2013-05-14T13:33:45-05:00 2012-06-30 GRANT THORNTON LLP 2001 MARKET STREET SUITE 3100 PHILADELPHIA PA 19103 990 2011-07-01 520445374 Civista Medical Center Inc % ERIK BOAS CIVI 3016094130 5 Garrett Ave PO Box 1070 La Plata MD 20646 ERIK BOAS 3016094130 2013-05-10 true Frank Giardini 2155614200 2011 2016-03-07 17:11:31Z Noel Cervino 5 Garrett Ave La Plata MD 20646 112004858 false X www.civista.org X 1980 MD 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. 17 14 978 115 151265 35891 1677803 165000 103083914 111209188 109879 88269 544515 542401 105416111 112004858 86592 34654 0 0 47133035 48691670 0 0 0 53602980 55007273 100822607 103733597 4593504 8271261 128003508 147245093 103718743 116457768 24284765 30787325 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. false false 82602757 111209188 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. 82602757 true true false true false false false false false true false false true true true false true false false true false false false false false true true true false true true false false false false false false false false false false false false false false false true true true false false false 151 0 true 978 true true true true CJ false false false false false false false false X 17 14 false true false false false false false true true false false true true true true true true true true false MD X ERIK BOAS 3016094130 5 GARRETT AVE La Plata MD 20646 X Shelly Culhane 3.0 X 0 0 0 B Larry Jenkins 3.0 X 0 0 0 R Wayne Barnes 3.0 X 0 0 0 Sara Middleton 3.0 X X 0 0 0 Candice Quinn Kelly 3.0 X 0 0 0 Faye Reed 3.0 X 0 0 0 Khadar Baig 3.0 X 0 0 0 Van Mitchell 3.0 X 0 0 0 Louis Jenkins Jr 3.0 X X 0 0 0 Seetaramayya Nagula 3.0 X 0 0 0 Richard Winkler 3.0 X X 0 0 0 Michael Cady 3.0 X 0 0 0 Ashvin J Patel MD 4.0 X X 0 0 0 James Burke 3.0 X 0 0 0 John Ashworth 1.0 X 0 569353 17755 Robert Chrencik 1.0 X 0 2073638 213731 Noel Cervino 40.0 X 0 548267 59420 Erik Boas 40.0 X 0 245642 22538 Mark Dumais 40.0 X 0 343708 32324 Gary Herbek 40.0 X 268014 0 13163 Melanie Sage 40.0 X 168565 0 8391 Paul Blackwood 40.0 X 174371 0 7905 Katherine Middleton 40.0 X 164429 0 10397 Marilyn Gregory 40.0 X 163035 0 9928 Gabriel Abiola 40.0 X 156575 0 8581 Stacey Cook 40.0 X 152934 0 13468 1247923 3780608 417601 38 false true false 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 24 165000 165000 NET PATIENT REVENUE 900099 111209188 111209188 111209188 85265 85265 0 0 3004 3004 3004 3004 0 0 0 ANSWERING SERVICE 561000 151265 151265 CAFETERIA & COFFEE BAR SALES 900099 322937 322937 APPLICATION FEES 900099 9250 9250 58949 58949 542401 112004858 111600324 151265 88269 34654 34654 0 0 0 1710032 1333825 376207 0 39191313 30569224 8622089 748984 584208 164776 4183606 3263213 920393 2857735 2229033 628702 0 455129 455129 416309 416309 60000 60000 0 0 11423990 8910712 2513278 268301 209275 59026 291316 227226 64090 0 0 3396893 2649577 747316 43199 9504 33695 0 0 2940560 2734721 205839 0 2629943 2445847 184096 2651500 2651500 SUPPLIES AND DRUGS 16417901 15268648 1149253 BAD DEBT 7678609 7678609 EQUIPMENT RENTAL AND MAINT. 3727851 1230191 2497660 TELEPHONE 360061 280848 79213 2245711 291942 1953769 103733597 82602757 21130840 0 0 0 33434372 37974354 0 0 9697092 11344222 0 0 0 0 0 0 1533556 1490645 895718 930555 111323629 44328687 63118976 66994942 0 0 0 0 0 0 0 0 19323794 28510375 128003508 147245093 14668027 13117763 0 0 0 0 57930947 54348613 0 0 0 0 20008435 21568471 0 0 11111334 27422921 103718743 116457768 X 23796141 30770543 488624 16782 0 0 24284765 30787325 128003508 147245093 X 8271261 -1768701 X false true true X X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 70624 70624 false Lobbying Activities Schedule C, Part II-B, Line 1i 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. 