2013-05-10T12:22:19-05:00 2012-06-30 990 2011-07-01 530196602 LUCY WEBB HAYES NATIONAL TRAINING SCHOOL FOR DEACONESSES & MISSIONARIES LUCY 2025374000 5255 LOUGHBORO RD NW WASHINGTON DC 20016 ROBERT L SLOAN 2025374000 2013-05-06 2011 2016-02-25 16:41:14Z SIBLEY MEMORIAL HOSPITAL RICHARD O DAVIS 5255 LOUGHBORO RD NW WASHINGTON DC 20016 1107797814 0 X WWW.SIBLEY.ORG X 1891 DC THE LUCY WEBB HAYES NATIONAL TRAINING SCHOOL FOR DEACONESSES AND MISSIONARIES PROVIDES ALL SERVICES WITHOUT REGARD TO RACE, CREED, SEX, NATIONAL ORIGIN, HANDICAP, AGE OR ABILITY TO PAY. 26 22 2004 197 192502 -24657 83464 110066 123975332 246266626 11932629 14536799 2080340 4459719 138071765 265373210 100000 697393 0 0 64005732 133235716 0 0 0 55067882 106148240 119173614 240081349 18898151 25291861 972401974 973001610 203029737 198386791 769372237 774614819 X THE LUCY WEBB HAYES NATIONAL TRAINING SCHOOL FOR DEACONESSES AND MISSIONARIES CONDUCTING SIBLEY MEMORIAL HOSPITAL IS A GENERAL SHORT-TERM ACUTE CARE HOSPITAL LOCATED IN N.W. WASHINGTON,DC. THE HOSPITAL PROVIDES ALL SVCS WITHOUT REGARD TO RACE, CREED, SEX, NATIONAL ORIGIN, HANDICAP, AGE OR ABILITY TO PAY. ITS MISSION IS TO PROVIDE QUALITY HEALTH SVCS AND FACILITIES FOR THE COMMUNITY, TO PROMOTE WELLNESS, RELIEVE SUFFERING, AND RESTORE HEALTH AS SWIFTLY, SAFELY AND HUMANELY AS IT CAN BE DONE CONSISTENT WITH BEST SVC POSSIBLE AT THE HIGHEST VALUE FOR ALL CONCERNED. ITS VISION IS TO MAKE AVAILABLE SUPERIOR HEALTHCARE SVC AND VALUE, WITH THE GOAL OF IMPROVING HEALTH AND WELL-BEING OF THE COMMUNITY. THE HOSPITAL PLANS TO CONTINUE TO IMPROVE THAT SVC BY USING SCIENTIFIC METHODS, TEAMWORK, AND KNOWLEDGE OF BEST PRACTICES AND CUSTOMER EXPECTATIONS. THE HOSPITAL HAS VALUES WHICH PROVIDE GUIDELINES AND PARAMETERS FOR DECISIONS NECESSARY TO IMPROVE PROCESSES AND RESPOND TO NEEDS OF ITS PATIENTS . 0 0 221345186 697393 249648680 PROVIDE ACUTE CARE HEALTHCARE SERVICES TO PATIENTS IN THE NORTHWEST WASHINGTON, DC AREA. TO PROVIDE QUALITY HEALTH SERVICES AND FACILITIES TO THIS COMMUNITY, PROMOTING WELLNESS, RELIEVE SUFFERING, AND RESTORE HEALTH AS SWIFTLY, SAFELY AND HUMANELY AS IT CAN BE DONE CONSISTENT WITH THE BEST SERVICE GIVEN AT THE HIGHEST VALUE.SIBLEY HOSPITAL IS A GENERAL SHORT TERM ACUTE CARE FACILITY LOCATED IN NORTHWEST WASHINGTON, DC. THE HOSPITAL PROVIDES ALL SERVICES WITHOUT REGARD TO RACE, CREED, SEX, SEXUAL PREFERENCE, NATIONAL ORIGIN, HANDICAP, AGE OR ABILITY TO PAY. IN NOVEMBER, 2010, THE HOSPITAL BECAME INTEGRATED WITH THE JOHNS HOPKINS HEALTH SYSTEM (JHHS). ONE OF THE REQUIREMENTS OF THE INTEGRATION WAS TO ADOPT THE FISCAL YEAR ACCOUNTING PERIOD OF JULY 1 TO JUNE 30. CONSEQUENTLY, THIS RETURN IS FOR THE 12-MONTH ACCOUNTING PERIOD JULY 1, 2011 TO JUNE 30, 2012. THE PREVIOUS RETURN WAS FOR THE 6 MONTH ACCOUNTING PERIOD OF JANUARY 1 TO JUNE 30, 2011. INHERENT IN THE PURPOSE IS THE HOSPITALS WILLINGNESS TO PROVIDE HEALTHCARE SERVICES TO MEMBERS OF THE COMMUNITY WHO ARE NOT ABLE TO PAY FOR SERVICES. FOR FISCAL YEAR 2012, THE HOSPITAL PROVIDED CHARITY CARE TO MORE THAN 1,300 PATIENTS, INCURRING COSTS OVER $3.1 MILLION. TOTAL BENEFITS AND UNCOMPENSATED COST OF CARE PROVIDED TO THE COMMUNITY EXCEEDED $ 6.6 MILLION. SIBLEY PROVIDES CHARITY CARE TO THE CLIENTS OF THE CATHOLIC HEALTH CARE NETWORK, MARYS CENTER FOR MATERNAL AND CHILD HEALTH, THE COMMUNITY OF HOPE, COLUMBIA ROAD CLINIC, UNITY HEALTHCARE, AND BREAD FOR THE CITY. THE HOSPITAL ADMITTED OVER 15,300 PATIENTS IN 2012, AND PROVIDED OVER 68,000 DAYS OF INPATIENT CARE. OVER 3,500 NEW BABIES WERE DELIVERED AS WELL. OVER 33,000 PATIENTS WERE TREATED IN OUR 24/7 EMERGENCY ROOM, AND OVER 138,000 PATIENTS RECEIVED SURGICAL, ENDOSCOPIC OR OTHER ANCILLIARY OUTPATIENT TREATMENTS OR PROCEDURES. 