2021-11-01T13:35:58-05:00 2020-12-31 351178661 BLUE & CO LLC 2650 EASTPOINT PKWY SUITE 300 LOUISVILLE KY 40223 990 2020-01-01 350895832 THE BETHANY CIRCLE OF KING'S DAUGHTERS' OF MADISON INDIANA INC BETH 8128010800 1373 EAST STATE ROAD 62 PO BOX 447 MADISON IN 47250 ANNIE SCHROEDER BOARD CHAIRWOMAN 8128010800 2021-11-01 1 ANNIE SCHROEDER 999009999 CARRIE A MERRILL CPA P00832283 5029923500 2021-11-01 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z KING'S DAUGHTERS' HEALTH JOHN PRICE 1373 EAST STATE ROAD 62 PO BOX 447 MADISON IN 47250 158972158 0 X WWW.KDHMADISON.ORG X 1899 IN TO IMPROVE THE HEALTH OF THE HOSPITAL'S PATIENTS THROUGH CARE, SERVICE, AND EDUCATION. 11 9 1080 74 39749 25409 330570 13788547 123174153 119279872 4942616 7749825 549491 439482 128996830 141257726 28860 11705 0 0 64060009 62868207 0 0 98016 60985056 60078380 125073925 122958292 3922905 18299434 300922993 327672291 106292529 101060585 194630464 226611706 THE MISSION OF THE HOSPITAL IS TO IMPROVE THE HEALTH OF THE HOSPITAL'S PATIENTS THROUGH CARE, SERVICE, AND EDUCATION. 0 0 92476742 11705 119362581 KING'S DAUGHTERS' HEALTH IS A NOT-FOR-PROFIT, ACUTE CARE HOSPITAL OWNED BY THE BETHANY CIRCLE OF KING'S DAUGHTERS' OF MADISON, INDIANA, INC., 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 2020, THE HOSPITAL PROVIDED HEALTHCARE TO PATIENTS AT THE FOLLOWING LEVELS:9,909 DAYS OF CARE TO ACUTE INPATIENTS990 DAYS OF CARE TO NEWBORN INFANTS184,105 VISITS ASSOCIATED WITH HOSPITAL OUTPATIENTS115,971 VISITS ASSOCIATED WITH PHYSICIAN CLINICS 1351928 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 2020, KING'S DAUGHTERS' HEALTH PROVIDED SERVICES TOTALING $1,351,928 IN GROSS CHARGES TO PATIENTS WHO MET THE HOSPITAL'S CHARITY CARE POLICY. 93828670 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 77 0 1 1080 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 0.00 X 250 0 0 DARLEEN CONNOLLY BOARD VICE-CHAIRWOMAN 1.00 0.00 X 500 0 0 SUSAN OHLENDORF BOARD SECRETARY 1.00 0.00 X 500 0 0 MARY BETTE VOYLES BOARD TREASURER 1.00 0.00 X 0 0 0 ANDREA FORRESTER BOARD ASSN'T TREASURER 1.00 0.00 X 0 0 0 BONNIE COLEN BOARD ASSN'T SECRETARY 1.00 0.00 X 0 0 0 JONATHAN HANSON MD BOARD MEMBER/PHYSICIAN 40.00 0.00 X 454702 0 34881 TINA HENDRICK MD BOARD MEMBER/PHYSICIAN 40.00 0.00 X 387494 0 14162 JOE CRAIG BOARD MEMBER 1.00 0.00 X 500 0 0 MARY KAY MCCUBBIN BOARD MEMBER 1.00 0.00 X 500 0 0 KEVIN TURNER BOARD MEMBER 1.00 0.00 X 500 0 0 CAROL DOZIER PRESIDENT/CEO 40.00 1.00 X 432203 0 14555 JOHN PRICE VP FINANCE 40.00 0.00 X 271809 0 19309 LISA MORGAN VP OUTPATIENT SERVICES 40.00 0.00 X 197177 0 17129 DENINE FALLIS-HALLGARTH VP PHYSICIAN PRACTICES 40.00 0.00 X 177362 0 16201 JENNIFER LITER VP INPATIENT SERVICES 40.00 0.00 X 174394 0 28442 NATHAN POLLEY MD EMPLOYED PHYSICIAN 40.00 0.00 X 1036680 0 37637 THOMAS ECKERT MD EMPLOYED PHYSICIAN 40.00 0.00 X 560735 0 21926 MICHAEL SCHMIDT MD EMPLOYED PHYSICIAN 40.00 0.00 X 553643 0 30035 RAYMONDA STEVENS MD EMPLOYED PHYSICIAN 40.00 0.00 X 548531 0 13950 BRENT SINICROPE MD EMPLOYED PHYSICIAN 40.00 0.00 X 682761 0 28379 5480241 0 276606 67 0 1 0 EMCARE INC 7032 COLLECTION CENTER DRIVE CHICAGO IL 60693 CONTRACTED PHYSICIAN & MID LEVEL PROVIDE 1510548 KAUFMAN HALL & ASSOCIATES 5202 OLD ORCHARD ROAD STE N700 SKOKIE IL 60077 FINANCIAL CONSULTING SERVICES 1216907 ARUP LABORATORIES PO BOX 27964 SALT LAKE CITY UT 84127 LABORATORY SERVICES 917169 COMPREHENSIVE MEDICAL MANAGEMENT 300 DAVE COWENS DRIVE STE 600 NEWPORT KY 41071 CONTRACTED PHYSICIAN BILLING SERVICES 639019 WEATHERBY LOCUMS INC PO BOX 972633 DALLAS TX 75397 CONTRACTED PHYSICIAN & MID LEVEL PROVIDE 