TY 2015 Form 990

(A) Name and Title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)
(1) PAULA HEIDERMAN...................................................................... Board Chairwoman	1.00 ................. 1.00	X	X	1,750	0
(2) MARJORIE HARE...................................................................... Board Vice Chairwoman	1.00 ................. 1.00	X	X	1,250	0
(3) PAM KIMMEL...................................................................... Board Secretary	1.00 ................. 1.00	X	X	500	0
(4) MARY BETTE VOYLES...................................................................... Assn't Secretary (Jan-May '15) & Board Treasurer	1.00 ................. 1.00	X	X	1,250	0
(5) Bonnie Colen...................................................................... Board Assn't Secretary (6.1.15-12.31.15)	1.00 ................. 0.00	X	X	500	0
(6) ANDREA FORRESTER...................................................................... Board Assn't Treasurer	1.00 ................. 1.00	X	X	500	0
(7) LINDA SLOFFER...................................................................... Board Treasurer (1.1.15-5.1.15)	1.00 ................. 1.00	X	X	500	0
(8) JONATHAN HANSON MD...................................................................... BOARD MEMBER/PHYSIcian	40.00 ................. 0.00	X		389,635	42,269
(9) PAT STACK MD...................................................................... Board Member/Physician	40.00 ................. 0.00	X		237,323	37,636
(10) JOE CRAIG...................................................................... Board Member	1.00 ................. 0.00	X		500	0
(11) Mary Kay McCubbin...................................................................... Board Member	1.00 ................. 0.00	X		750	0
(12) KEVIN TURNER...................................................................... Board member	1.00 ................. 0.00	X		500	0
(13) CAROL DOZIER...................................................................... PRESIDENT/CEO	40.00 ................. 1.00		X	349,564	14,552
(14) Steve Meacham...................................................................... VP Finance	40.00 ................. 0.00		X	198,745	48,912
(15) Lisa Morgan...................................................................... VP Patient Services	40.00 ................. 0.00		X	148,754	51,727
(16) Denine Fallis-Hallgarth...................................................................... VP Physician Practices	40.00 ................. 0.00		X	130,738	36,411
(17) HOLLY ROBINSON MD...................................................................... VP QUALITY / Physician	40.00 ................. 0.00		X	270,137	51,070

(A) Name and business address	(B) Description of services	(C) Compensation
MEDASSETS INC PO Box 405652 Atlanta,GA303845652	Revenue Cycle Consulting Services & Soft	1,503,982
WEHR CONSTRUCTORS INC 2517 Plantside Drive Louisville,KY40299	Contractor services for the construction	1,176,622
Comprehensive Medical Management 300 Dave Cowens Drive Ste 600 Newport,KY41071	Contracted Physician Billing Services	926,536
MAYO COLLABORATIVE SERVICES INC PO Box 9146 Minneapolis,MN554809146	Laboratory Services	779,274
Weatherby Locums Inc PO Box 972633 Dallas,TX753972633	Contracted Physician and Mid Level Provi	638,562
2 Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization 31

- TIN:

SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service

Public Charity Status and Public Support

Complete if the organization is a section 501(c)(3) organization or a section 4947(a)(1) nonexempt charitable trust.
right arrow

Attach to Form 990 or Form 990-EZ.
right arrow

Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public
Inspection

Name of the organization

The Bethany Circle of King's Daughters'
of Madison Indiana Inc

Employer identification number

35-0895832

Part I

Reason for Public Charity Status (All organizations must complete this part.) See instructions.

The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)

A church, convention of churches, or association of churches described in section 170(b)(1)(A)(i).

A school described in section 170(b)(1)(A)(ii). (Attach Schedule E (Form 990 or 990-EZ))

A hospital or a cooperative hospital service organization described in section 170(b)(1)(A)(iii).

A medical research organization operated in conjunction with a hospital described in section 170(b)(1)(A)(iii). Enter the hospital's name, city, and state:

An organization operated for the benefit of a college or university owned or operated by a governmental unit described in section 170(b)(1)(A)(iv). (Complete Part II.)

A federal, state, or local government or governmental unit described in section 170(b)(1)(A)(v).

An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in section 170(b)(1)(A)(vi). (Complete Part II.)

A community trust described in section 170(b)(1)(A)(vi). (Complete Part II.)

An organization that normally receives: (1) more than 331/3% of its support from contributions, membership fees, and gross receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)

An organization organized and operated exclusively to test for public safety. See section 509(a)(4).

An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). See section 509(a)(3). Check the box in lines 11a through 11d that describes the type of supporting organization and complete lines 11e, 11f, and 11g.

Type I. A supporting organization operated, supervised, or controlled by its supported organization(s), typically by giving the supported organization(s) the power to regularly appoint or elect a majority of the directors or trustees of the supporting organization. You must complete Part IV, Sections A and B.

Type II. A supporting organization supervised or controlled in connection with its supported organization(s), by having control or management of the supporting organization vested in the same persons that control or manage the supported organization(s). You must complete Part IV, Sections A and C.

Type III functionally integrated. A supporting organization operated in connection with, and functionally integrated with, its supported organization(s) (see instructions). You must complete Part IV, Sections A, D, and E.

Type III non-functionally integrated. A supporting organization operated in connection with its supported organization(s) that is not functionally integrated. The organization generally must satisfy a distribution requirement and an attentiveness requirement (see instructions). You must complete Part IV, Sections A and D, and Part V.

Check this box if the organization received a written determination from the IRS that it is a Type I, Type II, Type III functionally integrated, or Type III non-functionally integrated supporting organization.

Enter the number of supported organizations ..............

Provide the following information about the supported organization(s).

(i)Name of supported organization	(ii) EIN	(iv) Is the organization listed in your governing document?		(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)
(i)Name of supported organization	(ii) EIN	Yes	No	(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)


Total

For Paperwork Reduction Act Notice, see the Instructions for
Form 990 or 990-EZ.

Cat. No. 11285F

Schedule A (Form 990 or 990-EZ) 2015

Page 2

Part II

Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization fails to qualify under the tests listed below, please complete Part III.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2011	(b) 2012	(c) 2013	(d) 2014	(e) 2015	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any unusual grants.) ....
2	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......
3	The value of services or facilities furnished by a governmental unit to the organization without charge..
4	Total. Add lines 1 through 3
5	The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f)..
6	Public support. Subtract line 5 from line 4.

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2011	(b) 2012	(c) 2013	(d) 2014	(e) 2015	(f) Total
7	Amounts from line 4..
8	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...
9	Net income from unrelated business activities, whether or not the business is regularly carried on..
10	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.)..
11	Total support. Add lines 7 through 10.

Gross receipts from related activities, etc. (see instructions) ..................

First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization, check this box and stop here........................................ right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2015 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2014 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2015. If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization ....................... right arrow

33 1/3% support test—2014. If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization ..................... right arrow

17a

10%-facts-and-circumstances test—2015. If the organization did not check a box on line 13, 16a, or 16b, and line 14
is 10% or more, and if the organization meets the facts-and-circumstances test, check this box and stop here. Explain
in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported
organization ..................................................... right arrow

10%-facts-and-circumstances test—2014. If the organization did not check a box on line 13, 16a, 16b, or 17a, and line
15 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here.
Explain in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly
supported organization ................................................ right arrow

Private foundation. If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions ..................................................... right arrow

Schedule A (Form 990 or 990-EZ) 2015

Page 3

Part III

Support Schedule for Organizations Described in Section 509(a)(2)
(Complete only if you checked the box on line 9 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2011	(b) 2012	(c) 2013	(d) 2014	(e) 2015	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
2	Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose......
3	Gross receipts from activities that are not an unrelated trade or business under section 513...
4	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
5	The value of services or facilities furnished by a governmental unit to the organization without charge..
6	Total. Add lines 1 through 5.
7a	Amounts included on lines 1, 2, and 3 received from disqualified persons...
b	Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.
c	Add lines 7a and 7b..
8	Public support. (Subtract line 7c from line 6.)

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2011	(b) 2012	(c) 2013	(d) 2014	(e) 2015	(f) Total
9	Amounts from line 6...
10a	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
b	Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c	Add lines 10a and 10b.
11	Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
12	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.) ..
13	Total support. (Add lines 9, 10c, 11, and 12.)..

First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization,
check this box and stop here............................................. right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2015 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2014 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2015 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2014 Schedule A, Part III, line 17 .............

19a

331/3% support tests—2015. If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization ....... right arrow

33 1/3% support tests—2014. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization .... right arrow

Private foundation. If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions .... right arrow

Schedule A (Form 990 or 990-EZ) 2015

Page 4

Part IV

Supporting Organizations

(Complete only if you checked a box on line 11 of Part I. If you checked 11a of Part I, complete Sections A and B. If you checked 11b of Part I, complete Sections A and C. If you checked 11c of Part I, complete Sections A, D, and E. If you checked 11d of Part I, complete Sections A and D, and complete Part V.)

Section A. All Supporting Organizations

Yes

Are all of the organization’s supported organizations listed by name in the organization’s governing documents?
If "No," describe in Part VI how the supported organizations are designated. If designated by class or purpose,
describe the designation. If historic and continuing relationship, explain.

Did the organization have any supported organization that does not have an IRS determination of status under section 509(a)(1) or (2)? If "Yes," explain in Part VI how the organization determined that the supported organization was described in section 509(a)(1) or (2).

Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yes," answer (b) and (c) below.

Did the organization confirm that each supported organization qualified under section 501(c)(4), (5), or (6) and satisfied the public support tests under section 509(a)(2)? If "Yes," describe in Part VI when and how the organization made the determination.

Did the organization ensure that all support to such organizations was used exclusively for section 170(c)(2)(B) purposes? If "Yes," explain in Part VI what controls the organization put in place to ensure such use.

Was any supported organization not organized in the United States ("foreign supported organization")? If “Yes” and if you checked 11a or 11b in Part I, answer (b) and (c) below.

Did the organization have ultimate control and discretion in deciding whether to make grants to the foreign supported organization? If “Yes,” describe in Part VI how the organization had such control and discretion despite being controlled or supervised by or in connection with its supported organizations.

Did the organization support any foreign supported organization that does not have an IRS determination under sections 501(c)(3) and 509(a)(1) or (2)? If “Yes,” explain in Part VI what controls the organization used to ensure that all support to the foreign supported organization was used exclusively for section 170(c)(2)(B) purposes.

Did the organization add, substitute, or remove any supported organizations during the tax year? If “Yes,” answer (b) and (c) below (if applicable). Also, provide detail in Part VI, including (i) the names and EIN numbers of the supported organizations added, substituted, or removed; (ii) the reasons for each such action; (iii) the authority under the organization's organizing document authorizing such action; and (iv) how the action was accomplished (such as by amendment to the organizing document).

Type I or Type II only. Was any added or substituted supported organization part of a class already designated in the organization's organizing document?

Substitutions only. Was the substitution the result of an event beyond the organization's control?

Did the organization provide support (whether in the form of grants or the provision of services or facilities) to anyone other than (i) its supported organizations, (ii) individuals that are part of the charitable class benefited by one or more of its supported organizations, or (iii) other supporting organizations that also support or benefit one or more of the filing organization’s supported organizations? If “Yes,” provide detail in Part VI.

Did the organization provide a grant, loan, compensation, or other similar payment to a substantial contributor (defined in section 4958(c)(3)(C)), a family member of a substantial contributor, or a 35% controlled entity with regard to a substantial contributor? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ) .

Did the organization make a loan to a disqualified person (as defined in section 4958) not described in line 7? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ).

Was the organization controlled directly or indirectly at any time during the tax year by one or more disqualified persons as defined in section 4946 (other than foundation managers and organizations described in section 509(a)(1) or (2))? If “Yes,” provide detail in Part VI.

Did one or more disqualified persons (as defined in line 9a) hold a controlling interest in any entity in which the supporting organization had an interest? If “Yes,” provide detail in Part VI.

Did a disqualified person (as defined in line 9a) have an ownership interest in, or derive any personal benefit from, assets in which the supporting organization also had an interest? If “Yes,” provide detail in Part VI.

10a

Was the organization subject to the excess business holdings rules of section 4943 because of section 4943(f) (regarding certain Type II supporting organizations, and all Type III non-functionally integrated supporting organizations)? If “Yes,” answer line 10b below.

10a

Did the organization have any excess business holdings in the tax year? (Use Schedule C, Form 4720, to determine whether the organization had excess business holdings).

10b

Schedule A (Form 990 or 990-EZ) 2015

Page 5

Part IV

Supporting Organizations (continued)

Yes

Has the organization accepted a gift or contribution from any of the following persons?

A person who directly or indirectly controls, either alone or together with persons described in (b) and (c) below, the governing body of a supported organization?

11a

A family member of a person described in (a) above?

11b

A 35% controlled entity of a person described in (a) or (b) above? If “Yes” to a, b, or c, provide detail in Part VI.

11c

Section B. Type I Supporting Organizations

Yes

Did the directors, trustees, or membership of one or more supported organizations have the power to regularly appoint or elect at least a majority of the organization’s directors or trustees at all times during the tax year? If “No,” describe in Part VI how the supported organization(s) effectively operated, supervised, or controlled the organization’s activities. If the organization had more than one supported organization, describe how the powers to appoint and/or remove directors or trustees were allocated among the supported organizations and what conditions or restrictions, if any, applied to such powers during the tax year.

Did the organization operate for the benefit of any supported organization other than the supported organization(s) that operated, supervised, or controlled the supporting organization? If “Yes,” explain in Part VI how providing such benefit carried out the purposes of the supported organization(s) that operated, supervised or controlled the supporting organization.

Section C. Type II Supporting Organizations

Yes

Were a majority of the organization’s directors or trustees during the tax year also a majority of the directors or trustees of each of the organization’s supported organization(s)? If “No,” describe in Part VI how control or management of the supporting organization was vested in the same persons that controlled or managed the supported organization(s).

Section D. All Type III Supporting Organizations

Yes

Did the organization provide to each of its supported organizations, by the last day of the fifth month of the organization’s tax year, (i) a written notice describing the type and amount of support provided during the prior tax year, (ii) a copy of the Form 990 that was most recently filed as of the date of notification, and (iii) copies of the organization’s governing documents in effect on the date of notification, to the extent not previously provided?

