2021-05-07T13:30:58-05:00 2020-06-30 KPMG LLP 8350 Broad Street Suite 900 McLean VA 22102 990 2019-07-01 520646893 MONTGOMERY GENERAL HOSPITAL INC % JOEL BRYAN MONT 3017748640 18101 PRINCE PHILIP DRIVE OLNEY MD 20832 JOEL BRYAN VP/TREASURER 4107726721 2021-05-05 true JG WHITE P01498698 7032868000 2021-05-02 2019 2022-09-23 18:48:47Z MEDSTAR MONTGOMERY MEDICAL CENTER THOMAS SENKER 18101 PRINCE PHILIP DRIVE OLNEY MD 20832 175793430 false X WWW.MONTGOMERYGENERAL.ORG X 2000 MD MEDSTAR MONTGOMERY MEDICAL CENTER IS DEDICATED TO ENHANCING OUR COMMUNITY'S HEALTH BY OFFERING HIGH QUALITY, COMPASSIONATE AND PERSONALIZED CARE. 19 16 1202 276 1254319 0 3572403 4942874 166628151 168650796 74464 142862 1695052 2056898 171970070 175793430 55000 40000 0 0 84271748 89158151 0 0 0 80560766 82475596 164887514 171673747 7082556 4119683 111286595 107956332 29984715 59795169 81301880 48161163 X As a proud member of MedStar Health, MedStar Montgomery Medical Centers (MedStar Montgomery) mission is to enhance our communitys health and well-being by offering high quality, compassionate and personalized care. MedStar Montgomery is located in Olney, in northeastern Montgomery County, Maryland, a suburb of Washington, D.C. After over 90 years, the hospital remains true to its roots, offering a wide range of wellness programs and outpatient services in addition to inpatient treatment. In fiscal year 2020, MedStar Montgomery had approximately 5,956 inpatient admissions and approximately 90,080 outpatient visits and 29,344 emergency visits. false false 112761046 159846871 MedStar Montgomerys largest program is access to and the provision of acute hospital services to the communities of northeastern Montgomery County, Maryland and the surrounding areas. In addition to the program service expenses listed above, MedStar Montgomery incurred $41.3M of management and general expenses in providing services to its communities. The acute care hospital offers a cardiac and vascular program, general surgery, orthopedics, cancer care, and obstetrics. With the addition of specialists from MedStar Georgetown University Hospital and MedStar Washington Hospital Center, MedStar Montgomery brings specialty care closer to its patients. MedStar Montgomery also offers inpatient and outpatient mental health services. MedStar Montgomery includes an emergency department with a dedicated Pediatric Center, a Fast-Track unit and a separate unit for crisis evaluation. As one of the largest healthcare systems in Maryland and the Washington, D.C., region, MedStar Health and its affiliated entities cared for one in four COVID-19 patients in the region since March 2020. Operating as One MedStar and aligning with guidance from the Centers for Disease Control and Prevention (CDC) and local Departments of Health, MedStar Healths COVID-19 preparations and response were guided by two critical drivers: providing a safe care environment for patients and associates and ensuring operational continuity to fulfill our core mission of caring for our communities. These efforts included adding hospital beds in preparation for patient surges; balancing hospital admissions by using urgent care sites as frontline providers and facilitating telehealth interactions for virtual care and referrals; utilizing home health services to transition care from inpatient settings, ambulatory facilities, and a convention center field hospital; and standing up more than 40 COVID-19 testing locations. Underlying these actions is MedStar Healths commitment to the highest levels of quality and safety, reflected by the systemwide implementation of universal face masking for patients and associates, and acquisition of Personal Protective Equipment at usage levels 10 times normal use. 11160083 7654608 MedStar Montgomery provided $11.2M in subsidized (mission driven) health services in fiscal year 2020. These critical services, which are driven by community needs, operate at a loss. They address priorities primarily through disease prevention and improvement of health status. Services provided include palliative care, womens and childrens services, and continuing care. 3002037 MedStar Montgomery provided $3.0M in charity care services in fiscal year 2020. Charity care is provided pursuant to MedStar Healths Financial Assistance Policy to members of the community whose income is below certain thresholds and for which the hospital is not compensated. Under Marylands unique payer system, the amount reported represents MedStar Montgomerys charity care expense and revenues represent direct payments from the states charity care pool. Other charity care expenses are indirectly reimbursed via the state of Marylands payment system. 126923166 true true false false false false false false false false true false false false true true false true false false false false false false false false true true true false true false false false false false false false false true false false false true true true true false false true 0 0 true 1202 true true true false false false false false false false false false false false X 19 16 false false false false true true true true true false false true true true true true true true true true true MD X JOEL BRYAN 4107726721 10980 GRANTCHESTER WAY COLUMBIA MD 21044 X KENNETH A SAMET DIRECTOR 1.0 39.0 X 0 7598800 90696 FREDERICK FINELLI VP, MEDICAL AFFAIRS 40.0 0.0 X 806857 0 37492 THOMAS SENKER HOSPITAL PRESIDENT & SVP MSH 40.0 0.0 X X 742211 0 43808 Sujithra Jayaraj MD director 40.0 0.0 X 480236 0 34154 David Havrilla CFO/TREASURER 