2011-09-23T13:17:30-05:00 2010-12-31 BLUE & CO LLC 2650 EASTPOINT PKY LOUSIVILLE KY 40223 990 2010-01-01 350895832 THE KING'S DAUGHTERS' HOSPITAL AND HEALTH SERVICES KING 8122655211 ONE KINGS DAUGHTERS DRIVE MADISON IN 47250 STEVE MEACHAM 8122655211 2011-09-23 1 CARRIE A MERRILL CPA 5029923500 2010 2016-03-07 17:11:31Z STEVE MEACHAM ONE KINGS DAUGHTERS DRIVE MADISON IN 47250 141510592 0 X WWW.KDHHS.ORG X 1899 IN THE MISSION OF THE HOSPITAL IS TO IMPROVE THE HEALTH OF THE HOSPITAL'S PATIENTS THROUGH CARE, SERVICE, AND EDUCATION. 11 9 1071 110 51520 0 234056 111292 112523063 111975580 -910384 1926894 349597 383135 112196332 114396901 39041 90566 0 0 60951495 61651819 0 0 0 45677505 45965238 106668041 107707623 5528291 6689278 128221022 222731294 24103683 108562005 104117339 114169289 THE MISSION OF THE HOSPITAL IS TO IMPROVE THE HEALTH OF THE HOSPITAL'S PATIENTS THROUGH CARE, SERVICE, AND EDUCATION. 0 0 92832840 111992163 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 CALENDAR YEAR 2010, THE HOSPITAL PROVIDED HEALTHCARE TO PATIENTS AT THE FOLLOWING LEVELS:12,702 DAYS OF CARE TO ACUTE INPATIENTS926 DAYS OF CARE TO NEWBORN INFANTS172,276 VISITS ASSOCIATED WITH HOSPITAL OUTPATIENTS131,434 VISITS ASSOCIATED WITH PHYSICIAN CLINICS 3373317 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 2010, THE KING'S DAUGHTERS' HOSPITAL AND HEALTH SERVICES PROVIDED $3,373,317 IN CARE TO PATIENTS WHO MET THE HOSPITAL'S CHARITY CARE POLICY. 96206157 1 1 0 1 0 0 0 0 1 1 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 1 0 1 0 1 1 0 0 0 0 0 1 0 0 0 1 0 0 0 0 0 1 0 0 0 0 1 96 0 1 1071 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 8122650193 ONE KINGS DAUGHTERS DRIVE MADISON IN 47250 LESLIE GROTE 1.00 X X 5500 0 0 MAUREEN GETZ 1.00 X X 3250 0 0 PAULA HEIDERMAN 1.00 X X 2750 0 0 JEAN DONNELLON 1.00 X X 1500 0 0 LINDA SLOFFER 1.00 X X 3000 0 0 JENNIFER JOAS 1.00 X X 1250 0 0 TONY WALTZ 1.00 X 1500 0 0 PAM KIMMEL 1.00 X 1250 0 0 MARY BETTE VOYLES 1.00 X 0 0 0 EILEEN MCGARVEY MD 40.00 X 392575 0 22345 PAT STACK MD 40.00 X 217694 0 32233 ROGER ALLMAN 40.00 X 325430 0 34052 STEVE MEACHAM 40.00 X 196470 0 27141 MIKE BURNETT 40.00 X 150393 0 22601 LARRY KEITH 40.00 X 127028 0 20916 LISA MORGAN 40.00 X 125540 0 19221 CARL RISK 40.00 X 109780 0 18618 THOMAS ECKERT MD 40.00 X 757379 0 33810 GIL WEIZER MD 40.00 X 545303 0 34030 PAUL ROSENBERG MD 40.00 X 540266 0 33799 WILLIAM SKILES MD 40.00 X 530537 0 28425 ROBERT LEATHERMAN MD 40.00 X 522366 0 34420 4560761 0 361611 61 0 1 0 ARTEKNA DESIGN 321 E NEW YORK STREET INDIANAPOLIS IN 46204 ARCHITECTURE SERVICES 1498981 MADISON CATHETERIZATION SERVICES ONE KINGS DAUGHTERS DRIVE MADISON IN 47250 CARDIAC CATHETERIZATION SERVICES 566002 MAYO COLLABORATIVE SERVICES PO BOX 9146 MINNEAPOLIS MN 554809146 LABORATORY SERVICES 476682 BLUE & CO LLC 2650 EASTPOINT PARKWAY STE 300 LOUISVILLE KY 40223 AUDITING AND CONSULTING SERVICES 472859 SOUTHEASTERN EMERGENCY PHYSICIANS INC PO BOX 634850 CINCINNATI OH 45263 CONTRACTED PHYSICIAN MEDICAL SERVICES 352577 13 68700 42592 10001 111292 NET PATIENT SERVICE RE 621110 111975580 111924060 51520 111975580 1718531 1718531 66797 69241 -2444 -2444 -2444 27243413 9400 27027536 16914 215877 -7514 208363 208363 CAFETERIA REVENUE 722210 219564 219564 GIFT SHOP 453220 95468 95468 OTHER 621110 36672 36672 33875 33875 385579 114396901 111992163 51520 2241926 90566 90566 1862037 1489630 372407 47326313 42287648 5038665 2951337 2656203 295134 6445919 5801327 644592 3066213 2759592 306621 214187 214187 755517 755517 271595 271595 70987 63888 7099 1720289 1410637 309652 376769 339092 37677 1517256 1365530 151726 165416 148874 16542 601187 541068 60119 4934236 4440812 493424 1301390 1171251 130139 BAD DEBTS 13575949 13575949 DRUGS 6298600 6298600 SUPPLIES 4984093 4236479 747614 PURCHASED SERVICES 4865536 4378982 486554 OFFICE COLLECTIONS 536524 482872 53652 3775707 2667157 1108550 107707623 96206157 11501466 0 20728378 8699077 11745113 11212808 362960 324614 418152 556234 1889855 1970608 1074678 1038484 96755971 54429002 37055155 42326969 52427631 153056023 2519100 3546477 128221022 222731294 8021979 8631077 12050000 97853607 1328633 925638 2703071 1151683 24103683 108562005 X 103989784 114032135 117555 127154 10000 10000 104117339 114169289 128221022 222731294 X 6689278 3362672 X X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 8245 8245 0 EXPLANATION OF OTHER LOBBYING ACTIVITIES: PART II-B, LINE 1I: PORTION OF INDIANA HOSPITAL ASSOCIATION DUES ATTRIBUTABLE TO LOBBYING EXPENSES AS DEFINED BY FEDERAL LAW. 127555 62386 52787 137154 89334 84150 45929 127555 105321 20051 36038 89334 0.07000 0.93000 0 0 5442334 5442334 42695331 26306111 16389220 12960 2849 10111 38568861 28120042 10448819 10036485 10036485 42326969 DEFERRED COMPENSATION 851683 THIRD PARTY PAYABLE 300000 1151683 114396901 107707623 6689278 3430252 -67580 3362672 10051950 117573833 3430252 69241 3499493 114074340 271595 50966 322561 114396901 107454303 69241 69241 107385062 271595 50966 322561 107707623 DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: 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 12/31/2010. TEMPORARILY RESTRICTED NET ASSETS ARE DONOR-RESTRICTED FOR A SPECIFIC USE INCLUDING: PRENATAL/POSTNATAL EDUCATION PROGRAM FUND, TOBACCO SETTLEMENT FUND, TEEN EVENT FUND, GIRLS ON THE RUN FUND, AND MAY LIBRARY FUND. PART XI, LINE 8 - OTHER ADJUSTMENTS: MEMBERS' WITHDRAWAL -67,580. PART XII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES 69,241. PART XII, LINE 4B - OTHER ADJUSTMENTS: GRANTS 50,966. PART XIII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES 69,241. PART XIII, LINE 4B - OTHER ADJUSTMENTS: GRANTS 50,966. 1 1 1 X 1 X 0.0 1 1 0 1 1 1270223 1270223 0.01350 12139400 3726712 8412688 0.08940 13409623 3726712 9682911 0.10290 310657 3321 307336 0.00330 223499 33875 189624 0.00200 5326925 4059110 1267815 0.01350 96244 96244 0.00100 5957325 4096306 1861019 0.01980 19366948 7823018 11543930 0.12270 2703 2703 0.00000 2703 2703 0 5112024 0 20755547 20708271 47276 X 1 1 1 MADISON CATHETERIZATION SERVICES LLC PROVIDES CATHETERIZATION SERVICES 0.51000 0.00000 0.00000 1 1 KDHHS

