TY 2021 Form 990 Schedule O

efile Public Visual Render ObjectId: 202203189349318995 - Submission: 2022-11-14 TIN: 61-1028725

SCHEDULE O
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Information to Form 990 or 990-EZ

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

Attach to Form 990 or 990-EZ.
MediumBullet

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

OMB No. 1545-0047

2021

Open to Public
Inspection

Name of the organization

Norton Healthcare Inc

Employer identification number

61-1028725

Return Reference	Explanation
Form 990, Part III, Line 4a Program Service Accomplishment	(Continued from Part III) In 2021, Norton Healthcare, through its affiliate, Community Medical Associates Inc., had approximately 3.1 million patient encounters. Norton Healthcare's hospitals, diagnostic centers and Norton Cancer Institute served 68,502 inpatients and 646,869 outpatients, and saw 235,728 emergency room visits. In addition, Norton Healthcare hospitals' operating rooms cared for 16,312 inpatient surgical patients and 39,433 outpatient surgical patients. Additionally, 8,300 babies were delivered at Norton Healthcare birthing facilities at Norton Hospital and Norton Women's & Children's Hospital. As part of our commitment to improving the health of our community, Norton Healthcare provides funding for a wide array of lifesaving and life-enhancing services that benefit the communities we serve. In 2021, under its charity care program, Norton Healthcare provided free care to 7,291 patients, at a cost of $14.2 million. Also, Norton Healthcare grants a discount from billed charges to any patients who have no access to private health insurance or do not qualify for government assistance or charity care. Under this program, 7,498 patients were provided care at discounted rates. Another contribution to the community was educational support of $77.4 million, primarily to the University of Louisville (UofL) School of Medicine. Community health improvement services totaled $20.1 million and contributions to community groups were $1.9 million. Norton Healthcare employees donated more than 209,000 hours of community service, a benefit valued at more than $1.1 million in salaries. In addition, many employees self-reported personal volunteer activities. Norton Healthcare provides programmatic support to the UofL School of Medicine through funding and facilities. During the 2021 calendar year, 209 residents completed clinical rotations in 50 specialties at Norton Healthcare facilities. Residency programs are part of the $77.4 million in educational support and clinical funding provided to the medical school Contributions to the community * Norton Healthcare employees and physicians gave nearly $815,643 to our 2021-2022 Combined Giving Campaign to help support non-profit organizations that also are committed to improving the health and well-being of community residents. Supported organizations include WHAS Crusade for Children, Metro United Way, Fund for the Arts, and our own Norton Children's Hospital Foundation and Norton Healthcare Foundation. * In 2021, 68 employees helped "raise the roof" on Norton Healthcare's 16th Habitat for Humanity home. The number of participating employees remained limited compared to prior years due to COVID-19 restrictions. * In 2021, an estimated 1,400 Norton Healthcare employees donated time and funds to plan, purchase and deliver gifts, food and clothing for the Caring Tree program. The program assisted 521 employees and their 1,147 children and dependents by providing for their families at Christmas. * More than 44,000 pounds of usable surplus medical supplies valued at more than $716,000, and over $552,805 in equipment, were donated for use locally and around the world. Norton Healthcare donated syringe pumps to Malawi as they tried to recover from rain storms and cyclones in addition to the ongoing struggles against Covid-19. These supplies were delivered in February of 2022 and went to three hospitals and 6 smaller clinics serving orphans, women and infants. Community Education and Workforce Development Workforce Development encourages continuing education, offers programs to improve job performance and provides financial assistance for educational programs aimed toward key areas of workforce need within the organization. Norton Healthcare encourages and supports the career goals of employees and their dependents by providing financial assistance and scholarships as well as other advancement opportunities. Established in the early 2000s, Workforce Development has assisted more than 6,000 students with tuition assistance. In 2021, Workforce Development financially supported more than 750 students with over $4.5 million in educational assistance programs. * In 2021, Workforce Development provided nearly 1,400 career coaching sessions to employees and students. Each program participant worked directly with a career management coach. Coaches offer services in resume writing, career and education exploration, financial assistance opportunities and interviewing skills. * The accelerated Norton Healthcare Scholars Program, a student loan program for employees and nonemployees, provides educational funding to students interested in pursuing health care-related degrees in areas of workforce need. It is an affiliation between Norton Healthcare and over 100 colleges and universities nationally. Since 2014, this program has assisted more than 1,000 graduates continue their careers with Norton Healthcare. * In 2018, Norton Healthcare was one of the founding partners in Jefferson County Public Schools' Academies of Louisville, a strategic pipeline development program in conjunction with the local public school system. Jefferson County Public Schools created an academy model in which students have the opportunity to select career-focused education and earn industry-recognized credentials while in high school. Norton Healthcare transformed its summer program and previous high school scholarship offerings into a comprehensive internship program for students on the health care academy track. The program targets high school seniors in health care academy pathways via career exploration in identified health care areas. Beginning in junior year, health care academy students explore career pathways in one of four key areas: patient care, medical office, allied health and pharmacy technician. Each phase offers a rigorous curriculum, training in business acumen and professional development, and hands-on learning opportunities in the students' chosen career fields. The goal is to transition graduating students into staff positions with our organization after completion of the program. Tuition assistance is offered for these new employees to continue their academic and career pursuits while working at Norton Healthcare in the field of their choice. * In 2019, Norton Healthcare announced a strategic partnership program with UPS and its Metropolitan College program. Norton Healthcare-UPS Health Care Career Tracks provides a two-plus-two method, splitting a four-year bachelor's degree into two parts. Typically, the first two years are spent working with UPS in a general or preclinical designation, and then the student begins their clinical program in the last two years. This transition allows students to explore employment with Norton Healthcare as well as become a Norton Healthcare Scholar. This program helps to support career readiness in a health care-related field. The combined tuition assistance offers students a debt-free way to get a college education while working with two of the leading companies in the region. * The Student Nurse Apprenticeship Program (SNAP) is a 12- to 18-month apprenticeship through Norton Healthcare Center for Nursing Practice in which nursing students work and engage in hands-on learning with an experienced mentor while becoming integrated with Norton Healthcare. * In 2019, Norton Healthcare launched new apprenticeship programs. The Surgical Technologist Apprenticeship Program and the Respiratory Therapy Apprenticeship Program allow students to work and learn with tuition assistance as they grow their careers with Norton Healthcare. Development of the Medical Assistant Training Program launched in 2020 with a goal of offering internal training programs to produce quality, prepared medical assistants to introduce into the Norton Healthcare workforce. Several apprenticeship cohorts run throughout each year. Norton Healthcare Institute for Education & Development provides learning opportunities to enhance the professional, educational and personal development of all employees. It consists of seven centers: the Center for Academic Affairs, Center for Allied Health, Center for Continuing Medical, Nursing & Provider Education, Center for eLearning & Clinical Documentation Support, Center for Nursing Practice, Center for Professional Growth, and Center for System Nursing & Ancillary Education. The Center for Professional Growth provides learning and growth opportunities that meet the needs of Norton Healthcare employees. Three types of leadership development courses are offered to address the needs of new, aspiring and current leaders: * N the Know: This is our new leader orientation program. Newly hired and promoted leaders are automatically enrolled. The program has four required courses and six elective courses.
