2012-11-15T19:01:30-06:00 2011-12-31 521532556 ADVENTIST HEALTHCARE INC 1801 RESEARCH BLVD SUITE 400 ROCKVILLE MD 20850 990 2011-01-01 201486678 ADVENTIST REHABILITATION HOSPITAL OF MARYLAND ADVE 3013153030 1801 RESEARCH BOULEVARD NO 400 ROCKVILLE MD 20850 JAMES G LEE 3013153025 2012-11-15 1 THOMAS CHAN P01461717 3013153030 2011 2016-02-24 21:20:13Z WILLIAM G ROBERTSON 1801 RESEARCH BOULEVARD NO 400 ROCKVILLE MD 20850 47224715 0 X WWW.ADVENTISTHEALTHCARE.COM/AHRM X 2004 MD WE DEMONSTRATE GOD'S CARE BY IMPROVING THE HEALTH OF PEOPLE AND COMMUNITY THROUGH ( SEE SCH. O) A MINISTRY OF PHYSICAL, MENTAL, AND SPIRITUAL HEALING. 6 3 0 75 0 0 164853 161336 30516730 32210141 205330 206309 26104 50000 30913017 32627786 10366 2200 0 0 18934579 20085207 0 0 0 9671013 9982937 28615958 30070344 2297059 2557442 25314283 26966251 8622080 7730364 16692203 19235887 X TO OPERATE A REHABILITATION HOSPITAL AND OUTPATIENT SERVICES TO SERVE THE COMMUNITY IN MARYLAND. 0 0 23337818 32205441 ADVENTIST REHABILIATTION HOSPITAL OF MARYLAND, A SEPARATE LEGAL ENTITY MANAGED BY ADVENTIST HEALTHCARE EXECUTIVE TEAM, IS THE FIRST AND ONLY ACUTE REHABILIATTION HOSPITAL IN MONTGOMERY COUNTY, MD., THAT OFFERS COMPREHENSIVE REHABILITATION PROGRAMS FOR TRAUMATIC BRAIN INJURIES, SPINAL CORD INJURIES, STROKES, AMPUTATION, ORTHOPEDIC INJURIES AND SUGERIES, SPORTS-RELATED INJURIES, WORK-RELATED INJURIES, CARDIOPULMONARY CONDITIONS, AND NEUROLOGICAL DISORDERS.WE BELIEVE THAT REHABILITATION IS ALL ABOUT HELPING OUR PATIENTS SET THEIR GOALS AND REACH THEM. EXPERT CARE TEAMS WORKING SIDE-BY-SIDE WITH PATIENTS, USING INNOVATIVE THERAPIES, STATE-OF-THE-ART EQUIPMENT AND GROUND-BREAKING TECHNOLOGY COMBINE TO OFFER NEW WAYS TO HEAL. ADVENTIST REHABILITATION HOSPITAL IS BUILT AROUND OUR PATIENTS AND LEADS THE WAY BACK TO LIFE FROM STROKE, BRAIN INJURY, SPINAL CORD INJURY, AMPUTATION AND TRAUMA. EVERY DAY, WE CELEBRATE PATIENT ADVANCES, BIG AND SMALL.WE HAVE RECENTLY UPGRADED OUR SERVICES THROUGH THE ADDITION OF AN ACCESSIBLE VAN, REHABILITATION EQUIPMENT (SUCH AS POWER WHEEL CHAIRS OR LIGHT/SPORT WHEEL CHAIRS) A CAR SIMULATOR FOR PRACTICE CAR TRANSFERS AND SLEEPER CHAIRS. ADVENTIST REHAB HAS LOCATIONS IN ROCKVILLE AND TAKOMA PARK WITH OUTPATIENT SERVICES IN ROCKVILLE AND SILVER SPRING.ADVENTIST REHAB OFFERS SPECIALIZED INPATIENT AND OUTPATIENT TREATMENT FOR PERSONS WITH FUNCTIONAL LIMITATIONS, CARING FOR PATIENTS 18 AND OLDER AND, UNDER SPECIAL CIRCUMSTANCES, EMANCIPATED MINORS. OUR MANY REHABILITATION PROGRAMS AND SERVICES INCLUDE:ACUTE INPATIENT REHABILITATION SPINAL CORD INJURY AMPUTEE PROGRAM STROKE BRAIN INJURY ORTHOPEDIC PROGRAMSORTHOPEDIC REHABILITATION PROSTHETICS & ORTHOTICS OUTPATIENT SERVICESDRIVER REHABILITATION PROGRAM LYMPHEDEMA THERAPY JOINT REPLACEMENT PROGRAM SEATING & MOBILITY CLINIC LEE SILVERMAN VOICE TREATMENT (LSVT) SPEECH LANGUAGE & SWALLOWING THERAPY ADVENTIST REHABILITATION HOSPITAL OF MARYLAND IS THE ONLY HOSPITAL IN THE D.C. METROPOLITAN AREA AND THE THIRD IN THE NATION TO EARN A SPECIALTY ACCREDITATION IN AMPUTEE REHABILITATION FROM THE COMMISSION ON ACCREDITATION OF REHABILITATION FACILITIES (CARF) INTERNATIONAL. CARF INTRODUCED ITS AMPUTEE SPECIALTY STANDARDS IN JULY 2007 WITH INPUT FROM THE AMPUTEE COALITION OF AMERICA (ACA), VETERANS HEALTH ADMINISTRATION, DEPARTMENT OF DEFENSE, AMERICAN ACADEMY OF ORTHOTISTS & PROSTHETISTS, AND PERSONS WITH LIMB LOSS. THE STANDARDS, WHICH BECAME EFFECTIVE IN