TY 2024 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) VINCENT E PRICE...................................................................... DIRECTOR	3.00 ................. 48.30	X		0	2,137,417	62,628
(2) MARY E KLOTMAN MD...................................................................... DIRECTOR	12.00 ................. 49.20	X		0	1,522,644	58,317
(3) ERIK PAULSON...................................................................... DIRECTOR	1.00 ................. 60.00	X		0	1,002,049	73,226
(4) LESLIE E BAINS...................................................................... DIRECTOR	2.00 ................. 0.00	X		0	0	0
(5) GAIL BELVETT MD DDS...................................................................... DIRECTOR	4.00 ................. 0.00	X		0	616	0
(6) DENISE BENNETT...................................................................... DIRECTOR	2.00 ................. 0.00	X		0	0	0
(7) FEDERICO MANON...................................................................... DIRECTOR	1.00 ................. 0.00	X		0	0	0
(8) CARMICHAEL S ROBERTS JR...................................................................... DIRECTOR	1.00 ................. 1.00	X		0	0	0
(9) NANCY M SCHLICHTING...................................................................... DIRECTOR	2.00 ................. 2.00	X		0	0	0
(10) LAURENE SPERLING...................................................................... DIRECTOR	8.00 ................. 6.00	X		0	0	0
(11) CRAIG T ALBANESE MD...................................................................... DIRECTOR/CEO	42.00 ................. 0.20	X	X	2,279,485	0	59,414
(12) G RICHARD WAGONER JR...................................................................... DIRECTOR	1.00 ................. 0.00	X		0	0	0
(13) DENISE BARNES...................................................................... DIRECTOR	0.00 ................. 0.00	X		0	0	0
(14) PETER GROSSI...................................................................... DIRECTOR	1.00 ................. 40.00	X		0	1,076,490	54,947
(15) GARHENG KONG MD...................................................................... DIRECTOR	1.00 ................. 0.00	X		0	0	0
(16) THOMAS H LISTER...................................................................... DIRECTOR	6.00 ................. 2.00	X		0	0	0
(17) ALISON TOTH...................................................................... DIRECTOR	1.00 ................. 60.00	X		8,482	1,031,831	49,664

(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) GERALD HASSELL........................................................................ DIRECTOR	1.00 .......................0.00	X					0	0	0
(19) HOWARD FRANCIS MD........................................................................ DIRECTOR	1.00 .......................40.00	X					0	1,010,605	62,358
(20) AMANDA RICHARDS........................................................................ DIRECTOR	2.00 .......................0.00	X					0	0	0
(21) ADAM SILVER........................................................................ DIRECTOR	2.00 .......................6.10	X					0	0	0
(22) THOMAS A OWENS MD........................................................................ EXECUTIVE VP, DUHS & COO	55.00 .......................0.80		X				1,853,877	0	76,073
(23) MONTE D BROWN MD........................................................................ VP FOR ADMINISTRATION/SECRETARY	60.00 .......................0.20		X				2,213,088	0	55,851
(24) LISA M GOODLETT........................................................................ SENIOR VP, CFO, TREASURER	50.00 .......................0.80		X				1,253,560	0	62,316
(25) KATIE MCKITTRICK........................................................................ PART YEAR SECRETARY	40.00 .......................0.00		X				220,868	0	46,784
(26) MARY K MARTIN........................................................................ CHIEF OPERATING OFFICER, DUH	40.00 .......................0.00			X			1,151,375	0	79,565
(27) BARBARA M GRIFFITH MD........................................................................ PRESIDENT, DUKE RALEIGH HOSPITAL	40.00 .......................0.00			X			673,969	0	68,011
(28) DEVDUTTA SANGVAI MD........................................................................ PRESIDENT, DUKE REGIONAL HOSPITAL	60.00 .......................0.20			X			631,801	5,250	181,170
(29) TERRY MCDONNELL........................................................................ SVP-PART YEAR PATIENT CARE	40.00 .......................0.10			X			675,480	0	71,308
(30) JASON CARTER........................................................................ INTERIM PRESIDENT, DUKE REGIONAL HOSPITAL	55.00 .......................0.20			X			457,658	0	79,671
(31) BRYAN YOURICH........................................................................ CHIEF PHARMACY OFFICER, DUHS	40.00 .......................0.00			X			416,477	0	62,810
(32) GREGORY PAULY........................................................................ PRESIDENT DUH/ACUTE CARE SERVICES/VICE DEAN SOM	60.00 .......................1.00			X			1,420,831	65,000	79,404
(33) RICHARD P SHANNON MD........................................................................ CHIEF QUALITY OFFICER	40.00 .......................0.20				X		1,173,438	5,000	59,329
(34) JEFFREY M FERRANTI........................................................................ VP & CHIEF DIGITAL OFFICE	40.00 .......................0.00				X		1,126,154	211,189	77,229
(35) KEITH STOVER........................................................................ VP FINANCE/COO, PRMO	40.00 .......................0.00				X		915,292	0	71,448
(36) RHONDA BRANDON........................................................................ CHIEF HR OFFICER	40.00 .......................0.10				X		907,056	0	74,213
(37) JOHN A QUELCH........................................................................ EXECUTIVE VICE CHANCELLOR, DKU	25.00 .......................15.00				X		855,423	411,254	73,505
(38) WILLIAM J FULKERSON MD........................................................................ FORMER OFFICER	17.00 .......................39.00					X	201,901	448,111	49,534
(39) ROBERT N WILLIS........................................................................ FORMER OFFICER	50.00 .......................0.30					X	799,072	0	60,996
(40) A EUGENE WASHINGTON MD........................................................................ CHANCELLOR EMERITUS FOR HEALTH AFF.	0.00 .......................33.00					X	0	2,285,670	71,327
(41) MARY ANN FUCHS........................................................................ FORMER KEY EMPLOYEE	50.00 .......................0.00					X	102,863	0	13,289
(42) LEIGH BLEECKER........................................................................ FORMER KEY EMPLOYEE	0.10 .......................65.10					X	539,968	0	57,054
(43) PRISCILLA RAMSEUR........................................................................ FORMER KEY EMPLOYEE	50.00 .......................0.10					X	381,982	0	51,809

(A) Name and business address	(B) Description of services	(C) Compensation
KERNODLE CLINIC INC 1234 HUFFMAN MILL RD BURLINGTON,NC27215	MEDICAL SERVICES	38,177,475
VAYA WORKFORCE SOLUTIONS LLC PO BOX 713427 CHICAGO,IL60601	CONTRACT NURSING	31,693,840
ARAMARK SERVICES INC 1101 MARKET ST 12TH FLOOR PHILADELPHIA,PA19107	FOOD SERVICES	23,909,807
ROBINS & MORTON GROUP PO BOX 11407 DEPT 5870 BIRMINGHAM,AL35209	CONSTRUCTION SERVICES	15,949,732
C T WILSON CONSTRUCTION CO INC 150 GOLDEN DR 200 DURHAM,NC27705	CONSTRUCTION SERVICES	10,283,620
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 395

- 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.
right arrow

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

2024

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) 2024

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) 2020	(b) 2021	(c) 2022	(d) 2023	(e) 2024	(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) 2020	(b) 2021	(c) 2022	(d) 2023	(e) 2024	(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 2024 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2023 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2024. 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—2023. 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—2024. 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—2023. 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) 2024

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) 2020	(b) 2021	(c) 2022	(d) 2023	(e) 2024	(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) 2020	(b) 2021	(c) 2022	(d) 2023	(e) 2024	(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 2024 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2023 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2024 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2023 Schedule A, Part III, line 17 .............

19a

33 1/3% support tests-2024. 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—2023. 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) 2024

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) 2024

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) 2024

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) 2024

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 2024 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-2024	(iii) Distributable Amount for 2024
1 Distributable amount for 2024 from Section C, line 6
2 Underdistributions, if any, for years prior to 2024 (reasonable cause required-- explain in Part VI). See instructions.
3 Excess distributions carryover, if any, to 2024:
a From 2019.......
b From 2020.......
c From 2021.......
d From 2022.......
e From 2023.......
fTotal of lines 3a through e
g Applied to underdistributions of prior years
h Applied to 2024 distributable amount
i Carryover from 2019 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from line 3f.
4Distributions for 2024 from Section D, line 7:
$
a Applied to underdistributions of prior years
b Applied to 2024 distributable amount
c Remainder. Subtract lines 4a and 4b from line 4.
5 Remaining underdistributions for years prior to 2024, 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 2024. 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 2025. Add lines 3j and 4c.
8 Breakdown of line 7:
a Excess from 2020.....
b Excess from 2021.....
c Excess from 2022.....
d Excess from 2023.....
e Excess from 2024.....

Schedule A (Form 990) (2024)

Schedule A (Form 990) 2024

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) 2024

Additional Data

Software ID:
Software Version:

- TIN:

Schedule B
(Form 990)
(Rev. January 2025)

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

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 ......... Right Arrow

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) (Rev. 1-2025)

Schedule B (Form 990) (Rev. 1-2025) Page 2

Name of organization DUKE UNIVERSITY HEALTH SYSTEM INC

Part I	Contributors (see instructions). Use duplicate copies of Part I if additional space is needed.
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
RESTRICTED	,	$ RESTRICTED	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
Schedule B (Form 990) (Rev. 1-2025)

Schedule B (Form 990) (Rev. 1-2025)

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) (Rev. 1-2025)

Schedule B (Form 990) (Rev. 1-2025)

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) (Rev. 1-2025)

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

right arrow

Complete if the organization is described below. 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

2024

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 .................................................................... right arrow

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 ................................ right arrow

Enter the amount of any excise tax incurred by organization managers under section 4955 ....................... right arrow

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 ..... right arrow

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

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

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) 2024

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 right arrow

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 right arrow

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) 2021	(b) 2022	(c) 2023	(d) 2024	(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) 2024

Page 3

Part II-B

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

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

(a)

Yes

(b)

Amount

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

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

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

Yes

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

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

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

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

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

Yes

160,948

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

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

Yes

179,746

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

340,694

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, LOBBYING ACTIVITIES:	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, LOBBYING ACTIVITIES:

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) 2024

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.
right arrow

Attach to Form 990.
right arrow

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

OMB No. 1545-0047

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 July 25, 2006, 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 right arrow

Number of states where property subject to conservation easement is located right arrow

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
right arrow

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

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 ......................... right arrow

(ii)

Assets included in Form 990, Part X ............................... right arrow

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 .......................... right arrow

Assets included in Form 990, Part X ............................... right arrow

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

Cat. No. 52283D

Schedule D (Form 990) (Rev. 1-2025)

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 ....	65,017,463	60,980,241	57,427,577	74,699,445	59,559,614
b	Contributions ...	23,521,289	7,999,982	10,278,031	5,159,602	12,795,429
c	Net investment earnings, gains, and losses	1,291,238	1,080,778	-2,178,352	-2,443,178	14,542,065
d	Grants or scholarships ...
e	Other expenditures for facilities and programs ...	4,381,745	5,043,537	4,547,015	19,988,293	12,197,663
f	Administrative expenses ....
g	End of year balance ......	85,448,245	65,017,463	60,980,241	57,427,577	74,699,445

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

Board designated or quasi-endowment right arrow

0 %

Permanent endowment right arrow

55.559 %

Term endowment right arrow

44.441 %

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 .....	87,163,715		87,163,715
b	Buildings ....	3,167,125,457	1,503,344,849	1,663,780,608
c	Leasehold improvements
d	Equipment ....	1,069,036,795	867,532,258	201,504,537
e	Other .....	503,721,709	455,817,842	47,903,867
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..				2,000,352,727

Schedule D (Form 990) (Rev. 1-2025)

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	1,528,520,833	F
(B) HEDGE FUNDS	1,086,003,337	F
(C) CASH & CASH EQUIVALENTS	612,968,883	F
(D) NATURAL RESOURCES	261,895,567	F
(E) REAL ESTATE	172,545,044	F
(F) OTHER INVESTMENTS	164,572,049	F
(F)
(G)
(H)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)	3,826,505,713

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				464,251,474
(2)PREPAID PENSION ASSET				189,583,000
(3)ESTIMATED THIRD PARTY PAYOR SETTLEMENT				148,199,953
(4)OTHER NON-CURRENT ASSETS				74,065,409
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........				876,099,836

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
TAXABLE BOND LIABILITY	876,522,593
RIGHT-OF-USE OPERATING LEASE LIABILITIES	494,937,844
FINANCE LEASE LIABILITIES	134,622,659
POST RETIREMENT BENEFIT OBLIGATION	50,523,000
457 PLAN OBLIGATIONS	37,635,013
PROFESSIONAL LIABILITY COSTS	20,626,598
DERIVATIVE INSTRUMENTS	17,615,803
OTHER NON-CURRENT LIABILITIES	34,531,716

Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	1,667,015,226
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) (Rev. 1-2025)

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, 2025.

Schedule D (Form 990) (Rev. 1-2025)

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE F(Form 990)
(Rev. January 2025)

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 arrow

Attach to Form 990. Right arrow

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

OMB No. 1545-0047

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)	(e) If activity listed in (d) is a program service, describe specific type of service(s) in the region	(f) Total expenditures for and investments in the region
	CENTRAL AMERICA AND THE CARIBBEAN - ANTIGUA & BARBUDA, ARUBA, BAHAMAS,	0	0	INVESTMENTS		391,245,000
	CENTRAL AMERICA AND THE CARIBBEAN - ANTIGUA & BARBUDA, ARUBA, BAHAMAS,	0	0	SEMINAR		8,000
	EAST ASIA AND THE PACIFIC - AUSTRALIA, BRUNEI, BURMA, CAMBODIA,	0	0	PROGRAM SERVICES	STUDY ABROAD	12,000
	EAST ASIA AND THE PACIFIC - AUSTRALIA, BRUNEI, BURMA, CAMBODIA,	0	0	SEMINAR		47,000
	EUROPE (INCLUDING ICELAND & GREENLAND) - ALBANIA, ANDORRA, AUSTRIA, BELGIUM	0	0	SEMINAR		19,000
	MIDDLE EAST AND NORTH AFRICA - ALGERIA, BAHRAIN, DJIBOUTI, EGYPT,	0	0	SEMINAR		2,000
	NORTH AMERICA - CANADA AND MEXICO, BUT NOT THE UNITED STATES	0	0	SEMINAR		10,000
	SOUTH ASIA - AFGHANISTAN, BANGLADESH, BHUTAN, INDIA, MALDIVES, NEPAL,	0	0	GRANTMAKING		1,000
	SUB-SAHARAN AFRICA - ANGOLA, BENIN, BOTSWANA, BURKINA FASO,	0	0	GRANTMAKING		20,000
	SUB-SAHARAN AFRICA - ANGOLA, BENIN, BOTSWANA, BURKINA FASO,	0	0	SEMINAR		2,000







3a	Sub-total ....	0	0			391,344,000
b	Total from continuation sheets to Part I ...	0	0			22,000
c	Totals (add lines 3a and 3b)	0	0			391,366,000

For Paperwork Reduction Act Notice, see the Instructions for Form 990.Cat. No. 50082W Schedule F (Form 990) (Rev. 1-2025)

Schedule F (Form 990) (Rev. 1-2025)

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.

