2013-05-14T16:03:39-05:00 2012-06-30 COHEN RUTHERFORD KNIGHT PC 6903 ROCKLEDGE DRIVE SUITE 500 BETHESDA MD 208171800 990 2011-07-01 521452024 Carroll Hospital Center Inc % DAVID MCCORMICK CARR 4108716859 200 Memorial Avenue Westminster MD 21157 KEVIN KELBLY 2013-05-14 TINA C ECKLOFF 3018281008 2011 2016-02-25 16:41:14Z John Sernulka 200 MEMORIAL AVE WESTMINSTER MD 21774 229915438 false X www.carrollhospitalcenter.org X 1957 MD OUR COMMUNITIES EXPECT AND DESERVE SUPERIOR MEDICAL TREATMENT, COMPASSIONATE CARE, AND EXPERT GUIDANCE IN MAINTAINING THEIR HEALTH AND WELL-BEING. 15 14 1997 355 3124515 1090000 925000 201412609 224019831 3179446 4597814 532102 372793 206214157 229915438 115000 155000 0 0 97467463 106909146 0 0 0 91916180 107142153 189498643 214206299 16715514 15709139 313981970 338128205 195306839 233448150 118675131 104680055 OUR COMMUNITIES EXPECT AND DESERVE SUPERIOR MEDICAL TREATMENT, COMPASSIONATE CARE, AND EXPERT GUIDANCE IN MAINTAINING THEIR HEALTH AND WELL-BEING. AT CARROLL HOSPITAL CENTER, WE OFFER AN UNCOMPROMISING COMMITMENT TO THE HIGHEST QUALITY HEALTH CARE EXPERIENCE FOR PEOPLE IN ALL STAGES OF LIFE. WE ARE THE HEART OF HEALTH CARE IN OUR COMMUNITIES. false false 184976441 155000 221206753 Carroll Hospital Center, a 189 licensed bed acute care facility located in Westminster, Maryland offers the latest in medical technology and services, combined with a state-of-the-art facility and top-notch, skilled medical professionals, caring for patients with compassion. Currently, there are more than 400 physicians representing 38 specialties on our medical staff in addition to over 1,700 individuals employed by the Hospital - making CHC the second largest employer in Carroll County. The organization operates an acute care hospital serving the communities located in Carroll and surrounding counties as well as parts of Pennsylvania. In accordance with our tax-exempt function the organization operates an emergency room open to all persons regardless of their ability to pay and had over 56,600 patient visits last year. The hospital participates in Medicare and Medicaid programs, has a governing body comprised of independent persons representative of the community, all financial surpluses the hospital generates are used exclusively to further the charitable purposes of the organization and its medical staff is open to all qualified physicians in the area. As the only hospital in Carroll County, we offer our community a full array of services including, emergency services, comprehensive cancer care, pediatrics, maternity, geriatrics, the latest minimally invasive surgical procedures and advanced total and partial joint replacement procedures. In the year ending June 2012, Carroll Hospital Center recorded 15,083 inpatient admissions and observation stay cases, 1,128 births and approximately 8,500 surgical procedures, all contributing to a total of 330,000 patient encounters for the period. In line with our mission-"Our communities expect and deserve superior medical treatment, compassionate care, and expert guidance in maintaining their health and well-being. At Carroll Hospital Center, we offer an uncompromising commitment to the highest quality health care experience for people in all stages of life. We are the heart of health care in our communities." - the hospital also provides planned community benefit activities to improve access to health care and improve the overall health of our community. Our mission is pursued in collaboration with our related organizations: Carroll County Health Services, Carroll Hospice, The Partnership for a Healthier Carroll County (our community advocacy arm), and The Carroll Hospital Center Foundation (Also listed in Part VI) for more information on these subsidiaries, please see their individual Forms 990. 184976441 true true false true false false false false true true true true true true false false true false false true false false false false false true true true false true true false false false false false false false false true false false false false false true true true true false false true 256 0 true 1997 true true true true CJ false false false false false false false false false X 15 14 true false false false false false false true true false false true true true true true true true true true true CA MD X DAVID MCCORMICK 4108716859 200 MEMORIAL AVE Westminster MD 21157 X CHARLES O FISHER JR 1.0 X 0 0 0 MIRIAM BECK 1.0 X 0 0 0 ETHAN SEIDEL 1.0 X 0 0 0 JOHN SERNULKA 35.0 X X 409261 0 290544 KIMBERLY JOHNSTON MD 1.0 X 0 0 0 HAROLD WALSH 1.0 X 0 0 0 HELEN W WHITEHEAD 1.0 X 0 0 0 SYED HOSAIN MD 1.0 X 0 0 0 THOMAS WELLIVER 1.0 X 0 0 0 JEFFREY A WOTHERS 1.0 X 0 0 0 W DENNIS THOMAS 1.0 X GERALD LEE STURGILL 1.0 X 0 0 0 LARRY VAN SANT SR 1.0 X 0 0 0 JOHN STEERS MD 1.0 X 0 0 0 MARTIN HILL 1.0 X 0 0 0 CHARLES O FISHER SR 1.0 X 0 0 0 CHRISTOS BALLAS 1.0 X 0 0 0 STEPHAN HOCHULI MD 1.0 X 0 0 0 PAULA LANGMEAD 1.0 X 0 0 0 JACK TEVIS 1.0 X 0 0 0 LESLIE SIMMONS 38.0 X 329679 0 26026 KEVIN KELBLY 34.0 X 350751 0 28812 KEVIN SMOTHERS 40.0 X 421153 0 22640 STEPHANIE REID 40.0 X 170910 0 6782 DAVID HORN 40.0 X 215086 0 23952 M ELLEN FINNERTY MYERS 20.0 X 222452 0 6435 JOYCE ROMANS 40.0 X 211525 0 15078 TRACEY ELLISON 40.0 X 197579 0 0 DAVID LOUDER 40.0 X 324881 0 2135 FLAVIO KRUTER 38.0 X 475016 0 9947 JEROME MARAVE 40.0 X 223125 0 15151 DAVID SALINGER 39.0 X 301061 0 9606 DEE HUBBARD 40.0 X 264666 0 17630 AMANDEEP SINGH 40.0 X 245000 0 19730 4362145 0 494468 95 false true false CENTRAL MD REHABILITATION 4259 HARNEY RD TANEYTOWN MD 21787 physical therapy 3005060 CARROLL COUNTY ANES ASSOCIATION PO BOX 75193 BALTIMORE MD 21275 ANESTHESIA services 1800339 carroll county radiology 7253 ambassador rd BALTIMORE MD 21244 radiology services 712075 DIGITRACE CARE SERVICES 200 CORPORATE PLACE PEABODY MA 01960 neurology services 653150 healthcares information edge llc PO BOX 462 CHURCHVILLE MD 21028 CONSULTING 652426 5 925000 925000 NET PATIENT SERVICE REVENUE 216395218 216395218 CAFETERIA/VEND. 878942 878942 LAB 621500 3073563 3073563 OTHER OPERATING REVENUE 3672108 3672108 224019831 4593966 -61356 4655322 0 0 282793 282793 282793 260485 22308 3848 3848 3848 3848 0 0 0 CARROLL COUNTY MED SERVICES MGMT FEE 541610 90000 90000 90000 229915438 221206753 3124515 4659170 155000 155000 0 0 0 2823798 2823798 0 85208531 78008875 7199656 0 3449302 3057574 391728 9204080 8171021 1033059 6223435 5516656 706779 0 37944 37944 411201 411201 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200 MEMORIAL AVE WESTMINSTER MD 21157

X Carroll Hospital Center Inc 1 true true 300. true 375. true X X X X true true X X X X X X true false X X X X true X false false 5 carroll county radiology

7253 ambassador road baltimore MD 21244

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1430 progress way ste 108 eldersburg MD 21784

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193 stoner ave ste 200 westminster MD 21157

imaging center carroll county radiology

1 village square westminster MD 21157

imaging center carroll county radiology

844 washington road ste 102 westminster MD 21157

