The Social and Economic Contribution of LifeBridge Health to the Maryland and Baltimore Regional Economy

The Scial and Ecnmic Cntributin f LifeBridge Health t the Maryland and Baltimre Reginal Ecnmy Richard Clinch DIRECTOR, THE JACOB FRANCE INSTITUTE

Executive Summary LifeBridge Health is nt-fr-prfit, reginal health care system serving the greater Baltimre regin cnsisting f fur hspitals, Sinai Hspital f Baltimre, Nrthwest Hspital, Carrll Hspital, Levindale Hebrew Geriatric Center and Hspital, as well as numerus subsidiaries and affiliated units, including LifeBridge Health & Fitness and the LifeBridge Medical Care Centers in Eldersburg, Mays Chapel and Reisterstwn. LifeBridge Health s missin is t maintain and imprve the health and well-being f all peple in greater Baltimre, with a special emphasis n nrthwest Baltimre City and Baltimre and Carrll cunties. LifeBridge Health is bth an imprtant prvider f health care services and a majr surce f ecnmic activity. With FY2015 revenues f $1.2 billin and mre than 10,000 emplyees, LifeBridge Health system is an imprtant surce f ecnmic activity in the State, in the regin and in the cmmunities it serves. Mst imprtantly, with 39,106 in-patient, 1,270 subacute, and 70 nursing hme admissins in FY2015, LifeBridge plays an imprtant rle in the regin s healthcare delivery system. 1 While LifeBridge Health s cre missin is t prvide tp quality medical and health related services, it als prvides many ther benefits t the regin s ppulatin and ecnmy. LifeBridge Health retained the Jacb France Institute f the University f Baltimre t assess and describe the health system s cntributin t the State and reginal ecnmy, its ecnmic imprtance t the cre neighbrhds in Baltimre City and Baltimre Cunty in which it perates, and its brader impact n the cmmunity thrugh the delivery f healthcare and related cmmunity, educatinal and ecnmic develpment services. This reprt is the secnd f tw reprts and assesses the ecnmic cntributin made by LifeBridge Health t: the State f Maryland; t the City/Cunties; and t the eight Baltimre City/Cunty neighbrhds 2 in which its cre peratins are lcated. This reprt als describes the brader scial impacts f the health system. An verview f the State and City/Cunty ecnmic and fiscal benefits generated by LifeBridge Health are as fllws: LifeBridge Health generates widespread ecnmic impacts thrugh its purchases f gds, services, and labr and generated $2.6 billin in ecnmic activity in the Maryland ecnmy, supprted 18,372 jbs earning $1.2 billin in labr incme, and generated $109.0 millin in State and lcal gvernment revenues (Table ES-1); 3 and LifeBridge Health makes significant cntributins t City/Cunty ecnmies acrss the state. In FY2015 12,981 persns wrked fr the hspital system earning ver $650 millin in salaries, wages and benefits, with 94 percent f wrkers residing in and 93 percent f wages paid t residents f Maryland. In FY2015, LifeBridge Health spent $573 millin n purchases f gds and services, with half f suppliers lcated in and 39 percent f purchases made in Maryland. 1 Revenue and peratinal data are fr Fiscal 2015, which runs frm July 1, 2015 thrugh June 30 th, 2015. LifeBridge Health sld its 151-bed Curtland Gardens Nursing & Rehabilitatin Center in Nvember f 2014 and n April 1, 2015 Carrll Hspital became a subsidiary f LifeBridge Health. As a result the admissins data include data fr April thrugh June f 2014 data fr Curtland Gardens Nursing & Rehabilitatin Center and fr July thrugh September f 2015 fr Carrll Hspital. 2 Fr the purpses f this analysis neighbrhds are defined as the zip cdes neighbring and in which Levindale, Nrthwest and Sinai Hspitals are lcated because this is the lwest level f gegraphy fr which the IMPLAN input-utput mdel (described belw) is available. 3 Fr the purpses f the ecnmic impact analysis the gal was t measure the ecnmic activity assciated with LifeBridge Health System as it exists tday. Thus, the impacts assciated with Curtland Gardens Nursing & Rehabilitatin Center were nt included since LifeBridge has sld that peratin and the estimated annual revenue and spending assciated with Carrll Cunty Hspital were included fr the entire fiscal year. This was estimated based n the ne quarter f data available fr this analysis. Thus, these figures are higher than the actual revenue figures presented abve. LifeBridge Health system s revenues, emplyment and wages nt assciated with a specific hspital were allcated t each hspital based n their share f revenues.

Table ES-1: Ecnmic Impact f LifeBridge Health System 1 2 n Maryland - Fiscal 2015 3 Direct Impact Revenues Output Ttal Ecnmic Activity Labr Incme Emplyment (Jbs) State/Lcal Tax Revenue Ttal LifeBridge Health System $1,404.5 $2,624.0 $1,193.3 18,372 $109.0 Sinai Hspital $797.5 $1,485.3 $670.9 9,906 $61.3 Nrthwest Hspital $255.9 $481.7 $223.8 3,340 $20.3 Carrll Hspital 1 $263.9 $483.7 $208.7 3,577 $19.4 Levindale $81.4 $160.9 $84.3 1,368 $7.4 LifeBridge Health and Fitness $5.9 $12.3 $5.6 181 $0.7 (1) Carrll Cunty Hspital was nly Part f LifeBridge fr the furth quarter f FY 2015. N data were available fr the full fiscal year - s data were estimated based n ne quarter's perating infrmatin. (2) LifeBridge System revenues, emplyment and wages nt assciated with a specific hspital were allcated t each hspital based n their share f revenues. (3) FY2015 is July 1, 2014 t June 30th 2015 Individual analyses were cnducted fr each f LifeBridge Health s fur hspitals as well as fr LifeBridge Health and Fitness t assess the impact f each n the City/Cunty in which they perate. These analyses fund that: Sinai Hspital directly generates $797.5 millin in revenues and emplys 5,229 wrkers. When multiplier effects are included, Sinai Hspital generated $1.2 billin in ecnmic activity in the Baltimre City ecnmy, supprted 7,864 jbs earning $590.6 millin in labr incme, and generated $36.4 millin in State and City gvernment revenues; Nrthwest Hspital directly generates $255.9 millin in revenues and emplys 1,804 wrkers. When multiplier effects are included, Nrthwest Hspital generated $438.4 millin in ecnmic activity in the Baltimre Cunty ecnmy, supprted 3,218 jbs earning $209.0 millin in labr incme, and generated $18.2 millin in State and Cunty gvernment revenues; Carrll Hspital directly generates $263.9 millin in revenues and emplys 2,084 wrkers. When multiplier effects are included, Carrll Hspital generated $389.3 millin in ecnmic activity in the Carrll Cunty ecnmy, supprted 3,233 jbs earning $170.0 millin in labr incme, and generated $15.6 millin in State and Cunty gvernment revenues; Levindale Hspital directly generates $81.4 millin in revenues and emplys 825 wrkers. When multiplier effects are included, Levindale Hspital generated $128.3 millin in ecnmic activity in the Baltimre City ecnmy, supprted 1,126 jbs earning $74.7 millin in labr incme, and generated $4.3 millin in State and City gvernment revenues; and LifeBridge Health and Fitness directly generates $5.9 millin in revenues and emplys 140 wrkers. When multiplier effects are included, LifeBridge Health and Fitness generated $11.2 millin in ecnmic activity in the Baltimre Cunty ecnmy, supprted 178 jbs earning $5.2 millin in labr incme, and generated $0.6 millin in State and City/Cunty gvernment revenues. An verall analysis was cnducted fr LifeBridge Health system s ttal spending as well as individual analyses fr Levindale, Nrthwest, and Sinai Hspitals n the eight neighbrhds in which they are lcated. These analyses fund that: Nt nly des LifeBridge Health make imprtant cntributins t the State and City/Cunty ecnmies in which it is lcated, it als makes critical cntributins t the neighbrhds in E-2

which it perates thrugh bth the payrlls paid t neighbrhd residents as well as thrugh the purchases made frm suppliers lcated in each neighbrhd. Overall, LifeBridge Health emplys 3,454 persns earning $159.3 millin in salaries and wages and makes $22.4 millin in purchases in the eight targeted Baltimre City and Cunty neighbrhds analyzed. These payrlls and purchases make LifeBridge Health a key ecnmic driver as well as the majr surce f health care services in these cmmunities; and Overall, the $181.7 millin in payrlls and purchases supprts $168.6 millin in ecnmic activity in these eight Baltimre City/Cunty neighbrhds and supprts 1,134 jbs earning $57.4 millin in labr incme in these cmmunities. These activities generate a ttal f $10.2 millin in aggregate State and Lcal Gvernment revenues with an estimated $5.6 millin in State f Maryland revenues and $4.6 millin in City/Cunty gvernment revenues. 4 In additin t the ecnmic and fiscal impact analyses cnducted at the State, City/Cunty, and neighbrhd levels, the Jacb France Institute als prepared an analysis f the varius scial benefits accruing t the cmmunities served by LifeBridge Health, with a fcus n health care, cmmunity service, educatinal and ecnmic develpment prgrams. Sme f the key findings f this analysis are as fllws: LifeBridge Health plays its greatest rle in the cmmunities served thrugh its prvisin f tp quality health care services. As a natinally ranked medical system, LifeBridge Health s cre missin is t maintain and imprve the health and well-being f all peple in greater Baltimre thrugh the delivery f high quality health and medical care. With 40,446 admissins, 242,749 patient days, 65,789 nursing hme patient days and 135,960 utpatient visits, LifeBridge Health is a cre cmpnent f the regin s health care system. The quality f these services are evident in the fact that Sinai Hspital is ranked as the 9 th best hspital in Maryland by U.S. News and Wrld Reprt and that tw f LifeBridge Health s fur cmpnent hspitals (Sinai and Carrll) are amng the tp twelve hspitals in Maryland that received the highest patient apprval ratings in the Maryland Health Care Quality Reprt System; LifeBridge Health reprts $82.0 millin in cmmunity benefits, including $33.9 millin in Missin Driven Health Care Services; $24.1 millin in Health Prfessins Educatin and $9.6 millin in Charity Care; All f LifeBridge Health s hspitals ffer a variety f cmmunity health and cmmunity service prgrams that cntribute t the health and wellbeing f the cmmunities served; LifeBridge Health supprts ecnmic develpment in Maryland and the Baltimre regin thrugh the $1.3 millin in research it cnducts, thrugh the 77 active clinical trials underway, and thrugh the peratin f the LifeBridge BiIncubatr, Maryland s nly hspital-based incubatr; and LifeBridge Health, with the regin s third largest teaching hspital, plays an imprtant rle in training healthcare prfessinals. In the area f Graduate Medical Educatin, LifeBridge hsts 136 medical residents and 17 fellws and the health system plays an active rle in nursing training. Cnclusin -- LifeBridge Health makes imprtant cntributins t the ecnmic health and cmmunity wellbeing f the State f Maryland and the cmmunities it serves 4 The IMPLAN mdel used estimates ttal cmbined state and lcal revenues frm a variety f majr revenue surces, including incme, prperty and sales taxes and ther revenues. The Jacb France Institute distributed these IMPLAN estimated cmbined state and lcal revenues int their separate state and lcal revenue cmpnents based n the distributin f state versus lcal revenues derived by each majr revenue surce frm the U.S. Bureau f the Census State and Lcal Gvernment Finances Summary: 2013 reprt. Because several f the zip cdes crss the City/Cunty bundary it is nt pssible t break these ut int their estimated City/Cunty prtins. E-3

Table f Cntents Executive Summary... 1 Intrductin... 1 LifeBridge Health s Operatins... 1 Ecnmic Cntributin f LifeBridge Health s Operatins n the State f Maryland... 4 Ecnmic Cntributin f LifeBridge Health s Operatins t Baltimre City, Baltimre Cunty, and Carrll Cunty... 9 Sinai Hspital... 9 Nrthwest Hspital... 10 Carrll Hspital... 10 Levindale... 11 LifeBridge Health and Fitness... 12 Ecnmic Cntributin f LifeBridge Health s Operatins n Eight Targeted Baltimre City and Baltimre Cunty Neighbrhds... 13 Scial and Cmmunity Impacts f LifeBridge Health System... 19 Health Care Service Delivery... 19 Cmmunity Benefits, Charitable and Uncmpensated Care... 22 Research Discvery, Innvatin, and Cmmercializatin... 28 Wrkfrce Develpment and Graduate Medical Educatin... 31 In Cnclusin... 33 Appendix A- Ecnmic Activity Analysis Methdlgy and Terms... 34 Appendix B- Hspital Ecnmic Activity Summaries... 35

Intrductin LifeBridge Health s Operatins LifeBridge Health cnsists f Sinai Hspital f Baltimre, Nrthwest Hspital, Levindale Hebrew Geriatric Center and Hspital, Carrll Hspital, LifeBridge Health and Fitness, and ther subsidiaries and affiliates. As ne f the largest, mst cmprehensive and mst highly respected prviders f health-related services in the Baltimre regin, LifeBridge Health has the technlgy, skills and expertise f an academic system while still prviding care that is warm and persnal. Invlving patients and their family members as partners in care, LifeBridge Health ffers cmprehensive treatment, preventive and wellness services. In additin, LifeBridge Health prvides prgrams t educate and supprt the cmmunities it serves. With peratins acrss the Baltimre Metrplitan Area, LifeBridge Health is ne f the regin s largest emplyers with Fiscal Year 2015 (FY2015) revenues f $1.2 billin and 2,706 affiliated physicians and 10,120 emplyees. In FY2015, LifeBridge expanded its peratins by frmally affiliating with Carrll Hspital Center, increasing bth its service area and peratinal base. While LifeBridge s missin is t maintain and imprve the health and well-being f all peple in greater Baltimre thrugh the delivery f high quality health and medical care, it als prvides numerus ther scietal benefits. Ecnmically, LifeBridge Health is a majr emplyer, prviding jbs fr 10,120 persns acrss a brad range f healthcare, research, and educatinal psitins. LifeBridge Health has a brad and significant impact n the reginal ecnmy, generating widespread ecnmic impact thrugh its purchases f gds, services, and labr. Selected peratinal characteristics f LifeBridge Health are presented in Table 1, and include the fllwing: In FY2015, LifeBridge Health had $1.2 billin in revenues and emplyed 10,120 wrkers; In FY2015 LifeBridge Health had 39,106 in-patient, 1,270 subacute, and 70 nursing hme admissins; and In FY2015 LifeBridge Health had 215,565 in-patient days, 27,184 subacute patient days, 65,789 nursing hme patient days and 135,960 ut-patient visits. 5 In rder t quantify and describe the imprtant ecnmic and scietal rles played by LifeBridge Health in Maryland and in the Baltimre regin it serves, it retained the Jacb France Institute t prepare this ecnmic and scial impact analysis reprt. The Jacb France Institute is the spnsred research prgram f the Merrick Schl f Business at the University f Baltimre and has cnsiderable experience in evaluating the impact f health care, educatin, and research institutins in Maryland and acrss the natin. In this evaluatin f the ecnmic cntributins made by LifeBridge Health n the State, City/Cunty and neighbrhd ecnmies it serves, the Jacb France Institute emplyed input/utput (I/O) analysis t measure the direct, indirect, and induced ecnmic impacts f the peratins f LifeBridge Health n the State f Maryland, n each f the three City/Cunties and eight Baltimre City/Cunty neighbrhds in which its cre peratins are lcated. Fr a mre detailed descriptin f the methdlgy and terms used in this analysis, please reference the Methdlgy Sectin in Appendix A. 5 Data fr FY2015 include nly partial data fr Carrll Hspital, which jined the system fr the year, and als fr Curtland Gardens Nursing & Rehabilitatin Center, which the system sld during the fiscal year. 1

