2025-05-09T13:55:02-05:00 2024-06-30 135565207 KPMG LLP 8350 BROAD STREET SUITE 900 MCLEAN VA 22102 990 2023-07-01 520591607 THE GOOD SAMARITAN HOSPITAL OF MARYLAND INC GOOD 4107726721 5601 LOCH RAVEN BLVD BALTIMORE MD 21239 JOEL BRYAN VP/TREASURER/CIO 4107726721 2025-05-09 1 0 RAYMOND LY P01205643 7032868000 2023 2025-03-06 01:10:19Z MEDSTAR GOOD SAMARITAN HOSPITAL THOMAS J SENKER 5601 LOCH RAVEN BLVD BALTIMORE MD 21239 293325045 0 X WWW.GOODSAM-MD.ORG X 1920 MD SEE SCHEDULE OWE ARE GUIDED BY CATHOLIC TEACHINGS TO PROVIDE COMPASSIONATE, INCLUSIVE, AND CONNECTED CARE TO THE COMMUNITY WE ARE ENTRUSTED TO SERVE. 24 16 1828 282 0 0 12604961 9846737 272565390 281822970 86786 142438 2763598 1505290 288020735 293317435 110126 106913 0 0 154037923 151301609 0 0 0 132544717 134435334 286692766 285843856 1327969 7473579 190521931 198880193 33595541 32203599 156926390 166676594 X SEE SCHEDULE O 0 0 199625159 106913 267089182 SEE SCHEDULE OMEDSTAR GOOD SAMARITAN'S LARGEST PROGRAM IS ACCESS TO AND THE PROVISION OF ACUTE HOSPITAL SERVICES TO THE COMMUNITIES OF NORTHEASTERN BALTIMORE CITY, MARYLAND AND THE SURROUNDING AREAS. IN ADDITION TO THE PROGRAM SERVICE EXPENSES LISTED ABOVE, MEDSTAR GOOD SAMARITAN INCURRED $49.6M OF MANAGEMENT AND GENERAL EXPENSES IN PROVIDING SERVICES TO ITS COMMUNITIES. MEDSTAR GOOD SAMARITAN IS A JOINT COMMISSION ACCREDITED ACUTE CARE COMMUNITY HOSPITAL LOCATED IN THE NORTHEAST SECTION OF BALTIMORE CITY, MARYLAND. THE HOSPITAL OFFERS THE LATEST IN CLINICAL SERVICES IN CANCER CARE, WOUND HEALING AND HYPERBARIC MEDICINE, GERIATRICS AND COLLABORATIVE CARE PROGRAM WITH FOOD RX FOR THE MANAGEMENT OF CHRONIC ILLNESSES. MEDSTAR GOOD SAMARITAN HOSPITAL IS ACCREDITED BY THE JOINT COMMISSION (TJC) AND HAS ALSO RECEIVED ADVANCED CERTIFICATION IN INPATIENT REHABILITATION FOR AMPUTATION AND STROKE AND IS DESIGNATED AS A PRIMARY STROKE CENTER. THE AMERICAN HEART ASSOCIATION AND AMERICAN STROKE ASSOCIATION HONORED MEDSTAR GOOD SAMARITAN HOSPITAL WITH THE 2022 GET WITH THE GUIDELINES - STROKE GOLD PLUS; TARGET STROKE HONOR ROLL; TARGET TYPE 2 DIABETES HONOR ROLL AWARDS FOR HIGH-QUALITY CARE. MEDSTAR GOOD SAMARITAN RECEIVED A 4-STAR RATING FROM THE CENTER FOR MEDICARE AND MEDICAID SERVICES (CMS). MEDSTAR GOOD SAMARITAN AND MEDSTAR UNION MEMORIAL HOSPITAL WERE THE ONLY MEDSTAR HEALTH HOSPITALS TO EARN 4 STARS FOR QUALITY AND SAFETY. MEDSTAR GOOD SAMARITAN HOSPITAL HAS ACHIEVED AN "A" FROM THE LEAPFROG HOSPITAL SAFETY GRADE FOR THE 5TH CONSECUTIVE RATING PERIOD EARNING THE "ELITE STRAIGHT A DESIGNATION". WITH GRADES ANNOUNCED EACH FALL AND SPRING, MEDSTAR GOOD SAMARITAN HAS ATTAINED THE PRESTIGIOUS A GRADE REPEATEDLY SINCE FALL 2022 DEMONSTRATING OUR ONGOING COMMITMENT TO ADVANCING PATIENT SAFETY. MEDSTAR GOOD SAMARITAN WAS ALSO AWARDED AN A GRADE FROM THE LOWN INSTITUTE FOR OUTSTANDING SOCIAL RESPONSIBILITY, INCLUDING HEALTH EQUITY AND VALUE OF CARE. THE LOWN INSTITUTE IS THE ONLY AVAILABLE RANKING THAT COMBINES METRICS OF HEALTH EQUITY AND VALUE OF CARE ALONGSIDE PATIENT OUTCOMES. 22265666 14733788 MEDSTAR GOOD SAMARITAN PROVIDED $22.3M IN SUBSIDIZED (MISSION DRIVEN) HEALTH SERVICES IN FISCAL YEAR 2024. THESE CRITICAL SERVICES, WHICH ARE DRIVEN BY COMMUNITY NEEDS, OPERATE AT A LOSS. THEY ADDRESS PRIORITIES PRIMARILY THROUGH DISEASE PREVENTION AND IMPROVEMENT OF HEALTH STATUS. SERVICE INCLUDES EMERGENCY MEDICINE, PRIMARY CARE, WOMEN'S AND CHILDREN'S CARE, AND BEHAVIORAL HEALTH. 7674324 MEDSTAR GOOD SAMARITAN PROVIDED $7.7M IN CHARITY CARE SERVICES IN FISCAL YEAR 2024. CHARITY CARE IS PROVIDED PURSUANT TO MEDSTAR HEALTH'S FINANCIAL ASSISTANCE POLICY TO MEMBERS OF THE COMMUNITY WHOSE INCOME IS BELOW CERTAIN THRESHOLDS AND FOR WHICH THE HOSPITAL IS NOT COMPENSATED. UNDER MARYLAND'S UNIQUE PAYER SYSTEM, THE AMOUNT REPORTED REPRESENTS MEDSTAR GOOD SAMARITAN'S CHARITY CARE EXPENSE AND REVENUES REPRESENT DIRECT PAYMENTS FROM THE STATE'S CHARITY CARE POOL. OTHER CHARITY CARE EXPENSES ARE INDIRECTLY REIMBURSED VIA THE STATE OF MARYLAND'S PAYMENT SYSTEM. 229565149 1 1 0 0 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 1 1 0 0 0 0 0 1 0 0 0 0 0 0 0 1 1 0 0 0 1 0 0 1828 1 0 0 0 0 0 0 0 0 0 0 1 0 X 24 16 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 MD X JOEL BRYAN 4107726721 10980 GRANTCHESTER WAY COLUMBIA MD 21044 ANTHONY READ DIRECTOR 1.00 0.00 X 0 0 0 BISHOP DENIS J MADDEN DIRECTOR 1.00 0.00 X 0 0 0 DANIEL P CAHILL DIRECTOR 1.00 0.00 X 0 0 0 DAVID ZACHARY MARTIN MD DIRECTOR 39.00 1.00 X 1522463 0 32531 DAWN M MOTOVIDLAK CHAIR 1.00 0.00 X X 0 0 0 HOLLY TILFORD DIRECTOR 1.00 0.00 X 0 0 0 JEFFREY R ELKIN DIRECTOR 1.00 0.00 X 0 0 0 JUDITH FEUSTLE DIRECTOR 1.00 0.00 X 0 0 0 KATHLEEN DYER DIRECTOR 1.00 0.00 X 0 0 0 KENNETH A SAMET DIRECTOR 1.00 39.00 X 0 7083748 106087 KIM SYDNOR PHD VICE CHAIR 1.00 0.00 X X 0 0 0 LEO E GALLAGHER JR DIRECTOR 1.00 0.00 X 0 0 0 MAHSA MOHEBTASH MD DIRECTOR 39.00 1.00 X 816133 0 10702 MICHAEL RANDOLPH MD DIRECTOR 1.00 0.00 X 0 0 0 PAUL DENNIS CONNELLY DIRECTOR 1.00 0.00 X 0 0 0 PAUL SACK MD DIRECTOR 1.00 39.00 X 0 336527 29884 REBECCA E PEARCE DIRECTOR 1.00 0.00 X 0 0 0 SAMER S NAJJAR MD DIRECTOR 1.00 0.00 X 0 680102 32385 SHAMS T QUAZI MD DIRECTOR 20.00 20.00 X 252677 252677 32252 VERONICA COOL DIRECTOR 1.00 0.00 X 0 0 0 ZEENA DORAI MD DIRECTOR 1.00 39.00 X 0 1264811 20014 DEANA STOUT CFO/ASSISTANT TREASURER 39.00 1.00 X 565600 0 32895 THOMAS J SENKER PRESIDENT 20.00 20.00 X 497366 497366 39640 CAROLINA CHAVARRIA ASSISTANT SECRETARY 1.00 39.00 X 0 119094 19999 BERNARD RAVITZ PHYSICIAN 40.00 0.00 X 340199 0 10077 BRIAN CAWLEY SENIOR VP, OPERATIONS 1.00 39.00 X 0 369875 32557 JOSHUA DELP PHARMACY DIRECTOR 40.00 0.00 X 243551 0 31908 KENNETH WALSCH AVP, OPERATIONS 40.00 0.00 X 268142 0 34792 MICHAEL JACOBS MD PHYSICIAN 40.00 0.00 X 836988 0 28867 BRADLEY CHAMBERS FORMER PRESIDENT/DIRECTOR 1.00 39.00 X 0 1681164 59767 YOLANDA BROOKS FORMER OFFICER 39.00 1.00 X 0 110811 9443 STUART BELL MD FORMER VP, MEDICAL AFFAIRS 1.00 39.00 X 0 180310 24054 5343119 12576485 587854 281 1 1 0 AMN HEALTHCARE INC 2735 COLLECTION CENTER DR CHICAGO IL 60693 NURSE STAFFING SERVICES 8157284 AYA HEALTHCARE INC PO BOX 123519 DEPT 3519 DALLAS TX 753123519 STAFFING SERVICES 3488207 DVA RENAL HEALTHCARE INC PO BOX 781607 PHILADELPHIA PA 191781607 MEDICAL SERVICES 1571197 MEDICAL SOLUTIONS LLC PO BOX 850737 MINNEAPOLIS MN 554850737 STAFFING SERVICES 1441300 CROTHALL SVCS GROUP 13028 COLLECTIONS CENTER DRIVE CHICAGO IL 60693 ENVIRONMENTAL SERVICES 918286 21 3213000 3690521 2943216 9846737 NET PATIENT SERVICE RE 621400 270475249 270475249 PHARMACY INCOME 900099 11347721 11347721 281822970 102767 102767 552926 0 552926 