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        <ExplanationTxt>Facility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xplanationTxt>
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        <ExplanationTxt>Facility , 1 - MERCY MEDICAL CENTER. THE HEALTH AND SOCIAL NEEDS OF MERCY'S COMMUNITY WERE IDENTIFIED IN THE Community Health Needs Assessment (CHNA) which was completed and published before June 30, 2016. IN ADDITION, MERCY HAS COMPLETED AN UPDATED COMMUNITY HEALTH NEEDS ASSESSMENT AND IMPLEMENTATION STRATEGY IN JUNE 2018, JUNE 2021, as well as June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xplanationTxt>
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      <SupplementalInformationGrp>
        <FormAndLineReferenceDesc>Schedule H, Part V, Section B, Line 20 Facility , 1</FormAndLineReferenceDesc>
        <ExplanationTxt>Facility , 1 - MERCY MEDICAL CENTER. THE HOSPITAL FACILITY OR AN AUTHORIZED THIRD PARTY DID NOT UNDERTAKE ANY OF THE COLLECTION ACTIONS NOTED IN PART V, SECTION B, LINE 19 BEFORE MAKING REASONABLE EFFORTS TO DETERMINE ANY PATIENT'S ELIGIBILITY UNDER THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY. IN ORDER TO HELP DETERMINE PATIENTS' ELIGIBILITY UNDER THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY, THE HOSPITAL UNDERTAKES A NUMBER OF ACTIONS, INCLUDING NOTIFYING PATIENTS OF THE FINANCIAL ASSISTANCE POLICY ON ADMISSION, NOTIFYING PATIENTS OF THE FINANCIAL ASSISTANCE POLICY PROIOR TO DISCHARGE, NOTIFYING PATIENTS OF THE FINANCIAL ASSISTANCE POLICY IN COMMUNICATIONS WITH THE PATIENTS' BILLS, AND DOCUMENTING ITS DETERMINATION OF WHETHER PATIENTS WERE ELIGIBLE FOR FINANCIAL ASSISTANCE UNDER THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY.</ExplanationTxt>
      </SupplementalInformationGrp>
      <FacilityNum>0</FacilityNum>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Schedule H, Part I, Line 6a</FormAndLineReferenceDesc>
        <ExplanationTxt>COMMUNITY BENEFIT REPORT IS MADE AVAILABLE ON ANOTHER'S WEBSITE, SPECIFICALLY THE WEBSITE FOR THE MARYLAND HSCRC. MERCY MEDICAL CENTER PREPARES ITS COMMUNITY BENEFIT REPORT ANNUALLY AND ITS MADE AVAILABLE TO THE PUBLIC.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Schedule H, Part I, Line 7</FormAndLineReferenceDesc>
        <ExplanationTxt>7A. CHARITY CARE AT COST AND 7F. HEALTH PROFESSIONS EDUCATION ARE EXPLAINED IN THE FOLLOWING: MARYLAND'S REGULATORY SYSTEM CREATES A UNIQUE PROCESS FOR HOSPITAL PAYMENT THAT DIFFERS FROM THE REST OF THE NATION. THE HEALTH SERVICES COST REVIEW COMMISSION, (HSCRC) DETERMINES PAYMENT THROUGH A RATE SETTING PROCESS ALL PAYORS, INCLUDING GOVERNMENTAL PAYORS, PAY THE SAME AMOUNT FOR THE SAME SERVICES DELIVERED AT THE SAME HOSPITAL. MARYLAND'S UNIQUE ALL PAYOR SYSTEM INCLUDES A METHOD FOR REFERENCING UNCOMPENSATED CARE IN EACH PAYORS' RATES, WHICH DOES NOT ENABLE MARYLAND HOSPITALS TO BREAKOUT ANY OFFSETTING REVENUE RELATED TO UNCOMPENSATED CARE. 7B. UNREIMBURSED MEDICAID IS EXPLAINED IN THE FOLLOWING: MARYLAND'S REGULATORY SYSTEM CREATES A UNIQUE PROCESS FOR HOSPITAL PAYMENT THAT DIFFERS FROM THE REST OF THE NATION. THE HEALTH SERVICES COST REVIEW COMMISSION, (HSCRC) DETERMINES PAYMENT THROUGH A RATE SETTING PROCESS ALL PAYORS, INCLUDING GOVERNMENTAL PAYORS, PAY THE SAME AMOUNT FOR THE SAME SERVICES DELIVERED AT THE SAME HOSPITAL. MARYLAND'S UNIQUE ALL PAYOR SYSTEM INCLUDES A METHOD FOR REFERENCING UNCOMPENSATED CARE IN EACH PAYORS' RATES, WHICH DOES NOT ENABLE MARYLAND HOSPITALS TO BREAKOUT ANY DIRECTED OFFSETTING REVENUE RELATED TO UNCOMPENSATED CARE. COMMUNITY BENEFIT EXPENSES ARE EQUAL TO MEDICAID REVENUES IN MARYLAND, AS SUCH, THE NET EFFECT IS ZERO. THE EXCEPTION TO THIS IS THE IMPACT ON THE HOSPITAL OF ITS SHARE OF THE MEDICAID ASSESSMENT. IN RECENT YEARS, THE STATE OF MARYLAND HAS CLOSED FISCAL GAPS IN THE STATE MEDICAID BUDGET BY ASSESSING HOSPITALS THROUGH THE RATE SETTING SYSTEM. FOR FY 2025 MERCY MEDICAL CENTER'S SHARE OF THE MEDICAID ASSESSMENT WAS $1,860,865.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Schedule H, Part V, Section A</FormAndLineReferenceDesc>
        <ExplanationTxt>MERCY MEDICAL CENTER (MMC) IS A LICENCED HOSPITAL. MMC PROVIDES INPATIENT, OUTPATIENT AND EMERGENCY CARE SERVICES PRIMARILY FOR THE CITIZENS OF THE BALTIMORE METROPOLITAN AREA.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Schedule H, Part V, Section B, Line 21</FormAndLineReferenceDesc>
        <ExplanationTxt>THE HOSPITAL FACILITY PROVIDES A DISCOUNT OF AT LEAST 10% OFF OF GROSS CHARGES FOR THE PROVISION OF EMERGENCY AND OTHER MEDICALLY NECESSARY CARE TO ANY INDIVIDUAL THAT IS ELIGIBLE FOR FINANCIAL ASSISTANCE UNDER THE HOSPITAL FACILITY'S FINANCIAL ASSISTANCE POLICY. PURSUANT TO THE HEALTH SERVICES COST REVIEW COMMISSION (HSCRC) ALL-PAYOR SYSTEM FOR HOSPITALS IN THE STATE OF MARYLAND, THE GREATEST DISCOUNT OFF OF GROSS CHARGES FOR THE PROVISION OF EMERGENCY AND OTHER MEDICALLY NECESSARY CARE PERMITTED TO ANY COMMERCIAL INSURER OR MEDICARE IS ONLY 6%. AS A RESULT, THE HOSPITAL FACILITY WAS ABLE TO DETERMINE THAT THE MAXIMUM AMOUNT CHARGED TO INDIVIDUALS THAT WERE ELIGIBLE FOR FINANCIAL ASSISTANCE UNDER THE HOSPITAL FACILITY'S FINANCIAL ASSISTANCE POLICY WAS NOT GREATER THAN THE AMOUNT GENERALLY BILLED TO INDIVIDUALS WHO HAVE INSURANCE COVERING SUCH CARE.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Schedule H, Part V, Section B, Line 23</FormAndLineReferenceDesc>
        <ExplanationTxt>THE HOSPITAL DOES NOT CHARGE ANY INDIVIDUALS THAT ARE ELIGIBLE FOR FINANCIAL ASSISTANCE AN AMOUNT EQUAL TO THE GROSS CHARGES FOR ANY SERVICE. THE HOSPITAL USED THE CHARGEMASTER RATES FOR A SERVICE AS A STARTING POINT AGAINST WHICH REDUCTIONS ARE APPLIED TO DETERMINE THE AMOUNT ACTUALLY BILLED TO PATIENTS ELIGIBLE UNDER THE FINANCIAL ASSISTANCE POLICY.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Schedule H, Part I, Line 3c</FormAndLineReferenceDesc>
        <ExplanationTxt>MERCY MEDICAL CENTER PROVIDES EMERGENCY AND OTHER MEDICALLY NECESSARY CARE TO PATIENTS THAT QUALIFY FOR FINANCIAL ASSISTANCE AT NO CHARGE OR AT REDUCED-COST BASED ON A SLIDING SCALE FOR INCOME (UP TO APPROXIMATELY 500% OF THE FEDERAL POVERTY GUIDELINES) AND TAKING INTO ACCOUNT OTHER CONSIDERATIONS, AS DESCRIBED BELOW. IN ORDER TO QUALIFY FOR FINANCIAL ASSISTANCE UNDER MERCY MEDICAL CENTER'S FINANCIAL ASSISTANCE POLICY, A PATIENT MUST BE A U.S. CITIZEN OR PERMANENT LEGAL RESIDENT WHO QUALIFIES UNDER AT LEAST ONE OF THE FOLLOWING CONDITIONS: 1. A PATIENT WITH FAMILY INCOME AT OR BELOW 200% OF THE FEDERAL POVERTY LEVEL, WITH LESS THAN $100,000 IN HOUSEHOLD MONETARY ASSETS QUALIFIES FOR FULL FINANCIAL ASSISTANCE IN THE FORM OF FREE MEDICALLY NECESSARY CARE. 2. A PATIENT NOT OTHERWISE ELIGIBLE FOR MEDICAID OR CHIP WHO IS A BENEFICIARY/RECIPIENT OF A MEANS-TESTED SOCIAL SERVICES PROGRAM, INCLUDING BUT NOT NECESSARILY LIMITED TO THE FOLLOWING PROGRAMS, IS DEEMED ELIGIBLE FOR FINANCIAL ASSISTANCE IN THE FORM OF FREE MEDICALLY NECESSARY CARE, PROVIDED THAT THE PATIENT SUBMITS PROOF OF ENROLLMENT WITHIN 30 DAYS UNLESS THE PATIENT OR THE PATIENT'S REPRESENTATIVE REQUESTS AN ADDITIONAL 30 DAYS: A) HOUSEHOLDS WITH CHILDREN IN THE FREE OR REDUCED LUNCH PROGRAM B) SUPPLEMENTAL NUTRITIONAL ASSISTANCE PROGRAM (SNAP) C) LOW-INCOME-HOUSEHOLD ENERGY ASSISTANCE PROGRAM D) PRIMARY ADULT CARE PROGRAM (PAC), UNTIL SUCH TIME AS INPATIENT BENEFITS ARE ADDED TO THE PAC BENEFIT PACKAGE E) WOMEN, INFANTS, AND CHILDREN (WIC). 3. A PATIENT WITH FAMILY INCOME AT OR BELOW 500% OF FEDERAL POVERTY LEVEL, WITH LESS THAN $100,000 IN HOUSEHOLD MONETARY ASSETS QUALIFIES FOR PARTIAL FINANCIAL ASSISTANCE IN THE FORM OF REDUCED-COST MEDICALLY NECESSARY CARE. THE AMOUNT OF FINANCIAL ASSISTANCE IN THIS CASE IS BASED ON A SLIDING SCALE OF INCOME AND SHOWN IN THE ATTACHED TABLE AND OTHER FACTORS. 4. A PATIENT WITH: (I) FAMILY INCOME AT OR BELOW 500% OF FEDERAL POVERTY LEVEL; (II) WITH MEDICAL DEBT INCURRED WITHIN THE 12 MONTH PERIOD PRIOR TO APPLICATION THAT EXCEEDS 25% OF FAMILY INCOME FOR THE SAME PERIOD; AND (III) WITH LESS THAN $100,000 IN HOUSEHOLD MONETARY ASSETS WILL QUALIFY FOR PARTIAL FINANCIAL ASSISTANCE IN THE FORM OF REDUCED-COST MEDICALLY NECESSARY CARE. THE AMOUNT OF FINANCIAL ASSISTANCE IN THIS CASE IS BASED ON A SLIDING SCALE OF INCOME, AMOUNT OF MEDICAL DEBT, AND OTHER FACTORS. A) AN ELIGIBLE PATIENT OR ANY IMMEDIATE FAMILY MEMBER OF THE PATIENT LIVING IN THE SAME HOUSEHOLD SHALL REMAIN ELIGIBLE FOR REDUCED-COST MEDICALLY NECESSARY CARE WHEN SEEKING SUBSEQUENT CARE AT MERCY MEDICAL CENTER DURING THE 12-MONTH PERIOD BEGINNING ON THE DATE ON WHICH THE REDUCED-COST MEDICALLY NECESSARY CARE WAS INITIALLY RECEIVED. B) TO AVOID AN UNNECESSARY DUPLICATION OF MERCY MEDICAL CENTER'S DETERMINATIONS OF ELIGIBILITY FOR FINANCIAL ASSISTANCE, A PATIENT ELIGIBLE FOR CARE UNDER PARAGRAPH 4.A SHALL INFORM THE HOSPTIAL OF HIS OR HER ELIGIBILITY FOR THE REDUCED-COST MEDICALLY NECESSARY CARE. 5. AN UNINSURED PATIENT WITH FAMILY INCOME BETWEEN 200% AND 500% OF FEDERAL POVERTY LEVEL WHO REQUESTS ASSISTANCE QUALIFIES FOR A PAYMENT PLAN. 6. A HOMELESS PATIENT QUALIFIES FOR FINANCIAL ASSISTANCE. 7. A DECEASED PATIENT, WITH NO PERSON DESIGNATED AS DIRECTOR OF FINANCIAL AFFAIRS, OR NO ESTATE NUMBER ON FILE AT THE APPLICABLE REGISTRARS OF WILLS DEPARTMENT, QUALIFIES FOR FINANCIAL ASSISTANCE. 8. A MEDICAID PATIENT WHO HAS A REMAINING BALANCE AFTER RECEIVING MEDICAL ASSISTANCE QUALIFIES FOR FINANCIAL ASSISTANCE. 9. MERCY MEDICAL CENTER MAY ELECT TO GRANT PRESUMPTIVE CHARITY CARE TO PATIENTS BASED ON INFORMATION GATHERED DURING A DEBT COLLECTION PROCESS. FACTORS INCLUDE PROPENSITY TO PAY SCORING, ELIGIBILITY AND PARTICIPATION IN OTHER FEDERAL PROGRAMS, AND OTHER RELEVENT INFORMATION. 10. A PATIENT WHO DOES NOT QUALIFY UNDER THE PRECEDING CATEGORIES MAY STILL APPLY FOR FINANCIAL ASSISTANCE, AND MERCY MEDICAL CENTER WILL REVIEW THE APPLICATION AND MAKE A DETERMINATION ON A CASE-BY-CASE BASIS AS TO ELIGIBILITY FOR FINANCIAL ASSISTANCE. FACTORS THAT WILL BE CONSIDERED INCLUDE: A) FIXED INCOME SUCH AS SOCIAL SECURITY, RETIREMENT OR DISABILITY WITH NO ADDITIONAL INCOME SOURCES AVAILABLE B) MEDICAL EXPENSES AND/OR C) EXPENSES RELATED TO NECESSITIES OF LIFE COMPARED TO INCOME. FOR ALL PURPOSES OF THE FINANCIAL ASSISTANCE POLICY, "HOUSEHOLD MONETARY ASSETS" MEANS ASSETS THAT ARE CONVERTIBLE TO CASH. IN DETERMINING A PATIENT'S MONETARY ASSETS FOR PURPOSES OF MAKING AN ELIGIBILITY DETERMINATION UNDER THIS FINANCIAL ASSISTANCE POLICY, THE FOLLOWING ASSETS ARE EXCLUDED; (1) THE FIRST $10,000 OF MONETARY ASSETS; (2) EQUITY OF $150,000 IN A PRIMARY RESIDENCE; AND (3) RETIREMENT ASSETS TO WHICH THE IRS HAS GRANTED PREFERENTIAL TAX TREATMENT AS A RETIREMENT ACCOUNT, INCLUDING BUT NOT LIMITED TO, QUALIFIED AND NONQUALIFIED DEFERRED COMPENSATION PLANS.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Schedule H, Part I, Line 7g Subsidized Health Services</FormAndLineReferenceDesc>