221345186 1 1 0 0 0 0 0 0 1 0 1 1 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 208 0 1 2004 1 1 1 0 0 0 0 0 0 0 0 0 X 26 22 0 0 0 0 0 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 DC X STEPHEN MCDONNELL 2025374680 5255 LOUGHBORO RD NW WASHINGTON DC 20016 REV DAVID A ARGO 5.00 X 0 0 0 WILLIAM B BARTON ESQ 5.00 X X 0 0 0 GEOFFREY D BROWN 5.00 X 0 0 0 J RENE CARTER 5.00 X 0 0 0 CHARLES M COCHRAN JR 5.00 X 0 0 0 PAUL R ERICKSON 5.00 X 0 0 0 MICHAEL K FARR 5.00 X 0 0 0 SAMUAL P HARRINGTON MD 5.00 X X 0 0 0 BURKE F HAYES 5.00 X 0 0 0 DALE H HOSCHEIT ESQ 5.00 X 0 0 0 JOHN O MAY 5.00 X 0 0 0 EDWARD J MILLER JR 5.00 X X 0 0 0 A WALLACE MOORE JR 5.00 X 0 0 0 RICHARD E MORRIS 5.00 X X 0 0 0 PRISCILLA I PAGANO 5.00 X 0 0 0 CHARLES H ROSS 5.00 X 0 0 0 THOMAS J SCHAEFER 5.00 X 0 0 0 BISHOP JOHN R SCHOL 5.00 X 0 0 0 ROBERT L SLOAN 40.00 X X 2344316 0 82115 RONALD R PETERSON 5.00 X X 0 1703555 1777977 THOMAS H SULLIVAN 5.00 X 0 0 0 CARL L SYLVESTER JR MD 5.00 X 263400 0 0 KIMBERLY H WALTON ESQ 5.00 X 0 0 0 NILOO HOWE 5.00 X 0 0 0 THOMAS M MASTERSON MD 5.00 X 60000 0 0 SHARON PERCY ROCKEFELLER 5.00 X 0 0 0 STEPHEN C MCDONNELL 40.00 X 494484 0 70897 JOAN VINCENT 40.00 X 643977 0 83527 ALISON ARNOTT 40.00 X 150898 0 21539 QUEENIE PLATER 40.00 X 268305 0 64834 KENDA TAVAKOLI 40.00 X 290484 0 55197 PETER PETRUCCI MD 40.00 X 260872 0 24425 CHRISTINE STUPPY 40.00 X 192136 0 31298 JEFFERY JOYNER 40.00 X 204754 0 31411 JEFFREY L LIN 40.00 X 720801 0 47478 REBECCA ZUURBIER 40.00 X 501527 0 35744 JERRY L PRICE 40.00 X 619069 0 62587 HASAN ZIA 40.00 X 533119 0 30584 COLETTE M MAGNANT 40.00 X 542638 0 39968 AUDRY CARTER 40.00 X 214475 0 25549 8305255 1703555 2485130 16 1 1 0 JACKSON & CAMPBELL PC 1120 20TH STREET NW 300S WASHINGTON DC 20036 LEGAL 488739 THOMAS A FLEURY MD 5608 OVERLEA RD BETHESDA MD 20816 PATHOLOGY 432600 GITTLESON ZUPPAS 3 BETHESDA METRO CENTER 750 BETHESDA MD 20814 MEDICAL REAL ESTATE 378758 ROBERT S KLAPPENBACH MD 2337 BLAINE DRIVE CHEVY CHASE MD 20815 PATHOLOGY 298301 MARGARET M SHAFFER MD 11813 HAYFIELD CT POTOMAC MD 20854 PATHOLOGY 294677 16 110066 110066 PATIENT REVENUE 621990 219094300 219094300 ASSISTED LIVING 623000 18795358 18795358 PHYSICIAN BILLING 621990 6403611 6403611 MEDICAL OFFICE 621990 1787594 1787594 LAB REVENUE 621500 185763 185763 246266626 11098214 6739 11091475 845525152 20303 842106870 0 3418282 20303 3438585 3438585 446966 317734 129232 129232 PARKING LOT 900099 1505404 1505404 CAFETERIA/VENDING 900099 1210169 1210169 OTHER INCOME 900099 966546 966546 648368 648368 4330487 265373210 249648680 192502 15421962 697393 697393 5469297 5173955 295342 104973164 94837568 10135596 6016461 5691572 324889 9013364 8357670 655694 7763430 7344205 419225 976200 923485 52715 317280 145193 172087 227714 215417 12297 25823 25823 1930667 1930667 20276247 18881143 1395104 935066 861965 73101 1220868 369945 850923 3726843 3525593 201250 4753709 4497009 256700 75148 71090 4058 310908 294119 16789 4857790 4595471 262319 15342964 14514444 828520 DIRECT PATIENT SUPPLIES 30730745 30730745 0 OTHER SUPPLIES 10468759 9940163 528596 BAD DEBTS 7565940 7565940 PROVIDER TAX 1488151 1488151 917418 622950 294468 240081349 221345186 18736163 0 24524916 26895127 29934901 30869323 1215706 1504177 4343951 3613270 305566252 24811257 257910984 280754995 608387482 318844793 46084034 310519925 972401974 973001610 29460553 27758959 115406276 112365151 2374605 2374182 55788303 55888499 203029737 198386791 X 740886058 740671379 16121562 20489794 12364617 13453646 769372237 774614819 972401974 973001610 X 25291861 -20049279 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1 