4A (Expenses $ 29105527 including grants of $ 0) (Revenue $ 60500906)
LEVINDALE OPERATES A 120-BED CHRONIC HOSPITAL, WHICH PROVIDES SPECIALTY LONG STAY HOSPITAL SERVICES, REHABILITATION CARE, AND BEHAVIORAL HEALTH CARE. LEVINDALE PROVIDED 31,295 INPATIENT DAYS: 7,626 IN THE High-Intensity Care UNIT (HICU); 3,843 IN THE REHABILITATION UNIT; AND 19,826 IN THE BRAIN HEALTH UNIT.

4B (Expenses $ 30419161 including grants of $ 0) (Revenue $ 26642787)
LEVINDALE OPERATES A 210-BED NURSING FACILITY, WHICH INCLUDES A 60-BED SUBACUTE UNIT. LEVINDALE PROVIDED 21,454 PATIENT DAYS OF SUBACUTE CARE AND 48,004 DAYS OF INTERMEDIATE NURSING CARE.

4C (Expenses $ 2904516 including grants of $ 0) (Revenue $ 3110645)
LEVINDALE HEBREW GERIATRIC CENTER AND HOSPITAL PROVIDES ADULT DAY CARE, PARTIAL HOSPITALIZATION, CLINIC SERVICES, AND REHABILITATION SERVICES. LEVINDALE PROVIDED 9,076 DAYS IN ITS ADULT DAY CARE PROGRAM. THE PARTIAL HOSPITALIZATION PROGRAM HAD 1,707 DAYS. OTHER PROGRAM SERVICE EXPENSES INCLUDE CAFETERIA FOR RESIDENTS, VISITORS AND STAFF, AS WELL AS TRANSPORTATION FOR THE ELDERLY TO PROGRAMS RUN BY LEVINDALE.

SCHEDULE H, PART V, SECTION B, LINE 5:
DURING THE FY 21 CHNA PROCESS, THE PROJECT TEAM USED A MULTI-PRONGED APPROACH TO SOLICIT INPUT FROM THE BALTIMORE COMMUNITY REGARDING THEIR HEALTH NEEDS. DATA COLLECTION METHODOLOGIES INCLUDED SURVEYS, STAKEHOLDER INTERVIEWS, AND FOCUS GROUPS. FOCUS GROUPS AND INTERVIEWS INCLUDED COMMUNITY LEADERS, ASSOCIATIONS, AS WELL AS MEMBERS OF SPECIFIC DEMOGRAPHIC GROUPS-THOSE WITH DISABILITIES, RE-ENTRY RESIDENTS AND SPANISH SPEAKERS KNOWN TO HAVE PARTICULAR NEEDS. THE PROJECT TEAM PARTNERED WITH HEALTH SYSTEMS ACROSS BALTIMORE CITY IN DISSEMINATION OF A WEB-BASED AND HARDCOPY COMMUNITY SURVEY INSTRUMENT TO COLLECT INFORMATION FROM BALTIMORE CITY RESIDENTS REGARDING THEIR HEALTH AND SOCIAL NEEDS. THIS PROCESS RESULTED IN 3,170 SURVEY RESULTS. IN ADDITION, LEVINDALE AND ITS COMPANION LIFEBRIDGE HEALTH FACILIITES CONDUCTED FOCUS GROUPS AS WELL AS CONVERSATIONS WITH KEY STAKEHOLDERS WITHIN THE PRIMARY SERVICE AREAS. REPRESENTATIVES INCLUDED COMMUNITY LEADERS, ASSOCIATIONS, AS WELL AS MEMBERS OF THE DEMOGRAPHIC GROUPS IDENTIFIED ABOVE. FOUR STAKEHOLDER INTERVIEWS AND FOUR FOCUS GROUPS WERE CONDUCTED. THE STAKEHOLDERS WERE SELECTED BECAUSE THEY HAD SPECIAL KNOWLEDGE OF OR EXPERTISE IN PUBLIC HEALTH OR REPRESENTED THE BROAD INTEREST OF THE COMMUNITY SERVED BY LEVINDALE, INCLUDING THE INTEREST OF MEDICALLY UNDERSERVED, LOW-INCOME AND MINORITY POPULATIONS WITH CHRONIC DISEASE NEEDS. THE POPULATIONS THAT MADE UP THE FOCUS GROUPS AND THE DATES THE MEETINGS WERE HELD ARE LISTED BELOW: OLDER ADULTS FOCUS GROUP - MEETING HELD AUGUST 11, 2020 RE-ENTRY FOCUS GROUP - MEETING HELD SEPTEMBER 18, 2020 DISABILITIES FOCUS GROUP - MEETING HELD SEPTEMBER 21, 2020 SPANISH SPEAKING FOCUS GROUP - MEETING HELD NOVEMBER 20, 2020 THE STAKEHOLDER INTERVIEWS WERE CONDUCTED WITH REPRESENTATIVES FROM STEVENSWOOD COMMUNITY ASSOCIATION CENTRAL BAPTIST CHURCH, NEW SOLID ROCK FELLOWSHIP CHURCH, NORTH WEST FAITH BASED PARTNERSHIP, AND ROLLING OAKS COMMUNITY ASSOCIATION. THE BALTIMORE CITY HEALTH DEPARTMENT AND THE RESIDENT HEALTH SYSTEMS PREVIOUSLY COLLABORATED ON A CHNA IN 2017-2018 AND SOUGHT TO SO AGAIN IN 2020-2021 THOUGH IN A MORE LIMITED MANNER DUE TO THE COVID-19 VIRUS. THE 2020-2021 CHNA INCORPORATES A VARIETY OF SECONDARY DATA SOURCED THROUGH THE BALTIMORE NEIGHBORHOOD INDICATORS ALLIANCE - JACOB FRANCE INSTITUTE (BNIA), THE CENTERS FOR DISEASE CONTROL, AS WELL AS THE BALTIMORE CITY HEALTH DEPARTMENT'S NEIGHBORHOOD HEALTH PROFILE.

