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      <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>
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      <GrantsToDomesticIndividuals>
        <Total>0</Total>
      </GrantsToDomesticIndividuals>
      <ForeignGrants>
        <Total>0</Total>
      </ForeignGrants>
      <BenefitsToMembers>
        <Total>0</Total>
      </BenefitsToMembers>
      <CompCurrentOfficersDirectors>
        <Total>0</Total>
      </CompCurrentOfficersDirectors>
      <CompDisqualPersons>
        <Total>0</Total>
      </CompDisqualPersons>
      <OtherSalariesAndWages>
        <Total>0</Total>
      </OtherSalariesAndWages>
      <PensionPlanContributions>
        <Total>0</Total>
      </PensionPlanContributions>
      <OtherEmployeeBenefits>
        <Total>0</Total>
      </OtherEmployeeBenefits>
      <PayrollTaxes>
        <Total>0</Total>
      </PayrollTaxes>
      <FeesForServicesManagement>
        <Total>0</Total>
      </FeesForServicesManagement>
      <FeesForServicesLegal>
        <Total>1945</Total>
        <ManagementAndGeneral>1945</ManagementAndGeneral>
      </FeesForServicesLegal>
      <FeesForServicesAccounting>
        <Total>0</Total>
      </FeesForServicesAccounting>
      <FeesForServicesLobbying>
        <Total>0</Total>
      </FeesForServicesLobbying>
      <FeesForServicesProfFundraising>
        <Total>0</Total>
      </FeesForServicesProfFundraising>
      <FeesForServicesInvstMgmntFees>
        <Total>0</Total>
      </FeesForServicesInvstMgmntFees>
      <FeesForServicesOther>
        <Total>289212</Total>
        <ManagementAndGeneral>289212</ManagementAndGeneral>
      </FeesForServicesOther>
      <Advertising>
        <Total>0</Total>
      </Advertising>
      <OfficeExpenses>
        <Total>62</Total>
        <ManagementAndGeneral>62</ManagementAndGeneral>
      </OfficeExpenses>
      <InformationTechnology>
        <Total>0</Total>
      </InformationTechnology>
      <Royalties>
        <Total>0</Total>
      </Royalties>
      <Occupancy>
        <Total>64516</Total>
        <ManagementAndGeneral>64516</ManagementAndGeneral>
      </Occupancy>
      <Travel>
        <Total>0</Total>
      </Travel>
      <TravelEntrtnmntPublicOfficials>
        <Total>0</Total>
      </TravelEntrtnmntPublicOfficials>
      <ConferencesMeetings>
        <Total>0</Total>
      </ConferencesMeetings>
      <Interest>
        <Total>68861</Total>
        <ManagementAndGeneral>68861</ManagementAndGeneral>
      </Interest>
      <PaymentsToAffiliates>
        <Total>0</Total>
      </PaymentsToAffiliates>
      <DepreciationDepletion>
        <Total>198594</Total>
        <ManagementAndGeneral>198594</ManagementAndGeneral>
      </DepreciationDepletion>
      <Insurance>
        <Total>0</Total>
      </Insurance>
      <OtherExpenses>
        <Description>UMMS INDIRECT ALLOCATION</Description>
        <Total>1253292</Total>
        <ManagementAndGeneral>1253292</ManagementAndGeneral>
      </OtherExpenses>
      <OtherExpenses>
        <Description>BANK FEES</Description>
        <Total>62419</Total>
        <ManagementAndGeneral>62419</ManagementAndGeneral>
      </OtherExpenses>
      <OtherExpenses>
        <Description>MISCELLANEOUS</Description>
        <Total>60237</Total>
        <ManagementAndGeneral>60237</ManagementAndGeneral>
