Form990
Click to see attachment
Department of the TreasuryInternal Revenue Service
Return of Organization Exempt From Income Tax
Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except private
foundations)
MediumBullet Do not enter social security numbers on this form as it may be made public.
MediumBullet Information about Form 990 and its instructions is at www.IRS.gov/form990.
OMB No. 1545-0047
2015
Open to Public Inspection
A For the 2015 calendar year, or tax year beginning 07-01-2015 , and ending 06-30-2016
BCheck if applicable:
CName of organization
DUKE QUALITY NETWORK INC
 
 
Doing business as
 
 
Number and street (or P.O. box if mail is not delivered to street address)
324 BLACKWELL ST WASHIN BLDG NO 850
 
Room/suite
City or town, state or province, country, and ZIP or foreign postal code
DURHAM, NC27701
D Employer identification number

46-1340679
E Telephone number

G Gross receipts $ 0
F Name and address of principal officer:
WILLIAM J FULKERSON MD
615 DOUGLAS ST STE 700
DURHAM,NC27705
I
Tax-exempt status: (   ) LeftBullet (insert no.) or
J
Website:MediumBullet
N/A
H(a)
Is this a group return for
subordinates?
H(b)
Are all subordinates
included?
If "No," attach a list. (see instructions)
H(c)
Group exemption number MediumBullet  
K Form of organization:  
L Year of formation: 2013
M State of legal domicile: NC
Part I
Summary
Activities  & Governance 1 Briefly describe the organization’s mission or most significant activities: SEE SCHEDULE O FOR ORGANIZATION'S MISSION STATEMENTDUKE QUALITY NETWORK, INC. WAS CREATED TO SUPPORT DUKE UNIVERSITY HEALTH SYSTEM, INC.'S CHARITABLE AND EDUCATIONAL ACTIVITIES.
2 Check this box MediumBullet
3 Number of voting members of the governing body (Part VI, line 1a) ........ 3 3
4 Number of independent voting members of the governing body (Part VI, line 1b) ..... 4 0
5 Total number of individuals employed in calendar year 2015 (Part V, line 2a) ...... 5 0
6 Total number of volunteers (estimate if necessary) ............. 6 0
7a Total unrelated business revenue from Part VIII, column (C), line 12 ........ 7a 0
b Net unrelated business taxable income from Form 990-T, line 34 ......... 7b 0
Revenues Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) ......... 0 0
9 Program service revenue (Part VIII, line 2g) ......... 0 0
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... 0 0
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 0 0
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12) 0 0
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )... 0 0
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) 0 0
16a Professional fundraising fees (Part IX, column (A), line 11e) ..... 0 0
b Total fundraising expenses (Part IX, column (D), line 25) MediumBullet0    
17 Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e).... 0 0
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 0 0
19 Revenue less expenses. Subtract line 18 from line 12....... 0 0
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............. 652,875 652,875
21 Total liabilities (Part X, line 26)............. 0 0
22 Net assets or fund balances. Subtract line 21 from line 20..... 652,875 652,875
Part II
Signature Block
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge.
Sign Here
JumboBullet
Signature of officer Date
JumboBullet
Type or print name and title
Paid Preparer Use Only
Print/Type preparer's name
Preparer's signature
Date
PTIN
Firm's name MediumBullet
Firm's EIN MediumBullet
Firm's address MediumBullet



Phone no.
May the IRS discuss this return with the preparer shown above? (see instructions) ..........
For Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 11282Y Form 990 (2015)
Form 990 (2015)
Page 2
Part III
Statement of Program Service Accomplishments
Check if Schedule O contains a response or note to any line in this Part III ..............
1
Briefly describe the organization’s mission: DUKE QUALITY NETWORK, INC. WAS CREATED TO SUPPORT DUKE UNIVERSITY HEALTH SYSTEM, INC.'S CHARITABLE AND EDUCATIONAL ACTIVITIES.
2
Did the organization undertake any significant program services during the year which were not listed on
the prior Form 990 or 990-EZ? .....................
If "Yes," describe these new services on Schedule O.
3
Did the organization cease conducting, or make significant changes in how it conducts, any program
services? ...........................
If "Yes," describe these changes on Schedule O.
4
Describe the organization’s program service accomplishments for each of its three largest program services, as measured by expenses. Section 501(c)(3) and 501(c)(4) organizations are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.
4a (Code:   ) (Expenses $ 0 including grants of $ 0 ) (Revenue $ 0 )
HOLD PARTNERSHIP INVESTMENT - PARTNERSHIP ENTITY WAS CREATED TO IMPLEMENT CLINICAL QUALITY PROGRAMS IN RURAL HOSPITALS OR IN HOSPITALS IN AREAS WITH UNDERSERVED MEDICAL POPULATIONS TO SUPPORT EFFECTIVE CARE, DEVELOP HEALTH PROFESSIONALS' CLINICAL SKILLS, AND IMPROVE PATIENT SAFETY AT SUCH HOSPITALS.
4b (Code:   ) (Expenses $   including grants of $   ) (Revenue $   )
4c (Code:   ) (Expenses $   including grants of $   ) (Revenue $   )
4d Other program services (Describe in Schedule O.)
(Expenses $   including grants of $   ) (Revenue $   )
4e Total program service expensesMediumBullet  
Form 990 (2015)
Form 990 (2015)
Page 3
Part IV
Checklist of Required Schedules
Yes
No
1
Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If "Yes," complete Schedule AClick to see attachment.....................
1
Yes
 
2
Is the organization required to complete Schedule B, Schedule of Contributors (see instructions)? ...
2
 
No
3
Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for public office? If "Yes," complete Schedule C, Part IClick to see attachment.............
3
 
No
4
Section 501(c)(3) organizations. Did the organization engage in lobbying activities, or have a section 501(h) election in effect during the tax year? If "Yes," complete Schedule C, Part IIClick to see attachment..............
4
Yes
 
5
Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues, assessments, or similar amounts as defined in Revenue Procedure 98-19? If "Yes," complete Schedule C, Part IIIClick to see attachment.................
5
 
No
6
Did the organization maintain any donor advised funds or any similar funds or accounts for which donors have the right to provide advice on the distribution or investment of amounts in such funds or accounts? If "Yes," complete Schedule D, Part IClick to see attachment..................
6
 
No
7
Did the organization receive or hold a conservation easement, including easements to preserve open space,
the environment, historic land areas, or historic structures? If "Yes," complete Schedule D, Part IIClick to see attachment...
7
 
No
8
Did the organization maintain collections of works of art, historical treasures, or other similar assets? If "Yes," complete Schedule D, Part III Click to see attachment.............
8
 
No
9
Did the organization report an amount in Part X, line 21 for escrow or custodial account liability; serve as a custodian for amounts not listed in Part X; or provide credit counseling, debt management, credit repair, or debt negotiation services? If "Yes," complete Schedule D, Part IVClick to see attachment..............
9
 
No
10
Did the organization, directly or through a related organization, hold assets in temporarily restricted endowments, permanent endowments, or quasi-endowments? If "Yes," complete Schedule D, Part VClick to see attachment......
10
 
No
11
If the organization’s answer to any of the following questions is "Yes," then complete Schedule D, Parts VI, VII, VIII, IX, or X as applicable.
a
Did the organization report an amount for land, buildings, and equipment in Part X, line 10?
If "Yes," complete Schedule D, Part VI.Click to see attachment...................
11a
 
No
b
Did the organization report an amount for investments—other securities in Part X, line 12 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part VIIClick to see attachment.......
11b
Yes
 
c
Did the organization report an amount for investments—program related in Part X, line 13 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part VIIIClick to see attachment.......
11c
 
No
d
Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part IXClick to see attachment............
11d
 
No
e
Did the organization report an amount for other liabilities in Part X, line 25? If "Yes," complete Schedule D, Part XClick to see attachment
11e
 
No
f
Did the organization’s separate or consolidated financial statements for the tax year include a footnote that addresses the organization’s liability for uncertain tax positions under FIN 48 (ASC 740)? If "Yes," complete Schedule D, Part XClick to see attachment
11f
 
No
12a
Did the organization obtain separate, independent audited financial statements for the tax year?
If "Yes," complete Schedule D, Parts XI and XII Click to see attachment.................
12a
 
No
b
Was the organization included in consolidated, independent audited financial statements for the tax year? If "Yes," and if the organization answered "No" to line 12a, then completing Schedule D, Parts XI and XII is optional Click to see attachment
12b
Yes
 
13
Is the organization a school described in section 170(b)(1)(A)(ii)? If "Yes," complete Schedule E
13
 
No
14a
Did the organization maintain an office, employees, or agents outside of the United States? .....
14a
 
No
b
Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business, investment, and program service activities outside the United States, or aggregate foreign investments valued at $100,000 or more? If "Yes," complete Schedule F, Parts I and IV.........
14b
 
No
15
Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or other assistance to or for any foreign organization? If “Yes,” complete Schedule F, Parts II and IV.....
15
 
No
16
Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or other assistance to or for foreign individuals? If “Yes,” complete Schedule F, Parts III and IV...
16
 
No
17
Did the organization report a total of more than $15,000 of expenses for professional fundraising services on Part IX, column (A), lines 6 and 11e? If "Yes," complete Schedule G, Part I (see instructions) ....
17
 
No
18
Did the organization report more than $15,000 total of fundraising event gross income and contributions on Part VIII, lines 1c and 8a? If "Yes," complete Schedule G, Part II............
18
 
No
19
Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a? If "Yes," complete Schedule G, Part III...................
19
 
No
20a
Did the organization operate one or more hospital facilities? If "Yes," complete Schedule H....Click to see attachment
20a
Yes
 
b
If "Yes" to line 20a, did the organization attach a copy of its audited financial statements to this return? Click to see attachment
20b
Yes
 
Form 990 (2015)
Form 990 (2015)
Page 4
Part IV
Checklist of Required Schedules (continued)
21
Did the organization report more than $5,000 of grants or other assistance to any domestic organization or domestic government on Part IX, column (A), line 1? If “Yes,” complete Schedule I, Parts I and II.....
21
 
No
22
Did the organization report more than $5,000 of grants or other assistance to or for domestic individuals on Part IX, column (A), line 2? If “Yes,” complete Schedule I, Parts I and III........
22
 
No
23
Did the organization answer "Yes" to Part VII, Section A, line 3, 4, or 5 about compensation of the organization’s current and former officers, directors, trustees, key employees, and highest compensated employees? If "Yes," complete Schedule J....................... Click to see attachment
23
Yes
 
24a
Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $100,000 as of the last day of the year, that was issued after December 31, 2002? If “Yes,” answer lines 24b through 24d and complete Schedule K. If “No,” go to line 25a...............
24a
 
No
b
Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?...
24b
 
 
c
Did the organization maintain an escrow account other than a refunding escrow at any time during the year
to defease any tax-exempt bonds? ...............
24c
 
 
d
Did the organization act as an "on behalf of" issuer for bonds outstanding at any time during the year?...
24d
 
 
25a
Section 501(c)(3), 501(c)(4), and 501(c)(29) organizations. Did the organization engage in an excess benefit transaction with a disqualified person during the year? If "Yes," complete Schedule L, Part I............
25a
 
No
b
Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and that the transaction has not been reported on any of the organization’s prior Forms 990 or 990-EZ? If "Yes," complete Schedule L, Part I ...................
25b
 
No
26
Did the organization report any amount on Part X, line 5, 6, or 22 for receivables from or payables to any current or former officers, directors, trustees, key employees, highest compensated employees, or disqualified persons? If "Yes," complete Schedule L, Part II ................
26
 
No
27
Did the organization provide a grant or other assistance to an officer, director, trustee, key employee, substantial contributor or employee thereof, a grant selection committee member, or to a 35% controlled entity or family member of any of these persons? If "Yes," complete Schedule L, Part III.........
27
 
No
28
Was the organization a party to a business transaction with one of the following parties (see Schedule L, Part IV instructions for applicable filing thresholds, conditions, and exceptions):
a
A current or former officer, director, trustee, or key employee? If "Yes," complete Schedule L,
Part IV
........................
28a
 
No
b
A family member of a current or former officer, director, trustee, or key employee? If "Yes," complete Schedule L, Part IV.....................
28b
 
No
c
An entity of which a current or former officer, director, trustee, or key employee (or a family member thereof) was an officer, director, trustee, or direct or indirect owner? If "Yes," complete Schedule L, Part IV...
28c
 
No
29
Did the organization receive more than $25,000 in non-cash contributions? If "Yes," complete Schedule M..
29
 
No
30
Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions? If "Yes," complete Schedule M .............
30
 
No
31
Did the organization liquidate, terminate, or dissolve and cease operations? If "Yes," complete Schedule N, Part I.
31
 
No
32
Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If "Yes," complete Schedule N, Part II ...........
32
 
No
33
Did the organization own 100% of an entity disregarded as separate from the organization under Regulations sections 301.7701-2 and 301.7701-3? If "Yes," complete Schedule R, Part I ........Click to see attachment
33
 
No
34
Was the organization related to any tax-exempt or taxable entity? If "Yes," complete Schedule R, Part II, III, or IV, and Part V, line 1.........................Click to see attachment
34
Yes
 
35a
Did the organization have a controlled entity within the meaning of section 512(b)(13)?
35a
 
No
b
If ‘Yes’ to line 35a, did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 512(b)(13)? If "Yes," complete Schedule R, Part V, line 2 ...
35b
 
 
36
Section 501(c)(3) organizations. Did the organization make any transfers to an exempt non-charitable related organization? If "Yes," complete Schedule R, Part V, line 2............. Click to see attachment
36
 
No
37
Did the organization conduct more than 5% of its activities through an entity that is not a related organization and that is treated as a partnership for federal income tax purposes? If "Yes," complete Schedule R, Part VIClick to see attachment
37
 
No
38
Did the organization complete Schedule O and provide explanations in Schedule O for Part VI, lines 11b and 19? Note. All Form 990 filers are required to complete Schedule O. ............
38
Yes
 
Form 990 (2015)
Form 990 (2015)
Page 5
Part V
Statements Regarding Other IRS Filings and Tax Compliance
Check if Schedule O contains a response or note to any line in this Part V...........
Yes
No
1a
Enter the number reported in Box 3 of Form 1096 Enter -0- if not applicable ..
1a
0
b
Enter the number of Forms W-2G included in line 1a. Enter -0- if not applicable .
1b
0
c
Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming (gambling) winnings to prize winners? ..................
1c
Yes
 
2a
Enter the number of employees reported on Form W-3, Transmittal of Wage and
Tax Statements, filed for the calendar year ending with or within the year covered by this return ..................
2a
0
b
If at least one is reported on line 2a, did the organization file all required federal employment tax returns?
Note. If the sum of lines 1a and 2a is greater than 250, you may be required to e-file (see instructions)
2b
 
 
3a
Did the organization have unrelated business gross income of $1,000 or more during the year?...
3a
 
No
b
If “Yes,” has it filed a Form 990-T for this year? If “No” to line 3b, provide an explanation in Schedule O...
3b
 
 
4a
At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a financial account in a foreign country (such as a bank account, securities account, or other financial account)? ..
4a
 
No
b
If "Yes," enter the name of the foreign country: MediumBullet
See instructions for filing requirements for FinCEN Form 114, Report of Foreign Bank and Financial Accounts (FBAR).
5a
Was the organization a party to a prohibited tax shelter transaction at any time during the tax year? ..
5a
 
No
b
Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?
5b
 
No
c
If "Yes," to line 5a or 5b, did the organization file Form 8886-T? ............
5c
 
 
6a
Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization solicit any contributions that were not tax deductible as charitable contributions? ...
6a
 
No
b
If "Yes," did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible? ......................
6b
 
 
7
Organizations that may receive deductible contributions under section 170(c).
a
Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods and services provided to the payor? ....................
7a
 
No
b
If "Yes," did the organization notify the donor of the value of the goods or services provided? .....
7b
 
 
c
Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required to file Form 8282? .........................
7c
 
No
d
If "Yes," indicate the number of Forms 8282 filed during the year ....
7d
 
e
Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?
7e
 
No
f
Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract? ..
7f
 
No
g
If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required? ......................
7g
 
 
h
If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C? ..........................
7h
 
 
8
Sponsoring organizations maintaining donor advised funds.
Did a donor advised fund maintained by the sponsoring organization have excess business holdings at any time during the year? .........................
8
 
 
9a
Did the sponsoring organization make any taxable distributions under section 4966?...
9a
 
 
b
Did the sponsoring organization make a distribution to a donor, donor advisor, or related person?...
9b
 
 
10
Section 501(c)(7) organizations. Enter:
a
Initiation fees and capital contributions included on Part VIII, line 12 ...
10a
 
b
Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities
10b
 
11
Section 501(c)(12) organizations. Enter:
a
Gross income from members or shareholders .........
11a
 
b
Gross income from other sources (Do not net amounts due or paid to other sources against amounts due or received from them.) ..........
11b
 
12a
Section 4947(a)(1) non-exempt charitable trusts. Is the organization filing Form 990 in lieu of Form 1041?
12a
 
 
b
If "Yes," enter the amount of tax-exempt interest received or accrued during the year.
12b
 
13
Section 501(c)(29) qualified nonprofit health insurance issuers.
a
Is the organization licensed to issue qualified health plans in more than one state?
Note.
See the instructions for additional information the organization must report on Schedule O.
13a
 
 
b
Enter the amount of reserves the organization is required to maintain by the states in which the organization is licensed to issue qualified health plans ....
13b
 
c
Enter the amount of reserves on hand ............
13c
 
14a
Did the organization receive any payments for indoor tanning services during the tax year?.....
14a
 
No
b
If "Yes," has it filed a Form 720 to report these payments? If "No," provide an explanation in Schedule O..
14b
 
 
Form 990 (2015)
Form 990 (2015)
Page 6
Part VI
Governance, Management, and Disclosure For each "Yes" response to lines 2 through 7b below, and for a "No" response to lines 8a, 8b, or 10b below, describe the circumstances, processes, or changes in Schedule O. See instructions.
Check if Schedule O contains a response or note to any line in this Part VI ..............
Section A. Governing Body and Management
Yes
No
1a
Enter the number of voting members of the governing body at the end of the tax year
1a
3
If there are material differences in voting rights among members of the governing body, or if the governing body delegated broad authority to an executive committee or similar committee, explain in Schedule O.
b
Enter the number of voting members included in line 1a, above, who are independent
1b
0
2
Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any other officer, director, trustee, or key employee? .................
2
Yes
 
3
Did the organization delegate control over management duties customarily performed by or under the direct supervision of officers, directors or trustees, or key employees to a management company or other person? .
3
 
No
4
Did the organization make any significant changes to its governing documents since the prior Form 990 was filed? ...........................
4
 
No
5
Did the organization become aware during the year of a significant diversion of the organization’s assets? .
5
 
No
6
Did the organization have members or stockholders? ................
6
 
No
7a
Did the organization have members, stockholders, or other persons who had the power to elect or appoint one or more members of the governing body? ....................
7a
Yes
 
b
Are any governance decisions of the organization reserved to (or subject to approval by) members, stockholders, or persons other than the governing body? ...................
7b
Yes
 
8
Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:
a
The governing body? .......................
8a
Yes
 
b
Each committee with authority to act on behalf of the governing body? ............
8b
Yes
 
9
Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the organization’s mailing address? If "Yes," provide the names and addresses in Schedule O.......
9
 
No
Section B. Policies (This Section B requests information about policies not required by the Internal Revenue Code.)
Yes
No
10a
Did the organization have local chapters, branches, or affiliates? ............
10a
 
No
b
If "Yes," did the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure their operations are consistent with the organization's exempt purposes?
10b
 
 
11a
Has the organization provided a complete copy of this Form 990 to all members of its governing body before filing the form? ............................
11a
Yes
 
b
Describe in Schedule O the process, if any, used by the organization to review this Form 990. .....
12a
Did the organization have a written conflict of interest policy? If "No," go to line 13.......
12a
Yes
 
b
Were officers, directors, or trustees, and key employees required to disclose annually interests that could give rise to conflicts? ..........................
12b
Yes
 
c
Did the organization regularly and consistently monitor and enforce compliance with the policy? If "Yes," describe in Schedule O how this was done...................
12c
Yes
 
13
Did the organization have a written whistleblower policy? ...............
13
Yes
 
14
Did the organization have a written document retention and destruction policy? .........
14
Yes
 
15
Did the process for determining compensation of the following persons include a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision?
a
The organization’s CEO, Executive Director, or top management official ...........
15a
 
No
b
Other officers or key employees of the organization ................
15b
 
No
If "Yes" to line 15a or 15b, describe the process in Schedule O (see instructions).
16a
Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement with a taxable entity during the year? ......................
16a
Yes
 
b
If "Yes," did the organization follow a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicable federal tax law, and take steps to safeguard the organization’s exempt status with respect to such arrangements? ............
16b
 
No
Section C. Disclosure
17
List the States with which a copy of this Form 990 is required to be filedMediumBullet
18
Section 6104 requires an organization to make its Form 1023 (or 1024 if applicable), 990, and 990-T (501(c)(3)s only) available for public inspection. Indicate how you made these available. Check all that apply.
19
Describe in Schedule O whether (and if so, how) the organization made its governing documents, conflict of interest policy, and financial statements available to the public during the tax year.
20
State the name, address, and telephone number of the person who possesses the organization's books and records:
MediumBulletLAURA ALVIS615 DOUGLAS STREET STE 700   DURHAM,NC27705 (919) 613-8993
Form 990 (2015)
Form 990 (2015)
Page 7
Part VII
Compensation of Officers, Directors,Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors
Check if Schedule O contains a response or note to any line in this Part VII ..............
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees
1a Complete this table for all persons required to be listed. Report compensation for the calendar year ending with or within the organization’s tax year.
RoundBullet List all of the organization’s current officers, directors, trustees (whether individuals or organizations), regardless of amount
of compensation. Enter -0- in columns (D), (E), and (F) if no compensation was paid.

RoundBullet List all of the organization’s current key employees, if any. See instructions for definition of "key employee."
RoundBullet List the organization’s five current highest compensated employees (other than an officer, director, trustee or key employee)
who received reportable compensation (Box 5 of Form W-2 and/or Box 7 of Form 1099-MISC) of more than $100,000 from the
organization and any related organizations.

RoundBullet List all of the organization’s former officers, key employees, or highest compensated employees who received more than $100,000
of reportable compensation from the organization and any related organizations.

RoundBullet List all of the organization’s former directors or trustees that received, in the capacity as a former director or trustee of the
organization, more than $10,000 of reportable compensation from the organization and any related organizations.

List persons in the following order: individual trustees or directors; institutional trustees; officers; key employees; highest
compensated employees; and former such persons.
Check this box if neither the organization nor any related organization compensated any current officer, director, or trustee.
(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)
(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
Individual Trustee or Director; Institutional Trustee; OfficerInd; Key Employee; Highest compensated employee; FormerOfcrDirectorTrusteeInd;
(1) WILLIAM J FULKERSON JR MD......................................................................
DIRECTOR/PRESIDENT
0.10
.................
60.50
X   X       0 2,128,105 37,419
(2) PAUL L LINDIA......................................................................
DIRECTOR/VICE PRESIDENT
0.10
.................
60.20
X   X       0 328,057 96,854
(3) KENNETH C MORRIS......................................................................
DIRECTOR/TREASURER
0.30
.................
80.80
X   X       0 1,193,388 41,487
(4) CHRISTY M GUDAITIS......................................................................
SECRETARY
0.10
.................
50.30
    X       0 316,532 38,515


























Form 990 (2015)
Form 990 (2015)
Page 8
Part VII
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees (continued)
(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)
(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
Individual Trustee or Director; Institutional Trustee; OfficerInd; Key Employee; Highest compensated employee; FormerOfcrDirectorTrusteeInd;


























1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)...........MediumBullet 0 3,966,082 214,275
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable compensation from the organization MediumBullet0
Yes
No
3
Did the organization list any former officer, director or trustee, key employee, or highest compensated employee on line 1a? If "Yes," complete Schedule J for such individual ..............
3
 
No
4
For any individual listed on line 1a, is the sum of reportable compensation and other compensation from the organization and related organizations greater than $150,000? If "Yes," complete Schedule J for such
individual
...........................
4
Yes
 
5
Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual for services rendered to the organization? If "Yes," complete Schedule J for such person ........
5
 
