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Form

990

Return of Organization Exempt From Income Tax

Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except black lung

OMB No

1545-0047

 

1(0)11

 

Department of the Treasury Internal Revenue Service

benefit trust or private foundation) ► The organization may have to use a copy of this return to satisfy state reporting requirements

Open to Public Inspection

A

For the 2011 calendar year, or tax year beginning

 

2011. and ending

 

, 2 0

B

Check if applicable

C Name of organization

DEACONESS ASSOCIATIONS, INC.

 

D Employer identification number

Address change

Doing Business As

 

31-1209377

 

Name change

Number and street (or P O box if mail is not delivered to street address)

Room/suite

 

E Telephone number

 

Initial return

311 STRAIGHT

STREET

 

513-559-2100

 

Terminated

City or town, state or country, and ZIP + 4

 

Amended return

CINCINNATI, OH 45219

 

G Gross receipts $

 

81,530,277

Application pending

F Name and address of pnncipal officer

 

H(a)

Is this a group return for affiliates? L J Yes

[Z] No

 

E. Anthony Woods c/o DAI, 311 Straight St, Cinti. OH 45219

 

H(b)

Are all affiliates included?

 

Yes

D

No

I

Tax-exempt status

[Z] 501(c)(3)

D

501(c) (

) •< (insert no)

D

4947(a)(1) or

D

527

If "No," attach a list (see instructions)

J

Website: ►

 

H(c) Group exemption number ►

 

K

Form of organization \7] Corporation Q

Trust

Q

Association

Q

Other ►

L Year of formation

 

1986

M State of legal domicile

 

OH

o e

CO

C

>

o

CNJ.8

Summary

  • 1 Briefly describe the organization's mission or most significant activities:

Deaconess Associations, Inc. serves as a holding

company to coordinate the activities of its non-profit subsidiaries, including the Deaconess Health Association Fund, Inc. and Deaconess Long Term Care, Inc. The primary purpose of the Deaconess organization is to advance health care solutions.

  • 2 Check this box ► D if the organization discontinued its operations or disposed of more than 25% of its net assets.

  • 3 Number of voting members of the governing body (Part VI, line 1a)

4

Number of independent voting members of the governing body (Part VI, line 1b)

...

.

  • 5 Total number of individuals employed in calendar year 2011 (Part V, line 2a)

<

C_>

O -

  • 6 Total number of volunteers (estimate if necessary)

7a

b

Total unrelated business revenue from Part VIII, column (C), line 12 Net unrelated business taxable income from Form 990-T, line 34

If

8

9

10

11

Contributions and grants (Part VIII, line 1h)

Program service revenue (Part VIII, line 2g)

Investment income (Part VIII, column (A), lines 3, 4, and 7d)

Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)

. .

.

  • 12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)

  • 13 Grants and similar amounts paid (Part IX, column (A), lines 1-3) .

7a

7b

Prior Year

1,361,854

14,698,506

19,119

16,079,479

100,000

  • 14 Benefits paid to or for members (Part IX, column fA) line 4)

w

0)

V)

c

0>

a

x

ai

15

16a

b

17

18

19

O

*

■J3 C

W

CO

9.

20

21

Salaries, other compensation, employee benefits (|^p)Q<jpjilJT(rS<Oines 5

Professional fundraising fees (Part IX, r-ni|imn (A) irnpjiTp)—,—,—.

Total fundraising expenses (Part IX, colurjnrW D), line 25) ►

o

CO

Other expenses (Part IX, column (A), lines 1|JM[r$Vlfl2$ej20U .'

I

if)

Total expenses. Add lines 13-17 (must ec ual[Part IX, column (A). Ime_25)

Revenue less expenses. Subtract line 18 rom

OGDEN; UT

J

10)

Total assets (Part X, line 16)

Total liabilities (Part X, line 26)

  • 22 Net assets or fund balances. Subtract line 21 from line 20

Signature Block

63,914

2,811,439

2,975,353

13,014,126

Beginning of Current Year

375,126,823

23,851,632

351,275,191

Current Year

1,190,344

16,802,969

167

17,993,480

396,486

4,365,348

4,761,834

13,231,646

End of Year

375,493,140

24,558.095

350,935,045

Under penalties of perjury, I declare that I have examined this retura including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and compteJB DeelaratiotiJ* preparer (other/than officer) is based on all information of which preparer has any knowledge

Sign

Here

Paid

Preparer

Use Only

Signature of officer

Type or pnnt name and title *f

Pnnt/Type preparer's name

Firm's name

Firm's address ►

Preparer's signature

May the IRS discuss this return with the preparer shown above? (see instructions)

For Paperwork Reduction Act Notice, see the separate instructions.

 

I

WHIP-

Date?

I

 

Date

Check □

if

PTIN

 

self-employed

 

Firm's EIN ►

 

Phone no

 

Yes Q No

Cat

No

11282Y

Form 99 0 (2011)

qo-tf

Form 990 (2011)

Page 2

Statement of Program Service Accomplishments

Check if Schedule O contains a response to any question in this Part III

[7J

'1

Briefly describe the organization's mission:

 

Deaconess Associations, Inc. serves as a holding company to coordinate the activities of its non-profit subsidiaries including Deaconess Health Association Fund, Inc. and Deaconess Long Term Care Inc. The primary purpose of the Deaconess organization is to advance health care solutions by providing viable health care services and products, and releasing proceeds to support charitable initiatives.

2

Did the organization undertake any significant program services during the year which were not listed on the

 

prior Form 990 or 990-EZ?

 

[7] Yes

DN o

If "Yes," describe these new services on Schedule O.

 

3

Did the organization cease conducting, or make significant changes in how it conducts, any program services?

DYe s

0N

o

If "Yes," describe these changes on Schedule O.

 

4

Describe the organization's program service accomplishments for each of its three largest program services, as measured by expenses. Section 501(c)(3) and 501(c)(4) organizations and section 4947(a)(1) trusts are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.

4a

(Code:

) (Expenses $

_ 2 _,36l,7_45_ including grants of

$

) (Revenue $

6 _ 7 . 3 .' 3 .?. 8 .

)

Deaconess Associations, Inc. serves as a holding company to coordinate the activities of its non-profit subsidiaries including Deaconess Health Association Fund, Inc. and Deaconess Long Term Care, Inc. The primary purpose of the Deaconess organization is to advance health care solutions by providing viable health care services and products, and releasing proceeds to support charitable initiatives. Operations are conducted for the care, well being, and benefit of all persons in the community.

4b

(Code:

) (Expenses $

J??j?'.??.1. including grants of $

0

) (Revenue

$

5 _!7.:_V! 3 )

 

Deaconess Associations, Inc. serves as the sole owner of Deaconess Diagnostic LLC, making it a disregarded entity.

