2022-05-13T17:54:08-05:00 2021-06-30 135565207 KPMG LLP 8350 BROAD STREET SUITE 900 MCLEAN VA 22102 990 2020-07-01 521672866 GOOD SAMARITAN NURSING CENTER INC GOOD 4107726721 5601 LOCH RAVEN BLVD BALTIMORE MD 21239 JOEL BRYAN VP/TREASURER 4107726721 2022-05-11 1 JOEL BRYAN 999009999 ANDREW ROE P01876391 7032868000 2022-05-10 3 AAL1 IAL1 2020 2022-09-23 18:48:47Z BRADLEY CHAMBERS 5601 LOCH RAVEN BLVD BALTIMORE MD 21239 73000 0 X WWW.MEDSTARHEALTH.ORG X 1989 MD PROVISION OF LONG TERM CARE AND REHABILITATIVE SERVICES. 4 0 1 0 0 0 0 0 0 0 0 0 73000 73000 73000 73000 0 0 0 0 0 -4182 0 0 0 0 4181 0 -1 73000 73001 120000 120000 851888 836291 -731888 -716291 PROVISION OF LONG TERM CARE AND REHABILITATIVE SERVICES. 0 0 GOOD SAMARITAN NURSING CENTER, INC OPERATED A 147-BED COMPREHENSIVE CARE FACILITY LOCATED ON THE GOOD SAMARITAN HOSPITAL CAMPUS. THE FACILITY PROVIDED LONG-TERM CARE ASSISTANCE TO ITS RESIDENTS, 75% OF WHOM WERE STATE OF MARYLAND ASSISTANCE RECIPIENTS. IN ADDITION TO THESE SERVICES, THE ORGANIZATION OFFERED INTERGENERATIONAL PROGRAMMING FOR THE RESIDENTS THAT WAS DRAWN FROM SCHOOLS, DAY CARE CENTERS, ETC. IN ADDITION, THE ORGANIZATION PROVIDED ACTIVITIES WHERE THE COMMUNITY WAS WELCOMED TO JOIN IN, SUCH AS ITS RESPITE CARE PROGRAM, IN WHICH CAREGIVERS IN THE COMMUNITY WERE PROVIDED AN OPPORTUNITY TO HAVE A VACATION OR BREAK FROM CARING FOR A LOVED ONE AT HOME. 1 0 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 X 4 0 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X JOEL BRYAN 4107726721 10980 GRANTCHESTER WAY 6TH FL COLUMBIA MD 21044 OLIVER M JOHNSON II SECRETARY/DIRECTOR 1.00 39.00 X X 0 1526399 45442 BRADLEY CHAMBERS PRESIDENT/DIRECTOR 1.00 39.00 X X 0 1283172 55017 ROBERT GILBERT DIRECTOR 1.00 39.00 X 0 906122 41068 DEANA STOUT TREASURER/DIRECTOR 1.00 39.00 X X 0 544587 52574 0 4260280 194101 1 0 1 0 0 73000 0 73000 73000 73000 73000 0 0 73000 -4182 -4182 4181 4181 -1 0 -1 0 120000 120000 120000 120000 120000 847253 831656 4635 4635 851888 836291 X -731888 -716291 -731888 -716291 120000 120000 X 73001 -57404 X X 0 1 X 1 0 X 0 73000 73000 73000 73000 73000 365000 73000 73000 73000 73000 73000 365000 73000 73000 73000 73000 73000 365000 0.00000 0.97160 1.00000 0.02630 X 120000 120000 120000 INTERCOMPANY PAYABLES 4635 4635 X PART X, LINE 2: FIN 48 INCOME TAXES ARE ACCOUNTED FOR UNDER THE ASSET AND LIABILITY METHOD. DEFERRED TAX ASSETS AND LIABILITIES ARE RECOGNIZED FOR THE FUTURE TAX CONSEQUENCES ATTRIBUTABLE TO DIFFERENCES BETWEEN THE FINANCIAL STATEMENT CARRYING AMOUNTS OF EXISTING ASSETS AND LIABILITIES AND THEIR RESPECTIVE TAX BASES AND OPERATING LOSS AND TAX CREDIT CARRYFORWARDS. DEFERRED TAX ASSETS AND LIABILITIES ARE MEASURED USING ENACTED TAX RATES EXPECTED TO APPLY TO TAXABLE INCOME IN THE YEARS