2015-10-27T14:32:24-05:00 2014-12-31 351178661 BLUE & CO LLC ONE AMERICAN SQUARE 2200 INDIANAPOLIS IN 46282 990 2014-01-01 350895832 THE BETHANY CIRCLE OF KING'S DAUGHTERS' OF MADISON INDIANA INC BETH 8128010800 PO BOX 447 MADISON IN 47250 STEVE MEACHAM VP OF FINANCE 8128010800 2015-10-27 1 CARRIE A MERRILL CPA P00832283 3176334705 2014 2016-02-25 16:41:14Z KING'S DAUGHTERS' HEALTH STEVE MEACHAM PO BOX 447 MADISON IN 47250 135501139 0 X WWW.KDHMADISON.ORG X 1899 IN TO IMPROVE THE HEALTH OF THE HOSPITAL'S PATIENTS THROUGH CARE, SERVICE, AND EDUCATION. 11 9 1141 72 8192 -6863 1086439 66466 111685302 116873806 -1787533 3082095 2948480 2338156 113932688 122360523 64750 19566 0 0 66191410 62334347 0 0 0 55574589 55677874 121830749 118031787 -7898061 4328736 235555035 241257319 115305835 114823185 120249200 126434134 THE MISSION OF THE HOSPITAL IS TO IMPROVE THE HEALTH OF THE HOSPITAL'S PATIENTS THROUGH CARE, SERVICE, AND EDUCATION. 0 0 96638222 19566 118728200 THE KING'S DAUGHTERS' HOSPITAL AND HEALTH SERVICES 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 2014, THE HOSPITAL PROVIDED HEALTHCARE TO PATIENTS AT THE FOLLOWING LEVELS: 12,297 DAYS OF CARE TO ACUTE INPATIENTS 1,170 DAYS OF CARE TO NEWBORN INFANTS 179,924 VISITS ASSOCIATED WITH HOSPITAL OUTPATIENTS 130,008 VISITS ASSOCIATED WITH PHYSICIAN CLINICS 5896180 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 2014, THE KING'S DAUGHTERS' HOSPITAL AND HEALTH SERVICES PROVIDED SERVICES TOTALING $5,896,180 IN GROSS CHARGES TO PATIENTS WHO MET THE HOSPITAL'S CHARITY CARE POLICY. 102534402 1 1 0 1 0 0 0 0 0 1 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 1 0 0 0 1 0 0 0 0 0 1 0 0 0 1 63 0 1 1141 1 1 1 0 0 0 0 1 1 0 0 0 0 X 11 9 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 0 0 IN X DAWN NUNAN DIRECTOR OF ACCOUNTING 8128010193 PO BOX 447 MADISON IN 47250 MAUREEN GETZ BOARD CHAIRWOMAN 1.00 1.00 X X 250 0 0 PAULA HEIDERMAN BOARD VICE CHAIRWOMAN 1.00 1.00 X X 500 0 0 PAM KIMMEL BOARD SECRETARY 1.00 0.00 X X 0 0 0 MARY BETTE VOYLES BOARD ASSN'T SECRETARY 1.00 0.00 X X 250 0 0 LINDA SLOFFER BOARD TREASURER 1.00 1.00 X X 250 0 0 ANDREA FORRESTER BOARD ASSN'T TREASURER 1.00 0.00 X X 750 0 0 MARJORIE HARE BOARD MEMBER 1.00 0.00 X 500 0 0 JONATHAN HANSON MD BOARD MEMBER/PHYSICIAN 40.00 0.00 X 422855 0 39930 PAT STACK MD BOARD MEMBER/PHYSICIAN 40.00 0.00 X 288730 0 41101 JOE CRAIG BOARD MEMBER 1.00 0.00 X 0 0 0 KEVIN TURNER BOARD MEMBER 1.00 0.00 X 0 0 0 CAROL DOZIER PRESIDENT/CEO 40.00 1.00 X 341543 0 14393 STEVE MEACHAM VP FINANCE 40.00 0.00 X 209028 0 28939 LISA MORGAN VP PATIENT SERVICES 40.00 0.00 X 160911 0 30809 DENINE FALLIS-HALLGARTH VP PHYSICIAN PRACTICES 40.00 0.00 X 140671 0 17669 HOLLY ROBINSON VP QUALITY 40.00 0.00 X 297370 0 39978 THOMAS ECKERT MD EMPLOYED PHYSICIAN 40.00 0.00 X 741006 0 29232 TRAVIS CLEGG MD EMPLOYED PHYSICIAN 40.00 0.00 X 1377711 0 39713 WILLIAM SKILES MD EMPLOYED PHYSICIAN 40.00 0.00 X 627693 0 26773 MICHAEL SCHMIDT MD EMPLOYED PHYSICIAN 40.00 0.00 X 643742 0 40959 GEORGE ALCORN MD EMPLOYED PHYSICIAN 40.00 0.00 X 555879 0 23165 ROGER ALLMAN FORMER PRESIDENT/ CEO 40.00 1.00 X 298536 0 0 LARRY KEITH FORMER VP CLINICAL SERVICES 40.00 0.00 X 159311 0 0 6267486 0 372661 61 1 1 0 WEHR CONSTRUCTORS INC 2517 PLANTSIDE DRIVE LOUISVILLE KY 40299 CONTRACTOR SERVICES FOR THE CONSTRUCTION 4630691 MEDASSETS INC PO BOX 405652 ATLANTA GA 303845652 REVENUE CYCLE CONSULTING SERVICES & SOFT 804565 MAYO COLLABORATIVE SERVICES INC PO BOX 9146 MINNEAPOLIS MN 554809146 LABORATORY SERVICES 610397 FIRST UROLOGY PSC PO BOX 1087 JEFFERSONVILLE IN 47131 CONTRACTED PHYSICIAN MEDICAL SERVICES 473203 EMCARE 7032 COLLECTION CENTER DRIVE CHICAGO IL 60693 CONTRACTRED PHYSICIAN AND MID-LEVEL PROV 400411 34 64175 2291 66466 NET PATIENT SERVICE REVENUE 621110 116873806 116865614 8192 