JANUARY 2008, REQUIRE ACCREDITED AMPUTEE PROGRAMS TO PROVIDE A HOLISTIC, INTERDISCIPLINARY TEAM APPROACH TO CARE AND TO OFFER POST-CARE ASSISTANCE IN TRANSITIONING BACK TO THE COMMUNITY.OUR ACUTE INPATIENT REHABILITATION PROGRAM IS RUN BY A TEAM OF REHABILITATION EXPERTS WHO WILL GUIDE YOU ALONG A PRACTICAL AND PERSONAL TREATMENT PROGRAM FOCUSED ON INCREASING SELF-RELIANCE AND GAINING INDEPENDENCE. THE TEAM IS LED BY A PHYSIATRIST, A MEDICAL DOCTOR WHO SPECIALIZES IN PHYSICAL REHABILITATION. WE PROVIDE SPECIALIZED REHABILITATION NURSING 24 HOURS A DAY, SEVEN DAYS A WEEK. THERAPY SERVICES INCLUDE PHYSICAL THERAPY, OCCUPATIONAL THERAPY, SPEECH LANGUAGE PATHOLOGY, AND RECREATIONAL THERAPY.THE SPINAL CORD INJURY PROGRAM ADDRESSES BOTH TRAUMATIC SPINAL CORD INJURIES RESULT FROM A FALL OR SOME KIND OF ACCIDENT, AND NON-TRAUMATIC SPINAL CORD INJURIES THAT RESULT FROM A STROKE AND DISRUPTION TO THE SPINAL CORD, TUMOR ON SPINAL CORD, OR INFECTION. AGAIN, A TEAM APPROACH TO PUT TOGETHER AN INTERDISCIPLINARY PLAN OF CARE HELPS THE PATIENT ON THE ROAD TO RECOVERY.ADVENTIST REHABILITATION'S AMPUTEE PROGRAM UTILIZES AN INTERDISCIPLINARY TEAM APPROACH TO HELP POST-AMPUTEE PATIENTS TO ADJUST PHYSICALLY AND PSYCHOLOGICALLY AFTER THE LOSS OF A LIMB AND RESUME ACTIVE AND PRODUCTIVE LIVES. INDIVIDUALS MAY BE TREATED AS INPATIENTS OR OUTPATIENTS, DEPENDING ON THEIR PERSONAL NEEDS. PATIENTS WORK TO IMPROVE STRENGTH, COORDINATION AND ENDURANCE AND ALSO LEARN PROPER WOUND CARE. WHEN READY, OUR PATIENTS ARE PRESCRIBED PROSTHETIC DEVICES THAT ARE BOTH FUNCTIONAL AND COMFORTABLE TO WEAR. ONCE TINED WITH A NEW LIMB, THE PATIENT LEARNS TO USE THE PROSTHESIS WITH CONFIDENCE AND TO INCORPORATE IT INTO DAILY LIFE.THE INTERDISCIPLINARY TEAM APPROACH OF THE BRAIN INJURY PROGRAM AT ADVENTIST REHAB ADDRESSES TRAUMATIC BRAIN INJURIES CAUSED BY AN EXTERNAL PHYSICAL FORCE, SUCH AS A CAR ACCIDENT, FALL, SPORTS OR WORKPLACE INJURIES, ETC.; AS WELL AS ACQUIRED BRAIN INJURIES CAUSED BY INTERNAL TRAUMA TO THE BRAIN, SUCH AS TUMORS, BLOOD CLOTS, SEIZURES, INFECTIONS, ETC. EACH OF THESE TYPES OF BRAIN INJURIES MAY RESULT IN IMPAIRMENT OF PHYSICAL, COGNITIVE, BEHAVIORAL, AND/OR EMOTIONAL CAPABILITIES. REHABILITATION FOLLOWING A BRAIN INJURY IS VERY COMPLEX BECAUSE OF THE NEED TO ADDRESS MULTIPLE AREAS OF DEFICIT, INCLUDING PHYSICAL IMPAIRMENTS, FUNCTIONAL DEFICIENCIES (SUCH AS DIFFICULTY WALKING OR DRESSING), BEHAVIORAL DIFFICULTIES, EMOTIONAL CONSEQUENCES AND SOCIAL OR INTERPERSONAL LIMITATIONS. OFTEN, SIGNIFICANT COGNITIVE DEFICITS, SUCH AS LIMITED ATTENTION SPAN OR POOR MEMORY, UNDERLIE AND EXACERBATE THESE PROBLEMS. PATIENTS IN OUR BRAIN INJURY PROGRAM RECEIVE INTENSIVE, INTEGRATED REHABILITATION DESIGNED TO MAXIMIZE THEIR RECOVERY. TEAM MEMBERS, INCLUDING A NEUROPSYCHOLOGIST, MEET AT LEAST ONCE A WEEK TO DISCUSS GOALS, PROGRESS AND TREATMENT STRATEGIES.OTHER PROGRAMS OFFERED INCLUDE A STROKE PROGRAM FOR RECOVERING STROKE PATIENTS TO TAKE PART IN AN INTENSIVE COURSE OF INTEGRATED THERAPY AND MEDICAL MANAGEMENT. THE OBJECTIVE IS TO RESTORE MOVEMENT, IMPROVE SPEECH, TEACH SELF CARE AND HOME CARE SKILLS AND IMPROVE COGNITIVE AND MEMORY FUNCTIONS. STROKE PATIENTS AND THEIR FAMILIES WILL BE GUIDED THROUGH A PATIENT-FOCUSED, COMPREHENSIVE, AND OUTCOME-ORIENTED STROKE PROGRAM BY A CARING, COMPETENT TEAM OF HEALTHCARE PROFESSIONALS. THE ORTHOPEDIC REHABILITATION PROGRAM IS DESIGNED FOR THOSE WHO HAVE UNDERGONE A TOTAL HIP OR