UNIVERSITY OF MARYLAND CHARLES REGIONAL HEALTH INC: Form 990, tax year 2012
View the entire original 990 at ProPublica ↗
- Organization
- UNIVERSITY OF MARYLAND CHARLES REGIONAL HEALTH INC (EIN 52-2155576)
- Tax period
- 2012-07-01 to 2013-06-30
- Filed
- 2014-05-13
- IRS object ID
- 201441339349304154
- Schema version
- 2012v2.3
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2014-05-13T13:50:34-05:00 | Timestamp |
| Tax Period End Date | 2013-06-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | GRANT THORNTON LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2001 MARKET STREET SUITE 700 | AddressLine1 |
| City | PHILADELPHIA | City |
| State | PA | State |
| ZIP Code | 19103 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2012-07-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 522155576 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Civista Health Inc | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| In Care Of Name | % ERIK BOAS | InCareOfName |
| Name Control | CIVI | NameControl |
| Phone | 3016095163 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO Box 1070 | AddressLine1 |
| Address Line2 | Suite | AddressLine2 |
| City | La Plata | City |
| State | MD | State |
| ZIP Code | 206461070 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | ERIK BOAS | Name |
| Title | CFO | Title |
| Phone | 3016095163 | Phone |
| Date Signed | 2014-05-08 | DateSigned |
| Authorize Third Party | true | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Frank Giardini | Name |
| Phone | 2155614200 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2012 | TaxYear |
| Build TS | 2015-11-30 17:44:51Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | Noel Cervino | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO Box 1070 | AddressLine1 |
| City | La Plata | City |
| State | MD | State |
| ZIP Code | 206461070 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 767521 | GrossReceipts |
| Group Return For Affiliates | false | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | www.Civista.org | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1998 | YearFormation |
| State Legal Domicile | MD | StateLegalDomicile |
| Activity Or Mission Description | Civista Health, Inc. is the parent company of a regional integrated health system serving the health needs of Charles County and the citizens of southern Maryland. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 17 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 14 | NbrIndependentVotingMembers |
| Total Nbr Employees | 0 | TotalNbrEmployees |
| Total Nbr Volunteers | 0 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 0 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 583200 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 0 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 0 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 33209 | InvestmentIncomePriorYear |
| Investment Income Current Year | 27741 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 98142 | OtherRevenuePriorYear |
| Other Revenue Current Year | 156580 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 131351 | TotalRevenuePriorYear |
| Total Revenue Current Year | 767521 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 0 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 0 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 0 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 1252028 | OtherExpensePriorYear |
| Other Expenses Current Year | 2031674 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 1252028 | TotalExpensesPriorYear |
| Total Expenses Current Year | 2031674 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | -1120677 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | -1264153 | RevenuesLessExpensesCY |
| Total Assets BOY | 6796152 | TotalAssetsBOY |
| Total Assets EOY | 20289669 | TotalAssetsEOY |
| Total Liabilities BOY | 3431536 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 16272453 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 3364616 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 4017216 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | CIVISTA HEALTH, INC. IS A NOT-FOR-PROFIT HEALTHCARE SYSTEM CREATED TO PROVIDE EXCELLENCE IN ACUTE HEALTHCARE AND PREVENTIVE SERVICES IN CHARLES COUNTY AND THE SURROUNDING COMMUNITIES. | MissionDescription |
| Significant New Program Services | false | SignificantNewProgramServices |
| Significant Change | false | SignificantChange |
