2013-05-14T12:02:29-05:00 2012-06-30 GRANT THORNTON LLP 2001 MARKET STREET SUITE 3100 PHILADELPHIA PA 19103 990 2011-07-01 522155576 Civista Health Inc % ERIK BOAS CIVI 3016094000 PO Box 1070 La Plata MD 206461070 ERIK BOAS 3016094000 2013-05-10 true Frank Giardini 2155614200 2011 2016-03-07 17:11:31Z Noel Cervino PO Box 1070 La Plata MD 206461070 131351 false X www.Civista.org X 1998 MD 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. 17 14 0 0 0 0 0 0 0 203686 33209 24536 98142 228222 131351 0 0 0 0 0 0 0 0 0 137724 1252028 137724 1252028 90498 -1120677 2694673 6796152 2604175 3431536 90498 3364616 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. false false 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 Medical Center in Partnership with the Charles County Department of Health, has conducted a Needs Assessment of Charles County every 5 years. Beginning calendar year 2011, in accordance with new regulations, the Needs Assessment will be conducted every 3 years. The data included in this report was collected in calendar year 2011. Civista Health, Inc. and the Charles County Department of Health collaborated to complete a comprehensive assessment of the health needs (CHNA) of Charles County, Maryland. An epidemiologist with a Master's Degree in Public Health Epidemiology was contracted to analyze the qualitative and quantitative data. Civista lead the effort and covered 80% of the cost of the CHNA. To provide a comprehensive assessment of the health needs of the county, a four method plan was developed which included 4 different sources of data: a long online survey of Charles County residents perceptions of health and health behaviors, a short paper survey on health perceptions throughout the county, 7 focus groups with community leaders, citizens, and stakeholders, and a quantitative data analysis. The use of the multiple data collection methods strengthened the validity of the assessment's findings, as well as ensuring that Charles County residents had an opportunity to participate in the assessment process and to feel invested in its outcome. 302 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 3 question survey was distributed throughout the county regarding perceptions of health within the county. A total of 200 short surveys were completed. Surveys were located throughout the county including Civista waiting rooms, CCDOH waiting rooms, libraries, senior centers, community centers. 35 were completed in Spanish (17.5%). Seven focus groups were held throughout the county. The focus group topics included: age-related health issues, chronic disease specific health, special populations, county leadership, substance abuse, youth through the school nurses, and the Partnerships for a Healthier Charles County (PHCC) (community leaders and stakeholders). Approximately 165 people participated in the county focus groups. Quantitative data was analyzed for several health topics including: directives, arthritis and osteoporosis, breastfeeding, community disaster drills, school career days and 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. true false false false false false false false false true false false true true true false true false false false false false false false false false false false true false false false false false false false false false false false false true true true false false false true 0 0 true 0 false false false false false false false false false false false X 17 14 false false false false false false false true true false false true true true true true true false false false MD X ERIK BOAS 3026094130 5 GARRETT AVENUE La Plata MD 20646 X X Shelly Culhane 1.0 X 0 0 0 B Larry Jenkins 1.0 X 0 0 0 R Wayne Barnes 1.0 X 0 0 0 Sara Middleton 1.0 X X 0 0 0 Candice Quinn Kelly 1.0 X 0 0 0 Faye Reed 1.0 X 0 0 0 Khadar Baig 1.0 X 0 0 0 Van Mitchell 1.0 X 0 0 0 Louis Jenkins Jr 1.0 X X 0 0 0 Seetaramayya Nagula 1.0 X 0 0 0 Richard Winkler 1.0 X X 0 0 0 Michael Cady 1.0 X 0 0 0 Ashvin J Patel MD 1.0 X X 0 0 0 James Burke 1.0 X 0 0 0 Noel Cervino 1.0 X X 0 543267 59420 John Ashworth 1.0 X 0 569353 17755 Robert Chrencik 1.0 X 0 