2025-08-15T07:03:09-05:00 2024-09-30 351178661 BLUE & CO LLC 500 N MERIDIAN ST SUITE 200 INDIANAPOLIS IN 46204 990 2023-10-01 350877575 GIBSON GENERAL HOSPITAL GIBS 8123853401 1808 SHERMAN DRIVE PRINCETON IN 47670 SHANE HAYES CAO 8123853401 2025-08-14 1 0 EMILIE M KNIERIEM CPA P01330194 3176334705 2025-08-14 2023 2025-03-06 01:10:19Z DEACONESS GIBSON HOSPITAL SHANE HAYES 1808 SHERMAN DRIVE PRINCETON IN 47670 59696548 0 X WWW.DEACONESS.COM/DEACONESS-GIBSON-HOSPITAL X 1941 IN TO PROVIDE HIGH QUALITY, PATIENT-CENTERED, COST-EFFECTIVE CARE FOR PEOPLE IN THE COMMUNITY. 13 8 245 26 0 0 1076382 0 50726450 57293340 1401790 2073456 364327 329752 53568949 59696548 4606 0 0 0 17004171 17443161 0 0 0 25711143 26427365 42719920 43870526 10849029 15826022 59188001 74276673 18199909 17462559 40988092 56814114 THE MISSION OF GIBSON GENERAL HOSPITAL AND THE SKILLED NURSING FACILITY IS TO PROVIDE HIGH QUALITY, PATIENT-CENTERED, COST-EFFECTIVE CARE FOR PEOPLE IN OUR COMMUNITY. 0 0 34900337 57323975 THE HOSPITAL'S MISSION IS TO PROVIDE HIGH QUALITY AND COST-EFFECTIVE HEALTHCARE, WHICH INCLUDES PATIENT, OUTPATIENT, AND EMERGENCY CARE SERVICES TO THE RESIDENTS OF THE SURROUNDING TRI-STATE AREA. ALL EXPENSES RELATE TO COSTS ASSOCIATED WITH PROVIDING THESE SERVICES, AND MAINLY INCLUDE SALARIES AND WAGES TO STAFF AND SUPPLIES COST. THERE WERE 400 ADMISSIONS AND 43,890 VISITS DURING THE YEAR. 34900337 1 0 0 1 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 57 0 1 245 1 0 0 0 0 0 0 0 0 0 0 0 0 X 13 8 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 IN X CHERYL A WATHEN 8124503296 600 MARY STREET EVANSVILLE IN 47747 SUSAN STRAUB CHAIR 1.00 0.00 X X 0 1600 0 DEREK MCGRAW VICE CHAIR 1.00 0.00 X X 7736 0 0 STEPHEN LANKFORD SECRETARY 1.00 0.00 X X 0 0 0 GEORGE A BALLARD TREASURER 1.00 0.00 X X 0 0 0 DR DAVID PURDOM CHIEF OF STAFF 40.00 0.00 X 303612 0 48276 JENNIFER BARTLEY BOARD MEMBER 1.00 0.00 X 0 0 0 HENRY BREWSTER BOARD MEMBER 1.00 0.00 X 0 0 0 MARC JARED FLORENCE BOARD MEMBER 1.00 62.00 X 0 666289 152374 BOB GIBSON BOARD MEMBER 1.00 0.00 X 0 0 0 STEVEN IVY BOARD MEMBER 1.00 0.00 X 0 355959 49864 LYNN LINGAFELTER BOARD MEMBER 1.00 55.00 X 0 958823 192400 DUSTIN PRIESTLY BOARD MEMBER 1.00 0.00 X 0 0 0 GREG WRIGHT BOARD MEMBER 1.00 0.00 X 0 38021 0 WILLIAM ALLEN WHITE MD BOARD MEMBER PARTIAL YEAR 1.00 57.00 X 0 0 0 MARION JOCHIM CHAIR PARTIAL TERM 1.00 0.00 X X 0 0 0 LOIS MORGAN CAO 50.00 0.00 X 0 249919 35569 SHANE C HAYES CNO 50.00 0.00 X 131770 0 35312 COREY POTTS CRNA 40.00 0.00 X 279121 0 44697 BETH N MCGRAW LEAD MULTI-MODALITY TECH 40.00 0.00 X 134225 0 7527 SARAH A JENNE STAFF NURSE RN CAH 40.00 0.00 X 121907 0 15738 TAMMY R WARMACK DIRECTOR NURSING DEPT CAH 40.00 0.00 X 112367 0 22683 ASHLEY SMITH PHYSICIAN 40.00 0.00 X 313474 0 17177 SHAWN MCCOY CEO DHS 0.00 56.00 X 0 1726110 329209 1404212 3996721 950826 14 1 1 0 PROGRESSIVE HEALTH OF INDIANA 150 N ROSENBERGER EVANSVILLE IN 47710 THERAPY SERVICES 2294831 GREAT LAKES EMERGENCY PHYSICIANS 1602 AVENUE Q LUBBOCK TX 79401 MEDICAL PRO FEES 1009250 TOTAL MSP LLC 221 W COLLEGE AVE FLOOR 2 APPLETON WI 