| Description | Civista Health is the parent company of a regional integrated health system serving the health needs of Charles County and the citizens of Southern Maryland. Civista Medical Center'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. Civista Health 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. Civista lead the effort and covered 80% of the cost of 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 is available on the Civista Health 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 waiting rooms, CCDOH waiting rooms, libraries, senior centers, and 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, WE CAN! Childhood Obesity Program, Faith-Based Health Expo. Support groups such as Stroke Support, Parkinson's support group, Pink Ladies and Sister's at Heart and Ostomy Support Group. Clinics and clinic services such as pre natal and OB clinic, flu vaccine clinic, renal dialysis services, American Red Cross blood drives Community committees, boards, and organizations (employee participation) such as United Way, Partnerships for a Healthier Charles County, Charles County Tobacco Coalition, Leadership Maryland, Hospice of Charles County, Healthy Families, Health Partners Free Clinic Board, Fetal Infant Mortality Board, Center for Abused Persons, Juvenile Drug Court; Chamber of Commerce, Charles County Commission for Women, Charles County child advocacy partnership, healthcare roundtable community events such as Christmas Connection, Relay for Life, Alzheimer's Walk, March of Dimes, and safe nights. | Description |
| Total Program Service Expense | 0 | TotalProgramServiceExpense |
| Described In501 C3 | true | DescribedIn501C3 |
| Schedule B Required | true | ScheduleBRequired |
| Political Activities | false | PoliticalActivities |
| Lobbying Activities | false | LobbyingActivities |
| Subject To Proxy Tax | false | SubjectToProxyTax |
| Donor Advised Funds | false | DonorAdvisedFunds |
| Conservation Easements | false | ConservationEasements |
| Collections Of Art | false | CollectionsOfArt |
| Credit Counseling | false | CreditCounseling |
| Term Or Permanent Endowments | false | TermOrPermanentEndowments |
| Report Land Bldg Equip | true | ReportLandBldgEquip |
| Report Invest Oth Securities | false | ReportInvestOthSecurities |
| Report Prog Rel Invest | false | ReportProgRelInvest |
| Report Other Assets | true | ReportOtherAssets |
| Report Other Liabilities | true | ReportOtherLiabilities |
| Report Fin48 Footnote | true | ReportFin48Footnote |
| Independent Audit Financial Stmt | false | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | true | ConsolidatedAuditFinancialStmt |
| School | false | School |
| Foreign Office | false | ForeignOffice |
| Foreign Activities | false | ForeignActivities |
| More Than5000 K To Organizations | false | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividuals |
| Professional Fundraising | false | ProfessionalFundraising |
| Fundraising Activities | false | FundraisingActivities |
| Gaming | false | Gaming |
| Hospital | false | Hospital |
| Grants To Organizations | false | GrantsToOrganizations |
| Grants To Individuals | false | GrantsToIndividuals |
| Schedule J Required | true | ScheduleJRequired |
| Tax Exempt Bonds | false | TaxExemptBonds |
| Excess Benefit Transaction | false | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | false | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | false | LoanToOfficerOrDQP |
| Grant To Related Person | false | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | false | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | false | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | false | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | false | DeductibleNonCashContributions |
| Deductible Contributions Of Art | false | DeductibleContributionsOfArt |
| Terminated | false | Terminated |
| Partial Liquidation | false | PartialLiquidation |
| Disregarded Entity | true | DisregardedEntity |
| Related Entity | true | RelatedEntity |
| Related Org Controlled Entity | true | RelatedOrgControlledEntity |
| Transaction Related Entity | true | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | false | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | false | ActivitiesConductedPartnership |
| Schedule O Required | true | ScheduleORequired |
| Number Forms Transmitted With1096 | 0 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Number Of Employees | 0 | NumberOfEmployees |
| Unrelated Business Income | false | UnrelatedBusinessIncome |
| Foreign Financial Account | false | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTrans |
| Taxable Party Notification | false | TaxablePartyNotification |
| Non Deductible Contributions | false | NonDeductibleContributions |
| Quid Pro Quo Contributions | false | QuidProQuoContributions |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | false | FundsToPayPremiums |
| Premiums Paid | false | PremiumsPaid |
| Excess Business Holdings | false | ExcessBusinessHoldings |
| Indoor Tanning Services | false | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 17 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 14 | NumberIndependentVotingMembers |
