TY 2018 Form 990

(A) Name and Title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)
(1) PAULA HEIDERMAN...................................................................... BOARD CHAIRWOMAN	1.00 ................. 1.00	X			1,250	0
(2) MARJORIE HARE...................................................................... BOARD VICE CHAIRWOMAN	1.00 ................. 0.00	X			750	0
(3) ANNIE SCHROEDER...................................................................... BOARD SECRETARY	1.00 ................. 0.00	X			1,250	0
(4) MARY BETTE VOYLES...................................................................... BOARD TREASURER	1.00 ................. 0.00	X			1,250	0
(5) ANDREA FORRESTER...................................................................... BOARD ASSN'T TREASURER	1.00 ................. 0.00	X			1,250	0
(6) BONNIE COLEN...................................................................... BOARD ASSN'T SECRETARY	1.00 ................. 0.00	X			750	0
(7) JONATHAN HANSON MD...................................................................... BOARD MEMBER/PHYSICIAN	40.00 ................. 0.00	X			467,687	41,962
(8) PATRICK STACK MD...................................................................... BOARD MEMBER/PHYSICIAN	40.00 ................. 0.00	X			236,338	23,549
(9) JOE CRAIG...................................................................... BOARD MEMBER	1.00 ................. 0.00	X			1,250	0
(10) MARY KAY MCCUBBIN...................................................................... BOARD MEMBER	1.00 ................. 0.00	X			1,250	0
(11) KEVIN TURNER...................................................................... BOARD MEMBER	1.00 ................. 0.00	X			0	0
(12) CAROL DOZIER...................................................................... PRESIDENT/CEO	40.00 ................. 1.00		X		411,425	15,123
(13) JOHN PRICE...................................................................... VP FINANCE	40.00 ................. 0.00		X		249,348	18,418
(14) LISA MORGAN...................................................................... VP OUTPATIENT SERVICES	40.00 ................. 0.00		X		180,570	18,501
(15) DENINE FALLIS-HALLGARTH...................................................................... VP PHYSICIAN PRACTICES	40.00 ................. 0.00		X		161,950	18,615
(16) JENNIFER LITER...................................................................... VP INPATIENT SERVICES	40.00 ................. 0.00		X		155,861	20,371
(17) THOMAS ECKERT MD...................................................................... EMPLOYED PHYSICIAN	40.00 ................. 1.00			X	696,088	24,840

(A) Name and business address	(B) Description of services	(C) Compensation
ARUP LABORATORIES 500 CHIPETA WAY SALT LAKE CITY,UT84108	LABORATORY SERVICES	1,047,885
EMCARE INC 7032 COLLECTION CENTER DRIVE CHICAGO,IL60693	CONTRACTED PHYSICIAN & MID LEVEL PROVIDE	942,038
COMPREHENSIVE MEDICAL MANAGEMENT 300 DAVE COWENS DRIVE STE 600 NEWPORT,KY41071	CONTRACTED PHYSICIAN BILLING SERVICES	768,178
WEATHERBY LOCUMS INC PO BOX 972633 DALLAS,TX75397	CONTRACTED PHYSICIAN & MID LEVEL PROVIDE	726,590
NORTON HEALTHCARE PO BOX 35070 N-52 LOUISVILLE,KY40232	CONTRACTED PHSICIAN PROVIDER SERVICES	486,204
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 30

- TIN:

SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service

Public Charity Status and Public Support

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

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

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2018

Open to Public
Inspection

Name of the organization

THE BETHANY CIRCLE OF KING'S DAUGHTERS'
OF MADISON INDIANA INC

Employer identification number

35-0895832

Part I

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

The organization is not a private foundation because it is: (For lines 1 through 12, 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 agricultural research organization described in 170(b)(1)(A)(ix) operated in conjunction with a land-grant college or university or a non-land grant college of agriculture. See instructions. Enter the name, city, and state of the college or university:

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 12a through 12d that describes the type of supporting organization and complete lines 12e, 12f, and 12g.

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) 2018

Page 2

Part II

Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv), 170(b)(1)(A)(vi), and 170(b)(1)(A)(ix)
(Complete only if you checked the box on line 5, 7, 8, or 9 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) 2014	(b) 2015	(c) 2016	(d) 2017	(e) 2018	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") ..
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) 2014	(b) 2015	(c) 2016	(d) 2017	(e) 2018	(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 2018 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2017 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2018. 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—2017. 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—2018. 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—2017. 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) 2018

Page 3

Part III

Support Schedule for Organizations Described in Section 509(a)(2)
(Complete only if you checked the box on line 10 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) 2014	(b) 2015	(c) 2016	(d) 2017	(e) 2018	(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) 2014	(b) 2015	(c) 2016	(d) 2017	(e) 2018	(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 2018 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2017 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2018 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2017 Schedule A, Part III, line 17 .............

19a

331/3% support tests—2018. 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—2017. 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) 2018

Page 4

Part IV

Supporting Organizations

(Complete only if you checked a box on line 12 of Part I. If you checked 12a of Part I, complete Sections A and B. If you checked 12b of Part I, complete Sections A and C. If you checked 12c of Part I, complete Sections A, D, and E. If you checked 12d 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 12a or 12b 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) 2018

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) 2018

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 (explain in Part VI). 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) 2018

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 2018 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-2018	(iii) Distributable Amount for 2018
1 Distributable amount for 2018 from Section C, line 6
2 Underdistributions, if any, for years prior to 2018 (reasonable cause required-- explain in Part VI). See instructions.
3 Excess distributions carryover, if any, to 2018:
a From 2013.......
b From 2014.......
c From 2015.......
d From 2016.......
e From 2017.......
fTotal of lines 3a through e
g Applied to underdistributions of prior years
h Applied to 2018 distributable amount
i Carryover from 2013 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from 3f.
4Distributions for 2018 from Section D, line 7:
$
a Applied to underdistributions of prior years
b Applied to 2018 distributable amount
c Remainder. Subtract lines 4a and 4b from 4.
5 Remaining underdistributions for years prior to 2018, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions.
6 Remaining underdistributions for 2018. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions.
7 Excess distributions carryover to 2019. Add lines 3j and 4c.
8 Breakdown of line 7:
a Excess from 2014......
b Excess from 2015.....
c Excess from 2016.....
d Excess from 2017.....
e Excess from 2018.....

Schedule A (Form 990 or 990-EZ) (2018)

Schedule A (Form 990 or 990-EZ) 2018

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) 2018

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.

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2018

Name of the organization

THE BETHANY CIRCLE OF KING'S DAUGHTERS'
OF MADISON INDIANA INC

Employer identification number

35-0895832

Organization type (check one):

Filers of:

Section:

Form 990 or 990-EZ

501(c)( ) (enter number) organization

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

527 political organization

Form 990-PF

501(c)(3) exempt private foundation

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

501(c)(3) taxable private foundation

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

General Rule

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

Special Rules

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

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

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, contributions exclusively for religious, charitable, etc., purposes, but no such contributions totaled more than $1,000. If this box is checked, enter here the total contributions that were received during the year for an exclusively religious, charitable, etc., purpose. Don't 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 isn't covered by the General Rule and/or the Special Rules doesn't 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 doesn't 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) (2018)

Schedule B (Form 990, 990-EZ, or 990-PF) (2018) Page 2

Name of organization THE BETHANY CIRCLE OF KING'S DAUGHTERS' OF MADISON INDIANA INC

Part I	Contributors (See instructions). Use duplicate copies of Part I if additional space is needed.
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
RESTRICTED	,	$ RESTRICTED	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2018)

Schedule B (Form 990, 990-EZ, or 990-PF) (2018)

Page 3

Name of organization THE BETHANY CIRCLE OF KING'S DAUGHTERS' OF MADISON INDIANA INC		Employer identification number 35-0895832

Part II	Noncash Property (See instructions). Use duplicate copies of Part II if additional space is needed.
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
Schedule B (Form 990, 990-EZ, or 990-PF) (2018)

Schedule B (Form 990, 990-EZ, or 990-PF) (2018)

Page 4


Name of organization THE BETHANY CIRCLE OF KING'S DAUGHTERS' OF MADISON INDIANA INC			Employer identification number 35-0895832
Part III Exclusively religious, charitable, etc., contributions to organizations described in section 501(c)(7), (8), or (10) that total more than $1,000 for the year from any one contributor. Complete columns (a) through (e) and the following line entry. For organizations completing Part III, enter the total of exclusively religious, charitable, etc., contributions of $1,000 or less for the year. (Enter this information once. See instructions.) $ Use duplicate copies of Part III if additional space is needed.

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

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

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

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

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

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

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

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

Schedule B (Form 990, 990-EZ, or 990-PF) (2018)

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

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2018

Open to Public
Inspection

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

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

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

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

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

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

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

Name of the organization

THE BETHANY CIRCLE OF KING'S DAUGHTERS'
OF MADISON INDIANA INC

Employer identification number

35-0895832

Part I-A

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

Provide a description of the organization’s direct and indirect political campaign activities in Part IV (see instructions for definition of “political campaign activities")

Political campaign activity expenditures (see instructions) .................................................................... SchCMd Bullet

Volunteer hours for political campaign activities (see instructions) ..................................................................

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) 2018

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) 2015	(b) 2016	(c) 2017	(d) 2018	(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) 2018

Page 3

Part II-B

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

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

(a)

Yes

(b)

Amount

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

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

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

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

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

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

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

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

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

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

Yes

8,934

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

8,934

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

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

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

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

Part III-A

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

Yes

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

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

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

Part III-B

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

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

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

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

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

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

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

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

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

Part IV

Supplemental Information

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

Return Reference	Explanation
PART II-B, LINE 1:	PORTION OF INDIANA HOSPITAL ASSOCIATION DUES AND AMERICAN HOSPITAL ASSOCIATION DUES ATTRIBUTABLE TO LOBBYING EXPENSES AS DISCLOSED ON THE DUES NOTICES OF THE RESPECTIVE ASSOCIATIONS.

Schedule C (Form 990 or 990EZ) 2018

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.
SchDMd Bullet

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2018

Open to Public Inspection

Name of the organization

THE BETHANY CIRCLE OF KING'S DAUGHTERS'
OF MADISON INDIANA INC

Employer identification number

35-0895832

Part I

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

		(a) Donor advised funds	(b) Funds and other accounts
1	Total number at end of year .........
2	Aggregate value of contributions to (during year)
3	Aggregate value of grants from (during year)
4	Aggregate value at end of year ........

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

Yes No

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

Yes No

Part II

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

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

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

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

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


a	Total number of conservation easements ......................	2a
b	Total acreage restricted by conservation easements ....................	2b
c	Number of conservation easements on a certified historic structure included in (a) .....	2c
d	Number of conservation easements included in (c) acquired after 7/25/06, 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) 2018

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 ....	12,957	20,194	28,255	30,058	208,725
b	Contributions ...	3,208	28,678	356,398	506,513	50,077
c	Net investment earnings, gains, and losses
d	Grants or scholarships ...
e	Other expenditures for facilities and programs ...	3,315	35,915	364,459	508,316	228,744
f	Administrative expenses ....
g	End of year balance ......	12,850	12,957	20,194	28,255	30,058

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

Board designated or quasi-endowment SchDMd Bullet

0 %

Permanent endowment SchDMd Bullet

77.820 %

Temporarily restricted endowment SchDMd Bullet

22.180 %

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

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

Yes

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

3a(i)

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

3a(ii)

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

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

Part VI

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

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

1a	Land .....	4,039,775		4,039,775
b	Buildings ....	117,953,918	35,263,675	82,690,243
c	Leasehold improvements
d	Equipment ....	65,537,067	50,712,314	14,824,753
e	Other .....	406,086		406,086
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..				101,960,857

Schedule D (Form 990) 2018

Page 3

Part VII

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

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

Part VIII

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

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

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

Part IX

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

(a) Description				(b) Book value

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

Part X

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

1.(a) Description of liability	(b) Book value
(1) Federal income taxes
DEFERRED COMPENSATION	38,384
THIRD PARTY PAYABLE	1,712,532
LIFE INSURANCE POLICIES	395,457
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	2,146,373
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) 2018

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	124,177,400
2	Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a	Net unrealized gains (losses) on investments ....	2a	-13,013,699
b	Donated services and use of facilities .........	2b
c	Recoveries of prior year grants ...........	2c
d	Other (Describe in Part XIII.) ............	2d	441,687
e	Add lines 2a through 2d .....................			2e	-12,572,012
3	Subtract line 2e from line 1..................			3	136,749,412
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	576,528
b	Other (Describe in Part XIII.) ...........	4b	17,741
c	Add lines 4a and 4b....................			4c	594,269
5	Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ......			5	137,343,681

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	125,827,267
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	0
3	Subtract line 2e from line 1...................			3	125,827,267
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	576,528
b	Other (Describe in Part XIII.) ............	4b	17,741
c	Add lines 4a and 4b.....................			4c	594,269
5	Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ......			5	126,421,536

Part XIII

Supplemental Information

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

Return Reference	Explanation
PART V, LINE 4:	PERMANENT ENDOWMENT - INTENT IS TO HOLD THE INVESTMENT IN PERPETUITY. PER AUDITED FINANCIAL STATEMENTS, "THE PORTION OF PERPETUAL ENDOWMENT FUNDS THAT IS REQUIRED TO BE RETAINED PERMANENTLY EITHER BY EXPLICIT DONOR STIPULATION OR UPMIFA" IS $10,000 AT 12/31/2018. TERM ENDOWMENT - TEMPORARILY RESTRICTED NET ASSETS ARE DONOR-RESTRICTED FOR A SPECIFIC USE INCLUDING: INDIANA HOSPITAL ASSOCIATION FUND AND HIP 2.0 PREMIUM ASSISTANCE FUND.
PART X, LINE 2:	ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE HOSPITAL AND RECOGNIZE A TAX LIABILITY IF THE HOSPITAL HAS TAKEN AN UNCERTAIN TAX POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY VARIOUS FEDERAL AND STATE TAXING AUTHORITIES. MANAGEMENT HAS ANALYZED THE TAX POSITIONS TAKEN BY THE HOSPITAL, AND HAS CONCLUDED THAT AS OF DECEMBER 31, 2018 AND 2017, THERE ARE NO UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY OR DISCLOSURE IN THE ACCOMPANYING CONSOLIDATED FINANCIAL STATEMENTS. THE HOSPITAL IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, AS OF THE DATE THE FINANCIAL STATEMENTS WERE ISSUED, THERE WERE NO AUDITS FOR ANY TAX PERIODS IN PROGRESS.
PART XI, LINE 2D - OTHER ADJUSTMENTS:	CHANGE IN SUBSCRIBER SAVINGS CUMULATIVE ACCOUNT 441,687.
PART XI, LINE 4B - OTHER ADJUSTMENTS:	OTHER RENTAL INCOME 6,025. OTHER EXPENSE NETTED WITH INCOME ON FINANCIAL STATEMENTS 11,716.
PART XII, LINE 4B - OTHER ADJUSTMENTS:	OTHER RENTAL INCOME 6,025. OTHER EXPENSE NETTED WITH INCOME ON FINANCIAL STATEMENTS 11,716.

Schedule D (Form 990) 2018

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

Go to www.irs.gov/Form990EZ for instructions and the latest information.