54911 STAFFING 1008001 TRI-STATE GASTROENTEROLOGY PO BOX 5068 EVANSVILLE IN 47716 MEDICAL PRO FEES 590829 MID WEST HOSPITAL PHYSICIANS 1602 AVENUE Q LUBBOCK TX 79401 MEDICAL PRO FEES 304315 8 PATIENT SERVICE REVENUE 624100 57293340 57293340 57293340 2073456 2073456 150567 0 150567 150567 150567 CAFETERIA REVENUE 900099 148550 148550 30635 30635 179185 59696548 57323975 0 2372573 X 528049 528049 14135266 11943744 2191522 317237 258257 58980 1428476 788200 640276 1034133 854820 179313 87421 87421 11348419 8934194 2414225 16707 66 16641 365124 267850 97274 2545765 1233729 1312036 30355 26660 3695 25045 25045 367343 275867 91476 1896899 1424533 472366 402586 53515 349071 MEDICAL & DRUG SUPPLIES 6342301 6284526 57775 MEDICAID ASSESSMENT FEE 1165406 1165406 DUES & SUB. 106277 70420 35857 LICENSE AND FEES 25899 17161 8738 1701818 1276344 425474 43870526 34900337 8970189 0 34228417 25358714 1572783 1627504 5062518 6886267 81782 398563 391135 601953 336348 21318632 8022509 13953512 13296123 3288473 26380582 59188001 74276673 6239985 6244703 9756195 8842952 2203729 2374904 18199909 17462559 X 40988092 56814114 40988092 56814114 59188001 74276673 15826022 0 X X 0 1 X 1 0 X 0 0 0 0 0 0 0 0 1 7573 7573 0 PART II-B, LINE 1: THE HOSPITAL PAID MEMBERSHIP DUES TO INDIANA HOSPITAL ASSOCATION "IHA AND THE AMERICAN HOSPITAL ASSOCIATION "AHA". IHA ATTRIBUTED 12% OF THE $15,687 IN DUES TO LOBBYING EXPENSES. AHA ATTRIBUTED 39% OF THE $14,679 IN DUES TO LOBBYING EXPENSES. 440800 440800 8321390 2115621 6205769 10279709 5906888 4372821 2276733 2276733 13296123 OTHER MISCELLANEOUS ASSETS 105121 RIGHT OF USE ASSET 373821 FUNDS HELD BY TRUSTEE 203977 INVESTMENTS IN JOINT VENTURES 2507456 PHYSICIAN 457F 23190207 26380582 THIRD PARTY PAYABLE 1475875 RIGHT OF USE LIABILITIES 835717 PHYSICIAN 457F 63312 2374904 X PART X, LINE 2: ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE SYSTEM AND RECOGNIZE A TAX LIABILITY IF THE SYSTEM HAS TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY VARIOUS FEDERAL AND STATE TAXING AUTHORITIES. MANAGEMENT HAS ANALYZED THE TAX POSITIONS TAKEN BY THE SYSTEM AND HAS CONCLUDED THAT AS OF SEPTEMBER 30, 2024 AND 2023, THERE ARE NO UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY OR DISCLOSURE IN THE ACCOMPANYING CONSOLIDATED FINANCIAL STATEMENTS. THE SYSTEM IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. 1 1 X 1 X 1 X 1 1 1 0 1 1 839480 839480 0.01910 7522970 5622425 1900545 0.04330 8362450 5622425 2740025 0.06240 8362450 5622425 2740025 0.06240 1 2449678 25339346 20049419 5289927 X 1 1 1 1 GIBSON GENERAL HOSPITAL INC 1808 SHERMAN DRIVE PRINCETON IN 47670 WWW.DEACONESS.COM/DEACONESS-GIBSON-HOS 24-005019-1 X X X X GIBSON GENERAL HOSPITAL INC 0 0 1 X X X X X X X X X 24 1 0 1 1 X HTTPS://WWW.DEACONESS.COM/ABOUT-US/COMMUNITY-HEALTH-NEEDS-ASSESSMENT X X 1 24 1 HTTPS://WWW.DEACONESS.COM/ABOUT-US/COMMUNITY-HEALTH-NEEDS-ASSESSMENT 0 1 X 200.000000000000 350.000000000000 X X X X 1 1 X X X X 1 X HTTPS://WWW.DEACONESS.COM/PAY-MY-BILL/FINANCIAL-ASSISTANCE X HTTPS://WWW.DEACONESS.COM/PAY-MY-BILL/FINANCIAL-ASSISTANCE X