2020-07-09T16:58:23-05:00 2019-06-30 Grant Thornton LLP 1000 WILSON BLVD SUITE 1400 ARLINGTON VA 22209 990 2018-07-01 520591628 Peninsula Regional Medical Center % JIM GREGORY PENI 4105466400 100 East Carroll Street Salisbury MD 21801 BRUCE RITCHIE CFO 4105466400 2020-06-30 true MARY TORRETTA P00847851 7038477500 68.100.106.138 54681420201915000011 2020-07-09 P F3025B962F5CDC81089D134DBE2E83273904A17C 03CBAE45BD8E2F188EB28F31E827C7F4869431D2 2018 2020-09-23 17:36:50Z Steven Leonard CEO 100 East Carroll Street Salisbury MD 21801 689203781 false X www.peninsula.org X 1897 MD IMPROVE THE HEALTH OF THE COMMUNITIES WE SERVE. 16 11 3607 320 10082884 0 2514392 1445254 442908283 463023019 28677072 39905644 1073092 1048884 475172839 505422801 0 0 0 0 222301968 234717145 0 0 589565 215782545 226139423 438084513 460856568 37088326 44566233 710683927 750488371 205044508 203768078 505639419 546720293 X IMPROVE THE HEALTH OF THE COMMUNITIES WE SERVE. false false 416832381 0 453206658 SEE SCHEDULE O 416832381 true true false true false false false false false true true false false true true false false true false true true false false false false false true true false false true true false false false false false false true false false true false false false false false true true true false false true 295 0 true 3607 true true true true CJ false false false false false false false false false false X 16 11 true false false false true true true true true false false true true true true true true true true true true CA MD NC X JIM GREGORY 4109124979 100 EAST CARROLL STREET Salisbury MD 21801 X Herbert J Geary III Chairman 5.0 7.0 X X 41150 0 0 Deborah Abbott Vice Chairman 1.0 1.0 X X 0 0 0 Ryan McLaughlin Secretary 1.0 2.0 X X 0 0 0 David Rommel Treasurer 1.0 3.0 X X 0 0 0 Timothy Benning MD Board Member 1.0 1.0 X 0 0 0 Thomas Coates Board Member 1.0 1.0 X 0 0 0 Memo Diriker Board Member 1.0 2.0 X 0 0 0 Simona Eng DO Board Member 40.0 2.0 X 430819 0 50672 Mark Higdon Board Member 1.0 1.0 X 0 0 0 William R McCain Board Member (THRU 10/18) 1.0 1.0 X 0 0 0 Vel Natesan MD Board Member 1.0 1.0 X 38750 0 0 Martin Neat Board Member 1.0 2.0 X 0 0 0 Thomas Riccio MD Board Member 1.0 1.0 X 0 0 0 Montgomery Sayler Board Member 1.0 3.0 X 0 0 0 Julius Zant MD Board Member 1.0 1.0 X 0 0 0 Andrea Williams Board Member 1.0 1.0 X 0 0 0 Steven Leonard President/CEO 40.0 3.0 X X 1067567 0 174433 Lura Lunsford VP of Operations 40.0 2.0 X 903136 0 53205 Bruce I Ritchie CFO 40.0 3.0 X 924631 0 86376 Charles Silvia Jr MD VP - Chief Medical Officer 40.0 1.0 X 518209 0 65916 Sara Scott VP People & Organization Dev. 40.0 0.0 X 279887 0 65036 Kathryn Fiddler VP- Population Health 40.0 0.0 X 240501 0 30324 Thomas DeMarco MD VP - PRMG 40.0 0.0 X 393498 0 31289 Sheri Matter Thru 0818 VP Patient Care Services 40.0 0.0 X 232807 0 7065 James Todd MD Physician 40.0 0.0 X 987429 0 303260 Daniel Daniels MD Physician 40.0 0.0 X 1002633 0 26123 Zachary Baker MD Physician 40.0 0.0 X 733339 0 152453 Karim Arnaout MD Physician 40.0 0.0 X 823951 0 31002 Walid El Ayass MD Physician 40.0 0.0 X 820985 0 33029 Margaret Naleppa President/CEO (Thru 01/18) 0.0 0.0 X 1080124 0 1297 10519416 0 1111480 313 true true false SHERIDAN ANESTHESIA OF MD PO BOX 744883 ATLANTA GA 303744883 ANESTHESIA SERVICES 6721242 HORIZON CSA LLC 265 PIT ROAD MOORESVILLE NC 28115 BIOMEDICAL SERVICES 5909779 EPIC SYSTEMS CORP PO BOX 88314 MILWAUKEE WI 532880314 TECHNICAL SERVICES 4182838 FOCUSONE SOLUTIONS LLC PO BOX 3037 OMAHA NE 681030037 TEMP LABOR SERVICES 3572275 SLEEP WAVES INC 873 E BALTIMORE PIKE KENNETT SQUARE PA 19348 SLEEP LAB SERVICES 2815200 88 944754 500500 1445254 NET PATIENT SERVICES 621500 454266882 452989435 1277447 0 AMBULATORY PHARMACY 900099 8521242 0 8521242 0 INVESTMENT IN PREMIER 900099 234895 217223 17672 0 463023019 8773187 -150 8773337 0 0 179538 319826 -140288 0 -140288 -140288 214513452 80159 183396819 64335 31116633 15824 31132457 31132457 0 0 0 0 0 0 0 0 0 CAFETERIA 722514 915010 0 0 915010 MANAGEMENT FEES 561000 200000 0 200000 0 LIFELINE 532283 67135 0 67135 0 7027 0 -462 7489 1189172 505422801 453206658 10082884 40688005 X 0 0 0 0 4531013 4016048 506029 8936 0 184985463 164030259 20590382 364822 8062881 7146507 900473 15901 24657299 21805509 2802304 49486 12480489 11156892 1302742 20855 0 1406427 239680 1166747 211299 211299 14335 14335 0 1746504 1746504 54866221 44777756 10041339 47126 787917 787917 76630935 74713881 1850065 66989 1630906 1604002 24322 2582 0 4150712 4070929 79783 756576 567468 176913 12195 0 40190 40190 5140269 5140269 0 29689310 29360155 329155 5299285 3961536 1337749 BAD DEBTS 7975041 7975041 0 0 DUES 678086 322932 354481 673 MEDICAL SUPPLIES 35115410 35115410 0 0 460856568 416832381 43434622 589565 6080563 8705521 24606955 28985323 0 0 40179034 42498723 0 0 0 0 0 0 9452400 9104522 6097279 7401487 582556632 366318924 220434295 216237708 288997688 317793489 0 0 0 0 0 0 114835713 119761598 710683927 750488371 17074076 18752504 0 0 0 0 136625004 133622095 0 0 0 0 0 0 0 0 51345428 51393479 205044508 203768078 X 463247749 499696969 34155903 38777912 8235767 8245412 505639419 546720293 710683927 750488371 X 44566233 -630871 -2854488 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false false true 14335 14335 false OTHER ACTIVITIES SCHEDULE C, PART II-B, LINE 1I PENINSULA REGIONAL MEDICAL CENTER DOES NOT ENGAGE IN ANY DIRECT LOBBYING ACTIVITIES. THE ORGANIZATION PAYS MEMBERSHIP DUES TO MARYLAND HOSPITAL ASSOCIATION (MHA). MHA ENGAGES IN MANY SUPPORT ACTIVITIES INCLUDING LOBBYING AND ADVOCATING FOR ITS MEMBER HOSPITALS. THE MHA REPORTED THAT 4.80% OF MEMBER DUES WERE USED FOR LOBBYING PURPOSES AND SUCH, THE ORGANIZATION HAS REPORTED THIS AMOUNT ON SCHEDULE C PART IV AS LOBBYING ACTIVITIES. 64583287 7263806 9245 413409 71424439 56672686 257832 8059133 900 405464 64583287 49801243 250000 6985039 363596 56672686 50044611 500000 -399685 343683 49801243 45972891 647931 3765292 341503 50044611 0.47915 0.11645 0.40440 false true true 12022582 12022582 264379275 126989683 137389592 294350222 232411724 61938498 11804553 6917517 4887036 216237708 DONOR RESTRICTED FUND 43894152 BOARD DESIGNATED INVESTMENTS 34223095 SELF INSURANCE FUND 27896943 OTHER ASSETS 6903001 INTERCOMPANY RECEIVABLES 3703899 INVESTMENT IN PARTNERSHIPS 3140508 119761598 0 EMPLOYEE COMP RELATED PAYROLL TAXES 20596179 ACCRUED SELF INSURANCE LIABILITY 20308141 ADVANCES FROM THIRD PARTY PAYORS 9775169 OTHER LIABILITIES 713990 51393479 X 493212288 -1231132 319826 -911306 494123594 1746504 9552703 11299207 505422801 451254849 319826 319826 450935023 1746504 8175041 9921545 460856568 INTENDED USE OF ENDOWMENT FUNDS SCHEDULE D, PART V, LINE 4 THE ORGANIZATION'S ENDOWMENT FUNDS ARE USED FOR CAPITAL, PATIENT SERVICES OR EDUCATIONAL PURPOSES. FIN 48 (ASC 740) FOOTNOTE SCHEDULE D, PART X, LINE 2 Peninsula Regional Medical Center (PRMC) follows guidance that clarifies the accounting for uncertainty in tax positions taken or expected to be taken in a tax return, including issues relating to financial statement recognition and measurement. This guidance provides that the tax effects from an uncertain tax position can only be recognized in the financial statements if the position is "more-likely-than-not" to be sustained if the position were to be challenged by a taxing authority. The assessment of the tax position is based solely on the technical merits of the position, without regard to the likelihood that the tax position may be challenged. The tax years ending June 30, 2019, 2018, 2017 and 2016 are still open to audit for both federal and state purposes. PRMC has determined that there are no material uncertain tax positions that require recognition or disclosure in the consolidated financial statements for the years ended June 30, 2019 and 2018. RECONCILIATION OF REVENUE AND EXPENSES TO AUDITED FINANCIAL STATEMENTS SCHEDULE D, PART XI, LINE 2D RENT EXPENSES $319,826 SCHEDULE D, PART XI, LINE 4B BAD DEBT EXPENSES $7,975,041 Foundation Contributions $944,754 Other Contributions $500,500 MANAGEMENT FEES RECLASSED FROM EXPENSES $200,000 Partnership Income Tax Adjustment $(67,592) ----------- TOTAL $ 9,552,703 SCHEDULE D, PART XII, LINE 2D RENT EXPENSES $319,826 SCHEDULE D, PART XII, LINE 4B BAD DEBT EXPENSES $7,975,041 RECOVERY OF EXPENSES $200,000 ---------- TOTAL $8,175,041 Central America and the Caribbean 1 1 Investments 5673427 1 1 1 1 5673427 5673427 true false true false false false ACTIVITIES PER REGION SCHEDULE F, PART IV THE AMOUNTS IN COLUMN F WERE DETERMINED USING AN ACCRUAL METHOD OF ACCOUNTING. THE TOTAL AMOUNT REPRESENTS A CAPTIVE INSURANCE INVESTMENT. true true true X true X true true true false true true 7411983 7411983 0.01640 7411983 7411983 0.01640 54966 1676837 265489 1411348 0.00310 588 3875541 46200 3829341 0.00830 151404 76579285 31257311 45321974 0.09830 2628 168856 168856 0.00040 209586 82300519 31569000 50731519 0.11010 209586 89712502 31569000 58143502 0.12650 1 1036 1036 0.00000 359 309587 309587 0.00070 0 361022 361022 0.00080 751 2134115 2134115 0.00460 1111 2805760 2805760 0.00610 true 7975041 283453190 173991343 109461847 X true true 1 1 Peninsula Regional Medical Center 100 E Carroll Street Salisbury MD 21801 WWW.PENINSULA.ORG 210019 X X X Peninsula Regional Medical Center 1 false false true X X X X X X 19 true false true true X SEE SUPPLEMENTAL INFORMATION X X true 19 true SEE SUPPLEMENTAL INFORMATION false true X 200. 