2017-05-15T15:47:02-05:00 2016-06-30 ERNST & YOUNG US LLP 201 NORTH FRANKLIN STREET STE 2400 TAMPA FL 33602 990 2015-07-01 520591612 Frederick Memorial Hospital Inc % MICHELLE K MAHAN FRED 2405663000 400 WEST SEVENTH STREET FREDERICK MD 21701 MICHELLE K MAHAN CFO 2405663350 2017-05-15 true MELANIE A MCPEAK P01346034 8132254800 2015 2021-01-29 14:40:06Z THOMAS KLEINHANZL 400 WEST SEVENTH STREET FREDERICK MD 21701 399270076 false X WWW.FMH.ORG X 1897 MD TO CONTRIBUTE TO THE HEALTH AND WELL-BEING OF AREA RESIDENTS BY PROVIDING QUALITY HEALTHCARE IN A CARING, COST EFFICIENT, SAFE AND CONVENIENT MANNER. 21 17 2297 676 9186 4529757 5988839 330710595 345251128 7037579 4509473 -484627 -677315 341793304 355072125 100000 50000 0 0 134637638 135290435 48000 72000 648753 188814109 195281102 323599747 330693537 18193557 24378588 468398859 496222959 254689875 271801049 213708984 224421910 X THE MISSION OF FREDERICK MEMORIAL HOSPITAL, INC. IS TO CONTRIBUTE TO, THE HEALTH AND WELL-BEING OF AREA RESIDENTS BY PROVIDING QUALITY, HEALTH CARE IN A CARING, COST EFFICIENT, SAFE AND CONVENIENT MANNER, THROUGH A COORDINATED PROGRAM OF PREVENTION, DIAGNOSIS AND TREATMENT, REHABILITATION, AND SUPPORT. false false 35668175 50000 50702236 INPATIENT SERVICES IN FY2016, FREDERICK MEMORIAL HOSPITAL'S INPATIENT MEDICAL-SURGICAL DEPARTMENTS PROVIDED QUALITY, PATIENT-CENTERED CARE, REGARDLESS OF ABILITY TO PAY, TO APPROXIMATELY 23,193 INPATIENTS AND OBSERVATION PATIENTS. MAJOR MEDICAL AND SURGICAL SERVICES INCLUDE CARDIOLOGY, CONGESTIVE HEART FAILURE, POST-CARDIAC CATHETERIZATION, CENTER FOR CHEST PAIN, HEMODIALYSIS, PERITONEAL DIALYSIS, NEUROLOGY, NEUROSURGERY, PULMONOLOGY, ONCOLOGY, ORTHOPEDICS, GENERAL MEDICINE AND SURGICAL CARE. INPATIENT CARE IS SUPPORTED BY A TEAM OF BOARD-CERTIFIED PHYSICIAN HOSPITALISTS. IN ADDITION, FMH IS DESIGNATED AS A PRIMARY STROKE CENTER BY THE MARYLAND INSTITUTE OF EMERGENCY MEDICAL SERVICE SYSTEMS (MIEMSS) AND IS RECOGNIZED WITH THE STROKE CENTER GOLD PERFORMANCE AWARD BY THE AMERICAN HEART ASSOCIATION. OUR BARIATRIC SURGICAL PROGRAM IS ACCREDITED BY THE AMERICAN SOCIETY FOR METABOLIC AND BARIATRIC SURGERY AS A BARIATRIC SURGERY CENTER OF EXCELLENCE. IN ADDITION TO THE PROGRAM SERVICES EXPENSE LISTED HERE, FMH INCURRED $44.1 MILLION OF GENERAL AND ADMINISTRATIVE EXPENSES IN MEETING THE HEALTH NEEDS OF OUR PRIMARY SERVICE AREA. 33774907 0 59973314 PERIOPERATIVE SERVICES FREDERICK MEMORIAL HOSPITAL'S PERIOPERATIVE SERVICES PROVIDED HIGH QUALITY CARE TO 11,590 SURGICAL AND ENDOSCOPY PATIENTS IN FISCAL YEAR 2016. PROCEDURES WERE PERFORMED IN OUR STATE OF THE ART FACILITY WHICH INCLUDES A DEDICATED IMAGING ROOM FOR VASCULAR AND OTHER PROCEDURES. WE HAVE PARTICIPATED IN THE SCIP QUALITY IMPROVEMENT PROJECT FOR CONTINUAL IMPROVEMENTS IN CARE FOLLOWING EVIDENCE BASED MEDICINE. WE TRACKED OUR PATIENT SATISFACTION THROUGH PRESS GANEY TO BENCHMARK OUR RESULTS TO THE NATIONAL DATA BASE. IN ADDITION TO THE PROGRAM SERVICES EXPENSE LISTED HERE, FMH INCURRED $44.1 MILLION OF GENERAL AND ADMINISTRATIVE EXPENSES IN MEETING THE HEALTH NEEDS OF OUR PRIMARY SERVICE AREA. 26134216 0 39302421 ONCOLOGY FMH'S ONCOLOGY PROGRAM PROVIDES INTEGRATED, MULTIDISCIPLINARY, PATIENT CENTERED CANCER CARE FOR PATIENTS WITH MALIGNANCIES, REGARDLESS OF ABILITY TO PAY. SERVICES INCLUDE MEDICAL ONCOLOGY CONSULTATIONS, CHEMOTHERAPY, RADIATION ONCOLOGY CONSULTATIONS ANDTREATMENT AND SURGICAL ONCOLOGY CONSULTATIONS AND TREATMENT. WE OFFER COORDINATED MULTIDISCIPLINARY CLINICS FOR PATIENTS WITH CANCERS OF THE LUNG, BREAST AND PROSTATE. INTEGRATED PALLIATIVE CARE AND HOSPICE SERVICES, BOTH INPATIENT AND OUTPATIENT ARE AVAILABLE FOR PATIENTS WITH ADVANCED MALIGNANCIES. SUPPORT SERVICES INCLUDE NUTRITION, PATIENT NAVIGATION AND SOCIAL WORK, AS WELL AS OTHER FORMS OF PSYCHOSOCIAL SUPPORT. FOR THOSE WITH ADDITIONAL FINANCIAL NEED, FINANCIAL COUNSELORS AND A PATIENT ASSISTANCE FUND IS AVAILABLE. THE PROGRAM TREATS APPROXIMATELY 800 NEWLY DIAGNOSED CANCERS PER YEAR AND ALSO HAS A COMMUNITY OUTREACH PROGRAM THAT INCLUDES EDUCATION AND SCREENING. THE PROGRAM IS ACCREDITED BY THE AMERICAN COLLEGE OF SURGEONS COMMISSION ON CANCER. IN ADDITION TO THE PROGRAM SERVICES EXPENSE LISTED HERE, FMH INCURRED $44.1 MILLION OF GENERAL AND ADMINISTRATIVE EXPENSES IN MEETING THE HEALTH NEEDS OF OUR PRIMARY SERVICE AREA. 190308267 0 196598723 285885565 true true false true false false false false false true true false true false true false false true false false true false false true false false true true true false true true false false false false false false false false false false false false false false true true true true false false true 391 0 true 2297 true true true false false false false false false false false false X 21 17 false false false false true true true true true false true true true true true true true true true true true true MD X MICHELLE K MAHAN 2405663350 400 WEST SEVENTH STREET FREDERICK MD 21719 X J Frederick Manning SECRETARY/TREASURER 4.0 2.0 X X 0 0 0 P Gregory Rausch MD Chair, FMH Development Council 4.0 0.0 X 0 0 0 E James Reinsch Chairman 4.0 4.0 X X 0 0 0 Anne Herbert Rollins DIRECTOR 2.0 0.0 X 0 0 0 Neil Waravdekar MD DIRECTOR (END 09/30/15) 2.0 0.0 X 27248 2594 0 Rev Roger W Wilmer Jr Director 2.0 0.0 X 0 0 0 Gerald Winnan MD VICE CHAIRMAN 2.0 3.0 X X 0 0 0 Shawn Wolf Director 2.0 0.0 X 0 0 0 Ravi Yalamanchili DIRECTOR 2.0 0.0 X 88431 0 0 Cornelius Fay Director 2.0 0.0 X 0 0 0 Terrence McPherson Director 2.0 0.0 X 0 0 0 Laura Melia Director 2.0 0.0 X 0 0 0 Thomas A Kleinhanzl President and CEO 30.0 10.0 X X 880200 0 220432 R CARL BENNA DIRECTOR 2.0 0.0 X 0 0 0 ALLEN D MAWDSLEY DIRECTOR 2.0 0.0 X 0 0 0 ELLEN NOLAND DIRECTOR - END 7/1/16 2.0 0.0 X 0 0 0 ELIZABETH PAKENAS DIRECTOR 2.0 0.0 X 0 0 0 Gregory P Dormitzer Director 2.0 20.0 X 0 0 0 Theodore Luck Director 2.0 0.0 X 0 0 0 HONORABLE STEPHEN JOHNSON DIRECTOR - START 10/01/15 2.0 0.0 X 0 0 0 THOMAS MUNRO MD VC OF STAFF - START 10/1/15 5.0 0.0 X 10999 0 0 BERNARD GOUIN DIRECTOR - END 9/30/15 2.0 2.0 X 0 0 0 GERRIT SCHIPPER MD CHIEF OF STAFF 10.0 0.0 X 51996 0 0 Michelle K Mahan Sr VP and CFO 40.0 10.0 X 497160 0 48510 John R Verbus Sr VP and COO 40.0 10.0 X 547655 0 32679 Manuel A Casiano VP Medical Staff 40.0 0.0 X 651761 0 58382 Cheryl L Cioffi VP Chief Nursing Officer 40.0 0.0 X 278683 0 54275 Kenneth R Coffey II VP Chief Development Officer 40.0 0.0 X 203810 0 22045 Hannah R Jacobs VP Finance 40.0 0.0 X 204331 0 12866 Rachel I Mandel AVP Medical Affairs 40.0 0.0 X 197615 0 11898 Craig F Rosendale VP Ancillary Services 40.0 0.0 X 207312 0 26083 Donald R Schilling VP Ambulatory Services 40.0 