2022-11-02T10:30:56-05:00 2021-12-31 351178661 BLUE & CO LLC 2650 EASTPOINT PKWY SUITE 300 LOUISVILLE KY 40223 990 2021-01-01 350895832 NORTON - KING'S DAUGHTERS' HEALTH INC NORT 8128010800 1373 EAST STATE ROAD 62 PO BOX 447 MADISON IN 47250 DARLEEN CONNOLLY BOARD CHAIRWOMAN 8128010800 2022-11-01 1 DARLEEN CONNOLLY 999009999 NATHAN A RODGERS CPA P01568275 5029923500 2022-11-01 3 AAL1 IAL1 2021 2022-09-23 18:48:47Z KING'S DAUGHTERS' HEALTH JOHN PRICE 1373 EAST STATE ROAD 62 PO BOX 447 MADISON IN 47250 226791362 0 X WWW.KDHMADISON.ORG X 1899 IN TO IMPROVE THE HEALTH OF THE HOSPITAL'S PATIENTS THROUGH CARE, SERVICE, AND EDUCATION. 11 9 1102 13 49635 32687 13788547 4369853 119279872 145093966 7749825 22031572 439482 409944 141257726 171905335 11705 23579 0 0 62868207 71842418 0 0 107563 60078380 65268265 122958292 137134262 18299434 34771073 327672291 360802224 101060585 99917079 226611706 260885145 THE MISSION OF THE HOSPITAL IS TO IMPROVE THE HEALTH OF THE HOSPITAL'S PATIENTS THROUGH CARE, SERVICE, AND EDUCATION. 0 0 105389487 23579 145138874 NORTON - KING'S DAUGHTERS' HEALTH, INC. IS A NOT-FOR-PROFIT, ACUTE CARE HOSPITAL LOCATED IN MADISON, INDIANA. THE HOSPITAL IS ORGANIZED FOR THE PURPOSE OF PROVIDING HEALTHCARE SERVICES TO THE RESIDENTS OF JEFFERSON COUNTY AND THE SURROUNDING AREA.DURING THE CALENDAR YEAR 2021, THE HOSPITAL PROVIDED HEALTHCARE TO PATIENTS AT THE FOLLOWING LEVELS:10,786 DAYS OF CARE TO ACUTE INPATIENTS997 DAYS OF CARE TO NEWBORN INFANTS210,482 ASSOCIATED WITH HOSPITAL OUTPATIENTS131,028 VISITS ASSOCIATED WITH PHYSICIAN CLINICS THE HOSPITAL'S PRIMARY SOURCES OF SUPPORT ARE FROM PATIENT REVENUES. PATIENT REVENUES INCLUDE FUNDS RECEIVED FROM MEDICARE, STATE AGENCIES, INSURANCE COMPANIES, AND THE PATIENTS THEMSELVES. IN 2021, KING'S DAUGHTERS' HEALTH PROVIDED SERVICES TOTALING $1,742,749 IN GROSS CHARGES TO PATIENTS WHO MET THE HOSPITAL'S CHARITY CARE POLICY. 105389487 1 1 0 1 0 0 0 0 0 1 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 1 0 0 0 1 0 0 0 0 0 1 0 0 0 1 67 0 1 1102 1 1 1 0 0 0 0 1 1 0 0 0 0 0 0 X 11 9 0 0 1 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 0 0 IN X DAWN NUNAN DIRECTOR OF ACCOUNTING 8128010800 1373 EAST STATE ROAD 62 PO BOX 447 MADISON IN 47250 ANNIE SCHROEDER BOARD CHAIRWOMAN 1.00 X 1000 0 0 DARLEEN CONNOLLY BOARD VICE-CHAIRWOMAN 1.00 X 0 0 0 SUSAN OHLENDORF BOARD SECRETARY 1.00 X 1000 0 0 MARY BETTE VOYLES BOARD TREASURER 1.00 X 1000 0 0 BONNIE COLEN BOARD ASSN'T SECRETARY 1.00 X 1000 0 0 SHARYN WHITMAN BOARD ASSN'T TREASURER 1.00 X 0 0 0 JONATHAN HANSON MD BOARD MEMBER/PHYSICIAN 40.00 X 456098 0 37774 TINA HENDRICK MD BOARD MEMBER/PHYSICIAN 40.00 X 307511 0 15578 JOE CRAIG BOARD MEMBER 1.00 X 0 0 0 MARY KAY MCCUBBIN BOARD MEMBER 1.00 X 0 0 0 KEVIN TURNER BOARD MEMBER 1.00 X 0 0 0 CAROL DOZIER PRESIDENT/CEO 40.00 1.00 X 421792 0 14855 JOHN PRICE VP FINANCE 40.00 X 275183 0 20068 LISA MORGAN VP OUTPATIENT SERVICES 40.00 X 230754 0 17848 DENINE FALLIS-HALLGARTH VP PHYSICIAN PRACTICES 40.00 X 178402 0 16806 JENNIFER LITER VP INPATIENT SERVICES 40.00 X 180474 0 33627 NATHAN POLLEY MD EMPLOYED PHYSICIAN 40.00 X 1151724 0 36658 THOMAS ECKERT MD EMPLOYED PHYSICIAN 40.00 X 695765 0 23887 KENNETH MACKINLAY MD EMPLOYED PHYSICIAN 40.00 X 674516 0 36658 RAYMONDA STEVENS MD EMPLOYED PHYSICIAN 40.00 X 966520 0 14250 WILLIAM SKILES MD EMPLOYED PHYSICIAN 40.00 X 448843 0 29188 5991582 0 297197 85 0 1 0 ARUP LABORATORIES PO BOX 27964 SALT LAKE CITY UT 84127 LABORATORY SERVICES 1092111 KAUFMAN HALL & ASSOCIATES 5202 OLD ORCHARD ROAD STE N700 SKOKIE IL 60077 FINANCIAL CONSULTING SERVICES 1055719 EMCARE INC 7032 COLLECTION CENTER DRIVE CHICAGO IL 60693 CONTRACTED PHYSICIAN & MID LEVEL PROVIDE 975865 WEATHERBY LOCUMS INC PO BOX 972633 DALLAS TX 75397 CONTRACTED PHYSICIAN & MID LEVEL PROVIDE 799479 HALL RENDER KILLIAN HEATH & LYMAN P PO BOX 714570 CINCINNATI OH 45271 LEGAL SERVICES 768338 38 199072 4014985 155796 15778 4369853 NET PATIENT SERVICE REVENUE 621110 145093966 145093966 145093966 3968454 3968454 52445 23286 29159 29159 29159 72355131 570728 54856748 5993 17498383 564735 18063118 18063118 CAFETERIA REVENUE 722210 314963 314963 LAB 621500 32738 32738 GIFT SHOP 453220 438 438 32646 15749 16897 380785 171905335 145138874 49635 22346973 23579 23579 2210769 1699005 511764 55247765 42375972 12764230 107563 2279363 1751721 527642 8548100 6569327 1978773 3556421 2733156 823265 846620 846620 318720 318720 724699 724699 84815 84815 165242 126991 38251 530598 407772 122826 46710 35897 10813 2051636 1576709 474927 95237 73191 22046 5073013 3898677 1174336 8463536 6504339 1959197 1646721 1265527 381194 PURCHASED SERVICES 13462350 10345993 3116357 DRUGS 11936854 11936854 SUPPLIES 9350333 7185854 2164479 HOSPITAL ASSESSMENT FEE 4567032 4567032 5904149 2227076 3677073 137134262 105389487 31637212 107563 9524 9230 26905533 25181101 10759153 15510341 24363 57908 1309750 887443 3056386 3253610 1752074 1708255 188316065 101683575 90093824 86632490 184274988 219392303 9486696 8169543 327672291 360802224 9737204 10449107 169810 8421 89181804 86193262 569952 806393 1401815 2459896 101060585 99917079 X 226591151 260864458 20555 20687 226611706 260885145 327672291 360802224 X 34771073 -436392 -61242 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 10944 10944 0 PART II-B, LINE 1: "AMERCIAN HOSPITAL ASSOCIATION DUES AND INDIANA HOSPITAL ASSOCIATION DUES ATTRIBUTABLE TO LOBBYING EXPENSES AS DISCLOSED ON THE DUES NOTICES OF THE RESPECTIVE ASSOCIATIONS. AHA MEMBERSHIP DUES $28,110 X LOBBYING PERCENTAGE OF 26.47% = $7,441 IHA MEMBERSHIP DUES $42,774 X LOBBYING PERCENTAGE OF 8.19% = $3,503" 20555 3656 3524 20687 13121 15965 8531 20555 12850 4035 3764 13121 12957 3208 3315 12850 20194 28678 35915 12957 0.00000 0.48340 0.51660 0 0 4282249 4282249 119412547 48370445 71042102 64344756 53313130 11031626 276513 276513 86632490 DEFERRED COMPENSATION 34977 THIRD PARTY PAYABLE 1959325 LIFE INSURANCE POLICIES 403713 MEDICARE SETTLEMENT CURRENT YEAR 61881 2459896 X 170648934 -436392 -61242 -497634 171146568 724699 34068 758767 171905335 136375495 0 136375495 724699 34068 758767 137134262 PART V, LINE 4: PERMANENT ENDOWMENT - INTENT IS TO HOLD THE INVESTMENT IN PERPETUITY. PER AUDITED FINANCIAL STATEMENTS, "THE PORTION OF PERPETUAL ENDOWMENT FUNDS THAT IS REQUIRED TO BE RETAINED PERMANENTLY EITHER BY EXPLICIT DONOR STIPULATION OR UPMIFA" IS $10,000 AT 12/31/21. OTHER NET ASSETS WITH DONOR RESTRICTIONS INCLUDE FUNDS THAT ARE DONOR-RESTRICTED FOR A SPECIFIC USE INCLUDING: INDIANA CANCER CONSORTIUM GRANT AND HEALTHY INDIANA PLAN 2.0 PREMIUM ASSISTANCE FUND. PART X, LINE 2: ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE HOSPITAL AND RECOGNIZE A TAX LIABILITY IF THE HOSPITAL HAS TAKEN AN UNCERTAIN TAX POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY VARIOUS FEDERAL AND STATE TAXING AUTHORITIES. MANAGEMENT HAS ANALYZED THE TAX POSITIONS TAKEN BY THE HOSPITAL, AND HAS CONCLUDED THAT AS OF DECEMBER 31, 2021 AND 2020, THERE ARE NO UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY OR DISCLOSURE IN THE ACCOMPANYING CONSOLIDATED FINANCIAL STATEMENTS. THE HOSPITAL IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, AS OF THE DATE THE FINANCIAL STATEMENTS WERE ISSUED, THERE WERE NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. PART XI, LINE 2D - OTHER ADJUSTMENTS: CHANGE IN SUBSCRIBER SAVINGS CUMULATIVE ACCOUNT -61,242. ROUNDING PART XI, LINE 4B - OTHER ADJUSTMENTS: OTHER RENTAL INCOME 10,489. OTHER EXPENSE NETTED WITH INCOME ON FINANCIAL STATEMENTS 23,579. PART XII, LINE 4B - OTHER ADJUSTMENTS: OTHER RENTAL INCOME 10,489. OTHER EXPENSE NETTED WITH INCOME ON FINANCIAL STATEMENTS 23,579. 