| Family Or Business Relationship | false | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | false | DelegationOfManagementDuties |
| Changes To Organizing Docs | false | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuse |
| Members Or Stockholders | true | MembersOrStockholders |
| Election Of Board Members | true | ElectionOfBoardMembers |
| Decisions Subject To Approval | true | DecisionsSubjectToApproval |
| Minutes Of Governing Body | true | MinutesOfGoverningBody |
| Minutes Of Committees | true | MinutesOfCommittees |
| Officer Mailing Address | false | OfficerMailingAddress |
| Local Chapters | false | LocalChapters |
| Form990 Provided To Governing Body | true | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | true | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | true | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | true | RegularMonitoringEnforcement |
| Whistleblower Policy | true | WhistleblowerPolicy |
| Document Retention Policy | true | DocumentRetentionPolicy |
| Compensation Process CEO | true | CompensationProcessCEO |
| Compensation Process Other | true | CompensationProcessOther |
| Investment In Joint Venture | false | InvestmentInJointVenture |
| States Where Copy Of Return Is Filed | MD | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | ERIK BOAS | NamePerson |
| Telephone Number | 3026094130 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 5 GARRETT AVENUE | AddressLine1 |
| City | La Plata | City |
| State | MD | State |
| ZIP Code | 20646 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | X | InfoInScheduleOPartVII |
Form990 Part VII Section A Form990PartVIISectionA (18 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Average Hours Per Week RelatedAverageHoursPerWeekRelated |
|---|---|---|---|---|---|---|---|
| Shelly Culhane | |||||||
| Vice Chair | 2.0 | X | X | 0 | 0 | 0 | |
| B Larry Jenkins | |||||||
| Director | 1.0 | X | 0 | 0 | 0 | ||
| R Wayne Barnes | |||||||
| Director | 1.0 | X | 0 | 0 | 0 | ||
| Sara Middleton | |||||||
| Director | 1.0 | X | 0 | 0 | 0 | ||
| Candice Quinn Kelly | |||||||
| Ex-Officio/Director | 1.0 | X | 0 | 0 | 0 | ||
| Faye Reed | |||||||
| Ex-Officio/Director/Ret12-1-12 | 1.0 | X | 0 | 0 | 0 | ||
| Khadar Baig | |||||||
| Director | 1.0 | X | 0 | 0 | 0 | ||
| Van Mitchell | |||||||
| Director | 1.0 | X | 0 | 0 | 0 | ||
| Louis Jenkins Jr | |||||||
| Chairman | 2.0 | X | X | 0 | 0 | 0 | |
| Seetaramayya Nagula | |||||||
| Director | 1.0 | X | 0 | 0 | 0 | ||
| Richard Winkler | |||||||
| Secretary/Treasurer | 2.0 | X | X | 0 | 0 | 0 | |
| Michael Cady | |||||||
| Director | 1.0 | X | 0 | 0 | 0 | ||
| Ashvin J Patel MD | |||||||
| Ex-O/ChiefStaff/End12/31/12 | 1.0 | X | X | 0 | 0 | 0 | |
| James Burke | |||||||
| Director | 1.0 | X | 0 | 0 | 0 | ||
| Noel Cervino | |||||||
| Ex-Officio/President & CEO | 5.0 | X | X | 0 | 525741 | 66648 | 45.0 |
| John Ashworth | |||||||
| Ex-Officio/Director | 1.0 | X | 0 | 588536 | 20541 | 49.0 | |
| Robert Chrencik | |||||||
| Ex-Officio/Director | 1.0 | X | 0 | 2174569 | 234466 | 49.0 | |
| Erik Boas | |||||||
| Chief Financial Officer | 5.0 | X | 0 | 265742 | 23363 | 45.0 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 0 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 3554588 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 345018 | TotalOtherCompensation |
| Number Individuals GT100 K | 0 | NumberIndividualsGT100K |
| Formers Listed | false | FormersListed |
| Total Comp GT150 K | true | TotalCompGT150K |
| Compensation From Other Sources | false | CompensationFromOtherSources |
| Number Of Contractors GT100 K | 0 | NumberOfContractorsGT100K |
| Related Organizations | 583200 | RelatedOrganizations |
| Total Contributions | 583200 | TotalContributions |
| Total Program Service Revenue | 0 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 27741 | TotalRevenueColumn |
| Exclusion | $27,741 | ExclusionAmount |
Income From Invest Bond Proceeds IncomeFromInvestBondProceeds
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Royalties Revenue RoyaltiesRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 156580 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 156580 | Real |
| Personal | 0 | Personal |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 156580 | TotalRevenueColumn |
| Exclusion | $156,580 | ExclusionAmount |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Net Income From Fundraising Events NetIncomeFromFundraisingEvents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Net Income From Gaming NetIncomeFromGaming
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Net Income Or Loss NetIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 0 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 767521 | TotalRevenueColumn |
| Exclusion | $184,321 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | X | InfoInScheduleOPartIX |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Grants To Domestic Individuals GrantsToDomesticIndividuals
