2020-07-13T10:20:44-05:00 2019-06-30 990 2018-07-01 530196602 LUCY WEBB HAYES NATIONAL TRAINING SCHOOL FOR DEACONESSES & MISSIONARIES LUCY 2025374000 5255 LOUGHBORO RD NW WASHINGTON DC 20016 MARTIN BASSO SR VP FINANCE & CFO 2025374000 2020-07-13 128.220.159.45 2020-07-13 10:20:39 ED P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 AA414E185116BB862CEA1EFD9E057C93A361479B 2018 2020-09-22 18:59:49Z SIBLEY MEMORIAL HOSPITAL MARTIN BASSO 5255 LOUGHBORO RD NW WASHINGTON DC 20016 471708601 0 X WWW.SIBLEY.ORG X 1891 DC THE LUCY WEBB HAYES NATIONAL TRAINING SCHOOL FOR DEACONESSES AND MISSIONARIES MISSION IS TO DELIVER EXCELENCE AND COMPASSIONATE CARE TO EVERY PERSON, EVERY TIME. SIBLEY WILL BE THE ROLE MODEL FOR INNOVATION IN HEALTH CARE AND WELLNESS FOR ALL. THEIR VALUES ARE EXCELLENCE AND DISCOVERY, DIVERSITY AND INCLUSION, LEADERSHIP AND INTEGRITY, RESPECT AND COLLEGIALITY. 25 23 2708 265 39827 0 0 25000000 358524016 399665810 30216483 30704064 14961566 15780950 403702065 471150824 125050 332476 0 0 152056252 166159564 0 0 0 209481932 227299358 361663234 393791398 42038831 77359426 1109157438 1231329341 385664048 376705866 723493390 854623475 X THE LUCY WEBB HAYES NATIONAL TRAINING SCHOOL FOR DEACONESSES AND MISSIONARIES CONDUCTING BUSINESS AS SIBLEY MEMORIAL HOSPITAL IS A GENERAL SHORT-TERM ACUTE CARE HOSPITAL LOCATED IN N.W. WASHINGTON,DC. THE HOSPITAL PROVIDES ALL SERVICES WITHOUT REGARD TO RACE, CREED, SEX, NATIONAL ORIGIN, HANDICAP, AGE OR ABILITY TO PAY. ITS MISSION IS TO DELIVER EXCELLENCE AND COMPASSIONATE CARE TO EVERY PERSON, EVERY TIME. ITS VISION IS TO BE THE ROLE MODEL FOR INNOVATION IN HEALTH CARE AND WELLNESS FOR ALL. THE HOSPITAL VALUES EXCELLENCE AND DISCOVERY, DIVERSITY AND INCLUSION, LEADERSHIP AND INTEGRITY, RESPECT AND COLLEGIALITY. 0 0 340978063 332476 418803443 PROVIDE ACUTE CARE HEALTHCARE SERVICES TO PATIENTS IN THE NORTHWEST WASHINGTON, DC AREA. TO PROVIDE QUALITY HEALTH SERVICES AND FACILITIES TO THIS COMMUNITY, PROMOTING WELLNESS, RELIEVE SUFFERING, AND RESTORE HEALTH AS SWIFTLY, SAFELY AND HUMANELY AS IT CAN BE DONE CONSISTENT WITH THE BEST SERVICE GIVEN AT THE HIGHEST VALUE.SIBLEY HOSPITAL IS A GENERAL SHORT TERM ACUTE CARE FACILITY LOCATED IN NORTHWEST WASHINGTON, DC. THE HOSPITAL PROVIDES ALL SERVICES WITHOUT REGARD TO RACE, CREED, SEX, SEXUAL PREFERENCE, NATIONAL ORIGIN, HANDICAP, AGE OR ABILITY TO PAY. IN NOVEMBER, 2010, THE HOSPITAL BECAME INTEGRATED WITH THE JOHNS HOPKINS HEALTH SYSTEM (JHHS). ONE OF THE REQUIREMENTS OF THE INTEGRATION WAS TO ADOPT THE FISCAL YEAR ACCOUNTING PERIOD OF JULY 1 TO JUNE 30. CONSEQUENTLY, THIS RETURN IS FOR THE 12-MONTH ACCOUNTING PERIOD JULY 1, 2018 TO JUNE 30, 2019. INHERENT IN THE PURPOSE IS THE HOSPITALS WILLINGNESS TO PROVIDE HEALTHCARE SERVICES TO MEMBERS OF THE COMMUNITY WHO ARE NOT ABLE TO PAY FOR SERVICES. FOR FISCAL YEAR 2019, THE HOSPITAL PROVIDED CHARITY CARE TO MORE THAN 1,000 PATIENTS, INCURRING COSTS OF APPROXIMATELY $3.9 MILLION. TOTAL BENEFITS AND UNCOMPENSATED COST OF CARE PROVIDED TO THE COMMUNITY EXCEEDED $8.9 MILLION. SIBLEY PROVIDES CHARITY CARE TO THE CLIENTS OF THE CATHOLIC HEALTH CARE NETWORK, MARY'S CENTER FOR MATERNAL AND CHILD HEALTH, THE COMMUNITY OF HOPE, COLUMBIA ROAD CLINIC, UNITY HEALTHCARE, AND BREAD FOR THE CITY. THE HOSPITAL ADMITTED ABOUT 11,800 PATIENTS IN 2019, AND PROVIDED OVER 47,000 DAYS OF INPATIENT CARE. ADDITIONALLY, 4,200 NEW BABIES WERE DELIVERED AS WELL. ON THE OUTPATIENT SIDE, OVER 41,200 PATIENTS WERE TREATED IN OUR 24/7 EMERGENCY ROOM, APPROXIMATELY 11,650 SURGICAL CASES WERE PERFORMED AND APPROXIMATELY 98,000 VISITS WERE MADE FOR OTHER ANCILLARY OUTPATIENT TREATMENTS OR PROCEDURES. 340978063 1 1 0 1 0 0 0 0 1 0 1 1 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 336 0 1 2708 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 25 23 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 DC X MARTIN BASSO SR VP FINANCE & CFO 3018962333 5255 LOUGHBORO RD NW WASHINGTON DC 20016 RICHARD O DAVIS PRESIDENT/CEO/TRUSTEE 58.00 2.00 X X 0 941731 142286 MARK ABBRUZZESE MD TRUSTEE 5.00 0.00 X 0 0 0 WILLIAM B BARTON ESQ TRUSTEE/VICE CHAIRMAN 5.00 10.00 X 0 0 0 ROBERT BRANSON TRUSTEE 5.00 1.00 X 0 0 0 RICHARD E MORRIS TRUSTEE/TREASURER 5.00 10.00 X X 0 0 0 JOSHUA AMMERMAN MD TRUSTEE 5.00 X 0 0 0 REV A DAVID ARGO TRUSTEE 5.00 10.00 X 0 0 0 GEOFFREY D BROWN TRUSTEE 5.00 1.00 X 0 0 0 J RENE CARTER TRUSTEE/SECRETARY 5.00 20.00 X X 0 0 0 DONNA CRYER TRUSTEE 5.00 X 0 0 0 MICHAEL K FARR TRUSTEE 5.00 11.00 X 0 0 0 HARRY HERTZ PHD TRUSTEE 5.00 X 0 0 0 DALE H HOSCHEIT ESQ TRUSTEE 5.00 10.00 X 0 0 0 JOHN CASTELLANI TRUSTEE 5.00 X 0 0 0 PRISCILLA I PAGANO TRUSTEE 5.00 X 0 0 0 CHARLES ROSS TRUSTEE 5.00 X 0 0 0 THOMAS J SCHAEFER TRUSTEE 5.00 X 0 