Form 990, Part III, Line 4a Program Service Accomplishment	Continued * Learning the Norton Way: This six week program is focused on preparing employees for leadership. Leadership approval is required for all employees who wish to attend. * Leading the Norton Way: This program is for current Norton Healthcare leaders. It is a six-week program focused on best practices for effective leadership. * Additional leadership development is provided through quarterly Norton Healthcare leadership conferences. * Staff development programs include general enrichment courses and personal and professional development opportunities that honor Norton Healthcare's commitment to lifelong learning. A variety of online and instructor-led courses focus on learning topics such as communication, diversity, interpersonal relationship-building, accountability and proficiency in Microsoft Office tools. * Norton Healthcare uses a comprehensive learning management system to provide a variety of online programs that enable staff in any specialty as well as other employees to expand their knowledge and skills. These programs were designed to meet the needs of Norton Healthcare, as well as our community, and to ensure the highest quality of patient care. Norton Faith & Health Ministries Norton Faith & Health Ministries partners with faith communities to weave together health and wellness promotion with the intentional care of the spirit. The department provides mentoring, educational resources and networking opportunities to assist health ministry coordinators and faith community nurses in ministering to their members. In 2021, the department engaged in 62 events with faith partners, including: * Facilitating administering more than 6,000 COVID-19 vaccines at faith community site-based clinics. * Sponsoring health ministry networking programs on COVID-19 updates, legal documents for seniors and self-care practices for professional caregivers. * Partnering with a network of nearly 200 faith communities to supply speakers on whole-person health and wellness, and provide health educational tools, health screenings and one-on-one health ministry mentoring. The department continued to serve as a trusted communication source for timely health and wellness information through a monthly email to a network of health ministry coordinators, a bimonthly e-newsletter to 1,400 subscribers and three issues of the Health Ministries Connection newsletter distributed to faith communities, Norton Healthcare employees and more. Pastoral Care Department The Pastoral Care Department of Norton Healthcare continued in 2021 to follow through with what they learned during the first year of the pandemic - to bring care, comfort and compassion to weary staff, patients and families 24 hours a day, 7 days a week, every day throughout the year, across the five system hospitals and many outpatient areas. At the start of 2021, there was great hope that the restrictions and heartache from the COVID-19 pandemic would soon be gone, but the year turned out different than expected. Continuing with what was done in 2020, supporting staff remained a high priority for the chaplains. Leadership consistently called on chaplains to be a resource for employees experiencing many stresses throughout the year, and referrals to them were regularly highlighted in communications from leadership describing resources for staff support. While the vaccine was a great sign of hope, the polarization that came with it created uncomfortable situations. Patients continued to be very sick and die unvaccinated. Many departments struggled with staffing shortages. Employees were tired and often burned out. Chaplains responded with relational initiatives, virtual classes on resilience, and even a formal research study on moral distress in the intensive care unit. Chaplains provided care in more than 33,000 documented patient encounters, plus many thousands of family member encounters as well. Some of the many reasons chaplains become involved in the care of patients and families included: * Grief support and facilitation of decision-making at more than 2,000 deaths * Family support for pediatric trauma patients * Conversations about end of-life decisions and goals of care * Education about and enacting advance directives * Offering religious rituals and literature * Discussing ethical dilemmas * Providing comfort and conversation with patients who were lonely, afraid, conflicted, struggling or celebrating good news Chaplains care for people, regardless of their religious or spiritual backgrounds and beliefs, to help them use and strengthen their spiritual, emotional and relational resources to better cope and to thrive. Through formal and informal staff support efforts, teaching, committee involvement, ethics consultations and many other ways, chaplains are fully integrated into the life of the Norton Healthcare system. Norton Heart & Vascular Institute Norton Heart & Vascular Institute is Louisville's leading cardiovascular disease prevention and treatment program. Each year, it provides diagnostic, medical, interventional and surgical care for thousands of patients from Kentucky and Southern Indiana. Norton Heart & Vascular Institute specialists treat patients at Norton Healthcare's four adult-service hospitals and more than 28 outpatient clinics, diagnostic centers and specialty locations throughout Greater Louisville. * Kentucky has one of the highest occurrences of heart disease in the country. As a result, Norton Heart & Vascular Institute has committed to being a leader in acute chest pain care. All four of Norton Healthcare's adult-service hospitals in Louisville are recognized by the American College of Cardiology as Acute Chest Pain Centers. Optimal care for heart attack patients takes coordination at the hospital, emergency medical services and system levels. In 2021, all three Norton Healthcare adult STEMI receiving hospitals received the American Heart Association's Mission: Lifeline Gold Plus STEMI/Chest Pain Receiving Center designation, recognizing excellence in providing the highest level of care for heart attacks. * Many people in our region have more than one chronic health condition, and/or advancing heart disease, which is leading to increased occurrences of heart failure. The Norton Heart & Vascular Institute Advanced Heart Failure & Recovery Program provides comprehensive care to manage heart failure, and in some cases, help patients recover from heart failure. In 2020, the program expanded its advanced treatment offerings as Norton Audubon Hospital received ventricular assist device (VAD) accreditation from DNV Healthcare and the U.S. Centers for Medicare & Medicaid Services. This advanced level of care, partnered with navigation, patient education and support of those with heart failure, is key to impacting heart failure care in Kentucky. * Norton Healthcare achieved systemwide noninvasive cardiology accreditation from the Intersocietal Accreditation Commission in 2020. Departments that perform noninvasive cardiology procedures are many times the first touchpoint for Norton Healthcare patients for heart and vascular care. This recognition signifies the highest level of diagnostic capabilities at all Norton Healthcare locations through the use of noninvasive echocardiography, noninvasive vascular ultrasound, nuclear cardiology and positron emission tomography (PET) cardiology. In 2021, Norton Heart & Vascular Institute remains the only health system in Louisville that offers fractional flow reserve derived from computed tomography (FFRCT). * Cardiovascular disease is impacting our community across a wide variety of ages and demographics. In 2021, the Norton Heart & Vascular Institute Young Adult Cardiology Clinic was established to treat patients under age 35 with no prior cardiac care conditions who have been seen for chest pain in the emergency department or a primary care office. Norton Orthopedic Institute Norton Orthopedic Institute provides advanced orthopedic care for all bones and joints, and for people of all ages. Norton Orthopedic Institute is made up of board-certified physicians - many of whom are fellowship trained - who work together with therapists, physical rehabilitation specialists, primary care physicians, neurologists, certified athletic trainers and other care providers to offer a full range of multidisciplinary orthopedic services. These specialists practice a team approach in the diagnosis, treatment and rehabilitation of bone and joint conditions and injuries. Norton Orthopedic Institute's hip and knee replacement program has been certified as an Orthopaedic Center of Excellence by DNV Healthcare, as meeting guidelines of the American Academy of Orthopaedic Surgeons and the American Association of Hip and Knee Surgeons. With locations throughout Greater Louisville, including Southern Indiana, Norton Orthopedic Institute offers several specialty centers focused on providing
Form 990, Part III, Line 4a Program Service Accomplishments	continued expertise in general orthopedics, joint replacement, injuries, trauma, pediatrics, oncology, spinal conditions and sports health. Norton Women's Care * Norton Women's Care, with childbirth services at Norton Hospital and Norton Women's & Children's Hospital, was recognized as High Performing in Adult Maternity Care (Uncomplicated Pregnancy) by U.S. News & World Report. This was U.S. News & World Report's first time publishing a list of Best Hospitals for Maternity Care. * In 2021, Norton Women's Care birthing facilities at Norton Hospital and Norton Women's & Children's Hospital provided care and medical services for 8,300 deliveries. * Norton Hospital and Norton Women's & Children's Hospital offered free childbirth education classes, hosting a total of 436 in 2021. Norton Children's Prevention & Wellness * Child passenger safety technicians check car and booster seats and also provide car and booster seats at free checkup clinics statewide. In 2021 731 virtual and in-person car seat checks were completed. Additionally, 50 new child passenger safety technicians were certified on how to properly install car seats. * More than 6,300 second graders across Kentucky learned about bicycle safety through the Norton Children's Hospital Bike Safety Rodeo in 2021. Safety City also welcomed over 2,500 second-grade students to learn about bike and pedestrian safety. * In a virtual program, more than 5,200 kindergarten students participated in the 38th annual Children and Hospitals Week event. The program was held throughout the last three months of the school year, and supported by a Kohl's Cares grant. Children and Hospitals Week is designed to teach safe decisions and behaviors to help lessen the fear and anxiety children may have about coming to a hospital. * Norton Children's food pantries served over 16,000 individuals with food insecurity needs. * Norton Children's Prevention & Wellness provided 15,000 toothbrushes, toothpaste and oral hygiene information to the community. * Norton Children's Prevention & Wellness launched the "Parenting With You" podcast for parents to help children lead healthier lifestyles. Its 10 episodes in 2021 had more than 800 downloads. * After switching from in-person programming in March of 2020 due to the COVID-19 pandemic, Norton Children's Prevention & Wellness continued with virtual events in 2021, serving over 5,000 individuals with prevention and wellness programming. Events included cooking workshops, teen wellness workshops, child safety classes and safe grandparenting classes. * The "Just for Kids" Transport Team transports babies and children from across the region to Norton Children's Hospital. Transportation is provided by airplane, helicopter and specially equipped ambulances (mobile intensive care units). In 2021, 2,459 transportation trips were completed. Kentucky Poison Control Center of Norton Children's Hospital Norton Children's Hospital is home to the Kentucky Poison Control Center. In 2021, the center received more than 40,000 calls and provided continued assistance through more than 42,000 follow-up calls to concerned families in all 120 counties in Kentucky, as well as to physicians and other health care providers from every health care facility in the state. The center provided treatment consultation and education about how to correctly handle exposures to poisons. In addition, the center distributed more than 10,000 prevention education resources to physicians' offices, health departments and schools, and almost 1,000 packets of materials to individuals who called the poison hotline at (800) 222-1222, which is available 24 hours a day, 7 days a week. The staff