2016-05-16T10:41:35-05:00 2015-06-30 560747981 DIXON HUGHES GOODMAN LLP 1410 SPRING HILL ROAD 5TH FLOOR TYSONS VA 22102 990 2014-07-01 521452024 CARROLL HOSPITAL CENTER INC CARR 4108716859 200 MEMORIAL AVENUE WESTMINSTER MD 21157 KEVIN KELBLY CFO 4108716859 2016-05-13 1 TAMARA VINEYARD P01775208 7039700400 2014 2016-12-15 16:53:06Z LESLIE SIMMONS 200 MEMORIAL AVE WESTMINSTER MD 21774 232375074 0 X WWW.CARROLLHOSPITALCENTER.ORG X 1957 MD OUR COMMUNITIES EXPECT AND DESERVE SUPERIOR MEDICAL TREATMENT, COMPASSIONATE CARE, AND EXPERT GUIDANCE IN MAINTAINING THEIR HEALTH AND WELL-BEING. AT CARROLL HOSPITAL CENTER, WE OFFER AN UNCOMPROMISING COMMITMENT TO THE HIGHEST QUALITY HEALTH CARE EXPERIENCE FOR PEOPLE IN ALL STAGES OF LIFE. WE ARE THE HEART OF HEALTH CARE IN OUR COMMUNITIES. 17 12 2038 348 2645858 -232849 3054000 3347840 222597736 227964993 3094568 471761 533617 575633 229279921 232360227 105000 173000 0 0 104572998 107497742 0 0 0 106936658 113474480 211614656 221145222 17665265 11215005 369751968 352894518 220555142 189476490 149196826 163418028 X OUR COMMUNITIES EXPECT AND DESERVE SUPERIOR MEDICAL TREATMENT, COMPASSIONATE CARE, AND EXPERT GUIDANCE IN MAINTAINING THEIR HEALTH AND WELL-BEING. AT CARROLL HOSPITAL CENTER, WE OFFER AN UNCOMPROMISING COMMITMENT TO THE HIGHEST QUALITY HEALTH CARE EXPERIENCE FOR PEOPLE IN ALL STAGES OF LIFE. WE ARE THE HEART OF HEALTH CARE IN OUR COMMUNITIES. 0 0 184616647 173000 225313054 CARROLL HOSPITAL CENTER, A 189 LICENSED BED ACUTE CARE FACILITY LOCATED IN WESTMINSTER, MARYLAND OFFERS THE LATEST IN MEDICAL TECHNOLOGY AND SERVICES, COMBINED WITH A STATE-OF-THE-ART FACILITY AND TOP-NOTCH, SKILLED MEDICAL PROFESSIONALS, CARING FOR PATIENTS WITH COMPASSION. CURRENTLY, THERE ARE MORE THAN 450 PHYSICIANS REPRESENTING 38 SPECIALTIES ON OUR MEDICAL STAFF IN ADDITION TO OVER 2,038 INDIVIDUALS EMPLOYED BY THE HOSPITAL - MAKING CHC THE SECOND LARGEST EMPLOYER IN CARROLL COUNTY. THE ORGANIZATION OPERATES AN ACUTE CARE HOSPITAL SERVING THE COMMUNITIES LOCATED IN CARROLL AND SURROUNDING COUNTIES AS WELL AS PARTS OF PENNSYLVANIA. IN ACCORDANCE WITH OUR TAX-EXEMPT FUNCTION THE ORGANIZATION OPERATES AN EMERGENCY ROOM OPEN TO ALL PERSONS REGARDLESS OF THEIR ABILITY TO PAY AND HAD 53,302 PATIENT VISITS LAST YEAR. THE HOSPITAL PARTICIPATES IN MEDICARE AND MEDICAID PROGRAMS, HAS A GOVERNING BODY COMPRISED OF INDEPENDENT PERSONS REPRESENTATIVE OF THE COMMUNITY, ALL FINANCIAL SURPLUSES THE HOSPITAL GENERATES ARE USED EXCLUSIVELY TO FURTHER THE CHARITABLE PURPOSES OF THE ORGANIZATION AND ITS MEDICAL STAFF IS OPEN TO ALL QUALIFIED PHYSICIANS IN THE AREA. AS THE ONLY HOSPITAL IN CARROLL COUNTY, WE OFFER OUR COMMUNITY A FULL ARRAY OF SERVICES INCLUDING, EMERGENCY SERVICES, COMPREHENSIVE CANCER CARE, PEDIATRICS, MATERNITY, GERIATRICS, THE LATEST MINIMALLY INVASIVE SURGICAL PROCEDURES AND ADVANCED TOTAL AND PARTIAL JOINT REPLACEMENT PROCEDURES. IN THE YEAR ENDING JUNE 2015, CARROLL HOSPITAL CENTER RECORDED 14,813 INPATIENT ADMISSIONS AND OBSERVATION STAY CASES, 1,079 BIRTHS AND 7,676 SURGICAL PROCEDURES, ALL CONTRIBUTING TO A TOTAL OF 181,671 PATIENT ENCOUNTERS FOR THE PERIOD. IN LINE WITH OUR MISSION-"OUR COMMUNITIES EXPECT AND DESERVE SUPERIOR MEDICAL TREATMENT, COMPASSIONATE CARE, AND EXPERT GUIDANCE IN MAINTAINING THEIR HEALTH AND WELL-BEING. AT CARROLL HOSPITAL CENTER, WE OFFER AN UNCOMPROMISING COMMITMENT TO THE HIGHEST QUALITY HEALTH CARE EXPERIENCE FOR PEOPLE IN ALL STAGES OF LIFE. WE ARE THE HEART OF HEALTH CARE IN OUR COMMUNITIES." - THE HOSPITAL ALSO PROVIDES PLANNED COMMUNITY BENEFIT ACTIVITIES TO IMPROVE ACCESS TO HEALTH CARE AND IMPROVE THE OVERALL HEALTH OF OUR COMMUNITY. OUR MISSION IS PURSUED IN COLLABORATION WITH OUR RELATED ORGANIZATIONS: CARROLL COUNTY HEALTH SERVICES, CARROLL HOSPICE, THE PARTNERSHIP FOR A HEALTHIER CARROLL COUNTY (OUR COMMUNITY ADVOCACY ARM), AND THE CARROLL HOSPITAL CENTER FOUNDATION (ALSO LISTED IN PART VI). FOR MORE INFORMATION ON THESE SUBSIDIARIES, PLEASE SEE THEIR INDIVIDUAL FORMS 990. 184616647 1 1 0 1 0 0 0 0 0 1 1 1 1 0 1 1 0 1 0 0 1 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 0 0 1 1 1 0 0 0 0 1 1 1 1 0 0 1 356 0 1 2038 1 1 1 1 CJ 0 0 0 0 0 0 0 0 X 17 12 1 0 1 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 1 CA MD IN MN X DAVID MCCORMICK 4108716859 200 MEMORIAL AVE WESTMINSTER MD 21157 CHARLES O FISHER JR BOARD MEMBER 1.00 1.00 X 0 0 0 DR SOHAILIA ALI BOARD MEMBER 1.00 1.00 X 0 0 0 ETHAN SEIDEL PHD BOARD MEMBER 1.00 1.00 X 0 0 0 GERALD LEE STURGILL EX-OFFICIO 1.00 2.00 X 0 0 0 HELEN W WHITEHEAD CHAIR 1.00 1.00 X X 0 0 0 JASON BLAVATT ESQUIRE BOARD MEMBER 1.00 2.00 X 0 0 0 JEFFREY A WOTHERS BOARD MEMBER 1.00 1.00 X 0 0 0 JOHN STEERS MD BOARD MEMBER 1.00 1.00 X 0 0 0 KIMBERLY JOHNSTON MD BOARD MEMBER 1.00 1.00 X 0 0 0 LARRY VAN SANT SR BOARD MEMBER 1.00 X 0 0 0 LESLIE SIMMONS CHIEF EXECUTIVE OFFICER 37.00 3.00 X X 539559 0 30839 MARCUS PRIMM BOARD MEMBER 1.00 1.00 X 0 0 0 MARTIN HILL BOARD MEMBER 1.00 1.00 X 0 0 0 MIRIAM BECK SECRETARY 2.00 1.00 X X 0 0 0 NEIL MELTZER BOARD MEMBER 1.00 X 0 1500322 359290 THOMAS WELLIVER BOARD MEMBER 1.00 1.00 X 0 0 0 W DENNIS THOMAS BOARD MEMBER 1.00 1.00 X 0 0 0 KEVIN KELBLY SR VP FINANCE CFO 35.00 5.00 X 432142 0 45334 BOB EDMONDSON VICE PRESIDENT 40.00 X 312132 0 38290 CRIS COLEMAN VICE PRESIDENT 40.00 X 225512 0 39721 DAVID LOUDER VICE PRESIDENT 39.00 1.00 X 370696 0 27496 JED ROSEN CHIEF MEDICAL INFO OFFICER 40.00 X 486262 0 10146 JOYCE ROMANS VICE PRESIDENT 40.00 X 250804 0 31523 M ELLEN FINNERTY MYERS CHIEF DEVELOPMENT OFFICER 20.00 20.00 X 284067 0 18538 MARK OLSZYK VICE PRESIDENT 40.00 X 435333 0 19078 ROBERT WHITE VICE PRESIDENT 40.00 X 212611 0 24798 SHARON GOMEZ-SANDERS VICE PRESIDENT 39.00 1.00 X 190933 0 36188 STEPHANIE REID VICE PRESIDENT 39.00 1.00 X 214615 0 16074 TRACEY ELLISON VICE PRESIDENT 40.00 X 236185 0 43106 DAVID SALINGER PHYSICIAN 39.00 1.00 X 671269 0 35234 FLAVIO KRUTER PHYSICIAN 39.00 1.00 X 964319 0 39391 JANICE NAPIERALSKI AVP 40.00 X 204244 0 69143 JOHANNA DIMENTO PHYSICIAN 40.00 X 409547 0 24587 RICHARD RAVER EMPLOYEE 40.00 X 170776 0 24855 JOHN SERNULKA PRESIDENT/EX-OFFICIO 0.00 0.00 X 1797802 0 59385 8408808 1500322 993016 109 1 1 0 CENTRAL MD REHABILITATION 4259 HARNEY RD TANEYTOWN MD 21787 REHABILITATION SERVICES 3397001 CARROLL CO ANESTHESIA ASSOC PA PO BOX 75193 BALTIMORE MD 21275 ANESTHESIA SERVICES 1950462 MDICS 7250 PARKWAY DRIVE SUITE 500 HANOVER MD 21072 PHYSICIAN SERVICES 1297375 DEVANEY & ASSOCIATES INC 135 VILLAGE QUEEN DRIVE OWINGS MILLS MD 21117 ADVERTISING 1211426 BRENDA RAY CCS 674 LAKE SANTEE DR NORTH AUGUSTA SC 29841 TRANSCRIPTION/CODING 740995 37 3303940 43900 3347840 NET PATIENT SERVICE REVENUE 621300 223685430 223685430 NONPATIENT LAB 621500 2651939 2651939 CAFETERIA/VENDING 999999 880618 880618 OTHER OPERATING REVENUE 999999 747006 747006 227964993 486608 -118956 605564 473100 0 473100 473100 22875 450225 14847 -14847 -14847 -14847 CARROLL COUNTY MED SERVICES MGMT 541610 90000 90000 OTHER REVENUE 999999 12533 12533 102533 232360227 225325587 2645858 1040942 X 173000 173000 6216968 6216968 83948115 78012680 5935435 2363220 2084124 279096 7729503 6542530 1186973 7239936 6384902 855034 13659 13659 245988 245988 481896 481896 25829144 19779950 6049194 782324 750487 31837 2102328 2047616 54712 94692 65464 29228 4098068 2529668 1568400 506594 206205 300389 91074 59186 31888 5894245 4731587 1162658 15186189 14548369 637820 2491078 1578487 912591 MEDICAL SUPPLIES 35453495 35444443 9052 CONTRACTED SERVICES 11134640 4141342 6993298 DUES BOOKS AND SUBSCRIP 2215529 373049 1842480 OTHER PURCHASED SERVICE 1905343 1376753 528590 4948194 3786805 1161389 221145222 184616647 36528575 0 10340 2480 22314068 11466277 23389282 19510699 3041830 3018003 5660075 6017164 296940518 178479720 151175891 118460798 53795622 52419933 33614935 24864195 42701587 94534542 3050000 12600000 30998338 10000427 369751968 352894518 28868635 23278070 303287 211663 139094739 96060517 52288481 69926240 220555142 189476490 X 137821978 103620476 10202084 58624788 1172764 1172764 149196826 163418028 369751968 352894518 X 11215005 723234 2282963 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 8166 8166 0 PART II-B, LINE 1: ATTORNEY FEES RELATED TO LOBBYING ACTIVITIES 13894871 50512667 410422 11500 64806460 12400252 192482 1322825 20688 13894871 10859176 405024 1147052 11000 12400252 10086170 735458 48548 11000 10859176 7900509 690978 1503183 8500 10086170 0.19000 0.02000 0.79000 0 1 1 1983973 1983973 115345793 49088365 66257428 8488827 8488827 0 141381536 110541996 30839540 29740389 10360532 19379857 118460798 SHORT TERM INVESTMENT 6907545 F LONG-TERM INVESTMENTS 17922674 F L-T INVESTMENTS IN EXEC OPTION PLAN 33976 F 24864195 INVESTMENTS IN FOUNDATION 71455110 F INVESTMENT IN PREMIER 195176 