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Foreign Grants ForeignGrants
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Benefits To Members BenefitsToMembers
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Comp Disqual Persons CompDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1945 | Total |
| Management And General | 1945 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Lobbying FeesForServicesLobbying
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Prof Fundraising FeesForServicesProfFundraising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 289212 | Total |
| Management And General | 289212 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 62 | Total |
| Management And General | 62 | ManagementAndGeneral |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Royalties Royalties
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 64516 | Total |
| Management And General | 64516 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 68861 | Total |
| Management And General | 68861 | ManagementAndGeneral |
Payments To Affiliates PaymentsToAffiliates
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 198594 | Total |
| Management And General | 198594 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Management And GeneralManagementAndGeneral |
|---|---|---|
| UMMS INDIRECT ALLOCATION | 1253292 | 1253292 |
| BANK FEES | 62419 | 62419 |
| MISCELLANEOUS | 60237 | 60237 |
| TAXES | 32536 | 32536 |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2031674 | Total |
| Program Services | 0 | ProgramServices |
| Management And General | 2031674 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6900 | BOY |
| EOY | 61049 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Pledges And Grants Receivable PledgesAndGrantsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Receivables From Officers Etc ReceivablesFromOfficersEtc
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Receivables From Disqual Persons ReceivablesFromDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Other Notes Loans Receivable Net OtherNotesLoansReceivableNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 14752983 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 131720 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3262102 | BOY |
| EOY | 14621263 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Investments Program Related InvestmentsProgramRelated
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Intangible Assets IntangibleAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 910000 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3527150 | BOY |
| EOY | 4697357 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6796152 | BOY |
| EOY | 20289669 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 826 | EOY |
Grants Payable GrantsPayable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Deferred Revenue DeferredRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Tax Exempt Bond Liabilities TaxExemptBondLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Escrow Account Liability EscrowAccountLiability
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Loans From Officers Directors LoansFromOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1230155 | BOY |
| EOY | 1106607 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2201381 | BOY |
| EOY | 15165020 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3431536 | BOY |
| EOY | 16272453 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3364616 | BOY |
| EOY | 4017216 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Permanently Restricted Net Assets PermanentlyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3364616 | BOY |
| EOY | 4017216 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6796152 | BOY |
| EOY | 20289669 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | -1264153 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | 1916753 | ReconcilationOtherChanges |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | false | AccountantCompileOrReview |
| FS Audited | true | FSAudited |
FS Audited Basis FSAuditedBasis
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | true | AuditCommittee |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Supporting Organization509a3 | X | SupportingOrganization509a3 |
| Supporting Org509a3 Type3 Func Int | X | SupportingOrg509a3Type3FuncInt |
| Certification Checkbox | X | CertificationCheckbox |
| Contrib By Controlling Individual | false | ContribByControllingIndividual |
| Contribution By Related Party | false | ContributionByRelatedParty |
| Contrib By35 Controlled Entity | false | ContribBy35ControlledEntity |
Supported Org Information SupportedOrgInformation (2 entries)
