2013-08-14T14:02:04-07:00 2012-09-30 KPMG LLP 2 Financial Center 60 South St Boston MA 02111 990 2011-10-01 050258905 The Miriam Hospital MIRI 4017932500 164 Summit Avenue Providence RI 02906 Mary A Wakefield 2013-08-14 true 6179881000 2011 2016-02-24 21:20:13Z Timothy J Babineau MD 164 Summit Avenue Providence RI 02906 479098337 false false X www.miriamhospital.org X 1926 RI The mission of The Miriam Hospital(TMH) is to inspire one another to improve the health and spirit of the lives we touch. 19 16 2846 874 2645449 152121 3004364 8435033 391208224 411609404 1825832 8701381 8994542 15532616 405032962 444278434 507193 0 179893033 183243201 0 0 220130266 233040198 400023299 416790592 5009663 27487842 372660071 400605850 135106742 138226843 237553329 262379007 The mission of The Miriam Hospital(TMH) is to inspire one another to improve the health and spirit of the lives we touch. false false 315813554 507193 400021178 Patient Care:Services and programs provided by TMH include general medicine; general surgery; emergency medicine; cardiovascular care; orthopedics; nuclear cardiology; radiology; laboratory; renal dialysis; urology; gastroenterology; endocrinology; gynecology; nephrology; neurology; ophthalmology; trauma care; computerized tomography; and magnetic resonance imaging (MRI). During November 2011, the Total Joint Center, a program of the Orthopedic Institute at Rhode Island Hospital, began operations at TMH. (Continued on Schedule O). 27674800 23990800 Research:Since 1969, the level of research has increased from seven projects totaling $127,000 involving nine investigators to 355 projects totaling $27.7 million involving 76 investigators and 162 employees. The following represents significant areas of research being conducted at the Hospital: cancer treatment and prevention, epidemiological research, clinical trials in AIDS and HIV infection (including vaccine development), coronary heart disease, nutrition, exercise, weight control and lifestyle risk factors affecting health. TMH provided $3.7 million in support of research activities in fiscal year 2012. (Continued on Schedule O). 21455237 2790585 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 the Hospital exceeded the reimbursement received from third-party payors by $18.7 million in fiscal year 2012. (Continued on Schedule O). 364943591 true true false true false false false false false true true true false true true true true true false false true false false false false false true true true false true true false false false false false false false false true true false false false false false true false false false false true 191 0 true 2846 true true true false false false false false false false false false 0 false false false false false false false false false false false X 19 16 true false false false true true true true true false false false true true true true true true true true false false X Mary A Wakefield 4014447093 167 Point Street Providence RI 02903 X Brian J Zink MD 2.00 X 0 0 0 Jane Williams RN PhD 0.00 X 0 0 0 Fred J Schiffman MD 1.20 X 0 0 0 Lawrence Sadwin 3.00 X 0 0 0 James A Procaccianti 2.00 X 0 0 0 Michael J Perik 1.00 X 0 0 0 David A Marcoux MD 2.00 X 0 0 0 Joseph J MarcAurele 2.00 X 0 0 0 Alan H Litwin 6.00 X X 0 0 0 Bertram M Lederer 3.00 X X 0 0 0 Phillip Kydd 3.00 X 0 0 0 Mary Jo Kaplan 3.00 X X 0 0 0 Dayle H Joseph MSEdD 4.00 X 0 0 0 Michael L Hanna 4.00 X X 0 0 0 Brian Goldner 0.50 X 0 0 0 Edward D Feldstein 2.00 X 0 0 0 Jonathan J Elion MD 2.00 X 0 0 0 Penelope H Dennehy MD 2.00 X 0 199992 21912 Ellen A Collis 1.50 X 0 0 0 Jeffrey G Brier 2.00 X 0 0 0 Edmund C Bennett 2.00 X X 0 0 0 Roger N Begin 2.00 X 0 0 0 Emanuel Barrows 1.50 X 0 0 0 Timothy J Babineau MD 13.00 X X 0 833462 145667 Lawrence A Aubin Sr 1.00 X 0 0 0 Mary A Wakefield 12.00 X 0 677833 101701 Arthur J Sampson 40.00 X 0 481412 87140 Maria Ducharme 40.00 X 221784 0 62460 Jeffrey M Burock MD 40.00 X 255080 0 35802 Robert W Corwin MD 40.00 X 365058 0 23054 Lisa Goldstein MD 40.00 X 252241 0 23119 Rogers C Griffith MD 40.00 X 339259 0 35463 Rena R Wing 40.00 X 273484 0 25765 Kathleen Hittner MD 0.00 X 0 834997 29278 1706906 3027696 591361 183 true true false University Medicine Foundation Inc 17 Virginia Ave Providence RI 02905 Medical Services 8607623 Sodexo Inc 25 Royal Little Drive Providence RI 02904 Dietary/Cafe Svs 1301003 Quest Diagnostics Inc 12436 Collections Drive Chicago IL 60693 Laboratory Services 1267571 Narragansett Bay Anesthesia 164 Summit Avenue Providence RI 02906 Medical Services 1851798 Brown University 75 Waterman Street Providence RI 02912 Subcontracted Svcs. 1727794 30 8295633 31808 107592 8435033 Temp Restricted (SPFs) 900099 1493063 1493063 Patient Service Rev 900099 381326593 381326593 Laboratory 621500 2591091 2591091 Direct Rev from Research 900099 26198657 26198657 411609404 3174806 3174806 1069 1069 0 799990 509440 290550 290550 5451 285099 39835969 34310463 5525506 5525506 5525506 0 0 0 Joint Venture Revenue 900099 7192533 7192533 Indirect Rev from Grants 900099 5104216 5104216 Cafeteria Revenue 722210 1158807 1158807 1786510 1737603 48907 15242066 444278434 424211472 2645449 8986480 507193 507193 0 0 0 290399 290399 0 142737464 138230141 4507323 5599051 5422525 176526 24547747 23879932 667815 10068540 9751101 317439 0 0 0 3043 3043 0 372617 372617 19578036 19495226 82810 