      </OtherExpenses>
      <OtherExpenses>
        <Description>TAXES</Description>
        <Total>32536</Total>
        <ManagementAndGeneral>32536</ManagementAndGeneral>
      </OtherExpenses>
      <TotalFunctionalExpenses>
        <Total>2031674</Total>
        <ProgramServices>0</ProgramServices>
        <ManagementAndGeneral>2031674</ManagementAndGeneral>
        <Fundraising>0</Fundraising>
      </TotalFunctionalExpenses>
      <CashNonInterestBearing>
        <BOY>6900</BOY>
        <EOY>61049</EOY>
      </CashNonInterestBearing>
      <SavingsAndTempCashInvestments>
        <BOY>0</BOY>
        <EOY>0</EOY>
      </SavingsAndTempCashInvestments>
      <PledgesAndGrantsReceivable>
        <BOY>0</BOY>
        <EOY>0</EOY>
      </PledgesAndGrantsReceivable>
      <AccountsReceivable>
        <BOY>0</BOY>
        <EOY>0</EOY>
      </AccountsReceivable>
      <ReceivablesFromOfficersEtc>
        <BOY>0</BOY>
        <EOY>0</EOY>
      </ReceivablesFromOfficersEtc>
      <ReceivablesFromDisqualPersons>
        <BOY>0</BOY>
        <EOY>0</EOY>
      </ReceivablesFromDisqualPersons>
      <OtherNotesLoansReceivableNet>
        <BOY>0</BOY>
        <EOY>0</EOY>
      </OtherNotesLoansReceivableNet>
      <InventoriesForSaleOrUse>
        <BOY>0</BOY>
        <EOY>0</EOY>
      </InventoriesForSaleOrUse>
      <PrepaidExpensesDeferredCharges>
        <BOY>0</BOY>
        <EOY>0</EOY>
      </PrepaidExpensesDeferredCharges>
      <LandBuildingsEquipmentBasis>14752983</LandBuildingsEquipmentBasis>
      <LandBldgEquipmentAccumDeprec>131720</LandBldgEquipmentAccumDeprec>
      <LandBuildingsEquipmentBasisNet>
        <BOY>3262102</BOY>
        <EOY>14621263</EOY>
      </LandBuildingsEquipmentBasisNet>
      <InvestmentsPubTradedSecurities>
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        <EOY>0</EOY>
      </InvestmentsPubTradedSecurities>
      <InvestmentsOtherSecurities>
        <BOY>0</BOY>
        <EOY>0</EOY>
      </InvestmentsOtherSecurities>
      <InvestmentsProgramRelated>
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        <EOY>0</EOY>
      </InvestmentsProgramRelated>
      <IntangibleAssets>
        <BOY>0</BOY>
        <EOY>910000</EOY>
      </IntangibleAssets>
      <OtherAssetsTotal>
        <BOY>3527150</BOY>
        <EOY>4697357</EOY>
      </OtherAssetsTotal>
      <TotalAssets>
        <BOY>6796152</BOY>
        <EOY>20289669</EOY>
      </TotalAssets>
      <AccountsPayableAccruedExpenses>
        <BOY>0</BOY>
        <EOY>826</EOY>
      </AccountsPayableAccruedExpenses>
      <GrantsPayable>
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        <EOY>0</EOY>
      </GrantsPayable>
      <DeferredRevenue>
        <BOY>0</BOY>
        <EOY>0</EOY>
      </DeferredRevenue>
      <TaxExemptBondLiabilities>
        <BOY>0</BOY>
        <EOY>0</EOY>
      </TaxExemptBondLiabilities>
      <EscrowAccountLiability>
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        <EOY>0</EOY>
      </EscrowAccountLiability>
      <LoansFromOfficersDirectors>
        <BOY>0</BOY>
        <EOY>0</EOY>
      </LoansFromOfficersDirectors>
      <MortNotesPyblSecuredInvestProp>
        <BOY>0</BOY>
        <EOY>0</EOY>
      </MortNotesPyblSecuredInvestProp>
      <UnsecuredNotesLoansPayable>
        <BOY>1230155</BOY>
