NORTON - KINGS DAUGHTERS HEALTH INC: Form 990, tax year 2016
View the entire original 990 at ProPublica ↗
- Organization
- NORTON - KINGS DAUGHTERS HEALTH INC (EIN 35-0895832)
- Tax period
- 2016-01-01 to 2016-12-31
- Filed
- 2017-08-28
- IRS object ID
- 201722409349300407
- Schema version
- 2016v3.0
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule H
- Schedule I
- Schedule J
- Schedule K
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2017-08-28T08:37:02-05:00 | ReturnTs |
| Tax Period End | 2016-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 351178661 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Blue & Co LLC | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 500 N Meridian St Suite 200 | AddressLine1Txt |
| City | Indianapolis | CityNm |
| State Abbreviation | IN | StateAbbreviationCd |
| ZIP | 46204 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2016-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 350895832 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | The Bethany Circle of King's Daughters' | BusinessNameLine1Txt |
| Business Name Line2 | of Madison Indiana Inc | BusinessNameLine2Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | BETH | BusinessNameControlTxt |
| Phone | 8128010800 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1373 East State Road 62 Po Box 447 | AddressLine1Txt |
| City | Madison | CityNm |
| State Abbreviation | IN | StateAbbreviationCd |
| ZIP | 47250 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | PAULA HEIDERMAN | PersonNm |
| Person Title | Board Chairwoman | PersonTitleTxt |
| Phone | 8128010800 | PhoneNum |
| Signature | 2017-08-28 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Carrie A Merrill CPA | PreparerPersonNm |
| PTIN | P00832283 | PTIN |
| Phone | 3176334705 | PhoneNum |
| Preparation | 2017-08-28 | PreparationDt |
Filing Security Information FilingSecurityInformation
IP Address IPAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| I Pv4 Address | 38.109.186.2 | IPv4AddressTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IP | 2017-08-28 | IPDt |
| IP Tm | 08:24:35 | IPTm |
| IP Timezone | ED | IPTimezoneCd |
| Filing License Type | P | FilingLicenseTypeCd |
| At Submission Creation Device Id | DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | CEC041C7A28BF02AF1651001FA3B4F793CABA0CE | AtSubmissionFilingDeviceId |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2016 | TaxYr |
| Build TS | 2021-01-29 14:40:06Z | BuildTS |
Form 990 IRS990
Doing Business As Name DoingBusinessAsName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | King's Daughters' Health | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | John Price | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1373 East State Road 62 Po Box 447 | AddressLine1Txt |
| City | Madison | CityNm |
| State Abbreviation | IN | StateAbbreviationCd |
| ZIP | 47250 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $130,092,580 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | www.kdhmadison.org | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1899 | FormationYr |
| Legal Domicile State | IN | LegalDomicileStateCd |
| Activity Or Mission | To improve the health of the hospital's patients through care, service, and education. | ActivityOrMissionDesc |
| Voting Members Governing Body | 11 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 9 | VotingMembersIndependentCnt |
| Total Employee | 1149 | TotalEmployeeCnt |
| Total Volunteers | 88 | TotalVolunteersCnt |
| Total Gross UBI | $14,907 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | -$5,407 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $568,158 | PYContributionsGrantsAmt |
| CY Contributions Grants | $408,019 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $132,837,067 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $125,312,917 | CYProgramServiceRevenueAmt |
| PY Investment Income | $2,407,230 | PYInvestmentIncomeAmt |
| CY Investment Income | $1,734,690 | CYInvestmentIncomeAmt |
| PY Other Revenue | $735,637 | PYOtherRevenueAmt |
| CY Other Revenue | $2,152,739 | CYOtherRevenueAmt |
| PY Total Revenue | $136,548,092 | PYTotalRevenueAmt |
| CY Total Revenue | $129,608,365 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $43,737 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $131,389 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $62,858,895 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $63,171,103 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $58,362,666 | PYOtherExpensesAmt |
| CY Other Expenses | $59,706,871 | CYOtherExpensesAmt |
| PY Total Expenses | $121,265,298 | PYTotalExpensesAmt |
| CY Total Expenses | $123,009,363 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $15,282,794 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $6,599,002 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $248,968,944 | TotalAssetsBOYAmt |
| Total Assets EOY | $257,036,707 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $110,636,308 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $108,181,062 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $138,332,636 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $148,855,645 | NetAssetsOrFundBalancesEOYAmt |
| Mission | The mission of the hospital is to improve the health of the hospital's patients through care, service, and education. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $104,026,995 | ExpenseAmt |
| Grant | $131,389 | GrantAmt |
| Revenue | $126,991,493 | RevenueAmt |
| Desc | KING'S DAUGHTERS' HEALTH IS A NOT-FOR-PROFIT, ACUTE CARE HOSPITAL OWNED BY THE BETHANY CIRCLE OF KING'S DAUGHTERS' OF MADISON, INDIANA, INC., LOCATED IN MADISON, INDIANA. THE HOSPITAL IS ORGANIZED FOR THE PURPOSE OF PROVIDING HEALTHCARE SERVICES TO THE RESIDENTS OF JEFFERSON COUNTY AND THE SURROUNDING AREA.DURING THE CALENDAR YEAR 2016, THE HOSPITAL PROVIDED HEALTHCARE TO PATIENTS AT THE FOLLOWING LEVELS:11,946 DAYS OF CARE TO ACUTE INPATIENTS1,173 DAYS OF CARE TO NEWBORN INFANTS192,690 VISITS ASSOCIATED WITH HOSPITAL OUTPATIENTS132,062 VISITS ASSOCIATED WITH PHYSICIAN CLINICS | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $1,601,743 | ExpenseAmt |
| Desc | THE HOSPITAL'S PRIMARY SOURCES OF SUPPORT ARE FROM PATIENT REVENUES. PATIENT REVENUES INCLUDE FUNDS RECEIVED FROM MEDICARE, STATE AGENCIES, INSURANCE COMPANIES, AND THE PATIENTS THEMSELVES. IN 2016, THE KING'S DAUGHTERS' HOSPITAL AND HEALTH SERVICES PROVIDED SERVICES TOTALING $1,601,743 IN GROSS CHARGES TO PATIENTS WHO MET THE HOSPITAL'S CHARITY CARE POLICY. | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expenses | $105,628,738 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (1) | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Temp Or Permanent Endowments | Yes (1) | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | Yes (1) | GrantsToOrganizationsInd |
| Grants To Individuals | Yes (1) | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | Yes (1) | TaxExemptBondsInd |
| Invest Tax Exempt Bonds | 0 | InvestTaxExemptBondsInd |
| Escrow Account | 0 | EscrowAccountInd |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuerInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | Yes (1) | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | Yes (1) | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 86 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 1149 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | Yes (1) | UnrelatedBusIncmOverLimitInd |
| Form990 T Filed | Yes (1) | Form990TFiledInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | Yes (1) | QuidProQuoContributionsInd |
| Quid Pro Quo Contri Discl | Yes (1) | QuidProQuoContriDisclInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 11 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 9 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (1) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | 0 | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | IN | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | DAWN NUNAN DIRECTOR OF ACCOUNTING | PersonNm |
| Phone | 8128010800 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1373 EAST STATE ROAD 62 PO BOX 447 | AddressLine1Txt |
| City | MADISON | CityNm |
| State Abbreviation | IN | StateAbbreviationCd |
| ZIP | 47250 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (23 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| PAULA HEIDERMAN | ||||||||
| Board Chairwoman | 1.00 | 1.00 | Yes (X) | $1,000 | $0 | $0 | ||
| MARJORIE HARE | ||||||||
| Board Vice Chairwoman | 1.00 | 0.00 | Yes (X) | $1,000 | $0 | $0 | ||
| Annie Schroeder | ||||||||
| Board Secretary | 1.00 | 0.00 | Yes (X) | $1,500 | $0 | $0 | ||
| MARY BETTE VOYLES | ||||||||
| Board Treasurer | 1.00 | 0.00 | Yes (X) | $1,500 | $0 | $0 | ||
| ANDREA FORRESTER | ||||||||
| Board Assn't Treasurer | 1.00 | 0.00 | Yes (X) | $1,500 | $0 | $0 | ||
| Bonnie Colen | ||||||||
| Board Assn't Secretary | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| JONATHAN HANSON MD | ||||||||
| BOARD MEMBER/PHYSIcian | 40.00 | 0.00 | Yes (X) | $359,975 | $0 | $41,174 | ||
| PAT STACK MD | ||||||||
| Board Member/Physician | 40.00 | 0.00 | Yes (X) | $218,920 | $0 | $22,801 | ||
| JOE CRAIG | ||||||||
| Board Member | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| Mary Kay McCubbin | ||||||||
| Board Member | 1.00 | 0.00 | Yes (X) | $1,750 | $0 | $0 | ||
| KEVIN TURNER | ||||||||
| Board member | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| CAROL DOZIER | ||||||||
| PRESIDENT/CEO | 40.00 | 1.00 | $355,622 | $0 | $14,613 | Yes (X) | ||
| John Price | ||||||||
| VP Finance | 40.00 | 0.00 | $102,257 | $0 | $8,337 | Yes (X) | ||
| Stephen Meacham | ||||||||
| VP Finance (1/1/16- 1/1/16) | 40.00 | 0.00 | $127,983 | $0 | $3,245 | Yes (X) | ||
| Lisa Morgan | ||||||||
| VP outPatient Services | 40.00 | 0.00 | $152,824 | $0 | $50,494 | Yes (X) | ||
| Denine Fallis-Hallgarth | ||||||||
| VP Physician Practices | 40.00 | 0.00 | $135,967 | $0 | $36,735 | Yes (X) | ||
| Jennifer Liter | ||||||||
| VP Inpatient Services | 40.00 | 0.00 | $39,688 | $0 | $3,222 | Yes (X) | ||
| HOLLY ROBINSON MD | ||||||||
| VP QUALITY / Physician | 40.00 | 0.00 | $270,305 | $0 | $46,616 | Yes (X) | ||
| Thomas Eckert MD | ||||||||
| Employed Physician | 40.00 | 1.00 | $756,085 | $0 | $30,912 | Yes (X) | ||
| Travis Clegg MD | ||||||||
| Employed Physician | 40.00 | 0.00 | $1,708,901 | $0 | $41,469 | Yes (X) | ||
| Amy Gifalid MD | ||||||||
| Employed Physician | 40.00 | 0.00 | $960,955 | $0 | $968 | Yes (X) | ||
| Michael Schmidt MD | ||||||||
| Employed Physician | 40.00 | 0.00 | $662,128 | $0 | $41,852 | Yes (X) | ||
| Ronald Auer MD | ||||||||
| EMployed Physician | 40.00 | 0.00 | $694,405 | $0 | $42,092 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $6,554,265 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $384,530 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 60 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| MAYO COLLABORATIVE SERVICES INC | |||||
| PO Box 9146 | Minneapolis | MN | 554809146 | Laboratory Services | $1,064,259 |
| Comprehensive Medical Management | |||||
| 300 Dave Cowens Drive Ste 600 | Newport | KY | 41071 | Contracted Physician Billing Services | $1,004,581 |
| EMcare Inc | |||||
| 7032 Collection Center Drive | Chicago | IL | 60693 | Contracted Physician & Mid Level provide | $646,583 |
| First Urology | |||||
| PO Box 1087 | Jeffersonville | IN | 47131 | Contracted Physician Services | $478,443 |
| Norton Healthcare | |||||
| PO Box 35070 N-52 | Louisville | KY | 40232 | Contracted Physician Services and Affili | $398,197 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 25 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $350,000 | RelatedOrganizationsAmt |