122224 117777 4447 86853768 86594109 259659 0 0 8958019 8175679 782340 703093 651154 51939 0 419310 398253 21057 3493138 3493138 0 11132284 11132284 2119628 2119628 All Other Expenses 13169425 12248034 921391 License Fee 17700799 17700799 Provision for bad debts 24013379 24013379 Purch Svs & Equip Cont 44344484 15288268 29056216 56951 56951 416790592 364943591 51847001 0 0 14168190 14068133 1464558 1514332 36464708 41439931 0 0 508141 318703 4956106 5968500 888645 3427774 328083336 169223297 154894765 158860039 61584178 73630205 31534911 35075511 0 0 66195869 66302722 372660071 400605850 26928215 30020939 66056166 63953017 42122361 44252887 135106742 138226843 X 205353302 223650887 19575215 25771614 12624812 12956506 237553329 262379007 372660071 400605850 X 27487842 -2662164 X false true true X true true X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false false false true 3043 3043 false false Part II-B, Line 1i Part II-B, Line 1i - Other Activities Description The Miriam Hospital pays membership fees to the Hospital Association of Rhode Island (HARI), a portion of which is allocated to HARI's lobbying efforts. 97696217 35666188 10411008 32606107 111167306 96830355 25953487 678572 25766197 97696217 73337707 40371010 8097713 24976075 96830355 0.84750 0.15250 false false false 4288032 4288032 197681947 74455425 123226522 121927103 94767872 27159231 4186254 4186254 158860039 35075511 Trustee-held funds-bond indenture 8821673 Other 164318 Interest in Net Assets of TMH Foundation 53385328 Deferred financing costs 1469813 66302722 Third-party payor settlements 6913972 Post-retirement benefit liability 63100 Lease payable 425195 Health care benefit self-insurance 2867296 Due to affiliates 106424 Accrued pension liability 33696900 Abatement liability 180000 44252887 444278434 416790592 27487842 2162927 -4825091 -2662164 24825678 417739714 2162927 -4825091 -2662164 420401878 372617 23503939 23876556 444278434 392914036 392914036 372617 23503939 23876556 416790592 Part X Part X : FIN48 Footnote The Miriam Hospital (the Hospital), as a not-for-profit corporation, is recognized under Section 501(c)(3) of the Internal Revenue Code and is exempt from Federal income taxes. The Hospital recognizes the effect of income tax positions only if those positions are more likely than not of being 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. The Hospital did not recognize the effect of any income tax positions during the fiscal year ended September 30, 2012. Part XIII, Line 4b Part XIII, Line 4b: Other revenue amounts included on 990 but not included in F/S Debt-financed rental expenses $-12005 Non-debt-financed rental expenses $-497435 Provision for bad debts $24013379 Part XII, Line 4b Part XII, Line 4b: Other revenue amounts included on 990 but not included in F/S Debt-financed rental expenses $-12005 Non-debt-financed rental expenses $-497435 Provision for bad debts $24013379 Part XI, Line 8 Part XI, Line 8: Other Changes in Net Assets or Fund Balances Increase in Net Assets of TMHF $4003082 Change in funded status of pension and other postretirement $ -8828173 Decrease in Net Assets of TMHF $ -0 Part V, Line 4 Part V, Line 4: Intended uses of the endowment fund. The Miriam Hospital's unrestricted endowment consists of designated assets set aside by the Hospital'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 the Hospital are used to support: (1) renovations of the Hospital's Emergency Department (ED) to provide the capacity, privacy, and efficiency that the community needs. These renovations will also improve patient transportation, work flow, and collaboration among team members; (2) creation of a 21-bed ambulatory unit for patients coming to the Hospital for such procedures as cardiac catheterizations and electrophysiology, which will enhance cardiac care, while freeing beds in inpatient care units and facilitating faster admissions from the ED and expanding ED capacity; (3) replacement of the Hospital's hybrid catheterization laboratory; (4) purchase of an upgraded surgical robot; (5) the treatment and prevention of cancer, including the Cancer Patient Navigator Program, which assists cancer patients through the entire course of their care; (6) the Hospital's capital equipment and operating needs in providing services to patients; and (7) purchase of equipment for the operating rooms in the Total Joint Center, where orthopedic surgeons perform procedures that restore function to damaged joints, including total hip, knee, and shoulder replacement using minimally invasive surgical techniques. Europe 0 0 Program Services Research 7840 Middle East & No. Africa 0 0 Program Services Research 9698 Sub-Saharan Africa 0 0 Program Services Research 372188 South Asia 0 0 Program Services Research 17659 East Asia & the Pacific 0 0 Program Services Research 250 407635 407635 X false false false false false true true true true X true X true true false false true true 15330787 2609414 12721373 0.03240 35046201 29571257 5474944 0.01390 50376988 32180671 18196317 0.04630 361467 56679 304788 0.00080 21455237 2790585 18664652 0.04750 15892971 12513727 3379244 0.00860 27674800 23990800 3684000 0.00940 165271 165271 0.00040 65549746 39351791 26197955 0.06670 115926734 71532462 44394272 0.11300 true 5491860 938857 79436116 83760153 -4324037 X true true 1 0 The Miriam Hospital