OMB No. 1545-0047

2018

Open to Public Inspection

Name of the organization

THE BETHANY CIRCLE OF KING'S DAUGHTERS'
OF MADISON INDIANA INC

Employer identification number

35-0895832

Part I

Financial Assistance and Certain Other Community Benefits at Cost

Yes

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

Yes

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

Yes

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

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

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

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

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

Yes

100% 150% 200% Other %

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

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

Yes

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

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

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

Yes

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

Yes

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

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

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

Yes

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

Yes

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

Financial Assistance and Certain Other Community Benefits at Cost

Financial Assistance and Means-Tested Government Programs		(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) . . .	421,115		421,115	0.330 %
b	Medicaid (from Worksheet 3, column a) . . . . .	22,971,036	14,773,279	8,197,757	6.480 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) . .
d	Total Financial Assistance and Means-Tested Government Programs . . . . .	23,392,151	14,773,279	8,618,872	6.810 %
Other Benefits
e	Community health improvement services and community benefit operations (from Worksheet 4).	191,473	61,273	130,200	0.100 %
f	Health professions education (from Worksheet 5) . . .	170,718	45,275	125,443	0.100 %
g	Subsidized health services (from Worksheet 6) . . . .	2,366,683	2,231,825	134,858	0.110 %
h	Research (from Worksheet 7) .
i	Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .	18,166		18,166	0.010 %
j	Total. Other Benefits . .	2,747,040	2,338,373	408,667	0.320 %
k	Total. Add lines 7d and 7j .	26,139,191	17,111,652	9,027,539	7.130 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2018

Schedule H (Form 990) 2018

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.

		(c) Total community building expense	(e) Net community building expense	(f) Percent of total expense
1	Physical improvements and housing
2	Economic development
3	Community support	63	63	0 %
4	Environmental improvements
5	Leadership development and training for community members
6	Coalition building
7	Community health improvement advocacy	253,880	253,880	0.200 %
8	Workforce development	180	180	0 %
9	Other
10	Total	254,123	254,123	0.200 %

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

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

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

12,317,037

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).....

28,122,012

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

26,939,044

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

1,182,968

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) 2018

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?1Name, address, primary website address, and state license number (and if a group return, the name and EIN of the subordinate hospital organization that operates the hospital facility)
1	KING'S DAUGHTERS' HEALTH 1373 EAST STATE ROAD 62 PO BOX 447 MADISON,IN47250 WWW.KDHMADISON.ORG 18-005063-1	X	X	X

Schedule H (Form 990) 2018

Page 4

Part VFacility Information (continued)

Section B. Facility Policies and Practices

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

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

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

Yes

Community Health Needs Assessment

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

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

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

Yes

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

A definition of the community served by the hospital facility

Demographics of the community

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

How data was obtained

The significant health needs of the community

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

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

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

The impact of any actions taken to address the significant health needs identified in the hospital facility's prior CHNA(s)

Other (describe in Section C)

Indicate the tax year the hospital facility last conducted a CHNA: 20 16

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

Yes

6 a

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

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

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

Yes

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

Hospital facility’s website (list url): WWW.KDHMADISON.ORG/ABOUT-US/COMMUNITY-NEEDS-ASSESSMENT

Other website (list url):

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

Other (describe in Section C)

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

Yes

Indicate the tax year the hospital facility last adopted an implementation strategy: 20 17

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

Yes

If "Yes" (list url): HTTPS://WWW.KDHMADISON.ORG/ABOUT-US/COMMUNITY-NEEDS-ASSESSMENT

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) 2018

Page 5

Part VFacility Information (continued)

Financial Assistance Policy (FAP)

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

Yes

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

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

Yes

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

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

Was widely publicized within the community served by the hospital facility?........

Yes

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

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

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

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

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

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

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

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

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

Individuals were notified about the FAP by being offered a paper copy of the plain language summary of the FAP, by
receiving a conspicuous written notice about the FAP on their billing statements, and via conspicuous public displays or
other measures reasonably calculated to attract patients' attention

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

The FAP, FAP application form, and plain language summary of the FAP were translated into the primary language(s)
spoken by LEP populations

Other (describe in Section C)

Schedule H (Form 990) 2018

Page 6

Part VFacility Information (continued)

Billing and Collections

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

Yes

Did the hospital facility have in place during the tax year a 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 nonpayment?..................................

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

Deferring, denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

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

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

Deferring , denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

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):

Provided a written notice about upcoming ECAs (Extraordinary Collection Action) and a plain language summary of the
FAP at least 30 days before initiating those ECAs

Made a reasonable effort to orally notify individuals about the FAP and FAP application process

Processed incomplete and complete FAP applications

Made presumptive eligibility determinations

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)

Schedule H (Form 990) 2018

Page 7

Part VFacility Information (continued)

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

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

Yes

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 a look-back method based on claims allowed by Medicare fee-for-service during a prior 12-month period

The hospital facility used a look-back method based on claims allowed by Medicare fee-for-service and all private health insurers that pay claims to the hospital facility during a prior 12-month period

The hospital facility used a look-back method based on claims allowed by Medicaid, either alone or in combination with
Medicare fee-for-service and all private health insurers that pay claims to the hospital facility during a prior 12-month
period

The hospital facility used a prospective Medicare or Medicaid method

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

If "Yes," explain in Section C.

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

If "Yes," explain in Section C.

