2018-05-15T17:19:12-05:00 2017-06-30 990 2016-07-01 562070036 DUKE UNIVERSITY HEALTH SYSTEM INC DUKE 9196842006 324 BLACKWELL ST WASHIN BLDG NO 850 DURHAM NC 27701 KENNETH C MORRIS SVP, CFO, TREASURER 9196842006 2018-05-15 0 2016 2022-09-23 18:48:47Z A EUGENE WASHINGTON MD 615 DOUGLAS ST STE 700 DURHAM NC 27705 4888194157 0 X WWW.DUKEHEALTH.ORG X 1998 NC SEE SCHEDULE O FOR ORGANIZATION'S MISSION STATEMENT 22 14 19362 1211 205127 -882276 8218130 2882117 2936916539 3118023960 97734118 136108446 90308683 74659951 3133177470 3331674474 1823541 1615585 0 0 1271861355 1392576407 0 0 145661 1472089701 1544991410 2745774597 2939183402 387402873 392491072 4933202039 5374830842 2714201164 2654271874 2219000875 2720558968 X SEE SCHEDULE O 0 0 2181427021 1615585 3175020562 SEE SCHEDULE O 2181427021 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 559 0 1 19362 1 1 1 1 BR CI CH CO EZ DA GR HU ID EI JA KU MY NI NO PE PL PO RO KS SW TU UK BD 0 0 0 1 1 0 0 0 0 X 22 14 1 1 1 0 0 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 AK FL GA HI IL KS KY MD MA MI MN MS NH NJ NY OK OR PA SC TN UT WI X X LAURA ALVIS 9196138993 DUHS INC 615 DOUGLAS STREET SUITE DURHAM NC 27705 FARAD ALI DIRECTOR 2.00 0.00 X 0 0 0 NANCY ANDREWS MD DIRECTOR 3.00 56.20 X 0 959361 90625 LESLIE E BAINS DIRECTOR 1.00 0.00 X 0 0 0 GAIL BELVETT MD DDS DIRECTOR 1.00 0.10 X 0 0 0 JACK O BOVENDER JR DIRECTOR 3.00 8.00 X 0 0 0 RICHARD H BRODHEAD DIRECTOR 10.00 50.30 X 0 1258009 166091 JAMES F GOODMON DIRECTOR 2.00 0.00 X 0 0 0 THOMAS M GORRIE DIRECTOR 3.00 9.10 X 0 0 0 WILLIAM HAWKINS DIRECTOR 6.00 6.00 X 0 0 0 JOHN M KANE DIRECTOR 1.00 0.00 X 0 0 0 MARY E KLOTMAN MD DIRECTOR 25.00 40.20 X 0 404841 45474 MICHAEL MARSICANO DIRECTOR 1.00 4.00 X 0 0 0 LLOYD B MORGAN DIRECTOR 2.00 0.00 X 0 0 0 MARK F NEWMAN DIRECTOR 1.00 50.20 X 0 213689 46916 DAVID M RUBENSTEIN DIRECTOR 1.00 16.10 X 0 0 0 NANCY M SCHLICHTING DIRECTOR 6.00 0.00 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 2.00 0.00 X 0 0 0 A EUGENE WASHINGTON MD PRESIDENT & CEO DUHS/DIRECTOR 33.00 33.10 X X 0 2090109 144548 JIM WHITEHURST DIRECTOR 1.00 0.00 X 0 0 0 MONTE D BROWN MD VP FOR ADMINISTRATION/SECRETARY 60.00 0.10 X 669947 0 50232 WILLIAM J FULKERSON MD EXECUTIVE VP, DUHS 60.00 0.60 X 1425996 0 37490 KENNETH C MORRIS SVP, CFO, TREASURER 40.00 0.90 X 1271288 0 41825 MARY ANN FUCHS VP-PATIENT CARE/CHIEF NURSE EXEC 60.00 0.00 X 458734 0 38606 KATHLEEN GALBRAITH PRESIDENT, DUKE REGIONAL HOSPITAL 60.00 0.50 X 514452 0 48845 KEVIN SOWERS PRESIDENT, DUKE UNIVERSITY HOSPITAL 64.00 0.00 X 721326 0 43183 DAVID ZAAS MD PRESIDENT, DUKE RALEIGH HOSPITAL 60.00 0.00 X 539594 0 42104 RHONDA BRANDON CHIEF HUMAN RESOURCES OFFICER 40.00 0.00 X 545021 0 55204 MARC CALABRESE PHYSICIAN 40.00 0.00 X 439903 0 55060 CAROLYN C CARPENTER CHIEF OPERATING OFFICER DUH 40.00 0.00 X 444483 0 49464 JEFFREY M FERRANTI VP, CIO, DHTS ADMINISTRATION 44.50 5.50 X 622660 102220 53244 THOMAS A OWENS MD CHIEF MEDICAL OFFICER 60.00 0.20 X 711274 0 44421 VICTOR J DZAU MD FORMER DIRECTOR/OFFICER 0.00 0.00 X 0 143032 18666 8364678 5171261 1071998 1721 1 1 0 PRIVATE DIAGNOSTIC CLINIC PLLC DUMC 3070 DURHAM NC 27710 PHYSICIAN SERVICES 127722651 SKANSKA USA BUILDING INC 4309 EMPEROR BLVD STE 200 DURHAM NC 27703 CONSTRUCTION SERVICES 15367938 PRISM HEALTHCARE PARTNERS LTD 190 SOUTH LA SALLE ST 2900 CHICAGO IL 60603 CONSULTING SERVICES 13930118 ROBINS & MORTON GROUP 400 SHADES CREEK PKW BIRMINGHAM AL 35209 CONSTRUCTION SERVICES 13011582 KILPATRICK TOWNSEND & STOCKTON LLP 4208 SIX FORKS RD STE 1400 RALEIGH NC 27609 CONSULTING SERVICES 12226640 335 43858 459127 2379132 75443 2882117 PATIENT REVENUE 621990 3085205739 3085205739 ANCILLARY MEDICAL SVCS 621990 30094891 30094891 MEDICAL SERVICES 621990 2723330 2723330 3118023960 12810879 205127 12605752 10575729 10575729 13106145 11481278 1624867 1624867 1624867 1667524469 750696 1544130166 847432 123394303 -96736 123297567 123297567 78103 43858 60807 17296 17296 BILLING FEES 621990 40328325 40328325 LAB SERVICES 621990 3213662 3213662 TUITION REVENUE 611600 2316203 2316203 16583869 11138412 5445457 62442059 3331674474 3175020562 205127 153566668 1527135 1527135 56000 56000 32450 32450 5906714 576165 5282116 48433 886073 92530 793543 1095650750 753375773 342222218 52759 54444666 34297905 20143185 3576 160209236 84997028 75207186 5022 75478968 51639136 23836219 3613 10388991 9720430 668561 1949436 79997 1869439 533100 533100 4031053 4031053 246401602 144499956 101901236 410 7959089 521209 7437880 35184444 21917672 13237825 28947 48380253 2879325 45500928 64906382 42943318 21963046 18 5899563 2980432 2917798 1333 1250 1250 5698714 5698714 36791534 244927 36546607 152589324 112894532 39694792 5778207 5778207 MEDICAL SUPPLIES 749913845 749913845 EQUIPMENT RENTAL & MAIN 73447696 47459793 25987903 MEDICAID ASSESSMENT 72412084 72412084 LOSS - DEBT EXTINGUISH. 18328491 18328491 4396352 40587172 -36191120 300 2939183402 2181427021 757610720 145661 87611 89587 329162546 224797612 2033882 1036024 385991772 382630005 708155 569286 80843829 84835939 18726721 23117570 3122582679 1671657533 1433156774 1450925146 249703654 660358948 2396723865 2505806356 21109824 21109823 14953406 19554546 4933202039 5374830842 310640992 303899724 8442833 6965255 1078059351 1069719707 1317057988 1273687188 2714201164 2654271874 X 2161184588 2663381238 44116648 43472884 13699639 13704846 2219000875 2720558968 4933202039 5374830842 X 392491072 114585878 -5518857 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 0 0 0 0 1 184812 0 1 125060 309872 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. 57816285 2312345 1810497 4761397 57177730 57578816 7276856 -1590780 5448607 57816285 59083195 4849436 -29888 6323927 57578816 46947089 13413723 2988057 4265674 59083195 50036781 8190873 1409233 12689798 46947089 0.47120 0.52880 0 1 1 57155782 57155782 1850343316 813967218 1036376098 761474712 548550179 212924533 453608869 309140136 144468733 1450925146 HEDGED STRATEGIES 798349352 F SHORT-TERM INVESTMENTS 463232809 F PRIVATE CAPITAL 458455695 F REAL ASSETS 334713521 F FIXED INCOME 236503134 F EQUITIES 157047909 F OTHER INVESTMENTS 57503936 F 2505806356 INTERCOMPANY PAYABLE 11019963 INTEREST PAYABLE 12029537 PROFESSIONAL LIABILITY COSTS 6588052 POST RETIREMENT BENEFIT OBLIGATION 416631000 CAPITAL LEASE OBLIGATION 127571016 DERIVATIVE INSTRUMENTS 80650994 TAXABLE BOND LIABILITY 586511737 OTHER NON-CURRENT LIABILITIES 32684889 1273687188 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, 2017. 1 CENTRAL AMERICA AND THE CARIBBEAN 0 0 SEMINAR 7838 EAST ASIA AND THE PACIFIC 0 0 SEMINAR 13497 EUROPE (INCLUDING ICELAND & GREENLAND) 0 0 SEMINAR 27586 EAST ASIA AND THE PACIFIC 0 0 PROGRAM SERVICES EDUCATION 13567 SUB-SAHARAN AFRICA 0 0 SEMINAR 2500 NORTH AMERICA 0 0 SEMINAR 12381 SOUTH AMERICA 0 0 SEMINAR 1326 CENTRAL AMERICA AND THE CARIBBEAN 0 0 INVESTMENTS 211773945 CENTRAL AMERICA AND THE CARIBBEAN 0 0 PROGRAM SERVICES EDUCATION 123301 NORTH AMERICA 0 0 PROGRAM SERVICES EDUCATION 5250 SUB-SAHARAN AFRICA 0 0 GRANTMAKING 32450 EUROPE (INCLUDING ICELAND & GREENLAND) 0 0 PROGRAM SERVICES EDUCATION 3639 RUSSIA AND NEIGHBORING STATES 0 0 PROGRAM SERVICES RESEARCH 1462 SUB-SAHARAN AFRICA 0 0 PROGRAM SERVICES EDUCATION 7999 0 0 0 0 0 0 211852640 174101 212026741 SUB-SAHARAN AFRICA GENERAL SUPPORT 32450 MEDICAL EQUIPMENT FMV 1 0 0 0 1 0 0 0 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 121961 43858 78103 24789 20518 5986 9514 121961 43858 78103 24789 20518 5986 9514 60807 17296 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. THE AGREEMENT BETWEEN DUKE UNIVERSITY AND DUKE UNIVERSITY HEALTH SYSTEM, INC. DOES NOT DISTINGUISH BETWEEN PAYMENTS FOR PROFESSIONAL FUNDRAISING SERVICES AND EXPENSE PAYMENTS OR REIMBURSEMENTS. 1 1 X 1 X 1 X 1 1 0 1 1 96710397 96710397 0.03290 109018730 109018730 0.03710 205729127 205729127 0.07000 80124798 14847505 65277293 0.02220 12000255 12000255 0.00410 92125053 14847505 77277548 0.02630 297854180 14847505 283006675 0.09630 1 12619125 0 547314073 646276788 -98962715 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 15 1 1 1 1 X HTTP://WWW.DUKEHEALTH.ORG X HTTP://WWW.HEALTHYDURHAM.ORG X X 1 15 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 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://WWW.DUKEHEALTH.ORG X HTTP://WWW.ADVANCECHC.ORG/COMMUNITY/HEALTH-NEEDS-ASSESSMENT/ X 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 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 PARTNERSHIP FOR A HEALTHY DURHAM COMMITTEES.THE MOST RECENT ASSESSMENT PROCESS CONDUCTED IN CALENDAR YEAR 2014 COMPILED VALID AND RELIABLE INFORMATION ABOUT THE HEALTH OF DURHAM. IT INCLUDED 354 CITIZEN SURVEYS FROM RANDOMLY SELECTED HOUSEHOLDS AND 8 COMMUNITY LISTENING SESSIONS WITH 205 COMMUNITY MEMBERS. THE COMMUNITY HEALTH ASSESSMENT TEAM - COMPRISED OF MORE THAN 89 MEMBERS REPRESENTING, DUKE UNIVERSITY HOSPITAL AND DUKE REGIONAL HOSPITAL (FORMERLY DURHAM REGIONAL HOSPITAL), 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 2016 (TAX YEAR 2015).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 SIX HEALTH PRIORITIES FOR 2015 - 2017: 1. ACCESS TO MEDICAL AND DENTAL CARE 2. MENTAL HEALTH AND SUBSTANCE ABUSE3. OBESITY AND CHRONIC ILLNESS 4. HIV AND SEXUALLY TRANSMITTED INFECTIONS 5. POVERTY 6. EDUCATION ALL OF THE PROGRAMS DESCRIBED IN THE FOLLOWING IMPLEMENTATION PLAN ARE ALIGNED WITH THE SIX HEALTH PRIORITIES WITH MANY OF THE PROGRAMS ADDRESSING COMBINATIONS OF THE SIX 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 DOES NOT CONTAIN DESCRIPTIONS OF THE COMMUNITY HEALTH IMPROVEMENT WORK CARRIED OUT BY OTHER COMPONENTS OF THE LARGER DUKE HEALTH SYSTEM OR DUKE UNIVERSITY. THIS IMPLEMENTATION PLAN ONLY REPRESENTS DUKE HOSPITAL'S CONTINUALLY EVOLVING ACTIVITIES AND SUPPORT TO IMPROVE HEALTH WITH THE DURHAM COMMUNITY.IMPLEMENTATION PLANTOGETHER, 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. ACCESS TO MEDICAL AND DENTAL CARE INITIATIVES:ACCESS TO HEALTH CARE 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, DURHAM COUNTY IS PARTICULARLY HAMPERED BY A LACK OF HEALTH INSURANCE COVERAGE (WHETHER PRIVATE OR PUBLIC, SUCH AS MEDICAID) FOR MANY OF ITS RESIDENTS. IN DURHAM COUNTY, 19% OF ADULTS LESS THAN 65 YEARS ARE UNINSURED. 