No
Section B. Independent Contractors
1
Complete this table for your five highest compensated independent contractors that received more than $100,000 of compensation from the organization. Report compensation for the calendar year ending with or within the organization’s tax year.
(A)
Name and business address
(B)
Description of services
(C)
Compensation
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization MediumBullet0
Form 990 (2015)
Form 990 (2015)
Page 9
Part VIII
Statement of Revenue
Check if Schedule O contains a response or note to any line in this Part VIII .............
(A)
Total revenue
(B)
Related or
exempt
function
revenue
(C)
Unrelated
business
revenue
(D)
Revenue
excluded from
tax under sections
512-514
Contributions, Gifts, GrantAmt and OtherAmt Similar Amounts 1a Federated campaigns..1a  
b Membership dues..1b  
c Fundraising events..1c  
d Related organizations1d  
e Government grants (contributions)1e  
f All other contributions, gifts, grants, and similar amounts not included above1f  
g Noncash contributions included in lines 1a-1f:$  
h Total.Add lines 1a-1f.......MediumBullet  
 Program Service RevenueAmt Business Code
2a
b
c
d
e
f All other program service revenue.        
g Total.Add lines 2a–2f.....MediumBullet  
 OtherAmt RevenueAmt 3 Investment income (including dividends, interest, and othersimilar amounts) ..........MediumBullet        
4 Income from investment of tax-exempt bond proceedsMediumBullet        
5 Royalties...........MediumBullet        
(ii) Personal (i) Real
6a Gross rents    
b Less: rental expenses    
c Rental income or (loss)    
d Net rental income or (loss)......MediumBullet        
(ii) Other (i) Securities
7a Gross amount from sales of assets other than inventory    
b Less: cost or other basis and sales expenses    
c Gain or (loss)    
d Net gain or (loss).....MediumBullet        
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..MediumBullet      
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..MediumBullet        
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..MediumBullet        
Business Code Miscellaneous Revenue
11a            
b            
c            
d All other revenue ....        
e Total. Add lines 11a–11d ...... MediumBullet  
12 Total revenue. See Instructions......MediumBullet 0 0 0 0
Form 990 (2015)
Form 990 (2015)
Page 10
Part IX
Statement of Functional Expenses
Section 501(c)(3) and 501(c)(4) organizations must complete all columns. All other organizations must complete column (A).Check if Schedule O contains a response or note to any line in this Part IX ..............
Do not include amounts reported on lines 6b,
7b, 8b, 9b, and 10b of Part VIII.
(A)
Total expenses
(B)
Program service expenses
(C)
Management and general expenses
(D)
Fundraising expenses
1 Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21    
2 Grants and other assistance to individuals in the United States. See Part IV, line 22    
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 ....        
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        
8 Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....        
9 Other employee benefits .......        
10 Payroll taxes ...........        
11 Fees for services (non-employees):        
a Management ......        
b Legal .........        
c Accounting ...........        
d Lobbying ...........        
e Professional fundraising services. See Part IV, line 17    
f Investment management fees ......        
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 ....        
13 Office expenses .......        
14 Information technology ......        
15 Royalties ..        
16 Occupancy ...........        
17 Travel ............        
18 Payments of travel or entertainment expenses for any federal, state, or local public officials .        
19 Conferences, conventions, and meetings ....        
20 Interest ...........        
21 Payments to affiliates .......        
22 Depreciation, depletion, and amortization ..        
23 Insurance ...        
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
b
c
d
e All other expenses        
25 Total functional expenses. Add lines 1 through 24e 0 0 0 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 MediumBullet if following SOP 98-2 (ASC 958-720).        
Form 990 (2015)
Form 990 (2015)
Page 11
Part X
Balance Sheet
Check if Schedule O contains a response or note to any line in this Part IX ..............
(A)
Beginning of year
(B)
End of year
Assets 1 Cash–non-interest-bearing ........ 0 1 0
2 Savings and temporary cash investments .........   2  
3 Pledges and grants receivable, net ......   3  
4 Accounts receivable, net .............   4  
5 Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of Schedule L
  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 ....   7  
8 Inventories for sale or use ........   8  
9 Prepaid expenses and deferred charges ......   9  
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a  
b Less: accumulated depreciation 10b     10c  
11 Investments—publicly traded securities .   11  
12 Investments—other securities. See Part IV, line 11 ..... 652,875 12 652,875
13 Investments—program-related. See Part IV, line 11 ..   13  
14 Intangible assets ...............   14  
15 Other assets. See Part IV, line 11 ...........   15  
16 Total assets. Add lines 1 through 15 (must equal line 34)... 652,875 16 652,875
Liabilities 17 Accounts payable and accrued expenses .....   17  
18 Grants payable ...   18  
19 Deferred revenue .........   19  
20 Tax-exempt bond liabilities .........   20  
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 ..   23  
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   25  
26 Total liabilities. Add lines 17 through 25.. 0 26 0
Net Assets or Fund Balance Organizations that follow SFAS 117 (ASC 958), check here MediumBullet and complete lines 27 through 29, and lines 33 and 34.
27 Unrestricted net assets 652,875 27 652,875
28 Temporarily restricted net assets ...........   28  
29 Permanently restricted net assets   29  
Organizations that do not follow SFAS 117 (ASC 958), check here MediumBullet 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 ........... 652,875 33 652,875
34 Total liabilities and net assets/fund balances ........ 652,875 34 652,875
Form 990 (2015)
Form 990 (2015)
Page 12
Part XI
Reconcilliation of Net Assets
Check if Schedule O contains a response or note to any line in this Part XI ..............
1
Total revenue (must equal Part VIII, column (A), line 12) ............
1
0
2
Total expenses (must equal Part IX, column (A), line 25) ............
2
0
3
Revenue less expenses. Subtract line 2 from line 1 ..............
3
0
4
Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) ..
4
652,875
5
Net unrealized gains (losses) on investments ...............
5
 
6
Donated services and use of facilities .................
6
 
7
Investment expenses .....................
7
 
8
Prior period adjustments .....................
8
 
9
Other changes in net assets or fund balances (explain in Schedule O) ........
9
0
10
Net assets or fund balances at end of year. Combine lines 3 through 9 (must equal Part X, line 33, column (B))
10
652,875
Part XII
Financial Statements and Reporting
Check if Schedule O contains a response or note to any line in this Part XII .............
Yes
No
1
Accounting method used to prepare the Form 990:  
If the organization changed its method of accounting from a prior year or checked "Other," explain in
Schedule O.
2a
Were the organization’s financial statements compiled or reviewed by an independent accountant?
2a
 
No
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were compiled or reviewed on a separate basis, consolidated basis, or both:
b
Were the organization’s financial statements audited by an independent accountant?
2b
Yes
 
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were audited on a separate basis, consolidated basis, or both:
c
If "Yes," to line 2a or 2b, does the organization have a committee that assumes responsibility for oversight of the audit, review, or compilation of its financial statements and selection of an independent accountant?
2c
 
No
If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O.
3a
As a result of a federal award, was the organization required to undergo an audit or audits as set forth in the Single Audit Act and OMB Circular A-133?
3a
 
No
b
If "Yes," did the organization undergo the required audit or audits? If the organization did not undergo the required audit or audits, explain why in Schedule O and describe any steps taken to undergo such audits.
3b
 
 
Form 990 (2015)
Form 990 (2015)
Additional Data


Software ID:  
Software Version:  
Form 990, Special Condition Description:
Special Condition Description
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
DUKE QUALITY NETWORK INC
 
Employer identification number

46-1340679
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.)
1
2
3
4


5
6
7
8
9
10
11
a
b
c
d
e
f
Enter the number of supported organizations .............. 1

g
Provide the following information about the supported organization(s).
(i)Name of supported organization (ii) EIN (iii) Type of organization (described on lines 1- 9 above (see instructions)) (iv) Is the organization listed in your governing document? (v) Amount of monetary support (see instructions) (vi) Amount of other support (see instructions)
Yes No
(A) DUKE UNIVERSITY HEALTH SYSTEM INC
 
562070036 3 Yes   0 0
Total 1 0 0

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

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) right arrow (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) right arrow (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.  
12
12
 
13
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
14
14
 
15
15
 
16a
b
17a
b
18
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

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) right arrow (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) right arrow (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.)..            
14
Section C. Computation of Public Support Percentage
15
15
 
16
16
 
Section D. Computation of Investment Income Percentage
17
17
 
18
18
 
19a
b
20
Schedule A (Form 990 or 990-EZ) 2015

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
No
1
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.
1
Yes
 
2
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).
2
 
No
3a
Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yes," answer (b) and (c) below.
3a
 
No
b
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.
3b
 
 
c
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.
3c
 
 
4a
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.
4a
 
No
b
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.
4b
 
 
c
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.
4c
 
 
5a
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).
5a
 
No
b
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?
5b
 
 
c
Substitutions only. Was the substitution the result of an event beyond the organization's control?
5c
 
 
6
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.
6
 
No
7
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) .
7
 
No
8
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).
8
 
No
9a
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.
9a
 
No
b
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.
9b
 
No
c
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.
9c
 
No
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
 
No
b
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

Schedule A (Form 990 or 990-EZ) 2015
Page 5
Part IV
Supporting Organizations (continued)
Yes
No
11
Has the organization accepted a gift or contribution from any of the following persons?
a
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
 
No
b
A family member of a person described in (a) above?
11b
 
No
c
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
 
No
Section B. Type I Supporting Organizations
Yes
No
1
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.
1
Yes
 
2
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.
2
 
No
Section C. Type II Supporting Organizations
Yes
No
1
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).
1
 
 
Section D. All Type III Supporting Organizations
Yes
No
1
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?
1
 
 
2
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).
2
 
 
3
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.
3
 
 
Section E. Type III Functionally-Integrated Supporting Organizations
1
Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions):
a
b
c
2
Activities Test. Answer (a) and (b) below.
Yes
No
a
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.
2a
 
 
b
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.
2b
 
 
3
Parent of Supported Organizations. Answer (a) and (b) below.
a
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.
3a
 
 
b
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.
3b
 
 
Schedule A (Form 990 or 990-EZ) 2015

Schedule A (Form 990 or 990-EZ) 2015
Page 6
Part V
Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations
1
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  
7
Schedule A (Form 990 or 990-EZ) 2015

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:  
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 BulletInformation 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
DUKE QUALITY NETWORK INC
 
Employer identification number

46-1340679
Part I-A
Complete if the organization is exempt under section 501(c) or is a section 527 organization.

1
Provide a description of the organization’s direct and indirect political campaign activities in Part IV.
2
Political expenditures ......................................................................................................................SchCMd Bullet
$  
3
Volunteer hours .............................................................................................................................
 

Part I-B
Complete if the organization is exempt under section 501(c)(3).
1
Enter the amount of any excise tax incurred by the organization under section 4955 ................................SchCMd Bullet
$  
2
Enter the amount of any excise tax incurred by organization managers under section 4955 .......................SchCMd Bullet
$  
3
If the organization incurred a section 4955 tax, did it file Form 4720 for this year? .........................................
4a
Was a correction made? ......................................................................................................................
b
If "Yes," describe in Part IV.
Part I-C
Complete if the organization is exempt under section 501(c), except section 501(c)(3).
1
Enter the amount directly expended by the filing organization for section 527 exempt function activities ..... SchCMd Bullet
$  
2
Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt function activities ............................................................................................................................SchCMd Bullet

$  
3
Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, line 17b...........SchCMd Bullet

$  
4
Did the filing organization file Form 1120-POL for this year? ...................................................................
5
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

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 Bulletexpenses, and share of excess lobbying expenditures).
B Check SchCMd Bullet
Limits on Lobbying Expenditures
(The term "expenditures" means amounts paid or incurred.)
(a) Filing
organization's
totals
(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? ..............................................................................................................

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


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)
No
Yes
(b)
Amount
1
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:
a
Volunteers? ...........................................................................................................
 
No
b
Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ........
 
No
c
Media advertisements? ...................................................................................................
 
No
 
d
Mailings to members, legislators, or the public? .............................................................................
 
No
 
e
Publications, or published or broadcast statements? ...........................................................
 
No
 
f
Grants to other organizations for lobbying purposes? ..........................................................
 
No
 
g
Direct contact with legislators, their staffs, government officials, or a legislative body? .......................
 
No
 
h
Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ..................
 
No
 
i
Other activities? ...................................................................................................................
Yes
 
5,501
j
Total. Add lines 1c through 1i ....................................................................................................
5,501
2a
Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....
 
No
b
If "Yes," enter the amount of any tax incurred under section 4912 ...........................................
 
c
If "Yes," enter the amount of any tax incurred by organization managers under section 4912 ...................
 
d
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
No
1
Were substantially all (90% or more) dues received nondeductible by members? ...............................................
1
 
 
2
Did the organization make only in-house lobbying expenditures of $2,000 or less? ............................................
2
 
 
3
Did the organization agree to carry over lobbying and political expenditures from the prior year? .................................
3
 
 
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."
1
Dues, assessments and similar amounts from members ......................................................................
1
 
2
Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political expenses for which the section 527(f) tax was paid).
a
Current year .............................................................................................................................
2a
 
b
Carryover from last year ............................................................................................................
2b
 
c
Total ...........................................................................................................................................
2c
 
3
Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .
3
 
4
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? ......................................................................................................................
4
 
5
Taxable amount of lobbying and political expenditures (see instructions) .........................................
5
 
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: DUKE QUALITY NETWORK, INC. HAS 3% OWNERSHIP IN A PARTNERSHIP WHICH HAS MINIMAL LOBBYING EXPENSES.
Schedule C (Form 990 or 990EZ) 2015


Additional Data


Software ID:  
Software Version:  

SCHEDULE D
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Financial Statements
SchDMd Bullet 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
DUKE QUALITY NETWORK INC
 
Employer identification number

46-1340679
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 ....    
5
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? ...........
6
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? ............................
Part II
Conservation Easements. Complete if the organization answered "Yes" on Form 990, Part IV, line 7.
1
Purpose(s) of conservation easements held by the organization (check all that apply).
2
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.
Held at the End of the 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  
3
Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during the
tax year SchDMd Bullet  
4
Number of states where property subject to conservation easement is located SchDMd Bullet  
5
Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and enforcement of the conservation easements it holds? ............
6
Staff and volunteer hours devoted to monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet  
7
Amount of expenses incurred in monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet $  
8
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)? .............................
9
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.
1a
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.
b
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 $  
2
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:
a
Revenue included on Form 990, Part VIII, line 1 ..........................SchDMd Bullet $  
b
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

Schedule D (Form 990) 2015
Page 2
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)
3
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):
a
d
b
e
 
c
4
Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.
5
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?...
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.
1a
Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................
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  
2a
Did the organization include an amount on Form 990, Part X, line 21, for escrow or custodial account liability?
b
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 ....          
b Contributions ...          
c Net investment earnings, gains, and losses          
d Grants or scholarships ...          
e Other expenditures for facilities
and programs ...
         
f Administrative expenses ....          
g End of year balance ......          
2
Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:
a
Board designated or quasi-endowment SchDMd Bullet  
b
Permanent endowment SchDMd Bullet  
c
Temporarily restricted endowment SchDMd Bullet  
The percentages on lines 2a, 2b, and 2c should equal 100%.
3a
Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes
No
(i) unrelated organizations .................
3a(i)
 
 
(ii) related organizations .................
3a(ii)
 
 
b
If "Yes" on 3a(ii), are the related organizations listed as required on Schedule R? .........
3b
 
 
4
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 ...      
b Buildings        
c Leasehold improvements        
d Equipment ...        
e Other ...        
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..SchDMdBullet 0
Schedule D (Form 990) 2015

Schedule D (Form 990) 2015
Page 3
Part VII
Investments—Other 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) INVESTMENT IN PARTNERSHIP
652,875 C
(A)
(B)
(C)
(D)
(E)
(F)
(G)
(H)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)Small Bullet 652,875
Part VIII
Investments—Program 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.)Small Bullet  
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.)...........Small Bullet  
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  
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)Small Bullet  
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

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  
2 Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a Net unrealized gains (losses) on investments .... 2a  
b Donated services and use of facilities ......... 2b  
c Recoveries of prior year grants ........... 2c  
d Other (Describe in Part XIII.) ............ 2d  
e Add lines 2a through 2d ..................... 2e  
3 Subtract line 2e from line 1.................. 3  
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  
b Other (Describe in Part XIII.) ........... 4b  
c Add lines 4a and 4b.................... 4c  
5 Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ...... 5  
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  
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  
e Add lines 2a through 2d.................... 2e  
3 Subtract line 2e from line 1................... 3  
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  
b Other (Describe in Part XIII.) ............ 4b  
c Add lines 4a and 4b..................... 4c  
5 Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ...... 5  

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
Schedule D (Form 990) 2015


Additional Data


Software ID:  
Software Version:  




SCHEDULE H
(Form 990)
Department of the Treasury
Internal Revenue Service
Hospitals
MediumBullet 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
DUKE QUALITY NETWORK INC
 
Employer identification number

46-1340679
Part I
Financial Assistance and Certain Other Community Benefits at Cost
Yes
No
1a
Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a . . . .
1a
Yes
 
b
If "Yes," was it a written policy? ......................
1b
Yes
 
2
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.
3
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.
a
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:
3a
Yes
 
%
b
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: . . . . . . . .
3b
 
No
%
c
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.
4
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"? . . . . . . . . . . . . .

4

Yes

 
5a
Did the organization budget amounts for free or discounted care provided under its financial assistance policy during
the tax year? . . . . . . . . . . . . . . . . . . . . . . .

5a

Yes

 
b
If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? . . . . . .
5b
 
No
c
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? . . . . . . . . . . . . .
5c
 
 
6a
Did the organization prepare a community benefit report during the tax year? . . . . . . . . .
6a
Yes
 
b
If "Yes," did the organization make it available to the public? . . . . . . . . . . . . .
6b
Yes
 
Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.
7
Financial Assistance and Certain Other Community Benefits at Cost
Financial Assistance and
Means-Tested
Government Programs
(a) Number of activities or programs (optional) (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) . . .
    566,950 50,169 516,781  
b Medicaid (from Worksheet 3, column a) . . . . .     3,403,460 2,884,086 519,374  
c Costs of other means-tested government programs (from Worksheet 3, column b) . .     9,235 5,022 4,213  
d Total Financial Assistance and Means-Tested Government Programs . . . . .     3,979,645 2,939,277 1,040,368  
Other Benefits
e Community health improvement services and community benefit operations (from Worksheet 4).     18,057 1,762 16,295  
f Health professions education (from Worksheet 5) . . .     661,980 301,292 360,688  
g Subsidized health services (from Worksheet 6) . . . .     2,335,442 1,813,286 522,156  
h Research (from Worksheet 7) .     21,522 9,188 12,334  
i Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .     16,543 0 16,543  
j Total. Other Benefits . .     3,053,544 2,125,528 928,016  
k Total. Add lines 7d and 7j .     7,033,189 5,064,805 1,968,384  
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.
(a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community building expense (d) Direct offsetting
revenue
(e) Net community building expense (f) Percent of total expense
1 Physical improvements and housing     58,249   58,249  
2 Economic development     1,644   1,644  
3 Community support     704   704  
4 Environmental improvements     0      
5 Leadership development and
training for community members
    0      
6 Coalition building     0      
7 Community health improvement advocacy     55   55  
8 Workforce development     10,187   10,187  
9 Other     4,120   4,120  
10 Total     74,959   74,959  
Part III
Bad Debt, Medicare, & Collection Practices
Section A. Bad Debt Expense
Yes
No
1
Did the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................
1
 
No
2
Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......
2
1,857,790
3
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. ......
3
 
4
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
5
Enter total revenue received from Medicare (including DSH and IME).....
5
10,601,208
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
9,984,400
7
Subtract line 6 from line 5. This is the surplus (or shortfall)........
7
616,808
8
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:
Section C. Collection Practices
9a
Did the organization have a written debt collection policy during the tax year? ..........
9a
Yes
 
b
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 .........................

9b

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
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?12
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)
Licensed Hospital General-Medical-Surgical Children's Hospital Teaching Hospital Critical Hospital ResearchGrp Facility ER-24Hours ER-Other Other (Describe) Facility reporting group
1 DLP CONEMAUGH MEMORIAL MEDICAL CENTER
1086 FRANKLIN STREET
JOHNSTOWN,PA15905
WWW.CONEMAUGH.ORG
X X   X   X X   3% OWNERSHIP IN JOINT VENTURE A
2 DLP MARQUETTE GENERAL HOSPITAL LLC
580 W COLLEGE AVENUE
MARQUETTE,MI49855
WWW.MGH.ORG
X X   X   X X   3% OWNERSHIP IN JOINT VENTURE  
3 DLP WILSON MEDICAL CENTER
1705 TARBORO ST SW
WILSON,NC27893
WWW.WILSONMEDICAL.COM
X           X   3% OWNERSHIP IN JOINT VENTURE  
4 MARIA PARHAM MEDICAL CENTER
566 RUIN CREEK ROAD
HENDERSON,NC27536
WWW.MARIAPARHAM.COM
X           X   3% OWNERSHIP IN JOINT VENTURE  
5 HAYWOOD REGIONAL MEDICAL CENTER
262 LEROY GEORGE DR
CLYDE,NC28721
WWW.MYHAYWOODREGIONAL.COM
X X         X   3% OWNERSHIP IN JOINT VENTURE  
6 RUTHERFORD REGIONAL HEALTH SYSTEM
288 S RIDGECREST STREET
RUTHERFORDTON,NC28139
WWW.MYRUTHERFORDREGIONAL.COM
X X         X   3% OWNERSHIP IN JOINT VENTURE  
7 DLP HARRIS REGIONAL HOSPITAL
68 HOSPITAL ROAD
SYLVA,NC28779
WWW.MYHARRISREGIONAL.COM
X X         X   3% OWNERSHIP IN JOINT VENTURE  
8 TWIN COUNTY REGIONAL HEALTHCARE
200 HOSPITAL DRIVE
GALAX,VA54333
WWW.TCRH.ORG
X           X   3% OWNERSHIP IN JOINT VENTURE  
9 PERSON MEMORIAL HOSPITAL
615 RIDGE ROAD
ROXBORO,NC27573
WWW.PERSONHOSPITAL.COM
X           X   3% OWNERSHIP IN JOINT VENTURE  
10 DLP CONEMAUGH MINERS MEDICAL CENTER
290 HAIDA AVENUE
HASTINGS,PA16646
WWW.CONEMAUGH.ORG
X X         X   3% OWNERSHIP IN JOINT VENTURE A
11 DLP SWAIN COMMUNITY HOSPITAL
45 PLATEAU STREET
BRYSON CITY,NC28713
WWW.MYSWAINCOMMUNITY.COM
X       X   X   3% OWNERSHIP IN JOINT VENTURE  
12 DLP CONEMAUGH MEYERSDALE MEDICAL CENTER
200 HOSPITAL DRIVE
MEYERSDALE,PA15552
WWW.CONEMAUGH.ORG
X X     X   X   3% OWNERSHIP IN JOINT VENTURE A
Schedule H (Form 990) 2015
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)
FACILITY REPORTING GROUP - A
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 No
Community Health Needs Assessment
1 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?........................ 1   No
2 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............... 2 Yes  
3 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...................... 3 Yes  
If "Yes," indicate what the CHNA report describes (check all that apply):
a
b
c
d
e
f
g
h
i
j
4 Indicate the tax year the hospital facility last conducted a CHNA: 20 13
5 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 ................. 5 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.................................. 6a Yes  
b 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. ............................ 6b Yes  
7 Did the hospital facility make its CHNA report widely available to the public?.............. 7 Yes  
If "Yes," indicate how the CHNA report was made widely available (check all that apply):
a
b
c
d
8 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. ..............
8 Yes  
9 Indicate the tax year the hospital facility last adopted an implementation strategy: 20 13
10 Is the hospital facility's most recently adopted implementation strategy posted on a website?......... 10 Yes  
a If "Yes" (list url): HTTP:///WWW.CONEMAUGH.ORG/
b If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ...... 10b   No
11 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   No
b If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........ 12b    
c 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
Schedule H (Form 990) 2015
Page 5
Part VFacility Information (continued)

Financial Assistance Policy (FAP)
FACILITY REPORTING GROUP - A
Name of hospital facility or letter of facility reporting group  
Yes No
Did the hospital facility have in place during the tax year a written financial assistance policy that:
13 Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care? 13 Yes  
If “Yes,” indicate the eligibility criteria explained in the FAP:
a
b
c
d
e
f
g
h
14 Explained the basis for calculating amounts charged to patients?................. 14 Yes  
15 Explained the method for applying for financial assistance?................... 15 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):
a
b
c
d
e
16 Included measures to publicize the policy within the community served by the hospital facility?........ 16 Yes  
If "Yes," indicate how the hospital facility publicized the policy (check all that apply):
a
WWW.CONEMAUGH.ORG
b
WWW.CONEMAUGH.ORG
c
d
e
f
g
h
i
Billing and Collections
17 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?.................................. 17 Yes  
18 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:
a
b
c
d
e
Schedule H (Form 990) 2015
Schedule H (Form 990) 2015
Page 6
Part VFacility Information (continued)

FACILITY REPORTING GROUP - A
Name of hospital facility or letter of facility reporting group  
Yes No
19 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?............ 19   No
If "Yes," check all actions in which the hospital facility or a third party engaged:
a
b
c
d
20 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):
a
b
c
d
e
f
Policy Relating to Emergency Medical Care
21 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?.................. 21 Yes  
If "No," indicate why:
a
b
c
d
Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)
22 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.
a
b
c
d
23 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? ............................... 23   No
If "Yes," explain in Section C.
24 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? ........................... 24   No
If "Yes," explain in Section C.
Schedule H (Form 990) 2015
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)
DLP MARQUETTE GENERAL HOSPITAL LLC
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):
2
Yes No
Community Health Needs Assessment
1 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?........................ 1   No
2 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............... 2   No
3 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...................... 3   No
If "Yes," indicate what the CHNA report describes (check all that apply):
a
b
c
d
e
f
g
h
i
j
4 Indicate the tax year the hospital facility last conducted a CHNA: 20  
5 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 ................. 5    
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.................................. 6a    
b 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. ............................ 6b    
7 Did the hospital facility make its CHNA report widely available to the public?.............. 7    
If "Yes," indicate how the CHNA report was made widely available (check all that apply):
a
b
c
d
8 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. ..............
8    
9 Indicate the tax year the hospital facility last adopted an implementation strategy: 20  
10 Is the hospital facility's most recently adopted implementation strategy posted on a website?......... 10    
a If "Yes" (list url):  
b If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ...... 10b    
11 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   No
b If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........ 12b    
c 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
Schedule H (Form 990) 2015
Page 5
Part VFacility Information (continued)

Financial Assistance Policy (FAP)
DLP MARQUETTE GENERAL HOSPITAL LLC
Name of hospital facility or letter of facility reporting group  
Yes No
Did the hospital facility have in place during the tax year a written financial assistance policy that:
13 Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care? 13 Yes  
If “Yes,” indicate the eligibility criteria explained in the FAP:
a
b
c
d
e
f
g
h
14 Explained the basis for calculating amounts charged to patients?................. 14 Yes  
15 Explained the method for applying for financial assistance?................... 15 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):
a
b
c
d
e
16 Included measures to publicize the policy within the community served by the hospital facility?........ 16   No
If "Yes," indicate how the hospital facility publicized the policy (check all that apply):
a
 
b
 
c
d
e
f
g
h
i
Billing and Collections
17 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?.................................. 17 Yes  
18 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:
a
b
c
d
e
Schedule H (Form 990) 2015
Schedule H (Form 990) 2015
Page 6
Part VFacility Information (continued)

DLP MARQUETTE GENERAL HOSPITAL LLC
Name of hospital facility or letter of facility reporting group  
Yes No
19 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?............ 19 Yes  
If "Yes," check all actions in which the hospital facility or a third party engaged:
a
b
c
d
20 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):
a
b
c
d
e
f
Policy Relating to Emergency Medical Care
21 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?.................. 21 Yes  
If "No," indicate why:
a
b
c
d
Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)
22 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.
a
b
c
d
23 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? ............................... 23   No
If "Yes," explain in Section C.
24 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? ........................... 24   No
If "Yes," explain in Section C.
Schedule H (Form 990) 2015
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)
WILSON MEDICAL CENTER
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):
3
Yes No
Community Health Needs Assessment
1 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?........................ 1   No
2 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............... 2 Yes  
3 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...................... 3 Yes  
If "Yes," indicate what the CHNA report describes (check all that apply):
a
b
c
d
e
f
g
h
i
j
4 Indicate the tax year the hospital facility last conducted a CHNA: 20 14
5 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 ................. 5 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.................................. 6a   No
b 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. ............................ 6b   No
7 Did the hospital facility make its CHNA report widely available to the public?.............. 7 Yes  
If "Yes," indicate how the CHNA report was made widely available (check all that apply):
a
b
c
d
8 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. ..............
8   No
9 Indicate the tax year the hospital facility last adopted an implementation strategy: 20  
10 Is the hospital facility's most recently adopted implementation strategy posted on a website?......... 10    
a If "Yes" (list url):  
b If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ...... 10b    
11 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   No
b If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........ 12b    
c 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
Schedule H (Form 990) 2015
Page 5
Part VFacility Information (continued)