0 0 MARTIN G PAUL MD TRUSTEE 5.00 X 0 0 0 ROBERT S SILBERMAN TRUSTEE 5.00 X 0 0 0 PAUL STERN PHD TRUSTEE 5.00 X 0 0 0 DEOBRAH TRAUTMAN PHD RN TRUSTEE 5.00 X 0 0 0 EDWARD J MILLER JR TRUSTEE/CHAIRMAN 5.00 21.00 X 0 0 0 SHARON PERCY ROCKEFELLER TRUSTEE 5.00 X 0 0 0 KEVIN W SOWERS MSN RN FAA TRUSTEE, CORP VICE CHAIRMAN 5.00 55.00 X X 0 1201609 165117 HASAN ZIA MD INTERIM PRESDIENT, CMO, & TRUSTEE 60.00 X X 138693 379683 54766 ALISON ARNOTT VP SUPPORT SERVICES 60.00 X 0 238903 25173 CAROLINE SHAFA VP CLINICAL OPERATIONS 60.00 X 0 289008 30627 MARTIN BASSO VP FINANCE & CFO 30.00 30.00 X 0 634937 151136 LAURA HENDRICKS-JACKSON VP PATIENT CARE & CNO 60.00 X 126050 80123 70270 JERRY L PRICE SR VP REAL ESTATE & CONSTRU 60.00 X 230808 0 0 SANDRA POLIN MAMMOGRAPHY PHYSICIAN 40.00 X 444977 0 8006 POUNEH RAZAVI PHYSICIAN DIR BREAST IMAGING 40.00 X 521651 0 34683 SARA SHAYLOR RADIOLOGIST 40.00 X 457491 0 33653 ARMAN FIROUZI PHYSICIAN SURGICAL 40.00 X 405844 0 30441 COLETTE M MAGNANT BREAST SURGEON 40.00 X 634662 0 31575 RONALD PETERSON FORMER TRUSTEE, OFFICER 5.00 55.00 X 0 3223521 19840 QUEENIE PLATER FORMER VP & CHIEF HR OFFICER 30.00 30.00 X 0 392464 54486 LAWRENCE RAMMUNO FORMER OFFICER 60.00 X 0 429989 40848 JOANNE MILLER FORMER OFFICER 60.00 X 0 126253 37825 2960176 7938221 930732 263 1 1 0 GILBANE BUILDING COMPANY TOTAL 7 JACKSON WALKWAY PROVIDENCE RI 02903 CONSTRUCTION 27344393 BRASFIELD AND GORRIE LLC TOTAL 3021 7TH AVE S BIRMINGHAM AL 35233 CONSTRUCTION 13461565 AMN HEALTHCARE INC TOTAL 12400 HIGH BLUFFF DR SAN DIEGO CA 92130 STAFFING 1558837 RANDSTAD PROFESSIONALS US LP TOTAL 1711 YORK RD LUTHERVILLE MD 21093 EMPLOYEMENT AGENCY 885204 GEORGE WASHINGTON UNIVERSITY TOTAL 1919 PENNSYLVANIA AVE STE 2 WASHINGTON DC 20599 MEDICAL PROFESSIONALS 803437 55 25000000 25000000 PATIENT REVENUE 621990 378360892 378360892 ASSISTED LIVING 623000 21265091 21265091 LAB REVENUE 621500 39827 39827 399665810 11742028 11742028 19335594 0 373558 19335594 -373558 18962036 18962036 399643 184219 215424 215424 OTHER INCOME 900099 11820841 11820841 PARKING LOT 812930 2092408 2092408 CAFETERIA/VENDING 900099 1154123 1154123 498154 498154 15565526 471150824 418803443 39827 27307554 332476 332476 139953937 128449738 11504199 5552048 5095670 456378 10594540 9723670 870870 10059039 9232187 826852 51799 51799 320454 320454 25208 25208 1590163 1590163 26947089 24757694 2189395 1445476 160489 1284987 3708634 2179554 1529080 1586632 1456211 130421 7359099 6754182 604917 661828 6675 655153 371847 341281 30566 7593546 7593546 31990288 29360690 2629598 2997208 2608130 389078 DIRECT PATIENT SUPPLIES 97153133 96622161 530972 PURCHASED SERVICES 33978054 8742010 25236044 OTHER SUPPLIES 3955432 2477089 1478343 FOOD COSTS 3633574 3334895 298679 1929894 1749715 180179 393791398 340978063 52813335 0 28691711 79466150 39363461 44184171 7078152 8941284 4241460 4353749 716081620 165996923 530374126 550084697 410087940 444618426 89320588 99680864 1109157438 1231329341 40455496 44358444 1890625 1890625 343317927 330456797 385664048 376705866 X 719792882 850893422 1856491 1886036 1844017 1844017 723493390 854623475 1109157438 1231329341 X 77359426 21873206 31897453 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 1 1708 0 1 23500 25208 0 PART II-B, LINE 1: DIRECT CONTACT: SIBLEY MEMORIAL 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. OTHER ACTIVITIES: SIBLEY MEMORIAL HOSPITAL PAID ITS PARENT CORPORATION, THE JOHNS HOPKINS HEALTH SYSTEM CORPORATION $23,500 DURING FISCAL YEAR ENDED JUNE 30, 2019 TO SUPPORT THEIR LOBBYING ACTIVITIES. JOHNS HOPKINS OFFICE OF GOVERNMENT AND COMMUNITY AFFAIRS (GCA) SERVES JOHNS HOPKINS UNIVERSITY AND MEDICINE, JOHNS HOPKINS HEALTH SYSTEM AND AFFILIATES. THE PRIMARY PURPOSE OF THIS DEPARTMENT IS TO MAINTAIN CONTACT WITH ELECTED AND APPOINTED STATE OFFICIALS, AND OCCASIONAL FEDERAL OFFICIALS, REGARDING ISSUES WHICH IMPACT JOHNS HOPKINS HEALTH SYSTEM AND ITS AFFILIATES AS WELL AS THE HEALTHCARE INDUSTRY IN GENERAL. 0 1 X 50833065 50833065 269175423 72219947 196955476 108713 55894 52819 222500340 92588998 129911342 173464079 1132084 172331995 550084697 JOINT VENTURES 2831316 F OTHER SECURITIES 441787110 F 444618426 OTHER RECEIVABLES 2957739 INTEREST RECEIVABLE 2371390 OTHER ASSETS 15581087 LIMITED USE ASSETS 78770648 99680864 ALLOW FOR MALPRACTICE CLAIMS 9465895 MISCELLANEOUS LIABILITIES 16789027 DUE TO AFFILIATES 304160503 CAPITAL LEASE LT DEBT 41372 330456797 X PART IV, LINE 2B: THE HOSPITAL ACTS AS ADMINISTRATOR/TRUSTEE FOR A CHARITABLE GIFT ANNUITY (CGA) PROGRAM. THE ASSETS ARE CUSTODIED WITH THE FIDUCIARY TRUST COMPANY. DONORS MAKE ARRANGEMENTS WITH THE HOSPITAL AND THE CUSTODIAN TO MAKE A ONE-TIME CONTRIBUTION TO THE CGA. PERIODIC ANNUITY PAYMENTS ARE THEN MADE TO THE DONOR OVER THE LIFETIME OF THE DONOR. THE HOSPITAL INCLUDES ON ITS BALANCE SHEET THE MARKET VALUE OF THE ASSETS CONTRIBUTED BY ALL DONORS IN THE PROGRAM. THE HOSPITAL ALSO INCLUDES A LIABILITY FOR ESTIMATED PAYMENTS CALCULATED TO BE PAID TO ITS DONORS IN FUTURE YEARS. THE ASSETS ARE INVESTED IN FIXED INCOME AND EQUITY SECURITIES, MONITORED REGURARLY BY THE HOSPITAL'S INVESTMENT COMMITTEE. FOR FISCAL YEAR ENDING JUNE 30, 2019, THE MARKET VALUE OF THE ASSETS DECREASED BY $188,062. 