2014-05-13T09:21:30-05:00 2013-06-30 COHEN RUTHERFORD KNIGHT PC 6903 ROCKLEDGE DRIVE SUITE 500 BETHESDA MD 208171800 990 2012-07-01 520619000 Calvert Memorial Hospital of Calvert County % ROBERT KERTIS CALV 4105354000 100 Hospital Road Suite Prince Frederick MD 20678 JAMES XINIS 4105354000 2014-05-05 true TINA C ECKLOFF 3018281008 2014-05-01 2012 2015-11-30 17:44:51Z JAMES XINIS 100 HOSPITAL RD PRINCE FREDERICK MD 20678 126185046 false X www.calverthospital.org X 1918 MD CALVERT MEMORIAL HOSPITAL PROVIDES QUALITY INPATIENT AND AMBULATORY HEALTH CARE TO THE PEOPLE OF SOUTHERN MARYLAND THAT IS ACCESSIBLE, COST-EFFECTIVE AND COMPASSIONATE. 19 15 1299 198 1799338 -19725 609604 725689 122875723 120837283 266230 437957 6490394 4102507 130241951 126103436 0 5000 0 0 66329303 61667920 0 0 0 61113821 57341758 127443124 119014678 2798827 7088758 106515249 111862040 86442833 84365248 20072416 27496792 CALVERT MEMORIAL HOSPITAL PROVIDES QUALITY INPATIENT AND AMBULATORY HEALTH CARE TO THE PEOPLE OF SOUTHERN MARYLAND THAT IS ACCESSIBLE, COST-EFFECTIVE AND COMPASSIONATE. CMH WORKS IN PARTNERSHIP WITH THE COMMUNITY TO IMPROVE THE HEALTH STATUS OF ITS MEMBERS. false false 105909836 5000 123153488 CALVERT MEMORIAL HOSPITAL'S MISSION IS FOR THE CHARITABLE PURPOSE OF PROVIDING QUALITY INPATIENT AND AMBULATORY HEALTH CARE SERVICES TO THE CITIZENS OF SOUTHERN MARYLAND THAT IS ACCESSIBLE, COST EFFECTIVE AND COMPASSIONATE. THE HOSPITAL WORKS IN PARTNERSHIP WITH THE COMMUNITY TO IMPROVE THE HEALTH STATUS OF ITS MEMBERS. THE HOSPITAL PROVIDES MEDICAL SERVICES TO PATIENTS REGARDLESS OF RACE, CREED, SEX, NATIONAL ORIGIN, HANDICAP, AGE OR ABILITY TO PAY. IN FY 2013, THE HOSPITAL SERVED 8,001 INPATIENTS, 123,642 OUTPATIENTS AND PROVIDED 41,585 EMERGENCY ROOM VISITS. IN ADDITION TO THE INPATIENTS SERVED, THE HOSPITAL ALSO TREATED 1,546 MEDICAL OBservation PATIENTS. FOR FY 2013, THE HOSPITAL FILED WITH THE STATE OF MARYLAND A COMMUNITY BENEFIT REPORT THAT DOCUMENTED $18,620,002 IN COMMUNITY BENEFIT PROVIDED BY CALVERT MEMORIAL HOSPITAL. THE COMMUNITY BENEFIT REPORT IS AVAILABLE UPON REQUEST. ALL FINANCIAL SURPLUSES THE HOSPITAL GENERATES ARE USED EXCLUSIVELY TO FURTHER THE CHARITABLE PURPOSES OF THE ORGANIZATION. THE HOSPITAL IS GOVERNED BY A COMMUNITY BOARD COMPRISED OF CIVIC LEADERS THROUGHOUT CALVERT COUNTY WHO ARE COMMITTED TO AND REPRESENT THE HEALTHCARE NEEDS OF THE COMMUNITY. THE HOSPITAL IN FY 2013 PROVIDED $7,447,000 IN CHARITY CARE, TO RESIDENTS WHO WERE UNABLE TO PAY FOR THOSE SERVICES AND MET ELIGIBILITY CRITERIA. THE HOSPITAL, AS A SOLE COMMUNITY PROVIDER, PROVIDES ESSENTIAL HEALTHCARE SERVICES SUCH AS OBSTETRICS, PSYCHIATRY (BOTH INPATIENT AND OUTPATIENT), EMERGENCY SERVICES, URGENT CARE AND LONG-TERM CARE THAT OTHERWISE WOULD NOT BE PROVIDED WITHIN CALVERT COUNTY OR WOULD HAVE TO BE PROVIDED BY THE GOVERNMENT. MANY OF THESE SERVICES BY THEIR NATURE ARE UNPROFITABLE SERVICES DUE TO THEIR HIGH COSTS AND LOW REIMBURSEMENT. THESE SERVICES WOULD NOT BE PROVIDED IF THE HOSPITAL DID NOT STEP IN TO PROVIDE THEM. IN ADDITION, IN FY 2013, THE HOSPITAL PROVIDED $427,150 OF FREE HEALTH SERVICES FOR CALVERT HEALTHCARE SOLUTIONS PATIENTS. CALVERT HEALTHCARE SOLUTIONS IS A PARTNERSHIP BETWEEN THE LOCAL HEALTH DEPARTMENT, LOCAL PHYSICIANS AND THE HOSPITAL THAT PROVIDES PRIMARY CARE SERVICES TO PATIENTS WHO ARE UNINSURED. 105909836 true true false false false false false false false true false false true true false false true false false false false false false false false true true false false true true false false false false false false false false false true false false false false false true true true false false true 151 0 true 1299 true true true false false false false false false false false false X 19 15 false false false false false false false true true false false true true true true true true true true false MD X ROBERT KERTIS 4105354000 100 HOSPITAL ROAD PRINCE FREDERICK MD 20678 X CLIFF STEWART 1.0 1.0 X 0 0 0 JOSEPH BOYD 1.0 1.0 X 0 0 0 KEVIN BETZ 1.0 3.0 X 0 0 0 GAIL GIBSON 1.0 1.0 X 0 0 0 ERIC FRANKLIN 1.0 1.0 X 0 0 0 UDAY PATEL 1.0 1.0 X 0 0 0 KEVIN NIETMANN 4.0 2.0 X X 0 0 0 MARSHA PLATER 1.0 1.0 X 1472 0 0 SALLY SHOWALTER 1.0 3.0 X 0 0 0 LAURIE UHEREK 1.0 1.0 X X 0 0 0 JAMES XINIS 40.0 8.0 X X 1242289 0 216310 PETER DALY 1.0 1.0 X 0 0 0 JOHN WEIGEL 1.0 1.0 X 0 0 0 CIARAN BROWNE 2.0 1.0 X 0 0 0 HENRY TRENTMAN 5.0 5.0 X X 0 0 0 PATRICIA EDDLEMAN 4.0 1.0 X 0 0 0 BARBARA ESTES 4.0 1.0 X 23371 0 0 RICHARD FLEMING 1.0 1.0 X 0 0 0 ALONZO BARBER III 1.0 1.0 X 0 0 0 GEORGE GELLRICH 1.0 1.0 X 0 0 0 VARKEY MATHEW 3.0 1.0 X 26580 0 0 DONALD PARSONS JR 20.0 15.0 X X 0 0 0 ROBERT KERTIS 