0.0 X 215683 0 18513 Jennifer G Teeter AVP Payor Contracting 20.0 20.0 X 196487 0 25660 Jim R Williams VP Business Development 40.0 0.0 X 240228 0 28134 HEATHER R KIRBY AVP-CARE MGMT 40.0 0.0 X 160808 0 20109 Mark S Soberman Physician 40.0 0.0 X 439112 0 27516 DUSTIN M SIMONSON ONCOLOGY MEDICAL PHYSICIST 40.0 0.0 X 193471 0 27417 JAMES BLAKE TRUMBLE MEDICAL DIRECTOR 40.0 0.0 X 236989 0 28542 LILA J BEAULIEU DIRECTOR-SURGICAL SVCS 40.0 0.0 X 149872 0 10595 JENNIFER D HULVEY DIRECTOR-REVENUE COMPLIANCE 40.0 0.0 X 150260 0 19171 TERRY P O'MALLEY-LEFT 1215 VP HUMAN RESOURCES 0.0 0.0 X 224741 0 19446 6054852 2594 712273 91 true true false TXTEAM REHAB INC 4625 E STOP 11 ROAD INDIANAPOLIS IN 46237 REHAB SERVICES 6644922 SOUND PHYSICIANS PO BOX 742936 LOS ANGELES CA 90074 PHYSICIAN SERVICES 3160133 ALLIANCE RADIOSURGERY LLC PO BOX 6600 NEWPORT BEACH CA 92568 ONCOLOGY SERVICES 2884501 QUEST DIAGNOSTICS PO BOX 740709 ATLANTA GA 30374 LABORATORY SERVICES 1543141 MORRISON MANAGEMENT SPECIALIST PO BOX 102289 ATLANTA GA 30368 MANAGEMENT SERVICES 2920481 52 0 5988839 0 5988839 INPATIENT REVENUE 624110 170396903 170396903 0 0 OUTPATIENT REVENUE 621410 171358807 171358807 0 0 GROUP PURCHASING PREMIER 525990 204765 195579 9186 0 All other program service revenue 900099 3290653 3290653 0 0 345251128 3143473 3143473 0 0 264322 264322 0 264322 264322 45535625 28326 44161290 36661 1374335 -8335 1366000 1366000 0 0 0 CAFETERIA REVENUE 722511 1118689 1118689 0 0 MT. AIRY, LLC. MGMT. FEE 541610 206877 206877 0 0 LOSSES INTEREST RATE SWAP 900099 -2267203 0 0 -2267203 -941637 355072125 346567508 9186 2506592 X 50000 50000 0 0 0 0 0 0 5254098 0 5254098 0 100120268 95660369 4319700 140199 0 0 0 0 8764800 7956812 796327 11661 13587360 13241437 316606 29317 7563909 7044440 509399 10070 15714613 13426947 2287666 0 784183 0 784183 0 427459 0 427459 0 19067 19067 0 72000 72000 366548 0 366548 0 69616404 52382384 17115701 118319 1278377 12512 1065607 200258 6006909 5595068 375146 36695 4300202 4300202 0 0 0 0 0 0 3942714 3119183 823531 0 131505 89834 41096 575 0 0 0 0 181603 124057 56752 794 4494646 4211484 274173 8989 0 0 0 0 22896659 15855870 7027463 13326 1889129 14306 1874823 0 SUPPLIES & COGS 63231084 62800660 423874 6550 330693537 285885565 44159219 648753 0 0 0 24923467 30945038 4573065 6416992 47079421 45933758 0 0 0 0 0 0 6006311 6054643 2290779 3109905 484151726 275872098 196220517 208279628 128157562 126716003 0 0 51139776 57794224 0 0 8007961 10972768 468398859 496222959 37615091 47691282 0 0 0 0 164229787 162305192 0 0 0 0 0 0 0 0 52844997 61804575 254689875 271801049 X 203281498 211148698 9451309 12297035 976177 976177 213708984 224421910 468398859 496222959 X 24378588 -6070982 0 0 0 -7594680 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false 0 false 0 false 0 false 0 false 0 false 0 true 19067 19067 false SCHEDULE C, PART II-B, LINE 1I EXPENSE IS A PORTION OF DUES PAID TO THE AMERICAN HOSPITAL ASSOCIATION and MARYLAND HOSPITAL ASSOCIATION. 976177 976177 976177 976177 976177 976177 976177 976177 976177 976177 1.00000 false false 3893774 3893774 217870745 85410059 132460686 23734584 11361383 12373201 221659459 179100656 42558803 16993164 16993164 208279628 ASSETS LIMITED AS TO USE 4114473 F INVESTMENTS IN SUBSIDIARIES 21530988 F INTERCOMPANY RECEIVABLES 32148763 F 57794224 0 ADVANCES FROM THIRD PARTIES 8981703 INTEREST RATE SWAP CONTRACT 14057969 PENSION LIABILITY 24886355 MALPRACTICE INSURANCE LIABILITY 2690000 CAPITAL LEASE OBLIGATIONS 3871264 OTHER LIABILITIES 5985026 INTER COMPANY LIABILITIES 1332258 61804575 INTENDED USE OF ENDOWMENT FUNDS SCHEDULE D, PART V, LINE 4 ENDOWMENT FUNDS ARE USED FOR HEALTH CARE SERVICES. Central America and the Caribbean 1 Investments 13806517 Central America and the Caribbean 1 Program services self insurance 2880630 2 2 16687147 16687147 true false true false false false X X X X X X X true PRIDE PHILANTHROPY DEV CNSL SRVCS false 72000 72000 MD true true true X true X true true true false true true 8659184 0 8659184 0.02620 40411047 40580632 -169585 0.00000 49070231 40580632 8489599 0.02570 3962896 366705 3596191 0.01090 62503 0 62503 0.00020 15507050 819306 14687744 0.04440 19532449 1186011 18346438 0.05550 68602680 41766643 26836037 0.08120 false 3363154 252237 127947518 116502479 11445039 X true true 1 1 FREDERICK MEMORIAL HOSPITAL 400 W 7TH STREET FREDERICK MD 21701 WWW.FMH.ORG X X X Frederick Memorial Hospital false false true X X X X X X X X X 15 true false true true X SEE PART V, SECTION C X true 15 true SEE PART V, SECTION C false true X 200. 300. X X X true true X X true X SEE PART V, SECTION C X SEE PART V, SECTION C X SEE PART V, SECTION C X X X X X true X false X X X X X true X false false INPUT FROM COMMUNITY REPRESENTATIVES SCHEDULE H, PART V, SECTION B, LINE 5 Health Improvement Plan workgroups, and areas that routinely capture and report annual data. Topics of interest were also identified In order to provide a community-wide health assessment and reduce participation fatigue in our community, agencies that had conducted community needs or health assessments were surveyed by the Frederick County Health Department in January 2015 to determine the interest in conducting a joint assessment. The required timing of many agencies assessments created a challenge for such a venture. This included various sectors of the community: United Way, Religious Coalition for Emergency Human Needs, City of Frederick Community Action Agency, Mission of Mercy, Frederick Memorial Hospital, Department of Aging, and Local Management Board. While interest was expressed by many agencies, the final determination was that the next community assessment would be a collaboration primarily between the Frederick County Health Department and Frederick Memorial Hospital. These agencies agreed to conduct the data gathering and analysis and to query the other organizations about potential topics and survey questions to include. Data included in the community health assessment reflect areas of interest in the report year, datasets being used by the Local during the public comment of the draft, and added to the document. SCHEDULE H, PART V, SECTION B, LINE 6B The Frederick County Health Department, The Maryland Hospital Association, Johns Hopkins Health Care, the American Cancer Society, Health Services Cost Review Commission, Frederick City Government, United Way of Frederick County, Community Foundation of Frederick County, the Department of Health and Mental Hygiene, Community Action Council, the Religious Coalition of Frederick County, the Diversity Leadership Institute, Inc., the Family Services