2016-08-12T07:45:13-07:00 2015-09-30 KPMG LLP 2 Financial Center 60 South Street Boston MA 02111 990 2014-10-01 050258905 The Miriam Hospital MIRI 4017932500 164 Summit Avenue Providence RI 02906 Mary A Wakefield Treasurer 2016-08-12 true Tara D'Agostino P01245482 6179881000 2014 2016-09-27 15:27:22Z Arthur J Sampson 164 Summit Avenue Providence RI 02906 602249744 false false X www.miriamhospital.org X 1926 RI As a founding hospital in the Lifespan health system, The Miriam Hospital (TMH) is committed to its mission: Delivering health with care. 20 14 3112 875 949400 -8825 5076514 4048209 414432130 422526695 4292379 5441333 18767827 19149113 442568850 451165350 530229 402830 0 196043206 201374277 0 0 225138492 232179584 421711927 433956691 20856923 17208659 458786794 459129062 147475461 145006301 311311333 314122761 X As a founding hospital in the Lifespan health system, TMH is committed to its mission: Delivering health with care. false false 329507759 402830 415911576 Patient Care:TMH offers expertise in cardiology, oncology, orthopedics, men's health, and minimally invasive surgery and is home to the State's first Joint Commission- certified Stroke Center and robotic surgery program. Services and programs provided by TMH include general medicine; general surgery; emergency medicine; cardiovascular care; orthopedics; nuclear cardiology; radiology; laboratory; renal dialysis; urology; gastroenterology; endocrinology; gynecology; nephrology; neurology; ophthalmology; trauma care; computerized tomography; and magnetic resonance imaging (MRI). The Hospital is nationally known for its HIV/AIDS and behavioral and preventive medicine research, including weight control, physical activity, and smoking cessation. (Continued on Schedule O). 26048210 22154210 Research:Since 1969, the level of research has increased from seven projects totaling $127,000 involving nine investigators to 381 projects totaling $26.0 million involving 71 investigators and 124 employees. The Hospital conducts extensive medical research and is in the forefront of biomedical health care delivery research and among the leaders nationally in the National Institutes of Health programs. The Hospital also sponsors a significant level of these research activities. Federal support accounts for approximately 92% of all externally funded research at the Hospital. TMH provided $3.9 million in support of research activities in fiscal year 2015. (Continued on Schedule O). 20577190 3136613 Medical Education:TMH provides the setting for and substantially supports medical education in various clinical training and nursing programs. TMH is designated as a major teaching affiliate of The Warren Alpert Medical School of Brown University. The total cost of direct medical education provided by TMH exceeded the reimbursement received from third-party payors by $17.4 million in fiscal year 2015. (Continued on Schedule O). 376133159 true true false false false false false false false true true true false true true true true true false false true true false false false false true true true false true true false false false false false false false false true false false false false false false true false false false false true 259 0 true 3112 true true true false false false false false false 0 false false false false false false false false false false X 20 14 true false true false true true true true true false false true true true true true true true true false X Mary A Wakefield 4014447093 593 Eddy Street Providence RI 02903 X Thomas Anders MD Trustee 0.00 0.70 X 0 0 0 Lawrence Aubin Chair 0.50 6.50 X X 0 0 0 Timothy J Babineau MD Trustee 3.00 37.00 X 0 2097376 308492 Emanuel Barrows Trustee 0.00 6.00 X 0 0 0 Roger N Begin Trustee 0.00 1.00 X 0 0 0 David A Brown Trustee 0.00 0.00 X 0 0 0 Peter Capodilupo Trustee 0.00 8.00 X 0 0 0 Ellen Collis Trustee 0.00 1.00 X 0 0 0 Michael G Ehrlich MD Trustee 0.50 3.00 X 0 6439 0 Jonathan D Fain Trustee 0.00 1.00 X 0 0 0 Edward D Feldstein Trustee 2.00 3.00 X 0 0 0 David Gorelick MD Trustee 0.50 2.50 X 0 0 0 Michael L Hanna Trustee 0.75 3.45 X 0 0 0 Pamela Harrop MD Trustee 2.00 13.00 X 0 0 0 Marie J Langlois Trustee 1.00 2.00 X 0 0 0 Jerrold Lavine Trustee 0.00 0.00 X 0 0 0 Alan H Litwin Vice Chair 1.00 9.00 X X 0 0 0 Steven Pare Trustee 0.00 2.50 X 0 0 0 Lloyd Robertson Trustee 0.00 5.00 X 0 0 0 Lawrence Sadwin Trustee 0.00 5.50 X 0 0 0 Fred J Schiffman MD Trustee 0.00 0.00 X 0 0 0 Shivan Subramaniam Trustee 0.00 0.00 X 0 0 0 Jane Williams MD Trustee 0.00 0.00 X 0 0 0 Brian J Zink MD Trustee 0.30 1.30 X 0 1000 0 Kenneth E Arnold Secretary 6.00 34.00 X 0 732566 30234 Arthur J Sampson President 30.00 10.00 X 0 798579 32314 Mary A Wakefield Treasurer 5.00 35.00 X 0 1667207 124092 Robert W Corwin MD Chief Medical Officer 40.00 0.00 X 436130 0 25704 Maria P Ducharme Chief Nursing Officer 40.00 0.00 X 325042 0 71828 Jinnette D Abbott MD Physician 40.00 0.00 X 477465 0 37784 Douglas M Burtt MD Physician 40.00 0.00 X 466686 0 37106 Samuel C Dudley MD Physician 40.00 0.00 X 540430 0 18326 Paul C Gordon MD Physician 40.00 0.00 X 508138 0 19752 Barry L Sharaf MD Physician 40.00 0.00 X 475911 0 34510 3229802 5303167 740142 232 false true false University Medicine Foundation 593 Eddy Street Providence RI 02903 Medical Services 7486755 University Surgical Associates 2 Dudley Street Providence RI 02905 Medical Services 4102787 Brown University 75 Waterman Street Providence RI 02912 Medical Services 2275957 Sodexo Inc 25 Royal Little Drive Providence RI 02904 Dietary/Cafe Service 1807724 Ringo LLC 445 Broadhollow Road Melville NY 11747 Staffing 1505486 29 4024716 9500 13993 4048209 Direct Rev from Research 900099 23191628 23191628 Laboratory 621500 911909 911909 Patient Service Rev 900099 397726536 397726536 Temp Restricted (SPFs) 900099 696622 696622 422526695 4001045 4001045 817 817 0 1394592 958674 435918 435918 435918 151565191 150125720 1439471 1439471 1439471 0 0 0 Cafeteria Revenue 722210 1408799 1408799 Indirect Rev from Grants 900099 4377859 4377859 Joint Program Revenue 900099 10964944 10964944 1961593 1924102 37491 18713195 451165350 440290490 949400 5877251 396830 396830 0 6000 6000 0 717922 717922 0 158087655 155037675 3049980 6161700 6042895 118805 24922222 24490034 432188 11484778 11264129 220649 0 0 0 0 0 703491 703491 22375968 21902555 473413 153405 153405 76797067 76277559 519508 0 0 11146092 10162654 983438 622454 616584 5870 0 407389 398068 9321 3337224 3337224 0 14567082 14567082 4028356 4028356 Purch Svs & Equip Cont 49559048 16671395 32887653 Licence Fee 21066574 21066574 Provision for bad debts 15363104 15363104 Indirect Research & Other 12052330 11537420 514910 0 433956691 376133159 57823532 0 0 25236988 35570265 1204369 1300558 42060762 32923819 0 0 179793 179793 5266246 5359064 3773383 2282434 392524859 198474872 187511608 194049987 80560340 78517999 42070601 42759987 0 0 70922704 66185156 458786794 459129062 33601703 34250923 59619383 57307280 10110312 8494126 44144063 44953972 147475461 145006301 X 263666420 267553367 28076417 26870590 19568496 19698804 311311333 314122761 458786794 459129062 X 17208659 -7217722 -7179509 X false true X true true true X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 124326086 27341321 -2425603 26388135 122853669 117435496 30903911 5559275 29572596 124326086 111167306 33540223 6309324 33581357 117435496 97696217 35666188 10411008 32606107 111167306 96830355 25953487 678572 25766197 97696217 0.84400 0.15600 false true true 5406764 5406764 228561546 94779469 133782077 154417052 103695403 50721649 4139497 4139497 194049987 42759987 Deferred financing costs 1124150 Held by third parties under LTD Agrts. 6781456 Interest in net assets of TMH Foundation 56581277 Other 122590 66185156 Abatement liability 180380 Accrued pension liability 34518200 Due to affiliates 2972000 Health care benefit self-insurance 2875637 Lease payable 146534 Post-retirement benefit liability 145700 Third-party payor settlements 4115521 44953972 X 421676561 -7217722 -7179509 -14397231 436073792 703491 14388067 15091558 451165350 418865133 418865133 703491 14388067 15091558 433956691 Part V, Line 4: Intended uses of the endowment fund. The Miriam Hospital's (TMH) unrestricted endowment consists of designated assets set aside by TMH's Board for future capital improvements, over which the Board retains control and may at its discretion subsequently use for other purposes. The largest temporarily restricted funds held by TMH are used to support: (1) the Women's Medicine Collaborative, a comprehensive, multidisciplinary center dedicated to meeting the health care needs of women; (2) the advancement of patient care, research, and education related to cardiology; (3) upgrade of the patient call system technology; (4) purchase of an upgraded surgical robot; (5) the Department of Psychiatry operations, education, and research; (6) operational needs of all emergency medicine programs; (7) clinical care, research, and education to develop treatment for pelvic floor disorders; (8) cardiology labs and programs; (9) The Center for Prisoner Health and Human Rights, a program which seeks to improve the health and human rights of criminal justice populations through education, research, and advocacy; (10) the Surgery Department's educational and investigational functions; (11) the treatment and prevention of cancer, including the Cancer Patient Navigator Program, which assists cancer patients through the entire course of their care; and (12) TMH's capital equipment and operating needs in providing services to patients. Part X : FIN48 Footnote TMH, as a not-for-profit corporation, is recognized under Section 501(c)(3) of the Internal Revenue Code and is exempt from Federal income taxes. TMH recognizes the effect of income tax positions only if those positions are more likely than not to be sustained. Changes in measurement are reflected in the period in which the change in judgment occurs. TMH did not recognize the effect of any income tax positions during the fiscal year ended September 30, 2015. Part XI, Line 4b: Other revenue amounts included on 990 but not included in F/S Debt-financed rental expenses $-16363 Non debt-financed rental expenses $-958674 Provision for bad debts $15363104 Part XII, Line 4b: Other revenue amounts included on 990 but not included in F/S Debt-financed rental expenses $-16363 Non debt-financed rental expenses $-958674 Provision for bad debts $15363104 true Sub-Saharan Africa 0 0 Program Services Research 517558 East Asia and the Pacific 0 0 Program Services Research 21904 Europe 0 0 Program Services Research 4453 Middle East and North Africa 0 0 Grant Recipient in Region Philanthropy 6000 549915 549915 Middle East Philanthropy 6000 Check FMV 1 false false false false false true Part I, Line 2 - Grantmakers Explanation For Monitoring Use of Funds Outside US When a foreign institution is the subrecipient of an award received by a Lifespan affiliate, the following procedures are followed: A subrecipient agreement is prepared and executed between the foreign institution and the Lifespan affiliate. The agreement describes the funding source, terms and conditions of the award, statement of work, payment method, and audit. The foreign institution prepares an invoice to the Lifespan affiliate for expenses incurred under the agreement. Once received, the invoice is approved by both the principal investigator at the Lifespan affiliate and the responsible research administrator in the Office of Research Administration.Check requests and wire transfer forms are prepared by the principal investigator, approved by the research