for consulting with persons representing the community’s interests

The impact of any actions taken to address the significant health needs identified in the hospital facility's prior CHNA(s)

Other (describe in Section C)

Indicate the tax year the hospital facility last conducted a CHNA: 20 15

Yes

6 a

Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Section C..................................

Yes

Was the hospital facility’s CHNA conducted with one or more organizations other than hospital facilities?” If “Yes,” list the other organizations in Section C. ............................

Yes

Did the hospital facility make its CHNA report widely available to the public?..............

Yes

If "Yes," indicate how the CHNA report was made widely available (check all that apply):

Hospital facility’s website (list url): HTTP://WWW.DEACONESS.COM/CHNA

Other website (list url):

Made a paper copy available for public inspection without charge at the hospital facility

Other (describe in Section C)

Did the hospital facility adopt an implementation strategy to meet the significant community health needs
identified through its most recently conducted CHNA? If "No," skip to line 11. ..............

Yes

Indicate the tax year the hospital facility last adopted an implementation strategy: 20 15

Is the hospital facility's most recently adopted implementation strategy posted on a website?.........

Yes

If "Yes" (list url): HTTP://WWW.DEACONESS.COM/CHNA

If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ......

10b

12a

Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)?...............................

12a

If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........

12b

If "Yes" on line 12b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $

Schedule H (Form 990) 2019

Page 5

Part VFacility Information (continued)

Financial Assistance Policy (FAP)

	DEACONESS CROSS POINTE
Name of hospital facility or letter of facility reporting group

Yes

Did the hospital facility have in place during the tax year a written financial assistance policy that:

Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care?

Yes

If “Yes,” indicate the eligibility criteria explained in the FAP:

Federal poverty guidelines (FPG), with FPG family income limit for eligibility for free care of 200.000000000000%
and FPG family income limit for eligibility for discounted care of 400.000000000000%

Income level other than FPG (describe in Section C)

Asset level

Medical indigency

Insurance status

Underinsurance discount

Residency

Other (describe in Section C)

Explained the basis for calculating amounts charged to patients?.................

Yes

Explained the method for applying for financial assistance?...................

Yes

Described the information the hospital facility may require an individual to provide as part of his or her application

Described the supporting documentation the hospital facility may require an individual to submit as part of his or
her application

Provided the contact information of hospital facility staff who can provide an individual with information about the
FAP and FAP application process

Provided the contact information of nonprofit organizations or government agencies that may be sources of
assistance with FAP applications

Other (describe in Section C)

Was widely publicized within the community served by the hospital facility?........

Yes

If "Yes," indicate how the hospital facility publicized the policy (check all that apply):

The FAP was widely available on a website (list url):

SEE PART V

The FAP application form was widely available on a website (list url):

SEE PART V

A plain language summary of the FAP was widely available on a website (list url):
SEE PART V

The FAP was available upon request and without charge (in public locations in the hospital facility and by mail)

The FAP application form was available upon request and without charge (in public locations in the hospital facility
and by mail)

A plain language summary of the FAP was available upon request and without charge (in public locations in the
hospital facility and by mail)

Notified members of the community who are most likely to require financial assistance about availability of the FAP

The FAP, FAP application form, and plain language summary of the FAP were translated into the primary language(s)
spoken by LEP populations

Other (describe in Section C)

Schedule H (Form 990) 2019

Page 6

Part VFacility Information (continued)

Billing and Collections

	DEACONESS CROSS POINTE
Name of hospital facility or letter of facility reporting group

Yes

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Deferring, denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

None of these actions or other similar actions were permitted

If "Yes," check all actions in which the hospital facility or a third party engaged:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Deferring , denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 19. (check all that apply):

Provided a written notice about upcoming ECAs (Extraordinary Collection Action) and a plain language summary of the
FAP at least 30 days before initiating those ECAs (if not, describe in Section C)

Made a reasonable effort to orally notify individuals about the FAP and FAP application process (if not, describe in
Section C)

Processed incomplete and complete FAP applications (if not, describe in Section C)

Made presumptive eligibility determinations (if not, describe in Section C)

Other (describe in Section C)

None of these efforts were made

Policy Relating to Emergency Medical Care

Yes

If "No," indicate why:

The hospital facility did not provide care for any emergency medical conditions

The hospital facility’s policy was not in writing

The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Section C)

Other (describe in Section C)

Schedule H (Form 990) 2019

Page 7

Part VFacility Information (continued)

Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)

	DEACONESS CROSS POINTE
Name of hospital facility or letter of facility reporting group

Yes

Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.

The hospital facility used a look-back method based on claims allowed by Medicare fee-for-service during a prior 12-month period

The hospital facility used a prospective Medicare or Medicaid method

If "Yes," explain in Section C.

During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? ...........................

If "Yes," explain in Section C.

Schedule H (Form 990) 2019

Page 4

Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)

	THE HEART HOSPITAL
Name of hospital facility or letter of facility reporting group

Line number of hospital facility, or line numbers of hospital facilities in a facility
reporting group (from Part V, Section A):

Yes

Community Health Needs Assessment

Was the hospital facility first licensed, registered, or similarly recognized by a state as a hospital facility in the current tax year or the immediately preceding tax year?........................

During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 12......................

Yes

If "Yes," indicate what the CHNA report describes (check all that apply):

A definition of the community served by the hospital facility

Demographics of the community

Existing health care facilities and resources within the community that are available to respond to the health needs of the community

How data was obtained

The significant health needs of the community

Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups

The process for identifying and prioritizing community health needs and services to meet the community health needs

The process for consulting with persons representing the community’s interests

The impact of any actions taken to address the significant health needs identified in the hospital facility's prior CHNA(s)

Other (describe in Section C)

Indicate the tax year the hospital facility last conducted a CHNA: 20 15

Yes

6 a

Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Section C..................................

Yes

Was the hospital facility’s CHNA conducted with one or more organizations other than hospital facilities?” If “Yes,” list the other organizations in Section C. ............................

Yes

Did the hospital facility make its CHNA report widely available to the public?..............

Yes

If "Yes," indicate how the CHNA report was made widely available (check all that apply):

Hospital facility’s website (list url): HTTP://WWW.DEACONESS.COM/CHNA

Other website (list url):

Made a paper copy available for public inspection without charge at the hospital facility

Other (describe in Section C)

Did the hospital facility adopt an implementation strategy to meet the significant community health needs
identified through its most recently conducted CHNA? If "No," skip to line 11. ..............

Yes

Indicate the tax year the hospital facility last adopted an implementation strategy: 20 15

Is the hospital facility's most recently adopted implementation strategy posted on a website?.........

Yes

If "Yes" (list url): HTTP://WWW.DEACONESS.COM/CHNA

If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ......

10b

12a

Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)?...............................

12a

If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........

12b

If "Yes" on line 12b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $

Schedule H (Form 990) 2019

Page 5

Part VFacility Information (continued)

Financial Assistance Policy (FAP)

	THE HEART HOSPITAL
Name of hospital facility or letter of facility reporting group

Yes

Did the hospital facility have in place during the tax year a written financial assistance policy that:

Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care?

Yes

If “Yes,” indicate the eligibility criteria explained in the FAP:

Federal poverty guidelines (FPG), with FPG family income limit for eligibility for free care of 200.000000000000%
and FPG family income limit for eligibility for discounted care of 400.000000000000%

Income level other than FPG (describe in Section C)

Asset level

Medical indigency

Insurance status

Underinsurance discount

Residency

Other (describe in Section C)

Explained the basis for calculating amounts charged to patients?.................

Yes

Explained the method for applying for financial assistance?...................

Yes

Described the information the hospital facility may require an individual to provide as part of his or her application

Described the supporting documentation the hospital facility may require an individual to submit as part of his or
her application

Provided the contact information of hospital facility staff who can provide an individual with information about the
FAP and FAP application process

Provided the contact information of nonprofit organizations or government agencies that may be sources of
assistance with FAP applications

Other (describe in Section C)

Was widely publicized within the community served by the hospital facility?........

Yes

If "Yes," indicate how the hospital facility publicized the policy (check all that apply):

The FAP was widely available on a website (list url):

SEE PART V

The FAP application form was widely available on a website (list url):

SEE PART V

A plain language summary of the FAP was widely available on a website (list url):
SEE PART V

The FAP was available upon request and without charge (in public locations in the hospital facility and by mail)

The FAP application form was available upon request and without charge (in public locations in the hospital facility
and by mail)

A plain language summary of the FAP was available upon request and without charge (in public locations in the
hospital facility and by mail)

Notified members of the community who are most likely to require financial assistance about availability of the FAP

The FAP, FAP application form, and plain language summary of the FAP were translated into the primary language(s)
spoken by LEP populations

Other (describe in Section C)

Schedule H (Form 990) 2019

Page 6

Part VFacility Information (continued)

Billing and Collections

	THE HEART HOSPITAL
Name of hospital facility or letter of facility reporting group

Yes

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Deferring, denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

None of these actions or other similar actions were permitted

If "Yes," check all actions in which the hospital facility or a third party engaged:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Deferring , denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 19. (check all that apply):

Provided a written notice about upcoming ECAs (Extraordinary Collection Action) and a plain language summary of the
FAP at least 30 days before initiating those ECAs (if not, describe in Section C)

Made a reasonable effort to orally notify individuals about the FAP and FAP application process (if not, describe in
Section C)

Processed incomplete and complete FAP applications (if not, describe in Section C)

Made presumptive eligibility determinations (if not, describe in Section C)

Other (describe in Section C)

None of these efforts were made

Policy Relating to Emergency Medical Care

Yes

If "No," indicate why:

The hospital facility did not provide care for any emergency medical conditions

The hospital facility’s policy was not in writing

The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Section C)

Other (describe in Section C)

Schedule H (Form 990) 2019

Page 7

Part VFacility Information (continued)

Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)

	THE HEART HOSPITAL
Name of hospital facility or letter of facility reporting group

Yes

Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.

The hospital facility used a look-back method based on claims allowed by Medicare fee-for-service during a prior 12-month period

The hospital facility used a prospective Medicare or Medicaid method

If "Yes," explain in Section C.

During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? ...........................

If "Yes," explain in Section C.

Schedule H (Form 990) 2019

Page 8

Part V

Facility Information (continued)