(c) Region	(e) Amount of cash grant	(g) Amount of noncash assistance	(h) Description of noncash assistance	(i) Method of valuation (book, FMV, appraisal, other)
SUB-SAHARAN AFRICA	0	18,000	MEDICAL EQUIPMENT	FMV

2	Enter total number of recipient organizations listed above that are recognized as charities by the foreign country, recognized as tax-exempt by the IRS, or for which the grantee or counsel has provided a section 501(c)(3) equivalency letter .......	0
3	Enter total number of other organizations or entities .......................	1

Schedule F (Form 990) (Rev. 1-2025)

Schedule F (Form 990) (Rev. 1-2025)Page 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) (Rev. 1-2025)

Page 4

Part IV

Foreign Forms

Schedule F (Form 990) (Rev. 1-2025)

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.

Schedule F (Form 990) (Rev. 1-2025)

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE G (Form 990)
(Rev. January 2025)

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

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) (Rev. 1-2025)

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)	(b) Event #2 (event type)	(c) Other events (total number)	(d) Total events (add col. (a) through col. (c))
1	Gross receipts . . . . .	260,890			260,890
2	Less: Contributions . . . .	85,170			85,170
3	Gross income (line 1 minus line 2) . . . . . .	175,720			175,720

4	Cash prizes . . . . .
5	Noncash prizes . . . .	30,360	30,360
6	Rent/facility costs . . . .
7	Food and beverages . . .	43,406	43,406
8	Entertainment . . . .	10,500	10,500
9	Other direct expenses . . .	1,205	1,205
10	Direct expense summary. Add lines 4 through 9 in column (d) . . . . . . . . . .		85,471
11	Net income summary. Subtract line 10 from line 3, column (d). . . . . . . . . .		90,249

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) (Rev. 1-2025)

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) (Rev. 1-2025)

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.
Medium right arrow

Attach to Form 990.
Medium right arrow

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

OMB No. 1545-0047

2024

Open to Public Inspection

Name of the organization

DUKE UNIVERSITY HEALTH SYSTEM INC

Employer identification number

56-2070036

Part I

Financial Assistance and Certain Other Community Benefits at Cost

Yes

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

Yes

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

Yes

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

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

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

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

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

Yes

100% 150% 200% Other %

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

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

Yes

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

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

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

Yes

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

Yes

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

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

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

Yes

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

Yes

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

Financial Assistance and Certain Other Community Benefits at Cost

Financial Assistance and Means-Tested Government Programs		(c) Total community benefit expense	(d) Direct offsetting revenue	(e) Net community benefit expense	(f) Percent of total expense
a	Financial Assistance at cost (from Worksheet 1) . . .	167,472,118		167,472,118	3.100 %
b	Medicaid (from Worksheet 3, column a) . . . . .	58,075,510		58,075,510	1.080 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) . .
d	Total Financial Assistance and Means-Tested Government Programs . . . . .	225,547,628		225,547,628	4.180 %
Other Benefits
e	Community health improvement services and community benefit operations (from Worksheet 4).	3,218,190		3,218,190	0.060 %
f	Health professions education (from Worksheet 5) . . .	122,712,488	28,574,650	94,137,838	1.740 %
g	Subsidized health services (from Worksheet 6) . . . .
h	Research (from Worksheet 7) .
i	Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .	15,416,207		15,416,207	0.290 %
j	Total. Other Benefits . .	141,346,885	28,574,650	112,772,235	2.090 %
k	Total. Add lines 7d and 7j .	366,894,513	28,574,650	338,319,863	6.270 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2024

Schedule H (Form 990) 2024

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).....

630,529,259

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

775,731,764

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

-145,202,505

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) 2024

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 (UNIV CAMPUS) 2301 ERWIN ROADPRIMARY DURHAM CAMPUS DURHAM,NC27710 HTTP://WWW.DUKEHEALTH.ORG H0015	X	X	X	X	X	X	A
2	DUKE RALEIGH HOSPITAL A CAMPUS OF DUH 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) 2024