imaging center PART I, LINE 3C For patients that experience a medical hardship (medical debt that exceeds 25% of household income), Carroll Hospital Center also provides discounted care for individuals earning up to 500% of the federal poverty guidelines. If a patient has received reduced cost medically necessary care due to a medical hardship, the patient or any immediate family member of the patient living in the same household shall remain eligible for reduced cost medically necessary care when seeking subsequent care at the same hospital during the 12 month period beginning on the date on which the reduced cost medically necessary care was initially received. In addition, some patients are presumed to be eligible for financial assistance discounts on the basis of life circumstances. These patients that the Hospital has determined presumptively qualify for financial assistance are not required to complete additional forms or provide additional information and are granted 100% financial assistance discounts. The Hospital internally documents any and all recommendations to provide presumptive financial assistance discounts from patients and other sources, such as physicians, community or religious groups, internal or external social services or financial counseling personnel. The following are examples of patient situations that may reasonably assist in the determination of presumptive eligibility for financial assistance: (1) Patient has received care from and/or has participated in Women's, Infants and Children (WIC) programs, (2) patient is homeless and/or has received care from a homeless clinic, (3) patient's family is eligible for and is receiving food stamps, (4) patient's family is eligible for and is participating in subsidized school lunch programs, (5) patient qualifies for other state or local assistance programs that are unfounded or the patient's eligibility has been dismissed due to a technicality (i.e. Medicaid spend-down), (6) family or friends of a patient have provided information establishing the patient's inability to pay, (7) the patient's street address and documentation evidencing status in an affordable or subsidized housing development, (8) patient/guarantor's wages are insufficient for garnishment, as defined by state law, or (9) patient is deceased, with no known estate. PART I, LINE 5A CARROLL HOSPITAL CENTER DOES NOT DENY FINANCIAL ASSISTANCE TO ANY PATIENT ELIGILBE FOR FREE OR DISCOUNTED CARE UNDER ITS FINANCIAL ASSISTANCE POLICY REGARDLESS OF WHETHER OR NOT THE FINANCIAL ASSISTANCE BUDGET WAS EXCEEDED. PART I, LINE 7A, COLUMN C THE METHODOLOGY USED TO CALCULATE CHARITY CARE COST WAS A COST-TO-CHARGE RATIO DERIVED FROM WORKSHEET 2, RATIO OF PATIENT CARE-TO-CHARGES. PART I, LINE 7A MARYLAND'S 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 HOSPITAL. MARYLAND'S UNIQUE ALL-PAYOR SYSTEM INCLUDES A METHOD FOR REFERENCING UNCOMPENSATED CARE IN EACH PAYOR'S RATES, WHICH DOES NOT ENABLE MARYLAND HOSPITALS TO BREAKOUT ANY OFFSETTING REVENUE RELTED TO UNCOMPENSATED CARE. PART I, LINE 7B MARYLAND'S 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 HOSPITAL. MARYLAND'S UNIQUE ALL-PAYOR SYSTEM INCLUDES A METHOD FOR REFERENCING UNCOMPENSATED CARE IN EACH PAYOR'S RATES, WHICH DOES NOT ENABLE MARYLAND HOSPITALS TO BREAKOUT ANY OFFSETTING REVENUE RELTED TO UNCOMPENSATED CARE. COMMUNITY BENEFIT EXPENSES ARE EQUAL TO MEDICAID REVENUES IN MARYLAND, AS SUCH, THE NET EFFECT IS ZERO. THE EXCEPTION TO THIS IS THE IMPACT ON THE HOSPITAL FOR ITS SHARE OF MEDICAID ASSESSMENT. IN RECENT YEARS THE STATE OF MARYLAND HAS CLOSED FISCAL GAPS IN THE STATE MEDICAID BUDGET BY ASSESSING HOSPITALS THROUGH THE RATE-SETTING SYSTEM. FOR TAX YEAR 2010 CARROLL HOSPITAL CENTER'S MEDICAID BUDGET DEFICIT UNFUNDED ASSESSMENT AMOUNTED TO $504,659. PART I, LINE 6A MARYLAND HOSPITALS ARE REQUIRED TO SUBMIT AN ANNUAL COMMUNITY BENEFIT REPORT TO THE HEALTH SERVICES COST REVIEW COMMISSION (HSCRC) THAT DESCRIBES THE PROGRAMS AND SERVICES OFFERED THAT ARE DESIGNED TO PROMOTE THE HEALTH AND WELLNESS OF THE COMMUNITIES SERVED. THESE REPORTS ARE AVAILABLE TO THE PUBLIC ON THE HSCRC WEBSITE (WWW.HSCRC.STATE.MD.US). ADDITIONALLY, CARROLL HOSPITAL CENTER MAKES AVAILABLE ITS COMMUNITY BENEFIT REPORT ON ITS WEBSITE (WWW.CARROLLHOSPITALCENTER.ORG) PART I, LINE 7G Carroll Hospital Center incurred $5.4 million of net community benefit expense as a result of undertaking subsidized health services. A shortage of primary or specialty providers has perhaps posed the most significant challenges in inpatient care delivery. Substantial physician subsidies have become necessary to ensure that all patients requiring anesthesia and pediatric, psychiatric, obstetrical and critical and general medical care have the access they need once admitted to the hospital, including 24/7 coverage. Carroll Hospital Center has hospitalist programs in each of these areas and allocates a significant amount of resources sustaining the programs. In FY12, approximately $7 million was spent in ensuring care for all patients and recruiting and retaining Physicians - of which $4.8 million has been reported as subsidized health services. Equally important is access to physicians on an outpatient basis, not just for the uninsured, but also for all patients in our growing community. To ensure our community has access to quality physicians, Carroll Hospital Center continually monitors statistically calculated need by developing a comprehensive medical staff development plan based on the health care needs of our medical service area. The report includes both an analysis of the hospital's service area and specific recommendations regarding appropriate staffing levels in a variety of medical specialties. The physician needs assessment methodology used is based on a qualitative standard established by the Internal Revenue Service (IRS). The report guides the hospital's recruiting strategy, helps us to prioritize recruiting efforts and allows the hospital to place contingencies on recruited physicians to ensure they see medically underserved, uninsured, Medicare and Medicaid patients. While Carroll Hospital Center cares for patients with no means to pay their medical expenses throughout the hospital, it is seen most acutely in the Emergency Department (ED), where many uninsured patients often come for primary and emergent care. Since all patients presenting to the ED are treated for any medical condition regardless of their ability to pay for care, the uninsured population poses a significant challenge not only to the hospital, but also to physicians providing care in the hospital and in the ED. Due in part to a lack of, or minimal reimbursement, it has become increasingly difficult to find specialists to provide on-call services for the ED around-the-clock. The more serious issue is that this trend affects not only our uninsured patients, but all patients seeking treatment in our ED. The likelihood that patients present more acutely in the uninsured population and the accompanying increased potential for malpractice claims also has contributed to specialists choosing not to cover