Section C. Supplemental Information for Part V, Section B. Provide descriptions required for Part V, Section B, lines 2, 3j, 5, 6a, 6b, 7d, 11, 13b, 13h, 15e, 16j, 18e, 19e, 20a, 20b, 20c, 20d, 20e, 21c, 21d, 23, and 24. If applicable, provide separate descriptions for each hospital facility in a facility reporting group, designated by facility reporting group letter and hospital facility line number from Part V, Section A (“A, 1,” “A, 4,” “B, 2,” “B, 3,” etc.) and name of hospital facility.
Form and Line Reference	Explanation
DEACONESS HOSPITAL, INC.	PART V, SECTION B, LINE 5: PRIMARY DATA: COMMUNITY INPUT:TO EXPAND UPON THE INFORMATION GATHERED FROM THE SECONDARY DATA, THE COLLABORATIVE CONDUCTED 11 KEY INFORMANT INTERVIEWS AND 10 FOCUS GROUP DISCUSSIONS TO OBTAIN INPUT FROM PERSONS WITH EXPERTISE IN PUBLIC HEALTH AND THOSE WHO REPRESENT THE BROAD INTERESTS OF THE COMMUNITY. IN TOTAL, 84 PEOPLE PARTICIPATED IN PRIMARY DATA COLLECTION TO PROVIDE COMMUNITY INPUT WITH REPRESENTATION FROM THE ORGANIZATIONS BELOW: ALBION FELLOWS BACON CENTER ALCOA ARK CRISIS CHILD CARE CENTER AURORA BOYS AND GIRLS CLUB CAJE CAPE DEACONESS CROSS POINTE DEACONESS FAMILY MEDICINE RESIDENCY DEACONESS PHARMACY EASTER SEALS REHABILITATION ECHO EVANSVILLE FIRE DEPARTMENT EVANSVILLE MAYOR'S OFFICE EVANSVILLE PSYCHIATRIC CHILDREN'S CENTER (FSSA) EVANSVILLE STATE HOSPITAL (FSSA) EVANSVILLE VANDERBURGH SCHOOL CORPORATION (EVSC) GIRL SCOUTS OF SOUTHWEST INDIANA HARDING, SHYMANSKI & COMPANY HARRISON COLLEGE NURSING DEPARTMENT HEARING HEALTHCARE CENTER IPMG IVY TECH COMMUNITY COLLEGE KNIGHT TOWNSHIP TRUSTEE LAMPION CENTER OLD NATIONAL BANK ONE LIFE CHURCH SMOKE FREE COMMUNITIES SOUTHWESTERN BEHAVIORAL HEALTHCARE ST. VINCENT'S BEHAVIORAL SERVICES ST. VINCENT'S CASE MANAGEMENT ST. VINCENT'S CENTER FOR CHILDREN ST. VINCENT'S OUTREACH SERVICES ST. VINCENT'S PASTORAL CARE ST. VINCENT'S WEIGHT MANAGEMENT SWIRCA THE ARC OF EVANSVILLE TJ MAXX UNITED CARING SERVICES UNITED WAY UNITED WAY OF SOUTHWEST INDIANA UNIVERSITY OF EVANSVILLE UNIVERSITY OF SOUTHERN INDIANA UNIVERSITY OF SOUTHERN INDIANA (USI) NURSING DEPARTMENT VANDERBURGH COMMUNITY FOUNDATION VANDERBURGH COUNTY HEALTH DEPARTMENT WELBORN BAPTIST FOUNDATION YOUTH FIRST YWCAKEY INFORMANT INTERVIEWEES:CAROL BRADEN-CLARK, PRESIDENT, UNITED WAY OF SOUTHWEST INDIANADENNIS MORAN, CEO, SOUTHWESTERN HEALTHCARE, INC. (INCLUDING SOUTHWESTERN BEHAVIORAL HEALTHCARE)DR. LINDA BENNETT, PRESIDENT, UNIVERSITY OF SOUTHERN INDIANA JANE WILHELMUS, DIRECTOR OF PRIMARY CURRICULUM/INSTRUCTION K-5, WARRICK COUNTY SCHOOL CORPORATIONJONATHAN WEINZAPFEL, CHANCELLOR, IVY TECH COMMUNITY COLLEGEKEVIN BAIN, PRESIDENT, WELBORN BAPTIST FOUNDATIONLLOYD WINNECKE, MAYOR, CITY OF EVANSVILLESCOTT WYLIE, DIRECTOR, VANDERBURGH COMMUNITY FOUNDATIONSHARON JAMES, NURSING SUPERVISOR, WARRICK COUNTY HEALTH DEPARTMENTSTEVE CRUSE, ASSISTANT SUPERINTENDENT, EVANSVILLE STATE HOSPITALDR. TOM KAZEE, PRESIDENT, UNIVERSITY OF EVANSVILLE
DEACONESS GATEWAY HOSPITAL	PART V, SECTION B, LINE 5: DESCRIPTION OF COMMUNITY INPUT IS REPORTED THE SAME AS DEACONESS HOSPITAL, INC. (HOSPITAL FACILITY #1).
DEACONESS CROSS POINTE	PART V, SECTION B, LINE 5: DESCRIPTION OF COMMUNITY INPUT IS REPORTED THE SAME AS DEACONESS HOSPITAL, INC. (HOSPITAL FACILITY #1).
THE HEART HOSPITAL	PART V, SECTION B, LINE 5: DESCRIPTION OF COMMUNITY INPUT IS REPORTED THE SAME AS DEACONESS HOSPITAL, INC. (HOSPITAL FACILITY #1).
DEACONESS HOSPITAL, INC.	PART V, SECTION B, LINE 6A: OTHER HOSPITAL FACILITIES CHNA WAS CONDUCTED WITH:DEACONESS GATEWAY HOSPITALDEACONESS CROSS POINTEST. VINCENT EVANSVILLE/ASCENSION
DEACONESS GATEWAY HOSPITAL	PART V, SECTION B, LINE 6A: OTHER HOSPITAL FACILITIES CHNA WAS CONDUCTED WITH IS REPORTED THE SAME AS DEACONESS HOSPITAL, INC. (HOSPITAL FACILITY #1).
DEACONESS CROSS POINTE	PART V, SECTION B, LINE 6A: OTHER HOSPITAL FACILITIES CHNA WAS CONDUCTED WITH IS REPORTED THE SAME AS DEACONESS HOSPITAL, INC. (HOSPITAL FACILITY #1).
THE HEART HOSPITAL	PART V, SECTION B, LINE 6A: OTHER HOSPITAL FACILITIES CHNA WAS CONDUCTED WITH IS REPORTED THE SAME AS DEACONESS HOSPITAL, INC. (HOSPITAL FACILITY #1).
DEACONESS HOSPITAL, INC.	PART V, SECTION B, LINE 6B: OTHER ORGANIZATIONS CHNA WAS CONDUCTED WITH:ECHO COMMUNITY HEALTH CAREUNITED WAY OF SOUTHWEST INDIANAWELBORN BAPTIST FOUNDATIONVANDERBURGH COUNTY HEALTH DEPARTMENT
DEACONESS GATEWAY HOSPITAL	PART V, SECTION B, LINE 6B: OTHER ORGANIZATIONS CHNA WAS CONDUCTED WITH IS REPORTED THE SAME AS DEACONESS HOSPITAL, INC. (HOSPITAL FACILITY #1).
DEACONESS CROSS POINTE	PART V, SECTION B, LINE 6B: OTHER ORGANIZATIONS CHNA WAS CONDUCTED WITH IS REPORTED THE SAME AS DEACONESS HOSPITAL, INC. (HOSPITAL FACILITY #1).
THE HEART HOSPITAL	PART V, SECTION B, LINE 6B: OTHER ORGANIZATIONS CHNA WAS CONDUCTED WITH IS REPORTED THE SAME AS DEACONESS HOSPITAL, INC. (HOSPITAL FACILITY #1).
DEACONESS HOSPITAL, INC.	PART V, SECTION B, LINE 7D: THE CHNA IS MADE WIDELY AVAILABLE ON THE HOSPITAL'S WEBSITE:THE HOSPITAL COMMUNITY HEALTH NEEDS ASSESSMENT IS LOCATED AT HTTPS://WWW.DEACONESS.COM/ABOUT-US/COMMUNITY-HEALTH-NEEDS-ASSESSMENTCOPIES AND REQUESTS FOR COPIES WERE ALSO MADE AVAILABLE AT THE JUNE 2016 PRESS CONFERENCE. MEDIA AND COMMUNITY AND THE PUBLIC WERE INVITED TO ATTEND.
DEACONESS GATEWAY HOSPITAL	PART V, SECTION B, LINE 7D: THE CHNA IS MADE WIDELY AVAILABLE ON THE HOSPITAL'S WEBSITE: THE HOSPITAL COMMUNITY HEALTH NEEDS ASSESSMENT IS LOCATED AT HTTPS://WWW.DEACONESS.COM/ABOUT-US/COMMUNITY-HEALTH-NEEDS-ASSESSMENTCOPIES AND REQUESTS FOR COPIES WERE ALSO MADE AVAILABLE AT THE JUNE 2016 PRESS CONFERENCE. MEDIA AND COMMUNITY AND THE PUBLIC WERE INVITED TO ATTEND.
DEACONESS CROSS POINTE	PART V, SECTION B, LINE 7D: THE CHNA IS MADE WIDELY AVAILABLE ON THE HOSPITAL'S WEBSITE: THE HOSPITAL COMMUNITY HEALTH NEEDS ASSESSMENT IS LOCATED AT HTTPS://WWW.DEACONESS.COM/ABOUT-US/COMMUNITY-HEALTH-NEEDS-ASSESSMENTCOPIES AND REQUESTS FOR COPIES WERE ALSO MADE AVAILABLE AT THE JUNE 2016 PRESS CONFERENCE. MEDIA AND COMMUNITY AND THE PUBLIC WERE INVITED TO ATTEND.
THE HEART HOSPITAL	PART V, SECTION B, LINE 7D: THE CHNA IS MADE WIDELY AVAILABLE ON THE HOSPITAL'S WEBSITE: THE HOSPITAL COMMUNITY HEALTH NEEDS ASSESSMENT IS LOCATED AT HTTPS://WWW.DEACONESS.COM/ABOUT-US/COMMUNITY-HEALTH-NEEDS-ASSESSMENTCOPIES AND REQUESTS FOR COPIES WERE ALSO MADE AVAILABLE AT THE JUNE 2016 PRESS CONFERENCE. MEDIA AND COMMUNITY AND THE PUBLIC WERE INVITED TO ATTEND.
DEACONESS HOSPITAL, INC.	PART V, SECTION B, LINE 11: 1. BEHAVIORAL HEALTH: VANDERBURGH COUNTYA. ASSET MAPPINGASSET MAPPING REPORT WAS COMPLETED DURING FY16-17 AND INCLUDED IN THAT YEAR'S PROGRESS REPORT. PRESENTATION TO BEHAVIORAL HEALTH SUBCOMMITTEE TO SHARE FINDINGS FROM ASSET MAPPING PROCESS OCCURRED IN MAY 2018. FUNDING FOR A LOCAL, MORE IN-DEPTH SURVEY DIRECTLY RELATED TO BEHAVIORAL HEALTH WAS NOT SECURED. AN AUGUST 22ND MEETING REVIEWED FEEDBACK FROM THE ASSET MAPPING PRESENTATION TO THE SUBCOMMITTEE AND DETERMINED NEXT STEPS FOR THAT PART OF OUR ACTION PLAN.FOR YEAR 3 OF THE 2015 CHNA PLAN (JULY 1, 2018 TO JUNE 30, 2019), THE BEHAVIORAL HEALTH SUBCOMMITTEE WILL EXPLORE CREATION/IMPLEMENTATION OF THE FOLLOWING:-A SIMPLE TOOL TO HELP PEOPLE UNDERSTAND WHAT TYPE OF PROVIDER THEY NEED TO SEE.-A LIST OF ACTION ITEMS TO COMPLETE WHILE WAITING FOR A SCHEDULED APPOINTMENT (TO INCLUDE EMERGENCY CONTACT INFORMATION)B. YOUTH MENTAL HEALTH FIRST AIDSOUTHWEST INDIANA PROJECT AWARE SEEKS TO STRENGTHEN COMMUNITY CAPACITY TO ADDRESS ADOLESCENT MENTAL HEALTH NEEDS BY BOLSTERING COMMUNITY PARTNERSHIPS AND INCREASING THE NUMBER OF YOUTH-INTERACTING ADULTS IN VANDERBURGH COUNTY AND WARRICK COUNTY, INDIANA WHO ARE TRAINED IN YOUTH MENTAL HEALTH FIRST AID (YMHFA).THE EVANSVILLE-BASED GRANT STARTED SEPTEMBER 30, 2015. DATA FOR YEAR 3 OF THE GRANT, OCTOBER 2017 THROUGH SEPTEMBER 2018, SHOWS ALL 3 GOALS BEING MET - 270 YMHFA FIRST AIDERS TRAINED, 0 YMHFA TRAINERS TRAINED (GOAL PREVIOUSLY MET BY END OF YEAR TWO), AND 1,000 YOUTH REFERRED TO MENTAL HEALTH SERVICES, RESOURCES, OR SUPPORTS FROM THE FIRST AIDERS. C. SUBSTANCE ABUSE THE VANDERBURGH COUNTY HEALTH DEPARTMENT LEADS AN OPIOID FATALITY REVIEW COMMITTEE. THE DIVERSE GROUP OF ATTENDEES LOOKS AT CURRENT DATA TRENDS AND REVIEWS SPECIFIC LOCAL CASES THAT WERE "NEAR MISSES OR RULED AN OPIOID OVERDOSE.EVANSVILLE MAYOR LLOYD WINNECKE DIRECTED THE NO METH TASK FORCE TO EXPAND ITS MISSION AND FOCUS BEYOND JUST METH. THE GROUP RENAMED ITSELF THE MAYOR'S SUBSTANCE ABUSE TASK FORCE WITH A MISSION OF ENGAGING THE EVANSVILLE COMMUNITY IN WORKING TOGETHER TO PROMOTE SUBSTANCE ABUSE AWARENESS, EDUCATION, PREVENTION, AND TREATMENT. GOALS INCLUDE:1. HELP THE COMMUNITY ACKNOWLEDGE, UNDERSTAND, AND EFFECTIVELY ADDRESS THE PROBLEM OF SUBSTANCE ABUSE2. PROMOTE EFFECTIVE PREVENTION STRATEGIES AND PROGRAMS3. HELP PEOPLE ACCESS TREATMENT AND RECOVERY OPTIONSIN OCTOBER OF 2017, THE TASK FORCE HOSTED A C.R.A.F.T. TRAINING (COMMUNITY REINFORCEMENT AND FAMILY TRAINING) FOR ABOUT 40 MENTAL HEALTH PROFESSIONALS.THE GROUP IS ALSO EXPLORING THE FEASIBILITY OF PEER RECOVERY COACHES, LONG-TERM RECOVERY CENTERS, AND A WORKPLACE MESSAGING CAMPAIGN THAT COMPANIES CAN USE TO EDUCATE EMPLOYEES ABOUT SUBSTANCE USE, ABUSE, AND TREATMENT.THE WOMEN'S HOSPITAL PARTNERED WITH SOUTHWESTERN BEHAVIORAL HEALTH TO CREATE THE STEPPING FORWARD TRANSITIONAL RESIDENTIAL PROGRAM FOR PREGNANT WOMEN. THE GOAL IS TO REDUCE INCIDENCE AND IMPACT OF NEONATAL ABSTINENCE SYNDROME AND TO SUPPORT ONGOING RECOVERY POST PREGNANCY THROUGH THE SERVICES OF THIS PROGRAM.THIS YEAR, DEACONESS CROSS POINTE ADDED AN ADDITIONAL SUBSTANCE USE DISORDER PROGRAM CALLED MODIFIED MATRIX. THIS IS A DAYTIME, OUTPATIENT GROUP THERAPY PROGRAM FOR ADULTS THAT FOCUSES ON HELPING PEOPLE STRUGGLING WITH A VARIETY OF DRUG AND/OR ALCOHOL USE ISSUES. PARTICIPANTS LIVE AT HOME AND HAVE MORE INDEPENDENCE.EAP LIVE EMPLOYEE ASSISTANCE PROGRAM (EAP) PATIENTS CAN NOW CONNECT WITH A THERAPIST VIA TELEMEDICINE. DEACONESS CROSS POINTE IS THE TELEHEALTH PROVIDER OF PSYCHIATRIC ASSESSMENTS FOR -PERRY COUNTY MEMORIAL HOSPITAL (TELL CITY, IN) -GIBSON GENERAL HOSPITAL (PRINCETON, IN) -THE WOMEN'S HOSPITAL2. CHNA MATERNAL, FETAL, INFANT HEATH: VANDERBURGH COUNTYA. REDUCE INFANT MORTALITYWE WANT TO REDUCE MORTALITY BEFORE A BABY'S 1ST BIRTHDAY FROM THE 2010-2014 VANDERBURGH COUNTY AVERAGE OF 8.3 PER 1,000 LIVE BIRTHS TO THE HEALTHY PEOPLE 2020 GOAL OF 6.0/1000 LIVE BIRTHS.WE IDENTIFIED THE THREE LEADING CAUSES OF DEATH FOR BABIES IN OUR COUNTY - PRETERM BIRTH, BIRTH DEFECTS, AND SLEEP RELATED DEATHS. THE FETAL INFANT MORTALITY REVIEW COMMITTEE MEETS QUARTERLY TO DISCUSS ALL CASES OF INFANT DEATH INCLUDING THOSE CAUSED BY LOW BIRTH WEIGHT OR BEING BORN PRETERM.THANKS TO THE GREAT COMMUNITY EFFORT, VANDERBURGH COUNTY HAS SEEN A DECREASE IN THE INFANT MORTALITY RATE (IMR) OVER THE PAST FEW YEARS. THE IMR PEAKED AT 11.05/1,000 LIVE BIRTHS IN 2013, DECREASED TO 9.4/1,000 LIVE BIRTHS FOR 2014, 4.95/1,000 LIVE BIRTHS FOR 2015, AND INCREASED TO 6.2/1000 LIVE BIRTHS IN 2016. PRELIMINARY DATA FOR 2017 SHOWS 23 FETAL/INFANT DEATHS OUT OF 2,127 LIVE BIRTHS IN VANDERBURGH COUNTY. THAT MAKES THE INFANT MORTALITY RATE 10.8/1000 LIVE BIRTHS. (THIS RATE IS NOT CONFIRMED.)BABY AND ME TOBACCO FREE IS A PROGRAM THAT PROVIDES INCENTIVES TO PREGNANT WOMEN WHO QUIT SMOKING. THE GOAL IS TO KEEP WOMEN SMOKE FREE FOR AS LONG AS POSSIBLE BEFORE AND AFTER THEY GIVE BIRTH, AND TO ALSO HELP WOMEN GIVE BIRTH TO HEALTHY, FULL-TERM BABIES. 413 WOMEN WERE ENROLLED IN THE PROGRAM AT THE END OF THE 2018 GRANT YEAR - OCTOBER 1, 2017 TO SEPT 30, 2018. THERE WERE 161 BABIES BORN DURING THE 2018 GRANT YEAR.