| Government Grants | $49,843 | GovernmentGrantsAmt |
| All Other Contributions | $8,176 | AllOtherContributionsAmt |
| Total Contributions | $408,019 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | Net Patient Service Revenue | Desc |
| Business | 621110 | BusinessCd |
| Total Revenue Column | $125,312,917 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $125,298,010 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $14,907 | UnrelatedBusinessRevenueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $125,312,917 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $2,099,555 | TotalRevenueColumnAmt |
| Exclusion | $2,099,555 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $94,701 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $19,405 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $75,296 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $75,296 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $75,296 | RelatedOrExemptFuncIncomeAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $90,945 | SecuritiesAmt |
| Other | $9,000 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $0 | SecuritiesAmt |
| Other | $464,810 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $90,945 | SecuritiesAmt |
| Other | -$455,810 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$364,865 | TotalRevenueColumnAmt |
| Exclusion | -$364,865 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt | ExclusionExclusionAmt |
|---|---|---|---|---|
| EHR Income | 900099 | $1,038,181 | $1,038,181 | |
| Cafeteria Revenue | 722210 | $318,793 | $318,793 | |
| Gift Shop | 453220 | $140,463 | $140,463 |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $580,006 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $580,006 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $2,077,443 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $129,608,365 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $126,991,493 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $14,907 | UnrelatedBusinessRevenueAmt |
| Exclusion | $2,193,946 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $118,305 | TotalAmt |
| Program Services | $118,305 | ProgramServicesAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $13,084 | TotalAmt |
| Program Services | $13,084 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,999,028 | TotalAmt |
| Program Services | $1,716,575 | ProgramServicesAmt |
| Management And General | $282,453 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $49,058,943 | TotalAmt |
| Program Services | $41,368,530 | ProgramServicesAmt |
| Management And General | $7,690,413 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,661,657 | TotalAmt |
| Program Services | $1,426,873 | ProgramServicesAmt |
| Management And General | $234,784 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,182,209 | TotalAmt |
| Program Services | $6,167,398 | ProgramServicesAmt |
| Management And General | $1,014,811 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,269,266 | TotalAmt |
| Program Services | $2,807,335 | ProgramServicesAmt |
| Management And General | $461,931 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $283,335 | TotalAmt |
| Management And General | $283,335 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $113,462 | TotalAmt |
| Management And General | $113,462 | ManagementAndGeneralAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $344,382 | TotalAmt |
| Management And General | $344,382 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $653,316 | TotalAmt |
| Management And General | $653,316 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $172,746 | TotalAmt |
| Program Services | $148,338 | ProgramServicesAmt |
| Management And General | $24,408 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,022,010 | TotalAmt |
| Program Services | $877,605 | ProgramServicesAmt |
| Management And General | $144,405 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $333,119 | TotalAmt |
| Program Services | $286,051 | ProgramServicesAmt |
| Management And General | $47,068 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,980,557 | TotalAmt |
| Program Services | $1,700,714 | ProgramServicesAmt |
| Management And General | $279,843 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $125,746 | TotalAmt |
| Program Services | $107,979 | ProgramServicesAmt |
| Management And General | $17,767 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,412,700 | TotalAmt |
| Program Services | $4,647,912 | ProgramServicesAmt |
| Management And General | $764,788 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $12,203,311 | TotalAmt |
| Program Services | $10,479,043 | ProgramServicesAmt |
| Management And General | $1,724,268 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,434,777 | TotalAmt |
| Program Services | $1,232,050 | ProgramServicesAmt |
| Management And General | $202,727 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| Purchased Services | $9,998,890 | $8,586,096 | $1,412,794 |
| Drugs | $9,314,422 | $9,314,422 | |
| Supplies | $8,373,498 | $7,190,363 | $1,183,135 |
| Hospital Assessment Fee | $2,323,666 | $2,323,666 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,616,934 | TotalAmt |
| Program Services | $5,116,399 | ProgramServicesAmt |
| Management And General | $500,535 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $123,009,363 | TotalAmt |
| Program Services | $105,628,738 | ProgramServicesAmt |
| Management And General | $17,380,625 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $16,615,294 | BOYAmt |
| EOY | $20,980,469 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $12,214,616 | BOYAmt |
| EOY | $12,121,632 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,942,043 | BOYAmt |
| EOY | $576,185 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,580,826 | BOYAmt |
| EOY | $2,464,740 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,448,508 | BOYAmt |
| EOY | $1,953,950 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $188,568,804 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $73,018,343 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $124,956,955 | BOYAmt |
| EOY | $115,550,461 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $84,030,981 | BOYAmt |
| EOY | $96,442,587 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,179,721 | BOYAmt |
| EOY | $6,946,683 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $248,968,944 | BOYAmt |
| EOY | $257,036,707 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,528,709 | BOYAmt |
| EOY | $11,106,378 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $96,691,235 | BOYAmt |
| EOY | $95,318,589 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $644,324 | BOYAmt |
| EOY | $1,417,437 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,772,040 | BOYAmt |
| EOY | $338,658 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $110,636,308 | BOYAmt |
| EOY | $108,181,062 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $138,304,381 | BOYAmt |
| EOY | $148,835,451 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $18,255 | BOYAmt |
| EOY | $10,194 | EOYAmt |
Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,000 | BOYAmt |
| EOY | $10,000 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $138,332,636 | BOYAmt |
| EOY | $148,855,645 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $248,968,944 | BOYAmt |
| EOY | $257,036,707 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $6,599,002 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $3,746,917 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $177,090 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | VolunteersInd |
| Paid Staff Or Management | 0 | PaidStaffOrManagementInd |
| Media Advertisements | 0 | MediaAdvertisementsInd |
| Mailings Members | 0 | MailingsMembersInd |
| Publications Or Broadcast | 0 | PublicationsOrBroadcastInd |
| Grants Other Organizations | 0 | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | 0 | DirectContactLegislatorsInd |
| Rallies Demonstrations | 0 | RalliesDemonstrationsInd |
| Other Activities | Yes (1) | OtherActivitiesInd |
| Other Activities | $7,955 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $7,955 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | 0 | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part II-B, Line 1: | FormAndLineReferenceDesc |
| Explanation | Portion of Indiana Hospital Association dues and American Hospital Association dues attributable to lobbying expenses as disclosed on the dues notices of the respective associations. | ExplanationTxt |
Schedule D IRS990ScheduleD
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $28,255 | BeginningYearBalanceAmt |
| Contributions | $356,398 | ContributionsAmt |
| Other Expenditures | $364,459 | OtherExpendituresAmt |
| End Year Balance | $20,194 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $30,058 | BeginningYearBalanceAmt |
| Contributions | $506,513 | ContributionsAmt |
| Other Expenditures | $508,316 | OtherExpendituresAmt |
| End Year Balance | $28,255 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $208,725 | BeginningYearBalanceAmt |
| Contributions | $50,077 | ContributionsAmt |
| Other Expenditures | $228,744 | OtherExpendituresAmt |
| End Year Balance | $30,058 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $196,716 | BeginningYearBalanceAmt |
| Contributions | $48,484 | ContributionsAmt |
| Other Expenditures | $36,475 | OtherExpendituresAmt |
| End Year Balance | $208,725 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $129,738 | BeginningYearBalanceAmt |
| Contributions | $86,924 | ContributionsAmt |
| Other Expenditures | $19,946 | OtherExpendituresAmt |
| End Year Balance | $196,716 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated Balance EOY | 0.00000 | BoardDesignatedBalanceEOYPct |
| Prmnnt Endowment Balance EOY | 0.49520 | PrmnntEndowmentBalanceEOYPct |
| Term Endowment Balance EOY | 0.50480 | TermEndowmentBalanceEOYPct |
| Endowments Held Unrelated Org | 0 | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | 0 | EndowmentsHeldRelatedOrgInd |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $4,937,784 | OtherCostOrOtherBasisAmt |
| Book Value | $4,937,784 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $119,252,475 | OtherCostOrOtherBasisAmt |
| Depreciation | $27,275,688 | DepreciationAmt |
| Book Value | $91,976,787 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $64,213,779 | OtherCostOrOtherBasisAmt |
| Depreciation | $45,742,655 | DepreciationAmt |
| Book Value | $18,471,124 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $164,766 | OtherCostOrOtherBasisAmt |
| Book Value | $164,766 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $115,550,461 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (3 entries)
| DescDesc | AmtAmt |
|---|---|
| Deferred Compensation | $47,021 |
| Third party payable | -$80,000 |
| Life Insurance Policies | $371,637 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $338,658 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $133,063,249 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | $3,746,917 | NetUnrealizedGainsInvstAmt |
| Other Revenue | $171,501 | OtherRevenueAmt |
| Revenue Not Reported | $3,918,418 | RevenueNotReportedAmt |
| Revenue Subtotal | $129,144,831 | RevenueSubtotalAmt |
| Investment Expenses Not Incld | $344,382 | InvestmentExpensesNotIncldAmt |
| Other Revenues Not Included | $119,152 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | $463,534 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $129,608,365 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $122,540,240 | TotExpnsEtcAuditedFinclStmtAmt |
