TY 2022 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/1099-NEC)
(1) A EUGENE WASHINGTON MD...................................................................... DIRECTOR/PRESIDENT	33.00 ................. 33.20	X	X	0	3,142,252	51,351
(2) VINCENT E PRICE...................................................................... DIRECTOR	3.00 ................. 48.30	X		0	1,751,192	55,185
(3) MARY E KLOTMAN MD...................................................................... DIRECTOR	11.00 ................. 44.30	X		0	1,235,581	51,873
(4) ERIK PAULSON...................................................................... DIRECTOR	1.00 ................. 61.00	X		0	456,004	61,515
(5) LESLIE E BAINS...................................................................... DIRECTOR	2.00 ................. 0.00	X		0	0	0
(6) GAIL BELVETT MD DDS...................................................................... DIRECTOR	4.00 ................. 0.00	X		990	0	0
(7) DENISE BENNETT...................................................................... DIRECTOR	2.00 ................. 0.00	X		0	0	0
(8) GERALD HASSELL...................................................................... DIRECTOR	2.00 ................. 4.00	X		0	0	0
(9) WILLIAM HAWKINS...................................................................... DIRECTOR	4.00 ................. 6.00	X		0	0	0
(10) ROSEMARY JACKSON MD...................................................................... DIRECTOR	1.00 ................. 0.00	X		0	0	0
(11) FEDERICO MANON...................................................................... DIRECTOR	1.00 ................. 0.00	X		0	0	0
(12) CARMICHAEL S ROBERTS...................................................................... DIRECTOR	1.00 ................. 2.10	X		0	0	0
(13) NANCY M SCHLICHTING...................................................................... DIRECTOR	2.00 ................. 2.00	X		0	0	0
(14) LAURENE SPERLING...................................................................... DIRECTOR	8.00 ................. 6.10	X		0	0	0
(15) SUSAN M STALNECKER...................................................................... DIRECTOR	4.00 ................. 0.10	X		0	0	0
(16) MOIRA RYNN MD...................................................................... DIRECTOR	2.00 ................. 40.10	X		0	483,799	54,853
(17) G RICHARD WAGONER JR...................................................................... DIRECTOR	1.00 ................. 0.00	X		0	0	0

(A) Name and title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)	(E) Reportable compensation from related organizations (W-2/1099-MISC/1099-NEC)	(F) Estimated amount of other compensation from the organization and related organizations
(18) JIM WHITEHURST........................................................................ DIRECTOR	1.00 .......................0.00	X					0	0	0
(19) JOHN P MORDACH........................................................................ SVP, CFO, PART YEAR TREASURER	40.00 .......................0.60		X				1,582,991	0	66,153
(20) THOMAS A OWENS MD........................................................................ EXECUTIVE VICE PRESIDENT, DUHS	61.00 .......................0.70		X				1,441,308	0	50,390
(21) ROBERT N WILLIS........................................................................ VP FINANCE/CONTROLLER/CAO/INTERIM TREASURER	50.00 .......................0.70		X				684,760	0	53,493
(22) MONTE D BROWN MD........................................................................ VP FOR ADMINISTRATION/SECRETARY	60.00 .......................0.10		X				781,615	0	55,164
(23) CRAIG T ALBANESE MD........................................................................ CEO	60.00 .......................0.70		X				1,407,490	0	53,451
(24) KATHLEEN GALBRAITH........................................................................ PART YEAR PRESIDENT, DUKE REGIONAL HOSPITAL	60.00 .......................2.00			X			619,168	0	101,748
(25) MARY K MARTIN........................................................................ CHIEF OPERATING OFFICER, DUH	40.00 .......................0.00			X			679,639	0	66,153
(26) MARY ANN FUCHS........................................................................ VP PATIENT CARE/CHIEF NURSING OFFICER	50.00 .......................0.10			X			625,223	0	44,749
(27) BARBARA M GRIFFITH MD........................................................................ PRESIDENT, DUKE RALEIGH HOSPITAL	40.00 .......................0.00			X			612,137	0	62,567
(28) DEVDUTTA SANGVAI MD........................................................................ PART YEAR PRESIDENT, DUKE REGIONAL HOSPITAL	40.00 .......................0.20			X			539,272	8,564	112,431
(29) RICHARD PATRICK SHANNON........................................................................ CHIEF QUALITY OFFICER	40.00 .......................0.20				X		991,774	0	55,032
(30) JEFFREY M FERRANTI........................................................................ SENIOR VP/CHIEF DIGITAL OFFICER	40.00 .......................0.00				X		1,047,207	129,186	65,117
(31) KEITH STOVER........................................................................ VP FINANCE/COO, PRMO	40.00 .......................0.00				X		715,086	0	61,821
(32) RHONDA BRANDON........................................................................ CHIEF HR OFFICER	50.00 .......................0.10				X		822,395	0	64,332
(33) JOHN SMITH........................................................................ VP FINANCE	40.00 .......................0.00				X		649,908	0	50,745
(34) WILLIAM J FULKERSON MD........................................................................ FORMER OFFICER	0.00 .......................56.00					X	0	1,763,663	43,312
(35) LEIGH BLEECKER........................................................................ FORMER KEY EMPLOYEE	65.00 .......................0.00					X	405,081	0	49,609

(A) Name and business address	(B) Description of services	(C) Compensation
PRIVATE DIAGNOSTIC CLINIC PLLC PO BOX 15000 DURHAM,NC27710	MEDICAL SERVICES	208,195,956
AYA HEALTHCARE INC 5930 CORNERSTONE COURT W 300 SAN DIEGO,CA92121	CONTRACT NURSING	47,026,399
ROBINS & MORTON GROUP PO BOX 11407 DEPT 5870 BIRMINGHAM,AL35209	CONSTRUCTION SERVICES	20,993,669
ARAMARK SERVICES INC 1101 MARKET ST 12TH FLOOR PHILADELPHIA,PA19107	FOOD SERVICES	19,982,847
WHITING TURNER CONTRACTING CO 300 E JOPPA ROAD TOWSON,MD21286	CONSTRUCTION SERVICES	17,907,352
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 359

- TIN:

SCHEDULE A
(Form 990)

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.
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Attach to Form 990 or Form 990-EZ.
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Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2022

Open to Public
Inspection

Name of the organization

DUKE UNIVERSITY HEALTH SYSTEM INC

Employer identification number

56-2070036

Part I

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

The organization is not a private foundation because it is: (For lines 1 through 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).)

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 33 1/3% 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 33 1/3% 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 on 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) 2022

Page 2

Part II

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

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2018	(b) 2019	(c) 2020	(d) 2021	(e) 2022	(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) 2018	(b) 2019	(c) 2020	(d) 2021	(e) 2022	(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 5 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 2022 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2020 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2022. 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—2021. 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—2022. 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—2021. 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) 2022

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) 2018	(b) 2019	(c) 2020	(d) 2021	(e) 2022	(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) 2018	(b) 2019	(c) 2020	(d) 2021	(e) 2022	(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 on 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 5 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 2022 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2021 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2022 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2021 Schedule A, Part III, line 17 .............

19a

33 1/3% support tests-2022. 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—2021. 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) 2022

Page 4

Part IV

Supporting Organizations

(Complete only if you checked a box on line 12 of Part I. If you checked box 12a, of Part I, complete Sections A and B. If you checked box 12b, of Part I, complete Sections A and C. If you checked box 12c, of Part I, complete Sections A, D, and E. If you checked box12d, 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 lines 3b and 3c 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 box 12a or 12b in Part I, answer lines 4b and 4c 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 lines 5b and 5c 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) .

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

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 on 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 on 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) 2022

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 on lines 11b and 11c below, the governing body of a supported organization?

11a

A family member of a person described on 11a above?

11b

A 35% controlled entity of a person described on line 11a or 11b above? If “Yes” to 11a, 11b, or 11c, provide detail in Part VI.

11c

Section B. Type I Supporting Organizations

Yes

Did the officers, 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 line 2 above, 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 lines 2a and 2b 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 on line 2a, above 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 lines 3a and 3b 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?If "Yes" or "No", 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) 2022

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 0.015 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 0.035	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) 2022

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	1
2 Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity	2
3 Administrative expenses paid to accomplish exempt purposes of supported organizations	3
4 Amounts paid to acquire exempt-use assets	4
5 Qualified set-aside amounts (prior IRS approval required - provide details in Part VI)	5
6 Other distributions (describe in Part VI). See instructions	6
7Total annual distributions. Add lines 1 through 6.	7
8 Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions	8
9 Distributable amount for 2022 from Section C, line 6	9
10 Line 8 amount divided by Line 9 amount	10

Section E - Distribution Allocations (see instructions)		(i) Excess Distributions	(ii) Underdistributions Pre-2022	(iii) Distributable Amount for 2022
1 Distributable amount for 2022 from Section C, line 6
2 Underdistributions, if any, for years prior to 2022 (reasonable cause required-- explain in Part VI). See instructions.
3 Excess distributions carryover, if any, to 2022:
a From 2017.......
b From 2018.......
c From 2019.......
d From 2020.......
e From 2021.......
fTotal of lines 3a through e
g Applied to underdistributions of prior years
h Applied to 2022 distributable amount
i Carryover from 2017 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from line 3f.
4Distributions for 2022 from Section D, line 7:
$
a Applied to underdistributions of prior years
b Applied to 2022 distributable amount
c Remainder. Subtract lines 4a and 4b from line 4.
5 Remaining underdistributions for years prior to 2022, 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 2022. 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 2023. Add lines 3j and 4c.
8 Breakdown of line 7:
a Excess from 2018.....
b Excess from 2019.....
c Excess from 2020.....
d Excess from 2021.....
e Excess from 2022.....

Schedule A (Form 990) (2022)

Schedule A (Form 990) 2022

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) 2022

Additional Data

Software ID:
Software Version:

- TIN:

Schedule B
(Form 990)

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

2022

Name of the organization

DUKE UNIVERSITY HEALTH SYSTEM INC

Employer identification number

56-2070036

Organization type (check one):

Filers of:

Section:

Form 990 or 990-EZ

501(c)( ) (enter number) organization

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

527 political organization

Form 990-PF

501(c)(3) exempt private foundation

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

501(c)(3) taxable private foundation

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

General Rule

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

Special Rules

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

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

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, contributions exclusively for religious, charitable, etc., purposes, but no such contributions totaled more than $1,000. If this box is checked, enter here the total contributions that were received during the year for an exclusively religious, charitable, etc., purpose. 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) (2022)

Schedule B (Form 990) (2022) Page 2

Name of organization DUKE UNIVERSITY HEALTH SYSTEM INC

Part I Contributors	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) (2022)

Schedule B (Form 990) (2022)

Page 3

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

Part II	Noncash Property (see instructions). Use duplicate copies of Part II if additional space is needed.
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
Schedule B (Form 990) (2022)

Schedule B (Form 990) (2022)

Page 4


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

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

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

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

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

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

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

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

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

Schedule B (Form 990) (2022)

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE C
(Form 990)

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

2021

Open to Public
Inspection

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

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

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

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

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

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

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

Name of the organization

DUKE UNIVERSITY HEALTH SYSTEM INC

Employer identification number

56-2070036

Part I-A

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

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

Cat. No. 50084S

Schedule C (Form 990) 2021

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) 2018	(b) 2019	(c) 2020	(d) 2021	(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) 2021

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|No

(b)

Amount

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

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

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

Yes

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

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

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

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

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

Yes

183,938

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

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

Yes

237,702

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

421,640

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

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

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

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

Part III-A

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

Yes

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

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

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

Part III-B

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

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

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

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

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

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

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

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

Taxable amount of lobbying and political expenditures. See Instructions .........................................

Part IV

Supplemental Information

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

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

Return Reference

Explanation

PART II-B, LINE 1:

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

Schedule C (Form 990) 2021

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 instructions and the latest information.

OMB No. 1545-0047

2021

Open to Public Inspection

Name of the organization

DUKE UNIVERSITY HEALTH SYSTEM INC

Employer identification number

56-2070036

Part I

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

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

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

Yes No

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

Yes No

Part II

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

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

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

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

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


a	Total number of conservation easements ......................	2a
b	Total acreage restricted by conservation easements ....................	2b
c	Number of conservation easements on a certified historic structure included in (a) .....	2c
d	Number of conservation easements included in (c) acquired after 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 FASB 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 FASB 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 FASB 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) 2021

Page 2

Part III

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

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

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

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

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

Yes No

Part IV

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

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

Yes No


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

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

Yes No

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

Part V

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

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

1a	Beginning of year balance ....	57,427,577	74,699,445	59,559,614	60,648,900	58,627,787
b	Contributions ...	10,278,031	5,159,602	12,795,429	6,063,715	5,694,239
c	Net investment earnings, gains, and losses	-2,178,352	-2,443,178	14,542,065	-1,163,937	681,288
d	Grants or scholarships ...
e	Other expenditures for facilities and programs ...	4,547,015	19,988,293	12,197,663	5,989,064	4,354,414
f	Administrative expenses ....
g	End of year balance ......	60,980,241	57,427,577	74,699,445	59,559,614	60,648,900

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

Board designated or quasi-endowment SchDMd Bullet

Permanent endowment SchDMd Bullet

67.692 %

Term endowment SchDMd Bullet

32.308 %

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

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

Yes

(i) Unrelated organizations .................

3a(i)

(ii) Related organizations .................

3a(ii)

Yes

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

Yes

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

Part VI

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

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

1a	Land .....	86,040,386		86,040,386
b	Buildings ....	3,003,270,844	1,291,529,981	1,711,740,863
c	Leasehold improvements
d	Equipment ....	1,023,281,885	802,223,912	221,057,973
e	Other .....	491,101,305	447,185,115	43,916,190
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..				2,062,755,412

Schedule D (Form 990) 2021

Page 3

Part VII

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

(a) Description of security or category (including name of security)	(b) Book value	(c) Method of valuation: Cost or end-of-year market value
(1) Financial derivatives.........
(2) Closely-held equity interests........
(3) Other (A) PRIVATE CAPITAL	1,480,939,087	F
(B) HEDGE FUNDS	900,225,663	F
(C) CASH & CASH EQUIVALENTS	506,857,421	F
(D) NATURAL RESOURCES	280,718,144	F
(E) REAL ESTATE	157,405,009	F
(F) OTHER INVESTMENTS	127,985,939	F
(F)
(G)
(H)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)	3,454,131,263

Part VIII

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

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

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

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)RIGHT-OF-USE OPERATING LEASE ASSETS				304,389,176
(2)ESTIMATED THIRD PARTY PAYOR SETTLEMENT				74,097,222
(3)OTHER NON-CURRENT ASSETS				41,940,338
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........				420,426,736

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
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	1,535,367,924
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) 2021

Page 4

Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total revenue, gains, and other support per audited financial statements .......		1
2	Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a	Net unrealized gains (losses) on investments ....	2a
b	Donated services and use of facilities .........	2b
c	Recoveries of prior year grants ...........	2c
d	Other (Describe in Part XIII.) ............	2d
e	Add lines 2a through 2d .....................		2e
3	Subtract line 2e from line 1..................		3
4	Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b .	4a
b	Other (Describe in Part XIII.) ...........	4b
c	Add lines 4a and 4b....................		4c
5	Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ......		5

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

Part XIII

Supplemental Information

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

Return Reference

Explanation

PART V, LINE 4:

THE INTENDED USE FOR THE ORGANIZATION'S ENDOWMENT: GENERATE EARNINGS AND SUBSEQUENT DISTRIBUTIONS TO SUPPORT CAPITAL PURCHASES, OFFSET OPERATING COSTS, IMPROVE PATIENT SAFETY, SUPPORT THE NEEDS OF PATIENTS AND FAMILIES, AND FUND OTHER PROGRAMS CONSISTENT WITH THE CHARITABLE MISSION OF THE INSTITUTION.

PART X, LINE 2:

DUKE UNIVERSITY HEALTH SYSTEM, INC. ADOPTED THE REQUIREMENTS OF FASB ASC 740 AND CONSIDERED ITS TAX POSITIONS. BASED ON THAT ANALYSIS, THE PROVISIONS OF FASB ASC 740 ARE DEEMED IMMATERIAL TO THE DUKE UNIVERSITY HEALTH SYSTEM, INC. FINANCIAL STATEMENTS AND THEREFORE NO FASB ASC 740 SPECIFIC DISCLOSURES ARE MADE IN THE AUDITED FINANCIAL STATEMENTS OF DUKE UNIVERSITY HEALTH SYSTEM, INC. AND ITS AFFILIATES FOR FISCAL YEAR ENDED JUNE 30, 2023.

Schedule D (Form 990) 2021

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE F(Form 990)

Department of the Treasury
Internal Revenue Service

Statement of Activities Outside the United States

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

Attach to Form 990. Right pointing arrow large image

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

OMB No. 1545-0047

2022

Open to Public Inspection

Name of the organization
DUKE UNIVERSITY HEALTH SYSTEM INC

Employer identification number

56-2070036

Part I

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

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

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

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

Yes

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

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

(a) Region		(b) Number of offices in the region	(c) Number of employees, agents, and independent contractors in the region	(d) Activities conducted in region (by type) (such as, fundraising, program services, investments, grants to recipients located in the region)	(f) Total expenditures for and investments in the region
	CENTRAL AMERICA AND THE CARIBBEAN	0	0	INVESTMENTS	318,039,000
	CENTRAL AMERICA AND THE CARIBBEAN	0	0	SEMINAR	2,000
	EAST ASIA AND THE PACIFIC	0	0	SEMINAR	19,000
	EUROPE (INCLUDING ICELAND & GREENLAND)	0	0	SEMINAR	2,000
	SOUTH AMERICA	0	0	SEMINAR	2,000
	SUB-SAHARAN AFRICA	0	0	SEMINAR	9,000
	NORTH AMERICA	0	0	SEMINAR	15,000










3a	Sub-total ....	0	0		318,088,000
b	Total from continuation sheets to Part I ...	0	0		0
c	Totals (add lines 3a and 3b)	0	0		318,088,000

For Paperwork Reduction Act Notice, see the Instructions for Form 990.Cat. No. 50082W Schedule F (Form 990) 2022

Schedule F (Form 990) 2022

Page 2

Part II

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

1 (a) Name of organization		(b) IRS code section and EIN (if applicable)	(c) Region	(d) Purpose of grant	(e) Amount of cash grant	(f) Manner of cash disbursement	(g) Amount of noncash assistance	(h) Description of noncash assistance	(i) Method of valuation (book, FMV, appraisal, other)

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

Schedule F (Form 990) 2022

Schedule F (Form 990) 2022Page 3

Part III

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

Part III can be duplicated if additional space is needed.

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

Schedule F (Form 990) 2022

Page 4

Part IV

Foreign Forms

Schedule F (Form 990) 2022

Page 5

Part V

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

ReturnReference	Explanation
PART I, LINE 2:	DUKE UNIVERSITY HEALTH SYSTEM, INC. PERIODICALLY APPROVES NONCASH ASSISTANCE OR TRANSFERS MEDICAL EQUIPMENT AND SUPPLIES TO ORGANIZATIONS OUTSIDE THE UNITED STATES, USUALLY IN RESPONSE TO NATURAL DISASTERS. THE ORGANIZATIONS AWARDED THE ASSISTANCE MUST MONITOR THE APPROPRIATE USE OF THE ASSISTANCE TO ENSURE COMPLIANCE WITH LAWS, REGULATIONS, AND ANY TERMS AND CONDITIONS OF THE TRANSFER. SUBRECIPIENTS ARE NOT PERMITTED UNDER THE TERMS OF THE TRANSFER.
PART III ACCOUNTING METHOD:

Schedule F (Form 990) 2022

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE G (Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Information Regarding
Fundraising or Gaming Activities

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

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

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

OMB No. 1545-0047

2022

Open to Public Inspection

Name of the organization
DUKE UNIVERSITY HEALTH SYSTEM INC

Employer identification number

56-2070036

Part I

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

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

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

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

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

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

YesNo

If "Yes," list the 10 highest paid individuals or entities (fundraisers) pursuant to agreements under which the fundraiser is
to be compensated at least $5,000 by the organization.

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










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

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

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

Cat. No. 50083H

Schedule G (Form 990) 2022

Page 2

Part II

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

		(a) Event #1 GALA (event type)	(d) Total events (add col. (a) through col. (c))
1	Gross receipts . . . . .	196,899	196,899
2	Less: Contributions . . . .	63,870	63,870
3	Gross income (line 1 minus line 2) . . . . . .	133,029	133,029

4	Cash prizes . . . . .
5	Noncash prizes . . . .	31,225	31,225
6	Rent/facility costs . . . .
7	Food and beverages . . .	37,650	37,650
8	Entertainment . . . .	3,341	3,341
9	Other direct expenses . . .	3,488	3,488
10	Direct expense summary. Add lines 4 through 9 in column (d) . . . . . . . . . .		75,704
11	Net income summary. Subtract line 10 from line 3, column (d). . . . . . . . . .		57,325

Part III

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

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

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

Volunteer labor . . . .

	Yes %
	No

	Yes %
	No

	Yes %
	No

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

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

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

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

YesNo

If "No," explain:

10a

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

YesNo

If "Yes," explain:

Schedule G (Form 990) 2022

Page 3

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

YesNo

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

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

YesNo

Indicate the percentage of gaming activity conducted in:

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

13a

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

13b

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

Name

Address

15a

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

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

YesNo

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

$ and the

amount of gaming revenue retained by the third party right arrow

$ .

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

Name

Address

Gaming manager information:

Name

Gaming manager compensation right arrow

Description of services provided right arrow

Director/officer Employee Independent contractor

Mandatory distributions:

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

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

YesNo

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

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

Part IV

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

Return Reference

Explanation

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

DUKE UNIVERSITY HEALTH SYSTEM, INC. SUPPORTS THE FUNDRAISING ACTIVITIES PERFORMED BY EMPLOYEES OF DUKE UNIVERSITY. SUCH ACTIVITIES ARE DESIGNED TO DEVELOP SUPPORT FOR BOTH THE UNIVERSITY AND THE DUKE UNIVERSITY HEALTH SYSTEM, INC.'S EDUCATIONAL, RESEARCH AND HEALTHCARE PURPOSES. DUKE UNIVERSITY RECEIVES AND DIRECTS THE CONTRIBUTIONS AS APPROPRIATE TO DUKE UNIVERSITY HEALTH SYSTEM, INC. DUKE UNIVERSITY HEALTH SYSTEM, INC. HAS NOT ENTERED INTO ANY ARRANGEMENTS WITH FUNDRAISERS UNDER WHICH THE ORGANIZATION MADE PAYMENTS EXCLUSIVELY FOR SUCH EXPENSES BUT NOT FOR PROFESSIONAL FUNDRAISING SERVICES.

Schedule G (Form 990) 2022

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 20a.
MediumBullet

Attach to Form 990.
MediumBullet

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

OMB No. 1545-0047

2022

Open to Public Inspection

Name of the organization

DUKE UNIVERSITY HEALTH SYSTEM INC

Employer identification number

56-2070036

Part I

Financial Assistance and Certain Other Community Benefits at Cost

Yes

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

Yes

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

Yes

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

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

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

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

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

Yes

100% 150% 200% Other %

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

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

Yes

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

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

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

Yes

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

Yes

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

Yes

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) . . .	159,367,231		159,367,231	3.450 %
b	Medicaid (from Worksheet 3, column a) . . . . .	297,692,860		297,692,860	6.440 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) . .
d	Total Financial Assistance and Means-Tested Government Programs . . . . .	457,060,091		457,060,091	9.890 %
Other Benefits
e	Community health improvement services and community benefit operations (from Worksheet 4).	2,731,685		2,731,685	0.060 %
f	Health professions education (from Worksheet 5) . . .	103,578,001	23,731,222	79,846,779	1.730 %
g	Subsidized health services (from Worksheet 6) . . . .
h	Research (from Worksheet 7) .
i	Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .	13,607,100		13,607,100	0.290 %
j	Total. Other Benefits . .	119,916,786	23,731,222	96,185,564	2.080 %
k	Total. Add lines 7d and 7j .	576,976,877	23,731,222	553,245,655	11.970 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2022

Schedule H (Form 990) 2022

Page

Part II

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

		(a) Number of activities or programs (optional)	(b) Persons served (optional)	(c) Total community building expense	(d) Direct offsetting revenue	(e) Net community building expense	(f) Percent of total expense
1	Physical improvements and housing
2	Economic development
3	Community support
4	Environmental improvements
5	Leadership development and training for community members
6	Coalition building
7	Community health improvement advocacy
8	Workforce development
9	Other
10	Total

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

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

Yes

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

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).....

614,127,148

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

768,142,403

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

-154,015,255

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) 2022

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?3Name, address, primary website address, and state license number (and if a group return, the name and EIN of the subordinate hospital organization that operates the hospital facility)								Facility reporting group
1	DUKE UNIVERSITY HOSPITAL 2301 ERWIN ROAD PRIMARY CAMPUS DURHAM,NC27710 HTTP://WWW.DUKEHEALTH.ORG H0015	X	X	X	X	X	X	A
2	DUKE RALEIGH HOSPITAL 3400 WAKE FOREST ROAD PRIMARY CAMPUS RALEIGH,NC27609 HTTP://WWW.DUKEHEALTH.ORG H0238	X	X				X
3	DUKE REGIONAL HOSPITAL 3643 ROXBORO ROAD DURHAM,NC27704 HTTP://WWW.DUKEHEALTH.ORG H0233	X	X				X	A

Schedule H (Form 990) 2022

Page 4

Part VFacility Information (continued)

Section B. Facility Policies and Practices

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

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

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

Yes

Community Health Needs Assessment

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

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

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

Yes

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

A definition of the community served by the hospital facility

Demographics of the community

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

How data was obtained

The significant health needs of the community

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

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

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

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 21

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

Yes

6 a

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

Yes

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

Yes

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

Yes

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

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

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

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

Other (describe in Section C)

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

Yes

Indicate the tax year the hospital facility last adopted an implementation strategy: 20 21

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

Yes

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

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) 2022

Page 5

Part VFacility Information (continued)

Financial Assistance Policy (FAP)

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

Yes

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

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

Yes

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

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

Income level other than FPG (describe in Section C)

Asset level

Medical indigency

Insurance status

Underinsurance discount

Residency

Other (describe in Section C)

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

Yes

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

Yes

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

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

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

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

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

Other (describe in Section C)

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.DUKEHEALTH.ORG

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

HTTP://WWW.DUKEHEALTH.ORG

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

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

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

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

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) 2022

Page 6

Part VFacility Information (continued)

Billing and Collections

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

Yes

Did the hospital facility have in place during the tax year a 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 (if not, describe in Section C)

Made a reasonable effort to orally notify individuals about the FAP and FAP application process (if not, describe in
Section C)

Processed incomplete and complete FAP applications (if not, describe in Section C)

Made presumptive eligibility determinations (if not, describe in Section C)

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) 2022

Page 7

Part VFacility Information (continued)

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

	DUKE UNIVERSITYDUKE REGIONAL HOSPITALS
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? ...........................

