2018-05-10T12:07:28-05:00 2017-06-30 Grant Thornton LLP 1000 WILSON BLVD SUITE 1400 ARLINGTON VA 22209 990 2016-07-01 520591628 Peninsula Regional Medical Center % JIM GREGORY PENI 4105466400 100 East Carroll Street Salisbury MD 21801 BRUCE RITCHIE CFO 4105466400 2018-05-03 true Mary Torretta P00847851 7038477500 2016 2022-09-23 18:48:47Z Margaret Naleppa CEO 100 East Carroll Street Salisbury MD 21801 610387745 false X www.peninsula.org X 1897 MD IMPROVE THE HEALTH OF THE COMMUNITIES WE SERVE. 16 13 3660 281 7854508 -159138 541790 4228101 415667877 422224611 9246018 16466589 937804 950410 426393489 443869711 0 0 0 0 200320027 214366394 0 0 539655 218212886 230789410 418532913 445155804 7860576 -1286093 639262347 655510872 228707154 218362964 410555193 437147908 X IMPROVE THE HEALTH OF THE COMMUNITIES WE SERVE. false false 391417790 414570637 SEE SCHEDULE O 391417790 true true false true false false false false false true true false false true true false false true false true true false false false false false true true false false true true false false false false false false false false false true false false false false false true true true false false true 293 0 true 3660 true true true true CJ false false false false false false false false X 16 13 true false false false true true true true true false false true true true true true true true true true true CA MD NC X JIM GREGORY 4109124979 100 EAST CARROLL STREET Salisbury MD 21801 X MARGARET NALEPPA PRESIDENT/CEO 40.0 1.0 X X 932691 0 203244 WILLIAM R MCCAIN Board Member 1.0 2.0 X 0 0 0 MONTY SAYLER CHAIRMAN 1.0 1.0 X X 30000 0 0 DEBORAH ABBOTT SECRETARY 1.0 1.0 X X 0 0 0 HERBERT J GEARY III Vice Chairman 1.0 1.0 X X 0 0 0 TIMOTHY BENNING MD BOARD MEMBER 1.0 1.0 X 0 0 0 THOMAS COATES BOARD MEMBER 1.0 1.0 X 0 0 0 MEMO DIRIKER BOARD MEMBER 1.0 1.0 X 0 0 0 MARK HIGDON BOARD MEMBER 1.0 1.0 X 0 0 0 DAVID KERRIGAN MD BOARD MEMBER 1.0 1.0 X 0 0 0 MARION KEENAN BOARD MEMBER 1.0 1.0 X 0 0 0 RYAN MCLAUGHLIN Treasurer 1.0 1.0 X X 0 0 0 VEL NATESAN MD BOARD MEMBER 1.0 1.0 X 17000 0 0 MARTIN NEAT BOARD MEMBER 1.0 1.0 X 0 0 0 THOMAS RICCIO MD BOARD MEMBER 1.0 1.0 X 0 0 0 DAVID ROMMEL BOARD MEMBER 1.0 2.0 X 0 0 0 LURA LUNSFORD VP OF OPERATIONS 40.0 1.0 X 496406 0 87897 BRUCE I RITCHIE CFO 40.0 1.0 X 531783 0 118963 CHARLES SILVIA JR MD VP - CHIEF MEDICAL OFFICER 40.0 1.0 X 453976 0 61979 SARA SCOTT VP PEOPLE & ORGANIZATION DEV. 40.0 0.0 X 231215 0 55215 STEVEN LEONARD VP OPERATION OPTIMIZATION & IN 40.0 0.0 X 301949 0 87003 KAREN POISKER VP POPULATION HEALTH 40.0 0.0 X 320059 0 121944 THOMAS DEMARCO MD VP - PRMG 40.0 0.0 X 371956 0 29853 SHERI MATTER V.P. PATIENT CARE SERVICES 40.0 0.0 X 263223 0 29041 KATHRYN FIDDLER EXECUTIVE DIRECTOR-POP. HEALTH 40.0 0.0 X 172738 0 6002 JAMES TODD MD PHYSICIAN 40.0 0.0 X 866911 0 92900 KURT WEHBERG MD PHYSICIAN 40.0 0.0 X 850817 0 94062 DANIEL DANIELS MD PHYSICIAN 40.0 0.0 X 843273 0 23220 HALIM CHARBEL MD PHYSICIAN 40.0 0.0 X 840808 0 15852 KARIM ARNAOUT MD PHYSICIAN 40.0 0.0 X 792315 0 24661 8317120 0 1051836 303 false true false EPIC SYSTEMS CORPORATION PO BOX 88314 MILWAUKEE WI 532880314 TECHNICAL SERVICES 10648205 HORIZON CSA LLC 265 PIT ROAD MOORESVILLE NC 28115 BIOMEDICAL SERVICES 5643067 SHERIDAN ANESTHESIA OF MD PO BOX 452197 SUNRISE FL 333232197 ANESTHESIA SERVICES 3861533 MERCY SPECIALIZED BILLING SERVICES PO BOX 505125 ST LOUIS MO 631505125 TECHNICAL SERVICES 3654201 ENCORE HEALTH RESOURCES LLC DEPARTMENT 806 PO BOX 4652 HOUSTON TX 772104652 TECHNICAL SERVICES 3406459 90 3507208 720893 4228101 NET PATIENT SERVICES 621500 416044583 414112646 1931937 AMBULATORY PHARMACY 900099 5702820 5702820 INVESTMENT IN PREMIER 900099 477208 457991 19217 422224611 4682629 534 4682095 0 0 334684 494144 -159460 0 -159460 -159460 177425408 382442 165958339 65551 11467069 316891 11783960 11783960 0 0 0 0 0 0 0 0 0 CAFETERIA 722514 909851 909851 MANAGEMENT FEES 561000 200019 200000 19 1109870 443869711 414570637 7854508 17216465 0 0 0 0 4431203 3866179 556060 8964 0 171490962 149624053 21519944 346965 6389407 5574690 801790 12927 20257956 17670724 2546180 41052 11796866 10416588 1361658 18620 0 681118 92679 588439 228792 228792 27668 27668 0 1635154 1635154 60501542 48879073 11598651 23818 843161 843161 111535221 110238909 1223337 72975 1284488 1265346 18649 493 0 4636894 4539778 97116 622681 284069 325419 13193 0 26039 26039 5355480 5355480 0 26383333 26195844 187489 4819969 62389 4757580 BAD DEBTS 11673038 11673038 DUES 534832 191270 342914 648 445155804 391417790 53198359 539655 2261850 6107380 26994129 27488604 0 0 41519879 38956673 0 0 0 0 0 0 9363458 8403261 6275679 6326974 544868692 321941585 220671182 222927107 233113292 247986318 0 0 0 0 0 0 99062878 97314555 639262347 655510872 17724004 20397583 0 0 0 0 143614264 139517828 0 0 0 0 0 0 0 0 67368886 58447553 228707154 218362964 X 377252005 401770195 25058289 27122679 8244899 8255034 410555193 437147908 639262347 655510872 X -1286093 17900871 9977937 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false false true 27668 27668 false OTHER ACTIVITIES SCHEDULE C, PART II-B, LINE 1I PENINSULA REGIONAL MEDICAL CENTER DOES NOT ENGAGE IN ANY DIRECT LOBBYING ACTIVITIES. THE ORGANIZATION PAYS MEMBERSHIP DUES TO MARYLAND HOSPITAL ASSOCIATION (MHA) AND THE AMERICAN HOSPITAL ASSOCIATION (AHA). MHA AND AHA ENGAGE IN MANY SUPPORT ACTIVITIES INCLUDING LOBBYING AND ADVOCATING FOR THEIR MEMBER HOSPITALS. THE MHA AND AHA REPORTED THAT 6.46% AND 22.98% OF MEMBER DUES WERE USED FOR LOBBYING PURPOSES AND SUCH, THE ORGANIZATION HAS REPORTED THIS AMOUNT ON SCHEDULE C PART IV AS LOBBYING ACTIVITIES. 49801243 250000 6985039 363596 56672686 50044611 500000 -399685 343683 49801243 45972891 647931 3765292 341503 50044611 39054428 500000 6781222 41210 321549 45972891 34734107 6448 4624939 311066 39054428 0.52429 0.00157 0.47414 false false 10661389 10661389 247785209 104001721 143783488 274929064 212200239 62728825 11493030 5739625 5753405 222927107 DONOR RESTRICTED FUND 34842096 BOARD DESIGNATED INVESTMENTS 26946681 SELF INSURANCE FUND 21900751 OTHER ASSETS 8701505 INVESTMENT IN PARTNERSHIPS 3425288 CONSTRUCTION FUND 759664 INTERCOMPANY RECEIVABLES 738570 97314555 0 ACCRUED SELF INSURANCE LIABILITY 16676221 EMPLOYEE COMP RELATED PAYROLL TAXES 13730515 PENSION LIABILITY 10952038 ADVANCES FROM THIRD PARTY PAYORS 9806170 OTHER LIABILITIES 7282609 58447553 X 426454029 494144 494144 425959885 1635154 16274672 17909826 443869711 432141737 494144 494144 431647593 1635154 11873057 13508211 445155804 INTENDED USE OF ENDOWMENT FUNDS SCHEDULE D, PART V, LINE 4 THE ORGANIZATION'S ENDOWMENT FUNDS ARE USED FOR CAPITAL, PATIENT SERVICES OR EDUCATIONAL PURPOSES. FIN 48 FOOTNOTE Schedule D, Part X, Line 2 The Health System is a not-for-profit corporation as described in Section 501(c)(3) of the Internal Revenue Code (The Code) and is exempt from federal income taxes on related income pursuant to Section 501(a) of the Code. RECONCILIATION OF REVENUE AND EXPENSES TO AUDITED FINANCIAL STATEMENTS SCHEDULE D, PART XI, LINE 2D RENT EXPENSES $494,144 SCHEDULE D, PART XI, LINE 4B BAD DEBTS EXPENSES $11,673,038 FOUNDATION CONTRIBUTIONS $3,507,208 Recovery of Expense $200,019 OTHER CONTRIBUTIONS $700,000 PARTNERSHIP INCOME TAX ADJUSTMENT $194,407 ------------- TOTAL $16,274,672 SCHEDULE D, PART XII, LINE 2D RENT EXPENSES $494,144 SCHEDULE D, PART XII, LINE 4B BAD DEBT EXPENSES $11,673,038 MANAGEMENT FEES RECLASSED FROM EXPENSES $200,019 ----------- TOTAL $11,873,057 Central America and the Caribbean 1 1 INVESTMENTS 4109125 1 1 1 1 4109125 4109125 true false true false false false ACTIVITIES PER REGION SCHEDULE F, PART IV THE AMOUNTS IN COLUMN F WERE DETERMINED USING AN ACCRUAL METHOD OF ACCOUNTING. THE ENTIRE $4,109,125 REPRESENTS A CAPTIVE INSURANCE INVESTMENT. true true true X true X true true true false true true 7789268 7789268 0.01800 7789268 7789268 0.01800 54299 2023920 295829 1728091 0.00400 228 1265282 41100 1224182 0.00280 121228 51900339 22210049 26690290 0.06850 2963 2963 1680 253422 253422 0.00060 177435 55445926 22546978 29898948 0.07590 177435 63235194 22546978 37688216 0.09390 137 137 2101 2101 12983 12983 116772 116772 0.00030 1136 1136 1996116 1996116 0.00460 2129245 2129245 0.00490 true 11673038 256285647 178973931 77311716 X true true 1 1 Peninsula Regional Medical Center 100 E Carroll Street Salisbury MD 21801 WWW.PENINSULA.ORG 210019 X X X Peninsula Regional Medical Center 1 false false true X X X X X X 16 true false false true X WWW.PENINSULA.ORG X X true 16 true WWW.PENINSULA.ORG false true X 200. 