2073638 213731 Erik Boas 1.0 X 0 245642 22538 0 3431900 313444 0 false true false 0 0 0 33209 33209 0 0 98142 98142 98142 98142 0 0 0 0 0 131351 131351 0 0 0 0 0 0 0 0 0 0 0 70925 70925 0 0 0 0 40002 40002 0 0 0 0 0 0 0 0 74577 74577 0 12282 12282 0 UTILITIES AND MAINTENANCE 7681 7681 LEASES AND RENTALS 26111 26111 TAXES 20335 20335 UMMS INDIRECT ALLOCATION 1000115 1000115 1252028 0 1252028 0 0 6900 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3274384 12282 2082248 3262102 0 0 0 0 0 0 287094 0 325331 3527150 2694673 6796152 5496 0 0 0 0 0 0 0 0 0 0 0 0 0 1347970 1230155 1250709 2201381 2604175 3431536 X 90498 3364616 0 0 0 0 90498 3364616 2694673 6796152 X -1120677 4394795 X false true true X X X X false false false CIVISTA MEDICAL CENTER INC 520445374 03 true true true 0 CIVISTA HEALTH AUXILIARY 521131193 09 true true true 0 2 2141083 2141083 1133301 12282 1121019 0 0 0 3262102 DUE FROM AFFILIATES 762093 PREMIER RECEIVABLE 226863 STRATEGIC PROJECT FUND 2538194 3527150 0 DUE TO AFFILIATES 2201381 2201381 FIN 48 Schedule D Fin 48 Footnote CIVISTA MEDICAL CENTER, INC., CIVISTA HEALTH FOUNDATION, INC., AND CIVISTA HEALTH, INC. WERE RECOGNIZED AS PUBLIC CHARITIES GENERALLY EXEMPT FROM FEDERAL INCOME TAXATION UNDER 501(C)(3) OF THE INTERNAL REVENUE CODE PURSUANT TO DETERMINATION LETTERS ISSUED BY THE IRS IN 1980, 1986, AND 2001, RESPECTIVELY. CIVISTA CARE PARTNERS, INC (CCP) IS A FOR PROFIT ENTITY SUBJECT TO FEDERAL AND STATE INCOME TAXES, WHICH ARE RECORDED UNDER FASB ACCOUNTING STANDARDS CODIFICATION (ASC) TOPIC 740, ACCOUNTING FOR INCOME TAXES (ASC 740). ACCORDINGLY INCOME TAXES ARE ACCOUNTED FOR UNDER THE ASSET AND LIABILITY METHOD. UNDER THIS METHOD, DEFERRED TAX ASSETS AND LIABILITIES ARE RECOGNIZED FOR THE FUTURE TAX CONSEQUENCES ATTRIBUTABLE TO TEMPORARY DIFFERENCES BETWEEN THE FINANCIAL STATEMENT CARRYING AMOUNTS OF EXISTING ASSETS AND LIABILITIES AND THEIR RESPECTIVE TAX BASES AND OPERATING LOSS AND CREDIT CARRY FORWARDS. DEFERRED TAX ASSETS AND LIABILITIES ARE MEASURED USING ENACTED TAX RATES EXPECTED TO APPLY TO TAXABLE INCOME IN THE YEARS IN WHICH THOSE TEMPORARY DIFFERENCES ARE EXPECTED TO BE RECOVERED OR SETTLED. THE EFFECT ON DEFERRED TAX ASSETS AND LIABILITIES OF A CHANGE IN TAX RATES IS RECOGNIZED IN INCOME IN THE PERIOD THAT INCLUDES THE ENACTMENT DATE. false false false false false false false false false Noel Cervino 0 314370 0 165855 0 63042 0 54989 0 4431 0 602687 0 0 Erik Boas 0 186193 0 56273 0 3176 0 20767 0 1771 0 268180 0 0 John Ashworth 0 357011 0 155527 0 56815 0 9800 0 7955 0 587108 0 0 Robert Chrencik 0 1124953 0 937125 0 11560 0 204107 0 9624 0 2287369 0 0 Form 990 Review Process Form 990, Part VI, Line 11b The process for reviewing the Form 990 begins with Civista's Staff Accountant working with the Controller in reviewing the first Draft Form 990. The Staff Accountant and Controller will coordinate with the independent accounting firm, GRANT THORNTON, to update any necessary changes. While the Controller schedules the services of GRANT THORNTON to present the Final Draft Form 990 to the Finance Committee of the Board of Directors, the Chief Financial Officer will review the document before the Final Draft is generated. Once all necessary corrections are made, copies of the Final Draft Form 990 will be provided to the Finance Committee prior to the meeting for their review (which will be required to be kept confidential until the Form 990 is finalized and signed). The Final Draft Form 990 will be presented by GRANT THORNTON at the Finance Committee meeting for questions and final approval. Once the Finance Committee approves the Form 990 to be signed, the President and Chief Executive Officer will sign as Civista's authorized signer. The Final Form 990 will be provided to the full Board of Directors for informational purposes before filing. Conflict of Interest Policy Monitoring & Enforcement Form 990, Part VI, Line 12c The conflicts monitoring and enforcement policy is established to prohibit activities that may conflict or appear to conflict with Civista's business. Employees in key positions at Civista have an obligation to Civista