2017-05-10T22:16:59-05:00 2016-06-30 KPMG LLP 1676 INTERNATIONAL DRIVE McLean VA 22102 990 2015-07-01 520591607 The Good Samaritan Hospital of Maryland Inc % JOEL BRYAN GOOD 4107726721 5601 LOCH RAVEN BLVD Baltimore MD 21239 JOEL BRYAN VP/TREASURER 4107726721 2017-05-08 true JG WHITE P01498698 7032868000 2017-05-05 2015 2021-01-29 14:40:06Z BRADLEY CHAMBERS 5601 LOCH RAVEN BLVD BALTIMORE MD 21239 315450399 false X www.goodsam-md.org X 1920 MD WE ARE GOOD SAMARITANS, GUIDED BY CATHOLIC TRADITION AND TRUSTED TO TRADITION AND TRUSTED TO DELIVER IDEAL HEALTHCARE EXPERIENCES FOR THE PATIENTS WE SERVE. 19 11 2312 140 276421 626931 3058718 314065712 308986480 6555671 86197 3781048 3287167 325029362 315418562 0 0 0 0 154050181 157053747 0 0 96348 154097048 150501269 308147229 307555016 16882133 7863546 187336071 166104776 58760205 50399432 128575866 115705344 X AS A PROUD MEMBER OF MEDSTAR HEALTH, MEDSTAR GOOD SAMARITAN HOSPITAL'S (MEDSTAR GOOD SAMARITAN) MISSION IS TO BE GOOD SAMARITANS, GUIDED BY CATHOLIC TRADITION AND TRUSTED TO DELIVER IDEAL HEALTH EXPERIENCES. MEDSTAR GOOD SAMARITAN, LOCATED IN NORTHEAST BALTIMORE CITY, MARYLAND, IS KNOWN FOR ITS SPECIALTIES IN ORTHOPAEDICS, RHEUMATOLOGY, NEPHROLOGY, AND PHYSICAL MEDICINE AND REHABILITATION PROGRAMS. IN ADDITION TO GENERAL ADULT ACUTE CARE SERVICES, MEDSTAR GOOD SAMARITAN HAS A COMPREHENSIVE INPATIENT REHABILITATION UNIT AND A SUB-ACUTE CARE UNIT. THROUGH MGSH'S CENTER FOR SUCCESSFUL AGING, INTEGRATED CARE IS PROVIDED TO PATIENTS WHO EXPERIENCE AGE-RELATED HEALTH CONDITIONS. In fiscal year 2016, MedStar Good Samaritan had 14,722 admissions and observations, and 386,048 outpatient visits including 56,240 emergency visits. false false 212905575 287410981 MedStar 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 $54.1M of management and general expenses in providing services to its communities. It also offers community-based health services through the Good Health Center and provides senior living services through the Good Samaritan Nursing Center and two senior housing complexes located on its 43-acre campus. MedStar Good Samaritan's stroke care program has received the Gold Seal of Approval from the Joint Commission for Primary Stroke Centers. MedStar Good Samaritan has received the Bronze Performance Achievement award from the American Stroke Association for its exceptional care for stroke patients. The Stroke Center at MedStar Good Samaritan Hospital has received both the honored Bronze Award and Silver Plus Award from the American Heart Association for the outstanding work of the center as well as its preventive and community education programs. Practice Greenhealth awarded MedStar Good Samaritan Hospital the Greenhealth Emerald Award, which is given to healthcare facilities that have achieved improvements in mercury elimination, waste reduction, recycling, and source reduction programs. Winning facilities are further along the path to sustainability and show leadership in the local community and in the healthcare sector. 31411660 21575499 MedStar Good Samaritan provided $31.4M in subsidized (mission driven) health services in fiscal 2016. 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. Services provided include hospitalists, outpatient renal care, continuing care, and behavior health services. 9054627 MedStar Good Samaritan provided $9.1M in health professions education in fiscal year 2016. This category includes training in graduate medical education, and education for physicians, medical students, nurses, and other health professions. 253371862 true true false false false false false false false false true false false true true true false true false false false false false false true false true true false false true false false false false false true false false true false false false true true true true false false true 0 0 true 2312 true true true false false false false true true false false false false X 19 11 false false false false true true true true true false false true true true true true true true true false MD X JOEL BRYAN 4107726721 10980 GRANTCHESTER WAY COLUMBIA MD 21044 X DANIEL P CAHILL BOARD MEMBER 1.0 0.0 X 0 0 0 MOIRA P LARSEN MD BOARD MEMBER 1.0 39.0 X 225276 