F INVESTMENT IN MT AIRY HEALTH SERVICE 288 F INVESTMENT IN COLONIAL 7362 F INVESTMENT IN CMOA 523192 F INVESTMENT IN HOSPICE 10218291 F INVESTMENT IN CARROLL COUNTY RADIOLOGY 5802522 F INVESTMENT IN CEN MAR 6332601 F 94534542 ADVANCES FROM THIRD PARTY 6731774 ACCRUED PENSION 7742535 CAPITAL LEASE 743156 MOB DEBT 17192397 DEFERRED COMPENSATION 33976 DUE TO CENMAR 10128937 DUE TO AFFILIATES 27353465 69926240 X PART X, LINE 2: EFFECTIVE ON APRIL 1, 2015, CARROLL COUNTY HEALTH SERVICES CORPORATION (CCHS), TOGETHER WITH ITS SUBSIDIARIES CARROLL HOSPITAL CENTER INC AND OTHER CARROLL ENTITIES, BECAME AFFILIATED WITH LIFEBRIDGE HEALTH INC. (LHI), A 501(C)(3) EXEMPT ORGANIZATION. BEGINNING ON THAT DATE THE FINANCIAL POSITIONS AND RESULTS OF CCHS WERE CONSOLIDATED IN THE LHI AUDITED FINANCIAL STATEMENTS. THE FOLLOWING IS THE FIN 48 STATEMENT DISCLOSED IN THE FOOTNOTE TO LHI'S AUDITED FINANCIAL STATEMENTS: LIFEBRIDGE AND ITS NOT-FOR-PROFIT SUBSIDIARIES HAVE BEEN RECOGNIZED BY THE INTERNAL REVENUE SERVICES AS TAX-EXEMPT PURSUANT TO SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. LIFEBRIDGE'S INCORPORATED FOR-PROFIT SUBSIDIARIES ACCOUNT FOR INCOME TAXES IN ACCORDANCE WITH FINANCIALS ACCOUNTING STANDARDS BOARD (FASB) ASC TOPIC 740, INCOME TAXES. INCOME TAXES ARE ACCOUNTED FOR UNDER THE ASSET AND LIABILITY METHOD. DEFERRED TAX ASSETS ARE LIABILITIES ARE RECOGNIZED FOR THE FUTURE TAX CONSEQUENCES ATTRIBUTABLE TO DIFFERENCES BETWEEN THE FINANCIAL STATEMENTS CARRYING AMOUNTS OF EXISTING ASSETS AND LIABILITIES AND THEIR RESPECTIVE TAX BASES AND OPERATING LOSS AND TAX CREDIT CARRYFORWARDS. DEFERRED TAX ASSETS AND LIABILITIES ARE MEASURED USING ENACTED TAX RATES EXPECTED TO APPLY TO TAXABLE INCOME IN THE YEARS IN WHICH THOSE TEMPORARY DIFFERENCES ARE EXPECTED TO BE RECOVERED OR SETTLED. THE EFFECT ON DEFERRED TAX ASSETS AND LIABILITIES OF A CHANGE IN TAX RATES IS RECOGNIZED IN THE PERIOD THAT INCLUDES THE ENACTMENT DATE. ANY CHANGES TO THE VALUATION ALLOWANCE OF THE DEFERRED TAX ASSET ARE REFLECTED IN THE YEAR OF THE CHANGE. THE CORPORATION ACCOUNTS FOR UNCERTAIN TAX POSITIONS IN ACCORDANCE WITH ASC TOPIC 740. CENTRAL AMERICA AND THE CARIBBEAN - ANTIGUA & BARBUDA, ARUBA, BAHAMAS, INVESTMENTS 17898527 0 0 0 0 0 0 17898527 0 17898527 1 0 1 1 1 0 1 1 1 X 300.000000000000 1 X 375.000000000000 1 1 0 1 1 936883 936883 0.00420 936883 936883 0.00420 3467095 171927 3295168 0.01490 531839 531839 0.00240 6351077 6351077 0.02870 198904 198904 0.00090 223194 223194 0.00100 10772109 171927 10600182 0.04790 11708992 171927 11537065 0.05210 552314 552314 0.00250 552314 552314 0.00250 0 4345000 332000 95562236 89294983 6267253 1 1 1 CARROLL COUNTY RADIOLOGY LLC IMAGING CENTER 0.60000 0.40000 1 1 CARROLL HOSPITAL CENTER 200 MEMORIAL AVE WESTMINSTER MD 21157 X CARROLL HOSPITAL CENTER 1 0 0 1 X X X X X X X X 12 1 0 0 1 X CARROLLHOSPITALCENTER.ORG X HEALTHYCARROLL.ORG X X 1 13 1 HEALTHYCARROLL.COM 0 0 1 X 300.000000000000 375.000000000000 X X 1 1 X X X 1 X CARROLLHOSPITAL.ORG X CARROLLHOSPITAL.ORG X CARROLLHOSPITAL.ORG X X X X X 1 X 0 X X X X 1 X 0 0 CARROLL HOSPITAL CENTER PART V, SECTION B, LINE 5: THE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) TOOK INTO ACCOUNT INPUT FROM REPRESENTATIVES OF THE COMMUNITY SERVED BY THE HOSPITAL FACILITY, INCLUDING PERSONS WITH SPECIAL KNOWLEDGE OF OR EXPERTISE IN PUBLIC HEALTH, AS WELL AS LEADERS AND REPRESENTATIVES OF MEDICALLY UNDERSERVED, LOW-INCOME, AND MINORITY POPULATIONS. THE CHNA WRITTEN REPORT INCORPORATED EXPERTISE AND PARTICIPATION FROM SUCH COMMUNITY LEADERS AND REPRESENTATIVES, AS WELL AS LEADERS IN PUBLIC HEALTH, INCLUDING REPRESENTATIVES FROM THE CARROLL COUNTY HEALTH DEPARTMENT. AS PART OF THE CHNA, A KEY INFORMANT SURVEY OF 54 COMMUNITY LEADERS FROM A BROAD RANGE OF ACADEMIC, BUSINESS, GOVERNMENT, NON-PROFIT, PUBLIC HEALTH AND HEALTH CARE FIELDS WAS UNDERTAKEN. AMONG THE INDIVIDUALS WHO COMPLETED THE KEY INFORMANT SURVEY WERE REPRESENTATIVES FROM SUCH COMMUNITY ORGANIZATIONS AS THE ARC CARROLL COUNTY, CHANGE, INC., Y OF CENTRAL MARYLAND, AND THE WOMEN'S PLACE, AS WELL AS PUBLIC HEALTH EXPERTS INCLUDING A WIDE RANGE OF PHYSICIANS AND NUMEROUS MEMBERS OF THE CARROLL COUNTY HEALTH DEPARTMENT. IN ADDITION, THE CHNA INCLUDES FINDINGS FROM THE MARYLAND STATE HEALTH IMPROVEMENT PROCESS (SHIP), CARROLL COUNTY SHIP PROFILE AND CARROLL COUNTY LOCAL HEALTH IMPROVEMENT PLAN. FURTHERMORE, LEADERS FROM THE CARROLL COUNTY HEALTH DEPARTMENT AND THE PARTNERSHIP FOR A HEALTHIER CARROLL COUNTY ARE MEMBERS OF A COMMITTEE THAT HELPS OVERSEE THE DEVELOPMENT AND EXECUTION OF THE CHNA PLAN. CARROLL HOSPITAL CENTER PART V, SECTION B, LINE 11: PURSUANT TO THE CHNA UNDERTAKEN BY CARROLL HOSPITAL CENTER, 20 COMMUNITY HEALTH NEEDS WERE IDENTIFIED. THEN, WORKING COLLABORATIVELY, HOSPITAL AND COMMUNITY PUBLIC HEALTH LEADERS, AS WELL AS THE HOSPITAL'S COMMUNITY BENEFIT PLANNING COMMITTEE, BEGAN PRIORITIZING THE FOCUS FOR ACTION IN THE NEXT THREE YEARS. IN PARTICULAR, A JOINT STRATEGIES MEETING WAS CONVENED TO HELP DETERMINE THE PRIORITIZATION OF THE IDENTIFIED COMMUNITY HEALTH NEEDS. DURING THE JOINT STRATEGY MEETING, EACH OF THE 20 IDENTIFIED COMMUNITY HEALTH NEEDS WAS ADDRESSED. TAKING INTO CONSIDERATION THE LIMITED FINANCIAL RESOURCES AVAILABLE TO THE HOSPITAL, THE 20 IDENTIFIED NEEDS WERE PRIORITIZED BY HOSPITAL AND COMMUNITY PUBLIC HEALTH LEADERS ON THE FOLLOWING CRITERIA: COMMUNITY IMPACT, URGENCY, SIZE, SEVERITY, ALIGNMENT WITH CARROLL HOSPITAL CENTER/ THE PARTNERSHIP FOR A HEALTHIER CARROLL COUNTY AND RETURN ON INVESTMENT. FINAL CRITERIA SELECTION WAS DETERMINED BY THE EXECUTIVE COUNCIL MEMBERS OF CARROLL HOSPITAL CENTER, IN COLLABORATION WITH THE PARTNERSHIP FOR A HEALTHIER CARROLL COUNTY BOARD.PURSUANT TO THIS PRIORITIZATION PROCESS, IT WAS DETERMINED THAT THE NEEDS THE CARROLL HOSPITAL CENTER HOSPITAL FACILITY WOULD ATTEMPT TO ADDRESS WOULD BE NARROWED DOWN TO SEVEN (7) KEY COMMUNITY BENEFIT ISSUES, SO AS TO MAXIMIZE THE HOSPITAL'S RESOURCES TO ADDRESS NEEDS THE HOSPITAL FELT IT WAS IN THE BEST POSITION TO ATTEMPT TO MEET. AMONG THOSE NEEDS THAT THE HOSPITAL FACILITY DETERMINED IT WOULD NOT SPECIFICALLY FOCUS UPON ADDRESSING WERE: HEALTH CARE TRANSPORTATION, MOTOR VEHICLE DEATHS, AGE DISCRIMINATION, ARTHRITIS, ASTHMA, FLU, AND ORAL HEALTH CARE. CARROLL HOSPITAL CENTER PART V, SECTION B, LINE 20E: THE HOSPITAL FACILITY OR AN AUTHORIZED THIRD PARTY DID NOT UNDERTAKE ANY OF THE COLLECTION ACTIONS NOTED IN PART V, SECTION B, LINE 17 BEFORE MAKING REASONABLE EFFORTS TO DETERMINE ANY PATIENTS ELIGIBILITY UNDER THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY. IN ORDER TO HELP DETERMINE PATIENTS' ELIGIBILITY UNDER THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY, THE HOSPITAL UNDERTAKES A NUMBER OF ACTIONS, INCLUDING NOTIFYING PATIENTS OF THE FINANCIAL ASSISTANCE POLICY ON ADMISSION, NOTIFYING PATIENTS OF THE FINANCIAL ASSISTANCE POLICY PRIOR TO DISCHARGE, NOTIFYING PATIENTS OF THE FINANCIAL ASSISTANCE POLICY IN COMMIUNICATIONS WITH THE PATIENTS' BILLS, AND DOCUMENTING ITS DETERMINATION OF WHETHER PATIENTS WERE EILIGIBLE FOR FINANCIAL ASSISTANCE UNDER THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY. CARROLL HOSPITAL CENTER PART V, SECTION B, LINE 22D: THE HOSPITAL FACILITY PROVIDES A DISCOUNT OF AT LEAST 25% OFF OF GROSS CHARGES FOR THE PROVISION OF EMERGENCY AND OTHER MEDICALLY NECESSARY CARE TO ANY INDIVIDUAL THAT IS ELIGIBLE FOR DISCOUNTED CARE UNDER THE HOSPITAL FACILITY'S FINANCIAL ASSISTANCE POLICY AND AT LEAST 15% OFF OF GROSS CHARGES FOR THE PROVISION OF EMERGENCY AND OTHER MEDICALLY NECESSARY CARE TO ANY INDIVIDUAL THAT QUALIFIES UNDER THE MEDICAL HARDSHIP PROVISIONS OF THE HOSPITAL FACILITY'S FINANCIAL ASSISTANCE POLICY. PURSUANT TO THE HEALTH SERVICES COST REVIEW COMMISSION (HSCRC) ALL-PAYOR SYSTEM FOR HOSPITALS IN THE STATE OF MARYLAND, THE GREATEST DISCOUNT OFF OF GROSS CHARGES FOR THE PROVISION OF EMERGENCY AND OTHER MEDICALLY NECESSARY CARE PERMITTED TO ANY COMMERCIAL INSURER OR MEDICARE IS ONLY 6% AS A RESULT, THE HOSPTIAL FACILITY WAS ABLE TO DETERMINE THAT THE MAXIMUM AMOUNT CHARGED TO INDIVIDUALS THAT WERE ELIGIBLE FOR FINANCIAL ASSISTANCE UNDER THE HOSPITAL FACILITY'S FINANCIAL ASSISTANCE POLICY WAS NOT GREATER THAN THE AMOUNT GENERALLY BILLED TO INDIVIDUALS WHO HAVE INSURANCE COVERING SUCH CARE. CARROLL HOSPITAL CENTER PART V, SECTION B, LINE 24: THE HOSPITAL FACILITY DOES NOT CHARGE ANY INDIVIDUALS THAT IT KNOWS ARE ELIGIBLE FOR FINANCIAL ASSISTANCE AN AMOUNT EQUAL TO THE GROSS CHARGE FOR ANY SERVICE. THE HOSPITAL USES THE CHARGE MASTER RATES FOR A SERVICE AS A STARTING POINT AGAINST WHICH THE DISCOUNTS MANDATED IN THE HOSPITAL FACILITY'S FINANCIAL ASSISTANCE POLICY ARE APPLIED TO DETERMINE THE AMOUNT ACTUALLY BILLED TO PATIENTS ELIGIBLE UNDER THE FINANCIAL