300. X X X X true true X X X X true X SEE SUPPLEMENTAL INFORMATION X SEE SUPPLEMENTAL INFORMATION X SEE SUPPLEMENTAL INFORMATION X X X X X X true X false X X X X true X false false CONSULTING REPRESENTATIVES OF THE COMMUNITY SERVED BY THE HOSPITAL Schedule H, Part V, Line 5 Conduent Healthy Communities Institute (HCI), a Xerox Company, was retained by Peninsula Regional Medical Center to conduct the 2019 Community Health Needs Assessment (CHNA). HCI provides customizable, web-based information systems that offer a full range of tools and content to improve community health. HCI and PRHS have collaborated since 2012 to develop the PRHS Creating Healthy Communities platform. HCI consultants conducted key informant interviews in order to collect community input. Key Informant Interviews were conducted between 07/26/2018 and 08/30/2018. Interviewees who were asked to participate were recognized as having expertise in public health, special knowledge of community health needs and/or represented the broad interest of the community served by the health system, and/or could speak to the needs of the medically underserved or vulnerable populations. The following organizations are representative of the individuals who participated in the interviews: Chesapeake Health Center, CoreLife, Deer's Head Hospital Center, HOPE, Inc. (Health and Outreach Point of Entry), Lower Shore Clinic, Lower Shore Enterprises, MAC, Inc. (Maintaining Active Citizens), Salisbury Rehabilitation and Skilled Nursing Center Genesis Healthcare, Salisbury University, TGM Group LLC, Wicomico County Executive, Wicomico County Health Department, Peninsula Regional Medical Center, and the Somerset County Health Department. There were also three Focus Groups that were organized and facilitated by Peninsula Regional Medical Center, Wicomico County Health Department, and Somerset County Health Department. The focus groups convened on 08/23/2018, 08/29/2018, and 09/14/2018. The August 23rd focus group consisted of professionals and providers from various disciplines in the tri-county area and was held at PRMC. The August 29th focus group was held in Salisbury at the Salvation Army and included members of the greater Salisbury community. The September 14th focus group was held in Pocomoke City in Worcester County at the Pocomoke Library and included members of the greater Pocomoke area. A community survey was available using Survey Monkey, an online survey tool, and a paper version of the survey. The survey was distributed across PRMC's entire service area from 07/23/2018 to 09/10/2018. A total of 584 responses were collected and a report was created. CHNA CONDUCTED WITH ONE OR MORE ORGANIZATIONS OTHER THAN HOSPITAL FACILITIES Schedule H, Part V, Line 6B The hospital facility's CHNA is conducted with one or more organizations other than the hospital. These organizations we partnered with include the Wicomico County Health Department (WiCHD) and the Somerset County Health Department (SCHD). A partnership was formed between PRMC, WiCHD, and SCHD to collaborate for the benefit of the community. These organizations have been partnering together on local assessment efforts since 1995. Two of the organizations are required to complete a CHNA; PRMC is a non-profit hospital and WiCHD as an accredited health department. SCHD is in the early phase of public health accreditation. In December 2018, PRMC, SCHD, and WiCHD published their 2019 CHNA. The CHNA Report provides an overview of significant health needs in the Tri-County service area. This CHNA report was developed to provide an overview of the health needs in the Tri-County service area, including Somerset, Wicomico, and Worcester counties in Maryland. PRMC, SCHD, and WiCHD partnered with Conduent Healthy Communities Institute (HCI) to conduct the CHNA. The goal of this report is to offer a meaningful understanding of the greatest health needs across the Tri-County service area, as well as to guide planning efforts to address those needs. Special attention has been given to identify health disparities, needs of the vulnerable populations, unmet health needs or gaps in services, and input from the community. CHNA ON HOSPITAL FACILITY'S WEBSITE Schedule H, Part V, Line 7a https://www.peninsula.org/community/community-health-needs-assessment-and- implementation-plan OTHER WAYS THE HOSPITAL MAKES ITS CHNA REPORT AVAILABLE TO THE PUBLIC Schedule H, Part V, Line 7D Peninsula Regionals comprehensive CHNA Report is made available to the public online at https://www.peninsula.org/community/community-health-needs-assessment-and- implementation-plan and a paper copy is made available to the public at several locations within the hospital for public inspection. In addition, the report has been translated into Spanish and the hospital is looking into a further translation to Creole. We partner with Conduent Healthy Communities Institute to discover what the most pressing health challenges are in Somerset, Worcester and Wicomico Counties. The public can view the results of our Community Health Needs Assessment online, as well as our action plan of steps we plan to take based on the information gathered in the assessment. In addition, a community health data and resources section can be accessed by the public. As part of this Creating Healthy Communities, a module is available to the public in which they can explore multiple dashboards that provide a gauge to the health of the communities served, socio-demographics and promising practices. The dashboards include features such as a CHNA guide, health data, demographic data, health disparities, socio needs indexes, finding grants, indicator comparisons, and progress tracking. IMPLEMENTATION STRATEGY ON HOSPITAL FACILITY'S WEBSITE SCHEDULE H, PART V, LINE 10A https://www.peninsula.org/community/community-health-needs-assessment-and- implementation-plan HOW NEEDS IDENTIFIED IN THE CHNA ARE ADDRESSED SCHEDULE H, PART V, LINE 11 Peninsula Regional Medical Center has a fixed value of resources available, and the hospital focuses those resources to the areas with the greatest impact, therefore not all needs, to date, identified in the CHNA were able to be addressed. Non-prioritized needs included Access to Health Services, Older Adults & Aging, and Oral Health. These needs were not selected because they did not meet the prioritization criteria as strongly as the selected topics. Even though not all identified needs are addressed specifically in the "Implementation Strategy Community Benefits" plan, there are population health initiatives adopted through the Health System's 2020 Strategic Plan that promote health and well-being within the community, and address needs within the CHNA. Based on the significant needs identified in the Community Health Needs Assessment, the following implementation initiatives were developed and outlined in our 2019-2021 Implementation Strategy Plan for Peninsula Regional Medical Center, and also in the Community Health Improvement Plan for Somerset County Health Department and Wicomico County Health Department. This booklet can be found at https://www.peninsula.org/community/community-health-needs-assessment-and- implementation-plan in addition to where the Community Health Needs Assessment can also be found. After a thorough review of the health status in our community through the CHNA, we identified areas that we could address using our resources, expertise and community partners. The following are the prioritized health needs that will be addressed: - Behavioral Health (Mental Health and Mental Disorders as well as Substance Abuse) - Diabetes - Cancer (Focus Areas: Breast, Colorectal, Cervical, Lung, Skin) Priority Areas Identified Behavioral Health Goals: - Address behavioral issues in the Tri-County service area by reducing the instances of opioid related deaths. - Address behavioral issues in the Tri-County service area by targeting seniors suffering with minor to major depression. Strategies: - Collaboratively address the opioid crisis in the Tri-County service area with an emphasis on prevention, treatment, resources and enforcement. - Provide peer support for people who have overdosed or sought help for opioid addiction issues. - Address depression in adults 50 years or older through skill building, problem solving and socialization activities. Objectives and Anticipated Impact: - Work collaboratively to address policy, develop education and raise community awareness in the fight against opioid use, and continue to reduce instances of heroin overdose each year. - Utilizing the Community Outreach Addictions Team (COAT), contact and provide linkage to treatment and other support services to community members dealing with substance abuse issues. - Reduce the instances of depression in older adults through outreach and access to an evidence-based intervention program. Increase percent of program participants with a significant reduction of depression above the 2018 baseline of 50%. 1. Peninsula Regional to collaborate with Wicomico County Opioid Intervention Team and Somerset County Opioid United Team Activities: - Bring awareness, education and resources to the community to work toward eliminating opioid abuse. - Target awareness activities and campaigns to the community and schools. - Participation in drug awareness coalitions. - Narcan training for community members. - Develop and implement an Opioid Intervention Team educational trailer for parents, guardians and adults. This is a mock teenage bedroom set up to show possible red flags for unhealthy behavior and/or substance use. - Coordinate and host first responder dinner to help address compassion fatigue. - Work with community partners to coordinate the Go Purple Awareness Campaign Program. 