Yes

If "Yes," explain in Section C.

Schedule H (Form 990) 2022

Page 4

Part VFacility Information (continued)

Section B. Facility Policies and Practices

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

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

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

Yes

Community Health Needs Assessment

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

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

Yes

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

A definition of the community served by the hospital facility

Demographics of the community

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

How data was obtained

The significant health needs of the community

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

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

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

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 22

Yes

6 a

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

Yes

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

Yes

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

Yes

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

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

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

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

Other (describe in Section C)

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

Yes

Indicate the tax year the hospital facility last adopted an implementation strategy: 20 22

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

Yes

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

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

10b

12a

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

12a

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

12b

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

Schedule H (Form 990) 2022

Page 5

Part VFacility Information (continued)

Financial Assistance Policy (FAP)

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

Yes

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

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

Yes

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

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

Income level other than FPG (describe in Section C)

Asset level

Medical indigency

Insurance status

Underinsurance discount

Residency

Other (describe in Section C)

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

Yes

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

Yes

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

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

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

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

Other (describe in Section C)

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.DUKEHEALTH.ORG

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

HTTP://WWW.DUKEHEALTH.ORG

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

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

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

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

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) 2022

Page 6

Part VFacility Information (continued)

Billing and Collections

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

Yes

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

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 (if not, describe in Section C)

Made a reasonable effort to orally notify individuals about the FAP and FAP application process (if not, describe in
Section C)

Processed incomplete and complete FAP applications (if not, describe in Section C)

Made presumptive eligibility determinations (if not, describe in Section C)

Other (describe in Section C)

None of these efforts were made

Policy Relating to Emergency Medical Care

Yes

If "No," indicate why:

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

The hospital facility’s policy was not in writing

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

Other (describe in Section C)

Schedule H (Form 990) 2022

Page 7

Part VFacility Information (continued)

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

	DUKE RALEIGH HOSPITAL
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 prospective Medicare or Medicaid method

If "Yes," explain in Section C.

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

Yes

If "Yes," explain in Section C.