KNEE REPLACEMENT OR HAVE SUSTAINED TRAUMA TO BONES OR JOINTS. THE PROGRAM FOCUSES ON HELPING PATIENTS REGAIN THEIR STRENGTH, MOBILITY, ENDURANCE AND RANGE OF MOTION.THE DRIVER REHABILITATION PROGRAM DETERMINES WHETHER IT IS SAFE FOR THE CLIENT TO CONTINUE DRIVING FOLLOWING AN INJURY/ILLNESS OR AGE RELATED CHANGES. A DRIVING PROGRAM MAY INCLUDE A CLINICAL EVALUATION WHICH INCLUDES AN ASSESSMENT OF VISION, VISUAL PERCEPTION, COGNITION, REACTION TIME, AND MOTOR SKILLS RELATED TO DRIVING. IT MAY ALSO INCLUDE A BEHIND-THE-WHEEL EVALUATION, IN ADDITION TO TRAINING CONDUCTED BY AN OCCUPATIONAL THERAPIST WHO SPECIALIZES IN DRIVING REHABILITATION.OUR CERTIFIED LYMPHEDEMA THERAPISTS PROVIDE A COMPLETE DECONGESTIVE TREATMENT APPROACH FOR PEOPLE SUFFERING FROM LYMPHEDEMA. THIS INVOLVES A SPECIALIZED MASSAGE TECHNIQUE CALLED MANUAL LYMPH DRAINAGE (MLD), SKIN AND NAIL CARE, COMPRESSION BANDAGING AND GARMENTS, REMEDIAL EXERCISE AND SELF-CARE TRAINING. THE GOAL OF OUR PROGRAM IS TO HELP INDIVIDUALS REDUCE INCREASE VOLUME RESULTING FROM LYMPHEDEMA, RESTORE MOBILITY, IMPROVE COSMESIS, PREVENT INFECTION, AND IMPROVE THEIR QUALITY OF LIFE.A JOINT REPLACEMENT PROGRAM AT ADVENTIST REHABILITATION CENTER HELPS PATIENTS TO ACHIEVE GOALS FOR OPTIMAL RESULTS. ONE OF THE IMPORTANT CRITICAL FACTORS FOR SUCCESSFUL OUTCOMES FOLLOWING KNEE OR HIP REPLACEMENT FOR PATIENTS IS FOR PATIENTS TO DILIGENTLY FOLLOW THE PHYSICAL REHABILITATION PROCESS. ADVENTIST REHAB PROVIDES BOTH THE SUPPORT AND RESOURCES FOR A POSITIVE OUTCOME.LEE SILVERMAN VOICE TREATMENT (LSVT)-CERTIFIED SPEECH LANGUAGE PATHOLOGISTS AT ADVENTIST REHABILITATION CENTER CAN COMPLETE A COMPREHENSIVE ASSESSMENT TO DETERMINE CANDIDACY FOR LSVT. LSVT IS A HIGHLY EFFECTIVE INTENSIVE SPEECH THERAPY PROGRAM DESIGNED FOR PARKINSON'S PATIENTS. LSVT IS DESIGNED TO IMPROVE SPEECH AND VOICE FUNCTION. THE THERAPY TARGETS VOCAL LOUDNESS IN ORDER TO TRIGGER IMPROVED FUNCTION AND COORDINATION ACROSS THE VARIOUS SUBSYSTEMS OF SPEECH. LSVT COMBINES MOTOR RETRAINING WITH SENSORY RE-TRAINING TO ELICIT MAXIMUM OUTCOMES. THE TREATMENT REGIMEN INCLUDES EMPHASIS ON PATIENT EDUCATION AND CARRYOVER OF GAINS TO DAILY COMMUNICATION ENVIRONMENTS. THE LSVT PROTOCOL INVOLVES FOUR 1-HOUR THERAPY SESSIONS PER WEEK FOR 4 WEEKS.ADVENTIST REHABILITATION HOSPITAL IS BUILT AROUND OUR PATIENTS AND LEADS THE WAY BACK TO LIFE FROM STROKE, BRAIN INJURY, SPINAL CORD INJURY, AMPUTATION AND TRAUMA. EXPERT CARE TEAMS WORKING SIDE-BY-SIDE WITH PATIENTS, USING INNOVATIVE THERAPIES, STATE-OF-THE-ART EQUIPMENT AND GROUND-BREAKING TECHNOLOGY COMBINE TO OFFER NEW WAYS TO HEAL. AS A NONPROFIT ORGANIZATION, ADVENTIST REHABILITATION HOSPITAL DEPENDS ON THIS SUPPORT AND DOLLAR FOR DOLLAR, EVERY DONATION MAKES A DIFFERENCE BY HELPING US MAINTAIN OUTSTANDING PROGRAMS AND SERVICES AND KEEP PACE WITH THE LATEST ADVANCES IN TECHNOLOGY AND EQUIPMENT FOR REHABILITATIVE CARE. 23337818 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 X 6 3 0 0 0 0 1 1 1 1 1 0 1 1 1 1 1 1 1 1 1 1 0 X JAMES G LEE 3013153025 1801 RESEARCH BOULEVARD SUITE 400 ROCKVILLE MD 20850 TERRY FORDE 1.00 X X 0 612878 16196 JAMES G LEE 1.00 X X 0 604986 33175 BREBT REITZ 40.00 X X 0 0 0 CHARLES ATWELL 1.00 X 0 0 0 INDER CHAWLA MD 1.00 X 0 0 0 TONY TOUMA 1.00 X 0 0 0 WILLIAM G ROBERTSON 1.00 X 0 1187103 46883 VAL DANIELS 40.00 X 155310 0 16268 INGRID BLACK 40.00 X 133628 0 13980 DIANE OLECHNA 40.00 X 116443 0 7420 SUSANA JONES 40.00 X 