552926 552926 47281 0 7610 47281 -7610 39671 39671 REBATE INCOME 900099 411811 411811 540553 540553 952364 293317435 281822970 0 1647728 X 96163 96163 10750 10750 3766314 3419780 346534 121496186 110319773 11176413 1776772 1613309 163463 15751226 14292179 1459047 8511111 7738094 773017 28260893 28260893 46883 46883 42974457 36836826 6137631 118290 5514 112776 2016281 1471286 544995 569561 81770 487791 66314 56425 9889 11129 4480 6649 1920447 -1488 1921935 11672156 11253532 418624 2658419 2164197 494222 MED/SURG SUPPLIES 21719619 21706996 12623 MAINTENANCE 7481048 7168690 312358 UTILITIES 4122270 3851673 270597 FOOD SERVICES/SUPPLIES 3306442 3137256 169186 7491125 4337944 3153181 285843856 229565149 56278707 0 12531 4236 31932873 35662215 2515050 2228429 375381 279877 317495564 248463465 66773205 69032099 2387728 2857904 86525163 88815433 190521931 198880193 17006735 14174680 959913 998825 15628893 17030094 33595541 32203599 X 77826033 79215134 79100357 87461460 156926390 166676594 190521931 198880193 X 7473579 306342 1970283 X X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 110473485 76149621 34323864 1207960 813155 394805 195338936 168158091 27180845 10475183 3342598 7132585 69032099 OPERATING LEASE ROU ASSET 1424982 INTERCOMPANY RECEIVABLES 3435402 OTHER ASSETS 83955049 88815433 ADVANCES FROM 3RD PARTY PAYORS 6433648 ASBESTOS ABATEMENT LIABILITY 3181031 OPERATING LEASE LIABILITY 1702790 WORKERS COMPENSATION 2741395 CREDIT BALANCE PATIENT A/R 1340832 OTHER LIABILITIES 1630398 17030094 X PART X, LINE 2: FIN 48 FOOTNOTE INCOME TAXES ARE ACCOUNTED FOR UNDER THE ASSET AND LIABILITY METHOD. DEFERRED TAX ASSETS AND LIABILITIES ARE RECOGNIZED FOR THE FUTURE TAX CONSEQUENCES ATTRIBUTABLE TO DIFFERENCES BETWEEN THE FINANCIAL STATEMENT CARRYING AMOUNTS OF EXISTING ASSETS AND LIABILITIES AND THEIR RESPECTIVE TAX BASES AND OPERATING LOSS AND TAX CREDIT CARRYFORWARDS. DEFERRED TAX ASSETS AND LIABILITIES ARE MEASURED USING ENACTED TAX RATES EXPECTED TO APPLY TO TAXABLE INCOME IN THE YEARS IN WHICH THOSE TEMPORARY DIFFERENCES ARE EXPECTED TO BE RECOVERED OR SETTLED. THE EFFECT ON DEFERRED TAX ASSETS AND LIABILITIES OF A CHANGE IN TAX RATES IS RECOGNIZED IN THE PERIOD THAT INCLUDES THE ENACTMENT DATE. ANY CHANGES TO THE VALUATION ALLOWANCE ON THE DEFERRED TAX ASSET ARE REFLECTED IN THE YEAR OF CHANGE. THE CORPORATION ACCOUNTS FOR UNCERTAIN TAX POSITIONS IN ACCORDANCE WITH THE FASB ACCOUNTING STANDARDS CODIFICATION (ASC) TOPIC 740, INCOME TAXES. THERE WAS NO LIABILITY RECORDED FOR UNCERTAIN TAX POSITIONS AS OF JUNE 30, 2024. 1 1 X 1 X 1 X 1 1 1 0 1 1 7674324 7674324 0.02680 7674324 7674324 0.02680 3039731 256561 2783170 0.00970 5257616 5257616 0.01840 22265666 14733788 7531878 0.02630 174176 174176 0.00060 30737189 14990349 15746840 0.05500 38411513 14990349 23421164 0.08180 54597 54597 0.00020 35139 35139 0.00010 61301 61301 0.00020 151037 151037 0.00050 1 4845268 X 1 1 1 1 GOOD SAMARITAN HOSPITAL OF MARYLAND 5601 LOCH RAVEN BLVD BALTIMORE MD 21239 WWW.GOODSAM-MD.ORG STATE LICENSE NUMBER: 30029 X X X X GOOD SAMARITAN HOSPITAL OF MARYLAND 1 0 0 1 X X X X X X X X X 23 1 0 0 1 X WWW.GOODSAM-MD.ORG X 1 23 1 WWW.GOODSAM-MD.ORG 0 1 X 200.000000000000 400.000000000000 X X X X X X 1 1 X X X X 1 X WWW.GOODSAM-MD.ORG X WWW.GOODSAM-MD.ORG X WWW.GOODSAM-MD.ORG X X X X X X 1 X 0 X X X X 1 X 0 0 GOOD SAMARITAN HOSPITAL OF MARYLAND PART V, SECTION B, LINE 5: CHNA INPUTHOSPITAL LEADROLE DESCRIPTIONTHE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) HOSPITAL LEAD SERVES AS THE COORDINATOR OF ALL ASPECTS OF THE COMMUNITY HEALTH ASSESSMENT PROCESS. HE/SHE HELPS ESTABLISH AND COORDINATE THE ACTIVITIES OF THE ADVISORY TASK FORCE. THE LEAD ALSO HELPS PRODUCE THE HOSPITAL'S COMMUNITY HEALTH NEEDS ASSESSMENT AND IMPLEMENTATION STRATEGY. HE/SHE WORKS COLLABORATIVELY WITH REPRESENTATIVES FROM THE CORPORATE COMMUNITY HEALTH DEPARTMENT AND GEORGETOWN UNIVERSITY. THE LEAD ALSO WORKS CLOSELY WITH THE WRITER. HE/SHE REVIEWS ALL NARRATIVES PRIOR TO PUBLICATION.NAME OF HOSPITAL LEAD: KIMBERLY FLOYD, RN EXECUTIVE SPONSORROLE DESCRIPTIONTHE EXECUTIVE SPONSOR SERVES AS THE CONDUIT BETWEEN THE ADVISORY TASK FORCE AND THE SENIOR MANAGEMENT TEAM. THE SPONSOR IS AN ACTIVE PARTICIPANT OF THE ADVISORY TASK FORCE AND HE/SHE COMMUNICATES THE HOSPITAL'S CLINICAL STRENGTHS AND PROGRAM PRIORITIES TO DIVERSE AUDIENCES. NAME OF EXECUTIVE SPONSOR: THOMAS J. SENKER ADVISORY TASK FORCEROLE DESCRIPTIONTHE ADVISORY TASK FORCE (ATF) REVIEWS PRIMARY/SECONDARY DATA AND LOCAL/STATE/FEDERAL COMMUNITY HEALTH GOALS. BASED ON FINDINGS, THE ATF PROVIDES INPUT INTO THE HOSPITAL'S THREE-YEAR IMPLEMENTATION STRATEGY. AS AMBASSADORS FOR THE CHNA PROCESS, THE ATF MEMBERS SUPPORT EFFORTS TO OPTIMIZE COMMUNITY PARTICIPATION. NOTE: THE ATF SHOULD BE A COMBINATION OF COMMUNITY REPRESENTATIVES AND STAFF. COMMUNITY REPRESENTATIVES SHOULD MAKEUP AT LEAST 50% OF TOTAL PARTICIPANTS. NAME : DAWN MOTOVIDLAK TITLE/AFFILIATION WITH HOSPITAL : MGSH AND MUMH BOARD MEMBER, CHAIRNAME OF ORGANIZATION : BHS ONLINENAME : DANIEL P. CAHILLTITLE/AFFILIATION WITH HOSPITAL : MGSH AND MUMH BOARD MEMBER, CHAIRNAME OF ORGANIZATION : WEBB MASONNAME : VERONICA COOLTITLE/AFFILIATION WITH HOSPITAL : MGSH AND MUMH BOARD MEMBERNAME OF ORGANIZATION : COOL ASSOCIATESNAME : TRICIA ISENNOCK TITLE/AFFILIATION WITH HOSPITAL : COMMUNITY HEALTH ADVISORNAME OF ORGANIZATION : MEDSTAR HEALTHNAME : DANA FRANK, M.D.TITLE/AFFILIATION WITH HOSPITAL : CHAIRMAN, MEDICINE, MGSH/MUMHNAME OF ORGANIZATION : MEDSTAR HEALTHNAME : KENNETH WALSCH TITLE/AFFILIATION WITH HOSPITAL : ASSISTANT VICE PRESIDENT, QUALITY, SAFETY, RISK MANAGEMENT NAME OF ORGANIZATION : MEDSTAR HEALTHNAME : JOAN CARLSON TITLE/AFFILIATION WITH HOSPITAL : AVP, MISSION INTEGRATION, MGSHNAME OF ORGANIZATION : MEDSTAR HEALTHNAME : DEBORAH BANGLEDORF TITLE/AFFILIATION WITH HOSPITAL : DIRECTOR, MARKETING AND COMMUNICATIONS NAME OF ORGANIZATION : MEDSTAR HEALTHNAME : DIANE MCELVERSONTITLE/AFFILIATION WITH HOSPITAL : MD RESIDENT SERVICES COORDINATORNAME OF ORGANIZATION : J VAN STORY BRANCH/ COMMUNITY HOUSING PARTNERSNAME : PEGGY THOMAS TITLE/AFFILIATION WITH HOSPITAL : COMMUNITY REPRESENTATIVENAME OF ORGANIZATION : COMMUNITY RESIDENTNAME : SHEILA WILLIAMS TITLE/AFFILIATION WITH HOSPITAL : COMMUNITY REPRESENTATIVENAME OF ORGANIZATION : HUBER MEMORIAL CHURCHNAME : EVANGELINE WAIHENYA TITLE/AFFILIATION WITH HOSPITAL : PARISHIONERNAME OF ORGANIZATION : ST. MATTHEWS CHURCHNAME : SUSAN BENDERTITLE/AFFILIATION WITH HOSPITAL : COONAME OF ORGANIZATION : KESWICK NAME : NICHOLE BATTLE TITLE/AFFILIATION WITH HOSPITAL : CEO NAME OF ORGANIZATION : GEDCONAME : MARK FLETCHERTITLE/AFFILIATION