116873806 1460679 1460679 69459 15833 53626 53626 53626 14329743 416456 12330309 794474 1999434 -378018 1621416 1621416 EHR REVENUE 621110 1659533 1659533 CAFETERIA REVENUE 722210 300556 300556 GIFT SHOP 453220 175014 175014 149427 149427 2284530 122360523 118728200 8192 3557665 19566 19566 1149524 919619 229905 48466498 42861225 5605273 1712342 1541108 171234 7822544 7040290 782254 3183439 2865095 318344 212605 212605 2080139 2080139 258822 258822 175429 157886 17543 1926807 1579982 346825 436833 393150 43683 2048321 1843489 204832 128151 115336 12815 5481297 4933167 548130 11741231 10567108 1174123 1335898 1202308 133590 PURCHASED SERVICES 8679412 7811471 867941 DRUGS 7468870 7468870 SUPPLIES 6483286 5510793 972493 HOSPITAL ASSESSMENT FEE 1990312 1990312 5230461 3713627 1516834 118031787 102534402 15497385 0 7422970 18557562 1000000 0 10039288 12046508 195049 54039 422538 2653683 2323063 2667423 943738 996157 183712739 50076643 136620936 133636096 68718897 63987854 7868556 6657997 235555035 241257319 13166714 12650373 97975255 98015768 1306836 969093 2857030 3187951 115305835 114823185 X 120040475 126404076 198725 20058 10000 10000 120249200 126434134 235555035 241257319 X 4328736 65156 1805499 -14457 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 7537 7537 0 PART II-B, LINE 1: PORTION OF INDIANA HOSPITAL ASSOCIATION DUES AND AMERICAN HOSPITAL ASSOCIATION DUES ATTRIBUTABLE TO LOBBYING EXPENSES AS DISCLOSED ON THE DUES NOTICES OF THE RESPECTIVE ASSOCIATIONS. 208725 50077 228744 30058 196716 48484 36475 208725 129738 86924 19946 196716 137154 40020 47436 129738 127555 62386 52787 137154 0.00000 0.33270 0.66730 0 0 4924110 4924110 112651666 17894118 94757548 57482148 32182525 25299623 8654815 8654815 133636096 DEFERRED COMPENSATION 88102 THIRD PARTY PAYABLE 2300000 LIFE INSURANCE POLICIES 799849 3187951 X 122134479 50698 -8416 42282 122092197 258822 9504 268326 122360523 117755044 -8416 -8416 117763460 258822 9505 268327 118031787 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 12/31/2014. TERM ENDOWMENT - TEMPORARILY RESTRICTED NET ASSETS ARE DONOR-RESTRICTED FOR A SPECIFIC USE INCLUDING: PRENATAL/POSTNATAL EDUCATION PROGRAM FUND, TEEN EVENT FUND, MAY LIBRARY FUND, FIT KIDS FUND, NATIONAL NURSES WEEK FUND, PATIENT SCALES FUND AND NICOTINE REPLACEMENT THERAPY 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, 2014 AND 2013, 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, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. PART XI, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES -8,416. PART XI, LINE 4B - OTHER ADJUSTMENTS: GRANTS 9,504. PART XII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES -8,416. R PART XII, LINE 4B - OTHER ADJUSTMENTS: GRANTS 9,504. ROUNDING 1. 1 1 1 X 0 1 1 0 1 1 2050744 2050744 0.01740 17433480 9196050 8237430 0.06980 19484224 9196050 10288174 0.08720 7413 148962 50719 98243 0.00080 203 195027 33425 161602 0.00140 4835 4506764 3824519 682245 0.00580 19806 19806 0.00020 12451 4870559 3908663 961896 0.00820 12451 24354783 13104713 11250070 0.09540 300 306 306 0.00000 2400 1171 1171 0.00000 1100 176000 176000 0.00150 881 1037 1037 0.00000 4681 178514 178514 0.00150 0 14667665 0 23681108 24189675 -508567 X 1 1 1 1 KING'S DAUGHTERS' HEALTH 1373 EAST STATE ROAD 62 PO BOX 447 MADISON IN 47250 WWW.KDHMADISON.ORG 14-005063-1 X X X KING'S DAUGHTERS' HEALTH 1 0 0 1 X X X X X X X X X X 13 1 0 0 1 X WWW.KDHMADISON.ORG/ABOUT_NEEDSASSESSMENT.ASPX X X 1 13 1 WWW.KDHMADISON.ORG 0 0 1 X 200.000000000000 X X X X 1 1 X X X 1 X X X X X X X X 1 X 0 X X X X 1 X 0 0 KING'S DAUGHTERS' HEALTH PART V, SECTION B, LINE 3J: THE NEEDS ASSESSMENT PERFORMED BY THE HOSPITAL ALSO EXPLORED KEY ISSUES SUCH AS: 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_NEEDSASSESSMENT.ASPX. KING'S DAUGHTERS' HEALTH PART