2. Program to Encourage Active and Rewarding Lives (PEARLS) Activities: - Raise awareness of this free program through targeted outreach to clinicians caring for older adults, as well as senior centers and other local organizations serving older community members. - Provide engaging and impactful curriculum in an easy-to-learn approach through flexible one-on-one visits at locations convenient for the community member being served. 3. ER Utilization Reduction and Access Improvement Activities: - SWIFT, a mobile integrated health team, makes home-based visits to individuals utilizing 911 at least five times over a six-month period for non-life-threatening medical reasons. The team provides physical, mental and safety assessments and screens for social determinants of health. Based on their assessment, patients are referred, as necessary, for appropriate care interventions such as primary care providers, medical specialists, in home providers, financial and social resources, as well as other community resources. Alignment Opportunities: - PRMC, as part of a regional partnership with Atlantic General Hospital in Worcester County, SCHD and WiCHD, is collaborating with the Maryland Health Service Cost Review Commission to develop a regional approach to behavioral health for FY 2021. Work in these three areas will be incorporated into this Tri-County Regional Partnership and updated in this document in 2021. - WiCHD Strategic Plan 2017-2022, Priority #1: Improve community health and wellness by focusing on priority areas identified in collaboration with the Local Health Improvement Coalition: chronic disease and behavioral health. PRMC and WiCHD will build off the successful efforts that were included for this program in their 2016 Implementation Strategy Plan. Collaborative Activities: - Train peer support specialists. - Provide phone and in-person support for people who have overdosed or who struggle with opioid addiction, as well as other substance abuse issues. - Provide connections to resources including treatment options. - Provide peer outreach to high-risk areas of the community. - Maintain ongoing communications about metrics between PRMC and COAT team. - Evaluate expansion to Somerset County. Diabetes Goal: Improve health of people with diabetes or pre-diabetes in the Tri-County service area. Strategies: - Offer Evidence-Based Chronic Disease Self-Management Classes (CDSM) throughout the Tri-County service area. - Expand access to diabetes screening, education and resources throughout the Tri-County service area with the Wagner Wellness Van mobile clinic services. - Provide a free evidence-based weight loss, nutrition and physical activity program for women and children in Wicomico and Somerset Counties. Objectives and Anticipated Impact: - By December 2020, increase the number of six-week educational classes with identified diabetes patients and their supporting caregivers from 26 to 52 per year. - By partnering with other community stakeholders, the Community Wellness Program will increase access to diabetes screening, education and connection to community resources. This program, which includes the Wagner Wellness Van outreach, provides health outreach events that are both large-scale and small-scale, and can be aimed toward the public or a targeted population or geographic area. - Starting in September 2019 and ending in June 2021, SCALE's expected outcomes include: 80% of adult participants will report weight loss of at least 5% of their total body weight from baseline; 20% of adult participants will report a drop-in hemoglobin A1C by 0.2 points or more; 20% of adult participants will report a decrease in blood pressure (diastolic and systolic) by 5 points or more; demonstrated behavior change and improved health status. 1. Chronic Disease Self-Management (CDSM) Classes PRMC will build off the successful efforts that were included for this program in its 2016 Implementation Strategy Plan Activities. Activities: - Target and identify patients who have diabetes and their caregivers through self-referral or provider referral. - Train Community Peer Trainers and PRMC Community Health Workers to conduct classes. - Offer classes in English, Spanish and American Sign Language. - Explore the possibility to offer classes in Haitian-Creole, Korean and Mandarin languages, based on availability of peer trainers in these languages. - Offer six-week classes at least once weekly. - Educate participants on diabetes self-management and have them set and track weekly personal goals and share those with their providers. - Partner with MAC, Inc. to collect data on pre and post A1C values. - Connect with the statewide Health Information Exchange to make referrals between provider offices and MAC, Inc. for all CDSM classes. 2. Wagner Wellness Van Expansion PRMC and WiCHD will build off the successful efforts that were included for this program in its 2016 Implementation Strategy Plan. Activities: - Outreach to communities utilizing a Nurse Practitioner (NP) to provide primary care services. - Provide screenings for diabetes (other screenings provided as well). - ELIGIBILITY CRITERIA FOR FINANCIAL ASSISTANCE SCHEDULE H, PART V, LINES 13B & 13H PENINSULA REGIONAL MEDICAL CENTER OFFERS FINANCIAL ASSISTANCE TO PATIENTS WHOSE INCOME IS AT OR BELOW 200% OF THE FEDERAL POVERTY GUIDELINES. PRMC ALSO PROVIDES FINANCIAL ASSISTANCE BASED UPON SEVERAL SPECIAL SITUATIONS: 1) FINANCIAL ASSISTANCE WILL BE CONSIDERED IF PATIENT IS OVER INCOME CRITERION, BUT HAS A FINANCIAL HARDSHIP. A FINANCIAL HARDSHIP EXISTS WHEN THE AMOUNT OF MEDICAL DEBT AT PENINSULA REGIONAL MEDICAL CENTER EXCEEDS 25% OF THE FAMILY'S INCOME IN A YEAR. 2) A PATIENT THAT HAS QUALIFIED FOR MARYLAND MEDICAL ASSISTANCE IS DEEMED TO AUTOMATICALLY QUALIFY FOR PRMC'S FINANCIAL ASSISTANCE PROGRAM. THE AMOUNT DUE FROM A PATIENT ON THESE ACCOUNTS MAY BE WRITTEN OFF TO FINANCIAL ASSISTANCE WITH VERIFICATION OF MEDICAID ELIGIBILITY. NORMAL DOCUMENTATION REQUIREMENTS ARE WAIVED FOR FINANCIAL ASSISTANCE GRANTED UPON THE BASIS OF MARYLAND MEDICAL ASSISTANCE ELIGIBILITY. 3) PATIENTS WHO ARE BENEFICIARIES/RECIPIENTS OF CERTAIN MEANS-TESTED SOCIAL SERVICES PROGRAMS ADMINISTERED BY THE STATE OF MARYLAND ARE DEEMED TO HAVE PRESUMPTIVE ELIGIBILITY FOR PRMC'S FINANCIAL ASSISTANCE PROGRAM. THE AMOUNT DUE FROM A PATIENT ON THESE ACCOUNTS MAY BE WRITTEN OFF TO FINANCIAL ASSISTANCE WITH VERIFICATION OF ELIGIBILITY FOR ONE OF THESE PROGRAMS. NORMAL DOCUMENTATION REQUIREMENTS ARE WAIVED FOR FINANCIAL ASSISTANCE GRANTED UPON THE BASIS OF PRESUMPTIVE ELIGIBILITY. IT IS THE RESPONSIBILITY OF PATIENTS TO NOTIFY THE HOSPITAL THEY ARE IN A MEANS TESTED PROGRAM AND PROVIDE THE DOCUMENTATION, BUT PRMC STAFF DOES INQUIRE AS TO THIS STATUS DURING THE INTAKE PROCESS AND AT OTHER POINTS DURING THE FINANCIAL ASSISTANCE DETERMINATION PROCESS. PUBLICIZING THE FINANCIAL ASSISTANCE POLICY SCHEDULE H, PART V, LINE 15E IF A PATIENT IS UNABLE TO PAY DUE TO FINANCIAL RESOURCES, ALL EFFORTS WILL BE MADE TO HELP THE PATIENT OBTAIN ASSISTANCE THROUGH APPROPRIATE AGENCIES. IN THE EVENT THAT THE PATIENT HAS APPLIED FOR AND KEPT ALL NECESSARY APPOINTMENTS AND THIRD PARTY ASSISTANCE IS NOT AVAILABLE, PENINSULA REGIONAL MEDICAL CENTER WILL PROVIDE CARE AT REDUCED OR ZERO COST. WHEN NO THIRD PARTY ASSISTANCE IS AVAILABLE TO COVER THE TOTAL BILL AND THE PATIENT INDICATES THAT THEY HAVE INSUFFICIENT FUNDS, THE FOLLOWING PROCEDURE WILL OCCUR: 1) THE MARYLAND STATE UNIFORM FINANCIAL ASSISTANCE APPLICATION SHOULD BE REVIEWED BY STAFF, IN CONSULTATION WITH THE PATIENT, TO MAKE INITIAL ASSESSMENT OF ELIGIBILITY. 2) COMPARE PATIENT'S INCOME TO CURRENT FEDERAL POVERTY GUIDELINES. 3) IF PRELIMINARILY ELIGIBLE PER GUIDELINES, SEND MARYLAND STATE UNIFORM FINANCIAL ASSISTANCE APPLICATION TO PATIENT/GUARANTOR FOR COMPLETION AND SIGNATURE. PATIENT SHOULD ATTACH APPROPRIATE DOCUMENTATION AND RETURN TO REPRESENTATIVE WITHIN 10 DAYS. UPON RECEIPT OF THE FINANCIAL ASSISTANCE REQUEST, THE REPRESENTATIVE WILL REVIEW INCOME AND ALL DOCUMENTATION. THE PATIENT MUST BE NOTIFIED WITHIN TWO BUSINESS DAYS OF THEIR PROBABLE ELIGIBILITY AND INFORMED THAT THE FINAL DETERMINATION WILL BE MADE ONCE THE COMPLETED FORM AND ALL SUPPORTING DOCUMENTS ARE RECEIVED, REVIEWED, AND THE INFORMATION VERIFIED. INCOME INFORMATION WILL BE VERIFIED USING THE DOCUMENTATION PROVIDED BY THE PATIENT AND EXTERNAL RESOURCES WHEN AVAILABLE. A FINANCIAL ASSISTANCE DISCOUNT WILL BE APPLIED TO THE PATIENT'S RESPONSIBILITY ACCORDINGLY. 