2025-08-14T11:00:18-07:00 2024-09-30 990 2023-10-01 050258905 The Miriam Hospital MIRI 4017932500 164 Summit Avenue Providence RI 02906 Peter K Markell Treasurer 2025-08-14 true 2023 2025-03-06 01:10:19Z Maria P Ducharme 164 Summit Avenue Providence RI 02906 865784121 false X www.miriamhospital.org X 1926 RI As a founding hospital in the Brown University Health system, The Miriam Hospital (TMH) is committed to its mission: Delivering health with care. 18 14 4275 278 2095097 58114 6135730 7087083 602916860 695247024 10600311 28765082 26714782 24723455 646367683 755822644 361030 204430 0 296828199 311463090 0 0 327941499 411022850 625130728 722690370 21236955 33132274 617235590 800046092 170667249 297813505 446568341 502232587 X As a founding hospital in the Brown University Health system, TMH is committed to its mission: Delivering health with care. false false 547976662 339430 659084684 Patient Care:TMH offers expertise in cardiology, oncology, orthopedics, men's health, and minimally invasive surgery, and is home to the State's first Joint Commission- certified Stroke Center and robotic surgery program. Services and programs provided by TMH also include anesthesiology; general medicine; general surgery; psychiatry; emergency medicine; cardiovascular care; orthopedics; dermatology; nuclear cardiology; radiology; laboratory; renal dialysis; urology; gastroenterology; endocrinology; gynecology; nephrology; neurology; and ophthalmology. (Continued on Schedule O). 54626625 51744625 Research:TMH has 428 research projects with total expenses of $51.7 million in fiscal year 2024 (106 investigators and 170 employees). TMH conducts extensive medical research and is in the forefront of biomedical health care delivery research and among the leaders nationally in National Institutes of Health programs. TMH also sponsors a significant level of these research activities. Federal support accounts for approximately ???% of all externally funded research at TMH. Researchers focus on clinical trials which investigate prevention and treatment of HIV/AIDS, obesity, cancer, diabetes, cardiac disease, and mental health concerns. Included in total program expenses and revenue are $???K of research grants from for-profit organizations that are not reported in Schedule H.(See Schedule O). 30575525 6108871 Medical Education:TMH provides the setting for and substantially supports medical education in various clinical training and nursing programs. TMH is designated as a major teaching affiliate of The Warren Alpert Medical School of Brown University. The total cost of direct medical education provided by TMH exceeded the reimbursement received from third-party payors by $24.5 million in fiscal year 2024. (Continued on Schedule O). 633178812 true true false true false false false false false true true true false true true true false true false true true false false false false false true true true false true true true false false false false false false false false false false false false false false true true true false false true 187 0 true 4275 true true true false false false false false false 0 false false false false false false false X 18 14 true false false false true true true true true false false true true true true true true true true false RI X Peter K Markell 4014447093 167 Point Street Providence RI 02903 X Timothy J Babineau Fmr. Trustee 0.00 0.00 0 2343283 1336393 John Fernandez Trustee 7.00 43.00 X 0 2148746 307376 Ziya L Gokaslan MD Trustee 0.50 42.50 X 0 1656599 52686 Peter K Markell EVP & CFO 5.00 55.00 X 0 1193642 18928 Paul J Adler Secretary 5.00 35.00 X 0 926856 151085 Maria P Ducharme President 40.00 0.00 X 0 690465 129757 Eva Greenwood Treasurer 0.50 39.50 X 0 649185 87891 G Alan Kurose Fmr. Trustee 0.00 0.00 0 593347 11416 Mark A Deitch MD Chief Medical Officer 40.00 0.00 512703 0 83106 Janine Lairmore VP-CVI 40.00 0.00 359576 0 73925 Vanzetta V James DNP Chief Nursing Officer 40.00 0.00 406215 0 12240 Laura R Stroud Dir. Ctr Behavior 40.00 0.00 360592 0 49913 Rena R Wing Sr. Research 40.00 0.00 348240 0 42404 Jill Underwood Reg. Nurse 40.00 0.00 247855 0 21753 Erin P Avanzo Reg. Nurse 40.00 0.00 223595 0 488 Arthur J Sampson Fmr. Trustee 0.00 0.00 0 87962 0 Lawrence A Aubin Sr Chair 0.50 7.50 X X 0 0 0 Emanuel Barrows Trustee 1.50 5.50 X 0 0 0 Roger N Begin Trustee 2.00 10.50 X 0 0 0 Peter Capodilupo Vice Chair 0.00 5.00 X X 0 0 0 Chris Cocks Trustee 0.00 1.00 X 0 0 0 Sarah T Dowling JD LLM Trustee 0.00 13.00 X 0 0 0 Edward D Feldstein Esq Trustee 0.50 1.60 X 0 0 0 Michael L Hanna Trustee 0.50 1.70 X 0 0 0 Phillip Kydd Trustee 1.00 6.50 X 0 0 0 Alan H Litwin Vice Chair 2.00 7.50 X X 0 0 0 Martha B Mainiero MD Trustee 0.25 2.10 X 0 0 0 Paula McNamara Trustee 0.00 2.00 X 0 0 0 Steven Pare Trustee-12/23 0.00 3.00 X 0 0 0 Janet Robinson Trustee 0.00 0.00 X 0 0 0 Lawrence B Sadwin Trustee 1.00 16.00 X 0 0 0 Shivan Subramaniam Trustee 0.25 5.25 X 0 0 0 Angel Taveras Trustee 0.00 3.00 X 0 0 0 Jane Williams PhD RN Trustee-12/23 5.00 27.00 X 0 0 0 2458776 10290085 2379361 510 true true false Brown Medicine 110 Elm Street Providence RI 02903 Medical Services 11429550 AMN Healthcare Inc 2999 Olympus Blvd Dallas TX 75019 Contracted Labor 5981427 Brown Surgical Assoc Inc 2 Dudley St Ste 470 Providence RI 02905 Medical Services 3874194 ARUP Laboratories 500 Chipeta Way Salt Lake City UT 84108 Laboratory Services 3303232 Brown Emergency Medicine 125 Whipple St Providence RI 02908 Medical Services 3235060 43 3654407 3418817 13859 7087083 Direct Rev from Research 900099 51744625 51744625 Patient Service Rev 900099 642066398 642066398 Special Purpose Funds 900099 1436001 1436001 695247024 9181063 9181063 0 0 2536650 1599448 937202 937202 937202 127946048 108362029 19584019 19584019 19584019 0 0 0 Indirect Rev from Grants 900099 5592945 5592945 Joint Program Revenue 900099 15648729 15648729 Lab Revenue 900099 2079888 2079888 464691 449482 15209 23786253 755822644 716938180 2095097 29702284 204430 204430 0 0 0 1118708 1118708 0 242257826 240295913 1961913 13946923 13903536 43387 37511917 37127071 384846 16627716 16427067 200649 0 0 0 0 0 862648 862648 33768968 33682803 86165 60676 60676 57178545 57031798 146747 0 0 13819558 13819558 822426 821542 884 0 1237510 1215490 22020 2726318 2726318 0 19974710 19974710 6531614 6531614 Medical & Surgical Supplies 81833455 81833455 Purch Svs & Equip Contracts 77768042 17180013 60588029 License Fee 76744635 76744635 Provision for Bad Debts 23189813 23189813 14503932 13109398 1394534 722690370 633178812 89511558 0 172099 295010 3961055 18172422 1456443 1992823 51356728 53193910 0 0 0 6812558 7482268 43790306 47435807 384685995 219326997 163260201 165358998 167605370 176882471 83182996 78727927 22041067 0 95637834 228463389 617235590 800046092 45033372 63103901 14898 17465 34488406 42488297 49250000 157850000 41880573 34353842 170667249 297813505 X 366269336 405172822 80299005 97059765 446568341 502232587 617235590 800046092 X 33132274 19719153 2812819 X X false true X true true true X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false true false false false false false Part II-B, Line 1i - Other Activities Description TMH pays membership fees to the Association of American Medical Colleges and the Greater New York Hospital Association. A portion of the membership dues paid to these organizations is allocated to their lobbying efforts. Part IV - Additional Information 267125223 177110435 44708426 78754774 410189310 268275493 62653282 22867528 86671080 267125223 295359050 66302197 -34132762 59252992 268275493 218566531 94109929 45013085 62330495 295359050 176284901 56090522 16290611 30099503 218566531 0.86840 0.13160 false true true 3683785 3683785 244599690 152462971 92136719 122101686 66864026 55237660 14300834 14300834 165358998 78727927 Investment in Brown Investment Pool 22041067 F Deferred financing costs 1326605 Interest in net assets of TMH Foundation 77282938 Other assets 6365 Right of use leased assets 17309636 228463389 Accrued pension liability 4962200 Due to affiliates 1495428 Health Care Benefit Self-insurance 3437328 Non-curr arbitrage liab Series 2024 Bond 856255 Non-current operating lease. 17191653 Other Liabilities 2311110 Post-retirement benefit liability 86800 Third-party payor settlements 4013068 34353842 X 753525535 19719153 2812819 22531972 730993563 862648 23966433 24829081 755822644 697718283 1456442 1456442 696261841 862648 25565881 26428529 722690370 Part V, Line 4: Intended uses of the endowment fund. The Miriam Hospital's (TMH) unrestricted endowment consists of designated assets set aside by TMH's Board for future capital improvements, over which the Board retains control and may at its discretion subsequently use for other purposes. The largest temporarily restricted funds held by TMH are used to support: (1) recruitment for the Director of the Weight Control & Diabetes Center; (2) clinical care, research, and education to develop treatment for pelvic floor disorders; (3) general hospital programs; (4) support of Cardiology labs and programs; (5) the Surgery Department's educational and investigational functions; (6) operational support to the Womens Cardiac Program and physical space; (7) expand the Mobile Integrated Healthcare (MIH) program at TMH; (8) student loan repayment and tuition assistance in Nursing; (9) the Department of Psychiatry's operations, education, research, and capital needs; (10) general support to community populations in need; (11) neuroscience research; (12) Medical Staff Association needs; (13) growth and enhancement for metastatic cancer clinical research trials; (14) multidisciplinary program support for diagnosing and evaluating of lung modules; (15) TMHs staff and patient wellness program, including supplies and equipment, wellness training, development, and educational workshops; Part X : FIN48 Footnote The organization is included in the consolidated financial statements of Brown University Health system which includes the following footnote regarding uncertain tax positions:Brown Health and substantially all its affiliates are not-for-profit corporations as described in Section 501(c)(3) of the Internal Revenue Code (the Code) and are exempt from federal income taxes pursuant to Section 501(a) of the Code. Brown Health MSO, Inc., Lifespan Risk Services, Inc.(d/b/a Brown University Health Risk Services), and VNA Technicare, Inc. (d/b/a Brown Health Home Medical) are taxable corporations.TMH recognizes the effect of income tax positions only if those positions are more likely than not to be sustained. Recognized income tax positions are measured at the largest amount of benefit that is greater than fifty percent likely to be realized upon settlement. Changes in measurement are reflected in the period in which the change in judgment occurs. TMH did not recognize the effect of any income tax positions in either 2024 or 2023. Part XI, Line 2d: Other revenue amounts included in F/S but not included on form 990 Change in Funded Status of Pension & Oth $0 Increase Interest in Net Assets of TMHF $2812819 Transfer of Equipment $0 Joint Ventures $0 Captis Stock $0 Part XI, Line 4b: Other revenue amounts included on 990 but not included in F/S Non-UBI debt-financed rental expenses $-143006 Non-debt-financed rental expenses $-1456442 Provision for bad debts $22825534 Miscellanous non-operating loss $2739723 Interest expense on Line of Credit $624 Part XII, Line 2d: Other expenses and losses per audited F/S Non-UBI debt-financed rental expenses $-143006 Non-debt-financed rental expenses $1599448 Part XII, Line 4b: Other revenue amounts included on 990 but not included in F/S Provision for Bad Debts $22825534 Miscellanous non-operating loss $2739723 Interest expense on Line of Credit $624 true Sub-Saharan Africa 0 10 Program Services Research 269200 Middle East and North Africa 0 2 Program Services Research 31000 Europe 0 7 Program Services Research 21622 East Asia and the Pacific 0 3 Program Services Reserach 7007 South Asia 0 5 Program Services Research 5000 Central America & Caribbean 0 5 Program Services Research 26517 32 32 360346 360346 false false false false false false Part I, Line 2 - Grantmakers Explanation For Monitoring Use of Funds Outside US When a foreign institution is the subrecipient of an award received by a Brown Health affiliate, the following procedures are adhered to: A subrecipient agreement is prepared and executed between the foreign institution and the Brown Health affiliate. The agreement describes the funding source, terms and conditions of the award, statement of work, payment method, and