-149 BABIES BORN OVER 5.5 POUNDS-12 BABIES BORN UNDER 5.5 POUNDS-125 PARTNERS ENROLLED-7.5% LOW BIRTH WEIGHT RATE (MARCH OF DIMES GOAL FOR 2020 IS 8%)-93% DELIVERED BABIES WEIGHING OVER 5.5 POUNDS-95% DELIVERED OVER 37 GESTATIONAL WEEKSON MARCH 9, 2018, VANDERBURGH COUNTY HEALTH DEPARTMENT LAUNCHED PRE TO 3.PRE TO 3 IS A PROGRAM THAT PROVIDES LONG-TERM, CONSISTENT, HANDS-ON SUPPORT FOR BABIES AND FAMILIES. COMMUNITY HEALTH WORKERS VISIT CLIENTS IN THEIR HOME ONCE PER WEEK, EVERY WEEK, FROM THE TIME A WOMAN FINDS OUT SHE IS PREGNANT UNTIL HER BABY IS 3 YEARS OF AGE. DURING THESE VISITS, THE COMMUNITY HEALTH WORKER WILL GUIDE THE WOMAN AND HER FAMILY THROUGH A CURRICULUM CALLED "GROWING GREAT KIDS."MARCH - AUGUST 2018 -FAMILIES REACHED: 117 -PROGRAM BIRTHS: 16/16 FULL TERM AND 16/16 > 2,500 GRAMS -62% OF CLIENT MOTHERS RECEIVE WIC SERVICES -50% OF CLIENT CAREGIVERS REPORT HAVING A DIAGNOSED PSYCHOLOGICAL DISORDER -44% OF CLIENT MOTHERS ARE FIRST-TIME MOTHERS -19% OF CLIENT CAREGIVERS HAVE AN OPEN DCS CASE -16% OF CLIENT FAMILIES HAVE UNSTABLE HOUSINGTHE WOMEN'S HOSPITAL (TWH) PARTICIPATES IN SEVERAL PILOT AND QUALITY PROGRAMS RELATED TO PERINATAL SAFETY AND INFANT MORTALITY. TWH PERINATAL SUBSTANCE ABUSE COMMITTEE WORKS WITH COMMUNITY STAKEHOLDERS TO IDENTIFY AND FILL GAPS IN CARE. THANKS TO THIS COLLABORATION, TWH IS SCHEDULED TO HAVE A SURVEY NEXT FISCAL YEAR IN HOPES OF ACHIEVING LEVEL 3 REGIONAL PERINATAL CENTER STATUS.SUCCESS WITH OUR BABY-FRIENDLY INITIATIVE IS STARTING TO SHOW IN STATE REPORTS LIKE THE 2017 INDIANA NATALITY REPORT. BOTH VANDERBURGH AND WARRICK COUNTIES ARE LISTED AS "SIGNIFICANTLY HIGHER" FOR MOTHERS BREASTFEEDING AT DISCHARGE WHEN COMPARED TO THE REST OF THE STATE. B. CHILD ABUSETHE CHILD ABUSE AND NEGLECT RATE (THE RATE OF SUBSTANTIATED CASES OF CHILD ABUSE AND NEGLECT PER 1,000 CHILDREN YOUNGER THAN AGE 18) INCREASED SIGNIFICANTLY FROM 2016 TO 2017. 2015 RATE: 25.6/10002016 RATE: 24.8/10002017 RATE: 29.5/1000OUR LOCAL CHILD ABUSE TASK FORCE REVIEWED CASES OF 42 CHILDREN WITH SUSPECTED OR CONFIRMED ABUSE/NEGLECT DURING THE JULY 2017 THROUGH DECEMBER 2018 TIME PERIOD. ADDITIONALLY, THE CHILD FATALITY REVIEW COMMITTEE LOOKED AT 11 CASES OF CHILD DEATH OCCURRING BETWEEN JULY 2017 AND DECEMBER 2018.OUR WORK WITH SUBSTANCE ABUSE AND INFANT MORTALITY (DESCRIBED IN THIS REPORT) IS DIRECTLY RELATED TO ADDRESSING THIS INCREASE. 3. EXERCISE, NUTRITION, AND WEIGHT:A. PREDIABETESTHE GROUP WORKED TOGETHER TO STREAMLINE AND COORDINATE DIABETES CLASSES, GRANT PROJECTS, AND OTHER ACTIVITIES THROUGHOUT THE COMMUNITY. THE SUB-COMMITTEE DID NOT MEET IN FY17-18 BECAUSE COMMUNITY FOCUS SHIFTED TO SERIOUS SUBSTANCE ABUSE, INFANT DEATH, AND OPIOID OVERDOSES. (CONTINUED BELOW ON PART V)
DEACONESS GATEWAY HOSPITAL	PART V, SECTION B, LINE 11: HOW THE SIGNIFICANT NEEDS ARE BEING ADDRESSED IS REPORTED THE SAME AS DEACONESS HOSPITAL, INC. (HOSPITAL FACILITY #1).
DEACONESS CROSS POINTE	PART V, SECTION B, LINE 11: HOW THE SIGNIFICANT NEEDS ARE BEING ADDRESSED IS REPORTED THE SAME AS DEACONESS HOSPITAL, INC. (HOSPITAL FACILITY #1).
THE HEART HOSPITAL	PART V, SECTION B, LINE 11: HOW THE SIGNIFICANT NEEDS ARE BEING ADDRESSED IS REPORTED THE SAME AS DEACONESS HOSPITAL, INC. (HOSPITAL FACILITY #1).
DEACONESS HOSPITAL, INC.	PART V, SECTION B, LINE 15E: MED ASSIST IS AVAILABLE TO DEACONESS HEALTH SYSTEM PATIENTS TO ASSIST WITH APPLYING FOR MEDICAID OR EXCHANGE PRODUCTS.
DEACONESS GATEWAY HOSPITAL	PART V, SECTION B, LINE 15E: OTHER METHOD USED FOR APPLYING FOR FINANCIAL ASSISTANCE IS THE SAME AS DEACONESS HOSPITAL, INC. (HOSPITAL FACILITY #1).
DEACONESS CROSS POINTE	PART V, SECTION B, LINE 15E: OTHER METHOD USED FOR APPLYING FOR FINANCIAL ASSISTANCE IS THE SAME AS DEACONESS HOSPITAL, INC. (HOSPITAL FACILITY #1).
THE HEART HOSPITAL	PART V, SECTION B, LINE 15E: OTHER METHOD USED FOR APPLYING FOR FINANCIAL ASSISTANCE IS THE SAME AS DEACONESS HOSPITAL, INC. (HOSPITAL FACILITY #1).
DEACONESS HOSPITAL, INC.	PART V, SECTION B, LINE 16J: OTHER METHOD USED TO PUBLICIZE THE FINANCIAL ASSISTANCE POLICY: 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 FOR FISCAL YEAR 17 IMPACTED THE LIVES OF MORE THAN 9,400 MEMBERS OF OUR COMMUNITY BY HELPING THEM OBTAIN INSURANCE OR PROVIDE ASSISTANCE FOR THE UNDERINSURED.
DEACONESS GATEWAY HOSPITAL	PART V, SECTION B, LINE 16J: OTHER METHOD USED TO PUBLICIZE THE FINANCIAL ASSISTANCE POLICY IS REPORTED THE SAME AS DEACONESS HOSPITAL, INC. (HOSPITAL FACILITY #1).
DEACONESS CROSS POINTE	PART V, SECTION B, LINE 16J: OTHER METHOD USED TO PUBLICIZE THE FINANCIAL ASSISTANCE POLICY IS REPORTED THE SAME AS DEACONESS HOSPITAL, INC. (HOSPITAL FACILITY #1).
THE HEART HOSPITAL	PART V, SECTION B, LINE 16J: OTHER METHOD USED TO PUBLICIZE THE FINANCIAL ASSISTANCE POLICY IS REPORTED THE SAME AS DEACONESS HOSPITAL, INC. (HOSPITAL FACILITY #1).
PART V, SECTION B, LINE 16A, FAP WEBSITE:	THE FINANCIAL ASSISTANCE POLICY (FAP) FOR ALL FOUR HOSPITAL FACILITIES IS MADE WIDELY AVAILABLE ON THE FOLLOWING WEBSITE:HTTPS://WWW.DEACONESS.COM/FOR-YOU/PATIENTS-AND-VISITORS/PATIENTS/FINANCIAL-ASSISTANCE
PART V, SECTION B, LINE 16B, FAP APPLICATION WEBSITE:	THE FINANCIAL ASSISTANCE POLICY (FAP) APPLICATION FOR ALL FOUR HOSPITAL FACILITIES IS MADE WIDELY AVAILABLE ON THE FOLLOWING WEBSITE:HTTPS://WWW.DEACONESS.COM/FOR-YOU/PATIENTS-AND-VISITORS/PATIENTS/FINANCIAL-ASSISTANCE
PART V, SECTION B, LINE 16B, FAP PLAIN LANGUAGE SUMMARY WEBSITE:	THE FINANCIAL ASSISTANCE POLICY (FAP) PLAIN LANGUAGE SUMMARY FOR ALL FOUR HOSPITAL FACILITIES IS MADE WIDELY AVAILABLE ON THE FOLLOWING WEBSITE:HTTPS://WWW.DEACONESS.COM/FOR-YOU/PATIENTS-AND-VISITORS/PATIENTS/FINANCIAL-ASSISTANCE
PART V, SECTION B, LINE 11 CONTINUATION:	B. HEALTHY COMMUNITIES PARTNERSHIPDURING FY2017-18, HEALTHY COMMUNITIES PARTNERSHIP (HCP) NARROWED THE SCOPE OF ITS WORK TO FOCUS ON OBESITY. MORE SPECIFICALLY, THE GROUP SET A GOAL TO REDUCE CHILDHOOD OBESITY IN VANDERBURGH COUNTY 20% BY 2020. WHILE MANY LOCAL ORGANIZATIONS AND SERVICES PROVIDE EDUCATION ON DIET QUALITY AND EXERCISE, HCP FOCUSES ON IMPROVING HEALTH THROUGH POLICY, SYSTEMS, AND ENVIRONMENTAL CHANGES. FOUR STRATEGIC WORKGROUPS PROVIDE THE STRUCTURE. THEY ARE:1. COMMUNITY ENGAGEMENT WORKGROUP 2. PHYSICAL ACTIVITY WORKGROUP: -WROTE AND RECEIVED AN $8,500 GRANT FROM THE INDIANA STATE DEPARTMENT OF HEALTH TO BRING IN A NATIONAL COMPANY CALLED PLAYWORKS THAT SPECIALIZES IN YOUTH PHYSICAL ACTIVITY. TWENTY-SIX AFTERSCHOOL PROGRAM STAFF MEMBERS WERE TRAINED. -RECEIVED FUNDING FROM CARE SOURCE TO CREATE GREATER ACCESS TO PHYSICAL ACTIVITY OPPORTUNITIES. THE YMCA CALDWELL CENTER AND THE DREAM CENTER WERE BOTH GRANTED WITH PLAY EQUIPMENT OF THEIR CHOICE. -A SNICKERDOODLE ART ARTIST DESIGNED FRUIT AND VEGETABLE INSPIRED BLACKTOP GAMES FOR CHILDREN. HCP COMPLETED ONE PAINTED PLAY ZONE AT ST. MARK'S PRESCHOOL AND PLANS TO COMPLETE THREE MORE IN 2019.3. POLICY WORKGROUP: CONCENTRATED ON A SCREEN TIME AWARENESS CAMPAIGN TO ASSIST PARENTS UNDERSTANDING REGARDING SCREEN TIME AND THE IMPACT TO THEIR CHILDREN. THE GROUP WORKED CLOSELY WITH 4CS OF SOUTHERN INDIANA TO DISSEMINATE SCREEN TIME INFORMATION.4. HEALTHY EATING WORKGROUP:-LAUNCHED A CONCESSION STAND PILOT PROJECT WITH THE EVSC ATHLETIC DEPARTMENT DURING THE 2018 SOCCER SEASON.-PARTNERED WITH LARKINS PRODUCE TO OFFER A POP-UP PRODUCE STAND EVERY TUESDAY NEAR THE LOCAL HEALTH DEPARTMENT.-PARTNERED WITH URBAN SEEDS TO ADMINISTER SNAP BENEFITS AT BOTH THE DOWNTOWN FARMER'S MARKET AND THE FRANKLIN STREET BAZAAR.3. CANCER (BREAST AND PROSTATE): WARRICK COUNTYA. BREAST CANCERTHE GOAL FOR YEAR 2 OF THE CHNA IMPLEMENTATION PLAN INVOLVED INCREASING SCREENING MAMMOGRAMS AND COMMUNITY EDUCATION REGARDING MAMMOGRAMS. THE SUBCOMMITTEE PUT FORTH GREAT EFFORTS TO CREATE A COMMUNITY PRESENTATION AND THEN CONTACT CHURCHES, SCHOOLS, AND COMMUNITY GROUPS IN WARRICK COUNTY TO MAKE THEM AWARE OF THE AVAILABLE PRESENTATION. DESPITE ALL LETTERS AND PHONE CALLS, THERE WAS MINIMAL RESPONSE TO OUR OFFER TO PRESENT BREAST HEALTH EDUCATION PROGRAM TO GROUPS.MEMBERS OF THE SUBCOMMITTEE ALSO REACHED OUT TO LOCAL FESTIVAL ORGANIZERS AND BUSINESS OWNERS WITH A GOAL OF CREATING SCREENING EVENTS FOR THE PUBLIC. DESPITE TARGETING AREAS OF GREAT NEED, THE COMMITTEE RECEIVED MINIMAL OR NO RESPONSE TO SET UP A SCREENING EVENT.B. PROSTATE CANCERTHE GOAL FOR YEAR 2 OF THE CHNA IMPLEMENTATION PLAN INVOLVED INCREASING PROSTATE CANCER SCREENINGS AND COMMUNITY EDUCATION REGARDING CURRENT SCREENING GUIDELINES. THE SUBCOMMITTEE PUT FORTH GREAT EFFORTS TO CREATE A COMMUNITY PRESENTATION AND THEN CONTACT CHURCHES, SCHOOLS, AND COMMUNITY GROUPS IN WARRICK COUNTY TO MAKE THEM AWARE OF THE AVAILABLE PRESENTATION. DESPITE ALL LETTERS AND PHONE CALLS, THERE WAS MINIMAL RESPONSE TO OUR OFFER TO PRESENT A PROSTATE CANCER EDUCATION PROGRAM TO GROUPS.C. PUBLIC SERVICE ANNOUNCEMENT AND NEWS STORYEYEWITNESS NEWS CREATED A PUBLIC SERVICE ANNOUNCEMENT FOR RADIO AND IT AIRED THROUGHOUT THE MONTH OF JULY 2018 ON VARIOUS RADIO STATIONS. THE SAME NEWS STATION ALSO DID A STORY ABOUT THE HIGH RATE OF BREAST CANCER DEATHS IN WARRICK COUNTY. IT AIRED ON JULY 25, 2018 AND IS ON THE TRISTATEHOMEPAGE.COM WEBSITE. JACI BURGDORF FROM DEACONESS AND MARK CRUMMLEY FROM ST. VINCENT EVANSVILLE WERE LIVE ON THE 4PM NEWS ON JULY 25. THEY DISCUSSED THE HIGH RATES OF DEATH DUE TO PROSTATE CANCER AND PROMOTED EDUCATION THAT IS AVAILABLE TO COMMUNITY GROUPS.D. FREE EDUCATION AND CANCER SCREENINGS AT DEACONESSDURING THE FISCAL YEAR, DEACONESS PHYSICIANS, ADVANCED PRACTICE PROVIDERS, AND SOCIAL WORKERS CONDUCTED 8 CANCER-RELATED COMMUNITY PRESENTATIONS. THERE WERE 7 ADDITIONAL BLOGS AND/OR VIDEOS CREATED AND PUBLICLY DISTRIBUTED. ONCOLOGY SPECIALISTS PARTICIPATED IN 6 FACEBOOK LUNCH AND LEARNS.PHYSICIANS FROM ENT, DERMATOLOGY, AND ONCOLOGY PROVIDED FREE CANCER SCREENINGS WITH THE FOLLOWING RESULTS: -LOW DOSE CT SCAN FOR LUNG CANCER - 7 NEWLY-DIAGNOSED LUNG CANCERS AND 31 ABNORMAL SCREENINGS REQUIRING ADDITIONAL FOLLOW-UP (IMAGING, TISSUE SAMPLING, ETC.)-SKIN CANCER SCREENING - 62 NORMAL SCREENINGS WITH 22 PATIENTS RECOMMENDED FOR FOLLOW-UP WITH A DERMATOLOGIST-HEAD AND NECK CANCER SCREENING - NORMAL EXAM FOR 44 PATIENTS WITH 25 RECOMMENDED FOR FOLLOW-UP WITH A PRIMARY CARE PHYSICIAN OR ENTOTHER SIGNIFICANT COMMUNITY HEALTH NEEDSAS PART OF THE COMMUNITY HEALTH NEEDS ASSESSMENT PROCESS, THE PRIMARY AND SECONDARY DATA ANALYSIS IDENTIFIED ADDITIONAL SIGNIFICANT COMMUNITY HEALTH NEEDS. -ACCESS TO HEALTH SERVICES -DIABETES -IMMUNIZATIONS & INFECTIOUS DISEASES -PREVENTION & SAFETY -SOCIAL ENVIRONMENTTHESE NEEDS WERE NOT SELECTED AS ONE OF OUR PRIORITIES FOR THE CHNA FOR THE FOLLOWING REASONS:-ACCESS TO HEALTH SERVICES - EACH HOSPITAL HAS ITS OWN PLAN FOR INCREASING ACCESS TO SERVICES. THIS INCLUDES PHYSICIAN RECRUITMENT STRATEGIES, ADDING NEW SERVICES OR FACILITIES, AND ENHANCING TECHNOLOGY. WE ALL WORK WITH THE INDIANA HOSPITAL ASSOCIATION AND THE AMERICAN HOSPITAL ASSOCIATION TO FOLLOW GUIDELINES AND PROTOCOLS FOR SUCCESSFUL TRANSITION INTO THE NEW VALUE-BASED HEALTH CARE DELIVERY MODEL. BECAUSE A LOT OF THIS WORK INVOLVES PROPRIETARY BUSINESS INFORMATION, WE DID NOT CHOOSE IT AS A FOCUS FOR OUR COLLABORATIVE.-DIABETES - THE COMMUNITY HAS SEVERAL SUCCESSFUL DIABETES PROGRAMS IN THE INPATIENT AND OUTPATIENT ENVIRONMENT. AS A GROUP, WE DECIDED TO FOCUS OUR EFFORTS ON THE LARGE NUMBER OF PEOPLE WITH "PRE-DIABETES" INSTEAD OF THOSE ALREADY DIAGNOSED WITH PRIMARILY TYPE 2 DIABETES. PREVENTION WILL YIELD GREATER RESULTS AND BETTER HEALTH IN THE FUTURE. -IMMUNIZATIONS AND INFECTIOUS DISEASE - THE VANDERBURGH COUNTY HEALTH DEPARTMENT RECEIVED STATE GRANT FUNDS TO INCREASE IMMUNIZATION COMPLIANCE IN PEDIATRIC AND ADULT POPULATIONS. THE HOSPITALS AND CLINICS IN OUR COLLABORATIVE ALSO PARTICIPATE IN THE HEALTH DEPARTMENT'S IMMUNIZATION INITIATIVES. MAKING THIS A PRIORITY FOR THE GROUP WOULD BE A DUPLICATION OF EFFORT AND PREVENT US FROM ADDRESSING ANOTHER COMMUNITY HEALTH NEED. -PREVENTION AND SAFETY - BOTH PARTICIPATING HOSPITALS AND THE HEALTH DEPARTMENT ACTIVELY PROMOTE SAFETY AND HAVE DEDICATED TRAUMA TEAMS WHO PROVIDE EDUCATION IN THE REGION. WE WORK TOGETHER ON MAJOR INITIATIVES SUCH AS ATV SAFETY AND SAFE SLEEP FOR INFANTS. SELECTING THIS AS A CHNA PRIORITY TOPIC WOULD AGAIN BE A DUPLICATION OF EFFORT AND KEEP US FROM TACKLING ANOTHER ISSUE. -SOCIAL ENVIRONMENT - SINGLE PARENT HOUSEHOLDS AND CHILD ABUSE RATES FALL INTO THE SOCIAL ENVIRONMENT CATEGORY. WE CHOSE TO TAKE THOSE TWO ELEMENTS AND PLACE THEM IN OUR MATERNAL, FETAL, INFANT AND CHILDREN'S HEALTH TOPIC AREA.