ONE KINGS DAUGHTERS DRIVE MADISON IN 47250

X KDHHS 1 1 X X X X X X X X X X 10 1 0 1 X X X X X X X X X X X 0 1 1 150.000000000000 1 250.000000000000 1 X X X X X 1 1 X X X 1 X X X 1 X X X X X X X 1 X 0 0 10 REHABILITATION CENTER AND HOME CARE

2670 N MICHIGAN ROAD MADISON IN 47043

PHYSICIAN MEDICAL OFFICE HILLTOP CLINIC

445 CLIFTY DRIVE MADISON IN 47250

PHYSICIAN MEDICAL OFFICE VERSAILLES CLINIC - MAIN STREET

128 NORTH MAIN STREET VERSAILLES IN 47042

PHYSICIAN MEDICAL OFFICE KING'S DAUGHTER'S MEDICAL BUILDING

206 W TYSON STREET VERSAILLES IN 47042

PHYSICIAN MEDICAL OFFICE TRIMBLE COUNTY MEDICAL BUILDING

10235 US HIGHWAY 421 MILTON KY 40045

PHYSICIAN MEDICAL OFFICE RIVERBOURNE MEDICAL CENTER

205 MARWILL DRIVE CARROLLTON KY 41008

PHYSICIAN MEDICAL OFFICE SWITZERLAND COUNTY MEDICAL BUILDING

745 WEST HIGHWAY 56 VEVAY IN 47043

PHYSICIAN MEDICAL OFFICE HANOVER CLINIC

36 MEDICAL PLAZA HANOVER IN 47243

PHYSICIAN MEDICAL OFFICE VEVAY CLINIC

213 WEST MAIN STREET VEVAY IN 47043

PHYSICIAN MEDICAL OFFICE CONVENIENT CARE CENTER

443 EAST CLIFTY DRIVE MADISON IN 47043

PHYSICIAN MEDICAL OFFICE PART I, LINE 3C: THE HOSPITAL USES A SLIDING FEE SCALE ARRANGEMENT TO PROVIDE DISCOUNTED CARE TO LOW INCOME INDIVIDUALS. THE SCALE IS AS FOLLOWS:INCOME EQUAL TO 0-150% OF FPG = 100% WRITEOFFINCOME EQUAL TO 151-175% OF FPG = 80% WRITEOFFINCOME EQUAL TO 176-200% OF FPG = 60% WRITEOFFINCOME EQUAL TO 201-225% OF FPG = 40% WRITEOFFINCOME EQUAL TO 226-250% OF FPG = 20% WRITEOFF PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 13575949. PART II: NA PART III, LINE 4: PATIENT ACCOUNTS RECEIVABLE AND NET PATIENT SERVICE REVENUE - THE HOSPITAL HAS AGREEMENTS WITH THIRD-PARTY PAYORS THAT PROVIDE FOR PAYMENTS TO THE HOSPITAL AT AMOUNTS DIFFERENT FROM ITS ESTABLISHED RATES. PAYMENT ARRANGEMENTS INCLUDE PROSPECTIVELY DETERMINED RATES PER DISCHARGE, REIMBURSED COSTS, DISCOUNTED CHARGES, AND FEE SCHEDULE PAYMENTS. PATIENT ACCOUNTS RECEIVABLE AND NET PATIENT SERVICE REVENUE ARE REPORTED AT THE ESTIMATED NET REALIZABLE AMOUNTS FROM PATIENTS, THIRD-PARTY PAYORS, AND OTHERS FOR SERVICES RENDERED, INCLUDING ESTIMATED RETROACTIVE ADJUSTMENTS UNDER REIMBURSEMENT AGREEMENTS WITH THIRD-PARTY PAYORS. RETROACTIVE ADJUSTMENTS ARE ACCRUED ON AN ESTIMATED BASIS IN THE PERIOD AND THE RELATED SERVICES ARE RENDERED AND ADJUSTED IN FUTURE PERIODS AS FINAL SETTLEMENTS ARE DETERMINED.ALLOWANCES FOR PATIENT UNCOLLECTIBLE ACCOUNTS - THE HOSPITAL ESTIMATES AN ALLOWANCE FOR UNCOLLECTIBLE PATIENT ACCOUNTS RECEIVABLE BASED ON AN EVALUATION OF THE AGING OF THE ACCOUNTS, HISTORICAL LOSSES, CURRENT ECONOMIC CONDITIONS, AND OTHER FACTORS UNIQUE TO ITS SERVICE AREA AND THE HEALTHCARE INDUSTRY.THE COSTING METHODOLOGY USED TO DETERMINE THE AMOUNTS REPORTED ON LINE 2 IS APPLICATION OF THE COST-TO-CHARGE RATIO (AS COMPUTED PER WORKSHEET 2 IN 990 INSTRUCTIONS).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 8: THE HOSPITAL DETERMINED AMOUNTS FROM DATA SUBMITTED IN ITS 2010 MEDICARE COST REPORT. PART III, LINE 9B: N/A KDHHS PART V, SECTION B, LINE 1J: 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. KDHHS PART V, SECTION B, LINE 3: 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 KDHHS INCLUDING BOARD, STAFF AND MEDICAL STAFF;- IN-DEPTH-INTERVIEWS BY TELEPHONE OR IN-PERSON WITH 32 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 23 SENIOR CITIZENS;- A WEB-BASED SURVEY OPEN TO THE GENERAL PUBLIC WHICH RESULTED IN 61 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 KDHHS COULD HAVE AN IMPACT. KDHHS PART V, SECTION B, LINE 5C: 