40.0 8.0 X 212809 0 22641 ROBERT MCWHIRT 40.0 0.0 X 130173 0 19423 SUSAN DOHONY 40.0 0.0 X 199089 0 64050 EDWARD GROGAN 40.0 0.0 X 161780 0 33809 DIANE COUCHMAN 40.0 0.0 X 135447 0 25323 DEAN TEAGUE 40.0 0.0 X 97216 0 4424 JOHN BROOKS 40.0 0.0 X 35916 0 73 ANTHONY BLADEN 40.0 0.0 X 177620 0 15360 SEYED ALI MOHAMMADI 40.0 0.0 X 357765 0 33056 SCOTT INTNER 40.0 0.0 X 165440 0 20347 KARA HARRER 40.0 0.0 X 142166 0 13613 PILAR CROOK 40.0 0.0 X 142034 0 34808 SHARON BAKER 40.0 0.0 X 135605 0 18323 ROBERT SCHLAGER 40.0 0.0 X 121961 0 12606 3508733 0 534166 44 true true false EMERGENCY MEDICINE ASSOCIATES PA PC 20010 CENTURY BLD STE 200 GERMANTOWN MD 20874 URGENT CARE PHYS STF 575179 MARYLAND INPATIENT CARE SPECIALISTS 6934 AVIATION BLVD STE B GLEN BURNIE MD 21061 HOSPITALIST 558247 DIPAK K SHAH MD 22740 AVENMAR DRIVE LEONARDTOWN MD 20650 BEHAVIORAL HEALTH 473500 CALVERT INTERNAL MEDICINE GROUP 110 HOSPITAL RD STE 310 PRINCE FREDERICK MD 20678 OP CARDIAC TEST SERV 441229 MAYO MEDICAL LABORATORIES PO BOX 9146 MINNEAPOLIS MN 55480 LAB TESTING 393429 33 30000 220536 444331 30822 725689 INPATIENT REVENUE 26498068 26498068 OUTPATIENT REVENUE 30125451 30125451 EMERGENCY REVENUE 13307416 13307416 OTHER PATIENT REVENUE 569748 569748 MEDICARE/MEDICAID REVENUE 50336600 50336600 120837283 435437 435437 0 0 70519 81610 -11091 0 -11091 1945 -13036 2520 2520 2520 2520 0 0 0 OTHER REVENUE 1345062 1345062 PHARMACY SALES 446110 5666 5666 PHYSICIAN ANS SER 561000 33328 33328 2729542 971143 1758399 4113598 126103436 123153488 1799338 424921 0 5000 5000 0 0 2155444 0 2155444 0 0 47946804 43401054 4545750 3145523 2765866 379657 4756495 4120312 636183 3663654 3173639 490015 549635 509135 40500 510992 510992 124570 124570 0 0 0 4718865 4718865 0 0 102352 102112 240 5597553 4931682 665871 2623666 2465197 158469 0 2783531 2510196 273335 128661 49561 79100 0 185585 165479 20106 2348788 2294061 54727 0 8209515 8127929 81586 1488777 1458025 30752 MEDICAL SUPPLIES 17768494 17768494 PURCHASED SERVICES 4740684 3880369 860315 REPAIRS AND MAINTENANCE 2851508 2770259 81249 OTHER 2110378 692601 1417777 498204 498204 119014678 105909836 13104842 0 11081171 15229579 106741 46016 0 0 13243805 12234989 0 0 0 0 8184 0 2315807 2236702 1330572 1354549 143323614 84407314 62108594 58916300 5275414 4742261 3069034 1784162 0 0 0 0 7975927 15317482 106515249 111862040 17029456 14233776 0 0 0 0 52174352 50370745 0 0 0 0 0 0 0 0 17239025 19760727 86442833 84365248 X 19961405 26058970 111011 628893 0 808929 20072416 27496792 106515249 111862040 X 7088758 118618 217000 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 4881046 4881046 66522713 31857746 34664967 2893739 1614707 1279032 66493796 49645324 16848472 2581891 1215079 1366812 59040329 LT BOND FINANCING COSTS 825896 OTHER RECEIVABLES 498282 GOODWILL 15000 INVEST IN AFFILIATED ENTERPRIS 2644587 LT MIN LEASE PYMTS RECD 30000 MALPRACTICE INS RECOVERY 7064435 INVESTMENT IN FOUNDATION 3510489 DUE FROM RELATED PARTIES 728793 15317482 0 EXECUTIVE 457B 457F PLANS 2124185 ADVANCES FROM THIRD PARTIES 3708463 ACCRUED PENSION COSTS 5727143 PROFESSIONAL LIABILITY 8200936 19760727 true true true X true X true true true false true true 5272522 5272522 0.04430 5272522 5272522 0.04430 1397214 253137 1144077 0.00960 852620 852620 0.00720 12965459 4454349 8511110 0.07160 24081 24081 0.00020 15239374 4707486 10531888 0.08860 20511896 4707486 15804410 0.13290 548060 26400 521660 0.00440 92391 92391 0.00080 26656 26656 0.00020 667107 26400 640707 0.00540 true 1131256 46896643 33850158 13046485 X true true 1 1 Calvert Memorial Hospital

100 Hospital Road Prince Frederick MD 20678

X X X skilled nursing fac urgent care ctrs family prac clinic Calvert Memorial Hospital 1 true X X X X X X X X 11 true false true X X X X X X X X X X false false true true 200. true 300. true X X X X X X X true true X X X true false X X X X true X false false 6 DUNKIRK URGENT CARE

10845 TOWN CENTER BLVD SUITE 108 DUNKIRK MD 20754

URGENT CARE CENTER SOLOMONS URGENT CARE

14090 HG TRUEMAN ROAD SUITE 1300 SOLOMONS MD 20688

URGENT CARE CENTER CMH LABORATORY SERVICES

130 HOSPITAL ROAD SUITE 204 PRINCE FREDERICK MD 20678

LABORATORY DRAW STATION CMH LABORATORY SERVICES

14090 HG TRUEMAN ROAD SUITE 1400 SOLOMONS MD 20688

LABORATORY DRAW STATION BREAST CARE CENTER

130 HOSPITAL ROAD SUITE 102 PRINCE FREDERICK MD 20678

OUTPATIENT CLINIC WOMAN'S WELLNESS CENTER

130 HOSPITAL ROAD SUITE 102 PRINCE FREDERICK MD 20678