nonpaying patients in the ED. That gap is most significant in surgical specialties including, orthopaedics, otolaryngology (ENT), general surgery and plastic surgery. There also has been increasing reluctance from other specialties with significant ED volumes, including vascular surgery, neurosurgery and neurology. To help ease the effects of uncompensated care on physicians and address the gap in care for our patients, Carroll Hospital Center has continued two major, costly initiatives to address the gap proactively. First, the hospital contracts with 10 medical specialties to ensure 24/7 coverage in the ED. Implemented in 2006, those specialties include neurosurgery; general, plastic, vascular and oral surgery; orthopaedics; urology; podiatry; ophthalmology and ENT. Additionally, the growing volumes of uninsured patients has caused the hospital to recently institute an additional policy which allows physicians who see patients without a payment source in the ED to be reimbursed for physician services by the hospital at current Medicare rates. While payment for ED call may help with the gaps in coverage for the uninsured, it bears a significant financial toll on the hospital. The expense to pay physicians for ED call has cost the hospital $426,992 in FY12. All the initiatives and support listed above would not be provided if Carroll Hospital Center did not provide them. As the only hospital in the county, it is our primary responsibility to provide these services for the uninsured and underinsured, as well as all community members. No other organization or individual in the county would be able to provide all of these comprehensive services in the areas that the hospital does. PART I LINE 7 MARYLAND'S 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 AMOUTN FOR THE SAME SERVICES DELIVERED AT THE SAME HOSPITAL. MARYLAND'S UNIQUE ALL-PAYOR SYSTEM INCLUDES A METHOD FOR REFERENCING UNCOMPENSATED CARE IN EACH PAYOR'S RATES, WHICH DOES NOT ENABLE MARYLAND HOSPITALS TO BREAKOUT ANY OFFSETTING REVENUE RELATED TO UNCOMPENSATED CARE. PART III, LINE 4 CARROLL HOSPTIAL CENTER INCURRED $8,854,000 BAD DEBT EXPENSE DURING THE TAX YEAR 2011. THIS REFLECTS THE AMOUNT OF GROSS PATIENT CHARGES UNCOLLECTED FROM PATIENTS THAT DID NOT QUALIFY FOR FINANCIAL ASSISTANCE. PER AUDIT REPORT (1M): "NET PATIENT SERVICE FOR THE HOSPITAL REFLECTS ACTUAL CHARGES TO PATIENTS BASED ON RATES ESTABLISHED BY THE STATE OF MARYLAND HEALTH SERVICES COST REVIEW COMMISSION (HSCRC) IN EFFECT DURING THE PERIODS IN WHICH SERVICES ARE RENDERED, NET OF CONTRACTUAL ADJUSTMENTS. CONTRACTUAL ADJUSTMENTS REPRESENT THE DIFFERENCE BETWEEN AMOUNTS BILLED BY THE HOSPITAL AND AMOUNTS PAID BY THIRD-PARTY PAYORS. BECAUSE THE HOSPITAL DOES NOT PURSUE COLLECTION OF AMOUNTS DETERMINED TO QUALIFY AS CHARITY CARE, SUCH AMOUNTS ARE NOT REPORTED AS REVENUE". BAD DEBT EXPENSE REFLECTS ACTUAL PATIENT CHARGES THAT HAVE BEEN DETERMINED TO BE UNCOLLECTIBLE FOR PATIENTS THAT HAVE NOT QUALIFIED FOR CHARITY CARE. BAD DEBT EXPENSE MAY ALSO INCLUDE ADDITIONAL "BAD DEBT PROVISIONS" FOR DOUBTFUL ACCOUNTS BASED ON MANAGEMENT'S ESTIMATES OF FUTURE ACCOUNT COLLECTIONS BASED ON CHARGES IN SERVICE MIX AND PAYOR MIX. CARROLL HOSPITAL CENTER INC. DETERMINES ELIGIBILITY FOR FINANCIAL ASSISTANCE THROUGH OTHER VARIOUS MEANS (CREDIT REPORTS, DEBT AND ASSET REVIEWS, AND REFERRALS FROM THE HOSPITAL'S BILLING AGENTS) WHEN THE PATIENT HAS NOT COMPLETED THE FINANCIAL ASSISTANCE APPLICATION. IF A DETERMINATION IS MADE REGARDING THE PATIENT'S INABILITY TO PAY, THE ACCOUNT CAN BE APPROVED FOR FINANCIAL ASSISTANCE ON A PRESUMPTIVE BASIS RATHER THAN BE REFLECTED AS BAD DEBT EXPENSE. OF THE REMAINING BAD DEBT EXPENSE, IT IS ESTIMATED THAT $711,000 AT COST (10%) MAY BE ATTRIBUTABLE TO PATIENTS ELIGIBLE FOR FINANCIAL ASSISTANCE/CHARITY CARE. PART III, LINE 8 CARROLL HOSPITAL CENTER'S TAX YEAR 2011 (FISCAL YEAR 2012) MEDICARE COST REPORT SUBMISSION WAS UTILIZED AS THE SOURCE DOCUMENT TO REPORT MEDICARE TOTAL REVENUE AND ALLOWABLE COSTS. PART III, LINE 9B For those patients that do not initially apply or qualify for financial assistance, the organization continues to monitor whether the patient may qualify for financial assistance. If the patient is found to be eligible for financial assistance, at any point (including once collection efforts have begun), the organization will approve the patient for financial assistance. Collection efforts will be stopped immediately once the patient is found to qualify for financial assistance under the organization's financial assistance policy. Patients determined to be eligible for financial assistance subsequent to the date of service may be eligible for a refund of payments made if it is determined that the patient was eligible for financial assistance at the time of service. PART V, LINE 17 THE HOSPITAL FACILITY OR AN AUTHORIZED THIRD PARTY DID NOT UNDERTAKE ANY OF THE COLLECTION ACTIONS NOTED IN PART V, SECTION B, LINE 16 BEFORE MAKING REASONABLE EFFORTS TO DETERMINE ANY PATIENTS ELIGIBILITY UNDER THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY. IN ORDER TO HELP DETERMINE PATIENTS' ELIGIBILITY UNDER THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY, THE HOSPITAL UNDERTAKES A NUMBER OF ACTIONS, INCLUDING NOTIFYING PATIENTS OF THE FINANCIAL ASSISTANCE POLICY ON ADMISSION, NOTIFYING PATIENTS OF THE FINANCIAL ASSISTANCE POLICY PRIOR TO DISCHARGE, NOTIFYING PATIENTS OF THE FINANCIAL ASSISTANCE POLICY IN COMMIUNICATIONS WITH THE PATIENTS' BILLS, AND DOCUMENTING ITS DETERMINATION OF WHETHER PATIENTS WERE EILIGIBLE FOR FINANCIAL ASSISTANCE UNDER THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY. PART V, LINE 19D THE HOSPITAL FACILITY PROVIDES A DISCOUNT OF AT LEAST 25$% OFF OF GROSS CHARGES FOR THE PROVISION OF EMERGENCY AND OTHER MEDICALLY NECESSARY CARE TO ANY INDIVIDUAL THAT IS ELIGIBLE FOR DISCOUNTED CARE UNDER THE HOSPITAL FACILITY'S FINANCIAL ASSISTANCE POLICY AND AT LEAST 15% OFF OF GROSS CHARGES FOR THE PROVISION OF EMERGENCY AND OTHER MEDICALLY NECESSARY CARE TO ANY INDIVIDUAL THAT QUALIFIES UNDER THE MEDICAL HARDSHIP PROVISIONS OF THE HOSPITAL FACILITY'S FINANCIAL ASSISTANCE POLICY. PURSUANT TO THE HEALTH SERVICES COST REVIEW COMMISSION (HSCRC) ALL-PAYOR SYSTEM FOR HOSPITALS IN THE STATE OF MARYLAND, THE GREATEST DISCOUNT OFF OF GROSS CHARGES FOR THE PROVISION OF EMERGENCY AND OTHER MEDICALLY NECESSARY CARE PERMITTED TO ANY COMMERCIAL INSURER OR MEDICARE IS ONLY 6% AS A RESULT, THE HOSPTIAL FACILITY WAS ABLE TO DETERMINE THAT THE MAXIMUM AMOUNT CHARGED TO INDIVIDUALS THAT WERE ELIGIBLE FOR FINANCIAL ASSISTANCE UNDER THE HOSPITAL FACILITY'S FINANCIAL ASSISTANCE POLICY WAS NOT GREATER THAN THE AMOUNT GENERALLY BILLED TO INDIVIDUALS WHO HAVE INSURANCE COVERING SUCH CARE. PART V, LINE 21 The Hospital facility does not charge any individuals that it knows are eligible for financial assistance an amount equal to the gross charge for any service. The Hospital uses the charge master rates for a service as a starting point against which the discounts mandated in the hospital facility's financial assistance policy are applied to determine the amount