20.0 20.0 X 212335 212336 36843 Connie Stone VP, Patient Care Services 40.0 0.0 X 286443 0 17227 Nathaniel Barbo AVP, Professional Services 40.0 0.0 X 204964 0 17223 Derek Prochnicki REGISTERED NURSE 40.0 0.0 X 187636 0 17621 Kevin Mell FORMER VP, OPERATIONS 0.0 40.0 X 0 174757 15370 DENISE Kingsbury SR DIR, CLIN SUPPORT SERVICES 40.0 0.0 X 181760 0 6119 CAROLINA CHAVARRIA SECRETARY 40.0 0.0 X 80432 0 27374 JOSEPH BELL Director 1.0 0.0 X 0 0 0 RICHARD WEINSTEIN MD Director 1.0 0.0 X 0 0 0 JOHN FERGUSON VICE CHAIR 1.0 0.0 X 0 0 0 WENDY WALKER DVM DIRECTOR 1.0 0.0 X 0 0 0 JAMES BONIFANT DIRECTOR 1.0 0.0 X 0 0 0 KATHERINE W FARQUHAR PHD CHAIR 1.0 0.0 X 0 0 0 RICHARD KURNOT DIRECTOR 1.0 0.0 X 0 0 0 Steven Shimoura MD DIRECTOR 1.0 0.0 X 0 0 0 Ana Maldonado MD DIRECTOR 1.0 0.0 X 0 0 0 Alok Mathur MD DIRECTOR 1.0 0.0 X 0 0 0 Richard Hoffman DIRECTOR 1.0 0.0 X 0 0 0 Gary Fernandes Director 1.0 0.0 X 0 0 0 DEBORAH ELLINGHAUS DIRECTOR 1.0 0.0 X 0 0 0 MARK KOZAM MD DIRECTOR 1.0 0.0 X 0 0 0 KAREN NORDSTROM DIRECTOR 1.0 0.0 X 0 0 0 Neil R Ohora DPM DIRECTOR 1.0 0.0 X 0 0 0 3182874 7985893 343927 73 true true false SODEXO INC AFFILIATES 9801 WASHINGTONIAN BLVD GAITHERSBURG MD 20878 Food/Facilities Mgmt 1545019 COMMUNITY RADIOLOGY ASSOCIATES INC 10215 Fernwood Rd 620 BETHESDA MD 20817 Medical services 939636 ROLYN COMPANIES INC 5706 FREDERICK AVE ROCKVILLE MD 20852 Facilities services 937253 AMN HEALTHCARE INC 2735 Collection Center Dr CHICAGO IL 60693 Staffing Services 629533 EMERGENCY MEDICINE ASSOCIATES 20010 CENTURY BLVD STE 200 GERMANTOWN MD 20877 Medical Services 566324 27 255000 3727891 959983 67394 4942874 PATIENT SERVICE REVENUE 621300 167488579 167488579 PHARMACY REVENUE 900099 1149317 1149317 PHYSICIAN BILLING REVENUE 621110 12900 12900 168650796 65486 65486 0 0 618182 618182 0 618182 618182 77376 77376 77376 77376 0 0 0 0 0 0 0 0 0 REBATE INCOME 900099 317660 317660 EQUITY INTEREST IN AFFILIATES 900099 106286 106286 OTHER REVENUE 900099 1014770 105002 909768 1438716 175793430 167501479 1254319 2094758 40000 40000 0 0 0 1638973 1420754 218219 0 73605059 64022413 9582646 1009689 822869 186820 8493674 7055646 1438028 4410756 3833950 576806 18340198 18340198 0 0 0 0 7649 7649 15193485 13500246 1693239 762827 17014 745813 463045 704450 -241405 0 0 593891 982361 -388470 28522 18011 10511 0 42439 14544 27895 1077478 1077478 0 11034577 5479848 5554729 1909032 61509 1847523 MED/SURG SUPPLIES 17137238 17187913 -50675 MAINTENANCE 5635030 4270752 1364278 IMPLANTS/PROSTHESES 3607279 3607279 UTILITIES 2364619 2178875 185744 4278287 1704732 2573555 171673747 126923166 44750581 0 52 0 333114 379650 0 0 22955227 23017512 0 0 0 0 0 0 3370961 3591147 905580 680685 232373532 154929125 80932555 77444407 0 0 2789106 2842931 0 0 0 0 0 0 111286595 107956332 10607220 10606655 0 0 3186481 2992228 0 0 0 0 0 0 0 0 0 0 16191014 46196286 29984715 59795169 X 81301880 48161163 0 0 81301880 48161163 111286595 107956332 X 4119683 -61389 -37199011 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 146581 146581 107043162 55142830 51900332 2730140 2642199 87941 107904441 86996946 20907495 14549208 10147150 4402058 77444407 0 ADVANCES 38289450 OPERATING LEASE LIABILITIES 5392918 WORKERS COMPENSATION 990514 CREDIT BALANCES PATIENT AR 626147 GBR LIABILITY 334646 UCC POOL LIABILITY 260728 OTHER LIABILITIES 301883 46196286 X FIN 48 FOOTNOTE SCHEDULE D, PART X 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, 2020. true true X true X true X true true true false true true 3002037 3002037 0.01750 3002037 3002037 0.01750 1054366 17065 1037301 0.00600 242215 242215 0.00140 11160083 7654608 3505475 0.02040 134521 134521 0.00080 12591185 7671673 4919512 0.02860 15593222 7671673 7921549 0.04610 2302 2302 26386 26386 0.00020 9175 9175 0.00010 37863 37863 0.00030 true 4109428 true true 1 1 MONTGOMERY GENERAL HOSPITAL 18101 PRINCE PHILIP DRIVE OLNEY MD 20832 X X X MONTGOMERY GENERAL HOSPITAL 1 false false true X X X X X X X X X 17 true false false true X HTTP://WWW.MEDSTARMONTGOMERY.ORG/ X true 17 true HTTP://WWW.MEDSTARMONTGOMERY.ORG/ false true X 200. 400. X X X X X X true true X X X X true X HTTP://WWW.MEDSTARMONTGOMERY.ORG/ X HTTP://WWW.MEDSTARMONTGOMERY.ORG/ X HTTP://WWW.MEDSTARMONTGOMERY X X X X X X true X false X X X X true X false false CHNA INPUT PART V, SECTION B, LINE 5 HOSPITAL LEAD ROLE DESCRIPTION The Community Health Needs Assessment (CHNA) Hospital Lead serves as the coordinator of all aspects of the community health assessment process. He/she helps establish and coordinate the activities of the Advisory Task Force. The Lead also helps produce the hospital's Community Health Needs Assessment and Implementation Strategy. He/she works collaboratively with representatives from the Corporate Community Health Department and Georgetown University. The Lead also works closely with the writer. He/she reviews all narratives prior to publication. Name of Hospital Lead: Dairy Marroquin AND DIANA SALADINI Executive Sponsor Role Description The Executive Sponsor serves as the conduit between the Advisory Task Force and the Senior Management Team. The sponsor is an active participant of the Advisory Task Force and he/she communicates the hospital's clinical strengths and program priorities to diverse audiences. Name of Executive Sponsor: FREDERICK FINELLI, MD Advisory Task Force Role Description The Advisory Task Force (ATF) reviews primary/secondary data and local/state/federal community health goals. Based on findings, the ATF provides input into the hospital's three-year implementation strategy. As