TY 2015 Form 990

(A) Name and Title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)
(1) FARAD ALI...................................................................... DIRECTOR	2.00 ................. 0.00	X	0	0
(2) NANCY CATHERINE ANDREWS MD...................................................................... DIRECTOR	3.00 ................. 56.10	X	966,113	88,273
(3) LESLIE E BAINS...................................................................... DIRECTOR	1.00 ................. 0.00	X	0	0
(4) JACK O BOVENDER JR...................................................................... DIRECTOR	3.00 ................. 6.00	X	0	0
(5) RICHARD H BRODHEAD...................................................................... DIRECTOR	10.00 ................. 50.20	X	1,182,780	220,107
(6) JAMES F GOODMON...................................................................... DIRECTOR	2.00 ................. 0.00	X	0	0
(7) THOMAS M GORRIE...................................................................... DIRECTOR	3.00 ................. 9.10	X	0	0
(8) WILLIAM HAWKINS...................................................................... DIRECTOR	1.00 ................. 4.00	X	0	0
(9) JOHN M KANE...................................................................... DIRECTOR	1.00 ................. 0.00	X	0	0
(10) MARY KLOTMAN MD...................................................................... DIRECTOR	12.00 ................. 40.20	X	373,247	46,671
(11) MICHAEL MARSICANO...................................................................... DIRECTOR	2.00 ................. 4.00	X	0	0
(12) JOHN H MCARTHUR...................................................................... DIRECTOR	0.20 ................. 0.00	X	0	0
(13) LLOYD B MORGAN...................................................................... DIRECTOR	2.00 ................. 0.00	X	0	0
(14) MARK F NEWMAN...................................................................... DIRECTOR	1.00 ................. 50.20	X	234,572	48,845
(15) THEODORE NICK PAPPAS MD...................................................................... DIRECTOR	2.00 ................. 40.00	X	294,641	46,074
(16) DAVID M RUBENSTEIN...................................................................... DIRECTOR	1.00 ................. 16.10	X	0	0
(17) STEVEN SCOTT MD...................................................................... DIRECTOR	4.00 ................. 2.00	X	0	0

(A) Name and Title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)	(F) Estimated amount of other compensation from the organization and related organizations
(18) SUSAN M STALNECKER........................................................................ DIRECTOR	2.00 .......................0.00	X					0	0	0
(19) PETER VAN ETTEN........................................................................ DIRECTOR	1.00 .......................0.00	X					0	0	0
(20) G RICHARD WAGONER JR........................................................................ DIRECTOR	2.00 .......................0.00	X					0	0	0
(21) A EUGENE WASHINGTON MD........................................................................ PRESIDENT & CEO DUHS/DIRECTOR	33.00 .......................33.10	X	X				0	1,138,182	91,368
(22) JIM WHITEHURST........................................................................ DIRECTOR	1.00 .......................0.00	X					0	0	0
(23) MONTE D BROWN MD........................................................................ VP FOR ADMINISTRATION/SECRETARY	60.00 .......................0.10		X				657,427	0	48,437
(24) WILLIAM J FULKERSON JR MD........................................................................ EXECUTIVE VP, DUHS	60.00 .......................0.60		X				2,128,105	0	37,419
(25) KENNETH C MORRIS........................................................................ SVP, CFO, TREASURER	80.00 .......................0.90		X				1,193,388	0	41,487
(26) MARY ANN FUCHS........................................................................ VP-PATIENT CARE/CHIEF NURSE EXEC	60.00 .......................0.00			X			418,354	0	38,035
(27) KATHLEEN GALBRAITH........................................................................ PRESIDENT, DUKE REGIONAL HOSPITAL	65.00 .......................0.10			X			494,981	0	48,549
(28) KEVIN W SOWERS........................................................................ PRESIDENT, DUKE UNIVERSITY HOSPITAL	50.00 .......................0.00			X			682,473	0	42,803
(29) DAVID W ZAAS MD........................................................................ PRESIDENT, DUKE RALEIGH HOSPITAL	60.00 .......................0.00			X			518,912	0	41,944
(30) SANDRA DANOFF........................................................................ SVP, STRATEGIC PLANNING, BD, NS	80.00 .......................0.10				X		1,198,578	0	37,775
(31) JEFFREY M FERRANTI........................................................................ VP, CIO, DHTS ADMINISTRATION	44.50 .......................5.50				X		516,463	62,544	46,643
(32) THOMAS A OWENS MD........................................................................ CHIEF MEDICAL OFFICER	60.00 .......................0.10				X		608,407	0	43,510
(33) ANDREW T PICKENS........................................................................ PHYSICIAN	40.00 .......................0.00				X		461,019	0	43,925
(34) STEPHEN R SMITH........................................................................ CHIEF HR OFFICER	40.00 .......................0.00				X		472,945	0	45,236
(35) VICTOR J DZAU MD........................................................................ FORMER DIRECTOR/OFFICER	0.00 .......................40.00					X	0	240,729	31,565
(36) PAUL NEWMAN........................................................................ FORMER KEY EMPLOYEE	0.00 .......................41.00					X	0	255,861	37,050
(37) KERRY R WATSON........................................................................ FORMER KEY EMPLOYEE	40.00 .......................0.10					X	24,525	0	20,201

(A) Name and business address	(B) Description of services	(C) Compensation
PRIVATE DIAGNOSTIC CLINIC PLLC DUMC 3070 DURHAM,NC27710	PHYSICIAN SERVICES	102,246,182
DELOITTE LLP PO BOX 844708 DALLAS,TX752844708	CONSULTING SERVICES	17,687,076
ROBINS & MORTON GROUP 400 SHADES CREEK PKW BIRMINGHAM,AL35209	CONSTRUCTION SERVICE	13,029,781
PRISM HEALTHCARE PARTNERS LTD 190 SOUTH LA SALLE STREET CHICAGO,IL60603	CONSULTING SERVICES	11,820,363
ARAMARK SERVICES INC 25271 NETWORK PLACE CHICAGO,IL606731252	HEALTHCARE SERVICES	10,524,887
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 279

- TIN:

SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service

Public Charity Status and Public Support

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

Attach to Form 990 or Form 990-EZ.
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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 UNIVERSITY HEALTH SYSTEM INC

Employer identification number

56-2070036

Part I

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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


Total

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

Cat. No. 11285F

Schedule A (Form 990 or 990-EZ) 2015

Page 2

Part II

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

Section A. Public Support

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

Section B. Total Support

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

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

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

Section C. Computation of Public Support Percentage

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

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

16a

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

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

17a

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

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

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

Schedule A (Form 990 or 990-EZ) 2015

Page 3

Part III

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

Section A. Public Support

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

Section B. Total Support

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

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

Section C. Computation of Public Support Percentage

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

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

Section D. Computation of Investment Income Percentage

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

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

19a

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

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

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

Schedule A (Form 990 or 990-EZ) 2015

Page 4

Part IV

Supporting Organizations

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

Section A. All Supporting Organizations

Yes

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

10a

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

10a

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

10b

Schedule A (Form 990 or 990-EZ) 2015

Page 5

Part IV

Supporting Organizations (continued)

Yes

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

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

11a

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

11b

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

11c

Section B. Type I Supporting Organizations

Yes

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

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

Section C. Type II Supporting Organizations

Yes

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

Section D. All Type III Supporting Organizations

Yes

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

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

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

Section E. Type III Functionally-Integrated Supporting Organizations

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

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

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

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

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

Yes

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

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

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

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

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

Schedule A (Form 990 or 990-EZ) 2015

Page 6

Part V

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

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

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

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

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

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

Schedule A (Form 990 or 990-EZ) 2015

Page 7

Part V

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

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

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

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

Schedule A (Form 990 or 990-EZ) 2015

Page 8

Part VI

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

Facts And Circumstances Test

Return Reference	Explanation

Schedule A (Form 990 or 990-EZ) 2015

Additional Data

Software ID:
Software Version:

- TIN:

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

Department of the Treasury
Internal Revenue Service

Schedule of Contributors

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

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

OMB No. 1545-0047

2015

Name of the organization

DUKE UNIVERSITY HEALTH SYSTEM INC

Employer identification number

56-2070036

Organization type (check one):

Filers of:

Section:

Form 990 or 990-EZ

501(c)( ) (enter number) organization

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

527 political organization

Form 990-PF

501(c)(3) exempt private foundation

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

501(c)(3) taxable private foundation

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

General Rule

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

Special Rules

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

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

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

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

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

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

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

Name of organization DUKE UNIVERSITY HEALTH SYSTEM INC

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

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

Page 3

Name of organization DUKE UNIVERSITY HEALTH SYSTEM INC		Employer identification number 56-2070036

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

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

Page 4


Name of organization DUKE UNIVERSITY HEALTH SYSTEM INC			Employer identification number 56-2070036
Part III Exclusively religious, charitable, etc., contributions to organizations described in section 501(c)(7), (8), or (10) that total more than $1,000 for the year from any one contributor. Complete columns (a) through (e) and the following line entry. For organizations completing Part III, enter the total of exclusively religious, charitable, etc., contributions of $1,000 or less for the year. (Enter this information once. See instructions.) $ Use duplicate copies of Part III if additional space is needed.

(a)
No.from Part I

(b) Purpose of gift

(d) Description of how gift is held

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

(a)
No.from Part I

(b) Purpose of gift

(d) Description of how gift is held

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

(a)
No.from Part I

(b) Purpose of gift

(d) Description of how gift is held

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

(a)
No.from Part I

(b) Purpose of gift

(d) Description of how gift is held

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

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

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE C
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Political Campaign and Lobbying Activities

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

Complete if the organization is described below. SchCMd Bullet

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

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

OMB No. 1545-0047

2015

Open to Public
Inspection

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

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

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

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

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

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

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

Name of the organization

DUKE UNIVERSITY HEALTH SYSTEM INC

Employer identification number

56-2070036

Part I-A

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

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

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

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

Part I-B

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

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

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

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

Yes No

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

Yes No

If "Yes," describe in Part IV.

Part I-C

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

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

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

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

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

Yes No

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

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

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

Cat. No. 50084S

Schedule C (Form 990 or 990-EZ) 2015

Page 2

Part II-A

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

A Check SchCMd Bullet

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

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

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

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

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

2a	Lobbying nontaxable amount

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

c	Total lobbying expenditures

d	Grassroots nontaxable amount

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

f	Grassroots lobbying expenditures

Schedule C (Form 990 or 990-EZ) 2015

Page 3

Part II-B

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

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

(a)

Yes

(b)

Amount

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

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

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

Yes

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

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

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

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

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

Yes

121,357

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

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

Yes

191,606

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

312,963

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

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

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

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

Part III-A

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

Yes

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

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

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

Part III-B

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

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

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

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

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

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

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

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

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

Part IV

Supplemental Information

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

Return Reference	Explanation
PART II-B, LINE 1:	DUKE UNIVERSITY HEALTH SYSTEM, INC. EMPLOYS STAFF WHO PERFORM SOME LOBBYING ACTIVITIES AS PART OF THEIR JOB RESPONSIBILITIES. THESE SAME EMPLOYEES HAVE AND SOME SENIOR LEADERS MAY HAVE DIRECT CONTACT WITH LEGISLATORS, THEIR STAFFS, AND GOVERNMENT OFFICIALS. DUKE UNIVERSITY HEALTH SYSTEM, INC. PAYS MEMBERSHIP DUES TO OTHER ORGANIZATIONS. PER THE MEMBERSHIP DUES INVOICES, SOME OF THESE ORGANIZATIONS PROVIDE A DISCLOSURE OF LOBBYING PERCENTAGE OF THE DUES RECEIVED.

Return Reference

Explanation

PART II-B, LINE 1:

DUKE UNIVERSITY HEALTH SYSTEM, INC. EMPLOYS STAFF WHO PERFORM SOME LOBBYING ACTIVITIES AS PART OF THEIR JOB RESPONSIBILITIES. THESE SAME EMPLOYEES HAVE AND SOME SENIOR LEADERS MAY HAVE DIRECT CONTACT WITH LEGISLATORS, THEIR STAFFS, AND GOVERNMENT OFFICIALS. DUKE UNIVERSITY HEALTH SYSTEM, INC. PAYS MEMBERSHIP DUES TO OTHER ORGANIZATIONS. PER THE MEMBERSHIP DUES INVOICES, SOME OF THESE ORGANIZATIONS PROVIDE A DISCLOSURE OF LOBBYING PERCENTAGE OF THE DUES RECEIVED.

Schedule C (Form 990 or 990EZ) 2015

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

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

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

OMB No. 1545-0047

2015

Open to Public Inspection

Name of the organization

DUKE UNIVERSITY HEALTH SYSTEM INC

Employer identification number

56-2070036

Part I

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

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

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

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

Yes No

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

Yes No

Part II

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

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

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

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

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


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

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

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

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

Yes No

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

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

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

Yes No

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

Part III

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

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

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

(i)

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

(ii)

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

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

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

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

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

Cat. No. 52283D

Schedule D (Form 990) 2015

Page 2

Part III

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

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

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

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

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

Yes No

Part IV

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

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

Yes No


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

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

Yes No

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

Part V

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

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

1a	Beginning of year balance ....	57,578,816	59,083,195	46,947,089	50,036,781	53,700,068
b	Contributions ...	7,276,856	4,849,436	13,413,723	8,190,873	11,126,530
c	Net investment earnings, gains, and losses	-1,590,780	-29,888	2,988,057	1,409,233	-758,496
d	Grants or scholarships ...
e	Other expenditures for facilities and programs ...	5,448,607	6,323,927	4,265,674	12,689,798	14,031,321
f	Administrative expenses ....
g	End of year balance ......	57,816,285	57,578,816	59,083,195	46,947,089	50,036,781

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

Board designated or quasi-endowment SchDMd Bullet

Permanent endowment SchDMd Bullet

43.480 %

Temporarily restricted endowment SchDMd Bullet

56.520 %

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

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

Yes

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

3a(i)

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

3a(ii)

Yes

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

Yes

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 ...	27,304,086		27,304,086
b	Buildings	1,771,686,215	755,019,020	1,016,667,195
c	Leasehold improvements
d	Equipment ...	731,212,122	507,508,350	223,703,772
e	Other ...	449,368,386	283,886,665	165,481,721
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..				1,433,156,774

Schedule D (Form 990) 2015

Page 3

Part VII

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

(a) Description of security or category (including name of security)	(b)Book value	(c)Method of valuation: Cost or end-of-year market value
(1)Financial derivatives
(2)Closely-held equity interests
(3)Other (A) HEDGED STRATEGIES	522,428,607	F
(B) SHORT-TERM INVESTMENTS	224,888,307	F
(C) PRIVATE CAPITAL	393,947,506	F
(D) REAL ASSETS	265,065,489	F
(E) FIXED INCOME	239,297,820	F
(F) EQUITIES	219,584,630	F
(G) OTHER INVESTMENTS	531,511,506	F
(G)
(H)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)	2,396,723,865

Part VIII

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

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

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

Part IX

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

(a) Description				(b) Book value

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

Part X

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

1.(a) Description of liability	(b) Book value
(1) Federal income taxes
INTERCOMPANY PAYABLE	524,283,969
INTEREST PAYABLE	10,773,449
PROFESSIONAL LIABILITY COSTS	7,272,021
POST RETIREMENT BENEFIT OBLIGATION	471,107,000
CAPITAL LEASE OBLIGATION	123,417,219
DERIVATIVE INSTRUMENTS	117,187,395
OTHER NON-CURRENT LIABILITIES	63,016,935
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	1,317,057,988
2. Liability for uncertain tax positions. In Part XIII, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC 740). Check here if the text of the footnote has been provided in Part XIII

Schedule D (Form 990) 2015

Page 4

Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total revenue, gains, and other support per audited financial statements .......		1
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

PART V, LINE 4:

THE INTENDED USE FOR THE ORGANIZATION'S ENDOWMENT: FUNDS SUPPORT CAPITAL PURCHASES, OFFSET OPERATING COSTS, IMPROVE PATIENT SAFETY, AND SUPPORT THE NEEDS OF PATIENTS AND FAMILIES.

PART X, LINE 2:

DUKE UNIVERSITY HEALTH SYSTEM, INC. ADOPTED THE REQUIREMENTS OF FIN 48 AND CONSIDERED ITS TAX POSITIONS. BASED ON THAT ANALYSIS, THE PROVISIONS OF FIN 48 ARE DEEMED IMMATERIAL TO THE DUKE UNIVERSITY HEALTH SYSTEM, INC. FINANCIAL STATEMENTS AND THEREFORE NO FIN 48 SPECIFIC DISCLOSURES ARE MADE IN THE AUDITED FINANCIAL STATEMENTS OF DUKE UNIVERSITY HEALTH SYSTEM, INC. AND ITS AFFILIATES FOR FISCAL YEAR ENDED JUNE 30, 2016.

Schedule D (Form 990) 2015

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE F(Form 990)

Department of the Treasury
Internal Revenue Service

Statement of Activities Outside the United States

Complete if the organization answered "Yes" to Form 990,Part IV, line 14b, 15, or 16. Right pointing arrow large image

Attach to Form 990. Right pointing arrow large image

See separate instructions. Right pointing arrow large image

Information about Schedule F (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 UNIVERSITY HEALTH SYSTEM INC

Employer identification number

56-2070036

Part I

General Information on Activities Outside the United States. Complete if the organization answered "Yes" to Form 990, Part IV, line 14b.

For grantmakers.Does the organization maintain records to substantiate the amount of its grants and

other assistance, the grantees’ eligibility for the grants or assistance, and the selection criteria used

to award the grants or assistance? . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

For grantmakers. Describe in Part V the organization’s procedures for monitoring the use of its grants and other assistance outside the United States.

Activites per Region. (The following Part I, line 3 table can be duplicated if additional space is needed.)

(a) Region		(b) Number of offices in the region	(c) Number of employees, agents, and independent contractors in region	(d) Activities conducted in region (by type) (e.g., fundraising, program services, investments, grants to recipients located in the region)	(f) Total expenditures for and investments in region
	CENTRAL AMERICA AND THE CARIBBEAN	0	0	SEMINAR	35,424
	EAST ASIA AND THE PACIFIC	0	0	SEMINAR	10,895
	EUROPE	0	0	SEMINAR	10,327
	MIDDLE EAST AND NORTH AFRICA	0	0	SEMINAR	1,362
	SUB-SAHARAN AFRICA	0	0	SEMINAR	5,458
	NORTH AMERICA	0	0	SEMINAR	19,015
	SOUTH AMERICA	0	0	SEMINAR	203
	CENTRAL AMERICA AND THE CARIBBEAN	0	0	INVESTMENTS	190,296,686
	CENTRAL AMERICA AND THE CARIBBEAN	0	0	GRANTMAKING	8,385
	SOUTH AMERICA	0	0	GRANTMAKING	125,000
	SUB-SAHARAN AFRICA	0	0	GRANTMAKING	25,386






3a	Sub-total .....	0	0		190,379,370
b	Total from continuation sheets to Part I ...	0	0		158,771
c	Totals (add lines 3a and 3b)	0	0		190,538,141

For Paperwork Reduction Act Notice, see the Instructions for Form 990.Cat. No. 50082W Schedule F (Form 990) 2015

Schedule F (Form 990) 2015

Page 2

Part II

Grants and Other Assistance to Organizations or Entities Outside the United States. Complete if the organization answered "Yes" to Form 990, Part IV, line 15, for any recipient who received more than $5,000. Part II can be duplicated if additional space is needed.

(a)(c) Region	(b)(d) Purpose of grant	(e) Amount of cash grant	(g) Amount of non-cash assistance	(h) Description of non-cash assistance	(i) Method of valuation (book, FMV, appraisal, other)
CENTRAL AMERICA AND THE CARIBBEAN	GENERAL SUPPORT	0	8,385	MEDICAL EQUIPMENT	FMV
SOUTH AMERICA	GENERAL SUPPORT	0	125,000	MEDICAL EQUIPMENT	FMV
SUB-SAHARAN AFRICA	GENERAL SUPPORT	0	20,201	MEDICAL EQUIPMENT	FMV

2	Enter total number of recipient organizations listed above that are recognized as charities by the foreign country, recognized as tax-exempt by the IRS, or for which the grantee or counsel has provided a section 501(c)(3) equivalency letter .......	2
3	Enter total number of other organizations or entities .......................	2

Schedule F (Form 990) 2015

Schedule F (Form 990) 2015Page 3

Part III

Grants and Other Assistance to Individuals Outside the United States. Complete if the organization answered "Yes" to Form 990, Part IV, line 16.

Part III can be duplicated if additional space is needed.

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

Schedule F (Form 990) 2015

Page 4

Part IV

Foreign Forms

Schedule F (Form 990) 2015

Page 5

Part V

Supplemental Information
Provide the information required by Part I, line 2 (monitoring of funds); Part I, line 3, column (f) (accounting method; amounts of investments vs. expenditures per region); Part II, line 1 (accounting method); Part III (accounting method); and Part III, column (c) (estimated number of recipients), as applicable. Also complete this part to provide any additional information (see instructions).

ReturnReference	Explanation
PART I, LINE 2:	DUKE UNIVERSITY HEALTH SYSTEM, INC. PERIODICALLY APPROVES NONCASH ASSISTANCE AND TRANSFERS MEDICAL EQUIPMENT AND SUPPLIES TO ORGANIZATIONS OUTSIDE THE UNITED STATES, USUALLY IN RESPONSE TO NATURAL DISASTERS. THE ORGANIZATIONS AWARDED THE ASSISTANCE MUST MONITOR THE APPROPRIATE USE OF THE ASSISTANCE IN THE ORDINARY COURSE OF BUSINESS.

Schedule F (Form 990) 2015

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE G (Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Supplemental Information Regarding
Fundraising or Gaming Activities

Complete if the organization answered "Yes" on Form 990, Part IV, lines 17, 18, or 19, or if the organization entered more than $15,000 on Form 990-EZ, line 6a. right arrow

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

Information about Schedule G (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 UNIVERSITY HEALTH SYSTEM INC

Employer identification number

56-2070036

Part I

Fundraising Activities. Complete if the organization answered "Yes" on Form 990, Part IV, line 17.

Form 990-EZ filers are not required to complete this part.

Indicate whether the organization raised funds through any of the following activities. Check all that apply.

a	Mail solicitations	e	Solicitation of non-government grants
b	Internet and email solicitations	f	Solicitation of government grants
c	Phone solicitations	g	Special fundraising events
d	In-person solicitations

Did the organization have a written or oral agreement with any individual (including officers, directors, trustees

or key employees listed in Form 990, Part VII) or entity in connection with professional fundraising services?

YesNo

If "Yes," list the ten highest paid individuals or entities (fundraisers) pursuant to agreements under which the fundraiser is
to be compensated at least $5,000 by the organization.

(i) Name and address of individual or entity (fundraiser)	(iii) Did fundraiser have custody or control of contributions?
	Yes	No










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

List all states in which the organization is registered or licensed to solicit contributions or has been notified it is exempt from registration or licensing.

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

Cat. No. 50083H

Schedule G (Form 990 or 990-EZ) 2015

Page 2

Part II

Fundraising Events. Complete if the organization answered "Yes" on Form 990, Part IV, line 18, or reported more than $15,000 of fundraising event contributions and gross income on Form 990-EZ, lines 1 and 6b. List events with gross receipts greater than $5,000.

		(a) Event #1 GALA (event type)	(d) Total events (add col. (a) through col. (c))
1	Gross receipts . . . . .	124,474	124,474
2	Less: Contributions . . . .	51,066	51,066
3	Gross income (line 1 minus line 2) . . . . . .	73,408	73,408

4	Cash prizes . . . . .
5	Noncash prizes . . . .	33,768	33,768
6	Rent/facility costs . . . .
7	Food and beverages . . .	21,605	21,605
8	Entertainment . . . .	11,613	11,613
9	Other direct expenses . . .	11,868	11,868
10	Direct expense summary. Add lines 4 through 9 in column (d) . . . . . . . . . .		78,854
11	Net income summary. Subtract line 10 from line 3, column (d). . . . . . . . . .		-5,446

Part III

Gaming. Complete if the organization answered "Yes" on Form 990, Part IV, line 19, or reported more than $15,000 on Form 990-EZ, line 6a.

		(a) Bingo	(b) Pull tabs/Instant bingo/progressive bingo	(c) Other gaming	(d) Total gaming (add col.(a) through col.(c))
1	Gross revenue . . . . .

2	Cash prizes . . . . .
3	Noncash prizes . . . .
4	Rent/facility costs . . . .
5	Other direct expenses . . .	11,868	11,868

Volunteer labor . . . .

	Yes %
	No

	Yes %
	No

	Yes %
	No

Direct expense summary. Add lines 2 through 5 in column (d) . . . . . . . . . . right arrow

Net gaming income summary. Subtract line 7 from line 1, column (d). . . . . . . . . right arrow

Enter the state(s) in which the organization conducts gaming activities:

Is the organization licensed to conduct gaming activities in each of these states? . . . . . . . .

YesNo

If "No," explain:

10a

Were any of the organization's gaming licenses revoked, suspended or terminated during the tax year? . . .

YesNo

If "Yes," explain:

Schedule G (Form 990 or 990-EZ) 2015

Page 3

Does the organization conduct gaming activities with nonmembers? . . . . . . . . . . .

YesNo

Is the organization a grantor, beneficiary or trustee of a trust or a member of a partnership or other entity

formed to administer charitable gaming? . . . . . . . . . . . . . . . . .

YesNo

Indicate the percentage of gaming activity conducted in:

The organization's facility . . . . . . . . . . . . . . . . . .

13a

An outside facility . . . . . . . . . . . . . . . . . . . .

13b

Enter the name and address of the person who prepares the organization's gaming/special events books and records:

Name

Address

15a

Does the organization have a contract with a third party from whom the organization receives gaming

revenue? . . . . . . . . . . . . . . . . . . . . . . . .

YesNo

If "Yes," enter the amount of gaming revenue received by the organization right arrow

$ and the

amount of gaming revenue retained by the third party right arrow

$ .

If "Yes," enter name and address of the third party:

Name

Address

Gaming manager information:

Name

Gaming manager compensation right arrow

Description of services provided right arrow

Director/officer Employee Independent contractor

Mandatory distributions:

Is the organization required under state law to make charitable distributions from the gaming proceeds to

retain the state gaming license? . . . . . . . . . . . . . . . . . . .

YesNo

Enter the amount of distributions required under state law distributed to other exempt organizations or spent

in the organization's own exempt activities during the tax year right arrow

Part IV

Supplemental Information. Provide the explanations required by Part I, line 2b, columns (iii) and (v); and Part III, lines 9, 9b, 10b, 15b, 15c, 16, and 17b, as applicable. Also complete this part to provide any additional information (see instructions).

Return Reference

Explanation

FORM 990, SCHEDULE G, PART I, LINE 2B

DUKE UNIVERSITY HEALTH SYSTEM, INC. SUPPORTS THE FUNDRAISING ACTIVITIES PERFORMED BY EMPLOYEES OF DUKE UNIVERSITY. SUCH ACTIVITIES ARE DESIGNED TO DEVELOP SUPPORT FOR BOTH THE UNIVERSITY AND THE DUKE UNIVERSITY HEALTH SYSTEM, INC.'S EDUCATIONAL, RESEARCH AND HEALTHCARE PURPOSES. DUKE UNIVERSITY RECEIVES AND DIRECTS THE CONTRIBUTIONS AS APPROPRIATE TO DUKE UNIVERSITY HEALTH SYSTEM, INC. THE AGREEMENT BETWEEN DUKE UNIVERSITY AND DUKE UNIVERSITY HEALTH SYSTEM, INC. DOES NOT DISTINGUISH BETWEEN PAYMENTS FOR PROFESSIONAL FUNDRAISING SERVICES AND EXPENSE PAYMENTS OR REIMBURSEMENTS.

Schedule G (Form 990 or 990-EZ) 2015

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE H
(Form 990)

Department of the Treasury
Internal Revenue Service

Hospitals

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

Attach to Form 990.
MediumBullet

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

OMB No. 1545-0047

2015

Open to Public Inspection

Name of the organization

DUKE UNIVERSITY HEALTH SYSTEM INC

Employer identification number

56-2070036

Part I

Financial Assistance and Certain Other Community Benefits at Cost

Yes

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

Yes

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

Yes

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

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

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

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

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

Yes

100% 150% 200% Other %

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

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

Yes

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

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

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

Yes

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

Yes

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

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

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

Yes

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

Yes

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

Financial Assistance and Certain Other Community Benefits at Cost

Financial Assistance and Means-Tested Government Programs		(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) . . .	81,503,714		81,503,714	2.970 %
b	Medicaid (from Worksheet 3, column a) . . . . .	86,398,287		86,398,287	3.150 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) . .
d	Total Financial Assistance and Means-Tested Government Programs . . . . .	167,902,001		167,902,001	6.120 %
Other Benefits
e	Community health improvement services and community benefit operations (from Worksheet 4).
f	Health professions education (from Worksheet 5) . . .	77,207,718	14,372,392	62,835,326	2.290 %
g	Subsidized health services (from Worksheet 6) . . . .
h	Research (from Worksheet 7) .
i	Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .	11,592,329		11,592,329	0.420 %
j	Total. Other Benefits . .	88,800,047	14,372,392	74,427,655	2.710 %
k	Total. Add lines 7d and 7j .	256,702,048	14,372,392	242,329,656	8.830 %

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
2	Economic development
3	Community support
4	Environmental improvements
5	Leadership development and training for community members
6	Coalition building
7	Community health improvement advocacy
8	Workforce development
9	Other
10	Total

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

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

Yes

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

19,250,745

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

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

Section B. Medicare

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

535,717,278

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

613,567,452

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

-77,850,174

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

Cost accounting system Cost to charge ratio Other

Section C. Collection Practices

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

Yes

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

Yes

Part IV

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

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

Schedule H (Form 990) 2015

Page

Part VFacility Information

Section A. Hospital Facilities (list in order of size from largest to smallest—see instructions) How many hospital facilities did the organization operate during the tax year?3 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)								Facility reporting group
1	DUKE UNIVERSITY HOSPITAL 2301 ERWIN ROAD PRIMARY CAMPUS DURHAM,NC27710 HTTP://WWW.DUKEHEALTH.ORG	X	X	X	X	X	X	A
2	DUKE RALEIGH HOSPITAL 3400 WAKE FOREST ROAD PRIMARY CAMPUS RALEIGH,NC27609 HTTP://WWW.DUKEHEALTH.ORG	X	X				X
3	DUKE REGIONAL HOSPITAL 3643 ROXBORO ROAD DURHAM,NC27704 HTTP://WWW.DUKEHEALTH.ORG	X	X				X	A

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)

	DUKE UNIVERSITYDUKE REGIONAL HOSPITALS
Name of hospital facility or letter of facility reporting group

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

Yes

Community Health Needs Assessment

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

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

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

Yes

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

A definition of the community served by the hospital facility

Demographics of the community

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

How data was obtained

The significant health needs of the community

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

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

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

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

Other (describe in Section C)

Indicate the tax year the hospital facility last conducted a CHNA: 20 15

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

Yes

6 a

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

Yes

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. ............................