Were any of the organization’s officers, directors, or trustees either (i) appointed or elected by the supported organization(s) or (ii) serving on the governing body of a supported organization? If "No," explain in Part VI how the organization maintained a close and continuous working relationship with the supported organization(s).

By reason of the relationship described in (2), did the organization’s supported organizations have a significant voice in the organization’s investment policies and in directing the use of the organization’s income or assets at all times during the tax year? If "Yes," describe in Part VI the role the organization’s supported organizations played in this regard.

Section E. Type III Functionally-Integrated Supporting Organizations

Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions):

The organization satisfied the Activities Test. Complete line 2 below.

The organization is the parent of each of its supported organizations. Complete line 3 below.

The organization supported a governmental entity. Describe in Part VI how you supported a government entity (see instructions)

Activities Test. Answer (a) and (b) below.

Yes

Did substantially all of the organization’s activities during the tax year directly further the exempt purposes of the supported organization(s) to which the organization was responsive? If "Yes," then in Part VI identify those supported organizations and explain how these activities directly furthered their exempt purposes, how the organization was responsive to those supported organizations, and how the organization determined that these activities constituted substantially all of its activities.

Did the activities described in (a) constitute activities that, but for the organization’s involvement, one or more of the organization’s supported organization(s) would have been engaged in? If "Yes," explain in Part VI the reasons for the organization’s position that its supported organization(s) would have engaged in these activities but for the organization’s involvement.

Parent of Supported Organizations. Answer (a) and (b) below.

Did the organization have the power to regularly appoint or elect a majority of the officers, directors, or trustees of each of the supported organizations? Provide details in Part VI.

Did the organization exercise a substantial degree of direction over the policies, programs and activities of each of its supported organizations? If "Yes," describe in Part VI. the role played by the organization in this regard.

Schedule A (Form 990 or 990-EZ) 2015

Page 6

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations

Check here if the organization satisfied the Integral Part Test as a qualifying trust on Nov. 20, 1970. See instructions. All other Type III non-functionally integrated supporting organizations must complete Sections A through E.

	Section A - Adjusted Net Income		(A) Prior Year	(B) Current Year (optional)
1	Net short-term capital gain	1
2	Recoveries of prior-year distributions	2
3	Other gross income (see instructions)	3
4	Add lines 1 through 3	4
5	Depreciation and depletion	5
6	Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions)	6
7	Other expenses (see instructions)	7
8	Adjusted Net Income (subtract lines 5, 6 and 7 from line 4)	8

	Section B - Minimum Asset Amount		(A) Prior Year	(B) Current Year (optional)
1	Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year):	1
a	Average monthly value of securities	1a
b	Average monthly cash balances	1b
c	Fair market value of other non-exempt-use assets	1c
d	Total (add lines 1a, 1b, and 1c)	1d
e	Discount claimed for blockage or other factors (explain in detail in Part VI):
2	Acquisition indebtedness applicable to non-exempt use assets	2
3	Subtract line 2 from line 1d	3
4	Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount, see instructions).	4
5	Net value of non-exempt-use assets (subtract line 4 from line 3)	5
6	Multiply line 5 by .035	6
7	Recoveries of prior-year distributions	7
8	Minimum Asset Amount (add line 7 to line 6)	8

	Section C - Distributable Amount		Current Year
1	Adjusted net income for prior year (from Section A, line 8, Column A)	1
2	Enter 85% of line 1	2
3	Minimum asset amount for prior year (from Section B, line 8, Column A)	3
4	Enter greater of line 2 or line 3	4
5	Income tax imposed in prior year	5
6	Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions)	6

Check here if the current year is the organization's first as a non-functionally-integrated Type III supporting organization (see instructions)

Schedule A (Form 990 or 990-EZ) 2015

Page 7

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations (continued)

Section D - Distributions		Current Year
1 Amounts paid to supported organizations to accomplish exempt purposes
2 Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity
3 Administrative expenses paid to accomplish exempt purposes of supported organizations
4 Amounts paid to acquire exempt-use assets
5 Qualified set-aside amounts (prior IRS approval required)
6 Other distributions (describe in Part VI). See instructions
7Total annual distributions. Add lines 1 through 6.
8 Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions
9 Distributable amount for 2015 from Section C, line 6
10 Line 8 amount divided by Line 9 amount

Section E - Distribution Allocations (see instructions)		(i) Excess Distributions	(ii) Underdistributions Pre-2015	(iii) Distributable Amount for 2015
1 Distributable amount for 2015 from Section C, line 6
2 Underdistributions, if any, for years prior to 2015 (reasonable cause required--see instructions)
3 Excess distributions carryover, if any, to 2015:
a
b
c
d From 2013.......
e From 2014.......
fTotal of lines 3a through e
g Applied to underdistributions of prior years
h Applied to 2015 distributable amount
i Carryover from 2010 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from 3f.
4Distributions for 2015 from Section D, line 7:
$
a Applied to underdistributions of prior years
b Applied to 2015 distributable amount
c Remainder. Subtract lines 4a and 4b from 4.
5 Remaining underdistributions for years prior to 2015, if any. Subtract lines 3g and 4a from line 2 (if amount greater than zero, see instructions)
6 Remaining underdistributions for 2015. Subtract lines 3h and 4b from line 1 (if amount greater than zero, see instructions)
7 Excess distributions carryover to 2016. Add lines 3j and 4c.
8 Breakdown of line 7:
a
b
c Excess from 2013.......
d From 2014.......
e From 2015.......

Schedule A (Form 990 or 990-EZ) (2015)

Schedule A (Form 990 or 990-EZ) 2015

Page 8

Part VI

Supplemental Information. Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; Part III, line 12; Part IV, Section A, lines 1, 2, 3b, 3c, 4b, 4c, 5a, 6, 9a, 9b, 9c, 11a, 11b, and 11c; Part IV, Section B, lines 1 and 2; Part IV, Section C, line 1; Part IV, Section D, lines 2 and 3; Part IV, Section E, lines 1c, 2a, 2b, 3a and 3b; Part V, line 1; Part V, Section B, line 1e; Part V Section D, lines 5, 6, and 8; and Part V, Section E, lines 2, 5, and 6. Also complete this part for any additional information. (See instructions).

Facts And Circumstances Test

Return Reference	Explanation

Schedule A (Form 990 or 990-EZ) 2015

Additional Data

Software ID:
Software Version:

- TIN:

Schedule B
(Form 990, 990-EZ,
or 990-PF)

Department of the Treasury
Internal Revenue Service

Schedule of Contributors

Attach to Form 990, 990-EZ, or 990-PF.

Information about Schedule B (Form 990, 990-EZ, or 990-PF) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Name of the organization

The Bethany Circle of King's Daughters'
of Madison Indiana Inc

Employer identification number

35-0895832

Organization type (check one):

Filers of:

Section:

Form 990 or 990-EZ

501(c)( ) (enter number) organization

4947(a)(1) nonexempt charitable trust not treated as a private foundation

527 political organization

Form 990-PF

501(c)(3) exempt private foundation

4947(a)(1) nonexempt charitable trust treated as a private foundation

501(c)(3) taxable private foundation

Check if your organization is covered by the General Rule or a Special Rule.
Note. Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.

General Rule

For an organization filing Form 990, 990-EZ, or 990-PF that received, during the year, contributions totaling $5,000 or more (in money or other property) from any one contributor. Complete Parts I and II. See instructions for determining a contributor's total contributions.

Special Rules

For an organization described in section 501(c)(3) filing Form 990 or 990-EZ that met the 33¹/3% support test of the regulations
under sections 509(a)(1) and 170(b)(1)(A)(vi), that checked Schedule A (Form 990 or 990-EZ), Part II, line 13, 16a, or 16b, and that received from any one contributor, during the year, total contributions of the greater of (1) $5,000 or (2) 2% of the amount on (i) Form 990, Part VIII, line 1h, or (ii) Form 990-EZ, line 1. Complete Parts I and II.

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, total contributions of more than $1,000 exclusively for religious, charitable, scientific, literary, or educational purposes, or for the prevention of cruelty to children or animals. Complete Parts I, II, and III.

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, contributions exclusively for religious, charitable, etc., purposes, but no such contributions totaled more than $1,000. If this box is checked, enter here the total contributions that were received during the year for an exclusively religious, charitable, etc., purpose. Do not complete any of the parts unless the General Rule applies to this organization because it received nonexclusively religious, charitable, etc., contributions totaling $5,000 or more during the year ......... Arrow Bullet

Caution. An organization that is not covered by the General Rule and/or the Special Rules does not file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2, of its Form 990; or check the box on line H of its
Form 990-EZ or on its Form 990PF, Part I, line 2, to certify that it does not meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).

For Paperwork Reduction Act Notice, see the Instructions
for Form 990, 990-EZ, or 990-PF.

Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2015)

Schedule B (Form 990, 990-EZ, or 990-PF) (2015) Page 2

Name of organization The Bethany Circle of King's Daughters' of Madison Indiana Inc

Part I	Contributors (see instructions). Use duplicate copies of Part I if additional space is needed.
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
RESTRICTED	,	$ RESTRICTED	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2015)

Schedule B (Form 990, 990-EZ, or 990-PF) (2015)

Page 3

Name of organization The Bethany Circle of King's Daughters' of Madison Indiana Inc		Employer identification number 35-0895832

Part II	Noncash Property (see instructions). Use duplicate copies of Part II if additional space is needed.
(a) No.from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No.from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No.from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No.from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No.from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No.from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
Schedule B (Form 990, 990-EZ, or 990-PF) (2015)

Schedule B (Form 990, 990-EZ, or 990-PF) (2015)

Page 4


Name of organization The Bethany Circle of King's Daughters' of Madison Indiana Inc			Employer identification number 35-0895832
Part III Exclusively religious, charitable, etc., contributions to organizations described in section 501(c)(7), (8), or (10) that total more than $1,000 for the year from any one contributor. Complete columns (a) through (e) and the following line entry. For organizations completing Part III, enter the total of exclusively religious, charitable, etc., contributions of $1,000 or less for the year. (Enter this information once. See instructions.) $ Use duplicate copies of Part III if additional space is needed.

(a)
No.from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No.from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No.from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No.from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

Schedule B (Form 990, 990-EZ, or 990-PF) (2015)

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE C
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Political Campaign and Lobbying Activities

For Organizations Exempt From Income Tax Under section 501(c) and section 527
SchCMd Bullet

Complete if the organization is described below. SchCMd Bullet

Attach to Form 990 or Form 990-EZ.
SchCMd Bullet

Information about Schedule C (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public
Inspection

If the organization answered "Yes" on Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
Round Bullet

Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
Round Bullet

Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
Round Bullet

Section 527 organizations: Complete Part I-A only.
If the organization answered "Yes" on Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
Round Bullet

Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)): Complete Part II-A. Do not complete Part II-B.
Round Bullet

Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered "Yes" on Form 990, Part IV, Line 5 (Proxy Tax) (see separate instructions) or Form 990-EZ, Part V, line 35c (Proxy Tax) (see separate instructions), then
Round Bullet

Section 501(c)(4), (5), or (6) organizations: Complete Part III.

Name of the organization

The Bethany Circle of King's Daughters'
of Madison Indiana Inc

Employer identification number

35-0895832

Part I-A

Complete if the organization is exempt under section 501(c) or is a section 527 organization.

Provide a description of the organization’s direct and indirect political campaign activities in Part IV.

Political expenditures ...................................................................................................................... SchCMd Bullet

Volunteer hours .............................................................................................................................

Part I-B

Complete if the organization is exempt under section 501(c)(3).

Enter the amount of any excise tax incurred by the organization under section 4955 ................................ SchCMd Bullet

Enter the amount of any excise tax incurred by organization managers under section 4955 ....................... SchCMd Bullet

If the organization incurred a section 4955 tax, did it file Form 4720 for this year? .........................................

Yes No

Was a correction made? ......................................................................................................................

Yes No

If "Yes," describe in Part IV.

Part I-C

Complete if the organization is exempt under section 501(c), except section 501(c)(3).

Enter the amount directly expended by the filing organization for section 527 exempt function activities ..... SchCMd Bullet

Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt function activities ............................................................................................................................ SchCMd Bullet

Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, line 17b........... SchCMd Bullet

Did the filing organization file Form 1120-POL for this year? ...................................................................

Yes No

Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing
organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.

(a) Name	(b) Address	(c) EIN	(d) Amount paid from filing organization's funds. If none, enter -0-.	(e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.
1
2
3
4
5
6

For Paperwork Reduction Act Notice, see the instructions for Form 990 or 990-EZ.

Cat. No. 50084S

Schedule C (Form 990 or 990-EZ) 2015

Page 2

Part II-A

Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).

A Check SchCMd Bullet

if the filing organization belongs to an affiliated group (and list in Part IV each affiliated group member's name, address, EIN, expenses, and share of excess lobbying expenditures).
B Check SchCMd Bullet

if the filing organization checked box A and "limited control" provisions apply.

Limits on Lobbying Expenditures (The term "expenditures" means amounts paid or incurred.)		(b) Affiliated group totals
1a	Total lobbying expenditures to influence public opinion (grass roots lobbying) ...............................................
b	Total lobbying expenditures to influence a legislative body (direct lobbying) ...........................................
c	Total lobbying expenditures (add lines 1a and 1b) .......................................................................
d	Other exempt purpose expenditures .........................................................................................
e	Total exempt purpose expenditures (add lines 1c and 1d) ....................................................................
f	Lobbying nontaxable amount. Enter the amount from the following table in both columns.
	If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:
	Not over $500,00020% of the amount on line 1e.
	Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.
	Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.
	Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.
	Over $17,000,000$1,000,000.

g	Grassroots nontaxable amount (enter 25% of line 1f) ..........................................................................
h	Subtract line 1g from line 1a. If zero or less, enter -0-. ..........................................................................
i	Subtract line 1f from line 1c. If zero or less, enter -0-. ...........................................................................
j	If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting section 4911 tax for this year? ..............................................................................................................	Yes No

4-Year Averaging Period Under section 501(h) (Some organizations that made a section 501(h) election do not have to complete all of the five columns below. See the separate instructions for lines 2a through 2f.)
Lobbying Expenditures During 4-Year Averaging Period
	Calendar year (or fiscal year beginning in)	(a) 2012	(b) 2013	(c) 2014	(d) 2015	(e) Total

2a	Lobbying nontaxable amount

b	Lobbying ceiling amount (150% of line 2a, column(e))

c	Total lobbying expenditures

d	Grassroots nontaxable amount

e	Grassroots ceiling amount (150% of line 2d, column (e))

f	Grassroots lobbying expenditures

Schedule C (Form 990 or 990-EZ) 2015

Page 3

Part II-B

Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).