Schedule H (Form 990) 2018

Page 8

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, 16j, 18e, 19e, 20e, 21c, 21d, 23, and 24. If applicable, provide separate descriptions for each hospital facility in a facility reporting group, designated by facility reporting group letter and hospital facility line number from Part V, Section A (“A, 1,” “A, 4,” “B, 2,” “B, 3,” etc.) and name of hospital facility.
Form and Line Reference	Explanation
KING'S DAUGHTERS' HEALTH	PART V, SECTION B, LINE 3J: THE NEEDS ASSESSMENT PERFORMED BY THE HOSPITAL ALSO EXPLORED KEY ISSUES SUCH AS: PHYSICAL ACTIVITY, OVERWEIGHT AND OBESITY, TOBACCO USE, SUBSTANCE ABUSE/GAMBLING/ADDICTIONS, RESPONSIBLE SEXUAL BEHAVIOR, MENTAL HEALTH, INJURY AND VIOLENCE (INCLUDING DOMESTIC VIOLENCE AND SEXUAL ASSAULT), ENVIRONMENTAL QUALITY, IMMUNIZATION, ACCESS TO HEALTH CARE FOR THE INSURED AND UNINSURED, MATERNAL AND CHILD HEALTH, INFECTIOUS DISEASE, OCCUPATIONAL AND SAFETY HEALTH, SPECIAL NEEDS/DISABLED/IMPAIRED, AND CHRONIC DISEASE.
KING'S DAUGHTERS' HEALTH	PART V, SECTION B, LINE 5: THE FACILITY TOOK INTO ACCOUNT INPUT FROM PERSONS IN THE COMMUNITY BY UTILIZING THE FOLLOWING COMPONENTS:- ANALYSIS OF SECONDARY DATA TO DEVELOP A PROFILE OF THE RESIDENTS OF EACH COUNTY AND TO INDICATE, WHERE POSSIBLE FUTURE TRENDS AND TO SHOW COMPARISONS WITH STATE AND NATIONAL DATA;- IN-PERSON INTERVIEWS WITH 30 KEY LEADERS WITHIN KDH INCLUDING BOARD, STAFF AND MEDICAL STAFF;- IN-DEPTH-INTERVIEWS BY TELEPHONE OR IN-PERSON WITH 44 COMMUNITY LEADERS INCLUDING GOVERNMENT, MEDICAL, EDUCATION, AND OTHER COMMUNITY LEADERSHIP POSITIONS IN ALL FIVE COUNTIES;- IN-PERSON SURVEYS OF 72 INDIVIDUALS IN LOW INCOME LOCATIONS;- IN-PERSON DISCUSSIONS WITH 19 SENIOR CITIZENS;- A WEB-BASED SURVEY OPEN TO THE GENERAL PUBLIC WHICH RESULTED IN 184 COMPLETED INTERVIEWS. THIS ASSESSMENT ALLOWED ALL INDIVIDUALS TO PROVIDE RESPONSES ON ANY COMMUNITY NEEDS NOT LISTED IN THE QUESTIONS AND ALLOWED INDIVIDUALS TO MAKE COMMENTS ON COMMUNITY HEALTH ISSUES ON WHICH KDH C
KING'S DAUGHTERS' HEALTH	PART V, SECTION B, LINE 7D: RESULTS OF THE NEEDS ASSESSMENT HAVE BEEN MADE AVAILABLE THROUGH A VARIETY OF SOURCES: NEWSPAPER AND RADIO RELEASES, DISTRIBUTION OF INFORMATION IN THE COMMUNITY NEWSLETTER, THE VITAL SIGNS, THROUGH PUBLIC HEALTH FORUMS. IT IS ALSO AVAILABLE ON OUR WEBSITE @ WWW.KDHMADISON.ORG/ABOUT-US/COMMUNITY-NEEDS-ASSESSMENT.
KING'S DAUGHTERS' HEALTH	PART V, SECTION B, LINE 11: AFTER REVIEW OF THE COMMUNITY HEALTH NEEDS ASSESSMENT CONDUCTED IN 2017, A SMALL COMMITTEE OF INTERESTED INDIVIDUALS WAS INVITED TO PARTICIPATE IN MEETINGS TO DETERMINE WAYS WE CAN WORK TOGETHER TO BETTER MEET THE NEEDS OF THE COMMUNITIES WE SERVE. THIS SMALL GROUP INCLUDED PARTICIPATION FROM THE JEFFERSON COUNTY HEALTH DEPARTMENT, OUR STATE GRANT FOR TOBACCO PREVENTION AND OUR KDH COMMUNITY RELATIONS PARTICIPANTS. AMONG THIS GROUP WAS INPUT FROM OTHER PARTIES, AND AN INTERESTED VOLUNTEER MEDICAL STUDENT. THE NEEDS ASSESSMENT FINDINGS, AND THE IMPLEMENTATION STRATEGY, WERE SHARED WITH THE BOARD OF MANAGERS AND ALL ACTION PLAN ITEMS WILL BE INCORPORATED INTO THE WORKING STRATEGIC PLAN FOR THE ORGANIZATION.KDH GAPS: THERE DOES NOT APPEAR TO BE LARGE GAPS IN THE TOPICS OR TYPES OF COMMUNITY OUTREACH PROGRAMS THAT KDH HAS CONDUCTED IN THE PAST. HOWEVER, THERE MAY BE GAPS DUE TO FUNDING LEVELS OR STAFFING LEVELS IN THE NUMBER OF PROGRAMS AND THE GEOGRAPHIC REACH OF THE PROGRAMS THAT HAVE BEEN OFFERED. KDH WILL USE THE LIST OF MAJOR HEALTH ISSUES IN WHICH KDH IS EXPECTED TO HAVE A LEADERSHIP AND SUPPORTING ROLE AS WELL AS THE LIST OF SPECIFIC TOPICS SUGGESTED TO DEVELOP PROGRAMS AND APPLY FOR GRANTS TO IMPROVE HEALTH IN THE COMMUNITIES IT SERVES.IMPLEMENTATION STRATEGY 2017-2019 SAFE DRUG DROP OFF PROGRAM: KING'S DAUGHTERS' HEALTH WILL SUPPORT THE JEFFERSON COUNTY HEALTH DEPARTMENT WITH MULTIPLE DRUG DROP OFF EVENTS EACH YEAR. MANY OF THESE EVENTS WILL BE HOSTED ON THE KDH CAMPUS. KDH WILL ADVERTISE ALL DROP OFF EVENTS TO MEDICAL PROVIDERS, INTERNALLY TO STAFF, AND THROUGH SOCIAL MEDIA EFFORTS. GOALS: TO PROVIDE A SAFE ALTERNATIVE TO DISPOSING OF UNWANTED PRESCRIPTION MEDICATIONS. MEDICATIONS ARE INCINERATED BY LAW ENFORCEMENT AFTER COLLECTION. EVALUATION: THE HEALTH DEPARTMENT WILL EVALUATE THE NUMBER OF SPECIAL DROP OFF EVENTS EACH CALENDAR YEAR. THE NUMBER OF INDIVIDUALS DROPPING OFF DRUGS/MEDICINE WILL BE TRACKED AS WELL AS THE TOTAL POUNDS OF DRUGS COLLECTED. KDH WILL PROMOTE THE DRUG DROP OFF PROGRAM BY OFFERING A MINIMUM OF THREE DIFFERENT PROMOTIONAL METHODS FOR EACH SPECIAL EVENT.YEAR 2 - 2018 UPDATE:- NUMBER OF DRUG DROP OFF EVENTS IN 2018: 4 (ALL EVENTS WERE HELD AT THE KDH CAMPUS)- NUMBER OF INDIVIDUALS DROPPING OFF DRUGS/MEDICINE: 93- TOTAL POUNDS OF DRUGS COLLECTED: 211 LBS.- TOTAL POUNDS OF SYRINGES COLLECTED: 59.5 LBS.- SIMILAR PROMOTION METHODS FOR ALL DRUG DROP OFF EVENTS OCCURRED IN 2018. IN ADDITION, FLIERS WERE DISTRIBUTED BY THE LOCAL HEALTH DEPARTMENT. IN 2018 A TOTAL OF 10 DIFFERENT DOCUMENTED METHODS OF PROMOTION WERE RECORDED FROM PARTICIPANTS WHO WERE ASKED HOW THEY HEARD ABOUT THE DRUG DROP OFF EVENTS.OVERWEIGHT AND OBESITY AND LACK OF PHYSICAL ACTIVITY FIT KIDS DESCRIPTION: FIT KIDS IS A CURRICULUM-BASED HEALTH EDUCATION PROGRAM OFFERED IN THE SCHOOL CLASSROOM SETTING. KDH STAFF VISIT 5TH GRADE SCHOOL CLASSROOMS FOR 7 WEEKS OFFERING LESSONS TARGETING THE SUBJECT OF CHILDHOOD OBESITY. AGE-APPROPRIATE EDUCATION AND WEEKLY TAKE-HOME CHALLENGES TO INVOLVE FAMILIES ARE OFFERED EACH LESSON. ALL HEALTH LESSONS FOCUS ON A SPECIFIC AREA OF NUTRITION AND PHYSICAL ACTIVITY. GOALS: TO EXTEND THE FIT KIDS PROGRAM TO BOTH SWITZERLAND COUNTY, IN AND TRIMBLE COUNTY, KY ELEMENTARY SCHOOLS. IN ADDITION, THE PROGRAM WILL CONTINUE TO BE OFFERED TO ALL JEFFERSON COUNTY ELEMENTARY SCHOOLS. ANTICIPATED OUTCOMES IMPROVED HEART HEALTH KNOWLEDGE, INCREASE PHYSICAL ACTIVITY FOR CHILDREN, AND IMPROVED NUTRITION CHOICES SUCH AS; INCREASE WATER INTAKE, DECREASE HIGH SUGARY BEVERAGES, INCREASE IN FRUIT AND VEGETABLE CONSUMPTION, CONTROLLED PORTION SIZES, AND INCREASE PERCENTAGE OF CHILDREN WHO CONSUME BREAKFAST EACH DAY. PLAN TO EVALUATE: PRE/POST SURVEYS, WEEKLY TAKE HOME CHALLENGE PARTICIPATION. METRICS USED TO EVALUATE THE PROGRAM/ACTIVITY/INITIATIVE: A NEW PRE/POST SURVEY WILL BE DEVELOPED AND IMPLEMENTED FOR ALL PARTICIPATING STUDENTS. INSTRUCTORS WILL TRACK PERCENT OF STUDENTS WHO COMPLETE WEEKLY TAKE-HOME CHALLENGES.YEAR 2 - 2018 UPDATE:- THE PROGRAM WAS OFFERED AT THREE SCHOOL SYSTEMS IN JEFFERSON COUNTY.- ONE OF THE TWO ELEMENTARY SCHOOLS IN SWITZERLAND COUNTY WERE ADDED. THIS INCLUDED THREE NEW 5TH GRADE CLASSROOMS. - A TOTAL OF 18 CLASSROOMS WERE REACHED. THIS INCLUDED 382 STUDENTS AND 18 TEACHERS.- NEW VISUAL AIDS WERE ADDED IN 2018.- A NEW HOSPITAL FOUNDATION FUNDRAISER WAS ADDED IN 2018. PROCEEDS FROM THIS EVENT WERE DESIGNATED TO THE FIT KIDS PROGRAM. THIS FUNDING WILL HELP COVER STIPEND PAY FOR ADDITIONAL FIT KIDS INSTRUCTORS TO ASSIST THE WELLNESS COORDINATOR AND A HEALTHY SNACK AND GIFT FOR ALL 5TH GRADE STUDENTS. THESE ITEMS ARE GIVEN IN THE FINAL WEEK'S REVIEW LESSON.HEALTHY LIFESTYLES TEAM, COMMUNITY-WIDE WELLNESS CHALLENGES DESCRIPTION: THE NEWLY FORMED HEALTHY LIFESTYLES TEAM WILL CREATE AND IMPLEMENT A MINIMUM OF ONE COMMUNITY-WIDE WELLNESS CHALLENGE EACH CALENDAR YEAR. THESE CHALLENGES WILL BE INCENTIVE-BASED AND OPEN TO ALL COUNTY RESIDENTS. GOALS: CREATE CREATIVE CHALLENGES THAT WILL MOTIVATE PARTICIPANTS TO IMPROVE THEIR HEALTH. THE TEAM WILL WORK TO GET AS MANY LOCAL RESIDENTS INVOLVED BY TARGETING PROMOTION AND SIGNUPS TO INDUSTRIES/BUSINESSES, SCHOOLS, CHURCHES, AND CIVIC GROUPS. ANTICIPATED OUTCOMES: INCREASE PHYSICAL ACTIVITY, IMPROVE NUTRITIONAL HABITS, AND IMPROVE MISC. HEALTHY LIFESTYLE CHOICES LIKE STRESS MANAGEMENT AND QUALITY/QUANTITY OF SLEEP. THE ULTIMATE OUTCOME IS TO LOWER THE RATE OF OVERWEIGHT AND OBESE RESIDENTS IN THE COMMUNITY. PLAN TO EVALUATE: THE HEALTHY LIFESTYLES TEAM, UNDER THE LEADERSHIP OF THE HCI COORDINATOR AND WELLNESS COORDINATOR WILL EVALUATE PARTICIPATION LEVELS AND ANY BIOMETRIC MEASUREMENTS THAT CAN BE CAPTURED. PARTICIPATION SURVEYS WILL BE OFFERED WHEN POSSIBLE. METRICS USED TO EVALUATE THE PROGRAM/ACTIVITY/INITIATIVE: NUMBER OF CHALLENGES EACH CALENDAR YEAR WILL BE DOCUMENTED ALONG WITH NUMBER OF INDIVIDUALS PARTICIPATING AND PERCENT OF PEOPLE WHO COMPLETE/FINISH THE CHALLENGE. CHALLENGE TRACKING TOOLS WILL BE MEASURED, DEPENDING ON THE THEME/FOCUS OF THE CHALLENGE; EXAMPLE- CALCULATING TOTAL STEPS, EXERCISE MINUTES, CHANGE IN BMI, SERVINGS OF FRUITS/VEGETABLES, ETC. YEAR 2 - 2018 UPDATE:- HEALTHY LIFESTYLES TEAM MET 12 TIMES IN 2018. THE TEAM HAS 59 MEMBERS.- FREQUENT UPDATES ARE MADE FOR THE HEALTHY LIFESTYLES RESOURCE GUIDE. THIS JEFFERSON COUNTY GUIDE IS AVAILABLE ON-LINE AND IN PRINT.- A 2018 LIGHTEN UP JEFFERSON COUNTY COMMUNITY WEIGHT LOSS CHALLENGE WAS HELD. 126 ADULTS PARTICIPATED WITH A RECORDED 391 LB. TOTAL WEIGHT LOSS.- A SUMMER HEALTHY LIFESTYLES CHALLENGE WAS HELD AGAIN IN 2018.- SUMMER COMMUNITY PEP WALK WAS HELD.- A FALL 2018 HEALTHY YOUTH TAILGATE EVENT WAS HELD WITH 400 IN ATTENDANCE, 20 HEALTH EDUCATION BOOTHS, AND 50 VOLUNTEERS. STRIVE FOR 5 WEIGHT LOSS EDUCATION CLASS DESCRIPTION: THIS 5-WEEK CLASS SERIES TEACHES BASIC WEIGHT LOSS CONCEPTS AND FOCUSES ON DIFFERENT ASPECTS OF HEALTHY NUTRITION AND EXERCISE EACH WEEK. CLASS PARTICIPANTS WEIGH DURING THE FIRST AND LAST CLASS. THE ONE-TIME CLASS FEE OF $5 IS REFUNDED TO ANYONE WHO LOSES AT LEAST 5 POUNDS OF THEIR BODY WEIGHT. GOALS: OFFER A MINIMUM OF THREE 5-WEEK CLASS SERIES EACH CALENDAR YEAR, WITH A MINIMUM OF 30 PARTICIPANTS. ACHIEVE A 50% RATE EACH CLASS SERIES FOR PARTICIPANTS WHO LOSE THE MINIMUM OF 5 POUNDS OF BODY WEIGHT DURING THE 5 WEEK CLASS SERIES. ANTICIPATED OUTCOMES: IMPROVE NUTRITIONAL HABITS AND INCREASE PHYSICAL ACTIVITY FOR ALL CLASS PARTICIPANTS. MOTIVATE, EDUCATE, AND ASSIST CLASS PARTICIPANTS TO REDUCE BMI. PLAN TO EVALUATE: STRIVE FOR 5 INSTRUCTOR CALCULATIONS. METRICS USED TO EVALUATE THE PROGRAM/ACTIVITY/INITIATIVE: TRACK NUMBER OF CLASS SERIES OFFERED, NUMBER OF PARTICIPANTS, AND ATTENDANCE. OFFER PRE AND POST BODY WEIGHT CHECKS AND MEASURE ANY WEIGHT CHANGE. YEAR 2 - 2018 UPDATE:- TWO 5-WEEK CLASS SERIES WAS HELD IN 2018 WITH 19 TOTAL PARTICIPANTS.- 9 TOTAL PARTICIPANTS. 75% OF PARTICIPANTS COMPLETED THE 5 WEEK PROGRAM.- THESE CLASSES LOST A TOTAL OF 56.6 LBS. AND 85% OF PARTICIPANTS LOST WEIGHT. 35% OF PARTICIPANTS WHO COMPLETED THE CLASS LOST THE SUGGESTED 5+ LBS. DURING THE CLASS. TOBACCO USE DESCRIPTION: TOBACCO PREVENTION AND CESSATION COORDINATOR, EMPLOYED FULL TIME AT KDH, WILL PROVIDE EDUCATIONAL LITERATURE AND RESOURCES REGARDING THE HEALTH AND FINANCIAL EFFECTS OF SMOKING DURING PREGNANCY THROUGH WIC AND KDH OB/GYN PROVIDERS. THE COORDINATOR WILL MEET WITH WOMEN FACE TO FACE AS NECESSARY TO PROVIDE COUNSELING AND ADDITIONAL RESOURCES. GOALS: DECREASE SMOKING RATE AMONG PREGNANT WOMEN. ANTICIPATED OUTCOMES: THE MAIN ANTICIPATED OUTCOME IS A DECREASED SMOKING RATE AMONG PREGNANT WOMEN, WHICH WOULD ALSO LEAD TO DECREASED PRE-TERM BIRTHS, LOW BIRTH WEIGHT AND BIRTH DEFECTS DUE TO SMOKING.
KING'S DAUGHTERS' HEALTH	PART V, SECTION B, LINE 16J: AT THE TIME OF REGISTRATION, THE PATIENT IS OFFERED A PAMPHLET REGARDING THE POLICY, ELIGIBILITY REQUIREMENTS AND THE ASSOCIATED APPLICATION PROCESS. THE PATIENT MUST SIGN A FORM INDICATING THAT HE/SHE RECEIVED THIS INFORMATION. THE HOSPITAL ALSO HAS A REPRESENTATIVE ON SITE TO ASSIST PATIENTS WITH THE FINANCIAL AID APPLICATION PROCESS. PATIENTS ARE REMINDED TO CONTACT CUSTOMER SERVICE REGARDING FINANCIAL AID AND FEDERAL/STATE ASSISTANCE DIRECTLY ON THE PATIENT BILL ITSELF. THE HOSPITAL'S WEBSITE HAS A LINK TO THE FINANCIAL AID APPLICATION. IN ADDITION TO THE ACTIONS PREVIOUSLY LISTED, A FINANCIAL AID COUNSELOR WILL ATTEMPT TO MEET (DURING NORMAL BUSINESS HOURS) WITH ANY UNINSURED INPATIENT PRIOR TO DISCHARGE TO DISCUSS THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY.
KING'S DAUGHTERS' HEALTH	PART V, SECTION B, LINE 20E: AT THE TIME OF REGISTRATION, THE PATIENT IS OFFERED A PAMPHLET REGARDING THE POLICY, ELIGIBILITY REQUIREMENTS AND THE ASSOCIATED APPLICATION PROCESS. THE PATIENT MUST SIGN A FORM INDICATING THAT HE/SHE RECEIVED THIS INFORMATION. THE HOSPITAL ALSO HAS A REPRESENTATIVE ON SITE TO ASSIST PATIENTS WITH THE FINANCIAL AID APPLICATION PROCESS. PATIENTS ARE REMINDED TO CONTACT CUSTOMER SERVICE REGARDING FINANCIAL AID AND FEDERAL/STATE ASSISTANCE DIRECTLY ON THE PATIENT BILL ITSELF. THE HOSPITAL'S WEBSITE HAS A LINK TO THE FINANCIAL AID APPLICATION. IN ADDITION TO THE ACTIONS PREVIOUSLY LISTED, A FINANCIAL AID COUNSELOR WILL ATTEMPT TO MEET (DURING NORMAL BUSINESS HOURS) WITH ANY UNINSURED INPATIENT PRIOR TO DISCHARGE TO DISCUSS THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY.