ASSISTANCE POLICY. THE HOSPITAL FACILITY WILL NOT COLLECT PAYMENT FROM ANY PATIENT ELIGIBLE UNDER THE FINANCIAL ASSISTANCE POLICY IN EXCESS OF THE REDUCED AMOUNT THAT IS ACTUALLY BILLED TO SUCH FINANCIAL ASSISTANCE PATIENT. IN ADDITION, IF THE HOSPITAL CHARGED AN INDIVIDUAL THAT HAD NOT YET BEEN DETERMINED TO BE ELIGIBLE FOR FINANCIAL ASSISTANCE AT THE TIME OF THE CHARGE AN AMOUNT EQUAL TO GROSS CHARGES, THEN UPON DETERMINING THE INDIVIDUAL WAS ELIGIBLE FOR FINANCIAL ASSISTANCE UNDER THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY, THE HOSPITAL PROMPTLY CORRECTS THE BILL. PART V, SECTION B, LINE 16 FINANCIAL ASSISTANCE POLICY WEBSITE AVAILABILITY CARROLL HOSPITAL CENTER PART V, SECTION B, LINE 16A WEBSITE: CARROLLHOSPITAL.ORG CARROLL HOSPITAL CENTER PART V, SECTION B, LINE 16B WEBSITE: CARROLLHOSPITAL.ORG CARROLL HOSPITAL CENTER PART V, SECTION B, LINE 16C WEBSITE: CARROLLHOSPITAL.ORG 5 CARROLL COUNTY RADIOLOGY 7253 AMBASSADOR ROAD BALTIMORE MD 21244 IMAGING CENTER CARROLL COUNTY RADIOLOGY 1430 PROGRESS WAY STE 108 ELDERSBURG MD 21784 IMAGING CENTER CARROLL COUNTY RADIOLOGY 193 STONER AVE STE 200 WESTMINSTER MD 21157 IMAGING CENTER CARROLL COUNTY RADIOLOGY 1 VILLAGE SQUARE WESTMINSTER MD 21157 IMAGING CENTER CARROLL COUNTY RADIOLOGY 844 WASHINGTON ROAD STE 102 WESTMINSTER MD 21157 IMAGING CENTER PART I, LINE 3C: FOR PATIENTS THAT EXPERIENCE A MEDICAL HARDSHIP (MEDICAL DEBT THAT EXCEEDS 25% OF HOUSEHOLD INCOME), CARROLL HOSPITAL CENTER ALSO PROVIDES DISCOUNTED CARE FOR EMERGENCY OR OTHER MEDICALLY NECESSARY SERVICES TO INDIVIDUALS EARNING UP TO 500% OF THE FEDERAL POVERTY GUIDELINES. IF A PATIENT HAS RECEIVED REDUCED COST MEDICALLY NECESSARY CARE DUE TO A MEDICAL HARDSHIP, THE PATIENT OR ANY IMMEDIATE FAMILY MEMBER OF THE PATIENT LIVING IN THE SAME HOUSEHOLD SHALL REMAIN ELIGIBLE FOR REDUCED COST MEDICALLY NECESSARY CARE WHEN SEEKING SUBSEQUENT CARE AT THE SAME HOSPITAL DURING THE 12 MONTH PERIOD BEGINNING ON THE DATE ON WHICH THE REDUCED COST MEDICALLY NECESSARY CARE WAS INITIALLY RECEIVED.IN ADDITION, SOME PATIENTS ARE PRESUMED TO BE ELIGIBLE FOR FINANCIAL ASSISTANCE DISCOUNTS ON THE BASIS OF LIFE CIRCUMSTANCES. THESE PATIENTS THAT THE HOSPITAL HAS DETERMINED PRESUMPTIVELY QUALIFY FOR FINANCIALASSISTANCE ARE NOT REQUIRED TO COMPLETE ADDITIONAL FORMS OR PROVIDE ADDITIONAL INFORMATION AND ARE GRANTED 100% FINANCIAL ASSISTANCE DISCOUNTS. THE HOSPITAL INTERNALLY DOCUMENTS ANY AND ALL RECOMMENDATIONS TO PROVIDE PRESUMPTIVE FINANCIAL ASSISTANCE DISCOUNTS FROM PATIENTS AND OTHER SOURCES, SUCH AS PHYSICIANS, COMMUNITY OR RELIGIOUS GROUPS, INTERNAL OR EXTERNAL SOCIAL SERVICES OR FINANCIAL COUNSELING PERSONNEL.THE FOLLOWING ARE EXAMPLES OF PATIENT SITUATIONS THAT MAY REASONABLY ASSIST IN THE DETERMINATION OF PRESUMPTIVE ELIGIBILITY FOR FINANCIAL ASSISTANCE: (1) PATIENT HAS RECEIVED CARE FROM AND/OR HAS PARTICIPATED IN WOMEN'S, INFANTS AND CHILDREN (WIC) PROGRAMS, (2) PATIENT IS HOMELESS AND/OR HAS RECEIVED CARE FROM A HOMELESS CLINIC, (3) PATIENT'S FAMILY IS ELIGIBLE FOR AND IS RECEIVING FOOD STAMPS, (4) PATIENT'S FAMILY IS ELIGIBLE FOR AND IS PARTICIPATING IN SUBSIDIZED SCHOOL LUNCH PROGRAMS, (5) PATIENT QUALIFIES FOR OTHER STATE OR LOCAL ASSISTANCE PROGRAMS THAT ARE UNFOUNDED OR THE PATIENT'S ELIGIBILITY HAS BEEN DISMISSED DUE TO A TECHNICALITY (I.E. MEDICAID SPEND-DOWN), (6) FAMILY OR FRIENDS OF A PATIENT HAVE PROVIDED INFORMATION ESTABLISHING THE PATIENT'S INABILITY TO PAY, (7) THE PATIENT'S STREET ADDRESS AND DOCUMENTATION EVIDENCING STATUS IN AN AFFORDABLE OR SUBSIDIZED HOUSING DEVELOPMENT, (8) PATIENT/GUARANTOR'S WAGES ARE INSUFFICIENT FOR GARNISHMENT, AS DEFINED BY STATE LAW, OR (9) PATIENT IS DECEASED, WITH NO KNOWN ESTATE. PART I, LINE 7G: CARROLL HOSPITAL CENTER INCURRED $6.4 MILLION OF NET COMMUNITY BENEFIT EXPENSE AS A RESULT OF UNDERTAKING SUBSIDIZED HEALTH SERVICES.A SHORTAGE OF PRIMARY OR SPECIALTY PROVIDERS HAS PERHAPS POSED THE MOST SIGNIFICANT CHALLENGES IN INPATIENT CARE DELIVERY. SUBSTANTIAL PHYSICIAN SUBSIDIES HAVE BECOME NECESSARY TO ENSURE THAT ALL PATIENTSREQUIRING ANESTHESIA AND PEDIATRIC, PSYCHIATRIC, OBSTETRICAL AND CRITICAL AND GENERAL MEDICAL CARE HAVE THE ACCESS THEY NEED ONCE ADMITTED TO THE HOSPITAL, INCLUDING 24/7 COVERAGE. CARROLL HOSPITAL CENTER HASHOSPITALIST PROGRAMS IN EACH OF THESE AREAS AND ALLOCATES A SIGNIFICANT AMOUNT OF RESOURCES SUSTAINING THE PROGRAMS.IN FY15, APPROXIMATELY $7.7 MILLION WAS SPENT IN ENSURING CARE FOR ALL PATIENTS AND RECRUITING AND RETAINING PHYSICIANS.EQUALLY IMPORTANT IS ACCESS TO PHYSICIANS ON AN OUTPATIENT BASIS, NOT JUST FOR THE UNINSURED, BUT ALSO FOR ALL PATIENTS IN OUR GROWING COMMUNITY. TO ENSURE OUR COMMUNITY HAS ACCESS TO QUALITY PHYSICIANS, CARROLL HOSPITAL CENTER CONTINUALLY MONITORS STATISTICALLY CALCULATED NEED BY DEVELOPING A COMPREHENSIVE MEDICAL STAFF DEVELOPMENT PLAN BASED ON THE HEALTH CARE NEEDS OF OUR MEDICAL SERVICE AREA. THE REPORT INCLUDES BOTH AN ANALYSIS OF THE HOSPITAL'S SERVICE AREA AND SPECIFIC RECOMMENDATIONS REGARDING APPROPRIATE STAFFING LEVELS IN A VARIETY OF MEDICAL SPECIALTIES. THE PHYSICIAN NEEDS ASSESSMENT METHODOLOGY USED IS BASED ON A QUALITATIVE STANDARD ESTABLISHED BY THE INTERNAL REVENUE SERVICE (IRS). THE REPORT GUIDES THE HOSPITAL'S RECRUITING STRATEGY, HELPS US TO PRIORITIZE RECRUITING EFFORTS AND ALLOWS THE HOSPITAL TO PLACE CONTINGENCIES ON RECRUITED PHYSICIANS TO ENSURE THEY SEE MEDICALLY UNDERSERVED, UNINSURED, MEDICARE AND MEDICAID PATIENTS.WHILE CARROLL HOSPITAL CENTER CARES FOR PATIENTS WITH NO MEANS TO PAY THEIR MEDICAL EXPENSES THROUGHOUT THE HOSPITAL, IT IS SEEN MOST ACUTELY IN THE EMERGENCY DEPARTMENT (ED), WHERE MANY UNINSURED PATIENTS OFTEN COME FOR PRIMARY AND EMERGENT CARE. SINCE ALL PATIENTS PRESENTING TO THE ED ARE TREATED FOR ANY MEDICAL CONDITION REGARDLESS OF THEIR ABILITY TO PAY FOR CARE, THE UNINSURED POPULATION POSES A SIGNIFICANT CHALLENGE NOT ONLY TO THE HOSPITAL, BUT ALSO TO PHYSICIANS PROVIDING CARE IN THE HOSPITAL AND IN THE ED. DUE IN PART TO A LACK OF, OR MINIMAL REIMBURSEMENT, IT HAS BECOME INCREASINGLY DIFFICULT TO FIND SPECIALISTS TO PROVIDE ON-CALL SERVICES FOR THE ED AROUND-THE-CLOCK. THE MORE SERIOUS ISSUE IS THAT THIS TREND AFFECTS NOT ONLY OUR UNINSURED PATIENTS, BUT ALL PATIENTS SEEKING TREATMENT IN OUR ED.THE LIKELIHOOD THAT PATIENTS PRESENT MORE ACUTELY IN THE UNINSURED POPULATION AND THE ACCOMPANYING INCREASED POTENTIAL FOR MALPRACTICE CLAIMS ALSO HAS CONTRIBUTED TO SPECIALISTS CHOOSING NOT TO COVER NONPAYING PATIENTS IN THE ED. THAT GAP IS MOST SIGNIFICANT IN SURGICAL SPECIALTIES INCLUDING, ORTHOPAEDICS, OTOLARYNGOLOGY (ENT), GENERAL SURGERY AND PLASTIC SURGERY. THERE ALSO HAS BEEN INCREASING RELUCTANCE FROM OTHER SPECIALTIES WITH SIGNIFICANT ED VOLUMES, INCLUDING VASCULAR SURGERY, NEUROSURGERY AND NEUROLOGY.TO HELP EASE THE EFFECTS OF UNCOMPENSATED CARE ON PHYSICIANS AND ADDRESS THE GAP IN CARE FOR OUR PATIENTS, CARROLL HOSPITAL CENTER HAS CONTINUED TWO MAJOR, COSTLY INITIATIVES TO ADDRESS THE GAP PROACTIVELY. FIRST, THE HOSPITAL CONTRACTS WITH 10 MEDICAL SPECIALTIES TO ENSURE 24/7 COVERAGE IN THE ED. IMPLEMENTED IN 2006, THOSE SPECIALTIES INCLUDE NEUROSURGERY; GENERAL, PLASTIC, VASCULAR AND ORAL SURGERY; ORTHOPAEDICS; UROLOGY; PODIATRY; OPHTHALMOLOGY AND ENT. ADDITIONALLY, THE GROWING VOLUMES OF UNINSURED PATIENTS HAS CAUSED THE HOSPITAL TO RECENTLY INSTITUTE AN ADDITIONAL POLICY WHICH ALLOWS PHYSICIANS WHO SEE PATIENTS WITHOUT A PAYMENT SOURCE IN THE ED TO BE REIMBURSED FOR PHYSICIAN SERVICES BY THE HOSPITAL AT CURRENT MEDICARE RATES. WHILE PAYMENT FOR ED CALL MAY HELP WITH THE GAPS IN COVERAGE FOR THE UNINSURED, IT BEARS A SIGNIFICANT FINANCIAL TOLL ON THE HOSPITAL. THE EXPENSE TO PAY PHYSICIANS FOR ED CALL HAS COST THE HOSPITAL $854,602 IN FY15.ALL THE INITIATIVES AND SUPPORT LISTED ABOVE WOULD NOT BE PROVIDED IF CARROLL HOSPITAL CENTER DID NOT PROVIDE THEM. AS THE ONLY HOSPITAL IN THE COUNTY, IT IS OUR PRIMARY RESPONSIBILITY TO PROVIDE THESE SERVICES FOR THE UNINSURED AND UNDERINSURED, AS WELL AS ALL COMMUNITY MEMBERS. NO OTHER ORGANIZATION OR INDIVIDUAL IN THE COUNTY WOULD BE ABLE TO PROVIDE ALL OF THESE COMPREHENSIVE SERVICES IN THE AREAS THAT THE HOSPITAL DOES. PART I, LINE 5A CARROLL HOSPITAL CENTER DOES NOT DENY FINANCIAL ASSISTANCE TO ANY PATIENT ELIGILBE FOR FREE OR DISCOUNTED CARE UNDER ITS FINANCIAL ASSISTANCE POLICY REGARDLESS OF WHETHER OR NOT THE FINANCIAL ASSISTANCE BUDGET WAS EXCEEDED. PART I, LINE 6A MARYLAND HOSPITALS ARE REQUIRED TO SUBMIT AN ANNUAL COMMUNITY BENEFIT REPORT TO THE HEALTH SERVICES COST REVIEW COMMISSION (HSCRC) THAT DESCRIBES THE PROGRAMS AND SERVICES OFFERED THAT ARE DESIGNED TO PROMOTE THE HEALTH AND WELLNESS OF THE COMMUNITIES SERVED. THESE REPORTS ARE AVAILABLE TO THE PUBLIC ON THE HSCRC WEBSITE (WWW.HSCRC.STATE.MD.US). ADDITIONALLY, CARROLL