2016-05-12T04:15:12-05:00 2015-06-30 GRANT THORNTON LLP 2001 MARKET STREET SUITE 700 PHILADELPHIA PA 19103 990 2014-07-01 520445374 Civista Medical Center Inc % ERIK BOAS CIVI 3016094130 5 Garrett Avenue La Plata MD 20646 Erik Boas CFO 3016094130 2016-05-05 true Frank Giardini P00532355 2155614200 2014 2016-08-17 19:52:53Z Noel Cervino 5 Garrett Ave La Plata MD 20646 133759070 false X www.charlesregional.org X 1980 MD Civista Medical Center, Inc. is a component of a reginal integrated health system serving the health needs of Charles County and the citizens of southern Maryland. 17 14 1105 120 134498 -10898 373966 0 128305767 132649970 -79506 551842 510252 557258 129110479 133759070 87252 52129 0 0 52674539 54048003 0 0 0 65768408 64633320 118530199 118733452 10580280 15025618 158176511 149948298 107530822 103563868 50645689 46384430 X CIVISTA MEDICAL CENTER, INC. IS A COMPONENT OF A REGIONAL INTEGRATED HEALTHCARE SYSTEM CREATED TO PROVIDE EXCELLENCE IN ACUTE HEALTHCARE AND PREVENTIVE SERVICES IN CHARLES COUNTY AND THE SURROUNDING COMMUNITIES. false false 101234693 52129 133072730 University of Maryland Charles Regional Medical Center (UM CRMC) is the parent company of a regional integrated health system serving the health needs of Charles County and the citizens of Southern Maryland. UM CRMC's Community Benefits Program utilizes a planned, managed, organized, and measured approach to meeting the identified community needs of the area we serve. The mission is to improve overall community health by improving access to health care, enhancing the health of the community, advancing healthcare knowledge and working with health - providing agency partners. UM CRMC collaborated with the Charles County Department of Health (CCDOH) to complete a comprehensive assessment of the health needs (CHNA) of Charles County, Maryland. An epidemiologist with a Master's Degree in Public Health Epidemiology was contracted to analyze the qualitative and quantitative data. UM CRMC lead the effort and covered 80% of the cost of the CHNA. To provide a comprehensive assessment of the health needs of the county, a four method plan was developed which included four different sources of data: a long online survey of Charles County residents perceptions of health and health behaviors, a short paper survey on health perceptions throughout the county, seven focus groups with community leaders, citizens, and stakeholders, and a quantitative data analysis. The use of the multiple data collection methods strengthened the validity of the assessment's findings, as well as ensured that Charles County residents had an opportunity to participate in the assessment process and to feel invested in its outcome. Three hundred and two Charles County residents completed the 74 question online survey that was created using Survey Monkey. The link to the survey was available on the UM CRMC website. The first section of the survey asked participants about their perception of health and health services within the county. The second section asked them about their health behaviors, in order to determine their risk for the development of certain health conditions. A short three question survey was distributed throughout the county regarding perceptions of health within the county. A total of 200 short surveys were completed. Surveys were located throughout the county including UM CRMC waiting rooms, CCDOH waiting rooms, libraries, senior centers, community centers. Thirty five were completed in Spanish (17.5%). Seven focus groups were held throughout the county. The focus group topics included: age related health issues, chronic disease specific health, special populations, county leadership, substance abuse, youth through the school nurses, and the Partnerships for a Healthier Charles County (PHCC). Approximately 165 people participated in the county focus groups from a wide variety of organizations and community groups. Quantitative data was analyzed for several health topics including: mortality, population and demographic data, natality, infant mortality, heart disease, stroke, hypertension, access to health care/health uninsurance, cancer, asthma, injuries, diabetes, obesity, osteoporosis, arthritis, dementia/Alzheimer's disease, communicable disease, sexually transmitted diseases, HIV/AIDS, mental health, dental health, substance abuse, disabilities, and tobacco use. Cumulative analysis of all quantitative and qualitative data identified the top 11 health needs of Charles County which was presented to the Partnerships for a Healthier Charles County, a coalition of Charles County agencies and organizations. The direction of Partnerships for a Healthier Charles County is guided by the Steering Committee which consists of leadership from UM CRMC, Charles County Department of Health, Charles County Public Schools, the College of Southern Maryland as well as a Public Health Epidemiologist. Focus Groups Included representatives from the following organizations: Partnerships for a Healthier Charles County University of Maryland Charles Regional Medical Center UM CRMC, Board Of Directors Charles County Department of Health University of Maryland Clinical Trials Program Bel Alton Alumni Association Charles County Department of Community Services, Transportation Tri County Council for Southern Maryland Minister's Alliance of Charles County CC Department of Social services Maryland Foundation for Quality healthcare Health Partner's Clinic Shiloh Community United Methodist Church CC Nursing and Rehabilitation Center Alzheimer's Association Center for Children Chesapeake Potomac Home Health Agency College of Southern Maryland Charles County Department of Aging Priority partners Big Brothers/Big sisters Community Hispanic Advocates Black Leadership Council for Excellence Young Researchers Community Project Pinnacle Center (Mental Health) Hospice Breast Cancer Support Advocates Charles County Public Schools - School Nurses Charles County Commissioners Charles County Emergency Services Charles County Sheriff's Office So MD Delegates Charles County Community Foundation Community Physicians Charles County Fire and Rescue Board Accomplishments: UM CRMC provided $10.5 million in charity care, health professions education, community benefit operations, community health improvement services, subsidized health services, cash and in-kind donations and community building activities in FY 2015. This year, we provided and supported programs, activities and screenings such as blood pressure, glucose, cholesterol, breast and cervical cancer, prostate cancer and stroke risk reduction education. We provided health education programs on hearty healthy eating, diabetes education, cancer education, breast and cervical cancer, tobacco cessation program. In addition, we sponsored American Cancer Society's Look Good Feel Better, advanced directives, arthritis, car safety seat inspections, community disaster drills, school career days, the Young Researches Community Project, and support groups such as stroke support, cardiac support, and the Better Breathers Club. We offer clinics and clinic services such as prenatal, OB clinic, renal dialysis services and American Red Cross blood drives. We participated in community coalitions and boards such as the United Way, Partnerships for a Healthier Charles County, Charles County Tobacco Coalition, Leadership Southern Maryland, Hospice of Charles County, Healthy Families, Fetal Infant Mortality Board, Center for Abused Persons, Juvenile Drug Court, Mission of Mercy; Chamber of Commerce and Charles County Child Advocacy Partnership. We participated in community events such as Christmas Connection, American Cancer Society's Relay for Life, Alzheimer's Walk, March of Dimes and Safe Nights. 