Community Benefit Insight - Tax-exempt hospital

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Miami Jewish Health Systems Inc

Miami Jewish Health Systems Inc

5200 Ne 2nd Avenue
Miami, FL 33137

Bed count	32	Medicare provider number	100277	Member of the Council of Teaching Hospitals	NO	Children's hospital	NO

EIN: 590624414

Display data for year:

Community Benefit Spending- 2021
(as % of functional expenses, which all tax-exempt organizations report on Form 990 Schedule H)

3.59%

Spending by Community Benefit Category- 2021
(as % of total functional expenses)

* = CBI denoted preventative categories

Community Benefit Spending Compared to Functional Expenses, 2010-2021

Additional data

Community Benefit Expenditures: 2021

All tax-exempt organizations file a Form 990 with the IRS for every tax year. If the tax-exempt organization operates one or more hospital facilities during the tax year, the organization must attach a Schedule H to Form 990. On Part I of Schedule H, the organization records the expenditures it made during the tax year for various types of community benefits; 9 types are shown on this web tool. By default, this web tool presents community benefit expenditures as a percentage of the organization’s functional expenses, which it reports on Form 990, Part IX, Line 25, Column A. (The more commonly heard term, ‘total operating expenses’, which organizations report to CMS, is generally about 90% of the ‘functional expenses’). The user may change the default to see the dollar expenditures.
Amount spent in the following IRS community benefit categories:

Financial Assistance at cost as % of operating expenses	$ 0 0 %
Medicaid as % of operating expenses	$ 3,219,748 3.59 %
Costs of other means-tested government programs as % of operating expenses	$ 0 0 %
Health professions education as % of operating expenses	$ 0 0 %
Subsidized health services as % of operating expenses	$ 0 0 %
Research as % of operating expenses	$ 0 0 %
Community health improvement services and community benefit operations* as % of operating expenses Note: these two community benefit categories are reported together on the Schedule H, part I, line 7e.	$ 0 0 %
Cash and in-kind contributions for community benefit* as % of operating expenses	$ 0 0 %
Community building* as % of operating expenses	$ 0 0 %

* = CBI denoted preventative categories

Community building activities details:

Did tax-exempt hospital report community building activities?	Not available
Number of activities or programs (optional)	0
Physical improvements and housing	0
Economic development	0
Community support	0
Environmental improvements	0
Leadership development and training for community members	0
Coalition building	0
Community health improvement advocacy	0
Workforce development	0
Other	0
Persons served (optional)	0
Physical improvements and housing	0
Economic development	0
Community support	0
Environmental improvements	0
Leadership development and training for community members	0
Coalition building	0
Community health improvement advocacy	0
Workforce development	0
Other	0
Community building expense as % of operating expenses	$ 0 0 %
Physical improvements and housing as % of community building expenses	$ 0
Economic development as % of community building expenses	$ 0
Community support as % of community building expenses	$ 0
Environmental improvements as % of community building expenses	$ 0
Leadership development and training for community members as % of community building expenses	$ 0
Coalition building as % of community building expenses	$ 0
Community health improvement advocacy as % of community building expenses	$ 0
Workforce development as % of community building expenses	$ 0
Other as % of community building expenses	$ 0
Direct offsetting revenue	$ 0
Physical improvements and housing	$ 0
Economic development	$ 0
Community support	$ 0
Environmental improvements	$ 0
Leadership development and training for community members	$ 0
Coalition building	$ 0
Community health improvement advocacy	$ 0
Workforce development	$ 0
Other	$ 0

Other Useful Tax-exempt Hospital Information: 2021

In addition to community benefit and community building expenditures, the Schedule H worksheet includes sections on what percentage of bad debt can be attributable to patients eligible for financial assistance, and questions on the tax-exempt hospital's debt collection policy. When searching a specific tax-exempt hospital in this web tool, Section II provides information about bad debt and the financial assistance policy, and whether the state in which the tax-exempt hospital resides has expanded Medicaid coverage under the federal ACA.

Of the tax-exempt hospital’s overall operating expenses, amount reported as bad debt as % of operating expenses	$ 398,322 0.44 %
Is the tax-exempt hospital considered a "sole community hospital" under the Medicare program?	NO

Information about the tax-exempt hospital's Financial Assistance Policy and Debt Collection Policy
The Financial Assistance Policy section of Schedule H has changed over the years. The questions listed below reflect the questions on the 2009-2011 Schedule H forms and the answers tax-exempt hospitals provided for those years. The Financial Assistance Policy requirements were changed under the ACA. In the future, as the Community Benefit Insight web site is populated with 2021 data and subsequent years, the web tool will also be updated to reflect the new wording and requirements. In the meantime, if you have any questions about this section, we encourage you to contact your tax-exempt hospital directly.

