2020-07-15T13:53:41-05:00 2019-06-30 990 2018-07-01 562070036 DUKE UNIVERSITY HEALTH SYSTEM INC DUKE 9196688910 324 BLACKWELL ST WASHIN BLDG NO 850 DURHAM NC 27701 KENNETH C MORRIS SVP, CFO, TREASURER 9196688910 2020-04-06 152.3.34.51 2020-07-15 13:52:56 ED P 8121CA463AABFA4EFE5158FD2073B628CA1C8F6D 3825398A354F77A4FC8C6AFB894E9699CCCE251B 2018 2021-01-29 14:40:06Z A EUGENE WASHINGTON MD 615 DOUGLAS ST STE 700 DURHAM NC 27705 5708935214 0 X WWW.DUKEHEALTH.ORG X 1998 NC SEE SCHEDULE O FOR ORGANIZATION'S MISSION STATEMENT 19 11 21069 1345 1923576 -212525 4064813 5259309 3332141722 3566485727 158638074 126093393 81606317 78944553 3576450926 3776782982 1817270 1312254 0 0 1455535843 1558291299 0 0 172793 1669040569 1787073189 3126393682 3346676742 450057244 430106240 5904321303 6281178620 2509540735 2743496381 3394780568 3537682239 X SEE SCHEDULE O 0 0 2588487775 1312254 3618375075 SEE SCHEDULE O 2588487775 1 1 0 1 0 0 0 0 0 1 1 1 0 0 1 0 0 1 0 0 1 1 0 0 1 0 1 1 1 1 1 1 0 0 0 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 0 0 1 X 533 0 1 21069 1 1 1 1 SW DA NO MY PL UK EI PO GR BD 0 0 0 1 1 0 0 0 0 1 0 X 19 11 1 1 0 0 0 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 FL GA HI IL KS KY MD MA MI MN MS NH NJ NY ND OR PA SC TN UT WI X X X BETSY CASSIDY 9196688910 DUHS INC 615 DOUGLAS STREET SUITE DURHAM NC 27705 LESLIE E BAINS DIRECTOR 4.00 0.00 X 0 0 0 GAIL BELVETT DIRECTOR 1.00 0.00 X 0 0 0 JACK O BOVENDER JR DIRECTOR 3.00 8.10 X 0 0 0 WILLIAM HAWKINS DIRECTOR 8.00 6.00 X 0 0 0 BARBARA M HENDRIX DIRECTOR 1.00 0.10 X 0 0 0 MARY E KLOTMAN MD DIRECTOR 25.00 40.50 X 0 1065975 47861 MICHAEL MARSICANO DIRECTOR 1.00 4.00 X 0 0 0 LLOYD B MORGAN DIRECTOR 2.00 0.00 X 0 0 0 VINCENT E PRICE DIRECTOR 3.00 40.20 X 0 1339428 50100 ANN M REED DIRECTOR 11.00 40.10 X 23513 324811 39049 CARMICHAEL ROBERTS DIRECTOR 1.00 1.00 X 0 0 0 SEPIDEH SAIDI DIRECTOR 0.50 0.00 X 0 0 0 JOHN H SAMPSON MD PHD DIRECTOR 1.00 40.10 X 0 683439 103783 NANCY M SCHLICHTING DIRECTOR 6.00 2.00 X 0 0 0 STEVEN M SCOTT MD DIRECTOR 4.00 2.00 X 0 0 0 SUSAN STALNECKER DIRECTOR 2.00 0.00 X 0 0 0 GEORGE RICHARD WAGONER JR DIRECTOR 1.00 0.00 X 0 0 0 A EUGENE WASHINGTON MD DIRECTOR/PRESIDENT & CEO 33.00 33.20 X X 0 2610797 146391 JAMES WHITEHURST DIRECTOR 1.00 0.00 X 0 0 0 MONTE D BROWN MD VP FOR ADMINISTRATION/SECRETARY 50.00 10.10 X 821272 0 51022 WILLIAM J FULKERSON MD EXECUTIVE VP, DUHS 60.00 0.70 X 1852249 0 38933 KENNETH C MORRIS SVP, CFO, TREASURER 40.00 1.00 X 1385444 0 44047 MARY ANN FUCHS VP-PATIENT CARE/CHIEF NURSE EXEC 60.00 0.10 X 593971 0 40799 KATHLEEN B GALBRAITH PRESIDENT, DUKE REGIONAL HOSPITAL 60.00 1.00 X 697926 0 51134 THOMAS A OWENS MD PRESIDENT, DUH AND SVP, DUHS 60.00 0.20 X 1147835 0 45084 DAVID ZAAS MD PRESIDENT, DUKE RALEIGH HOSPITAL 60.00 0.00 X 687715 0 51535 RHONDA BRANDON CHIEF HUMAN RESOURCES OFFICER, DUHS 40.00 0.00 X 662176 0 60738 JEFFREY M FERRANTI CIO/VP FOR MEDICAL INFORMATICS 40.00 0.00 X 780801 113761 56906 JULIE SEEL CLINICAL PSYCHOLOGIST 40.00 0.00 X 633898 0 38858 JOHN S SMITH DUHS ASSOCIATE VP 40.00 0.00 X 594428 0 52922 ROBERT N WILLIS VP OF FINANCE & CORP CONTROLLER 55.00 5.00 X 609579 0 48308 KEVIN SOWERS FORMER KEY EMPLOYEE 0.00 0.00 X 283430 0 34474 10774237 6138211 1001944 2180 1 1 0 PRIVATE DIAGNOSTIC CLINIC PLLC 4101 ROXBORO RD DURHAM NC 27710 MEDICAL SERVICES 154021267 SKANSKA USA BUILDING INC 4309 EMPEROR BLVD SUITE 200 DURHAM NC 27703 CONSTRUCTION SERVICES 45810028 ROBINS & MORTON GROUP PO BOX 11407 DEPT 5870 BIRMINGHAM AL 35209 CONSTRUCTION SERVICES 41166273 BALFOUR BEATTY CONSTRUCTION LLC 406 S MCDOWELL ST SUITE 200 RALEIGH NC 27601 CONSTRUCTION SERVICES 17462686 ARAMARK SERVICES LLC 1101 MARKET ST SUITE 450 PHILADELPHIA PA 19107 FOOD SERVICES 13093779 344 63222 1067494 4128593 115676 5259309 PATIENT REVENUE 621990 3532004737 3532004737 ANCILLARY MEDICAL SVCS 621990 34139501 34139501 MEDICAL SERVICES 621990 341489 341489 3566485727 34680750 1923576 32757174 10195392 10195392 12194696 10749245 1445451 1445451 1445451 2012716506 1920136166 1167697 92580340 -1167697 91412643 91412643 109739 63222 99124 10615 10615 BILLING FEES 621990 44690032 44690032 DEEMED DIVIDEND 900003 6635025 6635025 LAB SERVICES 621990 3754975 3754975 12213063 3444341 8768722 67293095 3776782982 3618375075 1923576 151225022 1172799 1172799 44336 44336 95119 95119 7565047 431005 7134042 336322 75887 260435 1243451059 840018547 403347130 85382 73565204 47634746 25924576 5882 141690356 89090362 52588422 11572 91683311 61597387 30079667 6257 12939314 12270893 668421 4154925 202557 3952368 565500 565500 4441235 4441235 279002325 166167445 112821272 13608 3815755 80862 3734893 37165194 22752806 14382271 30117 59510315 5144773 54365542 70311663 46618815 23692848 9070406 5716098 3354308 7571623 1319966 6251657 54546119 54546119 157985483 118222469 39763014 9764116 9764116 MEDICAL SUPPLIES 912899239 912899239 EQUIPMENT RENTAL & MAIN 89319441 72036966 17282475 MEDICAID ASSESSMENT 80887646 80887646 LAUNDRY 8595594 8595594 -15472704 31101223 -46593902 19975 3346676742 2588487775 758016174 172793 92406 101882 319923765 784143999 907192 1423731 443472764 482629639 429050 287432 91549857 99753991 27120344 36336639 3644430837 1950742484 1527962404 1693688353 859604561 621244236 2588062243 2512783200 21465755 21465755 23730962 27319763 5904321303 6281178620 351954045 384650750 6837076 8314062 1040985793 1012051763 1109763821 1338479806 2509540735 2743496381 X 3336152781 3477033339 44593461 46102670 14034326 14546230 3394780568 3537682239 5904321303 6281178620 X 430106240 53558079 -340762648 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 0 0 0 0 1 138337 0 1 112368 250705 0 PART II-B, LINE 1: DUKE UNIVERSITY HEALTH SYSTEM, INC. EMPLOYS STAFF WHO PERFORM SOME LOBBYING ACTIVITIES AS PART OF THEIR JOB RESPONSIBILITIES. THESE SAME EMPLOYEES HAVE AND SOME SENIOR LEADERS MAY HAVE DIRECT CONTACT WITH LEGISLATORS, THEIR STAFFS, AND GOVERNMENT OFFICIALS. DUKE UNIVERSITY HEALTH SYSTEM, INC. PAYS MEMBERSHIP DUES TO OTHER ORGANIZATIONS. PER THE MEMBERSHIP DUES INVOICES, SOME OF THESE ORGANIZATIONS PROVIDE A DISCLOSURE OF LOBBYING PERCENTAGE OF THE DUES RECEIVED. 58627787 5694239 681288 4354414 60648900 57177730 3880934 2052778 4483655 58627787 57816285 2312345 1810497 4761397 57177730 57578816 7276856 -1590780 5448607 57816285 59083195 4849436 -29888 6323927 57578816 0.48380 0.51620 0 1 1 65300166 65300166 2090962130 943698206 1147263924 1008051420 645101932 362949488 480117121 361942346 118174775 1693688353 OTHER INVESTMENTS 103188804 F FIXED INCOME 104 F PRIVATE CAPITAL 731803326 F CASH & CASH EQUIVALENTS 253326515 F COMMODITIES 4176820 F HEDGE FUNDS 1052516244 F REAL ESTATE 145261390 F NATURAL RESOURCES 222509997 F 2512783200 INTEREST PAYABLE 12095290 PROFESSIONAL LIABILITY COSTS 6275943 POST RETIREMENT BENEFIT OBLIGATION 477568000 CAPITAL LEASE OBLIGATION 132622500 DERIVATIVE INSTRUMENTS 76448323 TAXABLE BOND LIABILITY 587265265 OTHER NON-CURRENT LIABILITIES 46204485 1338479806 PART V, LINE 4: THE INTENDED USE FOR THE ORGANIZATION'S ENDOWMENT: FUNDS SUPPORT CAPITAL PURCHASES, OFFSET OPERATING COSTS, IMPROVE PATIENT SAFETY, AND SUPPORT THE NEEDS OF PATIENTS AND FAMILIES. PART X, LINE 2: DUKE UNIVERSITY HEALTH SYSTEM, INC. ADOPTED THE REQUIREMENTS OF FIN 48 AND CONSIDERED ITS TAX POSITIONS. BASED ON THAT ANALYSIS, THE PROVISIONS OF FIN 48 ARE DEEMED IMMATERIAL TO THE DUKE UNIVERSITY HEALTH SYSTEM, INC. FINANCIAL STATEMENTS AND THEREFORE NO FIN 48 SPECIFIC DISCLOSURES ARE MADE IN THE AUDITED FINANCIAL STATEMENTS OF DUKE UNIVERSITY HEALTH SYSTEM, INC. AND ITS AFFILIATES FOR FISCAL YEAR ENDED JUNE 30, 2019. 1 CENTRAL AMERICA AND THE CARIBBEAN - ANTIGUA & BARBUDA, ARUBA, BAHAMAS, 0 0 PROGRAM SERVICES EDUCATION 3000 CENTRAL AMERICA AND THE CARIBBEAN - ANTIGUA & BARBUDA, ARUBA, BAHAMAS, 0 0 PROGRAM SERVICES STUDY ABROAD 5000 CENTRAL AMERICA AND THE CARIBBEAN - ANTIGUA & BARBUDA, ARUBA, BAHAMAS, 0 0 SEMINAR 11000 EAST ASIA AND THE PACIFIC - AUSTRALIA, BRUNEI, BURMA, CAMBODIA, 0 0 SEMINAR 13000 EUROPE (INCLUDING ICELAND & GREENLAND) - ALBANIA, ANDORRA, AUSTRIA, BELGIUM 0 0 PROGRAM SERVICES EDUCATION 10000 EUROPE (INCLUDING ICELAND & GREENLAND) - ALBANIA, ANDORRA, AUSTRIA, BELGIUM 0 0 SEMINAR 20000 MIDDLE EAST AND NORTH AFRICA - ALGERIA, BAHRAIN, DJIBOUTI, EGYPT, 0 0 SEMINAR 2000 NORTH AMERICA - CANADA AND MEXICO, BUT NOT THE UNITED STATES 0 0 PROGRAM SERVICES EDUCATION 6000 NORTH AMERICA - CANADA AND MEXICO, BUT NOT THE UNITED STATES 0 0 PROGRAM SERVICES STUDY ABROAD 7000 NORTH AMERICA - CANADA AND MEXICO, BUT NOT THE UNITED STATES 0 0 SEMINAR 11000 SOUTH AMERICA - ARGENTINA, BOLIVIA, BRAZIL, CHILE, COLUMBIA, ECUADOR, 0 0 PROGRAM SERVICES EDUCATION 1000 SOUTH AMERICA - ARGENTINA, BOLIVIA, BRAZIL, CHILE, COLUMBIA, ECUADOR, 0 0 SEMINAR 3000 SOUTH ASIA 0 0 SEMINAR 9000 SUB-SAHARAN AFRICA 0 0 PROGRAM SERVICES EDUCATION 3000 CENTRAL AMERICA AND THE CARIBBEAN 0 0 INVESTMENTS 239429000 CENTRAL AMERICA AND THE CARIBBEAN 0 0 GRANTMAKING 11000 SUB-SAHARAN AFRICA 0 0 GRANTMAKING 84000 0 0 0 0 0 0 70000 239558000 239628000 CENTRAL AMERICA AND THE CARIBBEAN GENERAL SUPPORT 10900 MEDICAL EQUIPMENT FMV SUB-SAHARAN AFRICA GENERAL SUPPORT 84219 MEDICAL EQUIPMENT FMV 0 2 0 0 1 0 0 1 PART I, LINE 2: DUKE UNIVERSITY HEALTH SYSTEM, INC. PERIODICALLY APPROVES NONCASH ASSISTANCE AND TRANSFERS MEDICAL EQUIPMENT AND SUPPLIES TO ORGANIZATIONS OUTSIDE THE UNITED STATES, USUALLY IN RESPONSE TO NATURAL DISASTERS. THE ORGANIZATIONS AWARDED THE ASSISTANCE MUST MONITOR THE APPROPRIATE USE OF THE ASSISTANCE IN THE ORDINARY COURSE OF BUSINESS. GALA 172961 63222 109739 37076 37747 8044 16257 172961 63222 109739 37076 37747 8044 16257 99124 10615 FORM 990, SCHEDULE G, PART I, LINE 2B DUKE UNIVERSITY HEALTH SYSTEM, INC. SUPPORTS THE FUNDRAISING ACTIVITIES PERFORMED BY EMPLOYEES OF DUKE UNIVERSITY. SUCH ACTIVITIES ARE DESIGNED TO DEVELOP SUPPORT FOR BOTH THE UNIVERSITY AND THE DUKE UNIVERSITY HEALTH SYSTEM, INC.'S EDUCATIONAL, RESEARCH AND HEALTHCARE PURPOSES. DUKE UNIVERSITY RECEIVES AND DIRECTS THE CONTRIBUTIONS AS APPROPRIATE TO DUKE UNIVERSITY HEALTH SYSTEM, INC. DUKE UNIVERSITY HEALTH SYSTEM, INC. HAS NOT ENTERED INTO ANY ARRANGEMENTS WITH FUNDRAISERS UNDER WHICH THE ORGANIZATION MADE PAYMENTS EXCLUSIVELY FOR SUCH EXPENSES BUT NOT FOR PROFESSIONAL FUNDRAISING SERVICES. 1 1 X 1 X 1 X 1 1 1 0 1 1 118460903 118460903 0.03540 94944909 94944909 0.02840 213405812 213405812 0.06380 87324619 16545744 70778875 0.02110 12236868 12236868 0.00370 99561487 16545744 83015743 0.02480 312967299 16545744 296421555 0.08860 1 0 0 603133241 741553108 -138419867 X 1 1 3 1 DUKE UNIVERSITY HOSPITAL 2301 ERWIN ROAD PRIMARY CAMPUS DURHAM NC 27710 HTTP://WWW.DUKEHEALTH.ORG H0015 X X X X X X A 2 DUKE RALEIGH HOSPITAL 3400 WAKE FOREST ROAD PRIMARY CAMPUS RALEIGH NC 27609 HTTP://WWW.DUKEHEALTH.ORG H0238 X X X 3 DUKE REGIONAL HOSPITAL 3643 ROXBORO ROAD DURHAM NC 27704 HTTP://WWW.DUKEHEALTH.ORG H0233 X X X A DUKE UNIVERSITYDUKE REGIONAL HOSPITALS 0 0 1 X X X X X X X X X 18 1 1 1 1 X HTTP:/CORPORATE.DUKEHEALTH.ORG/COMMUNITY X HTTP://WWW.HEALTHYDURHAM.ORG X 1 18 1 HTTP://WWW.DUKEHEALTH.ORG 0 1 X 200.000000000000 300.000000000000 X X X 1 1 X X X 1 X HTTP://WWW.DUKEHEALTH.ORG X HTTP://WWW.DUKEHEALTH.ORG X HTTP://WWW.DUKEHEALTH.ORG X X X X X X X 1 X 0 X X X 1 X 0 1 DUKE RALEIGH HOSPITAL 2 0 0 1 X X X X X X X X X 16 1 1 1 1 X HTTP:/CORPORATE.DUKEHEALTH.ORG/COMMUNITY X HTTP://WWW.ADVANCECHC-ORG/COMMUNITY/HEALTH-NEEDS-ASSESSMENT X 1 16 1 HTTP://WWW.DUKEHEALTH.ORG 0 1 X 200.000000000000 300.000000000000 X X X 1 1 X X X 1 X HTTP://WWW.DUKEHEALTH.ORG X HTTP://WWW.DUKEHEALTH.ORG X HTTP://WWW.DUKEHEALTH.ORG X X X X X X X 1 X 0 X X X 1 X 0 1 NOTE: THIS SCHEDULE H CONTAINS REFERENCES TO DUKE AND DUKE HEALTH WHICH ARE MEANT TO ENCOMPASS FOR THE PURPOSES OF THIS SCHEDULE DUKE UNIVERSITY HEALTH SYSTEM (DUHS), DUKE UNIVERSITY SCHOOL OF MEDICINE, AND DUKE UNIVERSITY SCHOOL OF NURSING. PART V, SECTION B:GROUP A - FACILITY 1 - DUKE UNIVERSITY HOSPITALPART V, SECTION B, LINE 5: DUKE UNIVERSITY HOSPITAL ("DUH") DUH COLLABORATES WITH THE PARTNERSHIP FOR A HEALTHY DURHAM (THE STATE CERTIFIED HEALTHY CAROLINIANS GROUP) AND THE DURHAM COUNTY HEALTH DEPARTMENT TO CONDUCT THE DURHAM COUNTY COMMUNITY HEALTH ASSESSMENT AND DEVELOPS STRATEGIES TO ADDRESS IDENTIFIED NEEDS. FACULTY AND STAFF OF THE DUKE DIVISION OF COMMUNITY HEALTH AND APPOINTED MEMBERS OF THE DUH SENIOR LEADERSHIP TEAM OFFICIALLY SERVE ON THE PARTNERSHIP FOR A HEALTHY DURHAM COMMITTEES.THE MOST RECENT ASSESSMENT PROCESS CONDUCTED IN CALENDAR YEAR 2017 COMPILED VALID AND RELIABLE INFORMATION ABOUT THE HEALTH OF DURHAM. IT INCLUDED 358 CITIZEN SURVEYS FROM RANDOMLY SELECTED HOUSEHOLDS AND 3 COMMUNITY LISTENING SESSIONS WITH 42 COMMUNITY MEMBERS. THE SURVEY WAS ALSO CONDUCTED IN PERSON AT GROCERY STORES, LIBRARIES, DURHAM COUNTY DEPARTMENT OF PUBLIC HEALTH CLINICS, AND BUS STATIONS. THE COMMUNITY HEALTH ASSESSMENT TEAM - COMPRISED OF MEMBERS REPRESENTING, DUKE UNIVERSITY HEALTH SYSTEM, UNIVERSITIES, LOCAL GOVERNMENT, SCHOOLS, NON-PROFIT ORGANIZATIONS AND BUSINESSES - WORKED TO DIRECT THE ACTIVITIES OF THE ASSESSMENT AND PROVIDE WRITTEN CONTENT AND EXPERTISE ON ISSUES OF INTEREST. THIS JOINT CHNA AND RELATED IMPLEMENTATION PLAN WAS ADOPTED BY THE DUHS BOARD OF DIRECTORS AND PUBLISHED ON THE DUKE HEALTH WEBSITE IN FISCAL YEAR 2019 (TAX YEAR 2018).GROUP A - FACILITY 1 - DUKE UNIVERSITY HOSPITALPART V, SECTION B, LINE 6A: DUKE REGIONAL HOSPITAL ("DRH")GROUP A - FACILITY 1 - DUKE UNIVERSITY HOSPITALPART V, SECTION B, LINE 6B: THE PARTNERSHIP FOR A HEALTHY DURHAM AND THE DURHAM COUNTY HEALTH DEPARTMENTGROUP A - FACILITY 1 - DUKE UNIVERSITY HOSPITALPART V, SECTION B, LINE 11: THE ASSESSMENT IDENTIFIED FIVE HEALTH PRIORITIES FOR 2018 - 2020: 1. AFFORDABLE HOUSING 2. ACCESS TO HEALTHCARE AND HEALTH INSURANCE3. POVERTY 4. MENTAL HEALTH 5. OBESITY, DIABETES AND FOOD ACCESS ALL OF THE PROGRAMS DESCRIBED IN THE FOLLOWING IMPLEMENTATION PLAN ARE ALIGNED WITH THE FIVE HEALTH PRIORITIES WITH MANY OF THE PROGRAMS ADDRESSING COMBINATIONS OF THE FIVE HEALTH PRIORITIES. A BRIEF EXCERPT FROM THE COMMUNITY HEALTH NEEDS ASSESSMENT DESCRIBING EACH PRIORITY IS INCLUDED IN THIS IMPLEMENTATION PLAN. DUH CONSIDERS THIS DOCUMENT TO BE A "WORKING PLAN" THAT WILL CONTINUE TO EVOLVE OVER THIS THREE YEAR PERIOD IN ORDER TO ENSURE THE EFFICACY OF STRATEGIES INTENDED TO MEET EXPRESSED COMMUNITY HEALTH NEEDS. THIS IMPLEMENTATION PLAN MAY NOTE, BUT DOES NOT CONTAIN DETAILED DESCRIPTIONS OF THE COMMUNITY HEALTH IMPROVEMENT WORK CARRIED OUT BY OTHER COMPONENTS OF THE LARGER DUKE HEALTH SYSTEM OR DUKE UNIVERSITY. THIS IMPLEMENTATION PLAN IS INTENDED TO HIGHLIGHT DUKE HOSPITAL'S CONTINUALLY EVOLVING ACTIVITIES AND SUPPORT TO IMPROVE HEALTH WITH THE DURHAM COMMUNITY.TOGETHER, WITH ITS PARTNERS, DUH ASKS ABOUT AND LISTENS TO CONCERNS, EXPLORES BARRIERS TO CARE, ANALYZES HEALTHCARE UTILIZATION AND COSTS, IDENTIFIES PARTNER NEEDS AND RESOURCES, PLANS/REDESIGNS SERVICES, TRACKS OUTCOMES, AND SHARES ACCOUNTABILITY IN ORDER TO DEVELOP EFFECTIVE PROGRAMS TO IMPROVE THE HEALTH OF THE DURHAM COMMUNITY. AS SUCH THIS IMPLEMENTATION PLAN INCLUDES NEW AND LONG-STANDING PROGRAMS. 