101234693 true false false true false false false false false false true false false true true true false true false false false false false false false false true true true false true false false false false false false false false false false false false false true false false false true 167 0 true 1105 true true true false false false false false false false false false X 17 14 false false false false true true true true true false false true true true true true true true true false MD X ERIK BOAS 3016094130 5 GARRETT AVE La Plata MD 20646 X Louis Jenkins Jr Chairman 1.0 0.0 X X 0 0 0 Shelly Culhane Vice Chair 1.0 0.0 X X 0 0 0 Richard Winkler Secretary/Treasurer 1.0 0.0 X X 0 0 0 Dianna Abney MD Director 1.0 0.0 X 0 0 0 Khadar Baig MD Director 1.0 0.0 X 0 0 0 Wayne Barnes Director 1.0 0.0 X 0 0 0 Michael Cady Director 1.0 0.0 X 0 0 0 Anthony Covington Director 1.0 0.0 X 0 0 0 B Larry Jenkins Jr MD Director 1.0 0.0 X 0 0 0 Sara A Middleton Director 1.0 0.0 X 0 0 0 Ashvin J Patel MD Director 1.0 0.0 X 0 0 0 Joseph Slater Director 1.0 0.0 X 0 0 0 Richard Ferraro MD Chief of Staff 1.0 0.0 X 0 0 0 Joel Sewchand MD Chief of Staff (THRU 12/31/14) 1.0 0.0 X 0 0 0 Candice Quinn Kelly Ex-Officio/Director 1.0 0.0 X 0 0 0 Jon P Burns Ex-Officio/Director 1.0 49.0 X 0 591209 20269 John W Ashworth III Ex-Officio/Dir. (thru 1/31/15) 1.0 49.0 X 0 597210 21095 Robert Chrencik Ex-Officio/Director 1.0 49.0 X 0 6881071 21095 Noel Cervino Ex-Officio/President & CEO 40.0 10.0 X X 881764 0 16975 Erik Boas Chief Financial Officer 40.0 10.0 X 405276 0 8169 Mark R Dumais Chief Medical Officer 40.0 0.0 X 406517 0 55136 Dana Levy Chief Nursing Officer 40.0 0.0 X 221998 0 30464 Paul Blackwood VP Planning 40.0 0.0 X 214558 0 34226 William Grimes VP Ancilliary Services 40.0 0.0 X 196399 0 20767 Stacey Cook VP Human Resources 40.0 0.0 X 207763 0 38799 Marilyn Gregory RN 40.0 0.0 X 190924 0 7545 Katherine Middleton RN 40.0 0.0 X 185666 0 13465 Eugene Suwandhi MD pediatric hospitalist phys. 40.0 0.0 X 173967 0 7553 Gabriel Abiola Pharmacist Manager 40.0 0.0 X 159900 0 21968 3244732 8069490 317526 55 false true false Maryland Inpatient Care Specialists 6934 Aviation Blvd Ste B GLEN BURNIE MD 21061 Physicians 1300000 Southern MD Pulmonary Critical Ca 4475 Regency Place Ste 303 WHITE PLAINS MD 20695 Respiratory 1091196 Healogics Wound Care 3087 Momentum Place CHICAGO IL 60689 Wound Care 750503 NDG Communications Inc 105 Centennial Str Ste K LA PLATA MD 20646 Marketing 625406 ROI Eligibility Services Corp 1920 Greenspring Dr Ste 200 TIMONIUM MD 21094 PT Acctg Purc Svc 606799 26 0 NET PATIENT REVENUE 900099 132649970 132649970 132649970 213406 213406 0 0 0 0 0 338436 338436 338436 338436 0 0 0 ANSWERING SERVICE 561000 134498 134498 CAFETERIA & COFFEE BAR SALES 900099 355975 355975 CHANGE IN EQUITY OF AFFILIATES CPHA 900099 74010 74010 -7225 -7225 557258 133759070 133072730 134498 551842 52129 52129 0 0 0 3244732 628515 2616217 0 39706094 35879687 3826407 1743629 1482085 261544 6202687 5272284 930403 3150861 2678232 472629 0 459255 459255 18631 18631 4869 4869 0 0 7375295 6269001 1106294 344943 293202 51741 3538121 3538121 0 0 3300029 2805025 495004 52433 44568 7865 0 188438 160172 28266 2791954 2373161 418793 0 4197028 3567474 629554 45758 38894 6864 SUPPLIES AND DRUGS 16586737 16586737 PURCHASED SERVICES 13800506 11730430 2070076 BAD DEBT 8221156 8221156 EQUIPMENT SERVICE CONTRACTS 1674918 1423680 251238 2033249 1728261 304988 118733452 101234693 17498759 0 0 0 21245679 20680284 0 0 7988094 7944863 0 0 0 0 0 0 1586764 1675458 205947 319972 110981019 40656610 70840719 70324409 20457797 20278998 0 0 0 0 0 0 35851511 28724314 158176511 149948298 13949677 13697614 0 0 0 0 0 0 0 0 0 0 19523669 18484229 0 0 74057476 71382025 107530822 103563868 X 50553092 46291833 92597 92597 0 0 50645689 46384430 158176511 149948298 X 15025618 -684431 -18602446 X false true X true X false false false false false false false false true 4869 4869 false Lobbying Activities Schedule C, Part II-B, Line 1i The organization does not engage in any direct lobbying activities. The organization pays membership dues to the Maryland Hospital Association (MHA) and the American Hospital Association (AHA). MHA and AHA engage in many support activities including lobbying and advocating for their member hospitals. The MHA and AHA reported that 4.80% and 22.80% of member dues were used for lobbying purposes and as such, the organization has reported this amount on Schedule C Part II-B as lobbying activities. 75134563 17208521 57926042 498563 292665 205898 35113499 23155424 11958075 234394 234394 70324409 SECURITY DEPOSITS 11473 OTHER CURRENT RECEIVABLES 665753 INV. CHES POTOMAC HEALTHCARE 3353172 OTHER ASSETS 19619520 PHYSICIAN LOANS 134136 INVESTMENT MARYLAND ECARE 10000 ECONOMIC INTEREST- NET ASSETS 4930260 28724314 0 ADVANCES FROM THIRD PARTIES 4161675 ACCRUED PENSION COSTS 6702525 DUE TO AFFILIATES 52689467 LEASE LIABILITIES 457331 MALPRACTICE IBNR 739274 OTHER LIABILITIES 6631753 71382025 X Liability for Uncertain Tax Position (ASC 740) Schedule D, Part X, Line 2 THE ORGANIZATION IS A SUBSIDIARY OF THE UNIVERSITY OF MARYLAND MEDICAL SYSTEM CORPORATION (THE CORPORATION). THE CORPORATION ADOPTED THE PROVISIONS OF ASC 740, ACCOUNTING FOR UNCERTAINTY IN THE INCOME TAXES (FIN 48) ON JULY 1, 2007. THE FOOTNOTE RELATED TO ASC 740 IN THE CORPORATION'S AUDITED FINANCIAL STATEMENTS IS AS FOLLOWS: THE CORPORATION FOLLOWS A THRESHOLD OF MORE-LIKELY-THAN-NOT FOR RECOGNITION AND DERECOGNITION OF TAX POSITIONS TAKEN OR EXPECTED TO BE TAKEN IN A TAX RETURN. MANAGEMENT DOES NOT BELIEVE THAT THERE ARE ANY UNRECOGNIZED TAX BENEFITS THAT SHOULD BE RECOGNIZED. true true true X true X true true true false true true 1400571 1400571 0.01270 1400571 1400571 0.01270 742003 742003 0.00670 502991 502991 0.00460 9089619 4951905 4137714 0.03740 58611 58611 0.00050 10393224 4951905 5441319 0.04920 11793795 4951905 6841890 0.06190 105 105 104630 104630 0.00090 11773 11773 0.00010 735 735 36794 36794 0.00030 154037 154037 0.00130 true 5959787 49198261 48003359 1194902 X true true 1 1 Civista Medical Center Inc 5 Garrett Avenue La Plata MD 20646 www.charlesregional.org 08-001 X X X Civista Medical Center Inc 1 false false true X X X X X X X X X 15 true false false true X http://www.charlesregional.org/siteasset X true 15 true http://www.charlesregional.org/siteasset false false true X 200. 300. X X X X X true true X X X X true X http://www.charlesregional.org X X X X true false X X X X X true X false false FINANCIAL ASSISTANCE POLICY Schedule H, Part V, Section B In compliance with the new IRC Section 501(r) regulations Civista Medical Center is currently in the process of updating their Financial ASsistance Policy to ensure its compliance with IRS regulations. Input from Individuals Representing the Community Schedule H, Part V, Section B, Line 5 Civista Medical Center DBA University of Maryland Charles Regional Medical Center (CRMC) completed the Community Health Needs Assessment CHNA) in FY 2015. This process involved the following people: PHCC Executive Committee: Noel A. Cervino CEO Civista Health (CRMC) Dr. Devadason Health Officer CC Health Department (CCDOH) Dr. Brad Gottfried President College of Southern Maryland (CSM) Jim Richmond Superintendent Charles County Public Schools PHCC Steering Committee: Joyce Riggs Dir., Community Dev./ Planning Civista (CRMC) Fay Reed, RN Deputy Health Officer CCDOH William Leebel Public Information Officer CCDOH Linda Smith Project Coordinator CSM Tanisha Saunders Coordinator of Integrated Student Services CCPS Amber Starn, MPH Epidemiologist (Contract) Civista (CRMC) Partnerships for a Healthier Charles County: Civista Medical Center Civista Health, Board Of Directors Charles County Department of Health University of Maryland Clinical Trials Program Bel Alton Alumni Community Development Association Charles County Department of Community Services, Transportation Tri County Council for Southern Maryland Ministers Alliance of Charles County Charles County Department of Social Services Maryland Foundation for Quality Healthcare Health Partners Clinic Greater Baden FQHC Shiloh Community United Methodist Church Charles County Nursing and Rehabilitation Center Alzheimers Association Center for Children Chesapeake Potomac Home Health Agency College of Southern Maryland Charles County Department of Aging Priority Partners Big Brothers/Big Sisters Community Hispanic Advocates Black Leadership Council for Excellence Young Researchers Community Project Pinnacle Center (Mental Health) Hospice of Charles County Breast Cancer Support Advocates Charles County Public Schools School Nurses Charles County Commissioners Charles County Emergency Services Charles County Sheriffs Office So. MD Delegation Charles County Community Foundation Community Physicians Charles County Fire and Rescue Board Lifestyles, Inc. (Homeless) The plan was presented and approved by the Board of Directors on 01/28/2015. Needs Not Addressed By the Most