HOSPITAL CENTER MAKES AVAILABLE ITS COMMUNITY BENEFIT REPORT ON ITS WEBSITE (WWW.CARROLLHOSPITALCENTER.ORG) PART I, LINE 7A MARYLAND'S REGULATORY SYSTEM CREATES A UNIQUE PROCESS FOR HOSPITAL PAYMENT THAT DIFFERS FROM THE REST OF THE NATION. THE HEALTH SERVICES COST REVIEW COMMISSION (HSCRC) DETERMINES PAYMENT THROUGH A RATE-SETTING PROCESS AND ALL PAYORS, INCLUDING GOVERNMENTAL PAYORS, PAY THE SAME AMOUNT FOR THE SAME SERVICES DELIVERED AT THE HOSPITAL. MARYLAND'S UNIQUE ALL-PAYOR SYSTEM INCLUDES A METHOD FOR REFERENCING UNCOMPENSATED CARE IN EACH PAYOR'S RATES, WHICH DOES NOT ENABLE MARYLAND HOSPITALS TO BREAKOUT ANY OFFSETTING REVENUE RELTED TO UNCOMPENSATED CARE. PART I, LINE 7A, COLUMN C THE METHODOLOGY USED TO CALCULATE CHARITY CARE COST WAS A COST-TO-CHARGE RATIO DERIVED FROM WORKSHEET 2, RATIO OF PATIENT CARE-TO-CHARGES. PART I, LINE 7B MARYLAND'S REGULATORY SYSTEM CREATES A UNIQUE PROCESS FOR HOSPITAL PAYMENT THAT DIFFERS FROM THE REST OF THE NATION. THE HEALTH SERVICES COST REVIEW COMMISSION (HSCRC) DETERMINES PAYMENT THROUGH A RATE-SETTING PROCESS AND ALL PAYORS, INCLUDING GOVERNMENTAL PAYORS, PAY THE SAME AMOUNT FOR THE SAME SERVICES DELIVERED AT THE HOSPITAL. MARYLAND'S UNIQUE ALL-PAYOR SYSTEM INCLUDES A METHOD FOR REFERENCING UNCOMPENSATED CARE IN EACH PAYOR'S RATES, WHICH DOES NOT ENABLE MARYLAND HOSPITALS TO BREAKOUT ANY OFFSETTING REVENUE RELTED TO UNCOMPENSATED CARE. COMMUNITY BENEFIT EXPENSES ARE EQUAL TO MEDICAID REVENUES IN MARYLAND, AS SUCH, THE NET EFFECT IS ZERO. THE EXCEPTION TO THIS IS THE IMPACT ON THE HOSPITAL FOR ITS SHARE OF MEDICAID ASSESSMENT. IN RECENT YEARS THE STATE OF MARYLAND HAS CLOSED FISCAL GAPS IN THE STATE MEDICAID BUDGET BY ASSESSING HOSPITALS THROUGH THE RATE-SETTING SYSTEM. FOR TAX YEAR 2012 CARROLL HOSPITAL CENTER'S MEDICAID BUDGET DEFICIT UNFUNDED ASSESSMENT AMOUNTED TO $929,190 PART I LINE 7F MARYLAND'S REGULATORY SYSTEM CREATES A UNIQUE PROCESS FOR HOSPITAL PAYMENT THAT DIFFERS FROM THE REST OF THE NATION. THE HEALTH SERVICES COST REVIEW COMMISSION (HSCRC) DETERMINES PAYMENT THROUGH A RATE-SETTING PROCESS AND ALL PAYORS, INCLUDING GOVERNMENTAL PAYORS, PAY THE SAME AMOUTN FOR THE SAME SERVICES DELIVERED AT THE SAME HOSPITAL. MARYLAND'S UNIQUE ALL-PAYOR SYSTEM INCLUDES A METHOD FOR REFERENCING UNCOMPENSATED CARE IN EACH PAYOR'S RATES, WHICH DOES NOT ENABLE MARYLAND HOSPITALS TO BREAKOUT ANY OFFSETTING REVENUE RELATED TO UNCOMPENSATED CARE. PART III, LINE 4: CARROLL HOSPTIAL CENTER INCURRED $4,345,000 BAD DEBT EXPENSE DURING THE TAX YEAR 2015. THIS REFLECTS THE AMOUNT OF GROSS PATIENT CHARGES UNCOLLECTED FROM PATIENTS THAT DID NOT QUALIFY FOR FINANCIAL ASSISTANCE. PER AUDIT REPORT (1N "PROVISION FOR BAD DEBTS"): "PATIENT ACCOUNTS RECEIVABLE ARE REDUCED BY PROVISION FOR BAD DEBTS. IN EVALUATING THE COLLECTABILITY OF ACCOUNTS RECEIVABLE, THE HEALTH SYSTEM ANALYZES HISTORICAL COLLECTIONS AND WRITE-OFFS AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE PROVISION FOR BAD DEBTS AND PROVISION FOR UNCOLLECTIBLE ACCOUNTS. MANAGEMENT REGULARLY REVIEWS ITS ESTIMATE AND EVALUATES THE SUFFICIENCY OF THE ALLLOWANCE FOR BAD DEBTS. THE HEALTH SYSTEM ANALYZES CONTRACTUAL AMOUNTS DUE FORM PATIENTS WHO HAVE THIRD PARTY COVERAGE AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS. FOR PATIENT ACCOUNTS RECEIVABLE ASSOCIATED WITH SELF-PAY PATIENTS, WHICH INCLUDES THOSE PATIENTS WIHTOUT INSURANCE COVERAGE EXISTS FOR A PORTION OF THE BILL, THE HEALTH SYSTEM RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS FOR PATIETNS THAT ARE UNABLE OR UNWILLING TO PAY FOR THE PORTION OF THE BILL REPRESENTING THEIR FINANCIAL RESPONSIBILITY. ACCOUNT BALANCES ARE CHARGED OFF AGAINST THE ALLOWANCE FOR BADE DEBTS AFTER ALL MEANS OF COLLECTION HAS BEEN EXHAUSTED. BAD DEBT EXPENSE REPORTED ON LINE 2 REFLECTS ACTUAL PATIENT CHARGES THAT HAVE BEEN DETERMINED TO BE UNCOLLECTIBLE FOR PATIENTS THAT HAVE NOT QUALIFIED FOR CHARITY CARE. BAD DEBT EXPENSE MAY ALSO INCLUDE ADDITIONAL "BAD DEBT PROVISIONS" FOR DOUBTFUL ACCOUNTS BASED ON MANAGEMENT'S ESTIMATES OF FUTURE ACCOUNT COLLECTIONS BASED ON CHARGES IN SERVICE MIX AND PAYOR MIX. CARROLL HOSPITAL CENTER INC. DETERMINES ELIGIBILITY FOR FINANCIAL ASSISTANCE THROUGH OTHER VARIOUS MEANS (CREDIT REPORTS, DEBT AND ASSET REVIEWS, AND REFERRALS FROM THE HOSPITAL'S BILLING AGENTS) WHEN THE PATIENT HAS NOT COMPLETED THE FINANCIAL ASSISTANCE APPLICATION. IF A DETERMINATION IS MADE REGARDING THE PATIENT'S INABILITY TO PAY, THE ACCOUNT CAN BE APPROVED FOR FINANCIAL ASSISTANCE ON A PRESUMPTIVE BASIS RATHER THAN BE REFLECTED AS BAD DEBT EXPENSE. OF THE REMAINING BAD DEBT EXPENSE, IT IS ESTIMATED THAT $332,000 AT COST MAY BE ATTRIBUTABLE TO PATIENTS ELIGIBLE FOR FINANCIAL ASSISTANCE/CHARITY CARE. PART III, LINE 8: CARROLL HOSPITAL CENTER'S TAX YEAR 2014 (FISCAL YEAR 2015) MEDICARE COST REPORT SUBMISSION WAS UTILIZED AS THE SOURCE DOCUMENT TO REPORT MEDICARE TOTAL REVENUE AND ALLOWABLE COSTS. PART III, LINE 9B: FOR THOSE PATIENTS THAT DO NOT INITIALLY APPLY OR QUALIFY FOR FINANCIAL ASSISTANCE, THE ORGANIZATION CONTINUES TO MONITOR WHETHER THE PATIENT MAY QUALIFY FOR FINANCIAL ASSISTANCE. IF THE PATIENT IS FOUND TO BE ELIGIBLE FOR FINANCIAL ASSISTANCE, AT ANY POINT (INCLUDING ONCE COLLECTION EFFORTS HAVE BEGUN), THE ORGANIZATION WILL APPROVE THE PATIENT FOR FINANCIAL ASSISTANCE. COLLECTION EFFORTS WILL BE STOPPED IMMEDIATELY ONCE THE PATIENT IS FOUND TO QUALIFY FOR FINANCIAL ASSISTANCE UNDER THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY. PATIENTS DETERMINED TO BE ELIGIBLE FOR FINANCIAL ASSISTANCE SUBSEQUENT TO THE DATE OF SERVICE MAY BE ELIGIBLE FOR A REFUND OF PAYMENTS MADE IF IT IS DETERMINED THAT THE PATIENT WAS ELIGIBLE FOR FINANCIAL ASSISTANCE AT THE TIME OF SERVICE. PART VI, LINE 2: MONITORING THE HEALTH STATUS OF THE COMMUNITY IS AN ONGOING AND INTERACTIVE PROCESS ENGAGED IN BY THE HOSPITAL, WITH SUBSTANTIAL INVOLVEMENT FROM OUR COMMUNITY VIA THE PARTNERSHIP FOR A HEALTHIER CARROLL COUNTY, INC. ("THE PARTNERSHIP"), AN ENTITY ESTABLISHED BY THE HOSPITAL AND THE CARROLL COUNTY HEALTH DEPARTMENT SPECIFICALLY TO ASSESS UNMET HEALTH NEEDS IN THE COMMUNITY, EXPAND THE CAPACITY FOR HEALTH ANDQUALITY OF LIFE IMPROVEMENT IN THE COMMUNITY, SERVE AS A COLLABORATIVE VEHICLE FOR INTERACTION WITH THE COMMUNITY, AND WITH OUR COMMUNITY, TO DRIVE THE EFFORT TO CREATE A HEALTHIER CARROLL COUNTY. THE PARTNERSHIP IS A RELATED SECTION 501(C)(3) TAX-EXEMPT ORGANIZATION OF THE HOSPITAL, WHICH RECEIVES A MAJORITY OF ITS OPERATING FUNDS FROM CONTRIBUTIONS MADE DIRECTLY BY THE HOSPITAL.IMPROVEMENT IN THE CORE HEALTH IMPROVEMENT AREAS (C.H.I.A.S) IS ONE OF THE HOSPITAL'S GOALS. THE C.H.I.A.S ARE THE NEED AREAS REQUIRING INDIVIDUAL AND ORGANIZATIONAL ACTION TO ACHIEVE TARGETED IMPROVED STATUS USING THE U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES' HEALTHY PEOPLE 2020 TARGETS AS THE BENCHMARK. THE HOSPITAL PARTICIPATES ACTIVELY IN MANY OF THE C.H.I.A. LEADERSHIP TEAMS COMPRISED OF DIVERSE INDIVIDUALS AND ORGANIZATIONS FROM THROUGHOUT THE HOSPITAL'S SERVICE AREA, WHO SHARE EXPERTISE AND INTEREST IN THE CHIA. WITH SUPPORT AND GUIDANCE FROM THE PARTNERSHIP, THOSE LEADERSHIP TEAMS DEVELOP AND IMPLEMENT ACTION PLANS SPECIFICALLY INTENDED TO ACCOMPLISH TARGETED RESULTS. "HEALTHY CARROLL VITAL SIGNS" (DESCRIBED BELOW) ARE THEN AFFIRMED, ARE SPECIFIC TO EACH CHIA LEADERSHIP TEAM AND SERVE AS ONE OF THE PRIMARY TOOLS FOR MEASURING AND REPORTING RESULTS TO THE HOSPITAL LEADERSHIP AND TO THE COMMUNITY. RECENTLY THE HOSPITAL HAS COLLABORATED WITH THE PARTNERSHIP WITH RESPECT TO AN ASSESSMENT OF HEALTH NEEDS VIA MARYLAND'S STATE HEALTH IMPROVEMENT PROCESS (S.H.I.P.), WHICH WAS ORGANIZED TO PRODUCE A LOCAL HEALTHIMPROVEMENT PLAN (L.H.I.P.). THE PARTNERSHIP ORGANIZATION ENTHUSIASTICALLY AGREED TO SERVE AS THE LOCAL COALITION REQUIRED IN THE S.H.I.P. PROCESS. THIS PROVIDED CARROLL HOSPITAL CENTER YET ANOTHER OPPORTUNITY FOR LINKAGE TO IMPORTANT, VALIDATED INFORMATION ABOUT HEALTH NEEDS IN OUR COMMUNITY AND ONGOING OPPORTUNITIES TO COLLABORATE WITH OUR LOCAL AND STATE HEALTH DEPARTMENT REGARDING IMPLEMENTATION STRATEGIES FOR TARGETED RESULTS.PURSUANT TO THE S.H.I.P. ASSESSMENT, THIRTY-NINE "HIGH IMPACT OBJECTIVES" WERE IDENTIFIED BY THE STAFF AT MARYLAND'S DEPARTMENT OF HEALTH AND MENTAL HYGIENE. A CARROLL COUNTY SPECIFIC DATA PROFILE SERVED AS THEBASELINE DOCUMENT. AFTER THOROUGH ANALYSIS, A LOCAL TEAM, WHICH INCLUDED THE HOSPITAL, PRODUCED A LOCAL HEALTH IMPROVEMENT PLAN (L.H.I.P.) ADDRESSING FIVE PRIORITY NEED AREAS. THE S.H.I.P. AND L.H.I.P. PROVIDEANOTHER IMPORTANT SET OF VERY USEFUL INFORMATION AND IS BEING FULLY INTEGRATED WITHIN THE HOSPITAL'S FIRST IRS COMPLIANT COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) AND COMMUNITY BENEFIT PLANNING