SCHEDULE H
(Form 990)
Department of the Treasury
Internal Revenue Service
Hospitals
MediumBullet Complete if the organization answered "Yes" on Form 990, Part IV, question 20.
MediumBullet Attach to Form 990.
MediumBullet Information about Schedule H (Form 990) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2015
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
No
1a
Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a . . . .
1a
Yes
 
b
If "Yes," was it a written policy? ......................
1b
Yes
 
2
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.
3
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.
a
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:
3a
Yes
 
%
b
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: . . . . . . . .
3b
Yes
 
%
c
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.
4
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"? . . . . . . . . . . . . .

4

Yes

 
5a
Did the organization budget amounts for free or discounted care provided under its financial assistance policy during
the tax year? . . . . . . . . . . . . . . . . . . . . . . .

5a

Yes

 
b
If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? . . . . . .
5b
 
No
c
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? . . . . . . . . . . . . .
5c
 
 
6a
Did the organization prepare a community benefit report during the tax year? . . . . . . . . .
6a
Yes
 
b
If "Yes," did the organization make it available to the public? . . . . . . . . . . . . .
6b
Yes
 
Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.
7
Financial Assistance and Certain Other Community Benefits at Cost
Financial Assistance and
Means-Tested
Government Programs
 (a) Number of activities or programs (optional) (b) Persons served (optional) (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) . . . 		    11,317,066   11,317,066 1.560 %
b Medicaid (from Worksheet 3, column a) . . . . .     121,745,825 96,870,198 24,875,627 3.420 %
c Costs of other means-tested government programs (from Worksheet 3, column b) . .            
d Total Financial Assistance and Means-Tested Government Programs . . . . .     133,062,891 96,870,198 36,192,693 4.980 %
Other Benefits
e Community health improvement services and community benefit operations (from Worksheet 4).     790,278   790,278 0.110 %
f Health professions education (from Worksheet 5) . . .     7,145,974 2,328,151 4,817,823 0.660 %
g Subsidized health services (from Worksheet 6) . . . .     2,712,760 372,970 2,339,790 0.320 %
h Research (from Worksheet 7) .            
i Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .     1,934,135 23,038 1,911,097 0.260 %
j Total. Other Benefits . .     12,583,147 2,724,159 9,858,988 1.350 %
k Total. Add lines 7d and 7j .     145,646,038 99,594,357 46,051,681 6.330 %
For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2015
Schedule H (Form 990) 2015
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.
(a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community building expense (d) Direct offsetting
revenue 		(e) Net community building expense (f) Percent of total expense
1 Physical improvements and housing     2,251   2,251 0 %
2 Economic development     27,238   27,238 0 %
3 Community support     13,633   13,633 0 %
4 Environmental improvements            
5 Leadership development and
training for community members		     6,300   6,300 0 %
6 Coalition building     13,983   13,983 0 %
7 Community health improvement advocacy            
8 Workforce development     74,946 16,674 58,272 0.010 %
9 Other            
10 Total     138,351 16,674 121,677 0.010 %
Part III
Bad Debt, Medicare, & Collection Practices
Section A. Bad Debt Expense
Yes
No
1
Did the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................
1
Yes
 
2
Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......
2
6,569,954
3
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. ......
3
 
4
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
5
Enter total revenue received from Medicare (including DSH and IME).....
5
150,945,812
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
167,606,353
7
Subtract line 6 from line 5. This is the surplus (or shortfall)........
7
-16,660,541
8
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:
Section C. Collection Practices
9a
Did the organization have a written debt collection policy during the tax year? ..........
9a
Yes
 
b
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 .........................