OUTPATIENT CLINIC PART I, LINE 3 FINANCIAL NEED WILL BE DETERMINED IN ACCORDANCE WITH PROCEDURES THAT INVOLVE A FACTS AND CIRCUMSTANCES ASSESSMENT OF THE FINANCIAL NEED OF THE PATIENT, WHICH MAY INCLUDE THE FOLLOWING: A) AN APPLICATION PROCESS, IN WHICH THE PATIENT OR THE PATIENT'S GUARANTOR ARE REQUIRED TO COOPERATE AND SUPPLY PERSONAL, FINANCIAL AND OTHER INFORMATION AND DOCUMENTATION RELEVENT TO MAKING A DETERMINATION OF FINANCIAL NEED. THE APPLICATION FORM IS THE MARYLAND STATE UNIFORM FINANCIAL ASSISTANCE APPLICATION. B) THE USE OF EXTERNAL PUBLICALLY AVALIABLE DATA SOURCES THAT PROVIDE INFORMATION ON A PATIENT'S OR A PATIENT'S GUARANTOR'S ABILITY TO PAY (SUCH AS CREDIT SCORING); C) REASONABLE EFFORTS BY CALVERT MEMORIAL HOSPITAL TO EXPLORE APPROPRIATE ALTERNATIVE SOURCES OF PAYMENT AND COVERAGE FROM PUBLIC AND PRIVATE PAYMENT PROGRAMS; D) TAKING INTO ACCOUNT THE PATIENT'S AVAIABLE ASSETS, AND ALL OTHER FINANCIAL RESOURCES AVAILABE TO THE PATIENT; AND E) A REVIEW OF THE PATIENT'S OUTSTANDING ACCOUNTS RECEIVABLE FOR PRIOR SERVICES RENDERED AND THE PATIENT'S PAYMENT HISTORY. IT IS PREFERRED BUT NOT REQUIRED THAT A REQUEST FOR FINANCIAL ASSISTANCE AND A DETERMINATION OF FINANCIAL NEED OCCUR PRIOR TO THE RENDERING OF SERVICES. HOWEVER, THE DETERMINATION MAY BE DONE AT ANY POINT IN THE COLLECTION CYCLE. THE NEED FOR PAYMENT ASSISTANCE SHALL BE RE-EVALUATED AT EACH SUBSEQUENT TIME OF SERVICES IF THE LAST FINANCIAL EVALUATION WAS COMPLETED MORE THAN SIX MONTHS PRIOR, OR AT ANY TIME ADDITIONAL INFORMATION RELEVENT TO THE ELIGIBILITY OF THE PATIENT FOR FINANCIAL ASSISTANCE BECOMES KNOWN. CALVERT MEMORIAL HOSPITAL PERFORMS REASONABLE COLLECTION EFFORTS AS DEFINED IN THEIR PRIVATE PAY COLLECTIONS POLICY BY SENDING PATIENTS THAT HAVE NOT YET QUALIFIED UNDER THE HOSPITAL'S FINANCIAL POLICY AT LEAST THREE STATEMENTS. PATIENTS MAY ALSO RECEIVE PHONE CALLS REMINDING THEM A BALANCE IS DUE. UNPAID PATIENT ACCOUNTS ARE IDENTIFIED AS PRE-BAD DEBT AFTER 75 TO 90 DAYS. PRIOR TO TRANSFERRING ACCOUNTS TO AN EXTERNAL COLLECTION AGENCY OR UNDERTAKING ANY OTHER COLLECTION ACTIONS, THE ACCOUNTS ARE BATCHED AND SCREENED FOR THE PATIENT'S ABILITY TO PAY AGAINST THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY STANDARDS WITHIN SEARCH AMERICA. ANY PATIENTS WHOSE FINANCIAL CONDITIONS QUALIFY FOR FINANCIAL ASSISTANCE PER THE SOFTWARE'S SEARCH ARE IMMEDIATELY APPROVED BY THE HOSPITAL FOR CHARITY CARE AND ALL COLLECTION EFFORTS ARE IMMEDIATELY CEASED. PART I, LINE 5A AND 5B Calvert Memorial Hospital offers free or discounted care to patients who are unable to pay for their services and meet the eligibility criteria regardless of the amount budgeted for financial assistance in the hospital's annual operating plan. PART I, LINE 6A, 6B Maryland's Health Services Cost Review Commission (HSCRC) requires all Maryland hospitals to complete and submit a Community Benefit Report annually. The HSCRC is responsible for collecting the data from the individual hospitals and compiling a statewide document that contains summary information as well as individual hospital reports. The statewide document is made available to the public on the HSCRC's website. PART I, LINE 7A, COLUMN 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. PART I, LINE 7B, COLUMNS C, D, E AND 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. The exception to this is the impact on the hospital of its share of the Medicaid assessment. In recent years, the state of Maryland has closed fiscal gaps in the state Medicaid budget by assessing hospitals through the rate setting system. The hospital portion of the Maryland Medicaid assessment for CMH for the 2012 tax year was $514,581. PART I, LINE 7F, COLUMN C AND 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. PART I, LINE 7G Subsidized health services include the following non-physician clinics: Woman's Wellness Center, Dunkirk Urgent Care, GYN-Oncology Clinic, Pediatric Orthopedic Clinic, Solomons Urgent Care and Spine Clinic. Costs attributable to the clinics totaled $1,119,675. THese services would likely not be undertaken in the community if not provided by Calvert Memorial Hospital. As a result Calvert Memorial Hospital has identified a community need for the provision of these services. PART I, LINE 7 The costing methodology used to calculate amounts reported in line 7 was a cost-to-charge ratio derived from Worksheet 2, Ratio of Patient Care Cost-to-Charges. PART II Calvert Memorial Hospital (CMH) is recognized as a leader in the provision of health care in the local area. It partners with many organizations and agencies to expand the reach for improving the health of its community. Activities include: Developing and leading a health ministry team program with 25 local area churches, school wellness council and area businesses to improve health of