Deaconess

Diagnostic provides Radiology services to the community and the tenants located in the Deaconess Hospital. In 2011, Deaconess

Diagnostic served 524 patients from the community.

 

4c

(Code:

) (Expenses $

including grants of $

) (Revenue $

4d

Other program services (Describe in Schedule O.)

 

(Expenses $

including grants of $

) (Revenue $

4e

Total program service expenses

$3,255,736

Form 990 (2011)

Form 990 (2011)

Checklist of Required Schedules

Page 3

Yes No

Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If "Yes," complete Schedule A

  • 2 Is the organization required to complete Schedule B, Schedule of Contributors (see instructions)?

. .

.

  • 3 Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for public office? If "Yes," complete Schedule C, Parti Section 501(c)(3) organizations. Did the organization engage in lobbying activities, or have a section 501(h) election in effect during the tax year? If "Yes," complete Schedule C, Part II Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues, assessments, or similar amounts as defined in Revenue Procedure 98-19? If "Yes," complete Schedule C, Part III Did the organization maintain any donor advised funds or any similar funds or accounts for which donors have

the right to provide advice on the distribution or investment of amounts in such funds or accounts? If

"Yes," complete Schedule D, Part I

Did the organization receive or hold a conservation easement, including easements to preserve open space,

the environment, historic land areas, or historic structures? If "Yes," complete Schedule D, Part II

.. Did the organization maintain collections of works of art, historical treasures, or other similar assets? If "Yes,"

.

complete Schedule D, Part III

Did the organization report an amount in Part X, line 21; serve as a custodian for amounts not listed in Part X; or provide credit counseling, debt management, credit repair, or debt negotiation services? If "Yes," complete Schedule D, Part IV .

10

Did the organization, directly or through a related organization, hold assets in temporarily restricted

endowments, permanent endowments, or quasi-endowments? If "Yes," complete Schedule D, Part V

.

.

10

  • 11 If the organization's answer to any of the following questions is "Yes," then complete Schedule D, Parts VI,

VII, VIII, IX, or X as applicable. Did the organization report

an amount for land, buildings, and equipment

complete Schedule D, Part

VI

in

Part

X,

line

10?

If "Yes,"

..

.

Did the organization report an amount for investments—other securities in Part X, line 12 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part VII

Did the organization report an amount for investments—program related in Part X, line 13 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part VIII

Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part IX

e

f

12a

Did the organization report an amount for other liabilities in Part X, line 25? If "Yes," complete Schedule D, Part X Did the organization's separate or consolidated financial statements for the tax year include a footnote that addresses

the organization's liability for uncertain tax positions under FIN 48 (ASC 740)? If "Yes," complete Schedule D, Part X Did the organization obtain separate, independent audited financial statements for the tax year? If "Yes," complete Schedule D, Parts XI, XII, and XIII Was the organization included in consolidated, independent audited financial statements for the tax year 9 If "Yes," and if the organization answered "No" to line 12a, then completing Schedule D, Parts XI, XII, and XIII is optional

.

  • 13 Is the organization a school described in section 170(b)(1)(A)(n)? If "Yes," complete Schedule E Did the organization maintain an office, employees, or agents outside of the United States? Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business, investment, and program service activities outside the United States, or aggregate foreign investments valued at $100,000 or more? If "Yes," complete Schedule F, Parts I and IV

14i

. . .

.

...

.

11a

11b

11c

11d

11e

11f

12a

12b

13

14a

14b

  • 15 Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or assistance to any organization or entity located outside the United States? If "Yes," complete Schedule F, Parts II and IV

.

.

15

  • 16 Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or assistance

to individuals located outside the United States? If "Yes," complete Schedule F, Parts III and IV

.

.

16

  • 17 Did the organization report a total of more than $15,000 of expenses for professional fundraising services on Part IX, column (A), lines 6 and 11 e? If "Yes," complete Schedule G, Part I (see instructions)

. .

.

17

  • 18 Did the organization report more than $15,000 total of fundraising event gross income and contributions on Part VIII, lines 1c and 8a? If "Yes," complete Schedule G, Part II

18

  • 19 Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a?

20

a

b

If "Yes," complete Schedule G, Part III

Did the organization operate one or more hospital facilities? If "Yes," complete Schedule H If "Yes" to line 20a, did the organization attach a copy of its audited financial statements to this return?

19

20a

20b

Form 990 (2011)

Form 990 (2011)

Page 4

Checklist of Required Schedules

(continued)

21

Did the organization report more than $5,000 of grants and other assistance to any government or organization in the United States on Part IX, column (A), line 1 ? If "Yes," complete Schedule I, Parts I and II

22

Did the organization report more than $5,000 of grants and other assistance to individuals in the United States on Part IX, column (A), line 2? If "Yes," complete Schedule I, Parts I and III

23

Did the organization answer "Yes" to

Part VII, Section

A,

line

3,

4,

or

5 about

compensation of the

organization's current and former officers, directors, trustees, key employees, and highest compensated

employees? If "Yes," complete Schedule J

.

24a Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $100,000 as of the last day of the year, that was issued after December 31, 2002? If "Yes," answer lines 24b through 24d and complete Schedule K. If "No," go to line 25

b

Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?

.

.

c

Did the organization maintain an escrow account other than a refunding escrow at any time during the year

to defease any tax-exempt bonds?

 

d

Did the organization act as an "on behalf of" issuer for bonds outstanding at any time during the year? .

.

25a

Section 501 (c)(3) and 501 (c)(4) organizations. Did the organization engage in an excess benefit transaction

b

with a disqualified person during the year? If "Yes," complete Schedule L, Part I Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior

year, and that the transaction has not been reported on any of the organization's prior Forms 990 or 990-EZ?

If "Yes," complete Schedule L, Part I

 

26

Was a loan to or by a current or former officer, director, trustee, key employee, highly compensated employee, or disqualified person outstanding as of the end of the organization's tax year? If "Yes," complete Schedule L, Part II

27

Did the organization provide a grant

or other

assistance to an officer,

director, trustee, key employee,

substantial contributor or employee thereof, a grant selection committee member, or to a 35% controlled entity or family member of any of these persons? If 'Yes," complete Schedule L, Part III

28

Was the organization a party to a business transaction with one of the following parties (see Schedule L, Part IV instructions for applicable filing thresholds, conditions, and exceptions):

a A current or former officer, director, trustee, or key employee? If "Yes," complete Schedule L, Part IV

 

b A family member of a current or former officer, director, trustee, or key employee? If "Yes," complete

 

Schedule

L, Part IV

c

An entity of which a current or former officer, director, trustee, or key employee (or a family member thereof)

was an officer, director, trustee, or direct or indirect owner? If "Yes," complete Schedule L, Part IV

.