HTTPS://WWW.DEACONESS.COM/PAY-MY-BILL/FINANCIAL-ASSISTANCE X X X X X X X 1 X 0 X X X X 1 X 0 0 GIBSON GENERAL HOSPITAL INC PART V, SECTION B, LINE 5: DEACONESS GIBSON HOSPITAL CONSULTED WITH THE FOLLOWING GROUPS TO GATHER INPUT AND DATA:- YMCA OF SOUTHWEST INDIANA- SW INDIANA WORKFORCE BOARD- AUXILIARY & FOUNDATION- GIBSON COUNTY HEALTH DEPARTMENT- ADDICTION SOLUTIONS- THE ISAIAH 1:17 PROJECT- GCCDA SENIOR CENTER- ASC- DEACONESS GIBSON FOUNDATION- UNIVERSITY OF SOUTHERN INDIANA- TULIP TREE FAMILY HEALTH- NORTH GIBSON SCHOOL CORPORATION- GIBSON COUNTY CHAMBER- COUNTY COMMISSIONER- MULTIPLE STAFF AND PROVIDERS FROM DEACONESS GIBSON HOSPITALTO INCLUDE THE VOICES OF PEOPLE REPRESENTING THE COMMUNITY, SURVEYS WERE SENT TO ORGANIZATIONS SERVING GIBSON COUNTY WITH UNIQUE PERSPECTIVES ON ISSUES IMPACTING HEALTH AND SOCIAL DETERMINANTS OF HEALTH AMONG RESIDENTS. GIBSON GENERAL HOSPITAL INC PART V, SECTION B, LINE 6B: INDIANA RURAL HEALTH ASSOCIATION GIBSON GENERAL HOSPITAL INC PART V, SECTION B, LINE 7D: CHNA LOCATION:THE CHNA REPORTS CAN BE LOCATED AT THE HOSPITAL'S WEBSITE LOCATED ON THE "COMMUNITY HEALTH NEEDS ASSESSMENT" PAGE LOCATED UNDER "ABOUT US". HTTPS://WWW.DEACONESS.COM/ABOUT-US/COMMUNITY-HEALTH-NEEDS-ASSESSMENT GIBSON GENERAL HOSPITAL INC PART V, SECTION B, LINE 11: BY ANALYZING ALL THREE PRIORITIZED LISTS FROM THE THREE FOCUS GROUPS, IRHA IDENTIFIED THE ITEMS THAT APPEARED MOST FREQUENTLY INDICATING THE COMMUNITY'S PERCEPTION OF AREAS OF GREATEST NEED. THE LIST FOLLOWS:-CHILDCARE -COORDINATION ACROSS PROGRAMS -SUBSTANCE USE/ABUSE -VAPING THC/NICOTINE/TOBACCO -COST OF LIVING -HOMELESSNESS -MENTAL HEALTH-TRANSPORTATION BASED ON THE INFORMATION GATHERED AS PART OF THE COMMUNITY HEALTH NEEDS ASSESSMENT, THE INDIANA RURAL HEALTH ASSOCIATION HAS IDENTIFIED THE AREAS OF GREATEST NEED IN GIBSON COUNTY. THROUGH THE COLLECTION OF HEALTH DATA AND COMMUNITY INPUT ON THE COUNTY'S ASSETS, VALUES, AND WEAKNESSES WITHIN THE HOSPITAL'S SERVICE AREA, THE FOLLOWING NEEDS WERE IDENTIFIED AS BEING OF THE HIGHEST IMPORTANCE:IDENTIFIED NEEDS-TRANSPORTATION AVAILABILITY & AFFORDABILITY-MENTAL HEALTH SERVICES AVAILABILITY, AFFORDABILITY, SUICIDE, STIGMA -SUBSTANCE USE/MISUSE SERVICES, EDUCATION, VAPING (NICOTINE AND THC)-PROVIDER ACCESS & AVAILABILITY ESPECIALLY SPECIALISTS AND THOSE THAT ACCEPT MEDICAIDOPPORTUNITIES:TRANSPORTATION: PARTNER WITH LOCAL COMMUNITY NON-PROFITS FOR RIDE SHARE PROGRAMS TO ASSIST WITH NON-EMERGENT MEDICAL APPOINTMENTS. COLLABORATE WITH LOCAL CHURCHES FOR RIDES FOR MEMBERS.MENTAL HEALTH:COLLABORATE WITH REGIONAL BEHAVIORAL AND MENTAL HEALTH PROVIDERS TO ENABLE TELEHEALTH OPTIONS. WORK TO ORGANIZE LOCAL SUPPORT GROUPS FOR RECOVERING PATIENTS AND FAMILY MEMBERS.WORK WITH LOCAL EMPLOYERS TO ENCOURAGE HEALTH PLANS THAT INCLUDE COVERAGE FOR MENTAL HEALTH SERVICES.COLLABORATE WITH VARIOUS SUICIDE PREVENTION ORGANIZATIONS TO PUT ON EDUCATION EVENTS FOR COMMUNITY.SUBSTANCE ABUSE/MISUSECREATE EDUCATION AND AWARENESS FOR THE COMMUNITY. COORDINATE WITH LOCAL SERVICE GROUPS AND COMMUNITY CHURCHES TO CREATE EDUCATION EVENTS.COLLABORATE WITH LOCAL POLICE AND