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. THERE WAS NO IMPACT ON THE ORGANIZATION'S FINANCIAL STATEMENTS DURING THE YEARS ENDED JUNE 30, 2019 AND 2018. 1 1 X 1 X 1 X 500.000000000000 1 1 1 0 1 1 2838053 0 2838053 0.00720 4950257 3280782 1669475 0.00420 10068595 9042378 1026217 0.00260 17856905 12323160 5533745 0.01400 2794761 135027 2659734 0.00680 1444694 233254 1211440 0.00310 22054930 11296491 10758439 0.02730 2646219 745992 1900227 0.00480 1251220 0 1251220 0.00320 30191824 12410764 17781060 0.04520 48048729 24733924 23314805 0.05920 1 7824433 0 88905962 124955517 -36049555 X 1 1 1 1 SIBLEY MEMORIAL HOSPITAL 5255 LOUGHBORO RD NW WASHINGTON DC 20016 WWW.HOPKINSMEDICINE.ORG/SIBLEY-MEMORIA HFD01-0213 X X X SIBLEY MEMORIAL HOSPITAL 1 0 0 1 X X X X X X X X X 18 1 1 0 1 X WWW.HOPKINSMEDICINE.ORG/SIBLEY-MEMORIAL-HOSPITAL/COMMUNITY-HEALTH/ X WWW.DCHEALTHMATTERS.ORG/ X 1 18 1 WWW.HOPKINSMEDICINE.ORG/SIBLEY-MEMORIAL-HOSPITAL/COMMUNITY-HEALTH/ 0 1 X 200.000000000000 500.000000000000 X X X 1 1 X X X X 1 X WWW.HOPKINSMEDICINE.ORG/PATIENT_CARE/PAY_BILL/ASSISTANCE_POLICIES.HTML X WWW.HOPKINSMEDICINE.ORG/PATIENT_CARE/PAY_BILL/ASSISTANCE_POLICIES.HTML X X X X X 1 X 0 X X X 1 X 0 0 SIBLEY MEMORIAL HOSPITAL PART V, SECTION B, LINE 5: SIBLEY MEMORIAL HOSPITAL, AS A MEMBER OF THE DC HEALTH MATTERS COLLABORATIVE, COMPLETED A COMMUNITY HEALTH NEEDS ASSESSMENT. IN OUR QUALITATIVE WORK, WE ENGAGED WITH OVER 300 COMMUNITY STAKEHOLDERS ACROSS A DIVERSE CROSS-SECTION OF DC SPANNING HEALTH AND NON-HEALTH DISCIPLINES. USING SEMI-STRUCTURED DATA COLLECTION TOOLS, WE CONDUCTED INTERVIEWS, FOCUS GROUPS, AND A TOWN HALL TO PROBE COMMUNITY PARTNERS ON HOW POLICY AND SYSTEMS CHANGES CAN ADDRESS COMMUNITY NEEDS WITH A PARTICULAR FOCUS ON ELEVATING HEALTH EQUITY IN OUR CITY. WE USED THE RAPID IDENTIFICATION OF THEMES FROM AUDIO (RITA) METHOD TO ANALYZE THE INTERVIEW AND FOCUS GROUP DATA WITHIN THE DEDOOSE QUALITATIVE SOFTWARE. AS A SUPPLEMENT TO THE FORMAL QUALITATIVE DATA COLLECTION PROCESS, WE PILOTED A PHOTOVOICE PROJECT WITH A GROUP OF ADOLESCENTS TO SOLICIT THEIR PERSPECTIVES RELATED TO THE INFLUENCE OF SCHOOLS AND COMMUNITIES ON THEIR MENTAL HEALTH. THE FOLLOWING WERE INTERVIEWED OR PARTICIPATED IN A FOCUS GROUP FOR THE COMMUNITY HEALTH NEEDS ASSESSMENT:ADVOCATES FOR JUSTICE AND EDUCATION, AMERIGROUP DC, MEDICAID ADVISORY NEIGHBORHOOD COMMISSIONS, APPLETREE EARLY LEARNING, BAINUM FAMILY FOUNDATION, BERNICE FONTENEAU SENIOR WELLNESS CENTER, BREAD FOR THE CITY, BRIDGEPORT HEALTHCARE, BRIYA PUBLIC CHARTER SCHOOL, CATHOLIC CHARITIES, CENTER FOR HEALTH AND HEALTH CARE IN SCHOOLS, CHILD AND FAMILY SERVICES AGENCY, CHILDREN'S NATIONAL HEALTH SYSTEM, CITY ARTS AND PREP PUBLIC CHARTER SCHOOL, CLEAN AIR PARTNERS (DC-MD-VA), COMMISSION ON FATHERS, MEN AND BOYS, COMMUNITY OF HOPE, DC COUNCILMEMBERS OR REPRESENTATIVES OF ANITA BONDS, BRIANNE NADEAU, CHARLES ALLEN, DAVID GROSSO, ELISSA SILVERMAN, JACK EVANS, MARY CHEH, ROBERT WHITE JR., VINCENT GRAY, DC AMERICAN ACADEMY OF PEDIATRICS CHAPTER, DC BEHAVIORAL HEALTH ASSOCIATION, DC BOARD OF MEDICINE, DC BOARD OF NURSING, DC BOARD OF PHARMACY, DC BOARD OF PSYCHOLOGY, DC CENTRAL KITCHEN, DC DENTAL SOCIETY, DC DEPARTMENT OF BEHAVIORAL HEALTH, DC DEPARTMENT OF CONSUMER AND REGULATORY AFFAIRS, DC DEPARTMENT OF FIRE AND EMERGENCY MEDICAL SERVICES, DC DEPARTMENT OF FORENSIC SERVICES, DC DEPARTMENT OF HEALTH CARE FINANCE, DC DEPARTMENT OF HOUSING AND COMMUNITY DEVELOPMENT, DC DEPARTMENT OF HUMAN RESOURCES, DC DEPARTMENT OF HUMAN SERVICES, DC DEPARTMENT OF INSURANCE, SECURITAS, AND BANKING, DC DEPARTMENT OF MOTOR VEHICLES, DC DEPARTMENT OF PARKS AND RECREATION, DC DEPARTMENT OF SMALL AND LOCAL BUSINESS DEVELOPMENT, DC DEPARTMENT OF TRANSPORTATION, DC DEPARTMENT OF YOUTH REHABILITATION SERVICES, DC DEPARTMENT ON DISABILITY SERVICES, DC DEPARTMENT OF PUBLIC WORKS, DC GREENS, DC HEALTH, DC HOSPITAL ASSOCIATION, DC OFFICE OF LATINO AFFAIRS, DC OFFICE OF THE DEPUTY MAYOR FOR EDUCATION, DC OFFICE OF THE DEPUTY MAYOR FOR HEALTH AND HUMAN SERVICES, DC OFFICE OF THE STATE SUPERINTENDENT FOR EDUCATION, DC OFFICE OF VETERANS AFFAIRS, DC OFFICE ON AGING, DC OFFICE ON WOMEN'S POLICY AND INITIATIVES, DC POLICE FOUNDATION, DC PREP PUBLIC CHARTER SCHOOL, DC