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 AND IS ALSO AVAILABLE ON OUR WEB SITE. KDHHS PART V, SECTION B, LINE 7: AS A RESULT OF THE 2010 COMMUNITY NEEDS ASSESSMENT, KDHHS WAS ABLE TO IDENTIFY 'GAPS' WHICH EXIST BETWEEN THE HOSPITAL'S COMMUNITY INVOLVEMENT AND THE UNFULFILLED NEEDS OF THE COMMUNITY WHICH IT SERVES. THESE NEEDS WERE IDENTIFIED VIA INQUIRIES OF COMMUNITY MEMBERS WHICH ARE DETAILED AT PART V LINE 3. THE EXAMPLES OF THESE ARE AS FOLLOWS:- THERE DO NOT APPEAR TO BE LARGE GAPS IN THE TOPICS OR TYPES OF COMMUNITY OUTREACH PROGRAMS THAT KDHHS 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. - SOME INDIVIDUALS ALSO EXPRESSED THE IDEA THAT RESIDENTS IN THE COMMUNITY SERVED BY KDHHS 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. - THE GAPS IN THE CURRENT MEDICAL SERVICE LINES AND THE MEDICAL SPECIALTIES DESIRED ARE WORTH EXPLORING. HOWEVER, THIS ANALYSIS FOCUSES ONLY ON EXPRESSED NEEDS AND DOES NOT CONTAIN PATIENT PROJECTION INFORMATION OR FINANCIAL ANALYSIS FOR A BUSINESS CASE ANALYSIS. - 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 AND HAVE AN IMPACT ON PATIENTS SERVED BY KDHHS FACILITIES. THE MAJORITY OF COMMUNITY LEADERS EXPECT KDHHS TO TAKE A LEADERSHIP ROLE IN ADDRESSING OVERWEIGHT AND OBESITY AND TOBACCO USE. THOSE IN OUTLYING COUNTIES HAVE ASKED THAT CURRENT KDHHS 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. 1. KDHHS SHOULD CONSIDER WAYS IN WHICH IT CAN SET AN EXAMPLE AT ITS OWN FACILITIES FOR THE COMMUNITY; TOBACCO-FREE CAMPUS, HEALTHY FOOD OFFERINGS IN ITS CAFETERIA, WELLNESS PROGRAM.2. IT SHOULD CONSIDER ASKING FOR GRANTS TO OFFER COMMUNITY OUTREACH PROGRAMS TO EDUCATE INDIVIDUALS ON TOPICS SUCH AS NUTRITION, HEALTHY WEIGHT, HEALTHY EATING, AND EXERCISE.- SUBSTANCE ABUSE - PARTICULARLY NARCOTIC AND PRESCRIPTION DRUGS, WAS ANOTHER TOP MAJOR HEALTH NEED CITED BY ALL GROUPS INTERVIEWED. IT IS PREVALENT IN ALL COUNTIES SERVED BY KDHHS.1. THE LACK OF SUBSTANCE TREATMENT CENTERS AND MENTAL CARE FACILITIES TO REFER THESE TYPES OF PATIENTS TO IS A MAJOR CONCERN. 2. 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/DETOXIFICATION REQUIRED. 3. THE NEED FOR FURTHER DRUG EDUCATION IN THE SCHOOLS FROM ELEMENTARY ON UP WAS MENTIONED NUMEROUS TIMES 4. BETTER COMMUNICATION BETWEEN KDHHS 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. KDHHS PHYSICIANS MENTIONED THAT THEY WOULD LIKE TO KNOW FROM THE LEGAL SYSTEM WHEN ONE OF THE DRUGS THEY PRESCRIBED IS INVOLVED IN A CASE.5. THERE IS A NEED FOR A QUARTERLY PRESCRIPTION DRUG DISPOSAL PROGRAM WHERE SUCH DRUGS CAN BE DISPOSED WITH NO QUESTIONS ASKED. - WHILE KDHHS 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 AN ON-STAFF PSYCHIATRIST OR AN IMPROVED REFERRAL PROGRAM FOR THOSE WITH MENTAL ILLNESS. KDHHS 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 KDHHS TO DETERMINE WHAT SUPPORTING ROLE IT CAN PROVIDE TO THE COMMUNITY IN THIS AREA.- ACCESS TO HEALTH CARE WAS VIEWED AS A MAJOR ISSUE BY THOSE RESPONDENTS OF THE WEB-BASED SURVEY AND BY THE LOWER INCOME CATEGORY. THERE APPEARS TO BE A NEED TO MAKE INDIVIDUALS WITHIN THE COMMUNITY MORE AWARE OF HEALTH CARE SERVICES AVAILABLE TO THEM RATHER THEY BE INSURED OR UNINSURED. THE VAST MAJORITY OF COMMUNITY LEADERS EXPECT KDHHS TO TAKE A LEADERSHIP ROLE IN ACCESS TO HEALTH CARE. IN ADDITION TO CONCERNS ABOUT ACCESS FOR LOW-INCOME OR THE UNDERINSURED OR UNINSURED, THERE ARE SOME CONCERNS ABOUT ACCESS TO:1. GETTING AN APPOINTMENT WITH A PHYSICIAN QUICKLY WHEN NEEDED2. GETTING SEEN IN THE EMERGENCY DEPARTMENT QUICKLY3. EVENING APPOINTMENTS FOR THOSE UNABLE TO