0 960 JEFFREY A MATTON BOARD MEMBER (UNTIL 6/2016) 40.0 0.0 X 951675 0 24176 KENNETH A SAMET BOARD MEMBER 1.0 39.0 X 0 4872708 66397 BERNARD H RAVITZ MD BOARD MEMBER 40.0 0.0 X 285026 0 4274 HOWARD S FREELAND MD BOARD MEMBER 40.0 0.0 X 317022 0 17159 LUIS GIMENEZ MD BOARD MEMBER 1.0 0.0 X 0 0 0 CHARLES L BAUERMANN BOARD MEMBER 1.0 0.0 X 0 0 0 KAY G BEE BOARD MEMBER 1.0 0.0 X 0 0 0 JEFFREY R DONNELLY BOARD MEMBER 1.0 0.0 X 0 0 0 SONYA H GRAY BOARD MEMBER 1.0 0.0 X 0 0 0 REV DENIS J MADDEN BOARD MEMBER 1.0 0.0 X 0 0 0 DR ALLAN NOONAN CHAIR 1.0 0.0 X 0 0 0 T EDGIE RUSSELL BOARD MEMBER 1.0 0.0 X 0 0 0 REV PM SMITH BOARD MEMBER 1.0 0.0 X 0 0 0 JOHN C SMYTH VICE CHAIR 1.0 0.0 X 0 0 0 KATHLEEN J WHITING BOARD MEMBER 1.0 0.0 X 0 0 0 DAVID WEISMAN DO BOARD MEMBER 1.0 0.0 X 186212 0 23079 THOMAS L OWSLEY BOARD MEMBER 1.0 0.0 X 0 0 0 MONS ADAM J PARKER BOARD MEMBER 1.0 0.0 X 0 0 0 ELIAS SHAYA MD BOARD MEMBER 1.0 39.0 X 442342 0 9227 MICHAEL JACOBS MD BOARD MEMBER 40.0 0.0 X 833860 0 19549 BRADLEY CHAMBERS President/DIRECTOR 20.0 20.0 X X 1031715 0 26549 ANTHONY READ BOARD MEMBER 40.0 0.0 X 0 0 0 DEANA STOUT TREASURER 20.0 20.0 X 368355 0 37990 SHIRLEY ROTH CHIEF NURSING OFFICER 40.0 0.0 X 266069 0 14922 STEPHEN KOENIGSBERG vice president 20.0 20.0 X 0 247976 21701 SHARON BOTTCHER CHIEF NURSING OFFICER 20.0 20.0 X 0 296298 15051 MARTIN BINSTOCK VP MEDICAL AFFAIRS 40.0 0.0 X 575303 0 32702 ROBERT PEROUTKA MD PHYSICIAN 40.0 0.0 X 681412 0 15937 DALE BUCHBINDER MD medical dir of vascular surger 40.0 0.0 X 660412 0 19386 MESFIN LEMMA MD PHYSICIAN 40.0 0.0 X 760861 0 969 CHARLES PADGETT PHYSICIAN 40.0 0.0 X 533982 0 12485 THOMAS SENKER FORMER SECRETARY 40.0 0.0 X 428137 0 21263 JENNIFER WILKERSON FORMER OFFICER 40.0 0.0 X 265698 0 19159 8813357 5416982 402935 167 true true false HUNT VALLEY ANES ASSOC PA PO BOX 20284 TOWSON MD 21284 Medical Services 6903000 JOHNS HOPKINS UNIVERSITY 12529 COLLECTIONS CENTER DRIVE CHICAGO IL 60693 PROFESSIONAL SERVICE 5026671 MORRISON HEALTHCARE FOOD SERVICES 4721 MORRISON DRIVE MOBILE AL 36609 food services 3888103 UNIVERSITY OF MARYLAND 110 S PACA STREET BALTIMORE MD 21201 PROFESSIONAL SERVICE 3617909 HEALOGICS WOUND CARE 5220 Belford 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STOCK OPTION PLAN 551329 OTHER LIABILITIES 1895463 27994360 X FIN 48 FOOTNOTE PART X, LINE 2 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, 2016. GOLF 122000 25000 97000 4505 21970 5363 0 122000 25000 97000 4505 21970 5363 31838 65162 true true X true X true X true true true false true true 3055405 3055405 0.00990 3055405 3055405 0.00990 1197925 41300 1156625 0.00380 9054627 9054627 0.02940 31411660 21575499 9836161 0.03200 24527 3000 21527 0.00010 41688739 21619799 20068940 0.06530 44744144 21619799 23124345 0.07520 832903 558908 273995 0.00090 26386 26386 0.00010 17192 17192 876481 558908 317573 0.00100 true 14659507 true true 1 1 MAIN HOSPITAL BUILDING 5601 LOCH RAVEN BLVD BALTIMORE MD 21239 X X X X MAIN HOSPITAL BUILDING 1 false false true X X X X X X X X X 14 true false false true X WWW.MEDSTARGOODSAM.ORG X true 14 true WWW.MEDSTARGOODSAM.ORG false false true X 200. 400. X X X X X X true true X X X X true X WWW.MEDSTARGOODSAM.ORG X WWW.MEDSTARGOODSAM.ORG X WWW.MEDSTARGOODSAM.ORG X X X X X true X false true X false false CHNA INPUT PART V, SECTION B, LINE 5 HOSPITAL LEAD ROLE DESCRIPTION The 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 on all Schedule Hs. The Lead also works closely with the writer. He/she reviews all narratives prior to publication. Name of Hospital Lead: Deborah Bena Executive Sponsor Role Description The 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: Bradley Chambers Advisory Task Force Role Description The 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: Title/Affiliation with Hospital: Name of Organization Deborah Bena Health Ministries Coordinator MedStar Good Samaritan Hospital Allan Noonan, MD Chair MedStar Good Samaritan Hospital Board Sonya Gray Board Member MedStar Good Samaritan Hospital Board David Weisman, MD Physician MedStar Good Samaritan Hospital Michelle Zikusoka,Physician MedStar Good MD Samaritan Hospital Bernadette Krol, Registered Nurse MedStar Good RN Samaritan Hospital Moira Larsen, MD Physician and Board Member MedStar Good Samaritan Hospital Rachel V. Neill Resident Govans Ecumenical Corporation (GEDCO) - CARES PROGRAM Patricia Stabile Program Director HARBEL Prevention and recovery Center Randolph Rowel, Chair $ Associate Professor Department of PhD Behavioral health Sciences, Morgan state university IMPLEMENTATION STRATEGY PART V, SECTION B, LINE 11 THE 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. 