Schedule H (Form 990) 2019

Page 9

Part VFacility Information (continued)

Section D. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility (list in order of size, from largest to smallest) How many non-hospital health care facilities did the organization operate during the tax year?36
Name and address		Type of Facility (describe)
1	1 - DEACONESS PROCEDURE CENTER 421 CHESTNUT STREET EVANSVILLE,IN47713	OUTPATIENT SERVICES
2	2 - DEACONESS HOSPITAL PHYSICAL MEDICINE 520 MARY STREET SUITE 280 EVANSVILLE,IN47747	OUTPATIENT SERVICES
3	3 - DEACONESS CLINIC GATEWAY REG LAB 4233 GATEWAY BLVD NEWBURGH,IN47630	DIAGNOSTIC CENTER
4	4 - DEACONESS COMPREHENSIVE PAIN CTR & PROG 4600 W LLOYD EXPRESSWAY EVANSVILLE,IN47712	OUTPATIENT SERVICES
5	5 - DEACONESS HOSPITAL INFUSION SVCS 421 CHESTNUT STREET EVANSVILLE,IN47713	OUTPATIENT SERVICES
6	6 - DEACONESS HOSPITAL PHYSICAL MEDICINE 10455 ORTHOPAEDIC DRIVE NEWBURGH,IN47630	OUTPATIENT SERVICES
7	7 - DEACONESS COMPREHENSIVE PAIN CTR-GATEWAY 4099 GATEWAY BLVD NEWBURGH,IN47630	OUTPATIENT SERVICES
8	8 - CHANCELLOR CENTER FOR ONCOLOGY 4055 GATEWAY BLVD NEWBURGH,IN47630	OUTPATIENT SERVICES
9	9 - DEACONESS SLEEP LAB 350 W COLUMBIA STREET SUITE 210 EVANSVILLE,IN47710	OUTPATIENT SERVICES
10	10 - DEACONESS SLEEP LAB 350 W COLUMBIA STREET SUITE LL-10 EVANSVILLE,IN47710	DIAGNOSTIC CENTER
11	11 - DEACONESS HOSPITAL BREAST CENTER 520 MARY STREET SUITE 140 EVANSVILLE,IN47710	DIAGNOSTIC CENTER
12	12 - DEACONESS CLINIC WEST REG LAB RADIOLOGY 545 S BOEHNE CAMP ROAD EVANSVILLE,IN47712	OUTPATIENT PHYSICIAN CLINIC
13	13 - DEACONESS CLINIC PRINCETON RADIOLOGY SRV 685 VAIL STREET PRINCETON,IN47670	OUTPATIENT PHYSICIAN CLINIC
14	14 - DEACONESS WOUND CARE CENTER 350 W COLUMBIA STREET SUITE 350 EVANSVILLE,IN47710	OUTPATIENT SERVICES
15	15 - DEACONESS ANTICOAGULATION CLINIC 4107 GATEWAY BLVD NEWBURGH,IN47630	OUTPATIENT SERVICES
16	16 - MT VERNON MEDICAL CENTER LAB & RADIOLOGY 1900 W FOURTH STREET MT VERNON,IN47620	DIAGNOSTIC CENTER
17	17 - MIDWEST RADIOLOGIC IMAGING 10455 ORTHOPAEDIC DRIVE NEWBURGH,IN47630	DIAGNOSTIC CENTER
18	18 - MIDWEST RADIOLOGICAL IMAGING 4087 GATEWAY BLVD NEWBURGH,IN47630	DIAGNOSTIC CENTER
19	19 - DEACONESS REGIONAL LABORATORY 4133 GATEWAY BLVD SUITE 110 NEWBURGH,IN47630	DIAGNOSTIC CENTER
20	20 - DEACONESS PRIMARY CARE FOR SENIORS 4498 FIRST AVENUE EVANSVILLE,IN47710	OUTPATIENT PHYSICIAN CLINIC
21	21 - DEACONESS PRIMARY CARE FOR SENIORS 1750 OAK HILL ROAD EVANSVILLE,IN47710	OUTPATIENT PHYSICIAN CLINIC
22	22 - DEACONESS DIABETES CENTER - EDUCATION 421 CHESTNUT STREET EVANSVILLE,IN47713	OUTPATIENT SERVICES
23	23 - DEACONESS PRE-ADMISSION TESTING 520 MARY STREET SUITE 330 EVANSVILLE,IN47747	DIAGNOSTIC CENTER
24	24 - DEACONESS WEIGHT LOSS SOLUTIONS 310 W IOWA STREET EVANSVILLE,IN47710	OUTPATIENT PHYSICIAN CLINIC
25	25 - DEACONESS HOSPITAL MAMMOGRAPHY & IMAGING 421 CHESTNUT STREET EVANSVILLE,IN47713	DIAGNOSTIC CENTER
26	26 - DEACONESS REGIONAL LABORATORY 4494 N FIRST AVENUE EVANSVILLE,IN47710	DIAGNOSTIC CENTER
27	27 - DEACONESS REGIONAL LABORATORY 421 CHESNUT STREET EVANSVILLE,IN47713	DIAGNOSTIC CENTER
28	28 - DEACONESS REGIONAL LABORATORY 1204 W WILLIAMS STREET OAKLAND CITY,IN47660	DIAGNOSTIC CENTER
29	29 - DEACONESS CROSS POINTE OUTPATIENT CLINIC 445 CROSS POINTE BLVD EVANSVILLE,IN47715	OUTPATIENT PHYSICIAN CLINIC
30	30 - DEACONESS RADIOLOGY LAB & RADIOLOGY 8600 NORTH KENTUCKY AVENUE EVANSVILLE,IN47725	DIAGNOSTIC CENTER
31	31 - DEACONESS FAMILY MEDICINE RESIDENCY 415 W COLUMBIA ST SUITE 110 EVANSVILLE,IN47710	OUTPATIENT PHYSICIAN CLINIC
32	32 - DEACONESS SLEEP CENTER-EAST 7307 E COLUMBIA ST EVANSVILLE,IN47715	DIAGNOSTIC CENTER
33	33 - DEACONESS HOSPITAL PHYSICAL MEDICINE 4600 W LLOYD EXPRESSWAY SUITE B EVANSVILLE,IN47715	OUTPATIENT SERVICES
34	34 - DEACONESS GATEWAY GASTROENTEROLOGY 4133 GATEWAY BLVD SUITE 290 NEWBURGH,IN47630	OUTPATIENT SERVICES
35	35 - DEACONESS RILEY CHILDRENS SPECIALTY CENT 4133 GATEWAT BLVD SUITE 220 NEWBURGH,IN47630	OUTPATIENT SERVICES
36	36 - DEACONESS SLEEP CENTER 350 W COLUMBIA STREET SUITE 210 EVANSVILLE,IN47710	OUTPATIENT SERVICES

Schedule H (Form 990) 2019

Page 10

Part VI

Supplemental Information

Provide the following information.

1	Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II and Part III, lines 2, 3, 4, 8 and 9b.
2	Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any CHNAs reported in Part V, Section B.
3	Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4	Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5	Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6	Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7	State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.

Form and Line Reference	Explanation
PART I, LINE 6A:	DEACONESS HOSPITAL PREPARES AN ANNUAL COMMUNITY BENEFIT REPORT. THE REPORT IS MADE AVAILABLE IN THE FOLLOWING WAYS:1. MAILED TO ALL THE MAJOR EMPLOYERS IN THE TRI-STATE AREA.2. AN ADVERTISEMENT IS PLACED IN THE SUNDAY PAPER OF THE EVANSVILLE COURIER AND PRESS.3. IS MADE AVAILABLE ON THE DEACONESS WEBSITE AT HTTPS://WWW.DEACONESS.COM/ABOUT-US/COMMUNITY-HEALTH-NEEDS-ASSESSMENT
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 $207,398. THESE CLINICS ARE OPERATED AS A BENEFIT TO THE COMMUNITY.
PART I, LN 7 COL(F):	THE BAD DEBT EXPENSE IS NOT INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A) DUE TO EARLY ADOPTION OF ACCOUNTING STANDARDS UPDATE (ASU) 2011-07, HEALTHCARE ENTITIES (TOPIC 954).
PART II, COMMUNITY BUILDING ACTIVITIES:	1. POPULATION HEALTH:DEACONESS DEVELOPED AND MANAGES THE ONLY COMPREHENSIVE POPULATION HEALTH INITIATIVE IN THE REGION. CURRENT HOSPITAL PARTNERS INCLUDE METHODIST HOSPITAL (KY), GIBSON GENERAL HOSPITAL, GOOD SAMARITAN HOSPITAL, MEMORIAL HOSPITAL AND HEALTH CARE CENTER, WABASH GENERAL HOSPITAL, FAIRFIELD MEMORIAL HOSPITAL, AND FERRELL HOSPITAL FOUNDATION.FOR THE SECOND YEAR IN A ROW, DEACONESS HEALTH SYSTEM'S NEXT GENERATION ACCOUNTABLE CARE ORGANIZATION (ACO), DEACONESS CARE INTEGRATION (DCI), HAS BEEN RANKED BY THE CENTERS FOR MEDICARE AND MEDICAID SERVICES (CMS) AS ONE OF THE TOP-PERFORMING NEXT GENERATION ACOS IN THE U.S. AS ANNOUNCED BY CMS ON DECEMBER 21, 2018, DCI GENERATED MORE THAN $16 MILLION IN SAVINGS TO MEDICARE DURING THE 2017 PERFORMANCE YEAR, WHICH RANKS DCI AS THE SECOND-BEST PERFORMING NEXT GENERATION ACO OUT OF 44 NEXT GENERATION ACOS IN TERMS OF EARNED SHARED SAVINGS IN 2017.IN ADDITION TO THESE SAVINGS, DCI ACHIEVED AN IMPRESSIVE CARE QUALITY SCORE OF 92.83% AND RANKED #10 ACROSS ALL NEXT GENERATION ACOS IN THE CATEGORY OF SAVINGS AS PERCENTAGE OF BENCHMARK. THESE RESULTS REFLECT DCI'S CONTINUED FOCUS ON DELIVERING HIGH-QUALITY CARE WHILE REDUCING UNNECESSARY HEALTH CARE COSTS FOR PATIENTS. SEVERAL DRIVERS CONTRIBUTED TO THESE CLINICAL AND FINANCIAL OUTCOMES, INCLUDING DCI'S EMPHASIS ON COORDINATING CARE TO HELP ENSURE PATIENTS, ESPECIALLY THE CHRONICALLY ILL OR THOSE WHO ARE HOSPITALIZED, GET THE RIGHT CARE AT THE RIGHT TIME, AND AVOID UNNEEDED DUPLICATION OF SERVICES. 2. HEALTH FAIRS/SCREENINGS: APPROXIMATELY 16,000 PEOPLE WERE SERVED WITH EDUCATION AND/OR HEALTH SCREENINGS AT THE 56 HEALTH FAIRS DEACONESS ATTENDED AS A PROVIDER/EXHIBITOR DURING THE FISCAL YEAR.-HOMELESS CONNECT AND COMMUNITY FIRST HEALTH FAIRDEACONESS CONTINUED TO PROVIDE ON-SITE SERVICES AT TWO COMMUNITY EVENTS INTENDED TO INCREASE ACCESS TO HEALTH CARE FOR THE HOMELESS, NEAR HOMELESS, AND THOSE LIVING IN POVERTY. SERVICES INCLUDE BLOOD PRESSURE CHECKS, BLOOD SUGAR SCREENINGS, PROSTATE CHECKS (DRE AND BLOOD TEST), MAMMOGRAMS, IMMUNIZATIONS, PAP SMEARS, HPV SCREENINGS, COLON CANCER FOBT KITS, AND CONNECTING PEOPLE WITH NEEDED SERVICES. -MOBILE BREAST CENTERTHE 40 FT. COACH TRAVELLED THROUGHOUT THE TRI-STATE AREA PROVIDING MAMMOGRAMS TO WOMEN WHERE THEY LIVE AND WORK. GRANT DOLLARS ARE AVAILABLE FOR IMMEDIATE USE FOR WOMEN WITH NO OR INADEQUATE INSURANCE NEEDING A MAMMOGRAM. FOR THE FISCAL YEAR, 10 GRANT-FUNDED MAMMOGRAMS WERE PERFORMED ON THE MOBILE UNIT.EVENT MONTH NUMBER SCREENEDON-SITE MAMMOGRAMS JANUARY 2018 148ON-SITE MAMMOGRAMS FEBRUARY 2018 183ON-SITE MAMMOGRAMS MARCH 2018 232ON-SITE MAMMOGRAMS APRIL 2018 245ON-SITE MAMMOGRAMS MAY 2018 291ON-SITE MAMMOGRAMS JUNE 2018 215ON-SITE MAMMOGRAMS JULY 2018 224ON-SITE MAMMOGRAMS AUGUST 2018 205ON-SITE MAMMOGRAMS SEPTEMBER 2018 247ON-SITE MAMMOGRAMS OCTOBER 2018 323ON-SITE MAMMOGRAMS NOVEMBER 2018 173ON-SITE MAMMOGRAMS DECEMBER 2018 1422,628 TOTAL3. PATIENT CARE: -MEDICATION ASSISTANCE AND FAMILY MEDICINE RESIDENCY CLINICDEACONESS ALSO PROVIDES FREE AND REDUCED CARE WITHIN OUR HOSPITAL BUILDINGS. THROUGH OUR MEDICATION ASSISTANCE PROGRAM AND OUR FAMILY PRACTICE RESIDENCY CLINIC, PATIENTS CAN ACCESS THE HIGH QUALITY HEALTH CARE THEY NEED IN CONVENIENT LOCATIONS AND AT A PRICE THEY CAN AFFORD. FINANCIAL INFORMATION RELATED TO THESE SERVICES APPEARS IN A DIFFERENT SECTION OF THIS FORM.-NEW HEALTH CARE SERVICES, LOCATIONS, AND PROVIDERS DEACONESS CLINIC OPENED OR IMPLEMENTED THE FOLLOWING LOCATIONS/SERVICES DURING FY17-18 TO MAKE ACCESSING CARE EASIER FOR PATIENTS WHO LIVE OUTSIDE OF THE EVANSVILLE CITY LIMITS. -GATEWAY MEDICAL OFFICE BUILDING 2 - OCTOBER 2017 -DEACONESS CLINIC EXPRESS WEST - OCTOBER 2017 -DEACONESS CLINIC AT WORK; FIRST GROUP: WARRICK COUNTY SCHOOL CORP - MARCH 2018 -ORTHO NEURO SPECIALTY SERVICES INSIDE THE ORTHOPEDIC AND NEUROSCIENCE HOSPITAL - MAY 2018 -GIBSON GENERAL DEACONESS CLINIC EXPRESS PRINCETON MAY 2018 -DEACONESS CLINIC EXPRESS MT. PLEASANT - MAY 2018 -DEACONESS CLINIC BOONVILLE SEPTEMBER 2018AT THE END OF FY 17-18, DEACONESS CLINIC EMPLOYED 261 PROVIDERS: 142 PHYSICIANS AND 119 ADVANCED PRACTICE PROVIDERS (APPS).4. EDUCATION:-DEACONESS TRAUMA SERVICES PROVIDED STOP THE BLEED TRAINING TO APPROXIMATELY 1,500 PEOPLE AT AREA SCHOOLS, CHURCHES, LIBRARIES, VOLUNTEER FIRE STATIONS, CITY OF EVANSVILLE DEPARTMENTS, POLICE STATIONS, AND BUSINESSES. OUR COMMUNITY ATV SAFETY PROGRAM FEATURING SAFETY SAM WAS PRESENTED TO MORE THAN 4,400 STUDENTS AND FAMILIES. -DEACONESS DEDICATED 526 STAFF HOURS TO EMS AND FIRST RESPONDER EDUCATION. THIS INCLUDES INSTRUCTION FOR MORE THAN 3,000 PEOPLE RELATED TO TOPICS SUCH AS ADMINISTERING NARCAN FOR OPIOID OVERDOSE, PRE-HOSPITAL TRAINING, STOP THE BLEED EDUCATION, ADVANCED CARDIAC LIFE SUPPORT (ACLS) AND PEDIATRIC ADVANCED LIFE SUPPORT (PALS) TRAINING, AND SUPPORTING RELATIONSHIPS WITH TRI-STATE EMS GROUPS, ESPECIALLY THOSE IN RURAL AREAS.-HEALTH SCIENCE INSTITUTE - DURING THE FISCAL YEAR, WE HELD THE 28TH ANNUAL HEALTH SCIENCE INSTITUTE (HSI), A HANDS-ON SUMMER PROGRAM FOR HIGH SCHOOL STUDENTS INTERESTED IN THE MEDICAL PROFESSION. THE STUDENTS SPEND TWO WEEKS LIVING IN DORM-STYLE HOUSING AT THE HOSPITAL WHILE LEARNING ABOUT ALL FACETS OF PATIENT CARE. THE TUITION PAID BY STUDENTS FOR THE ANNUAL INSTITUTE EQUALS APPROXIMATELY $16,000; HOWEVER, THE COST OF RUNNING THE TWO-WEEK PROGRAM IS CLOSER TO $70,000. DEACONESS CONTINUES TO OFFER HSI AT AN AVERAGE LOSS OF $50,000 EACH YEAR BECAUSE WE CONSIDER THE EXPENDITURE AN IMPORTANT INVESTMENT IN THE FUTURE OF MEDICINE.-SUICIDE PREVENTION - STAFF FROM DEACONESS CROSS POINTE SPENT APPROXIMATELY 1,300 HOURS EDUCATING THE SURROUNDING COMMUNITY ABOUT SUICIDE PREVENTION AND RELATED SUBJECTS.-FACEBOOK AND BLOGS - WE FACILITATED 33 FACEBOOK LUNCH AND LEARN SESSIONS WITH PHYSICIANS AND PROVIDERS. THESE SESSIONS DEDICATE ONE HOUR TO A SPECIFIC HEALTH TOPIC AND PROVIDE THE OPPORTUNITY FOR PEOPLE TO ENGAGE IN REAL TIME WITH SUBJECT-MATTER EXPERTS. (REACH -100,000) THE FACEBOOK LUNCH AND LEARNS WERE REPURPOSED TO CREATE 44 BLOGS FOR OUR WEBSITE.-HEARTSAVER PROGRAM - THE HEART HOSPITAL AND DEACONESS FOUNDATION, THRU A PROGRAM CALLED HEARTSAVER, CONTINUE TO COLLABORATE ON INSTALLING AUTOMATED EXTERNAL DEFIBRILLATORS (AEDS) IN TRI-STATE SCHOOLS, FIRST RESPONDER VEHICLES, CHURCHES, ORGANIZATIONS, AND COMMUNITY GATHERING FACILITIES. AS OF SEPTEMBER 30, 2018, THE HEARTSAVER COMMITTEE HAS RAISED ENOUGH MONEY AND PLACED 223 AEDS.-LOCAL SPONSORSHIPS - IN FY17-18, DEACONESS SPONSORED PROGRAMS AND ACTIVITIES FOR APPROXIMATELY 150 REGIONAL ORGANIZATIONS, CONTRIBUTING MORE THAN $1.2 MILLION IN SUPPORT OF CLUBS, GROUPS, SOCIAL SERVICE ORGANIZATIONS, AND OTHERS STRIVING TO MAKE OUR COMMUNITY A BETTER PLACE.
PART III, LINE 4:	THE FOOTNOTE DESCRIBING BAD DEBT EXPENSES IS INCLUDED IN THE ATTACHED AUDITED FINANCIAL STATEMENTS UNDER FOOTNOTE "CHARITY CARE, COMMUNITY BENEFIT AND ASSISTANCE TO THE UNINSURED" STARTING ON PAGE 11 AND "PATIENT ACCOUNTS RECEIVABLE AND NET PATIENT SERVICE REVENUE" STARTING ON PAGE 12.
PART III, LINE 8:	THE SOURCE USED TO DETERMINE THE AMOUNT OF MEDICARE REVENUE AND ALLOWABLE COSTS REPORTED FOR PART III, SECTION B, LINE 8: THE MEDICARE TOTAL REVENUE AND ALLOWABLE COSTS WERE ACTUAL BASED UPON THE 2017 MEDICARE COST REPORT. 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 DISTINCTION 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.
PART VI, LINE 2:	NEEDS ASSESSMENT PROCESS: IN ADDITION TO THE CHNA REPORTED IN PART V, SECTION B DEACONESS UTILIZES A VARIETY OF SOURCES TO GATHER DATA ON LOCAL HEALTH CARE NEEDS. WE USE DATA FROM THE UNITED WAY OF SOUTHWESTERN INDIANA'S COMPREHENSIVE NEEDS ASSESSMENT, COUNTY HEALTH RANKINGS WEBSITE, INDIANA STATE DEPARTMENT OF HEALTH, CENTERS FOR DISEASE CONTROL AND PREVENTION, NATIONAL CENTER FOR HEALTH STATISTICS, AND THE U.S. CENSUS BUREAU. ADDITIONAL INFORMATION COMES FROM OUR OWN ELECTRONIC MEDICAL RECORD SYSTEM AND THROUGH OUR INTERACTION WITH LOCAL SERVICE PROVIDERS AND OTHER NON-PROFIT ORGANIZATIONS.
PART VI, LINE 3:	PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE: 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 FINANCIAL 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. HTTPS://WWW.DEACONESS.COM/FOR-YOU/PATIENTS-AND-VISITORS/PATIENTS/FINANCIAL-ASSISTANCE
PART VI, LINE 4:	DEACONESS DEFINES ITS COMMUNITY AS ALL PEOPLE LIVING IN VANDERBURGH AND WARRICK COUNTIES AT ANY TIME DURING THE YEAR.VANDERBURGH COUNTY - ACCORDING TO THE 2018 COUNTY HEALTH RANKINGS, VANDERBURGH COUNTY RANKS 80TH OUT OF 92 INDIANA COUNTIES FOR HEALTH OUTCOMES. VANDERBURGH COUNTY'S POPULATION IS SIMILAR TO THE STATEWIDE POPULATION, WITH 84% OF THE POPULATION BEING WHITE, 9.4% BLACK/AFRICAN AMERICAN, 1.4% ASIAN, AND THE REMAINDER BEING OF OTHER OR 2 OR MORE RACES. HOWEVER, VANDERBURGH COUNTY REPORTS A 2.6% HISPANIC POPULATION COMPARED TO 6.8% FOR THE STATE. VANDERBURGH COUNTY IS ALSO ONE OF THE MORE URBAN AREAS WITH A 9.2% RURAL RATING COMPARED TO THE INDIANA AVERAGE OF 27.6%. INSTANCES OF VIOLENT CRIME, INJURY DEATHS, SEXUALLY TRANSMITTED INFECTIONS, AND CHILDREN LIVING IN POVERTY ARE HIGHER IN VANDERBURGH COUNTY THAN THE INDIANA AVERAGE. THIS INFORMATION MATCHES OUR CHNA DATA.WARRICK COUNTY - CONVERSELY, WARRICK COUNTY RANKS 12TH OUT OF 92 INDIANA COUNTIES FOR 2018 HEALTH OUTCOMES. INCIDENTS OF VIOLENT CRIME, INJURY DEATHS, SEXUALLY TRANSMITTED INFECTIONS, AND CHILDREN LIVING IN POVERTY ARE SIGNIFICANTLY LOWER THAN THE STATE AVERAGE. WARRICK COUNTY HAS LESS DIVERSITY THAN VANDERBURGH COUNTY AND THE STATE OF INDIANA. NEARLY 93% OF PEOPLE THERE IDENTIFY AS WHITE COMPARED TO 80% FOR INDIANA. ONLY 1.5 % OF THE POPULATION IS LISTED AS BLACK/AFRICAN AMERICAN AND 1.8% AS HISPANIC. THAT'S COMPARED TO STATE AVERAGES OF 9.3% AND 6.7% RESPECTIVELY. WARRICK COUNTY IS ALSO MORE RURAL THAN THE AVERAGE INDIANA COUNTY (29.3% RURAL IN WARRICK COUNTY COMPARED TO 27.6% STATE AVERAGE).
PART VI, LINE 5:	OTHER IMPORTANT COMMUNITY HEALTH PROMOTION: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 6:	AFFILIATED HEALTH CARE SYSTEM:DEACONESS HOSPITAL WORKS IN CONCERT WITH DEACONESS HEALTH SYSTEM, DEACONESS CLINIC AND DEACONESS SPECIALTY PHYSICIANS 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.PART VI, LINE 7, LIST OF STATES RECEIVING COMMUNITY BENEFIT REPORT: INDIANA