Table 1: LifeBridge Health - Operatinal Characteristics LifeBridge Health and Fitness Curtland 2 Ttal LifeBridge System Sinai Hspital Nrthwest Hspital Carrll Hspital 1 Levindale Other Operatins Revenues and Emplyment Revenues (Mil. $) $728.0 $233.6 $64.4 $74.3 $5.4 $2.0 $105.6 $1,213.2 Expenses (Mil. $) $690.5 $217.2 $60.1 $72.5 $5.6 $2.8 $113.8 $1,162.5 Emplyment (Ttal) 4,645 1,616 2,032 765 136 38 888 10,120 Salaries, Wages and Benefits (Mil. $) 312.1 107.0 29.7 44.5 2.7 1.6 164.7 662.3 Selected Operatinal Infrmatin In-Patient Admissins 24,342 10,430 3,022 1,312 39,106 Sub-Acute Admissins 805 465 1,270 Nursing Hme Admissins 36 34 70 In-Patient Days 121,536 50,085 9,432 34,512 215,565 Sub-Acute-Patient Days 12,217 14,967 27,184 Nursing Hme-Patient Days 57,838 7,951 65,789 Observatin Cases 2,872 3,549 951 7,372 Out-Patient Visits (Clinic) 98,973 30,738 6,249 135,960 (1) Three Mnths - April-June 2015 (2) Three Mnths - July- September 2014 Surce: LifeBridge Health 2

LifeBridge Health makes significant cntributins acrss the State f Maryland. While LifeBridge Health s cre peratins are cncentrated in Baltimre City, Baltimre Cunty, and Carrll Cunty, the health system cntributes t the ecnmic health and vitality f jurisdictins acrss the State thrugh payments made t wrkers and suppliers thrughut the Baltimre regin and State f Maryland. As presented in Chart 1 and Table 2: In FY2015 12,981 6 persns wrked fr the hspital earning ver $650 millin in salaries, wages and benefits, with: 94 percent f these wrkers residing in Maryland and 90 percent residing in the Baltimre regin; 93 percent f salaries and wages paid t Maryland residents and 89 percent paid t residents f the Baltimre Regin; In FY2015, LifeBridge Health spent $573 millin n purchases f gds and services, with: Half f suppliers lcated in Maryland and 31 percent lcated in the Baltimre Regin; and 39 percent f purchases made in Maryland and 36 percent made in the Baltimre regin. Chart 1: LifeBridge Health In-State and In-Regin Share f Emplyment, Wages, Suppliers and Purchases Surce: LifeBridge Health In rder t estimate the ecnmic cntributin f LifeBridge Health t the State f Maryland and the cre cunties and neighbrhds in which it perates, the Jacb France Institute used the IMPLAN input/utput (I/O) mdel. I/O mdels measure the interrelatinships amng ecnmic sectrs t shw the flw f cmmdities t industries between prducers and cnsumers fr any given regin. The data als shw cnsumptin activities by wrkers, wners f capital, and imprts frm utside the regin. These trade flws built int the mdel permit estimating the impacts f ne sectr r activity n ther sectrs and the ecnmy as a whle. The Jacb France Institute used the IMPLAN mdel fr the State f 6 This emplyment number is different frm the emplyment levels in Table 1 because in includes persns wh entered r exited emplyment at the Health System during the fiscal year. 3

Maryland, fr the tw cunties and Baltimre City, and fr the eight neighbrhds analyzed fr the ecnmic analysis presented belw. 7 Table 2: LifeBridge Health Emplyment and Prcurement by Cunty Fiscal 2015 Emplyment and Wages Suppliers and Purchases # f Emplyees Wages $s # f Suppliers Purchases ($s) Ttal 12,981 $651,593,022 9,126 $573,398,035 Anne Arundel Cunty 363 $16,930,605 190 $4,590,933 Baltimre Cunty 5,020 $273,669,019 1,634 $96,428,146 Carrll Cunty 2,221 $113,296,483 506 $8,415,728 Cecil Cunty 13 $643,558 10 $110,970 Frederick Cunty 195 $8,019,375 89 $5,807,250 Harfrd Cunty 414 $24,080,815 113 $3,103,662 Hward Cunty 595 $50,399,369 276 $8,296,726 Mntgmery Cunty 128 $10,046,120 1,527 $8,738,987 Prince Gerge's Cunty 106 $5,251,259 146 $2,974,501 Baltimre City 3,065 $103,247,051 69 $84,273,863 Other Maryland 52 $2,903,827 0 $0 Out f State 809 $43,105,540 4,566 $350,657,269 Surce: LifeBridge Health Ecnmic Cntributin f LifeBridge Health s Operatins n the State f Maryland LifeBridge Health had ttal estimated direct impacts (revenues) f $1.4 billin 8 in FY2015. As presented in Table 3, these revenues generated $2.6 billin in ecnmic activity in the Maryland ecnmy, amunting t an utput multiplier f 1.87, r $1.87 in ecnmic activity supprted fr each $1 in revenue. LifeBridge s direct emplyment f 10,082 is supplemented with an additinal 3,336 Indirect Impact jbs frm the lcal purchases f gds and services t supprt LifeBridge s peratins and 4,953 Induced Impact jbs attributable t the increase in lcal incmes frm LifeBridge s peratins fr a ttal f 18,372 jbs directly r indirectly supprted by LifeBridge Health. These 18,372 jbs accunt fr 0.5 percent f the ttal Maryland emplyment. There is a ttal f $1.2 billin in labr incme assciated with the jbs supprted by LifeBridge s peratins and estimated state and lcal gvernment revenues f $109.0 millin. 7 This analysis des nt assess the extent t which LifeBridge Health cmpetes with r substitutes fr ther hspital and health carerelated activity in Maryland r the Baltimre Metrplitan area and, as a result, this analysis measures the relatinship between LifeBridge Health and the larger Maryland, City/Cunty and neighbrhd ecnmies analyzed. This analysis emplys a similar methdlgy t that used in The Ecnmic Impact f the Academic Medical Infrastructure n New Yrk State and the New Yrk City Metrplitan Regin reprt prduced by the Greater New Yrk Hspital Assciatin in 1999. Thus, this reprt estimates the ecnmic activity ccurring in the areas studied, nt the true ecnmic impacts f these activities. Please nte that thrughut this reprt ttals may nt sum due t runding. 8 As described in Nte 3 (abve) the gal f this analysis was t measure the ecnmic activity assciated with LifeBridge Health System as it exists tday. Thus, the estimated direct impacts f LifeBridge Health used are different than the revenue figure in Table 2 because they exclude Curtland Gardens Nursing & Rehabilitatin Center and include the estimated annual revenue and spending assciated with Carrll Cunty Hspital fr the fiscal year. LifeBridge System revenues, emplyment and wages nt assciated with a specific hspital were allcated t each hspital and the Fitness Center based n each unit s share f revenues. 4

Table 3: Ecnmic Impact f LifeBridge Health System 1 2 n Maryland - Fiscal 2015 3 Output Labr Incme Emplyment State/Lcal Tax Revenue Direct Effect $1,404.5 $750.5 10,082 $38.7 Indirect Impacts $516.7 $202.6 3,336 $25.7 Induced Impacts $702.8 $240.2 4,953 $44.5 Ttal Impact $2,624.0 $1,193.3 18,372 $109.0 State Impact Multiplier 1.87 1.59 1.82 (1) Carrll Cunty Hspital was nly Part f LifeBridge fr the furth quarter f FY 2015. N data were available fr the full fiscal year - s data were estimated based n ne quarter's perating infrmatin. (2) LifeBridge System revenues, emplyment and wages nt assciated with a specific hspital were allcated t each hspital based n their share f revenues. (3) FY2015 is July 1, 2014 t June 30th 2015 Surce: JFI Calculatins Using the IMPLAN Mdel fr Maryland. In additin t its peratinal impacts, LifeBridge Health als cntributes t Maryland s ecnmic vitality thrugh its capital expenditures t imprve and expand its cre peratins. In FY2015, LifeBridge Health had ttal apprved capital spending f $107.5 millin, which increased Maryland ecnmic activity by $175.8 millin, supprted 938 jbs earning $64.3 millin in labr incme, and generated $6.8 millin in cmbined State and lcal gvernment revenues. Table 4: Ecnmic Impact f LifeBridge Health Capital Spending 1 n Maryland - Fiscal 2015 2 Output Labr Incme Emplyment State/Lcal Tax Revenue Direct Effect $107.5 $40.3 494 $2.3 Indirect Impacts $31.1 $11.1 181 $2.1 Induced Impacts $37.2 $12.9 263 $2.4 Ttal Impact $175.8 $64.3 938 $6.8 State Impact Multiplier 1.64 1.60 1.90 (1) Bard Apprved Capital Spending (2) FY2015 is July 1, 2014 t June 30th 2015 Surce: JFI Calculatins Using the IMPLAN Mdel fr Maryland. The Maryland ecnmic activity assciated with each f LifeBridge Health s cre peratins are presented in Table 5 thrugh Table 9 belw. A summary f the results f the state level ecnmic activity analysis assciated with each institutin is as fllws: Sinai Hspital directly generates $797.5 millin in revenues and emplys 5,229 wrkers. These direct impacts are augmented with $292.8 millin in ecnmic activity and 1,892 jbs in the frm f Indirect Impacts frm lcal purchases and $395.1 millin and 2,785 jbs in the frm f Induced Impacts frm the increase in husehld incmes assciated with the hspital fr a ttal State f Maryland impact f $1.5 billin in ecnmic activity, supprting 9,906 jbs earning $670.9 millin in labr incme, and generating $61.3 millin in State and lcal gvernment revenues (Table 5); 5

Nrthwest Hspital directly generates $255.9 millin in revenues and emplys 1,804 wrkers. These direct impacts are augmented with $94.0 millin in ecnmic activity and 607 jbs in the frm f Indirect Impacts frm lcal purchases and $131.8 millin and 929 jbs in the frm f Induced Impacts frm the increase in husehld incmes assciated with the hspital fr a ttal State f Maryland impact f $481.7 millin in ecnmic activity, supprting 3,340 jbs earning $223.8 millin in labr incme, and generating $20.3 millin in State and lcal gvernment revenues (Table 6); Carrll Hspital directly generates $263.9 millin in revenues and emplys 2,084 wrkers. These direct impacts are augmented with $96.9 millin in ecnmic activity and 626 jbs in the frm f Indirect Impacts frm lcal purchases and $122.9 millin and 866 jbs in the frm f Induced Impacts frm the increase in husehld incmes assciated with the hspital fr a ttal State f Maryland impact f $483.7 millin in ecnmic activity, supprting 3,577 jbs earning $208.7 millin in labr incme, and generating $19.4 millin in State and lcal gvernment revenues (Table 7); Levindale Hspital directly generates $81.4 millin in revenues and emplys 825 wrkers. These direct impacts are augmented with $29.9 millin in ecnmic activity and 193 jbs in the frm f Indirect Impacts frm lcal purchases and $49.6 millin and 350 jbs in the frm f Induced Impacts frm the increase in husehld incmes assciated with the hspital fr a ttal State f Maryland impact f $160.9 millin in ecnmic activity, supprting 1,368 jbs earning $84.3 millin in labr incme, and generating $7.4 millin in State and lcal gvernment revenues (Table 8); and LifeBridge Health and Fitness directly generates $5.9 millin in revenues and emplys 140 wrkers. These direct impacts are augmented with $3.2 millin in ecnmic activity and 17 jbs in the frm f Indirect Impacts frm lcal purchases and $3.3 millin and 23 jbs in the frm f Induced Impacts frm the increase in husehld incmes assciated with the fitness center fr a ttal State f Maryland impact f $12.3 millin in ecnmic activity, supprting 181 jbs earning $5.6 millin in labr incme, and generating $0.7 millin in State and lcal gvernment revenues (Table 9). Table 5: Ecnmic Impact f Sinai Hspital n Maryland - Fiscal 2015 1 Output Labr Incme Emplyment State/Lcal Tax Revenue Direct Effect $797.5 $420.9 5,229 $21.7 Indirect Impacts $292.8 $115.0 1,892 $14.6 Induced Impacts $395.1 $135.0 2,785 $25.0 Ttal Impact $1,485.3 $670.9 9,906 $61.3 State Impact Multiplier 1.86 1.59 1.89 (1) FY2015 is July 1, 2014 t June 30th 2015 Surce: JFI Calculatins Using the IMPLAN Mdel fr Maryland. 6