9b

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) 2015
Schedule H (Form 990) 2015
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?3
Name, 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) 		Licensed Hospital General-Medical-Surgical Children's Hospital Teaching Hospital Critical Hospital ResearchGrp Facility ER-24Hours ER-Other Other (Describe) Facility reporting group
1 DEACONESS HOSPITAL INC
600 Mary Street
Evansville,IN47747
www.deaconess.com
15-005074-1 		X X   X     X      
2 Deaconess Gateway Hospital
4011 Gateway Blvd
Newburgh,IN47630
www.deaconess.com
15-005074-1 		X X   X     X      
3 DEACONESS CROSS POINTE
7200 E Indiana Street
evansville,IN47715
www.deaconess.com
15-005074-1 		X                  
Schedule H (Form 990) 2015
Page 4
Schedule H (Form 990) 2015
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): 		1
Yes No
Community Health Needs Assessment
1 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?........................ 1   No
2 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............... 2   No
3 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...................... 3 Yes  
If "Yes," indicate what the CHNA report describes (check all that apply):
a
b
c
d
e
f
g
h
i
j
4 Indicate the tax year the hospital facility last conducted a CHNA: 20 15
5 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 ................. 5 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.................................. 6a Yes  
b 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. ............................ 6b Yes  
7 Did the hospital facility make its CHNA report widely available to the public?.............. 7 Yes  
If "Yes," indicate how the CHNA report was made widely available (check all that apply):
a
b
c
d
8 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. .............. 		8 Yes  
9 Indicate the tax year the hospital facility last adopted an implementation strategy: 20 15
10 Is the hospital facility's most recently adopted implementation strategy posted on a website?......... 10 Yes  
a If "Yes" (list url): http://www.healthyswin.org/
b If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ...... 10b   No
11 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   No
b If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........ 12b    
c 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) 2015
Page 5
Schedule H (Form 990) 2015
Page 5
Part VFacility Information (continued)

Financial Assistance Policy (FAP)
DEACONESS HOSPITAL INC
Name of hospital facility or letter of facility reporting group  
Yes No
Did the hospital facility have in place during the tax year a written financial assistance policy that:
13 Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care? 13 Yes  
If “Yes,” indicate the eligibility criteria explained in the FAP:
a
b
c
d
e
f
g
h
14 Explained the basis for calculating amounts charged to patients?................. 14 Yes  
15 Explained the method for applying for financial assistance?................... 15 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):
a
b
c
d
e
16 Included measures to publicize the policy within the community served by the hospital facility?........ 16 Yes  
If "Yes," indicate how the hospital facility publicized the policy (check all that apply):
a
 
b
 
c
d
e
f
g
h
i
Billing and Collections
17 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 non-payment?.................................. 17 Yes  
18 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:
a
b
c
d
e
Schedule H (Form 990) 2015
Page 6
Schedule H (Form 990) 2015
Page 6
Part VFacility Information (continued)

DEACONESS HOSPITAL INC
Name of hospital facility or letter of facility reporting group  
Yes No
19 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?............ 19   No
If "Yes," check all actions in which the hospital facility or a third party engaged:
a
b
c
d
20 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):
a
b
c
d
e
f
Policy Relating to Emergency Medical Care
21 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?.................. 21 Yes  
If "No," indicate why:
a
b
c
d
Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)
22 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.
a
b
c
d
23 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? ............................... 23   No
If "Yes," explain in Section C.
24 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? ........................... 24   No
If "Yes," explain in Section C.
Schedule H (Form 990) 2015
Page 4
Schedule H (Form 990) 2015
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): 		2
Yes No
Community Health Needs Assessment
1 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?........................ 1   No
2 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............... 2   No
3 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...................... 3 Yes  
If "Yes," indicate what the CHNA report describes (check all that apply):
a
b
c
d
e
f
g
h
i
j
4 Indicate the tax year the hospital facility last conducted a CHNA: 20 15
5 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 ................. 5 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.................................. 6a Yes  
b 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. ............................ 6b Yes  
7 Did the hospital facility make its CHNA report widely available to the public?.............. 7 Yes  
If "Yes," indicate how the CHNA report was made widely available (check all that apply):
a
b
c
d
8 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. .............. 		8 Yes  
9 Indicate the tax year the hospital facility last adopted an implementation strategy: 20 15
10 Is the hospital facility's most recently adopted implementation strategy posted on a website?......... 10 Yes  
a If "Yes" (list url): http://www.healthyswin.org/
b If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ...... 10b   No
11 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   No
b If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........ 12b    
c 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) 2015
Page 5
Schedule H (Form 990) 2015
Page 5
Part VFacility Information (continued)