ambassadors for the CHNA process, the ATF members support efforts to optimize community participation.Note: The ATF should be a combination of community representatives and staff. Community representatives should makeup at least 50% of total participants. Name: Title/AFFILIATION NAME OF ORGANIZATION WITH HOSPITAL Amy Shields Wilson Vice President of MINDOULA HEALTH Operations Dairy Marroquin (Lead) Community Outreach MMMC Coordinator Deb Otani Cancer Nurse Navigator MMMC Debbie Ellinghaus Managing Director Olney Theatre Diana Saladini Director, Population MMMC Health Edith Williams Community Member Millian United Methodist Church Frederick Finelli, MD Executive Sponsor MMMC VP Medical Affairs Jaqueline Hubbard Health Center Director Holy Cross HealthCenter- -Williams Aspen Hill Joe Podson Executive Director Homecrest House Karen Thompkins Sr. Planning Specialist Healthy Montgomery/ Montgomery County Health Department Lynda Suh Director, Quality & Risk MMMC Marsha Batista Resident Counselor III Housing Opportunities Commission Mary Jane Joseph Project Manager Primary Care Coalition Sharon Riser Case Manager Emergency MMMC Department Susan Montgomery Director of Social Leisure World Senior Services Community Thomas Brunetto (OHFL) Chair Olney Home for Life implementation strategies Part V, Section B, Line 11 The implementation strategies serve as a roadmap for how community benefit resources will be allocated and deployed. MedStar's hospitals will be able to measure our contribution to improving the health of underserved and vulnerable populations in the regions we serve. Three-year implementation strategies with measurable objectives were developed for each hospital's community benefit service area - a specific community or target population of focus. Priorities were based on community need as determined by quantitative data and community input, as well as on hospital expertise, resources, strengths of existing programming and partnerships, and alignment with national, state, and local health goals. The MedStar Health Corporate Community Health Department will provide system-wide coordination and oversight of community benefit programming.HOSPITAL ADVISORY TASK FORCES CONVENE AT LEAST ANNUALLY TO MONITOR PROGRESS OF STRATEGY EXECUTION AND TO PROVIDE ONGOING RECOMMENDATIONS RELATED TO OUTCOMES ACHIEVEMENT, PROGRAM DEVELOPMENT, PARTNERSHIP APPROACHES, AND OVERALL IMPLEMENTATION IMPROVEMENT.FOR SIGNIFICANT NEEDS IDENTIFIED IN THE CHNA THAT THE HOSPITAL HAS NOT PRIORITIZED AS FOCUS AREAS THROUGH ITS IMPLEMENTATION STRATEGY, THESE NEEDS WILL BE ADDRESSED BY COLLABORATING WITH OTHER LEADING ORGANIZATIONS, AND BY TAKING A SUPPORTER ROLE ON IDENTIFIED NEEDS THAT ARE BEYOND THE SCOPE OF THE HOSPITALS STRENGTHS. CHARITY CARE AT COST PART I, LINE 7A MARYLAND'S REGULATORY SYSTEM CREATES A UNIQUE PROCESS FOR HOSPITAL PAYMENT THAT DIFFERS FROM THE REST OF THE NATION. THE HEALTH SERVICES COST REVIEW COMMISSION (HSCRC), DETERMINES PAYMENT THROUGH A RATE-SETTING PROCESS AND ALL PAYORS, INCLUDING GOVERNMENTAL PAYORS, PAY THE SAME AMOUNT FOR THE SAME SERVICES DELIVERED AT THE SAME HOSPITAL. MARYLAND'S UNIQUE ALL-PAYOR SYSTEM INCLUDES A METHOD FOR REFERENCING UNCOMPENSATED CARE IN EACH PAYORS' RATES, WHICH DOES NOT ENABLE MARYLAND HOSPITALS TO BREAKOUT ANY OFFSETTING REVENUE RELATED TO UNCOMPENSATED CARE. UNREIMBURSED MEDICAID PART I, LINE 7B MARYLAND'S REGULATORY SYSTEM CREATES A UNIQUE PROCESS FOR HOSPITAL PAYMENT THAT DIFFERS FROM THE REST OF THE NATION. THE HEALTH SERVICES COST REVIEW COMMISSION (HSCRC), DETERMINES PAYMENT THROUGH A RATE-SETTING PROCESS AND ALL PAYORS, INCLUDING GOVERNMENTAL PAYORS, PAY THE SAME AMOUNT FOR THE SAME SERVICES DELIVERED AT THE SAME HOSPITAL. MARYLAND'S UNIQUE ALL-PAYOR SYSTEM INCLUDES A METHOD FOR REFERENCING UNCOMPENSATED CARE IN EACH PAYORS' RATES, WHICH DOES NOT ENABLE MARYLAND HOSPITALS TO BREAKOUT ANY OFFSETTING REVENUE RELATED TO UNCOMPENSATED CARE. COMMUNITY BENEFIT EXPENSES ARE EQUAL TO MEDICAID REVENUES IN MARYLAND, AS SUCH, THE NET EFFECT IS ZERO. THE EXCEPTION TO THIS IS THE IMPACT ON THE HOSPITAL OF ITS SHARE OF THE MEDICAID ASSESSMENT. IN RECENT YEARS, THE STATE OF MARYLAND HAS CLOSED FISCAL GAPS IN THE STATE MEDICAID BUDGET BY ASSESSING HOSPITALS THROUGH THE RATE-SETTING SYSTEM. BAD DEBT PART III, LINES 2 & 4 MEDSTAR HEALTH AND ITS AFFILIATED ORGANIZATIONS REPORT BAD DEBT EXPENSE IN ACCORDANCE WITH ASU 2011-07, WHICH REQUIRES CERTAIN HEALTHCARE ENTITIES TO CHANGE THE PRESENTATION OF THEIR STATEMENT OF OPERATIONS BY RECLASSIFYING THE PROVISION FOR BAD DEBTS ASSOCIATED WITH PATIENT SERVICE REVENUE FROM AN OPERATING EXPENSE TO A DEDUCTION FROM PATIENT SERVICE REVENUE (NET OF CONTRACTUAL ALLOWANCES AND DISCOUNTS). HOWEVER, MEDSTAR AND ITS AFFILIATED ENTITIES DO NOT MAKE A DETERMINATION AS TO WHETHER SELF PAY AMOUNTS ARE COLLECTIBLE IN DETERMINING REVENUE RECOGNITION. RESERVE MODELS, WHICH HAVE BEEN DEVELOPED BASED ON HISTORICAL COLLECTION RESULTS AND WHICH ARE ADJUSTED PERIODICALLY BASED ON ACTUAL COLLECTIONS EXPERIENCE, ARE USED TO ESTIMATE UNCOLLECTIBLE AMOUNTS ACROSS ALL PAYORS INCLUDING SELF PAY. BAD DEBT DETERMINATIONS ARE MADE ONLY AFTER SUFFICIENT EVIDENCE IS OBTAINED TO SUPPORT THAT AN AMOUNT IS NOT COLLECTIBLE. MEDICARE PART III, LINE 8 MARYLAND'S REGULATORY SYSTEM CREATES A UNIQUE PROCESS FOR HOSPITAL PAYMENT THAT DIFFERS FROM THE REST OF THE NATION. THE HEALTH SERVICES COST REVIEW COMMISSION (HSCRC) DETERMINES PAYMENT THROUGH A RATE-SETTING PROCESS AND ALL PAYORS, INCLUDING GOVERNMENTAL PAYORS, PAY THE SAME AMOUNT FOR THE