6 Transitional Care at Good Samaritan 5601 Loch Raven Blvd Baltimore MD 21239 Comprehensive Care Facility FutureCare ColdSpring 4700 Harford Rd Baltimore MD 21224 Renal Dialysis facility FutureCare Northpoint 1046 Northpoint Rd Baltimore MD 21239 Renal Dialysis facility ManorCare 6600 Ridge Rd Baltimore MD 21239 Renal Dialysis facility Lorien Frankford 5009 Frankford Ave Baltimore MD 21206 Renal Dialysis facility Good Samaritan Hospital at Cromwell 8710 Emge Rd Baltimore MD 21234 Renal Dialysis facility CHARITY CARE AT COST PART I, LINE 7A 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 OFFSETTING REVENUE RELATED TO UNCOMPENSATED CARE. UNREIMBURSED MEDICAID PART I, LINE 7B 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 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, LINE 4 MEDSTAR 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 8 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 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 2 In FY15, MedStar Good Samaritan Hospital 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 hospitals CHNA was led by 15 Advisory Task Force (ATF) members, which was comprised of a diverse group of individuals, including grassroots activists, community residents, faith-based leaders, hospital representatives, public health leaders, and other stakeholder organizations, such as representatives from local health departments. The ATF reviewed quantitative and qualitative community health data, as well as local, regional and national health goals. Based on their findings, the ATF designed a survey to identify trends in how participants perceived the severity of key health issues in the following categories: wellness and prevention, access to care, quality of life, and environment. Community members responded to the survey by attending a community input session or completing it online or via hardcopy. Based on the ATFs recommendation, the hospital identified Govans as its Community Benefit Service Area (CBSA) geography with a high density of low-income or vulnerable residents within close proximity of the hospital. Health priorities for the CBSA include chronic disease (heart disease/stroke, diabetes, and obesity). The hospitals FY15 CHNA and three-year Implementation Strategies were endorsed by MedStar Good Samaritans Board of Directors and approved by the MedStar Health Board of Directors. The document was published on the hospitals website on June 30, 2015. As a proud member of MedStar Health, representatives from MedStar Good Samaritan routinely participate in the MedStar Health community benefit workgroup. The workgroup is comprised of community health professionals who represent all ten MedStar hospitals. The team analyzes local and regional community health data, establishes system-wide community health programming performance and evaluation measures and shares best practices. PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE PART VI, LINE 3 As one of the regions leading not-for-profit healthcare systems, MedStar Health is committed to ensuring that uninsured patients within the communities we serve who lack financial resources have access to necessary hospital services. MedStar Health and its healthcare facilities will: * Treat all patients equitably, with dignity, with respect and with compassion. * Serve the emergency health care needs of everyone who presents at our facilities regardless of a patient's ability to pay for care. * Assist those patients who are admitted through our admissions process for non-urgent, medically necessary care who cannot pay for part of all of 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 Healths facilities work with their uninsured patients to gain an understanding of each patients