CIVISTA MEDICAL CENTER INC: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization: CIVISTA MEDICAL CENTER INC (EIN 52-0445374)
Tax period: 2011-07-01 to 2012-06-30
Filed: 2013-05-14
IRS object ID: 201301349349304415
Schema version: 2011v1.5
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
Form 990
Schedule A
Schedule B
Schedule C
Schedule D
Schedule F
Schedule H
Schedule I
Schedule J
Schedule K
Schedule O
Schedule R

Return header ReturnHeader

Field	Value	IRS element (for citing)
Timestamp	2013-05-14T13:33:45-05:00	Timestamp
Tax Period End Date	2012-06-30	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 3100	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	2011-07-01	TaxPeriodBeginDate

Filer Filer

Field	Value	IRS element (for citing)
EIN	520445374	EIN

Name Name

Field	Value	IRS element (for citing)
Business Name Line1	Civista Medical Center Inc	BusinessNameLine1

Field	Value	IRS element (for citing)
In Care Of Name	% ERIK BOAS	InCareOfName
Name Control	CIVI	NameControl
Phone	3016094130	Phone

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	5 Garrett Ave	AddressLine1
Address Line2	PO Box 1070	AddressLine2
City	La Plata	City
State	MD	State
ZIP Code	20646	ZIPCode

Officer Officer

Field	Value	IRS element (for citing)
Name	ERIK BOAS	Name
Title	CFO	Title
Phone	3016094130	Phone
Date Signed	2013-05-10	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	2011	TaxYear
Build TS	2016-03-07 17:11:31Z	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	5 Garrett Ave	AddressLine1
City	La Plata	City
State	MD	State
ZIP Code	20646	ZIPCode

Field	Value	IRS element (for citing)
Gross Receipts	112004858	GrossReceipts
Group Return For Affiliates	false	GroupReturnForAffiliates
Organization501c3	X	Organization501c3
Web Site	www.civista.org	WebSite
Type Of Organization Corporation	X	TypeOfOrganizationCorporation
Year Formation	1980	YearFormation
State Legal Domicile	MD	StateLegalDomicile
Activity Or Mission Description	Civista Medical Center, Inc. is a component 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	978	TotalNbrEmployees
Total Nbr Volunteers	115	TotalNbrVolunteers
Total Gross UBI	151265	TotalGrossUBI
Net Unrelated Business Txbl Income	35891	NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year	1677803	ContributionsGrantsPriorYear
Contributions Grants Current Year	165000	ContributionsGrantsCurrentYear
Program Service Revenue Prior Year	103083914	ProgramServiceRevenuePriorYear
Program Service Revenue CY	111209188	ProgramServiceRevenueCY
Investment Income Prior Year	109879	InvestmentIncomePriorYear
Investment Income Current Year	88269	InvestmentIncomeCurrentYear
Other Revenue Prior Year	544515	OtherRevenuePriorYear
Other Revenue Current Year	542401	OtherRevenueCurrentYear
Total Revenue Prior Year	105416111	TotalRevenuePriorYear
Total Revenue Current Year	112004858	TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year	86592	GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY	34654	GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year	0	BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY	0	BenefitsPaidToMembersCY
Salaries Etc Prior Year	47133035	SalariesEtcPriorYear
Salaries Etc Current Year	48691670	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	53602980	OtherExpensePriorYear
Other Expenses Current Year	55007273	OtherExpensesCurrentYear
Total Expenses Prior Year	100822607	TotalExpensesPriorYear
Total Expenses Current Year	103733597	TotalExpensesCurrentYear
Revenues Less Expenses Prior Year	4593504	RevenuesLessExpensesPriorYear
Revenues Less Expenses CY	8271261	RevenuesLessExpensesCY
Total Assets BOY	128003508	TotalAssetsBOY
Total Assets EOY	147245093	TotalAssetsEOY
Total Liabilities BOY	103718743	TotalLiabilitiesBOY
Total Liabilities EOY	116457768	TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY	24284765	NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY	30787325	NetAssetsOrFundBalancesEOY
Mission Description	CIVISTA MEDICAL CENTER, INC. IS A COMPONENT OF A REGIONAL INTEGRATED 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
Expense	82602757	Expense
Revenue	111209188	Revenue
Description	Civista Medical Center, Inc. is a component 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 Medical Center, 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: 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.	Description
Total Program Service Expense	82602757	TotalProgramServiceExpense
Described In501 C3	true	DescribedIn501C3
Schedule B Required	true	ScheduleBRequired
Political Activities	false	PoliticalActivities
Lobbying Activities	true	LobbyingActivities
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	true	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	true	Hospital
Financial Stmt Attached	true	FinancialStmtAttached
Grants To Organizations	true	GrantsToOrganizations
Grants To Individuals	false	GrantsToIndividuals
Schedule J Required	true	ScheduleJRequired
Tax Exempt Bonds	true	TaxExemptBonds
Invest Tax Exempt Bonds	false	InvestTaxExemptBonds
Escrow Account	false	EscrowAccount
On Behalf Of Issuer	false	OnBehalfOfIssuer
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	false	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	false	ScheduleORequired
Number Forms Transmitted With1096	151	NumberFormsTransmittedWith1096
Number W2 G Included	0	NumberW2GIncluded
Compliance With Backup Witholding	true	ComplianceWithBackupWitholding
Number Of Employees	978	NumberOfEmployees
Employment Tax Returns Filed	true	EmploymentTaxReturnsFiled
Unrelated Business Income	true	UnrelatedBusinessIncome
Form990-T Filed	true	Form990-TFiled
Foreign Financial Account	true	ForeignFinancialAccount
Name Of Foreign Country	CJ	NameOfForeignCountry
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
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	true	DelegationOfManagementDuties
Changes To Organizing Docs	false	ChangesToOrganizingDocs
Material Diversion Or Misuse	false	MaterialDiversionOrMisuse
Members Or Stockholders	false	MembersOrStockholders
Election Of Board Members	false	ElectionOfBoardMembers
Decisions Subject To Approval	false	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	3016094130	TelephoneNumber

Address US AddressUS

Field	Value	IRS element (for citing)
Address Line1	5 GARRETT AVE	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 (26 entries)

TitleTitle	Average Hours Per WeekAverageHoursPerWeek	Individual Trustee Or DirectorIndividualTrusteeOrDirector	Reportable Comp From OrganizationReportableCompFromOrganization	Reportable Comp From Related OrgsReportableCompFromRelatedOrgs	Other CompensationOtherCompensation	OfficerOfficer	Key EmployeeKeyEmployee	Highest Compensated EmployeeHighestCompensatedEmployee
Shelly Culhane
Director	3.0	X	0	0	0
B Larry Jenkins
Director	3.0	X	0	0	0
R Wayne Barnes
Director	3.0	X	0	0	0
Sara Middleton
Chair	3.0	X	0	0	0	X
Candice Quinn Kelly
Ex-Officio/Director	3.0	X	0	0	0
Faye Reed
Ex-Officio/Director	3.0	X	0	0	0
Khadar Baig
Director	3.0	X	0	0	0
Van Mitchell
Director	3.0	X	0	0	0
Louis Jenkins Jr
Vice Chair	3.0	X	0	0	0	X
Seetaramayya Nagula
Director	3.0	X	0	0	0
Richard Winkler
Secretary/Treasurer	3.0	X	0	0	0	X
Michael Cady
Director	3.0	X	0	0	0
Ashvin J Patel MD
Ex-Officio/Chief of Staff	4.0	X	0	0	0	X
James Burke
Director	3.0	X	0	0	0
John Ashworth
Ex-Officio/Director	1.0	X	0	569353	17755
Robert Chrencik
Ex-Officio/Director	1.0	X	0	2073638	213731
Noel Cervino
Ex-Officio/President & CEO	40.0		0	548267	59420	X
Erik Boas
Chief Financial Officer	40.0		0	245642	22538	X
Mark Dumais
Chief Medical Officer	40.0		0	343708	32324		X
Gary Herbek
COO	40.0		268014	0	13163		X
Melanie Sage
VP Patient Care/Nurse Exec.	40.0		168565	0	8391		X
Paul Blackwood
VP Planning	40.0		174371	0	7905			X
Katherine Middleton
RN	40.0		164429	0	10397			X
Marilyn Gregory
Clinical Nurse IV	40.0		163035	0	9928			X
Gabriel Abiola
Pharmacy Clinical Manager	40.0		156575	0	8581			X
Stacey Cook
VP Human Resources	40.0		152934	0	13468			X