EMS SERVICES TO PROVIDE EDUCATION AND DISCUSSION.ENGAGE RECOVERING PATIENTS INTO PRESENTATIONS FOR THE COMMUNITY AND LOCAL GROUPS.PROVIDER ACCESS AND AVAILABILITYEVALUATE SCHEDULES WITH OTHER DEACONESS SPECIALISTS TO BRING MORE TO GIBSON COUNTY.EVALUATE OPTIONS OF PROVIDING TRANSPORTATION TO GIBSON COUNTY RESIDENTS TO SPECIALISTS IN EVANSVILLE AND NEWBURGH.MAKE SURE COMMUNITY IS AWARE OF NEW PROVIDERS AND LOCAL AVAILABILITY. GIBSON GENERAL HOSPITAL INC PART V, SECTION B, LINE 15E: WELL FUND IS AVAILABLE TO DEACONESS HEALTH SYSTEM PATIENTS TO ASSIST WITH APPLYING FOR MEDICAID OR EXCHANGE PRODUCTS. GIBSON GENERAL HOSPITAL INC PART V, SECTION B, LINE 16J: 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. COLLECTIBILITY SCORING IS ALSO COMPLETED AND ALLOWANCES ARE MADE BASED UPON THESE SCORES. GIBSON GENERAL HOSPITAL, INC.: SCHEDULE H, PART V, LINE 7A:HTTPS://WWW.DEACONESS.COM/ABOUT-US/COMMUNITY-HEALTH-NEEDS-ASSESSMENT GIBSON GENERAL HOSPITAL, INC.: SCHEDULE H, PART V, LINE 10A:HTTPS://WWW.DEACONESS.COM/ABOUT-US/COMMUNITY-HEALTH-NEEDS-ASSESSMENT GIBSON GENERAL HOSPITAL, INC.: SCHEDULE H, PART V, LINE 16A:HTTPS://WWW.DEACONESS.COM/PAY-MY-BILL/FINANCIAL-ASSISTANCESCHEDULE H, PART V, LINE 16A:HTTPS://WWW.DEACONESS.COM/PAY-MY-BILL/FINANCIAL-ASSISTANCESCHEDULE H, PART V, LINE 16A:HTTPS://WWW.DEACONESS.COM/PAY-MY-BILL/FINANCIAL-ASSISTANCE 7 1 - STAR ONE REHAB 1808 SHERMAN DRIVE PRINCETON IN 47670 PHYSICAL THERAPY, OCCUPATIONAL THERAPY, SPEECH THERAPY 2 - PHYSICIAN OUTPATIENT CLINICS 1808 SHERMAN DRIVE PRINCETON IN 47670 SUBSIDIZED CARE PHYSICIAN PRACTICES 3 - LIFESTYLES DIABETES CENTER 1808 SHERMAN DRIVE PRINCETON IN 47670 DIABETES EDUCATION COUNSELING 4 - GGH-FAMILY PRACTICE 510 N MAIN ST PRINCETON IN 47670 FAMILY MEDICINE 5 - BRINK'S FAMILY PRACTICE 410 N MAIN ST PRINCETON IN 47670 FAMILY MEDICINE/ HOSPITALIST 6 - FORT BRANCH WELLNESS CLINIC 7851 S PROFESSIONAL DR FORT BRANCH IN 47648 FAMILY PRACTICE 7 - GGH-SKILLED NURSING FACILITY 1808 SHERMAN DRIVE PRINCETON IN 47670 SKILLED NURSING REHAB CENTER PART I, LINE 3C: GIBSON GENERAL HOSPITAL USES THE FOLLOWING FACTORS, IN ADDITION TO THE FPG, TO DETERMINE AN INDIVIDUAL'S ELIGIBILITY FOR FINANCIAL ASSISTANCE UNDER THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY: MEDICAL INDIGENCY, INSURANCE STATUS, AND UNDERINSURANCE STATUS. ADDITIONALLY, IF AN INDIVIDUAL IS HOMELESS, DECEASED, RECENTLY FILED FOR OR COMPLETED BANKRUPTCY, OR MEETS SPECIAL CIRCUMSTANCES RELATED TO ABILITY TO PAY, THE INDIVIDUAL MAY BE ELIGIBLE FOR FINANCIAL ASSISTANCE. PART I, LINE 7: GIBSON GENERAL HOSPITAL CALCULATED THE COST OF FINANCIAL ASSISTANCE AND MEANS-TESTED GOVERNMENT PROGRAMS, USING THE COST-TO-CHARGE RATIO DERIVED FROM SCHEDULE H, WORKSHEET 2, RATIO OF PATIENT CARE COST-TO-CHARGES. PART III, LINE 2: METHODOLOGY USED TO ESTIMATE BAD DEBT: MANAGEMENT ANALYZES THIRD-PARTY PAYOR SOURCES AND MAKES AN ESTIMATE BASED ON AGING OF ACCOUNTS, HISTORICAL LOSSES, CURRENT ECONOMIC CONDITIONS, AND OTHER FACTORS UNIQUE TO ITS SERVICE AREA. ADDITIONALLY, A SIGNIFICANT PROVISION IS ESTIMATED AND RECORDED FOR SELF-PAY PAYMENTS