TY 2018 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	33.00 ................. 22.00	X	X	776,080	371,300	213,381
(2) DANIEL HERMANN...................................................................... CHAIRMAN	3.00 ................. 2.00	X		0	0	0
(3) SHARON REED WALKER...................................................................... TREASURER	3.00 ................. 2.00	X		0	0	0
(4) DR LINDA BENNETT...................................................................... SECRETARY	3.00 ................. 2.00	X		0	0	0
(5) BRUCE ADYE MD...................................................................... DIRECTOR	3.00 ................. 2.00	X		3,150	0	0
(6) MAQBOOL AHMED MD...................................................................... DIRECTOR	3.00 ................. 53.00	X		720	779,955	42,859
(7) CURTIS BEGLE...................................................................... DIRECTOR-TERM BEGAN JAN'19	3.00 ................. 2.00	X		0	0	0
(8) JEROME BENKERT JR...................................................................... DIRECTOR-TERM BEGAN OCT'18	3.00 ................. 2.00	X		0	0	0
(9) STEVEN CHURCH...................................................................... DIRECTOR	3.00 ................. 2.00	X		0	0	0
(10) SCOTT CORDTS MD...................................................................... DIRECTOR-TERM BEGAN OCT'18	53.00 ................. 2.00	X		264,118	0	44,743
(11) TERI HOLLANDER ALBIN...................................................................... DIRECTOR	3.00 ................. 2.00	X		0	0	0
(12) ANTHONY KAISER MD...................................................................... DIRECTOR	3.00 ................. 2.00	X		0	0	0
(13) DAVE PAPARIELLA...................................................................... DIRECTOR-TERM BEGAN OCT'18	3.00 ................. 2.00	X		0	0	0
(14) BARRY PHILLIPS MD...................................................................... DIRECTOR	3.00 ................. 53.00	X		7,200	456,705	42,831
(15) JAMES RYAN III...................................................................... DIRECTOR	3.00 ................. 2.00	X		0	0	0
(16) DAVID RYON MD...................................................................... DIRECTOR	53.00 ................. 2.00	X		427,740	11,950	47,556
(17) ERIC SCHACH...................................................................... DIRECTOR	3.00 ................. 2.00	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	3.00 .......................3.00	X					0	0	0
(19) JONATHAN WEINZAPFEL........................................................................ DIRECTOR	3.00 .......................2.00	X					0	0	0
(20) JOHN ENGELBRECHT........................................................................ TREASURER-TERM ENDED OCT'18	3.00 .......................2.00	X					0	0	0
(21) MATHIAS KOLLECK II MD........................................................................ DIRECTOR-TERM ENDED OCT'18	53.00 .......................2.00	X					466,613	6,400	53,099
(22) CHERYL WATHEN........................................................................ CHIEF FINANCIAL OFFICER	30.00 .......................25.00		X				470,210	262,337	168,560
(23) JAMES PORTER MD........................................................................ PRESIDENT OF DEACONESS HEALTH	50.00 .......................3.00		X				1,098,818	2,800	176,617
(24) CHERONA HAJEWSKI........................................................................ CHIEF NURSING OFFICER	50.00 .......................0.00		X				525,022	0	112,593
(25) LYNN LINGAFELTER........................................................................ CHIEF OPERATION OFFICER	50.00 .......................4.00		X				515,346	4,000	95,251
(26) HERMAN BLANTON MD........................................................................ CHIEF MEDICAL OFFICER	50.00 .......................3.00		X				460,970	0	103,534
(27) MARC FLORENCE........................................................................ VICE PRESIDENT	50.00 .......................7.00		X				383,362	0	94,534
(28) KATHY SCHENK........................................................................ HR DIRECTOR	50.00 .......................0.00			X			161,675	0	38,169
(29) KENNETH DICKEN........................................................................ CONTROLLER, DIRECTOR FINAN	50.00 .......................0.00			X			287,411	3,400	42,290
(30) RICHARD PERRY........................................................................ CONTROLLER, PHYSICIAN PRAC	50.00 .......................0.00			X			214,937	0	27,185
(31) CAROLYN MORTON........................................................................ PHARMACY AND LAB DIRECTOR	50.00 .......................0.00			X			216,707	0	45,971
(32) SUSAN BRUMLEY........................................................................ IMAGING AND CARDIOVASCULAR	50.00 .......................0.00			X			180,471	0	34,283
(33) DOUGLAS WELP........................................................................ IN-HOUSE COUNSEL	50.00 .......................0.00			X			288,702	0	24,829
(34) VENKATESH MADADI MD........................................................................ ANESTHESIOLOGIST	50.00 .......................0.00				X		884,891	0	52,671
(35) NIRMAL JOSHI MD........................................................................ ANESTHESIOLOGIST	50.00 .......................0.00				X		776,718	0	49,831
(36) KISHWAR NAZ MD........................................................................ ANESTHESIOLOGIST	50.00 .......................0.00				X		756,905	0	35,913
(37) RAJESH PATEL MD........................................................................ ANESTHESIOLOGIST	50.00 .......................0.00				X		713,024	0	52,237
(38) DAVID FISH MD........................................................................ ANESTHESIOLOGIST	50.00 .......................0.00				X		717,809	0	37,763
(39) LINDA WHITE........................................................................ FORMER CEO EMERITA	50.00 .......................1.00					X	194,928	4,000	14,796
(40) BRUCE EPMEIER........................................................................ FORMER OFFICER	0.00 .......................0.00					X	156,420	2,000	0

(A) Name and business address	(B) Description of services	(C) Compensation
BARTON MALOW COMPANY 26500 AMERICAN DR SOUTHFIELD,MI48034	CONSTRUCTION SERVICES	42,878,978
EVANSVILLE SURGERY CENTER PO BOX 2185 EVANSVILLE,IN47728	SURGICAL SERVICES	31,637,919
PROGRESSIVE HEALTH INDIANA LLC 150 N ROSENBERGER AVE EVANSVILLE,IN47712	PHYSICAL THERAPY	16,153,706
EVOLENT HEALTH LLC 800 GLEBE RD SUITE 500 ARLINGTON,VA22203	CONSULTING SERVICES	13,829,116
ORTHOALIGN LLC 4011 GATEWAY BLVD NEWBURGH,IN47630	MEDICAL SERVICES	13,751,533
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 166

- 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 the latest information.

OMB No. 1545-0047

2018

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) 2018

Page 2

Part II

Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv), 170(b)(1)(A)(vi), and 170(b)(1)(A)(ix)
(Complete only if you checked the box on line 5, 7, 8, or 9 of Part I or if the organization failed to qualify under Part III. If the organization fails to qualify under the tests listed below, please complete Part III.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2014	(b) 2015	(c) 2016	(d) 2017	(e) 2018	(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) 2014	(b) 2015	(c) 2016	(d) 2017	(e) 2018	(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 2018 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2017 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2018. 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—2017. 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—2018. 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—2017. 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) 2018

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) 2014	(b) 2015	(c) 2016	(d) 2017	(e) 2018	(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) 2014	(b) 2015	(c) 2016	(d) 2017	(e) 2018	(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 2018 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2017 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2018 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2017 Schedule A, Part III, line 17 .............

19a

331/3% support tests—2018. 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—2017. 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) 2018

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) 2018

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) 2018

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) 2018

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 2018 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-2018	(iii) Distributable Amount for 2018
1 Distributable amount for 2018 from Section C, line 6
2 Underdistributions, if any, for years prior to 2018 (reasonable cause required-- explain in Part VI). See instructions.
3 Excess distributions carryover, if any, to 2018:
a From 2013.......
b From 2014.......
c From 2015.......
d From 2016.......
e From 2017.......
fTotal of lines 3a through e
g Applied to underdistributions of prior years
h Applied to 2018 distributable amount
i Carryover from 2013 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from 3f.
4Distributions for 2018 from Section D, line 7:
$
a Applied to underdistributions of prior years
b Applied to 2018 distributable amount
c Remainder. Subtract lines 4a and 4b from 4.
5 Remaining underdistributions for years prior to 2018, 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 2018. 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 2019. Add lines 3j and 4c.
8 Breakdown of line 7:
a Excess from 2014......
b Excess from 2015.....
c Excess from 2016.....
d Excess from 2017.....
e Excess from 2018.....

Schedule A (Form 990 or 990-EZ) (2018)

Schedule A (Form 990 or 990-EZ) 2018

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) 2018

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

2018

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) (2018)

Schedule B (Form 990, 990-EZ, or 990-PF) (2018) Page 2

Name of organization DEACONESS HOSPITAL INC

Part I	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
RESTRICTED	,	$ RESTRICTED	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) (2018)

Schedule B (Form 990, 990-EZ, or 990-PF) (2018)

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) (2018)

Schedule B (Form 990, 990-EZ, or 990-PF) (2018)

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) (2018)

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

2018

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) 2018

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) 2015	(b) 2016	(c) 2017	(d) 2018	(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) 2018

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

(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

32,802

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

32,802

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) 2018

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 the latest information.

