2016-05-13T11:42:42-05:00 2015-06-30 990 2014-07-01 520610545 SUBURBAN HOSPITAL INC SUBU 3018963900 8600 OLD GEORGETOWN ROAD BETHESDA MD 208141497 MARTIN BASSO SR VICE PRESIDENT FINANCE 3018963900 2016-05-13 2014 2016-08-17 19:52:53Z MARTIN BASSO SR 8600 OLD GEORGETOWN ROAD BETHESDA MD 208141497 323630063 0 X WWW.SUBURBANHOSPITAL.ORG X 1942 MD SUBURBAN HOSPITAL IS A COMMUNITY-BASED HOSPITAL SERVING MONTGOMERY COUNTY AND THE SURROUNDING AREA SINCE 1943. WE ARE A NOT-FOR-PROFIT HEALTHCARE PROVIDER GUIDED BY THE NEEDS OF OUR PATIENTS AND COMMUNITY. ON JUNE 30, 2009, SUBURBAN HOSPITAL BECAME A MEMBER OF JOHNS HOPKINS MEDICINE. THE DESIGNATED TRAUMA CENTER FOR MONTGOMERY COUNTY, SUBURBAN HOSPITAL IS AFFILIATED WITH MANY LOCAL HEALTHCARE ORGANIZATIONS, INCLUDING THE NATIONAL INSTITUTES OF HEALTH. IT IS COMMITTED TO CONTINUOUS IMPROVEMENT AND APPROPRIATE USE OF RESOURCES, AND CREATES AN ENVIRONMENT THAT ENCOURAGES THE SUCCESS AND FULFILLMENT OF OUR PHYSICIANS, STAFF, AND VOLUNTEERS.SUBURBAN HOSPITAL WILL SET THE STANDARD FOR EXCELLENCE IN HEALTHCARE IN THE WASHINGTON METROPOLITAN REGION. THROUGH OUR AFFILIATIONS, WE ASPIRE TO PROVIDE WORLD-CLASS PATIENT CARE, TECHNOLOGY, AND CLINICAL RESEARCH. 24 20 2097 399 1323750 -695643 7050079 7515285 243272744 250848860 4232092 3284176 10295639 12454905 264850554 274103226 1388302 47569 0 0 117988414 115689729 0 0 0 141592229 144577132 260968945 260314430 3881609 13788796 299172668 309412407 119767901 112898431 179404767 196513976 X SUBURBAN HOSPITAL WILL DELIVER SUPERIOR HEALTHCARE ENHANCED BY TECHNOLOGY, WELLNESS EDUCATION, RESEARCH, ADN INNOVATIVE PARTNERSHIPS WITH PHYSICIANS, HOSPITALS, THE COMMUNITY, AND THE NATIONAL INSTITUTES OF HEALTH. MISSION: IMPROVING HEALTH WITH SKILL AND COMPASSION. 0 0 78356405 113781692 SURGICAL PATIENT SERVICES:SUBURBAN HOSPITAL OFFERS COMPREHENSIVE INPATIENT AND OUTPATIENT SURGICAL SERVICES. THESE INCLUDE ORTHOPEDIC SERVICES, INCLUDING SPINE, NEUROSURGERY AND JOINT REPLACEMENT, WITH THE JOINT REPLACEMENT PROGRAM SERVING OVER 1,500 PATIENTS ANNUALLY. WITH THE DAVINCI SURGICAL SYSTEM, UROLOGIC, GYNECOLOGIC AND THORACIC PROCEDURES ARE PERFORMED WITH STATE-OF-THE-ART ROBOTIC TECHNOLOGY. SUBURBAN HOSPITAL IS THE ONLY CERTIFIED TRAUMA CENTER IN MONTGOMERY COUNTY. THE LEVEL II TRAUMA CENTER TREATS 1500 MAJOR TRAUMA CASES ANNUALLY AND HAS AN ORTHOPEDIC TRAUMATOLOGIST ON STAFF. THE FOLLOWING SPECIALISTS ARE ON CALL FOR EMERGENCIES: TRAUMA SURGEONS, NEUROSURGEONS, UROLOGISTS, ENT, OB/GYN, AND CARDIOLOGISTS. DURING 2014, SUBURBAN HOSPITAL ADMITTED 4,700 SURGICAL INPATIENTS. 10,000 OPERATING ROOM CASES WERE PERFORMED. 42627781 71313558 MEDICAL PATIENT SERVICES:SUBURBAN HOSPITAL PROVIDES ACUTE AND CRITICAL CARE FOR A COMPLETE RANGE OF MEDICAL DIAGNOSES. THE HOSPITAL IS A JOINT COMMISSION CERTIFIED PRIMARY STROKE CENTER FEATURING A DEDICATED NIH STROKE TEAM, WHICH PROVIDES RAPID DIAGNOSIS AND CUTTING-EDGE TREATMENT OF STROKES. SUBURBAN HOSPITAL ALSO OPERATES A CANCER CARE PROGRAM, WHICH IS ACCREDITED WITH COMMENDATION BY THE COMMISSION ON CANCER OF THE AMERICAN COLLEGE OF SURGEONS. THE COMPREHENSIVE PROGRAM SERVICES PATIENTS WITH ALL DIAGNOSES AND OFFERS CUTTING-EDGE TECHNOLOGY AND PERSONALIZED CARE. IN 2014, SUBURBAN HOSPITAL ADMITTED APPROXIMATELY 9,000 MEDICAL PATIENTS.SUBURBAN HOSPITAL'S OBJECTIVES ARE TO MEASURE AND ANALYZE VARIANCES AND IMPROVE CARE PROCESSES RELATED TO KEY TARGET ZERO QUALITY INITIATIVES: (1) FALLS WITH INJURY (2) CENTRAL-LINE ASSOCIATED BLOODSTREAM INFECTION (3) VENTILATOR ASSOCIATED PNEUMONIA (4) PRESSURE ULCER RATES. 29725616 42516003 CARDIOVASCULAR PATIENT SERVICES:SUBURBAN HOSPITAL'S SPECIALIZED CENTER FOR CARDIAC CARE, ANCHORED BY THE NIH HEART CENTER, BRINGS THE CLINICAL AND SCIENTIFIC EXCELLENCE OF TWO RENOWNED MEDICAL INSTITUTIONS TO A COMMUNITY-BASED CARDIAC PROGRAM. THROUGH COLLABORATION WITH THE NATIONAL HEART, LUNG, AND BLOOD INSTITUTE (NHLBI) OF THE NATIONAL INSTITUTES OF HEALTH AND JOHNS HOPKINS MEDICINE, SUBURBAN HOSPITAL PROVIDES PATIENTS EASY ACCESS TO ADVANCED CARDIOVASCULAR TREATMENTS AVAILABLE IN VERY FEW MEDICAL CENTERS. IN ADDITION TO STATE-OF-THE-ART CARDIAC SURGERY AND ANGIOPLASTY, THE NIH HEART CENTER AT SUBURBAN HOSPITAL COMPLEMENTS A BROAD RANGE OF EXISITING CARDIAC PROGRAMS AT SUBURBAN HOSPITAL - FROM EMERGENCY CARE TO CARDIAC DIAGNOSTICS AND REHABILITATION. DURING 2014 THERE WERE 1,800 ADMISSIONS AND 220 OPEN HEART SURGERY CASES. 