2011-11-15T12:26:29-06:00 2010-12-31 990 2010-01-01 530196602 LUCY WEBB HAYES NATIONAL TRAINING SCHOOL FOR DECONESSESS & MISSIONARIES LUCY 2025374000 5255 LOUGHBORO RD NW WASHINGTON DC 20016 ROBERT L SLOAN 2025374000 2011-11-15 2010 2016-03-07 17:11:31Z SIBLEY MEMORIAL HOSPITAL ROBERT L SLOAN 5255 LOUGHBORO RD NW WASHINGTON DC 20016 934297911 0 X WWW.SIBLEY.ORG X 1891 DC THE LUCY WEBB HAYES NATIONAL TRAINING SCHOOL FOR DECONESSES AND MISSIONARIES PROVIDES ALL SERVICES WITHOUT REGARD TO RACE, CREED, SEX, NATIONAL ORIGIN, HANDICAP, AGE OR ABILITY TO PAY. 33 30 2013 358 152636 0 145437 122366 229980755 239574739 -18345062 26336835 4176345 3555733 215957475 269589673 613262 0 0 0 128059293 128300980 0 0 0 97881353 99455168 226553908 227756148 -10596433 41833525 766726150 943298347 195102621 203041929 571623529 740256418 X THE LUCY WEBB HAYES NATIONAL TRAINING SCHOOL FOR DEACONESSES AND MISSIONARIES CONDUCTING SIBLEY MEMORIAL HOSPITAL IS A GENERAL SHORT-TERM ACUTE CARE HOSPITAL LOCATED IN N.W. WASHINGTON,DC. THE HOSPITAL PROVIDES ALL SVCS WITHOUT REGARD TO RACE, CREED, SEX, NATIONAL ORIGIN, HANDICAP, AGE OR ABILITY TO PAY. ITS MISSION IS TO PROVIDE QUALITY HEALTH SVCS AND FACILITIES FOR THE COMMUNITY, TO PROMOTE WELLNESS, RELIEVE SUFFERING, AND RESTORE HEALTH AS SWIFTLY, SAFELY AND HUMANELY AS IT CAN BE DONE CONSISTENT WITH BEST SVC POSSIBLE AT THE HIGHEST VALUE FOR ALL CONCERNED. ITS VISION IS TO MAKE AVAILABLE SUPERIOR HEALTHCARE SVC AND VALUE, WITH THE GOAL OF IMPROVING HEALTH AND WELL-BEING OF THE COMMUNITY. THE HOSPITAL PLANS TO CONTINUE TO IMPROVE THAT SVC BY USING SCIENTIFIC METHODS, TEAMWORK, AND KNOWLEDGE OF BEST PRACTICES AND CUSTOMER EXPECTATIONS. THE HOSPITAL HAS VALUES WHICH PROVIDE GUIDELINES AND PARAMETERS FOR DECISIONS NECESSARY TO IMPROVE PROCESSES AND RESPOND TO NEEDS OF ITS PATIENTS . 0 0 200693087 0 249825509 PROVIDE ACUTE CARE HEALTHCARE SERVICES TO PATIENTS IN THE NORTHWEST WASHINGTON, DC AREA. TO PROVIDE QUALITY HEALTH SERVICES AND FACILITIES TO THIS COMMUNITY, PROMOTING WELLNESS, RELIEVE SUFFERING, AND RESTORE HEALTH AS SWIFTLY, SAFELY AND HUMANELY AS IT CAN BE DONE CONSISTENT WITH THE BEST SERVICE GIVEN AT THE HIGHEST VALUE.SIBLEY HOSPITAL IS A GENERAL SHORT TERM ACUTE CARE FACILITY LOCATED IN NORTHWEST WASHINGTON, DC. THE HOSPITAL PROVIDES ALL SERVICES WITHOUT REGARD TO RACE, CREED, SEX, SEXUAL PREFERENCE, NATIONAL ORIGIN, HANDICAP, AGE OR ABILITY TO PAY. INHERENT IN THE PURPOSE IS THE HOSPITALS WILLINGNESS TO PROVIDE HEALTHCARE SERVICES TO MEMBERS OF THE COMMUNITY WHO ARE NOT ABLE TO PAY FOR SERVICES. FOR FISCAL YEAR 2010, THE HOSPITAL PROVIDED CHARITY CARE TO MORE THAN 1,500 PATIENTS, INCURRING COSTS OVER $3.8 MILLION. TOTAL BENEFITS AND UNCOMPENSATED COST OF CARE PROVIDED TO THE COMMUNITY EXCEEDED $ 5.6 MILLION. SIBLEY PROVIDES CHARITY CARE TO THE CLIENTS OF THE CATHOLIC HEALTH CARE NETWORK, MARYS CENTER FOR MATERNAL AND CHILD HEALTH, THE COMMUNITY OF HOPE, COLUMBIA ROAD CLINIC, UNITY HEALTHCARE, AND BREAD FOR THE CITY. THE HOSPITAL ADMITTED OVER 11,400 PATIENTS IN 2010, AND PROVIDED ALMOST 48,500 DAYS OF INPATIENT CARE. THERE WERE OVER 3,500NEWBORN DELIVERIES AS WELL. THERE WERE OVER27,000 PATIENTS IN OUR 24/7 EMERGENCY ROOM, AND OVER 116,000 PATIENTS RECEIVED SURGICAL, ENDOSCOPIC OR OTHER ANCILLIARY OUTPATIENT TREATMENTS. 