Financial Assistance Policy (FAP)
DEACONESS GATEWAY HOSPITAL
Name of hospital facility or letter of facility reporting group  
Yes No
Did the hospital facility have in place during the tax year a written financial assistance policy that:
13 Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care? 13 Yes  
If “Yes,” indicate the eligibility criteria explained in the FAP:
a
b
c
d
e
f
g
h
14 Explained the basis for calculating amounts charged to patients?................. 14 Yes  
15 Explained the method for applying for financial assistance?................... 15 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):
a
b
c
d
e
16 Included measures to publicize the policy within the community served by the hospital facility?........ 16 Yes  
If "Yes," indicate how the hospital facility publicized the policy (check all that apply):
a
 
b
 
c
d
e
f
g
h
i
Billing and Collections
17 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 non-payment?.................................. 17 Yes  
18 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:
a
b
c
d
e
Schedule H (Form 990) 2015
Page 6
Schedule H (Form 990) 2015
Page 6
Part VFacility Information (continued)

DEACONESS GATEWAY HOSPITAL
Name of hospital facility or letter of facility reporting group  
Yes No
19 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?............ 19   No
If "Yes," check all actions in which the hospital facility or a third party engaged:
a
b
c
d
20 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):
a
b
c
d
e
f
Policy Relating to Emergency Medical Care
21 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?.................. 21 Yes  
If "No," indicate why:
a
b
c
d
Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)
22 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.
a
b
c
d
23 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? ............................... 23   No
If "Yes," explain in Section C.
24 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? ........................... 24   No
If "Yes," explain in Section C.
Schedule H (Form 990) 2015
Page 4
Schedule H (Form 990) 2015
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): 		3
Yes No
Community Health Needs Assessment
1 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?........................ 1   No
2 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............... 2   No
3 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...................... 3 Yes  
If "Yes," indicate what the CHNA report describes (check all that apply):
a
b
c
d
e
f
g
h
i
j
4 Indicate the tax year the hospital facility last conducted a CHNA: 20 15
5 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 ................. 5 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.................................. 6a Yes  
b 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. ............................ 6b Yes  
7 Did the hospital facility make its CHNA report widely available to the public?.............. 7 Yes  
If "Yes," indicate how the CHNA report was made widely available (check all that apply):
a
b
c
d
8 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. .............. 		8 Yes  
9 Indicate the tax year the hospital facility last adopted an implementation strategy: 20 15
10 Is the hospital facility's most recently adopted implementation strategy posted on a website?......... 10 Yes  
a If "Yes" (list url): http://www.healthyswin.org/
b If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ...... 10b   No
11 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   No
b If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........ 12b    
c 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) 2015
Page 5
Schedule H (Form 990) 2015
Page 5
Part VFacility Information (continued)

Financial Assistance Policy (FAP)
DEACONESS CROSS POINTE
Name of hospital facility or letter of facility reporting group  
Yes No
Did the hospital facility have in place during the tax year a written financial assistance policy that:
13 Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care? 13 Yes  
If “Yes,” indicate the eligibility criteria explained in the FAP:
a
b
c
d
e
f
g
h
14 Explained the basis for calculating amounts charged to patients?................. 14 Yes  
15 Explained the method for applying for financial assistance?................... 15 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):
a
b
c
d
e
16 Included measures to publicize the policy within the community served by the hospital facility?........ 16 Yes  
If "Yes," indicate how the hospital facility publicized the policy (check all that apply):
a
 
b
 
c
d
e
f
g
h
i
Billing and Collections
17 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 non-payment?.................................. 17 Yes  
18 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:
a
b
c
d
e
Schedule H (Form 990) 2015
Page 6
Schedule H (Form 990) 2015
Page 6
Part VFacility Information (continued)