their employees. Supporting staff participation on local area boards, coalitions and collaboratives, such as the United Way of Calvert County, Hospice of Calvert County, Maryland Rural Health Association, the Office on Aging, Southern Maryland Community Network, Calvert County Oral Health Coalition, Tri-County Council, EMS Council, Maryland Perinatal Patient Safety Collaborative, Comptroller's Advisory Board and the Calvert Cancer Coalition. These are just a few of CMH's community building activities. Improving the health of the community is a priority area for the hospital and therefore drives many of our strategic plans. PART III, LINE 4 The following is the text of the footnote to the organization's financial statements that describes the organization's bad debt expense: Accounts receivable are reported at their net realizable value from third-party payers, patients, residents and others for services rendered. Allowances are provided for third-party payers based on estimated reimbursement rates. Allowances are also provided for bad debts on an estimate of uncollectible accounts. Write-off of uncollectible accounts is determined on a case-by-case basis after a review of the circumstances surrounding individual patient accounts. The amount reported on Part III, line 2 was determined by taking the amount reported as Provision for Uncollectible Accounts in the Hospital's Statement of Operations and applying the cost to charge ratio, as calculated in Worksheet 2, to calculate the cost of the organization's bad debt expense. The Hospital estimates that none of the actual bad debt expense in the 2012 tax year was attributable to patients eligible for financial assistance. This is based upon the process that has been put in place (described in the disclosure to Part I, Line 3) to determine if patients qualify for financial assistance prior to classifying the patient(s) account as bad debt. PART III, LINE 8 The costing source is the Medicare Cost Report and the methodology is Medicare allowable cost to Medicare revenues received. PART III, LINE 9B As stated in Calvert Memorial Hospital's Financial Assistance Policy, Part V, Section G: Calvert Memorial Hospital has developed policies and procedures for internal and external collection practices that take into account the extent to which the patient qualifies for financial assistance, a patient's good faith effort to apply for a governmental program or for financial assistance from Calvert Memorial Hospital, and a patient's good faith effort to comply with his or her payment agreements with Calvert Memorial Hospital. For patients who are cooperating with applying and qualifying for either Medical Assistance or financial assistance, Calvert Memorial Hospital will not send unpaid bills to outside collection agencies and will cease all collection activities. Once the collection process has begun, the Hospital continues to monitor whether the patient qualifies for charity care under the financial assistance policy. If the Hospital determines that a patient qualifies for financial assistance, including once the collection process has begun, the organization will approve the patient for charity care. Once charity care has been approved, there is no further attempt made by the organization to collect. Collection efforts will be stopped at any time during the collection process if the patient qualifies for charity care under the financial assistance policy. Furthermore, if a patient's financial situation changes at any point during the collection process, the patient may qualify for financial assistance at such point. 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 V, Line 3 CALVERT MEMORIAL HOSPITAL TOOK INTO ACCOUNT INPUT FROM REPRESENTATIVES OF THE COMMUNITY SERVED BY THE HOSPITAL FACILITY, INCLUDING THOSE WITH SPECIALIZED KNOWLEDGE OF OR EXPERTISE IN PUBLIC HEALTH, COMMUNITY LEADERS, AND LEADERS OR REPRESENTATIVES OF LOW INCOME OR UNDERSERVED GROUPS SERVED IN THE COMMUNITY. In PARTICULAR, CALVERT MEMORIAL HOSPITAL PARTNERED WITH NUMEROUS COMMUNITY LEADERS THROUGH THE CALVERT COUNTY COMMUNITY HEALTH IMPROVEMENT ROUNDTABLE (THE "ROUNDTABLE") TO JOINTLY DEVELOP THE CHNA. THE SPECIFIC MEMBERS OF THE ROUNDTABLE WERE AS FOLLOWS: BABS BUCHEISTER, RN, DIRECTOR OF NURSING CALVERT COUNTY HEALTH DEPARTMENT SEAN CROSBY DEPARTMENT OF SOCIAL SERVICES CANDICE D'AGOSTINO CALVERT ALLIANCE AGAINST SUBSTANCE ABUSE FATHER PETER DALEY SAINT JOHN VIANNEY CATHOLIC CHURCH RAYMON NOBLE,MD CALVERT HOSPICE BRENDA CALVERT HOSPICE MARGARET FOWLER, COMMUNITY WELLNESS DIRECTOR CALVERT MEMORIAL HOSPITAL HARRIET S YAFFE, EXECUTIVE DIRECTOR THE ARC OF