SAME SERVICES DELIVERED AT THE SAME HOSPITAL. MARYLAND'S UNIQUE ALL-PAYOR SYSTEM INCLUDES A METHOD FOR REFERENCING UNCOMPENSATED CARE IN EACH PAYORS' RATES, WHICH DOES NOT ENABLE MARYLAND HOSPITALS TO BREAKOUT ANY OFFSETTING REVENUE RELATED TO UNCOMPENSATED CARE. AS SUCH, THE NET EFFECT FOR MEDICARE EXPENSES AND REVENUES IN MARYLAND IS ZERO. PART III, LINE 9B IF IT IS DETERMINED THAT A PATIENT MAY POTENTIALLY QUALIFY FOR A CHARITABLE/FINANCIAL PROGRAM, A HOLD IS PLACED ON THE ACCOUNT TO PREVENT IT FROM BEING REPORTED AS BAD DEBT UNTIL PROGRAM APPROVALS HAVE BEEN OBTAINED. IF IT IS APPROVED, THE ACCOUNT IS DOCUMENTED AND THE NECESSARY ADJUSTMENTS ARE MADE TO CLOSE THE ACCOUNT. NEEDS ASSESSMENT PART VI, LINE 2 In FY18, MedStar Montgomery Medical Center (MMMC) conducted a Community Health Needs Assessment (CHNA) in accordance with the guidelines established by the Patient Protection and Affordable Care Act and the Internal Revenue Service. The hospitals FY18 CHNA and three-year Implementation Strategies were endorsed by MMMCs Board of Directors and approved by the MedStar Health Board of Directors. The document became available on the hospitals website on June 30, 2018. During FY19, key revisions were made across MedStar Health to more effectively impact the communities served throughout Maryland and Washington, DC. Several internal meetings were convened with leadership from each MedStar Health Hospital to review current practices and strategies. As a result of these meetings, the approach to the current CHNA for the remainder of the three-year cycle (FY19-FY21) was revised. A key revision to the CHNA is a greater focus on hospital area strategies that are most appropriate for the local communities served. The number of strategies each hospital is accountable for executing was reduced to encourage more meaningful reach within key areas contrasted with broader reach with reduced impact. Using the standard categories, Health and Wellness, Access to Care and Social Determinants of Health to determine what to prioritize for the CHNA IRS requirements, each hospital agreed to select two to three strategies as priorities that have size and scale impact and measurable outcomes. All other programming was integrated as part of the hospitals overall community health portfolio. These additional programs were captured in the inventory for the whole picture of contributing to the health of the communities served as well as sorted for what counts as community benefit for regulatory reporting. The hospitals Community Benefit Service Area (CBSA) remains the same, based on the Advisory Task Force (ATF) recommendation. The hospital identified Aspen Hill, Bel Pre and Rockville as its CBSA, which includes all residents living in ZIP code 20906 and 20853. The hospital selected this geographic area based on hospital utilization data and secondary public health data as well as its proximity to the hospital. The ATF included a diverse group of individuals, including hospital leaders, grassroots activists, community residents, faith-based leaders, hospital representatives, public health leaders and other stakeholder organizations, such as representatives from local health departments. MMMCs health priorities for the CBSA include health and wellness (chronic disease prevention and management, behavioral health) and social determinants of health (social needs screening and referrals). As a proud member of MedStar Health, representatives from MMMC routinely participate in the MedStar Health community health workgroup. The workgroup is comprised of community health professionals who represent all ten MedStar hospitals. The team analyzes local and regional community health data, establishes system-wide community health programming performance and evaluation measures and shares best practices. PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE PART VI, LINE 3 As one of the regions leading not-for-profit healthcare systems, MedStar Health is committed to ensuring that uninsured patients; underinsured patients meeting medical hardship criteria; and patients determined eligible for presumptive eligibility within the communities we serve who lack financial resources have access to emergency and medically necessary hospital services. MedStar hospitals and hospital based-physician practices will: . Treat all patients equitably, with dignity, respect, and compassion. . Serve the emergency health care needs of everyone who presents to our MedStar hospitals and hospital-based physician practices regardless of a patient's ability to pay for care. . Assist those patients who are admitted through our admission process for non-urgent, medically necessary care who cannot pay for the care they receive. . Balance needed financial assistance for some patients with broader fiscal responsibilities in order to keep its hospitals' doors open for all who may need care in the community. In meeting its commitments, MedStar hospitals and hospital-based physician practices will work with their uninsured patients seeking emergency and medically necessary care to gain an understanding of each patients financial resources. Based on this information and eligibility determination, MedStar hospitals and hospital-based physician practices will provide financial assistance to uninsured patients who reside within the communities we serve in one or more of the following ways: . Assist with enrollment in publicly-funded entitlement programs (e.g., Medicaid). . Refer patients to State or Federal Insurance Exchange Navigator