Financial Assistance Policy (FAP)
WILSON MEDICAL CENTER
Name of hospital facility or letter of facility reporting group  
Yes No
Did the hospital facility have in place during the tax year a written financial assistance policy that:
13 Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care? 13 Yes  
If “Yes,” indicate the eligibility criteria explained in the FAP:
a
b
c
d
e
f
g
h
14 Explained the basis for calculating amounts charged to patients?................. 14 Yes  
15 Explained the method for applying for financial assistance?................... 15 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):
a
b
c
d
e
16 Included measures to publicize the policy within the community served by the hospital facility?........ 16 Yes  
If "Yes," indicate how the hospital facility publicized the policy (check all that apply):
a
WWW.WILSONMEDICAL.COM
b
WWW.WILSONMEDICAL.COM
c
d
e
f
g
h
i
Billing and Collections
17 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?.................................. 17 Yes  
18 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:
a
b
c
d
e
Schedule H (Form 990) 2015
Schedule H (Form 990) 2015
Page 6
Part VFacility Information (continued)

WILSON MEDICAL CENTER
Name of hospital facility or letter of facility reporting group  
Yes No
19 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?............ 19   No
If "Yes," check all actions in which the hospital facility or a third party engaged:
a
b
c
d
20 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):
a
b
c
d
e
f
Policy Relating to Emergency Medical Care
21 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?.................. 21 Yes  
If "No," indicate why:
a
b
c
d
Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)
22 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.
a
b
c
d
23 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? ............................... 23   No
If "Yes," explain in Section C.
24 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? ........................... 24   No
If "Yes," explain in Section C.
Schedule H (Form 990) 2015
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)
MARIA PARHAM MEDICAL CENTER
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):
4
Yes No
Community Health Needs Assessment
1 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?........................ 1   No
2 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............... 2   No
3 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...................... 3   No
If "Yes," indicate what the CHNA report describes (check all that apply):
a
b
c
d
e
f
g
h
i
j
4 Indicate the tax year the hospital facility last conducted a CHNA: 20  
5 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 ................. 5    
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.................................. 6a    
b 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. ............................ 6b    
7 Did the hospital facility make its CHNA report widely available to the public?.............. 7    
If "Yes," indicate how the CHNA report was made widely available (check all that apply):
a
b
c
d
8 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. ..............
8    
9 Indicate the tax year the hospital facility last adopted an implementation strategy: 20  
10 Is the hospital facility's most recently adopted implementation strategy posted on a website?......... 10    
a If "Yes" (list url):  
b If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ...... 10b    
11 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   No
b If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........ 12b    
c 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
Schedule H (Form 990) 2015
Page 5
Part VFacility Information (continued)

Financial Assistance Policy (FAP)
MARIA PARHAM MEDICAL CENTER
Name of hospital facility or letter of facility reporting group  
Yes No
Did the hospital facility have in place during the tax year a written financial assistance policy that:
13 Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care? 13 Yes  
If “Yes,” indicate the eligibility criteria explained in the FAP:
a
b
c
d
e
f
g
h
14 Explained the basis for calculating amounts charged to patients?................. 14 Yes  
15 Explained the method for applying for financial assistance?................... 15 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):
a
b
c
d
e
16 Included measures to publicize the policy within the community served by the hospital facility?........ 16 Yes  
If "Yes," indicate how the hospital facility publicized the policy (check all that apply):
a
WWW.MARIAPARHAM.COM
b
WWW.MARIAPARHAM.COM
c
d
e
f
g
h
i
Billing and Collections
17 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?.................................. 17 Yes  
18 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:
a
b
c
d
e
Schedule H (Form 990) 2015
Schedule H (Form 990) 2015
Page 6
Part VFacility Information (continued)

MARIA PARHAM MEDICAL CENTER
Name of hospital facility or letter of facility reporting group  
Yes No
19 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?............ 19   No
If "Yes," check all actions in which the hospital facility or a third party engaged:
a
b
c
d
20 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):
a
b
c
d
e
f
Policy Relating to Emergency Medical Care
21 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?.................. 21 Yes  
If "No," indicate why:
a
b
c
d
Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)
22 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.
a
b
c
d
23 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? ............................... 23   No
If "Yes," explain in Section C.
24 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? ........................... 24   No
If "Yes," explain in Section C.
Schedule H (Form 990) 2015
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)
HAYWOOD REGIONAL MEDICAL CENTER
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):
5
Yes No
Community Health Needs Assessment
1 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?........................ 1 Yes  
2 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............... 2 Yes  
3 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...................... 3   No
If "Yes," indicate what the CHNA report describes (check all that apply):
a
b
c
d
e
f
g
h
i
j
4 Indicate the tax year the hospital facility last conducted a CHNA: 20  
5 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 ................. 5    
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.................................. 6a    
b 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. ............................ 6b    
7 Did the hospital facility make its CHNA report widely available to the public?.............. 7    
If "Yes," indicate how the CHNA report was made widely available (check all that apply):
a
b
c
d
8 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. ..............
8    
9 Indicate the tax year the hospital facility last adopted an implementation strategy: 20  
10 Is the hospital facility's most recently adopted implementation strategy posted on a website?......... 10    
a If "Yes" (list url):  
b If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ...... 10b    
11 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   No
b If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........ 12b    
c 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
Schedule H (Form 990) 2015
Page 5
Part VFacility Information (continued)

Financial Assistance Policy (FAP)
HAYWOOD REGIONAL MEDICAL CENTER
Name of hospital facility or letter of facility reporting group  
Yes No
Did the hospital facility have in place during the tax year a written financial assistance policy that:
13 Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care? 13 Yes  
If “Yes,” indicate the eligibility criteria explained in the FAP:
a
b
c
d
e
f
g
h
14 Explained the basis for calculating amounts charged to patients?................. 14 Yes  
15 Explained the method for applying for financial assistance?................... 15 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):
a
b
c
d
e
16 Included measures to publicize the policy within the community served by the hospital facility?........ 16 Yes  
If "Yes," indicate how the hospital facility publicized the policy (check all that apply):
a
WWW.MYHAYWOODREGIONAL.COM
b
WWW.MYHAYWOODREGIONAL.COM
c
d
e
f
g
h
i
Billing and Collections
17 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?.................................. 17 Yes  
18 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:
a
b
c
d
e
Schedule H (Form 990) 2015
Schedule H (Form 990) 2015
Page 6
Part VFacility Information (continued)

HAYWOOD REGIONAL MEDICAL CENTER
Name of hospital facility or letter of facility reporting group  
Yes No
19 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?............ 19   No
If "Yes," check all actions in which the hospital facility or a third party engaged:
a
b
c
d
20 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):
a
b
c
d
e
f
Policy Relating to Emergency Medical Care
21 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?.................. 21 Yes  
If "No," indicate why:
a
b
c
d
Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)
22 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.
a
b
c
d
23 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? ............................... 23   No
If "Yes," explain in Section C.
24 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? ........................... 24   No
If "Yes," explain in Section C.
Schedule H (Form 990) 2015
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)
RUTHERFORD REGIONAL HEALTH SYSTEM
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):
6
Yes No
Community Health Needs Assessment
1 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?........................ 1   No
2 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............... 2 Yes  
3 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...................... 3   No
If "Yes," indicate what the CHNA report describes (check all that apply):
a
b
c
d
e
f
g
h
i
j
4 Indicate the tax year the hospital facility last conducted a CHNA: 20  
5 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 ................. 5    
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.................................. 6a    
b 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. ............................ 6b    
7 Did the hospital facility make its CHNA report widely available to the public?.............. 7    
If "Yes," indicate how the CHNA report was made widely available (check all that apply):
a
b
c
d
8 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. ..............
8    
9 Indicate the tax year the hospital facility last adopted an implementation strategy: 20  
10 Is the hospital facility's most recently adopted implementation strategy posted on a website?......... 10    
a If "Yes" (list url):  
b If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ...... 10b    
11 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   No
b If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........ 12b    
c 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
Schedule H (Form 990) 2015
Page 5
Part VFacility Information (continued)

Financial Assistance Policy (FAP)
RUTHERFORD REGIONAL HEALTH SYSTEM
Name of hospital facility or letter of facility reporting group  
Yes No
Did the hospital facility have in place during the tax year a written financial assistance policy that:
13 Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care? 13 Yes  
If “Yes,” indicate the eligibility criteria explained in the FAP:
a
b
c
d
e
f
g
h
14 Explained the basis for calculating amounts charged to patients?................. 14 Yes  
15 Explained the method for applying for financial assistance?................... 15 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):
a
b
c
d
e
16 Included measures to publicize the policy within the community served by the hospital facility?........ 16 Yes  
If "Yes," indicate how the hospital facility publicized the policy (check all that apply):
a
WWW.MYRUTHERFORDREGIONAL.COM
b
WWW.MYRUTHERFORDREGIONAL.COM
c
d
e
f
g
h
i
Billing and Collections
17 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?.................................. 17 Yes  
18 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:
a
b
c
d
e
Schedule H (Form 990) 2015
Schedule H (Form 990) 2015
Page 6
Part VFacility Information (continued)

RUTHERFORD REGIONAL HEALTH SYSTEM
Name of hospital facility or letter of facility reporting group  
Yes No
19 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?............ 19   No
If "Yes," check all actions in which the hospital facility or a third party engaged:
a
b
c
d
20 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):
a
b
c
d
e
f
Policy Relating to Emergency Medical Care
21 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?.................. 21 Yes  
If "No," indicate why:
a
b
c
d
Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)
22 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.
a
b
c
d
23 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? ............................... 23   No
If "Yes," explain in Section C.
24 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? ........................... 24   No
If "Yes," explain in Section C.
Schedule H (Form 990) 2015
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)
DLP HARRIS REGIONAL HOSPITAL
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):
7
Yes No
Community Health Needs Assessment
1 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?........................ 1   No
2 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............... 2 Yes  
3 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...................... 3 Yes  
If "Yes," indicate what the CHNA report describes (check all that apply):
a
b
c
d
e
f
g
h
i
j
4 Indicate the tax year the hospital facility last conducted a CHNA: 20 13
5 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 ................. 5 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.................................. 6a Yes  
b 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. ............................ 6b Yes  
7 Did the hospital facility make its CHNA report widely available to the public?.............. 7 Yes  
If "Yes," indicate how the CHNA report was made widely available (check all that apply):
a
b
c
d
8 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. ..............
8 Yes  
9 Indicate the tax year the hospital facility last adopted an implementation strategy: 20 13
10 Is the hospital facility's most recently adopted implementation strategy posted on a website?......... 10   No
a If "Yes" (list url):  
b If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ...... 10b   No
11 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   No
b If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........ 12b    
c 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
Schedule H (Form 990) 2015
Page 5
Part VFacility Information (continued)

Financial Assistance Policy (FAP)
DLP HARRIS REGIONAL HOSPITAL
Name of hospital facility or letter of facility reporting group  
Yes No
Did the hospital facility have in place during the tax year a written financial assistance policy that:
13 Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care? 13 Yes  
If “Yes,” indicate the eligibility criteria explained in the FAP:
a
b
c
d
e
f
g
h
14 Explained the basis for calculating amounts charged to patients?................. 14 Yes  
15 Explained the method for applying for financial assistance?................... 15 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):
a
b
c
d
e
16 Included measures to publicize the policy within the community served by the hospital facility?........ 16 Yes  
If "Yes," indicate how the hospital facility publicized the policy (check all that apply):
a
HTTP://WWW.MYHARRISREGIONAL.COM/
b
HTTP://WWW.MYHARRISREGIONAL.COM/
c
d
e
f
g
h
i
Billing and Collections
17 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?.................................. 17 Yes  
18 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:
a
b
c
d
e
Schedule H (Form 990) 2015
Schedule H (Form 990) 2015
Page 6
Part VFacility Information (continued)

DLP HARRIS REGIONAL HOSPITAL
Name of hospital facility or letter of facility reporting group  
Yes No
19 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?............ 19   No
If "Yes," check all actions in which the hospital facility or a third party engaged:
a
b
c
d
20 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):
a
b
c
d
e
f
Policy Relating to Emergency Medical Care
21 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?.................. 21 Yes  
If "No," indicate why:
a
b
c
d
Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)
22 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.
a
b
c
d
23 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? ............................... 23   No
If "Yes," explain in Section C.
24 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? ........................... 24   No
If "Yes," explain in Section C.
Schedule H (Form 990) 2015
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)
TWIN COUNTY REGIONAL HEALTHCARE
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):
8
Yes No
Community Health Needs Assessment
1 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?........................ 1   No
2 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............... 2   No
3 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...................... 3 Yes  
If "Yes," indicate what the CHNA report describes (check all that apply):
a
b
c
d
e
f
g
h
i
j
4 Indicate the tax year the hospital facility last conducted a CHNA: 20 14
5 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 ................. 5 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.................................. 6a   No
b 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. ............................ 6b   No
7 Did the hospital facility make its CHNA report widely available to the public?.............. 7 Yes  
If "Yes," indicate how the CHNA report was made widely available (check all that apply):
a
b
c
d
8 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. ..............
8   No
9 Indicate the tax year the hospital facility last adopted an implementation strategy: 20  
10 Is the hospital facility's most recently adopted implementation strategy posted on a website?......... 10    
a If "Yes" (list url):  
b If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ...... 10b    
11 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   No
b If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........ 12b    
c 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
Schedule H (Form 990) 2015
Page 5
Part VFacility Information (continued)

Financial Assistance Policy (FAP)
TWIN COUNTY REGIONAL HEALTHCARE
Name of hospital facility or letter of facility reporting group  
Yes No
Did the hospital facility have in place during the tax year a written financial assistance policy that:
13 Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care? 13 Yes  
If “Yes,” indicate the eligibility criteria explained in the FAP:
a
b
c
d
e
f
g
h
14 Explained the basis for calculating amounts charged to patients?................. 14 Yes  
15 Explained the method for applying for financial assistance?................... 15 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):
a
b
c
d
e
16 Included measures to publicize the policy within the community served by the hospital facility?........ 16 Yes  
If "Yes," indicate how the hospital facility publicized the policy (check all that apply):
a
 
b
 
c
d
e
f
g
h
i
Billing and Collections
17 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?.................................. 17 Yes  
18 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:
a
b
c
d
e
Schedule H (Form 990) 2015
Schedule H (Form 990) 2015
Page 6
Part VFacility Information (continued)

TWIN COUNTY REGIONAL HEALTHCARE
Name of hospital facility or letter of facility reporting group  
Yes No
19 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?............ 19   No
If "Yes," check all actions in which the hospital facility or a third party engaged:
a
b
c
d
20 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):
a
b
c
d
e
f
Policy Relating to Emergency Medical Care
21 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?.................. 21 Yes  
If "No," indicate why:
a
b
c
d
Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)
22 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.
a
b
c
d
23 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? ............................... 23   No
If "Yes," explain in Section C.
24 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? ........................... 24 Yes  
If "Yes," explain in Section C.
Schedule H (Form 990) 2015
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)
PERSON MEMORIAL HOSPITAL
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):
9
Yes No
Community Health Needs Assessment
1 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?........................ 1   No
2 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............... 2   No
3 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...................... 3   No
If "Yes," indicate what the CHNA report describes (check all that apply):
a
b
c
d
e
f
g
h
i
j
4 Indicate the tax year the hospital facility last conducted a CHNA: 20  
5 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 ................. 5    
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.................................. 6a    
b 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. ............................ 6b    
7 Did the hospital facility make its CHNA report widely available to the public?.............. 7    
If "Yes," indicate how the CHNA report was made widely available (check all that apply):
a
b
c
d
8 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. ..............
8    
9 Indicate the tax year the hospital facility last adopted an implementation strategy: 20  
10 Is the hospital facility's most recently adopted implementation strategy posted on a website?......... 10    
a If "Yes" (list url):  
b If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ...... 10b    
11 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   No
b If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........ 12b    
c 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
Schedule H (Form 990) 2015
Page 5
Part VFacility Information (continued)

Financial Assistance Policy (FAP)
PERSON MEMORIAL HOSPITAL
Name of hospital facility or letter of facility reporting group  
Yes No
Did the hospital facility have in place during the tax year a written financial assistance policy that:
13 Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care? 13 Yes  
If “Yes,” indicate the eligibility criteria explained in the FAP:
a
b
c
d
e
f
g
h
14 Explained the basis for calculating amounts charged to patients?................. 14 Yes  
15 Explained the method for applying for financial assistance?................... 15 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):
a
b
c
d
e
16 Included measures to publicize the policy within the community served by the hospital facility?........ 16 Yes  
If "Yes," indicate how the hospital facility publicized the policy (check all that apply):
a
WWW.PERSONHOSPITAL.COM
b
 
c
d
e
f
g
h
i
Billing and Collections
17 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?.................................. 17 Yes  
18 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:
a
b
c
d
e
Schedule H (Form 990) 2015
Schedule H (Form 990) 2015
Page 6
Part VFacility Information (continued)

PERSON MEMORIAL HOSPITAL
Name of hospital facility or letter of facility reporting group  
Yes No
19 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?............ 19   No
If "Yes," check all actions in which the hospital facility or a third party engaged:
a
b
c
d
20 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):
a
b
c
d
e
f
Policy Relating to Emergency Medical Care
21 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?.................. 21 Yes  
If "No," indicate why:
a
b
c
d
Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)
22 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.
a
b
c
d
23 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? ............................... 23   No
If "Yes," explain in Section C.
24 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? ........................... 24   No
If "Yes," explain in Section C.
Schedule H (Form 990) 2015
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)
DLP SWAIN COMMUNITY HOSPITAL
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):
11
Yes No
Community Health Needs Assessment
1 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?........................ 1   No
2 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............... 2 Yes  
3 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...................... 3 Yes  
If "Yes," indicate what the CHNA report describes (check all that apply):
a
b
c
d
e
f
g
h
i
j
4 Indicate the tax year the hospital facility last conducted a CHNA: 20 13
5 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 ................. 5 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.................................. 6a Yes  
b 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. ............................ 6b Yes  
7 Did the hospital facility make its CHNA report widely available to the public?.............. 7 Yes  
If "Yes," indicate how the CHNA report was made widely available (check all that apply):
a
b
c
d
8 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. ..............
8 Yes  
9 Indicate the tax year the hospital facility last adopted an implementation strategy: 20 13
10 Is the hospital facility's most recently adopted implementation strategy posted on a website?......... 10   No
a If "Yes" (list url):  
b If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ...... 10b   No
11 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   No
b If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........ 12b    
c 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
Schedule H (Form 990) 2015
Page 5
Part VFacility Information (continued)

Financial Assistance Policy (FAP)
DLP SWAIN COMMUNITY HOSPITAL
Name of hospital facility or letter of facility reporting group  
Yes No
Did the hospital facility have in place during the tax year a written financial assistance policy that:
13 Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care? 13 Yes  
If “Yes,” indicate the eligibility criteria explained in the FAP:
a
b
c
d
e
f
g
h
14 Explained the basis for calculating amounts charged to patients?................. 14 Yes  
15 Explained the method for applying for financial assistance?................... 15 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):
a
b
c
d
e
16 Included measures to publicize the policy within the community served by the hospital facility?........ 16 Yes  
If "Yes," indicate how the hospital facility publicized the policy (check all that apply):
a
WWW.MYSWAINCOMMUNITY.COM
b
WWW.MYSWAINCOMMUNITY.COM
c
d
e
f
g
h
i
Billing and Collections
17 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?.................................. 17 Yes  
18 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:
a
b
c
d
e
Schedule H (Form 990) 2015
Schedule H (Form 990) 2015
Page 6
Part VFacility Information (continued)