WITH HOSPITAL : DEPUTY CHIEF OF EMSNAME OF ORGANIZATION : BALTIMORE CITY FIRE DEPARTMENTNAME : MELVIN WILSON TITLE/AFFILIATION WITH HOSPITAL : EXECUTIVE DIRECTOR NAME OF ORGANIZATION : TURNAROUND TUESDAYNAME : ADONGO MATTHEWSTITLE/AFFILIATION WITH HOSPITAL : EXECUTIVE DIRECTORNAME OF ORGANIZATION : SHEPHERD'S CLINICNAME : LISA JONESTITLE/AFFILIATION WITH HOSPITAL : COMMUNITY MEDIATION DIRECTORNAME OF ORGANIZATION : WOODBOURNE MCCABE SAFE STREETSNAME : PAT JONESTITLE/AFFILIATION WITH HOSPITAL : DIRECTORNAME OF ORGANIZATION : ST. MATTHEW'S CHURCHNAME : HEATHER WILSONTITLE/AFFILIATION WITH HOSPITAL : VICE PRESIDENT, OPERATIONSNAME OF ORGANIZATION : Y IN CENTRAL MARYLANDNAME : LUCAS CARLSON, M.D.TITLE/AFFILIATION WITH HOSPITAL : REGIONAL MEDICAL DIRECTOR, CARE TRANSFORMATIONNAME OF ORGANIZATION : MEDSTAR HEALTHNAME : JEFFREY GRIFFINTITLE/AFFILIATION WITH HOSPITAL : EXECUTIVE DIRECTORNAME OF ORGANIZATION : FRANCISCAN CENTERNAME : KIMBERLY LYLESTITLE/AFFILIATION WITH HOSPITAL : SENIOR DIRECTORNAME OF ORGANIZATION : HCAMNAME : HARVEY MILESTITLE/AFFILIATION WITH HOSPITAL : COMMUNITY SCHOOL COORDINATORNAME OF ORGANIZATION : GARDENVILLE ELEMENTARY SCHOOLNAME : ANGIE WINDERTITLE/AFFILIATION WITH HOSPITAL : PRESIDENTNAME OF ORGANIZATION : NECONAME : KIMBERLY FLOYDTITLE/AFFILIATION WITH HOSPITAL : RN PROGRAM MANAGER- COMMUNITY HEALTHNAME OF ORGANIZATION : MEDSTAR HEALTHNAME : PHYLLIS GRAYTITLE/AFFILIATION WITH HOSPITAL : AVP CARE TRANSFORMATIONNAME OF ORGANIZATION : MEDSTAR HEALTHNAME : AARON KAUFMANTITLE/AFFILIATION WITH HOSPITAL : DIRECTOR OF COMMUNITY PROJECTSNAME OF ORGANIZATION : CENTRAL BALTIMORE PARTNERSHIPNAME : ADEOLA ALAYANDETITLE/AFFILIATION WITH HOSPITAL : DIRECTOR HEALTH PROMOTION AND DISEASE PREVENTIONNAME OF ORGANIZATION : BALTIMORE CITY HEALTH DEPARTMENTNAME : ALEX YAZAJI, MDTITLE/AFFILIATION WITH HOSPITAL : VICE PRESIDENT, MEDICAL AFFAIRS, MUMH AND MGSHNAME OF ORGANIZATION : MEDSTAR HEALTHNAME : ALIZA AAMRINTITLE/AFFILIATION WITH HOSPITAL : COMMUNITY HEALTH PROGRAM COORDINATOR/JOY WELLNESSNAME OF ORGANIZATION : MEDSTAR HEALTHNAME : ANGELA PROFILITITLE/AFFILIATION WITH HOSPITAL : DIRECTOR NURSING EMERG SERVICESNAME OF ORGANIZATION : MEDSTAR HEALTHNAME : BERNARD RAVITZTITLE/AFFILIATION WITH HOSPITAL : AVP MEDICAL AFFAIRSNAME OF ORGANIZATION : MEDSTAR HEALTHNAME : CAT GOODRICHTITLE/AFFILIATION WITH HOSPITAL : PASTORNAME OF ORGANIZATION : FAITH PRESBYTERIAN CHURCHNAME : CLAIRE WILSONTITLE/AFFILIATION WITH HOSPITAL : REGIONAL DIRECTOR, COMMUNITY HEALTHNAME OF ORGANIZATION : MEDSTAR HEALTHNAME : DAVON CARTERTITLE/AFFILIATION WITH HOSPITAL : PROGRAM COORDINATOR SMOCNAME OF ORGANIZATION : MEDSTAR HEALTHNAME : DIANA EMERSONTITLE/AFFILIATION WITH HOSPITAL : EXECUTIVE DIRECTOR NAME OF ORGANIZATION : WAVERLY MAIN STREETNAME : DONALD EADDYTITLE/AFFILIATION WITH HOSPITAL : VP, STRATEGIC PARTNERSHIPS AND CIVIC ENGAGEMENTNAME OF ORGANIZATION : Y IN CENTRAL MARYLANDNAME : DESTINY MURDOCKTITLE/AFFILIATION WITH HOSPITAL : COMMUNITY HEALTH PROGRAM COORDINATOR/JVSBNAME OF ORGANIZATION : MEDSTAR HEALTHNAME : JOHN COLMERSTITLE/AFFILIATION WITH HOSPITAL : PARISHIONERNAME OF ORGANIZATION : FAITH PRESBYTERIAN CHURCHNAME : JOSEPH CRAWLEYTITLE/AFFILIATION WITH HOSPITAL : DIRECTORNAME OF ORGANIZATION : GEDCO CARESNAME : KAREN MEYERSTITLE/AFFILIATION WITH HOSPITAL : CHAIR OF SOCIAL AND ENVIRONMENTAL JUSTICE COUNCILNAME OF ORGANIZATION : FAITH PRESBYTERIAN CHURCHNAME : KATHLEEN MCHUGHTITLE/AFFILIATION WITH HOSPITAL : MEDICAL DIRECTORNAME OF ORGANIZATION : SHEPHERD'S CLINICNAME : DIANA QUINNTITLE/AFFILIATION WITH HOSPITAL : COMMUNITY HEALTH ADVISOR, COMMUNITY HEALTHNAME OF ORGANIZATION : MEDSTAR HEALTHNAME : KIM SYDNOR, PHDTITLE/AFFILIATION WITH HOSPITAL : DEAN - MORGAN STATE UNIVERSITY, MGSH AND MUMH BOARD MEMBERNAME OF ORGANIZATION : MORGAN STATE UNIVERSITYNAME : RENEE HILLIARDTITLE/AFFILIATION WITH HOSPITAL : SENIOR CLINICAL CONSULTANTNAME OF ORGANIZATION : MT ZION BAPTIST CHURCHNAME : NAISHA VINSONTITLE/AFFILIATION WITH HOSPITAL : AVP GRANT DEVELOPMENT - MEDSTARNAME OF ORGANIZATION : MEDSTAR HEALTHNAME : RAQUEL LAMPTEYTITLE/AFFILIATION WITH HOSPITAL : SR. DIRECTOR, COMMUNITY HEALTHNAME OF ORGANIZATION : MEDSTAR HEALTHNAME : REBECCA PETERSONTITLE/AFFILIATION WITH HOSPITAL : INTERIM SUPERVISOR- COMMUNITY HEALTH ADVOCATENAME OF ORGANIZATION : MEDSTAR HEALTHNAME : TARA MYERSTITLE/AFFILIATION WITH HOSPITAL : HUMAN SERVICES MANAGERNAME OF ORGANIZATION : MAYOR'S OFFICE OF CHILDREN & FAMILY SUCCESSNAME : SAMANTHA SALISMANTITLE/AFFILIATION WITH HOSPITAL : REG PROG MGR COMM HEALTH -COMMUNITY HEALTHNAME OF ORGANIZATION : MEDSTAR HEALTHNAME : SONYA GRAYTITLE/AFFILIATION WITH HOSPITAL : MGSH FORMER BOARD MEMBERNAME OF ORGANIZATION : MEDSTAR HEALTH(CONTINUED IN SECTION C) GOOD SAMARITAN HOSPITAL OF MARYLAND PART V, SECTION B, LINE 11: IMPLEMENTATION STRATEGYTHE IMPLEMENTATION STRATEGIES SERVE AS A ROADMAP FOR HOW COMMUNITY BENEFIT RESOURCES WILL BE ALLOCATED AND DEPLOYED. MEDSTAR'S HOSPITALS WILL BE ABLE TO MEASURE OUR CONTRIBUTION TO IMPROVING THE HEALTH OF UNDERSERVED AND VULNERABLE POPULATIONS IN THE REGIONS WE SERVE. THREE-YEAR IMPLEMENTATION STRATEGIES WITH MEASURABLE OBJECTIVES WERE DEVELOPED FOR EACH HOSPITAL'S COMMUNITY BENEFIT SERVICE AREA - A SPECIFIC COMMUNITY OR TARGET POPULATION OF FOCUS. PRIORITIES WERE BASED ON COMMUNITY NEED AS DETERMINED BY QUANTITATIVE DATA AND COMMUNITY INPUT, AS WELL AS ON HOSPITAL EXPERTISE, RESOURCES, STRENGTHS OF EXISTING PROGRAMMING AND PARTNERSHIPS, AND ALIGNMENT WITH NATIONAL, STATE, AND LOCAL HEALTH GOALS. THE MEDSTAR HEALTH CORPORATE COMMUNITY HEALTH DEPARTMENT WILL PROVIDE SYSTEM-WIDE COORDINATION AND OVERSIGHT OF COMMUNITY BENEFIT PROGRAMMING.HOSPITAL ADVISORY TASK FORCES CONVENE AT LEAST ANNUALLY TO MONITOR PROGRESS OF STRATEGY EXECUTION AND TO PROVIDE ONGOING RECOMMENDATIONS RELATED TO OUTCOMES ACHIEVEMENT, PROGRAM DEVELOPMENT, PARTNERSHIP APPROACHES, AND OVERALL IMPLEMENTATION IMPROVEMENT. FOR SIGNIFICANT NEEDS IDENTIFIED IN THE CHNA THAT THE HOSPITAL HAS NOT PRIORITIZED AS FOCUS AREAS THROUGH ITS IMPLEMENTATION STRATEGY, THESE NEEDS WILL BE ADDRESSED BY COLLABORATING WITH OTHER LEADING ORGANIZATIONS, AND BY TAKING A SUPPORTER ROLE ON IDENTIFIED NEEDS THAT ARE BEYOND THE SCOPE OF THE HOSPITAL'S STRENGTHS. PART V, SECTION B, LINE 5: CHNA INPUT (CONTINUED) NAME : STANLEY ZHENGTITLE/AFFILIATION WITH HOSPITAL : REG PROG MGR COMM HEALTH -COMMUNITY HEALTHNAME OF ORGANIZATION : MEDSTAR HEALTHNAME : THOMAS J. SENKERTITLE/AFFILIATION WITH HOSPITAL : PRESIDENT, MGSH AND MUMHNAME OF ORGANIZATION : MEDSTAR HEALTH CHARITY CARE AT COST PART I, LINE 7AMARYLAND'S REGULATORY SYSTEM CREATES A UNIQUE PROCESS FOR HOSPITAL