LEAVE WORK DURING THE DAY-DUE TO AN AGING WORKFORCE, IT IS ADVISABLE FOR KDHHS TO PUT A CONTINGENCY PLAN IN PLACE TO DEAL WITH ITS AGING NURSING WORKFORCE. KDHHS PART V, SECTION B, LINE 17E: IN ADDITION TO THE ACTIONS PREVIOUSLY LISTED, A FINANCIAL AID COUNSELOR WILL MEET WITH ANY UNINSURED INPATIENTS PRIOR TO DISCHARGE TO DISCUSS THE FINANCIAL ASSISTANCE POLICY. KDHHS PART V, SECTION B, LINE 19D: PATIENTS WITHOUT INSURANCE COVERAGE WILL RECEIVE A DISCOUNT BASED ON THE GREATER OF THE FOLLOWING:1) 20% DISCOUNT FROM GROSS CHARGES (WHICH IS HIGHER THAN ANY NEGOTIATED COMMERCIAL INSURANCE DISCOUNT FROM CHARGES CONTRACT)2) THE APPLICABLE SLIDING FEE SCALE ADJUSTMENT BASED ON THE PATIENT'S COMPLETED FINANCIAL ASSISTANCE APPLICATION PART VI, LINE 2: KING'S DAUGHTERS' HOSPITAL AND HEALTH SERVICES CONDUCTED A COMMUNITY NEEDS ANALYSIS DURING 2010 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). THE LAST TIME A COMMUNITY NEEDS ASSESSMENT WAS CONDUCTED WAS IN 2007. THE FOCUS OF THIS ASSESSMENT WAS ON THE HEALTH NEEDS THAT COULD BE ADDRESSED BY KDHHS AND CAN BE USED BY KDHHS 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 KDHHS INCLUDING BOARD, STAFF AND MEDICAL STAFF;- IN-DEPTH-INTERVIEWS BY TELEPHONE OR IN-PERSON WITH 32 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 23 SENIOR CITIZENS;- A WEB-BASED SURVEY OPEN TO THE GENERAL PUBLIC WHICH RESULTED IN 61 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 KDHHS 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 PART VI, LINE 3: THE HOSPITAL HAS SIGNAGE WHICH ENCOURAGES PATIENTS TO CONTACT CUSTOMER SERVICE FOR INFORMATION REGARDING BILLS, ELIGIBILITY FOR ASSISTANCE UNDER FEDERAL/STATE GOVERNMENT PROGRAMS AND THE HOSPITAL'S CHARITY CARE POLICY. SIGNS ARE POSTED IN SEVERAL AREAS FREQUENTLY ACCESSED BY PATIENTS. DISCUSSIONS REGARDING FINANCIAL ISSUES, AVAILABILITY OF FINANCIAL AID PROGRAMS, ELIGIBILITY REQUIREMENTS AND THE ASSOCIATED APPLICATION PROCESS ARE TYPICALLY DISCUSSED AT THE TIME OF REGISTRATION. THE HOSPITAL HAS A REPRESENTATIVE ON SITE TO ASSIST PATIENTS WITH THE FINANCIAL AID APPLICATION PROCESS. INFORMATION REGARDING THE HOSPITAL'S CHARITY CARE POLICY IS MADE AVAILABLE TO PATIENTS UPON REQUEST VIA A BROCHURE WHICH SUMMARIZES THE PROGRAM ELIGIBILITY REQUIREMENTS AND APPLICATION PROCESS. PATIENTS ARE REMINDED TO CONTACT CUSTOMER SERVICE REGARDING FINANCIAL AID AND FEDERAL/STATE ASSISTANCE DIRECTLY ON THE PATIENT BILL ITSELF. FURTHER, THE HOSPITAL'S WEBSITE INCLUDES LINKS TO THE FOLLOWING: "REQUEST A PRICE ESTIMATE", "ASK A BILLING QUESTION", "VIEW A SAMPLE BILL", "FINANCIAL AID APPLICATION", AND "INSURANCE PROVIDERS". PART VI, LINE 4: THE KING'S DAUGHTERS' HOSPITAL AND HEALTH SERVICES IDENTIFIES THE FOLLOWING AREAS AS ITS PRIMARY AND SECONDARY SERVICE AREAS:JEFFERSON COUNTY, IN: POPULATION 33,010PORTIONS OF RIPLEY COUNTY, INPORTIONS OF SWITZERLAND COUNTY, INPORTIONS OF TRIMBLE AND CARROLL COUNTIES, KYJEFFERSON COUNTY- JEFFERSON COUNTY IS EXPERIENCING A SLOW GROWTH IN TOTAL POPULATION, CURRENTLY AT 33,010, AND IS EXPERIENCING AN INWARD MIGRATION. BY 2020, THE POPULATION IS EXPECTED TO BE ABOUT 34,209. IT HAS A MEDIAN AGE OF 39.6, A SOMEWHAT OLDER POPULATION THAN THE STATE AVERAGE OF 36.7. THE UNEMPLOYMENT RATE OF 10.6% IS ABOVE THE INDIANA RATE OF 10.1%. THE POPULATION IS FAIRLY HOMOGENEOUS WITH A LARGELY CAUCASIAN POPULATION, 95%. THE AVERAGE HOUSEHOLD INCOME, OF $42,646, IS LOWER THAN THAT FOR INDIANA AND THE NATION. IN JEFFERSON COUNTY, ABOUT 13.2% OF THE INDIVIDUALS, OR ABOUT 4,357, LIVE BELOW THE POVERTY LEVEL, SIMILAR TO THE 12.9% POVERTY RATE OF INDIVIDUALS IN INDIANA AND MIRRORING THE 13.2% RATE FOR THE ENTIRE U.S. 53.9% OF ALL FAMILIES IN JEFFERSON COUNTY ARE SINGLE PARENT FAMILIES WITH 27.8% OF THESE FAMILIES IN POVERTY. IN INDIANA, 32.4% OF ALL FAMILIES ARE SINGLE PARENT FAMILIES WITH 27.6% 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. 