SCHEDULE H, PART V, SECTION B, LINE 6A:
LEVINDALE HEBREW GERIATRIC CENTER AND HOSPITAL, INC. CONDUCTED THE CHNA IN COLLABORATION WITH THE LIFEBRIDGE HEALTH SYSTEM'S SINAI HOSPITAL AND NORTHWEST HOSPITAL. FOR THE 2021 CHNA THE OTHER BALTIMORE AREA HOSPITALS THAT COLLABORATED WITH LEVINDALE IN GATHERING DATA FOR THE COMMUNITY NEEDS ASSESSMENT WERE JOHNS HOPKINS HOSPITAL, UNIVERSITY OF MARYLAND, MEDSTAR HEALTH, SAINT AGNES HOSPITAL AND MERCY HOSPITAL.

SCHEDULE H, PART V, SECTION B, LINE 7D:
COPIES OF THE CHNA WERE DISTRIBUTED TO KEY COMMUNITY PARTNERS. https://www.lifebridgehealth.org/Uploads/Public/main/about/CommunityHealth andWellbeing/LevindaleCHNA.pdf

SCHEDULE H, PART V, SECTION B, LINE 10A:
https://www.lifebridgehealth.org/Uploads/Public/main/about/CommunityHealth andWellbeing/LevindaleIP.pdf