Foundation, Community Living Inc. of Frederick County, Care Net of Frederick, Mission of Mercy and Frederick Memorial Hospital. SCHEDULE H, PART V, SECTION B, LINE 7A http://www.fmh.org/documents/PDFs/56183-Community-Health_Rev-829.pdf SCHEDULE H, PART V, SECTION B, LINE 10A https://www.fmh.org/documents/FMH-Community-Needs-Assessment-Implementatio n-Strategy-2016.pdf SCHEDULE H, PART V, SECTION B, LINE 11 In 2016 FMH conducted a Community Health Needs Assessment (CHNA) in partnership with the Frederick County Health Department to better understand the specific health needs of the community. In addition to the CHNA, FMH is required, in accordance with section 501(c)(3) of the Internal Revenue Code, to develop an Implementation Strategy that addresses the key findings brought forward in the assessment. Strategic Priorities: The themes throughout the CHNA presented themselves as three strategic priorities: 1) Access to Care 2) Health Care Navigation 3) Community Outreach and Health Literacy. All of the CHNA topic area and key findings below fall into one if not all of the strategic priorities listed. Frederick County Priority Setting Summit: On September 13, 2016 the Frederick County Health Department, with support from FMH, hosted more than 100 healthcare providers, administrators, non-profit leaders, health officials, government agency representatives and community members of Frederick County to review the findings of the CHNA. Although we agree that all health needs are important, the goal of the summit was to prioritize the areas of focus for the community at large. The general consensus for community collaboration was to focus on addressing the social determinants of health, which ultimately impact the prevalence and severity of mental health, substance abuse, and chronic disease. The top three priorities which received the most votes are: - Behavioral Health - Elderly Support - Adverse Childhood Experiences FMH will support a subset of those priorities as outlined in the Implementation Strategy Summary grid. The Frederick County Health Department and other community partners are actively working on their specific subsets. FMH will continue to actively support and participate in the county level work groups. The implementation strategy is intended to be a fluid document that continues to evolve as these findings are further interpreted and understood. Dental Care: Improve access to adult dental care, in the right place, right setting, right time. Mental Health: Improve identification and treatment of mental health. Substance Abuse/Addiction: Improve identification and treatment of substance abuse. Chronic disease management, Heart Disease and Stroke: Increase outreach, education and navigation to vulnerable communities. Chronic disease management, Lung Disease (COPD/Pediatric Asthma): Increase outreach education and navigation to vulnerable communities. Chronic disease management, Diabetes: Increase outreach education and navigation to vulnerable communities. Chronic disease management, Cancer: Increase outreach education and navigation to vulnerable communities. FMH COMMUNITY BENEFITS COMMITTEE The community benefits committee is comprised of key leaders and front line providers that review requests for FMH participation in community events, outreach and sponsorship. This committee will use the 2016 CHNA implementation strategy to guide them in decision making to allocate resources that align with the identified health needs of Frederick County. These initiatives include participation in local health fairs and events where we provide screenings, education and navigation to resources in the community and follow up information. For example in 2016 FMH is once again a key partner with the Asian American Center of Frederick at its annual Health Fair. FMH will offer 500 flu vaccine, 300 cholesterol and glucose screenings and bone density screening. Health Care Navigation, Health Literacy, Community Outreach. In addition to the implementation strategy summary, further narrative explanation of response to community needs is included below. Many of these programs were developed to address health disparities and to help us reach vulnerable populations. BRIDGES LAY HEALTH EDUCATOR PROGRAM FMH established Bridges and the Lay Health Educator (LHE} Program in response to feedback obtained during the 2012 Community Health Needs Assessment indicating that more FMH sponsored programs and seminars needed to be conducted in the community. The assessment showed that the multicultural community wanted and needed to be engaged to improve health and the overall quality of life. This focused new efforts to connect networks and build partnerships to close the gap on health disparities, decrease the incidence of chronic disease and preventable illness, and build a healthier Frederick. The LHE Program is designed to prepare volunteers from multicultural communities to start or energize health programs in the places that they live, work, worship and gather. Instructors are drawn from the hospital's physicians, other professional staff, nursing educators, advocacy groups and community physicians. To date, Bridges has prepared 42 people from 24 different faith based and community service organizations who represent more than 12 countries and languages. Some of the faith and culturally based organizations serve isolated and vulnerable senior populations, while others have health ministry members who perform outreach to local low income communities. One significant outcome is that people are reaching across racial, religious, and ethnic lines to build new bridges toward better health. Perhaps more significantly, they are now being integrated into other hospital programs that benefit from consumer involvement so that their diverse perspectives can be called upon in building the future of healthcare. Health Care Navigation & Literacy, Community Outreach Community Behavioral Health Case Management: The Community Behavioral Health Case Manager provides intensive community based services to individuals who have recently been hospitalized due to a mental health or substance use related crisis. FMH also contracts services from Potomac Case Management Inc. to provide similar services to the community as the volume of the need exceeds our available resources. Both the community behavioral health case manager and Potomac Case Management work to engage individuals in the community to coordinate services and remove barriers as they relate to: access to follow-up care and treatment, medications, transportation, health insurance, employment, and overall health