Schedule H (Form 990) 2022

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, 20a, 20b, 20c, 20d, 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
NOTE: THIS SCHEDULE H CONTAINS REFERENCES TO DUKE AND DUKE HEALTH WHICH ARE	MEANT TO ENCOMPASS FOR THE PURPOSES OF THIS SCHEDULE DUKE UNIVERSITY HEALTH SYSTEM (DUHS), DUKE UNIVERSITY SCHOOL OF MEDICINE, AND DUKE UNIVERSITY SCHOOL OF NURSING. PART V, SECTION B:GROUP A - FACILITY 1 - DUKE UNIVERSITY HOSPITALPART V, SECTION B, LINE 5: DUKE UNIVERSITY HOSPITAL ("DUH") DUH COLLABORATES WITH THE PARTNERSHIP FOR A HEALTHY DURHAM (THE STATE CERTIFIED HEALTHY CAROLINIANS GROUP) AND THE DURHAM COUNTY HEALTH DEPARTMENT TO CONDUCT THE DURHAM COUNTY COMMUNITY HEALTH ASSESSMENT AND DEVELOPS STRATEGIES TO ADDRESS IDENTIFIED NEEDS. FACULTY AND STAFF OF THE DUKE DIVISION OF COMMUNITY HEALTH AND APPOINTED MEMBERS OF THE DUH SENIOR LEADERSHIP TEAM OFFICIALLY SERVE ON THE PARTNERSHIP FOR A HEALTHY DURHAM COMMITTEES.THE 2020 COMMUNITY HEALTH ASSESSMENT REPORT WAS PUBLISHED BY DURHAM COUNTY IN 2021. THE 2020 SURVEY WAS CONDUCTED BETWEEN MAY AND SEPTEMBER 2019, AND CARRIED OUT BY 243 COMMUNITY VOLUNTEERS, PARTNERSHIP MEMBERS, AND STAFF FROM DURHAM COUNTY DEPARTMENT OF PUBLIC HEALTH AND DUKE HEALTH. THE COUNTY WIDE SURVEY SAMPLE SIZE WAS DOUBLED IN 2019 TO ANALYZE DATA BY RACE AND ETHNICITY. THE ASSESSMENT INCLUDED 612 RESIDENT SURVEYS IN COUNTY WIDE AND HISPANIC OR LATINO NEIGHBORHOOD SAMPLES. COMMUNITY LISTENING SESSIONS WERE CONDUCTED VIA ZOOM DUE TO COVID-19 RESTRICTIONS. THE COMMUNITY HEALTH ASSESSMENT TEAM - COMPRISED OF MEMBERS REPRESENTING LOCAL GOVERNMENTS, HEALTH CARE SYSTEMS, COLLEGES & UNIVERSITIES, COMMUNITY-BASED ORGANIZATIONS AND NON-PROFITS IN SECTORS OF PHYSICAL AND MENTAL HEALTH, TRANSPORTATION, EDUCATION, HOUSING, RESEARCH, FOOD ACCESS, PLANNING ENVIRONMENT AND MORE WORKED TO DIRECT THE ACTIVITIES OF THE ASSESSMENT AND PROVIDE WRITTEN CONTENT AND EXPERTISE ON ISSUES OF INTEREST. THIS JOINT CHNA AND RELATED IMPLEMENTATION PLAN WAS ADOPTED BY THE DUHS BOARD OF DIRECTORS AND PUBLISHED ON THE DUKE HEALTH WEBSITE IN FISCAL YEAR 2022 (TAX YEAR 2021).GROUP A - FACILITY 1 - DUKE UNIVERSITY HOSPITALPART V, SECTION B, LINE 6A: DUKE REGIONAL HOSPITAL ("DRH")GROUP A - FACILITY 1 - DUKE UNIVERSITY HOSPITALPART V, SECTION B, LINE 6B: THE PARTNERSHIP FOR A HEALTHY DURHAM AND THE DURHAM COUNTY HEALTH DEPARTMENTGROUP A - FACILITY 1 - DUKE UNIVERSITY HOSPITALPART V, SECTION B, LINE 11: THE ASSESSMENT IDENTIFIED THE SAME FIVE HEALTH PRIORITIES FOR 2021-2023 AS THOSE OF THE PREVIOUS ASSESSMENT CYCLE: 1. AFFORDABLE HOUSING 2. ACCESS TO HEALTHCARE AND HEALTH INSURANCE3. POVERTY 4. MENTAL HEALTH 5. OBESITY, DIABETES AND FOOD ACCESS THE DUKE UNIVERSITY HOSPITAL IMPLEMENTATION PLAN CONTAINING DETAILED DESCRIPTIONS OF HOW DUKE HOSPITAL PLANS TO ADDRESS EACH PRIORITY ALONG WITH PROGRESS REPORTS CAN BE FOUND ON THE DUKEHEALTH.ORG WEBSITE. DUH CONSIDERS THE IMPLEMENTATION PLAN TO BE A "WORKING PLAN" THAT WILL CONTINUE TO EVOLVE OVER THE THREE YEAR PERIOD IN ORDER TO ENSURE THE EFFICACY OF STRATEGIES INTENDED TO MEET EXPRESSED COMMUNITY HEALTH NEEDS. THE IMPLEMENTATION PLAN MAY NOTE, BUT DOES NOT CONTAIN DETAILED DESCRIPTIONS OF, THE COMMUNITY HEALTH IMPROVEMENT WORK CARRIED OUT BY OTHER COMPONENTS OF THE LARGER DUKE HEALTH SYSTEM OR DUKE UNIVERSITY. TOGETHER WITH ITS PARTNERS, DUH ASKS ABOUT AND LISTENS TO CONCERNS, EXPLORES BARRIERS TO CARE, ANALYZES HEALTHCARE UTILIZATION AND COSTS, IDENTIFIES PARTNER NEEDS AND RESOURCES, PLANS/REDESIGNS SERVICES, TRACKS OUTCOMES, AND SHARES ACCOUNTABILITY IN ORDER TO DEVELOP EFFECTIVE PROGRAMS TO IMPROVE THE HEALTH OF THE DURHAM COMMUNITY. 1. AFFORDABLE HOUSINGAFFORDABLE HOUSING, AS DEFINED BY HUD (U.S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT), REQUIRES NO MORE THAN 30% OF A FAMILY'S MONTHLY INCOME. IF A FAMILY SPENDS MORE THAN 30% OF INCOME ON HOUSING, THEY ARE LESS ABLE TO PAY FOR OTHER EXPENSES, SUCH AS FOOD AND HEALTHCARE. THE INCREASED COST BURDEN OF UNAFFORDABLE HOUSING ADDS TO PSYCHOSOCIAL STRESSORS THAT CAN NEGATIVELY IMPACT A FAMILY. RENTERS MAKE UP 40% OF HOUSEHOLDS IN DURHAM, AND ALMOST HALF OF THEM ARE DEFINED AS COST-BURDENED (I.E. PAYING MORE THAN 30% OF THEIR MONTHLY INCOME FOR HOUSING).DUH HAS PARTNERED WITH HABITAT FOR HUMANITY OF DURHAM ON A NUMBER OF HOME BUILDS. ADDITIONALLY, AFFORDABLE HOUSING IS A FOCUS OF DUH AS PART OF THE LARGER DUKE UNIVERSITY. DUKE'S WORK RELATED TO AFFORDABLE HOUSING IS LED BY DUKE UNIVERSITY'S OFFICE OF DURHAM AND PUBLIC AFFAIRS. FOR INSIGHT INTO THIS AND OTHER WORK LED BY THE OFFICE OF DURHAM AND COMMUNITY AFFAIRS, SEE: HTTPS://COMMUNITY.DUKE.EDU/PROGRAMS-INITIATIVES/HOUSING-NEIGHBORHOODS/.2. ACCESS TO HEALTHCARE AND HEALTH INSURANCE:ACCESS TO HEALTHCARE IN A COMMUNITY REFERS TO THE ABILITY OF RESIDENTS TO FIND A CONSISTENT MEDICAL PROVIDER FOR THEIR PRIMARY CARE NEEDS, TO FIND A SPECIALTY PROVIDER WHEN NEEDED AND TO BE ABLE TO RECEIVE THAT CARE WITHOUT ENCOUNTERING SIGNIFICANT BARRIERS. A NUMBER OF PROGRAMS SUPPORTED BY DUH SEEK TO INCREASE ACCESS TO CARE FOR UNINSURED, UNDERINSURED, AND/OR VULNERABLE INDIVIDUALS AND FAMILIES ARE DESCRIBED BELOW:PROJECT ACCESS OF DURHAM COUNTY (PADC): LINKS ELIGIBLE LOW-INCOME, UNINSURED DURHAM COUNTY RESIDENTS TO SPECIALTY MEDICAL CARE FULLY DONATED TO THE PATIENTS BY THE PHYSICIANS, HOSPITALS INCLUDING DUH, LABS, CLINICS AND OTHER PROVIDERS PARTICIPATING IN THE PADC NETWORK.DURING FY2023, PADC SERVED 2,000 PEOPLE PROVIDING MORE THAN 3,000 EPISODES OF CARE FROM SPECIALTY PHYSICIANS AND OTHER PROVIDERS. PADC'S DURHAM HOMELESS TRANSITIONS PROGRAM WORKED WITH MORE THAN 40 UNHOUSED PERSONS AND ITS HEALTH EQUIPMENT LOAN PROGRAM PROVIDED 1,000 PIECES OF DURABLE MEDICAL EQUIPMENT TO PADC CLIENTS.LOCAL ACCESS TO COORDINATED HEALTHCARE (LATCH): AIMS TO IMPROVE HEALTH KNOWLEDGE AND SELF-CARE, ACCESS TO HEALTH CARE AND HEALTH SERVICES UTILIZATION OUTCOMES AMONG DURHAM COUNTY'S UNINSURED. THE LATCH PARTNERSHIP INCLUDES DUH (WHICH NOW PROVIDES THE MAJORITY OF OPERATING FUNDS), LINCOLN COMMUNITY HEALTH CENTER, THE DURHAM COUNTY DEPARTMENTS OF HEALTH AND SOCIAL SERVICES, EL CENTRO HISPANO, AND A NUMBER OF COMMUNITY-BASED ORGANIZATIONS (CBOS). CARE MANAGEMENT SERVICES INCLUDE HEALTH SERVICES COORDINATION AND NAVIGATION (MEDICAL, SOCIAL, BEHAVIORAL); POST-HOSPITALIZATION FOLLOW-UP; PATIENT EDUCATION; CHRONIC DISEASE MANAGEMENT; PSYCHO-SOCIAL SUPPORT; ACCESS TO BENEFITS (MEDICAID/SSI/SSDI); BILLS ASSISTANCE; INTERPRETATION TRANSLATION; AND, TRANSPORTATION COORDINATION. IN PARTNERSHIP WITH OTHER COMMUNITY STAKEHOLDERS-HEALTHCARE AND SOCIAL SERVICE PROVIDERS, LOCAL GOVERNMENT AND COMMUNITY-BASED ORGANIZATIONS-LATCH MONITORS HEALTHCARE TRENDS, IDENTIFIES BARRIERS FACING UNINSURED PATIENTS, AND, WORKING AS A CONSORTIUM, ADDRESSES AND ELIMINATES BARRIERS.DURING FISCAL YEAR 2023, LATCH CONTINUED TO SERVE UNINSURED INDIVIDUALS IN DURHAM COUNTY.
THE COMPLEX CHILD PROGRAM (CCP) PROVIDES THE COORDINATION	OF MEDICAL AND CO-MANAGEMENT OF MEDICAL CARE FOR CHILDREN WITH MULTIPLE MEDICALLY COMPLEX ISSUES THAT REQUIRE THE INTERACTION WITH MULTIPLE SPECIALISTS. ON AVERAGE THESE CHILDREN WORK WITH 13 SPECIALISTS. THROUGH THE CCP PARENTS HAVE DIRECT PHONE ACCESS TO A COMPLEX CARE SERVICE (CCS) PROVIDER OR RN 24/7. THE CCP TEAM WORKS WITH PARENTS TO CREATE A COMPREHENSIVE "COMPLEX CARE PLAN" THAT IS PLACED IN THE CHILD'S MEDICAL RECORD AND GIVEN TO THE PARENTS. IN ADDITION, THE CCP TEAM COORDINATES INPATIENT INTENSIVE CARE TRANSITIONS PRIOR TO DISCHARGE AND CONDUCTS INTENSIVE OUTPATIENT "BETWEEN-VISIT" CONTACTS (PHONE, CLINIC VISITS, AND IN SOME CASES, HOME VISITS). DURING FY23, THE CCP CONTINUED TO MAXIMIZE SERVICES TO CHILDREN WITH MULTIPLE MEDICALLY COMPLEX ISSUES AND THEIR FAMILIES.SOUTHERN HIGH SCHOOL (SHS) WELLNESS CENTER: PROVIDES COMPREHENSIVE PRIMARY CARE AND MENTAL HEALTH SERVICES AT SHS TO STUDENTS AT THE SCHOOL AND IS OPEN TO ALL STUDENTS AND STAFF OF DURHAM PUBLIC SCHOOLS. IT IS OPERATED BY DUKE'S DIVISION OF COMMUNITY HEALTH ON BEHALF OF DUH.
JUST FOR US (JFU): PROVIDES AN IN-HOME CARE PROGRAM FOR LOW-INCOME,	FRAIL ELDERLY AND DISABLED. JFU IS A COLLABORATION OF DUKE, LINCOLN COMMUNITY HEALTH CENTER, DURHAM DEPARTMENT OF SOCIAL SERVICES (DSS), THE LOCAL AREA MENTAL HEALTH ENTITY, AND THE DURHAM HOUSING AUTHORITY. DUH PROVIDES THE MAJORITY OF ONGOING SUPPORT FOR THE PROGRAM. THROUGH JFU, AN INTERDISCIPLINARY TEAM OF PROVIDERS SERVES CLIENTS IN THEIR HOMES, PROVIDING MEDICAL CARE, MANAGEMENT OF CHRONIC ILLNESSES, AND CASE MANAGEMENT. EACH PARTICIPANT RECEIVES A HOME VISIT EVERY 5 WEEKS UNLESS THERE IS AN ACUTE EPISODE OR A HOSPITAL DISCHARGE, FOR WHICH A VISIT IS SCHEDULED IMMEDIATELY. VISITS INCLUDE MEDICATION RECONCILIATION, SOCIAL ISSUES, SUPPORT SERVICES, CHRONIC DISEASE MANAGEMENT, AND POST-HOSPITAL CARE. THE HEALTH CARE TEAM CONSISTS OF A CLINICAL PROVIDER (PA, NP OR MD), OCCUPATIONAL THERAPIST, REGISTERED DIETITIAN, SOCIAL WORKER, PHLEBOTOMIST, AND COMMUNITY HEALTH WORKER. NEIGHBORHOOD/COMMUNITY CLINICS: DUH IN PARTNERSHIP WITH LINCOLN COMMUNITY HEALTH CENTER COLLABORATIVELY OPERATES THREE COMMUNITY HEALTH CLINICS: THE LYON PARK COMMUNITY CLINIC, THE WALLTOWN NEIGHBORHOOD CLINIC AND THE HOLTON WELLNESS CENTER. THE CLINICS WERE DESIGNED TO PROVIDE PRIMARY CARE, HEALTH EDUCATION, AND DISEASE PREVENTION TO THE UNDERSERVED POPULATIONS OF DURHAM. THE CLINICS PROVIDE MEDICAL CARE FOR PERSONS WITH AND WITHOUT HEALTH INSURANCE. THOSE WITHOUT INSURANCE ARE SEEN BASED ON A SLIDING FEE SCALE. NO PATIENT IS DENIED CARE BASED ON INABILITY TO PAY FOR SERVICES. CLINICS RECEIVE SIGNIFICANT SUPPORT FROM DUH. THE CLINICS OPERATE AS FAMILY MEDICINE PRACTICES AND ARE OPEN 5 DAYS A WEEK. DURING FISCAL YEAR 2023, THE SOUTHERN HIGH SCHOOL WELLNESS CENTER, THE MICRO-CLINICS AND JUST FOR US PROVIDED 10,587 IN-PERSON AND VIDEO/TELEHEALTH PATIENT VISITS.
3. POVERTY	POVERTY HAS A STRONG IMPACT ON HEALTH AND IS AN IMPORTANT CONCERN FOR DURHAM RESIDENTS. RESEARCH NOW SHOWS THAT EVEN THE RISK OF AN ADVERSE CHANGE IN MATERIAL CONDITIONS, ECONOMIC AND HOUSING INSECURITY, AS WELL AS UNINSURED OR UNDERINSURED HEALTH INSURANCE COVERAGE, AFFECT HEALTH OUTCOMES. IN 2017, DUKE IMPLEMENTED A PLAN TO GRADUALLY INCREASE THE MINIMAM WAGE FOR ALL EMPLOYEES TO $15 PER HOUR, MORE THAN TWICE THE MINIMUM FEDERAL OR STATE HOURLY WAGE. THESE EFFORTS CONTINUED OVER SEVERAL YEARS, CULMINATING IN 2019 WITH A MINIMUM WAGE INCREASE TO $15 FOR ALL EMPLOYEES. ON JULY 1, 2022, DUKE UNIVERSITY, INCLUDING DUKE UNIVERSITY HEALTH SYSTEM, INCREASED THE MINIMUM WAGE TO $17 PER HOUR FOR ALL EMPLOYEES WORKING AT LEAST 20 HOURS PER WEEK AND 36 WEEKS PER YEAR. SSI/SSDI OUTREACH, ACCESS AND RECOVERY (SOAR) HELPS PATIENTS WHO ARE CHRONICALLY HOMELESS, OR AT RISK OF HOMELESSNESS ACCESS HEALTH INSURANCE, A STABLE INCOME, AND MEDICAL CARE BY ASSISTING THESE INDIVIDUALS IN APPLYING FOR SUPPLEMENTAL SECURITY INCOME (SSI) AND SOCIAL SECURITY DISABILITY INSURANCE (SSDI). THROUGH SOAR, THESE INDIVIDUALS WITH COMPLEX NEEDS ARE PROVIDED CASE MANAGEMENT FOR HOME, HOSPITAL, AND CLINIC VISITS; ARE PROVIDED WITH A STEP BY STEP EXPLANATION AND COMPLETION OF ALL APPLICATIONS FOR FEDERAL DISABILITY BENEFITS; RECEIVE EXPEDITED APPLICATIONS FOR MONTHLY INCOME AND MEDICAID/MEDICARE; AND ARE LINKED TO COMMUNITY RESOURCES. DUH FUNDS TWO SOAR CASE MANAGERS. DURING FY23, DUH CONTINUED TO ASSIST PATIENTS REFERRED TO THE SOAR PROGRAM.
BENEFITS ENROLLMENT COUNSELING (BEC) HELPS SENIORS AND THOSE WITH	DISABILITIES AND A LIMITED INCOME FIND AND ENROLL IN ALL THE BENEFIT PROGRAMS FOR WHICH THEY ARE ELIGIBLE. THE GOAL OF THE SERVICE IS TO ENABLE OLDER ADULTS TO ENJOY LIFE AND LIVE INDEPENDENTLY IN THEIR HOMES AND COMMUNITIES FOR AS LONG AS POSSIBLE. FOR THOSE WITH LIMITED INCOME AND RESOURCES, ADDITIONAL SUPPORT CAN BE CRITICAL IN MAINTAINING THEIR HEALTH AND AVOIDING COSTLY HOSPITALIZATIONS. THE BENEFITS PROVIDE CLIENTS SERVED WITH ACCESS TO HEALTHY FOOD, NEEDED MEDICAL CARE AND PRESCRIPTIONS, AS WELL AS OTHER SUPPORTIVE SERVICES. THE BENEFITS ALSO PROVIDE A COMMUNITY ECONOMIC STIMULUS, AS BENEFITS ARE SPENT LOCALLY IN PHARMACIES, GROCERY STORES, UTILITY COMPANIES, AND HEALTH CARE PROVIDERS. TO INCREASE THE REACH OF THE PROGRAM BEYOND GRANT FUNDING, BEC STAFF TRAIN VOLUNTEERS (FROM PARTNER COMMUNITY BASED ORGANIZATIONS AND DUKE) TO ASSIST CLIENTS IN DURHAM, GRANVILLE, AND PERSON COUNTIES. BEC WORKS WITH DUKE UNDERGRADUATES AND MEDICAL STUDENTS WHO ENGAGE IN SERVICE, OUTREACH, AND ADVOCACY EFFORTS AS WELL AS BUILD MEANINGFUL INTERGENERATIONAL RELATIONSHIPS.BEC PROGRAMS INCLUDE THE COPE INITIATIVE (COMMUNITY OUTREACH, PREVENTION AND EDUCATION), WHICH OFFERS HEALTH SCREENING AND EDUCATION IN THE COMMUNITY, AND INITIATIVES THAT DIRECTLY ADDRESS GAPS IN SENIOR HUNGER PREVENTION THROUGH TEACHING SELF-SUFFICIENT, SUSTAINABLE GARDENING PRACTICES, AND THE PROVISION OF COOKING CLASSES AT SENIOR CENTERS.BEC SAW SUBSTANTIAL GROWTH IN FY23 FROM FY22, SERVING 485 UNIQUE CLIENTS, UP FROM 350 IN FY22. THE ESTIMATED VALUE OF BENEFITS TO CLIENTS INCREASED FROM $1.2 MILLION IN FY22 TO OVER $1.5 MILLION IN FY23.4. MENTAL HEALTHDUH PARTNERS WITH AND SUPPORTS A NUMBER OF COLLABORATIVE INITIATIVES TO IMPROVE ACCESS TO MENTAL HEALTH SERVICES AND REDUCE SUBSTANCE ABUSE. DUH SERVES AS A KEY PARTNER IN THE FOLLOWING ACTIVITES:* COMMUNITY COALITIONS: DURHAM CRISIS COLLABORATIVE; PARTNERSHIP FOR A HEALTHY DURHAM MENTAL HEALTH COMMITTEE AND DURHAM TOGETHER FOR RESILIENT YOUTH; DURHAM COUNTY LEADERSHIP FORUM ON SUBSTANCE ABUSE AND MENTAL HEALTH.* NALOXONE OUTREACH: PHARMACIES (DUKE CLINIC PHARMACY, MAIN STREET, GURLEY'S, JOSEF'S, & DUKE CANCER SPECIALTY); DURHAM COUNTY DEPARTMENT OF PUBLIC HEALTH; DURHAM MOBILE CRISIS UNIT.* PROVIDER EDUCATION: PROVIDER TOOLKITS AND CME EDUCATION; USE OF PAIN AGREEMENTS; USE OF CONTROLLED SUBSTANCE REPORTING SYSTEM (CSRS); CHRONIC PAIN PROVIDER CONSULTATION CALLS.* DIVERSION CONTROL: PERMANENT DROP BOXES IN 5 OF 6 COUNTIES (DURHAM, FRANKLIN, PERSON, GRANVILLE, & VANCE).* CHRONIC PAIN PATIENT SUPPORT: CHRONIC PAIN SELF-MANAGEMENT WORKSHOPS AT LINCOLN COMMUNITY HEALTH CENTER; CHRONIC PAIN MANAGEMENT RESOURCES; KEY COMMUNITY PRESENTATIONS.* COUNTY-WIDE ADVERSE CHILDHOOD EXPERIENCES (ACES) AND COMMUNITY RESILIENCY MODEL (CRM): ACTIVITIES AND TRAINING.DURING FISCAL YEAR 2023 DUKE CONTINUED TO WORK WITH COMMUNITY PARTNERS TO DEVELOP COMMUNITY-BASED SUPPORTIVE SERVICES FOR INDIVIDUALS LIVING WITH OPIOID USE DISORDER/SUBSTANCE USE DISORDER.
DUHS SAFE OPIOID TASK FORCE: PROVIDES RECOMMENDATIONS	FOR THE INITIATION AND MANAGEMENT OF OPIOID THERAPY ACROSS DUKE UNIVERSITY HEALTH SYSTEM (DUHS) TO IMPROVE PERSONAL AND COMMUNITY SAFETY AND REDUCE HARM ASSOCIATED WITH THESE HIGH RISK TREATMENTS WHILE ENGAGING PATIENTS IN THEIR OWN CARE. DUH ALONG WITH DUKE REGIONAL AND DUKE RALEIGH HOSPITALS SERVES AS A PIVOTAL PLAYER IN ALL ASPECTS OF THE WORK OF THE TASK FORCE.
5. OBESITY, DIABETES, AND FOOD ACCESS	OBESITY IS A STRONG CONTRIBUTOR TO DIABETES. MANY DISEASES ARE LINKED TO NUTRITION, INCLUDING OBESITY, HYPERTENSION, HIGH CHOLESTEROL, DIABETES, AND SOME CANCERS. FOOD INSECURITY, THE STATE OF BEING WITHOUT RELIABLE ACCESS TO A SUFFICIENT QUANTITY OF AFFORDABLE, NUTRITIOUS FOOD, HAS A LARGE IMPACT ON A PERSON'S DIET.
BULL CITY FIT IS A COMMUNITY-BASED WELLNESS PROGRAM AND IS PART OF	THE LARGER DUKE CHILDREN'S HEALTHY LIFESTYLES PROGRAM. THE HEALTHY LIFESTYLES PROGRAM SEEKS TO ADDRESS WEIGHT-RELATED HEALTH PROBLEMS FOR CHILDREN BY OFFERING CARING PROVIDERS, FAMILY-CENTERED TREATMENT PROGRAMS, HIGHLY TRAINED EDUCATORS AND RESEARCHERS, AND STRONG COMMUNITY PARTNERSHIPS. BULL CITY FIT HELPS IN THIS EFFORT BY OFFERING FREE EVENING AND WEEKEND ACTIVITY SESSIONS FOR THE LARGER COMMUNITY. THESE SESSIONS COVER VARIOUS THEMES THAT ENCOURAGE AND PROMOTE ACTIVE LIVING, SUCH AS FITNESS GAMES, SPORT LESSONS, EXERCISE ROUTINES, SWIMMING, COOKING, AND GARDENING. EACH ACTIVITY IS FACILITATED WITH THE SUPPORT OF ENERGETIC STAFF AND VOLUNTEERS TO CREATE A POSITIVE AND FUN ENVIRONMENT FOR ALL.BULL CITY FIT EMPOWERS THE WHOLE FAMILY TO INCREASE KNOWLEDGE AND PRACTICE OF PHYSICAL ACTIVITY AND HEALTHY EATING; ADDRESS CURRENT WEIGHT-RELATED ILLNESS AND PREVENT CHRONIC DISEASE THROUGH INCREASED ACTIVITY LEVELS; IMPROVE QUALITY OF LIFE BY PROMOTING HEALTHY BEHAVIORS; INCREASE CONFIDENCE, SUPPORT POSITIVE CHANGE, AND BUILD A LIFELONG COMMITMENT TO A HEALTHY LIFESTYLE.PARTNERS OF BULL CITY FIT INCLUDE: DURHAM PARKS AND RECREATION; DURHAM CITY GOVERNMENT; DURHAM COUNTY DEPARTMENT OF PUBLIC HEALTH; EAST DURHAM CHILDREN'S INITIATIVE; LINCOLN COMMUNITY HEALTH CENTER; COMMUNITY NUTRITION PARTNERSHIP; VEGGIE VAN; BLUE POINTE YOGA; DURHAM PUBLIC SCHOOLS; PARTNERSHIP FOR A HEALTHY DURHAM; DUKE SERVICE LEARNING; DUKE FAMILY MEDICINE; DUKE CHILDREN'S HOSPITAL AND THE UNC SCHOOL OF SOCIAL WORK.DURING FY2023, DUH AND THE PARTNERSHIP SUCCESSFULLY SECURED A MULTI-YEAR IMPLEMENTATION GRANT TO CARRY OUT THE COMMUNITY-DRIVEN ACTIVITIES DEVELOPED DURING THE 2022 PLANNING GRANT PERIOD.
GROUP A - FACILITY 1 - DUKE UNIVERSITY HOSPITAL	PART V, SECTION B, LINE 16J: AS PART OF DUHS, DUKE UNIVERSITY HOSPITAL PROVIDES A BROCHURE TO ALL ADMISSIONS THAT INCLUDES A BRIEF SUMMARY OF DUHS FINANCIAL ASSISTANCE POLICIES. DUHS ALSO COMMENTS ON THE BACK OF ITS BILLING INVOICES THAT PATIENTS SHOULD CONTACT PATIENT ACCOUNT REPRESENTATIVES TO HELP THEM IF THEY CANNOT PAY THEIR BILL IN FULL. THIS COMMENT REFERENCES GOVERNMENT-SPONSORED PROGRAMS, MONTHLY PAYMENT PROGRAMS, AND OTHER FINANCIAL ASSISTANCE PROGRAMS AVAILABLE FOR PATIENTS WHO MEET CERTAIN FINANCIAL CRITERIA. DUHS ALSO PUBLICIZES ITS FINANCIAL ASSISTANCE POLICY VERBALLY THROUGH ITS FINANCIAL CARE COUNSELORS. PART V, SECTION B, LINE 24: CERTAIN ELECTIVE COSMETIC/AESTHETIC SERVICES, AND OTHER ELECTIVE SERVICES, WERE BILLED AT AN AMOUNT EQUAL TO GROSS CHARGES.DUKE RALEIGH HOSPITAL:PART V, SECTION B, LINE 5: DUKE RALEIGH HOSPITAL (DUKE RALEIGH OR DRAH) COLLABORATED WITH ADVANCE COMMUNITY HEALTH, ALLIANCE HEALTH, CITRIX, UNITED WAY, UNC REX HEALTHCARE, WAKE COUNTY HEALTH & HUMAN SERVICES, WAKE COUNTY MEDICAL SOCIETY COMMUNITY HEALTH FOUNDATION, WAKEMED HEALTH AND HOSPITALS, AND YOUTH THRIVE TO DEVELOP THE 2022 WAKE COUNTY COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA). THE CHNA INCLUDED ANALYSIS OF EXISTING STATISTICS FROM LOCAL, COUNTY, STATE, AND NATIONAL SOURCES AS WELL AS INPUT FROM 1,073 WAKE COUNTY RESIDENTS AND ORGANIZATIONAL LEADERS. COMMUNITY INPUT WAS GATHERED THROUGH INTERNET-BASED AND TELEPHONE SURVEYS, FOCUS GROUPS, AND AN INTERNET-BASED PRIORITIZATION SURVEY. ADDITIONAL ACTION WAS TAKEN BY THE CHNA STEERING COMMITTEE MEMBERS TO PROMOTE ENGAGEMENT DURING PRIORITIZATION, THROUGH DIRECT OUTREACH TO MEDICALLY UNDERSERVED, LOW-INCOME, AND MINORITY COMMUNITIES AND THOSE WHO WERE UNDERREPRESENTED. THIS JOINT CHNA AND RELATED IMPLEMENTATION PLAN WERE ADOPTED BY THE DUHS BOARD OF DIRECTORS AND PUBLISHED ON THE DUKE HEALTH WEBSITE IN FISCAL YEAR 2023.DUKE RALEIGH HOSPITAL:PART V, SECTION B, LINE 6A: UNC REX HEALTHCARE, WAKEMED HEALTH AND HOSPITALS.DUKE RALEIGH HOSPITAL:PART V, SECTION B, LINE 6B: UNITED WAY, WAKE COUNTY HEALTH & HUMAN SERVICES, ADVANCE COMMUNITY HEALTH, ALLIANCE HEALTH, CITRIX, NORTH CAROLINA INSTITUTE FOR PUBLIC HEALTH, YOUTH THRIVE, AND THE WAKE COUNTY MEDICAL SOCIETY COMMUNITY HEALTH FOUNDATION. DUKE RALEIGH HOSPITAL:PART V, SECTION B, LINE 11:THE FOLLOWING THREE PRIORITY AREAS WERE IDENTIFIED FOR 2023-2025:1. AFFORDABLE HOUSING & HOMELESSNESS2. ACCESS TO HEALTHCARE3. MENTAL HEALTHTHE DUKE RALEIGH HOSPITAL IMPLEMENTATION PLAN CONTAINING DETAILED DESCRIPTIONS OF HOW DUKE RALEIGH PLANS TO ADDRESS EACH PRIORITY ALONG WITH PROGRESS REPORTS CAN BE FOUND ON THE DUKEHEALTH.ORG WEBSITE.
1. AFFORDABLE HOUSING & HOMELESSNESS	THE AFFORDABLE HOUSING AND HOMELESSNESS PRIORITY INCLUDES COST OF HOUSING, HOUSING CHOICES, AND HOW MANY PEOPLE ARE HOMELESS. DUKE HEALTH ACKNOWLEDGES THAT HEALTHY HOMES PROMOTE GOOD PHYSICAL AND MENTAL HEALTH, AFFECTING THE OVERALL ABILITY OF FAMILIES TO MAKE HEALTHY CHOICES. DUKE RALEIGH PARTNERS WITH NON-PROFIT ORGANIZATIONS THAT WORK TO ENSURE THAT HOMELESSNESS IS INFREQUENT IN WAKE COUNTY BY INCREASING EFFORTS TO ADVANCE AFFORDABLE HOUSING LIKE THE WAKE COUNTY CONTINUUM OF CARE-NC 507 (COC). A DRAH REPRESENTATIVE ATTENDED THE NC 507 STRATEGIC SYSTEM DESIGN CLINIC THAT BROUGHT TOGETHER KEY STAKEHOLDERS TO UNDERSTAND AND DISCUSS ALIGNING SYSTEMS COMPONENTS WITH BEST PRACTICES, UNDERSTAND THE IMPORTANCE OF QUALITY DATA COLLECTION AND DATA-DRIVEN DECISION MAKING TO BETTER ALLOCATE FUNDS AND RESOURCES TOWARDS EFFECTIVE AND EFFICIENT INTERVENTIONS TO END HOMELESSNESS, IDENTIFY RECOMMENDATIONS TO IMPROVE THE LOCAL SYSTEMS TO END HOMELESSNESS, AND ENGAGE IN PLANNING TO DEVELOP ACTIONS TO ADDRESS RECOMMENDATIONS.DUKE RALEIGH SUPPORTS WAKE COC DURING WHITE FLAG WHICH PROVIDES TEMPORARY EMERGENCY SHELTER TO PEOPLE EXPERIENCING HOMELESSNESS DURING SEVERE WEATHER (NIGHTS WHEN THE TEMPERATURE OR WINDCHILL IS EXPECTED TO BE BELOW 35 DEGREES). DUKE RALEIGH SUPPORTS THE FOLLOWING ORGANIZATIONS FINANCIALLY AND THROUGH EMPLOYEE VOLUNTEERISM THAT WORK TOWARDS ADVANCING AFFORDABLE HOUSING AND ADDRESSING HOMELESSNESS: HEALING TRANSITIONS, TRIANGLE FAMILY SERVICES, HABITAT FOR HUMANITY, AND URBAN MINISTRIES OF WAKE COUNTY.2. ACCESS TO HEALTHCAREACCESS TO HEALTHCARE INCLUDES HOW AND WHY PEOPLE USE OR DO NOT USE HEALTHCARE, HOW MANY PEOPLE HAVE HEALTH INSURANCE, HOW MUCH HEALTHCARE THERE IS IN THE COMMUNITY, AND HOW MUCH INFORMATION THERE IS ABOUT HEALTHCARE. THE ABILITY TO ACCESS HEALTH SERVICES IS A CRITICAL PUBLIC HEALTH ISSUE, AS PRIMARY AND PREVENTATIVE SERVICES CAN HELP PREVENT OR MANAGE CHRONIC ILLNESSES AND THEREFORE IMPROVE THE HEALTH OF THE COMMUNITY. DUKE RALEIGH IS ACTIVELY ENGAGED IN IMPROVING ACCESS TO HEALTH SERVICES FOR ALL THROUGH STRATEGIC INITIATIVES AND COMMUNITY PARTNERSHIPS. THE BULLET POINTS BELOW DESCRIBE THE PROGRESS MADE BY DUKE RALEIGH DURING FY2023 ON INITIATIVES TO ADDRESS ACCESS TO HEALTHCARE:* PROVIDED APPROXIMATELY $19.8 MILLION (AT ESTIMATED COST) IN FINANCIAL ASSISTANCE TO PATIENTS. * DUKE RALEIGH ALSO SUPPORTED COMMUNITY PARTNERS WORKING TO PROVIDE CARE TO UNINSURED POPULATIONS. THESE COMMUNITY ORGANIZATIONS INCLUDE PROJECT ACCESS, URBAN MINISTRIES OF WAKE COUNTY, ALLIANCE MEDICAL MINISTRY, INTER-FAITH FOOD SHUTTLE, AND MEALS ON WHEELS. * DUKE RALEIGH PROVIDED IN-KIND LAB SERVICES TO URBAN MINISTRIES OF WAKE COUNTY'S OPEN-DOOR CLINIC AT AN ESTIMATED ANNUAL VALUE OF $2 MILLION.* DONATED AND PACKED 5,000+ POUNDS OF RICE AND BEANS FOR URBAN MINISTRIES OF WAKE COUNTY'S CLIENT CHOICE PANTRY BETWEEN FY17-FY23. * ORGANIZED TWO HEAD AND NECK CANCER SCREENING EVENTS IN FY23 RESULTING IN APPROXIMATELY 450 LIVES REACHED AND 56 SCREENING COMPLETED. * ORGANIZED A BACK-TO-SCHOOL GIVEAWAY FOR A LOCAL VULNERABLE COMMUNITY AND A LOCAL TITLE 1 SCHOOL RESULTING IN APPROXIMATELY 200 LIVES REACHED AND 100 BAGS DISTRIBUTED.* SPONSORED THE MIDTOWN FARMERS MARKET WHICH PROMOTES A HEALTHY LIFESTYLE AS WELL AS PROVIDES A VENUE FOR DUKE RALEIGH TO SHARE HEALTHY EDUCATION FROM APRIL-NOVEMBER HOSTING 4 DAYS FOCUSED ON MENTAL HEALTH, WELL-BEING AND CANCER CARE.
3. MENTAL HEALTH	WAKE COUNTY HAS EXPERIENCED AN INCREASE IN THE PREVALENCE AND SEVERITY OF MENTAL HEALTH ISSUES. WHILE THE IMPACTS OF MENTAL HEALTH ARE FAR REACHING, PRIORITIZATION DISCUSSIONS HAVE PLACED SPECIAL EMPHASIS ON SEVERAL POPULATIONS SPECIFICALLY IMPACTED BY MENTAL HEALTH IDENTIFYING THE RELATIONSHIP BETWEEN DISCRIMINATION, RACISM, AND MENTAL HEALTH. DUE TO THE SCOPE AND COMPLEXITY OF MENTAL HEALTH AND ITS TIE TO PHYSICAL HEALTH, A COLLECTIVE AND COLLABORATIVE APPROACH IS NEEDED. THE BULLET POINTS BELOW DESCRIBE THE PROGRESS MADE BY DUKE RALEIGH DURING FY2023 ON INITIATIVES TO ADDRESS ACCESS TO MENTAL HEALTH SERVICES.* PROVIDED FINANCIAL SUPPORT TO TRIANGLE FAMILY SERVICES TO SUPPORT THEIR EFFORTS TO EXPAND ACCESS TO SUSTAINABLE MENTAL HEALTH SERVICES IN OUR COMMUNITY* PROVIDED SUPPORT FOR THE ADVERSE CHILDHOOD EXPERIENCES (ACES) RESILIENCE IN WAKE COUNTY INITIATIVE. THIS IS A MULTI-SECTOR, COMMUNITY-DRIVEN MOVEMENT TO ADDRESS AND PREVENT ACES AND BUILD RESILIENCE IN WAKE COUNTY.* HOSTED A MENTAL HEALTH AND WELLBEING POPUP AT THE MIDTOWN FARMERS MARKET IN JULY 2022* SPONSORED THE NATIONAL ASSOCIATION OF MENTAL ILLNESS CELEBRATION OF COURAGE WALK AS A $2,500 SPONSOR AND PRESENTER THE DAY OF IN SEPTEMBER 2022* PARTICIPATED IN THE NORTH CAROLINA BEHAVIORAL HEALTH WORKGROUP.DUKE RALEIGH HOSPITAL:PART V, SECTION B, LINE 16J: AS PART OF DUHS, DUKE RALEIGH HOSPITAL PROVIDES A BROCHURE TO ALL ADMISSIONS THAT INCLUDES A BRIEF SUMMARY OF DUHS FINANCIAL ASSISTANCE POLICIES. DUHS ALSO COMMENTS ON THE BACK OF ITS BILLING INVOICES THAT PATIENTS SHOULD CONTACT PATIENT ACCOUNT REPRESENTATIVES TO HELP THEM IF THEY CANNOT PAY THEIR BILL IN FULL. THIS COMMENT REFERENCES GOVERNMENT-SPONSORED PROGRAMS, MONTHLY PAYMENT PROGRAMS, AND OTHER FINANCIAL ASSISTANCE PROGRAMS AVAILABLE FOR PATIENTS WHO MEET CERTAIN FINANCIAL CRITERIA. DUHS ALSO PUBLICIZED ITS FINANCIAL ASSISTANCE POLICY VERBALLY THROUGH ITS FINANCIAL CARE COUNSELORS.DUKE RALEIGH HOSPITAL:PART V, SECTION B, LINE 24: CERTAIN ELECTIVE COSMETIC/AESTHETIC SERVICES, AND OTHER ELECTIVE SERVICES, WERE BILLED AT AN AMOUNT EQUAL TO GROSS CHARGES.
GROUP A - FACILITY 3 - DUKE REGIONAL HOSPITAL:	PART V, SECTION B, LINE 5: AS PART OF DUKE HEALTH, DUKE REGIONAL HOSPITAL ("DRH") PARTNERED WITH DURHAM COUNTY DEPARTMENT OF PUBLIC HEALTH AND THE PARTNERSHIP FOR A HEALTHY DURHAM TO CONDUCT THE 2020 DURHAM COMMUNITY HEALTH ASSESSMENT. THE 2020 SURVEY WAS CONDUCTED BETWEEN MAY AND SEPTEMBER 2019, AND CARRIED OUT BY 243 COMMUNITY VOLUNTEERS, PARTNERSHIP MEMBERS, AND STAFF FROM DURHAM COUNTY DEPARTMENT OF PUBLIC HEALTH AND DUKE HEALTH. THE COUNTY WIDE SURVEY SAMPLE SIZE WAS DOUBLED IN 2019 TO ANALYZE DATA BY RACE AND ETHNICITY. THE ASSESSMENT INCLUDED 612 RESIDENT SURVEYS IN COUNTY WIDE AND HISPANIC OR LATINO NEIGHBORHOOD SAMPLES. COMMUNITY LISTENING SESSIONS WERE CONDUCTED VIA ZOOM DUE TO COVID-19 RESTRICTIONS. THE COMMUNITY HEALTH ASSESSMENT TEAM COMPRISED OF REPRESENTATIVES FROM LOCAL GOVERNMENTS, HEALTH CARE SYSTEMS, COLLEGES & UNIVERSITIES, COMMUNITY-BASED ORGANIZATIONS AND NON-PROFITS IN SECTORS OF PHYSICAL AND MENTAL HEALTH, TRANSPORTATION, EDUCATION, HOUSING, RESEARCH, FOOD ACCESS, PLANNING ENVIRONMENT AND MORE - WORKED TO DIRECT THE ACTIVITIES OF THE ASSESSMENT AND PROVIDE WRITTEN CONTENT AND EXPERTISE ON ISSUES OF INTEREST. THIS JOINT CHNA AND RELATED IMPLEMENTATION PLAN WAS ADOPTED BY THE DUHS BOARD OF DIRECTORS AND PUBLISHED ON THE DUKE HEALTH WEBSITE IN FISCAL YEAR 2022 (TAX YEAR 2021).GROUP A - FACILITY 3 - DUKE REGIONAL HOSPITAL:PART V, SECTION B, LINE 6A: DUKE UNIVERSITY HOSPITALGROUP A - FACILITY 3 - DUKE REGIONAL HOSPITAL:PART V, SECTION B, LINE 6B: THE PARTNERSHIP FOR A HEALTHY DURHAM AND THE DURHAM COUNTY HEALTH DEPARTMENTGROUP A - FACILITY 3 - DUKE REGIONAL HOSPITAL:PART V, SECTION B, LINE 11: THE ASSESSMENT IDENTIFIED FIVE HEALTH PRIORITIES FOR 2021-2023:1. AFFORDABLE HOUSING2. ACCESS TO HEALTHCARE AND HEALTH INSURANCE3. POVERTY4. MENTAL HEALTH5. OBESITY, DIABETES AND FOOD ACCESSTHE DUKE REGIONAL HOSPITAL IMPLEMENTATION PLAN CONTAINING DETAILED DESCRIPTIONS OF HOW DUKE REGIONAL PLANS TO ADDRESS EACH PRIORITY ALONG WITH PROGRESS REPORTS CAN BE FOUND ON THE DUKEHEALTH.ORG WEBSITE. DUKE REGIONAL HOSPITAL CONSIDERS THE DRH COMMUNITY HEALTH NEEDS ASSESSMENT AND IMPLEMENTATION PLAN DOCUMENT TO BE A "WORKING PLAN" THAT WILL CONTINUE TO EVOLVE OVER THIS THREE-YEAR PERIOD IN ORDER TO ENSURE THE EFFICACY OF STRATEGIES INTENDED TO MEET EXPRESSED COMMUNITY HEALTH NEEDS. THE IMPLEMENTATION PLAN DOES NOT CONTAIN DESCRIPTIONS OF THE COMMUNITY HEALTH IMPROVEMENT WORK CARRIED OUT BY OTHER COMPONENTS OF DUKE HEALTH OR DUKE UNIVERSITY BUT REPRESENTS ONLY DUKE REGIONAL HOSPITAL'S CONTINUALLY EVOLVING VARIETY OF PROGRAMS AND ACTIVITIES IN THE FIVE PRIORITY AREAS TO IMPROVE HEALTH WITHIN THE DURHAM COMMUNITY.1 AND 3. AFFORDABLE HOUSING AND POVERTYMINIMUM WAGE, IN 2017, DUKE IMPLEMENTED A PLAN TO GRADUALLY INCREASE THE MINIMAM WAGE FOR ALL EMPLOYEES TO $15 PER HOUR, MORE THAN TWICE THE MINIMUM FEDERAL OR STATE HOURLY WAGE. THESE EFFORTS CONTINUED OVER SEVERAL YEARS, CULMINATING IN 2019 WITH A MINIMUM WAGE INCREASE TO $15 FOR ALL EMPLOYEES. ON JULY 1, 2022, DUKE UNIVERSITY, INCLUDING DUKE UNIVERSITY HEALTH SYSTEM, INCREASED THE MINIMUM WAGE TO $17 PER HOUR FOR ALL EMPLOYEES WORKING AT LEAST 20 HOURS PER WEEK AND 36 WEEKS PER YEAR.FILL THAT BUS AND SALVATION ARMY ANGEL TREE: EMPLOYEES HAVE DONATED BINS OF SCHOOL SUPPLIES TO CRAYONS2CALCULATORS AND FILL THAT BUS! CAMPAIGN EACH YEAR SINCE 2015 TO SUPPORT DURHAM PUBLIC SCHOOLS. TEACHERS FROM THE SCHOOLS WITH THE HIGHEST POVERTY LEVELS WERE INVITED TO PICK OUT SUPPLIES NEEDED IN THEIR CLASSROOMS.EACH DECEMBER, EMPLOYEES "ADOPT" 100 CHILDREN FROM DUKE REGIONAL'S SALVATION ARMY ANGEL TREE. CHILDREN IN DURHAM HAVE RECEIVED CLOTHING, BOOKS AND TOYS THANKS TO THE GENEROUS DONATIONS. EXTRA GIFTS ARE ALSO DONATED TO THE SALVATION ARMY FOR OTHER NEEDY FAMILIES IN THE AREA.DURING FY2023, DUKE REGIONAL HOSPITAL SUPPORTED CRAYONS2CALCULATOR FILL THE BUS! CAMPAIGN, THE SALVATION ARMY TREE GIFT DRIVE AND A FOOD DRIVE FOR THE NORTH CAROLINA FOOD BANK OF CENTRAL AND EASTERN NC.EDUCATION: DUKE REGIONAL HOSPITAL HAS IDENTIFIED EDUCATION AS A PRIORITY OF ITS COMMUNITY STRATEGY TO HELP ADDRESS POVERTY. DUKE REGIONAL HOSPITAL IS COMMITTED TO HELP TRAIN THE HEALTHCARE WORKERS OF THE FUTURE. DURING FISCAL YEARS 2017 THROUGH 2020, DRH PROVIDED OPPORTUNITIES FOR 70 PRE-HEALTH UNDERGRADUATE STUDENTS FROM LOCAL COLLEGES AND UNIVERSITIES TO SHADOW AND VOLUNTEER ALONGSIDE CLINICAL AND CUSTOMER SERVICE STAFF AS AMBASSADORS IN THE EMERGENCY DEPARTMENT. DRH ALSO PROVIDED AN EIGHT-WEEK VOLUNTEER PROGRAM FOR AREA HIGH SCHOOL STUDENTS TO GAIN EXPERIENCES IN A HEALTH CARE SETTING EACH SUMMER. DUE TO COVID-19, IN-PERSON VOLUNTEER OPPORTUNITIES WERE HALTED IN MARCH 2020, BUT DRH CONTINUED TO FIND CREATIVE WAYS TO ENGAGE STUDENTS VIRTUALLY AND WELCOMED CLINICAL STUDENTS BACK TO CAMPUS USING A SLOW AND MEASURED RE-ENTRY OF STUDENTS STARTING IN THE SUMMER OF 2020. SINCE THAT TIME, CLINICAL STUDENTS AND VOLUNTEERS HAVE RETURNED TO THE HOSPITAL SETTING.DRH INVESTED $5.9 MILLION IN FISCAL YEAR 2023 TO TRAIN AND TEACH TOMORROW'S HEALTHCARE PROFESSIONALS. CITY OF MEDICINE ACADEMY: DUKE REGIONAL HOSPITAL HAS BEEN A PARTNER WITH CITY OF MEDICINE ACADEMY (CMA) AND DURHAM PUBLIC SCHOOLS SINCE THE PROGRAM'S INCEPTION AT SOUTHERN HIGH SCHOOL IN THE 1990S. IN AUGUST 2011, CMA MOVED TO A NEW FACILITY LOCATED ON THE DUKE REGIONAL CAMPUS. AS PART OF OUR PARTNERSHIP, DUKE REGIONAL HOSPITAL HOSTS STUDENTS FOR CLINICAL ROTATIONS AND INTERNSHIPS, PROVIDES CPR TRAINING AND HOSTS THE ANNUAL SENIOR AWARDS NIGHT IN THE HOSPITAL AUDITORIUM.PROJECT SEARCH: DUKE REGIONAL HOSPITAL WAS THE FIRST HOST HOSPITAL IN THE STATE FOR PROJECT SEARCH, A PARTNERSHIP WITH DURHAM PUBLIC SCHOOLS, OE ENTERPRISES, NORTH CAROLINA VOCATIONAL REHABILITATION AND ALLIANCE HEALTH THAT PROVIDES CAREER DEVELOPMENT EXPERIENCES TO SENIOR HIGH SCHOOL STUDENTS WITH DEVELOPMENTAL AND INTELLECTUAL DISABILITIES. DUKE REGIONAL HOSPITAL CONTINUED TO SERVE AS A HOST SITE FOR PROJECT SEARCH ADDING 6 NEW GRADUATES IN 2023 FOR A TOTAL OF GRADUATES TO 95 TO DATE. APPROXIMATELY HALF ARE STILL EMPLOYED IN THE COMMUNITY, WITH FOUR GRADUATES WORKING AT DUKE REGIONAL HOSPITAL.
2. ACCESS TO HEALTHCARE AND HEALTH INSURANCE	LINCOLN COMMUNITY HEALTH CENTER (LCHC): IS A FEDERALLY QUALIFIED COMMUNITY HEALTH CENTER THAT PROVIDES PRIMARY CARE SERVICES FOR ABOUT 40,000 PATIENTS EACH YEAR. APPROXIMATELY 50 PERCENT OF LCHC PATIENTS ARE UNINSURED AND 52% ARE LIVING AT OR BELOW 100% OF THE FEDERAL POVERTY LEVEL. IN ADDITION TO FINANCIAL SUPPORT, DUKE REGIONAL HOSPITAL PROVIDES ENGINEERING, ENVIRONMENTAL, LABORATORY, PHARMACY AND RADIOLOGY SERVICES. THE TOTAL DUKE REGIONAL HOSPITAL CONTRIBUTION TO LCHC IN FY 2023, INCLUDING MONETARY AND IN-KIND SERVICES, WAS $8.8 MILLION.DURHAM COUNTY EMERGENCY MEDICAL SERVICES (EMS): SERVES AS THE PRIMARY PROVIDER OF EMERGENCY AMBULANCE SERVICES AND ALTERNATIVE MEDICAL TRANSPORTATION IN DURHAM COUNTY. IN FY 2023, DUKE REGIONAL HOSPITAL CONTRIBUTED $2.8 MILLION TO THE COUNTY TO SUPPORT DURHAM EMS.PROJECT ACCESS OF DURHAM COUNTY (PADC): COORDINATES SPECIALTY CARE AT NO CHARGE TO UNINSURED AND UNDERINSURED DURHAM RESIDENTS LIVING AT OR BELOW 200 PERCENT OF THE FEDERAL POVERTY LEVEL. THESE RESIDENTS HAVE ACCESS TO PRIMARY HEALTH CARE THROUGH LINCOLN COMMUNITY HEALTH CENTER. IN FY2023, DUKE REGIONAL HOSPITAL PROVIDED FINANCIAL SUPPORT OF $20,000 IN LIEU OF PROVIDING SPACE AFTER PADC RELOCATED TO A NON-HOSPITAL BUILDING IN FY2021.FINANCIAL ASSISTANCE: EACH YEAR DUKE REGIONAL HOSPITAL PROVIDES NO-COST OR DISCOUNTED URGENT OR EMERGENT HEALTH CARE SERVICES TO PATIENTS WHO WERE UNABLE TO PAY. IN FY 2023 DUKE REGIONAL PROVIDED $31.9 MILLION (AT ESTIMATED COST) IN FINANCIAL ASSISTANCE.IN ADDITION, DUKE REGIONAL HOSPITAL PROVIDED $500,000 IN PATIENT SPONSORSHIP SERVICES, WHICH INCLUDES EXPENSES SUCH AS PAYMENT FOR POST-ACUTE CARE, DURABLE MEDICAL EQUIPMENT, LODGING AND MEALS BASED ON SPECIFIC INDIGENT FUNDING GUIDELINES.4. MENTAL HEALTHIN 2021, DUKE REGIONAL OPENED THE NEW BEHAVIORAL HEALTH CENTER NORTH DURHAM AND EXPANDED EMERGENCY DEPARTMENT TO PROVIDE MORE COMPREHENSIVE CARE FOR OUR BEHAVIORAL HEALTH PATIENTS. THIS $102.4 MILLION PROJECT EXPANDED THE HOSPITAL'S EMERGENCY ROOM AND CONSOLIDATED INPATIENT, OUTPATIENT, AND EMERGENCY BEHAVIORAL HEALTH SERVICES ON DUKE REGIONAL'S CAMPUS, WITH THE GOAL OF PROVIDING BETTER COORDINATION OF CARE FOR BEHAVIORAL HEALTH PATIENTS IN DURHAM AND REGIONALLY. THE CENTER INCORPORATES MEETING SPACE SPECIALLY DESIGNED TO BE USED BY COMMUNITY-BASED ORGANIZATIONS PROVIDING SERVICES FOR BEHAVIORAL HEALTH PATIENTS AND THEIR FAMILIES.5. OBESITY, DIABETES, AND FOOD ACCESSBEYOND ITS CLINICAL SERVICE LINES IN THE HOSPITAL, DRH COLLABORATES WITH NUMEROUS DURHAM NON-PROFITS AND OTHER ENTITIES WITHIN THE DUKE UNIVERSITY HEALTH SYSTEM THAT ARE SPECIFICALLY FOCUSED ON COMMUNITY-BASED MECHANISMS FOR THE PREVENTION AND TREATMENT OF OBESITY AND DIABETES AND ON ISSUES OF FOOD ACCESS.IN ADDITION TO THE ABOVE ACTIVITIES SPECIFICALLY RELATED TO THE CHNA IDENTIFIED HEALTH PRIORITIES, DUKE REGIONAL HOSPITAL SUPPORTS HEALTH NEEDS OF ITS COMMUNITY IN THE FOLLOWING WAYS:THE LOOK GOOD FEEL BETTER PROGRAM IS A NON-MEDICAL, BRAND-NEUTRAL PROGRAM THAT PROVIDES SUPPORT FOR FEMALE CANCER TREATMENT PATIENTS WHO HAVE EXPERIENCED HAIR LOSS OR OTHER PHYSICAL APPEARANCE CHANGES DUE TO CHEMOTHERAPY OR RADIATION TREATMENTS. FOR MORE THAN A DECADE, DRH HAS SUPPORTED THIS PROGRAM AS A HOST SITE. DUE TO COVID-19, DUKE REGIONAL SPONSORED THE MONTHLY WORKSHOPS IN A VIRTUAL FORMAT AND HAVE CONTINUED IN THIS FORMAT THROUGH THE PRESENT TIME.STROKE SUPPORT: DUKE REGIONAL OFFERS A MONTHLY STROKE SUPPORT GROUP THAT PROVIDES EDUCATION, SUPPORT AND RESOURCES FOR INDIVIDUALS WHO HAVE BEEN AFFECTED BY STROKE. THE SUPPORT GROUP STARTED IN 2006 AND TYPICALLY HOSTS 20-25 PARTICIPANTS A MONTH (WITH A COMBINATION OF SURVIVORS AND CARE GIVERS). DURING FISCAL YEAR 2023, DUKE REGIONAL CONTINUED THE MONTHLY STROKE SUPPORT PROGRAM AND MOVED TO HYBRID MEETINGS (PARTICIPANTS CHOSE TO ATTEND IN PERSON OR VIRTUALLY).FUNDRAISING AND OUTREACH: DUKE REGIONAL CONDUCTS A NUMBER OF FUNDRAISING AND OUTREACH ACTIVITIES IN THE DURHAM COMMUNITY AND BEYOND. DUKE REGIONAL EMPLOYEES RAISE FUNDS EACH YEAR FOR CHARITABLE ORGANIZATIONS, INCLUDING DUKE COMMUNITY GIVING (INCLUDING UNITED WAY OF THE GREATER TRIANGLE), AND THE AMERICAN HEART ASSOCIATION. IN FY2023, DUKE REGIONAL RAISED $29,857 TO SUPPORT LOCAL CHARITIES.THE HOSPITAL CONTINUES TO PARTNER WITH LOCAL NONPROFITS ON ENDEAVORS THAT EDUCATE OUR COMMUNITY ABOUT HEALTH INITIATIVES AND DISPARATIES AND PROVIDES OFFICE SPACE FOR THE DURHAM COMMUNITY HEALTH COALITION. IN FY2023, DRH PARTNERED WTH THE AMERICAN RED CROSS TO HOST 5 BLOOD DRIVES. THESE DRIVES RESULTED IN COLLECTING 103 UNITS OF BLOOD.
GROUP A - FACILITY 3 - DUKE REGIONAL HOSPITAL	PART V, SECTION B, LINE 16J: AS PART OF DUHS, DUKE REGIONAL HOSPITAL PROVIDES A BROCHURE TO ALL ADMISSIONS THAT INCLUDES A BRIEF SUMMARY OF DUHS FINANCIAL ASSISTANCE POLICIES. DUHS ALSO COMMENTS ON THE BACK OF ITS BILLING INVOICES THAT PATIENTS SHOULD CONTACT PATIENT ACCOUNT REPRESENTATIVES TO HELP THEM IF THEY CANNOT PAY THEIR BILL IN FULL. THIS COMMENT REFERENCES GOVERNMENT-SPONSORED PROGRAMS, MONTHLY PAYMENT PROGRAMS, AND OTHER FINANCIAL ASSISTANCE PROGRAMS AVAILABLE FOR PATIENTS WHO MEET CERTAIN FINANCIAL CRITERIA. DUHS ALSO PUBLICIZED ITS FINANCIAL ASSISTANCE POLICY VERBALLY THROUGH ITS FINANCIAL CARE COUNSELORS.GROUP A - FACILITY 3 - DUKE REGIONAL HOSPITALPART V, SECTION B, LINE 24: CERTAIN ELECTIVE COSMETIC/AESTHETIC SERVICES, AND OTHER ELECTIVE SERVICES, WERE BILLED AT AN AMOUNT EQUAL TO GROSS CHARGES.