V, SECTION B, LINE 11: AFTER REVIEW OF THE COMMUNITY HEALTH NEEDS ASSESSMENT CONDUCTED IN 2013, 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 WE 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 DO 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.IN 2014 KDH PARTICIPATED IN THREE CORPORATE AND COMMUNITY SCREENS WHERE EDUCATION INFORMATION AND TOBACCO CESSATION INFORMATION WERE DISTRIBUTED. SIMILAR EDUCATION LITERATURE WAS ALSO DISTRIBUTED AT TWO JEFFERSON CO. COMMUNITY HEALTH FAIRS AND THREE FAIRS IN OUTLYING COUNTIES. THE WELLNESS COORDINATOR AND TOBACCO EDUCATOR PROVIDED A COMBINED 22 SPEAKING ENGAGEMENTS TO COMMUNITY GROUPS IN 2014 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 KDH FIT KIDS PROGRAM, OFFERED IN 8 AREA SCHOOLS IN 2014, PROVIDES EDUCATION ON CHILDHOOD OBESITY, HEALTHY EATING, AND PHYSICAL ACTIVITY. IN ADDITION, THE KDH SPONSORED GIRLS ON THE RUN SITE IS A CHARACTER-DEVELOPMENT PROGRAM THAT USES THE POWER OF RUNNING FOR 3RD-5TH GRADE GIRLS TO PROMOTE EXERCISE AND TEACH HEALTHY LIFESTYLE CONCEPTS. THIS GIRLS ON THE RUN PROGRAM OFFERS A 5K EVENT IN ADDITION TO THE KDH RUN THE FALLS 5K EVENT. THESE TWO FITNESS OPPORTUNITIES BROUGHT IN A COMBINED 365 PARTICIPANTS IN 2014.THE SPEAKING OF WOMEN'S HEALTH PROGRAM OFFERED EXERCISE BREAKOUT SESSIONS IN 2014 AND A 12-WEEK PEP WALK PROGRAM "FREE WALKING PROGRAM" FOR OUR COMMUNITY.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.KDH EMPLOYEES WERE OFFERED A FREE HEALTH SCREEN IN 2014, WHICH INCLUDES A FINANCIAL INCENTIVE FOR ACHIEVING SET BIOMETRIC PARAMETERS. DURING THE YEAR THREE HEALTH INCENTIVE CHALLENGES WERE OFFERED TO STAFF. FIVE ON-SITE CLASSES WERE OFFERED AND EDUCATION EMAILS AND NEWSLETTERS WERE SENT. IN ADDITION, THREE NEW 5-WEEK WEIGHT LOSS EDUCATION CLASSES WERE ALSO AVAILABLE TO EMPLOYEES.KDH CONTINUED ENFORCEMENT OF IT'S TOBACCO-FREE CAMPUS. TOBACCO FREE EMPLOYEES HAVE AN OPPORTUNITY FOR A REDUCED HEALTH INSURANCE PREMIUM AND CESSATION ASSISTANCE IS AVAILABLE FOR ALL EMPLOYEES AND THEIR FAMILY MEMBERS.THE EMPLOYEE CAFETERIA INTRODUCED TWO NEW HEALTHY BEVERAGE OPTIONS FOR STAFF, TWO NEW HEALTHY SNACK OPTIONS AND ONE NEW HEALTHY MEAL ENTREE. IN ADDITION, IT WAS REPORTED IN 2014 THAT OVER HALF OF ALL VENDING MACHINE BEVERAGES WERE ZERO CALORIES OPTIONS AND HEART HEALTHY SNACK CHOICES CONTINUED TO BE AVAILABLE IN ALL VENDING MACHINE.IN ADDITION SEVERAL OPPORTUNITIES WERE AVAILABLE TO KDH EMPLOYEES DURING 2014 TARGETING OBESITY. THESE INCLUDED A BIOMETRIC SCREEN WITH INCENTIVE PROGRAM, CLASSES, INCENTIVE CHALLENGES, AND HEALTH EDUCATION.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 16I: AT THE TIME OF REGISTRATION, THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY IS DISCUSSED WITH EACH PATIENT. THE PATIENT IS PROVIDED 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. KING'S DAUGHTERS' HEALTH PART V, SECTION B, LINE 20E: IN ADDITION TO THE ACTIONS PREVIOUSLY LISTED, A FINANCIAL AID COUNSELOR WILL MEET WITH ANY UNINSURED INPATIENT PRIOR TO DISCHARGE TO DISCUSS THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY. KING'S DAUGHTERS' HEALTH PART V, SECTION B, LINE 22D: ALL UNINSURED PATIENTS RECEIVE AN AUTOMATIC 20% DISCOUNT FROM GROSS CHARGES. AT REGISTRATION, PATIENTS ARE NOTIFIED OF THE HOSPITAL'S FINANCIAL ASSISTANCE PROGRAM. THEY ARE PROVIDED 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 UP TO 100% ON THE OUTSTANDING ACCOUNT BALANCE. THE HOSPITAL WILL ATTEMPT TO COLLECT ANY BALANCE REMAINING ON THE UNINSURED ACCOUNT AFTER ALL FINANCIAL ASSISTANCE DISCOUNTS HAVE BEEN APPLIED USING A SERIES OF STATEMENTS, LETTERS, AND TELEPHONE CALLS. THE HOSPITAL WILL ALSO OFFER PATIENTS INTEREST-FREE EXTENDED PAYMENT PLANS. IF THE ACCOUNT REMAINS UNPAID, THE ACCOUNT MAY BE TURNED OVER TO A COLLECTION AGENCY. PART 