PRIMARY CARE ASSOCIATION, DC PUBLIC LIBRARY, DC PUBLIC SCHOOLS, DC SENIOR WELLNESS CENTERS, DISTRICT OF LEARNING/FAIR CHANCE DC, ELIANA'S LIGHT, ES FITNESS LLC., FOOD & FRIENDS, INC., FORT LINCOLN FAMILY MEDICINE, GEORGE WASHINGTON UNIVERSITY, GEORGETOWN UNIVERSITY, GEORGETOWN UNIVERSITY MEDICAL CENTER, HATTIE HOLMES SENIOR WELLNESS CENTER, HEALTH SERVICES FOR CHILDREN WITH SPECIAL NEEDS, HOWARD UNIVERSITY HOSPITAL, HSC HEALTH CARE SYSTEM, KIPP SCHOOLS DC, KOZMIQUE LIGHT MEDITATIONS, LA CLINICA DEL PUEBLO, LATIN AMERICAN YOUTH CENTER, MARY'S CENTER, MEDSTAR GEORGE WASHINGTON UNIVERSITY HOSPITAL, MEDSTAR HEALTH, MEDSTAR WASHINGTON HOSPITAL CENTER, MERIDIAN PUBLIC CHARTER SCHOOL, METRO HEALTH, METROPOLITAN POLICE DEPARTMENT, MISSION PARTNERS, MODEL CITIES SENIOR WELLNESS CENTER, MONUMENT ACADEMY, NATIONAL ALLIANCE TO ADVANCE ADOLESCENT HEALTH, NATIONAL COUNCIL FOR BEHAVIORAL HEALTH, PERRY FAMILY HEALTH CENTER, PLANNED PARENTHOOD OF METROPOLITAN WASHINGTON, DC, PRINCE GEORGE'S COUNTY PUBLIC SCHOOLS, PROVIDENCE HEALTH CARE SYSTEM, RADICAL MINDFULNESS, REDSTONE CENTER, RESTORATIVE DC, SEABURY RESOURCES FOR AGING, SIBLEY MEMORIAL HOSPITAL, SO OTHERS MIGHT EAT, SOMERSET PREP DC, SPANISH CATHOLIC CENTER, STATE BOARD OF EDUCATION, THE SIBLEY GROUP, TOTAL FAMILY CARE COALITION, UNITED WAY OF THE NATIONAL CAPITAL AREA, UNITY HEALTH CARE, UNIVERSITY OF THE DISTRICT OF COLUMBIA, WENDT CENTER FOR LOSS AND HEALING, AND WHITMAN-WALKER CLINIC. SIBLEY MEMORIAL HOSPITAL PART V, SECTION B, LINE 6A: CHILDREN'S NATIONAL, PROVIDENCE HOSPITAL, HOWARD UNIVERSITY HOSPITAL, HSC HOSPITAL SIBLEY MEMORIAL HOSPITAL PART V, SECTION B, LINE 6B: MARY'S CENTER, UNITY HEALTH, COMMUNITY OF HOPE, BREAD FOR THE CITY, DC HOSPITAL ASSOCIATION, DC HEALTH, DC BEHAVIORAL HEALTH ASSOCIATION, AND DC PRIMARY CARE ASSOCIATION, ALONG WITH SOME OTHER ORGANIZATIONS THAT ADVISED US PERIODICALLY IN A COMMUNITY ADVISORY BOARD. SIBLEY MEMORIAL HOSPITAL PART V, SECTION B, LINE 11: THE COMMUNITY HEALTH NEEDS ASSESSMENT REVEALED FOUR PRIMARY AREAS OF NEED: MENTAL HEALTH, CASE COORDINATION, PLACE-BASED CARE AND HEALTH LITERACY. THESE NEEDS WILL BE ADDRESSED OVER THE NEXT THREE YEARS WITH A COMMUNITY HEALTH IMPROVEMENT PLAN THAT WILL BE PUBLISHED BY NOVEMBER 2020. 1 1 - GRAND OAKS 5901 MACARTHUR BLVD NW WASHINGTON DC 20016 ASSISTED LIVING FACILITY PART I, LINE 7: A COST-TO-CHARGE RATIO (FROM WORKSHEET 2) IS USED TO CALCULATE THE AMOUNTS ON LINE 7A-7B (FINANCIAL ASSISTANCE AND UNREIMBURSED MEDICAID). THE AMOUNTS FOR LINES 7E-7I WOULD COME FROM THE BOOKS AND RECORDS OF SPECIFIC SEGMENTS OF THE ORGANIZATION AND WOULD NOT BE BASED ON A COST-TO CHARGE RATIO. PART I, LINE 7G: THERE ARE NO COSTS REPORTED THAT ARE ATTRIBUTABLE TO A PHYSICIANS CLINIC. PART II, COMMUNITY BUILDING ACTIVITIES: WARD INFINITYWARD INFINITY IS A COMMUNITY-FOCUSED INITIATIVE DEVELOPED BY SIBLEY MEMORIAL HOSPITAL TO STRENGTHEN LOCAL EFFORTS RELATED TO HEALTH AND WELLNESS IN WARDS 7 AND 8 IN THE DISTRICT OF COLUMBIA.WARD INFINITY IS A COMMUNITY-FOCUSED INITIATIVE DEVELOPED BY SIBLEY MEMORIAL HOSPITAL TO STRENGTHEN. AS PART OF ITS SECOND COHORT OF COMMUNITY HEALTH INNOVATORS IN RESIDENCE, RESIDENTS FROM EAST OF THE RIVER WORKED WITH SIBLEY EMPLOYEES AND THE WARD INFINITY ADVISORY COUNCIL A GROUP OF COMMUNITY AND GOVERNMENT LEADERS TO CONSTRUCT TARGETED, CREATIVE IDEAS TO ADDRESS HEALTH DISPARITIES IN THEIR NEIGHBORHOODS. EIGHT RESIDENTS PARTICIPATED AS INNOVATORS, EACH WITH PROJECTS ADDRESSING HEALTH ISSUES IN THE COMMUNITY RANGING FROM LACK OF ACCESS TO FRESH FOODS TO IMPROVING HOUSING OPTIONS TO USING TECHNOLOGY TO IMPROVE HEALTH LITERACY. THE SECOND COHORT CONCLUDED WITH A COMMUNITY TOWN HALL TO SHOWCASE INNOVATION PROGRAMS DEVELOPED BY THE COMMUNITY HEALTH INNOVATORS IN RESIDENCE. DURING THE TOWN HALL, TEAMS PRESENTED THEIR SOLUTIONS AND ENGAGED IN A COMMUNITY DISCUSSION TO HELP THEM TRANSITION FROM PROTOTYPING TO PROJECT IMPLEMENTATION. IN SUPPORT OF THE SECOND COHORT OF WARD INFINITY, SIBLEY MADE A $330,000 INVESTMENT AND PROVIDED 400 HOURS OF TECHNICAL ASSISTANCE AND COACHING FOR TEAMS, 800 HOURS OF DEDICATED STAFF SUPPORT, $124,000 IN DIRECT FUNDS TO INNOVATORS IN RESIDENCE, AND YEAR-ROUND ACCESS TO FREE INCUBATOR SPACE IN WARD 8. ON THE HEELS OF ADVANCING ITS SECOND COHORT OF INNOVATORS IN RESIDENCE THROUGH THE WARD INFINITY PROGRAM, SIBLEY HOSTED PROGRAM GRADUATES AND OTHER EARLY-STAGE ENTREPRENEURS OF COLOR FROM WARDS 7 AND 8 TO HEAR FROM AN EXPERT PANEL OF STARTUPS, ENTREPRENEURS AND MINORITY-OWNED BUSINESSES ON KEY PRINCIPLES TO DRIVE ENTREPRENEURIAL SUCCESS.DC ANCHOR PARTNERSHIPSIBLEY MEMORIAL HOSPITAL IS A FOUNDING MEMBER OF THE DC COMMUNITY ANCHOR PARTNERSHIP (DCAP), A COLLABORATIVE OF PROMINENT INSTITUTIONS COMMITTED TO