actually billed to patients eligible under the financial assistance policy. The hospital facility will not collect payment from any patient eligible under the financial assistance policy in excess of the reduced amount that is actually billed to such financial assistance patient. NEEDS ASSESSMENT PART VI, LINE 2 Monitoring the health status of the community is an ongoing and interactive process engaged in by the Hospital, with substantial involvement from our community via The Partnership for a Healthier Carroll County, Inc. ("The Partnership"), an entity established by the Hospital and the Carroll County Health Department specifically to assess unmet health needs in the community, expand the capacity for health and quality of life improvement in the community, serve as a collaborative vehicle for interaction with the community, and with our community, to drive the effort to create a healthier Carroll County. The Partnership is a related Section 501(c)(3) tax-exempt organization of the Hospital, which receives a majority of its operating funds from contributions made directly by the Hospital. Improvement in the core health improvement areas (C.H.I.A.s) is one of the Hospital's goals. The C.H.I.A.s are the need areas requiring individual and organizational action to achieve targeted improved status using the U.S. Department of Health and Human Services' Healthy People 2020 targets as the benchmark. The Hospital participates actively in many of the C.H.I.A. Leadership Teams comprised of diverse individuals and organizations from throughout the hospital's service area, who share expertise and interest in the CHIA. With support and guidance from The Partnership, those leadership teams develop and implement action plans specifically intended to accomplish targeted results. "Healthy Carroll Vital Signs" (described below) are then affirmed, are specific to each CHIA Leadership Team and serve as one of the primary tools for measuring and reporting results to the Hospital leadership and to the community. Recently the Hospital has collaborated with The Partnership with respect to an assessment of health needs via Maryland's State Health Improvement Process (S.H.I.P.), which was organized to produce a Local Health Improvement Plan (L.H.I.P.). The Partnership organization enthusiastically agreed to serve as the local coalition required in the S.H.I.P. process. This provided Carroll Hospital Center yet another opportunity for linkage to important, validated information about health needs in our community and ongoing opportunities to collaborate with our local and state health department regarding implementation strategies for targeted results. Pursuant to the S.H.I.P. assessment, thirty-nine "High Impact Objectives" were identified by the staff at Maryland's Department of Health and Mental Hygiene. A Carroll County specific data profile served as the baseline document. After thorough analysis, a local team, which included the hospital, produced a Local Health Improvement Plan (L.H.I.P.) addressing five priority need areas. The S.H.I.P. and L.H.I.P. provide another important set of very useful information and is being fully integrated within the hospital's first IRS compliant Community Health NEeds Assessment (CHNA) and community benefit planning processes. The Hospital and The Partnership have conducted multiple previous needs assessments, have made real progress towards community engagement in these processes and have integrated annual measurement systems into the health improvement work known as "Healthy Carroll Vital Signs (HCVS)." These measures build on national benchmarks and improvement targets such as HP 2020. Future editions of Healthy Carroll Vital Signs will also integrate S.H.I.P. 2014 benchmarks and improvment targets. IN TY 2011, the Hospital, in collaboration with The Partnership, began the process of undertaking the CHNA for the Carroll Hospital Center hospital facility. The Hospital expects that this CHNA will be completed in June 2013. The CHNA process being pursued by the Hospital will be in compliance with the IRS requirements. Furthermore the CHNA assessment and documentation process will assure the Hospital's ablility to develop a Hospital Board approved Community Benefits Plan for review and action by the Hospital's Board of Directors by spring 2013, as well as action by the Hospital to pursue and analyze the CHNA Implementation Strategy adopted by the Hospital thereafter. PATIENTS EDUCATION OF ELIGIBILITY FOR ASSISTANCE PART VI, LINE 3 CARROLL HOSPITAL CENTER (CHC) HAS A NUMBER OF PROGRAMS TO ASSIST PATIENTS WITH THEIR PAYMENT OBLIGATIONS. FIRST, WE PROVIDE A MEDICAID ENROLLMENT SERVICE TO PATIENTS WHO QUALIFY FOR MEDICAL ASSISTANCE. THIS SERVICE ASSISTS PATIENTS WITH PAPERWORK AND WILL EVEN PROVIDE TRANSPORTATION IF NEEDED. THIS PAST YEAR, CHC ASSISTED 310 PATIENTS IN APPLYING FO THE STATE'S MEDICAL ASSISTANCE PROGRAM. IN ADDITION, THE HOSPITAL HELD A, FREE ENROLLMENT SESSION FOR "COVER THE UNINSURED DAY' FOR UNINSURED COMMUNITY MEMBERS TO COME IN TO SEE IF THEY QUALIFIED FOR MEDICAL OR FNINANCIAL ASSISTANCE. FOR PATIENTS WHO DO NOT QUALIFY FOR MEDICAID COVERAGE, CHC HAS AN IN-HOUSE FINANCIAL ASSISTANCE PROGRAM. OUR ELIGIBILITY STANDARDS ARE MORE LENIENT THAN EVEN THOSE PROPOSED BY THE MARYLAND HOSPITAL ASSOCIATION GUIDELINES. WE WRITE OFF 100% OF THE BILL FOR PATIENTS WHOSE INCOME IS BELOW 300% OF THE FEDERAL POVERTY GUIDELINES (FPG) AND WRITE OFF A PORTION OF THE BILL FOR PATIENTS WHOSE INCOME IS BETWEEN 301%-375% OF THE FPG. WHEN PATIENTS EXPRESS THEIR INABILITY TO PAY FOR SERVICES, OUR STAFF WORKS TO FIND THE BEST POSSIBLE OPTION FOR THEM BY DISCUSSING IN DETAIL THEIR SITUATION. THE FAMILY IS INVOLVED IN THOSE CONVERSATIONS TO THE EXTENT THE PATIENT FEELS COMFORTABLE. THE HOSPITAL ALSO HAS A PROCESS IN PLACE FOR PATIENTS TO HAVE FINANCIAL ASSISTANCE DECISIONS RECONSIDERED AND THAT PROCESS IS CLEARLY OUTLINED IN OUR FINANCIAL ASSISTANCE POLICY AND IN INFORMATION PROVIDED TO OUR PATIENTS. IN ADDITION, FOR PATIENTS WITH INCOME BELOW 500% OF THE FPG AND WHOSE MEDICAL DEBT AT CHC IS IN EXCESS OF 25% OF THEIR HOUSEHOLD INCOME, THE HOSPITAL HAS A MEDICAL HARDSHIP PLAN THAT PROVIDES FOR REDUCED-COST CARE. THE HOSPITAL POSTS A SUMMARY OF ITS FINANCIAL ASSISTANCE POLICY, INFORMING PATIENTS OF THE AVAILABILITY OF FINANCIAL ASSISTANCE, IN ALL REGISTRATION AND INTAKE AREAS FOR ALL PATIENTS TO SEE. IN ADDITION, DETAILED INFORMATION ON OUR FINANCIAL ASSISTANCE POLICY IS INCLUDED IN EVERY ADMISSION FOLDER, ON BILLS MAILED TO PATIENTS AND ON THE HOSPITAL'S WEBSITE (WWW.CARROLLHOSPITALCENTER.ORG). COMMUNITY INFORMATION PART VI, LINE 4 AS THE ONLY HOSPITAL IN THE COUNTY, CHC'S PRIMARY SERVICE AREA IS THE ENTIRE COUNTY. THE HOSPITAL DOES, HOWEVER, ALSO SERVE PORTIONS OF BALTIMORE, FREDERICK AND MONTGOMERY COUNTIES AS WELL AS AREAS IN SOUTHERN PENNSYLVANIA. THE GENERAL DEMOGRAPHICS FOR OUR PRIMARY COMMUNITY (CARROLL COUNTY) ARE LISTED BELOW: POPULATION TOTAL POPULATION 2011: 167,288 POPULATION PERCENT CHANGE 2010 TO 2011: 0.1% PERSONS UNDER 5 YEARS PERCENT 2011: 5.1% PERSONS UNDER 18 YEARS PERCENT 2011: 23.8% PERSONS 