Field	Value	IRS element (for citing)
Total Reportable Comp From Org	1247923	TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs	3780608	TotalReportableCompFrmRltdOrgs
Total Other Compensation	417601	TotalOtherCompensation
Number Individuals GT100 K	38	NumberIndividualsGT100K
Formers Listed	false	FormersListed
Total Comp GT150 K	true	TotalCompGT150K
Compensation From Other Sources	false	CompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1	CityAddressOfContractor/AddressUS/City	StateAddressOfContractor/AddressUS/State	ZIP CodeAddressOfContractor/AddressUS/ZIPCode	Description Of ServicesDescriptionOfServices	CompensationCompensation
Maryland Inpatient Care Specialists
2007 Tidewater Colony Way Ste 1-A	ANNAPOLIS	MD	21401	Physicians	1300000
Digitrace Care Services Inc
200 Corporate Place Ste 58	PEABODY	MA	01960	EEG Purchased Serv	525888
ROI Eligibility Services Corp
1920 Greenspring Dr Ste 200	TIMONIUM	MD	21094	PT Acctg Purch Serv	481471
Mayflower Textile Service
PO Box 20659	BALTIMORE	MD	21223	Laundry	424115
FMC of Waldorf
PO Box 64741	BALTIMORE	MD	21264	Dialysis Pur. Serv	335122

Field	Value	IRS element (for citing)
Number Of Contractors GT100 K	24	NumberOfContractorsGT100K
Government Grants	165000	GovernmentGrants
Total Contributions	165000	TotalContributions

Program Service Revenue ProgramServiceRevenue

Field	Value	IRS element (for citing)
Description	NET PATIENT REVENUE	Description
Business Code	900099	BusinessCode
Total Revenue Column	111209188	TotalRevenueColumn
Related Or Exempt Function Income	111209188	RelatedOrExemptFunctionIncome

Field	Value	IRS element (for citing)
Total Program Service Revenue	111209188	TotalProgramServiceRevenue

Investment Income InvestmentIncome

Field	Value	IRS element (for citing)
Total Revenue Column	85265	TotalRevenueColumn
Exclusion	$85,265	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 Amount Sales Assets GrossAmountSalesAssets

Field	Value	IRS element (for citing)
Securities	3004	Securities

Gain Or Loss GainOrLoss

Field	Value	IRS element (for citing)
Securities	3004	Securities

Net Gain Or Loss Investments NetGainOrLossInvestments

Field	Value	IRS element (for citing)
Total Revenue Column	3004	TotalRevenueColumn
Exclusion	$3,004	ExclusionAmount

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

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescription	Business CodeBusinessCode	Total Revenue ColumnTotalRevenueColumn	Unrelated Business RevenueUnrelatedBusinessRevenue	Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome
ANSWERING SERVICE	561000	151265	151265
CAFETERIA & COFFEE BAR SALES	900099	322937		322937
APPLICATION FEES	900099	9250		9250

Miscellaneous Revenue MiscellaneousRevenue

Field	Value	IRS element (for citing)
Total Revenue Column	58949	TotalRevenueColumn
Related Or Exempt Function Income	58949	RelatedOrExemptFunctionIncome

Field	Value	IRS element (for citing)
Total Other Revenue	542401	TotalOtherRevenue

Total Revenue TotalRevenue

Field	Value	IRS element (for citing)
Total Revenue Column	112004858	TotalRevenueColumn
Related Or Exempt Function Income	111600324	RelatedOrExemptFunctionIncome
Unrelated Business Revenue	151265	UnrelatedBusinessRevenue
Exclusion	$88,269	ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

Field	Value	IRS element (for citing)
Total	34654	Total
Program Services	34654	ProgramServices

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	1710032	Total
Program Services	1333825	ProgramServices
Management And General	376207	ManagementAndGeneral

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	39191313	Total
Program Services	30569224	ProgramServices
Management And General	8622089	ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

Field	Value	IRS element (for citing)
Total	748984	Total
Program Services	584208	ProgramServices
Management And General	164776	ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

Field	Value	IRS element (for citing)
Total	4183606	Total
Program Services	3263213	ProgramServices
Management And General	920393	ManagementAndGeneral

Payroll Taxes PayrollTaxes

Field	Value	IRS element (for citing)
Total	2857735	Total
Program Services	2229033	ProgramServices
Management And General	628702	ManagementAndGeneral

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	455129	Total
Management And General	455129	ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

Field	Value	IRS element (for citing)
Total	416309	Total
Management And General	416309	ManagementAndGeneral

Fees For Services Lobbying FeesForServicesLobbying

Field	Value	IRS element (for citing)
Total	60000	Total
Management And General	60000	ManagementAndGeneral

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	11423990	Total
Program Services	8910712	ProgramServices
Management And General	2513278	ManagementAndGeneral

Advertising Advertising

Field	Value	IRS element (for citing)
Total	268301	Total
Program Services	209275	ProgramServices
Management And General	59026	ManagementAndGeneral

Office Expenses OfficeExpenses

Field	Value	IRS element (for citing)
Total	291316	Total
Program Services	227226	ProgramServices
Management And General	64090	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	3396893	Total
Program Services	2649577	ProgramServices
Management And General	747316	ManagementAndGeneral

Travel Travel

Field	Value	IRS element (for citing)
Total	43199	Total
Program Services	9504	ProgramServices
Management And General	33695	ManagementAndGeneral

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	2940560	Total
Program Services	2734721	ProgramServices
Management And General	205839	ManagementAndGeneral

Payments To Affiliates PaymentsToAffiliates

Field	Value	IRS element (for citing)
Total	0	Total

Depreciation Depletion DepreciationDepletion

Field	Value	IRS element (for citing)
Total	2629943	Total
Program Services	2445847	ProgramServices
Management And General	184096	ManagementAndGeneral

Insurance Insurance

Field	Value	IRS element (for citing)
Total	2651500	Total
Program Services	2651500	ProgramServices

Other Expenses OtherExpenses (4 entries)

DescriptionDescription	TotalTotal	Program ServicesProgramServices	Management And GeneralManagementAndGeneral
SUPPLIES AND DRUGS	16417901	15268648	1149253
BAD DEBT	7678609	7678609
EQUIPMENT RENTAL AND MAINT.	3727851	1230191	2497660
TELEPHONE	360061	280848	79213

All Other Expenses AllOtherExpenses

Field	Value	IRS element (for citing)
Total	2245711	Total
Program Services	291942	ProgramServices
Management And General	1953769	ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