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 24

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 24

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) 2024

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) 2024

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) 2024

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) 2024

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) 2024

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) 2024

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) 2024

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) 2024

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 DUH AND FROM ACROSS DUKE UNIVERSITY SERVE ON THE PARTNERSHIP FOR A HEALTHY DURHAM COMMITTEES.THE 2023 COMMUNITY HEALTH ASSESSMENT REPORT WAS PUBLISHED BY DURHAM COUNTY IN 2024. THE 2023 ASSESSMENT PROCESS INCLUDED 205 COUNTY-WIDE SURVEYS ADMINISTERED BY MORE THAN 50 VOLUNTEERS AND 176 COMUNIDAD LATINA SAMPLE SURVEYS ADMINISTERED BY SEVEN PAID CONTRACTORS. COMMUNITY MEMBERS, PARTNERSHIP FOR A HEALTHY DURHAM MEMBERS, STAFF FROM DURHAM COUNTY DEPARTMENT OF PUBLIC HEALTH AND DUKE UNIVERSITY, AND CONTRACTORS ADMINISTERED THE SURVEYS BETWEEN SEPTEMBER OF 2022 AND APRIL OF 2023. LISTENING SESSIONS CONDUCTED THROUGHOUT DURHAM DISPLAYED SURVEY RESULTS AND ENGAGED COMMUNITY MEMBERS IN DETERMINING THE TOP HEALTH PRIORITIES. THE COMMUNITY HEALTH ASSESSMENT TEAM - COMPRISED OF REPRESENTATIVES FROM DUKE UNIVERSITY HEALTH SYSTEM, LOCAL UNIVERSITIES, LOCAL GOVERNMENT, SCHOOLS, NON-PROFIT ORGANIZATIONS AND BUSINESSES 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 2025 (TAX YEAR 2024).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 FIVE HEALTH PRIORITY AREAS IDENTIFIED BY THE CHNA FOR FISCAL YEARS 2025-2027 ARE LISTED BELOW AND REMAIN THE SAME AS THOSE IDENTIFIED IN THE PREVIOUS CHNA EXCEPT FOR THE THIRD PRIORITY - POVERTY. IN THE LATEST ASSESSMENT "VIOLENT CRIME" WAS THE THIRD HEALTH PRIORITY NAMED, BUT IN CONSIDERATION OF UTILIZING AN ASSETS-BASED APPROACH, THE PRIORITY BROADENED TO "COMMUNITY SAFETY AND WELLBEING": 1. AFFORDABLE HOUSING 2. ACCESS TO HEALTHCARE AND HEALTH INSURANCE3. COMMUNITY SAFETY AND WELLBEING 4. MENTAL HEALTH 5. PHYSICAL ACTIVITY, NUTRITION 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 48% 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 COMMUNITY AFFAIRS. FOR INSIGHT INTO THIS AND OTHER WORK LED BY THE OFFICE OF DURHAM AND COMMUNITY AFFAIRS, SEE: HTTPS://COMMUNITY.DUKE.EDU/OUR-FOCUS-AREAS/NEIGHBORHOODS-HOUSING-AND-INFRASTRUCTURE/.2. ACCESS TO HEALTHCARE AND HEALTH INSURANCEACCESS 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 BY PHYSICIANS, HOSPITALS INCLUDING DUH, LABS, CLINICS AND OTHER PROVIDERS PARTICIPATING IN THE PADC NETWORK.DURING FY2025, 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.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. SHS'S STUDENT POPULATION IS 100% TOTAL ECONOMICALLY DISADVANTAGED AND 47% OF ITS STUDENT POPULATION INDENTIFIES AS HISPANIC/LATINO.
JUST FOR US (JFU): PROVIDES AN IN-HOME CARE PROGRAM FOR LOW-INCOME,	FRAIL ELDERLY AND PERSONS WITH DISABILITIES. 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. JFU ALSO UTILIZES MOBILE LAB AND IMAGING SERVICES. THE HEALTH CARE TEAM CONSISTS OF A CLINICAL PROVIDER (PA, NP OR MD), OCCUPATIONAL THERAPIST, REGISTERED DIETITIAN, SOCIAL WORKER, PHLEBOTOMIST, AND COMMUNITY HEALTH WORKER. JFU ALSO OFFERS FACILITATED TELEHEALTH SPECIALTY VISITS.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 ARE 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 2025, THE SOUTHERN HIGH SCHOOL WELLNESS CENTER, THE NEIGHBORHOOD CLINICS AND JUST FOR US EXPERIENCED SOME STAFFING SHORTAGES, BUT WERE STILL ABLE TO PROVIDE MORE THAN 10,500 PATIENT VISITS.
BENEFITS ENROLLMENT COUNSELING (BEC) : RECEIVES GRANT FUNDING THROUGH THE	NATIONAL COUNCIL ON AGING TO HELP 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. THE PROGRAM SERVES AS A PARTNER SITE FOR DUKE SERVICE-LEARNING, THE SCHOOL OF MEDICINE'S MASTER OF BIOMEDICAL SCIENCES PROGRAM, AND DUKE PRIMARY CARE'S LEADERSHIP TRACK.THE BEC CONTINUED TO EDUCATE STUDENT VOLUNTEERS, PROVIDING OPPORTUNITY FOR CLIENT ENGAGEMENT IN LONGITUDINAL RELATIONSHIPS, WITH TRAINING AROUND MEDICARE, SOCIAL SECURITY AND BENEFIT PROGRAMS TO UNDERGRADUATE AND GRADUATE STUDENTS ALIKE. THE BEC HELPED 448 CLIENTS SECURE $2.85 MILLION IN BENEFITS IN FY25.
3. COMMUNITY SAFETY AND WELLBEING	DURHAM COMMUNITY HEALTH ASSESSMENT SURVEY RESPONDENTS NOTED THAT NEIGHBORHOOD VIOLENCE WAS A PRIMARY CAUSE OF STRESS (12%). SPECIFICALLY, RESPONDENTS NOTED VIOLENT CRIME (18%), THEFT (4.7%), AND GANG ACTIVITY (4.2%) AS HAVING THE GREATEST IMPACT ON QUALITY OF LIFE.DUKE UNIVERSITY HOSPITAL VIOLENCE RECOVERY PROGRAM REFRAMES VIOLENCE AS A PREVENTABLE HEALTH ISSUE. FOUR TEAM MEMBERS SUPPORT RESIDENTS IN THE CITY OF DURHAM AND DURHAM COUNTY WHO HAVE EXPERIENCED VIOLENCE, WITH THE GOAL OF PREVENTING READMISSION TO THE DUKE TRAUMA CENTER.INTENSIVE CASE MANAGEMENT STARTS IN THE EMERGENCY DEPARTMENT WITH THE PATIENT AND FAMILY MEMBERS. THROUGHOUT A HOSPITAL STAY, PROGRAM STAFF MEET WITH THE PATIENT AND FAMILY. TEAM MEMBERS FOLLOW RESIDENTS FOR UP TO ONE YEAR. DURING THAT TIME, CASE MANAGEMENT SUPPORT INCLUDES TACKLING CONCERNS AROUND HOUSING, TRANSPORTATION, MENTAL HEALTH, EMPLOYMENT, LIFE SKILLS AND MORE.THE OFFICE OF COMMUNITY HEALTH SERVES ON THE STEERING COMMITTEE. THE WORK DONE CENTERS ON SUPPORTING EFFORTS TO UNIFY RESEARCH AND PRACTICAL EFFORTS ACROSS DUKE, WHILE ALSO FACILITATING THE WORK OF THE THREE SPECIALIZED SUBCOMMITTEES FOCUSED ON RESEARCH, FEASIBILITY FOR A NEW CENTER AND PEDIATRIC HEALTH RESPONSES.4. MENTAL HEALTHMOST DURHAM COMMUNITY HEALTH ASSESSMENT SURVEY RESPONDENTS (67.1%) REPORTED THAT THEY HAD FEWER THAN SIX BAD DAYS IN THE PAST 30 DAYS. UNFORTUNATELY, ALMOST 10% REPORTED THEY HAD GREATER THAN 20 BAD DAYS IN THE PAST 30 DAYS. FORTY PERCENT OF RESPONDENTS NOTED THAT THEIR MENTAL HEALTH WORSENED SINCE MARCH OF 2020. IN TERMS OF STRESS, FINANCIAL STRESS WAS THE MOST REPORTED REASON FOLLOWED BY WORK AND PERSONAL RELATIONSHIPS.IN 2021, DUKE OPENED THE DUKE BEHAVIORAL HEALTH CENTER ON DUKE REGIONAL HOSPITAL'S CAMPUS AND EXPANDED THE HOSPITAL'S EMERGENCY ROOM. THE $102.4 MILLION CENTER AND EXPANDED EMERGENCY ROOM 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 SPECIFICALLY DESIGNED FOR COMMUNITY BASED ORGANIZATIONS PROVIDING SERVICES FOR BEHAVIORAL HEALTH PATIENTS AND THEIR FAMILIES.DUKE PARTNERS WITH AND SUPPORTS THE INITIATIVES LISTED BELOW TO IMPROVE ACCESS TO MENTAL HEALTH SERVICES:* INTEGRATED EMERGENCY ROOM DIVERSION PROGRAM: DUKE HEALTH AND ALLIANCE HEALTH COLLABORATE THROUGH AN INTEGRATED EMERGENCY ROOM DIVERSION PROGRAM THAT INCLUDES EMBEDDING CONTRACT SOCIAL WORKERS AND CRISIS LIAISONS DIRECTLY WITHIN DUKE'S EMERGENCY DEPARTMENTS TO STREAMLINE TRANSITIONS TO SPECIALIZED CARE.* DURHAM FAMILIAR FACES INITIATIVE: DUKE HEALTH IS AN ACTIVE AND CENTRAL PARTNER IN THE DURHAM FAMILIAR FACES INITIATIVE (DFFI). THIS PROGRAM IS SPECIFICALLY DESIGNED TO ADDRESS THE NEEDS OF 'HIGH UTILIZERS", INDIVIDUALS WHO FREQUENTLY CYCLE THROUGH THE EMERGENCY DEPARTMENT, THE COUNTY JAIL, AND THE HOMELESS SHELTERS DUE TO UNTREATED MENTAL HEALTH OR SUBSTANCE ABUSE DISORDERS.* PEDIATRIC EMERGENCY DEPARTMENT EXTENSION AREA: THE PEDIATRIC ED EXTENSION AREA WHICH OPENED IN EARLY 2024 SERVED APPROXIMATELY 250 YOUTH RANGING FROM 6 TO 17 YEARS OLD DURING THE FIRST 10 MONTHS OF BEING OPEN. CLINICAL DATA SHOWED THAT MOVING CHILDREN TO THIS DEDICATED SPACE LEAD TO A MARKED DECREASE IN THE NEED FOR RAPID BEHAVIORAL RESPONSE INTERVENTIONS.
5. PHYSICAL ACTIVITY, NUTRITION AND FOOD ACCESS	MOST DURHAM COUNTY HEALTH ASSESSMENT SURVEY RESPONDENTS REPORTED THAT WALKING WAS THEIR PRIMARY FORM OF EXERCISE FOLLOWED BY LIFTING WEIGHTS AND GARDENING. TIME AND COST WERE THE MOST COMMON REASONS FOR NOT EATING HEALTHY, BUT 83% OF RESPONDENTS REPORTED THAT THEY NEVER WORRIED ABOUT FOOD RUNNING OUT BEFORE THEY COULD BUY MORE.DUKE HEALTH, IN PARTNERSHIP WITH THE DURHAM COUNTY DEPARTMENT OF PUBLIC HEALTH, SECURED A MULTI-YEAR GRANT TOTALING $750,000 FROM THE DUKE ENDOWMENT TO BECOME A PART OF THE ENDOWMENT'S HEALTHY PEOPLE, HEALTHY CAROLINA'S INITIATIVE. THIS INITIATIVE SUPPORTS COALITIONS AIMED AT IMPROVING THE HEALTH AND WELL-BEING OF COMMUNITIES TO REDUCE CHRONIC DISEASE AND PLACES SIGNIFICANT EMPHASIS ON PHYSICAL ACTIVITY, NUTRITION AND FOOD ACCESS.DURING FISCAL YEAR 2025 THE PARTNERSHIP FOR A HEALTHY DURHAM'S PHYSICAL ACTIVITY, NUTRITION AND FOOD ACCESS COMMITTEE (PANFA) ENCOURAGED CHILDREN TO ENGAGE IN PHYSICAL ACTIVITY BY MAKING ENHACEMENTS TO SCHOOL AND PUBLIC PLAYGROUNDS. FOUR HUNDRED THIRTEEN CHILDREN PARTICPATED IN TRACKING PHYSICAL ACTIVITY AND TEACHERS WERE SURVEYED REGARDING PHYSICAL ACTIVITY LEVELS AND ANY OTHER IMPACTS OF THE ENHANCEMENTS. SEVENTY-TWO PERCENT OF THE STUDENTS GOT 30-60 MINUTES OF ACTIVITY COMPARED TO 68% BEFORE THE ENHANCEMENTS. THE PERCENTAGE OF TIME STUDENTS SPENT BEING ACTIVE WHILE OUTSIDE INCREASED FROM 68% TO 86%. TEACHERS NOTED FEWER DISCIPLINE ISSUES DURING RECESS AS MORE STUDENTS ENGAGED IN PHYSICAL ACTIVITY. TEACHERS ALSO NOTED THAT STUDENTS SEEMED MORE INTERESTED AND ENGAGED IN CLASS.
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 FISCAL YEARS 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 THE 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). DRAH REPRESENTATIVES 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 CONTINUES TO SUPPORT 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) AND IN EFFORTS TO ELIMINATE HOMELESSNESS. DUKE RALEIGH HOSTED AN INTERNAL EDUCATION FAIR TO PROMOTE JOB PLACEMENT AND CAREER ADVANCEMENT OPPORTUNITIES FOR TEAM MEMBERS. DUKE RALEIGH WILL CONTINUE STRENGTHENING PATHWAYS THAT SUPPORT ECONOMIC STABILITY, INCLUDING INITIATIVES THAT HELP ADDRESS HOUSING INSECURITY AND HOMELESNESS THROUGH IMPROVED JOB ACCESS AND CAREER MOBILITY.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, 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 FY 2025 ON INITIATIVES TO ADDRESS ACCESS TO HEALTHCARE:* PROVIDED APPROXIMATELY $18.8 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 OF WAKE COUNTY, URBAN MINISTRIES OF WAKE COUNTY'S OPEN DOOR CLINIC, URBAN MINISTRIES OF WAKE COUNTY'S CLIENT CHOICE PANTRY, AND ALLIANCE MEDICAL MINISTRY. - DUKE RALEIGH PROVIDED IN-KIND LAB SERVICES TO URBAN MINISTRIES OF WAKE COUNTY'S OPEN-DOOR CLINIC AT AN ESTIMATED ANNUAL VALUE OF $1.67 MILLION. - DONATED AND PACKED 5,750+ POUNDS OF RICE AND BEANS FOR URBAN MINISTRIES OF WAKE COUNTY'S CLIENT CHOICE PANTRY BETWEEN FY17-25 (ENGAGING 30+ EMPLOYEES ANNUALLY). - ASSEMBLED AND DONATED 500+ FLU KITS TO URBAN MINISTRIES OF WAKE COUNTY AND ALLIANCE MINISTRIES AT THE HEIGHT OF FLU AND COVID BETWEEN FY23-25. - PROVIDED FINANCIAL SUPPORT TO ALLIANCE MEDICAL MINISTRY TO SUPPORT THEIR EFFORTS TO PROVIDE COMPREHENSIVE, COMPASSIONATE AND AFFORDABLE HEALTHCARE TO WORKING UNINSURED ADULTS IN WAKE COUNTY.
*PARTICIPATED IN COMMUNITY HEALTH FAIRS AND SCREENING EVENTS DESIGNED	TO EXPAND ACCESS TO CARE, PARTICULARLY IN UNDERSERVED SPECIALTIES AND POPULATIONS BY BRINGING PREVENTATIVE SERVICES, EDUCATION AND CONNECTIONS TO CARE DIRECTLY INTO HIGH-NEED NEIGHBORHOODS.DUKE RALEIGH PARTICIPATED IN THE FOLLOWING EVENTS DURING FY 2025: - RALEIGH FIREBIRDS STEM & HEALTHCARE FAIR - VOCAL HEALTH - RALEIGH FIREBIRDS HEAD & NECK CANCER SCREENING EVENT - BLACK FAMILY WELLNESS EXPO HEAD & NECK CANCER SCREEENING, SPEECH LANGUAGE PATHOLOGY, VOICE CARE AND AUDIOLOGY ASSESSMENTS - HEARING LOSS STIGMA PRESENTATION* PROVIDED HOLIDAY SUPPORT TO A LOCAL TITLE I MIDDLE AND HIGH SCHOOL PARTNER, ASSISTING MORE THAN 17 STUDENTS AND THEIR FAMILIES WITH ESSENTIAL RESOURCES DURING THE THANKSGIVING AND WINTER HOLIDAY SEASON, HELPING TO STRENGTHEN FAMILY STABILITY AND ADDRESS IMMEDIATE SOCIAL NEEDS THAT IMPACT OVERALL HEALTH.* PARTNERED WITH MEDASSIST IN COLLABORATION WITH THE BUILDING HEALTHY COMMUNITIES GRANT TO PROVIDE FREE OVER THE COUNTER MEDICATIONS TO COMMUNITY MEMBERS IN NEED.* 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. IN FY25, DUKE RALEIGH HOSTED ONE SATURDAY FOCUSED ON THE IMPORTANCE OF THE FLU VACCINE AND HAND WASHING.
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 FY 2025 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.* COLLABORATED WITH THE OFFICE OF COMMUNITY HEALTH TO HOST A YOUTH MENTAL HEALTH MINI SUMMIT IN PARTNERSHIP WITH SOUTHEAST RALEIGH PROMISE AND THE SOUTHEAST RALEIGH YMCA. THIS CONVENING FOCUSED ON EMERGING YOUTH MENTAL HEALTH CONCERNS, COMMUNITY-DRIVEN SOLUTIONS, AND STRENGTHENING LOCAL SUPPORT NETWORKS.PARTNERED WITH THE OFFICE OF COMMUNITY HEALTH TO SERVE AS PRESENTING SPONSORS OF THE ANNUAL NAMI WAKE COUNTY WALK. AS PART OF THE EFFORT, WE BROUGHT TOGETHER MENTAL HEALTH PROVIDERS AND CLINICIANS TO DEMONSTRATE SUPPORT FOR OUR COMMUNITY AND RAISE AWARENESS OF MENTAL HEALTH NEEDS.DEVELOPED A PROGRAM IN FY25 TO SUPPORT MINORS HOLDING IN THE ED WITH A COMFORTING AND SAFE, QUILT-MAKING ACTIVITY.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 2023 DURHAM COMMUNITY HEALTH ASSESSMENT. THE 2023 COMMUNITY HEALTH ASSESSMENT REPORT WAS PUBLISHED BY DURHAM COUNTY IN 2024. THE 2023 ASSESSMENT PROCESS INCLUDED 205 COUNTY-WIDE SURVEYS ADMINISTERED BY MORE THAN 50 VOLUNTEERS AND 176 COMUNIDAD LATINA SAMPLE SURVEYS ADMINISTERED BY 7 PAID CONTRACTORS. COMMUNITY MEMBERS, PARTNERSHIP FOR A HEALTHY DURHAM MEMBERS, STAFF FROM DURHAM COUNTY DEPARTMENT OF PUBLIC HEALTH AND DUKE UNIVERSITY AND CONTRACTORS ADMINISTERED THE SURVEYS BETWEEN SEPTEMBER OF 2022 AND APRIL OF 2023. LISTENING SESSIONS CONDUCTED THROUGHOUT DURHAM DISPLAYED SURVEY RESULTS AND ENGAGED COMMUNITY MEMBERS IN DETERMINING THE TOP HEALTH PRIORITIES. THE COMMUNITY HEALTH ASSESSMENT TEAM-COMPRISED OF REPRESENTATIVES FROM DUKE UNIVERSITY HEALTH SYSTEM, LOCAL UNIVERSITIES, LOCAL GOVERNMENTS, SCHOOLS, NON-PROFIT ORGANIZATIONS AND BUSINESSES 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 2025 (TAX YEAR 2024).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 FISCAL YEARS 2025-2027:1. AFFORDABLE HOUSING2. ACCESS TO HEALTHCARE AND HEALTH INSURANCE3. COMMUNITY SAFETY AND WELLBEING4. MENTAL HEALTH5. PHYSICAL ACTIVITY, NUTRITION 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. AFFORDABLE HOUSING AFFORDABLE HOUSING IS A FOCUS OF THE LARGER DUKE UNIVERSITY. DUKE UNIVERSITY'S OFFICE OF DURHAM AND COMMUNITY AFFAIRS LEADS DUKE'S WORK RELATED TO AFFORDABLE HOUSING. INSIGHT INTO THIS AND OTHER WORK LED BY THE OFFICE OF DURHAM AND COMMUNITY AFFAIRS IS AVAILABLE ON THEIR WEBSITE HTTPS://COMMUNITY.DUKE.EDU/OUR-FOCUS-AREAS/NEIGHBORHOODS-HOUSING-AND-INFRASTRUCTURE/. IN ADDITION, DUKE IMPLEMENTED A PLAN TO GRADUALLY INCREASE THE MINIMUM 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. IN JULY 2024, DUKE'S MINIMUM WAGE INCREASED TO $18 PER HOUR.
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 2025, INCLUDING MONETARY AND IN-KIND SERVICES, WAS $10.2 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 2025, DUKE REGIONAL HOSPITAL CONTRIBUTED $3.1 MILLION TO THE COUNTY TO SUPPORT DURHAM EMS AND DURHAM RECOVERY RESPONSE CENTER.PROJECT ACCESS OF DURHAM COUNTY (PADC): 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 FY 2025, DUKE REGIONAL HOSPITAL PROVIDED FINANCIAL SUPPORT OF $20,000 TO PADC.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 2025 DUKE REGIONAL PROVIDED $27.9 MILLION (AT ESTIMATED COST) IN FINANCIAL ASSISTANCE. IN ADDITION, DUKE REGIONAL ABSORBED $3.3 MILLION IN MEDICAID CARE LOSSES IN FY 2025 DUE TO GOVERNMENT REIMBURSEMENTS NOT FULLY MEETING THE COST OF TREATMENT.COMMUNITY HEALTH IMPROVEMENT SERVICES: IN 2025, DUKE REGIONAL HOSPITAL PROVIDED $700,000 IN PATIENT SPONSORSHIP SERVICES, WHICH INCLUDES EXPENSES SUCH AS PAYMENT FOR HOSPITALIZATION, TRANSPORTATION, PATIENT CARE SUPPLIES, DURABLE MEDICAL EQUIPMENT, OUTPATIENT CARE AND LODGING BASED ON SPECIFIC INDIGENT FUNDING GUIDELINES.3. COMMUNITY SAFETY AND WELLBEINGFILL 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 FROM 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 FY 2025 DUKE REGIONAL ALSO SUPPORTED A FOOD DRIVE FOR NORTH CAROLINA FOOD BANK OF CENTRAL & EASTERN NORTH CAROLINA AND A COAT DRIVE FOR OPEN TABLE MINISTRIES IN DURHAM.LOOK GOOD FEEL BETTER: 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. DURING FY 2025 DUKE REGIONAL SPONSORED THE MONTHLY WORKSHOPS IN A VIRTUAL FORMAT.STROKE SUPPORT: DUKE REGIONAL OFFERS A MONTHLY STROKE SUPPORT GROUP THAT OFFERS EDUCATION, SUPPORT AND RESOURCES FOR INDIVIDUALS WHO HAVE BEEN AFFECTED BY STROKE. THE STROKE GROUP HAS ADAPTED ITS FORMAT THROUGH THE YEARS AND IS CURRENTLY MEETING BOTH VIRTUALLY AND IN PERSON.EDUCATION INITIATIVES: EDUCATION IS AN UPSTREAM DRIVER OF HEALTH AND SOCIAL OUTCOMES. DUKE REGIONAL THEREFORE INTEGRATES EDUCATION INITIATIVES INTO ITS COMMUNITY STRATEGY TO ADVANCE THE PRIORITIES INDENTIFIED ABOVE, PARTICULARLY ACCESS TO HEALTHCARE AND COMMUNITY WELL-BEING AND IS COMMITTED TO HELPING TRAIN THE HEALTHCARE WORKERS OF THE FUTURE.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.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 DIVISION OF EMPLOYMENT AND INDEPENDENCE FOR PEOPLE WITH DISABILITIES ("EIPD") 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 8 NEW GRADUATES IN 2025 FOR A TOTAL OF 111 GRADUATES TO DATE.FUNDRAISING AND OUTREACH: DUKE REGIONAL HOSPITAL CONDUCTS A NUMBER OF FUNDRAISING AND OUTREACH ACTIVITIES IN THE DURHAM COMMUNITY AND BEYOND. DUKE REGIONAL RAISED $16,127 TO SUPPORT LOCAL CHARITIES DURING FY 2025.THE HOSPITAL CONTINUES TO PARTNER WITH LOCAL NONPROFITS ON ENDEAVERS THAT EDUCATE THE COMMUNITY ABOUT HEALTH INITIATIVES AND DISPARITIES AND PROVIDES OFFICE SPACE FOR THE DURHAM COMMUNITY HEALTH COALITION. IN FY 2025, DUKE REGIONAL HOSPITAL PARTNERED WITH THE AMERICAN RED CROSS TO HOST THREE BLOOD DRIVES THAT RESULTED IN 83 UNITS OF BLOOD COLLECTED.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. PHYSICAL ACTIVITY, NUTRITION AND FOOD ACCESS	WHILE DUKE REGIONAL HOSPITAL DOES NOT LEAD FACILITY SPECIFIC PROGRAMS FOCUSED ON THIS HEALTH PRIORITY, THE NEED IS ADDRESSED THROUGH BROADER DUKE HEALTH INITIATIVES THAT BENEFIT THE DUKE REGIONAL HOSPITAL COMMUNITY. DUKE HEALTH, IN PARTNERSHIP WITH THE DURHAM COUNTY DEPARTMENT OF PUBLIC HEALTH, SECURED A MULTI-YEAR GRANT TOTALING $750,000 FROM THE DUKE ENDOWMENT TO BECOME A PART OF THE ENDOWMENT'S HEALTHY PEOPLE, HEALTHY CAROLINAS INITIATIVE. THE INITIATIVE SUPPORTS COALITIONS AIMED AT IMPROVING THE HEALTH AND WELL-BEING OF COMMUNITIES TO REDUCE CHRONIC DISEASE. THE COALITIONS PLACE SIGNIFICANT EMPHASIS ON PHYSICAL ACTIVITY, NUTRITION AND FOOD ACCESS. DURHAM'S COALITION IS THE PARTNERSHIP FOR A HEALTHY DURHAM'S PHYSICAL ACTIVITY, NUTRITION AND FOOD ACCESS COMMITTEE.SEVERAL HEALTHY PEOPLE, HEALTHY CAROLINAS RELATED INITIATIVES WERE INITIATED DURING THE FIRST IMPLEMENTATION YEAR. THE FOOD RECOVERY PROGRAM SAVED OVER 2,000 POUNDS OF FOOD, FEEDING 1,725 PEOPLE. THE VAPING PREVENTION PROGRAM WAS SUCCESSFULLY INTRODUCED INTO ONE ELEMENTARY SCHOOL IN THE SPRING, TEACHING 33 STUDENTS. SIX LEADERS AND EIGHT COMMUNITY MEMBERS TRAINED IN SELF-MANAGEMENT SKILLS FOR CHRONIC ILLNESS IN A TRAIN-THE-TRAINER MODEL. PANFA COLLABORATED WITH CITY TRANSPORTATION STAFF TO INSTALL A BIKE FIX-IT STATION, A FREE RESOURCE FOR BICYCLISTS TO FIX MECHANICAL ISSUES, CONNECTING MULTIPLE PARKS. PANFA MEMBERS ENGAGE IN THE CITY'S VISION ZERO PLAN AND THE JOINT CITY AND COUNTY BIKE AND PEDESTRIAN PLAN, BOTH AIMING TO IMPROVE SAFETY OF STREETS AND ACCESS TO SAFE ACTIVITY.DURING FISCAL YEAR 2025, PANFA ENCOURAGED CHILDREN TO ENGAGE IN PHYSICAL ACTIVITY BY MAKING ENHANCEMENTS TO SCHOOL AND PUBLIC PLAYGROUNDS. FOUR HUNDRED THIRTEEN CHILDREN PARTICIPATED IN TRACKING PHYSICAL ACTIVITY AND TEACHERS WERE SURVEYED REGARDING PHYSICAL ACTIVITY LEVELS AND OTHER IMPACTS OF THE ENHANCEMENTS. SEVENTY-TWO PERCENT OF THE STUDENTS GOT 30-60 MINUTES OF ACTIVITY COMPARED TO 68% BEFORE THE ENHANCEMENTS. THE PERCENTAGE OF TIME THE STUDENTS SPENT BEING ACTIVE WHILE OUTSIDE INCREASED FROM 68% TO 86%. TEACHERS NOTED FEWER DISCIPLINE ISSUES DURING RECESS AS MORE STUDENTS ENGAGED IN PHYSICAL ACTIVITY. TEACHERS ALSO NOTED THAT STUDENTS SEEMED MORE INTERESTED AND ENGAGED IN CLASS.