SCHEDULE H, PART V, SECTION B, LINE 11:
LEVINDALE UTILIZED THE LIFEBRIDGE COMMUNITY HEALTH AND WELLNESS TEAM TO CONDUCT THE CHNA. TEAM MEMBERS IDENTIFIED FROM 3,170 PUBLIC SURVEYS THE MOST SIGNIFICANT NEEDS. THE LEVINDALE CEO AND CHNA LEADERSHIP MET WITH REPRESENTATIVES OF THE LEVINDALE HOSPITAL BOARD AND LEADERSHIP ON MARCH 19, 2021 TO REVIEW THE FINDINGS OF THE CHNA AND TO SEEK RECOMMENDATIONS TO PRIORITIZE THE HIGHEST NEEDS AND THOSE WITH THE HIGHEST FEASIBILITY. THE FOLLOWING NEEDS WERE SELECTED AS PRIORITIES: HEART DISEASE LEVINDALE WILL PROVIDE EDUCATION AND SCREENING DURING STROKE AWARENESS MONTH THROUGH VARIOUS EVENTS. WE PARTNERED WITH SEVERAL ORGANIZATIONS THROUGHOUT THE COMMUNITY INCLUDING THE AMERICAN HEART ASSOCIATION, BALTIMORE CITY HEALTH DEPARTMENT CARDIOVASCULAR DISPARITIES TASK FORCE AND THE PARK HEIGHTS COMMUNITY HEALTH ALLIANCE. MENTAL HEALTH, DEPRESSION, AND SUBSTANCE USE DISORDER LEVINDALE HOSPITAL OPERATES A PARTIAL HOSPITALIZATION PROGRAM (PHP) WHICH IS A SHORT-TERM PSYCHIATRIC DAY PROGRAM FOR OLDER ADULTS WHO ARE EXPERIENCING BEHAVIORAL HEALTH SYMPTOMS THAT PUT THEM AT RISK OF INPATIENT HOSPITALIZATION. PHP IS ALSO USED AS A STEPDOWN FOR PEOPLE BEING DISCHARGED FROM AN INPATIENT STAY, WHO MAY NEED CONTINUED SUPPORT IN PROGRESSING TOWARDS THEIR TREATMENT GOALS. COMMUNITY HEALTH AND WELLNESS EDUCATION A PASTORAL OUTREACH COORDINATOR AND COMMUNITY EDUCATORS PROVIDE OUTREACH TO THE FAITH COMMUNITIES AND OFFER EDUCATIONAL TOPICS RELATED TO ILLNESS PREVENTION. IN ADDITION, INFORMATION WAS ADDED ON THE CONNECTION BETWEEN FAITH AND HEALTH; AND THE INCLUSION OF MORE INFORMATION ON COMMUNITY RESOURCES FACILITATED MORE ACCESS. DIABETES THE DIABETES WELLNESS SERIES WAS DEVELOPED TO ADDRESS THOSE AT RISK OF DEVELOPING CHRONIC DISEASES, IN ADDITION TO THOSE WHO LIVE WITH CHRONIC DISEASE ALREADY. HEALTH DISPARITIES LEVINDALE WILL EXPLORE PARTNERSHIPS WITH COMMUNITY RESOURCE CENTER(S) TO BETTER REACH COMMUNITY RESIDENTS WITH HEALTH EDUCATION AND HEALTH CARE ACCESS. HOUSING LEVINDALE WILL EXPLORE IMPLEMENTING THE PACE PROGRAM TO ENABLE INDIVIDUALS NEEDING HEALTH SERVICES TO BE ABLE TO STAY IN THEIR HOME. IN ADDITION, LEVINDALE WILL PARTICIPATE IN THE LIVE NEAR YOUR WORK PROGRAM TO HELP INDIVIDUALS FIND AFFORDABLE, CONVENIENT HOUSING. FOOD INSECURITY LEVINDALE IN CONJUNCTION WITH SINAI IMPLEMENTED A FARMER'S MARKET WITH AFFORDABLE FRESH FOOD ON THE SINAI CAMPUS. COMMUNITY SAFETY LEVINDALE WORKS WITH THE CHANA-SAFE PROGRAM TO IDENTIFY AND PREVENT ELDER ABUSE AND NEGLECT. NEEDS NOT ADDRESSED WITHIN IMPLEMENTATION STRATEGY THE NEEDS LISTED BELOW WERE IDENTIFIED AS PRIORITIES DURING THE ASSESSMENT PROCESS, BUT ULTIMATELY WERE NOT CHOSEN AS PRIORITIES FOR ACTION, BECAUSE THE HOSPITAL OR ITS AFFILIATED ORGANIZATIONS HAVE BEEN ADDRESSING THEM IN OTHER WAYS, THE HOSPITAL DOES NOT HAVE SUFFICIENT RESOURCES TO ADDRESS THEM, OR OTHER ORGANIZATIONS ARE MORE CAPABLE OF MEETING THOSE NEEDS. LACK OF TRANSPORTATION LACK OF TRANSPORTATION AROSE IN THE SURVEYS AS AN IMPORTANT REASON FOR WHY PEOPLE DO NOT GET HEALTH CARE. THROUGH THE CARE MANAGEMENT DEPARTMENT AND OTHER PROGRAMS THAT WORK WITH PEOPLE IN THE COMMUNITY, TRANSPORTATION FUNDING IS PROVIDED FOR MANY PATIENTS WHO NEED HELP IN GETTING TO THEIR DOCTORS' APPOINTMENTS. SINCE PATIENTS AND CLIENTS ARE SERVED WELL BY THESE RESOURCES, THIS CONCERN WAS NOT PRIORITIZED FOR FURTHER INVESTMENT. ACCESS TO INSURANCE LEVINDALE HOSPITAL PROVIDES SIGN-UP ASSISTANCE TO PATIENTS WITHOUT INSURANCE WHEN THEY PRESENT AT THE HOSPITAL. A STAFF PERSON OVERSEES THIS FUNCTION. WORKFORCE DEVELOPMENT LEVINDALE HOSPITAL REFERS RESIDENTS AND PATIENTS WITHOUT EMPLOYMENT TO PARTNER ORGANIZATIONS, PARTICULARY BON SECOURS COMMUNITY WORKS IN SOUTH AND WEST BALTIMORE, TO ADDRESS THIS PRESSING SOCIAL NEED. SINAI HOSPITAL ALSO SUPPORTS VARIOUS AGENCIES IN ADDRESSING UNDERLYING FACTORS, E.G., FINANCIAL LITERACY AND EDUCATION TO MITIGATE CONDITIONS OF POVERTY. ACCESS TO PHYSICIANS A SYSTEM-WIDE EFFORT HAS BEEN DEVELOPED SINCE THE 2018 CHNA TO ADDRESS NEEDS OF VARIOUS PATIENTS. SPECIALISTS ARE READILY IDENTIFIED, AND REFERRALS ARE APPROPRIATELY MADE. DEPARTMENTS AND TEAM MEMEBERS CONTINUE IN EFFORTS TO REDUCE APPOINTMENT WAIT TIME FOR HEALTH CARE SERVICES LACKING COMMUNITY CAPACITY SUCH AS MENTAL HEALTH THERAPY. COORDINATION ACROSS SERVICES SINCE THE LAST CHNA, LEVINDALE HOSPITAL DEPARTMENTS, INCLUDING SOCIAL SERVICES AND CARE MANAGEMENT, HAVE WORKED MORE CLOSELY BOTH INTERNALLY AS WELL AS WITH COMMUNITY RESROUCES TO ENABLE PATIENTS TO ACCESS NECESSARY AND VALUABLE RESOURCES IN AS TIMELY A MANNER AS POSSIBLE. INCLUSION OF SOCIAL RESOURCES IN COORDINATION IS INTENDED TO REDUCE REOCCURENCE OF ACUTE HEALTH EPISODES THAT REQUIRE HOSPITALIZATIONS. LANGUAGE BARRIERS LEVINDALE HOSPITAL HAS INTERPRETIVE SERVICES AVAILABLE AND SIGNS IN MULTIPLE LANGUAGES AS WELL AS IN HARD COPY FORMS IN THE WELCOME PACKET PATIENTS RECEIVE. FORMS ARE AVAILABLE IN SPANISH AS WELL AS OTHER LANGUAGES, E.G., RUSSIAN. CONSENT FORMS ARE TRANSLATED INTO SEVERAL LANGUAGES AS WELL.