IN WHICH THOSE TEMPORARY DIFFERENCES ARE EXPECTED TO BE RECOVERED OR SETTLED. THE EFFECT ON DEFERRED TAX ASSETS AND LIABILITIES OF A CHANGE IN TAX RATES IS RECOGNIZED IN THE PERIOD THAT INCLUDES THE ENACTMENT DATE. ANY CHANGES TO THE VALUATION ALLOWANCE ON THE DEFERRED TAX ASSET ARE REFLECTED IN THE YEAR OF CHANGE.THE CORPORATION ACCOUNTS FOR UNCERTAIN TAX POSITIONS IN ACCORDANCE WITH THE FASB ACCOUNTING STANDARDS CODIFICATION (ASC) TOPIC 740, INCOME TAXES. THERE WAS NO LIABILITY RECORDED FOR UNCERTAIN TAX POSITIONS AS OF JUNE 30, 2021. X X X X X X 0 0 0 0 0 0 0 0 0 OLIVER M JOHNSON II SECRETARY/DIRECTOR 0 719148 0 807251 0 0 0 8550 0 36892 0 1571841 0 0 BRADLEY CHAMBERS PRESIDENT/DIRECTOR 0 646636 0 636536 0 0 0 22287 0 32730 0 1338189 0 0 ROBERT GILBERT DIRECTOR 0 464514 0 441403 0 205 0 8550 0 32518 0 947190 0 0 DEANA STOUT TREASURER/DIRECTOR 0 331485 0 164361 0 48741 0 28253 0 24321 0 597161 0 0 SCHEDULE J, PART III BRADLEY CHAMBERS' COMPENSATION IS FOR SERVICES PROVIDED AS PRESIDENT TO BOTH MEDSTAR GOOD SAMARITAN HOSPITAL AND MEDSTAR UNION MEMORIAL HOSPITAL. DEANA STOUT'S COMPENSATION IS FOR SERVICES PROVIDED AS CFO TO BOTH MEDSTAR GOOD SAMARITAN HOSPITAL AND MEDSTAR UNION MEMORIAL HOSPITAL. FORM 990, PART VI, SECTION A, LINE 6 ORGANIZATION MEMBERS THE ORGANIZATION IS AN AFFILIATE AND SUBSIDIARY OF MEDSTAR HEALTH, INC., A TAX-EXEMPT MARYLAND NON-STOCK CORPORATION. MEDSTAR HEALTH, INC., OR ONE OF ITS AFFILIATES AND SUBSIDIARIES, IS THE SOLE MEMBER OF THE ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 7A DESCRIPTION OF MEMBERS AS AN AFFILIATE AND SUBSIDIARY OF MEDSTAR HEALTH, INC., A TAX-EXEMPT MARYLAND NON-STOCK CORPORATION, THE ORGANIZATION MAY RECOMMEND PERSON(S) FOR MEMBERSHIP ON THE ORGANIZATION'S GOVERNING BODY. ANY SUCH RECOMMENDATION BY THE ORGANIZATION IS SUBJECT TO APPROVAL BY THE GOVERNANCE COMMITTEE OF THE BOARD OF DIRECTORS OF MEDSTAR HEALTH, INC. THE BOARD OF MEDSTAR HEALTH, INC. HAS DELEGATED CERTAIN APPROVAL AUTHORITY TO THE GOVERNANCE COMMITTEE AND THE PRESIDENT & CEO OF MEDSTAR HEALTH, INC. FORM 990, PART VI, SECTION A, LINE 7B DECISIONS OF GOVERNING BODY AS AN AFFILIATE AND SUBSIDIARY OF MEDSTAR HEALTH, INC., A TAX-EXEMPT MARYLAND NON-STOCK CORPORATION, THE BYLAWS OF THE ORGANIZATION ARE SUBJECT TO CERTAIN RESERVED POWERS, WHICH PROVIDE THAT THE SOLE MEMBER OF THE ORGANIZATION MUST APPROVE CERTAIN DECISIONS, INCLUDING BUT NOT LIMITED TO MATTERS CONCERNING THE SALE OR PURCHASE OF REAL OR PERSONAL PROPERTY, CAPITAL BUDGETS, STRATEGIC PLANNING, INVESTMENTS, AND CORPORATE GOVERNANCE. FORM 990, PART VI, SECTION B, LINE 11B PROCESS FOR REVIEWING FORM 990 THE PROCESS FOR REVIEWING THE FORM 990 INCLUDED EDUCATION AND TRANSPARENCY. SENIOR FINANCIAL EXECUTIVES, WORKING WITH INDEPENDENT OUTSIDE