.

29

Did the organization receive more than $25,000 in non-cash contributions? If "Yes," complete Schedule M

30

Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified

conservation contributions? If "Yes," complete Schedule M

 

.

31

Did the organization liquidate, terminate, or dissolve and cease operations? If "Yes," complete Schedule N, Parti

32

Did the organization sell, exchange, dispose of, or transfer

more than 25%

of

its

net assets? If "Yes,"

complete Schedule N, Part II

 

33

Did the organization own 100% of an entity disregarded as separate from the organization under Regulations

sections

301.7701 -2 and

301.7701 -3? If "Yes," complete Schedule R, Parti

 

34

Was the organization related to any tax-exempt or taxable entity? If "Yes," complete Schedule R, Parts II, III, IV, and V, line 1 .

35a

Did the

organization

have a controlled entity within the meaning of

section 512(b)(13)?

 

b

Did the organization receive any payment from or engage in any transaction with a controlled entity within the

meaning of section 512(b)(13)? If "Yes," complete Schedule R, Part V, line 2 .

.

.

36

Section 501(c)(3) organizations. Did the organization make any transfers to an exempt related organization? If "Yes," complete Schedule R, Part V, line 2

non-charitable

37

Did the organization conduct more than 5% of its activities through an entity that is not a related organization and that is treated as a partnership for federal income tax purposes? If "Yes," complete Schedule R, Part VI

38

Did the organization complete Schedule O and provide explanations in Schedule O for Part VI, lines 11 and 19? Note. All Form 990 filers are required to complete Schedule O

Yes

No

21

22

23

/

24a

24b

24c

24d

25a

25b

26

27

28a

28b

28c

29

30

31

32

33

/

34

35a

_/_

_/_

35b

/

36

37

38

/

Form 99 0 (2011)

Form 990 (2011)

Statements Regarding Other IRS Filings and Tax Compliance

Check if Schedule O contains a response to any question in this Part V

1a

b

c

2a

Enter the number reported in Box 3 of Form 1096. Enter-0-if not applicable

 

.

1a

51

Enter the

number of Forms W-2G

included in line 1 a. Enter -0- if not applicable

...

.

1b

Did the organization comply with

backup

withholding

rules for

reportable

payments

to vendors

and

reportable gaming (gambling) winnings to prize winners? Enter the number of employees reported on Form W-3, Transmittal of Wage and Tax Statements, filed for the calendar year ending with or within the year covered by this return

2a

If at least one is reported on line 2a, did the organization file all required federal employment tax returns? .

3a

b

4a

Note. If the sum of lines 1a and 2a is greater than 250, you may be required to e-file (see instructions)

.

.

Did the organization have unrelated business gross income of $1,000 or more during the year? If "Yes," has it filed a Form 990-T for this year? If "No," provide an explanation in Schedule O At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a financial account in a foreign country (such as a bank account, securities account, or other financial account)? If "Yes," enter the name of the foreign country: ► See instructions for filing requirements for Form TD F 90-22.1, Report of Foreign Bank and Financiaf Accounts.

...

.

5a

b

Was the organization a party to a prohibited tax shelter transaction at any time during the tax year? . Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?

  • c If "Yes" to line 5a or 5b, did the organization file Form 8886-T? Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization solicit any contributions that were not tax deductible? If "Yes," did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible?

6a

Organizations that may receive deductible contributions under section 170(c).

Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods and services provided to the payor?

If "Yes," did the organization notify the donor of the value of the goods or services provided? Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required to file Form 8282? If "Yes," indicate the number of Forms 8282 filed during the year | 7d | Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract? Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract? . If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required?

If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C?

Sponsoring organizations maintaining donor advised funds and section 509(a)(3) supporting organizations. Did the supporting organization, or a donor advised fund maintained by a sponsoring organization, have excess business holdings at any time during the year?

Sponsoring organizations maintaining donor advised funds.

Did the organization make any taxable distributions under section 4966?

Did the organization make a distribution to a donor, donor advisor, or related person?

  • 10 Section 501 (c)(7) organizations. Enter: Initiation fees and capital contributions included on Part VIII, line 12 10a

11

a

b

12a

b

Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities .

10b

Section 501(c)(12) organizations. Enter:

Gross income from members or shareholders

11a

Gross income from other sources (Do not net amounts due or paid to other sources against amounts due or received from them.)

11b

Section 4947(a)(1) non-exempt charitable trusts. Is the organization filing Form 990 in lieu of Form 1041?

If "Yes," enter the amount of tax-exempt interest received or accrued during the year.

.

112b |

  • 13 Section 501 (c)(29) qualified nonprofit health insurance issuers.

a

Is the organization licensed to issue qualified health plans in more than one state?

Note. See the instructions for additional information the organization must report on Schedule O. Enter the amount of reserves the organization is required to maintain by the states in which

the organization is licensed to issue qualified health plans

  • c Enter the amount of reserves on hand

13b

13c

14a

b

Did the organization receive any payments for indoor tanning services during the tax year? If "Yes," has it filed a Form 720 to report these payments? If "No," provide an explanation in Schedule O

 

Page 5

Yes

No

1c

2b

3a

3b

4a

5a

5b

5c

6a

6b

7a

7b

7c

7e

7f

7g

7h

9a

9b

12a

13a

14a

14b

Form 99 0 (2011)

Form 990 (2011)

'

 

Page 6

Governance, Management, and Disclosure For each "Yes" response to lines 2 through 7b below, and for a "No" response to line 8a, 8b, or 10b below, describe the circumstances, processes, or changes in Schedule 0. See instructions.

Check if Schedule O contains a response to any question in this Part VI

[7]

Section A. Governing Body and Management

 

Yes

No

1a

Enter the number of voting members of the governing body at the end of the tax year. If there are material differences in voting rights among members of the governing body, or if the governing body delegated broad authority to an executive committee or similar committee, explain in Schedule O.

.

1a

Enter the number of voting members included in line 1a, above, who are independent

1b

Did any officer, director, trustee, or key employee have a family relationship or a business relationship with

 

any other officer, director, trustee, or key employee?

 

Did the organization delegate control over management duties customarily performed by or under the direct supervision of officers, directors, or trustees, or key employees to a management company or other person?

 

4

Did the organization make any significant changes to its governing documents since the prior Form 990 was filed?

5

Did the organization become aware during the year of a significant diversion of the organization's assets? .

6

7a

Did the organization have members or stockholders?

Did the organization have members, stockholders, or other persons who had the power to elect or appoint

one or more members of the governing body?

.

...

.