administrator and forwarded to the Finance Department, where payment is processed to the foreign institution.Additionally, when the award is a federal award, a questionnaire is completed by the appropriate subrecipient official supplying information about the foreign institution's financial system and method of accounting for the award. A request is also made for the institution's audited financial statements. When a foreign individual is not associated with an institution, a Professional Services Agreement (PSA) is executed and the individual sends an invoice to the Lifespan affiliate principal investigator associated with the project or sponsored agreement that states the number of hours, dates of services, work performed, reimbursement for expenses, and compensation amount. The same approval process and payment is used as described above. true true true X true X true true false false true true 8162527 1865495 6297032 0.01500 59343998 49369715 9974283 0.02380 67506525 51235210 16271315 0.03880 347963 39727 308236 0.00070 20577190 3136613 17440577 0.04170 16187868 4534536 11653332 0.02780 26048210 22154210 3894000 0.00930 185860 185860 0.00050 63347091 29865086 33482005 0.08000 130853616 81100296 49753320 0.11880 true 3823877 307166 97576476 92705688 4870788 X true true 1 1 The Miriam Hospital 164 Summit Avenue Providence RI 02906 www.miriamhospital.org X X X X X The Miriam Hospital 1 false false true X X X X X X X X 13 true true false true X http://www.miriamhospital.org X X true 13 true Please refer to Schedule O supplemental info for full URL false false true X 200.0000 300.0000 X X X X X X true true X X X X true X See Schedule O X See Schedule O X X X X X X true X X true X X X X X X true X false false Part V, Line 5 - Account Input from Persons Who Represent the Community The CHNA encompassed intensive data collection and analysis, as well as qualitative research in the forms of interviews with and surveys of more than 100 internal and external stakeholders, including hospital-based physicians, nurses, social workers, administrators, and other professionals, as well as community-based stakeholders representing constituencies served by TMH and Lifespans three other hospitals. TMHs leadership team shaped the CHNA by recommending institutional and community leaders for participation, offering observations about community need, and providing insight about existing and planned programs.Qualitative data collected during the CHNA consist of: (1) interviews completed with internal stakeholders (i.e., hospital-based and Lifespan-based); (2) nearly two dozen key informant interviews with community leaders, representing an array of constituencies; and (3) a Community Stakeholder Survey of 54 organizations statewide.Interviews with leaders of organizations encompassed a wide range of issues and populations, including historically underserved communities, such as minority populations, children and youth, and immigrant/refugee populations, and also included leaders of organizations with specific interest or expertise in key issues such as obesity, cancer, and asthma. In a few cases, organizations submitted a completed questionnaire in lieu of participating in an interview. Leaders of organizations with a statewide focus on policy, advocacy, and social service provisions were interviewed, covering a broad range of social issue areas. A standard format and questionnaire were used for each interview.To ensure representation from a broad cross-section of the community, a statewide survey of 54 key community stakeholders was conducted. Those surveyed included members of medically underserved, low-income, and minority populations in the community; representatives of organizations that had knowledge, information, or relevant experience re: the health needs of the community (including the Brown University School of Public Health, The Warren Alpert Medical School of Brown University, the Economic Progress Institute, the United Way, and others); and representatives of the Rhode Island Department of Health. The survey was a 19-question instrument designed to elicit information about the general health and social needs of the community. Over 75% of those surveyed self-reported that they serve constituencies spanning either the entire State of Rhode Island or the entire State of Rhode Island and southeastern Massachusetts. Community Stakeholder Survey Respondents:1. AARP, Executive Director2. African Alliance of RI, President3. Aids Project RI, Executive Director4. American Cancer Society5. American Lung Association of the Northeast, Director of Health Education6. Blue Cross/Blue Shield7. Brown School of Public Health8. Camp Street Community Ministries9. Center for Prisoner Health and Human Rights, Miriam Hospital/Brown University Medical School, Executive Director10. Chinese Nursing Association11. Community Asthma Program12. Community Health Workers Association of Rhode Island, Brown Medical School13. Crossroads of Rhode Island, Director of Social Services14. Rhode Island Department of Health, Manager, Safe Rhode Island/Rhode Island Youth Suicide15. Rhode Island Department of Health16. Gateway Healthcare17. Goodwill Industries of Rhode Island, Case Manager / Employment Services Coordinator18. Health Centric Advisors, Senior Scientist19. Health Leads Providence, Executive Director20. Injury Prevention Center at Rhode Island Hospital21. James L. Maher Center, CEO22. Jewish Alliance of Greater Rhode Island, Community Relations Director23. Martin Luther King Community Center, Executive Director24. McAuley House, Associate Director25. Mental Health Association of Rhode Island, Executive Director26. The Miriam Hospital, Ambulatory TB/Immunology Department, Clinical Manager27. Mount Hope Learning Center28. Mount Hope Neighborhood Association29. NAACP Providence, President30. National Association of Social Workers (NASW) RI Chapter, President31. Newport County Community Mental Health Center32. Overeaters Anonymous33. Parent Support Network of Rhode Island34. Partnership to Reduce Cancer in RI, Secretary35. Progreso Latino, Executive Director36. Project Night Vision, Founder37. Providence School Department38. Refugee Clinic at Hasbro Children's Hospital39. Rhode Island Division of Elderly Affairs, Director40. Rhode Island Health Center Association, President & CEO41. Rhode Island Parent Information Network42. Rhode Island Public Health Association, President43. Rhode Island Public Health Institute at Brown University, Executive Director44. Rhode Island Adult Education Professional Development Center, Director45. Rhode Island Breast Cancer Coalition46. Rhode Island Dept. of Corrections, Medical Program Director47. Rhode Island Free Clinic48. Samuels Sinclair Dental Center, Director49. Socio-Economic Development Center for Southeast Asians, Executive Director50. Taming Asthma51. TB & Immunology, The RISE Clinic (The Miriam Hospital)52. United Way of Rhode Island, Director of Annual Giving53. Visiting Nurses Services of Newport and Bristol Counties54. Women's Center of Rhode Island, Residential Supervisor Part V, Line 6a - List Other Hospital Facilities that Jointly Conducted Needs Assessment Rhode Island HospitalEmma Pendleton Bradley HospitalNewport Hospital Part V, Line 7d - Description of Making Needs Assessment Widely Available A copy of the Community Health Needs Assessment report issued for TMH as of September 30, 2013 can be obtained by visiting: http://www.lifespan.org/Lifespan-Community-Health-Needs-Assessment-Reports.aspx or http://www.miriamhospital.org. Part V, Line 16i - Other Means Hospital Facility Publicized the Policy An abbreviated version of TMH's financial assistance policy is posted in various admitting and outpatient areas of TMH. Additionally, registration personnel refer uninsured and/or low income patients to Patient Financial Counselors to discuss the policy and/or answer any questions they might have. Part V, Line 18d - Other Collection Actions Against a Patient Once an account balance or a portion thereof is classified as self-pay, it is placed with TMH's pre-collect company until the balance is paid in full, a monthly payment plan is in place, or insurance information is provided for billing.After 120 days, if there is no payment activity, the account qualifies for bad debt and the pre-collect company returns the account to Patient Financial Services, which in turn forwards it to a collection agency.The collection agency sends 3 to 5 notices to the patient requesting payment. If there are no responses after the notices are sent, collection calls are made. If there is no response after 120 days, the account is reviewed for legal action in the appropriate court.If there are no assets to pursue, the collection agency deems the account uncollectible and returns it to Patient Financial Services for write-off.Note: In accordance with Center for Medicare and Medicaid Services mandates, Medicare patient accounts are held 130 days from last payment, after which if there has been no activity, the account is referred to collection. Part V, Line 19d - Other Actions Took Before Any Collection Actions TMH engages third parties to perform certain collection actions on its behalf. A pre-collect company is used for all self-pay accounts. Additionally, a collection agency is used if there is no payment activity on such accounts after 120 days. The collection process is explained in further detail in the response to Question 18d above. 17 Cardiovascular Institute 950 Warren Avenue East Providence RI 02914 Outpatient Cardiac Clinic TMH Diagnostic Imaging Center 195 Collyer Street Suite 101 Providence RI 02904 Outpatient Radiology Womens Medicine Collaborative 146 West River Street Providence RI 02904 Comprehensive Women's Outpatient Clinic Cardiovascular Institute 208 Collyer Street Suites 100 102 Providence RI 02904 Outpatient Cardiac Clinic TMH Immunology Research Center 14 Third Street 11 Fourth Street Providence RI 02906 Outpatient Counseling Cardiovascular Institute 1454 South County Trail Suite 2000 East Greenwich RI 02818 Outpatient Cardiac Clinic TMH Weight Control & Diabetes Research 196 Richmond Street Providence RI 02903 Outpatient Research & Education TMH Behavioral Medicine Research 1 Hoppin Street Providence RI 02903 Outpatient Research & Education TMH Cardiac RehabPulmonary Rehab 208 Collyer Street Providence RI 02904 Outpatient Cardiac Clinic TMH Laboratory 1 Hoppin Street Providence RI 02903 Phlebotomy Lab TMH Outpatient Rehabilitation 195 Collyer Street Providence RI 02904 Outpatient PT, OT, and Speech Rehab TMH Laboratory 1 Commerce Street Lincoln RI 02865 Phlebotomy Lab TMH Immunology Center 1125 North Main Street Providence RI 02904 Outpatient Clinic TMH Laboratory 400 Bald Hill Road Warwick RI 02886 Phlebotomy Lab RISE TB Clinic 14 Third Street Providence RI 02906 TB Clinic TMH Behavioral Medicine Clinic 146 West River Street Providence RI 02904 Outpatient Clinic TMH Pre-admission Testing Center 208 Collyer Street Third Floor Providence RI 02904 Outpatient Pre-admission Assessment and Education Part I, Line 3c - Charity Care Eligibility Criteria (FPG Is Not Used) The Miriam Hospital (TMH) uses a dual system for determining financial aid eligibility: federal poverty guidelines and an asset test.The financial screening process at TMH is intended to define probable eligibility for public assistance (Medicaid or Community Free Service ("CFS")) for those patients who do not have the means to pay for hospital services rendered, as follows:1. Upon patient indication of an inability to pay required monies, the patient is offered