EXPERTS, THOROUGHLY REVIEWED FORM 990 AND ACCOMPANYING INSTRUCTIONS. IN ADDITION, SENIOR EXECUTIVES REVIEWED THE RELEVANT SECTIONS OF THE FORM 990 WITH THE FOLLOWING COMMITTEES OF THE ORGANIZATION'S GOVERNING BODY: FINANCE, AUDIT, GOVERNANCE, STRATEGIC PLANNING, AND EXECUTIVE COMPENSATION. FOLLOWING THESE MEETINGS, THE GOVERNING BODY WAS PROVIDED A COPY OF THE FORM 990 IN ITS FINAL FORM AND GIVEN AN OPPORTUNITY TO PROVIDE ANY INPUT OR COMMENTS RELATING TO THE FORM 990 PRIOR TO ITS FILING. FORM 990, PART VI, SECTION B, LINE 12C CONFLICT OF INTEREST POLICY APPOINTMNENT OF BOARDS OF DIRECTORS MEDSTAR HEALTH (AND ITS SUBSIDIARIES) REQUIRE ALL NOMINATED DIRECTORS, PRIOR TO THEIR APPOINTMENT OR ELECTION, TO DISCLOSE THE EXISTENCE OF (OR POTENTIAL EXISTENCE OF) ANY TRANSACTION WITH MEDSTAR THAT WOULD RESULT IN A CONFLICT OF INTEREST. SUCH DISCLOSURES (IF ANY) ARE REVIEWED BY THE GOVERNANCE COMMITTEE OF THE MEDSTAR HEALTH BOARD OF DIRECTORS WHICH DETERMINES HOW THE MATTER SHOULD BE RESOLVED. ANNUAL DISCLOSURES - ALL OFFICERS, DIRECTORS, AND SENIOR MANAGERS ALL OFFICERS, DIRECTORS AND SERNIOR MANAGERS ARE REQUIRED, NOT LESS THAN ANNUALLY, TO COMPLETE A SURVEY OF QUESTIONS CONCERNING ANY TRANSACTIONS OR RELATIONSHIPS WHICH WOULD OR COULD REPRESENT A CONFLICT OF INTEREST. SUCH DISCLOSURES (IF ANY) RELATED TO DIRECTORS ARE REVIEWED BY THE GOVERNANCE COMMITTEE OF THE MEDSTAR HEALTH BOARD OF DIRECTORS WHICH DETERMINES HOW THE MATTER SHOULD BE RESOLVED. SUCH DISCLOSURES (IF ANY) RELATED TO OFFICERS AND SENIOR MANAGERS ARE REVIEWED BY AN APPROPRIATE EXECUTIVE WHO DETERMINES HOW THE MATTER SHOULD BE RESOLVED. IN ADDITION, OFFICERS AND DIRECTORS OF MARYLAND HOSPITALS AND NURSING CENTERS ARE REQUIRED TO ANNUALLY DISCLOSE ADDITIONAL INFORMATION RELATING TO POTENTIAL CONFLICTS OF INTEREST AND SUCH DISCLOSURES ARE REPORTED TO THE MARYLAND HEALTH SERVICES COST REVIEW COMISSION (HSCRC). FORM 990, PART VI, SECTION B, LINE 15 DESCRIPTION OF EXECUTIVE COMPENSATION PROCESS THE EXECUTIVE COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS OF MEDSTAR HEALTH, INC. (THE "COMMITTEE") HAS OVERSIGHT OVER THE EXECUTIVE COMPENSATION PROGRAM (THE "PROGRAM") OF MEDSTAR HEALTH, INC. AND ITS AFFILIATES. TOTAL COMPENSATION FOR THE TOP MANAGEMENT OFFICIALS, OFFICERS AND KEY EMPLOYEES OF MEDSTAR HEALTH, INC. AND ITS AFFILIATES ARE REVIEWED AND APPROVED BY THE COMMITTEE WITH ASSISTANCE AND GUIDANCE FROM AN INDEPENDENT THIRD PARTY ADVISOR. THE MEMBERS OF THE COMMITTEE ARE INDEPENDENT FROM ALL OF THE PARTICIPANTS IN THE PROGRAM. THE MAIN OBJECTIVE OF THE PROGRAM IS TO PROVIDE MARKET COMPETITIVE TOTAL COMPENSATION THAT IS INTERNALLY EQUITABLE AND HAS A STRONG PAY-FOR-PERFORMANCE LINKAGE. PERFORMANCE IS EVALUATED AT THE SYSTEM, OPERATING UNIT, AND INDIVIDUAL LEVELS. THE