OMB No. 1545-0047

2018

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 SFAS 116 (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 SFAS 116 (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 SFAS 116 (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) 2018

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 ....	7,914,040	7,389,906	6,877,438	6,660,917	6,749,437
b	Contributions ...	1,075	120	1,200	50	1,327
c	Net investment earnings, gains, and losses	195,423	606,614	705,719	445,045	-39,488
d	Grants or scholarships ...
e	Other expenditures for facilities and programs ...	73,258	82,600	194,451	228,574	50,341
f	Administrative expenses ....					18
g	End of year balance ......	8,037,280	7,914,040	7,389,906	6,877,438	6,660,917

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 %

Temporarily restricted endowment SchDMd Bullet

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 .....	4,714,090	17,708,691		22,422,781
b	Buildings ....	55,374,725	664,613,885	351,731,504	368,257,106
c	Leasehold improvements
d	Equipment ....		303,418,973	229,343,495	74,075,478
e	Other .....		40,075,612		40,075,612
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..					504,830,977

Schedule D (Form 990) 2018

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
(A)
(B)
(C)
(D)
(E)
(F)
(G)
(H)
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

(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
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

(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
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
ACCRUED RETIREMENT BENEFITS	109,134,507
ESTIMATED THIRD PARTY SETTLEMENTS	1,203,209
RELATED ORGANIZATION PAYABLES	1,276,706
TAXABLE BOND- SERIES 2016	52,500,000
DEBT ISSUE COSTS	-60,791
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	164,053,631
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) 2018

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:	THE DEACONESS HOSPITAL FOUNDATION UTILIZES ENDOWMENT FUNDS TO SUPPORT AND BENEFIT THE MISSION OF DEACONESS HOSPITAL. SPECIFICALLY, ENDOWMENT FUNDS ARE USED TO HELP SUPPORT ACTIVITIES OR PROJECTS THAT HELP TO PROVIDE QUALITY HEALTH CARE SERVICES WITH A COMPASSIONATE AND CARING SPIRIT TO PERSONS, FAMILIES AND COMMUNITIES OF THE TRI-STATE.
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, 2019 AND 2018, 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) 2018

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

2018

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 ten 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) 2018

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 . . . . .	242,100	248,534	490,634
2	Less: Contributions . . . .	121,350	223,374	344,724
3	Gross income (line 1 minus line 2) . . . . . .	120,750	25,160	145,910

4	Cash prizes . . . . .		950	950
5	Noncash prizes . . . .	6,500	32,510	39,010
6	Rent/facility costs . . . .	102,483	34,833	137,316
7	Food and beverages . . .	1,215	939	2,154
8	Entertainment . . . .	19,945	9,945	29,890
9	Other direct expenses . . .	4,721	8,219	12,940
10	Direct expense summary. Add lines 4 through 9 in column (d) . . . . . . . . . .			222,260
11	Net income summary. Subtract line 10 from line 3, column (d). . . . . . . . . .			-76,350

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) 2018

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) 2018

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

2018

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? . . . . . .

Yes

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) . . .	18,597,815		18,597,815	2.090 %
b	Medicaid (from Worksheet 3, column a) . . . . .	159,113,870	121,246,851	37,867,019	4.260 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) . .
d	Total Financial Assistance and Means-Tested Government Programs . . . . .	177,711,685	121,246,851	56,464,834	6.350 %
Other Benefits
e	Community health improvement services and community benefit operations (from Worksheet 4).	914,759		914,759	0.100 %
f	Health professions education (from Worksheet 5) . . .	7,578,963	2,428,939	5,150,024	0.580 %
g	Subsidized health services (from Worksheet 6) . . . .	211,935		211,935	0.020 %
h	Research (from Worksheet 7) .
i	Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .	1,699,525	31,041	1,668,484	0.190 %
j	Total. Other Benefits . .	10,405,182	2,459,980	7,945,202	0.890 %
k	Total. Add lines 7d and 7j .	188,116,867	123,706,831	64,410,036	7.240 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2018

Schedule H (Form 990) 2018

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	1,330		1,330	0 %
2	Economic development	6,970		6,970	0 %
3	Community support	46,477		46,477	0.010 %
4	Environmental improvements
5	Leadership development and training for community members	7,500		7,500	0 %
6	Coalition building
7	Community health improvement advocacy
8	Workforce development	85,824	33,150	52,674	0.010 %
9	Other
10	Total	148,101	33,150	114,951	0.020 %

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

Did the organization report bad debt expense in accordance with Heathcare 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. ......

22,392,598

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).....

223,243,321

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

217,875,231

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

5,368,090

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) 2018

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 20-005074-1	X	X	X	X
2	DEACONESS GATEWAY HOSPITAL 4011 GATEWAY BLVD NEWBURGH,IN47630 WWW.DEACONESS.COM 20-005074-1	X	X	X	X
3	DEACONESS CROSS POINTE 7200 E INDIANA STREET EVANSVILLE,IN47715 WWW.DEACONESS.COM 20-005074-1	X
4	THE HEART HOSPITAL 4007 GATEWAY BLVD NEWBURGH,IN47630 WWW.DEACONESS.COM 18-011772-1	X

Schedule H (Form 990) 2018

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 18

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 18

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) 2018

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) 2018

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

Made a reasonable effort to orally notify individuals about the FAP and FAP application process

Processed incomplete and complete FAP applications

Made presumptive eligibility determinations

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) 2018

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) 2018

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 18

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 18

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) 2018

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) 2018

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

Made a reasonable effort to orally notify individuals about the FAP and FAP application process

Processed incomplete and complete FAP applications

Made presumptive eligibility determinations

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) 2018

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) 2018

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 18

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 18

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) 2018

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) 2018

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

Made a reasonable effort to orally notify individuals about the FAP and FAP application process

Processed incomplete and complete FAP applications

Made presumptive eligibility determinations

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) 2018

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) 2018

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 18

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 18

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) 2018

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) 2018

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

Made a reasonable effort to orally notify individuals about the FAP and FAP application process

Processed incomplete and complete FAP applications

Made presumptive eligibility determinations

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) 2018

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) 2018

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, 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: CHNA PARTNERS CONDUCTING THE CHNA NECESSITATED COLLABORATION WITH A WIDE RANGE OF PUBLIC HEALTH AND SOCIAL SERVICE PARTNERS TO ENSURE THAT DIVERSE SCIENTIFIC AND COMMUNITY-BASED INSIGHTS WERE INCLUDED THROUGHOUT THE PROCESS. OF PARTICULAR IMPORTANCE WAS THE INCLUSION OF INDIVIDUALS WHO DIRECTLY OR INDIRECTLY REPRESENTED THE NEEDS OF THREE IMPORTANT GROUPS: 1) THOSE WITH PARTICULAR EXPERTISE IN PUBLIC HEALTH PRACTICE AND RESEARCH, 2) THOSE WHO ARE MEDICALLY UNDERSERVED, LOW-INCOME, OR CONSIDERED AMONG THE MINORITY POPULATIONS SERVED BY THE HOSPITAL, AND 3) THE BROADER COMMUNITY AT LARGE AND THOSE WHO REPRESENT THE BROAD INTERESTS AND NEEDS OF THE COMMUNITY SERVED.KEY PARTNER ORGANIZATIONS INCLUDED:-THE UNIVERSITY OF EVANSVILLE. FACULTY, STAFF, AND STUDENTS IN PUBLIC HEALTH AREAS COLLABORATED WITH THE HOSPITAL ON THE DATA-ORIENTED ASPECTS OF THE PROJECT.-INDIANA UNIVERSITY SCHOOL OF PUBLIC HEALTH. FACULTY AND STUDENTS COLLABORATED WITH THE HOSPITAL THROUGHOUT THE SURVEY PROCESS.-INDIANA UNIVERSITY CENTER FOR SURVEY RESEARCH. FACULTY AND STAFF PROVIDED IN-DEPTH TECHNICAL ASSISTANCE AND GUIDANCE THROUGHOUT THE SURVEY PROCESS, AND WORKED CLOSELY WITH THE HOSPITALS AND THE UNIVERSITY OF EVANSVILLE TO FIELD THE COMMUNITY HEALTH SURVEY.-MEASURES MATTER, LLC. MEASURES MATTER IS A COMMUNITY-BASED RESEARCH CONSULTING FIRM BASED IN BLOOMINGTON, INDIANA AND PALM SPRINGS, CALIFORNIA. MEASURES MATTER CONDUCTED AN INDEPENDENT ANALYSIS OF THE SURVEY DATA AND ALSO FACILITATED THE PRIORITIZATION PROCESS WITH THE HOSPITAL AND ITS PARTNERS.-COUNTY HEALTH DEPARTMENTS. REPRESENTATIVES OF THE VANDERBURGH COUNTY HEALTH DEPARTMENT WERE PARTNERS IN THE LARGER NETWORK OF ORGANIZATIONS AND HOSPITALS THAT WORKED TO ENHANCE CONSISTENCY IN STATEWIDE CHNA ACTIVITIES, PARTICULARLY THE CHNA COMMUNITY SURVEY AND FOCUS GROUPS. ADDITIONALLY, GIVEN THAT THE SURVEY PROCESS WAS COORDINATED IN CONJUNCTION WITH MULTIPLE OTHER HOSPITAL SYSTEMS AND LOCAL ORGANIZATIONS THROUGHOUT THE STATE, OTHER HEALTH DEPARTMENTS INVOLVED IN THE PROCESS INCLUDED THOSE FROM TIPPECANOE, CLAY, FOUNTAIN, WARREN, HOWARD, JENNINGS, LAWRENCE, MADISON, RANDOLPH, WASHINGTON, WARRICK, HAMILTON, AND MARION COUNTIES.-COMMUNITY HEALTH AND SOCIAL SERVICE ORGANIZATIONS. A WIDE RANGE OF COMMUNITY-BASED HEALTH AND SOCIAL SERVICE ORGANIZATIONS COLLABORATED THROUGHOUT THE CHNA PROCESS TO CONSIDER DATA FROM THE CHNA, MAKE DECISIONS REGARDING HEALTH PRIORITIES, AND INITIATE CONSIDERATIONS OF SUBSEQUENT ACTIONS BASED ON THE CHNA.CHNA PRIORITIZATION PROCESS ATTENDEES:LISA MAISH, DEACONESSLISA MEYER, ST. VINCENT EVVASHLEY TENBARGE, ST. VINCENT EVVLORI GRIMM, DEACONESS THE WOMEN'S HOSPITALDR. KEN SPEAR, VANDERBURGH COUNTY HEALTH DEPARTMENTJILL BUTTRY, DEACONESSANDREA HAYS, WELBORN BAPTIST FOUNDATIONAMY CANTERBURY, UNITED WAY OF SWIDR. CHAD PERKINS, ST. VINCENT EVVSANDEE STRADER-MCMILLEN, ECHO HEALTHPAM HIGHT, DEACONESSJANET RAISOR, ST. VINCENT EVVDR. MARIA DEL RIO HOOVER, ST. VINCENT EVVSABRINA JONES, ST. VINCENT EVVSCOTT BRANAM, DEACONESS CROSS POINTEASHLEY JOHNSON, DEACONESSJENNA ALVIA ST. VINCENT WARRICKDR. CARRIE ANN LAWRENCE, IU SCHOOL OF PUBLIC HEALTH - FACILITATOR
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:EIGHT HEALTH SYSTEMS WORKED TOGETHER TO ADMINISTER THE SAME CHNA SURVEY TO RESIDENTS IN 31 INDIANA COUNTIES. PARTICIPATING HEALTH SYSTEMS (IN ADDITION TO DEACONESS HEALTH SYSTEM) INCLUDED ASCENSION/ST. VINCENT, GIBSON GENERAL HOSPITAL, FRANCISCAN HEALTH, NORTH CENTRAL HEALTH SERVICES D.B.A. RIVER BEND HOSPITAL, IU HEALTH, COMMUNITY HEALTH NETWORK, AND RIVERVIEW HEALTH.
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: KEY PARTNER ORGANIZATIONS INCLUDED THE UNIVERSITY OF EVANSVILLE, INDIANA UNIVERSITY SCHOOL OF PUBLIC HEALTH, INDIANA UNIVERSITY CENTER FOR SURVEY RESEARCH, MEASURES MATTER, LLC. OTHER LOCAL ORGANIZATIONS PARTICIPATED IN OUR FOCUS GROUPS AND PRIORITIZATION SESSIONS.
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 HTTP://WWW.DEACONESS.COM/CHNACOPIES AND REQUESTS FOR COPIES WERE ALSO MADE AVAILABLE AT THE JUNE 2019 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 HTTP://WWW.DEACONESS.COM/CHNACOPIES AND REQUESTS FOR COPIES WERE ALSO MADE AVAILABLE AT THE JUNE 2019 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 HTTP://WWW.DEACONESS.COM/CHNACOPIES AND REQUESTS FOR COPIES WERE ALSO MADE AVAILABLE AT THE JUNE 2019 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 HTTP://WWW.DEACONESS.COM/CHNACOPIES AND REQUESTS FOR COPIES WERE ALSO MADE AVAILABLE AT THE JUNE 2019 PRESS CONFERENCE. MEDIA AND COMMUNITY AND THE PUBLIC WERE INVITED TO ATTEND.
DEACONESS HOSPITAL, INC.	PART V, SECTION B, LINE 11: WE ARE USING OUR IMPLEMENTATION PLAN TO GUIDE WORK IN THE IDENTIFIED AREAS OF NEED. THIS IS YEAR ONE OF THE NEW CYCLE AND INVOLVES A LOT OF MEETINGS AND PLANNING.VANDERBURGH COUNTY - FROM THE FIVE ENDORSED ISSUES IDENTIFIED FOR PRIORITIZATION, THE GROUP SELECTED MENTAL HEALTH, SUBSTANCE ABUSE, AND FOOD INSECURITY AS OUR PRIMARY POINTS OF FOCUS FOR THE NEXT CHNA PERIOD. IMPROVEMENT IN CHRONIC HEALTH CONDITIONS SHOULD BE A BY-PRODUCT OF SUCCESSFUL WORK IN THE OTHER THREE AREAS AND "POVERTY" CONSISTS OF MORE VARIABLES THAN THIS GROUP CAN ADDRESS.WARRICK COUNTY FROM THE FOUR ENDORSED ISSUES IDENTIFIED FOR PRIORITIZATION, THE GROUP SELECTED MENTAL HEALTH, SUBSTANCE ABUSE, AND ACCESS TO CARE AS OUR PRIMARY POINTS OF FOCUS FOR THE NEXT CHNA PERIOD. IMPROVEMENT IN CHRONIC HEALTH CONDITIONS SHOULD BE A BY-PRODUCT OF SUCCESSFUL WORK IN THE OTHER THREE AREAS.
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 19 IMPACTED THE LIVES OF MORE THAN 10,110 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