For each "Yes" response on lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.

(a)

Yes

(b)

Amount

During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:

Volunteers? ...........................................................................................................

Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ........

Media advertisements? ...................................................................................................

Mailings to members, legislators, or the public? .............................................................................

Publications, or published or broadcast statements? ...........................................................

Grants to other organizations for lobbying purposes? ..........................................................

Direct contact with legislators, their staffs, government officials, or a legislative body? .......................

Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ..................

Other activities? ...................................................................................................................

Yes

7,537

Total. Add lines 1c through 1i ....................................................................................................

7,537

Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....

If "Yes," enter the amount of any tax incurred under section 4912 ...........................................

If "Yes," enter the amount of any tax incurred by organization managers under section 4912 ...................

If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? ........................

Part III-A

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).

Yes

Were substantially all (90% or more) dues received nondeductible by members? ...............................................

Did the organization make only in-house lobbying expenditures of $2,000 or less? ............................................

Did the organization agree to carry over lobbying and political expenditures from the prior year? .................................

Part III-B

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) and if either (a) BOTH Part III-A, lines 1 and 2, are answered "No" OR (b) Part III-A, line 3, is answered “Yes."

Dues, assessments and similar amounts from members ......................................................................

Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political expenses for which the section 527(f) tax was paid).

Current year .............................................................................................................................

Carryover from last year ............................................................................................................

Total ...........................................................................................................................................

Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .

If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ......................................................................................................................

Taxable amount of lobbying and political expenditures (see instructions) .........................................

Part IV

Supplemental Information

Provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, line 5; Part II-A (affiliated group list); Part II-A, lines 1 and 2 (see instructions), and Part ll-B, line 1. Also, complete this part for any additional information.

Return Reference	Explanation
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.

Schedule C (Form 990 or 990EZ) 2015

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

Complete if the organization answered "Yes," on Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b.
SchDMd Bullet

Attach to Form 990.
Information about Schedule D (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public Inspection

Name of the organization

The Bethany Circle of King's Daughters'
of Madison Indiana Inc

Employer identification number

35-0895832

Part I

Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" on Form 990, Part IV, line 6.

			(a) Donor advised funds	(b) Funds and other accounts

1	Total number at end of year ....
2	Aggregate value of contributions to (during year)
3	Aggregate value of grants from (during year)
4	Aggregate value at end of year ....

Did the organization inform all donors and donor advisors in writing that the assets held in donor advised
funds are the organization's property, subject to the organization's exclusive legal control? ...........

Yes No

Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be
used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ............................

Yes No

Part II

Conservation Easements. Complete if the organization answered "Yes" on Form 990, Part IV, line 7.

Purpose(s) of conservation easements held by the organization (check all that apply).

Preservation of land for public use (e.g., recreation or education) Preservation of an historically important land area

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.


a	Total number of conservation easements ......................	2a
b	Total acreage restricted by conservation easements ....................	2b
c	Number of conservation easements on a certified historic structure included in (a) .....	2c
d	Number of conservation easements included in (c) acquired after 8/17/06, and not on a historic structure listed in the National Register ...	2d

Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during the
tax year SchDMd Bullet

Number of states where property subject to conservation easement is located SchDMd Bullet

Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and enforcement of the conservation easements it holds? ............

Yes No

Staff and volunteer hours devoted to monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

Amount of expenses incurred in monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(B)(i) and section 170(h)(4)(B)(ii)? .............................

Yes No

In Part XIII, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" on Form 990, Part IV, line 8.

If the organization elected, as permitted under SFAS 116 (ASC 958), not to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide, in Part XIII, the text of the footnote to its financial statements that describes these items.

If the organization elected, as permitted under SFAS 116 (ASC 958), to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide the following amounts relating to these items:

(i)

Revenue included on Form 990, Part VIII, line 1 ......................... SchDMd Bullet

(ii)

Assets included in Form 990, Part X ............................... SchDMd Bullet

If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under SFAS 116 (ASC 958) relating to these items:

Revenue included on Form 990, Part VIII, line 1 .......................... SchDMd Bullet

Assets included in Form 990, Part X ............................... SchDMd Bullet

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 52283D

Schedule D (Form 990) 2015

Page 2

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)

Using the organization’s acquisition, accession, and other records, check any of the following that are a significant use of its collection items (check all that apply):

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.

During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?...

Yes No

Part IV

Escrow and Custodial Arrangements. Complete if the organization answered "Yes" on Form 990, Part IV, line 9, or reported an amount on Form 990, Part X, line 21.

Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................

Yes No


b	If "Yes," explain the arrangement in Part XIII and complete the following table:		Amount
c	Beginning balance .............................	1c
d	Additions during the year ............................	1d
e	Distributions during the year ..........................	1e
f	Ending balance ................................	1f

Did the organization include an amount on Form 990, Part X, line 21, for escrow or custodial account liability?

Yes No

If "Yes," explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII ........

Part V

Endowment Funds. Complete if the organization answered "Yes" on Form 990, Part IV, line 10.

		(a)Current year	(b)Prior year	(c)Two years back	(d)Three years back	(e)Four years back

1a	Beginning of year balance ....	30,058	208,725	196,716	129,738	137,154
b	Contributions ...	506,513	50,077	48,484	86,924	40,020
c	Net investment earnings, gains, and losses
d	Grants or scholarships ...
e	Other expenditures for facilities and programs ...	508,316	228,744	36,475	19,946	47,436
f	Administrative expenses ....
g	End of year balance ......	28,255	30,058	208,725	196,716	129,738

Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:

Board designated or quasi-endowment SchDMd Bullet

0 %

Permanent endowment SchDMd Bullet

35.390 %

Temporarily restricted endowment SchDMd Bullet

64.610 %

The percentages on lines 2a, 2b, and 2c should equal 100%.

Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes

(i) unrelated organizations .................

3a(i)

(ii) related organizations .................

3a(ii)

If "Yes" on 3a(ii), are the related organizations listed as required on Schedule R? .........

Describe in Part XIII the intended uses of the organization's endowment funds.

Part VI

Land, Buildings, and Equipment.
Complete if the organization answered 'Yes' on Form 990, Part IV, line 11a. See Form 990, Part X, line 10.

Description of property		(a) Cost or other basis (investment)	(b)Cost or other basis (other)	(c) Accumulated depreciation	(d) Book value

1a	Land ...	4,937,784		4,937,784
b	Buildings	119,123,429	22,584,024	96,539,405
c	Leasehold improvements
d	Equipment ...	62,831,096	39,411,303	23,419,793
e	Other ...	59,973		59,973
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..				124,956,955

Schedule D (Form 990) 2015

Page 3

Part VII

InvestmentsOther Securities. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11b. See Form 990, Part X, line 12.

(a) Description of security or category (including name of security)	(b)Book value	(c)Method of valuation: Cost or end-of-year market value
(1)Financial derivatives
(2)Closely-held equity interests
(3)Other
(A)
(B)
(C)
(D)
(E)
(F)
(G)
(H)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)

Part VIII

InvestmentsProgram Related. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11c. See Form 990, Part X, line 13.

(a) Description of investment	(b) Book value	(c) Method of valuation: Cost or end-of-year market value

(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)

Part IX

Other Assets. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11d. See Form 990, Part X, line 15.

(a) Description				(b) Book value

(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........

Part X

Other Liabilities. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11e or 11f. See Form 990, Part X, line 25.

1.(a) Description of liability	(b) Book value
(1) Federal income taxes
Deferred Compensation	59,556
Third party payable	765,000
Life Insurance Policies	947,484
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	1,772,040
2. Liability for uncertain tax positions. In Part XIII, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC 740). Check here if the text of the footnote has been provided in Part XIII

Schedule D (Form 990) 2015

Page 4

Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total revenue, gains, and other support per audited financial statements .......			1	132,829,994
2	Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a	Net unrealized gains (losses) on investments ....	2a	-3,565,465
b	Donated services and use of facilities .........	2b
c	Recoveries of prior year grants ...........	2c
d	Other (Describe in Part XIII.) ............	2d	171,146
e	Add lines 2a through 2d .....................			2e	-3,394,319
3	Subtract line 2e from line 1..................			3	136,224,313
4	Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b .	4a	291,866
b	Other (Describe in Part XIII.) ...........	4b	31,913
c	Add lines 4a and 4b....................			4c	323,779
5	Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ......			5	136,548,092

Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total expenses and losses per audited financial statements ...........			1	120,931,492
2	Amounts included on line 1 but not on Form 990, Part IX, line 25:
a	Donated services and use of facilities .........	2a
b	Prior year adjustments ............	2b
c	Other losses ................	2c
d	Other (Describe in Part XIII.) ............	2d	-10,027
e	Add lines 2a through 2d....................			2e	-10,027
3	Subtract line 2e from line 1...................			3	120,941,519
4	Amounts included on Form 990, Part IX, line 25, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b ..	4a	291,866
b	Other (Describe in Part XIII.) ............	4b	31,913
c	Add lines 4a and 4b.....................			4c	323,779
5	Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ......			5	121,265,298

Part XIII

Supplemental Information

Provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b;
Part V, line 4; Part X, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.

Return Reference	Explanation
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 12/31/2015. 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, nicotine replacement therapy fund, and coalition against substance abuse 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, 2015 and 2014, there are no uncertain positions taken or expected to be taken that would require recognition of a liability or disclosure in the accompanying consolidated financial statements. The Hospital is subject to routine audits by taxing jurisdictions; however, as of the date the financial statements were issued, there were no audits for any tax periods in progress.
Part XI, Line 2d - Other Adjustments:	Rental Expenses -10,026. change in subscriber savings cumulative account 181,172.
Part XI, Line 4b - Other Adjustments:	Grants 31,913.
Part XII, Line 2d - Other Adjustments:	Rental Expenses -10,026. Rounding -1.
Part XII, Line 4b - Other Adjustments:	Grants 31,913.

Schedule D (Form 990) 2015

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE H
(Form 990)

Department of the Treasury
Internal Revenue Service

Hospitals

Complete if the organization answered "Yes" on Form 990, Part IV, question 20.
MediumBullet

Attach to Form 990.
MediumBullet

Information about Schedule H (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public Inspection

Name of the organization

The Bethany Circle of King's Daughters'
of Madison Indiana Inc

Employer identification number

35-0895832

Part I

Financial Assistance and Certain Other Community Benefits at Cost

Yes

Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a . . . .

Yes

If "Yes," was it a written policy? ......................

Yes

If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.

Applied uniformly to all hospital facilities Applied uniformly to most hospital facilities Generally tailored to individual hospital facilities

Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.

Did the organization use Federal Poverty Guidelines (FPG) as a factor in determining eligibility for providing free care?

If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:

Yes

100% 150% 200% Other %

Did the organization use FPG as a factor in determining eligibility for providing discounted care? If "Yes," indicate

which of the following was the family income limit for eligibility for discounted care: . . . . . . . .

Yes

200% 250% 300% 350% 400% Other %

If the organization used factors other than FPG in determining eligibility, describe in Part VI the criteria used for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, as a factor in determining eligibility for free or discounted care.

Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? . . . . . . . . . . . . .

Yes

Did the organization budget amounts for free or discounted care provided under its financial assistance policy during
the tax year? . . . . . . . . . . . . . . . . . . . . . . .

Yes

If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? . . . . . .

If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care? . . . . . . . . . . . . .

Did the organization prepare a community benefit report during the tax year? . . . . . . . . .

Yes

If "Yes," did the organization make it available to the public? . . . . . . . . . . . . .

Yes

Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.

Financial Assistance and Certain Other Community Benefits at Cost

Financial Assistance and Means-Tested Government Programs		(b) Persons served (optional)	(c) Total community benefit expense	(d) Direct offsetting revenue	(e) Net community benefit expense	(f) Percent of total expense
a	Financial Assistance at cost (from Worksheet 1) . . .		698,544		698,544	0.580 %
b	Medicaid (from Worksheet 3, column a) . . . . .		18,690,513	15,812,567	2,877,946	2.370 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) . .
d	Total Financial Assistance and Means-Tested Government Programs . . . . .		19,389,057	15,812,567	3,576,490	2.950 %
Other Benefits
e	Community health improvement services and community benefit operations (from Worksheet 4).	1,263	184,364	54,352	130,012	0.110 %
f	Health professions education (from Worksheet 5) . . .	79	204,554	36,550	168,004	0.140 %
g	Subsidized health services (from Worksheet 6) . . . .	4,792	4,333,841	3,675,463	658,378	0.540 %
h	Research (from Worksheet 7) .
i	Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .		42,763		42,763	0.040 %
j	Total. Other Benefits . .	6,134	4,765,522	3,766,365	999,157	0.830 %
k	Total. Add lines 7d and 7j .	6,134	24,154,579	19,578,932	4,575,647	3.780 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2015

Schedule H (Form 990) 2015

Page

Part II

Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.

		(b) Persons served (optional)	(c) Total community building expense	(e) Net community building expense	(f) Percent of total expense
1	Physical improvements and housing
2	Economic development
3	Community support
4	Environmental improvements
5	Leadership development and training for community members	80	208	208	0 %
6	Coalition building
7	Community health improvement advocacy	937	149,920	149,920	0.120 %
8	Workforce development	1	113	113	0 %
9	Other
10	Total	1,018	150,241	150,241	0.120 %

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

Did the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................

Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......

12,702,335

Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy. Explain in Part VI the methodology used by the organization to estimate this amount and the rationale, if any, for including this portion of bad debt as community benefit. ......

Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.

Section B. Medicare

Enter total revenue received from Medicare (including DSH and IME).....

25,681,631

Enter Medicare allowable costs of care relating to payments on line 5.....

26,100,685

Subtract line 6 from line 5. This is the surplus (or shortfall)........

-419,054

Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:

Cost accounting system Cost to charge ratio Other

Section C. Collection Practices

Did the organization have a written debt collection policy during the tax year? ..........

Yes

If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year
contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI .........................