4) IF INELIGIBLE, THE REPRESENTATIVE WILL NOTIFY THE PATIENT AND RESUME NORMAL DUNNING PROCESS AND FILE DENIAL WITH THE ACCOUNT. THE DENIALS WILL BE KEPT ON FILE IN THE COLLECTION OFFICE. ALL DENIALS WILL BE REVIEWED BY THE COLLECTION COORDINATOR LEVEL OR ABOVE. THE PATIENT MAY REQUEST RECONSIDERATION BY SUBMITTING A LETTER TO THE DIRECTOR OF PATIENT FINANCIAL SERVICES INDICATING THE REASON FOR THE REQUEST. ONLY INCOME AND FAMILY SIZE WILL BE CONSIDERED IN APPROVING APPLICATIONS FOR FINANCIAL ASSISTANCE UNLESS ONE OF THE FOLLOWING THREE SCENARIOS OCCURS: - THE AMOUNT REQUESTED IS GREATER THAN $50,000. - THE TAX RETURN SHOWS A SIGNIFICANT AMOUNT OF INTEREST INCOME, OR THE PATIENT STATES THEY HAVE BEEN LIVING OFF OF THEIR SAVINGS ACCOUNTS. - DOCUMENTATION INDICATES SIGNIFICANT WEALTH. IF ONE OF THE ABOVE THREE SCENARIOS ARE APPLICABLE IN THE APPLICATION, LIQUID ASSETS MAY BE CONSIDERED INCLUDING: CHECKING AND SAVINGS ACCOUNTS, STOCKS, BONDS, CERTIFICATES OF DEPOSIT, MONEY MARKET OR ANY OTHER ACCOUNTS FOR THE PAST THREE MONTHS ALONG WITH THE PAST YEAR'S TAX RETURN, AND A CREDIT REPORT MAY BE REVIEWED. THE FOLLOWING ASSETS ARE EXCLUDED: - THE FIRST $10,000 OF MONETARY ASSETS. - UP TO $150,000 IN A PRIMARY RESIDENCE. CERTAIN RETIREMENT BENEFITS (SUCH AS A 401-K WHERE THE IRS HAS GRANTED PREFERENTIAL TAX TREATMENT AS A RETIREMENT ACCOUNT INCLUDING BUT NOT LIMITED TO DEFERRED-COMPENSATION PLANS QUALIFIED UNDER THE INTERNAL REVENUE CODE, OR NONQUALIFIED DEFERRED-COMPENSATION PLANS) WHERE THE PATIENT POTENTIALLY COULD PAY TAXES AND/OR PENALTIES BY CASHING IN THE BENEFIT. IF THE BALANCE DUE IS SUFFICIENT TO WARRANT IT AND THE ASSETS ARE SUITABLE, A LIEN WILL BE PLACED ON THE ASSETS FOR THE AMOUNT OF THE BILL. COLLECTION EFFORTS WILL CONSIST OF PLACEMENT OF THE LIEN WHICH WILL RESULT IN PAYMENT TO THE HOSPITAL UPON SALE OR TRANSFER OF THE ASSET. 5) COLLECTION COORDINATOR WILL REVIEW DOCUMENTATION. IF ELIGIBLE, THE ACCOUNT WILL BE WRITTEN OFF TO FINANCIAL ASSISTANCE AND THE "REQUEST FOR FINANCIAL ASSISTANCE" FORM FINALIZED. A COPY IS RETAINED IN THE PATIENT'S FILE. THE REPRESENTATIVE WILL CALL THE PATIENT AND NOTIFY HIM/HER OF THE FINAL DETERMINATION OF ELIGIBILITY. 6) PENINSULA REGIONAL MEDICAL CENTER WILL REVIEW ONLY THOSE ACCOUNTS WHERE THE PATIENT OR GUARANTOR INQUIRE ABOUT FINANCIAL ASSISTANCE, MAILS IN AN APPLICATION, OR IN THE NORMAL WORKING OF THE ACCOUNT THERE IS INDICATION THAT THE PATIENT MAY BE ELIGIBLE. ANY PATIENT/CUSTOMER SERVICE REPRESENTATIVE, FINANCIAL COUNSELOR, OR COLLECTION REPRESENTATIVE MAY BEGIN THE REQUEST PROCESS. PRE-PLANNED SERVICE MAY ONLY BE CONSIDERED FOR FINANCIAL ASSISTANCE WHEN THE SERVICE IS MEDICALLY NECESSARY. FOR EXAMPLE, NO COSMETIC SURGERY WILL BE ELIGIBLE. INPATIENT, OUTPATIENT, EMERGENCY, AND PENINSULA REGIONAL MEDICAL GROUP PHYSICIAN CHARGES ARE ALL ELIGIBLE. FINANCIAL ASSISTANCE POLICY, APPLICATION FORM, PLAIN LANGUAGE SUMMARY AVAILABLE ON THE HOSPITAL'S WEBSITE SCHEDULE H, PART V, LINES 16A, 16B & 16C https://www.peninsula.org/patients-visitors/patient-billing-information/fi nancial-assistance-documents MAXIMUM CHARGE AMOUNTS FOR FAP-ELIGIBLE INDIVIDUALS SCHEDULE H, PART V, LINE 22D PENINSULA REGIONAL MEDICAL CENTER IS A MARYLAND HOSPITAL. AS SUCH PATIENTS AND ALL INSURANCE COMPANIES, INCLUDING MEDICARE & MEDICAID, PAY THE SAME RATE. THIS RATE IS DETERMINED BY THE STATE AGENCY, THE MARYLAND HEALTH SERVICES COST REVIEW COMMISSION. OTHER METHOD USED IN DETERMINING ELIGIBILITY FOR FINANCIAL ASSISTANCE SCHEDULE H, PART I, LINE 3C N/A - PENINSULA REGIONAL MEDICAL CENTER USES THE FPG IN DETERMINING ELIGIBILITY FOR FINANCIAL ASSISTANCE. FINANCIAL ASSISTANCE IS ALSO CONSIDERED IF A PATIENT IS OVER INCOME CRITERION BUT HAS FINANCIAL HARDSHIP BASED ON MEDICAL DEBT. PATIENTS WHO ARE BENEFICIARIES/RECIPIENTS OF CERTAIN MEANS-TESTED SOCIAL SERVICES PROGRAM ADMINISTERED BY THE STATE OF THE PATIENT'S RESIDENCE ARE DEEMED TO HAVE PRESUMPTIVE ELIGIBILITY FOR PRMC'S FA PROGRAM. COMMUNITY BENEFIT REPORT SCHEDULE H, PART I, LINE 6A PENINSULA REGIONAL MEDICAL CENTER FILES ANNUALLY A COMMUNITY BENEFIT REPORT WITH THE STATE OF MARYLAND. THE REPORT IS FILED WITH THE HSCRC (HEALTH SERVICES COST REVIEW COMMISSION). FINANCIAL ASSISTANCE AND CERTAIN OTHER COMMUNITY BENEFITS AT COST SCHEDULE H, PART I, LINE 7, COLUMN (F) THE AMOUNT OF BAD DEBT EXPENSE EXCLUDED FROM THE DENOMINATOR IN THE COLUMN (F) PERCENTAGES IS $7,975,041. LINE 7B COLUMN (C) & (F)- 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 DIRECTED OFFSETTING REVENUE RELATED TO UNCOMPENSATED CARE. COMMUNITY BENEFIT EXPENSES ARE EQUAL TO MEDICAID REVENUES IN MARYLAND, AS SUCH, THE NET EFFECT IS ZERO. THE EXCEPTION TO THIS IS THE IMPACT ON THE HOSPITAL OF ITS SHARE OF THE MEDICAID ASSESSMENT. IN RECENT YEARS, THE STATE OF MARYLAND HAS CLOSED FISCAL GAPS IN THE STATE MEDICAID BUDGET BY ASSESSING HOSPITALS THROUGH THE RATE-SETTING SYSTEM. THE COST METHODOLOGY FOR CHARITY CARE AND CERTAIN OTHER COMMUNITY BENEFITS IS THE COST-TO-CHARGE RATIO USED FOR THE CHARITY CARE PROGRAMS AND DIRECT COST METHOD FOR THE OTHER BENEFITS/PROGRAMS. COMMUNITY BUILDING ACTIVITIES SCHEDULE H, PART II PENINSULA REGIONAL FUNDS A VARIETY OF PROGRAMS THAT WORK TO PROMOTE THE HEALTH AND SAFETY OF OUR COMMUNITY. THESE PROGRAMS INCLUDE ACTIVITIES IN THE AREAS OF HOUSING, ECONOMIC DEVELOPMENT, COMMUNITY SUPPORT, ENVIRONMENTAL IMPROVEMENTS, COALITION BUILDING, AND WORKFORCE DEVELOPMENT. THE NUMBER OF PERSONS SERVED BY THE COMMUNITY BUILDING ACTIVITIES WERE NOT TRACKED FOR ALL PROGRAMS THROUGHOUT THE COURSE OF THE YEAR. COALITION BUILDING HISTORICALLY PENINSULA REGIONAL HAS FACILITATED INVOLVEMENT WITH HEALTH IMPROVEMENT ORGANIZATIONS TO IDENTIFY, ASSESS, AND CREATE AGGREGATE ACTION PLANS TO ADDRESS LOCAL EMERGING AND CHRONIC COMMUNITY BENEFIT SERVICE AREA HEALTHCARE ISSUES. KATHRYN FIDDLER (EXECUTIVE DIRECTOR OF POPULATION HEALTH) AND STEPHANIE ELLIOT (DIRECTOR OF COMMUNITY SERVICES HEALTH) ATTEND THE FOLLOWING LOCAL HEALTH IMPROVEMENT COALITION'S INCLUDING SOME OF THE FRONT-LINE CARE MANAGEMENT COORDINATORS AND PHYSICIANS. - WICOMICO COUNTY LHIC - WORCESTER COUNTY HRSA - HEALTHY SOMERSET COALITION - WORCESTER COUNTY LHIC - TRI COUNTY HEALTH IMPROVEMENT PLANNING - TRI COUNTY ALLIANCE FOR THE HOMELESS - PROJECT LIVING WELL ADVISORY COMMITTEE MAC (MAINTAINING ACTIVE CITIZENS) PHYSICIAN RECRUITING PENINSULA REGIONAL FEELS IT IS IMPORTANT TO CONTINUALLY MONITOR SPECIALTIES WHERE A SIGNIFICANT AMOUNT OF PATIENT CARE WITHIN THE SERVICE AREA IS PROVIDED BY OLDER PHYSICIANS, AS A SUDDEN OR UNEXPECTED LOSS OF COVERAGE COULD HAVE AN ADVERSE EFFECT ON THE PROVISION OF MEDICAL SERVICES TO THE COMMUNITY. SUCCESSION PLANNING AND RECRUITMENT GO HAND-IN-HAND, AS DOES SOCIO-DEMOGRAPHICS AND GOVERNMENTAL INITIATIVES ALL OF WHICH MUST BE CONSIDERED TO ASSESS APPROPRIATE PHYSICIAN RECRUITMENT. KEY FINDINGS, ACCORDING TO THE MOST RECENT MEDICAL STAFF DEVELOPMENT PLAN, INDICATE AN IMMEDIATE NEED FOR RECRUITMENT OF PRIMARY CARE PHYSICIANS TO ENGAGE IN CHRONIC DISEASE MANAGEMENT AS PART OF OUR POPULATION HEALTH INITIATIVES. SUCCESSION PLANNING IS A KEY OBJECTIVE AS TEN PRIMARY CARE PHYSICIANS ARE ABOVE THE AGE OF 55 WHICH WILL LEAVE A VOID IN AN ALREADY UNDERSERVED AREA. DEMOGRAPHICS ALSO PLAY A KEY ROLE AS THE MEDICARE POPULATION IS GROWING AT A FASTER RATE THAN THE STATE OF MARYLAND AND THE NATION. AS A GROWING RETIREMENT COMMUNITY, THERE IS AN INCREASED NEED FOR ADDITIONAL PRIMARY CARE PHYSICIANS AND CERTAIN SPECIALTIES. THERE WILL BE A 22.7% GROWTH OF THOSE BETWEEN THE AGES OF 65 TO 74 OVER THE NEXT 5 YEARS. DEFICIENCIES AND SURPLUSES IN THE CURRENT SUPPLY OF PHYSICIANS WERE DETERMINED BY REVIEWING PHYSICIAN TO-POPULATION RATIOS, PHYSICIAN PATIENT VOLUMES, POPULATION DATA, AND OTHER DATA. MANAGEMENT CONSULTANTS RECOMMEND EVALUATING POTENTIAL RECRUITMENT OF PRIMARY CARE FAMILY MEDICINE, PRIMARY CARE INTERNAL MEDICINE AND PRIMARY CARE PEDIATRICS OVER THE NEXT SEVERAL YEARS. MEDICAL SPECIALTY NEEDS ARE DRIVEN BY THE OVERALL MARKET SUPPLY, WAIT TIMES FOR NEW PATIENT APPOINTMENTS, AND CALL COVERAGE AND INPATIENT CONSULTATION NEEDS. CURRENT MEDICAL SPECIALTY RECOMMENDATIONS INCLUDE RECRUITMENT OF THE FOLLOWING PHYSICIAN SPECIALTIES DUE TO COMMUNITY NEEDS ASSESSMENT, MARKET DEMAND AND RETIREMENT: ALLERGY/IMMUNOLOGY, DERMATOLOGY, ENDOCRINOLOGY, INFECTIOUS DISEASE, NEUROLOGY, OB/GYN, PAIN MANAGEMENT, PSYCHIATRY AND RHEUMATOLOGY. OF THE MEDICAL STAFF, 32% IS EITHER AT OR ABOVE THE AGE OF 55, WHICH POSES SUCCESSION RISK. PENINSULA REGIONAL A RURAL HOSPITAL, AND OTHER LIKE-KIND RURAL COMMUNITIES ARE TYPICALLY CHALLENGED IN BOTH RECRUITMENT AND RETENTION OF PHYSICIANS DUE TO NUMEROUS FACTORS. SOME OF THESE CHALLENGES ARE DUE TO THE LOCATION AND GEOGRAPHY OF THE AREA AND AVAILABILITY OF HEALTHCARE RESOURCES. RETAINING AND RECRUITING RESOURCES IN SUB-SPECIALTIES CAN BE HARD FOR REGIONAL RURAL HOSPITALS AND PENINSULA REGIONAL MEDICAL CENTER IS NO EXCEPTION. TO ADDRESS SPECIFIC COMMUNITY HEALTHCARE NEEDS THE MEDICAL CENTER HAS HAD TO RECRUIT, RETAIN, EMPLOY AND SUBSIDIZE SOME OF THE FOLLOWING SUBSPECIALTIES; PULMONARY, NEURO-HOSPITALIST, NEUROSURGERY, MEDICAL ONCOLOGY & HEMATOLOGY, GASTROENTEROLOGY, PEDIATRIC SPECIALTIES, ENDOCRINOLOGY, CARDIOLOGY, CARDIOVASCULAR SURGERY, AND PAIN MANAGEMENT. RURAL COMMUNITIES LACK THE CULTURAL AND EDUCATIONAL RESOURCES THAT LARGER URBAN CENTERS PROVIDE MAKING IT HARDER TO RETAIN AND RECRUIT THESE PHYSICIANS. LOW POPULATION PATTERNS BY GEOGRAPHY MAKE IT MORE COSTLY AND HARDER FOR COMMUNITIES AND BUSINESSES TO PROVIDE VARIOUS TYPES OF SERVICES ESPECIALLY SPECIALTY PHYSICIAN SERVICES. OVERALL, OUR LOCAL ECONOMY IS NOT AS ROBUST AS THE URBAN CENTERS AS INDICATED BY OUR LOW AVERAGE HOUSEHOLD INCOME IN THE TRI-COUNTY AREA. DISASTER READINESS PENINSULA REGIONAL MEDICAL CENTER IS A MEMBER OF DRHMAG (DELMARVA REGIONAL HEALTH MUTUAL AID GROUP) WHICH IS A COALITION OF LOCAL HEALTH DEPARTMENTS, HOSPITALS AND NURSING HOMES. THEY MEET QUARTERLY TO DISCUSS ISSUES OF