DLP SWAIN COMMUNITY HOSPITAL
Name of hospital facility or letter of facility reporting group  
Yes No
19 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?............ 19   No
If "Yes," check all actions in which the hospital facility or a third party engaged:
a
b
c
d
20 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):
a
b
c
d
e
f
Policy Relating to Emergency Medical Care
21 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?.................. 21 Yes  
If "No," indicate why:
a
b
c
d
Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)
22 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.
a
b
c
d
23 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? ............................... 23   No
If "Yes," explain in Section C.
24 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? ........................... 24   No
If "Yes," explain in Section C.
Schedule H (Form 990) 2015
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
REPORTING GROUP A DLP CONEMAUGH MEMORIAL MEDICAL CENTER, DLP CONEMAUGH MINERS MEDICAL CENTER, DLP CONEMAUGH MEYERSDALE MEDICAL CENTER PART V, SECTION B, LINE 2:CONEMAUGH HEALTH SYSTEM WAS ACQUIRED BY DLP HEALTHCARE, LLC ON AUGUST 29, 2014. THE ACQUISITION INCLUDED CONEMAUGH'S THREE HOSPITALS, CONEMAUGH VALLEY MEMORIAL HOSPITAL, MEYERSDALE COMMUNITY HOSPITAL, AND MINERS HOSPITAL. PRIOR TO THE ACQUISITION BY DLP, THESE HOSPITALS WERE NONPROFIT CORPORATIONS.REPORTING GROUP ADLP CONEMAUGH MEMORIAL MEDICAL CENTER, DLP CONEMAUGH MINERS MEDICAL CENTER, DLP CONEMAUGH MEYERSDALE MEDICAL CENTER PART V, SECTION B, LINE 5:THE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) PROCESS INCLUDED INTERVIEWS TO GATHER INPUT FROM A BROAD RANGE OF COMMUNITY MEMBERS INCLUDING THOSE WITH PUBLIC HEALTH KNOWLEDGE AND EXPERTISE. KEY INDIVIDUALS WERE IDENTIFIED AND 26 OPEN-ENDED INTERVIEWS WERE COMPLETED WITH PARTICIPANTS FROM THE FOLLOWING PROFESSIONS: CHILD SERVICES, EDUCATION, CLERGY, ELECTED GOVERNMENT OFFICIALS, GOVERNMENT AGENCIES, HUMAN SERVICE AGENCIES, JUDICIAL, LAW, NURSES, PHYSICIANS, SENIOR SERVICES, AND PUBLIC SAFETY. EACH PROFESSIONAL WAS ASKED WHAT HE OR SHE PERCEIVED TO BE THE MOST PRESSING ISSUES IN THE COMMUNITY.IN ADDITION, PAPER AND/OR ELECTRONIC SURVEYS WERE ADMINISTERED TO ASSURE THAT COMMUNITY MEMBERS, INCLUDING UNDER-REPRESENTED RESIDENTS, WERE INCLUDED IN THE NEEDS ASSESSMENT PLANNING PROCESS. A TOTAL OF 3,491 SURVEYS WERE DISTRIBUTED AND 446 WERE RETURNED; A PARTICIPATION RATE OF 12.7%. THE CHNA PROCESS ALSO INCLUDED FOCUS GROUPS AT TWO PUBLIC HOUSING FACILITIES TO ENSURE THAT POTENTIALLY UNDER REPRESENTED RESIDENTS WERE INCLUDED.REPORTING GROUP ADLP CONEMAUGH MEMORIAL MEDICAL CENTER, DLP CONEMAUGH MINERS MEDICAL CENTER, DLP CONEMAUGH MEYERSDALE MEDICAL CENTERPART V, SECTION B, LINE 6A:THE CHNA WAS CONDUCTED WITH AND FOR ALL HOSPITALS WITHIN THE CONEMAUGH HEALTH SYSTEM: DLP CONEMAUGH MEMORIAL MEDICAL CENTER, DLP CONEMAUGH MINERS MEDICAL CENTER, AND DLP CONEMAUGH MEYERSDALE MEDICAL CENTER.REPORTING GROUP ADLP CONEMAUGH MEMORIAL MEDICAL CENTER, DLP CONEMAUGH MINERS MEDICAL CENTER, DLP CONEMAUGH MEYERSDALE MEDICAL CENTERPART V, SECTION B, LINE 6B:UNITED WAY OF THE LAUREL HIGHLANDSREPORTING GROUP ADLP CONEMAUGH MEMORIAL MEDICAL CENTER, DLP CONEMAUGH MINERS MEDICAL CENTER, DLP CONEMAUGH MEYERSDALE MEDICAL CENTERPART V, SECTION B, LINE 7A:THE CHNA REPORT WAS MADE WIDELY AVAILABLE TO THE PUBLIC ON HOSPITAL'S WEBSITE:HTTP://WWW.CONEMAUGH.ORG/CONTENT/UPLOADS/CONEMAUGH%20HEALTH%20SYSTEM/FILES/CHNA_FINAL.PDFREPORTING GROUP ADLP CONEMAUGH MEMORIAL MEDICAL CENTER, DLP CONEMAUGH MINERS MEDICAL CENTER, DLP CONEMAUGH MEYERSDALE MEDICAL CENTERPART V, SECTION B, LINE 7D:THE CHNA WAS PUT ON THE CONEMAUGH HEALTH SYSTEM (CHS) WEBSITE WHICH AVERAGES ABOUT 150,000 HITS PER MONTH. THE CHNA WAS ALSO MENTIONED IN MULTIPLE NEWS RELEASES, REVIEWED AT VARIOUS COMMUNITY BOARD MEETINGS AND GATHERINGS, AND SHARED WITH APPROXIMATELY 5,000 CONEMAUGH HEALTH SYSTEM EMPLOYEES THROUGH VARIOUS FORMATS INCLUDING THE WEEKLY HUDDLE, CARENOTES NEWSLETTER, AND PHYSICIAN NEWSLETTER. THE CHNA WAS ALSO HIGHLIGHTED IN THE CHS PRIME MAGAZINE WHICH IS MAILED TO APPROXIMATELY 28,000 CONSUMERS AND EMAILED TO ANOTHER 6,000 ON AVERAGE. THE CHNA WAS PRESENTED TO THE CHS BOARD AND TO THE HOSPITAL DIVISION BOARD GOVERNING DLP CONEMAUGH MEMORIAL MEDICAL CENTER, DLP CONEMAUGH MEYERSDALE MEDICAL CENTER, AND DLP CONEMAUGH MINERS MEDICAL CENTER.
REPORTING GROUP A DLP CONEMAUGH MEMORIAL MEDICAL CENTER, DLP CONEMAUGH MINERS MEDICAL CENTER, DLP CONEMAUGH MEYERSDALE MEDICAL CENTER PART V, SECTION B, LINE 11:ADDRESSING SIGNIFICANT NEEDS IDENTIFIED:THE ORGANIZATION DEVELOPED AND ADOPTED AN IMPLEMENTATION STRATEGY TO ADDRESS THE NEEDS IDENTIFIED WITHIN THE CHNA. THIS DOCUMENT IS AVAILABLE ON THE ORGANIZATION'S WEBSITE USING THIS SPECIFIC LINK: HTTP://WWW.CONEMAUGH.ORG THEN SEARCH ON COMMUNITY HEALTH ASSESSMENT.THE CHNA IDENTIFIED A TOTAL OF 8 PRIORITY HEALTH NEEDS. PLANS TO ADDRESS ALL 8 HAVE BEEN INITIATED BY MEMORIAL MEDICAL CENTER AND MEYERSDALE MEDICAL CENTER. PLANS TO ADDRESS 7 OF THESE NEEDS HAVE BEEN INITIATED BY MINERS MEDICAL CENTER (MIMC). THE ONLY NEED NOT BEING ADDRESSED IS THE NEED FOR PRIMARY CARE PHYSICIANS IN SOMERSET COUNTY. MIMC IS UNABLE TO IMPACT THIS NEED AS SOMERSET COUNTY IS NOT INCLUDED IN ITS PRIMARY SERVICE AREA. ALL ORGANIZATIONS HAVE CONCERNS ABOUT THE SUCCESS OF SIGNIFICANTLY IMPACTING OBESITY AND DRUG ADDITION, AS THESE ARE DEEP SEATED ISSUES IN OUR COMMUNITY AND THE ORGANIZATION HAS LIMITED FINANCIAL RESOURCES TO ADDRESS THESE ISSUES.1. INCREASE THE PERCENTAGE OF 40+ FEMALES THAT OBTAIN AN ANNUAL MAMMOGRAM: CHS ENGAGED IN A MULTI-MEDIA CAMPAIGN TO INCREASE MAMMOGRAM AWARENESS. CONEMAUGH PHYSICIAN GROUP (CPG) ENCOURAGES ANNUAL MAMMOGRAMS IN THE TARGET POPULATION. IN ADDITION, CHS PARTNERS WITH THE SUSAN G. KOMEN FOUNDATION TO PROVIDE VOUCHERS FOR FREE OR LOW COST MAMMOGRAMS. CHS IS DEVELOPING STRONGER RELATIONSHIPS WITH NATIONAL ORGANIZATIONS SUCH AS THE PENNSYLVANIA BREAST CANCER COALITION, AMERICAN CANCER SOCIETY, AND THE SUSAN G. KOMEN FOUNDATION. 2. INCREASE THE NUMBER OF INDIVIDUALS IN THE POPULATION WHO RECEIVE AN AWARENESS OF THE NEED TO GET AN ANNUAL FLU SHOT. CPG PROVIDERS ALSO ENCOURAGE PATIENTS TO GET THE ANNUAL FLU SHOT DURING THEIR PRIMARY CARE VISITS. IN ADDITION, IN 2015, ALL CHS EMPLOYEES WERE REQUIRED TO RECEIVE THE ANNUAL FLU SHOT AS A CONDITION OF EMPLOYMENT. CHS IS THE LARGEST EMPLOYER IN A MULTI-COUNTY REGION.3. INCREASE THE RATIO OF PRIMARY CARE PHYSICIANS TO POPULATION IN SOMERSET COUNTY: CPG IS ACTIVELY RECRUITING ADDITIONAL PRIMARY CARE PHYSICIANS IN SOMERSET COUNTY. THE MEYERSDALE OUTPATIENT CENTER OPENED IN THE FALL OF 2015 AND VIA CONSOLIDATING PRIMARY CARE PRACTICES, EXTENDED OFFICE HOURS ARE NOW AVAILABLE MONDAY - THURSDAY AS WELL AS SATURDAY. PLANS ARE ALSO UNDERWAY TO EXPAND THE PRIMARY CARE OFFICES IN SOMERSET BOROUGH TO HELP ATTRACT PRIMARY CARE PHYSICIANS TO A MORE AESTHETICALLY PLEASING PRACTICE.4. INCREASE THE RATIO OF MENTAL HEALTH PROVIDERS TO POPULATION: CPG IS WORKING WITH A NATIONAL HEALTHCARE PHYSICIAN RECRUITMENT FIRM AND ACTIVELY RECRUITING 3-4 PSYCHIATRISTS WHO WILL TREAT PATIENTS IN THE MEMORIAL MEDICAL CENTER PRIMARY SERVICE AREA OF CAMBRIA AND SOMERSET COUNTIES. UNFORTUNATELY, IN 2016, THE NUMBER OF PSYCHIATRISTS IN THE MARKET HAS DECREASED. ADDITIONAL PSYCHIATRISTS ARE BEING RECRUITED AS A HIGH PRIORITY SUBJECT TO AVAILABILITY OF PSYCHIATRISTS WITHIN THE NATIONAL POOL AS PSYCHIATRISTS ARE IN LIMITED SUPPLY.5. INCREASE ACCESS TO DENTAL CARE FOR INDIVIDUALS WHO ARE UNDER OR UNINSURED: THE UNITED WAY OF THE LAUREL HIGHLANDS (UWLH) HAS TAKEN THE LEAD ON THIS ISSUE, WORKING WITH SALVATION ARMY TO OPEN A DENTAL CLINIC IN 2014 THAT ACCEPTS MEDICAID AS WELL AS SLIDING PAYMENT SCALE PATIENTS. FURTHER, UWLH, PROVIDES ANNUAL FUNDING TO SUBSIDIZE ENHANCED ACCESS.6. IMPROVE COMMUNITY EDUCATION OF HOW TO LIVE A HEALTHY LIFESTYLE: USE OF TOBACCO PRODUCTS BY EMPLOYEES DURING WORK SHIFTS IS PROHIBITED AT CHS. COMMUNITY MESSAGING AND EASY TO ACCESS INFORMATION IS PROVIDED ON OUR WEB SITE ABOUT THE DANGERS OF TOBACCO USE. GROUP TOBACCO CESSATION CLASSES ARE ALSO OFFERED AT NO OR LIMITED COST TO THE COMMUNITY TO INCREASE AWARENESS, REGISTRATION AND COMPLETION RATES. IN ADDITION, CHS COLLABORATES WITH LOCAL BUSINESSES AND SCHOOL DISTRICTS TO PROMOTE A HEALTHIER WORKPLACE THROUGH THE ONLINE COMMUNITY WELLNESS PLATFORM.7. INCREASE COMMUNITY EDUCATION ABOUT DRUG/ALCOHOL DEPENDENCY AND TREATMENT: COMMUNITY DRUG AND ALCOHOL USE IS IDENTIFIED AS A SIGNIFICANT NEED AND IS BEING ADDRESSED BY THE UWLH WHICH FUNDS BOTVIN LIFE SKILLS TRAINING, AN EVIDENCE-BASED PREVENTION PROGRAM PROVIDED TO SCHOOLS IN SOMERSET AND CAMBRIA COUNTIES. CHS IN COLLABORATION WITH THE UWLH AND OTHER COMMUNITY LEADERS IS ACTIVELY DEVELOPING A DRUG FREE COMMUNITIES INITIATIVE, SEEKING GRANT FUNDING AND IS SEEKING TO OPERATIONALIZE THE NEW INITIATIVE IN 2016.8. INCREASE COMMUNITY EDUCATION ABOUT ACCESS TO CARE FOR UN/UNDER INSURED: CHS AND UWLH PROVIDE THE MAJORITY OF ANNUAL FUNDING TO THE JOHNSTOWN FREE CLINIC. CHS HOSPITALS ADVERTISE ACCESS OPTIONS AND HELP ELIGIBLE PATIENTS ENROLL IN THE HEALTHCARE EXCHANGES, MEDICAID, CHIP AND OTHER PROGRAMS BY UTILIZING BOTH INTERNAL AND EXTERNAL RESOURCES.REPORTING GROUP A DLP CONEMAUGH MEMORIAL MEDICAL CENTER, DLP CONEMAUGH MINERS MEDICAL CENTER, DLP CONEMAUGH MEYERSDALE MEDICAL CENTER PART V, SECTION B, LINE 13H:FEDERAL POVERTY GUIDELINES ARE NOT USED IN THE DETERMINATION OF DISCOUNTED CARE. ALL SELF-PAY, UNINSURED PATIENTS ARE OFFERED A 60% DISCOUNT OFF OF CHARGES.REPORTING GROUP ADLP CONEMAUGH MEMORIAL MEDICAL CENTER, DLP CONEMAUGH MINERS MEDICAL CENTER, DLP CONEMAUGH MEYERSDALE MEDICAL CENTER PART V, SECTION B, LINE 16A, B, C:THE FINANCIAL ASSISTANCE POLICY, APPLICATION AND PLAIN LANGUAGE SUMMARY WERE MADE WIDELY AVAILABLE ON THIS WEBSITE: HTTP://WWW.CONEMAUGH.ORG/PATIENTS-VISITORS/CHARITY-CAREREPORTING GROUP ADLP CONEMAUGH MEMORIAL MEDICAL CENTER, DLP CONEMAUGH MINERS MEDICAL CENTER, DLP CONEMAUGH MEYERSDALE MEDICAL CENTER PART V, SECTION B, LINE 16I:THE ORGANIZATION IS GOVERNED BY THE CONEMAUGH HEALTH SYSTEM'S FINANCIAL ASSISTANCE POLICY. A SUMMARY OF THIS POLICY IS MADE AVAILABLE VIA BROCHURES LOCATED AT ALL REGISTRATION SITES, AND IS INCLUDED IN THE ADMISSIONS PACKET. IN ADDITION, BILLING STATEMENTS INDICATE THAT "FINANCIAL ASSISTANCE PROGRAM APPLICATIONS ARE AVAILABLE ON REQUEST, OR VISIT OUR WEBSITE AT WWW.CONEMAUGH.ORG". THE POLICY IS ALSO ADVERTISED PERIODICALLY IN THE LOCAL NEWSPAPERS.REPORTING GROUP ADLP CONEMAUGH MEMORIAL MEDICAL CENTER, DLP CONEMAUGH MINERS MEDICAL CENTER, DLP CONEMAUGH MEYERSDALE MEDICAL CENTER PART V, SECTION B, LINE 20E:ALL REGISTRATION LOCATIONS HAVE THE HEALTH SYSTEM'S FINANCIAL ASSISTANCE POLICY INFORMATION ON HAND. THE INFORMATION IS ALSO AVAILABLE BY VISITING THE HEALTH SYSTEM'S WEBSITE AT WWW.CONEMAUGH.ORG.DLP MARQUETTE GENERAL HOSPITAL, LLCPART V, SECTION B, LINE 3:THE UPPER PENINSULA (UP) HEALTH SYSTEM MARQUETTE PREVIOUSLY CONDUCTED A CHNA IN 2012. A CHNA WAS CONDUCTED AND ADOPTED IN 2016 THAT ANALYZES PROGRESS SINCE THE 2012 CHNA AS WELL AS DEFINES PRIORITIES FOR THE NEXT 3 YEARS. DLP MARQUETTE GENERAL HOSPITAL, LLCPART V, SECTION B, LINE 22D:THE MAXIMUM AMOUNT THAT CAN BE CHARGED IS THE GROSS CHARGES FOR THE SERVICE PERFORMED MULTIPLIED BY 1 MINUS THE DISCOUNT PERCENT BASED ON INCOME LEVEL.DLP WILSON MEDICAL CENTERPART V, SECTION B, LINE 2WILSON MEDICAL CENTER WAS ACQUIRED BY DLP HEALTHCARE, LLC ON MARCH 1, 2014. PRIOR TO ACQUISITION, WILSON MEDICAL CENTER WAS A NORTH CAROLINA NONPROFIT CORPORATION (GOVERNMENT-OWNED HOSPITAL).DLP WILSON MEDICAL CENTERPART V, SECTION B, LINE 5THE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) PROCESS INCLUDED OVER 50 COMMUNITY AND HEALTH CARE ORGANIZATIONS COLLABORATING TO IMPLEMENT A 4 STAGE CHNA PROCESS FOCUSED ON IDENTIFYING AND DEFINING LOCAL HEALTH ISSUES, CONCERNS, AND NEEDS. IN ORDER TO GATHER INPUT FROM A BROAD RANGE OF COMMUNITY MEMBERS, DATA WAS GATHERED VIA FOCUS GROUPS, INFORMATION GATHERING FROM PUBLIC AND HOSPITAL-SPECIFIC SOURCES, SURVEYS OF PHYSICIANS AND EMPLOYEES, AND A COMMUNITY SUMMIT ON SEPTEMBER 11, 2014 THAT INCLUDED HEALTHCARE WORKERS, THE HEALTH DEPARTMENT, PHYSICIANS, BUSINESS LEADERS, SCHOOL SYSTEMS, GOVERNMENT REPRESENTATIVES, CLERGY AND OTHER COMMUNITY MEMBERS.DLP WILSON MEDICAL CENTERPART V, SECTION B, LINE 11:THE STRATEGIC ITEMS ADOPTED BY WILSON TO MEET THE NEEDS OF THE 2014 CHNA WERE AS FOLLOWS: RECRUITING PRIMARY CARE PROVIDERS, ADDRESSING BEHAVIORAL HEALTH NEEDS, ENGAGING WITH THE COMMUNITY, AND WORKING WITH CAROLINA'S FAMILY HEALTH CARE CENTER. THIS WAS THE FIRST YEAR OF THE CURRENT ADMINISTRATIVE STAFF SO THESE STRATEGIC ITEMS WERE NOT COMPLETED AS FOCUS WAS ON UNDERSTANDING THE NEEDS OF THE COMMUNITY.DLP WILSON MEDICAL CENTERPART V, SECTION B, LINE 22D:DLP WILSON MEDICAL CENTER CALCULATES ITS AGB USING THE "LOOK BACK METHOD" DESCRIBED IN APPLICABLE TREASURY REGULATIONS, BASED ON CLAIMS APPROVED BY MEDICARE AND PRIVATE INSURERS DURING A 12 MONTH MEASUREMENT PERIOD.
DLP MARIA PARHAM MEDICAL CENTER PART V, SECTION B, LINE 3A CHNA WAS CONDUCTED AND IMPLEMENTATION STRATEGY WAS ADOPTED IN SEPTEMBER 2016.DLP MARIA PARHAM MEDICAL CENTERPART V, SECTION B, LINE 22D:A PATIENT DETERMINED TO BE ELIGIBLE FOR FINANCIAL ASSISTANCE UNDER THE POLICY WILL NOT BE BILLED MORE THAN THE AMOUNT GENERALLY BILLED BY MARIA PARHAM MEDICAL CENTER TO INDIVIDUALS WHO HAVE INSURANCE COVERING SUCH CARE.DLP HAYWOOD REGIONAL MEDICAL CENTERPART V, SECTION B, LINE 2HAYWOOD REGIONAL MEDICAL CENTER WAS ACQUIRED BY DLP HEALTHCARE, LLC ON JULY 31, 2014. PRIOR TO THE ACQUISITION BY DLP, HAYWOOD WAS A NORTH CAROLINA PUBLIC HOSPITAL.DLP HAYWOOD REGIONAL MEDICAL CENTERPART V, SECTION B, LINE 3HAYWOOD REGIONAL MEDICAL CENTER'S BOARD OF DIRECTORS APPROVED AND ADOPTED ITS CHNA AND IMPLEMENTATION STRATEGY ON OCTOBER 27, 2016. IT WAS THEN MADE WIDELY AVAILABLE TO THE PUBLIC ON WWW.MYHAYWOODREGIONAL.COM WEBSITE ON OCTOBER 28, 2016.DLP HAYWOOD REGIONAL MEDICAL CENTERPART V, SECTION B, LINE 22DDLP HAYWOOD REGIONAL MEDICAL CENTER CALCULATES ITS AGB USING THE "LOOK BACK METHOD" DESCRIBED IN APPLICABLE TREASURY REGULATIONS, BASED ON CLAIMS APPROVED BY MEDICARE AND PRIVATE INSURERS DURING A 12 MONTH MEASUREMENT PERIOD. RUTHERFORD REGIONAL HEALTH SYSTEMPART V, SECTION B, LINE 2:DLP HEALTHCARE, LLC ACQUIRED AN 80% OWNERSHIP IN RUTHERFORD HOSPITAL, INC. ON JUNE 1, 2014. PRIOR TO THE ACQUISITION BY DLP, RUTHERFORD HOSPITAL, INC. WAS A NONPROFIT CORPORATION.RUTHERFORD REGIONAL HEALTH SYSTEMPART V, SECTION B, LINE 3:RUTHERFORD REGIONAL HEALTH SYSTEM PREVIOUSLY CONDUCTED A CHNA IN 2012. A CHNA WAS CONDUCTED AND ADOPTED IN 2016 THAT ANALYZES PROGRESS SINCE THE 2012 CHNA AS WELL AS DEFINES PRIORITIES FOR THE NEXT 3 YEARS.RUTHERFORD REGIONAL HEALTH SYSTEMPART V, SECTION B, LINE 16A AND 16B:THE FINANCIAL ASSISTANCE POLICY WAS MADE WIDELY AVAILALBE ON THIS WEBSITE:HTTP://WWW.MYRUTHERFORDREGIONAL.COM/PATIENTS-AND-VISITORS/RUTHERFORD REGIONAL HEALTH SYSTEMPART V, SECTION B, LINE 22D:OUR MEDICAL ASSISTANCE POLICY ALLOWS UP TO 120% OF FEDERAL POVERTY GUIDELINE FOR 100% REDUCTION OF BALANCE/CHARGES. THE SLIDING SCALE ALLOWS UP TO 250% OF THE FEDERAL POVERTY GUIDELINE IN ALLOWING A 30% REDUCTION OF THE BALANCE/CHARGES. ALL SELF PAY ACCOUNTS RECEIVE A 20% DISCOUNT OF CHARGES AT THE TIME OF FINAL BILLING. ALSO, IF SELF PAY BALANCE IS PAID PROMPTLY (15 DAYS FROM FINAL BILLING), PATIENT IS ENTITLED TO AND ADDITIONAL 30% DISCOUNT OF CHARGES.DLP HARRIS REGIONAL HOSPITALPART V, SECTION B, LINE 2:HARRIS REGIONAL HOSPITAL, INC AND SWAIN COMMUNITY HOSPITAL, INC. WERE ACQUIRED BY DLP HEALTHCARE, LLC ON JULY 31, 2014. PRIOR TO THE ACQUISITION BY DLP, THESE HOSPITALS WERE NONPROFIT CORPORATIONS.DLP HARRIS REGIONAL HOSPITALPART V, LINE 5HARRIS HOSPITAL TOOK INTO ACCOUNT THE INTEREST OF JACKSON COUNTY HEALTH DEPARTMENT. HARRIS HOSPITAL COMMUNICATED OUR INVOLVEMENT IN THE COMMUNITY AND PROVIDED PHYSICIAN SERVICES TO THE HEALTH DEPARTMENT TO HELP MEET THE NEEDS OF THE COMMUNITY.DLP HARRIS REGIONAL HOSPITALPART V, LINE 6ADLP SWAIN COMMUNITY HOSPITALDLP HARRIS REGIONAL HOSPITALPART V, LINE 6BJACKSON COUNTY HEALTH DEPARTMENTDLP HARRIS REGIONAL HOSPITALPART V, LINE 11:SUBSTANCE ABUSE IN ADOLESCENTS AND THE NEED FOR POSITIVE TEEN ACTIVITIES WAS A COMMUNITY HEALTH NEED PRIORITIZED IN THE JACKSON COUNTY COMMUNITY HEALTH ASSESSMENT. HARRIS REGIONAL HOSPITAL BELIEVES THIS HEALTH NEED CAN BE MORE ADEQUATELY ADDRESSED BY EXISTING PROGRAMS IN THE COMMUNITY SUCH AS WESTERN NORTH CAROLINA TEEN INSTITUTE AND ORGANIZATIONS IN THE COMMUNITY SUCH AS SMOKY MOUNTAIN CENTER. WESTERN NORTH CAROLINA TEEN INSTITUTE AND PREVENTION SERVICES ("WNCTIPS") IS A DEPARTMENT OF THE MOUNTAIN PROJECTS ORGANIZATION. THE WNCTIPS MISSION IS TO INCREASE RESILIENCE IN YOUTH, FAMILIES, AND COMMUNITIES THROUGH TARGETED EFFORTS TO REDUCE SUBSTANCE ABUSE AND OTHER RISKY BEHAVIORS. WNCTIPS PROVIDES VARIOUS PREVENTION SERVICES INCLUDING CLASSES, PRESENTATIONS, RESOURCES, NETWORKING, AND ALTERNATIVE ACTIVITIES. WNCTIPS IS BASED IN SYLVA, NORTH CAROLINA. SMOKY MOUNTAIN CENTER PROVIDES SCREENING, ASSESSMENT AND REFERRAL FOR MENTAL HEALTH, DEVELOPMENTAL DISABILITY, AND SUBSTANCE ABUSE SERVICES THROUGHOUT FIFTEEN WESTERN NORTH CAROLINA COUNTIES.DLP HARRIS REGIONAL HOSPITALPART V, SECTION B, LINE 22D:DLP HARRIS REGIONAL HOSPITAL USES CHARGE DESCRIPTION MASTER (CDM) RATES FOR EACH CHARGE. HARRIS REMOVES ALL OTHER ADJUSTMENTS; APPLIES THE FAP DISCOUNT BASED ON NATIONAL POVERTY LEVEL VS. INCOME (60-100%); AND THEN THE REMAINING BALANCE IS CHARGED TO THE PATIENT.