Table 6: Ecnmic Impact f Nrthwest Hspital n Maryland - Fiscal 2015 1 Output Labr Incme Emplyment State/Lcal Tax Revenue Direct Effect $255.9 $141.9 1,804 $7.2 Indirect Impacts $94.0 $36.9 607 $4.7 Induced Impacts $131.8 $45.1 929 $8.3 Ttal Impact $481.7 $223.8 3,340 $20.3 State Impact Multiplier 1.88 1.58 1.85 (1) FY2015 is July 1, 2014 t June 30th 2015 Surce: JFI Calculatins Using the IMPLAN Mdel fr Maryland. Table 7: Ecnmic Impact f Carrll Hspital 1 n Maryland - Fiscal 2015 2 Output Labr Incme Emplyment State/Lcal Tax Revenue Direct Effect $263.9 $128.7 2,084 $6.8 Indirect Impacts $96.9 $38.0 626 $4.8 Induced Impacts $122.9 $42.0 866 $7.8 Ttal Impact $483.7 $208.7 3,577 $19.4 State Impact Multiplier 1.83 1.62 1.72 (1) Carrll Cunty Hspital was nly Part f LifeBridge fr the furth quarter f FY 2105. N data were available fr the full fiscal year - s data were estimated based n ne quarter's perating infrmatin. (2) FY2015 is July 1, 2014 t June 30th 2015 Surce: JFI Calculatins Using the IMPLAN Mdel fr Maryland. Table 8: Ecnmic Impact f Levindale Hspital n Maryland - Fiscal 2015 1 Output Labr Incme Emplyment State/Lcal Tax Revenue Direct Effect $81.4 $55.6 825 $2.7 Indirect Impacts $29.9 $11.7 193 $1.5 Induced Impacts $49.6 $17.0 350 $3.1 Ttal Impact $160.9 $84.3 1,368 $7.4 State Impact Multiplier 1.98 1.52 1.66 Surce: JFI Calculatins Using the IMPLAN Mdel fr Maryland. 7

Table 9: Ecnmic Impact f LifeBridge Health and Fitness n Maryland - Fiscal 2015 1 Output Labr Incme Emplyment State/Lcal Tax Revenue Direct Effect $5.9 $3.5 140 $0.3 Indirect Impacts $3.2 $0.9 17 $0.1 Induced Impacts $3.3 $1.1 23 $0.2 Ttal Impact $12.3 $5.6 181 $0.7 State Impact Multiplier 2.10 1.58 1.29 Surce: JFI Calculatins Using the IMPLAN Mdel fr Maryland. 8

Ecnmic Cntributin f LifeBridge Health s Operatins t Baltimre City, Baltimre Cunty, and Carrll Cunty While the state level ecnmic activity assciated with LifeBridge Health is impressive, it is als imprtant t understand the impact f each f the health system s perating units n the City/Cunty in which they are lcated. In rder t estimate this, the Jacb France Institute als analyzed the ecnmic cntributin f each perating unit n the City r Cunty in which they are lcated using the IMPLAN mdel fr each jurisdictin. It is imprtant t nte that these ecnmic cntributin analyses are fr each f the fur hspitals and the fitness center alne. Because f crss-brder cmmuting and purchases, fr example emplyees cmmuting frm ne jurisdictin t a LifeBridge Health lcatin in anther jurisdictin r member hspitals making purchases frm suppliers lcated in ther jurisdictins, the impact f the verall LifeBridge Health system n each City/Cunty is likely t be higher. The ecnmic cntributin analyses presented belw represents the impact f each perating unit n the jurisdictin in which each is lcated. A descriptin f each f LifeBridge Health s fur hspitals and f LifeBridge Health and Fitness and their ecnmic cntributin t each f the jurisdictins in which they are lcated are described belw. Individual ne page summary impact analyses are presented fr each hspital in Appendix B. Sinai Hspital Sinai Hspital f Baltimre features renwned centers f excellence sme with natinal and internatinal acclaim. As the largest cmmunity hspital and the third largest teaching hspital in Maryland; Sinai Hspital s missin is t prvide quality patient care, educate medical students and residents, and engage in research t imprve the lives f peple all ver the wrld. Sinai Hspital is a 534 bed facility with 24,342 in-patient admissins, 121,536 in-patient days and 98,973 utpatient visits in FY2015. In terms f the hspital s impact n Baltimre City, Sinai Hspital directly generates $797.5 millin in revenues and emplys 5,229 wrkers. These direct impacts are augmented with $215.5 millin in ecnmic activity and 1,326 jbs in the frm f Indirect Impacts frm in-city purchases and $197.7 millin and 1,309 jbs in the frm f Induced Impacts frm the increase in husehld incmes assciated with the hspital fr a ttal Baltimre City impact f $1.2 billin in ecnmic activity, supprting 7,864 jbs earning $590.6 millin in labr incme, and generating $36.4 millin in State and Baltimre City gvernment revenues, including an estimated $15.3 millin in Baltimre City gvernment revenues. Table 10: Ecnmic Impact f Sinai Hspital n Baltimre City - Fiscal 2015 1 Output Labr Incme Emplyment State/Lcal Tax Revenue Direct Effect $797.5 $420.8 5,229 $16.2 Indirect Impacts $215.5 $96.3 1,326 $9.4 Induced Impacts $197.7 $73.5 1,309 $10.7 Ttal Impact $1,210.6 $590.6 7,864 $36.4 State Impact Multiplier 1.52 1.40 1.50 Surce: JFI Calculatins Using the IMPLAN Mdel fr Maryland. 9

Nrthwest Hspital Nrthwest Hspital, lcated in Randallstwn, Maryland, carries ut its visin t be the recgnized leader in clinical quality and custmer care in the nrthwest Baltimre metrplitan regin. Nrthwest Hspital s strng philsphy f patient-centered care is evident frm its friendly emplyee culture t its facility design. The hspital leads in surgical innvatin, has utpatient services that are highly acclaimed by patients and is hme t a cmpetent emergency department that expertly handles heavy vlumes. Nrthwest Hspital is a 272 bed facility with 10,430 in-patient admissins, 50,085 in-patient days and 30,738 utpatient visits in FY2015. In terms f the hspital s impact n Baltimre Cunty, Nrthwest Hspital directly generates $255.9 millin in revenues and emplys 1,804 wrkers. These direct impacts are augmented with $77.8 millin in ecnmic activity and 582 jbs in the frm f Indirect Impacts frm in-cunty purchases and $104.7 millin and 832 jbs in the frm f Induced Impacts frm the increase in husehld incmes assciated with the hspital fr a ttal Baltimre Cunty impact f $438.4 millin in ecnmic activity, supprting 3,218 jbs earning $209.0 millin in labr incme, and generating $18.2 millin in State and Baltimre Cunty gvernment revenues, including an estimated $7.8 millin in Baltimre Cunty gvernment revenues. Table 11: Ecnmic Impact f Nrthwest Hspital n Baltimre Cunty - Fiscal 2015 1 Output Labr Incme Emplyment State/Lcal Tax Revenue Direct Effect $255.9 $141.9 1,804 $7.2 Indirect Impacts $77.8 $30.3 582 $4.0 Induced Impacts $104.7 $36.7 832 $7.0 Ttal Impact $438.4 $209.0 3,218 $18.2 State Impact Multiplier 1.71 1.47 1.78 Surce: JFI Calculatins Using the IMPLAN Mdel fr Maryland. Carrll Hspital Carrll Hspital is a 193 bed nnprfit, acute care facility ffering the latest in medical technlgy, experienced medical prfessinals in a variety f specialties, and a cntinuum f prgrams and services t meet the needs f the cmmunity. Over the past five decades, Carrll Hspital has evlved significantly frm a cmmunity hspital t becme a true medical center n par with larger urban hspitals. Hwever, the hspital is still a tight-knit cmmunity where dctrs, nurses and staff members treat their friends, neighbrs and families. In terms f the hspital s impact n Carrll Cunty, Carrll Hspital directly generates $263.9 millin in revenues and emplys 2,084 wrkers. These direct impacts are augmented with $53.4 millin in ecnmic activity and 510 jbs in the frm f Indirect Impacts frm in-cunty purchases and $72.0 millin and 640 jbs in the frm f Induced Impacts frm the increase in husehld incmes assciated with the hspital fr a ttal Carrll Cunty impact f $389.3 millin in ecnmic activity, supprting 3,233 jbs earning $170.0 millin in labr incme, and generating $15.6 millin in State and Carrll Cunty gvernment revenues, with an estimated $6.8 millin in Carrll Cunty gvernment revenues. 10

Table 12: Ecnmic Impact f Carrll Hspital 1 n Carrll Cunty - Fiscal 2015 2 Output Labr Incme Emplyment State/Lcal Tax Revenue Direct Effect $263.9 $128.8 2,084 $6.6 Indirect Impacts $53.4 $18.9 510 $3.3 Induced Impacts $72.0 $22.4 640 $5.6 Ttal Impact $389.3 $170.0 3,233 $15.6 State Impact Multiplier 1.48 1.32 1.55 (1) Carrll Cunty Hspital was nly Part f LifeBridge fr the furth quarter f FY 2105. N data were available fr the full fiscal year - s data were estimated based n ne quarter's perating infrmatin. (2) FY2015 is July 1, 2014 t June 30th 2015 Surce: JFI Calculatins Using the IMPLAN Mdel fr Maryland. Levindale Levindale Hebrew Geriatric Center and Hspital has been carrying ut its visin fr nearly 125 years t prvide quality health care and frward lking prgrams fr peple wh are elderly and disabled. It was the first facility in Maryland t implement the Eden Alternative prgram fr elder care. This philsphy adds friendship, freedm and fun t the lives f residents and patients. Levindale Hebrew Geriatric Center and Hspital is a 330 bed facility with 210 nursing hme beds and 120 specialty hspital beds. In FT2015, the hspital had 1,777 in-patient admissins and 36 nursing hme admissins, 49,479 patient days and 57,838 nursing hme patient days. In terms f the hspital s impact n Baltimre City, Levindale Hspital directly generates $81.4 millin in revenues and emplys 825 wrkers. These direct impacts are augmented with $22.0 millin in ecnmic activity and 135 jbs in the frm f Indirect Impacts frm lcal purchases and $25.0 millin and 165 jbs in the frm f Induced Impacts frm the increase in husehld incmes assciated with the hspital fr a ttal Baltimre City impact f $128.3 millin in ecnmic activity, supprting 1,126 jbs earning $74.7 millin in labr incme, and generating $4.3 millin in State and Baltimre City gvernment revenues, including an estimated $1.8 millin in City gvernment revenues. Table 13: Ecnmic Impact f Levindale Hspital n Baltimre City - Fiscal 2015 1 Output Labr Incme Emplyment State/Lcal Tax Revenue Direct Effect $81.4 $55.6 825 $2.0 Indirect Impacts $22.0 $9.8 135 $1.0 Induced Impacts $25.0 $9.3 165 $1.4 Ttal Impact $128.3 $74.7 1,126 $4.3 State Impact Multiplier 1.58 1.34 1.36 (1) FY2015 is July 1, 2014 t June 30th 2015 Surce: JFI Calculatins Using the IMPLAN Mdel fr Maryland. 11

LifeBridge Health and Fitness LifeBridge Health and Fitness (LBHF) is a health and fitness center lcated in Pikesville, Maryland. LifeBridge Health and Fitness has wn numerus awards including being named a Tp 100 Club in the US, Baltimre s Best Place fr Yga and Pilates, and ranked in the tp 1% f all Health Clubs in America. Cnnected t the LifeBridge Reginal Health System, LifeBridge Health & Fitness ffers services, prducts, prgrams, equipment, and amenities with hspital-quality delivery and results. The facility ffers access t state-f-the-art equipment and prgrams and its fitness prfessinals guide members and guests f all fitness levels in their jurney t a healthy way f life. At almst 70,000 square feet, LBHF basts a vast cllectin f nly the best in state-f-the-art fitness services and equipment and prgrams in persnal training, grup exercise, Pilates, aquatics, cycling, yga and ther fitness areas. In terms f the Fitness Center s impact n Baltimre Cunty, LifeBridge Health and Fitness directly generates $5.9 millin in revenues and emplys 140 wrkers. These direct impacts are augmented with $2.8 millin in ecnmic activity and 17 jbs in the frm f Indirect Impacts frm lcal purchases and $2.6 millin and 21 jbs in the frm f Induced Impacts frm the increase in husehld incmes assciated with the fitness center fr a ttal Baltimre Cunty impact f $11.2 millin in ecnmic activity, supprting 178 jbs earning $5.2 millin in labr incme, and generating $0.6 millin in State and Baltimre Cunty gvernment revenues, including abut $267,000 in Cunty gvernment revenues. Table 14: Ecnmic Impact f LifeBridge Health and Fitness n Baltimre Cunty - Fiscal 2015 1 Output Labr Incme Emplyment State/Lcal Tax Revenue Direct Effect $5.9 $3.5 140 $0.3 Indirect Impacts $2.8 $0.8 17 $0.1 Induced Impacts $2.6 $0.9 21 $0.2 Ttal Impact $11.2 $5.2 178 $0.6 State Impact Multiplier 1.92 1.49 1.27 (1) FY2015 is July 1, 2014 t June 30th 2015 Surce: JFI Calculatins Using the IMPLAN Mdel fr Baltimre Cunty. 12