PART V, SECTION B, LINE 11 CONTINUED	PLAN TO EVALUATE: WIC AND OB/GYN PROVIDER TRACKING, INDIANA STATE DEPARTMENT OF HEALTH/CDC STATISTICS AND REPORTS. METRICS USED TO EVALUATE THE PROGRAM/ACTIVITY/INITIATIVE: NUMBER OF PREGNANT WOMEN WHO RECEIVE EDUCATIONAL MATERIALS, RESOURCES, COUNSELING, ETC. YEAR 2 - 2018 UPDATE:- NUMBER OF OB/GYN PATIENTS REFERRED TO THE TOBACCO QUITLINE 32.- EDUCATION/CESSATION LITERATURE CONTINUES TO BE PROVIDED TO EACH OB PATIENT.- 2018 JEFFERSON COUNTY SMOKING WHILE PREGNANT RATE DECREASED TO 28.2% (WAS 31.3% IN 2016 AND 30.4% IN 2017).INDIANA TOBACCO QUITLINE DESCRIPTION: KDH TOBACCO PREVENTION AND CESSATION COORDINATOR WILL PROMOTE THE INDIANA TOBACCO QUITLINE IN ORDER TO INCREASE THE NUMBER OF PEOPLE WHO UTILIZE OR ARE REFERRED TO THE QUITLINE VIA THEIR MEDICAL PROVIDER OR EMPLOYER. THE QUITLINE IS A FREE RESOURCE FOR ALL IN RESIDENTS THAT CONNECTS THEM WITH A CESSATION COUNSELOR AND PROVIDES FREE NICOTINE REPLACEMENT PRODUCTS FOR THOSE ENROLLED IN MEDICARE, MEDICAID, OR ARE UNINSURED. GOALS: DECREASE SMOKING RATE AMONG ADULTS. ANTICIPATED OUTCOMES: THE MAIN ANTICIPATED OUTCOME IS A DECREASED SMOKING RATE AMONG ADULTS, WHICH WOULD ALSO LEAD TO A DECREASED INCIDENCE OF CHRONIC DISEASE AND ILLNESS DUE TO SMOKING. PLAN TO EVALUATE: TOBACCO PREVENTION AND CESSATION TRACKING AND REPORTS. METRICS USED TO EVALUATE THE PROGRAM/ACTIVITY/INITIATIVE: NUMBER OF QUITLINE CALLS, NUMBER OF QUITLINE REFERRALS, NUMBER OF PATIENTS WHO ACCEPT QUITLINE SERVICES, DATA REGARDING HOW PATIENTS ARE HEARING ABOUT THE QUITLINE. YEAR 2 - 2018 UPDATE:- NUMBER OF 2018 QUITLINE REFERRALS 181.- NUMBER OF ACCEPTED SERVICES 32. (DOES NOT INCLUDE NOV/DEC DUE TO ERROR IN REPORT)- NUMBER OF DECLINED SERVICES 51. (DOES NOT INCLUDE NOV/DEC DUE TO ERROR IN REPORT)YOUTH OUTREACH THROUGH SCHOOLS AND YOUTH ORGANIZATIONS DESCRIPTION: KDH TOBACCO PREVENTION AND CESSATION COORDINATOR WILL HOLD PRESENTATIONS AND ORGANIZE ACTIVITIES AT SCHOOLS AND YOUTH ORGANIZATIONS REGARDING HEALTH EFFECTS OF TOBACCO USE, AND THE MARKETING TACTICS OF BIG TOBACCO AND E-CIGARETTES. GOALS: DECREASE CURRENT YOUTH SMOKING RATES AND DISCOURAGE YOUTH FROM SMOKING. EDUCATE YOUTH ABOUT MARKETING TACTICS OF BIG TOBACCO USED TO TARGET YOUNG PEOPLE. ANTICIPATED OUTCOMES: THE MAIN ANTICIPATED OUTCOME IS A DECREASED SMOKING RATE AMONG YOUTH, AS WELL AS A MORE EDUCATED GROUP OF YOUTH WHO DO NOT DESIRE TO START SMOKING AND CAN ALSO RECOGNIZE THE TACTICS BIG TOBACCO USES TO TARGET YOUNG PEOPLE. PLAN TO EVALUATE: SURVEYS, PRE AND POST TESTS, IN STATE DEPARTMENT OF HEALTH AND CDC STATISTICS AND REPORTS. METRICS USED TO EVALUATE THE PROGRAM/ACTIVITY/INITIATIVE: NUMBER OF PRESENTATIONS, NUMBER OF STUDENTS REACHED, SURVEY AND TEST RESULTS. YEAR 2 - 2018 UPDATE:- EIGHT YOUTH-BASED TOBACCO PRESENTATIONS WERE HELD IN 2018.- ONE YOUTH-BASED CIGARETTE BUTT CLEAN UP EVENT WAS HELD WITH SUPPORT OF THE BOYS & GIRLS CLUB STAFF AND YOUTH MEMBERS.- KDH PARTICIPATED IN THE YOUTH TOBACCO SURVEY AT SWITZERLAND COUNTY HIGH SCHOOL.- KDH PARTICIPATED IN THE STARS TOBACCO RETAIL SURVEY IN JEFFERSON COUNTY.OUTREACH THROUGH RESPIRATORY THERAPY DEPARTMENT DESCRIPTION: KDH TOBACCO PREVENTION AND CESSATION COORDINATOR WILL PROVIDE FREE NICOTINE PATCHES FOR RESPIRATORY THERAPY PATIENTS AT KDH. PATIENTS WHO SMOKE AND SUFFER FROM COPD WILL BE OFFERED NICOTINE REPLACEMENT PRODUCTS AND EDUCATIONAL INFORMATION REGARDING THE HEALTH EFFECTS OF SMOKING, AS WELL AS INFORMATION ABOUT THE IN TOBACCO QUITLINE. PATCHES WILL BE PURCHASED THROUGH A GRANT, FUNDED FROM THE JEFFERSON COUNTY JUSTICE, TREATMENT, AND PREVENTION COALITION. GOALS: ASSIST RESPIRATORY PATIENTS WITH SMOKING CESSATION. ANTICIPATED OUTCOMES: THE MAIN ANTICIPATED OUTCOME IS A DECREASED NUMBER OF RESPIRATORY PATIENTS THAT SMOKE, WHICH WOULD ALSO LEAD TO IMPROVED RESPIRATORY FUNCTION, AND POSSIBLY A DECREASED CHANCE OF HOSPITAL ADMISSIONS. PLAN TO EVALUATE: RESPIRATORY DEPARTMENT TRACKING. METRICS USED TO EVALUATE THE PROGRAM/ACTIVITY/INITIATIVE: NUMBER OF PATCHES DISTRIBUTED, NUMBER OF PATIENTS SEEN IN RESPIRATORY DEPARTMENT, NUMBER OF COPD PATIENTS WHO SMOKE. YEAR 2 - 2018 UPDATE:- NUMBER OF PATCHES GIVEN BY RESPIRATORY DEPARTMENT TO PATIENTS IN 2018: 5 - THE NUMBER OF INPATIENTS TO RECEIVING SMOKING CESSATION INFORMATION FROM THE RESPIRATORY DEPARTMENT STAFF IN 2018 WAS NOT RECORDED. ALL INPATIENT WHO ARE LABELED AS TOBACCO USERS ARE OFFERED CESSATION COUNSELING. QUITLINE REFERRALS ARE OFFERED AND CESSATION INFORMATION (BROCHURES, LITERATURE, ITEMS SUCH AS STRESS BALLS) ARE GIVEN WHEN THE PATIENT IS WILLING TO ACCEPT. A BETTER TRACKING SYSTEM WILL BE PUT INTO PLACE FOR 2019 TO IMPROVE TOBACCO CESSATION FOR INPATIENTS.CHRONIC DISEASE HOUSE OF HEALTH DESCRIPTION: THE KDH WELLNESS DEPARTMENT WILL OFFER A MONTHLY EDUCATION PROGRAM TARGETING CHRONIC DISEASE PREVENTION AND EARLY DETECTION AT THE HOUSE OF HEALTH FOOD PANTRY. THE HOUSE OF HEALTH PROGRAM IS THE LARGEST COMMUNITY FOOD PANTRY IN THE COUNTY. THE PROGRAM SERVES AN AVERAGE OF 400 LOW-INCOME FAMILIES PER MONTH. GOALS: LOWER CHRONIC DISEASE RISK BY OFFERING VALUABLE HEALTH INFORMATION AND FREE SCREENS TO A LOW-INCOME POPULATION. ANTICIPATED OUTCOMES: IMPROVE KNOWLEDGE AND HEALTH AWARENESS BY OFFERING INFORMATION ON SUCH TOPICS AS; HEART DISEASE, SKIN AND BREAST CANCER PREVENTION AND DETECTION, STD/HIV PREVENTION AND DETECTION, BASIC FIRST AID, ETC. PLAN TO EVALUATE: PERSONAL SUCCESS STORIES SHARED FROM PARTICIPANTS WILL BE DOCUMENTED. METRICS USED TO EVALUATE THE PROGRAM/ACTIVITY/INITIATIVE: NUMBER OF HOUSE OF HEALTH SESSIONS HELD. THE NUMBER OF PEOPLE IN ATTENDANCE WILL BE MEASURED. THE NUMBER OF PEOPLE PARTICIPATING IN FREE SCREENING SERVICES WILL BE MEASURED (EXAMPLE BLOOD PRESSURE, SKIN CANCER SCREEN).YEAR 2 - 2018 UPDATE:- ELEVEN PROGRAMS WERE HELD IN 2018.- ATTENDANCE RANGED FROM 30-75 PEOPLE EACH MONTH.- TOPICS INCLUDED: HEART HEALTH, NUTRITION, STD/HIV/HEP C, TOBACCO, MOSQUITOS, SKIN CANCER, IMMUNIZATIONS, HEALTHY COMMUNITIES, BREAST CANCER, FOOD SAFETY, WEIGHT LOSS.- THE ONLY BIOMETRIC SCREEN OFFERED IN 2018 WAS BLOOD PRESSURE. A TOTAL OF 25 PEOPLE WERE SCREENED.CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD) READMISSION PREVENTION PROGRAM DESCRIPTION: A MULTI-DISCIPLINARY TEAM OF STAFF AT KDH WILL TARGET COPD PATIENTS AND THE PROBLEM OF READMISSION. READMISSION IS COSTLY TO THE PATIENT, THE HEALTH CARE ORGANIZATION, THE INSURANCE COMPANY, AND READMISSIONS INCREASE HEALTH CONCERNS FOR THE PATIENT. EMERGENCY MEDICATION KITS WILL BE PROVIDED TO COPD PATIENTS WITH DETAILS INSTRUCTIONS FOR USE AND SELF-HOME CARE. TAKE-HOME BINDERS WITH HEALTH EDUCATION ARE ALSO GIVEN TO ALL COPD PATIENTS. GOALS: TO DECREASE READMISSION FOR COPD PATIENTS. ANTICIPATED OUTCOMES: IMPROVE CHRONIC DISEASE MANAGEMENT SKILLS SO THE PATIENT CAN MANAGE PROBLEMS SAFELY AND EFFECTIVELY AT HOME, TO AVOID A RETURN TO THE HOSPITAL FOR READMISSION. PLAN TO EVALUATE: READMISSION RATES ARE MEASURED BY A PROGRAM TITLED MEDISOLVE. FOLLOW UP PATIENT PHONE CALLS ARE ALSO DOCUMENTED. METRICS USED TO EVALUATE THE PROGRAM/ACTIVITY/INITIATIVE: THE NUMBER OF COPD PATIENTS WILL BE MEASURED. THE NUMBER OF COPD EMERGENCY MED KITS AND THE NUMBER OF HEALTH EDUCATION BINDERS DISTRIBUTED WILL BE DOCUMENTED. YEAR 2 - 2018 UPDATE:- # OF EMERGENCY MED KITS DISTRIBUTED TO COPD PATIENTS: 146- # OF HEALTH EDUCATION BINDERS DISTRIBUTED TO COPD PATIENTS: 74- A TOTAL OF 178 DOCUMENTED FOLLOW-UP PHONE CALLS WERE MADE IN 2018 TO COPD PATIENTS.
PART V, SECTION B, LINE 11 CONTINUED	CONGESTIVE HEART FAILURE (CHF) READMISSION PREVENTION PROGRAM DESCRIPTION: HOME SCALES TO TRACK BODY WEIGHT WILL BE GIVEN TO CHF PATIENTS IN NEED. CHF EDUCATION BINDERS WITH HEALTH INSTRUCTIONS FOR HOME CARE WILL ALSO BE GIVEN TO ALL CHF DIAGNOSED PATIENTS. IN ADDITION, THE ACO COORDINATOR WILL PROVIDE FOLLOW-UP WITH INDIVIDUALS ON AN OUT-PATIENT LEVEL, PROVIDING REMINDERS OF APPOINTMENTS, ATTENDING PHYSICIAN OFFICE VISITS IF NEEDED, AND WILL SERVE AS A RESOURCE TO HELP PATIENTS MEET NEEDS. GOALS: TO DECREASE READMISSION FOR CHF PATIENTS. ANTICIPATED OUTCOMES: IMPROVE CHRONIC DISEASE MANAGEMENT SKILLS SO THE PATIENT CAN RECOGNIZE PROBLEMS SAFELY AND EFFECTIVELY AT HOME, TO REDUCE RISK OF RETURNING TO THE HOSPITAL FOR A READMISSION. PLAN TO EVALUATE: READMISSION RATES ARE MEASURED BY A PROGRAM TITLED MEDISOLVE. FOLLOW UP PATIENT PHONE CALLS ARE DOCUMENTED ONE WEEK AFTER DISCHARGE. METRICS USED TO EVALUATE THE PROGRAM/ACTIVITY/INITIATIVE: THE NUMBER OF CHF PATIENTS WILL BE MEASURED. THE NUMBER OF SCALES GIVEN FOR HOME USE AND THE NUMBER OF HEALTH EDUCATION BINDERS DISTRIBUTED WILL BE DOCUMENTED. THE NUMBER OF HOME PHONE CALLS WILL BE TRACKED AND STATISTICS WILL BE GATHERED FROM THE ACO COORDINATOR. YEAR 2 - 2018 UPDATE:- # OF SCALES DISTRIBUTED TO CHF PATIENTS: 19- # OF HEALTH EDUCATION BINDERS DISTRIBUTED TO COPD PATIENTS: 85- ALL PATIENTS RECEIVED A FOLLOW UP PHONE CALL.MENTAL HEALTH / SUICIDE MENTAL HEALTH/SUICIDE TEAM, RESOURCE GUIDE DESCRIPTION: THE NEWLY FORMED MENTAL HEALTH/SUICIDE TEAM WILL PROMOTE AVAILABLE TRAININGS DESIGNED TO TEACH PEOPLE HOW TO RECOGNIZE INDIVIDUALS WHO ARE AT RISK FOR SUICIDE AND OFFER EARLY INTERVENTION TO RESOURCES. GOALS: INCREASE THE NUMBER OF INDIVIDUALS WHO ARE TRAINED IN A STRUCTURED PROGRAM SUCH AS, BUT NOT LIMITED TO; QUESTION PERSUADE AND REFER (QPR) OR APPLIED SUICIDE INTERVENTION SKILLS TRAINING (ASIST). CREATE A RESOURCE GUIDE THAT HIGHLIGHTS ALL SUICIDE PREVENTION PERSONAL AND ANY/ALL LOCAL MENTAL HEALTH/SUICIDE RESOURCES IN THE COMMUNITY. PROMOTE AND ADVERTISE THIS RESOURCE GUIDE COUNTY-WIDE. IN ADDITION, KDH WILL INCREASE THE NUMBER OF KDH STAFF MEMBERS WHO ARE TRAINED IN QPR OR ASIST. ANTICIPATED OUTCOMES: BY INCREASING THE NUMBER OF PEOPLE TRAINED IN SUICIDE SUPPORT, THE ULTIMATE OUTCOME IS TO REDUCE THE NUMBER OF SUICIDE ATTEMPTS AND DEATHS. PLAN TO EVALUATE: MENTAL HEALTH/SUICIDE TEAM TRACKING. METRICS USED TO EVALUATE THE PROGRAM/ACTIVITY/INITIATIVE: NUMBER OF TRAINED SUICIDE PREVENTION PERSONAL. WORK WITH KDH IT AND ER STAFF AND THE COUNTY CORONER'S OFFICE TO OBTAIN NUMBER OF SUICIDE ATTEMPTS AND NUMBER OF SUICIDE DEATHS EACH CALENDAR YEAR. NUMBER OF PROMOTIONAL METHODS FOR THE RESOURCE GUIDE WILL BE TABULATED. YEAR 2 - 2018 UPDATE:- MULTIPLE SUICIDE-FOCUSED TRAININGS WERE HELD IN 2018: AMSR (ACCESSING AND MANAGING SUICIDE RISK) TRAINING HELD AT KDH 25 PEOPLE TRAINED. THREE MENTAL HEALTH FIRST AID TRAINING CLASSES HELD 78 PEOPLE TRAINED. SIX JEFFERSON COUNTY PROFESSIONALS ATTENDED THE INDIANA STATE SUICIDE PREVENTION CONFERENCE. QPR/QUESTION, PERSUADE, REFER TRAIN THE TRAINER HELD 19 PEOPLE TRAINED. SAFETALK SUICIDE PREVENTION TRAIN THE TRAINER HELD. ASIST TRAIN THE TRAINER HELD 15 PEOPLE TRAINED.MENTAL HEALTH/SUICIDE TEAM, SCHOOL BASED MENTAL HEALTH GRANT DESCRIPTION: A LARGE GRANT, WHICH WILL SUPPORT A COMPREHENSIVE MENTAL HEALTH/SUICIDE PREVENTION PROGRAM IN THE COUNTY'S LARGEST SCHOOL SYSTEM, WILL BE RESEARCHED, WRITTEN, AND SUBMITTED. IF GRANT FUNDING IS OBTAINED, THIS PROGRAM WILL BE BASED OUT OF THE MADISON CONSOLIDATED SCHOOL SYSTEM'S SPECIAL SERVICES AND COUNSELING DEPARTMENTS. THE HCI MENTAL HEALTH/SUICIDE TEAM WILL SUPPORT THE SCHOOL SYSTEM WITH ALL PROGRAMMING IMPLEMENTED FROM GRANT FUNDING. GOALS: OBTAIN GRANT TO BRING A COMPREHENSIVE MENTAL HEALTH / SUICIDE PROGRAM TO THE MADISON CONSOLIDATED SCHOOL SYSTEM. ANTICIPATED OUTCOMES: AWARDING OF GRANT FUNDING. THE ULTIMATE OUTCOME IS TO REDUCE THE NUMBER OF SUICIDE ATTEMPTS AND DEATHS FROM SUICIDE. SECONDARY OUTCOMES INCLUDE; REDUCE BULLYING CONCERNS, IMPROVE SELF-WORTH IN STUDENTS, INCREASE SUPPORTIVE RESOURCES FOR STUDENTS, SCHOOL STAFF, AND FAMILIES, AND IMPROVE COUNSELING SERVICES. PLAN TO EVALUATE: SEE BELOW, METRICS USED TO EVALUATE. METRICS USED TO EVALUATE THE PROGRAM/ACTIVITY/INITIATIVE: SINCE GRANT FUNDING IS NOT CONFIRMED AT THE TIME OF IMPLEMENTATION STRATEGY SUBMISSION, METRICS WILL CURRENTLY NOT BE DETERMINED. IF/WHEN FUNDING IS ESTABLISHED, THE SPECIAL SERVICES AND COUNSELING DEPARTMENTS OF MCS WILL WORK WITH THE MENTAL HEALTH/SUICIDE TEAM TO DETERMINE EVALUATION METHODS AND METRICS. YEAR 2 - 2018 UPDATE:ZERO-SUICIDE PLAN BEGAN IN 2018 WITH $40,000 GRANT. ACCOMPLISHED ACTIVITIES SUPPORTED BY THE GRANT INCLUDE: - COUNTY-WIDE 40-DAY KINDNESS CHALLENGE HELD. - COMMUNITY AND SCHOOL-BASED PRESENTATIONS HELD WITH AUTHOR OF A CASE FOR KINDNESS. - COMMUNITY WIDE PRESENTATION HELD WITH KEVIN HINES, SUICIDE SURVIVOR. - SUICIDE HOTLINE POSTERS (AND FRAMES) PRINTED AND PLACED AROUND THE COUNTY. - PATHA CURRICULUM FUNDED AND IMPLEMENTED IN THE FALL OF 2018 AT AREA ELEMENTARY SCHOOL. - MULTIPLE SUICIDE-FOCUSED TRAINERS WERE HELD (SEE PREVIOUS INDICATOR).MCS-BASED LILLY GRANT WORK CONTINUES INDEPENDENTLY. SUPPORT LOCAL SUICIDE SUPPORT GROUP(S) AND AREA AWARENESS ACTIVITIES DESCRIPTION: KDH WILL SUPPORT THE LOCAL SUICIDE SUPPORT GROUP AND ANY SUICIDE PREVENTION COMMUNITY ACTIVITIES. GOALS: PROMOTE SUICIDE SUPPORT GROUP TO ALL INTERNAL KDH STAFF AND PATIENTS. SUPPORT THE GROUP BY OFFERING MEETING SPACE IF NEEDED. SUPPORT LOCAL OUT OF THE DARKNESS SUICIDE AWARENESS COMMUNITY EVENT. PROMOTE THE EVENT TO STAFF, FORM A TEAM OF KDH EMPLOYEES, ENCOURAGE FINANCIAL DONATIONS, AND SECURE THAT DONATIONS ARE BEING USED ON A LOCAL LEVEL. ANTICIPATED OUTCOMES: INCREASE NUMBER OF ATTENDEES AT MONTHLY SUICIDE SUPPORT GROUP. INCREASE NUMBER OF PARTICIPANTS AND FUNDS RAISED FOR LOCAL SUICIDE AWARENESS WALK EVENT. PLAN TO EVALUATE: SOCIAL SERVICES STAFF AT KDH WILL WORK WITH SUICIDE SUPPORT GROUP FACILITATOR. METRICS USED TO EVALUATE THE PROGRAM/ACTIVITY/INITIATIVE: TRACK NUMBER OF PARTICIPANTS AT MONTHLY SUICIDE SUPPORT GROUP MEETINGS. REPORT NUMBER OF PARTICIPANTS AT COMMUNITY OUT OF THE DARKNESS AWARENESS EVENT, DOLLARS RAISED AT THE EVENT, AND % OF DOLLARS THAT WILL STAY LOCAL IN JEFFERSON COUNTY. YEAR 2 - 2018 UPDATE:- ALMOST $25,000 WAS RAISED AT THE 2018 OUT OF THE DARKNESS WALK IN JEFFERSON COUNTY. SOME OF THIS MONEY RAISED REMAINED IN THE COUNTY TO PURCHASE BOOKS/TEACHING MATERIALS FOR THE SUICIDE PREVENTION TRAININGS MENTIONED ABOVE. KDH PROMOTED THIS EVENT TO ALL EMPLOYEES FOR PARTICIPATION AND SERVED AS A FINANCIAL SPONSOR FOR THE EVENT. - CANDLELIGHT SERVICE HELD IN CONJUNCTION WITH WORLD SUICIDE PREVENTION DAY AGAIN IN 2018.