0 0 73669856 20199904 53469952 2288604 1296958 991646 31478033 22831825 8646208 3887136 0 3887136 66994942 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 28510375 0 ADVANCES FROM THIRD PARTIES 3944049 ACCRUED INTEREST PAYABLE 1326419 ACCRUED PENSION COSTS 8706050 DUE TO AFFILIATES 220417 LEASE LIABILITIES 438031 MALPRACTICE IBNR 2050112 OTHER LIABILITIES 10737843 27422921 Supplemental Description - Other Schedule D, Part XI, Line 8 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. Central America and the Caribbean Program Services Insurance 1072786 1072786 1072786 true false true false false false true true true X true X true true true false true true 997486 997486 0.00960 997486 997486 0.00960 28 163349 721504 1275 720229 0.00690 9 43 273693 273693 0.00260 8 3703714 120044 3583670 0.03450 12 2100 96015 96015 0.00090 57 165492 4794926 121319 4673607 0.04490 57 165492 5792412 121319 5671093 0.05450 4 1029 1029 8 100 125322 125322 0.00120 2 1116 1116 6 292492 292492 0.00280 20 100 419959 419959 0.00400 true 5691385 42594984 40572518 2022466 X true true 1 1 Civista Medical Center Inc

5 Garrett Ave La Plata MD 20646

X X X Civista Medical Center Inc 1 true X X X X X X X X X 11 true false true X X X X X X X X X X X true true true 200. true 300. true X X X X X true true X X X X X true false X X X true X false false 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 true 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 5038 FMV Sponsor Reception ACS Relay for Life 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 5 Part I, Line2 Civista Medical Center makes financial and in-kind contributions to various organizations in the community. X X X X false false false false false false false true false 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 Non-Fixed Payments Part I, line 7 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. Maryland Health and Higher Education Facilities 520936061 574217UL7 2005-02-09 60097615 Hospital Additions/ Renovations false false false 0 0 60097615 4511625 0 0 3796282 0 0 51789708 0 0 2007 false false true true 0.00000 0.00000 0.00000 true false false 0 false 0 false false 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 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 Arundel Physicians Associates LLC 301 Hospital Drive Glen Burnie MD 20161 522000762 Healthcare MD na n/a Baltimore Washington Imaging LLC 301 Hospital Drive Glen Burnie MD 20161 200806027 Healthcare MD na n/a Central Maryland Radiology Oncology LLC 10710 Charter Drive Columbia MD 21044 270879418 Healthcare MD na n/a Innovative Health LLC 29165 Canvasback Drive Suite 100 Easton MD 21601 521997287 Billing MD na n/a NAHSunrise of Severna Park LLC 301 Hospital Drive Glen Burnie MD 20161 541810729 Healthcare MD na n/a North Arundel Senior Living LLC 301 Hospital Drive Glen Burnie MD 20161 541810728 Healthcare MD na n/a Shipley's Imaging Center LLC 22 South Greene Street Baltimore MD 21201 522040338 Healthcare MD na n/a Universitycare LLC 22 South Greene Street Baltimore MD 21201 521914892 Healthcare MD na n/a Arundel Physicians Associates Inc 301 Hospital Drive Glen Burnie MD 21061 521992649 Healthcare MD na C Corp Baltimore Washington Health Enterprises 301 Hospital Drive Glen Burnie MD 21061 521936656 Healthcare MD na C Corp BW Professional Services Inc 301 Hospital Drive Glen Burnie MD 21061 521655640 Healthcare MD na C Corp Civista Care Partners Inc PO Box 1070 La Plata MD 20646 522176314 Healthcare MD 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 PO Box 1109 Grand Cayman CJ KY1-1102 980129232 Insurance CJ na C Corp University Lithotripter Inc 22 South Greene Street Baltimore MD 21201 521451021 Healthcare MD na C Corp UMMS Self Insurance Trust 22 South Greene Street Baltimore MD 21201 526315433 Insurance MD na Trust false false false false false false false true false false false true true true false true true true