SCHEDULE H, PART V, SECTION B, LINE 16A:
HTTPS://WWW.LIFEBRIDGEHEALTH.ORG/UPLOADS/PUBLIC/MAIN/FINANCIALASSISTANCE/F AP/LBH_FINANCIAL%20ASSISTANCE%20211001ENGLISH.PDF

SCHEDULE H, PART V, SECTION B, LINE 16B:
HTTPS://WWW.LIFEBRIDGEHEALTH.ORG/UPLOADS/PUBLIC/DOCUMENTS/FINANCIAL%20ASSI STANCE%20UNIFORM%20APPL.PDF

SCHEDULE H, PART V, SECTION B, LINE 16C:
HTTPS://WWW.LIFEBRIDGEHEALTH.ORG/UPLOADS/PUBLIC/MAIN/FINANCIALASSISTANCE/P LS/LBH%20HOSPITAL%20INFORMATION%20SHEET%20220302_ENGLISH.PDF

SCHEDULE H, PART V, SECTION B, LINE 22C:
CHARGES FOR ALL HOSPITAL PATIENTS ARE STATE REGULATED. SERVICES ARE CHARGED TO ALL HOSPITAL PATIENTS AT THE SAME RATE. CHARGES FOR INDIVIDUALS FOUND ELIGIBLE FOR FAP BASED ON 300% OR LESS OF THE FEDERAL POVERTY LEVEL (FPL) ARE WRITTEN-OFF IN FULL TO FAP (THERE IS NO PATIENT LIABILITY). CHARGES FOR INDIVIDUALS FOUND ELIGIBLE FOR FAP BASED ON THE HSCRC'S FINANCIAL HARDSHIP CRITERIA OF 301%-500% OF FPL ARE CHARGED NO MORE THAN 25% OF THE ANNUAL HOUSEHOLD INCOME PER THE HSCRC'S FINANCIAL HARDSHIP CRITERIA. THE DIFFERENCE BETWEEN THE TOTAL CHARGES AND THE CALCULATED 25% OF THE ANNUAL HOUSEHOLD INCOME IS WRITTEN OFF TO FAP.

SCHEDULE H, PART I, LINE 3C:
LEVINDALE HEBREW GERIATRIC CENTER AND HOSPITAL, INC. PROVIDES CARE WITHOUT CHARGE OR AT AMOUNTS LESS THAN ITS ESTABLISHED RATES, TO PATIENTS WHO MEET THE CRITERIA OF ITS CHARITY CARE POLICY. IT DOES NOT PURSUE THE COLLECTION OF AMOUNTS DETERMINED TO QUALIFY AS CHARITY CARE AND THOSE AMOUNTS ARE NOT REPORTED AS REVENUE. THE CRITERIA FOR CHARITY CARE CONSIDER GROSS INCOME AND FAMILY SIZE ACCORDING TO CURRENT FEDERAL POVERTY GUIDELINES. PATIENTS WITH AN ANNUAL INCOME UP TO 300% OF THE FEDERAL POVERTY LEVEL MAY HAVE 100% OF THEIR HOSPITAL BILLS COVERED BY FINANCIAL ASSISTANCE. TO QUALIFY, THE PATIENT MUST SHOW PROOF OF INCOME 300% OR LESS OF THE FEDERAL POVERTY GUIDELINES. PATIENTS WITH ANNUAL INCOME ABOVE 300% OF THE FEDERAL LIMIT MAY HAVE A PORTION OF THEIR MEDICAL BILLS COVERED BY FINANCIAL ASSISTANCE BASED ON A SLIDING SCALE. ELIGIBILITY IS CALCULATED BASED ON THE NUMBER OF PEOPLE LIVING IN THE HOUSEHOLD.

SCHEDULE H, PART I, LINE 7:
MARYLAND'S REGULATORY SYSTEM CREATES A UNIQUE PROCESS FOR HOSPITAL PAYMENT THAT DIFFERS FROM THE REST OF THE NATION. THE HEALTH SERVICES COST REVIEW COMMISSION (HSCRC) DETERMINES PAYMENT THROUGH A RATE-SETTING PROCESS AND ALL PAYORS, INCLUDING GOVERNMENTAL PAYORS, PAY THE SAME AMOUNT FOR THE SAME SERVICES DELIVERED AT THE SAME HOSPITAL. MARYLAND'S UNIQUE ALL-PAYOR SYSTEM INCLUDES A METHOD FOR REIMBURSING UNCOMPENSATED CARE IN EACH PAYOR'S RATES, WHICH DOES NOT ENABLE MARYLAND HOSPITALS TO BREAK-OUT ANY OFFSETTING REVENUE RELATED TO UNCOMPENSATED CARE. IN RECENT YEARS, THE STATE OF MARYLAND HAS CLOSED FISCAL GAPS IN THE STATE MEDICAID BUDGET BY ASSESSING HOSPITALS THROUGH THE RATE-SETTING SYSTEM.