Schedule H (Form 990) 2018

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 - CARDIAC REHAB 4015 GATEWAY BLVD SUITE 2122 NEWBURGH,IN47630	OUTPATIENT SERVICES
2	2 - DEACONESS FAMILY MEDICINE RESIDENCY 415 W COLUMBIA ST SUITE 110 EVANSVILLE,IN47710	OUTPATIENT PHYSICIAN CLINIC
3	3 - DEACONESS HOSPITAL ANTICOAGMED THERAPY 350 W COLUMBIA ST SUITE 230 EVANSVILLE,IN47747	OUTPATIENT SERVICES
4	4 - DEACONESS ANTICOAGULATION CLINIC 4107 GATEWAY BLVD NEWBURGH,IN47630	OUTPATIENT SERVICES
5	5 - DEACONESS HOSPITAL BREAST CENTER 520 MARY STREET SUITE 140 EVANSVILLE,IN47710	DIAGNOSTIC CENTER
6	6 - DEACONESS HOSPITAL CANCER SERVICES 4055 GATEWAY BLVD NEWBURGH,IN47630	OUTPATIENT SERVICES
7	7 - DEACONESS HOSPITAL CANCER SERVICES 421 CHESTNUT STREET EVANSVILLE,IN47713	OUTPATIENT SERVICES
8	8 - DEACONESS COMPREHENSIVE PAIN CTR-GATEWAY 4099 GATEWAY BLVD NEWBURGH,IN47630	OUTPATIENT SERVICES
9	9 - DEACONESS COMPREHENSIVE PAIN CTR & PROG 4600 W LLOYD EXPRESSWAY SUITE A EVANSVILLE,IN47712	OUTPATIENT SERVICES
10	10 - DEACONESS CROSS POINTE OUTPATIENT CLINIC 445 CROSS POINTE BLVD EVANSVILLE,IN47715	OUTPATIENT PHYSICIAN CLINIC
11	11 - DEACONESS DIABETES CENTER - EDUCATION 421 CHESTNUT STREET EVANSVILLE,IN47713	OUTPATIENT SERVICES
12	12 - DEACONESS GATEWAY GASTROENTEROLOGY 4133 GATEWAY BLVD SUITE 290 NEWBURGH,IN47630	OUTPATIENT SERVICES
13	13 - DEACONESS HOSPITAL MAMMOGRAPHY & IMAGING 421 CHESTNUT STREET EVANSVILLE,IN47713	DIAGNOSTIC CENTER
14	14 - DEACONESS HOSPITAL INFUSION CTRPHARMACY 4111 GATEWAY BLVD NEWBURGH,IN47630	OUTPATIENT SERVICES
15	15 - DEACONESS HOSPITAL RADIOLOGY EXPRESS 10455 ORTHOPAEDIC DRIVE NEWBURGH,IN47630	DIAGNOSTIC CENTER
16	16 - DEACONESS HOSPITAL PHYSICAL MEDICINE 520 MARY STREET SUITE 280 EVANSVILLE,IN47747	OUTPATIENT SERVICES
17	17 - DEACONESS HOSPITAL PHYS MED-OA 10455 ORTHOPAEDIC DRIVE NEWBURGH,IN47630	OUTPATIENT SERVICES
18	18 - DEACONESS HOSPITAL PHYSICAL MEDICINE 4600 W LLOYD EXPRESSWAY SUITE B EVANSVILLE,IN47715	OUTPATIENT SERVICES
19	19 - DEACONESS PRIMARY CARE FOR SENIORS 1750 OAK HILL ROAD EVANSVILLE,IN47710	OUTPATIENT PHYSICIAN CLINIC
20	20 - DEACONESS PRIMARY CARE FOR SENIORS 4498 FIRST AVENUE EVANSVILLE,IN47710	OUTPATIENT PHYSICIAN CLINIC
21	21 - DEACONESS PROCEDURE CENTER 421 CHESTNUT STREET EVANSVILLE,IN47713	OUTPATIENT SERVICES
22	22 - MIDWEST RADIOLOGICAL IMAGING 4087 GATEWAY BLVD NEWBURGH,IN47630	DIAGNOSTIC CENTER
23	23 - DEACONESS REGIONAL LABORATORY 421 CHESNUT STREET EVANSVILLE,IN47713	DIAGNOSTIC CENTER
24	24 - DEACONESS CLINIC GATEWAY REG LAB 4233 GATEWAY BLVD SUITE 201 NEWBURGH,IN47630	DIAGNOSTIC CENTER
25	25 - DEACONESS HOSPITAL LAB & EKGDIABETES EDUC 520 MARY STREET SUITE 330 EVANSVILLE,IN47710	DIAGNOSTIC CENTER
26	26 - DEACONESS RADIOLOGY LAB & RADIOLOGY 8600 NORTH KENTUCKY AVENUE EVANSVILLE,IN47725	DIAGNOSTIC CENTER
27	27 - DEACONESS REGIONAL LABORATORY 4494 N FIRST AVENUE EVANSVILLE,IN47710	DIAGNOSTIC CENTER
28	28 - DEACONESS HOSPITAL LAB & RADIOLOGY 4209 GATEWAY BLVD NEWBURGH,IN47630	DIAGNOSTIC CENTER
29	29 - MT VERNON MEDICAL CENTER LAB & RADIOLOGY 1900 W FOURTH STREET MT VERNON,IN47620	DIAGNOSTIC CENTER
30	30 - DEACONESS REGIONAL LABORATORY 4133 GATEWAY BLVD SUITE 110 NEWBURGH,IN47630	DIAGNOSTIC CENTER
31	31 - DEACONESS RILEY CHILDRENS SPECIALTY CENT 4133 GATEWAY BLVD SUITE 220 NEWBURGH,IN47630	OUTPATIENT SERVICES
32	32 - DEACONESS SLEEP CENTER 350 W COLUMBIA STREET SUITE 100 EVANSVILLE,IN47710	OUTPATIENT SERVICES
33	33 - DEACONESS SLEEP CENTER-EAST 7307 E COLUMBIA ST EVANSVILLE,IN47715	DIAGNOSTIC CENTER
34	34 - DEACONESS SLEEP LAB 350 W COLUMBIA STREET SUITE LL-10 EVANSVILLE,IN47710	DIAGNOSTIC CENTER
35	35 - DEACONESS WEIGHT LOSS SOLUTIONS 310 W IOWA STREET EVANSVILLE,IN47710	OUTPATIENT PHYSICIAN CLINIC
36	36 - DEACONESS WOUND CARE CENTER 350 W COLUMBIA STREET SUITE 350 EVANSVILLE,IN47710	OUTPATIENT SERVICES