Ecnmic Cntributin f LifeBridge Health s Operatins n Eight Targeted Baltimre City and Baltimre Cunty Neighbrhds It is clear frm the State and Cunty/City level analyses abve that LifeBridge Health makes imprtant ecnmic cntributins t the State f Maryland and each f the three cre Cunty/City jurisdictins in which it perates. LifeBridge Health is als a key ecnmic driver f the Baltimre City and Cunty neighbrhds surrunding Levindale, Nrthwest and Sinai Hspitals. Because f the imprtant rle played by each f these institutins in the neighbrhds in which they are lcated, LifeBridge requested that the Jacb France Institute prepare an analysis f the ecnmic cntributin made by the verall health system and each f these three cre institutins n eight targeted Baltimre City and Cunty neighbrhds. 9 Sinai and Levindale Hspitals are especially imprtant t the Nrthwest Baltimre City cmmunities in which they are lcated as these neighbrhds have a higher level f pverty, at 26.3 percent, and lwer median husehld incme, at $34,968, than the City as a whle, with the verall City pverty rate being 24.2 percent and median City husehld incme being $41,819. 10 While the cmmunity in which Nrthwest Hspital is lcated is nt similarly distressed, the hspital is a cre driver f emplyment and ecnmic activity in that cmmunity. Each f these three institutins serve as anchr institutins fr their cmmunities, which the Initiative fr a Cmpetitive Inner City defines as institutins, universities, medical centers and cultural facilities, which spend billins n gds and services. As engines f lcal ecnmic grwth, anchrs play several distinct rles within their cmmunities, including purchaser, wrkfrce develper and cmmunity infrastructure builder. 11 Because these three anchr institutins frm a cluster f related health care services in these cmmunities, the Jacb France Institute prepared an analysis f the cntributin f the verall health system and f these three hspitals t an eight neighbrhd area in Baltimre City and Cunty. This neighbrhd level analysis estimates the ecnmic cntributin f the lcal purchases made by LifeBridge Health system and Levindale, Nrthwest and Sinai Hspitals frm suppliers lcated in and wages and salaries paid t residents f the eight zip cde area in Baltimre City and Cunty. The numbers presented belw represent the share f the ecnmic impacts described in the abve analyses attributable t LifeBridge Health, Levindale, Nrthwest and Sinai Hspital s spending in the eight zip cde area. LifeBridge Health and the three hspitals payrll and prcurement spending are presented in Table 15 and the ttal ecnmic activity in these City/Cunty neighbrhds supprted by the peratins f LifeBridge Health System the three hspitals analyzed are presented in Table 16. 12 LifeBridge Health emplys 3,454 persns and pays $159.3 millin t persns wh reside in and purchases $22.4 millin in gds and services frm suppliers lcated in the eight zip cde area. 9 As described abve in Nte 2, fr the purpses f this analysis neighbrhds are defined as the zip cdes adjacent t and in which Levindale, Nrthwest and Sinai Hspitals are lcated because this is the lwest level f gegraphy fr which the IMPLAN input-utput mdel (described belw) is available. 10 These data are frm the five year, 2010-14 U.S. Bureau f the Census American Cmmunity Survey (ACS) data. These data represent the average level ccurring fr each measure ver the five year data cllectin perid because this is the nly ACS data that is available at the zip cde level. 11 http://www.icic.rg/urban-ecnmic-develpment/insights-and-strategies. 12 In rder t evaluate the ecnmic cntributin f LifeBridge Health and the three individual hspitals n the eight zip cde City/Cunty regin, this analysis used an estimated bill f gds apprach t estimate ttal lcal spending and their assciated impacts. LifeBridge Health prvided data n ttal payrll paid t residents f and the ttal purchases made frm suppliers lcated in the eight zip cde area. The cmpsitin f lcal purchases was estimated based n the natinal average spending by hspitals and the cmpsitin f the lcal ecnmy. 13

Table 15: LifeBridge Health Neighbrhd Impacts - Emplyment, Payrll and Purchases by Zip cde Levindale Nrthwest Sinai Other 1 Ttal LifeBridge Health Emplyment and Payrll Emplyment Payrll ($s) Emplyment Payrll ($s) Emplyment Payrll ($s) Emplyment Payrll ($s) Emplyment Payrll ($s) 21117 - Baltimre Cunty 60 $2,483,627 200 $9,779,728 275 $20,445,333 83 $5,896,953 618 $38,605,640 21133 - Baltimre Cunty 37 $1,735,110 180 $7,034,280 130 $5,695,459 44 $896,419 391 $15,361,268 21207 - Bth Cunty and City 54 $1,835,293 116 $3,563,949 213 $7,409,214 57 $1,379,308 440 $14,187,764 21208 - Baltimre Cunty 43 $1,316,751 96 $4,184,379 204 $14,161,913 64 $4,456,704 407 $24,119,748 21209 - Bth Cunty and City 36 $1,663,614 49 $3,005,599 325 $22,489,254 47 $5,072,606 457 $32,231,074 21215 - Baltimre City 115 $3,537,982 68 $1,529,488 377 $11,385,551 44 $1,623,256 604 $18,076,277 21216 - Baltimre City 30 $950,521 29 $529,343 105 $2,773,806 17 $219,193 181 $4,472,863 21244 - Baltimre Cunty 40 $1,396,377 122 $3,781,328 160 $6,123,254 34 $921,445 356 $12,222,404 Ttal fr Eight Zip Cde Area 415 $14,919,276 860 $33,408,093 1789 $90,483,785 390 $20,465,883 3,454 $159,277,037 Levindale Nrthwest Sinai Other 1 Ttal LifeBridge Health Purchases # f Suppliers Prcurement ($s) # f Suppliers Prcurement ($s)# f Suppliers Prcurement ($s) # f Suppliers Prcurement ($s) # f Suppliers Prcurement ($s) 21117 - Baltimre Cunty 17 $416,498 42 $1,428,923 108 $3,142,276 5 $8,357 n.a $4,996,054 21133 - Baltimre Cunty 2 $2,696 17 $282,035 36 $47,215 2 $2,696 n.a $334,642 21207 - Bth Cunty and City 5 $4,958 6 $16,070 38 $69,803 8 $142,403 n.a $233,234 21208 - Baltimre Cunty 16 $60,407 25 $386,113 89 $8,948,830 16 $492,876 n.a $9,888,226 21209 - Bth Cunty and City 6 $89,999 7 $344,067 80 $2,529,332 8 $942,858 n.a $3,906,256 21215 - Baltimre City 12 $94,950 9 $201,983 152 $1,446,711 10 $188,358 n.a $1,932,002 21216 - Baltimre City 2 $1,282 1 $454 30 $169,766 0 $0 n.a $171,502 21244 - Baltimre Cunty 5 $17,793 8 $151,752 42 $760,633 1 $150 n.a $930,328 Ttal fr Eight Zip Cde Area 65 $688,583 115 $2,811,397 575 $17,114,566 50 $1,777,698 n.a $22,392,244 (1) Includes all LifeBridge Emplyees, Payrll and Purchases nt allcated t an individual hspital. Surce: LifeBridge Health 14

LifeBridge Health system s peratins supprt $168.6 millin in activity in the eight zip cde area analyzed; with an assciated 1,134 jbs earning a ttal f $57.4 millin in salaries and wages; and generated an estimated $10.2 in State and lcal gvernment revenues, including $4.6 millin in City/Cunty gvernment revenues. These figures represent the estimated prtin f the City/Cunty indirect and induced impacts described in the Baltimre Cunty/City impacts described abve that ccur in the target area. Table 16: LifeBridge Health System Neighbrhd (Zip Cde) Level Spending and Assciated Ecnmic Activity Payrll and Ecnmic Activity Prcurement Output Emplyment Labr State and Lcal Zip Cde Spending ($s) ($s) (Jbs) Incme ($s) Fiscal Impact ($s) Payrll and Prcurement Spending and Assciated Impacts 21117 - Baltimre Cunty $43,601,694 $18,631,488 110 $6,025,934 $1,213,058 21133 - Baltimre Cunty $15,695,910 $7,936,705 56 $2,661,695 $529,756 21207 - Bth Cunty and City $14,420,998 $6,909,973 48 $2,223,482 $423,337 21208 - Baltimre Cunty $34,007,974 $27,093,858 212 $9,703,796 $1,616,351 21209 - Bth Cunty and City $36,137,330 $18,608,119 124 $7,478,054 $1,101,000 21215 - Baltimre City $20,008,279 $14,580,521 99 $5,344,063 $828,733 21216 - Baltimre City $4,644,365 $1,634,534 10 $503,652 $115,545 21244 - Baltimre Cunty $13,152,732 $8,508,540 61 $2,646,910 $590,769 Inter Zip Cde Purchases n.m. $64,720,685 413 $20,836,892 $3,827,286 Ttal Cmmunity Activity $181,669,281 $168,624,423 1,134 $57,424,478 $10,245,835 Surce: JFI Calculatins Using the IMPLAN Mdel fr each zip cde and the aggregated area. As cre anchr institutins, LifeBridge Health and its cmpnent hspitals play a critical rle in each f these targeted neighbrhds. Including bth the direct emplyment f each f these three institutins in additin t the impacts assciated with lcal supplier purchases and resident payrll expenses, LifeBridge Health accunts fr 7 percent f ttal jbs lcated within the eight zip cde area. Lking at the zip cdes in which each institutin is lcated, LifeBridge Health generates 20 percent f all jbs ccurring in zip cde 21133 in Baltimre Cunty and 24 percent f jbs lcated in zip cde 21215 in Baltimre City (Table 17). Analyzing the place f residence fr LifeBridge Health emplyees nly, 13 LifeBridge Health emplyees accunt fr 2 percent f all emplyed wrkers in the eight zip cde area (Table 18). 13 It is nt pssible t identify the place f residence fr the wrkers whse jbs are supprted by the purchases made by (indirect effects) r payrlls paid by (induced effects) LifeBridge Health. 15

Table 17: LifeBridge Health System Neighbrhd (Zip Cde) Direct and Neighbrhd Impact Emplyment, by Place f Wrk Ttal Direct Spending Zip Cde LifeBridge Impact Ttal % f Zip Cde Emplyment 1 Emplyment 2 Emplyment 3 Emplyment Ttal Eight Target Zip Cdes 126,371 7,858 721 8,579 6.8% 21117 - Baltimre Cunty 8,621 110 110 1.3% 21133 - Baltimre Cunty 9,450 1,804 56 1,860 20% 21207 - Bth Cunty and City 11,962 48 48 0.4% 21208 - Baltimre Cunty 30,023 212 212 0.7% 21209 - Bth Cunty and City 13,451 124 124 0.9% 21215 - Baltimre City 25,688 6,054 99 6,153 24% 21216 - Baltimre City 2,769 10 10 0.4% 21244 - Baltimre Cunty 24,407 61 61 0.2% (1) Frm IMPLAN (2) Sinai and Levindale in Zip cde and Nrthwest Hspital in Zip cdes (3) Frm Neighbrhd impact analysis - Table 16 estimated impacts in each zip cde nly. Surce: JFI Calculatins Using the IMPLAN Mdel fr each zip cde and the aggregated area. Table 18: LifeBridge Health System Neighbrhd (Zip Cde) Emplyment by Place f Residence Ttal Direct Zip Cde LifeBridge % f Zip Cde Emplyment 1 Emplyment 2 Ttal Eight Target Zip Cdes 151,138 3,454 2.3% 21117 - Baltimre Cunty 31,481 618 2.0% 21133 - Baltimre Cunty 16,192 391 2.4% 21207 - Bth Cunty and City 22,119 440 2.0% 21208 - Baltimre Cunty 15,837 407 2.6% 21209 - Bth Cunty and City 14,306 457 3.2% 21215 - Baltimre City 22,780 604 2.7% 21216 - Baltimre City 9,896 181 1.8% 21244 - Baltimre Cunty 18,527 356 1.9% (1) Five Year Average 2009-2014 frm the U.S. Bureau f the Census - American Cmmunity Survey (2) Frm Table 15. Surce: JFI Calculatins Using the IMPLAN Mdel fr each zip cde and the aggregated area. Separate analyses were prepared fr the individual ecnmic activity generated by each f the three hspitals in the eight zip cde area. These analyses fund that: Levindale Hspital spends $15.6 millin n payrll and purchases in the eight zip cde area and these expenditures supprt $13.7 millin in ecnmic activity, with an assciated 93 jbs earning a ttal f $4.6 millin in salaries and wages and generated an estimated $0.9 millin in State and City gvernment revenues; Nrthwest Hspital spends $36.2 millin n payrll and purchases in the eight zip cde area and these expenditures supprt $32.5 millin in ecnmic activity, with an assciated 220 jbs earning a ttal f $11.0 millin in salaries and wages and generated an estimated $2.0 millin in State and Cunty gvernment revenues; and 16

Sinai Hspital spends $107.6 millin n payrll and purchases in the eight zip cde area and these expenditures supprt $102.4 millin in ecnmic activity, with an assciated 685 jbs earning a ttal f $35.0 millin in salaries and wages and generated an estimated $6.2 millin in State and City gvernment revenues. Table 19: Levindale Hspital Neighbrhd (Zip Cde) Level Spending and Assciated Ecnmic Activity Payrll and Ecnmic Activity Prcurement Output Emplyment Labr State and Lcal Zip Cde Spending ($s) ($s) (Jbs) Incme ($s) Fiscal Impact ($s) Payrll and Prcurement Spending and Assciated Impacts 21117 - Baltimre Cunty $2,900,125 $1,311,202 8 $430,487 $84,302 21133 - Baltimre Cunty $1,737,806 $852,545 6 $282,977 $57,375 21207 - Bth Cunty and City $1,840,251 $860,206 6 $275,445 $53,019 21208 - Baltimre Cunty $1,377,158 $823,145 7 $281,862 $53,548 21209 - Bth Cunty and City $1,753,613 $815,024 6 $321,413 $48,989 21215 - Baltimre City $3,632,932 $2,484,303 17 $898,813 $143,745 21216 - Baltimre City $951,803 $307,766 2 $94,749 $22,037 21244 - Baltimre Cunty $1,414,170 $852,365 6 $260,170 $60,912 Inter Zip Cde Purchases n.m. $5,370,127 36 $1,783,867 $327,375 Ttal Cmmunity Activity $15,607,859 $13,676,683 93 $4,629,783 $851,302 Surce: JFI Calculatins Using the IMPLAN Mdel fr each zip cde and the aggregated area. Table 20: Nrthwest Hspital Neighbrhd (Zip Cde) Level Spending and Assciated Ecnmic Activity Payrll and Ecnmic Activity Prcurement Output Emplyment Labr State and Lcal Zip Cde Spending ($s) ($s) (Jbs) Incme ($s) Fiscal Impact ($s) Payrll and Prcurement Spending and Assciated Impacts 21117 - Baltimre Cunty $11,208,651 $4,913,144 29 $1,600,051 $318,051 21133 - Baltimre Cunty $7,316,315 $3,795,598 27 $1,283,688 $251,626 21207 - Bth Cunty and City $3,580,019 $1,679,030 12 $537,997 $103,400 21208 - Baltimre Cunty $4,570,492 $2,881,446 23 $996,092 $184,215 21209 - Bth Cunty and City $3,349,666 $1,708,920 11 $685,657 $101,252 21215 - Baltimre City $1,731,471 $1,283,945 9 $472,188 $72,633 21216 - Baltimre City $529,797 $171,101 1 $52,675 $12,254 21244 - Baltimre Cunty $3,933,080 $2,448,274 17 $753,956 $172,652 Inter Zip Cde Purchases n.m. $13,652,741 90 $4,659,952 $787,887 Ttal Cmmunity Activity $36,219,490 $32,534,199 220 $11,042,256 $2,003,970 Surce: JFI Calculatins Using the IMPLAN Mdel fr each zip cde and the aggregated area. 17