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. IN FY15, PADC PROVIDED SERVICES TO MORE THAN 1,000 PATIENTS.PLANS FOR FY16: ENROLL AND CARE MANAGE AT LEAST 1,000 PATIENTS; RE-ESTABLISH THE MEDICAL DIRECTOR COMMITTEE TO REVIEW AND FINALIZE OUTCOME METRICS; CONTINUE CARE MANAGEMENT ASSISTANCE OF MEDICAL RESPITE PROGRAM.PROGRESS IN FY16: PADC ENROLLED 1117 PATIENTS AND EXPANDED ITS MEDICAL RESPITE PROGRAM SERVING A DOZEN PATIENTS. IN ADDITION TO EXCEEDING THOSE FY 16 GOALS, PADC IMPROVED OPERATIONS BY LAUNCHING A DIGITAL ENROLLMENT SYSTEM IN THE COACH WEB-BASED INFORMATION AND COMMUNICATION SYSTEM.PLANS FOR FY17: CONTINUE TO FUNCTION AND SERVE ITS DONATED NUMBER OF BUNDLED SERVICES (2500/YEAR). MAKE THE NECESSARY PROTOCOL AND OPERATIONAL ADJUSTMENTS TO THE MEDICAL RESPITE PROGRAM TO ALLOW PATIENTS TO STAY MORE THAN 30 DAYS WHILE HOUSING IS BEING ARRANGED.PROGRESS IN FY17: PADC CONTINUED TO MEET SERVICE GOALS IN FY17. EARLY EVALUATION RESULTS OF THE MEDICAL RESPITE PROGRAM DEMONSTRATED POSITIVE IMPACTS FOR PATIENTS SERVED INCLUDING A: 37% REDUCTION IN INPATIENT ADMISSIONS, 70% REDUCTION IN INPATIENT DAYS, AND 192% INCREASE IN OUTPATIENT VISITS. BENEFITS AND SERVICES OBTAINED FOR PARTICIPANTS THROUGH THE MEDICAL RESPITE PROGRAM INCLUDED CONNECTIONS TO PRIMARY CARE SERVICES, MENTAL HEALTH AND/OR SUBSTANCE ABUSE SERVICES, AND ASSISTANCE IN TRANSITIONING TO STABLE HOUSING. 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-HEALTH CARE AND SOCIAL SERVICE PROVIDERS, LOCAL GOVERNMENT AND COMMUNITY-BASED ORGANIZATIONS-LATCH MONITORS HEALTH CARE TRENDS, IDENTIFIES BARRIERS FACING UNINSURED PATIENTS, AND, WORKING AS A CONSORTIUM, ADDRESSES AND ELIMINATES BARRIERS. IN FY15 LATCH PROVIDED MORE THAN 6,000 CARE MANAGEMENT SERVICE ENCOUNTERS WITH PATIENTS. PRE- AND POST- ANALYSIS OF PATIENTS SERVED BY LATCH SHOWS A 17% DECREASE IN HOSPITALIZATIONS.PLANS FOR FY16: REACH OUT AND ENROLL NEW REFUGEE/IMMIGRANT POPULATIONS ARRIVING IN DURHAM FROM NUMEROUS AREAS OF THE WORLD, INCLUDING EAST ASIA, MIDDLE EAST, EAST AFRICA, AND BURMA; CONTINUE ENGAGEMENT WITH EL CENTRO HISPANO AND THE LATINO ROUNDTABLE; CONTINUE ENROLLING UNINSURED IN THE HEALTH INSURANCE EXCHANGE PROMOTING THE UNITED WAY "SPECIAL DISCOUNT" FOR DURHAM RESIDENTS; CONTINUE ENROLLING UNINSURED AND UNDERINSURED IN LATCH CASE MANAGEMENT SERVICES. PROGRESS IN FY16: LATCH WORKED WITH THE GROWING REFUGEE COMMUNITY AND THE LOCAL OFFICES OF NATIONAL REFUGEE RESETTLEMENT PROGRAMS. LATCH CONTINUED TO PERFORM AWARENESS OUTREACH IN THE COMMUNITY TO ENCOURAGE RESIDENTS TO ENROLL IN THE HEALTH INSURANCE EXCHANGE; AND BEGAN ASSISTING MOTHERS WITH CHILDREN AGES 0 -2 IN ENROLLING IN MEDICAID DUE TO LAPSES IN THE NC FAST ELIGIBILITY SYSTEM.PLANS FOR FY17: CONTINUE PROVIDING MEDICAID AND CHARITY CARE ASSISTANCE, TRANSLATION AND INTERPRETATION SERVICES, EXPAND MEDICAL RESPITE WITH A DAILY CENSUS MINIMUM OF A DOZEN PATIENTS; AND CONTINUE CASE MANAGEMENT OF UNINSURED AND UNDERINSURED PATIENTS WHO HAVE AN EMERGENCY DEPARTMENT (ED) ENCOUNTER. PROGRESS IN FY17: LATCH CONTINUED TO PERFORM AWARENESS OUTREACH IN THE COMMUNITY TO ENCOURAGE RESIDENTS TO ENROLL IN THE HEALTH INSURANCE EXCHANGE. LATCH PARTICIPATED IN THE RIDES TO WELLNESS INITIATIVE TO ADDRESS TRANSPORTATION BARRIERS. LATCH PROVIDED DISABILITY, MEDICAID AND CHARITY CARE ASSISTANCE, TRANSLATION AND INTERPRETATION SERVICES, AND CONTINUED CASE MANAGEMENT OF UNINSURED AND UNDERINSURED PATIENTS WHO HAVE AN ED ENCOUNTER. LATCH INCREASED ITS OWN COMMUNITY OUTREACH EFFORTS, ENROLLING UNINSURED INDIVIDUALS IN NEED OF ASSISTANCE AT VARIOUS CHURCHES AND COMMUNITY EVENTS. 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). IN FY15, CCP SERVED 22 CHILDREN AND THEIR FAMILIES. PLANS FOR FY16: DEVELOPMENT OF A COMPLEX CARE CLINIC AND ENROLL 50 NEW CHILDREN IN THE SERVICE.PROGRESS IN FY16: CCP IS NOW NAMED THE DUKE CHILDREN'S COMPLEX CARE SERVICE (CCS) AND IN FY 16, CCS ESTABLISHED A LONGITUDINAL CLINICAL FOLLOW UP CONTINUUM THAT CONSISTS OF THE COMPLEX CARE CLINIC, INPATIENT ROUNDS, AND DIRECT COMMUNICATION WITH PCP, SPECIALIST AND PATIENT'S GUARDIAN. THE CCS PROVIDES 24/7 AVAILABILITY. IN FY16 DUKE HOSPITAL FUNDED 1.0 MD FTE (DIVIDED AMONGST 3 MDS); 1.0 RN CLINICIAN AND 1.0 PROGRAM COORDINATOR (IN COLLABORATION WITH DUKE-NPCC). IN FY 16, CCS EXPANDED TO A STATEWIDE REPRESENTATION (WITH SIGNIFICANT REACH TOWARD CENTRAL AND EASTERN NC). CCS HAS EXPERIENCED A REDUCTION IN ED VISITS AND SUBSTANTIAL HOSPITAL STAY REDUCTION. THE PATIENT EXPERIENCE INCLUDED HOME VISITS, CONCURRENT AND PALLIATIVE CARE AND FAMILY CARE CONFERENCES. PLANS FOR FY17: PLANS INCLUDE NEW PATIENT SERVICES, A MOBILE APP FOR COMPLEX CARE PLANS, TELEHEALTH, AND PROGRAM EXPANSION WITH A TARGET OF SERVING 100 PATIENTS IN FY17.PROGRESS IN FY17: THE CCS PROGRAM CONTINUED TO DEVELOP ADDITIONAL RESOURCES FOR THE CHILDREN, FAMILIES, AND PROVIDERS SERVED BY THE PROGRAM AND CONTINUED TO WORK ON EXPANSION PLANS FOR THE PROGRAM. DUKE - DURHAM FOSTER CARE CLINIC PROGRAM IS A HIGHLY EFFECTIVE PARTNERSHIP BETWEEN DUKE AND DURHAM COUNTY. IN SEPTEMBER OF 2013 THE DUKE CHILD ABUSE AND NEGLECT MEDICAL EVALUATION CLINIC (CANMEC) PARTNERED WITH DURHAM COUNTY DEPARTMENT OF SOCIAL SERVICES (DSS) TO FORMALIZE A FOSTER CARE CLINIC. THIS CLINIC PROVIDES THE INITIAL SCREENING AND COMPREHENSIVE HEALTH ASSESSMENT ACCORDING TO THE AAP STANDARDS FOR CHILDREN IN FOSTER CARE IN DURHAM. CHILDREN RECEIVE A COMPREHENSIVE MEDICAL EVALUATION INCLUDING COMPLETE PHYSICAL EXAM, MEDICAL RECORD REVIEW AS WELL AS SCREENING FOR DENTAL, DEVELOPMENTAL, MENTAL HEALTH, AND SOCIAL CONCERNS. UNMET MEDICAL NEEDS ARE IDENTIFIED AND THE CLINIC IDENTIFIES A MEDICAL HOME; ARRANGES MEDICAL, MENTAL HEALTH, AND SOCIAL REFERRALS; PROVIDES FOLLOW UP CARE UNTIL A MEDICAL HOME IS ESTABLISHED; AND SUPPORTS SOCIAL WORKERS WITH NAVIGATING THE COMPLEX HEALTH SYSTEM.CHILDREN IN DURHAM COUNTY FOSTER CARE WHO HAVE COMPLETED A COMPREHENSIVE ASSESSMENT AT THE DUKE FOSTER CARE CLINIC ARE CURRENT ON IMMUNIZATIONS, ARE ENROLLED IN A MEDICAL HOME, ARE REFERRED FOR MENTAL HEALTH TREATMENT IF NEEDED, AND ARE HAVING THEIR ONGOING MEDICAL, DEVELOPMENTAL AND SOCIAL NEEDS ADDRESSED. THE DUKE-DURHAM FOSTER CARE CLINIC SERVES ALL CHILDREN IN THE FOSTER CARE SYSTEM IN DURHAM COUNTY. UNFORTUNATELY, THE NEED FOR THIS CLINIC CONTINUES TO GROW EACH YEAR.PLANS FOR FY16: ENABLE DSS SOCIAL WORKER TO BE ABLE TO CONTACT FOSTER PARENT(S) REGARDING UPCOMING MEDICAL APPOINTMENTS, AND FOLLOW UP WITH FOSTER PARENT(S) IN THE EVENT OF A CANCELATION AND TO RESCHEDULE THE CHILD FOR PRIMARY CARE AND SPECIALTY VISITS; ASSIST CANMEC AND PCP EXCHANGE MEDICAL AND PSYCH-SOCIAL PATIENT INFORMATION; PROVIDE PCP WITH A TOOL BOX FOR ASSESSING AT RISK KIDS.PROGRESS IN FY16: THE DURHAM DEPARTMENT OF SOCIAL SERVICES UTILIZED DUKE'S CLINICAL DECISION SUPPORT AND ELECTRONIC ALERT SYSTEM (COACH) TO MANAGE OVER 300 CHILDREN'S MEDICAL APPOINTMENTS. THROUGH THE USE OF COACHS' TARGETED MESSAGING SOCIAL SERVICE WORKERS WERE ABLE TO RECEIVE ADVANCE NOTIFICATION OF EACH CHILD'S MEDICAL APPOINTMENT AND ASSIST THE FOSTER PARENT IN GETTING TO THE APPOINTMENT. PLANS FOR FY17: ESTABLISH A REGISTRY FOR AGES 0-2 TO ASSIST PCP AND FOSTER PARENT IN SCHEDULING AND ATTENDING WELL CHILD VISITS AND IMMUNIZATIONS. PROGRESS IN FY17: CONTINUED TO PROVIDE LINKAGES FOR DURHAM COUNTY DEPARTMENT OF SOCIAL SERVICES TO MANAGE HEALTHCARE SERVICES FOR CHILDREN IN THE FOSTER CARE SYSTEM. SOUTHERN HIGH SCHOOL WELLNESS CENTER PROVIDES COMPREHENSIVE PRIMARY CARE AND MENTAL HEALTH SERVICES AT SOUTHERN HIGH SCHOOL TO STUDENTS AT THE SCHOOL AND IS OPEN TO ALL STUDENTS AND STAFF OF DURHAM PUBLIC SCHOOLS. OPERATED BY DUKE'S DIVISION OF COMMUNITY HEALTH ON BEHALF OF DUH, THE SOUTHERN HIGH SCHOOL WELLNESS CENTER WILL CELEBRATE ITS 20TH ANNIVERSARY IN 2016. IN FY15 THE SOUTHERN HIGH SCHOOL WELLNESS CENTER HAD TO SCALE BACK HOURS DUE TO STAFFING ISSUES, BUT STILL COMPLETED 188 PATIENT VISITS.PLANS FOR FY16: CONTINUE PRIMARY CARE AND MENTAL HEALTH SERVICES; CONTINUE NUTRITIONAL COUNSELING; ENROLL 520 NEW STUDENTS. ADD SERVICES FOR FACULTY AND STAFF OF THE SCHOOL AND EMPLOYEES OF DURHAM PUBLIC SCHOOLS.PROGRESS IN FY16: THE SOUTHERN HIGH SCHOOL (SHS) WELLNESS CENTER CELEBRATED ITS 20TH ANNIVERSARY IN APRIL OF 2016. THE CENTER CONTINUED TO STRUGGLE WITH STAFFING ISSUES IN EARLY FY16 BUT, CONTINUED TO INCREASE ITS ENROLLMENT AND BEGAN OUTREACH TO SERVE SCHOOL STAFF AND EMPLOYEES OF DURHAM PUBLIC SCHOOLS.PLANS FOR FY17: SECURE FULL-TIME CLINICIAN AND RESTORE PATIENT CARE SCHEDULE TO FIVE DAYS A WEEK. ROLL OUT THE SPARCS (STRUCTURED PSYCHOTHERAPY FOR ADOLESCENTS RESPONDING TO CHRONIC STRESS) PROGRAM TO INCLUDE ADDITIONAL GROUPS AND EXPAND THE PROGRAM TO SERVE NORTHERN HIGH SCHOOL. PARTNER WITH THE DURHAM COUNTY DEPARTMENT OF PUBLIC HEALTH TO EXPLORE THE FEASIBILITY OF PLACING A REGISTERED DIETICIAN IN THE CLINIC.PROGRESS IN FY17: EXPANDED SPARCS PROGRAM TO NORTHERN HIGH SCHOOL AND DEVELOPED A PLAN TO PLACE A DURHAM COUNTY DEPARTMENT OF PUBLIC HEALTH REGISTERED DIETICIAN IN THE SHS WELLNESS CENTER TO SEE CLIENTS. KEY FINDINGS OF THE 2-YEAR STUDENT SATISFACTION SURVEY RESULTS SHOW 62% OF THE RESPONDENTS REPORTED HAVING NO USUAL SOURCE OF CARE OUTSIDE OF THE SHS WELLNESS CENTER, 71% OF THE VISITS TO THE CENTER INVOLVED SICK CARE OR INJURY CARE, 14% SAID THEY WOULD HAVE NOT RECEIVED CARE WITHOUT THE CENTER, 9% SAID THEY WOULD HAVE GONE TO THE EMERGENCY DEPARTMENT. THE MEAN OVERALL SATISFACTION WITH THE CENTER WAS 4.9 OUT OF A POSSIBLE 5.DURHAM CHILD HEALTH ASSESSMENT AND PREVENTION PROGRAM (CHAPP) WAS CREATED TO CLOSE GAPS IN ACCESS FOR CHILDREN WHO HAVE MISSED PREVENTIVE VISITS. IN ADDITION, THE PROGRAM SEEKS TO RECONNECT THESE CHILDREN AND THEIR FAMILIES TO SUPPORTIVE MEDICAL HOMES. TOGETHER, DUH THROUGH THE DUKE DIVISION OF COMMUNITY HEALTH, THE DURHAM COUNTY DEPARTMENT OF PUBLIC HEALTH, AND DURHAM PUBLIC SCHOOLS CONVERTED THREE DUH ELEMENTARY SCHOOL BASED HEALTH CENTERS AND OPENED TWO ADDITIONAL ONES UTILIZING ENHANCED ROLE REGISTERED NURSES (ERRNS) TO DELIVER WELL-CHILD CARE TO CHILDREN WHO ARE OVERDUE FOR THEIR WELL-CHILD CHECKUPS. THE FIVE SCHOOLS ARE IN AREAS OF THE COUNTY THAT DEMONSTRATE SIGNIFICANT GAPS IN PEDIATRIC CARE AND THE CHAPP CLINICS OPERATE AS SATELLITES OF