and wellness. Access to Care, Health Care Navigation, Health Literacy Community Health Worker Program: The Community Health Worker is a front line public health worker. Their understanding of unique communities as it relates to culture, language, socio-economic status, and overall challenges the community faces around social determinates result in higher levels of trust and engagement. The Community Health Worker serves as a liaison between individuals/communities and the health and social services systems. They are navigators, advocates, educators, resource gathers, and promoters of improved self-management and independence. The Community Health Worker Program at FMH will focus on uninsured or underserved individuals as well as those with chronic conditions, including heart failure, COPD, Diabetes, and Asthma, while also working to strengthen the health and wellness of vulnerable communities across Frederick County. Access to Care, Health Care Navigation, Health Literacy, Chronic Disease CARE Clinic and Care Transitions Program: The CARE Clinic and Care Transitions Program provide comprehensive, multidisciplinary services to individuals with chronic conditions and with limited or no access to necessary healthcare services. Services provided include: health literacy education, medication management, self-management techniques/skills, care coordination and navigation as well as advocacy and navigation to remove financial barriers to care and social determinates of health. The CARE Clinic is a stable clinic setting within the hospital, while the Care Transitions team provides the same comprehensive service in a mobile environment, in homes, community centers, or in physician practices. The design of the program was created with flexibility in mind, allowing the team to engage individuals in the most appropriate setting. Lung Cancer Among African American Males in Frederick County: Research has shown that African Americans are more likely to die from lung cancer than people of any other race or ethnicity, although they are not more likely to smoke. African Americans are disproportionately affected by lung cancer. The percentage of African-American men diagnosed with lung cancer each year is at least 30% higher than among white men, even though they have similar rates of smoking as white men. In Frederick County, the incidence of lung cancer in African Americans is 66.7 per 100,000. The death rate from lung cancer is 52.8 compared to the Maryland rate of 49.0. Cancer mortality for African Americans in Frederick County increased 60% from 2008 to 2011, and was up 19% from 2010 to 2011. FMH is going to focus on this vulnerable population by educating African American males about lung cancer and the lung cancer screening p SCHEDULE H, PART V, SECTION B, LINE 13H STATE REGULATIONS SCHEDULE H, PART V, SECTION B, LINE 16A, 16B, and 16c http://www.fmh.org/About/Billing/Financial-Assistance.aspx Description of Financial Assistance Policy FMH reviews the Financial Assistance Policy (FAP) and the communication methodology we employ on a regular basis to make sure our patients have easy access to this information in a variety of formats and that it is culturally and linguistically sensitive. We review the FAP to make sure the reading comprehension level is appropriate for our audience and we provide English and Spanish versions to meet the needs of our CBSA. We have services available to provide any other languages when needed. The FAP is shown on our website (http://www.fmh.org/About/Billing/Financial-Assistance.aspx) and is offered to patients as part of the intake process at time of registration in the hospital and in the emergency department. Our billing statements reference our Financial Assistance Policy and include the URL for the online version. The billing statements are being updated during FY 17 to include detailed explanation of the FAP. FMH provides assistance to our patients who need to apply for government benefits when appropriate. Most common examples are "self-pay" Inpatients who admit through the Emergency Department and patients who come to our Prenatal Clinic. We have a Department of Social Services Representative onsite at our Prenatal Clinic to work directly with the patients. All patients receive the Patient Information Sheet, available in English and Spanish, which includes information about Financial Assistance. SCHEDULE H, PART V, SECTION B, LINE 20E PATIENTS WITH BALANCES GREATER THAN $10,000 RECEIVE A SPECIAL LETTER STATING THEY MAY QUALIFY FOR CHARITY AND REQUESTS THAT THEY CONTACT THE HOSPITAL. SCHEDULE H, PART V, SECTION B, LINE 22D MARYLAND'S HEALTH SERVICES COST REVIEW COMMISSION DETERMINES AMOUNTS CHARGED TO PATIENTS. 14 FMH KLINE HOSPICE HOUSE 7000 KIMMEL ROAD MT AIRY MD 21771 INPATIENT HOSPICE PATIENT FACILITY MT AIRY HEALTH SERVICES 1502 SOUTH MAIN STREET MT AIRY MD 21771 OUTPATIENT HEALTH FACILITY PARKVIEW MEDICAL GROUP MT AIRY 1502 SOUTH MAIN STREET MT AIRY MD 21771 PHYSICIAN PRACTICE PARKVIEW MEDICAL GROUP MYERSVILLE 3000-D VENTRIE COURT MYERSVILLE MD 21773 PHYSICIAN PRACTICE PARKVIEW MEDICAL GROUP FREDERICK 1564 OPPOSSUMTOWN PIKE FREDERICK MD 21702 PHYSICIAN PRACTICE FMH REGIONAL CANCER CARE THERAPY CTR 501 WEST SEVENTH STREET FREDERICK MD 21701 OUTPATIENT CANCER TREATMENT CENTER FMH ROSEHILL 1562 OPPOSSUMTOWN PIKE FREDERICK MD 21701 OUTPATIENT HEALTH FACILITY UNION BRIDGE FAMILY PRACTICE 104 NORTH MAIN STREET UNION BRIDGE MD 21701 PHYSICIAN PRACTICE FMH HOME HEALTH SERVICES 605 EAST CHURCH STREET FREDERICK MD 21701 HOME HEALTH NURSING ORGANIZATION HOSPICE OF FREDERICK COUNTY 516 TRAIL AVENUE FREDERICK MD 21701 HOSPICE CARE ORGANIZATION FMH ROSE HILL REHAB SERVICES 1562 OPPOSSUMTOWN PIKE FREDERICK MD 21702 PHYSICAL REHABILITATION CLINIC FMH CRESTWOOD 7211 BANK COURT FREDERICK MD 21703 OUTPATIENT HEALTH FACILITY FMH URBANA 3430 WORTHINGTON BLVD FREDERICK MD 21703 OUTPATIENT HEALTH FACILITY FMH IMMEDIATE CARE 850 OAK STREET FREDERICK MD 21702 WALK-IN CLINIC SUPPLEMENTAL INFORMATION SCHEDULE H, PART I FOR THE LAST 30 YEARS, MARYLAND HOSPITALS HAVE MET THEIR COMMUNITY BENEFIT OBLIGATIONS IN A UNIQUE MANNER THAT BUILDS THE COSTS OF UNCOMPENSATED CARE (CHARITY CARE AND PATIENT BAD DEBT) AND GRADUATE MEDICAL EDUCATION INTO THE RATES THAT HOSPITALS ARE REIMBURSED BY ALL PAYORS. THE SYSTEM IS BASED IN FEDERAL AND STATE LAW AND BENEFITS ALL MARYLAND RESIDENTS, INCLUDING THOSE IN NEED OF FINANCIAL ASSISTANCE TO PAY THEIR HOSPITAL BILLS. MARYLAND IS THE ONLY STATE IN WHICH ALL PAYORS (GOVERNMENTALLY-INSURED, COMMERCIALLY-INSURED, OR SELF-PAY) ARE CHARGED THE SAME PRICE FOR SERVICES AT ANY GIVEN