Schedule H (Form 990) 2024

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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 AND INDEPENDENT DIAGNOSTIC TESTING FACILITY
2	2 - DUKE HEALTH IMAGING AT HERITAGE 3000 ROGERS RD WAKE FOREST,NC27587	INDEPENDENT DIAGNOSTIC TESTING FACILITY
3	3 - DUKE IMAGING SERVICES 3700 NW CARY PARKWAY SUITE 120 CARY,NC27513	INDEPENDENT DIAGNOSTIC TESTING FACILITY
4	4 - DUKE PTOT AT HILLSBOROUGH 267 SOUTH CHURTON HILLSBOROUGH,NC27278	SPECIALTY
5	5 - DUKE HEALTH IMAGING AT HOLLY SPRINGS 401 IRVING PKWY HOLLY SPRINGS,NC27540	INDEPENDENT DIAGNOSTIC TESTING FACILITY
6	6 - DUKE MEADOWMONT CHAPEL HILL 802 W BARBEE CHAPEL ROAD SUITE 100 CHAPEL HILL,NC27517	SPECIALTY
7	7 - DUKE IMAGING COLEY HALL 66 VILCOM CENTER DR SUITE 101 CHAPEL HILL,NC27514	INDEPENDENT DIAGNOSTIC TESTING FACILITY
8	8 - HOCK FAMILY PAVILION 4023 NORTH ROXBORO ROAD DURHAM,NC27704	HOSPICE
9
10

Schedule H (Form 990) 2024

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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 6.8%.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 HEALTH INTEGRATED PRACTICE, 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. TOTAL ESTIMATED NET COMMUNITY BENEFIT EXPENSES FOR THESE ENTITIES TOTALED $112.5 MILLION IN FY2025.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 $36,043,000 IN FISCAL YEAR 2025. 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 18-21 IN THE FY2025 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, 2025 DUHS CONSOLIDATED FINANCIAL STATEMENTS ARE $708,572,000 AS COMPARED TO $145,202,505 AS REPORTED IN SECTION B, LINE 7 OF SCHEDULE H. THE DUHS TOTAL MEDICARE SHORTFALL OF $708,572,000 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, COSTS REIMBURSED THROUGH MEANS NOT REPORTED ON THE COST REPORT, AND UNREIMBURSED COSTS PROVIDED BY DUHS' SUPPORT CORPORATIONS THAT ARE NOT REQUIRED TO FILE A COST REPORT OR COMPLETE A SCHEDULE H.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 2.1 MILLION, THIS 7-COUNTY REGION REPRESENTS APPROXIMATELY 19.3% OF NC'S POPULATION BASED ON FEDERAL FISCAL YEAR (FFY) 2024 DATA. THE WEIGHTED AVERAGE MEDIAN HOUSEHOLD INCOME IN ITS PSA IS $74,695. APPROXIMATELY 68% OF INPATIENT DISCHARGES FROM DUHS FACILITIES IN FFY 2024 WERE PATIENTS FROM ITS PSA. THE POPULATION IN DUHS' PSA IS EXPECTED TO GROW AT A HIGHER RATE OVER THE NEXT 5 YEARS FROM 2025 TO 2029 COMPARED TO NC'S OVERALL EXPECTED POPULATION GROWTH RATE. THE PSA 5-YEAR CAGR IS EXPECTED TO BE 1.1% COMPARED TO THE OVERALL ESTIMATED NC RATE OF 0.9%. 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 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. FURTHERMORE, 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 TO ADDRESS SOCIAL DRIVERS OF HEALTH. DUHS' OFFICE OF COMMUNITY HEALTH'S CHIEF COMMUNITY HEALTH AND SOCIAL IMPACT OFFICER IS 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 IDENTIFIED BY THE COMMUNITY. IN ADDITION, THE OFFICE PROVIDES A POINT OF DIRECT CONTACT FOR COMMUNITY MEMBERS WHO HAVE QUESTIONS OR CONCERNS ABOUT COMMUNITY ISSUES OR ACCESS TO HEALTH CARE SERVICES. THE OFFICE ALSO PROVIDES DIRECT FINANCIAL SUPPORT TO A VARIED PORTFOLIO OF COMMUNITY GROUPS THROUGH THE BUILDING HEALTHY COMMUNITIES GRANTS PROGRAM. THE CHIEF HEALTH AND SOCIAL IMPACT OFFICER 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. DUHS' CEO ALSO HAS A 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 GRANT COMMITTEE TO REVIEW COMMUNITY REQUESTS FOR PHILANTHROPIC ASSISTANCE THAT PROMOTE HEALTH, WELLNESS, AND ECONOMIC MOBILITY. DUHS FORMED A COMMUNITY HEALTH EXECUTIVE COUNCIL IN 2022 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. EACH YEAR, DUKE RALEIGH HOSPITAL PARTNERS WITH ENLOE MAGNET HIGH SCHOOL AND SOUTHEAST RALEIGH MAGNET HIGH SCHOOL TO HOST A STEAM CAREER FAIR AND GUIDED HOSPITAL TOUR IN WAKE COUNTY. CLINICAL AND NON-CLINICAL TEAM MEMERS ACROSS THE HOSPITAL PARTICIPATE TO HELP STUDENTS EXPLORE THE MANY ROLES THAT SHAPE PATIENT CARE AND COMMUNITY HEALTH. THE EVENT IS DESIGNED TO SPARK CURIOSITY, HIGHLIGHT THE BREADTH OF CAREERS IN HEALTHCARE, AND SUPPORT EARLY PIPELINE DEVELOPMENT FOR THE NEXT GENERATION OF HEALTH PROFESSIONALS.DURHAM-ORANGE MEDICAL SOCIETY AND THE DURHAM ACADEMY OF MEDICINE, DENTISTRY AND PHARMACY (AN ASSOCIATION FOR AFRICAN-AMERICAN MEDICAL PROFESSIONALS) HELP 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. DUKE FACULTY ARE INVOLVED WITH MENTORING STUDENTS AND CLASSROOM LECTURES AT THE CITY MEDICINE ACADEMY.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 DUKE PATIENTS BASED ON PROVIDER PRESCRIPTIONS. OCH IS ALSO AN ADVISOR TO A STUDENT-LED GROUP AT DUKE 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 HEALTH CARE SERVICES ACROSS THE FULL CONTINUM OF CARE, FROM WELLNESS AND PREVENTATIVE SERVICES TO HOSPICE. DUHS' HEALTH CARE NETWORK INCLUDES FOUR HOSPITALS, AN EXTENSIVE AMBULATORY AND CLINIC NETWORK, AND AN INTEGRATED PHYSICIAN PRACTICE ORGANIZATION. DUHS IS ANCHORED BY DUKE UNIVERSITY HOSPITAL, WHICH OPERATES AS A SINGLE MULTI-CAMPUS HOSPITAL, INCLUDING ITS FLAGSHIP ACADEMIC MEDICAL CENTER LOCATED ON THE DUKE UNIVERSITY CAMPUS IN DURHAM, NORTH CAROLINA (THE DUKE UNIVERSITY HOSPITAL-UNIVERSITY CAMPUS) AND A COMMUNITY HOSPITAL LOCATED IN RALEIGH, NORTH CAROLINA (DUKE RALEIGH HOSPITAL). THE UNIVERSITY CAMPUS LOCATION IS AN ACADEMIC MEDICAL CENTER THAT PROVIDES COMPREHENSIVE DIAGNOSTIC AND THERAPEUTIC SERVICES AND SERVES AS A TEACHING AND RESEARCH HOSPITAL FOR STUDENTS OF MEDICINE, NURSING, AND ALLIED HEALTH SCIENCES. DUKE RALEIGH HOSPITAL IS A GENERAL ACUTE CARE COMMUNITY HOSPITAL PROVIDING SERVICES PRIMARILY TO RESIDENTS OF WAKE COUNTY AND SURROUNDING COMMUNITIES. DUHS ALSO OPERATES DUKE REGIONAL HOSPITAL, A GENERAL ACUTE CARE COMMUNITY HOSPITAL LOCATED IN DURHAM, NORTH CAROLINA, PROVIDING CARE TO RESIDENTS OF DURHAM AND SURROUNDING COMMUNITIES. ON APRIL 1, 2025, DUHS, THROUGH A WHOLLY CONTROLLED AFFILIATE, ACQUIRED LAKE NORMAN REGIONAL MEDICAL CENTER IN MOORESVILLE, NORTH CAROLINA, AND NOW OPERATES THIS FACILITY AS DUKE HEALTH LAKE NORMAN HOSPITAL, A COMMUNITY HOSPITAL SERVING SOUTHERN IREDELL COUNTY AND THE SURROUNDING REGION.ACROSS ITS HOSPITALS AND ABULATORY OPERATIONS, DUHS OFFERS A COMPREHENSIVE RANGE OF MEDICAL, SURGICAL, DIAGNOSTIC, EMERGENCY, REHABILITATIVE, BEHAVIORAL HEALTH, AND SPECIALTY SERVICES. DUHS' AMBULATORY FOOTPRINT INCLUDES A BROAD NETWORK OF CLINICS, PRIMARY CARE PRACTICES, AND SPECIALTY CLINICS LOCATED THROUGHOUT ITS SERVICE AREA.DUKE HEALTH INTEGRATED PRACTICE (DHIP) IS DUHS' EMPLOYED PHYSICIAN AND CLINICAL PRACTICE ORGANIZATION AND SUPPORTS THE DELIVERY OF PRIMARY AND MULTI-SPECIALTY CARE ACROSS THE SYSTEM. DUHS ALSO PROVIDES HOME HEALTH, HOME INFUSION, AND HOSPICE SERVICES, ENABLING CARE TO BE DELIVERED IN OUTPATIENT AND HOME-BASED SETTINGS WHEN CLINICALLY APPROPRIATE.DUHS' OPERATING UNITS WORK TOGETHER TO PROVIDE COORDINATED CARE AT THE APPROPRIATE LEVEL OF SERVICE, WITH AN EMPHASIS ON ACCESS, QUALITY AND COMMUNITY BENEFIT. LIST OF ALL STATES WHICH ORGANIZATION FILES A COMMUNITY BENEFIT REPORT:PART VI, LINE 7:NORTH CAROLINA