the financial screening option to determine eligibility for public assistance (Medicaid, CFS).2. The application for CFS is completed and includes information relative to income, expense, and other available resources, and requires proof of such information which may include:- most recently filed Federal income tax return and W-2 form(s)- copies of most recent savings and/or checking account statements- two most recently received payroll check stubs- copy of rent receipts for the last six months for proof of residency- copy of utility bills for the last month for proof of residency3. If the patient's financial situation falls within the guidelines for eligibility for Medicaid, RIte Care, or CFS, or if the patient has a long-term disability, the appropriate application process is completed. (Assistance to complete such applications is available from the Patient Financial Advocates (PFA) Office at the Hospital.)4. Uninsured patients receive a discount equal to the discount received by Medicare beneficiaries on TMH charges. Under Section 501(r)(5), the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care are the amounts generally billed to individuals who have Medicare insurance covering such care. In no case was there a situation where an uninsured patient paid more than amounts reimbursed from Medicare.5. Eligibility for CFS above the discount is provided for those applicants whose family gross income is at or below twice the Federal Poverty Guidelines, with a sliding scale for individuals up to three times the poverty level in effect at the time of application. Full charity care applicants with assets worth more than $9,400 for an individual (or $14,100 for a family) may not qualify for care without charge, but will qualify for discounted care. While the maximum 100% discount may not be available to all charity care applicants based on the results of their asset test, all uninsured patients who receive care are eligible for, at a minimum, the same charity care discount as provided by the Medicare program. 6. For patients who qualify for less than 100% of the financial assistance program, a payment schedule is determined and agreed upon (discussed further below). Payment arrangements are established prior to service for non-urgent care. 7. In either case, the final results of the financial screening are recorded in the comments section of the Hospital's billing system.Requests for Payment Arrangements:Patient Financial Advocates (PFA) will qualify patients that are receiving non-urgent, medically indicated procedures prior to services. The PFA will request 75% to 100% of estimated discounted charges if the balance is under $5,000 and 50% to 100% of estimated discounted charges if the estimated bill equals or exceeds $5,000.For elective or non-urgent cases, the policy will require financial clearance prior to services or an exception from the Medical Director based on the clinical circumstances if the patient cannot meet the above payment agreement.Patients who do not qualify for total or partial CFS, but who have difficulty in paying their bills after services are rendered, may request enrollment in a payment plan. Eligibility for the payment plan includes the following guidelines:1. Immediate payment in full will result in financial hardship to the patient or the patient's family.2. Deposit of one-half of the estimated total bill is requested prior to admission.3. The minimum monthly payment of $50.00.4. The maximum length of the payment plan is twenty-four months.The Customer Service staff will set up the payment plan using the above guidelines as well as complete the necessary information on the "Payment Agreement" form and mail to the patient for signature. Account documentation will be done online. The pre-collect agency will be sent a copy of the payment agreement and all forms will be scanned into the PFS Optical Imaging System. Part I, Line 7 - Explanation of Costing Methodology TMH's costing methodology used to calculate the amounts reported in Part I, Line 7 is as follows:a) Financial assistance at cost- involves utilization of a ratio derived from dividing patient costs, as defined, by patient charges, as defined, and applying that percentage to total charity care charges.Patient costs reported in the cost accounting system are calculated based on Medicare principles of reimbursement by reducing total operating expenses (as calculated by Form 990 requirements) by items such as bad debt expense, the cost of medical education, internally funded research, subsidized health services, community services, charitable contributions, and other operating revenue. Patient costs are then divided by patient charges to determine a ratio of cost to charges (RCC). This RCC is applied as the costing methodology for determining charity care expense.b) Medicaid- Medicaid expense is determined at cost as calculated by TMH's cost accounting system. The system applies historical costing methods applied to all patient segments based on various patient demographics and utilizations. These costing standards exclude bad debt, charity care, and the Medicaid portion of costs of health professions education, which are reported on other areas of Line 7. These expenses include Medicaid provider taxes. Direct offsetting revenue is reported as amounts received from Medicaid, as well as other payments which include reimbursement under Federal "Upper Payment Limit" (UPL) and "Disproportionate Share Hospital" (DSH) programs.e) Community health improvement services and community benefit operations- Community benefit operations expense is recorded as direct expenses incurred as reported by TMH's Community Health Services Department. Revenue received for these services is reported as direct offsetting revenue. f) Health professions education- Health professions education expenses represent direct costs related to amounts associated with resident and intern programs utilized at TMH. These costs are determined by reporting actual direct costs taken from the Medicare cost report. Direct offsetting revenue is reported as any direct Medicare reimbursements received for such services provided, as reported in TMH's Medicare cost report.g) Subsidized health services- Subsidized health services' community benefit expense is determined by TMH's cost accounting system. These subsidized health services are recorded at cost in TMH's cost accounting system for all qualified subsidized health service divisions. This expense is adjusted to remove all related Graduate Medical Education (GME) expenses, as well as bad debt, Medicaid, and charity costs already reported in the applicable sections of Line 7. Net patient service revenue is recorded as amounts received from various payer types related to these services. Revenue associated with Medicare GME and Medicaid is excluded from the amount disclosed for subsidized health services.h) Research- TMH conducts extensive medical research focused on the prevention and treatment of HIV/AIDS, obesity, cancer, diabetes, cardiac disease, neurological problems, orthopedic advancements, and mental health concerns. For all internal and external research conducted, the costs associated with these activities is calculated by combining the direct and indirect costs as reported within TMH's cost accounting system. Revenue received for these services is reported as direct offsetting revenue. i) Cash and in-kind contributions for community benefit- Expenses for cash and in-kind contributions for community benefit are made by the Hospital, including an allocation of contributions made by Lifespan Corporation on TMH's behalf. Part I, Line 7, Column F - Explanation of Bad Debt Expense The calculation of percentages disclosed for Schedule H, Part I, Line 7, column (f) "percent of total expense", does not include bad debt expense. Form 990, Part IX, Line 25 includes bad debt expense of $15,363,104. Part III, Line 2 - Methodology Used To Estimate Bad Debt Expense The amount reported as bad debt expense is determined by applying the ratio of cost to charges (RCC) to the total charges written off to bad debt. The RCC rate is determined using data from TMH's cost accounting system and is adjusted for medical education, internally funded research, subsidized health services, community services, and charitable contributions. Discounts and payments are applied to patient accounts before such account balances are transferred to bad debt. Part III, Line 3 - Methodology of Estimated Amount & Rationale for Including in Community Benefit Accounts pending transfer to bad debt are reviewed by the TMH's patient advocate staff to determine qualification for financial assistance under TMH's policy. Accounts with insufficient information to determine eligibility are assigned a separate identifying code. These accounts are ultimately transferred to bad debt if the appropriate qualifying documentation is not received. The amount reported on Schedule H, Part III, Section A, Line 3 represents the account balances at charge written off to bad debt from the pending code, which are in turn converted to cost by applying the RCC rate as identified in Schedule H, Part III, Section A, Line 2. Part III, Line 8 - Explanation Of Shortfall As Community Benefit There is not a Medicare shortfall for fiscal year 2015. If there was, it would not be treated as community benefit.The source of the Medicare allowable costs reported on Part III, Section B, Line 6 is the Medicare cost report, Form 2552-10. Part III, Line 9b - Provisions On Collection Practices For Qualified Patients For patients who've been identified as qualifying for financial assistance, TMH does not bill for the excess of charges over agreed upon reimbursement amounts from third-party payors. Rather, such differences are recorded as a reduction of revenue through contractual adjustments. Collection efforts are focused on co-payments, deductibles and amounts denied by insurers. After all collection attempts are exhausted, any remaining balances, including any co-payments and deductibles, are written off as a bad debt. TMH classifies its bad debts as uncompensated care. This does not apply to Medicaid, however, as there are no associated co-payments or deductibles for this payor.TMH does not require collateral or other security in extending credit to patients; however, it routinely obtains assignment of patients' benefits payable under their health insurance programs, plans or policies. Uninsured patients are offered Community Free Service and/or payment plan options.Lifespan's Patient Financial Services Department (PFS) has the responsibility for communicating and administering collection policies and procedures to all patient accounts. PFS engages the services of various pre-collect agencies as necessary. The following are highlights of the overall collection effort:* If a patient presents for admission who is not insured, staff assists the family with a Medicaid application.* If the patient is ineligible for Medicaid, a financial screening is performed to determine status of qualification for Community Free Service.* If the patient does not qualify for Community Free Service, PFS or the pre-collect agency attempts at least four contacts with the responsible party within the first 120 days.* If the third-party carrier denies in writing any responsibility for payment, arrangements regarding an extended payment plan are discussed with the patient.