Does the organization have a written financial assistance (charity care) policy?	YES
Did the tax-exempt hospital rely upon Federal Poverty Guidelines (FPG) to determine when to provide free or discounted care for patients?	YES
Amount of the tax-exempt hospital’s bad debt (at cost) attributed to patients eligible under the organization’s financial assistance (charity care) policy as % of operating expenses	$ 0 0 %

Did the tax-exempt hospital, or an authorized third party, take any of the following collection activities before determining whether the patient was eligible for financial assistance:
Under the ACA, states have the choice to expand Medicaid eligibility for their residents up to 138% of the federal poverty guidelines. The Medicaid expansion provision of the ACA did not go into effect until January 2014, so data in this web tool will not reflect each state's current Medicaid eligibility threshold. For up to date information, please visit the Terms and Glossary under the Resources tab.
The federal poverty guidelines (FPG) are set by the government and used to determine eligibility for many federal financial assistance programs. Tax-exempt hospitals often use FPG guidelines in their Financial Assistance policies to determine which patients will qualify for free or discounted care.
In addition to the federal requirements, some states have laws stipulating community benefit requirements as a result of tax-exemption. The laws vary from state to state and may require the tax-exempt hospitals to submit community benefit reports. Data on this web tool captures whether or not a state had a mandatory community benefit reporting law as of 2011. For more information, please see Community Benefit State Law Profiles Comparison at The Hilltop Institute.

Community Health Needs Assessment Activities: 2021

The ACA requires all 501(c)(3) tax-exempt hospitals to conduct a Community Health Needs Assessment (CHNA) every three years, starting with the hospital's tax year beginning after March 23, 2012. The 2011 Schedule H included an optional section of questions on the CHNA process. This web tool includes responses for those hospitals voluntary reporting this information. The web tool will be updated to reflect changes in these questions on the 2012 and subsequent Schedule H forms.

Did the tax-exempt hospital report that they had conducted a CHNA?	YES
Did the CHNA define the community served by the tax-exempt hospital?	YES
Did the CHNA consider input from individuals that represent the broad interests of the community served by the tax-exempt hospital?	YES
Did the tax-exempt hospital make the CHNA widely available (i.e. post online)?	YES
Did the tax-exempt hospital adopt an implementation strategy to address the community needs identified by the CHNA?	YES

Supplemental Information: 2021

This section presents qualitative information submitted by the hospital, verbatim from the 990H record.

Statement of Program Service Accomplishments
Description of the organization's program service accomplishments for each of its three largest program services, as measured by expenses. Section 501(c)(3) and 501(c)(4) organizations are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.

4A (Expenses $ 76205779 including grants of $ 0) (Revenue $ 71820072)
MIAMI JEWISH HEALTH SYSTEMS, INC. (MJHS) PROVIDES SKILLED NURSING, LONG-TERM CARE, RESIDENTIAL AND COMMUNITY-BASED SERVICES TO THE ELDERLY AND OTHERS WHO WOULD BENEFIT. SINCE ITS INCEPTION, THE ORGANIZATION HAS EXPANDED TO INCLUDE A NUMBER OF AFFILIATED ENTITIES, ORGANIZED TO PROVIDE AN ARRAY OF ADDITIONAL PROGRAMS, SUCH AS ASSISTIVE HOUSING, OUTPATIENT SERVICES, AND COMMUNITY-BASED PROGRAMS. THESE PROGRAMS OFFER ALTERNATIVES TO INSTITUTIONALIZATION, AS WELL AS RESEARCH, EDUCATION, AND TRAINING IN AREAS PRIMARILY FOCUSED ON CARE FOR THE ELDERLY. ACROSS ALL PROGRAMS, THERE WERE 109,515 PATIENT DAYS IN THE CURRENT YEAR.SEE SCHEDULE O FOR ADDITIONAL INFORMATION.HEALTHCARE - MIAMI JEWISH HEATH SYSTEMS, INC. IS A 494-BED FACILITY PROVIDING A FULL RANGE OF HEALTHCARE SERVICES TO THE ELDERLY. THESE INCLUDE ITS 462-BED NURSING HOME, WHICH PROVIDES LONG-TERM RESIDENTIAL CARE AND SKILLED NURSING CARE FOR OLDER ADULTS WITH CHRONIC ILLNESSES. THE FACILITY ALSO PROVIDES SHORT-TERM REHABILITATION SERVIES FOR MEDICARE BENEFICIARIES RECOVERING FROM SURGERY, STROKE, ETC. AND A 32-BED GERIATRIC MEDICAL SPECIALTY HOSPITAL, WHICH PROVIDES ACUTE CARE FOR THE ELDERLY. IN ADDITION, THE FACILITY'S AMBULATORY HEALTH CENTERS PROVIDE OUTPATIENT HEALTH SERVICES AND SUB-SPECIALTY SERVICES DELIVERED BY PHYSICIANS AND HEALTH PRACTITIONERS SPECIALIZING IN GERIATRIC HEALTHCARE, MENTAL HEALTH, PAIN MANAGEMENT, AND PSYCHIATRY.RESIDENTIAL CARE - MIAMI JEWISH HEALTH SYSTEMS, INC. PROVIDES TWO LEVELS OF ADULT LIVING FACILITIES THE FIRST IS A LICENSED 98-APARTMENT ADULT CONGREGATE LIVING FACILITY, WHICH PROVIDES MODERATE HOUSING DESIGNED FOR THE FRAIL, BUT INDEPENDENT ELDERLY. ITS TENANTS ARE OFFERED TRANSPORTATION AND CULTURAL/SOCIAL AMENITIES. THE OTHER FACILITY IS A LICENSED 92-APARTMENT ASSISTED LIVING FACILITY, WHICH PROVIDES PHYSICAL, MENTAL, AND SOCIAL ACTIVITIES, AS WELL AS DIRECT CARE ASSISTANCE AND NURSING SUPERVISION.CASE MANAGEMENT/DAY CARE - MIAMI JEWISH HEALTH SYSTEMS, INC. OPERATES A STATE SPONSORED PROGRAM IN WHICH CASE MANAGERS COORDINATE IN-HOME ASSISTANCE SUCH AS PERSONAL CARE, MEALS, ADULT DAY CARE, AND MEDICAL SUPPLIES. THE PROGRAM SERVES PEOPLE LIVING IN MIAMI-DADE OR BROWARD COUNTIES, AGE 60 OR OLDER, WHO ARE ELIGIBLE FOR CARE IN A NURSING HOME AS REQUIRED BY MEDICAID. MIAMI JEWISH HEALTH SYSTEMS OPERATES THE PROJECT ON BEHALF OF THE STATE OF FLORIDA'S AGENCY FOR HEALTHCARE ADMINISTRATION AND THE DEPARTMENT OF ELDER AFFAIRS.