        <ExplanationTxt>THERE ARE NO COSTS REPORTED THAT ARE ATTRIBUTABLE TO A PHYSICIAN CLINIC.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Schedule H, Part I, Line 7 Costing Methodology used to calculate financial assistance</FormAndLineReferenceDesc>
        <ExplanationTxt>THE COSTING METHODOLOGY USED TO CALCULATE AMOUNTS REPORTED IN LINE 7 WAS A COST-TO-CHARGE RATIO DERIVED FROM WORKSHEET 2, RATIO OF PATIENT CARE COST-TO-CHARGES.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Schedule H, Part III, Line 4 Bad debt expense - financial statement footnote</FormAndLineReferenceDesc>
        <ExplanationTxt>THE AMOUNT REPORTED AS BAD DEBT EXPENSE ON PART III, LINE 2 WAS DETERMINED USING ACTUAL BAD DEBT WRITE-OFFS LESS RECOVERIES RECEIVED DURING THE YEAR AND AN ADJUSTMENT TO THE BALANCE SHEET RESERVE. WRITE OFFS WERE AT CHARGE LEVEL. THE ORGANIZATION HAS NOT ESTIMATED ANY AMOUNT OF BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY. THE FOLLOWING IS A SUMMARY OF THE TEXT OF THE FOOTNOTE TO THE ORGANIZATION'S FINANCIAL STATEMENTS THAT DESCRIBE THE ORGANIZATION'S BAD DEBT EXPENSE. THE ACTUAL TEXT OF THE FOOTNOTE HAS NOT BEEN USED BECAUSE THE ORGANIZATION IS A MEMBER OF A GROUP WITH CONSOLIDATED FINANCIAL STATEMENTS: NET PATIENT SERVICE REVENUES AND ALLOWANCES NET PATIENT SERVICE REVENUES ARE REPORTED AT THE ESTIMATED NET REALIZABLE AMOUNTS FROM PATIENTS, THIRD-PARTY PAYERS, AND OTHERS FOR SERVICES RENDERED. THE ORGANIZATION'S CHARGES ARE BASED ON RATES ESTABLISHED BY THE STATE OF MARYLAND HEALTH SERVICES COST REVIEW COMMISSION; ACCORDINGLY, REVENUE REFLECTS ACTUAL CHARGES TO PATIENTS BASED ON RATES IN EFFECT DURING THE PERIOD IN WHICH THE SERVICES ARE RENDERED. CONTRACTUAL ADJUSTMENTS REPRESENT THE DIFFERENCE BETWEEN AMOUNTS BILLED AS PATIENT SERVICE REVENUE AND AMOUNTS ALLOWED BY THIRD-PARTY PAYERS, AND ARE ACCRUED IN THE PERIOD IN WHICH THE RELATED SERVICES ARE RENDERED. THE PROVISION FOR BAD DEBTS IS BASED UPON MANAGEMENT'S ASSESSMENT OF HISTORICAL AND EXPECTED NET COLLECTIONS. THIS ESTIMATE CONSIDERS BUSINESS AND GENERAL ECONOMIC CONDITIONS, TRENDS IN HEALTHCARE COVERAGE AND OTHER COLLECTION INDICATORS. THROUGHOUT THE YEAR, MANAGEMENT ASSESSES THE ADEQUACY OF THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS BASED UPON ITS REVIEW OF ACCOUNTS RECEIVABLE AND COLLECTIONS TO DATE. OTHER FACTORS, SUCH AS PAYER MIX, ACCOUNT AGING, APPROVED DISCOUNTS, DENIAL RATES, AND PAYMENT CYCLES ARE CONSIDERED WHEN ESTIMATING THE ALLOWANCES. THE RESULTS OF THESE ASSESSMENTS ARE USED TO DETERMINE THE PROVISION FOR BAD DEBTS AND TO ESTIMATE AN APPROPRIATE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS. THE ORGANIZATION FOLLOWS ESTABLISHED GUIDELINES FOR PLACING ITS SELF-PAY PATIENT ACCOUNTS WITH AN OUTSIDE COLLECTION AGENCY. AFTER COLLECTION EFFORTS ARE EXHAUSTED, THE UNCOLLECTED BALANCES ARE RETURNED TO BE WRITTEN OFF TO BAD DEBTS. THE ORGANIZATION DOES NOT MAINTAIN A MATERIAL ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS FROM THIRD-PARTY PAYERS, NOR DID IT HAVE SIGNIFICANT WRITE OFFS FROM THIRD-PARTY PAYERS.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Schedule H, Part III, Line 8 Community benefit &amp; methodology for determining medicare costs</FormAndLineReferenceDesc>
        <ExplanationTxt>THE COSTING SOURCE IS THE MEDICARE COST REPORT AND THE METHODOLOGY IS MEDICARE ALLOWABLE COST TO MEDICARE REVENUES RECEIVED.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance</FormAndLineReferenceDesc>
        <ExplanationTxt>ONCE THE COLLECTION PROCESS HAS BEGUN, THE ORGANIZATION CONTINUES TO MONITOR WHETHER THE PATIENT QUALIFIES FOR CHARITY CARE UNDER THE FINANCIAL ASSISTANCE POLICY. IF THE ORGANIZATION DETERMINES THAT A PATIENT QUALIFIES FOR FINANCIAL ASSISTANCE, INCLUDING ONCE THE COLLECTION PROCESS HAS BEGUN, THE ORGANIZATION WILL APPROVE THE PATIENT FOR CHARITY CARE. ONCE CHARITY CARE HAS BEEN APPROVED, THERE IS NO FURTHER ATTEMPT MADE BY THE ORGNANIZATION TO COLLECT. COLLECTION EFFORTS WILL BE STOPPED AT ANY TIME DURING THE COLLECTION PROCESS IF THE PATIENT QUALIFIES FOR CHARITY CARE UNDER THE FINANCIAL ASSISTANCE POLICY. FURTHERMORE, A PATIENT'S PATIENT'S FINANCIAL SITUATION CHANGES AT ANY POINT DURING THE COLLECTION PROCESS, THE PATIENT MAY QUALIFY FOR FINANCIAL ASSISTANCE AT SUCH POINT. PATIENTS DETERMINED TO BE ELIGIBLE FOR FINANCIAL ASSISTANCE SUBSEQUENT TO THE DATE OF SERVICE MAY BE ELIGIBLE FOR A REFUND OF PAYMENTS MADE IF IT IS DETERMINED THAT THE PATIENT WAS ELIGIBLE FOR A REFUND OF PAYMENTS MADE IF IT IS DETERMINED THAT THE PATIENT WAS ELIGIBLE FOR FINANCIAL ASSISTANCE AT THE TIME OF SERVICE.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Schedule H, Part V, Section B, Line 16a FAP website</FormAndLineReferenceDesc>
        <ExplanationTxt>- MERCY MEDICAL CENTER, INC: Line 16a URL: https://mdmercy.com/patients-and-visitors/billing-and-insurance/financial-assistance;</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Schedule H, Part V, Section B, Line 16b FAP Application website</FormAndLineReferenceDesc>
        <ExplanationTxt>- MERCY MEDICAL CENTER, INC: Line 16b URL: https://mdmercy.com/patients-and-visitors/billing-and-insurance/financial-assistance;</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Schedule H, Part V, Section B, Line 16c FAP plain language summary website</FormAndLineReferenceDesc>
        <ExplanationTxt>- MERCY MEDICAL CENTER, INC: Line 16c URL: https://mdmercy.com/patients-and-visitors/billing-and-insurance/financial-assistance;</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Schedule H, Part VI, Line 2 Needs assessment</FormAndLineReferenceDesc>
        <ExplanationTxt>MERCY MEDICAL CENTER GENERALLY EMPLOYS A MULTI-PRONGED APPROACH IN IDENTIFYING COMMUNITY HEALTH NEEDS. THESE APPROACHES ARE AS FOLLOWS: 1. AS PART OF THE QUANTITATIVE DATA GATHERING PROCESS FOR THE 2024 CHNA, MERCY'S COMMUNITY BENEFIT COMMITTEE MEMBERS WORKED COLLABORATIVELY WITH THE BALTIMORE NEIGHBORHOOD INDICATORS ALLIANCE-JACOB FRANCE INSTITUTE AT THE UNIVERSITY OF BALTIMORE (BNIA-JFI). BNIA-JFI IS A NONPROFIT ORGANIZATION WHOSE CORE MISSION IS TO PROVIDE OPEN ACCESS TO MEANINGFUL, RELIABLE, AND ACTIONABLE DATA ABOUT, AND FOR, THE CITY OF BALTIMORE AND ITS COMMUNITIES. BNIA-JFI BUILDS ON AND COORDINATES THE RELATED WORK OF CITYWIDE NONPROFIT ORGANIZATIONS, CITY AND STATE GOVERNMENT AGENCIES, NEIGHBORHOODS, FOUNDATIONS, BUSINESSES, AND UNIVERSITIES TO SUPPORT AND STRENGTHEN THE PRINCIPLE AND PRACTICE OF WELL INFORMED DECISION MAKING FOR CHANGE TOWARD STRONG NEIGHBORHOODS, IMPROVED QUALITY OF LIFE, AND A THRIVING CITY. BNIA-JFI IS ALSO A PARTNER MEMBER OF THE NATIONAL NEIGHBORHOOD INDICATORS PARTNERSHIP OF THE URBAN INSTITUTE (NNIP). NNIP IS A COLLABORATIVE EFFORT BY THE URBAN INSTITUTE AND NEARLY 40 LOCAL PARTNERS TO FURTHER THE DEVELOPMENT AND USE OF NEIGHBORHOOD-LEVEL INFORMATION SYSTEMS IN LOCAL POLICYMAKING AND COMMUNITY BUILDING. BNIA-JFI PROVIDED TO MERCY' COMMUNITY BENEFIT COMMITTEE A BROAD ARRAY OF NEIGHBORHOOD DATA INDICATORS THAT PROVIDE ALL OF THE FACTS AND CIRCUMSTANCES PRESENT IN MERCY'S COMMUNITY BENEFIT SERVICE AREA INCLUDING BARRIERS TO ACCESSING CARE, TO PREVENT ILLNESS, TO ENSURE ADEQUATE NUTRITION, OR TO ADDRESS SOCIAL, BEHAVIORAL AND ENVIRONMENTAL FACTORS THAT INFLUENCE HEALTH IN THE COMMUNITY. INCORPORATED INTO BNIA-JFI'S NEIGHBORHOOD-LEVEL SOCIOECONOMIC DATASETS ARE INDIVIDUAL NEIGHBORHOOD HEALTH PROFILES COMPLETED BY THE BALTIMORE CITY HEALTH DEPARTMENT AND UPDATED IN MARCH 2012. THE NEIGHBORHOOD HEALTH PROFILES EXAMINE AT THE UNDERLYING FACTORS THAT AFFECT HEALTH IN EACH NEIGHBORHOOD-THE SOCIAL DETERMINANTS OF HEALTH. THE SOCIAL DETERMINANTS OF HEALTH ARE THE CONDITIONS IN WHICH RESIDENTS LIVE, LEARN, WORK, AND PLAY, AND INCLUDE FACTORS LIKE ACCESS TO HEALTHY FOOD, HEALTHY HOUSING, QUALITY SCHOOLS, AND SAFE PLACES TO BE ACTIVE. THE NEIGHBORHOOD HEALTH PROFILES PRESENT HEALTH OUTCOME INFORMATION AT THE COMMUNITY STATISTICAL AREA (CSA) LEVEL IN BALTIMORE CITY IN ORDER TO SUPPORT COMMUNITY-LEVEL HEALTH IMPROVEMENT EFFORTS TO ACHIEVE THE HEALTHY BALTIMORE 2015 PLAN, THE CITY'S COMPREHENSIVE PUBLIC HEALTH AGENDA TO IMPROVE HEALTH OUTCOMES IN BALTIMORE. THE BALTIMORE CITY'S OFFICE OF EPIDEMIOLOGY UTILIZED RIGOROUS RESEARCH METHODS AND SURVEY ANALYSIS TECHNIQUES TO AGGREGATE ALL THE DATA TO THE COMMUNITY STATISTICAL AREA (CSA) LEVEL. THE USE OF THE MOST RECENTLY AVAILABLE NEIGHBORHOOD HEALTH PROFILE INFORMATION FROM THE BALTIMORE CITY HEALTH DEPARTMENT ENSURES THAT THE COMMUNITY HEALTH PRIORITIES OF MERCY MEDICAL CENTER REMAIN ALIGNED WITH THE CURRENT HEALTH PRIORITIES OF THE CITY. DATA SOURCES INCLUDE A VARIETY OF PUBLIC AND PRIVATE SOURCES SUCH AS: THE U.S. CENSUS, THE AMERICAN COMMUNITY SURVEY, THE VITAL STATISTICS ADMINISTRATION AT THE MARYLAND DEPARTMENT OF HEALTH AND MENTAL HYGIENE, THE NATIONAL CENTER FOR HEALTH STATISTICS, THE BALTIMORE CITY PUBLIC SCHOOLS SYSTEM, THE MAYOR'S OFFICE OF INFORMATION TECHNOLOGY, THE BALTIMORE CITY HOUSING DEPARTMENT, THE BALTIMORE CITY COMPTROLLER'S OFFICE, THE BALTIMORE CITY PLANNING DEPARTMENT, THE BALTIMORE CITY REAL PROPERTY MANAGEMENT DATABASE, THE BALTIMORE CITY LIQUOR BOARD, THE BALTIMORE CITY HEALTH DEPARTMENT, CENTER FOR A LIVABLE FUTURE, AND THE MARYLAND DEPARTMENT OF THE ENVIRONMENT. IN ADDITION, THE ORGANIZATION ACCESSES AND REVIEWS OTHER STATE OF MARYLAND HEALTH CARE DATA BASES RELATED TO HEALTH CARE NEEDS OF COMMUNITIES THAT MERCY MEDICAL CENTER SERVES IN ITS PSA. FURTHERMORE, MERCY MEDICAL CENTER REVIEWS PUBLICATIONS AND DATA AVAILABLE FROM ORGANIZATIONS IN WHICH MERCY MEDICAL CENTER PHYSICIAN AND ADMINISTRATIVE LEADERSHIP ARE ACTIVE PARTICIPANTS AND MEMBERS SUCH AS B'MORE FOR HEALTHY BABIES, JOURNEY HOME, FAMILY CRISIS CENTER OF BALTIMORE, AND BALTIMORE HOMELESS SERVICES, AMOUNG OTHERS. 