1 1 1 X 1 X 1 1 1 0 1 1 519310 519310 0.00380 27661191 17950075 9711116 0.07080 28180501 17950075 10230426 0.07460 192970 55864 137106 0.00100 196911 43605 153306 0.00110 2436428 2004974 431454 0.00310 20797 0 20797 0.00020 2847106 2104443 742663 0.00540 31027607 20054518 10973089 0.08000 242723 0 242723 0.00180 242723 242723 0.00180 0 8490291 23643776 22360889 1282887 X 1 1 1 1 NORTON - KING'S DAUGHTERS' HEALTH INC 1373 EAST STATE ROAD 62 PO BOX 447 MADISON IN 47250 WWW.KDHMADISON.ORG 20-005063-1 X X X NORTON - KING'S DAUGHTERS' HEALTH INC 1 0 0 1 X X X X X X X X X X 19 1 0 0 1 X WWW.KDHMADISON.ORG/ABOUT-US/COMMUNITY-HEALTH-NEEDS-ASSESSMENT/ X X 1 19 1 HTTPS://WWW.KDHMADISON.ORG/ABOUT-US/COMMUNITY-HEALTH-NEEDS-ASSESSMENT/ 0 1 X 200.000000000000 300.000000000000 X X X X 1 1 X X X X 1 X HTTPS://WWW.KDHMADISON.ORG/PATIENTS-VISITORS/PATIENTS/FINANCIAL-ASSISTANCE/ X HTTPS://WWW.KDHMADISON.ORG/FORMS/FINANCIAL-ASSISTANCE-APPLICATION/ X HTTPS://WWW.KDHMADISON.ORG/PATIENTS-VISITORS/PATIENTS/FINANCIAL-ASSISTANCE/ X X X X X X X 1 X 0 X X X X X 1 X 0 0 NORTON - KING'S DAUGHTERS' HEALTH, INC. PART V, SECTION B, LINE 3J: THE NEEDS ASSESSMENT PERFORMED BY THE HOSPITAL ALSO EXPLORED KEY ISSUES SUCH AS: CANCER, DIABETES, HEART DISEASE & STROKE, INJURY & VIOLENCE, MENTAL HEALTH, NUTRITION, PHYSICAL ACTIVITY, WEIGHT, RESPIRATORY DISEASES, SUBSTANCE ABUSE, TOBACCO USE, FAMILY PLANNING, INFANT/CHILD HEALTH, DEMENTIA/ALZHEIMER'S DISEASE, SEXUALLY TRANSMITTED DISEASES, ARTHRITIS/OSTEOPOROSIS/BACK CONDITIONS, ORAL HEALTH/DENTAL CARE, HIV/AIDS, IMMUNIZATION/INFECTIOUS DISEASES, AND HEARING & VISION PROBLEMS. NORTON - KING'S DAUGHTERS' HEALTH, INC. PART V, SECTION B, LINE 5: THE HOSPITAL TOOK INTO ACCOUNT INPUT FROM PERSONS IN THE COMMUNITY BY UTILIZING THE FOLLOWING COMPONENTS: TELEPHONE INTERVIEWS OF A RANDOM SAMPLE OF 200 INDIVIDUALS AGE 18 AND OLDER IN THE PRIMARY SERVICE AREA. NOTE THAT THE SAMPLE CONSITED SOLELY OF AREA RESIDENTS AGE 18 AND OLDER. DATA ON CHILDREN WERE GIVEN BY PROXY BY THE PERSON MOST RESPONSIBLE FOR THAT CHILD'S HEALTHCARE NEEDS. ON-LINE KEY INFORMANT SURVEY DIRECTED AT PHYSICIANS, PUBLIC HEALTH REPRESENTATIVES, OTHER HEALTH PROFESSIONALS, SOCIAL SERVICE PROVIDERS, AND A VARIETY OF OTHER COMMUNITY LEADERS. POTENTIAL PARTICIPANTS WERE CHOSEN BY KING'S DAUGHTERS' BECAUSE OF THEIR ABILITY TO IDENTIFY PRIMARY CONCERNS OF THE POPULATIONS WITH WHOM THEY WORK, AS WELL AS THE COMMUNITY OVERALL. THROUGH THIS PROCESS, INPUT WAS GATHERED FROM SEVERAL INDIVIDUALS WHOSE ORGANIZATIONS WORK WITH LOW-INCOME, MINORITY, OR OTHER MEDICALLY UNDERSERVED POPULATIONS. NORTON - KING'S DAUGHTERS' HEALTH, INC. PART V, SECTION B, LINE 7D: RESULTS OF THE NEEDS ASSESSMENT HAVE BEEN MADE AVAILABLE THROUGH A VARIETY OF SOURCES: NEWSPAPER AND RADIO RELEASES, DISTRIBUTION OF INFORMATION IN THE COMMUNITY NEWSLETTER, THE VITAL SIGNS, THROUGH PUBLIC HEALTH FORUMS. IT IS ALSO AVAILABLE ON OUR WEBSITE @ WWW.KDHMADISON.ORG/ABOUT-US/COMMUNITY-NEEDS-ASSESSMENT. NORTON - KING'S DAUGHTERS' HEALTH, INC. PART V, SECTION B, LINE 11: THE HOSPITAL CONDUCTED A NEEDS ASSESSMENT IN 2019 WHOSE IMPLEMENTATION STRATEGY WAS ADOPTED IN MARCH 2020. THE IMPLEMENTATION STRATEGY ASSOCIATED WITH THE 2019 NEEDS ASSESSMENT INCLUDED THE FOLLOWING PRIORITY AREAS- SUBSTANCE ABUSE, MENTAL HEALTH, TOBACCO USE, NUTRITION/PHYSICAL ACTIVITY/WEIGHT, DIABETES, HEALTH DISEASE & STROKE, AND CANCER. THIS IMPLEMENTATION STRATEGY WILL GUIDE THE ACTIVITIES FOR THREE CONSECUTIVE YEARS FOLLOWING THE MOST RECENT NEEDS ASSESSMENT (AN UPDATE TO THIS STRATEGY PLAN WILL BE PROVIDED AT THE END OF EACH CALENDAR YEAR (2020, 2021, AND 2022).KDH GAPS: THERE DOES NOT APPEAR TO BE LARGE GAPS IN THE TOPICS OR TYPES OF COMMUNITY OUTREACH PROGRAMS THAT KDH HAS CONDUCTED IN THE PAST. HOWEVER, THERE MAY BE GAPS DUE TO FUNDING LEVELS OR STAFFING LEVELS IN THE NUMBER OF PROGRAMS AND THE GEOGRAPHIC REACH OF THE PROGRAMS THAT HAVE BEEN OFFERED. KDH WILL USE THE LIST OF MAJOR HEALTH ISSUES IN WHICH KDH IS EXPECTED TO HAVE A LEADERSHIP AND SUPPORTING ROLE AS WELL AS THE LIST OF SPECIFIC TOPICS SUGGESTED TO DEVELOP PROGRAMS AND APPLY FOR GRANTS TO IMPROVE HEALTH IN THE COMMUNITIES IT SERVES.IMPLEMENTATION STRATEGY 2020-2022 PRIORITY AREA 1 - SUBSTANCE ABUSE - 2021, YEAR 2 UPDATESTRATEGY: KDH WILL TAKE A LEAD ROLE FOR THE HEALTHY COMMUNITIES INITIATIVE (HCI) SUBSTANCE ABUSE TEAM.OUTCOME: KDH EMPLOYS A PAID HCI COORDINATOR WHO OVERSEES THE HCI SUBSTANCE ABUSE TEAM, SCHEDULING MEETINGS AND SPEAKERS.ADDITIONAL INFORMATION: TWO KDH EMPLOYEES, A PEDIATRICIAN AND A PEDIATRIC SOCIAL WORKER PROVIDED A PRESENTATION AT A SUBSTANCE ABUSE TEAM MEETING IN 2021. DUE TO AN INCREASE IN THE NUMBER OF FENTANYL-LACED PILL OVERDOSE DEATHS, THE TEAM INCREASED PROMOTION OF NALAXONE AVAILABILITY TO THE COMMUNITY.STRATEGY: KDH WILL HAVE STAFF REPRESENTATIVES ACTIVELY SERVING ON THE FOLLOWING COUNTY SUBSTANCE ABUSE COALITIONS: - JCJTAP JEFFERSON COUNTY JUSTICE TREATMENT AND PREVENTION COALITION- SWITZERLAND COUNTY AWARENESS NETWORK AND/OR SIMILAR DRUG COALITIONOUTCOME: KDH HAS 3 EMPLOYEES WHO ACTIVELY SERVE ON THE JCJTAP COALITION. THE COALITION REJOINED IN-PERSON MEETINGS IN 2021. IN ADDITION, THE HCI COORDINATOR REMAINS THE SECRETARY FOR THE COALITION. ADDITIONAL INFORMATION: A GRANT WAS PROVIDED FROM THE COALITION TO PURCHASE ANTI-DRUG MATERIALS TO SHARE WITH AREA YOUTH. ITEMS WERE DISTRIBUTED AT A SPECIAL YOUTH EVENT AND DISTRIBUTED BY THE JUNIOR HIGH SCHOOL RESOURCE OFFICER. THE HCI COORDINATOR AND THREE KDH EMPLOYEES WORKED WITH A NEW STATE INITIATIVE TO CREATE A REGIONAL PREVENTION SYSTEM. A LOCAL CLIENT CONSULTATION BOARD (CCB) WAS FORMED IN JEFFERSON COUNTY IN 2021.STRATEGY: KDH WILL CREATE AND MAINTAIN AN EDUCATION AND COMMUNITY RESOURCE/REFERRAL BULLETIN BOARD FOR THE HOSPITAL EMERGENCY ROOM. OUTCOME: A SUBSTANCE ABUSE RESOURCE BULLETIN BOARD WAS PLACED IN THE EMERGENCY ROOM LOBBY IN 2020. IN 2021, AN ADDITIONAL RESOURCE BOARD WITH SUBSTANCE ABUSE LITERATURE WAS PLACED IN THE KDH CONVENIENT CARE CENTER LOBBY.ADDITIONAL INFORMATION: BOTH RESOURCE BOARDS INCLUDE TOBACCO CESSATION INFORMATION AND LOCAL RESOURCES FOR AA/NA MEETINGS. PRIORITY AREA 2 MENTAL HEALTH 2021, YEAR 2 UPDATE