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ObjectId: 202422289349303707 - Submission: 2024-08-15
TIN: 35-0593390
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.
Attach to Form 990.
Go to
www.irs.gov/Form990
for instructions and the latest information.
OMB No. 1545-0047
20
22
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
,
IN
47710
46-3509500
HEALTHCARE
IN
0
0
DEACONESS HOSPITAL
(2)
READY DEVELOPMENT OF INDIANA
600 MARY ST
EVANSVILLE
,
IN
47747
47-2040018
REAL ESTATE
IN
0
4,884,855
DEACONESS HOSPITAL
(3)
BASELINE INVESTORS LLC
600 MARY ST
EVANSVILLE
,
IN
47710
REAL ESTATE
IN
0
0
DEACONESS HOSPITAL
(4)
533 COLUMBIA LLC
600 MARY ST
EVANSVILLE
,
IN
47710
REAL ESTATE
IN
0
0
DEACONESS HOSPITAL
(5)
INVESTORS PROPERTY DEVELOPMENT LLC
600 MARY ST
EVANSVILLE
,
IN
47710
REAL ESTATE
IN
0
0
DEACONESS HOSPITAL
(6)
7307 E COLUMBIA LLC
600 MARY ST
EVANSVILLE
,
IN
47710
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?
Yes
No
(1)
DEACONESS HEALTH SYSTEM
600 MARY STREET
EVANSVILLE
,
IN
47747
35-1532889
HEALTHCARE
IN
501(C)(3)
LINE 12A, I
N/A
No
(2)
DEACONESS CLINIC INC
421 CHESNUT STREET
EVANSVILLE
,
IN
47713
26-3083364
HEALTHCARE
IN
501(C)(3)
LINE 3
DEACONESS HEALTH SYSTEM
No
(3)
DEACONESS VNA PLUS LLC
610 E WALNUT ST
EVANSVILLE
,
IN
47713
46-5223267
HEALTHCARE
IN
501(C)(3)
LINE 10
DEACONESS HEALTH SYSTEM
No
(4)
DEACONESS SPECIALTY PHYSICIANS INC
600 MARY STREET
EVANSVILLE
,
IN
47747
82-4503095
HEALTHCARE
IN
501(C)(3)
LINE 3
DEACONESS HEALTH SYSTEM
No
(5)
DEACONESS HEALTH KENTUCKY INC
600 MARY STREET
EVANSVILLE
,
IN
47747
83-0966826
HEALTHCARE
IN
501(C)(3)
LINE 10
DEACONESS HEALTH SYSTEM
No
(6)
METHODIST HEALTH INC
PO BOX 48
HENDERSON
,
KY
42419
61-0461753
HEALTHCARE
KY
501(C)(3)
LINE 3
DEACONESS HEALTH KENTUCKY
No
(7)
DEACONESS GIBSON HOSPITAL
1808 SHERMAN DR
PRINCETON
,
IN
47670
35-0877575
HEALTHCARE
IN
501(C)(3)
LINE 3
DEACONESS HEALTH SYSTEM
No
(8)
UNION COUNTY METHODIST HOSPITAL FOUNDATION
4604 US HWY 60 WEST
MORGANFIELD
,
KY
42437
61-1230297
SUPPORT METHODIST HEALTH
KY
501(C)(3)
LINE 10
DEACONESS HEALTH KENTUCKY
No
(9)
GIBSON GENERAL HEALTH FOUNDATION INC
1808 SHERMAN DRIVE
PRINCETON
,
IN
47670
35-0950175
SUPPORT GIBSON HOSPITAL
IN
501(C)(3)
LINE 12A, I
DEACONESS GIBSON HOSPITAL
No
(10)
DEACONESS UNION COUNTY HOSPITAL
4604 US HWY 60 WEST
MORGANFIELD
,
KY
42437
86-2614124
HEALTHCARE
KY
501(C)(3)
LINE 3
DEACONESS HEALTH KENTUCKY
No
(11)
DEACONESS WOMEN'S HOSPITAL OF SOUTHERN INDIANA LLC
4199 GATEWAY BLVD
NEWBURGH
,
IN
47630
35-2062016
HEALTHCARE
IN
501(C)(3)
LINE 3
DEACONESS HEALTH SYSTEM
No
(12)
DEACONESS ILLINOIS SPECIALTY CLINIC
600 MARY STREET
EVANSVILLE
,
IN
47747
92-0904755
HEALTHCARE
IN
501(C)(3)
LINE 10
DEACONESS HEALTH SYSTEM
No
(13)
DEACONESS ILLINOIS CLINIC
600 MARY STREET
EVANSVILLE
,
IN
47747
92-0574205
HEALTHCARE
IN
501(C)(3)
LINE 10
DEACONESS HEALTH SYSTEM
No
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2022
Page 2
Schedule R (Form 990) 2022
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
Yes
No
Yes
No
(1)
DEACONESS HEALTH PLANS LLC
7100 EAGLE CREST BLVD
EVANSVILLE
,
IN
47715
38-3492529
PREFERRED PROVIDER NETWORK
IN
DEACONESS HOSPITAL
RELATED
1,238,535
2,833,758
No
No
97.610 %
(2)
ENCOMPASS HEALTH DEACONESS REHABILIATION
9001 LIBERTY PARKWAY
BIRMINGHAM
,
AL
35242
72-1375246
OUTPATIENT
AL
DEACONESS HOSPITAL
RELATED
4,049,415
12,199,783
No
No
27.500 %
(3)
MAINSPRING MANAGERS LLC
4011 GATEWAY BLVD
NEWBURGH
,
IN
47630
46-4601001
NEUROLOGY SERVICES
IN
DEACONESS HOSPITAL
RELATED
1,446,514
1,248,301
No
Yes
53.620 %
(4)
ORTHOALIGN LLC
4011 GATEWAY BLVD
NEWBURGH
,
IN
47630
81-2816013
HEALTHCARE
IN
DEACONESS HOSPITAL
RELATED
1,985,007
1,221,209
No
No
51.000 %
(5)
PROGRESSIVE HEALTH OF IN LLC
150 N ROSENBERGER
EVANSVILLE
,
IN
47712
20-8480988
OUTPATIENT
IN
DEACONESS HOSPITAL
RELATED
4,668,806
2,533,509
No
No
51.000 %
(6)