25823 25823 0 EXPLANATION OF LOBBYING ACTIVITIES: PART II-B, LINE 1: SIBLEY MEMORIAL HOSPITAL PAID $25,823 DURING THE FISCAL YEAR ENDED JUNE 30, 2012 TO THE DISTRICT OF COLUMBIA HOSPITAL ASSOCIATION FOR LOBBYING PURPOSES AS PART OF THE ANNUAL DUES. 0 1 50500000 50500000 169078320 10743777 158334543 364066 6742 357324 56271323 14021054 42250269 29352543 39684 29312859 280754995 JOINT VENTURES 3186904 F OTHER SECURITIES 315657889 F 318844793 OTHER RECEIVABLES 11464846 INTEREST RECEIVABLE 1287411 OTHER ASSETS 11278897 BENEFICIAL INTEREST IN SIBLEY MEMORIAL HOSPITAL FDN 285994630 DUE FROM AFFILIATES 494141 310519925 ALLOW FOR MALPRACTICE CLAIMS 15818993 ESTIMATED THIRD PARTY SETTLE 8029625 DEFERRED PENSION OBLIGATION 24810296 MISCELLANEOUS LIABILITIES 4417197 INTEREST PAYABLE 1158323 DEFERRED COMPENSATION 1622204 CONT RETENTION MOB GARAGE 31861 55888499 PART IV, LINE 2B: THE HOSPITAL ACTS AS ADMINISTRATOR/TRUSTEE FOR A CHARITABLE GIFT ANNUITY (CGA) PROGRAM. THE ASSETS ARE CUSTODIED WITH THE FIDUCIARY TRUST COMPANY. DONORS MAKE ARRANGEMENTS WITH THE HOSPITAL AND THE CUSTODIAN TO MAKE A ONE-TIME CONTRIBUTION TO THE CGA. PERIODIC ANNUITY PAYMENTS ARE THEN MADE TO THE DONOR OVER THE LIFETIME OF THE DONOR. THE HOSPITAL INCLUDES ON ITS BALANCE SHEET THE MARKET VALUE OF THE ASSETS CONTRIBUTED BY ALL DONORS IN THE PROGRAM. THE HOSPITAL ALSO INCLUDES A LIABILITY FOR ESTIMATED PAYMENTS CALCULATED TO BE PAID TO ITS DONORS IN FUTURE YEARS. THE ASSETS ARE INVESTED IN FIXED INCOME AND EQUITY SECURITIES, MONITORED REGURARLY BY THE HOSPITAL'S INVESTMENT COMMITTEE. FOR FISCAL YEAR ENDING JUNE 30, 2012, THE MARKET VALUE OF THE ASSETS DECREASED BY $160,735. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: FASB'S GUIDANCE ON ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES CLARIFIES THE ACCOUNTING FOR UNCERTAINTY OF INCOME TAX POSITIONS. THIS GUIDANCE DEFINES THE THRESHOLD FOR RECOGNIZING TAX RETURN POSITIONS IN THE FINANCIAL STATEMENTS AS "MORE LIKELY THAN NOT" THAT THE POSITION IS SUSTAINABLE, BASED ON ITS TECHNICAL MERITS. THIS GUIDANCE ALSO PROVIDES GUIDANCE ON THE MEASUREMENT, CLASSIFICATION AND DISCLOSURE OF TAX RETURN POSITIONS IN THE FINANCIAL STATEMENTS. THE ORGANIZATION HAS ADOPTED THIS GUIDANCE, AND THERE WAS NO IMPACT ON ITS FINANCIAL STATEMENTS DURING THE YEAR ENDED JUNE 30, 2012. 1 1 X 1 X 1 X 500.000000000000 1 1 0 1 1 3232573 0 3232573 0.01390 5754230 2838689 2915541 0.01250 8986803 2838689 6148114 0.02640 783717 1200 782517 0.00340 928158 260132 668026 0.00290 15174492 11301918 3872574 0.01670 1192385 100980 1091405 0.00470 14200 0 14200 0.00010 18092952 11664230 6428722 0.02780 27079755 14502919 12576836 0.05420 1 7565940 0 58849642 74940016 -16090374 X 1 1 1 1 SIBLEY MEMORIAL HOSPITAL

5255 LOUGHBORO RD NW WASHINGTON DC 20016

X X X SIBLEY MEMORIAL HOSPITAL 1 0 1 1 200.000000000000 1 500.000000000000 1 X X X X X 1 1 X X X X X X 1 0 1 X 0 0 1 GRAND OAKS

5901 MACARTHUR BLVD NW WASHINGTON DC 20016

ASSISTED LIVING FACILITY PART I, LINE 7: A COST-TO-CHARGE RATIO (FROM WORKSHEET 2) IS USED TO CALCULATE THE AMOUNTS ON LINE 7A-7B (FINANCIAL ASSISTANCE AND UNREIMBURSED MEDICAID). THE AMOUNTS FOR LINES 7E-7I WOULD COME FROM THE BOOKS AND RECORDS OF SPECIFIC SEGMENTS OF THE ORGANIZATION AND WOULD NOT BE BASED ON A COST-TO CHARGE RATIO. PART I, LINE 7G: THERE ARE NO COSTS REPORTED THAT ARE ATTRIBUTABLE TO A PHYSICIANS CLINIC. PART I, L7 COL(F): THE AMOUNT OF BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $7,565,940. PART II: SIBLEY HOSPITAL DOES NOT PARTICIPATE IN COMMUNITY BUILDING ACTIVITIES NOR DO WE HAVE THE RESOURCES TO DO SO. PART III, LINE 4: BAD DEBT EXPENSE ENTERED