| EINEIN | Type Of OrganizationTypeOfOrganization | Listed In Governing DocListedInGoverningDoc | Supported Organization NotifiedSupportedOrganizationNotified | Organized In USOrganizedInUS | AmountAmount |
|---|---|---|---|---|---|
| CIVISTA MEDICAL CENTER INC | |||||
| 520445374 | 03 | true | true | true | $0 |
| CIVISTA HEALTH AUXILIARY | |||||
| 521131193 | 09 | true | true | true | $0 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Number Of Supported Orgs | 2 | TotalNumberOfSupportedOrgs |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Art Public Exhibition Amts | ArtPublicExhibitionAmts | |
| Held Works Of Art Amts | HeldWorksOfArtAmts | |
| Current Year Minus3 Years | CurrentYearMinus3Years | |
| Current Year Minus4 Years | CurrentYearMinus4Years |
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 2141083 | OtherCostOrOtherBasis |
| Book Value | 2141083 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 12506926 | OtherCostOrOtherBasis |
| Depreciation | 131720 | Depreciation |
| Book Value | 12375206 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Leasehold Improvements | LeaseholdImprovements | |
| Equipment | Equipment |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 104974 | OtherCostOrOtherBasis |
| Book Value | 104974 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 14621263 | TotalOfBookValueLandBuildings |
Other Assets OtherAssets (4 entries)
| DescriptionDescription | Book ValueBookValue |
|---|---|
| DUE FROM AFFILIATES | 1013392 |
| PREMIER RECEIVABLE | 205397 |
| STRATEGIC PROJECT FUND | 3484783 |
| SECURITY DEPOSITS | -6215 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | 4697357 | TotalBookValueOtherAssets |
| Federal Income Tax Liability | 0 | FederalIncomeTaxLiability |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | DUE TO AFFILIATES | Description |
| Amount | $15,165,020 | Amount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 15165020 | TotalOfAmounts |
| Footnote In Part XIII | X | FootnoteInPartXIII |
Form990 Schedule D Part XIII Form990ScheduleDPartXIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | Liability for Uncertain Tax Position (ASC 740) | Identifier |
| Return Reference | Schedule D, Part X, Line 2 | ReturnReference |
| Explanation | 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 81) 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. | Explanation |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | false | SeverancePayment |
| Supplemental Nonqual Retire Plan | true | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | false | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | false | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | false | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | false | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | false | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | false | AnyNonFixedPayments |
| Initial Contract Exception | false | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (4 entries)
| TitleTitle | Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Noel Cervino | ||||||||||||||
| Ex-Officio/President & CEO | 0 | 337544 | 0 | 167621 | 0 | 20576 | 0 | 61499 | 0 | 5149 | 0 | 592389 | 0 | 0 |
| John Ashworth | ||||||||||||||
| Ex-Officio/Director | 0 | 368549 | 0 | 157673 | 0 | 62314 | 0 | 10000 | 0 | 10541 | 0 | 609077 | 0 | 0 |
| Robert Chrencik | ||||||||||||||
| Ex-Officio/Director | 0 | 1166972 | 0 | 994524 | 0 | 13073 | 0 | 223385 | 0 | 11081 | 0 | 2409035 | 0 | 0 |
| Erik Boas | ||||||||||||||
| Chief Financial Officer | 0 | 192019 | 0 | 58118 | 0 | 15605 | 0 | 23363 | 0 | 0 | 0 | 289105 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| RELATED ORGANIZATION METHODS TO ESTABLISH COMPENSATION | SCHEDULE J, PART 1, LINE 3 | THE ORGANIZATION DOES NOT HAVE ANY PAID EMPLOYEES; ALL COMPENSATION TO OFFICERS, DIRECTORS, AND KEY EMPLOYEES REPORTED ON PART VII OF THE FORM 990 WAS PAID BY A RELATED ORGANIZATION, THE UNIVERSITY OF MARYLAND MEDICAL SYSTEM CORPORATION ("UMMSC") OR ANOTHER RELATED ENTITY IN THE UNIVERSITY OF MARYLAND MEDICAL SYSTEM. THE RELATED ENTITY CHECKS THE FOLLOWING BOXES FOR SCHEDULE J, QUESTION 3 ON ITS FORM 990: - COMPENSATION COMMITTEE - INDEPENDENT COMPENSATION CONSULTANT - COMPENSATION SURVEY OR STUDY - APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE |
| SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN | SCHEDULE J, PART I, LINE 4B | DURING THE FISCAL YEAR-ENDED JUNE 30, 2013, 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 THE INDIVIDUAL LISTED BELOW HAS 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: ROBERT A. CHRENCIK |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (7 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| Members or Stockholders | Form 990, Part VI, Lines 6, 7a, and 7b | UNIVERSITY Of MARYLAND MEDICAL SYSTEM CORPORATION (UMMS) IS THE SOLE MEMBER OF CIVISTA HEALTH, INC. UMMS MAY ELECT ONE OR MORE BOARD MEMBERS OF THE GOVERNING BODY AND ALL DECISIONS OF THE GOVERNING BODY MUST BE APPROVED BY UMMS. Form 990 Review Process Form 990, Part VI, Line 11b The I.R.S. 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. 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 I.R.S. 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 I.R.S. Form 990. At the discretion of the reviewing board member, such member will bring any issues or questions related to the completed I.R.S. Form 990 to the attention of the board. Notwithstanding the above, a board resolution is not required for the filing of the organization's I.R.S. form 990. Each board member is provided with a copy of the final I.R.S. 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, UNIVERSITY SPECIALTY HOSPITAL 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, UNIVERSITY SPECIALTY HOSPITAL 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. |
| Process for Determining Compensation | Form 990, Part VI, Line 15a and 15b | The organization did not compensate its executives; but, rather, the executives received compensation from a related organization. Accordingly, the organizations parent company 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 I.R.S. 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 I.R.S. 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 I.R.S. 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 10 ACUTE CARE HOSPITALS, 3 ACUTE CARE HOSPITALS OWNED IN JOINT VENTURE ARRANGEMENTS 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 | UMMS Contributions to CHI 2,500,000 Physician Loss Reimbursement to CMC (583,200) Miscellaneous (47) ------------------------------------------------- Changes in Net Assets 1,916,753 |
| OTHER FEES FOR SERVICES FOR NON-EMPLOYEES | FORM 990 PART IX LINE 11G | DESCRIPTION:PURCHASED SERVICES TOTAL FEES:289212 |
Schedule R IRS990ScheduleR
Form990 Schedule R Part I Form990ScheduleRPartI (2 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Total IncomeTotalIncome | EOY AssetsEOYAssets | Business Name Line1DirectControllingEntityName/BusinessNameLine1 |
|---|---|---|---|---|---|---|---|---|---|
| Civista Cambridge Properties LLC | |||||||||
| PO Box 1070 | La Plata | MD | 20646 | 201825174 | Real Estate | MD | 588359 | 9386166 | CCP |
| Civista Clinical Services LLC | |||||||||
| PO Box 1070 | La Plata | MD | 20646 | 260269489 | Healthcare | MD | 3058013 | 1495694 | CCP |
Form990 Schedule R Part II Form990ScheduleRPartII (30 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Controlled OrgControlledOrg |
|---|---|---|---|---|---|---|---|---|---|---|
| Baltimore Washington Emergency Phys Inc | ||||||||||
| 301 Hospital Drive | Glen Burnie | MD | 21061 | 521756326 | Healthcare | MD | 501(c)(3) | 11A | BWMS | false |
| Baltimore Washington Healthcare Services | ||||||||||
| 301 Hospital Drive | Glen Burnie | MD | 21061 | 521830243 | Healthcare | MD | 501(c)(3) | 11A | BWMS | false |
| Baltimore Washington Medical Center Inc | ||||||||||
| 301 Hospital Drive | Glen Burnie | MD | 21061 | 520689917 | Healthcare | MD | 501(c)(3) | 03 | BWMS | false |
| Baltimore Washington Medical System Inc | ||||||||||
| 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 | BWMS | 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) | BWMS | false | |
| Chester River Health Foundation Inc | ||||||||||
| 100 Brown Street | Chestertown | MD | 21620 | 521338861 | Fundraising | MD | 501(c)(3) | 07 | CRHS | false |
| Univ of MD Shore Regional Health Inc | ||||||||||
| 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 | CRHS | false |
| Chester River Manor Inc | ||||||||||
| 200 Morgnec Road | Chestertown | MD | 21620 | 526070333 | Healthcare | MD | 501(c)(3) | 09 | CRHS | false |
| Maryland General Clinical Practice Group | ||||||||||
| 827 Linden Avenue | Baltimore | MD | 21201 | 521566211 | Healthcare | MD | 501(c)(3) | 11B | MGHS | false |
| Maryland General Comm Health Foundation | ||||||||||
| 827 Linden Avenue | Baltimore | MD | 21201 | 522147532 | Fundraising | MD | 501(c)(3) | 11C | MGHS | 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 | MGHS | false |
| Care Health Services Inc | ||||||||||
| 219 South Washington Street | Easton | MD | 21601 | 521510269 | Healthcare | MD | 501(c)(3) | 09 | SHS | false |
| Dorchester General Hospital Foundation | ||||||||||
| 219 South Washington Street | Easton | MD | 21601 | 521703242 | Fundraising | MD | 501(c)(3) | 11D | SHS | false |
| Memorial Hospital Foundation Inc | ||||||||||
| 219 South Washington Street | Easton | MD | 21601 | 521282080 | Fundraising | MD | 501(c)(3) | 11A | SHS | false |
| Shore Clinical Foundation Inc | ||||||||||
| 219 South Washington Street | Easton | MD | 21601 | 521874111 | Healthcare | MD | 501(c)(3) | 03 | SHS | 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 |
| Shipleys Choice Medical Park Inc | ||||||||||