PAYMENT THAT DIFFERS FROM THE REST OF THE NATION. THE HEALTH SERVICES COST REVIEW COMMISSION (HSCRC), DETERMINES PAYMENT THROUGH A RATE-SETTING PROCESS AND ALL PAYORS, INCLUDING GOVERNMENTAL PAYORS, PAY THE SAME AMOUNT FOR THE SAME SERVICES DELIVERED AT THE SAME HOSPITAL. MARYLAND'S UNIQUE ALL-PAYOR SYSTEM INCLUDES A METHOD FOR REFERENCING UNCOMPENSATED CARE IN EACH PAYORS' RATES, WHICH DOES NOT ENABLE MARYLAND HOSPITALS TO BREAKOUT ANY OFFSETTING REVENUE RELATED TO UNCOMPENSATED CARE. UNREIMBURSED MEDICAID PART I, LINE 7BMARYLAND'S REGULATORY SYSTEM CREATES A UNIQUE PROCESS FOR HOSPITAL PAYMENT THAT DIFFERS FROM THE REST OF THE NATION. THE HEALTH SERVICES COST REVIEW COMMISSION (HSCRC), DETERMINES PAYMENT THROUGH A RATE-SETTING PROCESS AND ALL PAYORS, INCLUDING GOVERNMENTAL PAYORS, PAY THE SAME AMOUNT FOR THE SAME SERVICES DELIVERED AT THE SAME HOSPITAL. MARYLAND'S UNIQUE ALL-PAYOR SYSTEM INCLUDES A METHOD FOR REFERENCING UNCOMPENSATED CARE IN EACH PAYORS' RATES, WHICH DOES NOT ENABLE MARYLAND HOSPITALS TO BREAKOUT ANY OFFSETTING REVENUE RELATED TO UNCOMPENSATED CARE. COMMUNITY BENEFIT EXPENSES ARE EQUAL TO MEDICAID REVENUES IN MARYLAND, AS SUCH, THE NET EFFECT IS ZERO. THE EXCEPTION TO THIS IS THE IMPACT ON THE HOSPITAL OF ITS SHARE OF THE MEDICAID ASSESSMENT. IN RECENT YEARS, THE STATE OF MARYLAND HAS CLOSED FISCAL GAPS IN THE STATE MEDICAID BUDGET BY ASSESSING HOSPITALS THROUGH THE RATE-SETTING SYSTEM. BAD DEBT PART III, LINES 2 & 4MEDSTAR HEALTH AND ITS AFFILIATED ORGANIZATIONS REPORT BAD DEBT EXPENSE IN ACCORDANCE WITH ASU 2011-07, WHICH REQUIRES CERTAIN HEALTHCARE ENTITIES TO CHANGE THE PRESENTATION OF THEIR STATEMENT OF OPERATIONS BY RECLASSIFYING THE PROVISION FOR BAD DEBTS ASSOCIATED WITH PATIENT SERVICE REVENUE FROM AN OPERATING EXPENSE TO A DEDUCTION FROM PATIENT SERVICE REVENUE (NET OF CONTRACTUAL ALLOWANCES AND DISCOUNTS). HOWEVER, MEDSTAR AND ITS AFFILIATED ENTITIES DO NOT MAKE A DETERMINATION AS TO WHETHER SELF PAY AMOUNTS ARE COLLECTIBLE IN DETERMINING REVENUE RECOGNITION. RESERVE MODELS, WHICH HAVE BEEN DEVELOPED BASED ON HISTORICAL COLLECTION RESULTS AND WHICH ARE ADJUSTED PERIODICALLY BASED ON ACTUAL COLLECTIONS EXPERIENCE, ARE USED TO ESTIMATE UNCOLLECTIBLE AMOUNTS ACROSS ALL PAYORS INCLUDING SELF PAY. BAD DEBT DETERMINATIONS ARE MADE ONLY AFTER SUFFICIENT EVIDENCE IS OBTAINED TO SUPPORT THAT AN AMOUNT IS NOT COLLECTIBLE. MEDICARE PART III, LINE 8MARYLAND'S REGULATORY SYSTEM CREATES A UNIQUE PROCESS FOR HOSPITAL PAYMENT THAT DIFFERS FROM THE REST OF THE NATION. THE HEALTH SERVICES COST REVIEW COMMISSION (HSCRC) DETERMINES PAYMENT THROUGH A RATE-SETTING PROCESS AND ALL PAYORS, INCLUDING GOVERNMENTAL PAYORS, PAY THE SAME AMOUNT FOR THE SAME SERVICES DELIVERED AT THE SAME HOSPITAL. MARYLAND'S UNIQUE ALL-PAYOR SYSTEM INCLUDES A METHOD FOR REFERENCING UNCOMPENSATED CARE IN EACH PAYORS' RATES, WHICH DOES NOT ENABLE MARYLAND HOSPITALS TO BREAKOUT ANY OFFSETTING REVENUE RELATED TO UNCOMPENSATED CARE. AS SUCH, THE NET EFFECT FOR MEDICARE EXPENSES AND REVENUES IN MARYLAND IS ZERO. PART III, LINE 9B IF IT IS DETERMINED THAT A PATIENT MAY POTENTIALLY QUALIFY FOR A CHARITABLE/FINANCIAL PROGRAM, A HOLD IS PLACED ON THE ACCOUNT TO PREVENT IT FROM BEING REPORTED AS BAD DEBT UNTIL PROGRAM APPROVALS HAVE BEEN OBTAINED. IF IT IS APPROVED, THE ACCOUNT IS DOCUMENTED AND THE NECESSARY ADJUSTMENTS ARE MADE TO CLOSE THE ACCOUNT. NEEDS ASSESSMENT PART VI, LINE 2IN FY21, MEDSTAR GOOD SAMARITAN HOSPITAL (MGSH) CONDUCTED A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) IN ACCORDANCE WITH THE GUIDELINES ESTABLISHED BY THE PATIENT PROTECTION AND AFFORDABLE CARE ACT AND THE INTERNAL REVENUE SERVICE. THE HOSPITAL'S CHNA AND THREE-YEAR IMPLEMENTATION STRATEGIES WERE ENDORSED BY MGSH'S BOARD OF DIRECTORS AND APPROVED BY THE MEDSTAR HEALTH BOARD OF DIRECTORS. THE DOCUMENT BECAME AVAILABLE ON THE HOSPITAL'S WEBSITE ON JUNE 30, 2021 AND SERVED AS A GUIDE FOR PROGRAMMING PRIORITIES IN FISCAL YEARS 2022-2024.THE CATEGORIES HEALTH AND WELLNESS, ACCESS TO CARE AND SOCIAL DETERMINANTS OF HEALTH WERE USED TO DETERMINE WHAT PROGRAMMING TO PRIORITIZE FOR THE CHNA. TWO TO THREE STRATEGIES IN EACH CATEGORY WERE SELECTED AS PRIORITIES DUE TO THE SIZE AND SCALE OF IMPACT AND MEASURABLE OUTCOMES. ALL OTHER PROGRAMMING WAS INTEGRATED AS PART OF THE HOSPITAL'S OVERALL COMMUNITY HEALTH PORTFOLIO. THESE ADDITIONAL PROGRAMS WERE CAPTURED IN THE INVENTORY FOR THE WHOLE PICTURE OF CONTRIBUTING TO THE HEALTH OF THE COMMUNITIES SERVED AS WELL AS SORTED FOR WHAT COUNTS AS COMMUNITY BENEFIT FOR REGULATORY REPORTING.THE HOSPITAL'S COMMUNITY BENEFIT SERVICE AREA (CBSA) IS BASED ON THE ADVISORY TASK FORCE (ATF) RECOMMENDATION. THE HOSPITAL IDENTIFIED ZIP CODES 21206 AND 21239 AS ITS CBSA. THE HOSPITAL SELECTED THIS GEOGRAPHIC AREA BASED ON HOSPITAL UTILIZATION DATA AND SECONDARY PUBLIC HEALTH DATA AS WELL AS ITS PROXIMITY TO THE HOSPITAL. THE ATF INCLUDED A DIVERSE GROUP OF INDIVIDUALS, INCLUDING HOSPITAL LEADERS, GRASSROOTS ACTIVISTS, COMMUNITY RESIDENTS, FAITH-BASED LEADERS, HOSPITAL REPRESENTATIVES, PUBLIC HEALTH LEADERS AND OTHER STAKEHOLDER ORGANIZATIONS, SUCH AS REPRESENTATIVES FROM LOCAL HEALTH DEPARTMENTS.HEALTH PRIORITIES FOR THE CBSA INCLUDE HEALTH AND WELLNESS (CHRONIC DISEASE PREVENTION AND MANAGEMENT, BEHAVIORAL HEALTH AND AGING AND OLDER ADULT HEALTH), ACCESS TO HEALTH CARE SERVICES (TRANSPORTATION AND ACCESS TO AFFORDABLE HEALTH CARE AND INSURANCE) AND SOCIAL DETERMINANTS OF HEALTH (EMPLOYMENT, FOOD INSECURITY AND NEIGHBORHOOD SAFETY AND COMMUNITY VIOLENCE). REPRESENTATIVES FROM THE HOSPITAL ROUTINELY PARTICIPATE IN THE MEDSTAR HEALTH COMMUNITY HEALTH WORKGROUP. THE WORKGROUP IS COMPRISED OF COMMUNITY HEALTH PROFESSIONALS WHO REPRESENT ALL TEN MEDSTAR HEALTH HOSPITALS. THE TEAM ANALYZES LOCAL AND REGIONAL COMMUNITY HEALTH DATA, ESTABLISHES SYSTEM-WIDE COMMUNITY HEALTH PROGRAMMING PERFORMANCE AND EVALUATION MEASURES AND SHARES BEST PRACTICES. IN FY24, MEDSTAR GOOD SAMARITAN HOSPITAL CONDUCTED A CHNA AND PRODUCED A THREE-YEAR IMPLEMENTATION STRATEGY. THE DOCUMENT BECAME AVAILABLE ON THE HOSPITAL'S WEBSITE BY JUNE 30, 2024, AND WILL GUIDE PROGRAMMING PRIORITIES IN FISCAL YEARS 2025-2027. PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE PART VI, LINE 3AS ONE OF THE REGION'S LEADING NOT-FOR-PROFIT HEALTHCARE SYSTEMS, MEDSTAR HEALTH IS COMMITTED TO ENSURING THAT UNINSURED AND UNDERINSURED PATIENTS MEETING ELIGIBILITY CRITERIA, AND PATIENTS DETERMINED ELIGIBLE FOR PRESUMPTIVE ELIGIBILITY WITHIN THE COMMUNITIES WE SERVE WHO LACK FINANCIAL RESOURCES HAVE ACCESS TO MEDICALLY NECESSARY HOSPITAL SERVICES. MEDSTAR HEALTH HOSPITALS AND HOSPITAL-BASED PHYSICIAN PRACTICES WILL:- TREAT ALL PATIENTS EQUITABLY, WITH DIGNITY, RESPECT, AND COMPASSION.