Schedule H (Form 990) 2024

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Schedule I
(Form 990)
(Rev. January 2025)

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 instructions and the latest information.

OMB No. 1545-0047

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	(h) Purpose of grant or assistance
(1) ALLIANCE MEDICAL MINISTRY INC 101 DONALD ROSS DR RALEIGH,NC27610	56-2168673	501(C)(3)	50,000	COMMUNITY SUPPORT
(2) AMERICAN HEART ASSOCIATION INC PO BOX 843384 DALLAS,TX752843384	13-5613797	501(C)(3)	75,000	SPONSORSHIP
(3) AUTISM SUPPORT AND ADVOCACY CENTER 1901 CHAPEL HILL RD DURHAM,NC27707	26-4613218	501(C)(3)	15,000	COMMUNITY SUPPORT
(4) BACKPACK PROJECT DURHAM 1400 WEST MAIN ST BOX 97347 DURHAM,NC27708	92-3221822	501(C)(3)	7,500	COMMUNITY SUPPORT
(5) BLACK FARMERS MARKET PO BOX 13633 DURHAM,NC27709	87-2075264	501(C)(3)	10,000	COMMUNITY SUPPORT
(6) BOYS & GIRLS CLUBS OF DURHAM & ORAN 1010 MARTIN LUTHER KING JR PKW DURHAM,NC27713	56-6001906	501(C)(3)	11,000	COMMUNITY SUPPORT
(7) BOYS CLUB OF WAKE COUNTY INC 701 N RALEIGH BLVD RALEIGH,NC27610	56-0863051	501(C)(3)	20,000	SPONSORSHIP
(8) CAPSTONE EVENT GROUP INC 3803-B COMPUTER DR SUITE 205 RALEIGH,NC27609	46-4157559		7,500	SPONSORSHIP
(9) CENTRAL PARK SCHOOL FOR CHILDREN 724 FOSTER ST DURHAM,NC27701	20-1582345	501(C)(3)	20,000	COMMUNITY SUPPORT
(10) CHILDRENS CANCER PARTNERS 900 S PINE ST STE F SPARTANBURG,SC29302	20-2511033	501(C)(3)	8,500	COMMUNITY SUPPORT
(11) CHILDRENS FLIGHT OF HOPE INC 751 CORPORATE CENTER DR STE 130 RALEIGH,NC27607	56-1762824	501(C)(3)	20,000	COMMUNITY SUPPORT
(12) CITY OF MEDICINE VOLUNTEER MEDICAL 6409 FAYETTVILLE RD STE 120 334 DURHAM,NC27713	86-2706784	501(C)(3)	15,000	COMMUNITY SUPPORT
(13) COMMUNITIES IN PARTNERSHIP PO BOX 11247 DURHAM,NC27703	47-5567396	501(C)(3)	30,000	COMMUNITY SUPPORT
(14) COMMUNITY FOUNDATION OF MIDDLE TN 3421 BELMONT BLVD NASHVILLE,TN37215	62-1471789	501(C)(3)	50,000	COMMUNITY SUPPORT
(15) COMMUNITY HEALTH COALITION INC PO BOX 15176 DURHAM,NC277042755	56-2269385	501(C)(3)	8,500	COMMUNITY SUPPORT
(16) DURHAM CHILDRENS INITIATIVE 2101 ANGIER AVE 200 DURHAM,NC27703	32-0263133	501(C)(3)	8,500	COMMUNITY SUPPORT
(17) DURHAM NATIVITY SCHOOL 1004 N MANGUM ST DURHAM,NC27701	56-2274228	501(C)(3)	6,000	COMMUNITY SUPPORT
(18) DURHAM PUBLIC SCHOOLS FOUNDATION 600 E UMSTEAD ST DURHAM,NC27701	82-2803464	501(C)(3)	100,000	COMMUNITY SUPPORT
(19) DURHAM SUCCESS SUMMIT INC 732 9TH STREET 596 DURHAM,NC27705	86-2985757	501(C)(3)	7,250	COMMUNITY SUPPORT
(20) EL CENTRO HISPANO INC 2000 CHAPEL HILL RD 26A DURHAM,NC27707	56-2011661	501(C)(3)	7,500	SPONSORSHIP
(21) EMILY KRZYZEWSKI FAMILY LIFE CENTER 904 W CHAPEL HILL ST DURHAM,NC27701	56-2230469	501(C)(3)	25,000	SPONSORSHIP
(22) EMPOWERED PARENTS IN COMMUNITY PO BOX 51431 DURHAM,NC27717	84-1926159	501(C)(3)	7,500	SPONSORSHIP
(23) FAMILIES MOVING FORWARD PO BOX 25426 DURHAM,NC27702	56-1633998	501(C)(3)	20,000	COMMUNITY SUPPORT
(24) FAMILY VIOLENCE PREVENTION CTR INC 1012 OBERLINE RD SUITE 100 RALEIGH,NC27605	58-1320613	501(C)(3)	30,000	SPONSORSHIP
(25) FIGHT FOR 1 OF US INC 8024 GLENWOOD AVE SUITE 200 RALEIGH,NC27607	27-4754653	501(C)(3)	30,000	SPONSORSHIP
(26) FOOD BANK OF CENTRAL & EASTERN NC 1924 CAPITAL BLVD RALEIGH,NC27604	56-1283426	501(C)(3)	10,000	COMMUNITY SUPPORT
(27) GREAT 100 INC PO BOX 4875 GREENSBORO,NC274044875	56-1705456	501(C)(3)	20,000	SPONSORSHIP
(28) HABITAT FOR HUMANITY OF DURHAM 1823 CHAPEL HILL RD DURHAM,NC27707	58-1674794	501(C)(3)	75,000	COMMUNITY SUPPORT
(29) HELENE FOUNDATION 13200 STRICKLAND RD 114-308 RALEIGH,NC27613	27-0810112	501(C)(3)	7,500	COMMUNITY SUPPORT
(30) HOLT BROTHERS FOUNDATION INC 421 FAYETTEVILLE ST SUITE 1300 RALEIGH,NC27601	56-6570426	501(C)(3)	7,500	SPONSORSHIP
(31) HOUSING FOR NEW HOPE INC 18 W COLONY PLACE SUITE 250 DURHAM,NC27705	58-2089068	501(C)(3)	35,000	COMMUNITY SUPPORT
(32) IMMERSION FOR SPANISH LANGUAGE AQUI PO BOX 16278 CHAPEL HILL,NC27516	45-5336885	501(C)(3)	8,500	COMMUNITY SUPPORT
(33) INTER-FAITH FOOD SHUTTLE 1001 BLAIR DR RALEIGH,NC27620	56-1753180	501(C)(3)	15,000	COMMUNITY SUPPORT
(34) IVY COMMUNITY CENTER INC 4222 FAYETTEVILLE ROAD DURHAM,NC27713	56-1932352	501(C)(3)	10,000	COMMUNITY SUPPORT
(35) JEWISH FFEDERATION OF DURHAM CHAPEL 1937 W CORNWALLIS RD DURHAM,NC27705	58-1384316	501(C)(3)	10,000	COMMUNITY SUPPORT
(36) L ARCHE NORTH CAROLINA 504 W CHAPEL HILL ST DURHAM,NC27701	47-4421582	501(C)(3)	25,000	COMMUNITY SUPPORT
(37) LATIN 19 604 CHALFANT CT RALEIGH,NC27607	87-2248916	501(C)(3)	7,500	COMMUNITY SUPPORT
(38) LINCOLN COMMUNITY HEALTH CENTER INC 1301 FAYETTEVILLE ST DURHAM,NC27707	56-1031244	501(C)(3)	12,500	COMMUNITY SUPPORT
(39) MEALS ON WHEELS OF WAKE COUNTY 1001 BLAIR DRIVE SUITE 100 RALEIGH,NC27603	56-1061085	501(C)(3)	20,000	COMMUNITY SUPPORT
(40) MIDTOWN EVENTS LLC PO BOX 19107 RALEIGH,NC27619	27-1832351		10,000	SPONSORSHIP
(41) MIDTOWN RALEIGH ALLIANCE 7413 SIX FORKS RD STE 259 RALEIGH,NC27615	45-2559048	501(C)(3)	22,000	SPONSORSHIP
(42) NAMI WAKE COUNTY PO BOX 12562 RALEIGH,NC27605	56-1552949	501(C)(3)	15,000	COMMUNITY SUPPORT
(43) NORTH CAROLINA ORGANIZING COMMITTEE 401 HARRISON OAKS BLVD 210 CARY,NC27513	93-2199231	501(C)(3)	350,000	SPONSORSHIP
(44) NORTH CAROLINA VICTIM ASSISTANCE NE 1053 WHITAKER MILL RD STE 115 RALEIGH,NC27604	56-1525424	501(C)(3)	10,000	COMMUNITY SUPPORT
(45) OAK CITY CARES INC 1430 S WILMINGTON ST RALEIGH,NC27603	83-0826329	501(C)(3)	10,000	COMMUNITY SUPPORT
(46) PROJECT ENLIGHTENMENT FOUNDATION PO BOX 30574 RALEIGH,NC27622	20-5407465	501(C)(3)	8,000	COMMUNITY SUPPORT
(47) RECOVERY COMMUNITY OF DURHAM 1209 N ELIZABETH ST DURHAM,NC27701	47-3923808	501(C)(3)	6,200	COMMUNITY SUPPORT
(48) RONALD MCDONALD HOUSE OF DURHAM 506 ALEXANDER AVE DURHAM,NC27705	56-1220376	501(C)(3)	50,000	SPONSORSHIP
(49) SAMARITAN HEALTH CENTER PO BOX 51339 DURHAM,NC27717	26-3770762	501(C)(3)	12,500	COMMUNITY SUPPORT
(50) SENIOR PHARMASSIST INC 406 RIGSBEE AVE STE 201 DURHAM,NC277012186	56-2084639	501(C)(3)	10,000	SPONSORSHIP
(51) SOUTHLIGHT HEALTHCARE 3125 POPLARWOOD CT SUITE 203 RALEIGH,NC27604	56-0988422	501(C)(3)	10,000	COMMUNITY SUPPORT
(52) STUDENT U 600 E UMSTEAD ST DURHAM,NC27701	27-3460491	501(C)(3)	10,000	COMMUNITY SUPPORT
(53) SUSAN G KOMEN BREAST CANCER FOUNDATION 13770 NOEL ROAD DALLAS,TX75380	75-1835298	501(C)(3)	55,000	SPONSORSHIP
(54) TABLE MINISTRIES INC 311 E MAIN ST CARRBORO,NC27510	26-1471735	501(C)(3)	10,000	COMMUNITY SUPPORT
(55) TRIANGLE FAMILY SERVICES 3937 WESTERN BLVD RALEIGH,NC27606	56-0547491	501(C)(3)	12,500	COMMUNITY SUPPORT
(56) UNC HEALTH FOUNDATION INC 123 WEST FRANKLIN ST SUITE 510 CHAPEL HILL,NC27516	56-6057494	501(C)(3)	50,000	GENERAL SUPPORT
(57) URBAN MINISTRIES OF DURHAM 410 LIBERTY ST DURHAM,NC27701	58-1505891	501(C)(3)	72,500	COMMUNITY SUPPORT
(58) VELLE CARES FOUNDATION 2741 JORDAN BLVD NEW HILL,NC27562	46-3479904	501(C)(3)	50,000	GENERAL SUPPORT
(59) WAKEMED PO BOX 14549 RALEIGH,NC27620	56-2001346	501(C)(3)	35,000	GENERAL SUPPORT
(60) WEST END COMMUNITY FOUNDATION INC 1309 HALLEY ST DURHAM,NC27707	56-1858174	501(C)(3)	6,000	COMMUNITY SUPPORT
(61) WOMENS CENTER OF WAKE COUNTY INC 2200 NEW BERN AVE RALEIGH,NC27610	58-1316004	501(C)(3)	10,000	COMMUNITY SUPPORT
(62) YMCA OF THE TRIANGLE AREA INC 801 CORPORATE CENTER DR STE 200 RALEIGH,NC27607	56-0591307	501(C)(3)	30,000	GENERAL SUPPORT

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

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

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

Cat. No. 50055P

Schedule I (Form 990) Rev. 1-2025

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	73	67,258
(2) WATTS COLLEGE OF NURSING SCHOLARSHIPS	19	16,250
(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) Rev. 1-2025

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Schedule J
(Form 990)
(Rev. January 2025)

Department of the Treasury
Internal Revenue Service

Compensation Information

For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
medium right arrow graphic

Complete if the organization answered "Yes" on Form 990, Part IV, line 23.
medium right arrow graphic

Attach to Form 990.
medium right arrow graphic

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

OMB No. 1545-0047

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? .............