77717692 47569 36205925 77717692 47569 36205925 228427494 1 1 0 1 0 0 0 0 0 0 1 1 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 363 0 1 2097 1 1 1 0 0 0 0 0 0 0 X 24 20 0 0 0 0 0 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 MD X MARTIN BASSO SR VP FIN TREAS 3018962333 8600 OLD GEORGETOWN RD BETHESDA MD 208141497 SUE BAILEY MD TRUSTEE 2.50 X 0 0 0 DIANE L COLGAN MD TRUSTEE 2.50 4.00 X 0 0 0 MARY D KANE TRUSTEE 2.50 X 0 0 0 BELLE BROOKS O'BRIEN TRUSTEE 2.50 X 0 0 0 JOHN C OTSUKI TRUSTEE 2.50 X 0 0 0 SUDEEP ANAND PHD TRUSTEE 2.50 X 0 0 0 LARA EISENBERG MD TRUSTEE 4.00 2.50 X 0 0 0 LILY QI TRUSTEE 2.50 X 0 0 0 ALAN SHEFF TRUSTEE 2.50 X 0 0 0 DAVID C SILVER TRUSTEE, CHAIRMAN 2.50 4.00 X X 0 0 0 STANLEY H SNOW TRUSTEE, VICE CHAIRMAN 2.50 X X 0 0 0 WILLIAM SHAW TRUSTEE 2.50 X 0 0 0 CHARLES ALLEN WIEBE TRUSTEE 2.50 X 0 0 0 BRIAN A GRAGNOLATI TRUSTEE 2.50 X 0 1242705 58871 WILLIAM A BAUMGARTNER MD TRUSTEE 2.50 X 0 0 0 PATRICIA MC BROWN ESQUIRE TRUSTEE 2.50 57.50 X 0 779474 157856 HOWARD GLECKMAN TRUSTEE 2.50 X 0 0 0 THE HON ANN S HARRINGTON TRUSTEE 2.50 X 0 0 0 NORMAN K JENKINS TRUSTEE 2.50 X 0 0 0 RONALD R PETERSON CORPORATE VICE CHAIRMAN & 2.50 57.50 X X 0 2133111 481135 GENE E GREEN MD TRUSTEE, PRESIDENT 30.00 30.00 X X 0 685828 51188 ALBERT K LEE MD TRUSTEE 2.50 X 0 0 0 CURTIS POLK TRUSTEE 2.50 X 0 0 0 HARRY TOTONIS TRUSTEE 2.50 X 0 0 0 MARTIN BASSO SR VP FINANCE AND TREASURE 55.00 5.00 X 0 553851 55064 PETER B MANCINO ESQUIRE CORPORATE SECRETARY 2.50 47.50 X 0 279799 51821 DENNIS PARNELL SR VP HUMAN RESOURCES 59.00 1.00 X 0 403140 27615 JACQUELINE SCHULTZ RN EXECUTIVE V.P. & COO 59.00 1.00 X 0 574016 55362 CHRISTOPHER TIMBERS VP & COO 60.00 X 0 509182 46407 ROBERT ROTHSTEIN VP MEDICAL AFFAIRS 60.00 X 0 435515 134580 JOSEPH LINSTROM SR DIRECTOR 50.00 X 184885 0 33413 STEVEN COHEN PHYSICIAN ASST. 50.00 X 182998 0 30523 BARBARA STEWARD JACOBS SR DIRECTOR 50.00 X 206703 0 24444 MUHAMMAD MOHIUDDIN CHIEF TECHNICIAN 50.00 X 191787 0 30951 JOAN HALL SR DIRECTOR 50.00 X 182346 0 22657 NANCY MILLER FORMER OFFICER 50.00 X 145008 0 7190 MATTHEW POFFENROTH MD FORMER SR. V.P. 0.00 50.00 X 0 339963 34523 LESLIE FORD WEBER FORMER SR. VP, GOVT & COMMUNITY R 49.00 1.00 X 212108 0 9897 1305835 7936584 1313497 148 1 1 0 SODEXO INC PO BOX 536922 ATLANTA GA 30353 MANAGEMENT SERVICES 2534541 SCOTT-LONG CONSTRUCTION 14170 NEWBROOK DRIVE CHANTILLY VA 20151 CONSTRUCTION SERVICES 1861785 CROTHALL LAUNDRY SERVICES INC 13028 COLLECTIONS CENTER DR CHICAGO IL 60693 HOUSEKEEPING MANAGEMENT 1824483 ARAMARK CORPORATION 601 LIGHT STREET BALTIMORE MD 21230 FOOD SERVICES 1474078 PREMIER HEALTHCARE SOLUTIONS 5882 COLLECTIONS CENTER DR CHICAGO IL 60693 CONSULTING SERVICES 1046123 77 1710000 5755697 49588 7515285 NET PATIENT REVENUE 621990 249525110 249525110 LAB 541380 1323750 1323750 250848860 1447013 1447013 51364000 49526837 1837163 1837163 1837163 OTHER REVENUE 900099 10726951 10726951 PARKING 900099 703306 703306 CAFETERIA INCOME 900099 627085 627085 397563 397563 12454905 274103226 263817178 1323750 1447013 47569 47569 96610226 83084794 13525432 1742470 1498524 243946 10107547 8692490 1415057 7229486 6217358 1012128 190812 164098 26714 31004 26663 4341 35511 35511 81379149 74526314 6852835 3883880 3340137 543743 239471 205945 33526 39570 34030 5540 824148 708767 115381 15819228 13604536 2214692 1961625 1909620 52005 CONTRACTED SERVICES 32266207 28368415 3897792 PROFESSIONAL FEES 5406469 4164253 1242216 OTHER 1549036 882959 666077 INT EXP DERIVATIVES 951022 951022 260314430 228427494 31886936 0 8700 8701 11710614 17657272 39192572 34588611 5485 0 8529414 9755307 1201072 1364089 244487399 143050466 100047897 101436933 127479473 132545597 10997441 12055897 299172668 309412407 38140768 40113778 8235961 3355469 73391172 69429184 119767901 112898431 X 179404767 196513976 179404767 196513976 299172668 309412407 X 13788796 3320413 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 1 35511 0 0 35511 0 PART II-B, LINE 1: THE HOSPITAL RETAINS LEGAL COUNSEL TO PERFORM LOBBYING ACTIVITIES ON ITS BEHALF. THE LOBBYING ACTIVITIES RELATE TO PRESERVING AND PROTECTING THE HOSPITAL'S INTERESTS WITH REGARDS TO MATTERS AFFECTING HEALTH CARE AND HEALTH FACILITIES, INCLUDING STATE GRANTS AND UNCOMPENSATED CARE. 345094 345094 115181392 65067292 50114100 2129176 509170 1620006 86709745 59066231 27643514 40121992 18407773 21714219 101436933 LONG TERM INV 132545597 C 132545597 ADVANCES FROM THIRD PARTIES 8281556 HEDGE FAIR VALUE ADJUST 2376315 CAPITAL ACCUMULATION ACCOUNT 1475707 INTEREST PAYABLE 79020 ACCRUED RENT 200042 ACCRUED PENSION LONG TERM 2180000 457B FOR DIRECTORS 20690 DUE TO AFFILIATES 50682782 WORKERS COMPENSATION INSURANCE LIABILITY 1088287 MALPRACTICE INSURANCE 1167673 L/T MAL LIAB 1877112 69429184 X 272266063 0 272266063 1837163 1837163 274103226 259363409 0 259363409 951022 951022 260314431 PART X, LINE 2: FASB'S GUIDANCE ON ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES CLARIFIES THE ACCOUNTING FOR UNCERTAINTY OF INCOME TAX POSITIONS. THIS GUIDANCE DEFINES THE THRESHOLD FOR RECOGNIZING TAX RETURN POSITIONS IN THE FINANCIAL STATEMENTS AS "MORE LIKELY THAN NOT" THAT THE POSITION IS SUSTAINABLE, BASED ON ITS TECHNICAL MERITS. THIS GUIDANCE ALSO PROVIDES GUIDANCE ON THE MEASUREMENT, CLASSIFICATION AND DISCLOSURE OF TAX RETURN POSITIONS IN THE FINANCIAL STATEMENTS. THE HOSPITAL HAS ADOPTED THIS GUIDANCE, AND THERE WAS NO IMPACT ON ITS FINANCIAL STATEMENTS DURING THE YEARS ENDED JUNE 30, 2015 AND 2014. PART XI, LINE 4B - OTHER ADJUSTMENTS: REALIZED GAIN ON INVESTMENTS 1,837,163. PART XII, LINE 4B - OTHER ADJUSTMENTS: ROUNDING INT EXP DERIVATIVES 951,022. 