1. AFFORDABLE HOUSINGAFFORDABLE HOUSING, AS DEFINED BY HUD (U.S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT), REQUIRES NO MORE THAN 30% OF A FAMILY'S MONTHLY INCOME. IF A FAMILY SPENDS MORE THAN 30% OF INCOME ON HOUSING, THEY ARE LESS ABLE TO PAY FOR OTHER EXPENSES, SUCH AS FOOD AND HEALTHCARE. THE INCREASED COST BURDEN OF UNAFFORDABLE HOUSING ADDS TO PSYCHOSOCIAL STRESSORS THAT CAN NEGATIVELY IMPACT A FAMILY. RENTERS MAKE UP 40% OF HOUSEHOLDS IN DURHAM, AND ALMOST HALF OF THEM ARE DEFINED AS COST-BURDENED (I.E. PAYING MORE THAN 30% OF THEIR MONTHLY INCOME FOR HOUSING).WHILE DUH HAS PARTNERED WITH HABITAT FOR HUMANITY OF DURHAM ON A NUMBER OF HOME BUILDS, AFFORDABLE HOUSING IS A FOCUS OF THE LARGER DUKE UNIVERSITY. IN 2018, FUNDING FROM DUKE UNIVERSITY AND THE AJ FLETCHER FOUNDATION PROVIDED THE OPPORTUNITY TO DEVELOP TWO ACRES OF PRIME DOWNTOWN DURHAM LAND INTO MULTI-UNIT AFFORDABLE HOUSING. DUKE UNIVERSITY IS ALSO WORKING WITH THE CITY OF DURHAM TO DEVELOP AN AFFORDABLE HOUSING TRUST FUND. 2. ACCESS TO HEALTHCARE AND HEALTH INSURANCE:ACCESS TO HEALTHCARE IN A COMMUNITY REFERS TO THE ABILITY OF RESIDENTS TO FIND A CONSISTENT MEDICAL PROVIDER FOR THEIR PRIMARY CARE NEEDS, TO FIND A SPECIALTY PROVIDER WHEN NEEDED AND TO BE ABLE TO RECEIVE THAT CARE WITHOUT ENCOUNTERING SIGNIFICANT BARRIERS. ALTHOUGH THERE ARE MANY MEDICAL PROVIDERS, WHICH INCLUDES A NUMBER OF LOW COST AND FREE CLINICS IN DURHAM COUNTY, THERE ARE STILL MANY DURHAM RESIDENTS WHO HAVE TROUBLE ACCESSING CARE WHEN THEY NEED IT. BARRIERS TO OBTAINING HEALTHCARE CAN RANGE IN ISSUES WITH TRANSPORTATION, LANGUAGE BARRIERS, OR DISTRUST OF THE HEALTHCARE SYSTEM. ACCORDING TO THE COMMUNITY HEALTH ASSESSMENT SURVEY, THE TOP REASONS IDENTIFIED BY DURHAM COUNTY RESIDENTS FOR WHY THEY OR SOMEONE IN THEIR HOUSEHOLD COULD NOT ACCESS NECESSARY HEALTHCARE INCLUDED INSURANCE DIDN'T COVER SERVICE, COPAY WAS TOO HIGH, LACK OF INSURANCE, COULDN'T GET AN APPOINTMENT, DIDN'T KNOW WHERE TO GO OR PROVIDER DIDN'T TAKE THEIR INSURANCE.A NUMBER OF PROGRAMS SUPPORTED BY DUH SEEK TO INCREASE ACCESS TO CARE FOR UNINSURED, UNDERINSURED, AND/OR VULNERABLE INDIVIDUALS AND FAMILIES. THOSE PROGRAMS INCLUDE:PROJECT ACCESS OF DURHAM COUNTY (PADC): LINKS ELIGIBLE LOW-INCOME, UNINSURED, DURHAM COUNTY RESIDENTS TO SPECIALTY MEDICAL CARE FULLY DONATED TO THE PATIENTS BY THE PHYSICIANS, HOSPITALS INCLUDING DUH, LABS, CLINICS AND OTHER PROVIDERS PARTICIPATING IN THE PADC NETWORK.PLANS FOR FY19: CONTINUE TO WORK WITH PADC TO PROVIDE LOW-INCOME, UNINSURED DURHAM COUNTY RESIDENTS DONATED SPECIALTY SERVICES AND CONTINUE TO ASSIST IN SUPPORTING THE GROWTH OF THE MEDICAL RESPITE PROGRAM. THE MEDICAL RESPITE PROGRAM BENEFITS PARTICIPANTS BY PROVIDING CONNECTIONS TO PRIMARY CARE SERVICES, MENTAL HEALTH AND/OR SUBSTANCE ABUSE SERVICES, AND ASSISTANCE IN TRANSITIONING TO STABLE HOUSING.PROGRESS IN FY19: PADC CELEBRATED ITS 10TH ANNIVERSARY IN APRIL 2019 AND CONTINUED TO MEET ITS ANNUAL GOAL OF PROVIDING SPECIALTY CARE TO 2,000 INDIVIDUALS. WITH THE ADDED SUPPORT SERVICES, THE EPISODES OF CARE TOTAL APPROXIMATELY 3,000. PADC'S MEDICAL RESPITE PROGRAM, NOW NAMED THE DURHAM HOMELESS CARE TRANSITIONS PROGRAM, SERVES AN AVERAGE CENSUS OF 40 INDIVIDUALS. IN ADDITION, PADC HAS A LOAN PROGRAM FOR DURABLE MEDICAL EQUIPMENT. ON AVERAGE, THE HEALTH EQUIPMENT LOAN PROGRAM (HELP) LOANS 1,000 PIECES OF DURABLE MEDICAL EQUIPMENT EACH YEAR TO INDIVIDUALS WHO CANNOT AFFORD THESE NECESSARY RESOURCES.LOCAL ACCESS TO COORDINATED HEALTHCARE (LATCH): WAS INITIATED IN 2002 WITH HEALTHY COMMUNITIES ACCESS PROGRAM (HCAP) FUNDING FROM THE US HEALTH RESOURCES AND SERVICES ADMINISTRATION (HRSA) TO DUKE'S DIVISION OF COMMUNITY HEALTH, DEPARTMENT OF COMMUNITY AND FAMILY MEDICINE. THE FOUNDING AND SUSTAINING LATCH PARTNERSHIP INCLUDES DUH (WHICH NOW PROVIDES THE MAJORITY OF OPERATING FUNDS), LINCOLN COMMUNITY HEALTH CENTER, THE DURHAM COUNTY DEPARTMENTS OF HEALTH AND SOCIAL SERVICES, EL CENTRO HISPANO, AND A NUMBER OF COMMUNITY-BASED ORGANIZATIONS (CBOS). THROUGH COMMUNITY-BASED, LINGUISTICALLY AND CULTURALLY-RELEVANT CARE MANAGEMENT, LATCH AIMS TO IMPROVE HEALTH KNOWLEDGE AND SELF-CARE, ACCESS TO HEALTH CARE AND HEALTH SERVICES UTILIZATION OUTCOMES AMONG DURHAM COUNTY'S UNINSURED. CARE MANAGEMENT SERVICES INCLUDE: HEALTH SERVICES COORDINATION AND NAVIGATION (MEDICAL, SOCIAL, BEHAVIORAL); POST-HOSPITALIZATION FOLLOW-UP; PATIENT EDUCATION; CHRONIC DISEASE MANAGEMENT; PSYCHO-SOCIAL SUPPORT; ACCESS TO BENEFITS (MEDICAID/SSI/SSDI); BILLS ASSISTANCE; INTERPRETATION/TRANSLATION; AND, TRANSPORTATION COORDINATION. IN PARTNERSHIP WITH OTHER COMMUNITY STAKEHOLDERS-HEALTHCARE AND SOCIAL SERVICE PROVIDERS, LOCAL GOVERNMENT AND COMMUNITY-BASED ORGANIZATIONS-LATCH MONITORS HEALTHCARE TRENDS, IDENTIFIES BARRIERS FACING UNINSURED PATIENTS, AND, WORKING AS A CONSORTIUM, ADDRESSES AND ELIMINATES BARRIERS.PLANS FOR FY2019: LATCH ANTICIPATES SERVING AT LEAST 2,500 INDIVIDUALS IN 2019. PROGRESS IN FY19: DESPITE A NUMBER OF STAFFING CHANGES IN 2019, LATCH STILL SERVED APPROXIMATELY 2,100 INDIVIDUALS IN 2019.THE COMPLEX CHILD PROGRAM (CCP): PROVIDES THE COORDINATION OF MEDICAL AND CO-MANAGEMENT OF MEDICAL CARE FOR CHILDREN WITH MULTIPLE MEDICALLY COMPLEX ISSUES THAT REQUIRE THE INTERACTION WITH MULTIPLE SPECIALISTS. ON AVERAGE THESE CHILDREN WORK WITH 13 SPECIALISTS. BEFORE THE COMPLEX CHILD PROGRAM, CARE COULD SEEM FRAGMENTED AS PATIENTS/FAMILIES HAD NO CENTRAL "QUARTERBACK" HELPING TO OVERSEE THE BIG PICTURE.THROUGH THE CCP PARENTS NOW HAVE DIRECT PHONE ACCESS TO A COMPLEX CARE SERVICE (CCS) PROVIDER OR RN 24/7. THE CCP TEAM WORKS WITH PARENTS TO CREATE A COMPREHENSIVE "COMPLEX CARE PLAN" THAT IS PLACED IN THE CHILD'S MEDICAL RECORD AND GIVEN TO THE PARENTS. IN ADDITION, THE CCP TEAM COORDINATES INPATIENT INTENSIVE CARE TRANSITIONS PRIOR TO DISCHARGE AND CONDUCTS INTENSIVE OUTPATIENT "BETWEEN-VISIT" CONTACTS (PHONE, CLINIC VISITS, AND IN SOME CASES, HOME VISITS). THE SERVICE IS CURRENTLY PROVIDING CARE TO 92 PATIENTS.PLANS FOR FY2019: THE CCP PLANS TO INCREASE STAFF TO SUPPORT UP TO 160 PATIENTS. PROGRESS IN FY2019: CCP HAS SERVED 156 CHILDREN SINCE INCEPTION AND IS CURRENTLY PROVIDING CARE TO 106 PATIENTS. THE VOLUME/CENSUS OF THE PROGRAM DEPENDS UPON THE CHILDREN WHO NEED THE SERVICE, AND STAFFING VOLUME FLEXES TO MEET THE NEEDS OF THE CHILDREN AND THEIR FAMILIES.SOUTHERN HIGH SCHOOL (SHS) WELLNESS CENTER: PROVIDES COMPREHENSIVE PRIMARY CARE AND MENTAL HEALTH SERVICES AT SHS TO STUDENTS AT THE SCHOOL AND IS OPEN TO ALL STUDENTS AND STAFF OF DURHAM PUBLIC SCHOOLS. IT IS OPERATED BY DUKE'S DIVISION OF COMMUNITY HEALTH ON BEHALF OF DUH AND WILL CELEBRATE 23 YEARS OF SERVICE IN 2019. JUST FOR US (JFU): PROVIDES AN IN-HOME CARE PROGRAM FOR LOW-INCOME, FRAIL ELDERLY AND DISABLED. JFU WAS LAUNCHED IN 2002 AS A COLLABORATION OF DUKE, LINCOLN COMMUNITY HEALTH CENTER, DURHAM DEPARTMENT OF SOCIAL SERVICES (DSS), THE LOCAL AREA MENTAL HEALTH ENTITY, AND THE DURHAM HOUSING AUTHORITY. DUH PROVIDES THE MAJORITY OF ONGOING SUPPORT FOR THE PROGRAM. THROUGH JFU, AN INTERDISCIPLINARY TEAM OF PROVIDERS SERVES CLIENTS IN THEIR HOMES, PROVIDING MEDICAL CARE, MANAGEMENT OF CHRONIC ILLNESSES, AND CASE MANAGEMENT. EACH PARTICIPANT RECEIVES A HOME VISIT EVERY 5 WEEKS UNLESS THERE IS AN ACUTE EPISODE OR A HOSPITAL DISCHARGE, FOR WHICH A VISIT IS SCHEDULED IMMEDIATELY. VISITS INCLUDE MEDICATION RECONCILIATION, SOCIAL ISSUES, SUPPORT SERVICES, CHRONIC DISEASE MANAGEMENT, AND POST-HOSPITAL CARE. THE HEALTH CARE TEAM CONSISTS OF A CLINICAL PROVIDER (PA, NP OR MD), OCCUPATIONAL THERAPIST, REGISTERED DIETITIAN, SOCIAL WORKER, PHLEBOTOMIST, AND COMMUNITY HEALTH WORKER.NEIGHBORHOOD/COMMUNITY CLINICS: DUH IN PARTNERSHIP WITH LINCOLN COMMUNITY HEALTH CENTER COLLABORATIVELY OPERATES THREE COMMUNITY HEALTH CLINICS; THE LYON PARK COMMUNITY CLINIC, THE WALLTOWN NEIGHBORHOOD CLINIC AND THE HOLTON WELLNESS CENTER. THE CLINICS WERE DESIGNED TO PROVIDE PRIMARY CARE, HEALTH EDUCATION, AND DISEASE PREVENTION TO THE UNDERSERVED POPULATIONS OF DURHAM. THE CLINICS PROVIDE MEDICAL CARE FOR PERSONS WITH AND WITHOUT HEALTH INSURANCE. THOSE WITHOUT INSURANCE ARE SEEN BASED ON A SLIDING FEE SCALE. NO PATIENT IS DENIED CARE BASED ON INABILITY TO PAY FOR SERVICES. THE LYON PARK CLINIC WAS THE FIRST OF THE COLLABORATIVE NEIGHBORHOOD CLINICS, OPENING ITS DOORS FOR PATIENT CARE IN APRIL 2003. THE WALLTOWN CLINIC OPENED IN JANUARY 2005 AND THE HOLTON CLINIC OPENED IN AUGUST 2009. EACH CLINIC RECEIVED START-UP FUNDS THROUGH A DUKE ENDOWMENT GRANT. CLINICS GENERATE REVENUE THROUGH A CONTRACT WITH LINCOLN COMMUNITY HEALTH CENTER AND RECEIVE SIGNIFICANT SUPPORT FROM DUH. THE CLINICS OPERATE AS FAMILY MEDICINE PRACTICES AND ARE OPEN 5 DAYS A WEEK. STAFFING INCLUDES PHYSICIAN ASSISTANTS, NURSE PRACTITIONERS AND FAMILY PHYSICIANS, WHO SERVE AS SUPERVISING DOCTORS. EACH CLINIC IS SUPPORTED BY NURSING STAFF: CERTIFIED NURSING ASSISTANTS, LICENSED PRACTICAL NURSES, OR CERTIFIED MEDICAL ASSISTANTS AND A STAFF ASSISTANT. THE STAFF ASSISTANT PERFORMS ALL ADMINISTRATIVE TASKS FOR THE CLINIC INCLUDING ANSWERING INCOMING PHONE CALLS, REGISTRATION, SCHEDULING, ETC. PLANS FOR FY2019: THE SHS WELLNESS CENTER, JFU, AND THE NEIGHBORHOOD/COMMUNITY CLINICS ANTICIPATE PROVIDING MORE THAN 13,000 CLINICAL ENCOUNTERS IN 2019. PROGRESS IN FY2019: THE SHS WELLNESS CENTER, JFU, AND THE NEIGHBORHOOD/COMMUNITY CLINICS STRUGGLED WITH PERIODS OF STAFF SHORTAGES. IN SPITE OF PERIODS OF STRETCHED STAFFING, THE CLINICAL ENCOUNTERS FOR 2019 TOTALLED 11,753.3. POVERTYPOVERTY HAS A STRONG IMPACT ON HEALTH AND IS AN IMPORTANT CONCERN FOR DURHAM RESIDENTS. RESEARCH NOW SHOWS THAT EVEN THE RISK OF AN ADVERSE CHANGE IN MATERIAL CONDITIONS, ECONOMIC AND HOUSING INSECURITY, AS WELL AS UNINSURED OR UNDERINSURED HEALTH INSURANCE COVERAGE, AFFECT HEALTH OUTCOMES. REASONS FOR THE ASSOCIATION BETWEEN ECONOMIC INSECURITY AND HEALTH INCLUDE THE HEALTH EFFECTS OF STRESS RESULTING FROM ECONOMIC INSECURITY, EFFECTS OF STRESS AND SPENDING LIMITATIONS ON FOOD CONSUMPTION, AND RESTRICTED USE OF HEALTH SERVICES.IN CALENDAR YEAR 2019, DUKE UNIVERSITY AND HEALTH SYSTEM PLANNED TO INCREASE THE MINIMUM WAGE TO $15 DOLLARS PER HOUR FOR ALL EMPLOYEES AND EXPECTS ALL CONTRACTORS WITH EMPLOYEES WORKING FULL-TIME ON CAMPUS TO DO THE SAME. EFFECTIVE JULY 1, 2018, THE MINIMUM WAGE WAS INCREASED TO $14 PER HOUR FOR ALL ELIGIBLE STAFF, AND EFFECTIVE JULY 1, 2019, THE MINIMUM WAGE AT DUKE INCREASED TO $15 PER HOUR FOR ALL ELIGIBLE STAFF. IN ADDITION, DUKE STOPPED REQUIRING JOB APPLICANTS TO DISCLOSE CRIMINAL HISTORY DURING THE APLICATION PROCESS AS OF SEPTEMBER 2018.THE FOLLOWING PROGRAMS ALSO HELP ADDRESS THE COMMUNITY HEALTH NEED OF POVERTY:SSI/SSDI OUTREACH, ACCESS AND RECOVERY (SOAR): HELPS PATIENTS WHO ARE CHRONICALLY HOMELESS, OR AT RISK OF HOMELESSNESS ACCESS HEALTH INSURANCE, A STABLE INCOME, AND MEDICAL CARE BY ASSISTING THESE INDIVIDUALS IN APPLYING FOR SUPPLEMENTAL SECURITY INCOME (SSI) AND SOCIAL SECURITY DISABILITY INSURANCE (SSDI). THE HOMELESS POPULATION AND THOSE REENTERING THE COMMUNITY FROM AN INSTITUTION FACE NUMEROUS CHALLENGES IN ACCESSING SERVICES. APPROVAL ON INITIAL SSI AND SSDI APPLICATIONS FOR THESE AT-RISK POPULATIONS, WHO HAVE NO ONE TO ASSIST, IS ABOUT 10-15 PERCENT. FOR THOSE WITH MENTAL ILLNESS, SUBSTANCE ABUSE ISSUES, AND/OR CO-COGNITIVE IMPAIRMENT, THE APPLICATION PROCESS IS EVEN MORE DIFFICULT. EVEN WITH ASSISTANCE, THE APPLICATION PROCESS CAN TAKE UP TO SIX MONTHS. THROUGH SOAR, THESE INDIVIDUALS WITH COMPLEX NEEDS ARE PROVIDED CASE MANAGEMENT FOR HOME, HOSPITAL, AND CLINIC VISITS; PROVIDED WITH A STEP BY STEP EXPLANATION AND COMPLETION OF ALL APPLICATIONS FOR FEDERAL DISABILITY BENEFITS; RECEIVE EXPEDITED APPLICATIONS FOR MONTHLY INCOME AND MEDICAID/MEDICARE; AND LINKED TO COMMUNITY RESOURCES. DUH CURRENTLY FUNDS TWO SOAR CASE MANAGERS WHO HAVE SUCCESSFULLY HELPED MORE THAN 100 PATIENTS IN THE LAST THREE YEARS.PLANS FOR FY19: CONTINUE SOAR PROGRAM AND COMPLETE AT LEAST 200 REFERRALS PROGRESS IN FY19: UNFORTUNATELY, ONE OF THE SOAR PROGRAMS'S CASE MANAGERS LEFT THE PROGRAM IN FY 2019 AND REFERRALS DIPPED TO 97. HOWEVER, EVEN WITH REDUCED STAFFING, THE SOAR PROGRAM INCREASED ITS APPROVAL RATE TO 95%.BENEFITS ENROLLMENT COUNSELING (BEC): IN FY 16 THE DUKE DIVISION OF COMMUNITY HEALTH LAUNCHED THE BENEFITS ENROLLMENT COUNSELING PROGRAM (BEC) WITH GRANT FUNDING THROUGH THE NATIONAL COUNCIL ON AGING TO HELP SENIORS AND THOSE WITH DISABILITIES AND A LIMITED INCOME, FIND AND ENROLL IN ALL THE BENEFITS PROGRAMS FOR WHICH THEY ARE ELIGIBLE. THE GOAL OF THE SERVICE IS TO ENABLE OLDER ADULTS TO ENJOY LIFE AND LIVE INDEPENDENTLY IN THEIR HOMES AND COMMUNITIES FOR AS LONG AS POSSIBLE. FOR THOSE WITH LIMITED INCOME AND RESOURCES, ADDITIONAL SUPPORT CAN BE CRITICAL IN MAINTAINING THEIR HEALTH AND AVOIDING COSTLY HOSPITALIZATIONS. THE BENEFITS PROVIDE CLIENTS SERVED WITH ACCESS TO HEALTHY FOOD, NEEDED MEDICAL CARE AND PRESCRIPTIONS, AS WELL AS OTHER SUPPORTIVE SERVICES. THE