STRATEGY: KDH WILL TAKE A LEAD ROLE FOR THE HEALTHY COMMUNITIES INITIATIVE MENTAL HEALTH/ZERO SUICIDE TEAM. OUTCOME: KDH EMPLOYS A PAID COORDINATOR WHO OVERSEES THE HCI PROGRAM. THE HCI COORDINATOR PARTICIPATES IN THE IN SUICIDE PREVENTION COALITION.ADDITIONAL INFORMATION: IN 2021, A JEFFERSON COUNTY RESIDENTIAL TREATMENT FACILITY SUBCOMMITTEE WAS APPOINTED BY THE JUSTICE REINVESTMENT ADVISORY COUNCIL. THE GROUP IS INVESTIGATING THE FEASIBILITY OF DEVELOPING AN IN-PATIENT FACILITY ALONG WITH OTHER IDEAS TO ADDRESS MENTAL HEALTH ISSUES IN THE COUNTY. THE HCI COORDINATOR SERVES AS A MEMBER OF THIS SUBCOMMITTEE.STRATEGY: KDH STAFF WILL HELP LEAD HCI'S EFFORT TO BECOME A TRAUMA INFORMED COMMUNITY.OUTCOME: WORK CONTINUED IN 2021 ON THE ACES INITIATIVE (ADVERSE CHILDHOOD EXPERIENCES). THE HCI COORDINATOR AND TWO ADDITIONAL KDH STAFF MEMBERS SERVE ON THE ACES STEERING COMMITTEE.ADDITIONAL INFORMATION: LEADERSHIP STAFF AT KDH VIEWED THE DOCUMENTARY RESILIENCE: THE BIOLOGY OF STRESS & THE SCIENCE OF HOPE. THE HCI COORDINATOR BECAME A CERTIFIED ACE INTERFACE MASTER TRAINER TO PROVIDE ACES TRAINING FOR LOCAL GROUPS.THE KDH FOUNDATION OBTAINED A GRANT FROM THE LOCAL COMMUNITY FOUNDATION TO CONDUCT AN ACES SURVEY IN JEFFERSON COUNTY, WHICH WILL HELP DETERMINE ADDITIONAL PROGRAMMING NEEDS. KDH SUPPORTED BY ADVERTISING THE SURVEY AND MAKING COPIES AVAILABLE AT VARIOUS FACILITIES. STRATEGY: SCREENING TOOLS WILL BE UTILIZED AT KDH. THIS INCLUDES THE USE OF: - ANNUAL DEPRESSION SCREENING TOOL USED IN THE OUTPATIENT PHYSICIAN OFFICES. - EVERY EMERGENCY ROOM PATIENT RECEIVES A SUICIDAL SCREENING TOOL TO ASSESS FOR SUICIDAL RISKOUTCOME: THE PHQ-9 DEPRESSION SCREENING TOOL CONTINUES TO BE USED IN KDH OUTPATIENT PROVIDER OFFICES.THE KDH EMERGENCY ROOM CONTINUES TO USE THE C-SSRS DEPRESSION ASSESSMENT TOOL FOR ALL PATIENTS (EXCEPT INFANT/TODDLERS) TO HELP MAKE APPROPRIATE MENTAL HEALTH REFERRALS.ADDITIONAL INFORMATION: IN 2021, 69.94% OF PATIENTS AGE 12 AND OLDER RECEIVED THE PHQ-9 SCREENING TOOL IN THE OUTPATIENT PROVIDER OFFICES. THIS PERCENTAGE INCREASED, WHICH WAS 58% IN 2020. PRIORITY AREA 3 TOBACCO USE - 2021, YEAR 2 UPDATESTRATEGY: TOBACCO AWARENESS EDUCATION, INCLUDING PREVENTION AND CESSATION FOCUSED INFORMATION PROVIDED TO YOUTH OF JEFFERSON COUNTY. OUTCOME: COMPLETED THE STANDARDIZED TOBACCO ASSESSMENT FOR RETAIL SETTINGS (STARS) SURVEY AGAIN IN 2021 AT ALL 39 TOBACCO RETAILERS IN JEFFERSON COUNTY. YOUTH TOBACCO CESSATION RESOURCES WERE GIVEN TO JEFFERSON COUNTY MIDDLE AND HIGH SCHOOL COUNSELORS. PROVIDED SECONDHAND-SMOKE EDUCATION AT JEFFERSON COUNTY 4-H FAIR. ADDITIONAL INFORMATION: STARS SURVEY DATA IS UTILIZED TO PRESENT POINT-OF-SALE INFORMATION AND HOW TOBACCO PRODUCTS ARE MARKETED TO YOUTH.STRATEGY: TOBACCO AWARENESS EDUCATION AND CESSATION RESOURCES PROVIDED TO EXPECTING MOTHERS IN JEFFERSON COUNTY.OUTCOME: WORK CONTINUED IN 2021 WITH THE LOCAL WIC PROGRAM TO HELP REFER CLIENTS TO THE INDIANA TOBACCO QUITLINE. EXPECTING MOTHERS, FROM THE KDH OB/GYN OUTPATIENT DEPARTMENT WHO STATE THEY ARE TOBACCO USERS, ARE ALSO REFERRED TO THE TOBACCO QUITLINE.KDH HELPED TO ENROLL MOTHERS IN THE BABY & ME TOBACCO FREE PROGRAM. THE KDH TOBACCO COORDINATOR WORKED WITH THE PERINATAL EDUCATOR TO PROVIDE CESSATION LITERATURE TO TOBACCO USING EXPECTING MOTHERS DURING THEIR OB PREP VISIT PRIOR TO DELIVERY.ADDITIONAL INFORMATION: 2021 QUITLINE REFERRAL DATA AND BABY & ME TOBACCO FREE PROGRAM DATA WAS LOST WHEN KDH EXPERIENCED A COMPUTER SHUT-DOWN IN EARLY 2022. THE NUMBER OF REFERRALS FOR THESE PROGRAMS COULD NOT BE RECOVERED. THE INDIANA STATE DEPARTMENT OF HEALTH STOPPED FUNDING THE BABY & ME TOBACCO FREE PROGRAM IN 2021. THE TOBACCO COORDINATOR WAS ABLE TO OBTAIN A SEPARATE GRANT TO CONTINUE A TOBACCO CESSATION PROGRAM FOR NEW MOMS. STRATEGY: MEASURE AND WORK TO INCREASE REFERRALS TO THE INDIANA STATE TOBACCO QUITLINE.OUTCOME: THE NUMBER OF TOBACCO QUITLINE REFERRALS MADE BY KDH PROVIDERS FOR CALENDAR YEAR 2021 IS NOT AVAILABLE FOLLOWING THE COMPUTER SHUT-DOWN. ADDITIONAL INFORMATION: MONTHLY REFERRAL REPORTS WERE SENT TO ALL KDH PHYSICIANS AND NURSES WITH QUITLINE DATA.FAX REFERRALS TO THE QUITLINE FROM THE KDH CANCER TREATMENT CENTER CONTINUED THROUGH 2021 PRIORITY AREA 4 NUTRITION, PHYSICAL ACTIVITY, WEIGHT - 2021, YEAR 2 UPDATESTRATEGY: KDH WILL TAKE A LEAD ROLE FOR THE HEALTHY COMMUNITIES INITIATIVE HEALTHY LIFESTYLES TEAM. THIS TEAM INCLUDES WORK FOCUSING ON DISEASE PREVENTION, HEALTHY NUTRITION, PHYSICAL ACTIVITY, OBESITY, AND TOBACCO.OUTCOME: THE KDH WELLNESS COORDINATOR SERVES AS THE HEALTHY LIFESTYLES TEAM CHAIR. IN ADDITION, THE TOBACCO COORDINATOR IS ACTIVELY INVOLVED ON THIS TEAM.ADDITIONAL INFORMATION: 2021 HEALTHY LIFESTYLE ACCOMPLISHMENTS INCLUDED; - WORKING WITH THE LOCAL FARMER'S MARKET ON HEALTHY RECIPES.- HOLDING FIVE COMMUNITY WALKING EVENTS INCORPORATING CIGARETTE BUTT & LITTER CLEAN-UP. - HOSTING A COMMUNITY WALKING SCAVENGER HUNT.STRATEGY: TARGET AREA YOUTH WITH PROGRAMMING AIMED AT INCREASING PHYSICAL ACTIVITY AND TEACHING HEALTHY NUTRITION HABITS AT A YOUNG AGE. OUTCOME: THE KDH WELLNESS COORDINATOR TAUGHT THE FIT KIDS PROGRAM IN JEFFERSON COUNTY 5TH GRADE CLASSROOMS. THIS 4-LESSON EDUCATION PROGRAM TARGETS CHILDHOOD OBESITY BY TEACHING AGE-APPROPRIATE HEALTH, NUTRITION, AND EXERCISE LESSONS AND OFFERS TAKE HOME CHALLENGES FOR STUDENTS & FAMILIES. A LARGE HEALTHY YOUTH TAILGATE PARTY WAS HELD IN 2021 WHICH SERVED OVER 300 YOUTH AND GUARDIANS. TWENTY-TWO AGENCIES OFFERED INTERACTIVE BOOTHS WITH ACTIVITIES AND HEALTH INFORMATION. THE WELLNESS COORDINATOR CHAIRED THIS EVENT.CONTINUED NORTON - KING'S DAUGHTERS' HEALTH, INC. PART V, SECTION B, LINE 16J: AT THE TIME OF REGISTRATION, THE PATIENT IS OFFERED A PAMPHLET REGARDING THE POLICY, ELIGIBILITY REQUIREMENTS AND THE ASSOCIATED APPLICATION PROCESS. THE PATIENT MUST SIGN A FORM INDICATING THAT HE/SHE RECEIVED THIS INFORMATION. THE HOSPITAL ALSO HAS A REPRESENTATIVE ON SITE TO ASSIST PATIENTS WITH THE FINANCIAL AID APPLICATION PROCESS. PATIENTS ARE REMINDED TO CONTACT CUSTOMER SERVICE REGARDING FINANCIAL AID AND FEDERAL/STATE ASSISTANCE DIRECTLY ON THE PATIENT BILL ITSELF. THE HOSPITAL'S WEBSITE HAS A LINK TO THE FINANCIAL AID APPLICATION. IN ADDITION TO THE ACTIONS PREVIOUSLY LISTED, A FINANCIAL AID COUNSELOR WILL ATTEMPT TO MEET (DURING NORMAL BUSINESS HOURS) WITH ANY UNINSURED INPATIENT PRIOR TO DISCHARGE TO DISCUSS THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY. NORTON - KING'S DAUGHTERS' HEALTH, INC. PART V, SECTION B, LINE 20E: AT THE TIME OF REGISTRATION, THE PATIENT IS OFFERED A PAMPHLET REGARDING THE POLICY, ELIGIBILITY REQUIREMENTS AND THE ASSOCIATED APPLICATION PROCESS. THE PATIENT MUST SIGN A FORM INDICATING THAT HE/SHE RECEIVED THIS INFORMATION. THE HOSPITAL ALSO HAS A REPRESENTATIVE ON SITE TO ASSIST PATIENTS WITH THE FINANCIAL AID APPLICATION PROCESS. PATIENTS ARE REMINDED TO CONTACT CUSTOMER SERVICE REGARDING