PROCESSES. THE HOSPITAL AND THE PARTNERSHIP HAVE CONDUCTED MULTIPLE PREVIOUS NEEDS ASSESSMENTS, HAVE MADE REAL PROGRESS TOWARDS COMMUNITY ENGAGEMENT IN THESE PROCESSES AND HAVE INTEGRATED ANNUAL MEASUREMENT SYSTEMS INTO THEHEALTH IMPROVEMENT WORK KNOWN AS "HEALTHY CARROLL VITAL SIGNS (HCVS)." THESE MEASURES BUILD ON NATIONAL BENCHMARKS AND IMPROVEMENT TARGETS SUCH AS HP 2020. FUTURE EDITIONS OF HEALTHY CARROLL VITAL SIGNS WILL ALSO INTEGRATE S.H.I.P. 2014 BENCHMARKS AND IMPROVMENT TARGETS.DURING THE 2012 TAX YEAR, THE HOSPITAL CONDUCTED ITS FIRST COMMUNITY HEALTH NEEDS ASSESSMENT IN COMPLIANCE WITH IRS REQUIREMENTS ("CHNA"). SHORTLY THEREAFTER, THE HOSPITAL BEGAN TO UNDERTAKE CERTAIN INITIATIVES IDENTIFIED IN THE CHNA IMPLEMENTATION STRATEGY TO BEGIN TO ATTEMPT TO MEET IDENTIFIED COMMUNITY HEALTH NEEDS. THE INITIATIVES UNDERTAKEN DURING THE 2012 TAX YEAR TO HELP MEET IDENTIFIED COMMUNITY HEALTH NEEDS ARE FURTHER DESCRIBED IN THE DISCLOSURE TO PART V, SECTION B LINE 6. PART VI, LINE 3: CARROLL HOSPITAL CENTER (CHC) HAS A NUMBER OF PROGRAMS TO ASSIST PATIENTS WITH THEIR PAYMENT OBLIGATIONS. FIRST, WE PROVIDE A MEDICAID ENROLLMENT SERVICE TO PATIENTS WHO QUALIFY FOR MEDICAL ASSISTANCE. THIS SERVICE ASSISTS PATIENTS WITH PAPERWORK AND WILL EVEN PROVIDE TRANSPORTATION IF NEEDED. THIS PAST YEAR, CHC ASSISTED 235 PATIENTS IN APPLYING FO THE STATE'S MEDICAL ASSISTANCE PROGRAM. FOR PATIENTS WHO DO NOT QUALIFY FOR MEDICAID COVERAGE, CHC HAS AN IN-HOUSE FINANCIAL ASSISTANCE PROGRAM. OUR ELIGIBILITY STANDARDS ARE MORE LENIENT THAN EVEN THOSE PROPOSED BY THE MARYLAND HOSPITAL ASSOCIATION GUIDELINES. WE WRITE OFF 100% OF THE BILL FOR PATIENTS WHOSE INCOME IS BELOW 300% OF THE FEDERAL POVERTY GUIDELINES (FPG) AND WRITE OFF A PORTION OF THE BILL FOR PATIENTS WHOSE INCOME IS BETWEEN 301%-375% OF THE FPG. WHEN PATIENTS EXPRESS THEIR INABILITY TO PAY FOR SERVICES, OUR STAFF WORKS TO FIND THE BEST POSSIBLE OPTION FOR THEM BY DISCUSSING IN DETAIL THEIR SITUATION. THE FAMILY IS INVOLVED IN THOSE CONVERSATIONS TO THE EXTENT THE PATIENT FEELS COMFORTABLE. THE HOSPITAL ALSO HAS A PROCESS IN PLACE FOR PATIENTS TO HAVE FINANCIAL ASSISTANCE DECISIONS RECONSIDERED AND THAT PROCESS IS CLEARLY OUTLINED IN OUR FINANCIAL ASSISTANCE POLICY AND IN INFORMATION PROVIDED TO OURPATIENTS. IN ADDITION, FOR PATIENTS WITH INCOME BELOW 500% OF THE FPG AND WHOSE MEDICAL DEBT AT CHC IS IN EXCESS OF 25% OF THEIR HOUSEHOLD INCOME, THE HOSPITAL HAS A MEDICAL HARDSHIP PLAN THAT PROVIDES FOR REDUCED-COST CARE. IN ADDITION TO THE SIGNAGE AND PRINT COMMUNICATION, CARROLL HOSPITAL ALSO PROVIDES SERVICES AND INFORMATION DURING THE IN-TAKE AND DISCHARGE PROCESS. OUR POLICY IS OFFERED TO ANY PATIENT AT ALL ACCESS POINTS WHO IS EITHER UNINSURED OR UNDER-INSURED. PATIENTS ARE PRE-SCREENED FOR SCHEDULED SERVICES AND DO NOT NEED TO EXPRESS A HARDSHIP; RATHER, WE REACH OUT TO THEM PRIOR TO SERVICE TO DETERMINE IF THEY MAY MEET ELIGIBILITY FOR ANY PROGRAM OFFERED. OUR ADMITTED PATIENTS WHO ARE UNINSURED ARE VISITED BY FINANCIAL COUNSELORS AT BEDSIDE FOR CONSIDERATION OF ANY AND ALL PROGRAMS OF ASSISTANCE. APPLICATIONS FOR MEDICAID AND FINANCIAL ASSISTANCE ARE STARTED AT THAT POINT. IN ORDER TO ENSURE THERE ARE NO LANGUAGE BARRIERS, INTERPRETERS ARE USED IN THE APPLICATION PROCESS FOR EVERY PATIENT THAT NEEDS ONE. FAMILY MEMBERS ARE INVOLVED, AS THE PATIENT ALLOWS. CARROLL HOSPITAL HAS IMPLEMENTED A DISCHARGE PROCESS IN THE EMERGENCY DEPARTMENT TO ASSIST UNINSURED PATIENTS WITH MEDICAL ASSISTANCE APPLICATIONS ONLINE, IF THEIR HEALTH CONDITION ALLOWS. PATIENTS ARE PROVIDED A COPY OF THE FINANCIAL ASSISTANCE APPLICATION ALONG WITH CONTACT INFORMATION AND ENCOURAGED TO COMPLETE IT AT THE TIME OF SERVICE. FOLLOW-UP CALLS ARE MADE BY THE FINANCIAL COUNSELING OFFICE FOR RESOLUTION. WE ALSO HAVE STAFF MEMBERS WHO ARE CERTIFIED SSI/SSDI OUTREACH, ACCESS, AND RECOVERY(SOAR) SURROGATES, AND THEY SCREEN PATIENTS FOR ELIGIBILITY AND COMPLETE THE APPLICATION PROCESS. THE HOSPITAL ALSO ASSISTS WITH MARYLAND HEALTH INSURANCE PLAN (MHIP). PART VI, LINE 4: AS THE ONLY HOSPITAL IN THE COUNTY, CHC'S PRIMARY SERVICE AREA IS THE ENTIRE COUNTY. THE HOSPITAL DOES, HOWEVER, ALSO SERVE PORTIONS OF BALTIMORE, FREDERICK AND MONTGOMERY COUNTIES AS WELL AS AREAS IN SOUTHERN PENNSYLVANIA. THE GENERAL DEMOGRAPHICS FOR OUR PRIMARY COMMUNITY (CARROLL COUNTY) ARE LISTED BELOW:POPULATIONTOTAL POPULATION 2014: 167,830POPULATION PERCENT CHANGE 2010 TO 2014: 0.4%PERSONS UNDER 5 YEARS PERCENT 2014: 4.9%PERSONS UNDER 18 YEARS PERCENT 2014: 22.5%PERSONS 65 YEARS AND OVER PERCENT 2014: 15.3%FEMALE PERSONS, PERCENT 2014: 50.6%RACE WHITE PERSONS: 92.8%BLACK PERSONS: 3.6%PERSONS OF HISPANIC OR LATINO ORIGIN: 3.0%SOURCE: SOURCE US CENSUS BUREAU: STATE AND COUNTY QUICKFACTS.FAMILYTOTAL NUMBER OF HOUSEHOLDS (2007-2011): 59,314AVERAGE HOUSEHOLD SIZE (2007-2011): 2.75 PERSONSSOURCE: US CENSUS BUREAU: STATE AND COUNTY QUICK FACTS.ECONOMICSMEDIAN HOUSEHOLD INCOME: $84,790PERSONS BELOW POVERTY LEVEL, PERCENT: 5.6%SOURCES: CARROLL COUNTY DEPARTMENT OF ECONOMIC DEVELOPMENT AND US CENSUSBUREAU: STATE AND COUNTY QUICKFACTS.OTHER SIGNIFICANT DEMOGRAPHIC CHARACTERISTICSACCORDING TO AMREICAN COMMUNITY SURVEY THE PERCENTAGE OF UNINSURED PATIENTS IN CARROLL COUNTY IS 6.2%. IN TY 2015, OF THE CARROLL COUNTY RESIDENTS THAT WERE HOSPITALIZED (EITHER AT CHC OR OTHER HOSPITALS), 10.1% WERE ENROLLED IN MEDICAL ASSISTANCE PROGRAMS IN CARROLL COUNTY, WHICH INCLUDES MCHIP, PAC, AND MEDICAL ASSISTANCE. THE AVERAGE LIFE EXPECTANCY WITH CARROLL COUNTY WAS 79.7. PART VI, LINE 5: CARROLL HOSPITAL CENTER, FOUNDED IN 1961, IS THE SOLE HOSPITAL SERVING THE JURISDICTION OF CARROLL COUNTY, MARYLAND WITH A FY 2015 POPULATION ESTIMATED AT 168,000 PERSONS. CARROLL HOSPITAL CENTER IS THE SECOND -LARGEST EMPLOYER IN CARROLL COUNTY WITH OVER 1,750 ASSOCIATES IN FY 2012. CARROLL HOSPITAL CENTER IS ACCREDITED WITH COMMENDATION BY THE JOINT COMMISSION.OUR GOVERNING BODY IS COMPRISED PREDOMINANTLY OF INDEPENDENT LEADERS REPRESENTATIVE OF OUR COMMUNITY WHO ASSURE THAT ALL FINANCIAL SURPLUSES THE HOSPITAL GENERATES ARE USED EXCLUSIVELY TO FURTHER THE CHARITABLEPURPOSES OF THE ORGANIZATION.WE ARE A NOT-FOR-PROFIT ORGANIZATION WITH DIVERSE SERVICE LINES INCLUDING COMPREHENSIVE ACUTE CARE SUCH AS MEDICAL, SURGICAL, PERI-NATAL, PEDIATRICS, PSYCHIATRY, MEDICAL AND RADIATION ONCOLOGY, ADULT INTENSIVE CARE AND CARDIOVASCULAR SERVICES, INCLUDING EMERGENCY PERCUTANEOUS INTERVENTIONAL HEART SURGERY. BOTH HOME-BASED AND INPATIENT HOSPICE CARE IS PROVIDED THROUGH OUR AFFILIATED AGENCY, CARROLL HOSPICE INC. DIVERSE DIAGNOSTIC SERVICES ARE PROVIDED AT MULTIPLE LOCATIONS AND INCLUDE BOTH LABORATORY AND RADIOLOGIC CAPABILITIES. WE PARTICIPATE IN MEDICARE AND MEDICAID PROGRAMS.THERE ARE MORE THAN 400 PHYSICIANS REPRESENTING 38 SPECIALTIES ON OUR MEDICAL STAFF WHOSE MEMBERSHIP IS OPEN TO ALL QUALIFIED AREA PHYSICIANS. WE OPERATE AN EMERGENCY DEPARTMENT (ED) SERVING ALL PERSONS REGARDLESS OF ABILITY TO PAY. AN EXTENSIVE NETWORK OF HOSPITAL OPERATED PHYSICIAN PRACTICES ASSURES ADEQUATE AVAILABILITY OF BOTH PRIMARY AND SPECIALTY CARE PHYSICIANS THROUGHOUT THE SERVICE AREA-MEETING THE CARROLL HOSPITAL CENTER STANDARDS OF EXCELLENCE AND INCORPORATING THE SAME VALUES AND PRINCIPLES. BUILDING ON OUR LONG TRADITION OF COLLABORATION WITH OUR LOCAL RESIDENTS, THE HOSPITAL IN JOINT EFFORT WITH THE CARROLL COUNTY HEALTH DEPARTMENT, ESTABLISHED THE PARTNERSHIP FOR A HEALTHIER CARROLL COUNTY, INC. (THE PARTNERSHIP) IN 1999 TO LINK HOSPITAL STRENGTHS, ALONGSIDE THOSE OF OTHER WELL-ESTABLISHED COMMUNITY PARTNERS TO ACHIEVE AN IMPROVED HEALTH STATUS. THE PARTNERSHIP IS A RELATED SECTION 501(C)(3) TAX-EXEMPT ORGANIZATION OFCARROLL HOSPITAL CENTER, WHICH RECEIVES A MAJORITY OF ITS OPERATING FUNDS FROM CONTRIBUTIONS MADE DIRECTLY BY THE HOSPITAL.THE PARTNERSHIP WAS ESTABLISHED TO:* ASSESS UNMET HEALTH NEEDS IN OUR COMMUNITY* EXPAND THE CAPACITY FOR HEALTH AND QUALITY OF LIFE IMPROVEMENT IN OUR COMMUNITY* SERVE AS OUR COLLABORATIVE VEHICLE FOR INTERACTION WITH THE COMMUNITY* DRIVE THE EFFORT TO CREATE A HEALTHIER CARROLL COUNTY COMMUNITY.THIS STRATEGY HAS ALLOWED CARROLL HOSPITAL CENTER TO REMAIN CONTINUALLY WELL-CONNECTED TO THE COMMUNITY, TO LEVERAGE OUR RESOURCES IN ACTION ALONGSIDE THOSE OF OTHER KEY ORGANIZATIONS AND AGENCIES (PARTICULARLY,THE CARROLL COUNTY HEALTH DEPARTMENT) AND TO ASSURE MEASURABLE RESULTS. MONITORING THE HEALTH STATUS OF THE COMMUNITY IS AN ONGOING AND INTERACTIVE PROCESS ENGAGED IN BY CARROLL HOSPITAL CENTER AND THE PARTNERSHIP. CARROLL HOSPITAL CENTER AND THE PARTNERSHIP PURSUE IMPROVEMENT IN THE CORE HEALTH IMPROVEMENT AREAS (CHIAS) VIA LEADERSHIP TEAMS COMPRISED OF DIVERSE INDIVIDUALS AND ORGANIZATIONS WHO SHAREEXPERTISE AND INTEREST IN THE CHIA. THOSE LEADERS DEVELOP AND