164 Summit Avenue Providence RI 02906

X X X X X The Miriam Hospital 1 false true true 200.0000 true 400.0000 true X X X X X X true true X X X X X X true X X true X X X X X X true X false false 14 TMH Pre-admission Testing Center

208 Collyer Street 3rd Floor Providence RI 02904

Outpatient Pre-admission assessment and education TMH Behavioral Medicine Clinic

146 West River Street Providence RI 02904

Outpatient Clinic RISE TB Clinic

14 Third Street Providence RI 02906

TB Clinic TMH Laboratory

400 Bald Hill Road Warwick RI 02886

Phlebotomy Lab TMH Laboratory

1 Commerce Street Lincoln RI 02865

Phlebotomy Lab TMH Outpatient Rehabilitation

195 Collyer Street Providence RI 02904

Outpatient PT, OT and Speech Rehab TMH Laboratory

1 Hoppin Street Providence RI 02903

Phlebotomy Lab TMH Cardiac RehabPulmonary Rehab

208 Collyer Street Providence RI 02904

Outpatient Cardiac Clinic TMH Immunology Research

11 Fourth Street Providence RI 02906

Outpatient Research & Education TMH Immunology Research Center

14 Third Street Providence RI 02906

Outpatient Counseling TMH Weight Control & Diabetes Research

196 Richmond Street Providence RI 02903

Outpatient Research & Education Womens Medicine Collaborative

146 West River Street Providence RI 02904

Comprehensive Women's Outpatient Clinic Behavioral Medicine Research

1 Hoppin Street Providence RI 02903

Outpatient Research & Education TMH Diagnostic Imaging Center

195 Collyer Street Suite 101 Providence RI 02904

Outpatient Radiology Part VI - Affilated Health Care System Roles and Promotion Lifespan's mission is to improve the health status of the people it serves in RI and in southern New England through the provision of customer friendly, geographically accessible, high value services in the environment of an integrated academic health system. Lifespan affiliates provide comprehensive inpatient and outpatient medical, surgical and psychiatric services for adults and children. Lifespan and its affiliates employ more than 12,500 people. The Lifespan system has over 2,300 physicians on the medical staffs of its affiliated hospitals, operates 1,155 licensed beds in four hospital complexes, and in 2012 generated approximately $1.6 billion in total operating revenue. By each of these measures, Lifespan is RI's largest health system, serving a population of over 1.5 million. Three of its hospital members, Rhode Island Hospital (RIH), The Miriam Hospital (TMH) and Bradley Hospital (EPBH), are teaching affiliates of The Warren Alpert Medical School of Brown University with 78 percent of the residents and fellows in this program based at RIH, TMH, and EPBH.Lifespan is a RI 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, 2012, Lifespan Corporation employed approximately 700 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, telecommunications, risk management, legal, communications and public affairs, fundraising, facility development, strategic planning, internal audit/compliance, human resources, finance, 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, develop, negotiate and approve all managed care agreements, develop 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 reserved to Lifespan as sole member include: to elect and remove trustees; to approve the election of and to remove certain officers; to approve the 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.For a complete listing of affiliated members of Lifespan's integrated healthcare delivery system, please refer to Schedule R. Part VI - Explanation Of How Organization Furthers Its Exempt Purpose The Miriam Hospital is governed by a Board of Trustees, which is composed of 20 voting members; 17 who are elected by Lifespan Corporation as sole member of the Hospital, and three who serve ex officio. Lifespan approves the elected Trustees to serve one-year terms, until his/her successor is duly authorized and elected at the next Annual Meeting. The ex officio members of the Board with a vote are the President and Chief Executive Officer of the Hospital along with the Chair of The Miriam Hospital Foundation and the Chair of Rhode Island Hospital Foundation. Additionally, the Chair and the President and CEO of Lifespan Corporation are ex officio members of the Board without a vote. The Hospital's Board prescribes the duties and powers of committees appointed by the Chair and appoints members of the Medical Staff. The physicians on the Hospital's medical staff are both hospital-based and community-based. Part VI - Community Building Activities The Hospital substantially subsidizes various health services including the following programs: oncology, tuberculosis, and certain other specialty services. The Hospital 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 - Community Information The Miriam Hospital, 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 RI and southeastern Massachusetts. As a complement to its role in service and education, the Hospital actively supports research. The Hospital 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. The Hospital is also a member of Voluntary Hospitals of America, Inc. (VHA).In 1969, the Hospital 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). The Hospital 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, the Hospital has developed formal and informal educational affiliations with a number of accredited New England colleges and universities. The Hospital does not receive any compensation from the various schools for providing a clinical setting for the student nurse training.The Hospital 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 - Patient Education of Eligibility for Assistance The Miriam Hospital has multilingual signage in the Hospital's 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 the Hospital. Assistance eligibility is also summarized on the Hospital's website. Part VI - Needs Assessment Lifespan's Office of Strategic Planning and Analysis performs population-based studies for the Hospital 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. In addition to this approach, 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 sub-components 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, the Hospital 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 demands regarding clinical services. For example, in 2006, the Hospital was the first in the region