300. X X X X true true X X X X true X WWW.PENINSULA.ORG X WWW.PENINSULA.ORG X WWW.PENINSULA.ORG X X X X X X true X false X X X X true X false false CONSULTING A REPRESENTATIVE OF THE COMMUNITY SERVED BY THE HOSPITAL SCHEDULE H, PART V, LINE 5 HEALTH COMMUNITIES INSTITUTE (HCI), A XEROX COMPANY, WAS RETAINED BY PENINSULA REGIONAL MEDICAL CENTER TO CONDUCT THE 2016 COMMUNITY NEEDS ASSESSMENT. HCI PROVIDES CUSTOMIZABLE, WEB-BASED INFORMATION SYSTEMS THAT OFFER A FULL RANGE OF TOOLS AND CONTENT TO IMPROVE COMMUNITY HEALTH. HCI AND PRMC HAVE COLLABORATED SINCE 2012 TO DEVELOP THE PRMC CREATING HEALTH COMMUNITIES PLATFORM. HCI CONSULTANTS CONDUCTED KEY INFORMANT INTERVIEWS IN ORDER TO COLLECT COMMUNITY INPUT. INTERVIEWEES WHO WERE ASKED TO PARTICIPATE WERE RECOGNIZED AS HAVING EXPERTISE IN PUBLIC HEALTH, SPECIAL KNOWLEDGE OF COMMUNITY HEALTH NEEDS AND/OR REPRESENTED THE BROAD INTEREST OF THE COMMUNITY SERVED BY THE HOSPITAL, AND/OR COULD SPEAK TO THE NEEDS OF THE MEDICALLY UNDERSERVED OR VULNERABLE POPULATIONS. THE FOLLOWING ORGANIZATIONS ARE REPRESENTATIVE OF THE INDIVIDUALS WHO PARTICIPATED IN THE INTERVIEWS: CHESAPEAKE YMCA, COMMUNITY FOUNDATION OF THE EASTERN SHORE, LOWER SHORE CLINIC, MARYLAND STATE POLICE, SALISBURY UNIVERSITY, SOMERSET COUNTY HEALTH DEPARTMENT, ST. PAUL AME ZION EPISCOPAL CHURCH, THREE LOWER COUNTIES COMMUNITIES SERVICES, INC., UNITED WAY AND THE WICOMICO COUNTY HEALTH DEPARTMENT. IN ADDITION, THERE WAS INPUT FROM PENINSULA REGIONAL'S CLINICAL TEAM, EXECUTIVE STAFF AND BOARD IN THE OVERALL REVIEW AND IDENTIFICATION OF VULNERABLE POPULATIONS, CRITICAL COMMUNITY HEALTH NEEDS AND THE MEDICALLY UNDERSERVED. OTHER WAYS THE HOSPITAL MAKES ITS CHNA REPORT AVAILABLE TO THE PUBLIC SCHEDULE H, PART V, LINE 7D PENINSULA REGIONALS CHNA PLAN IS AVAILABLE TO THE PUBLIC, THROUGH OUR WEBSITE UNDER QUICK LINKS - COMMUNITY HEALTH NEEDS ASSESSMENT AT (www.peninsula.org/community/community-health-needs-assessment-and-impleme ntation-plan). AVAILABLE TO THE PUBLIC IS THE CURRENT AND COMPREHENSIVE COMMUNITY HEALTH NEEDS ASSESSMENT AND THE IMPLEMENTATION STRATEGY. IN ADDITION, THERE IS A COMMUNITY HEALTH DATA AND RESOURCES SECTION THAT CAN BE ACCESSED BY THE PUBLIC, COLLABORATION BETWEEN PENINSULA REGIONAL MEDICAL CENTER AND WICOMICO COUNTY. AS PART OF THIS CREATING HEALTHY COMMUNITIES MODULE AVAILABLE TO THE PUBLIC IS DISPARITY DASHBOARD, DEMOGRAPHICS, HEALTHY PEOPLE 2020 TRACKER, MARYLAND SHIP TRACKER AND PROMISING PARTNERS. HOW NEEDS IDENTIFIED IN CHNA ARE ADDRESSED SCHEDULE H, PART V, LINE 11 PENINSULA REGIONAL MEDICAL CENTER HAS A FIXED VALUE OF RESOURCES AVAILABLE AND THE HOSPITAL FOCUSES THOSE RESOURCES TO THE AREAS WITH THE GREATEST IMPACT, THEREFORE NOT ALL NEEDS IDENTIFIED IN THE CHNA WERE ABLE TO BE ADDRESSED TO DATE. BASED ON THE SIGNIFICANT NEEDS IDENTIFIED IN THE COMMUNITY HEALTH NEEDS ASSESSMENT, THE FOLLOWING IMPLEMENTATION INITIATIVES WERE DEVELOPED AND OUTLINED BELOW: 1) REDUCE DIABETES COMPLICATIONS: A. PROVIDE AWARENESS, EDUCATION AND DIABETES MANAGEMENT TO THE COMMUNITY. I. CONTINUE TO CREATE GENERAL PUBLIC AWARENESS AROUND THE HIGH PREVALENCE OF DIABETES IN THIS REGION. II. CREATE AND CONTINUE A "DIABETES SUPPORT GROUP FOR TEENS AND KIDS" THAT MEETS THE MEDICAL, EDUCATIONAL AND SOCIAL NEEDS OF THIS GROUP. III. "EDUCATING THE EDUCATORS." WORK WITH MULTIPLE EDUCATORS TO PROMOTE ADOLESCENT AND ADULT DIABETES AWARENESS. IV. SUPPORT AND PARTNER WITH THE TRI-COUNTY DIABETES ALLIANCE TO CREATE AWARENESS, EDUCATION AND MANAGEMENT OF THE DIABETES POPULATION IN THE LOWER THREE COUNTIES. V. DISEASE SELF- MANAGEMENT PROGRAM. PARTNER WITH MAINTAINING ACTIVE CITIZENS IN THE STATEWIDE LICENSE FOR CHRONIC DISEASE SELF-MANAGEMENT EDUCATION. THE PRIMARY OBJECTIVE IS TO DELIVER CHRONIC DISEASE SELF-MANAGEMENT SERVICES TO COMMUNITY RESIDENTS. THE PROGRAM WILL PROMOTE INCREASED PATIENT COMPETENCE AND COPING THROUGH TREATMENT PLANS THAT INCLUDE EDUCATION AND REFERRALS TO NECESSARY RESOURCES, PROVIDE COMPREHENSIVE ASSESSMENTS AND HELP THE PATIENT UTILIZE THE HEALTH SYSTEM APPROPRIATELY. HEALTHY LIVING WITH DIABETES. A DIABETES SELF-MANAGEMENT EDUCATION PROGRAM AT MAC. HEALTHY LIVING WITH DIABETES IS A 6-8 WEEK WORKSHOP DEVELOPED AT STANFORD UNIVERSITY, BASED ON SELF-MANAGEMENT. VI. PARTNER WITH LOCAL HEALTH DEPARTMENTS UNDER THE 1422 GRANT TO PREVENT OBESITY AND DIABETES. 2) REDUCE OBESITY: A. REDUCE THE NUMBER OF CHILD AND ADOLESCENTS IN WICOMICO, WORCESTER AND SOMERSET COUNTIES WHO ARE CONSIDERED OVERWEIGHT. B. DEVELOP EDUCATIONAL MODULES AND INCREASE EDUCATIONAL AWARENESS AROUND CHILDHOOD AND ADOLESCENT OBESITY TO REDUCE THE TOTAL NUMBER OF CHILDREN WHO ARE OVERWEIGHT. C. THE PRIMARY OBJECTIVE IS TO EDUCATE OUR CHILDREN ON HOW TO MAKE BETTER HEALTHY LIFESTYLE CHOICES AT A YOUNG AGE, AND TO INVOLVE THE PARENTS IN HEALTHY LIFESTYLE ACTIVITIES SO THEY WILL START TO COMMIT TO A HEALTHIER LIFESTYLE AND REINFORCE THIS WITH THEIR CHILDREN. D. CREATE DIABETES COMMUNITY AWARENESS AND PROVIDE EDUCATION REGARDING HEALTHY LIFESTYLES WITHIN THE TRI-COUNTY REGION (WICOMICO, WORCESTER & SOMERSET). E. PROVIDE SCREENINGS AND EDUCATION FOR UNDERSERVED AND UNINSURED MEMBERS OF THE COMMUNITY THROUGH HEALTHFEST, AN ANNUAL HEALTH EXPO. F. PROVIDE PEDIATRIC OBESITY SCREENINGS AND EDUCATION FOR UNDER AND UNINSURED COMMUNITY MEMBERS. INCREASE BREAST FEEDING RATES TO HELP LOWER PEDIATRIC OBESITY. PROMOTE PHYSICAL ACTIVITY. G. PROVIDE HEALTHY HEART SCREENINGS TO RESIDENTS OF DELMARVA USING A MOBILE VAN TO REACH COMMUNITIES THAT HAVE LIMITED ACCESS TO HEALTHCARE. THE TWO HEALTHY HEART INITIATIVES INCLUDE: - CCC- COASTAL CARDIAC CHECKS - WOMEN'S HEART SCREENINGS OBESITY COMPONENT AN INTEGRAL COMPONENT OF THESE HEART SCREENINGS INCLUDES AN EDUCATIONAL SESSION THAT HIGHLIGHTS REDUCING OBESITY, EXERCISING AND HEALTHY FOOD CHOICES - ALL OF WHICH CONTRIBUTE TO A HEALTHY HEART. - OBESITY SCREENING COMPONENT INCLUDES: - HEIGHT - WEIGHT - BMI - BODY FAT % - EDUCATIONAL SESSION ON NUTRITION AND HEALTHY LIFESTYLES - RESOURCES AVAILABLE - POTENTIAL REFERRAL IF NEEDED ELIGIBILITY CRITERIA FOR FINANCIAL ASSISTANCE SCHEDULE H, PART V, LINE 13 PENINSULA REGIONAL MEDICAL CENTER OFFERS FINANCIAL ASSISTANCE TO PATIENTS WHOSE INCOME IS AT OR BELOW 200% OF THE FEDERAL POVERTY GUIDELINES. PRMC ALSO PROVIDES FINANCIAL ASSISTANCE BASED UPON SEVERAL SPECIAL EXCEPTIONS: 1) FINANCIAL ASSISTANCE WILL BE CONSIDERED IF PATIENT IS OVER INCOME CRITERION, BUT HAVE A FINANCIAL HARDSHIP. A FINANCIAL HARDSHIP EXISTS WHEN THE AMOUNT OF MEDICAL DEBT AT PENINSULA REGIONAL MEDICAL CENTER EXCEEDS 25% OF THE FAMILY'S INCOME IN A YEAR. 2) A PATIENT THAT HAS QUALIFIED FOR MARYLAND MEDICAL ASSISTANCE IS DEEMED TO AUTOMATICALLY QUALIFY FOR PRMC'S FINANCIAL ASSISTANCE PROGRAM. THE AMOUNT DUE FROM A PATIENT ON THESE ACCOUNTS MAY BE WRITTEN OFF TO FINANCIAL ASSISTANCE WITH VERIFICATION OF MEDICAID ELIGIBILITY. NORMAL DOCUMENTATION REQUIREMENTS ARE WAIVED FOR FINANCIAL ASSISTANCE GRANTED UPON THE BASIS OF MARYLAND MEDICAL ASSISTANCE ELIGIBILITY. 3) PATIENTS WHO ARE BENEFICIARIES/RECIPIENTS OF CERTAIN MEANS-TESTED SOCIAL SERVICES PROGRAMS ADMINISTERED BY THE STATE OF MARYLAND ARE DEEMED TO HAVE PRESUMPTIVE ELIGIBILITY FOR PRMC'S FINANCIAL ASSISTANCE PROGRAM. THE AMOUNT DUE FROM A PATIENT ON THESE ACCOUNTS MAY BE WRITTEN OFF TO FINANCIAL ASSISTANCE WITH VERIFICATION OF ELIGIBILITY FOR ONE OF THESE PROGRAMS. NORMAL DOCUMENTATION REQUIREMENTS ARE WAIVED FOR FINANCIAL ASSISTANCE GRANTED UPON THE BASIS OF PRESUMPTIVE ELIGIBILITY. IT IS THE RESPONSIBILITY OF PATIENTS TO NOTIFY THE HOSPITAL THEY ARE IN A MEANS TESTED PROGRAM AND PROVIDE THE DOCUMENTATION. PUBLICIZING THE FINANCIAL ASSISTANCE POLICY SCHEDULE H, PART V, LINE 15 IF A PATIENT IS UNABLE TO PAY DUE TO FINANCIAL RESOURCES, ALL EFFORTS WILL BE MADE TO HELP THE PATIENT OBTAIN ASSISTANCE THROUGH APPROPRIATE AGENCIES. IN THE EVENT THAT THE PATIENT HAS APPLIED FOR AND KEPT ALL NECESSARY APPOINTMENTS AND THIRD PARTY ASSISTANCE IS NOT AVAILABLE, PENINSULA REGIONAL MEDICAL CENTER WILL PROVIDE CARE AT REDUCED OR ZERO COST. WHEN NO THIRD PARTY ASSISTANCE IS AVAILABLE TO COVER THE TOTAL BILL AND THE PATIENT INDICATES THAT THEY HAVE INSUFFICIENT FUNDS, THE FOLLOWING PROCEDURE WILL OCCUR: 1) THE MARYLAND STATE UNIFORM FINANCIAL ASSISTANCE APPLICATION SHOULD BE REVIEWED BY STAFF, IN CONSULTATION WITH THE PATIENT, TO MAKE INITIAL ASSESSMENT OF ELIGIBILITY. 2) COMPARE PATIENT'S INCOME TO CURRENT FEDERAL POVERTY GUIDELINES. 