562685 30 359768 13373815 54964 15130 13788547 NET PATIENT SERVICE REVENUE 621110 119279872 119279872 119279872 3419259 3419259 54310 23286 31024 31024 31024 21988481 33231 17690956 190 4297525 33041 4330566 4330566 CAFETERIA REVENUE 722210 315240 315240 LAB 621500 34415 34415 GIFT SHOP 453220 1784 1784 57019 51685 5334 408458 141257726 119362581 39749 8066849 11705 11705 2242567 1711288 531279 48742421 37120228 11524177 98016 1955716 1492394 463322 6501624 4961347 1540277 3425879 2614266 811613 345836 345836 289679 289679 660587 660587 171999 131251 40748 440148 335874 104274 59692 45551 14141 1836531 1401445 435086 93277 71179 22098 5163667 3940361 1223306 8436098 6437531 1998567 1519079 1159199 359880 PURCHASED SERVICES 14667005 11192296 3474709 DRUGS 10869022 10869022 SUPPLIES 7112538 5427531 1685007 HOSPITAL ASSESSMENT FEE 3665202 3665202 4748020 1241000 3507020 122958292 93828670 29031606 98016 9524 9524 14385357 26905533 9960805 10759153 34165 24363 544859 1309750 2442862 3056386 4114174 1752074 186267149 96173325 95921827 90093824 163970770 184274988 9538650 9486696 300922993 327672291 11479384 9737204 169810 90825285 89181804 1206861 569952 2780999 1401815 106292529 101060585 X 194617343 226591151 13121 20555 194630464 226611706 300922993 327672291 X 18299434 13430544 251264 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 10196 10196 0 PART II-B, LINE 1: PORTION OF INDIANA HOSPITAL ASSOCIATION DUES AND AMERICAN HOSPITAL ASSOCIATION DUES ATTRIBUTABLE TO LOBBYING EXPENSES AS DISCLOSED ON THE DUES NOTICES OF THE RESPECTIVE ASSOCIATIONS. 13121 15965 8531 20555 12850 4035 3764 13121 12957 3208 3315 12850 20194 28678 35915 12957 28255 356398 364459 20194 0.00000 0.48650 0.51350 0 0 3989556 3989556 118711592 43891241 74820351 63151848 52282084 10869764 414153 414153 90093824 DEFERRED COMPENSATION 53992 THIRD PARTY PAYABLE 850041 LIFE INSURANCE POLICIES 399224 MEDICARE SETTLEMENT 2020 98558 1401815 X 154256758 13430544 251264 13681808 140574950 660587 22189 682776 141257726 122275516 0 122275516 660587 22189 682776 122958292 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 12/31/2020. TERM ENDOWMENT - TEMPORARILY RESTRICTED NET ASSETS ARE DONOR-RESTRICTED FOR A SPECIFIC USE INCLUDING: INDIANA HOSPITAL ASSOCIATION FUND AND HIP 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, 2020 AND 2019, 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 251,265. ROUNDING -1. PART XI, LINE 4B - OTHER ADJUSTMENTS: OTHER RENTAL INCOME 10,484. OTHER EXPENSE NETTED WITH INCOME ON FINANCIAL STATEMENTS 11,705. PART XII, LINE 4B - OTHER ADJUSTMENTS: OTHER RENTAL INCOME 10,484. OTHER EXPENSE NETTED WITH INCOME ON FINANCIAL STATEMENTS 11,705. 1 1 1 X 1 X 1 1 0 1 1 437977 437977 0.00360 23396130 13814528 9581602 0.07790 23834107 13814528 10019579 0.08150 189137 53612 135525 0.00110 174945 49425 125520 0.00100 2417592 1781941 635651 0.00520 11705 11705 0.00010 2793379 1884978 908401 0.00740 26627486 15699506 10927980 0.08890 246828 246828 0.00200 246828 246828 0.00200 0 7637297 0 24363702 23302042 1061660 X 1 1 1 1 KING'S DAUGHTERS' HEALTH 1373 EAST STATE ROAD 62 PO BOX 447 MADISON IN 47250 WWW.KDHMADISON.ORG 20-005063-1 X X X KING'S DAUGHTERS' HEALTH 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 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 1 X 0 X X X X X 1 X 0 0 KING'S DAUGHTERS' HEALTH 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. KING'S DAUGHTERS' HEALTH 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. KING'S DAUGHTERS' HEALTH 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. KING'S DAUGHTERS' HEALTH 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 - 2020, YEAR 1 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: KDH HAS 12 EMPLOYEES WHO RECEIVE MINUTES FROM THE HCI SUBSTANCE ABUSE TEAM MEETINGS. HALF OF THESE INDIVIDUALS ACTIVELY ATTEND MEETINGS AND BRING INFORMATION BACK TO THEIR WORKPLACE.