Yes

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

Yes

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

Hospital facility’s website (list url): HTTP://WWW.DUKEHEALTH.ORG

Other website (list url): HTTP://WWW.HEALTHYDURHAM.ORG

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

Other (describe in Section C)

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

Yes

Indicate the tax year the hospital facility last adopted an implementation strategy: 20 15

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

Yes

If "Yes" (list url): HTTP://WWW.DUKEHEALTH.ORG

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

10b

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

12a

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

12a

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

12b

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

Schedule H (Form 990) 2015

Page 5

Part VFacility Information (continued)

Financial Assistance Policy (FAP)

	DUKE UNIVERSITYDUKE REGIONAL HOSPITALS
Name of hospital facility or letter of facility reporting group

Yes

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

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

Yes

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

Federal poverty guidelines (FPG), with FPG family income limit for eligibility for free care of 200.000000000000% and FPG family income limit for eligibility for discounted care of 300.000000000000%

Income level other than FPG (describe in Section C)

Asset level

Medical indigency

Insurance status

Underinsurance discount

Residency

Other (describe in Section C)

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

Yes

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

Yes

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

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

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

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

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

Other (describe in Section C)

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

Yes

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

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

HTTP://WWW.DUKEHEALTH.ORG

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

HTTP://WWW.DUKEHEALTH.ORG

A plain language summary of the FAP was widely available on a website (list url):
HTTP://WWW.DUKEHEALTH.ORG

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

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

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

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

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

Other (describe in Section C)

Billing and Collections

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

Yes

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

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

None of these actions or other similar actions were permitted

Schedule H (Form 990) 2015

Page 6

Part VFacility Information (continued)

	DUKE UNIVERSITYDUKE REGIONAL HOSPITALS
Name of hospital facility or letter of facility reporting group

Yes

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

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

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

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

Notified individuals of the financial assistance policy on admission

Notified individuals of the financial assistance policy prior to discharge

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

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

Other (describe in Section C)

None of these efforts were made

Policy Relating to Emergency Medical Care

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

Yes

If "No," indicate why:

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

The hospital facility’s policy was not in writing

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

Other (describe in Section C)

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

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

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

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

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

Other (describe in Section C)

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

If "Yes," explain in Section C.

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

Yes

If "Yes," explain in Section C.

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)

	DUKE RALEIGH 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):

Yes

Community Health Needs Assessment

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

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

Yes

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

A definition of the community served by the hospital facility

Demographics of the community

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

How data was obtained

The significant health needs of the community

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

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

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

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

Other (describe in Section C)

Indicate the tax year the hospital facility last conducted a CHNA: 20 15

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..................................

Yes

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. ............................

Yes

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

Yes

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

Hospital facility’s website (list url): HTTP://WWW.DUKEHEALTH.ORG

Other website (list url): HTTP://WWW.HEALTHYDURHAM.ORG

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

Other (describe in Section C)

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

Yes

Indicate the tax year the hospital facility last adopted an implementation strategy: 20 15

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

Yes

If "Yes" (list url): HTTP://WWW.DUKEHEALTH.ORG

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

10b

12a

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

12a

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

12b

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

Schedule H (Form 990) 2015

Page 5

Part VFacility Information (continued)

Financial Assistance Policy (FAP)

	DUKE RALEIGH HOSPITAL
Name of hospital facility or letter of facility reporting group

Yes

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

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

Yes

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

Federal poverty guidelines (FPG), with FPG family income limit for eligibility for free care of 200.000000000000% and FPG family income limit for eligibility for discounted care of 300.000000000000%

Income level other than FPG (describe in Section C)

Asset level

Medical indigency

Insurance status

Underinsurance discount

Residency

Other (describe in Section C)

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

Yes

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

Yes

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

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

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

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

Other (describe in Section C)

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

Yes

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

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

HTTP://WWW.DUKEHEALTH.ORG

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

HTTP://WWW.DUKEHEALTH.ORG

A plain language summary of the FAP was widely available on a website (list url):
HTTP://WWW.DUKEHEALTH.ORG

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

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

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

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

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

Other (describe in Section C)

Billing and Collections

Yes

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

None of these actions or other similar actions were permitted

Schedule H (Form 990) 2015

Page 6

Part VFacility Information (continued)

	DUKE RALEIGH HOSPITAL
Name of hospital facility or letter of facility reporting group

Yes

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

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

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

Notified individuals of the financial assistance policy on admission

Notified individuals of the financial assistance policy prior to discharge

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

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

Other (describe in Section C)

None of these efforts were made

Policy Relating to Emergency Medical Care

Yes

If "No," indicate why:

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

The hospital facility’s policy was not in writing

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

Other (describe in Section C)

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

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

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

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

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

Other (describe in Section C)

If "Yes," explain in Section C.

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

Yes

If "Yes," explain in Section C.

Schedule H (Form 990) 2015

Page 7

Part V

Facility Information (continued)