        <EOY>1106607</EOY>
      </UnsecuredNotesLoansPayable>
      <OtherLiabilities>
        <BOY>2201381</BOY>
        <EOY>15165020</EOY>
      </OtherLiabilities>
      <TotalLiabilities>
        <BOY>3431536</BOY>
        <EOY>16272453</EOY>
      </TotalLiabilities>
      <FollowSFAS117>X</FollowSFAS117>
      <UnrestrictedNetAssets>
        <BOY>3364616</BOY>
        <EOY>4017216</EOY>
      </UnrestrictedNetAssets>
      <TemporarilyRestrictedNetAssets>
        <BOY>0</BOY>
        <EOY>0</EOY>
      </TemporarilyRestrictedNetAssets>
      <PermanentlyRestrictedNetAssets>
        <BOY>0</BOY>
        <EOY>0</EOY>
      </PermanentlyRestrictedNetAssets>
      <TotalNetAssetsFundBalances>
        <BOY>3364616</BOY>
        <EOY>4017216</EOY>
      </TotalNetAssetsFundBalances>
      <TotalLiabNetAssetsFundBalances>
        <BOY>6796152</BOY>
        <EOY>20289669</EOY>
      </TotalLiabNetAssetsFundBalances>
      <InfoInScheduleOPartXI>X</InfoInScheduleOPartXI>
      <ReconcilationRevenueExpenses>-1264153</ReconcilationRevenueExpenses>
      <ReconcilationOtherChanges>1916753</ReconcilationOtherChanges>
      <MethodOfAccountingAccrual>X</MethodOfAccountingAccrual>
      <AccountantCompileOrReview>false</AccountantCompileOrReview>
      <FSAudited>true</FSAudited>
      <FSAuditedBasis>
        <FinancialStatementConsolidated>X</FinancialStatementConsolidated>
      </FSAuditedBasis>
      <AuditCommittee>true</AuditCommittee>
    </IRS990>
    <IRS990ScheduleA documentId="IRS990ScheduleA">
      <SupportingOrganization509a3>X</SupportingOrganization509a3>
      <SupportingOrg509a3Type3FuncInt>X</SupportingOrg509a3Type3FuncInt>
      <CertificationCheckbox>X</CertificationCheckbox>
      <ContribByControllingIndividual>false</ContribByControllingIndividual>
      <ContributionByRelatedParty>false</ContributionByRelatedParty>
      <ContribBy35ControlledEntity>false</ContribBy35ControlledEntity>
      <SupportedOrgInformation>
        <Name>
          <BusinessNameLine1>CIVISTA MEDICAL CENTER INC</BusinessNameLine1>
        </Name>
        <EIN>520445374</EIN>
        <TypeOfOrganization>03</TypeOfOrganization>
        <ListedInGoverningDoc>true</ListedInGoverningDoc>
        <SupportedOrganizationNotified>true</SupportedOrganizationNotified>
        <OrganizedInUS>true</OrganizedInUS>
        <Amount>0</Amount>
      </SupportedOrgInformation>
      <SupportedOrgInformation>
        <Name>
          <BusinessNameLine1>CIVISTA HEALTH AUXILIARY</BusinessNameLine1>
        </Name>
        <EIN>521131193</EIN>
        <TypeOfOrganization>09</TypeOfOrganization>
        <ListedInGoverningDoc>true</ListedInGoverningDoc>
        <SupportedOrganizationNotified>true</SupportedOrganizationNotified>
        <OrganizedInUS>true</OrganizedInUS>
        <Amount>0</Amount>
      </SupportedOrgInformation>
      <TotalNumberOfSupportedOrgs>2</TotalNumberOfSupportedOrgs>
    </IRS990ScheduleA>
    <IRS990ScheduleB documentId="IRS990ScheduleB">
      <ContributorInfo>
        <ContributorNumber>RESTRICTED</ContributorNumber>
        <ContributorNameBusiness>
          <BusinessNameLine1>RESTRICTED</BusinessNameLine1>
        </ContributorNameBusiness>
        <ContributorAddressUS>
          <AddressLine1>RESTRICTED</AddressLine1>
          <AddressLine2>RESTRICTED</AddressLine2>
          <City>RESTRICTED</City>