Field	Value	IRS element (for citing)
Total	103733597	Total
Program Services	82602757	ProgramServices
Management And General	21130840	ManagementAndGeneral
Fundraising	0	Fundraising

Cash Non Interest Bearing CashNonInterestBearing

Field	Value	IRS element (for citing)
BOY	0	BOY
EOY	0	EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

Field	Value	IRS element (for citing)
BOY	33434372	BOY
EOY	37974354	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	9697092	BOY
EOY	11344222	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	1533556	BOY
EOY	1490645	EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

Field	Value	IRS element (for citing)
BOY	895718	BOY
EOY	930555	EOY

Field	Value	IRS element (for citing)
Land Buildings Equipment Basis	111323629	LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec	44328687	LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

Field	Value	IRS element (for citing)
BOY	63118976	BOY
EOY	66994942	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	0	EOY

Other Assets Total OtherAssetsTotal

Field	Value	IRS element (for citing)
BOY	19323794	BOY
EOY	28510375	EOY

Total Assets TotalAssets

Field	Value	IRS element (for citing)
BOY	128003508	BOY
EOY	147245093	EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

Field	Value	IRS element (for citing)
BOY	14668027	BOY
EOY	13117763	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	57930947	BOY
EOY	54348613	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	20008435	BOY
EOY	21568471	EOY

Unsecured Notes Loans Payable UnsecuredNotesLoansPayable

Field	Value	IRS element (for citing)
BOY	0	BOY
EOY	0	EOY

Other Liabilities OtherLiabilities

Field	Value	IRS element (for citing)
BOY	11111334	BOY
EOY	27422921	EOY

Total Liabilities TotalLiabilities

Field	Value	IRS element (for citing)
BOY	103718743	BOY
EOY	116457768	EOY

Field	Value	IRS element (for citing)
Follow SFAS117	X	FollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

Field	Value	IRS element (for citing)
BOY	23796141	BOY
EOY	30770543	EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

Field	Value	IRS element (for citing)
BOY	488624	BOY
EOY	16782	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	24284765	BOY
EOY	30787325	EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	128003508	BOY
EOY	147245093	EOY

Field	Value	IRS element (for citing)
Info In Schedule O Part XI	X	InfoInScheduleOPartXI
Reconcilation Revenue Expenses	8271261	ReconcilationRevenueExpenses
Reconcilation Other Changes	-1768701	ReconcilationOtherChanges
Method Of Accounting Accrual	X	MethodOfAccountingAccrual
Accountant Compile Or Review	false	AccountantCompileOrReview
FS Audited	true	FSAudited
Audit Committee	true	AuditCommittee
Financial Statement Consolidated	X	FinancialStatementConsolidated

Schedule A IRS990ScheduleA

Field	Value	IRS element (for citing)
Hospital170b1 Aiii	X	Hospital170b1Aiii

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 C IRS990ScheduleC

Field	Value	IRS element (for citing)
Total Grassroots Lobbying		TotalGrassrootsLobbying
Total Direct Lobbying		TotalDirectLobbying
Total Lobbying Expenditures		TotalLobbyingExpenditures
Other Exempt Purpose Expenditures		OtherExemptPurposeExpenditures
Total Exempt Purpose Expenditures		TotalExemptPurposeExpenditures
Lobbying Nontaxable		LobbyingNontaxableAmount
Grassroots Nontaxable		GrassrootsNontaxableAmount
Tot Lobbying Grassroot Minus Non Tx		TotLobbyingGrassrootMinusNonTx
Tot Lobby Expend Mns Lobbying Nontx		TotLobbyExpendMnsLobbyingNontx
Volunteers	false	Volunteers
Paid Staff Or Management	false	PaidStaffOrManagement
Media Advertisements	false	MediaAdvertisements
Mailings Members	false	MailingsMembers
Publications Or Broadcast	false	PublicationsOrBroadcast
Grants Other Organizations	false	GrantsOtherOrganizations
Direct Contact Legislators	false	DirectContactLegislators
Rallies Demonstrations	false	RalliesDemonstrations
Other Activities	true	OtherActivities
Other Activities	$70,624	OtherActivitiesAmount
Total Lobbying Expenditures IIB	70624	TotalLobbyingExpendituresIIB
Not Described In501c3	false	NotDescribedIn501c3

Form990 Schedule C Part IV Form990ScheduleCPartIV

Field	Value	IRS element (for citing)
Identifier	Lobbying Activities	Identifier
Return Reference	Schedule C, Part II-B, Line 1i	ReturnReference
Explanation	The organization does not engage in any direct lobbying activities. The organzation pays Baxter Baker a monthly fee to represent Civista as well as other Maryland Hospitals to assist in lobbying and advertising for the Hospital. The organization pays membership dues to the Maryland Hospital Association (MHA) and the American Hospital Association (AHA). MHA and AHA engage in many support activities including lobbying and advocating for their member hospitals. The MHA and AHA reported that 7.35% and 24.60% of member dues were used for lobbying purposes and as such, the organization has reported this amount on Schedule C, Part II-B as lobbying activities.	Explanation

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

Land Land

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	0	OtherCostOrOtherBasis
Book Value	0	BookValue

Buildings Buildings

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	73669856	OtherCostOrOtherBasis
Depreciation	20199904	Depreciation
Book Value	53469952	BookValue

Leasehold Improvements LeaseholdImprovements

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	2288604	OtherCostOrOtherBasis
Depreciation	1296958	Depreciation
Book Value	991646	BookValue

Equipment Equipment

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	31478033	OtherCostOrOtherBasis
Depreciation	22831825	Depreciation
Book Value	8646208	BookValue

Other Land Buildings OtherLandBuildings

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	3887136	OtherCostOrOtherBasis
Depreciation	0	Depreciation
Book Value	3887136	BookValue

Field	Value	IRS element (for citing)
Total Of Book Value Land Buildings	66994942	TotalOfBookValueLandBuildings

Other Assets OtherAssets (10 entries)

DescriptionDescription	Book ValueBookValue
SECURITY DEPOSITS	2675
OTHER CURRENT RECEIVABLES	196473
INV CHES POTOMAC HEALTHCARE	3806198
OTHER ASSETS	17218616
PHYSICIAN LOANS	310326
INVESTMENT IN JV FREESTATE	15000
DEFERRED FINANCING COSTS	326100
INVESTMENT MARYLAND ECARE	10000
DUE FROM AFFILAITES	2726750
ECONOMIC INTEREST IN NET ASSET	3898237

Field	Value	IRS element (for citing)
Total Book Value Other Assets	28510375	TotalBookValueOtherAssets
Federal Income Tax Liability	0	FederalIncomeTaxLiability

Other Liabilities OtherLiabilities (7 entries)

DescriptionDescription	AmountAmount
ADVANCES FROM THIRD PARTIES	$3,944,049
ACCRUED INTEREST PAYABLE	$1,326,419
ACCRUED PENSION COSTS	$8,706,050
DUE TO AFFILIATES	$220,417
LEASE LIABILITIES	$438,031
MALPRACTICE IBNR	$2,050,112
OTHER LIABILITIES	$10,737,843

Field	Value	IRS element (for citing)
Total Of Amounts	27422921	TotalOfAmounts

Form990 Schedule D Part XIV Form990ScheduleDPartXIV

Field	Value	IRS element (for citing)
Identifier	Supplemental Description - Other	Identifier
Return Reference	Schedule D, Part XI, Line 8	ReturnReference
Explanation	The organization accounts for uncertainty in income taxes in accordance with FIN 48 (as codified). The organization's audited financial statements do not include any liabilities for uncertain tax positions.	Explanation