financial resources prior to admission (for scheduled services) or prior to billing (for emergency services). Based on this information and patient eligibility, MedStar Healths facilities assists uninsured patients who reside within the communities we serve in one or more of the following ways: * Assist with enrollment in publicly-funded entitlement programs (e.g., Medicaid). * Assist with consideration of funding that may be available from other charitable organizations. * Provide charity care and financial assistance according to applicable guidelines. * Provide financial assistance for payment of facility charges using a sliding scale based on patient family income and financial resources. * Offer periodic payment plans to assist patients with financing their healthcare services. Each facility posts the policy, including a description of the applicable communities it serves, in each major patient registration area and in any other areas required by applicable regulations, communicates the information to patients as required by this policy and applicable regulations and makes a copy of the policy available to all patients. Additionally, the Maryland Patient Information Sheet/MedStars Patient Information Sheet is provided to inpatients on admission and at time of final account billing. MedStar Health believes that its patients have personal responsibilities related to the financial aspects of their healthcare needs. The charity care, financial assistance, and periodic payment plans available under this policy are not available to those patients who fail to fulfill their responsibilities. For purposes of this policy, patient responsibilities include: * Completing financial disclosure forms necessary 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 Healths facilities to properly counsel patients concerning the availability of financial assistance. * Working with the facilitys financial counselors and other financial services staff to ensure there is a complete understanding of the patients financial situation and constraints. * Completing appropriate applications for publicly-funded healthcare programs. This responsibility includes responding in a timely fashion to requests for documentation to support eligibility. * 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 the facilitys financial counselors on a timely basis as the patients circumstances may change. * It is the responsibility of the patient to inform the MedStar hospital of their existing eligibility under a medical hardship during the 12-month period. Uninsured patients of MedStar Healths facilities may be eligible for charity care or sliding-scale financial assistance under this policy. The financial counselors and financial services staff determine eligibility for charity care and sliding-scale financial assistance based on review of income for the patient and their family (household), other financial resources available to the patients family, family size, and the extent of the medical costs to be incurred by the patient. COMMUNITY INFORMATION PART VI, LINE 4 Geographic: MedStar Good Samaritan Hospitals CBSA includes residents in ZIP code 21212, the Govans area of Baltimore. While the primary focus for targeted programming will be in this neighborhood, MGSH also provides services to individuals in need in the hospitals primary service area, which includes ZIP codes 21234, 21239, 21206, and 21214. The CBSA was selected due to its close proximity to the hospital, coupled with a high density of residents with low incomes. The Govans neighborhood is located in North Central Baltimore City, approximately two miles from Good Samaritan Hospital. The neighborhood features many different housing types, businesses, churches, a charter school and a neighborhood park. Govans has always been associated with York Road, first as an Indian trail, and then as an important commercial road and turnpike linking the Port of Baltimore to Pennsylvania. Demographics: According to statistics from the Baltimore City 2011 Neighborhoods Health Profile, the total population in Govans (ZIP code 21212) is 10,680, the majority of which is African American (91.3%). Whites account for 5.7% of the