Recently Conducted CHNA Schedule H, Part V, Section B, Line 11 All the primary needs outlined in the Community Health Needs Assessment are being addressed and funded by Civista Regional Medical Center either directly (i.e., OB Clinic, Physician Recruitment) or through partnerships with other organizations (i.e., Childhood Obesity Program, Fetal Infant Mortality). Policy to ensure its compliance with IRS regulations. Individuals Eligible for Financial Assistance Schedule H, Part V, Section B, Line 22D All patients are charged state regulated rates regardless of their ability to pay. Individuals Eligible for Financial Assistance Schedule H, Part V, Section B, Line 24 The State of Maryland is a unique State in regard to the provision of health care services and their related charges by hospitals. All hospital charges processed to all Payors, including Governmental Payors, are set through Marylands Health Services Cost Commission. Accordingly, all Hospital charges are NOT gross charges as defined by the IRS under Internal Revenue Code section 501(r)(5)(B). Related Organization Report Schedule H, Part I, Line 6a AN ANNUAL COMMUNITY BENEFIT REPORT IS PREPARED FOR EACH FISCAL YEAR ENDING JUNE 30. THIS REPORT IS SUBMITTED TO THE HEALTH SERVICES COST REVIEW COMMISSION (HSCRC), A STATE REGULATORY AGENCY, BY DECEMBER 31 OF EACH YEAR. IN ADDITION, THE ANNUAL COMMUNITY BENEFIT REPORT IS AVAILABLE UPON REQUEST AT THE ENTITY'S CORPORATE OFFICES. Cost Attributable to a Physical Clinic Schedule H, Part I, Line 7 Marylands regulatory system creates a unique process for hospital payment that differs from the rest of the Nation. The Health Services Cost Review Commission (HSCRC) determines payment through a rate setting process and All Payors, including Governmental Payors, pay the same amount for the same services delivered at the same hospital. Marylands unique All Payor system includes a method for referencing uncompensated care in each Payors rates, which does not enable Maryland hospitals to breakout any offsetting revenue related to uncompensated care. Schedule H, Part I, Line 7B, Columns (C) through (F) MARYLAND'S REGULATORY SYSTEM CREATES A UNIQUE PROCESS FOR HOSPITAL PAYMENT THAT DIFFERS FROM THE REST OF THE NATION. THE HEALTH SERVICES COST REVIEW COMMISSION, (HSCRC) DETERMINES PAYMENT THROUGH A RATE SETTING PROCESS AND ALL PAYORS, INCLUDING GOVERNMENTAL PAYORS, PAY THE SAME AMOUNT FOR THE SAME SERVICES DELIVERED AT THE SAME HOSPITAL. MARYLAND'S UNIQUE ALL PAYOR SYSTEM INCLUDES A METHOD FOR REFERENCING UNCOMPENSATED CARE IN EACH PAYORS' RATES, WHICH DOES NOT ENABLE MARYLAND HOSPITALS TO BREAKOUT ANY OFFSETTING REVENUE RELATED TO UNCOMPENSATED CARE. COMMUNITY BENEFIT EXPENSES ARE EQUAL TO MEDICAID REVENUES IN MARYLAND, AS SUCH, THE NET EFFECT IS ZERO. ADDITIONALLY, NET REVENUES FOR MEDICAID SHOULD REFLECT THE FULL IMPACT ON THE HOSPITAL OF ITS SHARE OF THE MEDICAID ASSESSMENT. SCHEDULE H, PART I, LINE 7F COLUMN (C) & (D) MARYLAND'S REGULATORY SYSTEM CREATES A UNIQUE PROCESS FOR HOSPITAL PAYMENT THAT DIFFERS FROM THE REST OF THE NATION. THE HEALTH SERVICES COST REVIEW COMMISSION, (HSCRC) DETERMINES PAYMENT THROUGH A RATE SETTING PROCESS AND ALL PAYORS, INCLUDING GOVERNMENTAL PAYORS, PAY THE SAME AMOUNT FOR THE SAME SERVICES DELIVERED AT THE SAME HOSPITAL. MARYLAND'S UNIQUE ALL PAYOR SYSTEM INCLUDES A METHOD FOR REFERENCING UNCOMPENSATED CARE IN EACH PAYORS' RATES, WHICH DOES NOT ENABLE MARYLAND HOSPITALS TO BREAKOUT ANY OFFSETTING REVENUE RELATED TO UNCOMPENSATED CARE. Community Building Activities Schedule H, Part II As the only hospital serving Charles County, Maryland, University of Maryland Charles Regional Medical Center (UM CRMC) supports programs and activities where the hospital's expertise and resources can influence the fundamental issues that affect the health of the community. UM CRMC supports economic development of the community through leadership participation in organizations such as the Chamber of Commerce, Economic Development Commission, Leadership Southern Maryland, and the Tri-County Council of Southern Maryland. UM CRMC participates in many County, State and Region-wide Emergency Preparedness planning activities and drills with our community partners such as Emergency Services, Fire and Rescue, Department of Health, County Government, FEMA and MEMA. This serves to ensure that in the event of a disaster, the hospital is ready to support and care for our community. Hospital Administration participates in healthcare workforce development by serving on committees such as the Charles County Commissioner's healthcare taskforce and support of College of Southern Maryland Nursing and Allied Health programs. In addition, UM CRMC participates and supports the Black Leadership Council on Excellence's Young Researchers Community Project which offers disadvantaged youth in high school an opportunity to shadow medical professionals. According to the 2007 Maryland Physician workforce study, the Southern Maryland region has a physician shortage for primary care physicians. Southern Maryland had the regional low requirement for primary care physicians per 100,000 residents of 56.5. The Maryland state average rate was 58.2 per 100,000 residents. Under medical specialties, the Southern Maryland region has a shortage for cardiology, dermatology, endocrinology, gastroenterology, hematology, oncology, infectious disease, nephrology, psychiatry, pulmonary medicine, and rheumatology. The only medical specialties with adequate physician supplies were allergy and neurology. Charles County has one Neurologist which is deemed adequate for the population; however, the physician plans to retire which will leave the county in a critical shortage in this specialty. As a result of the prevailing physician shortage, and to mitigate the effects of the lack of access of the community to medical care, UM CRMC has developed a robust and ongoing physician recruitment and retainment program. Bad Debt Expense Schedule H, Part III, Line 2 & 4 CIVISTA REPORTS BAD DEBT EXPENSE IN ACCORDANCE WITH GENERALLY ACCEPTED ACCOUNTING PRINCIPLES (GAAP) HFMA 15. THE PROVISION FOR BAD DEBTS IS BASED UPON MANAGEMENTS ASSESSMENT OF HISTORICAL AND EXPECTED NET COLLECTIONS CONSIDERING HISTORICAL BUSINESS AND ECONOMIC CONDITIONS, TRENDS IN HEALTH CARE COVERAGE, AND OTHER COLLECTION INDICATORS. PERIODICALLY THROUGHOUT THE YEAR, MANAGEMENT ASSESSES THE ADEQUACY OF THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS BASED UPON HISTORICAL WRITE-OFF EXPERIENCE BY PAYOR CATEGORY, AS WELL AS, THE ACCUMULATION OF RECEIVABLE BALANCES BY PERIOD OUTSTANDING. THE RESULTS OF THIS REVIEW ARE THEN USED TO MAKE ANY NECESSARY MODIFICATIONS TO THE PROVISION FOR BAD DEBTS AND THE ESTABLISHED ALLOWANCE FOR UNCOLLECTIBLE RECEIVABLES. AFTER COLLECTION OF AMOUNTS DUE FROM INSURERS, THE CORPORATION FOLLOWS INTERNAL GUIDELINES FOR PLACING CERTAIN PAST DUE BALANCES WITH COLLECTION AGENCIES. Medicare Cost Report Schedule H, Part III, Line 8 IN MARYLAND, THE HEALTH SERVICES COST REVIEW COMMISSION (HSCRC)STARTED SETTING HOSPITAL RATES IN 1974. AT THAT TIME, THE HSCRC APPROVED RATES APPLIED ONLY TO COMMERCIAL INSURERS. IN 1977, THE HSCRC NEGOTIATED A WAIVER FROM MEDICARE HOSPITAL PAYMENT RULES FOR MARYLAND HOSPITALS TO BRING THE FEDERAL MEDICARE PAYMENTS UNDER HSCRC CONTROL. MEDICARE REIMBURSES MARYLAND HOSPITALS ACCORDING TO RATES ESTABLISHED BY THE HSCRC AS LONG AS THE STATE CONTINUES TO MEET A TWO-PART TEST. THIS TWO-PART WAIVER TEST ALLOWS MEDICARE TO PARTICIPATE IN THE MARYLAND SYSTEM AS LONG AS TWO CONDITIONS ARE MET: ALL OTHER PAYERS PARTICIPATING IN THE SYSTEM PAY HSCRC SET RATES. THE RATE OF GROWTH IN MEDICARE PAYMENTS TO MARYLAND HOSPITALS FROM 1981 TO THE PRESENT IS NOT GREATER THAN THE RATE OF GROWTH IN MEDICARE PAYMENTS TO HOSPITALS NATIONALLY OVER THE SAME TIME FRAME. Collection Practices Schedule H, Part III, Line 9b THE ORGANIZATION EXPECTS PAYMENT AT THE TIME THE SERVICE IS PROVIDED. OUR POLICY IS TO COMPLY WITH ALL STATE AND FEDERAL LAW AND THIRD PARTY REGULATIONS AND TO PERFORM ALL CREDIT AND COLLECTION FUNCTIONS IN A DIGNIFIED AND RESPECTFUL MANNER. Currently, Civista Medical Center is in the process of updating its billing and collections process to ensure it is in compliance with the new IRC Section 501(R) regulations. EMERGENCY SERVICES WILL BE PROVIDED TO ALL PATIENTS REGARDLESS OF ABILITY TO