EQUITABLE ECONOMIC DEVELOPMENT IN THE DISTRICT OF COLUMBIA. THE GROUP'S FOCUS IS PROCUREMENT WITH DC MINORITY-OWNED BUSINESS ENTERPRISES (MBES) TO CREATE JOBS, INCOME, AND WEALTH FOR RESIDENTS OF COLOR IN DC, WHILE SUPPORTING A STRONG LOCAL ECONOMY AND BUSINESS NEEDS OF INSTITUTIONS. SIBLEY MEDICAL EXPLORERS THE HEALTH CARE INDUSTRY IS ONE OF THE FASTEST GROWING INDUSTRIES IN THE COUNTRY. SIBLEY RECOGNIZES THE GROWING DEMAND FOR PEOPLE PREPARED TO FILL THESE POSITIONS. TO EXPOSE YOUNG PEOPLE TO FUTURE JOB OPPORTUNITIES, SIBLEY LAUNCHED ITS MEDICAL EXPLORERS PROGRAM IN 2016. IN FY19 ALONE, OVER 200 DC HIGH SCHOOL STUDENTS FROM WARDS 5, 7 AND 8 LEARNED FIRST-HAND ABOUT THE MEDICAL FIELD BY MEETING SIBLEY PHYSICIANS, CLINICIANS AND ADMINISTRATORS. STUDENTS ATTENDED PANELS WITH THESE PROFESSIONALS WHO DISCUSSED THEIR FIELDS AND THE WIDE RANGE OF CAREER OPTIONS WITHIN THE BROADER HEALTH CARE INDUSTRY. SINCE THE PROGRAM LAUNCH, SIBLEY EMPLOYEES AND MEDICAL STAFF HAVE BOTH VISITED AND HOSTED STUDENTS FROM EIGHT DC PUBLIC SCHOOLS AND PUBLIC CHARTER SCHOOLS ANACOSTIA, COOLIDGE, DUNBAR, WOODSON, FRIENDSHIP COLLEGIATE, BASIS, MCKINLEY TECH AND WILSON. STUDENTS HEAR PREDOMINANTLY FROM PHYSICIANS OF COLOR, REFLECTIVE OF THE STUDENT POPULATION PARTICIPATING IN THE PROGRAM, AS WELL AS AN OPPORTUNITY TO SHOW STUDENTS THE DIVERSITY AT SIBLEY AND ENCOURAGE UNDERREPRESENTED POPULATIONS TO EXPLORE THE HEALTH CARE INDUSTRY. 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: SMH DOES NOT REPORT AN ESTIMATE FOR THE PORTION OF BAD DEBT EXPENSE THAT MAY BE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY. SMH TAKES THE POSITION THAT AMPLE OPPORTUNITY AND ASSISTANCE IS PROVIDED TO THE PATIENT TO QUALIFY UNDER THE FINANCIAL ASSISTANCE POLICY. IF SUFFICIENT INFORMATION IS NOT PROVIDED, THEN SMH MUST ASSUME THE PATIENT DOES NOT QUALIFY. PART III, LINE 4: THE JOHNS HOPKINS HEALTH SYSTEM CORPORATION AND AFFILIATES AUDITED FINANCIAL STATEMENTS PAGE 15 - 17 PART III, LINE 8: SIBLEY MEMORIAL HOSPITAL TREATS PATIENTS WITH MANY INSURANCE CARRIERS. HOWEVER, SMH'S MEDICARE INPATIENT VOLUME IS AMONG THE HIGHEST RATIO AMONG DISTRICT OF COLUMBIA HOSPITALS. ALTHOUGH PROVIDING THE BEST POSSIBLE CARE TO OUR MEDICARE PATIENTS CREATES A FINANCIAL LOSS, WE RELIEVE THE GOVERNMENT AND SURROUNDING OTHER HOSPITALS OF THE FINANCIAL BURDEN OF TREATING THESE PATIENTS INSURED BY THE MEDICARE PROGRAM. PART OF THE MISSION OF OUR HOSPITAL IS TO SERVE ITS ELDERLY PATIENTS WITHIN THE COMMUNITY THROUGH VARIOUS PROGRAMS THAT ARE DESIGNED TO EDUCATE AND IMPROVE THEIR HEALTH STATUS. THE HOSPITAL FEELS THAT PROVIDING THESE PROGRAMS HAS CONTRIBUTED TO THE IMPROVEMENT OF HEALTH OVERALL WITHIN THE COMMUNITY. PART III, LINE 9B: WHEN A PATIENT ASKS FOR CHARITY CARE OR FINANCIAL ASSISTANCE, THE PATIENT MUST COMPLETE AN APPLICATION AND PROVIDE FINANCIAL INFORMATION THAT WOULD DEMONSTRATE FINANCIAL NEED. THE APPLICATION IS REVIEWED BY FINANCIAL COUNSELORS FOR ELIGIBILITY. PART VI, LINE 3: SIBLEY PUBLISHED A NOTICE OF AVAILABILITY OF ITS UNCOMPENSATED CARE OBLIGATION IN A NEWSPAPER OF GENERAL CIRCULATION IN THE DISTRICT OF COLUMBIA. SIBLEY SUBMITTED A COPY OF SUCH NOTICE TO SHPDA. A NOTICE ANNOUNCING THE AVAILABILITY OF UNCOMPENSATED CARE WAS POSTED IN PLAIN VIEW IN THE PATIENT REGISTRATION SITES, ADMISSIONS DEPARTMENT, THE BUSINESS OFFICE AND THE EMERGENCY DEPARTMENT. THE NOTICE IS PUBLISHED IN ENGLISH AND SPANISH AND ANY OTHER LANGUAGE WHICH IS THE USUAL LANGUAGE OF HOUSEHOLDS OF TEN PERCENT OR MORE OF THE POPULATION OF THE DISTRICT OF COLUMBIA. SIBLEY COMMUNICATES THE CONTENTS OF THE POSTED NOTICE TO ANY PERSON WHO SIBLEY HAS REASON TO BELIEVE CANNOT READ THE NOTICE. NOTICE OF AVAILABILITY IS ALSO POSTED ON THE HOSPITALS WEBSITE. PART VI, LINE 4: SIBLEY IS LOCATED IN WASHINGTON, D.C., AN URBAN AREA, AND CONSIDERS THE DISTRICT OF COLUMBIA ITS PRIMARY COMMUNITY BENEFIT SERVICE AREA. - POPULATION: 880, 197 (CLARITAS)- AVERAGE INCOME: $82,604 (AMERICAN COMMUNITY SURVEY)- PERCENTAGE RESIDENTS WHO ARE UNINSURED OR MEDICAID RECIPIENTS: 34.6%- NUMBER OF HOSPITALS SERVING THE DISTRICT OF COLUMBIA: 10 (SIBLEY, HOWARD, CHILDREN'S, HSC, GEORGE WASHINGTON, GEORGETOWN, NATIONAL REHAB, ST. ELIZABETHS)- NUMBER OF FEDERAL RECOGNIZED MEDICALLY UNDERSERVED AREAS/POPULATIONS: 7 PART VI, LINE 5: THE SIBLEY SENIOR ASSOCIATION PROMOTES HEALTH EDUCATION AND SUPPORT IN EVERY WARD OF THE DISTRICT OF COLUMBIA, INCLUDING THE FEDERALLY RECOGNIZED MEDICALLY UNDERSERVED AREAS/POPULATIONS. SERVICES ARE PROVIDED AT NO CHARGE. SERVICES INCLUDE SUPPORT GROUPS, CLINICAL SEMINARS, AND OUR CLUB MEMORY PROGRAM, WHICH IS A STIGMA-FREE SOCIAL ENGAGEMENT GROUP DESIGNED TO REDUCE ISOLATION AND BUILD COMMUNITY FOR BOTH PERSONS WITH ALZHEIMER'S DISEASE AND RELATED DEMENTIAS AND THEIR CARE PARTNERS, AMONG OTHER HEALTH LITERACY BUILDING PROGRAMS. SIBLEY'S BONE AND JOINT INSTITUTE PROVIDE BONE AND JOINT EDUCATION TO ALL PERSONS, REGARDLESS OF WHETHER OR NOT THEY SELECT SIBLEY AS THEIR HOSPITAL OF CHOICE. WHILE THE BONE AND JOINT INSTITUTE SERVES ANY AGE, MOST OF THE INDIVIDUALS TAKING ADVANTAGE OF THE EDUCATION ARE IN THE 65+ AGE RANGE.CANCER SURVIVORSHIP, SUPPORT, AND EDUCATION IS PROVIDED TO THE GENERAL PUBLIC, REGARDLESS OF WHETHER OR NOT THEY CHOOSE SIBLEY AS THEIR HEALTH CARE PROVIDER. YOGA, MEDITATION AND MINDFULNESS, SUPPORT GROUPS, AND CANCER EDUCATION ARE PROVIDED TO MEET THE NEEDS OF CARE COORDINATION AND HEALTH LITERACY. 