Table 21: Sinai Hspital Neighbrhd (Zip Cde) Level Spending and Assciated Ecnmic Activity Payrll and Ecnmic Activity Prcurement Output Emplyment Labr State and Lcal Zip Cde Spending ($s) ($s) (Jbs) Incme ($s) Fiscal Impact ($s) Payrll and Prcurement Spending and Assciated Impacts 21117 - Baltimre Cunty $23,587,609 $10,454,843 62 $3,414,836 $675,119 21133 - Baltimre Cunty $5,742,674 $2,846,476 20 $948,178 $191,021 21207 - Bth Cunty and City $7,479,017 $3,539,166 25 $1,136,041 $217,481 21208 - Baltimre Cunty $23,110,743 $20,208,595 156 $7,322,713 $1,176,476 21209 - Bth Cunty and City $25,018,586 $12,728,112 85 $5,104,290 $754,442 21215 - Baltimre City $12,832,262 $9,483,545 64 $3,485,440 $536,967 21216 - Baltimre City $2,943,572 $1,085,028 7 $334,481 $76,192 21244 - Baltimre Cunty $6,883,887 $4,661,120 33 $1,466,634 $317,872 Inter Zip Cde Purchases n.m. $37,392,788 233 $11,745,841 $2,213,090 Ttal Cmmunity Activity $107,598,351 $102,399,673 685 $34,958,454 $6,158,660 Surce: JFI Calculatins Using the IMPLAN Mdel fr each zip cde and the aggregated area. 18

Scial and Cmmunity Impacts f LifeBridge Health System While it is evident frm the analysis abve that LifeBridge makes imprtant ecnmic cntributins t the cmmunities it serves, the Health System has its mst imprtant impact n the cmmunities it serves thrugh its prvisin f high quality health care services t the regin s residents as well as thrugh its cmmunity service, research and educatinal missins. Accrding t the American Hspital Assciatin, the natin s hspitals nt nly prvide the health care services needed by the public, they wrk t strengthen the cmmunities they serve. Hspitals prvide mre than patient care, they are: 1. Ecnmic Cntributrs and emply mre than 5 millin peple, making them America's secndlargest surce f private-sectr jbs; 2. Gateways t Care and serve every type f cmmunity: urban, rural, large and small. They are cnstantly wrking t imprve access t care fr all patients frm newbrns t senirs; 3. Centers f Innvatin and bring the latest medical innvatin and technlgy t patients, prviding highly specialized health care; and 4. Imprving Cmmunity Health by ging beynd treating illness t strengthen cmmunities by wrking nt just t mend bdies, but t make peple and cmmunities healthier. 14 Accrding t the Cmmunity Cnnectins Initiative f the American Hspital Assciatin, Hspitals are a vital part f their cmmunities and the services they prvide extend well beynd the fur walls f the hspital. Hspitals are wrking nt just t mend bdies, but als t make their patients and cmmunities healthier. This wrk extends far beynd the hspital building bringing free clinics, jb training, smking cessatin classes, back-t-schl immunizatins, literacy prgrams and s many ther resurces, ften with little fanfare, directly t the peple f the cmmunity. 15 This sectin f the reprt will describe the ways that LifeBridge Health cntributes t the general and scial wellbeing f the cmmunities it serves in the fllwing areas: Prviding tp quality health care services; Caring fr thse wh cannt affrd t pay; Prviding cmmunity health services; Supprting research t advance medical knwledge and prmte ecnmic develpment; and Assisting in training the next generatin f health care prfessinals. Health Care Service Delivery As ne f the largest and mst respected health care systems in the regin, LifeBridge Health is cmmitted t prviding the highest quality f medical services t meet the needs f the regin s ppulatin. This fcus n health care service delivery is evident in the system s Missin Statement, LifeBridge Health is dedicated t maintaining and imprving the health and well-being f all peple in greater Baltimre, with special emphasis n nrthwest Baltimre City and Baltimre and Carrll cunties. In s ding, LifeBridge is cmmitted t being the best, 14 http://www.aha.rg/advcacy-issues/initiatives/hsp-stry-index.shtml. 15 http://www.ahacmmunitycnnectins.rg/abut-us/index.shtml. 19

mst respected health care system serving the nrthwest regin, favred by the greatest number f patients and physicians in that area. LifeBridge Health values, abve all else, the delivery f cmpassinate, high quality health and health-related services t the cmmunity, regardless f age, race, ethnicity r financial circumstances f its patients r custmers. In delivering these services, LifeBridge Health hnrs the heritage f its cnstituent institutins, preserving their traditins and asserting their values bldly fr the benefit f all. LifeBridge Health is a $1.2 billin health care system whse fur hspitals have a ttal f 1,119 hspital beds and 210 nursing hme beds. In FY2015, LifeBridge Health: Admitted 39,106 patients, had 1,270 sub-acute admissins and 70 nursing hme admissins; Prvided 215,565 patient days, 27,184 sub-acute patient days and 65,789 nursing hme patient days; and Prvided 135,960 utpatient visits. The key driver f LifeBridge Health s success is the quality f the health care services it delivers. Accrding t the U.S. News and Wrld Reprt Hspital Rankings, Sinai Hspital is ranked 9 th best in Maryland. 16 Tw f LifeBridge Health s fur cmpnent hspitals (Sinai and Carrll) are amng the tp twelve hspitals in Maryland that received the highest patient apprval ratings in the Maryland Health Care Quality Reprts system. 17 While LifeBridge Health s fur cre hspitals ffer a full range f medical services, several f the health system s key medical specialty areas that stand ut include: The Sandra and Malclm Berman Brain & Spine Institute, perating at Sinai and Nrthwest hspitals, is the nly cmprehensive, integrated inpatient and utpatient prgram in Maryland dedicated t imprving utcmes in patients with diseases f the nervus system and spine. The Institute brings tgether multidisciplinary teams f neurlgic, neursurgical, neurpsychlgical and rehabilitatin physicians with ther medical specialists t wrk tgether t prvide the advanced resurces, expertise and cmprehensive care necessary t treat patients living with specific neurlgic disrders; The LifeBridge Health Bariatric and Minimally Invasive Surgery Center ffers bth surgical and nnsurgical treatment ptins fr weight lss, such as laparscpic gastric bypass surgery, laparscpic sleeve gastrectmy surgery and laparscpic adjustable gastric band at three lcatins in the regin; The Alvin & Lis Lapidus Cancer Institute at LifeBridge Health ffers advanced diagnsis and treatment fr a wide range f cancers. The Institute als prvides advanced treatment ptins fr varius cancers by cnducting clinical trials and case studies. The Institute s team f experts are cmmitted t develping and deplying new treatment methds t help patients in need. Using a team apprach that is fcused n patient-centered care, its specialists ffer a wide variety f treatment ptins and supprtive care in pain management and survivrship. In 16 http://health.usnews.cm/best-hspitals/area/md. 17 JFI analysis f the raw data frm https://healthcarequality.mhcc.maryland.gv/marylandhspitalcmpare/ index.html#/quality-ratings/cnditin?tpic=2&subtpic=6. 20

2014, the Institute was named a tp 100 Hspital with a Great Onclgy Prgram by Becker's Hspital Review; The William E. Kahlert Reginal Cancer Center at Carrll Hspital prvides patients with a full spectrum f cancer care services including diagnsis, a full range f treatment therapies and prcedures including, chemtherapy, radiatin therapy, advanced surgical prcedures, and supprt services and resurces. The Center fcusses n varian, breast, cln, uterine, lung, prstate, and skin cancers and leukemia; The LifeBridge Health Cardivascular Institute lcated at Sinai and Nrthwest hspitals is the mst cmprehensive, integrated inpatient and utpatient prgram dedicated t preventing, treating and imprving utcmes in heart disease, vascular disease and strke in its service area. Thrugh a variety f specialized centers, including the Ben and Zelda Chen Heart Rhythm Center, Benjamin and Margaret Schapir Cardiac Diagnstic Center, Beverly and Jerme Fine Cardiac Valve Center, the Cardiac Preventin Center, the Cardiac Rehabilitatin Center, the Emergency Chest Pain Center and the Heart Failure Center, the Institute prvides state-f-theart, patient-centered care and cnducts grundbreaking cardivascular research that exemplifies excellence and cmpassin; The ER-7 Centers at Sinai and Nrthwest hspitals feature expert emergency care physicians, nurses and staff wh use state-f-the-art medical technlgy t prvide the highest quality patient care. The Centers were built frm the grund up t set new standards f emergency care and custmer service. The ER-7 prvides treatment fr every health cncern, frm majr emergent illnesses and injuries t mre minr health-related prblems. These include strke symptms and chest pain; ear, eye, nse and thrat emergencies; brken, sprained r fractured bnes; prfuse bleeding; lss f cnsciusness; trauma; and specialized pediatric care; The Krieger Eye Institute at Nrthwest Hspital, Sinai Hspital and at Quarry Lake, prvides access t specialists, technlgies and persnalized care in the areas f glaucma, diabetic retinpathy, macular degeneratin, retinal services, cataracts, crnea transplant and care, neur-phthalmlgy, and pediatric phthalmlgy; The Herman & Walter Samuelsn Children's Hspital at Sinai delivers individualized care fcused n the family and patient in specialties such as cancer, neurlgic disrders, bwel disease and diabetes; The Rubin Institute fr Advanced Orthpedics, lcated at Sinai Hspital and Nrthwest Hspital and with eight reginal ffices, is hme t sme f the wrld's mst renwned rthpedic surgens wh prvide state-f-the-art rthpedic services fr children and adults. Its prgrams include the Internatinal Center fr Limb Lengthening, the Center fr Jint Preservatin and Replacement, the Center fr Diabetic Limb Preservatin and the Center fr Hand and Upper Extremity Surgery, amng thers; LifeBridge Health's Vascular Institute prvides treatment fr inpatient and utpatient vascular care. Cnsultatins, diagnstic services and surgical care are perfrmed at Nrthwest Hspital and Sinai Hspital; Nrthwest Hspital's Herman & Walter Samuelsn Breast Care Center is a cmprehensive center that ffers screening, diagnsis and treatment fr breast cancer. The Center prvides 21

sme f the mst advanced technlgies fr the evaluatin and treatment f breast disease, alng with a highly trained team that includes a dedicated breast-specialized radilgist, a fellwship-trained breast surgen, registered nurses and registered mammgraphy technlgists; Nrthwest Psychiatric Services pened its new and 23 bed expanded Inpatient Behaviral Health Unit in 2013. The inpatient unit prvides 24-hur skilled psychiatric nursing care and interventins, daily assessment and treatment versight by a psychiatrist, and a crdinated, gal-driven plan f care delivered by a multidisciplinary team f mental health prfessinals. The fcus is n rapid stabilizatin f acute psychiatric symptms; In 2014, Carrll Hspital pened the Tevis Center fr Wellness, which is lcated n the hspital s campus in Westminster, but als prvides satellite services in ther parts f the cunty, including Eldersburg and Taneytwn. The wellness center als has grwn its cmmunity health navigatin services, free prgrams t help individuals better manage their health; The Sinai Center fr Geriatric Surgery is the first cmprehensive, systematic and multidisciplinary center in the natin that is fully dedicated t geriatric surgery; and The Wmen s Wellness Center at Nrthwest Hspital ffers a hlistic apprach t health that includes annual gyneclgic exams and the develpment f cmprehensive wellness plans based n individual needs. Cmmunity Benefits, Charitable and Uncmpensated Care In additin t their vital rle in prviding health care services t a regin s ppulatin, hspitals pay a critical rle in imprving the health and wellbeing f the cmmunities served thrugh their cmmunity service prgrams and by prviding charitable and uncmpensated care t citizens in need. Accrding t the American Hspital Assciatin s 2015 Ernst & Yung Schedule H Benchmark Reprt fr the American Hspital Assciatin Tax Year 2012 reprt, Hspitals prvide benefits t the cmmunities they serve in a multitude f ways. They nt nly prvide financial assistance and make up fr underpayments by Medicaid and ther means tested gvernment prgrams, but als cver lsses due t unreimbursed Medicare and bad debt expense attributable t financial assistance. In additin, they ffer prgrams and activities t imprve cmmunity health, underwrite medical research and health prfessins educatin, and subsidize high-cst health services. 18 Hspitals and health systems are increasingly fcusing their cmmunity benefits effrts n brader cmmunity service and health prgrams in additin t their traditinal fcus n charity care and health educatin. Accrding t a 2015 Mdern Healthcare article, hspitals are bradening the scpe f their cmmunity engagement effrts and that, While health system leaders cite their nt-fr-prfit and/r religius missins t help their cmmunities as the reasn fr their public health push, they als recgnize that their systems face grwing pressure t justify their tax-exempt status as their charity-care burden shrinks under the Affrdable Care Act, particularly in states that have expanded Medicaid under the law. 19 In 2014, U.S. hspitals 18 http://www.aha.rg/cntent/15/2012schedhreprt.pdf - page 10. 19 http://www.mdernhealthcare.cm/article/20151121/magazine/311219988. 22

spent a ttal f $42.8 billin n uncmpensated care alne, 20 and in 2012 participating hspitals and systems reprted an average f 12.3 percent f their ttal annual expense n prviding benefits t the cmmunity. 21 Accrding t the Maryland Hspital Assciatin, Maryland s hspitals prvided apprximately $1.5 billin in cmmunity benefits in 2014 r almst 11 percent f all hspital perating expenses statewide, up frm $586.4 millin and 6.9 percent f revenues in 2004. 22 As presented in Table 22, based n its cmmunity benefits reprting system, LifeBridge Health System prvided nearly $82 millin in supprt f cmmunity benefits t its Baltimre Metrplitan Area service area. LifeBridge has its majr cmmunity impact thrugh the $33.9 millin in expenditures it makes n Missin Driven Health Care Services r services prvided t the cmmunity that were never expected t result in cash inflws but: 1) which the hspital undertakes as a direct result f its cmmunity r missin driven initiatives; r 2) wuld therwise nt be prvided in the cmmunity if the hspital did nt perfrm these services. The secnd majr area f LifeBridge cmmunity benefits is the $24.1 millin it spends n Health Prfessins Educatin, which includes expenditures n physician/medical resident training, nursing students training, and ther health care training related expenditures. This will be described in mre detail belw. Other key cmmunity benefits related activities include: LifeBridge Health spends $9.6 millin Charity Care r free r discunted health and healthrelated services prvided t persns wh cannt affrd t pay; $6.6 millin in Cmmunity Health Services which include activities carried ut t imprve cmmunity health; $3.7 millin in Medicaid Assessments- since FY 2013, Maryland hspitals are required t prvide a Deficit Assessment Fee t the Maryland Medicaid Prgram; $1.3 millin in expenditures n Research include clinical and cmmunity health research, as well as studies n health care delivery; $1.0 millin in expenditures n Cmmunity Building Activities which include cash, in-kind dnatins, and budgeted expenditures fr the develpment f cmmunity health prgrams and partnerships; $1.0 millin in expenditures n Cmmunity Benefit Operatins include csts assciated with dedicated staff, cmmunity health needs and/r assets assessment, and ther csts assciated with cmmunity benefit strategy and peratins; and $0.8 millin n Financial Cntributins in the frm f grants r ther supprt fr nt-fr-prfit cmmunity rganizatins, prjects, and initiatives. 20 http://www.aha.rg/cntent/16/uncmpensatedcarefactsheet.pdf. 21 http://www.aha.rg/cntent/15/2012schedhreprt.pdf - page 5. 22 http://www.mhanline.rg/dcs/default-surce/resurces/cmmunity-benefits/maryland-39-s-hspitals-2013- cmmunity-benefits-reprt.pdf?sfvrsn=3. 23