Yes

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) (Rev. 1-2025)

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 CHANCELLOR EMERITUS FOR HEALTH AFF.	(i) (ii)	0 ------------- 995,113	0 ------------- 1,267,557	0 ------------- 23,000	0 ------------- 42,072	0 ------------- 32,472	0 ------------- 2,360,214	0 ------------- 0
2CRAIG T ALBANESE MD DIRECTOR/CEO	(i) (ii)	1,583,735 ------------- 0	672,750 ------------- 0	23,000 ------------- 0	42,072 ------------- 0	22,513 ------------- 0	2,344,070 ------------- 0	0 ------------- 0
3MONTE D BROWN MD VP FOR ADMINISTRATION/SECRETARY	(i) (ii)	488,464 ------------- 0	657,136 ------------- 0	1,067,488 ------------- 0	42,072 ------------- 0	15,313 ------------- 0	2,270,473 ------------- 0	0 ------------- 0
4VINCENT E PRICE DIRECTOR	(i) (ii)	0 ------------- 2,114,417	0 ------------- 0	0 ------------- 23,000	0 ------------- 42,072	0 ------------- 27,489	0 ------------- 2,206,978	0 ------------- 0
5THOMAS A OWENS MD EXECUTIVE VP, DUHS & COO	(i) (ii)	1,177,120 ------------- 0	653,757 ------------- 0	23,000 ------------- 0	42,072 ------------- 0	37,821 ------------- 0	1,933,770 ------------- 0	0 ------------- 0
6MARY E KLOTMAN MD DIRECTOR	(i) (ii)	0 ------------- 1,147,203	0 ------------- 356,274	0 ------------- 19,167	0 ------------- 42,072	0 ------------- 19,983	0 ------------- 1,584,699	0 ------------- 0
7GREGORY PAULY PRESIDENT DUH/ACUTE CARE SERVICES/VI	(i) (ii)	1,090,031 ------------- 0	250,000 ------------- 0	80,800 ------------- 65,000	42,072 ------------- 0	40,864 ------------- 230	1,503,767 ------------- 65,230	0 ------------- 0
8JEFFREY M FERRANTI VP & CHIEF DIGITAL OFFICE	(i) (ii)	621,020 ------------- 115,827	482,134 ------------- 95,362	23,000 ------------- 0	42,072 ------------- 0	37,132 ------------- 385	1,205,358 ------------- 211,574	0 ------------- 0
9JOHN A QUELCH EXECUTIVE VICE CHANCELLOR, DKU	(i) (ii)	725,423 ------------- 411,254	107,000 ------------- 0	23,000 ------------- 0	42,072 ------------- 0	33,754 ------------- 1,379	931,249 ------------- 412,633	0 ------------- 0
10LISA M GOODLETT SENIOR VP, CFO, TREASURER	(i) (ii)	881,319 ------------- 0	250,000 ------------- 0	122,241 ------------- 0	42,072 ------------- 0	23,080 ------------- 0	1,318,712 ------------- 0	0 ------------- 0
11RICHARD P SHANNON MD CHIEF QUALITY OFFICER	(i) (ii)	763,447 ------------- 0	386,991 ------------- 0	23,000 ------------- 5,000	42,072 ------------- 0	19,725 ------------- 31	1,235,235 ------------- 5,031	0 ------------- 0
12MARY K MARTIN CHIEF OPERATING OFFICER, DUH	(i) (ii)	768,696 ------------- 0	382,679 ------------- 0	0 ------------- 0	42,072 ------------- 0	39,983 ------------- 0	1,233,430 ------------- 0	0 ------------- 0
13PETER GROSSI DIRECTOR	(i) (ii)	0 ------------- 882,479	0 ------------- 171,011	0 ------------- 23,000	0 ------------- 42,072	0 ------------- 15,742	0 ------------- 1,134,304	0 ------------- 0
14ALISON TOTH DIRECTOR	(i) (ii)	0 ------------- 995,931	0 ------------- 12,900	8,482 ------------- 23,000	0 ------------- 42,072	28 ------------- 10,810	8,510 ------------- 1,084,713	0 ------------- 0
15ERIK PAULSON DIRECTOR	(i) (ii)	0 ------------- 847,600	0 ------------- 131,449	0 ------------- 23,000	0 ------------- 42,072	0 ------------- 33,881	0 ------------- 1,078,002	0 ------------- 0
16HOWARD FRANCIS MD DIRECTOR	(i) (ii)	0 ------------- 852,552	0 ------------- 135,053	0 ------------- 23,000	0 ------------- 42,072	0 ------------- 23,029	0 ------------- 1,075,706	0 ------------- 0
17KEITH STOVER VP FINANCE/COO, PRMO	(i) (ii)	561,042 ------------- 0	331,250 ------------- 0	23,000 ------------- 0	42,072 ------------- 0	31,151 ------------- 0	988,515 ------------- 0	0 ------------- 0
18RHONDA BRANDON CHIEF HR OFFICER	(i) (ii)	622,602 ------------- 0	261,454 ------------- 0	23,000 ------------- 0	42,072 ------------- 0	34,121 ------------- 0	983,249 ------------- 0	0 ------------- 0
19ROBERT N WILLIS FORMER OFFICER	(i) (ii)	618,211 ------------- 0	157,861 ------------- 0	23,000 ------------- 0	42,072 ------------- 0	20,889 ------------- 0	862,033 ------------- 0	0 ------------- 0
20DEVDUTTA SANGVAI MD PRESIDENT, DUKE REGIONAL HOSPITAL	(i) (ii)	477,884 ------------- 0	153,917 ------------- 0	0 ------------- 5,250	42,072 ------------- 0	140,597 ------------- 31	814,470 ------------- 5,281	0 ------------- 0
21TERRY MCDONNELL SVP-PART YEAR PATIENT CARE	(i) (ii)	508,888 ------------- 0	62,720 ------------- 0	103,872 ------------- 0	42,072 ------------- 0	30,840 ------------- 0	748,392 ------------- 0	0 ------------- 0
22BARBARA M GRIFFITH MD PRESIDENT, DUKE RALEIGH HOSPITAL	(i) (ii)	510,170 ------------- 0	163,799 ------------- 0	0 ------------- 0	42,072 ------------- 0	27,546 ------------- 0	743,587 ------------- 0	0 ------------- 0
23WILLIAM J FULKERSON MD FORMER OFFICER	(i) (ii)	0 ------------- 425,111	201,901 ------------- 0	0 ------------- 23,000	0 ------------- 42,072	0 ------------- 8,785	201,901 ------------- 498,968	0 ------------- 0
24LEIGH BLEECKER FORMER KEY EMPLOYEE	(i) (ii)	351,869 ------------- 0	188,099 ------------- 0	0 ------------- 0	42,072 ------------- 0	16,063 ------------- 0	598,103 ------------- 0	0 ------------- 0
25JASON CARTER INTERIM PRESIDENT, DUKE REGIONAL HOS	(i) (ii)	357,924 ------------- 0	16,000 ------------- 0	83,734 ------------- 0	42,072 ------------- 0	38,775 ------------- 0	538,505 ------------- 0	0 ------------- 0
26BRYAN YOURICH CHIEF PHARMACY OFFICER, DUHS	(i) (ii)	310,828 ------------- 0	84,240 ------------- 0	21,409 ------------- 0	42,072 ------------- 0	21,723 ------------- 0	480,272 ------------- 0	0 ------------- 0
27PRISCILLA RAMSEUR FORMER KEY EMPLOYEE	(i) (ii)	287,549 ------------- 0	94,433 ------------- 0	0 ------------- 0	42,072 ------------- 0	10,620 ------------- 0	434,674 ------------- 0	0 ------------- 0
28KATIE MCKITTRICK PART YEAR SECRETARY	(i) (ii)	209,077 ------------- 0	10,500 ------------- 0	1,291 ------------- 0	26,958 ------------- 0	20,459 ------------- 0	268,285 ------------- 0	0 ------------- 0
29MARY ANN FUCHS FORMER KEY EMPLOYEE	(i) (ii)	0 ------------- 0	102,863 ------------- 0	0 ------------- 0	13,289 ------------- 0	1 ------------- 0	116,153 ------------- 0	0 ------------- 0

Schedule J (Form 990) (Rev. 1-2025)

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	CHARTER TRAVEL CRAIG T. ALBANESE, MD USED FIRST CLASS OR CHARTER TRAVEL SERVICES. SUCH TRAVEL WAS FOR BUSINESS PURPOSES AND NOT INCLUDED IN TAXABLE INCOME. TAX INDEMNIFICATION GREGORY PAULY, LISA M. GOODLETT, TERRY MCDONNELL AND JASON CARTER RECEIVED A BENEFIT THAT WAS GROSSED UP TO COMPENSATE FOR WITHHOLDING OF TAXES. SUCH AMOUNTS WERE INCLUDED IN THEIR TAXABLE INCOME.
PART I, LINE 4A	SEVERANCE PAYMENT MONTE D. BROWN, MD RECEIVED A PAYMENT IN CONNECTION WITH A SEPARATION AGREEMENT. SUCH AMOUNTS WERE INCLUDED IN SCHEDULE J, PART II, COLUMN B (III).
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) (Rev. 1-2025)

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

OMB No. 1545-0047

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	65821DUD1	05-26-2016	383,990,154	SEE PART VI		X		X		X
B	NORTH CAROLINA MEDICAL CARE COMMISSION	52-1309402	65821DVK4	08-11-2016	140,200,389	SEE PART VI		X		X		X
C	NORTH CAROLINA MEDICAL CARE COMMISSION	52-1309402	65821DZV6	06-25-2025	522,841,295	SEE PART VI		X		X		X

Part Ⅱ

Proceeds

	A		B		C		D
	1 Amount of bonds retired ..................	289,480,000
2 Amount of bonds legally defeased ..............
3 Total proceeds of issue ..................	383,990,154		140,200,389		522,841,295
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		3,196,295
8 Credit enhancement from proceeds .............
9 Working capital expenditures from proceeds .............
10 Capital expenditures from proceeds .............					10,034,031
11 Other spent proceeds .............	180,000,000				344,645,000
12 Other unspent proceeds .............					164,965,969
13 Year of substantial completion .............
	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
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
16 Has the final allocation of proceeds been made? ..........	X		X			X
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? ..................	X		X		X

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

Cat. No. 50193E

Schedule K (Form 990) (Rev. 1-2025)

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
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?	X
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 %
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 %
6 Total of lines 4 and 5 .............	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
2 If "No" to line 1, did the following apply? ....
a Rebate not due yet? .......		X		X	X
b Exception to rebate? ........		X		X		X
c No rebate due? .........	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

Schedule K (Form 990) (Rev. 1-2025)

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
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
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
7 Has the organization established written procedures to monitor the requirements of section 148? ...	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

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 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 B: 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 C: THE PURPOSE OF THE BONDS ISSUED 06/25/25 WAS TO REFINANCE THE 2005A, 2005B, 2016B AND 2016C BONDS ISSUED ON 03/01/22, AND TO REFINANCE THE 2006ABC BONDS ISSUED ON 02/14/22. THE BONDS WERE ALSO ISSUED TO FINANCE THE CONSTRUCTION OF DUKE HEALTH CARY BUILDING 200, WHICH WILL CONSIST OF A FREESTANDING EMERGENCY DEPARTMENT, AN AMBULATORY SURGERY CENTER, SPECIALITY CLINICS, AND OTHER MEDICAL FACILITIES. 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 (A) ABOVE. 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. NOTE FOR SCHEDULE K, PART III, LINES 4-6, BOND ISSUE A: RESPONSES REFLECT THE COMPUTATION OF THE PORTION OF THE ISSUE ALLOCABLE TO THE REFUNDING OF THE 2009A BONDS. NOTE FOR SCHEDULE K, PART IV, LINE 2C, BOND ISSUES (A) AND (B): BOND ISSUE (A) COMPLETED 06/01/19 (NO ARBITRAGE DUE AT THAT TIME AND THEREFORE NOT DUE IN 2024 AS NO MORE PROCEEDS WERE INVESTED). BOND ISSUE (B) COMPLETED 08/01/21. AS TO (C), NO ARBITRAGE COMPUTATION WAS NECESSARY BECAUSE ARBITRAGE IS NOT YET DUE. NOTE FOR BOND ISSUE (C): A PORTION OF THESE PROCEEDS WERE DISBURSED OR DEEMED DISBURSED UPON ISSUANCE TO CURRENTLY REFUND THE PRIOR BONDS AS DESCRIBED ABOVE.