resources. . Assist with consideration of funding that may be available from other charitable organizations. . Provide financial assistance according to applicable policy guidelines . Provide financial assistance for payment of MedStar hospital and hospital-based physician practice charges using a sliding-scale based on the patients household income and financial resources. . Offer periodic payment plans to assist patients with financing their healthcare services. MedStar Health will widely publicize the MedStar Financial Assistance Policy by: . Providing access to the MedStar Financial Assistance Policy, Financial Assistance Applications, and MedStar Patient Information Sheet on all hospital websites and patient portals. . Providing hard copies of the MedStar Financial Assistance Policy, MedStar Uniform Financial Assistance Application, and MedStar Patient Information Sheet to patients upon request. . Providing hard copies of the MedStar Financial Assistance Policy, MedStar Uniform Financial Assistance Application, and MedStar Patient Information Sheet to patients upon request by mail and without charge. . Providing notification and information about the MedStar Financial Assistance Policy by: . Offering copies as part of all registration or discharges processes, and answering questions on how to apply for assistance. . Providing written notices on billing statements. . Displaying MedStar Financial Assistance Policy information at all hospital registration points. . Translating the MedStar Financial Assistance Policy, MedStar Uniform Financial Assistance Application, and the Medstar Patient Information Sheet into primary languages of all significant populations with Limited English Proficiency. . MedStar Health will provide public notices yearly in local newspapers serving all hospital target populations. MedStar Health provides a financial assistance probable and likely eligibility determination to the patient within two business days from receipt of the initial financial assistance application. Final eligibility determinations are made and communicated to the patient based on receipt and review of a completed application. MedStar Health believes that its patients have personal responsibilities related to the financial aspects of their healthcare needs. Financial assistance and periodic payment plans available under this policy will not be available to those patients who fail to fulfill their responsibilities. For purposes of this policy, patient responsibilities include: . Comply with providing the necessary financial disclosure forms to evaluate their eligibility for publicly-funded healthcare programs, charity care programs, and other forms of financial assistance. These disclosure forms must be completed accurately, truthfully, and timely to allow MedStar Healths facilities to properly counsel patients concerning the availability of financial assistance. . Working with MedStar hospital Patient Advocates and Patient Financial Services staff to ensure there is a complete understanding of the patients financial situation and constraints. . Making applicable payments for services in a timely fashion, including any payments made pursuant to deferred and periodic payment schedules. . Providing updated financial information to MedStar hospital Patient Advocates or Customer Service Representatives on a timely basis as the patients financial circumstances may change. . It is a patients responsibility, during their 12-month eligibility period, to notify MedStar Health of their existing household eligibility for free care, reduced cost-care, and/or eligibility under medical hardship provisions for medical necessary care received during the 12-month eligibility period. . In the event a patient fails to meet these responsibilities, MedStar reserves the right to pursue additional billing and collection efforts. In the event of non-payment billing, and collection efforts are defined in the MedStar Billing and Collection Policy. A free copy is available on all hospital websites and patient portals via the following URL: www.medstarhealth.org/FinancialAssistance , or by call customer service at 1-800-280-9006. Uninsured patients of MedStar Healths facilities may be eligible for full financial assistance or partial sliding-scale financial assistance under this policy. The Patient Advocate and Patient Financial Services staff will determine eligibility for full financial assistance and partial sliding-scale financial assistance based on review of income for the patient and their family (household), other financial resources available to the patients family, family size, and the extent of the medical costs to be incurred by the patient. COMMUNITY INFORMATION PART VI, LINE 4 GEOGRAPHIC: MMMCs CBSA includes residents in the Aspen Hill/Bel Pre/Rockville neighborhoods of Montgomery County, Maryland (ZIP codes 20906 and 20853). This geographic area was selected based on hospital utilization and secondary public health data, as well as its proximity to the hospital, coupled with a high density of low-income residents, underserved seniors and an ethnically diverse population. Demographics: According to the Census Bureau, the Aspen Hill/Bel Pre area encompassed by ZIP code 20906 has 48,759 residents. Over 12.8% of residents are age 65 and older, compared to 16.1% of Montgomery County. The population is racially diverse, with 43.1% White, 20.3% Black/African American, 9.6% Asian, while 33.8% are of Hispanic origin. Relative to Montgomery County, there is a larger proportion of