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. DESPITE COVID, THE GROUP MET VIA ZOOM DURING 2020. ADDITIONAL INFORMATION: IN ADDITION, THE HCI COORDINATOR IS AN OFFICER, SERVING AS SECRETARY FOR THE JCJTAP COALITION. 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 PUT IN PLACE APRIL 15TH. THE BOARD WAS ON DISPLAY IN THE ER WAITING ROOM WHERE PATIENTS AND VISITORS COULD VIEW. ADDITIONAL INFORMATION: THE BOARD INCLUDES TOBACCO QUITLINE INFORMATION AND LOCAL RESOURCES FOR AA/NA MEETINGS. *PLANS ARE BEING MADE IN EARLY 2021 TO ADD A SUBSTANCE ABUSE BULLETIN BOARD TO THE CONVENIENT CARE CENTER LOBBY. PRIORITY AREA 2 MENTAL HEALTH 2020, YEAR 1 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. WHILE THE GENERAL MENTAL HEALTH/SUICIDE TEAM DID NOT MEET IN 2020, A SUBCOMMITTEE WAS FORMED TO BEGIN WORKING ON THE ACE INITIATIVE.ADDITIONAL INFORMATION: SPECIAL RECOGNITION TOOK PLACE FOR MENTAL HEALTH AWARENESS MONTH AND SUICIDE AWARENESS MONTH. A LIST OF LOCAL MENTAL HEALTH RESOURCES WAS CREATED AT THE BEGINNING OF THE COVID-19 CRISIS.STRATEGY: KDH STAFF WILL HELP LEAD HCI'S EFFORT TO BECOME A TRAUMA INFORMED COMMUNITY.OUTCOME: WORKING WITH THE LOCAL COMMUNITY FOUNDATION, KDH/HCI APPLIED FOR AND RECEIVED A PLANNING GRANT TO BEGIN WORK TO BECOME A TRAUMA INFORMED COMMUNITY. THIS FOCUSED ON THE ACE INITIATIVE (ADVERSE CHILDHOOD EXPERIENCES) KDH HOSTED TWO WORKSHOPS WITH COMMUNITY LEADERS TO BEGIN PLANNING EFFORTS.ADDITIONAL INFORMATION: FOLLOWING THE INITIAL PLANNING, KDH/HCI AND THE LOCAL COMMUNITY FOUNDATION APPLIED FOR AND RECEIVED A GRANT TO FUND A COMPREHENSIVE ACES PLAN WHICH WILL BE CALLED RESILIENT JEFFERSON COUNTY. A STEERING COMMITTEE WAS FORMED IN LATE 2020 TO MOVE FORWARD WITH THIS PLAN.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 WAS UTILIZED IN 2020 IN THE KDH OUTPATIENT PROVIDER OFFICES. THE KDH EMERGENCY ROOM COMPLETED THE C-SSRS ASSESSMENT TOOL FOR ALL PATIENTS (EXCEPTION INFANT/TODDLERS). THE CSSRS DEPRESSION SCREENING TOOL IS A NATIONALLY RECOGNIZED PSYCH ASSESSMENT WITH 6 SIMPLE QUESTIONS. IF A PATIENT ANSWERS YES TO ANY QUESTIONS, ADDITIONAL STEPS ARE MADE FOR APPROPRIATE MENTAL HEALTH REFERRALSADDITIONAL INFORMATION: IN 2020, 58% OF PATIENTS AGE 12 AND OLDER RECEIVED THE PHQ-9 SCREENING TOOL IN THE OUTPATIENT PROVIDER OFFICES. A FORMER KDH STAFF MEMBERS DID A THESIS PROJECT ON THIS VERY SUBJECT WHICH HELPED TO IMPROVE THIS PROCESS FOR ALL CSSRS SCREENINGS. REPORTS ARE CREATED FOR PATIENTS WHO HAVE A BEHAVIORAL HEALTH REPORT AND CAN TRACK REOCCURRING ER VISITS. PRIORITY AREA 3 TOBACCO USE - 2020, YEAR 1 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) SURVEYS AT ALL 39 TOBACCO RETAILERS IN JEFFERSON COUNTY. PROVIDED SECONDHAND-SMOKE EDUCATION AT YOUTH "MOVIE IN THE PARK" EVENT. YOUTH TOBACCO CESSATION RESOURCES WERE GIVEN TO JEFFERSON COUNTY MIDDLE AND HIGH SCHOOL COUNSELORS. 