to use a new technology to remove clots quickly, mitigating the debilitating effects of stroke. Over the past three years, the Hospital has expanded its groundbreaking robotic surgery program. The Hospital is home to the state's first Joint Commission-Certified Stroke Center and the only Women's Cardiac Center in Rhode Island. Number of Hospital Faciltiy - 0 Part V, Line 19d - Other Billing Determination of Individuals Without Insurance Uninsured patients receive an automatic 50% Community Benefit discount on Hospital charges. In no case was there a situation where an uninsured patient paid more than amounts charged through Medicare or negotiated commercial insurance rates. Number of Hospital Faciltiy - 0 Part V, Line 16e - Other Collection Actions by Facility or Third Party Engaged The Hospital engages third-parties to perform certain collection actions on its behalf. A pre-collect company is used for all self-pay accounts. Additionally, a collection agency is used if there is no payment activity on such accounts after 120 days. The collection process is explained in further detail in the response to Question 15e above. Number of Hospital Faciltiy - 0 Part V, Line 15e - Other Collection Actions Against a Patient Once an account balance or a portion thereof is classified as self-pay, it is placed with the Hospital's pre-collect company until the balance is paid in full, a monthly payment plan is in place, or insurance information is provided for billing.After 120 days, if there is no payment activity, the account qualifies for bad debt and the pre-collect company returns the account to Patient Financial Services, which in turn forwards it to a collection agency.The collection agency sends 3 to 5 notices to the patient requesting payment. If there are no responses after the notices are sent, collection calls are made. If there is no response after 120 days, the account is reviewed for legal action in the appropriate court.If there are no assets to pursue, the collection agency deems the account uncollectible and returns it to Patient Financial Services for writeoff.Note: In accordance with Center for Medicare and Medicaid Services mandates, Medicare patient accounts are held 130 days from last payment, after which if there has been no activity, the account is referred to collection. Number of Hospital Faciltiy - 0 Part V, Line 13g - Other Means Hospital Facility Publicized the Policy An abbreviated version of the Hospital's financial assistance policy is posted in various admitting and outpatient areas of the Hospital. 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 III, Line 9b - Provisions On Collection Practices For Qualified Patients The Hospital uses an outside pre-collection agency for all self-pay receivables. The pre-collection agency attempts to collect the debt for 120 days. During this time, 3 letters are sent to the patient's address of record and, for balances in excess of $50, attempts are made to reach the patient by telephone. If the agency makes contact with the patient and the patient expresses an inability to pay, payment plans and/or Community Free Service are offered. (Please refer to the Charity Care Eligibility Criteria and Additional Information sections for further detail on those processes.) If the pre-collection agency is unsuccessful in contacting the patient or no response is received within 120 days, the account is forwarded to a collection agency.The collection agency also sends statements and attempts to reach the patient via telephone. Again, if the agency makes contact with the patient and the patient expresses an inability to pay, payment plans and/or Community Free Service are offered. If no response is received, the claim is referred to small claims court and the patient is summoned to appear. If the patient does not appear, the Hospital will receive a judgment in its favor. If the Hospital learns that the claim has a related settlement, i.e., an automobile accident, the Hospital can put a lien on such settlement. Alternatively, if the collection agency deems the account uncollectible, it will be written off. Part III, Line 8 - Explanation Of Shortfall As Community Benefit Medicare shortfall has not been 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 4 - Bad Debt Expense Accounts receivable are reduced by an allowance for doubtful accounts. In evaluating the collectibility of accounts receivable, the Hospital analyzes its past 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, the Hospital 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), the Hospital 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.The Hospital's allowance for doubtful accounts for self-pay patients decreased from 81% of self-pay accounts receivable at September 30, 2011 to 79% of self-pay accounts receivable at September 30, 2012. The Hospital's self-pay writeoffs for the years ended September 30, 2012 and 2011 amounted to approximately $21,191,000 and $19,107,000, respectively. The Hospital did not change its charity care or uninsured discount policies during the years ended September 30, 2012 and 2011, respectively. The Hospital does not maintain a material allowance for doubtful accounts from third-party payors, nor did it have significant writeoffs from third-party payors in either 2012 or 2011.The Hospital provided $24,013,379 for uncollectible patient accounts during the year ended September 30, 2012. The associated cost reported on Line 2 of Part III was determined by applying an operating cost to charge ratio (exclusive of community benefit costs and charges) to the provision amount.Schedule H, Part III, Section A, Line 2The 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 the Hospital'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.Schedule H, Part III, Section A, Line 3Accounts pending transfer to bad debt are reviewed by the Hospital's patient advocate staff to determine qualification for financial assistance under the Hospital'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 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 bad debt expense of $24,013,379. Part I, Line 7 - Explanation of Costing Methodology The Hospital'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 expense.Patient costs are calculated based on Medicare principles of reimbursement by reducing total operating expenses 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 by cost as calculated by the Hospital's cost accounting system. The system applies 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 the Hospital's Community Health Services department. Revenue received for these services is reported as direct offsetting revenue. f) Health profession education- Health professions education expenses represent direct costs related to amounts associated with resident and intern programs utilized at the Hospital. 