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.2014 UPDATE: WE CONTINUE TO WORK CLOSELY WITH THE JEFFERSON AND SWITZERLAND COUNTY COALITIONS AGAINST SUBSTANCE ABUSE. KDH IS REPRESENTED AT MEETINGS AND CONTINUES TO ATTEND OTHER OUTREACH EFFORTS. THE OB OFFICES ADDRESS THE PROBLEM WITH THEIR PRENATAL CARE. THE PATIENT MUST SIGN A CONTRACT AND CONTINUE WITH FOLLOW UP CARE. PATIENTS ALSO ATTEND A MEETING CALLED THE ORCHARD PROGRAM. IT IS A BEGINNERS 12 STEP PROGRAM. THIS IS FOR PREGNANT MOTHERS, NEW MOTHERS, AND MOTHERS WITH OLDER CHILDREN BATTLING ADDICTION. STARTING IN 2015, EVERY TIME THEY ATTEND A MEETING THEY EARN "BABY BUCKS" TO BE USED AT A LOCAL BABY SUPPLY CLOSET. THESE MEETINGS OCCUR WEEKLY. IF THE MOTHER IS STILL USING AT TIME OF BIRTH, THE HISTORY IS COMMUNICATED TO THE STAFF. IN 2014 THAT WAS TESTING BY COLLECTING URINE AND MECONIUM. THE GOAL FOR 2015 WILL BE TO TEST VIA UMBILICAL CORD ANALYSIS. WE ALSO DO NAS (NEONATAL ABSTINENCE SYNDROME) SCORING. THE MOTHER RECEIVES AN OPPORTUNITY FOR FOLLOW UP CARE POST-DELIVERY. THEY HAVE ANOTHER OPPORTUNITY TO ATTEND THE ORCHARD PROGRAM. IF THE MOTHER IS USING CERTAIN MEDICATIONS, SUCH AS SUBUTEX OR METHADONE, OR SEBOXON, BABIES REMAIN HOSPITALIZED A MINIMUM OF 72 TO 96 HOURS TO ENSURE THE HEALTH OF THE BABY. IF SCORES ARE TOO HIGH, THEY ARE TREATED LONGER AS AN INPATIENT. FOLLOW UP IS ALSO DONE BY OUR HOME HEALTH AGENCY IN CASES OF ACTIVE WITHDRAWAL.SUPPORTING DATA:NUMBER OF ER ADMISSIONS IN 2014 WITH A DIAGNOSIS OF DRUG ABUSE / DEPENDENCY / OVERDOSE: 2430NUMBER OF ADMISSIONS IN 2014 WITH NEONATAL ABSTINENCE SYNDROME: 10 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.2014 UPDATE: IN 2014 KDH MADE A TOTAL OF 475 PATIENT REFERRALS FOR MENTAL HEALTH SERVICES. (THIS NUMBER EXCLUDES PEDIATRIC AND OB OUTPATIENTS). THE QUALITY AND RESOURCE MANAGEMENT TEAM, ALONG WITH SUPPORT FROM THE INFORMATION TECHNOLOGY DEPARTMENT, WILL BE WORKING TO IMPROVE DATA COLLECTION ACCURACY AND WILL HAVE THE CAPABILITY TO INCLUDE ALL PATIENT REFERRALS FOR THE YEAR 2015.KING'S DAUGHTERS' HEALTH HAS A TOTAL OF 19 MENTAL HEALTH PROVIDERS THAT ARE USED 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.2014 UPDATE: A NEW HOUSE OF HEALTH PROGRAM WAS DEVELOPED IN 2014. THIS PROGRAM HELD AT THE JEFFERSON COUNTY CLEARINGHOUSE HOUSE OF HOPE FOOD PANTRY, BEGAN IN JULY, WHICH PROVIDED SIX MONTHLY PROGRAMS FOR 2014. TWO OF THESE EVENTS PROVIDED FREE SCREENING SERVICES TO PARTICIPANTS. ATTENDANCE RANGED FROM 25-70 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 ADDRESS 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.2014 UPDATE: JOINT REPLACEMENT PROGRAM - 8 MONTH CAMPAIGN THAT INCLUDED ONE COMPREHENSIVE VIDEO AND FOUR SUBSET VIDEOS POSTED TO THE KDH WEBSITE AND PROMOTED FURTHER VIA THE PRINT CAMPAIGN, FACEBOOK, AND TWITTER. PRINT CAMPAIGN INCLUDED TESTIMONIALS FROM SEVERAL KNEE/HIP REPLACEMENT PATIENTS. BANNER ON MAIN PAGE OF KDH WEBSITE.COLON HEALTH / DR. ADAMU / COLONOSCOPIES - 5-MONTH TOTAL CAMPAIGN THAT INCLUDED BILLBOARDS IN MADISON, VERSAILLES, AND MILTON, ALONG WITH PRINT AND RADIO CAMPAIGNS IN ALL MEDIA PRIMARY MEDIA OUTLETS. BANNER ON MAIN PAGE OF KDH WEBSITE. TO YOUR HEALTH RADIO PROGRAM ON WORX INCLUDED A DISCUSSION WITH DR. THOMAS ECKERT ABOUT COLONOSCOPIES.COMMUNITY CAMPAIGN - FEATURED GENERAL INFORMATION PRINT ADS IN PRIMARY MEDIA OUTLETS WITH THE SLOGAN, COMMUNITY PEOPLE, QUALITY CARE. TALKED ABOUT OUR COMMITTMENT TO QUALITY CARE WITH PEOPLE YOU CAN TRUST, WHO CARE ABOUT YOU. 3-MONTH CAMPAIGN.MOTHER/BABY SERVICES - WE FEATURED TWO TESTIMONIAL VIDEOS ON A VARIETY OF FORMATS, INCLUDING FACEBOOK AND THE WEBSITE. THESE WERE BACKED BY A SERIES OF PRINT ADS PROMOTING THE VIDEOS AND SERVICES OF OUR OB/GYN TEAM. THIS WAS A ROUGHLY 6-MONTH CAMPAIGN DURING THE COURSE OF THE YEAR. WE FEATURED A VARIETY OF RADIO SPOTS IN