Section C. Supplemental Information for Part V, Section B. Provide descriptions required for Part V, Section B, lines 2, 3j, 5, 6a, 6b, 7d, 11, 13b, 13h, 15e, 16i, 18d, 19d, 20e, 21c, 21d, 22d, 23, and 24. If applicable, provide separate descriptions for each hospital facility in a facility reporting group, designated by facility reporting group letter and hospital facility line number from Part V, Section A (“A, 1,” “A, 4,” “B, 2,” “B, 3,” etc.) and name of hospital facility.
Form and Line Reference	Explanation
NOTE: THIS SCHEDULE H CONTAINS REFERENCES TO DUKE AND DUKE HEALTH WHICH ARE	MEANT TO ENCOMPASS FOR THE PURPOSES OF THIS SCHEDULE DUKE UNIVERSITY HEALTH SYSTEM (DUHS), DUKE UNIVERSITY SCHOOL OF MEDICINE, AND DUKE UNIVERSITY SCHOOL OF NURSING. PART V, SECTION B:GROUP A - FACILITY 1 - DUKE UNIVERSITY HOSPITALPART V, SECTION B, LINE 5: DUKE UNIVERSITY HOSPITAL ("DUH") COLLABORATED WITH THE PARTNERSHIP FOR A HEALTHY DURHAM (THE STATE CERTIFIED HEALTHY CAROLINIANS GROUP) AND THE DURHAM COUNTY HEALTH DEPARTMENT ON THE 2014 DURHAM COUNTY COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA). THE ASSESSMENT PROCESS INCLUDED 354 CITIZEN SURVEYS FROM RANDOMLY SELECTED HOUSEHOLDS AND 8 COMMUNITY LISTENING SESSIONS WITH 205 COMMUNITY MEMBERS. REPRESENTATIVES FROM DUH AND DUKE REGIONAL HOSPITAL ("DRH") PARTICIPATED AS MEMBERS ON THE COMMUNITY HEALTH ASSESSMENT TEAM ALONG WITH REPRESENTATIVES FROM OTHER UNIVERSITIES, LOCAL GOVERNMENT, SCHOOLS, NON-PROFIT ORGANIZATIONS, AND BUSINESSES. THE COMMUNITY HEALTH ASSESSMENT TEAM WORKED TO DIRECT THE ACTIVITIES OF THE ASSESSMENT AND PROVIDE WRITTEN CONTENT AND EXPERTISE ON ISSUES OF INTEREST. THIS JOINT CHNA AND RELATED IMPLEMENTATION PLAN WAS ADOPTED BY THE DUHS BOARD OF DIRECTORS AND PUBLISHED ON THE DUKE HEALTH WEBSITE IN FISCAL YEAR 2016 (TAX YEAR 2015).GROUP A - FACILITY 1 - DUKE UNIVERSITY HOSPITALPART V, SECTION B, LINE 6A: DUKE REGIONAL HOSPITAL ("DRH")GROUP A - FACILITY 1 - DUKE UNIVERSITY HOSPITALPART V, SECTION B, LINE 6B: THE PARTNERSHIP FOR A HEALTHY DURHAM AND THE DURHAM COUNTY HEALTH DEPARTMENTGROUP A - FACILITY 1 - DUKE UNIVERSITY HOSPITALPART V, SECTION B, LINE 7A: THE CHNA IS AVAILABLE ON THE WEBSITE BY NAVIGATING TO WWW.DUKEHEALTH.ORG, CLICK ON "PATIENTS & VISITORS", THEN "FINANCIAL ASSISTANCE", THEN "COMMUNITY HEALTH NEEDS ASSESSMENT; CLICK THE LINK FOR "DETAILS OF OUR COMMUNITY INVOLVEMENT CAN BE FOUND HERE; AND THEN CLICK ON "COMMUNITY HEALTH."GROUP A - FACILITY 1 - DUKE UNIVERSITY HOSPITALPART V, SECTION B, LINE 10A: THE IMPLEMENTATION STRATEGY AND PROGRESS REPORTS ARE AVAILABLE ON THE WEBSITE BY NAVIGATING TO HTTP://WWW.DUKEHEALTH.ORG, CLICK ON "PATIENTS & VISITORS", THEN "FINANCIAL ASSISTANCE", THEN "COMMUNITY HEALTH NEEDS ASSESSMENT; CLICK THE LINK FOR "DETAILS OF OUR COMMUNITY INVOLVEMENT CAN BE FOUND HERE; AND THEN CLICK ON "COMMUNITY HEALTH." CHOOSE ONE OF THE LINKS FOR THE DUKE UNIVERSITY HOSPITAL PROGRESS REPORT AND IMPLEMENTATION PLAN. GROUP A - FACILITY 1 - DUKE UNIVERSITY HOSPITALPART V, SECTION B, LINE 11: THE ASSESSMENT IDENTIFIED SIX HEALTH PRIORITIES FOR 2015 - 2017: 1. OBESITY AND CHRONIC ILLNESS 2. ACCESS TO MEDICAL AND DENTAL CARE 3. MENTAL HEALTH AND SUBSTANCE ABUSE 4. HIV AND SEXUALLY TRANSMITTED INFECTIONS 5. POVERTY 6. EDUCATIONACTIONS TAKEN TO ADDRESS THE SIGNIFICANT HEALTH NEEDS IDENTIFIED IN THE CHNA ARE AS FOLLOWS:1. OBESITY AND CHRONIC ILLNESS INITIATIVES:FOUR OF THE 10 LEADING CAUSES OF DEATH IN NORTH CAROLINA ARE RELATED TO OBESITY: HEART DISEASE, TYPE 2 DIABETES, STROKE AND SOME KINDS OF CANCER. OVERWEIGHT AND OBESITY WERE THE SECOND LEADING CAUSES OF PREVENTABLE DEATH IN NORTH CAROLINA IN 2010. OBESITY RATES CONTINUE TO RISE ACROSS ALL AGES, GENDERS AND RACIAL/ETHNIC GROUPS IN DURHAM COUNTY. THE MOST RECENT COMBINED OBESITY AND OVERWEIGHT RATES ARE: ADULTS, 65%; DURHAM PUBLIC SCHOOL HIGH SCHOOL STUDENTS, 32%, AND ENTERING KINDERGARTENERS, 19%. DIABETES IS THE 7TH LEADING CAUSE OF DEATH IN DURHAM COUNTY AND 8% OF ADULTS HAVE DIABETES. KOHL'S BULL CITY FIT IS A COMMUNITY-BASED WELLNESS PROGRAM AND IS PART OF THE LARGER DUKE CHILDREN'S HEALTHY LIFESTYLES PROGRAM. THE HEALTHY LIFESTYLES PROGRAM SEEKS TO ADDRESS WEIGHT-RELATED HEALTH PROBLEMS FOR CHILDREN BY OFFERING CARING PROVIDERS, FAMILY-CENTERED TREATMENT PROGRAMS, HIGHLY TRAINED EDUCATORS AND RESEARCHERS, AND STRONG COMMUNITY COLLABORATIONS. KOHL'S BULL CITY FIT HELPS IN THIS EFFORT BY OFFERING FREE EVENING AND WEEKEND ACTIVITY SESSIONS FOR THE LARGER COMMUNITY. THESE SESSIONS COVER VARIOUS THEMES THAT ENCOURAGE AND PROMOTE ACTIVE LIVING, SUCH AS FITNESS GAMES, SPORT LESSONS, EXERCISE ROUTINES, SWIMMING, COOKING, AND GARDENING. EACH ACTIVITY IS FACILITATED WITH THE SUPPORT OF ENERGETIC STAFF AND VOLUNTEERS TO CREATE A POSITIVE AND FUN ENVIRONMENT FOR ALL. KOHL'S BULL CITY FIT EMPOWERS THE WHOLE FAMILY TO INCREASE KNOWLEDGE AND PRACTICE OF PHYSICAL ACTIVITY AND HEALTHY EATING; ADDRESS CURRENT WEIGHT-RELATED ILLNESS AND PREVENT CHRONIC DISEASE THROUGH INCREASED ACTIVITY LEVELS; IMPROVE QUALITY OF LIFE BY PROMOTING HEALTHY BEHAVIORS; INCREASE CONFIDENCE, SUPPORT POSITIVE CHANGE, AND BUILD A LIFELONG COMMITMENT TO A HEALTHY LIFESTYLE. PARTICIPANTS INCLUDE: DURHAM PARKS AND RECREATION; DURHAM CITY GOVERNMENT; DURHAM COUNTY DEPARTMENT OF PUBLIC HEALTH; EAST DURHAM CHILDREN'S INITIATIVE; LINCOLN COMMUNITY HEALTH CENTER; COMMUNITY NUTRITION PARTNERSHIP; VEGGIE VAN; BLUE POINTE YOGA; DURHAM PUBLIC SCHOOLS; PARTNERSHIP FOR A HEALTHY DURHAM; DUKE SERVICE LEARNING; DUKE FAMILY MEDICINE; DUKE CHILDREN'S HOSPITAL AND THE UNC SCHOOL OF SOCIAL WORK.DUKE UNIVERSITY HOSPITAL (DUH) ALSO SUPPORTS INITIATIVES THROUGH THE NEIGHBORHOOD CLINICS, SCHOOL-BASED HEALTH CENTERS, JUST FOR US AND THE DUKE OUTPATIENT CLINIC THAT TARGET CHRONIC ILLNESS.IN FY16 DUH IDENTIFIED INCREASING RATES OF NON ALCOHOLIC FATTY LIVER DISEASE AMONG DURHAM'S HISPANIC PEDIATRIC POPULATION DUE PRIMARILY TO AN INCREASE IN "MILLENNIAL MORBIDITIES" - OBESITY, SUGARY DIET, SEDENTARY LIFESTYLE. 2. ACCESS TO MEDICAL AND DENTAL CARE INITIATIVES:ACCESS TO HEALTH CARE IN A COMMUNITY REFERS TO THE ABILITY OF RESIDENTS TO FIND A CONSISTENT MEDICAL PROVIDER FOR THEIR PRIMARY CARE NEEDS, TO FIND A SPECIALTY PROVIDER WHEN NEEDED AND TO BE ABLE TO RECEIVE THAT CARE WITHOUT ENCOUNTERING SIGNIFICANT BARRIERS. ALTHOUGH THERE ARE MANY MEDICAL PROVIDERS, DURHAM COUNTY IS PARTICULARLY HAMPERED BY A LACK OF HEALTH INSURANCE COVERAGE (WHETHER PRIVATE OR PUBLIC, SUCH AS MEDICAID) FOR MANY OF ITS RESIDENTS. IN DURHAM COUNTY, 19% OF ADULTS LESS THAN 65 YEARS OLD ARE UNINSURED.PROJECT ACCESS OF DURHAM COUNTY (PADC) LINKS ELIGIBLE LOW-INCOME, UNINSURED, DURHAM COUNTY RESIDENTS WITH ACCESS TO SPECIALTY MEDICAL CARE FULLY DONATED TO THE PATIENTS BY THE PHYSICIANS, HOSPITALS INCLUDING DUH, LABS, CLINICS AND OTHER PROVIDERS PARTICIPATING IN THE PADC NETWORK. IN FY16, PADC PROVIDED SERVICES TO 1,117 PATIENTS AND EXPANDED ITS MEDICAL RESPITE PROGRAM SERVICING A DOZEN PATIENTS.LOCAL ACCESS TO COORDINATED HEALTHCARE (LATCH) WAS INITIATED IN 2002 WITH HEALTHY COMMUNITIES ACCESS PROGRAM (HCAP) FUNDING FROM THE US HEALTH RESOURCES AND SERVICES ADMINISTRATION (HRSA) TO DUKE'S DIVISION OF COMMUNITY HEALTH, DEPARTMENT OF COMMUNITY AND FAMILY MEDICINE. THE FOUNDING AND SUSTAINING LATCH ORGANIZATIONS INCLUDES DUH (WHICH NOW PROVIDES THE MAJORITY OF OPERATING FUNDS), LINCOLN COMMUNITY HEALTH CENTER, THE DURHAM COUNTY DEPARTMENTS OF HEALTH AND SOCIAL SERVICES, EL CENTRO HISPANO, AND A NUMBER OF COMMUNITY BASED ORGANIZATIONS (CBOS). THROUGH COMMUNITY-BASED, LINGUISTICALLY AND CULTURALLY-RELEVANT CARE MANAGEMENT, LATCH AIMS TO IMPROVE HEALTH KNOWLEDGE AND SELF-CARE, ACCESS TO HEALTH CARE AND HEALTH SERVICES UTILIZATION OUTCOMES AMONG DURHAM COUNTY'S UNINSURED. CARE MANAGEMENT SERVICES INCLUDE: HEALTH SERVICES COORDINATION AND NAVIGATION (MEDICAL, SOCIAL, BEHAVIORAL); POST-HOSPITALIZATION FOLLOW-UP; PATIENT EDUCATION; CHRONIC DISEASE MANAGEMENT; PSYCHO-SOCIAL SUPPORT; ACCESS TO BENEFITS (MEDICAID/SUPPLEMENTAL SECURITY INCOME (SSI)/SOCIAL SECURITY DISABILTY INSURANCE (SSDI)); BILLING STATEMENT ASSISTANCE; INTERPRETATION/TRANSLATION; AND, TRANSPORTATION COORDINATION. IN COORDINATION WITH OTHER COMMUNITY STAKEHOLDERS-HEALTH CARE AND SOCIAL SERVICE PROVIDERS, LOCAL GOVERNMENT AND COMMUNITY-BASED ORGANIZATIONS-LATCH MONITORS HEALTH CARE TRENDS, IDENTIFIES BARRIERS FACING UNINSURED PATIENTS, AND, WORKING AS A CONSORTIUM, ADDRESSES AND ELIMINATES BARRIERS. IN FY16 LATCH WORKED WITH THE GROWING REFUGEE COMMUNITY AND THE LOCAL OFFICES OF NATIONAL REFUGEE RESETTLEMENT PROGRAMS. LATCH CONTINUED TO PERFORM AWARENESS OUTREACH IN THE COMMUNITY TO ENCOURAGE RESIDENTS TO ENROLL IN THE HEALTH INSURANCE EXCHANGE; AND BEGAN ASSISTING MOTHERS WITH CHILDREN AGES 0-2 IN ENROLLING IN MEDICAID DUE TO LAPSES IN ELIGIBILITY WITH THE NC FAST PROGRAM.
THE DUKE CHILDRENS'S COMPLEX CARE SERVICE (CCS) PROVIDES	THE COORDINATION OF MEDICAL AND CO-MANAGEMENT OF MEDICAL CARE FOR CHILDREN WITH MULTIPLE MEDICALLY COMPLEX ISSUES THAT REQUIRE THE INTERACTION WITH MULTIPLE SPECIALISTS. ON AVERAGE THESE CHILDREN WORK WITH 13 SPECIALISTS. BEFORE THE CCS CARE WAS VERY FRAGMENTED AND PATIENTS/FAMILIES HAD NO CENTRAL "QUARTERBACK" HELPING TO OVERSEE THE BIG PICTURE. THROUGH THE CCS PARENTS NOW HAVE DIRECT PHONE ACCESS TO A CCS PROVIDER OR REGISTERED NURSE 24/7. THE CCS TEAM WORKS WITH PARENTS TO CREATE A COMPREHENSIVE "COMPLEX CARE PLAN" THAT IS PLACED IN THE CHILD'S MEDICAL RECORD AND GIVEN TO THE PARENTS. IN ADDITION, THE CCS TEAM COORDINATES INPATIENT INTENSIVE CARE TRANSITIONS PRIOR TO DISCHARGE AND CONDUCTS INTENSIVE OUTPATIENT BETWEEN-VISIT CONTACTS (PHONE, CLINIC VISITS, AND IN SOME CASES, HOME VISITS). IN FY 16, CCS ESTABLISHED A LONGITUDINAL CLINICAL FOLLOW UP CONTINUUM THAT CONSISTS OF THE COMPLEX CARE CLINIC, INPATIENT ROUNDS, AND DIRECT COMMUNICATION WITH PRIMARY CARE PHYSICIAN, SPECIALIST AND PATIENT'S GUARDIAN. IN FY16 DUH FUNDED 1.0 FULL TIME EQUIVALENT MEDICAL DOCTOR (DIVIDED AMONGST 3 FULL TIME EQUIVALENT MEDICAL DOCTORS); 1.0 REGISTERED NURSE CLINICIAN AND 1.0 PROGRAM COORDINATOR. IN FY 16 CCS EXPANDED TO A STATEWIDE REPRESENTATION (SKEWED TOWARD CENTRAL AND EASTERN NC). CCS HAS EXPERIENCED A REDUCTION IN EMERGENCY DEPARTMENT VISITS AND SUBSTANTIAL HOSPITAL STAY REDUCTION AND COSTS AVOIDED FOR "UN-DISCHARGEABLE" PATIENTS. THE PATIENT EXPERIENCE INCLUDED HOME VISITS, CONCURRENT AND PALLIATIVE CARE AND FAMILY CARE CONFERENCES.DUKE-DURHAM FOSTER CARE CLINIC PROGRAM IS A HIGHLY EFFECTIVE EFFORT BETWEEN DUKE AND DURHAM COUNTY. IN SEPTEMBER OF 2013 THE DUKE CHILD ABUSE AND NEGLECT MEDICAL EVALUATION CLINIC (CANMEC) PARTNERED WITH DURHAM COUNTY DEPARTMENT OF SOCIAL SERVICES (DSS) TO FORMALIZE A FOSTER CARE CLINIC. THIS CLINIC PROVIDES THE INITIAL SCREENING AND COMPREHENSIVE HEALTH ASSESSMENT ACCORDING TO THE AMERICAN ACADEMY OF PEDIATRICS (AAP) STANDARDS FOR CHILDREN IN FOSTER CARE IN DURHAM. CHILDREN RECEIVE A COMPREHENSIVE MEDICAL EVALUATION INCLUDING COMPLETE PHYSICAL EXAM, MEDICAL RECORD REVIEW AS WELL AS SCREENING FOR DENTAL, DEVELOPMENTAL, MENTAL HEALTH, AND SOCIAL CONCERNS. UNMET MEDICAL NEEDS ARE IDENTIFIED AND THE CLINIC IDENTIFIES A MEDICAL HOME; ARRANGES MEDICAL, MENTAL HEALTH, AND SOCIAL REFERRALS; PROVIDES FOLLOW UP CARE UNTIL A MEDICAL HOME IS ESTABLISHED; AND SUPPORTS SOCIAL WORKERS WITH NAVIGATING THE COMPLEX HEALTH SYSTEM. CHILDREN IN DURHAM COUNTY FOSTER CARE WHO HAVE COMPLETED A COMPREHENSIVE ASSESSMENT AT THE DUKE FOSTER CARE CLINIC ARE CURRENT ON IMMUNIZATIONS, ARE ENROLLED IN A MEDICAL HOME, ARE REFERRED FOR MENTAL HEALTH TREATMENT IF NEEDED, AND ARE HAVING THEIR ONGOING MEDICAL, DEVELOPMENTAL AND SOCIAL NEEDS ADDRESSED. THE DUKE-DURHAM FOSTER CARE CLINIC SERVES ALL CHILDREN IN THE FOSTER CARE SYSTEM IN DURHAM COUNTY. IN FY16 THE DURHAM DEPARTMENT OF SOCIAL SERVICES UTILIZED DUKE'S CLINICAL DECISION SUPPORT AND ELECTRONIC ALERT SYSTEM (COACH) TO MANAGE OVER 300 CHILDREN'S MEDICAL APPOINTMENTS. THROUGH THE USE OF COACH'S TARGETED MESSAGING SOCIAL SERVICE WORKERS WERE ABLE TO RECEIVE ADVANCE NOTIFICATION OF EACH CHILD'S MEDICAL APPOINTMENT AND ASSIST THE FOSTER PARENT IN GETTING TO THE APPOINTMENT. SOUTHERN HIGH SCHOOL WELLNESS CENTER PROVIDES COMPREHENSIVE PRIMARY CARE AND MENTAL HEALTH SERVICES AT SOUTHERN HIGH SCHOOL TO STUDENTS AT THE SCHOOL AND IS OPEN TO ALL STUDENTS AND STAFF OF DURHAM PUBLIC SCHOOLS. OPERATED BY DUKE'S DIVISION OF COMMUNITY HEALTH ON BEHALF OF DUH, THE SOUTHERN HIGH SCHOOL WELLNESS CENTER CELEBRATED ITS 20TH ANNIVERSARY IN 2016. IN FY16 THE CENTER CONTINUED TO STRUGGLE WITH STAFFING ISSUES BUT IS CONTINUING TO INCREASE ITS ENROLLMENT AND REACHING OUT TO SCHOOL STAFF AND EMPLOYEES OF DURHAM PUBLIC SCHOOLS. DURHAM CHILD HEALTH ASSESSMENT AND PREVENTION PROGRAM (CHAPP) WAS CREATED TO CLOSE GAPS IN ACCESS FOR CHILDREN WHO HAVE MISSED PREVENTIVE VISITS. IN ADDITION, THE PROGRAM SEEKS TO RECONNECT THESE CHILDREN AND THEIR FAMILIES TO SUPPORTIVE MEDICAL HOMES. TOGETHER, DUH THROUGH THE DUKE DIVISION OF COMMUNITY HEALTH, THE DURHAM COUNTY DEPARTMENT OF PUBLIC HEALTH, AND DURHAM PUBLIC SCHOOLS CONVERTED THREE DUH ELEMENTARY SCHOOL BASED HEALTH CENTERS AND OPENED TWO ADDITIONAL ONES UTILIZING ENHANCED ROLE REGISTERED NURSES (ERRNS) TO DELIVER WELL-CHILD CARE TO CHILDREN WHO ARE OVERDUE FOR THEIR WELL-CHILD CHECKUPS. THE FIVE SCHOOLS ARE IN AREAS OF THE COUNTY THAT DEMONSTRATE SIGNIFICANT GAPS IN PEDIATRIC CARE AND THE CHAPP CLINICS OPERATE AS SATELLITES OF THE DURHAM COUNTY DEPARTMENT OF PUBLIC HEALTH. DUH CONTINUES TO SUPPORT MENTAL HEALTH SERVICES AT ALL FIVE OF THE SITES AND PROVIDES MEDICAL BACK UP. IN FY16 CHAAP WAS RENAMED HEALTHY FUTURES. IN THE FOURTH QUARTER OF FY 16, HEALTHY FUTURES WAS FULLY STAFFED AND OPERATIONAL. THE 3 FULL TIME EQUIVALENT (FTE) ENHANCED ROLE NURSES STAFFED FIVE DURHAM ELEMENTARY SCHOOL CLINICS AND PROVIDED THREE HUNDRED WELL CHILD VISITS OF WHICH 50% OF THE CHILDREN DID NOT HAVE A MEDICAL HOME PRIOR TO THEIR HEALTHY FUTURES VISIT. OTHER NOTABLE RESULTS INCLUDE: - 57% OF CHILDREN RECEIVED A VACCINE DURING THEIR VISIT AND 90% OF THOSE VACCINATIONS WERE A REQUIRED VACCINE TO CATCH UP. - 30% OF CLIENTS SAID THEIR MAIN REASON FOR CONTACTING HEALTHY FUTURES WAS THAT THEY WERE UNABLE TO GET AN APPOINTMENT WITH PEDIATRICS AND 15% STATED APPOINTMENT WAIT TIME WAS TOO LONG. - REASON FOR REFERRAL: 33% ACUTE CONCERN, 29% CHRONIC CARE, 14% DENTAL CONCERN, 10% FAILED VISION SCREEN, 9% BEHAVIORAL CONCERN. - REASON FOR CHRONIC CARE REFERRAL: OBESITY 20%, BLOOD PRESSURE 33%, DIABETES 7%, ASTHMA 7%.JUST FOR US (JFU) PROVIDES IN-HOME CARE PROGRAM FOR LOW-INCOME, FRAIL ELDERLY AND DISABLED. JFU WAS LAUNCHED IN 2002 AS A COLLABORATION OF DUKE, LINCOLN COMMUNITY HEALTH CENTER, DURHAM DEPARTMENT OF SOCIAL SERVICES (DSS), THE LOCAL AREA MENTAL HEALTH ENTITY, AND THE DURHAM HOUSING AUTHORITY. DUH PROVIDES THE MAJORITY OF ONGOING SUPPORT FOR THE PROGRAM. THROUGH JUST FOR US, AN INTERDISCIPLINARY TEAM OF PROVIDERS SERVES CLIENTS IN THEIR HOMES, PROVIDING MEDICAL CARE, MANAGEMENT OF CHRONIC ILLNESSES, AND CASE MANAGEMENT. EACH PARTICIPANT RECEIVES A HOME VISIT EVERY 5 WEEKS UNLESS THERE IS AN ACUTE EPISODE OR A HOSPITAL DISCHARGE, FOR WHICH A VISIT IS SCHEDULED IMMEDIATELY. VISITS INCLUDE MEDICATION RECONCILIATION, SOCIAL ISSUES, SUPPORT SERVICES, CHRONIC DISEASE MANAGEMENT, AND POST-HOSPITAL CARE. THE HEALTH CARE TEAM CONSISTS OF A CLINICAL PROVIDER (PHYSICIAN ASSISTANT, NURSE PRACTITIONER OR MEDICAL DOCTOR), OCCUPATIONAL THERAPIST, REGISTERED DIETITIAN, SOCIAL WORKER, PHLEBOTOMIST, AND COMMUNITY HEALTH WORKER. IN FY16 JUST FOR US CONTINUED CHRONIC CARE AND TRANSITIONAL CARE HOME VISITS TO DISABLED AND LOW INCOME PATIENTS; MONTHLY ENROLLMENT AVERAGED 275 PATIENTS AND OVER 1,200 ENCOUNTERS.COMMUNITY CLINICS: DUH AND LINCOLN COMMUNITY HEALTH CENTER COLLABORATIVELY OPERATE THE FOLLOWING THREE COMMUNITY HEALTH CLINICS: THE LYON PARK COMMUNITY CLINIC, THE WALLTOWN NEIGHBORHOOD CLINIC AND THE HOLTON WELLNESS CENTER. THE CLINICS WERE DESIGNED TO PROVIDE PRIMARY CARE, HEALTH EDUCATION, AND DISEASE PREVENTION TO THE UNDERSERVED POPULATIONS OF DURHAM. THE CLINICS PROVIDE MEDICAL CARE FOR PERSONS WITH AND WITHOUT HEALTH INSURANCE. THOSE WITHOUT INSURANCE ARE SEEN BASED ON A SLIDING FEE SCALE. NO PATIENT IS DENIED CARE BASED ON INABILITY TO PAY FOR SERVICES. THE LYON PARK CLINIC WAS THE FIRST OF THE COLLABORATIVE NEIGHBORHOOD CLINICS, OPENING ITS DOORS FOR PATIENT CARE IN APRIL 2003. THE WALLTOWN CLINIC OPENED IN JANUARY 2005 AND THE HOLTON CLINIC OPENED IN AUGUST 2009. EACH CLINIC RECEIVED START-UP FUNDS THROUGH A DUKE ENDOWMENT GRANT. CLINICS GENERATE REVENUE THROUGH A CONTRACT WITH LINCOLN COMMUNITY HEALTH CENTER AND RECEIVE SIGNIFICANT SUPPORT FROM DUH. THE CLINICS OPERATE AS FAMILY MEDICINE PRACTICES AND ARE OPEN 5 DAYS A WEEK. STAFFING INCLUDES PHYSICIAN ASSISTANTS, NURSE PRACTITIONERS AND FAMILY PHYSICIANS, WHO SERVE AS SUPERVISING DOCTORS. EACH CLINIC IS SUPPORTED BY NURSING STAFF: CERTIFIED NURSING ASSISTANTS, LICENSED PRACTICAL NURSES, OR CERTIFIED MEDICAL ASSISTANTS AND A STAFF ASSISTANT. THE STAFF ASSISTANT PERFORMS ALL ADMINISTRATIVE TASKS FOR THE CLINIC INCLUDING ANSWERING INCOMING PHONE CALLS, REGISTRATION, SCHEDULING, ETC. IN FY16 THE CLINICS EXPERIENCED SOME STAFFING ISSUES, BUT WERE ABLE TO PROVIDE PRIMARY CARE TO 5,404 UNIQUE PATIENTS WITH 12,000 ENCOUNTERS. THE COMMUNITY CLINICS CONTINUE TO HOUSE A DURHAM HEALTH DEPARTMENT HIV/STD SCREENING PROGRAM. IN ADDITION, A PEDIATRIC/ADOLESCENT CLINIC WAS LAUNCHED AT HOLTON AND LYON PARK TWO DAYS A WEEK. THE CLINICS TRANSITIONED THE BREAST AND CERVICAL CANCER CONTROL PROGRAM TO LINCOLN COMMUNITY HEALTH CENTER TO STREAMLINE THE SERVICE FOR PATIENTS.
3. MENTAL HEALTH AND SUBSTANCE ABUSE INITIATIVES:	AN ESTIMATED 17,000 RESIDENTS OF DURHAM COUNTY NEED MENTAL HEALTH TREATMENT AND 19,000 NEED SUBSTANCE ABUSE TREATMENT. ALCOHOL IS THE PRIMARY SUBSTANCE ABUSED BY DURHAM COUNTY RESIDENTS SEEKING CRISIS DETOXIFICATION SERVICES AND BY ADOLESCENTS IN DURHAM'S MIDDLE AND HIGH SCHOOLS. RESPONDENTS IN THE COMMUNITY HEALTH OPINION SURVEY IDENTIFIED ADDICTION TO ALCOHOL, DRUGS OR PRESCRIPTION PILLS AS THE NUMBER ONE COMMUNITY HEALTH PROBLEM. DUH SUPPORTS A NUMBER OF COLLABORATIVE INITIATIVES TO IMPROVE ACCESS TO MENTAL HEALTH SERVICES AND REDUCE SUBSTANCE ABUSE.PROJECT LAZARUS IN CONJUNCTION WITH COMMUNITY CARE OF NORTH CAROLINA(CCNC) AND DUH SEEKS TO REDUCE OPIOID-RELATED OVERDOSES; OPTIMIZE TREATMENT OF CHRONIC PAIN; AND MANAGE SUBSTANCE ABUSE ISSUES RELATED TO OPIOIDS. THE CORE COMPONENTS OF THE PROJECT LAZARUS MODEL ARE: 1) PUBLIC AWARENESS, 2) COALITION ACTION, AND 3) DATA & EVALUATION. STRATEGIES OF THE MODEL INCLUDE: COMMUNITY EDUCATION; PROVIDER EDUCATION; HOSPITAL EMERGENCY DEPARTMENT POLICIES; DIVERSION CONTROL; PAIN PATIENT SUPPORT; HARM REDUCTION; ADDICTION TREATMENT. DUH SUPPORTS THE FOLLOWING ACTIVITIES: A) COMMUNITY COALITIONS: DURHAM CRISIS COLLABORATIVE; PARTNERSHIP FOR A HEALTHY DURHAM SUBSTANCE USE AND MENTAL HEALTH COMMITTEE AND DURHAM TOGETHER FOR RESILIENT YOUTH. B) NALOXONE OUTREACH: PHARMACIES (DUKE SOUTH, CLINIC PHARMACY, MAIN STREET, GURLEY'S, JOSEF'S, & DUKE CANCER SPECIALTY); DURHAM COUNTY DEPARTMENT OF PUBLIC HEALTH; DURHAM MOBILE CRISIS UNIT. C) PROVIDER EDUCATION: PROVIDER TOOLKITS AND CME EDUCATION; USE OF PAIN AGREEMENTS; USE OF CONTROLLED SUBSTANCE REPORTING SYSTEM (CSRS); CHRONIC PAIN PROVIDER CONSULTATION CALLS. D) DIVERSION CONTROL: PERMANENT DROP BOXES IN 5 OF 6 COUNTIES (DURHAM, FRANKLIN, PERSON, GRANVILLE, & VANCE).E) CHRONIC PAIN PATIENT SUPPORT: CHRONIC PAIN SELF-MANAGEMENT WORKSHOPS; CHRONIC PAIN MANAGEMENT RESOURCES; KEY COMMUNITY PRESENTATIONS. IN FY16 NALOXONE DISTRIBUTION EFFORTS CONTINUED WITHIN THE COMMUNITY AND LOCAL PHARMACIES. IN JUNE 2016, THE STATE HEALTH DIRECTOR RANDALL WILLIAMS SIGNED A STATEWIDE STANDING ORDER FOR NALOXONE DISPENSING INTO LAW. NORTH CAROLINA DEPARTMENT OF HEALTH AND HUMAN SERVICES HAS SET UP A WEBSITE WHERE PHARMACISTS AND THE PUBLIC CAN ACCESS MORE INFORMATION ABOUT THE STANDING ORDER. THE WEBSITE IS WWW.NALOXONESAVES.ORG. PHARMACIES CAN GO TO THE WEBSITE AND SIGN ON TO DISPENSE UNDER STATEWIDE STANDING ORDER. THE CHRONIC PAIN COORDINATOR WORKED WITH NORTHERN PIEDMONT COMMUNITY CARE (NPCC)'S PHARMACY PROGRAM SPECIALIST, STEPHANIE YANG, TO REACH OUT TO LOCAL PHARMACIES IN THE NETWORK. APPROXIMATELY NINETY FIVE (95) PHARMACIES RECEIVED THE FAX THAT INCLUDED A COPY OF THE STANDING ORDER, A ONE-PAGER EXPLAINING THE STANDING ORDER FOR MEDICAID PHARMACIST AND PROVIDERS, AND THE CHRONIC PAIN COORDINATOR'S CONTACT INFORMATION. OUT OF THE 95 PHARMACIES, 78 WERE LISTED IN DURHAM. NPCC IN CONJUNCTION WITH THE SUBSTANCE USE/MENTAL HEALTH SUBCOMMITTEE OF THE PARTNERSHIP FOR A HEALTHY DURHAM WILL CONDUCT OUTREACH TO THE 78 PHARMACIES TO ASSIST THEM WITH REGISTERING ON WWW.NALOXONESAVES.ORG.
IN ADDITION TO WORKING ON NALOXONE OUTREACH TO PHARMACIES,	SUBSTANCE USE AND MENTAL HEALTH COMMITTEE (SUMH) OF THE PARTNERSHIP FOR A HEALTHY DURHAM IS ALSO WORKING ON A PROVIDER RESOURCE MANUAL TO BE IN LINE WITH THE NETWORK OF CARE WEBSITE RESOURCES AS WELL AS A USER-FRIENDLY HARD COPY VERSION TO DISSEMINATE THROUGHOUT THE DUHS.PROJECT LAZARUS (PL) KITS CONTINUE TO BE DISSEMINATED IN THE COMMUNITY AT LOCAL PHARMACIES. TO DATE APPROXIMATELY 60 KITS HAVE BEEN PROVIDED TO PHARMACIES UPON REQUEST. NUMBERS MAY VARY NOW WITH THE STATEWIDE NALOXONE STANDING ORDER IN PLACE AND LOCAL PHARMACIES DISPENSING FDA APPROVED NASAL NARCAN 4MG INTRANASAL SPRAY. CHRONIC PAIN SELF-MANAGEMENT (CPSMP) WORKSHOPS CONTINUE TO TAKE PLACE AT LINCOLN COMMUNITY HEALTH CENTER AND CONTINUE TO BE SUCCESSFUL. THERE HAVE BEEN 9 -SIX WEEK WORKSHOPS WITH APPROXIMATELY 130 PEOPLE REACHED IN THE WORKSHOPS.COMMUNITY CARE OF NORTH CAROLINA (CCNC) CHRONIC PAIN INITIATIVE TASK FORCE THROUGH THE WORK OF THE CCNC CHRONIC PAIN INITIATIVE (CPI) TASK FORCE AND DR. LARRY GREENBLATT'S LEADERSHIP WE ARE IN THE PROCESS OF UPDATING THE CCNC PROVIDER TOOLKIT TO DEVELOP AN UPDATED VERSION WITH MORE RESOURCES AND TOOLS TO ASSIST WITH THE ACCESS AND OTHERS AT CCNC. IN ADDITION, WE ARE WORKING ON THE DEVELOPMENT OF A CONTINUING MEDICAL EDUCATION (CME) ON SAFE OPIOID PRESCRIBING FOR OR PROVIDERS TO EDUCATE THEM ON THE LATEST GUIDELINES FROM THE NC MEDICAL BOARD AND THE CENTERS FOR DISEASE CONTROL AND PREVENTIONS RELATING TO OPIOID SAFETY AND CHRONIC PAIN MANAGEMENT.CHRONIC PAIN TELEPHONE CONSULTATIONS WITH PAIN SPECIALIST (DR. STEVEN PRAKKEN) ARE CONTINUING WITH OUTREACH AND AWARENESS EFFORTS TO INFORM PROVIDERS OF THIS RESOURCE. TO DATE WE HAVE HAD APPROXIMATELY 15 OF 17 PHONE CONSULTS WITH 32 PROVIDERS PARTICIPATING ON THE CALL. WE HAVE HAD PRIMARY CARE PHYSICIANS, NURSE PRACTITIONERS, AND BEHAVIORAL HEALTH PROVIDERS PARTICIPATE. THE BEHAVIORAL HEALTH PARTICIPATION IS A NEW FACTOR IN THE CALLS AND SOMETHING WE WOULD LIKE TO CONTINUE TO EXPLORE TO ADDRESS INTEGRATED HEALTHCARE EFFORTS.
HOMEBASE IS AN INTEGRATED MODEL OF PRIMARY CARE AND MENTAL	HEALTH DELIVERED BY A DUALLY-TRAINED PHYSICIAN ASSISTANTS AND SUPPORTED BY IN THE DUH OUTPATIENT CLINIC (DOC). THE GOALS OF THE PROGRAM ARE TO IMPROVE CARE AND OUTCOMES FOR DOC PATIENTS WITH CO-MORBID MENTAL HEALTH CONDITIONS; ENCOURAGE AND ENABLE PATIENTS TO SEEK SERVICES AT THE DOC FIRST AND NOT THE EMERGENCY DEPARTMENT; REINVENT A CARE TEAM MODEL AT DOC TO INCREASE PATIENT-PROVIDER CONTINUITY, PROVIDER ACCOUNTABILITY FOR PATIENT OUTCOMES, USE OF BEST PRACTICES; AND IMPROVE TRANSITIONS OF CARE FROM HOSPITAL AND EMERGENCY DEPARTMENT SETTINGS TO CLINIC AND HOME, PARTICULARLY FOR HIGH UTILIZER (HU) PATIENTS. IN FY 16 HOMEBASE CONTINUED SERVING AN EXTREMELY MEDICALLY COMPLEX PANEL OF DOC PATIENTS SERVING OVER 150 WITH INTENSIVE COMPLEX CARE MANAGEMENT. IN THE SECOND HALF OF FY 16, HOMEBASE LAUNCHED AN INTEGRATED CARE SCREENING AND BRIEF COUNSELING PROGRAM WITH 2 FTE LICENSED CLINICAL SOCIAL WORKERS FUNDED BY NPCC. EVERY PATIENT WHO SCREENS POSITIVE ON PHQ 9 (DEPRESSION SCREEN) WILL ALSO RECEIVE ANXIETY, SUBSTANCE ABUSE AND TRAUMA SCREENS AND COUNSELING.DUHS SAFE OPIOID TASK FORCE WAS CREATED TO IMPROVE THE SAFETY OF PAIN MANAGEMENT BY ENCOURAGING CLINICAL PRACTICE STANDARDIZATION, WHERE CLINICALLY APPROPRIATE, WHEN OPIOID THERAPY IS DESIGNATED FOR TREATMENT. THE OPIOID SAFETY TASK FORCE PROVIDES RECOMMENDATIONS FOR THE INITIATION AND MANAGEMENT OF OPIOID THERAPY ACROSS DUHS TO IMPROVE PERSONAL AND COMMUNITY SAFETY AND REDUCE HARM ASSOCIATED WITH THE HIGH RISK TREATMENTS WHILE ENGAGING PATIENTS IN THEIR OWN CARE. DUH ALONG WITH DUKE REGIONAL HOSPITAL (DRH) AND DUKE RALEIGH HOSPITAL ("DRAH") SERVES AS A PIVOTAL PLAYER IN ALL ASPECTS OF THE WORK OF THE TASK FORCE. OVER THE LAST THREE YEARS, ALL THREE HOSPITALS ENGAGED IN THE STANDARDIZATION OF NC MEDICAL BOARD GUIDELINES; HELPED TO DEVELOP 12 SMARTPHRASES IN DUHS' ELECTRONIC HEALTH RECORD SYSTEM (MAESTRO CARE); CREATED 12 PATIENT EDUCATION VIDEOS; AND PROVIDED 35 ADVANCED PRACTITIONERS WITH EDUCATION ON PAIN MANAGEMENT & SAFE OPIOID PRESCRIBING. IN FY16 THE OPIOID TASK FORCE IS CONTINUING TO WORK ON UPDATING INTAKE AND CHRONIC PAIN FOLLOW UP FORMS IN MAESTRO CARE AND THE LIAISONS ARE CONTINUING OUTREACH TO THE IDENTIFIED 15 HIGH VOLUME CLINICS.4. HIV AND SEXUALLY TRANSMITTED INFECTIONS:SEXUALLY TRANSMITTED INFECTIONS (STI) MAY LEAD TO PREMATURE DEATH AND DISABILITY AND CAN RESULT IN SIGNIFICANT HEALTH CARE COSTS. CHLAMYDIA, GONORRHEA, AND SYPHILIS ARE THE THREE MOST COMMON STIS IN NORTH CAROLINA AND DURHAM COUNTY. ALTHOUGH HIV IS NOT AS COMMON, DURHAM RANKS FOURTH HIGHEST IN NORTH CAROLINA, WITH AN AVERAGE RATE OF HIV DISEASE (29.9 PER 100,000) WELL ABOVE THE STATE RATE (16.4 PER 100,000). WHILE DUH THROUGH THE PROGRAMS DESCRIBED IN THIS DOCUMENT SUPPORTS MECHANISMS TO ADDRESS HIV AND SEXUALLY TRANSMITTED INFECTIONS, IT DOES NOT INCLUDE SPECIFIC STRATEGIES IN THIS PLAN TO ADDRESS THE RATE OF HIV AND SEXUALLY TRANSMITTED INFECTIONS, BECAUSE CONSIDERABLE WORK IS ALREADY BEING DONE THROUGH ORGANIZATIONS WITHIN THE COMMUNITY. THROUGH THE PARTNERSHIP FOR A HEALTHY DURHAM, THE HIV/STI ADVISORY COUNCIL BRINGS TOGETHER COMMUNITY MEMBERS AND AGENCIES TO FOCUS ON STRATEGIES TO PREVENT THE SPREAD OF SYPHILIS AND HIV/AIDS. IN ADDITION, LINCOLN COMMUNITY HEALTH CENTER OPERATES AN EARLY INTERVENTION CLINIC FOR PATIENTS WITH HIV/AIDS AT THE DURHAM COUNTY HEALTH DEPARTMENT.IN FY16 DUH CONTINUED TO WORK WITH THE MANY ORGANIZATIONS WORKING ON ADDRESSING HIV AND SEXUALLY TRANSMITTED INFECTIONS AND INTRODUCED HIV SCREENING INTO THE COMMUNITY CLINICS AS NOTED EARLIER IN THE IMPLEMENTATION PLAN.5. POVERTY:PEOPLE WITH HIGHER INCOMES, MORE YEARS OF EDUCATION, AND A HEALTHY AND SAFE ENVIRONMENT TO LIVE IN HAVE BETTER HEALTH OUTCOMES AND GENERALLY HAVE LONGER LIFE EXPECTANCIES. IN DURHAM COUNTY, 16.6% OF INDIVIDUALS LIVE IN POVERTY. FEMALE SINGLE-PARENT FAMILIES ARE DISPROPORTIONATELY AT RISK FOR POVERTY THAN MARRIED COUPLE FAMILIES (41.5% TO 8.7%) AND 40.6% OF FEMALE SINGLE-PARENT FAMILIES WITH RELATED CHILDREN UNDER 18 YEARS ARE LIVING IN POVERTY. NEARLY ONE-HALF OF DURHAM'S RENTERS ARE PAYING 30% OR MORE OF THEIR INCOME FOR HOUSING.DURHAM'S BULL CITY CONNECTOR IS A FARE-FREE CONNECTOR BUS SERVICE THAT CONTINUOUSLY LOOPS THROUGH STOPS FROM DOWNTOWN DURHAM ALL THE WAY TO THE DUKE UNIVERSITY HOSPITAL, DUKE CLINICS, AND DUKE EYE CENTER CAMPUSES. ON AVERAGE, BULL CITY CONNECTOR BUSES ACCUMULATE 1,500 RIDERS EVERY WEEKDAY AND COMPLETE THEIR LOOPS IN 17 MINUTE INTERVALS. SAFE AND EFFECTIVE TRANSPORTATION IS A KEY CORRELATE IN HEALTH AND ECONOMIC WELL-BEING. THE BULL CITY CONNECTOR HAS PROVEN TO BE AN ASSET FOR DUKE EMPLOYEES, STUDENTS, AND PATIENTS.SSI/SSDI OUTREACH, ACCESS AND RECOVERY (SOAR) HELPS PATIENTS WHO ARE CHRONICALLY HOMELESS, OR AT RISK OF HOMELESSNESS ACCESS HEALTH INSURANCE, A STABLE INCOME, AND MEDICAL CARE BY ASSISTING THESE INDIVIDUALS IN APPLYING FOR SUPPLEMENTAL SECURITY INCOME (SSI) AND SOCIAL SECURITY DISABILITY INSURANCE (SSDI). THE HOMELESS POPULATION AND THOSE REENTERING THE COMMUNITY FROM AN INSTITUTION FACE NUMEROUS CHALLENGES IN ACCESSING SERVICES. APPROVAL ON INITIAL SSI AND SSDI APPLICATIONS FOR THESE AT-RISK POPULATIONS, WHO HAVE NO ONE TO ASSIST, IS ABOUT 10-15 PERCENT. FOR THOSE WITH MENTAL ILLNESS, SUBSTANCE ABUSE ISSUES, AND/OR CO-COGNITIVE IMPAIRMENT, THE APPLICATION PROCESS IS EVEN MORE DIFFICULT. EVEN WITH ASSISTANCE, THE APPLICATION PROCESS CAN TAKE UP TO SIX MONTHS. THROUGH SOAR, THESE INDIVIDUALS WITH COMPLEX NEEDS ARE PROVIDED CASE MANAGEMENT FOR HOME, HOSPITAL, AND CLINIC VISITS; ARE PROVIDED WITH A STEP BY STEP EXPLANATION AND COMPLETION OF ALL APPLICATIONS FOR FEDERAL DISABILITY BENEFITS; RECEIVE EXPEDITED APPLICATIONS FOR MONTHLY INCOME AND MEDICAID/MEDICARE; AND ARE LINKED TO COMMUNITY RESOURCES. DUH CURRENTLY FUNDS TWO SOAR CASE MANAGERS WHO CONTINUE TO HELP PATIENTS. IN FY16, 152 INDIVIDUALS WERE ENROLLED IN SSI/SSDI OUTREACH, ACCESS AND RECOVERY SOAR. IN FY 16 LATCH LAUNCHED BEC (BENEFITS ENROLMENT COUNSELING). BEC STAFF TRAIN VOLUNTEERS TO ENROLL LOW INCOME SENIORS IN FOUR FEDERAL PROGRAMS: SNAP (FOOD ASSISTANCE), ENERGY ASSISTANCE, MEDICARE PRESCRIPTION LOW INCOME SUBSIDY, AND ASSISTANCE FOR DENTAL AND VISION CARE. THE BEC PROGRAM SERVES DURHAM, GRANVILLE AND PERSON COUNTIES' LOW INCOME SENIOR CITIZENS. DURHAM MEDICAL RESPITE PROGRAM IS A PILOT PROGRAM FOR HOMELESSPATIENTS THAT EMANATED OUT OF THE WORK OF PROJECT ACCESS OF DURHAM COUNTY (PADC) IN 2014. THE MEDICAL RESPITE PILOT PROGRAM OPERATES 24/7 AND PROVIDES PARTICIPANTS WITH CLEAN AND SAFE HOUSING WHICH WILL MEET THE STANDARDS THAT HOSPITALS USE WHEN PLANNING FOR DISCHARGE TO HOME. DEPENDING ON PARTICIPANT NEEDS AND DEMOGRAPHICS, POTENTIAL SITES INCLUDE TRANSITIONAL HOUSING (JUST A CLEAN HOUSE), MOTELS, OR HEALING WITH CAARE, INC. PER DIEM HOUSING. ROOM AND BOARD IS FUNDED BY DURHAM COUNTY DEPARTMENT OF PUBLIC HEALTH THROUGH A CONTRACT WITH PADC, ALONG WITH PRIVATE DONATIONS. AS THE PROGRAM BECOMES FULLY OPERATIONAL, EACH PROGRAM PARTICIPANT WILL WORK WITH A TRANSITIONAL NURSE CARE MANAGER (PROVIDED BY DUKE'S DIVISION OF COMMUNITY HEALTH) TO MAXIMIZE THEIR HEALTH AND CONNECT WITH APPROPRIATE COMMUNITY RESOURCES AND SERVICES. IN FY16 THE PROGRAM RECEIVED A HILLMAN GRANT TO COVER THE COST OF AN RN CARE MANAGER AND COMMUNITY HEALTH WORKERS. THE PROGRAM SERVED 29 PATIENTS OF WHOM 26 WERE MALE; 15 BLACK, 13 WHITE AND 1 HISPANIC. PRIOR TO MEDICAL RESPITE 10 LIVED IN SHELTERS AND 13 WERE UNSHELTERED AND POST-MEDICAL RESPITE 9 RECEIVED TRANSITIONAL HOUSING. SEVENTY FIVE PERCENT OF REFERRALS ORIGINATE FROM DUKE HOSPITAL, DUKE REGIONAL HOSPITAL AND DUKE OUTPATIENT CLINICS.