Facility Information

Schedule H (Form 990) Section C. Supplemental Information for Part V, Section B.

DOUGLAS GARDENS HOSPITAL
"PART V, SECTION B, LINE 5: DOUGLAS GARDENS HOSPITAL (DGH OR THE HOSPITAL) PROVIDES SERVICES TO MORE THAN 10,000 INDIVIDUALS ANNUALLY FROM MIAMI-DADE AND BROWARD COUNTY. FOR PURPOSES OF ITS 2022 COMMUNITY HEALTH NEEDS ASSESSMENT, THE HOSPITAL DEFINED ITS COMMUNITY AS THE COUNTY IN WHICH THE HOSPITAL FACILITY IS LOCATED, AND THE COMMUNITY SERVED BY THE HOSPITAL, AS WELL AS THOSE INDIVIDUALS RESIDING WITHIN THE HOSPITAL'S SERVICE AREA. IN PARTNERSHIP WITH HOLLERAN, AN INDEPENDENT RESEARCH AND CONSULTING FIRM, DOUGLAS GARDENS HOSPITAL COLLECTED AND INTERPRETED DATA FROM SECONDARY DATA SOURCES AND KEY INFORMANT INTERVIEWS FOR THE PURPOSE OF PRIORITIZING ITS IDENTIFIED COMMUNITY HEALTH NEEDS.AS PART OF ITS EFFORTS TO ENSURE BROAD COMMUNITY-BASED INPUT INTO THE CHNA PROCESS, KEY INFORMANT ONLINE SURVEYS WERE COMPLETED BY A TOTAL OF 19 KEY INFORMANTS. KEY INFORMANTS WERE DEFINED AS COMMUNITY STAKEHOLDERS WITH EXPERT KNOWLEDGE OF THE NEEDS OF OLDER ADULTS, INCLUDING SOCIAL SERVICE PROVIDERS, LONG-TERM CARE/AGING SERVICE PROVIDERS, PUBLIC AND PRIVATE HEALTH AND HEALTHCARE ORGANIZATIONS AND ASSOCIATIONS, EDUCATIONAL INSTITUTIONS, NON-PROFIT ORGANIZATIONS, AND OTHER COMMUNITY LEADERS. THESE KEY INFORMANTS PARTICIPATED IN A SURVEY FOCUSED AROUND OLDER ADULTS AND INCLUDED QUESTIONS THAT FOCUSED AROUND PRESSING ISSUES AND SERVICES, THE AVAILABILITY OF SUPPORT AND HEALTHCARE SERVICES THE PERCEPTION OF MIAMI-DADE COUNTY AS ""AGE FRIENDLY"" AS IT RELATES TO HOUSING, EMPLOYMENT, TRANSPORTATION, EMERGENCY SUPPORT, WALKABILITY, AND SOCIAL ACTIVITIES AS WELL AS SUGGESTIONS TO IMPROVE THE LIVES OF OLDER ADULTS.THE SECONDARY DATA PROFILE USED EXISTING LOCAL-LEVEL DATA WITH STATE AND NATIONAL COMPARISONS OF DEMOGRAPHIC AND HEALTH DATA FOCUSING SPECIFICALLY ON THE OLDER ADULT POPULATION IN MIAMI-DADE COUNTY. THE DATA SOURCES DEPICTED POPULATION AND HOUSEHOLD STATISTICS, EDUCATION AND ECONOMIC MEASURES, MORBIDITY AND MORTALITY RATES, INCIDENCE RATES, AND OTHER HEALTH STATISTICS FOR OLDER ADULTS IN MIAMI-DADE COUNTY.TOGETHER, THE RESULTS OF THIS DATA FACILITATE THE HOSPITAL'S IMPLEMENTATION PLAN AND HELP ALIGN THE COMMUNITY HEALTH NEEDS ASSESSMENT WITH THE NEEDS THAT ARE EXPRESSED BY THE COMMUNITY."