65 YEARS AND OVER PERCENT 2011: 13.5% FEMALE PERSONS, PERCENT 2011: 50.6% RACE WHITE PERSONS: 93.2% BLACK PERSONS: 3.5% AMERICAN INDIAN AND ALASKA NATIVE PERSONS: 0.2% ASIAN PERSONS: 1.5% NATIVE AMERICAN AND OTHER PACIFIC ISLANDER: 0 PERSONS REPORTING TWO OR MORE RACES: 1.5% PERSONS OF HISPANIC OR LATINO ORIGIN: 2.8% WHITE PERSONS NOT HISPANIC: 90.8% SOURCE: SOURCE US CENSUS BUREAU: STATE AND COUNTY QUICKFACTS. FAMILY TOTAL NUMBER OF HOUSEHOLDS (2007-2011): 59,314 AVERAGE HOUSEHOLD SIZE (2007-2011): 2.75 PERSONS SOURCE: US CENSUS BUREAU: STATE AND COUNTY QUICK FACTS. ECONOMICS MEDIAN HOUSEHOLD INCOME (2007-2011): $83,325 PERSONS BELOW POVERTY LEVEL, PERCENT (2007-2011): 5.6% SOURCES: CARROLL COUNTY DEPARTMENT OF ECONOMIC DEVELOPMENT AND US CENSUS BUREAU: STATE AND COUNTY QUICKFACTS. OTHER SIGNIFICANT DEMOGRAPHIC CHARACTERISTICS ACCORDING TO AMREICAN COMMUNITY SURVEY (2011) THE PERCENTAGE OF UNINSURED PATIENTS IN CARROLL COUNTY IS 6.6%. IN TY 2011, OF THE CARROLL COUNTY RESIDENTS THAT WERE HOSPITALIZED (EITHER AT CHC OR OTHER HOSPITALS), 10.4% WERE ENROLLED IN MEDICAL ASSISTANCE PROGRAMS IN CARROLL COUNTY, WHICH INCLUDES MCHIP, PAC, AND MEDICAL ASSISTANCE. THE AVERAGE LIFE EXPECTANCY WITH CARROLL COUNTY WAS 79.6. PROMOTION OF COMMUNITY HEALTH PART VI, LINE 5 Carroll Hospital Center, founded in 1961, is the sole hospital serving the jurisdiction of Carroll County, Maryland with a FY 2012 population estimated at more than 168,000 persons. Carroll Hospital Center is the second -largest employer in Carroll County with over 1,750 Associates in FY 2012. Carroll Hospital Center is accredited with commendation by the Joint Commission. Our governing body is comprised predominantly of independent leaders representative of our community who assure that all financial surpluses the hospital generates are used exclusively to further the charitable purposes of the organization. We are a not-for-profit organization with diverse service lines including comprehensive acute care such as medical, surgical, peri-natal, pediatrics, psychiatry, medical and radiation oncology, adult intensive care and cardiovascular services, including emergency Percutaneous interventional heart surgery. Both home-based and inpatient Hospice care is provided through our affiliated agency, Carroll Hospice Inc. Diverse diagnostic services are provided at multiple locations and include both laboratory and radiologic capabilities. We participate in Medicare and Medicaid programs. There are more than 400 Physicians representing 38 specialties on our medical staff whose membership is open to all qualified area physicians. We operate an Emergency Department (ED) serving all persons regardless of ability to pay. The ED had over 56,000 patient visits in FY 2012 and we also recorded 12,276 inpatient admissions, 2,807 observation stay cases, 1,128 births and approximately 8,485 surgical procedures. An extensive network of hospital operated physician practices assures adequate availability of both primary and specialty care physicians throughout the service area-meeting the Carroll Hospital Center standards of excellence and incorporating the same values and principles. Building on our long tradition of collaboration with our local residents, the hospital in joint effort with the Carroll County Health Department, established The Partnership for a Healthier Carroll County, Inc. (The Partnership) in 1999 to link hospital strengths, alongside those of other well-established community partners to achieve an improved health status. The Partnership is a related Section 501(c)(3) tax-exempt organization of Carroll Hospital Center, which receives a majority of its operating funds from contributions made directly by the Hospital. The Partnership was established to: * Assess unmet health needs in our community * Expand the capacity for health and quality of life improvement in our community * Serve as our collaborative vehicle for interaction with the community * Drive the effort to create a healthier Carroll County community. This strategy has allowed Carroll Hospital Center to remain continually well-connected to the community, to leverage our resources in action alongside those of other key organizations and agencies (particularly, the Carroll county health department) and to assure measurable results. Monitoring the health status of the community is an ongoing and interactive process engaged in by Carroll Hospital Center and The Partnership. Carroll Hospital Center and The Partnership pursue improvement in the core health improvement areas (CHIAs) via Leadership Teams comprised of diverse individuals and organizations who share expertise and interest in the CHIA. Those leaders develop and implement action plans specifically intended to accomplish targeted results. "Healthy Carroll Vital Signs" are then affirmed, are specific to each CHIA Leadership Team and serve as one of the primary tools for results reporting. www.HealthyCarroll.org is The Partnership's website where current secondary data, national benchmarks, improvement targets and best practice references are easily available, are as current as available and are available to anyone at no cost. Carroll Hospital Center has long recognized that promoting the Health of its community is one of its essential responsibilities. Extensive community outreach and learning programs are offered by the hospital with an emphasis on disease prevention, early intervention and wellness. In FY 2012 we expanded on an integrated approach to population health; seeking to assure access to excellent health care and disease management assistance. Our integrated approach recognizes and strives to eliminate barriers such as transportation challenges or limited abilities to purchase essential prescription products; it also includes more in-community care coordination and assistance with navigating the often complex world of health care associated services. CHC is one of the founding and funding partners in a unique and highly successful integrated primary care center known as Access Carroll. Inc. At Access Carroll, Inc. the barriers of low income and ineligibility for state, federal or other insurance assistance are being eliminated for significant numbers of Carroll County residents who are receiving the same stellar integrated primary and specialty care services needed to manage their acute and/or chronic disease issues as their higher income and insured neighbors. In addition to primary and specialty medical care and care management navigation assistance, the Access Carroll patients receive diagnostic laboratory and radiology services, prescription assistance (more than $1,000,000 retail value in FY 2012 from Pharmaceutical Prescription Assistance Programs coordinated by Access Carroll) and more. Carroll Hospital Center contributed $259,068 to Access Carroll in FY12 to cover salary and benefit expenses for the executive director, one full time RN case manager and two part-time positions (aide and development specialist), as well as additional funds toward their facility move and expansion. The hospital also provides laboratory