- SERVE THE EMERGENCY HEALTH CARE NEEDS OF EVERYONE WHO PRESENTS TO OUR MEDSTAR HEALTH HOSPITALS AND HOSPITAL-BASED PHYSICIAN PRACTICES REGARDLESS OF A PATIENT'S ABILITY TO PAY FOR CARE.- ASSIST THOSE PATIENTS WHO ARE ADMITTED THROUGH OUR ADMISSION PROCESS FOR NON-URGENT, MEDICALLY NECESSARY CARE WHO CANNOT PAY FOR THE CARE THEY RECEIVE.- BALANCE NEEDED FINANCIAL ASSISTANCE FOR SOME PATIENTS WITH BROADER FISCAL RESPONSIBILITIES IN ORDER TO KEEP ITS HOSPITALS' DOORS OPEN FOR ALL WHO MAY NEED CARE IN THE COMMUNITY.IN MEETING ITS COMMITMENTS, MEDSTAR HEALTH HOSPITALS AND HOSPITAL-BASED PHYSICIAN PRACTICES WILL WORK WITH THEIR PATIENTS SEEKING EMERGENCY AND MEDICALLY NECESSARY CARE TO GAIN AN UNDERSTANDING OF EACH PATIENT'S FINANCIAL RESOURCES. BASED ON THIS INFORMATION, MEDSTAR HEALTH HOSPITALS AND HOSPITAL-BASED PHYSICIAN PRACTICES WILL MAKE ELIGIBILITY DETERMINATIONS FOR FINANCIAL ASSISTANCE FOR PATIENTS WHO RESIDE WITHIN THE COMMUNITIES THAT WE SERVE. IN DETERMINING ELIGIBILITY FOR FINANCIAL ASSISTANCE, MEDSTAR HEALTH HOSPITALS AND HOSPITAL-BASED PHYSICIAN PRACTICES WILL: - DETERMINE WHETHER THE PATIENT HAS HEALTH INSURANCE. - DETERMINE WHETHER THE PATIENT IS PRESUMPTIVELY ELIGIBLE FOR FREE OR REDUCED-COST CARE. - DETERMINE WHETHER UNINSURED PATIENTS ARE ELIGIBLE FOR PUBLIC OR PRIVATE HEALTH INSURANCE. - TO THE EXTENT POSSIBLE, OFFER ASSISTANCE TO UNINSURED PATIENTS IF THE PATIENT CHOOSES TO APPLY FOR PUBLIC OR PRIVATE HEALTH INSURANCE. - USE INFORMATION IN THE POSSESSION OF THE HOSPITAL, IF AVAILABLE, TO DETERMINE WHETHER THE PATIENT IS QUALIFIED FOR FREE OR REDUCED-COST CARE UNDER THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY.- TO THE EXTENT PRACTICABLE, DETERMINE WHETHER THE PATIENT IS ELIGIBLE FOR OTHER PUBLIC PROGRAMS THAT MAY ASSIST WITH HEALTH CARE COSTS.- USE INFORMATION IN THE POSSESSION OF THE HOSPITAL, IF AVAILABLE, TO DETERMINE WHETHER THE PATIENT IS QUALIFIED FOR FREE OR REDUCED-COST CARE UNDER THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY.MEDSTAR HEALTH WILL WIDELY PUBLICIZE THE MEDSTAR FINANCIAL ASSISTANCE POLICY BY:- PROVIDING ACCESS TO THE MEDSTAR FINANCIAL ASSISTANCE POLICY, FINANCIAL ASSISTANCE APPLICATIONS, AND MEDSTAR PATIENT INFORMATION SHEET ON ALL HOSPITAL WEBSITES AND PATIENT PORTALS.- PROVIDING HARD COPIES OF THE MEDSTAR FINANCIAL ASSISTANCE POLICY, MEDSTAR UNIFORM FINANCIAL ASSISTANCE APPLICATION, AND MEDSTAR PATIENT INFORMATION SHEET TO PATIENTS UPON REQUEST.- PROVIDING HARD COPIES OF THE MEDSTAR FINANCIAL ASSISTANCE POLICY, MEDSTAR UNIFORM FINANCIAL ASSISTANCE APPLICATION, AND MEDSTAR PATIENT INFORMATION SHEET TO PATIENTS UPON REQUEST BY MAIL AND WITHOUT CHARGE.- PROVIDING NOTIFICATION AND INFORMATION ABOUT THE MEDSTAR FINANCIAL ASSISTANCE POLICY BY: . OFFERING COPIES AS PART OF ALL REGISTRATION OR DISCHARGES PROCESSES, AND ANSWERING QUESTIONS ON HOW TO APPLY FOR ASSISTANCE. . PROVIDING WRITTEN NOTICES ON BILLING STATEMENTS. . DISPLAYING MEDSTAR FINANCIAL ASSISTANCE POLICY INFORMATION AT ALL HOSPITAL REGISTRATION POINTS, INCLUDING THE BUSINESS OFFICE, INFORMING PATIENTS OF THEIR RIGHTS TO APPLY FOR FINANCIAL ASSISTANCE AND WHO TO CONTACT AT THE HOSPITAL FOR ADDITIONAL INFORMATION. . TRANSLATING THE MEDSTAR FINANCIAL ASSISTANCE POLICY, MEDSTAR UNIFORM FINANCIAL ASSISTANCE APPLICATION, AND THE MEDSTAR PATIENT INFORMATION SHEET INTO PRIMARY LANGUAGES THAT CONSTITUTE THE LESSER OF 1000 INDIVIDUALS OR 5% OF THE OVERALL POPULATION WITHIN THE CITY OR COUNTY IN WHICH THE HOSPITAL IS LOCATED AS MEASURED BY THE MOST RECENT CENSUS.- MEDSTAR HEALTH WILL PROVIDE PUBLIC NOTICES YEARLY IN LOCAL NEWSPAPERS SERVING ALL HOSPITAL TARGET POPULATIONS.THE MEDSTAR HEALTH PATIENT INFORMATION SHEET SHALL BE PROVIDED TO THE PATIENT, THE PATIENT'S FAMILY, OR THE PATIENT'S AUTHORIZED REPRESENTATIVE: - BEFORE DISCHARGE ;- WITH THE HOSPITAL BILL ; - ON REQUEST ; AND - IN EACH WRITTEN COMMUNICATION TO THE PATIENT REGARDING COLLECTION OF THE HOSPITAL BILL.MEDSTAR HEALTH WILL PROVIDE A FINANCIAL ASSISTANCE PROBABLE AND LIKELY ELIGIBILITY DETERMINATION TO THE PATIENT WITHIN TWO BUSINESS DAYS FROM RECEIPT OF THE INITIAL MEDSTAR HEALTH UNIFORM FINANCIAL ASSISTANCE APPLICATION. FINAL ELIGIBILITY DETERMINATIONS ARE MADE AND COMMUNICATED TO THE PATIENT BASED ON RECEIPT AND REVIEW OF A COMPLETED APPLICATION. MEDSTAR HEALTH BELIEVES THAT ITS PATIENTS HAVE PERSONAL RESPONSIBILITIES RELATED TO THE FINANCIAL ASPECTS OF THEIR HEALTHCARE NEEDS. FINANCIAL ASSISTANCE AND PERIODIC PAYMENT PLANS AVAILABLE UNDER THIS POLICY WILL NOT BE AVAILABLE TO THOSE PATIENTS WHO FAIL TO FULFILL THEIR RESPONSIBILITIES. FOR PURPOSES OF THIS POLICY, PATIENT RESPONSIBILITIES INCLUDE: - COMPLY WITH PROVIDING THE NECESSARY FINANCIAL DISCLOSURE FORMS TO EVALUATE THEIR ELIGIBILITY FOR PUBLICLY-FUNDED HEALTHCARE PROGRAMS, CHARITY CARE PROGRAMS, AND OTHER FORMS OF FINANCIAL ASSISTANCE. THESE DISCLOSURE FORMS MUST BE COMPLETED ACCURATELY, TRUTHFULLY, AND TIMELY TO ALLOW MEDSTAR HEALTH'S FACILITIES TO PROPERLY COUNSEL PATIENTS CONCERNING THE AVAILABILITY OF FINANCIAL ASSISTANCE. - WORKING WITH MEDSTAR HOSPITAL PATIENT ADVOCATES AND PATIENT FINANCIAL SERVICES STAFF TO ENSURE THERE IS A COMPLETE UNDERSTANDING OF THE PATIENT'S FINANCIAL SITUATION AND CONSTRAINTS. - MAKING APPLICABLE PAYMENTS FOR SERVICES IN A TIMELY FASHION, INCLUDING ANY PAYMENTS MADE PURSUANT TO DEFERRED AND PERIODIC PAYMENT SCHEDULES. - PROVIDING UPDATED FINANCIAL INFORMATION TO MEDSTAR HOSPITAL PATIENT ADVOCATES OR CUSTOMER SERVICE REPRESENTATIVES ON A TIMELY BASIS AS THE PATIENT'S FINANCIAL CIRCUMSTANCES MAY CHANGE. - IT IS A PATIENT'S RESPONSIBILITY, DURING THEIR 12-MONTH ELIGIBILITY PERIOD, TO NOTIFY MEDSTAR HEALTH OF THEIR EXISTING HOUSEHOLD ELIGIBILITY FOR FREE CARE, REDUCED COST-CARE, AND/OR ELIGIBILITY UNDER FINANCIAL HARDSHIP PROVISIONS FOR MEDICAL NECESSARY CARE RECEIVED DURING THE 12-MONTH ELIGIBILITY PERIOD.