OVERALL TOTAL COMPENSATION PHILOSOPHY IS MANAGED AT THE 75TH PERCENTILE OF THE COMPETITIVE MARKET FOR COMPARABLE SIZE (NET REVENUE)AND TYPE (TAX-EXEMPT HEALTHCARE ORGANIZATIONS). WHERE APPROPRIATE, ADDITIONAL INDUSTRY DATA IS CONSIDERED (GENERAL BUSINESS AND /OR TAXABLE HEALTHCARE) FOR SELECTED POSITIONS THAT CAN BE RECRUITED FROM OR POTENTIALLY LOST TO THESE INDUSTRIES (E.G.,INFORMATION TECHNOLOGY, FINANCE, ETC.). THE COMMITTEE HAS ENGAGED ERNST & YOUNG LLP ("E&Y") TO SERVE AS AN ADVISOR ON THE REASONABLENESS AND COMPETITIVENESS OF THE PROGRAM. IN DETERMINING THE REASONABLENESS AND COMPETITIVENESS, E&Y REVIEWS MARKET PRACTICES AND TRENDS, AND MAKES RECOMMENDATIONS RELATED TO THE PROGRAM. E&Y UTILIZES INFORMATION FROM CUSTOM SURVEYS, NATIONAL COMPENSATION SURVEYS, PROPRIETARY DATABASES, AND CLIENT EXPERIENCES TO DETERMINE ITS FINAL RECOMMENDATIONS. E&Y PRESENTS THEIR FINDINGS AND RECOMMENDATIONS TO THE COMMITTEE. THE COMMITTEE MAKES THE FINAL DECISIONS ON ALL THE COMPENSATION DETERMINATIONS OF THE PROGRAM. ALL DECISIONS MADE BY THE COMMITTEE ARE CONTEMPORANEOUSLY DOCUMENTED. FORM 990, PART VI, SECTION C, LINE 19 FINANCIAL STATEMENT AVAILABILITY MEDSTAR HEALTH POSTS ITS ANNUAL FINANCIAL AUDIT AND QUARTERLY FINANCIAL REPORTS TO THE ELECTRONIC MUNICIPAL MARKET ACCESS (EMMA) SYSTEM. THE ORGANIZATION ALSO E-MAILS ITS ANNUAL AND QUARTERLY DISCLOSURES TO HOLDERS OF THE COMPANY'S PUBLICLY TRADED DEBT. THE COMPANY'S GOVERNANCE DOCUMENTS AND CONFLICTS OF INTEREST POLICIES ARE AVAILABLE UPON REQUEST THROUGH ITS CORPORATE (OR AS APPLICABLE ENTITY) PUBLIC INFORMATION OFFICES. FORM 990, PART XI, LINE 9: EQUITY TRANSFERS -57,404. CHURCH HOME CORPORATION 10980 GRANTCHESTER WAY 6TH FLOOR COLUMBIA MD 21044 237374724 MEDICAL FUND MD 501(C)(3) PF N/A 1 FRANKLIN SQUARE HOSPITAL CENTER INC 9000 FRANKLIN SQUARE DRIVE BALTIMORE MD 21237 520608007 HOSPITAL MD 501(C)(3) 3 N/A 1 HARBOR HOSPITAL INC 3001 SOUTH HANOVER STREET BALTIMORE MD 21225 520491660 HOSPITAL MD 501(C)(3) 3 N/A 1 MEDSTAR HEALTH INC 10980 GRANTCHESTER WAY 6TH FLOOR COLUMBIA MD 21044 522087445 MEDICAL SVCS MD 501(C)(3) 12C III N/A 0 MONTGOMERY GENERAL HOSPITAL 18101 PRINCE PHILIP DRIVE OLNEY MD 20832 520646893 HOSPITAL MD 501(C)(3) 3 N/A 1 THE GOOD SAMARITAN HOSPITAL OF MARYLAND 5601 LOCH RAVEN BLVD BALTIMORE MD 21239 520591607 HOSPITAL MD 501(C)(3) 3 N/A 1 THE UNION MEMORIAL HOSPITAL 201 EAST UNIVERSITY PARKWAY BALTIMORE MD 21218 520591685 HOSPITAL MD 501(C)(3) 3 N/A 1 MEDSTAR HEALTH RESEARCH INSTITUTE 108 IRVING STREET NW WASHINGTON DC 20010 526056274 HOSPITAL DC 501(C)(3) 4 N/A 1 THE MEDSTAR-GEORGETOWN MEDICAL CENTER I HOPSITAL ADMIN 1 MAIN BLDG WASHINGTON DC 20007 522218584 HOSPITAL DC 501(C)(3) 3 N/A 1 WASHINGTON HOSPITAL CENTER CORPORATION 110 IRVING STREET NW WASHINGTON DC 20010 