and diagnostic imaging services to Access Carroll captured under Charity Care, which totaled $282,910 in FY12. Many Carroll Hospital Center affiliated physicians and specialists donate their time to and accept referrals from Access Carroll. In FY12, Access Carroll had 40,135 patient encounters. These health promotion efforts are in addition to programs and services that seek to also help people change their lifestyles to move toward a state of optimal health in mind, body and spirit. Carroll Hospital Center demonstrates its commitment to improving the health and wellness of the communities it serves by providing services and programs that address critical needs, including health care to vulnerable or underserved people; public health programs; and health education, screening and prevention services. As reported in the Fy 2012 State of Maryland Health Services Cost Review Commission (HSCRC) Community Benefit Report, Carroll Hospital Center provided $14,918,396 (net of revenues) on programs and activities benefiting the communities we serve. These programs and activities included hospice services, physician support, charity/uncompensated care, education programs, health screenings, support groups, health professions education and community contributions. The hospital's community education and wellness efforts are led by community educators in The Women's Place and The Learning Center departments, in coordination with The Partnership for a Healthier Carroll County, so as to maximize strategies and programs in addressing community health needs. Carroll Hospital Center, in Fy 2012, had 21,109 encounters in Community Health Education activities, 2,520 encounters for Support Groups, 153 encounters for Self-help programs and 1,825 encounters for screenings. Carroll Hospital Center offers these programs and services not only to address the needs of people with chronic or acute medical issues, but also to address prevention and education to keep our population well. The following are five examples of initiatives with measurable outcomes. Initiative A. Total Health Expo 2011 Costs: $32,732 Description: To provide free and low-cost screenings, as well as health and wellness educational informaiton, all in one free, fun event designed for the whole family. The free event included: * Free and low-cost screenings * Medical assistance enrollment & information * Health information booths * Kids activities * Interactive educational displays on nutrition, heart health, behavioral health, sleep disorders, cancer education, health department resources, prenatal resources, diabetes, concussion awareness, durable medical equipment, car seat safety, medication safety and more. * Physical activities * Adult CPR class * Complementary health mini-treatments * Healthy lunch free for all attendees * AND MORE! Participants were encouraged to fill out a healthy passport by visiting at least 4 educational booths and one screening. Completed passports were entered in a drawing for prizes. Outcome/results: * More than 300 people attended. More than 350 encounters with screenings, complementary health treatments and cla AFFILIATED HEALTH CARE SYSTEM PART VI, LINE 6 Carroll Hospital Center is part of an affiliated health care system that provides an array of health care services to its community. The Hospital, as a sole community provider, provides both inpatient and outpatient care, including essential health care services such as obstetrics, emergency services, pediatric, and critical care, which would likely otherwise not be provided within Carroll County due to their unprofitable nature (high cost services with relatively low reimbursement). Additionally, the Hospital is the sole member and employer of a group physician practice (Carroll Health Group), which provides primary and specialty care services to the community. The provision of the physician service helps meet an identified community health need for additional primary and specialty care physicians in the community. The physician practice runs at a substantial operating loss ($____ million in 2012), which is funded by contributions from Carroll Hospital Center. Carroll Hospice, an affiliate of Carroll Hospital Center, provides inpatient hospice care, as well as residential hospice and palliative care, to patients nearing the end-of-life. Carroll Hospice provides pain management and symptom control and helps coordinate home and inpatient services. In order to provide comprehensive and compassionate care, Carroll Hospice utilizes an interdisciplinary team, including physicians, nurses, social workers, clergy, pharmacists, and home health aides. Further, Carroll Hospice provides bereavement care for family members for up to thirteen months. STATE FILING OF COMMUNITY BENEFIT REPORT 990 SCHEDULE H, PART VI MD, true PARTNERSHIP FOR HEALTHIER CARROLL COUNTY 95 CARROLL ST WESTMINSTER MD 21157 155000 Hospital contribution to support the programs of the Partnership part i, line 2 The grant provided is to a related organization that is controlled by the organiYation and is a joint venture with the Carroll County Health department. The Partnership for a Healthier Carroll County is a 501(c)(3) tax-exempt organization that is dedicated to improving the health and quality of life of individuals living in Carroll County, Maryland. X X true true X X X X X false true false false false false false false false JOHN SERNULKA 243112 0 136955 0 29194 0 272296 0 18248 0 699805 0 LESLIE SIMMONS 254441 0 47184 0 28054 0 7489 0 18537 0 355705 0 KEVIN KELBLY 267672 0 52971 0 30108 0 11632 0 17180 0 379563 0 DAVID HORN 169233 0 34999 0 10854 0 5453 0 18499 0 239038 0 M ELLEN FINNERTY MYERS 185011 0 25946 0 11495 0 5549 0 886 0 228887 0 KEVIN SMOTHERS 325807 0 65784 0 29562 0 4103 0 18537 0 443793 0 JOYCE ROMANS 181379 0 18234 0 11912 0 2842 0 12236 0 226603 0 TRACEY ELLISON 163062 0 24303 0 10214 0 0 0 0 0 197579 0 FLAVIO KRUTER 300503 0 105671 0 68842 0 0 0 9947 0 484963 0 JEROME MARAVE 220839 0 0 0 2286 0 4114 0 11037 0 238276 0 DAVID SALINGER 240152 0 49842 0 11067 0 403 0 9203 0 310667 0 DEE HUBBARD 239069 0 24823 0 774 0 464 0 17166 0 282296 0 STEPHANIE REID 146640 0 17970 0 6300 0 5962 0 820 0 177692 0 AMANDEEP SINGH 228276 0 16562 0 162 0 1193 0 18537 0 264730 0 DAVID LOUDER 274954 0 34888 0 15039 0 1225 0 910 0 327016 0 PART I LINE 1A The Hospital has taken the position that it will include in taxable W-2 wages for the President and CFO certain business expenses that the IRS may question as not being tax deductible, so long as such expenses have a direct connection to the promotion of the Hospital's health care services. For 2011, these expenses were less than 3,000 in aggregate, for the President and CFO. Health or social club dues or initiation fees for the President were reimbursed by the Hospital and included on the President's W-2. The amount of the reimbursed fees was considered in the process for determining the President's compensation. nonqualified retirement plan The following employees participated in the organization's 457(f) deferred compensation plans and were paid and/or credited with