Schedule F IRS990ScheduleF

Accts Actvs Out US Table AcctsActvsOutUSTable

Field	Value	IRS element (for citing)
Region	Central America and the Caribbean	Region
Type Of Activities Conducted	Program Services	TypeOfActivitiesConducted
Specific Services Provided	Insurance	SpecificServicesProvided
Total Expenditures	1072786	TotalExpenditures

Field	Value	IRS element (for citing)
Subtotal Amount Spent	1072786	SubtotalAmountSpent
Total Amount Spent	1072786	TotalAmountSpent
Transfer To Foreign Corp	true	TransferToForeignCorp
Interest In Foreign Trust	false	InterestInForeignTrust
Own Foreign Corp	true	OwnForeignCorp
Passive Foreign Invest Co	false	PassiveForeignInvestCo
Foreign Partnership	false	ForeignPartnership
Boycott Countries	false	BoycottCountries

Schedule H IRS990ScheduleH

Field	Value	IRS element (for citing)
Charity Care Policy	true	CharityCarePolicy
Written Policy	true	WrittenPolicy
FPG Reference Free Care	true	FPGReferenceFreeCare
Pcent200	X	Pcent200
FPG Reference Discounted Care	true	FPGReferenceDiscountedCare
Pcent300	X	Pcent300
Free Disc Care Medically Indigent	true	FreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity Care	true	AmountsBudgetedForCharityCare
Expenses Exceeded Budget	true	ExpensesExceededBudget
Unable To Provide Care	false	UnableToProvideCare
Annual Community Benefit Report	true	AnnualCommunityBenefitReport
Report Publically Available	true	ReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

Field	Value	IRS element (for citing)
Total Community Benefit Expense	997486	TotalCommunityBenefitExpense
Net Community Benefit Expense	997486	NetCommunityBenefitExpense
Percent Of Total Expense	0.00960	PercentOfTotalExpense

Total Charity Care TotalCharityCare

Field	Value	IRS element (for citing)
Total Community Benefit Expense	997486	TotalCommunityBenefitExpense
Net Community Benefit Expense	997486	NetCommunityBenefitExpense
Percent Of Total Expense	0.00960	PercentOfTotalExpense

Community Health Services CommunityHealthServices

Field	Value	IRS element (for citing)
Number Of Activities Or Programs	28	NumberOfActivitiesOrPrograms
Persons Served	163349	PersonsServed
Total Community Benefit Expense	721504	TotalCommunityBenefitExpense
Direct Offsetting Revenue	1275	DirectOffsettingRevenue
Net Community Benefit Expense	720229	NetCommunityBenefitExpense
Percent Of Total Expense	0.00690	PercentOfTotalExpense

Health Professions Education HealthProfessionsEducation

Field	Value	IRS element (for citing)
Number Of Activities Or Programs	9	NumberOfActivitiesOrPrograms
Persons Served	43	PersonsServed
Total Community Benefit Expense	273693	TotalCommunityBenefitExpense
Net Community Benefit Expense	273693	NetCommunityBenefitExpense
Percent Of Total Expense	0.00260	PercentOfTotalExpense

Subsidized Health Services SubsidizedHealthServices

Field	Value	IRS element (for citing)
Number Of Activities Or Programs	8	NumberOfActivitiesOrPrograms
Total Community Benefit Expense	3703714	TotalCommunityBenefitExpense
Direct Offsetting Revenue	120044	DirectOffsettingRevenue
Net Community Benefit Expense	3583670	NetCommunityBenefitExpense
Percent Of Total Expense	0.03450	PercentOfTotalExpense

Cash And In Kind Contributions CashAndInKindContributions

Field	Value	IRS element (for citing)
Number Of Activities Or Programs	12	NumberOfActivitiesOrPrograms
Persons Served	2100	PersonsServed
Total Community Benefit Expense	96015	TotalCommunityBenefitExpense
Net Community Benefit Expense	96015	NetCommunityBenefitExpense
Percent Of Total Expense	0.00090	PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

Field	Value	IRS element (for citing)
Number Of Activities Or Programs	57	NumberOfActivitiesOrPrograms
Persons Served	165492	PersonsServed
Total Community Benefit Expense	4794926	TotalCommunityBenefitExpense
Direct Offsetting Revenue	121319	DirectOffsettingRevenue
Net Community Benefit Expense	4673607	NetCommunityBenefitExpense
Percent Of Total Expense	0.04490	PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

Field	Value	IRS element (for citing)
Number Of Activities Or Programs	57	NumberOfActivitiesOrPrograms
Persons Served	165492	PersonsServed
Total Community Benefit Expense	5792412	TotalCommunityBenefitExpense
Direct Offsetting Revenue	121319	DirectOffsettingRevenue
Net Community Benefit Expense	5671093	NetCommunityBenefitExpense
Percent Of Total Expense	0.05450	PercentOfTotalExpense

Economic Development EconomicDevelopment

Field	Value	IRS element (for citing)
Number Of Activities Or Programs	4	NumberOfActivitiesOrPrograms
Total Community Building Expense	1029	TotalCommunityBuildingExpense
Net Community Building Expense	1029	NetCommunityBuildingExpense

Community Support CommunitySupport

Field	Value	IRS element (for citing)
Number Of Activities Or Programs	8	NumberOfActivitiesOrPrograms
Persons Served	100	PersonsServed
Total Community Building Expense	125322	TotalCommunityBuildingExpense
Net Community Building Expense	125322	NetCommunityBuildingExpense
Percent Of Total Expense	0.00120	PercentOfTotalExpense

Coalition Building CoalitionBuilding

Field	Value	IRS element (for citing)
Number Of Activities Or Programs	2	NumberOfActivitiesOrPrograms
Total Community Building Expense	1116	TotalCommunityBuildingExpense
Net Community Building Expense	1116	NetCommunityBuildingExpense

Workforce Development WorkforceDevelopment

Field	Value	IRS element (for citing)
Number Of Activities Or Programs	6	NumberOfActivitiesOrPrograms
Total Community Building Expense	292492	TotalCommunityBuildingExpense
Net Community Building Expense	292492	NetCommunityBuildingExpense
Percent Of Total Expense	0.00280	PercentOfTotalExpense

Total Total

Field	Value	IRS element (for citing)
Number Of Activities Or Programs	20	NumberOfActivitiesOrPrograms
Persons Served	100	PersonsServed
Total Community Building Expense	419959	TotalCommunityBuildingExpense
Net Community Building Expense	419959	NetCommunityBuildingExpense
Percent Of Total Expense	0.00400	PercentOfTotalExpense

Field	Value	IRS element (for citing)
Bad Debt Expense Reported	true	BadDebtExpenseReported
Bad Debt Expense	$5,691,385	BadDebtExpenseAmount
Amount Reimbursed By Medicare	42594984	AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare	40572518	CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall	2022466	MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

Field	Value	IRS element (for citing)
Cost To Charge Ratio	X	CostToChargeRatio

Field	Value	IRS element (for citing)
Written Debt Collection Policy	true	WrittenDebtCollectionPolicy
Provision For Charity Care	true	ProvisionForCharityCare
Number Of Hospital Facilities	1	NumberOfHospitalFacilities

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA

Field	Value	IRS element (for citing)
Facility Number	1	FacilityNumber

Name Name

Field	Value	IRS element (for citing)
Business Name Line1	Civista Medical Center Inc	BusinessNameLine1