          <State>RESTRICTED</State>
          <ZIPCode>RESTRICTED</ZIPCode>
        </ContributorAddressUS>
        <AggregateContributions>RESTRICTED</AggregateContributions>
      </ContributorInfo>
    </IRS990ScheduleB>
    <IRS990ScheduleD documentId="IRS990ScheduleD">
      <ArtPublicExhibitionAmts />
      <HeldWorksOfArtAmts />
      <CurrentYearMinus3Years />
      <CurrentYearMinus4Years />
      <Land>
        <OtherCostOrOtherBasis>2141083</OtherCostOrOtherBasis>
        <BookValue>2141083</BookValue>
      </Land>
      <Buildings>
        <OtherCostOrOtherBasis>12506926</OtherCostOrOtherBasis>
        <Depreciation>131720</Depreciation>
        <BookValue>12375206</BookValue>
      </Buildings>
      <LeaseholdImprovements />
      <Equipment />
      <OtherLandBuildings>
        <OtherCostOrOtherBasis>104974</OtherCostOrOtherBasis>
        <BookValue>104974</BookValue>
      </OtherLandBuildings>
      <TotalOfBookValueLandBuildings>14621263</TotalOfBookValueLandBuildings>
      <OtherAssets>
        <Description>DUE FROM AFFILIATES</Description>
        <BookValue>1013392</BookValue>
      </OtherAssets>
      <OtherAssets>
        <Description>PREMIER RECEIVABLE</Description>
        <BookValue>205397</BookValue>
      </OtherAssets>
      <OtherAssets>
        <Description>STRATEGIC PROJECT FUND</Description>
        <BookValue>3484783</BookValue>
      </OtherAssets>
      <OtherAssets>
        <Description>SECURITY DEPOSITS</Description>
        <BookValue>-6215</BookValue>
      </OtherAssets>
      <TotalBookValueOtherAssets>4697357</TotalBookValueOtherAssets>
      <FederalIncomeTaxLiability>0</FederalIncomeTaxLiability>
      <OtherLiabilities>
        <Description>DUE TO AFFILIATES</Description>
        <Amount>15165020</Amount>
      </OtherLiabilities>
      <TotalOfAmounts>15165020</TotalOfAmounts>
      <FootnoteInPartXIII>X</FootnoteInPartXIII>
      <Form990ScheduleDPartXIII>
        <Identifier>Liability for Uncertain Tax Position (ASC 740)</Identifier>
        <ReturnReference>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>
      </Form990ScheduleDPartXIII>
    </IRS990ScheduleD>
    <IRS990ScheduleJ documentId="IRS990ScheduleJ">
      <SeverancePayment>false</SeverancePayment>
      <SupplementalNonqualRetirePlan>true</SupplementalNonqualRetirePlan>
      <EquityBasedCompArrangement>false</EquityBasedCompArrangement>
      <CompBasedOnRevenueOfFilingOrg>false</CompBasedOnRevenueOfFilingOrg>
      <CompBasedOnRevenueRelatedOrgs>false</CompBasedOnRevenueRelatedOrgs>
      <CompBasedNetEarningsFilingOrg>false</CompBasedNetEarningsFilingOrg>
      <CompBasedNetEarningsRelateOrgs>false</CompBasedNetEarningsRelateOrgs>
      <AnyNonFixedPayments>false</AnyNonFixedPayments>
      <InitialContractException>false</InitialContractException>
      <Form990ScheduleJPartII>
        <NamePerson>Noel Cervino</NamePerson>
        <Title>Ex-Officio/President &amp; CEO</Title>
        <BaseCompensationFilingOrg>0</BaseCompensationFilingOrg>
        <CompBasedOnRelatedOrgs>337544</CompBasedOnRelatedOrgs>
        <BonusFilingOrg>0</BonusFilingOrg>
        <BonusRelatedOrgs>167621</BonusRelatedOrgs>
        <OtherCompensationFilingOrg>0</OtherCompensationFilingOrg>
        <OtherCompensationRelatedOrgs>20576</OtherCompensationRelatedOrgs>