SOUTHERN MARYLAND MAUREEN T HOFFMAN,COMMUNITY RESOURCES DIRECTOR CALVERT COUNTY GOVERNMENT KERI LIPPERINI OFFICE ON AGING, DIVISION CHIEF VACANCY PENDING DEPARTMENT OF JUVENILE SERVICES LISA LASCHALT,R.S., M.P.H., PROGRAM SUPERVISOR CALVERT COUNTY HEALTH DEPARTMENT DONNA NICHOLS, SUPERVISOR OF HEALTH CALVERT COUNTY PUBLIC SCHOOLS LAURENCE POLSKY,MD,M.P.H., HEALTH OFFICER CALVERT COUNTY HEALTH DEPARTMENT KASIA SWEENEY, PUBLIC RELATIONS DIRECTOR CALVERT MEMORIAL HOSPITAL TAMMY HALTERMAN, HEALTH PROMOTIONS CALVERT COUNTY HEALTH DEPARTMENT MARY BAHEN,RN,BSN - HEALTH MINISTRY CALVERT MEMORIAL HOSPITAL JENNIFER MORELAND, DIRECTOR OF COMMUNITY IMPACT UNITED WAY OF CALVERT COUNTY JAMES XINIS, PRESIDENT&CEO CALVERT MEMORIAL HOSPITAL Part V, Line 5a THE DIRECT WEBSITE ADDRESS FOR THE HOSPITAL'S CHNA IS - http://www.calverthospital.org/workfiles/Calvert_Memorial_Hospital_impleme ntation_Plan_Document_FY12_14.pdf Part V, Line 6 During the 2012 tax year, the Hospital undertook a number of different programs to begin addressing the community health needs identified in the Community Health Needs Assessment (CHNA). Amoung the initiatives undertaken to attempt to improve the outcomes with respect to adolescent heatlh, heart disease, and obesity were the following: the provision of free online nutrition program through the Vitabot program, Walk off Weight program to churches and general community, developed walking clubs at 3 elementary schools, collaborated with Calvert County Health Department to provide smoking cessation programs, promoted 1800MD Quit Now, provided Tobacco Road Show education and awareness programs, undertook Calvert Can: Eat Right, Move More campaign, and engaged in Breathe Free county wide initiative with seven collaborating partners to offer healthy lifestyle programs focusing on fitness and nutrition. Part V, Line 7 THERE WERE TWO COMMUNITY HEALTH NEEDS IDENTIFIED IN THE CHNA THAT ARE NOT BEING ADDRESSED BY CALVERT MEMORIAL HOSPITAL . THESE TWO COMMUNITY HEALTH NEEDS ARE: (1) TRAFFIC SAFETY AND (2) AUTISM. AS DISCUSSED IN FURTHER DETAIL BELOW, CALVERT MEMORIAL HOSPITAL DETERMINED THAT IMPROVING TRAFFIC SAFETY WOULD BE ADDRESSED MORE EFFECTIVELY BY OTHER STAKEHOLDERS IN THE COMMUNITY BECAUSE TRAFFIC SAFETY IS NOT IN THE HOSPITAL'S CORE MISSION AND THE HOSPITAL DOES NOT CURRENTLY HAVE THE SKILL SET REQUIRED TO EFFECTIVELY MEET THIS COMMUNITY NEED. IN ADDITION, IT WAS DETERMINED THAT, DUE TO LIMITED RESOURCES AND A LACK OF THE REQUIRED SKILL SET, CALVERT MEMORIAL HOSPITAL IS NOT THE BEST PLACED ORGANIZATION WITHIN THE COMMUNITY TO ADDRESS THE COMMUNITY HEALTH NEEDS ASSOCIATED WITH AUTISM. THE TRAFFIC SAFETY ISSUES ARE BEING ADDRESSED BY DEBBIE JENNINGS OF THE CALVERT COUNTY TRAFFIC SAFETY COUNCIL. A SEPARATE TRAFFIC SAFETY ACTION PLAN HAS BEEN DRAFTED WHICH INCORPORATES INITIATIVES THAT ARE BEING HANDLED BY THE MARYLAND STATE HIGHWAY ADMINISTRATION. THE AUTISM NEEDS ARE BEING ADDRESSED BY HARRIET YAFFE, EXECUTIVE DIRECTOR OF THE ARC OF SOUTHERN MARYLAND. SHE IS WORKING IN COLLABORATION WITH OTHER AGENCIES WITHIN SOUTHERN MARYLAND WHO SERVE THE SPECIAL NEEDS POPULATION TO IDENTIFY GAPS IN SERVICES FOR THE AUTISM POPULATION. CURRENTLY, THE KENNEDY KRIEGER INSTITUTE AND CHILDREN'S NATIONAL MEDICAL CENTER ARE CONDUCTING A REGIONAL NEEDS SURVEY TO DETERMINE WHAT PROGRAMS EXIST IN SOUTHERN MARYLAND AND WILL SHARE THE SURVEY RESULTS WITH THE ROUNDTABLE. Part V, Line 18 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 patient's 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 communications with the patients' bills, and documenting its determination of whether patients were eligible for financial assistance under the Hospital's financial assistance policy. Part V, Line 20D CALVERT MEMORIAL HOSPITAL PROVIDES A DISCOUNT OF AT LEAST 20% OFF OF GROSS CHARGES FOR THE PROVISION OF EMERGENCY AND OTHER MEDICALLY NECESSARY CARE TO ANY INDIVIDUAL THAT IS ELIGIBLE FOR FINANCIAL ASSISTANCE UNDER 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 HOSPITAL 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. Part V, Line 22 Calvert Memorial Hospital does not charge any individuals that 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 reductions are applied to determine the amount actually billed to patients eligible under the financial assistance policy. Needs Assessment Part VI, Line 2 IN ADDITION TO BEGINNING TO IMPLEMENT THE COMMUNITY HEALTH NEEDS ASSESSMENT IMPLEMENTATION STRATEGY(IMPLEMENTATION STRATEGY), IN FY13 THE HOSPITAL ADOPTED THE MARYLAND STATE HEALTH IMPROVEMENT PLAN (SHIP) WHICH FOCUSES ON 39 OBJECTIVES FOR EACH COUNTY WITHIN THE STATE OF MARYLAND. THE