COMES FROM THE HOSPITALS BOOKS AND RECORDS.DISCOUNTS AND ALLOWANCES ARE ACCOUNTED FOR SEPARATELY FROM BAD DEBT EXPENSE.THE ORGANIZATIONS FINANCIAL STATEMENTS DO NOT INCLUDE A FOOTNOTE ON BAD DEBT EXPENSE. THE FINANCIAL STATEMENTS SHOW THE PROVISION FOR BAD DEBTS AS A SEPARATE LINE ITEM IN THE STATEMENTS OF OPERATIONS AND CHANGES IN NET ASSETS UNDER OPERATING EXPENSES. PART III, LINE 8: SIBLEY MEMORIAL HOSPITAL TREATS PATIENTS WITH MANY INSURANCE CARRIERS. HOWEVER, THE MEDICARE TOTAL VOLUME IS 39% OF TOTAL PATIENT VOLUME, WE BELIEVE THIS IS AMONG THE HIGHEST RATIO FOR THE DISTRICT OF COLUMBIA HOSPITALS. ALTHOUGH PROVIDING THE BEST POSSIBLE CARE TO OUR MEDICARE PATIENTS CREATES A FINANCIAL LOSS, WE RELIEVE THE GOVERNMENT AND SURROUNDING OTHER HOSPITALS OF THE FINANCIAL BURDEN OF TREATING THESE PATIENTS INSURED BY THE MEDICARE PROGRAM. PART OF THE MISSION OF OUR HOSPITAL IS TO SERVE ITS ELDERLY PATIENTS WITHIN THE COMMUNITY THROUGH VARIOUS PROGRAMS THAT ARE DESIGNED TO EDUCATE AND IMPROVE THEIR HEALTH STATUS. THE HOSPITAL FEELS THAT PROVIDING THESE PROGRAMS HAS CONTRIBUTED TO THE IMPROVEMENT OF HEALTH OVERALL WITHIN THE COMMUNITY.IN ADDITION TO PROVIDING EDUCATIONAL AND OTHER SELF IMPROVEMENT SEMINARS AND CLINICS FOR OUR MEDICARE PATIENT POPULATION, THE HOSPITAL INCURS COST FOR BEING IN A CONSTANT STATE OF READINESS FOR ANY EMERGENCIES, SUCH AS NATURAL DISASTERS, EPIDEMICS, CHEMICAL SPILLS OR TECHNICAL DISASTERS THAT MAY ARISE. THE HOSPITALS DISASTER TREATMENT TEAM WORKS ROUTINELY WITH THE DISTRICT OF COLUMBIA EMERGENCY HEALTHCARE COALITION, DC HOMELAND SECURITY ORGANIZATION, DC DEPARTMENT OF HEALTH AND OTHER SIMILAR ORGANIZATIONS IN PLANNING AND TRAINING FOR TREATMENT OF PATIENTS DURING ANY POTENTIAL DISASTERS. THE HOSPITAL MAKES AVAILABLE A 24/7 EMERGENCY CARE FACILITY, PROVIDES STATE-OF-THE-ART EQUIPMENT TO TREAT PATIENTS EFFICIENTLY AND QUICKLY, AND INCURS COSTS OF EDUCATING HOSPITAL STAFF TO ADMINISTER BETTER QUALITY CARE TO THE COMMUNITY. PART III, LINE 9B: WHEN A PATIENT ASKS FOR CHARITY CARE OR FINANCIAL ASSISTANCE, THE PATIENT MUST COMPLETE AN APPLICATION AND PROVIDE FINANCIAL INFORMATION THAT WOULD DEMONSTRATE FINANCIAL NEED. THE APPLICATION IS REVIEWED BY FINANCIAL COUNSELORS FOR ELIGIBILITY. SIBLEY MEMORIAL HOSPITAL PART V, SECTION B, LINE 19D: WHEN SIBLEY HOSPITAL DETERMINES A PATIENT TO BE FAP-ELIGIBLE, BASED ON AN APPLICATION FILED BY THE PATIENT AND VERIFIED BY SIBLEY HOSPITAL, THEY ARE PROVIDED FREE CARE. SINCE AN FAP-ELIGIBLE PATIENT IS NOT CHARGED FOR THEIR CARE THERE IS NO CALCULATION MADE FOR THE MAXIMUM AMOUNT THEY CAN BE CHARGED. PART VI, LINE 2: SIBLEY MEMORIAL HOSPITAL AND FOUR OTHER HOSPITALS AND TWO FEDERAL QUALIFIED HEALTH CLINICS IN THE DISTRICT OF COLUMBIA ARE UNDERTAKING AN EFFORT TO CONVENE STRATEGIC LEADERS TO WORK TOGETHER COLLABORATIVELY TO BETTER UNDERSTAND, MEASURE AND IMPACT THE HEALTH OF THE COMMUNITY WE JOINTLY SERVE. TO THAT END, STARTING IN 2011, THE ORGANIZATIONS BEGAN MEETING TO GATHER INFORMATION AND OPINIONS FROM PERSONS WHO REPRESENT BROADER INTERESTS OF THE COMMUNITY SERVED BY OUR HOSPITALS. BY NOVEMBER 30, 2012, THE ORGANIZATIONS DID DEVELOP A COMMUNITY HEALTH NEEDS ASSESSMENT STRATEGY FOR THE ENTIRE DISTRICT OF COLUMBIA AND WILL BEGIN WORKING COLLABORATIVELY ON DEVELOPING AN IMPLEMENTATION PLAN TO BEST SERVE THE DISTRICT OF COLUMBIA.SECONDARY DATA WERE COLLECTED FROM A VARIETY OF LOCAL, COUNTY, AND STATE SOURCES TO PRESENT A COMMUNITY PROFILE, ACCESS TO HEALTH CARE, CHRONIC DISEASES, SOCIAL ISSUES, AND OTHER HEALTH INDICATORS.IN ADDITION TO THE EFFORTS TO ESTABLISH A DC HEALTH COLLABORATIVE, SIBLEY MEMORIAL HOSPITAL CONSULTS WITH LOCAL AND RESPECTED SENIOR