THE DURHAM COUNTY DEPARTMENT OF PUBLIC HEALTH. DUH CONTINUES TO SUPPORT MENTAL HEALTH SERVICES AT ALL FIVE OF THE SITES AND PROVIDES MEDICAL BACK UP.PLANS FOR FY16: FY16 WILL BE THE FIRST FULL YEAR OF OPERATION FOR CHAAP. IT IS ANTICIPATED THAT THE PROGRAM WILL REDUCE THE COST OF WELL-CHILD VISITS WHILE EXPANDING ACCESS TO PHYSICIANS FOR COMPLEX ACUTE AND CHRONIC NEEDS BY ENSURING THAT BOTH ENHANCED ROLE NURSES AND PRIMARY CARE PHYSICIANS ARE WORKING AT THE TOP OF THEIR LICENSES. CHAPP EVALUATION METRICS WILL INCLUDE: NUMBER OF WELL CHILD CARE VISITS; NUMBER OF CHILDREN REFERRED TO A MEDICAL HOME; NUMBER OF VACCINATIONS ADMINISTRATED; NUMBER OF DENTAL, HEARING, VISION REFERRALS; AND FINANCIAL INPUTS AND OUTPUTS TO DETERMINE FISCAL EFFICACY, SUSTAINABILITY, AND IDEALLY, EXPANSION OPPORTUNITIES.PROGRESS IN FY16: CHAAP WAS RENAMED HEALTHY FUTURES. IN THE FOURTH QUARTER OF FY 16, HEALTHY FUTURES WAS FULLY STAFFED AND OPERATIONAL. THREE ENHANCED ROLE NURSES STAFFED FIVE DURHAM ELEMENTARY SCHOOL CLINICS AND PROVIDED THREE HUNDRED WELL CHILD VISITS OF WHICH 50% OF THE CHILDREN DID NOT HAVE A MEDICAL HOME PRIOR TO THEIR HEALTHY FUTURES VISIT. OTHER NOTABLE RESULTS INCLUDE:- 57% OF CHILDREN RECEIVED A VACCINE DURING THEIR VISIT AND 90% OF THOSE VACCINATIONS WERE A REQUIRED VACCINE TO CATCH UP TO THE AGE APPROPRIATE VACCINE SCHEDULE- 30% OF CLIENTS SAID THEIR MAIN REASON FOR CONTACTING HEALTHY FUTURES WAS THAT THEY WERE UNABLE TO GET AN APPOINTMENT WITH THEIR PEDIATRICIAN AND 15% STATED APPOINTMENT WAIT TIME WAS TOO LONG- REASON FOR REFERRAL: 33% ACUTE CONCERN, 29% CHRONIC CARE, 14% DENTAL CONCERN, 10% FAILED VISION SCREEN, 9% BEHAVIORAL CONCERN- REASON FOR CHRONIC CARE REFERRAL: OBESITY 20%, BLOOD PRESSURE 33%, DIABETES 7%, ASTHMA 7%PLANS FOR FY17: CONTINUE OUTREACH EFFORTS TO INCREASE THE NUMBER OF CHILDREN SERVED.PROGRESS IN FY17: HEALTHY FUTURES CONTINUED OUTREACH EFFORTS AND PROVIDED WELL-CHILD VISITS AND CONNECTIONS TO MEDICAL HOMES FOR CHILDREN THAT DID NOT HAVE A CONSISTENT CONNECTION TO A MEDICAL HOME. JUST FOR US (JFU) PROVIDES 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 JUST FOR US, 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. IN FY15, JUST FOR US TRANSITIONED TO EPIC (ELECTRONIC MEDICAL RECORD SYSTEM) AND EXPERIENCED THE TYPICAL DECREASE IN PRODUCTIVITY ASSOCIATED WITH SUCH TRANSITIONS. IN ADDITION, JUST FOR US LOST ONE OF ITS TEAM MEMBERS CAUSING A FURTHER REDUCTION IN THE ABILITY TO PROVIDE SERVICES. IN FY15 JUST FOR US COMPLETED 841 PATIENT ENCOUNTERS.PLANS FOR FY16: ENROLL 112 NEW PATIENTS; EXPAND GEOGRAPHY OF SERVICE TO OUTSIDE OF THE EXISTING SERVICE SITES BUILDINGS; ESTABLISH PROVIDER LINKAGE AND SUPPORT TO PATIENTS OF THE HOMELESS SHELTER AND THE DUKE CONGESTIVE HEART FAILURE (CHF) CLINIC.PROGRESS IN FY16: CONTINUED CHRONIC CARE AND TRANSITIONAL CARE HOME VISITS TO DISABLED AND LOW INCOME PATIENTS; MONTHLY ENROLLMENT AVERAGED 275 PATIENTS AND OVER 1200 ENCOUNTERS. JFU UTILIZES A CO-MANAGEMENT PROTOCOL WITH DURHAM PRIMARY CARE PRACTICES. PLANS FOR FY17: EXPAND THIS MODEL BY IMPLEMENTING A CO-MANAGEMENT PROTOCOL WITH DUKE'S CHF CLINIC. HIRE A FULL-TIME CLINICIAN AND DEVELOP CHRONIC CARE MANAGEMENT AND TRANSITIONAL CARE MANAGEMENT PROTOCOLS WITH THE JFU REGISTERED NURSE.PROGRESS IN FY17: JFU EXPERIENCED SIGNIFICANT STAFFING SHORTFALLS AS RECRUITING AND HIRING A DEDICATED CLINICIAN TOOK MUCH LONGER THAN ANTICIPATED. 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. IN FY2015, THE COMMUNITY CLINICS TRANSITIONED TO EPIC (ELECTRONIC MEDICAL RECORD SYSTEM) AND EXPERIENCED THE TYPICAL DECREASE IN PRODUCTIVITY ASSOCIATED WITH SUCH TRANSITIONS. IN FY15, THE CLINICS COMPLETED 11,000 PATIENT VISITS. PLANS FOR FY16: PROVIDE 15,000 PATIENT ENCOUNTERS; CONTINUE THE BREAST AND CERVICAL CANCER PREVENTION PROGRAM FOR UNINSURED WOMAN; CONTINUE HEALTH DEPARTMENT HIV/STD SCREENING PROGRAM; CONTINUE EVENING CLINIC HOURS.PROGRESS IN FY16: THE CLINICS EXPERIENCED SOME STAFFING ISSUES THROUGHOUT FY16, BUT WERE ABLE TO PROVIDE PRIMARY CARE TO 5,404 UNIQUE PATIENTS WITH 12,000 ENCOUNTERS. THE COMMUNITY CLINICS CONTINUE TO HOUSE A DURHAM HEALTH DEPARTMENT HIV/STD SCREENING PROGRAM. IN ADDITION, A PEDIATRIC/ADOLESCENT CLINIC WAS LAUNCHED AT HOLTON AND LYON PARK TWO DAYS A WEEK. THE CLINICS TRANSITIONED THE BREAST AND CERVICAL CANCER CONTROL PROGRAM TO LINCOLN COMMUNITY HEALTH CENTER TO STREAMLINE THE SERVICE FOR PATIENTS. PLANS FOR FY17: EXPAND ADOLESCENT CLINIC AND MENTAL HEALTH SERVICES BY PROVIDING 16,000 PRIMARY CARE VISITS; CONTINUE HIV/STD SCREENING PROGRAM AND LAUNCH ON-DEMAND TELE-BEHAVIORAL HEALTH CONSULT SERVICE WITH LINCOLN COMMUNITY HEALTH CENTER.PROGRESS IN FY17: THE CLINICS CONTINUED TO EXPERIENCE STAFFING SHORTFALLS THROUGHOUT FY17, BUT WERE ABLE TO CONDUCT 12,078 PRIMARY CARE VISITS. THE STAFFING SHORTFALLS HAMPERED PLANNED EFFORTS TO EXPAND CLINIC OFFERINGS. 2. MENTAL HEALTH AND SUBSTANCE ABUSE INITIATIVES AN ESTIMATED 17,000 RESIDENTS OF DURHAM COUNTY NEED MENTAL HEALTH TREATMENT AND 19,000 NEED SUBSTANCE USE TREATMENT. ALCOHOL IS THE PRIMARY SUBSTANCE ABUSED BY DURHAM COUNTY RESIDENTS SEEKING CRISIS DETOXIFICATION SERVICES AND BY ADOLESCENTS IN DURHAM'S MIDDLE AND HIGH SCHOOLS. RESPONDENTS IN THE COMMUNITY HEALTH OPINION SURVEY IDENTIFIED ADDICTION TO ALCOHOL, DRUGS OR PRESCRIPTION PILLS AS THE NUMBER ONE COMMUNITY HEALTH PROBLEM. DUH HAS PARTNERED WITH AND SUPPORTS A NUMBER OF COLLABORATIVE INITIATIVES TO IMPROVE ACCESS TO MENTAL HEALTH SERVICES AND REDUCE SUBSTANCE ABUSE.PROJECT LAZARUS, IN CONJUNCTION WITH COMMUNITY CARE OF NORTH CAROLINA (CCNC) AND DUH, SEEKS TO REDUCE OPIOID-RELATED OVERDOSES; OPTIMIZE TREATMENT OF CHRONIC PAIN; AND MANAGE SUBSTANCE ABUSE ISSUES RELATED TO OPIOIDS. THE CORE COMPONENTS OF THE PROJECT LAZARUS MODEL ARE: 1) PUBLIC AWARENESS, 2) COALITION ACTION, AND 3) DATA & EVALUATION. STRATEGIES OF THE MODEL INCLUDE: COMMUNITY EDUCATION; PROVIDER EDUCATION; HOSPITAL ED POLICIES; DIVERSION CONTROL; PAIN PATIENT SUPPORT; HARM REDUCTION; ADDICTION TREATMENT. DUH IS A KEY PARTNER IN SUPPORTING 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.- 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; CHRONIC PAIN MANAGEMENT RESOURCES; KEY COMMUNITY PRESENTATIONS. FY15 ACCOMPLISHMENTS INCLUDE: - 62 NALOXONE KITS PROVIDED TO PHARMACIES - 7 CLINICS WITH PROVIDERS PRESCRIBING NALOXONE- 35 PROVIDERS RECEIVED CME TRAINING FOR PROJECT LAZARUS- 6 MONTHLY CHRONIC PAIN TELEPHONE CONSULTATIONS FOR PRIMARY CARE PROVIDERS HELD REACHING 20 PROVIDERS- 20 PATIENTS RECEIVED CHRONIC DISEASE SELF-MANAGEMENT EDUCATION (STANFORD MODEL)- 120 PHARMACIES RECEIVED ANNOUNCEMENT FOR CME TRAINING OPPORTUNITIES- 50 PROVIDERS RECEIVED INFORMATION ON CHRONIC PAIN RESOURCES AND TELEPHONE CONSULTATION AT NORTHERN PIEDMONT COMMUNITY CARE (NPCC) BI-ANNUAL MEETING SESSION- 180 PROVIDER EDUCATIONAL HANDOUTS DISSEMINATED- 70 REFERRALS FOR CHRONIC PAIN RESOURCES- 60 PATIENT REMINDER CALLS FOR DUH -DOC PAIN CLASSES- 5 PATIENTS TO COMPLETE 8 WEEK DUH - DOC PAIN CLASSPLANS FOR FY16: LAUNCH AN INTEGRATED CARE ASSESSMENT AND SCREENING PROGRAM FOR MEDICAID AND UNINSURED ADULT PATIENTS IN A DURHAM HIGH VOLUME ADULT CLINIC THAT SCREENS FOR DEPRESSION, ANXIETY, SUBSTANCE ABUSE AND CHRONIC TRAUMA; CONTINUE PROJECT LAZARUS AND DISTRIBUTION OF NALOXONE KITS THROUGH PRIMARY CARE PHYSICIANS (PCPS), PHARMACIES, COMMUNITY PARTNERS AND COMMUNITY MENTAL HEALTH/SUBSTANCE ABUSE PROVIDERS; CONTINUE PROVIDER EDUCATION, DIVERSION CONTROL, COMMUNITY COALITIONS AND CHRONIC PAIN SUPPORT.PROGRESS IN FY16: - NALOXONE NALOXONE DISTRIBUTION EFFORTS CONTINUE WITHIN THE COMMUNITY AND LOCAL PHARMACIES. IN JUNE 2016, THE STATE HEALTH DIRECTOR SIGNED A STATEWIDE STANDING ORDER FOR NALOXONE DISPENSING. NC DHHS HAS SET UP A WEBSITE WHERE PHARMACIST AND THE PUBLIC CAN ACCESS MORE INFORMATION ABOUT THE STANDING ORDER. THE WEBSITE IS WWW.NALOXONESAVES.ORG. PHARMACIES CAN GO TO THE WEBSITE AND SIGN ON TO DISPENSE UNDER STATEWIDE STANDING ORDER. THE DUKE- NPCC CHRONIC PAIN COORDINATOR WORKED WITH NPCC'S PHARMACY PROGRAM SPECIALIST TO REACH OUT TO LOCAL PHARMACIES IN THE NETWORK. APPROXIMATELY NINETY FIVE (95) PHARMACIES RECEIVED THE FAX THAT INCLUDED A COPY OF THE STANDING ORDER, A ONE-PAGER EXPLAINING THE STANDING ORDER FOR MEDICAID PHARMACIST AND PROVIDERS, AND THE CHRONIC PAIN COORDINATOR'S CONTACT INFORMATION. OUT OF THE 95 PHARMACIES 78 WERE LISTED IN DURHAM. DUKE - NPCC IN PARTNERSHIP WITH THE SUBSTANCE USE/ MENTAL HEALTH SUBCOMMITTEE OF THE PARTNERSHIP FOR A HEALTHY DURHAM WILL CONDUCT OUTREACH TO THE 78 PHARMACIES TO ASSIST THEM WITH REGISTERING ON WWW.NALOXONESAVES.ORG. - SUBSTANCE USE AND MENTAL HEALTH COMMITTEE (SUMH) OF THE PARTNERSHIP FOR A HEALTHY DURHAMIN ADDITION TO WORKING ON NALOXONE OUTREACH TO PHARMACIES, SUMH IS ALSO WORKING ON A PROVIDER RESOURCE MANUAL TO BE IN LINE WITH THE NETWORK OF CARE WEBSITE RESOURCES AS WELL AS A USER-FRIENDLY HARD COPY VERSION TO DISSEMINATE THROUGHOUT THE DUHS.- PROJECT LAZARUS (PL) KITS CONTINUE TO BE DISSEMINATED IN THE COMMUNITY AT LOCAL PHARMACIES. TO DATE APPROXIMATELY 60 KITS WERE PROVIDED TO PHARMACIES UPON REQUEST. NUMBERS MAY VARY GOING FORWARD AS A RESULT OF THE STATEWIDE NALOXONE STANDING ORDER IN PLACE AND LOCAL PHARMACIES DISPENSING FDA APPROVED NASAL NARCAN 4MG INTRANASAL SPRAY. - CHRONIC PAIN SELF-MANAGEMENT (CPSMP) WORKSHOPSTHE CPSMP WORKSHOPS CONTINUE TO TAKE PLACE AT LINCOLN COMMUNITY HEALTH CENTER AND CONTINUE TO BE SUCCESSFUL. NINE SIX WEEK WORKSHOPS WERE HELD IN FY16, WITH APPROXIMATELY 130 PEOPLE REACHED IN THE WORKSHOPS. IN ADDITION TO THE WORKSHOPS, A CPSMP LEADER TRAINING WAS CONDUCTED OCTOBER 2016. AS A RESULT OF THE TRAINING, SIX NEWLY TRAINED LEADERS WILL IMPLEMENT WORKSHOPS UNDER THE DUKE NORTHERN PIEDMONT COMMUNITY CARE LICENSE. THE DUKE-NPCC CHRONIC PAIN COORDINATOR WILL OVERSEE THE CPSMP LEADERS EFFORTS AND PROVIDE SUPPORT AND INSTRUCTION ON STANFORD'S MODEL FOR CPSMP. - COMMUNITY CARE OF NORTH CAROLINA CHRONIC PAIN INITIATIVE TASK FORCE THROUGH THE WORK OF THE CCNC CHRONIC PAIN INITIATIVE (CPI) TASK FORCE (DUKE), THE COMMUNITY CARE OF NORTH CAROLINA PROVIDER TOOLKIT HAS BEEN UPDATED WITH MORE RESOURCES AND TOOLS. IN ADDITION, THE TASK FORCE IS WORKING ON THE DEVELOPMENT OF A CME ON SAFE OPIOID PRESCRIBING FOR OUR PROVIDERS TO EDUCATE ON THE LATEST GUIDELINES FROM THE NC MEDICAL BOARD AND THE CENTERS FOR DISEASE CONTROL AND PREVENTIONS RELATING TO OPIOID SAFETY AND CHRONIC PAIN MANAGEMENT.