6. EDUCATION:	QUALITY CHILD CARE AND EARLY EDUCATION PREDICT A CHILD'S FUTURE SUCCESS, AND THE ACADEMIC SUCCESS OF YOUNG ADULTS IS STRONGLY LINKED WITH THEIR HEALTH THROUGHOUT THEIR LIFETIME. THE IMPORTANCE OF A HIGH SCHOOL DIPLOMA AND HIGHER EDUCATION CANNOT BE OVERSTATED. COLLEGE GRADUATES AGE 25 AND OVER EARN NEARLY TWICE AS MUCH AS WORKERS WHO ONLY HAVE A HIGH SCHOOL DIPLOMA. THE UNEMPLOYMENT RATE FOR WORKERS WHO DROPPED OUT OF HIGH SCHOOL IS NEARLY FOUR TIMES THE RATE OF COLLEGE GRADUATES. IN DURHAM COUNTY, THE FOUR-YEAR HIGH SCHOOL GRADUATION RATE IS 79.6% COMPARED TO NORTH CAROLINA'S STATE RATE OF 82.5%. THE OVERALL 4-YEAR COHORT GRADUATION RATE HAS INCREASED BY NEARLY 10% SINCE 2010-11, BUT THERE IS STILL A DISPARITY IN THE PERCENTAGES OF WHITE VERSUS MINORITY STUDENTS WHO ARE GRADUATING FROM HIGH SCHOOL. FOR EXAMPLE, 84.7% OF WHITES GRADUATED IN 2011-2012 COMPARED TO 74.7% OF BLACKS AND 73% OF HISPANIC STUDENTS.LEARNING TOGETHER PROVIDES TRAINING AND OPPORTUNITIES FOR DUKE STUDENTS (LEARNERS) TO PARTICIPATE IN HEALTH-RELATED COMMUNITY SERVICE ACTIVITIES. SERVICE OPPORTUNITIES MAY INCLUDE PROVIDING HEALTH EDUCATION TO ELEMENTARY SCHOOL CHILDREN, HELPING FRAIL SENIORS COMPLETE THE APPLICATION PROCESS FOR FOOD STAMPS, AND CONDUCTING WORKSHOPS TO TEACH PATIENTS HOW TO EFFECTIVELY COMMUNICATE WITH THEIR DOCTOR. THROUGH LEARNING TOGETHER, LEARNERS WORK WITH A VARIETY OF POPULATIONS, EXPERIENCE THE INTERDISCIPLINARY NATURE OF COMMUNITY WORK, AND DEVELOP COMPETENCE FOR WORKING WITH DIVERSE COMMUNITIES AND CULTURES. LEARNERS WHO PARTICIPATE GAIN SKILLS THEY CAN USE TO WORK EFFECTIVELY WITH ANY COMMUNITY. IN FY16 THE LEARNING TOGETHER PROGRAM TRAINED 92 DUKE LEARNERS WHO IN TURN VOLUNTEERED FOR COMMUNITY SERVICES ACTIVITIES WHICH PROVIDED ASSISTANCE FOR 350 ADULTS AND 1,200 CHILDREN.GROUP A - FACILITY 1 - DUKE UNIVERSITY HOSPITALPART V, SECTION B, LINE 16I: DUHS PROVIDES A BROCHURE TO ALL ADMISSIONS THAT INCLUDES A BRIEF SUMMARY OF DUHS FINANCIAL ASSISTANCE POLICIES. DUHS ALSO COMMENTS ON THE BACK OF ITS BILLING INVOICES THAT PATIENTS SHOULD CONTACT PATIENT ACCOUNT REPRESENTATIVES TO HELP THEM IF THEY CANNOT PAY THEIR BILL IN FULL. THIS COMMENT REFERENCES GOVERNMENT-SPONSORED PROGRAMS, MONTHLY PAYMENT PROGRAMS, AND OTHER FINANCIAL ASSISTANCE PROGRAMS AVAILABLE FOR PATIENTS WHO MEET CERTAIN FINANCIAL CRITERIA. DUHS ALSO PUBLICIZED ITS FINANCIAL ASSISTANCE POLICY VERBALLY THROUGH ITS FINANCIAL CARE COUNSELORS.GROUP A - FACILITY 1 - DUKE UNIVERSITY HOSPITALPART V, SECTION B, LINE 22D: DUHS USED THE LOOK BACK METHOD AND SUMMED ALL CLAIMS SUBMITTED TO MEDICARE AND ALL PRIVATE HEALTH INSURERS DURING THE PRIOR 12 MONTH PERIOD DIVIDED BY THE SUM OF THE ASSOCIATED GROSS CHARGES RELATED TO THOSE CLAIMS.
GROUP A - FACILITY 1 - DUKE UNIVERSITY HOSPITAL	PART V, SECTION B, LINE 24: CERTAIN ELECTIVE COSMETIC/AESTHETIC SERVICES, AND OTHER SERVICES NOT COVERED BY INSURANCE, WILL BE BILLED AT AN AMOUNT EQUAL TO GROSS CHARGES.DUKE RALEIGH HOSPITAL:PART V, SECTION B, LINE 5: DUKE RALEIGH HOSPITAL ("DRAH") COLLABORATED WITH WAKE COUNTY HUMAN SERVICES, WAKEMED HEALTH AND HOSPITALS, REX HEALTHCARE, WAKE HEALTH SERVICES, AND THE UNITED WAY OF THE GREATER TRIANGLE IN CONDUCTING THE 2013 WAKE COUNTY COMMUNITY HEALTH NEEDS ASSESSMENT. THE WAKE COUNTY ASSESSMENT INCLUDED INPUT FROM 281 COMMUNITY HEALTH OPINION SURVEYS, 76 FOCUS GROUPS, AND 95 COMMUNITY FORUMS. A STEERING COMMITTEE COMPRISED OF MEMBERS FROM HOSPITALS, LOCAL GOVERNMENTS, FAITH-BASED ORGANIZATIONS, SCHOOLS, MEDIA, NON-PROFIT ORGANIZATIONS, AND BUSINESSES WORKED TO DIRECT THE ACTIVITIES OF THE ASSESSMENT PROCESS AND PROVIDE INPUT. THIS JOINT CHNA AND RELATED IMPLEMENTATION PLAN WAS ADOPTED BY THE DUHS BOARD OF DIRECTORS AND PUBLISHED ON THE DUKE HEALTH WEBSITE IN FISCAL YEAR 2016 (TAX YEAR 2015).DUKE RALEIGH HOSPITAL:PART V, SECTION B, LINE 6A: REX HEALTHCARE, WAKEMED HEALTH AND HOSPITALSDUKE RALEIGH HOSPITAL:PPART V, SECTION B, LINE 6B: WAKE HEALTH SERVICES, UNITED WAY OF THE GREATER TRIANGLE AND WAKE COUNTY HUMAN SERVICES DUKE RALEIGH HOSPITAL:PART V, SECTION B, LINE 7A: THE CHNA IS AVAILABLE ON THE WEBSITE BY NAVIGATING TO WWW.DUKEHEALTH.ORG, CLICK ON "PATIENTS & VISITORS", THEN "FINANCIAL ASSISTANCE", THEN "COMMUNITY HEALTH NEEDS ASSESSMENT; CLICK THE LINK FOR "DETAILS OF OUR COMMUNITY INVOLVEMENT CAN BE FOUND HERE; AND THEN CLICK ON "COMMUNITY HEALTH."DUKE RALEIGH HOSPITAL:PART V, SECTION B, LINE 10A: THE IMPLEMENTATION STRATEGY AND PROGRESS REPORTS ARE AVAILABLE ON THE WEBSITE BY NAVIGATING TO HTTP://WWW.DUKEHEALTH.ORG, CLICK ON "PATIENTS & VISITORS", THEN "FINANCIAL ASSISTANCE", THEN "COMMUNITY HEALTH NEEDS ASSESSMENT; CLICK THE LINK FOR "DETAILS OF OUR COMMUNITY INVOLVEMENT CAN BE FOUND HERE; AND THEN CLICK ON "COMMUNITY HEALTH." CHOOSE ONE OF THE LINKS FOR THE DUKE RALEIGH HOSPITAL PROGRESS REPORT AND IMPLEMENTATION PLAN.DUKE RALEIGH HOSPITAL:PART V, SECTION B, LINE 11: THE WAKE COUNTY HEALTH ASSESSMENT EVALUATED HEALTH NEEDS IN THE AREAS OF HEALTHCARE ACCESS AND UTILIZATION; MENTAL HEALTH AND SUBSTANCE ABUSE AND NUTRITION, PHYSICAL ACTIVITY AND OBESITY PREVENTION. DUKE RALEIGH HOSPITAL'S RESOURCES HAVE THE BIGGEST IMPACT IN THE FOLLOWING AREAS WITH KEY DATA INCLUDED FROM THE 2013 WAKE COUNTY COMMUNITY HEALTH NEEDS ASSESSMENT. NUTRITION, PHYSICAL ACTIVITY AND OBESITY PREVENTION:- THE THREE LEADING CAUSES OF DEATH IN WAKE COUNTY ARE CANCER, HEART DISEASE AND STROKE. PROMOTING HEALTHY LIFESTYLES GREATLY REDUCES THE RISK OF DEVELOPING THOSE DISEASES.- CANCER IS THE LEADING CAUSE OF DEATH IN WAKE COUNTY. ACCORDING TO THE CENTER FOR DISEASE CONTROL (CDC), A PERSON'S CANCER RISK CAN BE REDUCED BY RECEIVING REGULAR MEDICAL CARE, MAINTAINING A HEALTHY WEIGHT AND MAKING LIFESTYLE CHANGES INCLUDING PHYSICAL ACTIVITY AND A DIET RICH IN FRUITS AND VEGETABLES. CANCER SCREENING HELPS FIND THE DISEASE EARLY AT AN OFTEN HIGHLY TREATABLE STAGE (CENTERS FOR DISEASE CONTROL AND PREVENTION, CANCER PREVENTION AND CONTROL WEBSITE).- WAKE COUNTY'S MORTALITY RATE FOR CEREBROVASCULAR DISEASE (STROKE) IS 15% HIGHER THAN THE NATIONAL RATE.- IN WAKE COUNTY, ALMOST 2 OUT OF 3 ADULTS ARE EITHER OVERWEIGHT OR OBESE (NC STATE CENTER FOR HEALTH STATISTICS, BEHAVIORAL RISK FACTOR SURVEILLANCE SYSTEM, 2009).HEALTHCARE ACCESS AND UTILIZATION:- AFRICAN AMERICANS AND HISPANICS IN WAKE COUNTY EXPERIENCE DISPROPORTIONATELY HIGHER MORTALITY RATES FROM CANCER, HEART DISEASE, STROKE AND DIABETES.- IN 2012, MORE THAN 1700 WAKE COUNTY PATIENTS WERE SEEN IN WAKE COUNTY EMERGENCY DEPARTMENTS FOR DIABETES (TYPES 1 AND 2) RELATED ISSUES, A 17% INCREASE SINCE 2010.- IN THREE FOCUS GROUPS, DIABETES WAS IDENTIFIED AS A HEALTH CONCERN FOR WAKE COUNTY.DUKE RALEIGH LIFESTYLE AND DISEASE MANAGEMENT CENTER: THE DUKE RALEIGH LIFESTYLE AND DISEASE MANAGEMENT CENTER IS DESIGNED TO SUPPORT PATIENTS WITH CHRONIC ILLNESSES IN IMPROVING THEIR QUALITY OF LIFE. THE CENTER INCLUDES CARDIAC AND PULMONARY REHABILITATION, DIABETES EDUCATION, MEDICAL NUTRITION THERAPY FOR BARIATRIC SURGERY PATIENTS AND GENERAL WELLNESS, NUTRITION AND FITNESS PROGRAMS TO SUPPORT INDIVIDUALS IN ACHIEVING BETTER OVERALL HEALTH. THE LOSE TO LIVE WEIGHT LOSS PROGRAM IS DESIGNED TO HELP PARTICIPANTS MAKE IMPORTANT LIFESTYLE MODIFICATIONS TO DIET AND PHYSICAL ACTIVITY TO ACHIEVE WEIGHT LOSS SUCCESS.WEIGHT LOSS SURGERY: DUKE RALEIGH HOSPITAL IS ACCREDITED AS A LEVEL 1 FACILITY BY THE BARIATRIC SURGERY CENTER NETWORK ACCREDITATION PROGRAM OF THE AMERICAN COLLEGE OF SURGEONS. THE PROGRAM INCLUDES A SUPPORT PROGRAM FOR BARIATRIC SURGERY PATIENTS AFTER SURGERY AS WELL AS AN OPTIONAL MAINTENANCE WELLNESS PROGRAM OFFERED THROUGH THE DUKE RALEIGH LIFESTYLE AND DISEASE MANAGEMENT CENTER.COMMUNITY OUTREACH: HEALTHY FOCUS EDUCATIONAL SERIES: FOR MORE THAN EIGHT YEARS, DUKE RALEIGH HOSPITAL HAS HOSTED THE HEALTHY FOCUS COMMUNITY EDUCATION SERIES OF FREE PROGRAMS AVAILABLE TO COMMUNITY MEMBERS ON TOPICS SUCH AS:- LUNG CANCER- CARE OF THE AGING SHOULDER- NECK PAIN: HOW TO BEAT IT AND TREAT IT- ANKLE ARTHRITIS- MEN'S HEALTHTHE TRIANGLE STROKE EDUCATION OUTREACH INITIATIVE: DUKE RALEIGH HOSPITAL HAS JOINED WITH THE MINORITY WOMEN'S HEALTH PROJECT, INC., THE AMERICAN HEART ASSOCIATION AND REX HEALTHCARE TO PROMOTE THE SHARING OF SUPPORT, WELL-BEING, STRENGTHS, CHALLENGES AND RESOURCES FOR PEOPLE AFFECTED BY STROKE, THOSE WHO HAVE EXPERIENCED STROKE, AND THEIR FAMILY, FRIENDS, AND CARE PROVIDERS THROUGH A SUPPORT GROUP OFFERED AT AREA COMMUNITY CENTERS AND FAITH-BASED ORGANIZATIONS.DUKE RALEIGH HOSPITAL SUPPORTS THE DUKE HEART CENTER IN AN ANNUAL WOMEN AND HEART HEALTH INITIATIVE DURING THE MONTH OF FEBRUARY. EVENTS INCLUDE A WOMEN'S PRETTY PARTY IN RED OFFERING HEALTH SCREENINGS, HEART HEALTH EDUCATION AND A CELEBRATION OF HEART DISEASE SURVIVORSHIP. DUKE RALEIGH HOSPITAL IN CONJUNCTION WITH OTHERS WITHIN DUKE HEALTH WORK WITH THE AMERICAN HEART ASSOCIATION IN THE ANNUAL AMERICAN HEART WALK AT THE PNC ARENA. DUKE RALEIGH HOSPITAL DEPARTMENTS HOLD SEVERAL ON-CAMPUS FUNDRAISERS IN SUPPORT OF THE EVENT EACH YEAR.DUKE RALEIGH HOSPITAL'S EMPLOYEES ANNUALLY SUPPORT THE BACKPACK BUDDIES INITIATIVE COORDINATED THROUGH THE NC FOOD BANK.MIDTOWN FARMERS MARKET: DUKE RALEIGH HOSPITAL IS THE PRESENTING SPONSOR OF THE MIDTOWN FARMERS MARKET AND WELLNESS WEDNESDAYS LOCATED AT NORTH HILLS SHOPPING CENTER IN NORTH RALEIGH AND THE EXCLUSIVE HEALTH AND WELLNESS SUPPORTER. THE MARKET PROMOTES A HEALTHY LIFESTYLE FOR FAMILIES THROUGH THE PROVISION OF LOCAL PRODUCE, FRUITS, CHEESES AND OTHER PRODUCTS AVAILABLE EVERY SATURDAY MORNING FROM APRIL UNTIL NOVEMBER. DUKE RALEIGH HOSPITAL PROVIDES A WEEKLY BOOTH FOCUSING ON HEALTH AWARENESS AND EDUCATION. SOCIAL MEDIA: DUKE RALEIGH HOSPITAL'S SOCIAL MEDIA EFFORTS INCLUDE A COMMUNITY BLOG OFFERING HEALTHY RECIPES AND CONTENT TO SUPPORT A HEALTHY LIFESTYLE AND DELIVERED HEALTHY LIFESTYLE MESSAGES VIA SOCIAL MEDIA. CANCER: CANCER PATIENT NAVIGATOR PROGRAM: DUKE RALEIGH HOSPITAL'S PATIENT NAVIGATOR PROGRAM INCLUDES FOUR INDIVIDUALS WHO EACH HAVE A DISEASE-SPECIFIC FOCUS FOR THEIR PATIENT POPULATION. PATIENT NAVIGATORS PROVIDE IMPORTANT SUPPORT TO CANCER PATIENTS IN OBTAINING KNOWLEDGE AND RESOURCES TO HELP THEM COPE WITH THEIR CANCER DIAGNOSIS AND TO SERVE AS ADVOCATES FOR PATIENTS BY EMPOWERING THEM TO MAKE INFORMED DECISIONS ABOUT THEIR CARE.LUNG CANCER: DUKE CANCER CENTER RALEIGH'S LUNG CANCER CARE PROGRAM IS A MULTIDISCIPLINARY CLINIC COMPRISED OF LUNG CANCER SPECIALISTS WHO PROVIDE COMPREHENSIVE CARE. DUKE CANCER CENTER RALEIGH OFFERS A LUNG CANCER SCREENING CLINIC TO HELP THOSE AT RISK FOR LUNG CANCER AND A SURVIVORSHIP CLINIC TO EMPOWER LUNG CANCER SURVIVORS TO BE ENGAGED IN THEIR HEALTH. INDIVIDUALS AT HIGH RISK FOR DEVELOPING LUNG CANCER CAN PARTICIPATE IN THE LUNG CANCER SCREENING PROGRAM PROVIDING ACCESS TO THE MOST ADVANCED DIAGNOSTIC SCREENING TOOL: LOW-DOSE SPIRAL COMPUTED TOMOGRAPHY (CT) SCANS. IN ADDITION, SMOKING CESSATION EVALUATION AND COUNSELING IS PROVIDED AS WELL AS FOLLOW-UP TREATMENT IF NEEDED - ALL FROM A TEAM OF LUNG CANCER SPECIALISTS.COMMUNITY OUTREACH AND EDUCATION: DUKE RALEIGH HOSPITAL'S HEALTHY EDUCATION FOCUS EDUCATION SERIES INCORPORATED 2 CANCER-FOCUSED COMMUNITY PROGRAMS WHICH WERE ALSO RECORDED AND AVAILABLE ON YOU TUBE.
SUPPORT AND EDUCATION:	THE DUKE CANCER INSTITUTE IN WAKE COUNTY OFFERS A VARIETY OF SUPPORT SERVICES AVAILABLE AT NO COST TO CANCER CENTER PATIENTS AS WELL AS COMMUNITY MEMBERS.- CANCER SUPPORT GROUP: MONTHLY SUPPORT GROUP FOR PATIENTS LIVING WITH CANCER. THE GROUP IS OPEN TO PATIENTS WITH ANY TYPE OF CANCER, AND PATIENTS MAY BRING A FAMILY MEMBER IF THEY CHOOSE.- BREAST CANCER SUPPORT GROUP: PROVIDES A PLACE WHERE BREAST CANCER SURVIVORS CAN MEET OTHERS GOING THROUGH SIMILAR EXPERIENCES AND CAN ENJOY SUPPORT AND CAMARADERIE.- LOOK GOOD, FEEL BETTER: THIS SUPPORT GROUP WORKS WITH FEMALE CANCER PATIENTS TO IMPROVE THEIR APPEARANCE AND SELF-CONFIDENCE. MANY PATIENTS COMMENT ON THE MARKED IMPROVEMENT IN THEIR EMOTIONAL AND PHYSICAL HEALTH ONCE THEY FELT LIKE THEY LOOKED "NORMAL."- GYNECOLOGIC ONCOLOGY SUPPORT GROUP: THIS GROUP OFFERS A COMPASSIONATE AND UNDERSTANDING PLACE FOR PATIENTS WITH GYNECOLOGIC CANCER TO DISCUSS THEIR EXPERIENCES AND FIND SUPPORT THROUGH OTHERS.- SELF-HYPNOSIS TRAINING FOR CANCER PATIENTS: PATIENTS LEARN HOW TO USE SELF-HYPNOSIS TO HELP IN MANAGING ILLNESS AND SYMPTOMS, REDUCING PAIN AND STRESS, CONTROLLING THE SIDE EFFECTS OF MEDICATIONS AND RADIATION THERAPIES, AND GENERALLY ENHANCING QUALITY OF LIFE. THIS FOUR-WEEK COURSE IS AVAILABLE FREE OF CHARGE FOR CANCER PATIENTS.COMMUNITY OUTREACH:LUNG CANCER INITIATIVE OF NORTH CAROLINA: DUKE RALEIGH HOSPITAL HAS BEEN THE PRESENTING SPONSOR OF THE LUNG CANCER INITIATIVE OF NORTH CAROLINA LUNGE FORWARD 5K RUN/WALK SINCE ITS INCEPTION IN 2007. PROCEEDS FROM THIS ANNUAL EVENT SUPPORT LUNG CANCER RESEARCH AND ADVOCACY IN NORTH CAROLINA.OVARIAN CANCER AWARENESS WALK: THIS ANNUAL EVENT BENEFITS THE DUKE GYNECOLOGIC ONCOLOGY PROGRAM AND PROVIDES MUCH NEEDED FUNDING FOR RESEARCH AND EDUCATION FOR OVARIAN CANCER. DUKE RALEIGH HOSPITAL CANCER CENTER STAFFS A PATIENT RESOURCE AND EDUCATION BOOTH AT THIS EVENT EACH YEAR.ACCESS TO CARE:URBAN MINISTRIES OPEN DOOR CLINIC: DUKE RALEIGH HOSPITAL HAS WORKED WITH URBAN MINISTRIES SINCE THE INCEPTION OF THE OPEN DOOR CLINIC IN 1985. THE IN-KIND LAB SERVICES PROVIDED TO URBAN MINISTRIES BY DUKE RALEIGH HOSPITAL WAS VALUED AT $1.8 MILLION IN FY16. MANY DUKE RALEIGH STAFF INCLUDING NURSES AND PHYSICIANS HAVE ALSO CONTRIBUTED TIME TO THE OPEN DOOR CLINIC.ALLIANCE MEDICAL MINISTRIES (AAM): DUKE RALEIGH HOSPITAL CONTINUES TO PROVIDE MEDICAL AND FINIANCIAL SUPPORT THROUGH ITS RELATIONSHIP WITH AAM. AMM PROVIDES WORKING, UNINSURED PATIENTS, AGES 18-64 AND ADULT FAMILY MEMBERS WITH PRIMARY CARE AND ACCESS TO AFFORDABLE AND HIGH QUALITY HEALTH CARE.DUKE RALEIGH HOSPITAL PARTICIPATED IN THE 4TH CONGRESSIONAL DISTRICT HEALTH FAIR IN APRIL 2016, WHICH IS OPEN TO THE PUBLIC, WITH SPECIAL EMPHASIS ON HOMELESS, SENIORS, AND VETERAN POPULATIONS. DUKE RALEIGH STAFF WORKING WITH DUKE HEART CENTER PROVIDED HANDS ON CPR TRAINING.THE DUKE RALEIGH LIFESTYLE AND DISEASE MANAGEMENT CENTER PROVIDES A DIABETES EDUCATION PROGRAM OF TWO, THREE-HOUR CLASSES IN BOTH ENGLISH AND SPANISH FOR AAM PATIENTS. THROUGH THE CLASS, PARTICIPANTS LEARN HOW TO MANAGE THEIR DIABETES AS WELL AS HEALTHY COOKING AND DINING OPTIONS. DUKE RALEIGH HOSPITAL STAFF EVALUATE THREE, SIX AND 12-MONTH FOLLOW-UP DATA ON PARTICIPANTS TO MEASURE THE EFFECTIVENESS OF THE PROGRAM AND THE PARTICIPANT'S DIABETES METRICS INCLUDING GLUCOSE LEVEL, A1C, BMI AND WEIGHT.PROJECT ACCESS: DUKE RALEIGH HOSPITAL PROVIDED $2.2 MILLION OF IN-KIND SUPPORT IN FY16. MANY OF DUKE RALEIGH HOSPITAL'S MEDICAL STAFF SUPPORT THIS PROGRAM PROVIDING FREE CARE TO POOR, UNINSURED MEN, WOMEN AND CHILDREN IN WAKE COUNTY. THE PROGRAM OPERATES THROUGH THE COLLABORATION OF COMMUNITY HEALTH CLINICS, HOSPITALS AND PHYSICIANS. PATIENTS ARE REFERRED INTO THE PROGRAM IN ORDER TO BE ABLE TO ACCESS THE FREE MEDICAL SERVICES.WAKE COUNTY MEDICAL SOCIETY COMMUNITY HEALTH FOUNDATION: DUKE RALEIGH HOSPITAL IS AN ACTIVE PARTICIPANT IN THE WAKE COUNTY MEDICAL SOCIETY COMMUNITY HEALTH FOUNDATION WHICH SEEKS COLLABORATIVE WAYS TO ADDRESS THE NEEDS OF UNINSURED AND MEDICAID PATIENTS AND INCLUDES CAPITAL CARE COLLABORATIVE, COMMUNITY CARE OF NC, AND PROJECT ACCESS. DUKE RALEIGH HOSPITAL'S DIRECTOR OF CASE MANAGEMENT PROVIDES LEADERSHIP AS A MEMBER OF THE ADVISORY BOARD FOR THE COMMUNITY HEALTH FOUNDATION.NORTH CAROLINA-VIRGINIA HOSPITAL ENGAGEMENT NETWORK (HEN): DUKE RALEIGH HOSPITAL IS THE ONLY HOSPITAL IN WAKE COUNTY PARTICIPATING IN THIS INITIATIVE THROUGH THE NORTH CAROLINA HOSPITAL ASSOCIATION (NCHA) AND THE CAROLINAS CENTER FOR MEDICAL EXCELLENCE (CCME) AS A PART OF THE CENTERS FOR MEDICARE & MEDICAID SERVICES (CMS) $1 BILLION PARTNERSHIP FOR PATIENTS INITIATIVE. THE GOAL FOR THE INITIATIVE IS TO MAKE MEANINGFUL STRIDES IN ADVANCING THE QUALITY, SAFETY AND AFFORDABILITY OF HEALTH CARE. TEN AREAS OF FOCUS THROUGH THE HEN ARE ADVERSE DRUG EVENTS, CATHETER-ASSOCIATED URINARY TRACT INFECTIONS, CENTRAL LINE-ASSOCIATED BLOOD STREAM INFECTIONS, INJURIES FROM FALLS AND IMMOBILITY, OBSTETRICAL ADVERSE EVENTS, PRESSURE ULCERS, SURGICAL SITE INFECTIONS, VENOUS THROMBOEMBOLISM, VENTILATOR-ASSOCIATED PNEUMONIA AND PREVENTABLE READMISSIONS.DUKE RALEIGH HOSPITAL'S AREA OF FOCUS AS A PART OF THE HEN IS TO REDUCE READMISSIONS BY 20 PERCENT. DUKE RALEIGH HOSPITAL STAFF WORKED CLOSELY WITH PRIMARY CARE PHYSICIANS TO STREAMLINE COMMUNICATIONS AND IMPLEMENT A NEW PROTOCOL FOR PRIMARY CARE PHYSICIANS TO BE NOTIFIED WITHIN 48 HOURS OF A PATIENT'S ADMISSION. UPON DISCHARGE, A FOLLOW-UP APPOINTMENT IS SCHEDULED WITH THE PATIENT'S PRIMARY CARE PHYSICIAN WITHIN SEVEN DAYS.HOSPITAL LONG-TERM CARE COLLABORATION: DUKE RALEIGH HOSPITAL IS A PART OF THIS COLLABORATION THAT INCLUDES ALL THREE WAKE COUNTY HOSPITALS AND A PORTION OF SKILLED NURSING FACILITIES, ASSISTED LIVING FACILITIES AND HOME HEALTH ORGANIZATIONS. THE GOAL OF THE COLLABORATION IS TO BETTER UNDERSTAND THE REGULATORY REQUIREMENTS AND OTHER IMPORTANT PROCESSES THAT WOULD AFFECT A PATIENT BEING TRANSFERRED FROM THE HOSPITAL INTO THE CARE OF ANOTHER POST-ACUTE CARE PROVIDER. THE GROUP HAS ALREADY DEVELOPED LITERATURE PROVIDED TO PATIENTS UPON DISCHARGE THAT OUTLINES REALISTIC EXPECTATIONS IN A SKILLED NURSING FACILITY (SNF), HOME HOSPICE, HOME HEALTH OR AN ASSISTED LIVING FACILITY.DUKE RALEIGH HOSPITAL'S CASE MANAGEMENT TEAM VISITS NURSING HOMES AND OTHER POST-ACUTE CARE PROVIDERS TO BETTER COLLABORATE AND TO DETERMINE WHAT OPPORTUNITIES EXIST IN THE PATIENT TRANSITION PROCESS. THE DUKE RALEIGH HOSPITAL TEAM ALSO REVIEWS ALL READMISSIONS WITH THE POST-ACUTE PROVIDER TO DETERMINE WHAT OPPORTUNITIES MAY EXIST. AS A RESULT, THE DUKE RALEIGH HOSPITAL TEAM INSTITUTED A PROTOCOL TO MAKE A FOLLOW-UP CALL TO THE PATIENT'S POST-ACUTE CARE PROVIDER ONE DAY AFTER TRANSFER. THIS NEW PROCESS HAS PREVENTED READMISSIONS IN SEVERAL INSTANCES.WAKE CRISIS COOPERATIVE: THE COOPERATIVE INCLUDES ALL WAKE COUNTY HOSPITALS, REPRESENTATIVES FROM MENTAL HEALTH, LAW ENFORCEMENT AND OTHER STAKEHOLDERS IN CRISIS RESPONSE IN WAKE COUNTY. THE COOPERATIVE HAS:- STANDARDIZED THE MENTAL HEALTH ASSESSMENT TOOL FOR HEALTHCARE PROVIDERS IN WAKE COUNTY.- DEVELOPED MENTAL HEALTH AND SUBSTANCE ABUSE TRANSFER GUIDELINES FROM ACUTE TO INPATIENT TO BE USED ACROSS NORTH CAROLINA.- DEFINED HIGH ACUITY PATIENTS TO ASSIST IN PRIORITIZATION OF PATIENTS FROM THE EMERGENCY DEPARTMENT.- DEVELOPED A UNIFORM PROCESS FOR INVOLUNTARY COMMITMENT.- DESIGNED A ROTATION SCHEDULE FOR ACCEPTING PATIENTS WHEN THE MENTAL HEALTH CENTER GOES ON DIVERSION.DRAH DID NOT ADDRESS DENTAL CARE AS DENTAL CARE IS NOT OFFERED AS PART OF DRAH'S CONTINUUM OF SERVICES.FROM SEPTEMBER 2015 THROUGH JUNE 2016, DRAH COLLABORATED WITH WAKE COUNTY HUMAN SERVICES, WAKEMED HEALTH AND HOSPITALS, UNC REX HEALTHCARE, ADVANCE COMMUNITY HEALTH, UNITED WAY OF THE GREATER TRIANGLE, AND THE WAKE COUNTY MEDICAL SOCIETY COMMUNITY HEALTH FOUNDATION TO DEVELOP THE WAKE COUNTY 2016 COMMUNITY HEALTH NEEDS ASSESSMENT.DUKE RALEIGH HOSPITAL:PART V, SECTION B, LINE 16I: DUHS PROVIDES A BROCHURE TO ALL ADMISSIONS THAT INCLUDES A BRIEF SUMMARY OF DUHS FINANCIAL ASSISTANCE POLICIES. DUHS ALSO COMMENTS ON THE BACK OF ITS BILLING INVOICES THAT PATIENTS SHOULD CONTACT PATIENT ACCOUNT REPRESENTATIVES TO HELP THEM IF THEY CANNOT PAY THEIR BILL IN FULL. THIS COMMENT REFERENCES GOVERNMENT-SPONSORED PROGRAMS, MONTHLY PAYMENT PROGRAMS, AND OTHER FINANCIAL ASSISTANCE PROGRAMS AVAILABLE FOR PATIENTS WHO MEET CERTAIN FINANCIAL CRITERIA. DUHS ALSO PUBLICIZED ITS FINANCIAL ASSISTANCE POLICY VERBALLY THROUGH ITS FINANCIAL CARE COUNSELORS.DUKE RALEIGH HOSPITAL:PART V, SECTION B, LINE 22D: DUHS USED THE LOOK BACK METHOD AND SUMMED ALL CLAIMS SUBMITTED TO MEDICARE AND ALL PRIVATE HEALTH INSURERS DURING THE PRIOR 12 MONTH PERIOD DIVIDED BY THE SUM OF THE ASSOCIATED GROSS CHARGES RELATED TO THOSE CLAIMS.
DUKE RALEIGH HOSPITAL:	PART V, SECTION B, LINE 24: CERTAIN ELECTIVE COSMETIC/AESTHETIC SERVICES, AND OTHER SERVICES NOT COVERED BY INSURANCE, WILL BE BILLED AT AN AMOUNT EQUAL TO GROSS CHARGES.SCHEDULE H, PART V, SECTION B.GROUP A - FACILITY 3 - DUKE REGIONAL HOSPITAL:PART V, SECTION B, LINE 5: DUKE REGIONAL HOSPITAL ("DRH") WAS A PARTICIPANT IN THE 2014 DURHAM COMMUNITY HEALTH ASSESSMENT, LED BY PARTNERSHIP FOR A HEALTHY DURHAM. THE ASSESSMENT PROCESS INCLUDED 354 CITIZEN SURVEYS FROM RANDOMLY SELECTED HOUSEHOLDS AND 8 COMMUNITY LISTENING SESSIONS WITH 205 COMMUNITY MEMBERS. REPRESENTATIVES FROM DUKE UNIVERSITY HOSPITAL (DUH) AND DRH PARTICIPATED AS MEMBERS ON THE COMMUNITY HEALTH ASSESSMENT TEAM ALONG WITH REPRESENTATIVES FROM OTHER UNIVERSITIES, LOCAL GOVERNMENT, SCHOOLS, NON-PROFIT ORGANIZATIONS, AND BUSINESSES. THE COMMUNITY HEALTH ASSESSMENT TEAM WORKED TO DIRECT THE ACTIVITIES OF THE ASSESSMENT AND PROVIDE WRITTEN CONTENT AND EXPERTISE ON ISSUES OF INTEREST. THIS JOINT CHNA AND RELATED IMPLEMENTATION PLAN WAS ADOPTED BY THE DUHS BOARD OF DIRECTORS AND PUBLISHED ON THE DUKE HEALTH WEBSITE IN FISCAL YEAR 2016 (TAX YEAR 2015).GROUP A - FACILITY 3 - DUKE REGIONAL HOSPITAL:PART V, SECTION B, LINE 6A: DUKE UNIVERSITY HOSPITALGROUP A - FACILITY 3 - DUKE REGIONAL HOSPITAL:PART V, SECTION B, LINE 6B: THE PARTNERSHIP FOR A HEALTHY DURHAM AND THE DURHAM COUNTY HEALTH DEPARTMENTGROUP A - FACILITY 3 - DUKE REGIONAL HOSPITAL:PART V, SECTION B, LINE 7A: THE CHNA IS AVAILABLE ON THE WEBSITE BY NAVIGATING TO WWW.DUKEHEALTH.ORG, CLICK ON "PATIENTS & VISITORS", THEN "FINANCIAL ASSISTANCE", THEN "COMMUNITY HEALTH NEEDS ASSESSMENT; CLICK THE LINK FOR "DETAILS OF OUR COMMUNITY INVOLVEMENT CAN BE FOUND HERE; AND THEN CLICK ON "COMMUNITY HEALTH."GROUP A - FACILITY 3 - DUKE REGIONAL HOSPITAL:PART V, SECTION B, LINE 10ATHE IMPLEMENTATION STRATEGY AND PROGRESS REPORTS ARE AVAILABLE ON THE WEBSITE BY NAVIGATING TO HTTP://WWW.DUKEHEALTH.ORG, CLICK ON "PATIENTS & VISITORS", THEN "FINANCIAL ASSISTANCE", THEN "COMMUNITY HEALTH NEEDS ASSESSMENT; CLICK THE LINK FOR "DETAILS OF OUR COMMUNITY INVOLVEMENT CAN BE FOUND HERE; AND THEN CLICK ON "COMMUNITY HEALTH." CHOOSE ONE OF THE LINKS FOR THE DUKE REGIONAL HOSPITAL PROGRESS REPORT AND IMPLEMENTATION PLAN.GROUP A - FACILITY 3 - DUKE REGIONAL HOSPITAL:PPART V, SECTION B, LINE 11: DRH CHNA IDENTIFIED SIX HEALTH PRIORITIES FOR 2015 - 2017:1. OBESITY AND CHRONIC ILLNESS2. POVERTY3. EDUCATION4. ACCESS TO MEDICAL AND DENTAL CARE5. MENTAL HEALTH AND SUBSTANCE ABUSE6. HIV AND SEXUALLY TRANSMITTED INFECTIONSACTIONS TAKEN TO ADDRESS THE SIGNIFICANT HEALTH NEEDS IDENTIFIED IN THE CHNA ARE AS FOLLOWS:1. OBESITY AND CHRONIC ILLNESS:LOOK GOOD FEEL BETTER: THE AMERICAN CANCER SOCIETY'S LOOK GOOD FEEL BETTER PROGRAM PROVIDES SUPPORT FOR FEMALE CANCER TREATMENT PATIENTS WHO HAVE EXPERIENCED HAIR LOSS OR OTHER PHYSICAL APPEARANCE CHANGES DUE TO CHEMOTHERAPY OR RADIATION TREATMENTS.STROKE AWARENESS: DUKE REGIONAL HOSPITAL OFFERS A MONTHLY STROKE SUPPORT GROUP TO EDUCATE STROKE SURVIVORS, CARE GIVERS AND PEOPLE IN THE COMMUNITY ABOUT STROKE PREVENTION AND STROKE DISABILITIES. APPROXIMATELY 25 PEOPLE ATTEND THE GROUP EACH MONTH.2. POVERTY:FILL THAT BUS: EMPLOYEES DONATED BINS OF SCHOOL SUPPLIES TO FILL THAT BUS IN AUGUST TO SUPPORT DURHAM PUBLIC SCHOOLS. TEACHERS FROM THE HIGHEST POVERTY SCHOOLS WERE INVITED TO PICK OUT SUPPLIES NEEDED IN THEIR CLASSROOMS.SALVATION ARMY ANGEL TREE: EACH DECEMBER, EMPLOYEES ADOPT APPROXIMATELY 100 ANGELS FROM DUKE REGIONAL'S SALVATION ARMY ANGEL TREE. CHILDREN IN DURHAM HAVE RECEIVED BIKES, CLOTHING, DOLLS AND TOYS THANKS TO THE GENEROUS DONATIONS. EXTRA GIFTS ARE ALSO DONATED TO THE SALVATION ARMY FOR OTHER NEEDY FAMILIES IN THE AREA.3. EDUCATION:BYSTANDER CPR: TO CELEBRATE HEART MONTH IN FEBRUARY, DUKE REGIONAL OFFERS A FREE SEMINAR CALLED AND THE BEAT GOES ON...." PARTICIPANTS LEARN BYSTANDER CPR FROM DUKE REGIONAL EDUCATION SERVICES AND THE WARNING SIGNS AND TREATMENTS FOR ATRIAL FIBRILLATION. EDUCATION SERVICES ALSO PROVIDES A HEART SAVER CPR CLASS FOR A LOCAL YOUTH ORGANIZATION.HEALTH PROFESSIONS EDUCATION: DUKE REGIONAL HOSPITAL IS COMMITTED TO HELPING TRAIN THE HEALTHCARE WORKERS OF THE FUTURE. IN FY 2016, DRH CONTRIBUTED $3.4 MILLION TOWARD THE TRAINING AND TEACHING OF TOMORROW'S HEALTHCARE PROFESSIONALS.PROJECT SEARCH: DUKE REGIONAL HOSPITAL IS THE HOST BUSINESS FOR PROJECT SEARCH, AN EFFORT WITH DURHAM PUBLIC SCHOOLS, OE ENTERPRISES, VOCATIONAL REHAB AND DURHAM CENTER ACCESS THAT PROVIDES CAREER DEVELOPMENT EXPERIENCES TO SENIOR HIGH SCHOOL STUDENTS WITH DEVELOPMENTAL DISABILITIES. THE STUDENTS, ACCOMPANIED BY A TEACHER, TEACHER'S ASSISTANT AND JOB COACHES, COMPLETE INTERNSHIPS IN SEVERAL HOSPITAL DEPARTMENTS.CITY OF MEDICINE ACADEMY: DRH HAS WORKED IN CONJUNCTION WITH CITY OF MEDICINE ACADEMY (CMA) AND DURHAM PUBLIC SCHOOLS SINCE THE PROGRAM'S INCEPTION AT SOUTHERN HIGH SCHOOL IN THE 1990S. AS PART OF THAT EFFORT, DUKE REGIONAL HOSTS STUDENTS FOR CLINICAL ROTATIONS AND INTERNSHIPS, PROVIDES CPR TRAINING AND HOSTS THE ANNUAL SENIOR AWARDS NIGHT.4. ACCESS TO MEDICAL AND DENTAL CARE:LINCOLN COMMUNITY HEALTH CENTER: LINCOLN COMMUNITY HEALTH CENTER (LCHC) IS A FEDERALLY QUALIFIED COMMUNITY HEALTH CENTER THAT PROVIDES PRIMARY CARE SERVICES FOR ABOUT 40,000 PATIENTS EACH YEAR. APPROXIMATELY 80 PERCENT OF LCHC PATIENTS ARE UNINSURED AND LIVING AT OR BELOW THE POVERTY LEVEL. IN ADDITION TO GENEROUS FINANCIAL SUPPORT, DUKE REGIONAL PROVIDES ENGINEERING, ENVIRONMENTAL, LABORATORY, PHARMACY, RADIOLOGY AND INFORMATION TECHNOLOGY SERVICES. THE TOTAL DUKE REGIONAL HOSPITAL CONTRIBUTION TO LCHC IN FY 2016, INCLUDING MONETARY AND IN-KIND SERVICES, WAS MORE THAN $7.4 MILLION. DURHAM COUNTY EMERGENCY MEDICAL SERVICES: DURHAM COUNTY EMERGENCY MEDICAL SERVICES (EMS) SERVES AS THE PRIMARY PROVIDER OF EMERGENCY AMBULANCE SERVICES AND ALTERNATIVE MEDICAL TRANSPORTATION IN DURHAM COUNTY. IN FY 2016, DUKE REGIONAL HOSPITAL PAID THE COUNTY MORE THAN $2.4 MILLION TO SUPPORT DURHAM EMS. PROJECT ACCESS DURHAM COUNTY: PROJECT ACCESS OF DURHAM COUNTY (PADC) COORDINATES SPECIALTY CARE AT NO CHARGE TO UNINSURED AND UNDERINSURED DURHAM RESIDENTS LIVING AT OR BELOW 200 PERCENT OF THE FEDERAL POVERTY LEVEL. THESE RESIDENTS HAVE ACCESS TO PRIMARY HEALTH CARE THROUGH LINCOLN COMMUNITY HEALTH CENTER.CHARITY CARE: EACH YEAR DUKE REGIONAL HOSPITAL PROVIDES NO-COST OR DISCOUNTED URGENT OR EMERGENT HEALTH CARE SERVICES TO PATIENTS WHO WERE UNABLE TO PAY. IN FY 2016 DUKE REGIONAL PROVIDED $21.4 MILLION AT ESTIMATED COST IN CHARITY CARE.5. MENTAL HEALTH AND SUBSTANCE ABUSE:DURHAM CENTER ACCESS (OAKLEIGH) EACH YEAR DUKE REGIONAL HOSPITAL PROVIDES $100,000 TO SUPPORT DURHAM CENTER ACCESS, AN INPATIENT TREATMENT FACILITY FOR MENTAL HEALTH, DEVELOPMENTAL DISABILITY AND SUBSTANCE ABUSE SERVICES.6. HIV AND SEXUALLY TRANSMITTED INFECTIONS: DRH DOES NOT HAVE A SPECIFIC GOAL TO ADDRESS THE RATE OF HIV AND SEXUALLY TRANSMITTED INFECTIONS BECAUSE CONSIDERABLE WORK IS ALREADY BEING DONE THROUGH ORGANIZATIONS WITHIN THE COMMUNITY. THROUGH THE PARTNERSHIP FOR A HEALTHY DURHAM, THE HIV/STI ADVISORY COUNCIL BRINGS TOGETHER COMMUNITY MEMBERS AND AGENCIES TO FOCUS ON STRATEGIES TO PREVENT THE SPREAD OF SYPHILIS AND HIV/AIDS. IN ADDITION, LINCOLN COMMUNITY HEALTH CENTER, WHICH DUKE REGIONAL HOSPITAL SUPPORTS, OPERATES AN EARLY INTERVENTION CLINIC FOR PATIENTS WITH HIV/AIDS AT THE DURHAM COUNTY HEALTH DEPARTMENT.GROUP A - FACILITY 3 - DUKE REGIONAL HOSPITALPART V, SECTION B, LINE 16I: DUHS PROVIDES A BROCHURE TO ALL ADMISSIONS THAT INCLUDES A BRIEF SUMMARY OF DUHS FINANCIAL ASSISTANCE POLICIES. DUHS ALSO COMMENTS ON THE BACK OF ITS BILLING INVOICES THAT PATIENTS SHOULD CONTACT PATIENT ACCOUNT REPRESENTATIVES TO HELP THEM IF THEY CANNOT PAY THEIR BILL IN FULL. THIS COMMENT REFERENCES GOVERNMENT-SPONSORED PROGRAMS, MONTHLY PAYMENT PROGRAMS, AND OTHER FINANCIAL ASSISTANCE PROGRAMS AVAILABLE FOR PATIENTS WHO MEET CERTAIN FINANCIAL CRITERIA. DUHS ALSO PUBLICIZED ITS FINANCIAL ASSISTANCE POLICY VERBALLY THROUGH ITS FINANCIAL CARE COUNSELORS.GROUP A - FACILITY 3 - DUKE REGIONAL HOSPITAL:PART V, SECTION B, LINE 22D: DUHS USED THE LOOK BACK METHOD AND SUMMED ALL CLAIMS SUBMITTED TO MEDICARE AND ALL PRIVATE HEALTH INSURERS DURING THE PRIOR 12 MONTH PERIOD DIVIDED BY THE SUM OF THE ASSOCIATED GROSS CHARGES RELATED TO THOSE CLAIMS.PART V, SECTION B, LINE 24: CERTAIN ELECTIVE COSMETIC/AESTHETIC SERVICES, AND OTHER SERVICES NOT COVERED BY INSURANCE, WILL BE BILLED AT AN AMOUNT EQUAL TO GROSS CHARGES.