Schedule H (Form 990) 2018

Page 9

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?8
Name and address		Type of Facility (describe)
1	1 - REHABILITATION CENTER AND HOME CARE 2670 N MICHIGAN ROAD MADISON,IN47250	OUTPATIENT REHABILITATION CENTER AND HOME CARE SERVICES
2	2 - CONVENIENT CARE CENTER 445 CLIFTY DRIVE MADISON,IN47250	CONVENIENT CARE CENTER
3	3 - VERSAILLES MEDICAL OFFICE BLDG-TYSON ST 206 W TYSON STREET VERSAILLES,IN47042	PHYSICIAN MEDICAL OFFICE
4	4 - TRIMBLE COUNTY MEDICAL OFFICE BLDG 10235 US HIGHWAY 421 MILTON,KY40045	PHYSICIAN MEDICAL OFFICE
5	5 - CARROLLTON MEDICAL OFFICE BLDG 205 MARWILL DRIVE CARROLLTON,KY41008	PHYSICIAN MEDICAL OFFICE
6	6 - SWITZERLAND CNTY MEDICAL OFFICE BLDG 1190 WEST MAIN STREET VEVAY,IN47043	PHYSICIAN MEDICAL OFFICE
7	7 - HANOVER MEDICAL OFFICE BLDG 36 MEDICAL PLAZA HANOVER,IN47243	PHYSICIAN MEDICAL OFFICE
8	8 - DOWNTOWN MEDICAL OFFICE BLDG 630 NORTH BROADWAY MADISON,IN47250	PHYSICIAN MEDICAL OFFICE AND HOSPITAL STAFF
9
10

Schedule H (Form 990) 2018

Page 10

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 II, COMMUNITY BUILDING ACTIVITIES:	COMMUNITY BUILDING ACTIVITIES PROMOTED THE HEALTH OF THE COMMUNITY IN THE FOLLOWING WAYS:- PROMOTING HEALTHCARE CAREERS TO POTENTIAL "FUTURE EMPLOYEES" THROUGH JOB FAIRS AND PARTICIPATING IN HANOVER COLLEGE'S HEALTH CAREERS SUMMER ACADEMY.- ASSISTING COMMUNITY MEMBERS WITH MEDICAID PROGRAM ENROLLMENT VIA A FORMAL MEDICAID ENROLLMENT ASSISTANCE PROGRAM OFFERED BY THE HOSPITAL. THIS PROGRAM HELPS COMMUNITY MEMBERS ENROLL TO RECEIVE ALL TYPES OF MEDICAID ASSISTANCE (FOOD, HEALTHCARE, ETC.).
PART III, LINE 2:	IN 2018, THE HOSPITAL ADOPTED THE NEW REVENUE RECOGNITION ACCOUNTING STANDARD ISSUED BY FASB AND CODIFIED IN THE FASB ASC AS TOPIC 606 ("ASC 606"). AS A RESULT OF ADOPTING ASC 606, THE MAJORITY OF WHAT WAS PREVIOUSLY CLASSIFIED AS PROVISION FOR BAD DEBTS IN THE AUDITED FINANCIAL STATEMENTS (STATEMENT OF OPERATIONS AND CHANGES IN NET ASSETS) IS NOW REFLECTED AS IMPLICIT PRICE CONCESSIONS (AS DEFINED BY ASC 606) AND THEREFORE INCLUDED AS A REDUCTION TO NET PATIENT SERVICE REVENUE IN 2018.UPON ADOPTION OF ASC 606, NET PATIENT SERVICE REVENUES ARE RECORDED AT THE TRANSACTION PRICE ESTIMATED BY THE HOSPITAL TO REFLECT THE TOTAL CONSIDERATION DUE FROM PATIENTS AND THIRD-PARTY PAYORS IN EXCHANGE FOR PROVIDING GOODS AND SERVICES IN PATIENT CARE. THE TRANSACTION PRICE, WHICH INVOLVES SIGNIFICANT ESTIMATES, IS DETERMINED BASED ON THE HOSPITAL'S STANDARD CHARGES FOR THE GOODS AND SERVICES PROVIDED, WITH A REDUCTION RECORDED FOR PRICE CONCESSIONS RELATED TO THIRD-PARTY CONTRACTUAL ARRANGEMENTS AS WELL AS PATIENT DISCOUNTS AND OTHER PATIENT PRICE CONCESSIONS. THE HOSPITAL DETERMINES ITS ESTIMATES OF CONTRACTUAL ADJUSTMENTS AND DISCOUNTS BASED ON CONTRACTUAL AGREEMENTS, ITS DISCOUNT POLICIES, AND HISTORICAL EXPERIENCE. THE HOSPITAL DETERMINES ITS ESTIMATE OF IMPLICIT PRICE CONCESSIONS BASED ON ITS HISTORICAL COLLECTION EXPERIENCE WITH THIS CLASS OF PATIENTS.THE AMOUNT REPORTED ON LINE 2 IS "IMPLICIT PRICE CONCESSIONS" AS REFLECTED ON THE AUDITED, CONSOLIDATED TRIAL BALANCE FOR THE HOSPITAL.
PART III, LINE 3:	THE HOSPITAL HAS A DETAILED FINANCIAL ASSISTANCE POLICY WHICH STATES THAT TO PARTICIPATE IN CHARITY CARE CANDIDATES MUST COOPERATE FULLY. IN ADDITION THE HOSPITAL EDUCATES PATIENTS WITH LIMITED ABILITY TO PAY REGARDING FINANCIAL ASSISTANCE. FOR THIS REASON THE ORGANIZATION BELIEVES THAT IT ACCURATELY CAPTURES ALL CHARITY CARE DEDUCTIONS PROVIDED ACCORDING TO THE FINANCIAL ASSISTANCE POLICY AND THE AMOUNT OF BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S CHARITY CARE POLICY IS NEGLIGIBLE.
PART III, LINE 4:	IN 2018, THE HOSPITAL ADOPTED THE NEW REVENUE RECOGNITION ACCOUNTING STANDARD ISSUED BY FASB AND CODIFIED IN THE FASB ASC AS TOPIC 606 ("ASC 606"). AS A RESULT OF ADOPTING ASC 606, THE MAJORITY OF WHAT WAS PREVIOUSLY CLASSIFIED AS PROVISION FOR BAD DEBTS IN THE AUDITED FINANCIAL STATEMENTS (STATEMENT OF OPERATIONS AND CHANGES IN NET ASSETS) IS NOW REFLECTED AS IMPLICIT PRICE CONCESSIONS (AS DEFINED BY ASC 606) AND THEREFORE INCLUDED AS A REDUCTION TO NET PATIENT SERVICE REVENUE IN 2018.PLEASE REFER TO THE ATTACHED AUDITED FINANCIAL STATEMENTS - PAGES 8-9 "PATIENT ACCOUNTS RECEIVABLE AND NET PATIENT SERVICE REVENUE" PAGES 12-14 "CHANGED IN ACCOUNTING PRINCIPLE" PAGES 29-32 "NET PATIENT SERVICE REVENUE"
PART III, LINE 8:	THE MEDICARE COST REPORT WAS THE SOURCE OF INFORMATION REPORTED ON PART III LINE 6.
PART III, LINE 9B:	ALL UNINSURED PATIENTS RECEIVED AN AUTOMATIC 30% DISCOUNT FROM GROSS CHARGES. AT REGISTRATION, PATIENTS ARE NOTIFIED OF THE HOSPITAL'S FINANCIAL ASSISTANCE PROGRAM. THEY ARE OFFERED PAMPHLETS DETAILING THE PROGRAM. IF THE PATIENT IS KNOWN TO QUALIFY FOR FINANCIAL ASSISTANCE AND IS APPROVED FOR FINANCIAL ASSISTANCE, THE PATIENT WILL RECEIVE A DISCOUNT OF 100% ON THE OUTSTANDING ACCOUNT BALANCE. THE HOSPITAL WILL ATTEMPT TO COLLECT ANY BALANCE REMAINING ON THE UNINSURED ACCOUNT AFTER ALL FINANCIAL ASSISTANCE DISCOUNTS HAVE BEEN APPLIED USING A SERIES OF STATEMENTS, LETTERS, AND TELEPHONE CALLS. THE HOSPITAL WILL ALSO OFFER PATIENTS INTEREST-FREE EXTENDED PAYMENT PLANS. IF THE ACCOUNT REMAINS UNPAID, THE ACCOUNT MAY BE TURNED OVER TO A COLLECTION AGENCY.
PART VI, LINE 2:	THE HOSPITAL CONDUCTED A NEEDS ASSESSMENT IN 2016 WHOSE IMPLEMENTATION STRATEGY WAS ADOPTED IN APRIL 2017. - THE FOCUS OF THIS ASSESSMENT WAS ON THE HEALTH NEEDS THAT COULD BE ADDRESSED BY KDH AND CAN BE USED BY KDH IN PLANNING FUTURE SERVICES, APPLYING FOR GRANTS AND PLANNING OUTREACH EFFORTS.- THE STUDY INCLUDED THE FOLLOWING COMPONENTS:- ANALYSIS OF SECONDARY DATA TO DEVELOP A PROFILE OF THE RESIDENTS OF EACH COUNTY AND TO INDICATE, WHERE POSSIBLE FUTURE TRENDS AND TO SHOW COMPARISONS WITH STATE AND NATIONAL DATA;- IN-PERSON INTERVIEWS WITH 30 KEY LEADERS WITHIN KDH INCLUDING BOARD, STAFF AND MEDICAL STAFF;- IN-DEPTH-INTERVIEWS BY TELEPHONE OR IN-PERSON WITH 44 COMMUNITY LEADERS INCLUDING GOVERNMENT, MEDICAL, EDUCATION, AND OTHER COMMUNITY LEADERSHIP POSITIONS IN ALL FIVE COUNTIES;- IN-PERSON SURVEYS OF 72 INDIVIDUALS IN LOW INCOME LOCATIONS;- IN-PERSON DISCUSSIONS WITH 19 SENIOR CITIZENS;- A WEB-BASED SURVEY WAS OPEN TO THE GENERAL PUBLIC WHICH RESULTED IN 184 COMPLETED INTERVIEWS.- THIS ASSESSMENT ALLOWED ALL INDIVIDUALS TO PROVIDE RESPONSES ON ANY COMMUNITY NEEDS NOT LISTED IN THE QUESTIONS AND ALLOWED INDIVIDUALS TO MAKE COMMENTS ON COMMUNITY HEALTH ISSUES ON WHICH KDH COULD HAVE AN IMPACT.- KEY HEALTH ISSUES EXPLORED WERE THE FOLLOWING:- PHYSICAL ACTIVITY- OVERWEIGHT AND OBESITY- TOBACCO USE- SUBSTANCE ABUSE/GAMBLING/ADDICTIONS- RESPONSIBLE SEXUAL BEHAVIOR- MENTAL HEALTH- INJURY AND VIOLENCE (INCLUDING DOMESTIC VIOLENCE AND SEXUAL ASSAULT)- ENVIRONMENTAL QUALITY- IMMUNIZATION- ACCESS TO HEALTH CARE FOR THE INSURED AND UNINSURED- MATERNAL AND CHILD HEALTH- INFECTIOUS DISEASE- OCCUPATIONAL AND SAFETY HEALTH- SPECIAL NEEDS/DISABLED/IMPAIRED- CHRONIC DISEASERESULTS OF THE NEEDS ASSESSMENT HAVE BEEN MADE AVAILABLE THROUGH A VARIETY OF SOURCES:NEWSPAPER AND RADIO RELEASES, DISTRIBUTION OF INFORMATION IN THE COMMUNITY NEWSLETTER, VITAL SIGNS, AND IS ALSO AVAILABLE ON OUR WEB SITE.
PART VI, LINE 3:	-AT THE TIME OF REGISTRATION, THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY IS DISCUSSED WITH EACH PATIENT. THE PATIENT IS OFFERED A PAMPHLET REGARDING THE POLICY, ELIGIBILITY REQUIREMENTS AND THE ASSOCIATED APPLICATION PROCESS. THE PATIENT MUST SIGN A FORM INDICATING THAT THEY RECEIVED THIS INFORMATION.-THE HOSPITAL HAS A REPRESENTATIVE ON SITE TO ASSIST PATIENTS WITH THE FINANCIAL AID APPLICATION PROCESS.-PATIENTS ARE REMINDED TO CONTACT CUSTOMER SERVICE REGARDING FINANCIAL AID AND FEDERAL/STATE ASSISTANCE DIRECTLY ON THE PATIENT BILL ITSELF.-THE HOSPITAL'S WEBSITE HAS A LINK TO THE FINANCIAL AID APPLICATION.
PART VI, LINE 4:	KING'S DAUGHTER'S HEALTH PROVIDES HEALTH CARE SERVICES TO FIVE COUNTIES IN SOUTHERN INDIANA AND NORTHERN KENTUCKY. THE 2016 KDH CHNA INCLUDED ITS PRIMARY SERVICE AREAS OF JEFFERSON AND SWITZERLAND COUNTIES IN INDIANA AND TRIMBLE COUNTY IN KENTUCKY. THE ADDITIONAL TWO COUNTIES (RIPLEY IN INDIANA AND CARROLL IN KENTUCKY) HAVE MULTIPLE HEALTH CARE FACILITIES THAT CURRENTLY CONDUCT A CHNA. TO AVOID DUPLICATION, THE THREE PRIMARY COUNTIES DESCRIBED WERE INCLUDED IN THE 2016 KDH CHNA. A FEW DESCRIPTIVE DEMOGRAPHIC HIGHLIGHTS FOR THESE THREE COUNTIES INCLUDE:JEFFERSON COUNTY, INDIANA TOTAL POPULATION 32,428, MEDIAN AGE 40.9 (ABOVE STATE AVERAGE OF 37.0) RACIAL/ETHNIC COMPOSITION 95.4% CAUCASIAN PERCENT POVERTY 16.2% (ABOVE THE STATE AVERAGE OF 15.2%) PERCENT UNINSURED 14% ADULTS UNDER 65 HAVE NO INSURANCE (13.8% STATE AVERAGE) UNEMPLOYMENT RATE 6.0% (SAME AS STATE AVERAGE) EDUCATION LEVEL 15% OF ADULTS 25+ HAVE LESS THAN A HIGH SCHOOL DIPLOMA (STATE AVERAGE 12%)SWITZERLAND COUNTY, INDIANA TOTAL POPULATION 10,613 RACIAL/ETHNIC COMPOSITION 97.7% CAUCASIAN PERCENT POVERTY 28% PERCENT UNINSURED 15.7% ADULTS UNDER 65 HAVE NO INSURANCE UNEMPLOYMENT RATE 4.9% EDUCATION LEVEL 18% OF ADULTS 25+ HAVE LESS THAN A HIGH SCHOOL DIPLOMATRIMBLE COUNTY, KENTUCKY TOTAL POPULATION 8,769 RACIAL/ETHNIC COMPOSITION 94% CAUCASIAN PERCENT POVERTY 17.4% (BELOW STATE AVERAGE OF 18.9%) PERCENT UNINSURED 9.6% ADULTS UNDER 65 HAVE NO INSURANCE (9.8% STATE AVERAGE) UNEMPLOYMENT RATE 7.2% (ABOVE THE STATE AVERAGE OF 6.5%) EDUCATION LEVEL 15.8% OF ADULTS 25+ HAVE LESS THAN A HIGH SCHOOL DIPLOMA (SAME STATE AVERAGE)
PART VI, LINE 5:	THE MAJORITY OF KING'S DAUGHTERS' HEALTH BOARD OF MANAGERS IS COMPRISED OF INDIVIDUALS WHO LIVE AND WORK IN THE HOSPITAL SERVICES AREA. THE MAJORITY OF THESE INDIVIDUALS ARE NEITHER EMPLOYEES, NOR CONTRACTORS OF THE ORGANIZATION, NOR FAMILY MEMBERS THEREOF. THE HOSPITAL EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN ITS COMMUNITY FOR SOME OR ALL OF ITS DEPARTMENTS. THE ORGANIZATION ALSO APPLIES A PORTION OF SURPLUS FUNDS TO IMPROVEMENTS IN PATIENT CARE. HISTORICALLY, KDH HAS EMPLOYED A FULL TIME COMMUNITY WELLNESS COORDINATOR. THIS POSITION PROVIDES OUTREACH SERVICES IN AREAS OF NEED TO THE COMMUNITIES WE SERVE. IN ADDITION TO THESE SERVICES, KDH ALSO SERVES AS THE FISCAL AGENT FOR SEVERAL STATE AND FEDERAL GRANTS. ALL OF THESE SERVICES HELP US MEET THE IDENTIFIED NEEDS OF THE COMMUNITIES WE SERVE.PARTICIPATION IN THE BELOW COMMUNITY ORGANIZATIONS IS PART OF THE HOSPITAL'S INDIANA STATE DEPARTMENT OF HEALTH COMMUNITY BENEFIT PLAN AND GOALS.2018 KING'S DAUGHTERS' HEALTH OVERVIEW OF COMMUNITY BENEFIT ACTIVITIES1. HEALTH SCREENS/HEALTH FAIRS: A. CORPORATE HEALTH SCREENS / FAIRS: GROTE INDUSTRIES EMPLOYEE HEALTH FAIR IKE EMPLOYEE HEALTH FAIR IVY TECH HEALTH FAIR B. COMMUNITY HEALTH SCREENS / FAIRS: REMC HEALTH FAIR FOR RIPLEY AND DEARBORN COUNTIES IN IN. THORNTON TERRACE HEALTH FAIR IN JEFFERSON CO. TRIMBLE CO. KY HIGH SCHOOL HEALTH FAIR. SWISS VILLA HEALTH FAIR IN SWITZERLAND CO. IN. C. CORPORATE FLU SHOTS: LAW FIRM 12 EMPLOYEES D. 4-H FAIR PARTICIPATION: RIPLEY COUNTY, IN JEFFERSON COUNTY, IN TRIMBLE COUNTY, KY E. FREE TAKE-HOME COLOR CANCER SCREENING KITS: 71 KITS DISTRIBUTED THROUGH THE KDH LABORATORY2. COMMUNITY EDUCATION OPPORTUNITIES/CLASSES/SPECIAL EVENTS: A. WELLNESS DEPARTMENT 15 SPEAKING ENGAGEMENTS B. FIT KIDS PROGRAM (7 WEEK PROGRAM FOR AREA 5TH GRADE CLASSROOMS) 5 SCHOOL SYSTEMS / 18 CLASSROOMS / 448 KIDS + TEACHERS C. TOBACCO CESSATION & EDUCATION: KING'S DAUGHTERS' HEALTH EMPLOYS A FULL TIME STATE GRANT FUNDED TOBACCO COORDINATOR. WE HAVE SERVED AS THE FISCAL AGENT FOR THESE FUNDS SINCE 2009 FROM TPCC, TOBACCO PREVENTION AND CESSATION COMMISSION. CESSATION RESOURCES GIVEN TO 30 INDIVIDUALS IN 2018. KDH DOCUMENTED 181 ELECTRONIC PATIENT REFERRALS TO THE IN QUITLINE. TOBACCO COORDINATOR COMPLETED 16 SPEAKING ENGAGEMENTS. HELD 1 COMMUNITY CONVERSATION EVENT. HELD 2 CIGARETTE BUTT CLEAN UP EVENTS. PARTICIPATED IN YOUTH TOBACCO SURVEY AT SWITZERLAND CO. HIGH SCHOOL. PARTICIPATED IN STARS TOBACCO RETAIL SURVEY IN JEFFERSON CO. D. CPR AND FIRST AID CLASSES: COMMUNITY CLASSES - 492 TOTAL GRADUATES. BLS, PALS, ACLS, AND PEARS CLASSES HELD FOR KDH EMPLOYEES AND AREA HEALTH CARE PROFESSIONALS 708 TOTAL PEOPLE TRAINED. E. STRIVE FOR 5 PROGRAM: COMMUNITY 5-WEEK WEIGHT LOSS EDUCATION PROGRAM. TWO CLASSES HELD IN 2018, 19 PARTICIPANTS. F. PRENATAL EDUCATION: OB PREP PROGRAM 381 EXPECTING MOTHERS SERVED G. GIRLS ON THE RUN FALL SEASON: 93 GIRLS / 8 SITES / 25 TRAINED COACHES / 10 WEEK PROGRAM FALL 5K: 238 PARTICIPANTS AND 50 VOLUNTEERS H. HOUSE OF HEALTH: MONTHLY HEALTH EDUCATION OPPORTUNITY PROVIDED AT THE HOUSE OF HOPE FOOD PANTRY. APPROXIMATELY 25-70 PEOPLE ATTEND EACH MONTH. I. LET'S TALK LADIES WOMEN'S HEALTH EVENT: 42 WOMEN IN ATTENDANCE. 17 KDH STAFF OFFERED HEALTH INFORMATION AND FREE HEALTH SCREENS. J. MAN UP, MEN'S HEALTH EVENT: 65 MEN IN ATTENDANCE. 19 KDH STAFF OFFERED HEALTH INFORMATION AND FREE HEALTH SCREENS. K. MONTHLY "TO YOUR HEALTH" RADIO SHOW: 30-MINUTE HEALTH EDUCATION PROGRAM WITH VARIOUS TOPICS OFFERED EACH MONTH. L. WOMEN'S SAFETY & SELF-DEFENSE WORKSHOPS: FREE COMMUNITY WORKSHOP OFFERED TO COMMUNITY. 12 PARTICIPANTS. M. KDH RUN THE FALLS 5K WALK/RUN: 222 PEOPLE PARTICIPATED N. CANCER SUPPORT ACTIVITES: WOMEN AND CANCER SUPPORT GROUP PARTICIPATION IN JEFFERSON CO. IN AND TRIMBLE CO. KY RELAY FOR LIFE EVENTS. CANCER SURVIVOR'S DINNER HELD WITH 125 PARTICIPANTS3. EMPLOYEE HEALTH OPPORTUNITIES FOR KDH STAFF: WELLNESS NEWSLETTERS (ON-LINE AND PAPER VERSIONS AVAILABLE) WELLNESS COLUMN IN THE MONTHLY MONITOR NEWSLETTER MONTHLY PADLET WELLNESS NEWSLETTER CREATED AND SENT TO ALL STAFF FREE LIPID BLOOD TEST OFFERED FOR ALL STAFF WITH INSURANCE PREMIUM REDUCTION OPPORTUNITY SEATED CHAIR MASSAGE SESSIONS, PART OF HOLIDAY STRESS LESS CAMPAIGN 2018 GOAL SHEETS WITH INCENTIVE OFFERED 3 WELLNESS CHALLENGES: 47250 INCENTIVE CHALLENGE PARTICIPATION IN COMMUNITY-WIDE PHYSICAL ACTIVITY CHALLENGE PARTICIPATION IN COMMUNITY-WIDE WEIGHT LOSS CONTEST 4. COMMUNITY SERVICE ACTIVITIES: A. ACTIVE ATTENDANCE AND PARTICIPATION IN: JC-JTP JEFFERSON COUNTY JUSTICE TREATMENT PREVENTION COALITION SCAN SWITZERLAND COUNTY AWARENESS NETWORK MADISON CONSOLIDATED SCHOOLS WELLNESS COMMITTEE MASHER (AREA CORPORATE SAFETY GROUP) OVO HEAD START POLICY COUNCIL PURDUE EXTENSION HEALTH AND HUMAN SERVICES BOARD PERINATAL COMMUNITY TASK FORCE PARTICIPATION IN INDIANA HEALTH ROADSHOW. PROVIDED SPEAKERS AND SPONSORSHIP. B. EMS STAND-BY AT ALL COMMUNITY ACTIVITIES: EMS PROVIDES STAND-BY COVERAGE AT ALL JEFFERSON COUNTY ACTIVITIES. C. ATHLETIC TRAINING/REHAB SERVICES PROVIDED FOR THREE JEFFERSON COUNTY SCHOOLS. D. SUPPORT TO VARIOUS AREA SCHOOLS WITH INTERNSHIPS: SUPPORT MANY LOCAL AND AREA HIGH SCHOOLS AND COLLEGES WITH INTERNSHIPS AND JOB SHADOW EXPERIENCES: INCLUDES NURSING AND MEDICAL STUDENTS AMONG OTHERS.5. HEALTHY COMMUNITIES INITIATIVE (HCI): EFFORTS LED BY KING'S DAUGHTERS' HEALTH, PART-TIME COORDINATOR FUNDED BY KDH FOUNDATION THREE TEAMS, COMPRISED OF HOSPITAL STAFF AND COMMUNITY REPRESENTATIVES: MENTAL HEALTH/ZERO SUICIDE SUBSTANCE ABUSE HEALTHY LIFESTYLES (INCLUDES TOBACCO COALITION) 2018 HCI ACCOMPLISHMENTS: GENERAL: - HOSTED COMMUNITY POVERTY SIMULATION 52 PARTICIPANTS - PROVIDED HCI INFORMATION AT 12 COMMUNITY MEETINGS. SUBSTANCE ABUSE TEAM: - SUB-COMMITTEE ACTIVE FOR MENTOR FOR MOMS PROGRAM - SUB-COMMITTEE ACTIVE FOR ROAD TO RECOVERY PROGRAM AND VOLUNTEER TRAINING HELD. - HOSTED PRESENTATION ON THE IMPACT OF TRAUMA/SUBSTANCE ABUSE - HELD TWO COMMUNITY-WIDE SESSIONS ON HUMAN TRAFFICKING. MENTAL HEALTH/ZERO SUICIDE TEAM: - FORMAL ZERO SUICIDE INITIATIVE CORE TEAM FORMED. $40,000 GRANT AWARDED FROM THE MADISON JEFFERSON COUNTY COMMUNITY FOUNDATION FOR THIS INITIATIVE. - HOSTED AND/OR ATTENDED A VARIETY OF SUICIDE TRAININGS: ACCESSING AND MANAGING SUICIDE RISK INDIANA STATE SUICIDE PREVENTION CONFERENCE MENTAL HEALTH FIRST AID SAFETALK SUICIDE PREVENTION QPR QUESTION, PERSUADE, REFER - HOSTED 40 DAY KINDNESS CHALLENGE. INCLUDED HOSTING SCHOOL BASED AND COMMUNITY SPEAKER, AUTHOR OF A CASE FOR KINDNESS BOOK. - HOSTED KEVIN HINES PRESENTATION ON HOPE/SUICIDE. - HELD A COMMUNITY PRAYER SERVICE FOR WORLD SUICIDE DAY. HEALTHY LIFESTYLES TEAM: - HELD 12 MONTHLY MEETINGS IN 2018. - CREATED AND UPDATES HEALTHY LIFESTYLE RESOURCE GUIDE. - HELD LIGHTEN UP JEFFERSON COUNTY WEIGHT LOSS CONTEST. RECORDED A TOTAL OF 391 POUNDS LOST. HOSTED OUR FREE NUTRITION WORKSHOPS IN CONJUNCTION WITH THE CONTEST. - HOSTED COMMUNITY PEP WALK EVENT. - OFFERED SUMMER COMMUNITY-WIDE HEALTHY LIFESTYLES CHALLENGE WITH 150 PARTICIPANTS. - HELD HEALTHY YOUTH TAILGATE PARTY WITH OVER 400 PARTICIPANTS, 20 BOOTHS, AND 50 VOLUNTEERS. - HELD A QUIT COLD-TURKEY TOBACCO CESSATION EVENT.
PART VI, LINE 6:	NA
PART VI, LINE 7, REPORTS FILED WITH STATES	IN