120349 0 7509 BETH DAUGHERTY 40.00 X 176771 0 7226 BARBARA BLANDFORD 40.00 X 115879 0 17354 818380 2404967 166011 6 0 1 0 ASSOCIATES PROFESSIONAL REHABILITION SVC P O BOX 500 BROOKVILLE MD 208330500 SPEECH LANGUAGE THERAPY 367060 CARDINAL HEALTH PHARMACY MANAGEMENT 11 CENTENNIAL DRIVE PEABODY MA 019616041 PHARMACEUTICAL 281576 SODEXHO MARRIOTT SERVICES PO BOX 536922 ATLANTA GA 303526922 DIETARY AND PLANT OPS 162473 3 41727 119609 161336 OCCUPATIONAL/SPEECH/PH 900099 25087634 25087634 WOMEN AND CHILDREN 900099 6403576 6403576 ONCOLOGY 900099 255493 255493 463438 463438 32210141 135065 135065 50000 0 50000 50000 50000 14668173 14596929 71244 71244 71244 32627786 32210141 0 256309 2200 2200 171578 171578 16987548 14520770 2466778 353096 348815 4281 1303437 1013442 289995 1269548 1073159 196389 2822800 2642806 179994 113396 4057 109339 1962952 1223512 739440 1438951 1087991 350960 1065603 661814 403789 128879 88875 40004 32236 24787 7449 203086 203086 895285 895285 544062 508266 35796 117134 117134 MEDICAL SUPPLIES 483222 109509 373713 RECRUITING 109231 19040 90191 LOSS ON EXTINGUISHMENT 57325 57325 NON OPERATING LOSS 8775 8775 30070344 23337818 6732526 0 1200 1299 6301773 5766090 20706 9306113 11017694 25700 19621 104013 104013 182378 144897 15522178 7087886 8290144 8434292 386886 1070962 1038753 32000 32000 25314283 26966251 3164158 3182510 877765 4580157 4547854 8622080 7730364 X 16447875 19033148 244328 202739 16692203 19235887 25314283 26966251 X 2557442 -13758 X 0 1 1 X 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 11535632 3949697 7585935 181282 117185 64097 2534762 2008828 525934 1270502 1012176 258326 8434292 DUE TO AFFILIATES 4347854 COMPLIANCE LIABILITY RESERVE 200000 4547854 1 1 1 X 1 X 450.000000000000 1 1 0 0 225642 225642 0.00750 305320 305320 0.01020 530962 530962 0.01770 2200 2200 0.00010 2200 2200 0.00010 533162 533162 0.01780 1 305320 21631 11884351 16753521 -4869170 X 1 1 1 1 ADVENTIST REHABILITATION HOSP OF MD

1801 RESEARCH BLVD ROCKVILLE MD 20850

X REHAB HOSPITAL ADVENTIST REHABILITATION HOSP OF MD 1 1 1 100.000000000000 1 450.000000000000 1 X 1 1 X X X X X X 1 0 1 X 0 0 PART I, LINE 3C: IN CONSIDERATION FOR FINANCIAL ASSISTANCE TO OUR PATIENTS, ARHM ALSO CONSIDERS CIRCUMSTANCES BEYOND INCOME. OUR CIRCUMSTANCES COULD INCLUDE THE NEEDS OF THE PATIENT AND/OR FAMILY AND OTHER FINANCIAL RESOURCES. IT IS OUR MISSION TO PROVIDE NECESSARY MEDICAL CARE TO THOSE WHO ARE UNABLE TO PAY FOR THAT CARE. IN GENERAL, AHC HAS 12 LEVELS OF FINANCIAL ASSISTANCE. THEY ARE AS FOLLOW:- ANNUAL INCOME <= 1.0X OF FPL, 0% PATIENT RESPONSIBILITY- ANNUAL INCOME > 1.00X AND <= 1.25X OF FPL, 10% PATIENT RESPONSIBILITY- ANNUAL INCOME > 1.25X AND <= 1.50X OF FPL, 20% PATIENT RESPONSIBILITY- ANNUAL INCOME > 1.50X AND <= 1.75X OF FPL, 30% PATIENT RESPONSIBILITY- ANNUAL INCOME > 1.75X AND <= 2.00X OF FPL, 40% PATIENT RESPONSIBILITY- ANNUAL INCOME > 2.00X AND <= 2.25X OF FPL, 50% PATIENT RESPONSIBILITY- ANNUAL INCOME > 2.25X AND <= 2.50X OF FPL, 60% PATIENT RESPONSIBILITY- ANNUAL INCOME > 2.50X AND <= 2.75X OF FPL, 70% PATIENT RESPONSIBILITY- ANNUAL INCOME >2.75X AND <= 3.00X OF FPL, 80% PATIENT RESPONSIBILITY- ANNUAL INCOME >3.00X AND <= 3.50X OF FPL, 85% PATIENT RESPONSIBILITY- ANNUAL INCOME >3.50X AND <= 4.00X OF FPL, 90% PATIENT RESPONSIBILITY- ANNUAL INCOME >4.00X AND <= 4.50X OF FPL, 95% PATIENT RESPONSIBILITY PART I, L7 COL(F): BAD DEBT EXPENSENO BAD DEBT IS INCLUDED IN THE