Schedule H (Form 990) 2019

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Schedule I
(Form 990)

Department of the Treasury
Internal Revenue Service

Grants and Other Assistance to Organizations,
Governments and Individuals in the United States

Complete if the organization answered "Yes," on Form 990, Part IV, line 21 or 22.
lBullet

Attach to Form 990.
lBullet

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2019

Open to Public
Inspection

Name of the organization
DEACONESS HOSPITAL INC

Employer identification number
35-0593390

Part I

General Information on Grants and Assistance

Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ........................

Yes No

Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.

Part II

Grants and Other Assistance to Domestic Organizations and Domestic Governments. Complete if the organization answered "Yes" on Form 990, Part IV, line 21, for any recipient

that received more than $5,000. Part II can be duplicated if additional space is needed.

(a) Name and address of organization or government	(b) EIN	(c) IRC section (if applicable)	(d) Amount of cash grant	(h) Purpose of grant or assistance
(1) ALBION FELLOWS BACON CENTER PO BOX 3164 EVANSVILLE,IN47731	31-1029051	501(C)(3)	22,260	GENERAL SUPPORT
(2) AMERICAN CANCER SOCIETY 5250 VOGEL RD SUITE A EVANSVILLE,IN47715	13-1788491	501(C)(3)	12,500	GENERAL SUPPORT
(3) AMERICAN HEART ASSOCIATION 7272 GREENVILLE AVE DALLAS,TX75231	13-5613797	501(C)(3)	8,333	GENERAL SUPPORT
(4) AMERICAN RED CROSS 29 S STOCKWELL RD EVANSVILLE,IN47714	53-0196605	501(C)(3)	10,000	GENERAL SUPPORT
(5) BOYS & GIRLS CLUB OF EVANSVILLE IN PO BOX 6311 EVANSVILLE,IN47719	35-1007558	501(C)(3)	10,260	GENERAL SUPPORT
(6) CARVER COMMUNITY ORGANIZATION INC 400 SE 8TH STREET EVANSVILLE,IN47713	35-0869030	501(C)(3)	54,540	CAPITAL CAMPAIGN
(7) CHEMO BUDDIES 3699 EPWORTH RD NEWBURGH,IN47630	45-3043243	501(C)(3)	10,000	GENERAL SUPPORT
(8) CITY OF EVANSVILLE PARKS SPECIAL DISTRICT 1 NW MARTIN LUTHER KING BLVD ROOM 300 EVANSVILLE,IN47708	35-6001021		250,000	AQUATIC CENTER CAPITAL CAMPAIGN
(9) COMMUNITY FOUNDATION ALLIANCE INC 5000 E VIRGINIA ST STE 4 EVANSVILLE,IN47715	35-1830262	501(C)(3)	30,000	COMMUNITY BRANDING INITIATIVE
(10) COMMUNITY PATIENT SAFETY COALITION 13113 BROWNING ROAD EVANSVILLE,IN47725	61-1646052	501(C)(3)	18,752	GENERAL SUPPORT
(11) EASTER SEALS REHABILITATION CENTER 3701 BELLEMEADE AVE EVANSVILLE,IN47714	35-1087526	501(C)(3)	37,424	GENERAL SUPPORT & CAPITAL CAMPAIGN
(12) ECHO COMMUNITY HEALTH CARE 315 MULBERRY STREET EVANSVILLE,IN47713	35-1791786	501(C)(3)	30,000	FAMILY PRACTCE - MULTICULTURAL CLINIC
(13) EVANSVILLE EMERGENCY FOOD PANTRY CONSORTIUM INC PO BOX 2536 EVANSVILLE,IN47728	37-1697515	501(C)(3)	10,000	FOOD FOR FOOD PANTRIES
(14) EVANSVILLE MUSEUM OF ARTS HISTORY & SCIENCE PO BOX 3435 EVANSVILLE,IN47733	35-0874517	501(C)(3)	25,000	HEALTHY IS FOR EVERYONE INTERACTIVE EXHIBIT
(15) EVANSVILLE PARKS FOUNDATION INC PO BOX 3112 EVANSVILLE,IN47730	35-1520591	501(C)(3)	20,500	CAPITAL & GENERAL SUPPORT
(16) EVANSVILLE REGIONAL BUSINESS COMMITTEE INC ONE VECTREN SQUARE EVANSVILLE,IN47708	03-0408032	501(C)(3)	10,000	GENERAL SUPPORT
(17) EVANSVILLE VANDERBURGH SCHOOL CORP 1 SE NINTH STREET EVANSVILLE,IN47708	35-1071682	501(C)(3)	8,400	CLASSROOM SUPPLIES
(18) EVANSVILLE-AREA TRAILS COALITION INC PO BOX 5644 EVANSVILLE,IN47716	27-1556835	501(C)(3)	19,500	GENERAL SUPPORT
(19) EVANSVILLE-VANDERBURGH COUNTY CONVENTION & VISITOS COMMISSION 4300 HECKEL ROAD EVANSVILLE,IN47725	47-2582515	501(C)(3)	25,000	SUPPORT HEALTH TRAIL
(20) GOLF GIVES BACK INC ONE VECTREN SQUARE EVANSVILLE,IN47708	81-4223347	501(C)(3)	8,000	GENERAL SUPPORT
(21) HABITAT FOR HUMANITY OF EVANSVILLE 1401 N FARES AVENUE EVANSVILLE,IN47711	35-1602775	501(C)(3)	66,667	GENERAL SUPPORT
(22) INDIANA UNIVERSITY FOUNDATION PO BOX 500 BLOOMINGTON,IN47402	35-6018940	501(C)(3)	100,000	IUSM-EVANSVILLE FURNITURE & FIXTURE FUND
(23) IVY TECH FOUNDATION 3501 N 1ST AVENUE EVANSVILLE,IN47710	23-7073977	501(C)(3)	27,500	GENERAL SUPPORT & SCHOLARSHIPS
(24) JUNIOR ACHIEVEMENT OF SW INDIANA 431 E DIAMOND AVENUE EVANSVILLE,IN47711	35-6048156	501(C)(3)	28,500	INSPIRING OUR YOUTH PROGRAM & GENERAL SUPPORT
(25) MEDICAL EDUCATION FOUNDATION OF SOUTHWESTERN INDIANA 3116 E MORGAN AVE STE F EVANSVILLE,IN47711	23-7070350	501(C)(3)	10,000	GENERAL SUPPORT
(26) OTHERS 5000			155,963	GENERAL SUPPORT
(27) RONALD MCDONALD HOUSE CHARITIES OF THE OHIO VALLEY 3540 WASHINGTON AVENUE EVANSVILLE,IN477140136	35-1748468	501(C)(3)	19,800	GENERAL SUPPORT
(28) TULIP TREE HEALTH SERVICES 123 N MCCREARY FORT BRANCH,IN47648	35-2055749	501(C)(3)	10,000	GENERAL SUPPORT
(29) UNITED CARING SHELTERS 324 NW SIXTH STREET EVANSVILLE,IN47708	35-1892153	501(C)(3)	61,512	HOMELESS MEDICAL RESPITE & GENERAL SUPPORT
(30) UNIVERSITY OF SOUTHERN INDIANA FOUNDATION 8600 UNIVERSITY BOULEVARD EVANSVILLE,IN47712	23-7042320	501(C)(3)	42,200	HEALTH PROFESSION SCHOLARSHIPS & GENERAL SUPPORT
(31) WNIN TRI-STATE PUBLIC MEDIA 405 CARPENTER STREET EVANSVILLE,IN47705	35-1307165	501(C)(3)	26,000	GENERAL SUPPORT & CAPITAL CAMPAIGN
(32) YMCA OF SW INDIANA INC 222 NW 6TH ST EVANSVILLE,IN47708	35-0869074	501(C)(3)	25,833	GENERAL SUPPORT
(33) YOUTH FIRST 3420 EAST MORGAN AVE STE A EVANSVILLE,IN47715	35-2050168	501(C)(3)	12,000	GENERAL SUPPORT
(34) YWCA 118 VINE ST EVANSVILLE,IN47708	35-0869075	501(C)(3)	15,760	GENERAL SUPPORT

Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image

Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50055P

Schedule I (Form 990) 2019

Page 2

Part III

Grants and Other Assistance to Domestic Individuals. Complete if the organization answered "Yes" on Form 990, Part IV, line 22.
Part III can be duplicated if additional space is needed.

(a) Type of grant or assistance	(b) Number of recipients	(c) Amount of cash grant	(d) Amount of noncash assistance	(e) Method of valuation (book, FMV, appraisal, other)	(f) Description of noncash assistance

(1)
(2)
(3)
(4)
(5)
(6)
(7)

Part IV

Supplemental Information. Provide the information required in Part I, line 2; Part III, column (b); and any other additional information.

Return Reference	Explanation
PART I, LINE 2:	DEACONESS HOSPITAL CONFIRMS ALL RECIPIENTS OF FUNDS ARE ORGANIZATIONS 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.

Schedule I (Form 990) 2019

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Schedule J
(Form 990)

Department of the Treasury
Internal Revenue Service

Compensation Information

For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet

Complete if the organization answered "Yes" on Form 990, Part IV, line 23.
SchJMediumBullet

Attach to Form 990.
SchJMediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization

DEACONESS HOSPITAL INC

Employer identification number

35-0593390

Part I

Questions Regarding Compensation

Yes

Check the appropiate box(es) if the organization provided any of the following to or for a person listed on Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.

First-class or charter travel Housing allowance or residence for personal use

Travel for companions Payments for business use of personal residence

Tax idemnification and gross-up payments Health or social club dues or initiation fees

Discretionary spending account Personal services (e.g., maid, chauffeur, chef)

If any of the boxes on Line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all of the expenses described above? If "No," complete Part III to explain .........

Yes

Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
directors, trustees, officers, including the CEO/Executive Director, regarding the items checked on Line 1a? ..

Yes

Indicate which, if any, of the following the filing organization used to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

Form 990 of other organizations Approval by the board or compensation committee

During the year, did any person listed on Form 990, Part VII, Section A, line 1a, with respect to the filing organization or a related organization:

Receive a severance payment or change-of-control payment? .............

Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........

Yes

Participate in, or receive payment from, an equity-based compensation arrangement? .........

If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.

Only 501(c)(3), 501(c)(4), and 501(c)(29) organizations must complete lines 5-9.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:

The organization? ....................

Any related organization? .......................

If "Yes," on line 5a or 5b, describe in Part III.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:

The organization? ..................

Any related organization? ......................

Yes

If "Yes," on line 6a or 6b, describe in Part III.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization provide any nonfixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............

Were any amounts reported on Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III ..........................

If "Yes" on line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50053T

Schedule J (Form 990) 2019

Page 2

Part II

Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is needed.

For each individual whose compensation must be reported on Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions, on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.
Note. The sum of columns (B)(i)-(iii) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and (E) amounts for that individual.