1 1 X 1 X 1 X 500.000000000000 1 1 0 1 1 4622323 0 4622323 0.01780 4622323 4622323 0.01780 11011834 866989 10144845 0.03900 3612071 0 3612071 0.01390 0 0 4091383 4091383 818816 0 818816 0.00310 19534104 4958372 14575732 0.05600 24156427 4958372 19198055 0.07380 0 0 4261 0 4261 0.00000 410895 12548 398347 0.00150 65000 0 65000 0.00020 438 0 438 0.00000 165785 12548 153237 0.00060 7958 0 7958 0.00000 231209 0 231209 0.00090 885546 25096 860450 0.00320 0 7755429 0 114125936 117208747 -3082811 X 1 1 1 1 SUBURBAN HOSPITAL INC 8600 OLD GEORGETOWN RD BETHESDA MD 208141497 WWW.HOPKINSMEDICINE.ORG/SUBURBAN_HOSPI 15-028 X SUBURBAN HOSPITAL INC 1 0 0 1 X X X X X X X X X 12 1 0 0 1 X HTTP://WWW.HOPKINSMEDICINE.ORG/SUBURBAN_HOSPITAL/COMMUNITY_HEALTH/ X X 1 12 1 HTTP://WWW.HOPKINSMEDICINE.ORG/SUBURBAN_HOSPITAL/COMMUNITY_HEALTH/ 0 0 1 X 200.000000000000 500.000000000000 X X X 1 1 X X X 1 X WWW.HOPKINSMEDICINE.ORG/SUBURBAN_HOSPITAL/PLANNING_YOUR_VISIT/ X WWW.HOPKINSMEDICINE.ORG/SUBURBAN_HOSPITAL/PLANNING_YOUR_VISIT/ X WWW.HOPKINSMEDICINE.ORG/SUBURBAN_HOSPITAL/PLANNING_YOUR_VISIT/ X X X X X 1 X 0 X X X X 1 X 0 0 SUBURBAN HOSPITAL, INC. PART V, SECTION B, LINE 5: TO GATHER INPUT FROM PERSONS WHO REPRESENT THE BROAD INTERESTS OF THE COMMUNITY SERVED BY SHI THE FOLLOWING WAS DONE:A)COLLABORATED WITH THE MONTGOMERY COUNTY DEPARTMENT OF HEALTH AND HUMAN SERVICES AND FOUR OTHER COUNTY HOSPITALS TO CONDUCT A COUNTY-WIDE COMMUNITY HEALTH NEEDS ASSESSMENT CALLED "HEALTHY MONTGOMERY"B)ENGAGED COMMUNITY EXPERTS BY ESTABLISHING A COMMUNITY BENEFIT ADVISORY COUNCIL (CBAC) THAT ADVISES ON THE DIRECTION OF THE NEEDS ASSESSMENT. CHARTED BY THE HOSPITAL'S BOARD OF TRUSTEES AND CHARIED BY A TRUSTEE, THE CBAC IS COMPRISED OF A DIVERSE GROUP OF LOCAL BUSINESS, NON-FOR-PROFIT EXECUTIVES AND COMMUNITY ADVOCACY LEADERS WHO REPRESENT THE PERSPECTIVE OF THE COUNTY'S MEDICALLY UNDERSERVED, LOW-INCOME AND RACIALLY/ETHNICALLY DIVERSE POPULATIONS. THE CBAC REPRESENTS DIVERSE SECTORS OF SHI'S SERVICE AREA AND ACTS AS A LIAISON WITH THE COMMUNITY AND THE HOSPITAL TO IDENTIFY HEALTH IMPROVEMENT OPPORTUNITIES AND NEEDS.C)SHI'S COMMUNITY HEALTH AND WELLNESS DEPARTMENT (CHW) SERVED AS A KEY PLAYER BY INTEGRATING PUBLIC HEALTH KNOWLEDGE, PRINCIPLES AND EXPERTISE. THE CHW DEPARTMENT ACTED AS A PUBLIC HEALTH RESOURCE AND GUIDE, DUE IN PART TO THE EDUCATIONAL BACKGROUND OF THE STAFF, AND THE STRONG RELATIONSHIPS BUILT IN THE COMMUNITY AND FIRSTHAND KNOWLEDGE OF THE MAJOR HEALTH CONCERNS, BARRIERS AND NEEDS.D)CONDUCTED A COMMUNITY HEALTH SURVEY OF 997 MONTGOMERY COUNTY RESIDENTS TO ASSESS THE NEEDS AND INSIGHTS OF THE COMMUNITY MEMBERS BENEFITING FROM SUBURBAN'S PROGRAMS, SERVICES AND ACTIVITIES. SUBURBAN HOSPITAL, INC. PART V, SECTION B, LINE 7D: THE CHNA WAS DISTRIBUTED TO THE ADVISORY COUNCIL, BOARD OF TRUSTEES, SH CANCER COMMITTEE, VOLUNTEER DEPARTMENT, HOSPITAL INFORMATION DESK, AND COMMUNITY STAKEHOLDERS. SUBURBAN HOSPITAL, INC. PART V, SECTION B, LINE 11: SHI RECOGNIZES THE COMMUNITY'S UNMET OR POTENTIAL HEALTH NEEDS BY PARTICIPATING IN COMMUNITY COALITIONS, PARTNERSHIPS, ADVISORY GROUPS, BOARDS, PANELS, COMMITTEES, AND SERVING ON LOCAL COUNTY COMMISSIONS AND WORKING WITH PUBLIC HEALTH OFFICIALS AT MCDHHS. IN FY15, SHI CONDUCTED 2,761 COMMUNITY HEALTH IMPROVEMENT PROGRAMS, SCREENINGS, CLASSES, SEMINARS AND ACTIVITIES SERVING 80,273 INDIVIDUALS; OF WHICH 27,489 ARE FROM AN ETHNIC MINORITY GROUP. THE HEALTHY MONTGOMERY STEERING COMMITTEE ESTABLISHED SIX OFFICIAL HEALTH PRIORITIES TO BE TRACKED, MEASURED AND EVALUATED BASED ON HEALTH INEQUITIES, LACK OF ACCESS, AND UNHEALTHY BEHAVIORS. ONE OF THOSE HEALTH PRIORITIES INCLUDES MATERNAL AND CHILD HEALTH. SUBURBAN HOSPITAL MAY NOT BE IN A POSITION TO AFFECT ALL OF THE CHANGES REQUIRED TO ADDRESS THIS HEALTH PRIORITY GIVEN THAT THE HOSPITAL DOES NOT HAVE AN OBSTETRICS DESIGNATION OR DELIVER BABIES. ONE REASON FOR NOT SEEKING THIS DESIGNATION IS DUE TO THE FACT THAT THERE ARE SEVERAL OTHER COMMUNITY HOSPITALS WITHIN 5-10 MILES OF OUR BETHESDA LOCATION THAT HAVE REPUTABLE OBSTETRICS PROGRAMS. WHILE SUBURBAN HOSPITAL MAY NOT BE ABLE TO DIRECTLY ADDRESS THIS HEALTH PRIORITY, THE HOSPITAL DOES INDIRECTLY SUPPORT MATERNAL AND CHILD HEALTH INITIATIVES THROUGH FUNDING AND PROGRAMMING OF SEVERAL OTHER ORGANIZATIONS WHICH PROMOTE THE HEALTH AND WELL-BEING OF CHILDREN AND THEIR FAMILIES. SUBURBAN HOSPITAL, INC. PART V, SECTION B, LINE 22D: MARYLAND IS THE ONLY STATE IN WHICH ALL PAYORS (GOVERNMENTALLY-INSURED, COMMERCIALLY