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 on the Hospital's Medicare cost report.g) Subsidized health services- Subsidized health services' community benefit expense is determined by the cost accounting system. These subsidized health services are recorded at cost in the Hospital'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 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- The Hospital conducts extensive medical research focused on the prevention and treatment of HIV/AIDS, obesity, cancer, diabetes, cardiac disease, and mental health concerns. For all internal and external research conducted, the costs associated with these activities is calculated by combining the direct and indirect costs as reported within the Hospital'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 determined by using direct costs recorded in the general ledger and adding including an allocation of contributions made by Lifespan Corporation on the Hospital's behalf. Part I, Line 3c - Charity Care Eligibility Criteria (FPG Is Not Used) The Miriam Hospital (the Hospital) uses a dual system for determining financial aid eligibility: federal poverty guidelines and an asset test.The financial screening process at the Hospital 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, has a long-term disability, RIte Care, or CFS, 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 an automatic 50% deduction at the Hospital.5. Eligibility for CFS above the 50% 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 four times the poverty level in effect at the time of application. Full charity care applicants with assets worth more than $8,500 for an individual (or $13,500 for a family) may not qualify for care without charge, but may 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 50% charity care discount. 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 charges (net of the automatic 50% discount) if the balance is under $5,000 and 50% to 100% of estimated charges (net of the automatic 50% discount) if the estimated bill 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 the 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 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. true Thundermist Health Center 191 Social Street Woonsocket RI 02895 050355097 501(c)(3) 41250 0 Health Pgm Support Mt Hope Neighborhood Assoc 199 Camp Street Providence RI 02906 222599257 501(c)(3) 8490 0 General Support Mt Hope Learning Center 140 Cypress Street Providence RI 02906 050502405 501(c)(3) 9000 0 General Support Jewish Alliance of Greater RI 401 Elmgrove Avenue Providence RI 02906 274127671 501(c)(3) 5250 0 General Support Groundwork Providence 8 Third Street Providence RI 02906 050397766 501(c)(3) 18000 0 General Support Family Service of RI Inc PO Box 6688 Providence RI 02940 050258858 501(c)(3) 6500 0 General Support Downtown 5K Inc 183 Purgatory Road Exeter RI 02822 223047066 501(c)(3) 10000 0 General Support City of Providence 25 Dorrance Street Providence RI 02903 056000329 Gov't Org. 216000 0 Payment in lieu of taxes Brown University 164 Angell Street Providence RI 02912 050258809 501(c)(3) 149211 0 General Support 9 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 the Hospital. X X true true X X X X X false true false false false false false false false false Timothy J Babineau MD 670179 113906 49377 123194 22473 979129 21386 Rogers C Griffith MD 321352 10000 7907 15485 19978 374722 Robert W Corwin MD 239319 125739 7298 15756 388112 77800 Rena R Wing 266271 7213 17308 8457 299249 Penelope H Dennehy MD 193064 2470 4458 12594 9318 221904 Mary A Wakefield 499573 84291 93969 85853 15848 779534 67780 Maria Ducharme 204843 16941 42760 19700 284244 Lisa Goldstein MD 239174 11000 2067 14678 8441 275360 Kathleen Hittner MD 467419 79819 287759 9800 19478 864275 206559 Jeffrey M Burock MD 206573 40000 8507 14617 21185 290882 Arthur J Sampson 350388 59400 71624 70685 16455 568552 45490 Sch J, Part I, Line 1a Part I, Line 1a: Relevant information in regards to selections on 1a. Tax Indemnification and Gross-up Payments:The Lifespan Executive Long Term Disability program provides financial protection to designated Lifespan 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).Social Club Dues:The job responsibilities of certain executives include development of relationships with business leaders and donors. Those relationships are facilitated by the ability to meet in private sessions during which focused business discussions take place. The Hope and University Clubs, which require individual memberships, are places in Providence where businessmen and women, civic, community and social leaders can gather in a business-like atmosphere. The cost of membership is considered by Lifespan to be reasonable and necessary and thus a qualified business expense not taxable to the employee. IRS regulations regarding documentation requirements are followed for any payments made for meetings held at the respective club, including the business purpose and nature of the business benefit derived; the nature of the business discussion or activity; and the identity and business relationship of attendees. RI Health & Ed Bldg Corp 521300173 762243K36 2009-03-30 19582506 See Part V false false true RI Health & Ed Bldg Corp 521300173 762243SS3 2006-02-14 40725126 See Part V false false true 19582506 1955663 288639 339121 10338881 6660202 false false false true 4656100 37924625 40725126 348652 968829 39407645 2006 false true true true false false false true true 0.00500 0.00500 true false true false true true 0.00970 0.00970 true false false false false false false false false false false false false X Jessica Brier Employee 102665 Employee Compensation false Roberts Carroll Feldstein & Peirce Partner 113159 Legal Services false * Edward Feldstein, Trustee, is a partner in Roberts, Carroll, Feldstein and Peirce, a law firm that provides legal services to a sister company, Lifespan Risk Services. The common parent of TMH and Lifespan Risk Services is Lifespan Corporation. During fiscal year 2012, Lifespan Risk Services paid Roberts, Carroll, Feldstein and Peirce $113,159 for services regarding TMH matters.