of the poison control center also answer the Kentucky HIV and Kentucky Opioid Assistance and Resource hotlines, and managed the state's COVID-19 hotline during 2020 and 2021. Norton Neuroscience Institute Founded in 2009, Norton Neuroscience Institute is continuing its quest to be the regional and national leader in treatment, research and academic training for adult and pediatric neuroscience disciplines. Norton Neuroscience Institute ensures patients will be treated for neurological disorders without having to leave the region for care. Subspecialty neurosurgeons, neurologists and other neurology-related specialists have joined the growing institute. These physicians and advanced practice providers offer expertise in stroke care, epilepsy, Parkinson's disease, multiple sclerosis, amyotrophic lateral sclerosis (ALS), brain tumors, headaches, concussions, spine care, endovascular and cerebrovascular neurosurgery, and many other neurological conditions. * Kentucky is considered to be part of the "stroke belt," a region of the United States that sees a high number of incidents of stroke cases. As a result, Norton Neuroscience Institute has committed to being a leader in stroke care. Norton Brownsboro Hospital is a designated Comprehensive Stroke Center. Norton Audubon Hospital and Norton Hospital are certified Primary Stroke Centers, and Norton Women's & Children's Hospital is an Acute Stroke Ready certified center. * Neurosurgeons with Norton Neuroscience Institute were the first in Kentucky to use minimally invasive surgery techniques, including robotic surgery, laser ablation and stereoelectroencephalography (SEEG) in the treatment of brain tumors and epilepsy for children and adults. * Norton Neuroscience Institute offers treatment for all neurological disorders. Providers work together for the patient, providing multidisciplinary programs in areas of brain tumor, ALS, movement disorders, epilepsy, trigeminal neuralgia (face pain) and stroke. * In 2019, Norton Neuroscience Institute's pediatric neurosurgeons came together with the UofL School of Medicine Department of Neurology Division of Child Neurology to create Norton Children's Neuroscience Institute, affiliated with the UofL School of Medicine. While both groups having been working together for decades, the creation of the new institute allows for leading experts to work more seamlessly together to treat the full spectrum of spine and brain conditions in children. * In 2021, the Norton Neuroscience Institute Resource Center provided free opportunities for education and support to more than 8,442 total attendees. * In June 2021, a new Norton Neuroscience Institute facility opened on the Norton Brownsboro Hospital campus, providing comprehensive, multidisciplinary neuroscience services with leading-edge technologies and enhanced research and outreach efforts. Norton Neuroscience Institute - Brownsboro comprises more than 48,000 square feet and supports patients with many types of neurological conditions, including brain, spinal and nervous system tumors; stroke; epilepsy; migraine and headache; dementia; and memory disorders. It also is home to Norton Neuroscience Institute Cressman Parkinson's & Movement Disorders Center and Norton Neuroscience Institute Cressman Neurological Rehabilitation. Norton Community Medical Associates Norton Community Medical Associates offices provide primary care in Louisville, Southern Indiana and surrounding areas at over 30 locations. Offices are staffed by teams of experienced providers who help manage short- and long-term health goals, offer guidance on disease prevention, management of chronic conditions and diagnosis of medical concerns, and provide support navigating specialized care when needed. Physicians are involved in medical screening, community outreach and community education activities to promote wellness and early interventions. In December 2021, Norton Community Medical Associates - La Clinica Preston, Norton Healthcare's first 100% bilingual practice, opened in the Okolona area of Louisville. The staff and providers all speak English and Spanish and understand the unique concerns of Louisville's Latinx community and families. Norton Prevention & Wellness * Norton Prevention & Wellness played a key role in supporting the community throughout the COVID-19 pandemic. In 2021, this department conducted and supported COVID-19 vaccinations at fixed locations, as well as through mobile vaccine clinics at multiple sites, including places of worship, businesses and schools, providing over 12,000 first, second and third doses of vaccine to members of the community. * In 2021, Norton Prevention & Wellness staff provided preventive screenings aboard the Norton Prevention & Wellness Mobile Prevention Center in collaboration with various community partners. Over 1,400 women received mammograms and/or wellness exams, including cervical cancer screenings, aboard the mobile unit. Of those, approximately 11% had not been screened in the past five years and 12% had never had a mammogram. Of the 164 Mobile Prevention Center events, over half took place in underserved communities and over 60% of patients came from medically underserved areas.
Form 990, Part III, Line 4a Program Service Accomplishments	continued * Education on cardiovascular health, effects of smoking, prostate health, breast health and women's health and more was provided to almost 1,200 community members at various events, such as health fairs and presentations. If eligible and interested, participants were offered referrals for a colonoscopy or given an at-home testing kit that they could mail to the lab and later receive their results. Colonoscopy referrals were made for 65 people and 39 people received at-home testing kits. To help eliminate barriers to care, Norton Prevention & Wellness implemented a dedicated phone number, (502) 446-WELL, that links eligible patients to colonoscopy scheduling or requesting in-home tests. * In collaboration with many community partners, staff provided over 900 health screenings (blood pressure, body mass index, glucose and cholesterol levels) for almost 350 participants in multiple locations throughout Jefferson County and surrounding counties, including in Southern Indiana. Unfortunately, due to COVID-19, health events were significantly reduced. Each participant received education on healthy lifestyle choices, such as diet and exercise. Group education on various health and wellness topics was provided throughout the year. * Norton Prevention & Wellness conducted 15 American Lung Association Freedom From Smoking classes in 2021, with over 242 people attending. One-third reported they were tobacco-free. One class was taught in Spanish. * The Get Healthy Walking Club has over 6,000 members. 2021 brought over 1,000 new members to the free club aimed at improving overall health. Get Healthy Walking Club members have free access to walk at the Louisville Zoo each day from March through October, 8 to 9:30 a.m. Norton Healthcare Research Office Norton Healthcare guides one of the largest portfolios of clinical research of any community health care system in the United States. At any point in time, more than 750 clinical studies are active or pending at Norton Healthcare. These studies engage more than 400 Norton Healthcare staff and significantly impact our patients and their families. * Areas of clinical research focus include pediatrics, oncology, cardiology, orthopedics and spine, infectious diseases, neurology, neurosurgery, maternal-fetal medicine and pulmonology. * Norton Healthcare invests significantly in clinical research to benefit our community and patients, and to support clinical science by participating in the development of new clinical interventions (drugs, devices, procedures) that will become generalized and shared with a wide number of patient populations and medical professionals. These new, innovative treatments expand the medical community's knowledge and potentially improve the quality of medical care now and in the future. * In 2021, Norton Healthcare continued to respond to the COVID-19 pandemic by opening and guiding more than 20 COVID-19 treatment studies. As a clinical study site, Norton Healthcare enrolled the first patient in the world for three of those clinical trials. * Norton Healthcare guided a phase 3 study of the one-dose Johnson & Johnson COVID-19 vaccine that gained FDA emergency use authorization early in 2021. Norton Healthcare, in partnership with UK HealthCare and Baptist Health Lexington, gained visibility as the largest enrolling site in the world for this important study. In addition, in June 2021, Norton Children's Research Institute, affiliated with the UofL School of Medicine, announced it would participate in a phase 2/3 clinical trial of the Pfizer COVID-19 investigational vaccine for healthy children ages 6 months to 11 years. It was one of 100 participating sites around the world and the only site in Louisville offering the trial. The study evaluated safety, tolerability and immune response in this age group. Community support from Foundations The Norton Children's Hospital Foundation and Norton Healthcare Foundation raised $24.5 million in support of care at Norton Children's Hospital and its sister facilities and Norton Healthcare's adult-service facilities in 2021. Grants totaling more than $15.2 million were invested in Norton Healthcare facilities to improve access to care and spur innovation in services. The grants supported a wide range of initiatives to expand workforce, enhance facilities, establish new programs and provide advanced facilities. * A virtual reality balance assessment system, driving simulator, robotic-assisted therapy and more at Norton Neuroscience Institute - Brownsboro, a new facility in northeastern Louisville * Three Biotronik Zero-Gravity units purchased for Norton Brownsboro Hospital * Upgrades and equipment for Norton Heart & Vascular Institute * Renovation and modernization of one of our mobile units to establish Norton Prevention & Wellness Mobile Primary Care, a medical facility on wheels * Expressive therapists for the Norton Cancer Institute Pat Harrison Resource Center * Fellowship director for Norton Leatherman Spine * The Heel, Dog, Heal facility dog program across Norton Healthcare facilities, including 11 trained dogs and their handlers * Purchase of the Philips EPIQ Elite diagnostic breast ultrasound system * Operational funding for the Norton Children's Prevention & Wellness team, including Safety City and No Kid Hungry, as well as additional education and outreach * Clinical research nurse at Norton Children's Cancer Institute, affiliated with the UofL School of Medicine * Research and workforce in the development of CAR T-cell therapy for high-risk childhood cancers * Pediatric endocrinology fellowship, child life specialist and community health worker for the Wendy Novak Diabetes Center * Developing food pantries throughout the community * Giraffe Warmers for the neonatal intensive care unit at Norton Women's & Children's Hospital * Extracorporeal membrane oxygenation (ECMO) training simulators in the Jennifer Lawrence Cardiac Intensive Care Unit Norton Pharmacies PLLC Norton Pharmacies PLLC, a disregarded entity of Norton Healthcare, Inc. operates five retail pharmacies and one specialty pharmacy which dispense medications for the convenience of Norton patients and employees. Norton Institute for Health Equity * Norton Healthcare, Inc. established the Institute for Health Equity to address the health and racial inequalities in the community. The purpose of the Institute for Health Equity is to identify and remove obstacles that prevent people from receiving the healthcare they deserve, as well as to eliminate disparities in care. This includes increasing access to care and partnering with local organizations, positioning the Institute for Health Equity to serve as a central hub for community-based organizations and resources to come together to address factors that contribute to health disparities, including housing, healthy food options, transportation and child care.