the following amounts: John Sernulka - 260,900 MARYLAND HEALTH AND HIGHER EDUCATION FAC AUTHORITY 520936091 574217B53 2006-12-07 36179115 HOSPITAL RENOVATIONS AND EQUIPMENT false false false MARYLAND HEALTH & HIGHER EDUCATIONAL FAC AUTHORITY 520936091 000000000 2010-06-30 15000000 HOSPITAL RENOVATIONS AND EQUIPMENT false false false MARYLAND HEALTH & HIGHER EDUCATIONAL FAC AUTHORITY 520936091 574218HJ5 2012-05-31 93596537 REFUND 2002 BONDS, FAC ACQ, RENOVA false false false 0 0 38924938 3229120 0 0 683750 0 0 35012068 0 0 2009 false false true true 660640 0 15000000 0 0 0 255500 0 0 14744500 0 0 2010 false false true true 0 0 93596537 0 0 0 100764 0 0 9022546 78596537 5876690 2012 true false false true false false true true false 0 0.01000 0.01000 true false false true true false 0 0.01000 0.01000 true false false true true true true 0 0.01000 0.01000 true false false false 0 false 0 false true false true false 0 false 0 false true false true false 0 false 0 false true X SUPPLEMENTAL INFORMATION 0 DIFFERENCES BETWEEN ISSUE PRICE REPORTED IN PART I, COLUMN E AND TOTAL PROCEEDS REPORTED IN PART II, LINE 3 ARE ATTRIBUTABLE TO INVESTMENT EARNINGS AND CHANGES IN AMOUNTS REQUIRED TO BE HELD IN RESERVE FUNDS. KATHLEEN PALAIA SISTER/DAUGHTER DIRECTOR 85056 EMPLOYEE OF THE HOSPITAL false HEATHER SIMMONS DAUGHTER OF AN OFFICER 72217 EMPLOYEE OF THE HOSPITAL false CHELSEY SIMMONS DAUGHTER OF AN OFFICER 29884 EMPLOYEE OF THE HOSPITAL false ROBERT J BEAUVAIS SON-IN-LAW OF AN OFFICER 52916 EMPLOYEE OF THE HOSPITAL false FAMILY OR BUSINESS RELATIONSHIP PART VI LINE 2 CHARLES FISHER SR AND CHARLES FISHER JR HAVE A FATHER/SON RELATIONSHIP. CHARLES FISHER SR AND CHARLES FISHER JR HAVE A BUSINESS RELATIONSHIP. MIRIAM BECK AND JEFF WOTHERS HAVE A MOTHER-N-LAW/SON-N-LAW RELATIONSHIP. DESCRIPTION OF REVIEW PROCESS PART VI LINE 11 The Hospital's Form 990 is reviewed in detail between the preparer, an outside accounting firm, and the Finance Department of the Hospital. A copy of the draft Form 990 is presented to the Hospital's Risk, Audit and Compliance ("RAC") Committee, at which time RAC Committee members may ask any questions or provide comments regarding the draft Form 990. Prior to filing the Form 990, the Hospital provides a copy of the Form 990 to each member of the Board of Directors for their review, questions, and comments, which feedback is then incorporated into the filed Form 990. CONFLICTS MONITORING AND ENFORCEMENT PART VI LINE 12C The Conflict of Interest Policy applies to Carroll Hospital Center and its direct and indirect subsidiaries and parent organization. Review of Disclosure Statements/Report to the Board. The Chief Executive Officer of the Hospital Organization, the Governance Committee and the Corporate Compliance Officer shall review the matters disclosed in the Disclosure Statements and shall submit to the Hospital Organization's Board of Directors an annual summary or spreadsheet of the disclosures and his or her recommendation for the resolution of any conflicts disclosed. In formulating recommendations, the Chief Executive Officer shall consult with appropriate officers of the Hospital Organization and counsel as necessary. The Board of Directors of the Hospital Organization, acting in the best interests of the Hospital Organization, shall have sole discretion to make all final decisions regarding conflicts of interest, other than those regarding gifts to Hospital Organization employees which shall be resolved by the appropriate supervisory executive. However, no person shall be involved in considering the existence of an actual or potential conflict of interest, in the management and oversight of a conflict relationship, or in the determination of discipline for violations of this Policy, if that person is a party or potential party to that conflict. All final decisions regarding conflicts of interest shall be reflected in a revised annual summary or spreadsheet of conflict disclosures which will be shared with each director. The Chair and Vice-Chair of the Board, and all Board committee chairs, shall have this revised summary or spreadsheet available at the time of all Board and Board committee meetings in case a matter involving a potential conflict arises. CONFLICT OF INTEREST RECUSAL PROCEDURE FOR BOARD MEETINGS Whenever a Hospital Organizations' Board or Board committee is to consider a transaction or an arrangement with another organization, entity or individual in which or with whom a person covered by this Policy has a relationship creating an actual or potential conflict of interest, the following procedures shall be employed: A. The interested person must fully disclose the actual or potential conflict of interest to the Board; B. The interested person should be asked to leave the meeting during discussion of the potential conflict and any related votes, but the interested person may make a statement or answer any questions on the matter before departing the meeting; C. If appropriate, the Board or Board committee may appoint a non-interested person or committee to investigate alternatives to the proposed transaction or arrangement; D. To consider the proposed transaction or arrangement, the Board must: 1. find, by a majority vote of directors then in office, not counting the interested person, that the proposed transaction or arrangement is in the Hospital Organization's best interest and for the Hospital Organization's own benefit, it is fair and reasonable, and that, after reasonable investigation, the Hospital Organization cannot obtain a more advantageous transaction or arrangement using reasonable efforts; and 2. vote on the transaction or arrangement, approval requiring a majority vote of directors then in office, not counting the interested person. E. The minutes should include: (1) the name of the person disclosing the conflict of interest and a description of the conflict; (2) the Board's determination of whether there is a conflict; (3) the names and votes of persons present for the discussions and votes relating to the transaction or arrangement; and (4) the content of those discussions including the Board's determination of whether or not the transaction or arrangement is in the Hospital Organization's best interest, fair and reasonable, and the best reasonably available alternative Ongoing Duty to Disclose One's Own or Others' Conflicts of Interest. As an actual or potential conflict of interest can arise at any time, any actual or potential conflict must be disclosed promptly in writing by use of a supplemental Disclosure Statement, as soon as its existence is or should be known. If a person is in doubt about a situation, the person should consult with the Chief Executive Officer, Board Chairman or the Hospital Organization's Compliance Officer. Persons should err on the side of disclosure so that a conflict of interest assessment can be made. The potential conflict will be referred to the Governance committee for review and a response will be provided within 14 days. Noncompliance with the policy: The Organization's Board of Directors retains broad power and sole discretion