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: WIC CLIENTS REFERRED TO THE INDIANA TOBACCO QUITLINE IN 2020 84. NUMBER OF OB/GYN PATIENTS REFERRED TO THE TOBACCO QUITLINE IN 2020 44. CESSATION LITERATURE IS PROVIDED TO TOBACCO USING PREGNANT WOMEN AT PERINATAL EDUCATION APPOINTMENT (LITERATURE IS PREPARED BY TOBACCO COORDINATOR AND GIVEN TO MOTHERS BY PERINATAL EDUCATOR). PARTICIPANTS ENROLLED IN BABY & ME TOBACCO FREE PROGRAM IN 2020 8. STRATEGY: MEASURE AND WORK TO INCREASE REFERRALS TO THE INDIANA STATE TOBACCO QUITLINE.OUTCOME: TOBACCO QUITLINE REFERRALS MADE BY KDH PROVIDERS 1,032 (INCREASE FROM 237 REFERRALS IN 2019). MONTHLY REFERRAL REPORTS SENT TO ALL KDH PHYSICIANS AND NURSES WITH QUITLINE/TOBACCO CESSATION EDUCATIONAL INFORMATION. TOBACCO QUITLINE FAX REFERRAL METHOD IMPLEMENTED IN THE KDH CANCER CENTER. PRIORITY AREA 4 NUTRITION, PHYSICAL ACTIVITY, WEIGHT - 2020, YEAR 1 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 SERVED AS THE CHAIR FOR THE HEALTHY LIFESTYLES TEAM. THREE KDH EMPLOYEES PARTICIPATE ON THIS TEAM, INCLUDING THE FULL-TIME KDH TOBACCO PREVENTION & CESSATION COORDINATOR.ADDITIONAL INFORMATION: ANY MEETING SUPPLIES, SPECIAL EVENTS MATERIALS, AND ADVERTISING FOR ACTIVITIES WERE SUPPLIED BY KDH AND/OR THE KDH FOUNDATION.STRATEGY: TARGET AREA YOUTH WITH PROGRAMMING AIMED AT INCREASING PHYSICAL ACTIVITY AND TEACHING HEALTHY NUTRITION HABITS AT A YOUNG AGE.OUTCOME: THE KDH FIT KIDS PROGRAM WAS TAUGHT IN JEFFERSON COUNTY 5TH GRADE CLASSROOMS. THIS 7-LESSON EDUCATION PROGRAM TARGETS CHILDHOOD OBESITY BY TEACHING AGE-APPROPRIATE HEALTH, NUTRITION, AND EXERCISE EDUCATION AND OFFERS WEEKLY TAKE HOME CHALLENGES FOR STUDENTS AND THEIR FAMILIES. THE HEALTH LIFESTYLES TEAM HOSTED A YOUTH HEALTH EVENT DURING A LOCAL MOVIE IN THE PARK EVENT. HEALTH EDUCATION AND COMMUNITY RESOURCE MATERIALS WERE PROVIDED TO YOUTH AND THEIR FAMILIES. TWO OF THE EVENT BOOTHS WERE SPECIFIC TO HEALTHY NUTRITION AND PHYSICAL ACTIVITY FOR YOUTH.ADDITIONAL INFORMATION: DUE TO COVID, NOT ALL SCHOOLS RECEIVED THE PROGRAM DURING THE 2019-2020 SCHOOL YEAR. A TOTAL OF 3 SCHOOLS, INCLUDING 6 CLASSROOMS AND 151 STUDENTS AND TEACHERS RECEIVED THE FIT KIDS PROGRAM. IN ADDITION, THE KDH WELLNESS COORDINATOR AND HEALTHY LIFESTYLES TEAM HOSTED A MONTH-LONG PARK HOP FOR AREA YOUTH. THIS EVENT PROMOTED THE VALUE OF PHYSICAL ACTIVITY AND INCENTIVIZED YOUTH AND THEIR FAMILIES TO VISIT AREA PARKS AND TRAILS.CONTINUED KING'S DAUGHTERS' HEALTH 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. KING'S DAUGHTERS' HEALTH 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 -CONTINUEDSTRATEGY: KDH WELLNESS WILL HOST TWO COMMUNITY 5K RUN/WALK EVENTS TO ENCOURAGE PHYSICAL ACTIVITY.OUTCOME: DESPITE THE PANDEMIC, THE KDH RUN THE FALLS COMMUNITY 5K RUN/WALK TOOK PLACE IN SEPTEMBER WITH SPECIAL COVID PRECAUTIONS IN PLACE. 179 PARTICIPANTS FINISHED THE OUTDOOR EVENT AND A TOTAL OF 36 STAFF WORKED THE EVENT.ADDITIONAL INFORMATION: DUE TO COVID AND THE CANCELLATION OF THE FALL GIRLS ON THE RUN SEASON, THE GOTR 5K EVENT WAS NOT HELD. PRIORITY AREA 5 DIABETES - 2020, YEAR 1 UPDATESTRATEGY: EMPLOYEE A FULL TIME DIABETES COORDINATOR AT KDH TO PROVIDE SERVICES FOR BOTH INPATIENTS AND OUTPATIENTS.OUTCOME: KDH HIRED A FULL-TIME COORDINATOR IN NOV. 2019, AND SHE BEGAN PROVIDING SERVICES FOR INPATIENTS AND OUTPATIENTS 12/2020.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. THE DIABETES COORDINATOR SAW APPROXIMATELY 250 PATIENTS IN 2020.STRATEGY: PROVIDE DIABETIC CONSULTS THROUGH POPULATION HEALTH PROGRAM, WORKING TO DECREASE A1C RATES AND INCREASE REFERRALS.OUTCOME: THE DIABETES EDUCATOR IN THE KDH QUALITY DEPARTMENT AND WORKS DIRECTLY WITH THE POPULATION HEALTH NURSING STAFF.ADDITIONAL INFORMATION: THE AVERAGE A1C RATE IN 2019 WAS 33.53%. WE WERE ABLE TO DECREASE THIS TO 27.7% IN 2020 (LOWER RATES INDICATE BETTER QUALITY). STRATEGY: PROVIDE COMMUNITY EDUCATION AND OUTREACH FOCUSING ON THE PREVENTION OF DIABETES, EARLY DETECTION, AND MANAGEMENT.OUTCOME: DUE TO COVID, THE DIABETES COORDINATOR DID NOT PROVIDE ANY