30% OF ADULTS IN JEFFERSON COUNTY USE TOBACCO COMPARED TO 23% OF ADULTS LIVING IN THE STATE OF INDIANA. AN ESTIMATED 26.9% OF THE POPULATION AGE 18+ IS UNINSURED. 6% OF INDIVIDUALS WITH INSURANCE HAVE MEDICAID, A HIGHER PERCENT THAN INDIANA/4.9% OR THE NATION/4.5%. ACCORDING TO THE INDIANA STATE DEPARTMENT OF HEALTH 2009 REPORT, JEFFERSON COUNTY WAS NOT LISTED AS A COUNTY THAT HAD A SHORTAGE OF HEALTHCARE PROFESSIONALS OR OF MENTAL HEALTH PROFESSIONALS. HOWEVER, THE 2009 REPORT LISTS MILTON, SHELBY AND SMYRNA TOWNSHIPS AS MEDICALLY UNDERSERVED. THE RATE OF ALL CANCER INCIDENCE IS HIGHER IN JEFFERSON COUNTY, AT 521.6 FOR 100,000 POPULATION, THAN FOR INDIANA, AT 479.4 FOR 100,000 POPULATION. THE RATE OF LUNG AND BRONCHUS CANCER IS HIGHER IN JEFFERSON, AT 101.6 PER 100,000 POPULATION THAN FOR INDIANA AT 79.8 PER 100,000. THE RATE OF PROSTATE CANCER IS HIGHER IN JEFFERSON, AT 166.2 PER 100,000 POPULATION THAN FOR INDIANA AT 137.5 PER 100,000. THE RATE OF BREAST CANCER IN JEFFERSON IS HIGHER, AT 126.4 PER 100,000 POPULATION THAN FOR INDIANA AT 113.8 PER 100,000 POPULATION. THE RATE OF COLORECTAL CANCER IS LOWER IN JEFFERSON, AT 50.3 PER 100,000, THAN THE RATE FOR INDIANA, AT 52.2 PER 100,000. THE RATE OF ADULT ASTHMA IN JEFFERSON COUNTY, AT 7.13%, IS HIGHER THAN THE RATE FOR INDIANA, AT 6.88%, AS IS THE RATE OF CHRONIC BRONCHITIS (3.4% FOR JEFFERSON; 3.2% FOR INDIANA) AND FOR EMPHYSEMA (1.4% FOR JEFFERSON; 1.28% FOR INDIANA.) THE PERCENT OF MOTHERS WHO SMOKED DURING PREGNANCY IN JEFFERSON COUNTY IS 25.1% COMPARED TO THE STATE OF INDIANA AVERAGE OF 18.5%. IN 2007, THE PERCENT OF LOW-WEIGHT BIRTHS FOR JEFFERSON COUNTY WAS 8.9%, ABOVE THE 8.5% FOR INDIANA. THE NUMBER OF TEEN PREGNANCIES AMONG WOMEN 15 TO 19 YEARS OLD HAS DECREASED IN JEFFERSON COUNTY FROM 2002 TO THE MOST RECENT MEASUREMENT IN 2007. IN JEFFERSON COUNTY, THERE WERE 52 TEEN PREGNANCIES IN 2002 AND 46 TEEN PREGNANCIES IN 2007. IN INDIANA, AN OPPOSITE TREND TOOK PLACE - THERE WERE 11,378 TEEN PREGNANCIES IN 2002 AND 11,683 IN 2007. JEFFERSON COUNTY REPORTED 72 NEWLY DIAGNOSED CASES OF CHLAMYDIA IN 2008, AN INCREASE FROM THE 69 REPORTED IN 2007, BUT A DECREASE FROM THE 75 REPORTED IN 2006. THERE WERE 4 CASES OF GONORRHEA AND ONE CASE OF SYPHILIS REPORTED IN JEFFERSON COUNTY IN 2008. 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 DECREASED FROM 2005 - 359.9 PER 100,000 POPULATION TO 2007 - 309.1 PER 100,000 POPULATION. HOWEVER, THE 309.1 PER 100,000 POPULATION RATE IN 2007 IS HIGHER THAN BOTH THE INDIANA RATE OF 267.2 PER 100,000 AND THE NATIONAL RATE OF 190.9 PER 100,000. THE STROKE DEATH RATE IN JEFFERSON, AT 53.3 PER 100,000 POPULATION IN 2007, WAS HIGHER THAN THE 44.5 PER 100,000 POPULATION FOR INDIANA AND THE 45.1 PER 100,000 FOR THE NATION. RIPLEY COUNTY- RIPLEY COUNTY HAS A CURRENT POPULATION OF 27,421. THERE IS A NET OUTWARD MIGRATION. BY THE YEAR 2020, THE POPULATION WILL BE ABOUT 29,855. THE POPULATION IS 96.9% CAUCASIAN. THE HOUSEHOLD INCOME IN RIPLEY IS $51,603 - LOWER THAN THE NATIONAL AVERAGE OF $52,029, BUT HIGHER THAN THE INDIANA AVERAGE OF $48,010. THE PERCENT OF FAMILIES BELOW POVERTY IN RIPLEY IS 12.2%, LOWER THAN THE INDIANA AVERAGE OF 15.9% AND THE NATIONAL AVERAGE OF 16.5%. 