- CHRONIC PAIN TELEPHONE CONSULTATIONS WITH PAIN SPECIALIST PAIN CONSULTS ARE CONTINUING WITH OUTREACH AND AWARENESS EFFORTS TO INFORM PROVIDERS OF THIS RESOURCE. TO DATE THERE HAVE BEEN APPROXIMATELY 15 OF 17 PHONE CONSULTS WITH 32 PROVIDERS PARTICIPATING ON THE CALLS. PCPS, NPS, AND BEHAVIORAL HEALTH PROVIDERS PARTICIPATE.PLANS FOR FY17: IN COLLABORATION WITH THE PARTNERSHIP OF A HEALTHY DURHAM'S SUBSTANCE USE AND MENTAL HEALTH COMMITTEE, PHARMACY OUTREACH WILL BE IMPLEMENTED IN THE COMMUNITY TO INCREASE AWARENESS OF THE STATEWIDE NALOXONE STANDING ORDER AS WELL AS ASSISTANCE WITH REGISTERING AT WWW.NALOXONESAVES.ORG. TO PARTICIPATE UNDER THE STANDING ORDER AND FOR THOSE WHO REGISTER, SIGNAGE WILL BE OFFERED TO PUT UP IN THEIR PHARMACY TO SHOW THAT NALOXONE IS AVAILABLE IN THAT PARTICULAR PHARMACY. WORK WITH THE CPI TASK FORCE WILL RESULT IN MORE RESOURCES BEING MADE AVAILABLE IN THE PROVIDER TOOLKIT AND A CME FOR PROVIDERS TO LEARN MORE ABOUT SAFE OPIOID PRESCRIBING. THE PROVIDER TOOLKIT WILL BE MADE AVAILABLE ONLINE. CHRONIC PAIN CONSULT CALLS WILL CONTINUE WITH EXPANDED OUTREACH TO ENGAGE BEHAVIORAL HEALTH PROVIDERS WHO ARE TREATING CHRONIC PAIN PATIENTS.PROGRESS IN FY17: COORDINATED AND CO-HOSTED A SYMPOSIUM FOR MORE THAN 150 PROVIDERS ON SAFE OPIOID PRESCRIBING WITH THE NORTH CAROLINA MEDICAL BOARD AND THE GOVERNOR'S INSTITUTE ON SUBSTANCE ABUSE. COLLABORATED ON THE CREATION OF THE MENTAL HEALTH AND SUBSTANCE USE TREATMENT RESOURCES IN DURHAM AND SURROUNDING COUNTIES GUIDE. SIX HUNDRED AND FIFTY COPIES OF THE GUIDE WERE PROVIDED TO MEDICAL PRACTICES, HOSPITAL DEPARTMENTS AND COMMUNITY-BASED ORGANIZATIONS. A WEB-BASED VERSION OF THE GUIDE WILL BE MADE AVAILABLE IN LATE FY18. CONDUCTED FIVE 6-WEEK CHRONIC PAIN SELF-MANAGEMENT COURSES (STANFORD MODEL) AT LINCOLN COMMUNITY HEALTH CENTER. CONTINUED CHRONIC PAIN CONSULT CALLS.HOMEBASE: IS AN INTEGRATED MODEL OF PRIMARY CARE AND MENTAL HEALTH DELIVERED BY A DUALLY-TRAINED PA AND SUPPORTED BY THE DUH OUTPATIENT CLINIC (DOC). THE GOALS OF THE PROGRAM ARE TO IMPROVE CARE AND OUTCOMES FOR DOC PATIENTS WITH CO-MORBID MENTAL HEALTH CONDITIONS; ENCOURAGE AND ENABLE PATIENTS TO SEEK SERVICES AT THE DOC FIRST AND NOT THE ED; REINVENT A CARE TEAM MODEL AT DOC TO INCREASE PATIENT-PROVIDER CONTINUITY, PROVIDER ACCOUNTABILITY FOR PATIENT OUTCOMES, USE OF BEST PRACTICE; AND IMPROVE TRANSITIONS OF CARE FROM HOSPITAL AND ED SETTINGS TO CLINIC AND HOME, PARTICULARLY FOR HIGH UTILIZER (HU) PATIENTS. DURING ITS LAST TWO PILOT YEARS, HOMEBASE SERVED 44 PATIENTS DECREASING THEIR EMERGENCY DEPARTMENT USE BY 53% AND THEIR HOSPITALIZATIONS BY 36%.PLANS FOR FY16: CONTINUE ENROLLMENT OF HIGH RISK PATIENTS WITH A GOAL OF 100 CARE PLANS.PROGRESS IN FY16: IN FY 16 HOMEBASE CONTINUED SERVING AN EXTREMELY MEDICALLY COMPLEX PANEL OF DUKE MEDICAL OUTPATIENT CLINIC (DOC) PATIENTS SERVING OVER 150 WITH INTENSIVE COMPLEX CARE MANAGEMENT. IN THE SECOND HALF OF FY 16 AN INTEGRATED CARE SCREENING AND BRIEF COUNSELING PROGRAM WAS LAUNCHED WITH 2 FTE LICENSED CLINICAL SOCIAL WORKERS FUNDED BY DUKE-NPCC. EVERY PATIENT WHO SCREENS POSITIVE ON PHQ 9 (DEPRESSION SCREEN) WILL NOW RECEIVE ANXIETY, SUBSTANCE ABUSE AND TRAUMA SCREENS AND COUNSELING. PLANS FOR FY17: PLANS FOR FY 17 ARE TO CONTINUE HOMEBASE, THE DOC CLINIC WIDE BEHAVIORAL HEALTH SCREENING AND ADD PEER TO PEER SUPPORT TO THE INTEGRATED BEHAVIORAL HEALTH TEAM. PROGRESS IN FY17: IN ADDITION TO CONTINUING SUPPORT FOR THE HOMEBASE PROGRAM, DUH IS NOW SUPPORTING AN EXPANSION (HOMEBASE PLUS) OF CLINIC-BASED CARE MANAGEMENT AND INCREASED WALK-IN CAPACITY TO PROVIDE ON-SITE ACUTE ILLNESS AND OTHER CARE FOR HIGH-NEED PATIENTS WITH CHRONIC ILLNESSES WHO EXPERIENCE FREQUENT EXACERBATIONS SO THAT THE CLINIC CAN SERVE AS A CAPABLE AND APPROPRIATE ALTERNATIVE TO THE ED FOR SOME OF THE MOST COMMON PRESENTING COMPLAINTS.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. OVER THE LAST TWO YEARS, ALL THREE HOSPITALS ENGAGED IN THE STANDARDIZATION OF NC MEDICAL BOARD GUIDELINES; HELPED TO DEVELOP 12 SMARTPHRASES DEVELOPED IN EPIC; CREATED 12 PATIENT EDUCATION VIDEOS; AND PROVIDED 35 ADVANCED PRACTITIONERS EDUCATION ON PAIN MANAGEMENT & SAFE OPIOID PRESCRIBING.PLANS FOR FY16: CONDUCT PROVIDER EDUCATION WITH EVERY PRIMARY CARE, SPECIALTY CARE AND HOSPITAL SERVICE UNIT ADOPTING AND PRACTICING THE POLICY; OPERATIONALIZE SYSTEM TO TRACK AND MONITOR PROVIDERS ADHERENCE TO POLICY; CONTINUE MONTHLY PROVIDER LEARNING COLLABORATIVE WITH PAIN CLINIC. PROGRESS IN FY16: THE OPIOID TASK FORCE IS CONTINUING TO UPDATE THE INTAKE AND CHRONIC PAIN FOLLOW UP FORMS IN DUKE'S ELECTRONIC HEALTH RECORD (EHR) AND THE TASK FORCE LIAISONS ARE CONTINUING OUTREACH TO CLINICS. PLANS FOR FY17: DEVELOP AN OPIOID NOTE AND SMARTSET AS AN ADDITIONAL OPTION TO EXISTING FLOWSHEETS AND AS A METHOD TO ELIMINATE DUPLICATE DOCUMENTATION. PLAN AND PILOT IMPROVEMENTS TO NORTH CAROLINA CONTROLLED SUBSTANCE REPORTING SYSTEM (NCCSRS). CONTINUE TO PROVIDE OUTREACH AND OFFER TECHNICAL ASSISTANCE TO CLINICS.PROGRESS IN FY17: WORKED WITH THE NC PRESCRIPTION DRUG MONITORING PROGRAM LEADERSHIP TO INTEGRATE THE SUBSTANCE ABUSE REPORTING SYSTEM INTO DUKE'S EHR. CREATED AND DISTRIBUTED ROUTINE ELECTRONIC COMMUNICATIONS FROM HOSPITAL LEADERSHIP, AS WELL AS AN OPIOID SAFETY NEWSLETTER THAT COVERS A RANGE OF TOPICS FROM REGULATORY ISSUES TO HOW-TO GUIDES FOR INTERPRETING A URINE DRUG SCREEN AND LOCATING PATIENT EDUCATION RESOURCES.3. OBESITY AND CHRONIC ILLNESS INITIATIVESFOUR OF THE 10 LEADING CAUSES OF DEATH IN NORTH CAROLINA ARE RELATED TO OBESITY: HEART DISEASE, TYPE 2 DIABETES, STROKE AND SOME KINDS OF CANCER. OVERWEIGHT AND OBESITY WERE THE SECOND LEADING CAUSES OF PREVENTABLE DEATH IN NORTH CAROLINA IN 2010. OBESITY RATES CONTINUE TO RISE ACROSS ALL AGES, GENDERS AND RACIAL/ETHNIC GROUPS IN DURHAM COUNTY. THE MOST RECENT COMBINED OBESITY AND OVERWEIGHT RATES ARE: ADULTS, 65%; DURHAM PUBLIC SCHOOL HIGH SCHOOL STUDENTS, 32%, AND ENTERING KINDERGARTENERS, 19%. DIABETES IS THE 7TH LEADING CAUSE OF DEATH IN DURHAM COUNTY AND 8% OF ADULTS HAVE DIABETES.BULL CITY FIT IS A COMMUNITY-BASED WELLNESS PROGRAM AND IS PART OF 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.DUH ALSO SUPPORTS INITIATIVES THROUGH THE NEIGHBORHOOD CLINICS, SCHOOL-BASED HEALTH CENTERS, JFU AND THE DUKE OUTPATIENT CLINIC (ALL DESCRIBED EARLIER IN THIS DOCUMENT) THAT TARGET CHRONIC ILLNESS.PLANS FOR FY16: CONTINUE TO COLLABORATE AND LOOK FOR OPPORTUNITIES TO EXPAND THE PROGRAMS.PROGRESS IN FY16: IDENTIFIED INCREASING RATES OF NON ALCOHOLIC FATTY LIVER (NAFL) DISEASE DUE PRIMARILY TO AN INCREASE IN- OBESITY, SUGARY DIET, SEDENTARY LIFESTYLE. PLANS FOR FY17: ORGANIZE AND LAUNCH A DURHAM-WIDE EDUCATION CAMPAIGN TO INFORM COMMUNITY OF NAFL DISEASE AND ITS LONG TERM HEALTH REPERCUSSIONS. CONTINUE TO EXPAND THE BULL CITY FIT PROGRAM. PROGRESS IN FY17: BULL CITY FIT CONTINUED TO GROW AS AN INTEGRATED MODEL OF CHILD OBESITY TREATMENT, LEVERAGING THE STRENGTHS OF DUKE'S HIGH-QUALITY HEALTH CARE AND DURHAM'S EXTENSIVE PARKS SYSTEM AND RECREATION CENTERS. KEY SUPPORT FOR THE PROGRAM IS PROVIDED BY THE DUKE ENDOWMENT, THE DURHAM DEPARTMENT OF PARKS AND RECREATION, THE DEPARTMENT OF PEDIATRICS, THE DUKE CLINICAL RESEARCH INSTITUTE, AND THE DUKE CENTER FOR CHILDHOOD OBESITY RESEARCH. PRELIMINARY EVALUATION DATA HAS SHOWN HIGH LEVELS OF ENGAGEMENT WITH RACIALLY-DIVERSE AND LOW-INCOME FAMILIES, AND A RECENTLY PUBLISHED PROSPECTIVE TRIAL HAS DEMONSTRATED IMPROVEMENTS IN CHILD PHYSICAL ACTIVITY, FITNESS, AND QUALITY OF LIFE. BULL CITY FIT HAS TWO ONGOING STUDIES FUNDED BY THE DUKE ENDOWMENT AND AMERICAN HEART ASSOCIATION TO TEST IMPLEMENTATION AND OUTCOMES EFFECTIVENESS.4. HIV AND SEXUALLY TRANSMITTED INFECTIONSSEXUALLY TRANSMITTED INFECTIONS MAY LEAD TO PREMATURE DEATH AND DISABILITY AND CAN RESULT IN SIGNIFICANT HEALTH CARE COSTS. CHLAMYDIA, GONORRHEA, AND SYPHILIS ARE THE THREE MOST COMMON SEXUALLY TRANSMITTED INFECTIONS (STIS) IN NORTH CAROLINA AND DURHAM COUNTY. ALTHOUGH HIV IS NOT AS COMMON, DURHAM RANKS FOURTH HIGHEST IN NORTH CAROLINA, WITH AN AVERAGE RATE OF HIV DISEASE (29.9 PER 100,000) WELL ABOVE THE STATE RATE (16.4 PER 100,000).WHILE DUH THROUGH THE PROGRAMS DESCRIBED IN THIS DOCUMENT SUPPORTS MECHANISMS TO ADDRESS HIV AND SEXUALLY TRANSMITTED INFECTIONS, IT DOES NOT INCLUDE SPECIFIC STRATEGIES IN THIS PLAN TO ADDRESS THE RATE OF HIV AND SEXUALLY TRANSMITTED INFECTIONS, BECAUSE CONSIDERABLE WORK IS ALREADY BEING DONE THROUGH ORGANIZATIONS WITHIN THE COMMUNITY. THROUGH THE PARTNERSHIP FOR A HEALTHY DURHAM, THE HIV/STI ADVISORY COUNCIL BRINGS TOGETHER COMMUNITY MEMBERS AND AGENCIES TO FOCUS ON STRATEGIES TO PREVENT THE SPREAD OF SYPHILIS AND HIV/AIDS. IN ADDITION, LINCOLN COMMUNITY HEALTH CENTER OPERATES AN EARLY INTERVENTION CLINIC FOR PATIENTS WITH HIV/AIDS AT THE DURHAM COUNTY HEALTH DEPARTMENT. PLANS FOR FY16: DUH WILL CONTINUE TO PARTNER WITH THE MANY ORGANIZATIONS WORKING ON ADDRESSING HIV AND SEXUALLY TRANSMITTED INFECTIONS. DUH WILL ALSO BE A KEY PARTNER IN THE SOON TO LAUNCH DURHAM KNOWS PUBLIC HEALTH CAMPAIGN DESIGNED TO INCREASE ROUTINE HIV TESTING; INCREASE EARLY DIAGNOSIS OF HIV-INFECTED PERSONS AND ENHANCE LINKAGES TO CARE FOR INDIVIDUALS WHO ARE HIV POSITIVE.PROGRESS IN FY16: DUH CONTINUED TO WORK WITH THE MANY ORGANIZATIONS WORKING ON ADDRESSING HIV AND SEXUALLY TRANSMITTED INFECTIONS AND INTRODUCED HIV SCREENING INTO THE COMMUNITY CLINICS AS NOTED EARLIER IN THIS DOCUMENT.PLANS FOR FY17: CONTINUE HIV SCREENING IN THE COMMUNITY CLINICS AND CONTINUE TO SUPPORT THE EFFORTS OF THE DURHAM KNOWS CAMPAIGN.PROGRESS IN FY17: DUH, THROUGH THE DUKE DIVISION OF COMMUNITY HEALTH, CONTINUED TO SUPPORT THE COMMUNITY CLINICS AND THE EFFORTS OF THE DURHAM KNOWS CAMPAIGN. 