Address Address

Field	Value	IRS element (for citing)
Address Line1	5 Garrett Ave	AddressLine1
City	La Plata	City
State	MD	State
ZIP Code	20646	ZIPCode

Field	Value	IRS element (for citing)
Licensed Hospital	X	LicensedHospital
General Medical And Surgical	X	GeneralMedicalAndSurgical
Er24 Hours	X	Er24Hours

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB

Hospital Facility Name HospitalFacilityName

Field	Value	IRS element (for citing)
Business Name Line1	Civista Medical Center Inc	BusinessNameLine1

Field	Value	IRS element (for citing)
Hospital Facility Number	1	HospitalFacilityNumber
CHNA Conducted	true	CHNAConducted
Community Definition	X	CommunityDefinition
Community Demographics	X	CommunityDemographics
Existing Resources	X	ExistingResources
How Data Obtained	X	HowDataObtained
Community Health Needs	X	CommunityHealthNeeds
Other Health Issues	X	OtherHealthIssues
Identifying Process	X	IdentifyingProcess
Consulting Process	X	ConsultingProcess
Information Gaps	X	InformationGaps
Needs Assessment Conducted	11	NeedsAssessmentConducted
Take Into Account	true	TakeIntoAccount
Other Facilities	false	OtherFacilities
CHNA Widely Available	true	CHNAWidelyAvailable
Own Website	X	OwnWebsite
On Request	X	OnRequest
Other Method	X	OtherMethod
Adopt Implement Strategy	X	AdoptImplementStrategy
Execute Implement Strategy	X	ExecuteImplementStrategy
Develop Community Plan	X	DevelopCommunityPlan
Participate Community Plan	X	ParticipateCommunityPlan
Include Operational Plans	X	IncludeOperationalPlans
Adopt Budget	X	AdoptBudget
Prioritize Health Needs	X	PrioritizeHealthNeeds
Prioritize Services	X	PrioritizeServices
All Needs Addressed	true	AllNeedsAddressed
Eligibility Criteria Explained	true	EligibilityCriteriaExplained
Uses FPG Free	true	UsesFPGFree
FPG Free Percent	200.	FPGFreePercent
Uses FPG Discounted	true	UsesFPGDiscounted
FPG Discount Percent	300.	FPGDiscountPercent
Explains Basis	true	ExplainsBasis
Income Level	X	IncomeLevel
Asset Level	X	AssetLevel
Medicaid Medicare	X	MedicaidMedicare
State Regulation	X	StateRegulation
Other Factors	X	OtherFactors
Explains Application Method	true	ExplainsApplicationMethod
Includes Publicity Measures	true	IncludesPublicityMeasures
Posted On Website	X	PostedOnWebsite
Posted In Emergency Room	X	PostedInEmergencyRoom
Posted In Admission Office	X	PostedInAdmissionOffice
Available On Request	X	AvailableOnRequest
Other Publicity	X	OtherPublicity
Actions On Nonpayment	true	ActionsOnNonpayment
Collection Activities	false	CollectionActivities
Notify Upon Admission	X	NotifyUponAdmission
Notified All Patients	X	NotifiedAllPatients
Documented Determination	X	DocumentedDetermination
Nondiscrim Emergency Care Policy	true	NondiscrimEmergencyCarePolicy
Used Other Method	X	UsedOtherMethod
Amounts Generally Billed	false	AmountsGenerallyBilled
Gross Charges	false	GrossCharges

Form990 Schedule H Part VI Form990ScheduleHPartVI (11 entries)