Schedule H (Form 990) 2022

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 - DUKE HEALTH CENTER ARRINGDON 5601 ARRINGDON PARK DRIVE MORRISVILLE,NC27560	SPECIALTY
2	2 - DUKE MEADOWMONT CHAPEL HILL 802 W BARBEE CHAPEL ROAD SUITE 100 CHAPEL HILL,NC27517	SPECIALTY
3	3 - DUKE IMAGING SERVICES 3700 NW CARY PARKWAY SUITE 120 CARY,NC27513	INDEPENDENT DIAGNOSTIC TESTING FACILITY
4	4 - DUKE HEALTH IMAGING AT HERITAGE 3000 ROGERS RD WAKE FOREST,NC27587	INDEPENDENT DIAGNOSTIC TESTING FACILITY
5	5 - DUKE PTOT AT HILLSBOROUGH 267 SOUTH CHURTON HILLSBOROUGH,NC27278	SPECIALTY
6	6 - DUKE HEALTH IMAGING AT HOLLY SPRINGS 401 IRVING PKWY HOLLY SPRINGS,NC27540	INDEPENDENT DIAGNOSTIC TESTING FACILITY
7	7 - HOCK FAMILY PAVILION 4023 NORTH ROXBORO ROAD DURHAM,NC27704	HOSPICE
8	8 - DUKE IMAGING COLEY HALL 66 VILCOM CENTER DR SUITE 101 CHAPEL HILL,NC27514	INDEPENDENT DIAGNOSTIC TESTING FACILITY
9
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Schedule H (Form 990) 2022

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Part VI

Supplemental Information

Provide the following information.

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

Form and Line Reference	Explanation
PART I, LINE 3C:	NOT APPLICABLEPART I, LINE 6A:NOT APPLICABLEPART I, LINE 7, COLUMN F:TOTAL GROSS COMMUNITY BENEFIT EXPENSE AS A PERCENT OF TOTAL EXPENSES IS 12.5%.PART I, LINE 7:CHARITY CARE AT COST IS DETERMINED USING THE COST-TO-CHARGE CALCULATION FROM WORKSHEET 2, IN ORDER TO CALCULATE THE AMOUNTS REPORTED ON THE TABLE. UNREIMBURSED MEDICAID IS DETERMINED USING A COST ACCOUNTING SYSTEM THAT ADDRESSES ALL PATIENT SEGMENTS.CHARITY CARE, UNREIMBURSED MEDICAID, AND COMMUNITY HEALTH IMPROVEMENT SERVICES INCLUDE FINANCIAL ASSISTANCE AND OTHER COMMUNITY BENEFIT COSTS PROVIDED BY DUHS' SUPPORT CORPORATIONS, DUKE UNIVERSITY AFFILIATED PHYSICIANS, ASSOCIATED HEALTH SERVICES, DUKE INTEGRATED NETWORK, AND WATTS COLLEGE OF NURSING THAT FILE SEPARATE 990S BUT ARE NOT REQUIRED TO COMPLETE A SCHEDULE H SINCE NOT A HOSPITAL. TOTAL NET COMMUNITY BENEFIT EXPENSES FOR THESE ENTITIES TOTALED $25.9 MILLION IN FY2023.PART II, COMMUNITY BUILDING ACTIVITIES:THESE ACTIVITIES ARE INCLUDED IN DUKE UNIVERSITY HEALTH SYSTEM, INC.'S (DUHS) OPERATING EXPENSES AND ARE NOT TRACKED SEPARATELY FOR COMMUNITY BENEFIT REPORTING PURPOSES.PART III, LINE 1 AND LINE 2:DUHS PROVIDED UNCOMPENSATED CARE AT ESTIMATED COSTS IN THE FORM OF IMPLICIT PRICE CONCESSIONS (CONSIDERED BAD DEBT EXPENSE PRIOR TO ADOPTION OF ACCOUNTING STANDARDS UPDATE 2014-16, "REVENUE FROM CONTRACTS WITH CUSTOMERS" IN FY2019) ASSOCIATED WITH UNCOLLECTIBLE PATIENT ACCOUNTS AT AN ESTIMATED COST OF $31,791,000 IN FISCAL YEAR 2023. DUHS USED THE COST-TO-CHARGE RATIO FROM WORKSHEET 2 TO ESTIMATE COST.PART III, LINE 3:DUHS PRESUMPTIVELY SCREENS ALL UNINSURED PATIENTS AND ALL PATIENTS ENTERING THROUGH THE EMERGENCY DEPARTMENT, REGARDLESS OF INSURANCE STATUS, FOR FINANCIAL ASSISTANCE. WHILE THESE PRESUMPTIVE PROCESSES IDENTIFY A SUBSET OF PATIENTS ELIGIBLE FOR FINANCIAL ASSISTANCE WITHOUT NEEDING DIRECT INPUT FROM THE PATIENT, THOSE WHO DO NOT FALL UNDER THE PRESUMPTIVE SCREENING CRITERIA WILL NEED TO PROVIDE INFORMATION TO QUALIFY FOR FINANCIAL ASSISTANCE UNDER DUHS' FINANCIAL ASSISTANCE POLICY. A PORTION OF IMPLICIT PRICE CONCESSIONS (FORMERLY CONSIDERED BAD DEBT EXPENSE) SHOULD BE INCLUDED AS A COMMUNITY BENEFIT, BUT THE PORTION THAT IS ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER OUR FINANCIAL ASSISTANCE POLICY IS INDETERMINABLE BECAUSE OF THOSE PATIENTS WHO FAIL TO APPLY FOR OR PROVIDE INFORMATION NEEDED TO DETERMINE THEIR ELIGIBILITY UNDER THE DUHS FAP. DUHS, INC. FOLLOWS ITS MISSION TO THE COMMUNITY AND PROVIDES EMERGENT SERVICES TO PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. PATIENTS WHO MAY QUALIFY FOR FINANCIAL ASSISTANCE ARE REPORTED AS AN IMPLICIT PRICE CONCESSION INSTEAD BECAUSE OF THOSE PATIENTS' INABILITY OR UNWILLINGNESS TO PROVIDE THE NECESSARY DOCUMENTATION REQUIRED TO DETERMINE FINANCIAL ASSISTANCE CLASSIFICATION.PART III, LINE 4:PAGES 17-20 IN THE FY2023 AUDITED FINANCIAL STATEMENT FOOTNOTES DESCRIBE IMPLICIT PRICE CONCESSIONS RELATED TO UNINSURED PATIENTS.PART III, LINE 7:TOTAL UNREIMBURSED COSTS ATTRIBUTABLE TO PROVIDING SERVICES UNDER MEDICARE AS REPORTED IN THE JUNE 30, 2023 DUHS CONSOLIDATED FINANCIAL STATEMENTS ARE $502,845,000 AS COMPARED TO $154,015,255 AS REPORTED IN SECTION B, LINE 7 OF SCHEDULE H. THE DUHS TOTAL MEDICARE SHORTFALL OF $502,845,000 IS DERIVED FROM THE COST ACCOUNTING SYSTEM WHICH INCLUDES ALL PAYMENTS AND COSTS ASSOCIATED WITH MEDICARE PATIENTS, WHEREAS THE AMOUNT REPORTED IN SECTION B OF SCHEDULE H IS DERIVED BASED ON IRS INSTRUCTIONS. IRS INSTRUCTIONS SPECIFY THAT ONLY A PORTION OF COSTS ASSOCIATED WITH MEDICARE BENEFICIARIES BE REPORTED ON SCHEDULE H. SIGNIFICANT MEDICARE COSTS EXCLUDED FROM SCHEDULE H DATA INCLUDE THOSE ASSOCIATED WITH MEDICARE PATIENTS COVERED UNDER MANAGED CARE PLANS AND COSTS REIMBURSED THROUGH MEANS NOT REPORTED ON THE COST REPORT.PART III, LINE 8:MEDICARE RATES AND THE NUMBER OF MEDICARE PATIENTS DUHS TREATS ARE NOT NEGOTIATED. MEDICARE DOES NOT FULLY COMPENSATE DUHS FOR THE COST OF PROVIDING CARE TO MEDICARE BENEFICIARIES. DUHS CONTINUES TO SERVE THE MEDICARE POPULATION AS MEDICARE REIMBURSEMENT RATES DECLINE RELATIVE TO THE COST OF CARE. THEREFORE, ANY LOSS RELATED TO PROVIDING CARE FOR MEDICARE PATIENTS SHOULD BE CLASSIFIED AS A COMMUNITY BENEFIT. DUHS FOLLOWED THE MEDICARE COST REPORT RULES AND GUIDELINES IN DETERMINING THE COSTS REPORTED ON LINE 6. THESE RULES USE A VARIETY OF DIFFERENT METHODOLOGIES BASED ON THE TYPE OF SERVICE.PART III, LINE 9B:COLLECTION EFFORTS ARE IMMEDIATELY STOPPED FOR PATIENTS WHO SUBMIT A FINANCIAL ASSISTANCE APPLICATION. PATIENTS WHO QUALIFY FOR FINANCIAL ASSISTANCE ARE NOT PURSUED USING ANY DEBT COLLECTION PRACTICES.
NEEDS ASSESSMENT:	PART VI, LINE 2:DUHS USES SEVERAL MECHANISMS TO ASSESS AND ADDRESS THE HEALTH CARE NEEDS OF THE COMMUNITIES IT SERVES. DUHS IS A LEAD PARTNER ON THE DEVELOPMENT OF COMMUNITY HEALTH NEEDS ASSESSMENTS IN DURHAM COUNTY AND WAKE COUNTY. DUHS ACTIVELY VOLUNTEERS TO COLLECT DATA AND PARTICIPATE ON COMMITTEES IDENTIFYING THE PRIORITIES AND DEVELOPING STRATEGIES TO ADDRESS THE IDENTIFIED PRIORITIES. IN 2019, DUHS BEGAN A PILOT OF SCREENING ITS PATIENTS FOR UNMET SOCIAL NEEDS INCLUDING FOOD INSECURITY, HOUSING INSECURITY, TRANSPORTATION, AND MENTAL HEALTH. THE SCREENING IS MANAGED THROUGH EPIC AND WHEN PATIENTS SCREEN POSITIVE FOR A SOCIAL NEED, DUHS MAKES AN IMMEDIATE REFERRAL, THROUGH A STATEWIDE SYSTEM CALLED NCCARE360, TO COMMUNITY-BASED RESOURCES THAT PROVIDE SUPPORT SERVICES IN THE IDENTIFIED AREA(S). OVER 50 SITES ARE PARTICIPATING IN THE SCREENING OF SOCIAL NEEDS. DUKE UNIVERSITY'S BOARD OF TRUSTEES APPROVED THE STRATEGIC COMMUNITY IMPACT PLAN (SCIP) IN 2019 WHICH OUTLINES FIVE COMMUNITY FOCUS AREAS AND PRIORITIES BASED ON COMMUNITY LISTENING SESSIONS: (1) HOUSING (PRIORITY: AFFORDABLE HOUSING AND INFRASTRUCTURE; (2) EDUCATION (PRIORITY: EARLY CHILDHOOD DEVELOPMENT); (3) EMPLOYMENT (PRIORITY: COLLEGE AND CAREER READINESS); (4) HEALTH (PRIORITY: FOOD SECURITY); AND (5) COMMUNITY (PRIORITY: NONPROFIT CAPACITY). THESE FOCUS AREAS ALIGN WITH THE CHNA PRIORITIES AND PATIENT SCREENING DATA. DUHS HAS EMBRACED THE SCIP AS AN INTEGRAL PART OF ITS STRATEGIC GOAL TO ADVANCE HEALTH EQUITY. PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE:PART VI, LINE 3:DUHS EMPLOYS NUMEROUS MEANS TO EDUCATE PATIENTS ABOUT THEIR ELIGIBILITY FOR ASSISTANCE UNDER FEDERAL, STATE, OR LOCAL GOVERNMENT PROGRAMS OR UNDER THE DUHS FINANCIAL ASSISTANCE POLICY. DETAILED INFORMATION IS POSTED ON WWW.DUKEHEALTH.ORG (DUHS' WEBSITE) ALONG WITH HARDCOPY BROCHURES THAT ARE AVAILABLE IN ENGLISH OR SPANISH AT ALL OF OUR PATIENT REGISTRATION LOCATIONS. ALL INPATIENTS AND EMERGENCY DEPARTMENT PATIENTS ARE ALSO PROVIDED WITH A HARDCOPY, ONE-PAGE SUMMARY OF THE WAYS DUHS CAN ASSIST PATIENTS FINANCIALLY. FOR OUTPATIENTS, THIS SAME ONE-PAGE SUMMARY IS PROVIDED ON THEIR FIRST VISIT TO THE INSTITUTION. IN ADDITION, DUHS EMPLOYS FINANCIAL CARE COUNSELORS WHO MEET INDIVIDUALLY WITH PATIENTS WHO HAVE QUESTIONS REGARDING PAYMENT FOR THEIR CARE. DUHS ALSO EMPLOYS MEDICAID ASSISTANCE COUNSELORS WHO SPECIALIZE IN ASSISTING PATIENTS TO APPLY FOR MEDICAID, DISABILITY, AND OTHER FEDERAL, STATE, AND LOCAL PROGRAMS. DUHS ASSISTS BETWEEN 12,000-15,000 PATIENTS IN APPLYING AND BECOMING ELIGIBLE FOR THESE PROGRAMS ANNUALLY. FINALLY, PATIENTS MAY ALWAYS CONTACT DUHS' TOLL FREE CUSTOMER SERVICE NUMBER TO REQUEST INFORMATION ABOUT THEIR BILL OR OBTAIN A FINANCIAL ASSISTANCE APPLICATION.COMMUNITY INFORMATION:PART VI, LINE 4:DUHS SERVES A BROAD, CULTURALLY, RACIALLY AND SOCIALLY DIVERSE GEOGRAPHIC AND DEMOGRAPHIC REGION. DUHS' HOME CITY OF DURHAM IS THE CORE, BUT DUHS' REACH EXTENDS INTO THE SURROUNDING RESEARCH TRIANGLE AREA OF NORTH CAROLINA AND THE STATE'S LARGER NORTHERN PIEDMONT REGION, AS WELL AS STATEWIDE, NATIONALLY AND GLOBALLY. DUHS' PRIMARY SERVICE AREA (PSA) IS A 7-COUNTY REGION IN NC THAT INCLUDES ALAMANCE, DURHAM, GRANVILLE, ORANGE, PERSON, VANCE AND WAKE COUNTIES. WITH A POPULATION OF ALMOST 2.1 MILLION, THIS 7-COUNTY REGION REPRESENTS APPROXIMATELY 19% OF NC'S POPULATION BASED ON FEDERAL FISCAL YEAR (FFY) 2022 DATA. THE WEIGHTED AVERAGE MEDIAN HOUSEHOLD INCOME IN ITS PSA IS $74,695. APPROXIMATELY 67% OF INPATIENT DISCHARGES FROM DUHS FACILITIES IN FFY 2022 WERE PATIENTS FROM ITS PSA. THE POPULATION IN DUHS' PSA IS EXPECTED TO GROW AT A HIGHER RATE OVER THE NEXT 5 YEARS FROM 2023 TO 2028 COMPARED TO NC'S OVERALL EXPECTED POPULATION GROWTH RATE. THE PSA 5-YEAR CAGR IS EXPECTED TO BE 1.2% COMPARED TO THE OVERALL ESTIMATED NC RATE OF 0.7%. DUHS' SECONDARY SERVICE AREA COVERS 15 COUNTIES IN NORTH CAROLINA AND SOUTHERN VIRGINIA WITH A POPULATION OF APPROXIMATELY 2 MILLION. PROMOTION OF COMMUNITY HEALTH:PART VI, LINE 5:DUHS PROMOTES THE HEALTH OF THE COMMUNITIES IT SERVES THROUGH A NUMBER OF COMMUNITY BUILDING ACTIVITIES. CENTRAL TO MANY OF THE EFFORTS IS DUHS' OFFICE OF COMMUNITY HEALTH (OCH). OCH REPORTS DUALLY TO (1) THE CHANCELLOR/CEO OF THE HEALTH SYSTEM AND (2) DUKE'S VICE PRESIDENT OF COMMUNITY AFFAIRS TO FACILITATE LEVERAGING ASSETS ACROSS THE ENTIRE DUKE ENTERPRISE TO ASSESS AND ADDRESS COMMUNITY NEEDS. OCH ALSO FACILITATES THE DEVELOPMENT OF COORDINATED, SYSTEM-LEVEL INITIATIVES TO ADDRESS IDENTIFIED COMMUNITY NEEDS IN PARTNERSHIP WITH COMMUNITY-BASED ORGANIZATIONS. OCH ORGANIZES ANNUAL HEALTH SUMMITS TO BRING COMMUNITY MEMBERS, ELECTED OFFICIALS, PROVIDERS, AND OTHERS TOGETHER TO GENERATE AND SHARE INFORMATION, COLLECT ADDITIONAL DATA, AND DEVELOP STRATEGIES COLLABORATIVELY IN SOCIAL DRIVERS AREAS. DUHS' OFFICE OF COMMUNITY HEALTH ASSOCIATE VICE PRESIDENT SERVES AS A FULL-TIME LIAISON IN DURHAM AND IN DUHS' PRIMARY SERVICE AREAS. THE OFFICE SPONSORS AND FACILITATES COMMUNITY EVENTS SUCH AS THE ANNUAL COMMUNITY HEALTH SUMMIT AND SIMILAR REGIONAL AND STATE HEALTH SUMMITS THAT RAISE AWARENESS OF COMMUNITY HEALTH NEEDS, PROMOTE PREVENTION AND WELLNESS, AND CHART A COURSE FOR SOLVING HEALTH-RELATED SOCIAL NEED (HRSN) ISSUES AND DISPARITIES. IN ADDITION, THE OFFICE PROVIDES A POINT OF DIRECT CONTACT FOR COMMUNITY MEMBERS WHO HAVE QUESTIONS OR CONCERNS ABOUT COMMUNITY ISSUES OR ABOUT ACCESS TO HEALTH CARE SERVICES. THE OFFICE ALSO PROVIDES DIRECT FINANCIAL SUPPORT TO A VARIETY OF COMMUNITY GROUPS THROUGH THE BUILDING HEALTHY COMMUNITIES GRANTS PROGRAM. THE ASSOCIATE VICE-PRESIDENT AND STAFF SERVE ON A NUMBER OF COMMUNITY BOARDS AND HEALTH-RELATED COMMITTEES. STAFF FROM THE OFFICE OF COMMUNITY HEALTH AND DUHS REPRESENTATIVES IMMERSED IN COMMUNITY ENGAGEMENT ACTIVITIES CREATED FORMAL PRINCIPLES OF COMMUNITY ENGAGEMENT THAT COMMIT DUHS AND ITS COMMUNITY PARTNERS TO DEVELOPING PROPOSED PROJECTS AND INITIATIVES BASED ON TRUST, RESPECT, DIVERSITY, SAFETY AND COMMUNITY-IDENTIFIED NEEDS. THESE PRINCIPLES HAVE BEEN INCORPORATED INTO COMMUNITY-BASED HEALTHCARE PROJECTS INCLUDING COMMUNITY CLINICS, FOCUS GROUPS, CHNA IMPLEMENTATION PLANS, AND DUHS' ANNUAL HEALTH SUMMIT.
IN ADDITION TO COMMUNITY BUILDING ACTIVITIES,	DUHS PROMOTES THE HEALTH OF ITS COMMUNITIES IN A NUMBER OF IMPORTANT WAYS. ONE OF DUHS' THREE CONSTITUENT HOSPITALS, DUKE REGIONAL, HAS AN OPEN MEDICAL STAFF AND A HOSPITAL CORPORATION BOARD, WHICH IS A COUNTY APPOINTED BOARD RESPONSIBLE FOR HOSPITAL OVERSIGHT. IN ADDITION, APPROXIMATELY 50 LOCAL LEADERS IN THE DURHAM FAITH COMMUNITY ARE WORKING WITH DUKE HEALTH TO LOOK AT HOW TO ADDRESS THE NEEDS OF THEIR CONGREGATIONS AND COMMUNITIES BY COMBINING THE TRADITIONS OF THE FAITH COMMUNITY WITH THE KNOWLEDGE OF MODERN MEDICINE. DUHS' CEO ALSO HAS A CHANCELLOR'S COMMUNITY HEALTH ADVISORY BOARD TO PROVIDE FEEDBACK ON A VARIETY OF ISSUES, INCLUDING USE OF DUHS RESOURCES, HEALTH SERVICE DELIVERY SYSTEMS AND LONG-RANGE GOALS TO REDUCE HEALTH RISKS AND DISPARITIES IN DURHAM COUNTY. THE BOARD INCLUDES STATE AND LOCAL ELECTED OFFICIALS, NEIGHBORHOOD COUNCILS AND OTHER GRASSROOTS ORGANIZATIONS, POLITICAL GROUPS, DURHAM PUBLIC SCHOOLS, AMONG OTHERS. DUHS MAINTAINS A BUILDING HEALTHY COMMUNITIES GRANTS COMMITTEE TO REVIEW COMMUNITY REQUESTS FOR PHILANTHROPIC ASSISTANCE THAT PROMOTE HEALTH AND WELLNESS. DUHS FORMED A COMMUNITY HEALTH EXECUTIVE COUNCIL COMPRISED OF LEADERS ACROSS DUKE HEALTH TO OVERSEE STRATEGIES DESIGNED TO ADVANCE HEALTH EQUITY AND ADDRESS HEALTH-RELATED SOCIAL NEEDS. ADDITIONALLY, SEVERAL COMMITTEES/COUNCILS HAVE BEEN FORMED AROUND SPECIFIC HEALTH-RELATED SOCIAL NEEDS TO DISCUSS COMMUNITY STATUS, CAPACITY NEEDS OF COMMUNITY-BASED ORGANIZATIONS, AND TO INFORM SYSTEM-LEVEL EFFORTS.DUKE HEALTH PROVIDES VARIOUS OPPORTUNITIES FOR STUDENTS TO INTERACT WITH DIFFERENT HEALTH CARE PROFESSIONALS ACROSS THE SYSTEM. THE OFFICE OF COMMUNITY HEALTH, DRH, AND OTHER KEY COMMUNITY PARTICIPANTS ARE ACTIVE IN A WORKFORCE DEVELOPMENT PROJECT CALLED PROJECT SEARCH. THIS PROGRAM, MODELED AFTER THE PROGRAM AT CINCINNATI CHILDREN'S HOSPITAL, PROVIDES YOUTH WITH DISABILITIES EMPLOYMENT TRAINING AND CAREER OPPORTUNITIES IN DURHAM-ORANGE MEDICAL SOCIETY AND THE DURHAM ACADEMY OF MEDICINE, DENTISTRY AND PHARMACY (AN ASSOCIATION FOR AFRICAN-AMERICAN MEDICAL PROFESSIONALS) TO PROMOTE THE SUCCESS OF THE CITY OF MEDICINE ACADEMY (CMA). THE CMA IS A PUBLIC MAGNET HIGH SCHOOL DESIGNED FOR STUDENTS INTERESTED IN HEALTH CARE CAREERS. FACULTY ARE INVOLVED WITH MENTORING STUDENTS AND CLASSROOM LECTURES. DUHS IS A KEY PARTICIPANT IN THE ANNUAL BULL CITY FRESH START EVENT. STAFF FROM THE DUKE SCHOOL OF NURSING, DUKE EYE CENTER, AND STAFF AFFILIATED WITH LINCOLN COMMUNITY HEALTH CENTER HEALTHCARE FOR THE HOMELESS CLINIC VOLUNTEER TIME AND RESOURCES AT THIS IMPORTANT EVENT. STUDENTS FROM THE DUKE SCHOOLS OF MEDICINE AND NURSING ENGAGE COMMUNITIES IN DURHAM AND BEYOND IN ACTIVITIES THAT INCLUDE FREE BLOOD PRESSURE SCREENINGS FOR THE HOMELESS, AND IDENTIFYING THE HEALTH CARE NEEDS OF A LOW WEALTH COMMUNITY SCHOOL AND DEVELOPING A CURRICULUM FOR STUDENTS AND PARENTS THAT ADDRESSES THOSE NEEDS. STUDENTS HAVE ALSO FORMED FOOD SECURITY INITIATIVES INCLUDING ROOT CAUSES' FRESH PRODUCE PROGRAM THAT DISTRIBUTES FOOD TO COMMUNITY RESIDENTS BASED ON PROVIDER PRESCRIPTIONS. OCH IS ALSO AN ADVISOR TO A STUDENT-LED GROUP CALLED THE FOOD RECOVERY NETWORK THAT PACKAGES UNUSED, PREPARED MEALS FROM DINING SERVICES ACROSS THE UNIVERSITY AND DELIVERS THEM TO COMMUNITY-BASED ORGANIZATIONS FOR DISTRIBUTION TO COMMUNITY MEMBERS IN NEED.AFFILIATED HEALTH CARE SYSTEM ROLES:PART VI, LINE 6:DUHS PROVIDES VIRTUALLY ALL LEVELS OF CARE BEGINNING WITH DUKE UNIVERSITY AFFILIATED PHYSICIANS (DBA DUKE PRIMARY CARE) (DPC). DPC IS A BROAD NETWORK OF COMMUNITY-BASED SERVICES THAT INCLUDE FAMILY MEDICINE, PEDIATRICS, INTERNAL MEDICINE, AND URGENT CARE. THE HOSPITALS PROVIDE ROUTINE INPATIENT AND OUTPATIENT CARE. IN DURHAM COUNTY, DUH AND DRH WORK TOGETHER TO MAXIMIZE FACILITY UTILIZATION PROVIDING ROUTINE AND ADVANCED LEVELS OF CARE. DUH ALSO OPERATES A TRAUMA CENTER WITH AIR AMBULANCE SERVICE. DRAH SERVES THE WAKE COUNTY AREA AS A COMMUNITY HOSPITAL. THE DRAH CAMPUS HAS SEVERAL MEDICAL OFFICE BUILDINGS ENHANCING CONVENIENCE FOR THE PATIENT IN NON-EMERGENT CASES AND PROVIDES STREAMLINED ACCESS TO HIGH-DEMAND PROCEDURES SUCH AS CARDIAC CATHETERIZATION AND RADIOLOGY PROCEDURES. DUHS CONTINUES TO EXPAND ITS AMBULATORY FOOTPRINT TO PROVIDE CARE CLOSE TO PATIENTS' HOMES, EXTEND ACCESS TO NEW COMMUNITIES AND MEET GROWING POPULATION NEEDS EFFICIENTLY AND EFFECTIVELY. DUHS' POPULATION HEALTH MANAGEMENT OFFICE WITHIN DUKE INTEGRATED NETWORK, INC. IS THE CENTRAL ENTITY AT DUKE GUIDING CARE TRANSFORMATION FOR VALUE BASED CARE, INCLUDING CARE MANAGEMENT PROGRAMS AND DEPLOYMENT OF RELATED DATA AND ANALYTICS PROGRAMS, AS WELL AS FOSTERING RELATIONSHIPS WITH PAYERS, COMMUNITY RESOURCES, AND PHYSICIANS WITHIN THE SERVICE AREA. DUHS ALSO OPERATES HOME HEALTH AND HOME INFUSION SERVICES TO TREAT AND CARE FOR PATIENTS IN THE COMFORT OF THEIR HOME. THIS IS OBVIOUSLY PRACTICAL FOR PATIENTS NOT REQUIRING AN INPATIENT STAY BUT IN NEED OF ONGOING CARE AT A SUB-ACUTE LEVEL. FINALLY, HOSPICE PROVIDES PALLIATIVE CARE FOR PATIENTS NOT RESPONDING TO CURATIVE CARE. PAIN MANAGEMENT, SYMPTOM MANAGEMENT, AND PSYCHOLOGICAL AND SPIRITUAL SUPPORT PROVIDE A ROUNDED APPROACH TO COMPASSIONATELY ASSIST TERMINAL PATIENTS AND THEIR FAMILIES WITH THE PROCESS OF DYING. ALL OF THE OPERATING UNITS OF DUHS WORK TOGETHER TO PROVIDE THE RIGHT LEVEL OF CARE FOR THE PATIENT IN THE MOST BENEFICIAL MANNER. IN ADDITION TO THE REACTIVE ACTIVITIES OF DIAGNOSTIC CARE, DUHS ALSO SUPPORTS AND PROMOTES HEALTH AND WELL-BEING AT DUKE HEALTH & FITNESS CENTER, AND DUKE INTEGRATIVE MEDICINE. THESE SERVICES INCLUDE A MEDICALLY-BASED WEIGHT LOSS PROGRAM, MEDICALLY-BASED FITNESS, WELLNESS AND REHABILITATION PROGRAMS.LIST OF ALL STATES WHICH ORGANIZATION FILES A COMMUNITY BENEFIT REPORT:PART VI, LINE 7:NORTH CAROLINA