HOSPITAL. UNDER THIS SYSTEM, MARYLAND HOSPITALS ARE REGULATED BY A STATE AGENCY, KNOWN AS THE HEALTH SERVICES COST REVIEW COMMISSION (HSCRC), THAT IS REQUIRED TO: -PUBLICLY DISCLOSE INFORMATION ON THE COST AND FINANCIAL POSITION OF HOSPITALS; -REVIEW AND APPROVE HOSPITAL RATES; -COLLECT INFORMATION DETAILING TRANSACTIONS BETWEEN HOSPITALS AND FIRMS WITH WHICH THEIR TRUSTEES HAVE A FINANCIAL INTEREST; AND, -MAINTAIN THE SOLVENCY OF EFFICIENT AND EFFECTIVE HOSPITALS. SINCE 2000, THE RATE SETTING COMMISSION HAS HAD ITS OWN FRAMEWORK FOR REPORTING HOSPITALS' COMMUNITY BENEFITS AND ISSUING A REPORT ANNUALLY REGARDING HOSPITALS' COMMUNITY BENEFIT TOTALS. THAT REPORT IS AVAILABLE ON TTP://WWW.HSCRC.STATE.MD.US/ BECAUSE OF THIS UNIQUE STRUCTURE MARYLAND HOSPITALS' COMMUNITY BENEFITS NUMBERS WILL NOT COMPARE WITH THE REST OF THE NATION'S HOSPITALS. HOWEVER, MARYLAND HOSPITALS MEET OR EXCEED THE COMMUNITY BENEFIT STANDARD ESTABLISHED BY THE IRS IN 1969. ADDITIONAL DETAIL ILLUSTRATING THIS CAN BE FOUND WITHIN THIS SCHEDULE H REPORT. CRITERIA FOR DETERMINING ELIGIBILITY FOR FREE OR DISCOUNTED CARE Form 990, Schedule H, Part I, Line 3c IN ADDITION TO USING FPG TO DETERMINE FREE AND DISCOUNTED CASE, PATIENTS MAY RECEIVE ADDITIONAL FINANCIAL ASSISTANCE IF THEIR BILL IS 25% OR MORE OF THEIR ANNUAL INCOME. EVERY INPATIENT OR OUTPATIENT WHO ACCUMULATES $10,000 OR MORE IN CHARGES RECEIVES A VISIT FROM A FINANCIAL COUNSELOR ALONG WITH A FINANCIAL ASSISTANCE APPLICATION. WE ALSO MAIL THESE PATIENTS ANOTHER FINANCIAL ASSISTANCE APPLICATION WITH A COVER LETTER STATING THAT DUE TO THE BALANCE OF THEIR BILL, THEY MAY QUALIFY FOR FINANCIAL ASSISTANCE. Text of bad debt expense footnote FORM 990, SCHEDULE H, PART III, LINE 4 BAD DEBT VALUATION WAS CALCULATED USING THE COST-TO-CHARGE RATIO DERIVED FROM WORKSHEET 2. WE ESTIMATE APPROXIMATELY 7.5% OF BAD DEBT EXPENSE ISATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER OUR FINANCIAL ASSISTANCE POLICY. WE CONTINUE OUR EFFORTS TO QUALIFY PATIENTS FOR FREE OR REDUCED CARE. Medicare Costing Methodology Form 990, schedule H, part III, line 8 MEDICARE PS&R REPORTS USED AS SOURCE OF COSTS AND PAYMENTS. Application of Collection Practices to those Qualifying for Financial AssiTANCE FORM 990 SCHEDULE H, PART III, LINE 9B PATIENTS WHO QUALIFY FOR CHARITY CARE OR FINANCIAL ASSISTANCE ARE SPECIFICALLY EXCLUDED FROM THE COLLECTION PROCESS. SPECIFICALLY EXCLUDED FROM THE COLLECTION PROCESS. NEEDS ASSESSMENT SCHEDULE H, PART VI, LINE 2 THE 2013 FREDERICK COUNTY HEALTH ASSESSMENT IS A DATA DRIVEN APPROACH TO DETERMINING THE HEALTH STATUS OF FREDERICK COMMUNITY RESIDENTS BY CAPTURING AND COMPARING STATISTICAL INFORMATION FROM THREE INDEPENDENT COMMUNITY-BASED HEALTH FOCUSED AND HUMAN NEEDS DRIVEN ORGANIZATION: - THE FREDERICK COMMUNITY FOUNDATION'S HUMAN NEEDS ASSESSMENT CONDUCTED IN AUGUST OF 2011, - THE LOCAL HEALTH IMPROVEMENT PLAN (L-HIP) PRIORITIES SUMMIT CONDUCTED IN OCTOBER OF 2011, AND - FREDERICK MEMORIAL HOSPITAL'S UTILIZATION DATA FOR THE EMERGENCY ROOM, INPATIENT ADMISSIONS AND OUTPATIENT SERVICE PROVISION. THE FMH DATA SERVED AS AN EVIDENCE-BASED CONFIRMATION OF THE OTHER TWO STUDIES' FINDINGS. THE COMPARATIVE ASSESSMENT FINDINGS WERE ADDITIONALLY VERIFIED USING THE CURRENT DATA FROM THE STATE HEALTH IMPROVEMENT PLAN. IN ADDITION, THE ASSESSMENT USES THE MOST CURRENT STATISTICAL INFORMATION AVAILABLE FROM A VARIETY OF RESOURCES INCLUDING THE MARYLAND HEALTH SERVICES COST REVIEW COMMISSION, THE MARYLAND BEHAVIORAL RISK FACTOR SURVEILLANCE SYSTEM, THE MARYLAND DEPARTMENT OF HEALTH AND MENTAL HYGIENE, THE US CENSUS AND OTHER STATE AND FEDERAL AGENCIES. THE 2013 COMMUNITY HEALTH ASSESSMENT PROVIDES THE INFORMATION THAT THE FREDERICK COUNTY HEALTH DEPARTMENT, FREDERICK REGIONAL HEALTH SYSTEM, THE FREDERICK COUNTY HEALTH CARE COALITION AND PARTNER GRASS-ROOTS AGENCIES AND ORGANIZATIONS NEED TO IDENTIFY ISSUES OF GREATEST CONCERN. DECISIONS TO COMMIT RESOURCES TO THOSE AREAS IDENTIFIED IN THIS COMPARATIVE STUDY WILL ENSURE THAT OUR COLLECTIVE EFFORTS HAVE THE GREATEST IMPACT ON OUR COMMUNITY'S HEALTH STATUS. PROJECT GOALS THE 2013 FREDERICK COUNTY HEALTH ASSESSMENT WILL SERVE AS A RESOURCE AND TOOL FOR REACHING THREE GOALS: - TO IMPROVE THE HEALTH STATUS OF FREDERICK COUNTY RESIDENTS, ELEVATE THEIR OVERALL QUALITY OF LIFE, AND INCREASE THEIR LIFE SPANS. QUALITY OF LIFE ISSUES REMAIN AN IMPORTANT COMPONENT OF THE PLAN AS ALL AGREE THAT THE MEASURE OF OUR COMMUNITY'S HEALTH GOES BEYOND ADDRESSING PHYSICAL, DENTAL, MENTAL AND BEHAVIORAL HEALTH NEEDS. - TO IDENTIFY THE SOCIO-ECONOMIC FACTORS WHICH HAVE HISTORICALLY HAD A NEGATIVE IMPACT ON OUR RESIDENTS' HEALTH. BY IDENTIFYING POPULATION SEGMENTS THAT ARE MOST AT-RISK FOR VARIOUS DISEASES AND INJURIES WE WILL, AS A COMMUNITY, BE BETTER POSITIONED TO ADDRESS HEALTH DISPARITIES. - TO PROVIDE MORE ACCESSIBLE PREVENTIVE SERVICES TO ASSIST COMMUNITY PARTNERS IN IMPROVING THE HEALTH STATUS OF FREDERICK COUNTY RESIDENTS, AND TO HELP US AS A COMMUNITY KEEP THE COSTS OF PROVIDING CARE FOR LATE-STAGE DISEASE IN CHECK. LATE-STAGE DISEASE IN CHECK. PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE SCHEDULE H, PART VI, LINE 3 FREDERICK MEMORIAL HOSPITAL POSTS ITS CHARITY CARE POLICY AND FINANCIAL ASSISTANCE CONTACT INFORMATION IN ADMISSION AREAS, THE FMH EMERGENCY DEPARTMENT, AND IN ALL OF OUR SATELLITE FACILITIES IN AREAS WHERE ELIGIBLE PATIENTS ARE LIKELY TO PRESENT. FMH PROVIDES A SUMMARY OF THE CHARITY CARE POLICY AND FINANCIAL ASSISTANCE CONTACT INFORMATION TO ALL PATIENTS AT THE TIME OF ADMISSION TO THE HOSPITAL. FMH ADMISSIONS PERSONNEL DISCUSS THE AVAILABILITY OF VARIOUS GOVERNMENT BENEFITS SUCH AS MEDICAID OR STATE PROGRAMS WITH PATIENTS AND/OR THEIR FAMILY MEMBERS, AND THEY ASSIST PATIENTS WITH QUALIFICATION FOR THE PROGRAMS. FREDERICK MEMORIAL HOSPITAL INCREASED ITS EFFORTS TO PROVIDE FINANCIAL ASSISTANCE TO ITS PATIENTS THROUGH A VARIETY OF INITIATIVES. FMH INCREASED ITS FINANCIAL ASSISTANCE FOR CATASTROPHIC SITUATIONS. IN OUR PROGRAM, PATIENTS MAY RECEIVE FINANCIAL ASSISTANCE IF THEIR BILL IS 25% OR MORE OF THEIR ANNUAL INCOME. A FINANCIAL COUNSELOR MEETS WITH PATIENTS WHO HAVE NO INSURANCE THE DAY AFTER ADMISSION TO EXPLAIN OUR FINANCIAL ASSISTANCE PROGRAM AND THE STATE'S MEDICAL ASSISTANCE PROGRAM. EVERY INPATIENT OR OUTPATIENT WHO ACCUMULATES $10,000 OR MORE IN CHARGES WILL RECEIVE A SECOND VISIT FROM A FINANCIAL COUNSELOR ALONG WITH A FINANCIAL ASSISTANCE APPLICATION. ALSO, WE MAIL THESE PATIENTS ANOTHER FINANCIAL ASSISTANCE APPLICATION WITH A COVER LETTER STATING THAT DUE TO THE BALANCE OF THEIR BILL, THEY MAY QUALIFY FOR FINANCIAL ASSISTANCE. Community Information Schedule H, Part VI, Line 4 IN THE YEAR ENDED JUNE 30, 2016, FREDERICK MEMORIAL HOSPITAL ADMITTED 17,744 PATIENTS. THE FMH EMERGENCY DEPARTMENT TREATED 75,243 PATIENTS. THE HOSPITAL IS THE ONLY HOSPITAL LOCATED IN ITS PRIMARY SERVICE AREA AND THE ONLY HOSPITAL WITHIN A 25-MILE RADIUS OF THE CITY OF FREDERICK. APPROX. 