* The wife of Jeffrey Brier is employed by The Miriam Hospital as a Cardiovascular Clinical Nurse Specialist. In fiscal year 2012, The Miriam Hospital paid Jessica Brier $102,665 for her services. Form 990, Schedule K, Part V: The Hospital has in place written post-issuance tax compliance procedures for tax-exempt obligations. To ensure that its bonds continue to qualify for tax-exempt status, the Hospital consults with bond counsel and other legal counsel and advisors, as needed, to ensure that all applicable post-issuance requirements are met. The Hospital has not identified any non-compliance with the requirements of its tax-exempt bonds. Form 990, Schedule K, Part I, Line B, Column (f) The proceeds of the Series 2009A Bonds are being used for the purposes of financing projects consisting of: (i) the acquisition, construction, renovation, expansion and equipping of certain hospital and related health care facilities owned and operated or to be owned and operated by one or more of Rhode Island, The Miriam, or Emma Pendleton Bradley Hospitals, located at and in the vicinity of the Hospital Campuses; (ii) equipping, furnishing, and improving facilities and other depreciable assets used in health care operations on the Hospital Campuses; (iii) the funding of a debt service reserve fund for the Bonds; and (iv) and the payment of certain expenses of issuance with respect to the Bonds. Form 990, Schedule K, Part I, Line A, Column (f) The proceeds of the Series 2006A Bonds were used: (i) to advance refund a portion of the $214,585,000 Hospital Financing Revenue Bonds, Lifespan Obligated Group Issue, Series 1996; (ii) to advance refund a portion of the $78,000,000 Hospital Financing Revenue Bonds, Lifespan Obligated Group Issue, Series 2002 and (iii) to pay certain expenses incurred in connection with the issuance of the Series 2006A Bonds. Form 990, Part VI, Section B, Lines 15 a&b cont. 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, the office of the Senior Vice President of Human Resources works with the Committee's independent compensation consultant or relies 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. Form 990, Part VI, Section B, Lines 15 a&b The following applies to Lifespan and all of its affiliates, including The Miriam Hospital: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 with both law and 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 and affiliate 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 and long-term incentive and executive benefit plans* Approving performance objectives associated with Lifespan's annual and long-term incentive plans, 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(s)* 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. The independent consultants are not engaged by management to perform any services for Lifespan without prior approval by the Committee.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. Form 990, Part VI, Section B, Line 12c Lifespan Corporation has a Conflict of Interest Policy that is applicable to all affiliates, including The Miriam Hospital, 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. (For the bulk of Lifespan management staff awareness of 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 III, 4c 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 compete both clinically and academically.TMH participates in Brown programs in internal medicine and medicine subspecialties, general surgery and surgical subspecialties, psychiatry, emergency medicine, orthopedics, and dermatology and provides stipends to residents and physician fellows while in training. The Hospital is also a participating clinical training site for residents from other programs in infectious disease, OB/Gyn subspecialties, podiatry, psychiatry, geriatric psychiatry, and colorectal surgery. In addition, TMH Behavioral Medicine, in collaboration with Brown, sponsors research and clinical psychology training programs for interns, postdoctoral fellows, and faculty trainees. OTHER EDUCATIONAL AFFILIATIONS AND PROGRAMS:Nursing. TMH has developed formal and informal 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. Joseph's Health Services' School of Nursing; the University of Massachusetts campuses at Dartmouth, Boston, Amherst and Worcester; the University of Connecticut; New England Technical Institute; Walden University; 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.Sponsored Training Programs and Clinical Site Affiliations. TMH sponsors training programs for a variety of allied health care professionals including required clinical and fieldwork experiences in physical, speech, and occupational therapy to university students in each discipline through contracts with the various universities. TMH serves as a clinical training site for students from CCRI for the vascular and cardiology ultrasound programs and also provides training experiences for students in diagnostic radiology, medical technology, phlebotomy, and social work. The Hospital serves as a clinical training site for students from The Nuclear Medicine Institute of the University of Findlay (Ohio). TMH has clinical affiliations/student clinical training programs for pharmacy students provided through contracts with a number of colleges and universities. Form 990, Part III, 4b 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, supported by the National Cancer Institute, CALGB, and NSABP. TMH is a participating hospital in the Brown Univiersity-sponsored Cancer Oncology Group (BrUCOG).