| Other Expenses Included | -$5,588 | OtherExpensesIncludedAmt |
| Expenses Not Reported | -$5,588 | ExpensesNotReportedAmt |
| Expenses Subtotal | $122,545,828 | ExpensesSubtotalAmt |
| Investment Expenses Not Incld2 | $344,382 | InvestmentExpensesNotIncld2Amt |
| Other Expenses Not Included | $119,153 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $463,535 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $123,009,363 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part V, Line 4: | PERMANENT ENDOWMENT - INTENT IS TO HOLD THE INVESTMENT IN PERPETUITY. PER AUDITED FINANCIAL STATEMENTS, "THE PORTION OF PERPETUAL ENDOWMENT FUNDS THAT IS REQUIRED TO BE RETAINED PERMANENTLY EITHER BY EXPLICIT DONOR STIPULATION OR UPMIFA" IS $10,000 AT 12/31/2016. TERM ENDOWMENT - TEMPORARILY RESTRICTED NET ASSETS ARE DONOR-RESTRICTED FOR A SPECIFIC USE INCLUDING: PRENATAL/POSTNATAL EDUCATION PROGRAM FUND, TEEN FUND, MAY LIBRARY FUND, FIT FUND, National Nurses week Fund, Patient Scales Fund, Indiana Hospital Association Fund, and HIP 2.0 Premium Assistance fund. |
| Part X, Line 2: | Accounting principles generally accepted in the United States of America require management to evaluate tax positions taken by the Hospital and recognize a tax liability if the Hospital has taken an uncertain tax position that more likely than not would not be sustained upon examination by various federal and state taxing authorities. Management has analyzed the tax positions taken by the Hospital, and has concluded that as of December 31, 2016 and 2015, there are no uncertain positions taken or expected to be taken that would require recognition of a liability or disclosure in the accompanying consolidated financial statements. The Hospital is subject to routine audits by taxing jurisdictions; however, as of the date the financial statements were issued, there were no audits for any tax periods in progress. |
| Part XI, Line 2d - Other Adjustments: | Rental Expenses -5,588. change in subscriber savings cumulative account 177,090. Rounding -1. |
| Part XI, Line 4b - Other Adjustments: | Grants 119,152. |
| Part XII, Line 2d - Other Adjustments: | Rental Expenses -5,588. |
| Part XII, Line 4b - Other Adjustments: | Grants 119,152. Rounding 1. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent150 | Yes (X) | Percent150Ind |
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
| Percent250 | Yes (X) | Percent250Ind |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | 0 | ExpensesExceedBudgetInd |
| Annual Community Bnft Report | Yes (1) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (1) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $515,761 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $515,761 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00420 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $21,754,714 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $13,536,368 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $8,218,346 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.06680 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $22,270,475 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $13,536,368 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $8,734,107 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.07100 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $174,385 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $50,228 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $124,157 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00100 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $160,947 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $45,325 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $115,622 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00090 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $4,016,564 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,564,379 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $452,185 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00370 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $127,161 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $127,161 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00100 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $4,479,057 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,659,932 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $819,125 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00660 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $26,749,532 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $17,196,300 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $9,553,232 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.07760 | TotalExpensePct |
Health Improvement Advocacy HealthImprovementAdvocacyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $149,568 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $149,568 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00120 | TotalExpensePct |
Workforce Development WorkforceDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $269 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $269 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $149,837 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $149,837 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00120 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReportedInd |
| Bad Debt Expense | $12,305,614 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $0 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $23,581,358 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $23,057,469 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | $523,889 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | KING'S DAUGHTERS' HEALTH | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1373 East State Road 62 PO Box 447 | AddressLine1Txt |
| City | Madison | CityNm |
| State Abbreviation | IN | StateAbbreviationCd |
| ZIP | 47250 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | www.kdhmadison.org | WebsiteAddressTxt |
| State License | 16-005063-1 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
| Emergency Room Other | Yes (X) | EmergencyRoomOtherInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | KING'S DAUGHTERS' HEALTH | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | 0 | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Prior CHNA Impact | Yes (X) | PriorCHNAImpactInd |
| Other | Yes (X) | OtherInd |
| CHNA Conducted | 16 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | 0 | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | 0 | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | www.kdhmadison.org/about-us/community-needs-assessment | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Rpt Available Thru Other Method | Yes (X) | RptAvailableThruOtherMethodInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 16 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | https://www.kdhmadison.org/about-us/community-needs-assessment | StrategyWebsiteURLTxt |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 150.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 250.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Residency Criteria | Yes (X) | ResidencyCriteriaInd |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | http://www.kdhmadison.org/patients_financial.aspx | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | HTTP://WWW.KDHMADISON.ORG/PATIENTS_FINANCIAL.ASPX | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | http://www.kdhmadison.org/patients_financial.aspx | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| Other Publicity | Yes (X) | OtherPublicityInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Other Actions Taken | Yes (X) | OtherActionsTakenInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Look Back Medicare Private | Yes (X) | LookBackMedicarePrivateInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (9 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| KING'S DAUGHTERS' HEALTH | Part V, Section B, Line 3j: The Needs Assessment Performed by the Hospital also explored key issues such as: Physical Activity, overweight and obesity, tobacco use, substance abuse/gambling/addictions, responsible sexual behavior, mental health, injury and violence (including domestic violence and sexual assault), environmental quality, immunization, access to health care for the insured and uninsured, maternal and child health, infectious disease, occupational and safety health, special needs/disabled/impaired, and chronic disease. |
| KING'S DAUGHTERS' HEALTH | Part V, Section B, Line 5: The Facility took into account input from persons in the community by utilizing the following components:- Analysis of secondary data to develop a profile of the residents of each county and to indicate, where possible future trends and to show comparisons with state and national data;- In-person interviews with 30 key leaders within KDH including Board, staff and medical staff;- In-depth-interviews by telephone or in-person with 44 community leaders including government, medical, education, and other community leadership positions in all five counties;- In-person surveys of 72 individuals in low income locations;- In-person discussions with 19 senior citizens;- A web-based survey open to the general public which resulted in 184 completed interviews. This assessment allowed all individuals to provide responses on any community needs not listed in the questions and allowed individuals to make comments on community health issues on which KDH could have an impact. |
| KING'S DAUGHTERS' HEALTH | Part V, Section B, Line 7d: Results of the Needs Assessment have been made available through a variety of sources: Newspaper and Radio Releases, Distribution of information in the Community Newsletter, The Vital Signs, through Public Health Forums. It is also available on our website @www.kdhmadison.org/about-us/community-needs-assessment. |