7.1% OF ALL COUNTY RESIDENTS REPORT NO HEALTH INSURANCE AND 26.5% OF PATIENTS SEEN ARE MEDICAID RECIPIENTS. FMH DEFINES ITS PRIMARY SERVICE AREA AS FREDERICK COUNTY, MARYLAND AND IS THE ONLY HOSPITAL LOCATED IN ITS PRIMARY SERVICE AREA AND THE ONLY HOSPITAL WITHIN A 25-MILE RADIUS OF THE CITY OF FREDERICK. THE POPULATION OF FREDERICK COUNTY, MARYLAND IS 243,675 WITH 50.7% FEMALES, 75.7% WHITE AND 12.9% OF THE POPULATION OVER THE AGE OF 65. AVERAGE HOUSEHOLD INCOME IS $84,570 AND 91.3% OF THE POPULATION ARE HIGH SCHOOL GRADUATES. 6.1% OF POPULATION IS BELOW THE POVERTY LEVEL AND UNEMPLOYMENT IS 4.4% Promotion of Community Health Schedule H, Part VI, Line 5 Our work with the Frederick County Health Care Coalition includes the following initiatives: - Dental Health Home Ensuring every adult resident of the county as an affordable dental home. - Healthy Workplace Recognize work places committed to improving employee health and well being based upon evidence-based worksite wellness guidelines derived from the CDC Worksite Health Scorecard. - Health Disparities Education and Awareness Identify tools and resources to help address disparities and set objective outcome indicators within the other Coalition workgroups. - Low income Elderly advocacy No elderly person in Frederick County will have an unmet health need due to lack of funding including access to: health care, transportation, housing, assisted living and nursing home care. - Reduction of Deaths due to overdose and suicide Reduce overdose death rates by 20% by 2016. Provide a seamless system of prevention, intervention, treatment and recovery services regardless of ability to pay. Decrease County suicide rates by 9.1% by 2016. Our work with the Frederick County Local Health Disparities Committee (LHDC) (Frederick County Local Health Improvement Plan (LHIP) 2014-2016 Work Group): Promotes awareness about Health Disparities in Frederick County and mobilize partnerships for disparity reduction. Health disparities adversely affect groups of people who have experienced greater obstacles to health based on: - racial or ethnic group - religion - socioeconomic status - gender - age - mental health - geographic location - cognitive, sensory, or physical disability - sexual orientation or gender identity - or other characteristics historically linked to discrimination or exclusion. There are significant health disparities in some health outcomes in Frederick County Some affect men, some affect Blacks more Health Disparities impact us and people we love Health disparities are complicated It takes us all to reduce and eliminate Health Disparities! FMH subsidizes Intensivists, Behavioral Health and NICU providers. There would not be enough providers for these services within the Frederick community without our contractual arrangements. FMH also contractually subsidize anesthesia, emergency room physicians (both adult and peds), interventional cardiologists, and observation services. In all of those areas, we wouldn't have enough providers without subsidies to care for County patients. FMH subsidizes Hospitalists to meet the needs of our patients. There are not enough primary care providers in Frederick to accommodate all inpatient needs. Also, most community PCP physicians do not maintain their hospital privileges and therefore cannot care for their patients while in the hospital. FMH contracts with the following specialties to provide coverage on a 24/7 basis. - Anesthesiology - Cardiology - ENT - Gastroenterology - General Dentistry - Hematology/Oncology - Interventional Cardiologists - Nephrology - Neurology - Obstetrics - Ophthalmology - Oral/Maxillo/Facial - Orthopedics - Pediatrics - Plastic Surgery - Pulmonary Medicine - Urology - Vascular Surgery - Neuro Surgeon Increase life expectancy - Follow up educational phone calls made by Nurse Navigators to increase participation in the high risk breast cancer screening and prevention program Reduce infant mortality - Increased number of prenatal clinic visits for non-insured/underinsured community residents Reduce the % of adults who are current smokers - Pediatric Asthma Observation and Inpatients receive education on Trigger avoidance, which includes information on smoking cessation for the parent if needed Reduce the % of youth using any kind of tobacco product - Pediatric Asthma Observation and Inpatients receive education on Trigger avoidance, which includes information on smoking cessation if needed Reduce the AFFILIATED HEALTH CARE SYSTEM SCHEDULE H, PART VI, LINE 6 FREDERICK MEMORIAL HOSPITAL, INC. ("FMH") IS A PRIVATE, NON-STOCK, NOT-FOR-PROFIT 501 (C) (3) MARYLAND CORPORATION ORGANIZED IN 1897. AS OF JULY 1, 2011, FREDERICK REGIONAL HEALTH SYSTEM BECAME THE PARENT CORPORATION UNDER WHICH THE ENTITIES DESCRIBED BELOW EXIST AND OPERATE. FREDERICK REGIONAL HEALTH SYSTEM IS GOVERNED BY A SIXTEEN MEMBER BOARD OF DIRECTORS. THE BOARD MEETS MONTHLY, WITH ELECTION OF OFFICERS AND MEMBERS OCCURRING AT THE SEPTEMBER MEETING. MUCH OF THE BOARD'S WORK IS ACCOMPLISHED THROUGH STANDING COMMITTEES, INCLUDING THE EXECUTIVE, FINANCE, GOVERNANCE, EXECUTIVE COMPENSATION, JOINT CONFERENCE (WITH MEDICAL STAFF), PLANNING, AND HOSPITAL PERFORMANCE REVIEW COMMITTEES. FREDERICK MEMORIAL HOSPITAL IS A 298-BED ACUTE CARE HOSPITAL LOCATED IN FREDERICK, MARYLAND, APPROXIMATELY 50 MILES WEST OF BALTIMORE AND 45 MILES NORTHWEST OF WASHINGTON D. C. THE HOSPITAL OPENED IN 1902 AND IS CURRENTLY THE ONLY ACUTE CARE HOSPITAL IN FREDERICK COUNTY AND THE ONLY ACUTE CARE HOSPITAL WITHIN A 25-MILE RADIUS OF THE CITY OF FREDERICK. THE MAIN CAMPUS OF THE HOSPITAL IS LOCATED ON AN APPROXIMATELY 15.85-ACRE SITE IN FREDERICK, MARYLAND. THE TOTAL SQUARE FOOTAGE OF THE HOSPITAL IS APPROXIMATELY 596,000 SQUARE FEET. FMH'S HOSPITAL-BASED AND OFF-SITE OUTPATIENT SERVICES ACCOUNT FOR OVER 350,000 VISITS ANNUALLY INCLUDING HOME HEALTH SERVICES, WHICH MAKES APPROXIMATELY 35,000 VISITS PER YEAR. IN ADDITION, HOSPITAL-BASED HOSPICE SERVICES HANDLE APPROXIMATELY 15,000 VISITS PER YEAR. FREDERICK REGIONAL HEALTH SYSTEM IS THE PARENT CORPORATION FOR MONOCACY HEALTH PARTNERS, A PHYSICIAN LED ENTERPRISE COMPOSED OF THE FOLLOWING HEALTH SYSTEM OWNED PRACTICES FREDERICK REGIONAL HEALTH SYSTEM PROVIDES A FULL RANGE OF ACUTE CARE