audit process. The foreign institution prepares an invoice to the Brown Health affiliate for expenses incurred under the agreement. Once received, the invoice is reviewed and approved by both the principal investigator at the Brown Health affiliate and the responsible research administrator in the Brown Health Office of Research Administration.Check requests and wire transfer forms are prepared by the principal investigator, approved by the responsible research administrator, and forwarded to the Brown Health Finance Department, where payment is processed to the foreign institution.Additionally, when the award is a federal award, a questionnaire is completed by the appropriate subrecipient official supplying information about the foreign institution's financial system and method of accounting for the award. A request is also made for the institution's audited financial statements. When a foreign individual is not associated with an institution, a Professional Services Agreement (PSA) is executed and the individual sends an invoice to the Brown Health affiliate principal investigator associated with the project or sponsored agreement that states the number of hours, dates of services, work performed, expense reimbursement request, and compensation amount. The same approval and payment process is used as described above.Expenditures related to foreign activities are recorded on the accrual basis of accounting. true true true X true X true true true false true true 15860718 3755646 12105072 0.01730 15860718 3755646 12105072 0.01730 337110 41109 296001 0.00040 30575525 6108871 24466654 0.03500 15518369 8142003 7376366 0.01050 44969954 42087954 2882000 0.00410 71632 71632 0.00010 91472590 56379937 35092653 0.05010 107333308 60135583 47197725 0.06740 true 5811518 524824 90034179 99631196 -9597017 X true true 1 1 The Miriam Hospital 164 Summit Avenue Providence RI 02906 www.miriamhospital.org HOS00122 X X X X X false false true X X X X X X X X X X 22 true true false true X See Schedule H, Part V, Section C X true 22 true See Schedule H, Part V, Section C false false true X 200.0000 300.0000 X X X X X X true true X X X X true X See Schedule H, Part V, Section C X See Schedule H, Part V, Section C X See Schedule H, Part V, Section C X X X X X X X true X false X X X X true X false false Facility: - Part V, Section B, Line 3j Part V, Line 3e:The CHNA process involved the integration of information from a range of data sources to identify the significant health needs of the community served by The Miriam Hospital, prioritize those needs, and identify the resources, facilities, and programs to address them. In order to identify the significant health needs of this community, primary quantitative and qualitative data and secondary quantitative data were collected. Regarding the significant needs that were identified in TMH's 9/30/2022 CHNA, they have been prioritized in order of significant needs of the community, as determined by a steering committee comprised of the Community Liaisons, TMH liaison, Brown Health Community Health Institute (BUHHI) leadership, TMH leadership, and Brown Health leadership. Facility: - Part V, Section B, Line 5 The CHNA process involved the integration of information from a range of data sources to identify the significant health needs of the community served by TMH, prioritization of those needs, and identification of resources, facilities, and programs to address the prioritized needs. Both qualitative primary data and secondary quantitative data were gathered to identify the significant health needs of the community. Additionally, the ongoing COVID-19 pandemic has impacted the health concerns of the communities served by TMH as well as the hospitals provision of health services.The primary data sources included community health forums, individual surveys, and key informant interviews. Secondary data sources included national and local publications of state-specific data. These sources varied in sample size, method of data collection and measures reported, but all are publicly available sources, and in each case, the most recent publicly accessible data was presented. The data sources are described in more detail below.Community Health Forums:Qualitative data was collected through Community Health Forums (CHF) to solicit input from individuals representing the broad interests and perspectives of the community. Community forums are a standard qualitative social science data collection method, used in community-based or participatory action research. Participants in the CHFs included members of the medically underserved, low-income, and minority populations in the TMH service area.Two CHF were held on May 10, 2022 and May 14, 2022 in the TMH service area, with 23 participants. Participants were recruited using social media, electronic newsletter, email, and word of mouth. Virtual (Zoom) forums were scheduled at various times of the day. All CHF were open to the public and participants were fully engaged throughout the 90-minute discussion.Staff from the LCHI served as a hospital liaison to help plan and facilitate the CHF. The hospital liaison was a critical link between the LCHI as the coordinating body, the expertise and resources within the hospital, and the Community Liaisons described below.An important and unique component of the CHF was the involvement of Community Liaisons. Two people representing the diverse populations served by TMH were hired as consultants to assist with the CHNA. These Community Liaisons helped plan the CHF, recruited participants, and co-facilitated the forums. Community Liaisons were chosen through a competitive selection process and completed a 90-minute training prior to leading the CHF. The training included project planning tips, role-playing activities, conflict management tips, and logistical expectations. Community Liaisons were responsible for co-facilitating the discussion at the CHF with their hospital liaison.Each CHF was 90 minutes in duration and was co-facilitated by the hospital and Community Liaison. Discussion began with a brief presentation of TMHs 2019 CHNA priorities and examples of activities the hospital has performed in response. Participants were invited to share their reactions to what was presented as well as their current health concerns. Through discussion, the facilitators generated consensus on the participants health concerns, their prioritization of those concerns, and their ideas for how TMH could respond to those concerns. The input gathered during the CHF was assessed qualitatively to extract themes and quantitatively to determine the frequency with which those themes were cited. Community Liaisons also met with the LCHI hospital liaison to debrief the forums and offer their interpretation of the findings to ensure all input was captured and that priorities were appropriately aligned.Hiring, training, and empowering community members to serve as Community Liaisons in the CHNA process enriched the quantity and quality of community input. It also allowed TMH to build relationships with communities that might not otherwise have become aware of or engaged in the needs assessment process.Individual Surveys:To broaden the reach of community input, an online survey was promoted, and paper surveys were distributed and collected by LCHI staff at community events they attended in June 2022. The surveys addressed the same questions as the CHFs. Twenty individual surveys were received for TMH.Key Informant Interviews:Public health and health policy leaders who could inform the 2022 CHNA process and had knowledge, information, or expertise about the community that TMH serves were invited to be interviewed as part of the CHNA. Key informant interviews were conducted with these leaders to supplement the other quantitative and qualitative data collected. Key informants included: Chief Strategy Officer, Executive Office of Health and Human Services, State of Rhode Island Director of Policy, Planning and Research, Executive Office of Health and Human Services, State of Rhode Island Director, Health Equity Institute and Maternal and Child Health, Rhode Island Department of Health Vice President and Chief Medical Officer, Providence Community Health Centers Executive Director, Rhode Island Parent Information Network Director, Community Health Worker Association of Rhode Island Executive Vice President and Chief Medical Officer, Blue Cross Blue Shield Rhode IslandThe key informants identified the following statewide health priorities, with the first three named by multiple leaders: Apply hospital resources to address the social determinants of health, including housing, food, transportation, and employment, among other barriers to care. Improve access to behavioral health care for children and adults, especially noting access challenges for children and the burden of substance misuse among adults. Ensure the provision of equitable care with particular attention to ensuring equal access to high quality care for persons regardless of their race, ethnicity, language spoken or disability status. They noted that equitable care also required a workforce representative of the patients and implementation of the principles of anti-racism. Improve access to primary and specialty care locally. Grow the healthcare and behavioral health workforces through career pathways, higher reimbursement rates, and increased compensation. Improve access to community-based services including home-based therapeutic services for children with special needs. Reduce racial and ethnic disparities in maternal and child health.The interviewed leaders noted several opportunities for hospitals to contribute to efforts to address these goals including: innovate around care delivery models for behavioral health services for adults; invest in systems and technology to facilitate improved care coordination between primary and specialty care, as well as hospital and community-based providers; partner with state and community-based agencies on workforce development pathways for high-demand roles- notably behavioral health providers and community health workers; provide assistance to patients to help them navigate the healthcare system; and sustain access to telemedicine that was made available during the peak of the COVID-19 pandemic. Facility: - Part V, Section B, Line 6a Rhode Island HospitalEmma Pendleton Bradley HospitalNewport Hospital Facility: - Part V, Section B, Line 11 TMH's Community Health Needs Assessment issued for the fiscal year ended September 30, 2022 identified six significant health issue areas requiring a further implementation strategy. Those significant health issue areas include: (1) access to healthcare service; (2) chronic disease management; (3) mental and behavioral health services for patients and caregivers; (4) grow and diversify the workforce; (5) community-based access to health information; and (6) navigation supports in hospital and community settings. The implementation strategy to address those significant health needs outlined between October 1, 2022 - September 30, 2025 is available at: https://www.brownhealth.org/sites/default/files/2023-04/2022-TMH-CHNA-Implementation-Plan.pdfDuring the fiscal year ended September 30, 2024, TMH implemented specific actions listed below in order to address the significant community health needs outlined in its CHNA dated September 30, 2022.ACCESS TO CARE AND HEALTHCARE SERVICES- Roundtrip, a cloud-based application, continues to provide access to reliable, free or discounted transportation to medical appointments.-Additional Community Health Workers (CHW) were hired in TMH Social Work and Emergency Department for a total of 10 CHW positions at TMH. The addition of these positions in key service lines serves to improve continuity of care and availability. -Brown University Health Community Health Institute continued to offer free skin cancer screenings and add locations to diversify their audience. In FY24, held six(6) Skin Check Screenings serving 385 people. - Continue to offer community-based biometric screenings and flu clinics for low-income and uninsured residents in partnership with the Brown University Health Community Health Institute (LCHI) to promote primary prevention with appropriate referrals to treatment. In FY24, provided blood pressure and glucose screenings across 170 events, serving 2,383 people, and provided 417 flu vaccinations during 30 free clinic events.