| KING'S DAUGHTERS' HEALTH | Part V, Section B, Line 11: After review of the community health needs assessment conducted in 2016, a small committee of interested individuals was invited to participate in meetings to determine ways we can work together to better meet the needs of the communities we serve. This small group included participation from the Jefferson County Health Department, our state grant for Tobacco Prevention and our KDH Community Relations participants. Among this group was input from other parties, and an interested Volunteer Medical Student. The needs assessment findings, and the implementation strategy, were shared with the Board of Managers and all action plan items will be incorporated into the working Strategic Plan for the organization.KDH Gaps: There does not appear to be large gaps in the topics or types of community outreach programs that KDH has conducted in the past. However, there may be gaps due to funding levels or staffing levels in the number of programs and the geographic reach of the programs that have been offered. KDH will use the list of major health issues in which KDH is expected to have a leadership and supporting role as well as the list of specific topics suggested to develop programs and apply for grants to improve health in the communities it serves.Implementation Strategy 2013-2016Obesity, Lack of Physical Activity and Smoking leading to Chronic Disease: Several of the top major community health concerns involve addressing the frequently inter-related issues of obesity, lack of physical activity, and smoking. These health issues lead to chronic disease, such as stroke where the death rate in Jefferson County is nearly double the nation's death rate, and have an impact on patients served by KDH facilities. The majority of community leaders expect KDH to take a leadership role in addressing overweight and obesity and tobacco use. Those in outlying counties have asked that KDH programs available in Jefferson County be offered in their own counties or at a minimum that the Jefferson County programs be promoted to citizens in these other counties for their potential attendance. Action Plan: Leadership RoleOffer onsite and community based outreach events to improve patient and community education on prevention and management of chronic diseases. Target: At risk populations based on lifestyle, and those with chronic diseases. Evaluation: Number of events offered, Number of participants. Number of outreach efforts in outlying counties and / or promotion of such efforts.2016 UpdateIn 2016 KDH participated in nine community health fairs and screens where education information about a healthy lifestyle were distributed. Education included tools on exercise, healthy eating, healthy weight loss, and disease prevention including tobacco cessation. The Wellness Coordinator and Tobacco Educator provided a combined 22 speaking engagements to community groups in 2016 with health education messages. In addition the tobacco educator provided outreach services to area businesses, schools, and physician offices. To lower smoking rates, free nicotine replacement products and cessation counseling were also available to community members when requested. The 7-week 2016 KDH Fit Kids program reached 271 students in six area schools. This 5th grade program, which centers on childhood obesity, offers lessons on healthy eating and physical activity. In addition, KDH serves as a Girls on the Run Council. This is a 10-week character-development program that uses the power of running for 3rd-5th grade girls to promote exercise and teach healthy lifestyle concepts. KDH holds a community Girls on the Run 5K event and a community Run the Falls 5K Run/Walk. These two fitness opportunities brought in over 450 participants in 2016. The 2016 Speaking of Women's Health program offered three breakout sessions targeting healthy eating and exercise topics and four of the twelve House of Health events provided education on these health topics. The Strive for Five 5-week weight loss education class was also offered to the community with 18 participants. A new health education program, titled Man Up, was offered in 2016. This men's health event offered free BMI checks, tobacco cessation information, as well as nutrition and weight loss information. The KDH Wellness Coordinator served on the newly formed City of Madison Active Living team and helped to plan a community-wide step challenge titled Madison Moves.Employee Wellness: KDH should consider ways in which it can set an example at its own facilities for the community; an expanded and enforced tobacco-free campus, healthy food offerings in its cafeteria and vending machines, a wellness program which focuses on all employees including those at satellite offices. Action Plan: Leadership RoleImprove opportunities for our own staff to access healthy activities and offerings. Offer insurance-based incentives for a variety of healthy choices. (Ex: Non Smoking Family Plans) Expand and improve healthy eating options in the hospital cafe. Target: KDH Employees. Evaluation: Number of events / options offered, number of employees participating.2016 UpdateThe KDH Employee Wellness program continued in 2016. A free biometric health screen, which includes a financial incentive for achieving set biometric parameters, was offered for all employees. A free skin cancer screen was also available to employees through the Cancer Treatment Center. Staff submitted Healthy Resolution goal sheets for 2016. Employees had the chance to turn in a physical activity log sheet for National Walking Day and a 30-day healthy Beverage nutrition challenge. A Ton of Fun 8-week employee weight loss challenge was also held for staff. An impressive 442 lbs. weight loss was recorded. Employees were encouraged to participate in two community-wide events; Ride your Bike to work day and the Madison Moves step challenge.Stress management information was available to staff through the EAP program and seated chair massage sessions were offered to staff over the holidays. Healthy emails and newsletters were also sent to all employees throughout the year. In addition, tobacco free employees have an opportunity for a reduced health insurance premium and cessation assistance is available for all staff and their family members. KDH supports a tobacco free campus policy for all facilities. The employee cafeteria continues to introduce new healthy food and beverage options for employees in the cafeteria. Vending machines continue to meet heart healthy option standards.Substance Abuse: Substance Abuse - particularly narcotic (primarily heroin), methamphetamine, and prescription drugs, was one of the top major health needs cited by all groups interviewed. It is prevalent in all counties served by KDH. - The lack of substance treatment centers and mental care facilities to refer these types of patients to is a major concern. - Many interviewed felt the public needs to be aware of how much of an issue substance abuse is in the community i.e. amount of babies born addicted to meth/heroin and the detoxification required. - The need for further drug education in the schools from elementary on up was mentioned numerous times - Better communication between KDH and the local legal system is needed. Documentation of overdose cases in the ER with statistics of the types of drugs causing the overdose (street versus prescription) is the type of information helpful to the legal system. KDH physicians mentioned that they would like to know from the legal system when one of the drugs they prescribed is involved in a case. - There is a need for a quarterly prescription drug disposal program where such drugs can be disposed with no questions asked. |
| KING'S DAUGHTERS' HEALTH | Part V, Section B, Line 16j: At the time of registration, the patient is offered a pamphlet regarding the policy, eligibility requirements and the associated application process. The patient must sign a form indicating that he/she received this information. The hospital also has a representative on site to assist patients with the financial aid application process. Patients are reminded to contact customer service regarding financial aid and federal/state assistance directly on the patient bill itself. The hospital's website has a link to the financial aid application. In addition to the actions previously listed, a financial aid counselor will attempt to meet (during normal business hours) with any uninsured inpatient prior to discharge to discuss the Hospital's financial assistance policy. |
| KING'S DAUGHTERS' HEALTH | Part V, Section B, Line 20e: At the time of registration, the patient is offered a pamphlet regarding the policy, eligibility requirements and the associated application process. The patient must sign a form indicating that he/she received this information. The hospital also has a representative on site to assist patients with the financial aid application process. Patients are reminded to contact customer service regarding financial aid and federal/state assistance directly on the patient bill itself. The hospital's website has a link to the financial aid application. In addition to the actions previously listed, a financial aid counselor will attempt to meet (during normal business hours) with any uninsured inpatient prior to discharge to discuss the Hospital's financial assistance policy. |
| Part V, Section B, Line 11 Continued | Action Plan: Supportive RoleContinue to work closely with local Coalitions Against Substance Abuse and the Health Department to implement workable solutions to the above mentioned problems. Develop and assist in implementing a plan of action. Also, continue to intervene with pregnant women during pregnancy and delivery. Target: CASA in Jefferson County and SCAT in Switzerland County. Work with the Health Department to get physicians and law enforcement in the same room to develop an action plan. Evaluation: Number of meetings attended / number of action plans developed with these organizations. Number of documented substance abuse cases on OB/GYN.2016 UpdateKDH stayed involved with the local LCC agencies in 2016 (Jefferson County -County Coalitions Against Substance Abuse (CASA), and Switzerland County Switzerland County Awareness Team (SCAT)). The KDH grant-funded Tobacco Educator served as the CASA Coordinator in 2016 to increase involvement in community substance abuse activities. The OB offices address the problem with their prenatal care. Mothers are being tested at their first prenatal visit and sign a contract and are offered substance abuse education and referrals. If drug exposure is identified, mothers are still being referred to the Norton Inpatient Detox Program. When drug exposed babies are born at KDH, many stay for an extended period of time on Morphine. In support, the KDH Foundation purchased several mamaRoos units that were in use in 2016. These special infant seats, used in Obstetrics, are designed to sooth babies born with narcotic addictions. KDH continues to work closely with DCS and other community agencies for mother/child referrals. Supportive Numbers previously reported for ER Admissions for Drug Abuse/ Drug Dependency/ Drug Overdose and Neonatal Abstinence Syndrome Births: Unfortunately some of these numbers are no longer trackable due to changes in ICD9 to ICD10 coding. We are working on ways to capture this information in the future. We can report that 19% of babies born at KDH in 2016 were reported as drug addicted.Mental Health Issues:While KDH may not be expected to take a leadership role in addressing mental health issues, it cannot ignore the need for mental health services in all the counties it serves. Many interviewed mentioned the need for expanding TeleMed as a mental health resource, recruiting an on-staff psychiatrist or an improved referral program for those with mental illness. KDH leaders interviewed stressed the hours of staff time that is currently spent finding facilities to refer patients to with open beds. This issue is worth further study by KDH to determine what supporting role it can provide to the community in this area. Action Plan: Supportive RoleKDH will continue to explore ways to collaborate with local agencies to improve access to mental health resources. Improvement in other risk factor areas, such as lack of physical activity will affect mental health as well as other risk factors. Target: KDH Patients in need of mental health services. Evaluation: Number of referrals for mental health Services/Number of providers KDH is able to access.2016 UpdateIn the year 2016, KDH made a total of 105 mental health referrals. It should be noted that the referral count for 2015 should have read 160 not 1604. We admit an error for the 2015 update. The quality and resource management team states that the drop in referrals from 2014-2015 is due to the increase use of the teleassessment system. This tele-assessment system was in use for the duration of 2016 and is managed from the Emergency Room. In addition to the 105 referrals, an additional 12 referrals for mental health services were made specifically from the Pediatric social worker for Pediatric patients. KDH uses 30 behavioral health and 3 detox providers for referrals.Transportation: The lack of transportation was cited numerous times as a health issue particularly for those of lower income. Catch-a-Ride