Yes

Part IV

Management Companies and Joint Ventures(owned 10% or more by officers, directors, trustees, key employees, and physicians—see instructions)

(a) Name of entity	(b) Description of primary activity of entity	(c) Organization's profit % or stock ownership %	(d) Officers, directors, trustees, or key employees' profit % or stock ownership %	(e) Physicians' profit % or stock ownership %
1
2
3
4
5
6
7
8
9
10
11
12
13

Schedule H (Form 990) 2015

Page

Part VFacility Information

Section A. Hospital Facilities (list in order of size from largest to smallest—see instructions) How many hospital facilities did the organization operate during the tax year?1 Name, address, primary website address, and state license number (and if a group return, the name and EIN of the subordinate hospital organization that operates the hospital facility)
1	KING'S DAUGHTERS' HEALTH 1373 East State Road 62 PO Box 447 Madison,IN47250 www.kdhmadison.org 15-005063-1	X	X	X

Schedule H (Form 990) 2015

Page 4

Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)

	KING'S DAUGHTERS' HEALTH
Name of hospital facility or letter of facility reporting group

Line number of hospital facility, or line numbers of hospital facilities in a facility
reporting group (from Part V, Section A):

Yes

Community Health Needs Assessment

Was the hospital facility first licensed, registered, or similarly recognized by a state as a hospital facility in the current tax year or the immediately preceding tax year?........................

Was the hospital facility acquired or placed into service as a tax-exempt hospital in the current tax year or the immediately preceding tax year? If “Yes,” provide details of the acquisition in Section C...............

During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 12......................

Yes

If "Yes," indicate what the CHNA report describes (check all that apply):

A definition of the community served by the hospital facility

Demographics of the community

Existing health care facilities and resources within the community that are available to respond to the health needs of the community

How data was obtained

The significant health needs of the community

Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups

The process for identifying and prioritizing community health needs and services to meet the community health needs

The process for consulting with persons representing the community’s interests

Information gaps that limit the hospital facility’s ability to assess the community’s health needs

Other (describe in Section C)

Indicate the tax year the hospital facility last conducted a CHNA: 20 13

In conducting its most recent CHNA, did the hospital facility take into account input from persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If "Yes," describe in Section C how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted .................

Yes

6 a

Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Section C..................................

Was the hospital facility’s CHNA conducted with one or more organizations other than hospital facilities?” If “Yes,” list the other organizations in Section C. ............................

Did the hospital facility make its CHNA report widely available to the public?..............

Yes

If "Yes," indicate how the CHNA report was made widely available (check all that apply):

Hospital facility’s website (list url): www.kdhmadison.org/about_needsAssessment.aspx

Other website (list url):

Made a paper copy available for public inspection without charge at the hospital facility

Other (describe in Section C)

Did the hospital facility adopt an implementation strategy to meet the significant community health needs
identified through its most recently conducted CHNA? If "No," skip to line 11. ..............

Yes

Indicate the tax year the hospital facility last adopted an implementation strategy: 20 13

Is the hospital facility's most recently adopted implementation strategy posted on a website?.........

Yes

If "Yes" (list url): www.kdhmadison.org/about_needsAssessment.aspx

If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ......

10b

Describe in Section C how the hospital facility is addressing the significant needs identified in its most recently conducted CHNA and any such needs that are not being addressed together with the reasons why such needs are not being addressed.

12a

Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)?...............................

12a

If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........

12b

If "Yes" on line 12b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $

Schedule H (Form 990) 2015

Page 5

Part VFacility Information (continued)

Financial Assistance Policy (FAP)

	KING'S DAUGHTERS' HEALTH
Name of hospital facility or letter of facility reporting group

Yes

Did the hospital facility have in place during the tax year a written financial assistance policy that:

Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care?

Yes

If “Yes,” indicate the eligibility criteria explained in the FAP:

Federal poverty guidelines (FPG), with FPG family income limit for eligibility for free care of % and FPG family income limit for eligibility for discounted care of %

Income level other than FPG (describe in Section C)

Asset level

Medical indigency

Insurance status

Underinsurance discount

Residency

Other (describe in Section C)

Explained the basis for calculating amounts charged to patients?.................

Yes

Explained the method for applying for financial assistance?...................

Yes

If “Yes,” indicate how the hospital facility’s FAP or FAP application form (including accompanying instructions) explained the method for applying for financial assistance (check all that apply):

Described the information the hospital facility may require an individual to provide as part of his or her application

Described the supporting documentation the hospital facility may require an individual to submit as part of his or
her application

Provided the contact information of hospital facility staff who can provide an individual with information about the
FAP and FAP application process

Provided the contact information of nonprofit organizations or government agencies that may be sources of
assistance with FAP applications

Other (describe in Section C)

Included measures to publicize the policy within the community served by the hospital facility?........

Yes

If "Yes," indicate how the hospital facility publicized the policy (check all that apply):

The FAP was widely available on a website (list url):

http://www.kdhmadison.org/patients_financial.aspx

The FAP application form was widely available on a website (list url):

HTTP://WWW.KDHMADISON.ORG/PATIENTS_FINANCIAL.ASPX

A plain language summary of the FAP was widely available on a website (list url):
http://www.kdhmadison.org/patients_financial.aspx

The FAP was available upon request and without charge (in public locations in the hospital facility and by mail)

The FAP application form was available upon request and without charge (in public locations in the hospital facility
and by mail)

A plain language summary of the FAP was available upon request and without charge (in public locations in the
hospital facility and by mail)

Notice of availability of the FAP was conspicuously displayed throughout the hospital facility

Notified members of the community who are most likely to require financial assistance about availability of the FAP

Other (describe in Section C)

Billing and Collections

Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained all of the actions the hospital facility or other authorized party may take upon non-payment?..................................

Yes

Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

None of these actions or other similar actions were permitted

Schedule H (Form 990) 2015

Page 6

Part VFacility Information (continued)

	KING'S DAUGHTERS' HEALTH
Name of hospital facility or letter of facility reporting group

Yes

Did the hospital facility or other authorized party perform any of the following actions during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP?............

If "Yes," check all actions in which the hospital facility or a third party engaged:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 19. (check all that apply):

Notified individuals of the financial assistance policy on admission

Notified individuals of the financial assistance policy prior to discharge

Notified individuals of the financial assistance policy in communications with the individuals regarding the individuals’ bills

Documented its determination of whether individuals were eligible for financial assistance under the hospital facility’s financial assistance policy

Other (describe in Section C)

None of these efforts were made

Policy Relating to Emergency Medical Care

Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that required the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?..................

Yes

If "No," indicate why:

The hospital facility did not provide care for any emergency medical conditions

The hospital facility’s policy was not in writing

The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Section C)

Other (describe in Section C)

Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)

Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.

The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that
can be charged

The hospital facility used the average of its three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged

The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged

Other (describe in Section C)

During the tax year, did the hospital facility charge any FAP-eligible individual to whom the hospital facility provided emergency or other medically necessary services more than the amounts generally billed to individuals who had insurance covering such care? ...............................

If "Yes," explain in Section C.

During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? ...........................

If "Yes," explain in Section C.

Schedule H (Form 990) 2015

Page 7

Part V

Facility Information (continued)