        <DeferredCompFilingOrg>0</DeferredCompFilingOrg>
        <DeferredCompRelatedOrgs>61499</DeferredCompRelatedOrgs>
        <NontaxableBenefitsFilingOrg>0</NontaxableBenefitsFilingOrg>
        <NontaxableBenefitsRelatedOrgs>5149</NontaxableBenefitsRelatedOrgs>
        <TotalCompensationFilingOrg>0</TotalCompensationFilingOrg>
        <TotalCompensationRelatedOrgs>592389</TotalCompensationRelatedOrgs>
        <CompReportPrior990FilingOrg>0</CompReportPrior990FilingOrg>
        <CompReportPrior990RelatedOrgs>0</CompReportPrior990RelatedOrgs>
      </Form990ScheduleJPartII>
      <Form990ScheduleJPartII>
        <NamePerson>John Ashworth</NamePerson>
        <Title>Ex-Officio/Director</Title>
        <BaseCompensationFilingOrg>0</BaseCompensationFilingOrg>
        <CompBasedOnRelatedOrgs>368549</CompBasedOnRelatedOrgs>
        <BonusFilingOrg>0</BonusFilingOrg>
        <BonusRelatedOrgs>157673</BonusRelatedOrgs>
        <OtherCompensationFilingOrg>0</OtherCompensationFilingOrg>
        <OtherCompensationRelatedOrgs>62314</OtherCompensationRelatedOrgs>
        <DeferredCompFilingOrg>0</DeferredCompFilingOrg>
        <DeferredCompRelatedOrgs>10000</DeferredCompRelatedOrgs>
        <NontaxableBenefitsFilingOrg>0</NontaxableBenefitsFilingOrg>
        <NontaxableBenefitsRelatedOrgs>10541</NontaxableBenefitsRelatedOrgs>
        <TotalCompensationFilingOrg>0</TotalCompensationFilingOrg>
        <TotalCompensationRelatedOrgs>609077</TotalCompensationRelatedOrgs>
        <CompReportPrior990FilingOrg>0</CompReportPrior990FilingOrg>
        <CompReportPrior990RelatedOrgs>0</CompReportPrior990RelatedOrgs>
      </Form990ScheduleJPartII>
      <Form990ScheduleJPartII>
        <NamePerson>Robert Chrencik</NamePerson>
        <Title>Ex-Officio/Director</Title>
        <BaseCompensationFilingOrg>0</BaseCompensationFilingOrg>
        <CompBasedOnRelatedOrgs>1166972</CompBasedOnRelatedOrgs>
        <BonusFilingOrg>0</BonusFilingOrg>
        <BonusRelatedOrgs>994524</BonusRelatedOrgs>
        <OtherCompensationFilingOrg>0</OtherCompensationFilingOrg>
        <OtherCompensationRelatedOrgs>13073</OtherCompensationRelatedOrgs>
        <DeferredCompFilingOrg>0</DeferredCompFilingOrg>
        <DeferredCompRelatedOrgs>223385</DeferredCompRelatedOrgs>
        <NontaxableBenefitsFilingOrg>0</NontaxableBenefitsFilingOrg>
        <NontaxableBenefitsRelatedOrgs>11081</NontaxableBenefitsRelatedOrgs>
        <TotalCompensationFilingOrg>0</TotalCompensationFilingOrg>
        <TotalCompensationRelatedOrgs>2409035</TotalCompensationRelatedOrgs>
        <CompReportPrior990FilingOrg>0</CompReportPrior990FilingOrg>
        <CompReportPrior990RelatedOrgs>0</CompReportPrior990RelatedOrgs>
      </Form990ScheduleJPartII>
      <Form990ScheduleJPartII>
        <NamePerson>Erik Boas</NamePerson>
        <Title>Chief Financial Officer</Title>
        <BaseCompensationFilingOrg>0</BaseCompensationFilingOrg>
        <CompBasedOnRelatedOrgs>192019</CompBasedOnRelatedOrgs>
        <BonusFilingOrg>0</BonusFilingOrg>
        <BonusRelatedOrgs>58118</BonusRelatedOrgs>
        <OtherCompensationFilingOrg>0</OtherCompensationFilingOrg>
        <OtherCompensationRelatedOrgs>15605</OtherCompensationRelatedOrgs>
        <DeferredCompFilingOrg>0</DeferredCompFilingOrg>
        <DeferredCompRelatedOrgs>23363</DeferredCompRelatedOrgs>