Schedule H (Form 990) 2022

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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

2022

Open to Public
Inspection

Name of the organization
DUKE UNIVERSITY HEALTH SYSTEM INC

Employer identification number
56-2070036

Part I

General Information on Grants and Assistance

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

Yes No

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

Part II

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

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

(a) Name and address of organization or government	(b) EIN	(c) IRC section (if applicable)	(d) Amount of cash grant	(e) Amount of non-cash assistance	(f) Method of valuation (book, FMV, appraisal, other)	(g) Description of noncash assistance	(h) Purpose of grant or assistance
(1) ALICE AYCOCK POE CTR FOR HEALTH EDUCATION 224 SUNNYBROOK RD RALEIGH,NC27610	56-1500678	501(C)(3)	12,500	0			SPONSORSHIP
(2) ALLIANCE MEDICAL MINISTRY INC 101 DONALD ROSS DR RALEIGH,NC27610	56-2168673	501(C)(3)	30,000	0			COMMUNITY SUPPORT
(3) AMERICAN HEART ASSOCIATION INC PO BOX 4002900 DES MOINES,IA503402900	13-5613797	501(C)(3)	150,000	0			SPONSORSHIP
(4) BIG BROTHERS BIG SISTERS OF THE TRIANGLE 808 AVIATION PKWY SUITE 900 MORRISVILLE,NC27560	56-2109717	501(C)(3)	7,500	0			COMMUNITY SUPPORT
(5) BOYS & GIRLS CLUBS OF DURHAM & ORANGE COUNTIES 1010 MARTIN LUTHER KING JR PKW DURHAM,NC27713	56-6001906	501(C)(3)	25,000	0			COMMUNITY SUPPORT
(6) CAPSTONE EVENT GROUP LLC 3803-B COMPUTER DR SUITE 205 RALEIGH,NC27609	46-4157559		13,000	0			SPONSORSHIP
(7) CARING HOUSE INC 2625 PICKETT RD DURHAM,NC277055603	56-1647154	501(C)(3)	43,833	0			GENERAL SUPPORT
(8) CAROL EMMOTT FOUNDATION 4931 SW 76TH AVE 229 PORTLAND,OR97225	84-1882898	501(C)(3)	20,000	0			GENERAL SUPPORT
(9) CATHOLIC CHARITIES OF THE DIOCESE OF RALEIGH 7200 STONEHENGE DR RALEIGH,NC27613	56-0529943	501(C)(3)	25,000	0			COMMUNITY SUPPORT
(10) CENTER FOR VOLUNTEER CAREGIVING 1150 SE MAYNARD RD STE 210 CARY,NC27511	58-2067482	501(C)(3)	10,000	0			COMMUNITY SUPPORT
(11) CHATHAM OUTREACH ALLIANCE PO BOX 1326 PITTSBORO,NC27312	56-1668767	501(C)(3)	12,500	0			COMMUNITY SUPPORT
(12) CHILDRENS CANCER PARTNERS 900 S PINE ST STE F SPARTANBURG,SC29302	20-2511033	501(C)(3)	10,000	0			COMMUNITY SUPPORT
(13) CHILDRENS FLIGHT OF HOPE INC 1005 DRESSER CT RALEIGH,NC27609	56-1762824	501(C)(3)	30,000	0			COMMUNITY SUPPORT
(14) COMMUNITIES IN PARTNERSHIP PO BOX 11247 DURHAM,NC27703	47-5567396	501(C)(3)	60,000	0			COMMUNITY SUPPORT
(15) COMMUNITY EMPOWERMENT FUND 208 N COLUMBIA ST SUITE 100 CHAPEL HILL,NC275143504	27-0428981	501(C)(3)	7,500	0			COMMUNITY SUPPORT
(16) DURHAM CENTER FOR SENIOR LIFE 406 RIGSBEE AVE SUITE 202 DURHAM,NC27701	56-0886647	501(C)(3)	15,000	0			COMMUNITY SUPPORT
(17) DURHAM SUCCESS SUMMIT INC 732 9TH STREET 596 DURHAM,NC27705	86-2985757	501(C)(3)	7,500	0			COMMUNITY SUPPORT
(18) EL CENTRO HISPANO INC 2000 CHAPEL HILL RD 26A DURHAM,NC27707	56-2011661	501(C)(3)	10,000	0			COMMUNITY SUPPORT
(19) EL FUTURO INC 2020 E CHAPEL HILL ROAD SUITE 23 DURHAM,NC27707	80-0122334	501(C)(3)	59,000	0			COMMUNITY SUPPORT
(20) FAMILY VIOLENCE PREVENTION CENTER INC 1012 OBERLINE RD SUITE 100 RALEIGH,NC27605	58-1320613	501(C)(3)	62,500	0			COMMUNITY SUPPORT
(21) FIGHT FOR 1 OF US INC 8024 GLENWOOD AVE SUITE 200 RALEIGH,NC27607	27-4754653	501(C)(3)	16,750	0			SPONSORSHIP
(22) FOOD BANK OF CENTRAL AND EASTERN 1924 CAPITAL BLVD RALEIGH,NC27604	56-1283426	501(C)(3)	10,000	0			COMMUNITY SUPPORT
(23) FRIENDS OF FREMONT PEOPLE'S FREE 106 PANAMINT DRIVE DURHAM,NC27705	92-0823631	501(C)(3)	15,000	0			COMMUNITY SUPPORT
(24) GET HAPPY 115 WINDERMERE DRIVE 404 DURHAM,NC27712	86-3862455	501(C)(3)	7,500	0			SPONSORSHIP
(25) GREAT 100 INC PO BOX 4875 GREENSBORO,NC274044875	56-1705456	501(C)(3)	30,000	0			SPONSORSHIP
(26) GREATER RALEIGH CHAMBER OF COMMERCE 800 S SALISBURY ST RALEIGH,NC27601	56-0370850	501(C)(6)	62,625	0			COMMUNITY SUPPORT/SPONSORSHIP
(27) HEALING TRANSITIONS INC 1251 GOODE STREET RALEIGH,NC27603	56-2135246	501(C)(3)	25,000	0			COMMUNITY SUPPORT
(28) HOUSING FOR NEW HOPE INC 18 W COLONY PLACE SUITE 250 DURHAM,NC27705	58-2089068	501(C)(3)	25,525	0			COMMUNITY SUPPORT
(29) INTER-FAITH FOOD SHUTTLE 1001 BLAIR DR RALEIGH,NC27620	56-1753180	501(C)(3)	20,250	0			COMMUNITY SUPPORT
(30) JUSTICEMATTERS INC PO BOX 199 DURHAM,NC27702	27-1378558	501(C)(3)	7,500	0			COMMUNITY SUPPORT
(31) LATIN 19 100 W MORGAN ST DURHAM,NC27701	87-2248916	501(C)(3)	12,500	0			COMMUNITY SUPPORT
(32) LIFE SKILLS FOUNDATION PO BOX 51129 DURHAM,NC27712	20-3676000	501(C)(3)	14,750	0			COMMUNITY SUPPORT
(33) MEALS ON WHEELS OF DURHAM INC 2522 ROSS RD DURHAM,NC27703	56-1729111	501(C)(3)	5,500	0			COMMUNITY SUPPORT
(34) MIDTOWN EVENTS LLC 4321 LASSITER AT NORTH HILLS AVE ST RALEIGH,NC27609	27-1832351		20,000	0			SPONSORSHIP
(35) MIDTOWN RALEIGH ALLIANCE 7413 SIX FORKS RD STE 259 RALEIGH,NC27615	45-2559048	501(C)(3)	13,000	0			SPONSORSHIP
(36) MUDCATS BASEBALL LLC ONE BREWERS WAY MILWAUKEE,WI53214	27-4165120		6,000	0			SPONSORSHIP
(37) NATIONAL INSTITUTE OF MINORITY ECON 114 PARRISH ST DURHAM,NC27702	56-1579041	501(C)(3)	10,000	0			COMMUNITY SUPPORT
(38) NORTH CAROLINA SECRETARY OF STATE PO BOX 29622 RALEIGH,NC27626	56-1611340		0	7,517	FMV	COMMUNITY SUPPORT	COMMUNITY SUPPORT
(39) NORTH CAROLINA SYMPHONY SOCIETY INC 3700 GLENWOOD AVE SUITE 130 RALEIGH,NC27612	56-0556755	501(C)(3)	12,500	0			COMMUNITY SUPPORT
(40) NURSES ON BOARDS COALITION PO BOX 14535 MADISON,WI53708	82-1962611	501(C)(3)	10,000	0			GENERAL SUPPORT
(41) OPEN TABLES MINISTRY PO BOX 51363 DURHAM,NC27717	27-0977564	501(C)(3)	10,000	0			COMMUNITY SUPPORT
(42) REINVESTMENT PARTNERS PO BOX 1929 DURHAM,NC277021929	31-1587628	501(C)(3)	10,000	0			COMMUNITY SUPPORT
(43) RESCUE MISSIONS MINISTRIES INC PO BOX 11368 DURHAM,NC27703	58-1482590	501(C)(3)	15,000	0			COMMUNITY SUPPORT
(44) RONALD MCDONALD HOUSE OF DURHAM 506 ALEXANDER AVE DURHAM,NC27705	56-1220376	501(C)(3)	50,000	0			SPONSORSHIP
(45) SAMARITAN HEALTH CENTER PO BOX 51339 DURHAM,NC27717	26-3770762	501(C)(3)	25,000	0			COMMUNITY SUPPORT
(46) SENIOR PHARMASSIST INC 406 RIGSBEE AVE STE 201 DURHAM,NC277012186	56-2084639	501(C)(3)	11,000	0			COMMUNITY SUPPORT
(47) STEPUP DURHAM 112 BROADWAY ST SUITE B DURHAM,NC27701	47-4578727	501(C)(3)	10,000	0			COMMUNITY SUPPORT
(48) STRONGHER TOGETHER INC PO BOX 52142 DURHAM,NC27707	82-1595797	501(C)(3)	10,000	0			COMMUNITY SUPPORT
(49) STUDENT U 600 E UMSTEAD ST DURHAM,NC27701	27-3460491	501(C)(3)	30,000	0			COMMUNITY SUPPORT
(50) SUNRISE COMMUNITY FOR RECOVERY AND 50 S FRENCH BROAD AVE STE 246 ASHVILLE,NC28802	20-5775122	501(C)(3)	10,000	0			COMMUNITY SUPPORT
(51) SUSAN G KOMEN BREAST CANCER FOUNDATION 13770 NOEL RD STE 801889 DALLAS,TX75380	75-1835298	501(C)(3)	110,000	0			SPONSORSHIP
(52) TABLE MINISTRIES INC 209 E MAIN STREET CARRBORO,NC27510	26-1471735	501(C)(3)	17,500	0			COMMUNITY SUPPORT
(53) TRIANGLE FAMILY SERVICES 3937 WESTERN BLVD RALEIGH,NC27606	56-0547491	501(C)(3)	15,000	0			COMMUNITY SUPPORT
(54) TROSA INC 1820 JAMES ST DURHAM,NC277072024	56-1861158	501(C)(3)	55,000	0			COMMUNITY SUPPORT
(55) UNC HEALTH FOUNDATION INC PO BOX 1050 CB 7565 CHAPEL HILL,NC27514	56-6057494	501(C)(3)	100,000	0			COMMUNITY SUPPORT
(56) URBAN MINISTRIES OF DURHAM INC PO BOX 249 DURHAM,NC27702	58-1505891	501(C)(3)	12,500	0			COMMUNITY SUPPORT
(57) URBAN MINISTRIES OF WAKE COUNTY 1390 CAPITAL BLVD RALEIGH,NC27603	58-1422700	501(C)(3)	12,500	0			COMMUNITY SUPPORT
(58) WAKE COUNTY CONTINUMN OF CARE PO BOX 12044 RALEIGH,NC27605	65-1267717	501(C)(3)	12,500	0			COMMUNITY SUPPORT
(59) WAKE COUNTY MEDICAL SOCIETY COMM 7474 CREEDMOOR ROAD 164 RALEIGH,NC27613	56-2205175	501(C)(3)	8,333	0			SPONSORSHIP
(60) WAKE TECH COMM COLL FOUNDATION 9101 FAYETTEVILLE RD RALEIGH,NC276035696	23-7017752	501(C)(3)	17,000	0			COMMUNITY SUPPORT
(61) WEST END COMMUNITY FOUNDATION INC PO BOX 51398 DURHAM,NC27717	56-1858174	501(C)(3)	6,500	0			COMMUNITY SUPPORT
(62) WOMENS CENTER OF WAKE COUNTY INC 400 S WEST STREET RALEIGH,NC27601	58-1316004	501(C)(3)	20,000	0			COMMUNITY SUPPORT
(63) YMCA OF THE TRIANGLE AREA INC 801 CORPORATE CENTER DR STE 200 RALEIGH,NC27607	56-0591307	501(C)(3)	15,000	0			COMMUNITY SUPPORT

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

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

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

Cat. No. 50055P

Schedule I (Form 990) 2022

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) FINANCIAL ASSISTANCE	61	62,292	0
(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
SCHEDULE I, PART I, LINE 2	DUKE UNIVERSITY HEALTH SYSTEM, INC. PROVIDES GENERAL SUPPORT TO LOCAL ORGANIZATIONS BASED ON OUR AWARENESS OF THEIR ACTIVITIES WITHIN THE LOCAL COMMUNITY. DUKE UNIVERSITY HEALTH SYSTEM, INC. ALSO MAINTAINS A BUILDING HEALTHY COMMUNITIES GRANTS PROGRAM THAT REVIEWS COMMUNITY REQUESTS FOR PHILANTHROPIC ASSISTANCE THAT PROMOTE HEALTH AND WELLNESS.