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 Phillipines, and South Africa. The Lifespan/Tufts/Brown Center for Aids Research conducts clinical, basic, and translational research programs. The TB Clinic performs research in the area of co-infections of HIV and tuberculosis.Depression- The Center for Behavioral and Preventive Medicine (CBPM) is comprised of major centers including: (1) Weight Control and Diabetes, (2) Nicotine & Tobacco Research, and (3) Physical Activity Research.The Weight Control and Diabetes Center conducts research programs that focus on diet, exercise, maintenance strategies, home environment, adolescent issues, and pediatric obesity. The Physical Activity Research Center conducts research in the workplace, community settings and health care facilities, involving all age groups and focusing on the effects of exercise in disease preventions and treatment. Form 990, Part III, 4a, continued 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 2012, TMH discharged 15,606 inpatients, logged nearly 58,000 visits in its emergency department and performed over 10,000 inpatient and outpatient surgical procedures. Services provided in 2012 represent nearly 163,000 inpatient days and more than 71,000 clinic visits. TMH is staffed by more than 775 affiliated physicians, approximately 50 full-time house staff (medical school graduates), a nursing staff of 500 and more than 1,100 health care employees. In total, TMH employs more than 2,500 people. TMH is a major teaching hospital for 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 four times the poverty level. In addition, a substantial discount is offered to all other uninsured patients. The Hospital determines the cost 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 the Hospital to provide charity care amounted to $12,721,373 in fiscal 2012. Charges forgone, based on established rates, amounted to $41,579,316.TMH substantially subsidized various health services including oncology, HIV, tuberculosis and men's health clinics at a cost of $3,379,244 in fiscal year 2012. 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, physicianreferral services, and charitable contributions. The cost of these services amounted to $304,788 in fiscal year 2012.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. 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 positions 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, dietary, patient visitors, recovery room support, patient experience representatives, hand massage, and central transporters. 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 Comprehensive Cancer Center brings together world-renowned physicians and a group of specialists from TMH, Rhode Island Hospital and Newport Hospital, forming a multidisciplinary team whose level of knowledge and experience are unparalleled in Rhode Island.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 pain, cancer, heart disease (including those with implanted cardiac devices), pulmonary disease, and diabetes. The Weight Management Program provides comprehensive, medically supervised treatment for mildly, moderately, 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 Rhode Island Hospital were named Blue Distinction Centers for Complex and Rare Cancers by Blue Cross and Blue Shield of Rhode Island. TMH and Rhode Island Hospital 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 Rhode Island Hospital 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.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 Comprehensive Cancer Center has brought together nationally recognized leaders in the treatment and research of gastrointestinal cancers. 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.TMH's cardiac surgery department is led by four board certified cardiothoracic surgeons, each able to perform a wide variety of cardiac, thoracic and peripheral vascular procedures. They represent more than ninety years of cumulative experience.Anesthesiologists dedicated to the management of complex cardiothoracic and vascular procedures provide each patient with the latest measures of intraoperative therapy and assessment. Every patient is monitored with a transesophageal echocardiogram (sonogram). TMH's team of surgeons, anesthesiologists and cardiologists works closely together. This cooperative approach has led to outstanding results at all levels of complexity.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 and TMH uses this technology to treat different types of cancer. The Center's team-based approach provides state-of-the-art care for patients who have or are at risk for cancers of the upper gastrointestinal tract, such as pancreatic cancer, cancer of the esophagus, and tumors involving the liver.The gastrointestinal cancer care services available through the Comprehensive Cancer Center provide 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. In 2012, Lifespan, on behalf of Rhode Island Hospital and The Miriam Hospital, reached an agreement with the City of Providence to make voluntary payments of $800,000 a year for three years, for a total of $2.4 million to help stabilize the city's financial health. TMH's share of the voluntary payment is $216,000 a year, for a total of $648,000. Lifespan has always maintained a strong commitment to Providence through its many community-based programs, as well as through the charity care it provides. Community programs provide support to the city through various clinics, community health programs, employment training initiatives, youth employment and mentoring programs, and substantial financial support to various cityprograms.The Total Joint CenterThe Total Joint Center at The Miriam Hospital is dedicated to providing the most technologically advanced and specialized procedures focused on the replacement of joints and rehabilitation and care in treating diseases of, or injuries to, hips, knees, and shoulders. The Miriam Hospital 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.Medical and surgical services at the Total Joint 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 surgery techniques are used to perform surgery. These techniques have dramatically improved the quality of the post-operative and recovery experience for the patient. In some cases and when appropriate, 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.Award-Winning CareIn 2012, TMH's Stroke Center received a Gold Plus Performance Achievement Award from the American Heart Association/American Stroke Association. This is the association's highest honor for stroke care.National Stroke Center CertificationAlso in 2012, TMH earned the elite Gold Seal of Approval from The Joint Commission for Primary Stroke Centers, a national honor awarded to the country's top stroke programs. TMH, which was the first hospital in Rhode Island to be certified a Primary Stroke Center, holds distinction as the only