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?2
Name and address		Type of Facility (describe)
1	1 - HOSPICE OF MEADOWLANDS 1001 CORPORATE DRIVE HILLSBOROUGH,NC27278	HOSPICE
2	2 - HOCK FAMILY PAVILION 4023 NORTH ROXBORO ROAD DURHAM,NC27704	HOSPICE
3
4
5
6
7
8
9
10

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:	NOT APPLICABLEPART I, LINE 6A:NOT APPLICABLEPART I, LINE 7G:NOT APPLICABLEPART I, LINE 7, COLUMN F:TOTAL GROSS COMMUNITY BENEFIT EXPENSE AS A PERCENT OF TOTAL EXPENSES IS 9.35%.PART I, LINE 7:CHARITY CARE AT COST IS DETERMINED USING THE COST-TO-CHARGE CALCULATION FROM WORKSHEET 2, IN ORDER TO CALCULATE THE AMOUNTS REPORTED ON THE TABLE. UNREIMBURSED MEDICAID IS DETERMINED USING A COST ACCOUNTING SYSTEM THAT ADDRESSES ALL PATIENT SEGMENTS.PART II, COMMUNITY BUILDING ACTIVITIES:THESE ACTIVITIES ARE INCLUDED IN DUKE UNIVERSITY HEALTH SYSTEM, INC.'S (DUHS) OPERATING EXPENSES AND ARE NOT TRACKED SEPARATELY FOR COMMUNITY BENEFIT REPORTING PURPOSES.PART III, LINE 2:BAD DEBT AT COST IS DETERMINED USING THE COST-TO-CHARGE RATIO CALCULATION FROM WORKSHEET 2.PART III, LINE 3:A PORTION OF BAD DEBT EXPENSE SHOULD BE INCLUDED AS A COMMUNITY BENEFIT, BUT THE PORTION THAT IS ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER OUR FINANCIAL ASSISTANCE POLICY IS INDETERMINABLE BECAUSE THOSE PATIENTS FAIL TO APPLY FOR OR PROVIDE INFORMATION NEEDED TO DETERMINE THEIR ELIGIBILITY UNDER THE DUHS FAP. DUHS, INC. FOLLOWS ITS MISSION TO THE COMMUNITY AND PROVIDES EMERGENT SERVICES TO PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. BAD DEBT IS FURTHER COMPLICATED BY DOCUMENTATION REQUIRED BY THE CENTERS FOR MEDICARE AND MEDICAID SERVICES (CMS) FOR REPORTING CHARITY CARE. THEREFORE, PATIENTS WHO MAY QUALIFY FOR CHARITY CARE ARE REPORTED AS BAD DEBT EXPENSE INSTEAD BECAUSE OF THOSE PATIENTS' INABILITY OR UNWILLINGNESS TO PROVIDE THE NECESSARY DOCUMENTATION REQUIRED TO DETERMINE CHARITY CARE CLASSIFICATION.PART III, LINE 4:PAGES 16-18 IN THE FY2016 AUDITED FINANCIAL STATEMENT FOOTNOTES DESCRIBE BAD DEBT EXPENSE.PART III, LINE 7:TOTAL UNREIMBURSED COSTS ATTRIBUTABLE TO PROVIDING SERVICES UNDER MEDICARE AS REPORTED IN THE JUNE 30, 2016 DUHS CONSOLIDATED FINANCIAL STATEMENTS ARE $183,077,000 AS COMPARED TO $77,850,174 AS REPORTED IN SECTION B, LINE 7 OF SCHEDULE H. THE DUHS TOTAL MEDICARE SHORTFALL OF $183,077,000 IS DERIVED FROM THE COST ACCOUNTING SYSTEM WHICH INCLUDES ALL PAYMENTS AND COSTS ASSOCIATED WITH MEDICARE PATIENTS, WHEREAS THE AMOUNT REPORTED IN SECTION B OF SCHEDULE H IS DERIVED BASED ON IRS INSTRUCTIONS. IRS INSTRUCTIONS SPECIFY THAT ONLY A PORTION OF COSTS ASSOCIATED WITH MEDICARE BENEFICIARIES BE REPORTED ON SCHEDULE H. SIGNIFICANT MEDICARE COSTS EXCLUDED FROM SCHEDULE H DATA INCLUDE THOSE ASSOCIATED WITH MEDICARE PATIENTS COVERED UNDER MANAGED CARE PLANS AND COSTS REIMBURSED THROUGH MEANS NOT REPORTED ON THE COST REPORT.PART III, LINE 8:MEDICARE RATES AND THE NUMBER OF MEDICARE PATIENTS DUHS TREATS ARE NOT NEGOTIATED. MEDICARE DOES NOT FULLY COMPENSATE DUHS FOR THE COST OF PROVIDING CARE TO MEDICARE BENEFICIARIES. DUHS CONTINUES TO SERVE THE MEDICARE POPULATION AS MEDICARE REIMBURSEMENT RATES DECLINE RELATIVE TO THE COST OF CARE. THEREFORE, ANY LOSS RELATED TO PROVIDING CARE FOR MEDICARE PATIENTS SHOULD BE CLASSIFIED AS A COMMUNITY BENEFIT. DUHS FOLLOWED THE MEDICARE COST REPORT RULES AND GUIDELINES IN DETERMINING THE COSTS REPORTED ON LINE 6. THESE RULES USE A VARIETY OF DIFFERENT METHODOLOGIES BASED ON THE TYPE OF SERVICE.PART III, LINE 9B:COLLECTION EFFORTS ARE IMMEDIATELY STOPPED FOR PATIENTS WHO SUBMIT A FINANCIAL ASSISTANCE APPLICATION. PATIENTS WHO QUALIFY FOR FINANCIAL ASSISTANCE ARE NOT PURSUED USING ANY DEBT COLLECTION PRACTICES.
NEEDS ASSESSMENT:	PART VI, LINE 2:DUHS USES SEVERAL MECHANISMS TO ASSESS AND ADDRESS THE HEALTH CARE NEEDS OF THE COMMUNITIES IT SERVES. IN DURHAM COUNTY, DUHS AND THE DUKE UNIVERSITY SCHOOL OF MEDICINE FACULTY ARE ACTIVELY INVOLVED IN THE PARTNERSHIP FOR A HEALTHY DURHAM. THE PARTNERSHIP IS A COALITION OF LOCAL ORGANIZATIONS AND COMMUNITY MEMBERS WITH THE GOAL OF COLLABORATIVELY IMPROVING THE PHYSICAL, MENTAL, SOCIAL, HEALTH, AND WELL-BEING OF DURHAM COUNTY'S RESIDENTS. THE NETWORK IS A CERTIFIED HEALTH CAROLINIAN'S WORKGROUP. THE PARTNERSHIP EVALUATES COMMUNITY HEALTH CARE INFORMATION, THEN IDENTIFIES AND PRIORITIZES COMMUNITY-IDENTIFIED HEALTH CARE NEEDS AMONG SUBCOMMITTEES THAT FOCUS ON A DURHAM COUNTY HEALTH PRIORITY. SINCE 2002, DUHS' OFFICE OF COMMUNITY RELATIONS HAS PLAYED A CENTRAL ROLE IN CONDUCTING A DURHAM HEALTH SUMMIT. THIS IS AN EVENT THAT ATTRACTS HUNDREDS OF COMMUNITY MEMBERS, HEALTH OFFICIALS, ELECTED OFFICIALS, AND DUHS EXECUTIVES AND PHYSICIANS TO RAISE AWARENESS OF KEY HEALTH ISSUES IN THE COMMUNITY AND SEEK COLLABORATIVE SOLUTIONS TO THESE ISSUES. THE SUMMIT HAS PRODUCED A NUMBER OF COMMUNITY-DRIVEN HEALTH CARE PROGRAMS AND INITIATIVES, INCLUDING SPECIALTY PROJECT ACCESS, IN WHICH PHYSICIANS WHO PRACTICE AT DUHS FACILITIES AND OTHER DURHAM COUNTY PHYSICIANS OFFER FREE SPECIALTY CARE SERVICES TO RESIDENTS WHO OTHERWISE COULD NOT AFFORD SPECIALTY CARE. DUHS ALSO PLAYS A CENTRAL ROLE IN REGIONAL AND STATE HEALTH CARE SUMMITS USING THE SUMMITS' INFORMATION AND DATA TO ADDRESS THE HEALTH CARE NEEDS OF THOSE BROADER COMMUNITIES.PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE:PART VI, LINE 3:DUHS EMPLOYS NUMEROUS MEANS TO EDUCATE PATIENTS ABOUT THEIR ELIGIBILITY FOR ASSISTANCE UNDER FEDERAL, STATE, OR LOCAL GOVERNMENT PROGRAMS OR UNDER THE DUHS CHARITY CARE POLICY. DETAILED INFORMATION IS POSTED ON WWW.DUKEHEALTH.ORG (DUHS' WEBSITE) ALONG WITH HARDCOPY BROCHURES THAT ARE AVAILABLE IN ENGLISH OR SPANISH AT ALL OF OUR PATIENT REGISTRATION LOCATIONS. ALL INPATIENTS AND EMERGENCY DEPARTMENT PATIENTS ARE ALSO PROVIDED WITH A HARDCOPY, ONE-PAGE SUMMARY OF THE WAYS DUHS CAN ASSIST PATIENTS FINANCIALLY. FOR OUTPATIENTS, THIS SAME ONE-PAGE SUMMARY IS PROVIDED ON THEIR FIRST VISIT TO THE INSTITUTION. IN ADDITION, DUHS EMPLOYS FINANCIAL CARE COUNSELORS WHO MEET INDIVIDUALLY WITH PATIENTS WHO HAVE QUESTIONS REGARDING PAYMENT FOR THEIR CARE. DUHS ALSO EMPLOYS MEDICAID ASSISTANCE COUNSELORS WHO SPECIALIZE IN ASSISTING PATIENTS TO APPLY FOR MEDICAID, DISABILITY, AND OTHER FEDERAL, STATE, AND LOCAL PROGRAMS. DUHS ASSISTS BETWEEN 12,000-15,000 PATIENTS IN APPLYING AND BECOMING ELIGIBLE FOR THESE PROGRAMS ANNUALLY. FINALLY, PATIENTS MAY ALWAYS CONTACT DUHS' TOLL FREE CUSTOMER SERVICE NUMBER TO REQUEST INFORMATION ABOUT THEIR BILL OR OBTAIN A CHARITY CARE APPLICATION.
COMMUNITY INFORMATION:	PART VI, LINE 4:DUHS SERVES A BROAD, CULTURALLY, RACIALLY AND SOCIALLY DIVERSE GEOGRAPHIC AND DEMOGRAPHIC REGION. DUHS' HOME CITY OF DURHAM IS THE CORE, BUT DUHS' REACH EXTENDS INTO THE SURROUNDING RESEARCH TRIANGLE AREA OF NORTH CAROLINA AND THE STATE'S LARGER NORTHERN PIEDMONT REGION, AS WELL AS STATEWIDE, NATIONALLY AND GLOBALLY. DUHS PRIMARY SERVICE AREA IS A 7-COUNTY REGION IN NC THAT INCLUDES ALAMANCE, DURHAM, GRANVILLE, ORANGE, PERSON, VANCE AND WAKE COUNTIES. THIS 7-COUNTY REGION REPRESENTS APPROXIMATELY 18% OF NC'S POPULATION BASED ON FEDERAL FISCAL YEAR (FFY) 2015 DATA. APPROXIMATELY 70% OF INPATIENT DISCHARGES FROM DUHS FACILITIES IN FFY 2015 WERE PATIENTS FROM ITS PRIMARY SERVICE AREA. DUHS' SECONDARY SERVICE AREA COVERS 15 COUNTIES IN NORTH CAROLINA AND SOUTHERN VIRGINIA WITH A POPULATION OF APPROXIMATELY 2 MILLION. PROMOTION OF COMMUNITY HEALTH:PART VI, LINE 5:DUHS PROMOTES THE HEALTH OF THE COMMUNITIES IT SERVES THROUGH A NUMBER OF COMMUNITY BUILDING ACTIVITIES. CENTRAL TO MANY OF THE EFFORTS IS DUHS' OFFICE OF COMMUNITY RELATIONS, WHOSE ASSOCIATE VICE PRESIDENT REPORTS DIRECTLY TO DUHS' CEO AND SERVES AS A FULL-TIME LIAISON WITH THE DURHAM COMMUNITY. THE OFFICE SPONSORS AND FACILITATES COMMUNITY EVENTS SUCH AS THE ANNUAL DURHAM HEALTH SUMMIT AND SIMILAR REGIONAL AND STATE HEALTH SUMMITS THAT RAISE AWARENESS OF COMMUNITY HEALTH NEEDS, PROMOTE PREVENTION AND WELLNESS, AND CHART A COURSE FOR SOLVING HEALTH ISSUES AND DISPARITIES. IN ADDITION, THE OFFICE PROVIDES A POINT OF DIRECT CONTACT FOR COMMUNITY MEMBERS WHO HAVE QUESTIONS OR CONCERNS ABOUT COMMUNITY ISSUES OR ABOUT ACCESS TO HEALTH CARE SERVICES. THE OFFICE ALSO PROVIDES DIRECT FINANCIAL SUPPORT TO A VARIETY OF COMMUNITY GROUPS THROUGH THE CHARITABLE GRANTS AND GOODWILL GRANTS PROGRAM. THE ASSOCIATE VICE-PRESIDENT AND STAFF SERVE ON A NUMBER OF HEALTH CARE-RELATED COMMUNITY BOARDS AND HEALTH-RELATED COMMITTEES. STAFF FROM THE OFFICE OF COMMUNITY RELATIONS AND MEMBERS OF THE DUHS COMMUNITY HEALTH PLANNING GROUP CREATED A FORMAL PRINCIPLES OF COMMUNITY ENGAGEMENT POLICY THAT COMMITS DUHS AND ITS COMMUNITY COLLABORATES TO DEVELOPING PROPOSED PROJECTS AND INITIATIVES ON TRUST, RESPECT, DIVERSITY, SAFETY AND COMMUNITY-IDENTIFIED NEEDS. THESE PRINCIPLES HAVE BEEN INCORPORATED INTO COMMUNITY-BASED HEALTH CARE PROJECTS SUCH AS THE DEVELOPMENT OF THE HOLTON WELLNESS CENTER AND DURHAM HEALTH INNOVATIONS, A MULTIDISCIPLINARY COMMUNITY BASED JOINT EFFORT BETWEEN DUHS AND THE DURHAM COMMUNITY THAT FOCUSES ON IMPROVING HEALTH OUTCOMES THROUGH NEW AND CREATIVE APPROACHES TO HEALTH CARE DELIVERY.IN ADDITION TO COMMUNITY BUILDING ACTIVITIES, DUHS PROMOTES THE HEALTH OF ITS COMMUNITIES IN A NUMBER OF IMPORTANT WAYS. ONE OF DUHS' THREE CONSTITUENT HOSPITALS, DUKE REGIONAL, HAS AN OPEN MEDICAL STAFF AND A HOSPITAL CORPORATION BOARD, WHICH IS A COUNTY APPOINTED BOARD RESPONSIBLE FOR HOSPITAL OVERSIGHT. IN ADDITION, APPROXIMATELY 50 LOCAL LEADERS IN THE DURHAM FAITH COMMUNITY ARE WORKING WITH DUKE HEALTH TO LOOK AT HOW TO ADDRESS THE NEEDS OF THEIR CONGREGATIONS AND COMMUNITIES BY COMBINING THE TRADITIONS OF THE FAITH COMMUNITY WITH THE KNOWLEDGE OF MODERN MEDICINE. MEETINGS ARE HELD TO DETERMINE HOW DUKE HEALTH CAN ASSIST THE FAITH COMMUNITY TO SUPPORT HEALTH MINISTRY ACTIVITIES IN THEIR COMMUNITY AND PLACES OF WORSHIP.DUHS' CEO ALSO HAS A CHANCELLOR'S COMMUNITY HEALTH ADVISORY BOARD TO PROVIDE FEEDBACK ON A VARIETY OF ISSUES, INCLUDING USE OF DUHS RESOURCES, HEALTH SERVICE DELIVERY SYSTEMS AND LONG-RANGE GOALS TO REDUCE HEALTH RISKS AND DISPARITIES IN DURHAM COUNTY. THE BOARD INCLUDES STATE AND LOCAL ELECTED OFFICIALS, NEIGHBORHOOD COUNCILS AND OTHER GRASSROOTS ORGANIZATIONS, POLITICAL GROUPS, LOCAL PHYSICIANS, THE DURHAM PUBLIC SCHOOLS, AMONG OTHERS. DUHS MAINTAINS A CHARITABLE GRANTS COMMITTEE TO REVIEW COMMUNITY REQUESTS FOR PHILANTHROPIC ASSISTANCE THAT PROMOTE HEALTH AND WELLNESS. DUKE HEALTH PROVIDES VARIOUS OPPORTUNITIES FOR STUDENTS TO INTERACT WITH DIFFERENT HEALTH CARE PROFESSIONALS ACROSS THE SYSTEM. THE OFFICE OF COMMUNITY RELATIONS, DRH, AND OTHER KEY COMMUNITY PARTICIPANTS ARE ACTIVE IN A WORKFORCE DEVELOPMENT PROJECT CALLED PROJECT SEARCH. THIS PROGRAM, MODELED AFTER THE PROGRAM AT CINCINNATI CHILDREN'S HOSPITAL, PROVIDES YOUTH WITH DISABILITIES EMPLOYMENT TRAINING AND CAREER OPPORTUNITIES IN THE HEALTHCARE FIELD. THE OFFICE OF COMMUNITY RELATIONS WORKS WITH THE DURHAM-ORANGE MEDICAL SOCIETY AND THE DURHAM ACADEMY OF MEDICINE, DENTISTRY AND PHARMACY (AN ASSOCIATION FOR AFRICAN-AMERICAN MEDICAL PROFESSIONALS) TO PROMOTE THE SUCCESS OF THE CITY OF MEDICINE ACADEMY (CMA). THE CMA IS A PUBLIC MAGNET HIGH SCHOOL DESIGNED FOR STUDENTS INTERESTED IN HEALTH CARE CAREERS. FACULTY ARE INVOLVED WITH MENTORING STUDENTS AND CLASSROOM LECTURES. IN ADDITION, THE HEALTH SYSTEM CEO IS WORKING TO HELP THE CMA BECOME THE PREMIER HEALTH SCIENCE HIGH SCHOOL IN NORTH CAROLINA. DUHS IS A KEY PARTICIPANT IN THE ANNUAL DURHAM PROJECT HOMELESS CONNECT EVENT. STAFF FROM THE DUKE SCHOOL OF NURSING, DUKE EYE CENTER,AND STAFF AFFILIATED WITH LINCOLN COMMUNITY HEALTH CENTER HEALTHCARE FOR THE HOMELESS CLINIC VOLUNTEER TIME AND RESOURCES AT THIS IMPORTANT EVENT. STUDENTS FROM THE DUKE SCHOOLS OF MEDICINE AND NURSING ENGAGE COMMUNITIES IN DURHAM AND BEYOND IN ACTIVITIES THAT INCLUDE FREE BLOOD PRESSURE SCREENINGS FOR THE HOMELESS, AND IDENTIFYING THE HEALTH CARE NEEDS OF A LOW WEALTH COMMUNITY SCHOOL AND DEVELOPING A CURRICULUM FOR STUDENTS AND PARENTS THAT ADDRESSES THOSE NEEDS.AFFILIATED HEALTH CARE SYSTEM ROLES:PART VI, LINE 6:DUHS PROVIDES VIRTUALLY ALL LEVELS OF CARE BEGINNING WITH DUKE UNIVERSITY AFFILIATED PHYSICIANS (DBA DUKE PRIMARY CARE) (DPC). THE HOSPITALS PROVIDE ROUTINE INPATIENT AND OUTPATIENT CARE. IN DURHAM COUNTY, DUH AND DRH WORK TOGETHER TO MAXIMIZE FACILITY UTILIZATION PROVIDING ROUTINE AND ADVANCED LEVELS OF CARE. DUH ALSO OPERATES A TRAUMA CENTER WITH AIR AMBULANCE SERVICE. DRAH SERVES THE WAKE COUNTY AREA AS A COMMUNITY HOSPITAL. THE DRAH CAMPUS HAS SEVERAL MEDICAL OFFICE BUILDINGS ENHANCING CONVENIENCE FOR THE PATIENT IN NON-EMERGENT CASES AND PROVIDES STREAMLINED ACCESS TO HIGH-DEMAND PROCEDURES SUCH AS CARDIAC CATHETERIZATION AND RADIOLOGY PROCEDURES. DUHS ALSO OPERATES HOME HEALTH AND HOME INFUSION SERVICES TO TREAT AND CARE FOR PATIENTS IN THE COMFORT OF THEIR HOME. THIS IS OBVIOUSLY PRACTICAL FOR PATIENTS NOT REQUIRING AN INPATIENT STAY BUT IN NEED OF ONGOING CARE AT A SUB-ACUTE LEVEL. FINALLY, HOSPICE PROVIDES PALLIATIVE CARE FOR PATIENTS NOT RESPONDING TO CURATIVE CARE. PAIN MANAGEMENT, SYMPTOM MANAGEMENT, AND PSYCHOLOGICAL AND SPIRITUAL SUPPORT PROVIDE A ROUNDED APPROACH TO COMPASSIONATELY ASSIST TERMINAL PATIENTS AND THEIR FAMILIES WITH THE PROCESS OF DYING. ALL OF THE OPERATING UNITS OF DUHS WORK TOGETHER TO PROVIDE THE RIGHT LEVEL OF CARE FOR THE PATIENT IN THE MOST BENEFICIAL MANNER. IN ADDITION TO THE REACTIVE ACTIVITIES OF DIAGNOSTIC CARE, DUHS ALSO SUPPORTS AND PROMOTES HEALTHY LIFESTYLES IN THE DIET & FITNESS CENTER, CENTER FOR LIVING, AND DUKE INTEGRATIVE MEDICINE. THESE OPERATIONS FOCUS LARGELY ON PREVENTION AND EDUCATION TO AVOID OR MITIGATE THE POTENTIAL FOR FUTURE ILLNESS.LIST OF ALL STATES WHICH ORGANIZATION FILES A COMMUNITY BENEFIT REPORT:PART VI, LINE 7:NORTH CAROLINA