Schedule K (Form 990) (Rev. 1-2025)

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Schedule L
(Form 990)
(Rev. January 2025)

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

OMB No. 1545-0047

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. ........................... $

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

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) (Rev. 1-2025)

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	1,652,356	SEE PART V		No
(2) GARRY BARTELS	SEE PART V	79,874	SEE PART V		No
(3) XIOMARA BOYCE	SEE PART V	79,364	SEE PART V		No
(4) SAM KLOTMAN	SEE PART V	129,881	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: $1,652,356(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: $79,874 (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: $79,364 (D) DESCRIPTION OF TRANSACTION: PAYMENT FOR SALARY AND BENEFITS(E) SHARING OF ORGANIZATION REVENUE? = NO(A) NAME OF INTERESTED PERSON: SAM KLOTMAN(B) RELATIONSHIP BETWEEN INTERESTED PERSON AND ORGANIZATION: SAM KLOTMAN IS A FAMILY MEMBER OF A DUHS, INC. DIRECTOR(C) AMOUNT OF TRANSACTION: $ 129,881 (D) DESCRIPTION OF TRANSACTION: PAYMENT FOR SALARY AND BENEFITS(E) SHARING OF ORGANIZATION REVENUE? = NO

Schedule L (Form 990) (Rev. 1-2025)

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE M
(Form 990)

Department of the Treasury

Internal Revenue Service

Noncash Contributions

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

Attach to Form 990.
Right pointing arrow large image

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

OMB No. 1545-0047

2024

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 ....
2 Art—Historical treasures .
3 Art—Fractional interests ..
4 Books and publications ..
5 Clothing and household goods .......	X		1,400
6 Cars and other vehicles ..
7 Boats and planes ....
8 Intellectual property ...
9 Securities—Publicly traded .	X	6	153,339	MARKET QUOTE
10 Securities—Closely held stock .
11 Securities—Partnership, LLC, or trust interests ....
12 Securities—Miscellaneous ..
13 Qualified conservation contribution—Historic structures .....
14 Qualified conservation contribution—Other ...
15 Real estate—Residential .
16 Real estate—Commercial ..
17 Real estate—Other ...
18 Collectibles .....	X	3	700
19 Food inventory ...
20 Drugs and medical supplies .
21 Taxidermy ......
22 Historical artifacts ....
23 Scientific specimens ..
24 Archeological artifacts ...
25 Other ( ENTERTAINMENT )	X	31	26,660	VARIOUS
26 Other ( SPORTS )	X	4	2,800	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) (2024)

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) (2024)

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE O
(Form 990)
(Rev. January 2025)
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.
Attach to Form 990 or 990-EZ.
Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

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, OUR PHYSICIAN PRACTICE, DUKE HEALTH INTEGRATED 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, 2025. HOWEVER THE ORGANIZATION HAS FILED FORM 990-T FOR THE FISCAL YEAR ENDED JUNE 30, 2025 IN ORDER TO CARRY FORWARD THE NET OPERATING LOSS.
FORM 990, PART VI, SECTION A, LINE 2	DIRECTORS TOM LISTER, VINCENT E. PRICE, CARMICHAEL S. ROBERTS, NANCY M. SCHLICHTING, ADAM SILVER, AND LAURENE M. SPERLING ARE TRUSTEES OF DUKE UNIVERSITY. DIRECTORS MARY E. KLOTMAN, MD AND VINCENT E. PRICE ARE OFFICERS OF DUKE UNIVERSITY. DIRECTOR AND CEO CRAIG T. ALBANESE, MD AND OFFICER THOMAS A. OWENS, MD ARE DIRECTORS AND OFFICERS OF DUKE HEALTH INTEGRATED PRACTICE, INC. DIRECTOR MARY E. KLOTMAN, MD IS A DIRECTOR OF DUKE HEALTH INTEGRATED PRACTICE, INC. OFFICER LISA M. GOODLETT IS AN OFFICER OF DUKE HEALTH INTEGRATED PRACTICE, INC. THE FOLLOWING INDIVIDUALS ARE EMPLOYEES OF DUKE HEALTH INTEGRATED PRACTICE, INC: ALISON TOTH, HOWARD FRANCIS, MD, ERIK PAULSON, MD AND PETER GROSSI. OFFICERS LISA M. GOODLETT AND THOMAS A. OWENS, MD SERVED AS DIRECTORS AND OFFICERS OF DURHAM CASUALTY COMPANY, LTD. OFFICERS MONTE D BROWN, MD, LISA M. GOODLETT, AND THOMAS A. OWENS, MD SERVED AS DIRECTORS AND OFFICERS OF HEALTH SYSTEM MEDICAL STRATEGIES, INC.
FORM 990, PART VI, SECTION A, LINE 3	DUHS DELEGATES CONTROL TO A SUPPORTING ORGANIZATION FOR THE MANAGEMENT OF INVESTMENTS.
FORM 990, PART VI, SECTION A, LINE 7A	THE MEMBERS OF THE BOARD OF DIRECTORS OF DUHS, OTHER THAN THE EX OFFICIO MEMBERS, WILL BE NOMINATED BY THE BOARD OF DIRECTORS OF DUHS, AND WILL BE APPOINTED BY THE BOARD OF TRUSTEES OF DUKE UNIVERSITY. MEMBERS OF THE BOARD OF DIRECTORS OF DUHS WILL BE SUBJECT TO REMOVAL AT THE DISCRETION OF THE BOARD OF TRUSTEES OF DUKE UNIVERSITY IN ACCORDANCE WITH THE BYLAWS OF DUHS.
FORM 990, PART VI, SECTION A, LINE 7B	THE DUHS BYLAWS PROVIDE THAT DUHS MUST OBTAIN DUKE UNIVERSITY BOARD OF TRUSTEES APPROVAL FOR CERTAIN SIGNIFICANT TRANSACTIONS REGARDING DEBT ISSUANCES, CAPITAL ACQUISITIONS AND TANGIBLE PERSONAL AND REAL PROPERTY SALES.
FORM 990, PART VI, SECTION B, LINE 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 VII, SECTION A	(COMPENSATION REPORTING/HIGHEST COMPENSATED EMPLOYEES): THE ORGANIZATION DETERMINED THE INDIVIDUALS REPORTED AS THE "FIVE HIGHEST COMPENSATED EMPLOYEES" ON FORM 990, PART VII, SECTION A IN ACCORDANCE WITH THE APPLICABLE FORM 990 INSTRUCTIONS, WHICH CONSIDER REPORTABLE COMPENSATION PAID BY THE FILING ORGANIZATION AND BY RELATED ORGANIZATIONS. BECAUSE CERTAIN PERSONNEL HAVE SPLIT-FUNDED OR DUAL-ROLE ARRANGEMENTS ACROSS RELATED ORGANIZATIONS, AN INDIVIDUAL MAY BE AMONG THE FIVE HIGHEST COMPENSATED EMPLOYEES OF MORE THAN ONE RELATED ORGANIZATION BASED ON TOTAL REPORTABLE COMPENSATION, EVEN IF A SUBSTANTIAL PORTION OF THAT COMPENSATION IS PAID BY A RELATED ORGANIZATION. RELATED-ORGANIZATION COMPENSATION IS REPORTED ON PART VII, SECTION A, COLUMNS (E) AND (F), AS APPLICABLE (AND ON SCHEDULE J, IF APPLICABLE). FOR ADDITIONAL TRANSPARENCY TO READERS, THE ORGANIZATION IS ALSO PROVIDING THE FOLLOWING INFORMATION, WHICH IS NOT REQUIRED BY FORM 990: THE INDIVIDUALS WHO WOULD HAVE BEEN INCLUDED AS THE ORGANIZATION'S FIVE HIGHEST COMPENSATED EMPLOYEES BASED SOLELY ON COMPENSATION PAID BY THE FILING ORGANIZATION, BUT WHO ARE NOT INCLUDED ON PART VII BECAUSE THE PART VII LIST IS LIMITED TO FIVE INDIVIDUALS DETERMINED UNDER THE FORM 990 INSTRUCTIONS. ADDITIONAL HIGHLY COMPENSATED EMPLOYEES (VOLUNTARY DISCLOSURE; NOT REQUIRED FOR PART VII REPORTING): ARLENE N CHUA, PHYSICIAN - REPORTABLE COMPENSATION (W-2/1099): $785,454
FORM 990, PART XI, LINE 9:	NONPERIODIC CHANGES IN DEFINED BENEFIT PLANS: 49,914,703. NET TRANSFERS TO THE UNIVERSITY AND AFFILIATES: -761,550,495. DEEMED DIVIDEND: -19,965,031.

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

Cat. No. 51056K

Schedule O (Form 990) (Rev. 1-2025)

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE R
(Form 990)
(Rev. January 2025)

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

OMB No. 1545-0047

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	243,218,997	783,572	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)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
(2)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
(3)DUKE CORPORATE EDUCATION 310 BLACKWELL ST DURHAM,NC27701 42-1672476	EDUCATION	NC	501(C)(3)	12 TYPE 1	DUKE UNIVERSITY		No
(4)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
(5)DUKE GLOBAL INC 2200 W MAIN STREET STE 300 DURHAM,NC27705 61-1588319	SUPPORT	NC	501(C)(3)	12 TYPE 1	DUKE UNIVERSITY		No
(6)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
(7)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
(8)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
(9)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
(10)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
(11)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
(12)DUKE UNIVERSITY 2200 W MAIN STREET STE 300 DURHAM,NC27705 56-0532129	EDUCATION	NC	501(C)(3)	LINE 2	N/A		No
(13)DUMAC INC 280 S MANGUM STREET STE 210 DURHAM,NC27701 90-0754895	SUPPORT	NC	501(C)(3)	12 TYPE 1	DUKE UNIVERSITY		No
(14)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
(15)GOTHIC CORPORATION 280 S MANGUM STREET STE 210 DURHAM,NC27701 56-1776668	INVESTMENTS	NC	501(C)(3)	12 TYPE 1	DUKE UNIVERSITY		No
(16)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
(17)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
(18)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
(19)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
(20)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
(21)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
(22)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
(23)DUKE UNIV FED CRED UNION 2200 WEST MAIN STREET DURHAM,NC27705 56-1632379	BANKING	NC	501(C)(1)		N/A		No
(24)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
(25)DUKE HEALTH INTEGRATED PRACTICE INC 2200 W MAIN STREET STE 300 DURHAM,NC27705 86-2109896	HEALTHCARE	NC	501(C)(3)	LINE 3	DUKE UNIVERSITY HEALTH SYSTEM INC	Yes
(26)DONALD R WATSON FOUNDATION INC 601 SOUTH COLLEGE ROAD WILMINGTON,NC28403 56-1861816	SUPPORT	NC	501(C)(3)	12 TYPE 1	N/A		No
(27)FAMILY HEALTH MINISTRIES INC PO BOX 16783 CHAPEL HILL,NC27516 56-2206165	HEALTH CLINICS	NC	501(C)(3)	LINE 10	DUKE UNIVERSITY		No
(28)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
(29)DUKE HEALTH LAKE NORMAN REGIONAL MEDICAL CENTER INC 2200 W MAIN STREET STE 300 DURHAM,NC27705 33-2476324	HEALTHCARE	NC	501(C)(3)	LINE 3	DUKE UNIVERSITY HEALTH SYSTEM INC	Yes
(30)FACULTY CLUB OF DUKE UNIVERSITY INC 2200 W MAIN STREET STE 300 DURHAM,NC27705 51-0168730	RECREATIONAL	NC	501(C)(4)		DUKE UNIVERSITY		No

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

Cat. No. 50135Y

Schedule R (Form 990) (Rev. 1-2025)