FINANCIAL AID AND FEDERAL/STATE ASSISTANCE DIRECTLY ON THE PATIENT BILL ITSELF. THE HOSPITAL'S WEBSITE HAS A LINK TO THE FINANCIAL AID APPLICATION. IN ADDITION TO THE ACTIONS PREVIOUSLY LISTED, A FINANCIAL AID COUNSELOR WILL ATTEMPT TO MEET (DURING NORMAL BUSINESS HOURS) WITH ANY UNINSURED INPATIENT PRIOR TO DISCHARGE TO DISCUSS THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY. PART V, SECTION B, LINE 11 CONTINUED PRIORITY AREA 4 NUTRITION, PHYSICAL ACTIVITY, WEIGHT -CONTINUEDADDITIONAL INFORMATION: FOR THE 2020-2021 SCHOOL YEAR, THE FIT KIDS IN-PERSON PROGRAM WAS OFFERED TO 14 DIFFERENT CLASSROOMS (284 STUDENTS). AN ADDITIONAL 5 CLASSROOMS (86 STUDENTS) RECEIVED TAKE-HOME FIT KIDS PROGRAM MATERIAL.IN ADDITION, THE KDH WELLNESS COORDINATOR HELPED PLAN AND PROMOTE THE PARK HOP FOR AREA YOUTH IN 2021. THIS EVENT PROMOTED THE VALUE OF PHYSICAL ACTIVITY AND INCENTIVIZED YOUTH AND THEIR FAMILIES TO VISIT AREA PARKS AND TRAILS.STRATEGY: KDH WELLNESS WILL HOST TWO COMMUNITY 5K RUN/WALK EVENTS TO ENCOURAGE PHYSICAL ACTIVITY.OUTCOME: KDH HOSTED THE ANNUAL RUN THE FALLS COMMUNITY 5K RUN/WALK IN SEPTEMBER. 137 PARTICIPANTS FINISHED THE OUTDOOR FITNESS EVENT.ADDITIONAL INFORMATION: DUE TO COVID AND THE CANCELLATION OF THE FALL GIRLS ON THE RUN SEASON, THE GOTR 5K EVENT WAS NOT HELD. KDH PROVIDED IN-KIND SUPPORT FOR A LOCAL 10K FITNESS EVENT, WHICH WAS CHAIRED BY THE WELLNESS COORDINATOR. PRIORITY AREA 5 DIABETES - 2021, YEAR 2 UPDATESTRATEGY: EMPLOYEE A FULL TIME DIABETES COORDINATOR AT KDH TO PROVIDE SERVICES FOR BOTH INPATIENTS AND OUTPATIENTS.OUTCOME: KDH CONTINUES TO EMPLOY A FULL TIME DIABETES EDUCATOR. ADDITIONAL INFORMATION: PATIENTS ARE REFERRED TO THE DIABETES EDUCATOR WHEN THEY HAVE A NEW DIAGNOSIS, COMPLICATIONS, A CHANGE IN THERAPY, AN A1C >9%, HAVE GESTATIONAL DIABETES, OR IF A PATIENT REQUESTS DIABETES EDUCATION. THE EDUCATOR ALSO PERFORMS CONTINUOUS GLUCOSE MONITORING STUDIES ON PATIENTS. STRATEGY: PROVIDE DIABETIC CONSULTS THROUGH POPULATION HEALTH PROGRAM, WORKING TO DECREASE A1C RATES AND INCREASE REFERRALS.OUTCOME: THE DIABETES EDUCATOR, WHO WORKS IN THE KDH QUALITY DEPARTMENT, WORKS DIRECTLY WITH THE POPULATION HEALTH NURSING STAFF. ADDITIONAL INFORMATION: AVERAGE A1C RATE:2019 - 33.53%. 2020 27.7%2021 24.23%(LOWER RATES INDICATE BETTER QUALITY)STRATEGY: PROVIDE COMMUNITY EDUCATION AND OUTREACH FOCUSING ON THE PREVENTION OF DIABETES, EARLY DETECTION, AND MANAGEMENT.OUTCOME: IN 2021, THE DIABETES EDUCATOR PROVIDED EDUCATION INFORMATION TO THE COMMUNITY AT THE 4H FAIR. IN ADDITION, SHE SPOKE TO A GROUP OF RESIDENTS AT A SENIOR CITIZEN LIVING CENTER.ADDITIONAL INFORMATION: IN 2021, THE DIABETES COORDINATOR STARTED OFFERING FREE PRE-DIABETES EDUCATION TO COMMUNITY MEMBERS WHEN REFERRED BY A PHYSICIAN. PRIORITY AREA 6 HEART DISEASE & STROKE 2021, YEAR 2 UPDATESTRATEGY: OFFER A STRUCTURED POPULATION HEALTH PROGRAM, WHICH PROVIDES ANNUAL WELLNESS VISITS FOR AT-RISK INDIVIDUALS WITH A GOAL OF INCREASING PREVENTATIVE TESTING.OUTCOME: 903 ANNUAL WELLNESS VISITS WERE PROVIDED TO MEDICARE PATIENTS IN 2021.ADDITIONAL INFORMATION: IN 2021, 21 DIFFERENT SCREENING TOOLS RESULTED IN 672 TESTS OR IMMUNIZATIONS BEING ORDERED FOR PATIENTS DURING WELLNESS VISITS. STRATEGY: PROVIDE COMMUNITY AND/OR CORPORATE BLOOD PRESSURE CHECKS AT AREA HEALTH FAIRS AND SCREENS.OUTCOME: A CORPORATE HEALTH FAIR, INCLUDING BLOOD PRESSURE AND LIPID CHECKS WAS HELD FOR JEFFERSON COUNTY EMPLOYEES. BLOOD PRESSURE CHECKS WERE PROVIDED FOR VETERAN'S AND SPOUSES AT A REACHING RURAL VETERAN'S EVENT.ADDITIONAL INFORMATION: KDH TRAINED A TOTAL OF 1,051 PEOPLE IN 2021 IN AHA CLASSES (COMBINATION OF BLS, PALS, ACLS).STRATEGY: PROVIDE COMMUNITY EDUCATION AND OUTREACH FOCUSING ON THE PREVENTION AND WARNING SIGNS FOR HEART DISEASE AND STROKE.OUTCOME: THE WELLNESS COORDINATOR HAD NINE COMMUNITY PRESENTATIONS RELATED TO HEART DISEASE PREVENTION. ADDITIONAL INFORMATION: A NEW PARTNERSHIP WAS FORMED IN 2021 WITH THE INDIANA DEPARTMENT OF CORRECTIONS AND RIVER VALLEY RESOURCES. THE WELLNESS COORDINATOR BEGAN TEACHING A HEART HEALTH CLASS TWICE EACH MONTH TO LOCAL FEMALE OFFENDERS IN THE IDOC PRISON SYSTEM. PRIORITY AREA 7 CANCER 2021, YEAR 2 UPDATESTRATEGY: OFFER A MINIMUM OF ONE CANCER-SPECIFIC SCREENING EVENT.OUTCOME: TAKE-HOME COLO-RECTAL SCREENING KITS WERE DISTRIBUTED IN THE MONTH OF MARCH THROUGH PROVIDER OFFICES. A TOTAL OF 36 KITS WERE SUCCESSFULLY RETURNED TO THE LAB FOR PROCESSING. PATIENT FOLLOW-UP WAS PROVIDED FOR ALL POSITIVE TESTS.STRATEGY: OFFER A SUPPORT GROUP FOR CANCER SURVIVORS.OUTCOME: ONE WOMEN & CANCER SUPPORT GROUP WAS HELD AT KDH IN 2021. ADDITIONAL INFORMATION: ATTENDANCE WAS IMPACTED FOR SUPPORT GROUP MEETINGS DUE TO COVID CONCERNS.IN ADDITION, LOW LEVEL EXERCISE CLASSES WERE OFFERED AT NO COST FOR CANCER PATIENTS WITH FUNDING PROVIDED BY THE KDH FOUNDATION. THESE CLASSES PROVIDE EMOTIONAL AND SOCIAL SUPPORT FOR CANCER PATIENTS AND SURVIVORS. STRATEGY: PROVIDE COMMUNITY EDUCATION AND OUTREACH FOCUSING ON THE PREVENTION OF VARIOUS FORMS OF CANCER. OUTCOME: CANCER PREVENTION EDUCATION WAS PROVIDED TO THE COMMUNITY AT TWO COUNTY 4H FAIRS, THE JEFFERSON COUNTY RELAY FOR LIFE EVENT, THE KDH TO YOUR HEALTH PODCAST, AND PRESENTATIONS OFFERED BY THE WELLNESS COORDINATOR.ADDITIONAL INFORMATION: KDH STAFF ALSO RECEIVED SKIN CANCER PREVENTION INFORMATION AND FREE SUNSCREEN IN 2021. 8 1 - REHABILITATION CENTER AND HOME CARE 2670 N MICHIGAN ROAD MADISON IN 47250 OUTPATIENT REHABILITATION CENTER AND HOME CARE SERVICES 2 - CONVENIENT CARE CENTER 445 CLIFTY DRIVE MADISON IN 47250 CONVENIENT CARE CENTER 3 - VERSAILLES MEDICAL OFFICE BLDG-TYSON ST 206 W TYSON STREET VERSAILLES IN 47042 PHYSICIAN MEDICAL OFFICE 4 - TRIMBLE COUNTY MEDICAL OFFICE BLDG 10235 US HIGHWAY 421 MILTON KY 40045 PHYSICIAN MEDICAL OFFICE 5 - CARROLLTON MEDICAL OFFICE BLDG 205 MARWILL DRIVE CARROLLTON KY 41008 PHYSICIAN MEDICAL OFFICE 6 - SWITZERLAND CNTY MEDICAL OFFICE BLDG 1190 WEST MAIN STREET VEVAY IN 47043 PHYSICIAN MEDICAL OFFICE 7 - HANOVER MEDICAL OFFICE BLDG 36 MEDICAL PLAZA HANOVER IN 47243 PHYSICIAN MEDICAL OFFICE 8 - DOWNTOWN MEDICAL OFFICE BLDG 630 NORTH BROADWAY MADISON IN 47250 PHYSICIAN MEDICAL OFFICE AND HOSPITAL STAFF PART I, LINE 7 CONTINUED 5. HEALTHY COMMUNITIES INITIATIVE (HCI): EFFORTS ARE LED BY KING'S DAUGHTERS' HEALTH WHICH INCLUDE A PAID COORDINATOR FUNDED BY THE KDH FOUNDATION. HCI IS COMPRISED OF THREE TEAMS WHICH INCLUDE KDH STAFF AND COMMUNITY MEMBERS. 2021 HCI TEAM ACCOMPLISHMENTS:SUBSTANCE ABUSE TEAM:- A KDH PHYSICIAN AND PEDIATRIC SOCIAL WORKER SPOKE AT A TEAM MEETING.- RECEIVED A GRANT FOR INCENTIVE ITEMS TO ENCOURAGE YOUTH TO REMAIN DRUG FREE.- HCI COORDINATOR SERVES ON THE JEFFERSON COUNTY RESIDENTIAL TREATMENT FACILITY SUBCOMMITTEE. THIS GROUP IS INVESTIGATING THE FEASIBILITY OF AN IN-PATIENT FACILITY TO OFFER SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES.MENTAL HEALTH/ZERO SUICIDE TEAM:- RECOGNIZED MENTAL HEALTH AWARENESS MONTH AND SUICIDE AWARENESS MONTH.