200693087 1 1 0 1 0 0 0 1 0 1 1 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 1 1 1 0 0 1 212 0 1 2013 1 1 1 0 0 0 0 0 0 0 0 0 X 33 30 0 0 1 0 0 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 DC X STEPHEN MCDONNELL 2025374680 5255 LOUGHBORO RD NW WASHINGTON DC 20016 REV A DAVID ARGO 10.00 X 0 0 0 WILLIAM BARTON JR ESQ 10.00 X X 0 0 0 GEOFFREY D BROWN 10.00 X 0 0 0 J RENE CARTER 10.00 X 0 0 0 CHARLES M COCHRAN 10.00 X 0 0 0 LINDA C DOUGLAS 10.00 X 0 0 0 PAUL R ERICKSON 10.00 X 0 0 0 MICHAEL K FARR 10.00 X 0 0 0 SAMUAL P HARRINGTON MD 10.00 X X 0 0 0 BURKE HAYES 10.00 X 0 0 0 DALE H HOSCHEIT ESQ 10.00 X 0 0 0 JOHN O MAY 10.00 X 0 0 0 REV DAVID MCALLISTER-WILSON 10.00 X 0 0 0 EDWARD J MILLER JR 10.00 X X 0 0 0 A WALLACE MOORE 10.00 X 0 0 0 RICHARD E MORRIS 10.00 X X 0 0 0 PRISCILLA I PAGANO 10.00 X 0 0 0 JAMES S POWERS MD 10.00 X 0 0 0 RAMIN OSKOUI MD 10.00 X 0 0 0 CHARLES ROSS 10.00 X 0 0 0 THOMAS J SCHAEFER 10.00 X 0 0 0 BISHOP JOHN R SCHOL 10.00 X 0 0 0 JACK P SEGAL MD 10.00 X 0 0 0 ROBERT L SLOAN 40.00 X X 1041468 0 47425 ROBERT R PETERSON 10.00 X 0 1620305 246617 THOMAS H SULLIVAN 10.00 X 0 0 0 CARL L SYLVESTER JR MD 10.00 X 183333 0 0 KIMBERLY H WALTON ESQ 10.00 X 0 0 0 JOY B CHOPPIN 10.00 X 0 0 0 NILOO HOWE 10.00 X 0 0 0 ISHAM O BAKER 10.00 X 0 0 0 CYNTHIA K FREEMAN 10.00 X 0 0 0 MARTIN G JANOWIECKI 10.00 X 0 0 0 STEPHEN C MCDONNELL 40.00 X 552582 0 46602 JOAN VINCENT 40.00 X 342413 0 78655 AUDRY CARTER 40.00 X 248187 0 17695 QUEENIE PLATER 40.00 X 267157 0 22651 KENDA TAVAKOLI 40.00 X 252322 0 15555 PETER PETRUCCI 40.00 X 251187 0 16660 CHRISTINE STUPPY 40.00 X 184291 0 12819 JEFFERY JOYNER 40.00 X 204341 0 15622 JEFFREY L LIN 40.00 X 720380 0 30758 REBECCA ZUURBIER 40.00 X 449929 0 19820 ZIA HASAN 40.00 X 439894 0 19735 POUNEH RAZAVI 40.00 X 382881 0 11845 MARY T O'DONNELL 40.00 X 373565 0 19510 5893930 1620305 621969 169 0 1 0 HITT CONTRACTING PO BOX 403509 ATLANTA GA 30384 CONSTRUCTION 17149852 SODEXO MARRIOTT PO BOX 536922 ATLANTA GA 30353 FOOD SERVICE 3292928 CARETECH SOLUTIONS PO BOX 674271 DETROIT MI 48267 COMPUTER INFORMATION TECHNOLOGY 1423506 WILMONT SANZ INC 18310 MONTGOMERY VILLAGE AVE GAITHERSBURG MD 20789 ARCHITECTURE 1269782 HESS EGAN HAGGERTY 5530 WISCONSIN AVE CHEVY CHASE MD 20815 LEGAL 1059204 36 122366 122366 PATIENT REVENUE 621990 215988499 215988499 ASSISTED LIVING 623000 17506893 17506893 PHYSICIAN BILLING 621990 5947431 5947431 LAB REVENUE 621500 131916 131916 239574739 16013482 20720 15992762 674745388 87550 664509585 10235803 87550 10323353 10323353 257986 198653 59333 59333 CAFETERIA/VENDING 900099 1196091 1196091 PARKING LOT 900099 891512 891512 OTHER INCOME 900099 750014 750014 658783 658783 3496400 269589673 249825509 152636 19489162 3343947 3343947 102645771 90726080 11919691 6234953 5343354 891599 8636868 7426570 1210298 7439441 6375601 1063840 1482325 1270352 211973 195795 167796 27999 22557 22557 2219085 1900439 318646 18877606 16526382 2351224 889316 756601 132715 1760034 1044635 715399 3000701 2571601 429100 4675619 3987919 687700 51022 43725 7297 317102 248681 68421 4276059 3664583 611476 15930947 13652822 2278125 DIRECT PATIENT SUPPLIES 31623174 31623174 BAD DEBTS 7128957 7128957 OTHER SUPPLIES 5988497 5253678 734819 PROVIDER TAX 675728 675728 MISCELLANEOUS EXPENSE 340644 304409 36235 227756148 200693087 27063061 0 -1 18876073 23159499 18770628 27210867 1186889 1172890 3316888 3853084 254408676 2229135 156534588 252179541 561088194 595313330 6952890 40409137 766726150 943298347 22753258 26435261 109609024 116912386 2404082 2459107 60336257 57235175 195102621 203041929 X 564652943 713655831 5244530 14235970 1726056 12364617 571623529 740256418 766726150 943298347 X 41833525 126799364 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 