(A) Name and Title		(B) Breakdown of W-2 and/or 1099-MISC compensation			(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)	(F) Compensation in column (B) reported as deferred on prior Form 990
(A) Name and Title		(i) Base compensation	(ii) Bonus & incentive compensation	(iii) Other reportable compensation	(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)
1SHAWN MCCOY CEO OF DEACONESS HEALTH SYSTEM	(i) (ii)	439,159 ------------- 175,000	133,281 ------------- 0	330,873 ------------- 8,000	127,630 ------------- 33,487	17,640 ------------- 17,640	1,048,583 ------------- 234,127	61,490 ------------- 61,490
2LINDA WHITE CEO EMERITA	(i) (ii)	291,468 ------------- 194,679	150,862 ------------- 0	643,915 ------------- 6,000	22,351 ------------- 22,351	4,420 ------------- 4,420	1,113,016 ------------- 227,450	176,411 ------------- 176,410
3MAQBOOL AHMED MD DIRECTOR	(i) (ii)	0 ------------- 811,483	0 ------------- 61,979	720 ------------- 39,659	0 ------------- 18,864	0 ------------- 24,288	720 ------------- 956,273	0 ------------- 29,291
4MATHIAS KOLLECK II MD DIRECTOR	(i) (ii)	261,958 ------------- 0	107,405 ------------- 0	79,377 ------------- 5,600	27,120 ------------- 0	24,743 ------------- 0	500,603 ------------- 5,600	16,565 ------------- 0
5BARRY PHILLIPS MD DIRECTOR	(i) (ii)	0 ------------- 359,363	0 ------------- 77,603	7,200 ------------- 7,122	0 ------------- 17,569	0 ------------- 22,985	7,200 ------------- 484,642	0 ------------- 0
6DAVID RYON MD DIRECTOR	(i) (ii)	304,283 ------------- 0	23,680 ------------- 0	134,130 ------------- 8,030	23,184 ------------- 0	24,259 ------------- 0	509,536 ------------- 8,030	47,731 ------------- 0
7CHERYL WATHEN CHIEF FINANCIAL OFFICER	(i) (ii)	228,722 ------------- 237,471	83,710 ------------- 0	174,652 ------------- 9,000	70,618 ------------- 51,369	18,494 ------------- 18,494	576,196 ------------- 316,334	42,321 ------------- 42,321
8JAMES PORTER MD PRESIDENT OF DEACONESS HEALTH SYSTEM	(i) (ii)	533,643 ------------- 0	101,065 ------------- 0	192,298 ------------- 2,000	137,098 ------------- 0	30,023 ------------- 0	994,127 ------------- 2,000	188,208 ------------- 0
9CHERONA HAJEWSKI CHIEF NURSING OFFICER	(i) (ii)	302,445 ------------- 0	54,798 ------------- 0	219,195 ------------- 0	78,962 ------------- 0	25,950 ------------- 0	681,350 ------------- 0	202,459 ------------- 0
10LYNN LINGAFELTER CHIEF OPERATION OFFICER	(i) (ii)	318,245 ------------- 0	54,997 ------------- 0	105,931 ------------- 1,200	86,883 ------------- 0	9,873 ------------- 0	575,929 ------------- 1,200	48,918 ------------- 0
11HERMAN BLANTON MD CHIEF MEDICAL OFFICER	(i) (ii)	346,588 ------------- 0	62,930 ------------- 0	9,842 ------------- 0	59,812 ------------- 0	27,599 ------------- 0	506,771 ------------- 0	0 ------------- 0
12MARC FLORENCE VICE PRESIDENT	(i) (ii)	249,993 ------------- 0	45,843 ------------- 0	3,881 ------------- 0	51,900 ------------- 0	29,992 ------------- 0	381,609 ------------- 0	0 ------------- 0
13KATHY SCHENK HR DIRECTOR	(i) (ii)	135,807 ------------- 0	17,397 ------------- 0	1,231 ------------- 0	10,757 ------------- 0	20,055 ------------- 0	185,247 ------------- 0	0 ------------- 0
14KENNETH DICKEN CONTROLLER, DIRECTOR FINANCE	(i) (ii)	201,567 ------------- 0	25,521 ------------- 0	1,461 ------------- 2,400	12,468 ------------- 0	25,244 ------------- 0	266,261 ------------- 2,400	0 ------------- 0
15RICHARD PERRY CONTROLLER, PHYSICIAN PRACTICE MGMT.	(i) (ii)	181,674 ------------- 0	20,306 ------------- 0	1,868 ------------- 0	13,523 ------------- 0	10,028 ------------- 0	227,399 ------------- 0	0 ------------- 0
16CAROLYN MORTON PHARMACY AND LAB DIRECTOR	(i) (ii)	172,826 ------------- 0	25,832 ------------- 0	1,321 ------------- 0	13,848 ------------- 0	29,371 ------------- 0	243,198 ------------- 0	0 ------------- 0
17SUSAN BRUMLEY IMAGING AND CARDIOVASCULAR DIRECTOR	(i) (ii)	137,424 ------------- 0	17,865 ------------- 0	1,279 ------------- 0	7,982 ------------- 0	24,897 ------------- 0	189,447 ------------- 0	0 ------------- 0
18VENKATESH MADADI MD ANESTHESIOLOGIST	(i) (ii)	761,706 ------------- 0	0 ------------- 0	137,259 ------------- 0	28,584 ------------- 0	24,709 ------------- 0	952,258 ------------- 0	61,812 ------------- 0
19NIRMAL JOSHI MD ANESTHESIOLOGIST	(i) (ii)	537,922 ------------- 0	13,000 ------------- 0	245,143 ------------- 0	22,992 ------------- 0	25,095 ------------- 0	844,152 ------------- 0	14,423 ------------- 0
20KISHWAR NAZ MD ANESTHESIOLOGIST	(i) (ii)	714,292 ------------- 0	0 ------------- 0	64,452 ------------- 0	14,736 ------------- 0	19,953 ------------- 0	813,433 ------------- 0	0 ------------- 0
21SHIVON ABDULLAH MD ANESTHESIOLOGIST	(i) (ii)	711,330 ------------- 0	0 ------------- 0	54,566 ------------- 0	14,736 ------------- 0	24,659 ------------- 0	805,291 ------------- 0	0 ------------- 0
22RAJESH PATEL MD ANESTHESIOLOGIST	(i) (ii)	659,288 ------------- 0	0 ------------- 0	46,543 ------------- 0	23,513 ------------- 0	27,526 ------------- 0	756,870 ------------- 0	0 ------------- 0
23LARRY PILE FORMER HR DIRECTOR	(i) (ii)	174,699 ------------- 0	19,448 ------------- 0	2,997 ------------- 0	18,582 ------------- 0	8,665 ------------- 0	224,391 ------------- 0	0 ------------- 0

Schedule J (Form 990) 2019

Page 3

Part III

Supplemental Information

Provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II. Also complete this part for any additional information.

Return Reference	Explanation
PART I, LINE 1A	SOCIAL CLUB DUES ARE PAID FOR LINDA WHITE AND SHAWN MCCOY FOR ORGANIZATION BUSINESS ONLY. ANY PERSONAL USE OF THE CLUB MUST BE PAID BY THE EMPLOYEES.
PART I, LINE 4B	SEVERANCE, NONQUALIFIED, AND EQUITY-BASED PAYMENTS: SEVERANCE NONQUALIFIED EQUITY-BASED LINDA WHITE $ -0- $ 9,703 $ -0- SHAWN MCCOY 0 18,000 0 JAMES PORTER, M.D. 0 18,000 0 CHERONA HAJEWSKI 0 18,000 0 DAVID RYON, M.D. 0 18,000 0 VENKATESH MADADI, M.D. 0 18,000 0 RAJESH PATEL, M.D. 0 18,000 0 NIRMAL JOSHI, M.D. 0 18,000 0 CHERYL WATHEN 0 18,000 0 LYNN LINGAFELTER 0 18,000 0 MAQBOOL AHMED, M.D. 0 18,000 0 MATHIAS KOLLECK, II, M.D. 0 18,000 0 SEVERANCE NONQUALIFIED EQUITY-BASED MARC FLORENCE $ -0- $ 18,000 $ -0- KISHWAR NAZ, M.D. 0 18,000 0 HERMAN BLANTON, M.D. 0 18,000 0 PART I, 4B: LINDA WHITE: SUPPLEMENTAL ACCUMULATION ACCOUNT CONTRIBUTIONS OF $0 SUPPLEMENTAL ACCUMULATION ACCOUNT PAYOUT OF $171,589 SHAWN MCCOY: SUPPLEMENTAL ACCUMULATION ACCOUNT CONTRIBUTIONS OF $139,656 SUPPLEMENTAL ACCUMULATION ACCOUNT PAYOUT OF $122,980 CHERYL WATHEN: SUPPLEMENTAL ACCUMULATION ACCOUNT CONTRIBUTIONS OF $90,318 SUPPLEMENTAL ACCUMULATION ACCOUNT PAYOUT OF $84,641 JAMES PORTER: SUPPLEMENTAL ACCUMULATION ACCOUNT CONTRIBUTIONS OF $107,278 SUPPLEMENTAL ACCUMULATION ACCOUNT PAYOUT OF $188,208 CHERONA HAJEWSKI: SUPPLEMENTAL ACCUMULATION ACCOUNT CONTRIBUTIONS OF $46,568 SUPPLEMENTAL ACCUMULATION ACCOUNT PAYOUT OF $202,459 LYNN LINGAFELTER: SUPPLEMENTAL ACCUMULATION ACCOUNT CONTRIBUTIONS OF $53,924 SUPPLEMENTAL ACCUMULATION ACCOUNT PAYOUT OF $48,918 MARC FLORENCE: SUPPLEMENTAL ACCUMULATION ACCOUNT CONTRIBUTIONS OF $37,164 SUPPLEMENTAL ACCUMULATION ACCOUNT PAYOUT OF $0 HERMAN BLANTON: SUPPLEMENTAL ACCUMULATION ACCOUNT CONTRIBUTIONS OF $57,475 SUPPLEMENTAL ACCUMULATION ACCOUNT PAYOUT OF $0
PART I, LINE 6	RELATED ORG. COMPENSATION CONTINGENT UPON NET EARNINGS 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.

Schedule J (Form 990) 2019

Additional Data

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Schedule K
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Information on Tax-Exempt Bonds

Complete if the organization answered "Yes" to Form 990, Part Ⅵ, line 24a. Provide descriptions,
explanations, and any additional information in Part Ⅵ.
SchKMediumBullet

Attach to Form 990.
SchKMediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public
Inspection

Name of the organization
DEACONESS HOSPITAL INC

Employer identification number
35-0593390

Part Ⅰ

Bond Issues

(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	(g) Defeased		(h) On behalf of issuer		(i) Pool financing
(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	Yes	No	Yes	No	Yes	No
A	INDIANA FINANCE AUTHORITY	35-1602316	45471AES7	12-02-2011	20,667,197	3/15/99 REFUNDING		X		X		X
B	INDIANA FINANCE AUTHORITY	35-1602316		11-20-2012	13,005,000	1/17/1992 REFUNDING		X		X		X
C	INDIANA FINANCE AUTHORITY	35-1602316	45471ALU4	07-23-2013	40,180,000	3/26/09 REFUNDING		X		X		X
D	INDIANA FINANCE AUTHORITY-2013A	35-1602316	45471AKY7	03-05-2013	71,336,168	5/27/04 AND 3/26/09 REFUNDING		X		X		X
	INDIANA FINANCE AUTHORITY-2013B	35-1602316		03-05-2013	21,440,000	5/27/04 REFUNDING		X		X		X
	INDIANA FINANCE AUTHORITY-2015A	35-1602316	45506DUL7	07-09-2015	49,772,341	03/6/2009 REFUNDING		X		X		X
	INDIANA FINANCE AUTHORITY	35-1602316	45506DXT7	10-05-2016	109,999,091	NEW MONEY PROJECTS		X		X		X

Part Ⅱ

Proceeds

	A		B		C		D
	1 Amount of bonds retired ..................	6,140,000		6,655,000		750,000		1,920,000
2 Amount of bonds legally defeased ..............
3 Total proceeds of issue ..................	20,667,197		13,005,000		40,180,000		71,336,168
4 Gross proceeds in reserve funds .............
5 Capitalized interest from proceeds .............					4,660,332
6 Proceeds in refunding escrows ...............			44,003,157
7 Issuance costs from proceeds ...............	397,197		103,657		180,000		729,538
8 Credit enhancement from proceeds .............
9 Working capital expenditures from proceeds .............					2,885,418
10 Capital expenditures from proceeds .............					102,765,054
11 Other spent proceeds .............	20,270,000		12,901,343		40,000,000		70,606,631
12 Other unspent proceeds .............					127,003
13 Year of substantial completion .............
	Yes	No	Yes	No	Yes	No	Yes	No
14 Were the bonds issued as part of a current refunding issue of tax-exempt bonds (or, if issued prior to 2018, a current refunding issue)? ........
15 Were the bonds issued as part of an advance refunding issue of taxable bonds (or, if issued prior to 2018, an advance refunding issue)? ........
16 Has the final allocation of proceeds been made? ..........	X		X		X		X
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? ..................	X		X		X		X

Part Ⅲ

Private Business Use

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? .............		X		X		X		X
2 Are there any lease arrangements that may result in private business use of bond-financed property? ...............		X		X	X		X

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50193E

Schedule K (Form 990) 2019

Page 2

Part Ⅲ

Private Business Use (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
3a Are there any management or service contracts that may result in private business use of bond-financed property? .............		X		X		X		X
b If "Yes" to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property?
c Are there any research agreements that may result in private business use of bond-financed property? .............		X		X		X		X
d If "Yes" to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property?
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government ....	0 %		0 %		0 %		0 %
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government .........	0 %		0 %		0 %		0 %
6 Total of lines 4 and 5 .............	0 %		0 %		0 %		0 %
7 Does the bond issue meet the private security or payment test? ...		X		X		X		X
8a Has there been a sale or disposition of any of the bond-financed property to a nongovernmental person other than a 501(c)(3) organization since the bonds were issued?.............		X		X		X		X
b If "Yes" to line 8a, enter the percentage of bond-financed property sold or disposed of. ..
c If "Yes" to line 8a, was any remedial action taken pursuant to Regulations sections 1.141-12 and 1.145-2? .............
9 Has the organization established written procedures to ensure that all nonqualified bonds of the issue are remediated in accordance with the requirements under Regulations sections 1.141-12 and 1.145-2? ........	X		X		X		X

Part Ⅳ

Arbitrage

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Has the issuer filed Form 8038-T, Arbitrage Rebate, Yield Reduction and Penalty in Lieu of Arbitrage Rebate? ...		X		X		X		X
2 If "No" to line 1, did the following apply? ....
a Rebate not due yet? .......	X		X			X		X
b Exception to rebate? ........		X		X		X		X
c No rebate due? .........		X		X	X		X
If "Yes" to line 2c, provide in Part Ⅵ the date the rebate computation was performed ......
3 Is the bond issue a variable rate issue? .....		X		X	X			X
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?		X		X		X		X
b Name of provider ..........	FIFTH THIRD
c Term of hedge .........	1600.0000000000 %
d Was the hedge superintegrated? ......		X
e Was the hedge terminated? ........		X

Schedule K (Form 990) 2019

Page 3

Part Ⅳ

Arbitrage (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
5a Were gross proceeds invested in a guaranteed investment contract (GIC)?		X		X		X		X
b Name of provider ..........
c Term of GIC .........
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? ........
6 Were any gross proceeds invested beyond an available temporary period?		X		X		X		X
7 Has the organization established written procedures to monitor the requirements of section 148? ...	X		X		X		X

Part Ⅴ

Procedures To Undertake Corrective Action

---------------------------------------------------------------------------------------------------------------	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
Has the organization established written procedures to ensure that violations of federal tax requirements are timely identified and corrected through the voluntary closing agreement program if self-remediation is not available under applicable regulations?	X		X		X		X

Part Ⅵ

Supplemental Information. Provide additional information for responses to questions on Schedule K. (See instructions).

Return Reference	Explanation
PART II, LINE 3, COLUMN C, CUSIP 45506DXT7:	THE TOTAL PROCEEDS OF THE ISSUE EXCEED THE ISSUE PRICE DUE TO THE INVESTMENT EARNINGS ON THE PROJECT FUND.
PART II, LINE 11:	THE OTHER SPENT PROCEEDS ARE THE REFUNDING PROCEEDS OF THE ISSUE THAT ARE NO LONGER IN ESCROW.

Schedule K (Form 990) 2019

Additional Data

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Schedule K
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Information on Tax-Exempt Bonds

Complete if the organization answered "Yes" to Form 990, Part Ⅵ, line 24a. Provide descriptions,
explanations, and any additional information in Part Ⅵ.
SchKMediumBullet

Attach to Form 990.
SchKMediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public
Inspection

Name of the organization
DEACONESS HOSPITAL INC

Employer identification number
35-0593390

Part Ⅰ

Bond Issues

(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	(g) Defeased		(h) On behalf of issuer		(i) Pool financing
(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	Yes	No	Yes	No	Yes	No
A	INDIANA FINANCE AUTHORITY	35-1602316	45471AES7	12-02-2011	20,667,197	3/15/99 REFUNDING		X		X		X
B	INDIANA FINANCE AUTHORITY	35-1602316		11-20-2012	13,005,000	1/17/1992 REFUNDING		X		X		X
C	INDIANA FINANCE AUTHORITY	35-1602316	45471ALU4	07-23-2013	40,180,000	3/26/09 REFUNDING		X		X		X
D	INDIANA FINANCE AUTHORITY-2013A	35-1602316	45471AKY7	03-05-2013	71,336,168	5/27/04 AND 3/26/09 REFUNDING		X		X		X
	INDIANA FINANCE AUTHORITY-2013B	35-1602316		03-05-2013	21,440,000	5/27/04 REFUNDING		X		X		X
	INDIANA FINANCE AUTHORITY-2015A	35-1602316	45506DUL7	07-09-2015	49,772,341	03/6/2009 REFUNDING		X		X		X
	INDIANA FINANCE AUTHORITY	35-1602316	45506DXT7	10-05-2016	109,999,091	NEW MONEY PROJECTS		X		X		X

Part Ⅱ

Proceeds

	A		B		C		D
	1 Amount of bonds retired ..................	6,140,000		6,655,000		750,000		1,920,000
2 Amount of bonds legally defeased ..............
3 Total proceeds of issue ..................	20,667,197		13,005,000		40,180,000		71,336,168
4 Gross proceeds in reserve funds .............
5 Capitalized interest from proceeds .............					4,660,332
6 Proceeds in refunding escrows ...............			44,003,157
7 Issuance costs from proceeds ...............	397,197		103,657		180,000		729,538
8 Credit enhancement from proceeds .............
9 Working capital expenditures from proceeds .............					2,885,418
10 Capital expenditures from proceeds .............					102,765,054
11 Other spent proceeds .............	20,270,000		12,901,343		40,000,000		70,606,631
12 Other unspent proceeds .............					127,003
13 Year of substantial completion .............
	Yes	No	Yes	No	Yes	No	Yes	No
14 Were the bonds issued as part of a current refunding issue of tax-exempt bonds (or, if issued prior to 2018, a current refunding issue)? ........
15 Were the bonds issued as part of an advance refunding issue of taxable bonds (or, if issued prior to 2018, an advance refunding issue)? ........
16 Has the final allocation of proceeds been made? ..........	X		X		X		X
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? ..................	X		X		X		X

