2011-05-11T13:46:01-05:00 2010-06-30 990 2009-07-01 522019696 SUBURBAN HOSPITAL FOUNDATION INC SUBU 3018963971 8600 OLD GEORGETOWN ROAD BETHESDA MD 208141497 MARTIN BASSO 3018963971 2011-05-11 2009 2016-02-24 21:20:13Z MARTIN BASSO 8600 OLD GEORGETOWN ROAD BETHESDA MD 208141497 16795980 0 X WWW.SUBURBANHOSPITAL/CHARITABLEGIVING.ORG X 1995 MD SUPPORTING ORGANIZATION FOR SUBURBAN HOSPITAL, INC. 21 20 7 75 0 0 12710595 3221002 0 -626106 482340 29238 -50664 12113727 3652678 6039547 2041598 0 614184 756155 0 957840 415809 586081 7069540 3383834 5044187 268844 26380886 28504114 406801 463079 25974085 28041035 The Suburban Hospital Foundation raises and distributes philanthropic gifts in support of the programs and priorities of the Member (Suburban Hospital, Inc. 52-0610545). The Corporation shall have such other objectives as are approved by the Board of Trustees and the Member. 0 0 499000 The Suburban Hospital Foundation underwrote several initiatives within the Suburban Hospital Cancer Care Programs. These included several support groups and cancer education events attended by thousands of people, such as "Check It Out", Living After Cancer symposium, Prostate Cancer symposium, and Survivor Day. The Foundation also assisted in the provision of charity care by covering the costs of mammograms and ultrasound procedures for low-income women, and ancillary costs of treatment for several patients. The salaries and benefits of two nurse navigators are funded by the Foundation. These professionals are available to assist all patients with understanding their treatment options and coordinating care. They have a special role in identifying cancer patients in need of assistance with insurance, transportation, rent & utilities, and child care during treatment. Free screenings for community members for skin and prostate cancer were also provided 494000 The Suburban Hospital Foundation underwrote the activities of Suburban Hospital's Casey Center for Diagnostic Cardiology and Diabetes Education, which includes the activities of the Hospital's popular Cardiac Rehabilitation program. "Cardiac rehab" enrolls 400 patients every week, in three levels of activity. Our multidisciplinary team of health professionals is dedicated to improving the quality of life for those recovering from a heart attack, heart surgery, or cardiovascular disease through cardiac rehabilitation through a structured program of education, exercise and peer support designed to guide lifestyle modification. The funds from the Foundation ensure that the Center and its equipment is maintained and that staff are available with the proper continuing education credentials. The Diabetes Education program is available to both inpatient and outpatient populations. Diabetes educators are available for more than 60 inpatient consults monthly. The educators, along with community physicians, also conduct monthly "Diabetes School" programs and individual consults for over 300 patients annually. 186000 The Suburban Hospital Foundation contributed to equipment purchases and upgrades for several programs in Suburban Hospital including the emergency and trauma service and emergency preparedness for a possible pandemic flu outbreak. The SHF also contributed funds for the renovation of the patient admitting area to improve efficiency of operations and patient privacy. 