22557 22557 0 EXPLANATION OF OTHER LOBBYING ACTIVITIES: PART II-B, LINE 1I: SIBLEY MEMORIAL HOSPITAL PAID $22,557 DURING THE CALENDAR YEAR 2010 TO THE DISTRICT OF COLUMBIA HOSPITAL ASSOCIATION FOR LOBBYING PURPOSES AS PART OF THE ANNUAL DUES. 0 1 50500000 50500000 125850197 1725634 124124563 112538 674 111864 31801777 497106 31304671 46144164 5721 46138443 252179541 JOINT VENTURES 2660447 F OTHER SECURITIES 592652883 F 595313330 ALLOW FOR MALPRACTICE CLAIMS 20032384 ESTIMATED THIRD PARTY SETTLE 6736256 DEFERRED PENSION OBLIGATION 20638941 MISCELLANEOUS LIABILITIES 4152143 INTEREST PAYABLE 1181468 DEFERRED COMPENSATION 2595628 CONT RETENTION MOB GARAGE 1898355 57235175 PART IV, LINE 2B: THE HOSPITAL ACTS AS ADMINISTRATOR/TRUSTEE FOR A CHARITABLE GIFT ANNUITY (CGA) PROGRAM. THE ASSETS ARE CUSTODIED WITH THE FIDUCIARY TRUST COMPANY. DONORS MAKE ARRANGEMENTS WITH THE HOSPITAL AND THE CUSTODIAN TO MAKE A ONE-TIME CONTRIBUTION TO THE CGA. PERIODIC ANNUITY PAYMENTS ARE THEN MADE TO THE DONOR OVER THE LIFETIME OF THE DONOR. THE HOSPITAL INCLUDES ON ITS BALANCE SHEET THE MARKET VALUE OF THE ASSETS CONTRIBUTED BY ALL DONORS IN THE PROGRAM. THE HOSPITAL ALSO INCLUDES A LIABILITY FOR ESTIMATED PAYMENTS CALCULATED TO BE PAID TO ITS DONORS IN FUTURE YEARS. THE ASSETS ARE INVESTED IN FIXED INCOME AND EQUITY SECURITIES, MONITORED REGURARLY BY THE HOSPITAL'S INVESTMENT COMMITTEE. FOR 2010, THE MARKET VALUE OF THE ASSETS INCREASED BY $323,232. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: FASB'S GUIDANCE ON ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES CLARIFIES THE ACCOUNTING FOR UNCERTAINTY OF INCOME TAX POSITIONS. THIS GUIDANCE DEINES THE THRESHOLD FOR RECOGNIZING TAX RETURN POSITIONS IN THE FINANCIAL STATEMENTS AS "MORE LIKELY THAN NOT" THAT THE POSITION IS SUSTAINABLE, BASED ON ITS TECHNICAL MERITS. THIS GUIDANCE ALSO PROVIDES GUIDANCE ON THE MEASUREMENT, CLASSIFICATION AND DISCLOSURE OF TAX RETURN POSITIONS IN THE FINANCIAL STATEMENTS. THE ORGANIZATION HAS ADOPTED THIS GUIDANCE, AND THERE WAS NO IMPACT ON ITS FINANCIAL STATEMENTS DURING THE YEAR ENDED DECEMBER 31, 2010. 1 1 1 X 1 X 500.000000000000 1 1 0 1 1 2850884 0 2850884 0.01290 3423465 2045913 1377552 0.00620 0 0 6274349 2045913 4228436 0.01910 37626 14755 22871 0.00010 966021 252515 713506 0.00320 9198198 8515491 682707 0.00310 0 0 16300 0 16300 0.00010 10218145 8782761 1435384 0.00650 16492494 10828674 5663820 0.02560 1 3300930 0 46845727 58193062 -11347335 X 1 1 1 1 SIBLEY MEMORIAL HOSPITAL

5255 LOUGHBORO RD NW WASHINGTON DC 20016

X X X NA 1 0 0 0 0 0 0 0 0 0 0 0 PART I, LINE 7: A COST-TO-CHARGE RATIO (FROM WORKSHEET 2) IS USED TO CALCULATE THE AMOUNTS ON LINE 7A-7B (FINANCIAL ASSISTANCE AND UNREIMBURSED MEDICAID). THE AMOUNTS FOR LINES 7E-7I WOULD COME FROM THE BOOKS AND RECORDS OF SPECIFIC SEGMENTS OF THE ORGANIZATION AND WOULD NOT BE BASED ON A COST-TO CHARGE RATIO. PART I, LINE 7G: THERE ARE NO COSTS REPORTED THAT ARE ATTRIBUTABLE TO A PHYSICIANS CLINIC. PART I, L7 COL(F): THE AMOUNT OF BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $7,128,957. PART II: SIBLEY HOSPITAL DOES NOT PARTICIPATE IN COMMUNITY BUILDING ACTIVITIES NOR DO WE HAVE THE RESOURCES TO DO SO. PART III, LINE 4: BAD DEBT EXPENSE AT COST IS DETERMINED USING THE SAME COST-TO-CHARGE RATIO THAT IS USED TO CALCULATE CHARITY CARE AND UNREIMBURSED MEDICAID.DISCOUNTS AND ALLOWANCES ARE ACCOUNTED FOR SEPARATELY FROM BAD DEBT EXPENSE.THE ORGANIZATIONS FINANCIAL STATEMENTS DO NOT INCLUDE A FOOTNOTE ON BAD DEBT