Table 22: LifeBridge Reprted Cmmunity Benefits Cmmunity Benefit Area Levindale Nrthwest Sinai Carrll Ttal Ttal $2,842,192 $15,826,911 $50,421,644 $12,871,669 $81,962,417 Cmmunity Health Services $70,389 $1,673,569 $2,841,475 $1,995,254 $6,580,687 Health Prfessins Educatin $78,300 $732,793 $22,776,979 $531,839 $24,119,911 Missin Driven Health Care Services $1,434,939 $8,839,299 $15,490,185 $8,151,077 $33,915,500 Research $0 $69,748 $1,018,548 $198,904 $1,287,199 Financial Cntributins $18,193 $130,746 $412,421 $233,194 $794,555 Cmmunity Building Activities $34,498 $233,411 $387,453 $388,390 $1,043,752 Cmmunity Benefit Operatins $58,697 $39,899 $760,740 $144,215 $1,003,550 Charity Care $930,520 $3,226,996 $4,172,967 $1,228,796 $9,559,279 Medicaid Assesments 1 $216,657 $880,451 $2,560,877 $0 $3,657,985 (1) N data n Medicaid Assessments were available fr Carrll Hspital. Surce: LifeBridge Cmmunity Benefits Reprting System There is a strng need fr the cmmunity services and charitable/uncmpensated care prvided by LifeBridge Health and its fur cmpnent hspitals, especially in Baltimre City. Levindale and Sinai Hspitals are lcated in Baltimre City, Maryland which has a higher pverty rate than the natin as a whle, 24 percent, cmpared t 16 percent natinally. Nine percent f Baltimre City residents are uninsured, lwer than the 12 percent rate natinally; hwever, six percent f Baltimre City s residents receive their health insurance thrugh Medicare alne and 25 percent thrugh Medicaid alne, higher than five percent and 14 percent respectively natinally; Nrthwest Hspital serves Baltimre Cunty, which has a lwer pverty rate and share f uninsured ppulatin than the natin and State, but 7 percent f Cunty residents are uninsured, 4 percent rely n Medicare-alne and 12 percent rely n Medicaid alne, demnstrating a cntinuing need fr cmmunity services and charitable/uncmpensated care; and Carrll Hspital is the nly hspital serving Carrll Cunty, which has an even lwer pverty rate and share f uninsured ppulatin than the natin, state and regin, but still must prvide care fr the 4 percent f Cunty ppulatin lacking health insurance, 3 percent relying n Medicare-alne and 7 percent relying n Medicaid alne. 24

Table 23: Pverty and Health Insurance Status LifeBridge Health Service Area Percentage Belw Pverty Percentage Uninsured Percentage Medicare-Only 1 Percentage Medicaid Other Means Tested- Only 1 United States 15.5% 11.7% 4.7% 14.3% Maryland 10.1% 7.9% 3.5% 13.2% Baltimre Metr Area 11.1% 6.3% 3.8% 13.1% Baltimre Cunty 9.7% 7.4% 4.2% 12.4% Carrll Cunty 5.3% 3.6% 3.2% 7.4% Baltimre City 23.6% 8.5% 5.7% 24.6% (1) Persns with a single surce f insurance receiving Medicare r Medicaid nly as a percentage f the ttal ppulatin. Surce: U.S. Bureau f the Census - American Cmmunity Survey All f LifeBridge Health s cmpnent hspitals have perfrmed Cmmunity Health Needs Assessments t identify and meet the health needs f their respective service areas. Sinai Hspital perfrmed its cmmunity health needs assessment in 2011, Carrll Hspital in 2012, Nrthwest in 2013, and Levindale in 2015. Each f LifeBridge Health s fur cmpnent hspitals have develped and are implementing specific plans t meet their service area s cmmunity health needs identified in each assessment thrugh a systematic plan and delivery system: Overall, LifeBridge Health has a bard cmmittee fr the versight and guidance fr all cmmunity services and prgramming. The Cmmunity Missin Cmmittee members include Sinai, Nrthwest, and Levindale Bard Members and Executives, President f LifeBridge Health, Inc., and Vice Presidents. The Cmmunity Missin Cmmittee is respnsible fr reviewing, reprting, and advising cmmunity benefit activities; LifeBridge Health als created the Office f Cmmunity Health Imprvement t implement cmmunity health imprvement prjects. This department replaced the Cmmunity Health Educatin Department that was respnsible fr health prmtin and preventin effrts at Nrthwest Hspital. Althugh the department prvides services t individuals living in r arund Nrthwest, Sinai and Levindale Hspitals' surrunding cmmunities, the department is physically lcated at Nrthwest Hspital and its health prmtin fcus cntinues t prvide meaningful cmmunity benefit services t Nrthwest Hspital's cmmunity residents; The Sinai Hspital Cmmunity Benefit Cuncil, was frmed in early fiscal year 2012 in rder t respnd t the grwing need fr versight f cmmunity benefit prgraming. The Cuncil cntinues t meet quarterly t review new Cmmunity Benefit guidelines and reprting instructins, discuss hspital prgramming, and finalize annual reprts; At Carrll Hspital, the Cmmunity Benefit Planning and Evaluatin Team reviews and audits prgress twards achieving the CHNA s cmmunity service gals; and The Cmmunity Benefit Cuncil, Nrthwest Hspital was frmed in 2012 in rder t respnd t the grwing need fr versight f cmmunity benefit prgramming. The 25

cuncil meets biannually t review new Cmmunity Benefit guidelines and reprting instructins, discuss hspital prgramming and finalize annual reprts. Selected examples f LifeBridge Health s cmmunity service activities include: The Sinai Cmmunity Health Imprvement Prject (CHIP) - Changing Hearts is a cst free initiative t its patients designed t imprve the cardivascular health f individuals in the surrunding cmmunity. The prgram is designed t: 1) help individuals understand their identified risks fr heart disease; 2) demnstrate hw t minimize/mdify thse risk factrs; and 3) prvide educatin n hw t maintain a healthy lifestyle t prevent heart disease. The Changing Hearts Prgram includes: Live Heart health risk assessment; Chlesterl, glucse, etc. screenings wrk; Bld pressure reading; Bdy cmpsitin analysis; Health educatin cunseling with a registered nurse; Educatinal material t help facilitate lifestyle change; Fllw-up calls; Lifestyle classes t help maintain a lng-term lifestyle change; and Web-based links t resurces t imprve cardiac health. In FY 2015, the Changing Hearts prgram interacted with 1,147 individuals, has 23 active participants, cnducted 73 hme visits and had 29 wrkshp participants; Nt all f the cmmunity service activities prvided by Sinai Hspital are health related. Because the Park Heights cmmunity served by Sinai has a high verall and vilent crime rate, the hspital supprts the Park Heights Renaissance cmmunity rganizatin which manages crime reductin and ther cmmunity prgrams. As part f this interactin, Sinai develped a pilt prgram in the hspital t identify thse wh came t Sinai's ER as a result f an injury resulting frm vilence. It prvided a male mentr t meet yung men in the hspital and t fllw them after discharge, ffering them alternatives t vilence. We learned frm that pilt that Park Heights lacked a cmmunity-based vilence preventin prgram that culd prvide viable alternatives t vilence. Because f this experience, Sinai Hspital nw funds the Kujichagulia Yuth Center t address the issue f crime identified in the CHNA. The Kujichagulia Center (self-determinatin in Swahili) prvides yuth develpment and vilence preventin services t residents f zip cde 21215 wh are between 19 and 24-years f age. It als prvides Mentring fr Middle Schls students at Pimlic and KIPP Elementary-Middle schls and a YuthWrks Summer jbs prgram fr 14 t 21-year lds. In additin, vilence interventin services are available t lcal yuth 16 t 25 years ld, wh are admitted t Sinai s Trauma Unit after suffering injuries due t street vilence. Sinai prvides case management services that can help the yung persn escape the cycle f vilence and engage in needed educatinal r vcatinal prgramming. The prgram has: Prvided Wrkfrce Readiness/Life Skills training t 31 residents; The Pst Vilence Interventin Prgram has had 12 participants; The Sinai Vcatinal Services Prgram prvided 9 internships; and 26

Assisted 4 students t get their GED; Sinai Hspital prvides several assistance prgrams t meet the cmmunities health care needs including: Sinai Hspital partners with the Family League f Baltimre t prvide the Healthy Families America perinatal hme visiting service. HFA services begin prenatally r right after the birth f a baby and are ffered fr 3 t 5 years after the birth f the baby. It prvides hme visiting services with the gal f effectively cnnecting families with health and scial services that will enhance the lives f the entire family; HIV Care fr the Uninsured prvides Primary Medical Care and Medical and Nn-Medical Case Management fr uninsured r underinsured HIV-psitive persns and the Hspital s emergency rm prvides Rapid HIV Testing t patients with fllw-up appintments in the Hspital s infectius Disease Ambulatry Care Clinic. The Hspital s HIV Primary Care Services Department prvides medical care fr HIV+ individuals withut insurance r withut adequate insurance; The Medical Hme Extender fr Diabetes Management Prgram prvides diabetes chrnic care t a medically underserved cmmunity; and The Sinai Cmmunity Care clinic prvides primary care services t the uninsured and Medicaid recipients in the cmmunity; As the nly hspital in Carrll Cunty, Carrll Hspital plays a significant rle in designing, delivering and supprting cmmunity health and services prgrams. In 1999 the Hspital and Carrll Cunty Health Department frmed the Partnership fr a Healthier Carrll Cunty t better meet cmmunity health care needs. The hspital has cntinued t invest in the Partnership and its wrk in bringing rganizatins tgether fr cmmunity health initiatives has been an asset t the cmmunity. The hspital wrked with the Partnership fr a Healthier Carrll Cunty t create Access Carrll, a patientcentered and integrated health care hme fr lw-incme residents f Carrll Cunty. Primary medical care is prvided by vlunteer physicians, nurses and ther medical prfessinals. By remving traditinal barriers t quality health care, Access Carrll strives t help patients maintain gd health and learn t manage any acute r chrnic illnesses. Carrll Hspital cntributed $259,245 t Access Carrll in FY15 t cver salary and benefit expenses fr the executive directr, ne full-time RN case manager and tw part-time psitins (an aide and develpment specialist). The hspital als prvides labratry and diagnstic imaging services t Access Carrll. In 2015, Access Carrll served 3,766 lw incme individuals; In rder t address the issue f breast cancer in Carrll Cunty, Carrll Hspital created the One-n-One Breast Health Cnsultatin and Clinical Breast Exam and Breast Health Awareness Cmmunity Educatin prgrams t prvide screening, facilitate treatment and prmte breast cancer awareness prgrams. These prgrams served 1,589 wmen in FY 2015; 27