DEACONESS CROSS POINTE
Name of hospital facility or letter of facility reporting group  
Yes No
19 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?............ 19   No
If "Yes," check all actions in which the hospital facility or a third party engaged:
a
b
c
d
20 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):
a
b
c
d
e
f
Policy Relating to Emergency Medical Care
21 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?.................. 21 Yes  
If "No," indicate why:
a
b
c
d
Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)
22 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.
a
b
c
d
23 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? ............................... 23   No
If "Yes," explain in Section C.
24 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? ........................... 24   No
If "Yes," explain in Section C.
Schedule H (Form 990) 2015
Page 7
Schedule H (Form 990) 2015
Page 7
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, 16i, 18d, 19d, 20e, 21c, 21d, 22d, 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: DESCRIPTION OF COMMUNITY INPUT:Teams from Deaconess Health System, St. Mary's Health, ECHO Community Health Care, Vanderburgh County Health Department, United Way of Southwest Indiana, and the Welborn Baptist Foundation planned for and executed a second Community Health Needs Assessment in 2015. With assistance from Healthy Communities Institute (HCI), data was gathered in May and June 2015 through 12 focus groups and 17 "key informant interviews." Representation included social service agencies, education, law enforcement, public service, business and industry, government, non-profit organizations, and healthcare related organizations from both Vanderburgh County and Warrick County. The secondary data used in this assessment was obtained and analyzed from the HCI Data Platform which includes a comprehensive dashboard of over 100 community health and quality of life indicators covering over 20 topic areas. Indicator values for each county were compared to other counties in Indiana and nationwide to score health topics and compare relative areas of need. Other considerations for health areas of need included trends over time, Healthy People 2020 targets, and disparities by age, gender, and race/ethnicity.Primary and secondary data were evaluated and synthesized to identify the significant community health needs in each county. These needs were assessed and prioritized taking into consideration the ability to impact change, the opportunity to intervene at a prevention level, the magnitude of the health issue, and whether or not it addresses underserved and vulnerable populations. Behavioral Health (including substance abuse, tobacco use, and mental health) and Exercise, Nutrition, and Weight were two health needs identified for both Vanderburgh and Warrick County. Maternal-child health was also selected as an identified health need for Vanderburgh County and Cancer (specifically breast and prostate) was identified for Warrick County. A work group composed of people and organizations directly involved with each identified health need has been established. These groups are in the process of selecting specific goals for their topic area and will spend the next three years collectively working toward those goals. Our collaborative also created a public website called HealthySWIN to share not only our CHNA data but all publicly reportable data relevant to the identified health needs in our community. It can be found at www.healthyswin.org. A public presentation was held on June 22, 2016 at a local library to review the 2013-2015 CHNA successes and challenges as well as reveal the results from the 2015 CHNA. Our priority areas for each county were shared at this time.
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).
DEACONESS HOSPITAL, INC. Part V, Section B, Line 6a: Other Hospital Facilities CHNA was conducted with:Deaconess Gateway HospitalDeaconess Cross PointeSt. Mary's Health
DEACONESS GATEWAY HOSPITAL Part V, Section B, Line 6a: Other Hospital Facilities CHNA was conducted 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).
DEACONESS HOSPITAL, INC. Part V, Section B, Line 6b: Other organizations CHNA was conducted with:ECHO Community Health CareUnited Way of Southwest IndianaWelborn Baptist FoundationVanderburgh County Health Department
DEACONESS GATEWAY HOSPITAL Part V, Section B, Line 6b: Other organizations CHNA was conducted 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 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/CHNA.
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/CHNA.
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/CHNA.
