2013-05-14T13:46:10-05:00 2012-06-30 COHEN RUTHERFORD KNIGHT PC 6903 ROCKLEDGE DRIVE SUITE 500 BETHESDA MD 208171800 990 2011-07-01 521565870 CARROLL HOSPICE INC % DAVID MCCORMICK CARR 4108716695 292 STONER AVE WESTMINSTER MD 21157 KEVIN KELBLY 2013-05-10 TINA C ECKLOFF 3018281008 2011 2016-03-07 17:11:31Z DIANE LINK 535 OLD WESTMINSTER PIKE WESTMINSTER MD 21157 4920168 false X www.Carrollhospice.org X 1988 MD CARROLL HOSPICE, AN AFFILIATE OF CARROLL HOSPITAL CENTER, IS DEDICATED TO IMPROVING THE QUALITY OF LIFE FOR PATIENTS NEEDING END-OF-LIFE HOSPICE CARE. 13 12 0 150 0 0 681472 581474 3501364 4283299 0 0 8707 40318 4191543 4905091 0 0 0 0 3205302 3228645 0 0 260066 1164161 1194258 4369463 4422903 -177920 482188 6750451 7032060 507926 236386 6242525 6795674 CARROLL HOSPICE, AN AFFILIATE OF CARROLL HOSPITAL CENTER, IS DEDICATED TO IMPROVING THE QUALITY OF LIFE FOR PATIENTS NEEDING END-OF-LIFE HOSPICE CARE. OUR COMPREHENSIVE AND COMPASSIONATE CARE IS CENTERED AROUND A HOLISTIC PHILOSOPHY OF TREATMENT THAT ADDRESSES THE PATIENTS PHYSICAL, EMOTIONAL AND SPIRITUAL WELL-BEING, ALLOWING THEM TO LIVE AS FULLY AND COMFORTABLY AS POSSIBLE IN THEIR FINAL DAYS. OUR SERVICES INCLUDE A FULL SPECTRUM OF CARE: PAIN MANAGEMENT AND SYMPTOM CONTROL, COORDINATION OF HOME AND INPATIENT SERVICES, AN INTERDISCIPLINARY TEAM INCLUDING PHYSICIANS, NURSES, SOCIAL WORKERS, CLERGY, PHARMACISTS, HOSPICE VOLUNTEERS, AND HOME HEALTH AIDES, AND BEREAVEMENT CARE FOR FAMILY MEMBERS FOR UP TO 13 MONTHS. false false 1285190 0 1056286 INPATIENT HOSPICE (DOVE HOUSE) Patients in The Dove House receive care 24 hours a day from an expert medical team dedicated to helping them live as comfortable and supported as possible. Number of patients served in FY2012 - 319. Days of care provided FY2012 - 1,517. Programs provided - Hospice education to nursing facilities, General Hospice Patient Care, Palliative Care. 2250806 0 3226480 HOME HOSPICE Carroll Hospice provides hospice care in the patients home, nursing home or assisted living facility. Number of patients served in FY2012 - 491. Days of care provided FY2012 - 20,894. Programs provided - General Inpatient Hospice Care, Residential. 3535996 true true false false false false false false false true false false false true false false true false false false false false false true false false false false true false false false false false false false false false false false false false true true true false false true 27 0 true 0 false false false false false true true false false false false X 13 12 false false false false true true true true true false false true true true true true true false false false MD X DAVID MCCORMICK 4108716695 535 OLD WESTMINSTER PIKE SUITE 111 Westminster MD 21157 X X R WAYNE BARNES 1.0 X 0 0 0 SUSAN KREBS 1.0 X 0 0 0 DAVID HIGHFIELD 1.0 X X 0 0 0 MARY DARRELL 1.0 X 0 0 0 RICHARD P COYNE 1.0 X 0 0 0 SHIRLYN EVANS FORD 1.0 X X 0 0 0 FRANK POTEPAN 1.0 X 0 0 0 SCOTT MCKLEVIE 1.0 X 0 0 0 MARK BLACKSTEN 1.0 X X 0 0 0 FLAVIO WAINBERG KRUTER 1.0 X 0 475016 9947 DENISE WHITECOTTON 1.0 X 0 0 0 PHYLLIS ZUMBRUN 1.0 X 0 0 0 ERIN DANZ 1.0 X 0 0 0 THOMAS DALE FLETCHER 1.0 X 0 0 0 DIANE LINK 40.0 X 0 119748 2452 LESLIE R SIMMONS 2.0 X 0 329679 26026 KEVIN K KELBLY 2.0 X 0 350751 28812 0 1275194 67237 0 false true false CARROLL CARE PHARMACIES LLC PO BOX 1706 WESTMINSTER MD 211581706 PHARMACEUTICALS 296692 BEVERLY ENTERPRISES-MARYLAND INC 1234 WASHINGTON RD WESTMINSTER MD 21157 NURSING HOME 101076 2 88583 45000 447891 1102 581474 PRIVATE 343587 343587 0 0 MEDICARE/MEDICAID 3860341 3860341 0 0 PHYSICIAN SERVICE 78838 78838 0 0 OTHER 533 533 0 0 4283299 0 0 0 0 55395 88583 15077 40318 0 40318 0 0 0 4905091 4283299 0 40318 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2881501 2704885 0 176616 0 0 0 0 0 0 0 0 347144 311821 0 35323 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 10493 4094 6399 0 45270 0 43613 1657 0 0 0 0 0 0 0 0 0 0 0 0 84929 1360 83569 0 0 0 0 0 4760 0 4760 0 1820 0 1820 0 0 0 0 0 185943 0 185943 0 0 0 0 0 TRAINING AND EDUCATION 1148 0 1148 0 PURCHASED SERVICES 509967 263502 241891 4574 FUNDRAISING 41896 0 0 41896 MEDICAL SUPPLIES 256131 235161 20970 0 51901 15173 36728 4422903 3535996 626841 260066 1151439 1571848 0 0 3143 2143 404464 389503 0 0 0 0 0 0 0 0 11075 12832 5911532 1158907 4938567 4752625 0 0 0 0 0 0 0 0 241763 303109 6750451 7032060 