COMMUNITY OUTREACH ACTIVITIES IN 2020. PRIORITY AREA 6 HEART DISEASE & STROKE 2020, YEAR 1 UPDATESTRATEGY: OFFER A STRUCTURED POPULATION HEALTH PROGRAM, WHICH PROVIDES ANNUAL WELLNESS VISITS FOR AT-RISK INDIVIDUALS WITH A GOAL OF INCREASING PREVENTATIVE TESTING.OUTCOME: 907 ANNUAL WELLNESS VISITS WERE PROVIDED TO MEDICARE PATIENTS IN 2020. THIS NUMBER WOULD HAVE BEEN HIGHER, BUT THE POPULATION HEALTH PROGRAM DID NOT SEE PATIENTS FOR 3 MONTHS DUE TO THE PANDEMIC.ADDITIONAL INFORMATION: THESE VISITS RESULTED IN 21 DIFFERENT SCREENING TOOLS BEING ORDERED FOR PATIENTS DURING WELLNESS VISITS.STRATEGY: PROVIDE COMMUNITY AND/OR CORPORATE BLOOD PRESSURE CHECKS AT AREA HEALTH FAIRS AND SCREENS.OUTCOME: DUE TO COVID, COMMUNITY OUTREACH ACTIVITIES WERE VERY LIMITED. NO FORMAL COMMUNITY OR CORPORATE CVD SCREENS WERE HELD IN 2020.ADDITIONAL INFORMATION: NOTE, KDH TRAINED A TOTAL OF 1,061 PEOPLE IN 2020 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: CVD EDUCATION WAS PROVIDED TO THE COMMUNITY IN 2020 THROUGH THE "TO YOUR HEALTH" RADIO/PODCAST SHOW. IN ADDITION, THE WELLNESS COORDINATOR HAD 3 COMMUNITY PRESENTATIONS RELATED TO HEART DISEASE PREVENTION.ADDITIONAL INFORMATION: KDH STAFF RECEIVED CVD EDUCATION THROUGHOUT THE YEAR WITH VARIOUS WELLNESS INCENTIVE PROGRAMS. THIS INCLUDED PARTICIPATION IN THE GO RED CAMPAIGN.IN ADDITION, A SOCIAL MEDIA "SHELTER IN PLACE HEALTH TIPS" CAMPAIGN TOOK PLACE DURING THE PANDEMIC, OFFERING HEALTHY LIFESTYLE TIPS INCLUDING HEART DISEASE PREVENTION. PRIORITY AREA 7 CANCER 2020, YEAR 1 UPDATESTRATEGY: OFFER A MINIMUM OF ONE CANCER-SPECIFIC SCREENING EVENT.OUTCOME: TAKE-HOME COLOR-RECTAL SCREENING KITS WERE DISTRIBUTED IN THE MONTH OF MARCH THROUGH PROVIDER OFFICES. A TOTAL OF 44 KITS WERE SUCCESSFULLY RETURNED TO THE LAB FOR PROCESSING. PATIENT FOLLOW-UP WAS PROVIDED FOR 7 POSITIVE TESTS.ADDITIONAL INFORMATION: DUE TO COVID, PLANS FOR A SKIN-CANCER SCREEN DID NOT TAKE PLACE.STRATEGY: OFFER A SUPPORT GROUP FOR CANCER SURVIVORS.OUTCOME: ONE WOMEN & CANCER SUPPORT GROUP WAS HELD AT KDH IN FEB. 2020. THE REMAINDER OF THE SCHEDULED SUPPORT GROUPS WERE CANCELLED DUE TO COVID.ADDITIONAL INFORMATION: THE CANCER TREATMENT CENTER IS PLANNING TO RESUME SUPPORT GROUP MEETINGS IN THE SPRING OF 2021 IF COVID-RELATED MEETING RESTRICTIONS ARE LIFTED.STRATEGY: PROVIDE COMMUNITY EDUCATION AND OUTREACH FOCUSING ON THE PREVENTION OF VARIOUS FORMS OF CANCER. OUTCOME: DESPITE SOME OUTREACH BEING CANCELLED DUE TO THE PANDEMIC, CANCER AWARENESS AND EDUCATION TOOK PLACE THROUGH THE "TO YOUR HEALTH" RADIO / PODCAST SHOW AND THE "SHELTER IN PLACE HEALTH TIPS" SOCIAL MEDIA CAMPAIGN.ADDITIONAL INFORMATION: KDH STAFF RECEIVED CANCER PREVENTION AND AWARENESS EDUCATION THROUGHOUT THE YEAR WITH VARIOUS WELLNESS INCENTIVE PROGRAMS. STAFF WERE ALSO GIVEN FREE SUNSCREEN WITH SKIN CANCER PREVENTION EDUCATION IN 2020. 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 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 8-9 "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.2020 KING'S DAUGHTERS' HEALTH OVERVIEW OF COMMUNITY BENEFIT ACTIVITIES1. HEALTH SCREENS/HEALTH FAIRS: A. COMMUNITY HEALTH SCREENS / FAIRS: HOSTED A LUNG CANCER SCREENING EVENT FOR LOW INCOME PARTICIPANTS. *COVID NOTE ALL COMMUNITY AND CORPORATE HEALTH SCREENS AND FAIRS WERE CANCELLED IN 2020 DUE TO COVID. B. CORPORATE FLU SHOTS: 1 CORPORATE FLU SHOT CLINIC HELD WITH 10 EMPLOYEE RECEIVING THEIR FLU VACCINE. C. 4-H FAIR PARTICIPATION: BOTH JEFFERSON AND RIPLEY COUNTY INDIANA FAIRS WERE CANCELLED DUE TO COVID. D. FREE TAKE-HOME COLOR CANCER SCREENING KITS: 44 KITS WERE RETURNED FOR PROCESSING. THE NUMBER OF KITS DISTRIBUTED WAS NOT DOCUMENTED. PATIENT FOLLOW-UP WAS PROVIDED FOR ALL POSITIVE TEST RESULTS (7 OF 44). 