Schedule H (Form 990) 2018

Additional Data

Software ID:
Software Version:

- TIN:

Note: To capture the full content of this document, please select landscape mode (11" x 8.5") when printing.

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

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2018

Open to Public
Inspection

Name of the organization
THE BETHANY CIRCLE OF KING'S DAUGHTERS'
OF MADISON INDIANA INC

Employer identification number
35-0895832

Part I

General Information on Grants and Assistance

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

Yes No

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

Part II

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

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

(a) Name and address of organization or government	(b) EIN	(c) IRC section (if applicable)	(d) Amount of cash grant	(e) Amount of non-cash assistance	(f) Method of valuation (book, FMV, appraisal, other)	(g) Description of noncash assistance	(h) Purpose of grant or assistance
(1) IHA HOSPITAL ASSISTANCE FOUNDATION 500 NORTH MERIDIAN STREET STE 250 INDIANAPOLIS,IN46204	45-5573749		11,716				DONATION

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

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

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

Cat. No. 50055P

Schedule I (Form 990) 2018

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 noncash assistance	(e) Method of valuation (book, FMV, appraisal, other)	(f) Description of noncash assistance

(1)
(2)
(3)
(4)
(5)
(6)
(7)

Part IV

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

Return Reference	Explanation
PART I, LINE 2:	FUNDS ARE NOT GRANTED BUT ARE DONATED. DONATIONS ARE DETERMINED ON A DISCRETIONARY BASIS.