EXPENSE. THE FINANCIAL STATEMENTS SHOW THE PROVISION FOR BAD DEBTS AS A SEPARATE LINE ITEM IN THE STATEMENTS OF OPERATIONS AND CHANGES IN NET ASSETS UNDER OPERATING EXPENSES. PART III, LINE 8: SIBLEY MEMORIAL HOSPITAL TREATS PATIENTS WITH MANY INSURANCE CARRIERS. HOWEVER, THE MEDICARE INPATIENT VOLUME IS 46% OF TOTAL PATIENT VOLUME, THE HIGHEST RATIO AMONG DISTRICT OF COLUMBIA HOSPITALS. ALTHOUGH PROVIDING THE BEST POSSIBLE CARE TO OUR MEDICARE PATIENTS CREATES A FINANCIAL LOSS, WE RELIEVE THE GOVERNMENT AND SURROUNDING OTHER HOSPITALS OF THE FINANCIAL BURDEN OF TREATING THESE PATIENTS INSURED BY THE MEDICARE PROGRAM. PART OF THE MISSION OF OUR HOSPITAL IS TO SERVE ITS ELDERLY PATIENTS WITHIN THE COMMUNITY THROUGH VARIOUS PROGRAMS THAT ARE DESIGNED TO EDUCATE AND IMPROVE THEIR HEALTH STATUS. THE HOSPITAL FEELS THAT PROVIDING THESE PROGRAMS HAVE CONTRIBUTED TO THE IMPROVEMENT OF HEALTH OVERALL WITHIN THE COMMUNITY.IN ADDITION TO PROVIDING EDUCATIONAL AND OTHER SELF IMPROVEMENT SEMINARS AND CLINICS FOR OUR MEDICARE PATIENT POPULATION, THE HOSPITAL INCURS COST FOR BEING IN A CONSTANT STATE OF READINESS FOR ANY EMERGENCIES, SUCH AS NATURAL DISASTERS, EPIDEMICS, CHEMICAL SPILLS OR TECHNICAL DISASTERS THAT MAY ARISE. THE HOSPITALS DISASTER TREATMENT TEAM WORKS ROUTINELY WITH THE DISTRICT OF COLUMBIA EMERGENCY HEALTHCARE COALITION, DC HOMELAND SECURITY ORGANIZATION, DC DEPARTMENT OF HEALTH AND OTHER SIMILAR ORGANIZATIONS IN PLANNING AND TRAINING FOR TREATMENT OF PATIENTS DURING ANY POTENTIAL DISASTERS. THE HOSPITAL MAKES AVAILABLE A 24/7 EMERGENCY CARE FACILITY, PROVIDES STATE-OF-THE-ART EQUIPMENT TO TREAT PATIENTS EFFICIENTLY AND QUICKLY, AND INCURS COSTS OF EDUCATING HOSPITAL STAFF TO ADMINISTER BETTER QUALITY CARE TO THE COMMUNITY. PART III, LINE 9B: WHEN A PATIENT ASKS FOR CHARITY CARE OR FINANCIAL ASSISTANCE, THE PATIENT MUST COMPLETE AN APPLICATION AND PROVIDE FINANCIAL INFORMATION THAT WOULD DEMONSTRATE FINANCIAL NEED. THE APPLICATION IS REVIEWED BY FINANCIAL COUNSELORS FOR ELIGIBILITY. PART VI, LINE 2: THE HOSPITAL DOES AN EXTENSIVE ANNUAL PLANNING PROCESS TO ASSESS THE HEALTH CARE NEEDS OF THE COMMUNITY. PART OF THE PROCESS INCLUDES AN ENVIRONMENT ASSESSMENT, REVIEWING DATA TO HELP FORM THE HOSPITALS DIRECTION OVER THE NEXT SEVERAL YEARS. DATA GATHERING INCLUDES DEMOGRAPHIC TRENDS, DISEASE INCIDENCE AND PREVALENCE RATES, AND OTHER DATA. MARKET UTILIZATION DATA IS REVIEWED FOR POTENTIAL SERVICE GAPS WITHIN THE SERVICE AREA. INTERNAL HOSPITAL DATA, STATISTICS AND SUBSEQUENT TRENDS ARE REVIEWED TO ENSURE EXISTING OR POTENTIAL NEW SERVICES ARE CONSISTENT WITH COMMUNITY NEEDS. DIRECT INPUT FROM COMMUNITY GROUPS, PHYSICIAN STAFF, PATIENTS AND EMPLOYEES ARE COMBINED TO FORM FUTURE DIRECTION FOR THE HOSPITAL. THE HOSPITALS SENIOR ASSOCIATION, WITH OVER 7,000 ACTIVE MEMBERS, PROVIDES AN INVALUABLE RESOURCE FOR DETERMINING THE SERVICES AND NEEDS OF THE COMMUNITY. PART VI, LINE 3: WHEN A PATIENT IS FIRST REGISTERED, HE/SHE MUST READ THE POSTED NOTICE ABOUT COMMUNITY/FINANCIAL ASSISTANCE. THE NOTICE IS POSTED NOTICEABLY IN THE ADMISSIONS AREA. WHEN A PATIENT INQUIRES ABOUT COMMUNITY/FINANCIAL ASSISTANCE, HE/SHE IS GIVEN AN APPLICATION TO DETERMINE IF, IN FACT, HE/SHE IS ELIGIBLE FOR SUCH ASSISTANCE UNDER THE GUIDELINES ESTABLISHED BY THE DC MUNICIPAL REGULATION TITLE 22. PATIENT FINANCIAL COUNSELORS ARE ON STAFF TO ASSIST THE PATIENT WITH ANY QUESTIONS AND ULTIMATELY RECEIVE THE COMPLETED APPLICATION FOR FURTHER REVIEW. EACH YEAR THE HOSPITAL PUBLISHES AN EXTENSIVE NOTICE IN THE