IMPLEMENT ACTION PLANS SPECIFICALLY INTENDED TO ACCOMPLISH TARGETED RESULTS. "HEALTHY CARROLL VITAL SIGNS" ARE THEN AFFIRMED, ARE SPECIFIC TO EACH CHIA LEADERSHIP TEAM AND SERVE AS ONE OF THE PRIMARY TOOLS FOR RESULTS REPORTING. WWW.HEALTHYCARROLL.ORG IS THE PARTNERSHIP'S WEBSITE WHERE CURRENT SECONDARY DATA, NATIONAL BENCHMARKS, IMPROVEMENT TARGETS AND BEST PRACTICE REFERENCES ARE EASILY AVAILABLE, ARE AS CURRENT AS AVAILABLE AND ARE AVAILABLE TO ANYONE AT NO COST.CARROLL HOSPITAL CENTER HAS LONG RECOGNIZED THAT PROMOTING THE HEALTH OF ITS COMMUNITY IS ONE OF ITS ESSENTIAL RESPONSIBILITIES. EXTENSIVE COMMUNITY OUTREACH AND LEARNING PROGRAMS ARE OFFERED BY THE HOSPITAL WITH AN EMPHASIS ON DISEASE PREVENTION, EARLY INTERVENTION AND WELLNESS.IN FY 2012 WE EXPANDED ON AN INTEGRATED APPROACH TO POPULATION HEALTH; SEEKING TO ASSURE ACCESS TO EXCELLENT HEALTH CARE AND DISEASE MANAGEMENT ASSISTANCE. OUR INTEGRATED APPROACH RECOGNIZES AND STRIVES TO ELIMINATE BARRIERS SUCH AS TRANSPORTATION CHALLENGES OR LIMITED ABILITIES TO PURCHASE ESSENTIAL PRESCRIPTION PRODUCTS; IT ALSO INCLUDES MORE IN-COMMUNITY CARE COORDINATION AND ASSISTANCE WITH NAVIGATING THE OFTEN COMPLEX WORLD OF HEALTH CARE ASSOCIATED SERVICES.CHC IS ONE OF THE FOUNDING AND FUNDING PARTNERS IN A UNIQUE AND HIGHLY SUCCESSFUL INTEGRATED PRIMARY CARE CENTER KNOWN AS ACCESS CARROLL. INC. AT ACCESS CARROLL, INC. THE BARRIERS OF LOW INCOME AND INELIGIBILITY FOR STATE, FEDERAL OR OTHER INSURANCE ASSISTANCE ARE BEING ELIMINATED FOR SIGNIFICANT NUMBERS OF CARROLL COUNTY RESIDENTS WHO ARE RECEIVING THE SAME STELLAR INTEGRATED PRIMARY AND SPECIALTY CARE SERVICES NEEDED TO MANAGE THEIR ACUTE AND/OR CHRONIC DISEASE ISSUES AS THEIR HIGHER INCOME AND INSURED NEIGHBORS. IN ADDITION TO PRIMARY AND SPECIALTY MEDICAL CARE AND CARE MANAGEMENT NAVIGATION ASSISTANCE, THE ACCESS CARROLL PATIENTS RECEIVE DIAGNOSTIC LABORATORY AND RADIOLOGY SERVICES, PRESCRIPTION ASSISTANCE (MORE THAN $1,000,000 RETAIL VALUE IN FY 2012 FROM PHARMACEUTICAL PRESCRIPTION ASSISTANCE PROGRAMS COORDINATED BY ACCESS CARROLL) AND MORE. CARROLL HOSPITAL CENTER CONTRIBUTED $259,245 TO ACCESS CARROLL IN FY15 TO COVER SALARY AND BENEFIT EXPENSES FOR THE EXECUTIVE DIRECTOR, ONE FULL TIME RN CASE MANAGER AND TWO PART-TIME POSITIONS (AIDEAND DEVELOPMENT SPECIALIST). THE HOSPITAL ALSO PROVIDES LABORATORY AND DIAGNOSTIC IMAGING SERVICES TO ACCESS CARROLL, CAPTURED UNDER CHARITY CARE, WHICH TOTALED $132,657 IN FY15. THESE HEALTH PROMOTION EFFORTS ARE IN ADDITION TO PROGRAMS AND SERVICES THAT SEEK TO ALSO HELP PEOPLE CHANGE THEIR LIFESTYLES TO MOVE TOWARD A STATE OF OPTIMAL HEALTH IN MIND, BODY AND SPIRIT. CARROLL HOSPITAL CENTER DEMONSTRATES ITS COMMITMENT TO IMPROVING THE HEALTH AND WELLNESS OF THE COMMUNITIES IT SERVES BY PROVIDING SERVICES AND PROGRAMS THAT ADDRESS CRITICAL NEEDS, INCLUDING HEALTH CARE TO VULNERABLE OR UNDERSERVED PEOPLE; PUBLIC HEALTH PROGRAMS; AND HEALTH EDUCATION, SCREENING AND PREVENTION SERVICES. THESE PROGRAMS AND ACTIVITIES INCLUDED HOSPICE SERVICES, PHYSICIAN SUPPORT, CHARITY/UNCOMPENSATED CARE, EDUCATION PROGRAMS, HEALTH SCREENINGS, SUPPORT GROUPS, HEALTH PROFESSIONS EDUCATION AND COMMUNITY CONTRIBUTIONS.THE HOSPITAL'S COMMUNITY EDUCATION AND WELLNESS EFFORTS ARE LED BY COMMUNITY EDUCATORS IN THE WOMEN'S PLACE AND THE LEARNING CENTER DEPARTMENTS, IN COORDINATION WITH THE PARTNERSHIP FOR A HEALTHIER CARROLLCOUNTY, SO AS TO MAXIMIZE STRATEGIES AND PROGRAMS IN ADDRESSING COMMUNITY HEALTH NEEDS. CARROLL HOSPITAL CENTER OFFERS THESE PROGRAMS AND SERVICES NOT ONLY TO ADDRESS THE NEEDS OF PEOPLE WITH CHRONIC OR ACUTE MEDICAL ISSUES, BUT ALSO TO ADDRESS PREVENTION AND EDUCATION TO KEEP OUR POPULATION WELL. PART VI, LINE 6: CARROLL HOSPITAL CENTER IS PART OF AN AFFILIATED HEALTH CARE SYSTEM THAT PROVIDES AN ARRAY OF HEALTH CARE SERVICES TO ITS COMMUNITY. THE HOSPITAL, AS A SOLE COMMUNITY PROVIDER, PROVIDES BOTH INPATIENT AND OUTPATIENT CARE, INCLUDING ESSENTIAL HEALTH CARE SERVICES SUCH AS OBSTETRICS, EMERGENCY SERVICES, PEDIATRIC, AND CRITICAL CARE, WHICH WOULD LIKELY OTHERWISE NOT BE PROVIDED WITHIN CARROLL COUNTY DUE TO THEIR UNPROFITABLE NATURE (HIGH COST SERVICES WITH RELATIVELY LOW REIMBURSEMENT). ADDITIONALLY, THE HOSPITAL IS RELATED TO A GROUP PHYSICIAN PRACTICE (CARROLL HEALTH GROUP), WHICH PROVIDES PRIMARY AND SPECIALTY CARE SERVICES TO THE COMMUNITY. THE PROVISION OF THE PHYSICIAN SERVICE HELPS MEET AN IDENTIFIED COMMUNITY HEALTH NEED FOR ADDITIONAL PRIMARY AND SPECIALTY CARE PHYSICIANS IN THE COMMUNITY. CARROLL HOSPICE, AN AFFILIATE OF CARROLL HOSPITAL CENTER, PROVIDES INPATIENT HOSPICE CARE, AS WELL AS RESIDENTIAL HOSPICE AND PALLIATIVE CARE, TO PATIENTS NEARING THE END-OF-LIFE. CARROLL HOSPICE PROVIDES PAIN MANAGEMENT AND SYMPTOM CONTROL AND HELPS COORDINATE HOME AND INPATIENT SERVICES. IN ORDER TO PROVIDE COMPREHENSIVE AND COMPASSIONATE CARE, CARROLL HOSPICE UTILIZES AN INTERDISCIPLINARY TEAM, INCLUDING PHYSICIANS, NURSES, SOCIAL WORKERS, CLERGY, PHARMACISTS, AND HOME HEALTH AIDES. FURTHER, CARROLL HOSPICE PROVIDES BEREAVEMENT CARE FOR FAMILY MEMBERS FOR UP TO THIRTEEN MONTHS. PART VI, LINE 7, REPORTS FILED WITH STATES MD 1 PARTNERSHIP FOR HEALTHIER CARROLL COUNTY 535 OLD WESTMINSTER PIKE STE 102 WESTMINSTER MD 211575799 522156892 501(C)(3) 173000 TO SUPPORT THE OPERATIONS OF PARTNERSHIP. PART I, LINE 2: THE GRANT PROVIDED IS TO THE PARTNERSHIP FOR A HEALTHIER CARROLL COUNTY A RELATED ORGANIZATION THAT IS CONTROLLED BY THE ORGANIZATION AND IS A JOINT VENTURE WITH THE CARROLL COUNTY HEALTH DEPARTMENT. THE PARTNERSHIP FOR A HEALTHIER CARROLL COUNTY IS A 501(C)(3) TAX-EXEMPT ORGANIZATION THAT IS DEDICATED TO IMPROVING THE HEALTH AND QUALITY OF LIFE OF INDIVIDUALS LIVING IN CARROLL COUNTY, MARYLAND. X X 1 1 X X X X X 1 1 0 0 0 0 0 0 0 LESLIE SIMMONS CHIEF EXECUTIVE OFFICER 388820 0 102564 0 48175 0 17500 0 13339 0 570398 0 0 0 NEIL MELTZER BOARD MEMBER 0 790719 0 419867 0 289736 0 334475 0 24815 0 1859612 0 0 KEVIN KELBLY SR VP FINANCE CFO 308629 0 102505 0 21008 0 28309 0 17025 0 477476 0 0 0 BOB EDMONDSON VICE PRESIDENT 190860 0 108498 0 12774 0 12999 0 25291 0 350422 0 0 0 CRIS COLEMAN VICE PRESIDENT 179456 0 34929 0 11127 0 17221 0 22500 0 265233 0 0 0 DAVID LOUDER VICE PRESIDENT 292586 0 59054 0 19056 0 18977 0 8519 0 398192 0 0 0 JED ROSEN CHIEF MEDICAL INFO OFFICER 402474 0 82600 0 1188 0 0 0 10146 0 496408 0 0 0 JOYCE ROMANS VICE PRESIDENT 237563 0 0 0 13241 0 15057 0 16466 0 282327 0 0 0 M ELLEN FINNERTY MYERS CHIEF DEVELOPMENT OFFICER 220002 0 50550 0 13515 0 16490 0 2048 0 302605 0 0 0 MARK OLSZYK VICE PRESIDENT 319997 0 82214 0 33122 0 18538 0 540 0 454411 0 0 0 ROBERT WHITE VICE PRESIDENT 167524 0 33621 0 11466 0 12302 0 12496 0 237409 0 0 0 SHARON GOMEZ-SANDERS VICE PRESIDENT 151777 0 29443 0 9713 0 9438 0 26750 0 227121 0 0 0 STEPHANIE REID VICE PRESIDENT 169803 0 33947 0 10865 0 14813 0 1261 0 230689 0 0 0 TRACEY ELLISON VICE PRESIDENT 187553 0 36577 0 12055 0 14738 0 28368 0 279291 0 0 0 DAVID SALINGER PHYSICIAN 492420 0 151000 0 27849 0 10233 0 25001 0 706503 0 0 0 FLAVIO KRUTER PHYSICIAN 617866 0 198540 0 147913 0 16100 0 23291 0 1003710 0 0 0 JANICE NAPIERALSKI AVP 156173 0 40165 0 7906 0 61678 0 7465 0 273387 0 0 0 JOHANNA DIMENTO PHYSICIAN 337903 0 45495 0 26149 0 12047 0 12540 0 434134 0 0 0 RICHARD RAVER EMPLOYEE 170686 0 0 0 90 0 884 0 23971 0 195631 0 0 0 JOHN SERNULKA PRESIDENT/EX-OFFICIO 145464 0 166898 0 1485440 0 49209 0 10176 0 1857187 0 0 0 PART I, LINE 1A THE HOSPITAL HAS TAKEN THE POSITION THAT IT WILL INCLUDE IN TAXABLE W-2 WAGES FOR THE PRESIDENT CERTAIN BUSINESS EXPENSES THAT THE IRS MAY QUESTION AS NOT BEING TAX DEDUCTIBLE, SO LONG AS SUCH EXPENSES HAVE A DIRECT CONNECTION TO THE PROMOTION OF THE HOSPITAL'S HEALTH CARE SERVICES. FOR 2014, THESE EXPENSES WERE LESS THAN $5,400 IN AGGREGATE, FOR THE PRESIDENT. HEALTH OR SOCIAL CLUB DUES OR INITIATION FEES FOR THE PRESIDENT WERE REIMBURSED BY THE HOSPITAL AND INCLUDED ON THE PRESIDENT'S W-2. THE AMOUNT OF THE REIMBURSED FEES WAS CONSIDERED IN THE PROCESS FOR DETERMINING THE PRESIDENT'S COMPENSATION. PART I, LINES 4A-B LINE 4A: JOHN SERNULKA RECEIVED $1,484,817 SEVERANCE PAYMENT IN THE TAX YEAR. LINE 4B: JOHN SERNULKA PARTICIPATED IN THE 457(F) DEFERRED COMPENSATION PLANS AND WERE PAID AND/OR CREDITED WITH $31,709. THE BOARD MEMBER NEIL MELTZER MADE CONTRIBUTION TO 457(F) PLAN AS FOLLOWS: EMPLOYEE CONTRIBUTION $249,253 EMPLOYER CONTRIBUTION $305,095 A MARYLAND HEALTH AND HIGHER EDUCATION FAC AUTHORITY 520936091 574217B53 2006-12-07 36179115 HOSPITAL RENOVATIONS AND EQUIPMENT PURCHASE 0 0 0 B MARYLAND HEALTH AND HIGHER EDUCATION FAC AUTHORITY 520936091 2010-06-30 15000000 HOSPITAL RENOVATIONS AND EQUIPMENT PURCHASE 0 0 0 C MARYLAND HEALTH AND HIGHER EDUCATION FAC AUTHORITY 520936091 574218HJ5 2012-05-31 