- Kaizen event to improve collection of Real data held 1/24/2024, resulting in an action plan developed to address Data Analytics & EHR, Marketing & Communications, and Registration & Training. Director of Patient Registration and Revenue Cycle position was created to lead this work. Andreene Smith was hired in this role and started 7/22/2024.- Hospital Operations led effort to create a PowerBI dashboard to track key metrics in real time. Median door to doctor wait time decreased from 121 minutes to 57 minutes, active care time increased from 187 to 194 minutes, and disposition to departure was stable (28 to 27 minutes) between 9/23 and 9/24. Net promoter scores are now tracked monthly in PowerBI dashboard. The Pt Exp Team will be pushing clinic level trend reports to Ambulatory executive leadership starting in October 2024.CHRONIC DISEASE MANAGEMENT:-WomenCare offered a free breast and cervical cancer screening programs for women aged 21 and older. In FY24, screenings were held on 1/20/24 and 9/7/24, serving 23 and 46 women, respectively. No medical insurance was required for the screenings. -In partnership with HopeHealth, CVI contracted a palliative care provider to integrate palliative care early on and improve pain and disease management among patients, leading to an improved patient experience and improved cardiac outcomes. Solicitation for a new vendor has begun for FY25.-Brown University Health Cancer Institute is considering joining the second rollout of Enhanced referrals from primary care providers, ensuring referrals reach the department and are acted on in a timely manner. Enhanced referral mapping would occur in FY25-26.-CVI and Connect for Health program partnered to refer up to five patients at a time from the Hearts at Home program for social needs supports. The desired outcome is to assess SDOH among patients in the Heart Failure Clinic and consider the provision of medically tailored meals to food insecure patients. Nurses refer patients to Moms Meals, paid for by CMS, to design disease-specific diets for patients.- Continue to provide and promote tobacco prevention and cessation programs. Cardiac Rehab now offers their own smoking cessation program as well as Dean Ornish weight loss programs to facilitate skill-building for long-lasting behavior change as well as improved health outcomes from adoption of health-promoting behaviors.MENTAL AND BEHAVIORAL HEALTH SERVICES FOR PATIENTS AND CAREGIVERS-Collaborating with John Hopkins University, RI Department of Education and municipal school districts offer Mental Health First Aid (MHFA) in English and Spanish. The goal is to reduce the stigma associated with mental and behavioral health as well as increase community support by increasing in the number of individuals and school staff who can identify, understand, and respond to signs of mental illnesses and substance use disorders and who will reach out and provide initial help and support. In FY24, Bradley MHFA team taught 32 classes: 18 Adult MHFA, 11 Youth MHFA, and 3 Teen MHFA. A total of 421 MHFAs were trained: 289 in Adult, 39 youth were trained in teen. 93 school staff were trained in Youth. All classes provided in English due to the inability to recruit a certified, Spanish-speaking instructor.-Addiction Care Today (ACT) clinic opened at RIH in March of 2024 to provide urgent substance use disorder treatment, including medications, on a walk-in basis. ACT clinic began with part time hours and advertised services with community partners, especially those that serve disparately affected populations. The clinic accepts all patients, no matter what substances they use and whether their goal is to stop drug use, decrease use or to use more safely. Since opening, ACT has provided care to pregnant women, adolescents, patients who are unhoused, patients who have moved from out of state and patients who do not meet requirements for other addiction treatment programs in the state. -Brown University Health researchers contribute to statewide initiatives to reduce opioid overdose and fatality rates through research aimed at understanding the mechanisms underlying opioid use disorder, and the development of innovative solutions. The VP of Community Health & Equity continued to serve as Chair of the statewide Opioid Settlement Advisory Committee. Drs. Jody Rich and Tracy Greene continue to lead the Center of Biomedical Research Excellence on Opioids and Overdose (COBRE) at RIH, the first of its kind center in the nation to focus on collaboratively addressing the opioid epidemic. Brown University Health (formerly Lifespan) leads the nation in correctional health research; we host multiple NIH-funded grants, including the largest NIH R25 educational research program dedicated to this topic: the "Collaborative Justice-Involved Research and Training Program on Substance Use and HIV at Brown University Health".- Through participation on the Governors Overdose Task Force and Opioid Settlement Advisory Committee, $10.3 million of family- and community-based strategies that address social drivers of health, prevention, harm reduction, treatment, and recovery were funded in FY24.GROW AND DIVERSIFY WORKFORCE:-HR set targets to align with EEO compliance for diversity by sex, race, ethnicity, and veteran status.-Office of Belonging and Equity is working with GME to plan live and on-demand training for nursing and physician trainees.-TMH employees invited to participate in Team Brown Health volunteerism and to volunteer directly with the Community Health Institute through intranet promotions.-Five(5) Brown University Health volunteers offered half hour reading and mentoring Power Lunch sessions to eleven(11) students weekly at Martin Luther King Jr. Elementary School; Initiated planning process to develop job-shadow day at MLK Jr. Elementary School in Providence; Students from 3 area high schools participated in the Brown University Community Institute Health Mentoring Program that matches students 1:1 with mentors to provide academic reinforcement, professional exposure and social support.COMMUNITY-BASED ACCESS TO HEALTH INFORMATION:-TMH continues to deliver healthy living and healthy eating programs in community settings. -Twelve(12) LCH Ambassador workshops were delivered to 314 participants on topics generated by community partners: Financial Assistance, Skin Care, Substance Abuse Disorder, Identifying and Responding to Bullying, Certified Perinatal Workforce, Results of 2023 High School YRBS, Menopause, Tackling Misinformation in Your Community, Take a Stand for Posture, Food as Medicine, Nutrition & Mental Health, and Center for Health & Justice Transformation. Eight (8) additional conferences and workshops on topics requested by the community delivered to 307 participants. Nine cohorts of Diabetes Prevention Program launches with 73 people enrolled, and 720 people participated in food demonstrations, Food is Medicine, and A Taste of African Heritage food & Facility: - Part V, Section B, Line 16j An abbreviated version of TMH's Financial Assistance Policy is posted in various admitting and outpatient areas of TMH. Additionally, registration personnel refer uninsured and/or low-income patients to Patient Financial Counselors to discuss the policy and/or answer any questions they might have. Cardiovascular Institute 950 Warren Avenue East Providence RI 02914 Outpatient Cardiac Clinic TMH Immunology Research Center 14 Third Street 11 Fourth Street Providence RI 02906 Outpatient Counseling Cardiovascular Institute 1454 South County Trail Suite 2000 East Greenwich RI 02818 Outpatient Cardiac Clinic Cardiovascular Institute 208 Collyer Street Suites 100 102 Providence RI 02904 Outpatient Cardiac Clinic Womens Medicine Collaborative 146 West River Street Providence RI 02904 Comprehensive Women's Outpatient Clinic TMH Diagnostic Imaging Center 195 Collyer Street Suite 101 Providence RI 02904 Outpatient Radiology TMH Cardiac RehabPulmonary Rehab 208 Collyer Street Providence RI 02904 Outpatient Cardiac Clinic TMH Weight Control & Diabetes Research 196 Richmond Street Providence RI 02903 Outpatient Research & Education Intensive Cardiac Rehab Program 1454 South County Trail East Greenwich RI 02818 Outpatient Cardiac Clinic TMH Outpatient Rehabilitation 195 Collyer Street Providence RI 02904 Outpatient PT, OT, and Speech Rehab Mens Health & Infectious Disease 180 Corliss Street Suites C E Providence RI 02904 Comprehensive Men's Outpatient Clinic TMH Laboratory 1 Commerce Street Lincoln RI 02865 Phlebotomy Lab Blackstone Valley Community Health Center 1000 Broad Street Central Falls RI 02863 Outpatient Rehab Clinic Adult & Pediatric Rehabilitation Services 1 Commerce Street 2nd Floor Lincoln RI 02865 Outpatient Rehab Clinic Womens & Mens Health Pelvic Rehabiliation Services 148 West River Street Suite 1D Providence RI 02904 Outpatient Rehabilitation Services TMH Laboratory 1180 Hope Street Basement Floor Bristol RI 02809 Phlebotomy Lab RISE TB Clinic 14 Third Street Providence RI 02906 TB Clinic TMH Laboratory 400 Bald Hill Road Warwick RI 02886 Phlebotomy Lab East Providence Imaging 375 Wampanoag Trail Suite 101B Riverside RI 02915 Outpatient Diagnostic Imaging TMH Pre-admission Test Center 208 Collyer Street Third Floor Providence RI 02904 Outpatient Pre-admission Assessment & Education Brown University Health Medical Imaging 900 Warren Avenue Suite 100 East Providence RI 02914 Outpatient Radiology Part I, Line 3c - Charity Care Eligibility Criteria (FPG Is Not Used) The Miriam Hospital (TMH) uses a dual system for determining financial aid eligibility: federal poverty guidelines and an asset test.The financial screening process at TMH is intended to define probable eligibility for public assistance (Medicaid or Community Free Service ("CFS")) for those patients who do not have the means to pay for hospital services rendered, as follows:1. Upon patient indication of an inability to pay required monies, the patient is offered the financial screening option to determine eligibility for public assistance (Medicaid, CFS).2. The application for CFS is completed and includes information relative to income, expense, and other available resources, and requires proof of such information which may include:- most recently filed Federal income tax return and W-2 form(s)- copies of most recent savings and/or checking account statements- two most recently received payroll check stubs- copy of rent receipts for the last six months for proof of residency- copy of utility bills for the last month for proof of residency3. If the patient's financial situation falls within the guidelines for eligibility for Medicaid, RIte Care, or CFS, or if the patient has a long-term disability, the appropriate application process is completed. (Assistance to complete such applications is available from the Patient Financial Advocates (PFA) Office at TMH.)4. Uninsured patients receive a discount equal to the discount received by Medicare beneficiaries on TMH charges using the prospective method. Under Section 501(r)(5), the maximum amounts that can be charged to Financial Assistance Policy (FAP)-eligible individuals for emergency or other medically necessary care are the amounts generally billed to individuals who have Medicare insurance covering such care. In no case was there a situation where an uninsured patient paid more than amounts reimbursed from Medicare.5. Eligibility for CFS above the discount is provided for those applicants whose family gross income is at or below twice the Federal Poverty Guidelines, with a sliding scale for individuals up to three times the poverty level in effect at the time of application. Full charity care applicants with assets worth more than $9,400 for an individual (or $14,100 for a family) may not qualify for care without charge, but will qualify for discounted care. While the maximum 100% discount may not be available to all charity care applicants based on the results of their asset test, all uninsured patients who receive care are eligible for, at a minimum, the charity care discount as provided by the Medicare program. 