Section C. Supplemental Information for Part V, Section B. Provide descriptions required for Part V, Section B, lines 2, 3j, 5, 6a, 6b, 7d, 11, 13b, 13h, 15e, 16i, 18d, 19d, 20e, 21c, 21d, 22d, 23, and 24. If applicable, provide separate descriptions for each hospital facility in a facility reporting group, designated by facility reporting group letter and hospital facility line number from Part V, Section A (“A, 1,” “A, 4,” “B, 2,” “B, 3,” etc.) and name of hospital facility.
Form and Line Reference	Explanation
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 was input from other parties, and an interested Volunteer Medical Student. The needs assessment findings, and the implementation strategy, were shared with the Board of Managers and all action plan items will be incorporated into the working Strategic Plan for the organization.KDH Gaps: There 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.2015 UpdateIn 2015 KDH participated in nine community health fairs and screens where education information about healthy lifestyle were distributed. Education included tools on exercise, healthy eating, healthy weight loss, and disease prevention including tobacco cessation. The Wellness Coordinator and Tobacco Educator provided a combined 23 speaking engagements to community groups in 2015 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 2015 KDH Fit Kids program reached 249 students in six area schools. This 5th grade program, which centers on childhood obesity, offers lessons on healthy eating and physical activity. In addition, KDH serves as a Girls on the Run Council. This is a 10-week character-development program that uses the power of running for 3rd-5th grade girls to promote exercise and teach healthy lifestyle concepts. KDH holds a community Girls on the Run 5K event and a community Run the Falls 5K Run/Walk. These two fitness opportunities brought in over 400 participants in 2015. The Speaking of Women's Health program offered both an exercise and nutrition breakout session at the 2015 event and 7 of the 12 House of Health events provided education on healthy lifestyles and behaviors to lower chronic disease risk. In 2015 a new healthy weight loss class, titled Strive for 5, was offered to the 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.2015 UpdateThe KDH Employee Wellness program continued in 2015. A free health screen, which includes a financial incentive for achieving set biometric parameters, was offered for all employees. During the year three health incentive challenges were offered to staff. Four on-site classes were held, including a new weight loss education class. Healthy emails and newsletters were also sent to all employees. A 30-day walking campaign was offered in 2015. In addition, tobacco free employees have an opportunity for a reduced health insurance premium and cessation assistance is available for all staff and their family members. KDH supports a tobacco free campus policy for all facilities. KDH recognized the Great American Smokeout campaign and the Wear Red for Women campaign. The employee cafeteria continues to introduce new healthy food and beverage options for employees in the cafeteria. Vending machines continue to meet heart healthy option standards.Substance Abuse: Substance Abuse - particularly narcotic (primarily heroin), methamphetamine, and prescription drugs, was one of the top major health needs cited by all groups interviewed. It is prevalent in all counties served by KDH. - The lack of substance treatment centers and mental care facilities to refer these types of patients to is a major concern. - Many interviewed felt the public needs to be aware of how much of an issue substance abuse is in the community i.e. amount of babies born addicted to meth/heroin and the detoxification required. - The need for further drug education in the schools from elementary on up was mentioned numerous times - Better communication between KDH and the local legal system is needed. Documentation of overdose cases in the ER with statistics of the types of drugs causing the overdose (street versus prescription) is the type of information helpful to the legal system. KDH physicians mentioned that they would like to know from the legal system when one of the drugs they prescribed is involved in a case. - There is a need for a quarterly prescription drug disposal program where such drugs can be disposed with no questions asked.
KING'S DAUGHTERS' HEALTH	Part V, Section B, Line 13h: The Hospital's financial assistance policy changed midyear 2015. It detailed eligibility criteria for free or discounted care based on the following guidelines.Free Care: - From January to May 2015, the FPG family income limit for eligibility for free care was 200% - From June to December 2015, the FPG family income limit for eligibility for free care was 150%Discounted Care: - From January to May 2015, all uninsured patients received an automatic 20% discount from gross charges. - From June to December 2015, all uninsured patients received an automatic 30% discount from gross charges. For the outstanding balance due after applying the 30% discount, they could further qualify for additional discounted care using the FPG family income limit for eligibility of 250%.
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 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.
KING'S DAUGHTERS' HEALTH	Part V, Section B, Line 20e: 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.
KING'S DAUGHTERS' HEALTH	Part V, Section B, Line 22d: THE HOSPITAL CHANGED ITS POLICY MIDYEAR 2015. FROM JANUARYMAY 2015, ALL UNINSURED PATIENTS RECEIVED AN AUTOMATIC 20% DISCOUNT FROM GROSS CHARGES. FROM JUNEDECEMBER 2015, ALL UNINSURED PATIENTS RECEIVED AN AUTOMATIC 30% DISCOUNT FROM GROSS CHARGES. AT REGISTRATION, PATIENTS ARE NOTIFIED OF THE HOSPITAL'S FINANCIAL ASSISTANCE PROGRAM. THEY ARE 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 OF 100% ON THE OUTSTANDING ACCOUNT BALANCE. THE HOSPITAL WILL ATTEMPT TO COLLECT ANY BALANCE REMAINING ON THE UNINSURED ACCOUNT AFTER ALL FINANCIAL ASSISTANCE DISCOUNTS HAVE BEEN APPLIED USING A SERIES OF STATEMENTS, LETTERS, AND TELEPHONE CALLS. THE HOSPITAL WILL ALSO OFFER PATIENTS INTERESTFREE EXTENDED PAYMENT PLANS. IF THE ACCOUNT REMAINS UNPAID, THE ACCOUNT MAY BE TURNED OVER TO A COLLECTION AGENCY.
Part 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.2015 UpdateWe 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. Unfortunately the ORCHARD program was not successful, with no attendance from using mothers. Mothers are now being referred to the Norton Inpatient Detox Program if intrauterine drug exposure is identified. We are in the process of trying to track the number of Umbilical Cord Screens in suspicious cases that are returned positive for drug exposure. We are working closely with Child Protective Services. Preparation visits continue prior to delivery. 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: Due to the changes in the coding process from ICD9 codes to ICD10 coding we are no longer able to track admissions to the ER in the same way. Data reflected here is partial, and can be seen to show a definite increase, or upward trend.ER Admissions for Drug Abuse / Drug Dependency / Drug Overdose 2014 ; 2015 (1-15 through 9-15):Switzerland County 0 ; 237Jefferson County 2,430 ; 2,602Trimble County 224 ; 255Neonatal Abstinence Syndrome Births:2014: 102015 (9 months): 13Mental 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.2015 UpdateIn 2015, KDH made a total of 1,604 referrals. This data is probably more accurate as an effort to obtain more accurate data is in place. Our Pediatric Service Coordinator completed 26 mental health referrals from the outpatient OB office. ED providers began managing an increasing number of mental health patients via tele-assessment resulting in inpatient mental health transfers and outpatient referrals without involving Social Services. Emergency department documentation is narrative and would not be captured by data pulled from our Information Technology department.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 costprohibitive. 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.2015 UpdateThe House of Health program, which was developed half way through the 2014 calendar year, continued as a monthly program in 2015. This program is held at the Jefferson County Clearinghouse House of Hope food pantry. Each month featured a new health topic targeting a low income population and a free blood pressure screening was provided during two months. Attendance ranged from 35-80 participants each month.Awareness of Services and Programs: Some individuals also expressed the idea that residents in the community served by KDH may not be aware of the existing programs and services offered and may not be aware of the level of expertise of the staff. These are ideas that could be addressed in a strategic, well-planned, long-term public relations campaign. Action Plan: Leadership RoleDevelop and implement a public relations campaign to let people know of services and outreach through KDH. Target: Individuals in the KDH Primary Market. Evaluation: Number of promotional pieces and marketing activities geared toward the community to improve knowledge and education of outreach screens / classes / programs.2015 UpdateCommunity People, Quality Care - We continued to use this theme as our tagline and branding line on print, web, and audio marketing materials. It reflects who we are (Community People) and our mission (to provide Quality Care).Cancer Treatment Center - We opened our new Cancer Treatment Center in February.Marketing efforts included: development of a microsite (mini-website: www.kdhcancercare.org) to integrate with our current site. Further efforts included a print campaign for both PSA and SSA markets, focusing on the new technology, space, and staff. Print ads featured our staff members and their connection to cancer care. We launched several new videos that featured our staff and team members talking about what they do. We produced several radio spots using team members talking about why they chose cancer care. Staff members were also included on To Your Health programs and a feature in the Vital Signs Magazine. We had electronic banners on various websites including the Madison Courier, WIKI, and WKMNews.Carrollton Campaign - To increase awareness of Dr. Bessinger at the Carrollton office, we launched a multi-month campaign using targeted markets that focused on Dr. Bessinger and her team at the Carrollton Medical Building. In addition to family care, we promoted her OB services and pediatrics. Our purpose was to try and increase her patient base while also attracting new OB patients from the Carrollton area, along with new pediatric patients.New Providers / Physicians - Campaigns included the arrival of Dr. Patrick Matthiessen(Neurology), Sarah Hartman (NP-Family Practice), Dr. William Porter (Radiation Oncology), and Dr. Ronald Auer (Orthopedics). We also targeted a print, radio, and magazine campaign, along with web banners, to introduce our new Patient Access Line - a tool implemented to help us manage and engage potential new patients.Neurology - Two-month campaign featured the arrival of Dr. Patrick Matthiessen. He was also featured in the Vital Signs magazine. We promoted Neurology services via print, radio, social media, web banners, and a new Neurology section of the website. We also created a new physician pamphlet about Dr. Matthiessen for all physician office locations and integrated his concepts and programs into our Rehab/Therapy information (print/web).
PART V, SECTION B, LINE 11 CONTINUED	INTRODUCTION OF SEO - IN MARCH, WE BEGAN WORKING WITH LINK MEDIA 360 ON SEARCH ENGINE OPTIMIZATION (SEO). THE GOAL OF THIS PROGRAM WAS TO IMPROVE ONLINE SEARCH RESULTS IN THREE KEY AREAS - ORTHOPEDICS/JOINTS, CANCER TREATMENT CENTER, AND MOTHER-BABY. WE ALSO TRIALED A THREE-MONTH CAMPAIGN USING TARGETED FACEBOOK ADVERTISING SPECIFIC TO THESE THREE SERVICE LINES. DATA (ROI) SUGGESTED THAT WE MADE NUMEROUS IMPRESSIONS, ALTHOUGH ACTUAL RESPONSE (PHONE CALLS) WAS LOW. WE UNDERSTOOD THAT TO BE COMMON AND BELIEVE THE CAMPAIGN ITSELF, IN TERMS OF AWARENESS, WAS A SUCCESS. WE CONTINUE TO SEE GROWTH IN WEBSITE USAGE AND ACTIVITY BASED ON OUR SEO EFFORTS AND THROUGH THE INTEGRATION OF A NEW LOCATIONS SECTION OF THE WEBSITE THAT FOCUSED ON THOSE SEO EFFORTS AND GOOGLE-PLUS PAGES.PROMOTION OF SCREENINGS/EVENTS - THESE INCLUDED OUR LUNG CANCER SCREENING AND NAVIGATIONAL BRONCHOSCOPY, RUN THE FALLS 5K, DIRECT ACCESS TESTING, SPEAKING OF WOMEN'S HEALTH, HEALTH INSURANCE EXCHANGE PROGRAMS/NAVIGATORS (BUSINESS OFFICE FOR INSURANCE SETUP), DOCTOR'S DAY.VEVAY CAMPAIGN - WE FEATURED A THREE-MONTH CAMPAIGN IN VEVAY TO IMPROVE THE VISIBILITY OF OUR VEVAY OFFICE, INCLUDING DR. SCOTT FREDE AND RESOURCES SUCH AS MEDICAL IMAGING AND REHAB/THERAPY SERVICES. WE INTEGRATED PHOTOS OF THE STAFF IN PRINT ADS IN THE LOCAL PAPER AND RIVER TIMES, ALONG WITH RADIO ADS ON THE LOCAL STATION (FROGGY 95.9 FM).ORTHOPEDICS - WE CONTINUED TO FEATURE THE JOINT REPLACEMENT PROGRAM AND ORTHOPEDICS VIA WEB, SOCIAL MARKETING, AND THE VITAL SIGNS MAGAZINE. THIS INCLUDED THE ARRIVAL OF DR. RONALD AUER, A NEW MEMBER OF THE TEAM.MYKDH PORTAL - TO FURTHER FACILITATE PATIENT PORTAL REGISTRATIONS, WE WORKED WITH IT AND HIMS TO PROMOTE THE PORTAL FOR PATIENTS DURING ARRIVAL FOR APPOINTMENTS AND PRIOR TO DEPARTURE FROM INPATIENT SERVICES. WE ALSO USED SOCIAL MEDIA TO REMIND PATIENTS ABOUT THE BENEFITS OF THE PORTAL, FEATURED THE PORTAL IN THE VITAL SIGNS MAGAZINE, AND ENCOURAGED PROVIDERS TO PROMOTE THE SERVICE. TABLE TENTS AND FLYERS REMAIN IN PLACE.FOUNDATION - IN 2015, WE INHERITED THE KDH FOUNDATION. NEW EFFORTS INCLUDED PLANNING, ORGANIZATION, AND PROMOTION OF THE 2015 GOLF BENEFIT AND 2015 FOUNDATION GALA. MARKETING EFFORTS INCLUDED EVENT MATERIALS, POSTERS, INVITATIONS, AND CARDS. WE ALSO BEGAN WORKING TO IMPROVE THE APPEARANCE AND USAGE OF THE FOUNDATION TV MONITOR IN THE LOBBY OF THE MAIN HOSPITAL.NEWS RELEASES - GIRLS ON THE RUN REGISTRATION, ART OF HEALING RECEPTIONS, HEALTH INSURANCE ENROLLMENT, HIP 2.0 INFORMATION, KDH EMS AND SWITZERLAND COUNTY, COLON CANCER KITS/AWARENESS MONTH, PILOT CLUB DONATION (TO CANCER CENTER), SMOKING CESSATION COURSE, ANTHEM AND TOBACCO CESSATION, SPEAKING OF WOMEN'S HEALTH, NURSE PRACTITIONER SARAH HARTMAN, DR. RONALD AUER, DR. PATRICK MATTHIESSEN, MEDICAL EXPLORERS, CANCER CENTER - GOLD STATUS/OUTSTANDING ACHIEVEMENT AWARD, RUN THE FALLS 5K, LUNG CANCER SCREENINGS - NEW GUIDELINES, MARCH OF DIMES QUALITY AWARD (MOTHER-BABY).MEDICAL SERVICES AND PROVIDERS:GAPS IN THE CURRENT MEDICAL SERVICE LINES AND THE MEDICAL SPECIALTIES DESIRED ARE WORTH EXPLORING. ACTION PLAN: LEADERSHIP ROLECONTINUE TO IDENTIFY AREAS WHERE MEDICAL SERVICES ARE LACKING, AND TO RECRUIT MEDICAL PROVIDERS TO MEET THE NEEDS OF THE COMMUNITY. TARGET: PRIMARY SERVICE AREA. EVALUATION: NUMBER OF PROVIDERS (PRIMARY AND SECONDARY) PLACED IN PRACTICES IN OUR PRIMARY SERVICE AREA. 2015 UPDATETHE FOLLOWING SERVES / PROVIDERS WERE ADDED IN 2015 TO SERVE OUR AREA: DR. PATRICK MATTHIESSEN, NEUROLOGY DR. GENE SHILKROT, ANESTHESIA ALICIA MINCER, APN: NOCTURNIST DR. WILLIAM PORTER, RADIATION ONCOLOGY DR. RON AUER, ORTHOPEDIC SURGEON SARAH HARTMAN, APN: FAMILY PRACTICE DR. JENNIFER CHANG, ANESTHESIA DR. MAGDY KHALIL, ANESTHESIA, PRN

Schedule H (Form 990) 2015

Page 8

Part VFacility Information (continued)

Section D. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility (list in order of size, from largest to smallest) How many non-hospital health care facilities did the organization operate during the tax year?10
Name and address		Type of Facility (describe)
1	1 - REHABILITATION CENTER AND HOME CARE 2670 N MICHIGAN ROAD MADison,IN47250	outpatient rehabilitation center and home care services
2	2 - CLIFTY DR MED OFFICE BLDG & CONV CARE 445 Clifty Drive Madison,IN47250	PHYSICIAN MEDICAL OFFICE & CONVENIENT CARE CENTER
3	3 - VERSAILLES MEDICAL OFFICE BLDG-MAIN ST 128 North Main Street Versailles,IN47042	Physician Medical Office
4	4 - VERSAILLES MEDICAL OFFICE BLDG-TYSON ST 206 W Tyson Street Versailles,IN47042	Physician Medical Office
5	5 - TRIMBLE COUNTY MEDICAL OFFICE BLDG 10235 US Highway 421 Milton,KY40045	physician Medical Office
6	6 - CARROLLTON MEDICAL OFFICE BLDG 205 Marwill Drive Carrollton,KY41008	Physician Medical Office
7	7 - SWITZERLAND CNTY MEDICAL OFFICE BLDG 727 State Rd 56 Vevay,IN47043	Physician Medical Office
8	8 - HANOVER MEDICAL OFFICE BLDG 36 Medical Plaza Hanover,IN47243	Physician Medical Office
9	9 - CANCER TREATMENT CENTER 621 West street madison,IN47250	physician Medical Office
10	11 - DOWNTOWN MEDICAL OFFICE BLDG 630 North Broadway Madison,IN47250	physician Medical Office and hospital staff

Schedule H (Form 990) 2015

Page 9

Part VI

Supplemental Information

Provide the following information.

1	Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II and Part III, lines 2, 3, 4, 8 and 9b.
2	Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any CHNAs reported in Part V, Section B.
3	Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4	Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5	Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6	Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7	State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.