140298 207008 0 0 0 0 0 0 0 0 0 0 0 0 0 0 367628 29378 507926 236386 X 6000763 6492566 241762 303108 0 0 6242525 6795674 6750451 7032060 X 482188 70961 X false true true X false X 868082 1045468 874855 644121 447891 3880417 868082 1045468 874855 644121 447891 3880417 3880417 25891 8237 0 0 0 34128 3914545 18491900 0.99128 0.98774 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 5416180 778206 4637974 495352 380701 114651 4752625 0 DUE TO CARROLL HOSP CENTER 21405 DUE TO CARROLL HOSPITAL FOUNDA 7973 29378 TASTE OF CARROL 126376 77741 48635 2940 1773 2764 6479 SEASON TO REMEM 17602 10842 6760 1121 0 143978 88583 55395 2940 1773 2764 7600 15077 40318 false false false false false false false false false FLAVIO WAINBERG KRUTER 0 300503 0 105671 0 68842 0 0 0 9947 0 484963 0 0 LESLIE R SIMMONS 0 254441 0 47184 0 28054 0 7489 0 18537 0 355705 0 0 KEVIN K KELBLY 0 267672 0 52971 0 30108 0 11632 0 17180 0 379563 0 0 ESTABLISHING COMPENSATION SCHEDULE J, PART I, LINE 3 CARROLL HOSPITAL CENTER COMPENSATES THE EXECUTIVE OF THE ORGANIZATION AND THE ORGANIZATION RELIES ON CARROLL HOSPITAL CENTER TO UTILIZE THE FOLLOWING METHODS IN ESTABLISHING COMPENSATION: COMPENSATION COMMITTEE, WRITTEN EMPLOYMENT CONTRACT, INDEPENDENT COMPENSATION CONSULTANT, COMPENSATION SURVEY OR STUDY, FORM 990 OF OTHER ORGANIZATIONS, APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE REVIEWING THE 990 PART VI, SECTION A, LINE 11B The organization's Form 990 is reviewed in detail between the preparer, an outside accounting firm, and the Finance Department of Carroll Hospital Center. A copy of the draft Form 990 is submitted to the Carroll Hospital Center Risk, Audit and Compliance ("RAC") Committee members for their review and comments. Then, prior to filing the organization's Form 990, the organization provides a copy of the Form 990 to each Member of the organization's Board of Directors for their review, questions, and comments, which feedback is then incorporated into the filed Form 990. MONITORING CONFLICTS PART VI, SECTION B, LINE 12C The Conflict of Interest Policy applies to Carroll Hospital Center and its direct and indirect subsidiaries and parent organization. Review of Disclosure Statements/Report to the Board. The Chief Executive Officer of the Hospital Organization, the Governance Committee and the Corporate Compliance Officer shall review the matters disclosed in the Disclosure Statements and shall submit to the Hospital Organization's Board of Directors an annual summary or spreadsheet of the disclosures and his or her recommendation for the resolution of any conflicts disclosed. In formulating recommendations, the Chief Executive Officer shall consult with appropriate officers of the Hospital Organization and counsel as necessary. The Board of Directors of the Hospital Organization, acting in the best interests of the Hospital Organization, shall have sole discretion to make all final decisions regarding conflicts of interest, other than those regarding gifts to Hospital Organization employees which shall be resolved by the appropriate supervisory executive. However, no person shall be involved in considering the existence of an actual or potential conflict of interest, in the management and oversight of a conflict relationship, or in the determination of discipline for violations of this Policy, if that person is a party or potential party to that conflict. All final decisions regarding conflicts of interest shall be reflected in a revised annual summary or spreadsheet of conflict disclosures which will be shared with each director. The Chair and Vice-Chair of the Board, and all Board committee chairs, shall have this revised summary or spreadsheet available at the time of all Board and Board committee meetings in case a matter involving a potential conflict arises. CONFLICT OF INTEREST RECUSAL PROCEDURE FOR BOARD MEETINGS Whenever a Hospital Organizations' Board or Board committee is to consider a transaction or an arrangement with another organization, entity or individual in which or with whom a person covered by this Policy has a relationship creating an actual or potential conflict of interest, the following procedures shall be employed: A.The interested person must fully disclose the actual or potential conflict of interest to the Board; B.The interested person should be asked to leave the meeting during