4A (Expenses $ 436967103 including grants of $ 431030) (Revenue $ 519331301)
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).

4B (Expenses $ 45905434 including grants of $ 0) (Revenue $ 42114434)
Research:TMH has 381 research projects with total expenses of $45.9 million in fiscal year 2022 (94 investigators and 152 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 60% 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 $x.xx million of research grants from for-profit organizations that are not reported in Schedule H.(See Schedule O).

4C (Expenses $ 21696408 including grants of $ 0) (Revenue $ 5313319)
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 $16.4 million in fiscal year 2022. (Continued on Schedule O).

Facility: The Miriam Hospital - Part V, Section B, Line 3j
Part V, Line 3e:On February 27, 2020, the first COVID-19 patient in Rhode Island was admitted to TMH, moving the nations smallest state onto the worldwide coronavirus map. After that date, cases began to increase quickly throughout the state. The first stay-at-home order was issued on March 20, 2020, requiring all Rhode Island residents to stay at home unless getting food, medicine, or other essentials. Originally scheduled to remain in effect until April 13, the order also banned gatherings of more than five individuals and required out-of-state visitors to quarantine for 14 days. As cases increased, Governor Gina Raimondo announced on April 23 that schools would remain closed for the rest of the academic year. Many hospitals also postponed elective and non-emergent procedures until a later date. By April 28, 2020, COVID hospitalization rates were at their first all-time high at 373, with 88 of these patients in the ICU and 59 on ventilators. Eventually, hospitalization rates and case numbers began to decrease, reaching a low on July 7, 2020 with only 58 Rhode Islanders hospitalized due to COVID.During the month of July, the state started to slowly re-open allowing some beaches, restaurants, and entertainment businesses to resume operations (with minimum capacity), and hospitals to begin performing elective procedures again. By fall, most schools were also able to open up again. After an increase in COVID cases in November 2020, Governor Raimondo announced a statewide pause reclosing many bars, gyms, and recreational venues. By December 15, 2020, hospitalization rates reached a high of 514 in-patients. After this COVID peak, rates slowed for a period, partly due to the distribution of vaccines that started in February 2021 with doses initially being offered to individuals aged 75 and older. After first distributing the vaccine to those most at risk, Rhode Island gradually allowed other groups of residents to register.On July 20, 2021, hospitalization rates hit another low when only 23 patients were admitted with a diagnosis of COVID. However, as the season changed to winter, rates spiked again with a new all-time high of 618 inpatients on January 17, 2022. Despite this being the highest record of hospitalizations, the greatest number of COVID-related fatalities still occurred at the beginning of the pandemic.Since the beginning of 2022, COVID rates have decreased, with a slight increase as of the drafting of this report (June, 2022). Overall, the town of Central Falls has the highest rate of COVID cases in the state, followed by Pawtucket, East Greenwich, and Providence (respectively at 2nd, 3rd, and 4th place). In contrast, the towns of Little Compton and Jamestown have the lowest COVID rates and related hospitalizations. Across the state of Rhode Island, over 8 million COVID tests have been administered; approximately 400,000 positive cases have been reported; and over 3,500 COVID-related deaths have occurred. As of the June 2022, 98.5% of the Rhode Island population is at least partially vaccinated; 83% have completed their primary series; and 41.2% have received boosters. These statistics vary depending on age, gender, and race. For example, 99% of residents between the ages of 70 and 79 have received their primary COVID-19 vaccine series while those between 19 and 24 have a lower primary vaccination rate of 62.2%. Specifically at TMH, visitation was suspended on March 9, 2020, the same day the Governor declared a state of emergency. By March 18, 2020, elective procedures at TMH were suspended. April 27, 2020 marked the day the Lifespan Alternative Hospital Site, operated by RIH and one of two alternative hospitals stood up in Rhode Island, was ready for operations. Just two days later, the state experienced the largest one-day volume of COVID positive inpatients (241), as the first wave crested. With COVID cases declining, restrictions on elective procedures were lifted on May 11, 2020. Six months later, on December 14, 2020, the second COVID wave peaked just as the alternative hospital site began admitting patients. TMH began vaccinating frontline workers with the Pfizer COVID-19 vaccine in midDecember 2020 and by October 1, 2021, 98% of Lifespans workforce was vaccinated against COVID-19. TMH clinical and research milestones include: Lifespan researchers were at the forefront of investigating the potential of remdesivir, the experimental antiviral drug from Gilead Sciences, Inc., to shorten the course of COVID-19 illness in patients being treated at TMH, NH and RIH. Rhode Island is one of only three sites in the nation to be selected by the CDC for a study involving widespread antibody testing for the COVID virus. The National Institute of Allergy and Infectious Diseases awarded Karen Tashima, MD, an immunologist based at TMH, a grant of approximately $1.7 million to study the efficacy of a Novavax vaccine candidate to prevent COVID-19. Lifespan is one of about 115 sites in the United States and Mexico participating in the trial. TMH was named a clinical trial site for the National Institutes of Health ACTIV-2 study, testing potential breakthrough treatments for COVID-19 outpatients. As part of its continued response to the COVID-19 pandemic, TMH physician, Jennie Johnson, MD, opened a clinic for patients afflicted with long-COVID. This condition occurs when patients have ongoing COVID symptoms for a month or more after the initial infection 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, Lifespan Community Health Institute (LCHI) leadership, TMH leadership, and Lifespan leadership.

Facility: The Miriam Hospital - 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: The Miriam Hospital - Part V, Section B, Line 6a
Rhode Island HospitalEmma Pendleton Bradley HospitalNewport Hospital

Facility: The Miriam Hospital - 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.lifespan.org/sites/default/files/2023-04/2022-TMH-CHNA-Implementation-Plan.pdfFor implementation actions that TMH took between October 1, 2019 and September 30, 2022, refer to the 2022 Community Healths Needs Assessment The Miriam Hospital, pages 13 - 30, which can be found at https://www.lifespan.org/sites/default/files/2022-09/TMHCommunityHealthNeedsAssessment2022.pdf

Facility: The Miriam Hospital - 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.

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 Lifespan affiliated hospitals (The Miriam Hospital, Rhode Island Hospital, Emma Pendleton Bradley Hospital, and Newport Hospital) is maintained by Lifespan Corporation and included in Lifespan's Annual Report. The annual report for the year ended September 30, 2021 is available at the following link. https://www.lifespan.org/sites/default/files/2022-05/LS-Annual-Report-2021-22-05-26.pdfPlease see pages 5-6, 10, 30, and 38-39 of the Lifespan Annual Report for community benefit information.The annual report for the year ended September 30, 2022 is not yet available for publication at the time of the filings of this tax return.

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 $17,704,354."

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 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 Lifespan Corporation on TMH's behalf."

Part III, Line 8 - Explanation Of Shortfall As Community Benefit
There is no Medicare shortfall for fiscal year 2022. If there was, it would not be 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.Lifespan'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 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 7 - States Filing of Community Benefit Report
RI

Part VI, Line 2 - Needs Assessment
Lifespan'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. Lifespan 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 Lifespan.Based on a broad understanding of community health needs, TMH provides a wide range of services to both its primary and secondary service areas. Lifespan 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 5 - Promotion of Community Health
TMH is governed by a Board of Trustees, which is composed of leaders of the local community elected by Lifespan Corporation. 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
Lifespan's mission is delivering health with care. Lifespan is an academically based healthcare system at the forefront of medical care, continually engaging in research that will lead to medical breakthroughs. Lifespan affiliates provide comprehensive inpatient and outpatient medical, surgical, and psychiatric services for adults and children. Lifespan and its affiliates employ approximately 16,500 people. The Lifespan system has approximately 3,900 physicians on the medical staffs of its affiliated hospitals, operates 1,165 licensed beds in four hospital complexes, and in 2022 generated approximately $2.8 billion in total operating revenue. By each of these measures, Lifespan is Rhode Island's largest health system, serving a population of about 1.1 million. Three of its hospital members, The Miriam Hospital (TMH), Rhode Island Hospital (RIH), and Emma Pendleton Bradley Hospital (EPBH), are teaching affiliates of The Warren Alpert Medical School of Brown University.Lifespan is a Rhode Island nonprofit corporation that is community-based and community-governed. As a nonprofit organization, Lifespan is run by a voluntary Board of Directors who are community representatives. Lifespan 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, 2022, Lifespan Corporation employed approximately 1,100 full-time and part-time personnel, most of whom are located in Providence, Rhode Island. Lifespan Corporation 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 Lifespan in providing these services.CORPORATE AUTHORITY AND ROLELifespan Corporation 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 Lifespan to provide it with the means of effective oversight, coordination, and support of the system. Powers specifically reserved to Lifespan 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 Lifespan's integrated healthcare delivery system, please refer to Schedule R.

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.lifespan.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.lifespan.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.lifespan.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.lifespan.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.lifespan.org/sites/default/files/lifespan-files/documents/lifespan-main/pfs/Lifespan-Financial-Assistance-Summary_052020.pdf