Part Ⅲ

Private Business Use

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? .............		X		X		X		X
2 Are there any lease arrangements that may result in private business use of bond-financed property? ...............		X		X	X		X

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50193E

Schedule K (Form 990) 2019

Page 2

Part Ⅲ

Private Business Use (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
3a Are there any management or service contracts that may result in private business use of bond-financed property? .............		X		X		X		X
b If "Yes" to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property?
c Are there any research agreements that may result in private business use of bond-financed property? .............		X		X		X		X
d If "Yes" to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property?
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government ....	0 %		0 %		0 %		0 %
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government .........	0 %		0 %		0 %		0 %
6 Total of lines 4 and 5 .............	0 %		0 %		0 %		0 %
7 Does the bond issue meet the private security or payment test? ...		X		X		X		X
8a Has there been a sale or disposition of any of the bond-financed property to a nongovernmental person other than a 501(c)(3) organization since the bonds were issued?.............		X		X		X		X
b If "Yes" to line 8a, enter the percentage of bond-financed property sold or disposed of. ..
c If "Yes" to line 8a, was any remedial action taken pursuant to Regulations sections 1.141-12 and 1.145-2? .............
9 Has the organization established written procedures to ensure that all nonqualified bonds of the issue are remediated in accordance with the requirements under Regulations sections 1.141-12 and 1.145-2? ........	X		X		X		X

Part Ⅳ

Arbitrage

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Has the issuer filed Form 8038-T, Arbitrage Rebate, Yield Reduction and Penalty in Lieu of Arbitrage Rebate? ...		X		X		X		X
2 If "No" to line 1, did the following apply? ....
a Rebate not due yet? .......	X		X			X		X
b Exception to rebate? ........		X		X		X		X
c No rebate due? .........		X		X	X		X
If "Yes" to line 2c, provide in Part Ⅵ the date the rebate computation was performed ......
3 Is the bond issue a variable rate issue? .....		X		X	X			X
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?		X		X		X		X
b Name of provider ..........	FIFTH THIRD
c Term of hedge .........	1600.0000000000 %
d Was the hedge superintegrated? ......		X
e Was the hedge terminated? ........		X

Schedule K (Form 990) 2019

Page 3

Part Ⅳ

Arbitrage (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
5a Were gross proceeds invested in a guaranteed investment contract (GIC)?		X		X		X		X
b Name of provider ..........
c Term of GIC .........
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? ........
6 Were any gross proceeds invested beyond an available temporary period?		X		X		X		X
7 Has the organization established written procedures to monitor the requirements of section 148? ...	X		X		X		X

Part Ⅴ

Procedures To Undertake Corrective Action

---------------------------------------------------------------------------------------------------------------	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
Has the organization established written procedures to ensure that violations of federal tax requirements are timely identified and corrected through the voluntary closing agreement program if self-remediation is not available under applicable regulations?	X		X		X		X

Part Ⅵ

Supplemental Information. Provide additional information for responses to questions on Schedule K. (See instructions).

Return Reference	Explanation
PART II, LINE 3, COLUMN C, CUSIP 45506DXT7:	THE TOTAL PROCEEDS OF THE ISSUE EXCEED THE ISSUE PRICE DUE TO THE INVESTMENT EARNINGS ON THE PROJECT FUND.
PART II, LINE 11:	THE OTHER SPENT PROCEEDS ARE THE REFUNDING PROCEEDS OF THE ISSUE THAT ARE NO LONGER IN ESCROW.

Schedule K (Form 990) 2019

Additional Data

Software ID:
Software Version:

- TIN:

Schedule L
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Transactions with Interested Persons

Complete if the organization answered "Yes" on Form 990, Part IV, lines 25a, 25b, 26, 27, 28a, 28b, or 28c, or Form 990-EZ, Part V, line 38a or 40b.
MediumBullet

Attach to Form 990 or Form 990-EZ.
MediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization

DEACONESS HOSPITAL INC

Employer identification number

35-0593390

Part I

Excess Benefit Transactions (section 501(c)(3), section 501(c)(4), and section 501(c)(29) organizations only).
Complete if the organization answered "Yes" on Form 990, Part IV, line 25a or 25b, or Form 990-EZ, Part V, line 40b.

1(a) Name of disqualified person	(c) Description of transaction	(d) Corrected?
1(a) Name of disqualified person	(c) Description of transaction	Yes	No

Enter the amount of tax incurred by the organization managers or disqualified persons during the year under section 4958. ........................... Bullet Image

Enter the amount of tax, if any, on line 2, above, reimbursed by the organization ........ Bullet Image

Part II

Loans to and/or From Interested Persons.
Complete if the organization answered "Yes" on Form 990-EZ, Part V, line 38a, or Form 990, Part IV, line 26; or if the organization reported an amount on Form 990, Part X, line 5, 6, or 22

(a) Name of interested person	(b) Relationship with organization	(c) Purpose of loan	(d) Loan to or from the organization?		(e) Original principal amount	(f) Balance due	(g) In default?		(h) Approved by board or committee?		(i) Written agreement?
(a) Name of interested person	(b) Relationship with organization	(c) Purpose of loan	To	From	(e) Original principal amount	(f) Balance due	Yes	No	Yes	No	Yes	No






Total ............... $

Part III

Grants or Assistance Benefiting Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 27.

(a) Name of interested person	(b) Relationship between interested person and the organization	(c) Amount of assistance	(d) Type of assistance	(e) Purpose of assistance

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 50056A

Schedule L (Form 990 or 990-EZ) 2019

Page 2

Part IV

Business Transactions Involving Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 28a, 28b, or 28c.

(a) Name of interested person	(b) Relationship between interested person and the organization	(c) Amount of transaction	(d) Description of transaction	(e) Sharing of organization's revenues?
(a) Name of interested person		(c) Amount of transaction	(d) Description of transaction	Yes	No
(1) MISTY ADYE	SEE PART V	26,032	COMP.		No
(2) VECTREN ENERGY DELIVERY	SEE PART V	6,179,683	GAS/ELECTRICITY		No
(3) JESSICA COX	SEE PART V	65,053	COMP.		No
(4) MARY BETH COLE	SEE PART V	35,453	COMP.		No
(5) JOAN MCCOY	SEE PART V	27,948	COMP.		No
(6) IVY TECH FOUNDATION	SEE PART V	27,500	DONATION AND SUPPORT		No
(7) EVANSVILLE SURGICAL ASSOCIATES	SEE PART V	3,095,965	MEDICAL SERVICES		No
(8) OLD NATIONAL BANK	SEE PART V	996,280	INVESTMENT MANAGEMENT FEES		No

Part V

Supplemental Information
Provide additional information for responses to questions on Schedule L (see instructions).

Return Reference

Explanation

SCH L, PART IV, ABBREVIATION:

BD MBR = BOARD MEMBERCOMP. = REPORTABLE COMPENSATIONSRVS. = SERVICES

SCH L, PART V, RELATIONSHIP BETWEEN INTERESTED PERSON AND ORGANIZATION:

INTERESTED PERSON: MISTY ADYERELATIONSHIP: WIFE OF BOARD MEMBER BRUCE ADYEINTERESTED PERSON: VECTREN ENERGY DELIVERYRELATIONSHIP: DEACONESS HOSPITAL BOARD MEMBER ERIC SCHACH IS THE EVP & COO OF VECTREN. VECTREN PROVIDES SERVICES TO THE HOSPITAL.INTERESTED PERSON: JESSICA COXRELATIONSHIP: DAUGHTER TO LYNN LINGAFELTERINTERESTED PERSON: MARY BETH COLERELATIONSHIP: SISTER TO STEPHEN TITZERINTERESTED PERSON: JOAN MCCOYRELATIONSHIP: WIFE OF SHAWN MCCOYINTERESTED PERSON: IVY TECH FOUNDATIONRELATIONSHIP: BOARD MEMBER JOHNATHAN WEINZAPFEL IS THE CHANCELLOR AT IVY TECH COLLEGE. DEACONESS HOSPITAL CONTRIBUTES MONEY FOR NURSING EDUCATION.INTERESTED PERSON: EVANSVILLE SURGICAL ASSOCIATES RELATIONSHIP: BOARD MEMBER BRUCE ADYE IS A MEMBER OF ESA. EVANSVILLE SURGICAL ASSOCIATES PROVIDES TRAUMA COVERAGE AS WELL AS OTHER MEDICAL SERVICES.INTERESTED PERSON: OLD NATIONAL BANKRELATIONSHIP: BOARD MEMBER JAMES RYAN IS THE CFO OF OLD NATIONAL BANK. OLD NATIONAL BANK PROVIDES INVESTMENT MANAGEMENT SERVICES.

Schedule L (Form 990 or 990-EZ) 2019

Additional Data

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SCHEDULE M
(Form 990)

Department of the Treasury

Internal Revenue Service

Noncash Contributions

Complete if the organizations answered "Yes" on Form 990, Part IV, lines 29 or 30.
Right pointing arrow large image

Attach to Form 990.
Right pointing arrow large image

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization

DEACONESS HOSPITAL INC

Employer identification number

35-0593390

Part I

Types of Property

	(a) Check if applicable	(b) Number of contributions or items contributed	(c) Noncash contribution amounts reported on Form 990, Part VIII, line 1g	(d) Method of determining noncash contribution amounts
1 Art—Works of art ....
2 Art—Historical treasures .
3 Art—Fractional interests ..
4 Books and publications ..
5 Clothing and household goods .......
6 Cars and other vehicles ..
7 Boats and planes ....
8 Intellectual property ...
9 Securities—Publicly traded .
10 Securities—Closely held stock .
11 Securities—Partnership, LLC, or trust interests ....
12 Securities—Miscellaneous ..
13 Qualified conservation contribution—Historic structures .....
14 Qualified conservation contribution—Other ...
15 Real estate—Residential .	X	1	305,000	FAIR MARKET VALUE
16 Real estate—Commercial ..
17 Real estate—Other ...
18 Collectibles .....
19 Food inventory ...
20 Drugs and medical supplies .
21 Taxidermy ......
22 Historical artifacts ....
23 Scientific specimens ..
24 Archeological artifacts ...
25 Other ( JEWELRY )	X	1	7,500	COST
26 Other ( )
27 Other ( )
28 Other ( )

Number of Forms 8283 received by the organization during the tax year for contributions
for which the organization completed Form 8283, Part IV, Donee Acknowledgement

Yes

30a

During the year, did the organization receive by contribution any property reported in Part I, lines 1 through 28, that it must hold for at least three years from the date of the initial contribution, and which isn't required to be used for exempt purposes for the entire holding period? ...................

30a

If "Yes," describe the arrangement in Part II.

Does the organization have a gift acceptance policy that requires the review of any nonstandard contributions?

Yes

32a

Does the organization hire or use third parties or related organizations to solicit, process, or sell noncash

contributions? ..........................

32a

If "Yes," describe in Part II.

If the organization didn't report an amount in column (c) for a type of property for which column (a) is checked,

describe in Part II.

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 51227J

Schedule M (Form 990) (2019)

Page 2

Part IISupplemental Information. Provide the information required by Part I, lines 30b, 32b, and 33, and whether the organization is reporting in Part I, column (b), the number of contributions, the number of items received, or a combination of both. Also complete this part for any additional information.

Return Reference	Explanation
PART I, LINE 32B:	SCHEDULE M - SUPPLEMENTAL INFORMATION THE NUMBER OF CONTRIBUTIONS REPORTED IN COLUMN B ON SCHEDULE M IS THE ACTUAL NUMBER OF ITEMS RECEIVED FROM EACH CONTRIBUTOR.

Schedule M (Form 990) (2019)

Additional Data

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SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or 990-EZ or to provide any additional information.
MediumBullet

Attach to Form 990 or 990-EZ.
MediumBullet

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2019

Open to Public
Inspection

Name of the organization

DEACONESS HOSPITAL INC

Employer identification number

35-0593390

Return Reference	Explanation
FORM 990, PART III, LINE 1, ORGANIZATION'S MISSION:	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 HEALTHY LIFESTYLES, OFFERING SPIRITUAL AND PSYCHOLOGICAL SUPPORT, SUPPORTING HEALTH RELATED EDUCATION, AND ADVANCING HEALTH KNOWLEDGE THROUGH RESEARCH.
FORM 990, PART III, LINE 4A	PROGRAM SERVICES ACCOMPLISHMENT 1: PATIENT SERVICE REVENUE. DEACONESS HOSPITAL IS A MAJOR REFERRAL CENTER FOR A 26 COUNTY TRI-STATE AREA IN SOUTHWESTERN INDIANA, WESTERN KENTUCKY AND SOUTHEASTERN ILLINOIS. 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 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 266 BEDS CONSISTING OF 38 INTENSIVE CARE BEDS, 16 CARDIAC INTENSIVE CARE BEDS, 45 CARDIAC BEDS, 23 ONCOLOGY/ PULMONOLOGY BEDS, 61 ORTHOPAEDIC/ NEUROLOGICAL BEDS, 44 MEDICAL/ SURGICAL BEDS, 39 MEDICAL RENAL 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 278 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, 24 CARDIAC BEDS, AND 64 GENERAL MED/ TELEMETRY BEDS. THE ORTHOPEDIC NEUROSCIENCE HOSPITAL OPENED ON THE GATEWAY CAMPUS IN MAY OF 2018. THIS ADDITION TO THE CAMPUS CONSISTS OF 32 ORTHO SURGICAL BEDS AND 32 NEURO SURGICAL 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.
FORM 990, PART III, LINE 4B	PROGRAM SERVICES ACCOMPLISHMENT 2: CHARITY CARE/ SUBSIDIZED CARE. DEACONESS HOSPITAL MAKES A DISTINCTION BETWEEN CHARITY CARE 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 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 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 PROVIDES CARE TO PERSONS COVERED BY GOVERNMENTAL 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 $15.1 MILLION OF CHARITY CARE AND $32.7 MILLION OF SUBSIDIZED SERVICES TO THE MEDICAID PROGRAM, AND $74.7 MILLION OF SUBSIDIZED SERVICES TO THE MEDICARE PROGRAM.
FORM 990, PART III, LINE 4C	PROGRAM SERVICES ACCOMPLISHMENT 3: GRADUATE MEDICAL EDUCATION, MEDICAL EDUCATION & COMMUNITY BENEFITS. DEACONESS HOSPITAL PLAYS AN ACTIVE ROLE IN MEDICAL EDUCATION, OPERATING A THREE YEAR FAMILY MEDICINE RESIDENCY PROGRAM AND A POST-GRADUATE PHARMACY RESIDENCY 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 PROVIDED $9.7 MILLION IN COMMUNITY BENEFIT ACTIVITIES (ALL ON A COST BASIS), SERVING A MINIMUM OF 948,309 PEOPLE WITHIN THE TRI-STATE AREA.
FORM 990, PART III, LINE 4D	ALL OTHER ACCOMPLISHMENTS. OTHER PROGRAM SERVICE REVENUE CONSISTS OF DEACONESS HOSPITAL'S INCOME FROM THE INVESTMENT IN JOINT VENTURES. OTHER PROGRAM SERVICE EXPENSES CONSISTED OF COMMUNITY BENEFIT GRANTS/ASSISTANCE.
FORM 990, PART VI, SECTION A, LINE 6	CLASS OF MEMBERS OR STOCKHOLDERS: DEACONESS HEALTH SYSTEM, INC. IS THE SOLE CORPORATE MEMBER OF DEACONESS HOSPITAL, INC.
FORM 990, PART VI, SECTION A, LINE 7A	ELECTION OF GOVERNING BODY: 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 RECOMMENDATION BY THE GOVERNANCE COMMITTEE FOR MEMBERSHIP TO THE BOARD OF DIRECTORS. THAT RECOMMENDATION IS THEN REVIEWED 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 11B	FORM 990 REVIEW PROCESS: 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 CFO AND CEO OF THE ORGANIZATION FOR REVIEW. AFTER THIS REVIEW IS PERFORMED AND ALL QUESTIONS ARE ANSWERED, THE FORM 990 IS PRESENTED TO THE BOARD OF DIRECTORS OF DEACONESS HEALTH SYSTEM 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	COMPLIANCE WITH CONFLICT OF INTEREST POLICY: 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 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, PARTNERSHIP AND JOINT VENTURE ARRANGEMENTS.
FORM 990, PART VI, SECTION B, LINE 15	COMPENSATION FOR TOP OFFICIALS AND OTHER OFFICERS: DEACONESS HOSPITAL UTILIZES A COMPENSATION COMMITTEE TO APPROVE EXECUTIVE, DIRECTOR AND PHYSICIAN COMPENSATION AS WELL AS EXECUTIVE AND PHYSICIAN BENEFITS 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 19	GOVERNING DOCUMENTS DISCLOSURE EXPLANATION: DEACONESS HOSPITAL'S ARTICLES OF INCORPORATION ARE AVAILABLE ON THE SECRETARY OF STATE'S WEBSITE. DEACONESS HOSPITAL IS PART OF A CONSOLIDATED FINANCIAL STATEMENT WHICH IS AVAILABLE WITH THE PUBLIC DISCLOSURE COPY OF THE IRS FORM 990. ALSO, AS REQUIRED BY LAW, THE HOSPITAL SUBMITS ITS CONSOLIDATED FINANCIAL STATEMENTS TO THE INDIANA DEPARTMENT OF HEALTH WHICH ARE PUBLISHED ON ITS WEBSITE. GOVERNING DOCUMENTS, ASIDE FROM THE ARTICLES OF INCORPORATION, AND THE CONFLICT OF INTEREST POLICY ARE NOT AVAILABLE FOR PUBLIC INSPECTION.
FORM 990, PART IX, LINE 11G	PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 104,684,338. MANAGEMENT AND GENERAL EXPENSES 2,093,981. FUNDRAISING EXPENSES 44,221. TOTAL EXPENSES 106,822,540. PROFESSIONAL FEES- PHYSICIANS: PROGRAM SERVICE EXPENSES 15,228,020. MANAGEMENT AND GENERAL EXPENSES 28,978. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 15,256,998.
FORM 990, PART XI, LINE 9:	CHANGE IN PENSION LIABILITY 27,360,572. FOUNDATION MONIES GRANTED FROM RESTRICTION -3,512,332. CHANGE IN GENERAL FUND EQUITY -50,552,363.
FORM 990, PART XII, LINE 2C, 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.