DOUGLAS GARDENS HOSPITAL
PART V, SECTION B, LINE 11: THE INFORMATION PROVIDED BELOW EXPLAINS HOW THE HOSPITAL FACILITY ADDRESSED IN FISCAL YEAR 2022 THE SIGNIFICANT HEALTH NEEDS IDENTIFIED IN ITS 2019 AND 2022 COMMUNITY HEALTH NEEDS ASSESSMENT AND ANY SUCH NEEDS THAT WERE NOT ADDRESSED AND THE REASONS WHY SUCH NEEDS WERE NOT ADDRESSED. AS PART OF ITS 2022 COMMUNITY HEALTH NEEDS ASSESSMENT PROCESS, DOUGLAS GARDENS HOSPITAL (DGH OR THE HOSPITAL) DEVELOPED A STRATEGY TO ADDRESS THE IDENTIFIED COMMUNITY HEALTH PRIORITIES FROM THE COLLECTION OF DATA FROM SECONDARY DATA SOURCES AND KEY INFORMANT INTERVIEWS. BASED ON FEEDBACK FROM COMMUNITY PARTNERS, INCLUDING HEALTH CARE PROVIDERS, PUBLIC HEALTH EXPERTS, HEALTH AND OTHER COMMUNITY REPRESENTATIVES, THE HOSPITAL PLANS TO FOCUS COMMUNITY HEALTH IMPROVEMENT EFFORTS ON THE FOLLOWING FOUR (4) HEALTH ISSUES: - AFFORDABLE HEALTHCARE AND HOUSING PROGRAMS FOR THE ELDERLY- NAVIGATION OF THE HEALTHCARE SYSTEM- CHRONIC DISEASE MANAGEMENT- ALZHEIMER'S DISEASE AND DEMENTIA OBJECTIVES AND OUTCOMES RELATED TO THE FOUR (4) PRIORITIZED NEEDS ARE SUMMARIZED BELOW. AFFORDABLE HEALTHCARE AND HOUSING PROGRAMS FOR THE ELDERLYIN ORDER TO INCREASE HOUSING AFFORDABILITY AND ASSOCIATED SUPPORTIVE HEALTHCARE SERVICES TO SENIORS IN THE GREATER MIAMI JEWISH HEALTH SYSTEM'S SERVICE AREA, DOUGLAS GARDENS HOSPITAL WILL USE ITS CASE MANAGEMENT AND SOCIAL WORK RESOURCES IN CONJUNCTION WITH PACE, OUTSIDE HOME CARE AND CASE MANAGEMENT SERVICES, HUD/LOW INCOME HOUSING, EXISTING NETWORK OF OVER 350 ALFS, AND BEHAVIORAL HEALTH PROGRAMS. THESE RESOURCES WILL ALLOW FOR THE MAINTENANCE AND/OR INCREASE IN THE NUMBER OF HOSPITAL AND NURSING HOME PATIENTS DISCHARGED TO AFFORDABLE HEALTHCARE AND HOUSING PROGRAMS AND, WHERE APPLICABLE, BEHAVIORAL HEALTH. NAVIGATION OF THE HEALTHCARE SYSTEMTO IMPROVE NAVIGATION AND ACCESS TO QUALITY HEALTH CARE AS IT RELATES TO AGING FOR INDIVIDUALS LIVING THE COMMUNITY, DOUGLAS GARDENS HOSPITAL WILL USE ITS CASE MANAGEMENT AND SOCIAL WORK RESOURCES IN CONJUNCTION WITH PACE, OUTSIDE HOME CARE AND CASE MANAGEMENT SERVICES, HUD/LOW INCOME HOUSING, EXISTING