BENEFITS ALSO PROVIDE A COMMUNITY ECONOMIC STIMULUS, AS BENEFITS ARE SPENT LOCALLY IN PHARMACIES, GROCERY STORES, UTILITY COMPANIES, AND HEALTH CARE PROVIDERS. TO INCREASE THE REACH OF THE PROGRAM BEYOND GRANT FUNDING, BEC STAFF TRAIN VOLUNTEERS (FROM PARTNER COMMUNITY BASED ORGANIZATIONS AND DUKE) TO ASSIST CLIENTS IN DURHAM, GRANVILLE, AND PERSON COUNTIES. BEC CURRENTLY WORKS WITH 26 DUKE UNDERGRADUATES AND MEDICAL STUDENTS TO ENGAGE IN SERVICE, OUTREACH, AND ADVOCACY EFFORTS AS WELL AS BUILD MEANINGFUL INTERGENERATIONAL RELATIONSHIPS.PLANS FOR FY19: PROJECTS IN DEVELOPMENT ARE COPE (COMMUNITY OUTREACH, PREVENTION, AND EDUCATION) WHICH OFFERS HEALTH SCREENING AND EDUCATION IN THE COMMUNITY, AND INITIATIVES THAT DIRECTLY ADDRESS GAPS IN SENIOR HUNGER PREVENTION THROUGH SELF-SUFFICIENT, SUSTAINABLE GARDENING PRACTICES AND THE PROVISION OF COOKING CLASSES AT SENIOR CENTERS.PROGRESS IN FY19: IN 2019 BEC ASSISTED 894 INDIVIDUALS WITH A TOTAL OF 2,553 APPLICATIONS FOR BENEFIT PROGRAMS. THE TOTAL VALUE OF BENEFITS WAS $5,799,848. IN ADDITION, BEC ORGANIZED THE PLANNING AND HAS RECRUITED THE VOLUNTEER POWER TO INSTALL A TWO ACRE ROOFTOP GARDEN IN DOWNTOWN DURHAM THAT WILL GROW FRUITS AND VEGETABLES FOR CLIENTS SERVED BY BEC.4. MENTAL HEALTHMENTAL HEALTH AND SUBSTANCE USE DISORDERS HAVE DIRECT COSTS SUCH AS PREVENTION, TREATMENT, AND RECOVERY SUPPORTS. BUT, THERE ARE ALSO INDIRECT COSTS SUCH AS MOTOR VEHICLE ACCIDENTS, PREMATURE DEATH, COMORBID HEALTH CONDITIONS, DISABILITY, LOST PRODUCTIVITY, UNEMPLOYMENT, POVERTY, SCHOOL DIFFICULTIES, ENGAGEMENT WITH SOCIAL SERVICE, JUVENILE JUSTICE, CRIMINAL JUSTICE SYSTEMS, AND HOMELESSNESS, AMONG OTHER PROBLEMS. DUH PARTNERS WITH AND SUPPORTS A NUMBER OF COLLABORATIVE INITIATIVES TO IMPROVE ACCESS TO MENTAL HEALTH SERVICES AND REDUCE SUBSTANCE ABUSE. PLANS FOR FY19: DUH WILL CONTINUE TO SERVE AS A KEY PARTNER IN THE FOLLOWING ACTIVITIES:* COMMUNITY COALITIONS: DURHAM CRISIS COLLABORATIVE; PARTNERSHIP FOR A HEALTHY DURHAM SUBSTANCE USE AND MENTAL HEALTH COMMITTEE AND DURHAM TOGETHER FOR RESILIENT YOUTH; DURHAM COUNTY LEADERSHIP FORUM ON SUBSTANCE ABUSE AND MENTAL HEALTH.* NALOXONE OUTREACH: PHARMACIES (DUKE SOUTH, CLINIC PHARMACY, MAIN STREET, GURLEY'S, JOSEF'S, & DUKE CANCER SPECIALTY); DURHAM COUNTY DEPARTMENT OF PUBLIC HEALTH; DURHAM MOBILE CRISIS UNIT. * PROVIDER EDUCATION: PROVIDER TOOLKITS AND CME EDUCATION; USE OF PAIN AGREEMENTS; USE OF CONTROLLED SUBSTANCE REPORTING SYSTEM (CSRS); CHRONIC PAIN PROVIDER CONSULTATION CALLS.* DIVERSION CONTROL: PERMANENT DROP BOXES IN 5 OF 6 COUNTIES (DURHAM, FRANKLIN, PERSON, GRANVILLE, & VANCE).* CHRONIC PAIN PATIENT SUPPORT: CHRONIC PAIN SELF-MANAGEMENT WORKSHOPS AT LINCOLN COMMUNITY HEALTH CENTER; CHRONIC PAIN MANAGEMENT RESOURCES; KEY COMMUNITY PRESENTATIONS.* COUNTY-WIDE ADVERSE CHILDHOOD EXPERIENCES (ACES) AND COMMUNITY RESILIENCY MODEL (CRM): ACTIVITIES AND TRAINING.PROGRESS IN FY19: PARTNERSHIP IN THE ACTIVITIES LISTED ABOVE YIELDED A NUMBER OF ACCOMPLISHMENTS INCLUDING: HIRING PEER SUPPORT SPECIALISTS FOR THE DUH EMERGENCY DEPARTMENT; UPLOADING THE MENTAL HEALTH AND SUBSTANCE MISUSE RESOURCE GUIDE TO DUKE'S ELECTRONIC HEALTH RECORD FOR EASY ACCESS BY PROVIDERS; AND THE LAUNCH OF A MEDICATION ASSISTED THERAPY PROGRAM IN THE DURHAM COUNTY JAIL. IN ADDITION, CHRONIC PAIN SELF-MANAGEMENT WORKSHOPS CONTINUED AT LINCOLN COMMUNITY HEALTH CENTER AND THE ACTIVITIES AND TRAINING IN ACES AND CRM CONTINUED ACROSS THE COUNTY. DUHS SAFE OPIOID TASK FORCE: WAS CREATED TO IMPROVE THE SAFETY OF PAIN MANAGEMENT BY ENCOURAGING CLINICAL PRACTICE STANDARDIZATION, WHERE CLINICALLY APPROPRIATE, WHEN OPIOID THERAPY IS DESIGNATED FOR TREATMENT. THE OPIOID SAFETY TASK FORCE PROVIDES RECOMMENDATIONS FOR THE INITIATION AND MANAGEMENT OF OPIOID THERAPY ACROSS DUKE UNIVERSITY HEALTH SYSTEM (DUHS) TO IMPROVE PERSONAL AND COMMUNITY SAFETY AND REDUCE HARM ASSOCIATED WITH THE HIGH RISK TREATMENTS WHILE ENGAGING PATIENTS IN THEIR OWN CARE. DUH ALONG WITH DUKE REGIONAL AND DUKE RALEIGH HOSPITALS SERVES AS A PIVOTAL PLAYER IN ALL ASPECTS OF THE WORK OF THE TASK FORCE.PLANS FOR FY19: PROVIDE PROVIDER TRAINING IN MEDICATION ASSISTED THERAPY.PROGRESS IN FY19: 29 PROVIDERS ACROSS DUKE WERE TRAINED IN MEDICATION ASSISTED THERAPY.5. OBESITY, DIABETES, AND FOOD ACCESSAS OF 2016, 65% OF ADULTS IN THE PIEDMONT REGION, WHICH INCLUDES DURHAM, WERE OVERWEIGHT OR OBESE. ADDITIONALLY, 12% OF DURHAM HIGH SCHOOLERS WERE OBESE AS OF 2014. OBESITY IS A STRONG CONTRIBUTOR TO DIABETES. IN 2015, 14.1% OF DURHAM COUNTY RESIDENTS AGED 18 YEARS OR OLDER WHO RECEIVED SOME LEVEL OF CARE FROM DUKE HEALTH AND/OR LINCOLN COMMUNITY HEALTH CENTER HAD DIABETES. MANY DISEASES ARE LINKED TO NUTRITION, INCLUDING OBESITY, HYPERTENSION, HIGH CHOLESTEROL, DIABETES, AND SOME CANCERS. FOOD INSECURITY, THE STATE OF BEING WITHOUT RELIABLE ACCESS TO A SUFFICIENT QUANTITY OF AFFORDABLE, NUTRITIOUS FOOD, HAS A LARGE IMPACT ON A PERSON'S DIET. IT IS ESTIMATED THAT 17.9% OF DURHAM RESIDENTS (51,710 PEOPLE) HAVE FOOD INSECURITY. BULL CITY FIT: IS A COMMUNITY-BASED WELLNESS PROGRAM AND IS PART OF THE THE LARGER DUKE CHILDREN'S HEALTHY LIFESTYLES PROGRAM. THE HEALTHY LIFESTYLES PROGRAM SEEKS TO ADDRESS WEIGHT-RELATED HEALTH PROBLEMS FOR CHILDREN BY OFFERING CARING PROVIDERS, FAMILY-CENTERED TREATMENT PROGRAMS, HIGHLY TRAINED EDUCATORS AND RESEARCHERS, AND STRONG COMMUNITY PARTNERSHIPS. BULL CITY FIT HELPS IN THIS EFFORT BY OFFERING FREE EVENING AND WEEKEND ACTIVITY SESSIONS FOR THE LARGER COMMUNITY. THESE SESSIONS COVER VARIOUS THEMES THAT ENCOURAGE AND PROMOTE ACTIVE LIVING, SUCH AS FITNESS GAMES, SPORT LESSONS, EXERCISE ROUTINES, SWIMMING, COOKING, AND GARDENING. EACH ACTIVITY IS FACILITATED WITH THE SUPPORT OF ENERGETIC STAFF AND VOLUNTEERS TO CREATE A POSITIVE AND FUN ENVIRONMENT FOR ALL.BULL CITY FIT EMPOWERS THE WHOLE FAMILY TO INCREASE KNOWLEDGE AND PRACTICE OF PHYSICAL ACTIVITY AND HEALTHY EATING; ADDRESS CURRENT WEIGHT-RELATED ILLNESS AND PREVENT CHRONIC DISEASE THROUGH INCREASED ACTIVITY LEVELS; IMPROVE QUALITY OF LIFE BY PROMOTING HEALTHY BEHAVIORS; INCREASE CONFIDENCE, SUPPORT POSITIVE CHANGE, AND BUILD A LIFELONG COMMITMENT TO A HEALTHY LIFESTYLE.PARTNERS INCLUDE: DURHAM PARKS AND RECREATION; DURHAM CITY GOVERNMENT; DURHAM COUNTY DEPARTMENT OF PUBLIC HEALTH; EAST DURHAM CHILDREN'S INITIATIVE; LINCOLN COMMUNITY HEALTH CENTER; COMMUNITY NUTRITION PARTNERSHIP; VEGGIE VAN; BLUE POINTE YOGA; DURHAM PUBLIC SCHOOLS; PARTNERSHIP FOR A HEALTHY DURHAM; DUKE SERVICE LEARNING; DUKE FAMILY MEDICINE; DUKE CHILDREN'S HOSPITAL AND THE UNC SCHOOL OF SOCIAL WORK.PLANS FOR FY19: EXPAND THE BULL CITY FIT PROGRAM BY PLANNING FOR ADDITIONAL SITES.PROGRESS IN FY19: BULL CITY FIT SECURED EXTERNAL FUNDING IN 2019 TO EXPAND STAFFING AND BEGAN WORK TO MOVE FORWARD WITH EXPANSION TO ADDITIONAL SITES. GROUP A - FACILITY 1 - DUKE UNIVERSITY HOSPITAL PART V, SECTION B, LINE 16J: AS PART OF DUHS, DUKE UNIVERSITY HOSPITAL PROVIDES A BROCHURE TO ALL ADMISSIONS THAT INCLUDES A BRIEF SUMMARY OF DUHS FINANCIAL ASSISTANCE POLICIES. DUHS ALSO COMMENTS ON THE BACK OF ITS BILLING INVOICES THAT PATIENTS SHOULD CONTACT PATIENT ACCOUNT REPRESENTATIVES TO HELP THEM IF THEY CANNOT PAY THEIR BILL IN FULL. THIS COMMENT REFERENCES GOVERNMENT-SPONSORED PROGRAMS, MONTHLY PAYMENT PROGRAMS, AND OTHER FINANCIAL ASSISTANCE PROGRAMS AVAILABLE FOR PATIENTS WHO MEET CERTAIN FINANCIAL CRITERIA. DUHS ALSO PUBLICIZED ITS FINANCIAL ASSISTANCE POLICY VERBALLY THROUGH ITS FINANCIAL CARE COUNSELORS. PART V, SECTION B, LINE 24: CERTAIN ELECTIVE COSMETIC/AESTHETIC SERVICES, AND OTHER ELECTIVE SERVICES, WILL BE BILLED AT AN AMOUNT EQUAL TO GROSS CHARGES.DUKE RALEIGH HOSPITAL:PART V, SECTION B, LINE 5: DUKE RALEIGH HOSPITAL COLLABORATED WITH WAKE COUNTY HUMAN SERVICES, WAKEMED HEALTH AND HOSPITALS, UNC REX HEALTHCARE, ADVANCE COMMUNITY HEALTH, UNITED WAY OF THE GREATER TRIANGLE, AND THE WAKE COUNTY MEDICAL SOCIETY COMMUNITY HEALTH FOUNDATION IN CONDUCTING THE 2016 WAKE COUNTY COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA). THE PROCESS OF DETERMINING THE PRIORITY HEALTH NEEDS FOR THE 2016 WAKE COUNTY CHNA BEGAN WITH THE COLLECTION AND ANALYSIS OF HUNDREDS OF DATA POINTS. ALL INDIVIDUAL DATA MEASURES FROM BOTH PRIMARY (NEW) AND SECONDARY (EXISTING) SOURCES WERE GATHERED, ANALYZED, AND INTERPRETED. IN ORDER TO COMBINE DATA POINTS INTO MORE EASILY DISCUSSABLE CATEGORIES, DATA MEASURES WERE SORTED BY COMMON THEMES AND DEVELOPED INTO TWENTY-ONE DATA CATEGORIES. PRIMARY (NEW) DATA COLLECTION: COMMUNITY MEMBERS PROVIDED INPUT FOR THE STUDY THROUGH INTERNET-BASED AND TELEPHONE SURVEYS, FOCUS GROUPS, AND PRIORITIZATION MEETINGS THAT WERE HELD THROUGHOUT THE COUNTY. ADDITIONALLY, KEY LEADERS OF ORGANIZATIONS REPRESENTING BROAD INTERESTS OF THE COMMUNITY PROVIDED INPUT THROUGH AN INTERNET-BASED SURVEY, PARTICIPATION ON THE STEERING COMMITTEE, AND A PRIORITIZATION SURVEY. THE PROCESS ALSO HAD SIGNIFICANT INPUT AND DIRECTION FROM THE COMMUNITY HEALTH ASSESSMENT TEAM. CONSIDERING ALL OF THESE SOURCES, INPUT FROM MORE THAN 1,500 WAKE COUNTY RESIDENTS AND ORGANIZATIONAL LEADERS IS INCLUDED IN THIS COMMUNITY HEALTH NEEDS ASSESSMENT. SECONDARY (EXISTING) DATA: KEY SOURCES FOR EXISTING DATA ON WAKE COUNTY INCLUDED NUMEROUS PUBLIC DATA SOURCES RELATED TO DEMOGRAPHICS, SOCIAL AND ECONOMIC DETERMINANTS OF HEALTH, ENVIRONMENTAL HEALTH, HEALTH STATUS AND DISEASE TRENDS, MENTAL/BEHAVIORAL HEALTH TRENDS, AND MODIFIABLE HEALTH RISKS. FURTHER, SOME LOCAL ORGANIZATIONS PROVIDED INTERNAL DATA THAT WERE ALSO INCORPORATED INTO THE ANALYSIS PROCESS.IN AN EFFORT TO IDENTIFY THE TOP PRIORITIES FOR THE COUNTY, A PRIORITIZATION MATRIX WAS DEVELOPED. THE PRIORITIZATION MATRIX INCLUDED THE FINDINGS FROM THE ANALYSIS OF THE PRIMARY (NEW) AND SECONDARY (EXISTING) DATA, WHICH WERE PRESENTED TO THE STEERING COMMITTEE IN FEBRUARY 2016 AND TO COMMUNITY MEMBERS DURING THE PRIORITIZATION MEETINGS HELD ON MARCH 8, 2016. ADDITIONALLY, STEERING COMMITTEE MEMBERS WERE PROVIDED THE OPPORTUNITY TO COMPLETE AN INTERNET-BASED SURVEY IN WHICH THEY WERE ASKED TO IDENTIFY THE SIGNIFICANCE OF THE NEED FOR EACH OF THE TWENTY-ONE CATEGORIES AS HIGH, MEDIUM, OR LOW. COMMUNITY MEMBERS WERE ASKED TO PROVIDE THE SAME INFORMATION AT THE COMMUNITY PRIORITIZATION MEETINGS. THESE VARIOUS DATA COMPONENTS WERE THEN ANALYZED AND THE RESULTS WERE WEIGHTED AS FOLLOWS: SECONDARY (EXISTING) DATA - WEIGHTED 50 PERCENT; PRIMARY (NEW) DATA - WEIGHTED 50 PERCENT IN TOTAL, AS FOLLOWS: FOCUS GROUP FINDINGS, TELEPHONE SURVEY RESULTS, AND INTERNET-BASED COMMUNITY SURVEY RESULTS - WEIGHTED 20 PERCENT; COMMUNITY PRIORITIZATION MEETING RESULTS - WEIGHTED 20 PERCENT; AND, STEERING COMMITTEE PRIORITIZATION SURVEY RESULTS - WEIGHTED 10 PERCENT. THIS JOINT CHNA AND RELATED IMPLEMENTATION PLAN WERE ADOPTED BY THE DUHS BOARD OF DIRECTORS AND PUBLISHED ON THE DUKE HEALTH WEBSITE IN FISCAL YEAR 2017 (TAX YEAR 2016). DUKE RALEIGH HOSPITAL:PART V, SECTION B, LINE 6A: UNC REX HEALTHCARE, WAKEMED HEALTH AND HOSPITALS.DUKE RALEIGH HOSPITAL:PART V, SECTION B, LINE 6B: UNITED WAY OF THE GREATER TRIANGLE, WAKE COUNTY HUMAN SERVICES, ADVANCE COMMUNITY HEALTH AND THE WAKE COUNTY MEDICAL SOCIETY COMMUNITY HEALTH FOUNDATION. DUKE RALEIGH HOSPITAL:PART V, SECTION B, LINE 11:THE FOLLOWING CATEGORIES WERE IDENTIFIED AS THE FOUR PRIORITY AREAS FOR WAKE COUNTY THAT WILL BE ADDRESSED FOR 2017-2019:1. HEALTH INSURANCE COVERAGE2. TRANSPORTATION3. ACCESS TO HEALTH SERVICES4. MENTAL HEALTH AND SUBSTANCE USE 1. HEALTH INSURANCE COVERAGE ACCESS TO HEALTH INSURANCE COVERAGE WAS IDENTIFIED AS ONE OF THE MOST IMPORTANT ISSUES IMPACTING THE QUALITY OF LIFE OF WAKE COUNTY RESIDENTS. THIS ISSUE NOT ONLY ENCOMPASSES THOSE WHO LACK INSURANCE, BUT ALSO THOSE THAT ARE UNDERINSURED AS WELL AS THOSE UNDER GOVERNMENT PROGRAMS SUCH AS MEDICARE AND MEDICAID. CONCERNS WERE ALSO EXPRESSED REGARDING THE COMPLEXITY OF THE HEALTH CARE SYSTEM AND CONFUSION REGARDING HOW HEALTH INSURANCE WORKS. TO ADDRESS THIS PRIORITY DUKE RALEIGH WILL EMPLOY THE FOLLOWING STRATEGY ALONG WITH OUTLINED ACTION ITEMS: * CONTINUE TO PROVIDE FINANCIAL ASSISTANCE VIA DUKE UNIVERSITY HEALTH SYSTEM'S CHARITY AND DISCOUNTED CARE POLICIES. THESE POLICIES PROVIDE ELIGIBLE CARE AT A DISCOUNT OR WITHOUT CHARGE TO ALL QUALIFYING PATIENTS WHO DO NOT HAVE HEALTH INSURANCE, OR BECAUSE OF FINANCIAL HARDSHIP CANNOT PAY FOR THE CARE THEY RECEIVE FOR MEDICALLY NECESSARY SERVICES. * CONTINUE TO UTILIZE FINANCIAL CARE COUNSELORS TO HELP PATIENTS UNDERSTAND THEIR FINANCIAL RESPONSIBILITIES AND CONNECT PATIENTS WITH COMMUNITY RESOURCES. * CONTINUE TO HELP PATIENTS NAVIGATE THROUGH GOVERNMENT SPONSORED FINANCIAL ASSISTANCE PROGRAMS FOR WHICH THEY MAY QUALIFY.* CONTINUE TO PROVIDE SUPPORT TO ORGANIZATIONS SUCH AS ALLIANCE MEDICAL MINISTRY AND URBAN MINISTRIES OF WAKE COUNTY OPEN DOOR CLINIC, WHICH PROVIDES AFFORDABLE HEALTHCARE TO UNINSURED ADULTS IN WAKE COUNTY. IN FY19, DUKE RALEIGH HOSPITAL PERFORMED 7,706 LAB TESTS IN-KIND FOR URBAN MINISTRIES OF WAKE COUNTY OPEN DOOR CLINIC AND PROVIDED $17,500 IN FUNDING TO ALLIANCE MEDICAL MINISTRY.* CONTINUE TO PROVIDE IN KIND SUPPORT TO PROJECT ACCESS OF WAKE COUNTY, A PRIVATE, NONPROFIT PROGRAM THAT CONNECTS ELIGIBLE UNINSURED CLIENTS TO HIGH QUALITY MEDICAL SERVICES DONATED BY PHYSICIANS. IN FY2019, DUKE RALEIGH HOSPITAL PROVIDED OVER $13M OF IN KIND SUPPORT TO PROJECT ACCESS OF WAKE COUNTY CLIENTS.* IN FY19, DUKE RALEIGH HOSPITAL PROVIDED $7,500 TO NC MED ASSIST, A NONPROFIT PHARMACY THAT PROVIDES ACCESS TO LIFESAVING PRESCRIPTION MEDICATIONS TO UNINSURED NC RESIDENTS. * CONTINUE TO PROVIDE HEALTH LITERACY COURSE THROUGH OUR CLINICAL EDUCATION DEPARTMENT WHICH EDUCATED OVER 64 CLINICIANS IN FY19.2. TRANSPORTATIONACCESS TO AND COST OF TRANSPORTATION HAS IMPLICATIONS ON ONE'S HEALTH AS LACK OF TIMELY TRANSPORTATION CAN IMPACT THE ABILITY TO MAKE PHYSICIAN APPOINTMENTS AND OBTAIN PRESCRIPTIONS PARTICULARLY FOR OUR ELDERLY AND MOST DISADVANTAGED RESIDENTS. TO ADDRESS THIS PRIORITY DUKE RALEIGH WILL EMPLOY THE FOLLOWING STRATEGY ALONG WITH THE OUTLINED ACTION ITEMS:* CONTINUE TO EMPLOY MULTIDISCIPLINARY APPROACHES WITHIN THE CANCER CENTER TO FACILITATE MULTIPLE APPOINTMENTS IN THE SAME DAY THEREBY REDUCING TRANSPORTATION NEEDS.