INSURED, OR SELF-PAY) ARE CHARGED THE SAME PRICE FOR SERVICES AT ANY GIVEN HOSPITAL.UNDER THIS SYSTEM, MARYLAND HOSPITALS ARE REGULATED BY A STATE AGENCY: THE HEALTH SERVICES COST REVIEW COMMISSION (HSCRC). PART V, SECTION B, LINE 16 FINANCIAL ASSISTANCE POLICY WEBSITE AVAILABILITY SUBURBAN HOSPITAL, INC. PART V, SECTION B, LINE 16A WEBSITE: WWW.HOPKINSMEDICINE.ORG/SUBURBAN_HOSPITAL/PLANNING_YOUR_VISIT/ SUBURBAN HOSPITAL, INC. PART V, SECTION B, LINE 16B WEBSITE: WWW.HOPKINSMEDICINE.ORG/SUBURBAN_HOSPITAL/PLANNING_YOUR_VISIT/ SUBURBAN HOSPITAL, INC. PART V, SECTION B, LINE 16C WEBSITE: WWW.HOPKINSMEDICINE.ORG/SUBURBAN_HOSPITAL/PLANNING_YOUR_VISIT/ PART I, LINE 7: A COST-TO-CHARGE RATIO (FROM WORKSHEET 2) IS USED TO CALCULATE THE AMOUNTS ON LINE 7A AND 7B (FINANCIAL ASSISTANCE AT COST AND UNREIMBURSED MEDICAID). THE AMOUNTS FOR LINES 7E-7I WOULD COME FROM OUR HSCRC COMMUNITY BENEFIT REPORT FILED WITH THE STATE OF MARYLAND AND WOULD NOT BE BASED ON A COST-TO CHARGE RATIO. PART I, LINE 7G: SUBURBAN HOSPITAL, INC. DOES NOT HAVE ANY SUBSIDIZED HEALTH SERVICES. PART II, COMMUNITY BUILDING ACTIVITIES: SHI RECOGNIZES THE COMMUNITY'S UNMET OR POTENTIAL HEALTH NEEDS BY PARTICIPATING IN COMMUNITY COALITIONS, PARTNERSHIPS, ADVISORY GROUPS, BOARDS, PANELS, COMMITTEES, AND SERVING ON LOCAL COUNTY COMMISSIONS AND WORKING WITH PUBLIC HEALTH OFFICIALS AT MCDHHS. SHI'S COMMUNITY BUILDING ACTIVITIES PROMOTE THE HEALTH OF THE COMMUNITY IT SERVES THROUGH A NUMBER OF INITIATIVES THEY HAVE DEVELOPED. PART III, LINE 2: THE PROVISION FOR BAD DEBTS IS BASED UPON A COMBINATION OF THE PAYOR SOURCE, THE AGING OF RECEIVABLES AND MANAGEMENT'S ASSESSMENT OF HISTORICAL AND EXPECTED NET COLLECTIONS, TRENDS IN HEALTH INSURANCE COVERAGE, AND OTHER COLLECTION INDICATORS. PART III, LINE 3: MARYLAND HOSPITALS ARE RATE REGULATED UNDER THE HSCRC, WHICH INCLUDES BAD DEBT AS PART OF THE REIMBURSEMENT FORMULA FOR EACH HOSPITAL. DUE TO THE RATE REGULATION, SHI CANNOT DETERMINE THE AMOUNT THAT REASONABLE COULD BE ATTRIBUTABLE TO PATIENTS WHO LIKELY WOULD QUALIFY FOR FINANCIAL ASSISTANCE UNDER THE HOSPITAL'S CHARITY CARE POLICY. PART III, LINE 4: THE JOHNS HOPKINS HEALTH SYSTEM CORPORATION AND AFFILIATES AUDITED FINANCIAL STATEMENTS PAGES 13 AND 14. PART III, LINE 8: THE SHORTFALL IN MEDICARE ALLOWABLE COSTS IS NOT TREATED AS A COMMUNITY BENEFIT.THE TRIAL BALANCE EXPENSES ARE ADJUSTED TO ALLOWABLE EXPENSE IN ACCORDANCE WITH THE MEDICARE COST REPORTING RULES AND REGULATIONS. PART III, LINE 9B: THE HOSPITAL CONFORMS TO THE PRINCIPLES AND STANDARDS OF THE MHA HOSPITAL BILLING AND DEBT COLLECTION PRACTICES PRINCIPLES AS WELL AS THE MHA MINIMUM STANDARDS FOR FINANCIAL ASSISTANCE IN MARYLAND HOSPITALS. PART VI, LINE 2: UTILIZING THE HEALTHY PEOPLE 2020 GUIDELINES AS VITAL INFORMATION SOURCES, SHI MAINTAINS A CLOSE RELATIONSHIP WITH THE MONTGOMERY COUNTY DEPARTMENT OF HEALTH AND HUMAN SERVICES (MCDHHS) IN ORDER TO IDENTIFY COMMUNITY HEALTH NEEDS AND SET COMMUNITY BENEFIT STRATEGIC PROGRAMS AND ACTIVITIES. TO EFFECTIVELY IDENTIFY AND PRIORITIZE HEALTH NEEDS FOR MONTGOMERY COUNTY RESIDENTS, SHI HAS RELIED ON A THREE-TIERED APPROACH TO EXECUTE THE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA): (1) ESTABLISHING THE HEALTHY MONTGOMERY NEEDS ASSESSMENT; (2) ENGAGING HEALTH EXPERTS AND KEY STAKEHOLDERS; AND (3) CONDUCTING A COMMUNITY SURVEY. THROUGH THIS METHODOLOGY, SHI ENSURED MAXIMIZED COLLABORATION AND LEVERAGE OF RESOURCES, REDUCED REDUNDANCIES AND SUPPORTED AN ONGOING HEALTH IMPROVEMENT PROCESS AND INFRASTRUCTURE. THE CHNA PROCESS PRESENTED AN OPPORTUNITY FOR SHI TO PARTNER WITH THE MCDHHS, ALONG WITH FOUR OTHER MONTGOMERY COUNTY HOSPITALS TO CONDUCT A COUNTY-WIDE CHNA AS PART OF THE HEALTHY MONTGOMERY-COMMUNITY HEALTH IMPROVEMENT PROCESS. THE NEEDS ASSESSMENT IS FINANCIALLY SUPPORTED BY THE FIVE LOCAL HOSPITALS, AND PRESENTS THE RESULTS OF QUANTITATIVE AND QUALITATIVE DATA COLLECTION ACTIVITIES ALONG WITH TOOLS USED IN PRIORITY SETTING TO IMPROVE THE HEALTH AND WELL-BEING OF MONTGOMERY COUNTY RESIDENTS. FURTHERMORE, SHI PRIORITIZED THE NEED TO SUPPLEMENT HEALTHY MONTGOMERY DATA AND FINDINGS TO UNDERSTAND WHAT THE UNMET HEALTH NEEDS ARE IN SPECIFIC GEOGRAPHIC LOCATIONS WITHIN THE COUNTY. THIS PROCESS INCLUDED CONSULTATION WITH COMMUNITY STAKEHOLDERS AND LEADERS, AND THE DEVELOPMENT OF A COMMUNITY HEALTH SURVEY TOOL THAT ALLOWED DIRECT INPUT FROM COMMUNITY MEMBERS THAT ALREADY BENEFIT FROM SHI'S COMMUNITY HEALTH IMPROVEMENT CLASSES, EVENTS, AND SCREENINGS.SHI WORKS DIRECTLY WITH SEVERAL COMMUNITY CENTERS, ORGANIZATIONS, INSTITUTES, AND CORPORATIONS, INCLUDING THE AARP, A WIDER CIRCLE, ALPHA PHI ALPHA FRATERNITY, AMERICAN HEART ASSOCIATION, AMERICAN RED CROSS, AND BETHESDA CARES TO NAME A FEW. FURTHERMORE, SHI REPRESENTATIVES SERVE ON NUMEROUS COMMUNITY COALITIONS, BOARDS, COMMITTEES, PANELS, ADVISORY