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) LYRICAL BLUE RL PT 27-2994514 32 N DEAN ST ENGLEWOOD,NJ07631	INVESTMENTS	DE	N/A	N/A				No			No
(3) SBER LUCKY STRIKE 20-3891303 310 BLACKWELL ST DURHAM,NC27701	REAL ESTATE	NC	N/A	N/A				No			No
(4) MANGUM II LLC - 46-5135858 280 S MANGUM STREET STE 210 DURHAM,NC27701	INVESTMENTS	NC	N/A	N/A				No			No
(5) LS INVESTOR LLC 20-3891381 310 BLACKWELL ST DURHAM,NC27701	REAL ESTATE	NC	N/A	N/A				No			No
(6) DILWEG BLUE PF LP 47-1225569 5310 S ALSTON AVE STE 210 DURHAM,NC27713	INVESTMENTS	DE	N/A	N/A				No			No
(7) LYRICAL BLUE RL PT IV 47-1542108 32 N DEAN ST ENGLEWOOD,NJ07631	INVESTMENTS	DE	N/A	N/A				No			No
(8) STRATUS SCP II INVESTORS - C LP 50 LOTHIAN ROAD FESTIVAL SQUARE EDINBURGH EH3 9WJ UK	INVESTMENTS	UK	N/A	N/A				No			No
(9) ALTOS HYBRID D LLC 2882 SAND HILL ROAD SUITE 100 MENLO PARK,CA94025 47-3996176	INVESTMENTS	DE	N/A	N/A				No			No
(10) BLACKWELL PARTNERS LLC - SERIES C 280 S MANGUM ST STE 210 DURHAM,NC27701 81-1264533	INVESTMENTS	DE	N/A	N/A				No			No
(11) BLACKWELL PARTNERS LLC - SERIES B 280 S MANGUM ST STE 210 DURHAM,NC27701 47-2530719	INVESTMENTS	DE	N/A	N/A				No			No
(12) BLACKWELL PARTNERS LLC - SERIES D 280 S MANGUM ST STE 210 DURHAM,NC27701 81-3385353	INVESTMENTS	DE	N/A	N/A				No			No
(13) BLACKWELL PARTNERS LLC - SERIES E 280 S MANGUM ST STE 210 DURHAM,NC27701 81-1511048	INVESTMENTS	DE	N/A	N/A				No			No
(14) ALTOS HYBRID 2D LLC - 81-5176567 2882 SAND HILL ROAD STE 100 MENLO PARK,CA94025	INVESTMENTS	DE	N/A	N/A				No			No
(15) LYRICAL-BLUE 100 KINGSHIGHWAY PARTNERS LP 32 N DEAN ST ENGLEWOOD,NJ07631 82-3708328	INVESTMENTS	DE	N/A	N/A				No			No
(16) WASHINGTON GOTHIC LP 593 WASHINGTON STREET WELLESLEY,MA02482 83-4516893	INVESTMENTS	DE	N/A	N/A				No			No
(17) DUKE TRIANGLE ENDOSCOPY CENTER LLC 1A BURTON HILLS BLVD NASHVILLE,TN37215 20-4257024	HEALTHCARE	NC	N/A	N/A				No			No
(18) DWELLWORKS CO-INVESTMENT LLC 7 TIMES SQUARE STE 4307 NEW YORK,NY10036 83-2165945	INVESTMENTS	DE	N/A	N/A				No			No
(19) BEP LEGACY 1C LLC 1001 FANNIN ST STE 800 HOUSTON,TX77002 27-3871932	INVESTMENTS	DE	N/A	N/A				No			No
(20) 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
(21) ENIAC SPECIAL DELTA LLC 604 MISSION STREET 10TH FL SAN FRANCISCO,CA94105 84-2355221	INVESTMENTS	DE	N/A	N/A				No			No
(22) STRATUS SCP III INVESTORS - GAMMA LP 50 LOTHIAN ROAD FESTIVAL SQUARE EDINBURGH EH3 9WJ UK	INVESTMENTS	UK	N/A	N/A				No			No
(23) MANGUM LLC 280 S MANGUM STREET STE 210 DURHAM,NC27701 46-1275587	INVESTMENTS	NC	N/A	N/A				No			No
(24) CPF HEARTBEAT HEALTH INV A LLC 980 N MICHIGAN AVENUE SUITE 1998 CHICAGO,IL60611 88-1279232	INVESTMENTS	DE	N/A	N/A				No			No
(25) CPF TRIAS INVESTMENT II LLC 980 N MICHIGAN AVE STE 1998 CHICAGO,IL60611 87-4204000	INVESTMENTS	DE	N/A	N/A				No			No
(26) MANGUM III LLC 280 S MANGUM STREET STE 210 DURHAM,NC27701 92-3565585	INVESTMENTS	DE	N/A	N/A				No			No
(27) MANGUM III LLC - SERIES A 280 S MANGUM STREET STE 210 DURHAM,NC27701 92-3592240	INVESTMENTS	DE	N/A	N/A				No			No
(28) RALLYDAY LF CO-INVESTORS LP 250 FILLMORE ST STE 225 DENVER,CO80206 93-2940647	INVESTMENTS	DE	N/A	N/A				No			No
(29) MANGUM III LLC - SERIES E 280 S MANGUM STREET STE 210 DURHAM,NC27701 33-2777494	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 CORPORATE EDUCATION LIM 165 FLEET STREET LONDON EC4A 2DY UK 42-1672476	EDUCATION CONSULTING	UK	N/A	C					No
(4) DUKE CORPORATE EDUCATION RSA GROUND FLOOR TWICKEHNHAM BLDG BRYANSTON,JOHANNESBURG02021 SF 42-1672476	CONSULTING	SF	N/A	C					No
(5) DUKE GLOBAL CONSULTING (KUNSHAN) 1666 WEI CHEN NAN RD KUNSHAN PR,KUNSHAN215300 CH	CONSULTING	CH	N/A	C					No
(6) DUKE MEDICAL STRATEGIES INC 2200 WEST MAIN STREET STE 920 DURHAM,NC27705 56-1993799	HEALTHCARE	NC	N/A	C					No
(7) DURHAM CASUALTY COMPANY LTD AON HOUSE 30 WOODBOURNE AVE PEMBROKE HM 08 BD 98-0113277	INSURANCE	BD	DUHS INC	C	68,492,150	391,245,454	100.000 %	Yes
(8) GOTHIC INTERNATIONAL LTD 113 S CHURCH STREET QUEENSGATE HOU GRAND CAYMAN KY1-1108 CJ	INVESTMENTS	CJ	N/A	C					No
(9) HEALTH SYSTEM MEDICAL STRATEGIES INC 2200 W MAIN STREET STE 300 DURHAM,NC27705 56-2222444	HEALTH CARE	NC	DUHS INC	C	-15,412	14,969	100.000 %	Yes
(10) MARATHON BLUE CAYMAN FUND 89 NEXUS WAY PO BOX 31106 GRAND CAYMAN KY1-1205 CJ	INVESTMENTS	CJ	N/A	C					No
(11) GHI HOLDINGS MAURITIUS 9TH FL ORANGE TOWER CYBERCITY EBENE MP	INVESTMENTS	MP	N/A	C					No
(12) GHI ERP LTD 9TH FL ORANGE TOWER CYBERCITY EBENE MP	INVESTMENTS	MP	N/A	C					No
(13) GHI HSP LTD 9TH FL ORANGE TOWER CYBERCITY EBENE MP	INVESTMENTS	MP	N/A	C					No
(14) GHI JBD LTD 9TH FL ORANGE TOWER CYBERCITY EBENE MP	INVESTMENTS	MP	N/A	C					No
(15) GHI LTP LTD 9TH FL ORANGE TOWER CYBERCITY EBENE MP	INVESTMENTS	MP	N/A	C					No
(16) MCP PRIVATE CAPITAL (FEEDER) FUND I LP 6 RUE GABRIEL LIPPMANN LUXEMBOURG L-5365 LU	INVESTMENTS	LU	N/A	C					No
(17) DUKE INDIA SERVICES PRIVATE LIMITED 302 PRIDE ELITE 10 MUSEUM ROAD BANGALORE,KARNATAKA560001 IN	MEDICAL RESEARCH	IN	N/A	C					No
(18) DUKE GLOBAL GERMANY GMBH ESCHERSHEIMER LANDSTR 14 FRANKFURT 60322 GM	EDUCATION	GM	N/A	C					No
(19) DUKE CORP EDU INDIA PRIVATE ACADEMIC BLOCK NEW CAMPUS VASTRAPUR,AHMEDABAD380015 IN 42-1672476	CONSULTING	IN	N/A	C					No

Schedule R (Form 990) (Rev. 1-2025)

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 HEALTH INTEGRATED PRACTICE INC	R	133,994,148	FMV
(2) DUKE UNIVERSITY AFFILIATED PHYSICIANS INC	R	49,225,426	FMV
(3) ASSOCIATED HEALTH SERVICES INC	S	15,933,823	FMV
(4) DUKE AFFILIATIONS NETWORK INC	R	6,172,078	FMV
(5) DUKE INTERGRATED NETWORK INC	R	8,546,715	FMV
(6) WATTS COLLEGE OF NURSING INC	R	1,404,535	FMV
(7) DURHAM CASUALTY COMPANY INC	S	35,075,911	FMV
(8) DURHAM CASUALTY COMPANY INC	R	14,077,032	FMV
(9) DUKE TRIANGLE ENDOSCOPY CENTER LLC	L	201,090	FMV
(10) DUKE TRIANGLE ENDOSCOPY CENTER LLC	Q	174,456	FMV
(11) DUKE HEALTH LAKE NORMAN REGIONAL MEDICAL CENTER INC	R	302,809,438	FMV
(12) GOTHIC HSP CORPORATION	C	567,844,502	FMV
(13) GOTHIC HSP CORPORATION	B	577,613,067	FMV

Schedule R (Form 990) (Rev. 1-2025)

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) (Rev. 1-2025)

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) (Rev. 1-2025)

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	21
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	12
5	Total number of individuals employed in calendar year 2024 (Part V, line 2a) ......	5	27,913
6	Total number of volunteers (estimate if necessary) .............	6	840
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) .........	6,430,372	22,693,142
9	Program service revenue (Part VIII, line 2g) .........	5,330,811,108	5,656,796,724
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	295,728,981	296,004,546
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	133,330,171	189,615,154
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	5,766,300,632	6,165,109,566
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	1,834,150	2,180,270
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)	2,271,542,301	2,366,707,000
16a	Professional fundraising fees (Part IX, column (A), line 11e) .....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 371,437
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	2,800,243,408	3,030,609,171
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	5,073,619,859	5,399,496,441
19	Revenue less expenses. Subtract line 18 from line 12.......	692,680,773	765,613,125
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	8,567,717,732	8,966,684,526
21	Total liabilities (Part X, line 26).............	3,007,778,584	3,293,100,431
22	Net assets or fund balances. Subtract line 21 from line 20.....	5,559,939,148	5,673,584,095

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 4,579,795,039 including grants of $ 2,180,270 ) (Revenue $ 5,798,226,085 )
	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 expenses4,579,795,039

1b	Sub-Total..............
c	Total from continuation sheets to Part VII, Section A..
d	Total (add lines 1b and 1c).........	20,260,100	11,213,126	1,943,250

1a	Federated campaigns..		1a
b	Membership dues..		1b
c	Fundraising events..		1c	85,170
d	Related organizations		1d
e	Government grants (contributions)		1e	1,325,401

f	All other contributions, gifts, grants, and similar amounts not included above		1f	21,282,571

g	Noncash contributions included in lines 1a - 1f:$		1g	184,899

h Total. Add lines 1a-1f.......		22,693,142

		Business Code
2a	PATIENT REVENUE	622110	5,586,790,990	5,586,790,990
b	ANCILLARY MEDICAL SVCS	622110	70,005,734	70,005,734
c
d
e
f	All other program service revenue.
g	Total. Add lines 2a–2f .....		5,656,796,724

3 Investment income (including dividends, interest, and othersimilar amounts) ......			103,223,741			103,223,741
4 Income from investment of tax-exempt bond proceeds
5 Royalties...........			6,676,368			6,676,368
			(i) Real	(ii) Personal
6a	Gross rents	6a	1,453,639
b	Less: rental expenses	6b	1,213,040
c	Rental income or (loss)	6c	240,599
d	Net rental income or (loss).......			240,599			240,599
			(i) Securities	(ii) Other
7a	Gross amount from sales of assets other than inventory	7a	1,593,240,358
b	Less: cost or other basis and sales expenses	7b	1,400,459,553
c	Gain or (loss)	7c	192,780,805
d	Net gain or (loss).........			192,780,805			192,780,805
8a	Gross income from fundraising events (not including $ 85,170of contributions reported on line 1c). See Part IV, line 18 ....
			8a	175,720
b	Less: direct expenses ...		8b	85,471
c	Net income or (loss) from fundraising events..			90,249			90,249
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
11a	BILLING FEES		622110	74,141,565	74,141,565
b	NET BENEFIT COMPONENTS		622110	67,254,000	67,254,000
c	DEEMED DIVIDEND		622110	19,965,031			19,965,031
d	All other revenue ....			21,247,342	33,796		21,213,546
e	Total. Add lines 11a–11d ......			182,607,938
12	Total revenue. See instructions.....			6,165,109,566	5,798,226,085	0	344,190,339

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21 ....	2,075,662	2,075,662
2	Grants and other assistance to domestic individuals. See Part IV, line 22 ...........	83,508	83,508
3	Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See Part IV, lines 15 and 16. .............	21,100	21,100
4	Benefits paid to or for members .......
5	Compensation of current officers, directors, trustees, and key employees ...........	17,053,709	1,971,382	14,755,288	327,039
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .........	2,456,984	293,346	2,163,638
7	Other salaries and wages........	1,867,312,998	1,424,531,547	442,781,451
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	129,437,151	98,229,787	31,207,364
9	Other employee benefits .......	228,437,360	186,836,453	41,582,855	18,052
10	Payroll taxes ...........	122,008,798	92,300,495	29,700,107	8,196
11	Fees for services (non-employees):
a	Management ......	23,482,326	23,369,224	113,102
b	Legal .........	6,681,397	770,282	5,911,115
c	Accounting ...........	644,490		644,490
d	Lobbying ...........
e	Professional fundraising services. See Part IV, line 17
f	Investment management fees ......	6,540,385	6,540,385
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	257,504,795	111,308,657	146,196,138
12	Advertising and promotion ....	3,820,205	33,112	3,786,553	540
13	Office expenses .......	48,507,577	33,601,225	14,885,983	20,369
14	Information technology ......	91,057,797	6,728,529	84,328,944	324
15	Royalties ..
16	Occupancy ...........	88,237,391	61,901,603	26,335,788
17	Travel ............	17,264,061	15,675,578	1,587,291	1,192
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .
19	Conferences, conventions, and meetings ....	6,907,132	1,294,631	5,611,808	693
20	Interest ...........	70,068,054	70,068,054
21	Payments to affiliates .......
22	Depreciation, depletion, and amortization ..	170,472,396	151,707,190	18,765,206
23	Insurance ...	2,552,184	2,552,184
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	1,652,200,872	1,652,200,872
b	STATE PROVIDER ASSESS.	331,709,239	331,709,239
c	MEDICAL DIRECTOR & COV.	150,336,312	150,336,312
d	EQUIPMENT RENTAL & MAIN	130,184,578	97,423,903	32,760,675
e	All other expenses	-27,562,020	56,230,779	-83,787,831	-4,968
25	Total functional expenses. Add lines 1 through 24e	5,399,496,441	4,579,795,039	819,329,965	371,437
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 ........			106,008	1	94,529
2	Savings and temporary cash investments .........			232,323,432	2	432,556,014
3	Pledges and grants receivable, net ......			1,134,231	3	3,541,810
4	Accounts receivable, net .............			710,495,762	4	824,514,621
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 ...........			61,977	7	50,876
8	Inventories for sale or use ............			126,004,704	8	137,082,976
9	Prepaid expenses and deferred charges ......			45,130,849	9	42,476,489
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	4,827,047,676
b	Less: accumulated depreciation	10b	2,826,694,949	2,000,763,666	10c	2,000,352,727
11	Investments—publicly traded securities .			901,451,389	11	791,875,611
12	Investments—other securities. See Part IV, line 11 .....			3,636,061,648	12	3,826,505,713
13	Investments—program-related. See Part IV, line 11 ..				13
14	Intangible assets ...............			28,218,074	14	31,533,324
15	Other assets. See Part IV, line 11 ...........			885,965,992	15	876,099,836
16	Total assets. Add lines 1 through 15 (must equal line 33)...			8,567,717,732	16	8,966,684,526

17	Accounts payable and accrued expenses .....	429,058,277	17	502,861,301
18	Grants payable ...		18
19	Deferred revenue .........	8,892,426	19	10,205,585
20	Tax-exempt bond liabilities .........	572,621,422	20	714,047,847
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 ..	298,730,708	24	398,970,472
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	1,698,475,751	25	1,667,015,226
26	Total liabilities. Add lines 17 through 25..	3,007,778,584	26	3,293,100,431

	Organizations that follow FASB ASC 958, check here and complete lines 27, 28, 32, and 33.
27	Net assets without donor restrictions ..........	5,494,921,685	27	5,588,135,850
28	Net assets with donor restrictions ...........	65,017,463	28	85,448,245
	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 ...........	5,559,939,148	32	5,673,584,095
33	Total liabilities and net assets/fund balances ........	8,567,717,732	33	8,966,684,526

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