IdentifierIdentifier	Return ReferenceReturnReference	ExplanationExplanation
Costing Methodology	Schedule H, Part I, Line 7	Use of Lyon Software's CBISA System
Additional Line 7 Information	Schedule H, Part I, Line 7	Marylands regulatory system creates a unique process for hospital payment that differs from the rest of the Nation. The Health Services Cost Review Commission (HSCRC) determines payment through a rate setting process and All Payors, including Governmental Payors, pay the same amount for the same services delivered at the same hospital. Marylands unique All Payor system includes a method for referencing uncompensated care in each Payors rates, which does not enable Maryland hospitals to breakout any offsetting revenue related to uncompensated care.
Community Building Activities	Schedule H, Part II	As the only hospital serving Charles County, Maryland, Civista Medical Center supports programs and activities where the hospital's expertise and resources can influence the fundamental issues that affect the health of the community. Civista supports economic development of the community through leadership participation in organizations such as the Economic Development Commission and the Tri-County Council of Southern Maryland. Hospital Administration participates in healthcare workforce development through by serving on committees such as the Charles County Commissioner's healthcare taskforce and support of College of Southern Maryland Nursing and Allied Health programs. In addition, Civista Medical Center participates and supports the Black Leadership Council on Excellence's Young Researchers Community Project which offers disadvantage youth in high school an opportunity to shadow medical professionals. According to the 2007 Maryland Physician workforce study, the Southern Maryland region has a physician shortage for primary care physicians. Southern Maryland had the regional low requirement for primary care physicians per 100,000 residents of 56.5. The Maryland state average rate was 58.2 per 100,000 residents. Under medical specialties, the Southern Maryland region had a shortage for cardiology, dermatology, endocrinology, gastroenterology, hematology, oncology, infectious disease, nephrology, psychiatry, pulmonary medicine, and rheumatology. The only medical specialties with adequate physician supplies were allergy and neurology. Charles County has one Neurologist which is deemed adequate for the population however, the physician plans to retire which will leave the county in a critical shortage in this specialty. As a result of the prevailing physician shortage, and to mitigate the effects of the lack of access of the community to medical care, Civista Medical Center, along with the University of Maryland has developed a robust and ongoing physician recruitment and retainment program.
Bad Debt Expense	Schedule H, Part III, Line 4	CIVISTA REPORTS BAD DEBT EXPENSE IN ACCORDANCE WITH GENERALLY ACCEPTED ACCOUNTING PRINCIPLES (GAAP) HFMA 15. THE PROVISION FOR BAD DEBTS IS BASED UPON MANAGEMENT'S ASSESSMENT OF HISTORICAL AND EXPECTED NET COLLECTIONS CONSIDERING HISTORICAL BUSINESS AND ECONOMIC CONDITIONS, TRENDS IN HEALTH CARE COVERAGE, AND OTHER COLLECTION INDICATORS. PERIODICALLY THROUGHOUT THE YEAR, MANAGEMENT ASSESSES THE ADEQUACY OF THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS BASED UPON HISTORICAL WRITE-OFF EXPERIENCE BY PAYOR CATEGORY, AS WELL AS, THE ACCUMULATION OF RECEIVABLE BALANCES BY PERIOD OUTSTANDING. THE RESULTS OF THIS REVIEW ARE THEN USED TO MAKE ANY NECESSARY MODIFICATIONS TO THE PROVISION FOR BAD DEBTS AND THE ESTABLISHED ALLOWANCE FOR UNCOLLECTIBLE RECEIVABLES. AFTER COLLECTION OF AMOUNTS DUE FROM INSURERS, THE CORPORATION FOLLOWS INTERNAL GUIDELINES FOR PLACING CERTAIN PAST DUE BALANCES WITH COLLECTION AGENCIES.
Collection Practices	Schedule H, Part III, Line 9b	Regardless of the status of collections, if a patient applies for Charity and meets eligibility the balance is written off according to the percentage they qualify for.
Community Health Care Needs Assessment	Schedule H, Part VI, Line 2	I. Community Health Needs Assessment (CHNA) 1) Description of CHNA process: Civista Medical Center and the Charles County Department of Health (CCDOH) collaborated to complete a comprehensive assessment of the health needs (CHNA) of Charles County, Maryland. An epidemiologist with a Masters 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 assessments 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 (302) Charles County residents completed the 74 question online survey that was created using Survey Monkey. The link to the survey was available on the Civista Health Inc 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, community centers. Thirty five were completed in Spanish (17.5%). 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, dementia/Alzheimers disease, communicable disease, sexually transmitted diseases, HIV/AIDS, mental health, dental health, substance abuse, disabilities, and tobacco use. Cumulative analysis of all quantitative and qualitative data identified the top 11 health needs of Charles County which was presented to the Partnerships for a Healthier Charles County, a coalition of Charles County agencies and organizations. The direction of Partnerships for a Healthier Charles County is guided by the Steering Committee which consists of leadership from Civista, Charles County Department of Health, Charles County Public Schools and the College of Southern Maryland. 2.) Description of individuals and organizations consulted for CHNA input: Seven focus groups were held throughout the county with representation from the following organizations. 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. Partnerships for a Healthier Charles County Civista Health Civista Health, Board Of Directors Charles County Department of Health University of Maryland Clinical Trials Program Bel Alton Alumni Association Charles County Department of Community Services, Transportation Tri County Council for Southern Maryland Ministers Alliance of Charles County CC Department of Social services Maryland Foundation for Quality healthcare Health Partners Clinic Shiloh Community United Methodist Church CC Nursing and Rehabilitation Center Alzheimers Association Center for Children Chesapeake Potomac Home Health Agency College of Southern Maryland Charles County Department of Aging Priority partners Big Brothers/Big sisters Community Hispanic Advocates Black Leadership Council for Excellence Young Researchers Community Project Pinnacle Center (Mental Health) Hospice Breast Cancer Support Advocates Charles County Public Schools School Nurses Charles County Commissioners Charles County Emergency Services Charles County Sheriffs Office So MD Delegates Charles County Community Foundation Community Physicians Charles County Fire and Rescue Board Survey for community members: 302 Charles County residents completed the 74 question online survey that was created using Survey Monkey. The link to the survey was available on the Civista Health website. 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, Charles County Department of Health waiting rooms, libraries, senior centers, community centers. 35 were completed in Spanish (17.5%). The CHNA was completed during the fiscal year ended June 30, 2012 and is currently being implemented.
Eligibility Education	Schedule H, Part VI, Line 3	Civista Medical Center posts its Financial Assistance Policy (FAP), or a summary thereof, as well as financial assistance contact information, in admissions areas, emergency rooms, business offices and other areas of the facility where eligible patients are likely to present. In addition, the policy is available on the Civista website and is posted in the local paper twice each year. The FAP is written in a culturally sensitive and at an appropriate reading level. It is available in English and Spanish. During the intake or discharge process or when there is contact regarding a billing matter, if a patient discloses financial difficulty or concern with payment of the bill, the patient is provided with FAP information. Additionally, assistance is provided for patients or their families in qualification and application of government benefits, Medicaid and other state programs.
Description of Community Served	Schedule H, Part VI, Line 4	The Community Benefit Service Area for Civista Medical Center is all 28 zip codes located within the borders of Charles County, Maryland. Civista Medical Center is Charles Countys only hospital and, as such, serves the residents of the entire county. Geography Charles County is located 23 miles south of Washington, D.C. It is one of five Maryland counties, which are part of the Washington, DC, MD, VA metropolitan area. At 461 square miles, Charles County is the eighth largest of Marylands twenty four counties and accounts for about 5 percent of Marylands total landmass. The northern part of the county is the "development district" where commercial, residential, and business growth is focused. The major communities of Charles County are La Plata, the county seat; Port Tobacco, Indian Head, and St Charles; and the main commercial cluster of Hughesville, Waldorf, & White Plains. Approximately 60 percent of countys residents live in the greater Waldorf & La Plata area. Charles County has experienced rapid growth since 1970, expanding its population from 47,678 to 120,546 in the 2000 census. By contrast, the southern (Cobb Neck area) and western (Nanjemoy, Indian Head, Marbury) most areas of the region still remain very rural with smaller populations. Population Current US Census 2010 estimates are that the population is now 146,551. This magnitude of growth can be seen in the changes in population density. The 1990 census showed that there were 219.4 individuals per square mile, by 2000, there were 261.5 individuals per square mile, an increase of 19.2 percent, and by 2010 there were 320.2 individuals per square mile. Transportation The percent change in the population growth for Charles County has been slightly greater than the change seen in the Maryland population growth. This growth has created transportation issues for the County in particular for the "development district" in the northern part of the county where many residents commute to Washington D.C. to work. The average work commute time for a Charles County resident is 41.8 minutes, higher than the Maryland average by 10 minutes. Public transportation consists of commuter bus for out of county travel and the county run Van Go bus service for in county transportation. Diversity As the population of the county changes, the diversity of the county also increases. The African American population has experienced the greatest increases in population. In 2000, African Americans made up 26% of the total Charles County population; by 2010, they comprise 41.6% of the total county population. As of 2010, minorities make up 52.1% of the Charles County population. The Hispanic community has also seen increases over the past few years. They now comprise 4% of the total county population. This is the one of the highest percentages among the 24 Maryland jurisdictions. The 2010 Charles County gender breakdown is approximately 50/50. Males make up 48.3% of the population, and females make up 51.7% of the county population. Economy Employment and economic indicators for the county are fairly strong. The 2010 US Census estimates for Charles County found that 73.8% of the population is currently in the labor work force. Approximately 5.2% of Charles County individuals are living below the poverty level, as compared to 8.6% of Maryland individuals. The Charles County median household income was $88,825, well above the Maryland median household income of $70,647. The diversity of the county is represented in the business community as well with 29.3% of all Charles County businesses being Black owned firms. This is higher than the State of Maryland at 19.3%. Education Charles County has a larger percentage of high school graduates than Maryland (90.4% vs. 87.8%); however, Charles County has a smaller percentage of individuals with a bachelors degree or higher than Maryland (26.1% vs. 35.7%). Housing There is a high level of home ownership in Charles County (81.8%). The median value of a housing unit in Charles County is higher than the Maryland average ($355,800 vs. $329,400). The average number of people in a Charles County household is 2.86 persons. Life Expectancy The life expectancy for a Charles County resident as calculated for 2009 2011 was 78.4 years. This is similar to the state average life expectancy of 79.2 years. Births There were 1,808 births in Charles County in 2009. Charles County represents 43% of the births in Southern Maryland and 2.4% of the total births in Maryland for 2009. Minorities made up over half of the babies born in Charles County in 2009 (52%). Sources: 1. 2010 Charles County Current Population Survey Data. United States Census Bureau. Available at: www.census.gov. 2. 2000 and 2009 Maryland Vital Statistics Report. Charles County Demographic and Population Data. Maryland Department of Health and Mental Hygiene. Available at www.vsa.maryland.gov. 3. 2005 2009 US Census Bureau, American Community Survey 5 year estimates, Charles County and Maryland. Available at www.census.gov. 4. 2011 Charles County Health Needs Assessment. Available www.civista.org
Promoting the Health of the Community	Schedule H, Part VI, Line 5	Upon completion of the Community Health Needs Assessment, the Steering Committee of Partnerships for a Healthier Charles County (PHCC) of which Civista Medical Center is a member, reviewed the results and the identified top 11 health needs. The Steering Committee set county goals through 2014 based on Maryland SHIP objectives and Healthy People 2020 Goals. The goals are now the Charles County Health Improvement Plan (available at http://www.civista.org/pdfs/HealthImprovementPlan1024.pdf) The results were presented to the PHCC membership. Teams were formed to address the health needs and design action plans. The Team Action Plans are available at http://www.charlescountyhealth.org/CharlesCountyHealthImprovementProcess/P lanningForImprovementActionPlans/tabid/608/Default.aspx. All the primary needs outlined in the Needs Assessment are being addressed and funded by Civista either directly (i.e., OB Clinic, Physician Recruitment) or through partnerships with other organizations (i.e., Childhood Obesity Program, Fetal Infant Mortality). Where a need is appropriately addressed by another entity, Civista provides leadership through the Charles County Health Improvement Plan and the coalition of Partnerships for a Healthier Charles County to communicate initiatives, provide assistance when needed and review results (i.e., Substance Abuse, Mental Health). The majority of the governing body, the Board of Directors, of Civista Medical Center is comprised of persons who reside in the community served by the hospital and who are neither employees nor contractors of the organization. Civista Medical Center extends medical privileges to all qualified medical staff in the community. Continuing Medical Education seminars and Grand Rounds are open to all community physicians.
Affiliated Health Care System Roles	Schedule H, Part VI, Line 6	Civista Medical Center is a member of the University of Maryland Medical System (UMMS). System hospitals meet monthly to coordinate and plan Community Benefit Operations such as Health Needs Assessments and Maryland State Health Improvement Plan objectives. UMMS provides leadership and guidance to local system jurisdictions regarding alignment with System and State wide goals. Southern Maryland had the highest percentage of physician shortages of all of the regions in Maryland (89.9%). To address the shortage, Civista Medical Center and UMMS have developed a recruitment and retention plan to successfully attract and retain private physicians to the community.
Community Benefit Report State Filings	Schedule H, Part VI, Line 7	Maryland