- IN THE EVENT A PATIENT FAILS TO MEET THESE RESPONSIBILITIES, MEDSTAR RESERVES THE RIGHT TO PURSUE ADDITIONAL BILLING AND COLLECTION EFFORTS. IN THE EVENT OF NON-PAYMENT BILLING AND COLLECTION EFFORTS ARE DEFINED IN THE MEDSTAR BILLING AND COLLECTION POLICY. A FREE COPY IS AVAILABLE ON ALL HOSPITAL WEBSITES AND PATIENT PORTALS VIA THE FOLLOWING URL: WWW.MEDSTARHEALTH.ORG/FINANCIALASSISTANCE,OR BY CALLING CUSTOMER SERVICE AT 1-800-280-9006.PATIENTS OF MEDSTAR HEALTH'S HOSPITALS AND HOSPITAL-BASED PHYSICIAN PRACTICES MAY BE ELIGIBLE FOR FULL FINANCIAL ASSISTANCE OR PARTIAL SLIDING-SCALE FINANCIAL ASSISTANCE AS SET FORTH UNDER THIS POLICY. THE PATIENT ADVOCATE AND PATIENT FINANCIAL SERVICES STAFF WILL DETERMINE ELIGIBILITY FOR FULL FINANCIAL ASSISTANCE AND PARTIAL SLIDING-SCALE FINANCIAL ASSISTANCE BASED ON REVIEW OF INCOME FOR THE PATIENT AND THEIR FAMILY (HOUSEHOLD), OTHER FINANCIAL RESOURCES AVAILABLE TO THE PATIENT'S FAMILY, FAMILY SIZE, AND THE EXTENT OF THE MEDICAL COSTS TO BE INCURRED BY THE PATIENT. COMMUNITY INFORMATION PART VI, LINE 4GEOGRAPHIC AND DEMOGRAPHIC:THE COMMUNITIES SERVED BY MEDSTAR GOOD SAMARITAN HOSPITAL ARE LOCATED IN ZIP CODES 21239 AND 21206, BOTH OF WHICH ARE URBAN GEOGRAPHIC SERVICE AREAS. THERE ARE 17 HOSPITALS SERVING BALTIMORE CITY, AND 15 FEDERALLY DESIGNATED MEDICALLY UNDERSERVED AREAS PRESENT IN THE COMMUNITY.THE CURRENT POPULATION IN ZIP CODE 21239 (LOCH RAVEN VILLAGE/NORTHWOOD) IS 28,793 AND THE MEDIAN HOUSEHOLD INCOME IS $51,333. THERE ARE 50,846 RESIDENTS IN ZIP CODE 21206 (CEDONIA/FRANKFORD AREA) AND THE MEDIAN HOUSEHOLD INCOME IS $48,428. BALTIMORE CITY INCLUDES RESIDENTS WITH INCOMES BELOW THE FEDERAL POVERTY GUIDELINE (15.3%), UNINSURED (5.9%) AND MEDICAID RECIPIENTS (49.8%). CITY RESIDENTS STRUGGLE WITH ADULT OBESITY, WHICH IS EVIDENT WITH HIGHER RATES (37%) IN COMPARISON TO STATE AND NATIONAL (34%) RATES. RESIDENTS ALSO STRUGGLE WITH ADULT SMOKING (13%), DRUG OVERDOSE DEATHS (51 PER 100,000), UNEMPLOYMENT (3.3%), HOUSING COST BURDEN (15%), AND CHILDHOOD POVERTY (15%). PROMOTION OF COMMUNITY HEALTH PART VI, LINE 5AS A COMMUNITY PARTNER, MEDSTAR GOOD SAMARITAN HOSPITAL ENGAGES IN SEVERAL COMMUNITY BENEFIT ACTIVITIES TO IMPROVE AND PROMOTE THE HEALTH AND WELLBEING OF THE COMMUNITY. PRIORITY AREAS, AS DETERMINED BY THE CHNA, FALL UNDER THREE AREAS OF FOCUS INCLUDING HEALTH AND WELLNESS, ACCESS TO CARE, AND SOCIAL DETERMINANTS OF HEALTH. PROGRAMS INCLUDE (BUT ARE NOT LIMITED TO):HEALTH AND WELLNESSMEDSTAR GOOD SAMARITAN HOSPITAL ADDRESSES HEALTH AND WELLNESS BY OFFERING A VARIETY OF PROGRAMS AND RESOURCES THAT SEEK TO ADDRESS CHRONIC DISEASE PREVENTION AND MANAGEMENT. MEDSTAR GOOD SAMARITAN HOSPITAL SERVES AS A HUB TO SCREEN INDIVIDUALS FOR BREAST, CERVICAL, AND COLON CANCER. A DISTINCTIVE ASPECT OF THIS PROGRAM IS THAT IT PROVIDES SCREENING TO INDIVIDUALS WITHOUT INSURANCE AND/OR DOCUMENTATION. AS A RESULT, THE PROGRAM HAS BECOME A VITAL RESOURCE FOR THE HISPANIC/LATINO COMMUNITY, WITH OVER 50% OF PARTICIPANTS IDENTIFYING AS HISPANIC/LATINO. MEDSTAR GOOD SAMARITAN HOSPITAL'S COMMUNITY-BASED EDUCATION COURSES ARE OFFERED TO SUPPORT HEALTHY LIFESTYLE CHANGES FOR COMMUNITY MEMBERS. PROGRAMS INCLUDE DIABETES SELF-MANAGEMENT EDUCATION, FLU VACCINATION CLINICS, YOGA CLASSES, SENIOR PHYSICAL FITNESS CLASSES, SMOKING CESSATION EDUCATION, AND STROKE SUPPORT GROUPS.ACCESS TO CAREMEDSTAR GOOD SAMARITAN OFFERS A SCREENING, BRIEF INTERVENTION, AND REFERRAL TO TREATMENT (SBIRT) PROGRAM TO SUPPORT THOSE EXPERIENCING SUBSTANCE USE DISORDER. AN ENHANCEMENT OF SBIRT INCLUDES THE OPIOID OVERDOSE SURVIVOR OUTREACH PROGRAM (OSOP). OSOP LINKS COMMUNITY MEMBERS WITH A HISTORY OF SUBSTANCE ABUSE TREATMENT WITH THE RESOURCES THEY NEED TO RECOVER FROM ADDICTION AND PREVENT A FUTURE OVERDOSE. MEDSTAR GOOD SAMARITAN HOSPITAL ALSO ADDRESSES ACCESS TO CARE BY HELPING TO REDUCE THE FINANCIAL BURDEN FOR PATIENTS AND THEIR FAMILIES. PATIENT FINANCIAL SERVICES PROVIDES FINANCIAL ASSISTANCE TO UNINSURED PATIENTS WHO RESIDE WITHIN THE COMMUNITY BY ASSISTING WITH ENROLLMENT IN PUBLICLY FUNDED ENTITLEMENT PROGRAMS, REFERRING PATIENTS TO STATE OR FEDERAL INSURANCE EXCHANGE NAVIGATOR RESOURCES AND ASSISTING WITH CONSIDERATION OF FUNDING THAT MAY BE AVAILABLE FROM OTHER CHARITABLE ORGANIZATIONS.THE HOSPITAL SUBSIDIZES HEALTH SERVICES TO ENSURE RESIDENTS HAVE ACCESS TO THE CLINICAL CARE THEY NEED.SOCIAL DETERMINANTS OF HEALTHMEDSTAR GOOD SAMARITAN HOSPITAL IS COMMITTED TO ADDRESSING THE SOCIAL DETERMINANTS OF HEALTH OF THE COMMUNITY. INITIATED BY THE BALTIMORE POPULATION HEALTH WORKFORCE COLLABORATIVE PROGRAM AND CONTINUED WITH HOSPITAL RESOURCES, COMMUNITY RESIDENTS ARE HIRED AND TRAINED AS COMMUNITY HEALTH ADVOCATES OR PEER RECOVERY COACHES. THESE POSITIONS SERVE TO EMPOWER INDIVIDUALS AND THEIR FAMILIES INTO BETTER ECONOMIC CONDITIONS.MEDSTAR GOOD SAMARITAN HOSPITAL ALSO PROVIDES PATHWAYS FOR HEALTHCARE CAREERS FOR THE YOUTH IN ITS SURROUNDING COMMUNITY. THIS ALLOWS STUDENTS TO DEVELOP SKILLS AND EXPERIENCE WORKING IN THE MEDICAL FIELD, INCLUDING THE HOSPITAL'S PARTNERSHIP WITH MERCY HIGH SCHOOL. AS PART OF THEIR RESPONSIBILITIES, THE COMMUNITY HEALTH ADVOCATE CONDUCTS SOCIAL NEEDS SCREENINGS. SOCIAL NEEDS SCREENINGS ARE PROVIDED TO SCREEN FOR FOOD AND HOUSING INSECURITY, AND BARRIERS RELATED TO TRANSPORTATION, EMPLOYMENT, AND UTILITIES. IDENTIFIED NEEDS ARE ADDRESSED BY CONNECTING THE PARTICIPANT TO SOCIAL SERVICES AND OTHER RESOURCES IN THE COMMUNITY. MEDSTAR GOOD SAMARITAN HOSPITAL HAS A PARTNERSHIP WITH UBER HEALTH TO ADDRESS TRANSPORTATION BARRIERS TO ACCESS MEDICAL SERVICES AND COMMUNITY RESOURCES. THROUGH THIS PARTNERSHIP, RIDES ARE PROVIDED TO RESIDENTS WITH FINANCIAL NEED. THE TRANSPORTATION ASSISTANCE ENABLES RESIDENTS TO ACCESS COMMUNITY RESOURCES AND ATTEND NECESSARY APPOINTMENTS WITH THEIR HEALTH CARE PROVIDERS. FURTHER, MEDSTAR GOOD SAMARITAN HOSPITAL ADDRESSES FOOD INSECURITY THROUGH THE FOOD PRESCRIPTION DELIVERY PROGRAM IN PARTNERSHIP WITH HUNGRY HARVEST. THIS TEMPORARY SOURCE OF FOOD ASSISTANCE ALLOWS COMMUNITY HEALTH ADVOCATES TO IDENTIFY A LONG-TERM STRATEGY FOR FOOD ACCESS (E.G. MEALS ON WHEELS, ETC.). THE MEDSTAR GOOD SAMARITAN HOSPITAL FOOD RX PROGRAM PROVIDES PERSONALIZED NUTRITION COUNSELING, COOKING MATERIALS AND FRESH FOOD, AT NO COST TO ELIGIBLE PERSONS LIVING WITH DIABETES. AFFILIATED HEALTH CARE SYSTEM PART VI, LINE 6MEDSTAR GOOD SAMARITAN HOSPITAL IS PROUDLY PART OF MEDSTAR HEALTH, AND AS A RESULT, IS ABLE TO EXPAND ITS CAPACITY TO MEET THE NEEDS OF THE COMMUNITY BY PARTNERING WITH OTHER MEDSTAR HOSPITALS AND ASSOCIATED ENTITIES. MEDSTAR HEALTH RESOURCES ASSIST THE HOSPITAL IN COMMUNITY HEALTH PLANNING TO MEET THE NEEDS OF THE UNINSURED AND OTHER VULNERABLE POPULATIONS. THROUGH ITS COMMUNITY HEALTH FUNCTION, MEDSTAR HEALTH PROVIDES MEDSTAR GOOD SAMARITAN HOSPITAL TECHNICAL SUPPORT TO ENHANCE COMMUNITY HEALTH PROGRAMMING AND EVALUATION. MEDSTAR HEALTH'S CORPORATE PHILANTHROPY DEPARTMENT IDENTIFIES AND SEEKS PUBLIC AND PRIVATE FUNDING SOURCES TO ENSURE THE AVAILABILITY OF HIGH-QUALITY HEALTH SERVICES, REGARDLESS OF ABILITY TO PAY. STATE FILING OF COMMUNITY BENEFIT REPORT PART VI, LINE 7THE COMMUNITY BENEFIT REPORT FOR MEDSTAR GOOD SAMARITAN HOSPITAL IS FILED IN THE STATE OF MARYLAND. 