GROUPS, AND LOCAL COUNTY COMMISSIONS. SHI'S ACTIVE ROLE IN THESE AND SIMILAR COMMUNITY ENGAGEMENT ACTIVITIES SERVES AS A CATALYST FOR IDENTIFICATION AND PRIORITIZATION OF UNMET OR POTENTIAL COMMUNITY HEALTH NEEDS. PART VI, LINE 3: SHI'S PATIENT ACCESS DEPARTMENT PROVIDES ALL PATIENTS REGISTERED FOR EMERGENCY, OUTPATIENT, OR INPATIENT CARE A COPY OF OUR FINANCIAL ASSISTANCE INFORMATION SHEET. SIGNS ARE POSTED IN ENGLISH AND SPANISH EXPLAINING THE AVAILABILITY OF FINANCIAL ASSISTANCE AND WHERE TO CALL FOR ASSISTANCE. THE SIGNS ARE LOCATED IN THE EMERGENCY, PEDIATRICS, CATH LAB, AND FINANCIAL COUNSELING DEPARTMENTS, AS WELL AS THE MAIN REGISTRATION DESK. A FINANCIAL ASSISTANCE APPLICATION IS GIVEN TO EVERY SELF-PAY PATIENT WITH INSTRUCTIONS ON HOW TO APPLY AND WHO TO CONTACT FOR ASSISTANCE. THE SAME INFORMATION IS PROVIDED TO ALL OTHER PATIENTS UPON REQUEST. THIS INFORMATION IS ALSO AVAILABLE IN SPANISH.SUBURBAN HOSPITAL'S FINANCIAL COUNSELORS AND SOCIAL WORKERS ARE TRAINED TO ANSWER PATIENTS' QUESTIONS ABOUT FINANCIAL ASSISTANCE AND PROVIDE LINKAGE TO OTHER COMMUNITY ASSISTANCE RESOURCES PRIOR TO DISCHARGE. REGISTRATION AND PATIENT ACCOUNTING STAFF IS TRAINED TO ANSWER QUESTIONS REGARDING FINANCIAL ASSISTANCE AND WHO TO CONTACT TO APPLY. THE PATIENT ACCESS DEPARTMENT ALSO HAS MEDICAID SPECIALISTS ONSITE TO ASSIST PATIENTS IN APPLYING FOR MARYLAND MEDICAL ASSISTANCE. ALL UNINSURED PATIENTS ARE SCREENED FOR MEDICAID UPON ADMISSION AND PROVIDED WITH INFORMATION AND REFERRAL FOR FINANCIAL ASSISTANCE.THIS PAST MARCH, SUBURBAN HOSPITAL HELD ITS ANNUAL "COVERING THE UNINSURED" EVENT. THE PROGRAM HELD AT SUBURBAN HOSPITAL WHERE FINANCIAL ASSISTANCE CONSULTATION WAS PROVIDED TO COMMUNITY MEMBERS INCLUDING DISSEMINATION OF INFORMATION ON OUR FINANCIAL ASSISTANCE ELIGIBILITY CRITERIA, MEDICAID AND OTHER COMMUNITY RESOURCES. PART VI, LINE 4: SHI GEOGRAPHIC SERVICE AREA IS SUBURBAN.THE HOSPITAL CONSIDERS ITS COMMUNITY BENEFIT SERVICE AREA (CBSA) AS SPECIFIC POPULATIONS OR COMMUNITIES OF NEED TO WHICH THE HOSPITAL ALLOCATES RESOURCES THROUGH ITS COMMUNITY BENEFIT PLAN AND DOES NOT LIMIT ITS COMMUNITY SERVICES TO THE PRIMARY SERVICE AREA. THE CBSA IS DEFINED BY THE GEOGRAPHIC AREA CONTAINED WITHIN THE FOLLOWING FIFTEEN ZIP CODES: 20814, 20817, 20852, 20854, 20815, 20850, 20895, 20906, 20902, 20878, 20853, 20910, 20851, 20877, AND 20874. THE GENERAL DATA FOR THIS COMMUNITY BENEFIT SERVICE AREA ARE AS FOLLOWS: TOTAL POPULATION WAS 638,821 OF WHICH 48.03% WERE MALES AND 51.97% WERE FEMALES, AVERAGE HOUSEHOLD INCOME WAS $138,765, 3.61% OF RESIDENTS ARE UNINSURED, 14.6% OF RESIDENTS ARE COVERED BY MEDICAID/MEDICARE, 4.5% OF HOUSEHOLDS WITH INCOMES BELOW THE FEDERAL POVERTY GUIDELINES.NUMBER OF OTHER HOSPITALS SERVING THE COMMUNITY OR COMMUNITIES: 5FEDERALLY-DESIGNATED MEDICALLY UNDERSERVED AREAS OR POPULATIONS ARE PRESENT IN THE COMMUNITY . PART VI, LINE 5: FOR THE LAST 30 YEARS, MARYLAND HOSPITALS HAVE MET THEIR COMMUNITY BENEFIT OBLIGATIONS IN A UNIQUE MANNER THAT BUILDS THE COSTS OF UNCOMPENSATED CARE CHARITY CARE AND PATIENT BAD DEBT AND GRADUATE MEDICAL EDUCATION INTO THE RATES THAT HOSPITALS ARE REIMBURSED BY ALL PAYORS. THE SYSTEM IS BASED IN FEDERAL AND STATE LAW AND BENEFITS ALL MARYLAND RESIDENTS, INCLUDING THOSE IN NEED OF FINANCIAL ASSISTANCE TO PAY THEIR HOSPITAL BILLS. MARYLAND IS THE ONLY STATE IN WHICH ALL PAYORS GOVERNMENTALLY INSURED, COMMERCIALLY INSURED, OR SELF PAY ARE CHARGED THE SAME PRICE FOR SERVICES AT ANY GIVEN HOSPITAL.UNDER THIS SYSTEM, MARYLAND HOSPITALS ARE REGULATED BY A STATE AGENCY THE HEALTH SERVICES COST REVIEW COMMISSION (HSCRC) THAT IS REQUIRED TO:1) PUBLICLY DISCLOSE INFORMATION ON THE COST AND FINANCIAL POSITION OF HOSPITALS;2) REVIEW AND APPROVE HOSPITAL RATES;3) COLLECT INFORMATION DETAILING TRANSACTIONS BETWEEN HOSPITALS AND FIRMS WITH WHICH THEIR TRUSTEES HAVE A FINANCIAL INTEREST; AND,4) MAINTAIN THE SOLVENCY OF EFFICIENT AND EFFECTIVE HOSPITALS.SINCE 2000, THE RATE SETTING COMMISSION HAS HAD ITS OWN FRAMEWORK FOR REPORTING HOSPITALS COMMUNITY BENEFITS AND ISSUING A REPORT ANNUALLY REGARDING HOSPITALS COMMUNITY BENEFIT TOTALS. THAT REPORT IS AVAILABLE ON HTTP://WWW.HSCRC.STATE.MD.US/COMMUNITY_BENEFITS/DOCUMENTS/ CBR_FY2007_FINAL_REPORT.PDF. BECAUSE OF THIS UNIQUE STRUCTURE MARYLAND HOSPITALS COMMUNITY BENEFITS NUMBERS WILL NOT COMPARE WITH THE REST OF THE NATIONS HOSPITALS. HOWEVER, MARYLAND HOSPITALS MEET OR EXCEED THE COMMUNITY BENEFIT STANDARD ESTABLISHED BY THE IRS IN 1969. ADDITIONAL DETAIL ILLUSTRATING THIS CAN BE FOUND WITHIN THIS SCHEDULE H REPORT.LINE 7B - MARYLAND REGULATORY SYSTEM CREATES A UNIQUE PROCESS FOR HOSPITAL PAYMENT THAT DIFFERS FROM THE REST OF THE NATION. THE HEALTH SERVICES COST REVIEW COMMISSION, (HSCRC) DETERMINES PAYMENT THROUGH A RATE-SETTING PROCESS AND ALL PAYORS, INCLUDING GOVERNMENTAL