NETWORK OF OVER 350 ALFS, AND BEHAVIORAL HEALTH PROGRAMS. THESE RESOURCES WILL ASSIST IN MAINTAINING AND/OR INCREASING RESIDENTS' AWARENESS OF AGING HEALTH CARE OPTIONS, INCLUDING BEHAVIORAL HEALTH OPTIONS, AND HELP INDIVIDUALS NAVIGATE THE HEALTHCARE SYSTEM AS IT RELATES TO AGING THROUGH DISCHARGE PLANNING REFERRALS TO APPROPRIATE PROGRAMS. CHRONIC DISEASE MANAGEMENTTO ENHANCE CHRONIC DISEASE MANAGEMENT AND PREVALENCE OF CANCER AND RESPIRATORY DISEASE AMONG HOSPITAL AND NURSING HOME RESIDENTS, DOUGLAS GARDENS HOSPITAL WILL OFFER EDUCATION AND COMMUNITY OUTREACH THROUGH OUTREACH EVENTS AND PARTNERSHIPS IN THE COMMUNITY. THE HOSPITAL'S RESOURCES INCLUDE HOSPITAL AND NURSING HOME SERVICES THAT FOCUS ON CHRONIC DISEASE MANAGEMENT AND A GERIATRIC FELLOW OVERSEEING MANY OF THE CHRONIC CARE PATIENTS. IN ADDITION, DOUGLAS GARDENS HOSPITAL PLANS TO OPEN A SUPER SKILLED NURSING FACILITY THAT WILL FOCUS HIGHLY ON CANCER AND RESPIRATORY DISEASE. ALZHEIMER'S DISEASE AND DEMENTIATO IMPROVE OUTREACH AND AWARENESS OF RESEARCH AND EDUCATION PROGRAMS RELATED TO ALZHEIMER'S DISEASE AND DEMENTIA, DOUGLAS GARDENS HOSPITAL WILL INCREASE EDUCATION AND AWARENESS THROUGH HOSPITAL AND NURSING HOME SERVICES THAT FOCUS ON THESE ISSUES. IT WILL PROVIDE EDUCATIONAL PRESENTATIONS AND SPEAKING ENGAGEMENT EVENTS AND CONDUCT CLINICAL RESEARCH TRIALS RELATED TO ALZHEIMER'S DISEASE AND DEMENTIA. THE HOSPITAL'S RESOURCES FOR SUCH INCLUDE SUPPORT NETWORKS AND CAREGIVER GROUPS AS WELL AS A BOARD-CERTIFIED ADULT AND GERIATRIC PSYCHIATRIST WHO IS INVOLVED IN PLANNING AND OVERSEEING MANY OF THE ALZHEIMER'S AND DEMENTIA PATIENTS' CARE.DOUGLAS GARDENS HOSPITAL RECOGNIZES THAT THERE ARE SEVERAL KEY ISSUES AND SEVERE CHRONIC CONDITIONS FACING THE COMMUNITY, INCLUDING, BUT NOT LIMITED TO DIABETES, ARTHRITIS, AND HEART CONDITIONS. THE FOLLOWING COMMUNITY HEALTH ISSUES WERE IDENTIFIED, BUT THE HOSPITAL DID NOT CHOOSE THEM AS A PRIORITY DUE TO LIMITED RESOURCES AND WILL CONTINUE TO MONITOR THE TREATMENT AND ADJUST ITS PROGRAMMING AND SERVICES ACCORDINGLY:- ACCESS TO CARE- AGE-FRIENDLY COMMUNITY- AGING IN PLACE- HOME CARE SUPPORT SERVICES