TWIN COUNTY REGIONAL HEALTHCARE PART V, SECTION B, LINE 5: COMMUNITY MEMBERS, EMPLOYERS, NOT FOR PROFIT ORGANIZATIONS, SCHOOLS, AND GOVERNMENT REPRESENTATIVES PARTICIPATED IN FOCUS GROUPS FOR PERSPECTIVES ON COMMUNITY HEALTH NEEDS AND ISSUES. PHYSICIANS AND EMPLOYEES WERE SURVEYED ON LINE. A COMMUNITY SUMMIT INCLUDING HEALTHCARE WORKERS, BUSINESS LEADERS, SCHOOL SYSTEMS, GOVERNMENT REPRESENTATIVES, CLERGY, AND OTHER COMMUNITY MEMBERS WAS ALSO CONDUCTED TO OBTAIN INPUT FROM COMMUNITY REPRESENTATIVES.TWIN COUNTY REGIONAL HEALTHCARE PART V, SECTION B, LINE 11:TWIN COUNTY REGIONAL HEALTHCARE CONDUCTED A CHNA IN 2014. A CHNA WAS CONDUCTED AGAIN IN 2016 AND AN IMPLEMENTATION STRATEGY ADOPTED IN 2016 THAT ANALYZES PROGRESS SINCE THE 2014 CHNA AS WELL AS DEFINES PRIORITIES FOR THE NEXT 3 YEARS.TWIN COUNTY REGIONAL HEALTHCAREPART V, SECTION B, LINE 22D:GROSS CHARGES FOR PROCEDURES ARE USED TO BILL PATIENTS. IF PATIENTS MEET ELIGIBILITY FOR FINANCIAL ASSISTANCE, THE ENTIRE BALANCE IS WRITTEN OFF TO CHARITY CARE.TWIN COUNTY REGIONAL HEALTHCAREPART V, SECTION B, LINE 24:TWIN COUNTY REGIONAL HEALTHCARE CHARGES ALL PATIENTS AN AMOUNT EQUAL TO GROSS CHARGES. IF THE PATIENTS QUALIFY FOR CHARITY CARE, THE CHARGES ARE WRITTEN OFF TO CHARITY CARE.PERSON MEMORIAL HOSPITALPART V, SECTION B, LINE 3 & LINE 10:PERSON MEMORIAL HOSPITAL CONDUCTED AND ADOPTED A CHNA AND IMPLEMENTATION PLAN IN 2016.PERSON MEMORIAL HOSPITAL PART V, SECTION B, LINE 22D: ALL PATIENTS ARE CHARGED CONSISTENTLY REGARDLESS OF PAYOR OR ABILITY TO PAY. PATIENTS WHO FALL BETWEEN 125-200% OF FPG ARE ADJUSTED ACCORDINGLY.
DLP SWAIN COMMUNITY HOSPITAL PART V, SECTION B, LINE 2:SWAIN COMMUNITY HOSPITAL, INC. AND HARRIS REGIONAL HOSPITAL, INC. WERE ACQUIRED BY DLP HEALTHCARE, LLC ON JULY 31, 2014. PRIOR TO THE ACQUISITION BY DLP, THESE HOSPITALS WERE NONPROFIT CORPORATIONS.DLP SWAIN COMMUNITY HOSPITALPART V, SECTION B, LINE 5SWAIN COMMUNITY HOSPITAL TOOK INTO ACCOUNT THE INTEREST OF SWAIN COUNTY HEALTH DEPARTMENT. SWAIN COMMUNITY HOSPITAL COMMUNICATED OUR INVOLVEMENT IN THE COMMUNITY AND PROVIDED PHYSICIAN SERVICES TO THE HEALTH DEPARTMENT TO HELP MEET THE NEEDS OF THE COMMUNITY.DLP SWAIN COMMUNITY HOSPITALPART V, SECTION B, LINE 6ADLP HARRIS REGIONAL HOSPITALDLP SWAIN COMMUNITY HOSPITALPART V, SECTION B, LINE 6BSWAIN COUNTY HEALTH DEPARTMENTDLP SWAIN COMMUNITY HOSPITALPART V, SECTION B, LINE 11TOBACCO-FREE PARKS AND OBESITY PROGRAMS WERE COMMUNITY HEALTH NEEDS PRIORITIZED IN THE SWAIN COMMUNITY HEALTH ASSESSMENT. SWAIN BELIEVES THESE HEALTH NEEDS CAN BE MORE ADEQUATELY ADDRESSED BY EXISTING PROGRAMS IN THE COMMUNITY. SWAIN BELIEVES TOBACCO-FREE PARKS AND RECREATION IS A NEED MORE APPROPRIATELY ADDRESSED BY LOCAL GOVERNMENT THROUGH POLICY AND REGULATION.DLP SWAIN COMMUNITY HOSPITALPART V, SECTION B, LINE 22D:DLP SWAIN COMMUNITY HOSPITAL USES CDM RATES FOR EACH CHARGE. SWAIN REMOVES ALL OTHER ADJUSTMENTS; APPLIES THE FAP DISCOUNT BASED ON NATIONAL POVERTY LEVEL VS. INCOME (60-100%); AND THEN THE REMAINING BALANCE IS CHARGED TO THE PATIENT.
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
Schedule H (Form 990) 2015
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?104
Name and address Type of Facility (describe)
1 1 - ST BENEDICT RURAL HEALTH CLINIC
564 THEATRE ROAD
CARROLLTOWN,PA15722
PHYSICIAN PRACTICE - 3% OWNERSHIP IN JOINT VENTURE
2 2 - CPG CRESSO RHC
225 KEYSTONE AVENUE
CRESSON,PA16630
PHYSICIAN PRACTICE - 3% OWNERSHIP IN JOINT VENTURE
3 3 - CPG CRESSON
815 SECOND STREET
CRESSON,PA16630
PHYSICIAN PRACTICE - 3% OWNERSHIP IN JOINT VENTURE
4 4 - CPG - RHEUMATOLOGY NASON
1792 PLANK RD
DUNCANSVILLE,PA16635
SPECIALITY PRACTICE - 3% OWNERSHIP IN JOINT VENTURE
5 5 - CPG EBENSBURG
1100 WEST HIGH STREET
EBENSBURG,PA15931
PHYSICIAN PRACTICE - 3% OWNERSHIP IN JOINT VENTURE
6 6 - CPG EBENSBURG INDUSTRIAL PARK
188 INDUSTRIAL PARK ROAD SUITE B
EBENSBURG,PA15931
PHYSICIAN PRACTICE - 3% OWNERSHIP IN JOINT VENTURE
7 7 - CPG EBENSBURG-JAMESWAY ROAD
236 JAMESWAY ROAD
EBENSBURG,PA15931
PHYSICIAN & SPECIALTY PRACTICE - 3% OWNERSHIP IN JOINT VENTURE
8 8 - MEDWELL EBENSBURG
236 JAMESWAY ROAD
EBENSBURG,PA15931
SPECIALITY PRACTICE - 3% OWNERSHIP IN JOINT VENTURE
9 9 - CFP - CARDIOLOGY
2262 QUAKER VALLEY RD SUITE 4
FISHERTOWN,PA15539
SPECIALITY PRACTICE - 3% OWNERSHIP IN JOINT VENTURE
10 10 - CFP - CARDIOLOGY
290 HAIDA AVENUE
HASTINGS,PA16646
SPECIALITY PRACTICE - 3% OWNERSHIP IN JOINT VENTURE
11 11 - CPG DAVIDSVILLE - RHC
207 WOODSTOWN HIGHWAY
HOLLSOPPLE,PA15935
PHYSICIAN PRACTICE - 3% OWNERSHIP IN JOINT VENTURE
12 12 - CONEMAUGH EAST HILLS
1450 SCALP AVENUE
JOHNSTOWN,PA15904
PHYSICIAN PRACTICE - 3% OWNERSHIP IN JOINT VENTURE
13 13 - CONEMAUGH RICHLAND
1481 EISENHOWER BLVD
JOHNSTOWN,PA15904
PHYSICIAN PRACTICE - 3% OWNERSHIP IN JOINT VENTURE
14 14 - CPG INTERNAL MEDICINE
ONE TECH PARK DRIVE SUITE 1150
JOHNSTOWN,PA15901
PHYSICIAN PRACTICE - 3% OWNERSHIP IN JOINT VENTURE
15 15 - CPG PARKHILL
1940 WILLIAM PENN AVENUE
JOHNSTOWN,PA15909
PHYSICIAN PRACTICE - 3% OWNERSHIP IN JOINT VENTURE
16 16 - CPG EBANDJIEFF
1060 LLOYD STREET
JOHNSTOWN,PA15943
PHYSICIAN PRACTICE - 3% OWNERSHIP IN JOINT VENTURE
17 17 - CONEMAUGH EAST HILLS
1450 SCALP AVENUE STE 003B 1074
JOHNSTOWN,PA15904
PHYSICIAN & SPECIALTY PRACTICE - 3% OWNERSHIP IN JOINT VENTURE
18 18 - CPG MEDICAL PARK
ONE TECH PARK DRIVE SUITE 1120
JOHNSTOWN,PA15901
PHYSICIAN PRACTICE - 3% OWNERSHIP IN JOINT VENTURE
19 19 - CPG PLASTIC SURGERY
ONE TECH PARK DRIVE SUITE 15901
JOHNSTOWN,PA15905
SPECIALITY PRACTICE - 3% OWNERSHIP IN JOINT VENTURE
20 20 - TRANSITIONAL CARE UNIT
1086 FRANKLIN STREET
JOHNSTOWN,PA15905
TRANSITIONAL CARE - 3% OWNERSHIP IN JOINT VENTURE
21 21 - CPG - OCCUPATIONAL MEDICINE
1450 SCALP AVENUE SUITE 106
JOHNSTOWN,PA15904
SPECIALITY PRACTICE - 3% OWNERSHIP IN JOINT VENTURE
22 22 - CPG - PAIN MANAGEMENT
1450 SCALP AVENUE SUITE 2100
JOHNSTOWN,PA15904
SPECIALITY PRACTICE - 3% OWNERSHIP IN JOINT VENTURE
23 23 - CONEMAUGH COUNSELING ASSOCIATES
320 MAIN STREET
JOHNSTOWN,PA15901
SPECIALITY PRACTICE - 3% OWNERSHIP IN JOINT VENTURE
24 24 - CPG BREAST SURGERY
1111 FRANKLIN STREET SUITE 030
JOHNSTOWN,PA15905
SPECIALITY PRACTICE - 3% OWNERSHIP IN JOINT VENTURE
25 25 - CONEMAUGH CANCER CARE CENTER
1020 FRANKLIN STREET
JOHNSTOWN,PA15905
SPECIALITY PRACTICE - 3% OWNERSHIP IN JOINT VENTURE
26 26 - CPG CARDIOLOGY
ONE TECH PARK DRIVE
JOHNSTOWN,PA15901
SPECIALITY PRACTICE - 3% OWNERSHIP IN JOINT VENTURE
27 27 - VASCULAR SURGERYCARDIO THORACIC
1086 FRANKLIN STREET SUITE 3002
JOHNSTOWN,PA15905
SPECIALITY PRACTICE - 3% OWNERSHIP IN JOINT VENTURE
28 28 - NEUROLOGY
1450 SCALP AVENUE SUITE 2100
JOHNSTOWN,PA15904
SPECIALITY PRACTICE - 3% OWNERSHIP IN JOINT VENTURE
29 29 - NEUROSURGERYNEUROPSYCHOLOGY
1111 FRANKLIN STREET SUITE 130
JOHNSTOWN,PA15905
SPECIALITY PRACTICE - 3% OWNERSHIP IN JOINT VENTURE
30 30 - CPG UROLOGY
1111 FRANKLIN STREET SUITE 410
JOHNSTOWN,PA15905
SPECIALITY PRACTICE - 3% OWNERSHIP IN JOINT VENTURE
31 31 - CPG OBGYN
1111 FRANKLIN STREET SUITE 300
JOHNSTOWN,PA15905
SPECIALITY PRACTICE - 3% OWNERSHIP IN JOINT VENTURE
32 32 - CPG GASTROENTEROLOGY
1015 FRANKLIN ST LEVEL C WESSELL BL
JOHNSTOWN,PA15905
SPECIALITY PRACTICE - 3% OWNERSHIP IN JOINT VENTURE
33 33 - CPG ENDOCRINOLOGY
ONE TECH PARK DRIVE SUITE 1130
JOHNSTOWN,PA15901
SPECIALITY PRACTICE - 3% OWNERSHIP IN JOINT VENTURE
34 34 - CPG ENDOCRINOLOGY
1020 FRANKLIN STGOOD SAMT BLDSTE102
JOHNSTOWN,PA15901
SPECIALITY PRACTICE - 3% OWNERSHIP IN JOINT VENTURE
35 35 - CPG SURGERY
1020 FRANKLIN STREET GROUND FLOOR
JOHNSTOWN,PA15905
SPECIALITY PRACTICE - 3% OWNERSHIP IN JOINT VENTURE
36 36 - CPG SURGERY
200 HOSPITAL DRIVE
JOHNSTOWN,PA15905
SPECIALITY PRACTICE - 3% OWNERSHIP IN JOINT VENTURE
37 37 - CPG PATHOLOGY
1086 FRANKLIN STREET
JOHNSTOWN,PA15905
SPECIALITY PRACTICE - 3% OWNERSHIP IN JOINT VENTURE
38 38 - CPG LIGONIER
200 WEST MAIN STREET
LIGONIER,PA15658
PHYSICIAN PRACTICE - 3% OWNERSHIP IN JOINT VENTURE
39 39 - CPG NEW PARIS RHC
4186 CORTLAND DRIVE PO BOX 367
NEW PARIS,PA15554
PHYSICIAN PRACTICE - 3% OWNERSHIP IN JOINT VENTURE
40 40 - CPG PORTAGE RHC
3670 PORTAGE STREET SUITE 105
PORTAGE,PA15946
PHYSICIAN PRACTICE - 3% OWNERSHIP IN JOINT VENTURE
41 41 - CPG SEWARD
6854 ROUTE 711 SUITE 7
SEWARD,PA15954
PHYSICIAN PRACTICE - 3% OWNERSHIP IN JOINT VENTURE
42 42 - CPG HIGHLANDS RHC
4324 GLADES PIKE
SOMERSET,PA15501
PHYSICIAN PRACTICE - 3% OWNERSHIP IN JOINT VENTURE
43 43 - CFP SOMERSET
339 W UNION STREET
SOMERSET,PA15501
PHYSICIAN & SPECIALTY PRACTICE - 3% OWNERSHIP IN JOINT VENTURE
44 44 - FAMILY HEALTHCARE RHC MEYERSDALE
202 BEACHLEY STREET
MEYERSDALE,PA15552
RURAL HEALTH CLINIC - 3% OWNERSHIP IN JOINT VENTURE
45 45 - CONEMAUGH MEYERSDALE OP CTR-FAMILY HEALT
7160 MASON DIXON HWY
MEYERSDALE,PA15552
RURAL HEALTH CLINIC - 3% OWNERSHIP IN JOINT VENTURE
46 46 - FAMILY HEALTHCARE RHC SALISBURY
231 ORD STREET
SALISBURY,PA15558
RURAL HEALTH CLINIC - 3% OWNERSHIP IN JOINT VENTURE
47 47 - TRANSITIONAL CARE UNIT
1086 FRANKLIN STREET
JOHNSTOWN,PA15905
LONG TERM CARE FACILITY - 3% OWNERSHIP IN JOINT VENTURE
48 48 - PREMIER WOMEN'S HEALTH
1901 INDUSTRY DR
HENDERSON,NC27536
PHYSICIAN PRACTICE (WOMEN'S HEALTH) - 3% OWNERSHIP IN JOINT VENTURE
49 49 - NORTH CAROLINA SURGICAL ASSOCIATES
120 CHARLES ROLLINS ROAD SUITE 206
HENDERSON,NC27536
GENERAL SURGICAL PRACTICE - 3% OWNERSHIP IN JOINT VENTUREE
50 50 - MARIA PARHAM NEPHROLOGY&HYPERTENSION
568 RUIN CREEK ROAD SUITE 006
HENDERSON,NC27536
PHYSICIAN PRACTICE (NEPHROLOGY/HYPERTENSION) - 3% OWNERSHIP IN JOINT VENTURE
51 51 - MARIA PARHAM PAIN & PHYSICAL MEDICINE CL
568 RUIN CREEK RD STE 128
HENDERSON,NC27536
SPECIALITY PRACTICE - 3% OWNERSHIP IN JOINT VENTURE
52 52 - KERR LAKE ORTHOPAEDICS
120 CHARLES ROLLINS ROAD SUITE 205
HENDERSON,NC27536
PHYSICIAN PRACTICE (ORTHOPAEDICS) - 3% OWNERSHIP IN JOINT VENTURE
53 53 - MARIA PARHAM HOME HEALTH
566 RUIN CREEK ROAD
HENDERSON,NC27536
HOME HEALTH PRACTICE - 3% OWNERSHIP IN JOINT VENTURE
54 54 - NORTHERN CAROLINA CARDIOLOGY
568 RUIN CREEK ROAD SUITE 102
HENDERSON,NC27536
PHYSICIAN PRACTICE (CARDIOLOGY) - 3% OWNERSHIP IN JOINT VENTURE
55 55 - DLP MARIA PARHAM ENDOCRINOLOGY
120 CHARLES ROLLINS ROAD SUITE 206
HENDERSON,NC27536
PHYSICIAN PRACTICE (ENDOCRINOLOGY) - 3% OWNERSHIP IN JOINT VENTURE
56 56 - DLP MARIA PARHAM PRIMARY CARE
568 RUIN CREEK ROAD SUITE 003
HENDERSON,NC27536
PHYSICIAN PRACTICE (PRIMARY CARE) - 3% OWNERSHIP IN JOINT VENTURE
57 57 - MARIA PARHAM PAIN & PHYS MED CLINIC
568 RUIN CREED ROAD SUITE 128
HENDERSON,NC27536
PHYSICIAN PRACTICE (PAIN/PHYSICAL MEDICINE) - 3% OWNERSHIP IN JOINT VENTURE
58 58 - TWIN COUNTY PEDIATRICS
606 EAST STUART DRIVE
GALAX,VA24333
PHYSICIAN PRACTICE (PEDIATRICS) - 3% OWNERSHIP IN JOINT VENTURE
59 59 - INDEPENDENCE FAMILY CARE
217 S INDEPENDENCE AVENUE
INDEPENDENCE,VA24348
PHYSICIAN PRACTICE (PRIMARY CARE) - 3% OWNERSHIP IN JOINT VENTURE
60 60 - TWIN COUNTY ENT
104 DOCTORS PARK
GALAX,VA24333
PHYSICIAN PRACTICE (ENT) - 3% OWNERSHIP IN JOINT VENTURE
61 61 - TWIN COUNTY UROLOGY
104 CRANBERRY ROAD SUITE 200B
GALAX,VA24333
PHYSICIAN PRACTICE (UROLOGY) - 3% OWNERSHIP IN JOINT VENTURE
62 62 - TWIN COUNTY ORTHOPEDICS
106 DOCTORS PARK
GALAX,VA24333
PHYSICIAN PRACTICE (ORTHOPEDICS) - 3% OWNERSHIP IN JOINT VENTURE
63 63 - TWIN COUNTY SURGERY
225 HOSPITAL DRIVE
GALAX,VA24333
PHYSICIAN PRACTICE (SURGERY) - 3% OWNERSHIP IN JOINT VENTURE
64 64 - HILLSVILLE FAMILY CARE
702 PINE STREET
HILLSVILLE,VA24343
PHYSICIAN PRACTICE (PRIMARY CARE) - 3% OWNERSHIP IN JOINT VENTURE
65 65 - GALAX FAMILY CARE
104 CRANBERRY ROAD SUITE 200A
GALAX,VA24333
PHYSICIAN PRACTICE (PRIMARY CARE) - 3% OWNERSHIP IN JOINT VENTURE
66 66 - TWIN COUNTY HOME HEALTH
818 GLENDALE ROAD
GALAX,VA24333
HOME HEALTHCARE - 3% OWNERSHIP IN JOINT VENTURE
67 67 - TWIN COUNTY HOSPICE
818 GLENDALE ROAD
GALAX,VA24333
HOSPICE - 3% OWNERSHIP IN JOINT VENTURE
68 68 - TWIN COUNTY PAIN CLINIC
200 HOSPITAL DRIVE
GALAX,VA24333
PHYSICIAN PRACTICE - 3% OWNERSHIP IN JOINT VENTURE
69 69 - TWIN COUNTY RHEUMATOLOGY
200 HOSPITAL DRIVE
GALAX,VA24333
PHYSICIAN PRACTICE - 3% OWNERSHIP IN JOINT VENTURE
70 70 - TWIN COUNTY CT FOR BEHAVIORAL HEALTH
500 GLENDALE ROAD
GALAX,VA24333
PHYSICIAN PRACTICE - 3% OWNERSHIP IN JOINT VENTURE
71 71 - CAROLINA HOME CARE
2270 HWY 74-A SUITES 345
FOREST CITY,NC28043
HOME HEALTH - 3% OWNERSHIP IN JOINT VENTURE
72 72 - RUTHERFORD ORTHOPEDICS
139 DR HENRY MORRIS DRIVE
RUTHERFORDTON,NC28139
ORTHOPEDIC PRACTICE - 3% OWNERSHIP IN JOINT VENTURE
73 73 - RUTHERFORD SURGICAL ASSOCIATES
330 NC 109 HIGHWAY
RUTHERFORDTON,NC28139
SURGICAL PRACTICE - 3% OWNERSHIP IN JOINT VENTURE
74 74 - POLK MEDICAL SPECIALISTS
45 E MILLS ST
COLUMBUS,NC28722
FAMILY GENERAL MEDICINE - 3% OWNERSHIP IN JOINT VENTURE
75 75 - PERSON HEALTH PRIMARY CARE
3762 DURHAM ROAD SUITE B
ROXBORO,NC27573
PHYSICIAN PRACTICE (PRIMARY CARE) - 3% OWNERSHIP IN JOINT VENTURE
76 76 - FOREST CITY FAMILY CENTER
212 ALLENDALE DRIVE
FOREST CITY,NC28043
FAMILY GENERAL MEDICINE - 3% OWNERSHIP IN JOINT VENTURE
77 77 - RUTHERFORD CHILDREN'S CARE
162 COMMERCIAL DR STE B
FOREST CITY,NC28043
PEDIATRIC SERVICES - 3% OWNERSHIP IN JOINT VENTURE
78 78 - CHASE FAMILY ONE
1269 US HWY 74 BYPASS 341
FOREST CITY,NC28043
GENERAL MEDICAL & SURGICAL - 3% OWNERSHIP IN JOINT VENTURE
79 79 - RUTHERFORD EAST FAMILY CARE
605 NC 120 HIGHWAY
MOORESBORO,NC28114
FAMILY GENERAL MEDICINE - 3% OWNERSHIP IN JOINT VENTURE
80 80 - INSIGHTS PSYCHIATRIC RESOURCES
393 S OAK STREET SUITE 100
SPINDALE,NC28160
PSYCHIATRIC SERVICES - 3% OWNERSHIP IN JOINT VENTURE
81 81 - THE CLINIC AT WALMART
197 PLAZA DRIVE
FOREST CITY,NC28043
FAMILY GENERAL MEDICINE - 3% OWNERSHIP IN JOINT VENTURE
82 82 - RUTHERFORD OCCUPATIONAL MEDICINE
288 SOUTH RIDGECREST AVENUE
RUTHERFORDTON,NC28139
PEDIATRIC SERVICES - 3% OWNERSHIP IN JOINT VENTURE
83 83 - RUTHERFORD UROLOGY
288 SOUTH RIDGECREST AVENUE
RUTHERFORDTON,NC28139
UROLOGICAL SERVICES - 3% OWNERSHIP IN JOINT VENTURE
84 84 - DLP WILMED NURSING CARE & REHABILITATION
1705 TARBORO STREET SW
WILSON,NC27803
NURSING CARE & REHABILITATION CENTER - 3% OWNERSHIP IN JOINT VENTURE
85 85 - DLP WILSON PHYSICIAN PRACTICES
1705 TARBORO STREET SW
WILSON,NC27803
NURSING CARE & REHABILITATION CENTER - 3% OWNERSHIP IN JOINT VENTURE
86 86 - THE HOMESTEAD
127 SUNSET RIDGE RD
CLYDE,NC28721
HOSPICE - 3% OWNERSHIP IN JOINT VENTURE
87 87 - HAYWOOD URGENT CARE
55 BUCKEYE COVE ROAD
CANTON,NC28716
URGENT CARE - 3% OWNERSHIP IN JOINT VENTURE
88 88 - HAYWOOD URGENT CARE
556 HAZELWOOD ROAD
WAYNESVILLE,NC28786
URGENT CARE - 3% OWNERSHIP IN JOINT VENTURE
89 89 - HAYWOOD HOME CARE SERVICES
560 LEROY GEORGE DR
CLYDE,NC28721
HOME HEALTH - 3% OWNERSHIP IN JOINT VENTURE
90 90 - BLUE MOUNTAIN UROLOGY
15 BRETTWOOD TRACE
CLYDE,NC28721
SPECIALITY PRACTICE - 3% OWNERSHIP IN JOINT VENTURE
91 91 - HAYWOOD FAMILY PRACTICE
119 PARK STREET
CANTON,NC28716
PHYSICIAN PRACTICE - 3% OWNERSHIP IN JOINT VENTURE
92 92 - HAYWOOD MEDICAL ASSOCIATES
16 PHYSICIAN DRIVE
CLYDE,NC28721
PHYSICIAN PRACTICE - 3% OWNERSHIP IN JOINT VENTURE
93 93 - HAYWOOD SURGICAL ASSOCIATES
40 BRETTWOOD TRACE
CLYDE,NC28721
SPECIALITY PRACTICE - 3% OWNERSHIP IN JOINT VENTURE
94 94 - HAYWOOD THORACIC AND VASCULAR
581 LEROY GEORGE DRIVE SUITE 380
CLYDE,NC28721
SPECIALITY PRACTICE - 3% OWNERSHIP IN JOINT VENTURE
95 95 - HAYWOOD WOMENS MEDICAL CENTER
35 FACILITY DRIVE
CLYDE,NC28721
PHYSICIAN PRACTICE - 3% OWNERSHIP IN JOINT VENTURE
96 96 - MOUNTAIN MEDICAL ASSOCIATES
600 HOSPITAL DRIVE
CLYDE,NC28721
PHYSICIAN PRACTICE - 3% OWNERSHIP IN JOINT VENTURE
97 97 - MOUNTAIN PEDIATRIC GROUP
24 FALCON CREST LANE
CLYDE,NC28721
PHYSICIAN PRACTICE - 3% OWNERSHIP IN JOINT VENTURE
98 98 - MOUNTAIN SPINECARE
581 LEROY GEORGE DRIVE SUITE 380
CLYDE,NC28721
SPECIALITY PRACTICE - 3% OWNERSHIP IN JOINT VENTURE
99 99 - MOUNTAIN SPINECARE
68 HOSPITAL DRIVE SUITE 101
SYLVA,NC28779
SPECIALITY PRACTICE - 3% OWNERSHIP IN JOINT VENTURE
100 100 - WAYNESVILLE FAMILY PRACTICE
1272 EAST STREET
WAYNESVILLE,NC28786
PHYSICIAN PRACTICE - 3% OWNERSHIP IN JOINT VENTURE
101 101 - WESTERN CAROLINA CARDIOLOGY
32 PHYSICIANS DRIVE
CLYDE,NC28721
SPECIALITY PRACTICE - 3% OWNERSHIP IN JOINT VENTURE
102 102 - WESTERN CAROLINA ORTHO SPECIALISTS
581 LEROY GEORGE DRIVE SUITE 300
CLYDE,NC28721
SPECIALITY PRACTICE - 3% OWNERSHIP IN JOINT VENTURE
103 103 - CRICHTON REHABILITATION CENTER
320 MAIN STREET
JOHNSTOWN,PA15901
SPECIALITY PRACTICE - 3% OWNERSHIP IN JOINT VENTURE
104 104 - LEE AMBULATORY SURGICAL CENTER
320 MAIN STREET
JOHNSTOWN,PA15901
SPECIALITY PRACTICE - 3% OWNERSHIP IN JOINT VENTURE
Schedule H (Form 990) 2015