* CONTINUE TO SUPPORT ORGANIZATIONS SUCH AS THE GREATER RALEIGH CHAMBER OF COMMERCE AND MIDTOWN RALEIGH ALLIANCE, WHICH ADVOCATES FOR AN ENHANCED TRANSIT AND TRANSPORTATION SYSTEM FOR ALL RESIDENTS. THIS INCLUDES INVESTING IN THE GREATER RALEIGH CHAMBER EDGE 5 INITIATIVE WHICH SUPPORTS ECONOMIC DEVELOPMENT, TALENT RECRUITMENT, AND QUALITY OF LIFE INITIATIVES. IN FY19, DRAH FULFILLED ITS YEAR 5 OF ITS 5 YEAR COMMITMENT TO THIS INITIATIVE IN THE AMOUNT OF $25,000.* CONTINUE TO SUPPORT ORGANIZATIONS SUCH AS THE LUNG CANCER INITIATIVE OF NC, WHICH FUNDS A GAS CARD PROGRAM TO LESSEN THE FINANCIAL BURDEN OF LUNG CANCER PATIENTS SEEKING TREATMENT WHO NEED ASSISTANCE. IN FY19, DRAH DONATED $10,000 TO THE LUNG CANCER INITIATIVE OF NC. 3. ACCESS TO HEALTH SERVICES ACCESS TO HEALTH SERVICES IS KEY TO IMPROVING COMMUNITY HEALTH AND RESIDENTS HEALTH STATUS. THIS PRIORITY RELATES TO THE UTILIZATION OF EXISTING HEALTH FACILITIES, THE EASE OF ACCESSING HEALTH RESOURCES, AND PRIMARY AND PREVENTIVE CARE/SCREENINGS. THIS WAS IDENTIFIED AS A TOP PRIORITY BASED ON FEEDBACK FROM FOCUS GROUPS AND SURVEYS AS WELL AS THE RATE OF PREVENTABLE HOSPITAL STAYS FOR CONDITIONS SUCH AS DIABETES, COPD, ASTHMA, HEART FAILURE, BACTERIAL PNEUMONIA, UTI, AND DEHYDRATION. ALSO, THE COMPLEXITY OF NAVIGATING THE HEALTH CARE SYSTEM, AFFORDABILITY OF HEALTH SERVICES, AND PROVIDER AVAILABILITY AROSE AS KEY CONCERNS RELATED TO ACCESS TO HEALTH SERVICES. DUKE RALEIGH AS WELL AS DUKE HEALTH IS ACTIVELY ENGAGED IN IMPROVING ACCESS TO HEALTH SERVICES FOR ALL RESIDENTS THROUGH STRATEGIC INITIATIVES AS WELL AS THROUGH STRATEGIC COMMUNITY PARTNERSHIPS.CONTINUE TO IMPROVE THE DISCHARGE PROCESS TO ENSURE THAT DISCHARGED PATIENTS ARE CONNECTED WITH PRIMARY CARE RESOURCES. CONTINUE PARTNERSHIP WITH WAKE EMS AND AREA HOSPITALS ON TRIAGE AND DESTINATION PLAN FOR STROKE PATIENTS.AS DESCRIBED PREVIOUSLY, DUKE RALEIGH HOSPITAL CONTINUED TO PROVIDE IN-KIND LAB SERVICES TO URBAN MINISTRIES OF WAKE COUNTY OPEN DOOR CLINIC TO FACILITATE THE CARE FOR THOSE WHO LACK ADEQUATE INCOME, INSURANCE COVERAGE, AND OTHER MEANS TO HEALTH SERVICES.STRENGTHEN SUPPORT OF ALLIANCE MEDICAL MINISTRY AND URBAN MINISTRIES OF WAKE COUNTY THROUGH INCREASED EMPLOYEE VOLUNTEERISM IN EFFORTS TO EXPAND THEIR CAPACITY AND ABILITY TO SERVE PATIENTS. BETWEEN FY17-19, DUKE RALEIGH HOSPITAL DONATED AND PACKED OVER 3,000 POUNDS OF RICE AND BEANS FOR URBAN MINISTRIES OF WAKE COUNTY'S CLIENT CHOICE PANTRY, WHICH ENGAGED APPROXIMATELY 50 EMPLOYEES.CONTINUE PROGRAMS THROUGH THE DUKE SPECIALTY REHAB SERVICES MIDTOWN, WHICH OFFERS A VARIETY OF PROGRAMS DESIGNED TO HELP PEOPLE LOSE WEIGHT AND MAKE HEALTHY LIFESTYLE CHANGES. SERVICES OFFERED INCLUDE PULMONARY REHABILITATION PROGRAMS, PERSONALIZED DIABETES MANAGEMENT PLANS, MULTIDISCIPLINARY THERAPY FOR NEUROLOGICAL DISORDERS, PHYSICAL THERAPY, OCCUPATIONAL THERAPY, SPEECH THERAPY AS WELL AS CARDIOVASCULAR AND STRENGTH TRAINING EQUIPMENT.DUKE RALEIGH HOSPITAL SUPPORTED THE BOYS AND GIRLS CLUB WITH AN IN KIND DONATION OF $20,000 IN FY19 TO SUPPORT HEALTHY FAMILIES AND CHILD DEVELOPMENT PROGRAMS. CONTINUE COMMUNITY EDUCATION, HEALTHY FOCUS SEMINARS WITH EFFORTS TO EXPAND ATTENDANCE TO INCLUDE POPULATIONS THROUGHOUT WAKE COUNTY AS WELL AS A FOCUS ON TOPICS ALIGNED WITH THE NEEDS ASSESSMENT. IN APRIL 2019, DUKE RALEIGH PROVIDED HANDS-ONLY CPR EDUCATION AND CONNECTIONS TO THE DUKE BENEFIT ENROLLMENT CENTER AT THE SOUTHEAST RALEIGH HEALTH TRUCK RODEO LED BY THE RALEIGH ALUMNAE CHAPTER OF DELTA SIGMA THETA SORORITY, INC.DUKE RALEIGH HOSPITAL PROVIDED A $30,000 DONATION TO INTERACT OF WAKE COUNTY TO SUPPORT THE SOLACE CENTER, A COMMUNITY BASED SEXUAL ASSAULT FORENSIC EXAMINATION CENTER (THE FIRST IN NC). THIS IS A MULTI-YEAR COMMITMENT. EXPAND AND STRENGTHEN COMMUNITY OUTREACH EFFORTS AROUND STROKE, CARDIOVASCULAR DISEASE, DIABETES, CANCER, ORTHOPEDICS AND SPORTS MEDICINE ALONG WITH OUR COMMUNITY PARTNERS. DUKE RALEIGH DEVELOPED PROGRAMMING AND PROVIDED FINANCIAL SUPPORT TO INCREASE CHILDREN'S ACCESS TO NUTRITIOUS FOOD. THIS EFFORT INCLUDED SERVING APPROXIMATELY 700 MEALS IN THE SUMMER OF 2019 AS A NORTH CAROLINA SUMMER NUTRITION PROGRAM SPONSOR AND PROVIDING $25,000 IN FINANCIAL SUPPORT TO THE INTER-FAITH FOOD SHUTTLE IN FY2019 TO SUPPORT THEIR CHILD HUNGER HUB.4. MENTAL HEALTH AND SUBSTANCE USEWAKE COUNTY HAS EXPERIENCED AN INCREASE IN THE PREVALENCE AND SEVERITY OF MENTAL HEALTH AND SUBSTANCE USE PROBLEMS. THIS PRIORITY RELATES TO TOBACCO USE/EXPOSURE, ILLEGAL DRUG USE, EXCESSIVE DRINKING, ALCOHOL-IMPAIRED DRIVING DEATHS, SUICIDE RATES, MENTAL HEALTH EMERGENCY DEPARTMENT UTILIZATION AND THE AVAILABILITY OF RESOURCES TO MEET THIS GROWING DEMAND. DUE TO THE SCOPE AND COMPLEXITY OF MENTAL HEALTH AND SUBSTANCE USE ISSUES, A COLLECTIVE AND COLLABORATIVE APPROACH IS NEEDED. BELOW IS A LISTING OF A NUMBER OF INITIATIVES AND COLLABORATIONS THAT DUKE RALEIGH HOSPITAL IS ENGAGED WITH TO HAVE THE GREATEST IMPACT TO ADDRESS THIS ISSUE:* CONTINUE TO PARTICIPATE IN THE WAKE COUNTY CRISIS HOSPITAL COLLABORATIVE, WHICH INCLUDES ALL WAKE COUNTY HOSPITALS, REPRESENTATIVES FROM MENTAL HEALTH, LAW ENFORCEMENT AND OTHER STAKEHOLDERS IN CRISIS RESPONSE IN WAKE COUNTY.* CONTINUE TO CONVENE TREATMENT TEAM MEETINGS FOR INPATIENTS WHO ALSO HAVE SUBSTANCE USE AND CHRONIC PERSISTENT MENTAL ILLNESS WITH COMPLEX NEEDS. THE TREATMENT TEAM INCLUDES CARE COORDINATORS FROM MENTAL HEALTH AGENCIES, ALLIANCE BEHAVIORAL HEALTH AND OTHER PROVIDERS INVOLVED IN THE PATIENT'S CARE. * CONTINUE REGULAR MEETINGS WITH DUKE RALEIGH HOSPITAL CASE MANAGEMENT, ALLIANCE BEHAVIORAL HEALTH, CASE MANAGER WITH COMMUNITY CARE OF WAKE AND JOHNSTON COUNTIES (CCWJC), AND EMS TO ADDRESS BARRIERS TO CARE FOR HIGH RISK PATIENTS AND REDUCE NON-EMERGENT VISITS TO HOSPITALS. * CONTINUE TO UTILIZE COMMUNITY CARE OF JOHNSTON & WAKE COUNTIES PORTAL AND THE NORTH CAROLINA CONTROLLED SUBSTANCES REPORTING SYSTEM (CSRS) TO REDUCE NARCOTIC DEPENDENCY AND PREVENT OVERPRESCRIBING.* CONTINUE SUPPORT OF ORGANIZATIONS SUCH AS NATIONAL ALLIANCE ON MENTAL ILLNESS (NAMI) WAKE COUNTY, WHICH PROVIDES SUPPORT, EDUCATION, AND ADVOCACY FOR PEOPLE WITH MENTAL ILLNESS ALONG WITH THEIR FAMILIES AND FRIENDS.* STRENGTHEN SUPPORT OF TRIANGLE FAMILY SERVICES, WHICH FOCUSES ON BUILDING A STRONGER COMMUNITY BY STRENGTHENING THE FAMILY THROUGH FAMILY SAFETY, FINANCIAL STABILITY, AND MENTAL HEALTH. IN FY19, DUKE RALEIGH HOSPITAL PROVIDED $5,000 IN FUNDING TO TRIANGLE FAMILY SERVICES.* CONTINUE TOBACCO CESSATION SUPPORT FOR EMPLOYEES THROUGH THE DUKE LIVE FOR LIFE'S TOBACCO CESSATION PROGRAM. THIS 12-MONTH COACHING PROGRAM INVOLVES AN INITIAL CONSULTATION TO DEVELOP A QUIT PLAN, THEN FOLLOW-UP CALLS AT ONE, THREE, SIX, AND TWELVE MONTHS. COACHES PROVIDE ADDITIONAL RESOURCES AND MOTIVATION TO HELP PARTICIPANTS QUIT. ENROLLMENT ALSO INCLUDES ACCESS TO THREE MONTHS OF LOW-COST TREATMENT AT PARTICIPATING DUKE HOSPITAL OUTPATIENT PHARMACIES.DURING FY19, DUKE RALEIGH ALSO BEGAN THE FOLLOWING INITIATIVES TO ADDRESS MENTAL HEALTH AND SUBSTANCE ABUSE: * PROVIDED SUPPORT FOR THE ADVERSE CHILDHOOD EXPERIENCES (ACES) RESILIENCE IN WAKE COUNTY INITIATIVE. THIS INITIATIVE IS A MULTI-SECTOR, COMMUNITY DRIVEN MOVEMENT TO ADDRESS AND PREVENT ACES AND BUILD RESILIENCE IN WAKE COUNTY (FY18-FY19).* IN FY19 CREATED A BEHAVIORAL SERVICE LINE DIRECTOR POSITION TO PROVIDE OVERSIGHT AND LEADERSHIP FOR BEHAVIORAL HEALTH SERVICES AT DUKE RALEIGH HOSPITAL. * PARTICPIATED IN THE FOLLOWING COMMUNITY COALITIONS/WORKGROUPS: NORTH CAROLINA HEALTH CARE ASSOCIATION (NCHA) BEHAVIORAL HEALTH WORKGROUP; WAKE COUNTY DRUG OVERDOSE PREVENTION COALITION; AND WAKEBROOK COMMUNITY PARTNERSHIP. * PARTICIPATED IN THE DUKE UNIVERSITY HEALTH SYSTEM SAFE OPIOID TASK FORCE, WHICH WAS CREATED TO IMPROVE THE SAFETY OF PAIN MANAGEMENT BY ENCOURAGING CLINICAL PRACTICE STANDARDIZATION, WHERE CLINICALLY APPROPRIATE, WHEN OPIOID THERAPY IS DESIGNATED FOR TREATMENT.DUKE RALEIGH HOSPITAL:PART V, SECTION B, LINE 16J: AS PART OF DUHS, DUKE RALEIGH HOSPITAL PROVIDES A BROCHURE TO ALL ADMISSIONS THAT INCLUDES A BRIEF SUMMARY OF DUHS FINANCIAL ASSISTANCE POLICIES. DUHS ALSO COMMENTS ON THE BACK OF ITS BILLING INVOICES THAT PATIENTS SHOULD CONTACT PATIENT ACCOUNT REPRESENTATIVES TO HELP THEM IF THEY CANNOT PAY THEIR BILL IN FULL. THIS COMMENT REFERENCES GOVERNMENT-SPONSORED PROGRAMS, MONTHLY PAYMENT PROGRAMS, AND OTHER FINANCIAL ASSISTANCE PROGRAMS AVAILABLE FOR PATIENTS WHO MEET CERTAIN FINANCIAL CRITERIA. DUHS ALSO PUBLICIZED ITS FINANCIAL ASSISTANCE POLICY VERBALLY THROUGH ITS FINANCIAL CARE COUNSELORS.DUKE RALEIGH HOSPITAL:PART V, SECTION B, LINE 24: CERTAIN ELECTIVE COSMETIC/AESTHETIC SERVICES, AND OTHER ELECTIVE SERVICES, WILL BE BILLED AT AN AMOUNT EQUAL TO GROSS CHARGES. GROUP A - FACILITY 3 - DUKE REGIONAL HOSPITAL: PART V, SECTION B, LINE 5: DUKE REGIONAL HOSPITAL ("DRH") WAS A PARTICIPANT IN THE 2017 DURHAM COMMUNITY HEALTH ASSESSMENT, LED BY PARTNERSHIP FOR A HEALTHY DURHAM. THE ASSESSMENT PROCESS INCLUDED 358 CITIZEN SURVEYS FROM RANDOMLY SELECTED HOUSEHOLDS AND THREE COMMUNITY LISTENING SESSIONS WITH 42 COMMUNITY MEMBERS. THE SURVEY WAS ALSO CONDUCTED IN PERSON AT GROCERY STORES, LIBRARIES, DURHAM COUNTY DEPARTMENT OF PUBLIC HEALTH CLINICS AND BUS STATIONS. THE COMMUNITY HEALTH ASSESSMENT TEAM COMPRISED OF REPRESENTATIVES FROM DUKE UNIVERSITY HEALTH SYSTEM, UNIVERSITIES, LOCAL GOVERNMENT, SCHOOLS, NON-PROFIT ORGANIZATIONS, AND BUSINESSES - WORKED TO DIRECT THE ACTIVITIES OF THE ASSESSMENT AND PROVIDE WRITTEN CONTENT AND EXPERTISE ON ISSUES OF INTEREST. THIS JOINT CHNA AND RELATED IMPLEMENTATION PLAN WAS ADOPTED BY THE DUHS BOARD OF DIRECTORS AND PUBLISHED ON THE DUKE HEALTH WEBSITE IN FISCAL YEAR 2019 (TAX YEAR 2018).GROUP A - FACILITY 3 - DUKE REGIONAL HOSPITAL:PART V, SECTION B, LINE 6A: DUKE UNIVERSITY HOSPITALGROUP A - FACILITY 3 - DUKE REGIONAL HOSPITAL:PART V, SECTION B, LINE 6B: THE PARTNERSHIP FOR A HEALTHY DURHAM AND THE DURHAM COUNTY HEALTH DEPARTMENTGROUP A - FACILITY 3 - DUKE REGIONAL HOSPITAL:PART V, SECTION B, LINE 11: THE ASSESSMENT IDENTIFIED FIVE HEALTH PRIORITIES FOR 2018-2020:1. AFFORDABLE HOUSING2. ACCESS TO HEALTHCARE AND HEALTH INSURANCE3. POVERTY4. MENTAL HEALTH5. OBESITY, DIABETES AND FOOD ACCESSDUKE REGIONAL HOSPITAL CONSIDERS THE DRH COMMUNITY HEALTH NEEDS ASSESSMENT AND IMPLEMENTATION PLAN DOCUMENT TO BE A "WORKING PLAN" THAT WILL CONTINUE TO EVOLVE OVER THIS THREE-YEAR PERIOD IN ORDER TO ENSURE THE EFFICACY OF STRATEGIES INTENDED TO MEET EXPRESSED COMMUNITY HEALTH NEEDS. THIS IMPLEMENTATION PLAN DOES NOT CONTAIN DESCRIPTIONS OF THE COMMUNITY HEALTH IMPROVEMENT WORK CARRIED OUT BY OTHER COMPONENTS OF DUKE HEALTH OR DUKE UNIVERSITY. THIS IMPLEMENTATION PLAN REPRESENTS ONLY DUKE REGIONAL HOSPITAL'S CONTINUALLY EVOLVING VARIETY OF PROGRAMS AND ACTIVITIES IN THE FIVE PRIORITY AREAS TO IMPROVE HEALTH WITH THE DURHAM COMMUNITY.1 AND 3. AFFORDABLE HOUSING AND POVERTYMINIMUM WAGE: DUKE UNIVERSITY HEALTH SYSTEM WILL INCREASE THE MINIMUM WAGE TO $15 PER HOUR FOR ALL EMPLOYEES. EFFECTIVE JULY 1, 2018, DUKE INCREASED THE MINIMUM WAGE TO $14 PER HOUR FOR ALL ELIGIBLE STAFF, AND EFFECTIVE JULY 1, 2019, THE MINIMUM WAGE AT DUKE INCREASED TO $15 PER HOUR FOR ALL ELIGIBLE STAFF.FILL THAT BUS: EMPLOYEES DONATE BINS OF SCHOOL SUPPLIES TO FILL THAT BUS TO SUPPORT DURHAM PUBLIC SCHOOLS. TEACHERS FROM THE HIGHEST POVERTY SCHOOLS WERE INVITED TO PICK OUT SUPPLIES NEEDED IN THEIR CLASSROOMS.SALVATION ARMY ANGEL TREE: EACH DECEMBER, EMPLOYEES "ADOPT" 100 CHILDREN FROM DUKE REGIONAL'S SALVATION ARMY ANGEL TREE. CHILDREN IN DURHAM HAVE RECEIVED BIKES, CLOTHING, DOLLS AND TOYS THANKS TO THE GENEROUS DONATIONS. EXTRA GIFTS ARE ALSO DONATED TO THE SALVATION ARMY FOR OTHER NEEDY FAMILIES IN THE AREA.2019 GOAL: DUKE REGIONAL WILL AGAIN HOST AT LEAST ONE DRIVE TO BENEFIT UNDERSERVED CHILDREN OR FAMILIES IN OUR COMMUNITY.2019 PROGRESS: DUKE REGIONAL SUPPORTED CRAYONS2CALCULATOR DRIVE, SALVATION ARMY TREE GIFT DRIVE AND DONATED 600 POUNDS OF FOOD TO THE NORTH CAROLINA FOOD BANK OF CENTRAL AND EASTERN NC IN 2019.EDUCATION: DUKE REGIONAL HAS IDENTIFIED EDUCATION AS A PRIORITY OF ITS COMMUNITY STRATEGY TO HELP PREVENT POVERTY. DUKE REGIONAL IS COMMITTED TO HELP TRAIN THE HEALTHCARE WORKERS OF THE FUTURE. IN FY2018, DRH INVESTED $3.4 MILLION IN TEACHING AND TRAINING HEALTHCARE PROFESSIONALS, AND PROVIDED OPPORTUNITIES FOR 70 PRE-HEALTH UNDERGRADUATE STUDENTS FROM LOCAL COLLEGES AND UNIVERSITIES TO SHADOW AND VOLUNTEER ALONGSIDE CLINICAL AND CUSTOMER SERVICE STAFF AS AMBASSADORS IN THE EMERGENCY DEPARTMENT. DRH ALSO PROVIDED AN EIGHT-WEEK JUNIOR VOLUNTEER PROGRAM FOR AREA HIGH SCHOOL STUDENTS TO GAIN CLERICAL AND CUSTOMER SERVICE WORK EXPERIENCES IN A HEALTH CARE SETTING.FY2019 GOAL: DRH WILL CONTINUE THE SAME LEVEL OF SUPPORT IN FY2019.FY2019 PROGRESS: DRH INVESTED $4 MILLION IN TEACHING AND TRAINING HEALTHCARE PROFESSIONALS, AND PROVIDED OPPORTUNITIES FOR 70 PRE-HEALTH UNDERGRADUATE STUDENTS FROM LOCAL COLLEGES AND UNIVERSITIES TO SHADOW AND VOLUNTEER ALONGSIDE CLINICAL AND CUSTOMER SERVICE STAFF AS AMBASSADORS IN THE EMERGENCY DEPARTMENT. DRH ALSO PROVIDED AN EIGHT-WEEK JUNIOR VOLUNTEER PROGRAM FOR AREA HIGH SCHOOL STUDENTS TO GAIN CLERICAL AND CUSTOMER SERVICE WORK EXPERIENCES IN A HEALTH CARE SETTING.CITY OF MEDICINE ACADEMY: DUKE REGIONAL HAS BEEN A PARTNER WITH CITY OF MEDICINE ACADEMY (CMA) AND DURHAM PUBLIC SCHOOLS SINCE THE PROGRAM'S INCEPTION AT SOUTHERN HIGH SCHOOL IN THE 1990S. IN AUGUST 2011, CMA MOVED TO A NEW FACILITY LOCATED ON THE DUKE REGIONAL CAMPUS. AS PART OF OUR PARTNERSHIP, DUKE REGIONAL HOSTS STUDENTS FOR CLINICAL ROTATIONS AND INTERNSHIPS, PROVIDES CPR TRAINING AND HOSTS THE ANNUAL SENIOR AWARDS NIGHT.2019 GOAL: DUKE REGIONAL WILL CONTINUE ITS PARTNERSHIP WITH CMA IN FY2019.2019 PROGRESS: DUKE REGIONAL CONTINUED TO PARTNER WITH CMA, PROVIDING VARIOUS LEARNING EXPERIENCES FOR STUDENTS THROUGHOUT THE YEAR.PROJECT SEARCH: DUKE REGIONAL WAS THE FIRST HOST HOSPITAL IN THE STATE TO HOST PROJECT SEARCH, A PARTNERSHIP WITH DURHAM PUBLIC SCHOOLS, OE ENTERPRISES, NORTH CAROLINA VOCATIONAL REHABILITATION AND ALLIANCE BEHAVIORAL HEALTH THAT PROVIDES CAREER DEVELOPMENT EXPERIENCES TO SENIOR HIGH SCHOOL STUDENTS WITH DEVELOPMENTAL DISABILITIES. 