- WORK CONTINUED IN 2021 ON THE ACES INITIATIVE. TO SUPPORT THIS INITIATIVE, 40 DIRECTORS AND LEADERSHIP STAFF AT KDH VIEWED AN ACES RESILIENCE DOCUMENTARY. - A GRANT WAS SECURED FROM THE LOCAL COMMUNITY FOUNDATION TO CONDUCT AN ACES SURVEY IN JEFFERSON COUNTY. KDH ASSISTED WITH PROMOTION OF THIS SURVEY.HEALTHY LIFESTYLES TEAM: (OVERWEIGHT/OBESITY, TOBACCO, CHRONIC DISEASE)TEAM CHAIRED BY THE KDH WELLNESS COORDINATOR WITH ASSISTANCE FROM THE KDH TOBACCO COORDINATOR.- PARTNERED WITH A LOCAL AGENCY TO OFFER ANOTHER SPRING PARK HOP EVENT WHICH ENCOURAGED YOUTH AND THEIR FAMILIES TO EXPLORE AND USE PARKS IN JEFFERSON COUNTY. - ASSISTED THE LOCAL FARMER'S MARKET WITH HEALTHY RECIPE CARDS WHICH WERE DISTRIBUTED AT THE WEEKLY MARKET.- HELD FIVE LITTER AND CIGARETTE CLEAN-UP SITES ON EARTH DAY.- HOSTED A COMMUNITY WALKING HEALTHY SCAVENGER HUNT.- HOSTED A HEALTHY YOUTH TAILGATE PARTY. THIS EVENT SERVED OVER 300 YOUTH AND GUARDIANS. A TOTAL OF 22 AGENCIES AND 50 VOLUNTEERS OFFERED GAMES AND ACTIVITIES THAT OFFERED HEALTH RESOURCES AND HEALTH EDUCATION. PART II, COMMUNITY BUILDING ACTIVITIES: COMMUNITY BUILDING ACTIVITIES PROMOTED THE HEALTH OF THE COMMUNITY IN THE FOLLOWING WAYS:- ASSISTING COMMUNITY MEMBERS WITH MEDICAID PROGRAM ENROLLMENT VIA A FORMAL MEDICAID ENROLLMENT ASSISTANCE PROGRAM OFFERED BY THE HOSPITAL. THIS PROGRAM HELPS COMMUNITY MEMBERS ENROLL TO RECEIVE ALL TYPES OF MEDICAID ASSISTANCE (FOOD, HEALTHCARE, ETC.). PART III, LINE 2: IN 2018, THE HOSPITAL ADOPTED THE NEW REVENUE RECOGNITION ACCOUNTING STANDARD ISSUED BY FASB AND CODIFIED IN THE FASB ASC AS TOPIC 606 ("ASC 606"). AS A RESULT OF ADOPTING ASC 606, THE MAJORITY OF WHAT WAS PREVIOUSLY CLASSIFIED AS PROVISION FOR BAD DEBTS IN THE AUDITED FINANCIAL STATEMENTS (STATEMENT OF OPERATIONS AND CHANGES IN NET ASSETS) IS NOW REFLECTED AS IMPLICIT PRICE CONCESSIONS (AS DEFINED BY ASC 606) AND THEREFORE INCLUDED AS A REDUCTION TO NET PATIENT SERVICE REVENUE.UPON ADOPTION OF ASC 606, NET PATIENT SERVICE REVENUES ARE RECORDED AT THE TRANSACTION PRICE ESTIMATED BY THE HOSPITAL TO REFLECT THE TOTAL CONSIDERATION DUE FROM PATIENTS AND THIRD-PARTY PAYORS IN EXCHANGE FOR PROVIDING GOODS AND SERVICES IN PATIENT CARE. THE TRANSACTION PRICE, WHICH INVOLVES SIGNIFICANT ESTIMATES, IS DETERMINED BASED ON THE HOSPITAL'S STANDARD CHARGES FOR THE GOODS AND SERVICES PROVIDED, WITH A REDUCTION RECORDED FOR PRICE CONCESSIONS RELATED TO THIRD-PARTY CONTRACTUAL ARRANGEMENTS AS WELL AS PATIENT DISCOUNTS AND OTHER PATIENT PRICE CONCESSIONS. THE HOSPITAL DETERMINES ITS ESTIMATES OF CONTRACTUAL ADJUSTMENTS AND DISCOUNTS BASED ON CONTRACTUAL AGREEMENTS, ITS DISCOUNT POLICIES, AND HISTORICAL EXPERIENCE. THE HOSPITAL DETERMINES ITS ESTIMATE OF IMPLICIT PRICE CONCESSIONS BASED ON ITS HISTORICAL COLLECTION EXPERIENCE WITH THIS CLASS OF PATIENTS.THE AMOUNT REPORTED ON LINE 2 IS "IMPLICIT PRICE CONCESSIONS" AS REFLECTED ON THE AUDITED, CONSOLIDATED TRIAL BALANCE FOR THE HOSPITAL. THE SPECIFIC AMOUNT OF IMPLICIT PRICE CONCESSIONS IS NOT REQUIRED TO BE DISCLOSED IN THE AUDITED FINANCIAL STATEMENTS. PART III, LINE 3: THE HOSPITAL HAS A DETAILED FINANCIAL ASSISTANCE POLICY WHICH STATES THAT TO PARTICIPATE IN CHARITY CARE CANDIDATES MUST COOPERATE FULLY. IN ADDITION THE HOSPITAL EDUCATES PATIENTS WITH LIMITED ABILITY TO PAY REGARDING FINANCIAL ASSISTANCE. FOR THIS REASON THE ORGANIZATION BELIEVES THAT IT ACCURATELY CAPTURES ALL CHARITY CARE DEDUCTIONS PROVIDED ACCORDING TO THE FINANCIAL ASSISTANCE POLICY AND THE AMOUNT OF BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S CHARITY CARE POLICY IS NEGLIGIBLE. PART III, LINE 4: IN 2018, THE HOSPITAL ADOPTED THE NEW REVENUE RECOGNITION ACCOUNTING STANDARD ISSUED BY FASB AND CODIFIED IN THE FASB ASC AS TOPIC 606 ("ASC 606"). AS A RESULT OF ADOPTING ASC 606, THE MAJORITY OF WHAT WAS PREVIOUSLY CLASSIFIED AS PROVISION FOR BAD DEBTS IN THE AUDITED FINANCIAL STATEMENTS (STATEMENT OF OPERATIONS AND CHANGES IN NET ASSETS) IS NOW REFLECTED AS IMPLICIT PRICE CONCESSIONS (AS DEFINED BY ASC 606) AND THEREFORE INCLUDED AS A REDUCTION TO NET PATIENT SERVICE REVENUE. THE SPECIFIC AMOUNT OF IMPLICIT PRICE CONCESSIONS IS NOT REQUIRED TO BE DISCLOSED IN THE AUDITED FINANCIAL STATEMENTS. PLEASE REFER TO THE ATTACHED AUDITED FINANCIAL STATEMENTS - PAGES 9-10 "PATIENT ACCOUNTS RECEIVABLE AND NET PATIENT SERVICE REVENUE" PAGES 29-32 "NET PATIENT SERVICE REVENUE" PART III, LINE 8: THE MEDICARE COST REPORT WAS THE SOURCE OF INFORMATION REPORTED ON PART III LINE 6. PART III, LINE 9B: ALL UNINSURED PATIENTS RECEIVED AN AUTOMATIC 30% DISCOUNT FROM GROSS CHARGES. AT REGISTRATION, PATIENTS ARE NOTIFIED OF THE HOSPITAL'S FINANCIAL ASSISTANCE PROGRAM. THEY ARE OFFERED PAMPHLETS DETAILING THE PROGRAM. IF THE PATIENT IS KNOWN TO QUALIFY FOR FINANCIAL ASSISTANCE AND IS APPROVED FOR FINANCIAL ASSISTANCE, THE PATIENT WILL RECEIVE A DISCOUNT OF UP TO 100% ON THE OUTSTANDING ACCOUNT BALANCE. THE HOSPITAL WILL ATTEMPT TO COLLECT ANY BALANCE REMAINING ON THE UNINSURED ACCOUNT AFTER ALL FINANCIAL ASSISTANCE DISCOUNTS HAVE BEEN APPLIED USING A SERIES OF STATEMENTS, LETTERS, AND TELEPHONE CALLS. THE HOSPITAL WILL ALSO OFFER PATIENTS INTEREST-FREE EXTENDED PAYMENT PLANS. IF THE ACCOUNT REMAINS UNPAID, THE ACCOUNT MAY BE TURNED OVER TO A COLLECTION AGENCY. PART VI, LINE 2: THE HOSPITAL CONDUCTED ITS LATEST COMMUNITY HEALTH NEEDS ASSESSMENT IN 2019. THE COMMUNITY HEALTH NEEDS ASSESSMENT PROVIDES INFORMATION SO THAT THE COMMUNITY MAY IDENTIFY ISSUES OF GREATEST CONCERN AND DECIDE TO COMMIT RESOURCES TO THOSE AREAS, THEREBY MAKING THE GREATEST POSSIBLE IMPACT ON COMMUNITY HEALTH STATUS. THE 2019 COMMUNITY HEALTH NEEDS ASSESSMENT PROCESS TOOK INTO .ACCOUNT INPUT FROM PERSONS IN THE COMMUNITY BY UTILIZING THE FOLLOWING COMPONENTS: TELEPHONE INTERVIEWS OF A RANDOM SAMPLE OF 200 INDIVIDUALS AGE 18 AND OLDER IN THE PRIMARY SERVICE AREA. NOTE THAT THE SAMPLE CONSISTED SOLELY OF AREA RESIDENTS AGE 18 AND OLDER. DATA ON CHILDREN WERE GIVEN BY PROXY BY THE PERSON MOST RESPONSIBLE FOR THAT CHILD'S HEALTHCARE NEEDS. ON-LINE KEY INFORMANT SURVEY DIRECTED AT PHYSICIANS, PUBLIC HEALTH REPRESENTATIVES, OTHER HEALTH PROFESSIONALS, SOCIAL SERVICE PROVIDERS, AND A VARIETY OF OTHER COMMUNITY LEADERS. POTENTIAL PARTICIPANTS WERE CHOSEN BY KING'S DAUGHTERS' BECAUSE OF THEIR ABILITY TO IDENTIFY PRIMARY CONCERNS OF THE POPULATIONS WITH WHOM THEY WORK, AS WELL AS THE COMMUNITY OVERALL. THROUGH THIS PROCESS, INPUT WAS GATHERED FROM SEVERAL INDIVIDUALS WHOSE ORGANIZATIONS WORK WITH LOW-INCOME, MINORITY, OR OTHER MEDICAL UNDERSERVED POPULATIONS.BASED ON THE INFORMATION GATHERED THROUGH THIS COMMUNITY HEALTH NEEDS ASSESSMENT, THE HOSPITAL WAS ABLE TO PUT TOGETHER A LIST OF "AREAS OF OPPORTUNITY" REPRESENTING SIGNIFICANT HEALTH NEEDS OF THE COMMUNITY. THE AREAS OF OPPORTUNITY WERE DETERMINED AFTER CONSIDERATION OF VARIOUS CRITERIA, INCLUDING: STANDING IN COMPARISON WITH BENCHMARK DATA (PARTICULARLY NATIONAL DATA); THE PREPONDERANCE OF SIGNIFICANT FINDINGS WITHIN TOPIC AREAS; THE MAGNITUDE OF THE ISSUE IN TERMS OF THE NUMBER OF PERSONS AFFECTED; THE POTENTIAL HEALTH IMPACT OF A GIVEN ISSUE. THESE ALSO TAKE INTO ACCOUNT THOSE ISSUES OF GREATEST CONCERN TO THE COMMUNITY STAKEHOLDERS (KEY INFORMANTS) GIVING INPUT TO THIS PROCESS.THE PRIORITIZATION OF THE HEALTH NEEDS IDENTIFIED IN THIS ASSESSMENT WAS DETERMINED BASED ON A PRIORITIZATION EXERCISE CONDUCTED AMONG COMMUNITY STAKEHOLDERS (REPRESENTING A CROSS-SECTION OF COMMUNITY-BASED AGENCIES AND ORGANIZATIONS) IN CONJUNCTION WITH THE ADMINISTRATION OF THE ONLINE KEY INFORMANT SURVEY. IN THIS PROCESS, THESE KEY INFORMANTS WERE ASKED TO RATE THE SEVERITY OF A VARIETY OF HEALTH ISSUES IN THE COMMUNITY. INSOFAR AS THESE HEALTH ISSUES WERE IDENTIFIED THROUGH THE DATA ABOVE AND/OR WERE IDENTIFIED AS TOP CONCERNS AMONG KEY INFORMANTS, THEIR RANKING OF THESE ISSUES INFORMED THE FOLLOWING PRIORITIES:1. SUBSTANCE ABUSE2. MENTAL HEALTH3. TOBACCO USE4. NUTRITION, PHYSICAL ACTIVITY & WEIGHT5. DIABETES6. HEART DISEASE & STROKE7. CANCER8. RESPIRATORY DISEASES9. INJURY & VIOLENCE10. ACCESS TO HEALTHCARE SERVICES PART VI, LINE 3: -AT THE TIME OF REGISTRATION, THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY IS DISCUSSED WITH EACH PATIENT. THE PATIENT IS OFFERED A PAMPHLET REGARDING THE POLICY, ELIGIBILITY REQUIREMENTS AND THE ASSOCIATED APPLICATION PROCESS. THE PATIENT MUST SIGN A FORM INDICATING THAT THEY RECEIVED THIS INFORMATION.-THE HOSPITAL HAS A REPRESENTATIVE ON SITE TO ASSIST PATIENTS WITH THE FINANCIAL AID APPLICATION PROCESS.-PATIENTS ARE REMINDED TO CONTACT CUSTOMER SERVICE REGARDING FINANCIAL AID AND FEDERAL/STATE ASSISTANCE DIRECTLY ON THE PATIENT BILL ITSELF.-THE HOSPITAL'S WEBSITE HAS A LINK TO THE FINANCIAL AID APPLICATION. PART VI, LINE 4: KDH PROVIDES HEALTH CARE SERVICES TO FIVE COUNTIES IN SOUTHERN INDIANA AND NORTHERN KENTUCKY. THE 2019 KDH COMMUNITY HEALTH NEEDS ASSESSMENT INCLUDED ITS PRIMARY SERVICE AREAS OF JEFFERSON AND SWITZERLAND COUNTIES IN INDIANA AND TRIMBLE COUNTY IN KENTUCKY. THE ADDITIONAL TWO COUNTIES (RIPLEY IN INDIANA AND CARROL IN KENTUCKY) HAVE MULTIPLE HEALTH CARE FACILITIES THAT CURRENTLY CONDUCT A CHNA. TO AVOID DUPLICATION, THE THREE PRIMARY COUNTIES DESCRIBED WERE INCLUDED IN THE 2019 KDH CHNA. A FEWDESCRIPTIVE DEMOGRAPHIC HIGHLIGHTS FOR THE THREE COUNTIES DEFINED AS THE "PRIMARY SERVICE AREA" INCLUDE:- POPULATION: 51,607 (JEFFERSON CO= 32,293, SWITZERLAND CO= 10,617, TRIMBLE CO= 8,697)- URBAN VS. RURAL CLASSIFICATION: 35.2% URBAN AND 64.8% RURAL- AGE GROUP PERCENT: AGE 0-17 WAS 22.0%, AGE 18-64 WAS 61.4%, AGE+65 WAS 16.6%- MEDIAN AGE: JEFFERSON CO= 40.6, SWITZERLAND CO= 40.0, TRIMBLE CO= 41.9- RACE: 95.9% WHITE, 1.5% BLACK, 1.2% OTHER RACE, 1.4% MULTIPLE RACES- PERCENT POVERTY: 15.2%- EDUCATION LEVEL: 13.4% OF POPULATION AGE 25+ WITHOUT A HIGH SCHOOL DIPLOMA OR EQUIVALENT UNEMPLOYMENT RATE: 4.0% PART VI, LINE 5: THE MAJORITY OF KING'S DAUGHTERS' HEALTH BOARD OF MANAGERS IS COMPRISED OF INDIVIDUALS WHO LIVE AND WORK IN THE HOSPITAL SERVICES AREA. THE MAJORITY OF THESE INDIVIDUALS ARE NEITHER EMPLOYEES, NOR CONTRACTORS OF THE ORGANIZATION, NOR FAMILY MEMBERS THEREOF. THE HOSPITAL EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN ITS COMMUNITY FOR SOME OR ALL OF ITS DEPARTMENTS. THE ORGANIZATION ALSO APPLIES A PORTION OF SURPLUS FUNDS TO IMPROVEMENTS IN PATIENT CARE. HISTORICALLY, KDH HAS EMPLOYED A FULL TIME COMMUNITY WELLNESS COORDINATOR. THIS POSITION PROVIDES OUTREACH SERVICES IN AREAS OF NEED TO THE COMMUNITIES WE SERVE. IN ADDITION TO THESE SERVICES, KDH ALSO SERVES AS THE FISCAL AGENT FOR VARIOUS GRANTS. ALL OF THESE SERVICES HELP US MEET THE IDENTIFIED NEEDS OF THE COMMUNITIES WE SERVE.PARTICIPATION IN THE BELOW COMMUNITY ORGANIZATIONS IS PART OF THE HOSPITAL'S INDIANA STATE DEPARTMENT OF HEALTH COMMUNITY BENEFIT PLAN AND GOALS.2021 KING'S DAUGHTERS' HEALTH OVERVIEW OF COMMUNITY BENEFIT ACTIVITIES1. SCREENINGS/HEALTH FAIRS/FLU SHOTSHEALTH SCREENS / FAIRS:- HOSTED A CORPORATE HEALTH SCREEN FOR EMPLOYEES OF JEFFERSON COUNTY WITH 65 PARTICIPANTS.- PARTICIPATED IN THE JEFFERSON AND RIPLEY COUNTY 4-H FAIRS. HEALTH EDUCATION INFORMATION WAS PROVIDED FOR FIVE EVENINGS AT EACH FAIR.- HOSTED AN EDUCATION TABLE WITH BLOOD PRESSURE CHECKS FOR THE NEW REACHING RURAL VETERAN'S EVENT. THIS IS IN PARTNERSHIP WITH PURDUE UNIVERSITY AND WAS HELD IN NOVEMBER AND DECEMBER.- A TOTAL OF 36 FREE TAKE-HOME COLORECTAL TESTING KITS WERE DISTRIBUTED. PATIENT FOLLOW-UP WAS PROVIDED FOR ALL POSITIVE TEST RESULTS.CORPORATE FLU SHOTS: 1 CORPORATE FLU SHOT CLINIC HELD WITH 10 EMPLOYEES RECEIVING THEIR FLU VACCINE. 2. COVID TESTING/VACCINES:KDH SERVED AS THE STATE TESTING SITE FOR OUR COUNTY.IN 2021, KDH PROVIDED 8,871 PCR COVID TESTS AND 19,960 RAPID COVID TESTS.IN ADDITION, IT IS ESTIMATED THAT KDH ADMINISTERED 8,000 COVID VACCINATIONS IN 2021. THESE WERE GIVEN TO EMPLOYEES, COMMUNITY MEMBERS AT OUR ON-SITE VACCINE CLINICS, WALK-INS AT OUR PHARMACY, AND ADDITIONAL VACCINES WERE ADMINISTERED AT FIVE CORPORATE LOCATIONS.3. COMMUNITY HEALTH EDUCATION OPPORTUNITIES/CLASSES/SPECIAL EVENTS:HEALTH/WELLNESS SPEAKING ENGAGEMENTSTHE WELLNESS COORDINATOR COMPLETED 15 COMMUNITY SPEAKING ENGAGEMENTS IN 2021. THESE FOCUSED ON WELLNESS AND DISEASE PREVENTION TOPICS SUCH AS; NUTRITION, HEART DISEASE, STRESS MANAGEMENT, PHYSICAL ACTIVITY, SELF-DEFENSE, ETC. FIT KIDS PROGRAM FOUR LESSON PROGRAM FOR AREA 5TH GRADE CLASSROOMS TARGETING CHILDHOOD OBESITY. LESSONS AND TAKE HOME CHALLENGES AND GUARDIAN INFORMATION FOCUSED ON EXERCISE AND HEALTHY EATING.OFFERED THE PROGRAM TO 5 SCHOOL SYSTEMS AND REACHED;-14 5TH GRADE CLASSES (284 STUDENTS AND TEACHERS). - AN ADDITIONAL 5 CLASSES (86 STUDENTS) WERE UNABLE TO OFFER THE FULL PROGRAM, SO THESE STUDENTS RECEIVED TAKE HOME EDUCATION MATERIALS.STRIVE FOR 5FIVE WEEK WEIGHT LOSS EDUCATION CLASS HELPS PARTICIPANTS LOSE AT LEAST 5 POUNDS. LESSONS FOCUS ON HEALTHY NUTRITION AND PHYSICAL ACTIVITY. ONE CLASS SERIES HOSTED IN 2021 WITH 6 CLASS PARTICIPANTS.TOBACCO CESSATION & EDUCATION:KING'S DAUGHTERS' HEALTH EMPLOYS A FULL TIME STATE GRANT FUNDED TOBACCO COORDINATOR. 2021 ACCOMPLISHMENTS INCLUDE:- KDH DOCUMENTED 244 ELECTRONIC PATIENT REFERRALS TO THE IN QUITLINE.- CONTRIBUTED TO WRITING THE MOM AND ME TOBACCO-FREE PROGRAM GRANT FOR THE KDH MOTHER BABY UNIT.- PROVIDED PHYSICIAN OFFICES WITH FOLDERS FOR PATIENTS THAT INCLUDED CESSATION RESOURCES.- ASSISTED IN IMPLEMENTING AND MAINTAINING THE HEALTH SYSTEMS CHANGE PROJECT FOR THE KDH CANCER CENTER TOBACCO CESSATION PROGRAM.