BASED ON PAST EXPERIENCE. PART III, LINE 3: THE HOSPITAL DOES NOT PURSUE COLLECTION AMOUNTS DETERMINED TO QUALIFY AS CHARITY CARE. THESE AMOUNTS ARE NOT REPORTED AS NET PATIENT REVENUE BECAUSE THE HOSPITAL DOES NOT PURSUE COLLECTION OF AMOUNTS DETERMINED TO QUALIFY AS CHARITY CARE. GIBSON GENERAL 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 13 AND "PATIENT ACCOUNTS RECEIVABLE AND NET PATIENT SERVICE REVENUE" STARTING ON PAGE 12. PART III, LINE 8: MEDICARE SHORTFALL:THE HOSPITAL IS A CRITICAL ACCESS HOSPITAL AND IS REIMBURSED 101%, LESS 2% SEQUESTRATION, OF MEDICARE ALLOWANCE COSTS FOR INPATIENT SERVICES, SWING BED, AND OUTPATIENT PART B SERVICES. THE REVENUE SHORTFALL IS THE DIFFERENCE BETWEEN THE ALLOWABLE COST FOR THE SKILLED NURSING FACILITY AND THE PPS REIMBURSEMENT ALLOWED FOR THAT SKILLED NURSING FACILITY. THE SOURCE USED TO DETERMINE THE AMOUNT OF MEDICARE ALLOWABLE COSTS REPORTED FOR PART III, SECTION B, MEDICARE HAS BEEN PROVIDED FROM THE YEAR ENDED SEPTEMBER 30, 2024: HOSPITAL STATEMENT OF REIMBURSABLE COST. PART III, LINE 9B: COLLECTION PRACTICES:COLLECTION PRACTICES ARE APPLIED TO ALL PATIENTS AT GIBSON GENERAL HOSPITAL. ONCE PATIENTS RECEIVE SERVICES, THE PATIENTS' ACCOUNTS ARE BILLED TO THE APPROPRIATE INSURANCE COMPANY. ONCE PAYMENT IS RECEIVED FROM THE INSURANCE COMPANY, THE REMAINING BALANCE, IF ANY, BECOMES THE PATIENT'S RESPONSIBILITY. NOTIFICATION OF THE BALANCE DUE IS SENT VIA WRITTEN CORRESPONDENCE. IF THE BALANCE IS NOT PAID AND THE ACCOUNT DOES NOT QUALIFY FOR FINANCIAL ASSISTANCE, THE ACCOUNT IS SENT TO A COLLECTION AGENCY TO CONTINUE EFFORTS TO COLLECT THE REMAINING BALANCE DUE. IF THE BALANCE DUE IS NOT PAID WITHIN A CERTAIN NUMBER OF MONTHS, THE ACCOUNT IS RETURNED TO THE HOSPITAL AND THE ACCOUNT IS WRITTEN OFF AS UNCOLLECTIBLE. PART VI, LINE 2: ASSESSING COMMUNITY NEEDS:IN ADDITION TO COMPLETING A CHNA EVERY THREE YEARS, THE HOSPITAL'S LEADERSHIP IS COMPRISED OF COMMUNITY MEMBERS WHO ENGAGE IN DAILY CONVERSATIONS WITH OTHER COMMUNITY MEMBERS AND LEADERS REGARDING THE COMMUNITY THEY LIVE IN AND ITS NEEDS. THESE CONVERSATIONS SUPPLEMENT THE UNDERSTANDING OF THE COMMUNITY'S HEALTH NEEDS IDENTIFIED IN THE CHNA. HOSPITAL LEADERSHIP ALSO USES STRATEGIC PLANNING TO SPONSOR AND ENGAGE IN COMMUNITY ACTIVITIES THAT HELPS LEADERSHIP ASSESS THE HEALTH CARE NEEDS OF THE COMMUNITY THE HOSPITAL SERVES. PART VI, LINE 3: PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE: THE HOSPITAL DISPLAYS POSTERS IN THE CENTRAL REGISTRATION AND EMERGENCY ROOM WAITING-AREA NOTIFYING PATIENTS THAT THEY WILL BE SEEN REGARDLESS OF THEIR ABILITY TO PAY AND FINANCIAL ASSISTANCE IS AVAILABLE TO UNINSURED AND UNDERINSURED IN COMPLIANCE WITH EMTALA. THE FINANCIAL ASSISTANCE POLICY (FAP), FAP APPLICATION, AND PLAIN LANGUAGE SUMMARY ARE AVAILABLE ON THE HOSPITAL'S WEBSITE AT WWW.DEACONESS.COM/DEACONESS-GIBSON-HOSPITAL; AVAILABLE UPON REQUEST, WITHOUT CHARGE, AT THE BUSINESS OFFICE, ADMISSIONS, AND VIA MAIL; PLAIN LANGUAGE SUMMARY IS CONSPICUOUSLY DISPLAYED IN THE HOSPITAL AND CLINIC WAITING-AREAS; AND, THE PLAIN LANGUAGE SUMMARY IS