WASHINGTON POST DESCRIBING ITS CHARITY CARE POLICY FOR THOSE WHO APPLY. PART VI, LINE 4: THE HOSPITALS PRIMARY SERVICE AREA IN NORTHWEST WASHINGTON, DC, INCLUDES EIGHT ZIP CODES, COVERING (IN ADDITION TO NW DC) SUBURBAN AREAS OF BETHESDA, CHEVY CHASE AND POTOMAC, MD. APPROXIMATELY 50% OF PATIENTS COMPRISE THESE EIGHT ZIP CODES. SIBLEYS SECONDARY SERVICE AREA, COMPRISING TWENTY-SEVEN ZIP CODES, INCLUDING THE SUBURBAN AREAS OF MCLEAN, VA, N POTOMAC, AND SILVER SPRING ACCOUNT FOR AN ADDITIONAL 25% OF OUR PATIENTS. IN OUR SERVICE AREA, THE MOST PROMINENT INCOME LEVEL IS BETWEEN $75,000 TO $100,000, 41% HIGHER THAN THE NEXT INCOME LEVEL. THERE ARE 11 HOSPITALS COMPETING IN OUR SERVICE AREA. SIBLEY HAS THE THIRD HIGHEST RANKING AMONG CASES FOR ALL 11 HOSPITALS. DATA IS NOT AVAILABLE FOR COMMUNITY RESIDENTS WITH INCOMES BELOW THE FEDERAL POVERTY GUIDELINES, PATIENTS UNINSURED OR MEDICAID RECIPIENTS. PART VI, LINE 6: SIBLEY HOSPITAL ENSURES THAT ITS BOARD MEMBERS ARE LEADERS WITHIN THE LOCAL BUSINESS COMMUNITY AND HAVE EXPERTISE IN MANY DIFFERENT AREAS. THE SKILLS, DEDICATION AND LEADERSHIP OF THE BOARD OF TRUSTEES FORM THE FOUNDATION OF THE HOSPITALS ABILITY TO PROVIDE NEEDED SERVICES TO THE COMMUNITY. BEFORE BEING APPOINTED TO THE BOARD, POTENTIAL MEMBERS EXPERIENCE A RIGOROUS SCREENING PROCESS, ENSURING THAT THEY ARE NEITHER FAMILY MEMBERS OF CURRENT BOARD MEMBERS NOR CONTRACTORS OF SIBLEY. TO FURTHER BENEFIT THE COMMUNITY, THE HOSPITAL PROVIDES, THROUGH ITS EXCESS FUNDS, MANY PROGRAMS FOR THE CITIZENS OF THE COMMUNITY THAT ARE OF LITTLE OR NO COST TO ATTENDEES. THESE PROGRAMS ARE DESIGNED TO EDUCATE, COMFORT, IMPROVE HEALTH AND PROVIDE SUPPORT TO THOSE WHO ATTEND. A NUMBER OF FREE HEALTH AND WELLNESS SEMINARS ARE PROVIDED REGULARLY TO MEMBERS OF THE COMMUNITY, SUCH AS DIABETES EDUCATION, HEART HEALTHY EATING AND ARTHRITIS. PHYSICIANS AND STAFF DONATE THEIR TIME TO EDUCATE ATTENDEES ON WAYS TO MAINTAIN OR IMPROVE INDIVIDUAL HEALTH. CHILDBIRTH AND NEW PARENTING CLASSES ARE CONDUCTED REGULARLY, PREPARING NEW PATIENTS (AND GRANDPARENTS) ON VARIOUS ASPECTS OF CHILD REARING AND BABY CARE. THERE ARE SEVERAL ONGOING SUPPORT GROUPS THAT MEET REGULARLY. EXISTING AND NEW MEMBERS ARE STRONGLY ENCOURAGED TO ATTEND. INDIVIDUALS EXPERIENCING ALZHEIMERS, ARTHRITIS, LYME DISEASE, MACULAR DEGENERATION, OR PARKINSONS DISEASE ARE SPECIFICALLY ENCOURAGED TO ATTEND. IN ADDITION TO HAVING A NATIONALLY-KNOWN BREAST CANCER TREATMENT CENTER, AT LEAST FIVE CANCER SUPPORT GROUPS MEET ON A REGULAR BASIS. MEMBERS OF THE HOSPITAL STAFF AND PHYSICIANS ALSO TRAVEL OFF CAMPUS TO CONDUCT OR BE PART OF COMMUNITY HEALTH EVENTS HELD AT LOCAL CHURCHES OR COMMUNITY SOCIAL GATHERINGS. AND FINALLY, THE HOSPITAL PROVIDES ADDITIONAL FREE BENEFITS TO MEMBERS OF ITS SIBLEY SENIOR ASSOCIATION, CURRENTLY HAVING MORE THAN 7,000 ACTIVE MEMBERS. BENEFITS INCLUDE FREE HEALTH SCREENING, EDUCATIONAL PROGRAMS, A WIDOWED PERSONS SERVICE, AND SEMINARS ON HEALTH RELATED SUBJECTS. THIS ORGANIZATION PROVIDES VALUABLE INPUT TO DETERMINING PRESENT AND FUTURE NEEDS OF SERVICES THAT NEED TO BE PROVIDED TO THE COMMUNITY.DURING 2010, SIBLEY PROMOTED THE USE OF CLINICAL TRIALS. THESE TRIALS ARE USED TO TEST, MEASURE AND LEARN MORE ABOUT THE EFFECTIVENESS AND RISKS OF NEW TREATMENTS. PARTICIPANTS GAIN ACCESS TO NEW TREATMENTS BEFORE THEY ARE WIDELY AVAILABLE AND HELP OTHERS BY CONTRIBUTING TO MEDICAL RESEARCH THAT COULD LEAD TO NEW BREAKTHROUGHS. THE JANE BANCROFT ROBINSON FOUNDATION WAS ORGANIZED TO PROVIDE CHARITABLE HEALTH CARE AND