1 AMERICAN HEART ASSOCIATION NATIONAL CENTER 7272 GREENVILLE AVENUE DALLAS TX 75231 135613797 501(C)(3) 40000 0 SPONSORSHIP: HEART WALK CRISTO REY CORPORATE INTERNSHIP PROGRAM INC 420 SOUTH CHESTER STREET BALTIMORE MD 21231 205300491 501(C)(3) 14750 0 SPONSORSHIP BALTIMORE CIVIC FUND 1 N CHARLES ST STE 1600 BALTIMORE MD 21201 521212473 501(C)(3) 36413 0 SUPPORTIVE HOUSING INVESTMENT 3 0 SCHOLARSHIPS 5 10750 SCHOLARSHIPS PART I, LINE 2: OUR GRANT MONITORING PROCEDURE BRINGS TOGETHER ALL KEY PERSONNEL INVOLVED IN THE GRANT AT THE ONSET OF THE AWARD TO DISCUSS MANAGEMENT, RESPONSIBILITIES, BUDGETS, AND REPORTING. THIS INITIAL MEETING IS DOCUMENTED AND DISBURSED TO ALL INVOLVED. THE ACTUAL GRANT MONITORING IS DONE BY THE HOSPITAL DEPARTMENT IMPLEMENTING THE GRANT. MEDSTAR CORPORATE'S GRANTS AND PHILANTHROPY DEPARTMENT ENSURES THAT EACH GRANT HAS A COST CENTER AND/OR GRANT ACCOUNT SET UP BASED ON THE TERMS OF THE GRANT AWARD. MEDSTAR CORPORATE'S GRANTS AND PHILANTHROPY DEPARTMENT ALSO TRACKS AND REMINDS HOSPITAL DEPARTMENTS WHEN PROGRESS REPORTS ARE DUE THROUGHOUT THE LIFE OF THE GRANT. X 1 1 X X X X X X 0 1 0 0 0 0 0 0 0 KENNETH A SAMET DIRECTOR 0 2308151 0 3403165 0 1372432 0 68539 0 37548 0 7189835 0 0 BRADLEY CHAMBERS FORMER PRESIDENT/DIRECTOR 0 884291 0 796873 0 0 0 25052 0 34715 0 1740931 0 0 DAVID ZACHARY MARTIN MD DIRECTOR 1400899 0 120357 0 1207 0 9150 0 23381 0 1554994 0 0 0 ZEENA DORAI MD DIRECTOR 0 1122359 0 67452 0 75000 0 9150 0 10864 0 1284825 0 0 THOMAS J SENKER PRESIDENT 282379 282379 214987 214987 0 0 4575 4575 15245 15245 517186 517186 0 0 MICHAEL JACOBS MD PHYSICIAN 836988 0 0 0 0 0 10310 0 18557 0 865855 0 0 0 MAHSA MOHEBTASH MD DIRECTOR 729249 0 86884 0 0 0 9150 0 1552 0 826835 0 0 0 SAMER S NAJJAR MD DIRECTOR 0 643563 0 36539 0 0 0 9150 0 23235 0 712487 0 0 DEANA STOUT CFO/ASSISTANT TREASURER 381181 0 184419 0 0 0 9150 0 23745 0 598495 0 0 0 SHAMS T QUAZI MD DIRECTOR 227677 227677 25000 25000 0 0 4575 4575 11551 11551 268803 268803 0 0 BRIAN CAWLEY SENIOR VP, OPERATIONS 0 310870 0 59005 0 0 0 9150 0 23407 0 402432 0 0 PAUL SACK MD DIRECTOR 0 291632 0 44895 0 0 0 9150 0 20734 0 366411 0 0 BERNARD RAVITZ PHYSICIAN 301199 0 39000 0 0 0 8676 0 1401 0 350276 0 0 0 KENNETH WALSCH AVP, OPERATIONS 216224 0 51918 0 0 0 11891 0 22901 0 302934 0 0 0 JOSHUA DELP PHARMACY DIRECTOR 243551 0 0 0 0 0 9179 0 22729 0 275459 0 0 0 STUART BELL MD FORMER VP, MEDICAL AFFAIRS 0 125841 0 54469 0 0 0 9150 0 14904 0 204364 0 0 YOLANDA BROOKS FORMER OFFICER 0 101811 0 9000 0 0 0 325 0 9118 0 120254 0 0 PART I, LINE 1A HEALTH OR SOCIAL CLUB DUES: THE ORGANIZATION PAID BUSINESS CLUB DUES FOR TWO ASSOCIATES IN SENIOR MANAGEMENT THIS YEAR. PARTICIPATION IN THESE ACTIVITIES WAS FOR BUSINESS PURPOSES, AND HELPED THE ORGANIZATION FURTHER ITS EXEMPT PURPOSE. SCHEDULE J, PART I, LINE 4B MAHSA MOHEBTASH, M.D, AND ZEENA DORAI, M.D. PARTICIPATED IN A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN DESCRIBED IN SECTION 457(F) DURING THIS YEAR. SCHEDULE J, PART III DETAILED BELOW ARE SEVERAL ONE-TIME PAYMENTS TO CERTAIN EXECUTIVES RELATED TO VARIOUS RETIREMENT, RETENTION AND LONG-TERM INCENTIVE PLANS. THESE PLANS AND PAYMENTS ARE NOT A ROUTINE PART OF THE TYPICAL MEDSTAR EXECUTIVE COMPENSATION PROGRAM, AND SUPPORTED IMPORTANT OBJECTIVES OF OUR ORGANIZATION. MR. SAMET'S OTHER REPORTABLE COMPENSATION IN PART II, COLUMN (B)(III) INCLUDES A PAYMENT OF $1,372,432, WHICH REPRESENTS THE CASH VALUE OF THE SPLIT DOLLAR LIFE INSURANCE POLICY ASSIGNED TO MR. SAMET. DR. DORAI'S OTHER REPORTABLE COMPENSATION IN PART II, COLUMN (B)(III) INCLUDES $75,000 REPRESENTING RETENTION BONUS PAYMENTS RECEIVED BY DR. DORAI. DEANA STOUT'S COMPENSATION IS FOR SERVICES PROVIDED AS CFO/TREASURER AT MEDSTAR HARBOR HOSPITAL, MEDSTAR FRANKLIN SQUARE MEDICAL CENTER, MEDSTAR GOOD SAMARITAN HOSPITAL AND MEDSTAR UNION MEMORIAL HOSPITAL. THOMAS J. SENKER'S COMPENSATION IS FOR SERVICES PROVIDED AS PRESIDENT AT MEDSTAR GOOD SAMARITAN HOSPITAL AND MEDSTAR UNION MEMORIAL HOSPITAL. CROTHALL HEALTHCARE INC SEE PART V 1075296 ENVIRONMENTAL SERVICES 0 BUSINESS TRANSACTION INVOLVING INTERESTED PERSON SCHEDULE L, PART IVTHE FOLLOWING ARE SUBSTANTIAL CONTRIBUTORS (IN EXCESS OF $5,000) THATALSO PROVIDED SERVICES TO THE ABOVE-MENTIONED HOSPITAL VALUED IN EXCESSOF $100,000: CROTHALL HEALTHCARE, INC. PER MEDSTAR'S CONFLICT OF INTEREST POLICY, THESE TRANSACTIONS ARE AT ARMS-LENGTH FOR FAIR MARKET VALUE. FORM 990, PART III, LINE 1 AS A PROUD MEMBER OF MEDSTAR HEALTH, MEDSTAR GOOD SAMARITAN HOSPITAL'S (MEDSTAR GOOD SAMARITAN) MISSION IS TO BE GUIDED BY CATHOLIC TEACHINGS TO PROVIDE COMPASSIONATE, INCLUSIVE, AND CONNECTED CARE TO THE COMMUNITY WE ARE ENTRUSTED TO SERVE. MEDSTAR GOOD SAMARITAN IS KNOWN AS A HOSPITAL THAT CARES FOR ITS COMMUNITY. OFFERING THE LATEST TREATMENTS FOR INPATIENT REHABILITATION, IN PARTNERSHIP WITH MEDSTAR NATIONAL REHABILITATION NETWORK; GERIATRICS WITH THE CENTER FOR SUCCESSFUL AGING; WOUND CARE, HYPERBARIC MEDICINE, AND LIMB SAVING, AS PART OF THE MEDSTAR HEALTH WOUND HEALING INSTITUTE; AND CANCER CARE, IN PARTNERSHIP WITH MEDSTAR FRANKLIN SQUARE MEDICINE CENTER AND MEDSTAR GEORGETOWN CANCER INSTITUTE. LOCATED JUST THREE MILES AWAY, MEDSTAR GOOD SAMARITAN EXPERTS WORK IN PARTNERSHIP WITH MEDSTAR UNION MEMORIAL HOSPITAL, OFFERING THE LATEST MEDICAL AND SURGICAL ADVANCES IN HEART CARE, ORTHOPEDICS AND SPINE CARE, AND HAND CARE WITH THE CURTIS NATIONAL HAND CENTER. IN FISCAL YEAR 2024, MEDSTAR GOOD SAMARITAN HAD 8,060 INPATIENT ADMISSIONS AND 186,165 OUTPATIENT VISITS INCLUDING 39,997 EMERGENCY VISITS. FORM 990, PART VI, SECTION A, LINE 6 ORGANIZATION MEMBERS THE ORGANIZATION IS AN AFFILIATE AND SUBSIDIARY OF MEDSTAR HEALTH, INC., A TAX-EXEMPT MARYLAND NON-STOCK CORPORATION. MEDSTAR HEALTH, INC., OR ONE OF ITS AFFILIATES AND SUBSIDIARIES, IS THE SOLE MEMBER OF THE ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 7A DESCRIPTION OF MEMBERS AS AN AFFILIATE AND SUBSIDIARY OF MEDSTAR HEALTH, INC., A TAX-EXEMPT MARYLAND NON-STOCK CORPORATION, THE ORGANIZATION MAY RECOMMEND PERSON(S) FOR MEMBERSHIP ON THE ORGANIZATION'S GOVERNING BODY. ANY SUCH RECOMMENDATION BY THE ORGANIZATION IS SUBJECT TO APPROVAL BY THE GOVERNANCE COMMITTEE OF THE BOARD OF DIRECTORS OF MEDSTAR HEALTH, INC. THE BOARD OF MEDSTAR HEALTH, INC. HAS DELEGATED CERTAIN APPROVAL AUTHORITY TO THE GOVERNANCE COMMITTEE AND THE PRESIDENT & CEO OF MEDSTAR HEALTH, INC. FORM 990, PART VI, SECTION A, LINE 7B DECISIONS OF GOVERNING BODY AS AN AFFILIATE AND SUBSIDIARY OF MEDSTAR HEALTH, INC., A TAX-EXEMPT MARYLAND NON-STOCK CORPORATION, THE BYLAWS OF THE ORGANIZATION ARE SUBJECT TO CERTAIN RESERVED POWERS, WHICH PROVIDE THAT THE SOLE MEMBER OF THE ORGANIZATION