DISASTER PREPAREDNESS IN THE DELMARVA REGION. PRMC HAS AN INTERNAL EMERGENCY MANAGEMENT COMMITTEE THAT MEETS MONTHLY WHOSE MEMBERS INCLUDE THE SAFETY COORDINATOR, CHIEF OF SECURITY, EMERGENCY DEPARTMENT RN, RISK MANAGEMENT, INFECTION PREVENTION, EXECUTIVE TEAM REPRESENTATIVE, PHARMACIST, EMERGENCY MANAGEMENT COORDINATOR, FIREFIGHTER, AND A COUNTY HEALTH DEPARTMENT REPRESENTATIVE. PRMC ALSO MEETS QUARTERLY WITH OUR LOCAL PARTNERS THAT INCLUDE FIRE, POLICE, EMERGENCY MEDICAL SERVICES, AND WICOMICO COUNTY EMERGENCY MANAGEMENT TO FACILITATE DISASTER PLANNING AND MOCK DRILLS WITHIN THE COMMUNITY. METHODOLOGY USED TO ESTIMATE BAD DEBT EXPENSE SCHEDULE H, PART III, LINES 2 AND 3 SEE RESPONSE BELOW TO LINE 4 REGARDING THE METHODOLOGY USED BY THE ORGANIZATION REGARDING BAD DEBT. BAD DEBT FOOTNOTE IN THE AUDITED FINANCIAL STATEMENTS SCHEDULE H, PART III, LINE 4 Under the provisions of ASU 2014-09, when there is an unconditional right to payment, subject only to the passage of time, the right is treated as a receivable. Patient accounts receivable, including billed accounts and unbilled accounts, which have the unconditional right to payment, and estimated amounts due from third-party payers for retroactive adjustments, are recorded as receivables since the right to consideration is unconditional and only the passage of time is required before payment of that consideration is due. The estimated uncollectible amounts are generally considered implicit price concessions that are recorded as a direct reduction to patient accounts receivable rather than an allowance for doubtful accounts. Discounts ranging from 2% to 6% of charges are given to Medicare, Medicaid, and certain approved commercial health insurance and health maintenance organization programs for regulated services. Discounts in varying percentages are given for certain unregulated services. MEDICARE COSTING METHODOLOGY SCHEDULE H, PART III, LINE 8 MEDICARE ALLOWABLE COSTS WERE CALCULATED USING A COST TO CHARGE RATIO. PENINSULA REGIONAL MEDICAL CENTER PROVIDES QUALITY MEDICAL SERVICES TO ALL PATIENTS REGARDLESS OF WHAT INSURANCE THEY HAVE. APPROXIMATELY, 52% OF THE MEDICAL CENTER'S REVENUE IS ATTRIBUTABLE TO MEDICARE PATIENTS DURING THE YEAR ENDED JUNE 30, 2019. COLLECTION POLICY SCHEDULE H, PART III, LINE 9B THE PENINSULA REGIONAL MEDICAL CENTER COLLECTION POLICY INCLUDES INFORMATION ABOUT OUR FINANCIAL ASSISTANCE POLICY (FAP) AND HOW TO FIND THE FAP. THE DEBT COLLECTION POLICY APPLIES TO ALL PATIENTS. ADDITIONALLY OUR COLLECTION POLICY INSTRUCTS THAT EXTRAORDINARY COLLECTION ACTIONS (ECA) WILL BE SUSPENDED WHEN A PATIENT REQUESTS INFORMATION ON OUR FAP OR SUBMITS A FINANCIAL ASSISTANCE APPLICATION WITHIN 240 DAYS OF THE FIRST POST-DISCHARGE BILLING STATEMENT. OUR POLICY DESCRIBES WHAT TO DO IF THE FINANCIAL ASSISTANCE APPLICATION IS INCOMPLETE AND WHAT IS REQUIRED TO BE REFUNDED (AMOUNTS OVER $5) IF THE PATIENT QUALIFIES FOR FINANCIAL ASSISTANCE AFTER MAKING A PAYMENT. WE INCLUDE CLARIFICATION OF WHAT DATES OF SERVICES ARE INCLUDED IN THE FINANCIAL ASSISTANCE SO THAT WE UNDERSTAND WHEN NORMAL COLLECTION EFFORTS ARE APPROPRIATE. WITHIN OUR COLLECTION POLICY WE DESCRIBE THAT A PATIENT DENIED FINANCIAL ASSISTANCE MAY REQUEST A RECONSIDERATION. FOR DATES OF SERVICES APPROVED FOR FINANCIAL ASSISTANCE COLLECTIONS PROCESSES ARE HALTED AS THE ACCOUNT IS ADJUSTED TO ZERO DUE FROM PATIENT. THE POLICY STATES HOW TO PROCESS THE PATIENT BALANCE WHEN ONLY A PORTION OF THE CHARGE QUALIFIED FOR FINANCIAL ASSISTANCE; COLLECTIONS WILL ONLY BE PURSUED ON THE AMOUNT THAT DID NOT QUALIFY FOR FINANCIAL ASSISTANCE. NEEDS ASSESSMENT SCHEDULE H, PART VI, LINE 2 PENINSULA REGIONAL ASSESSES COMMUNITY HEALTH NEEDS IN PARTNERSHIP WITH THE LOCAL COUNTY HEALTH DEPARTMENTS (WICOMICO, WORCESTER, SOMERSET). WE MEET ON A REGULAR BASIS TO DISCUSS AND FORMULATE STRATEGIES AND ACTION PLANS IN WHICH WE COLLABORATE WITH EACH OTHER AND LOCAL ENTITIES TO ADDRESS RESIDENTS' MOST UNDERSERVED AND CRITICAL HEALTHCARE AND SOCIAL NEEDS. DEVELOPING RELATIONSHIPS WITH COMMUNITY PARTNERS IS CRITICAL TO CONTINUED IDENTIFICATION OF UNDERSERVED NEEDS AND POPULATION HEALTH MANAGEMENT SUCCESS; A CORNERSTONE OF PENINSULA REGIONAL STRATEGY. THE FOLLOWING LOCAL RELATIONSHIPS, PARTNERSHIPS AND MEMBERSHIPS HAS CREATED SYNERGY PRODUCING LOCAL HEALTHCARE DIVIDENDS, EXAMPLES OF THESE RELATIONSHIPS INCLUDE THE FOLLOWING: TRI-COUNTY DIABETES ALLIANCE, SWIFT (SALISBURY WICOMICO INTEGRATED FIRSTCARE TEAM), FEDERALLY QUALIFIED HEALTH CENTERS, YMCA, PATIENT CARE ADVISORY COUNCIL, LOCAL SNFS, FAITH BASED ENTITIES, MAC (MAINTAINING ACTIVE CITIZENS), SHELTERS (HALO, HOPE), LOCAL COLLEGES & HIGH SCHOOLS. WORKING TOGETHER WITH DIVERSE AND DISPARATE LOCAL ENTITIES FOR THE UNITED BUT COMMON GOAL OF MEETING RESIDENTS' UNDERSERVED NEEDS- PLANNING TOGETHER, APPLYING RESOURCES OUR GOAL IS A HEALTHIER COMMUNITY. IN ADDITION TO THE CHNA, PENINSULA REGIONAL HAS EMBARKED ON IDENTIFYING AND TARGETING "SUPER UTILIZERS" WITHIN OUR CBSA (COMMUNITY BENEFIT SERVICE AREA); THESE RESIDENTS WILL BE IDENTIFIED, AND TARGETED FOR POPULATION HEALTH MANAGEMENT. - DEMOGRAPHICS (BLOCK GROUPS, ZIP CODES) - RACE/ETHNICITY - AGE-COHORTS - CHRONIC CONDITIONS THE TARGET POPULATION INCLUDES PATIENTS THAT HAVE CHRONIC CONDITIONS WHO HAVE DEMONSTRATED TO HAVE BEEN HIGH UTILIZERS AT PRMC, OR ARE IDENTIFIED AS BEING AT RISK OF HIGH UTILIZATION BASED ON HIS/HER CHRONIC CONDITIONS AND PATTERNS OF CARE. CURRENT DATA INDICATES AN "OVERRELIANCE" BY LOCAL RESIDENTS ON PENINSULA REGIONAL'S EMERGENCY ROOM FOR PRIMARY AND CHRONIC CONDITION NEEDS. IN RESPONSE, PRMC HAS INTRODUCED INTERVENTIONS, CARE MANAGEMENT PROGRAMS, EDUCATION, AND FOLLOW-UP WITH MEASUREMENT AND OUTCOMES. BASED UPON A CURRENT ASSESSMENT THERE ARE APPROXIMATELY 1,000+ RESIDENTS THAT MEET THE CRITERIA OF "SUPER UTILIZERS" STRATIFIED BY SOCIO-DEMOGRAPHICS AND CHRONIC DISEASE. PENINSULA REGIONAL IS TARGETING CBSA ZIP CODES BASED UPON SOCIAL AND ECONOMIC DETERMINANTS OF HEALTH TO INCLUDE THE UNINSURED, INDIGENT POPULATION, RESIDENTS WHO LACK TRANSPORTATION, LACK OF EDUCATION AND AVAILABILITY OF HEALTHY FOODS. TARGETING THIS BY CLUSTER AND BLOCK GROUPS, WE SEEK TO IMPACT THE HEALTH BY PROVIDING PRIMARY HEALTH SERVICES, EDUCATION, ACCESS AND MORE IMPORTANTLY BY FOSTERING RELATIONSHIPS WITHIN THE COMMUNITY WE SERVE. FOR EXAMPLE, OUR WAGNER WELLNESS VAN TRAVELS LOCALLY TO BLOCK GROUPS WHERE THERE WAS AN IDENTIFIED NEED FOR BASIC HEALTH SERVICES, IN ADDITION TO PROVIDING HEALTH SERVICES AND EDUCATION TO LOCAL ETHNIC CHURCHES AND CIVIC ORGANIZATIONS. PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE SCHEDULE H, PART VI, LINE 3 PENINSULA REGIONAL MEDICAL CENTER MAKES AVAILABLE TO ALL PATIENTS THE HIGHEST QUALITY OF MEDICAL CARE POSSIBLE WITHIN THE RESOURCES AVAILABLE. IF A PATIENT IS UNABLE TO PAY DUE TO FINANCIAL RESOURCES, ALL EFFORTS WILL BE MADE TO HELP THE PATIENT OBTAIN ASSISTANCE THROUGH APPROPRIATE AGENCIES, OR, IF HELP IS NOT AVAILABLE, TO PROVIDE CARE AT REDUCED OR ZERO COST. ONE OF PENINSULA REGIONAL'S OVERALL GUIDING PRINCIPLES IS THAT CONCERN OVER A HOSPITAL BILL SHOULD NEVER PREVENT ANY INDIVIDUAL FROM RECEIVING EMERGENCY HEALTH SERVICES. THE MEDICAL CENTER WILL COMMUNICATE THIS MESSAGE CLEARLY TO PROSPECTIVE PATIENTS AND TO LOCAL COMMUNITY SERVICE AGENCIES AND MAKE IT CLEAR THAT EMERGENCY SERVICES WILL BE PROVIDED WITHOUT REGARD TO ABILITY TO PAY. THE MEDICAL CENTER WILL ENSURE THAT AN EMERGENCY ADMISSION OR TREATMENT IS NOT DELAYED OR DENIED PENDING DETERMINATION OF COVERAGE OR REQUIREMENT FOR PREPAYMENT OR DEPOSIT. THE MEDICAL CENTER WILL POST ADEQUATE NOTICE OF THE AVAILABILITY OF MEDICAL SERVICES, AND THE GENERAL OBLIGATION OF THE HOSPITAL TO PROVIDE CHARITY CARE. PENINSULA REGIONAL'S "FINANCIAL ASSISTANCE POLICY" INCLUDES THE REQUIRED LANGUAGE OF DETERMINATION OF PROBABLE ELIGIBILITY WITHIN TWO BUSINESS DAYS. ON PAGE 2, THE "FINANCIAL ASSISTANCE POLICY" STATES THAT UPON RECEIPT OF THE FINANCIAL ASSISTANCE REQUEST, THE REPRESENTATIVE WILL REVIEW INCOME AND ALL DOCUMENTATION. THE PATIENT MUST BE NOTIFIED WITHIN TWO BUSINESS DAYS OF THEIR PROBABLE ELIGIBILITY. IN ACCORDANCE WITH SECTION 1, 2 AND 3, PENINSULA REGIONAL PROVIDES PUBLIC NOTICE AND INFORMATION REGARDING ITS CHARITY CARE POLICY IN DELMARVA'S LARGEST PAPER "THE DAILY TIMES", POSTED SIGNS IN THE ADMISSION, BUSINESS OFFICE EMERGENCY ROOM AND OTHER MAJOR SERVICE AREAS OF THE MEDICAL CENTER; ADDITIONALLY INDIVIDUAL NOTICE IS PROVIDED TO EACH SELF-PAY ACCOUNT WHO SEEKS SERVICES IN THE MEDICAL CENTER AT THE TIME OF PRE-ADMISSION, ADMISSION, OR UPON REQUEST. A COPY OF THE FINANCIAL ASSISTANCE POLICY IS PROVIDED DURING INTAKE AND DISCHARGE PROCESS UPON REQUEST, AND A FINANCIAL ASSISTANCE INFORMATION BROCHURE IS PROVIDED TO ALL SELFPAY PATIENTS DURING INTAKE. THE AVAILABILITY OF FINANCIAL ASSISTANCE IS PRINTED ON BILLING STATEMENTS SENT TO PATIENTS. PRMC NOTIFIES THE PATIENT OR POTENTIAL PATIENT OF GOVERNMENT PROGRAMS, INCLUDING PROVIDING THEM WITH INITIAL ASSISTANCE TO APPLY FOR SUCH PROGRAMS. Community Information Schedule H, Part VI, Line 4 Peninsula Regional Medical Center at 266 licensed beds functions as the primary hospital provider for the rural southernmost three counties of the Eastern Shore of Maryland, which includes Wicomico, Worcester and Somerset Counties. Approximately 78% of the patients discharged from the Medical Center are residents of the primary service area, which has