SERVING AGENCIES SUCH AS IONA SENIOR SERVICES, SEABURY RESOURCES FOR AGING, MARYS CENTER FOR MATERNAL AND CHILD CARE, THE COMMUNITY OF HOPE, COLUMBIA ROAD CLINIC, UNITY HEALTHCARE (FORMERLY HEALTHCARE FOR THE HOMELESS), BREAD FOR THE CITY, CATHOLIC CHARITIES AND SOMOS AMIGOS MEDICAL MISSION. SIBLEY HAS ALSO WORKED SIDE-BY-SIDE WITH NON-PROFIT AGENCIES LIKE AMERICAN LUNG ASSOCIATION. PART VI, LINE 3: WHEN A PATIENT IS FIRST REGISTERED, HE/SHE MUST READ THE POSTED NOTICE ABOUT COMMUNITY/FINANCIAL ASSISTANCE. THE NOTICE IS POSTED NOTICEABLY IN THE ADMISSIONS DEPARTMENT, THE BUSINESS OFFICE, AND THE EMERGENCY DEPARTMENT. WHEN A PATIENT INQUIRES ABOUT COMMUNITY/FINANCIAL ASSISTANCE, HE/SHE IS GIVEN AN APPLICATION TO DETERMINE IF, IN FACT, HE/SHE IS ELIGIBLE FOR SUCH ASSISTANCE UNDER THE GUIDELINES ESTABLISHED BY THE DC MUNICIPAL REGULATION TITLE 22. PATIENT FINANCIAL COUNSELORS ARE ON STAFF TO ASSIST THE PATIENT WITH ANY QUESTIONS AND ULTIMATELY RECEIVE THE COMPLETED APPLICATION FOR FURTHER REVIEW. BEFORE THE BEGINNING OF ITS FISCAL YEAR, SIBLEY WILL PUBLISH A NOTICE OF AVAILABILITY OF ITS UNCOMPENSATED CARE OBLIGATION IN A NEWSPAPER OF GENERAL CIRCULATION IN THE DISTRICT OF COLUMBIA. SIBLEY WILL ALSO SUBMIT A COPY OF SUCH NOTICE TO THE STATE HEALTH PLANNING AND DEVELOPMENT AGENCY (SHPDA). THE NOTICE IS PUBLISHED IN ENGLISH AND SPANISH AND ANY OTHER LANGUAGE WHICH IS THE USUAL LANGUAGE OF HOUSEHOLDS OF TEN PERCENT OR MORE OF THE POPULATION OF THE DISTRICT OF COLUMBIA. SIBLEY COMMUNICATES THE CONTENTS OF THE POSTED NOTICE TO ANY PERSON WHO SIBLEY HAS REASON TO BELIEVE CANNOT READ THE NOTICE. PART VI, LINE 4: SMH GEOGRAPHIC SERVICE AREA IS URBAN.THE HOSPITAL CONSIDERS ITS COMMUNITY BENEFIT SERVICE AREA (CBSA) AS SPECIFIC POPULATIONS OR COMMUNITIES OF NEED TO WHICH THE HOSPITAL ALLOCATES RESOURCES THROUGH ITS COMMUNITY BENEFIT PLAN. THE CBSA IS DEFINED BY THE GEOGRAPHIC AREA CONTAINED WITHIN THE FOLLOWING ZIP CODES: 20016, 20815, 20008, 20015, 20816, 20007, 20009, 20817, 20002, 20854, 20011, 20814, 20003, 20852, 20001, 20010, 20910, 22101, 22207, AND 20895. THE GENERAL DATA FOR THIS COMMUNITY BENEFIT SERVICE AREA ARE AS FOLLOWS: TOTAL POPULATION WAS 786,229 OF WHICH 48.28% WERE MALES AND 51.72% WERE FEMALES, AVERAGE HOUSEHOLD INCOME WAS $55,251, 8.0% OF RESIDENTS ARE UNINSURED, 18.0% OF RESIDENTS ARE COVERED BY MEDICAID/MEDICARE, 19.2% OF HOUSEHOLDS WITH INCOMES BELOW THE FEDERAL POVERTY GUIDELINES.NUMBER OF OTHER HOSPITALS SERVING THE COMMUNITY OR COMMUNITIES: 4FEDERALLY-DESIGNATED MEDICALLY UNDERSERVED AREAS OR POPULATIONS ARE PRESENT IN THE COMMUNITY . PART VI, LINE 5: SIBLEY HOSPITAL ENSURES THAT ITS BOARD MEMBERS ARE LEADERS WITHIN THE LOCAL BUSINESS COMMUNITY AND HAVE EXPERTISE IN MANY DIFFERENT AREAS. THE SKILLS, DEDICATION AND LEADERSHIP OF THE BOARD OF TRUSTEES FORM THE FOUNDATION OF THE HOSPITALS ABILITY TO PROVIDE NEEDED SERVICES TO THE COMMUNITY. BEFORE BEING APPOINTED TO THE BOARD, POTENTIAL MEMBERS EXPERIENCE A RIGOROUS SCREENING PROCESS, ENSURING THAT THEY ARE NEITHER FAMILY MEMBERS OF CURRENT BOARD MEMBERS NOR CONTRACTORS OF SIBLEY. TO FURTHER BENEFIT THE COMMUNITY, THE HOSPITAL PROVIDES, THROUGH ITS EXCESS FUNDS, MANY PROGRAMS FOR THE CITIZENS OF THE COMMUNITY THAT ARE OF LITTLE OR NO COST TO ATTENDEES. THESE PROGRAMS ARE DESIGNED TO EDUCATE, COMFORT, IMPROVE HEALTH AND PROVIDE SUPPORT TO THOSE WHO ATTEND. A NUMBER OF FREE HEALTH AND WELLNESS SEMINARS ARE PROVIDED REGULARLY TO MEMBERS OF THE COMMUNITY, SUCH AS DIABETES EDUCATION, HEART HEALTHY EATING AND ARTHRITIS. PHYSICIANS AND STAFF DONATE THEIR TIME TO EDUCATE ATTENDEES ON WAYS TO MAINTAIN OR IMPROVE INDIVIDUAL HEALTH. CHILDBIRTH AND