Black/African American and Hispanic residents. The median income in the CBSA ($83,876) is lower than the countywide median ($106,287) and a higher proportion of families in Aspen Hill/Bel Pre live in poverty 10.6% compared to 6.9% in Montgomery County. The Rockville area encompassed by ZIP code 20853 has 68,079 residents. Over 15.6% of residents are age 65 and older, compared to 16.1% of Montgomery County. The population is racially diverse, with 56.5% White, 11.2% Black/African American, 20.4% Asian, while 15.9% are of Hispanic origin. PROMOTION OF COMMUNITY HEALTH PART VI, LINE 5 As a community partner, MMMC engages in several community benefit activities to improve and promote the health and wellbeing of the community. Priority areas, as determined by the 2018 CHNA, fall under three areas of focus including health and wellness, access to care, and social determinants of health. Programs include (but are not limited to): Health and Wellness Senior Wellness programs focus on chronic disease prevention and management among high-risk populations. Exercise is a key factor in managing chronic illnesses and improving quality of life. Community members aged 65 and can participate in free physical fitness classes such as Senior Strength and Balance, Tai-Chi for Health, and Senior Flow Yoga to increase flexibility, balance, coordination and cardiovascular endurance. Educational Programs are offered with the goal of improving community health and well-being. For example, the Living Well Chronic Disease Prevention and Management is a free seven-week health education and behavior change program focused on chronic disease self-management. The program is designed for adults living with a chronic condition, such as heart disease, diabetes, cancer, depression, chronic pain, arthritis, lung disease, multiple sclerosis or any chronic health concern. In addition, additional classes are offered such as Diabetes Self-Management, smoking cessation, nutrition, and weight management classes. Support groups are offered to community members for a variety of topics including mental health, smoking cessation, diabetes, weight management, breastfeeding and postpartum. Staff participate in community health events such as health fairs, festivals and expositions where screenings are performed, and health information is shared. Outreach is also provided in-person and virtually, hospital staff share their knowledge with the community through engaging interviews, seminars, blogs and videos. Access to Care MMMC is committed to meeting the needs of vulnerable populations by establishing strategic partnerships and alliances with safety-net clinics. The hospital continues to provide financial support to Holy Cross Health Center- Aspen Hill, which enables the clinic to treat low-income, uninsured, ethnically diverse residents at free or low cost. The hospital also provides in-kind space for day-to-day operation of Proyecto Saluds clinical space. With a focus on persons who speak Spanish as a primary language, services include physical examinations, health counseling, education, and laboratory services. In addition, Proyecto Salud offers a seasonal flu clinic. Prescription medications are made available through the Montgomery Cares program. The clinic also provides referrals for county specialty services, sexually transmitted infections and Human Immunodeficiency Virus (HIV) programs, Womens Cancer Control Program, Family Planning, and alcohol treatment and rehabilitation. The Screening, Brief Intervention, and Referral to Treatment (SBIRT) Program is provided to support substance abuse recovery in the community and promote access to behavioral health programs. This program includes three main components: screening, brief intervention, and referral to treatment. Those who screen positive for high-risk behaviors are connected to peer recovery coaches who conduct a brief intervention and refer to treatment if appropriate. Mindoula Behavioral Health Program was also implemented to improve access to mental health services and reduce ED utilization among behavioral health. Mindoula offers 30 days of virtually or in-person post-discharge case management services to the first thirty patients with a diagnosis of depression, schizophrenia and and/or Bipolar disorder. Staff works directly with hospital Social Work team to develop discharge and treatment plans, as well as provide patient education and coaching. In addition, Mindoula provides periodic health checks that track patients adherence to plans and identify red flags. In partnership with MedStar Pharmacy, MedStar Montgomery is dedicated to supporting access to proper Medication Adherence services by partnering with Giant Pharmacy to provide discounted medications to patients who cannot afford the cost during hours MedStar Outpatient Pharmacy is not open. This ensures that patients get their prescriptions in a timely manner. MedStar Montgomery also partners with Family and Nursing Care for proper in-home medication administration, in order to decrease drug interactions, adverse effects and non-compliance of discharged patients. Patient Financial Services provides financial assistance to uninsured patients who reside within the community by assisting with enrollment in publicly-funded entitlement programs, referring patients to State or Federal Insurance Exchange navigator resources and assisting with consideration of funding that may be available from other charitable organizations. Social Determinants of Health In support of social determinants of