SERVICES INCLUDING: MEDICINE, SURGERY, OBSTETRICS, GYNECOLOGY, PEDIATRICS, INTENSIVE CARE, CORONARY CARE, INTERVENTIONAL CARDIOLOGY, PRIMARY STROKE PROGRAM, WOUND CARE, JOINT REPLACEMENT PROGRAM, CYBERKNIFE RADIOSURGERY CENTER, PSYCHIATRIC CARE, MEDICAL FITNESS, WELLNESS PROGRAM/CENTER AND EMERGENCY SERVICES. IN ADDITION, THE HEALTH SYSTEM PROVIDES A COMPREHENSIVE RANGE OF OUTPATIENT SERVICES, INCLUDING: EMERGENCY MEDICINE, OUTPATIENT SURGERY, HOME HEALTH, RADIATION THERAPY, MRI, PET AND CT SCANNING, MEDICAL ONCOLOGY, AND COMPREHENSIVE WOMEN'S SERVICES. THROUGH THE SATELLITE LOCATIONS AND OUTPATIENT CENTERS, THE HEALTH SYSTEM PROVIDES: URGENT CARE, LABORATORY, DIAGNOSTIC RADIOLOGY, AMBULATORY SURGERY, VASCULAR IMAGING, REHABILITATION SERVICES, PAIN AND PALLIATIVE CARE. STATE FILING OF COMMUNITY BENEFIT REPORT SCHEDULE H, PART VI, LINE 7 MARYLAND true FREDERICK COMMUNITY COLLEGE 7932 OPOSSUMTOWN PIKE FREDERICK MD 21702 520743590 501(c)(3) 50000 SUPPORT OF ALLIED HEALTH PROG 1 PROCEDURES FOR MONITORING THE USE OF GRANTS FORM 990, SCHEDULE I, PART I, LINE 2 THE HOSPITAL PROVIDES FUNDING TO A LOCAL COMMUNITY COLLEGE (501(C)(3) IN AN EFFORT TO ENHANCE ITS ALLIED HEALTH PROGRAM. THROUGH THIS PROGRAM A FORMAL EDUCATION FORUM IS ESTABLISHED RESULTING IN FULLY ACCREDITED PROGRAMS THAT MEET THE HOSPITAL'S NEEDS. X true true X X X X true true false false false false false false false Manuel A Casiano VP Medical Staff 571073 0 78366 0 2322 0 45135 0 13247 0 710143 0 0 0 Cheryl L Cioffi VP Chief Nursing Officer 230305 0 47838 0 540 0 38498 0 15777 0 332958 0 0 0 Kenneth R Coffey II VP Chief Development Officer 177228 0 24252 0 2330 0 11001 0 11044 0 225855 0 0 0 Hannah R Jacobs VP Finance 179158 0 24633 0 540 0 10541 0 2325 0 217197 0 0 0 Thomas A Kleinhanzl President and CEO 663637 0 215321 0 1242 0 204655 0 15777 0 1100632 0 0 0 Michelle K Mahan Sr VP and CFO 394715 0 98881 0 3564 0 32733 0 15777 0 545670 0 0 0 Rachel I Mandel AVP Medical Affairs 175855 0 21484 0 276 0 9705 0 2193 0 209513 0 0 0 Craig F Rosendale VP Ancillary Services 179963 0 23785 0 3564 0 13255 0 12828 0 233395 0 0 0 Donald R Schilling VP Ambulatory Services 189584 0 23777 0 2322 0 5548 0 12965 0 234196 0 0 0 Mark S Soberman Physician 438080 0 0 1032 0 12207 0 15309 0 466628 0 0 0 Jennifer G Teeter AVP Payor Contracting 171911 0 23334 0 1242 0 13038 0 12622 0 222147 0 0 0 John R Verbus Sr VP and COO 465503 0 78588 0 3564 0 21348 0 11331 0 580334 0 0 0 Jim R Williams VP Business Development 208034 0 28630 0 3564 0 15169 0 12965 0 268362 0 0 0 DUSTIN M SIMONSON ONCOLOGY MEDICAL PHYSICIST 193229 0 122 0 120 0 12119 0 15298 0 220888 0 0 0 JAMES BLAKE TRUMBLE MEDICAL DIRECTOR 236809 0 0 0 180 0 12893 0 15649 0 265531 0 0 0 LILA J BEAULIEU DIRECTOR-SURGICAL SVCS 143228 0 6176 0 468 0 9168 0 1427 0 160467 0 0 0 JENNIFER D HULVEY DIRECTOR-REVENUE COMPLIANCE 148785 0 1205 0 270 0 3799 0 15372 0 169431 0 0 0 HEATHER R KIRBY AVP-CARE MGMT 144247 0 16449 0 112 0 4572 0 15537 0 180917 0 0 0 TERRY P O'MALLEY-LEFT 1215 VP HUMAN RESOURCES 218147 0 0 0 6594 0 6890 0 12556 0 244187 0 0 0 FORM 990, SCHEDULE J, PART I, LINE 1A FREDERICK MEMORIAL HOSPITAL HOLDS TWO CORPORATE MEMBERSHIPS TO A LOCAL GOLF/COUNTRY CLUB THAT ARE USED BY THE CHIEF EXECUTIVE OFFICER AND THE CHIEF FUND DEVELOPMENT OFFICER OF THE HOSPITAL. WHILE THE MAJORITY OF THE FEES ASSOCIATED WITH THE CLUB DUES, ETC. ARE BUSINESS RELATED, GENERAL PERSONAL USE EXPENSES ARE REIMBURSED BACK TO THE HOSPITAL BY THESE INDIVIDUALS AS NEEDED. FORM 990, SCHEDULE J, PART I, LINE 3 THE EXECUTIVE COMPENSATION PROGRAM IS DESIGNED TO CARRY OUT THE HEALTH SYSTEM MISSION, TO ACHIEVE THE CHARITABLE PURPOSE, TO ATTRACT, RETAIN, MOTIVATE AND REWARD EXECUTIVE MANAGEMENT, AND TO MAINTAIN A COMPETITIVE POSITION WITH PEER ORGANIZATIONS IN THE REGION. OVERSIGHT OF THE EXECUTIVE COMPENSATION PROGRAM IS PROVIDED BY THE EXECUTIVE COMPENSATION COMMITTEE OF THE BOARD, COMPOSED OF THE BOARD CHAIRMAN, VICE CHAIRMAN, IMMEDIATE PRECEDING CHAIRMAN, CHAIRMAN OF THE FINANCE COMMITTEE AND THE CHAIRMAN OF THE GOVERNANCE COMMITTEE. IN ADDITION TO THE BOARD'S COMPENSATION COMMITTEE, WE UTILIZED AN EXTERNAL INDEPENDENT CONSULTANT AND MARKET SURVEYS FOR ALL EXECUTIVE MANAGEMENT COMPENSATION. THE PRESIDENT AND CEO HAVE A WRITTEN EMPLOYMENT CONTRACT. FORM 990, SCHEDULE J, PART I, LINE 4A Through reorganization Mr. O'Malley's position was eliminated as of November 7, 2014. As part of a severance agreement he receive compensation for one year after termination. FORM 990, SCHEDULE J, PART I, LINE 4B FREDERICK MEMORIAL HOSPITAL HAS ONE 457(F) NON-QUALIFIED DEFERRED COMPENSATION PLAN FOR CERTAIN MEMBERS OF SENIOR MANAGEMENT. UNDER THE PLAN, THEY MAY CONTRIBUTE AMOUNTS FROM THEIR COMPENSATION TO THE PLAN AND MAY RECEIVE A DISCRETIONARY EMPLOYER CONTRIBUTION. EMPLOYEES ARE FULLY VESTED IN ALL EMPLOYEE CONTRIBUTIONS TO THE PLAN. VESTING IN EMPLOYER CONTRIBUTIONS OCCURS IN ACCORDANCE WITH THE UNDERLYING PLAN DOCUMENTS. ALL ASSETS OF THE PLAN ARE HELD IN A SEPARATE TRUST. TOTAL HOSPITAL CONTRIBUTIONS TO THIS PLAN WERE AS FOLLOWS: THOMAS A. KLEINHANZL $188,880 MICHELLE K. MAHAN $20,300 CHERYL L. CIOFFI $22,300 MANUEL A. CASIANO $30,350 JOHN R. VERBUS $6,719 A MARYLAND HEALTH & HIGHER EDU FACILITIES AUTH 2012A 520936091 574218LY7 2012-12-05 96240000 SEE PART VI false false false B MARYLAND HEALTH & HIGHER EDU FACILITIES AUTH 2012B 520936091 2012-12-05 70020000 SEE PART VI false false false A 68293488 0 108345805 0 1648756 0 1203561 0 0 37200000 0 0 2014 true false false true B 70020000 0 70690852 0 0 320948 349253 0 0 0 0 0 2012 true false true true A false true true true true true 0.00630 0.00630 false false false true B false true true true true true 0.00260 0.00260 false false false true A false true false false 0 false 0 false true B false true true true UBS AG STAMFORD 3.804 false false false 0 false true A true B true DESCRIPTION OF TAX EXEMPT BONDS DESCRIPTION OF TAX EXEMPT BONDS SCHEDULE K, PART I, COLUMN F MARYLAND HEALTH & HIGHER ED AUTHORITY 2012A: FINANCE 2012 PROJECT AND CURRENT REFUND 2002 BONDS WHICH FUNDED THE 2002 PROJECT. MARYLAND HEALTH & HIGHER ED AUTHORITY 2012B: REFUND THE 2008 SERIES BONDS WHICH WERE USED TO FINANCE THE 2006 AND PRIOR PROJECTS. SCHEDULE K, PART II, LINE 3 Difference Between issue Price and Total Proceeds MARYLAND HEALTH & HIGHER ED AUTHORITY 2012A: ORIGINAL ISSUE PREMIUM OF $3,989,854 AND PREVIOUSLY TRUSTEED HELD FUNDS OF $8,115,951. MARYLAND HEALTH & HIGHER ED AUTHORITY 2012B: PREVIOUSLY TRUSTEED HELD funds of $670,852. MANAGEMENT PRACTICES AND PROCEDURES SCHEDULE K, PART III, LINE 9 THE ORGANIZATION HAS POLICIES AND PROCEDURES