7a

Are any governance decisions of the organization reserved to stockholders, or persons other than the governing body?

.

(or subject

to

approval by) members,

7b

Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:

The governing body?

 

8a

/

Each committee with authority to act on behalf of the governing body?

8b

/

Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at

the organization's mailing address? If "Yes, "provide

the names and addresses in Schedule O.

.

.

/

Section B. Policies

(This Section

B requests

information

about policies

not required

. by the Internal Revenue

Code.)

 
 

Yes

10a

b

Did the organization have local chapters, branches, or affiliates?

11a

b

10a

If "Yes," did the organization have written policies and procedures governing the activities of such chapters,

affiliates, and branches to ensure their operations are consistent with the organization's exempt purposes?

10b

Has the organization provided a complete copy of this Form 990 to all members of its governing body before filing the form 9

11a

/

Describe in Schedule O the process, if any, used by the organization to review this Form 990.

 

12a

Did the organization have a written conflict of interest policy? If "No,"go

to line 13

 

12a

/

b

Were officers, directors, or trustees, and key employees required to disclose annually interests that could give rise to conflicts?

12b

/

c

Did the organization regularly and consistently monitor and enforce compliance with the policy? If "Yes," describe in Schedule O how this was done

12c

/

  • 13 Did the organization have a written whistleblower policy'?

 

13

/

  • 14 Did the organization have a written document retention and destruction policy?

 

14

/

  • 15 Did the process for determining compensation of the following persons include a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision? The organization's CEO, Executive Director, or top management official

16a

15a

/

Other officers or key employees of the organization

15b

/

If "Yes" to line 15a or 15b, describe the process in Schedule O (see instructions). Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement

 

with a taxable entity during the year?

16a

If "Yes," did the organization follow a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicable federal tax law, and take steps to safeguard the organization's exempt status with respect to such arrangements?

16b

Section C. Disclosure

  • 17 List the states with which a copy of this Form 990 is required to be filed ►

OH

  • 18- Section 6104 requires an organization to make its Forms 1023 (or 1024 if applicable), 990, and 990-T (Section 501(c)(3)s only) available for public inspection. Indicate how you made these available. Check all that apply. □

Own website

Another's website

E) Upon request

  • 19 Describe in Schedule O whether (and if so, how), the organization made its governing documents, conflict of interest policy, and financial statements available to the public during the tax year.

Form 990 (2011)

Page 7

|2?5E H

Compensation of Officers, Directors, Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors

Check if Schedule O contains a response to any question in this Part VII

[7]

Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees

1a Complete this table for all persons required to be listed. Report compensation for the calendar year ending with or within the organization's tax year. • List all of the organization's current officers, directors, trustees (whether individuals or organizations), regardless of amount of compensation. Enter -0- in columns (D), (E), and (F) if no compensation was paid.

• List all of the organization's current key employees, if any See instructions for definition of "key employee." • List the organization's five current highest compensated employees (other than an officer, director, trustee, or key employee)

who received reportable compensation

(Box

5 of

organization and any related organizations.

Form W-2 and/or

Box 7 of Form 1099-MISC)

of

more than $100,000 from the

• List all of the organization's former officers, key employees, and highest compensated employees who received more than $100,000 of reportable compensation from the organization and any related organizations.

• List all of the organization's former directors or trustees that received, in the capacity as a former director or trustee of the organization, more than $10,000 of reportable compensation from the organization and any related organizations.

List persons in the following order: individual trustees or directors; institutional trustees; officers; key employees; highest compensated employees; and former such persons.

  • D Check this box if neither the organization nor any related organization compensated any current officer, director, or trustee.

(A)

Name and Title

(1) E. Anthony Woods Chairman/CEO (2) William Bahl Board Member

(3) *

..

J.

McPhie

Board Member (4) Rodger Reed Board Member (5) Lee Scroggms Board Member (6) William Zimmer Board Member

(7)

(8)

(9)

(10)

(11)

(12)

(13)

(14) t

(B)

(B)

Average

Average

flours per

flours per

week

week

(describe

(describe

hours for

hours for

related

related

organizations

organizations

in Schedule

in Schedule

O)

O)

(C)

Position

(do not check more than one

box, unless person is both an

officer and a director/trustee)

R 5"

*t

ro a

o SL

c

W

CD

CD

i

i

i

t ij

-n

o

3

CD

(D)

(D)

(E)

(E)

Reportable

Reportable

compensation

compensation

from

from

the

the

organization

organization

(W-2/1099-MISC)

(W-2/1099-MISC)

Reportable

Reportable

compensation from

compensation from

related

related

organizations

organizations

(W-2/1099-MISC)

(W-2/1099-MISC)

(F)

(F)

Estimated

Estimated

amount of

amount of

other

other

compensation

compensation

from the

from the

organization

organization

and related

and related

organizations

organizations

25

0

0

0

00

00

/

/

/

/

//

//

/

0

0

0

0

00

00

1,872,000

0

0

0

00

00

330,933

0

0

0

0

0

Form 99 0 (2011)

Form 990 (2011)

Page 8

IJHSyjri

Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees (continued)

(A)

Name and title

(B)

(B)

Average

Average

hours per

hours per

week

week

(describe

(describe

hours for

hours for

related

related

organizations

organizations

in Schedule

in Schedule

O)

O)

(C)

Position

(do not check more than one

box, unless person is both

an

officer and a director/trustee)

ca

a.

c

Q-

EJSL

" ?

w

CD

CD

Z3

CO

c

5

GO

CD

CD

3

o

CD

1

1

!]

"n

o

i

CD

(D)

(D)

Reportable

Reportable

compensation

compensation

from

from

the

the

organization

organization

(W-2/1099-MISC)

(W-2/1099-MISC)

(E)

(E)

Reportable

Reportable

compensation from

compensation from

related

related

organizations

organizations

(W-2/1099-MISC)

(W-2/1099-MISC)

(F)

Estimated

amount of

compensation

from the

organization

and related

organizations

(15)

(16)

(17)

(18)

(19)

(20)

(21)

(22)

(23)

(24)

(25)

1b

c

d

Sub-total

Total from continuation sheets to Part VII, Section A

Total (add lines 1b and 1c)

0

0

0

1,872,000

0

1,872,000

330,933

0

330,933

Total number of individuals (including but not limited to those listed above) who received more than $100,000 of

reportable compensation from the organization ► 1

Yes

No

Did the organization list any former officer, director, or trustee, key employee, or highest compensated

employee on line 1a? If "Yes," complete Schedule J for such individual

/

For any individual listed on line 1a, is the sum of reportable compensation and other compensation from the

organization and related organizations greater than $150,000? If "Yes," complete

individual

..

.