Schedule H (Form 990) 2018

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. HARD COPIES WERE MADE AVAILABLE AT THE PRESS CONFERENCE ON WEDNESDAY, JUNE 19, 2019.2. IS MADE AVAILABLE ON THE DEACONESS WEBSITE AT HTTP://WWW.DEACONESS.COM/CHNA
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 $0.
PART I, LN 7 COL(F):	BAD DEBT EXPENSE IS NOT INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A) DUE TO ADOPTION OF (ASU) 2014-09 TOPIC 606.
PART II, COMMUNITY BUILDING ACTIVITIES:	DEACONESS PROVIDES SUPPORT TO NUMEROUS ORGANIZATIONS THAT FOCUS ON EDUCATION, COMMUNITY IMPROVEMENTS, AND LEADERSHIP DEVELOPMENT. DEACONESS BELIEVES THAT IN SUPPORTING THESE LOCAL SCHOOLS AND ORGANIZATIONS WE ARE PROVIDING ASSISTANCE IN BETTERING OUR COMMUNITY AND OUR PATIENTS.HEALTH SCIENCE INSTITUTE DURING THE FISCAL YEAR, WE HELD THE 29TH ANNUAL HEALTH SCIENCE INSTITUTE (HSI), A HANDS-ON SUMMER PROGRAM FOR HIGH SCHOOL STUDENTS INTERESTED IN THE MEDICAL PROFESSION. THE 28 LOCAL 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 $36,000; HOWEVER, THE COST OF RUNNING THE TWO-WEEK PROGRAM IS CLOSER TO $72,500. DEACONESS CONTINUES TO OFFER HSI AT AN AVERAGE LOSS OF $36,500 EACH YEAR BECAUSE WE CONSIDER THE EXPENDITURE AN IMPORTANT INVESTMENT IN THE FUTURE OF MEDICINE.CNA PROGRAM AT HARWOOD PREP HIGH SCHOOL- DURING THE FISCAL YEAR WE DONATED $9,600 TO THE CNA (CERTIFIED NURSING ASSISTANT) PROGRAM AT HARWOOD HIGH SCHOOL. THIS SCHOLARSHIP WILL PROVIDE 4 STUDENTS ALL THE MATERIAL AND SUPPLIES THEY NEED TO FOCUS ON LEARNING IN THE CLASSROOM AND IN LAB SETTINGS.
PART III, LINE 2:	THE SYSTEM ESTIMATES THE TRANSACTION PRICE FOR PATIENTS WITH DEDUCTIBLES AND COINSURANCE AND FROM THOSE WHO ARE UNINSURED BASED ON HISTORICAL EXPERIENCE AND CURRENT MARKET CONDITIONS. THE INITIAL ESTIMATE OF THE TRANSACTION PRICE IS DETERMINED BY REDUCING THE STANDARD CHARGE BY ANY CONTRACTUAL ADJUSTMENTS, DISCOUNTS, AND IMPLICIT PRICE CONCESSIONS. SUBSEQUENT CHANGES TO THE ESTIMATE OF THE TRANSACTION PRICE ARE GENERALLY RECORDED AS ADJUSTMENTS TO NET PATIENT SERVICE REVENUE IN THE PERIOD OF THE CHANGE. SUBSEQUENT CHANGES THAT ARE SIGNIFICANT AND DETERMINED TO BE THE RESULT OF AN ADVERSE CHANGE IN THE PATIENT'S ABILITY TO PAY, DETERMINED ON A PORTFOLIO BASIS, ARE RECORDED AS BAD DEBT EXPENSE. CONSISTENT WITH THE SYSTEM'S MISSION, CARE IS PROVIDED TO PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. THEREFORE, THE SYSTEM HAS DETERMINED IT HAS PROVIDED IMPLICIT PRICE CONCESSIONS TO UNINSURED PATIENTS AND PATIENTS WITH OTHER UNINSURED BALANCES. THE IMPLICIT PRICE CONCESSIONS INCLUDED IN ESTIMATING THE TRANSACTION PRICE REPRESENT THE DIFFERENCE BETWEEN AMOUNTS BILLED TO PATIENTS AND THE AMOUNTS THE SYSTEM EXPECTS TO COLLECT BASED ON ITS COLLECTION HISTORY WITH THOSE PATIENTS.
PART III, LINE 3:	DEACONESS HOSPITAL DOES NOT ATTRIBUTE ANY BAD DEBT EXPENSE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY (FAP), THEREFORE NO PORTION OF BAD DEBT ATTRIBUTABLE TO FAP-ELIGIBLE INDIVIDUALS IS CONSIDERED A COMMUNITY BENEFIT.
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 12 AND "PATIENT ACCOUNTS RECEIVABLE AND NET PATIENT SERVICE REVENUE" STARTING ON PAGE 11.
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 2019 MEDICARE COST REPORT.
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. IN ADDITION TO THE VARIOUS PLACES THAT THE PROGRAM IS PUBLISHED, IT IS ALSO REFERENCED ON OUR PATIENT STATEMENT AND PHONE MESSAGE WHEN THE PATIENT CALL THE BILLING PHONE NUMBER.
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 VANDERBURGH COUNTY IS MORE DIVERSE THAN MUCH OF INDIANA IN TERMS OF RACIAL AND ETHNICITY CHARACTERISTICS, EVENLY SPLIT WITH REGARD TO GENDER, WITH THE MAJORITY OF INDIVIDUALS LIVING IN AREAS CONSIDERED URBAN. VANDERBURGH COUNTY'S POPULATION OF 181,616 PERSONS IS SIMILAR TO THE STATEWIDE POPULATION, WITH 84% OF THE POPULATION BEING WHITE, 9.5% BLACK/AFRICAN AMERICAN, 1.4% ASIAN, AND THE REMAINDER BEING OF OTHER OR 2 OR MORE RACES. HOWEVER, VANDERBURGH COUNTY REPORTS A 2.7% HISPANIC POPULATION COMPARED TO 7% 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%. ACCORDING TO THE 2019 COUNTY HEALTH RANKINGS, VANDERBURGH COUNTY RANKS 81 OUT OF 92 INDIANA COUNTIES FOR HEALTH OUTCOMES AND 68 OUT OF 92 INDIANA COUNTIES FOR HEALTH FACTORS. 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 22 OUT OF 92 INDIANA COUNTIES FOR HEALTH OUTCOMES AND 5 OUT OF 92 INDIANA COUNTIES FOR HEALTH FACTORS ON THE 2019 COUNTY HEALTH RANKINGS. 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. MORE THAN 92% OF PEOPLE THERE IDENTIFY AS WHITE COMPARED TO 79% FOR INDIANA. ONLY 1.5 % OF THE POPULATION IS LISTED AS BLACK/AFRICAN AMERICAN AND 1.9% AS HISPANIC. THAT'S COMPARED TO STATE AVERAGES OF 9.4% AND 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:	HEALTH FAIRS/SCREENINGS - APPROXIMATELY 14,775 PEOPLE WERE SERVED WITH EDUCATION AND/OR HEALTH SCREENINGS AT THE 42 HEALTH FAIRS DEACONESS ATTENDED AS A PROVIDER/EXHIBITOR DURING THE FISCAL YEAR.HOMELESS CONNECT AND COMMUNITY FIRST HEALTH FAIR - DEACONESS 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 CENTER - THE 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. SCREENING MAMMOGRAMS VIA MOBILE BREAST CENTER:2018 NUMBER SCREENEDOCTOBER - 323NOVEMBER - 173DECEMBER - 1422019 NUMBER SCREENEDJANUARY - 141FEBRUARY - 246MARCH - 207APRIL - 255MAY - 271JUNE - 248JULY - 234CANCER SCREENING EVENTS:HEAD & NECK, APRIL 2019 - ENT PHYSICIANS AND ONCOLOGISTS SCREENED 47 PEOPLESKIN, MAY 2019 - DERMATOLOGISTS AND NPS SCREENED 44 PEOPLELUNG (LOW-DOSE CT) 2019 JANUARY-MAY, 292 SCREENINGS PATIENT CARE - MEDICATION ASSISTANCE AND FAMILY MEDICINE RESIDENCY CLINIC. DEACONESS 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.EDUCATION DEACONESS DEDICATED MORE THAN 650 STAFF HOURS TO EMS AND FIRST RESPONDER EDUCATION. THIS INCLUDES INSTRUCTION FOR MORE THAN 5,200 PEOPLE RELATED TO TOPICS SUCH AS 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, AND ADMINISTERING NALOXONE FOR OPIOID OVERDOSE.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.CANCER EDUCATION COOKING FOR CHEMO WITH CHEF RYAN CALLAHAN, FEB 2019 (SPECIALIZED CLASS ON COOKING FOR CHEMO PATIENTS TO IMPROVE NUTRITION, SATISFACTION WITH EATING AND OUTCOMES)SKIN CANCER PREVENTION AND DETECTION, NP LECTURE AT GILDA'S CLUB, MAY 2019 ANXIETY, LECTURE BY LCSW AT GILDA'S CLUB, MAY 2019ANXIETY GROUNDING TECHNIQUES, LECTURE BY LCSW AT GILDA'S CLUB, MAY 2019NO SHAVE NOVEMBER, SEVERAL ONCOLOGISTS SPENT TIME DURING THE MONTH SPEAKING ABOUT THE IMPORTANCE OF EARLY DETECTIONFACEBOOK, BLOGS, E-NEWSLETTER, PODCASTS - WE FACILITATED MORE THAN 30 FACEBOOK LUNCH AND LEARN SESSIONS WITH PHYSICIANS AND PROVIDERS. DURING THE FISCAL YEAR, WE INTRODUCED SOMETHING NEW - FACEBOOK LIVE SESSIONS WHERE PHYSICIANS COULD ANSWER QUESTIONS IN REAL TIME. WE REPURPOSED THE SESSION INFORMATION INTO BLOGS AND ARTICLES FOR OUR MONTHLY E-NEWSLETTER. WE ALSO BEGAN PODCASTING FOR WOMEN'S TOPICS THROUGH THE WOMEN'S HOSPITAL. THESE SESSIONS DEDICATE TIME TO A SPECIFIC HEALTH TOPIC AND PROVIDE THE OPPORTUNITY FOR PEOPLE TO ENGAGE IN REAL TIME WITH SUBJECT-MATTER EXPERTS. BEHAVIORAL HEALTH AND SUICIDE PREVENTION - STAFF FROM DEACONESS CROSS POINTE SPENT APPROXIMATELY 900 HOURS EDUCATING THE SURROUNDING COMMUNITY ABOUT BEHAVIORAL HEALTH, RELATED RESOURCES, AND SUICIDE PREVENTION.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, 2019, THE HEARTSAVER COMMITTEE HAS RAISED ENOUGH MONEY AND PLACED 370 AEDS.LOCAL SPONSORSHIPS - IN FY18-19, DEACONESS SPONSORED PROGRAMS AND ACTIVITIES FOR NEARLY 150 REGIONAL ORGANIZATIONS, CONTRIBUTING MORE THAN $1.3 MILLION IN SUPPORT OF CLUBS, GROUPS, SOCIAL SERVICE ORGANIZATIONS, AND OTHERS STRIVING TO MAKE OUR COMMUNITY A BETTER PLACE.
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.DEACONESS HEALTH SYSTEM HAS PARTNERED WITH MANY RURAL HOSPITALS TO PROVIDE RESOURCES NEEDED SO THAT RESIDENTS IN THESE COMMUNITIES HAVE ACCESS TO CARE CLOSE TO HOME. THESE HOSPITALS INCLUDE FERRELL HOSPITAL AND LAWRENCE COUNTY HOSPITAL IN ILLINOIS, GIBSON COUNTY HOPSITAL IN INDIANA, AND METHODIST HOSPITAL IN KENTUCKY.
PART VI, LINE 7, REPORTS FILED WITH STATES	IN