an estimated population of approximately 181,350 in 2019, and is expected to increase to 185,357 or by 2.2% by 2024. The Medical Center also services Dorchester County, Maryland, the southern portion of Sussex County, Delaware and the northern portion of Accomack County, Virginia. Peninsula Regional's CBSA (Community Benefits Service Area) consists of those zip codes within our primary service area. Most of the population resides in Wicomico County (105,103) with Salisbury serving as the capital of the Eastern Shore. Salisbury is located on the headwaters of the Wicomico River and it is located at the crossroads of the Bay and the Ocean. The region is unique; the city of Salisbury has similar socio-economic and demographic characteristics of a large city, however, the area surrounding Salisbury is rural and has like-kind characteristics of small-town America. Due to this dichotomy, serving both sometimes presents a challenge in delivering healthcare. The two other counties in Peninsula Regional's CBSA include Worcester County, with a population of 52,030 and Somerset County with a population of 24,217. The greater "metropolitan" Salisbury area (zip codes 21801, 21804) has a higher population density than the surrounding rural areas. This area has a vulnerable population that includes the indigent and a higher Medicaid mix. Moving east towards the beach, located in Worcester County are several larger towns, like Berlin (21811) and Ocean City (21842) that have a high population density. South of Salisbury, located in Somerset County, are the larger towns of Princess Anne (21853) and Crisfield (21817). Excluding the greater Salisbury area, the landscape and environment is considered rural, made up of small businesses and agriculture. All three counties can be classified as rural with a historic economic foundation in agriculture, poultry and tourism. Watermen and farmers have always comprised a large percentage of the peninsula population, however, their numbers have been declining with a growth in the population and expansion of other small businesses. Ocean City, MD located in Worcester County, is a major tourist destination. During the summer weekends, the city hosts between 320,000 and 345,000 vacationers, and up to 8 million visitors annually. The three counties have a diversified economic base; however, it is predominately made up of small employers (companies with less than 50 employees). Major employers include local hospitals, the poultry industry, local colleges and teaching institutions. The median income of $55,681 in our Community Benefits Service Area is considerably less than Marylands median income of $85,459. In addition, September 2019 unemployment rates were higher for Marylands most Eastern Shore counties. The unemployment rate in Maryland was 3.7%, the Nation 3.6% compared to Wicomico 4.1%; Worcester 4.7% and Somerset 5.4%. Research indicates lower median incomes and higher unemployment rates contribute to a disparity in access to medical care and a prevalence of untreated chronic disease. The baby boomer population (those aged 55+) represent a greater portion of the total population in Peninsula Regionals CBSA as compared to the Nation. The Eastern Shore of Maryland is becoming a popular retirement destination and the trend is likely to continue. The chronic conditions of this age grouping consume healthcare resources at much higher rates than some of the other younger age-cohorts. Medicare Population % ----------------------------- Wicomico 16.1% Worcester 27.8% Somerset 16.9% ----------------------------- Maryland 15.7% United States 16.2% Source: Truven Health Analytics/IBM 2019 Peninsula Regional's primary service area (Wicomico, Worcester, Somerset) represent some of the neediest counties in the state of Maryland (www.Countyhealthrankings.org/Maryland), based upon a SocioNeeds Index income, poverty, unemployment, occupation, educational attainment and linguistic barriers that are associated with poor health outcomes, including preventable hospitalizations and premature death. Peninsula Regional has zip codes in each of its primary service area counties with high SocioNeeds Index levels. Deployment of resources is key in these communities with high socioeconomic needs as we focus and target prevention and outreach services. To meet its mission of improving the health of the communities it serves, Peninsula Regional has developed a Population Health division and has engaged in population health strategies to support the Maryland Total Cost of Care Model, which aims to improve outcomes, improve the patient experience and reduce the total cost of care. The hospital is coordinating care, including mental health and post-acute care, across hospital and non-hospital settings. The Population Health division incorporates a multidisciplinary team of nurses, social workers and community health workers supporting the community with a broad range of primary care services. The division also fosters community partnerships with local hospitals Atlantic General and McCready Health in addition to community-based organizations including local health departments, fire departments, the Maryland state Area Agency on Aging and other agencies to provide patient support aligned with social determinants of health. Promotion of Community Health Schedule H, Part VI, Line 5 Peninsula Regional Medical Center is committed to the health of the rural communities it serves. In FY 2019, the Hospital's charity care was $8,454,930; combined charity and bad debt for FY 2019 was $16,429,970. As part of Peninsula Regionals ongoing commitment and mission statement "To Improve the Health of the Communities We Serve," we continue to assess the health needs of the community through building relationships and collaborations with organizations that are addressing unmet health needs. The Wagner Wellness Van is a mobile clinic that visits local shelters, churches and other areas in PRMC's Community Benefits Service Area where underserved residents can receive non-emergency medical care, chronic care management and healthy lifestyles education. The van visits areas where the social determinants of health indicate the greatest amount of need. It provides care in areas with a higher prevalence of ER visits, lower median incomes, indigent population, access issues, communication barriers and overall poor health outcomes. There has been improved control of diabetes and hypertension. The Wagner Wellness Van strives to educate patients by providing nutritional and healthy lifestyle counseling, in addition to medication compliance to control diabetes and hypertension. Health screenings are performed on residents to help determine appropriate education, self-management class information or referrals to community resources and services. These screenings include pre-diabetes, hypertension and obesity. When warranted, drug and alcohol misuse screenings are also conducted, and counseling is available. If a resident is at risk for diabetes, an A1C screening is performed to further assist with diagnosis and treatment. Smith Island Telehealth- Smith Island is known for its watermen, Smith Island cake, exceptional seafood and being isolated with limited contact from mainland visitors. For this reason, Peninsula Regional Medical Center created a partnership with McCready Health, MAC Area Agency on Aging, Somerset County Health Department and the Crisfield Clinic. The goal of the partnership is to improve the health of Smith Island residents, with the target of effectively reducing potentially avoidable ED utilization. The program was led by the Smith Island Community Health Staff, which provides chronic disease education, management and connects 250 residents of Smith Island via telehealth for primary care physician visits. Community health workers play an integral role in changing Island residents' health behaviors and actions; these embedded health facilitators are able to effectively bridge relationships with the residents of Smith Island. These facilitators are essentially a personal health coach that assists residents with medication management, timely compliance and ultimately helping guide residents through prescribed healthcare plans. Flu shots were administered ensuring the residents of Smith Island were protected during the flu season, effectively reducing ED visits. Since inception, the partnership has had great successes. For example, there has been substantial reductions in A1C levels in residents diagnosed with diabetes; a prime example of the "Triple Aim" improving health, providing access, chronic disease education, and reducing the probability of a future Emergency Department visit. Residents are learning how to self-manage their chronic diseases and are being exposed to the principles of leading healthy lifestyles. To expand our "Healthy Living" message, Peninsula Regional sponsors and participates in many community-based health fairs providing nutrition education, weight loss, diabetes assessment, multiple screenings and health literacy. Participation in health fairs include underserved areas like Smith Island, an island on the Chesapeake Bay with a population of only 250, a Haitian Creole Health Fair, HealthFest and screenings at the Governors Basketball Challenge at the Civic Center in Wicomico County. Transforming the culture through participation and sponsorship of healthy