PAY. FINANCIAL ASSISTANCE IS AVAILABLE FOR PATIENTS BASED ON FINANCIAL NEED AS DEFINED IN THE FINANCIAL ASSISTANCE POLICY. THE ORGANIZATION DOES NOT DISCRIMINATE ON THE BASIS OF AGE, RACE, CREED, SEX OR ABILITY TO PAY. PATIENTS WHO ARE UNABLE TO PAY MAY REQUEST A FINANCIAL ASSISTANCE APPLICATION AT ANY TIME PRIOR TO SERVICE OR DURING THE BILLING AND COLLECTION PROCESS. THE ORGANIZATION MAY REQUEST THE PATIENT TO APPLY FOR MEDICAL ASSISTANCE PRIOR TO APPLYING FOR FINANCIAL ASSISTANCE. THE ACCOUNT WILL NOT BE FORWARDED FOR COLLECTION DURING THE MEDICAL ASSISTANCE APPLICATION PROCESS OR THE FINANCIAL ASSISTANCE APPLICATION PROCESS. Community Health Care Needs Assessment Schedule H, Part VI, Line 2 Civista Medical Center completed a comprehensive community health needs assessment (CHNA) for fiscal year 2015 completed on 6/30/16. Fiscal year 2016 completes the first year of the implementation plan, which will be reported in the fiscal year 2016 community benefit report. The following summarizes the results of the community benefit report issued in fiscal year 2015, based on the fiscal year 2012 CHNA. These results represent the third and final year of the 2012 CHNA implementation plan. This process involved the following people: PHCC Executive Committee: Noel A. Cervino CEO Civista Health (CRMC) Dr. Devadason Health Officer CC Health Department (CCDOH) Dr. Brad Gottfried President College of Southern Maryland (CSM) Jim Richmond Superintendent Charles County Public Schools PHCC Steering Committee: Joyce Riggs Dir., Community Dev./ Planning Civista CRMC Fay Reed, RN Deputy Health Officer CCDOH William Leebel Public Information Officer CCDOH Linda Smith Project Coordinator CSM Tanisha Saunders Coordinator of Integrated Student Services CCPS Amber Starn, MPH Epidemiologist (Contract) Civista CRMC Partnerships for a Healthier Charles County: Civista Medical Center Civista Health, Board Of Directors Charles County Department of Health University of Maryland Clinical Trials Program Bel Alton Alumni Community Development Association Charles County Department of Community Services, Transportation Tri County Council for Southern Maryland Minister's Alliance of Charles County Charles County Department of Social Services Maryland Foundation for Quality Healthcare Health Partner's Clinic Greater Baden FQHC Shiloh Community United Methodist Church Charles County Nursing and Rehabilitation Center Alzheimer's Association Center for Children Chesapeake Potomac Home Health Agency College of Southern Maryland Charles County Department of Aging Priority Partners Big Brothers/Big Sisters Community Hispanic Advocates Black Leadership Council for Excellence Young Researchers Community Project Pinnacle Center (Mental Health) Hospice of Charles County Breast Cancer Support Advocates Charles County Public Schools School Nurses Charles County Commissioners Charles County Emergency Services Charles County Sheriff's Office So. MD Delegation Charles County Community Foundation Community Physicians Charles County Fire and Rescue Board Lifestyles, Inc. (Homeless) The plan was presented and approved by the Board of Directors on 11/28/2011. Hospital identified the following as needs of the community: - Reproductive Health - Healthy Babies (Infant Mortality Disparity) - STD Reduction/Prevention - Chronic Disease - Heart Disease - Diabetes - Obesity - Access to Care - Dental health - Transportation - Physician Shortage - Cancer Team - Lung Cancer - Prostate Cancer - Colorectal Cancer - Injury and Violence free Community - Roadway incidents - Injuries and Fall Prevention - Behavioral Health - Substance Abuse - Mental Health Hospital publicized the CHNA via website (www.charlesregional.org) and is available printed upon request. Did Civista Medical Center (CRMC) take into account input from representatives of the community it serves while conducting its CHNA? If yes, please describe how and by whom input was taken. Civista Health (CRMC) and the Charles County Department of Health (CCDOH) collaborated to complete a comprehensive assessment of the health needs (CHNA) of Charles County, Maryland. An epidemiologist with a Master's Degree in Public Health Epidemiology was contracted to analyze the qualitative and quantitative data. Civista lead the effort and covered 80% of the cost of the CHNA. To provide a comprehensive assessment of the health needs of the county, a four method plan was developed which included 4 different sources of data: a long online survey of Charles County residents perceptions of health and health behaviors, a short paper survey on health perceptions throughout the county, 7 focus groups with community leaders, citizens, and stakeholders, and a quantitative data analysis. The use of the multiple data collection methods strengthened the validity of the assessment's findings, as well as ensured that Charles County residents had an opportunity to participate in the assessment process and to feel invested in its outcome. Three hundred and two (302) Charles County residents completed the 74 question online survey that was created using Survey Monkey. The link to the survey was available on the Civista Health (CRMC) website. The first section of the survey asked participants about their perception of health and health services within the county. The second section asked them about their health behaviors, in order to determine their risk for the development of certain health conditions. A short three question survey was distributed throughout the county regarding perceptions of health within the county. A total of 200 short surveys were completed. Surveys were located throughout the county including Civista (CRMC) waiting rooms, CCDOH waiting rooms, libraries, senior centers, community centers. Thirty five were completed in Spanish (17.5%). Seven focus groups were held throughout the county. The focus group topics included: age related health issues, chronic disease specific health, special populations, county leadership, substance abuse, youth through the school nurses, and the Partnerships for a Healthier Charles County (PHCC) (community leaders and stakeholders). Approximately 165 people participated in the county focus groups. Survey for Community Members: 302 Charles County residents completed the 74 question online survey that was created using Survey Monkey. The link to the survey was available on the Civista Health (CRMC) website. A short 3 question survey was distributed throughout the county regarding perceptions of health within the county. A total of 200 short surveys were completed. Surveys were located throughout the county including Civista waiting rooms, Charles County Department of Health waiting rooms, libraries, senior centers, community centers. 35 were completed in Spanish (17.5%). Description of Individuals and Organizations Consulted for CHNA Input: Seven focus groups were held throughout the county with representation from the following organizations. The focus group topics included: age related health issues, chronic disease specific health, special populations, county leadership, substance abuse, youth through the school nurses, and the Partnerships for a Healthier Charles County (PHCC) (community leaders and stakeholders). Approximately 165 people participated in the county focus groups from the following Organizations. Organization Representative Name Title Amber Starn Epidemiologist CC Dept of Health Faye Grillo Deputy Health Officer Bel Alton Community Development Center Judy Rudolf Dept. of Community Services Brenda Walcott Van Go Jeff Barnett Donna Harris Tri County Council for So MD Elaine Lancaster First Gospel Church of Bryans Road Rev. James Briscoe Pastor Department of Social Services Juan Thompson Ombudsman Danielle Green Terry Sullivan Lifestyles, Inc. (Homeless) Sandy Washington Ex. Director Marie Robinson Renee Curry Health Partners Clinic Dr. Howard Haft Medical Director Chrissie Mulcahey Ex. Director Hispanic Community Representative Maria Michletec Community member CC Nursing and Rehab. Bud Zimmerman Ex. Director Bill Holman Denise McCann Alzheimer's Association Linda Gottfried Director Center for Children Colleen Wilburn UM CRMC Maureen Jenkins Mgr, Labor and Delivery Chesapeake Potomac Home Health Kelly Winters College of Southern MD Linda Smith CC Dept. Of Aging Bonnie Hampton CC Dept. of Health Linda Blake Director Priority Partners