2. COMMUNITY EDUCATION OPPORTUNITIES/CLASSES/SPECIAL EVENTS: A. WELLNESS DEPARTMENT 8 SPEAKING ENGAGEMENTS B. FIT KIDS PROGRAM (7 WEEK PROGRAM FOR AREA 5TH GRADE CLASSROOMS) DUE TO COVID, NOT ALL JEFFERSON COUNTY SCHOOLS RECEIVED THE FIT KIDS PROGRAM. WERE ABLE TO OFFER THE PROGRAM TO 3 SCHOOL SYSTEMS / 6 CLASSROOMS / 151 KIDS + TEACHERS. C. TOBACCO CESSATION & EDUCATION: -KING'S DAUGHTERS' HEALTH EMPLOYS A FULL TIME STATE GRANT FUNDED TOBACCO COORDINATOR. KDH DOCUMENTED 1,049 ELECTRONIC PATIENT REFERRALS TO THE INDIANA QUITLINE. -CONTRIBUTED TO WRITING THE INDIANA CANCER CONSORTIUM TOBACCO PREVENTION AND CESSATION HEALTH SYSTEMS CHANGE PROJECT GRANT. -ASSISTED IN CREATING AND IMPLEMENTING THE ICC TPC HEALTH SYSTEMS CHANGE PROJECT IN THE KDH CANCER CENTER BY CREATING A TOBACCO CESSATION PROGRAM. -COLLABORATED WITH THE JEFFERSON COUNTY SCHOOLS TO EDUCATE SCHOOL COUNSELORS ON TOBACCO CESSATION RESOURCES AVAILABLE TO YOUTH. - DISTRIBUTED "NO SMOKING WITHIN 8 FEET" SIGNAGE TO LOCAL BUSINESSES WITH THE HELP OF THE HCI OF JEFFERSON COUNTY HEALTHY LIFESTYLES TEAM. - RECEIVED GRANT FUNDING TO PROVIDE FREE NICOTINE REPLACEMENT THERAPY ALONG WITH CESSATION RESOURCES FOR COMMUNITY MEMBERS. - PARTNERED WITH THE JEFFERSON COUNTY HEALTH DEPARTMENT TO IMPLEMENT TOBACCO CESSATION BILLBOARDS. - PARTICIPATED IN STANDARDIZED TOBACCO ASSESSMENT OF RETAIL SETTINGS (STARS) SURVEY. - PARTICIPATED IN MULTI-UNIT HOUSING SURVEYS IN JEFFERSON COUNTY. - PARTNERED WITH JEFFERSON COUNTY WIC TO PROVIDE TOBACCO CESSATION RESOURCES TO TOBACCO USING MOTHERS. - HELD 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. D. CPR AND FIRST AID CLASSES: KDH SERVED 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. A TOTAL OF 1,061 PEOPLE RECEIVED TRAINING IN 2020. IN ADDITION, SEVERAL COMMUNITY CLASSES WERE CANCELLED IN 2020 DUE TO COVID. E. PRENATAL EDUCATION: OB PREP PROGRAM 405 EXPECTING MOTHERS SERVED WITH EDUCATIONAL PREP VISIT. IN ADDITION, 23 MOTHERS AND 21 SUPPORT PEOPLE ATTENDED THE CHILDBIRTH CLASS SERIES OFFERED BY KDH. ONE CLASS WAS CANCELLED DUE TO COVID. SERVED AS THE HOST SITE FOR LA LECHE LEAGUE COMMUNITY MEETINGS. TWO MEETINGS WERE HELD, WITH ADDITIONAL MEETINGS CANCELLED DUE TO COVID. F. GIRLS ON THE RUN NO FALL SEASON WAS HELD DUE TO COVID. G. MONTHLY "TO YOUR HEALTH" RADIO SHOW: 30-MINUTE HEALTH EDUCATION PROGRAM WITH VARIOUS TOPICS OFFERED EACH MONTH. H. KDH RUN THE FALLS 5K WALK/RUN: 180 PEOPLE PARTICIPATED I. CANCER SUPPORT ACTIVITES: WOMEN AND CANCER SUPPORT GROUP, MET ONLY 1 TIME IN 2020 DUE TO COVID. NO ADDITIONAL CANCER-RELATED ACTIVITIES WERE DOCUMENTED IN 2020 DUE TO COVID.3. EMPLOYEE HEALTH OPPORTUNITIES FOR KDH STAFF: WELLNESS NEWSLETTERS (ON-LINE AND PAPER VERSIONS AVAILABLE). 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. 2020 GOAL SHEETS OFFERED FOR STAFF WITH INCENTIVE. HEART MONTH EDUCATION WITH PROMOTION OF GO RED CAMPAIGN. 5-A-DAY WELLNESS INCENTIVE NUTRITION CHALLENGE. MONTH LONG HABIT TRACKING CAMPAIGN HELD. FREE SUNSCREEN DISTRIBUTION FOR STAFF WITH SKIN CANCER PREVENTION EDUCATION. WALK-TOBER WALKING CAMPAIGN HELD. PROVIDES FREE NICOTINE REPLACEMENT THERAPY PRODUCTS FOR STAFF WHEN REQUESTED.4. COMMUNITY SERVICE ACTIVITIES: A. ACTIVE ATTENDANCE AND PARTICIPATION IN THE FOLLOWING COMMUNITY COALITIONS/GROUPS: JCJTAP JEFFERSON COUNTY JUSTICE TREATMENT AND PREVENTION COALITION MADISON CONSOLIDATED SCHOOLS WELLNESS COMMITTEE PURDUE EXTENSION HEALTH AND HUMAN SERVICES BOARD PERINATAL COMMUNITY TASK FORCE (JUST 1 MEETING IN 2020) B. EMS STAND-BY AT ALL COMMUNITY ACTIVITIES: EMS PROVIDES STAND-BY COVERAGE AT ALL JEFFERSON COUNTY ACTIVITIES. C. ATHLETIC TRAINING/REHAB SERVICES PROVIDED FOR THREE JEFFERSON COUNTY SCHOOLS. D. SUPPORT TO VARIOUS AREA SCHOOLS WITH INTERNSHIPS: SUPPORT MANY LOCAL AND AREA HIGH SCHOOLS AND COLLEGES WITH INTERNSHIPS AND JOB SHADOW EXPERIENCES: INCLUDES NURSING AND MEDICAL STUDENTS AMONG OTHERS.