to avoid conflict of interest situations. Key employees are exempt administrative and non-exempt employees who have the authority to make commitments for Civista resources. All key employees must sign a disclosure of business interest/conflict of interest statement. It is the policy of Civista that key employees disclose any detail of any activities or interests which may conflict or appear to conflict with Civista's business. Conflict of interest behaviors are varied; however, it would be prohibited for an employee to be directly connected in any manner with any business or entity which sells or provides materials, supplies, equipment, facilities or services to or which is in direct or indirect competition with or which is a customer of Civista. All employees shall refrain from any conduct during the performance of their duties that has the appearance of impropriety or that could reasonably be construed as contrary to the interests and mission of this organization. An employee may not accept cash in any amount or other personal gifts having any value or any other personal favors for performance which goes beyond common courtesy in the performance of his/her job duties from anyone with whom Civista has or is likely to have any business dealings. These individuals may include an employee, perspective employees, customers, competitors or vendors. An employee may not disclose directly or indirectly any information of any kind acquired in the course of employment or association with Civista or use any such information to further any personal interests or to the detriment of Civista. Any employee who has knowledge of activities that he or she believes may violate any of these procedures has an obligation to report them immediately to their supervisor/department manager or the Vice President, Human Resources. Any individual who knowingly violates this policy is subject to disciplinary action up to and including discharge in addition to potential criminal prosecution. While all employees are required to sign a conflict of interest disclosure, it is the policy of Civista that key employees disclose any detail of any activities or interests which may conflict or appear to conflict with Civista's business. The responses are initially reviewed by human resources. If anything is disclosed, the disclosure is sent to the compliance officer who consults with outside attorneys. After review of the disclosures, if a conflict is identified, the employee would be notified of the conflict and asked to refrain from any further activity. Depending on the conflict, the appropriate action would be for the person involved to recuse themselves. If an individual knowingly violates this policy, they will be subject to disciplinary action up to and including discharge in addition to potential criminal prosecution. As part of the annual competencies, every employee completes a online module in Healthstream, Civista's online support page, which details their responsibility for disclosure under the policy. Process for Determining Compensation Form 990, Part VI, Line 15a The organization utilizes an independent compensation committee, an independent compensation consultant, a written employment contract, a compensation survey or study, and approval by the board/compensation committee. The chief executive officer/president and the executive committee of the board reviews and approves the compensation for the organization's top management officials and other officers and key employees. The salary of management employees are based a market study of comparable positions, education, and experience as related to the manager's position. In order to determine the manager's salary, the compensation and benefits specialist completes a relative market study to obtain information about comparable jobs in the healthcare industry. Human resources evaluates the market study and then makes a recommendation. Human resources also uses data prepared by independent compensation consultants. After deciding on the compensation of the management employee, the decision is documented in the executive committee minutes. The