Schedule I (Form 990) 2018

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

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2018

Open to Public Inspection

Name of the organization

THE BETHANY CIRCLE OF KING'S DAUGHTERS'
OF MADISON INDIANA INC

Employer identification number

35-0895832

Part I

Questions Regarding Compensation

Yes

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

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

Travel for companions Payments for business use of personal residence

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

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

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

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

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

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization provide any nonfixed
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) 2018

Page 2

Part II

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

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

(A) Name and Title		(B) Breakdown of W-2 and/or 1099-MISC compensation			(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)	(F) Compensation in column (B) reported as deferred on prior Form 990
(A) Name and Title		(i) Base compensation	(ii) Bonus & incentive compensation	(iii) Other reportable compensation	(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)
1JONATHAN HANSON MD BOARD MEMBER/PHYSICIAN	(i) (ii)	307,677 ------------- 0	159,650 ------------- 0	360 ------------- 0	13,750 ------------- 0	28,212 ------------- 0	509,649 ------------- 0	0 ------------- 0
2PATRICK STACK MD BOARD MEMBER/PHYSICIAN	(i) (ii)	140,987 ------------- 0	93,767 ------------- 0	1,584 ------------- 0	12,012 ------------- 0	11,537 ------------- 0	259,887 ------------- 0	0 ------------- 0
3CAROL DOZIER PRESIDENT/CEO	(i) (ii)	402,645 ------------- 0	0 ------------- 0	8,780 ------------- 0	13,750 ------------- 0	1,373 ------------- 0	426,548 ------------- 0	0 ------------- 0
4JOHN PRICE VP FINANCE	(i) (ii)	230,296 ------------- 0	0 ------------- 0	19,052 ------------- 0	11,560 ------------- 0	6,858 ------------- 0	267,766 ------------- 0	0 ------------- 0
5LISA MORGAN VP OUTPATIENT SERVICES	(i) (ii)	161,038 ------------- 0	0 ------------- 0	19,532 ------------- 0	8,206 ------------- 0	10,295 ------------- 0	199,071 ------------- 0	0 ------------- 0
6DENINE FALLIS-HALLGARTH VP PHYSICIAN PRACTICES	(i) (ii)	142,898 ------------- 0	0 ------------- 0	19,052 ------------- 0	7,348 ------------- 0	11,267 ------------- 0	180,565 ------------- 0	0 ------------- 0
7JENNIFER LITER VP INPATIENT SERVICES	(i) (ii)	137,124 ------------- 0	0 ------------- 0	18,737 ------------- 0	4,897 ------------- 0	15,474 ------------- 0	176,232 ------------- 0	0 ------------- 0
8THOMAS ECKERT MD EMPLOYED PHYSICIAN	(i) (ii)	422,821 ------------- 0	271,683 ------------- 0	1,584 ------------- 0	13,750 ------------- 0	11,090 ------------- 0	720,928 ------------- 0	0 ------------- 0
9TRAVIS CLEGG MD EMPLOYED PHYSICIAN	(i) (ii)	453,809 ------------- 0	1,341,489 ------------- 0	216 ------------- 0	13,750 ------------- 0	28,247 ------------- 0	1,837,511 ------------- 0	0 ------------- 0
10WILLIAM SKILES MD EMPLOYED PHYSICIAN	(i) (ii)	448,152 ------------- 0	204,587 ------------- 0	1,584 ------------- 0	13,750 ------------- 0	14,352 ------------- 0	682,425 ------------- 0	0 ------------- 0
11MICHAEL SCHMIDT MD EMPLOYED PHYSICIAN	(i) (ii)	447,994 ------------- 0	204,804 ------------- 0	360 ------------- 0	13,750 ------------- 0	18,211 ------------- 0	685,119 ------------- 0	0 ------------- 0
12RONALD AUER MD EMPLOYED PHYSICIAN	(i) (ii)	539,705 ------------- 0	357,852 ------------- 0	42,614 ------------- 0	13,750 ------------- 0	28,846 ------------- 0	982,767 ------------- 0	0 ------------- 0

Schedule J (Form 990) 2018

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

PART I, LINE 7

PHYSICIANS ARE ELIGIBLE FOR INCENTIVE COMPENSATION. THE PHYSICIAN IS COMPENSATED FOR EACH WORK RVU PERFORMED BY A PHYSICIAN IN A CALENDAR YEAR IN EXCESS OF THE PHYSICIAN'S WORK RVU INCENTIVE THRESHOLD FOR THE CALENDAR YEAR MULTIPLIED BY THE INCENTIVE RVU PAYMENT. NON-PHYSICIAN BONUS COMPENSATION IS DISCRETIONARY, SOLELY UP TO THE BOARD OF MANAGERS, AND THE CALCULATION FOR SAID BONUS COMPENSATION VARIES FROM YEAR TO YEAR.

ADDITIONAL SCHEDULE J DISCLOSURES

BOARD MEMBERS PAT STACK, MD AND JONATHAN HANSON, MD LISTED ABOVE ARE EMPLOYED PHYSICIANS OF THE HOSPITAL. DR. STACK AND DR. HANSON DO NOT RECEIVE COMPENSATION FOR SERVICES PROVIDED AS BOARD MEMBERS. THE COMPENSATION LISTED ABOVE FOR DR. STACK AND DR. HANSON IS COMPENSATION RECEIVED FOR SERVICES PROVIDED AS EMPLOYED PHYSICIANS.

Schedule J (Form 990) 2018

Additional Data

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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 Ⅵ, line 24a. Provide descriptions,
explanations, and any additional information in Part Ⅵ.
SchKMediumBullet

Attach to Form 990.
SchKMediumBullet

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2018

Open to Public
Inspection

Name of the organization
THE BETHANY CIRCLE OF KING'S DAUGHTERS'
OF MADISON INDIANA INC

Employer identification number
35-0895832

Part Ⅰ

Bond Issues

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

Part Ⅱ

Proceeds

	A		B		C		D
	1 Amount of bonds retired ..................
2 Amount of bonds legally defeased ..............
3 Total proceeds of issue ..................	97,847,058
4 Gross proceeds in reserve funds .............	6,756,861
5 Capitalized interest from proceeds .............
6 Proceeds in refunding escrows ...............
7 Issuance costs from proceeds ...............	1,749,243
8 Credit enhancement from proceeds .............
9 Working capital expenditures from proceeds .............
10 Capital expenditures from proceeds .............	88,974,097
11 Other spent proceeds .............	266,857
12 Other unspent proceeds .............
13 Year of substantial completion .............	2013
	Yes	No	Yes	No	Yes	No	Yes	No
14 Were the bonds issued as part of a current refunding issue? ....		X
15 Were the bonds issued as part of an advance refunding issue? .....		X
16 Has the final allocation of proceeds been made? ..........	X
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? ..................	X

Part Ⅲ

Private Business Use

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

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

Cat. No. 50193E

Schedule K (Form 990) 2018

Page 2

Part Ⅲ

Private Business Use (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
3a Are there any management or service contracts that may result in private business use of bond-financed property? .............	X
b If "Yes" to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property?	X
c Are there any research agreements that may result in private business use of bond-financed property? .............		X
d If "Yes" to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property?
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government ....	0.560 %
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government .........
6 Total of lines 4 and 5 .............	0.560 %
7 Does the bond issue meet the private security or payment test? ...		X
8a Has there been a sale or disposition of any of the bond-financed property to a nongovernmental person other than a 501(c)(3) organization since the bonds were issued?.............		X
b If "Yes" to line 8a, enter the percentage of bond-financed property sold or disposed of. ..
c If "Yes" to line 8a, was any remedial action taken pursuant to Regulations sections 1.141-12 and 1.145-2? .............
9 Has the organization established written procedures to ensure that all nonqualified bonds of the issue are remediated in accordance with the requirements under Regulations sections 1.141-12 and 1.145-2? ........		X

Part Ⅳ

Arbitrage

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

Schedule K (Form 990) 2018

Page 3

Part Ⅳ

Arbitrage (Continued)

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

Part Ⅴ

Procedures To Undertake Corrective Action

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

Part Ⅵ

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

Return Reference	Explanation
SCH K PART I LINE A - PURPOSE	THE PURPOSE OF THE BOND ISSUANCE IS TO FINANCE, REFINANCE, OR REIMBURSE A PORTION OF THE COSTS OF ACQUIRING, CONSTRUCTING, RENOVATING AND EQUIPPING VARIOUS HEALTH CARE FACILITIES OF THE HOSPITAL, INCLUDING A REPLACEMENT ACUTE CARE HOSPITAL FACILITY AND A MEDICAL OFFICE BUILDING.

Schedule K (Form 990) 2018

Additional Data

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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

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2018

Open to Public Inspection

Name of the organization

THE BETHANY CIRCLE OF KING'S DAUGHTERS'
OF MADISON INDIANA INC

Employer identification number

35-0895832

Part I

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

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

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

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

Part II

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

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






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

Part III

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

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

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

Cat. No. 50056A

Schedule L (Form 990 or 990-EZ) 2018

Page 2

Part IV

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

(a) Name of interested person	(b) Relationship between interested person and the organization	(c) Amount of transaction	(d) Description of transaction	(e) Sharing of organization's revenues?
(a) Name of interested person		(c) Amount of transaction	(d) Description of transaction	Yes	No
(1) A DATTILO FRUIT COMPANY	VICE PRESIDENT OF OUTPATIENT SERVICES OF KDH HAS 51% OWNERSHIP INTEREST	14,597	VICE PRESIDENT OF OUTPATIENT SERVICES OF KDH, LISA MORGAN, OWNS A 51% INTEREST IN A. DATILLO FRUIT COMPANY. KDH PURCHASES PRODUCE FROM A. DATTILO FRUIT COMPANY. THE HOSPITAL MADE PURCHASES TOTALING $ 14,597 IN 2018.		No
(2) GERMAN AMERICAN BANK	BOARD MEMBER IS THE SPOUSE OF THE FORMER REGIONAL CHAIRMAN OF THE GERMAN NA	163,418	BOARD ASST TREASURER, ANDREA FORRESTER, IS MARRIED TO THE FORMER REGIONAL CHAIRMAN OF THE GERMAN NATIONAL BANK. THE HOSPITAL'S OPERATING ACCOUNT IS HELD BY GERMAN NATIONAL BANK. THE HOSPITAL RECORDED INTEREST INCOME OF $156,130 AND SERVICE FEES OF $7,288 IN 2018 FROM ACTIVITY WITH THE BANK.		No
(3) MCCUBBIN MOTORS	BOARD MEMBER IS THE SPOUSE OF THE PRESIDENT OF MCCUBBIN MOTORS, INC.	46,828	BOARD OF MANAGERS MEMBER, MARY KAY MCCUBBIN, IS MARRIED TO THE PRESIDENT OF MCCUBBINS MOTORS, INC. KING'S DAUGHTERS' HEALTH UTILIZES MCCUBBIN MOTORS, INC. FOR SERVICING AND/OR REPAIR OF EMERGENCY VEHICLES. THE HOSPITAL PAID $46,828 TO MCCUNNIN MOTORS, INC. IN 2018 FOR THESE TYPES OF SERVICES.		No
(4) BENNETT MOTORS INC DBA CRAIG TOYOTA	BOARD MEMBER IS THE PRESIDENT OF BENNETT MOTORS, INC. (D/B/A CRAIG TOYOTA)	1,582	BOARD OF MANAGERS MEMBER, JOE CRAIG, IS THE PRESIDENT OF BENNETT MOTORS, INC. (D/B/A CRAIG TOYOTA). KING'S DAUGHTERS' HEALTH UTILIZES CRAIG TOYOTA FOR SERVICING AND/OR REPAIR OF EMERGENCY VEHICLES. THE HOSPITAL PAID $1,582 TO CRAIG TOYOTA IN 2018 FOR THESE TYPES OF SERVICES.		No

Part V

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

Return Reference	Explanation

Schedule L (Form 990 or 990-EZ) 2018

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

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2018

Open to Public
Inspection

Name of the organization

THE BETHANY CIRCLE OF KING'S DAUGHTERS'
OF MADISON INDIANA INC

Employer identification number

35-0895832

Return Reference	Explanation
FORM 990, PART VI, SECTION A, LINE 6	PER THE BYLAWS, THE MEMBERSHIP OF THE ORGANIZATION SHALL BE NON-SECTARIAN, NON-POLITICAL AND NOT CONFINED TO ANY CHRISTIAN RELIGIOUS DENOMINATION OR SECT. ANY SUCH PERSON OF GOOD REPUTE WHO HOLDS HERSELF RESPONSIBLE TO THE KING, CHRIST, OUR LORD AND SAVIOR, MAY BECOME A MEMBER OF THE ORGANIZATION. ALL MEMBERS MUST BE AND REMAIN PERMANENT RESIDENTS OF THE SERVICE AREA OF THE HOSPITAL, AS DETERMINED FROM TIME TO TIME BY THE HOSPITAL BOARD OF MANAGERS, AS A CONTINUING REQUIREMENT FOR MEMBERSHIP. FAILURE TO MAINTAIN SUCH RESIDENCY STATUS AUTOMATICALLY TERMINATES A PERSON'S MEMBERSHIP. HOSPITAL EMPLOYEES, MEMBERS OF THE MEDICAL STAFF, AND THEIR IMMEDIATE FAMILY MEMBERS SHALL NOT BE ELIGIBLE FOR MEMBERSHIP IN THE ORGANIZATION. THE IMMEDIATE FAMILY SHALL BE DEFINED AS INCLUDING THE MOTHER, FATHER, HUSBAND, WIFE, SISTER, BROTHER, DAUGHTER, SON, AND STEPCHILDREN.
FORM 990, PART VI, SECTION A, LINE 7A	THE ORGANIZATION SHALL HAVE TWO (2) CLASSES OF MEMBERS, ACTIVE AND HONORARY, AND ALL MEMBERS SHALL HAVE THE RIGHTS, PRIVILEGES, DUTIES, LIABILITIES, LIMITATIONS AND RESTRICTIONS AS SET FORTH FROM TIME TO TIME IN THE STANDING RULES. ANY ACTIVE MEMBER OF THE ORGANIZATION MAY PROPOSE ANY OTHER PERSON MEETING THE ELIGIBILITY REQUIREMENTS OUTLINED IN PART VI, 7A ABOVE FOR MEMBERSHIP. ONLY ACTIVE MEMBERS IN GOOD STANDING THAT HAVE BEEN A MEMBER FOR AT LEAST TWO ANNIVERSARY YEARS CAN PRESENT A PERSON'S NAME FOR MEMBERSHIP OR TO SERVE ON THE BOARD OF DIRECTORS. A MAJORITY VOTE OF THOSE PRESENT AND VOTING AFFIRMATIVELY AT ANY REGULAR MEETING OF THE ORGANIZATION AT WHICH A QUORUM IS PRESENT SHALL BE SUFFICIENT TO ELECT SUCH PROPOSED PERSON TO MEMBERSHIP. ONLY ACTIVE MEMBERS SHALL HAVE THE RIGHT AT EVERY MEETING OF THE MEMBERS TO CAST ONE (1) VOTE FOR HER MEMBERSHIP. THIS RIGHT TO VOTE MUST BE EXERCISED IN PERSON, OR AS THE BYLAWS MAY PROVIDE FROM TIME TO TIME.
FORM 990, PART VI, SECTION A, LINE 7B	ONLY ACTIVE MEMBERS SHALL HAVE THE RIGHT AT EVERY MEETING OF THE MEMBERS TO CAST ONE (1) VOTE FOR HIS/HER MEMBERSHIP. THIS RIGHT TO VOTE MUST BE EXERCISED IN PERSON, OR AS THE BYLAWS MAY PROVIDE FROM TIME TO TIME.
FORM 990, PART VI, SECTION B, LINE 11B	THE PROCESS OF REVIEWING THE FORM 990 ENTAILS A DETAILED REVIEW BY THE ORGANIZATION'S MANAGEMENT. THE BOARD OF MANAGERS RECEIVES A DRAFT COPY OF THE FORM 990 INCLUDING REQUESTED SCHEDULES PRIOR TO FILING WITH THE IRS. CHANGES OR REVISIONS ARE SUGGESTED BY THE BOARD IF NECESSARY. THE 990 WILL BE REVIEWED AT THE NEXT BOARD MEETING.
FORM 990, PART VI, SECTION B, LINE 12C	KING'S DAUGHTERS' HEALTH HAS A FORMAL CONFLICT OF INTEREST POLICY. THE CONFLICT OF INTEREST POLICY COVERS BOARD OF MANAGER MEMBERS, OFFICERS AND DIRECTORS. THE POLICY REQUIRES THE BOARD OF MANAGERS, OFFICERS AND DIRECTORS TO DISCLOSE ANNUALLY INFORMATION REGARDING THEIR INTERESTS AND THOSE OF THEIR FAMILY MEMBERS THAT COULD GIVE RISE TO CONFLICT. THIS INFORMATION IS TO BE DISCLOSED TO THE APPROPRIATE VICE PRESIDENT, THE PRESIDENT/CEO AND COMPLIANCE DEPARTMENT. SHOULD SUCH INFORMATION BE DISCLOSED, THE INTERESTED PERSON WILL REFRAIN FROM ANY SUBSEQUENT DISCUSSION AND DECISIONS RELATED TO THE OUTSIDE FIRM. AT SUCH TIME AS ANY MATTER COMES BEFORE THE BOARD OF MANAGERS CONCERNING AN EXISTING OR CONTEMPLATED TRANSACTION OR RELATIONSHIP BETWEEN THE HOSPITAL AND ANY PARTY MAY GIVE RISE TO A CONFLICT OF INTEREST 1.) THE BOARD OF MANAGERS MEMBER SHALL LEAVE THE MEETING DURING THE DISCUSSION OF AND THE VOTE ON THE TRANSACTION OR ARRANGEMENT. 2.) THE CHAIRPERSON OF THE BOARD OF MANAGERS SHALL, IF APPROPRIATE, APPOINT A DISINTERESTED PERSON OR COMMITTEE TO INVESTIGATE ALTERNATIVES TO THE PROPOSED TRANSACTION OR ARRANGEMENT. 3.) AFTER EXERCISING DUE DILIGENCE, THE BOARD OF MANAGERS SHALL DETERMINE WHETHER THE HOSPITAL CAN OBTAIN WITH REASONABLE EFFORTS A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT FROM A PERSON OR ENTITY THAT WOULD NOT GIVE RISE TO A CONFLICT OF INTEREST. 4.) IF A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT IS NOT REASONABLY POSSIBLE UNDER CIRCUMSTANCES NOT PRODUCING A CONFLICT OF INTEREST, THE BOARD OF MANAGERS SHALL DETERMINE BY A MAJORITY VOTE OF THE DISINTERESTED MEMBERS WHETHER THE TRANSACTION OR ARRANGEMENT IS IN THE HOSPITAL'S BEST INTEREST, FOR ITS OWN BENEFIT, AND WHETHER IT IS FAIR AND REASONABLE. IN CONFORMITY WITH THE ABOVE DETERMINATION, IT SHALL MAKE ITS DECISION AS TO WHETHER TO ENTER INTO THE TRANSACTION OR ARRANGEMENT. TO ENSURE THE HOSPITAL OPERATES IN A MANNER CONSISTENT WITH CHARITABLE PURPOSES AND DOES NOT ENGAGE IN ACTIVITIES THAT COULD JEOPARDIZE ITS TAX-EXEMPT STATUS, PERIODIC REVIEWS SHALL BE CONDUCTED. THE PERIODIC REVIEWS INCLUDE, AT A MINIMUM, - 1.) WHETHER COMPENSATION ARRANGEMENTS AND BENEFITS ARE REASONABLE, BASED ON COMPETENT SURVEY INFORMATION AND THE RESULT OF ARM'S LENGTH BARGAINING. 2.) WHETHER PARTNERSHIPS, JOINT VENTURES AND ARRANGEMENTS WITH MANAGEMENT ORGANIZATIONS CONFORM TO THE HOSPITAL'S WRITTEN POLICIES, ARE PROPERLY RECORDED, REFLECT REASONABLE INVESTMENT OR PAYMENTS FOR GOODS AND SERVICES, FURTHER CHARITABLE PURPOSES AND DO NOT RESULT IN INUREMENT, IMPERMISSIBLE PRIVATE BENEFIT, OR IN AN EXCESS BENEFIT TRANSACTION. DISCIPLINARY AND CORRECTION ACTION, UP TO AND INCLUDING TERMINATION OF EMPLOYMENT, CAN BE TAKEN FOR FAILURE TO DISCLOSE A CONFLICT OF INTEREST.
FORM 990, PART VI, SECTION B, LINE 15A	THE HOSPITAL'S BOARD OF MANAGERS REVIEWS ANNUAL CEO SURVEY INFORMATION FROM THE INDIANA HOSPITAL ASSOCIATION. THIS SURVEY COMPARES KDH'S CEO'S COMPENSATION WITH OTHER HOSPITAL CEO'S IN INDIANA. COMPARISONS ARE MADE WITH HOSPITALS THAT ARE IN KDH'S REGION IN INDIANA, HOSPITALS OF A SIMILAR SIZE, AND HOSPITALS THAT MIGHT REASONABLY BE EXPECTED TO COMPETE FOR SERVICES OF KDH'S CEO. THE BOARD OF MANAGERS, AFTER REVIEWING THE SURVEY AND A STATUS REPORT OF THE CEO'S ANNUAL GOALS, APPROVES THE CEO'S COMPENSATION. HOWEVER, PHYSICIAN BOARD MEMBERS WHO ARE ALSO HOSPITAL EMPLOYEES DO NOT PARTICIPATE IN VOTING FOR ANY CHANGES TO CEO COMPENSATION. MINUTES ARE TAKEN AT ALL OF THE BOARD OF MANAGERS MEETINGS AND EXECUTIVE SESSIONS.
FORM 990, PART VI, SECTION C, LINE 19	THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST, OR FINANCIAL STATEMENTS ARE NOT MADE AVAILABLE FOR PUBLIC INSPECTION. THE FORM 990 TAX RETURN IS AVAILABLE FOR PUBLIC INSPECTION UPON REQUEST.
FORM 990, PART XI, LINE 9:	CHANGE IN SUBSCRIBER SAVINGS CUMULATIVE ACCOUNT 441,687.
FORM 990, PART XI, LINE 2C, AUDIT OVERSIGHT	THE HOSPITAL'S FINANCE COMMITTEE ASSUMES RESPONSIBILITY FOR THE SELECTION OF AN INDEPENDENT CERTIFIED PUBLIC ACCOUNTING FIRM TO PERFORM THE ANNUAL AUDIT OF THE FINANCIAL STATEMENTS. THE FINANCE COMMITTEE ALSO IS RESPONSIBLE FOR OVERSIGHT OF THAT AUDIT PROCESS. THE TREASURER OF THE HOSPITAL'S BOARD OF MANAGERS SERVES AS THE CHAIR OF THE FINANCE COMMITTEE. THE FINANCE COMMITTEE REGULARLY MEETS EVERY OTHER MONTH, AND MEETS ONCE PER YEAR WITH THE INDEPENDENT AUDITORS.