DEACONESS HOSPITAL, INC. Part V, Section B, Line 11: As part of our agreement with the CHNA collaborative, Deaconess will focus time and resources for three years on creating positive change in the four identified topic areas from our 2015/2016 Community Health Needs Assessment. Our "scorecard" at the end of the 2013-2015 CHNA showed improvement in the overall health of the community, a decrease in the number of adult smokers, some progress with adult obesity, and an improvement in poor mental health days.Actions taken in the final year of our original CHNA include:Tobacco Report- We partnered with the Vanderburgh County Health Department to create and sustain the Baby and Me Tobacco Free Program. At the one-year mark, 118 women had participated in the program with 21 women in the post stage, 53 women actively participating, and 13 partners participating with the woman. We had 44 women drop out of the program giving us a 63 percent success rate. Deaconess referred 29 of the participants to the program. Obesity Report- Deaconess partnered with all of the Indiana District 10 hospitals to create "Healthy Baby Steps." This community education and resource campaign encourages women to do three things - get early prenatal care, stop smoking, and take a prenatal vitamin. This initiative followed the Vanderburgh County Health Department's sharing of statistics showing 60 percent of all fetal/infant deaths (in Vand. Co.) had mothers who were at an unhealthy weight (17% were overweight, 26% were obese, and 17% were morbidly obese). - Continuation of Healthier U Walks. For 12 Saturdays in April through June, individuals meet each week at a different park or walking trail to walk from 9-10am. The program encourages exercise but also provides people with the opportunity to explore new places to walk with the safety of a "tour guide and a group to walk with. We also have a service line attend each walk. This gives participants the opportunity to ask about heart care, cancer, women's health, pediatrics, etc.- Deaconess Hospital and the West Side Nut Club collaborated for a 4th year to provide a "Wise Choice" Fall Festival munchie map. The Fall Festival in Evansville (Vanderburgh County) has been said to be the second largest street festival next to Mardi Gras and draws over 200,000 individuals each year. The festival is known for their deep fried and other unhealthy options. The Wise Choice map features food items that are low calorie, low fat, and low sodium.- Continuation of a summer/fall farmers' market at both Deaconess Hospital locations and our downtown clinic. Continued participation in the Downtown Farmers' Market by providing healthy recipes, health information, and other service line related tests and information each week at the market. In 2015, we also participated in the Historic Newburgh Farmers' Market, the New Harmony Farmers' Market, and the Franklin Street Bazaar. - Our already robust employee wellness program was further enhanced with the addition of a Health Reimbursement Account. Employees now have a monetary incentive to get active and meet their fitness goals. Substance Abuse and Mental Health Report- The Healthcare Leadership Council honored Deaconess and St. Mary's with a Wellness Frontier Award for its Youth Mental Health First Aid Training, Project AWARE. Project AWARE was developed in 2015 with the goal of increasing awareness of mental health and substance abuse issues among school age youth. The Healthcare Leadership Council created the Wellness Frontiers Award to recognize health and wellness best practices and programs in communities and organizations across the nation. Winners are organizations developing and activating cost-effective, measurable community programs promoting wellness and disease prevention.
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).
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).
DEACONESS HOSPITAL, INC. Part V, Section B, Line 16i: 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 16 IMPACTED THE LIVES OF MORE THAN 9,400 MEMBERS OF OUR COMMUNITY BY HELPING THEM OBTAIN INSURANCE OR PROVIDE ASSISTANCE FOR THE UNDERINSURED.
DEACONESS GATEWAY HOSPITAL Part V, Section B, Line 16i: 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 16i: OTHER METHOD USED TO PUBLICIZE THE FINANCIAL ASSISTANCE POLICY is reported the same as Deaconess Hospital, Inc. (Hospital Facility #1).
DEACONESS HOSPITAL, INC. Part V, Section B, Line 22d: Deaconess uses a weighted average of medicare and managed care discounts.
DEACONESS GATEWAY HOSPITAL Part V, Section B, Line 22d: Deaconess uses a weighted average of medicare and managed care discounts.
DEACONESS CROSS POINTE Part V, Section B, Line 22d: Deaconess uses a weighted average of medicare and managed care discounts.
   