3) IF PRELIMINARILY ELIGIBLE PER GUIDELINES, SEND MARYLAND STATE UNIFORM FINANCIAL ASSISTANCE APPLICATION TO PATIENT/GUARANTOR FOR COMPLETION AND SIGNATURE. PATIENT SHOULD ATTACH APPROPRIATE DOCUMENTATION AND RETURN TO REPRESENTATIVE WITHIN 10 DAYS. UPON RECEIPT OF THE FINANCIAL ASSISTANCE REQUEST, THE REPRESENTATIVE WILL REVIEW INCOME AND ALL DOCUMENTATION. THE PATIENT MUST BE NOTIFIED WITHIN TWO BUSINESS DAYS OF THEIR PROBABLE ELIGIBILITY AND INFORMED THAT THE FINAL DETERMINATION WILL BE MADE ONCE THE COMPLETED FORM AND ALL SUPPORTING DOCUMENTS ARE RECEIVED, REVIEWED, AND THE INFORMATION VERIFIED. INCOME INFORMATION WILL BE VERIFIED USING THE DOCUMENTATION PROVIDED BY THE PATIENT AND EXTERNAL RESOURCES WHEN AVAILABLE. A FINANCIAL ASSISTANCE DISCOUNT WILL BE APPLIED TO THE PATIENT'S RESPONSIBILITY ACCORDINGLY. 4) IF INELIGIBLE, THE REPRESENTATIVE WILL NOTIFY THE PATIENT AND RESUME NORMAL DUNNING PROCESS AND FILE DENIAL WITH THE ACCOUNT. THE DENIALS WILL BE KEPT ON FILE IN THE COLLECTION OFFICE. ALL DENIALS WILL BE REVIEWED BY THE COLLECTION COORDINATOR LEVEL OR ABOVE. THE PATIENT MAY REQUEST RECONSIDERATION BY SUBMITTING A LETTER TO THE DIRECTOR OF PATIENT FINANCIAL SERVICES INDICATING THE REASON FOR THE REQUEST. ONLY INCOME AND FAMILY SIZE WILL BE CONSIDERED IN APPROVING APPLICATIONS FOR FINANCIAL ASSISTANCE UNLESS ONE OF THE FOLLOWING THREE SCENARIOS OCCURS: - THE AMOUNT REQUESTED IS GREATER THAN $50,000. - THE TAX RETURN SHOWS A SIGNIFICANT AMOUNT OF INTEREST INCOME, OR THE PATIENT STATES THEY HAVE BEEN LIVING OFF OF THEIR SAVINGS ACCOUNTS. - DOCUMENTATION INDICATES SIGNIFICANT WEALTH. IF ONE OF THE ABOVE THREE SCENARIOS ARE APPLICABLE IN THE APPLICATION, LIQUID ASSETS MAY BE CONSIDERED INCLUDING: CHECKING AND SAVINGS ACCOUNTS, STOCKS, BONDS, CD'S, MONEY MARKET OR ANY OTHER ACCOUNTS FOR THE PAST THREE MONTHS ALONG WITH THE PAST YEAR'S TAX RETURN, AND A CREDIT REPORT MAY BE REVIEWED. THE FOLLOWING ASSETS ARE EXCLUDED: - THE FIRST $10,000 OF MONETARY ASSETS. - UP TO $150,000 IN A PRIMARY RESIDENCE. CERTAIN RETIREMENT BENEFITS (SUCH AS A 401-K WHERE THE IRS HAS GRANTED PREFERENTIAL TAX TREATMENT AS A RETIREMENT ACCOUNT INCLUDING BUT NOT LIMITED TO DEFERRED-COMPENSATION PLANS QUALIFIED UNDER THE INTERNAL REVENUE CODE, OR NONQUALIFIED DEFERRED-COMPENSATION PLANS) WHERE THE PATIENT POTENTIALLY COULD PAY TAXES AND/OR PENALTIES BY CASHING IN THE BENEFIT. IF THE BALANCE DUE IS SUFFICIENT TO WARRANT IT AND THE ASSETS ARE SUITABLE, A LIEN WILL BE PLACED ON THE ASSETS FOR THE AMOUNT OF THE BILL. COLLECTION EFFORTS WILL CONSIST OF PLACEMENT OF THE LIEN WHICH WILL RESULT IN PAYMENT TO THE HOSPITAL UPON SALE OR TRANSFER OF THE ASSET. 5) COLLECTION COORDINATOR WILL REVIEW DOCUMENTATION. IF ELIGIBLE, THE ACCOUNT WILL BE WRITTEN OFF TO FINANCIAL ASSISTANCE AND THE "REQUEST FOR FINANCIAL ASSISTANCE" FORM FINALIZED. A COPY IS RETAINED IN THE PATIENT'S FILE. THE REPRESENTATIVE WILL CALL THE PATIENT AND NOTIFY HIM/HER OF THE FINAL DETERMINATION OF ELIGIBILITY. 6) PENINSULA REGIONAL MEDICAL CENTER WILL REVIEW ONLY THOSE ACCOUNTS WHERE THE PATIENT OR GUARANTOR INQUIRE ABOUT FINANCIAL ASSISTANCE, MAILS IN AN APPLICATION, OR IN THE NORMAL WORKING OF THE ACCOUNT THERE IS INDICATION THAT THE PATIENT MAY BE ELIGIBLE. ANY PATIENT/CUSTOMER SERVICE REPRESENTATIVE, FINANCIAL COUNSELOR, OR COLLECTION REPRESENTATIVE MAY BEGIN THE REQUEST PROCESS. PRE-PLANNED SERVICE MAY ONLY BE CONSIDERED FOR FINANCIAL ASSISTANCE WHEN THE SERVICE IS MEDICALLY NECESSARY. FOR EXAMPLE, NO COSMETIC SURGERY WILL BE ELIGIBLE. INPATIENT, OUTPATIENT, EMERGENCY, AND PENINSULA REGIONAL MEDICAL GROUP PHYSICIAN CHARGES ARE ALL ELIGIBLE. MAXIMUM CHARGE AMOUNTS FOR FAP-ELIGIBLE INDIVIDUALS SCHEDULE H, PART V, LINE 22D PENINSULA REGIONAL MEDICAL CENTER IS A MARYLAND HOSPITAL. AS SUCH PATIENTS AND ALL INSURANCE COMPANIES, INCLUDING MEDICARE & MEDICAID, PAY THE SAME RATE. THIS RATE IS DETERMINED BY THE STATE AGENCY, THE MARYLAND HEALTH SERVICES COST REVIEW COMMISSION. OTHER METHOD USED IN DETERMINING ELIGIBILITY FOR FINANCIAL ASSISTANCE SCHEDULE H, PART I, LINE 3C N/A - PENINSULA REGIONAL MEDICAL CENTER USES THE FPG IN DETERMINING ELIGIBILITY FOR FINANCIAL ASSISTANCE. FINANCIAL ASSISTANCE IS ALSO CONSIDERED IF A PATIENT IS OVER INCOME CRITERION BUT HAS FINANCIAL HARDSHIP BASED ON MEDICAL DEBT. PATIENTS WHO ARE BENEFICIARIES/RECIPIENTS OF CERTAIN MEANS-TESTED SOCIAL SERVICES PROGRAM administered by the state of the patient's residence are deemed TO HAVE PRESUMPTIVE ELIGIBILITY FOR PRMC'S FA PROGRAM. COMMUNITY BENEFIT REPORT SCHEDULE H, PART I, LINE 6A PENINSULA REGIONAL MEDICAL CENTER FUNCTIONS AS THE PRIMARY HOSPITAL PROVIDER FOR THE RURAL SOUTHERNMOST THREE COUNTIES OF THE EASTERN SHORE OF MARYLAND, WHICH INCLUDES WICOMICO, WORCESTER AND SOMERSET COUNTIES. IN FY 2017, APPROXIMATELY 77% OF THE PATIENTS DISCHARGED FROM THE MEDICAL CENTER WERE RESIDENTS OF THE PRIMARY SERVICE AREA, WHICH HAS AN ESTIMATED POPULATION OF APPROXIMATELY 180,533 IN 2017 AND IS EXPECTED TO INCREASE TO 184,828 IN 2022, OR BY 2.4%. THE PRIMARY SERVICE AREA POPULATION HAS GROWN BY AN ESTIMATED 5% SINCE 2010. PENINSULA REGIONALS CBSA (COMMUNITY BENEFIT SERVICE AREA) CONSISTS OF THOSE ZIP CODES WITHIN OUR PRIMARY SERVICE AREA. THE MAJORITY OF THE POPULATION RESIDES IN WICOMICO COUNTY (104,756) WITH SALISBURY SERVING AS THE CAPITAL OF THE EASTERN SHORE. SALISBURY IS LOCATED ON THE HEADWATERS OF THE WICOMICO RIVER AND IT IS LOCATED AT THE CROSSROADS OF THE BAY AND THE OCEAN. THE REGION IS UNIQUE; THE CITY OF SALISBURY HAS SIMILAR SOCIO-ECONOMIC AND DEMOGRAPHIC CHARACTERISTICS OF A LARGE CITY, HOWEVER, THE AREA SURROUNDING SALISBURY IS RURAL AND HAS LIKE-KIND CHARACTERISTICS OF SMALL TOWN AMERICA. DUE TO THIS DICHOTOMY, SERVING BOTH SOMETIMES PRESENTS A CHALLENGE IN DELIVERING HEALTHCARE. THE TWO OTHER COUNTIES IN PENINSULA REGIONALS CBSA INCLUDE WORCESTER COUNTY, WITH A POPULATION OF 52,052 AND SOMERSET COUNTY WITH A POPULATION OF 23,881. THE GREATER "METROPOLITAN" SALISBURY AREA (ZIP CODES 21801, 21804) HAS A HIGHER POPULATION DENSITY THAN THE SURROUNDING RURAL AREAS. THIS AREA HAS A VULNERABLE POPULATION THAT INCLUDES THE INDIGENT AND A HIGHER MEDICAID MIX. MOVING EAST TOWARDS THE BEACH LOCATED IN WORCESTER COUNTY SEVERAL OF THE LARGER TOWNS BERLIN (21811) AND OCEAN CITY (21842) HAVE A HIGHER POPULATION DENSITY. SOUTH OF SALISBURY, LOCATED IN SOMERSET COUNTY, THE TOWN OF PRINCESS ANNE (21853) AND CRISFIELD (21817) ARE TWO OF THE LARGER TOWNS. EXCLUDING THE GREATER SALISBURY AREA, THE LANDSCAPE AND ENVIRONMENT IS CONSIDERED RURAL, MADE UP OF SMALL BUSINESSES AND AGRICULTURE. ALL THREE COUNTIES CAN BE CLASSIFIED AS RURAL WITH A HISTORIC ECONOMIC FOUNDATION IN AGRICULTURE, POULTRY AND TOURISM. WATERMEN AND FARMERS HAVE ALWAYS COMPRISED A LARGE PERCENTAGE OF THE PENINSULA POPULATION; HOWEVER, THEIR NUMBERS HAVE BEEN DECLINING WITH GROWTH IN THE POPULATION AND EXPANSION OF OTHER SMALL BUSINESSES. OCEAN CITY, LOCATED IN WORCESTER COUNTY, IS A MAJOR TOURIST DESTINATION; DURING THE SUMMER WEEKENDS, THE CITY HOSTS BETWEEN 320,000 AND 345,000 VACATIONERS, AND UP TO 8 MILLION VISITORS ANNUALLY. THE THREE COUNTIES HAVE A DIVERSIFIED ECONOMIC BASE; HOWEVER, IT IS PREDOMINATELY MADE UP OF SMALL EMPLOYERS (COMPANIES WITH LESS THAN 50 EMPLOYEES). MAJOR EMPLOYERS INCLUDE LOCAL HOSPITALS, THE CHICKEN INDUSTRY, LOCAL COLLEGES AND TEACHING INSTITUTIONS. THE MEDIAN INCOME IN OUR COMMUNITY BENEFITS SERVICE AREA IS CONSIDERABLY LESS THAN $54,131, COMPARED TO MARYLANDS MEDIAN INCOME OF $77,385. IN ADDITION, 2015 UNEMPLOYMENT RATES WERE HIGHER FOR MARYLANDS MOST EASTERN SHORE COUNTIES. THE UNEMPLOYMENT RATE IN MARYLAND WAS 5.2%, THE NATION 5.3% COMPARED TO WICOMICO 6.0%; WORCESTER 8.6%; AND SOMERSET 8.1%. RESEARCH INDICATES LOWER MEDIAN INCOMES AND HIGHER UNEMPLOYMENT RATES CONTRIBUTE TO A DISPARITY IN ACCESS TO MEDICAL CARE AND A PREVALENCE OF UNTREATED CHRONIC DISEASE. IN THE PAST PENINSULA REGIONALS APPROACH TO RURAL POPULATION HEALTH AND COMMUNITY BENEFITS WAS GENERALIZED AND CONSISTED OF TOUCHING OUR THREE PRIMARY COUNTIES: WICOMICO, WORCESTER AND SOMERSET. HOWEVER, THERE ARE EXAMPLES WHERE PENINSULA REGIONAL HAS PARTICIPATED WITH OUR NEIGHBORS IN DELAWARE AND VIRGINIA ON URGENT COMMUNITY HEALTHCARE NEEDS. MANY OF THE SOCIAL DETERMINANTS OF RURAL HEALTH IN OUR THREE COUNTY AREAS SPILL OVER STATE LINES CREATING SIMILAR ISSUES IN OUR NEIGHBORING STATES AND ALLOWING US TO WORK TOGETHER. UNTIL NOW, MOST OF PRMCS