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 JOHNS HOPKINS ALL CHILDRENS HOSPITAL, INC (JHACH), A FL ACADEMIC CHILDRENS HOSPITAL. PART VI, LINE 7, REPORTS FILED WITH STATES DC 1 MEDSTAR GEORGETOWN UNIVERSITY HOSPITAL 2115 WISCONSIN AVE NW STE 200 WASHINGTON DC 20007 522218584 501(C )(3) 50000 GENERAL SUPPORT INSTITUTE FOR PUBLIC HEALTH INNOVATION 1301 CONNECTICUT AVE NW WASHINGTON DC 20036 463039129 501(C )(3) 50000 GENERAL SUPPORT CONGRESSIONAL BLACK CAUCUS FOUNDATION 1720 MASSACHUSETTS AVE NW WASHINGTON DC 20036 521160561 501(C )(3) 30000 GENERAL SUPPORT ALVIN AILEY DANCE FOUNDATION INC 405 WEST 55TH ST NEW YORK NY 10019 132584273 501(C )(3) 12300 GENERAL SUPPORT LIGHTHOUSE DC 1850 WYOMING AVE NW UNIT 1 WASHINGTON DC 20009 815313985 501(C )(3) 10000 GENERAL SUPPORT DISTRICT OF COLUMBIA HOSPITAL ASSOCIATION 1152 15TH ST NW STE 900 WASHINGTON DC 20005 521135713 501(C )(6) 10000 GENERAL SUPPORT DC PROUD 2019 INAUGURAL COMMITTEE 7927 ORCHID ST NW WASHINGTON DC 20012 832501269 10000 GENERAL SUPPORT DC CHAMBER OF COMMERCE 1133 21ST ST NW STE M200 WASHINGTON DC 20036 237158230 501(C )(6) 10000 GENERAL SUPPORT BOYS & GIRLS CLUBS OF GREATER WASHINGTON 4103 BENNING RD NE WASHINGTON DC 20019 530236759 501(C )(3) 10000 GENERAL SUPPORT WESLEY THEOLOGICAL SEMINARY 4500 MASSACHUSETTS AVE NW WASHINGTON DC 20016 530245887 501(C )(3) 8000 GENERAL SUPPORT NATIONAL CAPITAL POISON CENTER 3201 NEW MEXICO AVE 310 WASHINGTON DC 20016 521880478 501(C )(3) 5000 GENERAL SUPPORT KENNEDY KRIEGER INSTITUTE INC 2931 E BIDDLE ST BALTIMORE MD 21213 520607971 501(C )(3) 5000 GENERAL SUPPORT 9 3 PART I, LINE 2: THE PROCEDURES IN PLACE TO MONITOR THE USE OF GRANT FUNDS GIVEN TO THE ORGANIZATIONS LISTED CONSIST OF ANNUAL STATUS REPORTS. THESE REPORTS WILL CONTAIN A) PROGRESS ON THE RESEARCH CONDUCTED, B) FULL ACCOUNTING OF FUNDS SPENT, C) ACHIEVEMENT OF MEASURABLE OUTCOMES AND ANY CHANGES FROM THE ORIGINAL PROPOSAL, D) DATA GATHERING AND THE METHODS OR STRATEGIES USED, AND E) FINDINGS AND CONCLUSIONS. IN ADDITION, THE GRANTEES ARE REQUIRED TO MAINTAIN ACCOUNTING RECORDS WITH PRUDENT RECORD-KEEPING PROCEDURES AS REQUIRED BY ANY APPLICABLE FEDERAL, STATE, OR LOCAL LAWS, RULES OR REGULATIONS. THE GRANTOR (SIBLEY HOSPITAL) RESERVES THE RIGHT TO HAVE ACCESS TO AND EXAMINE ALL BOOKS AND RECORDS TO ASCERTAIN IF GRANT FUNDS ARE BEING DISBURSED PURSUANT TO THE TERMS OF THE AGREEMENTS. 1 X X X X X X 1 1 0 0 0 0 0 1 0 RICHARD O DAVIS PRESIDENT/CEO/TRUSTEE 0 408624 0 262510 0 270597 0 119653 0 22633 0 1084017 0 0 KEVIN W SOWERS MSN RN FAA TRUSTEE, CORP VICE CHAIRMAN 0 1016112 0 179392 0 6105 0 153370 0 11747 0 1366726 0 0 HASAN ZIA MD INTERIM PRESDIENT, CMO, & TRUSTEE 138565 352438 0 25573 128 1672 0 36425 1588 16753 140281 432861 0 0 ALISON ARNOTT VP SUPPORT SERVICES 0 194604 0 39694 0 4605 0 21401 0 3772 0 264076 0 0 CAROLINE SHAFA VP CLINICAL OPERATIONS 0 224898 0 47020 0 17090 0 22563 0 8064 0 319635 0 3952 MARTIN BASSO VP FINANCE & CFO 0 430541 0 87699 0 116697 0 131061 0 20075 0 786073 0 0 LAURA HENDRICKS-JACKSON VP PATIENT CARE & CNO 123389 69713 2500 10000 161 410 1769 58867 7418 2216 135237 141206 0 0 JERRY L PRICE SR VP REAL ESTATE & CONSTRU 200808 0 30000 0 0 0 0 0 0 0 230808 0 0 0 SANDRA POLIN MAMMOGRAPHY PHYSICIAN 365479 0 78932 0 566 0 4125 0 3881 0 452983 0 0 0 POUNEH RAZAVI PHYSICIAN DIR BREAST IMAGING 388442 0 132059 0 1150 0 5500 0 29183 0 556334 0 0 0 SARA SHAYLOR RADIOLOGIST 381294 0 75281 0 916 0 4125 0 29528 0 491144 0 0 0 ARMAN FIROUZI PHYSICIAN SURGICAL 404552 0 0 0 1292 0 16500 0 13941 0 436285 0 0 0 COLETTE M MAGNANT BREAST SURGEON 630005 0 0 0 4657 0 8250 0 23325 0 666237 0 0 0 RONALD PETERSON FORMER TRUSTEE, OFFICER 0 38162 0 286829 0 2898530 0 19446 0 394 0 3243361 0 2398868 QUEENIE PLATER FORMER VP & CHIEF HR OFFICER 0 310229 0 53766 0 28469 0 48085 0 6401 0 446950 0 0 LAWRENCE RAMMUNO FORMER OFFICER 0 142955 0 60270 0 226764 0 27092 0 13756 0 470837 0 0 JOANNE MILLER FORMER OFFICER 0 124292 0 0 0 1961 0 27866 0 9959 0 164078 0 0 PART I, LINES 4A-B SEVERANCE PAYMENTS: LAWRENCE RAMUNNO $ 219,962.19 A SELECT GROUP OF SENIOR LEADERS OF THE JOHNS HOPKINS HEALTH SYSTEM CORPORATION (JHHSC) AND AFFILIATES PARTICIPATE IN SUPPLEMENTAL RETIREMENT/DEFERRED COMPENSATION PROGRAMS, INCLUDING SOME LEGACY ARRANGEMENTS THAT ARE NO LONGER AVAILABLE TO NEW HIRES. PRE-2011 PARTICIPANTS RECEIVE CASH PAYMENTS EACH YEAR DETERMINED WITH REFERENCE TO THEIR SERVICE WITH JHHSC AND THEIR FINAL AVERAGE COMPENSATION. AS OF JANUARY 2019, FUTURE CASH PAYMENTS ARE MADE ACCORDING TO A FIXED SCHEDULE FOR THESE PARTICIPANTS. POST-2011 PARTICIPANTS ACCRUE BENEFITS UNDER A DEFINED CONTRIBUTION FORMULA WHERE CONTRIBUTIONS ARE TIERED BY POSITION LEVEL. CONTRIBUTIONS MADE IN 2018 AND PRIOR YEARS GENERALLY VEST AFTER THE LATER OF FIVE YEARS OF SERVICE WITH JHHSC OR THREE YEARS OF PLAN PARTICIPATION; CONTRIBUTIONS MADE IN 2019 AND FUTURE YEARS VEST THREE YEARS AFTER EACH CONTRIBUTION IS MADE, WITH FULL VESTING ON THE LATER OF AGE 65 OR THREE YEARS OF PLAN PARTICIPATION. ALL CONTRIBUTIONS VEST ON DEATH, DISABILITY OR INVOLUNTARY TERMINATION WITHOUT CAUSE. IF A PARTICIPANT VOLUNTARILY TERMINATES EMPLOYMENT OR IS TERMINATED BY THE EMPLOYER FOR CAUSE PRIOR TO THE APPLICABLE VESTING DATE, THE PARTICIPANT'S ENTIRE NON-VESTED BENEFIT IS FORFEITED ALL OF THESE ARRANGEMENTS WERE APPROVED, 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. THE FOLLOWING INDIVIDUALS LISTED ON FORM 990, PART VII, SECTION A, LINE 1A RECEIVED PAYMENT FROM ONE OR MORE SUPPLEMENTAL RETIREMENT/DEFERRED COMPENSATION PROGRAMS, WITH PAYMENTS REPORTED IN SCHEDULE J, PART II, COLUMN (B)(III); THE TOTAL OF AMOUNTS PAYABLE DURING 2018 BUT REPORTED AS DEFERRED COMPENSATION IN COLUMN (C) IN PREVIOUS YEARS IS REPORTED IN SCHEDULE J, PART II, COLUMN (F). THE AMOUNTS BELOW MAY REFLECT ANNUAL CASH PAYMENTS OR MULTIPLE YEARS OF ACCRUALS THAT VESTED IN 2018. MARTIN BASSO $94,656.00; QUEENIE PLATER $23,441.28; RICHARD DAVIS $235,192.00; ALISON ARNOTT $3,952.08 AND CAROLINE SHAFA $15,627.72 IN ADDITION TO THOSE LISTED ABOVE, RONALD PETERSON RECEIVED PAYMENT FROM A SUPPLEMENTAL RETIREMENT PROGRAM THAT WAS IN PLACE PRIOR TO 1986 AND SUBJECT TO DIFFERENT TAX RULES. MR. PETERSON ACCRUED BENEFITS OVER A 40+ YEAR CAREER AT JOHNS HOPKINS HEALTH SYSTEM AND THE BENEFIT HAS BEEN REPORTED ON THE FORM 990 TWICE ALREADY: ONCE WHEN ACCRUED AND AGAIN WHEN INCLUDED AS TAXABLE INCOME FOR MEDICARE TAX PURPOSES. BENEFITS ARE PAID AS AN ANNUITY TO MR. PETERSON OVER HIS REMAINING LIFETIME AND TAXED FOR INCOME TAX PURPOSES AS PAID. UNDER FORM 990 REPORTING REQUIREMENTS, MR. PETERSON'S BENEFIT IS REQUIRED TO BE REPORTED A THIRD TIME WHEN PAID. DURING 2018, MR. PETERSON RECEIVED A PAYMENT OF $1,275,825; THIS AMOUNT IS REPORTED IN SCHEDULE J, PART II, COLUMN (B)(III) AND ALSO IN SCHEDULE J, PART II, COLUMN (F). MR. PETERSON ALSO PARTICIPATED IN A LEGACY PROGRAM, FUNDED WITH EMPLOYEE CONTRIBUTIONS, THAT RESULTED IN A TOTAL PAYOUT OF $1,621,905 DURING 2018; THIS AMOUNT IS REPORTED IN SCHEDULE J, PART II, COLUMN (B)(III) AND ALSO IN SCHEDULE J, PART II, COLUMN (F) TO THE EXTENT PREVIOUSLY REPORTED AS DEFERRED COMPENSATION ACCRUALS IN PRIOR YEARS. PART I, LINE 7 ANNUAL INCENTIVE PLAN: EXECUTIVES PARTICIPATE IN AN ANNUAL INCENTIVE PLAN THAT REWARDS PARTICIPANTS FOR THE ACHIEVEMENT OF ORGANIZATION OBJECTIVES APPROVED BY THE JOHNS HOPKINS MEDICINE COMPENSATION COMMITTEE EACH YEAR, INCLUDING FINANCIAL AND NON-FINANCIAL MEASURES. A PORTION OF THE OVERALL AWARD IS DETERMINED BASED ON INDIVIDUAL PERFORMANCE. DEPENDENT TUITION REIMBURSEMENT: DUE TO THEIR CLOSE COLLABORATION WITH THE JOHNS HOPKINS UNIVERSITY (JHU), JHHSC PROVIDES LEADERS WITH DEPENDENT TUITION REIMBURSEMENT ON A SIMILAR BASIS AS THEIR JHU COUNTERPARTS. DEPENDENT TUITION REIMBURSEMENT IS TAXABLE FOR JHHSC EMPLOYEES. THE DEPENDENT MUST BE ENROLLED FULL TIME AT AN APPROVED, ACCREDITED COLLEGE OR UNIVERSITY AND IN GOOD ACADEMIC STANDING. PAYMENT IS LIMITED TO FOUR YEARS OF FULL TIME, UNDERGRADUATE STUDY PER DEPENDENT CHILD. TUITION REIMBURSEMENT: TUITION REIMBURSEMENT IS AVAILABLE TO EMPLOYEES THAT WORK 20 HOURS OR MORE A WEEK FOR UP TO A MAXIMUM BENEFIT OF $10,000 PER ACADEMIC YEAR. TO RECEIVE REIMBURSEMENT, ELIGIBLE EMPLOYEES MUST PURSUE A COURSE OF STUDY AT AN ACCREDITED UNIVERSITY OR COLLEGE THAT LEADS TO A LICENSURE, DEGREE, OR MEETS THE NECESSITY RELATED TO CURRENT POSITION OR ANOTHER POSITION WITHIN THE ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 6 JOHNS HOPKINS HEALTH SYSTEM CORPORATION, A IRC 501(C)(3) TAX EXEMPT ORGANIZATION, IS THE SOLE CORPORATE MEMBER OF THE LUCY WEBB HAYES NATIONAL TRAINING SCHOOL FOR DEACONESSES & MISSIONARIES. FORM 990, PART VI, SECTION A, LINE 7A JOHNS HOPKINS HEALTH SYSTEM CORPORATION, A IRC 501(C)(3) TAX EXEMPT PARENT