Schedule H (Form 990) 2018

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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

2018

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)	12,550	GENERAL SUPPORT
(2) AMERICAN CANCER SOCIETY 5250 VOGEL RD SUITE A EVANSVILLE,IN47715	13-1788491	501(C)(3)	10,000	GENERAL SUPPORT
(3) AMERICAN HEART ASSOCIATION 7272 GREENVILLE AVE DALLAS,TX75231	13-5613797	501(C)(3)	7,500	GENERAL SUPPORT
(4) AMERICAN RED CROSS 29 S STOCKWELL RD EVANSVILLE,IN47714	53-0196605	501(C)(3)	10,000	GENERAL SUPPORT
(5) CHEMO BUDDIES 3699 EPWORTH RD NEWBURGH,IN47630	45-3043243	501(C)(3)	10,000	GENERAL SUPPORT
(6) CHILDREN'S MUSEUM OF EVANSVILLE 22 SE 5TH STREET EVANSVILLE,IN47701	35-1951848	501(C)(3)	19,750	KEYS TO FITNESS EXHIBIT & GENERAL SUPPORT
(7) COMMUNITY FOUNDATION ALLIANCE INC 5000 E VIRGINIA ST STE 4 EVANSVILLE,IN47715	35-1830262	501(C)(3)	30,000	COMMUNITY BRANDING INITIATIVE
(8) COMMUNITY PATIENT SAFETY COALITION 13113 BROWNING ROAD EVANSVILLE,IN47725	61-1646052	501(C)(3)	18,752	GENERAL SUPPORT
(9) ECHO COMMUNITY HEALTH CARE 315 MULBERRY STREET EVANSVILLE,IN47713	35-1791786	501(C)(3)	30,000	FAMILY PRACTCE - MULTICULTURAL CLINIC
(10) ECONOMIC DEVELOPMENT COALITION OF SOUTHWEST INDIANA 318 MAIN STREET SUITE 400 EVANSVILLE,IN47708	32-0152563	501(C)(6)	25,000	ONE REGION-ONE ECONOMY-ONE VOICE CAMPAIGN
(11) EVANSVILLE EMERGENCY FOOD PANTRY CONSORTIUM INC PO BOX 2536 EVANSVILLE,IN47728	37-1697515	501(C)(3)	10,000	FOOD FOR FOOD PANTRIES
(12) EVANSVILLE PARKS FOUNDATION INC PO BOX 3112 EVANSVILLE,IN47730	35-1520591	501(C)(3)	11,000	CAPITAL & GENERAL SUPPORT
(13) EVANSVILLE REGIONAL BUSINESS COMMITTEE INC ONE VECTREN SQUARE EVANSVILLE,IN47708	03-0408032	501(C)(3)	10,000	GENERAL SUPPORT
(14) EVANSVILLE VANDERBURGH SCHOOL CORP 1 SE NINTH STREET EVANSVILLE,IN47708	35-1071682	501(C)(3)	8,550	CLASSROOM SUPPLIES
(15) EVANSVILLE-AREA TRAILS COALITION INC PO BOX 5644 EVANSVILLE,IN47716	27-1556835	501(C)(3)	18,000	GENERAL SUPPORT
(16) EVANSVILLE-VANDERBURGH COUNTY CONVENTION & VISITORS COMMISSION 4300 HECKEL ROAD EVANSVILLE,IN47725	47-2582515	501(C)(3)	25,000	SUPPORT HEALTH TRAIL
(17) GOLF GIVES BACK INC ONE VECTREN SQUARE EVANSVILLE,IN47708	81-4223347	501(C)(3)	8,000	GENERAL SUPPORT
(18) INDIANA UNIVERSITY FOUNDATION PO BOX 500 BLOOMINGTON,IN47402	35-6018940	501(C)(3)	100,000	IUSM-EVANSVILLE FURNITURE & FIXTURE FUND
(19) JUNIOR ACHIEVEMENT OF SW INDIANA 431 E DIAMOND AVENUE EVANSVILLE,IN47711	35-6048156	501(C)(3)	9,970	INSPIRING OUR YOUTH PROGRAM & GENERAL SUPPORT
(20) JUVENILE DIABETES RESEARCH FOUNDATION 10401 N MERIDIAN ST STE 150 INDIANAPOLIS,IN46290	23-1907729	501(C)(3)	15,000	GENERAL SUPPORT
(21) KOMEN GREATER EVANSVILLE AFFILIATE 4424 VOGEL RD STE 205 EVANSVILLE,IN47715	75-2844632	501(C)(3)	15,875	GENERAL SUPPORT
(22) OTHERS 5000			139,789	GENERAL SUPPORT
(23) RONALD MCDONALD HOUSE CHARITIES OF THE OHIO VALLEY 3540 WASHINGTON AVENUE EVANSVILLE,IN477140136	35-1748468	501(C)(3)	23,600	GENERAL SUPPORT
(24) UNITED WAY OF SOUTHWESTERN INDIANA PO BOX 18 EVANSVILLE,IN47701	35-0868069	501(C)(3)	20,000	GENERAL SUPPORT
(25) UNIVERSITY OF SOUTHERN INDIANA FOUNDATION 8600 UNIVERSITY BOULEVARD EVANSVILLE,IN47712	23-7042320	501(C)(3)	41,250	HEALTH PROFESSION SCHOLARSHIPS & GENERAL SUPPORT
(26) WARRICK WELLNESS PATHWAYS LLC PO BOX 906 NEWBURGH,IN47629	46-4049559	501(C)(3)	50,000	SUPPORT HEALTH TRAIL
(27) WNIN TRI-STATE PUBLIC MEDIA 405 CARPENTER STREET EVANSVILLE,IN47705	35-1307165	501(C)(3)	26,000	GENERAL SUPPORT & CAPITAL CAMPAIGN
(28) YMCA OF SW INDIANA INC 222 NW 6TH ST EVANSVILLE,IN47708	35-0869074	501(C)(3)	17,500	GENERAL SUPPORT
(29) YOUTH FIRST 111 SE THIRD STREET STE 405 EVANSVILLE,IN47708	35-2050168	501(C)(3)	17,000	GENERAL SUPPORT
(30) YWCA 118 VINE ST EVANSVILLE,IN47708	35-0869075	501(C)(3)	12,500	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) 2018

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) 2018

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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

2018

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 in 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 in 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? ..................