Form 990, Part V, Line 1a COMMON PAYING AGENT 1099S	NORTON HEALTHCARE, INC., EIN 61-1028725 IS THE COMMON PAYING AGENT FOR NORTON HEALTHCARE, INC., NORTON HOSPITALS, INC., COMMUNITY MEDICAL ASSOCIATES, INC., NORTON PROPERTIES, INC., NORTON HEALTHCARE FOUNDATION, INC. AND THE CHILDREN'S HOSPITAL FOUNDATION INC. THEREFORE, ALL VENDORS, INCLUDING INDEPENDENT CONTRACTORS, ARE PAID AND REPORTED BY NORTON HEALTHCARE, INC. ON BEHALF OF THESE NAMED ENTITIES. FOR PURPOSES OF PART V, LINE 1, THE NUMBER OF 1099S REPORTED AND FILED FOR 2021 BY NORTON HEALTHCARE, INC., WAS APPROXIMATELY 1228. NORTON HEALTHCARE, INC., HAS APPROXIMATELY 107 INDEPENDENT CONTRACTORS EXCEEDING $100,000 FOR 2021. NORTON HEALTHCARE, INC., THE COMMON PAYING AGENT, REPORTED 890 VENDORS ON FORM 1096 FOR 2021.
Form 990, Part V, Line 1b W-2 G COMMON PAYING AGENT	NORTON HEALTHCARE INC., AS THE COMMON PAYING AGENT, FILED TWO FORM W-2Gs ON BEHALF OF THE CHILDREN'S HOSPITAL FOUNDATION.
Form 990, Part V, Line 1c COMMON PAYING AGENT FOR VENDORS	NORTON HEALTHCARE, INC., EIN 61-1028725 IS THE COMMON PAYING AGENT FOR NORTON HEALTHCARE INC, AND ALL AFFILIATES. NORTON HEALTHCARE, INC. REQUIRES THAT ALL VENDORS PROVIDE AN ACCURATE TAXPAYER IDENTIFICATION NUMBER ON A FORM W-9, AS REQUIRED BY LAW, PRIOR TO ASSURANCE OF ANY PAYMENT.
Form 990, Part V, Line 2a COMMON PAYING AGENT FOR EMPLOYEES	NORTON HEALTHCARE, INC EIN 61-1028725 IS THE COMMON PAYING AGENT FOR NORTON HOSPITALS, INC., NORTON PROPERTIES, INC., COMMUNITY MEDICAL ASSOCIATES, INC., NORTON HEALTHCARE FOUNDATION, INC., AND THE CHILDREN'S HOSPITAL FOUNDATION, INC. THEREFORE, ALL APPLICABLE IRS TAX COMPLIANCE FILINGS ARE REPORTED BY NORTON HEALTHCARE, INC. ON BEHALF OF THESE NAMED ENTITIES. NORTON HEALTHCARE, INC. HAS APPROXIMATELY 2,994 EMPLOYEES. NORTON HEALTHCARE, INC., THE COMMON PAYING AGENT, REPORTED 20,929 EMPLOYEES ON FORM W-3 FOR 2021.
Form 990, Part VI, Line 1a Delegate broad authority to a committee	The Executive Committee shall possess and may exercise all the powers and authority of the Board of Trustees in the management and direction of the business and affairs of the Corporation. However, the Executive Committee does not possess the authority to do the following: a) fill vacancies on the Board; b) change the membership of the Executive Committee; c) make decisions to merge, liquidate, or otherwise make decisions outside of the normal course of business; d) make final determinations of long-term policy; e)hire or fire the Chief Executive Officer; and f)amend the Articles of Incorporation or Bylaws
Form 990, Part VI, Line 2 Family/business relationships amongst interested persons	James Frazier, Steve Heilman, Douglas Winkelhake - Business relationship, Russell F. Cox, Adam Kempf, Robert B. Azar (Officers, Norton Enterprise, Inc.) - Business relationship
Form 990, Part VI, Line 11b Review of form 990 by governing body	At the October 6, 2022 Norton Healthcare, Inc. (NHC) Finance Committee meeting and at the October 27, 2022 NHC Board of Trustees meeting , the Forms 990 and supplemental schedules were discussed and committee members and Trustees had an opportunity to ask questions. Coinciding with the Finance Committee meeting, electronic copies of the Forms 990 and supplemental schedules were made available to all members of the Finance Committee and the Board of Trustees through the Director's portal site, prior to the filing with the IRS. NHC is the parent of Community Medical Associates, Inc., Norton Hospitals, Inc., Norton Properties, Inc., Norton Healthcare Foundation, Inc., The Children's Hospital Foundation, Inc., and Norton Healthcare-Indiana, Inc.
Form 990, Part VI, Line 12c Conflict of interest policy	THE ORGANIZATION REGULARLY AND CONSISTENTLY MONITORS AND ENFORCES COMPLIANCE WITH THE CONFLICT OF INTEREST POLICY BY ANNUALLY DISTRIBUTING A QUESTIONNAIRE THAT REQUIRES OFFICERS, TRUSTEES, AND KEY EMPLOYEES TO DISCLOSE INTERESTS THAT MAY GIVE RISE TO CONFLICTS. IF A CONFLICT ARISES, THE POLICY PROVIDES PROCEDURES FOR ADDRESSING CONFLICTS TO ENSURE DECISIONS ARE MADE IN THE BEST INTEREST OF THE ORGANIZATION.
Form 990, Part VI, Line 15a Process to establish compensation of top management official	Please see explanation provided for Form 990, Part VI, Line 15b.
Form 990, Part VI, Line 15b Process to establish compensation of other employees	The organization takes all necessary steps to ensure that compensation for all officers, directors and key employees is reasonable and appropriate for the services provided to the organization. The organization provides a total compensation package that is on par with compensation provided by similar organizations and which conforms to the policies and guidelines set out by the Board of Trustees. Norton Healthcare, Inc. (NHC) engages an outside independent compensation consultant, Gallagher, to provide comparability data, including review of other health systems and hospital organizations that have filed Form 990s, for NHC's officers and key employees on total compensation for similar positions at health systems and hospital organizations similar in size, scope of services, and circumstances. In addition, the organization participates in third party surveys which provide aggregate, comparative compensation data for officers and key employees in similar positions at similar organizations. Gallagher consultants presented and discussed this comparability data in 2020 for the 2021 compensation review and met in 2021 for the 2022 compensation review with the Executive Committee of the Board of Trustees (Board). The Committee reviewed the executive compensation and benefits program, determined total compensation for the CEO, and approved compensation for other officers and key employees. The Committee reviewed NHC's variable compensation program and determined appropriate awards for performance relative to goals set for the year. After the Committee determined appropriate compensation and benefits for officers and key employees, the Board approved their total compensation.
Form 990, Part VI, Line 19 Required documents available to the public	CONSOLIDATED FINANCIAL STATEMENTS ARE AVAILABLE HERE: HTTPS://NORTONHEALTHCARE.COM/ABOUT-US/FINANCIAL-INFORMATION/. GOVERNING DOCUMENTS, AND CONFLICTS OF INTEREST POLICIES ARE NOT REQUIRED DISCLOSURES PURSUANT TO INTERNAL REVENUE CODE (IRC) SECTION 6104. THESE DOCUMENTS ARE NOT AVAILABLE TO THE PUBLIC
Form 990, Part VII, Section A, Line 1a, Column (D) Board Member Stipend Payments	Norton Healthcare, Inc. (NHC) and affiliates (Norton Hospitals, Inc., Community Medical Associates, Inc., Norton Properties, Inc., and The Children's Hospital Foundation, Inc.) encourages and facilitates board member attendance at educational programs and conferences on subjects relevant to NHC. NHC's travel policy for Board of Trustees provides that for each trustee that attends at least one out of town educational conference, a lump sum stipend will be paid to cover unreimbursed travel expense and other miscellaneous expenses associated with conference preparation, attendance or follow up. In compliance with IRS regulations, NHC provides a form 1099 to any trustee that receives a stipend. These amounts have been reported in Part VII or the form 990 as reportable compensation to the trustee receiving stipends in 2021.
Form 990, Part IX, Line 11g Other Fees	Outside Services - Total Expense: 55723360, Program Service Expense: 45222309, Management and General Expenses: 10501051, Fundraising Expenses: ; Other expenses - Total Expense: 1710205, Program Service Expense: 894153, Management and General Expenses: 816052, Fundraising Expenses: ; Contract Labor - Total Expense: 1299993, Program Service Expense: 1046511, Management and General Expenses: 253482, Fundraising Expenses: ; Professional Fees - Total Expense: 785538, Program Service Expense: 785538, Management and General Expenses: , Fundraising Expenses: ; Research Department Fees - Total Expense: 1095590, Program Service Expense: 1095590, Management and General Expenses: , Fundraising Expenses: ; Collection Fees - Total Expense: 2187300, Program Service Expense: 1892015, Management and General Expenses: 295285, Fundraising Expenses: ; Marketing Fees - Total Expense: 7951183, Program Service Expense: 3180473, Management and General Expenses: 4770710, Fundraising Expenses: ;
Form 990, Part XI, Line 9 Other changes in net assets or fund balances	AFFILIATE TRANSFER - -481322; SWAP MARK TO MARKET ADJUSTMENT - -11217617; CHANGE IN MINIMUM PENSION LIABILITY - 12115973; CHANGE IN NET PERIODIC PENSION COST - -1934087;
Form 990, Part XI, Line 9 Other changes in Net Assets or Fund Balance	In March 2017, the FASB issued ASU 2017-07 Compensation -Retirement Benefits (Topic 715): Improving the Presentation of Net Periodic Pension Cost and Net Periodic Postretirement Benefit Cost (ASU 2017-07), which changes how employers that sponsor defined benefit pension present the net periodic benefit cost in the statement of operations. ASU 2017-07 requires employers to present the service cost component of net periodic benefit cost in the same statement of operations line items as other employee compensation costs arising from services rendered during the period. Employers are to present the other components of net periodic benefit cost separately from the line item that includes the service cost and outside of any subtotal of operating income, if one is presented. Employers will have to disclose the lines used to present the other components of net periodic benefit cost, if the components are not presented separately in the statement of operations. The corporation elected to adopt the provisions of ASU 2017-07 as of January 1, 2017. The non-contribution defined benefit pension plan was frozen effective January 1, 2010. As a result no service cost was incurred during the year ended December 31, 2021. The other components of net periodic pension cost was $2.0 million for year ended December 31, 2021.