population, Asians account for 0.5% and 2.5% of the population self-reports as two or more races. Slightly more than one percent (1.3%) of the population is of Hispanic or Latino origin. Data provided by the U.S. Census Bureau, 2010 2014 shows that the median household income in Baltimore City is $41,819; $48,721 to $61,734 in the hospitals primary service area and $37,047 in Govans. Data also shows that the percentage of households with incomes below the federal poverty guideline is 19.5% in Baltimore City; 6.9% to 12.8% in hospitals primary service area and 11.6% in Govans. Cardiovascular disease mortality rate is 300.3 while stroke and diabetes are lower at 45.5 and 29.0. Source: Maryland Vital Statistics Administration 2013 Report Card. PROMOTION OF COMMUNITY HEALTH PART VI, LINE 5 As a community partner, MedStar Good Samaritan Hospital (MGSH) engages in a number of community benefit activities to improve and promote the health and well-being of the community. The priority area of focus, as determined by the Community Health Needs Assessment is chronic disease, specifically targeting heart disease, diabetes, and obesity. In FY16, MedStar Good Samaritan continued community partnerships with organizations, such as senior centers, churches and senior housing to provide health education classes, as well as exercise and weight loss programs. The Keep the Beat Heart Health Program is a four-week program focused on topics such as nutrition, exercise, and stress reduction. Eighteen participants completed the program. Fitness programs were held weekly at the Senior Network of North Baltimore and the Harford Senior Center. Classes focused on aerobic/cardio exercise, strength training and stretching. Approximately 80 people participated in the fitness programs in FY16. To address diabetes prevention, MGSH conducted two "National Diabetes Prevention Programs". The Life Balance/Weight Management Program (National Diabetes Prevention Program) began in September 2015 with 30 participants enrolled, and ended in August 2016 with 15 program completers. Cohort 2 of the Life Balance/Weight Management Program began in May 2016 with 20 participants enrolled. The program is intended to continue through April 2017. The Stanford Universitys "Living Well Program" for diabetes management was held at Govans Manor, a low-income senior resident building in the Govans community and at MGSH. Sixteen participants completed the program. AFFILIATED HEALTH CARE SYSTEM PART VI, LINE 6 As a proud member of MedStar Health, MedStar Good Samaritan 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 with technical support to enhance community health programming and evaluation. MedStars 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 7 The community benefit report for MedStar Good Samaritan Hospital is only filed in the state of Maryland. X true true X X X X X X true false false false false false false false false MOIRA P LARSEN MD BOARD MEMBER 221618 0 0 0 3658 0 0 0 960 0 226236 0 0 0 JEFFREY A MATTON BOARD MEMBER (UNTIL 6/2016) 519099 0 432576 0 0 0 16492 0 7684 0 975851 0 0 0 KENNETH A SAMET BOARD MEMBER 0 1689763 0 3167094 0 15851 0 45721 0 20676 0 4939105 0 0 BERNARD H RAVITZ MD BOARD MEMBER 265026 0 20000 0 0 0 3224 0 1050 0 289300 0 0 0 HOWARD S FREELAND MD BOARD MEMBER 246334 0 70688 0 0 0 6535 0 10624 0 334181 0 0 0 DAVID WEISMAN DO BOARD MEMBER 173586 0 12626 0 0 0 8678 0 14401 0 209291 0 0 0 ELIAS SHAYA MD BOARD MEMBER 396326 0 46016 0 0 0 8301 0 926 0 451569 0 0 0 MICHAEL JACOBS MD BOARD MEMBER 831360 0 2500 0 0 0 7800 0 11749 0 853409 0 0 0 THOMAS SENKER FORMER SECRETARY 232741 0 87477 0 107919 0 7800 0 13463 0 449400 0 0 0 MARTIN BINSTOCK VP MEDICAL AFFAIRS 367894 0 207409 0 0 0 18851 0 13851 0 608005 0 0 0 DEANA STOUT TREASURER 265190 0 103165 0 0 0 23238 0 14752 0 406345 0 0 0 SHIRLEY ROTH CHIEF NURSING OFFICER 135946 0 23484 0 106639 0 7176 0 7746 0 280991 0 0 0 ROBERT PEROUTKA MD PHYSICIAN 424302 0 257110 0 0 0 0 0 15937 0 697349 0 0 0 DALE BUCHBINDER MD medical dir of vascular surger 632412 0 28000 0 0 0 7761 0 11625 0 679798 0 0 0 MESFIN LEMMA MD PHYSICIAN 532491 0 228370 0 0 0 0 0 969 0 761830 0 0 0 JENNIFER WILKERSON FORMER OFFICER 219020 0 46678 0 0 