PROVIDED TO EACH PERSON UPON ADMISSION TO THE HOSPITAL. ANY PATIENTS WITHOUT INSURANCE OR WITH A BALANCE DUE AFTER INSURANCE IS BILLED ARE PROVIDED A PLAIN LANGUAGE SUMMARY, FAP APPLICATION, AND CONTACT INFORMATION FOR THE HOSPITAL'S PATIENT FINANCIAL COUNSELOR BY MAIL. PART VI, LINE 4: COMMUNITY INFORMATION/ COMMUNITY SERVED:THE HOSPITAL'S PRIMARY SERVICE AREA INCLUDES GIBSON COUNTY, INDIANA. GIBSON COUNTY IS LOCATED IN SOUTHWESTERN, INDIANA, AND IS LARGELY RURAL WITH AGRICULTURE AND COAL MINING AS PRIMARY INDUSTRIES. GIBSON COUNTY, INDIANA, IS APPROXIMATELY 155 MILES SOUTHWEST OF INDIANAPOLIS AND 25 MILES NORTH OF EVANSVILLE, INDIANA, WITH AN ESTIMATED POPULATION OF 33,145. IN 2019 THE POPULATION MEDIAN AGE WAS 41.4 YEARS WITH FORTY-FIVE PERCENT (45%) OF THE POPULATION AGE 45 AND OLDER. THE POVERTY RATE WAS 9.31% AND THE MEDIAN HOUSEHOLD ANNUAL INCOME WAS $55,462. APPROXIMATELY 75-80% OF THE HOSPITAL'S PATIENT POPULATION UTILIZES MEDICARE, MEDICAID, AND/OR OTHER GOVERNMENT-SUBSIDIZED PROGRAMS. TRADITIONALLY, THE HOSPITAL HAS BEEN RELIED UPON AS A SAFETY NET HOSPITAL FOR OLDER PATIENTS, LOW-INCOME PATIENTS, AND PATIENTS WITH LIMITED MEANS TO TRAVEL TO THE LARGER CITY OF EVANSVILLE, INDIANA. PART VI, LINE 5: COMMUNITY HEALTH PROMOTION:THE HOSPITAL PARTICIPATES IN MANY ORGANIZATIONS AND ACTIVITIES DESIGNED TO IMPROVE THE HEALTH AND WELFARE OF THE SURROUNDING COMMUNITY. IN ADDITION TO PARTICIPATION ON VARIOUS BOARDS AND CIVIC ORGANIZATIONS FOCUSED ON ECONOMIC DEVELOPMENT, THE HOSPITAL'S LEADERSHIP PARTICIPATES IN THE INDIANA PATIENT SAFETY COALITION, THE DEPARTMENT OF HOMELAND SECURITY, DISTRICT 10 EMERGENCY PREPAREDNESS AND NATIONAL INCIDENT MANAGEMENT SAFETY PROGRAMS. AS MEMBERS OF THE INDIANA RURAL HEATH ASSOCIATION AND THE INDIANA STATE RURAL HEALTH NETWORK, THE HOSPITAL PARTICIPATES IN PROGRAMS DESIGNED TO ASSIST RURAL HEALTHCARE ORGANIZATIONS STATEWIDE AND HAS ASSISTED IN OBTAINING AND IMPLEMENTING COMMUNICATION, INFORMATION SHARING, AND OTHER ACTIVITIES TO IMPROVE THE ACCESS TO HEALTHCARE IN GIBSON COUNTY AND THE SURROUNIDNG AREAS. PART VI, LINE 6: AFFILIATED HEALTH CARE SYSTEM:GIBSON GENERAL HOSPITAL BECAME AFFILIATED WITH DEACONESS HEALTH SYSTEM IN DECEMBER 2016 COOPERATING TO PROVIDE HEALTH CARE SERVICES TO THEIR COMMUNITIES. ADDITIONALLY, THE HOSPITAL DOES PARTICIPATE IN SEVERAL COALITIONS AND COOPERATIVES WITH OTHER PROVIDERS AND OFTEN COLLABORATES WITH THE LARGER SYSTEM IN THE EVANSVILLE AREA TO PROVIDE ACCESS TO SERVICES THE HOSPITAL CANNOT PROVIDE SUCH AS CARDIAC AND NEUROLOGICAL SURGERY. X 0 0 X X X X X 0 1 0 0 0 1 1 0 0 SHAWN MCCOY CEO DHS 0 1081630 0 432108 0 212372 0 283182 0 46027 0 2055319 0 201639 LYNN LINGAFELTER BOARD MEMBER 0 636923 0 216069 0 105831 0 158519 0 33881 0 1151223 0 98054 MARC JARED FLORENCE BOARD MEMBER 0 462519 0 133997 0 69773 0 111701 0 40673 0 818663 0 65642 STEVEN IVY BOARD MEMBER 0 295058 0 59470 0 1431 0 15428 0 34436 0 405823 0 0 DR DAVID PURDOM CHIEF OF STAFF 291291 0 0 0 12321 0 16744 0 31532 0 351888 0 0 0 ASHLEY SMITH PHYSICIAN 290514 0 0 0 22960 0 7031 0 10146 0 330651 0 0 0 COREY POTTS CRNA 