2. PARTNERSHIPS, WORKGROUPS, AND MEMBERSHIP IN ORGANIZATIONS THROUGH THE WORKGROUPS AND PARTNERSHIPS THAT HAVE BEEN ESTABLISHED WITH KEY ORGANIZATIONS SUCH AS HEALTH CARE FOR THE HOMELESS, BALTIMORE HOMELESS SERVICES, THE WEINBERG HOUSING AND RESOURCE CENTER, MAYOR'S OFFICE ON EMERGENCY MANAGEMENT, SEX AND FAMILY CRIMES DIVISION OF THE BALTIMORE CITY POLICE DEPARTMENT, TURN AROUND HOUSE OF RUTH, FAMILY CRISIS CENTER OF BALTIMORE, DOMESTIC VIOLENCE COORDINATING COUNCIL, B'MORE FOR HEALTHY BABIES AND FAMILY HEALTH CENTERS OF BALTIMORE, THE HOSPITAL RECEIVED SIGNIFICANT INPUT AND FEEDBACK ON THE HEALTH CARE NEEDS OF ITS IMMEDIATE SURROUNDING NEIGHBORHOODS AND COMMUNITIES. THIS WAS ACHIEVED THROUGH REGULAR MEETINGS AND DISCUSSIONS THROUGHOUT FY25. THROUGH PARTICIPATION OF THE HOSPITAL'S EXECUTIVE LEADERSHIP TEAM IN BUSINESS FORUMS SUCH AS THE DOWNTOWN PARTNERSHIP AND MEMBERSHIP IN OTHER ORGANIZATIONS, SIGNIFICANT FEEDBACK AND INFORMATION ON HEALTH CARE NEEDS AND GAPS WAS ALSO GATHERED. 3. MERCY HEALTH SERVICES MISSION AND CORPORATE ETHICS COMMITTEE OF THE BOARD OF TRUSTEES MEETS REGULARLY TO REVIEW AND COORDINATE ISSUES RELATED TO MISSION INTEGRATION AND COORDINATION. THIS BOARD COMMITTEE IS INFORMED AND CLEARLY UNDERSTANDS THE SCOPE AND DEPTH OF THE HOSPITAL'S COMMUNITY BENEFIT AND INITIATIVES. IN SUMMARY, THROUGH A QUANTITATIVE ASSESSMENT OF NEEDS BASED ON REVIEW OF CURRENT DATA SOURCES AND ACTIVE PARTICIPANTS IN SEVERAL COMMUNITY BASED ORGANIZATIONS, MERCY MEDICAL CENTER HAS BEEN ABLE TO DETERMINE AND PRIORITIZE ITS COMMUNITY HEALTH NEEDS FOCUS. IN ADDITION TO THE FOREGOING APPROACHES REGULARLY FOLLOWED BY MERCY MEDICAL CENTER, MERCY MEDICAL CENTER CONDUCTED ITS THIRD COMMUNITY HEALTH NEEDS ASSESSMENT, IN COMPLIANCE WITH THE REQUIREMENTS SET FORTH UNDER INTERNAL REVENUE CODE SECTION 501(R)(3) AND THE GUIDANCE PROVIDED BY IRS NOTICE 2011-52, DURING ITS 2024 TAX YEAR. MERCY MEDICAL CENTER WILL DIRECT ITS COMMUNITY HEALTH NEEDS PLANNING TOWARDS ADDRESSING THOSE COMMUNITY HEALTH NEEDS IDENTIFIED IN THE COMMUNITY HEALTH NEEDS ASSESSMENT IN ACCORDANCE WITH ITS IMPLEMENTATION STRATEGY. MERCY HAS COMPLETED AN UPDATED COMMUNITY HEALTH NEEDS ASSESSMENT AND IMPLEMENTATION STRATEGY IN JUNE 2024. THIS UPDATED VERSION IS AVAILABLE ON THE MERCY HEALTH SERVICES WEBSITE.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Schedule H, Part VI, Line 3 Patient education of eligibility for assistance</FormAndLineReferenceDesc>
        <ExplanationTxt>MERCY ATTEMPTS TO BE VERY PROACTIVE IN COMMUNICATING ITS FINANCIAL ASSISTANCE POLICY AND FINANCIAL ASSISTANCE CONTACT INFORMATION TO PATIENTS. THE FINANCIAL ASSISTANCE POLICY AND FINANCIAL ASSISTANCE CONTACT INFORMATION IS POSTED IN ALL ADMISSIONS AREAS, INCLUDING THE EMERGENCY ROOM. SUCH NOTICE IS POSTED IN ENGLISH, SPANISH AND/OR OTHER LANGUAGE THAT WILL BE UNDERSTANDABLE TO TARGET POPULATIONS OF PATIENTS UTLIZING HOSPITAL SERVICES. A COPY OF THE POLICY AND FINANCIAL ASSISTANCE CONTACT INFORMATION IS PROVIDED TO PATIENTS OR THEIR FAMILIES DURING THE PRE-ADMISSION, PRE-SURGERY AND ADMISSIONS PROCESS. ADDITIONALLY, A COPY OF THE POLICY AND FINANCIAL ASSISTANCE CONTACT INFORMATION IS PROVIDED TO PATIENTS OR THEIR FAMILIES UPON DISCHARGE. MERCY UTILIZES A THIRD PARTY, AS WELL AS IN-HOUSE FINANCIAL COUNSELING STAFF, TO CONTACT AND SUPPORT PATIENTS IN UNDERSTANDING AND COMPLETING THE FINANCIAL ASSISTANCE REQUIREMENTS. THEY ALSO DISCUSS WITH PATIENTS OR THEIR FAMILIES THE AVAILABILITY OF VARIOUS GOVERNMENT BENEFITS AND ASSIST PATIENTS WITH UNDERSTANDING THE QUALIFICATIONS FOR SUCH PROGRAMS. EVEN AFTER A PATIENT IS DISCHARGED, EACH BILLING STATEMENT CONTAINS AN OVERVIEW OF MERCY'S FINANCIAL ASSISTANCE POLICY, A PATIENT'S RIGHTS AND OBLIGATIONS, AND CONTACT NUMBERS FOR FINANCIAL ASSISTANCE, FINANCIAL COUNSELING, AND MARYLAND MEDICAID. FOLLOW-UP PHONE CALLS BY HOSPITAL BILLING/COLLECTION STAFF MADE TO PATIENTS WITH UNPAID BALANCES ALSO STRESS THE AVAILABILITY OF FINANCIAL ASSISTANCE AND CHARITY CARE AVAILABILITY. MERCY MEDICAL CENTER WILL MAKE AN EFFORT TO PROVIDE THE FINANCIAL ASSISTANCE APPLICATION, POLICIES, PROCEDURES AND INFORMATION IN ENGLISH, SPANISH, AND/OR ANY OTHER LANGUAGE THAT WILL BE UNDERSTANDABLE TO TARGET POPULATIONS OF PATIENTS UTILIZING HOSPITAL SERVICES. MERCY MEDICAL CENTER PROVIDES AND PROMOTES HEALTH SERVICES FOR THE PEOPLE OF BALTIMORE OF EVERY CREED, RACE, ECONOMIC, AND SOCIAL CONDITION. IN THE SPIRIT OF THE SISTERS OF MERCY WHO ARE ITS SPONSORS, MERCY CONTINUES TO HAVE A SPECIAL COMMITMENT TO THE UNDERSERVED AND UNINSURED.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Schedule H, Part VI, Line 4 Community information</FormAndLineReferenceDesc>
        <ExplanationTxt>LOCATED IN THE HEART OF DOWNTOWN BALTIMORE, MERCY MEDICAL CENTER DRAWS PATIENTS FROM THE GREATER BALTIMORE METROPOLITAN AREA FOR ITS LONGSTANDING TRADITION OF COMPASSIONATE CARE, COMMITMENT TO QUALIFY AND PATIENT SAFETY, AS WELL AS ITS PRIMARY CARE AND SPECIALIST PHYSICIANS. MERCY MEDICAL CENTER'S PRIMARY SERVICE AREA ("PSA") WHICH COMPRISES 16 ZIP CODES IN BALTIMORE CITY, ACCOUNTS FOR 46.7% OF ITS TOTAL ADMISSIONS. KEY DEMOGRAPHIC CHARACTERISTICS OF THE PSA ARE AS FOLLOWS: POPULATION 1. THE CHNA SERVICE AREA (CBSA) POPULATION IS 176,389, REPRESENTING APPROXIMATELY 30% OF BALTIMORE CITY'S TOTAL POPULATION. 2. THE PERCENTAGE OF HOUSEHOLDS LIVING BELOW THE FEDERAL POVERTY LINE IS DRAMATICALLY HIGHER THAN THE CITYWIDE PERCENTAGE (20.1% VS 14.5%). ADDITIONALLY, THERE ARE FAR MORE CHILDREN LIVING BELOW THE FEDERAL POVERTY LINE WITHIN MERCY'S CHNA SERVICE AREA THAN CITYWIDE (32.7% VS 25.8%). 3. UNEMPLOYMENT WITHIN BALTIMORE CITY IS SLIGHTLY HIGHER THAN STATEWIDE (3.8% VS 2.6%). PERHAPS MORE THAN ANY OTHER DATASET INCLUDED IN THIS REPORT, THIS DEMONSTRATES MERCY'S LONG-STANDING SPECIAL COMMITMENT TO SERVE THE POOR AND UNDERSERVED. ETHNICITY AND AGE 1. 56.0% BLACK; 31.6% CAUCASIAN IN CBSA. 2. APPROXIMATELY 54.0% OF PATIENTS SERVED BY MERCY MEDICAL CENTER ARE MEMBERS OF A RACIAL OR ETHNIC MINIORITIES; 66.2% ARE WOMEN 3. 29.5% OF THE POPULATION IS 65 YEARS IN AGE OR OLDER INCOME 1. 22.7% OF CBSA HOUSEHOLDS REPORTED LIVING BELOW THE FEDERAL POVERTY LINE. 2. THE PERCENTAGE OF FAMILIES LIVING IN MERCY'S CBSA THAT HAD INCOME THAT WAS BELOW THE POVERTY LEVEL WAS GREATER COMPARED TO ALL FAMILIES IN BALTIMORE CITY (22.7% VS 15.3%). MORTALITY OF NOTE, THE MAJOR COMMUNITY BENEFIT PROGRAMS THAT ARE IDENTIFIED IN PART VI, QUESTION 5 "PROMOTION OF COMMUNITY HEALTH" DIRECTLY ADDRESS KEY HEALTH CARE NEEDS OF THE POPULATION IN MERCY MEDICAL CENTER'S PSA. 1. % OF POTENTIALLY AVERTABLE DEATHS: 46.6 VS BALTIMORE RATE OF 36.2 2. TEEN BIRTH RATE PER 1,000: 26.8 VS BALTIMORE RATE OF 21.5 3. LOW BIRTH WEIGHT: 12.0% VS BALTIMORE RATE OF 11.7% AS SHOWN BY THESE SELECT INDICATORS, THERE IS A SIGNIFICANT HEALTH STATUS DISPARITY BETWEEN MERCY'S COMMUNITY BENEFIT SERVICE AREA (CBSA) AND BALTIMORE CITY'S RESIDENTS. DUE TO ITS LOCATION IN CENTER CITY, MERCY MEDICAL CENTER CARES FOR MANY OF THE AT-RISK, LOW INCOME POPULATION IN THE COMMUNITIES THAT IMMEDIATELY SURROUND THE HOSPITAL. THIS IS BEST EVIDENCED BY THE LARGE PERCENTAGE OF EMERGENCY ROOM VISITS BY THE MEDICAID, UNINSURED AND MEDICARE PATIENTS. MEDICAID COVERED AND UNINSURED PATIENTS ACCOUNTED FOR MORE THAN 54.8% OF THE FY25 EMERGENCY ROOM VISITS. THERE ARE A COUPLE NOTABLE REASONS FOR SUCH A HIGH MEDICAID AND UNINSURED PATIENT POPULATION VISITING THE EMERGENCY ROOM: 1. BALTIMORE CITY'S LARGEST HOMELESS SHELTER AT GUILFORD AVENUE IS WITHIN THREE BLOCKS OF THE HOSPITAL. 2. MERCY MEDICAL CENTER PROVIDES ALL OF THE MEDICAL STAFF (PHYSICIANS AND NURSING PERSONNEL) FOR HEALTHCARE FOR THE HOMELESS (HCH), A FEDERALLY QUALIFIED HEALTH CENTER, WHICH DELIVERS OUTPATIENT CARE TO A LARGE NUMBER OF HOMELESS PERSONS IN BALTIMORE CITY. THE HCH CLINIC IS LOCATED THREE BLOCKS FROM THE HOSPITAL.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Schedule H, Part VI, Line 5 Promotion of community health</FormAndLineReferenceDesc>