PAYORS, PAY THE SAME AMOUNT FOR THE SAME SERVICES DELIVERED AT THE SAME HOSPITAL. MARYLAND UNIQUE ALL-PAYOR SYSTEM INCLUDES A METHOD FOR REFERENCING UNCOMPENSATED CARE IN EACH PAYORS RATES, WHICH DOES NOT ENABLE MARYLAND HOSPITALS TO BREAKOUT ANY DIRECTED OFFSETTING REVENUE RELATED TO UNCOMPENSATED CARE. COMMUNITY BENEFIT EXPENSES ARE EQUAL TO MEDICAID REVENUES IN MARYLAND, AS SUCH, THE NET EFFECT IS ZERO. THE EXCEPTION TO THIS IS THE IMPACT ON THE HOSPITAL OF ITS SHARE OF THE MEDICAID ASSESSMENT. IN RECENT YEARS, THE STATE OF MARYLAND HAS CLOSED FISCAL GAPS IN THE STATE MEDICAID BUDGET BY ASSESSING HOSPITALS THROUGH THE RATE-SETTING SYSTEM.LINE 7F COLUMN (D) MARYLAND REGULATORY SYSTEM CREATES A UNIQUE PROCESS FOR HOSPITAL PAYMENT THAT DIFFERS FROM THE REST OF THE NATION. THE HEALTH SERVICES COST REVIEW COMMISSION, (HSCRC) DETERMINES PAYMENT THROUGH A RATE-SETTING PROCESS AND ALL PAYORS, INCLUDING GOVERNMENTAL PAYORS, PAY THE SAME AMOUNT FOR THE SAME SERVICES DELIVERED AT THE SAME HOSPITAL. MARYLAND UNIQUE ALL-PAYOR SYSTEM INCLUDES A METHOD FOR REFERENCING UNCOMPENSATED CARE IN EACH PAYORS RATES, WHICH DOES NOT ENABLE MARYLAND HOSPITALS TO BREAKOUT ANY OFFSETTING REVENUE RELATED TO HEALTH PROFESSIONS EDUCATION. PART VI, LINE 6: THE JOHNS HOPKINS HEALTH SYSTEM CORPORATION (JHHSC) IS INCORPORATED IN THE STATE OF MARYLAND TO, AMONG OTHER THINGS, FORMULATE POLICY AMONG AND PROVIDE CENTRALIZED MANAGEMENT FOR JHHSC AND AFFILIATES (JHHS). JHHS IS ORGANIZED AND OPERATED FOR THE PURPOSE OF PROMOTING HEALTH BY FUNCTIONING AS A PARENT HOLDING COMPANY OF AFFILIATES WHOSE COMBINED MISSION IS TO PROVIDE PATIENT CARE IN THE TREATMENT AND PREVENTION OF HUMAN ILLNESS WHICH COMPARES FAVORABLY WITH THAT RENDERED BY ANY OTHER INSTITUTION IN THIS COUNTRY OR ABROAD.JHHSC IS THE SOLE MEMBER OF THE JOHNS HOPKINS HOSPITAL (JHH), AN ACADEMIC MEDICAL CENTER, JOHNS HOPKINS BAYVIEW MEDICAL CENTER, INC. (JHBMC), A COMMUNITY BASED TEACHING HOSPITAL AND LONG-TERM CARE FACILITY, HOWARD COUNTY GENERAL HOSPITAL, INC. (HCGH), A COMMUNITY BASED HOSPITAL, SUBURBAN HOSPITAL, INC. (SHI), A COMMUNITY BASED HOSPITAL, SIBLEY MEMORIAL HOSPITAL (SMH), A D.C. COMMUNITY BASED HOSPITAL, AND ALL CHILDRENS HOSPITAL, INC (ACH), A FL ACADEMIC CHILDRENS HOSPITAL. PART VI, LINE 7, REPORTS FILED WITH STATES MD 1 INSTITUTE FOR PUBLIC HEALTH INNOVATION 1301 CONNECTICUT AVENUE NW WASHINGTON DC 20036 830398572 501(C)(3) 25000 LOCAL COMMUNITY ASSISTANCE 1 X X X X X 1 1 0 0 0 0 0 1 0 BRIAN A GRAGNOLATI TRUSTEE 0 724673 0 235291 0 282741 0 30362 0 28509 0 1301576 0 0 PATRICIA MC BROWN ESQUIRE TRUSTEE 0 450712 0 170336 0 158426 0 144382 0 13474 0 937330 0 136632 RONALD R PETERSON CORPORATE VICE CHAIRMAN & 0 1309445 0 566178 0 257488 0 456542 0 24593 0 2614246 0 0 GENE E GREEN MD TRUSTEE, PRESIDENT 0 398988 0 118080 0 168760 0 28374 0 22814 0 737016 0 0 MARTIN BASSO SR VP FINANCE AND TREASURE 0 358411 0 69111 0 126329 0 32052 0 23012 0 608915 0 0 PETER B MANCINO ESQUIRE CORPORATE SECRETARY 0 232915 0 46024 0 860 0 31488 0 20333 0 331620 0 0 DENNIS PARNELL SR VP HUMAN RESOURCES 0 152557 0 45916 0 204667 0 23688 0 3927 0 430755 0 0 JACQUELINE SCHULTZ RN EXECUTIVE V.P. & COO 0 311442 0 100162 0 162412 0 45103 0 10259 0 629378 0 118289 CHRISTOPHER TIMBERS VP & COO 0 197146 0 33173 0 278863 0 22591 0 23816 0 555589 0 0 ROBERT ROTHSTEIN VP MEDICAL AFFAIRS 0 342027 0 66580 0 26908 0 111919 0 22661 0 570095 0 0 JOSEPH LINSTROM SR DIRECTOR 170679 0 13530 0 676 0 7784 0 25629 0 218298 0 0 0 STEVEN COHEN PHYSICIAN ASST. 143103 0 3870 0 36025 0 7620 0 22903 0 213521 0 0 0 BARBARA STEWARD JACOBS SR DIRECTOR 190834 0 14845 0 1024 0 8552 0 15892 0 231147 0 0 0 MUHAMMAD MOHIUDDIN CHIEF TECHNICIAN 191164 0 0 0 623 0 7972 0 22979 0 222738 0 0 0 JOAN HALL SR DIRECTOR 165067 0 16400 0 879 0 7491 0 15166 0 205003 0 0 0 NANCY MILLER FORMER OFFICER 136062 0 8500 0 446 0 5810 0 1380 0 152198 0 0 0 MATTHEW POFFENROTH MD FORMER SR. V.P. 0 279748 0 32282 0 27933 0 14397 0 20126 0 374486 0 0 LESLIE FORD WEBER FORMER SR. VP, GOVT & COMMUNITY R 110519 0 73093 0 28496 0 8186 0 1711 0 222005 0 7946 0 PART I, LINES 4A-B THE FOLLOWING INDIVIDUAL RECEIVED A CHANGE-OF-CONTROL PAYMENT FROM SUBURBAN HOSPITAL, INC.: DENNIS PARNELL $90,952.22 THE SUBURBAN HOSPITAL, INC. SERP PLAN IS A NON-TAX QUALIFIED DEFINED CONTRIBUTION PLANS. THE PLAN PROVIDES A FIXED PERCENTAGE OF SALARY AS SUPPLEMENTAL RETIREMENT BENEFIT FOR EACH PARTICIPANT. IN THE MANNER REQUIRED BY APPLICABLE IRS RULES, THE DESIGN OF EACH OF THESE ARRANGEMENTS WAS APPROVED AS REASONABLE, IN ADVANCE, BY AN INDEPENDENT COMPENSATION COMMITTEE, WHICH BASED ITS DECISION ON DATA PROVIDED BY AN INDEPENDENT COMPENSATION CONSULTANT. PARTICIPANTS' INTERESTS UNDER THESE ARRANGEMENTS ARE NOT GUARANTEED OR SECURED AT ANY WAY AND AT ALL TIMES ARE SUBJECT TO CLAIMS OF EMPLOYER'S BANKRUPTCY/INSOLVENCY