Schedule J for such

Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual

for services rendered to the organization? If "Yes," complete Schedule J for such person

Section B. Independent Contractors

J_

5

1

Complete this table for your five highest compensated independent contractors that received more than $100,000 of

/

/

compensation from the organization. Report compensation for the calendar year ending with or within the organization's tax

year.

Health Strategy Partners

(A)

Name and business address

(B)

Description of services

Consulting

(C)

Compensation

139,411

2

Total number of

independent contractors (including but not limited to those listed above) who

received more than $100,000 of compensation from the organization ►

1

-

.

.

.

Form 990 (2011)

Form 990 (2011)

Page 9

SETT pin Statement of Revenue

pin

in

in

E

E

E

=

=

=

(3 ™

(3 ™

(3 ™

»

E

.2*2

5 "o

o

O

C

ra

3

a>

>

a>

cc

u

u

'e

'e

E

2

D_

-

0)
3

C

0)

>

CC

o

1a

1a

1a

1a

1a

1a

1a

1a

b b b b b b b b

c

c

c

c

c

c c

c

d

d

d

d

d d

d

d

e

e

e

e

e

e

e

e

f f f f f f f f

Federated campaigns

Federated campaigns

Federated campaigns

Federated campaigns

Federated campaigns

Federated campaigns

.

.

.

.

.

.

.

.

.

.

.

.

Membership dues

Membership dues

Membership dues

Membership dues

Membership dues

Membership dues

...

...

...

...

...

...

.

.

.

.

.

.

.

.

.

.

.

.

Fundraising events

Fundraising events

Fundraising events

Fundraising events

Fundraising events

Fundraising events

...

...

...

...

...

...

.

.

.

.

.

.

Related organizations

Related organizations

Related organizations

Related organizations

Related organizations

Related organizations

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

Government grants (contributions)

Government grants (contributions)

Government grants (contributions)

Government grants (contributions)

Government grants (contributions)

Government grants (contributions)

All other contributions, gifts, grants,

All other contributions, gifts, grants,

All other contributions, gifts, grants,

All other contributions, gifts, grants,

All other contributions, gifts, grants,

All other contributions, gifts, grants,

and similar amounts not included above

and similar amounts not included above

and similar amounts not included above

and similar amounts not included above

and similar amounts not included above

and similar amounts not included above

1a

1b

1c

1d

1e

1f

0

0

0

0

0

0

g g g g g g g g

Noncash contributions included in lines la-lf $

0

h h h h h h h h Total. Add lines 1a-1f . . . .
h h h h h h h h Total. Add lines 1a-1f
.
.
.
.
Business Code
2a
2a
2a
2a
2a
2a
2a
2a
Management Services
Management Services
Management Services
Management Services
Management Services
Management Services
561000
b b b b b b b b
Affiliated Rental Income
Affiliated Rental Income
Affiliated Rental Income
Affiliated Rental Income
Affiliated Rental Income
Affiliated Rental Income
531390
c
c
c
c
c
c
c
c
Patient Services
Patient Services
Patient Services
Patient Services
Patient Services
Patient Services
621990
d
d
d
d
d
d
d
d
e
e
e
e
e
e
e
e
f f f f f f f f
All other program service revenue .
g g g g g g g g Total. Add lines 2a-2f
.
.
.
.
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
Investment
Investment
income
income
including
dividends,
interest,
and
and other similar amo
other
similar
amo unts)
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
Income from investment of tax-exempt bond proceeds ►
Income from investment of tax-exempt bond proceeds ►
5
5
5
5
5
5
5
5
5
5
5
5
5
5
5
5
5
5
5
5
5
5
5
5
5
Royalties
Royalties
(i) Real
(n) Personal
6a
6a
6a
6a
6a
6a
6a
6a
6a
6a
6a
6a
6a
6a
6a
6a
6a
6a
6a
6a
6a
6a
6a
6a
6a
Gross rents
Gross rents
Gross rents
Gross rents
Gross rents
Gross rents
Gross rents
Gross rents
Gross rents
Gross rents
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
b b b b b b b b b b b b b b b b b b b b b b b b b
Less: rental expenses
Less: rental expenses
Less: rental expenses
Less: rental expenses
Less: rental expenses
Less: rental expenses
Less: rental expenses
Less: rental expenses
Less: rental expenses
Less: rental expenses
c
c
c
c
c c c c
c
c
c
c
c
c
c
c
c
c
c
c
c
c
c
c
c
Rental income or (loss)
Rental income or (loss)
Rental income or (loss)
Rental income or (loss)
Rental income or (loss)
Rental income or (loss)
Rental income or (loss)
Rental income or (loss)
Rental income or (loss)
Rental income or (loss)
0
d
d
d d d d
d
d
d
d
d
d
d
d
d
d
d
d
d
d
d
d
d
d
d
Net rental income or
Net rental income or
Net rental income or
Net rental income or
Net rental income or
Net rental income or
Net rental income or
Net rental income or
Net rental income or
Net rental income or
loss)
(u) Other
7a
7a
7a
7a
7a
7a
7a
7a
7a
7a
7a
7a
7a
7a
7a
7a
7a
7a
7a
7a
7a
7a
7a
7a
7a
Gross amount from sales of
Gross amount from sales of
Gross amount from sales of
Gross amount from sales of
Gross amount from sales of
Gross amount from sales of
Gross amount from sales of
Gross amount from sales of
Gross amount from sales of
Gross amount from sales of
(i) Securities
assets other than inventory
assets other than inventory
assets other than inventory
assets other than inventory
assets other than inventory
assets other than inventory
assets other than inventory
assets other than inventory
assets other than inventory
assets other than inventory
71,078,137
Less: cost or other basis
Less: cost or other basis
Less: cost or other basis
Less: cost or other basis
Less: cost or other basis
Less: cost or other basis
Less: cost or other basis
Less: cost or other basis
Less: cost or other basis
Less: cost or other basis
b b b b b b b b b b b b b b b b b b b b b b b b b
and sales expenses
and sales expenses
and sales expenses
and sales expenses
and sales expenses
and sales expenses
and sales expenses
and sales expenses
and sales expenses
and sales expenses
.
.
.
.
.
.
.
.
.
.
63,536,797
c
c
c
c
c
c
c
c
c
c
c
c
c
c
c
c
c
c
c
c c c c
c
c
Gain or (loss)
Gain or (loss)
Gain or (loss)
Gain or (loss)
Gain or (loss)
Gain or (loss)
Gain or (loss)
Gain or (loss)
Gain or (loss)
Gain or (loss)
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
7,541,340
d d d d
d
d
d
d
d
d
d
d
d
d
d
d
d
d
d
d
d
d
d
d
d
Net gain or (loss)
.
8a
8a
8a
8a
8a
8a
8a
8a
8a
8a
8a
8a
8a
8a
8a
8a
8a
8a
8a
8a
8a
8a
8a
8a
8a
Gross income from fundraising
Gross income from fundraising
events (not including $
events (not including $
o
o
of contributions reported on line 1 c).
of contributions reported on line 1 c).
See Part IV, line 18
See Part IV, line 18
a
a
b b b b b b b b b b b b b b b b b b b b b b b b b
Less: direct
Less: direct
expenses
expenses
.
.
.
.
.
.
.
.
b
b
Net income or (loss) from fundraising events
9a
9a
9a
9a
9a
9a
9a
9a
9a
9a
9a
9a
9a
9a
9a
9a
9a
9a
9a
9a
9a
9a
9a
9a
9a
Gross income from gaming activities.
Gross income from gaming activities.
See Part IV, line
See Part IV, line
19
19
a
a
b b b b b b b b b b b b b b b b b b b b b b b b b
Less: direct expenses
Less: direct expenses
.
.
.
.
.
.
.
.
b
b
c
c
c
c
c
c
c
c
c
c
c
c
c
c c c c
c
c
c
c
c
c
c
c
Net income or (loss) from gaming acti vities
.
.
10a
10a
10a
10a
10a
10a
10a
10a
10a
10a
10a
10a
10a
10a
10a
10a
10a
10a
10a
10a
10a
10a
10a
10a
10a
Gross
Gross
sales
sales
of
of
inventory,
inventory,
less
less
returns and allowances
returns and allowances
.
.
.
.
.
.
a
a
b b b b b b b b b b b b b b b b b b b b b b b b b
Less: cost
Less: cost
of goods sold
of goods sold
.
.
.
.
.
.
b
b
c
c
c
c
c
c
c c c
c
c
c
c
c
c
c
c
c
c
c
c
c
c
c
c
Net income or (loss)
from sales of invejntor y .
.
Miscellaneous Revenue
Business Code
11a
11a
11a
11a
11a
11a
Other receipts
Other receipts
Other receipts
561000
b
b
b
b
b
b
c
c
c
c
c
c
d
d
d
d
d
d
All other revenue
e
e
e
e
e
e
Total. Add lines 11a-
Total.
Add
lines
11a- 11d
...
.
.
.
.
.
12
12
12
12
12
12
Total revenue. See ir
Total revenue. See ir istructions