NEW PARENTING CLASSES ARE CONDUCTED REGULARLY, PREPARING NEW PATIENTS (AND GRANDPARENTS) ON VARIOUS ASPECTS OF CHILD REARING AND BABY CARE. THERE ARE SEVERAL ONGOING SUPPORT GROUPS THAT MEET REGULARLY. EXISTING AND NEW MEMBERS ARE STRONGLY ENCOURAGED TO ATTEND. INDIVIDUALS EXPERIENCING ALZHEIMERS, ARTHRITIS, LYME DISEASE, MACULAR DEGENERATION, OR PARKINSONS DISEASE ARE INVITED TO EXPERIENCE NEW WAYS OF FEELING BETTER. IN ADDITION TO HAVING A NATIONALLY-KNOWN BREAST CANCER TREATMENT CENTER, AT LEAST FIVE CANCER SUPPORT GROUPS MEET ON A REGULAR BASIS. MEMBERS OF THE HOSPITAL STAFF AND PHYSICIANS ALSO TRAVEL OFF CAMPUS TO CONDUCT OR BE PART OF COMMUNITY HEALTH EVENTS HELD AT LOCAL CHURCHES OR COMMUNITY SOCIAL GATHERINGS. IN JANUARY, 2012, SIBLEY PARTICIPATED IN THE NBC4 HEALTH AND FITNESS EXPO HELD AT THE WASHINGTON CONVENTION CENTER FOR THE GENERAL PUBLIC. SIBLEY AND OTHER HEALTH CARE PROVIDERS OFFERED MULTIPLE HEALTH SCREENINGS, INFORMATIVE HEALTH RELATED DISCUSSIONS AND WAYS TO STAY HEALTHY AND FIT. FINALLY, THE HOSPITAL PROVIDES ADDITIONAL FREE BENEFITS TO MEMBERS OF ITS SIBLEY SENIOR ASSOCIATION, CURRENTLY HAVING MORE THAN 7,000 ACTIVE MEMBERS. BENEFITS INCLUDE FREE HEALTH SCREENING, EDUCATIONAL PROGRAMS, A WIDOWED PERSONS SERVICE, AND SEMINARS ON HEALTH RELATED SUBJECTS. IN THE SPRING OF 2011, THE HOSPITAL BROKE GROUND TO CONSTRUCT A NEW RADIATION ONCOLOGY FACILITY AS PART THE NEXT PHASE OF OUR CAMPUS REDEVELOPMENT. THIS FACILITY IS SUBSTANTIALLY COMPLETED AS OF JUNE 30, 2012. IT WILL OFFER ADVANCED MODALITIES FOR RADIATION THERAPY, 3-D IMAGING AND OTHER TREATMENT SERVICES. THE NATIONAL CAPITAL REGIONAL PLANNING COMMITTEE WAS FORMED, COORDINATING ACUTE CARE AND OUTPATIENT SERVICES BETWEEN THE SUBURBAN HOSPITAL AND THE JOHNS HOPKINS HEALTH SYSTEM (JHHS). THE NEWLY CONSTRUCTED SIBLEY MEDICAL BUILDING BECAME FULLY OPERATIONAL IN JULY, 2011, AND OFFERS THE LATEST BREAKTHROUGHS IN OUTPATIENT SURGERY, IMAGING TECHNOLOGY, A COMMUNITY PHARMACY AND PHYSICIAN OFFICES. A NEW GIFT SHOP OFFERS COMFORT-CARE PRODUCTS FOR MATERNITY AND FEMALE ONCOLOGY PATIENTS. OUR EMERGENCY ROOM HAS CONTINUALLY STRIVED TO PROVIDE QUALITY TREATMENT QUICKLY AND EFFICIENTLY, ACHIEVING A 99TH PERCENTILE PRESS GANEY RANKING IN PATIENT SATISFACTION, WHILE RECEIVING TREATMENT IN 30 MINUTES OR LESS. THE HOSPITAL ALSO BEGAN ACTIVE PARTICIPATION IN THE GYNECOLOGICAL ONCOLOGY GROUP, A COOPERATIVE GROUP SPONSORED BY THE NATIONAL CANCER INSTITUTE TO SUPPORT RESEARCH STUDIES OF NEW CANCER TREATMENTS IN GYNECOLOGICAL CANCERS. IN THE FALL OF 2011, SIBLEY UNDERWENT AN UNANNOUNCED ON-SITE SURVEY BY A TEAM FROM THE JOINT COMMISSION. SIBLEY EARNED A 3-YEAR ACCREDITATION BY DEMONSTRATING COMPLIANCE WITH THEIR NATIONAL STANDARDS FOR HEALTH CARE QUALITY AND SAFETY. IN THE WINTER OF 2012, BETHESDA MAGAZINE VOTED SIBLEY AS BEST PLACE TO HAVE A BABY. IN CONJUNCTION WITH JHHS, THE HOSPITAL INCREASED COMPLIANCE WITH QUALITY SAFETY MEASURES, WHICH WILL RESULT IN MEASURABLE BENEFITS TO THE COMMUNITY. PART VI, LINE 6: THE JOHNS HOPKINS HEALTH SYSTEM CORPORATION (JHHSC) IS INCORPORATED IN THE STATE OF MARYLAND TO, AMONG OTHER THINGS, FORMULATE POLICY AMONG AND PROVIDE CENTRALIZED MANAGEMENT FOR JHHSC AND AFFILIATES (JHHS). JHHS IS ORGANIZED AND OPERATED FOR THE PURPOSE OF PROMOTING HEALTH BY FUNCTIONING AS A PARENT HOLDING COMPANY OF AFFILIATES WHOSE COMBINED MISSION IS TO PROVIDE PATIENT CARE IN THE TREATMENT AND PREVENTION OF HUMAN ILLNESS WHICH COMPARES FAVORABLY WITH THAT RENDERED BY ANY OTHER INSTITUTION IN THIS COUNTRY OR ABROAD.JHHSC IS THE SOLE MEMBER OF THE JOHNS HOPKINS HOSPITAL (JHH), AN ACADEMIC MEDICAL CENTER, JOHNS HOPKINS BAYVIEW MEDICAL