IN PLACE TO ENSURE TAX EXEMPT BOND POST ISSUANCE COMPLIANCE, WRITTEN POLICIES WERE CREATED AND ADOPTED DURING THE TAX YEAR. Description of Other Program Services FORM 990, PART III, LINE 4D OTHER PROGRAM SERVICES INCLUDE BEHAVIORAL HEALTH, CARDIOLOGY, SLEEP, HOSPICE & HOME CARE, IMAGING, WOMEN & CHILDREN AND WOUND CARE. Members or stockholders FORM 990, PART VI, LINE 6 THE SOLE MEMBER OF THE ORGANIZATION IS FREDERICK REGIONAL HEALTH SYSTEM. Power to elect or appoint members form 990, part vi, line 7a THE SOLE MEMBER, FREDERICK REGIONAL HEALTH SYSTEM, HAS THE POWER TO APPOINT THE PRESIDENT/CEO AND THE DIRECTORS OF FREDERICK MEMORIAL HOSPITAL. Decisions reserved to members or stockholders FORM 990, PART VI, LINE 7B THE MEMBER, FREDERICK REGIONAL HEALTH SYSTEM, MUST APPROVE THE INCURRENCE OF DEBT IF SUCH DEBT EXCEEDS A CERTAIN AMOUNT TO BE DESIGNATED BY THEMEMBER, CAPITAL EXPENDITURES EXCEEDING A CERTAIN AMOUNT TO BE DESIGNATED BY THE MEMBER, THE DECISION TO DISSOLVE OR LIQUIDATE, THE CREATION OF ASUBSIDIARY, AND AMENDMENTS TO THE BYLAWS. Process used to review the Form 990 FORM 990, PART VI, LINE 11B THE 990 IS PREPARED IN CONJUNCTION WITH OUTSIDE TAX ACCOUNTANTS AND REVIEWED BY UPPER MANAGEMENT PRIOR TO PROVIDING A COPY TO THE BOARD. A COPY OF FORM 990 IS PROVIDED TO ALL MEMBERS OF THE BOARD PRIOR TO FILING. Monitoring and enforcement of compliance with conflict of interest policy FORM 990, PART VI, LINE 12C THE FREDERICK MEMORIAL HOSPITAL, INC. BOARD OF DIRECTORS IS COMMITTED TO MEETING ITS FIDUCIARY RESPONSIBILITIES AND MAINTAINING ITS DUTY OF LOYALTY TO THE HOSPITAL AND THE COMMUNITY IT SERVES. TO THIS END, THE BOARD WILL EXERCISE VIGILANCE IN IDENTIFYING ANY CONFLICTS OF INTEREST.THE BOARD WILL ALSO MAINTAIN TRANSPARENCY AND OBJECTIVITY IN MAKING DECISIONS ABOUT CONFLICTS OF INTEREST SO THAT THE ORGANIZATION'S MISSION IS ALWAYS THE FIRST PRIORITY. THE CHAIRPERSON (OR VICE CHAIRPERSON IF THE CHAIR IS INVOLVED) WILL NOTIFY ALL DIRECTORS OF A REPORTED CONFLICT OF INTEREST AND DECIDE WHETHER TO TAKE THE MATTER TO THE FULL BOARD TO DECIDE WHETHER A CONFLICT EXISTS AND, IF SO, WHAT ACTION TO TAKE, OR WILL REFER THE MATTER TO THE GOVERNANCE COMMITTEE FOR AN IN-DEPTH EXAMINATION, SUMMARY, AND RECOMMENDATION PRIOR TO A FULL BOARD DISCUSSION AND DECISION. IF TIME IS OF THE ESSENCE, THE CHAIRPERSON OR VICE CHAIRPERSON WILL TAKE THE MATTER TO THE EXECUTIVE COMMITTEE FOR DISCUSSION AND A DECISION, AND WILL THEN NOTIFY THE FULL BOARD. WHERE A CONFLICT OF INTEREST HAS BEEN IDENTIFIED, THE BOARD MEMBER SHALL NOT VOTE OR BE PRESENT FOR THE DISCUSSION OR THE VOTE REGARDING THE TRANSACTION AT THE FULL BOARD, EXECUTIVE COMMITTEE, OR GOVERNANCE COMMITTEE MEETINGS, EXCEPT TO ANSWER QUESTIONS THAT MAY BE ASKED OF HIM OR HER. TO PREVENT ACTUAL OR PERCEIVED INFLUENCE ON THE BOARD'S DECISION, THE CONFLICTED MEMBER IS PROHIBITED, AFTER INITIAL DISCLOSURE, FROM DISCUSSING THE CONFLICT OF INTEREST EITHER FORMALLY OR INFORMALLY WITH FELLOW DIRECTORS OR WITH MEMBERS OF THE MANAGEMENT. THERE WILL BE AN ANNUAL REVIEW OF ALL BOARD MEMBERS AND OFFICERS TRANSACTIONS PREPARED BY THE ADMINISTRATION AND REVIEWED BY THE GOVERNANCE COMMITTEE AND THE FULL BOARD OF DIRECTORS. AT THAT TIME, ALL DIRECTORS WILL BE REMINDED OF THE IRS INTERMEDIATE SANCTIONS REGULATION THAT ESTABLISHES EXCISE TAXES AS A SANCTION AGAINST ADMINISTRATORS AND DIRECTORS OF TAX-EXEMPT ORGANIZATIONS WHO PARTICIPATE IN 'EXCESS BENEFIT TRANSACTIONS' (E.G., UNREASONABLY HIGH EMPLOYMENT COMPENSATION OR BUSINESS DEALS). Process for determining compensation FORM 990, PART VI, LINE 15 THE EXECUTIVE COMPENSATION PROGRAM IS DESIGNED TO CARRY OUT THE HEALTH SYSTEM MISSION, TO ACHIEVE THE CHARITABLE PURPOSE, TO ATTRACT, RETAIN,MOTIVATE AND REWARD EXECUTIVE MANAGEMENT, AND TO MAINTAIN A COMPETITIVE POSITION WITH PEER ORGANIZATIONS IN THE REGION. OVERSIGHT OF THEEXECUTIVE COMPENSATION PROGRAM IS PROVIDED BY THE EXECUTIVE COMPENSATION COMMITTEE OF THE BOARD, COMPOSED OF THE BOARD CHAIRMAN, VICE CHAIRMAN,IMMEDIATE PRECEDING CHAIRMAN, CHAIRMAN OF THE FINANCE COMMITTEE AND THE CHAIRMAN OF THE GOVERNANCE COMMITTEE. IN ADDITION TO THE BOARD'SCOMPENSATION COMMITTEE, WE UTILIZED AN EXTERNAL INDEPENDENT CONSULTANT AND MARKET SURVEYS FOR ALL EXECUTIVE MANAGEMENT COMPENSATION. THEPRESIDENT AND CEO HAVE A WRITTEN EMPLOYMENT CONTRACT. Process for making documents available to the public FORM 990, PART VI, LINE 19 GOVERNING DOCUMENTS AND THE CONFLICT OF INTEREST POLICY ARE AVAILABLE UPON REQUEST. FREDERICK MEMORIAL HOSPITAL, INC. CONSOLIDATED ANNUAL AUDITED FINANCIAL STATEMENTS ARE AVAILABLE AT WWW.FMH.ORG. OTHER CHANGES IN NET ASSETS FORM 990, PART XI, LINE 9 INCREASE IN TEMP REST NET ASSETS 2,845,725 RELEASED FROM REST FOR CAPITAL 245,920 RECON:MIN PENSION ADJUST (4,439,903) RECON:UNREALIZED LOSSES ON SWAP (2,780,732) EQUITY INVESTMENTS INCOME 212,906 TIMING OF PLEDGES RECIEVED (3,681,678) MISCELLANEOUS 3,082 ----------- TOTAL OTHER CHANGES (7,594,680) FORM 990 PART IX LINE 11G DESCRIPTION:CONTRACT SERVICES TOTAL FEES:61518492 FORM 990 PART IX LINE 11G DESCRIPTION:AMORTIZATION TOTAL FEES:115108 FORM 990 PART IX LINE 11G DESCRIPTION:OTHER EXPENSES TOTAL FEES:7824816 FORM 990 PART IX LINE 11G DESCRIPTION:SUPPLIES TOTAL FEES:128232 FORM 990 PART IX LINE 11G DESCRIPTION:UTILITIES TOTAL FEES:29756 HOSPICE OF FREDERICK COUNTY INC 400 WEST SEVENTH STREET FREDERICK MD 21701 521164513 HOSPICE CARE MD 501(c)(3) 9 FRHS true FREDERICK REGIONAL HEALTH SYSTEM INC 400 WEST SEVENTH STREET FREDERICK MD 21701 454133096 HEALTH SYSTEM MD 501(c)(3) 11b NA false MONOCACY HEALTH PARTNERS 400 WEST SEVENTH STREET FREDERICK MD 21701 453007639 PHYSICIAN ORG MD 501(c)(3) 9 FRHS true FREDERICK HEALTH SERVICES CORPORATION 400 WEST SEVENTH STREET FREDERICK MD 21701 521851661 MANAGEMENT CO MD frhs C Corp 0 0 false FREDERICK SURGICAL SERVICES CORPORATION 400 WEST SEVENTH STREET FREDERICK MD 21701 521642334 HOLDING COMPA MD FHSC C Corp 0 0 false MONOCACY INSURANCE LTD PO BOX 1159 GRAND CAYMAN CJ KY1-1102 981011570 INSURANCE CJ FRHS C Corp 0 0 false true false false false false false false false true true false false false true true true false true MONOCACY HEALTH PARTNERS INC s 12800000 CASH MONOCACY HEALTH PARTNERS INC o 412523 DIRECT COSTING MONOCACY HEALTH PARTNERS INC j 762160 FMV MONOCACY HEALTH PARTNERS INC q 23331564 DIRECT COSTING FREDERICK HEALTH SERVICES CORP a 106984 FMV FREDERICK HEALTH SERVICES CORP k 434506 FMV FREDERICK HEALTH SERVICES CORP o 156525 FMV FREDERICK HEALTH SERVICES CORP p 204172 DIRECT COSTING FREDERICK REGIONAL HEALTH SYSTEM INC q 413231 DIRECT COSTING HOSPICE OF FREDERICK COUNTY INC o 917455 DIRECT COSTING