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: THIS ANSWER IS BASED ON THE HOSPITAL FACILITIES THAT SERVED THE LARGEST NUMBER OF THE ORGANIZATION'S PATIENTS DURING THE TAX YEAR. FEDERAL POVERTY GUIDELINES ARE NOT USED IN THE DETERMINATION OF DISCOUNTED CARE. ALL SELF-PAY, UNINSURED PATIENTS ARE OFFERED A 60% DISCOUNT OFF OF CHARGES.PART I, LINE 6A:DQN HOLDS A 3% OWNERSHIP IN A PARTNERSHIP THAT IN TURN HOLDS A PERCENTAGE OWNERSHIP IN EACH OF THE HOSPITALS LISTED IN PART V, SECTION A. ACCORDINGLY, THE HOSPITAL FACILITIES PREPARE COMMUNITY BENEFIT REPORTS AS NECESSARY.PART I, LINE 7:THIS ANSWER IS BASED ON THE HOSPITAL FACILITIES THAT SERVED THE LARGEST NUMBER OF THE ORGANIZATION'S PATIENTS DURING THE TAX YEAR. THE COSTING METHODOLOGY USED TO CALCULATE THE AMOUNTS REPORTED ON PART I, LINES 7A, 7B, AND 7C WAS BASED ON THE COST ACCOUNTING SYSTEM AND ADDRESSES ALL PATIENT SEGMENTS. THE METHODOLOGY USED TO CALCULATE THE AMOUNTS REPORTED ON PART I, LINES 7E-7A, AS APPLICABLE, WAS BASED ON ACTUAL INCURRED REVENUES AND EXPENSES.PART II, COMMUNITY BUILDING ACTIVITIES:THE CONEMAUGH HEALTH SYSTEM'S OFFICE OF COMMUNITY HEALTH (OCH) BRINGS COMMUNITY GROUPS TOGETHER TO WORK COLLABORATELY TO IMPROVE THE OVERALL HEALTH AND WELL BEING OF AREA RESIDENTS AND TO ENCOURAGE THEIR ACTIVE PARTICIPATION IN DECISIONS RELATING TO THE HEALTH OF THE COMMUNITY IN WHICH THEY LIVE. SOME OF THE INITIATIVES INCLUDE: COMMUNITY HEALTH FAIRS, PHARMACIST PRESCRIPTION MEDICATION REVIEWS AND FREE HEALTH SCREENINGS FOR DIABETES, CARDIOVASCULAR DISEASE, SLEEP DISORDERS, OSTEOPOROSIS, CANCER AND MORE. CONEMAUGH MEMORIAL MEDICAL CENTER ALSO MADE VARIOUS CONTRIBUTIONS TO ORGANIZATIONS TO PROMOTE THE HEALTH, SAFETY, AND WELL BEING OF THE COMMUNITY. THESE CONTRIBUTIONS WERE MADE IN LINE WITH THE GOALS OF THE HEALTH SYSTEM TO SUPPORT ORGANIZATIONS AND PROGRAMS THAT FOCUS ON COMMUNITY HEALTH AND WELLNESS, ENHANCE THE DEVELOPMENT OF AREA YOUTH, ENRICH THE LIVES AND ENHANCE THE CULTURE OF THE REGION, AND CONTRIBUTE TO THE OVERALL GOOD OF THE COMMUNITY. PART III, LINE 2:THIS ANSWER IS BASED ON THE HOSPITAL FACILITIES THAT SERVED THE LARGEST NUMBER OF THE ORGANIZATION'S PATIENTS DURING THE TAX YEAR. THE AMOUNT OF THE ORGANIZATION'S BAD DEBT EXPENSE AT COST WAS ESTIMATED USING BAD DEBT REPORTED ON FINANCIAL STATEMENTS MULTIPLIED BY THE ORGANIZATION'S COST-TO-CHARGE RATIO".PART III, LINE 3:THIS ANSWER IS BASED ON THE HOSPITAL FACILITIES THAT SERVED THE LARGEST NUMBER OF THE ORGANIZATION'S PATIENTS DURING THE TAX YEAR. THERE SHOULD NOT BE A PORTION OF BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER ITS FINANCIAL ASSISTANCE POLICY AS THE HOSPITAL FACILITIES HAVE IMPLEMENTED A SCORING SYSTEM BASED ON FEDERAL POVERTY GUIDELINES THAT SEGREGATES PATIENT BALANCES THAT ARE WRITTEN OFF TO PRESUMPTIVE CHARITY CARE, RATHER THAN BEING SENT TO COLLECTION. THIS HAS RESULTED IN MOVING PATIENTS OUT OF BAD DEBT STATUS THAT WOULD OTHERWISE BE PRESUMED TO BE ELIGIBLE UNDER THE HOSPITAL FACILITIES' FINANCIAL ASSISTANCE POLICY. PART III, LINE 4:NOT APPLICABLEPART III, LINE 8: THIS ANSWER IS BASED ON THE HOSPITAL FACILITIES THAT SERVED THE LARGEST NUMBER OF THE ORGANIZATION'S PATIENTS DURING THE TAX YEAR. THE HOSPITAL FACILITIES USE ITS COST ACCOUNTING SYSTEM, HORIZON PERFORMANCE MANAGER (HPM), TO ESTIMATE THE AMOUNT REPORTED ON LINE 6. PART V, SECTION A:EACH HOSPITAL LISTED IS PART OF DQN'S 3% OWNERSHIP INTEREST IN A JOINT VENTURE WITH LIFEPOINT HOSPITALS INC.NEEDS ASSESSMENT:PART VI, LINE 2:THIS ANSWER IS BASED ON THE HOSPITAL FACILITIES THAT SERVED THE LARGEST NUMBER OF THE ORGANIZATION'S PATIENTS DURING THE TAX YEAR.REPORTING GROUP A:DLP CONEMAUGH MEMORIAL MEDICAL CENTER, DLP CONEMAUGH MINERS MEDICAL CENTER, DLP CONEMAUGH MEYERSDALE MEDICAL CENTERTHERE ARE VARIOUS WAYS THAT CONEMAUGH HEALTH SYSTEM ASSESSES THE HEALTH CARE NEEDS OF THE COMMUNITIES IT SERVES, IN ADDITION TO THE NEEDS ASSESSMENT REPORTED IN PART V, SECTION B. THE CONEMAUGH HEALTH SYSTEM (CHS) PROVIDES A WAY FOR PEOPLE WITHIN THE COMMUNITIES OF ALL MEMBER HOSPITALS TO ASK QUESTIONS THROUGH ITS WEBSITE. THROUGH EMAILUS@CONEMAUGH.ORG, THE HEALTH SYSTEM RECEIVES NUMEROUS QUESTIONS AND SUGGESTIONS, ALL OF WHICH ARE FILED BY ITS MARKETING DEPARTMENT AND THEN GIVEN TO THE APPROPRIATE PERSON OR DEPARTMENT FOR A QUICK AND ACCURATE RESPONSE. THESE EMAILS RANGE FROM SUGGESTIONS TO HEALTH QUESTIONS AND HELP FINDING AN APPROPRIATE PROVIDER OR SERVICE. IN ADDITION, NUMEROUS HEALTH FAIRS ARE HELD AT VARIOUS LOCATIONS THROUGHOUT CHS EACH YEAR TO ALLOW PEOPLE TO LEARN MORE ABOUT SPECIFIC HELP TOPICS. PEOPLE ARE ENCOURAGED TO SPEAK DIRECTLY TO CAREGIVERS AND HAVE THEIR SPECIFIC QUESTIONS ANSWERED WHEN APPROPRIATE. CHS PROVIDES A 1-800 NUMBER FOR PEOPLE TO CALL TO SEEK HELP FINDING A PHYSICIAN. CALLS COME IN DAILY WITH A VARIETY OF QUESTIONS RANGING FROM HELP FINDING A PHYSICIAN TO SPECIFIC MEDICAL QUESTIONS TO REQUESTS FOR SUPPORT GROUP INFORMATION. THE PHONE NUMBER IS INCLUDED IN MOST CHS ADVERTISING MATERIALS AS A WAY TO HELP PEOPLE FIND ADDITIONAL INFORMATION OR TO ASK QUESTIONS. THE CHS FACEBOOK PAGE PROVIDES ANOTHER OPPORTUNITY FOR PEOPLE TO PROVIDE FEEDBACK AND TO INQUIRE ABOUT HEALTH RELATED TOPICS AND SERVICES. IN ADDITION TO PROVIDING HEALTH INFORMATION AND WELLNESS TIPS, PEOPLE ARE ENCOURAGED TO PROVIDE TOPICS THEY WOULD LIKE TO LEARN MORE ABOUT. CHS USES THE VOICE OF THE CUSTOMER (VOC) TO HELP DETERMINE APPROPRIATE ADVERTISING MESSAGES AND TO PLAN PROGRAMMING. ONE WAY THE VOICE OF THE CUSTOMER IS ACQUIRED IS THROUGH A PATIENT ADVISORY COMMITTEE AT BOTH MEMORIAL AND MINERS WHICH PROVIDES CONSTRUCTIVE CRITICISM AND FEEDBACK REGARDING VARIOUS ASPECTS OF CARE DELIVERY. VOC IS ALSO USED WITHIN LEAN SIX SIGMA PROJECTS TAKING PLACE THROUGHOUT THE HEALTH SYSTEM AS A WAY TO IMPROVE PROCESSES AND THE PATIENT EXPERIENCE. IN ADDITION, THE MARKETING DEPARTMENT REGULARLY RECEIVES FEEDBACK ON ISSUES AND HEALTH TRENDS FROM PHYSICIANS AND OTHER CLINICAL CAREGIVERS. THESE TRENDS ARE THEN ADDRESSED THROUGH MARKETING, SOCIAL MEDIA, OR MEDIA RELEASES.DLP MARQUETTE GENERAL HOSPITAL:THE ORGANIZATION ASSESSES THE HEALTH CARE NEEDS OF THE COMMUNITIES IT SERVES BY UTILIZING NEEDS ASSESSMENTS CONDUCTED BY MULTIPLE AGENCIES PROVIDING HEALTH CARE SERVICES, AS WELL AS CONDUCTING AND DIRECTING QUALITATIVE (FOCUS GROUPS AND INDIVIDUAL, IN PERSON INTERVIEWS) AND QUANTITATIVE (PHONE SURVEYS) MARKET RESEARCH OF PERSONS WITHIN ITS SERVICE AREA. RESEARCH IS ALSO CONDUCTED VIA INTERVIEWS AND FOCUS GROUPS WITH PHYSICIANS AND MID-LEVEL PROVIDERS TO DETERMINE HEALTH CARE NEEDS.
PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE: PART VI, LINE 3:REPORTING GROUP A:DLP CONEMAUGH MEMORIAL MEDICAL CENTER, DLP CONEMAUGH MINERS MEDICAL CENTER AND DLP CONEMAUGH MEYERSDALE MEDICAL CENTERCONEMAUGH HEALTH SYSTEM (CHS) COMMUNICATES TO PATIENTS THE AVAILABILITY OF FINANCIAL ASSISTANCE UNDER FEDERAL, STATE AND LOCAL PROGRAMS, AS WELL AS THE CHARITY CARE PROGRAM, ON ITS WEBSITE, WHICH INCLUDES A DOWNLOADABLE CHARITY CARE APPLICATION AND INSTRUCTIONS. TABLE TOP BROCHURES ARE PROVIDED AT ALL POINTS OF REGISTRATION, AND BROCHURES ARE INCLUDED IN PATIENT ADMISSION PACKETS. INFORMATION ON THE AVAILABLITY OF FINANCIAL ASSITANCE IS ALSO INCLUDED ON PATIENT STATEMENTS. ASSISTANCE IS PROVIDED TO PATIENTS TO APPLY FOR MEDICAL ASSISTANCE THROUGH A THIRD-PARTY VENDOR. A ROBUST FINANCIAL COUNSELING AND CUSTOMER SERVICE DEPARTMENT IS AVAILABLE TO HANDLE SPECIFIC PATIENT NEEDS.DLP MARQUETTE GENERAL HOSPITALDLP MARQUETTE GENERAL HOSPITAL HAS IN-HOUSE MEDICAL ASSISTANCE EXPERTS WHO EXPLAIN PROGRAMS TO PATIENTS AND ASSIST WITH THE APPLICATION PROCESS. PATIENT ACCESS IDENTIFIES SELF-PAY AND UNDERINSURED PATIENTS AND REFERS THEM TO IN-HOUSE FINANCIAL COUNSELORS. FINANCIAL ASSISTANCE INFORMATION AND APPLICATIONS ARE AVAILABLE ON-LINE.DLP WILSON MEDICAL CENTERWILSON SCREENS PATIENTS FOR MEDICAID AND EMPLOYS FINANCIAL COUNSELORS TO DETERMINE IF FAP ELIGIBLE.MARIA PARHAM MEDICAL CENTERMARIA PARHAM MEDICAL CENTER'S CHARITY CARE POLICY IS AVAILABLE ON THE HOSPITAL'S WEBSITE. FINANCIAL COUNSELING, CUSTOMER SERVICE, COLLECTION, AND MEDICAL ASSISTANCE STAFF ALSO COMMUNICATE WITH PATIENTS ABOUT THE CHARITY CARE PROGRAM.DLP HAYWOOD REGIONAL MEDICAL CENTERHAYWOOD'S FINANCIAL ASSISTANCE, PLAIN LANGUAGE SUMMARY IS POSTED AT ALL REGISTRATION AREAS. PATIENTS ARE GIVEN AN APPLICATION IF THEY ARE INTERESTED. THE FINANCIAL ASSISTANCE POLICY, PLAIN LANGUAGE SUMMARY AND APPLICATION ARE ON HAYWOOD'S WEB-SITE.ALL SELF PAY PATIENTS ARE SCREENED FOR MEDICAID BY MEDASSIT, MEDICAID VENDOR. IF NOT ELIGIBLE THEY ARE INFORMED ON HOW TO APPLY FOR FINANCIAL ASSISTANCE. THERE IS INFORMATION ON STATEMENTS DIRECTING PATIENTS THAT NEED FINANCIAL ASSISTANCE TO THE WEBSITE THAT HAS THE FAP, PLAIN LANGUAGE SUMMARY AND APPLICATION. THERE IS ALSO A PHONE NUMBER TO CALL TO OBTAIN INFORMATION.RUTHERFORD REGIONAL HEALTH SYSTEMPATIENTS WITH ESTIMATED BALANCES AFTER INSURANCE ARE CONTACTED PRIOR TO VISIT. THIS ALLOWS THE ESTIMATE TO BE PROVIDED TO THE PATIENT, AND TO DISCUSS INSURANCE BENEFITS AND ESTIMATED BALANCES AFTER INSURANCE. THIS DOES INCLUDE ALL SELF PAY PATIENTS AS WELL. A FINANCIAL COUNSELOR MAKES THIS CALL AND EXPLAINS ALL PAYMENT OPTIONS AND OPPORTUNITIES TO APPLY FOR MEDICAL ASSISTANCE. PATIENT REPRESENTATIVES ALSO FOLLOW UP WITH ALL SELF PAY PATIENTS TO PURSUE QUALIFICATION OF PATIENT INTO SOME TYPE OF ASSISTANCE (NCMEDICAID, DISABILITY, CRIME VICTIMS, VOCATIONAL REHAB OR OTHER POSSIBLE PAYMENT SOURCE). IF NO RESOURCES ARE IDENTIFIED FROM PATIENT REPRESENTATIVES, THE REPRESENTATIVE FACILITATES GETTING A MEDICAL ASSISTANCE APPLICATION TO THE PATIENT FOR POSSIBLE QUALIFICATION. REGISTRATION EMPLOYEES HAVE MEDICAL ASSISTANCE FORMS AND ARE TO PROVIDE THESE TO PATIENTS AT TIME OF REGISTRATION. EXTENDED BUSINESS OFFICE STAFF ALSO HAVE MEDICAL ASSISTANCE APPLICATIONS AND ARE TO PROVIDE THESE AS NECESSARY TO PATIENTS AFTER PHONE CONTACT. THE MEDICAL ASSISTANCE POLICY IS ON THE RUTHERFORD REGIONAL HEALTH SYSTEM (RRHS) WEBSITE FOR PUBLIC VIEWING, ALONG WITH THE APPLICATION THAT CAN BE PRINTED FOR COMPLETION FROM THE INDIVIDUAL REQUESTING ASSISTANCE.DLP HARRIS REGIONAL HOSPITAL AND DLP SWAIN COMMUNITY HOSPITALTO COMMUNICATE THE HOSPITAL'S FINANCIAL POLICY TO THE PATIENT, THE HOSPITAL'S WEBSITE HAS A "FOR PATIENTS AND VISITORS" MENU WHERE PATIENTS CAN GO TO VIEW INFORMATION ABOUT PAYMENT POLICIES, INSURANCE INFORMATION, AND THE HOSPITAL FINANCIAL ASSISTANCE (CARE ASSISTANCE) PROGRAM. THE WEBSITE PROVIDES THE POLICY AND THE APPLICATION WHICH INCLUDES THE CONTACT NUMBER TO THE FINANCIAL ASSISTANCE BENEFITS ADVISOR. THE HOSPITAL'S CHARITY CARE POLICY AND FINANCIAL ASSISTANCE CONTACT INFORMATION IS POSTED IN THE ADMISSIONS AREAS, EMERGENCY AREAS, AND OTHER AREAS OF THE HOSPITAL'S FACILITIES IN WHICH ELIGIBLE PATIENTS MAY BE PRESENT. ALL STAFF WITH PATIENT CONTACT ARE KNOWLEDGEABLE ABOUT THE CHARITY CARE POLICY (ADMITTING AND BILLING CLERKS, NURSING AND MEDICAL STAFFS, SOCIAL WORKERS, CHAPLAINS, PATIENT ADVOCATES, ETC.). TWIN COUNTY REGIONAL HOSPITALTWIN COUNTY REGIONAL HOSPITAL HAS AN ELIGIBILITY WORKER IN PARTNERSHIP WITH MED ASSIST FOR PATIENT EDUCATION OF ELIGIBILITY. CASHIERS AND COLLECTION REPRESENTATIVES ARE TRAINED TO HELP ESTABLISH PAYMENT PLANS FOR PATIENTS WHO DO NOT QUALIFY FOR FINANCIAL ASSISTANCE. TWIN ALSO OFFERS A "PRE-PAY" PROGRAM WHICH DISCOUNTS SOME OF THE MOST POPULAR SERVICES OFFERED. BROCHURES ARE AVAILABLE AT LOCAL PHYSICIAN OFFICES AND ENTRY POINTS AT TWIN COUNTY REGIONAL HOSPITAL.PERSON MEMORIAL HOSPITALPERSON MEMORIAL HOSPITAL HAS AN ELIGIBILITY WORKER IN PARTNERSHIP WITHMED ASSIST FOR PATIENT EDUCATION OF ELIGIBILITY. CASHIERS AND REGISTRARS ARE TRAINED TO HELP ESTABLISH PAYMENT PLANS FOR PATIENTS WHO DO NOT QUALIFY FOR FINANCIAL ASSISTANCE.
COMMUNITY INFORMATION: PART VI, LINE 4:REPORTING GROUP A:DLP CONEMAUGH MEMORIAL MEDICAL CENTER, DLP CONEMAUGH MINERS MEDICAL CENTER AND DLP CONEMAUGH MEYERSDALE MEDICAL CENTERCONEMAUGH MEMORIAL MEDICAL CENTER (MMC) IS THE CONEMAUGH HEALTH SYSTEM'S FLAGSHIP, REGIONAL REFERRAL, TEACHING HOSPITAL. THE 539-BED MEDICAL CENTER IS THE MOST TECHNOLOGICALLY SOPHISTICATED HOSPITAL BETWEEN PITTSBURGH AND HERSHEY AND IS REPEATEDLY RECOGNIZED FOR EXCELLENT CLINICAL OUTCOMES. MMC HAS BEEN RECOGNIZED BY US NEWS AND WORLD REPORT AS A BEST HOSPITAL FOR CENTRAL PENNSYLVANIA WITH HIGH PERFORMANCE RECOGNITION FOR CARDIOLOGY AND HEART SURGERY, GASTROENTEROLOGY AND GI SURGERY, GERIATRICS AND PULMONOLOGY. WITH GENERALLY OLDER POPULATIONS, CAMBRIA AND SOMERSET COUNTIES HAVE LOWER BIRTH RATES THAN DEATH RATES WHICH WILL FURTHER REDUCE HOUSEHOLD SIZE AND RESULT IN A FURTHER INCREASE OF MEDIAN AGE OF THE POPULATION OVER TIME. MEDIAN HOUSEHOLD INCOME IN 2014 WAS $42,304 IN CAMBRIA COUNTY AND $44,255 IN SOMERSET COUNTY, WHICH ARE SIGNIFICANTLY LOWER THAN BOTH STATE AND NATIONAL AVERAGES OF $53,115 AND $53,482 RESPECTIVELY.THE CONEMAUGH HEALTH SYSTEM'S COVERAGE REGION ALSO PRESENTS SOME GEOGRAPHIC CHALLENGES DUE TO ITS MOUNTAINOUS TOPOGRAPHY AND HIGHWAY INFRASTRUCTURE. MINDFUL OF THESE CHALLENGES, THE HEALTH SYSTEM CONTINUES TO PRESENT EDUCATIONAL AND SCREENING OPPORTUNITIES TO COMMUNITIES OUTSIDE OF ITS IMMEDIATE REGION. DLP MARQUETTE GENERAL HOSPITALMARQUETTE GENERAL HOSPITAL SERVICES THE RESIDENTS OF THE UPPER PENINSULA OF MICHIGAN WHICH IS A RURAL REGION WITH APPROXIMATELY 310,000 RESIDENTS.DLP WILSON MEDICAL CENTERTHE HOSPITAL IS LOCATED IN WILSON COUNTY, NC WHICH IS APPROXIMATELY 45 MILES EAST OF RALEIGH, NC. FROM A GEOGRAPHIC PERSPECTIVE, WILSON COUNTY IS ROUGHLY LOCATED ON THE FALL LINE THAT SEPARATES THE PIEDMONT AND THE COASTAL PLAIN. ACCORDING TO THE DATA IN THE 2016 WILSON COUNTY COMMUNITY HEALTH NEEDS ASSESSMENT, THE POPULATION OF WILSON COUNTY IN 2015 WAS 83,022 WITH A LOWER MEDIAN HOUSEHOLD INCOME OF $38,017 COMPARED TO NC'S MEDIAN INCOME OF $47,019; THE POPULATION OF WILSON COUNTY IS PROJECTED TO INCREASE 0.22% PER YEAR DURING THE 2015 TO 2020 TIME PERIOD WHICH IS LOWER THAN THE NC PROJECTED GROWTH RATE OF 1.16%; WILSON COUNTY'S UNEMPLOYMENT RATE WAS 8.7% COMPARED TO NC'S RATE OF 4.9%; AND WILSON COUNTY'S POVERTY RATE WAS 23.9% IN 2014, 6.7% HIGHER THAN NC'S POVERTY RATE.MARIA PARHAM MEDICAL CENTERMARIA PARHAM'S PRIMARY SERVICE AREAS ARE VANCE AND WARREN COUNTIES WHICH ARE BOTH CONSIDERED MEDICALLY UNDERSERVED AREAS. THE UNEMPLOYMENT RATE, AVERAGE PER CAPITA INCOME, AND AVERAGE HOUSEHOLD INCOME FOR THESE COUNTIES FALL BELOW THE NORTH CAROLINA AVERAGES AND APPROXIMATELY 30% OF THE POPULATION FALLS AT OR BELOW THE 2013 POVERTY LEVEL.DLP HAYWOOD REGIONAL MEDICAL CENTERHAYWOOD REGIONAL IS LOCATED IN HAYWOOD COUNTY. HAYWOOD COUNTY IS SITUATED AMIDST THE BLUE RIDGE MOUNTAINS AND CONTAINS PARTS OF SEVERAL MAJOR SUBRANGES OF THE BLUE RIDGE, NAMELY THE GREAT SMOKY MOUNTAINS IN THE WEST AND THE PLOTT BALSAMS AND GREAT BALSAM MOUNTAINS IN THE SOUTH. PER THE 2016 HAYWOOD COMMUNITY HEALTH NEEDS ASSESSMENT, HAYWOOD COUNTY HAD 59,471 RESIDENTS IN 2014. THE HAYWOOD COUNTY POPULATION HAS A SLIGHTLY HIGHER PROPORTION OF FEMALES THAN MALES (WNC HEALTHY IMPACT, 2015). THE MEDIAN AGE OF THE HAYWOOD COUNTY POPULATION (45.6 YEARS) IS 0.9 YEARS "OLDER" THAN WNC REGIONAL AVERAGE AND 8.2 YEARS "OLDER" THAN THE NC AVERAGE (WNCHI, 2015). HAYWOOD COUNTY HAS LOWER PROPORTIONS OF "YOUNGER PERSONS AND HIGHER PROPORTIONS OF THE "OLDER PERSONS" THAN NC AS A WHOLE (WNCHI, 2015). THE MEDIAN HOUSEHOLD INCOME FOR HAYWOOD COUNTY WAS $41,557. THIS IS $4,777 LESS THAN THE MEDIAN HOUSEHOLD INCOME FOR NORTH CAROLINA (US CENSUS BUREAU, 2009-2013). IN 2014, HAYWOOD COUNTY HAD AN UNEMPLOYMENT RATE OF 5.1%, HAVING STEADILY DECLINED SINCE 2010. (NC DEPARTMENT OF COMMERCE). THERE WERE 23,100 HOUSEHOLDS OUT OF WHICH 26.20% HAD CHILDREN UNDER THE AGE OF 18 LIVING WITH THEM, 56.70% WERE MARRIED COUPLES LIVING TOGETHER, 9.50% HAD A FEMALE HOUSEHOLDER WITH NO HUSBAND PRESENT, AND 30.50% WERE NON-FAMILIES. 26.70% OF ALL HOUSEHOLDS WERE MADE UP OF INDIVIDUALS AND 12.30% HAD SOMEONE LIVING ALONE WHO WAS 65 YEARS OF AGE OR OLDER. THE AVERAGE HOUSEHOLD SIZE WAS 2.30 AND THE AVERAGE FAMILY SIZE WAS 2.76. IN THE COUNTY, THE POPULATION WAS SPREAD OUT WITH 20.80% UNDER THE AGE OF 18, 6.20% FROM 18 TO 24, 26.90% FROM 25 TO 44, 27.10% FROM 45 TO 64, AND 19.00% WHO WERE 65 YEARS OF AGE OR OLDER. THE MEDIAN AGE WAS 42 YEARS. FOR EVERY 100 FEMALES, THERE WERE 92 MALES. FOR EVERY 100 FEMALES AGE 18 AND OVER, THERE WERE 88.70 MALES. THE MEDIAN INCOME FOR A HOUSEHOLD IN THE COUNTY WAS $33,922, AND THE MEDIAN INCOME FOR A FAMILY WAS $40,438. MALES HAD A MEDIAN INCOME OF $30,731 VERSUS $21,750 FOR FEMALES. THE PER CAPITA INCOME FOR THE COUNTY WAS $18,554. ABOUT 8.10% OF FAMILIES AND 11.50% OF THE POPULATION WERE BELOW THE POVERTY LINE, INCLUDING 17.40% OF THOSE UNDER AGE 18 AND 10.30% OF THOSE AGE 65 OR OVER.RUTHERFORD REGIONAL HEALTH SYSTEMRUTHERFORD COUNTY IS A RURAL COUNTY LOCATED IN THE FOOTHILLS OF THE WESTERN REGION OF THE STATE. THE STATE OF SOUTH CAROLINA AND POLK, HENDERSON, BUNCOMBE, MCDOWELL, BURKE, AND CLEVELAND COUNTIES BOUND RUTHERFORD COUNTY. RUTHERFORD COUNTY'S LAND AREA COMPRISED OF VALLEYS, MOUNTAINS, AND FLAT LAND IS 564.12 SQUARE MILES, AND 2 SQUARE MILES OF WATER. ACCORDING TO DATA FROM THE 2010 US CENSUS, THE TOTAL POPULATION OF RUTHERFORD COUNTY IS 67,810. IN RUTHERFORD COUNTY, AS REGION-WIDE AND STATEWIDE, THERE IS A SLIGHTLY HIGHER PROPORTION OF FEMALES THAN MALES (51.7% VS. 48.3%).IN RUTHERFORD COUNTY 17.3% OF THE POPULATION IS IN THE 65-AND-OLDER AGE GROUP, COMPARED TO 19.0% REGION-WIDE AND 12.9% STATEWIDE. THE MEDIAN AGE IN RUTHERFORD COUNTY IS 42.5, WHILE THE REGIONAL MEAN MEDIAN AGE IS 44.7 YEARS AND THE STATE MEDIAN AGE IS 37.4 YEARS.IN TERMS OF RACIAL AND ETHNIC DIVERSITY, RUTHERFORD COUNTY IS MORE DIVERSE THAN WNC BUT LESS DIVERSE THAN NC AS A WHOLE. IN RUTHERFORD COUNTY THE POPULATION IS 87.4% WHITE/CAUCASIAN AND 14.1% NON-WHITE. REGION-WIDE, THE POPULATION IS 89.3% WHITE/CAUCASIAN AND 11.7% NONWHITE. STATEWIDE, THE COMPARABLE FIGURES ARE 68.5% WHITE AND 31.5% NON-WHITE. THE PROPORTION OF THE POPULATION THAT SELF-IDENTIFIES AS HISPANIC OR LATINO OF ANY RACE IS 3.5% IN RUTHERFORD COUNTY, 5.4% REGION-WIDE, AND 8.4% STATEWIDE. THE PREDOMINANT MINORITY IN RUTHERFORD COUNTY IS AFRICAN AMERICAN (10.1%).IN RUTHERFORD COUNTY THE MEDIAN HOUSEHOLD INCOME WAS $36,334 FOR THE PERIOD OF 2009-2013. THIS REPRESENTS A $970 INCREASE OVER THE PREVIOUS AGGREGATE PERIOD. THIS IS $2,553 BELOW THE WNC AVERAGE AND $10,000 BELOW THE NC AVERAGE. THE MEDIAN FAMILY INCOME WAS $42,636 FOR THE MOST CURRENT PERIOD CITED. THIS IS $1,066 LOWER THAN THE PREVIOUS AGGREGATE PERIOD. THIS IS $5,915 BELOW THE WNC AVERAGE AND $14,292 BELOW THE NC AVERAGE.THE THREE EMPLOYMENT SECTORS IN RUTHERFORD COUNTY WITH THE LARGEST PROPORTIONS OF WORK AND (AVERAGE WEEKLY WAGES) WERE: HEALTH CARE AND SOCIAL ASSISTANCE: 17.80% OF WORKFORCE; MANUFACTURING: 15.52% OF THE WORKFORCE; AND RETAIL TRADE: 13.16% OF WORKFORCE.COMPARED TO THE WNC REGION AVERAGE, RUTHERFORD COUNTY HAS:- 0.6% LOWER PERCENTAGE OF PERSONS IN THE POPULATION OVER AGE 25 HAVING ONLY A HIGH SCHOOL DIPLOMA OR EQUIVALENT (2009-2013 ESTIMATE)- 20% LOWER PERCENTAGE OF PERSONS IN THE POPULATION OVER AGE 25 HAVING A BACHELOR'S DEGREE OR HIGHER (2009-2013 ESTIMATE)- 7% LOWER OVERALL HS GRADUATION RATE (FOR A 4-YEAR COHORT OF 9TH GRADERS ENTERING SCHOOL IN SCHOOL YEAR 2010-2011 AND GRADUATING IN SCHOOL YEAR 2013-2014 OR EARLIER).DLP HARRIS REGIONAL HOSPITAL (HRH)THE HOSPITAL IS LOCATED IN SYLVA, JACKSON COUNTY, WHICH IS IN RURAL WESTERN NORTH CAROLINA. APPROXIMATELY 55% OF THE PATIENTS SERVED BY HARRIS HOSPITAL RESIDE IN JACKSON COUNTY. MORE THAN 15% OF THE PATIENTS SERVED BY HRH RESIDE IN JACKSON'S NEIGHBORING COUNTY, SWAIN. BOTH GEORGRAPHIC AND DEMOGRAPHIC FACTORS SPECIFIC TO JACKSON AND SWAIN COUNTIES ARE DETAILED WITHIN THE HRH COMMUNITY HEALTH NEEDS ASSESSMENT AVAILABLE ON THE HOSPITAL'S WEBSITE AT WWW.MYHARRISREGIONAL.COM