862598 2041598 3652678 862598 2041598 3652678 2041598 1 1 0 0 0 0 0 0 0 1 1 1 0 0 0 0 0 0 1 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 1 7 1 0 0 0 0 1 1 0 0 21 20 0 0 0 0 0 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 MD X LESLIE FORD WEBER EXEC VP 3018963971 8710 OLD GEORGETOWN ROAD BETHESDA MD 20814 LARRY BANK 4.00 X 0 0 0 Robert Easby-Smith 4.00 X 0 0 0 STEPHEN CEASTHAM 4.00 X 0 0 0 LARA EISENBERG MD 4.00 X 0 0 0 RHONDA BFRIEDMAN 4.00 X 0 0 0 DOUGLAS SINGRAM PHD 4.00 X 0 0 0 Leslie Malawer Keenan 4.00 X 0 0 0 Calvin Laroche 4.00 X 0 0 0 CHARLES MALAMENT 4.00 X 0 0 0 John J Jack McDonnell 4.00 X 0 0 0 GRANT BOTTENSTEIN 4.00 X 0 0 0 CURTIS POLK 4.00 X 0 0 0 CHARLES POSTAL 4.00 X 0 0 0 David A Ruben 4.00 X 0 0 0 Sabrina Weger 4.00 X 0 0 0 DAVID A WEXLER CLU CH 4.00 X 0 0 0 Brian AGragnolati 10.00 X 0 1555800 329737 BARRY ROGSTAD PHD 4.00 X 0 0 0 ERNEST HANOWELL MD 4.00 X 0 0 0 Phyllis Donoghue 4.00 X 0 0 0 Boi Carpenter-Mellady 4.00 X 0 0 0 Michael Hibler 4.00 X 0 0 0 Steven Rum 4.00 X 0 0 0 Leslie Weber 32.00 X 0 226341 39965 Marty Basso 4.00 X 0 436557 76140 SHIRA EOLER 40.00 X 130622 0 24571 rebecca Bull 40.00 X 118583 0 31270 249205 2218698 501683 2 0 1 0 0 382318 320803 2517881 11525 3221002 573639 573639 12812000 12903299 -91299 -91299 -91299 182465 382318 240003 -57538 -57538 Other 900099 6874 6874 6874 3652678 -91299 0 522975 2041598 2041598 155193 3104 152089 430573 30321 400252 141395 8068 133327 28994 1654 27340 28900 28900 49099 49099 84759 84759 1019 1019 5076 5076 4328 247 4081 1081 1081 other 217891 119951 97940 Purchased Services 191578 141971 49607 Repairs & Maintenance 2350 2350 3383834 2041598 384396 957840 5252 3605 4865076 1833737 595894 841600 51590 51590 3018 0 20911646 25825172 26380886 28504114 205385 220544 201416 242535 406801 463079 X 6675375 8473266 8607036 8875095 10691674 10692674 25974085 28041035 26380886 28504114 X 0 1 1 X 1 1 X X X 0 0 0 Suburban hospital inc 520610545 3 1 1 1 1894882 1 1894882 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 51590 51590 0 0 ANNUITIES PAYABLE 242535 242535 3652678 3383834 268844 2606543 -808437 1798106 2066950 3603579 0 3603579 49099 49099 3652678 3574738 240003 240003 3334735 49099 49099 3383834 Part XI, Line 8 - Other Adjustments: Increase in the provision for uncollectible pledges: -568957. rounding: 523. Special Events: -240003. Part XII, Line 4b - Other Adjustments: Investment fees: 49099. Part XIII, Line 2d - Other Adjustments: Special events: 240003. Part XIII, Line 4b - Other Adjustments: investment fees: 49099. showcase 224843 206889 17954 26218 7897 40777 63950 0 golf 180642 124953 55689 8345 15000 42103 0 8200 3 159298 50476 108822 21139 0 6074 0 300 564783 382318 182465 55702 22897 88954 63950 8500 240003 -57538 1 suburban hospital inc 8600 old georgetown road bethesda MD 208141497 520610545 501(c)(3) 1894882 support for the hospital St Jane Frances De Chantel Church 9701 Old Georgetown Rd bethesda MD 20814 520623158 501(c)(3) 8000 Community Benefit Jewish Chaplaincy Services 6123 Montrose Road Rockville MD 20852 530196598 501(c)(3) 8000 Community Benefit American Heart Association 4217 Park Place Court Glen Allen VA 23060 530213318 501(c)(3) 15000 Community Benefit MHEI 6820 Deerpath Road Elkridge MD 21075 520901664 501(c)(3) 6000 Community Benefit Big Train Community Baseball PO Box 30306 Bethesda MD 20824 522092719 501(c)(3) 5000 community benefit Scholarships 14 96000 Procedure for Monitoring Grants in the U.S.: Part I, Line 2: Schedule I, Part I, Line 2: THE BOARD OF TRUSTEES HAS DELEGATED THE FACILITATION AND ACCOUNTING FOR ALL GRANT PROGRAMS ADMINISTERED BY SUBURBAN HOSPITAL FOUNDATION, INC. TO THE