2019 GOAL: DUKE REGIONAL WILL CONTINUE TO SERVE AS A HOST SITE FOR PROJECT SEARCH.2019 PROGRESS: DUKE REGIONAL CONTINUED TO SERVE AS A HOST SITE FOR PROJECT SEARCH ADDING 8 NEW GRADUATES BRINGING THE TOTAL NUMBER OF GRADUATES TO 62 SINCE 2011. 2. ACCESS TO HEALTHCARE AND HEALTH INSURANCE LINCOLN COMMUNITY HEALTH CENTER (LCHC): IS A FEDERALLY QUALIFIED COMMUNITY HEALTH CENTER THAT PROVIDES PRIMARY CARE SERVICES FOR ABOUT 40,000 PATIENTS EACH YEAR. APPROXIMATELY 45 PERCENT OF LCHC PATIENTS ARE UNINSURED AND 84% ARE LIVING AT OR BELOW THE POVERTY LEVEL.IN ADDITION TO GENEROUS FINANCIAL SUPPORT, DUKE REGIONAL PROVIDES ENGINEERING, ENVIRONMENTAL, LABORATORY, PHARMACY AND RADIOLOGY SERVICES. THE TOTAL DUKE REGIONAL HOSPITAL CONTRIBUTION TO LCHC IN FY 2019, INCLUDING MONETARY AND IN-KIND SERVICES, WAS $8.4 MILLION.DURHAM COUNTY EMERGENCY MEDICAL SERVICES (EMS): SERVES AS THE PRIMARY PROVIDER OF EMERGENCY AMBULANCE SERVICES AND ALTERNATIVE MEDICAL TRANSPORTATION IN DURHAM COUNTY. IN FY 2019, DUKE REGIONAL PAID THE COUNTY $2.5 MILLION TO SUPPORT DURHAM EMS.PROJECT ACCESS OF DURHAM COUNTY (PADC): COORDINATES SPECIALTY CARE AT NO CHARGE TO UNINSURED AND UNDERINSURED DURHAM RESIDENTS LIVING AT OR BELOW 200 PERCENT OF THE FEDERAL POVERTY LEVEL. THESE RESIDENTS HAVE ACCESS TO PRIMARY HEALTH CARE THROUGH LINCOLN COMMUNITY HEALTH CENTER. DRH HAS PROVIDED OFFICE SPACE AS WELL AS TECHNOLOGICAL SUPPORT FOR PADC SINCE IT WAS ESTABLISHED.2019 GOAL: DUKE REGIONAL WILL CONTINUE TO PROVIDE OFFICE AND TECHNOLOGICAL SUPPORT TO PROJECT ACCESS DURHAM COUNTY.2019 PROGRESS: DUKE REGIONAL PROVIDED OFFICE SPACE AND TECH SUPPORT TO PADC IN FY19.CHARITY CARE: EACH YEAR DUKE REGIONAL PROVIDES NO-COST OR DISCOUNTED URGENT OR EMERGENT HEALTH CARE SERVICES TO PATIENTS WHO WERE UNABLE TO PAY. IN FY 2019 DUKE REGIONAL PROVIDED $27.5 MILLION (AT ESTIMATED COST) IN CHARITY CARE.4. MENTAL HEALTHIN 2018, DRH RECEIVED APPROVAL TO BUILD A NEW BEHAVIORAL HEALTH FACILITY WHICH WILL MOVE ALL DUKE HEALTH SYSTEM MENTAL HEALTH SERVICES TO DUKE REGIONAL'S CAMPUS INCLUDING INPATIENT AND OUTPATIENT CARE. THE EXPANSION IS A $102.4 MILLION INVESTMENT BY DUKE UNIVERSITY HEALTH SYSTEM, AND WILL PROVIDE BETTER COORDINATION OF CARE FOR PSYCHIATRIC PATIENTS IN DURHAM AND REGIONALLY. THE GROUNDBREAKING OCCURRED DURING FISCAL YEAR 2019.5. OBESITY, DIABETES, AND FOOD ACCESSBEYOND ITS CLINICAL SERVICE LINES IN THE HOSPITAL, DRH COLLABORATES WITH NUMEROUS DURHAM NON-PROFITS AND OTHER ENTITIES WITHIN THE DUKE HEALTH SYSTEM THAT ARE SPECIFICALLY FOCUSED ON COMMUNITY-BASED MECHANISMS FOR THE PREVENTION AND TREATMENT OF OBESITY AND DIABETES AND ON ISSUES OF FOOD ACCESS. GROUP A - FACILITY 3 - DUKE REGIONAL HOSPITAL PART V, SECTION B, LINE 16J: AS PART OF DUHS, DUKE REGIONAL HOSPITAL PROVIDES A BROCHURE TO ALL ADMISSIONS THAT INCLUDES A BRIEF SUMMARY OF DUHS FINANCIAL ASSISTANCE POLICIES. DUHS ALSO COMMENTS ON THE BACK OF ITS BILLING INVOICES THAT PATIENTS SHOULD CONTACT PATIENT ACCOUNT REPRESENTATIVES TO HELP THEM IF THEY CANNOT PAY THEIR BILL IN FULL. THIS COMMENT REFERENCES GOVERNMENT-SPONSORED PROGRAMS, MONTHLY PAYMENT PROGRAMS, AND OTHER FINANCIAL ASSISTANCE PROGRAMS AVAILABLE FOR PATIENTS WHO MEET CERTAIN FINANCIAL CRITERIA. DUHS ALSO PUBLICIZED ITS FINANCIAL ASSISTANCE POLICY VERBALLY THROUGH ITS FINANCIAL CARE COUNSELORS.GROUP A - FACILITY 3 - DUKE REGIONAL HOSPITALPART V, SECTION B, LINE 24: CERTAIN ELECTIVE COSMETIC/AESTHETIC SERVICES, AND OTHER ELECTIVE SERVICES, WILL BE BILLED AT AN AMOUNT EQUAL TO GROSS CHARGES. 6 1 - DUKE HEALTH HERITAGE 3000 ROGERS ROAD WAKE FOREST NC 27587 SPECIALTY 2 - DUKE HEALTH HOLLY SPRINGS 401 IRVING PARKWAY HOLLY SPRINGS NC 27540 SPECIALTY 3 - BRIER CREEK MEDICAL PAVILION 10207 CERNY STREET RALEIGH NC 27617 SPECIALTY 4 - DUKE IMAGING SERVICES 3700 NW CARY PARKWAY SUITE 120 CARY NC 27513 INDEPENDENT DIAGNOSTIC TESTING FACILITY 5 - HOCK FAMILY PAVILION 4023 NORTH ROXBORO ROAD DURHAM NC 27704 HOSPICE 6 - HOSPICE OF MEADOWLANDS 1001 CORPORATE DRIVE HILLSBOROUGH NC 27278 HOSPICE PART I, LINE 3C: NOT APPLICABLEPART I, LINE 6A:NOT APPLICABLEPART I, LINE 7, COLUMN F:TOTAL GROSS COMMUNITY BENEFIT EXPENSE AS A PERCENT OF TOTAL EXPENSES IS 9.4%.PART I, LINE 7:CHARITY CARE AT COST IS DETERMINED USING THE COST-TO-CHARGE CALCULATION FROM WORKSHEET 2, IN ORDER TO CALCULATE THE AMOUNTS REPORTED ON THE TABLE. UNREIMBURSED MEDICAID IS DETERMINED USING A COST ACCOUNTING SYSTEM THAT ADDRESSES ALL PATIENT SEGMENTS.PART II, COMMUNITY BUILDING ACTIVITIES:THESE ACTIVITIES ARE INCLUDED IN DUKE UNIVERSITY HEALTH SYSTEM, INC.'S (DUHS) OPERATING EXPENSES AND ARE NOT TRACKED SEPARATELY FOR COMMUNITY BENEFIT REPORTING PURPOSES.PART III, LINE 1 AND LINE 2:THE HEALTHCARE FINANCIAL MANAGEMENT ASSOCIATION (HFMA) REVISED ITS ACCOUNTING GUIDANCE RELATED TO UNCOMPENSATED CARE IN JUNE 2019 TO REFLECT CHANGES IN BAD DEBT REPORTING RESULTING FROM FINANCIAL ACCOUNTING STANDARDS BOARD ACCOUNTING STANDARDS UPDATE 2014-09, "REVENUE FROM CONTRACTS WITH CUSTOMERS (TOPIC 606)" (ASU 2014-09). DUHS ADOPTED ASU 2014-09 ON JULY 1, 2018. UPON ADOPTION OF ASU 2014-09 AND CONSISTENT WITH THE REVISED HFMA STATEMENT NO. 15, THE ESTIMATED UNCOLLECTIBLE AMOUNTS FROM SELF-PAY PATIENTS THAT WERE PREVIOUSLY REPORTED AS BAD DEBT EXPENSE PRIOR TO ADOPTION OF ASU 2014-09 ARE NOW CONSIDERED IMPLICIT PRICE CONCESSIONS DIRECTLY REDUCING NET PATIENT SERVICE REVENUE.DUHS PROVIDED UNCOMPENSATED CARE AT ESTIMATED COSTS IN THE FORM OF IMPLICIT PRICE CONCESSIONS (FORMERLY CONSIDERED BAD DEBT EXPENSE) ASSOCIATED WITH UNCOLLECTIBLE PATIENT ACCOUNTS AT AN ESTIMATED COST OF $23,801,000 IN FISCAL YEAR 2019. DUHS USED THE COST-TO-CHARGE RATIO FROM WORKSHEET 2 TO ESTIMATE COST.PART III, LINE 3:A PORTION OF IMPLICIT PRICE CONCESSIONS (FORMERLY CONSIDERED BAD DEBT EXPENSE) SHOULD BE INCLUDED AS A COMMUNITY BENEFIT, BUT THE PORTION THAT IS ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER OUR FINANCIAL ASSISTANCE POLICY IS INDETERMINABLE BECAUSE THOSE PATIENTS FAIL TO APPLY FOR OR PROVIDE INFORMATION NEEDED TO DETERMINE THEIR ELIGIBILITY UNDER THE DUHS FAP. DUHS, INC. FOLLOWS ITS MISSION TO THE COMMUNITY AND PROVIDES EMERGENT SERVICES TO PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. PATIENTS WHO MAY QUALIFY FOR CHARITY CARE ARE REPORTED AS AN IMPLICIT PRICE CONCESSION INSTEAD BECAUSE OF THOSE PATIENTS' INABILITY OR UNWILLINGNESS TO PROVIDE THE NECESSARY DOCUMENTATION REQUIRED TO DETERMINE CHARITY CARE CLASSIFICATION.PART III, LINE 4:PAGES 17-20 IN THE FY2019 AUDITED FINANCIAL STATEMENT FOOTNOTES DESCRIBE IMPLICIT PRICE CONCESSIONS RELATED TO UNINSURED PATIENTS.PART III, LINE 7:TOTAL UNREIMBURSED COSTS ATTRIBUTABLE TO PROVIDING SERVICES UNDER MEDICARE AS REPORTED IN THE JUNE 30, 2019 DUHS CONSOLIDATED FINANCIAL STATEMENTS ARE $277,157,000 AS COMPARED TO $138,419,867 AS REPORTED IN SECTION B, LINE 7 OF SCHEDULE H. THE DUHS TOTAL MEDICARE SHORTFALL OF $277,157,000 IS DERIVED FROM THE COST ACCOUNTING SYSTEM WHICH INCLUDES ALL PAYMENTS AND COSTS ASSOCIATED WITH MEDICARE PATIENTS, WHEREAS THE AMOUNT REPORTED IN SECTION B OF SCHEDULE H IS DERIVED BASED ON IRS INSTRUCTIONS. IRS INSTRUCTIONS SPECIFY THAT ONLY A PORTION OF COSTS ASSOCIATED WITH MEDICARE BENEFICIARIES BE REPORTED ON SCHEDULE H. SIGNIFICANT MEDICARE COSTS EXCLUDED FROM SCHEDULE H DATA INCLUDE THOSE ASSOCIATED WITH MEDICARE PATIENTS COVERED UNDER MANAGED CARE PLANS AND COSTS REIMBURSED THROUGH MEANS NOT REPORTED ON THE COST REPORT.PART III, LINE 8:MEDICARE RATES AND THE NUMBER OF MEDICARE PATIENTS DUHS TREATS ARE NOT NEGOTIATED. MEDICARE DOES NOT FULLY COMPENSATE DUHS FOR THE COST OF PROVIDING CARE TO MEDICARE BENEFICIARIES. DUHS CONTINUES TO SERVE THE MEDICARE POPULATION AS MEDICARE REIMBURSEMENT RATES DECLINE RELATIVE TO THE COST OF CARE. THEREFORE, ANY LOSS RELATED TO PROVIDING CARE FOR MEDICARE PATIENTS SHOULD BE CLASSIFIED AS A COMMUNITY BENEFIT. DUHS FOLLOWED THE MEDICARE COST REPORT RULES AND GUIDELINES IN DETERMINING THE COSTS REPORTED ON LINE 6. THESE RULES USE A VARIETY OF DIFFERENT METHODOLOGIES BASED ON THE TYPE OF SERVICE.PART III, LINE 9B:COLLECTION EFFORTS ARE IMMEDIATELY STOPPED FOR PATIENTS WHO SUBMIT A FINANCIAL ASSISTANCE APPLICATION. PATIENTS WHO QUALIFY FOR FINANCIAL ASSISTANCE ARE NOT PURSUED USING ANY DEBT COLLECTION PRACTICES. NEEDS ASSESSMENT: PART VI, LINE 2:DUHS USES SEVERAL MECHANISMS TO ASSESS AND ADDRESS THE HEALTH CARE NEEDS OF THE COMMUNITIES IT SERVES. IN DURHAM COUNTY, DUHS AND THE DUKE UNIVERSITY SCHOOL OF MEDICINE FACULTY ARE ACTIVELY INVOLVED IN THE PARTNERSHIP FOR A HEALTHY DURHAM. THE PARTNERSHIP IS A COALITION OF LOCAL ORGANIZATIONS AND COMMUNITY MEMBERS WITH THE GOAL OF COLLABORATIVELY IMPROVING THE PHYSICAL, MENTAL, SOCIAL, HEALTH, AND WELL-BEING OF DURHAM COUNTY'S RESIDENTS. THE NETWORK IS A CERTIFIED HEALTHY CAROLINIANS WORKGROUP. THE PARTNERSHIP EVALUATES COMMUNITY HEALTH CARE INFORMATION, THEN IDENTIFIES AND PRIORITIZES COMMUNITY-IDENTIFIED HEALTH CARE NEEDS AMONG SUBCOMMITTEES THAT FOCUS ON A DURHAM COUNTY HEALTH PRIORITY. SINCE 2002, DUHS' OFFICE OF COMMUNITY RELATIONS HAS PLAYED A CENTRAL ROLE IN CONDUCTING A DURHAM HEALTH SUMMIT. THIS IS AN EVENT THAT ATTRACTS HUNDREDS OF COMMUNITY MEMBERS, HEALTH OFFICIALS, ELECTED OFFICIALS, AND DUHS EXECUTIVES AND PHYSICIANS TO RAISE AWARENESS OF KEY HEALTH ISSUES IN THE COMMUNITY AND SEEK COLLABORATIVE SOLUTIONS TO THESE ISSUES. THE SUMMIT HAS PRODUCED A NUMBER OF COMMUNITY-DRIVEN HEALTH CARE PROGRAMS AND INITIATIVES, INCLUDING SPECIALTY PROJECT ACCESS, IN WHICH PHYSICIANS WHO PRACTICE AT DUHS FACILITIES AND OTHER DURHAM COUNTY PHYSICIANS OFFER FREE SPECIALTY CARE SERVICES TO RESIDENTS WHO OTHERWISE COULD NOT AFFORD SPECIALTY CARE. DUHS ALSO PLAYS A CENTRAL ROLE IN REGIONAL AND STATE HEALTH CARE SUMMITS USING THE SUMMITS' INFORMATION AND DATA TO ADDRESS THE HEALTH CARE NEEDS OF THOSE BROADER COMMUNITIES.PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE:PART VI, LINE 3:DUHS EMPLOYS NUMEROUS MEANS TO EDUCATE PATIENTS ABOUT THEIR ELIGIBILITY FOR ASSISTANCE UNDER FEDERAL, STATE, OR LOCAL GOVERNMENT PROGRAMS OR UNDER THE DUHS CHARITY CARE POLICY. DETAILED INFORMATION IS POSTED ON WWW.DUKEHEALTH.ORG (DUHS' WEBSITE) ALONG WITH HARDCOPY BROCHURES THAT ARE AVAILABLE IN ENGLISH OR SPANISH AT ALL OF OUR PATIENT REGISTRATION LOCATIONS. ALL INPATIENTS AND EMERGENCY DEPARTMENT PATIENTS ARE ALSO PROVIDED WITH A HARDCOPY, ONE-PAGE SUMMARY OF THE WAYS DUHS CAN ASSIST PATIENTS FINANCIALLY. FOR OUTPATIENTS, THIS SAME ONE-PAGE SUMMARY IS PROVIDED ON THEIR FIRST VISIT TO THE INSTITUTION. IN ADDITION, DUHS EMPLOYS FINANCIAL CARE COUNSELORS WHO MEET INDIVIDUALLY WITH PATIENTS WHO HAVE QUESTIONS REGARDING PAYMENT FOR THEIR CARE. DUHS ALSO EMPLOYS MEDICAID ASSISTANCE COUNSELORS WHO SPECIALIZE IN ASSISTING PATIENTS TO APPLY FOR MEDICAID, DISABILITY, AND OTHER FEDERAL, STATE, AND LOCAL PROGRAMS. DUHS ASSISTS BETWEEN 12,000-15,000 PATIENTS IN APPLYING AND BECOMING ELIGIBLE FOR THESE PROGRAMS ANNUALLY. FINALLY, PATIENTS MAY ALWAYS CONTACT DUHS' TOLL FREE CUSTOMER SERVICE NUMBER TO REQUEST INFORMATION ABOUT THEIR BILL OR OBTAIN A CHARITY CARE APPLICATION. COMMUNITY INFORMATION: PART VI, LINE 4:DUHS SERVES A BROAD, CULTURALLY, RACIALLY AND SOCIALLY DIVERSE GEOGRAPHIC AND DEMOGRAPHIC REGION. DUHS' HOME CITY OF DURHAM IS THE CORE, BUT DUHS' REACH EXTENDS INTO THE SURROUNDING RESEARCH TRIANGLE AREA OF NORTH CAROLINA AND THE STATE'S LARGER NORTHERN PIEDMONT REGION, AS WELL AS STATEWIDE, NATIONALLY AND GLOBALLY. DUHS' PRIMARY SERVICE AREA IS A 7-COUNTY REGION IN NC THAT INCLUDES ALAMANCE, DURHAM, GRANVILLE, ORANGE, PERSON, VANCE AND WAKE COUNTIES. THIS 7-COUNTY REGION REPRESENTS APPROXIMATELY 18% OF NC'S POPULATION BASED ON FEDERAL FISCAL YEAR (FFY) 2018 DATA. APPROXIMATELY 67% OF INPATIENT DISCHARGES FROM DUHS FACILITIES IN FFY 2018 WERE PATIENTS FROM ITS PRIMARY SERVICE AREA. DUHS' SECONDARY SERVICE AREA COVERS 15 COUNTIES IN NORTH CAROLINA AND SOUTHERN VIRGINIA WITH A POPULATION OF APPROXIMATELY 2 MILLION. PROMOTION OF COMMUNITY HEALTH:PART VI, LINE 5:DUHS PROMOTES THE HEALTH OF THE COMMUNITIES IT SERVES THROUGH A NUMBER OF COMMUNITY BUILDING ACTIVITIES. CENTRAL TO MANY OF THE EFFORTS IS DUHS' OFFICE OF COMMUNITY RELATIONS, WHOSE ASSOCIATE VICE PRESIDENT REPORTS DIRECTLY TO DUHS' CEO AND SERVES AS A FULL-TIME LIAISON WITH THE DURHAM COMMUNITY. THE OFFICE SPONSORS AND FACILITATES COMMUNITY EVENTS SUCH AS THE ANNUAL DURHAM HEALTH SUMMIT AND SIMILAR REGIONAL AND STATE HEALTH SUMMITS THAT RAISE AWARENESS OF COMMUNITY HEALTH NEEDS, PROMOTE PREVENTION AND WELLNESS, AND CHART A COURSE FOR SOLVING HEALTH ISSUES AND DISPARITIES. IN ADDITION, THE OFFICE PROVIDES A POINT OF DIRECT CONTACT FOR COMMUNITY MEMBERS WHO HAVE QUESTIONS OR CONCERNS ABOUT COMMUNITY ISSUES OR ABOUT ACCESS TO HEALTH CARE SERVICES. THE OFFICE ALSO PROVIDES DIRECT FINANCIAL SUPPORT TO A VARIETY OF COMMUNITY GROUPS THROUGH THE BUILDING HEALTHY COMMUNITIES GRANTS PROGRAM. THE ASSOCIATE VICE-PRESIDENT AND STAFF SERVE ON A NUMBER OF HEALTH CARE-RELATED COMMUNITY BOARDS AND HEALTH-RELATED COMMITTEES. STAFF FROM THE OFFICE OF COMMUNITY RELATIONS AND MEMBERS OF THE DUHS COMMUNITY HEALTH PLANNING GROUP CREATED A FORMAL PRINCIPLES OF COMMUNITY ENGAGEMENT POLICY THAT COMMITS DUHS AND ITS COMMUNITY PARTNERS TO DEVELOPING PROPOSED PROJECTS AND INITIATIVES ON TRUST, RESPECT, DIVERSITY, SAFETY AND COMMUNITY-IDENTIFIED NEEDS. THESE PRINCIPLES HAVE BEEN INCORPORATED INTO COMMUNITY-BASED HEALTH CARE PROJECTS SUCH AS THE DEVELOPMENT OF THE HOLTON WELLNESS CENTER AND DURHAM HEALTH INNOVATIONS, A MULTIDISCIPLINARY COMMUNITY BASED JOINT EFFORT BETWEEN DUHS AND THE DURHAM COMMUNITY THAT FOCUSES ON IMPROVING HEALTH OUTCOMES THROUGH NEW AND CREATIVE APPROACHES TO HEALTH CARE DELIVERY.IN ADDITION TO COMMUNITY BUILDING ACTIVITIES, DUHS