        <ExplanationTxt>MERCY FAMILY VIOLENCE RESPONSE PROGRAM THE MERCY FAMILY VIOLENCE RESPONSE PROGRAM WAS DEVELOPED BY A MULTIDISCIPLINARY STAFF TASK FORCE AT MERCY MEDICAL CENTER TO PROVIDE CRISIS INTERVENTION AND SAFETY PLANNING FOR VICTIMS OF FAMILY VIOLENCE (DOMESTIC VIOLENCE, CHILD ABUSE, ELDER AND VULNERABLE ADULT ABUSE) AND SEXUAL ASSAULT WHO COME TO MERCY MEDICAL CENTER AND ITS PHYSICIANS FOR TREATMENT. THIS PROGRAM IMPROVES BALTIMORE'S COORDINATED COMMUNITY RESPONSE TO VICTIMS OF VIOLENCE, AND CREATES AN ALERT WORKFORCE AT MERCY MEDICAL CENTER, SKILLED AT IDENTIFYING AND RESPONDING TO VICTIMS OF FAMILY VIOLENCE. DUE TO ITS LOCATION WITHIN THREE BLOCKS OF THE CITY'S LARGEST HOMELSS SHELTER AT GUILFORD AVENUE AND CLOSE PROXIMITY TO HCH, MERCY MEDICAL CENTER'S ER RECEIVES MANY VISITS FROM HOMELESS PERSONS. WITH DECADES OF EXPERIENCE IN PROVIDING EMERGENCY AND URGENT CARE TO POOR AND HOMELESS POPULATIONS, THE HOSPITAL HAS ESTABLISHED KEY SERVICES FOR THE MEDICALLY UNDERSERVED INCLUDING THE FOLLOWING: A FULL TIME SOCIAL WORKER IS A PART OF THE ER TEAM TO COORDINATE CARE AND OTHER SERVICES FOR HOMELESS PATIENTS WHO ARRIVE AT THE ER. ER PHYSICIANS AND NURSES MAKE VISITS TO BALTIMORE CITY SHELTERS TO PROVIDE THE FOLLOWING SERVICES: 1. ADMINISTRATION OF FLU VACCINATIONS TO RESIDENTS 2. PRESENTATIONS ON PARASITES AND INFECTIOUS DISEASE 3. INFECTIOUS DISEASE PREVENTION THE FORENSIC NURSE EXAMINER PROGRAM (FNE) IS HOUSED AT THE HOSPITAL'S ER AND PROVIDES 24/7 CARE TO PATIENTS WHO ARE VICTIMS OF SEXUAL, DOMESTIC, CHILD, ELDER AND INSTITUTIONAL VIOLENCE. FORENSIC NURSES PROVIDE COMPREHENSIVE FORENSIC MEDICAL INTERVIEWS, MEDICAL ASSESSMENTS, EVIDENCE COLLECTION, AND ASSURE CRISIS INTERVENTION TO AN EVER INCREASING VOLUME OF UNDERSERVED PATIENTS. DURING FY 2025, THE FNE PROGRAM CONDUCTED 423 EXAMINATIONS AND IS THE DESIGNATED SITE FOR PATIENTS IN BALTIMORE CITY. LOW BIRTH WEIGHT PROGRAM - DEPARTMENT OF OBSTETRICS MERCY MEDICAL CENTER DELIVERED 2,745 BABIES IN BALTIMORE CITY IN FY 2025. LOW BIRTH WEIGHT AND PREMATURITY ARE INTERTWINED AND CORRELATED. AS CITED IN QUESTION #2, LOW BIRTH WEIGHT IS A KEY HEALTH STATUS INDICATOR THAT IS MEASURED AND TRACKED BY BALTIMORE CITY DEPARTMENT OF HEALTH THAT MUST BE DECREASED IN INCIDENCE. THE HOSPITAL HAS TAKEN A LEADERSHIP ROLE THROUGH ITS ACTIVE PARTICIPATION IN "B'MORE FOR HEALTHLY BABIES", A LONG TERM INITIATIVE LED BY THE MAYOR'S OFFICE AND MANAGED BY BALTIMORE CITY HEALTH DEPARTMENT TO REDUCE THE INCIDENTS OF LOW BIRTH WEIGHT. DR ROBERT ATLAS, CHAIRMAN OF MERCY MEDICAL CENTER'S DEPARTMENT OF OBSTETRICS AND GYNECOLOGY, HAS A LEADERSHIP ROLE WITHIN THIS WORKGROUP. THE GOALS OF "B'MORE FOR HEALTHY BABIES" ARE REDUCTION IN THE FOLLOWING: 1. RATE OF PRE-TERM BIRTHS BY AT LEAST 10% 2. RATE OF LOW BIRTH WEIGHT INFANTS BY AT LEAST 10% 3. THE NUMBER OF DEATHS FROM UNSAFE SLEEP BY AT LEAST 10% OF NOTE 67.0% OF THE BABIES CARED FOR IN MERCY MEDICAL CENTER'S NEONATAL INTENSIVE CARE UNIT WERE EITHER MEDICAID BENEFICIARIES OR UNINSURED/SELF PAY. THIS POPULATION IS ESPECIALLY LINKED WITH LOW BIRTH RATE AND PREMATURITY DUE TO POVERTY THAT CLOSELY RELATES TO UNHEALTHY LIFESTYLES, PARTICULARLY POOR NUTRITION AND INADEQUATE PRENATAL CARE. IN ORDER TO ENSURE 24/7 COVERAGE FOR ITS OBSTETRICAL PATIENTS, REGARDLESS OF THEIR ABILITY TO PAY, MERCY MEDICAL CENTER PROVIDED $1,074,563 IN PHYSICIAN SUBSIDY FOR THIS SPECIALTY. DETERMINING THE NEEDS IN THE COMMUNITY TO BE ADDRESSED SINCE THE INCEPTION OF THE COMMUNITY BENEFIT REPORTING TO HSCRC, MERCY MEDICAL CENTER HAS CONSISTENTLY RANKED AMOUNG THE TOP QUARTILE OF HOSPITALS IN THE STATE OF MARYLAND IN TERMS OF THE PERCENTAGE OF OPERATING EXPENSE DEVOTED TO COMMUNITY NEEDS PROGRAMS. ACCESS TO CARE FOR AT-RISK, UNDERSERVED POPULATIONS HAS LONG BEEN A CORNERSTONE MISSION FOR MERCY MEDICAL CENTER. MAJOR PROGRAMS TO SERVE THIS NEED INCLUDE OUR FUNDING OF DIRECT PHYSICIAN CHARITY CARE ACROSS ALL SPECIALTIES AND THE PHARMACY CHARITY FUND TO PATIENTS WHO ARE UNINSURED AND UNABLE TO PAY. IN ADDITION, MERCY PROVIDES SUBSIDIZED SUPPORT TO ADULT AND PEDIATRIC PHYSICIAN OFFICES LOCATED ON THE MERCY CAMPUS THAT PROVIDES COST EFFICIENT AND ACCESSIBLE HELATH CARE REGARDLESS OF INSURANCE STATUS AND ARRANGES FOR SLIDING SCALE FEES TO ASSIST THE UNINSURED WITH PHYSICIAN AND OTHER EXPENSES. BASED UPON PRIOR NEEDS ASSESSMENTS, MERCY MEDICAL CENTER IDENTIFIED THREE KEY AREAS OF FOCUS FOR "MISSION DRIVEN HEALTH SERVICES" IN FY 2025: THEY ARE AS FOLLOWS: HOMELESSNESS: THE NEED TO RESPOND TO AND ACTIVELY SUPPORT THE MEDICAL PROFESSIONAL NEEDS OF ORGANIZATIONS THAT SERVE THE HOMELESS POPULATION OF BALTIMORE. EMERGENCY SERVICES: AS PROVIDED THROUGH THE EMERGENCY DEPARTMENT, GIVEN THE LARGE PERCENTAGE OF POOR AND UNINSURED PATIENTS WHO ACCESS THIS SERVICE. LOW BIRTH WEIGHT: MERCY MEDICAL CENTER DELIVERS MORE BABIES TO WOMEN AT OR BELOW THE POVERTY LINE THAN ANY OTHER HOSPITAL IN BALTIMORE. A SIGNIFICANT PERCENTAGE (&gt;10%) OF THESE BIRTHS ARE PREMATURE AND OF LOW BIRTH WEIGHT. ALL OF THESE PROGRAMS ARE INTERTWINED AS THEY SHARE A COMMON THREAD IN THAT ALL UNDERSERVED AND POOR POPULATIONS OF BALTIMORE ARE THE PRIMARY RECIPIENTS OF MEDICAL SERVICES PROVIDED BY MERCY MEDICAL CENTER ON AND OFF ITS CAMPUS. HOMELESSNESS THE NUMBER OF PEOPLE EXPERIENCING HOMELESSNESS HAS GROWN STEADILY OVER THE PAST 20 YEARS IN BALTIMORE AND THROUGHOUT THE ENTIRE NATION. THIS NUMBER IS EXPECTED TO CONTINUE TO RISE GIVEN THE DETERIORATING ECONOMIC CONDITIONS LOCALLY AND NATIONALLY THAT CAUSE HIGH UNEMPLOYMENT, LOSS OF HOMES, REDUCED FEDERAL ASSISTANCE TO MEDICAID AND OTHER SAFETY NET PROGRAMS. BALTIMORE'S HOMELESS POPULATION EXTENDS GREATLY BEYOND THOSE WHO CAN FIND BEDS IN CITY AND OTHER NONPROFIT RUN SHELTERS. MERCY MEDICAL CENTER IS DIRECTLY INVOLVED IN THE PROVISION OF MEDICAL SERVICES TO THE HOMELESS POPULATION THROUGH THREE AREAS. HEALTH CARE FOR THE HOMELESS HEALTH CARE FOR THE HOMELESS (HCH) WAS ESTABLISHED IN 1985 AND PROVIDES ADULT, PEDIATRIC, AND GERIATRIC MEDICAL CARE, DENTAL CARE, MENTAL HEALTH, HIV SERVICES, SOCIAL WORK AND CASE MANAGEMENT, ADDICTION TREATMENT, OUTREACH, PRISON RE-ENTRY, SUPPORTIVE HOUSING, AND ACCESS TO EDUCATION AND EMPLOYMENT. SINCE ITS INCEPTION IN 1985, MERCY MEDICAL CENTER HAS DIRECTLY EMPLOYED AND PROVIDED ALL OF THE PHYSICIAN AND NURSING STAFF TO HCH FOR MEDICAL SERVICES. WHILE THE HOSPITAL IS REIMBURSED FOR THE DIRECT COSTS OF ITS EMPLOYED CLINICIANS BY HCH, INDIRECT AND OTHER COSTS CONTRIBUTED TO HCH WERE $6,900 IN FY 2025. MERCY MEDICAL CENTER, THROUGH ITS SOLE MEMBER, MHS, IS GOVERNED BY A COMMUNITY BOARD COMPRISED OF CIVIC LEADERS WHO ARE COMMITTED TO AND REPRESENT THE HEALTHCARE NEEDS OF THE COMMUNITY. MERCY MEDICAL CENTER EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS FOR ALL OF ITS DEPARTMENTS. ALL FINANCIAL SURPLUSES MERCY MEDICAL CENTER GENERATES ARE USED EXCLUSIVELY TO FURTHER THE MISSION OF THE ORGANIZATION. COMMUNITY BOARD COMPRISED OF CIVIC LEADERS WHO ARE COMMITTED TO AND REPRESENT THE HEALTHCARE NEEDS OF THE COMMUNITY.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Schedule H, Part VI, Line 6 Affiliated health care system</FormAndLineReferenceDesc>
        <ExplanationTxt>MERCY MEDICAL CENTER IS A PART OF AN AFFILIATED HEALTH CARE SYSTEM, WHICH INCLUDES A NUMBER OF ORGANIZATIONS THAT ARE UNDER THE COMMON GOVERNANCE OF MERCY HEALTH SERVICES. THESE AFFILIATED ORGANIZATIONS WORK TOGETHER TO PROVIDE A RANGE OF HEALTHCARE SERVICES TO THEIR COMMUNITIES. AMOUNG MERCY MEDICAL CENTER'S AFFILIATES ARE SAINT PAUL PLACE SPECIALISTS, INC. (SPPS), MARYLAND FAMILY CARE, INC. (MFC), AND STELLA MARIS (SM). SPPS PROVIDES SPECIALITY PHYSICIAN SERVICES TO PATIENTS OF MERCY MEDICAL CENTER'S INPATIENT SERVICES AND OUTPATIENT CLINICS AND TO OTHER MEMBERS OF THE COMMUNITY THROUGHOUT CENTRAL MARYLAND AND BEYOND. DURING THE 2025 TAX YEAR, SPPS PROVIDED $2,643,033 OF CHARITY CARE TO PATIENTS SEEN BY SPPS PHYSICIANS. STELLA MARIS OWNS AND OPERATES A NURSING HOME, A RESIDENTIAL AND HOME HOSPICE SERVICE AND A HOME HEALTH AGENCY. DURING THE 2025 TAX YEAR, SM PROVIDED $75,119 OF CHARITY CARE TO ITS PATIENTS. MFC PROVIDES PRIMARY CARE SERVICES ON THE CAMPUS OF MERCY MEDICAL CENTER, THROUGHOUT BALTIMORE CITY, AND IN ANNE ARUNDEL AND BALTIMORE COUNTIES. ADDITIONALLY, MFC EMPLOYS AN NUMBER OF PHYSICIANS TO SERVE AS HOSPITALISTS, WHO CARE FOR PATIENTS ADMITTED TO MERCY MEDICAL CENTER. ALSO, MFC EMPLOYS NURSE PRACTITIONERS THAT PROVIDE SERVICES TO UNINSURED PATIENTS IN MERCY'S NURSERY AND CHILDREN'S HEALTH OUTREACH PROGRAM. MFC INCURS SUBSTANTIAL COSTS PROVIDING THE COMMUNITY WITH THE HOSPITALIST AND NURSE PRACTITIONER PROGRAMS. DURING THE 2025 TAX YEAR, MFC INCURRED A NET OPERATING LOSS FROM PROVIDING THE NURSE PRACTITIONER PROGRAM OF $2,149,810 IN ADDITION TO THE FOREGOING, THE AFFILIATED HEALTH CARE SYSTEM PARTICIPATES IN A NUMBER OF PARTNERSHIP/WORK GROUPS, INCLUDING THE FOLLOWING: GROUP NAME: HEALTH CARE FOR THE HOMELESS PURPOSE AND MMC PARTICIPATION: HCH PROVIDES HEALTH-RELATED SERVICES TO REDUCE THE INCIDENCE AND BURDENS OF HOMELESSNESS. ITS HEADQUARTERS/CLINIC IS LOCATED THREE BLOCKS FROM MERCY. CHRISTOPHER THOMASKUTTY, MERCY MEDICAL CENTER VICE PRESIDENT, SERVES ON THE HCH BOARD OF DIRECTORS. GROUP NAME: BALTIMORE HOMELESS SERVICES PURPOSE AND MMC PARTICIPATION: A PROGRAM WITHIN THE MAYOR'S OFFICE OF HUMAN SERVICES RESPONSIBLE FOR MANAGING THE CONTINUUM OF CARE PROVIDED TO THE CITY'S HOMELESS POPULATION. MERCY SUPPORTIVE HOUSING PROGRAM PROVIDES HOUSING COUNSELING AND CASE MANAGEMENT FOR HOMELESS FAMILIES UNDER GRANTS FROM THIS AGENCY. GROUP NAME: THE WEINBERG HOUSING AND RESOURCE CENTER PURPOSE AND MMC PARTICIPATION: BALTIMORE CITY'S FACILITY PROVIDING 24/7 EMERGENCY SHELTER BEDS AND 25 BEDS FOR THE MEDICALLY FRAGILE AS WELL AS PROGRAMS AND SERVICES FOR THE HOMELESS. MERCY EMPLOYEES ASSIST WITH THE PROGRAM. GROUP NAME: MAYOR'S OFFICE ON EMERGENCY MANAGEMENT PURPOSE AND MMC PARTICIPATION: MERCY SERVES ON THE EMERGENCY PREPAREDNESS TASK FORCE FOR BALTIMORE CITY. GROUP NAME: SEX AND FAMILY CRIMES DIVISION OF BALTIMORE CITY POLICE DEPARTMENT PURPOSE AND MMC PARTICIPATION: MERCY'S FORENSIC NURSE EXAMINER PROGRAM WORKS COLLLABORATIVELY WITH THE BALTIMORE CITY POLICE DEPARTMENT. MERCY PROVIDES THE FORENSIC NURSE EXAMINER PROGRAM IN THE METROPOLITAN AREA. GROUP NAME: TURN AROUND, HOUSE OF RUTH PURPOSE AND MMC PARTICIPATION: MERCY'S FAMILY VIOLENCE RESPONSE PROGRAM WORKS WITH TURN AROUND, HOUSE OF RUTH AND OTHER ORGANIZATIONS. MERCY ALSO IS TAKING A LEADERSHIP ROLE IN ESTABLISHING HOSPITAL-BASED FAMILY VIOLENCE RESPONSE PROGRAMS AT OTHER MARYLAND HOSPITALS. GROUP NAME: FAMILY CRISIS CENTER OF BALTIMORE (FCCB) PURPOSE AND MMC PARTICIPATION: FCCB IS A MAJOR REFFERAL PARTNER TO MERCY FORENSIC NURSE EXAMINER AND SUPPORTIVE HOUSING PROGRAMS. GROUP NAME: DOMESTIC VIOLENCE COORDINATING COUNCIL PURPOSE AND MMC PARTICPATION: COLLEEN MOORE, COORDINATOR OF MERCY'S FAMILY VIOLENCE REPONSE PROGRAM, SERVES ON THE ORGANIZATION'S STEERING COMMITTEE. GROUP NAME: B'MORE FOR HEALTHY BABIES PURPOSE AND MMC PARTICIPATION: BHB IS A COALITION OF PHYSICIANS AMOUNG BALTIMORE CITY'S MAJOR HOSPITALS THAT ADDRESSES WAYS TO REDUCE INFANT MORTALITY, PREMATURITY AND LOW BIRTH WEIGHT. ROBERT ATLAS, M.D. CHAIRMAN OF THE DEPARTMENT OF OBSTETRICS AND GYNECOLOGY AT MERCY AND A RECOGNIZED EXPERT IN AT-RISK PREGNANCY IS A LEADER WITH BHB. GROUP NAME: FAMILY HEALTH CENTERS OF BALTIMORE (FCHB) PURPOSE AND MMC PARTICIPATION: CHRISTOPHER THOMASKUTTY AND LISA CONIC, MERCY MEDICAL CENTER VICE PRESIDENTS, SERVE ON THE BOARD OF DIRECTORS OF FCHB, A FEDERALLY QUALIFIED HEALTH CENTER THAT SERVES CENTRAL AND SOUTH BALTIMORE CITY. GROUP NAME: TOTAL HEALTHCARE PURPOSE AND MMC PARTICIPATION: DONNELL HENRY, MERCY MEDICAL CENTER DIRECTOR OF FINANCIAL PLANNING AND BUDGET, SERVES ON THE BOARD OF DIRECTORS OF TOTAL HEALTHCARE, A FEDERALLY QUALIFIED HEALTH CENTER THAT SERVES CENTRAL BALTIMORE CITY.</ExplanationTxt>
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        <FormAndLineReferenceDesc>Schedule H, Part VI, Line 7 State filing of community benefit report</FormAndLineReferenceDesc>
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        <DeferredCompRltdOrgsAmt>0</DeferredCompRltdOrgsAmt>
        <NontaxableBenefitsFilingOrgAmt>33949</NontaxableBenefitsFilingOrgAmt>
        <NontaxableBenefitsRltdOrgsAmt>0</NontaxableBenefitsRltdOrgsAmt>
        <TotalCompensationFilingOrgAmt>573807</TotalCompensationFilingOrgAmt>
        <TotalCompensationRltdOrgsAmt>0</TotalCompensationRltdOrgsAmt>
        <CompReportPrior990FilingOrgAmt>0</CompReportPrior990FilingOrgAmt>
        <CompReportPrior990RltdOrgsAmt>0</CompReportPrior990RltdOrgsAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>Karen Mathura</PersonNm>
        <TitleTxt>CCO &amp; VP OF CLAIMS</TitleTxt>
        <BaseCompensationFilingOrgAmt>355354</BaseCompensationFilingOrgAmt>
        <CompensationBasedOnRltdOrgsAmt>0</CompensationBasedOnRltdOrgsAmt>
        <BonusFilingOrganizationAmount>66025</BonusFilingOrganizationAmount>
        <BonusRelatedOrganizationsAmt>0</BonusRelatedOrganizationsAmt>
        <OtherCompensationFilingOrgAmt>80299</OtherCompensationFilingOrgAmt>
        <OtherCompensationRltdOrgsAmt>0</OtherCompensationRltdOrgsAmt>
        <DeferredCompensationFlngOrgAmt>10350</DeferredCompensationFlngOrgAmt>
        <DeferredCompRltdOrgsAmt>0</DeferredCompRltdOrgsAmt>
        <NontaxableBenefitsFilingOrgAmt>33949</NontaxableBenefitsFilingOrgAmt>
        <NontaxableBenefitsRltdOrgsAmt>0</NontaxableBenefitsRltdOrgsAmt>
        <TotalCompensationFilingOrgAmt>545977</TotalCompensationFilingOrgAmt>
        <TotalCompensationRltdOrgsAmt>0</TotalCompensationRltdOrgsAmt>
        <CompReportPrior990FilingOrgAmt>0</CompReportPrior990FilingOrgAmt>
        <CompReportPrior990RltdOrgsAmt>0</CompReportPrior990RltdOrgsAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>Judith Weiland</PersonNm>
        <TitleTxt>SVP STRATEGIC &amp; CAPITAL PLANNING</TitleTxt>
        <BaseCompensationFilingOrgAmt>313168</BaseCompensationFilingOrgAmt>
        <CompensationBasedOnRltdOrgsAmt>0</CompensationBasedOnRltdOrgsAmt>
        <BonusFilingOrganizationAmount>152397</BonusFilingOrganizationAmount>
        <BonusRelatedOrganizationsAmt>0</BonusRelatedOrganizationsAmt>
        <OtherCompensationFilingOrgAmt>56164</OtherCompensationFilingOrgAmt>
        <OtherCompensationRltdOrgsAmt>0</OtherCompensationRltdOrgsAmt>
        <DeferredCompensationFlngOrgAmt>13777</DeferredCompensationFlngOrgAmt>
        <DeferredCompRltdOrgsAmt>0</DeferredCompRltdOrgsAmt>
        <NontaxableBenefitsFilingOrgAmt>10083</NontaxableBenefitsFilingOrgAmt>
        <NontaxableBenefitsRltdOrgsAmt>0</NontaxableBenefitsRltdOrgsAmt>
        <TotalCompensationFilingOrgAmt>545589</TotalCompensationFilingOrgAmt>
        <TotalCompensationRltdOrgsAmt>0</TotalCompensationRltdOrgsAmt>
        <CompReportPrior990FilingOrgAmt>0</CompReportPrior990FilingOrgAmt>
        <CompReportPrior990RltdOrgsAmt>0</CompReportPrior990RltdOrgsAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Schedule J, Part I, Line 3 Arrangement used to establish the top management official's compensation</FormAndLineReferenceDesc>
        <ExplanationTxt>THE ORGANIZATION RELIED ON A RELATED ORGANIZATION AND THAT RELATED ORGANIZATION USED THE FOLLOWING METHODS TO ESTABLISH THE TOP MANAGEMENT OFFICIAL'S COMPENSATION: 1. COMPENSATION COMMITTEE 2. INDEPENDENT COMPENSATION CONSULTANT 3. COMPENSATION SURVEY OR STUDY; AND 4. APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Schedule J, Part I, Line 7 Non-fixed payments</FormAndLineReferenceDesc>
        <ExplanationTxt>THE COMPENSATION COMMITTEE APPROVES NON-FIXED PAYMENTS FOR MANAGMENT BASED ON THE DEGREE OF MEETING CORPORATE PRIORITIES ESTABLISHED BY THE BOARD OF TRUSTEES. THE CORPORATE OBJECTIVES ARE DESIGNED TO ADVANCE THE ORGANIZATION IN THE AREAS OF QUALITY CARE, PATIENT SAFETY, PATIENT SATISFACTION, BUSINESS DEVELOPMENT AND FINANCIAL STRENGTH.</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleJ>
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      <TaxExemptBondsIssuesGrp>
        <BondReferenceCd>A</BondReferenceCd>
        <IssuerName>
          <BusinessNameLine1Txt>MARYLAND HEALTH &amp; HIGHER EDUcational FAC AUTHORITY</BusinessNameLine1Txt>
        </IssuerName>
        <BondIssuerEIN>520936091</BondIssuerEIN>
        <CUSIPNum>574217XX8</CUSIPNum>
        <BondIssuedDt>2006-08-03</BondIssuedDt>
        <IssuePriceAmt>35000000</IssuePriceAmt>
        <PurposeDesc>2006 REPLACEMENT GARAGE</PurposeDesc>
        <DefeasedInd>false</DefeasedInd>
        <OnBehalfOfIssuerInd>false</OnBehalfOfIssuerInd>
        <PoolFinancingInd>false</PoolFinancingInd>
      </TaxExemptBondsIssuesGrp>
      <TaxExemptBondsIssuesGrp>
        <BondReferenceCd>B</BondReferenceCd>
        <IssuerName>
          <BusinessNameLine1Txt>MARYLAND HEALTH &amp; HIGHER EDUcational FAC AUTHORITY</BusinessNameLine1Txt>
        </IssuerName>
        <BondIssuerEIN>520936091</BondIssuerEIN>
        <CUSIPNum>5742176K6</CUSIPNum>
        <BondIssuedDt>2010-04-01</BondIssuedDt>
        <IssuePriceAmt>30000000</IssuePriceAmt>
        <PurposeDesc>2010 PARTIAL CONVERSION 2007 BONDS</PurposeDesc>
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        <OnBehalfOfIssuerInd>false</OnBehalfOfIssuerInd>
        <PoolFinancingInd>false</PoolFinancingInd>
      </TaxExemptBondsIssuesGrp>
      <TaxExemptBondsIssuesGrp>
        <BondReferenceCd>C</BondReferenceCd>
        <IssuerName>
          <BusinessNameLine1Txt>MARYLAND HEALTH &amp; HIGHER EDUcational FAC AUTHORITY</BusinessNameLine1Txt>
        </IssuerName>
        <BondIssuerEIN>520936091</BondIssuerEIN>
        <CUSIPNum>574218EZ2</CUSIPNum>
        <BondIssuedDt>2012-04-25</BondIssuedDt>
        <IssuePriceAmt>51737448</IssuePriceAmt>
        <PurposeDesc>2012 BONDS REFUNDING 2001 BONDS</PurposeDesc>
        <DefeasedInd>false</DefeasedInd>
        <OnBehalfOfIssuerInd>false</OnBehalfOfIssuerInd>
        <PoolFinancingInd>false</PoolFinancingInd>
      </TaxExemptBondsIssuesGrp>
      <TaxExemptBondsIssuesGrp>
        <BondReferenceCd>D</BondReferenceCd>
        <IssuerName>
          <BusinessNameLine1Txt>MARYLAND HEALTH &amp; HIGHER EDUcational FAC AUTHORITY</BusinessNameLine1Txt>
        </IssuerName>
        <BondIssuerEIN>520936091</BondIssuerEIN>
        <CUSIPNum>574218B85</CUSIPNum>
        <BondIssuedDt>2016-03-02</BondIssuedDt>
        <IssuePriceAmt>144576937</IssuePriceAmt>
        <PurposeDesc>2016 a bonds refunding 2007 a</PurposeDesc>
        <DefeasedInd>false</DefeasedInd>
        <OnBehalfOfIssuerInd>false</OnBehalfOfIssuerInd>
        <PoolFinancingInd>false</PoolFinancingInd>
      </TaxExemptBondsIssuesGrp>
      <TaxExemptBondsProceedsGrp>
        <BondReferenceCd>A</BondReferenceCd>
        <RetiredAmt>13375000</RetiredAmt>
        <TotalProceedsAmt>35382595</TotalProceedsAmt>
        <CapitalizedInterestAmt>1492333</CapitalizedInterestAmt>
        <IssuanceCostsFromProceedsAmt>372010</IssuanceCostsFromProceedsAmt>
        <CapitalExpendituresAmt>33135657</CapitalExpendituresAmt>
        <SubstantialCompletionYr>2008</SubstantialCompletionYr>
        <RefundingTaxExemptBondsInd>false</RefundingTaxExemptBondsInd>
        <RefundingTaxableBondsInd>false</RefundingTaxableBondsInd>
        <FinalAllocationMadeInd>true</FinalAllocationMadeInd>
        <AdequateBooksAndRecMaintInd>true</AdequateBooksAndRecMaintInd>
      </TaxExemptBondsProceedsGrp>
      <TaxExemptBondsProceedsGrp>
        <BondReferenceCd>B</BondReferenceCd>
        <RetiredAmt>30000000</RetiredAmt>
        <TotalProceedsAmt>30000000</TotalProceedsAmt>
        <OtherSpentProceedsAmt>30000000</OtherSpentProceedsAmt>
        <SubstantialCompletionYr>2010</SubstantialCompletionYr>
        <RefundingTaxExemptBondsInd>true</RefundingTaxExemptBondsInd>
        <RefundingTaxableBondsInd>false</RefundingTaxableBondsInd>
        <FinalAllocationMadeInd>true</FinalAllocationMadeInd>
        <AdequateBooksAndRecMaintInd>true</AdequateBooksAndRecMaintInd>
      </TaxExemptBondsProceedsGrp>
      <TaxExemptBondsProceedsGrp>
        <BondReferenceCd>C</BondReferenceCd>
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        <InReserveFundAmt>1435719</InReserveFundAmt>
        <OtherSpentProceedsAmt>50301729</OtherSpentProceedsAmt>
        <SubstantialCompletionYr>2003</SubstantialCompletionYr>
        <RefundingTaxExemptBondsInd>true</RefundingTaxExemptBondsInd>
        <RefundingTaxableBondsInd>false</RefundingTaxableBondsInd>
        <FinalAllocationMadeInd>true</FinalAllocationMadeInd>
        <AdequateBooksAndRecMaintInd>true</AdequateBooksAndRecMaintInd>
      </TaxExemptBondsProceedsGrp>
      <TaxExemptBondsProceedsGrp>
        <BondReferenceCd>D</BondReferenceCd>
        <RetiredAmt>9326937</RetiredAmt>
        <TotalProceedsAmt>144576937</TotalProceedsAmt>
        <RefundingEscrowAmt>142845798</RefundingEscrowAmt>
        <IssuanceCostsFromProceedsAmt>1731139</IssuanceCostsFromProceedsAmt>
        <RefundingTaxExemptBondsInd>false</RefundingTaxExemptBondsInd>
        <RefundingTaxableBondsInd>true</RefundingTaxableBondsInd>
        <FinalAllocationMadeInd>true</FinalAllocationMadeInd>
        <AdequateBooksAndRecMaintInd>true</AdequateBooksAndRecMaintInd>
      </TaxExemptBondsProceedsGrp>
      <TaxExemptBondsPrivateBusUseGrp>
        <BondReferenceCd>A</BondReferenceCd>
        <OwningBondFinancedPropertyInd>false</OwningBondFinancedPropertyInd>
        <AnyLeaseArrangementsInd>false</AnyLeaseArrangementsInd>
        <MgmtContractBondFincdPropInd>true</MgmtContractBondFincdPropInd>
        <EngageBondCounselContractsInd>true</EngageBondCounselContractsInd>
        <AnyResearchAgreementsInd>false</AnyResearchAgreementsInd>
        <EngageBondCounselResearchInd>false</EngageBondCounselResearchInd>
        <PrivateBusUseByOthersPct>0.0</PrivateBusUseByOthersPct>
        <PrivateBusConcerningUBIPct>0.0</PrivateBusConcerningUBIPct>
        <TotalPrivateBusinessUsePct>0.0</TotalPrivateBusinessUsePct>
        <BondIssMeetPrvtSecPymtTestInd>false</BondIssMeetPrvtSecPymtTestInd>
        <ChangeInUseBondFinancedPropInd>false</ChangeInUseBondFinancedPropInd>
        <ChangeInUseBondFinancedPropPct>0</ChangeInUseBondFinancedPropPct>
        <RemedialActionTakenInd>false</RemedialActionTakenInd>
        <ProcsNonqualifiedBondRemdtdInd>true</ProcsNonqualifiedBondRemdtdInd>
      </TaxExemptBondsPrivateBusUseGrp>
      <TaxExemptBondsPrivateBusUseGrp>
        <BondReferenceCd>B</BondReferenceCd>
        <OwningBondFinancedPropertyInd>false</OwningBondFinancedPropertyInd>
        <AnyLeaseArrangementsInd>false</AnyLeaseArrangementsInd>
        <MgmtContractBondFincdPropInd>true</MgmtContractBondFincdPropInd>
        <EngageBondCounselContractsInd>true</EngageBondCounselContractsInd>
        <AnyResearchAgreementsInd>false</AnyResearchAgreementsInd>
        <EngageBondCounselResearchInd>false</EngageBondCounselResearchInd>
        <PrivateBusUseByOthersPct>0.0</PrivateBusUseByOthersPct>
        <PrivateBusConcerningUBIPct>0.0</PrivateBusConcerningUBIPct>
        <TotalPrivateBusinessUsePct>0.0</TotalPrivateBusinessUsePct>
        <BondIssMeetPrvtSecPymtTestInd>false</BondIssMeetPrvtSecPymtTestInd>
        <ChangeInUseBondFinancedPropInd>false</ChangeInUseBondFinancedPropInd>
        <ChangeInUseBondFinancedPropPct>0</ChangeInUseBondFinancedPropPct>
        <RemedialActionTakenInd>false</RemedialActionTakenInd>
        <ProcsNonqualifiedBondRemdtdInd>true</ProcsNonqualifiedBondRemdtdInd>
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      <TaxExemptBondsPrivateBusUseGrp>
        <BondReferenceCd>C</BondReferenceCd>
        <OwningBondFinancedPropertyInd>false</OwningBondFinancedPropertyInd>
        <AnyLeaseArrangementsInd>false</AnyLeaseArrangementsInd>
        <MgmtContractBondFincdPropInd>true</MgmtContractBondFincdPropInd>
        <EngageBondCounselContractsInd>true</EngageBondCounselContractsInd>
        <AnyResearchAgreementsInd>false</AnyResearchAgreementsInd>
        <EngageBondCounselResearchInd>false</EngageBondCounselResearchInd>
        <PrivateBusUseByOthersPct>0.0</PrivateBusUseByOthersPct>
        <PrivateBusConcerningUBIPct>0.0</PrivateBusConcerningUBIPct>
        <TotalPrivateBusinessUsePct>0.0</TotalPrivateBusinessUsePct>
        <BondIssMeetPrvtSecPymtTestInd>false</BondIssMeetPrvtSecPymtTestInd>
        <ChangeInUseBondFinancedPropInd>false</ChangeInUseBondFinancedPropInd>
        <ChangeInUseBondFinancedPropPct>0</ChangeInUseBondFinancedPropPct>
        <RemedialActionTakenInd>false</RemedialActionTakenInd>
        <ProcsNonqualifiedBondRemdtdInd>true</ProcsNonqualifiedBondRemdtdInd>
      </TaxExemptBondsPrivateBusUseGrp>
      <TaxExemptBondsPrivateBusUseGrp>
        <BondReferenceCd>D</BondReferenceCd>
        <OwningBondFinancedPropertyInd>false</OwningBondFinancedPropertyInd>
        <AnyLeaseArrangementsInd>false</AnyLeaseArrangementsInd>
        <MgmtContractBondFincdPropInd>true</MgmtContractBondFincdPropInd>
        <EngageBondCounselContractsInd>true</EngageBondCounselContractsInd>
        <AnyResearchAgreementsInd>false</AnyResearchAgreementsInd>
        <EngageBondCounselResearchInd>false</EngageBondCounselResearchInd>
        <PrivateBusUseByOthersPct>0.0</PrivateBusUseByOthersPct>
        <PrivateBusConcerningUBIPct>0.0</PrivateBusConcerningUBIPct>
        <TotalPrivateBusinessUsePct>0.0</TotalPrivateBusinessUsePct>
        <BondIssMeetPrvtSecPymtTestInd>false</BondIssMeetPrvtSecPymtTestInd>
        <ChangeInUseBondFinancedPropInd>false</ChangeInUseBondFinancedPropInd>
        <ChangeInUseBondFinancedPropPct>0</ChangeInUseBondFinancedPropPct>
        <RemedialActionTakenInd>false</RemedialActionTakenInd>
        <ProcsNonqualifiedBondRemdtdInd>true</ProcsNonqualifiedBondRemdtdInd>
      </TaxExemptBondsPrivateBusUseGrp>
      <TaxExemptBondsArbitrageGrp>
        <BondReferenceCd>A</BondReferenceCd>
        <Form8038TFiledInd>false</Form8038TFiledInd>
        <RebateNotDueYetInd>false</RebateNotDueYetInd>
        <ExceptionToRebateInd>true</ExceptionToRebateInd>
        <NoRebateDueInd>false</NoRebateDueInd>
        <VariableRateIssueInd>false</VariableRateIssueInd>
        <HedgeIdentifiedInBksAndRecInd>false</HedgeIdentifiedInBksAndRecInd>
        <TermOfHedgePct>0</TermOfHedgePct>
        <SuperintegratedHedgeInd>false</SuperintegratedHedgeInd>
        <HedgeTerminatedInd>false</HedgeTerminatedInd>
        <GrossProceedsInvestedInGICInd>false</GrossProceedsInvestedInGICInd>
        <TermOfGICPct>0</TermOfGICPct>
        <RegulatorySafeHarborStsfdInd>false</RegulatorySafeHarborStsfdInd>
        <GrossProceedsInvestedInd>false</GrossProceedsInvestedInd>
        <WrittenProcToMonitorReqsInd>true</WrittenProcToMonitorReqsInd>
      </TaxExemptBondsArbitrageGrp>
      <TaxExemptBondsArbitrageGrp>
        <BondReferenceCd>B</BondReferenceCd>
        <Form8038TFiledInd>false</Form8038TFiledInd>
        <RebateNotDueYetInd>false</RebateNotDueYetInd>
        <ExceptionToRebateInd>false</ExceptionToRebateInd>
        <NoRebateDueInd>true</NoRebateDueInd>
        <VariableRateIssueInd>false</VariableRateIssueInd>
        <HedgeIdentifiedInBksAndRecInd>false</HedgeIdentifiedInBksAndRecInd>
        <TermOfHedgePct>0</TermOfHedgePct>
        <SuperintegratedHedgeInd>false</SuperintegratedHedgeInd>
        <HedgeTerminatedInd>false</HedgeTerminatedInd>
        <GrossProceedsInvestedInGICInd>false</GrossProceedsInvestedInGICInd>
        <TermOfGICPct>0</TermOfGICPct>
        <RegulatorySafeHarborStsfdInd>false</RegulatorySafeHarborStsfdInd>
        <GrossProceedsInvestedInd>false</GrossProceedsInvestedInd>
        <WrittenProcToMonitorReqsInd>true</WrittenProcToMonitorReqsInd>
      </TaxExemptBondsArbitrageGrp>
      <TaxExemptBondsArbitrageGrp>
        <BondReferenceCd>C</BondReferenceCd>
        <Form8038TFiledInd>false</Form8038TFiledInd>
        <RebateNotDueYetInd>false</RebateNotDueYetInd>
        <ExceptionToRebateInd>false</ExceptionToRebateInd>
        <NoRebateDueInd>true</NoRebateDueInd>
        <VariableRateIssueInd>false</VariableRateIssueInd>
        <HedgeIdentifiedInBksAndRecInd>false</HedgeIdentifiedInBksAndRecInd>
        <TermOfHedgePct>0</TermOfHedgePct>
        <SuperintegratedHedgeInd>false</SuperintegratedHedgeInd>
        <HedgeTerminatedInd>false</HedgeTerminatedInd>
        <GrossProceedsInvestedInGICInd>false</GrossProceedsInvestedInGICInd>
        <TermOfGICPct>0</TermOfGICPct>
        <RegulatorySafeHarborStsfdInd>false</RegulatorySafeHarborStsfdInd>
        <GrossProceedsInvestedInd>false</GrossProceedsInvestedInd>
        <WrittenProcToMonitorReqsInd>true</WrittenProcToMonitorReqsInd>
      </TaxExemptBondsArbitrageGrp>
      <TaxExemptBondsArbitrageGrp>
        <BondReferenceCd>D</BondReferenceCd>
        <Form8038TFiledInd>false</Form8038TFiledInd>
        <RebateNotDueYetInd>true</RebateNotDueYetInd>
        <ExceptionToRebateInd>false</ExceptionToRebateInd>
        <NoRebateDueInd>true</NoRebateDueInd>
        <VariableRateIssueInd>false</VariableRateIssueInd>
        <HedgeIdentifiedInBksAndRecInd>false</HedgeIdentifiedInBksAndRecInd>
        <TermOfHedgePct>0</TermOfHedgePct>
        <SuperintegratedHedgeInd>false</SuperintegratedHedgeInd>
        <HedgeTerminatedInd>false</HedgeTerminatedInd>
        <GrossProceedsInvestedInGICInd>false</GrossProceedsInvestedInGICInd>
        <TermOfGICPct>0</TermOfGICPct>
        <RegulatorySafeHarborStsfdInd>false</RegulatorySafeHarborStsfdInd>
        <GrossProceedsInvestedInd>false</GrossProceedsInvestedInd>
        <WrittenProcToMonitorReqsInd>true</WrittenProcToMonitorReqsInd>
      </TaxExemptBondsArbitrageGrp>
      <ProceduresCorrectiveActionGrp>
        <BondReferenceCd>A</BondReferenceCd>
        <ProceduresCorrectiveActionInd>true</ProceduresCorrectiveActionInd>
      </ProceduresCorrectiveActionGrp>
      <ProceduresCorrectiveActionGrp>
        <BondReferenceCd>B</BondReferenceCd>
        <ProceduresCorrectiveActionInd>true</ProceduresCorrectiveActionInd>
      </ProceduresCorrectiveActionGrp>
      <ProceduresCorrectiveActionGrp>
        <BondReferenceCd>C</BondReferenceCd>
        <ProceduresCorrectiveActionInd>true</ProceduresCorrectiveActionInd>
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      <ProceduresCorrectiveActionGrp>
        <BondReferenceCd>D</BondReferenceCd>
        <ProceduresCorrectiveActionInd>true</ProceduresCorrectiveActionInd>
      </ProceduresCorrectiveActionGrp>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>TAX EXEMPT BONDS I, BOND A PART II, LINE 3</FormAndLineReferenceDesc>
        <ExplanationTxt>THE AMOUNT IN PART II, LINE 3 "TOTAL PROCEEDS" IS NOT EQUAL TO THE AMOUNT IN PART I, COLUMN E "ISSUE PRICE". THE "TOTAL PROCEEDS" FOR THE BOND ISSUANCE INCLUDES INVESTMENT EARNINGS ON THE PROCEEDS.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>TAX EXEMPT BONDS I BOND C &amp; D, and Bonds II Bond B, PART II LINE 7</FormAndLineReferenceDesc>
        <ExplanationTxt>THE ISSUANCE COSTS FOR THESE BOND ISSUANCES WERE NOT PAID OUT OF THE PROCEEDS FROM THE BOND ISSUANCES. RATHER, THE ISSUANCE COSTS WERE PAID OUT OF REGULAR OPERATING FUNDS OF THE ORGANIZATION.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>PART II, BOND C</FormAndLineReferenceDesc>
        <ExplanationTxt>THE TOTAL PROCEEDS OF THE ISSUE ARE LESS THAN THE GROSS PROCEEDS IN RESERVE FUNDS AND OTHER SPENT PROCEEDS FOR THE BOND ISSUANCE BECAUSE FUNDS PLEDGED TO THE SERIES 2001 BONDS, WHICH WERE REFUNDED BY THIS BOND ISSUANCE, WERE TRANSFERRED (AS PART OF THE BOND ISSUANCE) INTO THE DEBT SERVICE RESERVE FUND HELF FOR THIS BOND ISSUANCE.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>TAX EXEMPT BONDS I, BOND C PART II, LINE 3</FormAndLineReferenceDesc>
        <ExplanationTxt>THE AMOUNT IN PART II, LINE 3 "TOTAL PROCEEDS" IS NOT EQUAL TO THE AMOUNT IN PART I, COLUMN E "ISSUE PRICE". THE "TOTAL PROCEEDS" FOR THE BOND ISSUANCE INCLUDES INVESTMENT EARNINGS ON THE PROCEEDS.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>TAX EXEMPT BONDS 2, BOND B PART II, LINE 3</FormAndLineReferenceDesc>
        <ExplanationTxt>THE AMOUNT IN PART II, LINE 3 "TOTAL PROCEEDS" IS NOT EQUAL TO THE AMOUNT IN PART I, COLUMN E "ISSUE PRICE". THE "TOTAL PROCEEDS" FOR THE BOND ISSUANCE INCLUDES INVESTMENT EARNINGS ON THE PROCEEDS.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>TAX EXEMPT BONDS 2, BOND C PART II, LINE 3</FormAndLineReferenceDesc>
        <ExplanationTxt>THE AMOUNT IN PART II, LINE 3 "TOTAL PROCEEDS" IS NOT EQUAL TO THE AMOUNT IN PART I, COLUMN E "ISSUE PRICE". THE "TOTAL PROCEEDS" FOR THE BOND ISSUANCE INCLUDES INVESTMENT EARNINGS ON THE PROCEEDS.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Schedule K, Part IV, Line 2c COLUMN B</FormAndLineReferenceDesc>
        <ExplanationTxt>Issuer name: MARYLAND HEALTH &amp; HIGHER EDUcational FAC AUTHORITY The calculation for computing no rebate due was performed on 07/01/2012</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Schedule K, Part IV, Line 2c COLUMN C</FormAndLineReferenceDesc>
        <ExplanationTxt>Issuer name: MARYLAND HEALTH &amp; HIGHER EDUcational FAC AUTHORITY The calculation for computing no rebate due was performed on 07/01/2016</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Schedule K, Part IV, Line 2c COLUMN D</FormAndLineReferenceDesc>
        <ExplanationTxt>Issuer name: MARYLAND HEALTH &amp; HIGHER EDUcational FAC AUTHORITY The calculation for computing no rebate due was performed on 07/01/2020</ExplanationTxt>
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      <TaxExemptBondsIssuesGrp>
        <BondReferenceCd>A</BondReferenceCd>
        <IssuerName>
          <BusinessNameLine1Txt>MARYLAND HEALTH &amp; HIGHER EDUcational FAC AUTHORITY</BusinessNameLine1Txt>
        </IssuerName>
        <BondIssuerEIN>520936091</BondIssuerEIN>
        <BondIssuedDt>2016-05-19</BondIssuedDt>
        <IssuePriceAmt>65450000</IssuePriceAmt>
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          <BusinessNameLine1Txt>MARYLAND HEALTH &amp; HIGHER EDUcational FAC AUTHORITY</BusinessNameLine1Txt>
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        <BondIssuedDt>2021-04-21</BondIssuedDt>
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          <BusinessNameLine1Txt>MARYLAND HEALTH &amp; HIGHER EDUcational FAC AUTHORITY</BusinessNameLine1Txt>
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        <BondIssuedDt>2022-06-09</BondIssuedDt>
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          <BusinessNameLine1Txt>MARYLAND HEALTH &amp; HIGHER EDUcational FAC AUTHORITY</BusinessNameLine1Txt>
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        <BondReferenceCd>C</BondReferenceCd>
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        <ProcsNonqualifiedBondRemdtdInd>false</ProcsNonqualifiedBondRemdtdInd>
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        <BondReferenceCd>B</BondReferenceCd>
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        <OwningBondFinancedPropertyInd>false</OwningBondFinancedPropertyInd>
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        <Form8038TFiledInd>false</Form8038TFiledInd>
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        <ExceptionToRebateInd>false</ExceptionToRebateInd>
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        <BondReferenceCd>B</BondReferenceCd>
        <Form8038TFiledInd>false</Form8038TFiledInd>
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        <BondReferenceCd>C</BondReferenceCd>
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        <BondReferenceCd>D</BondReferenceCd>
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      </ProceduresCorrectiveActionGrp>
    </IRS990ScheduleK>
    <IRS990ScheduleO documentId="IRS990ScheduleO" softwareId="24020961" softwareVersionNum="2024v5.1">
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part III, Line 4a</FormAndLineReferenceDesc>
        <ExplanationTxt>MMC's second largest major service category is Medicine, representing 23.8% of total hospital revenue. In Fiscal Year 2025, Mercy served 7,402 medical admissions and observation cases and provided care for 45,549 Emergency Room visits. MMC's third largest major service category is Obstetrics/Neonatal Intensive Care/Pediatrics, representing 14.2% of total hospital revenue. In Fiscal Year 2025, MMC provided care for 2,383 Nursery Births and 340 NICU births during the period. MMC is the largest birthing hospital in Baltimore City. Approximately 57.5 % of mothers delivering at Mercy are Medicaid insured.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Line 15</FormAndLineReferenceDesc>
        <ExplanationTxt>THE ORGANIZATION'S BOARD HAS ADOPTED A COMPENSATION POLICY (THE "POLICY") FOR COVERED INDIVIDUALS. PURSUANT TO THE POLICY, A COMPENSATION COMMITTEE OF INDEPENDENT DIRECTORS OF THE BOARD OF THE ORGANIZATION'S PARENT CORPORATION WAS ESTABLISHED TO REVIEW THE COMPENSATION OF ALL EMPLOYEES SPECIFIED AS HAVING A SUBSTANTIAL INFLUENCE OVER THE ORGANIZATION AND WHO RECEIVE REMUNERATION FROM THE ORGANIZATION. THE COMPENSATION COMMITTEE IS ADVISED BY AN INDEPENDENT COMPENSATION CONSULTANT, WHICH OPINES TO THE COMPENSATION COMMITTEE THAT THE LEVEL OF COMPENSATION PAID AND THE PROCESS BY WHICH COMPENSATION IS ESTABLISHED MEET APPLICABLE IRS REASONABLENESS AND "SAFE HARBOR" STANDARDS. THE OUTSIDE COMPENSATION CONSULTANT PROVIDES DATA OF COMPENSATION PROVIDED AT SIMILAR ORGANIZATIONS TO ENSURE THAT THE ORGANIZATION DOES NOT COMPENSATE IN EXCESS OF MARKET NORMS. Mercy Health Services, Inc. (the Corporation's sole member) has a written policy regarding the review of physician compensation titled "Amended and Restated Physician Compensation Review." The policy applies to all MHS subsidiaries, including the Corporation, and it sets out the process and procedures for ensuring that physician compensation is appropriately reviewed and determined to be consistent with fair market value. Under the policy the review and determination must be documented in writing. The policy addresses internal reviews through benchmarking of physician compensation against nationally recognized compensation survey data, the use of independent compensation consultants and review by the MHS Board Compensation Committee. The policy further requires that all compensation reviews be performed in accordance with the MHS Conflict of Interest Policy.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Line 1b</FormAndLineReferenceDesc>
        <ExplanationTxt>Mercy Health Services, Inc. ("MHS"), a 501(c)(3) corporation, is the sole member of Mercy Medical Center, Inc. ("MMC"). MHS is governed by a 28-person Board of Trustees, of whom 21 are independent board members. The Board of Directors of MMC is currently made of 9 directors. The President of MHS serves as an ex officio member of MMC's Board and the balance of the MMC Board members are elected by, and subject to removal by, the Board of Trustees of MHS. All of the Board members are compensated as employees either of MMC or a related organization listed in Schedule R, Part II.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Line 18</FormAndLineReferenceDesc>
        <ExplanationTxt>The organization makes these forms available at www.hscrc.maryland.gov.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Line 6 Classes of members or stockholders</FormAndLineReferenceDesc>
        <ExplanationTxt>Mercy Health Services, Inc. ("MHS"), a 501(c)(3) corporation, is the sole member of Mercy Medical Center, Inc. ("MMC").</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Line 7a Members or stockholders electing members of governing body</FormAndLineReferenceDesc>
        <ExplanationTxt>The President of MHS serves as an ex officio voting member of the Board of Directors of MMC. As the member of MMC, the Board of Trustees of MHS elects all of the other members of the Board of MMC. All of the members of the MMC Board serve at the pleasure of the Board of Trustees of MHS and are subject to removal by the MHS Board.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders</FormAndLineReferenceDesc>
        <ExplanationTxt>The Board of Trustees of MHS exercises authority over MMC through its right to appoint and remove MMC Board members. In addition, MHS, as the member, is responsible for the following actions: a) to appoint members to MMC's Board of Directors; b) to review and approve or disapprove the strategic plan, annual budget and the annual operating goals and objectives of MMC as recommended to MHS by MMC's Board of Directors; c) to evaluate the performance of MMC's Board of Directors, officers, and operating management; d) to remove Board members of MMC in its discretion at any time; e) to approve the mission and vision that govern MMC's operations; f) to have ultimate responsibility for MMC's quality assurance, performance improvement, utilization review and risk management; and g) to appoint, reappoint and take any corrective action related to the Medical Staff of MMC (the "Medical Staff") in accordance with the Medical Staff Bylaws of MMC. The following actions require the approval of and affirmative corporate action by MHS: a) any disposition of all or substantially all of MMC's assets, dissolution, liquidation, winding up or abandonment of MMC; b) any amendment of the Articles of Incorporation or Bylaws of MMC or of the Medical Staff Bylaws of MMC; c) any borrowing or lending by MMC or the issuance of any guarantee by MMC in an amount in excess of an amount specified by MHS from time to time; d) any merger, consolidation or institutional affiliation with any other amount in excess of an amount specified from time to time by MHS corporation or other entity; and e) the purchase or sale of assets for an amount in excess of an amount specified from time to time by MHS. Ultimately, the Corporation is controlled by MHS's 29-person community board, which includes 21 independent directors as noted above.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Line 11b Review of form 990 by governing body</FormAndLineReferenceDesc>
        <ExplanationTxt>Mercy Health Services, Inc. ("MHS"), the sole parent of the Corporation, has a policy which requires the Corporation's 990 to be made available for review by the MHS Board and/or the MHS Board Executive Committee prior to its filing. At its board meeting, MHS Board Executive Committee members received a copy of the Corporation's draft form 990. The MHS CFO provided a power point presentation regarding the draft and there was an opportunity for questions and discussion. Following further revision of the draft 990 and prior to its filing, it was made available in final form to all members of the MHS Board and the Corporation's Board FOR THEIR REVIEW. ANY ADDITIONAL COMMENTS/QUESTIONS FROM BOARD MEMBERS ARE RESPONDED TO PRIOR TO FILING THE FORM 990.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Line 12c Conflict of interest policy</FormAndLineReferenceDesc>
        <ExplanationTxt>COI requests are sent out each fall for completion by the end of the calendar year. Results are reported to the Audit Committee at the meeting in January for discussion and review. Completion is tracked within the COI Smart electronic system. Any previously approved disclosure is noted as "previously reviewed and approved by the Audit Committee changes in outside Board participation as well as financial disclosures are listed for review and approval by the Audit Committee. Disclosures totaling &lt; $1,000 are not included on the disclosure report as these are routinely food and beverage reports on the CMS Open Payment Database.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Line 19 Required documents available to the public</FormAndLineReferenceDesc>
        <ExplanationTxt>The governing documents of the organization, its conflicts of interest policy, and its financial statements are available from the organization upon request and at mdmercy.com.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VII, Section A, Line 5</FormAndLineReferenceDesc>
        <ExplanationTxt>Many of the physicians that are on the Board receive financial compensation from clinical vendors either in the capacity of consultants, services other than consulting, education, associated research funding. All report on the annual disclosure and these amounts are checked against the CMS open payments database. See Disclosure Report.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VIII, Line 11d Other Miscellaneous Revenue</FormAndLineReferenceDesc>
        <ExplanationTxt>Parking Garage Income - Total Revenue: 1636470, Related or Exempt Function Revenue: 1522078, Unrelated Business Revenue: 114392, Revenue Excluded from Tax Under Sections 512, 513, or 514: ; Lab Revenue - Total Revenue: 528199, Related or Exempt Function Revenue: 528199, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ; Other Revenue - Total Revenue: 255668, Related or Exempt Function Revenue: 255668, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ; Advertising Income - Total Revenue: 29792, Related or Exempt Function Revenue: , Unrelated Business Revenue: 29792, Revenue Excluded from Tax Under Sections 512, 513, or 514: ; Answering Service Income - Total Revenue: 7488, Related or Exempt Function Revenue: , Unrelated Business Revenue: 7488, Revenue Excluded from Tax Under Sections 512, 513, or 514: ; Pharmacy Revenue - Total Revenue: -1423868, Related or Exempt Function Revenue: -1423868, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ;</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part XI, Line 2 PART XI, QUESTIONS 2 AND 3 - AUDITS</FormAndLineReferenceDesc>
        <ExplanationTxt>MERCY HEALTH SYSTEM, INC. AND ITS SUBSIDIARES INCLUDING THE ORGANIZATION FILING THIS FORM 990, UNDERGO A CONSOLIDATED AUDIT OF THEIR FINANCIAL STATEMENT THAT COMPLIES WITH SINGLE AUDIT ACT/OMB CIRCULAR A-133 REQUIREMENTS DUE TO THE EXPENDITURE OF FEDERAL AWARDS. THE ACCOUNTING FIRM OF Dixon Hughes Goodman LLP HAS ISSUED AN UNQUALIFIED OPINION REGARDING THE CONSOLIDATED FINANCIAL STATEMENTS IN CONFORMANCE WITH GENERALLY ACCEPTED AUDIT STANDARDS AND THE SINGLE AUDIT ACT/OMB CIRCULAR A-133 REQUIREMENTS FOR THE FISCAL YEAR THAT CORRESPONDS TO THE TAX REPORTING YEAR GOVERNED BY THIS FORM 990.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part XI, Line 9 Other changes in net assets or fund balances</FormAndLineReferenceDesc>
        <ExplanationTxt>Net assets released from restriction - 1235136; change in post retirement obligation - -64740; Unrealized gain on SWAP - -499036; Net assets transfer from affiliates - 3995481; Total - 4666841;</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part XII, Line 2c Change of oversight process or selection process</FormAndLineReferenceDesc>
        <ExplanationTxt>The process has not changed from the prior year.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Schedule F, Part I, Line 3</FormAndLineReferenceDesc>
        <ExplanationTxt>THE AMOUNT INDICATED AS FOREIGN INVESTMENTS IN PART I WAS MERCY MEDICAL CENTER'S OWNERSHIP INTEREST IN GREENLEAF INSURANCE COMPANY, LTD ("GREENLEAF"), A CAYMAN ISLAND CORPORATION. GREENLEAF IS A WHOLLY-OWNED SUBSIDIARY OF MERCY MEDICAL CENTER THAT PROVIDES DIRECT COVERAGE FOR PROFESSIONAL, MALPRACTICE, AND COMPREHENSIVE GENERAL LIABILITY FOR MERCY MEDICAL CENTER AND ITS ASSOCIATED HEALTH CARE FACILITIES. AS OF THE END OF THE 2020 TAX YEAR, THE VALUE OF MERCY MEDICAL CENTER'S OWNERSHIP IN GREENLEAF WAS $4,791,317 per book.</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleO>
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          <BusinessNameLine1Txt>MERCY HEALTH SERVICES INC</BusinessNameLine1Txt>
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          <AddressLine1Txt>301 ST PAUL PLACE</AddressLine1Txt>
          <CityNm>BALTIMORE</CityNm>
          <StateAbbreviationCd>MD</StateAbbreviationCd>
          <ZIPCd>21202</ZIPCd>
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          <BusinessNameLine1Txt>MERCY HEALTH FOUNDATION INC</BusinessNameLine1Txt>
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          <AddressLine1Txt>301 ST PAUL PLACE</AddressLine1Txt>
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          <StateAbbreviationCd>MD</StateAbbreviationCd>
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          <BusinessNameLine1Txt>STELLA MARIS INC</BusinessNameLine1Txt>
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          <AddressLine1Txt>2300 DULANEY VALLEY</AddressLine1Txt>
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          <ZIPCd>21093</ZIPCd>
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          <AddressLine1Txt>PO BOX 1363</AddressLine1Txt>
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      <LoansOrGuaranteesFromOthOrgInd>false</LoansOrGuaranteesFromOthOrgInd>
      <DivRelatedOrganizationInd>false</DivRelatedOrganizationInd>
      <AssetSaleToOtherOrgInd>false</AssetSaleToOtherOrgInd>
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        </OtherOrganizationName>
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        <InvolvedAmt>6155796</InvolvedAmt>
        <MethodOfAmountDeterminationTxt>FMV</MethodOfAmountDeterminationTxt>
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          <BusinessNameLine1Txt>MERCY TRANSITIONAL CARE SERVICES</BusinessNameLine1Txt>
        </OtherOrganizationName>
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        <InvolvedAmt>3197885</InvolvedAmt>
        <MethodOfAmountDeterminationTxt>FMV</MethodOfAmountDeterminationTxt>
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  </ReturnData>
</Return>