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2019

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

Complete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
MediumBullet

Attach to Form 990.
MediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization

DEACONESS HOSPITAL INC

Employer identification number

35-0593390

Part I

Identification of Disregarded Entities. Complete if the organization answered "Yes" on Form 990, Part IV, line 33.

(a) Name, address, and EIN (if applicable) of disregarded entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Total income	(e) End-of-year assets	(f) Direct controlling entity
(1) REGIONAL EMERGENCY DEPARTMENT 600 MARY ST EVANSVILLE,IN47710 46-3509500	HEALTHCARE	IN	0	0	DEACONESS HOSPITAL
(2) READY DEVELOPMENT OF INDIANA 600 MARY ST EVANSVILLE,IN47747 47-2040018	REAL ESTATE	IN	0	2,782,509	DEACONESS HOSPITAL
(3) HEART HOSPITAL AT DEACONESS GATEWAY LLC 4007 GATEWAY BLVD NEWBURGH,IN47630 26-1766835	HOSPITAL	DE	6,440,759	14,675,647	DEACONESS HOSPITAL

Part II

Identification of Related Tax-Exempt Organizations. Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	(g) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	Yes	No
(1)DEACONESS HEALTH SYSTEM INC 600 MARY STREET EVANSVILLE,IN47747 35-1532889	HEALTHCARE	IN	501(C)(3)	LINE 12B, II	N/A		No
(2)DEACONESS CLINIC INC 421 CHESNUT STREET EVANSVILLE,IN47713 26-3083364	HEALTHCARE	IN	501(C)(3)	LINE 3	DEACONESS HEALTH SYSTEM		No
(3)DEACONESS REGIONAL HEALTHCARE SERVICES ILLINOIS INC 600 MARY STREET EVANSVILLE,IN47747 81-0693478	HEALTHCARE	IL	501(C)(3)	LINE 10	DEACONESS HEALTH SYSTEM		No
(4)DEACONESS VNA PLUS LLC 610 E WALNUT ST EVANSVILLE,IN47713 46-5223267	HEALTHCARE	IN	501(C)(3)	LINE 11	DEACONESS HEALTH SYSTEM		No
(5)DEACONESS SPECIALTY PHYSICIANS INC 600 MARY STREET EVANSVILLE,IN47747 82-4503095	HEALTHCARE	IN	501(C)(3)	LINE 3	DEACONESS HEALTH SYSTEM		No
(6)DEACONESS HEALTH KENTUCKY INC 600 MARY STREET EVANSVILLE,IN47747 83-0966826	HEALTHCARE	IN	501(C)(3)	LINE 3	DEACONESS HEALTH SYSTEM		No

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50135Y

Schedule R (Form 990) 2019

Page 2

Part III

Identification of Related Organizations Taxable as a Partnership. Complete if the organization answered "Yes" on Form 990, Part IV, line 34, because it had one or more related organizations treated as a partnership during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Predominant income(related, unrelated, excluded from tax under sections 512-514)	(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?		(k) Percentage ownership
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity		(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No
(1) DEACONESS HEALTH PLANS LLC 350 W COLUMBIA SUITE 400 EVANSVILLE,IN47710 38-3492529	PREFERRED PROVIDER NETWORK	IN	DEACONESS HOSPITAL	RELATED	601,919	2,158,084		No			No	95.150 %
(2) PROGRESSIVE HEALTH OF IN LLC 150 N ROSENBERGER EVANSVILLE,IN47712 20-8480988	OUTPATIENT	IN	DEACONESS HOSPITAL	RELATED	3,723,302	1,701,498		No			No	51.000 %
(3) TRI-STATE RADIATION ONCOLOGY 1500 ROSECRANS AVENUE MANHATTAN BEACH,CA90266 26-3706834	OUTPATIENT	DE	DEACONESS HOSPITAL	RELATED	4,593,904	4,541,029		No			No	51.000 %
(4) MAINSPRING MANAGERS LLC 4011 GATEWAY BLVD NEWBURGH,IN47630 46-4601001	NEUROLOGY SERVICES	IN	DEACONESS HOSPITAL	RELATED	980,216	902,206		No			No	51.000 %
(5) VASCMED LLC 600 MARY STREET EVANSVILLE,IN47747 47-2578168	VASCULAR SERVICES	IN	DEACONESS HOSPITAL	RELATED	576,326	891,356		No			No	51.000 %
(6) ORTHOALIGN LLC 4011 GATEWAY BLVD NEWBURGH,IN47630 81-2816013	HEALTHCARE	IN	DEACONESS HOSPITAL	RELATED	1,005,097	682,172		No			No	51.000 %

Part IV

Identification of Related Organizations Taxable as a Corporation or Trust. Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	(h) Percentage ownership	(i) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets		Yes	No
(1) TRI-STATE MEDICAL MANAGEMENT INC 600 MARY STREET EVANSVILLE,IN47747 35-1875888	PHYSICIAN MANAGEMENT	IN	DEACONESS HOSPITAL	C			100.000 %	Yes

Schedule R (Form 990) 2019

Page 3

Part V

Transactions With Related Organizations. Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35b, or 36.

Note. Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.

Yes

1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?

a Receipt of (i) interest, (ii) annuities, (iii) royalties, or (iv) rent from a controlled entity .....................

b Gift, grant, or capital contribution to related organization(s) ............................

c Gift, grant, or capital contribution from related organization(s) ............................

d Loans or loan guarantees to or for related organization(s) ............................

e Loans or loan guarantees by related organization(s) ............................

f Dividends from related organization(s) ............................

g Sale of assets to related organization(s) ............................

h Purchase of assets from related organization(s) ............................

i Exchange of assets with related organization(s) ............................

j Lease of facilities, equipment, or other assets to related organization(s) .......................

k Lease of facilities, equipment, or other assets from related organization(s) ......................

Yes

l Performance of services or membership or fundraising solicitations for related organization(s) .....................

m Performance of services or membership or fundraising solicitations by related organization(s) .................

n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) ...................

o Sharing of paid employees with related organization(s) ............................

Yes

p Reimbursement paid to related organization(s) for expenses ............................

Yes

q Reimbursement paid by related organization(s) for expenses ............................

Yes

r Other transfer of cash or property to related organization(s) ............................

s Other transfer of cash or property from related organization(s) ............................

If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.

(a) Name of related organization	(b) Transaction type (a-s)	(c) Amount involved
(1) HEART HOSP AT DEAC GATEWAY LLC	Q	7,840,198
(2) HEART HOSP AT DEAC GATEWAY LLC	P	4,430,935
(3) HEART HOSP AT DEAC GATEWAY LLC	O	727,562
(4) MAINSPRING MANAGERS LLC	Q	328,298
(5) VASCMED LLC	Q	364,428
(6) ORTHOALIGN LLC	Q	662,283

Schedule R (Form 990) 2019

Page 4

Part VI

Unrelated Organizations Taxable as a Partnership. Complete if the organization answered "Yes" on Form 990, Part IV, line 37.

Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.

(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(e) Are all partners section 501(c)(3) organizations?		(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?
(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	Yes	No	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No

Schedule R (Form 990) 2019

Page 5

Part VII

Supplemental Information

Provide additional information for responses to questions on Schedule R. (see instructions).

Return Reference	Explanation

Schedule R (Form 990) 2019

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: PROVIDE QUALITY HEALTH CARE SERVICES WITH A COMPASSIONATE AND CARING SPIRIT CONTINUE TO SCH O TO PERSONS, FAMILIES AND COMMUNITIES OF THE TRI-STATE.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	18
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	11
5	Total number of individuals employed in calendar year 2019 (Part V, line 2a) ......	5	6,024
6	Total number of volunteers (estimate if necessary) .............	6	159
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	14,059,337
b	Net unrelated business taxable income from Form 990-T, line 39 .........	7b	611,482

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	2,910,466	1,678,599
9	Program service revenue (Part VIII, line 2g) .........	711,560,184	828,361,410
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	29,035,655	24,356,181
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	66,397,275	82,114,245
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	809,903,580	936,510,435
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	1,169,958	1,303,395
14	Benefits paid to or for members (Part IX, column (A), line 4).....	0	0
15	Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10)	330,500,444	347,286,715
16a	Professional fundraising fees (Part IX, column (A), line 11e) .....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 545,728
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	382,530,737	433,400,766
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	714,201,139	781,990,876
19	Revenue less expenses. Subtract line 18 from line 12.......	95,702,441	154,519,559
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	1,461,525,378	1,596,773,714
21	Total liabilities (Part X, line 26).............	549,831,501	524,523,861
22	Net assets or fund balances. Subtract line 21 from line 20.....	911,693,877	1,072,249,853

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 201,919,752 including grants of $ 0 ) (Revenue $ 464,555,576 )
	PATIENT SERVICE REVENUE. SEE SCHEDULE O.

4b	(Code: ) (Expenses $ 521,962,762 including grants of $ 0 ) (Revenue $ 360,812,408 )
	CHARITY CARE/SUBSIDIZED CARE. SEE SCHEDULE O.

4c	(Code: ) (Expenses $ 12,736,351 including grants of $ 0 ) (Revenue $ 2,993,426 )
	GRADUATE MEDICAL EDUCATION, MEDICAL EDUCATION AND COMMUNITY BENEFIT. SEE SCHEDULE O.

	(Code: ) (Expenses $ 1,303,395 including grants of $ 1,303,395 ) (Revenue $ 37,457,241 )


4d	Other program services (Describe in Schedule O.)
	(Expenses $ 1,303,395 including grants of $ 1,303,395 ) (Revenue $ 37,457,241 )
4e	Total program service expenses737,922,260

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	11,104,348	2,006,589	1,551,941

1a	Federated campaigns..		1a
b	Membership dues..		1b
c	Fundraising events..		1c	311,593
d	Related organizations		1d
e	Government grants (contributions)		1e	147,121

f	All other contributions, gifts, grants, and similar amounts not included above		1f	1,219,885

g	Noncash contributions included in lines 1a - 1f:$		1g	362,395

h Total. Add lines 1a-1f.......		1,678,599

		Business Code
2a	NET PATIENT REVENUE	900099	828,361,410	828,361,410
b
c
d
e
f	All other program service revenue.
g	Total. Add lines 2a–2f .....		828,361,410

3 Investment income (including dividends, interest, and othersimilar amounts) ......			14,211,389			14,211,389
4 Income from investment of tax-exempt bond proceeds
5 Royalties...........
		(ii) Personal	(i) Real
6a	Gross rents		10,696,908	6a
b	Less: rental expenses		7,940,470	6b
c	Rental income or (loss)		2,756,438	6c
d	Net rental income or (loss).......			2,756,438			2,756,438
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory	176,449	321,858,773	7a
b	Less: cost or other basis and sales expenses	1,501,896	310,388,534	7b
c	Gain or (loss)	-1,325,447	11,470,239	7c
d	Net gain or (loss).........			10,144,792			10,144,792
8a	Gross income from fundraising events (not including $ 311,593of contributions reported on line 1c). See Part IV, line 18 ....
			8a	154,345
b	Less: direct expenses ...		8b	195,843
c	Net income or (loss) from fundraising events..			-41,498			-41,498
9a	Gross income from gaming activities. See Part IV, line 19 ...
			9a
b	Less: direct expenses ...		9b
c	Net income or (loss) from gaming activities..
10a	Gross sales of inventory, less returns and allowances ..
			10a
b	Less: cost of goods sold ..		10b
c	Net income or (loss) from sales of inventory..
Business Code			Miscellaneous Revenue
11a	INVESTMENT IN JOINT VENTURES		900099	33,354,238	33,354,238
b	OTHER HOSPITAL SERVICES		900099	31,977,614	4,103,003		27,874,611
c	LABORATORY SALES		621500	10,474,908		10,474,908
d	All other revenue ....			3,592,545		3,584,429	8,116
e	Total. Add lines 11a–11d ......			79,399,305
12	Total revenue. See instructions.....			936,510,435	865,818,651	14,059,337	54,953,848

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21 ....	1,303,395	1,303,395
2	Grants and other assistance to domestic individuals. See Part IV, line 22 ...........
3	Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See Part IV, lines 15 and 16. .............
4	Benefits paid to or for members .......
5	Compensation of current officers, directors, trustees, and key employees ...........	6,861,058		6,861,058
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .........
7	Other salaries and wages........	259,305,074	247,067,238	11,893,315	344,521
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	21,087,459	20,184,549	890,477	12,433
9	Other employee benefits .......	42,134,319	39,450,320	2,683,999
10	Payroll taxes ...........	17,898,805	16,697,173	1,183,925	17,707
11	Fees for services (non-employees):
a	Management ......
b	Legal .........	1,872,326	8,221	1,864,105
c	Accounting ...........	302,114		302,114
d	Lobbying ...........	49,398		49,398
e	Professional fundraising services. See Part IV, line 17
f	Investment management fees ......	1,230,915		1,202,116	28,799
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	122,079,538	119,912,358	2,122,959	44,221
12	Advertising and promotion ....	1,346,218	59,685	1,286,533
13	Office expenses .......	13,230,594	11,682,464	1,507,179	40,951
14	Information technology ......	16,075,492	13,500,936	2,574,556
15	Royalties ..
16	Occupancy ...........	20,062,802	18,349,492	1,713,310
17	Travel ............	453,134	396,503	55,628	1,003
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .
19	Conferences, conventions, and meetings ....	976,005	639,831	334,137	2,037
20	Interest ...........	9,962,113	9,962,113
21	Payments to affiliates .......
22	Depreciation, depletion, and amortization ..	40,837,756	38,522,207	2,315,500	49
23	Insurance ...	3,009,234	2,980,771	28,463
24	Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a	MEDICAL/SURGICAL SUPPLI	143,517,367	143,517,367
b	MEDICAID ASSESSMENT FEE	28,356,399	28,356,399
c	EQUIP RENTAL/MAINTENANC	15,370,818	14,188,211	1,182,607
d	DUES & SUBSCRIPTIONS	775,116	364,154	408,354	2,608
e	All other expenses	13,893,427	10,778,873	3,063,155	51,399
25	Total functional expenses. Add lines 1 through 24e	781,990,876	737,922,260	43,522,888	545,728
26	Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here if following SOP 98-2 (ASC 958-720).

1	Cash–non-interest-bearing ........				1
2	Savings and temporary cash investments .........			143,784,349	2	72,567,000
3	Pledges and grants receivable, net ......				3
4	Accounts receivable, net .............			117,580,516	4	138,315,501
5	Loans and other payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .......
					5
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), and persons described in section 4958(c)(3)(B) ...
					6
7	Notes and loans receivable, net ...........			2,553,632	7	3,900,237
8	Inventories for sale or use ............			7,553,394	8	9,085,451
9	Prepaid expenses and deferred charges ......			12,525,786	9	12,417,895
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	1,074,454,565
b	Less: accumulated depreciation	10b	564,440,757	430,153,528	10c	510,013,808
11	Investments—publicly traded securities .			652,232,266	11	736,137,013
12	Investments—other securities. See Part IV, line 11 .....			45,875,146	12	42,457,424
13	Investments—program-related. See Part IV, line 11 ..				13
14	Intangible assets ...............			18,509,986	14	48,206,614
15	Other assets. See Part IV, line 11 ...........			30,756,775	15	23,672,771
16	Total assets. Add lines 1 through 15 (must equal line 33)...			1,461,525,378	16	1,596,773,714

17	Accounts payable and accrued expenses .....	88,495,220	17	96,177,167
18	Grants payable ...		18
19	Deferred revenue .........	1,602,216	19	1,472,480
20	Tax-exempt bond liabilities .........	305,260,994	20	300,504,348
21	Escrow or custodial account liability. Complete Part IV of Schedule D		21
22	Loans and other payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .........
			22
23	Secured mortgages and notes payable to unrelated third parties ..		23
24	Unsecured notes and loans payable to unrelated third parties ..		24
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17 - 24). Complete Part X of Schedule D	154,473,071	25	126,369,866
26	Total liabilities. Add lines 17 through 25..	549,831,501	26	524,523,861

	Organizations that follow FASB ASC 958, check here and complete lines 27, 28, 32, and 33.
27	Net assets without donor restrictions ..........		27
28	Net assets with donor restrictions ...........		28
	Organizations that do not follow FASB ASC 958, check here and complete lines 29 through 33.
29	Capital stock or trust principal, or current funds .....		29
30	Paid-in or capital surplus, or land, building or equipment fund ...		30
31	Retained earnings, endowment, accumulated income, or other funds		31
32	Total net assets or fund balances ...........	911,693,877	32	1,072,249,853
33	Total liabilities and net assets/fund balances ........	1,461,525,378	33	1,596,773,714