OFFICERS, DIRECTORS, AND KEY EMPLOYEES OF THE ORGANIZATION. X X 0 1 X X X X X 0 1 0 0 0 0 0 1 0 Brian AGragnolati 0 639991 0 420456 0 495353 0 303963 0 25774 0 1885537 0 0 Leslie Weber 0 179288 0 34010 0 13043 0 38034 0 1931 0 266306 0 0 Marty Basso 0 255194 0 142805 0 38558 0 53346 0 22794 0 512697 0 0 SHIRA EOLER 96786 0 11273 0 22563 0 7837 0 16734 0 155193 0 0 0 Part I, Line 1a Suburban Hospital Inc. provides a gross up on an auto lease and other certain benefits for a trusee of Suburban Hospital Foundation, Inc. Suburban Hospital Foundation is the supporting organization for Suburban Hospital Inc. The compensation committee of the board of directors approved the gross up. Proper business documentation was provided and the gross up was treated as taxable compensation to the employee. Suburban Hospital, INC. pays the dues for a country club membership for an officer, that serves as a trustee on Suburban Hospital Foundation, Inc. The amount of the dues paid is included in the employee's taxable compensation and is reported on Schedule J, Part II, Column B(iii). Part I, Line 1b An internal policy is used to award officers gross up payments. Part I, Line 4a The SERP Plans is a non-tax qualified defined contribution plans. The plan provides a fixed percentage of salary as supplemental retirement benefit for each participant. In the manner required by applicable IRS rules, the design of each of these arrangements was approved as reasonable, in advance, by an independent compensation committee, which based its decision on data provided by an independent compensation consultant. Participants interests under these arrangements are not guaranteed or secured at any way and at all times are subject to claims of employer's bankruptcy/insolvency creditors. If a participant voluntarily terminates employment and fails to satisfy certain non-compete provisions, the participant's account is forfeited. In addition, under current law, interests under these arrangements are reportable as taxable compensation when they become vested, even if those amounts are not yet payable to the participant (and even if those amounts are never paid to the participant). No rollover or other tax-deferral options are available to participants. Note that any SERP Plan vested amount or payment being reported as compensation was also reported in previous year(s) when that interest accrued under the plan. The following individuals listed on Form 990, Part VII, Section A, line 1a participated in a nonqualified retirement plan with the related organization suburban hospital, inc. and received accrued deferred compensation that is reported on Schedule J, Part II, Column (C): MARTIN BASSO $38,646.00; bRIAN gRAGNOLATI $289,263.00; AND LESLIE FORD WEBER $25,235.00 Part I, Line 7 The Executives and directors that are paid by the related organization Suburban Hospital, Inc. participate in an annual incentive plan. The annual incentive plan has three potential payout levels - threshold, target and maximum. Each year specific targets are established in the areas of Quality Patient Satisfaction, Finance, Human Resources and Individual Performance. The incentive amount depends on the level accomplished during the year. The employees of Suburban Foundation participate in an annual incentive program that is based on business activity and individual performance. The annual incentive plan has three potential payout levels - threshold, target and maximum. Supplemental Information Part III The Flexible Benefit Allowance Plan is