* At 120 days, if there is no payment activity or no hold placed on the account, the account is transferred to the appropriate collection agency. Part VI - Needs Assessment Lifespan's Office of Strategic Planning and Analysis performs population-based studies for TMH regarding the need for inpatient medical and surgical services for both adults and children and a wide range of outpatient services including: primary care office visits, specialty care, emergency services, imaging, ambulatory surgery, and specific high technology services such as radiation therapy and bone marrow transplantation. A population-based study examines the growth and changes in the population, the resources in the community, and the changing prevalence of diseases. In addition to this approach, Lifespan Strategic Planning also examines experience with wait times, the level of staffing, and the changing standards of care. All of this information is used to assess the demand for additional services to provide access to high quality care.In addition to population approaches to assessing and estimating need, all specialties and services monitor demand at the service-specific level by considering changing patterns of care and methods of treatment for the specific medical problem, wait times for visits/queues, and community resources. The service leadership then goes through a review process to add staff, expanded hours, and/or new sub-components to round out core services on an as-needed basis. At times, expansion requires more space, equipment, and staff, but often accommodation of community demand is achieved through expanded hours. Facilities are added as needed to accommodate these expansions, but most often minor renovations of existing locations with better, more modern layouts and equipment allow for greater patient access.The RI State Certificate of Need program requires a focused study of need for all projects over $5.25 million, which is an important part of the program development process across Lifespan.Based on a broad understanding of community health needs, TMH provides a wide range of services to both its primary and secondary service areas. Lifespan and its hospital affiliates monitor health trends in Rhode Island in an effort to identify areas of unmet demands regarding clinical services. Part VI - Patient Education of Eligibility for Assistance TMH has multilingual signage in its main lobby and waiting areas which provides information on financial aid contacts. The Registration Department meets with patients at the outset of care to discuss eligibility for assistance. The Registration staff provides interested patients with a "Welcome" booklet which includes information on patient rights and responsibilities. The signage and booklets contain a telephone number which connects patients with Registration staff who can answer any additional questions that may arise after the patient has left TMH. Assistance eligibility is also summarized on TMH's website, http://miriamhospital.org.As part of TMH's inpatient intake process, TMH provides a summary of the financial assistance policy, along with all assistance applications, and the Patient Financial Services contact number to all self-pay patients. The same process is also used for patients seen during the outpatient discharge process. Attempts are made to contact patients prior to their visit to screen for financial assistance and to inform them what documents are required for their financial assistance determination or to set up an appointment to see a "Patient Financial Advocate" (PFA) prior to service. PFA's discuss with patients the various government programs that might be available to them for financial assistance. PFA's also offer assistance with the financial application process and/or understanding the qualification factors for Medicaid, the Affordable Care Act, Medicare, Social Security Disability, Supplemental Nutrition Assistance Program (SNAP), and Rhode Island Temporary Disability Insurance and Unemployment. This is done for both inpatient and outpatient services. Part VI - Community Information TMH, located in Providence, Rhode Island, is a 247-bed nonprofit general acute care teaching hospital with university affiliation providing a comprehensive range of diagnostic and therapeutic services (excluding obstetrics) for the acute care of patients principally from Rhode Island and southeastern Massachusetts. As a complement to its role in service and education, the Hospital actively supports research. TMH is accredited by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) and participates as a provider primarily in Medicare, Blue Cross, and Medicaid programs. TMH is also a member of the formally named Voluntary Hospitals of America, Inc., which has partnered with UHC Alliance NewCo, Inc. to become Vizient, Inc. Vizient, Inc. is the largest member-owned health care company in the United States.In 1969, TMH and certain other Rhode Island hospitals entered into an affiliation agreement to participate jointly in various clinical training programs and research activities with The Warren Alpert Medical School of Brown University (Brown). TMH is designated as a major teaching affiliate of Brown. The goals of the partnership are to facilitate the expansion of joint educational and research programs in order to compete both clinically and academically.With respect to nursing education, TMH has developed formal and informal educational affiliations with a number of accredited New England colleges and universities. TMH does not receive any compensation from the various schools for providing a clinical setting for the student nurse training.TMH conducts extensive medical research and is in the forefront of biomedical health care delivery research and among the leaders nationally in National Institutes of Health programs. Part VI - Community Building Activities TMH substantially subsidizes various health services including various clinics and certain other specialty services. TMH also provides numerous other services to the community for which charges are not generated. These services include certain emergency services, community health screenings for cardiac health, prostate cancer and other diseases, smoking cessation, immunization and nutrition programs, diabetes education, community health training programs, patient advocacy, foreign language translation, physician referral services, and charitable contributions. Part VI - Explanation Of How Organization Furthers Its Exempt Purpose TMH is governed by a Board of Trustees, which is composed of leaders of the local community elected by Lifespan Corporation. TMH's purpose is to at all times be operated exclusively as a tax-exempt charitable hospital and, as such, shall dispense medical and surgical aid and care to the sick and disabled of any race, creed, or color in keeping with Jewish ethical aspirations; shall act in a fashion designed to further, improve, and advance the science or art of health care delivery, patient care, and the knowledge, practice, and teaching of medicine and nursing; and assist in the advancement of medical research and investigation and in the improvement of medical teaching facilities and methods. TMH works collaboratively with physicians, its employees, other health care organizations, and the community to create a measurably healthier community through the provision of high quality, cost-effective, customer-focused health care services in an environment that promotes patient safety. TMH monitors the healthcare needs of its service area to ensure alignment of its resources with its mission. TMH measures the results of the programs and services it provides based on the value added to the community as well as the financial health of each program and its impact on TMH. TMH is organized and operated for the benefit of the community it serves. Part VI - Affilated Health Care System Roles and Promotion Lifespan's mission is delivering health with care. Lifespan is an academically based healthcare system at the forefront of medical care, continually engaging in research that will lead to medical breakthroughs. Lifespan affiliates provide comprehensive inpatient and outpatient medical, surgical, and psychiatric services for adults and children. Lifespan and its affiliates employ approximately 14,000 people. The Lifespan system has approximately 2,400 physicians on the medical staffs of its affiliated hospitals, operates 1,155 licensed beds in four hospital complexes, and in 2015 generated approximately $1.9 billion in total operating revenue. By each of these measures, Lifespan is Rhode Island's largest health system, serving a population of over 1.5 million. Three of its hospital members, Rhode Island Hospital (RIH), TMH, and Emma Pendleton Bradley Hospital (EPBH), are teaching affiliates of The Warren Alpert Medical School of Brown University, with 69 percent of the residents and fellows in this program based at RIH, TMH, and EPBH.Lifespan is a Rhode Island nonprofit corporation that is community-based and community-governed. As a nonprofit organization, Lifespan is run by a voluntary Board of Directors who are community representatives. Lifespan and all of its nonprofit hospital affiliates have received written notification from the Internal Revenue Service that they have been recognized as being organized and operated as entities described in Internal Revenue Code (IRC) Section 501(c)(3) and are generally exempt from income taxes under IRC Section 501(a).As of September 30, 2015, Lifespan Corporation employed approximately 940 full-time and part-time personnel, most of whom are located in Providence, RI. Lifespan Corporation provides support services to its affiliates, such as information services, telecommunications, risk management, legal, communications and public affairs, fundraising, facility development, strategic planning, internal audit/compliance, human resources, finance, payor contracting, and investment management, for which each affiliate is charged a fee equivalent to the costs incurred by Lifespan in providing these services.Corporate Authority and RoleLifespan Corporation has no members and is governed by its Board of Directors. The Board has responsibility for planning, directing, and establishing policies intended to assure the development and delivery of quality health services, professional education, and biomedical research on an integrated, cost-effective basis. The Board's powers include the power to set accounting policies for its affiliates, develop, negotiate, and approve all managed care agreements, develop affiliations with other institutions for educational and research purposes, and approve human resource plans, executive compensation, and benefits for system affiliates. The bylaws of TMH confer certain reserved powers on Lifespan to provide it with the means of effective oversight, coordination, and support of the system. Powers reserved to Lifespan as sole member include: to elect and remove trustees; to approve the election of and to remove certain officers; to approve the amendment of the Articles of Incorporation and Bylaws and other Charter documents; to approve strategic plans; to approve investment policies and any capital or operating budgets or material non-budgeted expenditures; and to authorize incurrence or guaranty of material indebtedness.For a complete listing of affiliated members of Lifespan's integrated healthcare delivery system, please refer to Schedule R. Part VI - States Where Community Benefit Report Filed RI true Billy Taylor House 185 - 187 Camp Street Providence RI 02906 461249425 501(c)(3) 6000 0 General Support Brown University 164 Angell Street Providence RI 02912 050258809 501(c)(3) 155870 0 General Support City of