0

0

0

0

0

0

0

  • (A) (B)

Total revenue

Related or

exempt

function

revenue

0 0 0 0 0 0 0 0

481,027

481,027

192,204

517,113

0

0

0

1,190,344

9,261,629

9,261,629

0

0

481,027

481,027

192,204

517,113

0

0 0

0

0

0

7,541,340

7,541,340

7,541,340

7,541,340

7,541,340

7,541,340

0 0 0

0 0 0

0 0 0

167

167

0

0

0

167

17,993,480

167

167

1,190,511

(C)

Unrelated

business

revenue

n

( D )

Revenue

excluded from tax

under sections

512, 513, or 514

9,261,629

9,261,629

7,541,340

0

16,802,969

Form 990 (2011)

Form 990 (2011)

Page 10

Statement of Functional Expenses

Section 501(c)(3) and 501(c)(4) organizations must complete all columns. All other organizations must complete column (A) but are n required to complete columns (B), (C), and (D).

Check if Schedule O contains a response to any question in this Part IX

.

Do not

include

amounts

8b,

9b, and

10b of Part

reported

VIII.

on lines

6b,

7b,

  • (A) Program service

expenses

(B)

Total expenses

.

(C)

Management and

general expenses

(D)

Fundraising

expenses

 
  • 1 Grants and other assistance to governments and

 

organizations in the United States. See Part IV, line 21

 

0

  • 2 Grants and other assistance to individuals in

 
 

the United States. See Part IV, line 22

.

.

.

0

  • 3 Grants

and other

assistance to governments,

 
 

organizations,

and

individuals outside the

United States. See Part

IV, lines 15 and 16

.

.

0

  • 4 Benefits paid to or for members

...

.

0

  • 5 Compensation of current officers, directors,

 
 

trustees, and key employees

 

482,993

  • 6 Compensation not included above, to disqualified

 
 

persons (as defined under section 4958(f)(1)) and

persons described in section 4958(c)(3)(B)

 

.

0

  • 7 Other salaries and wages

 

0

  • 8 Pension plan accruals and contributions (include

 
 

section 401 (k) and 403(b) employer contributions)

 

0

  • 9 Other employee benefits

 

65,493

  • 10 Payroll taxes

0

  • 11 Fees for services (non-employees):

 

a

Management

0

b

Legal

5,566

c

Accounting

161,632

d

Lobbying

0

e

Professional fundraising services. See Part IV, line 17

 

0

f

Investment management fees

 

61.096

g

Other

1,217,951

  • 12 Advertising and promotion

 

11,657

  • 13 Office expenses

 

114,676

  • 14 Information technology

0

  • 15 Royalties

0

  • 16 Occupancy

202,823

  • 17 Travel

46,938

  • 18 Payments of travel or entertainment expenses

 
 

for any federal, state, or local public officials

 

0

  • 19 Conferences, conventions, and meetings

 

3,190

  • 20 Interest

 

0

  • 21 Payments to affiliates

0

  • 22 Depreciation, depletion, and amortization

 

188,696

  • 23 Insurance

 

329,977

  • 24 Other expenses. Itemize expenses not covered

 
 

above. (List miscellaneous expenses in line 24e. If

line 24e amount exceeds 10% of line 25, column

(A) amount, list line 24e expenses on Schedule O.)

a

Trustee Agency Fees

1,293,086

b

Allocated Salaries/Wages & Taxes

 

550,910

c

Management Fees

22,822

d

Bad Debt

2,328

e

All other expenses

0

  • 25 Total functional expenses. Add lines 1 through 24e

4,761,834

Joint

  • 26 costs.

Complete

this

line

only

if

the

 

organization reported in column (B) joint

costs

from a combined educational campaign and

fundraising solicitation. Check here

 

D

if

following SOP 98-2 (ASC 958-720)

 

.

0

482,993

49,261

16,232

5,566

161,632

 

t

&

^

61,096

953,407

264544

11,657

104,240

10,436

184,863

17,960

0

46,938

0

3,190

173,659

15,037

50,175

279,802

 

.