   
   
Schedule H (Form 990) 2015
Page 8
Schedule H (Form 990) 2015
Page 8
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?38
Name and address Type of Facility (describe)
1 1 - DEACONESS PROCEDURE CENTER
421 Chestnut street
Evansville,IN47713 		Outpatient Services
2 2 - Deaconess Hospital Physical Medicine
520 Mary Street Suite 280
Evansville,IN47747 		Outpatient Services
3 3 - Deaconess Chemotherapy Infusion Ctr
4055 Gateway Blvd Suite 1200
Newburgh,IN47630 		Outpatient Services
4 4 - Deaconess Clinic Gateway Reg Lab
4233 Gateway Blvd
Newburgh,IN47630 		Diagnostic Center
5 5 - Deaconess Comprehensive Pain Ctr & Prog
4600 W Lloyd Expressway
Evansville,IN47712 		Outpatient Services
6 6 - Deaconess Hospital Infusion Svcs
421 Chestnut street
Evansville,IN47713 		Outpatient Services
7 7 - Deaconess Hospital Physical Medicine
10455 Orthopaedic Drive
Newburgh,IN47630 		Outpatient Services
8 8 - Deaconess Comprehensive Pain Ctr-Gateway
4099 Gateway Blvd
Newburgh,IN47630 		Outpatient Services
9 9 - Chancellor Center for Oncology
4055 Gateway Blvd
Newburgh,IN47630 		Outpatient Services
10 10 - Deaconess Sleep Lab
350 W Columbia Street Suite 210
Evansville,IN47710 		Outpatient Services
11 11 - Deaconess Sleep Lab
350 W Columbia Street Suite LL-10
Evansville,IN47710 		Diagnostic Center
12 12 - Deaconess Hospital Breast Center
520 Mary Street Suite 140
Evansville,IN47710 		Diagnostic Center
13 13 - Deaconess Clinic West Reg Lab Radiology
545 S Boehne Camp Road
Evansville,IN47712 		Outpatient Physician Clinic
14 14 - Deaconess Clinic Princeton Radiology Srv
685 Vail Street
Princeton,IN47670 		Outpatient Physician Clinic
15 15 - Deaconess Wound Care Center
350 W Columbia Street Suite 350
Evansville,IN47710 		Outpatient Services
16 16 - Deaconess Anticoagulation Clinic
4107 Gateway Blvd
Newburgh,IN47630 		Outpatient Services
17 17 - Mt Vernon Medical Center Lab & Radiology
1900 W Fourth Street
MT Vernon,IN47620 		Diagnostic Center
18 18 - Midwest Radiologic Imaging
10455 Orthopaedic Drive
Newburgh,IN47630 		Diagnostic Center
19 19 - Midwest Radiological Imaging
4087 Gateway Blvd
Newburgh,IN47630 		Diagnostic Center
20 20 - Deaconess Regional Laboratory
4133 Gateway Blvd Suite 110
Newburgh,IN47630 		Diagnostic Center
21 21 - Deaconess Riley Children's Specialty Ctr
4133 Gateway Blvd
Newburgh,IN47630 		Outpatient Physician Clinic
22 22 - Deaconess Riley Speciality Ctr OP
4121 Gateway Blvd
Newburgh,IN47630 		Outpatient Physician Clinic
23 23 - Deaconess Primary Care for Seniors
4498 First Avenue
Evansville,IN47710 		Outpatient Physician Clinic
24 24 - Deaconess Primary Care for Seniors
1750 Oak Hill Road
Evansville,IN47710 		Outpatient Physician Clinic
25 25 - Deaconess Diabetes Center - Education
421 Chestnut street
Evansville,IN47713 		Outpatient Services
26 26 - Deaconess Pre-admission testing
520 Mary Street Suite 330
Evansville,IN47747 		Diagnostic Center
27 27 - Deaconess Gateway Gastroenterology
4133 Gateway Blvd
Newburgh,IN47630 		Outpatient Physician Clinic
28 28 - Deaconess Weight Loss Solutions
310 W Iowa Street
Evansville,IN47710 		Outpatient Physician Clinic
29 29 - Deaconess Hospital Mammography & Imaging
421 Chestnut street
Evansville,IN47713 		Diagnostic Center
30 30 - Deaconess Regional Laboratory
4494 N First Avenue
Evansville,IN47710 		Diagnostic Center
31 31 - Deaconess Regional Laboratory
421 Chesnut Street
Evansville,IN47713 		Diagnostic Center
32 32 - Deaconess Regional laboratory
1204 W Williams Street
Oakland City,IN47660 		Diagnostic Center
33 33 - Deaconess Cross Pointe Outpatient Clinic
445 Cross Pointe Blvd
Evansville,IN47715 		Outpatient Physician Clinic
34 34 - deaconess cross pointe
7200 E indiana
evansville,IN47715 		Outpatient Physician Clinic
35 35 - deaconess radiology lab & Radiology
8600 north kentucky avenue
evansville,IN47725 		Diagnostic Center
36 36 - Deaconess Family Medicine Residency
415 W Columbia St Suite 110
Evansville,IN47710 		Outpatient Physician Clinic
37 37 - Deaconess Sleep Center-East
7307 E Columbia St
Evansville,IN47715 		Diagnostic Center
38 38 - Deaconess Hospital Physical Medicine
4600 W Lloyd Expressway Suite B
Evansville,IN47715 		Outpatient services
Schedule H (Form 990) 2015
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Schedule H (Form 990) 2015
Page 9
Part VI
Supplemental Information
Provide the following information.
1 Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II and Part III, lines 2, 3, 4, 8 and 9b.
2 Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any CHNAs reported in Part V, Section B.
3 Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4 Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5 Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6 Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7 State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.