Schedule I (Form 990) 2022

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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

2022

Open to Public Inspection

Name of the organization

DUKE UNIVERSITY HEALTH SYSTEM INC

Employer identification number

56-2070036

Part I

Questions Regarding Compensation

Yes

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

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

Travel for companions Payments for business use of personal residence

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

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

If any of the boxes on 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 .....

Yes

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 on Line 1a? ....

Yes

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) 2022

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, 1099-MISC compensation, and/or 1099-NEC			(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)
1A EUGENE WASHINGTON MD DIRECTOR/PRESIDENT	(i) (ii)	0 ------------- 1,574,285	0 ------------- 1,547,467	0 ------------- 20,500	0 ------------- 37,164	0 ------------- 19,338	0 ------------- 3,198,754	0 ------------- 0
2VINCENT E PRICE DIRECTOR	(i) (ii)	0 ------------- 1,730,692	0 ------------- 0	0 ------------- 20,500	0 ------------- 37,164	0 ------------- 23,691	0 ------------- 1,812,047	0 ------------- 0
3WILLIAM J FULKERSON MD FORMER OFFICER	(i) (ii)	0 ------------- 952,651	0 ------------- 730,131	0 ------------- 80,881	0 ------------- 37,164	0 ------------- 9,235	0 ------------- 1,810,062	0 ------------- 0
4JOHN P MORDACH SVP, CFO, PART YEAR TREASURER	(i) (ii)	890,430 ------------- 0	672,061 ------------- 0	20,500 ------------- 0	37,164 ------------- 0	31,870 ------------- 0	1,652,025 ------------- 0	0 ------------- 0
5THOMAS A OWENS MD EXECUTIVE VICE PRESIDENT, DUHS	(i) (ii)	855,279 ------------- 0	505,470 ------------- 0	80,559 ------------- 0	37,164 ------------- 0	15,990 ------------- 0	1,494,462 ------------- 0	0 ------------- 0
6CRAIG T ALBANESE MD CEO	(i) (ii)	1,123,435 ------------- 0	263,555 ------------- 0	20,500 ------------- 0	37,164 ------------- 0	19,941 ------------- 0	1,464,595 ------------- 0	0 ------------- 0
7MARY E KLOTMAN MD DIRECTOR	(i) (ii)	0 ------------- 811,689	0 ------------- 403,392	0 ------------- 20,500	0 ------------- 37,164	0 ------------- 17,328	0 ------------- 1,290,073	0 ------------- 0
8JEFFREY M FERRANTI SENIOR VP/CHIEF DIGITAL OFFICER	(i) (ii)	579,609 ------------- 93,942	447,098 ------------- 35,244	20,500 ------------- 0	37,164 ------------- 0	30,135 ------------- 0	1,114,506 ------------- 129,186	0 ------------- 0
9RICHARD PATRICK SHANNON CHIEF QUALITY OFFICER	(i) (ii)	709,932 ------------- 0	261,342 ------------- 0	20,500 ------------- 0	37,164 ------------- 0	24,508 ------------- 0	1,053,446 ------------- 0	0 ------------- 0
10RHONDA BRANDON CHIEF HR OFFICER	(i) (ii)	521,551 ------------- 0	280,344 ------------- 0	20,500 ------------- 0	37,164 ------------- 0	28,824 ------------- 0	888,383 ------------- 0	0 ------------- 0
11MONTE D BROWN MD VP FOR ADMINISTRATION/SECRETARY	(i) (ii)	445,237 ------------- 0	304,240 ------------- 0	32,138 ------------- 0	37,164 ------------- 0	19,403 ------------- 0	838,182 ------------- 0	0 ------------- 0
12KEITH STOVER VP FINANCE/COO, PRMO	(i) (ii)	474,434 ------------- 0	220,075 ------------- 0	20,577 ------------- 0	37,164 ------------- 0	26,178 ------------- 0	778,428 ------------- 0	0 ------------- 0
13MARY K MARTIN CHIEF OPERATING OFFICER, DUH	(i) (ii)	506,635 ------------- 0	173,004 ------------- 0	0 ------------- 0	37,164 ------------- 0	30,617 ------------- 0	747,420 ------------- 0	0 ------------- 0
14ROBERT N WILLIS VP FINANCE/CONTROLLER/CAO/INTERIM TR	(i) (ii)	447,603 ------------- 0	216,657 ------------- 0	20,500 ------------- 0	37,164 ------------- 0	17,739 ------------- 0	739,663 ------------- 0	0 ------------- 0
15KATHLEEN GALBRAITH PART YEAR PRESIDENT, DUKE REGIONAL H	(i) (ii)	354,308 ------------- 0	249,860 ------------- 0	15,000 ------------- 0	37,164 ------------- 0	65,700 ------------- 0	722,032 ------------- 0	0 ------------- 0
16JOHN SMITH VP FINANCE	(i) (ii)	387,894 ------------- 0	241,514 ------------- 0	20,500 ------------- 0	37,164 ------------- 0	14,793 ------------- 0	701,865 ------------- 0	0 ------------- 0
17BARBARA M GRIFFITH MD PRESIDENT, DUKE RALEIGH HOSPITAL	(i) (ii)	498,612 ------------- 0	113,333 ------------- 0	192 ------------- 0	36,474 ------------- 0	27,673 ------------- 0	676,284 ------------- 0	0 ------------- 0
18MARY ANN FUCHS VP PATIENT CARE/CHIEF NURSING OFFICE	(i) (ii)	423,366 ------------- 0	201,857 ------------- 0	0 ------------- 0	37,164 ------------- 0	8,915 ------------- 0	671,302 ------------- 0	0 ------------- 0
19DEVDUTTA SANGVAI MD PART YEAR PRESIDENT, DUKE REGIONAL H	(i) (ii)	375,724 ------------- 8,564	163,548 ------------- 0	0 ------------- 0	36,552 ------------- 0	77,085 ------------- 0	652,909 ------------- 8,564	0 ------------- 0
20MOIRA RYNN MD DIRECTOR	(i) (ii)	0 ------------- 432,006	0 ------------- 51,793	0 ------------- 0	0 ------------- 37,164	0 ------------- 19,054	0 ------------- 540,017	0 ------------- 0
21ERIK PAULSON DIRECTOR	(i) (ii)	0 ------------- 363,084	0 ------------- 72,420	0 ------------- 20,500	0 ------------- 37,164	0 ------------- 25,508	0 ------------- 518,676	0 ------------- 0
22LEIGH BLEECKER FORMER KEY EMPLOYEE	(i) (ii)	246,661 ------------- 0	158,279 ------------- 0	141 ------------- 0	37,028 ------------- 0	13,324 ------------- 0	455,433 ------------- 0	0 ------------- 0

Schedule J (Form 990) 2022

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 1A

CRAIG T. ALBANESE, MD USED FIRST CLASS OR CHARTER TRAVEL SERVICES. SUCH TRAVEL WAS FOR BUSINESS PURPOSES AND NOT INCLUDED IN TAXABLE INCOME. BARBARA M GRIFFITH MD, KEITH STOVER, PRISCILLA RAMSEUR AND LEIGH BLEECKER RECEIVED A BENEFIT THAT WAS GROSSED UP TO COMPENSATE FOR WITHHOLDING OF TAXES.

SCHEDULE J, PART I, LINE 7

NON-FIXED PAYMENTS: DUHS MAINTAINS AN EXECUTIVE INCENTIVE COMPENSATION PLAN. PAYMENTS UNDER THE PLAN ARE BASED ON PRE-ESTABLISHED PERFORMANCE METRICS AND A FIXED CALCULATION METHODOLOGY APPROVED BY THE DUHS COMPENSATION COMMITTEE WITH ASSISTANCE AND INPUT FROM AN EXECUTIVE COMPENSATION CONSULTING FIRM ASSURING COMPARABILITY WITH SIMILAR SYSTEMS. THE PLAN ALLOWS FOR A MODIFICATION TO AN INDIVIDUAL'S INCENTIVE PAYMENT BASED ON LEADERSHIP COMPETENCIES AND OTHER FACTORS WITH PAYOUTS (AND MODIFICATIONS, IF ANY) APPROVED BY THE DUHS COMPENSATION COMMITTEE.

Schedule J (Form 990) 2022

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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 instructions and the latest information.

OMB No. 1545-0047

2021

Open to Public
Inspection

Name of the organization
DUKE UNIVERSITY HEALTH SYSTEM INC

Employer identification number
56-2070036

Part Ⅰ

Bond Issues

(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	(g) Defeased		(h) On behalf of issuer		(i) Pool financing
(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	Yes	No	Yes	No	Yes	No
A	NORTH CAROLINA MEDICAL CARE COMMISSION	52-1309402		03-01-2022	267,805,000	SEE PART VI		X		X		X
B	NORTH CAROLINA MEDICAL CARE COMMISSION	52-1309402		02-14-2022	121,620,000	SEE PART VI		X		X		X
C	NORTH CAROLINA MEDICAL CARE COMMISSION	52-1309402	65821DUD1	05-26-2016	383,990,154	SEE PART VI		X		X		X
D	NORTH CAROLINA MEDICAL CARE COMMISSION	52-1309402	65821DVK4	08-11-2016	140,200,389	SEE PART VI		X		X		X
	NORTH CAROLINA MEDICAL CARE COMMISSION	52-1309402		05-10-2018	38,062,676	SEE PART VI		X		X		X

Part Ⅱ

Proceeds

	A		B		C		D
	1 Amount of bonds retired ..................	18,650,000				255,625,000
2 Amount of bonds legally defeased ..............
3 Total proceeds of issue ..................	267,805,000		121,620,000		383,990,154		140,200,389
4 Gross proceeds in reserve funds .............
5 Capitalized interest from proceeds .............
6 Proceeds in refunding escrows ...............					201,888,819		139,008,505
7 Issuance costs from proceeds ...............					2,101,335		1,191,884
8 Credit enhancement from proceeds .............
9 Working capital expenditures from proceeds .............
10 Capital expenditures from proceeds .............	22,841,278
11 Other spent proceeds .............	267,805,000		121,620,000		180,000,000
12 Other unspent proceeds .............
13 Year of substantial completion .............	2020		2009
	Yes	No	Yes	No	Yes	No	Yes	No
14 Were the bonds issued as part of a current refunding issue of tax-exempt bonds (or, if issued prior to 2020, a current refunding issue)? ........	X		X		X			X
15 Were the bonds issued as part of an advance refunding issue of taxable bonds (or, if issued prior to 2020, an advance refunding issue)? ........		X		X	X		X
16 Has the final allocation of proceeds been made? ..........	X		X		X		X
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? ..................	X		X		X		X

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

Cat. No. 50193E

Schedule K (Form 990) 2021

Page 2

Part Ⅲ

Private Business Use

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? .............		X		X		X
2 Are there any lease arrangements that may result in private business use of bond-financed property? ...............		X		X		X
3a Are there any management or service contracts that may result in private business use of bond-financed property? .............	X		X		X
b If "Yes" to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property?	X		X		X
c Are there any research agreements that may result in private business use of bond-financed property? .............		X		X		X
d If "Yes" to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property?
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government ....	0 %		0 %		0 %
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government .........	0 %		0 %		0 %
6 Total of lines 4 and 5 .............	0 %		0 %		0 %
7 Does the bond issue meet the private security or payment test? ...		X		X		X
8a Has there been a sale or disposition of any of the bond-financed property to a nongovernmental person other than a 501(c)(3) organization since the bonds were issued?.............		X		X		X
b If "Yes" to line 8a, enter the percentage of bond-financed property sold or disposed of. ..
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		X		X

Part Ⅳ

Arbitrage

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Has the issuer filed Form 8038-T, Arbitrage Rebate, Yield Reduction and Penalty in Lieu of Arbitrage Rebate? ...		X		X		X		X
2 If "No" to line 1, did the following apply? ....
a Rebate not due yet? .......		X		X		X		X
b Exception to rebate? ........	X		X			X		X
c No rebate due? .........		X		X	X		X
If "Yes" to line 2c, provide in Part Ⅵ the date the rebate computation was performed ......
3 Is the bond issue a variable rate issue? .....	X		X		X			X

Schedule K (Form 990) 2021

Page 3

Part Ⅳ

Arbitrage (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?		X		X		X		X
b Name of provider ..........
c Term of hedge .........
d Was the hedge superintegrated? ......
e Was the hedge terminated? ........
5a Were gross proceeds invested in a guaranteed investment contract (GIC)?		X		X		X		X
b Name of provider ..........
c Term of GIC .........
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? ........
6 Were any gross proceeds invested beyond an available temporary period?		X		X		X		X
7 Has the organization established written procedures to monitor the requirements of section 148? ...	X		X		X		X

Part Ⅴ

Procedures To Undertake Corrective Action

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

Part Ⅵ

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

Return Reference

Explanation

SCHEDULE K, PART I, COLUMN F

BOND ISSUE A: THE PURPOSE OF THE BONDS ISSUED 03/01/22 WAS TO CONVERT THE 2005A AND 2005B REVENUE REFUNDING BONDS TO BEAR INTEREST AT A NEW BANK-BOUGHT INDEX FLOATING RATE. THE PURPOSE OF THE BONDS ISSUED 05/30/2012 WAS TO PARTIALLY REFUND THE 2005ABC BONDS ISSUED ON 03/22/2012. THE PURPOSE OF THE BONDS ISSUED 03/22/2012 WAS TO REFUND THE 2005ABC BONDS ISSUED ON 08/21/2009, WHICH REFUNDED THE ORIGINAL 2005ABC BONDS ISSUED ON 5/19/2005. THE PURPOSE OF THE BONDS ISSUED 05/19/2005 WAS TO PARTIALLY REFUND THE 1996C BONDS ISSUED ON 10/24/1996, 1998A BONDS ISSUED ON 08/27/1998, AND THE 1998B BONDS ISSUED ON 10/13/1998. THE BONDS ISSUED 03/01/22 WERE ALSO ISSUED TO CONVERT THE 2016(B) AND 2016 (C) BONDS TO BEAR INTEREST AT A NEW BANK-BOUGHT INDEX FLOATING RATE. SEE ALSO BOND ISSUE (D) BELOW. BOND ISSUE B: THE PURPOSE OF THE BONDS ISSUED 02/14/22 WAS TO CONVERT THE 2006ABC BONDS TO BEAR INTEREST AT A NEW BANK-BOUGHT INDEX FLOATING RATE. THE PURPOSE OF THE BONDS ISSUED 3/19/2015 WAS TO REFUND THE 2006ABC BONDS ISSUED ON 10/06/2011, WHICH REFUNDED THE BONDS ISSUED 11/15/2006 FOR HOSPITAL IMPROVEMENTS INCLUDING: ROUTINE INFRASTRUCTURE, RENOVATION AND IMPROVEMENT PROJECTS AT DUKE UNIVERSITY HOSPITAL AND DUKE RALEIGH HOSPITAL, IMPROVEMENTS TO INFORMATION SYSTEMS, RENOVATION AND EXPANSION OF EMERGENCY DEPARTMENT AT DUKE UNIVERSITY HOSPITAL, HELIPORT AND NEW ROOF IMPROVEMENTS AT DUKE UNIVERSITY HOSPITAL, AND PHASES 1 AND 2 OF AN OPERATING ROOM SUITE RENOVATION AND EXPANSION AT DUKE UNIVERSITY HOSPITAL. BOND ISSUE C: THE 2016B AND 2016C REVENUE REFUNDING BONDS WERE CONVERTED TO BEAR INTEREST AT A NEW BANK BOUGHT INDEX FLOATING RATE ON 03/01/22. THE PURPOSE OF THE BONDS ISSUED 05/26/16 WAS TO REFUND THE ORIGINAL 2009A BONDS ISSUED ON 10/22/09 TO FINANCE HOSPITAL IMPROVEMENTS INCLUDING THE AMBULATORY CANCER CENTER AT DUKE UNIVERSITY HOSPITAL AND OTHER RENOVATION AND IMPROVEMENT PROJECTS AT DUKE RALEIGH HOSPITAL, AND TO REFUND THE 2005C BONDS ISSUED ON 05/30/12 AND TO PARTIALLY REFUND THE 2005B BONDS ISSUED ON 05/30/12. THE PURPOSE OF THE BONDS ISSUED 05/30/2012 WAS TO PARTIALLY REFUND THE 2005ABC BONDS ISSUED ON 03/22/12, WHICH REFUNDED THE 2005ABC BONDS ISSUED ON 08/21/2009, WHICH REFUNDED THE ORIGINAL 2005ABC BONDS ISSUED ON 5/19/2005. THE PURPOSE OF THE BONDS ISSUED 05/19/2005 WAS TO PARTIALLY REFUND THE 1996C BONDS ISSUED ON 10/24/1996, 1998A BONDS ISSUED ON 08/27/1998, AND THE 1998B BONDS ISSUED ON 10/13/1998. BOND ISSUE D: THE PURPOSE OF THE BONDS ISSUED 08/11/16 WAS TO REFUND THE ORIGINAL 2010A BONDS ISSUED ON 04/02/10 TO FINANCE HOSPITAL CAPITAL IMPROVEMENTS INCLUDING: THE CONSTRUCTION OF A MAJOR TERTIARY CARE ADDITION TO DUKE UNIVERSITY HOSPITAL REFERRED TO AS THE DUKE MEDICINE PAVILION (DMP)WHICH INCLUDED A NEW 582,000 SQUARE FOOT TERTIARY CARE ADDITION INCLUDING FOUR 24-BED INTENSIVE CARE UNITS, TWO 32 BED INTERMEDIATE /STEP-DOWN UNITS, 16 OPERATING ROOMS, EXPANDED IMAGING FACILITIES, AND PATIENT AND FAMILY ORIENTED AMENITIES; A 9,000 SQUARE FOOT SOUTH CONCOURSE CONNECTOR CORRIDOR BETWEEN THE EXISTING CANCER CENTER AND DUKE CLINICS AND THE DMP; A 46,000 SQUARE FOOT NORTH CONCOURSE CONNECTOR CORRIDOR BETWEEN THE DMP AND DUKE UNIVERSITY HOSPITAL-NORTH; RENOVATION OF APPROXIMATELY 29,000 SQUARE FEET IN DUKE UNIVERSITY HOSPITAL AND ROAD IMPROVEMENT AND VEHICLE PARKING PROJECTS REQUIRED TO COMPLETE AND OPERATE THE NEW ADDITION. BOND ISSUE A(2): DRAW-DOWN FINANCING LEASE PROGRAM WITH TD EQUIPMENT FINANCE, OTHER THAN SCHEDULE 1, IN THE MAXIMUM PRINCIPAL AMOUNT OF $38,062,676 TO FINANCE MEDICAL, COMPUTER, OFFICE, AND CAPITAL EQUIPMENT. SCHEDULE K, PART II, LINE 3, BOND ISSUES A(2): PROCEEDS REFLECT ACTUAL PRINCIPAL DRAWN DOWN UNDER DRAW DOWN FINANCING LEASE PROGRAM. SCHEDULE K, PART III, LINES 4-6, BOND ISSUE C: RESPONSES REFLECT THE COMPUTATION OF THE PORTION OF THE ISSUE ALLOCABLE TO THE REFUNDING OF THE 2009A BONDS. SCHEDULE K, PART IV, LINE 2C, BOND ISSUES (C), (D), AND A(2): BOND ISSUE (C) COMPLETED 06/01/19; AND (D) COMPLETED 08/01/21. AS TO A(2), NO ARBITRAGE COMPUTATION WAS NECESSARY BECAUSE NO PROCEEDS WERE REINVESTED. BOND ISSUES (A) AND (B): THESE PROCEEDS WERE DISBURSED OR DEEMED DISBURSED UPON ISSUANCE TO CURRENTLY REFUND THE PRIOR BONDS. BOND ISSUES A(2): SALES PROCEEDS ALLOCATED UPON ISSUANCE AND NOT INVESTED.

Schedule K (Form 990) 2021

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 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 instructions and the latest information.

OMB No. 1545-0047

2021

Open to Public
Inspection

Name of the organization
DUKE UNIVERSITY HEALTH SYSTEM INC

Employer identification number
56-2070036

Part Ⅰ

Bond Issues

(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	(g) Defeased		(h) On behalf of issuer		(i) Pool financing
(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	Yes	No	Yes	No	Yes	No
A	NORTH CAROLINA MEDICAL CARE COMMISSION	52-1309402		03-01-2022	267,805,000	SEE PART VI		X		X		X
B	NORTH CAROLINA MEDICAL CARE COMMISSION	52-1309402		02-14-2022	121,620,000	SEE PART VI		X		X		X
C	NORTH CAROLINA MEDICAL CARE COMMISSION	52-1309402	65821DUD1	05-26-2016	383,990,154	SEE PART VI		X		X		X
D	NORTH CAROLINA MEDICAL CARE COMMISSION	52-1309402	65821DVK4	08-11-2016	140,200,389	SEE PART VI		X		X		X
	NORTH CAROLINA MEDICAL CARE COMMISSION	52-1309402		05-10-2018	38,062,676	SEE PART VI		X		X		X

Part Ⅱ

Proceeds

	A		B		C		D
	1 Amount of bonds retired ..................	18,650,000				255,625,000
2 Amount of bonds legally defeased ..............
3 Total proceeds of issue ..................	267,805,000		121,620,000		383,990,154		140,200,389
4 Gross proceeds in reserve funds .............
5 Capitalized interest from proceeds .............
6 Proceeds in refunding escrows ...............					201,888,819		139,008,505
7 Issuance costs from proceeds ...............					2,101,335		1,191,884
8 Credit enhancement from proceeds .............
9 Working capital expenditures from proceeds .............
10 Capital expenditures from proceeds .............	22,841,278
11 Other spent proceeds .............	267,805,000		121,620,000		180,000,000
12 Other unspent proceeds .............
13 Year of substantial completion .............	2020		2009
	Yes	No	Yes	No	Yes	No	Yes	No
14 Were the bonds issued as part of a current refunding issue of tax-exempt bonds (or, if issued prior to 2020, a current refunding issue)? ........	X		X		X			X
15 Were the bonds issued as part of an advance refunding issue of taxable bonds (or, if issued prior to 2020, an advance refunding issue)? ........		X		X	X		X
16 Has the final allocation of proceeds been made? ..........	X		X		X		X
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? ..................	X		X		X		X

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

Cat. No. 50193E

Schedule K (Form 990) 2021

Page 2

Part Ⅲ

Private Business Use

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? .............		X		X		X
2 Are there any lease arrangements that may result in private business use of bond-financed property? ...............		X		X		X
3a Are there any management or service contracts that may result in private business use of bond-financed property? .............	X		X		X
b If "Yes" to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property?	X		X		X
c Are there any research agreements that may result in private business use of bond-financed property? .............		X		X		X
d If "Yes" to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property?
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government ....	0 %		0 %		0 %
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government .........	0 %		0 %		0 %
6 Total of lines 4 and 5 .............	0 %		0 %		0 %
7 Does the bond issue meet the private security or payment test? ...		X		X		X
8a Has there been a sale or disposition of any of the bond-financed property to a nongovernmental person other than a 501(c)(3) organization since the bonds were issued?.............		X		X		X
b If "Yes" to line 8a, enter the percentage of bond-financed property sold or disposed of. ..
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		X		X

Part Ⅳ

Arbitrage

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Has the issuer filed Form 8038-T, Arbitrage Rebate, Yield Reduction and Penalty in Lieu of Arbitrage Rebate? ...		X		X		X		X
2 If "No" to line 1, did the following apply? ....
a Rebate not due yet? .......		X		X		X		X
b Exception to rebate? ........	X		X			X		X
c No rebate due? .........		X		X	X		X
If "Yes" to line 2c, provide in Part Ⅵ the date the rebate computation was performed ......
3 Is the bond issue a variable rate issue? .....	X		X		X			X

Schedule K (Form 990) 2021

Page 3

Part Ⅳ

Arbitrage (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?		X		X		X		X
b Name of provider ..........
c Term of hedge .........
d Was the hedge superintegrated? ......
e Was the hedge terminated? ........
5a Were gross proceeds invested in a guaranteed investment contract (GIC)?		X		X		X		X
b Name of provider ..........
c Term of GIC .........
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? ........
6 Were any gross proceeds invested beyond an available temporary period?		X		X		X		X
7 Has the organization established written procedures to monitor the requirements of section 148? ...	X		X		X		X

Part Ⅴ

Procedures To Undertake Corrective Action

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

Part Ⅵ

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

Return Reference

Explanation

SCHEDULE K, PART I, COLUMN F

Schedule K (Form 990) 2021

Additional Data

Software ID:
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Schedule L
(Form 990)

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 instructions and the latest information.