Yes

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) 2018

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)	354,441 ------------- 362,500	245,980 ------------- 0	175,659 ------------- 8,800	91,390 ------------- 86,103	17,944 ------------- 17,944	885,414 ------------- 475,347	84,746 ------------- 84,746
2MAQBOOL AHMED MD DIRECTOR	(i) (ii)	0 ------------- 715,661	0 ------------- 53,411	720 ------------- 10,883	0 ------------- 19,248	0 ------------- 23,611	720 ------------- 822,814	0 ------------- 0
3SCOTT CORDTS MD DIRECTOR-TERM BEGAN OCT'18	(i) (ii)	230,368 ------------- 0	20,796 ------------- 0	12,954 ------------- 0	22,063 ------------- 0	22,680 ------------- 0	308,861 ------------- 0	0 ------------- 0
4BARRY PHILLIPS MD DIRECTOR	(i) (ii)	0 ------------- 359,305	0 ------------- 90,478	7,200 ------------- 6,922	0 ------------- 20,298	0 ------------- 22,533	7,200 ------------- 499,536	0 ------------- 0
5DAVID RYON MD DIRECTOR	(i) (ii)	293,679 ------------- 0	91,961 ------------- 0	42,100 ------------- 11,950	23,648 ------------- 0	23,908 ------------- 0	475,296 ------------- 11,950	0 ------------- 0
6MATHIAS KOLLECK II MD DIRECTOR-TERM ENDED OCT'18	(i) (ii)	272,330 ------------- 0	118,681 ------------- 0	75,602 ------------- 6,400	27,680 ------------- 0	25,419 ------------- 0	519,712 ------------- 6,400	0 ------------- 0
7CHERYL WATHEN CHIEF FINANCIAL OFFICER	(i) (ii)	245,126 ------------- 253,137	126,223 ------------- 0	98,861 ------------- 9,200	77,823 ------------- 54,607	18,065 ------------- 18,065	566,098 ------------- 335,009	47,554 ------------- 47,555
8JAMES PORTER MD PRESIDENT OF DEACONESS HEALTH	(i) (ii)	569,828 ------------- 0	170,242 ------------- 0	358,748 ------------- 2,800	145,111 ------------- 0	31,506 ------------- 0	1,275,435 ------------- 2,800	234,275 ------------- 0
9CHERONA HAJEWSKI CHIEF NURSING OFFICER	(i) (ii)	310,619 ------------- 0	78,574 ------------- 0	135,829 ------------- 0	86,956 ------------- 0	25,637 ------------- 0	637,615 ------------- 0	128,861 ------------- 0
10LYNN LINGAFELTER CHIEF OPERATION OFFICER	(i) (ii)	365,760 ------------- 0	87,755 ------------- 0	61,831 ------------- 4,000	84,286 ------------- 0	10,965 ------------- 0	610,597 ------------- 4,000	60,122 ------------- 0
11HERMAN BLANTON MD CHIEF MEDICAL OFFICER	(i) (ii)	357,266 ------------- 0	90,222 ------------- 0	13,482 ------------- 0	77,532 ------------- 0	26,002 ------------- 0	564,504 ------------- 0	4,251 ------------- 0
12MARC FLORENCE VICE PRESIDENT	(i) (ii)	279,247 ------------- 0	78,879 ------------- 0	25,236 ------------- 0	63,858 ------------- 0	30,676 ------------- 0	477,896 ------------- 0	21,597 ------------- 0
13KATHY SCHENK HR DIRECTOR	(i) (ii)	139,115 ------------- 0	21,839 ------------- 0	721 ------------- 0	14,489 ------------- 0	23,680 ------------- 0	199,844 ------------- 0	0 ------------- 0
14KENNETH DICKEN CONTROLLER, DIRECTOR FINAN	(i) (ii)	207,782 ------------- 0	28,805 ------------- 0	50,824 ------------- 3,400	18,332 ------------- 0	23,958 ------------- 0	329,701 ------------- 3,400	0 ------------- 0
15RICHARD PERRY CONTROLLER, PHYSICIAN PRAC	(i) (ii)	186,396 ------------- 0	26,817 ------------- 0	1,724 ------------- 0	17,069 ------------- 0	10,116 ------------- 0	242,122 ------------- 0	0 ------------- 0
16CAROLYN MORTON PHARMACY AND LAB DIRECTOR	(i) (ii)	184,325 ------------- 0	31,064 ------------- 0	1,318 ------------- 0	17,877 ------------- 0	28,094 ------------- 0	262,678 ------------- 0	0 ------------- 0
17SUSAN BRUMLEY IMAGING AND CARDIOVASCULAR	(i) (ii)	150,501 ------------- 0	25,372 ------------- 0	4,598 ------------- 0	9,869 ------------- 0	24,414 ------------- 0	214,754 ------------- 0	0 ------------- 0
18DOUGLAS WELP IN-HOUSE COUNSEL	(i) (ii)	247,865 ------------- 0	38,528 ------------- 0	2,309 ------------- 0	2,342 ------------- 0	22,487 ------------- 0	313,531 ------------- 0	0 ------------- 0
19VENKATESH MADADI MD ANESTHESIOLOGIST	(i) (ii)	811,468 ------------- 0	132 ------------- 0	73,291 ------------- 0	29,148 ------------- 0	23,523 ------------- 0	937,562 ------------- 0	0 ------------- 0
20NIRMAL JOSHI MD ANESTHESIOLOGIST	(i) (ii)	548,876 ------------- 0	132 ------------- 0	227,710 ------------- 0	23,464 ------------- 0	26,367 ------------- 0	826,549 ------------- 0	0 ------------- 0
21KISHWAR NAZ MD ANESTHESIOLOGIST	(i) (ii)	634,203 ------------- 0	72,153 ------------- 0	50,549 ------------- 0	15,032 ------------- 0	20,881 ------------- 0	792,818 ------------- 0	0 ------------- 0
22RAJESH PATEL MD ANESTHESIOLOGIST	(i) (ii)	667,261 ------------- 0	132 ------------- 0	45,631 ------------- 0	26,868 ------------- 0	25,369 ------------- 0	765,261 ------------- 0	0 ------------- 0
23DAVID FISH MD ANESTHESIOLOGIST	(i) (ii)	563,977 ------------- 0	25,140 ------------- 0	128,692 ------------- 0	15,032 ------------- 0	22,731 ------------- 0	755,572 ------------- 0	29,743 ------------- 0
24LINDA WHITE FORMER CEO EMERITA	(i) (ii)	148,489 ------------- 0	17,272 ------------- 0	29,167 ------------- 4,000	6,087 ------------- 0	8,709 ------------- 0	209,724 ------------- 4,000	27,123 ------------- 0
25BRUCE EPMEIER FORMER OFFICER	(i) (ii)	0 ------------- 0	0 ------------- 0	156,420 ------------- 2,000	0 ------------- 0	0 ------------- 0	156,420 ------------- 2,000	0 ------------- 0

Schedule J (Form 990) 2018

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 SHAWN MCCOY $-0- $18,500 $-0- JAMES PORTER, MD 0 18,500 0 CHERONA HAJEWSKI 0 18,500 0 DAVID RYON, MD 0 18,500 0 VENKATESH MADADI, MD 0 18,500 0 RAJESH PATEL, MD 0 18,500 0 NIRMAL JOSHI, MD 0 18,500 0 CHERYL WATHEN 0 18,500 0 LYNN LINGAFELTER 0 18,500 0 MAQBOOL AHMED, MD 0 18,500 0 MATHIAS KOLLECK, II, MD 0 18,500 0 SEVERANCE NONQUALIFIED EQUITY-BASED MARC J. FLORENCE $ -0- $ 18,500 $ -0- HERMAN BLANTON, MD 0 18,500 0 PART I, 4B: LINDA WHITE: SUPPLEMENTAL ACCUMULATION ACCOUNT CONTRIBUTIONS OF $0 SUPPLEMENTAL ACCUMULATION ACCOUNT PAYOUT OF $27,123 SHAWN MCCOY: SUPPLEMENTAL ACCUMULATION ACCOUNT CONTRIBUTIONS OF $150,166 SUPPLEMENTAL ACCUMULATION ACCOUNT PAYOUT OF $169,492 CHERYL WATHEN: SUPPLEMENTAL ACCUMULATION ACCOUNT CONTRIBUTIONS OF $92,997 SUPPLEMENTAL ACCUMULATION ACCOUNT PAYOUT OF $95,109 JAMES PORTER: SUPPLEMENTAL ACCUMULATION ACCOUNT CONTRIBUTIONS OF $111,381 SUPPLEMENTAL ACCUMULATION ACCOUNT PAYOUT OF $234,275 CHERONA HAJEWSKI: SUPPLEMENTAL ACCUMULATION ACCOUNT CONTRIBUTIONS OF $48,055 SUPPLEMENTAL ACCUMULATION ACCOUNT PAYOUT OF $128,861 LYNN LINGAFELTER: SUPPLEMENTAL ACCUMULATION ACCOUNT CONTRIBUTIONS OF $58,933 SUPPLEMENTAL ACCUMULATION ACCOUNT PAYOUT OF $60,122 HERMAN BLANTON: SUPPLEMENTAL ACCUMULATION ACCOUNT CONTRIBUTIONS OF $59,200 SUPPLEMENTAL ACCUMULATION ACCOUNT PAYOUT OF $4,251 MARC J. FLORENCE: SUPPLEMENTAL ACCUMULATION ACCOUNT CONTRIBUTIONS OF $41,310 SUPPLEMENTAL ACCUMULATION ACCOUNT PAYOUT OF $21,597 DAVID FISH: SUPPLEMENTAL ACCUMULATION ACCOUNT CONTRIBUTIONS OF $0 SUPPLEMENTAL ACCUMULATION ACCOUNT PAYOUT OF $29,743
PART I, LINE 6	COMPENSATION CONTINGENT UPON NET EARNINGS: INCENTIVE COMPENSATION PAYMENTS MADE BY THE ORGANIZATION 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 OF BOTH THE ORGANIZATION AND RELATED ORGANIZATIONS. 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) 2018

Additional Data

Software ID:
Software Version:

- TIN:

Note: To capture the full content of this document, please select landscape mode (11" x 8.5") when printing.

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 the latest information.

OMB No. 1545-0047

2018

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-2016A	35-1602316	45506DXT7	10-05-2016	109,999,091	NEW MONEY PROJECTS		X		X		X
B	INDIANA FINANCE AUTHORITY-2015A	35-1602316	45506DUL7	07-09-2015	49,772,341	03/6/2009 REFUNDING		X		X		X
C	INDIANA FINANCE AUTHORITY-2013C	35-1602316	45471ALU4	07-23-2013	40,180,000	3/26/09 REFUNDING		X		X		X
D	INDIANA FINANCE AUTHORITY-2013B	35-1602316		03-05-2013	21,440,000	5/27/04 REFUNDING		X		X		X
	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-2012B	35-1602316		11-20-2012	13,005,000	1/17/1992 REFUNDING		X		X		X
	INDIANA FINANCE AUTHORITY-2011A	35-1602316	45471AES7	12-02-2011	20,667,197	3/15/99 REFUNDING		X		X		X

Part Ⅱ

Proceeds

	A		B		C		D
	1 Amount of bonds retired ..................	2,390,000		500,000		1,000,000		6,630,000
2 Amount of bonds legally defeased ..............
3 Total proceeds of issue ..................	111,373,335		49,772,341		40,180,000		21,440,000
4 Gross proceeds in reserve funds .............
5 Capitalized interest from proceeds .............	4,660,332
6 Proceeds in refunding escrows ...............
7 Issuance costs from proceeds ...............	935,528		601,847		180,000		125,000
8 Credit enhancement from proceeds .............
9 Working capital expenditures from proceeds .............	2,885,418
10 Capital expenditures from proceeds .............	102,892,057
11 Other spent proceeds .............	70,606,631		49,170,494		40,000,000		21,315,000
12 Other unspent proceeds .............
13 Year of substantial completion .............	2018
	Yes	No	Yes	No	Yes	No	Yes	No
14 Were the bonds issued as part of a current refunding issue? ....		X		X	X		X
15 Were the bonds issued as part of an advance refunding issue? .....		X	X			X		X
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) 2018

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 ....
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 .........
6 Total of lines 4 and 5 .............
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) 2018

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
DATE REBATE COMPUTATION PERFORMED	ISSUER NAME: INDIANA FINANCE AUTHORITY-2013A DATE THE REBATE COMPUTATION WAS PERFORMED: 06/22/2015 ISSUER NAME: INDIANA FINANCE AUTHORITY-2012B DATE THE REBATE COMPUTATION WAS PERFORMED: 06/22/2015
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) 2018

Additional Data

Software ID:
Software Version:

- TIN:

Note: To capture the full content of this document, please select landscape mode (11" x 8.5") when printing.