DEPARTMENT OF HEALTH AND MENTAL HYGIENE REQUESTED THAT THESE SHIP OBJECTIVES BE ADDRESSED BY THE CHNA AND INTEGRATED INTO THE HOSPITAL'S IMPLEMENTATION STRATEGY TO MEET THE COMMUNITY HEALTH NEEDS IDENTIFIED IN THE CHNA. THE SHIP OBJECTIVES WERE RATED RED, YELLOW OR GREEN IN EACH COUNTY, BASED UPON THE EXTENT TO WHICH THE COUNTY MET THE STATE STANDARDS FOR SUCH OBJECTIVES. THOSE OBJECTIVES THAT THE COUNTY HAD STRUGGLED TO MEET WERE GIVEN RED INDICATORS AND WERE DESIGNATED AS OBJECTIVES FOR THE COUNTY TO ADDRESS MOVING FORWARD. IN ORDER TO ADDRESS THOSE OBJECTIVES RECEIVING A RED INDICATOR, THE COMMUNITY HEALTH IMPROVEMENT ROUNDTABLE, A GROUP THAT THE CALVERT MEMORIAL HOSPITAL PARTICIPATES IN WITH OTHER COMMUNITY LEADERS TO ADDRESS COMMUNITY HEALTH ISSUES, DEVELOPED A SHIP ACTION PLAN DOCUMENT TO ADDRESS THE FOLLOWING TARGETED OBJECTIVES: SMOKING, OBESITY, DEATH RATES FROM HEART DISEASE, DEATH RATES FROM CANCER AND DISPARITIES IN EMERGENCY ROOM UTILIZATION BY AFRICAN AMERICAN FOR DIABETES AND HYPERTENSION. Patient Education of eligibility for assistance Part VI, Line 3 NOTIFICATION ABOUT THE AVAILABILITY OF FINANCIAL ASSISTANCE FROM CALVERT MEMORIAL HOSPITAL INCLUDES A CONTACT NUMBER AND IS DISSEMINATED BY CALVERT MEMORIAL HOSPITAL BY VARIOUS MEANS, WHICH INCLUDES, BUT IS NOT LIMITED TO, THE PUBLICATION OF NOTICES IN PATIENT BILLS AND BY POSTING NOTICES IN THE EMERGENCY DEPARTMENT, URGENT CARE CENTERS, waiting rooms, ADMITTING AND REGISTRATION DEPARTMENTS, AND PATIENT FINANCIAL SERVICES OFFICES. INFORMATION IS ALSO INCLUDED ON THE HOSPITAL'S WEBSITE AND at least annually, the hospital publishes in the local newspapers a notice of financial assistance and also highlights other programs the Hospital offers for patients without insurance or for patients in financial need. Notification of the hospital's financial assistance policy program is provided to each patient at the time of registration and a second time when patients receive their bill/statement. Such information is provided in the primary languages spoken by the population serviced by Calvert Memorial Hospital. Referral of patients for financial assistance may be made by any member of the Calvert Memorial Hospital staff or medical staff, including physicians, nurses, financial counselors, social workers, case managers, and chaplains. A request for financial assistance may be made by the patient or a family member, close friend, or associate of the patient, subject to applicable privacy laws. Community Information Part VI, Line 4 CALVERT MEMORIAL HOSPITAL (CMH) IS THE SOLE HOSPITAL PROVIDER IN CALVERT COUNTY, MARYLAND. CALVERT COUNTY IS LOCATED IN SOUTHERN MARYLAND AND IS ESSENTIALLY A PENINSULA BORDERED ON THE EAST BY THE CHESAPEAKE BAY AND ON THE WEST BY THE PATUXENT RIVER. WITH A LONG AND SKINNY TOPOGRAPHY, THE COUNTY'S "SPINE" IS MARYLAND ROUTES 2/4 RUNNING FROM DUNKIRK IN THE NORTH TO SOLOMONS ISLAND IN THE SOUTH FOR APPROXIMATELY 45 MILES. THIS TOPOGRAPHY PRESENTS CHALLENGES TO BOTH TRANSPORTATION AND SERVICE DELIVERY THAT ARE UNIQUE TO CALVERT COUNTY. IN RESPONSE TO THIS UNIQUE TOPOGRAPHY, CMH'S STRATEGIC GOAL IS TO ENSURE ACCESS TO PRIMARY CARE SERVICES WITHIN A 15 MINUTE DRIVE FROM ANY COUNTY LOCATION AND SPECIALTY CARE WITHIN 30 MINUTES. IN ADDITION, CMH'S SECONDARY MARKET AREA INCLUDES THE SURROUNDING AREAS OF SOUTHERN PRINCE GEORGES AND ANNE ARUNDEL COUNTIES, ST MARY'S COUNTY ON ITS SOUTHERN BORDER AND CHARLES COUNTY ON ITS WESTERN BORDER. Although CALVERT COUNTY is one of the most affluent counties in Maryland, it has pockets of impoverished areas. The median household income varies from $75,227 in the southern portion of the county to $120,119 in the north as compared to an $89,393 county average. Approximately 10% of the total households earn less than $25,000 annually. Overall, Calvert County has a poverty rate of 4.2% as compared to a state level of 8.6%. Within census tracts, this poverty rate ranges from 0.3% just north of hte county seat in Prince Frederick to 13.9% in an area just east of Prince Frederick. Financial assistance of Fy 2013 for CMH reveals that 5.3% of gross revenue was from self-pay or uninsured patients, 11.8% of gross revenue was from Medicaid recipients and 35.3% was from Medicare recipients. Caucasian residents comprise 81.3% of the population while African Americans comprise 13%. Major sources of employment with the area include education and healthcare, public administration, professional/research, construction and retail trade. The life expectancy in Calvert County is 77.9 years. Heart disease and cancer death rates are significantly higher than the state and national rates at 227.6 and 189.3 deaths per 100,000 respectively. Promotion of community health Part VI, Line 5 THE HOSPITAL IS GOVERNED BY A COMMUNITY BOARD COMPRISED OF CIVIC LEADERS THROUGHOUT CALVERT COUNTY WHO ARE COMMITTED TO AND REPRESENT THE HEALTHCARE NEEDS OF THE COMMUNITY. THE HOSPITAL EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS FOR ALL OF ITS DEPARTMENTS. ALL FINANCIAL SURPLUSES THE HOSPITAL GENERATES ARE USED EXCLUSIVELY TO FURTHER THE CHARITABLE PURPOSES OF THE ORGANIZATION. Affiliated health care system Part VI, Line 6 CALVERT MEMORIAL HOSPITAL IS PART OF AN AFFILIATED HEALTH CARE SYSTEM, Calvert Health System, Inc.