42.3% OF ALL FAMILIES IN RIPLEY COUNTY ARE SINGLE PARENT FAMILIES WITH 26.8% OF THESE FAMILIES IN POVERTY. IN INDIANA, 32.4% OF ALL FAMILIES ARE SINGLE PARENT FAMILIES WITH 27.6% OF THESE FAMILIES IN POVERTY. THE PERCENT OF THOSE AGE 18+ WHO ARE UNINSURED IS 26%, COMPARED TO 27% FOR INDIANA AND 27.3% FOR THE NATION. IN RIPLEY COUNTY, 2,955 CHILDREN ARE ENROLLED IN HOOSIER HEALTHWISE. THE PERCENT OF MOTHER IN RIPLEY COUNTY WHO SMOKE DURING PREGNANCY IS 26.6%, COMPARED TO 18.5% IN INDIANA. THE PERCENT OF LOW BIRTH WEIGHT IN RIPLEY COUNTY IS 6.5%, COMPARED TO 8.5% IN INDIANA. IN RIPLEY COUNTY, THE NUMBER OF TEEN PREGNANCIES (GIRLS 15 TO 19) DECREASED FROM 48 IN 2002 TO 45 IN 2007. THIS REPRESENTS A 8.9% TEEN BIRTH RATE IN RIPLEY, COMPARED TO A 20.8% TEEN BIRTH RATE 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 LUNG CANCER IN RIPLEY WAS 119.7 PER 100,000 POPULATIONS COMPARED TO 59.7 FOR INDIANA IN 2007. THE PNEUMONIA/INFLUENZA DEATH RATE IN 2007 FOR RIPLEY COUNTY WAS 22.65 PER 100,000 WHICH IS HIGHER THAN INDIANA AT 16.04 AND THE NATION AT 17.5.SWITZERLAND COUNTY- SWITZERLAND COUNTY HAS A POPULATION OF 9,675 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 11,041. THE ETHNICITY IS 97.6% WHITE. THE UNEMPLOYMENT RATE IS 7.9% IN SWITZERLAND COUNTY, LOWER THAN THE INDIANA RATE OF 10.1%. THE AVERAGE ANNUAL HOUSEHOLD INCOME IS $42,209, COMPARED TO $48,010 FOR INDIANA AND $52,029 FOR THE NATION. IN SWITZERLAND, 23.9% OF THE FAMILIES ARE BELOW THE POVERTY LEVEL, COMPARED TO 15.9% OF INDIANA FAMILIES, AND 16.5% OF FAMILIES IN THE NATION. 26.8% OF THE CHILDREN IN SWITZERLAND COUNTY ARE BELOW THE POVERTY LEVEL. IN 2007, 26.3% OF ALL ADULTS AGE 25+ HAD LESS THAN A HIGH SCHOOL DIPLOMA, WHILE 26.8% OF THOSE AGE 18+ ARE UNINSURED, COMPARED TO 27% IN INDIANA AND 27.3% IN THE NATION. 864 CHILDREN IN SWITZERLAND COUNTY ARE ENROLLED IN HOOSIER HEALTHWISE. 8.1% OF INDIVIDUALS WITH INSURANCE HAVE MEDICAID, A HIGHER PERCENT THAN INDIANA/4.9% OR THE NATION/4.5%. THE TEEN BIRTH RATE FOR SWITZERLAND COUNTY IN 2007 WAS 36.3 PER 1,000 FEMALES AGE 15-17, AND IS SIGNIFICANTLY HIGHER THAN THE INDIANA RAGE OF 22 PER 1,000. THE RATE OF MOTHERS SMOKING DURING PREGNANCY IS 29.6% IN SWITZERLAND COUNTY, COMPARED TO 18.5% IN INDIANA. IN SWITZERLAND, THERE IS A 9.6% LOW BIRTH WEIGHT, COMPARED TO 8.5% IN INDIANA. IN 2009, 30% OF ALCOHOL RELATED FATALITIES IN SWITZERLAND COUNTY HAD A BLOOD ALCOHOL CONCENTRATION (BAC) OF 0.1 OR HIGHER COMPARED TO 29% FOR INDIANA. SWITZERLAND COUNTY HAS A SHORTAGE OF HEALTH CARE PROFESSIONALS. ALL AREAS OF SWITZERLAND COUNTY ARE CONSIDERED MEDICALLY UNDERSERVED. SWITZERLAND COUNTY HAS A SHORTAGE OF MENTAL HEALTH PROFESSIONALS. THE RATE OF CHRONIC BRONCHITIS IN SWITZERLAND COUNTY, IS 3.4%, SIMILAR TO THE INDIANA RATE OF 3.2%. THE RATE OF EMPHYSEMA IN SWITZERLAND IS 1.38%, SIMILAR TO THE INDIANA RATE OF 1.28%. THERE ARE 379 ADULTS WITH SERIOUS MENTAL ILLNESS IN SWITZERLAND COUNTY AND 78 SERIOUSLY EMOTIONALLY DISTURBED CHILDREN. THE STROKE DEATH RATE PER 100,000 POPULATION IN 2007 WAS 67.9 FOR SWITZERLAND COUNTY COMPARED TO 44.5 FOR INDIANA AND 45.1 FOR THE NATION. PART VI, LINE 6: THE MAJORITY OF THE KING'S DAUGHTERS' HOSPITAL AND HEALTH SERVICES 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, KDHHS 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, KDHHS 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. IN ADDITION, IN 2007 THE HOSPITAL COMPLETED A COMPREHENSIVE NEEDS ASSESSMENT AND HAVE ADDED: OBESITY, PHYSICIAL ACTIVITY, AND TOBACCO USE TO OUR LIST OF HEALTH INITIATIVES FOR THE COUNTIES SERVED BY THE HOSPITAL.OVERVIEW