health priorities and in partnership with Nexus Montgomery the Wellness and Independence for Seniors at Home (WISH Program) was established to offer free health and wellness support programs to help maintain the health of the 65 and older community by connecting residents to resources that allow them to remain independent and in their own homes. A WISH coach visits the client in their home and helps them develop a personalized plan to maintain their health and independence. The coach coordinates healthcare and support services based on the client's unique situation. Social Needs Screenings are provided to screen for food and housing insecurity, and barriers related to transportation, employment, and utilities. Identified needs are addressed by connecting the participant to social services and other resources in the community. Our community partner, Aunt Bertha, provides an online platform that allows staff to track and manage referrals with local nonprofit groups. Our hospital partners with Uber Health to promote access to care for vulnerable populations. Through this partnership, rides are provided to patients and/or families with financial need. The transportation assistance enables patients to attend necessary appointments with their health care providers. MedStar Montgomery Medical Center has been one of the primary sponsors of Olney Home For Life (OHFL) for several years. Initially founded to address the transportation needs of local seniors, the organization now offers a range of services. From transportation to friendly calls, OHFL has enhanced the quality of life for seniors by helping them maintain their mobility, health, and social connections. Services are provided at no cost by community members, both seniors and others who volunteer their help. Through the support of OHFL, MedStar Montgomery is able to provide patients in need with a free alternative to costly transportation options, ensuring that they attend all follow-up treatments and appointments. Rx for Success provides robust student internship experiences for high-risk youth attending a high school, located in our CBSA. This eight-week summer internship connects the course curriculum with tangible onsite experience. This allows students to demonstrate skill development and experience working in the medical field. Disaster Readiness The hospital strengthened the community health resilience by improving the ability of the community to withstand and recover from coronavirus, a public health emergency that surfaced in March 2020. Leadership participated in community-wide task forces and staff implemented programs associated with addressing health needs arising from coronavirus. AFFILIATED HEALTH CARE SYSTEM PART VI, LINE 6 As a proud member of MedStar Health, MMMC is able to expand its capacity to meet the needs of the community by partnering with other MedStar hospitals and associated entities. MedStar Health resources assist the hospital in community health planning to meet the needs of the uninsured and other vulnerable populations. Through its community health function, MedStar Health provides MMMC with technical support to enhance community health programming and evaluation. MedStars corporate philanthropy department identifies and seeks public and private funding sources to ensure the availability of high quality health services, regardless of ability to pay. STATE FILING OF COMMUNITY BENEFIT REPORT PART VI, LINE 7 The community benefit report for MMMC is filed in the state of Maryland. true HOLY CROSS HEALTH INC 1500 forest Glen Rd Silver Spring MD 20910 520738041 501(C)(3) 40000 Clinic 1 SCHEDULE I, PART I, LINE 2 Our grant monitoring procedure brings together all key personnel involved in the grant at the onset of the award to discuss management, responsibilities, budgets, and reporting. This initial meeting is documented and disbursed to all involved. The actual grant monitoring is done by the hospital department implementing the grant. MedStar Corporate's Grants and Philanthropy Department ensures that each grant has a cost center and/or grant account set up based on the terms of the grant award. MedStar Corporate's Grants and Philanthropy Department also tracks and reminds hospital departments when progress reports are due througout the life of the grant. X X X X X X false false false false false false false false false KENNETH A SAMET DIRECTOR 0 1965427 0 5633373 0 0 0 54494 0 36202 0 7689496 0 0 Connie Stone VP, Patient Care Services 228175 0 58243 0 25 0 5850 0 11377 0 303670 0 0 0 David Havrilla CFO/TREASURER 144693 144694 62841 62842 4801 4800 8319 8318 10103 10103 230757 230757 0 0 Kevin Mell FORMER VP, OPERATIONS 0 171180 0 3577 0 0 0 5335 0 10035 0 190127 0 0 DENISE Kingsbury SR DIR, CLIN SUPPORT SERVICES 181735 0 0 0 25 0 5453 0 666 0 187879 0 0 0 FREDERICK FINELLI VP, MEDICAL AFFAIRS 546583 0 260274 0 0 0 8400 0 29092 0 844349 0 0 0 THOMAS SENKER HOSPITAL PRESIDENT & SVP MSH 390201 0 352010 0 0 0 8400 0 35408 0 786019 0 0 0 Sujithra Jayaraj MD director 372575 0 107661 0 0 0 8400 0 25754 0 514390 0 0 0 Nathaniel Barbo AVP, Professional Services 189939 0 15000 0 25 0 6184 0 11039 0 222187 0 0 0 Derek Prochnicki REGISTERED NURSE 187246 0 365 0 25 0 3500 0 14121 0 205257 0 0 0 SCHEDULE J, PART III Mr. Samet's compensation in Part II, Column (B) includes $2,636,097 representing benefits received from executive retirement plans that are comprised of target benefits determined annually based on compensation and years of service and long-term retention arrangements. David Havrillas