1,293,086

360,799

190,111

22,822

2,328

3,255,736

1,506,098

0

j

i

Form 990 (2011)

Form 990 (2011)

Page 11

12

12

-Ti9:m

Balance Sheet

1

2

2

2

3

3

3

4

4

4

5

Cash—non-interest-bearing

Savings and temporary cash investments

Savings and temporary cash investments

Savings and temporary cash investments

Pledges and grants receivable, net

Pledges and grants receivable, net

Pledges and grants receivable, net

Accounts receivable, net

Accounts receivable, net

Accounts receivable, net

Receivables from current and former officers, directors, trustees, key

(A)

Beginning of year

1,264,778

403,030

0

0

1

2

3

4

employees, and highest compensated employees. Complete Part II of

6

6

6

2

I

%

7

7

7

8

9

10a

10a

b

b

11

,.12

,.12

,.12

,.12

,.12

13

13

13

13

13

14

14

14

14

14

15

15

15

15

15

16

16

16

16

16

17

17

17

18

18

18

19

19

19

20

21

21

1

22

22

(Q

- i

23

23

23

23

24

24

24

24

25

25

25

25

26

26

1

27

■g

■g

1

28

29

o

J2

1

<

2

2

30

30

31

31

32

32

33

33

34

Schedule L

Receivables from other disqualified persons (as defined under section

Receivables from other disqualified persons (as defined under section

Receivables from other disqualified persons (as defined under section

4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing

4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing

4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing

employers and sponsoring organizations of section 501(c)(9) voluntary

employers and sponsoring organizations of section 501(c)(9) voluntary

employers and sponsoring organizations of section 501(c)(9) voluntary

employees' beneficiary organizations (see instructions)

employees' beneficiary organizations (see instructions)

employees' beneficiary organizations (see instructions)

Notes and loans receivable, net

Notes and loans receivable, net

Notes and loans receivable, net

Inventories for sale or use

Prepaid expenses and deferred charges

Land, buildings, and equipment: cost or

Land, buildings, and equipment: cost or

other basis. Complete Part VI of Schedule D

other basis. Complete Part VI of Schedule D

10a

Less: accumulated depreciation

Less: accumulated

depreciation

...

...

.

.

10b

Investments—publicly traded securities

.

.

Investments—other securities. See Part IV, line 11

Investments—other securities. See Part IV, line 11

Investments—other securities. See Part IV, line 11

Investments—other securities. See Part IV, line 11

Investments—other securities. See Part IV, line 11

...

...

...

...

...

Investments—program-related. See Part IV, line 11

Investments—program-related. See Part IV, line 11

Investments—program-related. See Part IV, line 11

Investments—program-related. See Part IV, line 11

Investments—program-related. See Part IV, line 11

Intangible assets

Intangible assets

Intangible assets

Intangible assets

Intangible assets

Other assets. See Part IV, line 11

Other assets. See Part IV, line 11

Other assets. See Part IV, line 11

Other assets. See Part IV, line 11

Other assets. See Part IV, line 11

...

...

...

...

...

Total assets. Add lines 1 through 15 (must equal line 34)

Total assets. Add lines 1 through 15 (must equal line 34)

Total assets. Add lines 1 through 15 (must equal line 34)

Total assets. Add lines 1 through 15 (must equal line 34)

Total assets. Add lines 1 through 15 (must equal line 34)

Accounts payable and accrued expenses

Accounts payable and accrued expenses

Accounts payable and accrued expenses

Grants payable

Grants payable

Grants payable

Deferred revenue

Deferred revenue

Deferred revenue

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

4,783,326

1,340,222

.

.

.

.

.

Tax-exempt bond liabilities

Escrow or custodial account liability. Complete Part IV of Schedule D .

Escrow or custodial account liability. Complete Part IV of Schedule D .

Payables

Payables

to

to

current

current

and

and

former

former

officers,

officers,

directors,

directors,

trustees,

trustees,

key

key

employees, highest compensated employees, and disqualified persons.

employees, highest compensated employees, and disqualified persons.

Complete Part II of Schedule L

Complete

Part

II of

Schedule L

Secured mortgages and notes payable to unrelated third parties

Secured mortgages and notes payable to unrelated third parties

Secured mortgages and notes payable to unrelated third parties

Secured mortgages and notes payable to unrelated third parties

Unsecured notes and loans payable to unrelated third parties

Unsecured notes and loans payable to unrelated third parties

Unsecured notes and loans payable to unrelated third parties

Unsecured notes and loans payable to unrelated third parties

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

Other liabilities (including federal income tax, payables to related third

Other liabilities (including federal income tax, payables to related third

Other liabilities (including federal income tax, payables to related third

Other liabilities (including federal income tax, payables to related third

parties, and other liabilities not included on lines 17-24). Complete Part X

parties, and other liabilities not included on lines 17-24). Complete Part X

parties, and other liabilities not included on lines 17-24). Complete Part X

parties, and other liabilities not included on lines 17-24). Complete Part X

of Schedule D

of Schedule D

of Schedule D

of Schedule D

Total liabilities. Add lines 17 through 25

Total

liabilities. Add

lines

17 through

25

Organizations that follow SFAS 117, check here ► □ and complete

lines 27 through 29, and lines 33 and 34.

Unrestricted net assets

Temporarily restricted net assets

Permanently restricted net assets

Organizations that do not follow SFAS 117, cl

Organizations

that

do

not

follow

SFAS

117,

cl leek here ►

complete lines 30 through 34.

complete lines 30 through 34.

and

Capital stock or trust principal, or current funds

Capital stock or trust principal, or current funds

Paid-in or capital surplus, or land, building, or ec

Paid-in

or

capital

surplus, or

land,

building, or ecjuipmen t fund

.

.

.

Retained earnings, endowment, accumulated income, or other funds .

Retained earnings, endowment, accumulated income, or other funds .

Total net assets or fund balances

Total net assets or fund balances

Total liabilities and net assets/fund balances

5

5

142,573

1,585

6

7

8

9

3,478,316

3,478,316

330,489,347

8,753,284

0

0

30,593,910

375,126,823

1,746,627

10c

10c

11

12

13

14

15

16

17

18

19

20

21

22,105,005

0

22

22

23

24

0

0

23,851,632

25

25

26

351,275,191

27

28

29

351,275,191

375,126,823

30

31

32

33

34

(B)

End of year

1,256,027

323,000

0

7,977

172.075

!