        <NontaxableBenefitsFilingOrg>0</NontaxableBenefitsFilingOrg>
        <NontaxableBenefitsRelatedOrgs>0</NontaxableBenefitsRelatedOrgs>
        <TotalCompensationFilingOrg>0</TotalCompensationFilingOrg>
        <TotalCompensationRelatedOrgs>289105</TotalCompensationRelatedOrgs>
        <CompReportPrior990FilingOrg>0</CompReportPrior990FilingOrg>
        <CompReportPrior990RelatedOrgs>0</CompReportPrior990RelatedOrgs>
      </Form990ScheduleJPartII>
      <Form990ScheduleJPartIII>
        <Identifier>RELATED ORGANIZATION METHODS TO ESTABLISH COMPENSATION</Identifier>
        <ReturnReference>SCHEDULE J, PART 1, LINE 3</ReturnReference>
        <Explanation>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</Explanation>
      </Form990ScheduleJPartIII>
      <Form990ScheduleJPartIII>
        <Identifier>SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN</Identifier>
        <ReturnReference>SCHEDULE J, PART I, LINE 4B</ReturnReference>
        <Explanation>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</Explanation>
      </Form990ScheduleJPartIII>
    </IRS990ScheduleJ>
    <IRS990ScheduleO documentId="IRS990ScheduleO">
      <GeneralExplanation>
        <Identifier>Members or Stockholders</Identifier>
        <ReturnReference>Form 990, Part VI, Lines 6, 7a, and 7b</ReturnReference>
        <Explanation>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.</Explanation>
      </GeneralExplanation>
      <GeneralExplanation>
        <Identifier>Conflict of Interest Policy Monitoring &amp; Enforcement</Identifier>
        <ReturnReference>Form 990, Part VI, Line 12c</ReturnReference>
        <Explanation>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.</Explanation>
      </GeneralExplanation>
      <GeneralExplanation>
        <Identifier>Process for Determining Compensation</Identifier>
        <ReturnReference>Form 990, Part VI, Line 15a and 15b</ReturnReference>
        <Explanation>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.</Explanation>
      </GeneralExplanation>
      <GeneralExplanation>
        <Identifier>How Documents are Made Available to the Public</Identifier>
        <ReturnReference>Form 990, Part VI, Line 19</ReturnReference>
        <Explanation>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.</Explanation>
      </GeneralExplanation>
      <GeneralExplanation>
        <Identifier>HOURS ON RELATED ENTITIES</Identifier>
        <ReturnReference>FORM 990, PART VII, SECTION A, COLUMN B</ReturnReference>
        <Explanation>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.</Explanation>
      </GeneralExplanation>
      <GeneralExplanation>
        <Identifier>OTHER CHANGES IN NET ASSETS OR FUND BALANCES</Identifier>
        <ReturnReference>FORM 990, PART XI, LINE 9</ReturnReference>
        <Explanation>UMMS Contributions to CHI 2,500,000 Physician Loss Reimbursement to CMC (583,200) Miscellaneous (47) ------------------------------------------------- Changes in Net Assets 1,916,753</Explanation>
      </GeneralExplanation>
      <GeneralExplanation>
        <Identifier>OTHER FEES FOR SERVICES FOR NON-EMPLOYEES</Identifier>
        <ReturnReference>FORM 990 PART IX LINE 11G</ReturnReference>
        <Explanation>DESCRIPTION:PURCHASED SERVICES TOTAL FEES:289212</Explanation>
      </GeneralExplanation>
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