PRIMARY MARKETS. WE ALSO COMPLETED A UNIQUE VIDEO THAT FEATURED PHOTOS OF A NEW MOM ARRIVING FOR DELIVERY, THROUGH DEPARTURE WITH THE NEW BABY. IT WAS WELL RECEIVED. BANNER ON MAIN KDH WEBSITE.PROMOTION OF SCREENINGS/EVENTS - THESE EVENTS AND PROGRAMS INCLUDED DIABETES AWARENESS, CHOLESTEROL SCREENING, DIRECT ACCESS TESTING AT ALL LOCATIONS (FLYERS, ADS), DOCTOR AND THE DIETICIAN, HEART MONTH, LUNG CANCER SCREENING ($88 FOR APPROPRIATE PATIENTS), PEP WALKS, SENIORCIZE, HOUSE OF HEALTH EVENTS AT THE CLEARINGHOUSE, GIRLS ON THE RUN, AND THE RUN THE FALLS 5K EVENT IN SEPTEMBER.PHYSICIANS - EFFORTS INCLUDED DR. ADAMU AND DR. ECKERT FOR COLONOSCOPIES AND COLON HEALTH, DR. VICTORIA SHIRLEY (OB), DR. DIAMOND HARRIS (PEDIATRICS), DR. DAWN MEACHAM (FAMILY PRACTICE), AND DR. MICHAEL WILLHITE AND LAUREN DUBBERLY, PA (VERSAILLES). WE ALSO FEATURED PRINT ADS IN VARIOUS SPORTS PROGRAMS THAT OUTLINE PHYSICIAN SERVICES IN CARROLLTON, TRIMBLE COUNTY, AND MADISON, IN PARTICULAR.VERSAILLES CAMPAIGN - WE FEATURED A FOUR-MONTH CAMPAIGN IN VERSAILLES (PSA) TO PROMOTE THE PHYSICIAN SERVICES AVAILABLE THROUGH DR. MICHAEL WILLHITE AND LAUREN DUBBERLY, PA - WHO HAD MOVED FROM NEUROLOGY AT THE TIME. THIS EXTENSIVE CAMPAIGN INCLUDED WEEKLY PRINT ADS, ALONG WITH A BILLBOARD IN THE VERSAILLES MARKET, AND RADIO ADS TO RUN IN THAT SPECIFIC AREA (INCLUDING MILAN AND LAWRENCEBURG).CANCER CENTER - PROMOTION ABOUT THE ARRIVAL (IN FEBRUARY 2015) OF THE NEW CANCER TREATMENT CENTER. THIS INCLUDED WORKING WITH THE FOUNDATION'S HOPE AND HEALING CAMPAIGN. WE STARTED THE CAMPAIGN LATE IN 2014 (NOVEMBER - DECEMBER) IN PREPARATION FOR THE FULL CAMPAIGN IN JANUARY 2015. PART V, SECTION B, LINE 11 CONTINUED WE PROVIDED LOCAL MEDIA MEMBERS AN EARLY TOUR OF THE FACILITY PRIOR TO COMPLETION AND USED THE ROUNDABOUT MADISON AND RIVER TIMES TO PROMOTE THE ARRIVAL OF THE NEW CANCER CENTER.MYKDH PORTAL - INTRODUCTION OF THE NEW ONLINE ELECTRONIC MEDICAL RECORDS -MYKDH. WE INTEGRATED FLYERS AT ALL KDH FACILITIES, POSTERS FOR DISPLAY, BANNER ON THE MAIN KDH WEBSITE - INCLUDING DIRECT LINKS FOR REGISTRATION, PROMOTION AT THE 4H FAIRS AND PHYSICIAN OFFICES, PRINT ADS, RADIO SPOTS, AND NEWS RELEASES IN ALL PRIMARY MEDIA OUTLETS. MEMBERS OF THE INFORMATION TECHNOLOGY TEAM ALSO HELPED REGISTER PEOPLE AT SPECIFIC EVENTS AND THE 4H FAIR.NEWS RELEASE - SPECIFIC NEWS RELEASES COVERED A WIDE RANGE OF TOPICS: COLON CANCER TAKE-HOME KITS, DIABETES AWARENESS EVENT, DOCTOR AND THE DIETICIAN PROGRAM, HEART MONTH, DIRECT ACCESS TESTING, JOINT REPLACEMENT PROGRAM, MYKDH PORTAL, STUDER GROUP QUALITY, TO YOUR HEALTH PROGRAMS, VERSAILLES PHYSICIAN SERVICES, CANCER PROGRAMS, LUNG CANCER SCREENING, DR. VICTORIA SHIRLEY, DR. DIAMOND HARRIS, DR. DAWN MEACHAMMEDICAL 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. 2014 UPDATE: THE FOLLOWING SERVICES / PROVIDERS WERE ADDED IN 2014 TO SERVE OUR AREA: MANDY WILSON, NP: NOCTURNIST DR. DAWN MEACHAM, FAMILY PRACTICE DR. DIAMOND HARRIS, PEDIATRICIAN DR. VICTORIA SHIRLEY, OB / GYN ALLISON FEIDER, NP, ORTHOPEDICS SUSAN KIRKWOOD, CRNA DAVID BROWN, CRNA THOMAS SEAVER, CRNA DR. OLIVER DE RAET, HOSPITALIST DR. HOSSLER BECAME THE DIRECTOR OF SILVER MEMORIES PART V, SECTION B, LINE 16 FINANCIAL ASSISTANCE POLICY WEBSITE AVAILABILITY KING'S DAUGHTERS' HEALTH PART V, SECTION B, LINE 16A WEBSITE: HTTP://WWW.KDHMADISON.ORG/PATIENTS_FINANCIAL.ASPX KING'S DAUGHTERS' HEALTH PART V, SECTION B, LINE 16B WEBSITE: HTTP://WWW.KDHMADISON.ORG/PATIENTS_FINANCIAL.ASPX KING'S DAUGHTERS' HEALTH PART V, SECTION B, LINE 16C WEBSITE: HTTP://WWW.KDHMADISON.ORG/PATIENTS_FINANCIAL.ASPX 10 REHABILITATION CENTER AND HOME CARE 2670 N MICHIGAN ROAD MADISON IN 47250 OUTPATIENT REHABILITATION CENTER AND HOME CARE SERVICES CLIFTY DR MED OFFICE BLDG & CONV CARE 445 CLIFTY DRIVE MADISON IN 47250 PHYSICIAN MEDICAL