5. POVERTYPEOPLE WITH HIGHER INCOMES, MORE YEARS OF EDUCATION, AND A HEALTHY AND SAFE ENVIRONMENT TO LIVE IN HAVE BETTER HEALTH OUTCOMES AND GENERALLY HAVE LONGER LIFE EXPECTANCIES. IN DURHAM COUNTY, 16.6% OF INDIVIDUALS LIVE IN POVERTY. FEMALE SINGLE-PARENT FAMILIES ARE DISPROPORTIONATELY AT RISK FOR POVERTY THAN MARRIED COUPLE FAMILIES (41.5% TO 8.7%) AND 40.6% OF FEMALE SINGLE-PARENT FAMILIES WITH RELATED CHILDREN UNDER 18 YEARS ARE LIVING IN POVERTY. NEARLY ONE-HALF OF DURHAM'S RENTERS ARE PAYING 30% OR MORE OF THEIR INCOME FOR HOUSING.DURHAM'S BULL CITY CONNECTOR IS A FARE-FREE CONNECTOR BUS SERVICE THAT CONTINUOUSLY LOOPS THROUGH STOPS FROM DOWNTOWN DURHAM ALL THE WAY TO THE DUKE HOSPITAL, DUKE CLINICS, AND DUKE EYE CENTER CAMPUSES. ON AVERAGE, BULL CITY CONNECTOR BUSES ACCUMULATE 1,500 RIDERS EVERY WEEKDAY AND COMPLETE THEIR LOOPS IN 17 MINUTE INTERVALS. SAFE AND EFFECTIVE TRANSPORTATION IS A KEY CORRELATE IN HEALTH AND ECONOMIC WELL-BEING. THE BULL CITY CONNECTOR HAS PROVEN TO BE AN ASSET FOR DUKE EMPLOYEES, STUDENTS, AND PATIENTS.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 3 YEARS. PLANS FOR FY16: CONTINUE AND EXPAND THE SOAR PROGRAMPROGRESS IN FY16: 152 INDIVIDUALS WERE ENROLLED IN SSI/SSDI OUTREACH, ACCESS AND RECOVERY SOAR. LATCH RURAL HEALTH WAS ADDED AS A GRANT FUNDED PROGRAM WHICH EXPANDED THE DURHAM SOAR PROGRAM AND ASSISTED IN COMPLETING SOAR APPLICATIONS FOR RESIDENTS IN TIER-1 COUNTIES SURROUNDING DURHAM. PLANS FOR FY17: CONTINUE SOAR PROGRAMPROGRESS IN FY17: 264 INDIVIDUALS WERE ENROLLED IN THE SOAR PROGRAM AND SCREENED FOR ELIGIBILITY. THE TEAM MAINTAINED A WAITLIST LIST AVERAGING AROUND 60 INDIVIDUALS WHO WOULD MOST LIKELY MEET FEDERAL DISABILITY CRITERIA AND THUS ELIGIBLE FOR DUH SOAR SERVICES. THE TWO PERSON TEAM AVERAGED 5 APPLICATIONS PER MONTH AND MAINTAINED A 90% APPROVAL RATE FOR THE YEAR WHICH EXCEEDS THE STATEWIDE SOAR APPROVAL RATE OF 79%. BENEFITS ENROLLMENT COUNSELING (BEC). IN FY 16 THE 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. PROGRESS IN FY17: BEC SCREENED 1,340 INDIVIDUALS. 1,199 OF THOSE INDIVIDUALS WERE ELIGIBLE TO RECEIVE ASSISTANCE FROM BEC TO FIND AND APPLY TO SUPPORTIVE BENEFITS PROGRAMS. BEC ASSISTED THESE INDIVIDUALS IN COMPLETING 4,773 BENEFIT APPLICATIONS.DURHAM MEDICAL RESPITE PROGRAM IS A PILOT PROGRAM FOR HOMELESS PATIENTS THAT EMANATED OUT OF THE WORK OF PADC (NOTED EARLIER IN THIS PLAN) IN 2014. THE MEDICAL RESPITE PILOT PROGRAM OPERATES 24/7 AND PROVIDES PARTICIPANTS WITH CLEAN AND SAFE HOUSING WHICH WILL MEET THE STANDARDS THAT HOSPITALS USE WHEN PLANNING FOR DISCHARGE TO HOME. DEPENDING ON PARTICIPANT NEEDS AND DEMOGRAPHICS, POTENTIAL SITES INCLUDE TRANSITIONAL HOUSING (JUST A CLEAN HOUSE), MOTELS, OR HEALING WITH CAARE, INC. PER DIEM HOUSING. ROOM AND BOARD IS FUNDED BY DURHAM COUNTY DEPARTMENT OF PUBLIC HEALTH THROUGH A CONTRACT WITH PROJECT ACCESS OF DURHAM COUNTY (PADC), ALONG WITH PRIVATE DONATIONS. AS THE PROGRAM BECOMES FULLY OPERATIONAL, EACH PROGRAM PARTICIPANT WILL WORK WITH A TRANSITIONAL NURSE CARE MANAGER (PROVIDED BY DUKE'S DIVISION OF COMMUNITY HEALTH) TO MAXIMIZE THEIR HEALTH AND CONNECT WITH APPROPRIATE COMMUNITY RESOURCES AND SERVICES. PLANS FOR FY16: ACHIEVE FULL OPERATIONAL STATUS FOR THE PROGRAM AND CONTINUE TO COLLABORATE ON POTENTIAL EXPANSION OPPORTUNITIES.PROGRESS IN FY16: THE PROGRAM RECEIVED A GRANT FROM THE HILLMAN FOUNDATION TO COVER THE COST OF AN RN CARE MANAGER AND COMMUNITY HEALTH WORKERS. THE PROGRAM SERVED 29 PATIENTS IN FY16. PRIOR TO MEDICAL RESPITE 10 LIVED IN SHELTERS AND 13 WERE UNSHELTERED AND POST-MEDICAL RESPITE 9 RECEIVED TRANSITIONAL HOUSING. SEVENTY FIVE PERCENT OF REFERRALS ORIGINATED FROM DUKE HOSPITAL, DUKE REGIONAL HOSPITAL AND DUKE OUTPATIENT CLINIC. PLANS FOR FY17: CONTINUE THE PROGRAM AND EXPAND REFERRAL SOURCES. PROGRESS IN FY17: EARLY EVALUATION RESULTS OF THE MEDICAL RESPITE PROGRAM DEMONSTRATED POSITIVE IMPACTS FOR PATIENTS SERVED INCLUDING A: 37% REDUCTION IN INPATIENT ADMISSIONS, 70% REDUCTION IN INPATIENT DAYS, AND 192% INCREASE IN OUTPATIENT VISITS. BENEFITS AND SERVICES OBTAINED FOR PARTICIPANTS THROUGH THE MEDICAL RESPITE PROGRAM INCLUDED CONNECTIONS TO PRIMARY CARE SERVICES, MENTAL HEALTH AND/OR SUBSTANCE ABUSE SERVICES, AND ASSISTANCE IN TRANSITIONING TO STABLE HOUSING. 6. EDUCATION QUALITY CHILD CARE AND EARLY EDUCATION PREDICT A CHILD'S FUTURE SUCCESS AND THE ACADEMIC SUCCESS OF YOUNG ADULTS IS STRONGLY LINKED WITH THEIR HEALTH THROUGHOUT THEIR LIFETIME. THE IMPORTANCE OF A HIGH SCHOOL DIPLOMA AND HIGHER EDUCATION CANNOT BE OVERSTATED. COLLEGE GRADUATES AGE 25 AND OVER EARN NEARLY TWICE AS MUCH AS WORKERS WHO ONLY HAVE A HIGH SCHOOL DIPLOMA. THE UNEMPLOYMENT RATE FOR WORKERS WHO DROPPED OUT OF HIGH SCHOOL IS NEARLY FOUR TIMES THE RATE FOR COLLEGE GRADUATES. IN DURHAM COUNTY, THE FOUR-YEAR HIGH SCHOOL GRADUATION RATE IS 79.6% COMPARED TO NORTH CAROLINA'S RATE OF 82.5%. THE OVERALL 4-YEAR COHORT GRADUATION RATE HAS INCREASED BY NEARLY 10% SINCE 2010-11, BUT THERE IS STILL A DISPARITY IN THE PERCENTAGES OF WHITE VERSUS MINORITY STUDENTS WHO ARE GRADUATING FROM HIGH SCHOOL. FOR EXAMPLE, 84.7% OF WHITES GRADUATED IN 2011-2012 COMPARED TO 74.7% OF BLACKS AND 73% OF HISPANIC STUDENTS.LEARNING TOGETHER PROVIDES TRAINING AND OPPORTUNITIES FOR DUKE STUDENTS (LEARNERS) TO PARTICIPATE IN HEALTH-RELATED COMMUNITY SERVICE ACTIVITIES. SERVICE OPPORTUNITIES MAY INCLUDE PROVIDING HEALTH EDUCATION TO ELEMENTARY SCHOOL CHILDREN, HELPING FRAIL SENIORS COMPLETE THE APPLICATION PROCESS FOR FOOD STAMPS, AND CONDUCTING WORKSHOPS TO TEACH PATIENTS HOW TO EFFECTIVELY COMMUNICATE WITH THEIR DOCTOR. THROUGH LEARNING TOGETHER, LEARNERS WORK WITH A VARIETY OF POPULATIONS, EXPERIENCE THE INTERDISCIPLINARY NATURE OF COMMUNITY WORK, AND DEVELOP COMPETENCE FOR WORKING WITH DIVERSE COMMUNITIES AND CULTURES. LEARNERS WHO PARTICIPATE GAIN SKILLS THEY CAN USE TO WORK EFFECTIVELY WITH ANY COMMUNITY. IN FY15 LEARNING TOGETHER TRAINED 126 DUKE LEARNERS WHO IN TURN VOLUNTEERED FOR COMMUNITY SERVICES ACTIVITIES WHICH PROVIDED ASSISTANCE FOR 300 ADULTS AND 1,125 CHILDREN.PLANS FOR FY16: CONTINUE TO OPERATE THE LEARNING TOGETHER PROGRAM WITH A SPECIAL FOCUS ON PARTNERING WITH DURHAM PUBLIC SCHOOLS AND OTHER EDUCATION AND HEALTH AND HUMAN SERVICES ENTITIES.PROGRESS IN FY16: THE LEARNING TOGETHER PROGRAM TRAINED 92 DUKE LEARNERS WHO IN TURN VOLUNTEERED FOR COMMUNITY SERVICES ACTIVITIES WHICH PROVIDED ASSISTANCE FOR 350 ADULTS AND 1200 CHILDREN.PLANS FOR FY17: CONTINUE THE SUCCESSFUL SERVICE-LEANING PARTNERSHIPS WITH DURHAM PUBLIC SCHOOLS AND OTHER EDUCATION AND HEALTH AND HUMAN SERVICE ENTITIES.PROGRESS IN FY17: THE LEARNING TOGETHER PROGRAM PREPARED AND/OR TRAINED 158 DUKE LEARNERS WHO IN TURN VOLUNTEERED FOR COMMUNITY SERVICE ACTIVITIES, PROVIDING HEALTH EDUCATION FOR 400 ADULTS AND 1200 CHILDREN. ADDITIONALLY, LEARNING TOGETHER STAFF CONDUCTED 10 VOCATIONAL/PERSONAL GROWTH SESSIONS FOR DUKE INTERNS AND FACILITATED A TOTAL OF 43 PSYCHOEDUCATIONAL GROUPS (SELF-ESTEEM, STRESS MANAGEMENT, AND COMMUNICATING WITH CONFIDENCE) FOR APPROXIMATELY 381 UNDERSERVED ELEMENTARY AND MIDDLE SCHOOL CHILDREN THROUGHOUT THE DURHAM COMMUNITY.GROUP A - FACILITY 1 - DUKE UNIVERSITY HOSPITALPART V, SECTION B, LINE 16J: DUHS 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 1 - DUKE UNIVERSITY HOSPITALPART V, SECTION B, LINE 24: CERTAIN ELECTIVE COSMETIC/AESTHETICSERVICES, AND OTHER SERVICES NOT COVERED BY INSURANCE, WILL BE BILLEDAT AN AMOUNT EQUAL TO GROSS CHARGES.DUKE RALEIGH HOSPITAL:PART V, SECTION B, LINE 5: DUKE RALEIGH HOSPITAL ("DRAH") COLLABORATEDWITH 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 NEEDSASSESSMENT (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 HOSPITALSDUKE 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 OVER THE NEXT THREE YEARS: 1. HEALTH INSURANCE COVERAGE 2. TRANSPORTATION3. ACCESS TO HEALTH SERVICES4. MENTAL HEALTH AND SUBSTANCE ABUSE1. HEALTH INSURANCE COVERAGEACCESS 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 OPEN DOOR CLINIC, WHICH PROVIDES AFFORDABLE HEALTHCARE TO UNINSURED ADULTS IN WAKE COUNTY.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 FY2017, DUKE RALEIGH HOSPITAL PROVIDED $2.8M OF IN KIND SUPPORT UP FROM $2.2M IN FY2016 TO PROJECT ACCESS OF WAKE COUNTY CLIENTS.CONTINUE TO PROVIDE HEALTH LITERACY COURSE THROUGH OUR CLINICAL EDUCATION DEPARTMENT WHICH EDUCATED OVER 40 CLINICIANS IN FY17. 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 EMPLOY THE DUHS RESOURCE CENTER IN ASSESSING AND ADDRESSING ANY BARRIERS, INCLUDING TRANSPORTATION THAT MAY IMPACT A PATIENT'S ABILITY TO GET TO THEIR FOLLOWUP APPOINTMENT.CONTINUE TO SUPPORT ORGANIZATIONS SUCH AS THE GREATER RALEIGH CHAMBER OF COMMERCE AND MIDTOWN RALEIGH ALLIANCE, WHICH ADVOCATES FOR AN ENHANCED TRANSIT SYSTEM FOR ALL RESIDENTS.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.3. ACCESS TO HEALTH SERVICESACCESS 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.DUKE PRIMARY CARE, AN ENTITY OF DUKE UNIVERSITY HEALTH SYSTEM, CONTINUES TO EVALUATE OPPORTUNITIES TO EXPAND ACCESS TO THE GROWING WAKE COUNTY POPULATION, ADDING TWO PRACTICES AND RELOCATING ONE PRACTICE IN FY17.CONTINUE TO IMPROVE THE DISCHARGE PROCESS TO ENSURE THAT DISCHARGED PATIENTS ARE CONNECTED WITH PRIMARY CARE RESOURCES.CONTINUE WORK OF THE DUHS RESOURCE CENTER IN FOLLOWING UP WITH DISCHARGED PATIENTS TO ENSURE THEY ARE SCHEDULED FOR THE APPROPRIATE FOLLOW UP TO REDUCE LIKELIHOOD OF UNNECESSARY READMISSIONS. THIS INCLUDES CONNECTING HOMEBOUND PATIENTS WITHOUT PRIMARY CARE TO ORGANIZATIONS THAT PERFORM HOME VISITS.CONTINUE PARTNERSHIP WITH WAKE EMS AND AREA HOSPITALS ON TRIAGE AND DESTINATION PLAN FOR STROKE PATIENTS.CONTINUE TO PROVIDE IN-KIND LAB SERVICES TO URBAN MINISTRIES OPEN DOOR CLINIC TO FACILITATE THE CARE FOR THOSE WHO LACK ADEQUATE INCOME, INSURANCE COVERAGE, AND OTHER MEANS TO HEALTH SERVICES. IN FY17, THIS IN-KIND DONATION WAS VALUED AT $1.8M.CONTINUE TO PROVIDE DIABETES EDUCATION TO ALLIANCE MEDICAL MINISTRY PATIENTS. THIS EDUCATION IS OFFERED BY CERTIFIED DIABETES EDUCATORS THROUGH DUKE SPECIALTY REHAB SERVICES MIDTOWN. STRENGTHEN SUPPORT OF ALLIANCE MEDICAL MINISTRY AND URBAN MINISTRIES THROUGH INCREASED EMPLOYEE VOLUNTEERISM IN EFFORTS TO EXPAND THEIR CAPACITY AND ABILITY TO SERVE PATIENTS. IN FY17, DUKE RALEIGH HOSTED A DAY OF SERVICE WHERE OVER 30 EMPLOYEES VOLUNTEERED THEIR TIME TO PACK 1,000 LBS OF RICE AND BEANS FOR URBAN MINISTRIES' CLIENT CHOICE FOOD PANTRY. FOR THE PAST TWO YEARS, DUKE RALEIGH EMPLOYEES VOLUNTEERED AT ALLIANCE MEDICAL MINISTRY AS PART OF THE TRIANGLE-WIDE MLK DAY OF SERVICE. DUKE RALEIGH CONTINUES TO EVALUATE OPPORTUNITIES FOR ONE-TIME AND ON-GOING SERVICE OPPORTUNITIES FOR THESE AND OTHER COMMUNITY PARTNERS. 