facility in the state to be certified four times.National Stroke Performance Award In both 2011 and 2010, TMH received the American Heart Association/American Stroke Associations Get With The Guidelines Stroke (GWTG-Stroke) Gold Plus Performance Achievement Award. The award recognizes TMH's commitment and success in providing the highest standard of stroke care for patients, according to evidence-based guidelines. This is the Associations highest honor for stroke care. Outstanding Achievement Award from the Commission on Cancer Also in 2011, The Leonard and Adele R. Decof Family Comprehensive Cancer Center at TMH earned the Outstanding Achievement Award from the Commission on Cancer (CoC) of the American College of Surgeons, among only 90 programs nationwide to receive thishonor. This award recognizes the significant commitment by medical staff,administration and support staff to providing high-quality cancer care to their patients, as well as meeting and exceeding the standards set by the CoC. Center of Excellence DesignationTMH was named an American Society for Metabolic and Bariatric Surgery (ASMBS) Bariatric Surgery Center of Excellence. The designation recognizes surgical programs with a demonstrated track record of excellence in providing superior and comprehensive bariatric surgery care.Blue Distinction Center RecognitionIn both 2011 and 2010, TMH was named a Blue Distinction Center for Bariatric Surgery by Blue Cross and Blue Shield of Rhode Island following a comprehensive review of its spine surgery and knee and hip replacement services. The Blue Distinction program recognizes facilities that meet objective, evidence-based thresholds for clinical quality, developed in collaboration with expert physicians and medical organizations.AACVPR Program Certification During 2011, The Miriam Hospital pulmonary rehabilitation program was awarded certification from the American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR). Certified AACVPR programs are recognized as leaders in the field of cardiovascular and pulmonary rehabilitation because they offer the most advanced practices available.Magnet Hospital DesignationIn 2010, for the fourth consecutive time, TMH received Magnet designation for overall nursing care and excellence from the American Nurses Credentialing Center (ANCC). Only three other facilities in the United States have been designated a Magnet hospital four times, and TMH is the only hospital in New England to earn this honor. The program provides a framework to recognize excellence in the managementphilosophy and practice of nursing services, adherence to standards for improving the quality of patient care, and continued competence of nursing personnel. In addition, recipient hospitals must demonstrate attention to the cultural and ethnic diversity of patients and their significant others, as well as the care providers in the system. The Magnet Award for Nursing Excellence is the highest level of recognition the American Nurses Credentialing Center can bestow upon organized nursing services in health care organizations. Form 990, Part VI, Line 19 Form 990, Part VI, Line 19: Other Organization Documents Publicly Available Lifespan and 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, currently make their annual and quarterly consolidated financial statements available to the public via DAC (Digital Assurance Certification LLC), a disclosure dissemination agent for issues of the 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 Chief Financial Officer, either in person or by mail. Form 990, Part VI, Line 11 Form 990, Part VI, Line 11: Form 990 Review Process The preparation and filing of the Form 990 and supporting schedules is the responsibility of the Chief Financial Officer and Lifespan's Finance Department, with review by Lifespan's tax advisors, KPMG LLP. 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. Further review is performed by the Director of Finance and the Vice President of Finance - Corporate Services. Once the draft Form 990 is complete, the Director of Finance forwards it with all supporting worksheets to KPMG, which then reviews the completed form in detail. The Director of Finance answers questions as they arise and provides additional information as needed. KPMG provides the Director of Finance 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 Chief Financial Officer for final management review. Prior to filing the return with the Internal Revenue Service, a copy of the entire form is sent to The Miriam Hospital's Board of Trustees in advance of its next Board meeting, at which the Chief Financial Officer discusses the highlights of the Form. All questions and concerns of the members of the Board are addressed by the Chief Financial Officer 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 a password protected website portal. The Chief Financial Officer is authorized to file the Form 990. Form 990, Part VI, Line 7b Form 990, Part VI, Line 7b: Describe Decisions of Governing Body Approval by Members or Shareholders 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 7a Form 990, Part VI, Line 7a: How Members or Shareholders Elect Governing Body The bylaws of The Miriam Hospital (TMH) confer certain reserved powers on 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 trustees and to approve the election of and to remove certain officers. At each annual meeting of the TMH Board of Trustees, a list is compiled of the names of those persons selected to serve as Trustees of TMH so that it can be approved and submitted to Lifespan for ratification and election. Form 990, Part VI, Line 6 Form 990, Part VI, Line 6: Explanation of Classes of Members or Shareholder Lifespan Corporation is the sole corporate member of The Miriam Hospital. Form 990, Part VI, Line 2 Form 990, Part VI, Line 2: Description of Business or Family Relationship of Officers, Directors, Et Timothy J. Babineau, MD, President, and Mary A. Wakefield, CFO, are employed by and officers of Lifespan Corporation. Ms. Wakefield is also an officer of Lifespan Management Services Organization, Inc (MSO). Arthur J. Sampson, key employee, is employed by Lifespan Corporation. Kathleen Hittner, former President of The Miriam Hospital, is a director of MSO and is also employed by Lifespan Corporation. 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