Return Reference

Explanation

Form 990, Part III, Line 4a Program Service Accomplishment

(Continued from Part III) In 2021, Norton Healthcare, through its affiliate, Community Medical Associates Inc., had approximately 3.1 million patient encounters. Norton Healthcare's hospitals, diagnostic centers and Norton Cancer Institute served 68,502 inpatients and 646,869 outpatients, and saw 235,728 emergency room visits. In addition, Norton Healthcare hospitals' operating rooms cared for 16,312 inpatient surgical patients and 39,433 outpatient surgical patients. Additionally, 8,300 babies were delivered at Norton Healthcare birthing facilities at Norton Hospital and Norton Women's & Children's Hospital. As part of our commitment to improving the health of our community, Norton Healthcare provides funding for a wide array of lifesaving and life-enhancing services that benefit the communities we serve. In 2021, under its charity care program, Norton Healthcare provided free care to 7,291 patients, at a cost of $14.2 million. Also, Norton Healthcare grants a discount from billed charges to any patients who have no access to private health insurance or do not qualify for government assistance or charity care. Under this program, 7,498 patients were provided care at discounted rates. Another contribution to the community was educational support of $77.4 million, primarily to the University of Louisville (UofL) School of Medicine. Community health improvement services totaled $20.1 million and contributions to community groups were $1.9 million. Norton Healthcare employees donated more than 209,000 hours of community service, a benefit valued at more than $1.1 million in salaries. In addition, many employees self-reported personal volunteer activities. Norton Healthcare provides programmatic support to the UofL School of Medicine through funding and facilities. During the 2021 calendar year, 209 residents completed clinical rotations in 50 specialties at Norton Healthcare facilities. Residency programs are part of the $77.4 million in educational support and clinical funding provided to the medical school Contributions to the community * Norton Healthcare employees and physicians gave nearly $815,643 to our 2021-2022 Combined Giving Campaign to help support non-profit organizations that also are committed to improving the health and well-being of community residents. Supported organizations include WHAS Crusade for Children, Metro United Way, Fund for the Arts, and our own Norton Children's Hospital Foundation and Norton Healthcare Foundation. * In 2021, 68 employees helped "raise the roof" on Norton Healthcare's 16th Habitat for Humanity home. The number of participating employees remained limited compared to prior years due to COVID-19 restrictions. * In 2021, an estimated 1,400 Norton Healthcare employees donated time and funds to plan, purchase and deliver gifts, food and clothing for the Caring Tree program. The program assisted 521 employees and their 1,147 children and dependents by providing for their families at Christmas. * More than 44,000 pounds of usable surplus medical supplies valued at more than $716,000, and over $552,805 in equipment, were donated for use locally and around the world. Norton Healthcare donated syringe pumps to Malawi as they tried to recover from rain storms and cyclones in addition to the ongoing struggles against Covid-19. These supplies were delivered in February of 2022 and went to three hospitals and 6 smaller clinics serving orphans, women and infants. Community Education and Workforce Development Workforce Development encourages continuing education, offers programs to improve job performance and provides financial assistance for educational programs aimed toward key areas of workforce need within the organization. Norton Healthcare encourages and supports the career goals of employees and their dependents by providing financial assistance and scholarships as well as other advancement opportunities. Established in the early 2000s, Workforce Development has assisted more than 6,000 students with tuition assistance. In 2021, Workforce Development financially supported more than 750 students with over $4.5 million in educational assistance programs. * In 2021, Workforce Development provided nearly 1,400 career coaching sessions to employees and students. Each program participant worked directly with a career management coach. Coaches offer services in resume writing, career and education exploration, financial assistance opportunities and interviewing skills. * The accelerated Norton Healthcare Scholars Program, a student loan program for employees and nonemployees, provides educational funding to students interested in pursuing health care-related degrees in areas of workforce need. It is an affiliation between Norton Healthcare and over 100 colleges and universities nationally. Since 2014, this program has assisted more than 1,000 graduates continue their careers with Norton Healthcare. * In 2018, Norton Healthcare was one of the founding partners in Jefferson County Public Schools' Academies of Louisville, a strategic pipeline development program in conjunction with the local public school system. Jefferson County Public Schools created an academy model in which students have the opportunity to select career-focused education and earn industry-recognized credentials while in high school. Norton Healthcare transformed its summer program and previous high school scholarship offerings into a comprehensive internship program for students on the health care academy track. The program targets high school seniors in health care academy pathways via career exploration in identified health care areas. Beginning in junior year, health care academy students explore career pathways in one of four key areas: patient care, medical office, allied health and pharmacy technician. Each phase offers a rigorous curriculum, training in business acumen and professional development, and hands-on learning opportunities in the students' chosen career fields. The goal is to transition graduating students into staff positions with our organization after completion of the program. Tuition assistance is offered for these new employees to continue their academic and career pursuits while working at Norton Healthcare in the field of their choice. * In 2019, Norton Healthcare announced a strategic partnership program with UPS and its Metropolitan College program. Norton Healthcare-UPS Health Care Career Tracks provides a two-plus-two method, splitting a four-year bachelor's degree into two parts. Typically, the first two years are spent working with UPS in a general or preclinical designation, and then the student begins their clinical program in the last two years. This transition allows students to explore employment with Norton Healthcare as well as become a Norton Healthcare Scholar. This program helps to support career readiness in a health care-related field. The combined tuition assistance offers students a debt-free way to get a college education while working with two of the leading companies in the region. * The Student Nurse Apprenticeship Program (SNAP) is a 12- to 18-month apprenticeship through Norton Healthcare Center for Nursing Practice in which nursing students work and engage in hands-on learning with an experienced mentor while becoming integrated with Norton Healthcare. * In 2019, Norton Healthcare launched new apprenticeship programs. The Surgical Technologist Apprenticeship Program and the Respiratory Therapy Apprenticeship Program allow students to work and learn with tuition assistance as they grow their careers with Norton Healthcare. Development of the Medical Assistant Training Program launched in 2020 with a goal of offering internal training programs to produce quality, prepared medical assistants to introduce into the Norton Healthcare workforce. Several apprenticeship cohorts run throughout each year. Norton Healthcare Institute for Education & Development provides learning opportunities to enhance the professional, educational and personal development of all employees. It consists of seven centers: the Center for Academic Affairs, Center for Allied Health, Center for Continuing Medical, Nursing & Provider Education, Center for eLearning & Clinical Documentation Support, Center for Nursing Practice, Center for Professional Growth, and Center for System Nursing & Ancillary Education. The Center for Professional Growth provides learning and growth opportunities that meet the needs of Norton Healthcare employees. Three types of leadership development courses are offered to address the needs of new, aspiring and current leaders: * N the Know: This is our new leader orientation program. Newly hired and promoted leaders are automatically enrolled. The program has four required courses and six elective courses.