SCHEDULE H, PART I, LINE 7A - I:
THE FOLLOWING COSTING METHODOLOGIES WERE USED TO CALCULATE LINES 7A THROUGH 7I ON THE COMMUNITY BENEFIT REPORT. OFFSETTING REVENUE - REVENUE FROM THE ACTIVITY DURING THE YEAR THAT OFFSETS THE TOTAL COMMUNITY BENEFIT EXPENSE OF THAT ACTIVITY. IT INCLUDES ANY REVENUE GENERATED BY THE ACTIVITY OR PROGRAM, SUCH AS A PAYMENT OR REIMBURSEMENT FOR SERVICES PROVIDED TO PROGRAM PATIENTS. OFFSETTING REVENUE INCLUDES RESTRICTED GRANTS OR CONTRIBUTIONS USED TO PROVIDE A COMMUNITY BENEFIT BUT DOES NOT INCLUDE UNRESTRICTED GRANTS OR CONTRIBUTIONS THAT THE ORGANIZATION USES TO PROVIDE COMMUNITY BENEFIT. DIRECT COSTS - DIRECT COSTS INCLUDE SALARIES, EMPLOYEE BENEFITS, SUPPLIES, INTEREST ON FINANCING, TRAVEL AND OTHER COSTS THAT ARE DIRECTLY ATTRIBUTABLE TO THE SPECIFIC SERVICE AND THAT WOULD NOT EXIST IF THE SERVICE OR EFFORT DID NOT EXIST. INDIRECT COSTS - INDIRECT COSTS ARE COSTS NOT ATTRIBUTED TO PRODUCTS AND/OR SERVICES THAT ARE INCLUDED IN THE CALCULATION OF COSTS FOR COMMUNITY BENEFIT. THESE COULD INCLUDE, BUT ARE NOT LIMITED TO, SALARIES FOR HUMAN RESOURCES AND FINANCE DEPARTMENTS, INSURANCE AND OVERHEAD EXPENSE PART II, COMMUNITY BUILDING ACTIVITIES: AS A LARGE EMPLOYER AND PROVIDER OF HEALTH SERVICES IN THE NORTHWEST QUADRANT OF BALTIMORE CITY AND PARTS OF BALTIMORE COUNTY, LIFEBRIDGE HEALTH PROVIDES COMMUNITY BENEFITS THAT ENHANCE THE OVERALL QUALITY OF LIFE IN OUR SURROUNDING COMMUNITIES. THIS IS ACCOMPLISHED THROUGH COALITION BUILDING AND WORKFORCE DEVELOPMENT. TO LIST A FEW EXAMPLES: THE CHANGING HEARTS/HEALTHY HEARTS INITIATIVE HOLDS SCREENINGS FOR THE COMMUNITY TO IDENTIFY HEART HEALTHY LIFESTYLES, TO PROVIDE EDUCATION AND TO IDENTIFY INDIVIDUALS AT RISK FOR HEART DISEASE. THE CAREER COACH WORKS WITH FRONT-LINE EMPLOYEES TO PROVIDE SOCIAL, RETENTION AND CAREER DEVELOPMENT SERVICES. THIS POSITION PROMOTES THE HEALTH OF THE COMMUNITY BECAUSE MANY OF THE CLIENTS SERVED BY THE COACH LIVE IN THE SURROUNDING COMMUNITY. ONE SERVICE THAT THE COACH FOCUSES ON FOR MANY EMPLOYEES IS FINANCIAL HEALTH, PROVIDING THEM WITH RESOURCES AND TIPS TO ENSURE THEIR STABILITY. THE WORKFORCE DEVELOPMENT DEPARTMENT OFFERS EDUCATIONAL COURSES LIKE MEDICAL TERMINOLOGY THAT ARE OPEN TO THE COMMUNITY. PARTICIPATION IN THESE COURSES PROVIDES FOUNDATIONAL KNOWLEDGE NEEDED FOR MANY ENTRY LEVEL POSITIONS WITHIN OUR HEALTH SYSTEM AND WITH OTHER AREA EMPLOYERS.

SCHEDULE H, PART III, LINE 2:
BAD DEBT EXPENSE IS ESTIMATED BY USING HISTORICAL RATES FOR EACH PAYOR AND THE LENGTH OF TIME THE RECEIVABLE HAS BEEN OUTSTANDING. THESE RATES ARE REVISTED FROM TIME TO TIME AND ADJUSTED WHEN DEEMED APPROPRIATE. ANY ADDITIONAL RESERVES ARE DETERMINED BY THE HOSPITAL'S EXECUTIVES.

SCHEDULE H, PART III, LINE 3:
LEVINDALE HEBREW GERIATRIC CENTER & HOSPITAL, INC. DETERMINES ELIGIBILITY FOR FINANCIAL ASSISTANCE THROUGH VARIOUS OTHER MEANS SUCH AS ELIGIBLE FOR MEDICAID PROGRAMS, OUT-OF STATE MEDICAID PROGRAMS, MARYLAND MEDICAID ELIGIBLE AFTER ADMISSION, APPROVED FINANCIAL ASSISTANCE UNDER PRESUMPTIVE ELIGIBILITY RULE AND IF THE PATIENT WAS DENIED MEDICAID FOR NOT MEETING DISABILITY REQUIREMENTS. OF THE REMAINING BAD DEBT EXPENSE, IT IS ESTIMATED THAT $3,609,339 IN COST MAY BE ATTRIBUTABLE TO PATIENTS ELIGIBLE FOR FINANCIAL ASSISTANCE/CHARITY CARE. AS DESCRIBED ELSEWHERE, THE HOSPITAL ENGAGES IN MULTIPLE EFFORTS TO INFORM PATIENTS OF THE AVAILABILITY OF FINANCIAL ASSISTANCE AND CHARITY CARE. THIS $3,609,339 WAS BILLED TO PATIENTS ONLY BECAUSE THEY, DESPITE THE HOSPITAL'S EFFORTS, DID NOT REQUEST, OR DID NOT COOPERATE WITH THE HOSPITAL'S EFFORTS TO PROVIDE THEM WITH, THE AVAILABLE FINANCIAL ASSISTANCE.