compensation is for services provided as CFO to MedStar Montgomery Medical Center, MedStar St. Marys Hospital, and MedStar Southern Maryland Hospital Center. X 3 67394 FMV false true false ORGANIZATION MEMBERS PART VI, LINE 6 THE ORGANIZATION IS AN AFFILIATE AND SUBSIDIARY OF MEDSTAR HEALTH, INC. MEDSTAR HEALTH, INC., OR ONE OF ITS AFFILIATES AND SUBSIDIARIES, IS THE SOLE MEMBER OF THE ORGANIZATION. DESCRIPTION OF MEMBERS PART VI, LINES 7A AS AN AFFILIATE AND SUBSIDIARY OF MEDSTAR HEALTH, INC., THE ORGANIZATION MAY RECOMMEND PERSON(S) FOR MEMBERSHIP ON THE ORGANIZATION'S GOVERNING BODY. ANY SUCH RECOMMENDATION BY THE ORGANIZATION IS SUBJECT TO APPROVAL BY THE GOVERNANCE COMMITTEE OF THE BOARD OF DIRECTORS OF MEDSTAR HEALTH, INC. THE BOARD OF MEDSTAR HEALTH, INC. HAS DELEGATED CERTAIN APPROVAL AUTHORITY TO THE GOVERNANCE COMMITTEE AND THE PRESIDENT & CEO OF MEDSTAR HEALTH, INC. DECISIONS OF GOVERNING BODY PART VI, LINES 7B AS AN AFFILIATE AND SUBSIDIARY OF MEDSTAR HEALTH, INC., 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 REVIEW PROCESS PART VI, LINE 11B THE PROCESS FOR REVIEWING THE FORM 990 INCLUDED EDUCATION AND TRANSPARENCY. SENIOR FINANCIAL EXECUTIVES, WORKING WITH INDEPENDENT OUTSIDE EXPERTS, THOROUGHLY REVIEWED FORM 990 AND ACCOMPANYING INSTRUCTIONS. IN ADDITION, SENIOR EXECUTIVES REVIEWED THE RELEVANT SECTIONS OF THE FORM 990 WITH THE FOLLOWING COMMITTEES OF THE ORGANIZATION'S GOVERNING BODY: FINANCE, AUDIT, GOVERNANCE, STRATEGIC PLANNING, AND EXECUTIVE COMPENSATION. FOLLOWING THESE MEETINGS, THE GOVERNING BODY WAS PROVIDED A COPY OF THE FORM 990 IN ITS FINAL FORM AND GIVEN AN OPPORTUNITY TO PROVIDE ANY INPUT OR COMMENTS RELATING TO THE FORM 990 PRIOR TO ITS FILING. CONFLICT OF INTEREST POLICY Part VI, Line 12C APPOINTMENT OF BOARDS OF DIRECTORS MEDSTAR HEALTH (AND ITS SUBSIDIARIES) REQUIRE ALL NOMINATED DIRECTORS, PRIOR TO THEIR APPOINTMENT OR ELECTION, TO DISCLOSE THE EXISTENCE OF (OR POTENTIAL EXISTENCE OF) ANY TRANSACTION WITH MEDSTAR THAT WOULD RESULT IN A CONFLICT OF INTEREST. SUCH DISCLOSURES (IF ANY) ARE REVIEWED BY THE GOVERNANCE COMMITTEE OF THE MEDSTAR HEALTH BOARD OF DIRECTORS WHICH DETERMINES HOW THE MATTER SHOULD BE RESOLVED. ANNUAL DISCLOSURES - ALL OFFICERS, DIRECTORS, AND SENIOR MANAGERS ALL OFFICERS, DIRECTORS AND SENIOR MANAGERS ARE REQUIRED, NOT LESS THAN ANNUALLY, TO COMPLETE A SURVEY OF QUESTIONS CONCERNING ANY TRANSACTIONS OR RELATIONSHIPS WHICH WOULD OR COULD REPRESENT A CONFLICT OF INTEREST. SUCH DISCLOSURES (IF ANY) RELATED TO DIRECTORS ARE REVIEWED BY THE GOVERNANCE COMMITTEE OF THE MEDSTAR HEALTH BOARD OF DIRECTORS WHICH DETERMINES HOW THE MATTER SHOULD BE RESOLVED. SUCH DISCLOSURES (IF ANY) RELATED TO OFFICERS AND SENIOR MANAGERS ARE REVIEWED BY AN APPROPRIATE EXECUTIVE WHO DETERMINES HOW THE MATTER SHOULD BE RESOLVED. IN ADDITION, OFFICERS AND DIRECTORS OF MARYLAND HOSPITALS AND NURSING CENTERS ARE REQUIRED TO ANNUALLY DISCLOSE ADDITIONAL INFORMATION RELATING TO POTENTIAL CONFLICTS OF INTEREST AND SUCH DISCLOSURES ARE REPORTED TO THE MARYLAND HEALTH SERVICES COST REVIEW COMMISSION (HSCRC). EXECUTIVE COMPENSATION PROCESS PART VI, LINE 15 THE EXECUTIVE COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS OF MEDSTAR HEALTH, INC. (THE "COMMITTEE") HAS OVERSIGHT OVER THE EXECUTIVE COMPENSATION PROGRAM (THE "PROGRAM") OF MEDSTAR HEALTH, INC. AND ITS AFFILIATES. TOTAL COMPENSATION FOR THE TOP MANAGEMENT OFFICIALS, OFFICERSAND KEY EMPLOYEES OF MEDSTAR HEALTH, INC. AND ITS AFFILIATES ARE REVIEWED AND APPROVED BY THE COMMITTEE WITH ASSISTANCE AND GUIDANCE FROM AN INDEPENDENT THIRD PARTY ADVISOR. THE MEMBERS OF THE COMMITTEE ARE INDEPENDENT FROM ALL OF THE PARTICIPANTS IN THE PROGRAM. THE MAIN OBJECTIVE OF THE PROGRAM IS TO PROVIDE MARKET COMPETITIVE TOTAL COMPENSATION THAT IS INTERNALLY EQUITABLE AND HAS A STRONG PAY-FOR-PERFORMANCE LINKAGE. PERFORMANCE IS EVALUATED AT THE SYSTEM,OPERATING UNIT, AND INDIVIDUAL LEVELS. THE OVERALL TOTAL COMPENSATION PHILOSOPHY IS MANAGED AT THE 75TH PERCENTILE OF THE COMPETITIVE MARKET FOR COMPARABLE SIZE (NET REVENUE) AND TYPE ("TAX-EXEMPT HEALTHCARE ORGANIZATIONS"). WHERE APPROPRIATE, ADDITIONAL INDUSTRY DATA IS CONSIDERED (GENERAL BUSINESS AND/OR TAXABLE HEALTHCARE) FOR SELECTED POSITIONS THAT CAN BE RECRUITED FROM OR POTENTIALLY LOST TO THESE INDUSTRIES (E.G., INFORMATION TECHNOLOGY, FINANCE, ETC.). THE COMMITTEE HAS ENGAGED ERNST & YOUNG LLP ("E&Y") TO SERVE AS AN ADVISOR ON THE REASONABLENESS AND COMPETITIVENESS OF THE PROGRAM. IN DETERMINING REASONABLENESS AND COMPETITIVENESS, E&Y REVIEWS MARKET PRACTICES AND TRENDS, AND MAKES RECOMMENDATIONS RELATED TO THE PROGRAM. E&Y UTILIZES INFORMATION FROM CUSTOM SURVEYS, NATIONAL COMPENSATION SURVEYS, PROPRIETARY DATABASES, AND CLIENT EXPERIENCES TO DETERMINE ITS FINAL RECOMMENDATIONS. E&Y PRESENTS THEIR FINDINGS AND RECOMMENDATIONS TO THE COMMITTEE. THE COMMITTEE MAKES THE FINAL DECISIONS ON ALL OF THE COMPENSATION DETERMINATIONS OF THE PROGRAM. ALL DECISIONS MADE BY THE COMMITTEE ARE CONTEMPORANEOUSLY DOCUMENTED. FINANCIAL STATEMENT AVAILABILITY PART VI, LINE 19 MEDSTAR HEALTH POSTS ITS ANNUAL FINANCIAL AUDIT AND QUARTERLY FINANCIAL REPORTS TO THE ELECTRONIC MUNICIPAL MARKET ACCESS (EMMA) SYSTEM. THE ORGANIZATION ALSO E-MAILS ITS ANNUAL AND QUARTERLY DISCLOSURES TO HOLDERS OF THE COMPANY'S PUBLICLY TRADED DEBT. THE COMPANY'S GOVERNANCE DOCUMENTS AND CONFLICTS OF INTEREST POLICIES ARE AVAILABLE UPON REQUEST THROUGH ITS CORPORATE (OR AS APPLICABLE ENTITY) PUBLIC INFORMATION OFFICES. 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