256667 0 21242 0 1212 0 15011 0 29686 0 323818 0 0 0 LOIS MORGAN CAO 0 205573 0 41220 0 3126 0 13010 0 22559 0 285488 0 0 SHANE C HAYES CNO 118251 0 12275 0 1244 0 6034 0 29278 0 167082 0 0 0 PART I, LINE 1A SOCIAL CLUB DUES ARE PAID FOR SHAWN MCCOY FOR ORGANIZATION BUSINESS ONLY. ANY PERSONAL USE OF THE CLUB MUST BE PAID BY THE EMPLOYEE. PART I, LINE 4B SEVERANCE, NONQUALIFIED, AND EQUITY-BASED PAYMENTS: SEVERANCE NONQUALIFIED EQUITY-BASED SHAWN MCCOY $ -0- $ 22,500 $ -0- MARC J. FLORENCE 0 22,500 0 DAVID PURDOM 0 22,500 0 LYNN LINGAFELTER 0 22,500 0 PART I, 4B: SHAWN MCCOY: SUPPLEMENTAL ACCUMULATION ACCOUNT CONTRIBUTIONS OF $256,206. SUPPLEMENTAL ACCUMULATION ACCOUNT PAYOUT OF $201,639. MARC J. FLORENCE: SUPPLEMENTAL ACCUMULATION ACCOUNT CONTRIBUTIONS OF $83,789. SUPPLEMENTAL ACCUMULATION ACCOUNT PAYOUT OF $65,642. LYNN LINGAFELTER: SUPPLEMENTAL ACCUMULATION ACCOUNT CONTRIBUTIONS OF $133,371. SUPPLEMENTAL ACCUMULATION ACCOUNT PAYOUT OF $98,054. 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. FORM 990, PART VI, SECTION A, LINE 6 CLASSES OF MEMBERS OR STOCKHOLDERS: DEACONESS HEALTH SYSTEM, INC., A TAX EXEMPT 501(C)(3) ORGANIZATION, IS THE SOLE CORPORATE MEMBER OF GIBSON GENERAL HOSPITAL. FORM 990, PART VI, SECTION A, LINE 7A POWER TO ELECT OR APPOINT: DEACONESS HEALTH SYSTEM, THE SOLE MEMBER OF THE ORGANIZATION, HAS THE POWER TO APPOINT AND REMOVE EACH MEMBER. THE ORGANIZATION GOVERNING DOCUMENTS ALLOWS FOR THE COUNTY COMMISSIONERS OF GIBSON COUNTY, INDIANA TO SELECT ONE (1) MEMBER OF THE BOARD OF TRUSTEES; THREE (3) REPRESENTATIVES FROM THE ORGANIZATION'S SOLE MEMBER; THE MAYOR OF PRINCETON, INDIANA; THE PRESIDENT OF GIBSON GENERAL HOSPITAL FOUNDATION; THE CHIEF OF STAFF OF GIBSON GENERAL HOSPITAL TO SERVE AS EX-OFFICIO MEMBER; AND TWO MEMBERS OF THE MEDICAL COMMUNITY. FORM 990, PART VI, SECTION A, LINE 7B THE FOLLOWING GOVERNANCE DECISIONS ARE RESERVED TO THE SOLE MEMBER OF THE ORGANIZATION, DEACONESS HEALTH SYSTEM. - APPROVAL OF ANNUAL OR LONG-TERM CAPITAL BUDGETS, OPERATING BUDGETS AND STRATEGIC PLANS, OR ANY EXPENDITURE IN EXCESS OF $150,000 NOT INCLUDED IN AN APPROVED BUDGET. - THE SALE OR TRANSFER OF SUBSTANTIALLY ALL OF THE ASSETS OF THE CORPORATION OR OF ANY KEY OPERATIONAL ASSETS. - THE FILING OF BANKRUPTCY OR SIMILAR INSOLVENCY PROCESS WITH RESPECT TO THE CORPORATION. - ANY TRANSFER OF SUBSTANTIAL MANAGEMENT RESPONSIBILITY WITH RESPECT TO THE CORPORATION. - ANY AMENDMENT TO THE CORPORATION'S ARTICLES OF INCORPORATION OR BYLAWS. - ANY BORROWING EQUAL TO OR GREATER THAN $150,000, OR ANY AMENDMENT TO FINANCING OR LOAN DOCUMENTS TO WHICH THE CORPORATION IS A PARTY. - ANY DECISION TO CHANGE THE NAME OF THE HOSPITAL, CHANGE THE HOSPITAL CAMPUS FROM A CRITICAL ACCESS HOSPITAL STATUS, RELOCATE OR SUBSTANTIALLY REDUCE OR TERMINATE SERVICES TO THE COMMUNITY. - ANY DECISION TO REDUCE THE LEVEL OF CHARITABLE SERVICES TO THE COMMUNITY. - ANY DECISION RELATING TO THE TERMINATION OF THE CORPORATION'S EMPLOYEE RETIREMENT PLAN. - ADOPTION OF ANY POLICIES RELATING TO THE OPERATION OF THE BOARD, THE CORPORATION, OR THE HOSPITAL THAT ARE INCONSISTENT WITH POLICIES OF DEACONESS. - ANY OF THE FOREGOING ACTIONS BY THE CORPORATION AS THE OWNER, MEMBER OF ANY OF THE CORPORATION'S SUBSIDIARIES OR AFFILIATES, INCLUDING THE HOSPITAL. FORM 990, PART VI, SECTION B, LINE 11B FORM 990 REVIEW PROCESS: THE PROCESS OF REVIEWING THE FORM 990 INCLUDES A DETAILED REVIEW OF THE FORM AND REQUIRED SCHEDULES BY THE CHIEF FINANCIAL OFFICER AND MANAGEMENT. 