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 the latest information.

OMB No. 1545-0047

2018

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-2016A	35-1602316	45506DXT7	10-05-2016	109,999,091	NEW MONEY PROJECTS		X		X		X
B	INDIANA FINANCE AUTHORITY-2015A	35-1602316	45506DUL7	07-09-2015	49,772,341	03/6/2009 REFUNDING		X		X		X
C	INDIANA FINANCE AUTHORITY-2013C	35-1602316	45471ALU4	07-23-2013	40,180,000	3/26/09 REFUNDING		X		X		X
D	INDIANA FINANCE AUTHORITY-2013B	35-1602316		03-05-2013	21,440,000	5/27/04 REFUNDING		X		X		X
	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-2012B	35-1602316		11-20-2012	13,005,000	1/17/1992 REFUNDING		X		X		X
	INDIANA FINANCE AUTHORITY-2011A	35-1602316	45471AES7	12-02-2011	20,667,197	3/15/99 REFUNDING		X		X		X

Part Ⅱ

Proceeds

	A		B		C		D
	1 Amount of bonds retired ..................	2,390,000		500,000		1,000,000		6,630,000
2 Amount of bonds legally defeased ..............
3 Total proceeds of issue ..................	111,373,335		49,772,341		40,180,000		21,440,000
4 Gross proceeds in reserve funds .............
5 Capitalized interest from proceeds .............	4,660,332
6 Proceeds in refunding escrows ...............
7 Issuance costs from proceeds ...............	935,528		601,847		180,000		125,000
8 Credit enhancement from proceeds .............
9 Working capital expenditures from proceeds .............	2,885,418
10 Capital expenditures from proceeds .............	102,892,057
11 Other spent proceeds .............	70,606,631		49,170,494		40,000,000		21,315,000
12 Other unspent proceeds .............
13 Year of substantial completion .............	2018
	Yes	No	Yes	No	Yes	No	Yes	No
14 Were the bonds issued as part of a current refunding issue? ....		X		X	X		X
15 Were the bonds issued as part of an advance refunding issue? .....		X	X			X		X
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) 2018

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 ....
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 .........
6 Total of lines 4 and 5 .............
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) 2018

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
DATE REBATE COMPUTATION PERFORMED	ISSUER NAME: INDIANA FINANCE AUTHORITY-2013A DATE THE REBATE COMPUTATION WAS PERFORMED: 06/22/2015 ISSUER NAME: INDIANA FINANCE AUTHORITY-2012B DATE THE REBATE COMPUTATION WAS PERFORMED: 06/22/2015
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) 2018

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 the latest information.

OMB No. 1545-0047

2018

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 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 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) 2018

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) ABBY PAPARIELLA	SEE PART V	55,584	COMP.		No
(2) BRITTNEY PHIPPS	SEE PART V	57,360	COMP.		No
(3) EVANSVILLE SURGICAL ASSOCIATES	SEE PART V	3,486,253	MEDICAL SERVICES		No
(4) IVY TECH FOUNDATION	SEE PART V	3,000	DONATION AND SUPPORT		No
(5) JESSICA COX	SEE PART V	70,115	COMP.		No
(6) JOAN MCCOY	SEE PART V	44,776	COMP.		No
(7) MARY BETH COLE	SEE PART V	38,569	COMP.		No
(8) MISTY ADYE	SEE PART V	41,405	COMP.		No
(9) OLD NATIONAL BANK	SEE PART V	209,372	INVESTMENT MANAGEMENT FEES		No
(10) SHERRI MCCOY	SEE PART V	26,638	COMP.		No
(11) UNIVERSITY OF SOUTHERN INDIANA	SEE PART V	73,986	SUPPORT		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: ABBY PAPARIELLARELATIONSHIP: DAUGHTER OF DAVE PAPARIELLAINTERESTED PERSON: BRITTNEY PHIPPSRELATIONSHIP: DAUGHTER OF DAVE PAPARIELLAINTERESTED 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: IVY TECH FOUNDATIONRELATIONSHIP: BOARD MEMBER JOHNATHAN WEINZAPFEL IS THE CHANCELLOR AT IVY TECH COLLEGE. DEACONESS HOSPITAL CONTRIBUTES MONEY FOR NURSING EDUCATION.INTERESTED PERSON: JESSICA COXRELATIONSHIP: DAUGHTER TO LYNN LINGAFELTERINTERESTED PERSON: JOAN MCCOYRELATIONSHIP: WIFE OF SHAWN MCCOYINTERESTED PERSON: MARY BETH COLERELATIONSHIP: SISTER TO STEPHEN TITZERINTERESTED PERSON: MISTY ADYERELATIONSHIP: WIFE OF BOARD MEMBER BRUCE ADYEINTERESTED PERSON: OLD NATIONAL BANKRELATIONSHIP: BOARD MEMBER JAMES RYAN IS THE CFO OF OLD NATIONAL BANK. OLD NATIONAL BANK PROVIDES INVESTMENT MANAGEMENT SERVICES.INTERESTED PERSON: SHERRI MCCOYRELATIONSHIP: SISTER OF SHAWN MCCOYINTERESTED PERSON: UNIVERSITY OF SOUTHERN INDIANARELATIONSHIP: DR. LINDA BENNETT, SECRETARY OF THE BOARD OF DIRECTORS OF DEACONESS HOSPITAL, IS PRESIDENT EMERITA OF UNIVERSITY OF SOUTHERN INDIANA. DEACONESS HOSPITAL PROVIDES GENERAL SUPPORT AND HEALTH PROFESSION SCHOLARSHIPS TO THE UNIVERSITY.

Schedule L (Form 990 or 990-EZ) 2018

Additional Data

Software ID:
Software Version:

- TIN:

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

2018

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 .
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 ( OTHER )	X	121	81,436	FMV
26 Other ( JEWELRY )	X	1	12,050	COST
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 is not 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 did not 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) (2018)

Page 2

Part II

Supplemental 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, COLUMN (B):	THE AMOUNT IN COLUMN (B) REPRESENTS THE NUMBER OF CONTRIBUTIONS RECEIVED.

Schedule M (Form 990) (2018)

Additional Data

Software ID:
Software Version:

- TIN:

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

2018

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 267 BEDS CONSISTING OF 38 INTENSIVE CARE BEDS, 16 CARDIAC INTENSIVE CARE BEDS, 45 CARDIAC BEDS, 23 ONCOLOGY/ PULMONOLOGY BEDS, 44 ORTHOPAEDIC/ NEUROLOGICAL BEDS, 44 MEDICAL/ SURGICAL BEDS, 39 MEDICAL RENAL BEDS, AND 18 BEDS DEDICATED TO PATIENTS IN OBSERVATION. 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, 48 ORTHOPAEDIC BEDS, 48 NEURO INTENSIVE CARE BEDS, 32 SURGICAL ONCOLOGY BEDS, 48 GENERAL MED/ TELEMETRY BEDS, 24 CARDIAC BEDS, AND 32 BEDS DEDICATED TO PATIENTS IN OBSERVATION. THE ORTHOPEDIC NEUROSCIENCE HOSPITAL OPENED ON THE GATEWAY CAMPUS IN MAY OF 2018. 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 $18.2 MILLION OF CHARITY CARE AND $35.1 MILLION OF SUBSIDIZED SERVICES TO THE MEDICAID PROGRAM, AND $63.1 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 $9.1 MILLION IN COMMUNITY BENEFIT ACTIVITIES (ALL ON A COST BASIS), SERVING A MINIMUM OF 991,538 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 122,013,322. MANAGEMENT AND GENERAL EXPENSES 2,982,148. FUNDRAISING EXPENSES 16,004. TOTAL EXPENSES 125,011,474. PROFESSIONAL FEES- PHYSICIANS: PROGRAM SERVICE EXPENSES 19,314,739. MANAGEMENT AND GENERAL EXPENSES 89,718. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 19,404,457.
FORM 990, PART XI, LINE 9:	CHANGE IN PENSION LIABILITY -46,775,864. FOUNDATION MONIES GRANTED FROM RESTRICTION -1,196,633. CHANGE IN GENERAL FUND EQUITY -84,160,134. CHANGE IN UNREALIZED GAIN/LOSS ON INVESTMENTS/SWAP 3,831,397.
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) 2018

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

2018

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			DEACONESS HOSPITAL
(2) READY DEVELOPMENT OF INDIANA 600 MARY ST EVANSVILLE,IN47747 47-2040018	REAL ESTATE	IN		5,149,354	DEACONESS HOSPITAL
(3) HEART HOSPITAL AT DEACONESS GATEWAY LLC 4007 GATEWAY BLVD NEWBURGH,IN47630 26-1766835	HOSPITAL	DE	2,247,648	14,333,717	DEACONESS HOSPITAL
(4) BASELINE INVESTORS LLC 600 MARY ST EVANSVILLE,IN47710	REAL ESTATE	IN	0	0	DEACONESS HOSPITAL
(5) 533 COLUMBIA LLC 600 MARY ST EVANSVILLE,IN47710	REAL ESTATE	IN	0	0	DEACONESS HOSPITAL
(6) INVESTORS PROPERTY DEVELOPMENT LLC 600 MARY ST EVANSVILLE,IN47710	REAL ESTATE	IN	0	0	DEACONESS HOSPITAL
(7) 7307 E COLUMBIA LLC 600 MARY ST EVANSVILLE,IN47710	REAL ESTATE	IN	0	0	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 12A, I	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 10	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) 2018