SCHEDULE H, PART III, LINE 8:
TOTAL REVENUE RECEIVED FROM MEDICARE (DSH & IME) AND MEDICARE ALLOWABLE COSTS ARE DERIVED FROM THE ANNUAL MEDICARE COST REPORT. THE INPATIENT ROUTINE COSTS ARE DERIVED FROM THE STEP-DOWN METHODOLOGY BASED ON ACCEPTED STATISTICAL ALLOCATION WITH A UNIFORM PER DIEM COST FOR EACH PAYOR TYPE. THE ANCILLARY MEDICARE ALLOWABLE COSTS ARE INITIALLY DERIVED FROM THE STEP-DOWN METHODOLOGY BUT ARE ALLOCATED TO THE PAYOR TYPES BASED ON THE RATIO OF COST TO CHARGE FOR EACH PAYOR.

SCHEDULE H, PART VI, LINE 5:
LEVINDALE HEBREW GERIATRIC CENTER AND HOSPITAL PROVIDES MEALS TO People who are living in their own homes but ARE UNABLE TO PREPARE A MEAL FOR THEMSELVES DUE TO AGE AND MEDICAL CONDITIONS. LEVINDALE also PROVIDES MEALS TO ADULT DAY CARE AND ASSISTED LIVING FACILITIES IN THE NEIGHBORHOOD.

SCHEDULE H, PART VI, LINE 6:
LEVINDALE HEBREW GERIATRIC CENTER & HOSPITAL IS A COMPONENT OF LIFEBRIDGE HEALTH, A NONPROFIT HEALTH SYSTEM THAT PROVIDES A WIDE VARIETY OF HEALTH CARE AND RELATED SERVICES TO THE RESIDENTS OF CENTRAL MARYLAND. THE COMPONENTS OF THE LIFEBRIDGE SYSTEM WORK TOGETHER CLOSELY TO ENSURE THAT AS MANY AS POSSIBLE OF THE COMMUNITY'S NEEDS ARE MET IN AN INTEGRATED, NONDUPLICATIVE MANNER. SINAI HOSPITAL OF BALTIMORE AND NORTHWEST HOSPITAL ARE AFFILIATES AND DISCHARGED PATIENTS REQUIRING CHRONIC HOSPITAL AND SUB-ACUTE CARE ARE OFTEN ADMITTED TO LEVINDALE FOR FURTHER CARE.

SCHEDULE H, PART III, LINE 4:
ALL PATIENT ACCOUNTS ARE HANDLED CONSISTENTLY AND APPROPRIATELY TO MAXIMIZE CASH FLOW AND TO IDENTIFY BAD DEBT ACCOUNTS TIMELY. ACTIVE ACCOUNTS ARE CONSIDERED BAD DEBT ACCOUNTS WHEN THEY MEET SPECIFIC COLLECTION ACTIVITY GUIDELINES AND/OR ARE REVIEWED BY THE APPROPRIATE MANAGEMENT AND DEEMED TO BE UNCOLLECTIBLE. EVERY EFFORT IS MADE TO IDENTIFY AND PURSUE ALL ACCOUNT BALANCE LIQUIDATION OPTIONS, INCLUDING BUT NOT LIMITED TO THIRD PARTY PAYOR REIMBURSEMENT, PATIENT PAYMENT ARRANGEMENTS, MEDICAID ELIGIBILITY AND FINANCIAL ASSISTANCE. THIRD PARTY RECEIVABLE MANAGEMENT AGENCIES PROVIDE EXTENDED BUSINESS OFFICE SERVICES AND INSURANCE OUTSOURCE SERVICES TO ENSURE MAXIMUM EFFORT IS TAKEN TO RECOVER INSURANCE AND SELF-PAY DOLLARS BEFORE TRANSFER TO BAD DEBT. CONTRACTUAL ARRANGEMENTS WITH THIRD PARTY COLLECTION AGENCIES ARE USED TO ASSIST IN THE RECOVERY OF BAD DEBT DOLLARS AFTER ALL INTERNAL COLLECTION EFFORTS HAVE BEEN EXHAUSTED. IN SO DOING, THE COLLECTION AGENCIES MUST OPERATE CONSISTENTLY WITH LEVINDALE HEBREW GERIATRIC CENTER AND HOSPITAL'S GOAL OF MAXIMUM BAD DEBT RECOVERY AND STRICT ADHERENCE WITH FAIR DEBT COLLECTIONS PRACTICES ACT (FDCPA) RULES AND REGULATIONS, WHILE MAINTAINING POSITIVE PATIENT RELATIONS. SEE AUDITED FINANCIAL STATEMENTS PAGE 17.