Schedule H (Form 990) 2015

Additional Data

Software ID:
Software Version:

- TIN:

Schedule I
(Form 990)

Department of the Treasury
Internal Revenue Service

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

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

Attach to Form 990.
lBullet

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

OMB No. 1545-0047

2015

Open to Public
Inspection

Name of the organization
DUKE UNIVERSITY HEALTH SYSTEM INC

Employer identification number
56-2070036

Part I

General Information on Grants and Assistance

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

Yes No

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

Part II

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

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

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

(1) AMERICAN HEART ASSOCIATION PO BOX 50045 PRESCOTT,AZ863045045	56-0529996	501(C)(3)	53,000				GENERAL SUPPORT
(2) CEO ROUNDTABLE ON CANCER INC 101 SAS CAMPUS DR CARY,NC27513	65-1230448	501(C)(3)	80,000				GENERAL SUPPORT
(3) BOYS CLUB OF WAKE COUNTY INC 701 N RALEIGH BLVD RALEIGH,NC27610	56-0863051	501(C)(3)	17,500				GENERAL SUPPORT
(4) DURHAM ACADEMY INC 3130 PICKETT RD DURHAM,NC277055599	56-0538019	501(C)(3)	25,000				GENERAL SUPPORT
(5) ALLIANCE FOR NC NONPROFITS INC 530 N BLOUNT STREET RALEIGH,NC27604	46-1358968	501(C)(6)	25,000				GENERAL SUPPORT
(6) EL CENTRO HISPANO INC 2000 CHAPEL HILL RD DURHAM,NC277071197	56-2011661	501(C)(3)	13,500				GENERAL SUPPORT
(7) FAMILY VIOLENCE PREVENTION CENTER 1012 OBERLINE RD SUITE 100 RALEIGH,NC27605	58-1320613	501(C)(3)	40,000				GENERAL SUPPORT
(8) ALLIANCE MEDICAL MINISTRY INC 101 DONALD ROSS DR RALEIGH,NC27610	56-2168673	501(C)(3)	20,000				GENERAL SUPPORT
(9) GREAT 100 INC PO BOX 4875 GREENSBORO,NC274044875	56-1705456	501(C)(3)	15,000				GENERAL SUPPORT
(10) BLUFORD HEALTHCARE LEADERSHIP 7900 LEES SUMMIT RD KANSAS CITY,MO64139	46-3328194	501(C)(3)	30,000				GENERAL SUPPORT
(11) DURHAM TECHNICAL COMMUNITY COLLEGE 1637 LAWSON STREET DURHAM,NC27703	56-1423848	501(C)(3)	9,000				GENERAL SUPPORT
(12) MEDICAL FOUNDATION OF NC INC CB7120 CHAPEL HILL,NC275997120	56-6057494	501(C)(3)	50,000				GENERAL SUPPORT
(13) MIDTOWN RALEIGH ALLIANCE 134 MINE LAKE CT RALEIGH,NC27615	45-2559048	501(C)(6)	12,000				GENERAL SUPPORT
(14) NC CENTER FOR NONPROFIT ORG INC 1110 NAVAHO DR SUITE 200 RALEIGH,NC276097322	56-1729407	501(C)(3)	10,000				GENERAL SUPPORT
(15) NORTH CAROLINA INSTITUTE OF MEDICINE 630 DAVIS DR STE 100 MORRISVILLE,NC27560	56-1506066	NC GOVERNMENT	6,000				GENERAL SUPPORT
(16) NORTH CAROLINA SYMPHONY SOCIETY 3700 GLENWOOD AVE SUITE 130 RALEIGH,NC27612	56-0556755	501(C)(3)	28,750				GENERAL SUPPORT
(17) PROJECT CURE PO BOX 651 EVERGREEN,CO80437	84-1568566	501(C)(3)	0	67,018	FMV	MEDICAL SUPPLY	GENERAL SUPPORT
(18) RALEIGH SCHOOL OF NURSE ANESTHESIA 3900 BARRETT DR SUITE 200 RALEIGH,NC27609	56-1684241	501(C)(3)	18,151				GENERAL SUPPORT
(19) SENIOR PHARMASSIST INC 406 RIGSBEE AVE STE 201 DURHAM,NC277012186	56-2084639	501(C)(3)	19,500				GENERAL SUPPORT
(20) UNITED WAY OF THE GREATER TRIANGLE 2400 PERIMETER PARK DR 150 MORRISVILLE,NC27560	56-1949103	501(C)(3)	548,853				GENERAL SUPPORT
(21) SUSAN G KOMEN FOR THE CURE NC 600 AIRPORT BLVD SUITE 100 MORRISVILLE,NC27560	75-2845066	501(C)(3)	65,000				GENERAL SUPPORT
(22) SAMARITAN HEALTH CENTER INC PO BOX 51339 DURHAM,NC27717	26-3770762	501(C)(3)	20,000				GENERAL SUPPORT
(23) REINVESTMENT PARTNERS PO BOX 1929 DURHAM,NC277021929	31-1587628	501(C)(3)	21,000				GENERAL SUPPORT FOR PEACH - LEAD HAZARDS PREVENTION PROGRAM
(24) RADIO ONE INC 8001-101 CREEDMOOR RD RALEIGH,NC27613	52-1166660		25,000				GENERAL SUPPORT FOR "TAKE A LOVED ONE TO THE DOCTOR AND "WOMEN'S EMPOWERMENT"
(25) EAST DURHAM CHILDRENS INITIATIVE 107 N DRIVER ST 3RD FLOOR DURHAM,NC27703	32-0263133	501(C)(3)	10,000				GENERAL SUPPORT
(26) FAMILIES MOVING FORWARD PO BOX 25426 DURHAM,NC27702	56-1633998	501(C)(3)	50,000				GENERAL SUPPORT
(27) HABITAT FOR HUMANITY OF DURHAM 215 N CHURCH ST DURHAM,NC27701	58-1674794	501(C)(3)	82,000				GENERAL SUPPORT
(28) HABITAT FOR HUMANITY OF WAKE 2420 RALEIGH BLVD RALEIGH,NC27604	56-1492703	501(C)(3)	10,000				GENERAL SUPPORT
(29) HEALING WITH CAARE INC 214 BROADWAY ST DURHAM,NC27701	56-1963988	501(C)(3)	18,000				GENERAL SUPPORT
(30) HOLT BROTHERS FOUNDATION INC 421 FAYETTEVILLE ST STE 1300 RALEIGH,NC27601	56-6570426	501(C)(3)	5,500				GENERAL SUPPORT
(31) HUMAN RIGHTS CAMPAIGN INC 1640 RHODE ISLAND AVE NW WASHINGTON,DC20036	52-1243457	501(C)(4)	15,000				GENERAL SUPPORT
(32) LGBT CENTER OF RALEIGH INC 324 S HARRINGTON COURT RALEIGH,NC27603	26-2998186	501(C)(3)	10,000				GENERAL SUPPORT
(33) MARCH OF DIMES FOUNDATION 1275 MAMARONECK AVE WHITE PLAINS,NY10605	13-1846366	501(C)(3)	10,000				GENERAL SUPPORT
(34) MUSEUM OF DURHAM HISTORY PO BOX 362 DURHAM,NC27702	94-3455685	501(C)(3)	11,000				GENERAL SUPPORT
(35) NC LUNG CANCER PARTNERSHIP 4000 BLUE RIDGE RD SUITE 170 RALEIGH,NC27612	26-2300885	501(C)(3)	25,000				GENERAL SUPPORT
(36) NC MUSEUM OF ART FOUNDATION INC 4630 MAIL SERVICE CENTER RALEIGH,NC276994630	23-7071511	501(C)(3)	12,500				GENERAL SUPPORT

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

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

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

Cat. No. 50055P

Schedule I (Form 990) 2015

Page 2

Part III

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

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

(1) FINANCIAL ASSISTANCE	32	38,935
(2) STUDENT SCHOLARSHIPS AND AWARDS	7	2,869
(2)
(3)
(4)
(5)
(6)
(7)

Part IV

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

Return Reference	Explanation
SCHEDULE I, PART I, LINE 2	DUKE UNIVERSITY HEALTH SYSTEM, INC. PROVIDES GENERAL SUPPORT TO LOCAL ORGANIZATIONS BASED ON OUR AWARENESS OF THEIR ACTIVITIES WITHIN THE LOCAL COMMUNITY. DUKE UNIVERSITY HEALTH SYSTEM, INC. ALSO MAINTAINS A CHARITABLE GRANTS COMMITTEE THAT REVIEWS COMMUNITY REQUESTS FOR PHILANTHROPIC ASSISTANCE THAT PROMOTE HEALTH AND WELLNESS.

Schedule I (Form 990) 2015

Additional Data

Software ID:
Software Version:

- TIN:

Schedule J
(Form 990)

Department of the Treasury
Internal Revenue Service

Compensation Information

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

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

Attach to Form 990.
SchJMediumBullet

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

OMB No. 1545-0047

2015

Open to Public Inspection

Name of the organization

DUKE UNIVERSITY HEALTH SYSTEM INC

Employer identification number

56-2070036

Part I

Questions Regarding Compensation

Yes

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

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

Travel for companions Payments for business use of personal residence

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

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

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

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

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

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

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

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

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

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

Yes

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

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

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

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

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

Any related organization?

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

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

The organization?

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

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

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

Yes

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

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

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

Cat. No. 50053T

Schedule J (Form 990) 2015

Page 2

Part II

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

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

(A) Name and Title		(B) Breakdown of W-2 and/or 1099-MISC compensation			(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)	(F) Compensation in column(B) reported as deferred on prior Form 990
(A) Name and Title		(i) Base compensation	(ii) Bonus & incentive compensation	(iii) Other reportable compensation	(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)
1NANCY CATHERINE ANDREWS MDDIRECTOR	(i) (ii)	0 ------------- 580,216	0 ------------- 367,897	0 ------------- 18,000	0 ------------- 32,443	0 ------------- 57,358	0 ------------- 1,055,914	0 ------------- 0
2RICHARD H BRODHEADDIRECTOR	(i) (ii)	0 ------------- 950,754	0 ------------- 0	0 ------------- 232,026	0 ------------- 147,443	0 ------------- 75,200	0 ------------- 1,405,423	0 ------------- 105,500
3MARY KLOTMAN MDDIRECTOR	(i) (ii)	0 ------------- 296,683	0 ------------- 58,564	0 ------------- 18,000	0 ------------- 32,443	0 ------------- 14,985	0 ------------- 420,675	0 ------------- 0
4MARK F NEWMANDIRECTOR	(i) (ii)	0 ------------- 180,294	0 ------------- 0	0 ------------- 54,278	0 ------------- 29,353	0 ------------- 19,951	0 ------------- 283,876	0 ------------- 0
5THEODORE NICK PAPPAS MDDIRECTOR	(i) (ii)	0 ------------- 261,641	0 ------------- 33,000	0 ------------- 0	0 ------------- 32,443	0 ------------- 14,358	0 ------------- 341,442	0 ------------- 0
6A EUGENE WASHINGTON MDPRESIDENT & CEO DUHS/DIRECTOR	(i) (ii)	0 ------------- 856,489	0 ------------- 271,917	0 ------------- 9,776	0 ------------- 82,443	0 ------------- 11,227	0 ------------- 1,231,852	0 ------------- 0
7MONTE D BROWN MDVP FOR ADMINISTRATION/SECRETARY	(i) (ii)	359,829 ------------- 0	272,141 ------------- 0	25,457 ------------- 0	32,443 ------------- 0	16,922 ------------- 0	706,792 ------------- 0	0 ------------- 0
8WILLIAM J FULKERSON JR MDEXECUTIVE VP, DUHS	(i) (ii)	787,915 ------------- 0	1,322,190 ------------- 0	18,000 ------------- 0	32,443 ------------- 0	7,069 ------------- 0	2,167,617 ------------- 0	0 ------------- 0
9KENNETH C MORRISSVP, CFO, TREASURER	(i) (ii)	710,180 ------------- 0	413,949 ------------- 0	69,259 ------------- 0	32,443 ------------- 0	10,925 ------------- 0	1,236,756 ------------- 0	0 ------------- 0
10MARY ANN FUCHSVP-PATIENT CARE/CHIEF NURSE EXEC	(i) (ii)	302,576 ------------- 0	115,778 ------------- 0	0 ------------- 0	32,443 ------------- 0	6,365 ------------- 0	457,162 ------------- 0	0 ------------- 0
11KATHLEEN GALBRAITHPRESIDENT, DUKE REGIONAL HOSPITAL	(i) (ii)	378,065 ------------- 0	103,463 ------------- 0	13,453 ------------- 0	32,443 ------------- 0	17,093 ------------- 0	544,517 ------------- 0	0 ------------- 0
12KEVIN W SOWERSPRESIDENT, DUKE UNIVERSITY HOSPITAL	(i) (ii)	467,154 ------------- 0	197,319 ------------- 0	18,000 ------------- 0	32,443 ------------- 0	11,580 ------------- 0	726,496 ------------- 0	0 ------------- 0
13DAVID W ZAAS MDPRESIDENT, DUKE RALEIGH HOSPITAL	(i) (ii)	361,435 ------------- 0	139,477 ------------- 0	18,000 ------------- 0	32,443 ------------- 0	15,033 ------------- 0	566,388 ------------- 0	0 ------------- 0
14SANDRA DANOFFSVP, STRATEGIC PLANNING, BD, NS	(i) (ii)	174,410 ------------- 0	1,006,168 ------------- 0	18,000 ------------- 0	32,443 ------------- 0	5,756 ------------- 0	1,236,777 ------------- 0	0 ------------- 0
15JEFFREY M FERRANTIVP, CIO, DHTS ADMINISTRATION	(i) (ii)	388,150 ------------- 62,544	110,313 ------------- 0	18,000 ------------- 0	32,443 ------------- 0	15,222 ------------- 0	564,128 ------------- 62,544	0 ------------- 0
16THOMAS A OWENS MDCHIEF MEDICAL OFFICER	(i) (ii)	419,260 ------------- 0	171,147 ------------- 0	18,000 ------------- 0	32,443 ------------- 0	12,173 ------------- 0	653,023 ------------- 0	0 ------------- 0
17ANDREW T PICKENSPHYSICIAN	(i) (ii)	360,561 ------------- 0	65,480 ------------- 0	34,978 ------------- 0	32,443 ------------- 0	14,721 ------------- 0	508,183 ------------- 0	0 ------------- 0
18STEPHEN R SMITHCHIEF HR OFFICER	(i) (ii)	328,927 ------------- 0	126,018 ------------- 0	18,000 ------------- 0	32,443 ------------- 0	13,654 ------------- 0	519,042 ------------- 0	0 ------------- 0
19VICTOR J DZAU MDFORMER DIRECTOR/OFFICER	(i) (ii)	0 ------------- 0	0 ------------- 240,729	0 ------------- 0	0 ------------- 31,565	0 ------------- 0	0 ------------- 272,294	0 ------------- 0
20PAUL NEWMANFORMER KEY EMPLOYEE	(i) (ii)	0 ------------- 255,861	0 ------------- 0	0 ------------- 0	0 ------------- 31,506	0 ------------- 6,240	0 ------------- 293,607	0 ------------- 0
21KERRY R WATSONFORMER KEY EMPLOYEE	(i) (ii)	24,525 ------------- 0	0 ------------- 0	0 ------------- 0	3,026 ------------- 0	17,257 ------------- 0	44,808 ------------- 0	0 ------------- 0

Schedule J (Form 990) 2015

Page 3

Part III

Supplemental Information

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

Return Reference

Explanation

SCHEDULE J, PART I, LINE 1A

FIRST-CLASS OR CHARTER TRAVEL: JOHN H. MCARTHUR TRAVELED FIRST CLASS FOR BUSINESS PURPOSES WHEN LOWER LEVEL CLASSES WERE NOT AVAILABLE. THIS TRAVEL WAS FOR NECESSARY BUSINESS PURPOSES. TAX INDEMNIFICATION: MONTE D. BROWN, MD RECEIVED A BENEFIT THAT WAS GROSSED UP TO COMPENSATE FOR WITHHOLDING OF TAXES. SCHEDULE J, PART I, LINE 4B SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN: THE FOLLOWING INDIVIDUAL PARTICIPATED IN AND RECEIVED PAYMENTS UNDER A DEFERRED COMPENSATION PLAN DESCRIBED UNDER SECTION 457(F) OF THE INTERNAL REVENUE CODE: RICHARD H. BRODHEAD $211,000. SUCH AMOUNT WAS SUBJECT TO A SUBSTANTIAL RISK OF FORFEITURE AS DEFINED UNDER IRC SECTION 457(F). SCHEDULE J, PART I, LINE 7 NON-FIXED PAYMENTS: DUHS MAINTAINS AN EXECUTIVE INCENTIVE COMPENSATION PLAN. PAYMENTS UNDER THE PLAN ARE BASED ON PRE-ESTABLISHED PERFORMANCE METRICS AND A FIXED CALCULATION METHODOLOGY APPROVED BY THE DUHS COMPENSATION COMMITTEE WITH ASSISTANCE AND INPUT FROM AN EXECUTIVE COMPENSATION CONSULTING FIRM ASSURING COMPARABILITY WITH SIMILAR SYSTEMS. THE PLAN ALLOWS FOR A MODIFICATION TO AN INDIVIDUAL'S INCENTIVE PAYMENT BASED ON LEADERSHIP COMPETENCIES AND OTHER FACTORS WITH PAYOUTS (AND MODIFICATIONS, IF ANY) APPROVED BY THE DUHS COMPENSATION COMMITTEE.

Schedule J (Form 990) 2015

Additional Data

Software ID:
Software Version:

- TIN:

Schedule K
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Information on Tax Exempt Bonds

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

Attach to Form 990.
SchKMediumBullet

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

OMB No. 1545-0047

2015

Open to Public
Inspection

Name of the organization
DUKE UNIVERSITY HEALTH SYSTEM INC

Employer identification number
56-2070036

Part I

Bond Issues

(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	(g) Defeased		(h) On behalf of issuer		(i) Pool financing
(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	Yes	No	Yes	No	Yes	No
A	NORTH CAROLINA MEDICAL CARE COMMISSION	52-1309402		03-22-2012	322,140,000	SEE PART VI		X		X		X
B	NORTH CAROLINA MEDICAL CARE COMMISSION	52-1309402		05-30-2012	214,598,930	SEE PART VI		X		X		X
C	NORTH CAROLINA MEDICAL CARE COMMISSION	52-1309402		03-19-2015	128,325,000	SEE PART VI		X		X		X
D	NORTH CAROLINA MEDICAL CARE COMMISSION	52-1309402	65821DDX6	04-28-2010	120,836,075	SEE PART VI		X		X		X
	NORTH CAROLINA MEDICAL CARE COMMISSION	52-1309402	65821DLJ8	06-28-2012	326,853,753	SEE PART VI		X		X		X
	NORTH CAROLINA MEDICAL CARE COMMISSION	52-1309402		08-28-2012	48,225,000	SEE PART VI		X		X		X
	NORTH CAROLINA MEDICAL CARE COMMISSION	52-1309402	65821DUD1	05-26-2016	383,990,154	SEE PART VI		X		X		X
	NORTH CAROLINA MEDICAL CARE COMMISSION	52-1309402		03-06-2012	40,000,000	SEE PART VI		X		X		X
	NORTH CAROLINA MEDICAL CARE COMMISSION	52-1309402		04-21-2015	40,000,000	SEE PART VI		X		X		X

Part II

Proceeds

	A		B		C		D
	1 Amount of bonds retired ..................	221,525,000		182,190,000		6,705,000		10,943,503
2 Amount of bonds legally defeased ..............
3 Total proceeds of issue ..................	322,140,000		214,760,000		128,325,000		121,162,021
4 Gross proceeds in reserve funds .............
5 Capitalized interest from proceeds .............	14,871,185
6 Proceeds in refunding escrows ...............					201,888,819
7 Issuance costs from proceeds ...............	2,737,864				2,101,335		1,460,854
8 Credit enhancement from proceeds .............
9 Working capital expenditures from proceeds .............
10 Capital expenditures from proceeds .............	309,386,345						119,701,167
11 Other spent proceeds .............	322,140,000		214,760,000		128,325,000		30,861,504
12 Other unspent proceeds .............
13 Year of substantial completion .............	2013				2009		2013
	Yes	No	Yes	No	Yes	No	Yes	No
14 Were the bonds issued as part of a current refunding issue? ....	X		X		X			X
15 Were the bonds issued as part of an advance refunding issue? .....		X		X		X		X
16 Has the final allocation of proceeds been made? ..........	X		X		X		X
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? ..................	X		X		X		X

Part III

Private Business Use

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

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

Cat. No. 50193E

Schedule K (Form 990) 2015

Page 2

Part III

Private Business Use (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
3a Are there any management or service contracts that may result in private business use of bond-financed property? .............	X		X		X
b If "Yes" to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property?	X		X		X
c Are there any research agreements that may result in private business use of bond-financed property? .............		X		X		X
d If "Yes" to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property?
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government ....	0 %		0 %		0 %
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government .........	0 %		0 %		0 %
6 Total of lines 4 and 5 .............	0 %		0 %		0 %
7 Does the bond issue meet the private security or payment test? ...		X		X		X
8a Has there been a sale or disposition of any of the bond-financed property to a nongovernmental person other than a 501(c)(3) organization since the bonds were issued?.............	X			X		X
b If "Yes" to line 8a, enter the percentage of bond-financed property sold or disposed of. ..	0.070 %
c If "Yes" to line 8a, was any remedial action taken pursuant to Regulations sections 1.141-12 and 1.145-2? .............	X
9 Has the organization established written procedures to ensure that all nonqualified bonds of the issue are remediated in accordance with the requirements under Regulations sections 1.141-12 and 1.145-2? ........	X		X		X

Part IV

Arbitrage

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

Schedule K (Form 990) 2015

Page 3

Part IV

Arbitrage (Continued)