discussion of the potential conflict and any related votes, but the interested person may make a statement or answer any questions on the matter before departing the meeting; C.If appropriate, the Board or Board committee may appoint a non-interested person or committee to investigate alternatives to the proposed transaction or arrangement; D.To consider the proposed transaction or arrangement, the Board must: 1.find, by a majority vote of directors then in office, not counting the interested person, that the proposed transaction or arrangement is in the Hospital Organization's best interest and for the Hospital Organization's own benefit, it is fair and reasonable, and that, after reasonable investigation, the Hospital Organization cannot obtain a more advantageous transaction or arrangement using reasonable efforts; and 2.vote on the transaction or arrangement, approval requiring a majority vote of directors then in office, not counting the interested person. E.The minutes should include: (1) the name of the person disclosing the conflict of interest and a description of the conflict; (2) the Board's determination of whether there is a conflict; (3) the names and votes of persons present for the discussions and votes relating to the transaction or arrangement; and (4) the content of those discussions including the Board's determination of whether or not the transaction or arrangement is in the Hospital Organization's best interest, fair and reasonable, and the best reasonably available alternative Ongoing Duty to Disclose One's Own or Others' Conflicts of Interest. As an actual or potential conflict of interest can arise at any time, any actual or potential conflict must be disclosed promptly in writing by use of a supplemental Disclosure Statement, as soon as its existence is or should be known. If a person is in doubt about a situation, the person should consult with the Chief Executive Officer, Board Chairman or the Hospital Organization's Compliance Officer. Persons should err on the side of disclosure so that a conflict of interest assessment can be made. The potential conflict will be referred to the Governance committee for review and a response will be provided within 14 days. Noncompliance with the policy: The Organization's Board of Directors retains broad power and sole discretion under this Policy to: (1) determine the existence of actual or potential conflicts of interest; (2) subject conflict of interest relationships to appropriate oversight, management, conditions, restrictions and prohibitions; and (3) impose appropriate sanctions. A breach of this Policy can become grounds for discipline, up to and including removal from office or, for management personnel, termination of employment. It may also result in cessation of business with a vendor and in liability for damages. Grounds for discipline include, but are not limited to: A.willful failure to sign and return the Conflict of Interest Disclosure Statement in accord with this Policy; B.a material misstatement or omission in the Disclosure Statement; C.willful failure to disclose an actual or potential conflict of interest at any time in accord with the requirements of this Policy; D.willful participation in a vote or decision involving a transaction which raises an undisclosed conflict of interest; or E.willful disclosure or use of confidential information regarding the affairs, business or plans of a Hospital Organization for any purpose other than in furtherance of the affairs and best interests of the Hospital Organization. DETERMINING COMPENSATION PART VI, SECTION B, LINE 15 CARROLL HOSPITAL CENTER, INC. DETERMINES THE COMPENSATION OF THE ORGANIZATION'S CEO, OFFICERS AND KEY EMPLOYEES. THE EXECUTIVE COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS OF CARROLL HOSPITAL CENTER, WHICH IS COMPRISED OF INDEPENDENT BOARD MEMBERS DETERMINED TO BE FREE OF ANY CONFLICT OF INTEREST, IS CHARGED WITH DETERMINING EXECUTIVE COMPENSATION AND ESTABLISHING PERFORMANCE CRITERIA ACCORDING TO AN APPROVED COMPENSATION PHILOSOPHY. THE COMMITTEE WORKS WITH AN INDEPENDENT EXECUTIVE COMPENSATION CONSULTING AND ADVISORY FIRM, YAFFE & COMPANY, THAT PROVIDES MARKET SURVEY DATA CONCERNING COMPENSATION AND BENEFIT LEVELS FOR FUNCTIONALLY COMPARABLE HEALTHCARE EXECUTIVES IN SIMILAR HOSPITALS ACROSS THE REGION AND THE NATION BASED ON SEVERAL FACTORS