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 INCLUDES KDH STAFF AND COMMUNITY MEMBERS. 2020 HCI TEAM ACCOMPLISHMENTS:SUBSTANCE ABUSE TEAM: WORKED WITH THE KDH TOBACCO COORDINATOR TO CREATE A "HIDDEN IN PLAIN SIGHT BACKPACK" DEMONSTRATION (VIDEO ALSO AVAILABLE) WHICH PROVIDES ABOUT WAYS YOUTH CAN HIDE TOBACCO AND OTHER DRUGS IN MATERIALS IN THEIR BACKPACK. RECEIVED A $500 GRANT TO PURCHASE MATERIALS TO PROMOTE RED RIBBON WEEK AND TO ENCOURAGE YOUTH TO REMAIN DRUG FREE. RECEIVED A $3,400 GRANT TO PURCHASE DRUG DISPOSAL POUCHES TO PROVIDE AN ENVIRONMENTALLY SAFE WAY FOR PERSONS TO DISPOSE OF UNUSED OR UNWANTED DRUGS IN THEIR HOUSEHOLD.MENTAL HEALTH/ZERO SUICIDE TEAM: RECOGNIZED MENTAL HEALTH AWARENESS MONTH AND SUICIDE AWARENESS MONTH. DEVELOPED A SET OF MENTAL HEALTH RESOURCES FOR COMMUNITY USE AT THE START OF THE PANDEMIC. WORKED WITH THE LOCAL COMMUNITY FOUNDATION TO RAISE AWARENESS OF ADVERSE CHILDHOOD EXPERIENCES (ACES) AND TO DEVELOP A PLAN TO COMBAT ACES. APPLIED FOR AND RECEIVED A GRANT FROM THE LILLY ENDOWMENT TO FUND A COMPREHENSIVE ACES PLAN CALLED RESILIENT JEFFERSON COUNTY WHICH WILL BEGIN IN 2021. A VIDEO WAS ALSO CREATED TO PROMOTE AWARENESS OF ACES. HEALTHY LIFESTYLES TEAM: (OVERWEIGHT/OBESITY, TOBACCO, CHRONIC DISEASE) PARTNERED WITH A LOCAL AGENCY TO OFFER A SPRING PARK HOP EVENT WHICH ENCOURAGED YOUTH AND THEIR FAMILIES TO EXPLORE AND USE PARKS IN JEFFERSON COUNTY. HELD A COMMUNITY CHALLENGE TITLED "47250" WHICH ENCOURAGED PARTICIPANTS TO MAKE DAILY HEALTHY CHOICES IN 5 CATEGORIES, EARNING POINTS FOR AN OPPORTUNITY TO WIN PRIZES. HOSTED A COMMUNITY WALKING HEALTHY SCAVENGER HUNT. HOSTED A HEALTH-FOCUSED YOUTH EVENT IN PARTNERSHIP WITH THE CITY OF MADISON MOVIE IN THE PARKS. THIS WAS HELD IN PLACE OF THE YOUTH TAILGATE PARTY WHICH WAS CANCELLED DUE TO COVID. ASSISTED THE TOBACCO COORDINATOR WITH THE STARS SURVEY PROJECT AND THE DISTRIBUTION OF REQUIRED BUSINESS TOBACCO SIGNAGE. PART VI, LINE 6: NA PART VI, LINE 7, REPORTS FILED WITH STATES IN 1 COMMUNITY FOUNDATION OF MADISON AND JEFFERSON COUNTY INC PO BOX 306 MADISON IN 47250 351847297 501(C)(3) 5000 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 255330 0 198820 0 552 0 13950 0 20931 0 489583 0 0 0 TINA HENDRICK MD BOARD MEMBER/PHYSICIAN 260217 0 127037 0 240 0 13950 0 212 0 401656 0 0 0 CAROL DOZIER PRESIDENT/CEO 423562 0 0 0 8641 0 13950 0 605 0 446758 0 0 0 JOHN PRICE VP FINANCE 251177 0 100 0 20532 0 12662 0 6647 0 291118 0 0 0 LISA MORGAN VP OUTPATIENT SERVICES 176545 0 100 0 20532 0 8990 0 8139 0 214306 0 0 0 DENINE FALLIS-HALLGARTH VP PHYSICIAN PRACTICES 156730 0 100 0 20532 0 8062 0 8139 0 193563 0 0 0 JENNIFER LITER VP INPATIENT SERVICES 154434 0 100 0 19860 0 7983 0 20459 0 202836 0 0 0 NATHAN POLLEY MD EMPLOYED PHYSICIAN 636561 0 370353 0 29766 0 13950 0 23687 0 1074317 0 0 0 THOMAS ECKERT MD EMPLOYED PHYSICIAN 442332 0 116688 0 1715 0 13950 0 7976 0 582661 0 0 0 MICHAEL SCHMIDT MD EMPLOYED PHYSICIAN 461599 0 91492 0 552 0 13950 0 16085 0 583678 0 0 0 RAYMONDA STEVENS MD EMPLOYED PHYSICIAN 467307 0 80672 0 552 0 13950 0 0 0 562481 0 0 0 BRENT SINICROPE MD EMPLOYED PHYSICIAN 643397 0 6350 0 33014 0 13950 0 14429 0 711140 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 