OF 2010 COMMUNITY BENEFIT ACTIVITIES1. HEALTH SCREENS74 COMMUNITY HEALTH SCREENS 21 CORPORATE HEALTH SCREENS51 SKIN CANCER SCREENS PERFORMED AT 1 EVENT30 BREAST CANCER SCREENS PERFORMED AT 1 EVENT87 COLON CANCER SCREENS PERFORMED370 STUDENTS BENEFITED FROM HIGH SCHOOL SPORTS PHYSICALS265 CORPORATE FLU SHOTS GIVEN120 FLU SHOTS SOLD TO IVY TECH FOR SELF ADMINISTRATION2. HEALTH FAIRSHEARTBEATS HEALTH FAIR IN VERSAILLESRIPLEY COUNTY 4H FAIRJEFFERSON COUNTY 4H FAIR: HOSPITAL AND CASA BOOTHSBELTERRA EMPLOYEE HEALTH FAIRHEALTHY KIDS DAY AT YMCA IN VEVAYREMC HEALTH FAIR IN VERSAILLESCOMMUNITY DAY AT WINDRIDGE/PRESIDENTIALNORTH MADISON CHRISTIAN CHURCH HEALTH FAIRECO15 DAY AT IVY TECH3. COMMUNITY EDUCATIONSPEAKERS BUREAU - 36 SPEAKING ENGAGEMENTS IN 2010SAFE SITTER CLASSES - 3 CLASSES AND 47 GRADUATESACE FIT KIDS PROGRAM - 337 STUDENTS IN 9 SCHOOLS AND 17 CLASSROOMSSMOKING CESSATION CLASSES - 14 GRADUATES IN ADULT PROGRAM, 56 YOUTH IN TAP/TEG PROGRAM COURSE PRIDE YOUTH PROGRAM - 40 YOUTH CONTRACTED TO PARTICIPATE AND REMAIN DRUG AND ALCOHOL FREECPR AND FIRST AID CLASSES - 600 GRADUATES CREATING POSITIVE RELATIONSHIPS/ABSTINENCE EDUCATION PROGRAM - 1,400 PARTICIPANTS FROM 4 SCHOOLSPRENATAL AND LAMAZE CLASSES (HELD QUARTERLY BY OB DEPARTMENT) - SERVED APPROXIMATELY 64 COUPLES AND 28 SIBLINGS GIRLS ON THE RUN PROGRAM - 60 PARTICIPANTS FROM LOCAL SCHOOLS (GRADES 3-5) AND 196 PARTICIPANTS IN A 5K RUNWELLNESS CLASSES - 8 TYPES OF CLASSES PLUS YOGA OFFERED IN 5-6 WEEKLY CLASS SESSIONSLIFESKILLS CURRICULUM (DRUG AND ALCOHOL AWARENESS PROGRAM FOR YOUTH) - OFFERED AT 4 SCHOOLS FOR 6TH THROUGH 8TH GRADERS4. EMPLOYEE HEALTHEMPLOYEE HEALTH NEWSLETTER - ON-LINE PUBLICATION THROUGHOUT THE YEAREMPLOYEE WEIGHT WATCHERS - OFFERED THROUGHOUT 2010SPECIAL EMPLOYEE WELLNESS PROGRAMS - WELLNESS COLUMN IN THE MONITOR, WELLNESS CALENDAR DISTRIBUTION, ONE LUNCH AND LEARN EDUCATION SESSION (WORKOUT WITH WATER, 28 PARTICIPANTS), 2 QUARTERLY WELLNESS CHALLENGES (BIGGEST LOSER WITH 147 PARTICIPANTS, A TO Z BACK TO BETTER HEALTH: 194 PARTICIPANTS)5. COMMUNITY SERVICE ACTIVITIESCANCER SURVIVORS DAY (IN CONJUNCTION WITH RELAY FOR LIFE) - SERVED AROUND 300 PEOPLECHAUTAUQUA - FIRST AID BOOTH (SUPPLIES ONLY)SUPPORT GROUPS - BREAST CANCER, DIABETES, SURVIVING SPOUSE, NEW MOMSACTIVE ATTENDANCE AND PARTICIPATION IN: CASA (COALITION AGAINST SUBSTANCE ABUSE, JEFFERSON COUNTY) SCAT (SWITZERLAND COUNTY AWARENESS TEAM) ITPC (INDIANA TOBACCO PREVENTION CESSATION) JEFFERSON AND SWITZERLAND COUNTIES RED RIBBON WEEK CAMPAIGN - MADISON SCHOOLS, SOUTHWESTERN, AND SWITZERLAND COUNTIES PRIDE NATIONAL CONFERENCE - 16 YOUTH ATTENDED KDH CLIFTY WALK/RUN - 248 PARTICIPANTS IN 5K AND 12 IN KIDS K PRIDE RELAY FOR LIFE TEAM6. SUCCESSFUL GRANT ACTIVITYISDH PROJECT RESPECT GRANT - FUNDS THE CPR (CREATING POSITIVE RELATIONSHIPS) PROGRAM COORDINATOR FROM OCTOBER OF 1999 UNTIL SEPTEMBER 2002. EXTENDED ONE MORE YEAR (SEPT 2003). PROGRAM LOST FUNDING IN SEPTEMBER 2003. TAUGHT BY VOLUNTEERS FROM OCTOBER 2003 UNTIL DECEMBER 2005. REAPPLIED AND FUNDED IN NOVEMBER 2005 THROUGH SEPTEMBER 2007. NEW COORDINATOR HIRED. REAPPLIED IN FEBRUARY 2007 FOR FUNDING IN OCTOBER 2007. FUNDING PULLED AT THE FEDERAL LEVEL, THEN LOST STATE FUNDING. WE HAVE BEEN OPERATING SINCE THAT TIME FROM PRIVATE DONATIONS AND SCHOOL BASED FUNDING. ITPC: INDIANA TOBACCO PREVENTION AND CESSATION:FUNDING RECEIVED FROM THE STATE FOR JEFFERSON AND SWITZERLAND COUNTIES. FULL TIME COORDINATOR IN PLACE FOR FULL YEAR OF 2010.CASA/SCAT GRANTS:TO FUND NICOTINE REPLACEMENT THERAPY FOR INDIVIDUALS WISHING TO QUIT