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.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 FY2017, WE LAUNCHED THE 11TH YEAR OF THE HEALTH FOCUS EDUCATION SERIES WITH TOPICS INCLUDING, BUT NOT LIMITED TO CANCER, CARDIOVASCULAR DISEASE, AND STROKE.IN FY17, DUKE RALEIGH CONTINUED TO SPONSOR MIDTOWN FARMERS MARKET, WHICH PROMOTES A HEALTHY LIFESTYLE AS WELL AS PROVIDES A VENUE FOR DUKE RALEIGH TO SHARE HEALTHY EDUCATION.EXPAND AND STRENGTHEN COMMUNITY OUTREACH EFFORTS AROUND STROKE, CARDIOVASCULAR DISEASE, DIABETES, CANCER, ORTHOPEDICS AND SPORTS MEDICINE ALONG WITH OUR COMMUNITY PARTNERS. IN FY2017, WE PARTICIPATED AGAIN IN THE 4TH CONGRESSIONAL DISTRICT HEALTH FAIR WHERE OUR STROKE CHAMPIONS PROVIDED HEALTH EDUCATION. 4.MENTAL HEALTH AND SUBSTANCE ABUSEWAKE 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. CONTINUE TOBACCO CESSATION SUPPORT FOR EMPLOYEES AND DEPENDENTS THROUGH LIVE FOR LIFE'S STEPS TO HEALTH 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 12 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.DUKE RALEIGH HOSPITAL:PART V, SECTION B, LINE 16J: DUHS 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 SERVICES NOT COVERED BY INSURANCE, WILL BE BILLED AT AN AMOUNT EQUAL TO GROSS CHARGES.SCHEDULE H, PART V, SECTION BGROUP A - FACILITY 3 - DUKE REGIONAL HOSPITAL:PART V, SECTION B, LINE 5: DUKE REGIONAL HOSPITAL ("DRH") WAS A PARTICIPANT IN THE 2014 DURHAM COMMUNITY HEALTH ASSESSMENT, LED BY PARTNERSHIP FOR A HEALTHY DURHAM. THE ASSESSMENT PROCESS INCLUDED 354 CITIZEN SURVEYS FROM RANDOMLY SELECTED HOUSEHOLDS AND 8 COMMUNITY LISTENING SESSIONS WITH 205 COMMUNITY MEMBERS. REPRESENTATIVES FROM DUKE UNIVERSITY HOSPITAL (DUH) AND DRH PARTICIPATED AS MEMBERS ON THE COMMUNITY HEALTH ASSESSMENT TEAM ALONG WITH REPRESENTATIVES FROM OTHER UNIVERSITIES, LOCAL GOVERNMENT, SCHOOLS, NON-PROFIT ORGANIZATIONS, AND BUSINESSES. THE COMMUNITY HEALTH ASSESSMENT TEAM 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 2016 (TAX YEAR 2015).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 SIX HEALTH PRIORITIES FOR 2015-2017:1. OBESITY AND CHRONIC ILLNESS2. POVERTY3. EDUCATION4. ACCESS TO MEDICAL AND DENTAL CARE5. MENTAL HEALTH AND SUBSTANCE ABUSE6. HIV AND SEXUALLY TRANSMITTED INFECTIONSDUKE REGIONAL HOSPITAL 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 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 SIX PRIORITY AREAS TO IMPROVE HEALTH WITH THE DURHAM COMMUNITY. 1. OBESITY AND CHRONIC ILLNESSLOOK GOOD FEEL BETTER THE AMERICAN CANCER SOCIETY'S LOOK GOOD FEEL BETTER PROGRAM PROVIDES SUPPORT FOR FEMALE CANCER TREATMENT PATIENTS WHO HAVE EXPERIENCED HAIR LOSS OR OTHER PHYSICAL APPEARANCE CHANGES DUE TO CHEMOTHERAPY OR RADIATION TREATMENTS. IN FY 2014, THIS MONTHLY SUPPORT PROGRAM HELPED 58 WOMEN. 2016 GOAL: DUKE REGIONAL WILL CONTINUE TO SUPPORT THE PROGRAM IN 2016 WITH A GOAL OF REACHING 65 PATIENTS. 2016 PROGRESS: 45 WOMEN PARTICIPATED IN THE LOOK GOOD FEEL BETTER PROGRAM HOSTED AT DUKE REGIONAL.2017 GOAL: DUKE REGIONAL WILL CONTINUE TO HOST THE MONTHLY PROGRAM. 2017 PROGRESS: 50 WOMEN PARTICIPATED IN THE LOOK GOOD FEEL BETTER PROGRAM HOSTED AT DUKE REGIONAL.STROKE AWARENESSDUKE REGIONAL OFFERS A MONTHLY STROKE SUPPORT GROUP TO EDUCATE STROKE SURVIVORS, CARE GIVERS AND PEOPLE IN THE COMMUNITY ABOUT STROKE PREVENTION AND STROKE DISABILITIES. APPROXIMATELY, 25 PEOPLE ATTEND THE GROUP EACH MONTH. 2016 GOAL: DUKE REGIONAL WILL CONTINUE TO OFFER A MONTHLY STROKE SUPPORT GROUP. 2016 PROGRESS: DUKE REGIONAL OFFERED A PEER-LED MONTHLY STROKE SUPPORT GROUP WITH APPROXIMATELY 25 PEOPLE PARTICIPATING. 2017 GOAL: CONTINUE TO OFFER A MONTHLY STROKE SUPPORT GROUP WITH A GOAL OF 25 PARTICIPANTS. 2017 PROGRESS: DUKE REGIONAL OFFERED A PEER-LED MONTHLY STROKE SUPPORT GROUP WITH APPROXIMATELY 20 PEOPLE PARTICIPATING. 2. POVERTYFILL THAT BUSEMPLOYEES DONATED BINS OF SCHOOL SUPPLIES TO FILL THAT BUS IN AUGUST 2015 TO SUPPORT DURHAM PUBLIC SCHOOLS. TEACHERS FROM THE HIGHEST POVERTY SCHOOLS WERE INVITED TO PICK OUT SUPPLIES NEEDED IN THEIR CLASSROOMS.SALVATION ARMY ANGEL TREEEACH 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.2016 GOAL: DUKE REGIONAL WILL HOST A DRIVE TO BENEFIT UNDERSERVED CHILDREN OR FAMILIES IN OUR COMMUNITY. 2016 PROGRESS: IN AUGUST 2015, DRH DONATED 25 BINS OF CRAYONS, GLUE STICKS, MARKERS, PAPER, PENCILS AND MORE TO THE FILL THAT BUS! CAMPAIGN FOR DURHAM PUBLIC SCHOOLS CLASSROOMS. THE HOSPITAL ALSO "ADOPTED" 100 CHILDREN THROUGH THE SALVATION ARMY ANGEL TREE PROGRAM IN DECEMBER 2015.2017 GOAL: DUKE REGIONAL WILL AGAIN HOST AT LEAST ONE DRIVE TO BENEFIT UNDERSERVED CHILDREN OR FAMILIES IN OUR COMMUNITY. 2017 PROGRESS: DUKE REGIONAL DONATED 40 BINS OF CRAYONS, GLUE STICKS, MARKERS, PAPER, PENCILS AND MORE TO THE CRAYONS2CALCULATORS FILL THAT BUS! CAMPAIGN FOR DURHAM PUBLIC SCHOOLS TEACHERS IN HIGH-NEED AND HIGH-POVERTY AREAS. THE HOSPITAL ALSO GRANTED 100 HOLIDAY WISHES THROUGH THE SALVATION ARMY ANGEL TREE PROGRAM. 3. EDUCATIONHEALTH PROFESSIONS EDUCATIONDUKE REGIONAL IS COMMITTED TO HELPING TRAIN THE HEALTHCARE WORKERS OF THE FUTURE. IN FY 2015, DRH CONTRIBUTED OVER $3 MILLION TOWARD THE TRAINING AND TEACHING OF TOMORROW'S HEALTHCARE PROFESSIONALS. 2016 GOAL: DUKE REGIONAL WILL CONTINUE THAT LEVEL OF SUPPORT IN FY 2016. 2016 PROGRESS: DRH INVESTED $3.4 MILLION IN TEACHING AND TRAINING HEALTHCARE PROFESSIONALS. DRH ALSO PROVIDED OPPORTUNITIES FOR 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, OPERATING ROOM AND WOMEN'S SERVICES.2017 GOAL: DUKE REGIONAL WILL CONTINUE THAT LEVEL OF SUPPORT IN FY 17. 2017 PROGRESS: DRH INVESTED $3.5 MILLION IN TEACHING AND TRAINING HEALTHCARE PROFESSIONALS. DRH ALSO 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 SERVICES WORK EXPERIENCES IN A HEALTH CARE SETTING.PROJECT SEARCHDUKE REGIONAL IS THE HOST BUSINESS FOR PROJECT SEARCH, A PARTNERSHIP WITH DURHAM PUBLIC SCHOOLS, OE ENTERPRISES, VOCATIONAL REHAB AND DURHAM CENTER ACCESS THAT PROVIDES CAREER DEVELOPMENT EXPERIENCES TO SENIOR HIGH SCHOOL STUDENTS WITH DEVELOPMENTAL DISABILITIES. THE STUDENTS, ACCOMPANIED BY A TEACHER, TEACHER'S ASSISTANT AND JOB COACHES, COMPLETE INTERNSHIPS IN SEVERAL HOSPITAL DEPARTMENTS DURING THE ACADEMIC YEAR. SIX STUDENTS GRADUATED IN MAY 2015, AND FIVE WERE EMPLOYED IN THE COMMUNITY BY THE END OF THE SUMMER. 2016 GOAL: DUKE REGIONAL WILL CONTINUE TO SERVE AS A HOST SITE FOR PROJECT SEARCH FOR THE 2015-16 ACADEMIC YEAR. 2016 PROGRESS: MORE THAN 40 STUDENTS HAVE GRADUATED FROM THE PROJECT SEARCH PROGRAM SINCE ITS INCEPTION IN 2011 AND MORE THAN HALF ARE CURRENTLY EMPLOYED IN THE COMMUNITY. 2017 GOAL: DUKE REGIONAL WILL CONTINUE TO SERVE AS A HOST SITE FOR THE 2016-2017 ACADEMIC YEAR. 2017 PROGRESS: DUKE REGIONAL CONTINUED TO SERVE AS A HOST SITE FOR PROJECT SEARCH ADDING 8 NEW GRADUATES BRINGING THE TOTAL NUMBER OF GRADUATES TO 48 SINCE 2011.CITY OF MEDICINE ACADEMYDUKE 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. 2016 GOAL: DUKE REGIONAL WILL CONTINUE THIS PARTNERSHIP WITH CMA IN FY 2016.2016 PROGRESS: DUKE REGIONAL CONTINUED TO PARTNER WITH CMA, HOSTING STUDENTS THROUGHOUT THE YEAR AND HOSTING THE ANNUAL SENIOR AWARDS NIGHT IN THE HOSPITAL AUDITORIUM. 2017 GOAL: DUKE REGIONAL WILL CONTINUE ITS PARTNERSHIP WITH CMA IN FY 2017. 2017 PROGRESS: DUKE REGIONAL CONTINUED TO PARTNER WITH CMA, PROVIDING VARIOUS LEARNING EXPERIENCES FOR STUDENTS THROUGHOUT THE YEAR.4. ACCESS TO MEDICAL AND DENTAL CARELINCOLN COMMUNITY HEALTH CENTERLINCOLN COMMUNITY HEALTH CENTER (LCHC) IS A FEDERALLY QUALIFIED COMMUNITY HEALTH CENTER THAT PROVIDES PRIMARY CARE SERVICES FOR ABOUT 40,000 PATIENTS EACH YEAR. APPROXIMATELY 80 PERCENT OF LCHC PATIENTS ARE UNINSURED AND 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 FISCAL YEAR (FY) 2015, INCLUDING MONETARY AND IN-KIND SERVICES, WAS MORE THAN $7.5 MILLION. 2016 GOAL: DUKE REGIONAL WILL CONTINUE THAT LEVEL OF SUPPORT IN FY 2016. 2016 PROGRESS: DUKE REGIONAL CONTRIBUTED $7.4 MILLION IN MONETARY DONATIONS AND IN-KIND SERVICES TO LCHC.2017 GOAL: DUKE REGIONAL WILL CONTINUE THAT LEVEL OF SUPPORT IN FY 17. 2017 PROGRESS: DUKE REGIONAL CONTRIBUTED $7.9 MILLION IN MONETARY DONATIONS AND IN-KIND SERVICES TO LCHC.DURHAM COUNTY EMERGENCY MEDICAL SERVICESDURHAM COUNTY EMERGENCY MEDICAL SERVICES (EMS) SERVES AS THE PRIMARY PROVIDER OF EMERGENCY AMBULANCE SERVICES AND ALTERNATIVE MEDICAL TRANSPORTATION IN DURHAM COUNTY. IN FY 2015, DUKE REGIONAL PAID THE COUNTY MORE THAN $2.3 MILLION TO SUPPORT DURHAM EMS. 2016 GOAL: DUKE REGIONAL WILL CONTINUE THAT LEVEL OF SUPPORT IN FY 2016. 2016 PROGRESS: DRH PAID $2.4 MILLION TO SUPPORT DURHAM COUNTY EMS.2017 GOAL: DRH WILL CONTINUE THAT LEVEL OF SUPPORT IN FY 17. 2017 PROGRESS: DRH PAID $2.4 MILLION TO SUPPORT DURHAM COUNTY EMS.PROJECT ACCESS DURHAM COUNTYPROJECT 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. 2016 GOAL: DUKE REGIONAL WILL CONTINUE TO PROVIDE OFFICE SPACE AS WELL AS TECHNOLOGICAL SUPPORT FOR PADC IN FY 2016. 2016 PROGRESS: DUKE REGIONAL PROVIDED OFFICE SPACE AND TECHNOLOGICAL SUPPORT TO PROJECT ACCESS DURHAM COUNTY. 2017 GOAL: DUKE REGIONAL WILL CONTINUE THIS LEVEL OF SUPPORT IN FY 17. 2017 PROGRESS: DUKE REGIONAL PROVIDED OFFICE SPACE AND TECH SUPPORT TO PADC IN FY17. CHARITY CAREEACH YEAR DUKE REGIONAL PROVIDES NO-COST OR DISCOUNTED URGENT OR EMERGENT HEALTH CARE SERVICES TO PATIENTS WHO WERE UNABLE TO PAY. IN FY 2015 DUKE REGIONAL PROVIDED $16.7 MILLION IN CHARITY CARE. 2016 GOAL: DUKE REGIONAL WILL CONTINUE TO PROVIDE CHARITY CARE AT A SIMILAR LEVEL IN FY 2016. 2016 PROGRESS: DRH PROVIDED $21.4 MILLION IN CHARITY CARE.2017 GOAL: DUKE REGIONAL WILL CONTINUE TO PROVIDE CHARITY CARE AT A SIMILAR LEVEL IN FY 17. 2017 PROGRESS: DUKE REGIONAL PROVIDED $21.9 MILLION IN CHARITY CARE.5. MENTAL HEALTH AND SUBSTANCE ABUSEDURHAM CENTER ACCESS (OAKLEIGH)EACH YEAR DUKE REGIONAL PROVIDES $100,000 TO SUPPORT DURHAM CENTER ACCESS, AN INPATIENT TREATMENT FACILITY FOR MENTAL HEALTH, DEVELOPMENTAL DISABILITY AND SUBSTANCE ABUSE SERVICES. 2016 GOAL: DUKE REGIONAL WILL CONTINUE THAT LEVEL OF SUPPORT IN FY 2016. 