Carrll Hspital prvides Strke Cmmunity Educatin & Screenings t educate the cmmunity abut strke warning signs. This educatin is targeted nt nly t peple wh may be at risk fr strke but ptential caregivers and children wh may be able t recgnize the signs and call 9-1-1 as sn as pssible. This was accmplished thrugh articles, newspaper ads, magnets, cmmunity presentatins/ educatin and scial media psts. These effrts reached 4,981 individuals since 2012; Levindale Hspital ffers the Stp Abuse f Elders (SAFE) prgram t supprt the preventin and treatment f elder abuse. The SAFE prgram prvides a cmprehensive apprach that includes: crisis interventin, shelter, psychtherapy, advcacy, service crdinatin and cmmunity educatin and reached 235 senirs thrugh wrkshps at Senir Centers and with 80 clergy members and 8,000 cmmunity members thrugh webinars, presentatins and ther utreach effrts; The Freedm t Screen prgram at Nrthwest Hspital prvides cmmunity utreach, breast cancer educatin, screenings and exams, mammgrams, and fllw-up diagnstic prcedures fr lwer-incme, uninsured and under-insured wmen in Baltimre Cunty and City. The gal f the prgram is t prvide wmen with the resurces they need t increase breast cancer awareness and preventin. Additinal assistance is ffered t wmen wh need help with patient navigatin services. Patient navigatrs help wmen wh have received a breast cancer diagnsis deal with their medical fears and develp a rad t recvery; and Nrthwest Hspital - Dmestic Vilence (DOVE) Prgram prvides 24/7 crisis interventin t victims f dmestic vilence in the emergency department, cmplete dcumentatin f physical and psychlgical injuries, referrals t cmmunity and legal resurces, as well as fllw-up case management, supprt grups and cunseling. Staff includes crisis interventinists, a frensic nurse, case managers and a psychtherapist. Research Discvery, Innvatin, and Cmmercializatin The health care and life sciences sectrs have emerged as key drivers f the natinal and reginal ecnmies. This is especially true in urban areas, like the Baltimre Metrplitan area, where healthcare and life sciences have prvided a stable a grwing base f emplyment grwth and ecnmic develpment activity. The 2016 Best is the Standard: A Strategic Plan fr Accelerating Ecnmic Develpment in Maryland strategic plan identifies Bihealth and Life Sciences as ne f ten targeted industry grwth clusters fr the state. 23 The Ecnmic Alliance f Greater Baltimre (EAGB) has identified BiHealth and Health Care as tw f the thirteen cre industry clusters that are driving the reginal ecnmy. The EAGB reprts that: Greater Baltimre is a glbal center fr health care services. The regin is hme t wrld class institutins and practitiners, has a high cncentratin f emplyment in the health care industry and is experiencing rapid expansin and investment in critical infrastructure. The sectr emplys ver 189,000 wrkers and that the regin is hme t the third highest cncentratin f health care services emplyees in the cuntry. The Health Care sectr is nt 23 http://cmmerce.maryland.gv/dcuments/prgramreprt/strategicplan2016.pdf. 28

just a majr emplyment and grwth sectr fr the reginal ecnmy, it supprts the grwth and develpment f the regin s IT, cyber, bisciences, and finance (health care plans) sectrs as well; 24 and The Baltimre-Washingtn regin is amng the tp 5 BiHealth hubs in the US, based n emplyment, number f firms and venture capital investment. The regin is ranked first natinally in life sciences research, making the regin the wrld s largest hub fr medical research and discvery. 25 Each f the three jurisdictins in which LifeBridge Health s cre peratins are lcated explicitly recgnize the imprtant rle played by hspitals and the health care sectr in each Cunty/City s ecnmic base: In Baltimre City, where Sinai and Levindale Hspitals are lcated, the City s Cmprehensive Ecnmic Develpment Strategy identifies the Health and Biscience Technlgy industry as ne f the City s six cre industry clusters and reprts that With wrld-class medical facilities and research institutins, Baltimre already has the fundatin fr an even strnger health and biscience technlgy industry. In terms f the City s ecnmic develpment strategy the City CEDS reprts that, Blstering this sectr ffers the pprtunity fr majr rewards fr Baltimre in terms f well-paying jbs and increased prminence in the field; 26 In Baltimre Cunty, hme t Nrthwest Hspital, the Cunty s ecnmic develpment strategy identifies Healthcare as ne f the six cre industry clusters driving the Cunty ecnmy and that Baltimre Cunty is hme t five majr hspitals and the healthcare industry accunts fr many jbs and significant investment. New mdels are being applied t the prvisin f healthcare natinally and Baltimre Cunty stands t benefit frm the decentralizatin f medical services; 27 and The Carrll Cunty Department f Ecnmic Develpment reprts that Lcal Bitechnlgy and Bimedical industry leaders are cnducting cutting-edge research fr natinal and internatinal pharmaceutical cmpanies, and that Carrll Hspital is a key cntributr t the Cunty s emplyment base and quality f life advantages. 28 The State, reginal and Cunty/City ecnmic develpment strategies in place all explicitly recgnize the imprtant rle played by the healthcare and life sciences sectr t the State and reginal ecnmies. The strength and reputatin f the regin s healthcare sectr is a cre determinant f Maryland s ecnmic develpment success. Health systems, including Jhns Hpkins, University f Maryland Medical System, MedStar and LifeBridge all play a majr rle in this sectr by cnducting cutting edge research, as riginatrs f new technlgies, and perfrmers f clinical trials. LifeBridge Health cntributes t the grwth and develpment f the regin s healthcare and life sciences sectr thrugh the research it cnducts, thrugh the diffusin f new medical techniques and ther discveries, and thrugh its supprt fr new medical research discveries thrugh clinical trials. 24 See http://www.greaterbaltimre.rg/prtals/_default/publicatins/industry%20prfiles/healthcare.pdf. 25 See http://www.greaterbaltimre.rg/prtals/_default/publicatins/industry%20prfiles/bihealth.pdf. 26 See http://baltimredevelpment.cm/resurces/ceds/. 27 See http://baltimrecuntybusiness.cm/finalstrategicplan2012.pdf. 28 See http://carrllbiz.rg/tech http://carrllbiz.rg/technlgy/develpment.phpnlgy/develpment.php. 29

The LifeBridge Health Department f Research prvides cutting-edge medical research t help treat a variety f health cncerns in the surrunding cmmunity. Its expert researchers cnduct clinical trials t help in the advancement f new medical devices and drugs that can imprve and save lives. The Department f Research is charged with the versight, facilitatin and supprt f all research activity ccurring within LifeBridge Health. The department serves as a resurce fr faculty, physicians, residents, fellws and administratrs, prviding supprt services and guidance in fulfilling the bligatin t plan and cnduct all experimental prcedures with the highest scientific, humane and ethical principles. LifeBridge Health was invlved in $1.3 millin in research activities in FY2015. LifeBridge Health is engaged in the fllwing research activities: 125 cperative research agreements, mstly nclgy clinical trials; 22 Federal and State funded research prjects; 76 Industry funded research prjects, which mainly cnsist f cntracts t d research f interest t different pharmaceutical r medical device cmpanies, with much f this activity is currently based at the Rubin Institute; 9 nnprfit funded research prjects; and The LifeBridge Health Department f Research website lists 77 active clinical trials underway, with mst in the areas f cancer treatment; The Alvin & Lis Lapidus Cancer Institute Translatinal Research Labratry, lcated at Sinai Hspital is ne f the majr research centers in LifeBridge Health. The aim f translatinal research is t rapidly mve scientific discveries frm the bench t the bedside t ultimately imprve patient care. Michael A. Tangrea, Ph.D., leads the research effrt with interests in mlecular diagnstics, tissue micrdissectin and genmic medicine. Wrking with clinicians and residents, the Translatinal Research Labratry is engaged in research studies f triple negative breast cancer, lung cancer, chrnic lymphcytic leukemia and melanma. The Translatinal Research Labratry als trains undergraduate students and currently has students frm Lyla University Maryland, Twsn University and Stevensn University; The Central Research Labratry (CRL) at Sinai Hspital is a 2,800 square ft labratry facility fcusing n research n physilgy, cell bilgy, cellular metablism, micrenvirnments, and bienergetics. The CRL is designed t assist in the develpment and perfrmance f investigatrinitiated research prjects, cllabrate with staff and physicians n fundable/funded research pprtunities, and mentr department-spnsred resident research activity. An n-site animal husing facility and surgical suites supprt CRL prjects; and The LifeBridge BiIncubatr at Sinai Hspital is Maryland s nly hspital-based biincubatr. The facility ffers: 11 wet lab spaces ranging frm 90 t 320 square feet; Prebuilt lab space t facilitate rapid mve-in; each lab equipped with backup pwer and Internet access; Rms available with bisafety level 2 cntainment hds and CO₂ incubatrs t accmmdate mammalian, stem cell r micrbial cultures; A cmmn equipment rm with Type 1 ultrapure water, autclave, dishwasher, gel imager -80 freezer and ice machine; and 30

Access t cnference rms with vide cnferencing capabilities. The LifeBridge BiIncubatr at Sinai Hspital s missin is t imprve human health by bringing tgether emerging businesses, innvative technlgies and leading physicians. The incubatr ffers direct access t patients, bilgical samples and investigatrs; a USDA-regulated research animal facility n site with access t large and small animals, and including a surgical theater; and streamlined IRB and administrative versight. The incubatr targets medical device and diagnstic start-up cmpanies. In additin t its supprt fr brad based ecnmic develpment thrugh research, clinical trials and the Biincubatr, LifeBridge Health supprts cmmunity redevelpment effrts ccurring in its service area thrugh grants, staff and vlunteer supprt. Sme examples f cmmunity redevelpment activities supprted by LifeBridge Health include: Park Heights Renaissance, $50,000 in grant supprt fr husing redevelpment/public safety prgramming; Cylburn Cmbined Cmmunity Assciatins, $25,000 in grant supprt fr Cmmunity-Building Events/Public Safety/Schlarships; Aging in Place, $80,000 in grant supprt fr husing rehab/cmmunity stabilizatin effrts; and Mt. Washingtn Schl, $5,000 in grant supprt fr the Schl/Cmmunity Partnership. Wrkfrce Develpment and Graduate Medical Educatin The presence f a skilled and educated wrkfrce is amng the chief determinants f success in state and reginal ecnmic develpment. In additin t its rle in supprting health and life sciences research and cmmercializatin, LifeBridge Health cntributes t the educatin and training f healthcare prfessinals in the regin. Accrding t the American Hspital Assciatin, Teaching Hspitals, such as LifeBridge s Sinai hspital which is the third largest teaching hspital in Maryland, play a critical rle in medical educatin and that, teaching hspitals serve as centers fr training future health care prfessinals, while als supprting an envirnment in which bimedical and clinical research can flurish, ffering specialized services and prviding patient care, ften in the mst disadvantaged cmmunities. 29 All f LifeBridge s cmpnent hspitals play an imprtant rle in Graduate Medical Educatin (GME) as well as in supprting the training f nurses, lab technicians, as well as ther medical prfessinals. The Wrkfrce Develpment and Graduate Medical Educatin impacts f LifeBridge Health include: In the area f Graduate Medical Educatin, Sinai Hspital ffers 6 ACGME apprved residency prgrams and 8 nn-accredited fellwship prgrams. Sinai currently hsts 136 medical residents and 17 fellws as part f its GME prgram. In additin Sinai hsts apprximately 350 t 400 medical students, residents, Physician s Assistants and Nurse Practitiner students frm utside institutins fr training rtatins at Sinai; The Sinai Center fr Nursing Advancement is dedicated t the pursuit f nursing schlarship and prfessinal develpment fr nurses at all levels acrss the Sinai Hspital rganizatin. Under the leadership f Chief Nursing Officer Diane Jhnsn, the Center was created t prvide 29 See http://www.aha.rg/research/reprts/tw/15june-tw-teachinghsp.pdf. 31

nging educatin and develpment thrugh a variety f prcesses and partnerships with schls and rganizatins acrss the Baltimre-Washingtn regin; Nrthwest Hspital Nursing Residency Prgram: PROJECT CONNECT, ffers nursing graduates a residency prgram. The residency prgram is available thrughut the hspital specifically in the fllwing areas: Emergency Department; ICU; IMC; Heart Care Unit; Medical Onclgy; Geriatric Respiratry Care; and Surgical/Orthpedics. The RN Residency Prgram is a cmprehensive 12 week prgram that fcuses n classrm, as well as, hands-n training. Eligible participants include recent nursing graduates and thse wh will have passed the nursing bards; Carrll Hspital ffers externships t qualified nursing students actively enrlled in an accredited prgram. Students must first serve an externship befre advancing t an internship, which is available t senir level nursing students within six mnths f graduatin; Carrll Hspital als ffers a 1-year Pharmacy Residency Prgram that prvides a cncentrated learning experience equivalent t apprximately 3 t 5 years f prfessinal experience in the field; Levindale Hspital is a training site fr health care prfessins students wh seek the skills necessary t care fr an aging ppulatin. Training prgrams include: Geriatric nurse practitiner prgram; Geriatric training fr pharmacy students; Geriatric training fr dental students; Geriatric training fr registered nurses and licensed practical nurses; Inpatient geriatric clinical experience fr nursing students; Training experience fr physical therapy, speech therapy, ccupatinal therapy and respiratry therapy students and baccalaureate nursing students; Graduate scial wrk internship prgram; Supervised clinical educatin experience fr medical recrds students; Supervised clinical educatin experience fr physician assistant students; Fellwship prgram in cntinence and urlgy; and Rehabilitatin medicine residency prgram. The LifeBridge Health Wrkfrce Develpment Initiative, which was launched in 2007 and includes the Schl at Wrk prgram, a pre-allied health bridge curse, jb training and life skills caching was awarded ne f 9 Frntline Healthcare Wrker Champins in the natin in 2014. The prgram prvides: Life-skills caching and Career and educatinal caching with a fcus n retentin and advancement. The gal f the prgram is t assist frnt line wrkers with jb retentin and advancement pprtunities. Each year, ur prgram spnsrs a variety f free classes fr emplyees that aim t enhance their academic and life management skills. Additinally, when the business need arises, it can ffer jb training prgrams that train and place ur incumbent emplyees in higher paying jbs. Tw Life Skills/Career Caches are a part f the WFD team and wrk clsely with frnt line staff t address many wrkplace and persnal issues. Last year, apprximately 300 emplyees tk advantage f WFD services. 32

In Cnclusin LifeBridge Health makes imprtant cntributins t the ecnmic and verall wellbeing f the State f Maryland and the Baltimre Regin. Cnsisting f fur hspitals and a hst f affiliated institutins, including Sinai, Carrll Levindale, and Nrthwest Hspitals, and LifeBridge Health and Fitness, LifeBridge Health, makes its mst imprtant cntributin by prviding tp quality health care services that imprve the health and quality f life fr residents f Baltimre City, Baltimre Cunty and Carrll Cunty. In fulfilling its health care missin, LifeBridge Health als makes imprtant cntributins t the ecnmic and scial vitality f the State, regin, and cmmunities it serves. LifeBridge Health is a Critical Ecnmic Driver - As a $1.2 billin health care system emplying ver 10,000 wrkers, LifeBridge Health is an imprtant surce f ecnmic activity: LifeBridge Health generates widespread ecnmic impacts thrugh its purchases f gds, services, and labr and generated $2.6 billin in ecnmic activity in the Maryland ecnmy, supprted 18,372 jbs earning $1.2 billin in labr incme, and generated $109.0 millin in State and lcal gvernment revenues; Sinai Hspital supprts $1.2 billin in ecnmic activity and 7,864 jbs in Baltimre City; Nrthwest Hspital supprts $438.4 millin in ecnmic activity and 3,218 jbs in Baltimre Cunty; Carrll Hspital supprts $389.3 millin in ecnmic activity and 3,233 jbs in Carrll Cunty; Levindale Hspital supprts $438.4 millin in ecnmic activity and 3,218 jbs in Baltimre City; and LifeBridge Health and Fitness supprts $11.2 millin in ecnmic activity and 178 jbs in Baltimre Cunty. LifeBridge Health system s Sinai, Levindale and Nrthwest Hspitals are anchr institutins that frm an integrated cluster f health care activity in the Baltimre City and Cunty neighbrhds in which these hspitals are lcated, and LifeBridge s peratins supprt $168.6 millin in activity and 1,134 jbs in an eight zip cde area cmmunity service area. LifeBridge Health Prvides Substantial Cmmunity Benefits In additin t serving as a generatr f ecnmic activity, LifeBridge Health als imprves the verall health and wellbeing f the cmmunities it serves thrugh the cmmunity service, educatinal and ecnmic develpment prgrams it ffers. The cmmunity benefits supprted by LifeBridge Health include the fllwing: Prvides $82.0 millin in cmmunity benefits, including $33.9 millin Missin Driven Health Care Services, $24.1 millin in Health Prfessins Educatin, and $9.6 millin in Charity Care; Supprts ecnmic develpment thrugh its research, clinical trials and incubatr prgram; and Educates health care prfessinals thrugh Graduate Medical Educatin, nursing and related health care prfessins training prgrams. By the bjective measures presented in this reprt, LifeBridge Health supprts the verall health, ecnmic and cmmunity wellbeing f the cmmunities it serves and supprts bth Maryland and the Baltimre Regin s natinally recgnized excellence in the health care and life sciences sectr. 33