RELATED SERVICES AND FINANCIAL SUPPORT FOR THE SPIRITUAL, PHYSICAL AND EMOTIONAL NEED OF THE POOR WITHIN THE COMMUNITY. THE STACY MARK REED FOUNDATION WAS ORGANIZED TO RECEIVE, ADMINISTER AND EXPEND FUNDS FOR CHARITABLE, SCIENTIFIC AND EDUCATIONAL PURPOSES. PART VI, LINE 7: ON NOVEMBER 1, 2010, THE JOHNS HOPKINS HEALTH SYSTEM BECAME THE SOLE MEMBER OF THE SIBLEY MEMORIAL HOSPITAL. THE JOHNS HOPKINS HEALTH SYSTEM CORPORATION (JHHSC) IS INCORPORATED IN THE STATE OF MARYLAND TO, AMONG OTHER THINGS, FORMULATE POLICY AMONG AND PROVIDE CENTRALIZED MANAGEMENT FOR JHHSC AND AFFILIATES (JHHS). JHHS IS ORGANIZED AND OPERATED FOR THE PURPOSE OF PROMOTING HEALTH BY FUNCTIONING AS A PARENT HOLDING COMPANY OF AFFILIATES WHOSE COMBINED MISSION IS TO PROVIDE PATIENT CARE IN THE TREATMENT AND PREVENTION OF HUMAN ILLNESS WHICH COMPARES FAVORABLY WITH THAT RENDERED BY ANY OTHER INSTITUTION IN THIS COUNTRY OR ABROAD.JHHSC IS THE SOLE MEMBER OF THE JOHNS HOPKINS HOSPITAL (JHH), AN ACADEMIC MEDICAL CENTER, JOHNS HOPKINS BAYVIEW MEDICAL CENTER, INC. (JHBMC), A COMMUNITY BASED TEACHING HOSPITAL AND LONG-TERM CARE FACILITY, HOWARD COUNTY GENERAL HOSPITAL, INC. (HCGH), A COMMUNITY BASED HOSPITAL, SUBURBAN HOSPITAL, INC. (SHI), A COMMUNITY BASED HOSPITAL, AND SIBLEY MEMORIAL HOSPITAL, INC. (SMH), A COMMUNITY BASED HOSPITAL. REPORTS FILED WITH STATES PART VI, LINE 7 DC X 1 1 X X X X X X 0 1 0 0 0 0 0 0 0 ROBERT L SLOAN 622037 0 236317 0 183114 0 34151 0 13274 0 1088893 0 0 0 ROBERT R PETERSON 0 1051740 0 392713 0 175852 0 223972 0 22645 0 1866922 0 0 CARL L SYLVESTER JR MD 183333 0 0 0 0 0 0 0 0 0 183333 0 0 0 STEPHEN C MCDONNELL 399800 0 135944 0 16838 0 37381 0 9221 0 599184 0 0 0 JOAN VINCENT 273380 0 60685 0 8348 0 70908 0 7747 0 421068 0 0 0 AUDRY CARTER 248187 0 0 0 0 0 7821 0 9874 0 265882 0 0 0 QUEENIE PLATER 231475 0 31336 0 4346 0 16482 0 6169 0 289808 0 0 0 KENDA TAVAKOLI 205372 0 39780 0 7170 0 7135 0 8420 0 267877 0 0 0 PETER PETRUCCI 233112 0 18075 0 0 0 11025 0 5635 0 267847 0 0 0 CHRISTINE STUPPY 159486 0 24805 0 0 0 5999 0 6820 0 197110 0 0 0 JEFFERY JOYNER 177199 0 27142 0 0 0 6123 0 9499 0 219963 0 0 0 JEFFREY L LIN 559882 0 158882 0 1616 0 18850 0 11908 0 751138 0 0 0 REBECCA ZUURBIER 449929 0 0 0 0 0 5379 0 14441 0 469749 0 0 0 ZIA HASAN 439894 0 0 0 0 0 10470 0 9265 0 459629 0 0 0 POUNEH RAZAVI 315606 0 67275 0 0 0 3661 0 8184 0 394726 0 0 0 MARY T O'DONNELL 336565 0 37000 0 0 0 9467 0 10043 0 393075 0 0 0 PART I, LINE 4B DURING 2010 THE PRESIDENT/CEO, ROBERT SLOAN RECEIVED $183,114.30 AND THE SENIOR VP/CFO, STEPHEN MCDONNELL RECEIVED $18,690.73 FROM A NONQUALIFIED RETIREMENT PLAN WHICH IS BASED ON BENEFITS EARNED FROM PRIOR YEARS OF SERVICE. THE FOLLOWING INDIVIDUALS LISTED ON FORM 990, PART VII, SECTION A, LINE 1A PARTICIPATED IN A NONQUALIFIED RETIREMENT PLAN WITH THE RELATED ORGANIZATION JOHNS HOPKINS HEALTH SYSTEM CORPORATION AND RECEIVED ACCRUED DEFERRED COMPENSATION THAT IS REPORTED ON SCHEDULE J, PART II, COLUMN (C): RONALD R. PETERSON $212,947.00 DISTRICT OF COLUMBIA 536001131 254764HX4 2009-07-15 62798209 CONSTRUCTION OF MEDICAL BUILDING FOR OUTPATIENT SERVICES AND OFFICES 0 0 0 DISTRICT OF COLUMBIA 536001131 2010-12-29 30000000 REFUNDING OF PRIOR ISSUE 7/24/02 0 0 0 62798209 4941119 315000 57542090 2011 0 0 0 1 30000000 30000000 2005 1 0 1 1 0 1 1 0 1 0.00000 0.00000 0.00000 1 0 1 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 CARL L SYLVESTER JR MD BOARD MEMBER 183333 ANESTHESIA SERVICES 0 FORM 990, PART VI, SECTION A, LINE 4 ON NOVEMBER 1, 2010, LUCY