CREDITORS. IF A PARTICIPANT VOLUNTARILY TERMINATES EMPLOYMENT AND FAILS TO SATISFY CERTAIN NON-COMPETE PROVISIONS, THE PARTICIPANT'S ACCOUNT IS FORFEITED. IN ADDITION, UNDER CURRENT LAW, INTERESTS UNDER THESE ARRANGEMENTS ARE REPORTABLE AS TAXABLE COMPENSATION WHEN THEY BECOME VESTED, EVEN IF THOSE AMOUNTS ARE NOT YET PAYABLE TO THE PARTICIPANT (AND EVEN IF THOSE AMOUNTS ARE NEVER PAID TO THE PARTICIPANT). NO ROLLOVER OR OTHER TAX-DEFERRAL OPTIONS ARE AVAILABLE TO PARTICIPANTS. NOTE THAT ANY SERP PLAN VESTED AMOUNT OR PAYMENT BEING REPORTED AS COMPENSATION WAS ALSO REPORTED IN PREVIOUS YEAR(S) WHEN THAT INTEREST ACCRUED UNDER THE PLAN. THE FOLLOWING INDIVIDUALS LISTED ON FORM 990, PART VII, SECTION A, LINE 1A PARTICIPATED IN A NON QUALIFIED RETIREMENT PLAN WITH THE RELATED ORGANIZATION SUBURBAN HOSPITAL, INC AND RECEIVED PAYMENT FROM THE PLAN, IT IS REPORTED ON SCHEDULE J, PART II, COLUMN (B)(III) AS WELL AS SCHEDULE J, PART II, COLUMN (F) IF THEY WERE REQUIRED TO BE DISCLOSED ON PRIOR YEAR'S FORMS 990: MARTY BASSO $72,985.21; JACQUELINE SCHULTZ $118,288.99; DENNIS PARNELL $43,673.88 AND BRIAN GRAGNOLATI $255,378.61 THE JOHNS HOPKINS HEALTH SYSTEM CORPORATION'S MAKE WHOLE AND SERP I PLANS ARE FROZEN, NON-TAX QUALIFIED DEFINED BENEFIT PLANS. PARTICIPATION IN THE PLANS IS LIMITED TO THE EXISTING PLAN PARTICIPANTS. THE BENEFITS UNDER THE PLANS ARE BASED UPON THE PARTICIPANT'S LENGTH OF SERVICE AND COMPENSATION. THE MAKE WHOLE PLAN WAS DESIGNED TO REPLACE THE BENEFITS THE PARTICIPANTS LOST DUE TO THE COMPENSATION LIMITS IMPOSED BY LAW UPON OUR QUALIFIED DEFINED BENEFIT PLAN. IN THE MANNER REQUIRED BY APPLICABLE IRS RULES, THE DESIGN OF EACH OF THESE ARRANGEMENTS WAS APPROVED AS REASONABLE, IN ADVANCE, BY AN INDEPENDENT COMPENSATION COMMITTEE, WHICH BASED ITS DECISION ON DATA PROVIDED BY AN INDEPENDENT COMPENSATION CONSULTANT. PARTICIPANTS' INTERESTS UNDER THESE ARRANGEMENTS ARE NOT GUARANTEED OR SECURED AT ANY WAY AND AT ALL TIMES ARE SUBJECT TO CLAIMS OF EMPLOYER'S BANKRUPTCY/INSOLVENCY CREDITORS. FURTHERMORE, IF A PARTICIPANT VOLUNTARILY TERMINATES EMPLOYMENT OR IS TERMINATED BY THE EMPLOYER FOR CAUSE PRIOR TO THE APPLICABLE VESTING DATE UNDER THE MAKE WHOLE PLAN, THE PARTICIPANT'S ENTIRE MAKE WHOLE PLAN BENEFIT IS FORFEITED. IF A PARTICIPANT TERMINATES EMPLOYMENT FOR ANY REASON PRIOR TO THE APPLICABLE VESTING DATE UNDER THE SERP I, THE PARTICIPANT'S ENTIRE SERP I BENEFIT IS FORFEITED. IN ADDITION, UNDER CURRENT LAW, INTERESTS UNDER THESE ARRANGEMENTS ARE REPORTABLE AS TAXABLE COMPENSATION WHEN THEY BECOME VESTED, EVEN IF THOSE AMOUNTS ARE NOT YET PAYABLE TO THE PARTICIPANT (AND EVEN IF THOSE AMOUNTS ARE NEVER PAID TO THE PARTICIPANT). NO ROLLOVER OR OTHER TAX-DEFERRAL OPTIONS ARE AVAILABLE TO PARTICIPANTS. NOTE THAT ANY MAKE WHOLE PLAN OR SERP I VESTED AMOUNT OR PAYMENT BEING REPORTED AS COMPENSATION WAS ALSO REPORTED IN PREVIOUS YEAR(S) WHEN THAT INTEREST ACCRUED UNDER THE PLAN. THE JOHNS HOPKINS HEALTH SYSTEM CORPORATION'S SERP II AND SRP PLANS ARE ACTIVE; NON-TAX QUALIFIED DEFINED CONTRIBUTION TARGET BENEFIT PLANS. THE PLANS ARE DESIGNED TO ACHIEVE A REASONABLE TARGETED RETIREMENT BENEFIT LEVEL FOR EACH PARTICIPANT (IN COMBINATION WITH THE OTHER RETIREMENT PROGRAMS OF THE EMPLOYER) BASED UPON CERTAIN CRITERIA, SUCH AS EACH PARTICIPANT'S LENGTH OF SERVICE AND COMPENSATION. IN THE MANNER REQUIRED BY APPLICABLE IRS RULES, THE DESIGN OF EACH OF THESE ARRANGEMENTS WAS APPROVED AS REASONABLE, IN ADVANCE, BY AN INDEPENDENT COMPENSATION COMMITTEE, WHICH BASED ITS DECISION ON DATA PROVIDED BY AN INDEPENDENT COMPENSATION CONSULTANT. PARTICIPANTS' INTERESTS UNDER THESE ARRANGEMENTS ARE NOT GUARANTEED OR SECURED AT ANY WAY AND AT ALL TIMES ARE SUBJECT TO CLAIMS OF EMPLOYER'S BANKRUPTCY/INSOLVENCY CREDITORS. IF A PARTICIPANT VOLUNTARILY TERMINATES EMPLOYMENT OR IS TERMINATED BY THE EMPLOYER FOR CAUSE PRIOR TO THE APPLICABLE VESTING DATE UNDER EACH ARRANGEMENT, THE PARTICIPANT'S ACCOUNT IS FORFEITED. IN ADDITION, UNDER CURRENT LAW, INTERESTS UNDER THESE ARRANGEMENTS ARE REPORTABLE AS TAXABLE COMPENSATION WHEN THEY BECOME VESTED, EVEN IF THOSE AMOUNTS ARE NOT YET PAYABLE TO THE PARTICIPANT (AND EVEN IF THOSE AMOUNTS ARE NEVER PAID TO THE PARTICIPANT). NO ROLLOVER OR OTHER TAX-DEFERRAL OPTIONS ARE AVAILABLE TO PARTICIPANTS. NOTE THAT ANY SERP II OR SRP PLAN VESTED AMOUNT OR PAYMENT BEING REPORTED AS COMPENSATION WAS ALSO REPORTED IN PREVIOUS YEAR(S) WHEN THAT INTEREST ACCRUED UNDER THE PLAN. THE FOLLOWING INDIVIDUALS LISTED ON FORM 990, PART VII, SECTION A, LINE 1A PARTICIPATED IN A NONQUALIFIED RETIREMENT PLAN WITH THE RELATED ORGANIZATION JOHNS HOPKINS HEALTH SYSTEM CORPORATION AND RECEIVED ACCRUED DEFERRED COMPENSATION THAT IS REPORTED ON SCHEDULE J, PART II, COLUMN (C): RONALD PETERSON $450,612; PATRICIA BROWN $103,493.21; PETER MANCINO $13,072.00; AND ROBERT