Form and Line Reference	Explanation
Part I, Line 3c:	The Hospital changed its policies regarding free and discounted care mid-year 2015.Free Care:- From January to May 2015, the FPG family income limit for eligibility for free care was 200%- From June to December 2015, the FPG family income limit for eligibility for free care was 150%Discounted Care:- From January to May 2015, all uninsured patients received an automatic 20% discount from gross charges.- From June to December 2015, all uninsured patients received an automatic 30% discount from gross charges. For the outstanding balance due after applying the 30% discount, they could further qualify for additional discounted care using the FPG family income limit for eligibility of 250%.
Part II, Community Building Activities:	Community Building Activities promoted the health of the community in the following ways:- Promoting healthcare careers to potential "future employees" through Job Fairs at the local community college- Participation in "Women in Business" events - speaking engagements to promote leadership development- Assisting community members with Medicaid program enrollment via a formal Medicaid Enrollment Assistance Program offered by the Hospital. This program helps community members enroll to receive all types of Medicaid assistance (food, healthcare, etc.)
Part III, Line 2:	As reported on the attached financial statements, page 4, "Consolidated Statements of Operations Years Ended December 31, 2015 and 2014".
Part III, Line 3:	The hospital has a detailed Financial Assistance Policy which states that to participate in charity care candidates must cooperate fully. In addition the hospital educates patients with limited ability to pay regarding financial assistance. For this reason the organization believes that it accurately captures all charity care deductions provided according to the financial assistance policy and the amount of bad debt expense attributable to patients eligible under the organization's charity care policy is negligible.
Part III, Line 4:	See pages 8-10 on the attached financial statements.
Part III, Line 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 12/31/2015 report: Hospital Statement of Reimbursable Cost.
Part III, Line 9b:	The Hospital changed its policy mid-year 2015. From January-May 2015, all uninsured patients received an automatic 20% discount from gross charges. From June-December 2015, all uninsured patients received an automatic 30% discount from gross charges. At registration, patients are notified of the Hospital's financial assistance program. They are 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 of 100% on the outstanding account balance. The Hospital will attempt to collect any balance remaining on the uninsured account after all financial assistance discounts have been applied using a series of statements, letters, and telephone calls. The Hospital will also offer patients 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 DISEASERESULTS OF THE NEEDS ASSESSMENT HAVE BEEN MADE AVAILABLE THROUGH A VARIETY OF SOURCES:NEWSPAPER AND RADIO RELEASES, DISTRIBUTION OF INFORMATION IN THE COMMUNITY NEWSLETTER, VITAL SIGNS, AND IS ALSO AVAILABLE ON OUR WEB SITE.
Part VI, Line 3:	-At the time of registration, the Hospital's Financial Assistance Policy is discussed with each patient. The patient is 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.
Part VI, Line 4:	Jefferson County- Jefferson County is experiencing a slow growth in total population, currently at 32,554. By 2020, the population is expected to be about 38,811. It has a median age of 37.1, nearly identical to the state average of 37.0. The unemployment rate of 8.4% is slightly above the Indiana rate of 8.2%.- The population is fairly homogeneous with a largely Caucasian population, 96%- The median average household income, of $40,386, is lower than that for Indiana and the nation. In Jefferson County, about 14.3% of the individuals, or about 4,326, live below the poverty level, below the 15.8% poverty rate of individuals in Indiana and the 15.9% rate for the entire U.S.- 35% of all families in Jefferson County are single parent families with 28.3% of these families in poverty. In Indiana, 32.9% of all families are single parent families with 27.4% of these families in poverty.- Jefferson County ranks first in Indiana in terms of the number of acres devoted to tobacco with tobacco crop sales of $1.6 million in 2007. 28% of adults in Jefferson County use tobacco compared to 24% of adults living in the state of Indiana.- According to the Indiana State Department of Health 2012 report, Jefferson County was not listed as a county that had a shortage of healthcare professionals or of mental health professionals. However, the 2012 report lists Milton, Shelby and Smyrna townships as medically underserved.- The rate of all cancer incidence is higher in Jefferson County, at 502 for 100,000 population, than for Indiana, at 476 for 100,000 population. The rate of lung cancer is higher in Jefferson, at 96 per 100,000 population than for Indiana at 80 per 100,000. The rate of prostate cancer is higher in Jefferson, at 152 per 100,000 population than for Indiana at 136 per 100,000. The rate of breast cancer in Jefferson is slightly lower, at 115 per 100,000 population than for Indiana at 116 per 100,000 population. The rate of colorectal cancer is lower in Jefferson, at 48 per 100,000, than the rate for Indiana, at 51 per 100,000.- The rate of adult asthma in Jefferson County, at 7.3%, is slightly higher than the rate for Indiana, at 7.2%, as is the rate of chronic bronchitis (3.4% for Jefferson; 3.3% for Indiana) and for emphysema (1.6% for Jefferson; 1.4% for Indiana.)- The percent of mothers who smoked during pregnancy in Jefferson County is 25.8% significantly higher than the state of Indiana average of 17.1%. In 2010, the percent of lowweight births for Jefferson County was 9.6%, above the 8.0% for Indiana.- The number of teen pregnancies among women 15 to 19 years old has slightly decreased in Jefferson County from 2007 to the most recent measurement in 2010. In Jefferson County, there were 46 teen pregnancies in 2007 and 44 teen pregnancies in 2010. In Indiana, a significant decrease took place - there were 11,683 teen pregnancies in 2007 and 8,654 in 2010.- Jefferson County reported 97 newly diagnosed cases of Chlamydia in 2011, an increase from the 82 reported in 2009. There were 12 cases of gonorrhea in 2011 and increase from the less than five reported in Jefferson County in 2009.- The most recent information from the Indiana Family and Social Service Administration in 2008 shows 1,324 adults in Jefferson County with serious mental illness and 247 seriously emotionally disturbed children.- The rate of deaths related to major cardio vascular diseases in Jefferson County increased from 2008 - 249.8 per 100,000 population to 2010 - 372.1 per 100,000 population. The opposite trend occurred in Indiana with 214.3 per 100,000 deaths recorded in 2008 falling to 206.5 per 100,000 in 2010.- The stroke death rate in Jefferson, at 79.4 per 100,000 population in 2010, was significantly higher than the 47.5 per 100,000 population for Indiana and the 41.9 per 100,000 for the nation.- The incidence of cancer rate (all sites) was higher in Jefferson County - 502 per 100,000 population compared to Indiana's rate of 476 per 100,000. Ripley County- Ripley County has a current population of 28,583. There is a net outward migration. By the year 2020, the population will be about 30,754.- The population is 97.8% Caucasian.- The median household income in Ripley is $47,900 - lower than the national average of $50,502, but higher than the Indiana average of $46,438.- The percent of families below poverty in Ripley is 15.4%, lower than the Indiana average of 20.6% and the national average of 20.8%.- 29.8% of all families in Ripley County are single parent families with 27% of these families in poverty. In Indiana, 32.9% of all families are single parent families with 27.4% of these families in poverty.- The percent of mothers in Ripley County who smoke during pregnancy is 22.8%, compared to 17.1% in Indiana. The percent of low birth weight in Ripley County is 7%, compared to 8% in Indiana.- The most recent information from the Indiana Family and Social Service Administration in 2008 shows 1,071 adults in Ripley County with serious mental illness and 250 seriously emotionally disturbed children.- Ripley County does not have a shortage of health care professionals. The townships of Delaware, Center and Brown are considered medically underserved. Ripley has a shortage of mental health professionals.- The rate of individuals with prostate cancer in Ripley was 146 per 100,000 populations compared to 136 for Indiana in 2008.- The death rate from major cardiovascular disease was 246.6 per 100,000 population for Ripley County in 2010. This is higher than Indiana's 206.5 and the nation's 193.6 per 100,000 during the same period.- The incidence of cancer rate (all sites) was higher in Ripley County - 518 per 100,000 population compared to Indiana's rate of 476 per 100,000. Switzerland County- Switzerland County has a population of 10,424 and has a slow growth rate of 0.5 which mirrors that for Indiana. There is a net migration into the county. By 2020, the population will be 11,950.- The ethnicity is 98.1% white.- The unemployment rate is 6.9% in Switzerland County, lower than the Indiana rate of 8.4%.- The median household income is $42,285, compared to $46,438 for Indiana and $50,502 for the nation. In Switzerland, 28% of the families are below the poverty level, compared to 20.6% of Indiana families, and 20.8% of families in the nation. 29.4% of the children in Switzerland County are below the poverty level.- In 2010, 22.5% of all adults age 25+ had less than a high school diploma.- The teen birth rate for Switzerland County in 2009 was 37.8 per 1,000 females age 15-17. This is significantly higher than the rate for Indiana of 20.8 per 1,000.- The rate of mothers smoking during pregnancy is 27.3% in Switzerland County, compared to 17.1% in Indiana. In Switzerland, there is a 6.8% low birth weight, compared to 8.0% in Indiana.- Switzerland County has a shortage of health care professionals. All areas of Switzerland County are considered medically underserved. Switzerland County also has a shortage of mental health professionals.- The rate of chronic bronchitis in Switzerland County and in Indiana is 3.0%. The rate of emphysema in Switzerland is 1.5%, slightly higher than the Indiana rate of 1.4%.- There are 379 adults with serious mental illness in Switzerland County and 78 seriously emotionally disturbed children.- The death rate from major cardiovascular disease was 347.0 per 100,000 population for Switzerland County in 2010. This is significantly higher than Indiana's 206.5 and the nation's 193.6 per 100,000 during the same period.- The incidence of cancer rate (all sites) was higher in Switzerland County - 562 per 100,000 population compared to Indiana's rate of 476 per 100,000. The only type of cancer in which Switzerland County recorded an incidence rate lower than Indiana was Breast Cancer - Switzerland County 82 per 100,000 versus Indiana's 116 per 100,000 population. Carroll County, Kentucky- Carroll County Kentucky currently has a population of 11,013 with a total of 4,195 households. The population is projected to be about 11,440 by 2020.- The population is 95.1% Caucasian.- The average median household income in 2011 was $40,685 - higher than the $41,141 for Kentucky, but lower than the $50,512 for the nation.- The average percent of mothers who smoke during pregnancy for Carroll County is 30%, compared to 24% for Kentucky.- As far as smoking prevalence is concerned, 30% of the adults in Carroll smoke, compared to 29% of Kentucky and 21% of the nation. The percent of high school students in Carroll who smoke is 31%, compared to 25% for Kentucky and 19% for the nation.- Carroll County Kentucky has 25% of the population obese, compared to 29% of Kentucky and 24% of the nation.- In Carroll, 43% of the population lack physical activity, compared to 32% in Kentucky and 24% in the nation.
Part VI, Line 5:	The majority of King's Daughters' Health Board of Managers is comprised of individuals who live and work in the Hospital services area. The majority of these individuals are neither employees, nor contractors of the organization, nor family members thereof. The Hospital extends medical staff privileges to all qualified physicians in its community for some or all of its departments. The organization also applies a portion of surplus funds to improvements in patient care. Historically, KDH has employed a full time Community Wellness Coordinator. This position provides outreach services in areas of need to the Communities we serve. In addition to these services, KDH also serves as the fiscal agent for several state and federal grants. All of these services help us meet the identified needs of the communities we serve.Participation in the below community organizations is part of the Hospital's Indiana State Department of Health Community Benefit Plan and Goals.2015 KING'S DAUGHTERS' HEALTH OVERVIEW OF COMMUNITY BENEFIT ACTIVITIES1. HEALTH SCREENS: A. CORPORATE HEALTH SCREENS / FAIRS Clifty Engineering Screen: 15 Belterra Health Fair participation (no screenings provided) B. COLON CANCER SCREENING KITS: 30 returns. C. CORPORATE FLU SHOTS: (172 total) Animal Clinic: 6 AGS Law Office: 9 SET Enterprises: 17 140 sold to IVY Tech for selfadministration2. COMMUNITY HEALTH FAIRS: (Participated by offering a booth with health education) A. RIPLEY COUNTY 4H FAIR B. JEFFERSON COUNTY 4H FAIR C. REMC HEALTH FAIR IN VERSAILLES D. WAL-MART CANCER AWARENESS EVENT E. HEALTHY KIDS DAY AT SWITZERLAND CO. YMCA F. BACK TO SCHOOL HEALTH FAIR G. Community Day/Health Fair at Local Low-Income housing complex 3. COMMUNITY EDUCATION OPPORTUNITIES/CLASSES/SPECIAL EVENTS: A. SPEAKERS BUREAU: Heather (Wellness): 12 speaking engagements Stephanie (Tobacco): 11 speaking engagements B. FIT KIDS PROGRAM (7 WK program for area 5th grade classrooms) 6 Schools / 10 Classrooms / 249 Kids + teachers C. TOBACCO CESSATION & EDUCATION: Provided outreach to: 8 businesses 15 School Visits KDH Physician Offices D. CPR AND FIRST AID CLASSES: Community classes held with 672 graduates School-based classes held with 97 students participating E. Strive for 5 Program: Community 5-week weight loss education program One class held in 2015, 11 total participants F. PRENATAL EDUCATION: OB Prep Program - 392 people served Prepared Childcare Essential classes - 11 people served Lamaze classes - 3 people served Sibling classes - 5 people served G. GIRLS ON THE RUN Fall Season: 56 girls / 5 sites / 26 trained coaches / 10 week program Fall 5K: 200 participants and 50 volunteers H. HOUSE OF HEALTH: Monthly education opportunity provided at the House of Hope food pantry. Approximately 25-70 people attend each month. 12 Topics for 2015 include: CPR Friends & Family, Heart Health, Nutrition, Emergency Preparedness, Car Seat Safety, Sun Safety, Tobacco, Kids Health, Safe Drug Drop Off/HIV testing, Breast Cancer, Diabetes, and Holiday Food Safety. I. SPEAKING OF WOMEN'S HEALTH 331 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 J. Monthly "To your health" radio show 30 Minute health education program with various topics offered each month4. 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: 47250 healthy habit challenge 30day Walking campaign 2 onsite employee Wellness classes Heart month activities Wear Red Day participation (heart health education) Two Strive for 5 weight loss classes held (5 week series)5. COMMUNITY SERVICE ACTIVITIES: A. SUPPORT GROUPS: Breast Cancer Support Group B. ACTIVE ATTENDANCE AND PARTICIPATION IN: CASA (Coalition Against Substance Abuse, Jefferson County) SCAT (Switzerland County Awareness Team) TPCC and Jefferson County Tobacco Coalition (State & Local tobacco efforts) Active Living Committee Envision Jefferson County MASHER (area corporate health and safety group) C. KDH RUN THE FALLS 5K WALK/RUN HELD AT CLIFTY FALLS STATE PARK 202 People participated D. EMS STANDBY AT ALL COMMUNITY ACTIVITIES: EMS provides standby coverage at all Jefferson County activities. E. SUPPORT TO VARIOUS AREA SCHOOLS WITH INTERNSHIPS: Support many Local and area High Schools and Colleges with Internships and Job Shadow experiences: Includes Nursing and Medical Students among others.6. SUCCESSFUL GRANT ACTIVITY: A. TPCC: TOBACCO PREVENTION AND CESSATION COMMISsION: Funding to hire full time coordinator, starting in 2009, continues for Jefferson Co. B. CASA / SCAT GRANTS: To fund Nicotine Replacement Therapy for individuals wishing to quit tobacco.
Part VI, Line 6:	NA
Part VI, Line 7, Reports Filed With States	IN
Part VI, Line 4 continued	Carroll County, Kentucky (continued)- The unemployment rate in Carroll County is 9.6%, higher than both Kentucky's 8.2% and the nation's 8.1%.- The death rate from heart disease in Carroll County is 299.8 per 100,000 compared to 205.6 per 100,000 for Kentucky and 173.7 per 100,000 for the nation.- The death rate per 100,000 due to Chronic Respiratory Disease in 2011 was 112.1 for Carroll County compared to 63.1 per 100,000 for Kentucky and 42.7 per 100,000 for the nation.- In 2011, Carroll County had nearly two and half times the number of Drug Arrests per 100,000 in comparison to Kentucky: 2,162 versus 870. Trimble County, Kentucky- Trimble County, Kentucky, has a population of 8,725 and a declining growth rate of -1.0 per 1,000 population, compared to 0.6% increased growth for Kentucky. By 2020, the population will be 9,514.- The population is 97.2% white.- The average median household income in Trimble County is $44,141 compared to $43,677 in Kentucky and $50,502 in the nation. The unemployment rate is 8.2%, compared to 8.2% for Kentucky and 8.1% for the nation.- The rate of smoking during pregnancy in Trimble County is 44%, compared to 24% in Kentucky. The low birth weight rate in Trimble County is 6% which is below Kentucky's 9%.- In Trimble County, 30% of adults smoke, which is higher than the 29% for Kentucky and the 19% for the nation. In Trimble County, 25% of high school students smoke, the same as in Kentucky, but higher than the 23% in the nation.- In Trimble County, 29% of the adults are obese, the same as for Kentucky, but higher than the 24% for the nation. In Trimble, 14% lack physical activity, compared to 32% in Kentucky and 24% in the nation.- In Trimble County, there is an 9% rate of adult diabetes, compared to 8% in Kentucky and 10% for the nation. The death rate per 100,000 due to diabetes was 55.4 for Trimble County, compared to 28.0 for Kentucky and 25.3 for the nation.- Deaths due to Breast Cancer were 15 per 100,000 for Trimble County compared to 14 per 100,000 for Kentucky. Deaths due to Prostate Cancer were 23 per 100,000 for Trimble County and 18 per 100,000 for Kentucky.