Providence 25 Dorrance Street Providence RI 02903 056000329 Government Org. 108000 0 Payment in lieu of taxes Festival Ballet Providence 825 Hope Street Providence RI 02906 050377245 501(c)(3) 7910 0 General Support Groundwork Providence 8 Third Street Providence RI 02906 050397766 501(c)(3) 12500 0 General Support Mt Hope Learning Center 140 Cypress Street Providence RI 02906 050502405 501(c)(3) 12000 0 General Support Mt Hope Neighborhood Assoc 199 Camp Street Providence RI 02906 222599257 501(c)(3) 10650 0 General Support Rhode Island Medical Society 235 Promenade Street Providence RI 02908 050250010 501(c)(3) 7500 0 Health Program Support Thundermist Health Center 191 Social Street Woonsocket RI 02895 050355097 501(c)(3) 49500 0 Health Program Support 9 0 Additional Supplemental Information The Miriam Hospital is committed to community programs and provides support to various charitable organizations in Rhode Island. Donations are made to organizations recognized by the IRS as being described in IRC Section 501(c)(3). All contributions are approved by management and are made to organizations whose missions and goals align with those of the Hospital.In 2012, Lifespan, on behalf of Rhode Island Hospital and The Miriam Hospital, reached an agreement with the City of Providence, Rhode Island to make voluntary payments to help stabilize the city's financial health. Lifespan has always maintained a strong commitment to Providence through its many community-based programs, as well as through the charity care it provides. As an organization, Lifespan understands that Providence's fiscal health is vital to the economic health of the entire State of Rhode Island. The agreement is a groundbreaking partnership that demonstrates Lifespan's commitment to help ensure a strong and vital Providence. X true true X X X X X false true false false false false false true false false Arthur J Sampson President 433050 132000 233529 15600 16714 830893 171029 Barry L Sharaf MD Physician 366917 95468 13526 14950 19560 510421 Douglas M Burtt MD Physician 350408 103485 12793 14950 22156 503792 Jinnette D Abbott MD Physician 366424 100382 10659 14950 22834 515249 Kenneth E Arnold Secretary 479128 155561 97877 13000 17234 762800 Maria P Ducharme Chief Nursing Officer 213620 62500 48922 48621 23207 396870 33569 Mary A Wakefield Treasurer 645835 221000 800372 107538 16554 1791299 526051 Paul C Gordon MD Physician 366263 130479 11396 14950 4802 527890 Robert W Corwin MD Chief Medical Officer 293198 75000 67932 6500 19204 461834 Samuel C Dudley MD Physician 489756 49000 1674 14950 3376 558756 Timothy J Babineau MD Trustee 1037312 616410 443654 285101 23391 2405868 123313 Part I, Line 1a: Relevant information in regards to selections on 1a. Tax Indemnification and Gross-up Payments:The Lifespan Executive Long Term Disability program provides financial protection to designated Lifespan executives in the event that they become disabled. Premiums are paid to the insurance carrier by the insureds on an after tax basis to allow for income replacement at a reasonable cost. The income associated with the premiums is grossed-up to cover the total cost of the benefit as provided in the Lifespan Executive Benefit Plan and is included in Medicare wages, more specifically on Schedule J, Part II, Column B (iii).Also, TMH purchases professional liability prior acts coverage for certain newly-hired physicians. Premiums were paid to insurance carriers by the insureds on an after tax basis. The income associated with the premiums is grossed-up to cover the total cost of the benefit as provided in their employment contracts and is included in Medicare wages, more specifically on Schedule J, Part II, Column B (iii). Part I, Line 7: Non-Fixed payments not listed above The Lifespan Annual Incentive Compensation Plan provides a financial award opportunity for designated members of management, based on quantified objectives that are approved in advance by the Compensation Committee of the Lifespan Corporation Board of Directors. A specified level of financial and non-financial performance must be met before any award is earned. The objectives vary from year to year and generally include various aspects of financial measures in addition to non-financial performance measures. For certain participants in the Annual Incentive Compensation Plan, the award opportunity is divided into two pools. The first pool represents 70% of any earned incentive award, based on the achievement of the team performance objectives. The remaining 30% pool is distributed on an individual basis to participants at the discretion of the CEO, in each case subject to approval by the Compensation Committee of the Lifespan Corporation Board of Directors.Additionally, certain physicians and executives participate in incentive compensation plans arranged through individual contractual agreements which stipulate non-fixed payments based on meeting criteria comprised of various quality and productivity markers. Part III, Additional Information Included in the Schedule J, Part II, Line (B)(iii) calendar year 2014 compensation for Timothy J. Babineau, MD, President & Chief Executive Officer, was a retention payment of $250,000 (earned during the transition to a new Lifespan CEO) made by Lifespan Corporation to Dr. Babineau in his capacity as President & CEO of the Lifespan health system.Included in the Schedule J, Part II, Line (B)(iii) calendar year 2014 compensation for Mary A. Wakefield, Executive Vice President & Chief Financial Officer, was a one-time retention payment in the amount of $700,000 (earned during the transition to a new Lifespan CEO) made by Lifespan Corporation to Ms. Wakefield in her capacity as EVP & CFO of the Lifespan health system. A RIHEBC Series 2006A 521300173 762243SS3 2006-02-14 40725126 Refund 1996 & 2002 Bonds false false true B RIHEBC Series 2009A 521300173 762243K36 2009-03-30 19582506 Construction & Renovations false false true A 10552480 37924625 40725126 348652 968829 39407645 2006 false true true true B 19582506 1954745 300287 339121 12380113 4608240 false false false true A false false false true true 0.00310 0.00760 0.01070 false false true B false false false true true 0.00500 0.00500 false false true A false false false true false false false true B false false false true false false false true A false B false Part VI Schedule K, Part I, Lines A & B, Column (f):The proceeds of the Series 2006A Bonds were used: (i) to advance refund a portion of the $214,585,000 Hospital Financing Revenue Bonds, Lifespan Obligated Group Issue, Series 1996; (ii) to advance refund a portion of the $78,000,000 Hospital Financing Revenue Bonds, Lifespan Obligated Group Issue, Series 2002; and (iii) to pay certain expenses incurred in connection with the issuance of the Series 2006A Bonds.The proceeds of the Series 2009A Bonds are being used for the purposes of financing projects consisting of: (i) the acquisition, construction, renovation, expansion and equipping of certain hospital and related health care facilities owned and operated or to be owned and operated by one or more of Rhode Island, The Miriam, or Emma Pendleton Bradley Hospitals, located at and in the vicinity of TMH Campuses; (ii) equipping, furnishing, and improving facilities and other depreciable assets used in health care operations on the TMH Campuses; (iii) the funding of a debt service reserve fund for the Bonds; and (iv) and the payment of certain expenses of issuance with respect to the Bonds.Schedule K, Part IV, Line 2c:For the 2006 Lifespan Obligated Group bond issuance, a rebate computation was performed on May 31, 2014 which reflected no rebate due.For the 2009 Lifespan Obligated Group bond issuance, a rebate computation was performed on May 31, 2014 which reflected no rebate due.Schedule K, Part V:TMH has in place written post-issuance tax compliance procedures for tax-exempt obligations. To ensure that its bonds continue to qualify for tax-exempt status, TMH consults with bond counsel and other legal counsel and advisors, as needed, to ensure that all applicable post-issuance requirements are met. TMH has not identified any non-compliance with the requirements of its tax-exempt bonds. Marilyn J Weigner Employee 424312 Employee Comp. false Roberts Carroll Feldste Partner 100124 Legal Services false Citizens Asset Finance Off./Trustee 1777338 Debt Financing false Schedule L, Part V Supplemental Information * The spouse of Pamela Harrop, MD, Trustee, is employed as a physician at The Miriam Hospital (TMH). In fiscal year 2015, TMH paid Marilyn J. Weigner $424,312 for her services.* Edward Feldstein, Trustee, is a partner in Roberts, Carroll, Feldstein and Peirce, a law firm that provides legal services to a sister company, Lifespan Risk Services. The common parent of TMH and Lifespan Risk Services is Lifespan Corporation. During fiscal year 2015, Lifespan Risk Services paid Roberts, Carroll, Feldstein and Peirce $100,124 for services related to TMH matters.*Lawrence Aubin, Chair, and Shivan Subramaniam, Trustee, are Directors of Citizens Bank (Citizens). In 2013, Rhode Island Hospital (RIH), TMH, and Emma Pendleton Bradley Hospital (EPBH) entered into a master lease and loan and security agreement (the 2013 Financing) with Citizens Asset Finance, an affiliate of Citizens. RIH, TMH, and EPBH are jointly and severally liable for repayment of the 2013 Financing. TMH made debt service and interest payments (1.66%) of $1,777,338 in fiscal year 2015. Form 990, Part VI, Line 2: Description of Business or Family Relationship of Officers, Directors, Et Kenneth E. Arnold, Secretary, Timothy J. Babineau, MD, Trustee, and Mary A. Wakefield, Treasurer, are officers of related for-profit corporations. Mr. Arnold and Ms. Wakefield are officers of Lifespan Management Services Organization, Inc. (MSO) and Lifespan Risk Services, Inc. Dr. Babineau and Ms. Wakefield are officers of VNA Technicare, Inc. (VNA). Lawrence Aubin, Chairman, and Shivan Subramaniam, Trustee, are Directors of Citizens Bank.Jonathan Fain, Trustee, is the CEO of Teknor Apex Co. Bertram Lederer, Trustee, is a Director of Teknor Apex Co. Form 990, Part VI, Line 4: Description of Significant Changes to Organizational Documents Changes made to the orgnization's bylaws during the fiscal year ended September 30, 2015 include:(1) the Chairs of each of Rhode Island Hospital Foundation, The Miriam Hospital Foundation, Newport Hospital Foundation, Bradley Hospital Foundation, and Gateway Foundation are no longer considered ex-officio voting directors of Lifespan Corporation; and(2) the number of elected directors of the Board has been changed to a minimum of fourteen, from nine, and a maximum of thirty-one, from twenty-six. Form 990, Part VI, Line 6: Explanation of Classes of Members or Shareholder Lifespan Corporation is the sole corporate member of TMH. Form 990, Part VI, Line 7a: How Members or Shareholders Elect Governing Body Effective October 23, 2012, the Board of Directors of Lifespan and the Boards of Trustees of Rhode Island Hospital, TMH, Newport Health Care Corporation, Newport Hospital, and Emma Pendleton Bradley Hospital approved a restructuring of their governance. The restructuring has increased governance effectiveness and has streamlined governance operation, as well as provided a single strategic perspective for the Lifespan system hospitals. Pursuant to the restructuring, the bylaws of each of the affiliates were amended such that the composition of the boards of trustees of each of the hospitals and Newport Health Care Corporation is defined as those persons