6. For patients who qualify for less than 100% of the financial assistance program, a payment schedule is determined and agreed upon (discussed further below). Payment arrangements are established prior to service for non-urgent care. 7. In either case, the final results of the financial screening are recorded in the comments section of TMH's billing system.Requests for Payment Arrangements:Patient Financial Advocates (PFAs) will qualify patients that are receiving non-urgent, medically indicated procedures prior to services. The PFAs will request 75% to 100% of estimated discounted charges if the balance is under $5,000 and 50% to 100% of estimated discounted charges if the estimated bill equals or exceeds $5,000.For elective or non-urgent cases, the policy requires financial clearance prior to services or an exception from the Medical Director based on the clinical circumstances if the patient cannot meet the above payment agreement.Patients who do not qualify for total or partial CFS, but who have difficulty in paying their bills after services are rendered, may request enrollment in a payment plan. Eligibility for the payment plan includes the following guidelines:1. Immediate payment in full will result in financial hardship to the patient or the patient's family.2. Deposit of one-half of the estimated total bill is requested prior to admission.3. The minimum monthly payment of $50.00.4. The maximum length of the payment plan is twenty-four months.The Customer Service staff will set up the payment plan using the above guidelines as well as complete the necessary information on the "Payment Agreement" form and mail to the patient for signature. Account documentation will be done online. The pre-collect agency will be sent a copy of the payment agreement and all forms will be scanned into the PFS Optical Imaging System. Part I, Line 6a - Related Organization Community Benefit Report The community benefit report for all Brown University Health affiliated hospitals (The Miriam Hospital (TMH), Rhode Island Hospital (RIH), Emma Pendleton Bradley Hospital (EPBH), and Newport Hospital (NH)) is maintained by Brown Health and included in Brown Health's annual report. The annual report for the year ended September 30, 2024 is available at the following link. https://www.brownhealth.org/sites/default/files/2025-07/Annual-Report-2024_250709.pdf Part I, Line 7 - Explanation of Costing Methodology TMH's costing methodology used to calculate the amounts reported in Part I, Line 7 is as follows:a) Financial assistance at cost- involves utilization of a ratio derived from dividing patient costs, as defined, by patient charges, as defined, and applying that percentage to total charity care charges.Patient costs reported in the cost accounting system are calculated based on Medicare principles of reimbursement by reducing total operating expenses (as calculated by Form 990 requirements) by items such as bad debt expense, the cost of medical education, internally funded research, subsidized health services, community services, charitable contributions, and other operating revenue. Patient costs are then divided by patient charges to determine a ratio of cost to charges (RCC). This RCC is applied as the costing methodology for determining charity care expense.b) Medicaid- Medicaid expense is determined at cost as calculated by TMH's cost accounting system. The system uses historical costing methods applied to all patient segments based on various patient demographics and utilizations. These costing standards exclude bad debt, charity care, and the Medicaid portion of costs of health professions education, which are reported on other areas of Line 7. These expenses include Medicaid provider taxes. Direct offsetting revenue is reported as amounts received from Medicaid, as well as other payments which include reimbursement under Federal "Upper Payment Limit" (UPL) and "Disproportionate Share Hospital" (DSH) programs.e) Community health improvement services and community benefit operations- Community benefit operations expense is recorded as direct expenses incurred as reported by TMH's Community Health Services Department. Revenue received for these services is reported as direct offsetting revenue. f) Health professions education- Health professions education expenses represent direct costs related to amounts associated with resident and intern programs utilized at TMH. These costs are determined by reporting actual direct costs taken from the Medicare cost report. Direct offsetting revenue is reported as any direct Medicare reimbursements received for such services provided, as reported in TMH's Medicare cost report.g) Subsidized health services- Subsidized health services' community benefit expense is determined by TMH's cost accounting system. These subsidized health services are recorded at cost in TMH's cost accounting system for all qualified subsidized health service divisions. This expense is adjusted to remove all related Graduate Medical Education (GME) expenses, as well as bad debt, Medicaid, and charity costs already reported in the applicable sections of Line 7. Net patient service revenue is recorded as amounts received from various payer types related to these services. Revenue associated with Medicare GME and Medicaid is excluded from the amount disclosed for subsidized health services.h) Research- TMH conducts extensive medical research focused on the prevention and treatment of HIV/AIDS, obesity, cancer, diabetes, cardiac disease, neurological problems, orthopedic advancements, and mental health concerns. For all internal and external research conducted, the costs associated with these activities are calculated by combining the direct and indirect costs as reported within TMH's cost accounting system. Revenue received for these services is reported as direct offsetting revenue. i) Cash and in-kind contributions for community benefit- Expenses for cash and in-kind community benefit contributions are incurred by TMH, including an allocation of contributions made by Brown University Health on TMH's behalf. Part I, Line 7, Column F - Explanation of Bad Debt Expense The calculation of percentages disclosed for Schedule H, Part I, Line 7, column (f) "percent of total expense", does not include bad debt expense. Form 990, Part IX, Line 25 includes provision for bad debts of $23,189,813. Part III, Line 2 - Methodology Used To Estimate Bad Debt Expense The amount reported as bad debt expense is determined by applying the ratio of cost to charges (RCC) to the total charges written off to bad debt. The RCC rate is determined using data from TMH's cost accounting system and is adjusted for medical education, internally funded research, subsidized health services, community services, and charitable contributions. Discounts and payments are applied to patient accounts before such account balances are transferred to bad debt. Part III, Line 3 - Methodology of Estimated Amount & Rationale for Including in Community Benefit Accounts pending transfer to bad debt are reviewed by TMH's Patient Financial Advocate staff to determine qualification for financial assistance under TMH's policy. Accounts with insufficient information to determine eligibility are assigned a separate identifying code. These accounts are ultimately transferred to bad debt if the appropriate qualifying documentation is not received. The amount reported on Schedule H, Part III, Section A, Line 3 represents the account balances at charge written off to bad debt from the pending code, which are in turn converted to cost by applying the RCC rate as identified in Schedule H, Part III, Section A, Line 2. Part III, Line 4 - Bad Debt Expense Due to the adoption of ASU No. 2014-09 in 2019 - Revenue From Contracts With Customers (Topic 606), bad debt expense is no longer reported in the audited financial statements as a separate line item, but rather is treated as a price concession. TMHs adoption of the ASU did not materially change the timing or amount of revenue recognized. However, the ASU requires that patient service revenue be presented in the statement of operations and changes in net assets at the transaction price, i.e., net of any provision for bad debts. Part III, Line 8 - Explanation Of Shortfall As Community Benefit The Medicare shortfall for fiscal year 2024 was not treated as a community benefit.The source of the Medicare allowable costs reported on Part III, Section B, Line 6 is the Medicare cost report, Form 2552-10. Part III, Line 9b - Provisions On Collection Practices For Qualified Patients TMH does not bill for the excess of charges over agreed upon reimbursement amounts from third-party payors. Rather, such differences are recorded as a reduction of revenue through contractual adjustments. Collection efforts are focused on copayments, deductibles and amounts denied by insurers. After all collection attempts are exhausted, any remaining balances, including any copayments and deductibles, are written off as a bad debt. TMH classifies its bad debts as uncompensated care. This does not apply to Medicaid, however, as there are no associated copayments or deductibles for this payor.TMH generally does not require collateral or other security in extending credit to patients; however, it routinely obtains assignment of patients' benefits payable under their health insurance programs, plans, or policies. Uninsured patients are offered Community Free Service and/or payment plan options.Brown Health's Patient Financial Services Department (PFS) has the responsibility for communicating and administering collection policies and procedures to all patient accounts. PFS engages the services of various pre-collect agencies as necessary. The following are highlights of the overall collection effort:* If a patient presents for admission who is not insured, staff assists the family with a Medicaid application.* If the patient is ineligible for Medicaid, a financial screening is performed to determine status of qualification for charity care. All patients without medical insurance receive at a minimum a self-pay discount calculated using the Prospective Method of amounts generally billed.* If the patient does not qualify for charity care, PFS or the pre-collect agency attempts at least four contacts with the responsible party within the first 120 days.* At 120 days, if there is no payment activity or no hold placed on the account, the account is transferred to the appropriate collection agency. Part VI, Line 2 - Needs Assessment Brown Health's Office of Strategic Planning and Analysis performs population-based studies for TMH regarding the need for inpatient medical and surgical services and a wide range of outpatient services including: primary care office visits, specialty care, emergency services, imaging, ambulatory surgery, and specific high technology services such as radiation therapy and bone marrow transplantation. A population-based study examines the growth and changes in the population, the resources in the community, and the changing prevalence of diseases. Brown Health Strategic Planning also examines experience with wait times, the level of staffing, and the changing standards of care. All of this information is used to assess the demand for additional services to provide access to high quality care.In addition to population approaches to assessing and estimating need, all specialties and services monitor demand at the service-specific level by considering changing patterns of care and methods of treatment for the specific medical problem, wait times for visits/queues, and community resources. The service leadership then goes through a review process to add staff, expanded hours, and/or new subcomponents to round out core services on an as-needed basis. At times, expansion requires more space, equipment, and staff, but often accommodation of community demand is achieved through expanded hours. Facilities are added as needed to accommodate these expansions, but most often minor renovations of existing locations with better, more modern layouts and equipment allow for greater patient access.The Rhode Island State Certificate of Need program requires a focused study of need for all projects over $5.25 million, which is an important part of the program development process across Brown Health.Based on a broad understanding of community health needs, TMH provides a wide range of services to both its primary and secondary service areas. Brown Health and its hospital affiliates monitor health trends in Rhode Island in an effort to identify areas of unmet demand regarding clinical services. Part VI, Line 3 - Patient Education of Eligibility for Assistance TMH has multilingual signage in its main lobby and waiting areas which provides information on financial aid contacts. The Registration Department meets with patients at the outset of care to discuss eligibility for assistance. The Registration staff provides interested patients with a "Welcome" booklet which includes information on patient rights and responsibilities. The signage and booklets contain a telephone number which connects patients with Registration staff