FUNCTIONAL EXPENSES INPART IX OF THE FORM 990 AND THEREFORE NO ADJUSTMENT WAS NECESSARY TOCOMPUTE THE PERCENTAGES IN THE CHART FOR LINE 7. PART III, LINE 4: BAD DEBTPATIENT ACCOUNTS ARE WRITTEN OFF WHEN THEY AREDETERMINED TO BE UNCOLLECTIBLE BASED UPON MANAGEMENT'S ASSESSMENT OFINDIVIDUAL ACCOUNTS. THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS ISESTIMATED BASED UPON A PERIODIC REVIEW OF THE ACCOUNTS RECEIVABLE AGING,PAYOR CLASSIFICATIONS, AND APPLICATION OF HISTORICAL WRITE-OFFPERCENTAGES.AS PRESCRIBED BY HFMA STATEMENT 15, THERE ARE INSTANCES IN WHICH OURCOLLECTION EFFORTS PROVIDE INFORMATION THAT HELPS US DETERMINE AN ACCOUNTACTUALLY QUALIFIES FOR CHARITY CARE. WHEN THIS OCCURS, WE RECORD THISCHANGE IN OUR BILLING AND COLLECTION SYSTEM USING A UNIQUE SERVICE CODE.WE PREPARED AN ANALYSIS THAT PROVIDED US WITH A RATIO OF BAD DEBT ACCOUNTSTHAT WERE SUBSEQUENTLY RECLASSIFIED AS CHARITY CARE. WE THEN MULTIPLIEDTHAT RATIO TIMES OUR BAD DEBT PROVISIONS TO DETERMINE THE AMOUNT OF BADDEBT THAT WE BELIEVE WILL ULTIMATELY MEET OUR CRITERIA FOR CHARITY CARE. PART III, LINE 8: MEDICAREIN ORDER TO DETERMINE THE COST OF PROVIDING MEDICARE SERVICES,ADVENTIST REHABILITATION HOSPITAL OF MARYLANDL UTILIZED COST TO CHARGE RATIOS ASDETERMINED BY THE HOSPITALS MEDICARE COST REPORT. THE TOTAL COST WASCOMPARED TO PAYMENTS RECEIVED FROM THE MEDICARE PROGRAM. THE SHORTFALLCALCULATED REPRESENTS UNREIMBURSED COSTS UNDER THE MEDICARE PROGRAM THATTHE HOSPITAL ABSORBS ON BEHALF OF THE PATIENTS THAT IT SERVES.AHC USED MEDICARE'S COST REPORT STEP DOWN AND INDIRECT COST ALLOCATION TOCOMPUTE COST TO CHARGE RATIO TO ASSESS THE LEVEL OF COMMUNITY BENEFITS INPROVIDING BAD DEBT, CHARITY AND ADMINISTRATIVE DEDUCTIONS. SINCEMARYLAND'S COST REGULATION COMMISSION AND RELATED AGENCIES ALSO ASSESSHOSPITAL PROVIDERS TO SUBSIDIZE MEDICAID AND DISPROPORTION SHARE HOSPITALPROVIDERS, THESE ASSESSMENTS ARE ALSO COUNTED TOWARD COMMUNITY BENEFITS. PART III, LINE 9B: ARHM PROVIDES QUALITY MEDICAL SERVICES REGARDLESS OFA PATIENT'S ABILITY TO PAY, RACE, CREED, SEX, AGE, NATIONAL ORIGIN ORFINANCIAL STATUS. OUR FINANICAL ASSISTANCE POLICY ENCOURAGES THE PATIENTAND THEIR REPRESENTATIVE TO COOPERATE WITH AND AVAIL THEMSELVES OF ALLAVAILABLE PROGRAMS (INCLUDING MEDICAID, WORKERS COMPENSATION, AND STATEAND LOCAL PROGRAMS) WHICH MIGHT PROVIDE COVERAGE. OUR REGISTRATION,FINANCIAL COUNSELORS, CUSTOMER SERVICE, AND COLLECTION STAFF ARETHOROUGHLY FAMILIAR WITH THE CRITERIA AND PROCESS OF FINANCIAL ASSISTANCE.FINANCIAL ASSISTANCE PROCESS AND COLLECTION PROTOCOL ARE WELL DEFINED WITHMANAGERS AVAILABLE TO GUIDE AND HANDLE EXCEPTION SITUATIONS. OUTSOURCEDAGENCIES AND COLLECTIONS FIRMS ARE EXPECTED TO ADHERE TO AHC'S POLICYWITHOUT EXCEPTIONS. BAD DEBT, CHARITY AND ADMINISRATIVE WRITEOFF ARECLEARLY DEFINED WITH PRE-DETEMRINED AUTHORIZATION LEVELS DEPENDING ON THEMAGNITUDE GRANTED. AHC ALSO REVISES ITS FINANCIAL ASSISTANCE POLICY ASFEDERAL GOVERNMENT AND/OR STATE GOVERNMENT REVISE THEIR POVERTYGUIDELINES. OVERALL, AHC EXPECTS ITS STAFF TO TREAT ITS PATIENTS WITHDIGNITY AND RESPECT, AS THEY WOULD LIKE TO BE TREATED. PART VI, LINE 2: PART VI, LINE 3: PART VI, LINE 4: PART VI, LINE 5: PART VI, LINE 6: X X X X 0 1 0 0 0 0 0 0 0 TERRY FORDE 0 278424 0 10000 0 324454 0 0 0 16196 0 629074 0 0 JAMES G LEE 0 395746 0 98105 0 111135 0 12250 0 20925 0 638161 0 0 WILLIAM G ROBERTSON 0 728552 0 256569 0 201982 0 12250 0 34633 0 1233986 0 0 VAL