Form and Line Reference Explanation
Part I, Line 6a: Deaconess Hospital prepares an annual community benefit report. The report is made available in the following ways:1. Mailed to all the major employers in the tri-state area.2. An advertisement is placed in the Sunday paper of the Evansville Courier and Press.3. Is made available on the Deaconess website at http://www.deaconess.com/Careers/For-Our-Employees/ Our-Community/Community-Benefit.aspx
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 $422,576. THESE CLINICS ARE OPERATED AS A BENEFIT TO THE COMMUNITY.
Part I, Ln 7 Col(f): The Bad Debt expense is not included on form 990, part IX, line 25, column (a) due to early adoption of accounting standards update (ASU) 2011-07, Healthcare entities (Topic 954).
Part II, Community Building Activities: Population Health - Deaconess developed and manages the only comprehensive population health initiative in the region. Current hospital partners include Methodist Hospital (KY), Gibson General Hospital, Good Samaritan Hospital, Memorial Hospital and Health Care Center, Wabash General Hospital, Fairfield Memorial Hospital, and Ferrell Hospital Foundation.In FY15-16, we launched the OneCare Specialist Council to foster efficient, optimal referral relationships. We expanded our care programs to include Catastrophic Care and Advanced Illness Care. Due to our infrastructure and experience, the Deaconess ACO was selected as a Care Management delegation pilot site by Anthem and selected to participate in the Next Generation ACO Model.Increased Childhood ImmunizationFor 2016, the Indiana State Department of Health Immunization Program analyzed immunization rates for completion of the 4:3:1:3:3:1:4 series (4 doses of DTaP, 3 doses of IPV, 1 dose of MMR, 3 doses of Hib, 3 doses of Hep B, 1 dose of varicella and 4 doses of PCV). The average immunization rate in Indiana was 60% for completion of the 4:3:1:3:3:1:4 series at 19-35 months. Nearly 70% of the counties were at or above the rate of 60%, with a median (or midpoint) of 64.5%. Vanderburgh County's rate was 71%. That is a vast improvement from our 52% completion rate in 2014 and our 67% completion rate in 2015. The positive momentum is thanks to an immunization task force created by the Vanderburgh County Health Department. Deaconess had heavy participation in the work of the task force.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, churches, organizations and community gathering facilities. As of September 2016, the committee has raised enough money and placed 85 AEDs. Homeless Connect and Community First Health FairDeaconess continued to provide on-site services at two community events intended to increase access to health care for the homeless, near homeless, and those living in poverty. Services include blood pressure checks, blood sugar screenings, prostate checks (DRE and blood test), mammograms, immunizations, connecting people with needed services. Mobile Breast CenterThe 40 ft. coach travelled throughout the tri-state area providing mammograms to women where they live and work. Grant dollars are available for immediate use for women with no or inadequate insurance needing a mammogram. In FY15-16, Deaconess sponsored programs and activities for 180 organizations, contributing more than $1.3 million. (Disease-Related Organization or Event - $94,666.02; Service Provider - $328,374.00; Medical-Related Organization - $305,757.75; School Donations - $214,189.23; Public Service Organizations - $3,800.00; Economic Development - $193,750.00; Other Groups - $194,904.70) All of that money stayed in our service area to improve the health and safety of the community.Trauma Education - Deaconess Trauma Services and the Business Development Group increased the amount of time and resources devoted to educating EMS personnel and other first responders in the region. This includes pre-hospital training and building relationships with tri-state EMS groups. Health Science Institute - We held the 26th annual Health Science Institute, a hands-on summer program for high school students interested in the medical profession. The students spend two weeks living in dorm-style housing at the hospital while learning about all facets of patient care. Suicide Prevention - Members of our mental health hospital travel around the region to provide suicide prevention training to schools, churches, non-profit groups, etc.Deaconess also provides free and reduced care within our hospital buildings. Through our Medication Assistance Program, our Family Practice Residency Clinic, and community health screenings, area residents can access the high quality healthcare they need in convenient locations and at a price they can afford.