SCHEDULE H, PART III, LINE 9B:
LEVINDALE HEBREW GERIATRIC CENTER AND HOSPITAL, INC. PROVIDES CARE WITHOUT CHARGE OR AT AMOUNTS LESS THAN ITS ESTABLISHED RATES, TO PATIENTS WHO MEET THE CRITERIA OF ITS CHARITY CARE POLICY. IT DOES NOT PURSUE THE COLLECTION OF AMOUNTS DETERMINED TO QUALIFY AS CHARITY CARE AND THOSE AMOUNTS ARE NOT REPORTED AS REVENUE. THE CRITERIA FOR CHARITY CARE CONSIDER GROSS INCOME AND FAMILY SIZE ACCORDING TO CURRENT FEDERAL POVERTY GUIDELINES. PATIENTS WITH AN ANNUAL INCOME UP TO 300% OF THE FEDERAL POVERTY LEVEL MAY HAVE 100% OF THEIR HOSPITAL BILLS COVERED BY FINANCIAL ASSISTANCE. TO QUALIFY, THE PATIENT MUST SHOW PROOF OF INCOME 300% OR LESS OF THE FEDERAL POVERTY GUIDELINES. PATIENTS WITH ANNUAL INCOME ABOVE 300% OF THE FEDERAL LIMIT MAY HAVE A PORTION OF THEIR MEDICAL BILLS COVERED BY FINANCIAL ASSISTANCE BASED ON A SLIDING SCALE. ELIGIBILITY IS CALCULATED BASED ON THE NUMBER OF PEOPLE LIVING IN THE HOUSEHOLD.

SCHEDULE H, PART VI, LINE 2:
THE ORGANIZATION ASSESSES THE HEALTH CARE NEEDS OF THE COMMUNITIES IT SERVES BY: A) ANALYZING PRIMARY AND SECONDARY HEALTH DATA AT THE HOSPITAL AND COMMUNITY LEVEL AND B) INVOLVING PUBLIC HEALTH EXPERTS, COMMUNITY MEMBERS AND KEY COMMUNITY GROUPS IN FURTHER IDENTIFYING PRIORITY CONCERNS AND NEEDS. LEVINDALE HEBREW GERIATRIC CENTER AND HOSPITAL, INC. IS INVOLVED WITH THE BALTIMORE CITY HEALTH DEPARTMENT'S ACCOUNTABLE HEALTH COMMUNITIES PROJECT, IDENTIFYING AREAS OF SIGNIFICANT SOCIAL NEED AND TARGETING EFFORTS AROUND THESE AREAS. WE ALSO WORK REGULARLY WITH A GROUP OF BALTIMORE CITY HOSPITALS LOOKING CONTINUALLY AT NEEDS OF OUR SURROUNDING COMMUNITIES AND ADDRESSING THOSE NEEDS. THROUGH OUR CARE COORDINATION PROGRAMS, WE USE ASSESSMENTS AND DATA ANALYTICS TO IDENTIFY NEEDS AND DEVELOP TARGETED POPULATION HEALTH PROGRAMS AS WELL AS INDIVIDUAL CARE GOALS. WE OFTEN USE INFORMATION GATHERED DURING OUR EDUCATIONAL PROGRAM EVALUATIONS (DONE BY SURVEY AND INFORMAL CONVERSATION) WHICH ASK IF THERE ARE (1) ANY CHANGES SUGGESTED TO THE PROGRAM; AND (2) ANY TOPICS PEOPLE WOULD LIKE TO SEE COVERED THAT WERE NOT COVERED IN THE PROGRAM. WE ALSO WORK IN CLOSE COLLABORATION WITH THE LOCAL HEALTH DEPARTMENTS (BALTIMORE CITY AND COUNTY) WITH REGARD TO THEIR HEALTH INITIATIVES AND STATISTICS, AND ALSO DIRECTLY WITH ORGANIZATIONS TO MEET THEIR REQUESTS FOR SUBJECT MATTER. WE ALSO WORK WITH INTERNAL SPECIALTIES within LifeBridge Health TO AID IN TARGETED HEALTH EDUCATION AS NEEDED.

SCHEDULE H, PART VI, LINE 3:
LEVINDALE USES THE FOLLOWING MEANS TO INFORM AND ASSIST PATIENTS REGARDING ELIGIBILITY FOR FINANCIAL ASSISTANCE UNDER GOVERNMENTAL PROGRAMS AND THE HOSPITAL'S CHARITY CARE PROGRAM. FINANCIAL ASSISTANCE NOTICES, INCLUDING CONTACT INFORMATION, ARE POSTED IN THE BUSINESS OFFICE AND ADMITTING, AS WELL AS POINTS OF ENTRY AND REGISTRATION THROUGHOUT THE HOSPITAL. PATIENT FINANCIAL SERVICES BROCHURE 'FREEDOM TO CARE' IS AVAILABLE TO ALL INPATIENTS. BROCHURES ARE ALSO AVAILABLE IN ALL OUTPATIENT REGISTRATION AND SERVICE AREAS. LEVINDALE EMPLOYS A FINANCIAL ASSISTANCE LIAISON WHO IS AVAILABLE TO ANSWER QUESTIONS AND TO ASSIST PATIENTS AND FAMILY MEMBERS WITH THE PROCESS OF APPLYING FOR FINANCIAL ASSISTANCE. A PATIENT INFORMATION SHEET IS GIVEN TO ALL INPATIENTS PRIOR TO DISCHARGE AND MAILED TO ALL INPATIENTS. LEVINDALE'S UNINSURED (SELF-PAY) AND UNDER-INSURED (MEDICARE BENEFICIARY WITH NO SECONDARY) MEDICAL ASSISTANCE ELIGIBILITY PROGRAM SCREENS, ASSISTS WITH THE APPLICATION PROCESS AND ULTIMATELY CONVERTS PATIENTS TO VARIOUS MEDICAL ASSISTANCE COVERAGE AND INCLUDES ELIGIBILITY SCREENING AND ASSISTANCE WITH COMPLETING THE FINANCIAL ASSISTANCE APPLICATION AS PART OF THAT PROCESS. ALL HOSPITAL STATEMENTS INCLUDE A MESSAGE REFERENCING THE AVAILABILITY OF FINANCIAL ASSISTANCE FOR THOSE WHO ARE EXPERIENCING FINANCIAL DIFFICULTY AND PROVIDES CONTACT INFORMATION TO DISCUSS LEVINDALE'S FINANCIAL ASSISTANCE PROGRAM. ALL HOSPITAL PATIENT FINANCIAL SERVICES STAFF AND MEDICAID ELIGIBILITY VENDORS ARE TRAINED TO IDENTIFY POTENTIAL FINANCIAL ASSISTANCE ELIGIBILITY AND ASSIST PATIENTS WITH THE FINANCIAL ASSISTANCE APPLICATION PROCESS. FINANCIAL ASSISTANCE APPLICATION AND INSTRUCTIONS COVER SHEET ARE AVAILABLE IN RUSSIAN AND SPANISH.