OFFICE & CONVENIENT CARE CENTER VERSAILLES MEDICAL OFFICE BLDG-MAIN ST 128 NORTH MAIN STREET VERSAILLES IN 47042 PHYSICIAN MEDICAL OFFICE VERSAILLES MEDICAL OFFICE BLDG-TYSON ST 206 W TYSON STREET VERSAILLES IN 47042 PHYSICIAN MEDICAL OFFICE TRIMBLE COUNTY MEDICAL OFFICE BLDG 10235 US HIGHWAY 421 MILTON KY 40045 PHYSICIAN MEDICAL OFFICE CARROLLTON MEDICAL OFFICE BLDG 205 MARWILL DRIVE CARROLLTON KY 41008 PHYSICIAN MEDICAL OFFICE SWITZERLAND CNTY MEDICAL OFFICE BLDG 727 STATE RD 56 VEVAY IN 47043 PHYSICIAN MEDICAL OFFICE HANOVER MEDICAL OFFICE BLDG 36 MEDICAL PLAZA HANOVER IN 47243 PHYSICIAN MEDICAL OFFICE CANCER TREATMENT CENTER 621 WEST STREET MADISON IN 47250 PHYSICIAN MEDICAL OFFICE DOWNTOWN MEDICAL OFFICE BLDG 630 NORTH BROADWAY MADISON IN 47250 PHYSICIAN MEDICAL OFFICE AND HOSPITAL STAFF PART I, LINE 3C: THE HOSPITAL USED FACTORS OTHER THAN FEDERAL POVERTY GUIDELINES IN DETERMINING ELIGIBILITY FOR DISCOUNTED CARE. A PATIENT CAN APPLY FOR THE HOSPITAL'S CATASTROPHIC DISCOUNT PROGRAM. THIS POLICY WILL LIMIT THE PATIENT'S TOTAL FINANCIAL OBLIGATION TO 20% OF THE PATIENT'S TOTAL ANNUAL FAMILY INCOME. 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 CAREER DAYS AT LOCAL SCHOOLS AND JOB FAIRS AT THE LOCAL COMMUNITY COLLEGE- PARTICIPATION ON LOCAL COMMUNITY COLLEGE BOARD- 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.)- SUPPORTING THE LOCAL AMERICAN CANCER SOCIETY RELAY FOR LIFE EVENT ALONG WITH A CANCER SURVIVORS DINNER PART III, LINE 2: AS REPORTED ON THE FINANCIAL STATEMENTS PAGE 5. 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 THESE REASONS, THE HOSPITAL BELIEVES THAT IT ACCURATELY CAPTURES ALL CHARITY CARE DEDUCTIONS PROVIDED ACCORDING TO THE FINANCIAL ASSISTANCE POLICY, AND THE AMOUNT OF BAD DEBT ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S CHARITY CARE POLICY IS NEGLIGIBLE. PART III, LINE 4: SEE PAGES 10 AND 11 ON THE ATTACHED FINANCIAL STATEMENTS. PART III, LINE 8: THIS SHOULD BE TREATED AS COMMUNITY BENEFIT AS MORE SERVICES WERE PROVIDED TO THE ELDERLY POPULATION THAN WERE REIMBURSED. THE SOURCE USED TO DETERMINE THE AMOUNT OF MEDICARE ALLOWABLE COSTS REPORTED FOR PART III, SECTION B, MEDICARE HAS BEEN PROVIDED FROM THE YEAR ENDED 12/31/2014 REPORT: HOSPITAL STATEMENT OF REIMBURSABLE COST. PART III, LINE 9B: ALL UNINSURED PATIENTS RECEIVE AN AUTOMATIC 20% DISCOUNT FROM GROSS CHARGES. AT REGISTRATION, PATIENTS ARE NOTIFIED OF THE HOSPITAL'S FINANCIAL ASSISTANCE PROGRAM. THEY ARE PROVIDED 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 UP TO 100% ON THE OUTSTANDING ACCOUNT BALANCE. THE HOSPITAL WILL ATTEMPT TO COLLECT ANY BALANCE REMAINING ON THE UNINSURED ACCOUNT AFTER ALL FINANCIAL ASSISTANCE DISCOUNTS HAVE BEEN APPLIED USING A SERIES OF STATEMENTS, LETTERS, AND TELEPHONE CALLS. THE HOSPITAL WILL ALSO OFFER PATIENTS INTEREST-FREE EXTENDED PAYMENT PLANS. IF THE ACCOUNT REMAINS UNPAID, THE ACCOUNT MAY BE TURNED OVER TO A COLLECTION AGENCY. PART VI, LINE 2: KING'S DAUGHTERS' HEALTH, (KDH), CONDUCTED A COMMUNITY NEEDS ANALYSIS IN 2013 THAT INVOLVED BOTH ITS PRIMARY SERVICE AREA (JEFFERSON COUNTY, RIPLEY COUNTY, AND SWITZERLAND COUNTY, INDIANA) AND ITS SECONDARY SERVICE AREA (TRIMBLE COUNTY AND CARROLL COUNTY, KENTUCKY). PRIOR TO THIS A COMMUNITY NEEDS ASSESSMENT WAS CONDUCTED IN 2010.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 DISEASE 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, 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 PROVIDED 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 MEET WITH ANY UNINSURED INPATIENT PRIOR TO DISCHARGE TO DISCUSS THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY. 