TWIN COUNTY REGIONAL HOSPITAL TWIN COUNTY'S PRIMARY SERVICE AREAS ARE THE CITY OF GALAX AND GRAYSON AND CARROLL COUNTIES IN VIRGINIA. THESE COUNTIES ARE LOCATED IN SOUTHWEST VIRGINIA. GALAX CITY POPULATION IS 7,072 PEOPLE WITH SURROUNDING COUNTIES OF GRAYSON AND CARROLL COUNTIES OF 15,331 AND 30,121, RESPECTIVELY. THE AREA IS RURAL WITH SEVERAL PHYSICIAN OFFICES MEETING THE NEEDS OF RESIDENTS. OVER 23.2% AND 21.3% OF THE POPULATION IN GRAYSON COUNTY AND CARROLL COUNTY, RESPECTIVELY, IS OVER 65 YEARS OF AGE, 85% AND 88% OF THE POPULATION IN GRAYSON COUNTY AND CARROLL COUNTY, RESPECTIVELY, ARE HIGH SCHOOL GRADUATES, AND MOST CITIZENS HAVE AN AVERAGE DAILY COMMUTE TO WORK OF APPROXIMATELY 30 MINUTES. THE UNEMPLOYMENT RATE OF THE TWO COUNTIES IS OVER 4.2% AND MOST JOBS ARE IN MANUFACTURING AND LOCAL GOVERNMENT. IN THESE COUNTIES, 18.1-25.3% OF THE POPULATION IS BELOW THE FEDERAL POVERTY LEVEL.PERSON MEMORIAL HOSPITALPERSON MEMORIAL'S PRIMARY SERVICE AREA IS PERSON COUNTY WHICH IS LOCATED IN THE PIEDMONT REGION OF NORTH CAROLINA. PERSON COUNTY HAS A PERMANENT POPULATION OF 39,409 PEOPLE, SLIGHTLY MORE THAN HALF OF WHOM ARE FEMALE. OVER 17% OF PERSON COUNTY'S POPULATION IS OVER 65 YEARS OF AGE, 77% OF THE POPULATION IS A HIGH SCHOOL GRADUATE, AND 44% OF WORKING MEMBERS ARE EMPLOYED OUTSIDE OF THE COUNTY. THE UNEMPLOYMENT RATE FLUCTUATES BETWEEN 4% AND 8%, AND THE LARGEST PERCENTAGE OF THE WORKFORCE IS IN SERVICES, FOLLOWED BY MANUFACTURING AND RETAIL TRADE. IN PERSON COUNTY, 16% OF THE POPULATION IS BELOW THE POVERTY LEVEL.DLP SWAIN COMMUNITY HOSPITALTHE HOSPITAL IS LOCATED IN BRYSON CITY, SWAIN COUNTY WHICH IS IN RURAL WESTERN NORTH CAROLINA. APPROXIMATELY 63% OF THE PATIENTS SERVED BY SWAIN RESIDE IN SWAIN COUNTY. MORE THAN 16% OF THE PATIENTS SERVED BY SWAIN RESIDE IN SWAIN'S NEIGHBORING COUNTY, GRAHAM. BOTH GEOGRAPHIC AND DEMOGRAPHOC FACTORS SPECIFIC TO SWAIN AND GRAHAM COUNTIES ARE DETAILED WITHIN THE SWAIN COUNTY HOSPITAL COMMUNITY HEALTH NEEDS ASSESSMENT AVAILABLE ON THE HOSPITAL'S WEBSITE AT WWW.MYSWAINCOMMUNITY.COM
PROMOTION OF COMMUNITY HEALTH: PART VI, LINE 5:REPORTING GROUP A:DLP CONEMAUGH MEMORIAL MEDICAL CENTER, DLP CONEMAUGH MINERS MEDICAL CENTER, AND DLP CONEMAUGH MEYERSDALE MEDICAL CENTERTHE CONEMAUGH HEALTH SYSTEM (CHS), WHICH INCLUDES MEMORIAL MEDICAL CENTER (MMC), MINERS MEDICAL CENTER (MIMC), AND MEYERSDALE MEDICAL CENTER (MYMC) IS COMPRISED OF A MEDICAL STAFF OF ABOUT 350 PHYSICIANS REPRESENTING NUMEROUS SPECIALTIES THROUGHOUT A WIDE GEOGRAPHIC REGION. IN ADDITION, THE CONEMAUGH PHYSICIAN GROUP WITHIN THE SYSTEM IS A MULTI-SPECIALTY GROUP OF MORE THAN 120 PHYSICIANS PARTICIPATING AT SITES CONVENIENTLY LOCATED ACROSS 5 COUNTIES. ALL PRIMARY CARE PHYSICIAN OFFICES ARE CONNECTED TO ALL CHS HOSPITALS BY AN ELECTRONIC MEDICAL RECORD SYSTEM. THE SYSTEM IS FORTUNATE TO HAVE NOT ONLY STRONG PHYSICIAN LEADERSHIP, BUT STRONG BOARD LEADERSHIP. THE BOARD IS COMPRISED OF A WIDE VARIETY OF DEDICATED LEADERS REPRESENTING DIVERSE FIELDS WHICH INCLUDES AREA BUSINESS LEADERS, EDUCATORS, AND PHYSICIANS, BOTH FROM CONEMAUGH PHYSICIAN GROUP AS WELL AS INDEPENDENT PHYSICIANS. AN ACTIVE PATIENT ADVISORY COMMITTEE CONTRIBUTES REGULAR CONSTRUCTIVE CRITICISM AND FEEDBACK REGARDING VARIOUS ASPECTS OF CARE DELIVERY INCLUDING WAY FINDING, MARKETING, AND SERVICE EXCELLENCE. MMC ALSO ENJOYS A HEALTHY VOLUNTEER PROGRAM, MELDING A DIVERSE GROUP OF STUDENTS FROM LOCAL HIGH SCHOOL AND COLLEGES, MID-CAREER VOLUNTEERS WHO WISH TO GIVE BACK TO THE COMMUNITY, RETIREES WHO SPEND COUNTLESS HOURS PROVIDING SUPPORT TO ITS WORKFORCE, AND PASTORAL CARE VOLUNTEERS WHO SUPPORT EMPLOYEES AND PATIENTS' SPIRITUAL AND RELIGIOUS NEEDS.CONEMAUGH CONTINUES TO OFFER NUMEROUS SCREENINGS AND EDUCATIONAL EVENTS THROUGHOUT THE YEAR WHICH ARE FREE AND OPEN TO ALL. SOME HIGHLIGHTS INCLUDE: HEART MONTH FESTIVITIES WITH CARDIAC SCREENINGS AND WELLNESS FAIRS BOTH ON THE MEMORIAL CAMPUS AS WELL AS CARDIAC/VASCULAR AND DIABETES SCREENINGS THROUGHOUT THE REGION. LINKED IN PINK BREAST CANCER SCREENINGS AND HEALTH FAIRS WERE HELD THROUGHOUT THE MONTH OF OCTOBER WITH SPECIAL EDUCATIONAL EVENTS AND SCREENINGS FOR EMPLOYEES, THE GENERAL PUBLIC, THE UNINSURED, AND THE UNDERINSURED. STROKE AWARENESS MONTH WAS CELEBRATED WITH NUMEROUS EDUCATIONAL EFFORTS AND PROGRAMS; DRUG, ALCOHOL AND ANTI-BULLYING EDUCATION PROGRAMS WERE CONDUCTED; OTHER SCREENINGS SUPPORTED BY MMC THROUGHOUT THE YEAR INCLUDE BREAST CANCER, PROSTATE CANCER, CARDIAC, DIABETES, AND OSTEOPOROSIS SCREENINTS.EMPLOYEES CONTINUE TO BE GENEROUS WITH THEIR TIME, VOLUNTEERING AT NUMEROUS COMMUNITY EVENTS AND ORGANIZATIONS. EMPLOYEES PARTICIPATE IN A UNITED WAY FUND DRIVE EACH YEAR. THE CONEMAUGH HEALTH SYSTEM CARING INITIATIVE HAS BEEN IN PLACE FOR YEARS. ONE OF THE ASPECTS OF THIS INITIATIVE IS THE CARING BOXES, EMPLOYEE DONATIONS ARE COLLECTED EACH MONTH FOR A DIFFERENT ORGANIZATION IN THE COMMUNITY. THE BOXES ARE PLACED AT VARIOUS LOCATIONS THROUGHOUT THE CONEMAUGH HEALTH SYSTEM. ITEMS COLLECTED HAVE INCLUDED CANNED GOODS, PET SUPPLIES, PERSONAL HYGIENE PRODUCTS, TOYS FOR THE HOLIDAYS, WINTER COATS AND MORE. CONEMAUGH CONTINUED ITS PARTNERSHIP WITH THE CENTER FOR ORGAN RECOVERY AND EDUCATION (CORE) HOLDING A SPECIAL EVENT FOR THE FAMILIES OF ORGAN DONORS AND UNVEILING A NEW SERIES OF DONOR PHOTOS. THERE HAS BEEN CONTINUED COLLABORATION AND SUPPORT OF JOHNSTOWN'S FREE MEDICAL CLINIC WHICH PROVIDES CARE TO MANY UNDERINSURED AND UNINSURED. LABORATORY STAFF ALSO MEETS REGULARLY TO COLLABORATE WITH THE AMERICAN RED CROSS IN AN EFFORT TO INCREASE MUCH NEEDED BLOOD DONATIONS. PARTNERSHIPS WITH LOCAL SPORTS TEAMS ALSO CONTINUE WITH EDUCATIONAL NIGHTS AIMED AT PROMOTING CANCER AWARENESS AND SUPPORT AS WELL AS EDUCATION ON ORGAN DONATION AND CONCUSSIONS.MMC IS HOME TO NUMEROUS SPECIALIZED SERVICES, INCLUDING A REGIONAL REFERRAL LEVEL 1 TRAUMA CENTER, HIGH-RISK OBSTETRICAL CARE, AND A LEVEL 3 REGIONAL INTENSIVE CARE NURSERY. TECHNOLOGY AVAILABLE AT MMC INCLUDES: ROBOTIC ASSISTED SURGERY, PHILIPS HYBRID OPERATING ROOM WITH ALLURACLARITY TECHNOLOGY WHICH ALLOWS SURGEONS TO PERFORM A FULL RANGE OF ENDOVASCULAR, CONVENTIONAL SURGICAL AND HYBRID PROCEDURES WHILE USING LOWER RADIATION DOSES; AN EXPANDED EPILEPSY MONITORING UNIT; PHYSICIAN ORDER ENTRY INFORMATION TECHNOLOGY; DIGITAL MAMMOGRAPHY; STATE OF THE ART CARDIAC CATHETERIZATION AND ELCTROPHYSIOLOGY LABS; MINIMALLY INVASIVE OPERATING SUITES; VASCULAR ORS; INTERVENTIONAL RADIOLOGY LABS; AND IMAGING EQUIPMENT. MMC IS A TEACHING HOSPTIAL AND HOME TO SEVEN MEDICAL RESIDENCY PROGRAMS INCLUDING: AOA INTERNSHIP, AOA FAMILY PRACTICE, AOA EMERGENCY MEDICINE, AOA INTERNAL MEDICINE, ACGME INTERNAL MEDICINE, ACGME FAMILY MEDICINE, AND ACGME GENERAL SURGERY AS WELL AS A PHARM RESIDENCY AND AN EMS FELLOWHIP. THE CONEMAUGH SCHOOL OF NURSING PROVIDES A TWO-YEAR ACCREDITED PROGRAM APPROVED BY THE PENNSYLVANIA STATE BOARD OF NURSING WHICH IS NOTED FOR ITS HIGH JOB PLACEMENT WITHIN WEEKS OF GRADUATION AND LOW STUDENT-TO-FACULTY RATIOS. MMC ALSO OFFERS FIVE ALLIED HEALTH PROGRAMS AND AN ACCREDITED MEDICAL SKILLS LABORATORY, ONE OF ONLY 66 LEVEL 1 ACCREDITED SIMULATION LABORATORIES IN THE WORLD. THE MEDICAL SKILLS LAB HAS ADDED A MOTHER/CHILD BIRTHING SIMULATOR TO HELP TRAIN CLINICAL STAFF ON PROCEDURES INVOLVING THE BIRTH CANAL, EPIDURAL ACCESS AND C-SECTIONS.THE LEE CAMPUS OF MMC IS HOME TO NUMEROUS OUTPATIENT SERVICES AND SOME INPATIENT CARE INCLUDING THE TRANSITIONAL CARE UNIT AND THE CRICHTON REHABILITATION CENTER. CRICHTON IS THE ONLY INPATIENT REHABILITATION CENTER IN THE REGION TO RECEIVE ACCREDITATION FROM THE COMMISSION ON ACCREDITATION OF REHABILITATION FACILITIES (CARF). THE LEE CAMPUS ALSO HOUSES THE DIABETES INSTITUTE, IMAGING AND DIGITAL MAMOGRAPHY SERVICES AND THE LEE AMBULATORY SUGERY CENTER, WHICH WAS RECENTLY RECOGNIZED BY THE HOSPITAL ASSOCIATION OF PENNSYLVANIA FOR INNOVATIONS IN SURGICAL SAFETY. THE SLEEP DISORDERS CENTER IS ALSO LOCATED AT THE LEE CAMPUS. HOME SLEEP TESTING TECHNOLOGY HELPS DIAGNOSE PATIENTS FROM THE COMFORT OF THEIR OWN HOME. A LARGE COMMUNITY ROOM AT THE LEE CAMPUS IS AVAILABLE FOR PUBLIC USE AS WELL AS A LOCATION FOR SPIRITUAL NEEDS. MEETING ROOMS AT THE LEE CAMPUS ARE ALSO USED FOR AREA NON-PROFITS AND COMMUNITY GROUPS INCLUDING ORGANIZATIONS THAT HELP PEOPLE WITH DRUG AND ALCOHOL ADDICTION RECOVERY.
DLP MARQUETTE GENERAL HOSPITAL UPPER PENINSULA HEALTH SYSTEM MARQUETTE (UPHSM) EXTENDS MEDICAL STAFF PRIVILEGES TO QUALIFIED PHYSICIANS IN THE COMMUNITY AND IS A LEVEL II TRAUMA CENTER THAT PROVIDES EMERGENCY SERVICES TO ANYONE, REGARDLESS OF ABILITY TO PAY. AS A TEACHING HOSPITAL, UPHSM WORKS WITH UNIVERSITIES AND COMMUNITY COLLEGES THROUGHOUT THE STATE OF MICHIGAN AND MIDWEST IN TRAINING MEDICAL STUDENTS, FAMILY MEDICINE RESIDENTS, PHARMACISTS, NURSES, PHYSICAL AND OCCUPATIONAL THERAPISTS, NURSE ANESTHETISTS, RADIOGRAPHERS, SURGICAL TECHNICIANS, AND DIETICIANS. UPHSM OFFERS A VARIETY OF FREE AND LOW-COST CLASSES, SEMINARS AND OTHER PROGRAMS TO COMMUNITY MEMBERS. EXAMPLES INCLUDE BIRTHING AND PARENTING CLASSES, MANAGEMENT AND HEALTHY LIFESTYLE PROGRAMS, PRESENTATIONS ON SPECIFIC HEALTH TOPICS BY EMPLOYED AND GUEST HEALTH PRACTITIONERS, AND SUPPORT GROUPS. UPHSM ALSO PROVIDES THE MAJORITY OF FUNDING AND IS A PRIMARY PARTICIPANT IN ASK THE DOCTORS, A LIVE TV CALL-IN PROGRAM PRODUCED 17 TIMES EACH YEAR THAT PROVIDES LOCAL VIEWERS AN OPPORTUNITY TO CALL IN AND HAVE THEIR MEDICAL QUESTIONS ANSWERED BY A PANEL OF LOCAL DOCTORS.AT UPPER PENINSULA HEALTH SYSTEM - MARQUETTE, WE CONTINUE TO WORK DILIGENTLY ON IMPROVING THE HEALTH OF OUR COMMUNITIES. SERVING THE ENTIRE UPPER PENINSULA, WE IDENTIFIED A NEED TO INCREASE ACCESS TO SPECIALTY CARE IN OUR SECONDARY SERVICE AREAS. INCLUDING OUR 2015 ADDITIONS OF CLINICS FOR CARDIOVASCULAR SERVICES, CANCER CARE, ORTHOPAEDICS, NEUROLOGY AND NEUROSURGERY IN HOUGHTON, DICKINSON, SCHOOLCRAFT, DELTA AND CHIPPEWA COUNTIES.AS WE RECOGNIZE THE RISE OF SUBSTANCE ABUSE AND MENTAL HEALTH ISSUES IN OUR COMMUNITIES, SUCCESSFUL RECRUITMENT OF PROVIDERS SPECIALIZING IN THESE AREAS IS OUR TOP PRIORITY. IN 2015, WE REVAMPED OUR RECRUITING EFFORTS TO BE MORE STRATEGIC AND TAILORED TO TODAY'S DIGITAL WORLD. THESE STRATEGIES WILL ALLOW US TO BE MORE SUCCESSFUL AS WE MOVE FORWARD IN A VERY COMPETITIVE RECRUITING MARKET.TO HELP IMPROVE THE OVERALL HEALTH OF OUR COMMUNITIES, WE PROUDLY SPONSOR MANY FITNESS RELATED EVENTS. THESE EVENTS INCLUDE THE YMCA 5K, THE NOQUEMANON SKI MARATHON, THE ORE TO SHORE BIKE RACE AND MUCH MORE. THESE ARE ONLY A FEW EXAMPLES OF HOW WE STRIVE EVERYDAY TO SUPPORT OUR HOSPITAL'S MISSION - WHICH IS TO MAKE OUR COMMUNITIES HEALTHIER.MARIA PARHAM MEDICAL CENTERMARIA PARHAM HAS BEEN SERVING RESIDENTS OF VANCE, WARREN, FRANKLIN, AND GRANVILLE COUNTIES SINCE 1925. DELIVERING QUALITY HEALTH CARE CLOSE TO HOME WHILE WORKING TOWARD THE GOAL OF IMPROVING THE OVERALL HEALTH OF OUR COMMUNITIES ARE THE MOST IMPORTANT CONTRIBUTIONS WE MAKE TO THE COMMUNITIES WE SERVE. HIGHLIGHTS FOR 2015 INCLUDE RECEIVING COLLEGE OF AMERICAN PATHOLOGISTS (CAP) ACCREDITATION IN OUR LABORATORY, EARNING HOMECARE ELITE STATUS IN OUR HOME HEALTH SERVICES, AND BEING NAMED "MOST WIRED" HOSPITAL FOR ANOTHER CONSECUTIVE YEAR. HIGHLIGHTS FROM THE 2015 COMMUNITY BENEFIT REPORT INCLUDE: CAPITAL IMPROVEMENTS OF $4.7M, TAXES PAID OF $1.8M, ANNUAL PAYROLL OF $45.6M, AVERAGE NUMBER OF EMPLOYEES 707, AND $7.6M IN SERVICES TO INDIVIDUALS WITHOUT THE ABILITY TO PAY. IN 2015, MARIA PARHAM HAD A VERY SUCCESSFUL YEAR RECRUITING AN ADDITIONAL 20 PHYSICIANS AND MORE THAN 10 OTHER PROVIDERS TO OUR HIGHLY RESPECTED MEDICAL STAFF. HIGHLIGHTS IN RECRUITMENT INCLUDE THE ADDITION OF AN OB/GYN SPECIALIST AT PREMIER WOMEN'S HEALTH PROFESSIONALS AND ADDITIONS IN EMERGENCY MEDICINE AND SURGERY.RUTHERFORD REGIONAL HEALTH SYSTEMRUTHERFORD SPONSORED OR CONDUCTED A NUMBER OF COMMUNITY EVENTS AIMED AT PROMOTING HEALTH AND WELLNESS FOR PEOPLE OF ALL AGES. INCLUDED WERE:-THE BABY AND CHILDREN'S FAIR AND OPEN HOUSE IN WHICH EDUCATIONAL INFORMATION AND RESOURCES WERE DISTRIBUTED TO EXPECTANT PARENTS OR PARENTS OF NEWBORNS/TODDLERS;-THE HEALTHY GENERATIONS EXPO IN WHICH PEOPLE OF ALL AGES WERE INVITED TO LEARN HOW TO CARE FOR OR REHABILITATE THEMSELVES IF THEY SUFFER FROM INJURIES OR CONDITIONS PREVENTING THEM FROM EXERCISING;-THE PRIME OF LIFE FESTIVAL IN WHICH PROVIDERS AND CLINICIANS COUNSELED AND SCREENED ATTENDEES WHO WERE OVER THE AGE OF 55 FOR SIGNS OF CHRONIC DISEASE OR HIGH BLOOD PRESSURE, DIRECTING THOSE WITH ABNORMAL RESULTS TO AREA HEALTHCARE PROVIDERS; -THE CHANGE 4 LIFE EXPO IN WHICH THE HEALTH SYSTEM LED A COMMUNITY-WIDE EFFORT TO PROMOTE HEALTHY EATING AND ACTIVE LIVING;-THE RUTHERFORD BUSINESS EXPO DURING WHICH LOCAL EMPLOYERS WERE EDUCATED ON DISEASE MANAGEMENT PROGRAMS AND CLINICIANS WHO ARE AVAILABLE TO CONSULT WITH EMPLOYEE DESIRING TO PURSUE HEALTHIER LIFESTYLES;-SUPPORT GROUPS FOR THOSE WITH DIABETES, CANCER, OR SUFFERING FROM THE EFFECTS OF STROKE, ARE HELD ON A MONTHLY BASIS AT NO COST TO PARTICIPANTS;-CAMPS WERE HELD DURING THE SUMMER FOR CHILDREN SUFFERING FROM ASTHMA AND DIABETES TO EDUCATE PARTICIPANTS ABOUT HOW TO MANAGE THEIR CONDITIONS AND CONTINUE AN ACTIVE LIFESTYLE;-ALSO, VARIOUS COMMUNITY HEALTH FAIRS, AS WELL EDUCATIONAL SESSIONS WITH SCHOOL-AGE CHILDREN (I.E., ASTHMA, DANGERS OF SMOKING), WERE HELD THROUGHOUT THE COMMUNITY DURING WHICH RUTHERFORD REGIONAL HAD A SIGNIFICANT PRESENCE IN EDUCATING PARTICIPANTS AND DISSEMINATING INFORMATION ABOUT HEALTHY LIFESTYLES; -RUTHERFORD REGIONAL ALSO SPONSORED ALL ACTIVITIES COORDINATED THROUGH THE RUTHERFORD OUTDOOR COALITION, WHICH CONDUCTS RUNNING AND CYCLING EVENTS THROUGHOUT THE COMMUNITY, AS WELL AS THE LAKE LURE OLYMPIAD THAT FEATURED A NUMBER OF EVENTS AND ACTIVITIES GEARED TOWARD MOVING PEOPLE FROM INACTIVITY TO EXERCISING;-RUTHERFORD REGIONAL MEDICAL CENTER'S OCCUPATIONAL MEDICINE PROGRAM PROVIDES A VARIETY OF COST-EFFECTIVE HEALTHCARE SERVICES TO LOCAL BUSINESS AND INDUSTRY WITH THE GOAL OF ASSISTING EMPLOYERS WITH REDUCING WORKER'S COMPENSATION CLAIMS. THE RUTHERFORD REGIONAL AUXILIARY RAISED MONEY THROUGH FUNDRAISING PROJECTS SUCH AS $5 JEWELRY SALES AND UNIFORM SALES, AND THROUGH THE OPERATION OF THE GIFT SHOP. THE AUXILIARY'S SERVICE AREAS INCLUDE THE FRONT DESK, GIFT SHOP, INTENSIVE CARE WAITING, MESSENGER, OUTPATIENT SERVICES AND SURGERY WAITING. VOLUNTEERS ALSO SERVE IN FOOD SERVICES, THE PET THERAPY PROGRAM, WITH THE TOY CHEST GROUP, AT THE CANCER RESOURCE CENTER AND ONESOURCE (REHAB), AND AS TEEN VOLUNTEERS. A TOTAL OF 184 ADULT VOLUNTEERS VOLUNTEERED 19,142 HOURS AND A TOTAL OF 158 TEEN VOLUNTEERS VOLUNTEERED 18,317 HOURS WITH A COMBINED TOTAL OF 37,458 SERVICE HOURS IN 2015. THE SCHOOL OF CLINICAL PASTORAL EDUCATION OF RUTHERFORD REGIONAL MEDICAL CENTER IS ACCREDITED TO OFFER CPE LEVELS I & II BY THE ASSOCIATION FOR CLINICAL PASTORAL EDUCATION, INC (ACPE). CLINICAL PASTORAL EDUCATION WILL ENABLE YOU TO INTEGRATE FAITH, EXPERIENCE AND KNOWLEDGE FOR MORE EFFECTIVE MINISTRY. CPE IS PROFESSIONAL TRAINING FOR MINISTRY DESIGNED FOR SEMINARIANS, CLERGY AND LAITY OF DIVERSE CULTURES, ETHNIC GROUPS AND FAITH TRADITIONS. THE METHOD IS LEARNING BY DOING AND REFLECTING UNDER THE DIRECTION OF A CERTIFIED ACPE SUPERVISOR; INSTRUCTED BY AN INTERDISCIPLINARY ADJUNCT FACULTY IN A SUPPORTIVE COLLEGIAL GROUP.DLP HARRIS REGIONAL HOSPITAL AND DLP SWAIN COMMUNITY HOSPITALTHE HOSPITALS ARE DEDICATED TO SERVING THE COMMUNITY BY IMPROVING THE QUALITY OF LIFE OF THE COMMUNITY THROUGH BETTER HEALTH. THE HOSPITALS ARE COMMITTED TO PROVIDING QUALITY HEALTH CARE SERVICES IN A CARING ENVIRONMENT THAT FULFILLS THE NEEDS OF OUR PATIENTS, PHYSICIANS, EMPLOYERS, EMPLOYEES, AND COMMUNITY. THE HOSPITAL OPERATES AN EMERGENCY ROOM OPEN TO ALL PERSONS, WITHOUT REGARD TO THE ABILITY TO PAY. THE HOSPITAL USES ANY SURPLUS FUNDS TO IMPROVE THE QUALITY OF PATIENT CARE, EXPAND, OR IMPROVE ITS FACILITIES, AND ADVANCE ITS MEDICAL TRAINING, EDUCATION AND RESEARCH PROGRAMS. THE HOSPITAL'S BOARD OF DIRECTORS CONSISTS OF INDIVIDUALS REPRESENTING THE COMMUNITY. THE HOSPITAL MAINTAINS AN OPEN MEDICAL STAFF, WITH MEMBERSHIP AND PRIVILEGES AVAILABLE TO ALL QUALIFIED PHYSICIANS AND HEALTHCARE PROFESSIONALS. IN THESE AND OTHER RESPECTS, THE HOSPITALS ARE ORGANIZED AND OPERATED IN A MANNER THAT PROMOTES THE HEALTH OF THE COMMUNITY.TWIN COUNTY REGIONAL HOSPITALTHE TWIN COUNTY COALITION WAS ORGANIZED TO PROVIDE OPPORTUNITIES FOR PREVENTION, RECOVERY, AND SUPPORT FOR VARIOUS HEALTH ISSUES, PREVENTION, COMMUNITY EDUCATION AND MANY EARLY CHILDHOOD PROGRAMS.
PERSON MEMORIAL HOSPITAL PERSON MEMORIAL HOSPITAL (PMH) PROMOTES COMMUNITY HEALTH THROUGH A VARIETY OF VEHICLES AND CHANNELS. PMH MAINTAINS A LEGACY BOARD FOCUSED ON IDENTIFYING AND FINANCIALLY SUPPORTING COMMUNITY HEALTH INITIATIVES NECESSARY TO ENHANCE THE HEALTH OF ITS COMMUNITY. IN ADDITION, PMH CONTINUALLY RAISES COMMUNITY AWARENESS AROUND BREAST CANCER, HEART DISEASE, STROKE AND OTHER COMMON DISEASE STATES THROUGH COMMUNITY EVENTS AND PREVENTION EDUCATION. FINALLY, TO FURTHER EXTEND THE ORGANIZATION'S REACH, PMH IS AN ACTIVE MEMBER OF THE NORTH CAROLINA HOSPITAL ASSOCIATION (NCHA) WORKING DILIGENTLY TO IMPROVE NC'S ABILITY TO ENHANCE THE QUALITY OF CARE DELIVERED AS WELL AS THEIR RESPONSE TO ACTS OF BIOTERRORISM, DISEASE OUTBREAKS, EMERGING INFECTIONS AND OTHER PUBLIC HEALTH EMERGENCIES.AFFILIATED HEALTH CARE SYSTEM ROLES: PART VI, LINE 6:DQN DOES NOT DIRECTLY CONTROL OR MANAGE ANY HOSPITALS; HOWEVER, THE ORGANIZATION HAS A 3% OWNERSHIP IN A PARTNERSHIP THAT MANAGES THE HOSPITAL FACILITIES LISTED IN PART V, SECTION A.LIST OF ALL STATES WHICH ORGANIZATION FILES A COMMUNITY BENEFIT REPORT:PART VI, LINE 7NORTH CAROLINA, VIRGINIA
Schedule H (Form 990) 2015
Additional Data