93596537 REFUND 2002 BONDS, FAC ACQ, RENOVATION 0 0 0 A 38920902 3225084 683750 35012068 2009 0 0 1 1 B 15000000 15000000 255500 14744500 2010 0 0 1 1 C 33170000 93596537 100764 14899236 78596537 2012 1 0 1 1 A 0 0 1 1 0 0.01000 0.01000 0 0 1 B 0 0 1 1 0 0.01000 0.01000 0 0 1 C 0 0 1 1 1 1 0.01000 0.01000 0 0 1 A 0 0 0 1 0 0 0 0 1 B 0 0 0 1 1 0 0 0 1 C 0 0 0 1 1 0 0 0 1 A 1 B 1 C 1 DATE REBATE COMPUTATION PERFORMED ISSUER NAME: MARYLAND HEALTH AND HIGHER EDUCATION FAC AUTHORITY DATE THE REBATE COMPUTATION WAS PERFORMED: 08/10/2011 ISSUER NAME: MARYLAND HEALTH AND HIGHER EDUCATION FAC AUTHORITY DATE THE REBATE COMPUTATION WAS PERFORMED: 10/06/2014 ISSUER NAME: MARYLAND HEALTH AND HIGHER EDUCATION FAC AUTHORITY DATE THE REBATE COMPUTATION WAS PERFORMED: 10/22/2015 HEATHER GREEN DAUGHTER OF AN OFFICER, LESLIE SIMMONS 62616 EMPLOYEE OF THE HOSPITAL 0 CHELSEA BEAUVAIS DAUGHTER OF AN OFFICER, LESLIE SIMMONS 38600 EMPLOYEE OF THE HOSPITAL 0 ROBERT J BEAUVAIS SON-IN-LAW OF AN OFFICER, LESLIE SIMMONS 65336 EMPLOYEE OF THE HOSPITAL 0 RANDY C GREEN JR SON-IN-LAW OF AN OFFICER, LESLIE SIMMONS 78208 EMPLOYEE OF THE HOSPITAL 0 SOMMER DORSEY STEP DAUGHTER OF A KEY EMPLOYEE, SHARON GOMEZ-SANDERS 30107 EMPLOYEE OF THE HOSPITAL 0 JOHN A STEERS MD PA BUSINESS OWNED BY A BOARD MEMBER JOHN STEERS 581740 INDEPENDENT CONTRACTOR WITH CARROLL HEALTH GROUP 0 JOHN A STEERS BOARD MEMBER 106015 RENT OF SUITE 0 VASCULAR AND CARDIOTHORACIC ASSOCIATES OF MARYLAND BUSINESS OWNED BY A BOARD MEMBER DR SOHAILIA ALI 96744 MEDICAL SERVICES 0 JOHN A STEERS MD PA BUSINESS OWNED BY A BOARD MEMBER JOHN STEERS 67740 ED ON CALL - HOSPITAL 0 JOYCE VANSANT SPOUSE OF A BOARD MEMBER LARRY VAN SANT SR 25420 EMPLOYEE OF THE HOSPITAL/FOUNDATION 0 AMANDA VETTER DAUGHTER OF A BOARD MEMBER JOHN STEERS 52941 EMPLOYEE OF HOSPITAL/FOUNDATION 0 0 FORM 990, PART VI, SECTION A, LINE 2 MIRIAM BECK AND JEFF WOTHERS HAVE A MOTHER-N-LAW/SON-N-LAW RELATIONSHIP. FORM 990, PART VI, SECTION A, LINE 4 THE ORGANIZATION HAD THE BYLAWS RESTATED AFTER THE MERGER WITH LIFEBRIDGE HEALTH INC. FORM 990, PART VI, SECTION B, LINE 11 THE HOSPITAL'S FORM 990 IS REVIEWED IN DETAIL BETWEEN THE PREPARER, AN OUTSIDE ACCOUNTING FIRM, AND THE FINANCE DEPARTMENT OF THE HOSPITAL. A COPY OF THE DRAFT FORM 990 IS PRESENTED TO THE HOSPITAL'S RISK, AUDIT AND COMPLIANCE ("RAC") COMMITTEE, AT WHICH TIME RAC COMMITTEE MEMBERS MAY ASK ANY QUESTIONS OR PROVIDE COMMENTS REGARDING THE DRAFT FORM 990. PRIOR TO FILING THE FORM 990, THE HOSPITAL PROVIDES A COPY OF THE FORM 990 TO EACH MEMBER OF THE BOARD OF DIRECTORS FOR THEIR REVIEW, QUESTIONS, AND COMMENTS, WHICH FEEDBACK IS THEN INCORPORATED INTO THE FILED FORM 990. FORM 990, PART VI, SECTION B, LINE 12C THE CONFLICT OF INTEREST POLICY APPLIES TO CARROLL HOSPITAL CENTER AND ITS DIRECT AND INDIRECT SUBSIDIARIES AND PARENT ORGANIZATION. REVIEW OF DISCLOSURE STATEMENTS/REPORT TO THE BOARD. THE CHIEF EXECUTIVE OFFICER OF THE HOSPITAL ORGANIZATION, THE GOVERNANCE COMMITTEE AND THE CORPORATE COMPLIANCE OFFICER SHALL REVIEW THE MATTERS DISCLOSED IN THE DISCLOSURE STATEMENTS AND SHALL SUBMIT TO THE HOSPITAL ORGANIZATION'S BOARD OF DIRECTORS AN ANNUAL SUMMARY OR SPREADSHEET OF THE DISCLOSURES AND HIS OR HER RECOMMENDATION FOR THE RESOLUTION OF ANY CONFLICTS DISCLOSED. IN FORMULATING RECOMMENDATIONS, THE CHIEF EXECUTIVE OFFICER SHALL CONSULT WITH APPROPRIATE OFFICERS OF THE HOSPITAL ORGANIZATION AND COUNSEL AS NECESSARY. THE BOARD OF DIRECTORS OF THE HOSPITAL ORGANIZATION, ACTING IN THE BEST INTERESTS OF THE HOSPITAL ORGANIZATION, SHALL HAVE SOLE DISCRETION TO MAKE ALL FINAL DECISIONS REGARDING CONFLICTS OF INTEREST, OTHER THAN THOSE REGARDING GIFTS TO HOSPITAL ORGANIZATION EMPLOYEES WHICH SHALL BE RESOLVED BY THE APPROPRIATE SUPERVISORY EXECUTIVE. HOWEVER, NO PERSON SHALL BE INVOLVED IN CONSIDERING THE EXISTENCE OF AN ACTUAL OR POTENTIAL CONFLICT OF INTEREST, IN THE MANAGEMENT AND OVERSIGHT OF A CONFLICT RELATIONSHIP, OR IN THE DETERMINATION OF DISCIPLINE FOR VIOLATIONS OF THIS POLICY, IF THAT PERSON IS A PARTY OR POTENTIAL PARTY TO THAT CONFLICT. ALL FINAL DECISIONS REGARDING CONFLICTS OF INTEREST SHALL BE REFLECTED IN A REVISED ANNUAL SUMMARY OR SPREADSHEET OF CONFLICT DISCLOSURES WHICH WILL BE SHARED WITH EACH DIRECTOR. THE CHAIR AND VICE-CHAIR OF THE BOARD, AND ALL BOARD COMMITTEE CHAIRS, SHALL HAVE THIS REVISED SUMMARY OR SPREADSHEET AVAILABLE AT THE TIME OF ALL BOARD AND BOARD COMMITTEE MEETINGS IN CASE A MATTER INVOLVING A POTENTIAL CONFLICT ARISES. CONFLICT OF INTEREST RECUSAL PROCEDURE FOR BOARD MEETINGS WHENEVER A HOSPITAL ORGANIZATIONS' BOARD OR BOARD COMMITTEE IS TO CONSIDER A TRANSACTION OR AN ARRANGEMENT WITH ANOTHER ORGANIZATION, ENTITY OR INDIVIDUAL IN WHICH OR WITH WHOM A PERSON COVERED BY THIS POLICY HAS A RELATIONSHIP CREATING AN ACTUAL OR POTENTIAL CONFLICT OF INTEREST, THE FOLLOWING PROCEDURES SHALL BE EMPLOYED: A. THE INTERESTED PERSON MUST FULLY DISCLOSE THE ACTUAL OR POTENTIAL CONFLICT OF INTEREST TO THE BOARD; B. THE INTERESTED PERSON SHOULD BE ASKED TO LEAVE THE MEETING DURING DISCUSSION OF THE POTENTIAL CONFLICT AND ANY RELATED VOTES, BUT THE INTERESTED PERSON MAY MAKE A STATEMENT OR ANSWER ANY QUESTIONS ON THE MATTER BEFORE DEPARTING THE MEETING; C. IF APPROPRIATE, THE BOARD OR BOARD COMMITTEE MAY APPOINT A NON-INTERESTED PERSON OR COMMITTEE TO INVESTIGATE ALTERNATIVES TO THE PROPOSED TRANSACTION OR ARRANGEMENT; D. TO CONSIDER THE PROPOSED TRANSACTION OR ARRANGEMENT, THE BOARD MUST: 1. FIND, BY A MAJORITY VOTE OF DIRECTORS THEN IN OFFICE, NOT COUNTING THE INTERESTED PERSON, THAT THE PROPOSED TRANSACTION OR ARRANGEMENT IS IN THE HOSPITAL ORGANIZATION'S BEST INTEREST AND FOR THE HOSPITAL ORGANIZATION'S OWN BENEFIT, IT IS FAIR AND REASONABLE, AND THAT, AFTER REASONABLE INVESTIGATION, THE HOSPITAL ORGANIZATION CANNOT OBTAIN A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT USING REASONABLE EFFORTS; AND 2. VOTE ON THE TRANSACTION OR ARRANGEMENT, APPROVAL REQUIRING A MAJORITY VOTE OF DIRECTORS THEN IN OFFICE, NOT COUNTING THE INTERESTED PERSON. E. THE MINUTES SHOULD INCLUDE: (1) THE NAME OF THE PERSON DISCLOSING THE CONFLICT OF INTEREST AND A DESCRIPTION OF THE CONFLICT; (2) THE BOARD'S DETERMINATION OF WHETHER THERE IS A CONFLICT; (3) THE NAMES AND VOTES OF PERSONS PRESENT FOR THE DISCUSSIONS AND VOTES RELATING TO THE TRANSACTION OR ARRANGEMENT; AND (4) THE CONTENT OF THOSE DISCUSSIONS INCLUDING THE BOARD'S DETERMINATION OF WHETHER OR NOT THE TRANSACTION OR ARRANGEMENT IS IN THE HOSPITAL ORGANIZATION'S BEST INTEREST, FAIR AND REASONABLE, AND THE BEST REASONABLY AVAILABLE ALTERNATIVE ONGOING DUTY TO DISCLOSE ONE'S OWN OR OTHERS' CONFLICTS OF INTEREST. AS AN ACTUAL OR POTENTIAL CONFLICT OF INTEREST CAN ARISE AT ANY TIME, ANY ACTUAL OR POTENTIAL CONFLICT MUST BE DISCLOSED PROMPTLY IN WRITING BY USE OF A SUPPLEMENTAL DISCLOSURE STATEMENT, AS SOON AS ITS EXISTENCE IS OR SHOULD BE KNOWN. IF A PERSON IS IN DOUBT ABOUT A SITUATION, THE PERSON SHOULD CONSULT WITH THE CHIEF EXECUTIVE OFFICER, BOARD CHAIRMAN OR THE HOSPITAL ORGANIZATION'S COMPLIANCE OFFICER. PERSONS SHOULD ERR ON THE SIDE OF DISCLOSURE SO THAT A CONFLICT OF INTEREST ASSESSMENT CAN BE MADE. THE POTENTIAL CONFLICT WILL BE REFERRED TO THE GOVERNANCE COMMITTEE FOR REVIEW AND A RESPONSE WILL BE PROVIDED WITHIN 14 DAYS. NONCOMPLIANCE WITH THE POLICY: THE ORGANIZATION'S BOARD OF DIRECTORS RETAINS BROAD POWER AND SOLE DISCRETION UNDER THIS POLICY TO: (1) DETERMINE THE EXISTENCE OF ACTUAL OR POTENTIAL CONFLICTS OF INTEREST; (2) SUBJECT CONFLICT OF INTEREST RELATIONSHIPS TO APPROPRIATE OVERSIGHT, MANAGEMENT, CONDITIONS, RESTRICTIONS AND PROHIBITIONS; AND (3) IMPOSE APPROPRIATE SANCTIONS. A BREACH OF THIS POLICY CAN BECOME GROUNDS FOR DISCIPLINE, UP TO AND INCLUDING REMOVAL FROM OFFICE OR, FOR MANAGEMENT PERSONNEL, TERMINATION OF EMPLOYMENT. IT MAY ALSO RESULT IN CESSATION OF BUSINESS WITH A VENDOR AND IN LIABILITY FOR DAMAGES. GROUNDS FOR DISCIPLINE INCLUDE, BUT ARE NOT LIMITED TO: A. WILLFUL FAILURE TO SIGN AND RETURN THE CONFLICT OF INTEREST DISCLOSURE STATEMENT IN ACCORD WITH THIS POLICY; B. A MATERIAL MISSTATEMENT OR OMISSION IN THE DISCLOSURE STATEMENT; C. WILLFUL FAILURE TO DISCLOSE AN ACTUAL OR POTENTIAL CONFLICT OF INTEREST AT ANY TIME IN ACCORD WITH THE REQUIREMENTS OF THIS POLICY; D. WILLFUL PARTICIPATION IN A VOTE OR DECISION INVOLVING A TRANSACTION WHICH RAISES AN UNDISCLOSED CONFLICT OF INTEREST; OR E. WILLFUL DISCLOSURE OR USE OF CONFIDENTIAL INFORMATION REGARDING THE AFFAIRS, BUSINESS OR PLANS OF A HOSPITAL ORGANIZATION FOR ANY PURPOSE OTHER THAN IN FURTHERANCE OF THE AFFAIRS AND BEST INTERESTS OF THE HOSPITAL ORGANIZATION. FORM 990, PART VI, SECTION B, LINE 15 THE EXECUTIVE COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS OF CARROLL HOSPITAL CENTER, WHICH IS COMPRISED OF