INITIATIVES HAVE BEEN "REACTIVE," ACTIVATED BY PATIENTS PRESENTING IN THE EMERGENCY ROOM OR AS INPATIENTS. PRMC NOW SEEKS TO DEPLOY RESOURCES AND EMBED CARE MANAGEMENT FUNCTIONS WITHIN PRIMARY CARE PRACTICES TO ADDRESS SOME OF THE DETERMINANTS (OR ROOT CAUSES) OF HIGH UTILIZATION. BY MOVING CARE BACK OUT INTO THE COMMUNITY WITH PCPS (PRIMARY CARE PROVIDERS) AND CARE MANAGERS EMBEDDED WITHIN THOSE PCPS, THE RIGHT CARE WILL BE DELIVERED, REDUCING THE NEED FOR INPATIENT HOSPITAL ADMISSIONS AND READMISSIONS. PENINSULA REGIONAL HAS EMBARKED ON IDENTIFYING AND TARGETING "SUPER UTILIZERS" WITHIN OUR CBSA; THESE RESIDENTS WILL BE IDENTIFIED, AND TARGETED FOR POPULATION HEALTH MANAGEMENT. - DEMOGRAPHICS (BLOCK GROUPS, ZIP CODES) - RACE/ETHNICITY - AGE-COHORTS - CHRONIC CONDITIONS THE TARGET POPULATION INCLUDES PATIENTS THAT HAVE CHRONIC CONDITIONS WHO HAVE DEMONSTRATED TO HAVE BEEN HIGH UTILIZERS AT PRMC, OR ARE IDENTIFIED AS BEING AT RISK OF HIGH UTILIZATION BASED ON HIS/HER CHRONIC CONDITIONS AND PATTERNS OF CARE. CURRENT DATA INDICATES AN "OVERRELIANCE" BY LOCAL RESIDENTS ON PENINSULA REGIONALS EMERGENCY ROOM FOR PRIMARY AND CHRONIC CONDITION NEEDS. IN RESPONSE, PRMC HAS INTRODUCED INTERVENTIONS, CARE MANAGEMENT PROGRAMS, EDUCATION, AND FOLLOW-UP WITH MEASUREMENT AND OUTCOMES. BASED UPON A CURRENT ASSESSMENT THERE ARE APPROXIMATELY 1,330 RESIDENTS THAT MEET THE CRITERIA OF "SUPER UTILIZERS" STRATIFIED BY SOCIO-DEMOGRAPHICS AND CHRONIC DISEASE. PENINSULA REGIONAL IS TARGETING CBSA ZIP CODES BASED UPON SOCIAL AND ECONOMIC DETERMINANTS OF HEALTH TO INCLUDE THE UNINSURED, INDIGENT POPULATION, RESIDENTS WHO LACK TRANSPORTATION, LACK OF EDUCATION AND AVAILABILITY OF HEALTHY FOODS. TARGETING THIS BY CLUSTER AND BLOCK GROUPS, WE SEEK TO IMPACT THE HEALTH BY PROVIDING PRIMARY HEALTH SERVICES, EDUCATION, ACCESS AND MORE IMPORTANTLY BY FOSTERING RELATIONSHIPS WITHIN THE COMMUNITY WE SERVE. FOR EXAMPLE, OUR WAGNER WELLNESS VAN TRAVELS LOCALLY TO BLOCK GROUPS WHERE THERE WAS AN IDENTIFIED NEED FOR BASIC HEALTH SERVICES, IN ADDITION TO PROVIDING HEALTH SERVICES AND EDUCATION TO LOCAL ETHNIC CHURCHES AND CIVIC ORGANIZATIONS. PENINSULA REGIONAL MEDICAL CENTER FILES ANNUALLY A COMMUNITY BENEFIT REPORT WITH THE STATE OF MARYLAND. THE REPORT IS FILED WITH THE HSCRC (HEALTH SERVICES COST REVIEW COMMISSION). FINANCIAL ASSISTANCE AND CERTAIN OTHER COMMUNITY BENEFITS AT COST SCHEDULE H, PART I, LINE 7, COLUMN (F) THE AMOUNT OF BAD DEBT EXPENSE EXCLUDED FROM THE DENOMINATOR IN THE COLUMN (F) PERCENTAGES IS $11,673,037. LINE 7B COLUMN (C) & (F)- MARYLAND'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 DIRECTED 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. THE COST METHODOLOGY FOR CHARITY CARE AND CERTAIN OTHER COMMUNITY BENEFITS IS THE COST-TO-CHARGE RATIO USED FOR THE CHARITY CARE PROGRAMS AND DIRECT COST METHOD FOR THE OTHER BENEFITS/PROGRAMS. COMMUNITY BUILDING ACTIVITIES SCHEDULE H, PART II Peninsula Regional funds a variety of programs that work to promote the health and safety of our community. These programs include activities in the areas of housing, economic development, community support, environmental improvements, coalition building, and workforce development. The number of persons served by the community building activities were not tracked for all programs throughout the course of the year. Coalition Building Historically Peninsula Regional has facilitated involvement with health improvement organizations to identify, assess, and create aggregate action plans to address local emerging and chronic Community Benefit Service area healthcare issues. Kathryn Fiddler (Executive Director of Population Health) and Stephanie Elliot (Director of Community Services Health) attend the following Local Health Improvement Coalition's including some of the front-line care management coordinators and physicians. - Wicomico County LHIC - Worcester County HRSA - Healthy Somerset Coalition - Worcester County LHIC - Tri County Health Improvement Planning - Tri County Alliance for the Homeless - Project Living Well Advisory Committee MAC (Maintaining Active Citizens) Physician Recruiting Peninsula Regional feels it is important to continually monitor specialties where a significant amount of patient care within the service area is provided by older physicians, as a sudden or unexpected loss of coverage could have an adverse effect on the provision of medical services to the community. Succession planning and recruitment go hand-in-hand, as does socio-demographics and governmental initiatives all of which must be considered to assess appropriate physician recruitment. Key findings, according to the most recent Medical Staff Development Plan, indicate an immediate need for recruitment of Primary Care Physicians to engage in chronic disease management as part of our population health initiatives. Succession planning is a key objective as ten primary care physicians are above the age of 55 which will leave a void in an already underserved area. Demographics also play a key role as the Medicare population is growing at a faster rate than the State of Maryland and the Nation. As a growing retirement community, there is an increased need for additional primary care physicians and certain specialties. There will be a 22.7% growth of those between the ages of 65 to 74 over the next 5 years. Deficiencies and surpluses in the current supply of physicians were determined by reviewing physician to-population ratios, physician patient volumes, population data, and other data. Management Consultants recommend evaluating potential recruitment of Primary Care Family Medicine, Primary Care Internal Medicine and Primary Care Pediatrics over the next several years. Medical specialty needs are driven by the overall market supply, wait times for new patient appointments, and call coverage and inpatient consultation needs. Current medical specialty recommendations include recruitment of the following physician specialties due to community needs assessment, market demand and retirement: Allergy/immunology, Dermatology, Endocrinology, Infectious Disease, Neurology, OB/GYN, Pain Management, Psychiatry and Rheumatology. Of the medical staff, 32% is either at or above the age of 55, which poses succession risk. Peninsula Regional a rural hospital, and other like-kind rural communities are typically challenged in both recruitment and retention of physicians due to numerous factors. Some of these challenges are due to the location and geography of the area and availability of healthcare resources. Retaining and recruiting resources in sub-specialties can be hard for regional rural hospitals and Peninsula Regional Medical Center is no exception. To address specific community healthcare needs the Medical Center has had to recruit, retain, employ and subsidize some of the following subspecialties; Pulmonary, Neuro-Hospitalist, Neurosurgery, Medical Oncology & Hematology, Gastroenterology, Pediatric Specialties, Endocrinology, Cardiology, Cardiovascular Surgery, and Pain Management. Rural communities lack the cultural and educational resources that larger urban centers provide making it harder to retain and recruit these physicians. Low population patterns by geography make it more costly and harder for communities and businesses to provide various types of services especially specialty physician services. Overall, our local economy is not as robust as the urban centers as indicated by our low average household income in the Tri-County area. Disaster readiness Peninsula Regional Medical Center is a member of DRHMAG (Delmarva Regional Health Mutual Aid Group) which is a coalition of local health departments, hospitals and nursing homes. They meet quarterly to discuss issues of disaster preparedness in the Delmarva region. PRMC has an internal emergency management committee that meets monthly whose members include the Safety Coordinator, Chief of Security, Emergency department RN, Risk management, Infection prevention, Executive team representative, Pharmacist, Emergency management coordinator, firefighter, and a County Health department representative. PRMC also meets quarterly with our local partners that include fire, police, Emergency Medical Services, and Wicomico County Emergency Management to facilitate disaster planning and mock drills within the community. METHODOLOGY USED TO ESTIMATE BAD DEBT EXPENSE SCHEDULE H, PART III, LINES 2 AND 3 SEE RESPONSE BELOW TO LINE 4 REGARDING