CENTER, INC. (JHBMC), A COMMUNITY BASED TEACHING HOSPITAL AND LONG-TERM CARE FACILITY, HOWARD COUNTY GENERAL HOSPITAL, INC. (HCGH), A COMMUNITY BASED HOSPITAL, SUBURBAN HOSPITAL, INC. (SHI), A COMMUNITY BASED HOSPITAL, SIBLEY MEMORIAL HOSPITAL (SMH), A D.C. COMMUNITY BASED HOSPITAL, AND ALL CHILDRENS HOSPITAL, INC (ACH), A FL ACADEMIC CHILDRENS HOSPITAL. REPORTS FILED WITH STATES PART VI, LINE 7 DC 1 THE WISTAR INSTITUTE OF ANATOMY AND BIOLOGY 3601 SPRUCE STREET PHILADELPHIA PA 19104 236434390 501(C)(3) 100000 RESEARCH JOHNS HOPKINS UNIVERSITY 3910 KESWICK ROAD N-4327B BALTIMORE MD 21211 520595110 501(C)(3) 597393 RESEARCH 2 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: THE PROCEDURES IN PLACE TO MONITOR THE USE OF GRANT FUNDS GIVEN TO THE ORGANIZATIONS LISTED CONSIST OF ANNUAL STATUS REPORTS. THESE REPORTS WILL CONTAIN A) PROGRESS ON THE RESEARCH CONDUCTED, B) FULL ACCOUNTING OF FUNDS SPENT, C) ACHIEVEMENT OF MEASURABLE OUTCOMES AND ANY CHANGES FROM THE ORIGINAL PROPOSAL, D) DATA GATHERING AND THE METHODS OR STRATEGIES USED, AND E) FINDINGS AND CONCLUSIONS. IN ADDITION, THE GRANTEES ARE REQUIRED TO MAINTAIN ACCOUNTING RECORDS WITH PRUDENT RECORD-KEEPING PROCEDURES AS REQUIRED BY ANY APPLICABLE FEDERAL, STATE, OR LOCAL LAWS, RULES OR REGULATIONS. THE GRANTOR (SIBLEY HOSPITAL) RESERVES THE RIGHT TO HAVE ACCESS TO AND EXAMINE ALL BOOKS AND RECORDS TO ASCERTAIN IF GRANT FUNDS ARE BEING DISBURSED PURSUANT TO THE TERMS OF THE AGREEMENTS. X 1 1 X X X X X X 0 1 0 0 0 0 0 0 0 ROBERT L SLOAN 864437 0 373229 0 1106650 0 71000 0 11115 0 2426431 0 0 0 RONALD R PETERSON 0 1101197 0 451124 0 151234 0 1754885 0 23092 0 3481532 0 0 CARL L SYLVESTER JR MD 0 0 0 0 263400 0 0 0 0 0 263400 0 0 0 STEPHEN C MCDONNELL 400488 0 72686 0 21310 0 60550 0 10347 0 565381 0 0 0 JOAN VINCENT 314794 0 32658 0 296525 0 71000 0 12527 0 727504 0 0 0 ALISON ARNOTT 137240 0 6149 0 7509 0 15710 0 5829 0 172437 0 0 0 QUEENIE PLATER 244718 0 17098 0 6489 0 57315 0 7519 0 333139 0 0 0 KENDA TAVAKOLI 256249 0 24175 0 10060 0 46997 0 8200 0 345681 0 0 0 PETER PETRUCCI MD 248421 0 11869 0 582 0 19065 0 5360 0 285297 0 0 0 CHRISTINE STUPPY 177270 0 14180 0 686 0 22380 0 8918 0 223434 0 0 0 JEFFERY JOYNER 187101 0 17176 0 477 0 21884 0 9527 0 236165 0 0 0 JEFFREY L LIN 620683 0 100118 0 0 0 36179 0 11299 0 768279 0 0 0 REBECCA ZUURBIER 420438 0 0 0 81089 0 26132 0 9612 0 537271 0 0 0 JERRY L PRICE 313825 0 0 0 305244 0 54500 0 8087 0 681656 0 0 0 HASAN ZIA 451741 0 0 0 81378 0 21136 0 9448 0 563703 0 0 0 COLETTE M MAGNANT 508513 0 34125 0 0 0 37598 0 2370 0 582606 0 0 0 AUDRY CARTER 152711 0 16267 0 45497 0 20037 0 5512 0 240024 0 0 0 PART I, LINE 4B DURING 2011 THE PRESIDENT/CEO ROBERT SLOAN RECEIVED $1,106,649.60, THE VICE PRESIDENT REAL ESTATE & CONSTRUCTION, JERRY L. PRICE RECEIVED $305,344.32 AND VICE PRESIDENT OF PATIENT CARE SERVICES, JOAN VINCENT RECEIVED $286,038.00 FROM A NONQUALIFIED RETIREMENT PLAN WHICH IS BASED ON BENEFITS EARNED FROM PRIOR YEARS. THE FOLLOWING INDIVIDUALS LISTED ON FORM 990, PART VII, SECTION A, LINE 1A PARTICIPATED IN A NONQUALIFIED RETIREMENT PLAN WITH THE RELATED ORGANIZATION JOHNS HOPKINS HEALTH SYSTEM CORPORATION AND RECEIVED ACCRUED DEFERRED COMPENSATION THAT IS REPORTED ON SCHEDULE J, PART II, COLUMN (C): RONALD PETERSON $1,626,957.00 DISTRICT OF COLUMBIA 536001131 254764HX4 2009-07-15 62798209 CONSTRUCTION OF MEDICAL BLDG FOR OUTPATIENT SVCS AND OFFICES 0 0 0 DISTRICT OF COLUMBIA 536001131 2010-12-29 30000000 REISSUE PRIOR ISSUE 7/24/02 0 0 0 DISTRICT OF COLUMBIA 536001131 2010-12-29 5398555 REISSUE PRIOR ISSUE 7/24/02 0 0 0 62798209 4954686 315000 57542090 2011 0 0 0 1 1175910 30000000 2005 1 0 1 1 204546 5398555 2005 1 0 1 1 0 1 1 1 0 0.00310 0.00000 0.00310 1 0 1 1 1 0 1 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X FORM 990, PART VI, SECTION A, LINE 7A DURING THE TRANSITION PERIOD JOHNS HOPKINS HEALTH SYSTEM CORPORTION, AN IRC 501C(3) TAX EXEMPT PARENT ORGANIZATION OF SIBLEY MEMORIAL HOSPITAL MAY ELECT ONE TRUSTEE. AFTER THE STATED TRANSITION PERIOD, JOHNS HOPKINS HEALTH SYSTEM CORPORATION ELECTS THE BOARD OF TRUSTEES. FORM 990, PART VI, SECTION A, LINE 7B THE GOVERNING BODY OF SIBLEY MEMORIAL HOSPITAL IS EMPOWERED BY ITS BY-LAWS TO MAKE CERTAIN DECISIONS; ALL OTHER DECISIONS ARE SUBJECT TO APPROVAL OF THE PARENT ORGANIZATION JOHNS HOPKINS HEALTH SYSTEM CORPORATION. FORM 990, PART VI, SECTION B, LINE 11 A COPY OF THE FORM 990 WAS PROVIDED TO THE FINANCE COMMITTEE BEFORE IT WAS FILED. FORM 990, PART VI, SECTION B, LINE 12C THE HOSPITAL HAS AN EXISTING POLICY (#02-25-09) WHICH SPECIFICALLY ADDRESSES POTENTIAL CONFLICT(S) OF INTEREST FOR DECISION MAKERS AT ALL LEVELS WITHIN ITS BORDERS. THIS COVERAGE INCLUDES MEMBERS OF THE GOVERNING BOARD, ADMINISTRATION, MEDICAL STAFF, AND ALL OTHER EMPLOYEES. DISCLOSURE FORMS ASKING FOR POTENTIAL CONFLICTS OF INTEREST ARE DISTRIBUTED AT LEAST ANNUALLY SO THAT APPROPRIATE ACTION MAY BE TAKEN TO ENSURE THAT SUCH POTENTIAL CONFLICTS DO NOT INFLUENCE IMPORTANT DECISIONS. THE HOSPITAL'S BOARD MEMBERS ARE ASKED TO SUBMIT DISCLOSURE FORMS SEMI-ANNUALLY AND ON A CASE-BY-CASE BASIS. THE GOVERNING BOARD, SENIOR MANAGEMENT, AND THE EXECUTIVE COMMITTEE OF THE MEDCAL STAFF (AS APPROPRATE) BEAR RESPONSIBILITY FOR ADDRESSING AND REVIEWING ALL POTENTIAL CONFLICTS AND TAKING APPROPRIATE ACTION. WHEN CONFLICTS DO ARISE, THE MATTER IS BROUGHT BEFORE THE APPROPRIATE GOVERNING BODY AND DISCUSSED, AND THE CONFLICT IS ELIMINATED. FORM 990, PART VI, SECTION B, LINE 15 THE ORGANIZATION USES AN INDEPENDENT COMPENSATION COMMITTEE, AN INDEPENDENT COMPENSATION CONSULTANT, A WRITTEN EMPLOYMENT CONTRACT, A COMPENSATION SURVEY OR STUDY, APPROVAL BY THE BOARD AND CONTEMPORANEOUS WRITTEN SUBSTANTIATION OF THE DECISION-MAKING PROCESS WHEN DETERMINING COMPENSATION FOR THE CEO AND OTHER OFFICERS OF THE ORGANIZATION. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED GAINS ON INVESTMENTS: 691,768. CHANGE IN BENEFICIAL INTEREST IN FOUNDATION -1,423,292. PREMIER PURCHASING PARTNERS K-1 -507,119. COLONIAL REGIONAL ALLIANCE K-1 20,738. ROCKVILLE IMAGING K-1 11,494. CHEVY CHASE IMAGING K-1 59,934. CHANGE IN MINIMUM PENSION LIABILITY -9,615,014. NET ASSETS RELEASED 1,355,624. INTERCOMPANY TRANSFERS -10,643,412. TOTAL TO FORM 990, PART XI, LINE 5: -20,049,279. JOHNS HOPKINS HEALTH SYSTEM CORPORATION 3910 KESWICK RD SOUTH BLDG 4TH FL S BALTIMORE MD 21211 521465301 SUPPORTING ORGANIZATION MD 501(C)(3) LINE 11C, III-FI JOHNS HOPKINS HEALTH SYSTEM CORPORATION 0 JOHNS HOPKINS BAYVIEW MEDICAL CENTER INC 3910 KESWICK RD SOUTH BLDG 4TH FL S BALTIMORE MD 21211 521341890 HOSPITAL MD 501(C)(3) LINE 3 JOHNS HOPKINS HEALTH SYSTEM CORPORATION 0 JOHNS HOPKINS COMMUNITY PHYSICIANS INC 3910 KESWICK RD SOUTH BLDG 4TH FL S BALTIMORE MD 21211 521467441 HEALTHCARE SERVICES MD 501(C)(3) LINE 11C, III-FI JOHNS HOPKINS HEALTH SYSTEM CORPORATION 0 JOHNS HOPKINS MEDICAL SERVICES CORPORATION 3910 KESWICK RD SOUTH BLDG 4TH FL S BALTIMORE MD 21211 521232569 HEALTHCARE SERVICES MD 501(C)(3) LINE 3 JOHNS HOPKINS HEALTH SYSTEM CORPORATION 0 THE JOHNS HOPKINS HOSPITAL 3910 KESWICK RD SOUTH BLDG 4TH FL S BALTIMORE MD 21211 520591656 HOSPITAL MD 501(C)(3) LINE 3 JOHNS HOPKINS HEALTH SYSTEM CORPORATION 0 SUBURBAN HOSPITAL HEALTHCARE SYSTEM INC 8600 OLD GEORGETOWN ROAD BETHESDA 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