serving from time to time as the directors of Lifespan. As a result, the Boards of each entity are comprised of the same individuals. The Board of each entity retains its responsibilities and authorities notwithstanding the revision in its composition. The Board of Directors of Lifespan consists of not less than fourteen nor more than thirty-one directors, including the President and CEO of Lifespan, who serves ex-officio with vote.Additionally, the bylaws of TMH confer certain reserved powers upon Lifespan to provide it with the means of effective oversight, coordination, and support of the system. Powers reserved to Lifespan include: to elect and remove TMH trustees and to approve the election of and to remove certain officers. Form 990, Part VI, Line 7b: Describe Decisions of Governing Body Approval by Members or Shareholders As noted above, the TMH Board is comprised of the same individuals who serve on the Lifespan Board. Lifespan has the responsibility for planning, directing, and establishing policies intended to assure the development and delivery of quality health services on an integrated, cost-effective basis. Powers reserved to Lifespan, in addition to those noted above, include: to approve amendment of the Articles of Incorporation and Bylaws and other charter documents; to approve strategic plans; to approve investment policies and any capital or operating budgets or material non-budgeted expenditures; and to authorize incurrence or guaranty of material indebtedness. Form 990, Part VI, Line 11b: Form 990 Review Process The preparation and filing of the Form 990 and supporting schedules is the responsibility of the Executive Vice President & Chief Financial Officer (EVP/CFO) and Lifespan's Finance Department, with review by Lifespan's tax advisors, KPMG LLP (KPMG). The Form 990 is prepared by the accounting staff upon completion of Lifespan's annual independent audit and reviewed by the Corporate Services Tax Compliance Manager, the Director of Finance, and the Vice President of Finance - Corporate Services. The Form 990 is forwarded to KPMG for further review. KPMG provides the Tax Compliance Manager with any recommended changes which are reviewed, and if agreed upon, are incorporated into the return. The draft Form 990 is then provided to the EVP/CFO for final management review. Prior to filing the return with the Internal Revenue Service, a copy of the entire form, along with a video presentation detailing form highlights, are posted to the TMH's Board of Trustees website portal in advance of its next Board meeting, at which all questions and concerns of the members of the Board are addressed by the EVP/CFO and incorporated into the Form 990 when appropriate. Once the Form 990 is complete and ready to be filed, the members of the Board are notified via email that a copy of the final version of the Form 990 is accessible through the same password protected website portal. The EVP/CFO is authorized to file the Form 990. Form 990, Part VI, Line 19: Other Organization Documents Publicly Available Lifespan and the Lifespan Obligated Group, which consists of TMH, RIH and Affiliates, Emma Pendleton Bradley Hospital, Rhode Island Hospital Foundation, and The Miriam Hospital Foundation, currently make their annual and quarterly consolidated financial statements available to the public via DAC (Digital Assurance Certification LLC), a disclosure dissemination agent for issues of tax-exempt bonds which electronically posts and transmits Lifespan's financial information to repositories and investors alike. In addition, copies of TMH's Articles of Incorporation, Bylaws, and Conflict of Interest Policy are available upon request from the office of the Lifespan EVP/CFO, either in person or by mail. Other Changes In Net Assets Or Fund Balances - Other Decreases Change in funded status of pension and other postretirement = -$3385800 Other Changes In Net Assets Or Fund Balances - Other Decreases Decrease in Net Assets of TMHF = -$3793709 . In 2015, TMH was named the top hospital in Rhode Island and southeastern Massachusetts for the fourth consecutive year, according to U.S. News & World Report. Environmental Partnership Award:TMH has received the "Partner Recognition Award" from Practice Greenhealth, a health care membership community that promotes efficiency and environmental stewardship while improving patient safety and care.TMH has been named among the nation's 100 top hospitals for cardiovascular care by Thompson Healthcare. Thompson's annual study identifies hospitals that are setting benchmark levels of performance for cardiovascular services throughout the nation. It recognizes the hospitals and their management teams for superior clinical, operational, and financial performance in the area of cardiovascular service.TMH's cardiac surgery department is led by four board-certified cardiothoracic surgeons, each able to perform a wide variety of cardiac, thoracic, and peripheral vascular procedures. They represent more than ninety years of cumulative experience.Anesthesiologists dedicated to the management of complex cardiothoracic and vascular procedures provide each patient with the latest measures of intraoperative therapy and assessment. Every patient is monitored with a transesophageal echocardiogram (sonogram). TMH's team of surgeons, anesthesiologists, and cardiologists works closely together. This cooperative approach has led to outstanding results at all levels of complexity.Thanks to the latest evolution in surgical technology, physicians now have an effective alternative to traditional open surgery and laparoscopy that allows them to provide patients with the best of both approaches. This alternative is the da Vinci Surgical System and TMH uses this technology to treat different types of cancer.TMH's surgeons are leaders in their field. TMH, as part of an academic medical center, prizes the mastery of new technologies in order to improve the quality of life for patients. TMH surgeons have successfully performed over 1,000 procedures using the da Vinci surgical system and have made its use a cornerstone of cancer treatment at TMH. The Hospital's Adult Outpatient Behavioral Medicine Services help individuals improve health through behavior change. Services are offered to help patients adjust to chronic medical conditions, including their associated physical and emotional distress; modify unhealthy ways of living (for example, smoking cessation) to help prevent the onset or progression of disease; and treat mood and anxiety disorders that interfere with management of medical conditions. Services are available to help individuals with behavioral and psychosocial management of medical conditions such as headache, pain, cancer, heart disease (including those with implanted cardiac devices), pulmonary disease, and diabetes. The Weight Management Program provides comprehensive, medically supervised treatment for mild, moderate, and severely overweight adults. Specialized programs are also available for adolescents and diabetics. Treatment combines medical monitoring, behavioral therapy, exercise instruction, three levels of calorie reduction, and nutrition education. The Hospital's clinicians include surgical oncologists, medical oncologists, radiation oncologists, hematologists, pathologists, physical therapists, radiologists, nurses, clinical social workers, patient advocates, pharmacists, and nutritionists. These dedicated specialists work with patients every step of the way, from diagnosis to treatment to follow-up care.To help patients and their families cope with breast cancer, TMH offers the Breast Health Navigator Program. The program assists breast cancer patients through the entire course of their cancer care with breast health navigators, registered nurses trained in oncology who possess an in-depth understanding of breast cancer and theprocess undergone by patients. They guide patients through diagnosis, treatment, andrecovery, while helping them make informed decisions and cope with the variety of issues they face.TMH and RIH were named Blue Distinction Centers for Complex and Rare Cancers by Blue Cross and Blue Shield of Rhode Island. TMH and RIH are the only two hospitals in the State to receive this distinction. Blue Distinction Centers for Complex and Rare Cancers are facilities within participating Blue Cross and Blue Shield network service areas that offer comprehensive inpatient cancer care programs for adults, delivered by multidisciplinary teams with subspecialty training and distinguished clinical expertise in treating complex and rare subtypes of cancer. TMH and RIH have both been recognized for excellence in treating esophageal, gastric, liver, pancreatic, rectal, and thyroid cancer.The division of gastrointestinal and liver pathology is committed to providing high quality diagnostic services for gastrointestinal and liver diseases in patients.Collectively, gastrointestinal cancers are among the most common form of malignancies suffered today, affecting nearly a quarter of a million Americans each year. To address this, the Comprehensive Cancer Center has brought together nationally recognized leaders in the treatment and research of gastrointestinal cancers.The Center's team-based approach provides state-of-the-art care for patients who have or are at risk for cancers of the upper gastrointestinal tract, such as pancreatic cancer, cancer of the esophagus, and tumors involving the liver.The gastrointestinal cancer care services available through the Comprehensive Cancer Center provide care for patients who have or are at risk for the following types of cancer: bile duct, esophagus, gallbladder, endocrine, and cystic tumors of the pancreas, liver, and stomach. TMH also offers medical nutrition therapy on an outpatient basis designed to help prevent and control gastrointestinal disorders. Form 990, Part I, Line 6 Volunteers support and contribute to the mission of TMH every day. They are able to learn, meet other dedicated volunteers, better understand the healthcare environment, and gain personal satisfaction knowing they are making a difference to patients, families, visitors, and vendors alike. Volunteer opportunities are available for both teens and adults in a wide variety of positions, including greeters, family liaisons, emergency room support, gift shop support, nurse aides, office support, pet therapy, physical therapy, patient visitors, recovery room support, art therapy, and central transporters. Volunteers also transport students and serve as guides, escorts, and interpreter aides. Form 990, Part III, 4a: TMH is licensed to operate 247 acute care beds by the Rhode Island Department of Health. Notable medical accomplishments of TMH include performance of Rhode Island's first lung operation, first kidney transplant, and first aortic valvuloplasty (a procedure to clear blocked heart valves). In 2015, TMH discharged 16,690 inpatients, logged more than 62,000 visits in its Emergency Department, and performed more than 11,500 inpatient and outpatient surgical procedures. Services provided in 2015 represent 67,350 inpatient days and more than 86,000 clinic visits. TMH is staffed by more than 1,100 affiliated physicians, approximately 60 full-time house staff (medical school graduates), and a nursing staff of more than 700. In total, TMH employs more than 2,700 people. TMH is a major teaching affiliate for The Warren Alpert Medical School of Brown University, providing clinical rotations for residents.TMH provides full charity care for individuals at or below twice the federal poverty level, with