PROMOTES THE HEALTH OF ITS COMMUNITIES IN A NUMBER OF IMPORTANT WAYS. ONE OF DUHS' THREE CONSTITUENT HOSPITALS, DUKE REGIONAL, HAS AN OPEN MEDICAL STAFF AND A HOSPITAL CORPORATION BOARD, WHICH IS A COUNTY APPOINTED BOARD RESPONSIBLE FOR HOSPITAL OVERSIGHT. IN ADDITION, APPROXIMATELY 50 LOCAL LEADERS IN THE DURHAM FAITH COMMUNITY ARE WORKING WITH DUKE HEALTH TO LOOK AT HOW TO ADDRESS THE NEEDS OF THEIR CONGREGATIONS AND COMMUNITIES BY COMBINING THE TRADITIONS OF THE FAITH COMMUNITY WITH THE KNOWLEDGE OF MODERN MEDICINE. MEETINGS ARE HELD TO DETERMINE HOW DUKE HEALTH CAN ASSIST THE FAITH COMMUNITY TO SUPPORT HEALTH MINISTRY ACTIVITIES IN THEIR COMMUNITY AND PLACES OF WORSHIP.DUHS' CEO ALSO HAS A CHANCELLOR'S COMMUNITY HEALTH ADVISORY BOARD TO PROVIDE FEEDBACK ON A VARIETY OF ISSUES, INCLUDING USE OF DUHS RESOURCES, HEALTH SERVICE DELIVERY SYSTEMS AND LONG-RANGE GOALS TO REDUCE HEALTH RISKS AND DISPARITIES IN DURHAM COUNTY. THE BOARD INCLUDES STATE AND LOCAL ELECTED OFFICIALS, NEIGHBORHOOD COUNCILS AND OTHER GRASSROOTS ORGANIZATIONS, POLITICAL GROUPS, LOCAL PHYSICIANS, THE DURHAM PUBLIC SCHOOLS, AMONG OTHERS. DUHS MAINTAINS A BUILDING HEALTHY COMMUNITIES GRANTS COMMITTEE TO REVIEW COMMUNITY REQUESTS FOR PHILANTHROPIC ASSISTANCE THAT PROMOTE HEALTH AND WELLNESS. DUKE HEALTH PROVIDES VARIOUS OPPORTUNITIES FOR STUDENTS TO INTERACT WITH DIFFERENT HEALTH CARE PROFESSIONALS ACROSS THE SYSTEM. THE OFFICE OF COMMUNITY RELATIONS, DRH, AND OTHER KEY COMMUNITY PARTICIPANTS ARE ACTIVE IN A WORKFORCE DEVELOPMENT PROJECT CALLED PROJECT SEARCH. THIS PROGRAM, MODELED AFTER THE PROGRAM AT CINCINNATI CHILDREN'S HOSPITAL, PROVIDES YOUTH WITH DISABILITIES EMPLOYMENT TRAINING AND CAREER OPPORTUNITIES IN THE HEALTHCARE FIELD. THE OFFICE OF COMMUNITY RELATIONS WORKS WITH THE DURHAM-ORANGE MEDICAL SOCIETY AND THE DURHAM ACADEMY OF MEDICINE, DENTISTRY AND PHARMACY (AN ASSOCIATION FOR AFRICAN-AMERICAN MEDICAL PROFESSIONALS) TO PROMOTE THE SUCCESS OF THE CITY OF MEDICINE ACADEMY (CMA). THE CMA IS A PUBLIC MAGNET HIGH SCHOOL DESIGNED FOR STUDENTS INTERESTED IN HEALTH CARE CAREERS. FACULTY ARE INVOLVED WITH MENTORING STUDENTS AND CLASSROOM LECTURES. IN ADDITION, THE HEALTH SYSTEM CEO IS WORKING TO HELP THE CMA BECOME THE PREMIER HEALTH SCIENCE HIGH SCHOOL IN NORTH CAROLINA. DUHS IS A KEY PARTICIPANT IN THE ANNUAL BULL CITY FRESH START EVENT. STAFF FROM THE DUKE SCHOOL OF NURSING, DUKE EYE CENTER, AND STAFF AFFILIATED WITH LINCOLN COMMUNITY HEALTH CENTER HEALTHCARE FOR THE HOMELESS CLINIC VOLUNTEER TIME AND RESOURCES AT THIS IMPORTANT EVENT. STUDENTS FROM THE DUKE SCHOOLS OF MEDICINE AND NURSING ENGAGE COMMUNITIES IN DURHAM AND BEYOND IN ACTIVITIES THAT INCLUDE FREE BLOOD PRESSURE SCREENINGS FOR THE HOMELESS, AND IDENTIFYING THE HEALTH CARE NEEDS OF A LOW WEALTH COMMUNITY SCHOOL AND DEVELOPING A CURRICULUM FOR STUDENTS AND PARENTS THAT ADDRESSES THOSE NEEDS.AFFILIATED HEALTH CARE SYSTEM ROLES:PART VI, LINE 6:DUHS PROVIDES VIRTUALLY ALL LEVELS OF CARE BEGINNING WITH DUKE UNIVERSITY AFFILIATED PHYSICIANS (DBA DUKE PRIMARY CARE) (DPC). THE HOSPITALS PROVIDE ROUTINE INPATIENT AND OUTPATIENT CARE. IN DURHAM COUNTY, DUH AND DRH WORK TOGETHER TO MAXIMIZE FACILITY UTILIZATION PROVIDING ROUTINE AND ADVANCED LEVELS OF CARE. DUH ALSO OPERATES A TRAUMA CENTER WITH AIR AMBULANCE SERVICE. DRAH SERVES THE WAKE COUNTY AREA AS A COMMUNITY HOSPITAL. THE DRAH CAMPUS HAS SEVERAL MEDICAL OFFICE BUILDINGS ENHANCING CONVENIENCE FOR THE PATIENT IN NON-EMERGENT CASES AND PROVIDES STREAMLINED ACCESS TO HIGH-DEMAND PROCEDURES SUCH AS CARDIAC CATHETERIZATION AND RADIOLOGY PROCEDURES. DUHS ALSO OPERATES HOME HEALTH AND HOME INFUSION SERVICES TO TREAT AND CARE FOR PATIENTS IN THE COMFORT OF THEIR HOME. THIS IS OBVIOUSLY PRACTICAL FOR PATIENTS NOT REQUIRING AN INPATIENT STAY BUT IN NEED OF ONGOING CARE AT A SUB-ACUTE LEVEL. FINALLY, HOSPICE PROVIDES PALLIATIVE CARE FOR PATIENTS NOT RESPONDING TO CURATIVE CARE. PAIN MANAGEMENT, SYMPTOM MANAGEMENT, AND PSYCHOLOGICAL AND SPIRITUAL SUPPORT PROVIDE A ROUNDED APPROACH TO COMPASSIONATELY ASSIST TERMINAL PATIENTS AND THEIR FAMILIES WITH THE PROCESS OF DYING. ALL OF THE OPERATING UNITS OF DUHS WORK TOGETHER TO PROVIDE THE RIGHT LEVEL OF CARE FOR THE PATIENT IN THE MOST BENEFICIAL MANNER. IN ADDITION TO THE REACTIVE ACTIVITIES OF DIAGNOSTIC CARE, DUHS ALSO SUPPORTS AND PROMOTES HEALTHY LIFESTYLES IN THE DIET & FITNESS CENTER, CENTER FOR LIVING, AND DUKE INTEGRATIVE MEDICINE. THESE OPERATIONS FOCUS LARGELY ON PREVENTION AND EDUCATION TO AVOID OR MITIGATE THE POTENTIAL FOR FUTURE ILLNESS.LIST OF ALL STATES WHICH ORGANIZATION FILES A COMMUNITY BENEFIT REPORT:PART VI, LINE 7:NORTH CAROLINA 1 ALLIANCE MEDICAL MINISTRY INC 101 DONALD ROSS DR RALEIGH NC 27610 562168673 501(C)(3) 37500 GENERAL SUPPORT AMERICAN HEART ASSOCIATION 3131 RDU CENTER DR SUITE 100 MORRISVILLE NC 27560 135613797 501(C)(3) 6260 GENERAL SUPPORT AMERICAN NATIONAL RED CROSS 4737 UNIVERSITY DR DURHAM NC 27707 530196605 501(C)(3) 15000 SPONSORSHIP BAND TOGETHER PO BOX 6445 RALEIGH NC 276286445 562273756 501(C)(3) 25000 SPONSORSHIP BOYS & GIRLS CLUB OF GREATER DURHAM 808 E PETTIGREW ST DURHAM NC 27701 566001906 501(C)(3) 10000 GENERAL SUPPORT BOYS CLUB OF WAKE COUNTY INC 701 N RALEIGH BLVD RALEIGH NC 27610 560863051 501(C)(3) 20000 GENERAL SUPPORT CAPSTONE EVENT GROUP LLC 3803-B COMPUTER DR SUITE 205 RALEIGH NC 27609 464157559 12500 SPONSORSHIP CARING COMMUNITY FOUNDATION INC PO BOX 1364 CARY NC 27512 200036976 501(C)(3) 10000 SPONSORSHIP CEO ROUNDTABLE ON CANCER INC 100 SAS CAMPUS DR CARY NC 27513 651230448 501(C)(3) 10000 GENERAL SUPPORT CITY OF MEDICINE ACADEMY 301 CRUTCHFIELD ST DURHAM NC 27704 566001021 GOV'T ENTITY 26037 GENERAL SUPPORT COMMUNITIES IN PARTNERSHIP PO BOX 11247 DURHAM NC 27703 475567396 501(C)(3) 20000 GENERAL SUPPORT DUKE SCHOOL FOR CHILDREN 3716 OLD ERWIN RD DURHAM NC 27705 581521494 501(C)(3) 25000 GENERAL SUPPORT DURHAM ALUMNAE DELTA HOUSE INC 65 TW ALEXANDER DR POB 12319 DURHAM NC 27709 581621884 501(C)(3) 7500 SPONSORSHIP DURHAM COUNTY PO BOX 810 DURHAM NC 27702 566000297 GOV'T ENTITY 10650 GENERAL SUPPORT EAST DURHAM CHILDRENS INITIATIVE 2101 ANGIER AVE 3RD FLOOR DURHAM NC 27703 320263133 501(C)(3) 10000 GENERAL SUPPORT ECONOMIC DEVELOPMENT PARTNERSHIP 15000 WESTON PKY CARY NC 27513 464840814 501(C)(3) 20000 GENERAL SUPPORT EL CENTRO HISPANO INC 2000 CHAPEL HILL RD 26A DURHAM NC 27707 562011661 501(C)(3) 11000 GENERAL SUPPORT EL FUTURO INC 2020 E CHAPEL HILL ROAD SUITE DURHAM NC 27707 800122334 501(C)(3) 16000 GENERAL SUPPORT FAMILY VIOLENCE PREVENTION CTR 1012 OBERLINE RD SUITE 100 RALEIGH NC 27605 581320613 501(C)(3) 30000 GENERAL SUPPORT GREAT 100 INC PO BOX 4875 GREENSBORO NC 274044875 561705456 501(C)(3) 15000 GENERAL SUPPORT GREATER RALEIGH CHAMBER OF COMMERCE PO BOX 2978 RALEIGH NC 276022978 560370850 501(C)(6) 13417 SPONSORSHIP HABITAT FOR HUMANITY OF DURHAM 215 N CHURCH ST DURHAM NC 27701 581674794 501(C)(3) 75000 SPONSORSHIP HABITAT FOR HUMANITY OF WAKE COUNTY 2420 RALEIGH BLVD RALEIGH NC 27604 561492703 501(C)(3) 10000 SPONSORSHIP HUMAN RIGHTS CAMPAIGN INC 1640 RHODE ISLAND AVE NW WASHINGTON DC 20036 521243457 501(C)(4) 15000 SPONSORSHIP MADE IN DURHAM 359 BLACKWELL ST SUITE 200 DURHAM NC 27701 472262963 501(C)(3) 15000 SPONSORSHIP MARCH OF DIMES FOUNDATION 6504 FALLS OF NEUSE RD STE 100 RALEIGH NC 27615 131846366 501(C)(3) 7500 SPONSORSHIP MEDASSIST OF MECKLENBURG 4428 TAGGART CREEK RD STE 101 CHARLOTTE NC 28208 562018957 501(C)(3) 7500 SPONSORSHIP MEDICAL FOUNDATION OF NC INC SUITE 4100 BONDURANT HALL CB 7 CHAPEL HILL NC 275997145 566057494 501(C)(3) 50000 GENERAL SUPPORT MIDTOWN EVENTS LLC PO BOX 19107 RALEIGH NC 27619 271832351 50000 SPONSORSHIP MIDTOWN RALEIGH ALLIANCE 1110 NAVAHO DR SUITE 100 RALEIGH NC 27609 452559048 501(C)(6) 12000 SPONSORSHIP MIRACLE LEAGUE OF THE TRIANGLE PO BOX 4193 CARY NC 27519 202696836 501(C)(3) 30000 SPONSORSHIP NC LUNG CANCER PARTNERSHIP 4000 BLUE RIDGE RD SUITE 170 RALEIGH NC 27612 262300885 501(C)(3) 10000 SPONSORSHIP NC PHYSICIANS HEALTH PROGRAM INC 220 HORIZON DRIVE 201 RALEIGH NC 27615 561846599 501(C)(3) 16000 GENERAL SUPPORT NORTH CAROLINA INSTITUTE OF MEDICINE 630 DAVIS DR STE 100 MORRISVILLE NC 27560 561506066 GOV'T ENTITY 7500 GENERAL SUPPORT NORTH CAROLINA SYMPHONY SOCIETY 3700 GLENWOOD AVE SUITE 130 RALEIGH NC 27612 560556755 501(C)(3) 25000 GENERAL SUPPORT NURSES ON BOARDS COALITION PO BOX 14535 MADISON WI 53708 821962611 501(C)(3) 10000 GENERAL SUPPORT POLKA DOT MAMA MELANOMA FOUNDATION 925 ALDEN BRIDGE DR CARY NC 27519 474543960 501(C)(3) 20000 SPONSORSHIP PROJECT ACCESS OF DURHAM COUNTY PO BOX 15339 DURHAM NC 27704 261925378 501(C)(3) 20000 GENERAL SUPPORT RADIO ONE INC 8001-1001 CREEDMOOR ROAD RALEIGH NC 27613 521166660 25000 SPONSORSHIP REX HEALTHCARE INC 211 FRIDAY CENTER DR SUITE 201 CHAPEL HILL NC 27517 561509260 501(C)(3) 34675 GENERAL SUPPORT SENIOR PHARMASSIST INC 406 RIGSBEE AVE STE 201 DURHAM NC 277012186 562084639 501(C)(3) 18500 SPONSORSHIP SUSAN G KOMEN FOR THE CURE NC 600 AIRPORT BLVD SUITE 100 MORRISVILLE NC 27560 752845066 501(C)(3) 60000 SPONSORSHIP TRIANGLE FAMILY SERVICES INC 3937 WESTERN BLVD RALEIGH NC 27606 560547491 501(C)(3) 10000 SPONSORSHIP UNITED NEGRO COLLEGE FUND INC 309 E MOREHEAD ST SUITE 260 CHARLOTTE NC 28202 131624241 501(C)(3) 8250 SPONSORSHIP UNITED WAY OF THE GREATER TRIANGLE 2400 PERIMETER PARK DR 150 MORRISVILLE NC 27560 561949103 501(C)(3) 133104 GENERAL SUPPORT URBAN MINISTRIES OF DURHAM 410 LIBERTY ST DURHAM NC 27701 581505891 501(C)(3) 25000 GENERAL SUPPORT VIDEO DIALOG INC 2725 SEVIER ST DURHAM NC 27705 561624853 10000 GENERAL SUPPORT WAKE TECH COMM COLL FOUNDATION INC 9101 FAYETTEVILLE RD RALEIGH NC 276035696 237017752 501(C)(3) 16600 SPONSORSHIP WESTERN THEOLOGICAL SEMINARY 101 EAST 13TH STREET HOLLAND MI 49423 382009204 501(C)(3) 13208 GENERAL SUPPORT YMCA OF THE TRIANGLE AREA INC 801 CORPORATE CENTER DR STE 20 RALEIGH NC 27606 560591307 501(C)(3) 10500 SPONSORSHIP 43 7 FINANCIAL ASSISTANCE 29 25674 PRIZES AND AWARDS 20 18662 SCHEDULE I, PART I, LINE 2 DUKE UNIVERSITY HEALTH SYSTEM, INC. PROVIDES GENERAL SUPPORT TO LOCAL ORGANIZATIONS BASED ON OUR AWARENESS OF THEIR ACTIVITIES WITHIN THE LOCAL COMMUNITY. DUKE UNIVERSITY HEALTH SYSTEM, INC. ALSO MAINTAINS A BUILDING HEALTHY COMMUNITIES GRANTS PROGRAM THAT REVIEWS COMMUNITY REQUESTS FOR PHILANTHROPIC ASSISTANCE THAT PROMOTE HEALTH AND WELLNESS. X 0 0 X X X X X X 0 1 0 0 0 0 0 1 0 MARY E KLOTMAN MD DIRECTOR 0 702795 0 344680 0 18500 0 33548 0 16579 0 1116102 0 0 VINCENT E PRICE DIRECTOR 0 1320928 0 0 0 18500 0 33548 0 20870 0 1393846 0 0 ANN M REED DIRECTOR 0 291464 23513 33347 0 0 0 33548 0 6453 23513 364812 0 0 JOHN H SAMPSON MD PHD DIRECTOR 0 561338 0 122101 0 0 0 33548 0 72058 0 789045 0 0 A EUGENE WASHINGTON MD DIRECTOR/PRESIDENT & CEO 0 1271705 0 1320592 0 18500 0 133548 0 16998 0 2761343 0 0 MONTE D BROWN MD VP FOR ADMINISTRATION/SECRETARY 404229 0 374237 0 42806 0 33548 0 18749 0 873569 0 0 0 WILLIAM J FULKERSON MD EXECUTIVE VP, DUHS 923411 0 802931 0 125907 0 33548 0 8383 0 1894180 0 0 0 KENNETH C MORRIS SVP, CFO, TREASURER 777630 0 601648 0 6166 0 33548 0 13013 0 1432005 0 0 0 MARY ANN FUCHS VP-PATIENT CARE/CHIEF NURSE EXEC 362292 0 201750 0 29929 0 33548 0 8386 0 635905 0 0 0 KATHLEEN B GALBRAITH PRESIDENT, DUKE REGIONAL HOSPITAL 390550 0 281455 0 25921 0 33548 0 18835 0 750309 0 0 0 THOMAS A OWENS MD PRESIDENT, DUH AND SVP, DUHS 624809 0 461076 0 61950 0 33548 0 13543 0 1194926 0 0 0 DAVID ZAAS MD PRESIDENT, DUKE RALEIGH HOSPITAL 391621 0 277594 0 18500 0 33548 0 19240 0 740503 0 0 0 RHONDA BRANDON CHIEF HUMAN RESOURCES OFFICER, DUHS 364606 0 279070 0 18500 0 33548 0 28333 0 724057 0 0 0 JEFFREY M FERRANTI CIO/VP FOR MEDICAL INFORMATICS 460428 24373 301873 89388 18500 0 33548 0 24839 0 839188 113761 0 0 JULIE SEEL CLINICAL PSYCHOLOGIST 279146 0 337793 0 16959 0 33548 0 9924 0 677370 0 0 0 JOHN S SMITH DUHS ASSOCIATE VP 358562 0 235866 0 0 0 33548 0 20507 0 648483 0 0 0 ROBERT N WILLIS VP OF FINANCE & CORP CONTROLLER 411848 0 94205 0 103526 0 33548 0 16060 0 659187 0 0 0 KEVIN SOWERS FORMER KEY EMPLOYEE 41719 0 226734 0 14977 0 33548 0 1072 0 318050 0 0 0 SCHEDULE J, PART I, LINE 1A TAX INDEMNIFICATION: THOMAS OWENS, MD RECEIVED A BENEFIT THAT WAS GROSSED UP TO COMPENSATE FOR WITHHOLDING OF TAXES. SCHEDULE J, PART I, LINE 1B THE BOXES CHECKED ON LINE 1A ARE BASED ON CONTRACTUAL OBLIGATIONS APPROVED BY THE DUHS COMPENSATION COMMITTEE, NOT A RECURRING POLICY OF THE ORGANIZATION AND HENCE SUBSTANTIATION WAS NOT REQUIRED. SCHEDULE J, PART I, LINE 7 NON-FIXED PAYMENTS: DUHS MAINTAINS AN EXECUTIVE INCENTIVE COMPENSATION PLAN. PAYMENTS UNDER THE PLAN ARE BASED ON PRE-ESTABLISHED PERFORMANCE METRICS AND A FIXED CALCULATION METHODOLOGY APPROVED BY THE DUHS COMPENSATION COMMITTEE WITH ASSISTANCE AND INPUT FROM AN EXECUTIVE COMPENSATION CONSULTING FIRM ASSURING COMPARABILITY WITH SIMILAR SYSTEMS. THE PLAN ALLOWS FOR A MODIFICATION TO AN INDIVIDUAL'S INCENTIVE PAYMENT BASED ON LEADERSHIP COMPETENCIES AND OTHER FACTORS WITH PAYOUTS (AND MODIFICATIONS, IF ANY) APPROVED BY THE DUHS COMPENSATION COMMITTEE. A NORTH CAROLINA MEDICAL CARE COMMISSION 521309402 2018-04-24 273320000 SEE PART VI 0 0 0 B NORTH CAROLINA MEDICAL CARE COMMISSION 521309402 2012-05-30 214598930 SEE PART VI 0 0 0 C NORTH CAROLINA MEDICAL CARE COMMISSION 521309402 2015-03-19 128325000 SEE PART VI 0 0 0 D NORTH CAROLINA MEDICAL CARE COMMISSION 521309402 65821DLJ8 2012-06-28 326853753 SEE PART VI 0 0 0 A 13850000 273320000 273320000 1 0 1 1 B 189035000 214760000 214760000 1 0 1 1 C 6705000 128325000 128325000 2009 1 0 1 1 D 23725000 326995394 14871185 2737864 309386345 2013 0 0 1 1 C 0 0 1 1 0 0.00000 0.00000 0.00000 0 1 0.00070 1 1 D 0 0 1 1 0 0.00000 0.00000 0.00000 0 0 1 A 0 0 0 1 1 0 0 0 1 B 0 0 0 1 1 0 0 0 1 C 0 1 0 0 1 0 0 0 1 D 0 0 0 1 0 0 0 0 1 A 1 B 1 C 1 D 1 SCHEDULE K, PART I, COLUMN F BOND ISSUE A: THE PURPOSE OF THE BONDS ISSUED 04/24/18 WAS TO CONVERT THE 2005A REVENUE REFUNDING BONDS TO BEAR INTEREST AT A NEW BANK-BOUGHT INDEX FLOATING RATE. THE PURPOSE OF THE BONDS ISSUED 03/22/2012 