Form 990, Part III, Line 4a Program Service Accomplishment

Continued * Learning the Norton Way: This six week program is focused on preparing employees for leadership. Leadership approval is required for all employees who wish to attend. * Leading the Norton Way: This program is for current Norton Healthcare leaders. It is a six-week program focused on best practices for effective leadership. * Additional leadership development is provided through quarterly Norton Healthcare leadership conferences. * Staff development programs include general enrichment courses and personal and professional development opportunities that honor Norton Healthcare's commitment to lifelong learning. A variety of online and instructor-led courses focus on learning topics such as communication, diversity, interpersonal relationship-building, accountability and proficiency in Microsoft Office tools. * Norton Healthcare uses a comprehensive learning management system to provide a variety of online programs that enable staff in any specialty as well as other employees to expand their knowledge and skills. These programs were designed to meet the needs of Norton Healthcare, as well as our community, and to ensure the highest quality of patient care. Norton Faith & Health Ministries Norton Faith & Health Ministries partners with faith communities to weave together health and wellness promotion with the intentional care of the spirit. The department provides mentoring, educational resources and networking opportunities to assist health ministry coordinators and faith community nurses in ministering to their members. In 2021, the department engaged in 62 events with faith partners, including: * Facilitating administering more than 6,000 COVID-19 vaccines at faith community site-based clinics. * Sponsoring health ministry networking programs on COVID-19 updates, legal documents for seniors and self-care practices for professional caregivers. * Partnering with a network of nearly 200 faith communities to supply speakers on whole-person health and wellness, and provide health educational tools, health screenings and one-on-one health ministry mentoring. The department continued to serve as a trusted communication source for timely health and wellness information through a monthly email to a network of health ministry coordinators, a bimonthly e-newsletter to 1,400 subscribers and three issues of the Health Ministries Connection newsletter distributed to faith communities, Norton Healthcare employees and more. Pastoral Care Department The Pastoral Care Department of Norton Healthcare continued in 2021 to follow through with what they learned during the first year of the pandemic - to bring care, comfort and compassion to weary staff, patients and families 24 hours a day, 7 days a week, every day throughout the year, across the five system hospitals and many outpatient areas. At the start of 2021, there was great hope that the restrictions and heartache from the COVID-19 pandemic would soon be gone, but the year turned out different than expected. Continuing with what was done in 2020, supporting staff remained a high priority for the chaplains. Leadership consistently called on chaplains to be a resource for employees experiencing many stresses throughout the year, and referrals to them were regularly highlighted in communications from leadership describing resources for staff support. While the vaccine was a great sign of hope, the polarization that came with it created uncomfortable situations. Patients continued to be very sick and die unvaccinated. Many departments struggled with staffing shortages. Employees were tired and often burned out. Chaplains responded with relational initiatives, virtual classes on resilience, and even a formal research study on moral distress in the intensive care unit. Chaplains provided care in more than 33,000 documented patient encounters, plus many thousands of family member encounters as well. Some of the many reasons chaplains become involved in the care of patients and families included: * Grief support and facilitation of decision-making at more than 2,000 deaths * Family support for pediatric trauma patients * Conversations about end of-life decisions and goals of care * Education about and enacting advance directives * Offering religious rituals and literature * Discussing ethical dilemmas * Providing comfort and conversation with patients who were lonely, afraid, conflicted, struggling or celebrating good news Chaplains care for people, regardless of their religious or spiritual backgrounds and beliefs, to help them use and strengthen their spiritual, emotional and relational resources to better cope and to thrive. Through formal and informal staff support efforts, teaching, committee involvement, ethics consultations and many other ways, chaplains are fully integrated into the life of the Norton Healthcare system. Norton Heart & Vascular Institute Norton Heart & Vascular Institute is Louisville's leading cardiovascular disease prevention and treatment program. Each year, it provides diagnostic, medical, interventional and surgical care for thousands of patients from Kentucky and Southern Indiana. Norton Heart & Vascular Institute specialists treat patients at Norton Healthcare's four adult-service hospitals and more than 28 outpatient clinics, diagnostic centers and specialty locations throughout Greater Louisville. * Kentucky has one of the highest occurrences of heart disease in the country. As a result, Norton Heart & Vascular Institute has committed to being a leader in acute chest pain care. All four of Norton Healthcare's adult-service hospitals in Louisville are recognized by the American College of Cardiology as Acute Chest Pain Centers. Optimal care for heart attack patients takes coordination at the hospital, emergency medical services and system levels. In 2021, all three Norton Healthcare adult STEMI receiving hospitals received the American Heart Association's Mission: Lifeline Gold Plus STEMI/Chest Pain Receiving Center designation, recognizing excellence in providing the highest level of care for heart attacks. * Many people in our region have more than one chronic health condition, and/or advancing heart disease, which is leading to increased occurrences of heart failure. The Norton Heart & Vascular Institute Advanced Heart Failure & Recovery Program provides comprehensive care to manage heart failure, and in some cases, help patients recover from heart failure. In 2020, the program expanded its advanced treatment offerings as Norton Audubon Hospital received ventricular assist device (VAD) accreditation from DNV Healthcare and the U.S. Centers for Medicare & Medicaid Services. This advanced level of care, partnered with navigation, patient education and support of those with heart failure, is key to impacting heart failure care in Kentucky. * Norton Healthcare achieved systemwide noninvasive cardiology accreditation from the Intersocietal Accreditation Commission in 2020. Departments that perform noninvasive cardiology procedures are many times the first touchpoint for Norton Healthcare patients for heart and vascular care. This recognition signifies the highest level of diagnostic capabilities at all Norton Healthcare locations through the use of noninvasive echocardiography, noninvasive vascular ultrasound, nuclear cardiology and positron emission tomography (PET) cardiology. In 2021, Norton Heart & Vascular Institute remains the only health system in Louisville that offers fractional flow reserve derived from computed tomography (FFRCT). * Cardiovascular disease is impacting our community across a wide variety of ages and demographics. In 2021, the Norton Heart & Vascular Institute Young Adult Cardiology Clinic was established to treat patients under age 35 with no prior cardiac care conditions who have been seen for chest pain in the emergency department or a primary care office. Norton Orthopedic Institute Norton Orthopedic Institute provides advanced orthopedic care for all bones and joints, and for people of all ages. Norton Orthopedic Institute is made up of board-certified physicians - many of whom are fellowship trained - who work together with therapists, physical rehabilitation specialists, primary care physicians, neurologists, certified athletic trainers and other care providers to offer a full range of multidisciplinary orthopedic services. These specialists practice a team approach in the diagnosis, treatment and rehabilitation of bone and joint conditions and injuries. Norton Orthopedic Institute's hip and knee replacement program has been certified as an Orthopaedic Center of Excellence by DNV Healthcare, as meeting guidelines of the American Academy of Orthopaedic Surgeons and the American Association of Hip and Knee Surgeons. With locations throughout Greater Louisville, including Southern Indiana, Norton Orthopedic Institute offers several specialty centers focused on providing

Form 990, Part III, Line 4a Program Service Accomplishments

continued expertise in general orthopedics, joint replacement, injuries, trauma, pediatrics, oncology, spinal conditions and sports health. Norton Women's Care * Norton Women's Care, with childbirth services at Norton Hospital and Norton Women's & Children's Hospital, was recognized as High Performing in Adult Maternity Care (Uncomplicated Pregnancy) by U.S. News & World Report. This was U.S. News & World Report's first time publishing a list of Best Hospitals for Maternity Care. * In 2021, Norton Women's Care birthing facilities at Norton Hospital and Norton Women's & Children's Hospital provided care and medical services for 8,300 deliveries. * Norton Hospital and Norton Women's & Children's Hospital offered free childbirth education classes, hosting a total of 436 in 2021. Norton Children's Prevention & Wellness * Child passenger safety technicians check car and booster seats and also provide car and booster seats at free checkup clinics statewide. In 2021 731 virtual and in-person car seat checks were completed. Additionally, 50 new child passenger safety technicians were certified on how to properly install car seats. * More than 6,300 second graders across Kentucky learned about bicycle safety through the Norton Children's Hospital Bike Safety Rodeo in 2021. Safety City also welcomed over 2,500 second-grade students to learn about bike and pedestrian safety. * In a virtual program, more than 5,200 kindergarten students participated in the 38th annual Children and Hospitals Week event. The program was held throughout the last three months of the school year, and supported by a Kohl's Cares grant. Children and Hospitals Week is designed to teach safe decisions and behaviors to help lessen the fear and anxiety children may have about coming to a hospital. * Norton Children's food pantries served over 16,000 individuals with food insecurity needs. * Norton Children's Prevention & Wellness provided 15,000 toothbrushes, toothpaste and oral hygiene information to the community. * Norton Children's Prevention & Wellness launched the "Parenting With You" podcast for parents to help children lead healthier lifestyles. Its 10 episodes in 2021 had more than 800 downloads. * After switching from in-person programming in March of 2020 due to the COVID-19 pandemic, Norton Children's Prevention & Wellness continued with virtual events in 2021, serving over 5,000 individuals with prevention and wellness programming. Events included cooking workshops, teen wellness workshops, child safety classes and safe grandparenting classes. * The "Just for Kids" Transport Team transports babies and children from across the region to Norton Children's Hospital. Transportation is provided by airplane, helicopter and specially equipped ambulances (mobile intensive care units). In 2021, 2,459 transportation trips were completed. Kentucky Poison Control Center of Norton Children's Hospital Norton Children's Hospital is home to the Kentucky Poison Control Center. In 2021, the center received more than 40,000 calls and provided continued assistance through more than 42,000 follow-up calls to concerned families in all 120 counties in Kentucky, as well as to physicians and other health care providers from every health care facility in the state. The center provided treatment consultation and education about how to correctly handle exposures to poisons. In addition, the center distributed more than 10,000 prevention education resources to physicians' offices, health departments and schools, and almost 1,000 packets of materials to individuals who called the poison hotline at (800) 222-1222, which is available 24 hours a day, 7 days a week. The staff of the poison control center also answer the Kentucky HIV and Kentucky Opioid Assistance and Resource hotlines, and managed the state's COVID-19 hotline during 2020 and 2021. Norton Neuroscience Institute Founded in 2009, Norton Neuroscience Institute is continuing its quest to be the regional and national leader in treatment, research and academic training for adult and pediatric neuroscience disciplines. Norton Neuroscience Institute ensures patients will be treated for neurological disorders without having to leave the region for care. Subspecialty neurosurgeons, neurologists and other neurology-related specialists have joined the growing institute. These physicians and advanced practice providers offer expertise in stroke care, epilepsy, Parkinson's disease, multiple sclerosis, amyotrophic lateral sclerosis (ALS), brain tumors, headaches, concussions, spine care, endovascular and cerebrovascular neurosurgery, and many other neurological conditions. * Kentucky is considered to be part of the "stroke belt," a region of the United States that sees a high number of incidents of stroke cases. As a result, Norton Neuroscience Institute has committed to being a leader in stroke care. Norton Brownsboro Hospital is a designated Comprehensive Stroke Center. Norton Audubon Hospital and Norton Hospital are certified Primary Stroke Centers, and Norton Women's & Children's Hospital is an Acute Stroke Ready certified center. * Neurosurgeons with Norton Neuroscience Institute were the first in Kentucky to use minimally invasive surgery techniques, including robotic surgery, laser ablation and stereoelectroencephalography (SEEG) in the treatment of brain tumors and epilepsy for children and adults. * Norton Neuroscience Institute offers treatment for all neurological disorders. Providers work together for the patient, providing multidisciplinary programs in areas of brain tumor, ALS, movement disorders, epilepsy, trigeminal neuralgia (face pain) and stroke. * In 2019, Norton Neuroscience Institute's pediatric neurosurgeons came together with the UofL School of Medicine Department of Neurology Division of Child Neurology to create Norton Children's Neuroscience Institute, affiliated with the UofL School of Medicine. While both groups having been working together for decades, the creation of the new institute allows for leading experts to work more seamlessly together to treat the full spectrum of spine and brain conditions in children. * In 2021, the Norton Neuroscience Institute Resource Center provided free opportunities for education and support to more than 8,442 total attendees. * In June 2021, a new Norton Neuroscience Institute facility opened on the Norton Brownsboro Hospital campus, providing comprehensive, multidisciplinary neuroscience services with leading-edge technologies and enhanced research and outreach efforts. Norton Neuroscience Institute - Brownsboro comprises more than 48,000 square feet and supports patients with many types of neurological conditions, including brain, spinal and nervous system tumors; stroke; epilepsy; migraine and headache; dementia; and memory disorders. It also is home to Norton Neuroscience Institute Cressman Parkinson's & Movement Disorders Center and Norton Neuroscience Institute Cressman Neurological Rehabilitation. Norton Community Medical Associates Norton Community Medical Associates offices provide primary care in Louisville, Southern Indiana and surrounding areas at over 30 locations. Offices are staffed by teams of experienced providers who help manage short- and long-term health goals, offer guidance on disease prevention, management of chronic conditions and diagnosis of medical concerns, and provide support navigating specialized care when needed. Physicians are involved in medical screening, community outreach and community education activities to promote wellness and early interventions. In December 2021, Norton Community Medical Associates - La Clinica Preston, Norton Healthcare's first 100% bilingual practice, opened in the Okolona area of Louisville. The staff and providers all speak English and Spanish and understand the unique concerns of Louisville's Latinx community and families. Norton Prevention & Wellness * Norton Prevention & Wellness played a key role in supporting the community throughout the COVID-19 pandemic. In 2021, this department conducted and supported COVID-19 vaccinations at fixed locations, as well as through mobile vaccine clinics at multiple sites, including places of worship, businesses and schools, providing over 12,000 first, second and third doses of vaccine to members of the community. * In 2021, Norton Prevention & Wellness staff provided preventive screenings aboard the Norton Prevention & Wellness Mobile Prevention Center in collaboration with various community partners. Over 1,400 women received mammograms and/or wellness exams, including cervical cancer screenings, aboard the mobile unit. Of those, approximately 11% had not been screened in the past five years and 12% had never had a mammogram. Of the 164 Mobile Prevention Center events, over half took place in underserved communities and over 60% of patients came from medically underserved areas.