Schedule H (Form 990) 2015

Additional Data

Software ID:
Software Version:

- TIN:

Schedule I
(Form 990)

Department of the Treasury
Internal Revenue Service

Grants and Other Assistance to Organizations,
Governments and Individuals in the United States

Complete if the organization answered "Yes," on Form 990, Part IV, line 21 or 22.
lBullet

Attach to Form 990.
lBullet

Information about Schedule I (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public
Inspection

Name of the organization
The Bethany Circle of King's Daughters'
of Madison Indiana Inc

Employer identification number
35-0895832

Part I

General Information on Grants and Assistance

Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ........................

Yes No

Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.

Part II

Grants and Other Assistance to Domestic Organizations and Domestic Governments. Complete if the organization answered "Yes" on Form 990, Part IV, line 21, for any recipient

that received more than $5,000. Part II can be duplicated if additional space is needed.

(a) Name and address of organization or government	(b) EIN	(c) IRC section if applicable	(d) Amount of cash grant	(e) Amount of non-cash assistance	(f) Method of valuation (book, FMV, appraisal, other)	(g) Description of non-cash assistance	(h) Purpose of grant or assistance

(1) Ivy Tech Foundation Inc 50 WEst Fall Creek Parkway North Indianapolis,IN46208	23-7073977	501(c)(3)	5,000				Donation
(2) Indiana Hospital Assistance Foundation Inc 1 American Square Suite 1900 Indianapolis,IN46282	45-5573749	501(c)(3)	13,830				Donation

Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image

Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50055P

Schedule I (Form 990) 2015

Page 2

Part III

Grants and Other Assistance to Domestic Individuals. Complete if the organization answered "Yes" on Form 990, Part IV, line 22.
Part III can be duplicated if additional space is needed.

(a) Type of grant or assistance	(b) Number of recipients	(c) Amount of cash grant	(d) Amount of non-cash assistance	(e) Method of valuation (book, FMV, appraisal, other)	(f) Description of non-cash assistance

(1) Medical Supplies	18,033	FMV	Various Medical Supplies
(1)
(2)
(3)
(4)
(5)
(6)
(7)

Part IV

Supplemental Information. Provide the information required in Part I, line 2, Part III, column (b), and any other additional information.

Return Reference	Explanation
Part I, Line 2:	Funds are not granted to organizations but are donated. Donations are determined on a discretionary basis.

Schedule I (Form 990) 2015

Additional Data

Software ID:
Software Version:

- TIN:

Schedule J
(Form 990)

Department of the Treasury
Internal Revenue Service

Compensation Information

For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet

Complete if the organization answered "Yes" on Form 990, Part IV, line 23.
SchJMediumBullet

Attach to Form 990.
SchJMediumBullet

Information about Schedule J (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public Inspection

Name of the organization

The Bethany Circle of King's Daughters'
of Madison Indiana Inc

Employer identification number

35-0895832

Part I

Questions Regarding Compensation

Yes

Check the appropiate box(es) if the organization provided any of the following to or for a person listed on Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.

First-class or charter travel Housing allowance or residence for personal use

Travel for companions Payments for business use of personal residence

Tax idemnification and gross-up payments Health or social club dues or initiation fees

Discretionary spending account Personal services (e.g., maid, chauffeur, chef)

If any of the boxes in line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all of the expenses described above? If "No," complete Part III to explain .........

Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
directors, trustees, officers, including the CEO/Executive Director, regarding the items checked in line 1a? ..

Indicate which, if any, of the following the filing organization used to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

Form 990 of other organizations Approval by the board or compensation committee

During the year, did any person listed on Form 990, Part VII, Section A, line 1a with respect to the filing organization or a related organization:

Receive a severance payment or change-of-control payment? ................

Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........

Participate in, or receive payment from, an equity-based compensation arrangement? .........

If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.

Only 501(c)(3), 501(c)(4), and 501(c)(29) organizations must complete lines 5-9.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:

The organization? ...........................

Any related organization?

If "Yes," on line 5a or 5b, describe in Part III.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:

The organization?

Any related organization? .........................

If "Yes," on line 6a or 6b, describe in Part III.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization provide any non-fixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............

Were any amounts reported on Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III .............................

If "Yes" on line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50053T

Schedule J (Form 990) 2015

Page 2

Part II

Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is needed.

For each individual whose compensation must be reported on Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions, on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.
Note. The sum of columns (B)(i)-(iii) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and (E) amounts for that individual.

(A) Name and Title		(B) Breakdown of W-2 and/or 1099-MISC compensation			(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)	(F) Compensation in column(B) reported as deferred on prior Form 990
(A) Name and Title		(i) Base compensation	(ii) Bonus & incentive compensation	(iii) Other reportable compensation	(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)
1JONATHAN HANSON MDBOARD MEMBER/PHYSIcian	(i) (ii)	272,679 ------------- 0	116,596 ------------- 0	360 ------------- 0	13,250 ------------- 0	29,019 ------------- 0	431,904 ------------- 0	0 ------------- 0
2PAT STACK MDBoard Member/Physician	(i) (ii)	148,932 ------------- 0	86,807 ------------- 0	1,584 ------------- 0	12,271 ------------- 0	25,365 ------------- 0	274,959 ------------- 0	0 ------------- 0
3CAROL DOZIERPRESIDENT/CEO	(i) (ii)	348,817 ------------- 0	195 ------------- 0	552 ------------- 0	13,250 ------------- 0	1,302 ------------- 0	364,116 ------------- 0	0 ------------- 0
4Steve MeachamVP Finance	(i) (ii)	196,966 ------------- 0	195 ------------- 0	1,584 ------------- 0	27,636 ------------- 0	21,276 ------------- 0	247,657 ------------- 0	0 ------------- 0
5Lisa MorganVP Patient Services	(i) (ii)	148,007 ------------- 0	195 ------------- 0	552 ------------- 0	25,104 ------------- 0	26,623 ------------- 0	200,481 ------------- 0	0 ------------- 0
6Denine Fallis-HallgarthVP Physician Practices	(i) (ii)	129,991 ------------- 0	195 ------------- 0	552 ------------- 0	24,228 ------------- 0	12,183 ------------- 0	167,149 ------------- 0	0 ------------- 0
7HOLLY ROBINSON MDVP QUALITY / Physician	(i) (ii)	210,304 ------------- 0	59,593 ------------- 0	240 ------------- 0	22,000 ------------- 0	29,070 ------------- 0	321,207 ------------- 0	0 ------------- 0
8Thomas Eckert MDEmployed Physician	(i) (ii)	424,300 ------------- 0	317,359 ------------- 0	1,584 ------------- 0	13,250 ------------- 0	18,374 ------------- 0	774,867 ------------- 0	0 ------------- 0
9Travis Clegg MDEmployed Physician	(i) (ii)	478,474 ------------- 0	1,173,450 ------------- 0	46,077 ------------- 0	13,250 ------------- 0	28,921 ------------- 0	1,740,172 ------------- 0	0 ------------- 0
10William Skiles MDEmployed Physician	(i) (ii)	448,466 ------------- 0	199,740 ------------- 0	1,032 ------------- 0	13,250 ------------- 0	15,129 ------------- 0	677,617 ------------- 0	0 ------------- 0
11Michael Schmidt MDEmployed Physician	(i) (ii)	445,579 ------------- 0	208,355 ------------- 0	10,496 ------------- 0	13,250 ------------- 0	31,201 ------------- 0	708,881 ------------- 0	0 ------------- 0
12George Alcorn MDEMployed Physician	(i) (ii)	307,502 ------------- 0	297,412 ------------- 0	1,584 ------------- 0	13,250 ------------- 0	9,116 ------------- 0	628,864 ------------- 0	0 ------------- 0

Schedule J (Form 990) 2015

Page 3

Part III

Supplemental Information

Provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II. Also complete this part for any additional information.

Return Reference	Explanation
ADDITIONAL SCHEDULE J DISCLOSURES	Board members Pat Stack, MD and Jonathan Hanson, MD listed above are employed physicians of the Hospital. Dr. Stack and Dr. Hanson do not receive compensation for services provided as board members. The compensation listed above for Dr. Stack and Dr. Hanson is compensation received for services provided as employed physicians.

Schedule J (Form 990) 2015

Additional Data

Software ID:
Software Version:

- TIN:

Schedule K
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Information on Tax Exempt Bonds

Complete if the organization answered "Yes" to Form 990, Part IV, line 24a. Provide descriptions,
explanations, and any additional information in Part VI.
SchKMediumBullet

Attach to Form 990.
SchKMediumBullet

Information about Schedule K (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public
Inspection

Name of the organization
The Bethany Circle of King's Daughters'
of Madison Indiana Inc

Employer identification number
35-0895832

Part I

Bond Issues

(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	(g) Defeased		(h) On behalf of issuer		(i) Pool financing
(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	Yes	No	Yes	No	Yes	No
A	Indiana Finance Authority	35-1602316	45471ACW0	11-03-2010	97,847,058	See Part VI		X		X		X

Part II

Proceeds

	A		B		C		D
	1 Amount of bonds retired ..................
2 Amount of bonds legally defeased ..............
3 Total proceeds of issue ..................	97,847,058
4 Gross proceeds in reserve funds .............	6,756,861
5 Capitalized interest from proceeds .............
6 Proceeds in refunding escrows ...............
7 Issuance costs from proceeds ...............	1,749,243
8 Credit enhancement from proceeds .............
9 Working capital expenditures from proceeds .............
10 Capital expenditures from proceeds .............	88,974,097
11 Other spent proceeds .............	366,857
12 Other unspent proceeds .............
13 Year of substantial completion .............	2013
	Yes	No	Yes	No	Yes	No	Yes	No
14 Were the bonds issued as part of a current refunding issue? ....		X
15 Were the bonds issued as part of an advance refunding issue? .....		X
16 Has the final allocation of proceeds been made? ..........	X
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? ..................	X

Part III

Private Business Use

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? .............		X
2 Are there any lease arrangements that may result in private business use of bond-financed property? ...............		X

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50193E

Schedule K (Form 990) 2015

Page 2

Part III

Private Business Use (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
3a Are there any management or service contracts that may result in private business use of bond-financed property? .............	X
b If "Yes" to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property?	X
c Are there any research agreements that may result in private business use of bond-financed property? .............		X
d If "Yes" to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property?
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government ....
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government .........
6 Total of lines 4 and 5 .............
7 Does the bond issue meet the private security or payment test? ...		X
8a Has there been a sale or disposition of any of the bond-financed property to a nongovernmental person other than a 501(c)(3) organization since the bonds were issued?.............		X
b If "Yes" to line 8a, enter the percentage of bond-financed property sold or disposed of. ..
c If "Yes" to line 8a, was any remedial action taken pursuant to Regulations sections 1.141-12 and 1.145-2? .............
9 Has the organization established written procedures to ensure that all nonqualified bonds of the issue are remediated in accordance with the requirements under Regulations sections 1.141-12 and 1.145-2? ........		X

Part IV

Arbitrage

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Has the issuer filed Form 8038-T, Arbitrage Rebate, Yield Reduction and Penalty in Lieu of Arbitrage Rebate? ...		X
2 If "No" to line 1, did the following apply? ....
a Rebate not due yet? .......		X
b Exception to rebate? ........		X
c No rebate due? .........		X
If "Yes" to line 2c, provide in Part VI the date the rebate computation was performed ......
3 Is the bond issue a variable rate issue? .....		X
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?		X
b Name of provider ..........
c Term of hedge .........
d Was the hedge superintegrated? ......
e Was the hedge terminated? ........

Schedule K (Form 990) 2015

Page 3

Part IV

Arbitrage (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
5a Were gross proceeds invested in a guaranteed investment contract (GIC)?		X
b Name of provider ..........
c Term of GIC .........
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? ........
6 Were any gross proceeds invested beyond an available temporary period?		X
7 Has the organization established written procedures to monitor the requirements of section 148? ...	X

Part V

Procedures To Undertake Corrective Action

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
Has the organization established written procedures to ensure that violations of federal tax requirements are timely identified and corrected through the voluntary closing agreement program if self-remediation is not available under applicable regulations?	X

Part VI

Supplemental Information. Provide additional information for responses to questions on Schedule K (see instructions).

Return Reference	Explanation
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.

Schedule K (Form 990) 2015

Additional Data

Software ID:
Software Version:

- TIN:

Schedule L
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Transactions with Interested Persons

Complete if the organization answered
"Yes" on Form 990, Part IV, lines 25a, 25b, 26, 27, 28a, 28b, or 28c,
or Form 990-EZ, Part V, line 38a or 40b.
MediumBullet

Attach to Form 990 or Form 990-EZ.
MediumBullet

Information about Schedule L (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public Inspection

Name of the organization

The Bethany Circle of King's Daughters'
of Madison Indiana Inc

Employer identification number

35-0895832

Part I

Excess Benefit Transactions (section 501(c)(3), section 501(c)(4), and 501(c)(29) organizations only).
Complete if the organization answered "Yes" on Form 990, Part IV, line 25a or 25b, or Form 990-EZ, Part V, line 40b.

1(a) Name of disqualified person	(c) Description of transaction	(d) Corrected?
1(a) Name of disqualified person	(c) Description of transaction	Yes	No

Enter the amount of tax incurred by organization managers or disqualified persons during the year under section 4958. ........................... Bullet Image

Enter the amount of tax, if any, on line 2, above, reimbursed by the organization ........ Bullet Image

Part II

Loans to and/or From Interested Persons.
Complete if the organization answered "Yes" on Form 990-EZ, Part V, line 38a, or Form 990, Part IV, line 26; or if the organization reported an amount on Form 990, Part X, line 5, 6, or 22

(a) Name of interested person	(b) Relationship with organization	(c) Purpose of loan	(d) Loan to or from the organization?		(e)Original principal amount	(f)Balance due	(g) In default?		(h) Approved by board or committee?		(i)Written agreement?
(a) Name of interested person	(b) Relationship with organization	(c) Purpose of loan	To	From	(e)Original principal amount	(f)Balance due	Yes	No	Yes	No	Yes	No










Total ............... $

Part III

Grants or Assistance Benefiting Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 27.

(a) Name of interested person	(b) Relationship between interested person and the organization	(c) Amount of assistance	(d) Type of assistance	(e) Purpose of assistance

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 50056A

Schedule L (Form 990 or 990-EZ) 2015

Page 2

Part IV

Business Transactions Involving Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 28a, 28b, or 28c.