Angela Deale Outreach worker Big Brothers Big Sisters Cynthia Graham Black leadership Council for Excellence Bonita Adeeb Rose Haft Young Researchers CP Anthony Quick Community member Pinnacle Counseling Center Jackie Burson Lic. Counselor Hospice Colleen Wilson CC Dept. of Health Mary Beth Klick Tobacco Counselor UM CRMC Betsy Wolford CDE CCDOH Dawn Cox Breast and Cervical Cancer UM CRMC Dr. Rich Ferraro Med. Dir. ED. Sisters at Heart Roberta Kieliger Chair Cambridge Pediatrics Diana Abney, MD Pediatrician UM CRMC Angie Booker Respiratory Therapist UM CRMC Teresa Brannigan Director of Nursing School Nurses - Sheila Brockman - Cheryl Smith - Peggy Bird - Tammy Dilling - Carolyn Engleson - Tammy Crozier - Jennifer Ledford - Lisa Bazzare - Kathleen DeBolt - Patricia Horner - Karl J.Muehlfeld - Lucy Wathen - Charlene Falken - Joanne Collins - Marge Charron - Elizabeth Gallacher - Erica Hadley - Jan Siewertsen - Lenure Petty - Natasha Williams - Kofo Williams - Nadja De Los Santos - Phyliss Renard - Karen Grace - Deborah Heim - Constance Larsen - Diane Gardiner - Shelley Presnell - Laurie Mulert - Betsy Keesler - Edith Patten - Barbara Balazek - Carole Noyes - Katie Popp - Dorothy Reeves - Kim Jameson - Stephanie Kiesel - Carol A. Dawn Charles Coun Eligibility Education Schedule H, Part VI, Line 3 Civista Medical Center DBA University of Maryland Charles Regional Medical Center (UM CRMC). UM CRMC posts its charity care policy, or a summary thereof, as well as financial assistance contact information, in admissions areas, emergency rooms, business offices and other areas of the facility where eligible patients are likely to present. In addition, the policy is available on the UM CRMC website and is posted in the local paper twice each year. The FAP is written in a culturally sensitive and at an appropriate reading level. It is available in English and Spanish. All Patient Access Customer Service Staff have training in the financial assistance process. During the intake or discharge process or when there is contact regarding a billing matter, if a patient discloses financial difficulty or concern with payment of the bill, the patient is provided with FAP information. A packet with the application, criteria and a documentation checklist is provided. Assistance completing the application is available. Additionally, assistance is provided for patients or their families in qualification and application of government benefits, Medicaid and other state programs. Once an application is processed and if it is deemed incomplete, a letter is sent to the patient requesting the missing or incomplete items. Patients may call the Call Center or come into the Patient Access Office for assistance. In compliance with the new IRC Section 501(R) regulations Civista Medical Center is currently in the process of updating their Financial Assistance Policy to ensure its compliance with IRS regulations. Description of Community Served Schedule H, Part VI, Line 4 The Community Benefit Service Area for Civista Medical Center (UM CRMC) is all 28 zip codes located within the borders of Charles County. This includes the six zip codes identified as the Primary Service Area. Civista Medical Center (UM CRMC) is Charles County's only hospital and, as such, serves the residents of the entire county. Geography Charles County is located 23 miles south of Washington, D.C. It is one of five Maryland counties, which are part of the Washington, DC MD VA metropolitan area. At 458 square miles, Charles County is the eighth largest of Maryland's twenty four counties and accounts for about 5 percent of Maryland's total landmass. The northern part of the county is the "development district" where commercial, residential, and business growth is focused. The major communities of Charles County are La Plata (the county seat), Port Tobacco, Indian Head, and St Charles, and the main commercial cluster of Hughesville Waldorf White Plains. Approximately 60 percent of the county's residents live in the greater Waldorf La Plata area. By contrast, the southern (Cobb Neck area) and western (Nanjemoy, Indian Head, Marbury) areas of the region still remain very rural with smaller populations. Population Charles County has experienced rapid growth since 1970, expanding its population from 47,678 in 1970 to 120,546 in the 2000 census and 146,551 in the 2010 census. The current Census Bureau 2012 estimates the population at 150,592 for a 2.8% increase in two years. The magnitude of growth can be seen in the changes in population density. The 1990 census showed that there were 219.4 individuals per square mile, which increased to 261.5 individuals per square mile by 2000, an increase of 19.2%, and to 320.2 individuals per square mile by 2010, an increase of 22.5%. Transportation The percent change in the population growth for Charles County has been slightly greater than the change seen in the Maryland population growth. This growth has created transportation issues for the County in particular for the "development district" in the northern part of the county where many residents commute to Washington D.C. to work. The average work commute time for a Charles County resident is 42.3 minutes which is higher than the Maryland average by slightly more than 10 minutes. Public transportation consists of commuter bus for out of county travel and the county run Van Go bus service for in county transportation. Diversity As the population of the county changes, the diversity of the county also increases. The African American population has experienced the greatest increase. In 2000, African Americans made up 26% of the total Charles County population; by 2012, they comprise 42.4% of the total county population. As of 2012, minorities make up roughly 54% of the Charles County population. The Hispanic community has also seen increases over the past few years. They now comprise 4.7% of the total county population. This is the one of the highest percentages among the 24 Maryland jurisdictions. Economy Employment and economic indicators for the county are fairly strong. The 2010 US Census estimates found that 73.8% of the Charles County population is currently in the labor work force. The 2011 update estimates that approximately 5.6% of Charles County individuals are living below the poverty level, up 0.4% from 2010, however this is lower than the Maryland rate of 9% in 2011. The Charles County median household income was $92,135, an increase of $3,310 over the 2010 estimates and still well above the Maryland median household income of $72,419. The diversity of the county is also represented in the business community with 29.3% of all Charles County businesses being Black owned firms. This is higher than the State of Maryland at 19.3%. Education Charles County has a larger percentage of high school graduates than Maryland (90.6% vs. 88.2%); however, Charles County has a smaller percentage than Maryland of individuals with a bachelor's degree or higher (26.3% vs. 36.1%). Housing There is a high level of home ownership in Charles County (80.1%), however, this is slightly down from the 2010 level of 81.8%. The median value of a housing unit in Charles County is higher than the Maryland average ($341,200 vs. $319,800). Home values across Maryland have decreased and Charles County showed a slightly larger decrease than the Maryland average (4% vs. 3%). The average household size in Charles County is 2.86 persons. Life Expectancy The life expectancy for a Charles County resident, as calculated for 2009 2011, was 78.4 years. This is similar to the state average life expectancy of 79.2 years. Births There were 1,923 births in Charles County in 2012. Charles County represents 54% of the births in Southern Maryland (up 11% from 2009) and 2.6% of the total births in Maryland for 2012. Minorities made up just over half of the babies born in Charles County in 2012 (51.5%) which is in line with the composition of the county. Source: 2012 Maryland Vital Statistics Report Promoting the Health of the Community Schedule H, Part VI, Line 5 Implementation Strategy: The Charles County Health Improvement Plan (CCHIP): Upon completion of the CHNA, the Steering Committee of Partnerships for a Healthier Charles County (PHCC) reviewed the results and the identified top 11 health needs. The Steering Committee set county objectives through 2015 based on