WAS TO REFUND THE 2005ABC BONDS ISSUED ON 08/21/2009, WHICH REFUNDED THE ORIGINAL 2005ABC BONDS ISSUED ON 5/19/2005. THE PURPOSE OF THE BONDS ISSUED 05/19/2005 WAS TO PARTIALLY REFUND THE 1996C BONDS ISSUED ON 10/24/1996, 1998A BONDS ISSUED ON 08/27/1998, AND THE 1998B BONDS ISSUED ON 10/13/1998. THE BONDS ISSUED 04/24/18 WERE ALSO ISSUED TO CONVERT THE 2016(B) AND 2016(C) BONDS TO BEAR INTEREST AT A NEW BANK-BOUGHT INDEX FLOATING RATE. SEE ALSO BOND ISSUE B(2) BELOW. BOND ISSUE B: THE PURPOSE OF THE BONDS ISSUED 05/30/2012 WAS TO PARTIALLY REFUND THE 2005ABC BONDS ISSUED ON 03/22/12, WHICH REFUNDED THE 2005ABC BONDS ISSUED ON 08/21/2009, WHICH REFUNDED THE ORIGINAL 2005ABC BONDS ISSUED ON 5/19/2005. THE PURPOSE OF THE BONDS ISSUED 05/19/2005 WAS TO PARTIALLY REFUND THE 1996C BONDS ISSUED ON 10/24/1996, 1998A BONDS ISSUED ON 08/27/1998, AND THE 1998B BONDS ISSUED ON 10/13/1998. BOND ISSUE C: THE PURPOSE OF THE BONDS ISSUED 03/19/2015 WAS TO REFUND THE 2006ABC BONDS ISSUED ON 10/06/2011, WHICH REFUNDED THE BONDS ISSUED 11/15/2006 FOR HOSPITAL IMPROVEMENTS INCLUDING: ROUTINE INFRASTRUCTURE, RENOVATION AND IMPROVEMENT PROJECTS AT DUKE UNIVERSITY HOSPITAL AND DUKE RALEIGH HOSPITAL, IMPROVEMENTS TO INFORMATION SYSTEMS, RENOVATION AND EXPANSION OF EMERGENCY DEPARTMENT AT DUKE UNIVERSITY HOSPITAL, HELIPORT AND NEW ROOF IMPROVEMENTS AT DUKE UNIVERSITY HOSPITAL, AND PHASES 1 AND 2 OF AN OPERATING ROOM SUITE RENOVATION AND EXPANSION AT DUKE UNIVERSITY HOSPITAL. BOND ISSUE D: THE PURPOSE OF THE BONDS ISSUED 06/28/12 WAS TO FINANCE PART OF THE COST OF HOSPITAL CAPITAL IMPROVEMENTS INCLUDING: THE CONSTRUCTION OF A MAJOR TERTIARY CARE ADDITION TO DUKE UNIVERSITY HOSPITAL REFERRED TO AS THE DUKE MEDICINE PAVILION (DMP) WHICH INCLUDED A NEW 609,000 SQUARE FOOT TERTIARY CARE ADDITION INCLUDING FOUR 24-BED INTENSIVE CARE UNITS, TWO 32 BED INTERMEDIATE/STEP-DOWN UNITS, 16 OPERATING ROOMS, EXPANDED IMAGING FACILITIES, AND PATIENT AND FAMILY ORIENTED AMENITIES; A 9,000 SQUARE FOOT SOUTH CONCOURSE CONNECTOR CORRIDOR BETWEEN THE EXISTING CANCER CENTER AND DUKE CLINICS AND THE DMP; A 46,000 SQUARE FOOT NORTH CONCOURSE CONNECTOR CORRIDOR BETWEEN THE DMP AND DUKE UNIVERSITY HOSPITAL-NORTH; RENOVATION OF APPROXIMATELY 29,000 SQUARE FEET IN DUKE UNIVERSITY HOSPITAL AND ROAD IMPROVEMENT AND VEHICLE PARKING PROJECTS REQUIRED TO COMPLETE AND OPERATE THE NEW ADDITION. BOND ISSUE A (2): THE ISSUANCE OF THE BONDS ON 7/25/2018 WAS A DEEMED CURRENT REFUNDING OF THE 2012B BONDS DUE TO THE CONVERSION OF THE 2012B BONDS TO BEAR INTEREST AT A NEW BANK-BOUGHT INDEX FLOATING RATE. THE PURPOSE OF THE BONDS ISSUED 08/28/2012 WAS TO REFUND THE ORIGINAL 1985B BONDS ISSUED ON 10/02/1985 FOR THE ACQUISITION OF A MAINTENANCE BUILDING, PARKING, AND A DEBT SERVICE FUND, AND TO REFUND THE ORIGINAL 1993A BONDS ISSUED ON 08/12/1993. THE PURPOSE OF THE BONDS ISSUED 08/12/1993 WAS TO PARTIALLY REFUND THE 1991D BONDS ISSUED ON 7/1/1991 AND THE 1985A BONDS ISSUED ON 10/02/1985. THE 2012C BONDS WERE PAID OFF EFFECTIVE JUNE 1, 2015. BOND ISSUE B (2): THE 2016B AND 2016C REVENUE REFUNDING BONDS WERE CONVERTED TO BEAR INTEREST AT A NEW BANK-BOUGHT INDEX FLOATING RATE ON 04/24/18. THE PURPOSE OF THE BONDS ISSUED 05/26/16 WAS TO REFUND THE ORIGINAL 2009A BONDS ISSUED ON 10/22/09 TO FINANCE HOSPITAL IMPROVEMENTS INCLUDING THE AMBULATORY CANCER CENTER AT DUKE UNIVERSITY HOSPITAL AND OTHER RENOVATION AND IMPROVEMENT PROJECTS AT DUKE RALEIGH HOSPITAL, AND TO REFUND THE 2005C BONDS ISSUED ON 05/30/12 AND TO PARTIALLY REFUND THE 2005B BONDS ISSUED ON 05/30/12. THE PURPOSE OF THE BONDS ISSUED ON 05/30/2012 WAS TO PARTIALLY REFUND THE 2005ABC BONDS ISSUED ON 03/22/12, WHICH REFUNDED THE 2005ABC BONDS ISSUED ON 08/21/2009, WHICH REFUNDED THE ORIGINAL 2005ABC BONDS ISSUED ON 5/19/2005. THE PURPOSE OF THE BONDS ISSUED 05/19/2005 WAS TO PARTIALLY REFUND THE 1996C BONDS ISSUED ON 10/24/1996, 1998A BONDS ISSUED ON 08/27/1998, AND THE 1998B BONDS ISSUED ON 10/13/1998. BOND ISSUE C (2): THE PURPOSE OF THE BONDS ISSUED 08/11/16 WAS TO REFUND THE ORIGINAL 2010A BONDS ISSUED ON 04/2/10 TO FINANCE HOSPITAL CAPITAL IMPROVEMENTS INCLUDING: THE CONSTRUCTION OF A MAJOR TERTIARY CARE ADDITION TO DUKE UNIVERSITY HOSPITAL REFERRED TO AS THE DUKE MEDICINE PAVILION (DMP) WHICH INCLUDED A NEW 582,000 SQUARE FOOT TERTIARY CARE ADDITION INCLUDING FOUR 24-BED INTENSIVE CARE UNITS, TWO 32 BED INTERMEDIATE /STEP-DOWN UNITS, 16 OPERATING ROOMS, EXPANDED IMAGING FACILITIES, AND PATIENT AND FAMILY ORIENTED AMENITIES; A 9,000 SQUARE FOOT SOUTH CONCOURSE CONNECTOR CORRIDOR BETWEEN THE EXISTING CANCER CENTER AND DUKE CLINICS AND THE DMP; A 46,000 SQUARE FOOT NORTH CONCOURSE CONNECTOR CORRIDOR BETWEEN THE DMP AND DUKE UNIVERSITY HOSPITAL-NORTH; RENOVATION OF APPROXIMATELY 29,000 SQUARE FEET IN DUKE UNIVERSITY HOSPITAL AND ROAD IMPROVEMENT AND VEHICLE PARKING PROJECTS REQUIRED TO COMPLETE AND OPERATE THE NEW ADDITION. BOND ISSUE D (2): DRAW-DOWN FINANCING LEASE PROGRAM WITH SUNTRUST EQUIPMENT FINANCE & LEASING CORP. IN THE MAXIMUM PRINCIPAL AMOUNT OF $40,000,000 TO FINANCE MEDICAL, COMPUTER, OFFICE, AND CAPITAL EQUIPMENT. BOND ISSUE A (3): SCHEDULE NO. 1 OF THE FINANCING LEASE PROGRAM WITH TD EQUIPMENT FINANCE IN THE PRINCIPAL AMOUNT OF $1,937,324 TO FINANCE MEDICAL, COMPUTER, OFFICE, AND CAPITAL EQUIPMENT ISSUE PRICE DIFFERS FROM THAT SHOWN ON FORM 8038 BECAUSE FORM 8038 ASSUMED ALL SCHEDULES UNDER THE PROGRAM WOULD BE DRAWN DOWN AS ONE ($40,000,000) ISSUE, BUT NOW SCHEDULE NO. 1 IS SINGLE ISSUE. BOND ISSUE B (3): DRAW-DOWN FINANCING LEASE PROGRAM WITH TD EQUIPMENT FINANCE, OTHER THAN SCHEDULE 1, IN THE MAXIMUM PRINCIPAL AMOUNT OF $38,062,676 TO FINANCE MEDICAL, COMPUTER, OFFICE, AND CAPITAL EQUIPMENT. SCHEDULE K, PART II, LINE 3, BOND ISSUE (B): PROCEEDS INCLUDE ISSUE PRICE PLUS ORIGINAL ISSUE DISCOUNT / UPFRONT FEE PAID DIRECTLY BY DUHS TO THE BANK UPON ISSUANCE. SCHEDULE K, PART II, LINE 3, BOND ISSUE (D): PROCEEDS INCLUDE INVESTMENT EARNINGS. SCHEDULE K, PART II, LINE 3, BOND ISSUES D (2), A (3), AND B (3): PROCEEDS REFLECT ACTUAL PRINCIPAL DRAWN DOWN UNDER DRAW DOWN FINANCING LEASE PROGRAM. SCHEDULE K, PART III, B (2), LINES 4-6: RESPONSES REFLECT THE COMPUTATION OF THE PORTION OF THE ISSUE ALLOCABLE TO THE REFUNDING OF THE 2009A BONDS. SCHEDULE K, PART IV, LINE 2C, BOND ISSUES (A), (B), (D), A (2), B (2), AND C (2): BOND ISSUE (A) COMPLETED 06/01/19; (B) COMPLETED 05/30/17; (D) COMPLETED 05/31/17; A(2) COMPLETED 07/25/18; B(2) COMPLETED 06/01/19; AND C(2) COMPLETED 08/01/17. AS TO D(2), A(3), AND B(3), NO ARBITRAGE COMPUTATION WAS NECESSARY BECAUSE NO PROCEEDS WERE REINVESTED. BOND ISSUES (A), (B), (C), AND A (2): THESE PROCEEDS WERE DISBURSED OR DEEMED DISBURSED UPON ISSUANCE TO CURRENTLY REFUND THE PRIOR BONDS. BOND ISSUES D (2), A (3), AND B (3): SALES PROCEEDS ALLOCATED UPON ISSUANCE AND NOT INVESTED. SCHEDULE K, PART III, LINE 8C, BOND ISSUE (C) : DISPOSITION WAS THE SUBJECT OF A CLOSING AGREEMENT ACCEPTED AND CLOSED WITH THE IRS IN OCTOBER 2014 THROUGH THE TAX EXEMPT BONDS VOLUNTARY CLOSING AGREEMENT PROGRAM. A NORTH CAROLINA MEDICAL CARE COMMISSION 521309402 2018-07-25 28650000 SEE PART VI 0 0 0 B NORTH CAROLINA MEDICAL CARE COMMISSION 521309402 65821DUD1 2016-05-26 383990154 SEE PART VI 0 0 0 C NORTH CAROLINA MEDICAL CARE COMMISSION 521309402 65821DVK4 2016-08-11 140200389 SEE PART VI 0 0 0 D NORTH CAROLINA MEDICAL CARE COMMISSION 521309402 2015-04-21 40000000 SEE PART VI 0 0 0 A 5160000 28650000 28650000 1 0 1 1 B 212930000 383990154 201888819 2101335 180000000 1 1 1 1 C 140200389 139008505 1191884 0 1 1 1 D 7444099 19035078 19035078 2017 0 0 1 1 B 0 0 1 1 0 0 0 1 C 0 0 1 1 0 0.00000 0.00000 0.00000 0 0 1 D 0 0 1 1 0 0.00000 0.00000 0.00000 0 0 1 A 0 1 0 0 1 0 0 0 1 B 0 0 0 1 1 0 0 0 1 C 0 0 0 1 0 0 0 0 1 D 0 1 0 0 0 0 0 0 1 A 1 B 1 C 1 D 1 A NORTH CAROLINA MEDICAL CARE COMMISSION 521309402 2017-10-26 1937324 SEE PART VI 0 0 0 B NORTH CAROLINA MEDICAL CARE COMMISSION 521309402 2018-05-10 38062676 SEE PART VI 0 0 0 A 627549 1937324 1937324 2018 0 0 1 1 B 1015870 9262883 9262883 0 0 0 1 A 0 0 1 1 0 0.00000 0.00000 0.00000 0 0 1 B 0 0 1 1 0 0.00000 0.00000 0.00000 0 0 1 A 0 1 0 0 0 0 0 0 1 B 0 1 0 0 0 0 0 0 1 A 1 B 1 BIOVENTUS LLC SEE PART V 582574 SEE PART V 0 DANIEL J SCOTT MD SEE PART V 65748 SEE PART V 0 SCH L, PART IV, BUSINESS TRANSACTIONS INVOLVING INTERESTED PERSONS: (A) NAME OF INTERESTED PERSON: BIOVENTUS, LLC(B) RELATIONSHIP BETWEEN INTERESTED PERSON AND ORGANIZATION: BIOVENTUS, LLC DIRECTORS ARE DUHS, INC. DIRECTORS(C) AMOUNT OF TRANSACTION: $582,574(D) DESCRIPTION OF TRANSACTION: PAYMENT FOR GOODS OR SERVICES(E) SHARING OF ORGANIZATION REVENUE? = NO(A) NAME OF INTERESTED PERSON: DANIEL J. SCOTT, MD(B) RELATIONSHIP BETWEEN INTERESTED PERSON AND ORGANIZATION: DANIEL J. SCOTT, MD IS A FAMILY MEMBER OF A DUHS, INC. DIRECTOR(C) AMOUNT OF TRANSACTION: $65,748(D) DESCRIPTION OF TRANSACTION: PAYMENT FOR SALARY AND BENEFITS(E) SHARING OF ORGANIZATION REVENUE? = NO X 2 2 ESTIMATE X 15658 FMV X 7 51906 MARKET QUOTE X 2 300 FMV X 1 24000 FMV X ENTERTAINMENT 51 19648 VARIOUS X SPORTS 15 4162 VARIOUS 0 0 1 1 PART I, LINE 32B: DUKE UNIVERSITY HEALTH SYSTEM, INC. USES INVESTMENT BROKERS TO SELL INVESTMENTS. DUKE UNIVERSITY HEALTH SYSTEM, INC. MAY OCCASIONALLY USE THIRD PARTIES TO SELL OTHER TYPES OF NON-CASH CONTRIBUTIONS, AS THE NEED ARISES. FORM 990, PART I, LINE 1, & PART III, DESCRIPTION OF ORGANIZATION MISSION: DUHS, AS PART OF DUKE HEALTH, IS COMMITTED TO ADVANCING HEALTH TOGETHER BY DELIVERING TOMORROW'S HEALTH CARE TODAY, ACCELERATING DISCOVERY AND ITS TRANSLATION, CREATING EDUCATION THAT IS TRANSFORMING, BUILDING HEALTHY COMMUNITIES, AND CONNECTING WITH THE WORLD TO IMPROVE HEALTH GLOBALLY. FORM 990, PART III, LINE 4A STATEMENT OF PROGRAM SERVICE ACCOMPLISHMENTS HISTORY AND ORGANIZATION IN 1925, JAMES B. DUKE WILLED $4 MILLION TO ESTABLISH DUKE UNIVERSITY HOSPITAL AND ITS MEDICAL SCHOOL TO IMPROVE HEALTH CARE IN THE CAROLINAS, THEN A POOR REGION LACKING HOSPITALS AND HEALTH CARE PROVIDERS. DUKE UNIVERSITY HOSPITAL HAS GROWN TO BE RECOGNIZED AS ONE OF THE WORLD'S GREAT HEALTH CARE PROVIDERS. IN 1998 AND CONCURRENT WITH ACQUIRING CONTROL OF TWO LOCAL COMMUNITY HOSPITALS, THE DUKE UNIVERSITY BOARD OF TRUSTEES ESTABLISHED DUKE UNIVERSITY HOSPITAL AS THE FLAGSHIP OF THE NEWLY INCORPORATED DUKE UNIVERSITY HEALTH SYSTEM, INC. (DUHS) TO MANAGE A WIDE RANGE OF HEALTH CARE PROGRAMS AT THE SAME HIGH LEVEL OF QUALITY THAT HAS TRADITIONALLY MADE DUKE UNIVERSITY HOSPITAL A WORLD LEADER. THIS NETWORK OF REGIONAL HEALTH CARE ORGANIZATIONS IS DEDICATED TO EMPLOYING DUKE'S STRENGTHS IN PATIENT CARE, EDUCATION, AND RESEARCH. DUHS IS A COMPONENT OF DUKE HEALTH WHICH CONCEPTUALLY INTEGRATES THE DUKE UNIVERSITY SCHOOL OF MEDICINE, DUKE-NUS MEDICAL SCHOOL, DUKE UNIVERSITY SCHOOL OF NURSING, DUKE UNIVERSITY HEALTH SYSTEM, PRIVATE DIAGNOSTIC CLINIC (DUKE PHYSICIANS PRACTICE), AND INCORPORATES THE HEALTH AND HEALTH RESEARCH PROGRAMS WITHIN THE DUKE GLOBAL HEALTH INSTITUTE AS WELL AS THOSE IN SCHOOLS AND CENTERS ACROSS DUKE UNIVERSITY, INCLUDING THE DUKE ROBERT J. MARGOLIS CENTER FOR HEALTH POLICY. THE DUKE HEALTH CLINICAL ENTERPRISE IS INTENDED TO FUNCTION AS A FULLY ALIGNED AND UNIFIED ORGANIZATION FOCUSED ON IMPROVING THE HEALTH OF THE COMMUNITIES WE SERVE, DELIVERING ADVANCED TREATMENT FOR THOSE WHO NEED IT, AND EXTENDING NEW KNOWLEDGE BEYOND OUR SYSTEMS TO THE BENEFIT OF OTHERS. LEVERAGING THE DEPTH AND BREADTH OF CAPABILITIES THAT EXIST ACROSS DUKE HEALTH AND THE ENTIRE UNIVERSITY, WE PLAN TO ACHIEVE THE VISION TO DELIVER TOMORROW'S HEALTH CARE TODAY BY LEADING IN THE DELIVERY OF HIGHEST-QUALITY, PATIENT CENTERED CARE, INTEGRATING TO OPTIMIZE COORDINATION OF CARE, GROWING AND EXTENDING OUR REACH LOCALLY, REGIONALLY, AND NATIONALLY, INVESTING IN INNOVATION TO CREATE SUSTAINABLE DIFFERENTIATION AND VALUE AND DELIVERING ON THE PROMISE OF POPULATION HEALTH. MANY PROGRAM SERVICE ACCOMPLISHMENTS ARE INCLUDED IN SCHEDULE H OF THIS FORM INCLUDING THE FINANCIAL COMMITMENT MADE TO THE COMMUNITY BY DUHS IN TERMS OF CHARITY CARE AND OTHER DIRECT AND MEASURABLE INVESTMENTS. FURTHER DETAIL OF DUHS' COMMITMENT TO PROMOTING HEALTH, WELLNESS, AND ACCESS TO QUALITY CARE FOR THE PEOPLE AND COMMUNITIES IT SERVES IS REPORTED IN DUHS' ANNUAL COMMUNITY BENEFIT REPORT. THE 2020 REPORT WHICH CONTAINS FY2019 FINANCIAL DATA IS AVAILABLE ONLINE AT HTTPS://CORPORATE.DUKEHEALTH.ORG/COMMUNITY FORM 990, PART VI, SECTION A, LINE 2 DIRECTORS JACK O. BOVENDER, JR., WILLIAM HAWKINS, MICHAEL MARSICANO, VINCENT E. PRICE, CARMICHAEL ROBERTS, NANCY M. SCHLICHTING, AND STEVEN M. SCOTT, MD ARE TRUSTEES OF DUKE UNIVERSITY. DIRECTOR AND PRESIDENT/CEO, A. EUGENE WASHINGTON, MD, IS AN OFFICER OF DUKE UNIVERSITY. DIRECTOR MARY E. KLOTMAN, MD IS A KEY EMPLOYEE OF DUKE UNIVERSITY. THE FOLLOWING INDIVIDUALS ARE EMPLOYEES OF DUKE UNIVERSITY: ANN M. REED AND JOHN H. SAMPSON, MD. DIRECTOR AND PRESIDENT/CEO, A. EUGENE WASHINGTON, MD, AND OFFICERS WILLIAM J. FULKERSON, MD, AND KENNETH C. MORRIS ARE DIRECTORS OF DURHAM CASUALTY COMPANY, LTD. DIRECTOR AND PRESIDENT/CEO, A. EUGENE WASHINGTON, MD, AND OFFICERS WILLIAM J. FULKERSON, MD, ANN M. REED, AND JOHN H. SAMPSON, MD ARE BOARD MEMBERS OF PRIVATE DIAGNOSTIC CLINIC, PLLC. OFFICERS WILLIAM J. FULKERSON, MD AND KENNETH C. MORRIS ARE BOTH DIRECTORS AND OFFICERS OF HEALTH SYSTEM MEDICAL STRATEGIES, INC. WILLIAM HAWKINS AND SUSAN STALNECKER ARE BOTH DIRECTORS OF BIOVENTUS, LLC. FORM 990, PART VI, SECTION A, LINE 3 DUHS DELEGATES CONTROL TO A SUPPORTING ORGANIZATION FOR THE MANAGEMENT OF INVESTMENTS. FORM 990, PART VI, SECTION A, LINE 7A THE MEMBERS OF THE BOARD OF DIRECTORS OF DUHS, OTHER THAN THE EX OFFICIO MEMBERS, WILL BE NOMINATED BY THE BOARD OF DIRECTORS OF DUHS, AND WILL BE APPOINTED BY THE BOARD OF TRUSTEES OF DUKE UNIVERSITY. MEMBERS OF THE BOARD OF DIRECTORS OF DUHS WILL BE SUBJECT TO REMOVAL AT THE DISCRETION OF THE BOARD OF TRUSTEES OF DUKE UNIVERSITY IN ACCORDANCE WITH THE BYLAWS OF DUHS. FORM 990, PART VI, SECTION A, LINE 7B THE DUHS BYLAWS PROVIDE THAT DUHS MUST OBTAIN DUKE UNIVERSITY