Form 990, Part III, Line 4a Program Service Accomplishments

continued * Education on cardiovascular health, effects of smoking, prostate health, breast health and women's health and more was provided to almost 1,200 community members at various events, such as health fairs and presentations. If eligible and interested, participants were offered referrals for a colonoscopy or given an at-home testing kit that they could mail to the lab and later receive their results. Colonoscopy referrals were made for 65 people and 39 people received at-home testing kits. To help eliminate barriers to care, Norton Prevention & Wellness implemented a dedicated phone number, (502) 446-WELL, that links eligible patients to colonoscopy scheduling or requesting in-home tests. * In collaboration with many community partners, staff provided over 900 health screenings (blood pressure, body mass index, glucose and cholesterol levels) for almost 350 participants in multiple locations throughout Jefferson County and surrounding counties, including in Southern Indiana. Unfortunately, due to COVID-19, health events were significantly reduced. Each participant received education on healthy lifestyle choices, such as diet and exercise. Group education on various health and wellness topics was provided throughout the year. * Norton Prevention & Wellness conducted 15 American Lung Association Freedom From Smoking classes in 2021, with over 242 people attending. One-third reported they were tobacco-free. One class was taught in Spanish. * The Get Healthy Walking Club has over 6,000 members. 2021 brought over 1,000 new members to the free club aimed at improving overall health. Get Healthy Walking Club members have free access to walk at the Louisville Zoo each day from March through October, 8 to 9:30 a.m. Norton Healthcare Research Office Norton Healthcare guides one of the largest portfolios of clinical research of any community health care system in the United States. At any point in time, more than 750 clinical studies are active or pending at Norton Healthcare. These studies engage more than 400 Norton Healthcare staff and significantly impact our patients and their families. * Areas of clinical research focus include pediatrics, oncology, cardiology, orthopedics and spine, infectious diseases, neurology, neurosurgery, maternal-fetal medicine and pulmonology. * Norton Healthcare invests significantly in clinical research to benefit our community and patients, and to support clinical science by participating in the development of new clinical interventions (drugs, devices, procedures) that will become generalized and shared with a wide number of patient populations and medical professionals. These new, innovative treatments expand the medical community's knowledge and potentially improve the quality of medical care now and in the future. * In 2021, Norton Healthcare continued to respond to the COVID-19 pandemic by opening and guiding more than 20 COVID-19 treatment studies. As a clinical study site, Norton Healthcare enrolled the first patient in the world for three of those clinical trials. * Norton Healthcare guided a phase 3 study of the one-dose Johnson & Johnson COVID-19 vaccine that gained FDA emergency use authorization early in 2021. Norton Healthcare, in partnership with UK HealthCare and Baptist Health Lexington, gained visibility as the largest enrolling site in the world for this important study. In addition, in June 2021, Norton Children's Research Institute, affiliated with the UofL School of Medicine, announced it would participate in a phase 2/3 clinical trial of the Pfizer COVID-19 investigational vaccine for healthy children ages 6 months to 11 years. It was one of 100 participating sites around the world and the only site in Louisville offering the trial. The study evaluated safety, tolerability and immune response in this age group. Community support from Foundations The Norton Children's Hospital Foundation and Norton Healthcare Foundation raised $24.5 million in support of care at Norton Children's Hospital and its sister facilities and Norton Healthcare's adult-service facilities in 2021. Grants totaling more than $15.2 million were invested in Norton Healthcare facilities to improve access to care and spur innovation in services. The grants supported a wide range of initiatives to expand workforce, enhance facilities, establish new programs and provide advanced facilities. * A virtual reality balance assessment system, driving simulator, robotic-assisted therapy and more at Norton Neuroscience Institute - Brownsboro, a new facility in northeastern Louisville * Three Biotronik Zero-Gravity units purchased for Norton Brownsboro Hospital * Upgrades and equipment for Norton Heart & Vascular Institute * Renovation and modernization of one of our mobile units to establish Norton Prevention & Wellness Mobile Primary Care, a medical facility on wheels * Expressive therapists for the Norton Cancer Institute Pat Harrison Resource Center * Fellowship director for Norton Leatherman Spine * The Heel, Dog, Heal facility dog program across Norton Healthcare facilities, including 11 trained dogs and their handlers * Purchase of the Philips EPIQ Elite diagnostic breast ultrasound system * Operational funding for the Norton Children's Prevention & Wellness team, including Safety City and No Kid Hungry, as well as additional education and outreach * Clinical research nurse at Norton Children's Cancer Institute, affiliated with the UofL School of Medicine * Research and workforce in the development of CAR T-cell therapy for high-risk childhood cancers * Pediatric endocrinology fellowship, child life specialist and community health worker for the Wendy Novak Diabetes Center * Developing food pantries throughout the community * Giraffe Warmers for the neonatal intensive care unit at Norton Women's & Children's Hospital * Extracorporeal membrane oxygenation (ECMO) training simulators in the Jennifer Lawrence Cardiac Intensive Care Unit Norton Pharmacies PLLC Norton Pharmacies PLLC, a disregarded entity of Norton Healthcare, Inc. operates five retail pharmacies and one specialty pharmacy which dispense medications for the convenience of Norton patients and employees. Norton Institute for Health Equity * Norton Healthcare, Inc. established the Institute for Health Equity to address the health and racial inequalities in the community. The purpose of the Institute for Health Equity is to identify and remove obstacles that prevent people from receiving the healthcare they deserve, as well as to eliminate disparities in care. This includes increasing access to care and partnering with local organizations, positioning the Institute for Health Equity to serve as a central hub for community-based organizations and resources to come together to address factors that contribute to health disparities, including housing, healthy food options, transportation and child care.

Form 990, Part V, Line 1a COMMON PAYING AGENT 1099S

NORTON HEALTHCARE, INC., EIN 61-1028725 IS THE COMMON PAYING AGENT FOR NORTON HEALTHCARE, INC., NORTON HOSPITALS, INC., COMMUNITY MEDICAL ASSOCIATES, INC., NORTON PROPERTIES, INC., NORTON HEALTHCARE FOUNDATION, INC. AND THE CHILDREN'S HOSPITAL FOUNDATION INC. THEREFORE, ALL VENDORS, INCLUDING INDEPENDENT CONTRACTORS, ARE PAID AND REPORTED BY NORTON HEALTHCARE, INC. ON BEHALF OF THESE NAMED ENTITIES. FOR PURPOSES OF PART V, LINE 1, THE NUMBER OF 1099S REPORTED AND FILED FOR 2021 BY NORTON HEALTHCARE, INC., WAS APPROXIMATELY 1228. NORTON HEALTHCARE, INC., HAS APPROXIMATELY 107 INDEPENDENT CONTRACTORS EXCEEDING $100,000 FOR 2021. NORTON HEALTHCARE, INC., THE COMMON PAYING AGENT, REPORTED 890 VENDORS ON FORM 1096 FOR 2021.