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 PER 100,000 POPULATION, THAN FOR INDIANA, AT 476 PER 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 LOW-WEIGHT 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 AN 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 POPULATION 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'S 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 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.2014 KING'S DAUGHTERS' HEALTH OVERVIEW OF COMMUNITY BENEFIT ACTIVITIES1. HEALTH SCREENS: A. CORPORATE HEALTH SCREENS / FAIRS CLIFTY ENGINEERING SCREEN: 18 ARVIN SANGO HEALTH FAIR: APX. 150 EMPLOYEES IN ATTENDANCE B. SKIN CANCER SCREENING: HELD IN MAY, 101 PEOPLE SCREENED C. BREAST CANCER SCREENINGS: HELD IN OCTOBER, 12 PEOPLE SCREENED. D. COLON CANCER SCREENING KITS: 42 RETURNS. E. CHOLESTEROL/BLOOD PRESSURE SCREEN: HELD IN FEBRUARY, 10 PEOPLE SCREENED. F. CORPORATE FLU SHOTS: MADISON ANIMAL CLINIC: 5 AGS LAW OFFICE: 11 SET ENTERPRISES: 13 CLIFTY ENGINEERING: 14 140 SOLD TO IVY TECH FOR SELF-ADMINISTRATION 2. 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 (INCLUDING FREE GLUCOSE CHECKS FOR 100) D. HISPANIC CULTURAL AWARENESS DAY E. WAL-MART CANCER AWARENESS EVENT: F. HEALTHY KIDS DAY AT SWITZERLAND CO. YMCA G. BACK TO SCHOOL HEALTH FAIR 3. COMMUNITY EDUCATION OPPORTUNITIES/CLASSES/SPECIAL EVENTS: A. SPEAKERS BUREAU: HEATHER (WELLNESS): 17 SPEAKING ENGAGEMENTS ELIZABETH/STEPHANIE (TOBACCO): 5 SPEAKING ENGAGEMENTS B. FIT KIDS PROGRAM (7 WK PROGRAM FOR AREA 5TH GRADE CLASSROOMS) 8 SCHOOLS / 13 CLASSROOMS / 340 KIDS + TEACHERS C. TOBACCO CESSATION & EDUCATION: PROVIDED OUTREACH TO: 8 BUSINESSES 25 PHYSICIAN OFFICES 5 SCHOOL VISITS D. CPR AND FIRST AID CLASSES: COMMUNITY CLASSES HELD WITH 453 GRADUATES SCHOOL-BASED CLASSES HELD WITH 183 STUDENTS PARTICIPATING E. PRENATAL EDUCATION: OB PREP PROGRAM - 405 PEOPLE SERVED PREPARED CHILDCARE ESSENTIAL CLASSES - 46 PEOPLE SERVED LAMAZE CLASSES - 12 PEOPLE SERVED SIBLING CLASSES - 9 PEOPLE SERVED F. GIRLS ON THE RUN FALL SEASON: 41 GIRLS / 5 SITES / 16 TRAINED COACHES / 10 WEEK PROGRAM FALL 5K: 157 PARTICIPANTS AND 50 VOLUNTEERS G. HOUSE OF HEALTH: (OFFERED JULY-DEC. FOR 2014) MONTHLY EDUCATION OPPORTUNITY PROVIDED AT THE HOUSE OF HOPE FOOD PANTRY. APPROXIMATELY 25-70 PEOPLE ATTEND EACH MONTH. TOPICS FOR 2014 INCLUDE: SUN SAFETY, DIABETES, HAND WASHING & FLU PREVENTION, BREAST CANCER, TOBACCO, AND MEDICATION Q&A & SAFE DRUG DROP OFF . H. SPEAKING OF WOMEN'S HEALTH 308 WOMEN IN ATTENDANCE. KDH PROVIDED: STEERING COMMITTEE SUPPORT FINANCIAL SPONSORSHIP AND IN-KIND SUPPORT FREE CHOLESTEROL TESTING FOR ALL PARTICIPANTS 80% OF ALL BREAKOUT SESSIONS SPEAKERS WERE IN-KIND KDH STAFF GIFT FOR PARTICIPANT GIFT BAG I. HEART HEALTH EDUCATION OFFERRED IN FEBRUARY4. 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 HEALTH SCREEN AVAILABLE FOR ALL STAFF WITH INSURANCE PREMIUM REDUCTION INCENTIVE PROGRAM AVAILABLE FOR EMPLOYEES WITH HEALTH INSURANCE. 3 WELLNESS CHALLENGES: TRIPLE THREAT WEIGHT LOSS CHALLENGE GET IN SHAPE IN INDIANA CHALLENGE STRESS LESS 5 ON-SITE EMPLOYEE WELLNESS CLASSES HEART MONTH ACTIVITIES WEIGHT WATCHERS AT WORK PROGRAM HELD THE FIRST QUARTER OF 2014 THREE STRIVE FOR 5 WEIGHT LOSS CLASSES HELD (5 WEEK SERIES) 5. COMMUNITY SERVICE ACTIVITIES: A. CANCER SURVIVORS DAY: HELD IN CONJUNCTION WITH THE RELAY FOR LIFE. SERVED ABOUT 200 PEOPLE. B. SUPPORT GROUPS: BREAST CANCER SUPPORT GROUP C. ACTIVE ATTENDANCE AND PARTICIPATION IN: CASA (COALITION AGAINST SUBSTANCE ABUSE, JEFFERSON COUNTY). SCAT (SWITZERLAND COUNTY AWARENESS TEAM). TPCC (TOBACCO PREVENTION & CESSATION COMMISSION). D. KDH RUN THE FALLS 5K WALK/RUN HELD AT CLIFTY FALLS STATE PARK 208 PEOPLE PARTICIPATED E. PEP WALK PROGRAM 12-WEEK FREE COMMUNITY WALKING PROGRAM F. EMS STAND-BY AT ALL COMMUNITY ACTIVITIES: EMS PROVIDES STAND-BY COVERAGE AT ALL JEFFERSON COUNTY ACTIVITIES. G. 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. 