ORGANIZATION OF LUCY WEBB HAYES NATIONAL TRAINING SCHOOL FOR DEACONESSES & MISSIONARIES ELECTS THE MAJORITY OF THE BOARD OF TRUSTEES. FORM 990, PART VI, SECTION A, LINE 7B THE GOVERNING BODY OF SIBLEY MEMORIAL HOSPITAL IS EMPOWERED BY ITS BY-LAWS TO MAKE CERTAIN DECISIONS; ALL OTHER DECISIONS ARE SUBJECT TO APPROVAL OF THE PARENT ORGANIZATION JOHNS HOPKINS HEALTH SYSTEM CORPORATION. FORM 990, PART VI, SECTION B, LINE 11B A COPY OF THE FORM 990 WAS PROVIDED TO THE FINANCE COMMITTEE BEFORE IT WAS FILED. FORM 990, PART VI, SECTION B, LINE 12C THE HOSPITAL HAS AN EXISTING POLICY (#02-25-09) WHICH SPECIFICALLY ADDRESSES POTENTIAL CONFLICT(S) OF INTEREST FOR DECISION MAKERS AT ALL LEVELS WITHIN ITS BORDERS. THIS COVERAGE INCLUDES MEMBERS OF THE GOVERNING BOARD, ADMINISTRATION, MEDICAL STAFF, AND ALL OTHER EMPLOYEES. DISCLOSURE FORMS ASKING FOR POTENTIAL CONFLICTS OF INTEREST ARE DISTRIBUTED AT LEAST ANNUALLY SO THAT APPROPRIATE ACTION MAY BE TAKEN TO ENSURE THAT SUCH POTENTIAL CONFLICTS DO NOT INFLUENCE IMPORTANT DECISIONS. THE HOSPITAL'S BOARD MEMBERS ARE ASKED TO SUBMIT DISCLOSURE FORMS SEMI-ANNUALLY AND ON A CASE-BY-CASE BASIS. THE GOVERNING BOARD, SENIOR MANAGEMENT, AND THE EXECUTIVE COMMITTEE OF THE MEDCAL STAFF (AS APPROPRATE) BEAR RESPONSIBILITY FOR ADDRESSING AND REVIEWING ALL POTENTIAL CONFLICTS AND TAKING APPROPRIATE ACTION. WHEN CONFLICTS DO ARISE, THE MATTER IS BROUGHT BEFORE THE APPROPRIATE GOVERNING BODY AND DISCUSSED, AND THE CONFLICT IS ELIMINATED. FORM 990, PART VI, SECTION B, LINE 15 THE ORGANIZATION USES AN INDEPENDENT COMPENSATION COMMITTEE, AN INDEPENDENT COMPENSATION CONSULTANT, A WRITTEN EMPLOYMENT CONTRACT, A COMPENSATION SURVEY OR STUDY, APPROVAL BY THE BOARD AND CONTEMPORANEOUS WRITTEN SUBSTANTIATION OF THE DECISION-MAKING PROCESS WHEN DETERMINING COMPENSATION FOR THE CEO AND OTHER OFFICERS OF THE ORGANIZATION. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XI, LINE 9: CHANGE IN MINIMUM PENSION LIABILITY 23,214,000. NET ASSETS RELEASED 10,161,673. INTERCOMPANY TRANSFERS 16,463,005. NON-OPERATING SERVICES -134,225. OTHER COMPONENTS OF NET PERIODIC PENSION COST -17,807,000. JOHNS HOPKINS HEALTH SYSTEM CORPORATION 3910 KESWICK RD SOUTH BLDG 4TH FL S BALTIMORE MD 21211 521465301 SUPPORTING ORGANIZATION MD 501(C)(3) LINE 12C, III-FI 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 501(C)(3) LINE 3 JOHNS HOPKINS HEALTH SYSTEM CORPORATION 0 JOHNS HOPKINS COMMUNITY PHYSICIANS INC 3910 KESWICK RD SOUTH BLDG 4TH FL S BALTIMORE MD 21211 521467441 HEALTHCARE SERVICES MD 501(C)(3) LINE 12C, III-FI JOHNS HOPKINS HEALTH SYSTEM CORPORATION 0 JOHNS HOPKINS MEDICAL SERVICES CORPORATION 3910 KESWICK RD SOUTH BLDG 4TH FL S BALTIMORE MD 21211 521232569 HEALTHCARE SERVICES MD 501(C)(3) LINE 3 JOHNS HOPKINS HEALTH SYSTEM CORPORATION 0 THE JOHNS HOPKINS HOSPITAL 3910 KESWICK RD SOUTH BLDG 4TH FL S BALTIMORE MD 21211 520591656 HOSPITAL MD 501(C)(3) LINE 3 JOHNS HOPKINS HEALTH SYSTEM CORPORATION 0 SUBURBAN HOSPITAL HEALTHCARE SYSTEM INC 8600 OLD GEORGETOWN ROAD BETHESDA MD 20814 522052354 HEALTHCARE SERVICES MD 501(C)(3) LINE 12C, III-FI 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 SUBURBAN HOSPITAL INC 8600 OLD GEORGETOWN ROAD BETHESDA MD 20814 520610545 HOSPITAL MD 501(C)(3) LINE 3 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 THE STACY MARK REED FOUNDATION 5255 LOUGHBORO ROAD NW WASHINGTON DC 20016 273818765 FINANCIAL SUPPORT DC 501(C)(3) LINE 12B, II LUCY WEBB HAYES NATIONAL TRAINING SCHOOL FOR DEACONESSES & MISSIONARIES 1 SIBLEY MEMORIAL HOSPITAL FOUNDATION 5255 LOUGHBORO ROAD NW WASHINGTON DC 20016 450562642 FINANCIAL SUPPORT DC 501(C)(3) LINE 7 LUCY WEBB HAYES NATIONAL TRAINING SCHOOL FOR DEACONESSES & MISSIONARIES 1 THE JANE BANCROFT ROBINSON FOUNDATION 5255 LOUGHBORO ROAD NW WASHINGTON DC 20016 273818431 FINANCIAL SUPPORT DC 501(C)(3) LINE 12C, III-FI LUCY WEBB HAYES NATIONAL TRAINING SCHOOL FOR DEACONESSES & MISSIONARIES 1 POTOMAC HOME SUPPORT INC 6001 MONTROSE ROAD NO 1020 ROCKVILLE MD 20852 521750383 HOME HEALTH CARE MD 501(C)(3) LINE 10 N/A 0 SIBLEY SUBURBAN HOME HEALTH AGENCY 6001 MONTROSE ROAD NO 307 ROCKVILLE MD 20852 521450142 HOME HEALTH CARE MD 501(C)(3) LINE 10 N/A 0 PEDIATRIC PHYSICIAN SERVICES INC 501 SIXTH AVENUE SOUTH ST PETERSBURG FL 33701 593425191 PEDIATRIC MEDICAL SERVICES FL 501(C)(3) LINE 10 ALL CHILDREN'S HEALTH SYSTEM INC 0 ALL CHILDREN'S HOSPITAL FOUNDATION INC 501 SIXTH AVENUE SOUTH ST PETERSBURG FL 33701 592481738 FOUNDATION FL 501(C)(3) LINE 7 ALL CHILDREN'S HEALTH SYSTEM INC 0 ALL CHILDREN'S HOSPITAL INC 501 SIXTH AVENUE SOUTH ST PETERSBURG FL 33701 590683252 HOSPITAL FL 501(C)(3) LINE 3 JOHNS HOPKINS HEALTH SYSTEM CORPORATION 0 ALL 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