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

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2018

Additional Data

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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

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2018

Open to Public Inspection

Name of the organization

THE BETHANY CIRCLE OF KING'S DAUGHTERS'
OF MADISON INDIANA INC

Employer identification number

35-0895832

Part I

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

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

Part II

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

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	(g) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	Yes	No
(1)THE KING'S DAUGHTERS' HOSPITAL FOUNDATION INC PO BOX 447 MADISON,IN47250 20-2148950	FUNDRAISING TO SUPPORT THE PROVISION OF HEALTHCARE SERVICES	IN	501(C)(3)	LINE 7	N/A		No

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

Cat. No. 50135Y

Schedule R (Form 990) 2018

Page 2

Part III

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

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

Part IV

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

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

Schedule R (Form 990) 2018

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) ............................

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

Yes

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

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

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

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

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

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

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

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

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

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

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

Yes

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

Yes

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

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

Yes

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

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

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

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

Schedule R (Form 990) 2018

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) 2018

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) 2018

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: TO IMPROVE THE HEALTH OF THE HOSPITAL'S PATIENTS THROUGH CARE, SERVICE, AND EDUCATION.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	11
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	9
5	Total number of individuals employed in calendar year 2018 (Part V, line 2a) ......	5	1,102
6	Total number of volunteers (estimate if necessary) .............	6	75
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	59,038
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) .........	140,093	323,957
9	Program service revenue (Part VIII, line 2g) .........	127,224,164	131,389,037
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	4,937,314	5,035,094
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	1,374,463	595,593
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	133,676,034	137,343,681
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	4,664	17,791
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)	64,434,304	65,393,601
16a	Professional fundraising fees (Part IX, column (A), line 11e) .....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 92,091
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	59,643,999	61,010,144
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	124,082,967	126,421,536
19	Revenue less expenses. Subtract line 18 from line 12.......	9,593,067	10,922,145
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	277,232,984	275,324,825
21	Total liabilities (Part X, line 26).............	107,951,699	107,693,407
22	Net assets or fund balances. Subtract line 21 from line 20.....	169,281,285	167,631,418

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 97,234,228 including grants of $ 17,791 ) (Revenue $ 131,500,787 )
	KING'S DAUGHTERS' HEALTH IS A NOT-FOR-PROFIT, ACUTE CARE HOSPITAL OWNED BY THE BETHANY CIRCLE OF KING'S DAUGHTERS' OF MADISON, INDIANA, INC., LOCATED IN MADISON, INDIANA. THE HOSPITAL IS ORGANIZED FOR THE PURPOSE OF PROVIDING HEALTHCARE SERVICES TO THE RESIDENTS OF JEFFERSON COUNTY AND THE SURROUNDING AREA.DURING THE CALENDAR YEAR 2018, THE HOSPITAL PROVIDED HEALTHCARE TO PATIENTS AT THE FOLLOWING LEVELS:11,122 DAYS OF CARE TO ACUTE INPATIENTS1,250 DAYS OF CARE TO NEWBORN INFANTS191,482 VISITS ASSOCIATED WITH HOSPITAL OUTPATIENTS135,814 VISITS ASSOCIATED WITH PHYSICIAN CLINICS

4b	(Code: ) (Expenses $ 1,377,147 including grants of $ ) (Revenue $ )
	THE HOSPITAL'S PRIMARY SOURCES OF SUPPORT ARE FROM PATIENT REVENUES. PATIENT REVENUES INCLUDE FUNDS RECEIVED FROM MEDICARE, STATE AGENCIES, INSURANCE COMPANIES, AND THE PATIENTS THEMSELVES. IN 2018, KING'S DAUGHTERS' HEALTH PROVIDED SERVICES TOTALING $1,377,147 IN GROSS CHARGES TO PATIENTS WHO MET THE HOSPITAL'S CHARITY CARE POLICY.

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












4d	Other program services (Describe in Schedule O.)
	(Expenses $ including grants of $ ) (Revenue $ )
4e	Total program service expenses98,611,375

(A) Name and Title	(B) Average hours per week (list any hours for related organizations below dotted line)		(D) Reportable compensation from the organization (W- 2/1099-MISC)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)	(F) Estimated amount of other compensation from the organization and related organizations
(A) Name and Title
(18) TRAVIS CLEGG MD........................................................................ EMPLOYED PHYSICIAN	40.00 .......................0.00	X	1,795,514	0	41,997
(19) WILLIAM SKILES MD........................................................................ EMPLOYED PHYSICIAN	40.00 .......................0.00	X	654,323	0	28,102
(20) MICHAEL SCHMIDT MD........................................................................ EMPLOYED PHYSICIAN	40.00 .......................0.00	X	653,158	0	31,961
(21) RONALD AUER MD........................................................................ EMPLOYED PHYSICIAN	40.00 .......................0.00	X	940,171	0	42,596

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	6,611,433	0	326,035

1a	Federated campaigns..		1a
b	Membership dues..		1b
c	Fundraising events..		1c
d	Related organizations		1d
e	Government grants (contributions)		1e	60,199

f	All other contributions, gifts, grants, and similar amounts not included above		1f	263,758

g	Noncash contributions included in lines 1a - 1f:$
h Total. Add lines 1a-1f.......		323,957

		Business Code
2a	NET PATIENT SERVICE REVENUE	621110	131,389,037	131,389,037
b
c
d
e
f	All other program service revenue.
g	Total. Add lines 2a–2f ....		131,389,037

3 Investment income (including dividends, interest, and othersimilar amounts) ......			3,407,995			3,407,995
4 Income from investment of tax-exempt bond proceeds
5 Royalties...........
		(ii) Personal	(i) Real
6a	Gross rents		49,531
b	Less: rental expenses		23,286
c	Rental income or (loss)		26,245
d	Net rental income or (loss)......			26,245	26,245
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory	197,289	36,852,683
b	Less: cost or other basis and sales expenses	99,603	35,323,270
c	Gain or (loss)	97,686	1,529,413
d	Net gain or (loss).....			1,627,099			1,627,099
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ....
	a
b	Less: direct expenses ...b
c	Net income or (loss) from fundraising events..
9a	Gross income from gaming activities. See Part IV, line 19 ...
	a
b	Less: direct expenses ...b
c	Net income or (loss) from gaming activities..
10a	Gross sales of inventory, less returns and allowances ..
	a
b	Less: cost of goods sold ..b
c	Net income or (loss) from sales of inventory..
Business Code			Miscellaneous Revenue
11a	CAFETERIA REVENUE		722210	414,193			414,193
b	GIFT SHOP		453220	10,612			10,612
c	EHR INCOME		900099	10,443	10,443
d	All other revenue ....			134,100	75,062	59,038
e	Total. Add lines 11a–11d ......			569,348
12	Total revenue. See Instructions......			137,343,681	131,500,787	59,038	5,459,899

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21	17,791	17,791
2	Grants and other assistance to domestic individuals. See Part IV, line 22
3	Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See Part IV, line 15 and 16.
4	Benefits paid to or for members
5	Compensation of current officers, directors, trustees, and key employees ....	2,028,718	1,582,400	446,318
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ....
7	Other salaries and wages	50,012,426	38,952,695	10,986,657	73,074
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	2,005,921	1,564,618	441,303
9	Other employee benefits .......	8,140,412	6,334,889	1,786,764	18,759
10	Payroll taxes ...........	3,206,124	2,500,777	705,347
11	Fees for services (non-employees):
a	Management ......
b	Legal .........	325,958		325,958
c	Accounting ...........	117,520		117,520
d	Lobbying ...........
e	Professional fundraising services. See Part IV, line 17
f	Investment management fees ......	576,528		576,528
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	211,370		211,370
12	Advertising and promotion ....	195,908	152,808	43,100
13	Office expenses .......	635,592	495,762	139,830
14	Information technology ......	32,467	25,324	7,143
15	Royalties ..
16	Occupancy ...........	1,974,844	1,540,378	434,466
17	Travel ............	113,879	88,826	25,053
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .
19	Conferences, conventions, and meetings ....
20	Interest ...........	5,345,831	4,169,748	1,176,083
21	Payments to affiliates .......
22	Depreciation, depletion, and amortization ..	8,748,228	6,823,618	1,924,352	258
23	Insurance ...	1,609,189	1,255,167	354,022
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	PURCHASED SERVICES	11,825,732	9,224,071	2,601,661
b	DRUGS	10,385,673	10,385,673
c	SUPPLIES	9,983,682	7,787,272	2,196,410
d	HOSPITAL ASSESSMENT FEE	3,391,276	3,391,276
e	All other expenses	5,536,467	2,318,282	3,218,185
25	Total functional expenses. Add lines 1 through 24e	126,421,536	98,611,375	27,718,070	92,091
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 ........			9,474	1	9,574
2	Savings and temporary cash investments .........			16,294,366	2	19,678,050
3	Pledges and grants receivable, net ......				3
4	Accounts receivable, net .............			10,370,400	4	9,340,720
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 ....			456,146	7	309,153
8	Inventories for sale or use ........			2,497,096	8	2,507,284
9	Prepaid expenses and deferred charges ......			2,917,927	9	3,741,312
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	187,936,846
b	Less: accumulated depreciation	10b	85,975,989	107,005,759	10c	101,960,857
11	Investments—publicly traded securities .			129,961,696	11	129,076,266
12	Investments—other securities. See Part IV, line 11 .....				12
13	Investments—program-related. See Part IV, line 11 ..				13
14	Intangible assets ...............				14
15	Other assets. See Part IV, line 11 ...........			7,720,120	15	8,701,609
16	Total assets. Add lines 1 through 15 (must equal line 34)...			277,232,984	16	275,324,825

17	Accounts payable and accrued expenses .....	10,511,186	17	11,412,609
18	Grants payable ...		18
19	Deferred revenue .........		19
20	Tax-exempt bond liabilities .........	93,886,785	20	92,387,457
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 ..	1,370,016	23	1,746,968
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	2,183,712	25	2,146,373
26	Total liabilities. Add lines 17 through 25..	107,951,699	26	107,693,407

	Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets	169,268,328	27	167,618,568
28	Temporarily restricted net assets ...........	2,957	28	2,850
29	Permanently restricted net assets	10,000	29	10,000
	Organizations that do not follow SFAS 117 (ASC 958), check here and complete lines 30 through 34.
30	Capital stock or trust principal, or current funds .....		30
31	Paid-in or capital surplus, or land, building or equipment fund ...		31
32	Retained earnings, endowment, accumulated income, or other funds		32
33	Total net assets or fund balances ...........	169,281,285	33	167,631,418
34	Total liabilities and net assets/fund balances ........	277,232,984	34	275,324,825