who can answer any additional questions that may arise after the patient has left TMH. Assistance eligibility is also summarized on TMH's website, http://miriamhospital.org.As part of TMH's inpatient intake process, TMH provides a summary of its Financial Assistance Policy, along with all assistance applications and the Patient Financial Services contact number, to all self-pay patients. The same process is also used for patients seen during the outpatient discharge process. Attempts are made to contact patients prior to their visit to screen for financial assistance and to inform them what documents are required for their financial assistance determination or to set up an appointment to see a "Patient Financial Advocate" (PFA) prior to service. PFAs discuss with patients the various government programs that might be available to them for financial assistance. PFAs also offer assistance with the financial application process and/or understanding the qualification factors for Medicaid, the Affordable Care Act, Medicare, Social Security Disability, the Supplemental Nutrition Assistance Program (SNAP), and Rhode Island Temporary Disability Insurance and Unemployment. This is done for both inpatient and outpatient services. Part VI, Line 4 - Community Information TMH, located in Providence, Rhode Island, is a 247-bed nonprofit general acute care teaching hospital with university affiliation providing a comprehensive range of diagnostic and therapeutic services (excluding obstetrics) for the acute care of patients principally from Rhode Island and southeastern Massachusetts. As a complement to its role in service and education, the Hospital actively supports research. TMH is accredited by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) and participates as a provider primarily in Medicare, Blue Cross, and Medicaid programs. TMH is also a member of the formerly-named Voluntary Hospitals of America, Inc., which has partnered with UHC Alliance NewCo, Inc. to become Vizient, Inc., the largest member-owned health care company in the United States.In 1969, TMH and certain other Rhode Island hospitals entered into an affiliation agreement to participate jointly in various clinical training programs and research activities with The Warren Alpert Medical School of Brown University (Brown). TMH is designated as a major teaching affiliate of Brown. The goals of the partnership are to facilitate the expansion of joint educational and research programs in order to compete both clinically and academically.With respect to nursing education, TMH has developed formal and informal educational affiliations with a number of accredited New England colleges and universities. TMH does not receive any compensation from the various schools for providing a clinical setting for the student nurse training.TMH conducts extensive medical research and is in the forefront of biomedical health care delivery research and among the leaders nationally in National Institutes of Health programs. Part VI, Line 4 - Community Building Activities TMH substantially subsidizes various health services including clinics and certain other specialty services. TMH also provides numerous other services to the community for which charges are not generated. These services include certain emergency services, community health screenings for cardiac health, prostate cancer and other diseases, smoking cessation, immunization and nutrition programs, diabetes education, community health training programs, patient advocacy, foreign language translation, physician referral services, and charitable contributions. Part VI, Line 5 - Promotion of Community Health TMH is governed by a Board of Trustees, which is composed of leaders of the local community elected by Brown Health. TMH's purpose is to at all times be operated exclusively as a tax-exempt charitable hospital and, as such, shall dispense medical and surgical aid and care to the sick and disabled of any race, creed, or color in keeping with Jewish ethical aspirations; shall act in a fashion designed to further, improve, and advance the science or art of health care delivery, patient care, and the knowledge, practice, and teaching of medicine and nursing; and assist in the advancement of medical research and investigation and in the improvement of medical teaching facilities and methods. TMH works collaboratively with physicians, its employees, other health care organizations, and the community to create a measurably healthier community through the provision of high quality, cost-effective, customer-focused health care services in an environment that promotes patient safety. TMH monitors the healthcare needs of its service area to ensure alignment of its resources with its mission. TMH measures the results of the programs and services it provides based on the value added to the community as well as the financial health of each program and its impact on TMH. TMH is organized and operated for the benefit of the community it serves. Part VI, Line 6 - Affilated Health Care System Brown Health's mission is delivering health with care. Brown Health is an academically based healthcare system at the forefront of medical care, continually engaging in research that will lead to medical breakthroughs. Brown Health affiliates provide comprehensive inpatient and outpatient medical, surgical, and psychiatric services for adults and children. Brown Health and its affiliates employ approximately 18,000 people. The Brown Health system has approximately 4,100 physicians on the medical staffs of its affiliated hospitals, operates 1,165 licensed beds in four hospital complexes, and in 2024 generated approximately $3.5 billion in total operating revenue. By each of these measures, Brown Health is Rhode Island's largest health system, serving a population of about 1.1 million. Three of its hospital members, Rhode Island Hospital (RIH), The Miriam Hospital (TMH), and Emma Pendleton Bradley Hospital (EPBH), are teaching affiliates of The Warren Alpert Medical School of Brown University.Brown Health is a Rhode Island nonprofit corporation that is community-based and community-governed. As a nonprofit organization, Brown Health is run by a voluntary Board of Directors who are community representatives. Brown Health and all of its nonprofit hospital affiliates have received written notification from the Internal Revenue Service that they have been recognized as being organized and operated as entities described in Internal Revenue Code (IRC) Section 501(c)(3) and are generally exempt from income taxes under IRC Section 501(a).As of September 30, 2024, Brown Health employed approximately 1,300 full-time and part-time personnel, most of whom are located in Providence, Rhode Island. Brown Health provides support services to its affiliates, such as information services, risk management, legal, communications and public affairs, fundraising, facility development, strategic planning, internal audit/compliance, human resources, finance, payor contracting, and investment management, for which each affiliate is charged a fee equivalent to the estimated costs incurred by Brown Health in providing these services.CORPORATE AUTHORITY AND ROLEBrown Health has no members and is governed by its Board of Directors. The Board has responsibility for planning, directing, and establishing policies intended to assure the development and delivery of quality health services, professional education, and biomedical research on an integrated, cost-effective basis. The Board's powers include the power to set accounting policies for its affiliates, approve all managed care agreements, negotiate, develop, and approve affiliations with other institutions for educational and research purposes, and approve human resource plans, executive compensation, and benefits for system affiliates. The bylaws of TMH confer certain reserved powers on Brown Health to provide it with the means of effective oversight, coordination, and support of the system. Powers specifically reserved to Brown Health as sole member of TMH include: to approve the amendment of the Articles of Incorporation and Bylaws and other Charter documents; to develop and approve strategic plans; to approve capital or operating budgets or material non-budgeted expenditures; and to authorize incurrence or guaranty of material indebtedness.For a complete listing of affiliated members of Brown Health's integrated healthcare delivery system, please refer to Schedule R. Part VI, Line 7 - States Filing of Community Benefit Report RI Part VI - Additional Information Form 990, Schedule H, Part V, Line 7: The website which makes TMH's CHNA report widely available is located at the following URL:https://www.brownhealth.org/sites/default/files/2022-09/TMHCommunityHealthNeedsAssessment2022.pdfForm 990, Schedule H, Part V, Line 10a: The URL to view TMH's most recently adopted CHNA implementation strategy is below:https://www.brownhealth.org/sites/default/files/2023-04/2022-TMH-CHNA-Implementation-Plan.pdfForm 990, Schedule H, Part V, Line 16a: The URL to view and download TMH's Financial Assistance Policy is below:https://www.brownhealth.org/sites/default/files/2023-04/2023_04_23_Lifespan-Financial-Assistance-Policy.pdfForm 990, Schedule H, Part V, Line 16b: The URL to view and download TMH's Financial Assistance Policy application form is below:https://www.brownhealth.org/sites/default/files/lifespan-files/documents/lifespan-main/pfs/cfs-english_051920.pdfForm 990, Schedule H, Part V, Line 16c: The URL to view TMH's plain language summary of its Financial Assistance Policy is below:https://www.brownhealth.org/sites/default/files/lifespan-files/documents/lifespan-main/pfs/Lifespan-Financial-Assistance-Summary_052020.pdfCompliance with requirements of IRC Section 501(r):During a review of the hospitals section 501(r) compliance in FY24, it was discovered that the hospitals Financial Assistance Policy (FAP) and Billing and Collection Policy (collectively the Policies) required clarification or correction. Although the FAP included a list of providers of emergency and medically necessary care in the hospital, listing which providers were and which providers were not covered by the FAP, the list had not been timely updated. The provider list has since been updated on a quarterly basis. Additionally, neither the FAP, nor a separate policy, specifically required the hospital to provide care for emergency medical conditions to individuals regardless of their eligibility under the FAP and prohibited the hospital from engaging in actions that discourage individuals from seeking emergency medical care. The FAP has been updated to include this language. Finally, although the Policies had been approved and adopted by the CFO, the CFO had not yet been delegated such authority from the Board. On August 5, 2025, the Board approved and adopted the Policies and delegated authority to the CFO to revise and amend the Policies from time to time as deemed appropriate or prudent. The hospital also determined that it had not been taking adequate steps to widely publicize its FAP in a manner reasonably calculated to reach those members of the community served by the hospital who are most likely to require financial assistance. The hospital has taken the following steps to more clearly align its efforts to publicize its FAP with the examples in the 501(r) regulations: (i) distributing copies of the plain language summary of its FAP and its FAP application form to referring staff physicians and to the community health centers serving its community, (ii) distributing copies of these documents to the local health department and to public agencies, including the Rhode Island Executive Office of Health and Human Services and the Rhode Island Department of Health, and nonprofit organizations in its community that address the health issues and other needs of low-income populations, including Blackstone Valley, Esperanza/Hope Clinic, and (iii) including verbiage in patient statements that inform readers that the hospital offers financial assistance and that people having trouble paying their hospital bills may be eligible for financial assistance.It was further discovered that the hospitals 2022 Community Health Needs Assessment (CHNA) did not identify and describe resources potentially available to address the communitys significant health needs and did not report either a description of how the hospital solicited and took into account written comments on its prior CHNA report and implementation strategy, or if the hospital solicited but did not receive written comments, the efforts the hospital undertook to solicit input. At the time that these deficiencies were discovered, the 2025 CHNA was in progress. Accordingly, the hospital determined it was most reasonable and appropriate to address these deficiencies by including such information in the 2025 CHNA.On May 13, 2025, the Board adopted a 501(r) Compliance Policy setting forth the hospitals commitment to ensuring ongoing overall compliance with the requirements of section 501(r). This policy requires that the hospital regularly review its policies and procedures to (1) ensure that the Hospitals community health needs assessments and implementation strategies satisfy the requirements of section 501(r)(3) of the Internal Revenue Code and section 1.501(r)-3 of the regulations and (2) that the Hospitals financial assistance policies, financial assistance applications, plain language summaries, and billing and collection policies, as well as the Hospitals practices and procedures in connection with promoting its financial assistance policy, billing patients and engaging in collections activities, satisfy the requirements of sections 501(r)(4)-(6) of the Internal Revenue Code and sections 1.501(r)-4, -5 and -6 of the regulations. true Brown University 164 Angell St Providence RI 02912 050258809 501(C)(3) 204430 0 General Support 1 0 Additional Supplemental Information TMH is committed to community programs and provides support to various charitable organizations in Rhode Island. Donations are made to organizations recognized by the IRS as being described in IRC Section 501(c). All contributions are approved by management and are made to organizations whose missions and goals align with those of TMH. X X true true X X X X X true true false false false false false true false Arthur J Sampson Fmr. Trustee 86539 1423 87962 Erin P Avanzo Reg. Nurse 193411 30000 184 488 224083 Eva Greenwood Treasurer 450817 165150 33218 66165 21726 737076 G Alan Kurose Fmr. Trustee 426299 167048 1065 10351 604763 Janine Lairmore VP-CVI 270293 50532 38751 44037 29888 433501 27938 Jill Underwood Reg. Nurse 247195 660 11155 10598 269608 John Fernandez Trustee 1208249 858333 82164 280199 27177 2456122 Laura R Stroud Dir. Ctr Behavior 337766 21000 1826 16152 33761 410505 Maria P Ducharme President 503364 110180 76921 100021 29736 820222 44702 Mark A Deitch MD Chief Medical Officer 417680 69472 25551 82921 185 595809 Paul J Adler Secretary 641242 158116 127498 121810 29275 1077941 86031 Peter K Markell EVP & CFO 883350 186333 123959 18928 1212570 Rena R Wing Sr. Research 340824 7416 16154 26250 390644 Timothy J Babineau Fmr. Trustee 2343283 1336393 3679676 2343283 Vanzetta V James DNP Chief Nursing Officer 277970 46760 81485 1277 10963 418455 Ziya L Gokaslan MD Trustee 1511075 138000 7524 19800 32886 1709285 Part I, Line 1a: Relevant information in regards to selections on 1a. Tax Indemnification and Grossed Up Payments:The Brown Health Executive Long Term Disability program provides financial protection to designated Brown Health physicians and executives in the event that they become disabled. Premiums are paid to the insurance carrier by the insureds on an after-tax basis to allow for income replacement at a reasonable cost. The income associated with the premiums is grossed up to cover the total cost of the benefit as provided in the Brown Health Executive Benefit Plan and is included in Medicare wages, more specifically on Schedule J, Part II, Column B (iii). Part I, Line 7: Non-Fixed payments not listed above Certain physicians and executives participate in incentive compensation plans arranged through individual contractual agreements which stipulate non-fixed payments based on meeting criteria comprised of various quality and productivity markers. A RIHEBC Series 2016 521300173 762244FP1 2016-08-11 57000732 Refund 1996, 2006, 2009 Bonds false false true B RIHEBC Series 2024 521300173 762244LW9 2024-02-14 120479012 Capital Improvements false false false A 2896175 57000732 419512 56581220 true true true true B 121610650 966648 8138064 112505938 false false false true A false false false true true false false true B false false false true true false false true A false true false false false false false true B false true false false false false true true A true B true Part VI Schedule K, Part I, Line A(f):The bond proceeds listed in line 3a & 3b differ from the bond issue disclosed per IRS Form 8038 due to the fact that TMH is part of the BHOG previously mentioned in Part I, Line A(f). Of the $308,112,067 disclosed in Form 8038 for the RIHEBC Series 2016 Bonds, TMH was allocated $57,000,732 of the total issuance proceeds disclosed in line 3a.Of the $332,814,949 disclosed in Form 8038 for the RIHEBC Series 2024 Bonds, TMH was allocated $120,479,012 of the total issuance proceeds disclosed in line 3b.Schedule K, Part I, Line 3 (Column B):The total proceeds shown in Part II, Line 3 differs from the issue price shown in Part I(e) due to interest earnings on invested proceeds. Form 990, Part VI, Section A, Line 2 Lawrence A. Aubin, Sr., Chairman, and Michael L. Hanna, Trustee, are partners in the same for-profit organization. Form 990, Part VI, Section A, Line 6 Brown University Health is the sole member of TMH. Form 990, Part VI, Section A, Line 7a The sole member of TMH is Brown University Health, a non-profit corporation organized and existing under the Rhode Island Nonprofit Corporation Act.Additionally, the bylaws of TMH confer certain reserved powers upon Brown Health to provide it with the means of effective oversight, coordination, and support of the system. Powers reserved to Brown Health include: to elect and remove TMH trustees and to approve the election/removal of certain officers. Form 990, Part VI, Section A, Line 7b The TMH Board is comprised of the same individuals who serve on the Brown Health Board. Brown Health has the responsibility for planning, directing, and establishing policies intended to assure the development and delivery of quality health services on an integrated, cost-effective basis. Powers reserved to Brown Health, in addition to those noted above, include: to approve amendment of the Articles of Incorporation and Bylaws and other charter documents; to approve strategic plans; to approve investment policies and any capital or operating budgets or material non-budgeted expenditures; and to authorize incurrence or guaranty of material indebtedness. Form 990, Part VI, Section B, Line 11b The preparation and filing of the Form 990 and supporting schedules is the responsibility of the Executive Vice President & Chief Financial Officer (EVP/CFO) and Brown Health's Finance Department. The Form 990 is prepared by the accounting staff upon completion of Brown Health's annual independent audit and is reviewed by the Corporate Services Tax Compliance Manager and the Director of Finance. The draft Form 990 is then provided to the EVP/CFO for final management review. Prior to filing the return with the Internal Revenue Service, a copy of the entire form is posted to TMH's Board of Trustees website portal in advance of its next Board meeting. At the time of the Board Meeting the 990 is presented by the Brown Health Director of Finance and EVP/CFO, at which time all questions and concerns of the members of the Board are addressed by the EVP/CFO and incorporated into the Form 990 when appropriate. Once the Form 990 is complete and ready to be filed, the members of the Board are notified via email that a copy of the final version of the Form 990 is accessible through the same password-protected website portal. The EVP/CFO is authorized to file the Form 990 Form 990, Part VI, Section C, Line 19 Brown Health and the Brown Health Obligated Group, which consists of TMH, RIH, Emma Pendleton Bradley Hospital, Rhode Island Hospital Foundation, and The Miriam Hospital Foundation, currently make their annual and quarterly consolidated financial statements available to the public via DAC (Digital Assurance Certification, LLC), a disclosure dissemination agent for issuers of tax-exempt bonds which electronically posts and transmits Brown Health's financial information to repositories and investors alike. In addition, copies of TMH's Articles of Incorporation, Bylaws, and Conflict of Interest Policy are available upon request from the office of the Brown Health EVP/CFO, either in person or by mail. Form 990, Part XI, Line 9 Change in Funded Status of Pension & Other Postretirement = $0 Form 990, Part XI, Line 9 Increase in Interest in Net Assets of TMHF = $2812819 . TMH's multidisciplinary medical teams include many dedicated specialists - surgeons, internal medicine specialists, anesthesiologists, nurses, rehabilitation therapists, and social workers who work with patients from diagnosis to treatment to follow-up care. The physical therapy and nursing teams work together after surgery to get patients moving for faster recovery, and physicians, nurses, and therapists work collaboratively to follow-up care.Each patient benefits from individualized treatment plans and rehabilitation to aid recovery and restore functionality as quickly as possible. Whenever possible, minimally invasive surgical techniques are used to perform surgery, which have dramatically improved the quality of the post-operative and recovery experience for the patient. In certain cases, computer navigation technology is used for knee and hip replacement surgeries. Computer navigation can assist the surgeon and improve the level of accuracy, bringing the precision of bone cuts and implant alignment in joint replacement surgery to a whole new level of accuracy, reliability, and longevity.Thanks to the latest evolution in surgical technology, physicians now have an effective alternative to traditional open surgery and laparoscopy that allows them to provide patients with the best of both approaches. This alternative is the da Vinci Surgical System, which TMH uses to treat different types of cancer.TMH's surgeons are leaders in their respective fields. TMH, as part of an academic medical center, prizes the mastery of new technologies in order to improve the quality of life for patients. TMH surgeons have successfully performed over 1,000 procedures using the da Vinci Surgical System and have made its use a cornerstone of cancer treatment at TMH. TMH's Adult Outpatient Behavioral Medicine Services help individuals improve health through behavior change. Services are offered to help patients adjust to chronic medical conditions, including their associated physical and emotional distress; modify unhealthy ways of living (for example, smoking cessation) to help prevent the onset or progression of disease; and treat mood and anxiety disorders that interfere with management of medical conditions. Services are available to help individuals with behavioral and psychosocial management of medical conditions such as headache, pain, cancer, heart disease (including those with implanted cardiac devices), pulmonary disease, and diabetes. The Weight Management Program provides comprehensive, medically supervised treatment for mild, moderate, and severely overweight adults. Specialized programs are also available for adolescents and diabetics. Treatment combines medical monitoring, behavioral therapy, exercise instruction, three levels of calorie reduction, and nutrition education. TMH's clinicians also include surgical oncologists, medical oncologists, radiation oncologists, hematologists, pathologists, physical therapists, radiologists, patient advocates, pharmacists, and nutritionists.To help patients and their families cope with breast cancer, TMH offers the Breast Health Navigator Program, which assists breast cancer patients through the entire course of their cancer care by providing breast health navigators, registered nurses trained in oncology who possess an in-depth understanding of breast cancer and theprocess undergone by patients. These navigators guide patients through diagnosis, treatment, and recovery, while helping them make informed decisions and cope with the variety of issues they face.TMH and RIH were named Blue Distinction Centers for Complex and Rare Cancers by Blue Cross and Blue Shield of Rhode Island. TMH and RIH are the only two hospitals in the State to receive this distinction. Blue Distinction Centers for Complex and Rare Cancers are facilities within participating Blue Cross and Blue Shield network service areas that offer comprehensive inpatient cancer care programs for adults, delivered by multidisciplinary teams with subspecialty training and distinguished clinical expertise in treating complex and rare subtypes of cancer. TMH and RIH have both been recognized for excellence in treating esophageal, gastric, liver, pancreatic, rectal, and thyroid cancer.TMH's division of gastrointestinal and liver pathology is committed to providing high quality diagnostic services for gastrointestinal and liver diseases in patients. Collectively, gastrointestinal cancers are among the most common form of malignancies suffered today, affecting nearly a quarter of a million Americans each year. To address this, the Brown Health Cancer Institute has brought together a team of nationally recognized leaders in the treatment and research of gastrointestinal cancers.The gastrointestinal cancer care services available through the Brown Health Cancer Institute at TMH provide state-of-the-art care for patients who have or are at risk for the following types of cancer: bile duct, esophagus, gallbladder, endocrine, and cystic tumors of the pancreas, liver, and stomach. TMH also offers medical nutrition therapy on an outpatient basis designed to help prevent and control gastrointestinal disorders. Form 990, Part I, Line 6 Volunteers support and contribute to the mission of TMH every day. They are able to learn, meet other dedicated volunteers, better understand the healthcare environment, and gain personal satisfaction knowing they are making a difference to patients, families, visitors, and vendors alike. Volunteer opportunities are available for both teens and adults in a wide variety of positions, including greeters, family liaisons, emergency room support, gift shop support, nurse aides, office support, pet therapy, physical therapy, patient visitors, recovery room support, art therapy, and central transporters. Volunteers also transport students and serve as guides, escorts, and interpreter aides. Form 990, Part III, 4a: TMH is licensed to operate 247 acute care beds by the Rhode Island Department of Health. Notable medical accomplishments of TMH include performance of Rhode Island's first lung operation, first kidney transplant, and first aortic balloon valvuloplasty (a procedure to clear blocked heart valves). In 2023, TMH discharged 17,580 inpatients, logged more than 70,000 visits in its Emergency Department, and performed 11,990 inpatient and outpatient surgical procedures. Services provided in 2024 represent 74,903 inpatient days and more than 142,000 clinic visits. TMH is staffed by 1,298 privileged physicians, approximately 92 full-time house staff (medical school graduates), and a nursing staff of 927. In total, TMH employs more than 3,500 people. TMH is a major teaching affiliate of The Warren Alpert Medical School of Brown University, providing clinical rotations for residents.TMH provides full charity care for individuals at or below twice the federal poverty level, with a sliding scale for individuals up to three times the poverty level, as set by the Department of Health and Human Services. In addition, a substantial discount consistent with Medicare program reimbursement is offered to all other uninsured patients. TMH determines the costs associated with providing charity care by aggregating the applicable direct and indirect costs, including compensation and benefits, supplies, and other operating expenses, based on data from its costing system. The total cost, excluding medical education and research, incurred by TMH to provide charity care amounted to $12,105,072 in fiscal 2024. Charges forgone, based on established rates, amounted to $32,083,084.TMH substantially subsidized various health services including the following programs: adult psychiatry, tuberculosis, and certain other specialty services at a net cost of $7,376,366 in fiscal year 2024. TMH also provides numerous other services to the community for which charges are not generated. These services include certain emergency services, community health screenings for cardiac health, prostate cancer and other diseases, smoking cessation, immunization and nutrition programs, diabetes education, community health training programs, patient advocacy, foreign language translation, physician referral services, and charitable contributions. The net cost of these services amounted to $296,001 in fiscal year 2024.TMH subsidizes the cost of treating patients who receive government assistance where reimbursement is below cost. Medicaid is a means-tested health insurance program, jointly funded by state and federal governments. States administer the program and set rules for eligibility, benefits, and provider payments within broad federal guidelines. The program provides health care coverage to low-income children and families, pregnant women, long-term unemployed adults, seniors, and persons with disabilities. Eligibility is determined by a variety of factors, which include income relative to the federal poverty line, age and immigration status, and assets.TMH offers expertise in total joint replacement, minimally invasive and robotic surgery, and bariatric surgery, among many other specialties.The Leonard and Adele R. Decof Family Comprehensive Cancer Center at TMH brings together world-renowned physicians and a team of specialists from TMH, Rhode Island Hospital (RIH), and Newport Hospital (NH), forming a multidisciplinary team whose level of knowledge and experience are unparalleled in the State of Rhode Island. TMH, as a part of the Brown University Health Cancer Institute, provides state-of-the-art care for patients with cancer.Award-Winning Care:Through the years, The Miriam Hospital has received numerous distinctions and awards. TMH is one of an elite group of hospitals nationwide and internationally to achieve Magnet designation for nursing excellence six times from the American Nurses Credentialing Center (ANCC), with a current designation through 2024. This is the highest nursing credential, earned after an extensive application process is conducted every four years, in a hospital where nurses participate at all levels of care, making clinical and systems decisions to improve patient outcomes and experience.The Magnet Model promotes the critical role of nurses in achieving improved empirical outcomes through transformational leadership, structural empowerment, exemplary professional practice and new knowledge, innovations and improvements. A Magnet designated hospitals must possess high level nurse-to-patient ratios above non-magnet hospitals and demonstrate improved patient outcomes with superb nursing care for retaining this credential.The Miriam Hospital earned the Top Hospital in Rhode Island designation from US News & World Report for the 13th year in a row in its 2024 to 2025 report on the best hospitals in the country. The Miriam also ranked as the Top Hospital in the Providence metro area, which includes Providence, Pawtucket, Rhode Island, Fall River, Massachusetts, and New Bedford, Massachusetts.Additionally, US News & World Report awarded The Miriam a "high performing," rating for treatment of 10 conditions and adult specialty areas including hip and knee replacements, colon cancer surgery, heart and kidney failure, heart attack, stroke, prostate cancer surgery, pneumonia and chronic obstructive pulmonary disease.The Spine Center at The Miriam Hospital has earned an Advanced Certification in Spine Surgery (ACSS) from The Joint Commission, making it the first program in the region to earn an advanced certification, after a rigorous two-day survey by The Joint Commission resulting in zero findings, making it an accredited Spine Center of Excellence.The Miriam Hospital was named one of Avant-Garde Healths 16 Healthcare Research All-Stars, in 2024, placing it among the top one percent of spine research hospitals in the nation. Alan Daniels, MD, chief for the division of spine surgery and director of adult spinal deformity service at Rhode Island and The Miriam hospitals, and spine surgeon Eren O. Kuris, MD, were among the 2024 Avant Garde Healths 52 Spine Research All-Stars. a distinction for top surgeons and hospitals across 10 specialties, measured through procedural volumes, peer-reviewed publications, and publication weight.In 2024, the Center for Bariatric Surgery, a program of Rhode Island and The Miriam hospitals, was reaccredited as a Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) Comprehensive Center with Adolescent and Obesity Medicine Qualifications. This recognition acknowledges our commitment to providing and supporting quality improvement and patient safety efforts for metabolic and bariatric surgery patients. The program is also designated an Aetna Institute of Quality Bariatric Surgery Facility for 2022-2024, recognizing high-performing healthcare facilities that offer specialized care and meet high standards of quality and cost-efficiency. The Center for Bariatric Surgery is recognized for consistently delivering evidence-based, quality care for bariatric surgery patients from the interprofessional team of doctors, nurses, nutritionists, and pharmacists.The American Heart Association/American Stroke Association presented The Miriam Hospital, a primary stroke center, with the Get with the Guidelines - Stroke Gold Plus, award in 2024 including the Type 2 Diabetes and Stroke Honor Rolls. Receiving the Gold Plus award means that The Miriam continues to reach an aggressive goal of treating patients with 85 percent or higher compliance to core standard levels of care outlined by the AHA for 24 consecutive months or more. This award honors the hospitals commitment to ensuring stroke patients receive the most appropriate, leading-edge treatment, as quickly as possible, in accordance with nationally recognized, evidence-based guidelines.In the spring of 2023, The Miriam Hospital earned a Leapfrog Hospital Safety Grade of A. The Leapfrog Group is a national nonprofit upholding the standard of patient safety in hospitals and ambulatory surgery centers. The Miriam received this national distinction for its achievements in prioritizing patient safety by protecting patients from preventable harm and errors. This grade reflected performance primarily during the height of the pandemic. Form 990, Part III, 4b: TMH provided $2,882,000 in support of research activities in fiscal year 2024. TMH conducts extensive medical research and is in the forefront of biomedical health care delivery research and among the leaders nationally in National Institutes of Health programs. Major areas of research include:Cancer - TMH conducts clinical and behavioral research focusing on the many facets of cancer including prevention, education, and therapeutics, which are supported by the National Cancer Institute, the Cancer and Leukemia Group B, and the National Surgical Adjuvant Breast and Bowel Project. TMH is a participating hospital in the Brown University-sponsored Cancer Oncology Group.HIV/AIDS - The Brown Health/Tufts/Brown Center for AIDS Research (CFAR) is a joint research effort among Brown University and Tufts University and their affiliated hospitals and centers. It is one of 20 centers located at academic medical centers throughout the United States that are part of the national CFAR program of the National Institutes of Health. The program emphasizes the importance of interdisciplinary collaboration, especially between basic and clinical investigators, and also encourages training and mentoring of young investigators as well as an inclusion of women and minorities. As part of the CFAR, division researchers engage in clinical, basic, and translational research designed to improve the prevention and treatment of HIV/AIDS, with a major focus on women, racial and ethnic minorities, and individuals with substance abuse problems. At TMH, research focuses on the treatment and prevention of HIV infections, especially in hard-to-reach populations, both in the U.S. and abroad. There are international sites located in Cambodia, India, Kenya, Indonesia, The Philippines, and South Africa. TMH's TB Clinic performs research in the area of co-infections of HIV and tuberculosis. The Centers for Behavioral and Preventive Medicine aims to improve health through behavioral change and the integration of behavioral and biomedical science using clinical, community, and laboratory-based research. The Centers' research bridges biomedical, sociobehavioral, and population/public health scientific disciplines. Faculty members are committed to both basic research on discovering the mechanisms underlying behavioral factors in health and illness (e.g., examining the stress response among children and adolescents, neuroimaging of AIDS, and other medical conditions), and to applied research on the translation of these discoveries for clinical and community health improvement. Programs range from those that focus on primary prevention (e.g., promoting smoking cessation, preventing weight gain, increasing physical activity, and HIV/AIDS prevention) to improving the effectiveness of treatment and enhancing quality of life in populations such as cancer survivors and patients enrolled in cardiac rehabilitation programs. Form 990, Part III, 4c: TMH provides the setting for and substantially supports medical education in various clinical training and nursing programs. The total cost of medical education provided by TMH exceeded the reimbursement received from third-party payors by $24,466,654 in 2024.In 1969, TMH and certain other Rhode Island hospitals entered into an affiliation agreement to participate jointly in various clinical training programs and research activities with Brown Medical School, renamed The Warren Alpert Medical School of Brown University (Brown). The goals of the partnership are to facilitate the expansion of joint educational and research programs to enable competition both clinically and academically.TMH participates in Brown programs in anesthesiology, internal medicine and medicine subspecialties, general surgery and surgical subspecialties, psychiatry, emergency medicine and emergency medicine subspecialties, orthopedics and orthopedic subspecialties, and dermatology. TMH provides stipends to residents and physician fellows while in training.In addition, TMH is a participating clinical training site for residents from other programs in anesthesiology, family medicine, internal medicine, emergency medicine, hematology/oncology, obstetrics/gynecology (OB/Gyn) and OB/Gyn subspecialties, dermatology, dermatopathology and pediatric pathology, otolaryngology, pediatric dentistry, podiatry, psychiatry and its subspecialties of forensic psychiatry, consult liaison psychiatry and geriatric psychiatry, orthopedics, rheumatology, and radiation oncology.Various departments and specialties at TMH serve as clinical sites for the physician assistant schools of Johnson & Wales University, Bryant University, and the Massachusetts College of Pharmacy. In addition, Behavioral Medicine at TMH, in collaboration with Brown, sponsors research and clinical psychology training programs for interns, postdoctoral fellows, and faculty trainees.With respect to nursing education, TMH has developed educational affiliations with the University of Rhode Island College of Nursing; Community College of Rhode Island (CCRI); Salve Regina University; Boston College; Yale University; Regis College; Simmons College; the University of Massachusetts campuses at Dartmouth, Boston, Amherst, and Worcester; Framingham State University; the University of Connecticut; The New England Institute of Technology; Northeastern University; Drexel University; Walden University; Georgetown University School of Nursing and Health Studies; Duke University School of Nursing; and the University of Pennsylvania, as well as other Schools of Nursing, pursuant to which their nursing students obtain clinical training and experience at TMH. TMH does not receive any compensation from the various schools for providing a clinical setting for the student nurse training. The Brown Health School of Medical Imaging collaborates with Rhode Island College in the following programs: diagnostic medical sonography; nuclear medicine technology; radiography; and magnetic resonance imaging. Students complete educational experiences at the Hospital, as well as other outpatient sites.TMH sponsors training programs for a variety of allied health care professionals, including required clinical and fieldwork experiences in physical, speech, and occupational therapy, which are provided to university students in each discipline through contracts with the various universities. TMH acts as a clinical training site for students from CCRI in its vascular and cardiology ultrasound programs and provides training experiences for both phlebotomy students and physical therapy assistant students. TMH serves as a clinical training site for students from The Nuclear Medicine Institute of the University of Findlay (Ohio) and has educational affiliations with the respiratory programs at both CCRI and The New England Institute of Technology. TMHs EEG Department provides clinical training to neurodiagnostic technology students from Laboure College (Massachusetts).TMH has clinical affiliations/student clinical training programs for pharmacy students provided through contracts with various colleges and universities. Most of the pharmacy students attend the University of Rhode Island, Massachusetts College of Pharmacy and Health Sciences, and Northeastern University. TMH has clinical social work student contracts with Rhode Island College, Boston University, Boston College, Smith College, Simmons College, and Bridgewater State University. Form 990, Part VI, Section A, Line 1b: *Lawrence A. Aubin, Sr., Chair, and Michael Hanna, Trustee, are owners of New England Real Estate Holding Group, LLC (NEREHG), with which Brown Health has entered into an operating lease of a health care facility. During fiscal year 2024, Brown Health paid rent to NEREHG under the terms of its lease. Terms of the rent expense related to the lease have been established at fair market value. Form 990, Part VI, Section B, Line 12c: Brown University Health has a Conflict of Interest Policy that is applicable to all affiliates, including TMH, and administered by Brown Health's Corporate Compliance Department as follows: Each designated person subject to Brown Health's conflict of interest policy is required to provide Brown Health with an initial disclosure statement and thereafter an annual statement attesting that: (i) the designated person has read and is familiar with this policy, and (ii) the designated person and, to the best of his/her knowledge, family members, have not in the past engaged in, are not presently engaging in, or plan to engage in, any activity which contravenes this policy.If, at any time during the course of employment or association, a designated person has reason to believe that an existing or contemplated activity may contravene this policy, the person shall submit a full written description of the activity to the Brown Health Compliance Officer or the Office of the General Counsel to seek a determination as to whether the contemplated activity does or does not contravene this policy. If the activity in question involves either the Chief Executive Officer, the Senior Vice President and General Counsel, or a Trustee, a full written disclosure must be made to, and a determination sought from, the Chairman of the Board of Directors of Brown University Health.Annually, the Brown Health Compliance Officer shall review and report to the Brown Health Executive Corporate Compliance Committee and to the Brown Health Audit and Compliance Committee on the administration of this policy.Failure on the part of any designated person to comply with this policy, including failure to submit in a timely fashion the conflict of interest disclosure statement, will be grounds for removal from his/her position and/or termination of his/her employment with Brown Health. Form 990, Part VI, Section B, Lines 15 a&b: The following applies to Brown Health and all of its affiliates, including TMH:EXECUTIVE COMPENSATIONBrown Health's executive compensation philosophy balances appropriate stewardship of resources and the need to be competitive in recruiting and retaining talented individuals. It incorporates market-competitive and performance-related principles, and covers the President and CEO of Brown Health as well as other officers, senior management, and key employees. Brown Health's executive compensation program complies both with law and with contemporary ethical norms, and is administered consistent with the organization's tax-exempt status under Section 501(c)(3) of the Internal Revenue Code (IRC) and the avoidance of transactions subject to intermediate sanctions under Section 4958 of the IRC. Executive compensation is also administered consistent with Brown Health's Corporate Compliance Policy on Excess Benefit Transactions.The Compensation Committee of the Brown University Health Board of Directors (the Committee), comprised of disinterested Brown Health Board members, is responsible for diligent oversight of executive compensation to ensure compliance with IRC requirements. Its duties include:* Approving eligibility for participation in the executive compensation program * Approving changes in compensation for existing executive participants * Approving guidelines, such as salary ranges and contract terms, on appropriate levels of compensation for other key employees* Approving new, and modifying or terminating existing, executive compensation plans including, but not limited to, annual incentive and executive benefit plans* Approving performance objectives associated with Brown Health's annual incentive plan, including measuring points, and using verified actual performance relative to these objectives as a precondition to approving the payment of any awards under the plan* Authorizing periodic performance benchmark studies to be conducted for purposes of assessing Brown Health's performance within the healthcare industry and the degree to which total remuneration levels at Brown Health are generally commensurate with Brown Health performance relative to healthcare industry performance* Conducting an annual performance review of Brown Health's Chief Executive Officer. The Chair of the Committee conducts and documents this review, based on his/her observations and interpretation of feedback from members of the Board of Directors.* Selecting and engaging qualified, independent, third-party compensation valuation consultants that the Committee charges with rendering opinions with respect to the reasonableness and comparability of compensation as well as the comparative organizations against which compensation is assessed, in accordance with relevant sections of the IRC and Brown Health's executive compensation philosophy.Brown Health's Chief Executive Officer works closely with the Committee to make recommendations on the above topics and keep the Committee informed about contemplated compensation changes for executives and other key employees, as well as candidates for these roles. The CEO also provides periodic updates to the Committee regarding Brown Health's performance relative to compensation-related performance objectives. The Committee's deliberations and actions are documented in minutes prepared for each meeting.PROCESS FOR DETERMINING COMPENSATION Valuation of Total Cash and Total Remuneration: No less frequently than annually, the Committee receives and reviews a total cash compensation valuation of all existing executive compensation program participants prepared by its independent compensation consultant. Annually, the Committee also receives and reviews a total remuneration valuation of all existing executive compensation participants.Base Salary Actions: The CEO recommends any salary adjustments for participants in the executive compensation program, using the results of the valuation study and his/her assessment of individual performance or other pertinent information, for the Committee's consideration.New Participants in Executive Compensation Program: With respect to compensation offers for individuals expected to participate in the executive compensation program, certain members of the Brown Health CEO's leadership team work with the Committee's independent compensation consultant or rely on information previously provided by the consultant to establish a range of reasonable cash compensation within which recruitment is expected to conclude with acceptance of a reasonable compensation offer. Form 990, Part XII, Line 2: TMH was included in the Brown Health and Affiliates audited consolidated financial statements as of and for the fiscal year ended September 30, 2024. Included in the amounts reported for TMH include activity of TMH and VNA Technicare, Inc., d/b/a Brown University Health Home Medical. The Brown Health Audit and Compliance Committee assumes responsibility for oversight of the audit of TMH's consolidated financial statements and the selection of Brown Health's independent accountant. 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