2016 PROGRESS: DRH PROVIDED $100,000 TO DURHAM CENTER ACCESS.2017 GOAL: DRH WILL CONTINUE THAT LEVEL OF SUPPORT IN FY 17. 2017 PROGRESS: DRH PROVIDED $100,000 TO DURHAM CENTER ACCESS.6. HIV AND SEXUALLY TRANSMITTED INFECTIONSDUKE REGIONAL DOES NOT HAVE A SPECIFIC GOAL TO ADDRESS THE RATE OF HIV AND SEXUALLY TRANSMITTED INFECTIONS BECAUSE CONSIDERABLE WORK IS ALREADY BEING DONE THROUGH ORGANIZATIONS WITHIN THE COMMUNITY. THROUGH THE PARTNERSHIP FOR A HEALTHY DURHAM, THE HIV/STI ADVISORY COUNCIL BRINGS TOGETHER COMMUNITY MEMBERS AND AGENCIES TO FOCUS ON STRATEGIES TO PREVENT THE SPREAD OF SYPHILIS AND HIV/AIDS. IN ADDITION, LINCOLN COMMUNITY HEALTH CENTER, WHICH DUKE REGIONAL SUPPORTS, OPERATES AN EARLY INTERVENTION CLINIC FOR PATIENTS WITH HIV/AIDS AT THE DURHAM COUNTY HEALTH DEPARTMENT. FUNDRAISING AND OUTREACHIN ADDITION TO THE ACTIVITIES DESCRIBED IN THE PREVIOUS SECTIONS, DUKE REGIONAL CONDUCTS A NUMBER OF FUNDRAISING AND OUTREACH ACTIVITIES IN THE DURHAM COMMUNITY AND BEYOND. DUKE REGIONAL EMPLOYEES RAISED $31,763 FOR THE FOLLOWING CHARITABLE ORGANIZATIONS IN FY 2015: - DUKE COMMUNITY GIVING $20,906 (INCLUDES UNITED WAY)- UNITED WAY OF THE GREATER TRIANGLE (SEE ABOVE)- AMERICAN HEART ASSOCIATION HEART WALK $10,8572016 GOAL: DUKE REGIONAL WILL RAISE AT LEAST $35,000 FOR LOCAL CHARITIES, INCLUDING DUKE COMMUNITY GIVING/ UNITED WAY OF THE GREATER TRIANGLE, THE AMERICAN HEART ASSOCIATION HEART WALK AND AT LEAST ONE ADDITIONAL COMMUNITY-WIDE FUNDRAISING EFFORT.2016 PROGRESS: DRH RAISED $18,665 THROUGH DUKE'S DOING GOOD IN THE NEIGHBORHOOD CAMPAIGN, WHICH INCLUDES DUKE COMMUNITY GIVING AND UNITED WAY OF THE GREATER TRIANGLE; $8,173 FOR THE AMERICAN HEART ASSOCIATION TRIANGLE HEART WALK; AND $14,316 FOR THE MARCH OF DIMES MARCH FOR BABIES.2017 GOAL: DUKE REGIONAL WILL RAISE AT LEAST $35,000 FOR LOCAL CHARITIES. 2017 PROGRESS: DRH RAISED $15,066 THROUGH DUKE'S DOING GOOD IN THE NEIGHBORHOOD CAMPAIGN, WHICH INCLUDES DUKE COMMUNITY GIVING AND UNITED WAY OF THE GREATER TRIANGLE; $15,333 FOR THE AMERICAN HEART ASSOCIATION TRIANGLE HEART WALK; AND $7,840 FOR THE MARCH OF DIMES MARCH FOR BABIES.THE HOSPITAL CONTINUES TO PARTNER WITH LOCAL NONPROFITS ON ENDEAVORS THAT EDUCATE OUR COMMUNITY ON HEALTH INITIATIVES AND DISPARITIES, AND PROVIDES MEETING SPACE FOR DURHAM AND ORANGE COUNTY'S DOMESTIC VIOLENCE AND SEXUAL ASSAULT PROGRAM, COMMUNITY HEALTH COALITION, AMERICAN CANCER SOCIETY'S LOOK GOOD FEEL BETTER PROGRAM, AND PROJECT ACCESS. IN ADDITION, THE HOSPITAL:-PARTNERED WITH THE AMERICAN RED CROSS TO HOST BLOOD DRIVES, COLLECTING 84 UNITS OF BLOOD FROM 252 DONORS.-MARCHED IN THE NORTH CAROLINA PRIDEFEST PARADE IN SUPPORT OF THE LESBIAN, GAY, BISEXUAL, TRANSGENDER, AND QUEER/QUESTIONING (LGBTQ) COMMUNITY AND SURVEYED ATTENDEES TO IDENTIFY SERVICE GAPS.-DONATED 1,028 POUNDS OF NONPERISHABLE FOOD, CLEANING SUPPLIES, PERSONAL CARE ITEMS AND MORE FOR FAMILIES AFFECTED BY HURRICANE MATTHEW. GROUP A - FACILITY 3 - DUKE REGIONAL HOSPITAL PART V, SECTION B, LINE 16J: DUHS 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 SERVICES NOT COVERED BY INSURANCE, WILL BE BILLED AT AN AMOUNT EQUAL TO GROSS CHARGES. 3 1 - HOSPICE OF MEADOWLANDS 1001 CORPORATE DRIVE HILLSBOROUGH NC 27278 HOSPICE 2 - HOCK FAMILY PAVILION 4023 NORTH ROXBORO ROAD DURHAM NC 27704 HOSPICE 3 - DUKE IMAGING SERVICES 3700 NW CARY PARKWAY SUITE 120 CARY NC 27513 INDEPENDENT DIAGNOSTIC TESTING FACILITY 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 10.14%.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 2:BAD DEBT AT COST IS DETERMINED USING THE COST-TO-CHARGE RATIO CALCULATION FROM WORKSHEET 2.PART III, LINE 3:A PORTION OF 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. BAD DEBT IS FURTHER COMPLICATED BY DOCUMENTATION REQUIRED BY THE CENTERS FOR MEDICARE AND MEDICAID SERVICES (CMS) FOR REPORTING CHARITY CARE. THEREFORE, PATIENTS WHO MAY QUALIFY FOR CHARITY CARE ARE REPORTED AS BAD DEBT EXPENSE INSTEAD BECAUSE OF THOSE PATIENTS' INABILITY OR UNWILLINGNESS TO PROVIDE THE NECESSARY DOCUMENTATION REQUIRED TO DETERMINE CHARITY CARE CLASSIFICATION.PART III, LINE 4:PAGES 16-18 IN THE FY2017 AUDITED FINANCIAL STATEMENT FOOTNOTES DESCRIBE BAD DEBT EXPENSE.PART III, LINE 7:TOTAL UNREIMBURSED COSTS ATTRIBUTABLE TO PROVIDING SERVICES UNDER MEDICARE AS REPORTED IN THE JUNE 30, 2017 DUHS CONSOLIDATED FINANCIAL STATEMENTS ARE $212,922,000 AS COMPARED TO $98,962,712 AS REPORTED IN SECTION B, LINE 7 OF SCHEDULE H. THE DUHS TOTAL MEDICARE SHORTFALL OF $212,922,000 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 HEALTH CAROLINIAN'S 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) 2015 DATA. APPROXIMATELY 70% OF INPATIENT DISCHARGES FROM DUHS FACILITIES IN FFY 2015 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 CHARITABLE GRANTS AND GOODWILL 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 COLLABORATES 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 CHARITABLE 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) 17500 GENERAL SUPPORT AMERICAN HEART ASSOCIATION PO BOX 50045 PRESCOTT AZ 863045045 560529996 501(C)(3) 34000 GENERAL SUPPORT AMERICAN ORG OF NURSE EXECUTIVES 75 REMITTANCE DR SUITE 1201 CHICAGO IL 606751201 363591337 501(C)(6) 12000 GENERAL SUPPORT AUTISM SOCIETY OF NORTH CAROLINA 505 OBERLILN RD SUITE 230 RALEIGH NC 27605 237087887 501(C)(3) 25000 GENERAL SUPPORT BOYS & GIRLS CLUB OF GREATER DURHAM 808 E PETTIGREW ST DURHAM NC 27701 566001906 501(C)(3) 6500 GENERAL SUPPORT BOYS CLUB OF WAKE COUNTY INC 701 N RALEIGH BLVD RALEIGH NC 27610 560863051 501(C)(3) 20000 GENERAL SUPPORT CARING HOUSE INC 2625 PICKETT RD DURHAM NC 277055603 561647154 501(C)(3) 10000 GENERAL SUPPORT CAROLINA THEATRE OF DURHAM INC 309 W MORGAN STREET DURHAM NC 277012119 561759337 501(C)(3) 20000 SPONSORSHIP CEO ROUNDTABLE ON CANCER INC 101 SAS CAMPUS DR CARY NC 27513 651230448 501(C)(3) 40000 GENERAL SUPPORT CITY OF DURHAM 101 CITY HALL PLAZA DURHAM NC 27701 566000225 GOV'T ENTITY 25000 GENERAL SUPPORT COMMUNITIES IN PARTNERSHIP PO BOX 11247 DURHAM NC 27703 475567396 501(C)(3) 15000 GENERAL SUPPORT DIX VISIONARIES PO BOX 28575 RALEIGH NC 27611 208421281 501(C)(3) 10000 GENERAL SUPPORT DUKE SCHOOL FOR CHILDREN 3716 OLD ERWIN RD DURHAM NC 27705 581521494 501(C)(3) 25000 GENERAL SUPPORT DURHAM ACADEMY INC 3130 PICKETT RD DURHAM NC 277055599 560538019 501(C)(3) 25000 GENERAL SUPPORT DURHAM CONGREGATIONS IN ACTION 504 W CHAPEL HILL ST DURHAM NC 27701 237208424 501(C)(3) 11500 GENERAL SUPPORT DURHAM PUBLIC SCHOOLS 301 CRUTCHFIELD ST DURHAM NC 27704 566001021 GOV'T ENTITY 15000 GENERAL SUPPORT EAST DURHAM CHILDRENS INITIATIVE 107 N DRIVER ST 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) 10000 GENERAL SUPPORT EL CENTRO HISPANO INC 2000 CHAPEL HILL RD DURHAM NC 277071197 562011661 501(C)(3) 6000 GENERAL SUPPORT FAMILY VIOLENCE PREVENTION CTR 1012 OBERLINE RD SUITE 100 RALEIGH NC 27605 581320613 501(C)(3) 20000 GENERAL SUPPORT GREATER RALEIGH CHAMBER OF COMMERCE PO BOX 2978 RALEIGH NC 276022978 560370850 501(C)(6) 27750 GENERAL SUPPORT HABITAT FOR HUMANITY OF WAKE COUNTY 2420 RALEIGH BLVD RALEIGH NC 27604 561492703 501(C)(3) 20000 GENERAL SUPPORT HOLT BROTHERS FOUNDATION INC 421 FAYETTEVILLE ST STE 1300 RALEIGH NC 27601 566570426 501(C)(3) 5500 GENERAL SUPPORT HUMAN RIGHTS CAMPAIGN INC 1640 RHODE ISLAND AVE NW WASHINGTON DC 20036 521243457 501(C)(4) 15000 GENERAL SUPPORT JUNIOR LEAGUE OF RALEIGH INC PO BOX 25728 RALEIGH NC 276115728 560562849 501(C)(3) 10000 GENERAL SUPPORT MARCH OF DIMES FOUNDATION 6504 FALLS OF NEUSE ROAD STE 100 RALEIGH NY 27615 131846366 501(C)(3) 7500 GENERAL SUPPORT MEDICAL FOUNDATION OF NC INC CB 7145 SUITE 4100 BONDURANT CHAPEL HILL NC 275997120 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 MUSEUM OF DURHAM HISTORY PO BOX 362 DURHAM NC 27702 943455685 501(C)(3) 10000 GENERAL SUPPORT NC LUNG CANCER PARTNERSHIP 4000 BLUE RIDGE RD SUITE 170 RALEIGH NC 27612 262300885 501(C)(3) 25000 GENERAL SUPPORT NC PHYSICIANS HEALTH PROGRAM INC 220 HORIZON DRIVE 201 RALEIGH NC 27615 561846599 501(C)(3) 16000 GENERAL SUPPORT NORTH CAROLINA SYMPHONY SOCIETY 3700 GLENWOOD AVE SUITE 130 RALEIGH NC 27612 560556755 501(C)(3) 33500 GENERAL SUPPORT ORANGE COUNTY RAPE CRISIS CENTER 1506 E FRANKLIN ST SUITE 302 CHAPEL HILL NC 27514 581356356 501(C)(3) 10000 GENERAL SUPPORT POLKA DOT MAMA MELANOMA FOUNDATION 925 ALDEN BRIDGE DR CARY NC 27519 474543960 501(C)(3) 10250 GENERAL SUPPORT RACE 131 LLC 3803-B COMPUTER DR STE 205 RALEIGH NC 27609 464157559 7500 SPONSORSHIP RALEIGH SCHOOL OF NURSE ANESTHESIA 3900 BARRETT DR SUITE 200 RALEIGH NC 27609 561684241 501(C)(3) 18151 GENERAL SUPPORT RONALD MCDONALD HOUSE OF DURHAM 506 ALEXANDER AVE DURHAM NC 27705 561220376 501(C)(3) 15000 GENERAL SUPPORT SENIOR PHARMASSIST INC 406 RIGSBEE AVE STE 201 DURHAM NC 277012186 562084639 501(C)(3) 20000 GENERAL SUPPORT SHAW UNIVERSITY 118 E SOUTH ST RALEIGH NC 27601 560530235 501(C)(3) 6500 GENERAL SUPPORT SUSAN G KOMEN FOR THE CURE NC 600 AIRPORT BLVD SUITE 100 MORRISVILLE NC 27560 752845066 501(C)(3) 65000 GENERAL SUPPORT THE UNIVERSITY OF NORTH CAROLINA CAMPUS BOX 3480 CHAPEL HILL NC 275993480 566001393 501(C)(3) 12000 SPONSORSHIP UNITED WAY OF THE GREATER TRIANGLE 2400 PERIMETER PARK DR 150 MORRISVILLE NC 27560 561949103 501(C)(3) 593895 SPONSORSHIP YMCA OF THE TRIANGLE AREA INC 801 CORPORATE CENTER DR STE 20 RALEIGH NC 27606 560591307 501(C)(3) 10000 GENERAL SUPPORT 36 8 FINANCIAL ASSISTANCE 43 56000 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 CHARITABLE GRANTS COMMITTEE 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 NANCY ANDREWS MD DIRECTOR 0 594822 0 346539 0 18000 0 32411 0 59782 0 1051554 0 0 RICHARD H BRODHEAD DIRECTOR 0 994475 0 0 0 263534 0 153161 0 15585 0 1426755 0 115000 MARY E KLOTMAN MD DIRECTOR 0 310727 0 76114 0 18000 0 32411 0 13859 0 451111 0 0 MARK F NEWMAN DIRECTOR 0 184681 0 0 0 29008 0 26603 0 20784 0 261076 0 0 A EUGENE WASHINGTON MD PRESIDENT & CEO DUHS/DIRECTOR 0 1161674 0 904735 0 23700 0 132411 0 15246 0 2237766 0 0 MONTE D BROWN MD VP FOR ADMINISTRATION/SECRETARY 329638 0 247336 0 92973 0 32411 0 18667 0 721025 0 0 0 WILLIAM J FULKERSON MD EXECUTIVE VP, DUHS 813955 0 594041 0 18000 0 32411 0 7243 0 1465650 0 0 0 KENNETH C MORRIS SVP, CFO, TREASURER 728235 0 473611 