INDEPENDENT BOARD MEMBERS DETERMINED TO BE FREE OF ANY CONFLICT OF INTEREST, IS CHARGED WITH DETERMINING EXECUTIVE COMPENSATION AND ESTABLISHING PERFORMANCE CRITERIA ACCORDING TO AN APPROVED COMPENSATION PHILOSOPHY. THE COMMITTEE WORKS WITH AN INDEPENDENT EXECUTIVE COMPENSATION CONSULTING AND ADVISORY FIRM THAT PROVIDES MARKET SURVEY DATA CONCERNING COMPENSATION AND BENEFIT LEVELS FOR FUNCTIONALLY COMPARABLE HEALTHCARE EXECUTIVES IN SIMILAR HOSPITALS ACROSS THE REGION AND THE NATION BASED ON SEVERAL FACTORS INCLUDING SIZE, GEOGRAPHY, HOSPITAL TYPE AND COMPLEXITY. THE COMMITTEE REVIEWS AND APPROVES THE COMPENSATION OF THE SENIOR EXECUTIVES AND ENSURES THAT ALL FORMS OF EXECUTIVE COMPENSATION ARE REASONABLE, APPROPRIATE AND CONSISTENT WITH ITS COMPENSATION PHILOSOPHY. CARROLL HOSPITAL CENTER HAS A WRITTEN POLICY REGARDING THE REVIEW OF PHYSICIAN COMPENSATION TO ENSURE THE PAYMENTS BETWEEN THE HOSPITAL AND THE PHYSICIAN ARE BOTH COMMERCIALLY REASONABLE AND NOT GREATER THAN FAIR MARKET VALUE FOR THE SERVICES RENDERED. THE POLICY APPLIES TO CARROLL HOSPITAL CENTER AND EACH OF ITS SUBSIDIARIES/AFFILIATES. PURSUANT TO THE POLICY, CARROLL HOSPITAL CENTER, IN ORDER TO ENSURE THE PAYMENTS TO PHYSICIANS ARE COMMERCIALLY REASONABLE AND CONSISTENT WITH FAIR MARKET VALUE, UNDERTAKES A NUMBER OF REVIEW ACTIVITIES, INCLUDING REVIEWING COMPENSATION INFORMATION FROM COMPENSATION SURVEYS AND RELIABLE DATA SUCH AS RECENT EARNINGS AND THIRD PARTY VALUATIONS. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART IX, LINE 11G PHYSICIAN FEES: PROGRAM SERVICE EXPENSES 13,535,972. MANAGEMENT AND GENERAL EXPENSES 5,700. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 13,541,672. CONSULTING: PROGRAM SERVICE EXPENSES 759,258. MANAGEMENT AND GENERAL EXPENSES 2,544,378. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,303,636. OTHER FEES: PROGRAM SERVICE EXPENSES 5,484,720. MANAGEMENT AND GENERAL EXPENSES 3,499,116. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 8,983,836. FORM 990, PART XI, LINE 9: UNREALIZED LOSS FROM INTEREST RATE HEDGE -4,614,188. CONTRIBUTION -43,900. INVESTMENT IN CARROLL COUNTY MED SERVICES -15,925,000. ASSET IMPAIRMENT -28,523,000. EQUITY INVESTMENT IN SUBS 54,774,119. CHANGE IN MINUMUM PENSION LIABILITY -3,385,066. ROUNDING -2. PART VIII, LINE 6 CARROLL HOSPITAL CENTER (CHC) HAS A LEASE WITH AN UNRELATED THIRD PARTY FOR THE USE OF SPACE IN THE FISHER BUILDING. CHC SUBLEASES SPACE IN THE FISHER BUILDING TO SUBTENANTS AT ITS LEASE COST. CARROLL HOSPITAL CENTER MOB INVEST LLC 200 MEMORIAL AVE WESTMINSTER MD 21157 271528335 INVESTMENTS MD 0 532985 CHC CARROLL REGIONAL CANCER CTR PHYSICIANS 200 MEMORIAL AVE WESTMINSTER MD 21157 452463175 HEALTHCARE MD 1038432 740720 CHC CARROLL COUNTY HEALTH SERVICES INC 200 MEMORIAL AVE WESTMINSTER MD 21157 520691413 SUPPORT ORGANIZATION MD 501(C)(3) 509(A)(3) N/A 0 CARROLL HOSPITAL CENTER FOUNDATION 200 MEMORIAL AVE WESTMINSTER MD 21157 521115038 FOUNDATION MD 501(C)(3) 509(A)(3) CHC 1 CARROLL HOSPICE INC 200 MEMORIAL AVE WESTMINSTER MD 21157 521565870 HOSPICE MD 501(C)(3) 170(B)(1A) CHC 1 PARTNERSHIP FOR A HEALTHIER CARROLL CTY 200 MEMORIAL AVE WESTMINSTER MD 21157 522156892 HEALTH SERVICES MD 501(C)(3) 170B1(A)VI N/A 1 LEVINDALE HEBREW GERIATRIC CENTER AND HOSPITAL INC 2434 WEST BELVEDERE AVE BALTIMORE MD 21215 520607913 GERIATRIC HOSPITAL DEDICATED TO PROVIDING SERVICE TO THE AGED MD 501(C)(3) LINE 3 LIFEBRIDGE HEALTH INC 0 SINAI HOSPITAL OF BALTIMORE INC 2401 WEST BELVEDERE AVE BALTIMORE MD 21215 520486540 PROVIDE MEDICAL CARE, EDUCATE STUDENTS, & PERFORM MEDICAL RESEARCH MD 501(C)(3) LINE 3 LIFEBRIDGE HEALTH INC 0 COURTLAND GARDENS NURSING AND REHABILITATION 2434 WEST BELVEDERE AVE BALTIMORE MD 21215 520607907 SKILLED NURSING CARE FOR THE ELDERLY AND DISABLED MD 501(C)(3) LINE 9 LEVINDALE 0 NORTHWEST HOSPITAL CENTER INC 5401 OLD COURT ROAD RANDALLSTOWN MD 21133 521372665 A HOSPITAL ASPIRING TO IMPROVE THE WELLBEING OF THE COMMUNITY IT SERVES MD 501(C)(3) LINE 3 LIFEBRIDGE HEALTH INC 0 CHILDREN'S HOSPITAL OF BALTIMORE CITY 2401 WEST BELVEDERE AVE BALTIMORE MD 21215 520591592 CHARITY SUPPORT FOR SINAI HOSPITAL OF BALTIMORE, INC. MD 501(C)(3) LINE 11B, II LIFEBRIDGE HEALTH INC 0 THE BALTIMORE JEWISH HEALTH FOUNDATION INC 2401 WEST BELVEDERE AVE BALTIMORE MD 21215 522111541 CHARITY SUPPORT FOR SINAI HOSPITAL OF BALTIMORE, INC. MD 501(C)(3) LINE 11B, II LIFEBRIDGE HEALTH INC 0 CHILDREN'S HOSPITAL AT SINAI FOUNDATION 2401 WEST BELVEDERE AVE BALTIMORE MD 21215 522167587 CHARITY SUPPORT FOR SINAI HOSPITAL OF BALTIMORE, INC. MD 501(C)(3) LINE 11B, II LIFEBRIDGE HEALTH INC 0 THE BALTIMORE JEWISH ELDERCARE FOUNDATION 2401 WEST BELVEDERE AVE BALTIMORE MD 21215 522337669 CHARITY SUPPORT FOR LEVINDALE HEBREW GERIATRIC CENTER HOSPITAL MD 501(C)(3) LINE 11B, II LIFEBRIDGE HEALTH INC 0 LIFEBRIDGE HEALTH INC 2401 WEST BELVEDERE AVE BALTIMORE MD 21215 521402373 HEALTH SERVICES MD 501(C)(3) LINE 11A, I N/A 0 CARROLL COUNTY RADIOLOGY LLC 7253 AMBASSADOR RD BALTIMORE MD 21244 522190849 RADIOLOGY MD CHC 2273939 10749899 0 0 0.60000 CARROLL CARE PHARMACIES LLC 95 CARROLL ST STE 104 WESTMINSTER MD 21157 201141106 PHARMACY MD CCMS 0 0 CARROLL OCCUPATIONAL HEALTH LLC 7001 CORPORATE CENTER CT WESTMINSTER MD 21157 202769332 OCCUPATIONAL MD CCMS 0 0 CARDIOVASCULAR ASSOCIATES OF MARYLAND LLC 2401 WEST BELVEDERE AVE BALTIMORE MD 21215 462935110 MEDICAL SERVICES MD 0 0 HOMECARE MARYLAND LLC 8028 RITCHIE HIGHWAY SUITE 210B PASADENA MD 21122 261378175 MEDICAL SERVICES MD 0 0 LIFEBRIDGE CARDIOLOGY OF PARKVILLE LLC 2401 WEST BELVEDERE AVE BALTIMORE MD 21215 463742313 MEDICAL SERVICES MD 0 0 LIFEBRIDGE COMMUNITY GASTROENTEROLOGY LLC 2401 WEST BELVEDERE AVE BALTIMORE MD 21215 462863298 MEDICAL SERVICES MD 0 0 LIFEBRIDGE COMMUNITY PEDIATRICS LLC 2401 WEST BELVEDERE AVE BALTIMORE MD 21215 462842468 MEDICAL SERVICES MD 0 0 LIFEBRIDGE COMMUNITY PULMONOLOGY LLC 2401 WEST BELVEDERE AVE BALTIMORE MD 21215 461401312 MEDICAL SERVICES MD 0 0 LIFEBRIDGE GYNECOLOGY OF PIKESVILLE LLC 2401 WEST BELVEDERE AVE BALTIMORE MD 21215 462949092 MEDICAL SERVICES MD 0 0 LIFEBRIDGE MEDICAL ASSOCIATES LLC 2401 WEST BELVEDERE AVE BALTIMORE MD 21215 462941505 MEDICAL SERVICES MD 0 0 LIFEBRIDGE ORTHOPEDIC SPECIALISTS LLC 2401 WEST BELVEDERE AVE BALTIMORE MD 21215 450719598 MEDICAL SERVICES MD 0 0 LIFEBRIDGE PRIMARY CARE OF ELDERSBURG LLC 2401 WEST BELVEDERE AVE BALTIMORE MD 21215 383897702 MEDICAL SERVICES MD 0 0 LIFEBRIDGE PRIMARY CARE OF NORTH CARROLL LLC 2401 WEST BELVEDERE AVE BALTIMORE MD 21215 800883321 MEDICAL SERVICES MD 0 0 CARROLL COUNTY MED SERVICES INC 200 MEMORIAL AVE WESTMINSTER MD 21157 521891102 MEDICAL SERVICES MD CCHS C 1 CEN-MAR ASSURANCE CO PO BOX 1085 GRAND CAYMAN CJ KY1-1102 986011607 INSURANCE CJ CHC C 2209586 18453758 1.00000 1 CARROLL HEALTH GROUP LLC 200 MEMORIAL AVE WESTMINSTER MD 21157 271956453 HEALTH CARE MD CCMS C 1 CARROLL URGENT CARE LLC 200 MEMORIAL AVE WESTMINSTER MD 21157 465739154 REAL ESTATE MD CCMS C 1 CARROLL PHO LLC 200 MEMORIAL AVE WESTMINSTER MD 21157 460613864 HEALTH CARE MD CCMS C 0 CARROLL ACO LLC 200 MEMORIAL AVE WESTMINSTER MD 21157 465641917 HEALTH CARE MD CCMS C 0 LIFEBRIDGE INVESTMENTS INC 2401 WEST BELVEDERE AVE BALTIMORE MD 21215 521483166 INVESTMENT MD LIFEBRIDGE HEALTH INC C 1 HEALTHSTAR MEDICAL SERVICES INC 2401 WEST BELVEDERE AVE BALTIMORE MD 21215 521829098 HEALTH CARE MD LIFEBRIDGE HEALTH INC C 1 PRACTICE DYNAMICS INC 124 BUSINESS CENTER DRIVE REISTERSTOWN MD 21136 521960319 MANAGEMENT MD LIFEBRIDGE HEALTH INC C 1 SURGICAL ONCOLOGY ASSOCIATES INC 2401 WEST BELVEDERE AVE BALTIMORE MD 21215 521804659 HEALTH CARE MD LIFEBRIDGE HEALTH INC C 1 LIFEBRIDGE INSURANCE COMPANY LTD PO BOX 1109 GRAND CAYMAN GRAND CAYMAN CJ 980415396 INSURANCE CJ LIFEBRIDGE HEALTH INC C 1 LIFEBRIDGE COMMUNITY PHYSICIANS INC 2401 WEST BELVEDERE AVE BALTIMORE MD 21215 800719005 HEALTH CARE MD LIFEBRIDGE INVESTMENTS C 1 0 1 1 0 0 0 0 0 0 0 0 1 1 0 1 0 1 1 0 CARROLL HOSPITAL FOUNDATION C 3303940 CASH CARROLL HOSPICE Q 3800000 FMV CARROLL HOSPICE L 75000 FMV CEN-MAR ASSURANCE CO R 2370297 CASH PARTNERSHIP FOR A HEALTHIER CARROLL COUNTY B 173000 CASH SCHEDULE R PART II, III, & IV ON MARCH 27, 2015 CARROLL COUNTY HEALTH SERVICES CORPORATION (CCHS), THE ULTIMATE PARENT OF CARROLL HOSPITAL CENTER INC. AND THE OTHER CARROLL ENTITIES, VOTED TO APPROVE AN AFFILIATION AGREEMENT WITH LIFEBRIDGE HEALTH INC. (LHI), A 501(C)(3) EXEMPT ORGANIZATION. EFFECTIVE APRIL 1, 2015, LHI BECAME THE SOLE CORPORATE MEMBER OF CCHS AND ALL OF ITS SUBSIDIARIES. AS A RESULT, LBH AND ALL OF ITS RELATED EXEMPT ORGANIZATIONS, PARTNERSHIPS, AND CORPORATIONS BECAME RELATED EXEMPT ORGANIZATIONS, PARTNERSHIPS, AND CORPORATIONS OF CARROLL HOSPITAL CENTER, AND ARE REPORTED IN THE PART II, III, AND IV OF THE ORGANIZATION'S FORM 990 SCHEDULE R.