a sliding scale for individuals up to three times the poverty level. In addition, a substantial discount consistent with Medicare program reimbursement is offered to all other uninsured patients. TMH determines the costs associated with providing charity care by aggregating the applicable direct and indirect costs, including compensation and benefits, supplies, and other operating expenses, based on data from its costing system. The total cost, excluding medical education and research, incurred by TMH to provide charity care amounted to $6,297,032 in fiscal 2015. Charges forgone, based on established rates, amounted to $17,770,911.TMH substantially subsidized various health services including the following programs: psychiatry, tuberculosis, and certain other specialty services at a net cost of $11,653,332 in fiscal year 2015. TMH also provides numerous other services to the community for which charges are not generated. These services include certain emergency services, community health screenings for cardiac health, prostate cancer and other diseases, smoking cessation, immunization and nutrition programs, diabetes education, community health training programs, patient advocacy, foreign language translation, physician referral services, and charitable contributions. The net cost of these services amounted to $308,236 in fiscal year 2015.TMH subsidizes the cost of treating patients who receive government assistance where reimbursement is below cost. Medicaid is a means-tested health insurance program, jointly funded by state and federal governments. States administer the program and set rules for eligibility, benefits, and provider payments within broad federal guidelines. The program provides health care coverage to low-income children and families, pregnant women, long-term unemployed adults, seniors, and persons with disabilities. Eligibility is determined by a variety of factors, which include income relative to the federal poverty line, age and immigration status, and assets.The Leonard and Adele R. Decof Family Comprehensive Cancer Center at TMH:This Comprehensive Cancer Center brings together world-renowned physicians and a team of specialists from Rhode Island Hospital (RIH), TMH, and Newport Hospital (NH), forming a multidisciplinary team whose level of knowledge and experience are unparalleled in the State of Rhode Island. TMH, as a part of the Comprehensive Cancer Center, provides state-of-the-art care for patients with cancer.Award-Winning Care:TMH has received many awards and distinctions, including: (1) the Quality Oncology Practice Initiative certification, demonstrating commitment to excellence and ongoing quality improvement practice; (2) Commission on Cancer three-year accreditation with commendation; and (3) Blue Distinction Center for Complex and Rare Cancers by Blue Cross and Blue Shield of Rhode Island.In 2015, The Miriam Hospital and Newport Hospital, both affiliates of Lifespan Corporation, tied for first place in U.S. News & World Report's best regional hospitals ranking. They were the only two hospitals in Rhode Island to make the list.Also in 2015, The Miriam Hospital received the highest nursing credential for the fifth time from the American Nurses Credentialing Center's (ANCC) Magnet Recognition Program. TMH is one of only four hospitals nationwide to achieve Magnet designation five times. The unanimous ANCC decision to redesignate TMH was based on its continued adherence to rigorous national standards of nursing practice, as well as meeting specific goals for nurse certification and nurse satisfaction and engagement. The Magnet Recognition Program serves as the gold standard for nursing excellence and provides consumers with the ultimate benchmark for measuring quality of care.During 2015, TMH was one of two local hospitals recognized by Becker's Hospital Review (BHR) as having among the lowest heart attack mortality rates in the nation. According to BHR, a health care industry website, 53 hospitals or health systems made the list, which based its findings on clinical data from the Centers for Medicare and Medicaid Services. All of the hospitals have a 30-day mortality rate from heart attack of 11.7% or less, below the national average of 14.2%, according to Becker's. TMH's rate is 11.4%.TMH was awarded a special designation for bariatric surgery in 2015, conferred by Blue Cross Blue Shield of Rhode Island. TMH is among the first hospitals in the nation to receive the designation. The Center for Bariatric Surgery has been a Center of Excellence in Bariatric Surgery since 2011 and was reaccredited in 2014 by the American College of Surgeons Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program.The Total Joint Center:The Total Joint Center at The Miriam Hospital (the Center) is dedicated to providing the most technologically advanced and specialized procedures focused on the replacement of joints and rehabilitation and care in treating diseases of, or injuries to, hips, knees, and shoulders. TMH is a Blue Cross Blue Shield Blue Distinction Center for Knee and Hip Replacement, which is a designation given to hospitals that demonstrate an expertise in quality care by meeting objective clinical measures, resulting in better outcomes for patients.In 2014, the Center earned The Joint Commission's Gold Seal of Approval for its knee and total hip replacement programs. The certification recognizes the Center's compliance with national standards for health care quality and safety in a disease-specific care set by The Joint Commission. It also acknowledges the Center's dedication to continuous compliance with The Joint Commission's state-of-the-art standards.Medical and surgical services at the Center are provided in a personalized, caring environment within the context of an academic medical center. All services focus on the patient experience from initial consultation through recovery.Multidisciplinary medical teams include many dedicated specialists - surgeons, internal medicine specialists, anesthesiologists, nurses, rehabilitation therapists, and social workers who work with patients from diagnosis to treatment to follow-up care. The physical therapy and nursing teams work together after surgery to get patients moving for faster recovery, and physicians, nurses, and therapists work collaboratively to follow up care.Each patient benefits from individualized treatment plans and rehabilitation to aid recovery and restore functionality as quickly as possible. Whenever possible, minimally invasive surgical techniques are used to perform surgery. These techniques have dramatically improved the quality of the post-operative and recovery experience for the patient. In certain cases, computer navigation technology is used for knee and hip replacement surgeries. Computer navigation can assist the surgeon and improve the level of accuracy, bringing the precision of bone cuts and implant alignment in joint replacement surgery to a whole new level of accuracy, reliability, and longevity.Stroke Care:In 2014, The Miriam Hospital received the Get With The Guidelines-Stroke Gold-Plus Quality Achievement Award for using American Heart Association/American Stroke Association quality improvement measures when treating stroke patients. The distinction acknowledges TMH's commitment to quality care. TMH treats more than 600 stroke patients each year and has received the Gold or Gold Plus designation for stroke care every year since 2008. The Get With The Guidelines-Stroke quality program embodies adoption of the latest research-based treatment guidelines intended to speed recovery and reduce death and disability among stroke patients. To receive the award, TMH met specific quality achievement measures for the rapid diagnosis and treatment of stroke patients. These measures include achieving and sustaining 85 percent or higher adherence to specific evidence-based guidelines over 24 consecutive months and aggressively usi Form 990, Part III, 4b: TMH conducts extensive medical research and is in the forefront of biomedical health care delivery research and among the leaders nationally in National Institutes of Health programs.Major areas of research include:Cancer - TMH conducts clinical and behavioral research focusing on the many facets of cancer including prevention, education, and therapeutics which are supported by the National Cancer Institute, CALGB, and NSABP. TMH is a participating hospital in the Brown University-sponsored Cancer Oncology Group (BrUCOG).AIDS - As part of the Lifespan/Tufts/Brown Center for AIDS Research (CFAR), division researchers engage in clinical, basic, and translational research designed to improve the prevention and treatment of HIV/AIDS, with a major focus on women, racial and ethnic minorities, and individuals with substance abuse problems.The Lifespan/Tufts/Brown CFAR is a joint research effort among Brown University and Tufts University and their affiliated hospitals and centers. It is one of 20 centers located at academic medical centers throughout the United States that are part of the national CFAR program of the National Institutes of Health. The program emphasizes the importance of interdisciplinary collaboration, especially between basic and clinical investigators, and also encourages training and mentoring of young investigators as well as an inclusion of women and minorities.HIV - At TMH, research focuses on the treatment and prevention of HIV infections, especially in hard-to-reach populations, both in the U.S. and abroad. There are international sites located in Cambodia, India, Kenya, Indonesia, The Philippines, and South Africa. The Lifespan/Tufts/Brown Center for AIDS Research conducts clinical, basic, and translational research programs. The TB Clinic performs research in the area of co-infections of HIV and tuberculosis. The Centers for Behavioral and Preventive Medicine aims to improve health through behavioral change and the integration of behavioral and biomedical science using clinical, community, and laboratory-based research.The Centers' research bridges biomedical, sociobehavioral, and population/public health scientific disciplines. Faculty members are committed to both basic research on discovering the mechanisms underlying behavioral factors in health and illness (e.g., examining the stress response among children and adolescents, neuroimaging of AIDS, and other medical conditions), as well as to applied research on the translation of these discoveries for clinical and community health improvement.Programs range from those that focus on primary prevention (e.g., promoting tobacco cessation, preventing weight gain, increasing physical activity, and HIV/AIDS prevention) to improving the effectiveness of treatment and enhancing quality of life in populations such as cancer survivors and patients enrolled in cardiac rehabilitation programs. Form 990, Part III, 4c: In 1969, TMH and certain other Rhode Island hospitals entered into an affiliation agreement to participate jointly in various clinical training programs and research activities with Brown Medical School, renamed The Warren Alpert Medical School of Brown University (Brown). The goals of the partnership are to facilitate the expansion of joint educational and research programs to compete both clinically and academically.TMH participates in Brown programs in internal medicine and medicine subspecialties, general surgery and surgical subspecialties, psychiatry, emergency medicine, orthopedics, and dermatology. TMH provides stipends to residents and physician fellows while in training.TMH is also a