0 69442 0 32411 0 11345 0 1315044 0 0 0 MARY ANN FUCHS VP-PATIENT CARE/CHIEF NURSE EXEC 321029 0 137705 0 0 0 32411 0 7018 0 498163 0 0 0 KATHLEEN GALBRAITH PRESIDENT, DUKE REGIONAL HOSPITAL 372099 0 114986 0 27367 0 32411 0 17405 0 564268 0 0 0 KEVIN SOWERS PRESIDENT, DUKE UNIVERSITY HOSPITAL 480618 0 222708 0 18000 0 32411 0 12029 0 765766 0 0 0 DAVID ZAAS MD PRESIDENT, DUKE RALEIGH HOSPITAL 370857 0 150721 0 18016 0 32411 0 15449 0 587454 0 0 0 RHONDA BRANDON CHIEF HUMAN RESOURCES OFFICER 308231 0 212744 0 24046 0 32411 0 23587 0 601019 0 0 0 MARC CALABRESE PHYSICIAN 377657 0 42986 0 19260 0 32411 0 23643 0 495957 0 0 0 CAROLYN C CARPENTER CHIEF OPERATING OFFICER DUH 320062 0 124421 0 0 0 32411 0 19802 0 496696 0 0 0 JEFFREY M FERRANTI VP, CIO, DHTS ADMINISTRATION 399756 21236 204904 80984 18000 0 32411 0 21886 0 676957 102220 0 0 THOMAS A OWENS MD CHIEF MEDICAL OFFICER 429419 0 199154 0 82701 0 32411 0 13144 0 756829 0 0 0 VICTOR J DZAU MD FORMER DIRECTOR/OFFICER 0 0 0 143032 0 0 0 18666 0 15 0 161713 0 0 SCHEDULE J, PART I, LINE 1A TAX INDEMNIFICATION: RHONDA BRANDON AND DAVID ZAAS, MD RECEIVED A BENEFIT THAT WAS GROSSED UP TO COMPENSATE FOR WITHHOLDING OF TAXES. SCHEDULE J, PART I, LINE 4B SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN: THE FOLLOWING INDIVIDUAL PARTICIPATED IN AND RECEIVED PAYMENTS UNDER A DEFERRED COMPENSATION PLAN DESCRIBED UNDER SECTION 457(F) OF THE INTERNAL REVENUE CODE: RICHARD H. BRODHEAD $230,000. SUCH AMOUNT WAS SUBJECT TO A SUBSTANTIAL RISK OF FORFEITURE AS DEFINED UNDER IRC SECTION 457(F). 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 2012-03-22 322140000 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 228820000 322140000 322140000 1 0 1 1 B 184550000 214760000 214760000 1 0 1 1 C 6705000 128325000 128325000 2009 1 0 1 1 D 21695000 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 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. 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 06/14/12 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 FACILTITES, 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 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 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 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 FACILTITES, 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 BANC OF AMERICA PUBLIC CAPITAL CORP. IN THE MAXIMUM PRINCIPAL AMOUNT OF $40,000,000 TO FINANCE MEDICAL, COMPUTER, OFFICE, AND CAPITAL EQUIPMENT. BOND ISSUE A (3): DRAW-DOWN FINANCING LEASE PROGRAM WITH SUNTRUST EQUIPMENT FINANCE AND LEASING CORP. IN THE MAXIMUM PRINCIPAL AMOUNT OF $40,000,000 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. BOND ISSUES D: PROCEEDS INCLUDE INVESTMENT EARNINGS. BOND ISSUES D (2) AND A (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, AND D: BOND ISSUE (A) ARBITRAGE REPORT COMPLETED 03/22/17; (B) COMPLETED 05/30/17; (D) COMPLETED 05/31/17. AS TO D(2) AND A(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), AND A (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 2012-08-28 48225000 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 2012-03-06 40000000 SEE PART VI 0 0 0 A 19575000 48225000 48225000 1 0 1 1 B 11355000 383990154 201888819 2101335 180000000 1 1 1 1 C 140200389 139008505 1191884 0 1 1 1 D 14988274 30861504 30861504 2014 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 0 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 1 0 0 1 0 0 0 1 C 0 1 0 0 0 0 0 0 1 D 0 0 0 1 0 0 0 0 1 A 1 B 1 C 1 D 1 A NORTH CAROLINA MEDICAL CARE COMMISSION 521309402 2015-04-21 40000000 SEE PART VI 0 0 0 A 1457421 19035078 19035078 0 0 0 1 A 0 0 1 1 0 0.00000 0.00000 0.00000 0 0 1 A 0 1 0 0 0 0 0 0 1 A 1 BIOVENTUS LLC SEE PART V 636582 SEE PART V 0 DANIEL J SCOTT MD SEE PART V 67752 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, DIRECTOR IS A DUHS, INC. DIRECTOR(C) AMOUNT OF TRANSACTION: $636,582(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: $67,752(D) DESCRIPTION OF TRANSACTION: PAYMENT FOR SALARY AND BENEFITS(E) SHARING OF ORGANIZATION REVENUE? = NO X 2 THRIFT STORE VALUE X 2813 THRIFT STORE VALUE X 10 50398 MARKET QUOTE X EQUIPMENT 2 20696 MARKET QUOTE X ENTERTAINMENT 9 790 MARKET QUOTE X SPORTS 4 744 MARKET QUOTE 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. BELOW ARE EXCERPTS FROM THE ANNUAL DUHS REPORT ON COMMUNITY BENEFIT. THE COST OF THESE ACTIVITIES CAN BE DIFFICULT TO MEASURE. SOMETIMES THEY INCLUDE THE PARTICIPATION OF DUKE UNIVERSITY SO REFERENCES TO "DUKE" ARE MEANT TO INCLUDE DUHS AND DUKE UNIVERSITY IN THEIR RESPECTIVE MISSION CAPACITIES. DUKE: A PARTNER IN CARE FOR PEOPLE, COMMUNITIES ACROSS NORTH CAROLINA WHEN ITS MEDICAL SCHOOL AND FIRST HOSPITAL OPENED MORE THAN 85 YEARS AGO, DUKE DEDICATED ITSELF TO IMPROVING THE HEALTH OF PEOPLE ACROSS NORTH CAROLINA. TODAY, IN WHAT HAS EVOLVED INTO DUKE UNIVERSITY HEALTH SYSTEM, THAT PROUD COMMITMENT TO CARE CONTINUES. THIS EDITION OF OUR ANNUAL REPORT ON COMMUNITY BENEFIT TELLS HOW. FOR THE FISCAL YEAR THAT ENDED JUNE 30, 2017, DUKE PROVIDED A TOTAL COMMUNITY BENEFIT AND INVESTMENT OF $509 MILLION. OF THAT FIGURE, $97 MILLION REPRESENTS CHARITY CARE AT ESTIMATED COST PROVIDED TO 235,417 PATIENTS, WITH 95% FROM NORTH CAROLINA. INCLUDING THE $509 MILLION FOR FY2017, DUKE'S TOTAL COMMUNITY BENEFIT AND INVESTMENT OVER THE PAST 10 YEARS EXCEEDS $3 BILLION. MORE THAN 7,000 DUKE-TRAINED HEALTHCARE PROFESSIONALS MAKE THEIR HOME IN NORTH CAROLINA: * PHYSICIANS 3,348 * NURSES 2,734 * PHYSICIAN ASSISTANTS 653 * PHYSICAL THERAPISTS 299 * PATHOLOGY ASSISTANTS 28 FOR A TOTAL OF 7,062 DUKE PROVIDED $97 MILLION IN CHARITY CARE AT ESTIMATED COST TO 235,417 PATIENTS DURING THE FISCAL YEAR THAT ENDED ON JUNE 30, 2017. 95 PERCENT OF THESE PATIENTS WERE RESIDENTS OF NORTH CAROLINA. 84 PERCENT RESIDED IN DUKE'S PRIMARY SERVICE AREA OF ALAMANCE, DURHAM, GRANVILLE, ORANGE, PERSON, VANCE AND WAKE COUNTIES. HIGHLIGHTS OF DUKE'S CHARITY CARE AND DISCOUNTED CARE POLICIES: * DUKE PROVIDES WORLD-CLASS CARE WITH A CONSISTENTLY HIGH LEVEL OF DIGNITY, RESPECT AND SKILL TO ALL PATIENTS, REGARDLESS OF THEIR ABILITY TO PAY. * DUKE PROVIDES ELIGIBLE CARE AT A DISCOUNT OR WITHOUT CHARGE TO ALL QUALIFYING PATIENTS WHO DO NOT HAVE HEALTH INSURANCE, OR WHO CANNOT PAY FOR CARE BECAUSE OF FINANCIAL HARDSHIP (ONLY MEDICALLY NECESSARY SERVICES ARE ELIGIBLE.) * DUKE PHYSICIANS DONATE EMERGENCY, PRIMARY, AND SPECIALTY CARE SERVICES TO ELIGIBLE UNINSURED PATIENTS THROUGH PROJECT ACCESS, A PROGRAM IN DURHAM AND WAKE COUNTIES. * DUKE HELPS PATIENTS NAVIGATE THROUGH GOVERNMENT-SPONSORED FINANCIAL-ASSISTANCE PROGRAMS. * DUKE ABSORBS COST DIFFERENCES WHEN GOVERNMENT PROGRAMS SUCH AS MEDICAID DO NOT COMPLETELY COVER THE COST OF CARE. DUKE UNIVERSITY HEALTH SYSTEM, AS WELL AS DUKE HEALTH, WORKS WITHIN THE COMMUNITIES IT SERVES TO PROMOTE WELLNESS AND ACCESS TO CARE. PARTNERING WITH LOCAL RESIDENTS, WE ADDRESS PRESSING NEEDS TO ENSURE HEALTHY NORTH CAROLINIANS. IN ADDITION, THROUGH ITS TWO HOSPITALS IN DURHAM AND ONE IN RALEIGH, DUKE COLLABORATES WITH PUBLIC HEALTH DEPARTMENTS IN DURHAM AND WAKE COUNTIES AND NUMEROUS COMMUNITY ORGANIZATIONS TO BETTER UNDERSTAND THE NEEDS OF THE PEOPLE WHO LIVE HERE. SUPPORTING THE WORK OF COMMUNITY GROUPS: DUKE AND ITS LOCAL PARTNERS CONTINUE COLLABORATIVE EFFORTS TO ELIMINATE HEALTHCARE DISPARITIES AND IMPROVE ACCESS TO HIGH-QUALITY MEDICAL CARE. IN THE 2017 FISCAL YEAR, DUKE PROVIDED $12 MILLION IN CASH AND IN-KIND SUPPORT FOR COMMUNITY GROUPS, INCLUDING: (1) $8.0 MILLION FOR LINCOLN COMMUNITY HEALTH CENTER AND ITS SATELLITE COMMUNITY CLINICS, WHICH SERVE A MAJORITY POOR AND UNINSURED POPULATION; (2) $2.4 MILLION FOR DURHAM COUNTY'S EMERGENCY MEDICAL SERVICES PROGRAM; (3) $1.6 MILLION IN CASH CONTRIBUTIONS TO OTHER COMMUNITY ORGANIZATIONS. INVESTING IN HEALTH PROFESSIONS EDUCATION: EDUCATING THE NEXT GENERATION OF PHYSICIANS, NURSES, NURSE PRACTITIONERS, PHYSICIAN ASSISTANTS, PHYSICAL THERAPISTS, AND PATHOLOGY ASSISTANTS IS CENTRAL TO DUKE'S MISSION TO IMPROVE HEALTHCARE FOR PATIENTS AND THE COMMUNITY. IN THE 2017 FISCAL YEAR, DUKE INVESTED MORE THAN $65 MILLION IN ITS HEALTH PROFESSIONS EDUCATION PROGRAM. THE PROGRAM REMAINS AMONG THE MOST CHALLENGING AND INNOVATIVE IN THE COUNTRY AND EMPHASIZES NEW MODELS OF COMMUNITY-FOCUSED CARE ON HEALTH, WELLNESS, AND SELF-CARE, AS WELL AS POPULATION HEALTH MANAGEMENT. FORM 990, PART VI, SECTION A, LINE 2 DIRECTORS JACK O. BOVENDER, JR., RICHARD H. BRODHEAD, THOMAS M. GORRIE, WILLIAM HAWKINS, MICHAEL MARSICANO, DAVID M. RUBENSTEIN, AND STEVEN SCOTT, MD ARE TRUSTEES OF DUKE UNIVERSITY. DIRECTOR AND PRESIDENT/CEO, A. EUGENE WASHINGTON, MD, IS AN OFFICER OF DUKE UNIVERSITY. THE FOLLOWING INDIVIDUALS ARE EMPLOYEES OF DUKE UNIVERSITY: NANCY CATHERINE ANDREWS, MD, MARY KLOTMAN, MD, AND MARK F. NEWMAN. DIRECTOR AND PRESIDENT/CEO, A. EUGENE WASHINGTON, MD, DIRECTOR MARK F. NEWMAN, 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, DIRECTORS MARY KLOTMAN, MD, MARK F. NEWMAN, AND OFFICER WILLIAM J. FULKERSON, 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. 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 4 DUHS AMENDED BYLAWS BECAME EFFECTIVE APRIL 7, 2017 STATING THE FOLLOWING SIGNIFICANT CHANGE: QUORUM - AT ALL MEETINGS OF THE BOARD OF DIRECTORS, THE PRESENCE OF ONE-HALF (1/2 ) OF THE DIRECTORS THEN HOLDING OFFICE SHALL BE NECESSARY AND SUFFICIENT TO CONSTITUTE A QUORUM FOR THE TRANSACTION OF BUSINESS, AND THE ACT OF A MAJORITY OF THE DIRECTORS PRESENT AT ANY MEETING AT WHICH THERE IS A QUORUM SHALL BE THE ACT OF THE BOARD OF DIRECTORS, EXCEPT AS MAY BE OTHERWISE SPECIFICALLY PROVIDED BY STATUTE, THE ARTICLES OF INCORPORATION, OR THESE BYLAWS. 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 EMAILED 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 ALL 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 BY GOING TO WWW.DUKEHEALTH.ORG; SELECTING "ABOUT DUKEHEALTH; CLICKING ON "CLINICAL ENTERPRISE AND SELECTING "FINANCIAL INFORMATION". FORM 990, PART XI, LINE 9: NONPERIODIC CHANGES IN DEFINED BENEFIT PLANS: 83,820,252. NET TRANSFERS TO THE UNIVERSITY AND AFFILIATES: -125,875,511. CHANGE IN MARKET VALUE OF DERIVATIVES: 36,536,402. 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