under this Policy to: (1) determine the existence of actual or potential conflicts of interest; (2) subject conflict of interest relationships to appropriate oversight, management, conditions, restrictions and prohibitions; and (3) impose appropriate sanctions. A breach of this Policy can become grounds for discipline, up to and including removal from office or, for management personnel, termination of employment. It may also result in cessation of business with a vendor and in liability for damages. Grounds for discipline include, but are not limited to: A. willful failure to sign and return the Conflict of Interest Disclosure Statement in accord with this Policy; B. a material misstatement or omission in the Disclosure Statement; C. willful failure to disclose an actual or potential conflict of interest at any time in accord with the requirements of this Policy; D. willful participation in a vote or decision involving a transaction which raises an undisclosed conflict of interest; or E. willful disclosure or use of confidential information regarding the affairs, business or plans of a Hospital Organization for any purpose other than in furtherance of the affairs and best interests of the Hospital Organization. PROCESS FOR DETERMINING COMPENSATION PART VI LINE 15 THE EXECUTIVE COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS OF CARROLL HOSPITAL CENTER, WHICH IS COMPRISED OF INDEPENDENT BOARD MEMBERS DETERMINED TO BE FREE OF ANY CONFLICT OF INTEREST, IS CHARGED WITH DETERMINING EXECUTIVE COMPENSATION AND ESTABLISHING PERFORMANCE CRITERIA ACCORDING TO AN APPROVED COMPENSATION PHILOSOPHY. THE COMMITTEE WORKS WITH AN INDEPENDENT EXECUTIVE COMPENSATION CONSULTING AND ADVISORY FIRM, YAFFE & COMPANY, THAT PROVIDES MARKET SURVEY DATA CONCERNING COMPENSATION AND BENEFIT LEVELS FOR FUNCTIONALLY COMPARABLE HEALTHCARE EXECUTIVES IN SIMILAR HOSPITALS ACROSS THE REGION AND THE NATION BASED ON SEVERAL FACTORS INCLUDING SIZE, GEOGRAPHY, HOSPITAL TYPE AND COMPLEXITY. THE COMMITTEE REVIEWS AND APPROVES THE COMPENSATION OF THE SENIOR EXECUTIVES AND ENSURES THAT ALL FORMS OF EXECUTIVE COMPENSATION ARE REASONABLE, APPROPRIATE AND CONSISTENT WITH ITS COMPENSATION PHILOSOPHY. THE COMMITTEE CONTEMORANEOUSLY DOCUMENTS ITS DECISIONS IN MEETING MINUTES. DOCUMENT AVAILABILITY PART VI, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. RECONCILIATION OF NET ASSETS PART XI, LINE 5 UNREALIZED Loss $( 1,776,104) BOOK/TAX DIFFERENCE K-1 ( 2,133,773) INTEREST RATE ADJUST ON INVEST (11,115,765) changes to investment 130,967 investment in cc med-services (14,809,540) ----------- TOTAL $(29,704,215) HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:CHARLES O FISHER JR TITLE:DIRECTOR HOURS:1 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:MIRIAM BECK TITLE:DIRECTOR HOURS:1 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:ETHAN SEIDEL TITLE:DIRECTOR HOURS:1 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:JOHN SERNULKA TITLE:PRESIDENT HOURS:5 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:KIMBERLY JOHNSTON MD TITLE:BOARD MEMBER HOURS:1 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:HAROLD WALSH TITLE:BOARD MEMBER HOURS:1 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:HELEN W WHITEHEAD TITLE:BOARD MEMBER HOURS:1 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:SYED HOSAIN MD TITLE:BOARD MEMBER HOURS: HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:THOMAS WELLIVER TITLE:BOARD MEMBER HOURS:1 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:JEFFREY A WOTHERS TITLE:BOARD MEMBER HOURS:1 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:W DENNIS THOMAS TITLE:BOARD MEMBER HOURS:1 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:GERALD LEE STURGILL TITLE:BOARD MEMBER HOURS:2 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:LARRY VAN SANT SR TITLE:BOARD MEMBER HOURS:1 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:JOHN STEERS MD TITLE:BOARD MEMBER HOURS:1 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:MARTIN HILL TITLE:BOARD MEMBER HOURS:1 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:CHARLES O FISHER, SR TITLE:DIRECTOR HOURS:1 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:CHRISTOS BALLAS TITLE:DIRECTOR HOURS:1 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:STEPHAN HOCHULI, MD TITLE:DIRECTOR HOURS:1 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:PAULA LANGMEAD TITLE:DIRECTOR HOURS:1 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:JACK TEVIS TITLE:DIRECTOR HOURS:1 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:LESLIE SIMMONS TITLE:CHIEF OPERATING OFFICER HOURS:2 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:KEVIN KELBLY TITLE:SR VP FINANCE CFO HOURS:6 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:KEVIN SMOTHERS TITLE:CHIEF MEDICAL OFFICER HOURS: HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:STEPHANIE REID TITLE:ASSISTANT VICE PRESIDENT HOURS: HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:DAVID HORN TITLE:VICE PRESIDENT HOURS: HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:M ELLEN FINNERTY MYERS TITLE:VICE PRESIDENT HOURS:20 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:JOYCE ROMANS TITLE:VICE PRESIDENT HOURS: HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:TRACEY ELLISON TITLE:VICE PRESIDENT HOURS: HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:DAVID LOUDER TITLE:VICE PRESIDENT HOURS: HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:FLAVIO KRUTER TITLE:PHYSICIAN HOURS:2 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:JEROME MARAVE TITLE:PHYSICIAN HOURS: HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:DAVID SALINGER TITLE:PHYSICIAN HOURS:1 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:DEE HUBBARD TITLE:PHYSICIAN HOURS: HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:AMANDEEP SINGH TITLE:PHYSICIAN HOURS: OTHER EXPENSES FORM 990 PART IX DESCRIPTION:SUPPLIES TOTAL EXPENSES:710595 PROGRAM SERVICES:678383 MANAGEMENT AND GENERAL:32212 OTHER EXPENSES FORM 990 PART IX DESCRIPTION:REPAIRS AND MAINT TOTAL EXPENSES:1325580 PROGRAM SERVICES:1279640 MANAGEMENT AND GENERAL:45940 OTHER EXPENSES FORM 990 PART IX DESCRIPTION:DUES BOOKS AND SUBS TOTAL EXPENSES:1795641 PROGRAM SERVICES:343363 MANAGEMENT AND GENERAL:1452278 OTHER EXPENSES FORM 990 PART IX DESCRIPTION:LICENSES AND TAXES TOTAL EXPENSES:73834 PROGRAM SERVICES:25932 MANAGEMENT AND GENERAL:47902 OTHER EXPENSES FORM 990 PART IX DESCRIPTION:TELEPHONE AND CABLE TOTAL EXPENSES:338375 PROGRAM SERVICES:63196 MANAGEMENT AND GENERAL:275179 OTHER EXPENSES FORM 990 PART IX DESCRIPTION:EQUIPMENT RENTALS TOTAL EXPENSES:1212791 PROGRAM SERVICES:791613 MANAGEMENT AND GENERAL:421178 OTHER EXPENSES FORM 990 PART IX DESCRIPTION:PROFESSIONAL FEES TOTAL EXPENSES:11078083 PROGRAM SERVICES:9187491 MANAGEMENT AND GENERAL:1890592 OTHER EXPENSES FORM 990 PART IX DESCRIPTION:BAD DEBTS TOTAL EXPENSES:8854060 PROGRAM SERVICES:8854060 OTHER EXPENSES FORM 990 PART IX DESCRIPTION:K-1 GREENSPRING GLOBAL TOTAL EXPENSES:9333 MANAGEMENT AND GENERAL:9333 OTHER 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