Form 990, Part V, Line 1b W-2 G COMMON PAYING AGENT

NORTON HEALTHCARE INC., AS THE COMMON PAYING AGENT, FILED TWO FORM W-2Gs ON BEHALF OF THE CHILDREN'S HOSPITAL FOUNDATION.

Form 990, Part V, Line 1c COMMON PAYING AGENT FOR VENDORS

NORTON HEALTHCARE, INC., EIN 61-1028725 IS THE COMMON PAYING AGENT FOR NORTON HEALTHCARE INC, AND ALL AFFILIATES. NORTON HEALTHCARE, INC. REQUIRES THAT ALL VENDORS PROVIDE AN ACCURATE TAXPAYER IDENTIFICATION NUMBER ON A FORM W-9, AS REQUIRED BY LAW, PRIOR TO ASSURANCE OF ANY PAYMENT.

Form 990, Part V, Line 2a COMMON PAYING AGENT FOR EMPLOYEES

NORTON HEALTHCARE, INC EIN 61-1028725 IS THE COMMON PAYING AGENT FOR NORTON HOSPITALS, INC., NORTON PROPERTIES, INC., COMMUNITY MEDICAL ASSOCIATES, INC., NORTON HEALTHCARE FOUNDATION, INC., AND THE CHILDREN'S HOSPITAL FOUNDATION, INC. THEREFORE, ALL APPLICABLE IRS TAX COMPLIANCE FILINGS ARE REPORTED BY NORTON HEALTHCARE, INC. ON BEHALF OF THESE NAMED ENTITIES. NORTON HEALTHCARE, INC. HAS APPROXIMATELY 2,994 EMPLOYEES. NORTON HEALTHCARE, INC., THE COMMON PAYING AGENT, REPORTED 20,929 EMPLOYEES ON FORM W-3 FOR 2021.

Form 990, Part VI, Line 1a Delegate broad authority to a committee

The Executive Committee shall possess and may exercise all the powers and authority of the Board of Trustees in the management and direction of the business and affairs of the Corporation. However, the Executive Committee does not possess the authority to do the following: a) fill vacancies on the Board; b) change the membership of the Executive Committee; c) make decisions to merge, liquidate, or otherwise make decisions outside of the normal course of business; d) make final determinations of long-term policy; e)hire or fire the Chief Executive Officer; and f)amend the Articles of Incorporation or Bylaws

Form 990, Part VI, Line 2 Family/business relationships amongst interested persons

James Frazier, Steve Heilman, Douglas Winkelhake - Business relationship, Russell F. Cox, Adam Kempf, Robert B. Azar (Officers, Norton Enterprise, Inc.) - Business relationship

Form 990, Part VI, Line 11b Review of form 990 by governing body

At the October 6, 2022 Norton Healthcare, Inc. (NHC) Finance Committee meeting and at the October 27, 2022 NHC Board of Trustees meeting , the Forms 990 and supplemental schedules were discussed and committee members and Trustees had an opportunity to ask questions. Coinciding with the Finance Committee meeting, electronic copies of the Forms 990 and supplemental schedules were made available to all members of the Finance Committee and the Board of Trustees through the Director's portal site, prior to the filing with the IRS. NHC is the parent of Community Medical Associates, Inc., Norton Hospitals, Inc., Norton Properties, Inc., Norton Healthcare Foundation, Inc., The Children's Hospital Foundation, Inc., and Norton Healthcare-Indiana, Inc.

Form 990, Part VI, Line 12c Conflict of interest policy

THE ORGANIZATION REGULARLY AND CONSISTENTLY MONITORS AND ENFORCES COMPLIANCE WITH THE CONFLICT OF INTEREST POLICY BY ANNUALLY DISTRIBUTING A QUESTIONNAIRE THAT REQUIRES OFFICERS, TRUSTEES, AND KEY EMPLOYEES TO DISCLOSE INTERESTS THAT MAY GIVE RISE TO CONFLICTS. IF A CONFLICT ARISES, THE POLICY PROVIDES PROCEDURES FOR ADDRESSING CONFLICTS TO ENSURE DECISIONS ARE MADE IN THE BEST INTEREST OF THE ORGANIZATION.

Form 990, Part VI, Line 15a Process to establish compensation of top management official

Please see explanation provided for Form 990, Part VI, Line 15b.

Form 990, Part VI, Line 15b Process to establish compensation of other employees

The organization takes all necessary steps to ensure that compensation for all officers, directors and key employees is reasonable and appropriate for the services provided to the organization. The organization provides a total compensation package that is on par with compensation provided by similar organizations and which conforms to the policies and guidelines set out by the Board of Trustees. Norton Healthcare, Inc. (NHC) engages an outside independent compensation consultant, Gallagher, to provide comparability data, including review of other health systems and hospital organizations that have filed Form 990s, for NHC's officers and key employees on total compensation for similar positions at health systems and hospital organizations similar in size, scope of services, and circumstances. In addition, the organization participates in third party surveys which provide aggregate, comparative compensation data for officers and key employees in similar positions at similar organizations. Gallagher consultants presented and discussed this comparability data in 2020 for the 2021 compensation review and met in 2021 for the 2022 compensation review with the Executive Committee of the Board of Trustees (Board). The Committee reviewed the executive compensation and benefits program, determined total compensation for the CEO, and approved compensation for other officers and key employees. The Committee reviewed NHC's variable compensation program and determined appropriate awards for performance relative to goals set for the year. After the Committee determined appropriate compensation and benefits for officers and key employees, the Board approved their total compensation.

Form 990, Part VI, Line 19 Required documents available to the public

CONSOLIDATED FINANCIAL STATEMENTS ARE AVAILABLE HERE: HTTPS://NORTONHEALTHCARE.COM/ABOUT-US/FINANCIAL-INFORMATION/. GOVERNING DOCUMENTS, AND CONFLICTS OF INTEREST POLICIES ARE NOT REQUIRED DISCLOSURES PURSUANT TO INTERNAL REVENUE CODE (IRC) SECTION 6104. THESE DOCUMENTS ARE NOT AVAILABLE TO THE PUBLIC

Form 990, Part VII, Section A, Line 1a, Column (D) Board Member Stipend Payments

Norton Healthcare, Inc. (NHC) and affiliates (Norton Hospitals, Inc., Community Medical Associates, Inc., Norton Properties, Inc., and The Children's Hospital Foundation, Inc.) encourages and facilitates board member attendance at educational programs and conferences on subjects relevant to NHC. NHC's travel policy for Board of Trustees provides that for each trustee that attends at least one out of town educational conference, a lump sum stipend will be paid to cover unreimbursed travel expense and other miscellaneous expenses associated with conference preparation, attendance or follow up. In compliance with IRS regulations, NHC provides a form 1099 to any trustee that receives a stipend. These amounts have been reported in Part VII or the form 990 as reportable compensation to the trustee receiving stipends in 2021.

Form 990, Part IX, Line 11g Other Fees

Outside Services - Total Expense: 55723360, Program Service Expense: 45222309, Management and General Expenses: 10501051, Fundraising Expenses: ; Other expenses - Total Expense: 1710205, Program Service Expense: 894153, Management and General Expenses: 816052, Fundraising Expenses: ; Contract Labor - Total Expense: 1299993, Program Service Expense: 1046511, Management and General Expenses: 253482, Fundraising Expenses: ; Professional Fees - Total Expense: 785538, Program Service Expense: 785538, Management and General Expenses: , Fundraising Expenses: ; Research Department Fees - Total Expense: 1095590, Program Service Expense: 1095590, Management and General Expenses: , Fundraising Expenses: ; Collection Fees - Total Expense: 2187300, Program Service Expense: 1892015, Management and General Expenses: 295285, Fundraising Expenses: ; Marketing Fees - Total Expense: 7951183, Program Service Expense: 3180473, Management and General Expenses: 4770710, Fundraising Expenses: ;

Form 990, Part XI, Line 9 Other changes in net assets or fund balances

AFFILIATE TRANSFER - -481322; SWAP MARK TO MARKET ADJUSTMENT - -11217617; CHANGE IN MINIMUM PENSION LIABILITY - 12115973; CHANGE IN NET PERIODIC PENSION COST - -1934087;

Form 990, Part XI, Line 9 Other changes in Net Assets or Fund Balance

In March 2017, the FASB issued ASU 2017-07 Compensation -Retirement Benefits (Topic 715): Improving the Presentation of Net Periodic Pension Cost and Net Periodic Postretirement Benefit Cost (ASU 2017-07), which changes how employers that sponsor defined benefit pension present the net periodic benefit cost in the statement of operations. ASU 2017-07 requires employers to present the service cost component of net periodic benefit cost in the same statement of operations line items as other employee compensation costs arising from services rendered during the period. Employers are to present the other components of net periodic benefit cost separately from the line item that includes the service cost and outside of any subtotal of operating income, if one is presented. Employers will have to disclose the lines used to present the other components of net periodic benefit cost, if the components are not presented separately in the statement of operations. The corporation elected to adopt the provisions of ASU 2017-07 as of January 1, 2017. The non-contribution defined benefit pension plan was frozen effective January 1, 2010. As a result no service cost was incurred during the year ended December 31, 2021. The other components of net periodic pension cost was $2.0 million for year ended December 31, 2021.

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

Cat. No. 51056K

Schedule O (Form 990) 2021

Software ID:	21014044
Software Version:	2021v4.2