,

660

3,443,104

332,020,764

8,452,947

0

0

29,816,586

375,493,140

853,090

23,705,005

0

0

24,558,095

350,935,045

350,935,045

375,493,140

Form 990 (2011)

Form 990 (2011)

Page 12

Reconciliation of Net Assets

Check if Schedule O contains a response to any question in this Part XI 0 1
Check if Schedule O contains a response to any question in this Part XI
0
1
Total revenue (must equal Part VIII, column (A), line 12)
1
17,993,480
2
Total expenses (must equal Part IX, column (A), line 25)
2
4,761,834
3
Revenue less
expenses. Subtract line 2 from line 1
3
13,231,646
4
Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)).
.
.
4
351,275,191
5
Other changes in net assets or fund balances (explain in Schedule 0)
5
-13,571,792
6
Net assets or fund balances at end of year. Combine lines 3, 4, and 5 (must equal Part X, line 33,
column (B))
66
350,935,04
350,935,0455
I22SED T Financial Statements and Reporting
Check if Schedule O contains a response to any question in this Part XII
Yes
No
1
Accounting method used to prepare the Form 990: □ Cash
0 Accrual
Other
If the organization changed its method of accounting from a prior year or checked "Other,"
explain in
Schedule O.
2a
/
2a
Were the organization's financial statements compiled or reviewed by an independent accountant?
.
.
.
b
Were the organization's financial statements audited by an independent accountant?
2b
/
c
If "Yes" to line 2a or 2b, does the organization have a committee that assumes responsibility for oversight
of the audit, review, or compilation of its financial statements and selection of an independent accountant?
2c
/
If the organization changed either its oversight process or selection process during the tax year, explain in
Schedule O.
d
If "Yes" to line 2a or 2b, check a box below to indicate whether the financial statements for the year were
issued on a separate basis, consolidated basis, or both:
□ Separate basis 0 Consolidated basis D Both consolidated and separate basis
3a
As a result of a federal award, was the organization required to undergo an audit or audits as set forth in
the Single Audit Act and OMB Circular A-133?
3a
/
b
If "Yes," did the organization undergo the required audit or audits? If the organization did not undergo the
required audit or audits, explain why in Schedule O and describe any steps taken to undergo such audits
3b

Form 99 0 (2011)

SCHEDULE A

(Form 990 or 990-EZ)

Department of the Treasury

Internal Revenue Service

Name of the organization

Deaconess Associations, Inc.

Public Charity Status and Public Support

Complete if the organization is a section 501(c)(3) organization or a section

4947(a)(1) nonexempt charitable trust

► Attach to Form 990 or Form 990-EZ.

► See separate instructions.

OMBNo 1545-0047

'OH

Open to Public

Inspection

Employer identification number

31-1209377

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

The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)

1

2

3

4

5

 

D

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

D

A school described in section 170(b)(1)(A)(ii). (Attach Schedule E.)

D

A

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

D

A medical research organization operated in conjunction with a hospital described in section 170(b)(1)(A)(iii). Enter the

 

hospital's name, city, and state:

An organization operated for the benefit of a college or university owned or operated by a governmental unit described in

section 170(b)(1)(A)(iv). (Complete Part II.)

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

□ An organization that normally receives a substantial part of its support from a governmental unit or from the general public

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

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

  • D An organization that normally receives: (1) more than 33 1 /3% of its support from contributions, membership fees, and gross receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 33V3% of its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)

10

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

11

 

IZI An organization organized and operated exclusively for the benefit of, to

perform the functions

of,

or

to

carry out

the

 

purposes of one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). See section

509(a)(3). Check the box that describes the type of supporting organization and complete lines 11 e through 11 h.

 

a

Type I

b

Type II

c

0

Type lll-Functionally

integrated

 

d

Type Ill-Other

 

e

0

By checking this box, I certify that the organization is not controlled directly or indirectly by one or more disqualified persons

 

other than foundation managers and other than one or more publicly supported organizations described in section 509(a)(1)

or section 509(a)(2).

 

f

If the organization received a written determination from the IRS that

it

is

a Type

I, Type

II, or

Type

III

supporting

 

organization, check this box

 
 

g

Since August 17, 2006, has the organization accepted any gift or contribution from any of the

 
 

following persons?

(j)

A person who directly or indirectly controls, either alone or together with persons described in (ii) and

Yes

No

(iii) below, the governing body of the supported organization?

 

ng(i)

/

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

 

11g(»)

/

(iii) A 35% controlled entity of a person described in (i) or (n) above?

 

11g(iifl

/

 

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

(i) Name of supported

organization

(ii)

(ii)

EIN

EIN

(iii) Type of organization

(iii) Type of organization

(described on lines 1-9

(described on lines 1-9

(iv) Is the organization

in col

(i) listed in your

(v) Did you notify

the organization in

(vi) Is the

organization in col

(vii) Amount of

support

 

above or IRC section

above or IRC section

governing document?

col

(i) of your

(i) organized in the

(see instructions))

(see instructions))

support?

U S?

 

Yes

No

Yes

No

Yes

No

i£\

Deaconess

 

Healthcare Services

 

31-1365388

3

/

/

/

52,053

ia\

Deaconess Long

 

Term Care

 

31-1391195

11b

/

/

0

IQ\

Deaconess Hospital

 

ofCinti. OH

 

31-0537109

11b

/

/

/

2,241,752

in\

Deaconess Health

 

Assoc. Fund

 

31-1209378

11b

/

/

/

368,479

(E)

Total

 

For Paperwork Reduction Act Notice, see the Instructions for

 

Cat No 11285F

 

Schedule A (Form 990 or 990-EZ) 2011

Form 990 or 990-EZ.

 

Version A, cycle 1

Schedule A (Form 990 or 990-EZ) 2011

Page 2

Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)

(Complete only if you checked

the box

on line 5, 7, or 8 of Part I or if the organization failed to qualify

under

Part III. If the organization fails to qualify under the tests listed below, please complete Part III.)

 

Section A. Public Support

Calendar year (or fiscal year beginning in) ► (a)

2007

(b) 2008

 

(c) 2009

(d)2010

(e) 2011

(f) Total

  • 1 Gifts, grants, contributions,

 

and

membership fees received. (Do not

include any "unusual grants.")

.

.

.

Tax

  • 2 revenues

levied

for

the

organization's

benefit and either paid

to or expended on its behalf

.

.

.

  • 3 value

The

of

services

or facilities

furnished by a governmental unit to the

organization without charge

...

.

  • 4 Total. Add lines 1 through 3 .

.

.

.

  • 5 The portion of total contributions

by

each

person

(other

than

a

governmental

unit

or

publicly

supported

organization)

included

on

line

1 that exceeds 2%

of

the amount

shown on line 11, column (f).

.

.

.

  • 6 Public support. Subtract line 5 from line 4.

Section B. Total Support

Calendar year (or fiscal year beginning in) ►

(a) 2007

(b) 2008

 

(c) 2009

(d)2010

(e) 2011

(f) Total

  • 7 Amounts from line 4

  • 8 Gross income from interest, dividends,

 

payments received on securities loans,

rents, royalties and income from similar

sources