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	649,797	2,205,858		No			No	95.150 %
(2) PROGRESSIVE HEALTH OF IN LLC 150 N ROSENBERGER EVANSVILLE,IN47712 20-8480988	OUTPATIENT	IN	DEACONESS HOSPITAL	RELATED	3,553,352	2,114,930		No			No	51.000 %
(3) TRI-STATE RADIATION ONCOLOGY 1500 ROSECRANS AVENUE MANHATTAN BEACH,CA90266 26-3706834	OUTPATIENT	DE	DEACONESS HOSPITAL	RELATED	3,260,537	4,699,466		No			No	51.000 %
(4) MAINSPRING MANAGERS LLC 4011 GATEWAY BLVD NEWBURGH,IN47630 46-4601001	NEUROLOGY SERVICES	IN	DEACONESS HOSPITAL	RELATED	1,067,137	903,371		No			No	51.000 %
(5) VASCMED LLC 600 MARY STREET EVANSVILLE,IN47747 47-2578168	VASCULAR SERVICES	IN	DEACONESS HOSPITAL	RELATED	740,140	891,356		No			No	51.000 %
(6) ORTHOALIGN LLC 4011 GATEWAY BLVD NEWBURGH,IN47630 81-2816013	HEALTHCARE	IN	DEACONESS HOSPITAL	RELATED	1,669,261	705,137		No			No	51.000 %
(7) HEALTHCARE RESOURCE SOLUTIONS 600 MARY STREET EVANSVILLE,IN47747 83-3275390	HEALTHCARE	IN	N/A

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) 2018

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) MAINSPRING MANAGERS LLC	P	359,573
(2) VASCMED LLC	P	306,863
(3) ORTHOALIGN LLC	P	1,116,062
(4) DEACONESS HEALTH PLANS LLC	P	155,955

Schedule R (Form 990) 2018

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) 2018

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) 2018

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	19
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	12
5	Total number of individuals employed in calendar year 2018 (Part V, line 2a) ......	5	6,386
6	Total number of volunteers (estimate if necessary) .............	6	137
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	15,899,116
b	Net unrelated business taxable income from Form 990-T, line 34 .........	7b	508,464

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	1,678,599	1,646,761
9	Program service revenue (Part VIII, line 2g) .........	828,361,410	942,375,847
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	24,356,181	20,915,857
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	82,114,245	82,689,151
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	936,510,435	1,047,627,616
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	1,303,395	850,589
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)	347,286,715	371,491,921
16a	Professional fundraising fees (Part IX, column (A), line 11e) .....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 537,131
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	433,400,766	515,947,339
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	781,990,876	888,289,849
19	Revenue less expenses. Subtract line 18 from line 12.......	154,519,559	159,337,767
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	1,596,773,714	1,654,034,103
21	Total liabilities (Part X, line 26).............	524,523,861	550,747,717
22	Net assets or fund balances. Subtract line 21 from line 20.....	1,072,249,853	1,103,286,386

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 167,975,717 including grants of $ ) (Revenue $ 531,164,965 )
	PATIENT SERVICE REVENUE. SEE SCHEDULE O.

4b	(Code: ) (Expenses $ 617,757,487 including grants of $ ) (Revenue $ 407,727,651 )
	CHARITY CARE/SUBSIDIZED CARE. SEE SCHEDULE O.

4c	(Code: ) (Expenses $ 12,551,818 including grants of $ ) (Revenue $ 3,483,231 )
	GRADUATE MEDICAL EDUCATION, MEDICAL EDUCATION AND COMMUNITY BENEFIT. SEE SCHEDULE O.

	(Code: ) (Expenses $ 850,589 including grants of $ 850,589 ) (Revenue $ 39,990,164 )
	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.

4d	Other program services (Describe in Schedule O.)
	(Expenses $ 850,589 including grants of $ 850,589 ) (Revenue $ 39,990,164 )
4e	Total program service expenses799,135,611

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	10,949,947	1,904,847	1,651,496

1a	Federated campaigns..		1a
b	Membership dues..		1b
c	Fundraising events..		1c	344,724
d	Related organizations		1d
e	Government grants (contributions)		1e	129,477

f	All other contributions, gifts, grants, and similar amounts not included above		1f	1,172,560

g	Noncash contributions included in lines 1a - 1f:$ 93,486
h Total. Add lines 1a-1f.......		1,646,761

		Business Code
2a	NET PATIENT REVENUE	900099	942,375,847	942,375,847
b
c
d
e
f	All other program service revenue.
g	Total. Add lines 2a–2f ....		942,375,847

3 Investment income (including dividends, interest, and othersimilar amounts) ......			15,160,807			15,160,807
4 Income from investment of tax-exempt bond proceeds
5 Royalties...........
		(ii) Personal	(i) Real
6a	Gross rents		9,741,205
b	Less: rental expenses		5,032,826
c	Rental income or (loss)		4,708,379
d	Net rental income or (loss)......			4,708,379			4,708,379
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory	37,212,499	374,268,500
b	Less: cost or other basis and sales expenses	37,596,297	368,129,652
c	Gain or (loss)	-383,798	6,138,848
d	Net gain or (loss).....			5,755,050			5,755,050
8a	Gross income from fundraising events (not including $ 344,724of contributions reported on line 1c). See Part IV, line 18 ....
	a		145,910
b	Less: direct expenses ...b		222,260
c	Net income or (loss) from fundraising events..			-76,350			-76,350
9a	Gross income from gaming activities. See Part IV, line 19 ...
	a
b	Less: direct expenses ...b
c	Net income or (loss) from gaming activities..
10a	Gross sales of inventory, less returns and allowances ..
	a
b	Less: cost of goods sold ..b
c	Net income or (loss) from sales of inventory..
Business Code			Miscellaneous Revenue
11a	INVESTMENT IN JOINT VENTURES		900099	34,416,255	34,416,255
b	OTHER HOSPITAL SERVICES		900099	27,741,751	5,573,909		22,167,842
c	LABORATORY SALES		621500	12,882,214		12,882,214
d	All other revenue ....			3,016,902		3,016,902
e	Total. Add lines 11a–11d ......			78,057,122
12	Total revenue. See Instructions......			1,047,627,616	982,366,011	15,899,116	47,715,728

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21	850,589	850,589
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, line 15 and 16.
4	Benefits paid to or for members
5	Compensation of current officers, directors, trustees, and key employees ....	7,475,213		7,475,213
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	280,764,705	261,942,907	18,471,953	349,845
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	15,063,932	13,075,051	1,971,846	17,035
9	Other employee benefits .......	49,247,372	41,576,154	7,671,218
10	Payroll taxes ...........	18,940,699	17,203,129	1,716,697	20,873
11	Fees for services (non-employees):
a	Management ......
b	Legal .........	1,466,226		1,466,226
c	Accounting ...........	195,156		195,156
d	Lobbying ...........	32,802		32,802
e	Professional fundraising services. See Part IV, line 17
f	Investment management fees ......	1,805,074		1,805,074
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	144,415,931	141,328,061	3,071,866	16,004
12	Advertising and promotion ....	1,135,563	49,412	1,086,151
13	Office expenses .......	13,575,625	11,075,810	2,462,953	36,862
14	Information technology ......	16,931,799	11,120,312	5,811,487
15	Royalties ..
16	Occupancy ...........	18,403,794	11,871,430	6,532,364
17	Travel ............	528,312	338,688	186,628	2,996
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .
19	Conferences, conventions, and meetings ....	1,135,017	719,947	411,874	3,196
20	Interest ...........	12,103,020	7,134,976	4,968,044
21	Payments to affiliates .......
22	Depreciation, depletion, and amortization ..	50,378,309	33,421,615	16,956,645	49
23	Insurance ...	3,266,259	3,253,857	12,402
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	177,761,656	177,761,656
b	MEDICAID ASSESSMENT FEE	37,503,663	37,503,663
c	EQUIP RENTAL/MAINTENANC	18,214,071	16,471,611	1,742,460
d	DUES & SUBSCRIPTIONS	736,618	228,931	501,447	6,240
e	All other expenses	16,358,444	12,207,812	4,066,601	84,031
25	Total functional expenses. Add lines 1 through 24e	888,289,849	799,135,611	88,617,107	537,131
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 .........			72,567,000	2	83,582,828
3	Pledges and grants receivable, net ......				3
4	Accounts receivable, net .............			138,315,501	4	133,412,369
5	Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of Schedule L .............
					5
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing employers and sponsoring organizations of section 501(c)(9) voluntary employees' beneficiary organizations (see instructions) Complete Part II of Schedule L ..............
					6
7	Notes and loans receivable, net ....			3,900,237	7	1,549,060
8	Inventories for sale or use ........			9,085,451	8	7,388,324
9	Prepaid expenses and deferred charges ......			12,417,895	9	12,822,146
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	1,085,905,976
b	Less: accumulated depreciation	10b	581,074,999	510,013,808	10c	504,830,977
11	Investments—publicly traded securities .			736,137,013	11	770,685,857
12	Investments—other securities. See Part IV, line 11 .....			42,457,424	12	51,664,486
13	Investments—program-related. See Part IV, line 11 ..				13
14	Intangible assets ...............			48,206,614	14	48,206,614
15	Other assets. See Part IV, line 11 ...........			23,672,771	15	39,891,442
16	Total assets. Add lines 1 through 15 (must equal line 34)...			1,596,773,714	16	1,654,034,103

17	Accounts payable and accrued expenses .....	96,177,167	17	89,449,202
18	Grants payable ...		18
19	Deferred revenue .........	1,472,480	19	1,643,957
20	Tax-exempt bond liabilities .........	300,504,348	20	295,600,927
21	Escrow or custodial account liability. Complete Part IV of Schedule D		21
22	Loans and other payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
	persons. Complete Part II of Schedule L..		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	126,369,866	25	164,053,631
26	Total liabilities. Add lines 17 through 25..	524,523,861	26	550,747,717

	Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets	1,065,971,369	27	1,097,044,932
28	Temporarily restricted net assets ...........	4,375,983	28	4,375,402
29	Permanently restricted net assets	1,902,501	29	1,866,052
	Organizations that do not follow SFAS 117 (ASC 958), check here and complete lines 30 through 34.
30	Capital stock or trust principal, or current funds .....		30
31	Paid-in or capital surplus, or land, building or equipment fund ...		31
32	Retained earnings, endowment, accumulated income, or other funds		32
33	Total net assets or fund balances ...........	1,072,249,853	33	1,103,286,386
34	Total liabilities and net assets/fund balances ........	1,596,773,714	34	1,654,034,103