Part III, Line 4: THE FOOTNOTE DESCRIBING BAD DEBT EXPENSES IS INCLUDED IN THE ATTACHED AUDITED FINANCIAL STATEMENTS UNDER FOOTNOTE "CHARITY CARE, COMMUNITY BENEFIT AND ASSISTANCE TO THE UNINSURED" STARTING ON PAGE 11 AND "PATIENT ACCOUNTS RECEIVABLE AND NET PATIENT SERVICE REVENUE" STARTING ON PAGE 12.
Part III, Line 8: THE SOURCE USED TO DETERMINE THE AMOUNT OF MEDICARE REVENUE AND ALLOWABLE COSTS REPORTED FOR PART III, SECTION B, LINE 8: THE MEDICARE TOTAL REVENUE AND ALLOWABLE COSTS WERE ACTUAL BASED UPON THE 2014 MEDICARE COST REPORT. THE MEDICARE SHORTFALL FOR DEACONESS HOSPITAL IS TREATED AS COMMUNITY BENEFIT DUE TO THE HOSPITAL PROVIDING CARE TO MEDICARE PATIENTS AT LESS THAN THE ALLOWABLE MEDICARE COSTS.
Part III, Line 9b: DEACONESS HOSPITAL MAKES A DISTINCTION BETWEEN CHARITY AND BAD DEBT. IN DETERMINING AN INDIVIDUAL OR FAMILY'S ABILITY TO PAY, DEACONESS HOSPITAL EVALUATES WHETHER OR NOT THE RESPONSIBLE PARTY HAS SUFFICIENT RESOURCES FOR PAYMENT. IF AN INDIVIDUAL IS DETERMINED TO NOT HAVE SUFFICIENT RESOURCES TO PAY, THEY WILL BE CONSIDERED ELIGIBLE FOR CHARITY CARE AND WILL NOT BE PROCESSED THROUGH EITHER INTERNAL OR EXTERNAL COLLECTIONS. ACCOUNTS OF CHARITY CARE PATIENTS WHO ARE UNABLE TO PAY DO NOT RESULT IN BAD DEBT AND ARE NOT COLLECTED UPON.
Part VI, Line 2: NEEDS ASSESSMENT PROCESS: IN ADDITION TO THE CHNA REPORTED IN PART V, SECTION B DEACONESS HOSPITAL UTILIZES A VARIETY OF SOURCES TO GATHER DATA ON LOCAL HEALTH CARE NEEDS. A MAJOR SOURCE IS THE 7-COUNTY HEALTH SURVEY CONDUCTED BY WELBORN BAPTIST FOUNDATION. DEACONESS ALSO USES 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 THROUGH THE HOSPITAL'S 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. http://www.deaconess.com/DeaconessHospital/Business-Office/Financial-Assistance.aspx
Part VI, Line 4: Deaconess defines its community as all people living in Vanderburgh and Warrick Counties at any time during the year.Vanderburgh County - According to the 2015 County Health Rankings, Vanderburgh County ranks 78th out of 92 Indiana counties for health outcomes. Vanderburgh County's population is similar to the statewide population, with 85.6% of the population being White, 9% Black/African American, 1.2% Asian, and the remainder being of Other or 2 or More Races. There are also fewer Hispanic/Latinos, at 2.7% of the population. Approximately 10.5% of families are living in poverty, which is slightly lower than the state. The median household income for Vanderburgh County at $44,396 is about $5,000 lower than the state overall. HCI's SocioNeeds Index identified the zip codes of 47708 and 47713 as having the greatest socioeconomic need. Warrick County - According to the 2015 County Health Rankings, Warrick County ranks 30th out of 92 Indiana counties in overall health outcomes. Warrick County demographics are similar to those of the overall Indiana state population, with about 2% less 18-24 year olds and 1.5% more 65 and older. Less than 6% of Warrick County residents are non-white or Caucasian. The median household income is about $66,500 annually which is about $17,500 more than that of the state median, and roughly 6.6% of Warrick County families are living in poverty, which is lower than the state. HCI's SocioNeeds Index identified the zip codes of 47523 and 47637 as having the greatest socioeconomic need.
Part VI, Line 5: OTHER IMPORTANT COMMUNITY HEALTH PROMOTION:A MAJORITY OF ORGANIZATION'S GOVERNING BODY IS INDEPENDENT AND COMPRISED OF PERSONS WHO RESIDED IN THE ORGANIZATION'S PRIMARY SERVICE AREA; EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN ITS COMMUNITY; AND APPLIES SURPLUS FUNDS TO IMPROVEMENTS IN PATIENT CARE.
Part VI, Line 6: Affiliated Health Care System:Deaconess Hospital works in concert with Deaconess Health System and Deaconess Clinic to provide healthcare services with a compassionate and caring spirit to persons, families and communities of the tri-state. Deaconess Health System works to increase access to healthcare services within our community through Deaconess Hospital and Deaconess Clinic. Deaconess Hospital is a medical institution dedicated to providing quality patient care with unrelenting attention to clinical excellence, patient safety and an unparalleled passion and commitment to assure the very best healthcare for the patients served. Deaconess clinic provides excellent primary and multi-specialty healthcare in a personalized fashion with a dedicated focus to serve the community with excellent, timely and compassionate patient care.Part VI, line 7, list of states receiving community benefit report: Indiana
Schedule H (Form 990) 2015
Additional Data


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