THE METHODOLOGY USED BY THE ORGANIZATION REGARDING BAD DEBT. BAD DEBT FOOTNOTE IN THE AUDITED FINANCIAL STATEMENTS SCHEDULE H, PART III, LINE 4 THE HOSPITAL, THROUGH ITS MEMBER COMPANIES, PROVIDES SERVICES TO PATIENTS IN THE EASTERN SHORE AREA OF MARYLAND, DELAWARE, AND VIRGINIA, THE MAJORITY OF WHOM ARE COVERED BY THIRD-PARTY HEALTH INSURANCE. THE HOSPITAL BILLS THE INSURER DIRECTLY FOR SERVICES PROVIDED. INSURANCE COVERAGE AND FINANCIAL INFORMATION IS OBTAINED FROM PATIENTS UPON ADMISSION WHEN AVAILABLE. THE HOSPITAL'S POLICY IS TO PERFORM IN-HOUSE COLLECTION PROCEDURES FOR APPROXIMATELY 85 DAYS. A DETERMINATION IS MADE AT THAT TIME AS TO WHICH ADDITIONAL COLLECTION EFFORTS TO PURSUE. A PROVISION FOR UNCOLLECTIBLE ACCOUNTS IS RECORDED FOR AMOUNTS NOT YET WRITTEN OFF, WHICH ARE EXPECTED TO BECOME UNCOLLECTIBLE. DISCOUNTS RANGING FROM 2% TO 6% OF CHARGES ARE GIVEN TO MEDICARE, MEDICAID, AND CERTAIN APPROVED COMMERCIAL HEALTH INSURANCE AND HEALTH MAINTENANCE ORGANIZATION PROGRAMS FOR REGULATED SERVICES. DISCOUNTS IN VARYING PERCENTAGES ARE GIVEN FOR CERTAIN UNREGULATED SERVICES. THESE MAJOR PAYORS ROUTINELY REVIEW PATIENT BILLINGS AND DENY PAYMENT FOR CERTAIN CHARGES AS MEDICALLY UNNECESSARY OR AS PERFORMED WITHOUT APPROPRIATE PREAUTHORIZATION. DISCOUNTS AND DENIALS ARE RECORDED AS REDUCTIONS OF NET PATIENT SERVICE REVENUE. REVENUE AND ACCOUNTS RECEIVABLE FROM THESE THIRD-PARTY PAYORS HAVE BEEN ADJUSTED TO REFLECT THE DIFFERENCE BETWEEN CHARGES AND THE ESTIMATED REIMBURSABLE AMOUNTS. APPROXIMATELY 35% OF ACCOUNTS RECEIVABLE WERE DUE FROM THE MEDICARE PROGRAM AS OF JUNE 30, 2017 AND 2016. THE MEDICARE AND MEDICAID REIMBURSEMENT PROGRAMS REPRESENT A SUBSTANTIAL PORTION OF THE HOSPITAL'S REVENUES. THE HOSPITAL'S OPERATIONS ARE SUBJECT TO NUMEROUS LAWS AND REGULATIONS OF FEDERAL, STATE, AND LOCAL GOVERNMENTS. THESE LAWS AND REGULATIONS INCLUDE, BUT ARE NOT NECESSARILY LIMITED TO, MATTERS SUCH AS LICENSURE, ACCREDITATION, GOVERNMENT HEALTH CARE PROGRAM PARTICIPATION REQUIREMENTS, REIMBURSEMENT FOR PATIENT SERVICES AND MEDICARE, AND MEDICAID FRAUD AND ABUSE. MEDICARE COSTING METHODOLOGY SCHEDULE H, PART III, LINE 8 MEDICARE ALLOWABLE COSTS WERE CALCULATED USING A COST TO CHARGE RATIO. PENINSULA REGIONAL MEDICAL CENTER PROVIDES QUALITY MEDICAL SERVICES TO ALL PATIENTS REGARDLESS OF WHAT INSURANCE THEY HAVE. APPROXIMATELY, 36% OF THE MEDICAL CENTER'S REVENUE IS ATTRIBUTABLE TO MEDICARE PATIENTS DURING THE YEAR ENDED JUNE 30, 2017. COLLECTION POLICY SCHEDULE H, PART III, LINE 9B The Peninsula Regional Medical Center collection policy includes information about our financial assistance policy (FAP) and how to find the FAP. Additionally our collection policy instructs that extraordinary collection actions (ECA) will be suspended when a patient requests information on our FAP or submits a financial assistance application within 240 days of the first post-discharge billing statement. Our policy describes what to do if the financial assistance application is incomplete and what is required to be refunded (amounts over $5) if the patient qualifies for financial assistance after making a payment. We include clarification of what dates of services are included in the financial assistance so that we understand when normal collection efforts are appropriate. Within our collection policy we describe that a patient denied financial assistance may request a reconsideration. For dates of services approved for financial assistance collections processes are halted as the account is adjusted to zero due from patient. The policy states how to process the patient balance when only a portion of the charge qualified for financial assistance; collections will only be pursued on the amount that did not qualify for financial assistance. NEEDS ASSESSMENT - PROMOTION OF COMMUNITY HEALTH SCHEDULE H, PART VI, LINE 2 PENINSULA REGIONAL MEDICAL CENTER IN COOPERATION WITH THE WICOMICO COUNTY HEALTH DEPARTMENT, HAS BEEN CONDUCTING COMMUNITY HEALTH SURVEYS OF THE TRI-COUNTY AREA SINCE 1995. PENINSULA REGIONAL MEDICAL CENTER FUNCTIONS AS THE PRIMARY HOSPITAL FOR THE RURAL SOUTHERNMOST THREE COUNTIES OF THE EASTERN SHORE OF MARYLAND, WHICH INCLUDES SOMERSET, WICOMICO, AND WORCESTER. COMMUNITY HEALTH NEEDS ARE WOVEN THROUGHOUT PENINSULA REGIONALS STRATEGIC PLAN AND ARE INTEGRAL TO EACH ONE OF THEIR STRATEGIC TENETS, WHICH ENCOMPASS THE FOLLOWING THEMES: PATIENT-CENTERED CARE, POPULATION HEALTH MANAGEMENT, AND EXPANDING ACCESS THROUGH GROWTH OF AN AMBULATORY PRESENCE. PENINSULA REGIONAL'S MISSION STATEMENT IS TO "IMPROVE THE HEALTH OF THE COMMUNITIES WE SERVE." IN JUNE 2016, PENINSULA REGIONAL MEDICAL CENTER (PRMC) PUBLISHED THEIR 2016 COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA). THIS CHNA REPORT WAS DEVELOPED TO PROVIDE AN OVERVIEW OF THE HEALTH NEEDS IN THE PRMC TRI-COUNTY SERVICE AREA, INCLUDING SOMERSET, WICOMICO, AND WORCESTER COUNTIES. PRMC PARTNERED WITH HEALTHY COMMUNITIES INSTITUTE (HCI), A XEROX COMPANY, TO CONDUCT THE CHNA. THE GOAL OF THIS REPORT WAS TO OFFER A MEANINGFUL UNDERSTANDING OF THE GREATEST HEALTH NEEDS ACROSS THE PRMC SERVICE AREA, AS WELL AS TO GUIDE PLANNING EFFORTS TO ADDRESS THOSE NEEDS. SPECIAL ATTENTION WAS GIVEN TO IDENTIFY HEALTH DISPARITIES, NEEDS OF VULNERABLE POPULATIONS, UNMET HEALTH NEEDS OR GAPS IN SERVICES, AND INPUT FROM THE COMMUNITY. THE CHNA FINDINGS WERE DRAWN FROM AN ANALYSIS OF AN EXTENSIVE SET OF SECONDARY DATA (OVER 100 INDICATORS FROM NATIONAL AND STATE DATA SOURCES) AND IN-DEPTH PRIMARY DATA FROM COMMUNITY HEALTH LEADERS (INCLUDING THE HEALTH OFFICERS FROM THE THREE HEALTH DEPARTMENTS) AND ORGANIZATIONS THAT SERVE THE COMMUNITY AT LARGE, AS WELL AS NON-HEALTH PROFESSIONALS AND COMMUNITY MEMBERS. THE MAIN SOURCE FOR THE SECONDARY DATA, OR DATA THAT HAS BEEN PREVIOUSLY COLLECTED, WAS THE PENINSULA REGIONAL MEDICAL CENTER CREATING HEALTHY COMMUNITIES PLATFORM, A PUBLICLY AVAILABLE DATA PLATFORM THAT IS EMBEDDED ON THE MAIN PRMC WEBSITE. ON JUNE 8, 2016, PRMCS COMMUNITY BENEFIT TEAM AND OTHER MEMBERS FROM VARIOUS DEPARTMENTS IN THE HOSPITAL CAME TOGETHER TO PRIORITIZE THE SIGNIFICANT HEALTH NEEDS IN A SESSION LED BY CONSULTANTS FROM HCI. THE TEAM REVIEWED THE SIGNIFICANT HEALTH NEEDS USING THE FOLLOWING PRIORITIZATION CRITERIA: - IMPORTANCE OF PROBLEM TO THE COMMUNITY - ALIGNMENT WITH 2017 MD SHIP OBJECTIVES - OPPORTUNITY FOR PARTNERSHIP - ADDRESSES DISPARITIES OF SUBGROUPS - EXISTING RESOURCES/PROGRAMS TO ADDRESS THE PROBLEM USING THE PRIORITIZATION MATRIX METHOD, THE FOLLOWING THREE TOPICS WERE IDENTIFIED AS PRIORITIES TO ADDRESS: - DIABETES - EXERCISE, NUTRITION, AND WEIGHT - BEHAVIORAL HEALTH (FOCUSING ON THE TOPIC AREAS OF MENTAL HEALTH AND MENTAL DISORDERS AS WELL AS SUBSTANCE ABUSE) OTHER SIGNIFICANT HEALTH NEEDS NOT CHOSEN WERE: ACCESS TO HEALTH SERVICES, CANCER, HEART DISEASE AND STROKE, AND PREVENTION AND SAFETY. THESE NEEDS WERE NOT SELECTED BECAUSE THEY DID NOT MEET THE PRIORITIZATION CRITERIA AS STRONGLY AS THE SELECTED TOPICS. PRMC HAS OTHER PROGRAMS IN THESE AREAS, BUT THEY ARE NOT THE FOCUS OF THIS REPORT. THE COMMUNITY HEALTH ASSESSMENT SURVEY IS A SYSTEMATIC, DATA-DRIVEN APPROACH TO DETERMINING THE HEALTH STATUS, BEHAVIORS AND NEEDS OF OUR COMMUNITY RESIDENTS. SURVEY RESULTS ARE SHARED WITH THE COMMUNITY AND ARE POSTED TO THE PARTICIPANTS' WEBSITES. THIS COMMUNITY HEALTH ASSESSMENT SERVES AS A TOOL TOWARDS REACHING THE FOLLOWING THREE GOALS: 1. TO IMPROVE RESIDENTS' HEALTH STATUS, INCREASE THEIR LIFE SPANS, AND ELEVATE THEIR OVERALL QUALITY OF LIFE. 2. REDUCE THE HEALTH DISPARITIES AMONG RESIDENTS BY GATHERING DEMOGRAPHIC INFORMATION ALONG WITH HEALTH STATUS AND BEHAVIOR DATA. 3. TO INCREASE ACCESSIBILITY TO PREVENTIVE SERVICES FOR ALL COMMUNITY RESIDENTS. RESULTS OF THESE SURVEYS ARE USED BY THE PARTICIPANTS TO ASSESS COMMUNITY HEALTH NEEDS AND PLAN FUTURE SERVICES WITHIN THE REGION. THE RESULTS OF THE LATEST SURVEY WAS THE DEVELOPMENT OF AN IMPLEMENTATION STRATEGY PLAN THAT WAS APPROVED BY PENINSULA REGIONAL'S BOARD OF DIRECTORS. THE IMPLEMENTATION PLAN DESCRIBES HOW PENINSULA REGIONAL COLLABORATES AND CREATES COMMUNITY BENEFIT PROGRAMS THAT ADDRESS THE PRECEDING IDENTIFIED PRIORITIZED NEEDS REFERENCING THE 2016 CHNA. THIS IMPLEMENTATION PLAN CAN BE ACCESSED THROUGH PENINSULA REGIONAL'S WEBSITE LANDING PAGE AT WWW.PENINUSLA.ORG. CLICK ON COMMUNITY TAB AND SUBSEQUENTLY CLICK ON COMMUNITY HEALTH NEEDS ASSESSMENT AND IMPLEMENTATION PLAN. PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE SCHEDULE H, PART VI, LINE 3 PENINSULA REGIONAL MEDICAL CENTER MAKES AVAILABLE TO ALL PATIENTS THE HIGHEST QUALITY OF MEDICAL CARE POSSIBLE WITHIN THE RESOURCES AVAILABLE. IF A PATIENT IS UNABLE TO PAY DUE TO FINANCIAL RESOURCES, ALL EFFORTS WILL BE MADE TO HELP THE PATIENT OBTAIN ASSISTANCE THROUGH APPROPRIATE AGENCIES, OR, IF HELP IS NOT AVAILABLE, TO PROVIDE CARE AT REDUCED OR ZERO COST. ONE OF PENINSULA REGIONAL'S OVERALL GUIDING PRINCIPLES IS THAT CONCERN OVER A HOSPITAL BILL SHOULD NEVER PREVENT ANY INDIVIDUAL FROM RECEIVING EMERGENCY HEALTH SERVICES. THE MEDICAL CENTER WILL COMMUNICATE THIS MESSAGE CLEARLY TO PROSPECTIVE PATIENTS AND TO LOCAL COMMUNITY SERVICE AGENCIES AND MAKE IT CLEAR THAT EMERGENCY SERVICES WILL BE PROVIDED WITHOUT REGARD TO ABILITY TO PAY. THE MEDICAL CENTER WILL ENSURE THAT AN EMERGENCY ADMISSION OR TREATMENT IS NOT DELAYED OR DENIED PENDING DETERMINATION OF COVERAGE OR REQUIREMENT FOR PREPAYMENT OR DEPOSIT. THE MEDICAL CENTER WILL POST ADEQUATE NOTICE OF THE AVAILABILITY OF MEDICAL SERVICES, AND THE GENERAL OBLIGATION OF THE HOSPITAL TO PROVIDE CHARITY CARE. PENINSULA REGIONAL'S "FINANCIAL ASSISTANCE POLICY" INCLUDES THE REQUIRED LANGUAGE OF DETERMINATION OF PROBABLE ELIGIBILITY WITHIN TWO BUSINESS DAYS. ON PAGE 2, THE "FINANCIAL ASSISTANCE POLICY" STATES THAT UPON RECEIPT OF THE FINANCIAL ASSISTANCE REQUEST, THE REPRESENTATIVE WILL REVIEW INCOME AND ALL DOCUMENTATION. THE PATIENT MUST BE NOTIFIED WITHIN TWO BUSINESS DAYS OF THEIR PROBABLE ELIGIBILITY. IN ACCORDANCE WITH SECTION 1, 2 AND 3, PENINSULA REGIONAL PROVIDES PUBLIC NOTICE AND INFORMATION REGARDING ITS CHARITY CARE POLICY IN DELMARVA'S LARGEST PAPER "THE DAILY TIMES", POSTED SIGNS IN THE ADMISSION, BUSINESS OFFICE EMERGENCY ROOM AND OTHER MAJOR SERVICE AREAS OF THE MEDICAL CENTER; ADDITIONALLY INDIVIDUAL NOTICE IS provided to each self-pay account who seeks services in the medical center at the time of pre-admission, admission, or upon request. A copy of the financial assistance policy is provided during intake and discharge process upon request, and a financial assistance information brochure is provided to all selfpay patients during intake. The availability of financial assistance is printed on billing statements sent to patients. PRMC notifies the patient or potential patient of government programs, including providing them with initial assistance to apply for such programs. COMMUNITY INFORMATION SCHEDULE H, PART VI, LINE 4 PENINSULA REGIONAL IS LOCATED IN SALISBURY, MARYLAND. THE HOSPITAL'S SERVICE AREA IS PREDOMINATELY RURAL AND COVERS 6 COUNTIES LOCATED IN THREE DIFFERENT STATES: MARYLAND, DELAWARE AND VIRGINIA. SOME OF THE UNIQUE HEALTHCARE CHARACTERISTICS OF THESE COUNTIES INCLUDE A HIGH PREVALENCE OF DIABETES WHICH IS APPROXIMATELY TWICE THAT OF THE STATE OF MARYLAND. THERE IS A HIGHER INCIDENCE OF SKIN CANCER AND THE INCIDENCE RATE FOR HEART DISEASE IS STATISTICALLY SIGNIFICANTLY HIGHER THAN MARYLAND. IN FY 2017, APPROXIMATELY 77% OF THE PATIENTS DISCHARGED FROM THE MEDICAL CENTER WERE RESIDENTS OF THE PRIMARY SERVICE AREA, WHICH HAS AN ESTIMATED POPULATION OF APPROXIMATELY 180,533 IN 2017 AND IS EXPECTED TO INCREASE TO 184,828 IN 2022, OR BY 2.4%. THE PRIMARY SERVICE AREA POPULATION HAS GROWN BY AN ESTIMATED 5% SINCE 2010. THE FASTEST GROWING AND LARGEST AGE COHORT IN OUR PRIMARY SERVICE AREA IS REPRESENTED BY THOSE 55 AND OLDER. THIS SENIORS AGE CATEGORY REPRESENTS 32% OF OUR POPULATION WHICH IS 4% HIGHER THAN THE NATIONAL DISTRIBUTION RATE OF 28%. THIS AGE-COHORT HAS A PER CAPITA CONSUMPTION OF HEALTH SERVICES 3 TIMES MORE THAN YOUNGER ADULTS. THE OLDER ADULTS ALSO HAVE VASTLY DIFFERENT NEEDS AND NEARLY 80% OF SENIORS HAVE BEEN DIAGNOSED WITH ONE CHRONIC CONDITION, AND HALF HAVE BEEN DIAGNOSED WITH AT LEAST TWO. THE MEDICAL CENTER ALSO SERVICES DORCHESTER COUNTY, MARYLAND, THE SOUTHERN PORTION OF SUSSEX COUNTY, DELAWARE AND THE NORTHERN PORTION OF ACCOMACK COUNTY, VIRGINIA. THESE COUNTIES COMPRISED AN ADDITIONAL 21 PERCENT OF THE MEDICAL CENTER'S TOTAL DISCHARGES DURING THE SAME TIME PERIOD. PATIENTS DISCHARGED FROM THE FOLLOWING GEOGRAPHICAL AREAS: AREA 2017 DISCHARGES % ------------------------------------------------------------------------ WICOMICO 9,664 50.4% WORCESTER 3,097 16.2% SOMERSET 2,032 10.6% DORCHESTER, TALBOT, CAROLINE 593 3.1% DELAWARE 2,072 10.8% VIRGINIA 1,218 6.4% ALL OTHERS 488 2.6% ------ ------ TOTAL 19,164 100.0% SOURCE: PENINSULA REGIONAL MEDICAL CENTER, FINANCIAL AND STATISTICAL REPORT, JUNE 30, 2017. At 281 licensed beds and multi-specialty service lines, Peninsula Regional Medical Center serves as the largest regional tertiary care referral center on the Eastern Shore of Delmarva. Our primary service area consists of Wicomico, Worcester, and Somerset Counties of which several smaller hospital facilities also serve these rural residents. Atlantic General Hospital is located 25 miles east of PRMC and is a 45 licensed bed community hospital located in the city of Berlin, Worcester County, MD. Edward W. McCready Memorial hospital is licensed for 3 beds and is located 30 miles South of PRMC in the town of Crisfield adjacent to the Chesapeake Bay Somerset County, MD. All three Hospital have partnered on various emergent and urgent community health and wellness issues as identified through the Community Health Needs Assessment and have developed actionable programs to improve the health of the residents. Located in Peninsula Regionals primary service area is Somerset County, this county is one of the neediest counties in the State of Maryland according to (www.countyhealthrankings.org/maryland). Maryland County Health Rankings 2017 asserts Somerset County is second to last for health factors. Marylands summary ranks health factors based on weighted scores for socio-economic factors, health behaviors, physical environment and clinical care. According to Department of Health & Human Services/HRSA the Somerset service area is listed as a Medically Underserved Area (MUA) as is Worcester County, in addition to certain census tracks in Wicomico County that PRMC serves. MUA is a designation that indicates a population having to few primary care providers and having higher socio-determinants of health such as poverty health illiteracy that prevent optimum health outcomes. There is also a shortage of primary care physicians in various geographic pockets of this three county region areas as supported by a Medical Staff Development Plan Report completed by consultants and substantiated by HPSA (Health Professional Shortage Area) designation. PROMOTION OF COMMUNITY HEALTH SCHEDULE H, PART VI, LINE 5 PENINSULA REGIONAL MEDICAL CENTER IS COMMITTED TO THE HEALTH OF THE RURAL COMMUNITIES IT SERVES. IN FY 2017, THE HOSPITAL'S CHARITY CARE WAS $9,225,353; COMBINED CHARITY AND BAD DEBT FOR FY 2017 WAS $20,898,390. AS PART OF PENINSULA REGIONAL'S ONGOING COMMITMENT AND MISSION STATEMENT "TO IMPROVE THE HEALTH OF THE COMMUNITIES WE SERVE," WE CONTINUE TO ASSESS THE HEALTH NEEDS OF THE COMMUNITY. WE ATTEND TRI-COUNTY COMMUNITY HEALTH IMPROVEMENT (T-CHIP) PROCESS MEETINGS. THESE MEETINGS ARE MADE UP OF WICOMICO, WORCESTER AND SOMERSET'S HEALTH DEPARTMENT, LOCAL HOSPITALS, LOCAL AND NATIONAL COMMUNITY HEALTH ORGANIZATIONS AND OTHER LOCAL HEALTHY LIFESTYLE PROGRAMS. WE SYNERGIZE AS A GROUP WORKING TOWARD OUR IDENTIFIED SHIP (STATE HEALTH IMPROVEMENT PROCESS INITIATIVES) IN ADDITION TO SHARING WITH EACH OTHER OUR PROGRAM SUCCESSES AND SOMETIMES FAILURES. THE DIVERSITY OF THE PARTICIPANTS AND THE DYNAMICS OF THIS PARTICULAR GROUP ALLOW US TO KEEP A BETTER PULSE IN THE NEEDS OF THE COMMUNITY WHICH CONTRIBUTES TO PLANNING AND FORMULATION OF TACTICS TO MEET LOCAL HEALTH OBJECTIVES. PENINSULA REGIONAL CLINICIANS AND EXECUTIVES ATTEND VARIOUS PUBLIC MEETINGS AS REQUESTED BY EITHER ENTITY AS WE EXCHANGE COMMUNITY HEALTH IDEAS, DATA OR BRING RESOURCES TO BEAR THAT BOTH PARTIES CAN BENEFIT FROM. AS MENTIONED EARLIER, IN JUNE 2016, PENINSULA REGIONAL MEDICAL CENTER PUBLISHED THEIR 2016 COMMUNITY HEALTH NEEDS ASSESSMENT. THE CHNA WAS DEVELOPED AFTER CAREFUL REVIEW OF EXTENSIVE SECONDARY DATA, INPUT FROM KEY INFORMANTS INCLUDING THE HEALTH OFFICERS FROM WICOMICO, WORCESTER AND SOMMERSET COUNTIES. AS PART OF MARYLAND'S SHIP INITIATIVE, THE T-CHIP IS ADOPTING SHIP OBJECTIVE 27: REDUCE DIABETES COMPLICATIONS AND REDUCE DIABETES RELATED EMERGENCY DEPARTMENT VISITS, AND SHIP OBJECTIVE 31: REDUCE THE PROPORTION OF CHILDREN AND ADOLESCENTS WHO ARE