SMOKING.INDIANA YOUTH INSTITUTE:RECEIVED A $726 GRANT FROM THE INDIANA YOUTH INSTITUTE. THIS GRANT COVERED EXPENSES ASSOCIATED WITH THE GIRLS ON THE RUN PROGRAM.7. PUBLIC RELATIONS ACTIVITIESEMS STAND-BY AT ALL COMMUNITY EVENTS:EMS PROVIDES STAND-BY COVERAGE AT ALL JEFFERSON COUNTY ACTIVITIES. PART VI, LINE 7: NA REPORTS FILED WITH STATES PART VI, LINE 7 IN 1 THE KING'S DAUGHTERS' HOSPITAL FOUNDATION INC ONE KINGS DAUGHTERS DRIVE MADISON IN 47250 202148950 501(C)(3) 48700 SUPPORT ORGANIZATION'S MISSION. ECONOMIC DEVELOPMENT PARTNERSMIDCOR PO BOX 369 MADISON IN 47250 351695852 501(C)(4) 7500 SUPPORT ORGANIZATIONS MISSION VARIOUS MISSIONS (NONE 5000) 34366 PURCHASE COST MEDICAL SUPPLIES PROVIDE MEDICAL SUPPLIES AS DONATIONS 1 1 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: FUNDS ARE NOT GRANTED TO ORGANIZATIONS BUT ARE DONATED. DONATIONS ARE DETERMINED ON A DISCRETIONARY BASIS. X X X X 0 0 0 0 0 0 0 0 0 EILEEN MCGARVEY MD 385582 0 5409 0 1584 0 17150 0 5195 0 414920 0 0 0 PAT STACK MD 149118 0 65725 0 2851 0 15584 0 16649 0 249927 0 0 0 ROGER ALLMAN 311686 0 3442 0 10302 0 17150 0 16902 0 359482 0 0 0 STEVE MEACHAM 178368 0 17070 0 1032 0 10261 0 16880 0 223611 0 0 0 MIKE BURNETT 147981 0 828 0 1584 0 10744 0 11857 0 172994 0 0 0 THOMAS ECKERT MD 421949 0 334398 0 1032 0 17150 0 16660 0 791189 0 0 0 GIL WEIZER MD 398096 0 146967 0 240 0 17150 0 16880 0 579333 0 0 0 PAUL ROSENBERG MD 480611 0 57183 0 2472 0 17150 0 16649 0 574065 0 0 0 WILLIAM SKILES MD 424228 0 105757 0 552 0 17150 0 11275 0 558962 0 0 0 ROBERT LEATHERMAN MD 420463 0 81113 0 20790 0 17150 0 17270 0 556786 0 0 0 SUPPLEMENTAL INFORMATION PART III BOARD MEMBERS PAT STACK, MD AND EILEEN MCGARVEY, MD LISTED ABOVE ARE EMPLOYED PHYSICIANS OF THE HOSPITAL. DR. STACK AND DR. MCGARVEY DO NOT RECEIVE COMPENSATION FOR SERVICES PROVIDED AS BOARD MEMBERS. THE COMPENSATION LISTED ABOVE FOR DR. STACK AND DR. MCGARVEY IS COMPENSATION RECEIVED FOR SERVICES PROVIDED AS EMPLOYED PHYSICIANS. INDIANA FINANCE AUTHORITY 351602316 45471ACW0 2010-11-03 97847058 SEE SCHEDULE O 0 0 0 97847058 6756300 1749243 3079319 259913 86002283 0 0 0 1 0 0 0 0 1 0.00000 0.00000 0.00000 1 0 0 0 0 0 0 DR ROBERT LEATHERMAN TUITION ASSISTANCE X 75000 15000 0 1 1 DR GIL WEIZER PAYBACK OF AMOUNTS PAID IN ERROR X 364782 300828 0 1 1 DR PAUL ROSENBERG PAYBACK OF AMOUNTS PAID IN ERROR X 24175 8786 0 1 1 324614 A DATTILO FRUIT COMPANY VICE PRESIDENT OF PATIENT SERVICES OF KDHHS HAS 51% OWNERSHIP INTEREST 42999 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 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 BOARD APPROVES THE DRAFT COPY OF THE 990 WITH THE CONTINGENCY THAT THE CHANGES/REVISIONS WILL BE INCORPORATED INTO THE FINAL VERSION OF THE TAX RETURN. 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. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED GAINS ON INVESTMENTS: 3,430,252. MEMBERS' WITHDRAWAL -67,580. TOTAL TO FORM 990, PART XI, LINE 5: 3,362,672. AUDIT OVERSIGHT FORM 990, PART XI, LINE 2C 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. DESCRIPTION OF PURPOSE SCHEDULE K, PART I, LINE A 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 COMMUNITY AND MEDICAL ARTS CENTER. THE KING'S DAUGHTERS' HOSPITAL FOUNDATION INC ONE KINGS DAUGHTERS DRIVE MADISON IN 47250 202148950 FUNDRAISING TO SUPPORT THE PROVISION OF HEALTHCARE SERVICES IN 501(C)(3) LINE 7 N/A 0 MADISON CATHETERIZATION SERVICES LLC ONE KINGS DAUGHTERS DRIVE MADISON IN 47250 203391301 CATHETERIZATION SERVICES IN N/A RELATED 51802 119571 0 1 0.51000 0 1 0 0 0 0 0 0 0 1 0 0 1 1 0 1 0 0