ROTHSTEIN $68,940.00 THE FOLLOWING INDIVIDUALS LISTED ON FORM 990, PART VII, SECTION A, LINE 1A PARTICIPATED IN A NON QUALIFIED RETIREMENT PLAN AND RECEIVED PAYMENT FROM THE PLAN, IT IS REPORTED ON SCHEDULE J, PART II, COLUMN (B)(III) AS WELL AS SCHEDULE J, PART II, COLUMN (F) IF THEY WERE REQUIRED TO BE DISCLOSED ON PRIOR YEAR'S FORMS 990: PATRICIA M.C. BROWN $136,631.76; GENE GREEN $125,209.51; LESLIE FORD-WEBER $7,945.55; AND CHRIS TIMBERS $246,086.03 PART I, LINE 7 EXECUTIVES, CEO AND DIRECTORS PARTICIPATE IN AN ANNUAL INCENTIVE PLAN. THE ANNUAL INCENTIVE PLAN HAS THREE POTENTIAL PAYOUT LEVELS - THRESHOLD, TARGET AND MAXIMUM. EACH YEAR SPECIFIC TARGETS ARE ESTABLISHED IN THE AREAS OF QUALITY PATIENT SATISFACTION, FINANCE, HUMAN RESOURCES AND INDIVIDUAL PERFORMANCE. THE INCENTIVE AMOUNT DEPENDS ON THE LEVEL ACCOMPLISHED DURING THE YEAR. THERE IS A 3 YEAR EXECUTIVE LONG TERM INCENTIVE PLAN ONLY AVAILABLE TO CEO AND SENIOR VICE PRESIDENTS. PAYOUT LEVELS ARE THE SAME AS THE ANNUAL PLAN EXCEPT THAT THE PAYOUTS UNDER THE PLAN ARE MADE IN TWO PARTS - 50% OF THE PAYOUT IS MADE AT THE END OF THE 3 YEAR CYCLE AND THE REMAINING 50% IS PAID OUT THE FOLLOWING YEAR. SCHEDULE J, PART II, OFFICERS THE CURRENT OFFICERS OF SUBURBAN HOSPITAL, INC. WERE TRANSFERRED TO THE PAYROLL OF THE RELATED ORGANIZATION JOHNS HOPKINS HEALTH SYSTEM CORPORATION. JOHNS HOPKINS HEALTH SYSTEM CORPORATION IS THE PARENT ORGANIZATION OF SUBURBAN HOSPITAL. THE SALARY AND BENEFIT EXPENSE FOR THOSE EXECUTIVES IS PAID FROM SUBURBAN HOSPITAL TO JOHNS HOPKINS HEALTH SYSTEM THROUGH A MONTHLY CHARGEBACK. THE EXPENSE IS INCLUDED ON THIS RETURN IN PURCHASED SERVICES. A MARYLAND HEALTH AND HIGHER EDUCATIONAL FACILITIES AUTHORITY 520936091 574217SB2 2004-06-30 32445000 REFUND PRIOR ISSUE 10/14/1993 0 0 0 A 29135000 32445000 351215 1 0 1 1 A 0 0 0 0 0 0 0 A 0 0 0 0 0 0 0 1 0 A 1 SCHEDULE K, PART III, LINES 7-9 NONQUALIFIED BONDS THE ORGANIZATION ANSWERED 'NO' BECAUSE IT HAS NO NONQUALIFIED BONDS. FORM 990, PART VI, SECTION A, LINE 7A JOHNS HOPKINS HEALTH SYSTEM CORPORATION, AN IRC 501C (3) TAX EXEMPT ORGANIZATION AND THE SOLE MEMBER OF SUBURBAN HOSPITAL, INC. ELECTS THE MAJORITY OF THE BOARD OF TRUSTEES. FORM 990, PART VI, SECTION A, LINE 7B THE GOVERNING BODY OF SUBURBAN HOSPITAL, INC. IS EMPOWERED BY ITS BY-LAWS TO MAKE CERTAIN DECISIONS; ALL OTHER DECISIONS ARE SUBJECT TO APPROVAL OF THE SOLE MEMBER JOHNS HOPKINS HEALTH SYSTEM CORPORATION. FORM 990, PART VI, SECTION B, LINE 11 A COPY OF THE FORM 990 WAS PROVIDED TO THE BOARD OF TRUSTEES AND THE EXECUTIVE COMMITTEE BEFORE IT WAS FILED. FORM 990, PART VI, SECTION B, LINE 12C THE CONFLICT OF INTEREST POLICY IS PART OF THE ANNUAL FINANCIAL AUDIT CONFIRMATION PROCESS PROVIDED ONLINE. ALL OFFICERS, DIRECTORS, TRUSTEES, AND KEY EMPLOYEES ARE REQUIRED TO COMPLY ON AN ANNUAL BASIS. FORM 990, PART VI, SECTION B, LINE 15 EVERY THREE YEARS AN INDEPENDENT STUDY IS CONDUCTED GATHERING INDUSTRY COMPENSATION AVERAGES FROM SELECT PEER INSTITUTIONS. EVERY YEAR THE JOHNS HOPKINS BOARD OF TRUSTEES COMPENSATION COMMITTEE REVIEWS COMPENSATION AMOUNTS FOR OFFICERS AND ALL EMPLOYEES AT THE DIRECTOR AND HIGHER LEVELS. FORM 990, PART VI, SECTION C, LINE 19 INTERNAL POLICIES, INCLUDING CONFLICT OF INTEREST POLICY, ARE PROVIDED TO THE PUBLIC ON THE ORGANIZATIONS WEBSITE. FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST, THE GOVERNING DOCUMENTS HAVE BEEN MADE AVAILABLE IN OUR PUBLIC FILING WITH THE STATE OF MARYLAND AND THE INTERNAL REVENUE SERVICE. FORM 990, PART XI, LINE 9: CHANGE IN DEFINED BENEFIT PLAN -2,267,000. CHANGE IN MARKET VALUE ON SWAP 614,361. NET ASSETS RELEASED FOR RESTRICTION 912,745. CONTRIBUTIONS TO/FROM AFFILIATES -75,000. CHANGE IN UNRELATED ENTITY TRANSFER 7,799,039. UNREALIZED LOSS ON ALTERNATIVE INVESTMENT -3,663,732. SUBURBAN PHYSICIAN ASSISTANT ASSOCIATES LLC 8600 OLD GEORGETOWN ROAD BETHESDA MD 20814 010642496 MEDICAL SERVICES MD 667605 88009 SUBURBAN HOSPITAL INC SUBURBAN HOSPITAL FOUNDATION INC 8600 OLD GEORGETOWN ROAD BETHESDA MD 20814 522019696 SUPPORTING ORGANIZATION MD 501(C)(3) LINE 11A, I SUBURBAN HOSPITAL INC 1 JOHNS HOPKINS HEALTH SYSTEM CORPORATION 3910 KESWICK RD SOUTH BLDG 4TH FL S BALTIMORE MD 21211 521465301 SUPPORTING ORGANIZATION MD 501(C)(3) LINE 11C, III-FI JOHNS HOPKINS HEALTH SYSTEM CORPORATION 0 HOWARD COUNTY GENERAL HOSPITAL INC 3910 KESWICK RD SOUTH BLDG 4TH FL S BALTIMORE MD 21211 522093120 HOSPITAL MD 501(C)(3) LINE 3 JOHNS HOPKINS HEALTH SYSTEM CORPORATION 0 HOWARD COUNTY LIQUIDATION CORPORATION 3910 KESWICK RD SOUTH BLDG 4TH FL S BALTIMORE MD 21211 520892284 INACTIVE TAX-EXEMPT ORGANIZATION MD 501(C)(3) LINE 3 JOHNS HOPKINS HEALTH SYSTEM CORPORATION 0 JOHNS HOPKINS BAYVIEW MEDICAL CENTER INC 3910 KESWICK RD SOUTH BLDG 4TH FL S BALTIMORE MD 21211 521341890 HOSPITAL MD 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