DANIELS 138521 0 11733 0 5056 0 2875 0 13393 0 171578 0 0 0 BETH DAUGHERTY 162718 0 12337 0 1716 0 3283 0 3943 0 183997 0 0 0 PART I, LINE 3 INDEPENDENT GUIDELINES: WHEN SETTING COMPENSATION FOR THE OFFICERS, DIRECTORS, TRUSTEES, KEY EMPLOYEES, AND THE HIGHEST COMPENSATED EMPLOYEES, ADVENTIST HEALTHCARE FULLY COMPLIES WITH THE PROCEDURAL SAFE GUARDS EMBODIED IN IRS REGULATIONS. COMPENSATION FOR ADVENTIST HEALTHCARE OFFICERS, DIRECTORS, TRUSTEES, KEY EMPLOYEES, AND THE HIGHEST COMPENSATED EMPLOYEES IS ENTIRELY SET BY A COMMITTEE OF ADVENTIST HEALTHCARE BOARD OF TRUSTEES. IN SETTING COMPENSATION, THE GOVERNING BOARD COMMITTEE RELIES UPON MARKET COMPARABILITY DATA PROVIDED BY AN INDEPENDENT OUTSIDE COMPENSATION CONSULTANT WHO PROVIDES A SUMMARY OF HEALTH CARE SALARIES AND BENEFITS FOR COMPARABLE SIZED ORGANIZATIONS BOTH NATIONALLY AND IN THE BALTIMORE-WASHINGTON REGION. TO FURTHER ENSURE REASONABLENESS, BOTH COMPENSATION AND BENEFITS ARE TARGETED AT THE 50TH PERCENTILE (OR MEDIAN) OF THE MARKET. PAY PHILOSOPHY: FOR ALL ADVENTIST HEALTHCARE EMPLOYEES INCLUDING THOSE LISTED ON SCHEDULE J, THE GOAL OF ADVENTIST HEALTHCARE IS TO OFFER COMPETITIVE SALARIES IN ORDER TO ATTRACT, HIRE AND RETAIN QUALIFIED AND TALENTED INDIVIDUALS. MAINTAINING A QUALITY, STABLE WORKFORCE HAS A POSITIVE IMPACT ON THE WORKPLACE AND ON THE CARE PROVIDED TO OUR PATIENTS/RESIDENTS AND THEIR FAMILIES. IN GENERAL, NON-EXECUTIVE EMPLOYEES ARE COMPENSATED UTILIZING THE FULL WAGE SCALE FOR THEIR RESPECTIVE POSITIONS, COMPARED TO THE MARKET. HOWEVER, EXECUTIVES ARE GENERALLY LIMITED TO THE MEDIAN OF THE MARKET FOR THEIR RESPECTIVE POSITIONS. PART I, LINE 4B CUMULATIVE LUMP-SUM TAXABLE PAYMENTS MADE AS A RESULT OF TAX LAW CHANGES THAT AFFECTED THE ADMINISTRATION OF THE ADVENTIST HEALTHCARES CAPITAL ACCUMULATION ACCOUNT (CAA) PLAN ESTABLISHED PURSUANT TO SECTION 457(F) OF THE INTERNAL REVENUE CODE WERE AS FOLLOWS: WILLIAM G. ROBERTSON: $180.793 JAMES G. LEE: $85,654 TERRY FORDE: $71,448 SUPPLEMENTAL INFORMATION PART III COMPENSATION DEFINED THE COMPENSATION REPORTED FOR THE EMPLOYEES SET FORTH ON SCHEDULE J IS COMPRISED OF THE FOLLOWING: **BASE COMPENSATION - INCLUDES NONDISCRETIONARY PAYMENTS, AGREED UPON IN ADVANCE, CONTINGENT ONLY UPON THE PAYEE'S PERFORMANCE OF AGREED UPON SERVICES (SUCH AS SALARY OR FEES). **INCENTIVE COMPENSATION - INCLUDES PAYMENTS BASED ON SATISFACTION OF PRE-DETERMINED PERFORMANCE TARGETS SUCH AS QUALITY/PATIENT SAFETY GOALS, EMPLOYEE AND CUSTOMER ENGAGEMENT GOALS, ORGANIZATIONAL GROWTH, AND FINANCIAL PERFORMANCE, AMONG OTHER THINGS. **OTHER REPORTABLE COMPENSATION - INCLUDES CERTAIN CUMULATIVE LUMP-SUM TAXABLE PAYMENTS MADE AS A RESULT OF TAX LAW CHANGES THAT AFFECTED THE ADMINISTRATION OF ADVENTIST HEALTHCARE'S CAPITAL ACCUMULATION ACCOUNT ("CAA") PLAN ESTABLISHED PURSUANT TO SECTION 457(F) OF THE INTERNAL REVENUE CODE. IN ADDITION, "OTHER REPORTABLE COMPENSATION" INCLUDES LONG-TERM DISABILITY COVERAGE, CELL PHONE ALLOWANCES, CASH-OUT OF UNUSED PAID TIME OFF (PTO) HOURS, IMPUTED VALUE OF LIFE INSURANCE BENEFITS, OUT-OF-STATE COMMUTE, AND SEVERANCE, AS APPLICABLE. "OTHER REPORTABLE COMPENSATION" ALSO INCLUDES THE FOLLOWING, AS APPROVED BY THE COMPENSATION COMMITTEE: TAXABLE HOUSING ASSISTANCE FOR RELOCATION TO THE AREA FOR ACCEPTANCE OF EMPLOYMENT: TERRY FORDE **NON-TAXABLE BENEFITS - INCLUDES THE EMPLOYER PORTION OF CERTAIN BENEFITS SUCH AS HEALTH INSURANCE, DENTAL INSURANCE, VISION