a non-tax qualified flexible benefit plan. The plan is designed to provide a fixed percentage of salary for supplemental health welfare benefits for each participant. In the manner required by applicable IRS rules, the design of each of these arrangements was approved as reasonable, in advance, by an independent compensation committee, which based its decision on data provided by an independent compensation consultant. Participants' interests under these arrangements are not guaranteed or secured at any way and at all times are subject to claims of employer's bankruptcy/insolvency creditors. If a participant voluntarily terminates employment and fails to satisfy certain non-compete provisions, the participant's account is forfeited. In addition, under current law, interests under these arrangements are reportable as taxable compensation when they become vested, even if those amounts are not yet payable to the participant (and even if those amounts are never paid to the participant). No rollover or other tax-deferral options are available to participants. Note that any Flexible Benefit Allowance Plan vested amount or payment being reported as compensation was also reported in previous year(s) when that interest accrued under the plan. Form 990, Part VI, Section A, line 7a Suburban Hospital, Inc., the IRC 501c (3) tax exempt supported organization of Suburban Hospital Foundation, Inc. elects the majority of the board of trustees at the annual meeting. Form 990, Part VI, Section A, line 7b The governing body of Suburban Hospital, Inc. 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 CONFLICT OF INTEREST POLICY IS A PART OF THE ANNUAL FINANCIAL AUDIT CONFIRMATION PROCESS PROVIDED ONLINE. ALL OFFICERS, DIRECTORS, TRUSTEES, AND KEY EMPLOYEES ARE REQUIRED TO COMPLY ON AN ANNUAL BASIS. Form 990, Part VI, Section B, line 15 EVERY THREE YEARS AN INDEPENDENT STUDY IS CONDUCTED GATHERING INDUSTRY COMPENSATION AVERAGES FROM SELECT PEER INSTITUTIONS. EVERY YEAR THE JOHNS HOPKINS BOARD OF TRUSTEES COMPENSATION COMMITTEE REVIEWS COMPENSATION AMOUNTS FOR OFFICERS AND ALL EMPLOYEES AT THE DIRECTOR AND HIGHER LEVELS. Form 990, Part VI, Section C, line 19 INTERNAL POLICIES, INCLUDING CONFLICT OF INTERST POLICY, ARE PROVIDED TO THE PUBLIC ON THE ORGANIZATION'S WEBSITE. FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST, THE GOVERNING DOCUMENTS HAVE BEEN MADE AVAILABLE IN OUR PUBLIC FILING WITH THE STATE OF MARYLAND AND THE INTERNAL REVENUE SERVICE. FORM 990, PART V, LINES 2A & 2B: NUMBER OF EMPLOYEES REPORTED AND REQUIRED FEDERAL EMPLOYMENT TAX: THE 7 EMPLOYEES REPORTED ON LINE 2A ARE PAID AND REPORTED ON FORM W-3 BY THE SUPPORTED ORGANIZATION Suburban Hospital, Inc. (52-0610545). ALL REQUIRED FEDERAL AND STATE EMPLOYMENT TAX RETURNS ARE FILED BY HOWARD COUNTY GENERAL HOSPITAL, INC. FORM 990, PART XI, LINES 3A & 3B AUDIT REPORTS ON FEDERAL AWARDS IN ACCORDANCE WITH OMB CIRCULAR A-122 THE FEDERAL AWARDS ISSUED TO SUBURBAN HOSPITAL FOUNDATION, INC. WERE INCLUDED IN THE OMB CIRCULAR A-133 AUDIT OF SUBURBAN HOSPITAL, INC. AND AFFILIATES. FORM 990, SCHEDULE B, PART I CONTRIBUTORS THE LIST OF CONTRIBUTORS ON SCHEDULE B INCLUDE PLEDGE PAYMENTS RECEIVED IN FISCAL YEAR 2010 THAT WERE REPORTED ON PRIOR FORM 990'S AS REVENUE ON PART VIII, LINES 1A-G BUT NOT REPORTED ON SCHEDULE B. Suburban hospital inc 8600 Old Georgetown Road Bethesda MD 208141497 520610545 hospital MD 501 (c)(3) line 3 SUBURBAN HOSPITAL HEALTHCARE SYSTEM INC 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0