TRI - STATE HEALTHCARE CONSULTING LLC
4199 GATEWAY BLVD
NEWBURGH
,
IN
47630
92-2120911
HEALTHCARE
IN
DEACONESS HOSPITAL
RELATED
5,241
5,241
No
No
51.000 %
(7)
TRI-STATE RADIATION ONCOLOGY
PO BOX 819067 TAX DEPT
DALLAS
,
TX
75381
26-3706834
OUTPATIENT
DE
DEACONESS HOSPITAL
RELATED
7,800,440
10,816,455
No
No
51.000 %
(8)
VASCMED LLC
600 MARY STREET
EVANSVILLE
,
IN
47747
47-2578168
VASCULAR SERVICES
IN
DEACONESS HOSPITAL
RELATED
667,358
611,875
No
No
51.000 %
(9)
BURKHARDT CANCER CENTER
4972 LINCOLN AVENUE STE 100
EVANSVILLE
,
IN
47715
30-0256432
HEALTHCARE
IN
N/A
No
No
(10)
BOSTON IVF FERTILITY SERVICES AT THE WOMEN'S HOSPITAL
4199 GATEWAY BLVD
NEWBURGH
,
IN
47630
45-5549778
HEALTHCARE
IN
N/A
No
No
(11)
INNOVATIVE HEALTHCARE COLLABORATIVE OF INDIANA LLC
600 MARY STREET
EVANSVILLE
,
IN
47747
83-3592473
HEALTHCARE
IN
N/A
No
No
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?
Yes
No
(1)
TRI-STATE MEDICAL MANAGEMENT INC
600 MARY STREET
EVANSVILLE
,
IN
47747
35-1875888
PHYSICIAN MANAGEMENT
IN
DEACONESS HOSPITAL
C
No
Schedule R (Form 990) 2022
Page 3
Schedule R (Form 990) 2022
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
No
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
.....................
1a
No
b
Gift, grant, or capital contribution to related organization(s)
............................
1b
No
c
Gift, grant, or capital contribution from related organization(s)
............................
1c
No
d
Loans or loan guarantees to or for related organization(s)
............................
1d
No
e
Loans or loan guarantees by related organization(s)
............................
1e
No
f
Dividends from related organization(s)
............................
1f
No
g
Sale of assets to related organization(s)
............................
1g
No
h
Purchase of assets from related organization(s)
............................
1h
No
i
Exchange of assets with related organization(s)
............................
1i
No
j
Lease of facilities, equipment, or other assets to related organization(s)
.......................
1j
No
k
Lease of facilities, equipment, or other assets from related organization(s)
......................
1k
Yes
l
Performance of services or membership or fundraising solicitations for related organization(s)
.....................
1l
No
m
Performance of services or membership or fundraising solicitations by related organization(s)
.................
1m
No
n
Sharing of facilities, equipment, mailing lists, or other assets with related organization(s)
...................
1n
No
o
Sharing of paid employees with related organization(s)
............................
1o
Yes
p
Reimbursement paid to related organization(s) for expenses
............................
1p
Yes
q
Reimbursement paid by related organization(s) for expenses
............................
1q
Yes
r
Other transfer of cash or property to related organization(s)
............................
1r
No
s
Other transfer of cash or property from related organization(s)
............................
1s
No
2
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
(d)
Method of determining amount involved
(1)
DEACONESS HEALTH PLANS LLC
P
168,109
COST
(2)
MAINSPRING
P
3,056,927
COST
(3)
VASCMED
P
183,287
COST
(4)
ORTHOALIGN
P
582,310
COST
(5)
HEALTHCARE RESOURCE SOLUTIONS
P
9,180,210
COST
(6)
MAINSPRING
Q
8,120,780
COST
(7)
VASCMED
Q
3,672,190
COST
(8)
ORTHOALIGN
Q
14,039,106
COST
Schedule R (Form 990) 2022
Page 4
Schedule R (Form 990) 2022
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)
(d)
Predominant income (related, unrelated, excluded from tax under sections 512-514)
(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?
(k)
Percentage
ownership
Yes
No
Yes
No
Yes
No
Schedule R (Form 990) 2022
Page 5
Schedule R (Form 990) 2022
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) 2022
Additional Data
Software ID:
Software Version: