TY 2021 Form 990

(A) Name and title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)	(E) Reportable compensation from related organizations (W-2/1099-MISC/1099-NEC)	(F) Estimated amount of other compensation from the organization and related organizations
(1) NEIL MELTZER...................................................................... PRESIDENT/CEO LBH	0.0 ................. 40.0					X	0	3,103,147	60,154
(2) David Krajewski...................................................................... ex officio-Assistant Treasurer	1.0 ................. 40.0		X				0	1,586,119	227,190
(3) Jason Weiner...................................................................... ex officio-Assistant Secretary	1.0 ................. 40.0		X				0	908,657	145,235
(4) DANIEL BLUM...................................................................... President & COO Sinai & Grace	1.0 ................. 40.0	X	X				0	921,795	103,756
(5) Matthew Poffenroth MD...................................................................... VICE PRESIDENT	1.0 ................. 40.0		X				0	835,822	161,645
(6) REBECCA ALTMAN...................................................................... VICE PRESIDENT	1.0 ................. 40.0		X				0	401,095	73,792
(7) ARSALAN SHEIKH MD...................................................................... CHAIR OF MEDICINE	40.0 ................. 0.0			X			429,230	0	30,286
(8) THEODORA BALIS MD...................................................................... PRIMARY CARE PHYSICIAN	40.0 ................. 0.0				X		351,353	0	30,790
(9) SHANTA POWELL MD...................................................................... PHYSICIAN	40.0 ................. 0.0				X		336,284	0	31,049
(10) DAVID HAUSER MD...................................................................... PSYCHIATRIST	40.0 ................. 0.0				X		333,339	0	11,503
(11) Mohamed Dauda MD...................................................................... President Medical Staff	40.0 ................. 0.0	X					293,798	0	30,430
(12) Yasmeen Ahmed MD...................................................................... PHYSICIAN	40.0 ................. 0.0				X		274,232	0	29,748
(13) Chideha Ohuoha MD...................................................................... Physician	40.0 ................. 0.0				X		283,699	0	2,746
(14) MATT ANSEL THRU 122021...................................................................... Executive Director	40.0 ................. 0.0			X			217,889	0	26,390
(15) Jonathan Davidov...................................................................... CHAIR	1.0 ................. 0.0	X	X				0	0	0
(16) DENNIS WEINMAN...................................................................... Vice Chair/Secretary/Treasurer	1.0 ................. 0.0	X	X				0	0	0
(17) Michael Gaines Sr...................................................................... Director	1.0 ................. 0.0	X					0	0	0

(A) Name and business address	(B) Description of services	(C) Compensation
MEP HEALTH LLC, 4535 Dressler Road NW CANTON,OH44718	Physician Services	1,456,822
CROTHALL HEALTHCARE, 1500 LIBERTY RIDGE DRIVE SUITE 210 WAYNE,PA19087	Contract Cleaning	1,209,166
UNIVERSAL PROTECTION, 36 S Charles Street 2204 BALTIMORE,MA21201	Security Services	877,885
JOHNSON CONTROLS INC, 5757 N Green Bay Avenue MILWAUKEE,WI53201	EQUIP. MAINTENANCE	717,637
MORRISON MANAGEMENT, PO Box 102289 ATLANTA,GA303682269	Food Services	601,031
2 Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization 29

- TIN:

SCHEDULE A
(Form 990)

Department of the Treasury
Internal Revenue Service

Public Charity Status and Public Support

Complete if the organization is a section 501(c)(3) organization or a section 4947(a)(1) nonexempt charitable trust.
right arrow

Attach to Form 990 or Form 990-EZ.
right arrow

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2021

Open to Public
Inspection

Name of the organization

GRACE MEDICAL CENTER INC

Employer identification number

52-0591555

Part I

Reason for Public Charity Status (All organizations must complete this part.) See instructions.

The organization is not a private foundation because it is: (For lines 1 through 12, check only one box.)

A church, convention of churches, or association of churches described in section 170(b)(1)(A)(i).

A school described in section 170(b)(1)(A)(ii). (Attach Schedule E (Form 990).)

A hospital or a cooperative hospital service organization described in section 170(b)(1)(A)(iii).

A medical research organization operated in conjunction with a hospital described in section 170(b)(1)(A)(iii). Enter the hospital's name, city, and state:

An organization operated for the benefit of a college or university owned or operated by a governmental unit described in section 170(b)(1)(A)(iv). (Complete Part II.)

A federal, state, or local government or governmental unit described in section 170(b)(1)(A)(v).

An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in section 170(b)(1)(A)(vi). (Complete Part II.)

A community trust described in section 170(b)(1)(A)(vi). (Complete Part II.)

An agricultural research organization described in 170(b)(1)(A)(ix) operated in conjunction with a land-grant college or university or a non-land grant college of agriculture. See instructions. Enter the name, city, and state of the college or university:

An organization that normally receives: (1) more than 33 1/3% of its support from contributions, membership fees, and gross receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 33 1/3% of its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)

An organization organized and operated exclusively to test for public safety. See section 509(a)(4).

An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). See section 509(a)(3). Check the box on lines 12a through 12d that describes the type of supporting organization and complete lines 12e, 12f, and 12g.

Type I. A supporting organization operated, supervised, or controlled by its supported organization(s), typically by giving the supported organization(s) the power to regularly appoint or elect a majority of the directors or trustees of the supporting organization. You must complete Part IV, Sections A and B.

Type II. A supporting organization supervised or controlled in connection with its supported organization(s), by having control or management of the supporting organization vested in the same persons that control or manage the supported organization(s). You must complete Part IV, Sections A and C.

Type III functionally integrated. A supporting organization operated in connection with, and functionally integrated with, its supported organization(s) (see instructions). You must complete Part IV, Sections A, D, and E.

Type III non-functionally integrated. A supporting organization operated in connection with its supported organization(s) that is not functionally integrated. The organization generally must satisfy a distribution requirement and an attentiveness requirement (see instructions). You must complete Part IV, Sections A and D, and Part V.

Check this box if the organization received a written determination from the IRS that it is a Type I, Type II, Type III functionally integrated, or Type III non-functionally integrated supporting organization.

Enter the number of supported organizations ...............................

Provide the following information about the supported organization(s).

(i) Name of supported organization	(ii) EIN	(iv) Is the organization listed in your governing document?		(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)
(i) Name of supported organization	(ii) EIN	Yes	No	(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)


Total

For Paperwork Reduction Act Notice, see the Instructions for
Form 990 or 990-EZ.

Cat. No. 11285F

Schedule A (Form 990) 2021

Page 2

Part II

Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization failed to qualify under the tests listed below, please complete Part III.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2017	(b) 2018	(c) 2019	(d) 2020	(e) 2021	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") ..
2	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf....
3	The value of services or facilities furnished by a governmental unit to the organization without charge..
4	Total. Add lines 1 through 3
5	The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f) ..
6	Public support. Subtract line 5 from line 4.

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2017	(b) 2018	(c) 2019	(d) 2020	(e) 2021	(f) Total
7	Amounts from line 4..
8	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...
9	Net income from unrelated business activities, whether or not the business is regularly carried on..
10	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.)..
11	Total support. Add lines 7 through 10

Gross receipts from related activities, etc. (see instructions) ..................

First 5 years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization, check this box and stop here ........................................ right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2021 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2020 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2021. If the organization did not check the box on line 13, and line 14 is 33 1/3 % or more, check this box
and stop here. The organization qualifies as a publicly supported organization ....................... right arrow

33 1/3% support test—2020. If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization ..................... right arrow

17a

10%-facts-and-circumstances test—2021. If the organization did not check a box on line 13, 16a, or 16b, and line 14
is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here. Explain
in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported
organization ..................................................... right arrow

10%-facts-and-circumstances test—2020. If the organization did not check a box on line 13, 16a, 16b, or 17a, and line
15 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here.
Explain in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly
supported organization ................................................ right arrow

Private foundation. If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions ..................................................... right arrow

Schedule A (Form 990) 2021

Page 3

Part III

Support Schedule for Organizations Described in Section 509(a)(2)
(Complete only if you checked the box on line 10 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2017	(b) 2018	(c) 2019	(d) 2020	(e) 2021	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
2	Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose
3	Gross receipts from activities that are not an unrelated trade or business under section 513 .....
4	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
5	The value of services or facilities furnished by a governmental unit to the organization without charge
6	Total. Add lines 1 through 5
7a	Amounts included on lines 1, 2, and 3 received from disqualified persons
b	Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.
c	Add lines 7a and 7b..
8	Public support. (Subtract line 7c from line 6.)

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2017	(b) 2018	(c) 2019	(d) 2020	(e) 2021	(f) Total
9	Amounts from line 6...
10a	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
b	Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c	Add lines 10a and 10b.
11	Net income from unrelated business activities not included on line 10b, whether or not the business is regularly carried on.
12	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.) ..
13	Total support. (Add lines 9, 10c, 11, and 12.)..

First 5 years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization,
check this box and stop here............................................. right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2021 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2020 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2021 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2020 Schedule A, Part III, line 17 .............

19a

331/3% support tests—2021. If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization ....... right arrow

33 1/3% support tests—2020. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization .... right arrow

Private foundation. If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions .... right arrow

Schedule A (Form 990) 2021

Page 4

Part IV

Supporting Organizations

(Complete only if you checked a box on line 12 of Part I. If you checked box 12a, of Part I, complete Sections A and B. If you checked box 12b, of Part I, complete Sections A and C. If you checked box 12c, of Part I, complete Sections A, D, and E. If you checked box12d, of Part I, complete Sections A and D, and complete Part V.)

Section A. All Supporting Organizations

Yes

Are all of the organization’s supported organizations listed by name in the organization’s governing documents?
If "No," describe in Part VI how the supported organizations are designated. If designated by class or purpose,
describe the designation. If historic and continuing relationship, explain.

Did the organization have any supported organization that does not have an IRS determination of status under section 509(a)(1) or (2)? If "Yes," explain in Part VI how the organization determined that the supported organization was described in section 509(a)(1) or (2).

Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yes," answer lines 3b and 3c below.

Did the organization confirm that each supported organization qualified under section 501(c)(4), (5), or (6) and satisfied the public support tests under section 509(a)(2)? If "Yes," describe in Part VI when and how the organization made the determination.

Did the organization ensure that all support to such organizations was used exclusively for section 170(c)(2)(B) purposes? If "Yes," explain in Part VI what controls the organization put in place to ensure such use.

Was any supported organization not organized in the United States ("foreign supported organization")? If “Yes” and if you checked box 12a or 12b in Part I, answer lines 4b and 4c below.

Did the organization have ultimate control and discretion in deciding whether to make grants to the foreign supported organization? If “Yes,” describe in Part VI how the organization had such control and discretion despite being controlled or supervised by or in connection with its supported organizations.

Did the organization support any foreign supported organization that does not have an IRS determination under sections 501(c)(3) and 509(a)(1) or (2)? If “Yes,” explain in Part VI what controls the organization used to ensure that all support to the foreign supported organization was used exclusively for section 170(c)(2)(B) purposes.

Did the organization add, substitute, or remove any supported organizations during the tax year? If “Yes,” answer lines 5b and 5c below (if applicable). Also, provide detail in Part VI, including (i) the names and EIN numbers of the supported organizations added, substituted, or removed; (ii) the reasons for each such action; (iii) the authority under the organization's organizing document authorizing such action; and (iv) how the action was accomplished (such as by amendment to the organizing document).

Type I or Type II only. Was any added or substituted supported organization part of a class already designated in the organization's organizing document?

Substitutions only. Was the substitution the result of an event beyond the organization's control?

Did the organization provide support (whether in the form of grants or the provision of services or facilities) to anyone other than (i) its supported organizations, (ii) individuals that are part of the charitable class benefited by one or more of its supported organizations, or (iii) other supporting organizations that also support or benefit one or more of the filing organization’s supported organizations? If “Yes,” provide detail in Part VI.

Did the organization provide a grant, loan, compensation, or other similar payment to a substantial contributor (defined in section 4958(c)(3)(C)), a family member of a substantial contributor, or a 35% controlled entity with regard to a substantial contributor? If “Yes,” complete Part I of Schedule L (Form 990) .

Did the organization make a loan to a disqualified person (as defined in section 4958) not described on line 7? If “Yes,” complete Part I of Schedule L (Form 990).

Was the organization controlled directly or indirectly at any time during the tax year by one or more disqualified persons, as defined in section 4946 (other than foundation managers and organizations described in section 509(a)(1) or (2))? If “Yes,” provide detail in Part VI.

Did one or more disqualified persons (as defined on line 9a) hold a controlling interest in any entity in which the supporting organization had an interest? If “Yes,” provide detail in Part VI.

Did a disqualified person (as defined on line 9a) have an ownership interest in, or derive any personal benefit from, assets in which the supporting organization also had an interest? If “Yes,” provide detail in Part VI.

10a

Was the organization subject to the excess business holdings rules of section 4943 because of section 4943(f) (regarding certain Type II supporting organizations, and all Type III non-functionally integrated supporting organizations)? If “Yes,” answer line 10b below.

10a

Did the organization have any excess business holdings in the tax year? (Use Schedule C, Form 4720, to determine whether the organization had excess business holdings).

10b

Schedule A (Form 990) 2021

Page 5

Part IV

Supporting Organizations (continued)

Yes

Has the organization accepted a gift or contribution from any of the following persons?

A person who directly or indirectly controls, either alone or together with persons described on lines 11b and 11c below, the governing body of a supported organization?

11a

A family member of a person described on 11a above?

11b

A 35% controlled entity of a person described on line 11a or 11b above? If “Yes” to 11a, 11b, or 11c, provide detail in Part VI.

11c

Section B. Type I Supporting Organizations

Yes

Did the officers, directors, trustees, or membership of one or more supported organizations have the power to regularly appoint or elect at least a majority of the organization’s directors or trustees at all times during the tax year? If “No,” describe in Part VI how the supported organization(s) effectively operated, supervised, or controlled the organization’s activities. If the organization had more than one supported organization, describe how the powers to appoint and/or remove directors or trustees were allocated among the supported organizations and what conditions or restrictions, if any, applied to such powers during the tax year.

Did the organization operate for the benefit of any supported organization other than the supported organization(s) that operated, supervised, or controlled the supporting organization? If “Yes,” explain in Part VI how providing such benefit carried out the purposes of the supported organization(s) that operated, supervised or controlled the supporting organization.

Section C. Type II Supporting Organizations

Yes

Were a majority of the organization’s directors or trustees during the tax year also a majority of the directors or trustees of each of the organization’s supported organization(s)? If “No,” describe in Part VI how control or management of the supporting organization was vested in the same persons that controlled or managed the supported organization(s).

Section D. All Type III Supporting Organizations

Yes

Did the organization provide to each of its supported organizations, by the last day of the fifth month of the organization’s tax year, (i) a written notice describing the type and amount of support provided during the prior tax year, (ii) a copy of the Form 990 that was most recently filed as of the date of notification, and (iii) copies of the organization’s governing documents in effect on the date of notification, to the extent not previously provided?

Were any of the organization’s officers, directors, or trustees either (i) appointed or elected by the supported organization(s) or (ii) serving on the governing body of a supported organization? If "No," explain in Part VI how the organization maintained a close and continuous working relationship with the supported organization(s).

By reason of the relationship described in line 2 above, did the organization’s supported organizations have a significant voice in the organization’s investment policies and in directing the use of the organization’s income or assets at all times during the tax year? If "Yes," describe in Part VI the role the organization’s supported organizations played in this regard.

Section E. Type III Functionally-Integrated Supporting Organizations

Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions):

The organization satisfied the Activities Test. Complete line 2 below.

The organization is the parent of each of its supported organizations. Complete line 3 below.

The organization supported a governmental entity. Describe in Part VI how you supported a government entity (see instructions)

Activities Test. Answer lines 2a and 2b below.

Yes

Did substantially all of the organization’s activities during the tax year directly further the exempt purposes of the supported organization(s) to which the organization was responsive? If "Yes," then in Part VI identify those supported organizations and explain how these activities directly furthered their exempt purposes, how the organization was responsive to those supported organizations, and how the organization determined that these activities constituted substantially all of its activities.

Did the activities described on line 2a, above constitute activities that, but for the organization’s involvement, one or more of the organization’s supported organization(s) would have been engaged in? If "Yes," explain in Part VI the reasons for the organization’s position that its supported organization(s) would have engaged in these activities but for the organization’s involvement.

Parent of Supported Organizations. Answer lines 3a and 3b below.

Did the organization have the power to regularly appoint or elect a majority of the officers, directors, or trustees of each of the supported organizations?If "Yes" or "No", provide details in Part VI.

Did the organization exercise a substantial degree of direction over the policies, programs and activities of each of its supported organizations? If "Yes," describe in Part VI. the role played by the organization in this regard.

Schedule A (Form 990) 2021

Page 6

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations

Check here if the organization satisfied the Integral Part Test as a qualifying trust on Nov. 20, 1970 (explain in Part VI). See instructions. All other Type III non-functionally integrated supporting organizations must complete Sections A through E.

	Section A - Adjusted Net Income		(A) Prior Year	(B) Current Year (optional)
1	Net short-term capital gain	1
2	Recoveries of prior-year distributions	2
3	Other gross income (see instructions)	3
4	Add lines 1 through 3	4
5	Depreciation and depletion	5
6	Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions)	6
7	Other expenses (see instructions)	7
8	Adjusted Net Income (subtract lines 5, 6 and 7 from line 4)	8

	Section B - Minimum Asset Amount		(A) Prior Year	(B) Current Year (optional)
1	Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year):	1
a	Average monthly value of securities	1a
b	Average monthly cash balances	1b
c	Fair market value of other non-exempt-use assets	1c
d	Total (add lines 1a, 1b, and 1c)	1d
e	Discount claimed for blockage or other factors (explain in detail in Part VI):
2	Acquisition indebtedness applicable to non-exempt use assets	2
3	Subtract line 2 from line 1d	3
4	Cash deemed held for exempt use. Enter 0.015 of line 3 (for greater amount, see instructions).	4
5	Net value of non-exempt-use assets (subtract line 4 from line 3)	5
6	Multiply line 5 by 0.035	6
7	Recoveries of prior-year distributions	7
8	Minimum Asset Amount (add line 7 to line 6)	8

	Section C - Distributable Amount		Current Year
1	Adjusted net income for prior year (from Section A, line 8, Column A)	1
2	Enter 85% of line 1	2
3	Minimum asset amount for prior year (from Section B, line 8, Column A)	3
4	Enter greater of line 2 or line 3	4
5	Income tax imposed in prior year	5
6	Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions)	6

Check here if the current year is the organization's first as a non-functionally-integrated Type III supporting organization (see instructions)

Schedule A (Form 990) 2021

Page 7

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations(continued)

Section D - Distributions		Current Year
1 Amounts paid to supported organizations to accomplish exempt purposes	1
2 Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity	2
3 Administrative expenses paid to accomplish exempt purposes of supported organizations	3
4 Amounts paid to acquire exempt-use assets	4
5 Qualified set-aside amounts (prior IRS approval required - provide details in Part VI)	5
6 Other distributions (describe in Part VI). See instructions	6
7Total annual distributions. Add lines 1 through 6.	7
8 Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions	8
9 Distributable amount for 2021 from Section C, line 6	9
10 Line 8 amount divided by Line 9 amount	10

Section E - Distribution Allocations (see instructions)		(i) Excess Distributions	(ii) Underdistributions Pre-2021	(iii) Distributable Amount for 2021
1 Distributable amount for 2021 from Section C, line 6
2 Underdistributions, if any, for years prior to 2021 (reasonable cause required-- explain in Part VI). See instructions.
3 Excess distributions carryover, if any, to 2021:
a From 2016.......
b From 2017.......
c From 2018.......
d From 2019.......
e From 2020.......
fTotal of lines 3a through e
g Applied to underdistributions of prior years
h Applied to 2021 distributable amount
i Carryover from 2016 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from line 3f.
4Distributions for 2021 from Section D, line 7:
$
a Applied to underdistributions of prior years
b Applied to 2021 distributable amount
c Remainder. Subtract lines 4a and 4b from line 4.
5 Remaining underdistributions for years prior to 2021, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions.
6 Remaining underdistributions for 2021. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions.
7 Excess distributions carryover to 2022. Add lines 3j and 4c.
8 Breakdown of line 7:
a Excess from 2017.....
b Excess from 2018.....
c Excess from 2019.....
d Excess from 2020.....
e Excess from 2021.....

Schedule A (Form 990) (2021)

Schedule A (Form 990) 2021

Page 8

Part VI

Supplemental Information. Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; Part III, line 12; Part IV, Section A, lines 1, 2, 3b, 3c, 4b, 4c, 5a, 6, 9a, 9b, 9c, 11a, 11b, and 11c; Part IV, Section B, lines 1 and 2; Part IV, Section C, line 1; Part IV, Section D, lines 2 and 3; Part IV, Section E, lines 1c, 2a, 2b, 3a and 3b; Part V, line 1; Part V, Section B, line 1e; Part V Section D, lines 5, 6, and 8; and Part V, Section E, lines 2, 5, and 6. Also complete this part for any additional information. (See instructions).

Facts And Circumstances Test

Return Reference	Explanation

Schedule A (Form 990) 2021

Additional Data

Software ID:
Software Version:

- TIN:

Schedule B
(Form 990)

Department of the Treasury
Internal Revenue Service

Schedule of Contributors

Attach to Form 990, 990-EZ, or 990-PF.

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2021

Name of the organization

GRACE MEDICAL CENTER INC

Employer identification number

52-0591555

Organization type (check one):

Filers of:

Section:

Form 990 or 990-EZ

501(c)( ) (enter number) organization

4947(a)(1) nonexempt charitable trust not treated as a private foundation

527 political organization

Form 990-PF

501(c)(3) exempt private foundation

4947(a)(1) nonexempt charitable trust treated as a private foundation

501(c)(3) taxable private foundation

Check if your organization is covered by the General Rule or a Special Rule.
Note: Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.

General Rule

For an organization filing Form 990, 990-EZ, or 990-PF that received, during the year, contributions totaling $5,000 or more (in money or other property) from any one contributor. Complete Parts I and II. See instructions for determining a contributor's total contributions.

Special Rules

For an organization described in section 501(c)(3) filing Form 990 or 990-EZ that met the 33¹/3% support test of the regulations
under sections 509(a)(1) and 170(b)(1)(A)(vi), that checked Schedule A (Form 990 or 990-EZ), Part II, line 13, 16a, or 16b, and that received from any one contributor, during the year, total contributions of the greater of (1) $5,000 or (2) 2% of the amount on (i) Form 990, Part VIII, line 1h, or (ii) Form 990-EZ, line 1. Complete Parts I and II.

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, total contributions of more than $1,000 exclusively for religious, charitable, scientific, literary, or educational purposes, or for the prevention of cruelty to children or animals. Complete Parts I, II, and III.

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, contributions exclusively for religious, charitable, etc., purposes, but no such contributions totaled more than $1,000. If this box is checked, enter here the total contributions that were received during the year for an exclusively religious, charitable, etc., purpose. Don't complete any of the parts unless the General Rule applies to this organization because it received nonexclusively religious, charitable, etc., contributions totaling $5,000 or more during the year ......... Arrow Bullet

Caution: An organization that isn't covered by the General Rule and/or the Special Rules doesn't file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2, of its Form 990; or check the box on line H of its Form 990-EZ
or on its Form 990PF, Part I, line 2, to certify that it doesn't meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).

For Paperwork Reduction Act Notice, see the Instructions
for Form 990, 990-EZ, or 990-PF.

Cat. No. 30613XSchedule B (Form 990) (2021)

Schedule B (Form 990) (2021) Page 2

Name of organization GRACE MEDICAL CENTER INC

Part I Contributors	Contributors (see instructions). Use duplicate copies of Part I if additional space is needed.
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
RESTRICTED	,	$ RESTRICTED	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
Schedule B (Form 990) (2021)

Schedule B (Form 990) (2021)

Page 3

Name of organization GRACE MEDICAL CENTER INC		Employer identification number 52-0591555

Part II	Noncash Property (see instructions). Use duplicate copies of Part II if additional space is needed.
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
Schedule B (Form 990) (2021)

Schedule B (Form 990) (2021)

Page 4


Name of organization GRACE MEDICAL CENTER INC			Employer identification number 52-0591555
Part III Exclusively religious, charitable, etc., contributions to organizations described in section 501(c)(7), (8), or (10) that total more than $1,000 for the year from any one contributor. Complete columns (a) through (e) and the following line entry. For organizations completing Part III, enter the total of exclusively religious, charitable, etc., contributions of $1,000 or less for the year. (Enter this information once. See instructions.) $ Use duplicate copies of Part III if additional space is needed.

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

Schedule B (Form 990) (2021)

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE C
(Form 990)

Department of the Treasury
Internal Revenue Service

Political Campaign and Lobbying Activities

For Organizations Exempt From Income Tax Under section 501(c) and section 527

SchCMd Bullet

Complete if the organization is described below. SchCMd Bullet

Attach to Form 990 or Form 990-EZ.
SchCMd Bullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2021

Open to Public
Inspection

If the organization answered "Yes" on Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
Round Bullet

Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
Round Bullet

Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
Round Bullet

Section 527 organizations: Complete Part I-A only.
If the organization answered "Yes" on Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
Round Bullet

Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)): Complete Part II-A. Do not complete Part II-B.
Round Bullet

Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered "Yes" on Form 990, Part IV, Line 5 (Proxy Tax) (see separate instructions) or Form 990-EZ, Part V, line 35c (Proxy Tax) (see separate instructions), then
Round Bullet

Section 501(c)(4), (5), or (6) organizations: Complete Part III.

Name of the organization

GRACE MEDICAL CENTER INC

Employer identification number

52-0591555

Part I-A

Complete if the organization is exempt under section 501(c) or is a section 527 organization.

Provide a description of the organization’s direct and indirect political campaign activities in Part IV. See instructions for definition of “political campaign activities."

Political campaign activity expenditures. See instructions .................................................................... SchCMd Bullet

Volunteer hours for political campaign activities. See instructions ..................................................................

Part I-B

Complete if the organization is exempt under section 501(c)(3).

Enter the amount of any excise tax incurred by the organization under section 4955 ................................ SchCMd Bullet

Enter the amount of any excise tax incurred by organization managers under section 4955 ....................... SchCMd Bullet

If the organization incurred a section 4955 tax, did it file Form 4720 for this year? .........................................

Yes No

Was a correction made? ......................................................................................................................

Yes No

If "Yes," describe in Part IV.

Part I-C

Complete if the organization is exempt under section 501(c), except section 501(c)(3).

Enter the amount directly expended by the filing organization for section 527 exempt function activities ..... SchCMd Bullet

Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt function activities ............................................................................................................................ SchCMd Bullet

Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, line 17b........... SchCMd Bullet

Did the filing organization file Form 1120-POL for this year? ...................................................................

Yes No

Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing
organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.

(a) Name	(b) Address	(c) EIN	(d) Amount paid from filing organization's funds. If none, enter -0-.	(e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.
1
2
3
4
5
6

For Paperwork Reduction Act Notice, see the instructions for Form 990.

Cat. No. 50084S

Schedule C (Form 990) 2021

Page 2

Part II-A

Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).

A Check SchCMd Bullet

if the filing organization belongs to an affiliated group (and list in Part IV each affiliated group member's name, address, EIN, expenses, and share of excess lobbying expenditures).
B Check SchCMd Bullet

if the filing organization checked box A and "limited control" provisions apply.

Limits on Lobbying Expenditures (The term "expenditures" means amounts paid or incurred.)		(b) Affiliated group totals
1a	Total lobbying expenditures to influence public opinion (grass roots lobbying) ......................
b	Total lobbying expenditures to influence a legislative body (direct lobbying) ........................
c	Total lobbying expenditures (add lines 1a and 1b) ............................................................
d	Other exempt purpose expenditures ...............................................................................
e	Total exempt purpose expenditures (add lines 1c and 1d) ..................................................
f	Lobbying nontaxable amount. Enter the amount from the following table in both columns.
	If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:
	Not over $500,00020% of the amount on line 1e.
	Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.
	Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.
	Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.
	Over $17,000,000$1,000,000.

g	Grassroots nontaxable amount (enter 25% of line 1f) .................................................
h	Subtract line 1g from line 1a. If zero or less, enter -0-. ................................................
i	Subtract line 1f from line 1c. If zero or less, enter -0-. ................................................
j	If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting section 4911 tax for this year? ...................................................................................................................	Yes No

4-Year Averaging Period Under Section 501(h) (Some organizations that made a section 501(h) election do not have to complete all of the five columns below. See the separate instructions for lines 2a through 2f.)
Lobbying Expenditures During 4-Year Averaging Period
	Calendar year (or fiscal year beginning in)	(a) 2018	(b) 2019	(c) 2020	(d) 2021	(e) Total

2a	Lobbying nontaxable amount

b	Lobbying ceiling amount (150% of line 2a, column(e))

c	Total lobbying expenditures

d	Grassroots nontaxable amount

e	Grassroots ceiling amount (150% of line 2d, column (e))

f	Grassroots lobbying expenditures

Schedule C (Form 990) 2021

Page 3

Part II-B

Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).

For each "Yes" response on lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.

(a)

Yes|No

(b)

Amount

During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:

Volunteers? ...........................................................................................................

Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ........

Media advertisements? ...................................................................................................

Mailings to members, legislators, or the public? .............................................................................

Publications, or published or broadcast statements? ...........................................................

Grants to other organizations for lobbying purposes? ..........................................................

Direct contact with legislators, their staffs, government officials, or a legislative body? .......................

Yes

27,088

Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ..................

Other activities? ...................................................................................................................

Yes

17,374

Total. Add lines 1c through 1i ....................................................................................................

44,462

Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....

If "Yes," enter the amount of any tax incurred under section 4912 ...........................................

If "Yes," enter the amount of any tax incurred by organization managers under section 4912 ...................

If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? ........................

Part III-A

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).

Yes

Were substantially all (90% or more) dues received nondeductible by members? ...............................................

Did the organization make only in-house lobbying expenditures of $2,000 or less? ............................................

Did the organization agree to carry over lobbying and political expenditures from the prior year? .................................

Part III-B

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) and if either (a) BOTH Part III-A, lines 1 and 2, are answered "No" OR (b) Part III-A, line 3, is answered “Yes."

Dues, assessments and similar amounts from members ......................................................................

Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political expenses for which the section 527(f) tax was paid).

Current year .............................................................................................................................

Carryover from last year ............................................................................................................

Total ...........................................................................................................................................

Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .

If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ......................................................................................................................

Taxable amount of lobbying and political expenditures. See Instructions .........................................

Part IV

Supplemental Information

Provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, line 5; Part II-A (affiliated group list); Part II-A, lines 1 and 2 (see instructions), and Part ll-B, line 1. Also, complete this part for any additional information.

Return Reference	Explanation
SCHEDULE C, PART II-B, LINE 1, LOBBYING ACTIVITIES:	LOBBYING INCLUDES A PORTION OF THE MARYLAND HOSPITAL ASSOCIATION DUES RELATED TO LOBBYING ACTIVITIES PERFORMED ON BEHALF OF THE HOSPITAL REGARDING COMMUNITY STABILIZATION AND DEVELOPMENT, HEALTH CARE MALPRACTICE, HEALTHCARE FACILITIES AND BUDGETS.

Schedule C (Form 990) 2021

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

Complete if the organization answered "Yes," on Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b.
SchDMd Bullet

Attach to Form 990.
SchDMd Bullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2021

Open to Public Inspection

Name of the organization

GRACE MEDICAL CENTER INC

Employer identification number

52-0591555

Part I

Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" on Form 990, Part IV, line 6.

		(a) Donor advised funds	(b) Funds and other accounts
1	Total number at end of year .........
2	Aggregate value of contributions to (during year)
3	Aggregate value of grants from (during year)
4	Aggregate value at end of year ........

Did the organization inform all donors and donor advisors in writing that the assets held in donor advised funds are the organization’s property, subject to the organization’s exclusive legal control? ............

Yes No

Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ...................................

Yes No

Part II

Conservation Easements.
Complete if the organization answered "Yes" on Form 990, Part IV, line 7.

Purpose(s) of conservation easements held by the organization (check all that apply).

Preservation of land for public use (e.g., recreation or education) Preservation of an historically important land area

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.


a	Total number of conservation easements ......................	2a
b	Total acreage restricted by conservation easements ....................	2b
c	Number of conservation easements on a certified historic structure included in (a) .....	2c
d	Number of conservation easements included in (c) acquired after 7/25/06, and not on a historic structure listed in the National Register ...	2d

Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during the
tax year SchDMd Bullet

Number of states where property subject to conservation easement is located SchDMd Bullet

Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and enforcement of the conservation easements it holds? ............

Yes No

Staff and volunteer hours devoted to monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

Amount of expenses incurred in monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(B)(i) and section 170(h)(4)(B)(ii)? .............................

Yes No

In Part XIII, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" on Form 990, Part IV, line 8.

If the organization elected, as permitted under FASB ASC 958, not to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide, in Part XIII, the text of the footnote to its financial statements that describes these items.

If the organization elected, as permitted under FASB ASC 958, to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide the following amounts relating to these items:

(i)

Revenue included on Form 990, Part VIII, line 1 ......................... SchDMd Bullet

(ii)

Assets included in Form 990, Part X ............................... SchDMd Bullet

If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under FASB ASC 958 relating to these items:

Revenue included on Form 990, Part VIII, line 1 .......................... SchDMd Bullet

Assets included in Form 990, Part X ............................... SchDMd Bullet

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 52283D

Schedule D (Form 990) 2021

Page 2

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)

Using the organization’s acquisition, accession, and other records, check any of the following that are a significant use of its collection items (check all that apply):

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.

During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?...

Yes No

Part IV

Escrow and Custodial Arrangements. Complete if the organization answered "Yes" on Form 990, Part IV, line 9, or reported an amount on Form 990, Part X, line 21.

Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................

Yes No


b	If "Yes," explain the arrangement in Part XIII and complete the following table:		Amount
c	Beginning balance .............................	1c
d	Additions during the year ............................	1d
e	Distributions during the year ..........................	1e
f	Ending balance ................................	1f

Did the organization include an amount on Form 990, Part X, line 21, for escrow or custodial account liability? ...

Yes No

If "Yes," explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII ....

Part V

Endowment Funds.
Complete if the organization answered "Yes" on Form 990, Part IV, line 10.

		(a) Current year	(b) Prior year	(c) Two years back	(d) Three years back	(e) Four years back

1a	Beginning of year balance ....
b	Contributions ...
c	Net investment earnings, gains, and losses
d	Grants or scholarships ...
e	Other expenditures for facilities and programs ...
f	Administrative expenses ....
g	End of year balance ......

Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:

Board designated or quasi-endowment SchDMd Bullet

Permanent endowment SchDMd Bullet

Term endowment SchDMd Bullet

The percentages on lines 2a, 2b, and 2c should equal 100%.

Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes

(i) Unrelated organizations .................

3a(i)

(ii) Related organizations .................

3a(ii)

If "Yes" on 3a(ii), are the related organizations listed as required on Schedule R? .........

Describe in Part XIII the intended uses of the organization's endowment funds.

Part VI

Land, Buildings, and Equipment.
Complete if the organization answered "Yes" on Form 990, Part IV, line 11a. See Form 990, Part X, line 10.

Description of property		(a) Cost or other basis (investment)	(b) Cost or other basis (other)	(c) Accumulated depreciation	(d) Book value

1a	Land .....	1,369,700		1,369,700
b	Buildings ....	64,064,950	23,337,220	40,727,730
c	Leasehold improvements
d	Equipment ....	52,596,382	42,092,183	10,504,199
e	Other .....	2,573,474		2,573,474
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..				55,175,103

Schedule D (Form 990) 2021

Page 3

Part VII

Investments - Other Securities.
Complete if the organization answered "Yes" on Form 990, Part IV, line 11b. See Form 990, Part X, line 12.

(a) Description of security or category (including name of security)	(b) Book value	(c) Method of valuation: Cost or end-of-year market value
(1) Financial derivatives.........
(2) Closely-held equity interests........
(3)Other
(A)
(B)
(C)
(D)
(E)
(F)
(G)
(H)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)

Part VIII

Investments - Program Related. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11c. See Form 990, Part X, line 13.

(a) Description of investment	(b) Book value	(c) Method of valuation: Cost or end-of-year market value

(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)

Part IX

Other Assets.
Complete if the organization answered 'Yes' on Form 990, Part IV, line 11d. See Form 990, Part X, line 15.

(a) Description				(b) Book value
(1)ASSETS LIM TO USE - CONSTRUCT				30,084,496
(2)RIGHT OF USE ASSET - OPERATING				1,043,075
(3)OTHER ASSET				716,000
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........				31,843,571

Part X

Other Liabilities.
Complete if the organization answered 'Yes' on Form 990, Part IV, line 11e or 11f. See Form 990, Part X, line 25.

1.(a) Description of liability	(b) Book value
(1) Federal income taxes	0
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	40,801,266
2. Liability for uncertain tax positions. In Part XIII, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC 740). Check here if the text of the footnote has been provided in Part XIII

Schedule D (Form 990) 2021

Page 4

Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total revenue, gains, and other support per audited financial statements .......			1	23,623,794
2	Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a	Net unrealized gains (losses) on investments ....	2a	45,337
b	Donated services and use of facilities .........	2b
c	Recoveries of prior year grants ...........	2c
d	Other (Describe in Part XIII.) ............	2d
e	Add lines 2a through 2d .....................			2e	45,337
3	Subtract line 2e from line 1..................			3	23,578,457
4	Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b .	4a
b	Other (Describe in Part XIII.) ...........	4b	-337,361
c	Add lines 4a and 4b....................			4c	-337,361
5	Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ......			5	23,241,096

Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total expenses and losses per audited financial statements ...........			1	34,425,768
2	Amounts included on line 1 but not on Form 990, Part IX, line 25:
a	Donated services and use of facilities .........	2a
b	Prior year adjustments ............	2b
c	Other losses ................	2c
d	Other (Describe in Part XIII.) ............	2d	337,361
e	Add lines 2a through 2d....................			2e	337,361
3	Subtract line 2e from line 1...................			3	34,088,407
4	Amounts included on Form 990, Part IX, line 25, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b ..	4a
b	Other (Describe in Part XIII.) ............	4b
c	Add lines 4a and 4b.....................			4c
5	Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ......			5	34,088,407

Part XIII

Supplemental Information

Provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b; Part V, line 4; Part X, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.

Return Reference	Explanation
SCHEDULE D, PART IV, LINE 2B:	GRACE MEDICAL CENTER HELD, SAFEGUARDED, MANAGED AND ACCOUNTED FOR THE SOCIAL SECURITY FUNDS OF CERTAIN PATIENTS. THESE FUNDS WERE HELD IN AN FDIC INSURED BANKING INSTITUTION. WITH THE ASSISTANCE OF HOSPITAL PERSONNEL, FUNDS WERE GENERALLY ACCESSED BY THE PATIENT THROUGH THE USE OF ATM CARDS OR VISA GIFT CARDS WHICH WAS PURCHASED ON THEIR BEHALF.
SCHEDULE D, PART X, LINE 2:	THE CORPORATION HAS BEEN RECOGNIZED BY THE INTERNAL REVENUE SERVICE AS TAX-EXEMPT PURSUANT TO SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. THE CORPORATION ACCOUNTS FOR UNCERTAIN TAX POSITIONS IN ACCORDANCE WITH FINANCIAL ACCOUNTING STANDARDS BOARD (FASB) ACCOUNTING STANDARDS CODIFICATION (ASC) TOPIC 740, INCOME TAXES.
SCHEDULE D, PART XI, LINE 4B:	LOSS ON FIXED ASSETS ($ 337,361)
SCHEDULE D, PART XII, LINE 2D:	LOSS ON FIXED ASSETS $ 337,361

Schedule D (Form 990) 2021

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE H
(Form 990)

Department of the Treasury
Internal Revenue Service

Hospitals

Complete if the organization answered "Yes" on Form 990, Part IV, question 20.
MediumBullet

Attach to Form 990.
MediumBullet

Go to www.irs.gov/Form990EZ for instructions and the latest information.

OMB No. 1545-0047

2021

Open to Public Inspection

Name of the organization

GRACE MEDICAL CENTER INC

Employer identification number

52-0591555

Part I

Financial Assistance and Certain Other Community Benefits at Cost

Yes

Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a . . . .

Yes

If "Yes," was it a written policy? ......................

Yes

If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.

Applied uniformly to all hospital facilities Applied uniformly to most hospital facilities Generally tailored to individual hospital facilities

Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.

Did the organization use Federal Poverty Guidelines (FPG) as a factor in determining eligibility for providing free care?

If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:

Yes

100% 150% 200% Other 300 %

Did the organization use FPG as a factor in determining eligibility for providing discounted care? If "Yes," indicate

which of the following was the family income limit for eligibility for discounted care: . . . . . . . .

Yes

200% 250% 300% 350% 400% Other 500 %

If the organization used factors other than FPG in determining eligibility, describe in Part VI the criteria used for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, as a factor in determining eligibility for free or discounted care.

Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? . . . . . . . . . . . . .

Yes

Did the organization budget amounts for free or discounted care provided under its financial assistance policy during
the tax year? . . . . . . . . . . . . . . . . . . . . . . .

Yes

If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? . . . . . .

If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care? . . . . . . . . . . . . .

Did the organization prepare a community benefit report during the tax year? . . . . . . . . .

Yes

If "Yes," did the organization make it available to the public? . . . . . . . . . . . . .

Yes

Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.

Financial Assistance and Certain Other Community Benefits at Cost

Financial Assistance and Means-Tested Government Programs		(c) Total community benefit expense	(d) Direct offsetting revenue	(e) Net community benefit expense	(f) Percent of total expense
a	Financial Assistance at cost (from Worksheet 1) . . .	100,167		100,167	0.290 %
b	Medicaid (from Worksheet 3, column a) . . . . .	-144,996		-144,996	0.420 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) . .
d	Total Financial Assistance and Means-Tested Government Programs . . . . .	-44,829		-44,829	0.130 %
Other Benefits
e	Community health improvement services and community benefit operations (from Worksheet 4).	6,406,914	3,716,416	2,690,498	7.830 %
f	Health professions education (from Worksheet 5) . . .	122,250		122,250	0.360 %
g	Subsidized health services (from Worksheet 6) . . . .	854,769		854,769	2.490 %
h	Research (from Worksheet 7) .
i	Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .	15,819		15,819	0.050 %
j	Total. Other Benefits . .	7,399,752	3,716,416	3,683,336	10.730 %
k	Total. Add lines 7d and 7j .	7,354,923	3,716,416	3,638,507	10.600 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2021

Schedule H (Form 990) 2021

Page

Part II

Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.

		(c) Total community building expense	(e) Net community building expense
1	Physical improvements and housing
2	Economic development
3	Community support
4	Environmental improvements
5	Leadership development and training for community members
6	Coalition building	1,347	1,347
7	Community health improvement advocacy
8	Workforce development
9	Other
10	Total	1,347	1,347

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

Did the organization report bad debt expense in accordance with Healthcare Financial Management Association Statement No. 15? ..........................

Yes

Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......

257,562

Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy. Explain in Part VI the methodology used by the organization to estimate this amount and the rationale, if any, for including this portion of bad debt as community benefit. ......

123,226

Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.

Section B. Medicare

Enter total revenue received from Medicare (including DSH and IME).....

3,024,996

Enter Medicare allowable costs of care relating to payments on line 5.....

3,856,044

Subtract line 6 from line 5. This is the surplus (or shortfall)........

-831,048

Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:

Cost accounting system Cost to charge ratio Other

Section C. Collection Practices

Did the organization have a written debt collection policy during the tax year? ..........

Yes

If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year
contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI .........................

Yes

Part IV

Management Companies and Joint Ventures(owned 10% or more by officers, directors, trustees, key employees, and physicians—see instructions)

(a) Name of entity	(b) Description of primary activity of entity	(c) Organization's profit % or stock ownership %	(d) Officers, directors, trustees, or key employees' profit % or stock ownership %	(e) Physicians' profit % or stock ownership %
1
2
3
4
5
6
7
8
9
10
11
12
13

Schedule H (Form 990) 2021

Page

Part VFacility Information

Section A. Hospital Facilities (list in order of size from largest to smallest—see instructions)How many hospital facilities did the organization operate during the tax year?1Name, address, primary website address, and state license number (and if a group return, the name and EIN of the subordinate hospital organization that operates the hospital facility)
1	GRACE MEDICAL CENTER INC 2000 W BALTIMORE STREET BALTIMORE,MD21215 https://www.lifebridgehealth.org/Grace/G	X	X	X	X

Schedule H (Form 990) 2021

Page 4

Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)

	GRACE MEDICAL CENTER INC
Name of hospital facility or letter of facility reporting group

Line number of hospital facility, or line numbers of hospital facilities in a facility
reporting group (from Part V, Section A):

Yes

Community Health Needs Assessment

Was the hospital facility first licensed, registered, or similarly recognized by a state as a hospital facility in the current tax year or the immediately preceding tax year?........................

Was the hospital facility acquired or placed into service as a tax-exempt hospital in the current tax year or the immediately preceding tax year? If “Yes,” provide details of the acquisition in Section C...............

During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 12......................

Yes

If "Yes," indicate what the CHNA report describes (check all that apply):

A definition of the community served by the hospital facility

Demographics of the community

Existing health care facilities and resources within the community that are available to respond to the health needs of the community

How data was obtained

The significant health needs of the community

Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups

The process for identifying and prioritizing community health needs and services to meet the community health needs

The process for consulting with persons representing the community’s interests

The impact of any actions taken to address the significant health needs identified in the hospital facility's prior CHNA(s)

Other (describe in Section C)

Indicate the tax year the hospital facility last conducted a CHNA: 20 20

In conducting its most recent CHNA, did the hospital facility take into account input from persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If "Yes," describe in Section C how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted .................

Yes

6 a

Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Section C..................................

Was the hospital facility’s CHNA conducted with one or more organizations other than hospital facilities?” If “Yes,” list the other organizations in Section C. ............................

Did the hospital facility make its CHNA report widely available to the public?..............

Yes

If "Yes," indicate how the CHNA report was made widely available (check all that apply):

Hospital facility’s website (list url): SEE SCHEDULE H, PART V, SECTION C

Other website (list url):

Made a paper copy available for public inspection without charge at the hospital facility

Other (describe in Section C)

Did the hospital facility adopt an implementation strategy to meet the significant community health needs
identified through its most recently conducted CHNA? If "No," skip to line 11. ..............

Yes

Indicate the tax year the hospital facility last adopted an implementation strategy: 20 20

Is the hospital facility's most recently adopted implementation strategy posted on a website?.........

Yes

If "Yes" (list url): SEE SCHEDULE H, PART V, SECTION C

If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ......

10b

Describe in Section C how the hospital facility is addressing the significant needs identified in its most recently conducted CHNA and any such needs that are not being addressed together with the reasons why such needs are not being addressed.

12a

Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)?...............................

12a

If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........

12b

If "Yes" on line 12b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $

Schedule H (Form 990) 2021

Page 5

Part VFacility Information (continued)

Financial Assistance Policy (FAP)

	GRACE MEDICAL CENTER INC
Name of hospital facility or letter of facility reporting group

Yes

Did the hospital facility have in place during the tax year a written financial assistance policy that:

Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care?

Yes

If “Yes,” indicate the eligibility criteria explained in the FAP:

Federal poverty guidelines (FPG), with FPG family income limit for eligibility for free care of 300.%
and FPG family income limit for eligibility for discounted care of 500.%

Income level other than FPG (describe in Section C)

Asset level

Medical indigency

Insurance status

Underinsurance discount

Residency

Other (describe in Section C)

Explained the basis for calculating amounts charged to patients?.................

Yes

Explained the method for applying for financial assistance?...................

Yes

If “Yes,” indicate how the hospital facility’s FAP or FAP application form (including accompanying instructions) explained the method for applying for financial assistance (check all that apply):

Described the information the hospital facility may require an individual to provide as part of his or her application

Described the supporting documentation the hospital facility may require an individual to submit as part of his or
her application

Provided the contact information of hospital facility staff who can provide an individual with information about the
FAP and FAP application process

Provided the contact information of nonprofit organizations or government agencies that may be sources of
assistance with FAP applications

Other (describe in Section C)

Was widely publicized within the community served by the hospital facility?........

Yes

If "Yes," indicate how the hospital facility publicized the policy (check all that apply):

The FAP was widely available on a website (list url):

SEE SCHEDULE H, PART V, SECTION C

The FAP application form was widely available on a website (list url):

SEE SCHEDULE H, PART V, SECTION C

A plain language summary of the FAP was widely available on a website (list url):
SEE SCH H, PART V, SEC C

The FAP was available upon request and without charge (in public locations in the hospital facility and by mail)

The FAP application form was available upon request and without charge (in public locations in the hospital facility
and by mail)

A plain language summary of the FAP was available upon request and without charge (in public locations in the
hospital facility and by mail)

Individuals were notified about the FAP by being offered a paper copy of the plain language summary of the FAP, by
receiving a conspicuous written notice about the FAP on their billing statements, and via conspicuous public displays or
other measures reasonably calculated to attract patients' attention

Notified members of the community who are most likely to require financial assistance about availability of the FAP

The FAP, FAP application form, and plain language summary of the FAP were translated into the primary language(s)
spoken by LEP populations

Other (describe in Section C)

Schedule H (Form 990) 2021

Page 6

Part VFacility Information (continued)

Billing and Collections

	GRACE MEDICAL CENTER INC
Name of hospital facility or letter of facility reporting group

Yes

Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained all of the actions the hospital facility or other authorized party may take upon nonpayment?..................................

Yes

Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Deferring, denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

None of these actions or other similar actions were permitted

Did the hospital facility or other authorized party perform any of the following actions during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP?............

If "Yes," check all actions in which the hospital facility or a third party engaged:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Deferring , denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 19. (check all that apply):

Provided a written notice about upcoming ECAs (Extraordinary Collection Action) and a plain language summary of the
FAP at least 30 days before initiating those ECAs (if not, describe in Section C)

Made a reasonable effort to orally notify individuals about the FAP and FAP application process (if not, describe in
Section C)

Processed incomplete and complete FAP applications (if not, describe in Section C)

Made presumptive eligibility determinations (if not, describe in Section C)

Other (describe in Section C)

None of these efforts were made

Policy Relating to Emergency Medical Care

Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that required the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?..................

Yes

If "No," indicate why:

The hospital facility did not provide care for any emergency medical conditions

The hospital facility’s policy was not in writing

The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Section C)

Other (describe in Section C)

Schedule H (Form 990) 2021

Page 7

Part VFacility Information (continued)

Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)

	GRACE MEDICAL CENTER INC
Name of hospital facility or letter of facility reporting group

Yes

Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.

The hospital facility used a look-back method based on claims allowed by Medicare fee-for-service during a prior 12-month period

The hospital facility used a look-back method based on claims allowed by Medicare fee-for-service and all private health insurers that pay claims to the hospital facility during a prior 12-month period

The hospital facility used a look-back method based on claims allowed by Medicaid, either alone or in combination with
Medicare fee-for-service and all private health insurers that pay claims to the hospital facility during a prior 12-month
period

The hospital facility used a prospective Medicare or Medicaid method

During the tax year, did the hospital facility charge any FAP-eligible individual to whom the hospital facility provided emergency or other medically necessary services more than the amounts generally billed to individuals who had insurance covering such care? ...............................

If "Yes," explain in Section C.

During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? ...........................

If "Yes," explain in Section C.

Schedule H (Form 990) 2021

Page 8

Part V

Facility Information (continued)

Section C. Supplemental Information for Part V, Section B. Provide descriptions required for Part V, Section B, lines 2, 3j, 5, 6a, 6b, 7d, 11, 13b, 13h, 15e, 16j, 18e, 19e, 20a, 20b, 20c, 20d, 20e, 21c, 21d, 23, and 24. If applicable, provide separate descriptions for each hospital facility in a facility reporting group, designated by facility reporting group letter and hospital facility line number from Part V, Section A (“A, 1,” “A, 4,” “B, 2,” “B, 3,” etc.) and name of hospital facility.
Form and Line Reference	Explanation
SCHEDULE H, PART V, SECTION B, LINE 5:	THE CHNA TEAM USED A MULTI-PRONGED APPROACH TO SOLICIT INPUT FROM THE WEST BALTIMORE COMMUNITY REGARDING THEIR HEALTH NEEDS. DATA COLLECTION METHODOLOGIES INCLUDED SURVEYS, STAKEHOLDER INTERVIEWS, AND FOCUS GROUPS. THE TEAM ENGAGED WITH REPRESENTATIVES OF THE COMMUNITY (E.G., MARYLAND DEPARTMENT OF HEALTH AND MENTAL HYGIENE AND THE BALTIMORE CITY HEALTH DEPARTMENT) WHO HAD KNOWLEDGE OF PUBLIC HEALTH ISSUES AND INSIGHT INTO THE BROAD INTERESTS OF THE COMMUNITIES SERVED BY THE ORGANIZATION AS WELL AS THE SPECIFIC NEEDS OF THE MEDICALLY UNDERSERVED, LOW-INCOME AND VULNERABLE POPULATIONS, AND PEOPLE WITH CHRONIC DISEASES. THE CHNA WORK GROUP MET WITH SENIORS, RE-ENTRY RESIDENTS, FAITH-BASED STAKEHOLDERS, COMMUNITY LEADERS, HEALTH CARE PROVIDERS, NEIGHBORHOOD ASSOCIATIONS, REPRESENTATIVES FROM COMMUNITY-BASED ORGANIZATIONS AND OTHER KEY COMMUNITY STAKEHOLDERS WITH AN INTIMATE KNOWLEDGE OF THE WEST BALTIMORE COMMUNITY AND ITS HEALTH NEEDS. TWO HUNDRED SEVENTY-THREE (273) SURVEYS WERE COLLECTED WITHIN THE DEFINED SERVICE AREA. ELEVEN (11) STAKEHOLDER INTERVIEWS AND THREE (3) FOCUS GROUPS WERE CONDUCTED BETWEEN JANUARY AND MARCH 2020. ALL METHODS FOCUSED ON COMMUNITY HEALTH NEEDS, COMMUNITY ASSETS AND RESOURCES AVAILABLE TO RESPOND TO THE COMMUNITY HEALTH NEEDS, BARRIERS AND CHALLENGES TO ACCESSING THE COMMUNITY ASSETS AND RESOURCES, AND WAYS IN WHICH GRACE MEDICAL CENTER COULD HELP ADDRESS THE HEALTH NEEDS.
SCHEDULE H, PART V, SECTION B, LINE 7A:	HTTPS://WWW.LIFEBRIDGEHEALTH.ORG/UPLOADS/PUBLIC/DOCUMENTS/POPULATION%20HEA LTH/GRACE%20MEDICAL%20CENTER_CHNA_FINAL.PDF
SCHEDULE H, PART V, SECTION B, LINE 7D:	COPIES OF THE CHNA WERE DISTRIBUTED TO KEY COMMUNITY PARTNERS.
SCHEDULE H, PART V, SECTION B, LINE 10A:	https://www.lifebridgehealth.org/Uploads/Public/Documents/Grace%20Medical% 20Center/Grace-Medical-Center-Implementation-Plan.pdf
SCHEDULE H, PART V, SECTION B, LINE 11:	GRACE MEDICAL CENTER CHNA IMPLEMENTATION PLAN IN THE WINTER AND SPRING OF 2019 BON SECOURS HOSPITAL IN SOUTHWEST BALTIMORE CONDUCTED ITS TRI-ANNUAL COMMUNITY HEALTH NEEDS ASSESSMENT ("CHNA"). THE CHNA INCLUDED COMMUNITY MEETINGS, SURVEYS AND INTERVIEWS WITH THOSE WHO HAVE A KNOWLEDGE OF PUBLIC HEALTH, THE BROAD INTERESTS OF THE COMMUNITY SERVED, AS WELL AS SPECIAL KNOWLEDGE OF THE MEDICALLY UNDERSERVED, LOW-INCOME AND VULNERABLE POPULATIONS AND PEOPLE WITH CHRONIC CONDITIONS. THE CHNA WAS COMPLETED AND APPROVED BY THE HOSPITAL BOARD OF DIRECTORS IN JULY 2020. THE FOLLOWING HEALTH AND SOCIAL CONDITIONS WERE IDENTIFIED AS SIGNIFICANT NEEDS OF THE COMMUNITY BEING SERVED: - BEHAVIORAL HEALTH/SUBSTANCE ABUSE/OPIOIDS - CRIME AND RELATED TRAUMA - CHRONIC CONDITIONS - HOUSING AND HOMELESSNESS - ACCESS TO PRIMARY PHYSICIANS - COMMUNITY ENGAGEMENT - CHILDREN'S HEALTH - EMPLOYMENT & WORKFORCE DEVELOPMENT - HEALTH EDUCATION WITHIN THE PUBLIC EDUCATION SYSTEM - TRANSPORTATION - ACCESS TO HEALTHY FOODS - SUPPORT FOR SENIOR SERVICES - YOUTH SERVICES (AGES 5-18) - FINANCIAL COUNSELING AND LITERACY - COORDINATION OF SERVICES ACROSS COMMUNITY PRIOR TO DEVELOPMENT OF AN ASSOCIATED CHNA IMPLEMENTATION PLAN, BON SECOURS HOSPITAL WAS SOLD TO LIFEBRIDGE HEALTH, A MULTI-HOSPITAL HEALTH SYSTEM WITHIN MARYLAND. BON SECOURS HOSPITAL WAS RENAMED GRACE MEDICAL CENTER. IN THE SPRING OF 2021, THE LEADERSHIP OF GRACE MEDICAL CENTER REVIEWED THE COMPLETED CHNA AND PRIORITIZED THE FOLLOWING IDENTIFIED NEEDS FOR DEVELOPMENT OF A CHNA IMPLEMENTATION PLAN FOR APPROVAL AND ADOPTION BY ITS BOARD: - BEHAVIORAL HEALTH/SUBSTANCE ABUSE/OPIOIDS - ACCESS TO PRIMARY AND SPECIALTY CARE PROVIDERS - CHRONIC CONDITIONS - CRIME AND TRAUMA - COMMUNITY ENGAGEMENT & DEVELOPMENT - TRANSPORTATION FOR ITS HOSPITALS' 2018 CHNA IMPLEMENTATION PLANS LIFEBRIDGE HEALTH ORGANIZED ITS PRIORITIZED NEEDS INTO THREE MAJOR CATEGORIES: HEALTH, SOCIAL AND ENVIRONMENTAL, AND ACCESS AND DEVELOPED SPECIFIC GOALS AND ACTIONS. SIMILARLY, GRACE MEDICAL CENTER HAS DEVELOPED A SIMILAR IMPLEMENTATION PLAN FOR THE PRIORITIZED NEEDS ABOVE CONSISTENT WITH THE LIFEBRIDGE HEALTH MODEL. HEALTH -BEHAVIORAL HEALTH/SUBSTANCE ABUSE/OPIOIDS: SUBSTANCE ABUSE TREATMENT PROGRAMMING TO PREVENT OVERDOSE FATALITIES AMONG ENROLLEES IN OPIOID TREATMENT PROGRAMS AS WELL AS THE SOUTHWEST BALTIMORE COMMUNITY IN GENERAL. IMPROVE THE HEALTH STATUS OF RESIDENTS OF SOUTHWEST BALTIMORE BY INCREASING THE NUMBER OF SBIRT INTERVENTIONS AND OVERDOSE SURVIVOR'S OUTREACH PROGRAM (OSOP) REFERRALS. GRACE MEDICAL'S SCREENING BRIEF INTERVENTION REFERRAL TO TREATMENT ("SBIRT") IS DESIGNED SO THAT ALL PATIENTS THAT ENTER THE HOSPITAL THROUGH THE EMERGENCY DEPARTMENT OR THROUGH A DIRECT ADMISSION ARE SCREENED BY HOSPITAL NURSING STAFF AS PART OF THE NURSING ASSESSMENT. NURSES AND OTHER MEMBERS OF THE HEALTH CARE TEAM REFER PATIENTS AT HIGH RISK TO PEER RECOVERY COACHES (PRCO) TO PROVIDE BRIEF INTERVENTIONS AND REFERRALS TO TREATMENT. -AMBULATORY CLINICS (PRIMARY CARE, MULTI-SPECIALTY, AND PEDIATRIC): IMPROVE AND EXPAND ACCESS TO PRIMARY CARE, PREVENTIVE SERVICES, AND SPECIALTY CARE. IMPROVE THE HEALTH OF THE COMMUNITY BY INCREASING THE NUMBER OF PEOPLE CONNECTED TO A PRIMARY CARE MEDICAL HOME AND INCREASING ANNUAL PRIMARY CARE VISITS -CARE TRANSITIONS, CASE MANAGEMENT, AND COMMUNITY PROGRAMS: IMPROVE THE HEALTH STATUS OF SOUTHWEST BALTIMORE RESIDENTS BY ENGAGING THE COMMUNITY IN SCREENINGS AND EDUCATIONAL EVENTS THAT PROMOTE HEALTHIER LIFESTYLES AND BETTER SELF-MANAGEMENT OF HEALTH AND CHRONIC CONDITIONS. IMPROVE MANAGEMENT OF CHRONIC CONDITIONS BY EARLY IDENTIFICATION OF PATIENTS AT RISK, PROVISION OF CARE, MANAGEMENT OF THOSE WITH CHRONIC CONDITIONS, AND ENROLLMENT INTO CARE MANAGEMENT AND/OR CARE TRANSITIONS PROGRAMS SOCIAL AND ENVIRONMENTAL -CRIME AND TRAUMA: 1. PROVIDE VIOLENCE INTERVENTION & PREVENTION AWARENESS TRAINING FOR ALL GMC STAFF ON ALL FORMS OF VIOLENCE & ABUSE 2. ASSESS NEED FOR ONSITE VIOLENCE RESPONDERS & COMMUNITY VIOLENCE INTERRUPTERS (I.E. ESTABLISH A SAFE STREETS SITE) TO ENSURE THAT PATIENTS WHO HAVE BEEN VICTIMS OF GUN VIOLENCE, STABBINGS, DOMESTIC VIOLENCE, ELDER ABUSE, AND OTHER FORMS OF VIOLENCE HAVE THE SUPPORT NEEDED WHILE AT GRACE MEDICAL AND WITHIN THE COMMUNITY 3. PROVIDE CASE MANAGEMENT, INCLUDING INDIVIDUALIZED NEEDS ASSESSMENTS, TAILORED CASE PLANNING, AND COMMUNITY-BASED CLIENT ADVOCACY, FOR SURVIVORS OF VIOLENCE RELATED TRAUMA 4. PROVIDE TRAUMA RESPONSIVE MENTAL HEALTH SERVICES FOR SURVIVORS OF VIOLENCE RELATED TRAUMA 5. PROVIDE SCHOOL-BASED VIOLENCE PREVENTION SERVICES, INCLUDING ACADEMIC ENRICHMENT OPPORTUNITIES, LIFE SKILLS TRAINING, AND STUDENT SUPPORT GROUPS THROUGH AN EVIDENCE-BASED VIOLENCE PREVENTION CURRICULUM -COMMUNITY ENGAGEMENT AND DEVELOPMENT: MULTIPLE COMMUNITY-BASED INITIATIVES TO ADDRESS KEY HEALTH AND SOCIO-ECONOMIC CHALLENGES IN WEST BALTIMORE. PROMOTE QUALITY, HEALTHY FOOD ACCESS IN WEST BALTIMORE THROUGH AN INITIATIVE, E.G. FOOD EDUCATION, FOOD MARKET OR ORGANIZATIONAL PARTNERSHIP. EXPAND LIFEBRIDGE HEALTH LIVE NEAR YOUR WORK PROGRAM IN THE WEST BALTIMORE SERVICE AREA. IN PARTNERSHIP WITH POPULATION HEALTH AND BALTIMORE CHILD ABUSE CENTER (BCAC), OFFER TWO HEALTH EDUCATION-BASED WORKSHOPS AND/OR EVENTS EACH YEAR TO THE WEST BALTIMORE COMMUNITY. BUILD PARTNERSHIPS WITH TWO WORKFORCE DEVELOPMENT ORGANIZATIONS AND CONDUCT TWO OUTREACH EVENTS PER YEAR TO CONNECT AREA RESIDENTS TO EMPLOYMENT OPPORTUNITIES. ACCESS -TRANSPORTATION: PROVIDE TRANSPORTATION TO COMMUNITY RESIDENTS FOR CLINIC APPOINTMENTS AND DIALYSIS TREATMENTS THE FOLLOWING NEEDS WERE NOT SPECIFICALLY INCLUDED IN THE IMPLEMENTATION PLAN AS THE NEEDS ARE BEING ADDRESSED IN CONJUNCTION WITH OTHER PARTNERING ORGANIZATIONS THAT HAVE NUMEROUS PROGRAMS AND SERVICES AVAILABLE TO ADDRESS MANY OF THE IDENTIFIED COMMUNITY HEALTH NEEDS. - HOUSING AND HOMELESSNESS - COMMUNITY ENGAGEMENT- EMPLOYMENT & WORKFORCE DEVELOPMENT - HEALTH EDUCATION WITHIN THE PUBLIC EDUCATION SYSTEM - ACCESS TO HEALTHY FOODS - SUPPORT FOR SENIOR SERVICES - YOUTH SERVICES (AGES 5-18) - FINANCIAL COUNSELING AND LITERACY - COORDINATION OF SERVICES ACROSS COMMUNITY
SCHEDULE H, PART V, SECTION B, LINE 16A:	https://www.lifebridgehealth.org/Main/LifeBridgeHealthFinancialAssistance. aspx
SCHEDULE H, PART V, SECTION B, LINE 16B:	https://www.lifebridgehealth.org/Main/LifeBridgeHealthFinancialAssistance. aspx
SCHEDULE H, PART V, SECTION B, LINE 16C:	https://www.lifebridgehealth.org/Main/LifeBridgeHealthFinancialAssistance. aspx
SCHEDULE H, PART V, SECTION B, LINE 22C:	CHARGES FOR ALL HOSPITAL PATIENTS ARE STATE REGULATED. SERVICES ARE CHARGED TO ALL HOSPITAL PATIENTS AT THE SAME RATE. CHARGES FOR INDIVIDUALS FOUND ELIGIBLE FOR FAP BASED ON 300% OR LESS OF THE FEDERAL POVERTY LEVEL (FPL) ARE WRITTEN-OFF IN FULL TO FAP (THERE IS NO PATIENT LIABILITY). CHARGES FOR INDIVIDUALS WHOSE PRESUMPTIVE FPL SCORE IS <200 ARE WRITTEN OFF TO FAP IN FULL (THERE IS NO PATIENT LIABILITY). CHARGES FOR INDIVIDUALS FOUND ELIGIBLE FOR FAP BASED ON THE HSCRC'S FINANCIAL HARDSHIP CRITERIA OF 301%-500% OF FPL ARE CHARGED NO MORE THAN 25% OF THE ANNUAL HOUSEHOLD INCOME PER THE HSCRC'S FINANCIAL HARDSHIP CRITERIA. THE DIFFERENCE BETWEEN THE TOTAL CHARGES AND THE CALCULATED 25% OF THE ANNUAL HOUSEHOLD INCOME IS WRITTEN OFF TO FAP.

Schedule H (Form 990) 2021

Page 9

Part VFacility Information (continued)

Section D. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility (list in order of size, from largest to smallest) How many non-hospital health care facilities did the organization operate during the tax year?4
Name and address		Type of Facility (describe)
1	GRACE MEDICAL NEW HOPE 2401 West Baltimore Street Baltimore,MD21223	BEHAVIORAL HEALTH SERVICES
2	GRACE MEDICAL CIBSSCMPACTNEW PHASES 6000 METRO DRIVE SUITE 110 BALTIMORE,MD21215	BEHAVIORAL HEALTH SERVICES
3	FAMILY HEALTH AND WELLNESS 2000 WEST BALTIMORE STREET SUITE 3 BALTIMORE,MD21223	COMMUNITY MEDICAL CENTER
4	GRACE MEDICAL CIBSADAPT 2401 WEST BALTIMORE STREET BALTIMORE,MD21223	BEHAVIORAL HEALTH SERVICES
5
6
7
8
9
10

Schedule H (Form 990) 2021

Page 10

Part VI

Supplemental Information

Provide the following information.

1	Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II and Part III, lines 2, 3, 4, 8 and 9b.
2	Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any CHNAs reported in Part V, Section B.
3	Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4	Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5	Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6	Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7	State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.

Form and Line Reference	Explanation
SCHEDULE H, PART I, LINE 3C:	GRACE MEDICAL CENTER, INC. PROVIDES SERVICES WITHOUT CHARGE OR AT AMOUNTS LESS THAN ITS ESTABLISHED RATES TO PATIENTS WHO MEET THE CRITERIA OF ITS CHARITY CARE POLICY. IT DOES NOT PURSUE THE COLLECTION OF AMOUNTS DETERMINED TO QUALIFY AS CHARITY CARE AND THOSE AMOUNTS ARE NOT REPORTED AS REVENUE. THE CRITERIA CONSIDER GROSS INCOME AND FAMILY SIZE ACCORDING TO CURRENT FEDERAL POVERTY GUIDELINES. TO QUALIFY, THE PATIENT MUST SHOW PROOF OF INCOME 300% OR LESS OF THE FEDERAL POVERTY GUIDELINES. A SLIDING SCALE IS USED TO DETERMINE ELIGIBILITY FOR THOSE WHOSE INCOME EXCEEDS 300%. ELIGIBILITY IS CALCULATED BASED ON THE NUMBER OF PEOPLE LIVING IN THE HOUSEHOLD. THE PROGRAM COVERS UNINSURED, UNDER-INSURED AND PATIENT LIABILITY AFTER INSURANCE(S) PAY. APPROVALS ARE GRANTED FOR A TWELVE MONTH PERIOD OF TIME AND PATIENTS ARE ENCOURAGED TO RE-APPLY FOR CONTINUED ELIGIBILITY.
SCHEDULE H, PART I, LINE 7:	MARYLAND'S REGULATORY SYSTEM CREATES A UNIQUE PROCESS FOR HOSPITAL PAYMENT THAT DIFFERS FROM THE REST OF THE NATION. THE HEALTH SERVICES COST REVIEW COMMISSION (HSCRC) DETERMINES PAYMENT THROUGH A RATE-SETTING PROCESS AND ALL PAYORS, INCLUDING GOVERNMENTAL PAYORS, PAY THE SAME AMOUNT FOR THE SAME SERVICES DELIVERED AT THE SAME HOSPITAL. MARYLAND'S UNIQUE ALL-PAYOR SYSTEM INCLUDES A METHOD FOR REFERENCING UNCOMPENSATED CARE IN EACH PAYOR'S RATES, WHICH DOES NOT ENABLE MARYLAND HOSPITALS TO BREAK-OUT ANY OFFSETTING REVENUE RELATED TO UNCOMPENSATED CARE. THE COST OF RENDERING SERVICES FOR MEDICAL ASSISTANCE PATIENTS IS APPROXIMATELY EQUAL TO MEDICAID REVENUES IN MARYLAND. THUS, THE NET EFFECT IS APPROXIMATELY 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.
SCHEDULE H, PART I, LINE 7A - I:	THE FOLLOWING COSTING METHODOLOGIES WERE USED TO CALCULATE LINES 7A THROUGH 7I ON THE COMMUNITY BENEFIT REPORT. OFFSETTING REVENUE - REVENUE FROM THE ACTIVITY DURING THE YEAR THAT OFFSETS THE TOTAL COMMUNITY BENEFIT EXPENSE OF THAT ACTIVITY. IT INCLUDES ANY REVENUE GENERATED BY THE ACTIVITY OR PROGRAM, SUCH AS A PAYMENT OR REIMBURSEMENT FOR SERVICES PROVIDED TO PROGRAM PATIENTS. OFFSETTING REVENUE INCLUDES RESTRICTED GRANTS OR CONTRIBUTIONS USED TO PROVIDE A COMMUNITY BENEFIT, BUT DOES NOT INCLUDE UNRESTRICTED GRANTS OR CONTRIBUTIONS THAT THE ORGANIZATION USES TO PROVIDE COMMUNITY BENEFIT. DIRECT COSTS - DIRECT COSTS INCLUDE SALARIES, EMPLOYEE BENEFITS, SUPPLIES, INTEREST ON FINANCING, TRAVEL AND OTHER COSTS THAT ARE DIRECTLY ATTRIBUTABLE TO THE SPECIFIC SERVICE AND THAT WOULD NOT EXIST IF THE SERVICE OR EFFORT DID NOT EXIST. INDIRECT COSTS - INDIRECT COSTS ARE COSTS NOT ATTRIBUTED TO PRODUCTS AND/OR SERVICES THAT ARE INCLUDED IN THE CALCULATION OF COSTS FOR COMMUNITY BENEFIT. THESE COULD INCLUDE, BUT ARE NOT LIMITED TO, SALARIES FOR HUMAN RESOURCES AND FINANCE DEPARTMENTS, INSURANCE AND OVERHEAD EXPENSES
SCHEDULE H, PART I, LINE 7G:	PART II, COMMUNITY BUILDING ACTIVITIES: GRACE MEDICAL CENTER, INC. ADDRESSES VARIOUS COMMUNITY CONCERNS INCLUDING HEALTH IMPROVEMENT, POVERTY, WORKFORCE DEVELOPMENT, AND ACCESS TO HEALTH CARE. GRACE MEDICAL CENTER, INC. CONDUCTS COMMUNITY HEALTH EDUCATION AND SUPPORT GROUPS, HEALTH FAIRS AND SCREENINGS FOR THE COMMUNITIES SERVED. GRACE MEDICAL CENTER, INC. WORKS WITH STATE AND LOCAL LEADERSHIP TO ADDRESS COMMUNITY NEEDS AND PROVIDE HEALTHCARE SERVICES TO THE POOR AND UNDERSERVED.
SCHEDULE H, PART III, LINE 2:	BAD DEBT EXPENSE IS ESTIMATED BY USING HISTORICAL RATES FOR EACH PAYOR AND THE LENGTH OF TIME THE RECEIVABLE HAS BEEN OUTSTANDING. THESE RATES ARE REVISITED FROM TIME TO TIME AND ADJUSTED WHEN DEEMED APPROPRIATE. ANY ADDITIONAL RESERVES ARE DETERMINED BY THE HOSPITAL'S EXECUTIVES.
SCHEDULE H, PART III, LINE 3:	GRACE MEDICAL CENTER, INC. DETERMINES ELIGIBILITY FOR FINANCIAL ASSISTANCE THROUGH OTHER VARIOUS MEANS SUCH AS ELIGIBLE FOR NON-REIMBURSABLE MEDICAID PROGRAMS, ENROLLED IN MEANS-TESTED SOCIAL PROGRAMS, ENROLLED IN STATE OF MARYLAND GRANT FUNDED PROGRAMS WHERE REIMBURSEMENT IS LESS THAN THE CHARGE, OUT-OF-STATE MEDICAID PROGRAMS, MARYLAND MEDICAID ELIGIBLE AFTER ADMISSION, MARYLAND MEDICAID AND IF THE PATIENT WAS DENIED MEDICAID FOR NOT MEETING DISABILITY REQUIREMENTS.
SCHEDULE H, PART III, LINE 4:	ALL PATIENT ACCOUNTS ARE HANDLED CONSISTENTLY AND APPROPRIATELY TO MAXIMIZE CASH FLOW AND TO IDENTIFY BAD DEBT ACCOUNTS TIMELY. ACTIVE ACCOUNTS ARE CONSIDERED BAD DEBT ACCOUNTS WHEN THEY MEET SPECIFIC COLLECTION ACTIVITY GUIDELINES AND/OR ARE REVIEWED BY THE APPROPRIATE MANAGEMENT AND DEEMED TO BE UNCOLLECTIBLE. EVERY EFFORT IS MADE TO IDENTIFY AND PURSUE ALL ACCOUNT BALANCE LIQUIDATION OPTIONS, INCLUDING BUT NOT LIMITED TO THIRD PARTY PAYOR REIMBURSEMENT, PATIENT PAYMENT ARRANGEMENTS, MEDICAID ELIGIBILITY AND FINANCIAL ASSISTANCE. THIRD PARTY RECEIVABLE MANAGEMENT AGENCIES PROVIDE EXTENDED BUSINESS OFFICE SERVICES AND INSURANCE OUTSOURCE SERVICES TO ENSURE MAXIMUM EFFORT IS TAKEN TO RECOVER INSURANCE AND SELF-PAY DOLLARS BEFORE TRANSFER TO BAD DEBT. CONTRACTUAL ARRANGEMENTS WITH THIRD PARTY COLLECTION AGENCIES WERE USED TO ASSIST IN THE RECOVERY OF BAD DEBT AFTER ALL INTERNAL COLLECTION EFFORTS HAVE BEEN EXHAUSTED. IN SO DOING, THE COLLECTION AGENCIES MUST OPERATE CONSISTENTLY WITH THE GOAL OF MAXIMUM BAD DEBT RECOVERY AND STRICT ADHERENCE WITH FAIR DEBT COLLECTIONS PRACTICES ACT (FDCPA) RULES AND REGULATIONS, WHILE MAINTAINING POSITIVE PATIENT RELATIONS
SCHEDULE H, PART III, LINE 8:	COSTING METHODOLOGY - MEDICARE ALLOWABLE COSTS, TOTAL REVENUE RECEIVED FROM MEDICARE (DSH & IME) AND MEDICARE ALLOWABLE COSTS ARE DERIVED FROM THE ANNUAL MEDICARE COST REPORT. THE INPATIENT ROUTINE COSTS ARE DERIVED FROM THE STEP-DOWN METHODOLOGY BASED ON ACCEPTED STATISTICAL ALLOCATION WITH A UNIFORM PER DIEM COST FOR EACH PAYOR TYPE. THE ANCILLARY MEDICARE ALLOWABLE COSTS ARE INITIALLY DERIVED FROM THE STEP-DOWN METHODOLOGY BUT ARE ALLOCATED TO THE PAYOR TYPES BASED ON THE RATIO OF COST TO CHARGE FOR EACH PAYOR.
SCHEDULE H, PART III, LINE 9B:	PATIENTS CAN BE DETERMINED ELIGIBLE FOR FINANCIAL ASSISTANCE (F.A.) PROSPECTIVELY OR RETROSPECTIVELY. THE F.A. ELIGIBILITY PERIOD EXPIRES ONE YEAR FROM THE MONTH ELIGIBILITY IS APPROVED FOR MEDICALLY NECESSARY SERVICES. THE PATIENT IS ASKED TO PROVIDE THE F.A. APPROVAL LETTER FOR SERVICES PROVIDED WITHIN THE ELIGIBILITY PERIOD. THE HOSPITAL WILL MAKE EVERY EFFORT TO IDENTIFY PATIENTS ELIGIBLE FOR F.A., ALTHOUGH HOSPITAL SYSTEMS DO NOT ALLOW FOR THIS TO BE AUTOMATED. BALANCES APPROVED FOR FINANCIAL ASSISTANCE ARE WRITTEN-OFF TO A ZERO BALANCE AND THEREFORE NOT PURSUED BY INTERNAL COLLECTION PROCESSES OR THIRD PARTY AGENCIES. BALANCES ALREADY PLACED WITH THIRD PARTY AGENCIES ARE WRITTEN-OFF TO A ZERO BALANCE AND THE ACCOUNTS ARE CLOSED AND RETURNED BY THE THIRD PARTY AGENCY.
SCHEDULE H, PART VI, LINE 2:	GRACE MEDICAL CENTER ASSESSES AND CONTINUALLY RESPONDS TO CHANGING COMMUNITY NEEDS THROUGH THE SERVICES OFFERED. GRACE MEDICAL CENTER JOINS AN EXISTING COMMUNITY-BASED NEEDS ASSESSMENT EVERY THREE YEARS AND UPDATES ARE PROVIDED BETWEEN ASSESSMENTS. GRACE MEDICAL CENTER INCORPORATES PLANNING FOR COMMUNITY BENEFITS AS PART OF ITS ANNUAL BUSINESS AND STRATEGIC PLANNING PROCESSES. GRACE MEDICAL CENTER RECOGNIZES THE HEALTH OF THE COMMUNITY IS INFLUENCED BY SOCIAL, ECONOMIC, AND ENVIRONMENTAL FACTORS, NOT JUST BY DISEASE AND ILLNESS. OUR COMMUNITY BENEFIT ANALYSIS INCLUDES BOTH QUALITATIVE AND QUANTITATIVE DATA; DEMOGRAPHICS INCLUDING RACE, AGE, AND ETHNICITY; SOCIOECONOMIC DATA INCLUDING INCOME, EDUCATION, AND HEALTH INSURANCE RATES; PRIMARY CARE AND CHRONIC DISEASE NEEDS OF UNINSURED PERSONS; AND DATA ON HEALTH DISPARITIES IN HEALTH OUTCOMES AMONG MINORITY GROUPS. GRACE MEDICAL CENTER COMMUNITY BENEFITS COMMITTEES MEET TO PROVIDE OVERSIGHT TO THE ORGANIZATION'S COMMUNITY BENEFITS PROGRAM. GRACE MEDICAL CENTER WORKS CLOSELY WITH HEALTH AND HUMAN SERVICE ORGANIZATIONS IN THE AREA, PARTNERING WITH SOME TO PROVIDE SERVICES TO AVOID DUPLICATION.
SCHEDULE H, PART VI, LINE 3:	THE FOLLOWING DESCRIBES MEANS USED AT GRACE MEDICAL CENTER TO INFORM AND ASSIST PATIENTS REGARDING ELIGIBLITY FOR FINANCIAL ASSISTANCE UNDER GOVERNMENTAL PROGRAMS AND THE HOSPITAL'S CHARITY CARE PROGRAM. FINANCIAL ASSISTANCE NOTICES, INCLUDING CONTACT INFORMATION, ARE POSTED IN THE BUSINESS OFFICE AND ADMITTING, AS WELL AS POINTS OF ENTRY AND REGISTRATION THROUGHOUT THE HOSPITAL. PATIENT FINANCIAL SERVICES BROCHURE 'FREEDOM TO CARE' IS AVAILABLE TO ALL INPATIENTS. BROCHURES ARE ALSO AVAILABLE IN ALL OUTPATIENT REGISTRATION AND SERVICE AREAS. GRACE MEDICAL EMPLOYS A FINANICAL ASSISTANCE LIAISON WHO IS AVAILABLE TO ANSWER QUESTIONS AND TO ASSIST PATIENTS AND FAMILY MEMBERS WITH THE PROCESS OF APPLYING FOR FINANCIAL ASSISTANCE. A PATIENT INFORMATION SHEET IS MADE AVAILABLE TO ALL PATIENTS PRIOR TO DISCHARGE. GRACE MEDICAL'S UNINSURED (SELF-PAY) AND UNDER-INSURED (MEDICARE BENEFICIARY WITH NO SECONDARY) MEDICAL ASSISTANCE ELIGIBILITY PROGRAM SCREENS, ASSISTS WITH THE APPLICATION PROCESS AND ULTIMATELY CONVERTS PATIENTS TO VARIOUS MEDICAL ASSISTANCE COVERAGE AND INCLUDES ELIGIBILITY SCREENING AND ASSISTANCE WITH COMPLETING THE FINANCIAL ASSISTANCE APPLICATION AS PART OF THAT PROCESS. ALL HOSPITAL STATEMENTS AND ACTIVE ACCOUNTS RECEIVABLE OUTSOURCE VENDORS INCLUDE A MESSAGE REFERENCING THE AVAILABILITY OF FINANCIAL ASSISTANCE FOR THOSE WHO ARE EXPERIENCING FINANCIAL DIFFICULTY AND PROVIDES CONTACT INFORMATION TO DISCUSS GRACE'S FINANCIAL ASSISTANCE PROGRAM. COLLECTION AGENCIES' INITIAL STATEMENT REFERENCES THE AVAILABILITY OF FINANCIAL ASSISTANCE FOR THOSE WHO ARE EXPERIENCING FINANCIAL DIFFICULTY AND PROVIDES CONTACT INFORMATION TO DISCUSS GRACE'S FINANCIAL ASSISTANCE PROGRAM. ALL HOSPITAL PATIENT FINANCIAL SERVICES STAFF, ACTIVE ACCOUNTS RECEIVABLE OUTSOURCE VENDORS, COLLECTION AGENCIES AND MEDICAID ELIGIBILITY VENDORS ARE TRAINED TO IDENTIFY POTENTIAL FINANCIAL ASSISTANCE ELIGIBILITY AND ASSIST PATIENTS WITH THE FINANCIAL ASSISTANCE APPLICATION PROCESS. FINANCIAL ASSISTANCE APPLICATION AND INSTRUCTIONS COVER SHEET IS AVAILABLE IN RUSSIAN, SPANISH AND FRENCH. GRACE MEDICAL HOSTS AND PARTICIPATES IN VARIOUS DEPARTMENT OF HEALTH AND MENTAL HYGIENE AND MARYLAND HOSPITAL ASSOCIATION SPONSORED CAMPAIGNS LIKE 'COVER THE UNINSURED WEEK'.
SCHEDULE H, PART VI, LINE 4:	GRACE MEDICAL'S SERVICE AREA INCLUDES 40.5% OF BALTIMORE CITY'S POPULATION. GRACE MEDICAL'S SERVICE AREA IS SIMILAR TO BALTIMORE CITY AND MARYLAND IN REGARD TO AGE AND GENDER, BUT IS DIFFERENT IN TERMS OF RACE/ETHNICITY AND INCOME. THE AREA HAS A LOWER HOUSEHOLD INCOME AND A LARGER PROPORTION OF AFRICAN AMERICANS THAN BALTIMORE CITY AND MARYLAND. THE AREA ALSO EXPERIENCES A HIGHER RATE OF PUBLIC INSURANCE THAN MARYLAND. WITHIN GRACE MEDICAL'S SERVICE AREA'S SEVEN ZIP CODES THERE IS WIDE VARIATION. ZIP CODES 21217 AND 21223 HAVE A POPULATION THAT IS YOUNGER THAN THE OTHER ZIP CODES, WHILE 21215 AND 21216 HAVE A POPULATION THAT IS OLDER THAN THE OTHER ZIP CODES. THERE IS ALSO WIDE VARIATION IN RACE/ETHNICITY AND INSURANCE COVERAGE WITHIN THE AREA. OVERALL, THE AREA IS A MAJORITY AFRICAN AMERICAN, LOW INCOME, AND IN MOST ZIP CODES PUBLICLY INSURED. 40.5% OF BALTIMORE CITY'S RESIDENTS ARE WITHIN GRACE MEDICAL'S SERVICE AREA. ZIP CODES 21215, 21229, AND 21217 COMPRISE THE LARGEST SEGMENTS OF THE AREA, AND REPRESENT 59.6% OF THE TOTAL RESIDENTS IN THE AREA. HOUSEHOLD INCOMES ARE MUCH LOWER IN THE AREA ON AVERAGE THAN THE STATE OF MARYLAND AND BALTIMORE CITY. 29.9% HAVE AN INCOME UNDER $25,000. 55.1% OF HOUSEHOLD INCOMES ARE BELOW $50,000, WHEREAS 50.3% OF BALTIMORE CITY AND 26.3% OF MARYLAND HOUSEHOLD INCOMES ARE BELOW $50,000. 57.3% OF MARYLAND HOUSEHOLD INCOMES ARE $75,000 OR OVER, WHILE 27.6% OF GRACE MEDICAL'S SERVICE AREA HOUSEHOLDS HAVE AN INCOME OF $75,000 OR OVER. THE AREA HAS A HIGHER PERCENT OF INDIVIDUALS THAT HAVE PUBLIC INSURANCE COMPARED TO MARYLAND. MORE THAN 30% OF THEIR POPULATION IS ENROLLED IN PUBLIC INSURANCE. THERE IS ALSO A HIGHER PROPORTION OF UNINSURED PERSONS COMPARED TO BALTIMORE AND MARYLAND. FOUR OF 7 ZIP CODES WITHIN THE GRACE MEDICAL SERVICE AREA HAVE 50% OR MORE OF THEIR POPULATION ENROLLED IN PUBLIC INSURANCE. THE GRACE MEDICAL SERVICE AREA ALSO HAS ONE OF THE HIGHEST DISEASE BURDEN AND SOME OF THE WORST INDICATORS OF SOCIAL DETERMINANTS OF HEALTH OF ANY COMMUNITY IN MARYLAND. THESE NEIGHBORHOODS ESTABLISH THE LOWER EXTREMES FOR HEALTH DISPARITIES IN THE CITY AND THE STATE ACROSS ALL MAJOR CHRONIC ILLNESSES. FAMILIES IN THE ZONE EXPERIENCE POVERTY (20%) AT HIGHER RATES THAN THOSE IN MARYLAND (6%) AND IN BALTIMORE CITY (17%). LIFE EXPECTANCY CAN BE UP TO 12 YEARS SHORTER IN THESE ZIP CODES THAN IN OTHER PARTS OF MARYLAND.
SCHEDULE H, PART VI, LINE 5:	GRACE MEDICAL OPERATES AN EMERGENCY ROOM OPEN TO ALL PERSONS REGARDLESS OF ABILITY TO PAY. IN ADDITION TO PROVIDING EMERGENCY SERVICES, GRACE MEDICAL ALSO PROVIDES MINOR EMERGENCY AND URGENT CARE SERVICES TO ALL REGARDLESS OF ABILITY TO PAY. GRACE MEDICAL PARTICIPATES IN MEDICAID, MEDICARE, CHAMPUS, AND OTHER GOVERNMENT-SPONSORED HEALTH CARE PROGRAMS. GRACE MEDICAL'S EMERGENCY DEPARTMENT TREATS A LARGE NUMBER OF PATIENTS WHO USE THE FACILITY FOR PRIMARY CARE NEEDS. PATIENT DEMOGRAPHICS REFLECT THE CHANGING COMMUNITY. AS IN OTHER COMMUNITIES, SOME AREA PHYSICIANS PLACE LIMITS ON THEIR ACCEPTANCE OF MEDICAID PATIENTS. IN ADDITION, SOME PRIMARY CARE PHYSICIANS REFER PATIENTS WITH AFTERHOURS NEEDS DIRECTLY TO AREA EMERGENCY ROOMS. COMMUNITY GROUPS AND INDIVIDUALS ARE VERY SUPPORTIVE OF GRACE MEDICAL CENTER.
SCHEDULE H, PART VI, LINE 6:	SINCE NOVEMBER 1, 2019, GRACE MEDICAL HAS BEEN A COMPONENT OF LIFEBRIDGE HEALTH, A NONPROFIT HEALTH SYSTEM THAT PROVIDES A WIDE VARIETY OF HEALTH CARE AND RELATED SERVICES TO THE RESIDENTS OF CENTRAL MARYLAND. THE COMPONENTS OF THE LIFEBRIDGE SYSTEM WORK TOGETHER CLOSELY TO ENSURE THAT AS MANY AS POSSIBLE OF THE COMMUNITY'S NEEDS ARE MET IN AN INTEGRATED NONDUPLICATIVE MANNER.
SCHEDULE H, PART VI, LINE 7:	THE COMMUNITY BENEFIT REPORT IS FILED IN THE STATE OF MARYLAND.

Schedule H (Form 990) 2021

Additional Data

Software ID:
Software Version:

- TIN:

Schedule J
(Form 990)

Department of the Treasury
Internal Revenue Service

Compensation Information

For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet

Complete if the organization answered "Yes" on Form 990, Part IV, line 23.
SchJMediumBullet

Attach to Form 990.
SchJMediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2021

Open to Public Inspection

Name of the organization

GRACE MEDICAL CENTER INC

Employer identification number

52-0591555

Part I

Questions Regarding Compensation

Yes

Check the appropiate box(es) if the organization provided any of the following to or for a person listed on Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.

First-class or charter travel Housing allowance or residence for personal use

Travel for companions Payments for business use of personal residence

Tax idemnification and gross-up payments Health or social club dues or initiation fees

Discretionary spending account Personal services (e.g., maid, chauffeur, chef)

If any of the boxes on Line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all of the expenses described above? If "No," complete Part III to explain .....

Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
directors, trustees, officers, including the CEO/Executive Director, regarding the items checked on Line 1a? ....

Indicate which, if any, of the following the filing organization used to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

Form 990 of other organizations Approval by the board or compensation committee

During the year, did any person listed on Form 990, Part VII, Section A, line 1a, with respect to the filing organization or a related organization:

Receive a severance payment or change-of-control payment? .............

Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........

Yes

Participate in, or receive payment from, an equity-based compensation arrangement? .........

If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.

Only 501(c)(3), 501(c)(4), and 501(c)(29) organizations must complete lines 5-9.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:

The organization? ....................

Any related organization? .......................

If "Yes," on line 5a or 5b, describe in Part III.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:

The organization? ..................

Any related organization? ......................

If "Yes," on line 6a or 6b, describe in Part III.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization provide any nonfixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............

Were any amounts reported on Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III ..........................

If "Yes" on line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50053T

Schedule J (Form 990) 2021

Page 2

Part II

Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is needed.

For each individual whose compensation must be reported on Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions, on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.
Note. The sum of columns (B)(i)-(iii) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and (E) amounts for that individual.

(A) Name and Title		(B) Breakdown of W-2, 1099-MISC compensation, and/or 1099-NEC			(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)	(F) Compensation in column (B) reported as deferred on prior Form 990
(A) Name and Title		(i) Base compensation	(ii) Bonus & incentive compensation	(iii) Other reportable compensation	(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)
1REBECCA ALTMAN VICE PRESIDENT	(i) (ii)	0 ------------- 328,534	0 ------------- 72,561	0 -------------	0 ------------- 43,437	0 ------------- 30,355	0 ------------- 474,887	0 ------------- 0
2Chideha Ohuoha MD Physician	(i) (ii)	283,699 ------------- 0	0 ------------- 0	0 ------------- 0	0 ------------- 0	2,746 ------------- 0	286,445 ------------- 0	0 ------------- 0
3MATT ANSEL THRU 122021 Executive Director	(i) (ii)	190,885 ------------- 0	27,004 ------------- 0	0 ------------- 0	0 ------------- 0	26,390 ------------- 0	244,279 ------------- 0	0 ------------- 0
4THEODORA BALIS MD PRIMARY CARE PHYSICIAN	(i) (ii)	331,353 ------------- 0	20,000 ------------- 0	0 ------------- 0	0 ------------- 0	30,790 ------------- 0	382,143 ------------- 0	0 ------------- 0
5DAVID HAUSER MD PSYCHIATRIST	(i) (ii)	308,339 ------------- 0	25,000 ------------- 0	0 ------------- 0	0 ------------- 0	11,503 ------------- 0	344,842 ------------- 0	0 ------------- 0
6Mohamed Dauda MD President Medical Staff	(i) (ii)	272,598 ------------- 0	2,000 ------------- 0	19,200 ------------- 0	0 ------------- 0	30,430 ------------- 0	324,228 ------------- 0	0 ------------- 0
7SHANTA POWELL MD PHYSICIAN	(i) (ii)	323,784 ------------- 0	12,500 ------------- 0	0 ------------- 0	0 ------------- 0	31,049 ------------- 0	367,333 ------------- 0	0 ------------- 0
8Matthew Poffenroth MD VICE PRESIDENT	(i) (ii)	0 ------------- 562,783	0 ------------- 258,657	0 ------------- 14,382	0 ------------- 130,852	0 ------------- 30,793	0 ------------- 997,467	0 ------------- 0
9DANIEL BLUM President & COO Sinai & Grace	(i) (ii)	0 ------------- 650,018	0 ------------- 259,675	0 ------------- 12,102	0 ------------- 72,800	0 ------------- 30,956	0 ------------- 1,025,551	0 ------------- 0
10ARSALAN SHEIKH MD CHAIR OF MEDICINE	(i) (ii)	359,147 ------------- 0	70,083 ------------- 0	0 ------------- 0	0 ------------- 0	30,286 ------------- 0	459,516 ------------- 0	0 ------------- 0
11David Krajewski ex officio-Assistant Treasurer	(i) (ii)	0 ------------- 743,929	0 ------------- 505,741	0 ------------- 336,449	0 ------------- 197,271	0 ------------- 29,919	0 ------------- 1,813,309	0 ------------- 280,798
12Jason Weiner ex officio-Assistant Secretary	(i) (ii)	0 ------------- 436,068	0 ------------- 349,371	0 ------------- 123,218	0 ------------- 119,556	0 ------------- 25,679	0 ------------- 1,053,892	0 ------------- 0
13Yasmeen Ahmed MD PHYSICIAN	(i) (ii)	268,898 ------------- 0	5,334 ------------- 0	0 ------------- 0	0 ------------- 0	29,748 ------------- 0	303,980 ------------- 0	0 ------------- 0
14NEIL MELTZER PRESIDENT/CEO LBH	(i) (ii)	0 ------------- 1,052,468	0 ------------- 1,442,162	0 ------------- 608,517	0 ------------- 34,349	0 ------------- 25,805	0 ------------- 3,163,301	0 ------------- 402,199

Schedule J (Form 990) 2021

Page 3

Part III

Supplemental Information

Provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II. Also complete this part for any additional information.

Return Reference

Explanation

SCHEDULE J, PART I, LINE 3:

SINCE NOVEMBER 1, 2020, THE ORGANIZATION HAS BEEN PART OF LIFEBRIDGE HEALTH ("LBH"). THE COMPENSATION OF THE ORGANIZATION'S PRESIDENT IS ESTABLISHED BY LBH AS PART OF ITS PROCESS FOR SETTING EXECUTIVE COMPENSATION ACROSS THE HEALTH SYSTEM. METHODS USED BY LBH INCLUDE A COMPENSATION COMMITTEE, INDEPENDENT COMPENSATION CONSULTANT, COMPENSATION SURVEY OR STUDY, AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE.

SCHEDULE J, PART I, LINES 4B:

The following directors and officers participated in a LifeBridge Health sponsored supplemental nonqualified retirement plan during the year. The amounts reported below represent employer contributions to the Section 457(f) plan made during the year: David Krajewski $ 159,849 MATTHEW POFFENROTH, MD $ 117,066 JASON WEINER $ 93,461 DANIEL BLUM $ 72,800 REBECCA ALTMAN $ 37,311 DURING THE YEAR, THE FOLLOWING DIRECTORS AND OFFICERS RECEIVED PAYMENTS AS PART OF THEIR PARTICIPATION IN A LIFEBRIDGE HEALTH SPONSORED SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN: David Krajewski $ 299,687 JASON WEINER $ 93,008 NEIL MELTZER $ 550,299 COMPENSATION PROVIDED BY RELATED ORGANIZATIONS: MR. BLUM RECEIVED COMPENSATION AS A SENIOR VICE PRESIDENT OF LIFEBRIDGE HEALTH, INC./PRESIDENT OF SINAI HOSPITAL OF BALTIMORE, INC. & GRACE MEDICAL CENTER, NOT AS A DIRECTOR. MR. KRAJEWSKI RECEIVED COMPENSATION AS AN EXECUTIVE VICE PRESIDENT AND THE CHIEF FINANCIAL OFFICER OF LIFEBRIDGE HEALTH, INC., NOT AS AN OFFICER OF GRACE MEDICAL CENTER, INC. MR. WEINER RECEIVED COMPENSATION AS A SENIOR VICE PRESIDENT AND THE GENERAL COUNSEL OF LIFEBRIDGE HEALTH, INC., NOT AS AN OFFICER OF GRACE MEDICAL CENTER, INC. MR. POFFENROTH RECEIVED COMPENSATION AS A SENIOR VICE PRESIDENT OF LIFEBRIDGE HEALTH, INC., NOT AS AN OFFICER OF GRACE MEDICAL CENTER, INC. MR. MELTZER RECEIVED COMPENSATION AS THE CHIEF EXECUTIVE OFFICER AND PRESIDENT OF LIFEBRIDGE HEALTH, INC., NOT AS A DIRECTOR OR OFFICER OF GRACE MEDICAL CENTER, INC. MS. ALTMAN RECEIVED COMPENSATION AS A VICE PRESIDENT AND THE CHIEF INTEGRATION OFFICER OF LIFEBRIDGE HEALTH, INC., NOT AS A DIRECTOR OR OFFICER OF GRACE MEDICAL CENTER, INC. DR. DAUDA RECEIVED COMPENSATION AS AN EMPLOYED PHYSICIAN OF GRACE MEDICAL CENTER, INC., NOT AS A DIRECTOR OF GRACE MEDICAL CENTER, INC.

Schedule J (Form 990) 2021

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE O
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or 990-EZ or to provide any additional information.
MediumBullet

Attach to Form 990 or 990-EZ.
MediumBullet

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2021

Open to Public
Inspection

Name of the organization

GRACE MEDICAL CENTER INC

Employer identification number

52-0591555

Return Reference	Explanation
FORM 990, Part III, Line 3:	Grace Medical Center, Inc. ("Grace") had historically operated an acute care general hospital known as Grace Medical Center (formerly known as Bon Secours Hospital) located at 2000 W. Baltimore Street, Baltimore, Maryland 21223. In 2021, Grace and its affiliate, Sinai Hospital of Baltimore, Inc., which operates an acute care general hospital located at 2401 W. Belvedere Avenue, Baltimore, Maryland 21215 ("Sinai"), jointly submitted an application to the Maryland Health Care Commission (the "Commission") to convert Grace Medical Center to a freestanding medical facility ("FMF"). Under Maryland law, an FMF is a facility offering medical and health services similar in nature to, but more narrow in scope than, those which may be provided by a hospital. For example, an FMF is generally not permitted to provide inpatient services and may only retain patients overnight for observation. In addition, under Maryland law, an FMF must be an administrative part of an acute care general hospital, which is referred to as the "parent hospital" of the FMF. In the conversion plan submitted to the Commission, Sinai would serve as the parent hospital for the FMF. Therefore Sinai, and not Grace, would hold the applicable FMF license and be responsible for its day-to-day operations. Following approval of the application by the Commission, Grace Medical Center converted to an FMF operated by Sinai, effective March 1, 2022 (the "Conversion Date"). Despite the fact that it is no longer licensed to operate an acute care general hospital, the principal purpose of Grace has continued to be the provision of medical care and related services. Following the Conversion Date, Grace has continued to provide medical and health services under numerous service lines unrelated to the FMF, including those described below. In addition, because Grace is the owner of the facility and related real property on which the FMF is located, as well as the employer of many of the individuals needed to operate the FMF, Sinai and Grace entered into several agreements, effective as of the Conversion Date, pursuant to which Grace leases to Sinai the real property constituting the FMF, as well as certain equipment and employees necessary for Sinai to operate the FMF. Below is a brief summary of certain services provided by Grace following the Conversion Date: 1. Outpatient dialysis services; 2. Outpatient physical therapy, vascular, and mammography services; 3. The following ambulatory services provided by physicians, providers, or technicians employed or contracted by Grace: a. Family Medicine; b. Endocrinology; c. Gastroenterology; d. Orthopedics; e. Podiatry; f. Anti-coagulation clinic; g. Dietician; and h. Ancillary services; 4. Ambulatory care management services, including, but not limited to, complex case management, and transitional care management programs to engage at risk populations in care coordination services to promote healthy behaviors and improved health outcomes while decreasing unnecessary utilization of healthcare resources and improving total cost of care; 5. Community health and wellness programs including, but not limited to community screenings, health education, disease management, smoking cessation, health and housing, faith community partnerships, mobile health clinics, and COVID vaccinations in the community; 6. Numerous mental health programs, including the following: a. Mental Health Case Management Services (Specialized Case Management Program) - a mental health case management program accredited by the Commission on Accreditation of Rehabilitation Facilities ("CARF") which provides clients experiencing varying degrees of mental illness with assistance in gaining access to needed medical, mental health, social, educational, and other community-based services; b. Supported Employment Services - a CARF-accredited vocational program that aims to assist clients living with mental illness to gain meaningful employment; and c. Assisted Outpatient Treatment - pilot program under the State of Maryland for high inpatient utilizers to provide wrap-around support services for the severely mentally ill that are mandated to receive treatment by a court magistrate. Grace currently operates the only program of this type in the State of Maryland; 7. Substance use disorder treatment services, including, but not limited to, Screening Brief Intervention and Referral to Treatment and Overdose Survivor Outreach Program, at New Hope Treatment Center; 8. Residential services for women in recovery from substance use at Tania House (1847 West Lexington Avenue, Baltimore, MD 21223); 9. New Phases Psychiatric Rehabilitation Program - a CARF-accredited adult day program providing support and structure to individuals living with severe mental illness designed to assist individuals with societal reintegration and promote symptom management and patient independence; 10. New Phases Residential Program - a CARF-accredited housing program serving individuals with severe mental illness providing supervision and rehabilitation services to assist individuals reintegrating into society with the core goal of obtaining independent housing; 11. Mobile Treatment Team (Assertive Community Treatment) - a CARF-accredited program providing a multifaceted approach to caring for and treating individuals with a severe mental health diagnosis and who are unable to utilize traditional outpatient mental health services as a way to manage their illness(es). 12. Leasing space (including examination rooms and a physician office or work space), on a session basis, to affiliated entities providing the following specialty services on an outpatient basis: a. Obstetrics/ Gynecology; b. General Surgery; c. Pediatrics; d. Ophthalmology; e. Cardiology; and f. Infectious Disease; 13. Leasing space (including examination rooms and a physician office or work space), on a session basis, to private practice physician practices providing the following specialty services on an outpatient basis: a. Nephrology; b. Cardiology; and c. Vascular Surgery; 14. Leasing space at below fair market value rates (or without cost) to other non-profit entities, such as Medicine for Peace, Inc. and Healthcare for the Homeless, Inc., for the provision of medical services.
FORM 990, PART III, LINE 4A, PROGRAM SERVICE ACCOMPLISHMENTS:	OUTPATIENT SERVICES: RENAL DIALYSIS, HIV/AIDS SERVICES, MENTAL HEALTH, SUBSTANCE ABUSE TREATMENT, HEALTH EDUCATION, PEDIATRICS, OBGYN SERVICES, CARDIAC REHABILITATION AND WELLNESS PROGRAMS AND TELE-HEALTH PROGRAM FOR PATIENTS WITH CONGESTIVE HEART DISEASE. THE HOSPITAL OPERATES AN EMERGENCY ROOM THAT IS OPEN 24 HOURS PER DAY, SEVEN DAYS PER WEEK, SERVING PERSONS REGARDLESS OF THEIR ABILITY TO PAY. SEE SCH H FOR ADDITIONAL INFORMATION.
FORM 990, PART VI, SECTION A, LINE 6:	THE CORPORATION SHALL HAVE ONE MEMBER, LIFEBRIDGE HEALTH, INC. (THE "MEMBER"), A MARYLAND NON-STOCK CORPORATION. MEMBERSHIP IN THE CORPORATION SHALL NOT BE TRANSFERABLE.
FORM 990, PART VI, SECTION A, LINE 7A:	THE MEMBER SHALL HAVE THE EXCLUSIVE POWER AND AUTHORITY TO TAKE THE FOLLOWING ACTIONS: (1) EXCEPT FOR EX OFFICIO DIRECTORS AS PROVIDED FOR IN THE BYLAWS, TO NOMINATE, ELECT, AND REMOVE, WITH OR WITHOUT CAUSE, THE DIRECTORS OF THE CORPORATION; (2) TO APPOINT THE PRESIDENT OF THE CORPORATION WITH THE ADVICE AND CONSENT OF THE BOARD OF DIRECTORS; (3) TO NOMINATE AND ELECT THE CORPORATION'S CHAIR, VICE CHAIR, SECRETARY, AND TREASURER; AND (4) TO REMOVE EACH OF THE ABOVE NAMED OFFICERS (WITH OR WITHOUT CAUSE), PROVIDED THAT THE BOARD OF DIRECTORS OF THE CORPORATION SHALL ALSO HAVE THE POWER TO REMOVE ANY OFFICER OF THE CORPORATION.
FORM 990, PART VI, SECTION A, LINE 7B:	THE MEMBER HAS POWER TO APPOINT AND/OR REMOVE MEMBERS OF THE GOVERNING BODY.
FORM 990, PART VI, SECTION B, LINE 11B:	THE LIFEBRIDGE EXEMPT ENTITIES 990'S ARE INITIALLY REVIEWED BY THE ASSISTANT VICE PRESIDENT OF FINANCIAL REPORTING. IN ADDITION, AN INDEPENDENT ACCOUNTING FIRM ALSO REVIEWS ALL THE 990 RETURNS. A FORMAL MEETING IS THEN SCHEDULED WITH THE CHIEF FINANCIAL OFFICER, VICE PRESIDENT OF FINANCIAL REPORTING, GENERAL COUNSEL AND THE ASSISTANT VICE PRESIDENT OF FINANCIAL REPORTING TO REVIEW IN THEIR ENTIRETY ALL THE LIFEBRIDGE EXEMPT ENTITIES 990'S. MANAGEMENT THEN PROVIDES A COPY OF THE 990'S TO THE AUDIT AND COMPLIANCE COMMITTEE OF THE LIFEBRIDGE HEALTH BOARD AND TO EACH INDIVIDUAL BOARD DIRECTOR PRIOR TO THE FILING DATE FOR REVIEW.
FORM 990, PART VI, SECTION B, LINE 12C:	ALL DIRECTORS, OFFICERS, EMPLOYEES, MEDICAL STAFF MEMBERS, AND VOLUNTEERS ARE EXPECTED TO RECOGNIZE AND DISCLOSE AT THE EARLIEST POSSIBLE TIME ACTUAL AND POTENTIAL CONFLICTS OF INTEREST. AN INDIVIDUAL IS CONSIDERED TO HAVE A CONFLICT OF INTEREST WITH REGARD TO A MATTER OR TRANSACTION IF THE INDIVIDUAL OR A FAMILY MEMBER OF THE INDIVIDUAL HAS A PERSONAL OR FINANCIAL INTEREST THAT HAS THE POTENTIAL TO INFLUENCE THE ACTION TAKEN BY THE INDIVIDUAL ON BEHALF OF LIFEBRIDGE HEALTH. ADDITIONAL INFORMATION REGARDING WHAT CONSTITUTES A CONFLICT OF INTEREST AND HOW TO DISCLOSE A CONFLICT IS OUTLINED BELOW. LIFEBRIDGE AND ALL OF ITS SUBSIDIARIES SHALL REQUIRE ALL EMPLOYEES, MEDICAL STAFF, AND MEMBERS OF THE BOARD TO DISCLOSE ANY ACTIVITIES THAT COULD RESULT IN A POSSIBLE CONFLICT OF INTEREST. IF A CONFLICT IS IDENTIFIED, THE PERSON INVOLVED WOULD RECUSE HIM/HERSELF FROM DELIBERATIONS REGARDING THE TRANSACTIONS. AN INDIVIDUAL IS CONSIDERED TO HAVE A CONFLICT OF INTEREST WITH REGARD TO A MATTER OR TRANSACTION IF THE INDIVIDUAL HAS A PERSONAL OR FINANCIAL INTEREST THAT HAS THE POTENTIAL TO INFLUENCE THE ACTION TAKEN BY THE INDIVIDUAL ON BEHALF OF LIFEBRIDGE OR ANY OF ITS SUBSIDIARIES. AN INDIVIDUAL IS CONSIDERED TO HAVE A "PERSONAL INTEREST" IN A MATTER IF IT IS LIKELY TO HAVE A DIRECT AND MATERIAL IMPACT ON THE INDIVIDUAL'S RELATIONSHIP WITH LIFEBRIDGE OR ANY OF ITS SUBSIDIARIES (E.G., THE INDIVIDUAL'S CONTINUED MEMBERSHIP ON A SUBSIDIARY HOSPITAL'S MEDICAL STAFF), OR ON THE INDIVIDUAL'S OWN HEALTH CARE, OR THE INDIVIDUAL IS PERSONALLY INVOLVED IN A SUBSTANTIAL WAY (E.G., SERVES AS AN OFFICER, DIRECTOR, TRUSTEE, OR KEY EMPLOYEE) WITH ANOTHER ORGANIZATION THAT HAS A SIGNIFICANT INTEREST IN THE MATTER. AN INDIVIDUAL IS CONSIDERED TO HAVE A "FINANCIAL INTEREST" IN A TRANSACTION IF THE INDIVIDUAL, OR THEIR FAMILY MEMBER, (I) IS A PARTY TO THE TRANSACTION, (II) WILL BENEFIT PERSONALLY FROM THE TRANSACTION, OR (III) HAS, DIRECTLY OR INDIRECTLY, A CURRENT OR ANTICIPATED OWNERSHIP OR INVESTMENT IN, OR COMPENSATION ARRANGEMENT WITH, A PARTY TO THE TRANSACTION. AN OWNERSHIP INTEREST OF LESS THAN 5% IN AN ENTITY WILL NOT, IN AND OF ITSELF, GENERALLY BE CONSIDERED A FINANCIAL INTEREST; HOWEVER, TO THE EXTENT THE INDIVIDUAL'S COMPENSATION FROM THE ENTITY IS DIRECTLY LINKED TO THE ENTITY'S BUSINESS WITH LIFEBRIDGE HEALTH, SUCH COMPENSATION WILL CONSTITUTE A FINANCIAL INTEREST. FOR THE PURPOSES OF THIS POLICY, A "FAMILY MEMBER" INCLUDES SPOUSE OR DOMESTIC PARTNER, PARENTS, BROTHERS AND SISTERS, CHILDREN (WHETHER NATURAL OR ADOPTED), GRANDPARENTS, GRANDCHILDREN, GREAT-GRANDCHILDREN, AND IN-LAWS, SPOUSES OF BROTHERS, SISTERS, CHILDREN, GRANDCHILDREN, AND GREAT-GRANDCHILDREN, AND ANY OTHER MEMBER OF A HOUSEHOLD OF THE INDIVIDUAL. CONFLICTS OF INTEREST ARE TO BE REPORTED BY EMPLOYEES TO THEIR SUPERVISOR, WHO WILL BE RESPONSIBLE FOR DETERMINING WHETHER FURTHER DISSEMINATION IS NECESSARY. MEMBERS OF THE MEDICAL STAFF SHOULD REPORT CONFLICTS TO THE CHIEF OF THEIR DEPARTMENT, AND MEMBERS OF THE BOARD SHOULD REPORT THEM TO THE CHIEF COMPLIANCE OFFICER. QUESTIONNAIRES ARE SENT OUT TO MEMBERS OF THE BOARD ON AN ANNUAL BASIS. IF QUESTIONS ARISE OR FURTHER GUIDANCE IS SOUGHT, INDIVIDUALS CAN CONTACT THE CHIEF COMPLIANCE OFFICER OR CONFIDENTIAL COMPLIANCE HOTLINE. NOTHING IN THIS DEFINITION IS INTENDED TO RELIEVE ANY PERSON OF ANY ADDITIONAL OBLIGATIONS THAT MAY BE IMPOSED BY STATE OR FEDERAL LAW.
FORM 990, PART VI, SECTION C, LINE 19:	IT IS THE POLICY OF LIFEBRIDGE HEALTH INC. AND ITS SUBSIDIARIES TO MAKE AVAILABLE UPON REQUEST THE AUDITED FINANCIAL STATEMENTS TO THE GENERAL PUBLIC. THE LIFEBRIDGE HEALTH INC. AND SUBSIDIARY GOVERNING DOCUMENTS ARE NOT MADE AVAILABLE TO THE GENERAL PUBLIC UPON REQUEST OR VIA A WEBSITE. THE CONFLICT OF INTEREST POLICY IS INCLUDED ON SCHEDULE O.
FORM 990, PART XI, LINE 9, CHANGES IN NET ASSETS:	TRANSFERS TO AFFILIATES $ 15,892,746 OTHER ADJUSTMENT $ 275,672
FORM 990, PART XII, LINE 2C:	THE AUDIT COMMITTEE REVIEW PROCESS FOR GRACE MEDICAL CENTER, INC. FOLLOWS LIFEBRIDGE HEALTH, INC.'S AUDIT COMMITTEE REVIEW PROCESS.
FORM 990 PART IX LINE 11G	DESCRIPTION:AGENCY NURSING TOTAL FEES:1204232
FORM 990 PART IX LINE 11G	DESCRIPTION:LAUNDRY AND EVS TOTAL FEES:1536464
FORM 990 PART IX LINE 11G	DESCRIPTION:OTHER PURCHASED SERVICES TOTAL FEES:882972
FORM 990 PART IX LINE 11G	DESCRIPTION:PROFESSIONAL & TECHNICAL TOTAL FEES:2077560
FORM 990 PART IX LINE 11G	DESCRIPTION:AMBULANCE SERVICE TOTAL FEES:488163

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 51056K

Schedule O (Form 990) 2021

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

Complete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
MediumBullet

Attach to Form 990.
MediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2021

Open to Public Inspection

Name of the organization

GRACE MEDICAL CENTER INC

Employer identification number

52-0591555

Part I

Identification of Disregarded Entities. Complete if the organization answered "Yes" on Form 990, Part IV, line 33.

(a) Name, address, and EIN (if applicable) of disregarded entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Total income	(e) End-of-year assets	(f) Direct controlling entity

Part II

Identification of Related Tax-Exempt Organizations. Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	(g) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	Yes	No
(1)Carroll Hospital Center Inc 200 Memorial Avenue Westminster,MD21157 52-1452024	Hospital	MD	501(C)(3)	3	CCHS		No
(2)Bridginglife Inc 292 Stoner Avenue Westminster,MD21157 52-1565870	Hospice	MD	501(C)(3)	7	CHC		No
(3)Carroll Hospital Center Foundation Inc 200 Memorial Avenue Westminster,MD21157 52-1115038	Foundation	MD	501(C)(3)	12A, I	CHC		No
(4)Partnership for a Healthier Carroll Cty 535 Old Westminster Pike 102 Westminster,MD21157 52-2156892	Health Svcs	MD	501(C)(3)	7	CHC		No
(5)Levindale Hebrew Geriatric Center Hosp 2434 West Belvedere Avenue Baltimore,MD21215 52-0607913	Hospital	MD	501(C)(3)	3	LBH		No
(6)Sinai Hospital of Baltimore Inc 2401 West Belvedere Avenue Baltimore,MD21215 52-0486540	Hospital	MD	501(C)(3)	3	LBH		No
(7)Courtland Gardens Nursing and Rehab Ctr 2434 West Belvedere Avenue Baltimore,MD21215 52-0607907	Nursing	MD	501(C)(3)	10	LBH		No
(8)Northwest Hospital Center Inc 5401 Old Court Road Randallstown,MD21133 52-1372665	Hospital	MD	501(C)(3)	3	LBH		No
(9)Childrens Hospital of Baltimore City Inc 2401 West Belvedere Avenue Baltimore,MD21215 52-0591592	Hospital supp	MD	501(C)(3)	12B, II	LBH		No
(10)The Baltimore Jewish Health Fdn Inc 2401 West Belvedere Avenue Baltimore,MD21215 52-2111541	Hospital supp	MD	501(C)(3)	12B, II	LBH		No
(11)Childrens Hospital at Sinai Foundation 2401 West Belvedere Avenue Baltimore,MD21215 52-2167587	Hospital supp	MD	501(C)(3)	12B, II	LBH		No
(12)The Baltimore Jewish Eldercare Fdn 2401 West Belvedere Avenue Baltimore,MD21215 52-2337669	Hospital supp	MD	501(C)(3)	12B, II	LBH		No
(13)Center for Hope Inc 5400 Preakness Way Baltimore,MD21215 52-1681279	Child Svcs	MD	501(C)(3)	7	LBH		No
(14)West Baltimore Renaissance Fdn Inc 2401 West Belvedere Avenue Baltimore,MD21215 84-3355332	Community Ctr	MD	501(C)(3)	7	LBH		No
(15)Carroll County Health Services Corp 200 Memorial Avenue Westminster,MD21157 52-0691413	Hospital supp	MD	501(C)(3)	12B, II	LBH		No
(16)LifeBridge Center for Hope Inc 2401 West Belvedere Avenue Baltimore,MD21215 85-3920012	Real Estate	MD	501(C)(3)	12A, I	SHB		No
(17)LifeBridge Health Inc 2401 West Belvedere Avenue Baltimore,MD21215 52-1402373	Support	MD	501(C)(3)	12C, III	NA		No

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50135Y

Schedule R (Form 990) 2021

Page 2

Part III

Identification of Related Organizations Taxable as a Partnership. Complete if the organization answered "Yes" on Form 990, Part IV, line 34, because it had one or more related organizations treated as a partnership during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Predominant income(related, unrelated, excluded from tax under sections 512-514)	(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?		(k) Percentage ownership
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity		(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No	(k) Percentage ownership
(1) Carroll County Radiology LLC 7523 Ambassador Road Baltimore,MD21244 52-2190849	Radiology	MD	NA	N/A	0	0		No	0		No	0 %
(2) Carroll Occupational Health LLC 7001 Corporate Center Court Westminster,MD21157 20-2769332	Medical Services	MD	NA	N/A	0	0		No	0		No	0 %
(3) Cardiovascular Associates of Maryland 2401 West Belvedere Avenue Baltimore,MD21215 46-2935110	Medical Services	MD	NA	N/A	0	0		No	0		No	0 %
(4) LifeBridge Cardiology of Parkville LLC 2401 West Belvedere Avenue Baltimore,MD21215 46-3742313	Medical Services	MD	NA	N/A	0	0		No	0		No	0 %
(5) LifeBridge Community Gastroenterology 2401 West Belvedere Avenue Baltimore,MD21215 46-2863298	Medical Services	MD	NA	N/A	0	0		No	0		No	0 %
(6) LifeBridge Community Pediatrics LLC 2401 West Belvedere Avenue Baltimore,MD21215 46-2842468	Medical Services	MD	NA	N/A	0	0		No	0		No	0 %
(7) LifeBridge Community Pulmonology LLC 2401 West Belvedere Avenue Baltimore,MD21215 46-1401312	Medical Services	MD	NA	N/A	0	0		No	0		No	0 %
(8) LifeBridge Gynecology of Pikesville LLC 2401 West Belvedere Avenue Baltimore,MD21215 46-2949092	Medical Services	MD	NA	N/A	0	0		No	0		No	0 %
(9) LifeBridge Medical Associates LLC 2401 West Belvedere Avenue Baltimore,MD21215 46-2941505	Medical Services	MD	NA	N/A	0	0		No	0		No	0 %
(10) LifeBridge Neurosciences LLC 2401 West Belvedere Avenue Baltimore,MD21215 45-0719598	Medical Services	MD	NA	N/A	0	0		No	0		No	0 %
(11) LifeBridge Primary Care of Eldersburg 2401 West Belvedere Avenue Baltimore,MD21215 38-3897702	Medical Services	MD	NA	N/A	0	0		No	0		No	0 %
(12) LifeBridge Primary Care of North Carroll 2401 West Belvedere Avenue Baltimore,MD21215 80-0883321	Medical Services	MD	NA	N/A	0	0		No	0		No	0 %
(13) Homecare Maryland LLC 8028 Ritchie Highway Pasadena,MD21122 26-1378175	Home Health Srvc	MD	NA	N/A	0	0		No	0		No	0 %
(14) LifeBridge Rehabilitation Services LLC 2401 West Belvedere Avenue Baltimore,MD21215 81-1504380	Rehab Services	MD	NA	N/A	0	0		No	0		No	0 %
(15) Ellicott City ASC Management LLC 2401 West Belvedere Avenue Baltimore,MD21215 52-2331663	Medical Services	MD	NA	N/A	0	0		No	0		No	0 %
(16) Surgicenter of Baltimore LLC 2401 West Belvedere Avenue Baltimore,MD21215 52-1658841	Medical Services	MD	NA	N/A	0	0		No	0		No	0 %
(17) Springwell Partners LLC 2200 Pine Hill Farms Lane Hunt Valley,MD21030 27-1971171	Assisted Living	MD	NA	N/A	0	0		No	0		No	0 %
(18) LifeBridge Suburban Physician Group II 5401 Old Court Road Randallstown,MD21133 81-4209029	Medical Services	MD	NA	N/A	0	0		No	0		No	0 %
(19) LifeBridge Lab Management LLC 2401 West Belvedere Avenue Baltimore,MD21215 82-1113874	Lab Services	MD	NA	N/A	0	0		No	0		No	0 %
(20) LifeBridge Metropolitan Physician GrpII 2401 West Belvedere Avenue Baltimore,MD21215 81-4223537	Medical Services	MD	NA	N/A	0	0		No	0		No	0 %
(21) LifeBridge Multi-Specialty LLC 41 Magna Way Suite 100 Westminster,MD21157 46-3753120	Medical Services	MD	NA	N/A	0	0		No	0		No	0 %
(22) Ellicott City Ambulatory Surgery Center 2850 N Ridge Road Ellicott City,MD21043 52-2331663	Medical Services	MD	NA	N/A	0	0		No	0		No	0 %
(23) Oak Farm Solutions LLC 1122 Kenilworth Drive Towson,MD21204 47-4944865	Home Health Srvc	MD	NA	N/A	0	0		No	0		No	0 %
(24) MNR Industries LLC 5 Bel Air South Parkway Bel Air,MD21015 33-1095434	Urgent Care Srvc	MD	NA	N/A	0	0		No	0		No	0 %
(25) MNR of Frederick County LLC 5 Bel Air South Parkway Bel Air,MD21015 81-3781457	Urgent Care Srvc	MD	NA	N/A	0	0		No	0		No	0 %
(26) Baker Rehab Group LLC 197 Thomas Johnson Drive Frederick,MD21702 88-0864449	Rehab Services	MD	NA	N/A	0	0		No	0		No	0 %
(27) Advanced Endo Ctr of Howard Cty LLC 8875 Centre Park Drive Columbia,MD21045 52-2210078	Medical Services	MD	NA	N/A	0	0		No	0		No	0 %

Part IV

Identification of Related Organizations Taxable as a Corporation or Trust. Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	(h) Percentage ownership	(i) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	(h) Percentage ownership	Yes	No
(1) Carroll County Med-Services Inc 200 Memorial Avenue Westminster,MD21157 52-1891102	Medical Services	MD	CCMS INC	C Corp	0	0	0 %		No
(2) LifeBridge Investments Inc 2401 West Belvedere Avenue Baltimore,MD21215 52-1483166	Investment	MD	LBH	C Corp	0	0	0 %		No
(3) Healthstar Medical Services Inc 2401 West Belvedere Avenue Baltimore,MD21215 52-1829098	Healthcare	MD	LB INV INC	C Corp	0	0	0 %		No
(4) Practice Dynamics Inc 124 Business Center Drive Reisterstown,MD21136 52-1960319	Management	MD	LB INV INC	C Corp	0	0	0 %		No
(5) LifeBridge Insurance Company Ltd PO Box 1109 Grand Cayman KY1-1102 CJ 98-0415396	Insurance	CJ	LBH	C Corp	0	0	0 %		No
(6) LifeBridge Community Physicians Inc 2401 West Belvedere Avenue Baltimore,MD21215 80-0719005	Healthcare	MD	LB INV INC	C Corp	0	0	0 %		No
(7) Carroll Billing Services Inc 200 Memorial Avenue Westminster,MD21215 30-0026598	Billing Services	MD	CHC INC	C Corp	0	0	0 %		No
(8) Carroll County Gen Hosp South Carroll 200 Memorial Avenue Westminster,MD21157	Real Estate	MD	NA	C Corp	0	0	0 %		No
(9) Med-Services Holdings Inc 200 Memorial Avenue Westminster,MD21157	Medical Services	MD	CCMS INC	C Corp	0	0	0 %		No
(10) LifeBridge Health Israel Ltd 16 Abba Hillel Road Rahmat Gan 5250608 IS 51-5804516	Healthcare	IS	LB INV INC	C Corp	0	0	0 %		No

Schedule R (Form 990) 2021

Page 3

Part V

Transactions With Related Organizations. Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35b, or 36.

Note. Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.

Yes

1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?

a Receipt of (i) interest, (ii) annuities, (iii) royalties, or (iv) rent from a controlled entity .....................

b Gift, grant, or capital contribution to related organization(s) ............................

c Gift, grant, or capital contribution from related organization(s) ............................

d Loans or loan guarantees to or for related organization(s) ............................

e Loans or loan guarantees by related organization(s) ............................

f Dividends from related organization(s) ............................

g Sale of assets to related organization(s) ............................

h Purchase of assets from related organization(s) ............................

i Exchange of assets with related organization(s) ............................

j Lease of facilities, equipment, or other assets to related organization(s) .......................

k Lease of facilities, equipment, or other assets from related organization(s) ......................

l Performance of services or membership or fundraising solicitations for related organization(s) .....................

m Performance of services or membership or fundraising solicitations by related organization(s) .................

n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) ...................

o Sharing of paid employees with related organization(s) ............................

p Reimbursement paid to related organization(s) for expenses ............................

Yes

q Reimbursement paid by related organization(s) for expenses ............................

Yes

r Other transfer of cash or property to related organization(s) ............................

Yes

s Other transfer of cash or property from related organization(s) ............................

Yes

If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.

(a) Name of related organization	(b) Transaction type (a-s)	(c) Amount involved	(d) Method of determining amount involved

Schedule R (Form 990) 2021

Page 4

Part VI

Unrelated Organizations Taxable as a Partnership. Complete if the organization answered "Yes" on Form 990, Part IV, line 37.

Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.

(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(e) Are all partners section 501(c)(3) organizations?		(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?		(k) Percentage ownership
(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	Yes	No	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No	(k) Percentage ownership

Schedule R (Form 990) 2021

Page 5

Part VII

Supplemental Information

Provide additional information for responses to questions on Schedule R. See instructions.

Return Reference	Explanation

Schedule R (Form 990) 2021

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: TO PROVIDE QUALITY COMPASSIONATE HEALTH CARE AND COMMUNITY-BASED SERVICES THAT SEEK TO IMPROVE THE HEALTH OF THE COMMUNITY.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	6
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	4
5	Total number of individuals employed in calendar year 2021 (Part V, line 2a) ......	5	509
6	Total number of volunteers (estimate if necessary) .............	6	4
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	0
b	Net unrelated business taxable income from Form 990-T, Part I, line 11 .........	7b	0

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	7,372,082	592,277
9	Program service revenue (Part VIII, line 2g) .........	30,060,071	21,402,433
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	-3,228,000	-337,361
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	673,012	1,583,747
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	34,877,165	23,241,096
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	0	0
14	Benefits paid to or for members (Part IX, column (A), line 4).....	0	0
15	Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10)	33,309,634	17,971,908
16a	Professional fundraising fees (Part IX, column (A), line 11e) .....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 0
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	29,840,636	16,116,499
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	63,150,270	34,088,407
19	Revenue less expenses. Subtract line 18 from line 12.......	-28,273,105	-10,847,311
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	110,112,234	106,741,883
21	Total liabilities (Part X, line 26).............	99,061,699	90,324,904
22	Net assets or fund balances. Subtract line 21 from line 20.....	11,050,535	16,416,979

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 24,876,571 including grants of $ 0 ) (Revenue $ 22,906,691 )
	SEE SCHEDULE O.

4b	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4c	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4d	Other program services (Describe in Schedule O.)
	(Expenses $ including grants of $ ) (Revenue $ )
4e	Total program service expenses24,876,571

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	2,519,824	7,756,635	964,714

(A) Name and title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)	(D) Reportable compensation from the organization (W-2/1099-MISC/1099-NEC)	(E) Reportable compensation from related organizations (W-2/1099-MISC/1099-NEC)	(F) Estimated amount of other compensation from the organization and related organizations
(A) Name and title
(18) Venroy July........................................................................ DIRECTOR	1.0 .......................0.0	X	0	0	0

1a	Federated campaigns..		1a
b	Membership dues..		1b
c	Fundraising events..		1c
d	Related organizations		1d	16,941
e	Government grants (contributions)		1e

f	All other contributions, gifts, grants, and similar amounts not included above		1f	575,336

g	Noncash contributions included in lines 1a - 1f:$		1g

h Total. Add lines 1a-1f.......		592,277

		Business Code
2a	PATIENT SERVICE REVENUE	621110	21,402,433	21,402,433
b
c
d
e
f	All other program service revenue.
g	Total. Add lines 2a–2f .....		21,402,433

3 Investment income (including dividends, interest, and othersimilar amounts) ......			0
4 Income from investment of tax-exempt bond proceeds			0
5 Royalties...........			0
		(ii) Personal	(i) Real
6a	Gross rents		79,489	6a
b	Less: rental expenses			6b
c	Rental income or (loss)	0	79,489	6c
d	Net rental income or (loss).......			79,489		0	79,489
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory	221,247		7a
b	Less: cost or other basis and sales expenses	558,608		7b
c	Gain or (loss)	-337,361		7c
d	Net gain or (loss).........			-337,361			-337,361
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ....
			8a	0
b	Less: direct expenses ...		8b	0
c	Net income or (loss) from fundraising events..			0
9a	Gross income from gaming activities. See Part IV, line 19 ...
			9a	0
b	Less: direct expenses ...		9b	0
c	Net income or (loss) from gaming activities..			0
10a	Gross sales of inventory, less returns and allowances ..
			10a	0
b	Less: cost of goods sold ..		10b	0
c	Net income or (loss) from sales of inventory..			0
Business Code			Miscellaneous Revenue
11a	340B PHARMACY		446110	284,291	284,291
b	MISCELLANEOUS REVENUE		900099	261,264	261,264
c	FMF ALLOCATION		900099	958,703	958,703
d	All other revenue ....
e	Total. Add lines 11a–11d ......			1,504,258
12	Total revenue. See instructions.....			23,241,096	22,906,691	0	-257,872

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21 ....	0
2	Grants and other assistance to domestic individuals. See Part IV, line 22 ...........	0
3	Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See Part IV, lines 15 and 16. .............	0
4	Benefits paid to or for members .......	0
5	Compensation of current officers, directors, trustees, and key employees ...........	1,028,023	750,457	277,566
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .........	0
7	Other salaries and wages........	13,860,035	11,025,972	2,834,063
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	207,335	164,002	43,333
9	Other employee benefits .......	1,649,005	1,304,360	344,645
10	Payroll taxes ...........	1,227,510	970,958	256,552
11	Fees for services (non-employees):
a	Management ......	0
b	Legal .........	0
c	Accounting ...........	0
d	Lobbying ...........	0
e	Professional fundraising services. See Part IV, line 17	0
f	Investment management fees ......	0
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	6,189,391	4,075,307	2,114,084	0
12	Advertising and promotion ....	43,960	4,457	39,503
13	Office expenses .......	815,526	96,187	719,339
14	Information technology ......	0
15	Royalties ..	0
16	Occupancy ...........	1,507,863	1,163,713	344,150
17	Travel ............	6,203	6,023	180
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .	0
19	Conferences, conventions, and meetings ....	21,265	9,073	12,192
20	Interest ...........	520,841		520,841
21	Payments to affiliates .......	0
22	Depreciation, depletion, and amortization ..	3,754,920	2,564,892	1,190,028
23	Insurance ...	0
24	Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a	SUPPLIES	3,162,197	2,735,393	426,804	0
b	DUES/MEMBERSHIP	29,044	5,777	23,267	0
c	BANK FEES	65,289	0	65,289	0
d
e	All other expenses
25	Total functional expenses. Add lines 1 through 24e	34,088,407	24,876,571	9,211,836	0
26	Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here if following SOP 98-2 (ASC 958-720).

1	Cash–non-interest-bearing ........			4,937,438	1	14,806,327
2	Savings and temporary cash investments .........			0	2	0
3	Pledges and grants receivable, net ......			0	3	0
4	Accounts receivable, net .............			5,617,153	4	4,476,620
5	Loans and other receivables from any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .......
				0	5	0
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), and persons described in section 4958(c)(3)(B) ...
				0	6	0
7	Notes and loans receivable, net ...........			750	7	750
8	Inventories for sale or use ............			883,667	8	372,152
9	Prepaid expenses and deferred charges ......			166,744	9	67,360
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	120,604,506
b	Less: accumulated depreciation	10b	65,429,403	53,164,419	10c	55,175,103
11	Investments—publicly traded securities .			0	11	0
12	Investments—other securities. See Part IV, line 11 .....			0	12	0
13	Investments—program-related. See Part IV, line 11 ..			0	13	0
14	Intangible assets ...............			0	14	0
15	Other assets. See Part IV, line 11 ...........			45,342,063	15	31,843,571
16	Total assets. Add lines 1 through 15 (must equal line 33)...			110,112,234	16	106,741,883

17	Accounts payable and accrued expenses .....	14,407,101	17	6,290,353
18	Grants payable ...	0	18	0
19	Deferred revenue .........	11,331,431	19	7,650,540
20	Tax-exempt bond liabilities .........	0	20	0
21	Escrow or custodial account liability. Complete Part IV of Schedule D	0	21	0
22	Loans and other payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .........
		0	22	0
23	Secured mortgages and notes payable to unrelated third parties ..	42,717,576	23	35,582,745
24	Unsecured notes and loans payable to unrelated third parties ..	0	24	0
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17 - 24). Complete Part X of Schedule D	30,605,591	25	40,801,266
26	Total liabilities. Add lines 17 through 25..	99,061,699	26	90,324,904

	Organizations that follow FASB ASC 958, check here and complete lines 27, 28, 32, and 33.
27	Net assets without donor restrictions ..........	10,897,684	27	15,989,346
28	Net assets with donor restrictions ...........	152,851	28	427,633
	Organizations that do not follow FASB ASC 958, check here and complete lines 29 through 33.
29	Capital stock or trust principal, or current funds .....		29
30	Paid-in or capital surplus, or land, building or equipment fund ...		30
31	Retained earnings, endowment, accumulated income, or other funds		31
32	Total net assets or fund balances ...........	11,050,535	32	16,416,979
33	Total liabilities and net assets/fund balances ........	110,112,234	33	106,741,883