and Medi-cab are well utilized in the KDH service area, but they do not operate after 5 p.m. nor do they run on weekends. For some, the fee associated for the service is cost-prohibitive. KDH may want to consider offering alternative transportation and/or explore offering preventative health screenings such as blood pressure, glucose etc. at events where those of lower income may gather such as the Salvation Army End of the Month Meal, the distribution at the House of Hope Food Pantry, etc. Action Plan: Supportive RoleDevelop a series of classes and screens to be offered in low income areas. To take services to those in need, who are unable to come to KDH. Target: Low income populations as identified through the House of Hope and / or the Salvation Army. Evaluation: Number of classes and screens held / Number of individuals participating.2016 UpdateThe House of Health program continued during the 2016 year. This program, held at the Jefferson County Clearinghouse House of Hope food pantry, targets a low-income population and offers free screens and health information at a convenient location which eliminates transportation concerns for attendees. Attendance ranged from 35-80 participants each month.Awareness of Services and Programs: Some individuals also expressed the idea that residents in the community served by KDH may not be aware of the existing programs and services offered and may not be aware of the level of expertise of the staff. These are ideas that could be addressed in a strategic, well-planned, long-term public relations campaign. Action Plan: Leadership RoleDevelop and implement a public relations campaign to let people know of services and outreach through KDH. Target: Individuals in the KDH Primary Market. Evaluation: Number of promotional pieces and marketing activities geared toward the community to improve knowledge and education of outreach screens / classes / programs.2016 UpdateOrthopedic / Joint Replacement Campaigns - Now in its third year, the 2016 Orthopedic Campaign featured testimonial advertisements and posters distributed and posted throughout our primary and secondary services areas. Print ads were placed in Madison, Versailles, Vevay, Carrollton, Trimble County, Scott County (Scottsburg), and into portions of northeastern Clark County. The campaign also included radio spots featuring providers - running on WORX, WIKI (local), as well as WKID (Vevay) and WMPI (Scottsburg). We also completed several new videos featuring our providers discussing various orthopedic issues, including joint replacement, sports medicine, and pediatric care. These were posted on our website and social media outlets during the year. In October, we held a free Joint Replacement screening in Versailles. As noted below (SEO), our campaign to include paid searches through Google has resulted in significant leads into our Joint Replacement and Orthopedic programs.New Providers / Physicians - New provider campaigns included Dr. Russell Gornichec (General Surgery), Dr. Thomas Barley (Internal Medicine - Hanover), Dr. Rick Chamberlain (Family Medicine - Versailles), Natalie Hill, APN (OB/GYN), Susan Berns, APN (Pediatrics), Hannah Lair, APN (Family Practice).Continuation of SEO- Since we began working with Link Media 360 in March of 2015, we've seen significant growth in our Search Engine Optimization (SEO) efforts. In May 2016, we also introduced our first Pay-Per-Click campaign with Orthopedics. We began competing for keywords and ad-words used by people in our service area to improve our listings and likelihood of people linking to our services via Google searches. We saw immediate returns and continue to receive 15-20 leads per month through this campaign. Overall, our SEO continues to benefit both organic and paid search results.Promotion of Screenings/Events - These included our Lung Cancer Screening and, RUN the FALLS 5K, Direct Access Testing, Speaking of Women's Health, Health Insurance Exchange programs/navigators (Business Office for Insurance set up), Doctor's Day, Joint Replacement, participation in House of Health, along with various health and wellness speaking engagements.MyKDH Portal - Through both internal and external channels, we continue to build our network of participation in the My KDH Patient. IT staff, Registration Staff, etc. have worked with patients to enroll them when they're here for testing, treatment, or a hospital stay. We also continue to promote the value of secure messaging and appointment request options through the Portal. |
| PART V, SECTION B, LINE 11 CONTINUED | Cancer Treatment Center - Promotion of quality related to being named a Gold Standard facility "Outstanding Achievement Award" by the American College of Surgeons (2015). Our focus continued to be the delivery of high quality cancer services close to home. This recognition/ achievement was marketed through print (newspaper, magazine) and radio media during the year.Foundation - In 2016, the KDH Foundation hosted its annual Golf Benefit (June) and Gala (November). Combined, these events raised over $60,000 for the KDH Foundation, which supports the mission of the hospital. We are working to improve the visibility of the Foundation by using its name and logo whenever the Foundation is involved with support of an event or program. Further, the Foundation is featured every year (quick report) in the Vital Signs Magazine that is sent to round 21,000 households in our service area.Vital Signs Magazine - This eight-page, full color magazine is distributed quarterly in the months of March, June, September, and December. The magazine provides health information, wellness ideas, a healthy recipe, along with promotion of KDH services through personal stories, physician input, and details about programs and events.News Releases - Girls on the Run Registration, Art of Healing Receptions, Health Insurance Enrollment, HIP 2.0 Information, Colon Cancer Kits/Awareness Month, Quit Line and Tobacco Cessation programs, Dr. Russell Gornichec, Medical Explorers, Natalie Hill, APN, Susan Berns, APN, Dr. Thomas Barley, RUN the FALLS 5K,), House of Health Events, Be Strong Exercise Classes, Outstanding Achievement Award - Cancer Center, Hanna Lair, APN, Lung Cancer Screening Program.MEDICAL SERVICES AND PROVIDERS:GAPS IN THE CURRENT MEDICAL SERVICE LINES AND THE MEDICAL SPECIALTIES DESIRED ARE WORTH EXPLORING. ACTION PLAN: LEADERSHIP ROLECONTINUE TO IDENTIFY AREAS WHERE MEDICAL SERVICES ARE LACKING, AND TO RECRUIT MEDICAL PROVIDERS TO MEET THE NEEDS OF THE COMMUNITY. TARGET: PRIMARY SERVICE AREA. EVALUATION: NUMBER OF PROVIDERS (PRIMARY AND SECONDARY) PLACED IN PRACTICES IN OUR PRIMARY SERVICE AREA. 2016 UPDATETHE FOLLOWING SERVicES / PROVIDERS WERE ADDED IN 2016 TO SERVE OUR AREA: Dr. Russell Gornichec, General Surgery Hannah Lair, APN, Family Medicine Natalie Hill, APN, OB/GYN Susan Berns, APN, Pediatrics Dr. Thomas Barely, Internal Medicine Dr. Rick Chamberlain, Family Medicine Heath Perkins, CRNA, Anesthesia Dr. John Brumfield, Anesthesia |
| Part V, Section B, Line 16i | The Hospital evaluated the size of the limited English proficiency populations of the community. No group contained 1,000 individuals or represented at least 5 percent of the community served. Therefore, no translations of the FAP, FAP application form or plain language summary of the FAP were required. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 9 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (9 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| 1 - REHABILITATION CENTER AND HOME CARE | ||||
| 2670 N MICHIGAN ROAD | MADison | IN | 47250 | outpatient rehabilitation center and home care services |
| 2 - CLIFTY DR MED OFFICE BLDG & CONV CARE | ||||
| 445 Clifty Drive | Madison | IN | 47250 | PHYSICIAN MEDICAL OFFICE & CONVENIENT CARE CENTER |
| 3 - VERSAILLES MEDICAL OFFICE BLDG-MAIN ST | ||||
| 128 North Main Street | Versailles | IN | 47042 | Physician Medical Office |
| 4 - VERSAILLES MEDICAL OFFICE BLDG-TYSON ST | ||||
| 206 W Tyson Street | Versailles | IN | 47042 | Physician Medical Office |
| 5 - TRIMBLE COUNTY MEDICAL OFFICE BLDG | ||||
| 10235 US Highway 421 | Milton | KY | 40045 | physician Medical Office |
| 6 - CARROLLTON MEDICAL OFFICE BLDG | ||||
| 205 Marwill Drive | Carrollton | KY | 41008 | Physician Medical Office |
| 7 - SWITZERLAND CNTY MEDICAL OFFICE BLDG | ||||
| 1190 West Main Street | Vevay | IN | 47043 | Physician Medical Office |
| 8 - HANOVER MEDICAL OFFICE BLDG | ||||
| 36 Medical Plaza | Hanover | IN | 47243 | Physician Medical Office |
| 10 - DOWNTOWN MEDICAL OFFICE BLDG | ||||
| 630 North Broadway | Madison | IN | 47250 | physician Medical Office and hospital staff |
Supplemental Information Detail SupplementalInformationDetail (12 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part II, Community Building Activities: | Community Building Activities promoted the health of the community in the following ways:- Promoting healthcare careers to potential "future employees" through Job Fairs at the local community college- Assisting community members with Medicaid program enrollment via a formal Medicaid Enrollment Assistance Program offered by the Hospital. This program helps community members enroll to receive all types of Medicaid assistance (food, healthcare, etc.) |
| Part III, Line 2: | As reported on the attached financial statements, page 4, "Consolidated Statements of Operations Years Ended December 31, 2016 and 2015". |
| Part III, Line 3: | The hospital has a detailed Financial Assistance Policy which states that to participate in charity care candidates must cooperate fully. In addition the hospital educates patients with limited ability to pay regarding financial assistance. For this reason the organization believes that it accurately captures all charity care deductions provided according to the financial assistance policy and the amount of bad debt expense attributable to patients eligible under the organization's charity care policy is negligible. |
| Part III, Line 4: | See pages 8-10 on the attached financial statements. |
| Part III, Line 9b: | All uninsured patients received an automatic 30% discount from gross charges. At registration, patients are notified of the Hospital's financial assistance program. They are offered pamphlets detailing the program. If the patient is known to qualify for financial assistance and is approved for financial assistance, the patient will receive a discount of 100% on the outstanding account balance. The Hospital will attempt to collect any balance remaining on the uninsured account after all financial assistance discounts have been applied using a series of statements, letters, and telephone calls. The Hospital will also offer patients interestfree extended payment plans. If the account remains unpaid, the account may be turned over to a collection agency. |