(CHS), that cooperates in providing health care services to its community. The hospital, as a sole community provider, provides essential health care services such as obstetrics, psychiatry(inpatient and outpatient), emergency services, urgent care and long-term care that otherwise would not be provided within Calvert county due to their unprofitable nature(high cost services with low reimbursement), or would need to be provided by another tax-exempt organization or the government. For the 2012 tax year, the hospital provided $5,272,522 in charity care, at cost, to patients that qualified for financial assistance. Furthermore, the hospital provided $427,150 of free health services for Calvert Healthcare Solutions patients. Calvert Healthcare Solutions is a partnership between the local health department, local physicians and the hospital that provides primary care services to patients who are uninsured. In addition to the hospital, CHS is also the sole member and employer of a physician group, Calvert Physician Associates, LLC, which provides primary and specialty care services to the community. The provision of these physician services to the community meets an identified need. STATE FILING OF COMMUNITY BENEFIT REPORT 990 SCHEDULE H, PART VI MD, X X true true X X X X X false true false false false false false false false JAMES XINIS 405511 0 214122 0 622656 0 215050 0 1260 0 1458599 0 0 0 ROBERT KERTIS 189775 0 22464 0 570 0 17135 0 5506 0 235450 0 0 0 SUSAN DOHONY 149421 0 14753 0 34915 0 55051 0 8999 0 263139 0 0 0 EDWARD GROGAN 145501 0 16279 0 0 0 21848 0 11961 0 195589 0 0 0 ROBERT SCHLAGER 71216 0 0 0 50745 0 9000 0 3606 0 134567 0 21501 0 SEYED ALI MOHAMMADI 312387 0 31824 0 13554 0 21007 0 12049 0 390821 0 0 0 DIANE COUCHMAN 135447 0 0 0 0 0 13363 0 11960 0 160770 0 0 0 SCOTT INTNER 138548 0 26892 0 0 0 8386 0 11961 0 185787 0 0 0 ANTHONY BLADEN 153352 0 19088 0 5180 0 14938 0 422 0 192980 0 0 0 KARA HARRER 133629 0 7717 0 820 0 12729 0 884 0 155779 0 0 0 PILAR CROOK 86852 0 0 0 55182 0 25921 0 8887 0 176842 0 0 0 SHARON BAKER 135235 0 0 0 370 0 9594 0 8729 0 153928 0 0 0 PART I, LINE 1A THE PRESIDENT/CEO RECEIVED BENEFITS THAT ARE INCLUDED IN PART I, LINE 1. PART I, LINE 4 The following employees contributed to (employee and employer portion) the organization's 457(f) deferred compensation plan: James Xinis $148,661 Robert Kertis $ 7,799 Anthony Bladen $ 6,997 Diane Couchman $ 4,073 Robert Schlager $ 3,796 Dean Teague $ 2,369 In addition, during the 2012 tax year, as part of the supplemental retirement plan issued to him, the president and CEO, James Xinis, exercised options issued to him pursuant to a grandfathered mutual fund option plan. All of the options that were exercised were issued to James Xinis prior to May 8, 2002. The value of the exercised options minus the exercise price was $386,276. PART II, LINE 1, COLUMN B(II) THE BONUS AND INCENTIVE COMPENSATION PAID TO THE PRESIDENT AND CEO, JAMES XINIS, DURING THE 2012 TAX YEAR WAS FOR INCENTIVES EARNED FOR BOTH CALENDAR YEAR 2011 AND CALENDAR YEAR 2012. THE BONUS RELATED TO THE 2011 CALENDAR YEAR WAS PAID TO THE PRESIDENT AND CEO, JAMES XINIS, DURING JANUARY 2012. THE BONUS RELATED TO THE 2012 CALENDAR YEAR WAS PAID TO THE PRESIDENT AND CEO, JAMES XINIS, DURING DECEMBER 2012. PART II, LINE 1, COLUMN B(III) OTHER REPORTABLE COMPENSATION PAID TO THE PRESIDENT AND CEO, JAMES XINIS, INCLUDES VACATION PAYOUT FOR HOURS ACCUMULATED OVER THE LAST TWENTY PLUS YEARS OF SERVICE (567 HOURS OF VACATION, WHICH EQUALED $109,044). A MD HEALTH & HIGHER EDUCATIONAL FAC AUTHORITY 520936091 574127sp1 2004-07-01 32925000 ACQUIRE, RENOVATE AND CONSTRUCTION false false false B maryland health & higher educational fac authority 520936091 000000000 2012-07-01 19199000 refund the series 1998 revenue bon false false false A 495000 0 34646470 4253714 3639436 0 450216 0 572942 28195347 0 0 2008 false false true true B 881159 0 19199000 0 0 0 27962 0 0 0 19171038 0 true false true true A