521272129 HOSPITAL DC 501(C)(3) 3 N/A 1 HH MEDSTAR HEALTH INC 10980 GRANTCHESTER WAY 6TH FLOOR COLUMBIA MD 21044 521542230 MEDICAL SVCS MD 501(C)(3) 12C III N/A 1 MEDSTAR AMBULATORY SERVICES INC 10980 GRANTCHESTER WAY 6TH FLOOR COLUMBIA MD 21044 521132992 ADMIN SVCS MD 501(C)(3) 12C III N/A 1 BAY LIFE SERVICES INC 10980 GRANTCHESTER WAY 6TH FLOOR COLUMBIA MD 21044 521496539 MENTAL HEALTH MD 501(C)(3) 10 N/A 1 MEDSTAR SURGERY CENTER INC 4061 POWDERMILL ROAD SUITE 210 CALVERTON MD 20705 521061679 MEDICAL SVCS MD 501(C)(3) 10 N/A 1 CHURCH HOME AND HOSPITAL OF THE CITY OF 10980 GRANTCHESTER WAY 6TH FLOOR COLUMBIA MD 21044 520591600 MEDICAL FUND MD 501(C)(3) 12A I N/A 1 GS HOUSING INC 5601 LOCH RAVEN BLVD BALTIMORE MD 21239 521481656 ELDER HOUSING MD 501(C)(3) 10 N/A 1 GS PROPERTIES INC 5601 LOCH RAVEN BLVD BALTIMORE MD 21239 521429853 ADMIN SVCS MD 501(C)(3) 12A I N/A 1 MEDSTAR HEALTH INFUSION INC 4061 POWDERMILL ROAD SUITE 210 CALVERTON MD 20705 521980510 MEDICAL SVCS MD 501(C)(3) 10 N/A 1 MEDSTAR HEALTH VISITING NURSES ASSOCIATI 4061 POWDERMILL ROAD CALVERTON MD 20705 530196597 MEDICAL SVCS MD 501(C)(3) 10 N/A 1 MEDSTAR VNA HEALTHCARE 4061 POWDERMILL ROAD SUITE 210 CALVERTON MD 20705 521458516 MEDICAL SVCS MD 501(C)(3) 10 N/A 1 MGH COMMUNITY HEALTH INC 18101 PRINCE PHILIP DRIVE OLNEY MD 20832 521372467 MEDICAL SVCS MD 501(C)(3) 10 N/A 1 MGH HEALTH SERVICES INC 18101 PRINCE PHILIP DRIVE OLNEY MD 20832 521366812 FOUNDATION MD 501(C)(3) 12B II N/A 1 MGH WOMEN'S BOARD 18101 PRINCE PHILIP DRIVE OLNEY MD 20832 526039600 FOUNDATION MD 501(C)(3) 12C III N/A 1 NATIONAL REHABILITATION HOSPITAL 102 IRVING STREET NW WASHINGTON DC 20010 521369749 HOSPITAL DC 501(C)(3) 3 N/A 1 NRH REGIONAL REHAB AT OLNEY 18101 PRINCE PHILIP DRIVE OLNEY MD 20832 522310902 MEDICAL SVCS MD 501(C)(3) 3 N/A 1 SUBURBAN NRH MEDICAL REHABILITATION I 102 IRVING STREET NW WASHINGTON DC 20010 521931151 MEDICAL SVCS DC 501(C)(3) 3 N/A 1 THE THOMAS O'NEIL CATHOLIC HEALTH CARE F 5601 LOCH RAVEN BLVD BALTIMORE MD 21239 521104382 FOUNDATION MD 501(C)(3) 12D III N/A 1 VNA INC 4061 POWDERMILL ROAD SUITE 210 CALVERTON MD 20705 521332411 ADMIN SVCS MD 501(C)(3) 12A I N/A 1 WOODBOURNE WOODS INC 5601 LOCH RAVEN BLVD BALTIMORE MD 21239 522299070 ELDER HOUSING MD 501(C)(3) 10 N/A 1 HOSPICE OF ST MARY'S INC PO BOX 527 LEONARDTOWN MD 20650 522153926 SUPPORT ORG MD 501(C)(3) 12A I N/A 1 ST MARY'S HOSPITAL OF ST MARY'S COUNTY 25500 POINT LOOKOUT ROAD LEONARDTOWN MD 20650 520619006 HOSPITAL MD 501(C)(3) 3 N/A 1 MEDSTAR SOUTHERN MD HOSPITAL CENTER INC 7503 SURRATTS ROAD CLINTON MD 20735 460726303 HOSPITAL MD 501(C)(3) 3 N/A 1 MEDSTAR HEALTH INC AND AFFILIATES MASTER 10980 GRANTCHESTER WAY 6TH FLOOR COLUMBIA MD 21044 467454613 RET. 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