INCLUDING SIZE, GEOGRAPHY, HOSPITAL TYPE AND COMPLEXITY. THE COMMITTEE REVIEWS AND APPROVES THE COMPENSATION OF THE SENIOR EXECUTIVES AND ENSURES THAT ALL FORMS OF EXECUTIVE COMPENSATION ARE REASONABLE, APPROPRIATE AND CONSISTENT WITH ITS COMPENSATION PHILOSOPHY. THE COMMITTEE CONTEMPORANEOUSLY DOCUMENTS ITS DECISIONS IN MEETING MINUTES. MAKING DOCUMENTS AVAILABLE PART VI, SECTION C, LINE 19 THIS ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICTS OF INTEREST POLICY AND AUDITED FINANCIALS AVAILABLE TO THE PUBLIC UPON REQUEST. PART VI, LINE 6 Carroll Hospital Center, Inc., a 501(c)(3) corporation, is the sole member of Carroll Hospice, Inc. PART VI, LINE 7A The Sole Member of the Corporation has the right to elect and remove trustees of the Corporation. All elected trustees shall serve terms of three years, with the terms staggered so that one-third of the trustees will have their terms expire in each year. The trustees shall be divided into three classes as nearly equal in number as possible. At the first meeting of the Board, one class of trustees shall be designated to serve for a one-year term, one class shall be designated to serve for a two-year term and one class shall be designated to serve for a three-year term. At each successive annual meeting of the Sole Member, the Sole member shall elect trustees of each successive class to serve for three-year terms and until their successors are elected and qualify. The Sole Member may remove any elected trustee at any time, with or without cause. Ex officio trustees shall be deemed to be removed as of the time they cease to hold the office on which their ex officio status is based. A vacancy in an ex officio position shall be filled by the individual appointed to the underlying office. PART VI, LINE 7B The Sole Member of the Corporation has the right to elect and remove trustees of the Corporation, the right to approve amendments to the Bylaws, and such other rights as may be conferred by law on the members of a non-stock corporation organized under the laws of the State of Maryland. NET ASSETS RECONCILIATION PART XI, LINE 5 ASSETS RELEASED FROM RESTRICTION 54,615 INCREASE OF TEMPORARILY RESTRICTED ASSETS 61,346 GRANT NOT ON BOOK (45,000) -------- TOTAL 70,961 other program services BEREAVEMENT SERVICES Carroll Hospice bereavement program helps families to better understand and cope with their grief, while respecting their unique grieving style. Served 1,037 families in FY2012. Served 1,537 individuals in various BV support groups in FY2012. Programs provided - PATHWAYS, BV LUNCHEON, WIDOW SUPPORT, WIDOWER SUPPORT, GRIEF SPEAKER AT HOSPICE, REMEMBRANCE SERVICE, PET LOSS SUPPORT, HEALING HEARTS DAY CAMP. HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:R WAYNE BARNES TITLE:BOARD MEMBER HOURS: HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:SUSAN KREBS TITLE:BOARD MEMBER HOURS: HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:DAVID HIGHFIELD TITLE:VICE CHAIR HOURS: HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:MARY DARRELL TITLE:BOARD MEMBER HOURS: HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:RICHARD P. COYNE TITLE:BOARD MEMBER HOURS: HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:SHIRLYN EVANS FORD TITLE:BOARD MEMBER/SECRETARY HOURS: HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:FRANK POTEPAN TITLE:BOARD MEMBER HOURS: HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:SCOTT MCKLEVIE TITLE:BOARD MEMBER HOURS: HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:MARK BLACKSTEN TITLE:CHAIR HOURS:2 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:FLAVIO WAINBERG KRUTER TITLE:BOARD MEMBER HOURS:1 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:DENISE WHITECOTTON TITLE:BOARD MEMBER HOURS: HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:PHYLLIS ZUMBRUN TITLE:BOARD MEMBER HOURS: HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:ERIN DANZ TITLE:BOARD MEMBER HOURS: HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:THOMAS DALE FLETCHER TITLE:BOARD MEMBER HOURS: HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:DIANE LINK TITLE:EXECUTIVE DIRECTOR HOURS: HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:LESLIE R. SIMMONS TITLE:COO HOURS:38 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:KEVIN K. 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