| 22 South Greene Street | Baltimore | MD | 21201 | 043643849 | Real Estate | MD | 501(c)(2) | 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 Specialty Hospital | ||||||||||
| 611 South Charles Street | Baltimore | MD | 21230 | 520882914 | Healthcare | MD | 501(c)(3) | 03 | UMMSC | false |
| Civista Health Foundation Inc | ||||||||||
| PO Box 1070 | La Plata | MD | 20646 | 521414564 | Fundraising | MD | 501(c)(3) | 11A | CIVHS | true |
| Civista Health Auxiliary Inc | ||||||||||
| PO Box 1070 | La Plata | MD | 20646 | 521131193 | Fundraising | MD | 501(c)(3) | 11A | CIVHS | true |
| Civista Medical Center Inc | ||||||||||
| PO Box 1070 | La Plata | MD | 20646 | 520445374 | Healthcare | MD | 501(c)(3) | 03 | CIVHS | true |
| Univ of MD St Joseph Foundation Inc | ||||||||||
| 7601 Osler Drive | Towson | MD | 21204 | 521681044 | Fundraising | MD | 501(c)(3) | 11A | UMMSC | false |
Form990 Schedule R Part III Form990ScheduleRPartIII (9 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivityPrimaryActivity | Legal Domicile StateLegalDomicileState | Business Name Line1DirectControllingEntityName/BusinessNameLine1 |
|---|---|---|---|---|---|---|---|
| Arundel Physicians Associates LLC | |||||||
| 301 Hospital Drive | Glen Burnie | MD | 20161 | 522000762 | Healthcare | MD | NA |
| Baltimore Washington Imaging LLC | |||||||
| 301 Hospital Drive | Glen Burnie | MD | 20161 | 200806027 | Healthcare | MD | NA |
| Central Maryland Radiology Oncology LLC | |||||||
| 10710 Charter Drive | Columbia | MD | 21044 | 270879418 | Healthcare | MD | NA |
| Innovative Health LLC | |||||||
| 29165 Canvasback Drive Suite 100 | Easton | MD | 21601 | 521997287 | Billing | MD | NA |
| NAHSunrise of Severna Park LLC | |||||||
| 301 Hospital Drive | Glen Burnie | MD | 20161 | 541810729 | Healthcare | MD | NA |
| North Arundel Senior Living LLC | |||||||
| 301 Hospital Drive | Glen Burnie | MD | 20161 | 541810728 | Healthcare | MD | NA |
| Shipley's Imaging Center LLC | |||||||
| 22 South Greene Street | Baltimore | MD | 21201 | 522040338 | Healthcare | MD | NA |
| Universitycare LLC | |||||||
| 22 South Greene Street | Baltimore | MD | 21201 | 521914892 | Healthcare | MD | NA |
| O'Dea Medical Arts Limited Partnership | |||||||
| 7601 Osler Drive | Towson | MD | 21204 | 521682964 | Healthcare | MD | NA |
Form990 Schedule R Part IV Form990ScheduleRPartIV (9 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivityPrimaryActivity | Legal Domicile StateLegalDomicileState | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Type Of EntityTypeOfEntity | Share Of Total IncomeShareOfTotalIncome | Share Of EOY AssetsShareOfEOYAssets | Percentage OwnershipPercentageOwnership | Controlled OrgControlledOrg |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 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 | ||||
| Civista Care Partners Inc | ||||||||||||
| PO Box 1070 | La Plata | MD | 20646 | 522176314 | Healthcare | MD | CIVHS | C Corp | 3674985 | 5357275 | 1.00000 | true |
| Univ Midtown Prof Center A Condominium | ||||||||||||
| 827 Linden Avenue | Baltimore | MD | 21201 | 521891126 | Real Estate | MD | NA | C Corp | ||||
| Shore Health Enterprises Inc | ||||||||||||
| 219 South Washington Street | Easton | MD | 21601 | 521363201 | 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 | ||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | false | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | false | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | true | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | false | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | false | LoansOrGuaranteesFromOtherOrg |
| Dividends Related Organization | false | DividendsRelatedOrganization |
| Sale Of Assets To Other Org | false | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | false | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | false | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | true | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | false | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | false | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | false | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | false | SharingOfFacilities |
| Sharing Of Paid Employees | false | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | false | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | false | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | false | OtherTransferToOtherOrg |
| Other Transfer From Other Org | false | OtherTransferFromOtherOrg |
Transactions Related Orgs Table TransactionsRelatedOrgsTable (2 entries)
| Transaction TypeTransactionType | Amount InvolvedAmountInvolved | Method Of Amt DeterminationMethodOfAmtDetermination |
|---|---|---|
| Civista Medical Center Inc | ||
| C | 583200 | Cash |
| Civista Care Partners Inc | ||
| J | 98142 | Cash |