(a) Name of interested person	(b) Relationship between interested person and the organization	(c) Amount of transaction	(d) Description of transaction	(e) Sharing of organization's revenues?
(a) Name of interested person		(c) Amount of transaction	(d) Description of transaction	Yes	No
(1) A DATTILO FRUIT COMPANY	Vice President of Patient Services of KDH has 51% ownership interest	41,827	Lisa Morgan, Vice President of Patient Services of KDH owns a 51% interest in A. Datillo Fruit Company. KDH purchases produce from A. Dattilo Fruit Company. The Hospital made purchases totaling $41,827 in 2015.		No
(2) RIVER VALLEY FINANCIAL BANK	Board member is the spouse of president and CEO of River Valley Fin. Bank		Andrea Forrester, Board Asst Treasurer, is married to the Pres and CEO of River Valley Financial Bank. The Hospital's operating account is with the bank. The Hospital recorded interest income of $126,896 and service fees of $8,102 from activity with the bank.		No

Part V

Supplemental Information
Provide additional information for responses to questions on Schedule L (see instructions).

Return Reference	Explanation

Schedule L (Form 990 or 990-EZ) 2015

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or 990-EZ or to provide any additional information.
MediumBullet

Attach to Form 990 or 990-EZ.
MediumBullet

Information about Schedule O (Form 990 or 990-EZ) and its instructions is at
www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public
Inspection

Name of the organization

The Bethany Circle of King's Daughters'
of Madison Indiana Inc

Employer identification number

35-0895832

Return Reference	Explanation
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 181,173.
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.

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2015

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

Complete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
MediumBullet

Attach to Form 990.
MediumBullet

Information about Schedule R (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public Inspection

Name of the organization

The Bethany Circle of King's Daughters'
of Madison Indiana Inc

Employer identification number

35-0895832

Part I

Identification of Disregarded Entities Complete if the organization answered "Yes" on Form 990, Part IV, line 33.

(a) Name, address, and EIN (if applicable) of disregarded entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Total income	(e) End-of-year assets	(f) Direct controlling entity

Part II

Identification of Related Tax-Exempt Organizations Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	(g) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	Yes	No
(1)The King's Daughters' Hospital Foundation Inc PO Box 447 Madison,IN47250 20-2148950	Fundraising to support the provision of healthcare services	IN	501(c)(3)	Line 7	N/A		No

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50135Y

Schedule R (Form 990) 2015

Page 2

Part III

Identification of Related Organizations Taxable as a Partnership Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a partnership during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No

Part IV

Identification of Related Organizations Taxable as a Corporation or Trust Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	(i) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	Yes	No

Schedule R (Form 990) 2015

Page 3

Part V

Transactions With Related Organizations Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35b, or 36.

Note. Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.

Yes

1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?

a Receipt of (i) interest, (ii) annuities, (iii) royalties, or (iv) rent from a controlled entity .....................

b Gift, grant, or capital contribution to related organization(s) ............................

Yes

c Gift, grant, or capital contribution from related organization(s) ............................

Yes

d Loans or loan guarantees to or for related organization(s) ............................

e Loans or loan guarantees by related organization(s) ............................

f Dividends from related organization(s) ............................

g Sale of assets to related organization(s) ............................

h Purchase of assets from related organization(s) ............................

i Exchange of assets with related organization(s) ............................

j Lease of facilities, equipment, or other assets to related organization(s) .......................

k Lease of facilities, equipment, or other assets from related organization(s) ......................

l Performance of services or membership or fundraising solicitations for related organization(s) .....................

m Performance of services or membership or fundraising solicitations by related organization(s) .................

n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) ...................

Yes

o Sharing of paid employees with related organization(s) ............................

Yes

p Reimbursement paid to related organization(s) for expenses ............................

q Reimbursement paid by related organization(s) for expenses ............................

Yes

r Other transfer of cash or property to related organization(s) ............................

s Other transfer of cash or property from related organization(s) ............................

If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.

(a) Name of related organization	(b) Transaction type (a-s)	(c) Amount involved	(d) Method of determining amount involved

Schedule R (Form 990) 2015

Page 4

Part VI

Unrelated Organizations Taxable as a Partnership Complete if the organization answered "Yes" on Form 990, Part IV, line 37.

Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.

(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(e) Are all partners section 501(c)(3) organizations?		(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?
(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	Yes	No	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No

Schedule R (Form 990) 2015

Page 5

Part VII

Supplemental Information

Provide additional information for responses to questions on Schedule R (see instructions).

Return Reference	Explanation

Schedule R (Form 990) 2015

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: To improve the health of the hospital's patients through care, service, and education.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	11
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	9
5	Total number of individuals employed in calendar year 2015 (Part V, line 2a) ......	5	1,147
6	Total number of volunteers (estimate if necessary) .............	6	115
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	16,894
b	Net unrelated business taxable income from Form 990-T, line 34 .........	7b	-8,965

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	66,466	568,158
9	Program service revenue (Part VIII, line 2g) .........	116,873,806	132,837,067
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	3,082,095	2,407,230
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	2,338,156	735,637
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	122,360,523	136,548,092
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	19,566	43,737
14	Benefits paid to or for members (Part IX, column (A), line 4).....	0	0
15	Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10)	62,334,347	62,858,895
16a	Professional fundraising fees (Part IX, column (A), line 11e) .....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 0
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	55,677,874	58,362,666
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	118,031,787	121,265,298
19	Revenue less expenses. Subtract line 18 from line 12.......	4,328,736	15,282,794
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	241,257,319	248,968,944
21	Total liabilities (Part X, line 26).............	114,823,185	110,636,308
22	Net assets or fund balances. Subtract line 21 from line 20.....	126,434,134	138,332,636

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 101,694,158 including grants of $ 43,737 ) (Revenue $ 133,041,877 )
	KING'S DAUGHTERS' HEALTH IS A NOT-FOR-PROFIT, ACUTE CARE HOSPITAL OWNED BY THE BETHANY CIRCLE OF KING'S DAUGHTERS' OF MADISON, INDIANA, INC., LOCATED IN MADISON, INDIANA. THE HOSPITAL IS ORGANIZED FOR THE PURPOSE OF PROVIDING HEALTHCARE SERVICES TO THE RESIDENTS OF JEFFERSON COUNTY AND THE SURROUNDING AREA.DURING THE CALENDAR YEAR 2015, THE HOSPITAL PROVIDED HEALTHCARE TO PATIENTS AT THE FOLLOWING LEVELS:12,467 DAYS OF CARE TO ACUTE INPATIENTS1,190 DAYS OF CARE TO NEWBORN INFANTS200,503 VISITS ASSOCIATED WITH HOSPITAL OUTPATIENTS131,061 VISITS ASSOCIATED WITH PHYSICIAN CLINICS

4b	(Code: ) (Expenses $ 2,129,004 including grants of $ ) (Revenue $ )
	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 2015, THE KING'S DAUGHTERS' HOSPITAL AND HEALTH SERVICES PROVIDED SERVICES TOTALING $2,129,004 IN GROSS CHARGES TO PATIENTS WHO MET THE HOSPITAL'S CHARITY CARE POLICY.

4c	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4d	Other program services (Describe in Schedule O.)
	(Expenses $ including grants of $ ) (Revenue $ )
4e	Total program service expenses103,823,162

(A) Name and Title	(B) Average hours per week (list any hours for related organizations below dotted line)		(D) Reportable compensation from the organization (W- 2/1099-MISC)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)	(F) Estimated amount of other compensation from the organization and related organizations
(A) Name and Title
(18) Thomas Eckert MD........................................................................ Employed Physician	40.00 .......................1.00	X	743,243	0	31,624
(19) Travis Clegg MD........................................................................ Employed Physician	40.00 .......................0.00	X	1,698,001	0	42,171
(20) William Skiles MD........................................................................ Employed Physician	40.00 .......................0.00	X	649,238	0	28,379
(21) Michael Schmidt MD........................................................................ Employed Physician	40.00 .......................0.00	X	664,430	0	44,451
(22) George Alcorn MD........................................................................ EMployed Physician	40.00 .......................0.00	X	606,498	0	22,366

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	6,094,306	0	451,568

1a	Federated campaigns..		1a
b	Membership dues..		1b
c	Fundraising events..		1c
d	Related organizations		1d	500,000
e	Government grants (contributions)		1e	52,062

f	All other contributions, gifts, grants, and similar amounts not included above		1f	16,096

g	Noncash contributions included in lines 1a-1f:$
h Total.Add lines 1a-1f.......		568,158

			Business Code
2a	Net Patient Service Revenue	621110	132,837,067	132,820,173	16,894
b
c
d
e
f	All other program service revenue.
g Total.Add lines 2a–2f.....			132,837,067

3 Investment income (including dividends, interest, and othersimilar amounts) ..........			1,818,718			1,818,718
4 Income from investment of tax-exempt bond proceeds
5 Royalties...........
		(ii) Personal	(i) Real
6a	Gross rents		95,151
b	Less: rental expenses		15,525
c	Rental income or (loss)		79,626
d	Net rental income or (loss)......			79,626	79,626
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory		15,100,587
b	Less: cost or other basis and sales expenses	10,879	14,501,196
c	Gain or (loss)	-10,879	599,391
d	Net gain or (loss).....			588,512			588,512
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ....
	a
b	Less: direct expenses ...b
c	Net income or (loss) from fundraising events..
9a	Gross income from gaming activities. See Part IV, line 19 ...
	a
b	Less: direct expenses ...b
c	Net income or (loss) from gaming activities..
10a	Gross sales of inventory, less returns and allowances ..
	a
b	Less: cost of goods sold ..b
c	Net income or (loss) from sales of inventory..
Business Code			Miscellaneous Revenue
11a	Cafeteria Revenue		722210	332,066			332,066
b	Gift Shop		453220	181,867			181,867
c	Other		621110	105,528	105,528
d	All other revenue ....			36,550	36,550
e	Total. Add lines 11a–11d ......			656,011
12	Total revenue. See Instructions......			136,548,092	133,041,877	16,894	2,921,163

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21	18,830	18,830
2	Grants and other assistance to individuals in the United States. See Part IV, line 22	24,907	24,907
3	Grants and other assistance to governments, organizations, and individuals outside the United States. See Part IV, lines 15 and 16
4	Benefits paid to or for members
5	Compensation of current officers, directors, trustees, and key employees ....	2,015,474	1,725,579	289,895
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ....
7	Other salaries and wages	48,585,014	40,838,189	7,746,825
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	1,702,855	1,457,926	244,929
9	Other employee benefits .......	7,408,195	6,342,641	1,065,554
10	Payroll taxes ...........	3,147,357	2,694,658	452,699
11	Fees for services (non-employees):
a	Management ......
b	Legal .........	249,715		249,715
c	Accounting ...........	1,220,446		1,220,446
d	Lobbying ...........
e	Professional fundraising services. See Part IV, line 17
f	Investment management fees ......	291,866		291,866
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)
12	Advertising and promotion ....	169,376	145,014	24,362
13	Office expenses .......	1,984,519	1,699,077	285,442
14	Information technology ......	368,509	315,505	53,004
15	Royalties ..
16	Occupancy ...........	1,743,815	1,492,994	250,821
17	Travel ............	127,120	108,836	18,284
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .
19	Conferences, conventions, and meetings ....
20	Interest ...........	5,445,574	4,662,312	783,262
21	Payments to affiliates .......
22	Depreciation, depletion, and amortization ..	12,554,036	10,748,332	1,805,704
23	Insurance ...	1,478,716	1,266,026	212,690
24	Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a	Drugs	8,386,368	8,386,368
b	Purchased Services	8,272,105	7,082,291	1,189,814
c	Supplies	7,597,159	6,504,425	1,092,734
d	Hospital Assessment Fee	1,586,599	1,586,599
e	All other expenses	6,886,743	6,722,653	164,090
25	Total functional expenses. Add lines 1 through 24e	121,265,298	103,823,162	17,442,136	0
26	Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here if following SOP 98-2 (ASC 958-720).

1	Cash–non-interest-bearing ........				1
2	Savings and temporary cash investments .........			18,557,562	2	16,615,294
3	Pledges and grants receivable, net ......				3
4	Accounts receivable, net .............			12,046,508	4	12,214,616
5	Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of Schedule L
				54,039	5
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing employers and sponsoring organizations of section 501(c)(9) voluntary employees' beneficiary organizations (see instructions) Complete Part II of Schedule L
					6
7	Notes and loans receivable, net ....			2,653,683	7	2,942,043
8	Inventories for sale or use ........			2,667,423	8	2,580,826
9	Prepaid expenses and deferred charges ......			996,157	9	1,448,508
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	186,952,282
b	Less: accumulated depreciation	10b	61,995,327	133,636,096	10c	124,956,955
11	Investments—publicly traded securities .			63,987,854	11	84,030,981
12	Investments—other securities. See Part IV, line 11 .....				12
13	Investments—program-related. See Part IV, line 11 ..				13
14	Intangible assets ...............				14
15	Other assets. See Part IV, line 11 ...........			6,657,997	15	4,179,721
16	Total assets. Add lines 1 through 15 (must equal line 34)...			241,257,319	16	248,968,944

17	Accounts payable and accrued expenses .....	12,650,373	17	11,528,709
18	Grants payable ...		18
19	Deferred revenue .........		19
20	Tax-exempt bond liabilities .........	98,015,768	20	96,691,235
21	Escrow or custodial account liability. Complete Part IV of Schedule D		21
22	Loans and other payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
	persons. Complete Part II of Schedule L..		22
23	Secured mortgages and notes payable to unrelated third parties ..	969,093	23	644,324
24	Unsecured notes and loans payable to unrelated third parties ..		24
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D	3,187,951	25	1,772,040
26	Total liabilities. Add lines 17 through 25..	114,823,185	26	110,636,308

	Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets	126,404,076	27	138,304,381
28	Temporarily restricted net assets ...........	20,058	28	18,255
29	Permanently restricted net assets	10,000	29	10,000
	Organizations that do not follow SFAS 117 (ASC 958), check here and complete lines 30 through 34.
30	Capital stock or trust principal, or current funds .....		30
31	Paid-in or capital surplus, or land, building or equipment fund ...		31
32	Retained earnings, endowment, accumulated income, or other funds		32
33	Total net assets or fund balances ...........	126,434,134	33	138,332,636
34	Total liabilities and net assets/fund balances ........	241,257,319	34	248,968,944