MUST APPROVE CERTAIN DECISIONS, INCLUDING BUT NOT LIMITED TO MATTERS CONCERNING THE SALE OR PURCHASE OF REAL OR PERSONAL PROPERTY, CAPITAL BUDGETS, STRATEGIC PLANNING, INVESTMENTS, AND CORPORATE GOVERNANCE. FORM 990, PART VI, SECTION B, LINE 11B PROCESS FOR REVIEWING FORM 990 THE PROCESS FOR REVIEWING THE FORM 990 INCLUDED EDUCATION AND TRANSPARENCY. SENIOR FINANCIAL EXECUTIVES, WORKING WITH INDEPENDENT OUTSIDE EXPERTS, THOROUGHLY REVIEWED FORM 990 AND ACCOMPANYING INSTRUCTIONS. IN ADDITION, SENIOR EXECUTIVES REVIEWED THE RELEVANT SECTIONS OF THE FORM 990 WITH THE FOLLOWING COMMITTEES OF THE ORGANIZATION'S GOVERNING BODY: FINANCE, AUDIT, GOVERNANCE AND EXECUTIVE COMPENSATION. FOLLOWING THESE MEETINGS, THE GOVERNING BODY WAS PROVIDED A COPY OF THE FORM 990 IN ITS FINAL FORM AND GIVEN AN OPPORTUNITY TO PROVIDE ANY INPUT OR COMMENTS RELATING TO THE FORM 990 PRIOR TO ITS FILING. FORM 990, PART VI, SECTION B, LINE 12C CONFLICT OF INTEREST POLICY APPOINTMENT OF BOARDS OF DIRECTORS MEDSTAR HEALTH (AND ITS SUBSIDIARIES) REQUIRE ALL NOMINATED DIRECTORS, PRIOR TO THEIR APPOINTMENT OR ELECTION, TO DISCLOSE THE EXISTENCE OF (OR POTENTIAL EXISTENCE OF) ANY TRANSACTION WITH MEDSTAR THAT WOULD RESULT IN A CONFLICT OF INTEREST. SUCH DISCLOSURES (IF ANY) ARE REVIEWED BY THE GOVERNANCE COMMITTEE OF THE MEDSTAR HEALTH BOARD OF DIRECTORS WHICH DETERMINES HOW THE MATTER SHOULD BE RESOLVED. ANNUAL DISCLOSURES - ALL OFFICERS, DIRECTORS, AND SENIOR MANAGERS ALL OFFICERS, DIRECTORS AND SENIOR MANAGERS ARE REQUIRED, NOT LESS THAN ANNUALLY, TO COMPLETE A SURVEY OF QUESTIONS CONCERNING ANY TRANSACTIONS OR RELATIONSHIPS WHICH WOULD OR COULD REPRESENT A CONFLICT OF INTEREST. SUCH DISCLOSURES (IF ANY) RELATED TO DIRECTORS ARE REVIEWED BY THE GOVERNANCE COMMITTEE OF THE MEDSTAR HEALTH BOARD OF DIRECTORS WHICH DETERMINES HOW THE MATTER SHOULD BE RESOLVED. SUCH DISCLOSURES (IF ANY) RELATED TO OFFICERS AND SENIOR MANAGERS ARE REVIEWED BY AN APPROPRIATE EXECUTIVE WHO DETERMINES HOW THE MATTER SHOULD BE RESOLVED IN ADDITION, OFFICERS AND DIRECTORS OF MARYLAND HOSPITALS AND NURSING CENTERS ARE REQUIRED TO ANNUALLY DISCLOSE ADDITIONAL INFORMATION RELATING TO POTENTIAL CONFLICTS OF INTEREST AND SUCH DISCLOSURES ARE REPORTED TO THE MARYLAND HEALTH SERVICES COST REVIEW COMMISSION (HSCRC). FORM 990, PART VI, SECTION B, LINE 15 DESCRIPTION OF EXECUTIVE COMPENSATION PROCESS THE EXECUTIVE COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS OF MEDSTAR HEALTH, INC. (THE "COMMITTEE") HAS OVERSIGHT OF THE EXECUTIVE COMPENSATION PROGRAM (THE "PROGRAM") OF MEDSTAR HEALTH, INC. AND ITS AFFILIATES. TOTAL COMPENSATION FOR THE TOP MANAGEMENT OFFICIALS, OFFICERS AND KEY EMPLOYEES OF MEDSTAR HEALTH, INC. AND ITS AFFILIATES ARE REVIEWED AND APPROVED BY THE COMMITTEE WITH ASSISTANCE AND GUIDANCE FROM AN INDEPENDENT THIRD PARTY ADVISOR. THE MEMBERS OF THE COMMITTEE ARE INDEPENDENT FROM ALL OF THE PARTICIPANTS IN THE PROGRAM. THE MAIN OBJECTIVE OF THE PROGRAM IS TO PROVIDE MARKET COMPETITIVE TOTAL COMPENSATION THAT IS INTERNALLY EQUITABLE AND HAS A STRONG PAY-FOR-PERFORMANCE LINKAGE. PERFORMANCE IS EVALUATED AT THE SYSTEM, OPERATING UNIT, AND INDIVIDUAL LEVELS. THE OVERALL TOTAL COMPENSATION PHILOSOPHY IS MANAGED AT THE 75TH PERCENTILE OF THE COMPETITIVE MARKET FOR COMPARABLE SIZE (NET REVENUE) AND TYPE (TAX-EXEMPT HEALTHCARE ORGANIZATIONS). WHERE APPROPRIATE, ADDITIONAL INDUSTRY DATA IS CONSIDERED (GENERAL BUSINESS AND/OR TAXABLE HEALTHCARE) FOR SELECTED POSITIONS THAT CAN BE RECRUITED FROM OR POTENTIALLY LOST TO THESE INDUSTRIES (E.G., INFORMATION TECHNOLOGY, FINANCE, ETC.). THE COMMITTEE HAS ENGAGED ERNST & YOUNG LLP ("E&Y") TO SERVE AS AN ADVISOR ON THE REASONABLENESS AND COMPETITIVENESS OF THE PROGRAM. IN DETERMINING REASONABLENESS AND COMPETITIVENESS, E&Y REVIEWS MARKET PRACTICES AND TRENDS, AND MAKES RECOMMENDATIONS RELATED TO THE PROGRAM. E&Y UTILIZES INFORMATION FROM CUSTOM SURVEYS, NATIONAL COMPENSATION SURVEYS, PROPRIETARY DATABASES, AND CLIENT EXPERIENCES TO DETERMINE ITS FINAL RECOMMENDATIONS. E&Y PRESENTS THEIR FINDINGS AND RECOMMENDATIONS TO THE COMMITTEE. THE COMMITTEE MAKES THE FINAL DECISIONS ON ALL OF THE COMPENSATION DETERMINATIONS OF THE PROGRAM. ALL DECISIONS MADE BY THE COMMITTEE ARE CONTEMPORANEOUSLY DOCUMENTED. FORM 990, PART VI, SECTION C, LINE 19 FINANCIAL STATEMENT AVAILABILITY MEDSTAR HEALTH POSTS ITS ANNUAL FINANCIAL AUDIT AND QUARTERLY FINANCIAL REPORTS TO THE ELECTRONIC MUNICIPAL MARKET ACCESS (EMMA) SYSTEM. THE ORGANIZATION ALSO E-MAILS ITS ANNUAL AND QUARTERLY DISCLOSURES TO HOLDERS OF THE COMPANY'S PUBLICLY TRADED DEBT. THE COMPANY'S GOVERNANCE DOCUMENTS AND CONFLICTS OF INTEREST POLICIES ARE AVAILABLE UPON REQUEST THROUGH ITS CORPORATE (OR AS APPLICABLE ENTITY) PUBLIC INFORMATION OFFICES. FORM 990, PART IX, LINE 11G PURCHASED PROFESSIONAL SERVICES: PROGRAM SERVICE EXPENSES 3,634,176. MANAGEMENT AND GENERAL EXPENSES 425,189. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,059,365. PHYSICIAN SERVICES: PROGRAM SERVICE EXPENSES 32,500. MANAGEMENT AND GENERAL EXPENSES 474,472. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 506,972. TESTING & DIAGNOSTIC SERVICES: PROGRAM SERVICE EXPENSES 84,293. MANAGEMENT AND GENERAL EXPENSES 125. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 84,418. PHARMACY SERVICES: PROGRAM SERVICE EXPENSES 68,847. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 68,847. LAB SERVICES: PROGRAM SERVICE EXPENSES 443,640. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 443,640. SUBSIDY EXPENSE - INTERCOMPANY: PROGRAM SERVICE EXPENSES 25,300,925. MANAGEMENT AND GENERAL EXPENSES 2,901,721. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 28,202,646. NON-PHYS INTERCO PURCH SRVS: PROGRAM SERVICE EXPENSES 4,943,240. MANAGEMENT AND GENERAL EXPENSES 33. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,943,273. MISC FIXED PURCH SRVCS: PROGRAM SERVICE EXPENSES 168,627. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 168,627. CONSULTING FEES: PROGRAM SERVICE EXPENSES 67,413. MANAGEMENT AND GENERAL EXPENSES 1,746,012. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,813,425. MISCELLANEOUS: PROGRAM SERVICE EXPENSES 2,093,165. MANAGEMENT AND GENERAL EXPENSES 590,079. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,683,244. FORM 990, PART XI, LINE 9: EQUITY TRANSFERS - NET ASSETS -6,207,495. O'NEILL EQUITY 8,177,778. FINANCIAL STATEMENTS AND REPORTING PART XII, LINE 2C THE GOOD SAMARITAN HOSPITAL OF MARYLAND, INC. IS AN AFFILIATE OF THE MEDSTAR HEALTH, INC. AUDIT AND SUBJECT TO OVERSIGHT BY THE AUDIT COMMITTEE OF THE MEDSTAR BOARD. 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