Maryland SHIP objectives and Healthy People 2020 Goals. The results and goals were presented to the PHCC membership at the quarterly General Membership Meeting. Six teams were formed based on expertise and interest to formulate 3 year action plans to address the following health needs using one or more of the "Seven Strategies for Community Change" found on the last page of the Charles County Health Improvement Plan. 1. Reproductive Health A. Healthy Babies (Infant Mortality Disparity) B. STD Reduction/Prevention 2. Chronic Disease A. Heart Disease B. Diabetes C. Obesity 3. Access to Care A. Dental health B. Transportation C. Physician Shortage 4. Cancer Team A. Lung Cancer B. Prostate Cancer C. Colorectal Cancer 5. Injury and Violence free Community A. Roadway incidents B. Injuries and Fall Prevention 6. Behavioral Health A. Substance Abuse B. Mental Health The Charles County Health Needs Assessment and Health Improvement Plan were presented to the Civista Health Board (UM CRMC) of Directors and approved. Annual updates to the Plan are reviewed and approved. The CCHIP objectives are the Charles County Health Improvement Plan and available at: http://www.charlesregional.org/index.cfm? fuseaction=HealthResources.showHealthActionPlans The Health Improvement Team Action Plans (Implementation Plans) are available at: http://www.charlesregional.org/index.cfm?fuseaction=HealthResources. showHealthActionPlans All the primary needs outlined in the Needs Assessment are being addressed by Civista Health (UM CRMC) either directly (i.e., OB Clinic, Physician Recruitment) or through partnerships with other organizations (i.e., Childhood Obesity Program, Fetal Infant Mortality, Prostate Cancer) or through the PHCC which is led and primarily financed by Civista Health (UM CRMC). Where a need is appropriately addressed by another entity, Civista provides leadership through the Charles County Health Improvement Plan and the local health coalition (PHCC) to communicate initiatives, provide financial support and/or assistance when needed and review results (i.e., Substance Abuse, Mental Health). All the primary needs outlined in the Needs Assessment are being addressed and funded by Civista (UM CRMC) either directly (i.e., OB Clinic, Physician Recruitment) or through partnerships with other organizations (i.e., Childhood Obesity Program, Fetal Infant Mortality). Where a need is appropriately addressed by another entity, Civista provides leadership through the Charles County Health Improvement Plan and the coalition of Partnerships for a Healthier Charles County to communicate initiatives, provide assistance when needed and review results (i.e., Substance Abuse, Mental Health). The majority of the governing body, the Board of Directors, of Civista Medical Center (UM CRMC) is comprised of persons who reside in the community served by the hospital and who are neither employees nor contractors of the organization. Civista Medical Center (UM CRMC) extends medical privileges to all qualified medical staff in the community. Continuing Medical Education seminars and Grand Rounds are open to all community physicians. Affiliated Health Care System Roles Schedule H, Part VI, Line 6 Civista Medical Center (UM CRMC) is a member of the University of Maryland Medical System (UMMS). System hospitals meet monthly to coordinate and plan Community Benefit Operations such as Health Needs Assessments and Maryland State Health Improvement Plan objectives. UMMS provides leadership and guidance to local system jurisdictions regarding alignment with System and State wide goals. Southern Maryland had the highest percentage of physician shortages of all of the regions in Maryland (89.9%). To address the shortage, Civista Medical Center (UM CRMC) and UMMS have developed a recruitment and retention plan to successfully attract and retain private physicians to the community. Community Benefit Report State Filings Schedule H, Part VI, Line 7 Community Benefit Report was filed in the state of Maryland. true Charles County Chamber of Commerce 101 Centennial St Ste A laplata La Plata MD 20646 520699475 11150 2015 Sponsorship Charles Regional Medical Center Foundation 5 Garrett Avenue La Plata MD 20646 521414564 501(c)(3) 8000 Paint the Town Pink 2 Procedure for Monitoring Use of Grant Funds Inside U.S. Part I, Line 2 CIVISTY MEDICAL CENTER MAKES FINANCIAL AND IN-KIND CONTRIBUTIONS TO VARIOUS ORGANIZATIONS IN THE COMMUNITY. EACH OF THE CONTRIBUTION RECIPIENTS ARE EITHER GOVERNMENTAL UNITS OR SECTION 501(c)(3) CHARITABLE ORGANIZATIONS WHICH WORK TO FULFILL THE ORGANIZATION'S MISSION OF PROMOTING HEALTH WITHIN THE COMMUNITY. X true true X X X X false true false false false false false true false Jon P Burns Ex-Officio/Director 0 381339 0 154634 0 55236 0 10400 0 9869 0 611478 0 0 John W Ashworth III Ex-Officio/Dir. (thru 1/31/15) 0 373547 0 155458 0 68205 0 10400 0 10695 0 618305 0 0 Robert Chrencik Ex-Officio/Director 0 1183796 0 1004469 0 4692806 0 10400 0 10695 0 6902166 0 4526360 Noel Cervino Ex-Officio/President & CEO 356893 0 182000 0 342871 0 10400 0 6575 0 898739 0 0 253407 Erik Boas Chief Financial Officer 202281 0 75000 0 127995 0 8169 0 0 0 413445 0 88982 0 Mark R Dumais Chief Medical Officer 283580 0 122005 0 932 0 44441 0 10695 0 461653 0 0 0 Dana Levy Chief Nursing Officer 179270 0 40014 0 2714 0 23558 0 6906 0 252462 0 0 0 Paul Blackwood VP Planning 173501 0 40015 0 1042 0 23598 0 10628 0 248784 0 0 0 William Grimes VP Ancilliary Services 154255 0 37500 0 4644 0 20357 0 410 0 217166 0 0 0 Stacey Cook VP Human Resources 160449 0 45010 0 2304 0 22435 0 16364 0 246562 0 0 0 Marilyn Gregory RN 190595 0 0 0 329 0 2700 0 4845 0 198469 0 0 0 Katherine Middleton RN 185590 0 0 0 76 0 13300 0 165 0 199131 0 0 0 Eugene Suwandhi MD pediatric hospitalist phys. 173867 0 0 0 100 0 3085 0 4468 0 181520 0 0 0 Gabriel Abiola Pharmacist Manager 159120 0 0 0 780 0 17500 0 4468 0 181868 0 0 0 Health or Social Club Dues Schedule J, Part I, Line 1a UMMS Executives receive a benefit package which may be used towards health club dues or other health maintenance programs. Such benefits are capped at $7,000, $5,000, or $3,000 depending on job title as described in the program documents. SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN SCHEDULE J, PART I, LINE 4B DURING THE FISCAL YEAR ENDED JUNE 30, 2015, CERTAIN OFFICERS AND KEY EMPLOYEES PARTICIPATED IN THE UNIVERSITY OF MARYLAND MEDICAL SYSTEM (UMMS) SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN. THE INDIVIDUALS LISTED BELOW HAVE NOT VESTED IN THE PLAN. THEREFORE, THE ACCRUED CONTRIBUTION TO THE PLAN FOR THE FISCAL YEAR IS REPORTED ON SCHEDULE J, PART II, COLUMN C, RETIREMENT AND OTHER DEFERRED COMPENSATION: MARK R DUMAIS DANA LEVY PAUL BLACKWOOD WILLIAM GRIMES DURING THE FISCAL YEAR ENDED JUNE 30, 2015, CERTAIN OFFICERS AND KEY EMPLOYEES PARTICIPATED IN THE UNIVERSITY OF MARYLAND MEDICAL SYSTEM (UMMS) SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN. THE INDIVIDUALS LISTED BELOW HAVE VESTED IN THE PLAN IN A PRIOR YEAR. THEREFORE, THE CONTRIBUTIONS TO THE PLAN FOR THE FISCAL YEAR ARE REPORTED AS TAXABLE COMPENSATION AND REPORTED ON SCHEDULE J, PART II, LINE B(III), OTHER REPORTABLE COMPENSATION: JOHN W. ASHWORTH, III JON BURNS DURING THE FISCAL YEAR ENDED JUNE 30, 2015, CERTAIN OFFICERS AND KEY EMPLOYEES PARTICIPATED IN THE UNIVERSITY OF MARYLAND MEDICAL SYSTEM (UMMS) SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN. THE INDIVIDUALS LISTED BELOW HAVE VESTED IN THE PLAN IN THE REPORTING TAX YAR. THEREFORE, THE FULL VALUE OF THE PLAN, INCLUDING ANY CONTRIBUTIONS TO THE PLAN FOR THE CURRENT FISCAL YEAR, IS REPORTED AS TAXABLE COMPENSATION AND REPORTED ON SCHEDULE J, PART II, LINE B(III), OTHER REPORTABLE COMPENSATION. PRIOR YEAR CONTRIBUTIONS TO THE PLAN WERE PREVIOUSLY REPORTED ON FORM 990 AND ARE INDICATED ON SCHEDULE J, PART II, COLUMN (F). ROBERT CHRENCIK NOEL CERVINO ERIK BOAS Non-fixed payments Schedule J, Part I, Line 7 Bonuses paid are based on a number of variables including but not limited to individual goal achievements as well as organization operation achievements. The final determination of the bonus amount is determined and approved by the board as part of the overall compensation review of the officers and key employees. Tax Exempt Bond Issues Form 990, Part IV, Question 24 Pursuant to a Master Loan Agreement dated