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 6094 0 1 1 BRENT SINICROPE MD EMPLOYED PHYSICIAN - TOP 5 HIGHEST COMPENSATED EMPLOYEE CONTRACT EXECUTION LOAN/PRACTICE COMMENCEMENT LOAN X 50000 18269 0 1 1 24363 A DATTILO FRUIT COMPANY VP OF OUTPATIENT SERVICES OF KDH HAS A PERCENTAGE OWNERSHIP INTEREST 15843 LISA MORGAN IS THE VICE PRESIDENT OF OUTPATIENT SERVICES WITH KING'S DAUGHTERS' HEALTH. LISA OWNS A PERCENTAGE INTEREST IN A. DATTIOL FRUIT COMPANY. KING'S DAUGTHER'S HEALTH PURCHASED PRODUCE FROM A. DATTILO FRUIT COMPANY. KING'S DAUGHTERS' HEALTH MADE PURCHASES TOTALING $15,843 IN 2020. 0 MCCUBBIN MOTORS BOARD MEMBER IS THE SPOUSE OF THE PRESIDENT OF MCCUBBIN MOTORS, INC. 45631 MARY KAY MCCUBBIN IS A KING'S DAUGHTERS' HEALTH BOARD MEMBER. MARY KAY MCCUBBIN IS MARRIED TO THE PRESIDENT OF MCCUBBIN MOTORS, INC. KING'S DAUGHTERS' HEALTH UTILIZED MCCUBBIN MOTORS FOR SERVICING AND/OR REPAIR OF EMERGENCY VEHICLES AND VEHCILE LEASING SERVICES IN 2020. KING'S DAUGHTERS' HEALTH PAID $45,631 TO MCCUBBIN MOTORS IN 2020 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 PER THE BYLAWS, THE MEMBERSHIP OF THE ORGANIZATION SHALL BE NON-SECTARIAN, NON-POLITICAL AND NOT CONFINED TO ANY CHRISTIAN RELIGIOUS DENOMINATION OR SECT. ANY SUCH PERSON OF GOOD REPUTE WHO HOLDS HERSELF RESPONSIBLE TO THE KING, CHRIST, OUR LORD AND SAVIOR, MAY BECOME A MEMBER OF THE ORGANIZATION. ALL MEMBERS MUST BE AND REMAIN PERMANENT RESIDENTS OF THE SERVICE AREA OF THE HOSPITAL, AS DETERMINED FROM TIME TO TIME BY THE HOSPITAL BOARD OF MANAGERS, AS A CONTINUING REQUIREMENT FOR MEMBERSHIP. FAILURE TO MAINTAIN SUCH RESIDENCY STATUS AUTOMATICALLY TERMINATES A PERSON'S MEMBERSHIP. HOSPITAL EMPLOYEES, MEMBERS OF THE MEDICAL STAFF, AND THEIR IMMEDIATE FAMILY MEMBERS SHALL NOT BE ELIGIBLE FOR MEMBERSHIP IN THE ORGANIZATION. THE IMMEDIATE FAMILY SHALL BE DEFINED AS INCLUDING THE MOTHER, FATHER, HUSBAND, WIFE, SISTER, BROTHER, DAUGHTER, SON, AND STEPCHILDREN. FORM 990, PART VI, SECTION A, LINE 7A THE ORGANIZATION SHALL HAVE TWO (2) CLASSES OF MEMBERS, ACTIVE AND HONORARY, AND ALL MEMBERS SHALL HAVE THE RIGHTS, PRIVILEGES, DUTIES, LIABILITIES, LIMITATIONS AND RESTRICTIONS AS SET FORTH FROM TIME TO TIME IN THE STANDING RULES. ANY ACTIVE MEMBER OF THE ORGANIZATION MAY PROPOSE ANY OTHER PERSON MEETING THE ELIGIBILITY REQUIREMENTS OUTLINED IN PART VI, 7A ABOVE FOR MEMBERSHIP. ONLY ACTIVE MEMBERS IN GOOD STANDING THAT HAVE BEEN A MEMBER FOR AT LEAST TWO ANNIVERSARY YEARS CAN PRESENT A PERSON'S NAME FOR MEMBERSHIP OR TO SERVE ON THE BOARD OF DIRECTORS. A MAJORITY VOTE OF THOSE PRESENT AND VOTING AFFIRMATIVELY AT ANY REGULAR MEETING OF THE ORGANIZATION AT WHICH A QUORUM IS PRESENT SHALL BE SUFFICIENT TO ELECT SUCH PROPOSED PERSON TO MEMBERSHIP. ONLY ACTIVE MEMBERS SHALL HAVE THE RIGHT AT EVERY MEETING OF THE MEMBERS TO CAST ONE (1) VOTE FOR HER MEMBERSHIP. THIS RIGHT TO VOTE MUST BE EXERCISED IN PERSON, OR AS THE BYLAWS MAY PROVIDE FROM TIME TO TIME. FORM 990, PART VI, SECTION A, LINE 7B ONLY ACTIVE MEMBERS SHALL HAVE THE RIGHT AT EVERY MEETING OF THE MEMBERS TO CAST ONE (1) VOTE FOR HIS/HER MEMBERSHIP. THIS RIGHT TO VOTE MUST BE EXERCISED IN PERSON, OR AS THE BYLAWS MAY PROVIDE FROM TIME TO TIME. 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 MANAGERS RECEIVES A DRAFT COPY OF THE FORM 990 INCLUDING REQUESTED SCHEDULES PRIOR TO FILING WITH THE IRS. 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 MANAGERS SHALL DETERMINE WHETHER THE HOSPITAL 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 251,264. 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