- COLLABORATED WITH THE JEFFERSON COUNTY SCHOOLS TO EDUCATE SCHOOL COUNSELORS ON TOBACCO CESSATION RESOURCES AVAILABLE TO YOUTH. - PARTICIPATED IN MULTI-UNIT HOUSING SURVEYS IN JEFFERSON COUNTY AND OFFERED CESSATION RESOURCES TO TENANTS. ALSO PROVIDED TOBACCO RESOURCES TO LOW INCOME MOTHERS. - MAILED PACKETS OFFERING TOBACCO CESSATION AND ASSISTANCE WITH SMOKE-FREE POLICY IMPLEMENTATION TO NEARLY 100 JEFFERSON COUNTY EMPLOYERS. - PARTNERED WITH PURDUE EXTENSION TO HOLD AN E-CIGARETTE EDUCATION EVENT FOR ADULTS TO LEARN MORE ABOUT DANGERS OF VAPING, TRENDS IN SCHOOLS, WHAT PARENTS SHOULD LOOK FOR, AND HOW TO TALK TO TEENS ABOUT VAPING.CPR AND FIRST AID CLASSES: KDH SERVES AS AN AHA PROVIDER SITE HOSTING CPR/AED/FIRST AID COMMUNITY CLASSES AND BLS, PALS, AND ACLS TRAININGS FOR KDH EMPLOYEES AND AREA HEALTH CARE PROFESSIONALS AND COMMUNITY MEMBERS.IN 2021, A TOTAL OF 1,051 PEOPLE RECEIVED TRAINING AND AN E-COMPLETION CARD.FORMAL COMMUNITY CLASSES WERE NOT HELD ON-SITE DUE TO COVID.PRENATAL EDUCATION:OB PREP PROGRAM 385 EXPECTING MOTHERS PARTICIPATED IN AN EDUCATIONAL PREP VISIT PRIOR TO DELIVERY. IN ADDITION, 14 MOTHERS AND 14 SUPPORT PEOPLE ATTENDED THE CHILDBIRTH CLASS SERIES OFFERED BY KDH. MONTHLY "TO YOUR HEALTH" PODCAST: 30-MINUTE HEALTH EDUCATION PODCAST WITH VARIOUS TOPICS IS OFFERED EVERY MONTH ON A LOCAL RADIO STATION AND AVAILABLE TO LISTEN ON THE HOSPITALS' WEBSITE.KDH RUN THE FALLS 5K WALK/RUN:137 PEOPLE PARTICIPATED IN THIS COMMUNITY FITNESS EVENT HOSTED BY KDH. CANCER SUPPORT ACTIVITES:WOMEN AND CANCER SUPPORT GROUP, MET ONLY 1 TIME IN 2021 DUE TO COVID.NO ADDITIONAL CANCER-RELATED ACTIVITIES WERE DOCUMENTED IN 2021 DUE TO COVID.COMMUNITY COOKING CLASS:SUPPORTED A LOCAL HEALTHY COOKING DEMONSTRATION CLASS WITH PROMOTIONAL SUPPORT AND NUTRITION AND HEALTH EDUCATION WRITTEN MATERIALS AND HEALTHY RECIPE CARDS.EMPLOYEE HEALTH OPPORTUNITIES FOR KDH STAFF:WELLNESS NEWSLETTERS AND CALENDARS PROVIDED TO STAFF.WELLNESS COLUMN IN THE MONTHLY MONITOR NEWSLETTER.MONTHLY PADLET WELLNESS NEWSLETTER CREATED AND SENT TO ALL STAFF.FREE LIPID BLOOD TEST OFFERED FOR ALL STAFF WITH INSURANCE PREMIUM REDUCTION OPPORTUNITY.MONTH LONG STRESS LESS CAMPAIGN.WELLNESS GOAL SETTING OPPORTUNITY WITH INCENTIVE.FREE SUNSCREEN DISTRIBUTION FOR STAFF WITH SKIN CANCER PREVENTION EDUCATION.WALKING INCENTIVE CAMPAIGN HELD IN JUNE.FREE NICOTINE REPLACEMENT THERAPY PRODUCTS FOR STAFF WHEN REQUESTED.4. COMMUNITY SERVICE ACTIVITIES:ACTIVE ATTENDANCE AND PARTICIPATION IN THE FOLLOWING COMMUNITY COALITIONS/GROUPS:JCJTAP JEFFERSON COUNTY JUSTICE TREATMENT AND PREVENTION COALITIONMADISON CONSOLIDATED SCHOOLS WELLNESS COMMITTEEPURDUE EXTENSION HEALTH AND HUMAN SERVICES BOARDPARTNER AND HOST SITE FOR THE LEADERSHIP JEFFERSON COUNTY PROGRAMEMS STAND-BY AT ALL COMMUNITY ACTIVITIES:EMS PROVIDES STAND-BY COVERAGE AT ALL JEFFERSON COUNTY ACTIVITIES.ATHLETIC TRAINING/REHAB SERVICES SPORTS MEDICINE SERVICES WERE PROVIDED TO THREE JEFFERSON COUNTY SCHOOLS. IN ADDITION, SPEECH THERAPY SERVICES WERE PROVIDED TO RIPLEY CO. SCHOOL.SUPPORT TO VARIOUS AREA SCHOOLS WITH INTERNSHIPS:A TOTAL OF 179 COLLEGE STUDENTS WERE HOSTED FOR JOB SHADOW OPPORTUNITIES OR STRUCTURED INTERNSHIPS IN 2021. NO HIGH SCHOOL STUDENTS WERE PERMITTED FOR JOB SHADOW IN 2021 DUE TO COVID RESTRICTIONS. ART OF HEALING EXHIBITHOST A QUARTERLY ART SHOW FOR THE MADISON ART CLUB. VARIOUS PAINTINGS ARE ON DISPLAY IN THE HOSPITAL CAF AS PART OF THE ON-GOING ART OF HEALING EXHIBIT. PART VI, LINE 6: NA PART VI, LINE 7, REPORTS FILED WITH STATES IN 1 IHA HOSPITAL ASSISTANCE FOUNDATION 500 NORTH MERIDIAN STREET SUITE 250 INDIANAPOLIS IN 46204 455573749 501(C)(3) 14172 0 DONATION 1 0 PART I, LINE 2: FUNDS ARE NOT GRANTED BUT ARE DONATED. DONATIONS ARE DETERMINED ON A DISCRETIONARY BASIS. X X X X 0 0 0 0 0 0 0 1 0 JONATHAN HANSON MD BOARD MEMBER/PHYSICIAN 241417 0 214129 0 552 0 14250 0 23524 0 493872 0 0 0 TINA HENDRICK MD BOARD MEMBER/PHYSICIAN 248101 0 59170 0 240 0 14250 0 1328 0 323089 0 0 0 CAROL DOZIER PRESIDENT/CEO 410997 0 0 0 10795 0 14250 0 605 0 436647 0 0 0 JOHN PRICE VP FINANCE 254351 0 300 0 20532 0 12932 0 7136 0 295251 0 0 0 LISA MORGAN VP OUTPATIENT SERVICES 193608 0 16872 0 20274 0 9780 0 8068 0 248602 0 0 0 DENINE FALLIS-HALLGARTH VP PHYSICIAN PRACTICES 157570 0 300 0 20532 0 8123 0 8683 0 195208 0 0 0 JENNIFER LITER VP INPATIENT SERVICES 160314 0 300 0 19860 0 8377 0 25250 0 214101 0 0 0 NATHAN POLLEY MD EMPLOYED PHYSICIAN 614237 0 535104 0 2383 0 14250 0 22408 0 1188382 0 0 0 THOMAS ECKERT MD EMPLOYED PHYSICIAN 427236 0 266814 0 1715 0 14250 0 9637 0 719652 0 0 0 KENNETH MACKINLAY MD EMPLOYED PHYSICIAN 639340 0 543 0 34633 0 14250 0 22408 0 711174 0 0 0 RAYMONDA STEVENS MD EMPLOYED PHYSICIAN 493269 0 472699 0 552 0 14250 0 0 0 980770 0 0 0 WILLIAM SKILES MD EMPLOYED PHYSICIAN 446959 0 300 0 1584 0 14250 0 14938 0 478031 0 0 0 PART I, LINE 7 PHYSICIANS ARE ELIGIBLE FOR INCENTIVE COMPENSATION. THE PHYSICIAN IS COMPENSATED FOR EACH WORK RVU PERFORMED BY A PHYSICIAN IN A CALENDAR YEAR IN EXCESS OF THE PHYSICIAN'S WORK RVU INCENTIVE THRESHOLD FOR THE CALENDAR YEAR MULTIPLIED BY THE INCENTIVE RVU PAYMENT. NON-PHYSICIAN BONUS COMPENSATION IS DISCRETIONARY, SOLELY UP TO THE BOARD OF MANAGERS, AND THE CALCULATION FOR SAID BONUS COMPENSATION VARIES FROM YEAR TO YEAR. ADDITIONAL SCHEDULE J DISCLOSURES BOARD MEMBERS TINA HENDRICK, MD AND JONATHAN HANSON, MD LISTED ABOVE ARE EMPLOYED PHYSICIANS OF THE HOSPITAL. DR. HENDRICK AND DR. HANSON DO NOT RECEIVE COMPENSATION FOR SERVICES PROVIDED AS BOARD MEMBERS. THE COMPENSATION LISTED ABOVE FOR DR. HENDRICK AND DR. HANSON IS COMPENSATION RECEIVED FOR SERVICES PROVIDED AS EMPLOYED PHYSICIANS. A INDIANA FINANCE AUTHORITY 351602316 45471ACW0 2010-11-03 97847058 SEE PART VI 0 0 0 A 97847058 6756861 1749243 88974097 266857 2013 0 0 1 1 A 0 1 1 1 0 0.00560 0.00560 0 1 0.01350 0 0 A 0 0 0 0 0 0 0 0 1 A 1 SCH K PART I LINE A - PURPOSE THE PURPOSE OF THE BOND ISSUANCE IS TO FINANCE, REFINANCE, OR REIMBURSE A PORTION OF THE COSTS OF ACQUIRING, CONSTRUCTING, RENOVATING AND EQUIPPING VARIOUS HEALTH CARE FACILITIES OF THE HOSPITAL, INCLUDING A REPLACEMENT ACUTE CARE HOSPITAL FACILITY AND A MEDICAL OFFICE BUILDING. NATHAN POLLEY MD EMPLOYED PHYSICIAN - TOP 5 HIGHEST COMPENSATED EMPLOYEE MEDICAL EDUCATION LOAN REPAYMENT ASSISTANCE X 10000 4062 0 1 1 KENNETH MACKINLAY MD EMPLOYED PHYSICIAN - TOP 5 HIGHEST COMPENSATED EMPLOYEE CONTRACT EXECUTION LOAN X 100000 53846 0 1 1 57908 A DATTILO FRUIT COMPANY VP OF OUTPATIENT SERVICES OF KDH HAS A PERCENTAGE OWNERSHIP INTEREST 13925 LISA MORGAN WAS THE VICE PRESIDENT OF OUTPATIENT SERVICES WITH NORTON - KING'S DAUGHTERS' HEALTH, INC. LISA RETIRED FROM NORTON - KING'S DAUGHTERS' HEALTH, INC. IN OCTOBER 2021. LISA OWNS A PERCENTAGE INTEREST IN A. DATTIOL FRUIT COMPANY. NORTON - KING'S DAUGTHER'S HEALTH, INC. PURCHASED PRODUCE FROM A. DATTILO FRUIT COMPANY. NORTON - KING'S DAUGHTERS' HEALTH, INC. MADE PURCHASES TOTALING $13,925 IN 2021. 