participating clinical training site for residents from other programs in anesthesiology, pediatric dentistry, family medicine, infectious disease, obstetrics/gynecology (OB/Gyn) and OB/Gyn subspecialties, otolaryngology, podiatry, psychiatry, geriatric psychiatry, orthopedics, rheumatology, and radiation oncology. In addition, TMH Behavioral Medicine, in collaboration with Brown, sponsors research and clinical psychology training programs for interns, postdoctoral fellows, and faculty trainees.With respect to nursing education, TMH has developed educational affiliations with the University of Rhode Island College of Nursing; Rhode Island College School of Nursing; Community College of Rhode Island (CCRI); Salve Regina University; Boston College; Yale University; Regis College; Simmons College; St. Josephs Health Services School of Nursing; the University of Massachusetts campuses at Dartmouth, Boston, Amherst, and Worcester; the University of Connecticut; New England Technical Institute; Northeastern University; Walden University; Georgetown University School of Nursing and Health Studies; and the University of Pennsylvania, as well as other Schools of Nursing, pursuant to which their nursing students obtain clinical training and experience at TMH. TMH does not receive any compensation from the various schools for providing a clinical setting for the student nurse training.TMH sponsors training programs for a variety of allied health care professionals including required clinical and fieldwork experiences in physical, speech, and occupational therapy to university students in each discipline through contracts with the various universities. TMH serves as a clinical training site for students from CCRI for the vascular and cardiology ultrasound programs and also provides training experiences for students in diagnostic radiology, medical technology, phlebotomy, and social work. TMH serves as a clinical training site for students from The Nuclear Medicine Institute of the University of Findlay (Ohio). TMH has clinical affiliations/student clinical training programs for pharmacy students provided through contracts with a number of colleges and universities. Form 990, Part VI, Section A, Line 1b: *Lawrence A. Aubin, Chair, is the owner of Lawrence Investments, LLC, with which Lifespan entered into a ten-year operating lease of certain health care facilities in July 2015. During fiscal year 2015, Lifespan paid rent to Lawrence Investments, LLC under the terms of this lease. Also, Lifespan entered into a credit agreement with Citizens Bank in April 2015 for a line of credit facility to finance working capital requirements. During fiscal year 2015, Rhode Island Hospital (RIH) and Emma Pendleton Bradley Hospital (EPBH) paid Citizens interest payments on the outstanding facility balance. *Shivan Subramaniam, Trustee, is the Chairman of FM Global and served as CEO of FM Global through December 31, 2014. Lifespan purchases property insurance coverage from Factory Mutual Insurance Company, a member of FM Global. Additionally, Mr. Subramaniam and Lawrence A. Aubin, Chair, are Directors of Citizens Bank. Also, Lifespan entered into a credit agreement with Citizens Bank in April 2015 for a line of credit facility to finance working capital requirements. During fiscal year 2015, RIH and EPBH paid Citizens interest payments on the outstanding facility balance. *Brian J. Zink, MD, Trustee, received taxable tuition reimbursement from RIH. Form 990, Part VI, Section B, Line 12c Lifespan Corporation has a Conflict of Interest Policy that is applicable to all affiliates, including TMH, and administered by Lifespan's Corporate Compliance Department as follows: Each designated person subject to Lifespan's conflict of interest policy is required to provide Lifespan with an initial disclosure statement and thereafter an annual statement attesting that: (i) the designated person has read and is familiar with this policy, and (ii) the designated person and, to the best of his/her knowledge, family members, have not in the past engaged in, are not presently engaging in, or plan to engage in, any activity which contravenes this policy.If, at any time during the course of employment or association, a designated person has reason to believe that an existing or contemplated activity may contravene this policy, the person shall submit a full written description of the activity to the Lifespan Compliance Officer or the Office of the General Counsel to seek a determination as to whether the contemplated activity does or does not contravene this policy. This requirement shall be acknowledged as part of the annual performance evaluation process. If the activity in question involves either the Chief Executive Officer, the Senior Vice President and General Counsel, or a Trustee, a full written disclosure must be made to, and a determination sought from, the Chairman of the Board of Directors of Lifespan Corporation.Annually, the Lifespan Compliance Officer shall review and report to the Lifespan Executive Corporate Compliance Committee and to the Lifespan Audit and Compliance Committee on the administration of this policy.Failure on the part of any designated person to comply with this policy, including failure to submit in a timely fashion the conflict of interest disclosure statement, will be grounds for removal from his/her position and/or termination of his/her employment with Lifespan. Form 990, Part VI, Section B, Lines 15 a&b The following applies to Lifespan and all of its affiliates, including The Miriam Hospital:EXECUTIVE COMPENSATIONLifespan's executive compensation philosophy balances appropriate stewardship of resources and the need to be competitive in recruiting and retaining talented individuals. It incorporates market-competitive and performance-related principles, and covers the President and CEO of Lifespan as well as other officers, senior management, and key employees. Lifespan's executive compensation program complies both with law and with contemporary ethical norms, and is administered consistent with the organization's tax-exempt status under Section 501(c)(3) of the Internal Revenue Code (IRC) and the avoidance of transactions subject to intermediate sanctions under Section 4958 of the IRC. Executive compensation is also administered consistent with Lifespan's Corporate Compliance Policy on Excess Benefit Transactions.The Compensation Committee of the Lifespan Corporation Board of Directors (the Committee), comprised of disinterested Lifespan and affiliate Board members, is responsible for diligent oversight of executive compensation to ensure compliance with IRC requirements. Its duties include:* Approving eligibility for participation in the executive compensation program * Approving changes in compensation for existing executive participants * Approving guidelines, such as salary ranges and contract terms, on appropriate levels of compensation for other key employees* Approving new, and modifying or terminating existing, executive compensation plans including, but not limited to, annual incentive and executive benefit plans* Approving performance objectives associated with Lifespan's annual incentive plan, including measuring points, and using audited actual performance relative to these objectives as a precondition to approving the payment of any awards under the plan* Authorizing periodic performance benchmark studies to be conducted for purposes of assessing Lifespan's performance within the healthcare industry and the degree to which total remuneration levels at Lifespan are generally commensurate with Lifespan performance relative to healthcare industry performance* Conducting an annual performance review of Lifespan's Chief Executive Officer. The Chair of the Committee conducts and documents this review, based on his/her observations and interpretation of feedback from members of the Board of Directors* Selecting and engaging qualified, independent, third-party compensation valuation consultants that the Committee charges with rendering opinions with respect to the reasonableness and comparability of compensation as well as the comparative organizations against which compensation is assessed, in accordance with relevant sections of the IRC and Lifespan's executive compensation philosophy. The independent consultants are not engaged by management to perform any services for Lifespan without prior approval by the Committee.Lifespan's Chief Executive Officer works closely with the Committee to make recommendations on the above topics and keep the Committee informed about contemplated compensation changes for executives and other key employees, as well as candidates for these roles. The CEO also provides periodic updates to the Committee regarding Lifespan's performance relative to compensation-related performance objectives. The Committee's deliberations and actions are documented in minutes prepared for each meeting.PROCESS FOR DETERMINING COMPENSATION Valuation of Total Cash and Total Remuneration: No less frequently than annually, the Committee receives and reviews a total cash compensation valuation of all existing executive compensation program participants prepared by its independent compensation consultant. Annually, the Committee also receives and reviews a total remuneration valuation of all existing executive compensation participants.Base Salary Actions: The CEO recommends any salary adjustments for participants in the executive compensation program, using the results of the valuation study and his/her assessment of individual performance or other pertinent information, for the Committee's consideration.New Participants in Executive Compensation Program: With respect to compensation offers for individuals expected to participate in the executive compensation program, certain members of the Lifespan CEO's Council work with the Committee's independent compensation consultant or relies on information previously provided by the consultant to establish a range of reasonable cash compensation within which recruitment is expected to conclude with acceptance of a reasonable compensation offer. Form 990, Schedule H, Part V, Line 10a: The URL to view TMH's most recently adopted implementation strategy is below:http://www.miriamhospital.org/uploadedFiles/TMH/Content/About_Us/MiriamCHNA_2013.pdfPlease refer to page 46 of the CHNA to view details of the implementation strategy. Form 990, Schedule H, Part V, Line 16b: The URL to view and download TMH's Financial Assistance Policy application form is below:http://www.lifespan.org/uploadedFiles/Lifespan/Content/Patient_Financial_Services/Lifespan-FAF-ENG.pdf Form 990, Schedule H, Part V, Line 16c: The URL to view TMH's plain language summary of the Financial Assistance Policy is below:http://www.lifespan.org/lifespan-customer-service.html Alternative Living Concepts 249 Roosevelt Avenue Pawtucket RI 02860 050442015 Housing for Elderly and Mentally Ill RI 501(c)(3) 9 Gateway Healthcare Inc false Bayberry Courts Inc 249 Roosevelt Avenue Pawtucket RI 02860 204590384 Housing for Elderly and Mentally Ill RI 501(c)(3) 9 Gateway Healthcare Inc false Bradley Hospital Foundation 167 Point Street Providence RI 02903 050500688 Philanthropic Activities RI 501(c)(3) 7 Lifespan Corporation false Capital City Community Centers Inc 249 Roosevelt Avenue Pawtucket RI 02860 050259090 Daycare Services RI 501(c)(3) 7 Gateway Healthcare Inc false Emma Pendleton Bradley Hospital 1011 Veterans Memorial Parkway East Providence RI 02915 050258806 Pediatric Psych. 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