SCHEDULE H, PART VI, LINE 4:
LEVINDALE HEBREW GERIATRIC CENTER AND HOSPITAL IS LOCATED IN THE NORTHWEST QUADRANT OF BALTIMORE CITY. IT DRAWS MANY PATIENTS FROM THE NEIGHBORHOODS PROXIMATE TO THE FACILITY. CONSISTENT WITH ITS MISSION TO SERVE THE JEWISH COMMUNITY, LEVINDALE ALSO SERVES PATIENTS FROM THROUGHOUT THE BALTIMORE METROPOLITAN AREA. IN ADDITION, AS ONE OF A SMALL NUMBER OF CHRONIC HOSPITALS IN THE STATE, LEVINDALE DRAWS PATIENTS FROM ACROSS CENTRAL MARYLAND. THE NEIGHBORHOODS SURROUNDING LEVINDALE ARE IDENTIFIED BY THE BALTIMORE NEIGHBORHOOD INDICATORS ALLIANCE (BNIA) AS SOUTHERN PARK HEIGHTS (SPH) AND PIMLICO/ARLINGTON/HILLTOP (PAH). TOGETHER THEY CONSTITUTE AN AREA THAT IS PREDOMINANTLY AFRICAN AMERICAN WITH A BELOW AVERAGE MEDIAN FAMILY INCOME, BUT ABOVE AVERAGE RATES FOR UNEMPLOYMENT AND OTHER SOCIAL DETERMINANTS OF POOR HEALTH. SPH AND PAH'S MEDIAN HOUSEHOLD INCOME WAS $26,015 AND $32,410 RESPECTIVELY. THIS IS COMPARED TO BALTIMORE CITY'S MEDIAN HOUSEHOLD INCOME OF $41,819. THE PERCENTAGE OF FAMILIES WITH INCOMES BELOW THE FEDERAL POVERTY GUIDELINES IN SPH WAS 46.4% AND IN PAH, 28.4%. THE UNEMPLOYMENT RATE FOR BALTIMORE CITY WAS 13.1%. SPH AND PAH HAD UNEMPLOYMENT RATES OF 23.6% AND 17.1% RESPECTIVELY. THE NINE ZIP CODES THAT REPRESENT THE PRIMARY SERVICE AREA IN FISCAL YEAR 2017 WERE 21215, 21207, 21208, 21209, 21117, 21216, 21133, 21234 AND 21228. THE BALTIMORE CITY HEALTH DEPARTMENT USES COMMUNITY STATISTICAL AREAS (CSA) WHEN ANALYZING HEALTH OUTCOMES AND RISK FACTORS. THE DATA PROVIDED FOR THE PRIMARY RACIAL COMPOSITION, MEDIAN INCOME AND HOUSEHOLD BELOW POVERTY LEVEL WAS OBTAINED FROM THE BALTIMORE CITY HEALTH DEPARTMENT'S 2017 NEIGHBORHOOD HEALTH PROFILES. THE LIFE EXPECTANCY DATA WAS OBTAINED FROM THE BALTIMORE CITY HEALTH DEPARTMENT. THE RACIAL COMPOSITION AND INCOME DISTRIBUTION OF THESE ZIP CODES REFLECT THE SEGREGATION AND INCOME DISPARITY CHARACTERISTICS OF THE BALTIMORE METROPOLITAN REGION. AS INDICATED ABOVE, THOSE ZIP CODES THAT HAVE A PREDOMINANTLY AFRICAN AMERICAN POPULATION, INCLUDING 21215, IN WHICH THE HOSPITAL IS LOCATED, REFLECT THE RACIAL SEGREGATION AND POVERTY REPRESENTATIVE OF BALTIMORE CITY. THIS IS IN CONTRAST TO THE NEIGHBORING BALTIMORE COUNTY ZIP CODES (21208 & 21209) IN WHICH THE MEDIAN HOUSEHOLD INCOME WAS MUCH HIGHER, AND IN WHICH THE POPULATION IS PREDOMINANTLY WHITE.