OMB No. 1545-0047

2021

Open to Public Inspection

Name of the organization

DUKE UNIVERSITY HEALTH SYSTEM INC

Employer identification number

56-2070036

Part I

Excess Benefit Transactions (section 501(c)(3), section 501(c)(4), and section 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 the 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) 2021

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) AGILITI HEALTH INC	SEE PART V	779,203	SEE PART V		No
(2) GARRY BARTELS	SEE PART V	73,113	SEE PART V		No
(3) XIOMARA BOYCE	SEE PART V	76,785	SEE PART V		No

Part V

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

Return Reference

Explanation

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

(A) NAME OF INTERESTED PERSON: AGILITY HEALTH, INC.(B) RELATIONSHIP BETWEEN INTERESTED PERSON AND ORGANIZATION: AGILITY HEALTH, INC. DIRECTOR IS ALSO A DUHS, INC. DIRECTOR(C) AMOUNT OF TRANSACTION: $779,203(D) DESCRIPTION OF TRANSACTION: PAYMENT FOR GOODS OR SERVICES(E) SHARING OF ORGANIZATION REVENUE? = NO(A) NAME OF INTERESTED PERSON: GARRY BARTELS(B) RELATIONSHIP BETWEEN INTERESTED PERSON AND ORGANIZATION: GARRY BARTELS IS A FAMILY MEMBER OF A DUHS, INC. DIRECTOR(C) AMOUNT OF TRANSACTION: $73,113(D) DESCRIPTION OF TRANSACTION: PAYMENT FOR SALARY AND BENEFITS(E) SHARING OF ORGANIZATION REVENUE? = NO(A) NAME OF INTERESTED PERSON: XIOMARA BOYCE(B) RELATIONSHIP BETWEEN INTERESTED PERSON AND ORGANIZATION: XIOMARA BOYCE IS A FAMILY MEMBER OF A DUHS, INC. DIRECTOR(C) AMOUNT OF TRANSACTION: $76,785(D) DESCRIPTION OF TRANSACTION: PAYMENT FOR SALARY AND BENEFITS(E) SHARING OF ORGANIZATION REVENUE? = NO

Schedule L (Form 990) 2021

Additional Data

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SCHEDULE M
(Form 990)

Department of the Treasury

Internal Revenue Service

Noncash Contributions

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

Attach to Form 990.
Right pointing arrow large image

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

OMB No. 1545-0047

2022

Open to Public Inspection

Name of the organization

DUKE UNIVERSITY HEALTH SYSTEM INC

Employer identification number

56-2070036

Part I

Types of Property

	(a) Check if applicable	(b) Number of contributions or items contributed	(c) Noncash contribution amounts reported on Form 990, Part VIII, line 1g	(d) Method of determining noncash contribution amounts
1 Art—Works of art ....	X	1	1
2 Art—Historical treasures .
3 Art—Fractional interests ..
4 Books and publications ..
5 Clothing and household goods .......	X		6,825
6 Cars and other vehicles ..
7 Boats and planes ....
8 Intellectual property ...
9 Securities—Publicly traded .	X	1	10,000	MARKET QUOTE
10 Securities—Closely held stock .
11 Securities—Partnership, LLC, or trust interests ....
12 Securities—Miscellaneous ..
13 Qualified conservation contribution—Historic structures .....
14 Qualified conservation contribution—Other ...
15 Real estate—Residential .
16 Real estate—Commercial ..
17 Real estate—Other ...
18 Collectibles .....
19 Food inventory ...
20 Drugs and medical supplies .
21 Taxidermy ......
22 Historical artifacts ....
23 Scientific specimens ..
24 Archeological artifacts ...
25 Other ( ENTERTAINMENT )	X	21	21,150	VARIOUS
26 Other ( SPORTS )	X	10	3,250	VARIOUS
27 Other ( )
28 Other ( )

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

Yes

30a

During the year, did the organization receive by contribution any property reported in Part I, lines 1 through 28, that it must hold for at least three years from the date of the initial contribution, and which isn't required to be used for exempt purposes for the entire holding period? ...................

30a

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

Does the organization have a gift acceptance policy that requires the review of any nonstandard contributions?

Yes

32a

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

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

32a

Yes

If "Yes," describe in Part II.

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

describe in Part II.

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

Cat. No. 51227J

Schedule M (Form 990) (2022)

Page 2

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

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

Schedule M (Form 990) (2022)

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE O
(Form 990)

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

2021

Open to Public
Inspection

Name of the organization

DUKE UNIVERSITY HEALTH SYSTEM INC

Employer identification number

56-2070036

Return Reference	Explanation
FORM 990, PART I, LINE 1, & PART III, DESCRIPTION OF ORGANIZATION MISSION:	DUHS, AS PART OF DUKE HEALTH, IS COMMITTED TO ADVANCING HEALTH TOGETHER BY DELIVERING TOMORROW'S HEALTH CARE TODAY, ACCELERATING DISCOVERY AND ITS TRANSLATION, CREATING EDUCATION THAT IS TRANSFORMING, BUILDING HEALTHY COMMUNITIES, AND CONNECTING WITH THE WORLD TO IMPROVE HEALTH GLOBALLY.
FORM 990, PART III, LINE 4A	STATEMENT OF PROGRAM SERVICE ACCOMPLISHMENTS HISTORY AND ORGANIZATION IN 1925, JAMES B. DUKE WILLED $4 MILLION TO ESTABLISH DUKE UNIVERSITY HOSPITAL AND ITS MEDICAL SCHOOL TO IMPROVE HEALTH CARE IN THE CAROLINAS, THEN A POOR REGION LACKING HOSPITALS AND HEALTH CARE PROVIDERS. DUKE UNIVERSITY HOSPITAL HAS GROWN TO BE RECOGNIZED AS ONE OF THE WORLD'S GREAT HEALTH CARE PROVIDERS. IN 1998 AND CONCURRENT WITH ACQUIRING CONTROL OF TWO LOCAL COMMUNITY HOSPITALS, THE DUKE UNIVERSITY BOARD OF TRUSTEES ESTABLISHED DUKE UNIVERSITY HOSPITAL AS THE FLAGSHIP OF THE NEWLY INCORPORATED DUKE UNIVERSITY HEALTH SYSTEM, INC. (DUHS) TO MANAGE A WIDE RANGE OF HEALTH CARE PROGRAMS AT THE SAME HIGH LEVEL OF QUALITY THAT HAS TRADITIONALLY MADE DUKE UNIVERSITY HOSPITAL A WORLD LEADER. THIS NETWORK OF REGIONAL HEALTH CARE ORGANIZATIONS IS DEDICATED TO EMPLOYING DUKE'S STRENGTHS IN PATIENT CARE, EDUCATION, AND RESEARCH. DUHS IS A COMPONENT OF DUKE HEALTH WHICH CONCEPTUALLY INTEGRATES THE DUKE UNIVERSITY SCHOOL OF MEDICINE, DUKE-NUS MEDICAL SCHOOL, DUKE UNIVERSITY SCHOOL OF NURSING, DUKE UNIVERSITY HEALTH SYSTEM, PRIVATE DIAGNOSTIC CLINIC (DUKE PHYSICIANS PRACTICE), AND INCORPORATES THE HEALTH AND HEALTH RESEARCH PROGRAMS WITHIN THE DUKE GLOBAL HEALTH INSTITUTE AS WELL AS THOSE IN SCHOOLS AND CENTERS ACROSS DUKE UNIVERSITY, INCLUDING THE DUKE ROBERT J. MARGOLIS CENTER FOR HEALTH POLICY. THE DUKE HEALTH CLINICAL ENTERPRISE IS INTENDED TO FUNCTION AS A FULLY ALIGNED AND UNIFIED ORGANIZATION FOCUSED ON IMPROVING THE HEALTH OF THE COMMUNITIES WE SERVE, DELIVERING ADVANCED TREATMENT FOR THOSE WHO NEED IT, AND EXTENDING NEW KNOWLEDGE BEYOND OUR SYSTEMS TO THE BENEFIT OF OTHERS. LEVERAGING THE DEPTH AND BREADTH OF CAPABILITIES THAT EXIST ACROSS DUKE HEALTH AND THE ENTIRE UNIVERSITY, WE PLAN TO ACHIEVE THE VISION TO DELIVER TOMORROW'S HEALTH CARE TODAY BY LEADING IN THE DELIVERY OF HIGHEST-QUALITY, PATIENT CENTERED CARE, INTEGRATING TO OPTIMIZE COORDINATION OF CARE, GROWING AND EXTENDING OUR REACH LOCALLY, REGIONALLY, AND NATIONALLY, INVESTING IN INNOVATION TO CREATE SUSTAINABLE DIFFERENTIATION AND VALUE AND DELIVERING ON THE PROMISE OF POPULATION HEALTH. MANY PROGRAM SERVICE ACCOMPLISHMENTS ARE INCLUDED IN SCHEDULE H OF THIS FORM INCLUDING THE FINANCIAL COMMITMENT MADE TO THE COMMUNITY BY DUHS IN TERMS OF CHARITY CARE AND OTHER DIRECT AND MEASURABLE INVESTMENTS. FURTHER DETAIL OF DUHS' COMMITMENT TO PROMOTING HEALTH, WELLNESS, AND ACCESS TO QUALITY CARE FOR THE PEOPLE AND COMMUNITIES IT SERVES IS REPORTED IN DUHS' ANNUAL COMMUNITY BENEFIT REPORT. THE COMMUNITY BENEFIT REPORT IS AVAILABLE ONLINE AT HTTPS://CORPORATE.DUKEHEALTH.ORG/COMMUNITY.
FORM 990, PART V, LINE 3B	THE ORGANIZATION DID NOT HAVE UNRELATED BUSINESS GROSS INCOME OF $1,000 OR MORE DURING THE FISCAL YEAR ENDED JUNE 30, 2023. HOWEVER THE ORGANIZATION HAS FILED FORM 990-T FOR THE FISCAL YEAR ENDED JUNE 30, 2023 IN ORDER TO CARRY FORWARD THE NET OPERATING LOSS.
FORM 990, PART VI, SECTION A, LINE 2	DIRECTORS WILLIAM HAWKINS, GERALD HASSELL, VINCENT E. PRICE, CARMICHAEL S. ROBERTS, NANCY M. SCHLICHTING, AND LAURENE M. SPERLING ARE TRUSTEES OF DUKE UNIVERSITY. DIRECTOR AND PRESIDENT, A. EUGENE WASHINGTON, MD, IS AN OFFICER OF DUKE UNIVERSITY. DIRECTOR MARY E. KLOTMAN, MD IS A KEY EMPLOYEE OF DUKE UNIVERSITY. THE FOLLOWING INDIVIDUALS ARE EMPLOYEES OF DUKE UNIVERSITY: MOIRA RYNN, MD AND ERIK PAULSON, MD. DIRECTOR AND PRESIDENT, A. EUGENE WASHINGTON, MD, OFFICERS CRAIG T. ALBANESE, MD, ROBERT N. WILLIS, JOHN P. MORDACH AND THOMAS A. OWENS, MD SERVED AS DIRECTORS AND OFFICERS OF DURHAM CASUALTY COMPANY, LTD. DURING FISCAL YEAR ENDED JUNE 30, 2023. DIRECTOR AND PRESIDENT, A. EUGENE WASHINGTON, MD, AND DIRECTORS MORIA RYNN, MD AND ERIK PAULSON SERVED AS BOARD MEMBERS OF PRIVATE DIAGNOSTIC CLINIC, PLLC. DURING FISCAL YEAR ENDED JUNE 30, 2023. OFFICERS CRAIG T. ALBANESE, MD, ROBERT N. WILLIS, JOHN P. MORDACH AND THOMAS A. OWENS, MD SERVED AS DIRECTORS AND OFFICERS OF HEALTH SYSTEM MEDICAL STRATEGIES, INC. DURING FISCAL YEAR ENDED JUNE 30, 2023. WILLIAM HAWKINS AND SUSAN STALNECKER ARE BOTH DIRECTORS OF BIOVENTUS, LLC. LAURENE SPERLING IS A DIRECTOR OF AGILITI HEALTH, INC.
FORM 990, PART VI, SECTION A, LINE 3	DUHS DELEGATES CONTROL TO A SUPPORTING ORGANIZATION FOR THE MANAGEMENT OF INVESTMENTS.
FORM 990, PART VI, SECTION A, LINE 4	THE ORGANIZATION AMENDED THE ARTICLES OF INCORPORATION EFFECTIVE JULY 1, 2023 STATING THE FOLLOWING REPORTABLE UPDATE TO ARTICLE IX: THE BOARD OF DIRECTORS SHALL INCLUDE FOUR (4) EX OFFICIO MEMBERS, WHO SHALL BE THE INDIVIDUALS SERVING AS PRESIDENT OF DUKE UNIVERSITY, THE CHIEF EXECUTIVE OFFICER OF THE CORPORATION, THE CHAIR OF THE BOARD OF TRUSTEES OF DUKE UNIVERSITY, AND THE EXECUTIVE VICE PRESIDENT FOR HEALTH AFFAIRS/DEAN OF THE DUKE UNIVERSITY SCHOOL OF MEDICINE. THE ORGANIZATION AMENDED THE BYLAWS EFFECTIVE JULY 1, 2023 STATING THE FOLLOWING REPORTABLE UPDATES: THE BOARD OF DIRECTORS SHALL INCLUDE FOUR (4) EX OFFICIO MEMBERS, WHO SHALL BE THE INDIVIDUALS SERVING AS PRESIDENT OF DUKE UNIVERSITY, THE CHIEF EXECUTIVE OFFICER OF THE CORPORATION, THE CHAIR OF THE BOARD OF TRUSTEES OF DUKE UNIVERSITY, AND THE EXECUTIVE VICE PRESIDENT FOR HEALTH AFFAIRS/DEAN OF THE DUKE UNIVERSITY SCHOOL OF MEDICINE. THE CEO SHALL BE NOMINATED BY THE PRESIDENT OF DUKE UNIVERSITY AND APPOINTED BY THE BOARD OF DIRECTORS OF THE CORPORATION. THE CEO SHALL REPORT TO THE PRESIDENT OF DUKE UNIVERSITY; AND TO THE BOARD OF DIRECTORS OF THE CORPORATION. ONLY THE PRESIDENT OF DUKE UNIVERSITY HAS THE POWER TO REMOVE THE CHIEF EXECUTIVE OFFICER OF THE CORPORATION, AFTER APPROPRIATE CONSULTATION.
FORM 990, PART VI, SECTION A, LINE 7A	THE MEMBERS OF THE BOARD OF DIRECTORS OF DUHS, OTHER THAN THE EX OFFICIO MEMBERS, WILL BE NOMINATED BY THE BOARD OF DIRECTORS OF DUHS, AND WILL BE APPOINTED BY THE BOARD OF TRUSTEES OF DUKE UNIVERSITY. MEMBERS OF THE BOARD OF DIRECTORS OF DUHS WILL BE SUBJECT TO REMOVAL AT THE DISCRETION OF THE BOARD OF TRUSTEES OF DUKE UNIVERSITY IN ACCORDANCE WITH THE BYLAWS OF DUHS.
FORM 990, PART VI, SECTION A, LINE 7B	THE DUHS BYLAWS PROVIDE THAT DUHS MUST OBTAIN DUKE UNIVERSITY BOARD OF TRUSTEES APPROVAL FOR CERTAIN SIGNIFICANT TRANSACTIONS REGARDING DEBT ISSUANCES, CAPITAL ACQUISITIONS AND TANGIBLE PERSONAL AND REAL PROPERTY SALES.
FORM 990, PART VI, SECTION B, LINE 11B	AFTER STAFF PREPARATION AND MANAGEMENT REVIEW, THE DUHS FORM 990 IS PRESENTED TO THE DUHS COMPLIANCE/AUDIT COMMITTEE OF THE BOARD OF DIRECTORS FOR REVIEW AND DISCUSSION. DUHS BOARD LEVEL COMMENT AND DISCUSSION ARE INCORPORATED INTO THE FORM AS APPROPRIATE PRIOR TO FILING. A FINAL VERSION OF THE FORM IS MADE AVAILABLE TO THE DUHS BOARD OF DIRECTORS FOR FURTHER REVIEW AND COMMENT BEFORE FILING.
FORM 990, PART VI, SECTION B, LINE 12C	DUHS MONITORS AND ENFORCES COMPLIANCE RELATED TO CONFLICT OF INTEREST VIA AN ANNUAL CONFLICT OF INTEREST QUESTIONNAIRE DISTRIBUTED TO INDIVIDUALS INCLUDING OFFICERS, DIRECTORS, AND KEY EMPLOYEES, RELYING ON SELF DISCLOSURE OF ALL THOSE SUBJECT TO THE COI POLICY.
FORM 990, PART VI, SECTION B, LINE 15	THE DUHS COMPENSATION COMMITTEE, COMPRISED OF MEMBERS OF THE DUHS BOARD OF DIRECTORS, REVIEWS AND APPROVES ALL EXECUTIVE COMPENSATION FOR CERTAIN DISQUALIFIED PERSONS AND OTHER KEY EMPLOYEES. THE DUHS COMPENSATION COMMITTEE REVIEWS AND RECOMMENDS TO THE DUKE UNIVERSITY COMPENSATION COMMITTEE THE COMPENSATION FOR THE PRESIDENT AND CEO OF DUHS WHO IS ALSO AN OFFICER OF DUKE UNIVERSITY. DUHS HAS ADOPTED A STATEMENT OF COMPENSATION PHILOSOPHY THAT ARTICULATES BROAD OBJECTIVES TO HELP GUIDE THE DUHS COMPENSATION COMMITTEE IN ITS MISSION. THE DUHS COMPENSATION COMMITTEE ENGAGES THE SERVICES OF AN OUTSIDE EXECUTIVE COMPENSATION CONSULTING FIRM TO ESTABLISH COMPARABILITY DATA OF OTHER HEALTH CARE SYSTEMS OF SIMILAR SIZE AND COMPLEXITY AS DUHS. THE DUHS COMPENSATION COMMITTEE REVIEWS THE MARKET ANALYSIS THEN DETERMINES THE REASONABLENESS AND APPROPRIATENESS OF ALL ASPECTS OF EXECUTIVE COMPENSATION. THE DUHS COMPENSATION COMMITTEE ALSO SETS THE METRICS AND APPROVES THE PAYOUTS FOR THE DUHS INCENTIVE COMPENSATION PLANS FOR THESE INDIVIDUALS. THE DELIBERATIONS AND CONCLUSIONS OF THE DUHS COMPENSATION COMMITTEE ARE KEPT BY A RECORDING SECRETARY WHO RECORDS THE MINUTES OF THE COMMITTEE MEETINGS. FORM 990, PART VI, SECTION B, LINE 16B: DUHS FOLLOWS A WRITTEN POLICY THAT REQUIRES DUHS TO EVALUATE ITS PARTICIPATION IN JOINT VENTURE ARRANGEMENTS AND NEGOTIATE TERMS AND SAFEGUARDS TO PROTECT THE ORGANIZATION'S ASSETS AND EXEMPT STATUS. DUHS PUTS TERMS AND SAFEGUARDS IN AGREEMENTS WITH THIRD PARTIES TO PROTECT THE ASSETS AND EXEMPT STATUS OF THE ORGANIZATION.
FORM 990, PART VI, SECTION C, LINE 18	IN ADDITION TO PROVIDING THE ORGANIZATION'S FORM 990 UPON REQUEST, THE ORGANIZATION'S FORM 990 IS AVAILABLE TO THE PUBLIC ON SEVERAL THIRD PARTY WEBSITES. WHILE THE ORGANIZATION DOES NOT PROVIDE THE FORM 990 DIRECTLY TO THESE THIRD PARTIES, THE FORM 990 IS OBTAINED FROM THE INTERNAL REVENUE SERVICE. THE THIRD PARTIES SUBSEQUENTLY AND INDEPENDENTLY PROVIDE ACCESS TO THE FORM 990 ON THEIR PLATFORM.
FORM 990, PART VI, SECTION C, LINE 19	DUKE UNIVERSITY HEALTH SYSTEM, INC.'S GOVERNING DOCUMENTS (ARTICLES OF INCORPORATION AND ANY SUBSEQUENT AMENDMENTS OR RESTATEMENTS) ARE AVAILABLE TO THE PUBLIC ON THE NORTH CAROLINA SECRETARY OF STATE WEBSITE. DUKE UNIVERSITY HEALTH SYSTEM, INC. MAKES ITS CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. INDEPENDENTLY AUDITED FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC AT: HTTPS://CORPORATE.DUKEHEALTH.ORG/FINANCIAL-INFORMATION
FORM 990, PART XI, LINE 9:	NONPERIODIC CHANGES IN DEFINED BENEFIT PLANS: -119,082,320. NET TRANSFERS TO THE UNIVERSITY AND AFFILIATES: -192,134,361.
FORM 990, PART XII, LINE 3B:	FEDERAL AWARDS RECEIVED BY THE ORGANIZATION ARE INCLUDED IN THE DUKE UNIVERSITY FY2023 SINGLE AUDIT. ITS AUDIT UNDER THE UNIFORM ADMINISTRATIVE REQUIREMENTS, COST PRINCIPLES, AND AUDIT REQUIREMENTS FOR FEDERAL AWARDS WAS ISSUED BY THE DUE DATE OF MARCH 31, 2024.

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

Cat. No. 51056K

Schedule O (Form 990) 2021

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

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

Attach to Form 990.
MediumBullet

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

OMB No. 1545-0047

2021

Open to Public Inspection

Name of the organization

DUKE UNIVERSITY HEALTH SYSTEM INC

Employer identification number

56-2070036

Part I

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

(a) Name, address, and EIN (if applicable) of disregarded entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Total income	(e) End-of-year assets	(f) Direct controlling entity
(1) DUKE PRMO LLC 615 DOUGLAS STREET SUITE 700 DURHAM,NC27705	MEDICAL BILLING	NC	187,573,782	470,416	DUKE UNIVERSITY HEALTH SYSTEM INC
(2) SAME DAY SURGERY CENTER FRANKLIN LLC 310 BLACKWELL STREET 4TH FLOOR BOX DURHAM,NC27710	SUPPORT	NC	0	0	DUKE UNIVERSITY HEALTH SYSTEM INC

Part II

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

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	(g) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	Yes	No
(1)AMER ASSOC FOR GIFTED CHILDREN - 56-1686219 2200 W MAIN STREET STE 300 DURHAM,NC27705	SUPPORT	NC	501(C)(3)	12 TYPE 1	DUKE UNIVERSITY		No
(2)ASSOCIATED HEALTH SVCS INC 2200 W MAIN STREET STE 300 DURHAM,NC27705 56-1845329	HEALTHCARE	NC	501(C)(3)	12 TYPE 1	DUKE UNIVERSITY HEALTH SYSTEM INC	Yes
(3)DU SPECIAL VENTURES FUND INC 280 S MANGUM STREET STE 210 DURHAM,NC27701 56-1465177	INVESTMENTS	NC	501(C)(3)	12 TYPE 1	DUKE UNIVERSITY		No
(4)DUKE ALUMNI ASSOCIATION INC 2200 W MAIN STREET STE 300 DURHAM,NC27705 56-1594088	SUPPORT	NC	501(C)(3)	12 TYPE 1	DUKE UNIVERSITY		No
(5)DUKE CORPORATE EDUCATION 310 BLACKWELL ST DURHAM,NC27701 42-1672476	EDUCATION	NC	501(C)(3)	12 TYPE 1	DUKE UNIVERSITY		No
(6)DUKE GIFT PROPERTIES INC 2200 W MAIN STREET STE 300 DURHAM,NC27705 57-1211078	SUPPORT	NC	501(C)(3)	12 TYPE 1	DUKE UNIVERSITY		No
(7)DUKE GLOBAL INC 2200 W MAIN STREET STE 300 DURHAM,NC27705 61-1588319	SUPPORT	NC	501(C)(3)	12 TYPE 1	DUKE UNIVERSITY		No
(8)DUKE INTEGRATED NETWORK INC 2200 W MAIN STREET STE 300 DURHAM,NC27705 46-3129771	SUPPORT	NC	501(C)(3)	12 TYPE 1	DUKE UNIVERSITY HEALTH SYSTEM INC	Yes
(9)DUKE MEDICINE GLOBAL SUPP CORP- 61-1593721 2200 W MAIN STREET STE 300 DURHAM,NC27705	SUPPORT	NC	501(C)(3)	12 TYPE 1	DUKE UNIVERSITY		No
(10)DUKE QUALITY NETWORK INC 2200 W MAIN STREET STE 300 DURHAM,NC27705 46-1340679	SUPPORT	NC	501(C)(3)	12 TYPE 1	DUKE UNIVERSITY HEALTH SYSTEM INC	Yes
(11)DUKE SCHOLARLY EXHIBITS INC 2200 W MAIN STREET STE 300 DURHAM,NC27705 56-1701245	SUPPORT	NC	501(C)(3)	12 TYPE 1	DUKE UNIVERSITY		No
(12)DUKE UNIV AFFILIATED PHYSICIANS 2200 W MAIN STREET STE 300 DURHAM,NC27705 56-1902501	HEALTHCARE	NC	501(C)(3)	12 TYPE 1	DUKE UNIVERSITY HEALTH SYSTEM INC	Yes
(13)DUKE UNIV PHILANTHROPIES INC 2200 W MAIN STREET STE 300 DURHAM,NC27705 57-1211099	SUPPORT	NC	501(C)(3)	12 TYPE 1	DUKE UNIVERSITY		No
(14)DUKE UNIV SCH OF MED RESEARCH FDN 56-2247203 2200 W MAIN STREET STE 300 DURHAM,NC27705	SUPPORT	NC	501(C)(3)	12 TYPE 1	DUKE UNIVERSITY		No
(15)DUKE UNIVERSITY 2200 W MAIN STREET STE 300 DURHAM,NC27705 56-0532129	EDUCATION	NC	501(C)(3)	LINE 2	N/A		No
(16)DUMAC INC 280 S MANGUM STREET STE 210 DURHAM,NC27701 90-0754895	SUPPORT	NC	501(C)(3)	12 TYPE 1	DUKE UNIVERSITY		No
(17)DURHAM ASSET MGMT COMPANY INC 2200 W MAIN STREET STE 300 DURHAM,NC27705 56-1757238	SUPPORT	NC	501(C)(3)	12 TYPE 1	DUKE UNIVERSITY		No
(18)DURHAM REALTY INC 2200 W MAIN STREET STE 300 DURHAM,NC27705 56-1917936	SUPPORT	NC	501(C)(3)	12 TYPE 1	DUKE UNIVERSITY		No
(19)GOTHIC CORPORATION 280 S MANGUM STREET STE 210 DURHAM,NC27701 56-1776668	INVESTMENTS	NC	501(C)(3)	12 TYPE 1	DUKE UNIVERSITY		No
(20)GOTHIC HSP CORPORATION 280 S MANGUM STREET STE 210 DURHAM,NC27701 27-1325761	INVESTMENTS	NC	501(C)(3)	12 TYPE 1	DUKE UNIVERSITY HEALTH SYSTEM INC	Yes
(21)HIGH POINT REALTY ASSOCIATES INC 2200 W MAIN STREET STE 300 DURHAM,NC27705 56-1917939	SUPPORT	NC	501(C)(3)	12 TYPE 1	DUKE UNIVERSITY		No
(22)INNOVATIONS IN HEALTHCARE INC 2200 W MAIN STREET STE 300 DURHAM,NC27705 32-0358709	SUPPORT	NC	501(C)(3)	12 TYPE 1	DUKE UNIVERSITY		No
(23)RUTH K BROAD BIOMED RES FDN 2200 W MAIN STREET STE 300 DURHAM,NC27705 65-0045051	SUPPORT	NC	501(C)(3)	12 TYPE 1	DUKE UNIVERSITY		No
(24)THE CTR FOR DOCUMENTARY STUDIES 1317 PETTIGREW STREET DURHAM,NC27705 56-1655039	SUPPORT	NC	501(C)(3)	12 TYPE 1	DUKE UNIVERSITY		No
(25)THE LORD FDN OF NORTH CAROLINA 2200 W MAIN STREET STE 300 DURHAM,NC27705 56-1415423	SUPPORT	NC	501(C)(3)	12 TYPE 1	DUKE UNIVERSITY		No
(26)DUKE JANJUN SERVICES INC 2200 W MAIN STREET STE 300 DURHAM,NC27705 47-1150667	SUPPORT	NC	501(C)(3)	12 TYPE 1	DUKE UNIVERSITY		No
(27)DUKE JULDEC SERVICES INC 2200 W MAIN STREET STE 300 DURHAM,NC27705 47-1143245	SUPPORT	NC	501(C)(3)	12 TYPE 1	DUKE UNIVERSITY		No
(28)DUKE ALLMO SERVICES INC 2200 W MAIN STREET STE 300 DURHAM,NC27705 47-1133466	SUPPORT	NC	501(C)(3)	12 TYPE 1	DUKE UNIVERSITY		No
(29)DUKE AFFILIATIONS NETWORK INC 2200 W MAIN STREET STE 300 DURHAM,NC27705 81-2623775	SUPPORT	NC	501(C)(3)	12 TYPE 1	DUKE UNIVERSITY HEALTH SYSTEM INC	Yes
(30)DUKE UNIV FED CRED UNION 2200 WEST MAIN STREET DURHAM,NC27705 56-1632379	BANKING	NC	501(C)(1)		N/A		No
(31)WATTS COLLEGE OF NURSING INC 2200 W MAIN STREET STE 300 DURHAM,NC27705 83-3076664	SUPPORT	NC	501(C)(3)	12 TYPE 1	DUKE UNIVERSITY HEALTH SYSTEM INC	Yes
(32)DUKE HEALTH INTEGRATED PRACTICE INC 2200 W MAIN STREET STE 300 DURHAM,NC27705 86-2109896	HEALTHCARE	NC	501(C)(3)	LINE 3	DUKE UNIVERSITY		No
(33)DONALD R WATSON FOUNDATION INC 601 SOUTH COLLEGE ROAD WILMINGTON,NC28403 56-1861816	SUPPORT	NC	501(C)(3)	12 TYPE 1	N/A		No
(34)FAMILY HEALTH MINISTRIES INC PO BOX 16783 CHAPEL HILL,NC27516 56-2206165	HEALTH CLINICS	NC	501(C)(3)	LINE 10	DUKE UNIVERSITY		No
(35)LENOX BAKER CHILDREN'S HOSPITAL FOUNDATION INC 1513 TYONEK DRIVE DURHAM,NC27703 56-1550944	FINANCIAL SUPPORT	NC	501(C)(3)	LINE 4	DUKE UNIVERSITY HEALTH SYSTEM INC	Yes