1 PART I, LINE 2: FUNDS ARE NOT GRANTED TO ORGANIZATIONS BUT ARE DONATED. DONATIONS ARE DETERMINED ON A DISCRETIONARY BASIS. NO ONE ENTITY OR INDIVIDUAL RECEIVED $5,000 OR MORE DURING THE YEAR. X X X X 0 0 0 0 0 0 0 0 0 JONATHAN HANSON MD BOARD MEMBER/PHYSICIAN 273275 0 149220 0 360 0 13000 0 26930 0 462785 0 0 0 PAT STACK MD BOARD MEMBER/PHYSICIAN 169895 0 117803 0 1032 0 13000 0 28101 0 329831 0 0 0 CAROL DOZIER PRESIDENT/CEO 340956 0 35 0 552 0 13000 0 1393 0 355936 0 0 0 STEVE MEACHAM VP FINANCE 189909 0 35 0 19084 0 9767 0 19172 0 237967 0 0 0 LISA MORGAN VP PATIENT SERVICES 142824 0 35 0 18052 0 7325 0 23484 0 191720 0 0 0 DENINE FALLIS-HALLGARTH VP PHYSICIAN PRACTICES 122584 0 35 0 18052 0 6349 0 11320 0 158340 0 0 0 HOLLY ROBINSON VP QUALITY 203349 0 76281 0 17740 0 13000 0 26978 0 337348 0 0 0 THOMAS ECKERT MD EMPLOYED PHYSICIAN 423664 0 315758 0 1584 0 13000 0 16232 0 770238 0 0 0 TRAVIS CLEGG MD EMPLOYED PHYSICIAN 577509 0 720494 0 79708 0 13000 0 26713 0 1417424 0 0 0 WILLIAM SKILES MD EMPLOYED PHYSICIAN 448532 0 178129 0 1032 0 13000 0 13773 0 654466 0 0 0 MICHAEL SCHMIDT MD EMPLOYED PHYSICIAN 445191 0 182823 0 15728 0 13000 0 27959 0 684701 0 0 0 GEORGE ALCORN MD EMPLOYED PHYSICIAN 322492 0 224503 0 8884 0 13000 0 10165 0 579044 0 0 0 ROGER ALLMAN FORMER PRESIDENT/ CEO 0 0 0 0 298536 0 0 0 0 0 298536 0 0 0 LARRY KEITH FORMER VP CLINICAL SERVICES 0 0 0 0 159311 0 0 0 0 0 159311 0 0 0 PART II 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. A INDIANA FINANCE AUTHORITY 351602316 45471ACW0 2010-11-03 97847058 SEE PART VI 0 0 0 A 97847058 6756861 1749243 88974097 366857 2013 0 0 1 1 A 0 0 1 1 0 0 0 0 A 0 0 0 0 0 0 0 0 1 A 1 SCH K PART I LINE A - PURPOSE THE PURPOSE OF THE BOND ISSUANCE IS TO FINANCE, REFINANCE, OR REIMBURSE A PORTION OF THE COSTS OF ACQUIRING, CONSTRUCTING, RENOVATING AND EQUIPPING VARIOUS HEALTH CARE FACILITIES OF THE HOSPITAL, INCLUDING A REPLACEMENT ACUTE CARE HOSPITAL FACILITY AND A MEDICAL OFFICE BUILDING. DR MICHAEL SCHMIDT PRATICE COMMENCEMENT ASSISTANCE X 75000 9808 0 1 1 DR TRAVIS CLEGG PRATICE COMMENCEMENT ASSISTANCE X 176664 25000 0 1 1 DR TRAVIS CLEGG INTERIM LIVING EXPENSE ASSISTANCE X 93333 19231 0 1 1 54039 A DATTILO FRUIT COMPANY VICE PRESIDENT OF PATIENT SERVICES OF KDHHS HAS 51% OWNERSHIP INTEREST 37572 LISA MORGAN, VICE PRESIDENT OF PATIENT SERVICES OF KDHHS OWNS A 51% INTEREST IN A. DATILLO FRUIT COMPANY. KDHHS PURCHASES PRODUCE FROM A. DATTILO FRUIT COMPANY. 0 RIVER VALLEY FINANCIAL BANK BOARD MEMBER IS THE SPOUSE OF PRESIDENT AND CEO OF RIVER VALLEY FIN. BANK 0 ANDREA FORRESTER, BOARD ASST TREASURER, IS MARRIED TO THE PRESIDENT AND CEO OF RIVER VALLEY FINANCIAL BANK. THE HOSPITAL'S OPERATING ACCOUNT IS WITH THE BANK, AND DURING 2014, THE HOSPITAL HELD RIVERVALLEY PREFERRED STOCK TOTALING 1,000,000 (THE PREFERRED STOCK WAS REDEEMED BY THE BANK BY YEAR-END). THE HOSPITAL RECORDED INTEREST INCOME OF $145,772, DIVIDEND INCOME OF $72,500 AND SERVICE FEES OF $7,395 FROM ACTIVITY WITH THE BANK. 0 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 11 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 CONSUMER PRICE INDEX FOR ALL URBAN CONSUMERS (CPI-U) FOR THE PRIOR TWELVE MONTH PERIOD IS ALSO REVIEWED AND CONSIDERED. 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 -14,458. ROUNDING 1. 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 MONTH, AND MEETS ONCE PER YEAR WITH THE INDEPENDENT AUDITORS. THE KING'S DAUGHTERS' HOSPITAL FOUNDATION INC PO BOX 447 MADISON IN 47250 202148950 FUNDRAISING TO SUPPORT THE PROVISION OF HEALTHCARE SERVICES IN 501(C)(3) LINE 7 N/A 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 1 0 1 THE KING'S DAUGHTERS' HOSPITAL FOUNDATION INCORPORATED O 148109 THE KING'S DAUGHTERS' HOSPITAL FOUNDATION INCORPORATED Q 44068 THE KING'S DAUGHTERS' HOSPITAL FOUNDATION INCORPORATED N 29893