PART V, LINE 16A, FAP WEBSITE:
WWW.MIAMIJEWISHHEALTH.ORG/RESOURCES/PART V, LINE 16B, FAP APPLICATION WEBSITE:WWW.MIAMIJEWISHHEALTH.ORG/RESOURCES/PART V, LINE 16C, FAP PLAIN LANGUAGE SUMMARY WEBSITE:WWW.MIAMIJEWISHHEALTH.ORG/RESOURCES/

Supplemental Information

Schedule H (Form 990) Part VI

PART I, LINE 7:
AMOUNTS REPORTED IN THE TABLE IN LINE 7 OF PART I OF SCHEDULE H WERE DETERMINED BY UTILIZING A COST-TO-CHARGE RATIO DERIVED FROM WORKSHEET 2, RATIO OF PATIENT CARE COST-TO-CHARGES, CONTAINED IN THE SCHEDULE H INSTRUCTIONS.

PART III, LINE 2:
THE ORGANIZATION RECOGNIZES REVENUE AS PERFORMANCE OBLIGATIONS ARE SATISFIED. MJHS DETERMINES THE TRANSACTION PRICE BASED ON STANDARD CHARGES FOR GOODS AND SERVICES PROVIDED, REDUCED BY CONTRACTUAL ADJUSTMENTS PROVIDED TO THIRD-PARTY PAYORS, DISCOUNTS PROVIDED TO UNINSURED PATIENTS IN ACCORDANCE WITH MJHS'S POLICY, OR IMPLICIT PRICE CONCESSIONS PROVIDED TO UNINSURED PATIENTS. MJHS DETERMINES ITS ESTIMATES OF CONTRACTUAL ADJUSTMENTS AND DISCOUNTS BASED ON CONTRACTUAL AGREEMENTS, ITS DISCOUNT POLICIES, AND HISTORICAL EXPERIENCE. MJHS DETERMINES ITS ESTIMATE OF IMPLICIT PRICE CONCESSIONS BASED ON ITS HISTORICAL COLLECTION EXPERIENCE WITH THIS CLASS OF PATIENTS. AGREEMENTS WITH THIRD-PARTY PAYORS PROVIDE FOR PAYMENTS AT AMOUNTS LESS THAN ESTABLISHED CHARGES. SUBSEQUENT MATERIAL EVENTS THAT ALTER THE PAYOR'S ABILITY TO PAY ARE RECORDED AS BAD DEBT EXPENSE.

PART III, LINE 3:
THE BAD DEBT EXPENSE IS REPORTED AT TOTAL BAD DEBT EXPENSE PER THE ORGANIZATION'S AUDITED FINANCIAL STATEMENTS. DISCOUNTS AND PAYMENTS ON PATIENT ACCOUNTS ARE NOT INCLUDED IN BAD DEBT EXPENSE.

PART III, LINE 4:
IN THE CURRENT YEAR, THE APPLICABLE FOOTNOTE FROM THE ATTACHED CONSOLIDATED AUDITED FINANCIAL STATEMENTS THAT ADDRESSES BAD DEBT EXPENSE CAN BE FOUND ON PAGE 15.

PART III, LINE 8:
THE ORGANIZATION USED THE MEDICARE COST REPORT TO DETERMINE THE TOTAL REVENUE RECEIVED FROM MEDICARE AND ALLOWABLES COSTS.MIAMI JEWISH HEALTH SYSTEMS (MJHS) ACCEPTS ALL MEDICARE PATIENTS WITH THE KNOWLEDGE THAT THERE MAY BE SHORTFALLS AND OPERATES TO PROMOTE THE HEALTH OF THE COMMUNITY. MJHS BELIEVES THAT THE MEDICARE SHORTFALL SHOULD BE TREATED AS A COMMUNITY BENEFIT BECAUSE MEDICARE DOES NOT FULLY COMPENSATE HOSPITALS FOR THE COST OF PROVIDING HOSPITAL CARE TO MEDICARE BENEFICIARIES.

PART III, LINE 9B:
ACCOUNTS RECEIVABLE MAY, FOR A VARIETY OF REASONS, NOT BE PAID ON A TIMELY BASIS. IT IS THE POLICY OF MIAMI JEWISH HEALTH SYSTEMS, INC. NOT TO ENGAGE IN EXTRAORDINARY COLLECTION ACTIONS (ECAS) UNTIL ALL REASONABLE EFFORTS ARE MADE TO DETERMINE WHETHER THE INDIVIDUAL IS ELIGIBLE FOR FINANCIAL ASSISTANCE. IF A PERSON IS KNOWN TO QUALIFY FOR FINANCIAL ASSISTANCE, THE ORGANIZATION IMMEDIATELY STOPS ALL COLLECTION EFFORTS. ADDITIONALLY, CERTAIN PROCEDURES MUST BE FOLLOWED IN COLLECTION EFFORTS TO ENSURE THAT ALL PATIENTS ARE TREATED IN A PROFESSIONAL MANNER AND THE SAME PROCESS IS BEING FOLLOWED FOR ALL PAYORS.