0 5819 0 13340 0 284857 0 0 0 BRADLEY CHAMBERS President/DIRECTOR 571563 0 460152 0 0 0 18563 0 7986 0 1058264 0 0 0 CHARLES PADGETT PHYSICIAN 531482 0 2500 0 0 0 0 0 12485 0 546467 0 0 0 STEPHEN KOENIGSBERG vice president 0 206240 0 41736 0 0 0 10107 0 11594 0 269677 0 0 SHARON BOTTCHER CHIEF NURSING OFFICER 0 251495 0 44803 0 0 0 14289 0 762 0 311349 0 0 SOCIAL CLUB DUES SCHEDULE J, PART I, LINE 1 THE ORGANIZATION PAID SOCIAL CLUB DUES FOR ONE OF ITS OFFICERS DURING THIS YEAR. PARTICIPATION IN THESE ACTIVITIES BY THE OFFICER WAS FOR BUSINESS PURPOSES, AND HELPED THE ORGANIZATION FURTHER ITS EXEMPT PURPOSES. SCHEDULE J, PART I, LINE 4A Shirley Roths Other reportable compensation in Part II, Column (B) (iii) includes $80,817 representing severance payments received by Ms. Roth. SCHEDULE J, PART III Mr. Samet's bonus and incentive compensation in Part II, Column (B) (ii) includes $878,413 representing benefits received from executive retirement plans that are comprised of target benefits determined annually based on compensation and years of service. Bradley Chambers compensation is for services provided as President to both MedStar Good Samaritan Hospital and MedStar Union Memorial Hospital. Deana Stouts compensation is for services provided as CFO to both MedStar Good Samaritan Hospital and MedStar Union Memorial Hospital. MORRISON HEALTHCARE FOOD SERVICES SEE PART V 3888103 FOOD SERVICES false WebbMason SEE PART V 171295 Marketing Strategies false Acme Paper Supply Co Inc SEE PART V 271116 Manufacturing services false BUSINESS TRANSACTIONS INVOLVING INTERESTED PERSONS SCHEDULE L, PART IV MORRISON HEALTHCARE FOOD SERVICES IS A SUBSTANTIAL CONTRIBUTOR THAT ALSO PROVIDED FOOD SERVICES TO THE GOOD SAMARITAN HOSPITAL, INC. Webb/Mason is a substantial contributor that also provided Marketing Strategies services to the Good Samaritan Hospital, Inc. Acme Paper & Supply Co., Inc. is a substantial contributor that also provided Manufacturing services to the Good Samaritan Hospital, Inc. Per the conflict of interest policy, all transactions between the hospital and outside vendors should be at Arms-length for fair market value. X 37176 FMV false false false ORGANIZATION MEMBERS PART VI, LINE 6 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. DESCRIPTION OF MEMBERS PART VI, LINE 7A 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. DECISIONS OF GOVERNING BODY PART VI, LINE 7B 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. PROCESS FOR REVIEWING FORM 990 PART VI, LINE 11A 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, STRATEGIC PLANNING, 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. CONFLICT OF INTEREST POLICY PART VI, LINE 12C 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). DESCRIPTION OF EXECUTIVE COMPENSATION PROCESS PART VI, LINE 15 THE EXECUTIVE COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS OF MEDSTAR HEALTH, INC. (THE "COMMITTEE") HAS OVERSIGHT OVER 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. FINANCIAL STATEMENT AVAILABILITY PART VI, LINE 19 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. 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. OTHER CHANGES IN NET ASSETS PART XI, LINE 9 EQUITY TRANSFERS - NET ASSETS.....................$(12,368,754) O'NEILL EQUITY.....................................$(8,357,257) ------------- TOTAL OTHER CHANGES IN NET ASSETS.................$(20,726,011) FORM 990 PART IX LINE 11G DESCRIPTION:PURCHASED PROFESSIONAL SERVICE TOTAL FEES:3893294 FORM 990 PART IX LINE 11G DESCRIPTION:PHYSICIAN SERVICES TOTAL FEES:6590160 FORM 990 PART IX LINE 11G DESCRIPTION:PHYSICIAN SERVICES - FIXED TOTAL FEES:11022288 FORM 990 PART IX LINE 11G DESCRIPTION:PROFESSIONAL FEES-OTHER TOTAL FEES:4588562 FORM 990 PART IX LINE 11G DESCRIPTION:PHARMACY SERVICES TOTAL FEES:1217340 FORM 990 PART IX LINE 11G DESCRIPTION:MISC PURCHASED SERVICES TOTAL FEES:2758038 FORM 990 PART IX LINE 11G DESCRIPTION:BILLING SERVICE EXPENSE TOTAL FEES:1762785 FORM 990 PART IX LINE 11G DESCRIPTION:BLOOD BANK FEES TOTAL FEES:934811 FORM 990 PART IX LINE 11G DESCRIPTION:MISCELLANEOUS FEES TOTAL FEES:1227245 MEDSTAR HEALTH ANESTHESIA SERVICES 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