year that this process was last undertaken for these types of positions was in the current year. How Documents are Made Available to the Public Form 990, Part VI, Line 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. OTHER CHANGES IN NET ASSETS OR FUND BALANCES FORM 990, PART XI, LINE 5 UMMS CONTRIBUTIONS 6,500,000. FMV ADJUSTMENT AFTER VALUATION -2,105,205 ------------------------------ ------------ CHANGES IN NET ASSETS 4,394,795 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Noel Cervino TITLE:Ex-Officio/President & CEO HOURS:40 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:John Ashworth TITLE:Ex-Officio/Director HOURS:40 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Robert Chrencik TITLE:Ex-Officio/Director HOURS:50 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Erik Boas TITLE:Chief Financial Officer HOURS:40 Civista Cambridge Properties LLC PO Box 1070 La Plata MD 20646 201825174 Real Estate MD -284970 9115096 CCP Civista Clinical Services LLC PO Box 1070 La Plata MD 20646 260269489 Healthcare MD -210644 -3816943 CCP Baltimore Washington Emergency Phys Inc 301 Hospital Drive Glen Burnie MD 21061 521756326 Healthcare MD 501(c)(3) 11-I BWMS false Baltimore Washington Healthcare Services 301 Hospital Drive Glen Burnie MD 21061 521830243 Healthcare MD 501(c)(3) 11-I 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) 11-I 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 Chester River Health System Inc 100 Brown Street Chestertown MD 21620 522046500 Healthcare MD 501(c)(3) 11-I 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) 11-II MGHS false Maryland General Comm Health Foundation 827 Linden Avenue Baltimore MD 21201 522147532 Fundraising MD 501(c)(3) 11c MGHS false Maryland General Health Systems Inc 827 Linden Avenue Baltimore MD 21201 521175337 Healthcare MD 501(c)(3) 11-II 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) 11-I 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) 11-II 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) 11-I 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) 11-I CIVHS true Civista Health Auxiliary Inc PO Box 1070 La Plata MD 20646 521131193 Fundraising MD 501(c)(3) 11-I CIVHS true Civista Medical Center Inc PO Box 1070 La Plata MD 20646 520445374 Healthcare MD 501(c)(3) 03 CIVHS true Arundel Physicians Associates LLC 301 Hospital Drive Glen Burnie MD 20161 522000762 Healthcare MD na n/a Baltimore Washington Imaging LLC 301 Hospital Drive Glen Burnie MD 20161 200806027 Healthcare MD na n/a Central Maryland Radiology Oncology LLC 10710 Charter Drive Columbia MD 21044 270879418 Healthcare MD na n/a Innovative Health LLC 29165 Canvasback Drive Suite 100 Easton MD 21601 521997287 Billing MD na n/a NAHSunrise of Severna Park LLC 301 Hospital Drive Glen Burnie MD 20161 541810729 Healthcare MD na n/a North Arundel Senior Living LLC 301 Hospital Drive Glen Burnie MD 20161 541810728 Healthcare MD na n/a Shipley's Imaging Center LLC 22 South Greene Street Baltimore MD 21201 522040338 Healthcare MD na n/a Universitycare LLC 22 South Greene Street Baltimore MD 21201 521914892 Healthcare MD na n/a Arundel Physicians Associates Inc 301 Hospital Drive Glen Burnie MD 21061 521992649 Healthcare MD na C Corp Baltimore Washington Health Enterprises 301 Hospital Drive Glen Burnie MD 21061 521936656 Healthcare MD na C Corp BW Professional Services Inc 301 Hospital Drive Glen Burnie MD 21061 521655640 Healthcare MD na C Corp Civista Care Partners Inc PO Box 1070 La Plata MD 20646 522176314 Healthcare MD CivHS C Corp 3106384 10046123 1.00000 Council of Unit Owners of MD Gen Prof Ce 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 PO Box 1109 Grand Cayman CJ KY1-1102 980129232 Insurance CJ na C Corp University Lithotripter Inc 22 South Greene Street Baltimore MD 21201 521451021 Healthcare MD na C Corp UMMS Self Insurance Trust 22 South Greene Street Baltimore MD 21201 526315433 Insurance MD na Trust false false true false false false false false true false false false false false false false false true Civista Medical Center Inc r 634178 Cash Civista Care Partners Inc CCS LLC i 98142 Cash