BOARD OF TRUSTEES APPROVAL FOR CERTAIN SIGNIFICANT TRANSACTIONS REGARDING DEBT ISSUANCES, CAPITAL ACQUISITIONS AND TANGIBLE PERSONAL AND REAL PROPERTY SALES. FORM 990, PART VI, SECTION B, LINE 11B AFTER STAFF PREPARATION AND MANAGEMENT REVIEW, THE DUHS FORM 990 IS PRESENTED TO THE DUHS COMPLIANCE/AUDIT COMMITTEE OF THE BOARD OF DIRECTORS FOR REVIEW AND DISCUSSION. DUHS BOARD LEVEL COMMENT AND DISCUSSION ARE INCORPORATED INTO THE FORM AS APPROPRIATE PRIOR TO FILING. A FINAL VERSION OF THE FORM IS MADE AVAILABLE TO THE DUHS BOARD OF DIRECTORS FOR FURTHER REVIEW AND COMMENT BEFORE FILING. FORM 990, PART VI, SECTION B, LINE 12C DUHS MONITORS AND ENFORCES COMPLIANCE RELATED TO CONFLICT OF INTEREST VIA AN ANNUAL CONFLICT OF INTEREST QUESTIONNAIRE, RELYING ON SELF DISCLOSURE OF ALL THOSE SUBJECT TO THE COI POLICY. FORM 990, PART VI, SECTION B, LINE 15 THE DUHS COMPENSATION COMMITTEE, COMPRISED OF MEMBERS OF THE DUHS BOARD OF DIRECTORS, REVIEWS AND APPROVES ALL EXECUTIVE COMPENSATION FOR CERTAIN DISQUALIFIED PERSONS AND OTHER KEY EMPLOYEES. THE DUHS COMPENSATION COMMITTEE REVIEWS AND RECOMMENDS TO THE DUKE UNIVERSITY COMPENSATION COMMITTEE THE COMPENSATION FOR THE PRESIDENT AND CEO OF DUHS WHO IS ALSO AN OFFICER OF DUKE UNIVERSITY. DUHS HAS ADOPTED A STATEMENT OF COMPENSATION PHILOSOPHY THAT ARTICULATES BROAD OBJECTIVES TO HELP GUIDE THE DUHS COMPENSATION COMMITTEE IN ITS MISSION. THE DUHS COMPENSATION COMMITTEE ENGAGES THE SERVICES OF AN OUTSIDE EXECUTIVE COMPENSATION CONSULTING FIRM TO ESTABLISH COMPARABILITY DATA OF OTHER HEALTH CARE SYSTEMS OF SIMILAR SIZE AND COMPLEXITY AS DUHS. THE DUHS COMPENSATION COMMITTEE REVIEWS THE MARKET ANALYSIS THEN DETERMINES THE REASONABLENESS AND APPROPRIATENESS OF ALL ASPECTS OF EXECUTIVE COMPENSATION. THE DUHS COMPENSATION COMMITTEE ALSO SETS THE METRICS AND APPROVES THE PAYOUTS FOR THE DUHS INCENTIVE COMPENSATION PLANS FOR THESE INDIVIDUALS. THE DELIBERATIONS AND CONCLUSIONS OF THE DUHS COMPENSATION COMMITTEE ARE KEPT BY A RECORDING SECRETARY WHO RECORDS THE MINUTES OF THE COMMITTEE MEETINGS. FORM 990, PART VI, SECTION C, LINE 18 DUKE UNIVERSITY HEALTH SYSTEM, INC.'S FORM 990 IS AVAILABLE TO THE PUBLIC ON WWW.GUIDESTAR.ORG. GUIDESTAR INDEPENDENTLY POSTS TAX-EXEMPT ORGANIZATIONS' FORM 990'S ON THEIR WEBSITE, OBTAINED FROM THE INTERNAL REVENUE SERVICE. FORM 990, PART VI, SECTION C, LINE 19 DUKE UNIVERSITY HEALTH SYSTEM, INC.'S GOVERNING DOCUMENTS (ARTICLES OF INCORPORATION AND ANY SUBSEQUENT AMENDMENTS OR RESTATEMENTS) ARE AVAILABLE TO THE PUBLIC ON THE NORTH CAROLINA SECRETARY OF STATE WEBSITE. DUKE UNIVERSITY HEALTH SYSTEM, INC. MAKES ITS CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. INDEPENDENTLY AUDITED FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC AT: HTTPS://CORPORATE.DUKEHEALTH.ORG/FINANCIAL-INFORMATION FORM 990, PART XI, LINE 9: NONPERIODIC CHANGES IN DEFINED BENEFIT PLANS: -179,438,870. NET TRANSFERS TO THE UNIVERSITY AND AFFILIATES: -134,300,921. CHANGE IN MARKET VALUE OF DERIVATIVES: -20,387,832. DEEMED DIVIDEND -6,635,025. DUKE PRMO LLC 615 DOUGLAS STREET SUITE 700 DURHAM NC 27705 MEDICAL BILLING NC 157257279 2197599 DUKE UNIVERSITY HEALTH SYSTEM INC DUHS GLOBAL LLC 310 BLACKWELL STREET 4TH FLOOR BOX DURHAM NC 27710 SUPPORT NC 0 0 DUKE UNIVERSITY HEALTH SYSTEM INC SAME DAY SURGERY CENTER FRANKLIN LLC 310 BLACKWELL STREET 4TH FLOOR BOX DURHAM NC 27710 SUPPORT NC 0 0 DUKE UNIVERSITY HEALTH SYSTEM INC AMER ASSOC FOR GIFTED CHILDREN - 56-1686219 324 BLACKWELL STREET STE 850 DURHAM NC 27701 SUPPORT NC 501(C)(3) 12 TYPE 1 DUKE UNIVERSITY 0 ASSOCIATED HEALTH SVCS INC 324 BLACKWELL STREET STE 850 DURHAM NC 27701 561845329 HEALTHCARE NC 501(C)(3) 12 TYPE 1 DUKE UNIVERSITY HEALTH SYSTEM INC 1 DU SPECIAL VENTURES FUND INC 280 S MANGUM STREET STE 210 DURHAM NC 27701 561465177 INVESTMENTS NC 501(C)(3) 12 TYPE 1 DUKE UNIVERSITY 0 DUKE ALUMNI ASSOCIATION INC 324 BLACKWELL STREET STE 850 DURHAM NC 27701 561594088 SUPPORT NC 501(C)(3) 12 TYPE 1 DUKE UNIVERSITY 0 DUKE CORPORATE EDUCATION 310 BLACKWELL ST DURHAM NC 27701 421672476 EDUCATION NC 501(C)(3) 12 TYPE 1 DUKE UNIVERSITY 0 DUKE GIFT PROPERTIES INC 324 BLACKWELL STREET STE 850 DURHAM NC 27701 571211078 SUPPORT NC 501(C)(3) 12 TYPE 1 DUKE UNIVERSITY 0 DUKE GLOBAL INC 324 BLACKWELL STREET STE 850 DURHAM NC 27701 611588319 SUPPORT NC 501(C)(3) 12 TYPE 1 DUKE UNIVERSITY 0 DUKE HOSPITAL AUXILIARY INC PO BOX 2895 DURHAM NC 27710 561825604 SUPPORT NC 501(C)(3) 12 TYPE III-O N/A 0 DUKE INTEGRATED NETWORK INC 324 BLACKWELL STREET STE 850 DURHAM NC 27701 463129771 SUPPORT NC 501(C)(3) 12 TYPE 1 DUKE UNIVERSITY HEALTH SYSTEM INC 1 DUKE MEDICINE GLOBAL SUPP CORP- 61-1593721 324 BLACKWELL STREET STE 850 DURHAM NC 27701 SUPPORT NC 501(C)(3) 12 TYPE 1 DUKE UNIVERSITY 0 DUKE QUALITY NETWORK INC 324 BLACKWELL STREET STE 850 DURHAM NC 27701 461340679 SUPPORT NC 501(C)(3) 12 TYPE 1 DUKE UNIVERSITY HEALTH SYSTEM INC 1 DUKE SCHOLARLY EXHIBITS INC 324 BLACKWELL STREET STE 850 DURHAM NC 27701 561701245 SUPPORT NC 501(C)(3) 12 TYPE 1 DUKE UNIVERSITY 0 DUKE UNIV AFFILIATED PHYSICIANS 324 BLACKWELL STREET STE 850 DURHAM NC 27701 561902501 HEALTHCARE NC 501(C)(3) 12 TYPE 1 DUKE UNIVERSITY HEALTH SYSTEM INC 1 DUKE UNIV PHILANTHROPIES INC 324 BLACKWELL STREET STE 850 DURHAM NC 27701 571211099 SUPPORT NC 501(C)(3) 12 TYPE 1 DUKE UNIVERSITY 0 DUKE UNIV SCH OF MED RESEARCH FDN 56-2247203 324 BLACKWELL STREET STE 850 DURHAM NC 27701 SUPPORT NC 501(C)(3) 12 TYPE 1 DUKE UNIVERSITY 0 DUKE UNIVERSITY 324 BLACKWELL STREET STE 850 DURHAM NC 27701 560532129 EDUCATION NC 501(C)(3) LINE 2 N/A 0 DUMAC INC 280 S MANGUM STREET STE 210 DURHAM NC 27701 900754895 SUPPORT NC 501(C)(3) 12 TYPE 1 DUKE UNIVERSITY 0 DURHAM ASSET MGMT COMPANY INC 324 BLACKWELL STREET STE 850 DURHAM NC 27701 561757238 SUPPORT NC 501(C)(3) 12 TYPE 1 DUKE UNIVERSITY 0 DURHAM REALTY INC 324 BLACKWELL STREET STE 850 DURHAM NC 27701 561917936 SUPPORT NC 501(C)(3) 12 TYPE 1 DUKE UNIVERSITY 0 GOTHIC CORPORATION 280 S MANGUM STREET STE 210 DURHAM NC 27701 561776668 INVESTMENTS NC 501(C)(3) 12 TYPE 1 DUKE UNIVERSITY 0 GOTHIC HSP CORPORATION 280 S MANGUM STREET STE 210 DURHAM NC 27701 271325761 INVESTMENTS NC 501(C)(3) 12 TYPE 1 DUKE UNIVERSITY HEALTH SYSTEM INC 1 HIGH POINT REALTY ASSOCIATES INC 324 BLACKWELL STREET STE 850 DURHAM NC 27701 561917939 SUPPORT NC 501(C)(3) 12 TYPE 1 DUKE UNIVERSITY 0 INNOVATIONS IN HEALTHCARE INC 324 BLACKWELL STREET STE 850 DURHAM NC 27701 320358709 SUPPORT NC 501(C)(3) 12 TYPE 1 DUKE UNIVERSITY 0 RUTH K BROAD BIOMED RES FDN 324 BLACKWELL STREET STE 850 DURHAM NC 27701 650045051 SUPPORT NC 501(C)(3) 12 TYPE 1 DUKE UNIVERSITY 0 THE CTR FOR DOCUMENTARY STUDIES 1317 PETTIGREW STREET DURHAM NC 27705 561655039 SUPPORT NC 501(C)(3) 12 TYPE 1 DUKE UNIVERSITY 0 THE LORD FDN OF NORTH CAROLINA 324 BLACKWELL STREET STE 850 DURHAM NC 27701 561415423 SUPPORT NC 501(C)(3) 12 TYPE 1 DUKE UNIVERSITY 0 DUKE JANJUN SERVICES INC 324 BLACKWELL STREET STE 850 DURHAM NC 27701 471150667 SUPPORT NC 501(C)(3) 12 TYPE 1 DUKE UNIVERSITY 0 DUKE JULDEC SERVICES INC 324 BLACKWELL STREET STE 850 DURHAM NC 27701 471143245 SUPPORT NC 501(C)(3) 12 TYPE 1 DUKE UNIVERSITY 0 DUKE ALLMO SERVICES INC 324 BLACKWELL STREET STE 850 DURHAM NC 27701 471133466 SUPPORT NC 501(C)(3) 12 TYPE 1 DUKE UNIVERSITY 0 DUKE INVESTMENT EDUCATION INC 324 BLACKWELL STREET STE 850 DURHAM NC 27701 475555092 SUPPORT NC 501(C)(3) 12 TYPE 1 DUKE UNIVERSITY 0 FSB REALTY INC 324 BLACKWELL STREET STE 850 DURHAM NC 27701 811309454 SUPPORT NC 501(C)(3) 12 TYPE 1 DUKE UNIVERSITY 0 DUKE AFFILIATIONS NETWORK INC 324 BLACKWELL STREET STE 850 DURHAM NC 27701 812623775 SUPPORT NC 501(C)(3) 12 TYPE 1 DUKE UNIVERSITY HEALTH SYSTEM INC 1 TRIANGLE FIBER GROUP 310 BLACKWELL STREET 4TH FLOOR DURHAM NC 27701 815328550 SUPPORT NC 501(C)(3) 12 TYPE 1 DUKE UNIVERSITY 0 DUKE UNIV FED CRED UNION 2200 WEST MAIN STREET DURHAM NC 27705 561632379 BANKING NC 501(C)(1) N/A 0 WATTS COLLEGE OF NURSING INC 324 BLACKWELL STEET STE 850 DURHAM NC 27701 833076664 SUPPORT NC 501(C)(3) 12 TYPE 1 DUKE UNIVERSITY HEALTH SYSTEM INC 1 BLACKWELL PARTNERS LLC - SERIES A - 20-8075455 280 S MANGUM ST STE 210 DURHAM NC 27701 INVESTMENTS DE N/A N/A 0 0 CANYON BLUE INV FD 27-0186996 AVE OF STARS LA CA 90067 INVESTMENTS DE N/A N/A 0 0 CD FUND LP - 27-0130641 MCKINNEY AVE DALLAS TX 75201 INVESTMENTS TX N/A N/A 0 0 LIQUID REALTY PTR 05-0537755 LINDA MESA DANVILLE CA 94526 INVESTMENTS DE N/A N/A 0 0 LYRICAL BLUE RL PT 27-2994514 32 N DEAN ST ENGLEWOOD NJ 07631 INVESTMENTS DE N/A N/A 0 0 LYRICAL-BLUE RGNT 45-3626577 32 N DEAN ST ENGLEWOOD NJ 07631 INVESTMENTS DE N/A N/A 0 0 SBER LUCKY STRIKE 20-3891303 310 BLACKWELL ST DURHAM NC 27701 REAL ESTATE NC N/A N/A 0 0 MANGUM II LLC - 46-5135858 280 S MANGUM STREET STE 210 DURHAM NC 27701 INVESTMENTS NC N/A N/A 0 0 LS INVESTOR LLC 20-3891381 310 BLACKWELL ST DURHAM NC 27701 REAL ESTATE NC N/A N/A 0 0 DILWEG BLUE PF LP 47-1225569 5310 S ALSTON AVE STE 210 DURHAM NC 27713 INVESTMENTS DE N/A N/A 0 0 LYRICAL BLUE RL PT IV 47-2172270 32 N DEAN ST ENGLEWOOD NJ 07631 INVESTMENTS DE N/A N/A 0 0 LYRICAL BLUE CHP PT 35-2503856 32 N DEAN ST ENGLEWOOD NJ 07631 INVESTMENTS DE N/A N/A 0 0 LIQUID RLT PTR II TE - 20-4362819 10 MARKET ST 769 CAMANA BAY GRAND CAYMAN CJ KY1-9006 INVESTMENTS DE N/A N/A 0 0 STRATUS CAPITAL PARTNERS C LP 50 LOTHIAN ROAD FESTIVAL SQUARE EDINBURGH UK EH3 9WJ INVESTMENTS UK N/A N/A 0 0 ALTOS HYBRID D LLC 2882 SAND HILL ROAD SUITE 100 MENLO PARK CA 94025 473996176 INVESTMENTS DE N/A N/A 0 0 GPE HOLDCO LLC 2000 AVE OF THE STARS 11TH FL LOS ANGELES CA 90067 475652832 INVESTMENTS DE N/A N/A 0 0 BLACKWELL PARTNERS LLC - SERIES C 280 S MANGUM ST STE 210 DURHAM NC 27701 811264533 INVESTMENTS DE N/A N/A 0 0 BLACKWELL PARTNERS LLC - SERIES B 280 S MANGUM ST STE 210 DURHAM NC 27701 472530719 INVESTMENTS DE N/A N/A 0 0 BLACKWELL PARTNERS LLC - SERIES D 280 S MANGUM ST STE 210 DURHAM NC 27701 813385353 INVESTMENTS DE N/A N/A 0 0 BLACKWELL PARTNERS LLC - SERIES E 280 S MANGUM ST STE 210 DURHAM NC 27701 811511048 INVESTMENTS DE N/A N/A 0 0 ALTOS HYBRID 2D LLC - 81-5176567 2882 SAND HILL ROAD STE 100 MENLO PARK CA 94025 INVESTMENTS DE N/A N/A 0 0 GILEAD CAPITAL PARTNERS LP 157 COLUMBUS AVE SUITE 403 NEW YORK NY 10023 320520146 INVESTMENTS DE N/A N/A 0 0 TOWER VIEW LIMITED 89 NEXUS WAY CAMANA BAY GRAND CAYMAN CJ KY1-9007 INVESTMENTS CJ N/A N/A 0 0 ENIAC SPECIAL GAMMA LLC 604 MISSION STREET 10TH FL SAN FRANCSICO CA 94105 855033123 INVESTMENTS DE N/A N/A 0 0 FOURPOINT HOLDINGS LLC 100 ST PAUL STREET STE 400 DENVER CO 80206 464275257 INVESTMENTS DE N/A N/A 0 0 LYRICAL-BLUE 100 KINGSHIGHWAY PARTNERS LP 32 N DEAN ST ENGLEWOOD NJ 07631 823708328 INVESTMENTS DE N/A N/A 0 0 LYRICAL-BLUE SOTP PARTNERS LP 32 N DEAN ST ENGLEWOOD NJ 07631 814468378 INVESTMENTS DE N/A N/A 0 0 WASHINGTON GOTHIC LP 593 WASHINGTON STREET WELLESLEY MA 02482 834516893 INVESTMENTS DE N/A N/A 0 0 DUKE TRIANGLE ENDOSCOPY CENTER LLC 1A BURTON HILLS BLVD NASHVILLE TN 37215 204257024 HEALTHCARE NC N/A N/A 0 0 COLONY INVESTORS III LP 515 S FLOWER ST 44TH FL LOS ANGELES CA 90071 954665622 INVESTMENTS DE N/A N/A 0 0 DWELLWORKS CO-INVESTMENT LLC 7 TIMES SQUARE STE 4307 NEW YORK NY 10036 832165945 INVESTMENTS DE N/A N/A 0 0 BEP LEGACY 1C LLC 1001 FANNIN ST STE 800 HOUSTON TX 77002 273871932 INVESTMENTS DE N/A N/A 0 0 WELLINGTON TRUST CO NA - CTF OPP FIXED INC ALLOC II POR 280 CONGRESS STREET BOSTON MA 02210 831264831 INVESTMENTS DE N/A N/A 0 0 INNOVEX CO-INVEST FUND LP 1221 MCKINNEY ST STE 4100 HOUSTON TX 77010 841799796 INVESTMENTS DE N/A N/A 0 0 DUKE CE LS INC 310 BLACKWELL STREET DURHAM NC 27701 202004016 REAL ESTATE NC N/A C 0 DUKE CE (SEA) PRIVATE LIMITED 1 RAFFLES PLACE TOWER 2 SINGAPORE SN 048616 SUPPORT SN N/A C 0 DUKE CORP EDU INDIA PRIVATE ACADEMIC BLOCK NEW CAMPUS VASTRAPUR AHMEDABAD IN 380015 421672476 CONSULTING IN N/A C 0 DUKE CORPORATE EDUCATION LIM 165 FLEET STREET LONDON UK EC4A 2DY 421672476 EDUCATION CONSULTING UK N/A C 0 DUKE CORPORATE EDUCATION RSA GROUND FLOOR TWICKEHNHAM BLDG BRYANSTON JOHANNESBURG SF 02021 421672476 CONSULTING SF N/A C 0 DUKE GLOBAL CONSULTING (KUNSHAN) 1666 WEI CHEN NAN RD KUNSHAN PR KUNSHAN CH 215300 CONSULTING CH N/A C 0 DUKE MEDICAL STRATEGIES INC 2200 WEST MAIN STREET STE 920 DURHAM NC 27705 561993799 HEALTHCARE NC N/A C 0 DUKE MEDICINE ASIA PTE LTD 5 SHENTON WAY 07-00 UIC BLD SING SN 0688 MEDICAL RESEARCH SN N/A C 0 DURHAM CASUALTY COMPANY LTD AON HOUSE 30 WOODBOURNE AVE PEMBROKE BD HM 08 980113277 INSURANCE BD DUHS INC C 21378856 239429176 1.00000 1 DUSVF EUROPEAN LP 7 CAVENDISH SQUARE LONDON UK W1G 0PE 980346042 INVESTMENTS UK N/A C 0 GOTHIC INTERNATIONAL LTD 113 S CHURCH STREET QUEENSGATE HOU GRAND CAYMAN CJ KY1-1108 INVESTMENTS CJ N/A C 0 HEALTH SYSTEM MEDICAL STRATEGIES INC 324 BLACKWELL STREET STE 850 DURHAM NC 27701 562222444 HEALTH CARE NC DUHS INC C 11573 -4737 1.00000 1 MARATHON BLUE CAYMAN FUND 89 NEXUS WAY PO BOX 31106 GRAND CAYMAN CJ KY1-1205 INVESTMENTS CJ N/A C 0 GHI HOLDINGS MAURITIUS 9TH FL ORANGE TOWER CYBERCITY EBENE MP INVESTMENTS MP N/A C 0 GHI ERP LTD 9TH FL ORANGE TOWER CYBERCITY EBENE MP INVESTMENTS MP N/A C 0 GHI HSP LTD 9TH FL ORANGE TOWER CYBERCITY EBENE MP INVESTMENTS MP N/A C 0 GHI JBD LTD 9TH FL ORANGE TOWER CYBERCITY EBENE MP INVESTMENTS MP N/A C 0 GHI LTP LTD 9TH FL ORANGE TOWER CYBERCITY EBENE MP INVESTMENTS MP N/A C 0 MCP PRIVATE CAPITAL (FEEDER) FUND I LP 6 RUE GABRIEL LIPPMANN LUXEMBOURG LU L-5365 INVESTMENTS LU N/A C 0 DUKE INDIA SERVICES PRIVATE LIMITED 302 PRIDE ELITE 10 MUSEUM ROAD BANGALORE KARNATAKA IN 560001 MEDICAL RESEARCH IN N/A C 0 CPP OFFICE PORTFOLIO (FEEDER) LP 50 LOTHIAN ROAD FESTIVAL SQUARE EDINBURGH UK EH3 9WJ 981152490 REAL ESTATE UK N/A C 0 1 1 1 0 0 0 0 0 0 0 0 0 0 1 1 0 0 1 1 DUKE UNIVERSITY AFFILIATED PHYSICIANS INC R 36528830 FMV ASSOCIATED HEALTH SERVICES INC S 5309724 FMV ASSOCIATED HEALTH SERVICES INC O 5148516 FMV DURHAM CASUALTY COMPANY INC R 10937586 FMV DURHAM CASUALTY COMPANY INC S 9279222 FMV DUKE AFFILIATIONS NETWORK INC S 105993 FMV DUKE INTEGRATED NETWORK INC E 6822385 FMV GOTHIC HSP CORPORATION B 513182352 FMV GOTHIC HSP CORPORATION C 453691252 FMV