lifestyles and screenings, meeting residents at community events located throughout the Tri-County area. Health Assessments - Cholesterol, HDL, Triglycerides - Resting 12-Lead EKG - Body Fat / Mass Index - Blood Pressure Testing - Pulse Oximetry Testing - 10-Year Risk Analysis - Review Current Medications - Follow-up Care Plan - Exercise/Nutrition WalkWicomico promotes walking Trails, personal challenges, and avenues to enjoy the outdoors- the primary objective is to increase awareness of and engagement in healthy lifestyle behaviors promoting exercise to help with weight loss, increase energy, reduce risk of chronic disease and make people feel happier. WalkWicomico is primarily targeting those that reside in the county (pop. 100,000+); however, it would also be an attraction for adjacent counties including visitors. Peninsula Regional, as a participant, has a common goal to transform the community's culture by providing education, guidance and resources towards promoting exercise through walkability as an integral part of a healthy lifestyle. The Coalition's initiatives included creating a website and phone app specific to walking in Wicomico County; communicating with the community via social media; working with civic organizations, churches, local businesses, towns, county health departments and other groups to encourage local walkability. WalkWicomico has marked walking routes, increased the number of walking routes, participated in and launched walking events, and is engaged with decision makers through input and feedback about making walking safer easier and more accessible. Peninsula Regional participates with many partners that make it possible to create and deliver population programs that improve the health of the communities we serve. These partners have provided expertise and allocated resources to meet those urgent healthcare needs within our community. Some of these partners include: Wicomico County Health Department, Somerset County Health Department, Worcester County Health Department, Wicomico County Local Health Improvement Coalition, The City of Salisbury, YMCA, Crisfield Clinic, Chesapeake Health Care, SWIFT, Salisbury Fire Department/EMS, Atlantic General Hospital, Faith Based Organizations, McCready Memorial Hospital, MAC (Maintaining Active Citizens), Local Colleges/ and Schools, C.O.A.T, National Kidney Foundation, Peninsula Regional Employees, Post-Acute Care Facilities, HALO, WalkWicomico (Coalition), Lower Shore Clinic, Wicomico County Sheriffs Office, Resource and Recovery Center and others. Sheriffs Office, Resource and Recovery Center and others. AFFILIATED HEALTH CARE SYSTEM ROLES SCHEDULE H, PART VI, LINE 6 PENINSULA REGIONAL MEDICAL CENTER IS PART OF THE PENINSULA REGIONAL HEALTH SYSTEM. THE SYSTEM INCLUDES A FOUNDATION AND FOR-PROFIT ENTITIES WITH INTERESTS IN VARIOUS HEALTH CARE JOINT VENTURES. IN ADDITION TO THE COMMUNITY BENEFITS PROVIDED BY THE MEDICAL CENTER, THE HEALTH SYSTEM EVALUATES THE NEEDS OF THE COMMUNITY AND WILL PARTICIPATE IN COMMUNITY BENEFIT PROGRAMS AS NEEDED. COMMUNITY BENEFIT REPORT STATE FILINGS SCHEDULE H, PART VI, LINE 7 STATE(S) WITH WHICH THE ORGANIZATION FILES A COMMUNITY BENEFIT REPORT: MARYLAND X true true X X X X X true true false false false true true true false Margaret Naleppa President/CEO (Thru 01/18) 679 0 0 0 1079445 0 692 0 605 0 1081421 0 500000 0 Simona Eng DO Board Member 372601 0 57000 0 1218 0 39032 0 11640 0 481491 0 0 0 Lura Lunsford VP of Operations 464484 0 168644 0 270008 0 45699 0 7506 0 956341 0 200000 0 Bruce I Ritchie CFO 470854 0 122051 0 331726 0 66374 0 20002 0 1011007 0 200000 0 Charles Silvia Jr MD VP - Chief Medical Officer 442983 0 74008 0 1218 0 50942 0 14974 0 584125 0 0 0 Sara Scott VP People & Organization Dev. 244152 0 29817 0 5918 0 46984 0 18052 0 344923 0 0 0 Kathryn Fiddler VP- Population Health 212094 0 27425 0 982 0 29678 0 646 0 270825 0 0 0 Thomas DeMarco MD VP - PRMG 326000 0 58223 0 9275 0 14327 0 16962 0 424787 0 0 0 Sheri Matter Thru 0818 VP Patient Care Services 43168 0 0 0 189639 0 6854 0 211 0 239872 0 0 0 James Todd MD Physician 853597 0 0 0 133832 0 284796 0 18464 0 1290689 0 132614 0 Daniel Daniels MD Physician 512477 0 488938 0 1218 0 18900 0 7223 0 1028756 0 0 0 Zachary Baker MD Physician 694668 0 0 0 38671 0 135933 0 16520 0 885792 0 0 0 Karim Arnaout MD Physician 610299 0 212434 0 1218 0 14836 0 16166 0 854953 0 0 0 Walid El Ayass MD Physician 613517 0 206250 0 1218 0 17953 0 15076 0 854014 0 0 0 Steven Leonard President/CEO 568970 0 169400 0 329197 0 147358 0 27075 0 1242000 0 200000 0 Travel for Companions SCHEDULE J, PART I, LINE 1A PRMC PROVIDES TRAVEL FOR COMPANIONS OF BOARD MEMBERS AND REPORTS THE VALUE OF THE COMPENSATION PROVIDED AS TAXABLE TO THE RECIPIENT. THIS POLICY HAS BEEN APPROVED BY THE BOARD. Severance Payment or Change-of-control Payment Schedule J, Part I, Line 4a The following employee received a severance payment: SHERI MATTER $135,116 SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN SCHEDULE J, PART I, LINE 4B PRMC HAS A NON-QUALIFIED SUPPLEMENTAL RETIREMENT PLAN (UNDER SECTION 457 (F)). THIS PLAN WAS APPROVED BY THE COMPENSATION COMMITTEE OF THE PRMC BOARD OF DIRECTORS TO SUPPLEMENT THE EXECUTIVE'S RETIREMENT INCOME. THE SUPPLEMENTAL RETIREMENT PLAN WAS DEVELOPED BASED ON AN INDEPENDENT CONSULTANT REPORT ON MARKET-BASED PRACTICES FOR SUPPLEMENTAL RETIREMENT PLANS. THE PERCENTAGE OF FINAL AVERAGE PAY, THE REQUIREMENTS FOR VESTING, PARTICIPANTS, AND PAY-OUT PROVISIONS WERE ESTABLISHED, REVIEWED, AND APPROVED BY THE COMPENSATION COMMITTEE. THE CONTRIBUTIONS TO THE SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN ARE INCLUDED IN SCHEDULE J, PART II, COLUMN C OR IN SCHEDULE J, PART II, COLUMN B(III) AS PART OF DEFERRED COMPENSATION. THE FOLLOWING INDIVIDUALS PARTICIPATED IN THIS SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN: MARGARET NALEPPA, LURA LUNSFORD, BRUCE RITCHIE, STEVEN LEONARD, AND JAMES TODD. AMOUNTS REPORTED ON SCHEDULE J, PART II, COLUMN B (III) INCLUDE DEFERRED COMPENSATION AMOUNTS UNDER A BOARD OF TRUSTEES APPROVED EXECUTIVE COMPENSATION PLAN IN ACCORDANCE WITH SECTION 457(F) OF THE INTERNAL REVENUE CODE. THESE AMOUNTS WERE DISTRIBUTED FROM A QUALIFIED RETIREMENT PLAN TRUSTEE DUE TO VESTING. FOR CEO MARGARET NALEPPA, PRMC CONTRIBITED $500,000 WHICH APPRECIATED WITH INVESTMENT EARNINGS TO $988,823 BETWEEN THE PERIOD OF 06/24/11 AND 01/01/18. PRMC CONTRIBUTED $200,000 EACH FOR STEVEN LEONARD, LURA LUNSFORD AND BRUCE RITCHIE WHICH APPRECIATED TO $315,180, $264,040, AND $330,508 RESPECTIVELY, BETWEEN THE PERIOD OF 01/01/13 AND 01/01/18. JAMES TODD RECIEVED A PARTIAL DISTRIBUTION OF $132,614 DURING 2018 BASED ON HIS PLAN'S VESTING DATES. PRMC PROVIDED THE FOLLOWING FUNDING AMOUNTS DURING 2018: STEVEN LEONARD $98,750 JAMES TODD $250,000 ZACHARY BAKER $125,000 Contingent Compensation SCHEDULE J, PART I, LINE 6A, 6B AND 7 OFFICERS AND KEY EMPLOYEES OF PENINSULA REGIONAL MEDICAL CENTER ARE PAID COMPENSATION DETERMINED BY A NUMBER OF VARIABLES INCLUDING BUT NOT LIMITED TO INDIVIDUAL GOALS AS WELL AS ORGANIZATION OPERATIONAL ACHIEVEMENTS IN SERVICE, QUALITY, SAFETY, EMPLOYEE SATISFACTION, AND COST. THE FINAL DETERMINATION OF THE CONTINGENT COMPENSATION AMOUNT IS DETERMINED AND APPROVED BY THE BOARD AS PART OF THE OVERALL COMPENSATION REVIEW OF OFFICERS AND KEY EMPLOYEES. VARIABLE COMPENSATION PAYMENTS ARE REPORTED IN SCHEDULE J, PART II, COLUMN B(II) AND REFLECT ATTAINMENT OF CERTAIN GOALS. ALSO INCLUDED IN THAT COLUMN ARE PRODUCTIVITY PAYMENTS OF $461,938 (DANIELS), $212,434 (ARNAOUT) AND $206,250 (EL AYASS). A Maryland Health & Higher Education Facilities 520936091 574217UF8 2015-02-05 122212727 Refer to Part VI true false false B Maryland Health & Higher Education Facilities 520936091 574218UE1 2015-02-05 25222024 Refer to Part VI true false false A 525000 0 122212727 0 0 121024047 1188680 0 0 0 0 0 false true true true B 250000 0 25222024 0 0 0 222024 0 0 25000000 0 0 false false false true A false true true true true true 0.00810 0.00540 0.01350 false false false true B false true true true true true 0.00810 0.00540 0.01350 false false false true A false true false false 0 false 0 false true B false false false false 0 false 0 false true A true B true Description of Purpose Schedule K, Part I, Column F PROCEEDS OF PUBLICLY-OFFERED, FIXED RATE SERIES 2015 BONDS, TOGETHER WITH FUNDS HELD IN AN EXISTING DEBT SERVICE RESERVE FUND ACCOUNT AND THE EXISTING PRINCIPAL AND INTEREST ACCOUNTS, HAVE BEEN USED TO 1) ADVANCE REFUND ALL OF PENINSULA REGIONAL MEDICAL CENTER'S ("PRMC") OUTSTANDING SERIES 2006 BONDS (ISSUED 2/09/06) FOR SAVINGS, 2) FUND VARIOUS CAPITAL EXPENDITURES (INCLUDING EQUIPMENT PURCHASES) (THE "PROJECT"), AND 3) PAY ALL BOND ISSUANCE EXPENSES. Schedule K, Part I, Line A (F) REFUNDING OF BONDS ISSUED ON 02/09/2006 Schedule K, Part II, Line 13 A - 2006 PROJECTS - 2009; 1993 PROJECTS - 1998 B - 2015 PROJECTS - 2017 SIMONA ENG DO TRUSTEE 137715 MEDICAL STAFF FEES false David Rommel TRUSTEE 739219 ELECTRICAL/MECHANICAL SERVICES false Kirstie Silvia Family Member of Officer 62231 Employee Compensation false Brian Ritchie Family Member of Officer 58750 Employee Compensation false DESCRIPTION OF TRANSACTIONS WITH INTERESTED PERSONS SCHEDULE L, PART IV EACH OF THE ABOVE-NAMED TRUSTEES ARE OWNERS OF BUSINESSES WHICH PROVIDE SERVICES TO PRMC. THE SERVICES PROVIDED WERE APPROVED BY INDEPENDENT MEMBERS OF THE GOVERNING BODY AND ARE CHARGED AT FAIR MARKET VALUE RATES. STATEMENT OF PROGRAM SERVICE ACCOMPLISHMENTS FORM 990, PART III, LINE 4A PENINSULA REGIONAL MEDICAL CENTER IS A NOT-FOR-PROFIT 501(C)(3) NON-STOCK CORPORATION FOUNDED IN 1897 TO SERVE THE HEALTH CARE NEEDS OF THE COMMUNITY. THE HOSPITAL'S PRIMARY PURPOSE IS TO PROVIDE THE HIGHEST PRIMARY, SECONDARY, AND SELECTED TERTIARY HEALTH CARE SERVICES TO RESIDENTS OF AND VISITORS TO THE MID-DELMARVA PENINSULA IN A COMPETENT, COMPASSIONATE, AND COST-EFFECTIVE MANNER DESIGNED TO ELICIT A HIGH DEGREE OF CUSTOMER SATISFACTION. THE HOSPITAL'S MISSION IS TO IMPROVE THE HEALTH OF THE COMMUNITIES WE SERVE BY PROVIDING QUALITY MEDICAL CARE REGARDLESS OF RACE, CREED, SEX, NATIONAL ORIGIN, HANDICAP, OR AGE. IF A PATIENT IS UNABLE TO PAY DUE TO FINANCIAL RESOURCES, EFFORTS WILL BE TAKEN TO ASSURE CARE AT AN AFFORDABLE COST, OR OBTAINED ASSISTANCE THROUGH APPROPRIATE AGENCIES ON THE PATIENT'S BEHALF. EMERGENCY SERVICES CARE WILL BE PROVIDED TO EVERYONE REGARDLESS OF ABILITY TO PAY. PENINSULA REGIONAL MEDICAL CENTER SERVED OVER 17,000 INPATIENTS AND PROVIDED MORE THAN 614,000 OUTPATIENT SERVICES DURING FISCAL 2019. FOOD SERVICE PROVIDED MORE THAN 460,000 MEALS TO PATIENTS AND EMPLOYEES. ALTHOUGH REIMBURSEMENT FOR SERVICES RENDERED IS CRITICAL TO THE OPERATION AND STABILITY OF PENINSULA REGIONAL MEDICAL CENTER, IT IS RECOGNIZED THAT NOT ALL INDIVIDUALS POSSESS THE ABILITY TO PAY FOR ESSENTIAL MEDICAL SERVICES. THE HOSPITAL, IN KEEPING WITH THE COMMITMENT TO SERVE ALL MEMBERS OF THE COMMUNITY, DURING FISCAL 2019 PROVIDED: - CHARITY AND OTHER ALLOWANCES TOTALING $43,432,697 - DISCOUNTS TO THIRD PARTY PAYORS INCLUDING GOVERNMENT PROGRAMS SUCH AS MEDICARE AND MEDICAID $73,815,885 - WRITE-OFF OF UNCOLLECTIBLE ACCOUNTS $7,975,041 - TOTAL UNREIMBURSED VALUE OF PROVIDING CARE TO THESE PATIENTS IS $125,223,622 ALSO PROVIDED ARE MANY WELLNESS PROGRAMS, COMMUNITY EDUCATION AND FREE PROGRAMS OFFERED THROUGHOUT THE YEAR BASED UPON ACTIVITIES AND SERVICES THAT PENINSULA REGIONAL MEDICAL CENTER BELIEVES WILL SERVE A BONA FIDE COMMUNITY HEALTH NEED. SOME OF THE PROGRAMS ARE AS FOLLOWS: - A VARIETY OF BROCHURES ARE DISPLAYED IN ALL HOSPITAL WAITING AREAS TO EDUCATE MEMBERS OF THE COMMUNITY REGARDING PROGRAMS AND SERVICES. - PARTICIPATION IN HEALTH FAIRS DURING FY 2019 IN ORDER TO FOSTER HEALTH EDUCATION IN THE COMMUNITY. - WE PROVIDE CHILDBIRTH PREPARATION CLASSES, EXERCISE CLASSES FOR PRENATAL AND POSTPARTUM WOMEN AND CPR CLASSES. - WE PROVIDE ASSISTANCE TO EDUCATORS THROUGH OUR WORK WITH STUDENT NURSES, RADIOLOGY, RESPIRATORY AND LABORATORY TECHNICIANS. DURING FY 2019, PENINSULA REGIONAL MEDICAL CENTER VOLUNTEERS CONTRIBUTED OVER 24,500 HOURS TOWARD THE COMMON PURPOSE OF SERVICING THE HEALTH CARE OF THE COMMUNITY. PROGRAM ACTIVITY DURING FY 2019, PENINSULA REGIONAL MEDICAL CENTER PERFORMED OVER 500 COMMUNITY OUTREACH ACTIVITIES. SPECIFIC EXAMPLES OF EDUCATION AND OUTREACH PROGRAMS, SUPPORT GROUPS, COMMUNITY HEALTH SCREENINGS, AND FITNESS AND WELLNESS ACTIVITIES SUPPORTED BY PENINSULA REGIONAL MEDICAL CENTER ARE AS FOLLOWS: COMMUNITY EDUCATIONAL AND OUTREACH PROGRAMS: - CPR - CHILDBIRTH PREPARATION CLASSES - REFRESHER COURSE - CHILDBIRTH - INFANT CARE CLASSES - SAFE SITTER PROGRAM - WOMEN'S HEALTH EDUCATION SUPPORT GROUPS: - DIABETES SUPPORT GROUP - HEAD AND NECK CANCER SUPPORT GROUP - CAREGIVER SUPPORT GROUP EVENTS: - COMMUNITY SCREENINGS - HEIGHT/WEIGHT, BLOOD PRESSURE - SKIN CANCER SCREENINGS - ORAL, HEAD AND NECK CANCER SCREENINGS - HEARING SCREENINGS - FLU CLINIC - EDUCATIONAL EXHIBITS TO PROMOTE HEALTHY LIFESTYLES BENEFITS: - UNITED WAY - HEALTHFEST - MARCH OF DIMES FITNESS/EXERCISE PROGRAMMING: - CARDIAC REHABILITATION - INDOOR CYCLING AND WEIGHTS BUSINESS RELATIONSHIPS FORM 990, PART VI, SECTION A, LINE 2 STEVEN LEONARD, DAVID ROMMEL, MEMO DIRIKER, MARGARET NALEPPA, RYAN MCLAUGHLIN AND MONTY SAYLER ARE MEMBERS OF THE BOARD OF DIRECTORS OF PENINSULA HEALTH VENTURES, A WHOLLY-OWNED TAXABLE SUBSIDIARY OF PENINSULA REGIONAL HEALTH SYSTEM. BRUCE I. RITCHIE, PRMC'S CFO, ALSO SERVES AS SECRETARY/TREASURER OF PENINSULA HEALTH VENTURES. MEMBERS OR STOCKHOLDERS FORM 990, PART VI, SECTION A, LINE 6 PENINSULA REGIONAL HEALTH SYSTEM IS THE SOLE CORPORATE MEMBER OF THE MEDICAL CENTER. MEMBERS OR STOCKHOLDERS WHO MAY ELECT FORM 990, PART VI, SECTION A, LINE 7A IN ITS CAPACITY AS THE SOLE CORPORATE MEMBER OF THE MEDICAL CENTER, PENINSULA REGIONAL HEALTH SYSTEM HAS THE ABILITY TO ELECT MEMBERS OF THE MEDICAL CENTER'S GOVERNING BODY. DECISIONS SUBJECT TO APPROVAL FORM 990, PART VI, SECTION A, LINE 7B AS THE SOLE CORPORATE MEMBER, PENINSULA REGIONAL HEALTH SYSTEM HAS THE ABILITY TO APPROVE MAJOR EXPENDITURES AND LONG TERM BORROWINGS OF THE MEDICAL CENTER. FORM 990 REVIEW PROCESS FORM 990, PART VI, SECTION B, LINE 11B OVERSIGHT OF THE COMPLETION OF THE ORGANIZATION'S FORM 990 HAS BEEN DELEGATED TO THE CHIEF FINANCIAL OFFICER OF PENINSULA REGIONAL MEDICAL CENTER BY THE PRESIDENT OF THE ORGANIZATION. ONCE THE FORM 990 AND ALL SCHEDULES HAVE BEEN PREPARED BY THE ORGANIZATION'S INDEPENDENT TAX SERVICES PROVIDER, THEY ARE REVIEWED BY THE PRESIDENT PRIOR TO FILING. THE RETURN IS PRESENTED TO THE BOARD OF TRUSTEES BY THE ORGANIZATION'S INDEPENDENT TAX ADVISORS FROM GRANT THORNTON LLP AND APPROVED FOR SUBMISSION. CONFLICT OF INTEREST POLICY MONITORING & ENFORCEMENT FORM 990, PART VI, SECTION B, LINE 12C THE BOARD OF TRUSTEES ARE REQUIRED TO DISCLOSE ANNUALLY, IN WRITING, ANY AND ALL INTEREST WHICH THEY OR ANY IMMEDIATE MEMBER OF THEIR FAMILY MAY HAVE IN ANY BUSINESS ENTITY WHICH HAS OR SEEKS A CONTRACTUAL OR COMPETITIVE RELATIONSHIP WITH THE ORGANIZATION. THE BOARD HAS THE AUTHORITY TO DETERMINE IF A VIOLATION HAS OCCURRED AND WHETHER ANY INTEREST WHICH SHOULD BE DISCLOSED SHOULD DISQUALIFY A DIRECTOR FROM PARTICIPATING IN ANY SPECIFIC BOARD DISCUSSION OR BOARD MEMBERSHIP. ALL DISCLOSURES ARE REVIEWED BY THE ORGANIZATION'S CHIEF COMPLIANCE OFFICER. ANY CONFLICTS ARE PRESENTED TO THE BOARD. IF A PERSON IS CONFLICTED, THEY WILL RECUSE THEMSELVES FROM ALL DISCUSSIONS AND DELIBERATIONS TO WHICH THEY WOULD APPEAR TO BE CONFLICTED. PROCESS FOR DETERMINING COMPENSATION FORM 990, PART VI, SECTION B, LINES 15A & 15B THE ORGANIZATION USES A COMPENSATION COMMITTEE TO DETERMINE THE COMPENSATION OF THE CEO/EXECUTIVE DIRECTOR AND OTHER KEY EMPLOYEES. THE CEO OF THE ORGANIZATION HAS A WRITTEN EMPLOYMENT CONTRACT. THE COMPENSATION COMMITTEE USES AN INDEPENDENT CONSULTANT, COMPENSATION SURVEYS AND OTHER ORGANIZATION'S FORM 990 IN THE DETERMINATION PROCESS. THE MEMBERS OF THE COMPENSATION COMMITTEE ARE INDEPENDENT AND RELY ON THIS COMPARABILITY DATA WHEN THEY DISCUSS AND DETERMINE THE INDIVIDUAL'S COMPENSATION. CONTEMPORANEOUS MINUTES OF SUCH DISCUSSIONS ARE KEPT AND MAINTAINED IN THE ORGANIZATION'S FILES. HOW DOCUMENTS ARE MADE AVAILABLE TO THE PUBLIC FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, FINANCIAL STATEMENTS, AND FORM 990 ARE AVAILABLE TO THE PUBLIC UPON REQUEST TO THE PUBLIC INFORMATION OFFICE OF PENINSULA REGIONAL MEDICAL CENTER AT 100 EAST CARROLL STREET, SALISBURY, MD 21801. OTHER CHANGES IN NET ASSETS FORM 990, PART XI, LINE 9 PENSION ADJUSTMENT FAS 158 $(4,653,741) Contribution from foundation $(944,754) Other contributions $(500,500) Increase in capital $3,176,915 Partnership income - tax adjustment $67,592 ------------- TOTAL $(2,854,488) FORM 990 PART IX LINE 11G DESCRIPTION:TECHNICAL PROFESSIONAL FEES TOTAL FEES:7066510 FORM 990 PART IX LINE 11G DESCRIPTION:REFERENCE LAB WORK TOTAL FEES:2665025 FORM 990 PART IX LINE 11G DESCRIPTION:MEDICAL STAFF ADMINISTRATION TOTAL FEES:77500 FORM 990 PART IX LINE 11G DESCRIPTION:CONTRACTED SERVICES TOTAL FEES:23854434 FORM 990 PART IX LINE 11G DESCRIPTION:LICENSES TAXES TOTAL FEES:347260 FORM 990 PART IX LINE 11G DESCRIPTION:COLLECTION FEES TOTAL FEES:844574 FORM 990 PART IX LINE 11G DESCRIPTION:TEMPORARY LABOR TOTAL FEES:5832168 FORM 990 PART IX LINE 11G DESCRIPTION:PEST CONTROL TOTAL FEES:53476 FORM 990 PART IX LINE 11G DESCRIPTION:TRASH PICKUP TOTAL FEES:417536 FORM 990 PART IX LINE 11G DESCRIPTION:CANDIDATE EXPENSE TOTAL FEES:222885 FORM 990 PART IX LINE 11G DESCRIPTION:EMPLOYEE MOVING EXPENSE TOTAL FEES:79854 FORM 990 PART IX LINE 11G DESCRIPTION:PHYSICIAN PROFESSIONAL FEES TOTAL FEES:13438031 FORM 990 PART IX LINE 11G DESCRIPTION:RECOVERY OF EXPENSES TOTAL FEES:-33032 Peninsula Regional Med Center Foundation 100 East Carroll Street Salisbury MD 21801 521851935 Fundraising MD 501(c)(3) 07 PRHS false Peninsula Regional Health System (PRHS) 100 East Carroll Street Salisbury MD 21801 522132761 Parent MD 501(c)(3) 12-II NA false Peninsula General Hospital INS Trust 100 East Carroll Street Salisbury MD 21801 526321234 Insurance MD 501(c)(3) 12 type III PRHS false Delmarva Peninsula Insurance Company PO Box 1159 KY1-1102 Grand Cayman CJ 981110617 Insurance CJ 501(c)(3) PRMC true Delmarva Surg Ctr 641 S Salisbury Salisbury MD 21801 522251436 Healthcare MD NA n/a Delmarva Endosc Ctr 11103 Cathage Road Berlin MD 21811 831509115 Healthcare MD NA N/A Peninsula Health Ventures (PHV) 100 East Carroll Street Salisbury MD 21801 522250012 P'SHIP INV MD NA C Corp PRLTC Inc 100 East Carroll Street Salisbury MD 21801 522190588 LT Care MD NA C Corp false false true false false false false false false false false true true true true false true true true DELMARVA PENINSULA INSURANCE COMPANY r 5673427 FMV