| Part VI, Line 2: | The Hospital conducted a needs assessment in 2013 whose implementation strategy was adopted in January 2014. The Hospital conducted a needs assessment in 2016 whose implementation strategy was adopted in April 2017. This adoption date met IRS filing requirements which state "specifically requiring an authorized body of the hospital facility to adopt an implementation strategy to meet the health needs identified through a CHNA on or before the 15th day of the fifth month after the end of the taxable year in which the hospital facility finishes conducting the CHNA."- THE FOCUS OF THIS ASSESSMENT WAS ON THE HEALTH NEEDS THAT COULD BE ADDRESSED BY KDH AND CAN BE USED BY KDH IN PLANNING FUTURE SERVICES, APPLYING FOR GRANTS AND PLANNING OUTREACH EFFORTS.- THE STUDY INCLUDED THE FOLLOWING COMPONENTS:- ANALYSIS OF SECONDARY DATA TO DEVELOP A PROFILE OF THE RESIDENTS OF EACH COUNTY AND TO INDICATE, WHERE POSSIBLE FUTURE TRENDS AND TO SHOW COMPARISONS WITH STATE AND NATIONAL DATA;- IN-PERSON INTERVIEWS WITH 30 KEY LEADERS WITHIN KDH INCLUDING BOARD, STAFF AND MEDICAL STAFF;- IN-DEPTH-INTERVIEWS BY TELEPHONE OR IN-PERSON WITH 44 COMMUNITY LEADERS INCLUDING GOVERNMENT, MEDICAL, EDUCATION, AND OTHER COMMUNITY LEADERSHIP POSITIONS IN ALL FIVE COUNTIES;- IN-PERSON SURVEYS OF 72 INDIVIDUALS IN LOW INCOME LOCATIONS;- IN-PERSON DISCUSSIONS WITH 19 SENIOR CITIZENS;- A WEB-BASED SURVEY WAS OPEN TO THE GENERAL PUBLIC WHICH RESULTED IN 184 COMPLETED INTERVIEWS.- THIS ASSESSMENT ALLOWED ALL INDIVIDUALS TO PROVIDE RESPONSES ON ANY COMMUNITY NEEDS NOT LISTED IN THE QUESTIONS AND ALLOWED INDIVIDUALS TO MAKE COMMENTS ON COMMUNITY HEALTH ISSUES ON WHICH KDH COULD HAVE AN IMPACT.- KEY HEALTH ISSUES EXPLORED WERE THE FOLLOWING:- PHYSICAL ACTIVITY- OVERWEIGHT AND OBESITY- TOBACCO USE- SUBSTANCE ABUSE/GAMBLING/ADDICTIONS- RESPONSIBLE SEXUAL BEHAVIOR- MENTAL HEALTH- INJURY AND VIOLENCE (INCLUDING DOMESTIC VIOLENCE AND SEXUAL ASSAULT)- ENVIRONMENTAL QUALITY- IMMUNIZATION- ACCESS TO HEALTH CARE FOR THE INSURED AND UNINSURED- MATERNAL AND CHILD HEALTH- INFECTIOUS DISEASE- OCCUPATIONAL AND SAFETY HEALTH- SPECIAL NEEDS/DISABLED/IMPAIRED- CHRONIC DISEASERESULTS OF THE NEEDS ASSESSMENT HAVE BEEN MADE AVAILABLE THROUGH A VARIETY OF SOURCES:NEWSPAPER AND RADIO RELEASES, DISTRIBUTION OF INFORMATION IN THE COMMUNITY NEWSLETTER, VITAL SIGNS, AND IS ALSO AVAILABLE ON OUR WEB SITE. |
| Part VI, Line 3: | -At the time of registration, the Hospital's Financial Assistance Policy is discussed with each patient. The patient is offered a pamphlet regarding the policy, eligibility requirements and the associated application process. The patient must sign a form indicating that they received this information.-The Hospital has a representative on site to assist patients with the financial aid application process.-Patients are reminded to contact customer service regarding financial aid and federal/state assistance directly on the patient bill itself.-The Hospital's website has a link to the financial aid application. |
| Part VI, Line 4: | Jefferson County- Jefferson County is experiencing a slow growth in total population, currently at 32,554. By 2020, the population is expected to be about 38,811. It has a median age of 37.1, nearly identical to the state average of 37.0. The unemployment rate of 8.4% is slightly above the Indiana rate of 8.2%.- The population is fairly homogeneous with a largely Caucasian population, 96%.- The median average household income, of $40,386, is lower than that for Indiana and the nation. In Jefferson County, about 14.3% of the individuals, or about 4,326, live below the poverty level, below the 15.8% poverty rate of individuals in Indiana and the 15.9% rate for the entire U.S.- 35% of all families in Jefferson County are single parent families with 28.3% of these families in poverty. In Indiana, 32.9% of all families are single parent families with 27.4% of these families in poverty.- Jefferson County ranks first in Indiana in terms of the number of acres devoted to tobacco with tobacco crop sales of $1.6 million in 2007. 28% of adults in Jefferson County use tobacco compared to 24% of adults living in the state of Indiana.- According to the Indiana State Department of Health 2012 report, Jefferson County was not listed as a county that had a shortage of healthcare professionals or of mental health professionals. However, the 2012 report lists Milton, Shelby and Smyrna townships as medically underserved.- The rate of all cancer incidence is higher in Jefferson County, at 502 for 100,000 population, than for Indiana, at 476 for 100,000 population. The rate of lung cancer is higher in Jefferson, at 96 per 100,000 population than for Indiana at 80 per 100,000. The rate of prostate cancer is higher in Jefferson, at 152 per 100,000 population than for Indiana at 136 per 100,000. The rate of breast cancer in Jefferson is slightly lower, at 115 per 100,000 population than for Indiana at 116 per 100,000 population. The rate of colorectal cancer is lower in Jefferson, at 48 per 100,000, than the rate for Indiana, at 51 per 100,000.- The rate of adult asthma in Jefferson County, at 7.3%, is slightly higher than the rate for Indiana, at 7.2%, as is the rate of chronic bronchitis (3.4% for Jefferson; 3.3% for Indiana) and for emphysema (1.6% for Jefferson; 1.4% for Indiana.)- The percent of mothers who smoked during pregnancy in Jefferson County is 25.8% significantly higher than the state of Indiana average of 17.1%. In 2010, the percent of lowweight births for Jefferson County was 9.6%, above the 8.0% for Indiana.- The number of teen pregnancies among women 15 to 19 years old has slightly decreased in Jefferson County from 2007 to the most recent measurement in 2010. In Jefferson County, there were 46 teen pregnancies in 2007 and 44 teen pregnancies in 2010. In Indiana, a significant decrease took place - there were 11,683 teen pregnancies in 2007 and 8,654 in 2010.- Jefferson County reported 97 newly diagnosed cases of Chlamydia in 2011, an increase from the 82 reported in 2009. There were 12 cases of gonorrhea in 2011 and increase from the less than five reported in Jefferson County in 2009.- The most recent information from the Indiana Family and Social Service Administration in 2008 shows 1,324 adults in Jefferson County with serious mental illness and 247 seriously emotionally disturbed children.- The rate of deaths related to major cardio vascular diseases in Jefferson County increased from 2008 - 249.8 per 100,000 population to 2010 - 372.1 per 100,000 population. The opposite trend occurred in Indiana with 214.3 per 100,000 deaths recorded in 2008 falling to 206.5 per 100,000 in 2010.- The stroke death rate in Jefferson, at 79.4 per 100,000 population in 2010, was significantly higher than the 47.5 per 100,000 population for Indiana and the 41.9 per 100,000 for the nation.- The incidence of cancer rate (all sites) was higher in Jefferson County - 502 per 100,000 population compared to Indiana's rate of 476 per 100,000. Ripley County- Ripley County has a current population of 28,583. There is a net outward migration. By the year 2020, the population will be about 30,754.- The population is 97.8% Caucasian.- The median household income in Ripley is $47,900 - lower than the national average of $50,502, but higher than the Indiana average of $46,438.- The percent of families below poverty in Ripley is 15.4%, lower than the Indiana average of 20.6% and the national average of 20.8%.- 29.8% of all families in Ripley County are single parent families with 27% of these families in poverty. In Indiana, 32.9% of all families are single parent families with 27.4% of these families in poverty.- The percent of mothers in Ripley County who smoke during pregnancy is 22.8%, compared to 17.1% in Indiana. The percent of low birth weight in Ripley County is 7%, compared to 8% in Indiana.- The most recent information from the Indiana Family and Social Service Administration in 2008 shows 1,071 adults in Ripley County with serious mental illness and 250 seriously emotionally disturbed children.- Ripley County does not have a shortage of health care professionals. The townships of Delaware, Center and Brown are considered medically underserved. Ripley has a shortage of mental health professionals.- The rate of individuals with prostate cancer in Ripley was 146 per 100,000 populations compared to 136 for Indiana in 2008.- The death rate from major cardiovascular disease was 246.6 per 100,000 population for Ripley County in 2010. This is higher than Indiana's 206.5 and the nation's 193.6 per 100,000 during the same period.- The incidence of cancer rate (all sites) was higher in Ripley County - 518 per 100,000 population compared to Indiana's rate of 476 per 100,000. Switzerland County- Switzerland County has a population of 10,424 and has a slow growth rate of 0.5 which mirrors that for Indiana. There is a net migration into the county. By 2020, the population will be 11,950.- The ethnicity is 98.1% white.- The unemployment rate is 6.9% in Switzerland County, lower than the Indiana rate of 8.4%.- The median household income is $42,285, compared to $46,438 for Indiana and $50,502 for the nation. In Switzerland, 28% of the families are below the poverty level, compared to 20.6% of Indiana families, and 20.8% of families in the nation. 29.4% of the children in Switzerland County are below the poverty level.- In 2010, 22.5% of all adults age 25+ had less than a high school diploma.- The teen birth rate for Switzerland County in 2009 was 37.8 per 1,000 females age 15-17. This is significantly higher than the rate for Indiana of 20.8 per 1,000.- The rate of mothers smoking during pregnancy is 27.3% in Switzerland County, compared to 17.1% in Indiana. In Switzerland, there is a 6.8% low birth weight, compared to 8.0% in Indiana.- Switzerland County has a shortage of health care professionals. All areas of Switzerland County are considered medically underserved. Switzerland County also has a shortage of mental health professionals.- The rate of chronic bronchitis in Switzerland County and in Indiana is 3.0%. The rate of emphysema in Switzerland is 1.5%, slightly higher than the Indiana rate of 1.4%.- There are 379 adults with serious mental illness in Switzerland County and 78 seriously emotionally disturbed children.- The death rate from major cardiovascular disease was 347.0 per 100,000 population for Switzerland County in 2010. This is significantly higher than Indiana's 206.5 and the nation's 193.6 per 100,000 during the same period.- The incidence of cancer rate (all sites) was higher in Switzerland County - 562 per 100,000 population compared to Indiana's rate of 476 per 100,000. The only type of cancer in which Switzerland County recorded an incidence rate lower than Indiana was Breast Cancer - Switzerland County 82 per 100,000 versus Indiana's 116 per 100,000 population. Carroll County, Kentucky- Carroll County Kentucky currently has a population of 11,013 with a total of 4,195 households. The population is projected to be about 11,440 by 2020.- The population is 95.1% Caucasian.- The average median household income in 2011 was $40,685 - lower than the $41,141 for Kentucky and lower than the $50,512 for the nation.- The average percent of mothers who smoke during pregnancy for Carroll County is 30%, compared to 24% for Kentucky.- As far as smoking prevalence is concerned, 30% of the adults in Carroll smoke, compared to 29% of Kentucky and 21% of the nation. The percent of high school students in Carroll who smoke is 31%, compared to 25% for Kentucky and 19% for the nation.- Carroll County Kentucky has 25% of the population obese, compared to 29% of Kentucky and 24% of the nation.- In Carroll, 43% of the population lack physical activity, compared to 32% in Kentucky and 24% in the nation. |