Schedule I IRS990ScheduleI

Field	Value	IRS element (for citing)
Records Maintained	true	RecordsMaintained

Recipient Table RecipientTable (5 entries)

Address Line1AddressUS/AddressLine1	CityAddressUS/City	StateAddressUS/State	ZIP CodeAddressUS/ZIPCode	EIN Of RecipientEINOfRecipient	IRC SectionIRCSection	Amount Of Cash GrantAmountOfCashGrant	Purpose Of GrantPurposeOfGrant	Amount Of Non Cash AssistanceAmountOfNonCashAssistance	Method Of ValuationMethodOfValuation	Description Of Non Cash AssistanceDescriptionOfNonCashAssistance
Hospice of Charles County
2505 Davis Road	Waldorf	MD	20603	251289626	501 (c) 3	18276	House Check Presentation Tour
Baltimore Shock Trauma
22 South Greene St	Baltimore	MD	21201	522238893	501 (c) 3	7498	Baltimore Shock Trauma Gala
American Cancer Society
7500 Greenway Center Drive Ste 3	Greenbelt	MD	20770	580659875	501 (c) 3		ACS Relay for Life Reception	5038	FMV	Sponsor Reception
Charles County Department of Health
250 Williams Street	LaPlata	MD	20646	522046030	501 (c) 3	15000	Prostate Cancer Program Sponsor
Civista Health Foundation Inc
PO 1070	LaPlata	MD	20646	521414564	501 (c) 3	8000	Paint the Park Pink Sponsorship

Field	Value	IRS element (for citing)
Total Nbr Of501 C3 And Govt Grants	5	TotalNbrOf501C3AndGovtGrants

Form990 Schedule I Part IV Form990ScheduleIPartIV

Field	Value	IRS element (for citing)
Identifier	Part I, Line2	Identifier
Explanation	Civista Medical Center makes financial and in-kind contributions to various organizations in the community.	Explanation

Schedule J IRS990ScheduleJ

Field	Value	IRS element (for citing)
Compensation Committee	X	CompensationCommittee
Independent Consultant	X	IndependentConsultant
Compensation Survey	X	CompensationSurvey
Board Or Committee Approval	X	BoardOrCommitteeApproval
Severance Payment	false	SeverancePayment
Supplemental Nonqual Retire Plan	false	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	true	AnyNonFixedPayments
Initial Contract Exception	false	InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (12 entries)

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
0	319370	0	165855	0	63042	0	54989	0	4431	0	607687	0	0
Erik Boas
0	186193	0	56273	0	3176	0	20767	0	1771	0	268180	0	0
Mark Dumais
0	251309	0	85000	0	7399	0	27820	0	4504	0	376032	0	0
Gary Herbek
199886	0	66739	0	1389	0	10473	0	2690	0	281177	0	0	0
Melanie Sage
151015	0	17355	0	195	0	7063	0	1328	0	176956	0	0	0
Paul Blackwood
156283	0	16672	0	1416	0	4447	0	3458	0	182276	0	0	0
Katherine Middleton
164362	0	0	0	67	0	8097	0	2300	0	174826	0	0	0
Marilyn Gregory
162842	0	0	0	193	0	6194	0	3734	0	172963	0	0	0
Gabriel Abiola
147056	0	9018	0	501	0	6059	0	2522	0	165156	0	0	0
Stacey Cook
134210	0	18294	0	430	0	7633	0	5835	0	166402	0	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

Form990 Schedule J Part III Form990ScheduleJPartIII

Field	Value	IRS element (for citing)
Identifier	Non-Fixed Payments	Identifier
Return Reference	Part I, line 7	ReturnReference
Explanation	Officers receive non fixed bonuses based on an annual review of personal and organizational goals. The compensation committee reviews and approves the bonus for the chief executive officer. The Chief Executive Officer with the executive committee of the Board approves the bonuses of the other officers.	Explanation

Schedule K IRS990ScheduleK

Form990 Schedule K Part I Form990ScheduleKPartI

Issuer Name IssuerName

Field	Value	IRS element (for citing)
Business Name Line1	Maryland Health and Higher Education Facilities	BusinessNameLine1

Field	Value	IRS element (for citing)
Issuer EIN	520936061	IssuerEIN
CUSIP Number	574217UL7	CUSIPNumber
Date Issued	2005-02-09	DateIssued
Issue Price	60097615	IssuePrice
Description Of Purpose	Hospital Additions/ Renovations	DescriptionOfPurpose
Defeased	false	Defeased
On Behalf Of Issuer	false	OnBehalfOfIssuer
Pool Financing	false	PoolFinancing

Form990 Schedule K Part II Form990ScheduleKPartII

Field	Value	IRS element (for citing)
Amount Retired	0	AmountRetired
Amount Bond Defeased	0	AmountBondDefeased
Total Proceeds	60097615	TotalProceeds
Amount In Reserve Fund	4511625	AmountInReserveFund
Capitalized Interest	0	CapitalizedInterest
Refunding Escrow	0	RefundingEscrow
Issuance Costs From Proceeds	3796282	IssuanceCostsFromProceeds
Credit Enhancement	0	CreditEnhancement
Working Capital Expenditures	0	WorkingCapitalExpenditures
Capital Expenditures	51789708	CapitalExpenditures
Other Spent Proceeds	0	OtherSpentProceeds
Amount Unspent	0	AmountUnspent
Year Of Subst Completion	2007	YearOfSubstCompletion
Current Refunding	false	CurrentRefunding
Advance Refunding	false	AdvanceRefunding
Final Allocation Made	true	FinalAllocationMade
Adequate Books And Recds Maintaind	true	AdequateBooksAndRecdsMaintaind