PART VI, LINE 2:
IN ADDITION TO THE COMMUNITY NEEDS HEALTH ASSESSMENT DISCUSSED IN PART V OF SCHEDULE H, MIAMI JEWISH HEALTH SYSTEMS EMPLOYS MULTIPLE PATHS TO IDENTIFY THE HEALTH CARE NEEDS OF THE COMMUNITIES IT SERVES:1. FREQUENT, OPEN, DIRECT COMMUNICATION WITH OUR REFERRAL PARTNERS, PARTICULARLY WITH THE HOSPITALS WHO PROVIDE OUR CORE REFERRAL BASE.2. PARTICIPATION IN COMMUNITY-WIDE HEALTH CARE ORGANIZATIONS SUCH AS THE LEADING AGE, ALLIANCE FOR AGING, SOUTH FLORIDA HOSPITAL & HEALTHCARE ASSOCIATION, THE CHAMBER OF COMMERCE, AND ALZHEIMER'S ASSOCIATION TO IDENTIFY BROAD COMMUNITY HEALTH NEEDS.3. ANALYSIS OF ADMISSIONS AND DISCHARGES TO MIAMI JEWISH HEALTH SYSTEMS PROGRAMS. IDENTIFY TRENDS IN THE DIAGNOSES, LENGTH OF STAY, AND OUTCOME PERFORMANCE. FOR EXAMPLE, ONE SUCH ANALYSIS LED TO THE DEVELOPMENT OF A SPECIALIZED WOUND CARE PROGRAM. TODAY, MIAMI JEWISH HEALTH SYSTEMS CURES MORE WOUNDS THAN ANY OTHER NURSING HOME IN MIAMI-DADE COUNTY.4. ANALYSIS OF FALLS STATISTICS TO IDENTIFY TRENDS IN THE INCIDENCE AND CONTRIBUTING FACTORS. SUCH ANALYSIS LED TO THE DEVELOPMENT OF A SPECIALIZED FALL-PREVENTION PROGRAM. TODAY, MIAMI JEWISH HEALTH SYSTEMS HAS A FALL INCIDENT RATE BETTER THAN LOCAL AND NATIONAL AVERAGES.5. MIAMI JEWISH HEALTH SYSTEMS CONDUCTS, THROUGH INDEPENDENT THIRD PARTIES, CUSTOMER SATISFACTION TRACKING. THESE SURVEYS ARE CONDUCTED SEVERAL TIMES PER YEAR. RESULTS FROM THE CUSTOMER SATISFACTION TRACKING ARE SHARED THROUGHOUT THE ORGANIZATION FROM THE FRONT LINE OPERATORS TO THE BOARD OF DIRECTORS. RESULTS FROM THE CUSTOMER SATISFACTION PROGRAM HAVE CHANGED ELEMENTS OF THE SERVICE PROTOCOL IN A NUMBER OF PROGRAMS THAT WE OFFER TO IMPROVE SERVICE DELIVERY.6. IN CONJUNCTION WITH NATIONAL AND INTERNATIONAL PHARMACEUTICAL COMPANIES AND RESEARCH FACILITIES, MIAMI JEWISH HEALTH SYSTEMS PARTICIPATES IN MULTIPLE CLINICAL TRIALS TO TEST THE EFFICACY OF NEW DRUGS FOR THE TREATMENT OF ALZHEIMER'S, DEMENTIA, AND OTHER AILMENTS.

PART VI, LINE 3:
MIAMI JEWISH HEALTH SYSTEMS, INC. COMPLIES WITH SECTION 501(R) OF THE INTERNAL REVENUE CODE WHICH REQUIRES HOSPITAL ORGANIZATIONS TO ESTABLISH A WRITTEN FINANCIAL ASSISTANCE POLICY (FAP). UPON ADMISSION, ALL PATIENTS RECEIVE A FINANCIAL SCREENING AND ARE NOTIFIED OF PROGRAMS UNDER WHICH THEY MAY QUALIFY FOR FINANCIAL ASSISTANCE. IN ADDITION, FINANCIAL ASSISTANCE OPTIONS ARE PUBLICIZED WITHIN THE HOSPITAL AND ON THE ORGANIZATION'S WEBSITE. THE FINANCIAL ASSISTANCE POLICY IS AVAILABLE UPON REQUEST AND THE PLAIN LANGUAGE SUMMARY IS MADE AVAILABLE ONLINE AND IN-PERSON AND IS DISTRIBUTED TO ALL PATIENTS OF THE HOSPITAL.

PART VI, LINE 5:
MIAMI JEWISH HEALTH SYSTEMS, INC. IS DEDICATED TO PROMOTING THE HEALTH AND WELFARE OF THE SOUTH FLORIDA COMMUNITY OF WHICH THEY HAVE BEEN A PART OF FOR MORE THAN 75 YEARS. SOME OF THE WAYS IN WHICH THE HEALTH OF THE COMMUNITY IS PROMOTED IS AS FOLLOWS:- COMMUNITY BOARDS: MJHS HAS AN INDEPENDENT COMMUNITY BOARD STAFFED BY HEALTH CARE PROFESSIONALS AND COMMUNITY ACTIVISTS AND MEMBERS.- MEDICAL STAFF: QUALIFIED PHYSICIANS AND PRACTITIONERS FROM ACROSS THE COMMUNITY CAN BE CREDENTIALED TO PRACTICE AT MIAMI JEWISH HEALTH SYSTEMS.- EMPLOYEE WELLNESS, HEALTH, AND SAFETY: MJHS IS THE LARGEST EMPLOYER IN THE HAITIAN COMMUNITY.

PART VI, LINE 6:
MIAMI JEWISH HEALTH SYSTEMS, INC. HAS MANY AFFILIATED ENTITIES THAT PROVIDE AN ARRAY OF PROGRAMS SUCH AS ASSISTED LIVING, OUTPATIENT PROGRAMS, AND COMMUNITY-BASED PROGRAMS. THE ORGANIZATION AND ITS AFFILIATES INCLUDE: A 462-BED SKILLED NURSING FACILITY, A MEDICARE CERTIFIED HOSPITAL UNIT WITH 32 ACUTE CARE BEDS, SEVERAL INDEPENDENT AND ASSISTED LIVING FACILITIES, AN AMBULATORY HEALTH CENTER, A REHABILITATION CENTER, A PROGRAM FOR THE ALL-INCLUSIVE CARE OF THE ELDERLY (PACE), AND IN ADDITION, THE ORGANIZATION OPERATES A NURSE REGISTRY PROGRAM, A PROGRAM TO PROVIDE MANAGEMENT SERVICES TO SENIOR HOUSING PROVIDERS, AND TWO FOUNDATIONS.

PART VI, LINE 4:
THE PRIMARY SERVICE AREA OF THE HOSPITAL FACILITY INCLUDES MIAMI-DADE COUNTY, FLORIDA. IN 2017, MIAMI-DADE COUNTY HAD A POPULATION OF 2,751,796, RENDERING IT THE MOST POPULATED COUNTY IN FLORIDA. THE COUNTY EXPERIENCED A POPULATION GROWTH OF 8.3% BETWEEN 2010 AND 2017. THE OVERALL POPULATION OF BOTH MIAMI-DADE COUNTY AND FLORIDA HAS GROWN FASTER BETWEEN 2000 AND 2017 (8.3% AND 7.9%) THAN THE OVERALL POPULATION IN THE ENTIRE NATION (4.0%). IN ADDITION, THE POPULATION IN MIAMI-DADE COUNTY IS NOTABLY OLDER WHEN COMPARED TO THE STATE AND THE NATION. ACCORDING TO THE U.S. CENSUS BUREAU, THE MEDIAN AGE OF RESIDENTS AGED 65 YEARS AND OVER IN MIAMI-DADE COUNTY WAS 74.2; WHEREAS STATE RESIDENTS HAD A MEDIAN AGE OF 73.8 AND 73.2 ACROSS THE NATION. THE OLDER POPULATION TENDS TO HAVE A HIGHER SHARE OF FEMALES IN THE POPULATION IN MIAMI-DADE COUNTY (58.3%) WHEN COMPARED TO FLORIDA (55.0%) AND THE NATION (55.9%). IN ADDITION, THE OLDER ADULT POPULATION AGED 65 YEARS AND OVER ARE PREDOMINANTLY WHITE (81.7%), NEARLY TWO-THIRDS OF THE OVERALL POPULATION IN MIAMI-DADE COUNTY. (69.5%) IS HISPANIC OR LATINO. THIS PERCENTAGE IS MUCH HIGHER THAN BOTH FLORIDA (14.6%) AND THE NATION (7.9%). THE RACIAL BREAKDOWN DOES PROVIDE A FOUNDATION FOR PRIMARY LANGUAGE STATISTICS. ALMOST THREE QUARTERS OF MIAMI-DADE COUNTY RESIDENTS AGED 65 YEARS AND OVER (74.5%) SPEAK A LANGUAGE OTHER THAN ENGLISH AS THEIR PRIMARY LANGUAGE AT HOME COMPARED TO 20.5% IN FLORIDA AND ALMOST 15% IN THE UNITED STATES. OF THOSE WHO SPEAK A LANGUAGE OTHER THAN ENGLISH AT HOME IN MIAMI-DADE COUNTY, 58.3% SPEAK ENGLISH LESS THAN VERY WELL, WHICH IS SIGNIFICANTLY HIGHER THAN THE STATE AND THE NATION. AS MIAMI-DADE COUNTY CONTINUES TO GROW IN DIVERSITY, IT WILL BE INCREASING IMPORTANT TO ADDRESS THE LANGUAGE NEEDS AND HEALTH BARRIER THAT EXISTS FOR INDIVIDUALS WITH LIMITED ENGLISH PROFICIENCY AND FOR WHOM ENGLISH IS NOT THEIR PRIMARY LANGUAGE. LASTLY, IN MIAMI-DADE COUNTY, ABOUT 41% OF OLDER ADULTS LIVE IN A SINGLE-PERSON HOUSEHOLD, WHICH IS EQUIVALENT TO NEARLY 83,525 OLDER ADULTS. LIVING ALONE GENERALLY ENTAILS A HIGHER RISK FOR SOCIAL ISOLATION AND THIS FIGURE MAY WARRANT ATTENTION.

Operating expenses	$ 89,706,238
Total amount spent on community benefits as % of operating expenses	$ 3,219,748 3.59 %