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

Part V

Procedures To Undertake Corrective Action

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

Part VI

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

Return Reference

Explanation

SCHEDULE K, PART I, COLUMN F

BOND ISSUE A: THE PURPOSE OF THE BONDS ISSUED 03/22/2012 WAS TO REFUND THE 2005ABC BONDS ISSUED ON 08/21/2009, WHICH REFUNDED THE ORIGINAL 2005ABC BONDS ISSUED ON 5/19/2005. THE PURPOSE OF THE BONDS ISSUED 05/19/2005 WAS TO PARTIALLY REFUND THE 1996C BONDS ISSUED ON 10/24/1996, 1998A BONDS ISSUED ON 08/27/1998, AND THE 1998B BONDS ISSUED ON 10/13/1998. BOND ISSUE B: THE PURPOSE OF THE BONDS ISSUED 05/30/2012 WAS TO PARTIALLY REFUND THE 2005ABC BONDS ISSUED ON 03/22/12, WHICH REFUNDED THE 2005ABC BONDS ISSUED ON 08/21/2009, WHICH REFUNDED THE ORIGINAL 2005ABC BONDS ISSUED ON 5/19/2005. THE PURPOSE OF THE BONDS ISSUED 05/19/2005 WAS TO PARTIALLY REFUND THE 1996C BONDS ISSUED ON 10/24/1996, 1998A BONDS ISSUED ON 08/27/1998, AND THE 1998B BONDS ISSUED ON 10/13/1998. BOND ISSUE C: THE PURPOSE OF THE BONDS ISSUED 03/19/2015 WAS TO REFUND THE 2006ABC BONDS ISSUED ON 10/06/2011,WHICH REFUNDED THE BONDS ISSUED 11/15/2006 FOR HOSPITAL IMPROVEMENTS INCLUDING: ROUTINE INFRASTRUCTURE, RENOVATION AND IMPROVEMENT PROJECTS AT DUKE UNIVERSITY HOSPITAL AND DUKE RALEIGH HOSPITAL, IMPROVEMENTS TO INFORMATION SYSTEMS, RENOVATION AND EXPANSION OF EMERGENCY DEPARTMENT AT DUKE UNIVERSITY HOSPITAL, HELIPORT AND NEW ROOF IMPROVEMENTS AT DUKE UNIVERSITY HOSPITAL, AND PHASES 1 AND 2 OF AN OPERATING ROOM SUITE RENOVATION AND EXPANSION AT DUKE UNIVERSITY HOSPITAL. BOND ISSUE D: HOSPITAL IMPROVEMENTS INCLUDE THE DUKE MEDICINE PAVILION AND THE DUKE NORTH CONCOURSE AT DUKE UNIVERSITY HOSPITAL. BOND ISSUE A (2): HOSPITAL IMPROVEMENTS INCLUDE THE DUKE MEDICINE PAVILION AND THE DUKE NORTH CONCOURSE AT DUKE UNIVERSITY HOSPITAL. BOND ISSUE B (2): THE PURPOSE OF THE BONDS ISSUED 08/28/2012 WAS TO REFUND THE ORIGINAL 1985B BONDS ISSUED ON 10/02/1985 FOR THE ACQUISITION OF A MAINTENANCE BUILDING, PARKING, AND A DEBT SERVICE FUND AND TO REFUND THE ORIGINAL 1993A BONDS ISSUED ON 08/12/1993. THE PURPOSE OF THE BONDS ISSUED 08/12/1993 WAS TO PARTIALLY REFUND THE 1991D BONDS ISSUED ON 7/1/1991 AND THE 1985A BONDS ISSUED ON 10/02/1985. THE 2012C BONDS WERE PAID OFF EFFECTIVE JUNE 1, 2015. BOND ISSUE C (2): THE PURPOSE OF THE BONDS ISSUED 05/26/2016 WAS TO REFUND THE ORIGINAL 2009A BONDS ISSUED ON 10/22/2009 TO FINANCE HOSPITAL IMPROVEMENTS INCLUDING THE AMBULATORY CANCER CENTER AT DUKE UNIVERSITY HOSPITAL AND OTHER RENOVATION AND IMPROVEMENT PROJECTS AT DUKE RALEIGH HOSPITAL, AND TO REFUND THE 2005C BONDS ISSUED ON 05/30/2012 AND TO PARTIALLY REFUND THE 2005B BONDS ISSUED ON 05/30/2012. THE PURPOSE OF THE BONDS ISSUED 05/30/2012 WAS TO PARTIALLY REFUND THE 2005ABC BONDS ISSUED ON 03/22/2012, WHICH REFUNDED THE 2005ABC BONDS ISSUED ON 08/21/2009, WHICH REFUNDED THE ORIGINAL 2005ABC BONDS ISSUED ON 05/19/2005. THE PURPOSE OF THE BONDS ISSUED 05/19/2005 WAS TO PARTIALLY REFUND THE 1996C BONDS ISSUED ON 10/24/1996, 1998A BONDS ISSUED ON 08/27/1998, AND THE 1998B BONDS ISSUED ON 10/13/1998. BOND ISSUE D (2): DRAW-DOWN FINANCING LEASE PROGRAM WITH BANC OF AMERICA PUBLIC CAPITAL CORP. IN THE MAXIMUM PRINCIPAL AMOUNT OF $40,000,000 TO FINANCE MEDICAL, COMPUTER, OFFICE, AND CAPITAL EQUIPMENT. BOND ISSUE A (3): DRAW-DOWN FINANCING LEASE PROGRAM WITH SUNTRUST EQUIPMENT FINANCE AND LEASING CORP. IN THE MAXIMUM PRINCIPAL AMOUNT OF $40,000,000 TO FINANCE MEDICAL, COMPUTER, OFFICE, AND CAPITAL EQUIPMENT. SCHEDULE K, PART II, LINE 3 BOND ISSUE B: PROCEEDS INCLUDE ISSUE PRICE PLUS ORIGINAL ISSUE DISCOUNT / UPFRONT FEE PAID DIRECTLY BY DUHS TO THE BANK UPON ISSUANCE. BOND ISSUES D AND A (2): PROCEEDS INCLUDE INVESTMENT EARNINGS. BOND ISSUES D (2) AND A (3): PROCEEDS REFLECT ACTUAL PRINCIPAL DRAWN DOWN UNDER DRAW DOWN FINANCING LEASE PROGRAM. SCHEDULE K, PART III, LINE 8C, BOND ISSUE (C): DISPOSITION WAS THE SUBJECT OF A CLOSING AGREEMENT ACCEPTED AND CLOSED WITH THE IRS IN OCTOBER 2014 THROUGH THE TAX EXEMPT BONDS VOLUNTARY CLOSING AGREEMENT PROGRAM. SCHEDULE K, PART IV, LINE 2C BOND ISSUES A, B, C, D, A (2), AND B (2): BOND ISSUE A AND B ARBITRAGE REPORT COMPLETED 3/22/13, BOND ISSUE C COMPLETED 9/30/2013, BOND ISSUE D COMPLETED 04/01/2015, A (2) COMPLETED 05/31/2013, B (2) COMPLETED 5/31/2013. AS TO D (2) AND A (3) NO ARBITRAGE COMPUTATION WAS NECESSARY BECAUSE NO PROCEEDS WERE REINVESTED. BOND ISSUES A, B, C AND B (2): THESE PROCEEDS WERE DISBURSED OR DEEMED DISBURSED UPON ISSUANCE TO CURRENTLY REFUND THE PRIOR BONDS. BOND ISSUES D (2), AND A (3): SALES PROCEEDS ALLOCATED UPON ISSUANCE AND NOT INVESTED.

Schedule K (Form 990) 2015

Additional Data

Software ID:
Software Version:

- TIN:

Schedule K
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Information on Tax Exempt Bonds

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

Attach to Form 990.
SchKMediumBullet

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

OMB No. 1545-0047

2015

Open to Public
Inspection

Name of the organization
DUKE UNIVERSITY HEALTH SYSTEM INC

Employer identification number
56-2070036

Part I

Bond Issues

(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	(g) Defeased		(h) On behalf of issuer		(i) Pool financing
(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	Yes	No	Yes	No	Yes	No
A	NORTH CAROLINA MEDICAL CARE COMMISSION	52-1309402		03-22-2012	322,140,000	SEE PART VI		X		X		X
B	NORTH CAROLINA MEDICAL CARE COMMISSION	52-1309402		05-30-2012	214,598,930	SEE PART VI		X		X		X
C	NORTH CAROLINA MEDICAL CARE COMMISSION	52-1309402		03-19-2015	128,325,000	SEE PART VI		X		X		X
D	NORTH CAROLINA MEDICAL CARE COMMISSION	52-1309402	65821DDX6	04-28-2010	120,836,075	SEE PART VI		X		X		X
	NORTH CAROLINA MEDICAL CARE COMMISSION	52-1309402	65821DLJ8	06-28-2012	326,853,753	SEE PART VI		X		X		X
	NORTH CAROLINA MEDICAL CARE COMMISSION	52-1309402		08-28-2012	48,225,000	SEE PART VI		X		X		X
	NORTH CAROLINA MEDICAL CARE COMMISSION	52-1309402	65821DUD1	05-26-2016	383,990,154	SEE PART VI		X		X		X
	NORTH CAROLINA MEDICAL CARE COMMISSION	52-1309402		03-06-2012	40,000,000	SEE PART VI		X		X		X
	NORTH CAROLINA MEDICAL CARE COMMISSION	52-1309402		04-21-2015	40,000,000	SEE PART VI		X		X		X

Part II

Proceeds

	A		B		C		D
	1 Amount of bonds retired ..................	221,525,000		182,190,000		6,705,000		10,943,503
2 Amount of bonds legally defeased ..............
3 Total proceeds of issue ..................	322,140,000		214,760,000		128,325,000		121,162,021
4 Gross proceeds in reserve funds .............
5 Capitalized interest from proceeds .............	14,871,185
6 Proceeds in refunding escrows ...............					201,888,819
7 Issuance costs from proceeds ...............	2,737,864				2,101,335		1,460,854
8 Credit enhancement from proceeds .............
9 Working capital expenditures from proceeds .............
10 Capital expenditures from proceeds .............	309,386,345						119,701,167
11 Other spent proceeds .............	322,140,000		214,760,000		128,325,000		30,861,504
12 Other unspent proceeds .............
13 Year of substantial completion .............	2013				2009		2013
	Yes	No	Yes	No	Yes	No	Yes	No
14 Were the bonds issued as part of a current refunding issue? ....	X		X		X			X
15 Were the bonds issued as part of an advance refunding issue? .....		X		X		X		X
16 Has the final allocation of proceeds been made? ..........	X		X		X		X
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? ..................	X		X		X		X

Part III

Private Business Use

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

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

Cat. No. 50193E

Schedule K (Form 990) 2015

Page 2

Part III

Private Business Use (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
3a Are there any management or service contracts that may result in private business use of bond-financed property? .............	X		X		X
b If "Yes" to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property?	X		X		X
c Are there any research agreements that may result in private business use of bond-financed property? .............		X		X		X
d If "Yes" to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property?
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government ....	0 %		0 %		0 %
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government .........	0 %		0 %		0 %
6 Total of lines 4 and 5 .............	0 %		0 %		0 %
7 Does the bond issue meet the private security or payment test? ...		X		X		X
8a Has there been a sale or disposition of any of the bond-financed property to a nongovernmental person other than a 501(c)(3) organization since the bonds were issued?.............	X			X		X
b If "Yes" to line 8a, enter the percentage of bond-financed property sold or disposed of. ..	0.070 %
c If "Yes" to line 8a, was any remedial action taken pursuant to Regulations sections 1.141-12 and 1.145-2? .............	X
9 Has the organization established written procedures to ensure that all nonqualified bonds of the issue are remediated in accordance with the requirements under Regulations sections 1.141-12 and 1.145-2? ........	X		X		X

Part IV

Arbitrage

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

Schedule K (Form 990) 2015

Page 3

Part IV

Arbitrage (Continued)

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

Part V

Procedures To Undertake Corrective Action

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

Part VI

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

Return Reference

Explanation

SCHEDULE K, PART I, COLUMN F

Schedule K (Form 990) 2015

Additional Data

Software ID:
Software Version:

- TIN:

Schedule K
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Information on Tax Exempt Bonds

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

Attach to Form 990.
SchKMediumBullet

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

OMB No. 1545-0047

2015

Open to Public
Inspection

Name of the organization
DUKE UNIVERSITY HEALTH SYSTEM INC

Employer identification number
56-2070036

Part I

Bond Issues

(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	(g) Defeased		(h) On behalf of issuer		(i) Pool financing
(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	Yes	No	Yes	No	Yes	No
A	NORTH CAROLINA MEDICAL CARE COMMISSION	52-1309402		03-22-2012	322,140,000	SEE PART VI		X		X		X
B	NORTH CAROLINA MEDICAL CARE COMMISSION	52-1309402		05-30-2012	214,598,930	SEE PART VI		X		X		X
C	NORTH CAROLINA MEDICAL CARE COMMISSION	52-1309402		03-19-2015	128,325,000	SEE PART VI		X		X		X
D	NORTH CAROLINA MEDICAL CARE COMMISSION	52-1309402	65821DDX6	04-28-2010	120,836,075	SEE PART VI		X		X		X
	NORTH CAROLINA MEDICAL CARE COMMISSION	52-1309402	65821DLJ8	06-28-2012	326,853,753	SEE PART VI		X		X		X
	NORTH CAROLINA MEDICAL CARE COMMISSION	52-1309402		08-28-2012	48,225,000	SEE PART VI		X		X		X
	NORTH CAROLINA MEDICAL CARE COMMISSION	52-1309402	65821DUD1	05-26-2016	383,990,154	SEE PART VI		X		X		X
	NORTH CAROLINA MEDICAL CARE COMMISSION	52-1309402		03-06-2012	40,000,000	SEE PART VI		X		X		X
	NORTH CAROLINA MEDICAL CARE COMMISSION	52-1309402		04-21-2015	40,000,000	SEE PART VI		X		X		X

Part II

Proceeds

	A		B		C		D
	1 Amount of bonds retired ..................	221,525,000		182,190,000		6,705,000		10,943,503
2 Amount of bonds legally defeased ..............
3 Total proceeds of issue ..................	322,140,000		214,760,000		128,325,000		121,162,021
4 Gross proceeds in reserve funds .............
5 Capitalized interest from proceeds .............	14,871,185
6 Proceeds in refunding escrows ...............					201,888,819
7 Issuance costs from proceeds ...............	2,737,864				2,101,335		1,460,854
8 Credit enhancement from proceeds .............
9 Working capital expenditures from proceeds .............
10 Capital expenditures from proceeds .............	309,386,345						119,701,167
11 Other spent proceeds .............	322,140,000		214,760,000		128,325,000		30,861,504
12 Other unspent proceeds .............
13 Year of substantial completion .............	2013				2009		2013
	Yes	No	Yes	No	Yes	No	Yes	No
14 Were the bonds issued as part of a current refunding issue? ....	X		X		X			X
15 Were the bonds issued as part of an advance refunding issue? .....		X		X		X		X
16 Has the final allocation of proceeds been made? ..........	X		X		X		X
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? ..................	X		X		X		X

Part III

Private Business Use

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

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

Cat. No. 50193E

Schedule K (Form 990) 2015

Page 2

Part III

Private Business Use (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
3a Are there any management or service contracts that may result in private business use of bond-financed property? .............	X		X		X
b If "Yes" to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property?	X		X		X
c Are there any research agreements that may result in private business use of bond-financed property? .............		X		X		X
d If "Yes" to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property?
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government ....	0 %		0 %		0 %
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government .........	0 %		0 %		0 %
6 Total of lines 4 and 5 .............	0 %		0 %		0 %
7 Does the bond issue meet the private security or payment test? ...		X		X		X
8a Has there been a sale or disposition of any of the bond-financed property to a nongovernmental person other than a 501(c)(3) organization since the bonds were issued?.............	X			X		X
b If "Yes" to line 8a, enter the percentage of bond-financed property sold or disposed of. ..	0.070 %
c If "Yes" to line 8a, was any remedial action taken pursuant to Regulations sections 1.141-12 and 1.145-2? .............	X
9 Has the organization established written procedures to ensure that all nonqualified bonds of the issue are remediated in accordance with the requirements under Regulations sections 1.141-12 and 1.145-2? ........	X		X		X

Part IV

Arbitrage

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

Schedule K (Form 990) 2015

Page 3

Part IV

Arbitrage (Continued)

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

Part V

Procedures To Undertake Corrective Action

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

Part VI

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

Return Reference

Explanation

SCHEDULE K, PART I, COLUMN F

Schedule K (Form 990) 2015

Additional Data

Software ID:
Software Version:

- TIN:

Schedule L
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Transactions with Interested Persons

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

Attach to Form 990 or Form 990-EZ.
MediumBullet

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

OMB No. 1545-0047

2015

Open to Public Inspection

Name of the organization

DUKE UNIVERSITY HEALTH SYSTEM INC

Employer identification number

56-2070036

Part I

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

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

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

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

Part II

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

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










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

Part III

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

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

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

Cat. No. 50056A

Schedule L (Form 990 or 990-EZ) 2015

Page 2

Part IV

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

(a) Name of interested person	(b) Relationship between interested person and the organization	(c) Amount of transaction	(d) Description of transaction	(e) Sharing of organization's revenues?
(a) Name of interested person		(c) Amount of transaction	(d) Description of transaction	Yes	No
(1) THE DURHAM BULLS BASEBALL CLUB INC	SEE PART V	50,741	SEE PART V		No
(2) GENESE NEWMAN	SEE PART V	68,767	SEE PART V		No
(3) DANIEL J SCOTT MD	SEE PART V	54,808	SEE PART V		No

Part V

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

Return Reference

Explanation

SCH L, PART IV, BUSINESS TRANSACTIONS INVOLVING INTERESTED PERSONS:

(A) NAME OF INTERESTED PERSON: THE DURHAM BULLS BASEBALL CLUB, INC.(B) RELATIONSHIP BETWEEN INTERESTED PERSON AND ORGANIZATION: THE DURHAM BULLS BASEBALL CLUB, INC. CEO IS A DUHS, INC. DIRECTOR.(C) AMOUNT OF TRANSACTION: $50,741(D) DESCRIPTION OF TRANSACTION: PAYMENT FOR GOODS OR SERVICES(E) SHARING OF ORGANIZATION REVENUE? = NO(A) NAME OF INTERESTED PERSON: GENESE NEWMAN(B) RELATIONSHIP BETWEEN INTERESTED PERSON AND ORGANIZATION: GENESE NEWMAN IS A FAMILY MEMBER OF A DUHS, INC. FORMER KEY EMPLOYEE(C) AMOUNT OF TRANSACTION: $68,767(D) DESCRIPTION OF TRANSACTION: PAYMENT FOR SALARY AND BENEFITS(E) SHARING OF ORGANIZATION REVENUE? = NO(A) NAME OF INTERESTED PERSON: DANIEL J. SCOTT, MD(B) RELATIONSHIP BETWEEN INTERESTED PERSON AND ORGANIZATION: DANIEL J. SCOTT IS A FAMILY MEMBER OF A DUHS, INC. DIRECTOR(C) AMOUNT OF TRANSACTION: $54,808(D) DESCRIPTION OF TRANSACTION: PAYMENT FOR SALARY AND BENEFITS(E) SHARING OF ORGANIZATION REVENUE? = NO

Schedule L (Form 990 or 990-EZ) 2015

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE M
(Form 990)

Department of the Treasury

Internal Revenue Service

Noncash Contributions

Complete if the organizations answered "Yes" on Form 990, Part IV, lines 29 or 30.
Right pointing arrow large image

Attach to Form 990.
Right pointing arrow large image

Information about Schedule M (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 UNIVERSITY HEALTH SYSTEM INC

Employer identification number

56-2070036

Part I

Types of Property

	(a) Check if applicable	(b) Number of contributions or items contributed	(c) Noncash contribution amounts reported on Form 990, Part VIII, line 1g	(d) Method of determining noncash contribution amounts
1 Art—Works of art ....	X	1	50	MARKET QUOTE
2 Art—Historical treasures .
3 Art—Fractional interests ..
4 Books and publications ..	X		1	THRIFT STORE VALUE
5 Clothing and household goods .......	X		541	THRIFT STORE VALUE
6 Cars and other vehicles ..
7 Boats and planes ....
8 Intellectual property ...
9 Securities—Publicly traded .	X	11	2,970,431	MARKET QUOTE
10 Securities—Closely held stock .
11 Securities—Partnership, LLC, or trust interests ....
12 Securities—Miscellaneous ..
13 Qualified conservation contribution—Historic structures .....
14 Qualified conservation contribution—Other ...
15 Real estate—Residential .
16 Real estate—Commercial ..
17 Real estate—Other ...
18 Collectibles .....	X	3	345	MARKET QUOTE
19 Food inventory ...	X	1	297	VARIOUS
20 Drugs and medical supplies .
21 Taxidermy ......
22 Historical artifacts ....
23 Scientific specimens ..
24 Archeological artifacts ...
25 Other ( ENTERTAINMENT )	X	11	1,793	MARKET QUOTE
26 Other ( SPORTS )	X	4	925	MARKET QUOTE
27 Other ( )
28 Other ( )

Number of Forms 8283 received by the organization during the tax year for contributions
for which the organization completed Form 8283, Part IV, Donee Acknowledgement

Yes

30a

During the year, did the organization receive by contribution any property reported in Part I, lines 1 through 28, that

it must hold for at least three years from the date of the initial contribution, and which is not required to be used

for exempt purposes for the entire holding period? ..................

30a

If "Yes," describe the arrangement in Part II.

Does the organization have a gift acceptance policy that requires the review of any non-standard contributions?

Yes

32a

Does the organization hire or use third parties or related organizations to solicit, process, or sell noncash

contributions? ..........................

32a

Yes

If "Yes," describe in Part II.

If the organization did not report an amount in column (c) for a type of property for which column (a) is checked,

describe in Part II.

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

Cat. No. 51227J

Schedule M (Form 990) (2015)

Page 2

Part II

Supplemental Information. Provide the information required by Part I, lines 30b, 32b, and 33, and whether the organization is reporting in Part I, column (b), the number of contributions, the number of items received, or a combination of both. Also complete this part for any additional information.

Return Reference	Explanation
PART I, LINE 32B:	DUKE UNIVERSITY HEALTH SYSTEM, INC. USES INVESTMENT BROKERS TO SELL INVESTMENTS. DUKE UNIVERSITY HEALTH SYSTEM, INC. MAY OCCASIONALLY USE THIRD PARTIES TO SELL OTHER TYPES OF NON-CASH CONTRIBUTIONS, AS THE NEED ARISES.

Schedule M (Form 990) (2015)

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Supplemental Information to Form 990 or 990-EZ