Form990 Schedule K Part III Form990ScheduleKPartIII

Field	Value	IRS element (for citing)
Prcntge Prvt Business Use By Others	0.00000	PrcntgePrvtBusinessUseByOthers
Percentage Of Prvt Business Re UBI	0.00000	PercentageOfPrvtBusinessReUBI
Total Private Business Use	0.00000	TotalPrivateBusinessUse

Form990 Schedule K Part IV Form990ScheduleKPartIV

Field	Value	IRS element (for citing)
Form8038 T Filed	true	Form8038TFiled
Variable Rate Issue	false	VariableRateIssue
Hedge Identified In Books And Recds	false	HedgeIdentifiedInBooksAndRecds

Name Of Hedge Provider NameOfHedgeProvider

Field	Value	IRS element (for citing)
Business Name Line1	0	BusinessNameLine1

Field	Value	IRS element (for citing)
Gross Proceeds Invested In GIC	false	GrossProceedsInvestedInGIC

Name Of GIC Provider NameOfGICProvider

Field	Value	IRS element (for citing)
Business Name Line1	0	BusinessNameLine1

Field	Value	IRS element (for citing)
Gross Proceeds Invested	false	GrossProceedsInvested
Exception To Rebate	false	ExceptionToRebate

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (11 entries)

IdentifierIdentifier	Return ReferenceReturnReference	ExplanationExplanation
Delegation of Control over Management Duties	Form 990, Part VI, Line 3	EFFECTIVE OCTOBER 1, 2009, CIVISTA HEALTH AND ITS RELATED ORGANIZATIONS SIGNED A MANAGEMENT SERVICES AGREEMENT WITH UNIVERSITY OF MARYLAND MEDICAL SYSTEM CORPORATION (""UMMS"", A SECTION 501(C)(3) ORGANIZATION) WHEREBY UMMS PROVIDES MANAGEMENT SUPERVISION FOR THE OPERATION AND STRATEGIC DEVELOPMENT OF CIVISTA WITH THE GOAL OF IMPROVING SERVICE, QUALITY OF CARE AND OTHER AREAS OF OPERATION. THE CHIEF EXECUTIVE OFFICER, THE CHIEF FINANCIAL OFFICER AND THE CHIEF MEDICAL OFFICER ARE EMPLOYEES OF UMMS, BUT CIVISTA MEDICAL CENTER REIMBURSES UMMS FOR THEIR COMPENSATION PACKAGES. IN ADDITION TO REIMBURSING UMMS FOR THE SERVICES OF THE SENIOR EXECUTIVE PERSONNEL, CIVISTA MEDICAL CENTER PAYS UMMS A FEE FOR OTHER SERVICES UNDER THE AGREEMENT.
Form 990 Review Process	Form 990, Part VI, Line 11b	The process for reviewing the Form 990 begins with Civista's Accountant working with the Controller in reviewing the first Draft Form 990. The 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 EMPLOYESS 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. KEY EMPLOYEES ARE EXEMPT ADMINISTRATIVE AND NON-EXEMPT EMPLOYEES WHO HAVE THE AUTHORITY TO MAKE COMMITMENTS FOR CIVISTA'S RESOURCES. 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. THE CHIEF EXECUTIVE OFFICER/PRESIDENT IS THE ONLY EMPLOYEE WHO HAS A WRITTEN CONTRACT. THE CHIEF EXECUTIVE OFFICER, CHIEF FINANCIAL OFFICER, AND CHIEF MEDICAL OFFICER ARE EMPLOYEES OF THE UNIVERSITY OF MARYLAND MEDICAL SYSTEM (UMMS) AND THEIR COMPENSATION PACKAGES ARE DETERMINED PER AN UMMS EXECUTIVE COMPENSATION COMMITTEE.
Process for Determining Compensation	Form 990, Part VI, Line 15b	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. The chief executive officer/president is the only employee who has a written contract. THE CHIEF EXECUTIVE OFFICER, CHIEF FINANCIAL OFFICER, AND CHIEF MEDICAL OFFICER ARE EMPLOYEES OF THE UNIVERSITY OF MARYLAND MEDICAL SYSTEM (UMMS) AND THEIR COMPENSATION PACKAGES ARE DETERMINED PER AN UMMS EXECUTIVE COMPENSATION COMMITTEE.
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	Reduce Deferred Financing -1,805,634 FMV adjustment after valuation 1,998,750 Bonds FMV Adjustment 12,522,972 Change in Pension Liability -5,218,419 Net assets release from restriction -339,046 Equity of affiliates, Foundation 373,090 Equity of affiliates, CPHA 306,199 Unrealized Bonds FMV Adjustment -9,606,613 ------------------------------------ ------------ Total change in net assets -1,768,701
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:Noel Cervino TITLE:Ex-Officio/President & CEO HOURS:1
HOURS DEVOTED FOR RELATED ORGANIZATION	FORM 990 PART VII	NAME:Erik Boas TITLE:Chief Financial Officer HOURS:1

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (29 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)	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 Inc
PO Box 1070	La Plata	MD	20646	522155576	Healthcare	MD	501(c)(3)	11-III FI	UMMSC	false
Civista Health Foundation Inc
PO Box 1070	La Plata	MD	20646	521414564	Fundraising	MD	501(c)(3)	03	CIVHS	false
Civista Health Auxiliary Inc
PO Box 1070	La Plata	MD	20646	521131193	Fundraising	MD	501(c)(3)	11-I	CIVHS	false

Form990 Schedule R Part III Form990ScheduleRPartIII (8 entries)

Address Line1AddressUS/AddressLine1	CityAddressUS/City	StateAddressUS/State	ZIP CodeAddressUS/ZIPCode	EINEIN	Primary ActivityPrimaryActivity	Legal Domicile StateLegalDomicileState	Business Name Line1DirectControllingEntityName/BusinessNameLine1	Predominant Income TypePredominantIncomeType
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

Form990 Schedule R Part IV Form990ScheduleRPartIV (10 entries)

Address Line1AddressUS/AddressLine1	CityAddressUS/City	StateAddressUS/State	ZIP CodeAddressUS/ZIPCode	EINEIN	Primary ActivityPrimaryActivity	Legal Domicile StateLegalDomicileState	Business Name Line1DirectControllingEntityName/BusinessNameLine1	Type Of EntityTypeOfEntity	Address Line1AddressForeign/AddressLine1	CityAddressForeign/City	CountryAddressForeign/Country	Postal CodeAddressForeign/PostalCode	Legal Domicile Foreign CountryLegalDomicileForeignCountry
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	na	C Corp
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
				980129232	Insurance		na	C Corp	PO Box 1109	Grand Cayman	CJ	KY1-1102	CJ
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

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	false	GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org	false	LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org	false	LoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other Org	false	SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org	false	PurchaseOfAssetsFromOtherOrg
Exchange Of Assets	true	ExchangeOfAssets
Rental Of Facilities To Other Orgs	false	RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs	false	RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs	false	PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs	true	PerformOfServicesByOtherOrgs
Sharing Of Facilities	true	SharingOfFacilities
Sharing Of Paid Employees	true	SharingOfPaidEmployees
Reimbursement Paid To Other Org	false	ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org	true	ReimbursementPaidByOtherOrg
Other Transfer To Other Org	true	OtherTransferToOtherOrg
Other Transfer From Other Org	true	OtherTransferFromOtherOrg