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

Cat. No. 50135Y

Schedule R (Form 990) 2021

Page 2

Part III

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

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Predominant income(related, unrelated, excluded from tax under sections 512-514)	(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?		(k) Percentage ownership
(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	(k) Percentage ownership
(1) BLACKWELL PARTNERS LLC - SERIES A - 20-8075455 280 S MANGUM ST STE 210 DURHAM,NC27701	INVESTMENTS	DE	N/A	N/A				No			No
(2) CANYON BLUE INV FD 27-0186996 AVE OF STARS LA,CA90067	INVESTMENTS	DE	N/A	N/A				No			No
(3) LYRICAL BLUE RL PT 27-2994514 32 N DEAN ST ENGLEWOOD,NJ07631	INVESTMENTS	DE	N/A	N/A				No			No
(4) LYRICAL-BLUE RGNT 45-3626577 32 N DEAN ST ENGLEWOOD,NJ07631	INVESTMENTS	DE	N/A	N/A				No			No
(5) SBER LUCKY STRIKE 20-3891303 310 BLACKWELL ST DURHAM,NC27701	REAL ESTATE	NC	N/A	N/A				No			No
(6) MANGUM II LLC - 46-5135858 280 S MANGUM STREET STE 210 DURHAM,NC27701	INVESTMENTS	NC	N/A	N/A				No			No
(7) LS INVESTOR LLC 20-3891381 310 BLACKWELL ST DURHAM,NC27701	REAL ESTATE	NC	N/A	N/A				No			No
(8) DILWEG BLUE PF LP 47-1225569 5310 S ALSTON AVE STE 210 DURHAM,NC27713	INVESTMENTS	DE	N/A	N/A				No			No
(9) LYRICAL BLUE RL PT IV 47-1542108 32 N DEAN ST ENGLEWOOD,NJ07631	INVESTMENTS	DE	N/A	N/A				No			No
(10) STRATUS SCP II INVESTORS - C LP 50 LOTHIAN ROAD FESTIVAL SQUARE EDINBURGH EH3 9WJ UK	INVESTMENTS	UK	N/A	N/A				No			No
(11) ALTOS HYBRID D LLC 2882 SAND HILL ROAD SUITE 100 MENLO PARK,CA94025 47-3996176	INVESTMENTS	DE	N/A	N/A				No			No
(12) BLACKWELL PARTNERS LLC - SERIES C 280 S MANGUM ST STE 210 DURHAM,NC27701 81-1264533	INVESTMENTS	DE	N/A	N/A				No			No
(13) BLACKWELL PARTNERS LLC - SERIES B 280 S MANGUM ST STE 210 DURHAM,NC27701 47-2530719	INVESTMENTS	DE	N/A	N/A				No			No
(14) BLACKWELL PARTNERS LLC - SERIES D 280 S MANGUM ST STE 210 DURHAM,NC27701 81-3385353	INVESTMENTS	DE	N/A	N/A				No			No
(15) BLACKWELL PARTNERS LLC - SERIES E 280 S MANGUM ST STE 210 DURHAM,NC27701 81-1511048	INVESTMENTS	DE	N/A	N/A				No			No
(16) ALTOS HYBRID 2D LLC - 81-5176567 2882 SAND HILL ROAD STE 100 MENLO PARK,CA94025	INVESTMENTS	DE	N/A	N/A				No			No
(17) LYRICAL-BLUE 100 KINGSHIGHWAY PARTNERS LP 32 N DEAN ST ENGLEWOOD,NJ07631 82-3708328	INVESTMENTS	DE	N/A	N/A				No			No
(18) WASHINGTON GOTHIC LP 593 WASHINGTON STREET WELLESLEY,MA02482 83-4516893	INVESTMENTS	DE	N/A	N/A				No			No
(19) DUKE TRIANGLE ENDOSCOPY CENTER LLC 1A BURTON HILLS BLVD NASHVILLE,TN37215 20-4257024	HEALTHCARE	NC	N/A	N/A				No			No
(20) DWELLWORKS CO-INVESTMENT LLC 7 TIMES SQUARE STE 4307 NEW YORK,NY10036 83-2165945	INVESTMENTS	DE	N/A	N/A				No			No
(21) BEP LEGACY 1C LLC 1001 FANNIN ST STE 800 HOUSTON,TX77002 27-3871932	INVESTMENTS	DE	N/A	N/A				No			No
(22) WELLINGTON TRUST CO NA - CTF OPP FIXED INC ALLOC II POR 280 CONGRESS STREET BOSTON,MA02210 83-1264831	INVESTMENTS	DE	N/A	N/A				No			No
(23) ENIAC SPECIAL DELTA LLC 604 MISSION STREET 10TH FL SAN FRANCISCO,CA94105 84-2355221	INVESTMENTS	DE	N/A	N/A				No			No
(24) STRATUS SCP III INVESTORS - GAMMA LP 50 LOTHIAN ROAD FESTIVAL SQUARE EDINBURGH EH3 9WJ UK	INVESTMENTS	UK	N/A	N/A				No			No
(25) STRATUS SCP COINVESTMENT II - FIP-M RUA FUNCHAL 418 28 ANDAR VILA OLI SAO PAULO 04551-060 BR	INVESTMENTS	BR	N/A	N/A				No			No
(26) MANGUM LLC 280 S MANGUM STREET STE 210 DURHAM,NC27701 46-1275587	INVESTMENTS	NC	N/A	N/A				No			No
(27) CPF HEARTBEAT HEALTH INVES B LLC 980 N MICHIGAN AVE STE 1998 CHICAGO,IL60611 88-1256134	INVESTMENTS	DE	N/A	N/A				No			No
(28) CPF TRIAS INVESTMENT LLC 980 N MICHIGAN AVE STE 1998 CHICAGO,IL60611 87-4202934	INVESTMENTS	DE	N/A	N/A				No			No
(29) CPF HEARTBEAT HEALTH INV A LLC 980 N MICHIGAN AVENUE SUITE 1998 CHICAGO,IL60611 88-1279232	INVESTMENTS	DE	N/A	N/A				No			No
(30) CPF TRIAS INVESTMENT II LLC 980 N MICHIGAN AVE STE 1998 CHICAGO,IL60611 87-4204000	INVESTMENTS	DE	N/A	N/A				No			No
(31) THRIVE CAPITAL PARTNERS IV SEGMENT LLC 295 LAFAYETTE STREET NEW YORK,NY10012 47-4031040	INVESTMENTS	DE	N/A	N/A				No			No
(32) MANGUM III LLC 280 S MANGUM STREET STE 210 DURHAM,NC27701 92-3565585	INVESTMENTS	DE	N/A	N/A				No			No
(33) MANGUM III LLC - SERIES A 280 S MANGUM STREET STE 210 DURHAM,NC27701 92-3592240	INVESTMENTS	DE	N/A	N/A				No			No

Part IV

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

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	(h) Percentage ownership	(i) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	(h) Percentage ownership	Yes	No
(1) DUKE CE LS INC 310 BLACKWELL STREET DURHAM,NC27701 20-2004016	REAL ESTATE	NC	N/A	C					No
(2) DUKE CE (SEA) PRIVATE LIMITED 1 RAFFLES PLACE TOWER 2 SINGAPORE 048616 SN	SUPPORT	SN	N/A	C					No
(3) DUKE CORP EDU INDIA PRIVATE ACADEMIC BLOCK NEW CAMPUS VASTRAPUR,AHMEDABAD380015 IN 42-1672476	CONSULTING	IN	N/A	C					No
(4) DUKE CORPORATE EDUCATION LIM 165 FLEET STREET LONDON EC4A 2DY UK 42-1672476	EDUCATION CONSULTING	UK	N/A	C					No
(5) DUKE CORPORATE EDUCATION RSA GROUND FLOOR TWICKEHNHAM BLDG BRYANSTON,JOHANNESBURG02021 SF 42-1672476	CONSULTING	SF	N/A	C					No
(6) DUKE GLOBAL CONSULTING (KUNSHAN) 1666 WEI CHEN NAN RD KUNSHAN PR,KUNSHAN215300 CH	CONSULTING	CH	N/A	C					No
(7) DUKE MEDICAL STRATEGIES INC 2200 WEST MAIN STREET STE 920 DURHAM,NC27705 56-1993799	HEALTHCARE	NC	N/A	C					No
(8) DUKE MEDICINE ASIA PTE LTD 5 SHENTON WAY 07-00 UIC BLD SINGAPORE 068808 SN	MEDICAL RESEARCH	SN	N/A	C					No
(9) DURHAM CASUALTY COMPANY LTD AON HOUSE 30 WOODBOURNE AVE PEMBROKE HM 08 BD 98-0113277	INSURANCE	BD	DUHS INC	C	44,300,589	318,039,272	100.000 %	Yes
(10) GOTHIC INTERNATIONAL LTD 113 S CHURCH STREET QUEENSGATE HOU GRAND CAYMAN KY1-1108 CJ	INVESTMENTS	CJ	N/A	C					No
(11) HEALTH SYSTEM MEDICAL STRATEGIES INC 2200 W MAIN STREET STE 300 DURHAM,NC27705 56-2222444	HEALTH CARE	NC	DUHS INC	C	-21,147	14,452	100.000 %	Yes
(12) MARATHON BLUE CAYMAN FUND 89 NEXUS WAY PO BOX 31106 GRAND CAYMAN KY1-1205 CJ	INVESTMENTS	CJ	N/A	C					No
(13) GHI HOLDINGS MAURITIUS 9TH FL ORANGE TOWER CYBERCITY EBENE MP	INVESTMENTS	MP	N/A	C					No
(14) GHI ERP LTD 9TH FL ORANGE TOWER CYBERCITY EBENE MP	INVESTMENTS	MP	N/A	C					No
(15) GHI HSP LTD 9TH FL ORANGE TOWER CYBERCITY EBENE MP	INVESTMENTS	MP	N/A	C					No
(16) GHI JBD LTD 9TH FL ORANGE TOWER CYBERCITY EBENE MP	INVESTMENTS	MP	N/A	C					No
(17) GHI LTP LTD 9TH FL ORANGE TOWER CYBERCITY EBENE MP	INVESTMENTS	MP	N/A	C					No
(18) MCP PRIVATE CAPITAL (FEEDER) FUND I LP 6 RUE GABRIEL LIPPMANN LUXEMBOURG L-5365 LU	INVESTMENTS	LU	N/A	C					No
(19) DUKE INDIA SERVICES PRIVATE LIMITED 302 PRIDE ELITE 10 MUSEUM ROAD BANGALORE,KARNATAKA560001 IN	MEDICAL RESEARCH	IN	N/A	C					No
(20) VITA BELLAVISTA CASA 84 SRL EDIFICIO BLP CENTRO EMPRESARIAL VI SAN JOSE,SANTA ANA/BELLENKM3 CS	REAL ESTATE	CS	N/A	C					No
(21) VITA BELLAVISTA CASA DIECINUEVE SRL EDIFICIO BLP CENTRO EMPRESARIAL VI SAN JOSE,SANTA ANA/BELLENKM3 CS	REAL ESTATE	CS	N/A	C					No
(22) DUKE GLOBAL GERMANY GMBH ESCHERSHEIMER LANDSTR 14 FRANKFURT 60322 GM	EDUCATION	GM	N/A	C					No

Schedule R (Form 990) 2021

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

Yes

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

Yes

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

Yes

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

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

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

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

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

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

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

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

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

Yes

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

Yes

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

Yes

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

Yes

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

(a) Name of related organization	(b) Transaction type (a-s)	(c) Amount involved	(d) Method of determining amount involved
(1) DUKE UNIVERSITY AFFILIATED PHYSICIANS INC	R	57,833,668	FMV
(2) ASSOCIATED HEALTH SERVICES INC	S	9,191,043	FMV
(3) DUKE AFFILIATIONS NETWORK INC	R	434,702	FMV
(4) DUKE INTERGRATED NETWORK INC	R	9,597,900	FMV
(5) WATTS COLLEGE OF NURSING INC	R	387,113	FMV
(6) DURHAM CASUALTY COMPANY INC	S	14,629,560	FMV
(7) DURHAM CASUALTY COMPANY INC	R	11,185,116	FMV
(8) DUKE TRIANGLE ENDOSCOPY CENTER LLC	L	171,031	FMV
(9) DUKE TRIANGLE ENDOSCOPY CENTER LLC	Q	174,456	FMV
(10) GOTHIC HSP CORPORATION	B	294,940,146	FMV
(11) GOTHIC HSP CORPORATION	C	431,930,716	FMV

Schedule R (Form 990) 2021

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?		(k) Percentage ownership
(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	(k) Percentage ownership

Schedule R (Form 990) 2021

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) 2021

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: SEE SCHEDULE O FOR ORGANIZATION'S MISSION STATEMENT
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	18
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	11
5	Total number of individuals employed in calendar year 2021 (Part V, line 2a) ......	5	26,017
6	Total number of volunteers (estimate if necessary) .............	6	505
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	0
b	Net unrelated business taxable income from Form 990-T, Part I, line 11 .........	7b	0

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	65,812,130	17,395,022
9	Program service revenue (Part VIII, line 2g) .........	4,061,183,925	4,441,855,976
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	372,772,809	95,601,985
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	100,737,132	117,981,685
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	4,600,505,996	4,672,834,668
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	2,048,176	2,054,288
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)	2,016,472,500	2,251,243,997
16a	Professional fundraising fees (Part IX, column (A), line 11e) .....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 285,902
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	2,155,618,846	2,369,918,261
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	4,174,139,522	4,623,216,546
19	Revenue less expenses. Subtract line 18 from line 12.......	426,366,474	49,618,122
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	8,260,774,039	7,958,888,279
21	Total liabilities (Part X, line 26).............	2,800,050,325	2,835,375,323
22	Net assets or fund balances. Subtract line 21 from line 20.....	5,460,723,714	5,123,512,956

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 3,842,016,118 including grants of $ 2,054,288 ) (Revenue $ 4,542,702,009 )
	SEE SCHEDULE O

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












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












4d	Other program services (Describe in Schedule O.)
	(Expenses $ including grants of $ ) (Revenue $ )
4e	Total program service expenses3,842,016,118

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	13,606,044	8,970,241	1,331,044

1a	Federated campaigns..		1a
b	Membership dues..		1b
c	Fundraising events..		1c	63,870
d	Related organizations		1d
e	Government grants (contributions)		1e	9,402,519

f	All other contributions, gifts, grants, and similar amounts not included above		1f	7,928,633

g	Noncash contributions included in lines 1a - 1f:$		1g	37,351

h Total. Add lines 1a-1f.......		17,395,022

		Business Code
2a	PATIENT REVENUE	622110	4,402,793,657	4,402,793,657
b	ANCILLARY MEDICAL SVCS	622110	39,062,319	39,062,319
c
d
e
f	All other program service revenue.
g	Total. Add lines 2a–2f .....		4,441,855,976

3 Investment income (including dividends, interest, and othersimilar amounts) ......			81,132,069			81,132,069
4 Income from investment of tax-exempt bond proceeds
5 Royalties...........			6,393,855			6,393,855
		(ii) Personal	(i) Real
6a	Gross rents		19,414,817	6a
b	Less: rental expenses		14,675,973	6b
c	Rental income or (loss)		4,738,844	6c
d	Net rental income or (loss).......			4,738,844			4,738,844
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory		1,599,610,713	7a
b	Less: cost or other basis and sales expenses	1,564,830	1,583,575,967	7b
c	Gain or (loss)	-1,564,830	16,034,746	7c
d	Net gain or (loss).........			14,469,916			14,469,916
8a	Gross income from fundraising events (not including $ 63,870of contributions reported on line 1c). See Part IV, line 18 ....
			8a	133,029
b	Less: direct expenses ...		8b	75,704
c	Net income or (loss) from fundraising events..			57,325			57,325
9a	Gross income from gaming activities. See Part IV, line 19 ...
			9a
b	Less: direct expenses ...		9b
c	Net income or (loss) from gaming activities..
10a	Gross sales of inventory, less returns and allowances ..
			10a
b	Less: cost of goods sold ..		10b
c	Net income or (loss) from sales of inventory..
Business Code			Miscellaneous Revenue
11a	BILLING FEES		622110	54,275,159	54,275,159
b	NET BENEFIT COMPONENTS		622110	39,264,000	39,264,000
c	LAB SERVICES		621511	5,525,317	5,525,317
d	All other revenue ....			7,727,185	1,781,557		5,945,628
e	Total. Add lines 11a–11d ......			106,791,661
12	Total revenue. See instructions.....			4,672,834,668	4,542,702,009	0	112,737,637

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21 ....	1,991,996	1,991,996
2	Grants and other assistance to domestic individuals. See Part IV, line 22 ...........	62,292	62,292
3	Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See Part IV, lines 15 and 16. .............
4	Benefits paid to or for members .......
5	Compensation of current officers, directors, trustees, and key employees ...........	11,626,179	469,442	11,050,578	106,159
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .........	574,939	149,898	425,041
7	Other salaries and wages........	1,807,462,417	1,412,511,927	394,831,689	118,801
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	118,482,171	90,788,197	27,687,007	6,967
9	Other employee benefits .......	189,976,645	150,103,147	39,860,343	13,155
10	Payroll taxes ...........	123,121,646	95,643,399	27,462,486	15,761
11	Fees for services (non-employees):
a	Management ......	21,271,430	21,271,430
b	Legal .........	10,316,564	4,195,698	6,120,866
c	Accounting ...........	648,777		648,777
d	Lobbying ...........
e	Professional fundraising services. See Part IV, line 17
f	Investment management fees ......	4,834,779		4,834,779
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	366,701,076	205,947,314	160,753,762
12	Advertising and promotion ....	3,365,439	53,629	3,309,967	1,843
13	Office expenses .......	37,123,032	22,888,770	14,211,046	23,216
14	Information technology ......	79,200,528	6,153,424	73,047,104
15	Royalties ..
16	Occupancy ...........	83,220,828	55,011,737	28,209,091
17	Travel ............	10,386,149	9,492,495	893,654
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .
19	Conferences, conventions, and meetings ....	5,518,743	1,562,714	3,956,029
20	Interest ...........	56,473,509	56,473,509
21	Payments to affiliates .......
22	Depreciation, depletion, and amortization ..	197,160,687	174,576,539	22,584,148
23	Insurance ...	13,496,274	13,496,274
24	Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a	MEDICAL SUPPLIES	1,287,743,293	1,287,743,293
b	MEDICAID ASSESSMENT	101,187,677	101,187,677
c	EQUIPMENT RENTAL & MAIN	96,056,736	64,888,966	31,167,770
d	INTERVIEW & RECRUITING	12,567,509	7,581,721	4,985,788
e	All other expenses	-17,354,769	57,770,630	-75,125,399
25	Total functional expenses. Add lines 1 through 24e	4,623,216,546	3,842,016,118	780,914,526	285,902
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 ........			117,763	1	127,009
2	Savings and temporary cash investments .........			472,331,439	2	484,647,422
3	Pledges and grants receivable, net ......			882,384	3	1,591,928
4	Accounts receivable, net .............			561,593,108	4	643,735,889
5	Loans and other receivables from any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .......
					5
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), and persons described in section 4958(c)(3)(B) ...
					6
7	Notes and loans receivable, net ...........			84,177	7	73,077
8	Inventories for sale or use ............			137,742,780	8	117,660,579
9	Prepaid expenses and deferred charges ......			35,959,046	9	42,037,222
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	4,603,694,420
b	Less: accumulated depreciation	10b	2,540,939,008	2,165,937,441	10c	2,062,755,412
11	Investments—publicly traded securities .			719,112,041	11	707,532,851
12	Investments—other securities. See Part IV, line 11 .....			3,681,086,884	12	3,454,131,263
13	Investments—program-related. See Part IV, line 11 ..				13
14	Intangible assets ...............			21,965,765	14	24,168,891
15	Other assets. See Part IV, line 11 ...........			463,961,211	15	420,426,736
16	Total assets. Add lines 1 through 15 (must equal line 33)...			8,260,774,039	16	7,958,888,279

17	Accounts payable and accrued expenses .....	512,026,066	17	436,023,395
18	Grants payable ...		18
19	Deferred revenue .........	9,664,456	19	10,304,827
20	Tax-exempt bond liabilities .........	636,101,119	20	605,293,427
21	Escrow or custodial account liability. Complete Part IV of Schedule D		21
22	Loans and other payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .........
			22
23	Secured mortgages and notes payable to unrelated third parties ..		23
24	Unsecured notes and loans payable to unrelated third parties ..	0	24	248,385,750
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	1,642,258,684	25	1,535,367,924
26	Total liabilities. Add lines 17 through 25..	2,800,050,325	26	2,835,375,323

	Organizations that follow FASB ASC 958, check here and complete lines 27, 28, 32, and 33.
27	Net assets without donor restrictions ..........	5,403,296,138	27	5,062,532,715
28	Net assets with donor restrictions ...........	57,427,576	28	60,980,241
	Organizations that do not follow FASB ASC 958, check here and complete lines 29 through 33.
29	Capital stock or trust principal, or current funds .....		29
30	Paid-in or capital surplus, or land, building or equipment fund ...		30
31	Retained earnings, endowment, accumulated income, or other funds		31
32	Total net assets or fund balances ...........	5,460,723,714	32	5,123,512,956
33	Total liabilities and net assets/fund balances ........	8,260,774,039	33	7,958,888,279

1	Was the organization a U.S. transferor of property to a foreign corporation during the tax year? If "Yes," the organization may be required to file Form 926, Return by a U.S. Transferor of Property to a Foreign Corporation (see Instructions for Form 926). . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	Yes	No
2	Did the organization have an interest in a foreign trust during the tax year? If "Yes," the organization may be required to separately file Form 3520, Annual Return to Report Transactions with Foreign Trusts and Receipt of Certain Foreign Gifts, and/or Form 3520-A, Annual Information Return of Foreign Trust With a U.S. Owner (see Instructions for Forms 3520 and 3520-A; don't file with Form 990). . . . . . . . . . . . . . . . . . . . . . . .	Yes	No
3	Did the organization have an ownership interest in a foreign corporation during the tax year? If "Yes," the organization may be required to file Form 5471, Information Return of U.S. Persons with Respect to Certain Foreign Corporations. (see Instructions for Form 5471). . . . . . . . . . . . . . . . . . . . . . . . . . . .	Yes	No
4	Was the organization a direct or indirect shareholder of a passive foreign investment company or a qualified electing fund during the tax year? If “Yes,” the organization may be required to file Form 8621, Information Return by a Shareholder of a Passive Foreign Investment Company or Qualified Electing Fund. (see Instructions for Form 8621) .	Yes	No
5	Did the organization have an ownership interest in a foreign partnership during the tax year? If "Yes," the organization may be required to file Form 8865, Return of U.S. Persons with Respect to Certain Foreign Partnerships (see Instructions for Form 8865). . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	Yes	No
6	Did the organization have any operations in or related to any boycotting countries during the tax year? If "Yes," the organization may be required to separately file Form 5713, International Boycott Report (see Instructions for Form 5713; don't file with Form 990).. . . . . . . . . . . . . . . . . . . . . . . . . . . .	Yes	No