0 MCCUBBIN MOTORS BOARD MEMBER IS THE SPOUSE OF THE PRESIDENT OF MCCUBBIN MOTORS, INC. 16599 MARY KAY MCCUBBIN IS A NORTON - KING'S DAUGHTERS' HEALTH, INC. BOARD MEMBER. MARY KAY MCCUBBIN IS MARRIED TO THE FORMER PRESIDENT OF MCCUBBIN MOTORS, INC. MARY KAY AND HER HUBAND SOLD MCCUBBIN MOTORS IN MARCH OF 2021. HOWERVER, NORTON - KING'S DAUGHTERS' HEALTH, INC. UTILIZED MCCUBBIN MOTORS FOR SERVICING AND/OR REPAIR OF EMERGENCY VEHICLES AND VEHCILE LEASING SERVICES IN 2021. NORTON - KING'S DAUGHTERS' HEALTH, INC. PAID $16,599 TO MCCUBBIN MOTORS IN 2021 FOR THESE SERVICES. 0 FORM 990, PART VI, SECTION A, LINE 4 THE ORGANIZATION HAS UPDATED THE BYLAWS. FORM 990, PART VI, SECTION A, LINE 6 BETHANY HOLDING, LLC, AN INDIANA LIMITED LIABILITY COMPANY, IS THE SOLE MEMBER OF THE CORPORATION (THE "CORPORATE MEMBER"). NOTWITHSTANDING THE FOREGOING, ALL RIGHTS, POWER AND AUTHORITY OF BETHANY HOLDING LLC IN ITS CAPACITY AS THE MEMBER OF THE CORPORATION, WHETHER SET FORTH IN THE ARTICLES OF INCORPORATION, THESE BYLAWS, OR UNDER LAW, SHALL BE VESTED IN, AND EXCLUSIVELY EXERCISED BY, NORTON HEALTHCARE - INDIANA, INC., AN INDIANA NONPROFIT CORPORATION WHICH IS THE SOLE MEMBER OF BETHANY HOLDING, LLC. NORTON HEALTHCARE, INC., A KENTUCKY NONPROFIT CORPORATION IS THE SOLE CORPORATE MEMBER OF NORTON HEALTHCARE - INDIANA, INC. FORM 990, PART VI, SECTION A, LINE 7A SUBJECT TO POWERS RESERVED TO NORTON HEALTHCARE - INDIANA, INC., THE BUSINESS AND AFFAIRS OF THE CORPORATION SHALL BE MANAGED AND CONTROLLED BY THE BOARD OF TRUSTEES. THE BOARD SHALL HAVE ALL OF THE DECISION-MAKING AUTHORITY, INCLUDING AUTHORITY TO DELEGATE, AND ALL OF THE POWER TO OPERATE THE CORPORATION WHICH A BOARD MAY LAWFULLY HAVE. FORM 990, PART VI, SECTION A, LINE 7B THE BOARD OF TRUSTEES OF NORTON HEALTHCARE - INDIANA, INC. SHALL APPOINT ALL TRUSTEES. IN ADDITION, THE PRESIDENT AND CHIEF EXECUTIVE OFFICER OF THE CORPORATION SHALL SERVE AS AN EX-OFFICIO MEMBER OF THE BOARD OF TRUSTEES. THE PRESIDENT AND CHIEF EXECUTIVE OFFICER SHALL HAVE VOTING RIGHTS IN THAT PERSON'S CAPACITY AS A MEMBER OF THE BOARD OF TRUSTEES AND ANY COMMITTEE ON WHICH THEY SERVE. FORM 990, PART VI, SECTION B, LINE 11B THE PROCESS OF REVIEWING THE FORM 990 ENTAILS A DETAILED REVIEW BY THE ORGANIZATION'S MANAGEMENT. THE BOARD OF TRUSTEES RECEIVES A DRAFT COPY OF THE FORM 990 INCLUDING REQUESTED SCHEDULES PRIOR TO FILING WITH THE IRS (UNLESS EXTENUATING CIRCUMSTANCES PREVENT THAT). CHANGES OR REVISIONS ARE SUGGESTED BY THE BOARD IF NECESSARY. THE 990 WILL BE REVIEWED AT THE NEXT BOARD MEETING. FORM 990, PART VI, SECTION B, LINE 12C KING'S DAUGHTERS' HEALTH HAS A FORMAL CONFLICT OF INTEREST POLICY. THE CONFLICT OF INTEREST POLICY COVERS BOARD OF MANAGER MEMBERS, OFFICERS AND DIRECTORS. THE POLICY REQUIRES THE BOARD OF MANAGERS, OFFICERS AND DIRECTORS TO DISCLOSE ANNUALLY INFORMATION REGARDING THEIR INTERESTS AND THOSE OF THEIR FAMILY MEMBERS THAT COULD GIVE RISE TO CONFLICT. THIS INFORMATION IS TO BE DISCLOSED TO THE APPROPRIATE VICE PRESIDENT, THE PRESIDENT/CEO AND COMPLIANCE DEPARTMENT. SHOULD SUCH INFORMATION BE DISCLOSED, THE INTERESTED PERSON WILL REFRAIN FROM ANY SUBSEQUENT DISCUSSION AND DECISIONS RELATED TO THE OUTSIDE FIRM. AT SUCH TIME AS ANY MATTER COMES BEFORE THE BOARD OF MANAGERS CONCERNING AN EXISTING OR CONTEMPLATED TRANSACTION OR RELATIONSHIP BETWEEN THE HOSPITAL AND ANY PARTY MAY GIVE RISE TO A CONFLICT OF INTEREST 1.) THE BOARD OF MANAGERS MEMBER SHALL LEAVE THE MEETING DURING THE DISCUSSION OF AND THE VOTE ON THE TRANSACTION OR ARRANGEMENT. 2.) THE CHAIRPERSON OF THE BOARD OF MANAGERS SHALL, IF APPROPRIATE, APPOINT A DISINTERESTED PERSON OR COMMITTEE TO INVESTIGATE ALTERNATIVES TO THE PROPOSED TRANSACTION OR ARRANGEMENT. 3.) AFTER EXERCISING DUE DILIGENCE, THE BOARD OF TRUSTEES OR COMMITTEE SHALL DETERMINE WHETHER THE CORPORATION CAN OBTAIN WITH REASONABLE EFFORTS A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT FROM A PERSON OR ENTITY THAT WOULD NOT GIVE RISE TO A CONFLICT OF INTEREST. 4.) IF A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT IS NOT REASONABLY POSSIBLE UNDER CIRCUMSTANCES NOT PRODUCING A CONFLICT OF INTEREST, THE BOARD OF MANAGERS SHALL DETERMINE BY A MAJORITY VOTE OF THE DISINTERESTED MEMBERS WHETHER THE TRANSACTION OR ARRANGEMENT IS IN THE HOSPITAL'S BEST INTEREST, FOR ITS OWN BENEFIT, AND WHETHER IT IS FAIR AND REASONABLE. IN CONFORMITY WITH THE ABOVE DETERMINATION, IT SHALL MAKE ITS DECISION AS TO WHETHER TO ENTER INTO THE TRANSACTION OR ARRANGEMENT. TO ENSURE THE HOSPITAL OPERATES IN A MANNER CONSISTENT WITH CHARITABLE PURPOSES AND DOES NOT ENGAGE IN ACTIVITIES THAT COULD JEOPARDIZE ITS TAX-EXEMPT STATUS, PERIODIC REVIEWS SHALL BE CONDUCTED. THE PERIODIC REVIEWS INCLUDE, AT A MINIMUM, - 1.) WHETHER COMPENSATION ARRANGEMENTS AND BENEFITS ARE REASONABLE, BASED ON COMPETENT SURVEY INFORMATION AND THE RESULT OF ARM'S LENGTH BARGAINING. 2.) WHETHER PARTNERSHIPS, JOINT VENTURES AND ARRANGEMENTS WITH MANAGEMENT ORGANIZATIONS CONFORM TO THE HOSPITAL'S WRITTEN POLICIES, ARE PROPERLY RECORDED, REFLECT REASONABLE INVESTMENT OR PAYMENTS FOR GOODS AND SERVICES, FURTHER CHARITABLE PURPOSES AND DO NOT RESULT IN INUREMENT, IMPERMISSIBLE PRIVATE BENEFIT, OR IN AN EXCESS BENEFIT TRANSACTION. DISCIPLINARY AND CORRECTION ACTION, UP TO AND INCLUDING TERMINATION OF EMPLOYMENT, CAN BE TAKEN FOR FAILURE TO DISCLOSE A CONFLICT OF INTEREST. FORM 990, PART VI, SECTION B, LINE 15A THE HOSPITAL'S BOARD OF MANAGERS REVIEWS ANNUAL CEO SURVEY INFORMATION FROM THE INDIANA HOSPITAL ASSOCIATION. THIS SURVEY COMPARES KDH'S CEO'S COMPENSATION WITH OTHER HOSPITAL CEO'S IN INDIANA. COMPARISONS ARE MADE WITH HOSPITALS THAT ARE IN KDH'S REGION IN INDIANA, HOSPITALS OF A SIMILAR SIZE, AND HOSPITALS THAT MIGHT REASONABLY BE EXPECTED TO COMPETE FOR SERVICES OF KDH'S CEO. THE BOARD OF MANAGERS, AFTER REVIEWING THE SURVEY AND A STATUS REPORT OF THE CEO'S ANNUAL GOALS, APPROVES THE CEO'S COMPENSATION. HOWEVER, PHYSICIAN BOARD MEMBERS WHO ARE ALSO HOSPITAL EMPLOYEES DO NOT PARTICIPATE IN VOTING FOR ANY CHANGES TO CEO COMPENSATION. MINUTES ARE TAKEN AT ALL OF THE BOARD OF MANAGERS MEETINGS AND EXECUTIVE SESSIONS. FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST, OR FINANCIAL STATEMENTS ARE NOT MADE AVAILABLE FOR PUBLIC INSPECTION. THE FORM 990 TAX RETURN IS AVAILABLE FOR PUBLIC INSPECTION UPON REQUEST. FORM 990, PART XI, LINE 9: CHANGE IN SUBSCRIBER SAVINGS CUMULATIVE ACCOUNT -61,242. FORM 990, PART XI, LINE 2C, AUDIT OVERSIGHT THE HOSPITAL'S FINANCE COMMITTEE ASSUMES RESPONSIBILITY FOR THE SELECTION OF AN INDEPENDENT CERTIFIED PUBLIC ACCOUNTING FIRM TO PERFORM THE ANNUAL AUDIT OF THE FINANCIAL STATEMENTS. THE FINANCE COMMITTEE ALSO IS RESPONSIBLE FOR OVERSIGHT OF THAT AUDIT PROCESS. THE TREASURER OF THE HOSPITAL'S BOARD OF MANAGERS SERVES AS THE CHAIR OF THE FINANCE COMMITTEE. THE FINANCE COMMITTEE REGULARLY MEETS EVERY OTHER MONTH, AND MEETS ONCE PER YEAR WITH THE INDEPENDENT AUDITORS. THE KING'S DAUGHTERS' HOSPITAL FOUNDATION INC PO BOX 447 MADISON IN 47250 202148950 FUNDRAISING TO SUPPORT THE PROVISION OF HEALTHCARE SERVICES IN 501(C)(3) LINE 7 N/A 0 0 0 1 0 0 0 0 0 0 0 0 0 0 1 1 0 1 0 0