false false true true false false 0 false false true B 0 A false false false true false false 0 true morgan 2.2 false false true B false true false false false false 0 false 0 false true A false B false Schedule K, Part II, Line 7, Column B 0 Monies in the amount of 151,023(representing amounts in the debt service FUND for the refunded 1998 bonds) was used to pay the costs of issuance of the 2012 bonds. Schedule K, Part IV, Line 2c, Column A 0 The 2004 bond rebate computation was performed on 7/1/2009. JAMES XINIS DIRECTOR AND OFFICER 24620826 CAREFIRST TRANSACTIONS (ON BD) false ARATI PATEL SPOUSE OF DIRECTOR 387497 EMPLOYEE OF CALVERT PHYS ASSOC false SCHEDULE L, PART IV CMH received net revenue of $24,620,826 from Blue Cross for health care services provided to patients insured by Blue Cross. DESCRIPTION OF 990 REVIEW PROCESS PART VI, LINE 11 The Form 990 is reviewed by the Audit Committee of the Calvert Health System, Inc. Board of Directors after completion and prior to submission to the IRS. The document is delivered to the Committee members prior to the Committee meeting so that they can review the information and respond to or question any or all of the data. The Chief Executive Officer and Chief Financial Officer are present at the Audit Committee meeting. Prior to submission to the IRS, a copy of the final Form 990 is posted on the Board of Directors portal which is password-protected. All board members are notified by email that the Form 990 has been posted on the portal and is available for review. Any additional comments or questions from board members are responded to prior to filing the form 990. CONFLICTS MONITORING AND ENFORCEMENT PART VI, LINE 12C Calvert Health System, Inc. and subsidiaries (the Health System) have a Conflict of Interest process. At its core are three distinct policies; one each for the Board of Directors, Medical Staff, and all employees and associates of the Health System. These policies require all organizational leadership, as well as rank and file associates in key positions or with relationships with outside parties that do business with the Health System, to disclose any actual or potential conflict of interest. Annual disclosures are required and documented with a further requirement to promptly supplement when an actual or potential conflict is discovered or created. The Health System requires that these policies be construed broadly to avoid the appearance of improper activity and requires disclosure and resolution of potential conflicts as well. The process is overseen by the Chief Compliance Officer of the Health System who has access to external resources, including outside counsel. Remedies range from disclosure and monitoring for the most attenuated potential conflicts to resignation/termination for unresolvable conflicts. PROCESS FOR DETERMINING COMPENSATION PART VI, LINE 15 THE ORGANIZATION UTILIZES A COMPENSATION COMMITTEE, AN INDEPENDENT COMPENSATION CONSULTANT, A WRITTEN EMPLOYMENT CONTRACT, A COMPENSATION SURVEY OR STUDY, APPROVAL BY BOARD/COMPENSATION COMMITTEE AND CONTEMPORANEOUS WRITTEN SUBSTANTIATION OF THE DECISION-MAKING PROCESS TO DETERMINE COMPENSATION of the ceo. DOCUMENT AVAILABILITY PART VI, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. AUDITED FINANCIAL STATEMENTS Part XI line 2b The organizations financial statements are audited by an independent accounting firm as part of the consolidated audit of the health system. OTHER CHANGES TO NET ASSETS PART XI, LINE 5 investment in foundation 3,393,741 net asset transfer to CHS (7,312,591) PENSION RELATED CHANGES 4,152,279 UNREALIZED loss (16,429) ----------- TOTAL $ 217,000 CALVERT HEALTH SYSTEM INC 100 HOSPITAL RD PRINCE FREDERICK MD 20678 522347324 HEALTHCARE MD 501(C)(3) 170B1Aiii N/A false CMH HOLDING CO 100 HOSPITAL RD PRINCE FREDERICK MD 20678 522176827 REAL ESTATE MD 501(C)(2) CHS true CMH II HOLDING CO 100 HOSPITAL RD PRINCE FREDERICK MD 20678 522178784 REAL ESTATE MD 501(C)(2) CHS true CALVERT MEMORIAL HOSPITAL FOUNDATION INC 100 HOSPITAL RD PRINCE FREDERICK MD 20678 521680647 FUND RAISING MD 501(C)(3) 509(A)(3) CMH true CALVERT HEALTH VENTURES INC 100 HOSPITAL RD PRINCE FREDERICK MD 20678 521625432 HEALTHCARE MD chs C CORP 0 0 0.00000 true CALVERT COMMUNITY HEALTH INC 100 HOSPITAL RD PRINCE FREDERICK MD 20678 521996371 HEALTHCARE MD CMH C CORP 0 0 1.00000 true false false true true false false false false false true true true true true true true true true false CALVERT MEMORIAL HOSPITAL FOUNDATION INC c and 220536 cash cmh holding co l and 368908 cash cmh ii holidng co d, l, 8683555 cash calvert health ventures inc l and 82223 cash