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 CONFLICT OF INTEREST POLICY: THE CONFLICT OF INTEREST POLICY IS INCLUDED WITHIN THE BYLAW OF THE ORGANIZATION AND COVERS ALL BOARD OF TRUSTEES. THE POLICY PROVIDES PROCEDURES TO PREVENT THOSE WITH DUALITY OF INTEREST OR POSSIBLE CONFLICTS OF INTEREST FROM PARTICIPATING IN ANY ACTION THAT COULD PERSONALLY BENEFIT THE INDIVIDUAL TRUSTEE. THE CEO AND/OR BOARD COMPLIANCE OFFICER REVIEW ANNUAL WRITTEN AND SIGNED CONFLICT OF INTEREST STATEMENTS THAT PROVIDE ANY DUALITY OF INTEREST OR POSSIBLE CONFLICTS OF INTEREST DISCLOSED BY ALL BOARD OF TRUSTEES. THE INDIVIDUAL TRUSTEE WILL AGAIN DISCLOSE TO THE BOARD WHEN THE INTEREST BECOMES A MATTER OF BOARD ACTION AND RECUES HIMSELF OR HERSELF FROM VOTING ON THE RELATED ISSUE. THE BOARD MEETING MINUTES DOCUMENT THE DISCLOSURE MADE, WHO ABSTAINED FROM VOTING, AND THE QUORUM SITUATION. FORM 990, PART VI, SECTION B, LINE 15 COMPENSATION PROCESS: CEO: THE CEO EVALUATION COMMITTEE, CONSISTING OF FOUR INDEPENDENT AND BOARD CHAIR APPOINTMENT TRUSTEE MEMBERS, EVALUTATES THE PERFORMANCE OF THE CEO ON AN ANNUAL BASIS AND MAKES COMPENSATION-RELATED RECOMMENDATIONS TO THE BOARD PRIOR TO THE CEO'S ANNUAL REVIEW DATE FOR APPROVAL. THE EVALUATION COMMITTEE USES A COMPENSATION CONSULTANT, COMPENSATION SURVEY, AND COMPARATIVE DATA FROM SIMLIAR ORGANIZATION TO DETERMINE THE CEO'S COMPENSATION PACKAGE. ALL DELIBERATION AND DECISIONS ARE DOCUMENTED IN THE EVALUATION COMMITTEE'S MINUTES. OFFICERS AND/OR KEY EMPLOYEES: ANNUAL REVIEWS FOR TOP MANAGEMENT OFFICIALS ARE CONDUCTED BY THE CEO. THE COMPENSATION IS ANNUALLY REVIEWED AND APPROVED BY THE BOARD OF TRUSTEES. FORM 990, PART VI, SECTION C, LINE 19 THE HOSPITAL'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON WRITTEN REQUEST AND BOARD OF TRUSTEES APPROVAL. WRITTEN REQUESTS SHOULD BE SENT TO ATTN: JAMES CHILDERS, AT THE ADDRESS LISTED ON PAGE 1 OF THE FORM 990. FORM 990, PART VI, LINE 16B, JOINT VENTURE POLICY: THE ORGANIZATION DOES NOT HAVE A FORMAL WRITTEN POLICY ON EVALUATING PARTICIPATION IN A JOINT VENTURE, HOWEVER, THE ORGANIZATION PERFORMS DUE DILIGENCE AND INVOLVES LEGAL COUNSEL TO REVIEW ANY PARTNERSHIPS ENSURING THAT THE JOINT VENTURE WOULD BE ORGANIZED AND OPERATED IN A MANNER CONSISTENT WITH THE HOSPITAL'S EXEMPT PURPOSE AND STATUS. FORM 990, PART IX, LINE 11G PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 8,934,194. MANAGEMENT AND GENERAL EXPENSES 2,414,225. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 11,348,419. FORM 990, PART XII, LINE 2C, OVERSIGHT OF AUDIT: THE BOARD OF TRUSTEES 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. 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