CONSIDERED OBESE OR OVERWEIGHT. PENINSULA REGIONAL WILL CONTINUE TO PARTNER WITH T-CHIP AND WICOMICO COUNTY HEALTH DEPARTMENT TO CREATE STRATEGIES AND TACTICS AROUND SHIP OBJECTIVE 27 AND 31. BY ADOPTING THE SAME HEALTH IMPROVEMENT OBJECTIVES WE HOPE TO CREATE ALIGNMENT, SYNERGY, AND EFFICIENT RESOURCE ALLOCATION FOR ESTABLISHING AND PROMOTING THESE COMMUNITY HEALTHCARE IMPROVEMENT OBJECTIVES. IN FY15 PENINSULA REGIONAL KICKED OFF A "LIVE WELL" COMMUNITY CAMPAIGN THAT SPANS SEVERAL YEARS AND WILL ADDRESS AND PROMOTE HEALTH LIFESTYLE CHOICES WITH A NEW MONTHLY THEME. A LIVE WELL DELMARVA WEBSITE WAS LAUNCHED THAT EMBODIES THE SPIRIT OF CARE/COACH/CONNECT, WHERE PRMC WILL CARE FOR YOU, COACH YOU TO WELLNESS AND CONNECT YOU WITH THE RIGHT PROVIDERS. THE SITE PROVIDES INFORMATION ON HEALTHY LIFESTYLE CHOICES WITH LOCAL AND REGIONAL INFORMATION SUCH AS "FARM TO TABLE" IN-SEASON FRESH FRUITS AND VEGETABLES, INCLUDING NUTRITIONAL RECIPES. THE IMPORTANCE OF EXERCISE AND NUTRITION IS A THEME THAT IS WOVEN THROUGHOUT, WITH LISTINGS OF FREE SCREENINGS AND EVENTS FOR THE COMMUNITY THAT INCLUDE FREE SKIN CANCER SCREENINGS, LIVE WELL HEALTH FEST EVENT, FREE HEART SCREENINGS, BABIES HEALTH STARTS, DRIVE-THRU FLU CLINIC, HEALTH TIPS AND CANCER SURVIVORSHIP CELEBRATIONS. THE WEBSITE ALSO ADDRESSES REGIONAL HEALTH ISSUES NATIVE TO THE EASTERN SHORE. A majority of PRMC's Board is comprised of representatives of the community served by PRMC. Further, A majority of the Board are not employees, independent contractors or family members of such persons of PRMC or its related entitites. PRMC extends staff privileges to qualified physicians following a credentialing process. AFFILIATED HEALTH CARE SYSTEM ROLES SCHEDULE H, PART VI, LINE 6 PENINSULA REGIONAL MEDICAL CENTER IS PART OF THE PENINSULA REGIONAL HEALTH SYSTEM. THE SYSTEM INCLUDES A FOUNDATION AND FOR-PROFIT ENTITIES WITH INTERESTS IN VARIOUS HEALTH CARE JOINT VENTURES. IN ADDITION TO THE COMMUNITY BENEFITS PROVIDED BY THE MEDICAL CENTER, THE HEALTH SYSTEM EVALUATES THE NEEDS OF THE COMMUNITY AND WILL PARTICIPATE IN COMMUNITY BENEFIT PROGRAMS AS NEEDED. COMMUNITY BENEFIT REPORT STATE FILINGS SCHEDULE H, PART VI, LINE 7 STATE(S) WITH WHICH THE ORGANIZATION FILES A COMMUNITY BENEFIT REPORT: MARYLAND X true true X X X X X false true false false false true true true false MARGARET NALEPPA PRESIDENT/CEO 721779 0 195776 0 15136 0 189389 0 13855 0 1135935 0 0 0 LURA LUNSFORD VP OF OPERATIONS 418696 0 76492 0 1218 0 80737 0 7160 0 584303 0 0 0 BRUCE I RITCHIE CFO 443316 0 87249 0 1218 0 96707 0 22256 0 650746 0 0 0 CHARLES SILVIA JR MD VP - CHIEF MEDICAL OFFICER 400683 0 52075 0 1218 0 41225 0 20754 0 515955 0 0 0 SARA SCOTT VP PEOPLE & ORGANIZATION DEV. 210857 0 19140 0 1218 0 34909 0 20306 0 286430 0 0 0 STEVEN LEONARD VP OPERATION OPTIMIZATION & IN 274849 0 25882 0 1218 0 61067 0 25936 0 388952 0 0 0 KAREN POISKER VP POPULATION HEALTH 304256 0 14585 0 1218 0 105539 0 16405 0 442003 0 0 0 THOMAS DEMARCO MD VP - PRMG 335458 0 35280 0 1218 0 11063 0 18790 0 401809 0 0 0 SHERI MATTER V.P. PATIENT CARE SERVICES 246644 0 15595 0 984 0 28291 0 750 0 292264 0 0 0 KATHRYN FIDDLER EXECUTIVE DIRECTOR-POP. HEALTH 165723 0 7015 0 0 0 5702 0 300 0 178740 0 0 0 JAMES TODD MD PHYSICIAN 803193 0 62500 0 1218 0 75308 0 17592 0 959811 0 0 0 KURT WEHBERG MD PHYSICIAN 787099 0 62500 0 1218 0 74970 0 19092 0 944879 0 0 0 DANIEL DANIELS MD PHYSICIAN 489514 0 314221 0 39538 0 14696 0 8524 0 866493 0 0 0 HALIM CHARBEL MD PHYSICIAN 370238 0 451312 0 19258 0 15592 0 260 0 856660 0 0 0 KARIM ARNAOUT MD PHYSICIAN 737629 0 53468 0 1218 0 10987 0 13674 0 816976 0 0 0 Travel for Companions Schedule J, Part I, Line 1a PRMC provides travel for companions of Board members and reports the value of the compensation provided as taxable to the recipient. This policy has been approved by the Board. RECEIVE PAYMENT FROM A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN SCHEDULE J, PART I, LINE 4B PRMC HAS A NON-QUALIFIED SUPPLEMENTAL RETIREMENT PLAN (UNDER SECTION 457 (F)). THIS PLAN WAS APPROVED BY THE COMPENSATION COMMITTEE OF THE PRMC BOARD OF DIRECTORS TO SUPPLEMENT THE EXECUTIVE'S RETIREMENT INCOME. THE SUPPLEMENTAL RETIREMENT PLAN WAS DEVELOPED BASED ON AN INDEPENDENT CONSULTANT REPORT ON MARKET-BASED PRACTICES FOR SUPPLEMENTAL RETIREMENT PLANS. THE PERCENTAGE OF FINAL AVERAGE PAY, THE REQUIREMENTS FOR VESTING, PARTICIPANTS, AND PAY-OUT PROVISIONS WERE ESTABLISHED, REVIEWED, AND APPROVED BY THE COMPENSATION COMMITTEE. THE CONTRIBUTIONS TO THE SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN ARE INCLUDED IN SCHEDULE J, PART II, COLUMN C OR IN SCHEDULE J, PART II, COLUMN B(III) AS PART OF DEFERRED COMPENSATION. THE FOLLOWING INDIVIDUALS PARTICIPATED IN THIS SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN: Margaret Naleppa $76,923 Lura Lunsford $40,000 Bruce I. Ritchie $40,000 Steven Leonard $40,000 James Todd, M.D. $50,000 Kurt Wehberg, M.D. $50,000 PRMC provided $69,000 in funding to Dr. Naleppa's Plan on 10/15/2016. CONTINGENT COMPENSATION SCHEDULE J, PART I, LINE 6A AND 6B OFFICERS AND KEY EMPLOYEES OF PENINSULA REGIONAL MEDICAL CENTER ARE PAID COMPENSATION DETERMINED BY A NUMBER OF VARIABLES INCLUDING BUT NOT LIMITED TO INDIVIDUAL GOALS AS WELL AS ORGANIZATION OPERATIONAL ACHIEVEMENTS IN SERVICE, QUALITY, SAFETY, EMPLOYEE SATISFACTION, AND COST. THE FINAL DETERMINATION OF THE CONTIGENT COMPENSATION AMOUNT IS DETERMINED AND APPROVED BY THE BOARD AS PART OF THE OVERALL COMPENSATION REVIEW OF OFFICERS AND KEY EMPLOYEES. Variable compensation payments are reported in Schedule J, Part II, Column B(ii) and reflect attainment of certain goals. Also included in that column are productivity payments of $415,312 (Charbel) and $284,221 (Daniels). A MARYLAND HEALTH & HIGHER EDUCATION FACILITIES 520936091 574217UF8 2015-02-05 122212727 Refer to part VI true false false B Maryland Health & Higher Education Facilities 520936091 574218UE1 2015-02-05 25222024 Refer to part VI true false false A 525000 0 122212727 0 0 121024047 1188680 0 0 0 0 0 false true true true B 250000 0 25222024 0 0 0 222024 0 0 25000000 0 0 false false false true A false true true true true true 0.00850 0.00810 0.01660 false false false true B false true true true true true 0.00850 0.00810 0.01660 false false false true A false true false false 0 false 0 false true B false false false false 0 false 0 false true A true B true DESCRIPTION OF PURPOSE SCHEDULE K, PART I, COLUMN F PROCEEDS OF PUBLICLY-OFFERED, FIXED RATE SERIES 2015 BONDS, TOGETHER WITH FUNDS HELD IN AN EXISTING DEBT SERVICE RESERVE FUND ACCOUNT AND THE EXISTING PRINCIPAL AND INTEREST ACCOUNTS, HAVE BEEN USED TO 1) ADVANCE REFUND ALL OF PENINSULA REGIONAL MEDICAL CENTER'S ("PRMC") OUTSTANDING SERIES 2006 BONDS (ISSUED 2/09/06) FOR SAVINGS, 2) FUND VARIOUS CAPITAL EXPENDITURES (INCLUDING EQUIPMENT PURCHASES) (THE "PROJECT"), AND 3) PAY ALL BOND ISSUANCE EXPENSES. SCHEDULE K, PART I, LINE A (F) REFUNDING OF BONDS ISSUED ON 02/09/2006 SCHEDULE K, PART II, LINE 13 YEAR OF SUBSTANTIAL COMPLETION A - 2006 PROJECTS - 2009; 1993 PROJECTS - 1998 B - 2015 PROJECTS - 2017 David Kerrigan MD Trustee 123621 Medical Staff Fees false David Kerrigan MD Trustee 424913 Medical Director Fees false David Rommel Trustee 1646760 Electrical/Mechancial Service false Vel Natsan MD Trustee 43507 Real Estate Rental false William McCain Trustee 10326 Real Estate Valuation Fees false DESCRIPTION OF TRANSACTIONS WITH INTERESTED PERSONS SCHEDULE L, PART IV EACH OF THE ABOVE-NAMED TRUSTEES ARE OWNERS OF BUSINESSES WHICH PROVIDE SERVICES TO PRMC. THE SERVICES PROVIDED WERE APPROVED BY INDEPENDENT MEMBERS OF THE GOVERNING BODY AND ARE CHARGED AT FAIR MARKET VALUE RATES. STATEMENT OF PROGRAM SERVICE ACCOMPLISHMENTS FORM 990, PART III, LINE 4 PENINSULA REGIONAL MEDICAL CENTER IS A NOT-FOR-PROFIT 501(C)(3) NON-STOCK CORPORATION FOUNDED IN 1897 TO SERVE THE HEALTH CARE NEEDS OF THE COMMUNITY. THE HOSPITALS PRIMARY PURPOSE IS TO PROVIDE THE HIGHEST PRIMARY, SECONDARY, AND SELECTED TERTIARY HEALTH CARE SERVICES TO RESIDENTS OF AND VISITORS TO THE MID-DELMARVA PENINSULA IN A COMPETENT, COMPASSIONATE, AND COST-EFFECTIVE MANNER DESIGNED TO ELICIT A HIGH DEGREE OF CUSTOMER SATISFACTION. THE HOSPITALS MISSION IS TO IMPROVE THE HEALTH OF THE COMMUNITIES WE SERVE BY PROVIDING QUALITY MEDICAL CARE REGARDLESS OF RACE, CREED, SEX, NATIONAL ORIGIN, HANDICAP, OR AGE. IF A PATIENT IS UNABLE TO PAY DUE TO FINANCIAL RESOURCES, EFFORTS WILL BE