| Part VI, Line 5: | The majority of King's Daughters' Health Board of Managers is comprised of individuals who live and work in the Hospital services area. The majority of these individuals are neither employees, nor contractors of the organization, nor family members thereof. The Hospital extends medical staff privileges to all qualified physicians in its community for some or all of its departments. The organization also applies a portion of surplus funds to improvements in patient care. Historically, KDH has employed a full time Community Wellness Coordinator. This position provides outreach services in areas of need to the Communities we serve. In addition to these services, KDH also serves as the fiscal agent for several state and federal grants. All of these services help us meet the identified needs of the communities we serve.Participation in the below community organizations is part of the Hospital's Indiana State Department of Health Community Benefit Plan and Goals.2016 KING'S DAUGHTERS' HEALTH OVERVIEW OF COMMUNITY BENEFIT ACTIVITIES1. HEALTH SCREENS: A. CORPORATE HEALTH SCREENS / FAIRS Clifty Engineering Screen: 15 Belterra Health Fair participation (no screenings provided) Ivy Tech Health fair participation B. COLON CANCER SCREENING KITS: 34 returns. C. CORPORATE FLU SHOTS: (122 total) AGS Law Office: 12 110 sold to IVY Tech for selfadministration2. COMMUNITY HEALTH FAIRS: (Participated by offering a booth with health education) A. RIPLEY COUNTY 4H FAIR B. JEFFERSON COUNTY 4H FAIR C. REMC HEALTH FAIR IN VERSAILLES D. River terrace community senior citizens health fair E. CELEBRATE SOUTHWESTERN COMMUNITY FAIR, HANOVER F. STAND DOWN VETERANS COMMUNITY FAIR 3. COMMUNITY EDUCATION OPPORTUNITIES/CLASSES/SPECIAL EVENTS: A. SPEAKERS BUREAU: Wellness: 12 speaking engagements Tobacco: 15 speaking engagements B. FIT KIDS PROGRAM (7 week program for area 5th grade classrooms) 6 Schools / 11 Classrooms / 272 Kids + teachers C. TOBACCO CESSATION & EDUCATION: Provided outreach to: 14 School Visits 30 KDH Physician Offices D. CPR AND FIRST AID CLASSES: Community classes held with 633 graduates School-based classes held with 36 students participating E. Strive for 5 Program: Community 5-week weight loss education program Two classes held in 2016, 18 total participants F. PRENATAL EDUCATION: OB Prep Program - 408 people served Prepared Childcare Essential classes - 32 people served Sibling classes - 3 people served G. GIRLS ON THE RUN Fall Season: 81 girls / 6 sites / 25 trained coaches / 10 week program Fall 5K: 203 participants and 52 volunteers H. HOUSE OF HEALTH: Monthly education opportunity provided at the House of Hope food pantry. Approximately 25-70 people attend each month. 10 Topics for 2016 include: Health insurance, safe medication disposal, heart health, car seat safety, sun safety, cholesterol, healthy kids, dealing with emergencies, food safety, tobacco. I. SPEAKING OF WOMEN'S HEALTH 277 women in attendance. KDH provided: Steering committee support Financial sponsorship and in-kind support Free cholesterol testing for all participants 66% of all breakout sessions speakers were in-kind KDH staff Gift for participant gift bag J. Man UP, Men's health event New event for 2016. Free health screenings and health education opportunity for all participants. 76 total participants. K. Monthly "to your health" radio show 30 minute health education program with various topics offered each month. L. Women's safety and self-defense workshop Free workshop offered to women. 30 total participants. M. Rising Leaders Partnerships with local schools. This event hosted apx. 100 students in 9th & 10th grade for a leadership day. Students could apply for "seed funding" for start-up projects to "pay it forward and implement a project locally, nationally, or internationally. 4. EMPLOYEE HEALTH OPPORTUNITIES FOR KDH STAFF: Wellness newsletters (on-line and paper versions available) Wellness Column in the monthly Monitor newsletter Wellness Calendar distribution to all staff Employee skin cancer screen held Employee Health Screen available for all staff with Insurance Premium Reduction Incentive Program available for employees with health insurance. Participation in bike to work day Seated chair massage sessions 2016 goal sheets with incentive offered 4 Wellness Challenges: Beverage Bingo 30-day AHA exercise campaign Ton of fun weight loss contest Participation in community-wide Madison Moves challenge5. COMMUNITY SERVICE ACTIVITIES: A. SUPPORT GROUPS: Women and Cancer Support Group B. ACTIVE ATTENDANCE AND PARTICIPATION IN: CASA (Coalition Against Substance Abuse, Jefferson County) The group was renamed JC-JTP in 2016-Jefferson County Justice, Treatment, Prevention. SCAT (Switzerland County Awareness Team) TPCC and Jefferson County Tobacco Coalition (State & Local tobacco efforts) Active Living Committee/City of Madison Bike & Pedestrian Master Plan Committee Envision Jefferson County Madison Consolidated Schools Wellness Policy COmmittee MASHER (area corporate health and safety group) C. KDH RUN THE FALLS 5K WALK/RUN HELD AT CLIFTY FALLS STATE PARK 217 People participated D. EMS STANDBY AT ALL COMMUNITY ACTIVITIES: EMS provides standby coverage at all Jefferson County activities. E. SUPPORT TO VARIOUS AREA SCHOOLS WITH INTERNSHIPS: Support many Local and area High Schools and Colleges with Internships and Job Shadow experiences: Includes Nursing and Medical Students among others.6. SUCCESSFUL GRANT ACTIVITY: A. TPCC: TOBACCO PREVENTION AND CESSATION COMMISsION: Funding to hire full time coordinator, starting in 2009, continues for Jefferson Co. B. CASA / SCAT GRANTS: To fund Nicotine Replacement Therapy for individuals wishing to quit tobacco. |
| Part VI, Line 6: | NA |
| Part VI, Line 7, Reports Filed With States | IN |
| Part VI, Line 4 continued | Carroll County, Kentucky (continued)- The unemployment rate in Carroll County is 9.6%, higher than both Kentucky's 8.2% and the nation's 8.1%.- The death rate from heart disease in Carroll County is 299.8 per 100,000 compared to 205.6 per 100,000 for Kentucky and 173.7 per 100,000 for the nation.- The death rate per 100,000 due to Chronic Respiratory Disease in 2011 was 112.1 for Carroll County compared to 63.1 per 100,000 for Kentucky and 42.7 per 100,000 for the nation.- In 2011, Carroll County had nearly two and half times the number of Drug Arrests per 100,000 in comparison to Kentucky: 2,162 versus 870. Trimble County, Kentucky- Trimble County, Kentucky, has a population of 8,725 and a declining growth rate of -1.0 per 1,000 population, compared to 0.6% increased growth for Kentucky. By 2020, the population will be 9,514.- The population is 97.2% white.- The average median household income in Trimble County is $44,141 compared to $43,677 in Kentucky and $50,502 in the nation. The unemployment rate is 8.2%, compared to 8.2% for Kentucky and 8.1% for the nation.- The rate of smoking during pregnancy in Trimble County is 44%, compared to 24% in Kentucky. The low birth weight rate in Trimble County is 6% which is below Kentucky's 9%.- In Trimble County, 30% of adults smoke, which is higher than the 29% for Kentucky and the 19% for the nation. In Trimble County, 25% of high school students smoke, the same as in Kentucky, but higher than the 23% in the nation.- In Trimble County, 29% of the adults are obese, the same as for Kentucky, but higher than the 24% for the nation. In Trimble, 14% lack physical activity, compared to 32% in Kentucky and 24% in the nation.- In Trimble County, there is an 9% rate of adult diabetes, compared to 8% in Kentucky and 10% for the nation. The death rate per 100,000 due to diabetes was 55.4 for Trimble County, compared to 28.0 for Kentucky and 25.3 for the nation.- Deaths due to Breast Cancer were 15 per 100,000 for Trimble County compared to 14 per 100,000 for Kentucky. Deaths due to Prostate Cancer were 23 per 100,000 for Trimble County and 18 per 100,000 for Kentucky. |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (1) | GrantRecordsMaintainedInd |
Recipient Table RecipientTable
Recipient Business Name RecipientBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | The King's Daughters' Hospital Foundation Inc | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1373 East State Road Po box 447 | AddressLine1Txt |
| City | Madison | CityNm |
| State Abbreviation | IN | StateAbbreviationCd |
| ZIP | 47250 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Recipient EIN | 202148950 | RecipientEIN |
| IRC Section | 501(c)(3) | IRCSectionDesc |
| Cash Grant | $100,000 | CashGrantAmt |
| Purpose Of Grant | Donation | PurposeOfGrantTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 1 | Total501c3OrgCnt |
| Total Other Org | 0 | TotalOtherOrgCnt |
Grants Other Asst To Indiv In US GrantsOtherAsstToIndivInUSGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Type | Medical Supplies | GrantTypeTxt |
| Non Cash Assistance | $13,084 | NonCashAssistanceAmt |
| Valuation Method Used | FMV | ValuationMethodUsedDesc |
| Non Cash Assistance | Various Medical Supplies | NonCashAssistanceDesc |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part I, Line 2: | FormAndLineReferenceDesc |
| Explanation | Funds are not granted to organizations but are donated. Donations are determined on a discretionary basis. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Independent Consultant | Yes (X) | IndependentConsultantInd |
| Written Employment Contract | Yes (X) | WrittenEmploymentContractInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | Yes (1) | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (11 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| JONATHAN HANSON MD | ||||||||||||||
| BOARD MEMBER/PHYSIcian | $380,678 | $0 | $74,129 | $0 | -$94,832 | $0 | $13,250 | $0 | $27,924 | $0 | $401,149 | $0 | $0 | $0 |
| PAT STACK MD | ||||||||||||||
| Board Member/Physician | $144,597 | $0 | $72,739 | $0 | $1,584 | $0 | $11,142 | $0 | $11,659 | $0 | $241,721 | $0 | $0 | $0 |
| CAROL DOZIER | ||||||||||||||
| PRESIDENT/CEO | $365,086 | $0 | $0 | $0 | -$9,464 | $0 | $13,250 | $0 | $1,363 | $0 | $370,235 | $0 | $0 | $0 |
| Lisa Morgan | ||||||||||||||
| VP outPatient Services | $152,272 | $0 | $0 | $0 | $552 | $0 | $25,833 | $0 | $24,661 | $0 | $203,318 | $0 | $0 | $0 |
| Denine Fallis-Hallgarth | ||||||||||||||
| VP Physician Practices | $135,415 | $0 | $0 | $0 | $552 | $0 | $24,990 | $0 | $11,745 | $0 | $172,702 | $0 | $0 | $0 |
| HOLLY ROBINSON MD | ||||||||||||||
| VP QUALITY / Physician | $217,906 | $0 | $52,039 | $0 | $360 | $0 | $22,250 | $0 | $24,366 | $0 | $316,921 | $0 | $0 | $0 |
| Thomas Eckert MD | ||||||||||||||
| Employed Physician | $424,434 | $0 | $330,067 | $0 | $1,584 | $0 | $13,250 | $0 | $17,662 | $0 | $786,997 | $0 | $0 | $0 |
| Travis Clegg MD | ||||||||||||||
| Employed Physician | $577,646 | $0 | $1,331,039 | $0 | -$199,784 | $0 | $13,250 | $0 | $28,219 | $0 | $1,750,370 | $0 | $0 | $0 |
| Amy Gifalid MD | ||||||||||||||
| Employed Physician | $723,413 | $0 | $0 | $0 | $237,542 | $0 | $968 | $0 | $0 | $0 | $961,923 | $0 | $0 | $0 |
| Michael Schmidt MD | ||||||||||||||
| Employed Physician | $446,630 | $0 | $215,138 | $0 | $360 | $0 | $13,250 | $0 | $28,602 | $0 | $703,980 | $0 | $0 | $0 |
| Ronald Auer MD | ||||||||||||||
| EMployed Physician | $540,131 | $0 | $85,146 | $0 | $69,128 | $0 | $13,250 | $0 | $28,842 | $0 | $736,497 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part I, Line 7 | Physicians are eligible for incentive compensation. The physician is compensated for each work RVU performed by a physician in a calendar year in excess of the physician's work RVU incentive threshold for the calendar year multiplied by the Incentive RVU payment. Non-physician bonus compensation is discretionary, solely up to the board of managers, and the calculation for said bonus compensation varies from year to year. |
| ADDITIONAL SCHEDULE J DISCLOSURES | Board members Pat Stack, MD and Jonathan Hanson, MD listed above are employed physicians of the Hospital. Dr. Stack and Dr. Hanson do not receive compensation for services provided as board members. The compensation listed above for Dr. Stack and Dr. Hanson is compensation received for services provided as employed physicians. |
Schedule K IRS990ScheduleK
Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