INSURANCE, LIFE INSURANCE, BASE CONTRIBUTIONS TO RETIREMENT PLANS, MATCHING OF EMPLOYEES' RETIREMENT CONTRIBUTIONS, ETC. PAY PRACTICE: ADVENTIST HEALTHCARE UTILIZES A SINGLE EMPLOYER ID FOR ALL OF ITS AFFILIATED ENTITIES FOR EMPLOYMENT PURPOSES. AS SUCH, ACTUAL COMPENSATION AND BENEFITS ARE CHARGED TO THE RESPECTIVE ENTITIES AND THE RESULTING COMPENSATION AND BENEFITS ARE REPORTED ON EACH AFFILIATE IRS FORM 990 AS IF PAID DIRECTLY BY SUCH AFFILIATE. AS APPLICABLE, THE SAME AND NON-ADDITIVE COMPENSATION AND EMPLOYMENT BENEFIT PLAN CONTRIBUTION AMOUNTS WERE ALSO DISCLOSED IN THE ADVENTIST HEALTHCARE INC. RELATED ENTITIES RETURNS. FORM 990, PART VI, SECTION A, LINE 6 ADVENTIST HEALTHCARE, INC. IS THE SOLE CORPORATE MEMBER OF ADVENTIST REHABILITATION HOSPITAL OF MARYLAND, INC. WITH THE AUTHORITY TO APPROVE ITS BOARD MEMBERSHIP. FORM 990, PART VI, SECTION A, LINE 7A THE BOARD OF TRUSTEES OF ADVENTIST HEALTHCARE, INC. APPOINTS THE MEMBERS OF ADVENTIST REHABILITATION HOSPITAL OF MARYLAND GOVERNING BODY. FORM 990, PART VI, SECTION A, LINE 7B THE BOARD OF TRUSTEES APPROVES ALL ACTIONS OF MANAGEMENT. FORM 990, PART VI, SECTION B, LINE 11 DURING THE PREPARATION PROCESS, EXECUTIVE MANAGEMENT TEAM REVIEWED VARIOUS SECTIONS OF THE DRAFT FORM 990 BASED ON A PLANNED COMPLETION TIME TABLE. IN ADDITION, THE EXECUTIVE COMMITTEE OF THE BOARD REVIEWED CERTAIN KEY SECTIONS OF THE FORM. PRIOR TO FILING, ALL MEMBERS OF THE BOARD ARE PROVIDED A COPY OF THIS FORM 990 THROUGH EMAIL, WHICH IS LINKED TO THE COMPANY'S INTRANET WEBSITE. FORM 990, PART VI, SECTION B, LINE 12C PURSUANT TO THE ORGANIZATIONS CONFLICT OF INTEREST POLICY, EACH FACILITY BOARD MEMBER, OFFICER, DIRECTOR AND ANY EMPLOYEE IN A POSITION THAT REQUIRES COORDINATION AND/OR NEGOTIATION WITH CONTRACTORS OR SUPPLIES, IS REQUIRED ON AN ANNUAL BASIS TO DISCLOSE ANY BUSINESS OR FINANCIAL RELATIONSHIP OUTSIDE OF THE ORGANIZATION. COMPLIANCE WITH POLICY IS MONITORED AND ENFORCED BY THE HUMAN RESOURCES DEPARTMENT, CORPORATE INTEGRITY DEPARTMENT AND THE LEGAL DEPARTMENT. FORM 990, PART VI, SECTION B, LINE 15 WHEN SETTING EXECUTIVE COMPENSATION, OFFICERS OR KEY EMPLOYEES, THE ORGANIZATION FULLY COMPLIES WITH THE PROCEDURAL SAFEGUARDS EMBEDDED IN THE IRS REGULATIONS. EXECUTIVE COMPENSATION IS ENTIRELY SET BY A COMMITTEE OF THE BOARD OF TRUSTEES. IN SETTING COMPENSATION, THE GOVERNING BOARD COMMITTEE RELIES UPON MARKET COMPARABILITY DATA PROVIDED BY AN INDEPENDED OUTSIDE COMPENSATION CONSULTANT. TO ENSURE REASONABLENESS, COMPENSATION IS SET AT THE 50TH PERCENTILE OF THE NATURAL MARKET. FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS, ARE AVAILABLE TO THE PUBLIC UPON REQUEST. GENERAL EXPLANATION EMPLOYEES OF ANY OF THE ADVENTIST HEALTHCARE INC. AND AFFILIATED TAX EXEMPT ENTITIES IN THE STATE OF MARYLAND ARE PAID THROUGH A COMMON PAYMASTER, ADVENTIST HEALTHCARE, INC. AND ARE REPORTED ON ITS FORM 941. SALARY AND BENEFIT EXPENSES REPORTED ON THEIR RESPECTIVE RETURNS ARE ACTUAL CHARGES RELATED TO THE EMPLOYEES WORKING ON THE SPECIFIC TAX EXEMPT ENTITY. COMPENSATION INCLUDED REGULAR BASE SALARY, BONUS, PAID TIME OFF CASH OUT, TAXABLE RELOCATION ALLOWANCE, HOLIDAY GIFT, RETROACTIVE COMPENSATION ADJUSTMENT, BEREAVEMENT LEAVE, EDUCATION, AND WITHDRAWAL OF DEFERRED COMPENSATION, AS APPLICABLE. THE SAME AND NON-ADDITIVE COMPENSATION AND EMPLOYMENT BENEFIT PLAN CONTRIBUTIOON AMOUNTS WERE ALSO DISCLOSED IN THE ADVENTIST HEALTHCARE INC.'S RELATED ENTITIES RETURNS. VENDORS PAYMENT FOR ANY OF THE ADVENTIST HEALTHCARE, INC. AND RELATED ENTITIES IN THE STATE OF MARYLAND ARE MADE THROUGH A COMMON PAYMASTER, ADVENTIST HEALTHCARE, INC. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: MARKET ADJUSTMENT -13,758. TOTAL TO FORM 990, PART XI, LINE 5: -13,758. ADVENTIST HEALTHCARE INC 1801 RESEARCH BOULEVARD SUITE 400 ROCKVILLE MD 20850 521532556 HEALTHCARE SERVICES MD 501 ( C) (3) LINE 3 N/A 0 ADVENTIST HOME HEALTH SERVICES INC 1801 RESEARCH BOULEVARD SUITE 400 ROCKVILLE MD 20850 520986808 HOME HEALTH AGENCY MD 501 ( C) (3) LINE 9 N/A 0 ADVENTIST PHYSICIAN SERVICES INC 1801 RESEARCH BLVD SUITE 400 ROCKVILLE MD 20850 204600646 PHYSICIAN SERVICES MD 501 ( C) (3) LINE 9 N/A 0 ADVENTIST SENIOR LIVING SERVICES 1801 RESEARCH BLVD SUITE 400 ROCKVILLE MD 20850 521739959 LTC MANAGEMENT MD 501 ( C) (3) LINE 9 N/A 0 BRADFORD OAKS NURSING AND REHABILITATION CENTER 7520 SURRATTS ROAD CLINTON MD 20735 521999975 NURSING HOME MD 501 ( C) (3) LINE 9 N/A 0 FAIRLAND NURSING & REHAB CENTER 1801 RESEARCH BLVD SUITE 400 ROCKVILLE MD 20850 521876447 NURSING HOME MD 501 ( C) (3) LINE 9 N/A 0 GLADE VALLEY NURSING AND REHABILITATION CENTER 1801 RESEARCH BLVD SUITE 400 ROCKVILLE MD 20850 521924309 NURSING HOME MD 501 ( C) (3) LINE 9 N/A 0 HACKETTSTOWN COMMUNITY HOSPITAL 651 WILLOW GROVE STREET HACKETTSTOWN NJ 07840 226106281 HOSPITAL NJ 501 ( C) (3) LINE 3 N/A 0 HACKETTSTOWN COMMUNITY HOSPITAL FOUNDATION 651 WILLOW GROVE STREET HACKETTSTOWN NJ 07840 222333410 FUNDRAISING NJ 501 ( C) (3) LINE 11A, I N/A 0 HCH EMERGENCY MEDICAL SERVICES 651 WILLOW GROVE STREET HACKETTSTOWN NJ 07840 270820164 AMBULANCE SERVICE NJ 501 ( C) (3) LINE 11B, II N/A 0 MID-ATLANTIC ADVENTIST HEALTHCARE CORPORATION 1801 RESEARCH BLVD SUITE 400 ROCKVILLE MD 20850 511884153 HOLDING COMPANY MD 501 ( C) (3) LINE 9 N/A 0 POTOMAC RIDGE BEHAVIORAL HEALTH FOUNDATION 1801 RESEARCH BLVD SUITE 400 ROCKVILLE MD 20850 205479860 FUNDRAISING MD 501 ( C) (3) LINE 11A, I N/A 0 REGINALD S LOURIE CENTER FOR INFANTS AND YOUNG CHILDREN 1801 RESEARCH BLVD SUITE 400 ROCKVILLE MD 20850 521255870 BEHAVIORAL CARE MD 501 ( C) (3) LINE 9 N/A 0 SHADY GROVE ADVENTIST HOSPITAL FOUNDATION 1801 RESEARCH BLVD SUITE 400 ROCKVILLE MD 20850 521216429 FUNDRAISING MD 501 ( C) (3) LINE 11A, I N/A 0 SHADY GROVE NURSING HOME AND REHABILITATION CENTER 9701 MEDICAL CENTER DRIVE ROCKVILLE MD 20850 521442495 NURSING HOME MD 501 ( C) (3) LINE 9 N/A 0 SLIGO CREEK NURSING & REHABILITATION CENTER INC 7525 CARROLL AVENUE TAKOMA PARK MD 20912 521736368 NURSING HOME MD 501 ( C) (3) LINE 9 N/A 0 SPRINGBROOK ADVENTIST NURSING AND REHABILITATION CENTER INC 1801 RESEARCH BLVD SUITE 400 ROCKVILLE MD 20850 521736305 NURSING HOME MD 501 ( C) (3) LINE 9 N/A 0 WASHINGTON ADVENTIST HOSPITAL FOUNDATION 1801 RESEARCH BLVD SUITE 400 ROCKVILLE MD 20850 521692158 FUNDRAISING MD 501 ( C) (3) LINE 11A, I N/A 0 GERMANTOWN OUTPATIENT IMAGING 1801 RESEARCH BOULEVARD SUITE 400 ROCKVILLE MD 20850 204395818 OUTPATIENT IMAGING MD SHADY GROVE RADIOLOGY CONSULTANTS PC 0 0 ADVENTIST MANAGEMENT SERVICES INC 1801 RESEARCH BLVD SUITE 400 ROCKVILLE MD 20850 521575694 MANAGEMENT SERVICES MD N/A C LIFEWORK STRATEGIES INC 1801 RESEARCH BLVD SUITE 400 ROCKVILLE MD 20850 521704500 EMPLOYER ASSISTANCE MD N/A C PREMIER MEDICAL NETWORK INC 1801 RESEARCH BLVD SUITE 400 ROCKVILLE MD 20850 521952469 JOINT PHYSICIAN CONT. MD N/A C 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0