June 20, 1991 (The "Master Loan Agreement"), as Amended, The University Of Maryland Medical System Corporation (The "Corporation") and several of its subsidiaries have issued debt through the Maryland Health and Higher Educational Facilities Authority (the "Authority"). As Security for the performance of the bond obligation under the Master Loan Agreement, The Authority maintains a security interest in the revenue of the obligors. The Master Loan Agreement contains certain restrictive covenants. These covenants require that rates and charges be set at certain levels, limit incurrence of additional debt, require compliance with certain operating ratios and restrict the disposition of assets. The obligated group under the Master Loan Agreement includes the Corporation, The James Lawrence Kernan Hospital, Inc., Maryland General Hospital, Inc., Baltimore Washington Medical Center, Inc., Shore Health System, Inc., Chester River Hospital Center, Inc., Civista Medical Center, Inc., University of Maryland St. Joseph Medical Center, LLC, Upper Chesapeake Medical Center, Inc., Harford Memorial Hospital, Inc. and the University of Maryland Medical System Foundation, Inc. Each member of the obligated Group is jointly and severally liable for the repayment of the obligations under the Master Loan Agreement of the Corporation's $1,417,355,000 of outstanding Authority Bonds on June 30, 2015. All of the bonds were issued in the name of the University of Maryland Medical System Corporation and are reported on Schedule K of its Form 990. Members or Stockholders Form 990, Part VI, Line 6, 7A AND 7B University of Maryland Charles Regional Health, Inc. and University of Maryland Medical System Corporation may elect members and approve decisions of the Civista Medical Center board. Form 990 Review Process Form 990, Part VI, Line 11b THE IRS FORM 990 IS PREPARED AND REVIEWED BY THE ACCOUNTING FIRM OF GRANT THORNTON. ACCOUNTING PERSONNEL IN FINANCE SHARED SERVICES AT THE UNIVERSITY OF MARYLAND MEDICAL SYSTEM GATHER THE INFORMATION NEEDED TO COMPLETE THE RETURN AND INPUT THE DATA INTO THE GRANT THORNTON TAX ORGANIZER, WHICH IS AN EXCEL-BASED SYSTEM. WHEN ALL DATA HAS BEEN ENTERED, THE INFORMATION IS SUBMITTED TO GRANT THORNTON FOR IMPORTATION INTO THEIR TAX SOFTWARE. AT THIS POINT, GRANT THORNTON STAFF MEMBERS REVIEW THE DATA, ASK FOR ADDITIONAL INFORMATION IF NEEDED AND PREPARE THE TAX RETURN. EACH RETURN IS REVIEWED AT SEVERAL LEVELS AT GRANT THORNTON INCLUDING THE TAX PARTNER. AFTER THEIR REVIEW PROCESS, A DRAFT RETURN IS SENT TO THE ACCOUNTING STAFF AT UMMS FOR AN IN-HOUSE REVIEW. UPON COMPLETION OF THE IN-HOUSE REVIEW, GRANT THORNTON IS INSTRUCTED TO MAKE ANY NECESSARY CHANGES AND TO PREPARE THE FINAL TAX RETURN. THE FINAL RETURN UNDERGOES ANOTHER REVIEW BY THE ACCOUNTING STAFF AT FINANCE SHARED SERVICES AND IS ALSO REVIEWED BY THE ACCOUNTING MANAGER, THE DIRECTOR OF FINANCIAL REPORTING, THE VICE PRESIDENT OF FINANCE AND THE CFO, WHO SIGNS THE RETURN. PRIOR TO FILING THE IRS FORM 990, THE ORGANIZATION'S BOARD CHAIRMAN, TREASURER, AUDIT COMMITTEE CHAIRMAN, EXECUTIVE COMMITTEE CHAIRMAN OR OTHER MEMBER OF THE BOARD WITH SIMILAR AUTHORITY WILL REVIEW THE IRS FORM 990. AT THE DISCRETION OF THE REVIEWING BOARD MEMBER, SUCH MEMBER WILL BRING ANY ISSUES OR QUESTIONS RELATED TO THE COMPLETED IRS FORM 990 TO THE ATTENTION OF THE BOARD. NOTWITHSTANDING THE ABOVE, A BOARD RESOLUTION IS NOT REQUIRED FOR THE FILING OF THE ORGANIZATION'S IRS FORM 990. EACH BOARD MEMBER IS PROVIDED WITH A COPY OF THE FINAL IRS FORM 990 BEFORE FILING. Conflict of Interest Policy Monitoring & Enforcement Form 990, Part VI, Line 12c THE ORGANIZATION'S OFFICERS, DIRECTORS, EMPLOYEES AND MEDICAL STAFF MEMBERS, AS APPLICABLE, SHALL DISCLOSE CONFLICTS OF INTEREST OR POTENTIAL CONFLICTS OF INTEREST BETWEEN THEIR PERSONAL INTERESTS AND THE INTERESTS OF THE ORGANIZATION, OR ANY ENTITY CONTROLLED BY OR OWNED IN SUBSTANTIAL PART BY THE ORGANIZATION. A QUESTIONNAIRE WHICH DISCLOSES POTENTIAL CONFLICTS OF INTEREST IS DISTRIBUTED ANNUALLY TO ALL OFFICERS, DIRECTORS AND KEY EMPLOYEES. THE GENERAL COUNSEL OF THE UNIVERSITY OF MARYLAND MEDICAL SYSTEM CORPORATION (UMMSC) REVIEWS THE RESPONSES FOR UMMSC AND JAMES LAWRENCE KERNAN HOSPITAL. THE CEO OR CFO OF EACH OF THE OTHER ENTITIES IN THE UNIVERSITY OF MARYLAND MEDICAL SYSTEM REVIEWS THE RESPONSES FOR THOSE ENTITIES. THE GENERAL COUNSEL, IN CONSULTATION WITH THE AUDIT COMMITTEE, IF NECESSARY, WOULD DETERMINE IF A CONFLICT OF INTEREST EXISTED FOR UMMSC, AND JAMES LAWRENCE KERNAN HOSPITAL. WITH RESPECT TO THE OTHER ENTITIES IN THE UNIVERSITY OF MARYLAND MEDICAL SYSTEM, THE GENERAL COUNSEL MAY BE CALLED FOR CONSULT. IF SO, THE GENERAL COUNSEL MAY CONSULT THE AUDIT COMMITTEE, IF NECESSARY. WHENEVER A CONFLICT OR POTENTIAL CONFLICT OF INTEREST EXISTS, THE NATURE OF THE CONFLICT OR POTENTIAL CONFLICT OF INTEREST MUST BE DISCLOSED IN WRITING TO THE ORGANIZATION'S BOARD, BOARD COMMITTEE, AN OFFICER OF THE ORGANIZATION OR OTHER APPROPRIATE EXECUTIVE. SUCH INDIVIDUAL HAVING A POTENTIAL CONFLICT OF INTEREST SHALL PLAY NO ROLE ON BEHALF OF THE ORGANIZATION, OR ANY ORGANIZATION CONTROLLED OR SUBSTANTIALLY OWNED, IN ANY TRANSACTION IN WHICH A CONFLICT EXISTS. ALL INVITATIONS FOR BIDS, PROPOSALS OR SOLICITATIONS FOR OFFERS INCLUDE THE FOLLOWING PROVISION: ANY VENDOR, SUPPLIER OR CONTRACTOR MUST DISCLOSE ANY ACTUAL OR POTENTIAL TRANSACTION WITH ANY ORGANIZATION OFFICER, DIRECTOR, EMPLOYEE OR MEMBER OF THE MEDICAL STAFF, INCLUDING FAMILY MEMBERS WITHIN FIVE DAYS OF THE TRANSACTION. FAILURE TO COMPLY WITH THIS PROVISION IS A MATERIAL BREACH OF AGREEMENT. IN ADDITION, A BOARD DISCLOSURE REPORT IS FILED WITH THE MARYLAND HEALTH SERVICES COST REVIEW COMMISSION ON AN ANNUAL BASIS SHOWING ANY BUSINESS TRANSACTIONS BETWEEN THE BOARD MEMBERS AND THE ORGANIZATION. Process for Determining Compensation Form 990, Part VI, Line 15a & 15b THE ORGANIZATION DETERMINES THE EXECUTIVE COMPENSATION PAID TO ITS EXECUTIVES IN THE FOLLOWING MANNER PRESCRIBED IN THE IRS REGULATIONS: EXECUTIVE COMPENSATION PACKAGES ARE DETERMINED BY A COMMITTEE OF THE BOARD THAT IS COMPOSED ENTIRELY OF BOARD MEMBERS WHO HAVE NO CONFLICT OF INTEREST. THE COMMITTEE ACQUIRES CREDIBLE COMPARABILITY MARKET DATA CONCERNING THE COMPENSATION PACKAGES OF SIMILARLY SITUATED EXECUTIVES. THE COMMITTEE CAREFULLY REVIEWS THAT DATA, THE EXECUTIVE'S PERFORMANCE AND THE PROPOSED COMPENSATION PACKAGES DURING THE DECISION MAKING PROCESS. THE COMMITTEE MEMORIALIZES ITS DELIBERATIONS IN DETAILED MINUTES REVIEWED AND ADOPTED AT THE NEXT-FOLLOWING MEETING. THE COMMITTEE SEEKS AN OPINION OF COUNSEL THAT IT HAS MET THE REQUIREMENTS OF THE IRS INTERMEDIATE SANCTIONS REGULATIONS. THIS PROCESS IS USED TO DETERMINE THE COMPENSATION PACKAGES FOR ALL MANAGEMENT EMPLOYEES FROM THE VICE PRESIDENT LEVEL AND UP. How Documents are Made Available to the Public Form 990, Part VI, Line 19 IN GENERAL, FINANCIAL AND TAX INFORMATION RELATING TO THE ORGANIZATION IS DEEMED PROPRIETARY AND NOT SUBJECT TO DISCLOSURE UPON REQUEST. HOWEVER, SPECIFIC PROVISIONS OF FEDERAL AND STATE LAW REQUIRE THE ORGANIZATION TO DISCLOSE CERTAIN LIMITED FINANCIAL AND TAX DATA UPON A SPECIFIC REQUEST FOR THAT INFORMATION. REQUESTS FOR FORM 990 AND FORM 1023: A REQUESTOR SEEKING TO REVIEW AND/OR OBTAIN A COPY OF THE ORGANIZATION'S IRS FORM 990 OR FORM 1023 AS FILED WITH THE INTERNAL REVENUE SERVICE, INCLUDING ALL SCHEDULES AND ATTACHMENTS, MAY APPEAR IN PERSON OR SUBMIT A WRITTEN REQUEST. THE MOST RECENT THREE YEARS OF IRS FORM 990 MAY BE REQUESTED. IF THE REQUESTER APPEARS IN PERSON, THE INDIVIDUAL IS DIRECTED TO THE OFFICE OF THE CHIEF FINANCIAL OFFICER FOR THE ORGANIZATION AND THE FORM 990 AND/OR FORM 1023 ARE MADE AVAILABLE FOR INSPECTION. THE INDIVIDUAL IS PERMITTED TO REVIEW THE RETURN, TAKE NOTES AND REQUEST A COPY. IF REQUESTED, A COPY IS PROVIDED ON THE SAME DAY. A NOMINAL FEE IS CHARGED FOR MAKING THE COPIES. THE ORGANIZATION MAY HAVE AN EMPLOYEE PRESENT DURING THE PUBLIC INSPECTION OF THE DOCUMENT. WRITTEN REQUESTS FOR AN ENTITY'S FORM 990 OR FORM 1023 ARE DIRECTED IMMEDIATELY TO THE OFFICE OF THE CHIEF FINANCIAL OFFICER FOR THE ORGANIZATION. THE REQUESTED COPIES ARE MAILED WITHIN 30 DAYS OF THE REQUEST. REPRODUCTION FEES AND MAILING COSTS ARE CHARGED TO THE REQUESTOR. CONFLICT OF INTEREST POLICY AND GOVERNING DOCUMENTS: IF THE GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY OF OUR ORGANIZATION ARE SUBJECT TO THE FEDERAL PUBLIC DISCLOSURE RULES (OR STATE PUBLIC DISCLOSURE RULES), THESE DOCUMENTS WILL BE MADE PUBLICLY AVAILABLE AS APPLICABLE LAW MAY REQUIRE. OTHERWISE, THE GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY WILL BE PROVIDED TO THE PUBLIC AT THE DISCRETION OF MANAGEMENT. Hours on Related Entities FORM 990, PART VII, SECTION A, COLUMN B THE UNIVERSITY OF MARYLAND MEDICAL SYSTEM (UMMS) IS A MULTI-ENTITY HEALTH CARE SYSTEM THAT INCLUDES 11 ACUTE CARE HOSPITALS, 1 ACUTE CARE HOSPITAL OWNED IN A JOINT VENTURE ARRANGEMENT AND VARIOUS SUPPORTING ENTITIES. A NUMBER OF INDIVIDUALS PROVIDE SERVICES TO VARIOUS ENTITIES WITHIN THE SYSTEM. IN GENERAL, THE OFFICERS AND KEY EMPLOYEES OF UMMS AVERAGE IN EXCESS OF 40 HOURS PER WEEK SERVING THE DIFFERENT ENTITIES THAT COMPRISE UMMS. Other Changes in Net Assets or Fund Balances Form 990, Part XI, Line 9 Change in Equity of Affiliates, ccs -3,489,794 Change in Equity of Affiliates, chi -10,000,000 Change in Equity of Affiliates, ccp -4,061,250 Change in Equity of Affiliates, Foundation -11,752 Change in FMV of Alternative Investments -47,986 Pension liability adjustment -991,664 ------------ -18,602,446 Baltimore Washington Emergency Phys Inc 301 Hospital Drive Glen Burnie MD 21061 521756326 Healthcare MD 501(c)(3) 11a UMBWMS false Baltimore Washington Healthcare Services 301 Hospital Drive Glen Burnie MD 21061 521830243 Healthcare MD 501(c)(3) 11a UMBWMS false Baltimore Washington Medical Center Inc 301 Hospital Drive Glen Burnie MD 21061 520689917 Healthcare MD 501(c)(3) 03 UMBWMS false UMD Baltimore Washington Medical Center 301 Hospital Drive Glen Burnie MD 21061 521830242 Healthcare MD 501(c)(3) 11a UMMSC false BW Medical Center Foundation Inc 301 Hospital Drive Glen Burnie MD 21061 521813656 Fundraising MD 501(c)(3) 11c UMBWMS false North Arundel Development Corporation 301 Hospital Drive Glen Burnie MD 21061 521318404 Real Estate MD 501(c)(2) ncc false North County Corporation 301 Hospital Drive Glen Burnie MD 21061 521591355 Real Estate MD 501(c)(2) UMBWMS false Shipleys Choice Medical Park Inc 22 South Greene Street Baltimore MD 21201 043643849 Real Estate MD 501(c)(2) ncc false Chester River Health Foundation Inc 100 Brown Street Chestertown MD 21620 521338861 Fundraising MD 501(c)(3) 08 umsrh false Univ of MD Shore Regional HealthInc 100 Brown Street Chestertown MD 21620 522046500 Healthcare MD 501(c)(3) 11a UMMSC false Chester River Hospital Center 100 Brown Street Chestertown MD 21620 520679694 Healthcare MD 501(c)(3) 03 umsrh false Chester River Manor Inc 200 Morgnec Road Chestertown MD 21620 526070333 Healthcare MD 501(c)(3) 09 umsrh false Maryland General Clinical Practice Group 827 Linden Avenue Baltimore MD 21201 521566211 Healthcare MD 501(c)(3) 11b ummth false Maryland General Comm Health Foundation 827 Linden Avenue Baltimore MD 21201 522147532 Fundraising MD 501(c)(3) 11c ummth false University of Maryland Midtown Health 827 Linden Avenue Baltimore MD 21201 521175337 Healthcare MD 501(c)(3) 11b UMMSC false Maryland General Hospital Inc 827 Linden Avenue Baltimore MD 21201 520591667 Healthcare MD 501(c)(3) 03 ummth false Care Health Services Inc 219 South Washington Street Easton MD 21601 521510269 Healthcare MD 501(c)(3) 09 umsrh false Dorchester General Hospital Foundation 219 South Washington Street Easton MD 21601 521703242 Fundraising MD 501(c)(3) 11d umsrh false Memorial Hospital Foundation Inc 219 South Washington Street Easton MD 21601 521282080 Fundraising MD 501(c)(3) 11a umsrh false UM Community Medical Group Inc 920 Elkridge Landing Road Linthicum MD 21090 521874111 Healthcare MD 501(c)(3) 03 UMMSC false Shore Health System Inc 219 South Washington Street Easton MD 21601 520610538 Healthcare MD 501(c)(3) 03 UMMSC false James Lawrence Kernan Hosp Endow Fd 2200 Kernan Drive Baltimore MD 21207 237360743 Fundraising MD 501(c)(3) 11b UMMSC false James Lawrence Kernan Hospital Inc 2200 Kernan Drive Baltimore MD 21207 520591639 Healthcare MD 501(c)(3) 03 UMMSC false UMMS Foundation Inc 22 South Greene Street Baltimore MD 21201 522238893 Fundraising MD 501(c)(3) 11a UMMSC false University of MD Medical System Corp 22 South Greene Street Baltimore MD 21201 521362793 Healthcare MD 501(c)(3) 03 NA false University of Maryland Charles Regional PO Box 1070 La Plata MD 20646 522155576 Healthcare MD 501(c)(3) 11c UMMSC false Charles Regional Medical Center Foundati PO Box 1070 La Plata MD 20646 521414564 Fundraising MD 501(c)(3) 11a umcrh false Charles Regional Medical Center Auxiliar PO Box 1070 La Plata MD 21204 521131193 Fundraising MD 501(c)(3) 11a umcrh false Univ of MD St Joseph Foundation Inc 7601 Osler Drive Towson MD 21014 521681044 Fundraising MD 501(c)(3) 11a UMMSC false Harford Memorial Hospital Inc 520 Upper Chesapeake Dr Bel Air MD 21014 520591484 Healthcare MD 501(c)(3) 03 UMUCHS false UCH Legacy Funding Corporation 520 Upper Chesapeake Dr Bel Air MD 21014 520882914 Fundraising MD 501(c)(3) 11a UMUCHS false Univ of MD Upper Chesapeake Health Sys 520 Upper Chesapeake Dr Bel Air MD 21014 521398513 Healthcare MD 501(c)(3) 11c; III-FI UMUCHS false Upper Chesapeake Health Foundation Inc 520 Upper Chesapeake Dr Bel Air MD 21014 521398507 Fundraising MD 501(c)(3) 11a UMUCHS false Upper Chesapeake Medical Center Inc 520 Upper Chesapeake Dr Bel Air MD 21014 521253920 Healthcare MD 501(c)(3) 03 UMUCHS false Upper Chesapeake Medical Services Inc 520 Upper Chesapeake Dr Bel Air MD 21014 521501734 Healthcare MD 501(c)(3) 09 UMUCHS false Upper Chesapeake Properties Inc 520 Upper Chesapeake Dr Bel Air MD 21014 521907237 Real Estate MD 501(c)(2) UMUCHS false Upper Ches Residential Hospice House 520 Upper Chesapeake Dr Bel Air MD 21014 260737028 Hospice MD 501(c)(3) 07 UMUCHS false Upper ChesapeakeSt Joe's Home Careinc 520 Upper Chesapeake Dr Bel Air MD 21204 521229742 Hospice MD 501(c)(3) 09 UMUCHS false UMSJ Health System LLC 7601 Osler Drive Towson MD 21204 460797956 Healthcare MD 501(c)(3) 03 UMMSC false Arundel Physicians Associates LLC 301 Hospital Drive Glen Burnie MD 20161 522000762 Healthcare MD NA N/A Baltimore Washington Imaging LLC 301 Hospital Drive Glen Burnie MD 20161 200806027 Healthcare MD NA N/A NAHSunrise of Severna Park LLC 301 Hospital Drive Glen Burnie MD 20161 541810729 Healthcare MD NA N/A North Arundel Senior Living LLC 301 Hospital Drive Glen Burnie MD 20161 541810728 Healthcare MD NA N/A Innovative Health LLC 29165 Canvasback Drive Suite 100 Easton MD 21601 521997287 Billing MD NA N/A Central Maryland Radiology Oncology LLC 10710 Charter Drive Columbia MD 21044 270879418 Healthcare MD NA N/A Universitycare LLC 22 South Greene Street Baltimore MD 21201 521914892 Healthcare MD NA N/A O'Dea Medical Arts Limited Partnership 7601 Osler Drive Towson MD 21204 521682964 Rental MD NA N/A Advanced Imaging at St Joseph Medical C 7601 Osler Drive Towson MD 21204 521958002 Healthcare MD NA N/A UCHSUMMS Real Estate Trust 520 Upper Chesapeake Dr Bel Air MD 21014 276803540 Real Estate MD NA N/A Arundel Physicians Associates Inc 301 Hospital Drive Glen Burnie MD 21061 521992649 Healthcare MD NA C Corp Baltimore Washington Health Enterprises 301 Hospital Drive Glen Burnie MD 21061 521936656 Healthcare MD NA C Corp BW Professional Services Inc 301 Hospital Drive Glen Burnie MD 21061 521655640 Healthcare MD NA C Corp Univ of Maryland Charles Regional Care P PO Box 1070 La Plata MD 20646 522176314 Healthcare MD NA C Corp University Midtown Prof Center A Condo 827 Linden Avenue Baltimore MD 21201 521891126 Real Estate MD NA C Corp NA Executive Building Condo Assn Inc 301 Hospital Drive Glen Burnie MD 21061 Real Estate MD NA C Corp Terrapin Insurance Company 980129232 Insurance NA C Corp UMMS Self Insurance Trust 22 South Greene Street Baltimore MD 21201 526315433 Insurance MD NA Trust Upper Chesapeake Insurance Company PO Box 1109 Grand Cayman Cayman Islands CJ 980468438 Captive Insurance CJ NA ltd Upper Chesapeake Health Ventures Inc 520 Upper Chesapeake Dr Bel Air MD 21014 522031264 Healthcare MD NA C Corp Upper Chesapeake Medical Center Land Con 520 Upper Chesapeake Dr Bel Air MD 21014 770674478 Real Estate MD NA C Corp Upper Chesapeake Medical Office Building 520 Upper Chesapeake Dr Bel Air MD 21014 521946829 Real Estate MD NA C Corp false false false false false false false false true false false false false true true false true true true