Issuer Name IssuerName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Indiana Finance Authority | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Issuer EIN | 351602316 | BondIssuerEIN |
| CUSIP | 45471ACW0 | CUSIPNum |
| Bond Issued | 2010-11-03 | BondIssuedDt |
| Issue Price | $97,847,058 | IssuePriceAmt |
| Purpose | See Part VI | PurposeDesc |
| Defeased | 0 | DefeasedInd |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuerInd |
| Pool Financing | 0 | PoolFinancingInd |
Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Total Proceeds | $97,847,058 | TotalProceedsAmt |
| In Reserve Fund | $6,756,861 | InReserveFundAmt |
| Issuance Costs From Proceeds | $1,749,243 | IssuanceCostsFromProceedsAmt |
| Capital Expenditures | $88,974,097 | CapitalExpendituresAmt |
| Other Spent Proceeds | $366,857 | OtherSpentProceedsAmt |
| Substantial Completion | 2013 | SubstantialCompletionYr |
| Current Refunding | 0 | CurrentRefundingInd |
| Advance Refunding | 0 | AdvanceRefundingInd |
| Final Allocation Made | Yes (1) | FinalAllocationMadeInd |
| Adequate Books And Rec Maint | Yes (1) | AdequateBooksAndRecMaintInd |
Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Owning Bond Financed Property | 0 | OwningBondFinancedPropertyInd |
| Any Lease Arrangements | Yes (1) | AnyLeaseArrangementsInd |
| Mgmt Contract Bond Fincd Prop | Yes (1) | MgmtContractBondFincdPropInd |
| Engage Bond Counsel Contracts | Yes (1) | EngageBondCounselContractsInd |
| Any Research Agreements | 0 | AnyResearchAgreementsInd |
| Private Bus Use By Others | 0.00250 | PrivateBusUseByOthersPct |
| Total Private Business Use | 0.00250 | TotalPrivateBusinessUsePct |
| Bond Iss Meet Prvt Sec Pymt Test | 0 | BondIssMeetPrvtSecPymtTestInd |
| Change In Use Bond Financed Prop | 0 | ChangeInUseBondFinancedPropInd |
| Procs Nonqualified Bond Remdtd | 0 | ProcsNonqualifiedBondRemdtdInd |
Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Form8038 T Filed | 0 | Form8038TFiledInd |
| Rebate Not Due Yet | 0 | RebateNotDueYetInd |
| Exception To Rebate | 0 | ExceptionToRebateInd |
| No Rebate Due | 0 | NoRebateDueInd |
| Variable Rate Issue | 0 | VariableRateIssueInd |
| Hedge Identified In Bks And Rec | 0 | HedgeIdentifiedInBksAndRecInd |
| Gross Proceeds Invested In GIC | 0 | GrossProceedsInvestedInGICInd |
| Gross Proceeds Invested | 0 | GrossProceedsInvestedInd |
| Written Proc To Monitor Reqs | Yes (1) | WrittenProcToMonitorReqsInd |
Procedures Corrective Action ProceduresCorrectiveActionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Procedures Corrective Action | Yes (1) | ProceduresCorrectiveActionInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Sch K Part I Line A - Purpose | FormAndLineReferenceDesc |
| Explanation | THE PURPOSE OF THE BOND ISSUANCE IS TO FINANCE, REFINANCE, OR REIMBURSE A PORTION OF THE COSTS OF ACQUIRING, CONSTRUCTING, RENOVATING AND EQUIPPING VARIOUS HEALTH CARE FACILITIES OF THE HOSPITAL, INCLUDING A REPLACEMENT ACUTE CARE HOSPITAL FACILITY AND A MEDICAL OFFICE BUILDING. | ExplanationTxt |
Schedule L IRS990ScheduleL
Loans Btwn Org Interested Prsn LoansBtwnOrgInterestedPrsnGrp (2 entries)
| Relationship With OrgRelationshipWithOrgTxt | Loan PurposeLoanPurposeTxt | Loan From OrganizationLoanFromOrganizationInd | Original PrincipalOriginalPrincipalAmt | Balance DueBalanceDueAmt | DefaultDefaultInd | Board Or Committee ApprovalBoardOrCommitteeApprovalInd | Written AgreementWrittenAgreementInd |
|---|---|---|---|---|---|---|---|
| Dr Ronald Auer | |||||||
| Doctor | Practice Commencement Assistance | Yes (X) | $50,000 | $26,923 | 0 | Yes (1) | Yes (1) |
| Dr Ronald Auer | |||||||
| Doctor | Student Loan Repayment Assistance | Yes (X) | $150,000 | $80,929 | 0 | Yes (1) | Yes (1) |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Balance Due | $107,852 | TotalBalanceDueAmt |
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp (2 entries)
| Relationship DescriptionRelationshipDescriptionTxt | TransactionTransactionAmt | TransactionTransactionDesc | Sharing Of RevenuesSharingOfRevenuesInd |
|---|---|---|---|
| A DATTILO FRUIT COMPANY | |||
| Vice President of outPatient Services of KDH has 51% ownership interest | $40,323 | Lisa Morgan, Vice President of outPatient Services of KDH owns a 51% interest in A. Datillo Fruit Company. KDH purchases produce from A. Dattilo Fruit Company. The Hospital made purchases totaling $40,323 in 2016. | 0 |
| German American Bank | |||
| Board member is the spouse of the Regional Chairman of the German National | Andrea Forrester, Board Asst Treasurer, is married to the Regional Chairman of the German National Bank. The Hospital's operating account is with the bank. The Hospital recorded interest income of $137,527 and service fees of $6,798 in 2016 from activity with the bank. | 0 | |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (9 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part VI, Section A, line 6 | Per the bylaws, the membership of the Organization shall be non-sectarian, non-political and not confined to any Christian religious denomination or sect. Any such person of good repute who holds herself responsible to the King, Christ, our Lord and Savior, may become a member of the organization. All members must be and remain permanent residents of the service area of the Hospital, as determined from time to time by the Hospital Board of Managers, as a continuing requirement for membership. Failure to maintain such residency status automatically terminates a person's membership. Hospital employees, members of the Medical Staff, and their immediate family members shall not be eligible for membership in the organization. The immediate family shall be defined as including the mother, father, husband, wife, sister, brother, daughter, son, and stepchildren. |
| Form 990, Part VI, Section A, line 7a | The Organization shall have two (2) classes of members, Active and Honorary, and all members shall have the rights, privileges, duties, liabilities, limitations and restrictions as set forth from time to time in the Standing Rules. Any Active Member of the Organization may propose any other person meeting the eligibility requirements outlined in Part VI, 7a above for membership. Only Active members in good standing that have been a member for at least two anniversary years can present a person's name for membership or to serve on the Board of Directors. A majority vote of those present and voting affirmatively at any regular meeting of the Organization at which a quorum is present shall be sufficient to elect such proposed person to membership. Only Active Members shall have the right at every meeting of the members to cast one (1) vote for her membership. This right to vote must be exercised in person, or as the Bylaws may provide from time to time. |
| Form 990, Part VI, Section A, line 7b | Only Active Members shall have the right at every meeting of the members to cast one (1) vote for his/her membership. This right to vote must be exercised in person, or as the Bylaws may provide from time to time. |
| Form 990, Part VI, Section B, line 11b | The process of reviewing the Form 990 entails a detailed review by the organization's management. the Board of Managers receives a draft copy of the Form 990 including requested schedules prior to filing with the IRS. Changes or revisions are suggested by the board if necessary. The 990 will be reviewed at the next board meeting. |
| Form 990, Part VI, Section B, line 12c | Board members are required to disclose annually interests that could give rise to conflict. Officers and key employees are not required to annually disclose interests that could give rise to conflicts. However the HR Conflict of Interest policy does state that any employee who is an officer, owner, partner or employee of an organization with which the hospital may enter into a relationship or transaction(or whose spouse or child is an officer, owner, partner or employee of an organization with which the hospital may enter into a relationship or transaction) must disclose this information to the appropriate Vice President and the President/CEO. Should such information be disclosed, the employee will refrain from any subsequent discussion and decisions related to the outside firm. A conflict of interest statement must be completed by every board member each year. At such time as any matter comes before the Board concerning an existing or contemplated transaction or relationship between the Organization and any party in which a Board member or the spouse or minor children of such Board member has an interest or otherwise may give rise to a conflict of interest between the Board member and the organization, the affected Board member shall make known the potential conflict, whether disclosed by his or her written statement or not, and after answering any questions that might be asked of him or her, shall withdraw from the meeting for so long as the matter shall continue under discussion. Should the matter be brought to a vote, the affected Board member shall not vote on it. |
| Form 990, Part VI, Section B, line 15a | The Hospital's Board Executive Committee reviews annual CEO survey information from the Indiana Hospital Association that compares the Hospital's CEO's compensation with other hospital CEO's in Indiana. Comparisons are made with hospitals that are in the Hospital's region in Indiana, hospitals similar in size to KDHHS, and hospitals that might reasonably be expected to compete for services of the Hospital's CEO. The Executive Committee, after reviewing a status report of the CEO's annual goals, recommends changes in the CEO's compensation to the full Board of Managers. Any action taken on the recommendation is made by the full board. However, physician board members who are hospital employees do not participate in voting for any change to CEO compensation. Minutes are taken at all Board Executive Committee and full board meetings. |
| Form 990, Part VI, Section C, line 19 | The governing documents, conflict of interest, or financial statements are not made available for public inspection. The Form 990 tax return is available for public inspection upon request. |
| Form 990, Part XI, line 9: | change in subscriber savings cumulative account 177,090. |
| Form 990, Part XI, Line 2c, Audit Oversight | The Hospital's Finance Committee assumes responsibility for the selection of an independent certified public accounting firm to perform the annual audit of the financial statements. The Finance Committee also is responsible for oversight of that audit process. The treasurer of the Hospital's Board of Managers serves as the Chair of the Finance Committee. The Finance Committee regularly meets every other month, and meets once per year with the independent auditors. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | The King's Daughters' Hospital Foundation Inc | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO Box 447 | AddressLine1Txt |
| City | Madison | CityNm |
| State Abbreviation | IN | StateAbbreviationCd |
| ZIP | 47250 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 202148950 | EIN |
| Primary Activities | Fundraising to support the provision of healthcare services | PrimaryActivitiesTxt |
| Legal Domicile State | IN | LegalDomicileStateCd |
| Exempt Code Section | 501(c)(3) | ExemptCodeSectionTxt |
| Public Charity Status | Line 7 | PublicCharityStatusTxt |
| Direct Controlling NA | N/A | DirectControllingNACd |
| Controlled Organization | 0 | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | Yes (1) | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (1) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (1) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (1) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |