2019-08-15T05:49:03-07:00 2018-09-30 135565207 KPMG LLP 2 Financial Center 60 South Street Boston MA 02111 990 2017-10-01 050258905 The Miriam Hospital MIRI 4017932500 164 Summit Avenue Providence RI 02906 Mary A Wakefield Treasurer 2019-08-15 true Tara D'Agostino P01245482 6179881000 2017 2019-02-21 02:37:17Z Arthur J Sampson 164 Summit Avenue Providence RI 02906 631240419 false false X www.miriamhospital.org X 1926 RI As a founding hospital in the Lifespan health system, The Miriam Hospital (TMH) is committed to its mission: Delivering health with care. 15 12 3725 812 1486967 201047 4596292 3336850 448769301 475218295 9977338 9126278 11556045 13562517 474898976 501243940 433117 291360 0 221318006 232844528 0 0 240424471 248095114 462175594 481231002 12723382 20012938 488693019 497912272 152214148 130578942 336478871 367333330 X As a founding hospital in the Lifespan health system, TMH is committed to its mission: Delivering health with care. false false 370934098 275257 464295728 Patient Care:TMH offers expertise in cardiology, oncology, orthopedics, men's health, and minimally invasive surgery, and is home to the State's first Joint Commission- certified Stroke Center and robotic surgery program. Services and programs provided by TMH include anesthesiology; general medicine; general surgery; psychiatry; emergency medicine; cardiovascular care; orthopedics; dermatology; nuclear cardiology; radiology; laboratory; renal dialysis; urology; gastroenterology; endocrinology; gynecology; nephrology; neurology; and ophthalmology. The Hospital is nationally known for its HIV/AIDS research as well as its behavioral/preventive medicine research, including weight control, physical activity, and smoking cessation. (Continued on Schedule O). 22588714 19743714 Research:Since 1969, research projects have increased from seven totaling $127,000 including nine investigators to 386 totaling $20.1 million including 78 investigators and 111 employees. TMH conducts extensive medical research and is in the forefront of biomedical health care delivery research and among the leaders nationally in the National Institutes of Health programs. TMH also sponsors a significant level of these research activities. Federal support accounts for approximately 87% of all externally funded research at TMH. Researchers focus on clinical trials which investigate prevention and treatment of cancer, diabetes, cardiac disease, and mental health concerns. Included in the totals are $2.5 million of research grants from for-profit organizations that are not reported in Schedule H.(See Schedule O). 21044728 3516844 Medical Education:TMH provides the setting for and substantially supports medical education in various clinical training and nursing programs. TMH is designated as a major teaching affiliate of The Warren Alpert Medical School of Brown University. The total cost of direct medical education provided by TMH exceeded the reimbursement received from third-party payors by $17.5 million in fiscal year 2018. (Continued on Schedule O). 414567540 true true false true false false false false false true true true false true true true true true false false true true false false false false true true true false true true false false false false false false false false true false false false false false false true false false false true 209 0 true 3725 true true true false false false false false false 0 false false false false false false false false false false X 15 12 true false false false true true true true true false false true true true true true true true true false RI X Mary A Wakefield 4014447093 593 Eddy Street Providence RI 02903 X Lawrence A Aubin Sr Chair 1.00 29.00 X X 0 0 0 Timothy J Babineau MD Trustee 9.00 31.00 X 0 2217856 527817 Emanuel Barrows Trustee 0.50 2.50 X 0 0 0 Roger N Begin Trustee 0.50 9.50 X 0 0 0 Peter Capodilupo Vice Chair 0.50 8.50 X X 0 0 0 Jonathan D Fain Trustee 0.25 0.75 X 0 0 0 Edward D Feldstein Esq Trustee 1.00 12.00 X 0 0 0 Michael L Hanna Trustee 1.00 4.60 X 0 0 0 Pamela Harrop MD Trustee 0.25 7.75 X 0 35000 0 Alan H Litwin Vice Chair 1.00 9.00 X X 0 0 0 Joseph J MarcAurele Trustee 0.25 4.00 X 0 0 0 Steven Pare Trustee 2.00 10.50 X 0 0 0 Lawrence B Sadwin Trustee 1.25 12.50 X 0 0 0 Shivan Subramaniam Trustee 0.25 5.25 X 0 0 0 Jane Williams MD Trustee 0.10 5.30 X 0 0 0 Brian J Zink MD Trustee- 12/17 2.00 26.50 X 0 0 0 Paul J Adler Secretary 5.00 35.00 X 0 532564 99156 Arthur J Sampson President 40.00 3.50 X 0 641102 34406 Mary A Wakefield Treasurer 5.00 35.00 X 0 1022911 282563 Robert W Corwin Chief Medical Officer 40.00 0.00 X 233126 0 0 Maria P Ducharme Chief Nursing Officer 40.00 0.00 X 349400 0 78448 Eirini Apostolidou MD Physician 40.00 0.00 X 282324 0 24027 Michael P Carey MD Physician 40.00 0.00 X 366189 0 38192 Rogers C Griffith MD Physician 40.00 0.00 X 316442 0 39903 Joseph D Sweeney MD Physician 40.00 0.00 X 288455 0 38563 Rena R Wing MD Physician 40.00 0.00 X 283056 0 24224 2118992 4449433 1187299 239 false true false University Medicine Fdtn 17 Virginia Avenue Providence RI 02903 Medical Services 6860178 University Surgical Associates Inc PO Box 16149 Rumford RI 02916 Medical Services 3888242 RINGO LLC 445 Broadhollow Road Melville NY 11747 Staffing Services 3214483 Quest Diagnostics 12436 Collections Center Drive Chicago IL 60693 Laboratory Services 2149629 Sodexo Inc 25 Royal Little Drive Providence RI 02904 Dietary/Cafe Service 1942468 38 3305199 11875 19776 3336850 Direct Rev from Research 900099 19743714 19743714 Patient Service Rev 900099 453101093 453101093 Temp Restricted (SPFs) 900099 2373488 2373488 475218295 5164579 5164579 402 402 0 1861013 2123454 -262441 -262441 -262441 131834322 127873025 3961297 3961297 3961297 0 0 0 Cafeteria Revenue 722210 1640242 1640242 Indirect Rev from Grants 900099 3695063 3695063 Joint Program Revenue 900099 5363837 5363837 3125816 1638849 1486967 13824958 501243940 487556286 1486967 8863837 275257 275257 0 16103 16103 0 400028 400028 528238 528238 180133486 176241809 3891677 7843305 7673719 169586 31768073 31143149 624924 12171398 11909694 261704 0 0 0 453 453 0 873411 873411 19669785 19171022 498763 166808 165343 1465 33184502 32356103 828399 0 0 12882189 11609273 1272916 604834 597531 7303 0 417962 417043 919 1646740 1646740 0 18687565 18687565 4756409 4756409 Purch Svs & Equip Contracts 56500197 19058766 37441431 Medical & surgical supplies 52528763 52393828 134935 License Fee 22793014 22793014 Provision for Bad Debts 14687449 14687449 8695033 8373309 321724 481231002 414567540 66663462 0 0 32003679 31189105 1810763 1906948 39532553 39565787 0 0 179793 0 5519935 6318824 5089591 2240752 414086108 230158859 184684744 183927249 113272150 118804892 45236363 53456485 0 0 61363448 60502230 488693019 497912272 33891093 36176552 53465396 50513617 5180484 3482123 59677175 40406650 152214148 130578942 X 285415433 315581611 31066087 31649584 19997351 20102135 336478871 367333330 488693019 497912272 X 20012938 177812 10663709 X X false true X true true true X false false false false false false false false false false true 453 453 false false Part II-B, Line 1i - Other Activities Description TMH pays membership fees to the Association of American Medical Colleges. A portion of the membership dues paid to these organizations is allocated to their lobbying efforts. 161149968 28824519 7989653 24393611 173570529 130155405 41953120 13531256 24489813 161149968 122853669 26598596 6425189 25722049 130155405 124326086 27341321 -2425603 26388135 122853669 117435496 30903911 5559275 29572596 124326086 0.86820 0.13180 false true true 5125675 5125675 242353948 117778864 124575084 162729734 112379995 50349739 3876751 3876751 183927249 53456485 Deferred financing costs 343070 Interest in net assets of TMH Foundation 58802938 Other 46838 60502230 Accrued pension liability 21657800 Due to affiliates 7848964 Health Care Benefit Self-insurance 3706261 Post-retirement benefit liability 109100 Third-party payor settlements 7084525 40406650 X 498648055 177812 10663709 10841521 487806534 873411 12563995 13437406 501243940 467793596 467793596 873411 12563995 13437406 481231002 Part V, Line 4: Intended uses of the endowment fund. The Miriam Hospital's (TMH) unrestricted endowment consists of designated assets set aside by TMH's Board for future capital improvements, over which the Board retains control and may at its discretion subsequently use for other purposes. The largest temporarily restricted funds held by TMH are used to support: (1) recruitment for the Director of the Weight Control & Diabetes Center; (2) the Ryan White Program, to support salaries and other costs of staff who work with HIV-infected patients; (3) operational needs of all emergency medicine programs; (4) the Women's Medicine Collaborative, a comprehensive, multidisciplinary center dedicated to meeting the health care needs of women; (5) clinical care, research, and education to develop treatment for pelvic floor disorders; (6) the Hospital's Mammography Equipment upgrade to provide three-dimensional technology; (7) upgrade of patient call system technology; (8) The Center for Prisoner Health and Human Rights, a program which seeks to improve the health and human rights of criminal justice populations through education, research, and advocacy; (9) the Palliative Care Program for cancer patients; (10) research and program development for genitourinary cancer care; (11) the advancement of patient care in cardiology; (12) the Department of Psychiatry's operations, education, research, and capital needs; (13) the treatment and prevention of cancer; (14) the Surgery Department's educational and investigational functions; and (15) TMH's capital equipment and operating needs in providing services to patients. Part X : FIN48 Footnote TMH is a not-for-profit corporation as described in Section 501(c)(3) of the Internal Revenue Code (the Code) and is exempt from Federal income taxes pursuant to Section 501(a) of the Code. TMH recognizes the effect of income tax positions only if those positions are more likely than not to be sustained. Recognized income tax positions are measured at the largest amount of benefit that is greater than fifty percent likely to be realized upon settlement. Changes in measurement are reflected in the period in which the change in judgment occurs. TMH did not recognize the effect of any income tax positions in either 2018 or 2017. Part XI, Line 2d: Other revenue amounts included in F/S but not included on form 990 Change in funded status of pension $10149000 Increase in net assets of TMHF $514709 Part XI, Line 4b: Other revenue amounts included on 990 but not included in F/S Non-UBI debt-financed rental expenses $-5317 Non-debt-financed rental expenses $-2118137 Provision for bad debts $14687449 Part XII, Line 4b: Other revenue amounts included on 990 but not included in F/S Non-UBI debt-financed rental expenses $-5317 Non-debt-financed rental expenses $-2118137 Provision for bad debts $14687449 true Sub-Saharan Africa 0 0 Program Services Research 22406 Russia & Newly Independ States 0 0 Program Services Research 18633 Europe 0 0 Program Services Research 8024 South Asia 0 0 Program Services Research 6341 East Asia and the Pacific 0 0 Program Services Research 1500 Middle East and North Africa 0 0 Grant Recipient in Region Philanthropy 16103 73007 73007 Middle East Program Support 16103 Wire FMV 1 false false false false false true Part I, Line 2 - Grantmakers Explanation For Monitoring Use of Funds Outside US When a foreign institution is the subrecipient of an award received by a Lifespan affiliate, the following procedures are adhered to: A subrecipient agreement is prepared and executed between the foreign institution and the Lifespan affiliate. The agreement describes the funding source, terms and conditions of the award, statement of work, payment method, and audit process. The foreign institution prepares an invoice to the Lifespan affiliate for expenses incurred under the agreement. Once received, the invoice is reviewed and approved by both the principal investigator at the Lifespan affiliate and the responsible research administrator in the Lifespan Office of Research Administration.Check requests and wire transfer forms are prepared by the principal investigator, approved by the responsible research administrator, and forwarded to the Finance Department, where payment is processed to the foreign institution.Additionally, when the award is a federal award, a questionnaire is completed by the appropriate subrecipient official supplying information about the foreign institution's financial system and method of accounting for the award. A request is also made for the institution's audited financial statements. When a foreign individual is not associated with an institution, a Professional Services Agreement (PSA) is executed and the individual sends an invoice to the Lifespan affiliate principal investigator associated with the project or sponsored agreement that states the number of hours, dates of services, work performed, expense reimbursement request, and compensation amount. The same approval and payment process is used as described above.Expenditures related to foreign activities are recorded on the accrual basis of accounting. true true true X true X true true true false true true 8220240 1082647 7137593 0.01530 72878804 54712618 18166186 0.03890 81099044 55795265 25303779 0.05420 159139 21581 137558 0.00030 21044728 3516844 17527884 0.03760 17209289 5772318 11436971 0.02450 20107327 17262327 2845000 0.00610 184678 184678 0.00040 58705161 26573070 32132091 0.06890 139804205 82368335 57435870 0.12310 true 3592550 349655 100887424 93627528 7259896 X true true 1 1 The Miriam Hospital 164 Summit Avenue Providence RI 02906 www.miriamhospital.org HOS00122 X X X X X The Miriam Hospital 1 false false true X X X X X X X X X X 16 true true false true X Please refer to Schedule O X X true 16 true Please refer to Schedule O supplemental info for full URL false false true X 200.0000 300.0000 X X X X X X true true X X X X true X Please refer to Schedule O X Please refer to Schedule O X Please refer to Schedule O X X X X X X X true false X X X X true X false false Part V, Line 3j - Description of Other Needs Assessment Part V, Line 3e- The significant needs identified in TMH's 9/30/2016 CHNA have been prioritized in order of significant needs of the community, as determined by the organization. Part V, Line 5 - Account Input from Persons Who Represent the Community The CHNA encompassed intensive data collection and analysis, as well as qualitative research in the form of interviews with internal and external stakeholders, including hospital-based physicians, nurses, social workers, administrators, and other professionals, as well as community-based stakeholders representing constituencies served by TMH and Lifespans three other hospitals. TMH also conducted four Community Health Forums (CHFs) between May-June 2016 which are a qualitative social science data collection method used in community-based or participatory action research. These CHFs were held strategically throughout various locations identified within TMH's patient population community as a way to increase the mix of the participants in an effort to identify the entire community's most significant health needs. The CHFs were open to the public and provided opportunities for residents to share their health concerns and needs with Lifespan staff. TMHs leadership team shaped the CHNA by recommending institutional and community leaders for participation, offering observations about community needs, and providing insight about existing and planned programs.Qualitative data collected during the course of 2015-2016 related to the preparation of the CHNA consist of: (1) interviews completed with internal stakeholders (i.e., hospital-based and Lifespan-based); (2) interviews with key informant community leaders, representing an array of constituencies; and (3) four Community Health Forums held within the communities of the TMH patient population.Interviews with leaders of organizations encompassed a wide range of issues and populations, including historically underserved communities, such as minority populations, children and youth, and immigrant/refugee populations, and also included leaders of organizations with specific interests or expertise in key issues such as obesity, cancer, and asthma. To ensure representation from a broad cross-section of the community, CHF's were held in the following locations:- Laurelmead, an active senior living center located at 355 Blackstone Boulevard, Providence, RI 02906;- New Dimension Apostolic Church, located at 100 Niantic Avenue, Providence, Rhode Island 02907;-Olney Street Baptist Church, located at 100 Olney Street, Providence, Rhode Island 02906; and-Rochambeau Library, located at 708 Hope Street, Providence, Rhode Island 02906. Part V, Line 6a - List Other Hospital Facilities that Jointly Conducted Needs Assessment Rhode Island HospitalEmma Pendleton Bradley HospitalNewport Hospital Part V, Line 7d - Description of Making Needs Assessment Widely Available A copy of the Community Health Needs Assessment report issued for TMH as of September 30, 2016 can be obtained by visiting: https://www.lifespan.org/sites/default/files/lifespan-files/documents/centers/lifespan-community-health/The-Miriam-Hospital-2016-CHNA.pdf Part V, Line 16j - Other Means Hospital Facility Publicized the Policy An abbreviated version of TMH's Financial Assistance Policy is posted in various admitting and outpatient areas of TMH. Additionally, registration personnel refer uninsured and/or low-income patients to Patient Financial Counselors to discuss the policy and/or answer any questions they might have. Part V, Line 22d - Other Billing Determination of Individuals Without Insurance TMH uses the prospective method in determining amounts generally billed. Internal Revenue Code Section 501(r) defines the prospective method as the amount Medicare would reimburse TMH for billed care (including both the amount that would be reimbursed by Medicare and the amount the beneficiary would be personally responsible for paying in the form of co-payments, co-insurance, and deductibles) if the patient was a Medicare fee-for-service beneficiary. Cardiovascular Institute 950 Warren Avenue East Providence RI 02914 Outpatient Cardiac Clinic Womens Medicine Collaborative 146 West River Street Providence RI 02904 Comprehensive Women's Outpatient Clinic TMH Diagnostic Imaging Center 195 Collyer Street Suite 101 Providence RI 02904 Outpatient Radiology Cardiovascular Institute 208 Collyer Street Suites 100 102 Providence RI 02904 Outpatient Cardiac Clinic Cardiovascular Institute 1454 South County Trail Suite 2000 East Greenwich RI 02818 Outpatient Cardiac Clinic TMH Immunology Research Center 14 Third Street 11 Fourth Street Providence RI 02906 Outpatient Counseling TMH Cardiac RehabPulmonary Rehab 208 Collyer Street Providence RI 02904 Outpatient Cardiac Clinic TMH Behavioral Medicine Research 1 Hoppin Street Providence RI 02903 Outpatient Research & Education TMH Weight Control & Diabetes Research 196 Richmond Street Providence RI 02903 Outpatient Research & Education TMH Outpatient Rehabilitation 195 Collyer Street Providence RI 02904 Outpatient PT, OT, and Speech Rehab Intensive Cardiac Rehab Program 1454 South County Trail East Greenwich RI 02818 Outpatient Cardiac Clinic TMH Laboratory 1 Commerce Street Lincoln RI 02904 Phlebotomy Lab TMH Laboratory 1 Hoppin Street Providence RI 02903 Phlebotomy Lab TMH Immunology Center 1125 North Main Street Providence RI 02904 Outpatient Clinic TMH Laboratory 400 Bald Hill Road Warwick RI 02886 Outpatient Clinic Womens & Mens Health Rehabilitation Services 148 West River Street Suite 1D Providence RI 02904 Outpatient Rehab Clinic The Center for Weight & Wellness 1377 South County Trail East Greenwich RI 02818 Outpatient Clinic RISE TB Clinic 14 Third Street Providence RI 02906 TB Clinic East Providence Imaging 375 Wampanoag Trail Suite 101B Riverside RI 02915 Outpatient Diagnostic Imaging TMH Behavioral Medicine Clinic 146 West River Street Providence RI 02904 Outpatient Clinic TMH Pre-Admission Testing Center 208 Collyer Street Third Floor Providence RI 02904 Outpatient Pre-admission Assessment and Education Part I, Line 3c - Charity Care Eligibility Criteria (FPG Is Not Used) The Miriam Hospital (TMH) uses a dual system for determining financial aid eligibility: federal poverty guidelines and an asset test.The financial screening process at TMH is intended to define probable eligibility for public assistance (Medicaid or Community Free Service ("CFS")) for those patients who do not have the means to pay for hospital services rendered, as follows:1. Upon patient indication of an inability to pay required monies, the patient is offered the financial screening option to determine eligibility for public assistance (Medicaid, CFS).2. The application for CFS is completed and includes information relative to income, expense, and other available resources, and requires proof of such information which may include:- most recently filed Federal income tax return and W-2 form(s)- copies of most recent savings and/or checking account statements- two most recently received payroll check stubs- copy of rent receipts for the last six months for proof of residency- copy of utility bills for the last month for proof of residency3. If the patient's financial situation falls within the guidelines for eligibility for Medicaid, RIte Care, or CFS, or if the patient has a long-term disability, the appropriate application process is completed. (Assistance to complete such applications is available from the Patient Financial Advocates (PFA) Office at the Hospital.)4. Uninsured patients receive a discount equal to the discount received by Medicare beneficiaries on TMH charges using the prospective method. Under Section 501(r)(5), the maximum amounts that can be charged to Financial Assistance Policy (FAP)-eligible individuals for emergency or other medically necessary care are the amounts generally billed to individuals who have Medicare insurance covering such care. In no case was there a situation where an uninsured patient paid more than amounts reimbursed from Medicare.5. Eligibility for CFS above the discount is provided for those applicants whose family gross income is at or below twice the Federal Poverty Guidelines, with a sliding scale for individuals up to three times the poverty level in effect at the time of application. Full charity care applicants with assets worth more than $9,400 for an individual (or $14,100 for a family) may not qualify for care without charge, but will qualify for discounted care. While the maximum 100% discount may not be available to all charity care applicants based on the results of their asset test, all uninsured patients who receive care are eligible for, at a minimum, the charity care discount as provided by the Medicare program. 6. For patients who qualify for less than 100% of the financial assistance program, a payment schedule is determined and agreed upon (discussed further below). Payment arrangements are established prior to service for non-urgent care. 7. In either case, the final results of the financial screening are recorded in the comments section of the Hospital's billing system.Requests for Payment Arrangements:Patient Financial Advocates (PFA) will qualify patients that are receiving non-urgent, medically indicated procedures prior to services. The PFA will request 75% to 100% of estimated discounted charges if the balance is under $5,000 and 50% to 100% of estimated discounted charges if the estimated bill equals or exceeds $5,000.For elective or non-urgent cases, the policy will require financial clearance prior to services or an exception from the Medical Director based on the clinical circumstances if the patient cannot meet the above payment agreement.Patients who do not qualify for total or partial CFS, but who have difficulty in paying their bills after services are rendered, may request enrollment in a payment plan. Eligibility for the payment plan includes the following guidelines:1. Immediate payment in full will result in financial hardship to the patient or the patient's family.2. Deposit of one-half of the estimated total bill is requested prior to admission.3. The minimum monthly payment of $50.00.4. The maximum length of the payment plan is twenty-four months.The Customer Service staff will set up the payment plan using the above guidelines as well as complete the necessary information on the "Payment Agreement" form and mail to the patient for signature. Account documentation will be done online. The pre-collect agency will be sent a copy of the payment agreement and all forms will be scanned into the PFS Optical Imaging System. Part I, Line 6a - Related Organization Community Benefit Report The community benefit report maintained for all Lifespan affiliated hospitals (The Miriam Hospital, Rhode Island Hospital, Emma Pendleton Bradley Hospital, and Newport Hospital) is maintained by Lifespan Corporation and included in Lifespan's annual report. The annual report for the year ended September 30, 2018 is available at the following link. https://issuu.com/lifespanmc/docs/2018-annual-report-final-190419?e=28083767/69263174Please see pages 5 and 23-24 of the Lifespan Annual Report for community benefit information. Part I, Line 7 - Explanation of Costing Methodology TMH's costing methodology used to calculate the amounts reported in Part I, Line 7 is as follows:a) Financial assistance at cost- involves utilization of a ratio derived from dividing patient costs, as defined, by patient charges, as defined, and applying that percentage to total charity care charges.Patient costs reported in the cost accounting system are calculated based on Medicare principles of reimbursement by reducing total operating expenses (as calculated by Form 990 requirements) by items such as bad debt expense, the cost of medical education, internally funded research, subsidized health services, community services, charitable contributions, and other operating revenue. Patient costs are then divided by patient charges to determine a ratio of cost to charges (RCC). This RCC is applied as the costing methodology for determining charity care expense.b) Medicaid- Medicaid expense is determined at cost as calculated by TMH's cost accounting system. The system uses historical costing methods applied to all patient segments based on various patient demographics and utilizations. These costing standards exclude bad debt, charity care, and the Medicaid portion of costs of health professions education, which are reported on other areas of Line 7. These expenses include Medicaid provider taxes. Direct offsetting revenue is reported as amounts received from Medicaid, as well as other payments which include reimbursement under Federal "Upper Payment Limit" (UPL) and "Disproportionate Share Hospital" (DSH) programs.e) Community health improvement services and community benefit operations- Community benefit operations expense is recorded as direct expenses incurred as reported by TMH's Community Health Services Department. Revenue received for these services is reported as direct offsetting revenue. f) Health professions education- Health professions education expenses represent direct costs related to amounts associated with resident and intern programs utilized at TMH. These costs are determined by reporting actual direct costs taken from the Medicare cost report. Direct offsetting revenue is reported as any direct Medicare reimbursements received for such services provided, as reported in TMH's Medicare cost report.g) Subsidized health services- Subsidized health services' community benefit expense is determined by TMH's cost accounting system. These subsidized health services are recorded at cost in TMH's cost accounting system for all qualified subsidized health service divisions. This expense is adjusted to remove all related Graduate Medical Education (GME) expenses, as well as bad debt, Medicaid, and charity costs already reported in the applicable sections of Line 7. Net patient service revenue is recorded as amounts received from various payer types related to these services. Revenue associated with Medicare GME and Medicaid is excluded from the amount disclosed for subsidized health services.h) Research- TMH conducts extensive medical research focused on the prevention and treatment of HIV/AIDS, obesity, cancer, diabetes, cardiac disease, neurological problems, orthopedic advancements, and mental health concerns. For all internal and external research conducted, the costs associated with these activities are calculated by combining the direct and indirect costs as reported within TMH's cost accounting system. Revenue received for these services is reported as direct offsetting revenue. i) Cash and in-kind contributions for community benefit- Expenses for cash and in-kind contributions for community benefit are made by the Hospital, including an allocation of contributions made by Lifespan Corporation on TMH's behalf. Part I, Line 7, Column F - Explanation of Bad Debt Expense The calculation of percentages disclosed for Schedule H, Part I, Line 7, column (f) "percent of total expense", does not include bad debt expense. Form 990, Part IX, Line 25 includes provision for bad debts of $14,687,449. Part III, Line 2 - Methodology Used To Estimate Bad Debt Expense The amount reported as bad debt expense is determined by applying the ratio of cost to charges (RCC) to the total charges written off to bad debt. The RCC rate is determined using data from TMH's cost accounting system and is adjusted for medical education, internally funded research, subsidized health services, community services, and charitable contributions. Discounts and payments are applied to patient accounts before such account balances are transferred to bad debt. Part III, Line 3 - Methodology of Estimated Amount & Rationale for Including in Community Benefit Accounts pending transfer to bad debt are reviewed by TMH's patient advocate staff to determine qualification for financial assistance under TMH's policy. Accounts with insufficient information to determine eligibility are assigned a separate identifying code. These accounts are ultimately transferred to bad debt if the appropriate qualifying documentation is not received. The amount reported on Schedule H, Part III, Section A, Line 3 represents the account balances at charge written off to bad debt from the pending code, which are in turn converted to cost by applying the RCC rate as identified in Schedule H, Part III, Section A, Line 2. Part III, Line 4 - Bad Debt Expense Accounts receivable are reduced by an allowance for doubtful accounts. In evaluating the collectibility of accounts receivable, TMH analyzes its history and identifies its revenue trends for each of its major payors to estimate the appropriate allowance for doubtful accounts and the associated provision for bad debts. Management regularly reviews data about these major payor sources of revenue in evaluating the sufficiency of the allowance for doubtful accounts. For receivables associated with services provided to patients who have third-party coverage, TMH analyzes contractually due amounts and provides an allowance for doubtful accounts and a provision for bad debts, if necessary (for example, for expected uncollectible deductibles and copayments on accounts for which the third-party payor has not yet paid, or for payors who are known to be having financial difficulties that make the realization of amounts due unlikely). For receivables associated with self-pay patients (which includes both patients without insurance and patients with deductible and copayment balances due for which third-party coverage exists for part of the bill), TMH records a significant allowance for doubtful accounts and provision for bad debts in the period of service on the basis of its past experience, which indicates that many patients are unable or unwilling to pay the portion of their bill for which they are financially responsible. The difference between the standard rates (or the discounted rates, if applicable) and the amounts actually collected after all reasonable collection efforts have been exhausted is charged off against the allowance for doubtful accounts.TMH's allowance for doubtful accounts for self-pay patients decreased from 79% of self-pay accounts receivable at September 30, 2017 to 61% of self-pay accounts receivable at September 30, 2018. TMH's self-pay writeoffs for the years ended September 30, 2018 and 2017 amounted to approximately $15,083,000 and $18,545,000, respectively. TMH did not change its charity care or uninsured discount policies during the years ended September 30, 2018 and 2017. Part III, Line 8 - Explanation Of Shortfall As Community Benefit There is no Medicare shortfall for fiscal year 2018. If there was, it would not be treated as a community benefit.The source of the Medicare allowable costs reported on Part III, Section B, Line 6 is the Medicare cost report, Form 2552-10. Part III, Line 9b - Provisions On Collection Practices For Qualified Patients TMH does not bill for the excess of charges over agreed upon reimbursement amounts from third-party payors. Rather, such differences are recorded as a reduction of revenue through contractual adjustments. Collection efforts are focused on copayments, deductibles and amounts denied by insurers. After all collection attempts are exhausted, any remaining balances, including any copayments and deductibles, are written off as a bad debt. TMH classifies its bad debts as uncompensated care. This does not apply to Medicaid, however, as there are no associated copayments or deductibles for this payor.TMH does not require collateral or other security in extending credit to patients; however, it routinely obtains assignment of patients' benefits payable under their health insurance programs, plans or policies. Uninsured patients are offered Community Free Service and/or payment plan options.Lifespan's Patient Financial Services Department (PFS) has the responsibility for communicating and administering collection policies and procedures to all patient accounts. PFS engages the services of various pre-collect agencies as necessary. The following are highlights of the overall collection effort:* If a patient presents for admission who is not insured, staff assists the family with a Medicaid application.* If the patient is ineligible for Medicaid, a financial screening is performed to determine status of qualification for Community Free Service.* If the patient does not qualify for Community Free Service, PFS or the pre-collect agency attempts at least four contacts with the responsible party within the first 120 days.* If the third-party carrier denies in writing any responsibility for payment, arrangements regarding an extended payment plan are discussed with the patient.* At 120 days, if there is no payment activity or no hold placed on the account, the account is transferred to the appropriate collection agency. Part VI, Line 2 - Needs Assessment Lifespan's Office of Strategic Planning and Analysis performs population-based studies for TMH regarding the need for inpatient medical and surgical services for both adults and children and a wide range of outpatient services including: primary care office visits, specialty care, emergency services, imaging, ambulatory surgery, and specific high technology services such as radiation therapy and bone marrow transplantation. A population-based study examines the growth and changes in the population, the resources in the community, and the changing prevalence of diseases. Lifespan Strategic Planning also examines experience with wait times, the level of staffing, and the changing standards of care. All of this information is used to assess the demand for additional services to provide access to high quality care.In addition to population approaches to assessing and estimating need, all specialties and services monitor demand at the service-specific level by considering changing patterns of care and methods of treatment for the specific medical problem, wait times for visits/queues, and community resources. The service leadership then goes through a review process to add staff, expanded hours, and/or new subcomponents to round out core services on an as-needed basis. At times, expansion requires more space, equipment, and staff, but often accommodation of community demand is achieved through expanded hours. Facilities are added as needed to accommodate these expansions, but most often minor renovations of existing locations with better, more modern layouts and equipment allow for greater patient access.The RI State Certificate of Need program requires a focused study of need for all projects over $5.25 million, which is an important part of the program development process across Lifespan.Based on a broad understanding of community health needs, TMH provides a wide range of services to both its primary and secondary service areas. Lifespan and its hospital affiliates monitor health trends in Rhode Island in an effort to identify areas of unmet demand regarding clinical services. Part VI, Line 3 - Patient Education of Eligibility for Assistance TMH has multilingual signage in its main lobby and waiting areas which provides information on financial aid contacts. The Registration Department meets with patients at the outset of care to discuss eligibility for assistance. The Registration staff provides interested patients with a "Welcome" booklet which includes information on patient rights and responsibilities. The signage and booklets contain a telephone number which connects patients with Registration staff who can answer any additional questions that may arise after the patient has left TMH. Assistance eligibility is also summarized on TMH's website, http://miriamhospital.org.As part of TMH's inpatient intake process, TMH provides a summary of the financial assistance policy, along with all assistance applications and the Patient Financial Services contact number, to all self-pay patients. The same process is also used for patients seen during the outpatient discharge process. Attempts are made to contact patients prior to their visit to screen for financial assistance and to inform them what documents are required for their financial assistance determination or to set up an appointment to see a "Patient Financial Advocate" (PFA) prior to service. PFAs discuss with patients the various government programs that might be available to them for financial assistance. PFA's also offer assistance with the financial application process and/or understanding the qualification factors for Medicaid, the Affordable Care Act, Medicare, Social Security Disability, Supplemental Nutrition Assistance Program (SNAP), and Rhode Island Temporary Disability Insurance and Unemployment. This is done for both inpatient and outpatient services. Part VI, Line 4 - Community Information TMH, located in Providence, Rhode Island, is a 247-bed nonprofit general acute care teaching hospital with university affiliation providing a comprehensive range of diagnostic and therapeutic services (excluding obstetrics) for the acute care of patients principally from Rhode Island and southeastern Massachusetts. As a complement to its role in service and education, the Hospital actively supports research. TMH is accredited by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) and participates as a provider primarily in Medicare, Blue Cross, and Medicaid programs. TMH is also a member of the formerly-named Voluntary Hospitals of America, Inc., which has partnered with UHC Alliance NewCo, Inc. to become Vizient, Inc., the largest member-owned health care company in the United States.In 1969, TMH and certain other Rhode Island hospitals entered into an affiliation agreement to participate jointly in various clinical training programs and research activities with The Warren Alpert Medical School of Brown University (Brown). TMH is designated as a major teaching affiliate of Brown. The goals of the partnership are to facilitate the expansion of joint educational and research programs in order to compete both clinically and academically.With respect to nursing education, TMH has developed formal and informal educational affiliations with a number of accredited New England colleges and universities. TMH does not receive any compensation from the various schools for providing a clinical setting for the student nurse training.TMH conducts extensive medical research and is in the forefront of biomedical health care delivery research and among the leaders nationally in National Institutes of Health programs. Part VI, Line 4 - Community Building Activities TMH substantially subsidizes various health services including various clinics and certain other specialty services. TMH also provides numerous other services to the community for which charges are not generated. These services include certain emergency services, community health screenings for cardiac health, prostate cancer and other diseases, smoking cessation, immunization and nutrition programs, diabetes education, community health training programs, patient advocacy, foreign language translation, physician referral services, and charitable contributions. Part VI, Line 5 - Promotion of Community Health TMH is governed by a Board of Trustees, which is composed of leaders of the local community elected by Lifespan Corporation. TMH's purpose is to at all times be operated exclusively as a tax-exempt charitable hospital and, as such, shall dispense medical and surgical aid and care to the sick and disabled of any race, creed, or color in keeping with Jewish ethical aspirations; shall act in a fashion designed to further, improve, and advance the science or art of health care delivery, patient care, and the knowledge, practice, and teaching of medicine and nursing; and assist in the advancement of medical research and investigation and in the improvement of medical teaching facilities and methods. TMH works collaboratively with physicians, its employees, other health care organizations, and the community to create a measurably healthier community through the provision of high quality, cost-effective, customer-focused health care services in an environment that promotes patient safety. TMH monitors the healthcare needs of its service area to ensure alignment of its resources with its mission. TMH measures the results of the programs and services it provides based on the value added to the community as well as the financial health of each program and its impact on TMH. TMH is organized and operated for the benefit of the community it serves. Part VI, Line 6 - Affilated Health Care System Lifespan's mission is delivering health with care. Lifespan is an academically based healthcare system at the forefront of medical care, continually engaging in research that will lead to medical breakthroughs. Lifespan affiliates provide comprehensive inpatient and outpatient medical, surgical, and psychiatric services for adults and children. Lifespan and its affiliates employ approximately 15,000 people. The Lifespan system has approximately 3,500 physicians on the medical staffs of its affiliated hospitals, operates 1,165 licensed beds in four hospital complexes, and in 2018 generated approximately $2.3 billion in total operating revenue. By each of these measures, Lifespan is Rhode Island's largest health system, serving a population of over 1.0 million. Three of its hospital members, Rhode Island Hospital, The Miriam Hospital, and Emma Pendleton Bradley Hospital, are teaching affiliates of The Warren Alpert Medical School of Brown University, with 76 percent of the residents and fellows in this program based at RIH, TMH, and EPBH.Lifespan is a Rhode Island nonprofit corporation that is community-based and community-governed. As a nonprofit organization, Lifespan is run by a voluntary Board of Directors who are community representatives. Lifespan and all of its nonprofit hospital affiliates have received written notification from the Internal Revenue Service that they have been recognized as being organized and operated as entities described in Internal Revenue Code (IRC) Section 501(c)(3) and are generally exempt from income taxes under IRC Section 501(a).As of September 30, 2018, Lifespan Corporation employed approximately 1,020 full-time and part-time personnel, most of whom are located in Providence, RI. Lifespan Corporation provides support services to its affiliates, such as information services, risk management, legal, communications and public affairs, fundraising, facility development, strategic planning, internal audit/compliance, human resources, finance, payor contracting, and investment management, for which each affiliate is charged a fee equivalent to the costs incurred by Lifespan in providing these services.CORPORATE AUTHORITY AND ROLELifespan Corporation has no members and is governed by its Board of Directors. The Board has responsibility for planning, directing, and establishing policies intended to assure the development and delivery of quality health services, professional education, and biomedical research on an integrated, cost-effective basis. The Board's powers include the power to set accounting policies for its affiliates, approve all managed care agreements, negotiate, develop, and approve affiliations with other institutions for educational and research purposes, and approve human resource plans, executive compensation, and benefits for system affiliates. The bylaws of TMH confer certain reserved powers on Lifespan to provide it with the means of effective oversight, coordination, and support of the system. Powers specifically reserved to Lifespan as sole member of TMH include: to approve the amendment of the Articles of Incorporation and Bylaws and other Charter documents; to develop and approve strategic plans; to approve capital or operating budgets or material non-budgeted expenditures; and to authorize incurrence or guaranty of material indebtedness.For a complete listing of affiliated members of Lifespan's integrated healthcare delivery system, please refer to Schedule R. Part VI, Line 7 - States Filing of Community Benefit Report RI Part VI - Additional Information Form 990, Schedule H, Part V, Line 7: The TMH website which makes the hospital's CHNA report widely available is located at the following URL:https://www.lifespan.org/centers-services/lifespan-community-health-institute/community-health-reports-and-resourcesForm 990, Schedule H, Part V, Line 10a: The URL to view TMH's most recently adopted implementation strategy is below:https://www.lifespan.org/sites/default/files/lifespan-files/documents/centers/lifespan-community-health/The-Miriam-Hospital-2016-CHNA.pdfPlease refer to page 19 of the CHNA to view details of the implementation strategy.Form 990, Schedule H, Part V, Line 16b: The URL to view and download TMH's Financial Assistance Policy application form is below:https://www.lifespan.org/uploadedFiles/Lifespan/Content/Patient_Financial_Services/Lifespan-FAF-ENG.pdfForm 990, Schedule H, Part V, Line 16c: The URL to view TMH's plain language summary of the Financial Assistance Policy is below:https://www.lifespan.org/sites/default/files/lifespan-files/documents/lifespan-main/pfs/Lifespan-Financial-Assistance-Summary.pdf true Brown University 164 Angell Street Providence RI 02912 050258809 501(c)(3) 161398 0 General Support Everett Co Stage & School 9 Duncan Avenue Providence RI 02906 050451784 501(c)(3) 10080 0 General Support Festival Ballet Providence 825 Hope Street Providence RI 02906 050377245 501(c)(3) 11633 0 General Support Groundwork Providence 1005 Main Street Pawtucket RI 02860 050397766 501(c)(3) 12000 0 General Support Mt Hope Neighborhood Assoc 199 Camp Street Providence RI 02906 222599257 501(c)(3) 9890 0 General Support Prov After School Alliance 81 Carpenter Street Providence RI 02903 260319193 501(c)(3) 10000 0 General Support Social Enterprise Greenhouse 10 Davol Square Providence RI 02903 263772899 501(c)(3) 12000 0 General Support Stages of Freedom 10 Westminster Street Providence RI 02903 200027676 501(c)(3) 12000 0 General Support Thundermist Health Center 171 Service Avenue Warwick RI 02886 050355097 501(c)(3) 11850 0 Health Program Support YMCA 438 Hope Street Providence RI 02906 050258878 501(c)(3) 12000 0 General Support 10 0 Additional Supplemental Information The Miriam Hospital is committed to community programs and provides support to various charitable organizations in Rhode Island. Donations are made to organizations recognized by the IRS as being described in IRC Section 501(c)(3). All contributions are approved by management and are made to organizations whose missions and goals align with those of TMH. X true true X X X X X false true false false false false false true false false Arthur J Sampson President 425373 127000 88729 16200 18206 675508 Eirini Apostolidou MD Physician 238409 43500 415 12332 11695 306351 Joseph D Sweeney MD Physician 284279 4176 15145 23418 327018 Maria P Ducharme Chief Nursing Officer 238543 61000 49857 56040 22408 427848 32986 Mary A Wakefield Treasurer 684712 209000 129199 264493 18070 1305474 97769 Michael P Carey MD Physician 364574 1615 15240 22952 404381 Paul J Adler Secretary 384397 95000 53167 74695 24461 631720 1533 Rena R Wing MD Physician 279760 3296 14553 9671 307280 Robert W Corwin Chief Medical Officer 227588 5538 233126 Rogers C Griffith MD Physician 306794 9648 15240 24663 356345 Timothy J Babineau MD Trustee 1261691 600490 355675 501925 25892 2745673 267558 Part I, Line 1a: Relevant information in regards to selections on 1a. Tax Indemnification and Grossed Up Payments:The Lifespan Executive Long Term Disability program provides financial protection to designated Lifespan physicians and executives in the event that they become disabled. Premiums are paid to the insurance carrier by the insureds on an after-tax basis to allow for income replacement at a reasonable cost. The income associated with the premiums is grossed up to cover the total cost of the benefit as provided in the Lifespan Executive Benefit Plan and is included in Medicare wages, more specifically on Schedule J, Part II, Column B (iii). Part I, Line 7: Non-Fixed payments not listed above Certain physicians and executives participate in incentive compensation plans arranged through individual contractual agreements which stipulate non-fixed payments based on meeting criteria comprised of various quality and productivity markers. A RIHEBC Series 2016 521300173 762244FP1 2016-08-11 57000732 Refund 1996, 2006, 2009 Bonds false false true A 2722275 57000732 419512 56581220 true true true true A false false false true true false false true A false true false false false false false true A true Part VI Schedule K, Part I, Line A(f):On August 11, 2016, the Rhode Island Health and Educational Building Corporation (RIHEBC) issued, on behalf of the Lifespan Obligated Group, which consists of The Miriam Hospital, Rhode Island Hospital, Emma Pendleton Bradley Hospital, Rhode Island Hospital Foundation, and The Miriam Hospital Foundation, $265,470,000 of tax-exempt fixed rate serial and term bonds (the 2016 Bonds) used for the purpose of refunding existing bonds issued to the Lifespan Obligated Group, as well as to pay certain expenses of issuance with respect to the 2016 Bonds. The portion of the 2016 Bonds' proceeds allocable to TMH is $57,000,732. For purposes of TMH, the 2016 issuance resulted in the complete refinancing of its RIHEBC Series 2006A and 2009A Bonds. Schedule K, Part I, Line 3:The bond proceeds listed in line 3 differ from the bond issue price disclosed per IRS Form 8038 due to the fact that TMH is part of the Lifespan Obligated Group previously mentioned in Part I, line A(f). Of the $308,112,067 disclosed in Form 8038, TMH was allocated $57,000,732 of the total issuance proceeds. Marilyn J Weigner Employee 501861 Employee Comp. false Schedule L, Part V Supplemental Information * The spouse of Pamela Harrop, MD, Trustee, is employed as a physician at The Miriam Hospital (TMH). In fiscal year 2018, TMH and Lifespan Physician Group, Inc. paid Marilyn J. Weigner a total of $501,861 for her services. Form 990, Part VI, Line 2: Description of Business or Family Relationship of Officers, Directors, Et Timothy J. Babineau, MD, President & CEO, and Mary A. Wakefield, Treasurer/EVP/CFO, are board members of VNA Technicare, Inc. (VNA), a related for-profit corporation. Dr. Babineau is a director and Ms. Wakefield is an officer of VNA. Additionally, Ms. Wakefield and Paul J. Adler, Secretary, are board members of Lifespan MSO, Inc. (MSO) and Lifespan Risk Services, Inc. (LRS), separate related for-profit organizations. Mr. Adler is a director of MSO and LRS while Ms. Wakefield is an officer of those two organizations.Lawrence A. Aubin, Sr., Chair, and Shivan Subramaniam, Trustee, are Directors of the same for-profit organization. Form 990, Part VI, Line 6: Explanation of Classes of Members or Shareholder Lifespan Corporation is the sole corporate member of TMH. Form 990, Part VI, Line 7a: How Members or Shareholders Elect Governing Body Effective October 23, 2012, the Board of Directors of Lifespan and the Boards of Trustees of Rhode Island Hospital, TMH, Newport Health Care Corporation, Newport Hospital, and Emma Pendleton Bradley Hospital approved a restructuring of their governance. The restructuring has increased governance effectiveness and has streamlined governance operation, as well as provided a single strategic perspective for the Lifespan system hospitals. Pursuant to the restructuring, the bylaws of each of the affiliates were amended such that the composition of the boards of trustees of each of the hospitals and Newport Health Care Corporation is defined as those persons serving from time to time as the directors of Lifespan. As a result, the Boards of each entity are comprised of the same individuals. The Board of each entity retains its responsibilities and authorities notwithstanding the revision in its composition. The Board of Directors of Lifespan consists of not less than fourteen nor more than thirty-one directors, including the President and CEO of Lifespan, who serves ex-officio with vote.Additionally, the bylaws of TMH confer certain reserved powers upon Lifespan to provide it with the means of effective oversight, coordination, and support of the system. Powers reserved to Lifespan include: to elect and remove TMH trustees and to approve the election of and removal of certain officers. Form 990, Part VI, Line 7b: Describe Decisions of Governing Body Approval by Members or Shareholders The TMH Board is comprised of the same individuals who serve on the Lifespan Board. Lifespan has the responsibility for planning, directing, and establishing policies intended to assure the development and delivery of quality health services on an integrated, cost-effective basis. Powers reserved to Lifespan, in addition to those noted above, include: to approve amendment of the Articles of Incorporation and Bylaws and other charter documents; to approve strategic plans; to approve investment policies and any capital or operating budgets or material non-budgeted expenditures; and to authorize incurrence or guaranty of material indebtedness. Form 990, Part VI, Line 11b: Form 990 Review Process The preparation and filing of the Form 990 and supporting schedules is the responsibility of the Executive Vice President & Chief Financial Officer (EVP/CFO) and Lifespan's Finance Department, with review by Lifespan's tax advisors, KPMG LLP (KPMG). The Form 990 is prepared by the accounting staff upon completion of Lifespan's annual independent audit and reviewed by the Corporate Services Tax Compliance Manager, the Director of Finance, and the Vice President of Finance - Corporate Services. The Form 990 is forwarded to KPMG for further review. KPMG provides the Tax Compliance Manager with any recommended changes which are reviewed, and if agreed upon, are incorporated into the return. The draft Form 990 is then provided to the EVP/CFO for final management review. Prior to filing the return with the Internal Revenue Service, a copy of the entire form, along with a video presentation detailing form highlights, are posted to TMH's Board of Trustees website portal in advance of its next Board meeting, at which all questions and concerns of the members of the Board are addressed by the EVP/CFO and incorporated into the Form 990 when appropriate. Once the Form 990 is complete and ready to be filed, the members of the Board are notified via email that a copy of the final version of the Form 990 is accessible through the same password-protected website portal. The EVP/CFO is authorized to file the Form 990. Form 990, Part VI, Line 19: Other Organization Documents Publicly Available Lifespan and the Lifespan Obligated Group, which consists of TMH, RIH and Affiliates, Emma Pendleton Bradley Hospital, Rhode Island Hospital Foundation, and The Miriam Hospital Foundation, currently make their annual and quarterly consolidated financial statements available to the public via DAC (Digital Assurance Certification, LLC), a disclosure dissemination agent for issuers of tax-exempt bonds which electronically posts and transmits Lifespan's financial information to repositories and investors alike. In addition, copies of TMH's Articles of Incorporation, Bylaws, and Conflict of Interest Policy are available upon request from the office of the Lifespan EVP/CFO, either in person or by mail. Other Changes In Net Assets Or Fund Balances - Other Increases Change in funded status of pension and other postretirement = $10149000 Other Changes In Net Assets Or Fund Balances - Other Increases Increase in interest in net assets of TMHF = $514709 . The Total Joint Center:The Total Joint Center at The Miriam Hospital (the Center) is dedicated to providing the most technologically advanced and specialized procedures focused on the replacement of joints as well as rehabilitation and care in treating diseases of, or injuries to, hips, knees, and shoulders. TMH is a Blue Cross Blue Shield Blue Distinction Center for Knee and Hip Replacement, which is a designation given to hospitals that demonstrate an expertise in quality care by meeting objective clinical measures, resulting in better outcomes for patients. In 2017, the Gold Seal of Approval for Advanced Certification for Total Hip and Total Knee Replacement was awarded to the Center. The Miriam's second Joint Commission Gold Seal of Approval, the advanced designation which recognizes quality, consistency, and safety of services and patient care set by The Joint Commission and the Total Joint Center, is the only Rhode Island program to achieve advanced certification.Medical and surgical services at the Center are provided in a personalized, caring environment within the context of an academic medical center. All services focus on the patient experience from initial consultation through recovery.Multidisciplinary medical teams include many dedicated specialists - surgeons, internal medicine specialists, anesthesiologists, nurses, rehabilitation therapists, and social workers who work with patients from diagnosis to treatment to follow-up care. The physical therapy and nursing teams work together after surgery to get patients moving for faster recovery, and physicians, nurses, and therapists work collaboratively to follow up care.Each patient benefits from individualized treatment plans and rehabilitation to aid recovery and restore functionality as quickly as possible. Whenever possible, minimally invasive surgical techniques are used to perform surgery. These techniques have dramatically improved the quality of the post-operative and recovery experience for the patient. In certain cases, computer navigation technology is used for knee and hip replacement surgeries. Computer navigation can assist the surgeon and improve the level of accuracy, bringing the precision of bone cuts and implant alignment in joint replacement surgery to a whole new level of accuracy, reliability, and longevity.Environmental Partnership Award:TMH has received the "Partner Recognition Award" from Practice Greenhealth, a health care membership community that promotes efficiency and environmental stewardship while improving patient safety and care.TMH has been named among the nation's 100 top hospitals for cardiovascular care by Thompson Healthcare. Thompson's annual study identifies hospitals that are setting benchmark levels of performance for cardiovascular services throughout the nation. It recognizes the hospitals and their management teams for superior clinical, operational, and financial performance in the area of cardiovascular service.Thanks to the latest evolution in surgical technology, physicians now have an effective alternative to traditional open surgery and laparoscopy that allows them to provide patients with the best of both approaches. This alternative is the da Vinci Surgical System, which TMH uses to treat different types of cancer.TMH's surgeons are leaders in their field. TMH, as part of an academic medical center, prizes the mastery of new technologies in order to improve the quality of life for patients. TMH surgeons have successfully performed over 1,000 procedures using the da Vinci Surgical System and have made its use a cornerstone of cancer treatment at TMH. The Hospital's Adult Outpatient Behavioral Medicine Services help individuals improve health through behavior change. Services are offered to help patients adjust to chronic medical conditions, including their associated physical and emotional distress; modify unhealthy ways of living (for example, smoking cessation) to help prevent the onset or progression of disease; and treat mood and anxiety disorders that interfere with management of medical conditions. Services are available to help individuals with behavioral and psychosocial management of medical conditions such as headache, pain, cancer, heart disease (including those with implanted cardiac devices), pulmonary disease, and diabetes. The Weight Management Program provides comprehensive, medically supervised treatment for mild, moderate, and severely overweight adults. Specialized programs are also available for adolescents and diabetics. Treatment combines medical monitoring, behavioral therapy, exercise instruction, three levels of calorie reduction, and nutrition education. The Hospital's clinicians include surgical oncologists, medical oncologists, radiation oncologists, hematologists, pathologists, physical therapists, radiologists, nurses, clinical social workers, patient advocates, pharmacists, and nutritionists. These dedicated specialists work with patients every step of the way, from diagnosis to treatment to follow-up care.To help patients and their families cope with breast cancer, TMH offers the Breast Health Navigator Program. The program assists breast cancer patients through the entire course of their cancer care with breast health navigators, registered nurses trained in oncology who possess an in-depth understanding of breast cancer and theprocess undergone by patients. They guide patients through diagnosis, treatment, andrecovery, while helping them make informed decisions and cope with the variety of issues they face.TMH and RIH were named Blue Distinction Centers for Complex and Rare Cancers by Blue Cross and Blue Shield of Rhode Island. TMH and RIH are the only two hospitals in the State to receive this distinction. Blue Distinction Centers for Complex and Rare Cancers are facilities within participating Blue Cross and Blue Shield network service areas that offer comprehensive inpatient cancer care programs for adults, delivered by multidisciplinary teams with subspecialty training and distinguished clinical expertise in treating complex and rare subtypes of cancer. TMH and RIH have both been recognized for excellence in treating esophageal, gastric, liver, pancreatic, rectal, and thyroid cancer.The division of gastrointestinal and liver pathology is committed to providing high quality diagnostic services for gastrointestinal and liver diseases in patients.Collectively, gastrointestinal cancers are among the most common form of malignancies suffered today, affecting nearly a quarter of a million Americans each year. To address this, the Lifespan Cancer Institute has brought together a team of nationally recognized leaders in the treatment and research of gastrointestinal cancers.The gastrointestinal cancer care services available through the Lifespan Cancer Institute provide state-of-the-art care for patients who have or are at risk for the following types of cancer: bile duct, esophagus, gallbladder, endocrine, and cystic tumors of the pancreas, liver, and stomach. TMH also offers medical nutrition therapy on an outpatient basis designed to help prevent and control gastrointestinal disorders. Form 990, Part I, Line 6 Volunteers support and contribute to the mission of TMH every day. They are able to learn, meet other dedicated volunteers, better understand the healthcare environment, and gain personal satisfaction knowing they are making a difference to patients, families, visitors, and vendors alike. Volunteer opportunities are available for both teens and adults in a wide variety of positions, including greeters, family liaisons, emergency room support, gift shop support, nurse aides, office support, pet therapy, physical therapy, patient visitors, recovery room support, art therapy, and central transporters. Volunteers also transport students and serve as guides, escorts, and interpreter aides. Form 990, Part I, Line 7B: The amount reported on Part I, Line 7b includes certain fringe benefit expenses subject to unrelated business taxable income under IRC Section 512(A)(7). Such amounts are not considered revenue, and therefore, are not reported as such on Form 990, Part VIII. Form 990, Part III, 4a: TMH is licensed to operate 247 acute care beds by the Rhode Island Department of Health. Notable medical accomplishments of TMH include performance of Rhode Island's first lung operation, first kidney transplant, and first aortic valvuloplasty (a procedure to clear blocked heart valves). In 2018, TMH discharged 19,264 inpatients, logged more than 72,000 visits in its Emergency Department, and performed 11,587 inpatient and outpatient surgical procedures. Services provided in 2018 represent 73,681 inpatient days and more than 128,000 clinic visits. TMH is staffed by nearly 1,100 privileged physicians, approximately 80 full-time house staff (medical school graduates), and a nursing staff of 900. In total, TMH employs more than 3,200 people. TMH is a major teaching affiliate of The Warren Alpert Medical School of Brown University, providing clinical rotations for residents.TMH provides full charity care for individuals at or below twice the federal poverty level, with a sliding scale for individuals up to three times the poverty level. In addition, a substantial discount consistent with Medicare program reimbursement is offered to all other uninsured patients. TMH determines the costs associated with providing charity care by aggregating the applicable direct and indirect costs, including compensation and benefits, supplies, and other operating expenses, based on data from its costing system. The total cost, excluding medical education and research, incurred by TMH to provide charity care amounted to $7,137,593 in fiscal 2018. Charges forgone, based on established rates, amounted to $20,659,090.TMH substantially subsidized various health services including the following programs: adult psychiatry, tuberculosis, and certain other specialty services at a net cost of $11,436,971 in fiscal year 2018. TMH also provides numerous other services to the community for which charges are not generated. These services include certain emergency services, community health screenings for cardiac health, prostate cancer and other diseases, smoking cessation, immunization and nutrition programs, diabetes education, community health training programs, patient advocacy, foreign language translation, physician referral services, and charitable contributions. The net cost of these services amounted to $137,558 in fiscal year 2018.TMH subsidizes the cost of treating patients who receive government assistance where reimbursement is below cost. Medicaid is a means-tested health insurance program, jointly funded by state and federal governments. States administer the program and set rules for eligibility, benefits, and provider payments within broad federal guidelines. The program provides health care coverage to low-income children and families, pregnant women, long-term unemployed adults, seniors, and persons with disabilities. Eligibility is determined by a variety of factors, which include income relative to the federal poverty line, age and immigration status, and assets.TMH offers expertise in total joint replacement, minimally invasive and robotic surgery, and bariatric surgery, among many other specialties.The Leonard and Adele R. Decof Family Comprehensive Cancer Center at TMH:This Comprehensive Cancer Center brings together world-renowned physicians and a team of specialists from Rhode Island Hospital (RIH), TMH, and Newport Hospital (NH), forming a multidisciplinary team whose level of knowledge and experience are unparalleled in the State of Rhode Island. TMH, as a part of the Lifespan Cancer Institute, provides state-of-the-art care for patients with cancer.Award-Winning Care:The Miriam Hospital has received numerous distinctions and awards. It is certified by the Joint Commission as a Primary Stroke Center, and was the first in Rhode Island to be designated as such. TMH has received the American Heart Association/American Stroke Association's Gold or Gold Plus designation for stroke care every year since 2008. TMH, which treats over 300 stroke patients a year, received the awards for attaining targeted quality measures and ensuring stroke patients receive the most appropriate medical treatment based on nationally recognized, research-based guidelines. Blue Cross Blue Shield of Rhode Island awarded TMH a Blue Distinction Center+ designation for bariatric surgery. The Center for Bariatric Surgery at TMH has been a Center of Excellence in Bariatric Surgery and was re-accredited in 2018 by the American College of Surgeons Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program. The Total Joint Center at TMH is recognized by the Joint Commission with a Gold Seal of Approval for its total knee and total hip replacement programs. TMH has earned the prestigious Magnet Award for nursing excellence and is one of the very few hospitals in the country to receive Magnet designation continuously over 20 years. The hospital has been named multiple times as a top regional hospital by U.S. News & World Report.In 2018 and 2017, The Miriam Hospital and Rhode Island Hospital were among the nation's top hospitals for clinical excellence, according to Healthgrades, a leading on-line resource for comprehensive information about the nation's physicians and hospitals.According to Healthgrades, the Distinguished Hospitals for Clinical Excellence Award recipients demonstrate comprehensive, consistent quality across a range of conditions and procedures, while other hospitals may possess specific areas of expertise and high-quality outcomes for some conditions and procedures.TMH and RIH were ranked among those with the lowest risk-adjusted mortality and complication rates during the 2018 study period between 2014 and 2016. The study rated results for patients in the Medicare population across at least 21 of 32 common conditions and procedures, as measured by objective clinical outcomes performance data (risk-adjusted mortality and in-hospital complications).Patients treated in hospitals receiving the Distinguished Hospital for Clinical Excellence Award have a 26.3 percent lower risk of dying than if they were treated in hospitals without the designation, according to Healthgrades.In 2018, The Miriam Hospital reached an aggressive goal of treating stroke patients with 85 percent or higher compliance with core standard levels of care as outlined by the American Heart Association/American Stroke Association for two consecutive calendar years.Blue Cross and Blue Shield of Rhode Island named The Miriam Hospital a Blue Distinction Center for knee and hip replacement in 2018. The honor is a recognition of expertise in delivering quality care and improved patient safety. For 2018, Blue Cross also designated The Miriam as a Blue Distinction Center + for bariatric surgery for expertise and cost-efficiency in delivery of specialty care.In 2018, The Miriam Hospital was once again ranked No. 1 in Rhode Island in the U.S. News & World Report's annual review of Best Regional Hospitals. The magazine also designated The Miriam as a "high performer" in the areas of chronic obstructive pulmonary disease (COPD), colon cancer surgery, heart failure, hip replacement, knee replacement, and in the specialties of geriatrics and pulmonology. The hospital has been named a Best Regional Hospital for four consecutive years.In 2018, The Miriam Hospital won its sixth semi-annual "A" grade for hospital safety from The Leapfrog Group. Leapfrog, for the second year in a row, included The Miriam Hospital on a list of the nation's "Top Teaching Hospitals."Continuing its excellence in stroke care, The Miriam Hospital in 2018 received top honors from the American Heart Association/American Stroke Association's "Get With The Guidelines" stroke program -- a "Gold-Plus" quality achievement award and "Target: Stroke Honor Roll Elite" award. The Miriam has been honored by the association virtually every year for more than a decade.The Miriam Hospital was named the best in Rhode Island for total joint replacement by CareChex in its 2018 Hospital Quality Rankings, a national survey.The Miriam Hospital was voted "Best Hospital" in the Providence Journal's 2017 Reader's Choice Awards.Accreditations and Certifications:In 2017, The Total Joint Center at The Miriam Hospital received The Joint Commission's Gold Seal of Approval for Advanced Certification for Total Hip and Total Knee Replacement.The Miriam Hospital's Center for Bariatric Surgery has been a Center of Excellence in Bariatric Surgery since 2011 and was accredited in 2014 and re-accredited in 2017 by the American College of Surgeons' Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program as an adult and adolescent center for weight loss surgery. Form 990, Part III, 4b: TMH provided $2,845,000 million in support of research activities in fiscal year 2018. TMH conducts extensive medical research and is in the forefront of biomedical health care delivery research and among the leaders nationally in National Institutes of Health programs. Major areas of research include:Cancer - TMH conducts clinical and behavioral research focusing on the many facets of cancer including prevention, education, and therapeutics which are supported by the National Cancer Institute, CALGB, and NSABP. TMH is a participating hospital in the Brown University-sponsored Cancer Oncology Group (BrUCOG).AIDS - As part of the Lifespan/Tufts/Brown Center for AIDS Research (CFAR), division researchers engage in clinical, basic, and translational research designed to improve the prevention and treatment of HIV/AIDS, with a major focus on women, racial and ethnic minorities, and individuals with substance abuse problems.The Lifespan/Tufts/Brown CFAR is a joint research effort among Brown University and Tufts University and their affiliated hospitals and centers. It is one of 20 centers located at academic medical centers throughout the United States that are part of the national CFAR program of the National Institutes of Health. The program emphasizes the importance of interdisciplinary collaboration, especially between basic and clinical investigators, and also encourages training and mentoring of young investigators as well as an inclusion of women and minorities.HIV - At TMH, research focuses on the treatment and prevention of HIV infections, especially in hard-to-reach populations, both in the U.S. and abroad. There are international sites located in Cambodia, India, Kenya, Indonesia, The Philippines, and South Africa. The TB Clinic performs research in the area of co-infections of HIV and tuberculosis. The Centers for Behavioral and Preventive Medicine aims to improve health through behavioral change and the integration of behavioral and biomedical science using clinical, community, and laboratory-based research. The Centers' research bridges biomedical, sociobehavioral, and population/public health scientific disciplines. Faculty members are committed to both basic research on discovering the mechanisms underlying behavioral factors in health and illness (e.g., examining the stress response among children and adolescents, neuroimaging of AIDS, and other medical conditions), as well as to applied research on the translation of these discoveries for clinical and community health improvement. Programs range from those that focus on primary prevention (e.g., promoting smoking cessation, preventing weight gain, increasing physical activity, and HIV/AIDS prevention) to improving the effectiveness of treatment and enhancing quality of life in populations such as cancer survivors and patients enrolled in cardiac rehabilitation programs. Form 990, Part III, 4c: TMH provides the setting for and substantially supports medical education in various clinical training and nursing programs. The total cost of medical education provided by TMH exceeded the reimbursement received from third-party payors by $17,527,884 in 2018.In 1969, TMH and certain other Rhode Island hospitals entered into an affiliation agreement to participate jointly in various clinical training programs and research activities with Brown Medical School, renamed The Warren Alpert Medical School of Brown University (Brown). The goals of the partnership are to facilitate the expansion of joint educational and research programs to enable competition both clinically and academically.TMH participates in Brown programs in anesthesiology, internal medicine and medicine subspecialties, general surgery and surgical subspecialties, psychiatry, emergency medicine and emergency medicine subspecialties, orthopedics and orthopedics subspecialties, and dermatology. TMH provides stipends to residents and physician fellows while in training.In addition, TMH is a participating clinical training site for residents from other programs in anesthesiology, family medicine, internal medicine, hematology/oncology, obstetrics/gynecology (OB/Gyn) and OB/Gyn subspecialties, otolaryngology, pediatric dentistry, podiatry, psychiatry and its subspecialties of forensic psychiatry, consult liaison psychiatry, and geriatric psychiatry, orthopedics, rheumatology, and radiation oncology. Various departments and specialties at TMH serve as clinical sites for the physician assistant schools of Johnson & Wales University, Bryant University, and the Massachusetts College of Pharmacy. In addition, Behavioral Medicine at TMH, in collaboration with Brown, sponsors research and clinical psychology training programs for interns, postdoctoral fellows, and faculty trainees.With respect to nursing education, TMH has developed educational affiliations with the University of Rhode Island College of Nursing; Rhode Island College School of Nursing; Community College of Rhode Island (CCRI); Salve Regina University; Boston College; Yale University; Regis College; Simmons College; St. Josephs Health Services School of Nursing; the University of Massachusetts campuses at Dartmouth, Boston, Amherst, and Worcester; Framingham State University; the University of Connecticut; The New England Institute of Technology; Northeastern University; Drexel University; Walden University; Georgetown University School of Nursing and Health Studies; Duke University School of Nursing; and the University of Pennsylvania, as well as other Schools of Nursing, pursuant to which their nursing students obtain clinical training and experience at TMH. TMH does not receive any compensation from the various schools for providing a clinical setting for the student nurse training. TMH also serves as a clinical site for Medical Assistants.The Lifespan School of Medical Imaging collaborates with Rhode Island College in the following programs: diagnostic medical sonography; nuclear medicine technology; radiography; and magnetic resonance imaging. Students complete educational experiences at TMH, as well as other outpatient sites.TMH sponsors training programs for a variety of allied health care professionals, including required clinical and fieldwork experiences in physical, speech, and occupational therapy, which are provided to university students in each discipline through contracts with the various universities. TMH acts as a clinical training site for students from CCRI in its vascular and cardiology ultrasound programs and provides training experiences for both phlebotomy students and physical therapy assistant students. TMH serves as a clinical training site for students from The Nuclear Medicine Institute of the University of Findlay (Ohio) and has educational affiliations with the respiratory programs at both CCRI and The New England Institute of Technology. TMHs EEG Department provides clinical training to neurodiagnostic technology students from Laboure College (Massachusetts).TMH has clinical affiliations/student clinical training programs for pharmacy students provided through contracts with a number of colleges and universities. Most of the pharmacy students attend the University of Rhode Island, Massachusetts College of Pharmacy and Allied Health Sciences, and Northeastern University. TMH has clinical social work student contracts with Rhode Island College, Boston University, Boston College, Smith College, Simmons College, and Bridgewater State University. Form 990, Part VI, Section A, Line 1b: *Lawrence A. Aubin, Sr., Chair, is the owner of Lawrence Investments, LLC, with which Lifespan entered into a ten-year operating lease of certain health care facilities in July 2015. During fiscal year 2018, Lifespan paid rent to Lawrence Investments, LLC under the terms of this lease. Form 990, Part VI, Section B, Line 12c Lifespan Corporation has a Conflict of Interest Policy that is applicable to all affiliates, including TMH, and administered by Lifespan's Corporate Compliance Department as follows: Each designated person subject to Lifespan's conflict of interest policy is required to provide Lifespan with an initial disclosure statement and thereafter an annual statement attesting that: (i) the designated person has read and is familiar with this policy, and (ii) the designated person and, to the best of his/her knowledge, family members, have not in the past engaged in, are not presently engaging in, or plan to engage in, any activity which contravenes this policy.If, at any time during the course of employment or association, a designated person has reason to believe that an existing or contemplated activity may contravene this policy, the person shall submit a full written description of the activity to the Lifespan Compliance Officer or the Office of the General Counsel to seek a determination as to whether the contemplated activity does or does not contravene this policy. This requirement shall be acknowledged as part of the annual performance evaluation process. If the activity in question involves either the Chief Executive Officer, the Senior Vice President and General Counsel, or a Trustee, a full written disclosure must be made to, and a determination sought from, the Chairman of the Board of Directors of Lifespan Corporation.Annually, the Lifespan Compliance Officer shall review and report to the Lifespan Executive Corporate Compliance Committee and to the Lifespan Audit and Compliance Committee on the administration of this policy.Failure on the part of any designated person to comply with this policy, including failure to submit in a timely fashion the conflict of interest disclosure statement, will be grounds for removal from his/her position and/or termination of his/her employment with Lifespan. Form 990, Part VI, Section B, Lines 15 a&b The following applies to Lifespan and all of its affiliates, including TMH:EXECUTIVE COMPENSATIONLifespan's executive compensation philosophy balances appropriate stewardship of resources and the need to be competitive in recruiting and retaining talented individuals. It incorporates market-competitive and performance-related principles, and covers the President and CEO of Lifespan as well as other officers, senior management, and key employees. Lifespan's executive compensation program complies both with law and with contemporary ethical norms, and is administered consistent with the organization's tax-exempt status under Section 501(c)(3) of the Internal Revenue Code (IRC) and the avoidance of transactions subject to intermediate sanctions under Section 4958 of the IRC. Executive compensation is also administered consistent with Lifespan's Corporate Compliance Policy on Excess Benefit Transactions.The Compensation Committee of the Lifespan Corporation Board of Directors (the Committee), comprised of disinterested Lifespan Board members, is responsible for diligent oversight of executive compensation to ensure compliance with IRC requirements. Its duties include:* Approving eligibility for participation in the executive compensation program * Approving changes in compensation for existing executive participants * Approving guidelines, such as salary ranges and contract terms, on appropriate levels of compensation for other key employees* Approving new, and modifying or terminating existing, executive compensation plans including, but not limited to, annual incentive and executive benefit plans* Approving performance objectives associated with Lifespan's annual incentive plan, including measuring points, and using audited actual performance relative to these objectives as a precondition to approving the payment of any awards under the plan* Authorizing periodic performance benchmark studies to be conducted for purposes of assessing Lifespan's performance within the healthcare industry and the degree to which total remuneration levels at Lifespan are generally commensurate with Lifespan performance relative to healthcare industry performance* Conducting an annual performance review of Lifespan's Chief Executive Officer. The Chair of the Committee conducts and documents this review, based on his/her observations and interpretation of feedback from members of the Board of Directors* Selecting and engaging qualified, independent, third-party compensation valuation consultants that the Committee charges with rendering opinions with respect to the reasonableness and comparability of compensation as well as the comparative organizations against which compensation is assessed, in accordance with relevant sections of the IRC and Lifespan's executive compensation philosophy.Lifespan's Chief Executive Officer works closely with the Committee to make recommendations on the above topics and keep the Committee informed about contemplated compensation changes for executives and other key employees, as well as candidates for these roles. The CEO also provides periodic updates to the Committee regarding Lifespan's performance relative to compensation-related performance objectives. The Committee's deliberations and actions are documented in minutes prepared for each meeting.PROCESS FOR DETERMINING COMPENSATION Valuation of Total Cash and Total Remuneration: No less frequently than annually, the Committee receives and reviews a total cash compensation valuation of all existing executive compensation program participants prepared by its independent compensation consultant. Annually, the Committee also receives and reviews a total remuneration valuation of all existing executive compensation participants.Base Salary Actions: The CEO recommends any salary adjustments for participants in the executive compensation program, using the results of the valuation study and his/her assessment of individual performance or other pertinent information, for the Committee's consideration.New Participants in Executive Compensation Program: With respect to compensation offers for individuals expected to participate in the executive compensation program, certain members of the Lifespan CEO's Council work with the Committee's independent compensation consultant or rely on information previously provided by the consultant to establish a range of reasonable cash compensation within which recruitment is expected to conclude with acceptance of a reasonable compensation offer. ALC dba HSR 249 Roosevelt Avenue Pawtucket RI 02860 050442015 Housing for Elderly and Mentally Ill RI 501(c)(3) 10 Gateway Healthcare Inc false Bayberry Courts Inc 249 Roosevelt Avenue Pawtucket RI 02860 204590384 Housing for Elderly and Mentally Ill RI 501(c)(3) 10 Gateway Healthcare Inc false Bradley Hospital Foundation 167 Point Street Providence RI 02903 050500688 Philanthropic Activities RI 501(c)(3) 7 Lifespan Corporation false Capital City Community Centers Inc 249 Roosevelt Avenue Pawtucket RI 02860 050259090 Daycare Services RI 501(c)(3) 7 Gateway Healthcare Inc false Emma Pendleton Bradley Hospital 1011 Veterans Memorial Parkway East Providence RI 02915 050258806 Pediatric Psych. 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