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

Attach to Form 990 or 990-EZ.
MediumBullet

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

OMB No. 1545-0047

2015

Open to Public
Inspection

Name of the organization

DUKE UNIVERSITY HEALTH SYSTEM INC

Employer identification number

56-2070036

Return Reference	Explanation
FORM 990, PART I, LINE 1, & PART III, DESCRIPTION OF ORGANIZATION MISSION:	DUHS, AS PART OF DUKE HEALTH, IS COMMITTED TO ADVANCING HEALTH TOGETHER BY DELIVERING TOMORROW'S HEALTH CARE TODAY, ACCELERATING DISCOVERY AND ITS TRANSLATION, CREATING EDUCATION THAT IS TRANSFORMING, BUILDING HEALTHY COMMUNITIES, AND CONNECTING WITH THE WORLD TO IMPROVE HEALTH GLOBALLY.
FORM 990, PART III, LINE 4A	STATEMENT OF PROGRAM SERVICE ACCOMPLISHMENTS HISTORY AND ORGANIZATION IN 1925, JAMES B. DUKE WILLED $4 MILLION TO ESTABLISH DUKE UNIVERSITY HOSPITAL AND ITS MEDICAL SCHOOL TO IMPROVE HEALTH CARE IN THE CAROLINAS, THEN A POOR REGION LACKING HOSPITALS AND HEALTH CARE PROVIDERS. DUKE UNIVERSITY HOSPITAL HAS GROWN TO BE RECOGNIZED AS ONE OF THE WORLD'S GREAT HEALTH CARE PROVIDERS. IN 1998 AND CONCURRENT WITH ACQUIRING CONTROL OF TWO LOCAL COMMUNITY HOSPITALS, THE DUKE UNIVERSITY BOARD OF TRUSTEES ESTABLISHED DUKE UNIVERSITY HOSPITAL AS THE FLAGSHIP OF THE NEWLY INCORPORATED DUKE UNIVERSITY HEALTH SYSTEM, INC. (DUHS) TO MANAGE A WIDE RANGE OF HEALTH CARE PROGRAMS AT THE SAME HIGH LEVEL OF QUALITY THAT HAS TRADITIONALLY MADE DUKE UNIVERSITY HOSPITAL A WORLD LEADER. THIS NETWORK OF REGIONAL HEALTH CARE ORGANIZATIONS IS DEDICATED TO EMPLOYING DUKE'S STRENGTHS IN PATIENT CARE, EDUCATION, AND RESEARCH. DUHS IS A COMPONENT OF DUKE HEALTH WHICH CONCEPTUALLY INTEGRATES THE DUKE UNIVERSITY SCHOOL OF MEDICINE, DUKE-NUS MEDICAL SCHOOL, DUKE UNIVERSITY SCHOOL OF NURSING, DUKE UNIVERSITY HEALTH SYSTEM, PRIVATE DIAGNOSTIC CLINIC (DUKE PHYSICIANS PRACTICE), AND INCORPORATES THE HEALTH AND HEALTH RESEARCH PROGRAMS WITHIN THE DUKE GLOBAL HEALTH INSTITUTE AS WELL AS THOSE IN SCHOOLS AND CENTERS ACROSS DUKE UNIVERSITY, INCLUDING THE DUKE ROBERT J. MARGOLIS CENTER FOR HEALTH POLICY. THE DUKE HEALTH CLINICAL ENTERPRISE IS INTENDED TO FUNCTION AS A FULLY ALIGNED AND UNIFIED ORGANIZATION FOCUSED ON IMPROVING THE HEALTH OF THE COMMUNITIES WE SERVE, DELIVERING ADVANCED TREATMENT FOR THOSE WHO NEED IT, AND EXTENDING NEW KNOWLEDGE BEYOND OUR SYSTEMS TO THE BENEFIT OF OTHERS. LEVERAGING THE DEPTH AND BREADTH OF CAPABILITIES THAT EXIST ACROSS DUKE HEALTH AND THE ENTIRE UNIVERSITY, WE PLAN TO ACHIEVE THE VISION TO DELIVER TOMORROW'S HEALTH CARE TODAY BY LEADING IN THE DELIVERY OF HIGHEST-QUALITY, PATIENT CENTERED CARE, INTEGRATING TO OPTIMIZE COORDINATION OF CARE, GROWING AND EXTENDING OUR REACH LOCALLY, REGIONALLY, AND NATIONALLY, INVESTING IN INNOVATION TO CREATE SUSTAINABLE DIFFERENTIATION AND VALUE AND DELIVERING ON THE PROMISE OF POPULATION HEALTH. MANY PROGRAM SERVICE ACCOMPLISHMENTS ARE INCLUDED IN SCHEDULE H OF THIS FORM INCLUDING THE FINANCIAL COMMITMENT MADE TO THE COMMUNITY BY DUHS IN TERMS OF CHARITY CARE AND OTHER DIRECT AND MEASURABLE INVESTMENTS. BELOW ARE EXCERPTS FROM THE ANNUAL DUHS REPORT ON COMMUNITY BENEFIT. THE COST OF THESE ACTIVITIES CAN BE DIFFICULT TO MEASURE. SOMETIMES THEY INCLUDE THE PARTICIPATION OF DUKE UNIVERSITY SO REFERENCES TO "DUKE" ARE MEANT TO INCLUDE DUHS AND DUKE UNIVERSITY IN THEIR RESPECTIVE MISSION CAPACITIES. DUKE: A PARTNER IN CARE FOR PEOPLE, COMMUNITIES ACROSS NORTH CAROLINA WHEN ITS MEDICAL SCHOOL AND FIRST HOSPITAL OPENED MORE THAN 85 YEARS AGO, DUKE DEDICATED ITSELF TO IMPROVING THE HEALTH OF PEOPLE ACROSS NORTH CAROLINA. TODAY, IN WHAT HAS EVOLVED INTO DUKE UNIVERSITY HEALTH SYSTEM, THAT PROUD COMMITMENT TO CARE CONTINUES. THIS EDITION OF OUR ANNUAL REPORT ON COMMUNITY BENEFIT TELLS HOW. FOR THE FISCAL YEAR THAT ENDED JUNE 30, 2016, DUKE PROVIDED A TOTAL COMMUNITY BENEFIT AND INVESTMENT OF $445 MILLION. OF THAT FIGURE, $82 MILLION REPRESENTS CHARITY CARE AT ESTIMATED COST PROVIDED TO 221,000 PATIENTS, WITH 95% FROM NORTH CAROLINA. INCLUDING THE $445 MILLION FOR FY2016, DUKE'S TOTAL COMMUNITY BENEFIT AND INVESTMENT OVER THE PAST 10 YEARS EXCEEDS $3 BILLION. THIS YEAR'S REPORT ON COMMUNITY BENEFIT IS AVAILABLE ONLINE AT: HTTPS://CORPORATE.DUKEHEALTH.ORG/WHO-WE-ARE/COMMUNITY. CLICK ON "WHO WE ARE" AT THE TOP LEFT, THEN ON "COMMUNITY HEALTH" IN THE DROP-DOWN MENU. SCROLL DOWN THE PAGE AND CLICK ON "2017 REPORT ON COMMUNITY BENEFIT" IN THE BLUE AND WHITE BOX. MORE THAN 6,700 DUKE-TRAINED HEALTHCARE PROFESSIONALS MAKE THEIR HOME IN NORTH CAROLINA: * PHYSICIANS 3,172 * NURSES 2,635 * PHYSICIAN ASSISTANTS 612 * PHYSICAL THERAPISTS 276 * PATHOLOGY ASSISTANTS 28 FOR A TOTAL OF 6,723 DUKE PROVIDED $82 MILLION IN CHARITY CARE AT ESTIMATED COST TO 220,698 PATIENTS DURING THE FISCAL YEAR THAT ENDED ON JUNE 30, 2016. NEARLY 95 PERCENT OF THESE PATIENTS (210,721) WERE RESIDENTS OF NORTH CAROLINA. MORE THAN 85 PERCENT (188,662) RESIDED IN DUKE'S PRIMARY SERVICE AREA OF ALAMANCE, DURHAM, GRANVILLE, ORANGE, PERSON, VANCE AND WAKE COUNTIES. HIGHLIGHTS OF DUKE'S CHARITY CARE AND DISCOUNTED CARE POLICIES: * DUKE PROVIDES WORLD-CLASS, EFFECTIVE CARE WITH A CONSISTENTLY HIGH LEVEL OF DIGNITY, RESPECT AND SKILL TO ALL PATIENTS IT SERVES, REGARDLESS OF THEIR ABILITY TO PAY. * DUKE PROVIDES ELIGIBLE CARE AT A DISCOUNT OR WITHOUT CHARGE TO ALL QUALIFYING PATIENTS WHO DO NOT HAVE HEALTH INSURANCE, OR WHO BECAUSE OF FINANCIAL HARDSHIP CANNOT PAY FOR THE CARE THEY RECEIVE. (COSMETIC PROCEDURES ARE NOT ELIGIBLE.) * IN ADDITION TO PROVIDING EMERGENCY AND PRIMARY CARE AT NO CHARGE, DUKE PHYSICIANS DONATE SPECIALTY CARE SERVICES TO ELIGIBLE UNINSURED PATIENTS THROUGH PROJECT ACCESS, A PROGRAM IN DURHAM AND WAKE COUNTIES. * DUKE HELPS PATIENTS NAVIGATE THROUGH GOVERNMENT-SPONSORED FINANCIAL-ASSISTANCE PROGRAMS FOR WHICH THEY MAY QUALIFY. * WHEN GOVERNMENT PROGRAMS SUCH AS MEDICAID DO NOT COMPLETELY COVER DUKE'S COST OF CARE, DUKE ABSORBS THE DIFFERENCE IN ACCORDANCE WITH ITS POLICIES. DUKE WORKS WITH COMMUNITIES TO PROMOTE HEALTH, WELLNESS, AND ACCESS DUKE UNIVERSITY HEALTH SYSTEM, AS WELL AS THE OVER-ARCHING DUKE HEALTH, JOINS WITH MANY OTHER ORGANIZATIONS IN COMMUNITIES IT SERVES. WORKING TOGETHER, WE IDENTIFY AND ADDRESS THE HEALTHCARE NEEDS OF THOSE COMMUNITIES. IN ADDITION, THROUGH ITS TWO HOSPITALS IN DURHAM AND ONE IN RALEIGH, DUKE COLLABORATES WITH THE PUBLIC HEALTH DEPARTMENTS IN DURHAM AND WAKE COUNTIES, COMMUNITY MEMBERS, AND NUMEROUS COMMUNITY PARTNER ORGANIZATIONS TO CONDUCT REGULAR ASSESSMENTS OF COMMUNITY HEALTH NEEDS. IN ACCORDANCE WITH FEDERAL REQUIREMENTS, LINKS ARE AVAILABLE TO THE ASSESSMENTS FOR DURHAM AND WAKE COUNTIES, AND TO EACH OF THE DUKE HOSPITALS' REPORTS. GO TO HTTPS://CORPORATE.DUKEHEALTH.ORG/WHO-WE-ARE/COMMUNITY. CLICK ON "WHO WE ARE" AT THE TOP LEFT, THEN ON "COMMUNITY HEALTH" IN THE DROP-DOWN MENU. SCROLL DOWN THE PAGE TO "COMMUNITY HEALTH NEEDS ASSESSMENT AND CLICK ON ACCOMPANYING LINKS. SUPPORTING THE WORK OF COMMUNITY GROUPS: DUKE AND ITS COMMUNITY PARTNERS CONTINUE THEIR LONGSTANDING COLLABORATIVE EFFORT TO ELIMINATE HEALTHCARE DISPARITIES AND IMPROVE RESIDENTS' ACCESS TO HIGH-QUALITY MEDICAL CARE. IN THE 2016 FISCAL YEAR, DUKE PROVIDED MORE THAN $12 MILLION IN CASH AND IN-KIND SUPPORT FOR COMMUNITY GROUPS, INCLUDING: (1) $7.37 MILLION FOR LINCOLN COMMUNITY HEALTH CENTER AND ITS SATELLITE COMMUNITY CLINICS, WHICH SERVE A MAJORITY POOR AND UNINSURED POPULATION; (2) $2.41 MILLION FOR DURHAM COUNTY'S EMERGENCY MEDICAL SERVICES PROGRAM; (3) $1.8 MILLION IN CASH CONTRIBUTIONS TO OTHER COMMUNITY ORGANIZATIONS. INVESTING IN HEALTH PROFESSIONS EDUCATION: EDUCATING THE NEXT GENERATION OF PHYSICIANS, NURSES, NURSE PRACTITIONERS, PHYSICIAN ASSISTANTS, AND PHYSICAL THERAPISTS, AND PATHOLOGY ASSISTANTS IS CENTRAL TO DUKE'S MISSION TO IMPROVE HEALTHCARE FOR PATIENTS AND THE COMMUNITY. IN THE 2016 FISCAL YEAR, DUKE INVESTED ALMOST $63 MILLION IN ITS HEALTH PROFESSIONS EDUCATION PROGRAM. THE PROGRAM REMAINS AMONG THE MOST CHALLENGING AND INNOVATIVE IN THE COUNTRY AS NEW MODELS OF COMMUNITY-FOCUSED CARE EMERGE THAT EMPHASIZE HEALTH, WELLNESS, AND INDIVIDUAL SELF-CARE, AS WELL AS POPULATION HEALTH MANAGEMENT.
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	DIRECTORS JACK O. BOVENDER, JR., RICHARD H. BRODHEAD, THOMAS M. GORRIE, WILLIAM HAWKINS, MICHAEL MARSICANO, DAVID M. RUBENSTEIN, AND STEVEN SCOTT, MD ARE TRUSTEES OF DUKE UNIVERSITY. DIRECTOR AND PRESIDENT/CEO, A. EUGENE WASHINGTON, MD, IS AN OFFICER OF DUKE UNIVERSITY. THE FOLLOWING INDIVIDUALS ARE EMPLOYEES OF DUKE UNIVERSITY: NANCY CATHERINE ANDREWS, MD, MARY KLOTMAN, MD, MARK F. NEWMAN, AND THEODORE N. PAPPAS, MD. DIRECTOR AND PRESIDENT/CEO, A. EUGENE WASHINGTON, MD, DIRECTOR MARK F. NEWMAN, AND OFFICERS WILLIAM J. FULKERSON, JR., MD, AND KENNETH C. MORRIS ARE DIRECTORS OF DURHAM CASUALTY COMPANY, LTD. DIRECTOR AND PRESIDENT/CEO, A. EUGENE WASHINGTON, MD, DIRECTORS MARY KLOTMAN, MD, MARK F. NEWMAN, AND OFFICER WILLIAM J. FULKERSON, JR., MD, ARE BOARD MEMBERS OF PRIVATE DIAGNOSTIC CLINIC, PLLC. OFFICERS WILLIAM J. FULKERSON, MD AND KENNETH C. MORRIS ARE BOTH DIRECTORS AND OFFICERS OF HEALTH SYSTEM MEDICAL STRATEGIES, INC.
FORM 990, PART VI, SECTION A, LINE 3	DUHS DELEGATES CONTROL TO A SUPPORTING ORGANIZATION FOR THE MANAGEMENT OF INVESTMENTS.
FORM 990, PART VI, SECTION A, LINE 7A	THE MEMBERS OF THE BOARD OF DIRECTORS OF DUHS, OTHER THAN THE EX OFFICIO MEMBERS, WILL BE NOMINATED BY THE BOARD OF DIRECTORS OF DUHS, AND WILL BE APPOINTED BY THE BOARD OF TRUSTEES OF DUKE UNIVERSITY. MEMBERS OF THE BOARD OF DIRECTORS OF DUHS WILL BE SUBJECT TO REMOVAL AT THE DISCRETION OF THE BOARD OF TRUSTEES OF DUKE UNIVERSITY IN ACCORDANCE WITH THE BYLAWS OF DUHS.
FORM 990, PART VI, SECTION A, LINE 7B	THE DUHS BYLAWS PROVIDE THAT DUHS MUST OBTAIN DUKE UNIVERSITY BOARD OF TRUSTEES APPROVAL FOR CERTAIN SIGNIFICANT TRANSACTIONS REGARDING DEBT ISSUANCES, CAPITAL ACQUISITIONS AND TANGIBLE PERSONAL AND REAL PROPERTY SALES.
FORM 990, PART VI, SECTION B, LINE 11	AFTER STAFF PREPARATION AND MANAGEMENT REVIEW, THE DUHS FORM 990 IS PRESENTED TO THE DUHS COMPLIANCE/AUDIT COMMITTEE OF THE BOARD OF DIRECTORS FOR REVIEW AND DISCUSSION. DUHS BOARD LEVEL COMMENT AND DISCUSSION ARE INCORPORATED INTO THE FORM AS APPROPRIATE PRIOR TO FILING. A FINAL VERSION OF THE FORM IS EMAILED TO THE DUHS BOARD OF DIRECTORS FOR FURTHER REVIEW AND COMMENT BEFORE FILING.
FORM 990, PART VI, SECTION B, LINE 12C	DUHS MONITORS AND ENFORCES COMPLIANCE RELATED TO CONFLICT OF INTEREST VIA AN ANNUAL CONFLICT OF INTEREST QUESTIONNAIRE, RELYING ON SELF DISCLOSURE OF ALL THOSE SUBJECT TO THE COI POLICY.
FORM 990, PART VI, SECTION B, LINE 15	THE DUHS COMPENSATION COMMITTEE, COMPRISED OF MEMBERS OF THE DUHS BOARD OF DIRECTORS, REVIEWS AND APPROVES ALL EXECUTIVE COMPENSATION FOR ALL DISQUALIFIED PERSONS AND OTHER KEY EMPLOYEES. THE DUHS COMPENSATION COMMITTEE REVIEWS AND RECOMMENDS TO THE DUKE UNIVERSITY COMPENSATION COMMITTEE THE COMPENSATION FOR THE PRESIDENT AND CEO OF DUHS WHO IS ALSO AN OFFICER OF DUKE UNIVERSITY. DUHS HAS ADOPTED A STATEMENT OF COMPENSATION PHILOSOPHY THAT ARTICULATES BROAD OBJECTIVES TO HELP GUIDE THE DUHS COMPENSATION COMMITTEE IN ITS MISSION. THE DUHS COMPENSATION COMMITTEE ENGAGES THE SERVICES OF AN OUTSIDE EXECUTIVE COMPENSATION CONSULTING FIRM TO ESTABLISH COMPARABILITY DATA OF OTHER HEALTH CARE SYSTEMS OF SIMILAR SIZE AND COMPLEXITY AS DUHS. THE DUHS COMPENSATION COMMITTEE REVIEWS THE MARKET ANALYSIS THEN DETERMINES THE REASONABLENESS AND APPROPRIATENESS OF ALL ASPECTS OF EXECUTIVE COMPENSATION. THE DUHS COMPENSATION COMMITTEE ALSO SETS THE METRICS AND APPROVES THE PAYOUTS FOR THE DUHS INCENTIVE COMPENSATION PLANS FOR THESE INDIVIDUALS. THE DELIBERATIONS AND CONCLUSIONS OF THE DUHS COMPENSATION COMMITTEE ARE KEPT BY A RECORDING SECRETARY WHO RECORDS THE MINUTES OF THE COMMITTEE MEETINGS.
FORM 990, PART VI, SECTION C, LINE 18	DUKE UNIVERSITY HEALTH SYSTEM, 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 UNIVERSITY HEALTH SYSTEM, INC.'S 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 UNIVERSITY HEALTH SYSTEM, INC. MAKES ITS CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FINANCIAL STATEMENTS ARE ALSO 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 SEARCH BOX, CHOOSE "SERIES 2016". ACCEPT THE TERMS OF THE WEBSITE, AND CLICK ON "CONTINUING DISCLOSURE".
FORM 990, PART XI, LINE 9:	NONPERIODIC CHANGES IN DEFINED BENEFIT PLANS: -308,489,942. NET TRANSFERS TO THE UNIVERSITY AND AFFILIATES: -622,263,615. CHANGE IN MARKET VALUE OF DERIVATIVES: -27,829,430. DEEMED DIVIDEND: -16,360,810.

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

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2015

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

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

Attach to Form 990.
MediumBullet

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

OMB No. 1545-0047

2015

Open to Public Inspection

Name of the organization

DUKE UNIVERSITY HEALTH SYSTEM INC

Employer identification number

56-2070036

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
(1) DUKE PRMO LLC 615 DOUGLAS STREET SUITE 700 DURHAM,NC27705	MEDICAL BILLING	NC	145,160,808	2,280,680	DUKE UNIVERSITY HEALTH SYSTEM INC
(2) DUHS GLOBAL LLC 310 BLACKWELL STREET 4TH FLOOR BOX DURHAM,NC27710	SUPPORT	NC	0	0	DUKE UNIVERSITY HEALTH SYSTEM INC

Part II

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

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	(g) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	Yes	No
(1)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	Yes
(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 HOSPITAL AUXILIARY INC PO BOX 2895 DURHAM,NC27710 56-1825604	SUPPORT	NC	501(C)(3)	11 TYPE III-O	N/A		No
(9)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	Yes
(10)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
(11)DUKE QUALITY NETWORK INC 324 BLACKWELL STREET STE 850 DURHAM,NC27701 46-1340679	SUPPORT	NC	501(C)(3)	11 TYPE 1	DUKE UNIVERSITY HEALTH SYSTEM INC	Yes
(12)DUKE SCHOLARLY EXHIBITS INC 324 BLACKWELL STREET STE 850 DURHAM,NC27701 56-1701245	SUPPORT	NC	501(C)(3)	11 TYPE 1	DUKE UNIVERSITY		No
(13)DUKE UNIV AFFILIATED PHYSICIANS 324 BLACKWELL STREET STE 850 DURHAM,NC27701 56-1902501	HEALTHCARE	NC	501(C)(3)	11 TYPE 1	DUKE UNIVERSITY HEALTH SYSTEM INC	Yes
(14)DUKE UNIV PHILANTHROPIES INC 324 BLACKWELL STREET STE 850 DURHAM,NC27701 57-1211099	SUPPORT	NC	501(C)(3)	11 TYPE 1	DUKE UNIVERSITY		No
(15)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
(16)DUKE UNIVERSITY 324 BLACKWELL STREET STE 850 DURHAM,NC27701 56-0532129	EDUCATION	NC	501(C)(3)	LINE 2	N/A		No
(17)DUMAC INC 280 S MANGUM STREET STE 210 DURHAM,NC27701 90-0754895	SUPPORT	NC	501(C)(3)	11 TYPE 1	DUKE UNIVERSITY		No
(18)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
(19)DURHAM REALTY INC 324 BLACKWELL STREET STE 850 DURHAM,NC27701 56-1917936	SUPPORT	NC	501(C)(3)	11 TYPE 1	DUKE UNIVERSITY		No
(20)GOTHIC CORPORATION 280 S MANGUM STREET STE 210 DURHAM,NC27701 56-1776668	INVESTMENTS	NC	501(C)(3)	11 TYPE 1	DUKE UNIVERSITY		No
(21)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	Yes
(22)HIGH POINT REALTY ASSOCIATES INC 324 BLACKWELL STREET STE 850 DURHAM,NC27701 56-1917939	SUPPORT	NC	501(C)(3)	11 TYPE 1	DUKE UNIVERSITY		No
(23)INNOVATIONS IN HEALTHCARE INC 324 BLACKWELL STREET STE 850 DURHAM,NC27701 32-0358709	SUPPORT	NC	501(C)(3)	11 TYPE 1	DUKE UNIVERSITY		No
(24)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
(25)THE CTR FOR DOCUMENTARY STUDIES 1317 PETTIGREW STREET DURHAM,NC27705 56-1655039	SUPPORT	NC	501(C)(3)	11 TYPE 1	DUKE UNIVERSITY		No
(26)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
(27)DUKE JANJUN SERVICES INC 324 BLACKWELL STREET STE 850 DURHAM,NC27701 47-1150667	SUPPORT	NC	501(C)(3)	11 TYPE 1	DUKE UNIVERSITY		No
(28)DUKE JULDEC SERVICES INC 324 BLACKWELL STREET STE 850 DURHAM,NC27701 47-1143245	SUPPORT	NC	501(C)(3)	11 TYPE 1	DUKE UNIVERSITY		No
(29)DUKE ALLMO SERVICES INC 324 BLACKWELL STREET STE 850 DURHAM,NC27701 47-1133466	SUPPORT	NC	501(C)(3)	11 TYPE 1	DUKE UNIVERSITY		No
(30)DUKE INVESTMENT EDUCATION INC 324 BLACKWELL STREET STE 850 DURHAM,NC27701 47-5555092	SUPPORT	NC	501(C)(3)	11 TYPE 1	DUKE UNIVERSITY		No
(31)FSB REALTY INC 324 BLACKWELL STREET STE 850 DURHAM,NC27701 81-1309454	SUPPORT	NC	501(C)(3)	11 TYPE 1	DUKE UNIVERSITY		No
(32)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	Yes

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

Cat. No. 50135Y

Schedule R (Form 990) 2015

Page 2

Part III

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

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(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?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity		(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No
(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?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets		Yes	No
(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	DUHS INC	C	5,384,321	190,296,686	100.000 %	Yes
(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) HEALTH SYSTEM MEDICAL STRATEGIES INC 324 BLACKWELL STREET STE 850 DURHAM,NC27701 56-2222444	HEALTH CARE	NC	DUHS INC	C	130,775	11,137	100.000 %	Yes
(13) MARATHON BLUE CAYMAN FUND 89 NEXUS WAY PO BOX 31106 GRAND CAYMAN KY1-1205 CJ	INVESTMENTS	CJ	N/A	C					No
(14) GHI HOLDINGS MAURITIUS 9TH FL ORANGE TOWER CYBERCITY EBENE MP	INVESTMENTS	MP	N/A	C					No
(15) GHI ERP LTD 9TH FL ORANGE TOWER CYBERCITY EBENE MP	INVESTMENTS	MP	N/A	C					No
(16) GHI HSP LTD 9TH FL ORANGE TOWER CYBERCITY EBENE MP	INVESTMENTS	MP	N/A	C					No
(17) GHI JBD LTD 9TH FL ORANGE TOWER CYBERCITY EBENE MP	INVESTMENTS	MP	N/A	C					No
(18) GHI LTP LTD 9TH FL ORANGE TOWER CYBERCITY EBENE MP	INVESTMENTS	MP	N/A	C					No
(19) QUORUM FUND LIMITED PO BOX 1043 GEORGE TOWN GRAND CAYMAN KY1-1102 CJ	INVESTMENTS	CJ	N/A	C					No
(20) MCP PRIVATE CAPITAL (FEEDER) FUND I LP 6 RUE GABRIEL LIPPMAN LUXEMBOURG L-5365 LU	INVESTMENTS	LU	N/A	C					No
(21) DUKE INDIA SERVICES PRIVATE LIMITED 302 PRIDE ELITE 10 MUSEUM ROAD BANGALORE,KARNATAKA560001 IN	MEDICAL RESEARCH	IN	N/A	C					No
(22) CPP OFFICE PORTFOLIO (FEEDER) LP 50 LOTHIAN ROAD FESTIVAL SQUARE EDINBURGH EH3 9WJ UK 98-1152490	REAL ESTATE	UK	N/A	C					No

Schedule R (Form 990) 2015

Page 3

Part V

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

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

Yes

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

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

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

Yes

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

Yes

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

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

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

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

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

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

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

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

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

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

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

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

Yes

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

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

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

Yes

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

Yes

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
(1) DUKE UNIVERSITY AFFILIATED PHYSICIANS INC	R	9,334,106	FMV
(2) DUKE UNIVERSITY AFFILIATED PHYSICIANS INC	S	248,260	FMV
(3) ASSOCIATED HEALTH SERVICES INC	S	5,367,050	FMV
(4) ASSOCIATED HEALTH SERVICES INC	O	4,149,506	FMV
(5) DURHAM CASUALTY COMPANYINC	R	10,400,301	FMV
(6) DURHAM CASUALTY COMPANYINC	S	5,542,485	FMV
(7) GOTHIC HSP CORPORATION	B	330,800,280	FMV
(8) GOTHIC HSP CORPORATION	C	290,827,510	FMV
(9) DUKE INTEGRATED NETWORK INC	R	2,316,039	FMV
(10) DUKE INTEGRATED NETWORK INC	O	731,310	FMV
(11) DUKE AFFILIATIONS NETWORK INC	R	1,739,565	FMV

Schedule R (Form 990) 2015

Page 4

Part VI

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

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

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

Schedule R (Form 990) 2015

Page 5

Part VII

Supplemental Information

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

Return Reference	Explanation

Schedule R (Form 990) 2015

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: SEE SCHEDULE O FOR ORGANIZATION'S MISSION STATEMENT
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	22
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	14
5	Total number of individuals employed in calendar year 2015 (Part V, line 2a) ......	5	18,416
6	Total number of volunteers (estimate if necessary) .............	6	1,307
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

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	5,820,061	8,218,130
9	Program service revenue (Part VIII, line 2g) .........	2,818,682,038	2,936,916,539
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	101,336,100	97,734,118
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	104,331,321	90,308,683
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	3,030,169,520	3,133,177,470
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	1,263,620	1,823,541
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)	1,202,472,908	1,271,861,355
16a	Professional fundraising fees (Part IX, column (A), line 11e) .....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 165,340
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	1,373,610,219	1,472,089,701
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	2,577,346,747	2,745,774,597
19	Revenue less expenses. Subtract line 18 from line 12.......	452,822,773	387,402,873
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	4,807,967,846	4,933,202,039
21	Total liabilities (Part X, line 26).............	1,801,917,400	2,714,201,164
22	Net assets or fund balances. Subtract line 21 from line 20.....	3,006,050,446	2,219,000,875

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 2,010,129,790 including grants of $ 1,823,541 ) (Revenue $ 2,991,309,310 )
	SEE SCHEDULE O

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 expenses2,010,129,790

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	9,375,577	4,748,669	1,145,917

1a	Federated campaigns..		1a
b	Membership dues..		1b
c	Fundraising events..		1c	51,066
d	Related organizations		1d	6,300
e	Government grants (contributions)		1e	401,882

f	All other contributions, gifts, grants, and similar amounts not included above		1f	7,758,882

g	Noncash contributions included in lines 1a-1f:$ 3,005,038
h Total.Add lines 1a-1f.......		8,218,130

			Business Code
2a	PATIENT REVENUE	621990	2,905,650,825	2,905,650,825
b	ANCILLARY MEDICAL	621990	28,335,783	28,335,783
c	MEDICAL SERVICES	621990	2,929,931	2,929,931
d
e
f	All other program service revenue.
g Total.Add lines 2a–2f.....			2,936,916,539

3 Investment income (including dividends, interest, and othersimilar amounts) ..........			27,410,546			27,410,546
4 Income from investment of tax-exempt bond proceeds
5 Royalties...........			10,155,359			10,155,359
		(ii) Personal	(i) Real
6a	Gross rents		13,672,544
b	Less: rental expenses		11,863,696
c	Rental income or (loss)		1,808,848
d	Net rental income or (loss)......			1,808,848			1,808,848
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory	627,351	1,627,572,359
b	Less: cost or other basis and sales expenses	945,565	1,556,930,573
c	Gain or (loss)	-318,214	70,641,786
d	Net gain or (loss).....			70,323,572			70,323,572
8a	Gross income from fundraising events (not including $ 51,066of contributions reported on line 1c). See Part IV, line 18 ....
	a		73,408
b	Less: direct expenses ...b		78,854
c	Net income or (loss) from fundraising events..			-5,446			-5,446
9a	Gross income from gaming activities. See Part IV, line 19 ...
	a
b	Less: direct expenses ...b
c	Net income or (loss) from gaming activities..
10a	Gross sales of inventory, less returns and allowances ..
	a
b	Less: cost of goods sold ..b
c	Net income or (loss) from sales of inventory..
Business Code			Miscellaneous Revenue
11a	BILLING FEES		621990	39,796,794	39,796,794
b	DEEMED DIVIDEND		900003	16,360,810			16,360,810
c	MEANINGFUL USE REVENUE		621990	4,341,380			4,341,380
d	All other revenue ....			17,850,938	14,595,977		3,254,961
e	Total. Add lines 11a–11d ......			78,349,922
12	Total revenue. See Instructions......			3,133,177,470	2,991,309,310	0	133,650,030

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21	1,622,966	1,622,966
2	Grants and other assistance to individuals in the United States. See Part IV, line 22	41,804	41,804
3	Grants and other assistance to governments, organizations, and individuals outside the United States. See Part IV, lines 15 and 16	158,771	158,771
4	Benefits paid to or for members
5	Compensation of current officers, directors, trustees, and key employees ....	5,691,919	666,688	4,947,336	77,895
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ....	250,459	143,559	106,625	275
7	Other salaries and wages	1,008,493,552	692,680,569	315,762,274	50,709
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	50,339,409	31,690,381	18,645,366	3,662
9	Other employee benefits .......	137,718,199	67,672,139	70,042,019	4,041
10	Payroll taxes ...........	69,367,817	47,432,344	21,932,004	3,469
11	Fees for services (non-employees):
a	Management ......	10,173,614	9,555,447	618,167
b	Legal .........	1,220,412	65,316	1,155,096
c	Accounting ...........	517,400		517,400
d	Lobbying ...........
e	Professional fundraising services. See Part IV, line 17
f	Investment management fees ......	2,745,646		2,745,646
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	233,819,308	121,703,745	112,115,563
12	Advertising and promotion ....	2,058,323	194,441	1,863,882
13	Office expenses .......	32,255,833	21,174,433	11,059,090	22,310
14	Information technology ......	49,348,172	2,466,203	46,881,969
15	Royalties ..
16	Occupancy ...........	62,957,491	42,422,249	20,535,225	17
17	Travel ............	6,953,860	4,229,232	2,724,453	175
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .
19	Conferences, conventions, and meetings ....	5,105,369		5,103,404	1,965
20	Interest ...........	40,941,137	250,236	40,690,901
21	Payments to affiliates .......
22	Depreciation, depletion, and amortization ..	150,454,094	112,674,863	37,779,231
23	Insurance ...	5,901,684	5,901,684
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	MEDICAL SUPPLIES	692,471,279	692,471,279
b	EQUIPMENT RENTAL & MAIN	75,095,596	48,095,830	26,999,536	230
c	MEDICAID ASSESSMENT	68,032,391	68,032,391
d	LOSS - DEBT EXTINGUISH.	25,077,686		25,077,686
e	All other expenses	6,960,406	38,783,220	-31,823,406	592
25	Total functional expenses. Add lines 1 through 24e	2,745,774,597	2,010,129,790	735,479,467	165,340
26	Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here if following SOP 98-2 (ASC 958-720).

1	Cash–non-interest-bearing ........			83,380	1	87,611
2	Savings and temporary cash investments .........			472,424,814	2	329,162,546
3	Pledges and grants receivable, net ......			3,844,516	3	2,033,882
4	Accounts receivable, net .............			419,624,025	4	385,991,772
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 ....			845,659	7	708,155
8	Inventories for sale or use ........			75,714,452	8	80,843,829
9	Prepaid expenses and deferred charges ......			15,304,455	9	18,726,721
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	2,979,570,809
b	Less: accumulated depreciation	10b	1,546,414,035	1,437,729,307	10c	1,433,156,774
11	Investments—publicly traded securities .			285,794,906	11	249,703,654
12	Investments—other securities. See Part IV, line 11 .....			2,063,136,861	12	2,396,723,865
13	Investments—program-related. See Part IV, line 11 ..				13
14	Intangible assets ...............			21,109,824	14	21,109,824
15	Other assets. See Part IV, line 11 ...........			12,355,647	15	14,953,406
16	Total assets. Add lines 1 through 15 (must equal line 34)...			4,807,967,846	16	4,933,202,039

17	Accounts payable and accrued expenses .....	284,748,675	17	310,640,992
18	Grants payable ...		18
19	Deferred revenue .........	5,707,181	19	8,442,833
20	Tax-exempt bond liabilities .........	1,064,585,790	20	1,078,059,351
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	446,875,754	25	1,317,057,988
26	Total liabilities. Add lines 17 through 25..	1,801,917,400	26	2,714,201,164

	Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets	2,948,471,628	27	2,161,184,588
28	Temporarily restricted net assets ...........	46,074,912	28	44,116,648
29	Permanently restricted net assets	11,503,906	29	13,699,639
	Organizations that do not follow SFAS 117 (ASC 958), check here and complete lines 30 through 34.
30	Capital stock or trust principal, or current funds .....		30
31	Paid-in or capital surplus, or land, building or equipment fund ...		31
32	Retained earnings, endowment, accumulated income, or other funds		32
33	Total net assets or fund balances ...........	3,006,050,446	33	2,219,000,875
34	Total liabilities and net assets/fund balances ........	4,807,967,846	34	4,933,202,039

1	Was the organization a U.S. transferor of property to a foreign corporation during the tax year? If "Yes,"the organization may be required to file Form 926, Return by a U.S. Transferor of Property to a Foreign Corporation (see Instructions for Form 926). . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	Yes	No
2	Did the organization have an interest in a foreign trust during the tax year? If "Yes," the organization may be required to separately file Form 3520, Annual Return to Report Transactions with Foreign Trusts and Receipt of Certain Foreign Gifts, and/or Form 3520-A, Annual Information Return of Foreign Trust With a U.S. Owner (see Instructions for Forms 3520 and 3520-A). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	Yes	No
3	Did the organization have an ownership interest in a foreign corporation during the tax year? If "Yes," the organization may be required to file Form 5471, Information Return of U.S. Persons with Respect to Certain Foreign Corporations. (see Instructions for Form 5471). . . . . . . . . . . . . . . . . . . . . . . . . . . .	Yes	No
4	Was the organization a direct or indirect shareholder of a passive foreign investment company or a qualified electing fund during the tax year? If “Yes,” the organization may be required to file Form 8621, Information Return by a Shareholder of a Passive Foreign Investment Company or Qualified Electing Fund. (see Instructions for Form 8621) .	Yes	No
5	Did the organization have an ownership interest in a foreign partnership during the tax year? If "Yes," the organization may be required to file Form 8865, Return of U.S. Persons with Respect to Certain Foreign Partnerships. (see Instructions for Form 8865). . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	Yes	No
6	Did the organization have any operations in or related to any boycotting countries during the tax year? If "Yes," the organization may be required to separately file Form 5713, International Boycott Report (see Instructions for Form 5713).. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	Yes	No