WEBB HAYES NATIONAL TRAINING SCHOOL FOR DEACONESSES AND MISSIONARIES (DBA: SIBLEY MEMORIAL HOSPITAL) MERGED WITH THE JOHNS HOPKINS HEALTH SYSTEM, INC. THE ORGANIZATION DOCUMENTS HAVE BEEN AMENDED TO REFLECT THIS CHANGE. FORM 990, PART VI, SECTION A, LINE 7A DURING THE TRANSITION PERIOD JOHNS HOPKINS HEALTH SYSTEM CORPORTION, AN IRC 501C(3) TAX EXEMPT PARENT ORGANIZATION OF SIBLEY MEMORIAL HOSPITAL MAY ELECT ONE TRUSTEE. AFTER THE STATED TRANSITION PERIOD, JOHNS HOPKINS HEALTH SYSTEM CORPORATION ELECTS THE BOARD OF TRUSTEES. FORM 990, PART VI, SECTION A, LINE 7B THE GOVERNING BODY OF SIBLEY MEMORIAL HOSPITAL IS EMPOWERED BY ITS BY-LAWS TO MAKE CERTAIN DECISIONS; ALL OTHER DECISIONS ARE SUBJECT TO APPROVAL OF THE PARENT ORGANIZATION JOHNS HOPKINS HEALTH SYSTEM CORPORATION. FORM 990, PART VI, SECTION B, LINE 11 A COPY OF THE FORM 990 WAS PROVIDED TO THE EXECUTIVE COMMITTEE BEFORE IT WAS FILED. FORM 990, PART VI, SECTION B, LINE 12C THE HOSPITAL HAS AN EXISTING POLICY (#02-25-09) WHICH SPECIFICALLY ADDRESSES POTENTIAL CONFLICT(S) OF INTEREST FOR DECISION MAKERS AT ALL LEVELS WITHIN ITS BORDERS. THIS COVERAGE INCLUDES MEMBERS OF THE GOVERNING BOARD, ADMINISTRATION, MEDICAL STAFF, AND ALL OTHER EMPLOYEES. DISCLOSURE FORMS ASKING FOR POTENTIAL CONFLICTS OF INTEREST ARE DISTRIBUTED AT LEAST ANNUALLY SO THAT APPROPRIATE ACTION MAY BE TAKEN TO ENSURE THAT SUCH POTENTIAL CONFLICTS DO NOT INFLUENCE IMPORTANT DECISIONS. THE HOSPITAL'S BOARD MEMBERS ARE ASKED TO SUBMIT DISCLOSURE FORMS SEMI-ANNUALLY AND ON A CASE-BY-CASE BASIS. THE GOVERNING BOARD, SENIOR MANAGEMENT, AND THE EXECUTIVE COMMITTEE OF THE MEDCAL STAFF (AS APPROPRATE) BEAR RESPONSIBILITY FOR ADDRESSING AND REVIEWING ALL POTENTIAL CONFLICTS AND TAKING APPROPRIATE ACTION. WHEN CONFLICTS DO ARISE, THE MATTER IS BROUGHT BEFORE THE APPROPRIATE GOVERNING BODY AND DISCUSSED, AND THE CONFLICT IS ELIMINATED. FORM 990, PART VI, SECTION B, LINE 15 THE ORGANIZATION USES AN INDEPENDENT COMPENSATION COMMITTEE, AN INDEPENDENT COMPENSATION CONSULTANT, A WRITTEN EMPLOYMENT CONTRACT, A COMPENSATION SURVEY OR STUDY, APPROVAL BY THE BOARD AND CONTEMPORANEOUS WRITTEN SUBSTANTIATION OF THE DECISION-MAKING PROCESS WHEN DETERMINING COMPENSATION FOR THE CEO AND OTHER OFFICERS OF THE ORGANIZATION. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNIGN DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED GAINS ON INVESTMENTS: 29,984,588. PRIOR PERIOD ADJUSTMENTS: 21,715,146. CHANGE IN BENEFICIAL INTEREST IN FOUNDATION 10,064,685. PREMIER PURCHASING PARTNERS K-1 -474,725. COLONIAL REGIONAL ALLIANCE K-1 -10,160. ROCKVILLE IMAGING K-1 113,743. CHEVY CHASE IMAGING K-1 20,484. PURCHASED ACCOUNTING ADJUSTMENT 43,684,089. CHANGE IN MINIMUM PENSION LIABILITY 21,786,269. NET ASSETS RELEASED -84,755. TOTAL TO FORM 990, PART XI, LINE 5: 126,799,364. JOHNS HOPKINS HEALTH SYSTEM CORPORATION 3910 KESWICK RD SOUTH BLDG 4TH FL S BALTIMORE MD 21211 521465301 SUPPORTING ORGANIZATION MD 501(C)(3) LINE 11C, III-FI JOHNS HOPKINS HEALTH SYSTEM CORPORATION 0 JOHNS HOPKINS BAYVIEW MEDICAL CENTER INC 3910 KESWICK RD SOUTH BLDG 4TH FL S BALTIMORE MD 21211 521341890 HOSPITAL MD 501(C)(3) LINE 3 JOHNS HOPKINS HEALTH SYSTEM CORPORATION 0 JOHNS HOPKINS COMMUNITY PHYSICIANS INC 3910 KESWICK RD SOUTH BLDG 4TH FL S BALTIMORE MD 21211 521467441 HEALTHCARE SERVICES MD 501(C)(3) LINE 11C, III-FI JOHNS HOPKINS HEALTH SYSTEM CORPORATION 0 JOHNS HOPKINS MEDICAL SERVICES CORPORATION 3910 KESWICK RD SOUTH BLDG 4TH FL S BALTIMORE MD 21211 521232569 HEALTHCARE SERVICES MD 