Software ID:  
Software Version:  
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
DUKE QUALITY NETWORK INC
 
Employer identification number

46-1340679
Part I
Questions Regarding Compensation
Yes
No
1a
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.
b
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 .........
1b
 
 
2
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? ..
2
 
 
3
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.
4
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:
a
Receive a severance payment or change-of-control payment? ................
4a
 
No
b
Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........
4b
 
No
c
Participate in, or receive payment from, an equity-based compensation arrangement? .........
4c
 
No
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.
5
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:
a
The organization? ...........................
5a
 
No
b
Any related organization?
5b
 
No
If "Yes," on line 5a or 5b, describe in Part III.
6
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:
a
The organization?
6a
 
No
b
Any related organization? .........................
6b
 
No
If "Yes," on line 6a or 6b, describe in Part III.
7
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 ............
7
 
No
8
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 .............................
8
 
No
9
If "Yes" on line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................
9
 
 
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50053T
Schedule J (Form 990) 2015

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
(i) Base compensation (ii) Bonus & incentive compensation (iii) Other reportable compensation
1WILLIAM J FULKERSON JR MDDIRECTOR/PRESIDENT (i)

(ii)
0
-------------
787,915
0
-------------
1,322,190
0
-------------
18,000
0
-------------
32,443
0
-------------
7,069
0
-------------
2,167,617
0
-------------
0
2PAUL L LINDIADIRECTOR/VICE PRESIDENT (i)

(ii)
0
-------------
297,555
0
-------------
30,502
0
-------------
0
0
-------------
32,443
0
-------------
65,190
0
-------------
425,690
0
-------------
0
3KENNETH C MORRISDIRECTOR/TREASURER (i)

(ii)
0
-------------
710,180
0
-------------
413,949
0
-------------
69,259
0
-------------
32,443
0
-------------
10,925
0
-------------
1,236,756
0
-------------
0
4CHRISTY M GUDAITISSECRETARY (i)

(ii)
0
-------------
299,032
0
-------------
0
0
-------------
17,500
0
-------------
32,443
0
-------------
6,835
0
-------------
355,810
0
-------------
0
Schedule J (Form 990) 2015

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
Schedule J (Form 990) 2015
Additional Data


Software ID:  
Software Version:  
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
DUKE QUALITY NETWORK INC
 
Employer identification number

46-1340679
Return Reference Explanation
FORM 990, PART V, LINE 3B THE ORGANIZATION DID NOT HAVE UNRELATED BUSINESS GROSS INCOME OF $1,000 OR MORE DURING THE FISCAL YEAR ENDED JUNE 30, 2016. AS A RESULT, FORM 990-T IS NOT REQUIRED FOR THE FISCAL YEAR ENDED JUNE 30, 2016.
FORM 990, PART VI, SECTION A, LINE 2 KENNETH C. MORRIS AND WILLIAM J. FULKERSON JR. MD, ARE OFFICERS OF DUKE UNIVERSITY HEALTH SYSTEM, INC. PAUL L. LINDIA WAS AN EMPLOYEE OF DUKE UNIVERSITY HEALTH SYSTEM, INC. DURING DUKE QUALITY NETWORK, INC.'S FISCAL YEAR ENDED JUNE 30, 2016. DUKE QUALITY NETWORK, INC. DIRECTORS KENNETH C. MORRIS AND WILLIAM J. FULKERSON JR. MD, ARE DIRECTORS OF DURHAM CASUALTY COMPANY, LTD. DUKE QUALITY NETWORK, INC. DIRECTORS KENNETH C. MORRIS, WILLIAM J. FULKERSON JR. MD, AND PAUL L. LINDIA ARE OFFICERS AND DIRECTORS OF HEALTH SYSTEM MEDICAL STRATEGIES, INC.
FORM 990, PART VI, SECTION A, LINE 7A APPOINTMENT TO THE BOARD OF DIRECTORS OF DUKE QUALITY NETWORK, INC. IS CONTROLLED BY DUKE UNIVERSITY HEALTH SYSTEM, INC.
FORM 990, PART VI, SECTION A, LINE 7B THE ANNUAL BUDGET FOR DUKE QUALITY NETWORK, INC. IS APPROVED BY DUKE UNIVERSITY HEALTH SYSTEM, INC. MANAGEMENT AND BOARD.
FORM 990, PART VI, SECTION B, LINE 11 AFTER STAFF PREPARATION AND MANAGEMENT REVIEW, DUKE QUALITY NETWORK, INC. FORM 990 IS PROVIDED TO THE BOARD OF DIRECTORS FOR REVIEW AND COMMENT. BOARD LEVEL COMMENT AND DISCUSSION ARE INCORPORATED INTO THE FORM AS APPROPRIATE PRIOR TO FILING.
FORM 990, PART VI, SECTION B, LINE 12C DUKE QUALITY NETWORK, INC. MONITORS AND ENFORCES COMPLIANCE RELATED TO CONFLICT OF INTEREST VIA DUKE QUALITY NETWORK, INC.'S FORM 990 CONFLICT OF INTEREST QUESTIONNAIRE. THIS QUESTIONNAIRE IS COMPLETE ANNUALLY.
FORM 990, PART VI, SECTION C, LINE 18 DUKE QUALITY NETWORK, INC.'S FORM 990 IS AVAILABLE TO THE PUBLIC ON WWW.GUIDESTAR.ORG. GUIDESTAR INDEPENDENTLY POSTS TAX-EXEMPT ORGANIZATIONS' FORM 990'S ON THEIR WEBSITE, OBTAINED FROM THE INTERNAL REVENUE SERVICE.
FORM 990, PART VI, SECTION C, LINE 19 DUKE QUALITY NETWORK, INC. GOVERNING DOCUMENTS (ARTICLES OF INCORPORATION AND ANY SUBSEQUENT AMENDMENTS OR RESTATEMENTS) ARE AVAILABLE TO THE PUBLIC ON THE NORTH CAROLINA SECRETARY OF STATE WEBSITE. DUKE QUALITY NETWORK, INC. IS INCLUDED IN CONSOLIDATED, INDEPENDENT AUDITED FINANCIAL STATEMENTS OF DUKE UNIVERSITY HEALTH SYSTEM, INC. WHICH ARE AVAILABLE TO THE PUBLIC ON THE ELECTRONIC MUNICIPAL MARKET ACCESS WEBSITE. NAVIGATE TO HTTP://EMMA.MSRB.ORG AND ENTER "DUKE UNIVERSITY HEALTH SYSTEM" IN THE MUNI SEARCH BOX. CHOOSE SERIES 2016, ACCEPT THE TERMS OF THE WEBSITE, AND CLICK ON "CONTINUING DISCLOSURE".
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:  
SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service
Related Organizations and Unrelated Partnerships
MediumBulletComplete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
MediumBulletAttach 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
DUKE QUALITY NETWORK INC
 
Employer identification number

46-1340679
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?
Yes No
(1)AMER ASSOC FOR GIFTED CHILDREN - 56-1686219
324 BLACKWELL STREET STE 850

DURHAM,NC27701
SUPPORT NC 501(C)(3) 11 TYPE 1 DUKE UNIVERSITY
 
 
No
(2)ASSOCIATED HEALTH SVCS INC
324 BLACKWELL STREET STE 850

DURHAM,NC27701
56-1845329
HEALTHCARE NC 501(C)(3) 11 TYPE 1 DUKE UNIVERSITY HEALTH SYSTEM INC
 
 
No
(3)DU SPECIAL VENTURES FUND INC
280 S MANGUM STREET STE 210

DURHAM,NC27701
56-1465177
INVESTMENTS NC 501(C)(3) 11 TYPE 1 DUKE UNIVERSITY
 
 
No
(4)DUKE ALUMNI ASSOCIATION INC
324 BLACKWELL STREET STE 850

DURHAM,NC27701
56-1594088
SUPPORT NC 501(C)(3) 11 TYPE 1 DUKE UNIVERSITY
 
 
No
(5)DUKE CORPORATE EDUCATION
310 BLACKWELL ST

DURHAM,NC27701
42-1672476
EDUCATION NC 501(C)(3) 11 TYPE 1 DUKE UNIVERSITY
 
 
No
(6)DUKE GIFT PROPERTIES INC
324 BLACKWELL STREET STE 850

DURHAM,NC27701
57-1211078
SUPPORT NC 501(C)(3) 11 TYPE 1 DUKE UNIVERSITY
 
 
No
(7)DUKE GLOBAL INC
324 BLACKWELL STREET STE 850

DURHAM,NC27701
61-1588319
SUPPORT NC 501(C)(3) 11 TYPE 1 DUKE UNIVERSITY
 
 
No
(8)DUKE INTEGRATED NETWORK INC
324 BLACKWELL STREET STE 850

DURHAM,NC27701
46-3129771
SUPPORT NC 501(C)(3) 11 TYPE 1 DUKE UNIVERSITY HEALTH SYSTEM INC
 
 
No
(9)DUKE MEDICINE GLOBAL SUPP CORP- 61-1593721
324 BLACKWELL STREET STE 850

DURHAM,NC27701
SUPPORT NC 501(C)(3) 11 TYPE 1 DUKE UNIVERSITY
 
 
No
(10)DUKE UNIV AFFILIATED PHYSICIANS
324 BLACKWELL STREET STE 850

DURHAM,NC27701
56-1902501
SUPPORT NC 501(C)(3) 11 TYPE 1 DUKE UNIVERSITY HEALTH SYSTEM INC
 
 
No
(11)DUKE SCHOLARLY EXHIBITS INC
324 BLACKWELL STREET STE 850

DURHAM,NC27701
56-1701245
SUPPORT NC 501(C)(3) 11 TYPE 1 DUKE UNIVERSITY
 
 
No
(12)DUKE UNIV HEALTH SYSTEM INC
324 BLACKWELL STREET STE 850

DURHAM,NC27701
56-2070036
HEALTHCARE NC 501(C)(3) LINE 3 DUKE UNIVERSITY
 
 
No
(13)DUKE UNIV PHILANTHROPIES INC
324 BLACKWELL STREET STE 850

DURHAM,NC27701
57-1211099
SUPPORT NC 501(C)(3) 11 TYPE 1 DUKE UNIVERSITY
 
 
No
(14)DUKE UNIV SCH OF MED RESEARCH FDN 56-2247203
324 BLACKWELL STREET STE 850

DURHAM,NC27701
SUPPORT NC 501(C)(3) 11 TYPE 1 DUKE UNIVERSITY
 
 
No
(15)DUKE UNIVERSITY
324 BLACKWELL STREET STE 850

DURHAM,NC27701
56-0532129
EDUCATION NC 501(C)(3) LINE 2 N/A
 
No
(16)DUMAC INC
280 S MANGUM STREET STE 210

DURHAM,NC27701
90-0754895
SUPPORT NC 501(C)(3) 11 TYPE 1 DUKE UNIVERSITY
 
 
No
(17)DURHAM ASSET MGMT COMPANY INC
324 BLACKWELL STREET STE 850

DURHAM,NC27701
56-1757238
SUPPORT NC 501(C)(3) 11 TYPE 1 DUKE UNIVERSITY
 
 
No
(18)DURHAM REALTY INC
324 BLACKWELL STREET STE 850

DURHAM,NC27701
56-1917936
SUPPORT NC 501(C)(3) 11 TYPE 1 DUKE UNIVERSITY
 
 
No
(19)GOTHIC CORPORATION
280 S MANGUM STREET STE 210

DURHAM,NC27701
56-1776668
INVESTMENTS NC 501(C)(3) 11 TYPE 1 DUKE UNIVERSITY
 
 
No
(20)GOTHIC HSP CORPORATION
280 S MANGUM STREET STE 210

DURHAM,NC27701
27-1325761
INVESTMENTS NC 501(C)(3) 11 TYPE 1 DUKE UNIVERSITY HEALTH SYSTEM INC
 
 
No
(21)HIGH POINT REALTY ASSOC INC
324 BLACKWELL STREET STE 850

DURHAM,NC27701
56-1917939
SUPPORT NC 501(C)(3) 11 TYPE 1 DUKE UNIVERSITY
 
 
No
(22)INNOVATIONS IN HEALTHCARE INC
324 BLACKWELL STREET STE 850

DURHAM,NC27701
32-0358709
SUPPORT NC 501(C)(3) 11 TYPE 1 DUKE UNIVERSITY
 
 
No
(23)RUTH K BROAD BIOMED RES FDN
324 BLACKWELL STREET STE 850

DURHAM,NC27701
65-0045051
SUPPORT NC 501(C)(3) 11 TYPE 1 DUKE UNIVERSITY
 
 
No
(24)THE CTR FOR DOCUMENTARY STUDIES
1317 PETTIGREW STREET

DURHAM,NC27705
56-1655039
SUPPORT NC 501(C)(3) 11 TYPE 1 DUKE UNIVERSITY
 
 
No
(25)THE LORD FDN OF NORTH CAROLINA
324 BLACKWELL STREET STE 850

DURHAM,NC27701
56-1415423
SUPPORT NC 501(C)(3) 11 TYPE 1 DUKE UNIVERSITY
 
 
No
(26)DUKE JANJUN SERVICES INC
324 BLACKWELL STREET STE 850

DURHAM,NC27701
47-1150667
SUPPORT NC 501(C)(3) 11 TYPE 1 DUKE UNIVERSITY
 
 
No
(27)DUKE JULDEC SERVICES INC
324 BLACKWELL STREET STE 850

DURHAM,NC27701
47-1143245
SUPPORT NC 501(C)(3) 11 TYPE 1 DUKE UNIVERSITY
 
 
No
(28)DUKE ALLMO SERVICES INC
324 BLACKWELL STREET STE 850

DURHAM,NC27701
47-1133466
SUPPORT NC 501(C)(3) 11 TYPE 1 DUKE UNIVERSITY
 
 
No
(29)DUKE INVESTMENT EDUCATION INC
324 BLACKWELL STREET STE 850

DURHAM,NC27701
47-5555092
SUPPORT NC 501(C)(3) 11 TYPE 1 DUKE UNIVERSITY
 
 
No
(30)FSB REALTY INC
324 BLACKWELL STREET STE 850

DURHAM,NC27701
81-1309454
SUPPORT NC 501(C)(3) 11 TYPE 1 DUKE UNIVERSITY
 
 
No
(31)DUKE AFFILIATIONS NETWORK INC
324 BLACKWELL STREET STE 850

DURHAM,NC27701
81-2623775
SUPPORT NC 501(C)(3) 11 TYPE 1 DUKE UNIVERSITY HEALTH SYSTEM INC
 
 
No
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2015
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



(e)
Predominant income(related, unrelated, excluded from tax under sections 512-514)

(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?



(k)
Percentage
ownership


Yes No Yes No
(1) BLACKWELL PARTNERS LLC - SERIES A - 20-8075455

280 S MANGUM ST STE 210
DURHAM,NC27701
INVESTMENTS DE N/A
N/A       No     No  
(2) CANYON BLUE INV FD 27-0186996

AVE OF STARS
LA,CA90067
INVESTMENTS DE N/A
N/A       No     No  
(3) CD FUND LP - 27-0130641

MCKINNEY AVE
DALLAS,TX75201
INVESTMENTS TX N/A
N/A       No     No  
(4) LIQUID REALTY PTR 05-0537755

LINDA MESA
DANVILLE,CA94526
INVESTMENTS DE N/A
N/A       No     No  
(5) LYRICAL BLUE RL PT 27-2994514

32 N DEAN ST
ENGLEWOOD,NJ07631
INVESTMENTS DE N/A
N/A       No     No  
(6) LYRICAL-BLUE RGNT 45-3626577

32 N DEAN ST
ENGLEWOOD,NJ07631
INVESTMENTS DE N/A
N/A       No     No  
(7) OCTAVIAN BLUE FD 27-2408711

5TH AVENUE
NY,NY10151
INVESTMENTS DE N/A
N/A       No     No  
(8) SBER LUCKY STRIKE 20-3891303

310 BLACKWELL ST
DURHAM,NC27701
REAL ESTATE NC N/A
N/A       No     No  
(9) TAIYO BLUE FUND LP 80-0613746

5300 CARILLON POINT
KIRKLAND,WA98033
INVESTMENTS DE N/A
N/A       No     No  
(10) MANGUM II LLC - 46-5135858

280 S MANGUM STREET STE 210
DURHAM,NC27701
INVESTMENTS NC N/A
N/A       No     No  
(11) LS INVESTOR LLC 20-3891381

310 BLACKWELL ST
DURHAM,NC27701
REAL ESTATE NC N/A
N/A       No     No  
(12) DILWEG BLUE PF LP 47-1225569

5310 S ALSTON AVE STE 210
DURHAM,NC27713
INVESTMENTS DE N/A
N/A       No     No  
(13) LYRICAL BLUE RL PT IV 47-2172270

32 N DEAN ST
ENGLEWOOD,NJ07631
INVESTMENTS DE N/A
N/A       No     No  
(14) LYRICAL BLUE CHP PT 35-2503856

32 N DEAN ST
ENGLEWOOD,NJ07631
INVESTMENTS DE N/A
N/A       No     No  
(15) LIQUID RLT PTR II TE - 20-4362819

10 MARKET ST 769 CAMANA BAY
GRAND CAYMAN   KY1-9006
CJ
INVESTMENTS DE N/A
N/A       No     No  
(16) STRATUS CAPITAL PARTNERS C LP

50 LOTHIAN ROAD FESTIVAL SQUARE
EDINBURGH   EH3 9WJ
UK
INVESTMENTS UK N/A
N/A       No     No  
(17) ALTOS HYBRID D LLC - 47-3996176

2882 SAND HILL ROAD SUITE 100
MENLO PARK,CA94025
INVESTMENTS DE N/A
N/A       No     No  
(18) GPE HOLDCO LLC - 47-5652832

2000 AVE OF THE STARS 11TH FL
LOS ANGELES,CA90067
INVESTMENTS DE N/A
N/A       No     No  
(19) BLACKWELL PARTNERS LLC - SERIES C - 81-1264533

280 S MANGUM ST STE 210
DURHAM,NC27701
INVESTMENTS DE N/A
N/A       No     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
(h)
Percentage
ownership
(i)
Section 512(b)(13) controlled entity?
Yes No
(1) DUKE CE LS INC

310 BLACKWELL STREET
DURHAM,NC27701
20-2004016
REAL ESTATE NC N/A
C         No
(2) DUKE CE (SEA) PRIVATE LIMITED

1 RAFFLES PLACE TOWER 2
SINGAPORE   048616
SN
SUPPORT SN N/A
C         No
(3) DUKE CORP EDU INDIA PRIVATE

ACADEMIC BLOCK NEW CAMPUS
VASTRAPUR,AHMEDABAD380015
IN
42-1672476
CONSULTING IN N/A
C         No
(4) DUKE CORPORATE EDUCATION LIM

165 FLEET STREET
LONDON   EC4A 2DY
UK
42-1672476
EDUCATION CONSULTING UK N/A
C         No
(5) DUKE CORPORATE EDUCATION RSA

GROUND FLOOR TWICKEHNHAM BLDG
BRYANSTON,JOHANNESBURG02021
SF
42-1672476
CONSULTING SF N/A
C         No
(6) DUKE GLOBAL CONSULTING (KUNSHAN)

1666 WEI CHEN NAN RD
KUNSHAN PR,KUNSHAN215300
CH
CONSULTING CH N/A
C         No
(7) DUKE MEDICAL STRATEGIES INC

2200 WEST MAIN STREET STE 920
DURHAM,NC27705
56-1993799
HEALTHCARE NC N/A
C         No
(8) DUKE MEDICINE ASIA PTE LTD

5 SHENTON WAY 07-00 UIC BLD
SING   0688
SN
MEDICAL RESEARCH SN N/A
C         No
(9) DURHAM CASUALTY COMPANY LTD

AON HOUSE 30 WOODBOURNE AVE
PEMBROKE   HM 08
BD
98-0113277
INSURANCE BD N/A
C         No
(10) DUSVF EUROPEAN LP

7 CAVENDISH SQUARE
LONDON   W1G 0PE
UK
98-0346042
INVESTMENTS UK N/A
C         No
(11) GOTHIC INTERNATIONAL LTD

113 S CHURCH STREET QUEENSGATE HOU
GRAND CAYMAN   KY1-1108
CJ
INVESTMENTS CJ N/A
C         No
(12) MARATHON BLUE CAYMAN FUND

89 NEXUS WAY PO BOX 31106
GRAND CAYMAN   KY1-1205
CJ
INVESTMENTS CJ N/A
C         No
(13) GHI HOLDINGS MAURITIUS

9TH FL ORANGE TOWER CYBERCITY
EBENE    
MP
INVESTMENTS MP N/A
C         No
(14) GHI ERP LTD

9TH FL ORANGE TOWER CYBERCITY
EBENE    
MP
INVESTMENTS MP N/A
C         No
(15) GHI HSP LTD

9TH FL ORANGE TOWER CYBERCITY
EBENE    
MP
INVESTMENTS MP N/A
C         No
(16) GHI JBD LTD

9TH FL ORANGE TOWER CYBERCITY
EBENE    
MP
INVESTMENTS MP N/A
C         No
(17) GHI LTP LTD

9TH FL ORANGE TOWER CYBERCITY
EBENE    
MP
INVESTMENTS MP N/A
C         No
(18) QUORUM FUND LIMITED

PO BOX 1043 GEORGE TOWN
GRAND CAYMAN   KY1-1102
CJ
INVESTMENTS CJ N/A
C         No
(19) MCP PRIVATE CAPITAL (FEEDER) FUND I LP

6 RUE GABRIEL LIPPMAN
LUXEMBORG   L-5365
LU
INVESTMENTS LU N/A
C         No
(20) DUKE INDIA SERVICES PRIVATE LIMITED

302 PRIDE ELITE 10 MUSEUM ROAD
BANGALORE,KARNATAKA560001
IN
MEDICAL RESEARCH IN N/A
C         No
(21) CPP OFFICE PORTFOLIO (FEEDER) LP

50 LOTHIAN ROAD FESTIVAL SQUARE
EDINBURGH   EH3 9WJ
UK
98-1152490
REAL ESTATE UK N/A
C         No
(22) HEALTH SYSTEM MEDICAL STRATEGIES INC

324 BLACKWELL STREET STE 850
DURHAM,NC27701
56-2222444
HEALTHCARE NC N/A
C         No
Schedule R (Form 990) 2015
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
No
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 .....................
1a
 
No
b Gift, grant, or capital contribution to related organization(s) ............................
1b
 
No
c Gift, grant, or capital contribution from related organization(s) ............................
1c
 
No
d Loans or loan guarantees to or for related organization(s) ............................
1d
 
No
e Loans or loan guarantees by related organization(s) ............................
1e
 
No
f Dividends from related organization(s) ............................
1f
 
No
g Sale of assets to related organization(s) ............................
1g
 
No
h Purchase of assets from related organization(s) ............................
1h
 
No
i Exchange of assets with related organization(s) ............................
1i
 
No
j Lease of facilities, equipment, or other assets to related organization(s) .......................
1j
 
No
k Lease of facilities, equipment, or other assets from related organization(s) ......................
1k
 
No
l Performance of services or membership or fundraising solicitations for related organization(s) .....................
1l
 
No
m Performance of services or membership or fundraising solicitations by related organization(s) .................
1m
 
No
n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) ...................
1n
 
No
o Sharing of paid employees with related organization(s) ............................
1o
 
No
p Reimbursement paid to related organization(s) for expenses ............................
1p
 
No
q Reimbursement paid by related organization(s) for expenses ............................
1q
 
No
r Other transfer of cash or property to related organization(s) ............................
1r
 
No
s Other transfer of cash or property from related organization(s) ............................
1s
 
No
2
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
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)
(d)
Predominant income (related, unrelated, excluded from tax under sections 512-514)

(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?
(k)
Percentage
ownership


Yes No Yes No Yes No






























Schedule R (Form 990) 2015
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


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