Appendix A- Ecnmic Activity Analysis Methdlgy and Terms LifeBridge Health retained the Jacb France Institute t prepare an analysis f the ecnmic cntributin f the verall health system n the State f Maryland, n the three jurisdictins Baltimre City, Baltimre Cunty, and Carrll Cunty, and eight neighbrhds -- in which its principal facilities are lcated. This ecnmic cntributin analysis used the IMPLAN input-utput mdel fr the State f Maryland and the three jurisdictins analyzed. IMPLAN is ne f the mst widely used mdels in the natin, and can be used t analyze the impacts f cmpanies, prjects, r f entire industries. An input-utput analysis examines the relatinships amng businesses and amng businesses and final cnsumers. Input-utput analysis is based n the use f multipliers, which describe the respnse f an ecnmy t a change in demand r prductin. Multipliers measure the effects n an ecnmy frm a surce f ecnmic activity, in this case the prvisin f health care, nursing hme and fitness services. The ecnmic activity generated in a city, cunty, regin r state is greater than the simple ttal f spending assciated with the event r activity being studied. This is because as this mney is earned it is, in turn, spent, earned and re-spent by ther businesses and wrkers in the state ecnmy thrugh successive cycles f spending, earning and spending. Hwever, the spending in each successive cycle is less than in the preceding cycle because a certain prtin f spending leaks ut f the ecnmy in each rund f spending. Leakages ccur thugh purchases f gds r services frm utside f the regin and federal taxatin. The IMPLAN multipliers used in this analysis capture the effects f these multiple runds f spending. This analysis fcuses n fur measures f ecnmic impact: Output. The ttal value f prductin r sales in all industries; Emplyment. The ttal number f full and part time jbs in all industries; Labr Incme. The wages and salaries, including benefits, and ther labr incme earned by the wrkers hlding the jbs created; and State and Lcal Gvernment Revenues. The revenues accruing t the State f Maryland, cunty, City and municipal gvernments. Fur measures f the ecnmic activity and impact f the jbs supprted LifeBridge Health and its cmpnent units are included in this reprt: Direct effects. The change in ecnmic activity being analyzed in this case the prvisin f health care and fitness services; Indirect effects. The changes in inter-industry purchases, fr example the purchase f medical supplies by a hspital, in respnse t the change in demand frm the directly affected industries; Induced effects. The changes in spending frm husehlds as incme and ppulatin increase due t changes in prductin; and Ttal effects. The cmbined ttal f direct, indirect and induced effects. 34

Appendix B- Hspital Ecnmic Activity Summaries 35

Sinai Hspital Sinai Hspital f Baltimre features renwned centers f excellence sme with natinal and internatinal acclaim. As the largest cmmunity hspital and the third largest teaching hspital in Maryland; Sinai Hspital s missin is t prvide quality patient care, educate medical students and residents, and engage in research t imprve the lives f peple all ver the wrld. With 342 beds, revenues FY2015 revenues f $728.0 millin and 24,342 admissins, Sinai Hspital is the largest f LifeBridge Health s fur hspitals. Maryland Ecnmic Impact Summary: Sinai Hspital directly generates $797.5 millin in revenues and emplys 5,229 wrkers. These direct impacts are augmented with $292.8 millin in ecnmic activity and 1,892 jbs in the frm f Indirect Impacts frm lcal purchases and $395.1 millin and 2,785 jbs in the frm f Induced Impacts frm the increase in husehld incmes assciated with the hspital fr a ttal State f Maryland impact f $1.5 billin in ecnmic activity, supprting 9,906 jbs earning $670.9 millin in labr incme, and generating $61.3 millin in State and lcal gvernment revenues. Appendix Table B-1: Ecnmic Impact f Sinai Hspital n Maryland - Fiscal 2015 1 Output Labr Incme Emplyment State/Lcal Tax Revenue Direct Effect $797.5 $420.9 5,229 $21.7 Indirect Impacts $292.8 $115.0 1,892 $14.6 Induced Impacts $395.1 $135.0 2,785 $25.0 Ttal Impact $1,485.3 $670.9 9,906 $61.3 State Impact Multiplier 1.86 1.59 1.89 (1) FY2015 is July 1, 2014 t June 30th 2015 Surce: JFI Calculatins Using the IMPLAN Mdel Neighbrhd Ecnmic Impact Summary: Sinai Hspital spends $107.6 millin n payrll and purchases in its eight zip cde Baltimre City/Cunty neighbrhd area and these expenditures supprt $102.4 millin in ecnmic activity, with an assciated 685 jbs earning a ttal f $35.0 millin in salaries and wages and generated an estimated $6.2 millin in State and City gvernment revenues in the targeted cmmunities. Selected Scial and Cmmunity Impacts: Sinai Hspital spent ver $50 millin t prvide cmmunity benefits t its Baltimre Metrplitan Area service area. As a teaching hspital, Sinai s largest scial and cmmunity impact is frm the $23 millin it spends n Health Prfessins Educatin, which includes expenditures n physician/medical resident training, nursing students training, and ther health care training related expenditures. The hspital s secnd majr area f scial and cmmunity impact is thrugh its $15 millin in expenditures n Missin Driven Health Care Services r free r reduced price services prvided t the cmmunity as a direct result f its cmmunity service missin and the Hspital prvided ver $4 millin in Charity Care. 36

Nrthwest Hspital Nrthwest Hspital, lcated in Randallstwn, Maryland, carries ut its visin t be the recgnized leader in clinical quality and custmer care in the nrthwest Baltimre metrplitan regin. Nrthwest Hspital s strng philsphy f patient-centered care is evident frm its friendly emplyee culture t its facility design. The hspital leads in surgical innvatin, has utpatient services that are highly acclaimed by patients and is hme t a cmpetent emergency department that expertly handles heavy vlumes. With 320 beds, FY2015 revenues f $233.6 millin and 10,430 admissins, Nrthwest Hspital is the third largest f LifeBridge Health s fur hspitals. Maryland Ecnmic Impact Summary: Nrthwest Hspital directly generates $255.9 millin in revenues and emplys 1,804 wrkers. These direct impacts are augmented with $94.0 millin in ecnmic activity and 607 jbs in the frm f Indirect Impacts frm lcal purchases and $131.8 millin and 929 jbs in the frm f Induced Impacts frm the increase in husehld incmes assciated with the hspital fr a ttal State f Maryland impact f $481.7 millin in ecnmic activity, supprting 3,340 jbs earning $223.8 millin in labr incme, and generating $20.3 millin in State and lcal gvernment revenues. Appendix Table B-2: Ecnmic Impact f Nrthwest Hspital n Maryland - Fiscal 2015 1 Output Labr Incme Emplyment State/Lcal Tax Revenue Direct Effect $255.9 $141.9 1,804 $7.2 Indirect Impacts $94.0 $36.9 607 $4.7 Induced Impacts $131.8 $45.1 929 $8.3 Ttal Impact $481.7 $223.8 3,340 $20.3 State Impact Multiplier 1.88 1.58 1.85 (1) FY2015 is July 1, 2014 t June 30th 2015 Surce: JFI Calculatins Using the IMPLAN Mdel fr Maryland. Neighbrhd Ecnmic Impact Summary: Nrthwest Hspital spends $36.2 millin n payrll and purchases in its eight zip cde Baltimre City/Cunty neighbrhd area and these expenditures supprt $32.5 millin in ecnmic activity, with an assciated 220 jbs earning a ttal f $11.0 millin in salaries and wages and generated an estimated $2.0 millin in State and Cunty gvernment revenues. Selected Scial and Cmmunity Impacts: Nrthwest Hspital spent nearly $16 millin t prvide cmmunity benefits t its Baltimre Metrplitan Area service area. Its main area f scial and cmmunity benefits is $9 millin in expenditures n Missin Driven Health Care Services r free r reduced price services prvided t the cmmunity as a direct result f its cmmunity service missin and the Hspital prvided ver $3 millin in Charity Care. 37

Carrll Hspital Carrll Hspital is a nnprfit, acute care facility ffering the latest in medical technlgy, experienced medical prfessinals in a variety f specialties, and a cntinuum f prgrams and services t meet the needs f the cmmunity. Over the past five decades, Carrll Hspital has evlved significantly frm a cmmunity hspital t becme a true medical center n par with larger urban hspitals. Hwever, the hspital is still a tight-knit cmmunity where dctrs, nurses and staff members treat their friends, neighbrs and families. With 139 beds, estimated FY2015 revenues f ver $250 millin and 12,000 admissins, 30 Carrll Hspital is the secnd largest f LifeBridge Health s fur hspitals. Maryland Ecnmic Impact Summary: Carrll Hspital directly generates $263.9 millin in revenues and emplys 2,084 wrkers. These direct impacts are augmented with $96.9 millin in ecnmic activity and 626 jbs in the frm f Indirect Impacts frm lcal purchases and $122.9 millin and 866 jbs in the frm f Induced Impacts frm the increase in husehld incmes assciated with the hspital fr a ttal State f Maryland impact f $483.7 millin in ecnmic activity, supprting 3,577 jbs earning $208.7 millin in labr incme, and generating $19.4 millin in State and lcal gvernment revenues. Table B-3: Ecnmic Impact f Carrll Hspital 1 n Maryland - Fiscal 2015 2 Output Labr Incme Emplyment State/Lcal Tax Revenue Direct Effect $263.9 $128.7 2,084 $6.8 Indirect Impacts $96.9 $38.0 626 $4.8 Induced Impacts $122.9 $42.0 866 $7.8 Ttal Impact $483.7 $208.7 3,577 $19.4 State Impact Multiplier 1.83 1.62 1.72 (1) Carrll Cunty Hspital was nly Part f LifeBridge fr the furth quarter f FY 2105. N data were available fr the full fiscal year - s data were estimated based n ne quarter's perating infrmatin. (2) FY2015 is July 1, 2014 t June 30th 2015 Surce: JFI Calculatins Using the IMPLAN Mdel fr Maryland. Selected Scial and Cmmunity Impacts: Carrll Hspital has a unique service missin as the Cunty s nly hspital. The Hspital spent nearly $13 millin t prvide cmmunity benefits t its Carrll Cunty/Baltimre Metrplitan Area service area. Its main area f scial and cmmunity benefits are: $8 millin in expenditures n Missin Driven Health Care Services r free r reduced price services prvided t the cmmunity as a direct result f its cmmunity service missin; $2 millin Cmmunity Health Services; and the Hspital prvided ver $1 millin in Charity Care. 30 Because Carrll Hspital jined LifeBridge in the final quarter f FY2015, ttal revenues and admissins fr the year are estimated. 38

Levindale Hebrew Geriatric Center and Hspital Levindale Hebrew Geriatric Center and Hspital has been carrying ut its visin fr nearly 125 years t prvide quality health care and frward-lking prgrams fr peple wh are elderly and disabled. It was the first facility in Maryland t implement the Eden Alternative prgram fr elder care. This philsphy adds friendship, freedm and fun t the lives f residents and patients. As a 210 nursing hme bed and 120 hspital bed cmbined nursing hme and specialty hspital and with FY2015 revenues f $74.3 millin Levindale Hebrew Geriatric Center and Hspital is the smallest f LifeBridge Health s fur hspitals. Maryland Ecnmic Impact Summary: Levindale Hspital directly generates $81.4 millin in revenues and emplys 825 wrkers. These direct impacts are augmented with $29.9 millin in ecnmic activity and 193 jbs in the frm f Indirect Impacts frm lcal purchases and $49.6 millin and 350 jbs in the frm f Induced Impacts frm the increase in husehld incmes assciated with the hspital fr a ttal State f Maryland impact f $160.9 millin in ecnmic activity, supprting 1,368 jbs earning $84.3 millin in labr incme, and generating $7.4 millin in State and lcal gvernment revenues. Table B-4: Ecnmic Impact f Levindale Hspital n Maryland - Fiscal 2015 1 Output Labr Incme Emplyment State/Lcal Tax Revenue Direct Effect $81.4 $55.6 825 $2.7 Indirect Impacts $29.9 $11.7 193 $1.5 Induced Impacts $49.6 $17.0 350 $3.1 Ttal Impact $160.9 $84.3 1,368 $7.4 State Impact Multiplier 1.98 1.52 1.66 Surce: JFI Calculatins Using the IMPLAN Mdel fr Maryland. Neighbrhd Ecnmic Impact Summary: Levindale Hspital spends $15.6 millin n payrll and purchases in its eight zip cde Baltimre City/Cunty neighbrhd area and these expenditures supprt $13.7 millin in ecnmic activity, with an assciated 93 jbs earning a ttal f $4.6 millin in salaries and wages and generated an estimated $0.9 millin in State and City gvernment revenues. Selected Scial and Cmmunity Impacts: Levindale Hspital spent nearly $3 millin t prvide cmmunity benefits t its Baltimre Metrplitan Area service area. Its main area f scial and cmmunity benefits is $1.4 millin in expenditures n Missin Driven Health Care Services r free r reduced price services prvided t the cmmunity as a direct result f its cmmunity service missin and the Hspital prvided nearly $1 millin in Charity Care. 39