501(C)(3) LINE 3 JOHNS HOPKINS HEALTH SYSTEM CORPORATION 0 THE JOHNS HOPKINS HOSPITAL 3910 KESWICK RD SOUTH BLDG 4TH FL S BALTIMORE MD 21211 520591656 HOSPITAL MD 501(C)(3) LINE 3 JOHNS HOPKINS HEALTH SYSTEM CORPORATION 0 SUBURBAN HOSPITAL HEALTHCARE SYSTEM INC 8600 OLD GEORGETOWN ROAD BETHESDA MD 20814 522052354 HEALTHCARE SERVICES MD 501(C)(3) LINE 11C, III-FI JOHNS HOPKINS HEALTH SYSTEM CORPORATION 0 HOWARD COUNTY LIQUIDATION CORPORATION 3910 KESWICK RD SOUTH BLDG 4TH FL S BALTIMORE MD 21211 520892284 INACTIVE TAX-EXEMPT ORGANIZATION MD 501(C)(3) LINE 3 JOHNS HOPKINS HEALTH SYSTEM CORPORATION 0 SUBURBAN HOSPITAL INC 8600 OLD GEORGETOWN ROAD BETHESDA MD 20814 520610545 HOSPITAL MD 501(C)(3) LINE 3 JOHNS HOPKINS HEALTH SYSTEM CORPORATION 0 HOWARD COUNTY GENERAL HOSPITAL INC 3910 KESWICK RD SOUTH BLDG 4TH FL S BALTIMORE MD 21211 522093120 HOSPITAL MD 501(C)(3) LINE 3 JOHNS HOPKINS HEALTH SYSTEM CORPORATION 0 THE STACY MARK REED FOUNDATION 5255 LOUGHBORO ROAD NW WASHINGTON DC 20016 273818765 FINANCIAL SUPPORT DC 501(C)(3) LINE 11A, I SIBLEY MEMORIAL HOSPITAL 0 SIBLEY MEMORIAL HOSPITAL FOUNDATION 5255 LOUGHBORO ROAD NW WASHINGTON DC 20016 450562642 FINANCIAL SUPPORT DC 501(C)(3) LINE 7 SIBLEY MEMORIAL HOSPITAL 0 THE JANE BANCROFT ROBINSON FOUNDATION 5255 LOUGHBORO ROAD NW WASHINGTON DC 20016 273818431 FINANCIAL SUPPORT DC 501(C)(3) LINE 11C, III-FI SIBLEY MEMORIAL HOSPITAL 0 POTOMAC HOME SUPPORT INC 6001 MONTROSE ROAD NO 1020 ROCKVILLE MD 20852 521750383 HOME HEALTH CARE MD 501(C)(3) LINE 9 N/A 0 SIBLEY SUBURBAN HOME HEALTH AGENCY 6001 MONTROSE ROAD NO 307 ROCKVILLE MD 20852 521450142 HOME HEALTH CARE MD 501(C)(3) LINE 9 N/A 0 SIBLEY HEALTH NETWORK LLC 5255 LOUGHBORO ROAD NW WASHINGTON DC 20016 521932344 HEALTHCARE SERVICES DC N/A INVESTMENT -18 3 0 0 OPHTHALMOLOGY ASSOCIATES LLC 3910 KESWICK RD SOUTH BLDG 4TH FL S BALTIMORE MD 21211 521890957 OPHTHALMOLOGY SERVICES MD N/A SUBURBAN WELLNESS CENTER LLC 20500 GOLDENROD LANE GERMANTOWN MD 20874 562296930 REAL ESTATE MD N/A GCM SURBURBAN IMAGING LLC 1201 SEVEN LOCKS ROAD STE 200 ROCKVILLE MD 20854 522326237 OUTPATIENT RADIOLOGY MD N/A SIBLEY HEALTHCARE AFFILIATES 5255 LOUGHBORO RD NW WASHINGTON DC 20016 521928494 HEALTHCARE SERVICES DC SIBLEY MEMORIAL HOSPITAL C 12 8554 1.00000 HCP VENTURE ONE CORPORATION 3910 KESWICK RD SOUTH BLDG 4TH FL S BALTIMORE MD 21211 521558858 MEDICAL SERVICES MD N/A C HSI MEDICAL SERVICES CORPORATION 3910 KESWICK RD SOUTH BLDG 4TH FL S BALTIMORE MD 21211 521847705 HEALTHCARE-SLEEP DIAGNOSTICS MD N/A C HOWARD COUNTY HEALTH SERVICES INC 3910 KESWICK RD SOUTH BLDG 4TH FL S BALTIMORE MD 21211 521434783 HEALTHCARE MANAGEMENT MD N/A C JOHNS HOPKINS MEDICAL MANAGEMENT CORPORATION 3910 KESWICK RD SOUTH BLDG 4TH FL S BALTIMORE MD 21211 521250028 NURSING SERVICES MD N/A C JOHNS HOPKINS EMPLOYER HEALTH PROGRAM 3910 KESWICK RD SOUTH BLDG 4TH FL S BALTIMORE MD 21211 521947678 BENEFIT PLANS MD N/A C TCAS INC 3910 KESWICK RD SOUTH BLDG 4TH FL S BALTIMORE MD 21211 521979344 NURSING SERVICES MD N/A C SUBURBAN CONTRACTING CORP INC 8600 OLD GEORGETOWN ROAD BETHESDA MD 20814 522188022 MEDICARE CONTRACTING MD N/A C SUBURBAN HEALTH ENTERPRISES INC 8600 OLD GEORGETOWN ROAD BETHESDA MD 20814 522052352 MEDICAL OFFICE LEASING AND RELEASING MD N/A C SUBURBAN SPECIALTY CARE PHYSICIANS PC 8600 OLD GEORGETOWN ROAD BETHESDA MD 20814 522116011 MULTI SPECIALTY MEDICAL PRACTICE MD N/A C 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 SIBLEY MEMORIAL HOSPITAL FOUNDATION O 3704112 SIBLEY MEMORIAL HOSPITAL FOUNDATION R 693293