TAKEN TO ASSURE CARE AT AN AFFORDABLE COST, OR OBTAINED ASSISTANCE THROUGH APPROPRIATE AGENCIES ON THE PATIENTS BEHALF. EMERGENCY SERVICES CARE WILL BE PROVIDED TO EVERYONE REGARDLESS OF ABILITY TO PAY. PENINSULA REGIONAL MEDICAL CENTER SERVED OVER 19,000 INPATIENTS AND PROVIDED MORE THAN 560,000 OUTPATIENT SERVICES DURING FISCAL 2017. FOOD SERVICE PROVIDED MORE THAN 479,000 MEALS TO PATIENTS AND EMPLOYEES. ALTHOUGH REIMBURSEMENT FOR SERVICES RENDERED IS CRITICAL TO THE OPERATION AND STABILITY OF PENINSULA REGIONAL MEDICAL CENTER, IT IS RECOGNIZED THAT NOT ALL INDIVIDUALS POSSESS THE ABILITY TO PAY FOR ESSENTIAL MEDICAL SERVICES. THE HOSPITAL, IN KEEPING WITH THE COMMITMENT TO SERVE ALL MEMBERS OF THE COMMUNITY, DURING FISCAL 2017 PROVIDED: - CHARITY AND OTHER ALLOWANCES TOTALING $43,622,628 - DISCOUNTS TO THIRD PARTY PAYORS INCLUDING GOVERNMENT PROGRAMS SUCH AS MEDICARE AND MEDICAID $56,579,762 - WRITE-OFF OF UNCOLLECTIBLE ACCOUNTS $11,673,037 - THE TOTAL UNREIMBURSED VALUE OF PROVIDING CARE TO THESE PATIENTS IS $111,875,427 ALSO PROVIDED ARE MANY WELLNESS PROGRAMS, COMMUNITY EDUCATION AND FREE PROGRAMS OFFERED THROUGHOUT THE YEAR BASED UPON ACTIVITIES AND SERVICES THAT PENINSULA REGIONAL MEDICAL CENTER BELIEVES WILL SERVE A BONA FIDE COMMUNITY HEALTH NEED. SOME OF THE PROGRAMS ARE AS FOLLOWS: - A VARIETY OF BROCHURES ARE DISPLAYED IN ALL HOSPITAL WAITING AREAS TO EDUCATE MEMBERS OF THE COMMUNITY REGARDING PROGRAMS AND SERVICES. - PARTICIPATION IN HEALTH FAIRS DURING FY 2017 IN ORDER TO FOSTER HEALTH EDUCATION IN THE COMMUNITY. - BEING CALLED UPON TO SPEAK BEFORE COMMUNITY ORGANIZATIONS ON A VARIETY OF HEALTHCARE TOPICS. WE PROVIDE CHILDBIRTH PREPARATION CLASSES, EXERCISE CLASSES FOR PRENATAL AND POSTPARTUM WOMEN AND CPR CLASSES. - WE PROVIDE ASSISTANCE TO EDUCATORS THROUGH OUR WORK WITH STUDENT NURSES, RADIOLOGY, RESPIRATORY AND LABORATORY TECHNICIANS. DURING FY 2017, PENINSULA REGIONAL MEDICAL CENTER VOLUNTEERS CONTRIBUTED OVER 27,500 HOURS TOWARD THE COMMON PURPOSE OF SERVICING THE HEALTH CARE OF THE COMMUNITY. DURING FY 2017, PENINSULA REGIONAL MEDICAL CENTER PERFORMED OVER 550 COMMUNITY OUTREACH ACTIVITIES. SPECIFIC EXAMPLES OF EDUCATION AND OUTREACH PROGRAMS, SUPPORT GROUPS, COMMUNITY HEALTH SCREENINGS, AND FITNESS AND WELLNESS ACTIVITIES SUPPORTED BY PENINSULA REGIONAL MEDICAL CENTER ARE AS FOLLOWS: COMMUNITY EDUCATIONAL AND OUTREACH PROGRAMS: - CPR - CHILDBIRTH PREPARATION CLASSES - REFRESHER COURSE - CHILDBIRTH - INFANT CARE CLASSES - SAFE SITTER PROGRAM - WOMENS HEALTH EDUCATION SUPPORT GROUPS: - DIABETES SUPPORT GROUP - HEAD AND NECK CANCER SUPPORT GROUP - CAREGIVER SUPPORT GROUP EVENTS: - COMMUNITY SCREENINGS - HEIGHT/WEIGHT, BLOOD PRESSURE - SKIN CANCER SCREENINGS - ORAL, HEAD AND NECK CANCER SCREENINGS - HEARING SCREENINGS - FLU CLINIC - EDUCATIONAL EXHIBITS TO PROMOTE HEALTHY LIFESTYLES BENEFITS: - UNITED WAY - HEALTHFEST - MARCH OF DIMES FITNESS/EXERCISE PROGRAMMING: - CARDIAC REHABILITATION - INDOOR CYCLING AND WEIGHTS BUSINESS RELATIONSHIPS FORM 990, PART VI, LINE 2 MARGARET NALEPPA, MARTIN NEAT, RYAN MCLAUGHLIN, HERBERT GEARY III, AND MONTY SAYLER ARE MEMBERS OF THE BOARD OF DIRECTORS OF PENINSULA HEALTH VENTURES, A WHOLLY-OWNED TAXABLE SUBSIDIARY OF PENINSULA REGIONAL HEALTH SYSTEM. BRUCE I. RITCHIE, PRMC'S CFO, ALSO SERVES AS SECRETARY/TREASURER OF PENINSULA HEALTH VENTURES. MEMBERS OR STOCKHOLDERS FORM 990, PART VI, LINE 6 PENINSULA REGIONAL HEALTH SYSTEM IS THE SOLE CORPORATE MEMBER OF THE MEDICAL CENTER. MEMBERS OR STOCKHOLDERS WHO MAY ELECT FORM 990, PART VI, LINE 7A MEMBER'S ABILITY TO ELECT MEMBERS OF THE GOVERNING BODY IN ITS CAPACITY AS THE SOLE CORPORATE MEMBER OF THE MEDICAL CENTER, PENINSULA REGIONAL HEALTH SYSTEM HAS THE ABILITY TO ELECT MEMBERS OF THE MEDICAL CENTER'S GOVERNING BODY. DECISIONS SUBJECT TO APPROVAL FORM 990, PART VI, LINE 7B DECISIONS SUBJECT TO APPROVAL BY MEMBERS AS THE SOLE CORPORATE MEMBER, PENINSULA REGIONAL HEALTH SYSTEM HAS THE ABILITY TO APPROVE MAJOR EXPENDITURES AND LONG TERM BORROWINGS OF THE MEDICAL CENTER. FORM 990 REVIEW PROCESS FORM 990, PART VI, LINE 11B OVERSIGHT OF THE COMPLETION OF THE ORGANIZATION'S FORM 990 HAS BEEN DELEGATED TO THE CHIEF FINANCIAL OFFICER OF PENINSULA REGIONAL MEDICAL CENTER BY THE PRESIDENT OF THE ORGANIZATION. ONCE THE FORM 990 AND ALL SCHEDULES HAVE BEEN PREPARED BY THE ORGANIZATION'S INDEPENDENT TAX SERVICES PROVIDER, THEY ARE REVIEWED BY THE PRESIDENT PRIOR TO FILING. THE RETURN IS PRESENTED TO THE BOARD OF TRUSTEES BY THE ORGANIZATION'S INDEPENDENT TAX ADVISORS FROM GRANT THORNTON LLP AND APPROVED FOR SUBMISSION. CONFLICT OF INTEREST POLICY MONITORING & ENFORCEMENT FORM 990, PART VI, LINE 12C THE BOARD OF TRUSTEES ARE REQUIRED TO DISCLOSE ANNUALLY, IN WRITING, ANY AND ALL INTEREST WHICH THEY OR ANY IMMEDIATE MEMBER OF THEIR FAMILY MAY HAVE IN ANY BUSINESS ENTITY WHICH HAS OR SEEKS A CONTRACTUAL OR COMPETITIVE RELATIONSHIP WITH THE ORGANIZATION. THE BOARD HAS THE AUTHORITY TO DETERMINE IF A VIOLATION HAS OCCURED AND WHETHER ANY INTEREST WHICH SHOULD BE DISCLOSED SHOULD DISQUALIFY A DIRECTOR FROM PARTICIPATING IN ANY SPECIFIC BOARD DISCUSSION OR BOARD MEMBERSHIP. ALL DISCLOSURES ARE REVIEWED BY THE ORGANIZATION'S CHIEF COMPLIANCE OFFICER. ANY CONFLICTS ARE PRESENTED TO THE BOARD. IF A PERSON IS CONFLICTED, THEY WILL RECUSE THEMSELVES FROM ALL DISCUSSIONS AND DELIBERATIONS TO WHICH THEY WOULD APPEAR TO BE CONFLICTED. PROCESS FOR DETERMINING COMPENSATION FORM 990, PART VI, LINES 15A & 15B THE ORGANIZATION USES A COMPENSATION COMMITTEE TO DETERMINE THE COMPENSATION OF THE CEO/EXECUTIVE DIRECTOR AND OTHER KEY EMPLOYEES. THE CEO OF THE ORGANIZATION HAS A WRITTEN EMPLOYMENT CONTRACT. THE COMPENSATION COMMITTEE USES AN INDEPENDENT CONSULTANT, COMPENSATION SURVEYS AND OTHER ORGANIZATION'S FORM 990 IN THE DETERMINATION PROCESS. THE MEMBERS OF THE COMPENSATION COMMITTEE ARE INDEPENDENT AND RELY ON THIS COMPARABILITY DATA WHEN THEY DISCUSS AND DETERMINE THE INDIVIDUAL'S COMPENSATION. CONTEMPORANEOUS MINUTES OF SUCH DISCUSSIONS ARE KEPT AND MAINTAINED IN THE ORGANIZATION'S FILES. HOW DOCUMENTS ARE MADE AVAILABLE TO THE PUBLIC FORM 990, PART VI, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST TO THE PUBLIC INFORMATION OFFICE OF PENINSULA REGIONAL MEDICAL CENTER AT 100 EAST CARROLL STREET, SALISBURY, MD 21801. OTHER CHANGES IN NET ASSETS FORM 990, PART XI, LINE 9 PENSION ADJUSTMENT - FAS 158 $10,703,964 Partnership Income - Tax Adjustment $(194,407) Contribution from Foundation $(3,507,208) Other Contributions $(700,000) Increase in Capital $3,675,588 --------------- TOTAL $9,977,937 FORM 990 PART IX LINE 11G DESCRIPTION:TECHNICAL PROFESSIONAL FEES TOTAL FEES:9692736 FORM 990 PART IX LINE 11G DESCRIPTION:REFERENCE LAB WORK TOTAL FEES:1779834 FORM 990 PART IX LINE 11G DESCRIPTION:MEDICAL STAFF ADMINISTRATION TOTAL FEES:75000 FORM 990 PART IX LINE 11G DESCRIPTION:CONTRACTED SERVICES TOTAL FEES:30526366 FORM 990 PART IX LINE 11G DESCRIPTION:LICENSES TAXES TOTAL FEES:971834 FORM 990 PART IX LINE 11G DESCRIPTION:COLLECTION FEES TOTAL FEES:920063 FORM 990 PART IX LINE 11G DESCRIPTION:TEMPORARY LABOR TOTAL FEES:5221437 FORM 990 PART IX LINE 11G DESCRIPTION:PEST CONTROL TOTAL FEES:49104 FORM 990 PART IX LINE 11G DESCRIPTION:TRASH PICKUP TOTAL FEES:270981 FORM 990 PART IX LINE 11G DESCRIPTION:CANDIDATE EXPENSE TOTAL FEES:296562 FORM 990 PART IX LINE 11G DESCRIPTION:EMPLOYEE MOVING EXPENSE TOTAL FEES:22957 FORM 990 PART IX LINE 11G DESCRIPTION:PHYSICIAN CONTRACTED SERVICES TOTAL FEES:10674668 Peninsula Regional Medical Center Fdn 100 East Carroll Street Salisbury MD 21801 521851935 Fundraising MD 501(c)(3) 12 TYPE I PRHS false Peninsula Regional Health System (PRHS) 100 East Carroll Street Salisbury MD 21801 522132761 Parent MD 501(c)(3) 12 type II NA false Peninsula General Hospital INS Trust 100 East Carroll Street Salisbury MD 21801 526321234 Insurance MD 501(c)(3) 12 TYPE III PRHS false Delmarva Surg Ctr 641 S Salisbury Blvd Salisbury MD 21801 522251436 Healthcare MD NA N/A Peninsula Health Ventures (PHV) 100 East Carroll Street Salisbury MD 21801 522250012 P'SHIP INV MD NA C Corp PRLTC Inc 100 East Carroll Street Salisbury MD 21801 522190588 LT Care MD NA C Corp Delmarva Peninsula Insurance Company PO Box 1159 KY1-1102 Grand Cayman CJ 981110617 Insurance CJ PRMC C Corp 1 22893088 1.00000 true false false true false false false false false false false false true true true true false true true true DELMARVA PENINSULA INSURANCE COMPANY R 4109125 FMV