2013-05-14T17:17:40-05:00 2012-06-30 Ernst & Young US LLP 155 NORTH WACKER DRIVE CHICAGO IL 60606 990 2011-07-01 520591612 Frederick Memorial Hospital Inc % MICHELLE MAHAN FRED 2405663300 400 WEST SEVENTH STREET FREDERICK MD 21701 Michelle Mahan 2013-05-14 true 3128792000 2011 2016-02-24 21:20:13Z THOMAS A KLEINHANZL 400 WEST 7TH STREET FREDERICK MD 21701 398441099 false X WWW.FMH.ORG X 1897 MD TO CONTRIBUTE TO THE HEALTH AND WELL-BEING OF AREA RESIDENTS BY PROVIDING QUALITY HEALTHCARE IN A CARING, COST EFFICIENT, SAFE AND CONVENIENT MANNER. 18 13 3233 790 9843 1975386 1544404 340072234 349642033 7459520 5813060 -876778 -454399 348630362 356545098 100000 100000 0 0 167577086 178059458 0 0 760292 164986730 171529894 332663816 349689352 15966546 6855746 406175936 415327620 228526672 253045947 177649264 162281673 X SEE SCHEDULE O. false false 40119017 100000 62184089 In FY2012, Frederick Memorial Hospital's Inpatient Medical-Surgical Departments provided quality, patient-centered care, regardless of ability to pay, to approximately 22,758 inpatients and observation patients. Major Medical and Surgical Services include Cardiology, Congestive Heart Failure, Post-Cardiac Catheterization, Center for Chest Pain, Hemodialysis, Peritoneal Dialysis, Neurology, Neurosurgery, Pulmonology, Oncology, Orthopedics, General Medicine and Surgical Care. Inpatient care is supported by a team of Board-Certified Physician Hospitalists. In 2012 FMH opened a brand new 12-bed inpatient unit specializing in the care of patients requiring Medical and Surgical Oncology, Thoracic Surgery, and Inpatient Hospice Care. This unit was designed with the patient and family at the center of thought in all planning activities. The FMH Joint Works Program received the UnitedHealth Premium Total Joint Replacement Specialty Center Designation in recognition of quality care, serving approximately 2,150 patients in 2012. In addition, FMH is designated as a Primary Stroke Center by the Maryland Institute of Emergency Medical Service Systems (MIEMSS) and we pursued and achieved the Stroke Center Gold Performance Award by the American Heart Association in 2012. In addition to the program services expense listed here, FMH incurred $37.7 million of general and administrative expenses in meeting the health needs of our primary service area. 20819263 28512457 FMH's Oncology Program provides integrated, multidisciplinary, patient centered cancer care for patients with malignancies, regardless of ability to pay. Services include medical oncology consultations, chemotherapy, radiation oncology consultations and treatment, and surgical oncology consultations and treatment. FMH offers coordinated multidisciplinary clinics for patients with cancers of the lung, breast and prostate. Integrated palliative care and hospice services, both inpatient and outpatient are available for patients with advanced malignancies. Support services include nutrition, patient navigation and social work, as well as other forms of psychosocial support. For those with additional financial need, financial counselors and a patient assistance fund are available. The program treats approximately 800 newly diagnosed cancers per year and also has a community outreach program that includes education and screening. This past year, educational seminars were held for the community on breast and prostate cancer, as well as a community screening event for prostate cancer. The program is accredited by the American College of Surgeons Commission on Cancer, and in 2013, received an award of exceptional achievement from the commission, meriting commendation in all 8 of the 8 assessed competencies. 36101543 50478801 PMH's Perioperative Services provided high quality care to 13,800 surgical and endoscopy patients in fiscal year 2012. Procedures were performed in our state of the art facility which includes a dedicated imaging room for vascular and other procedures. Our total joint replacement patients participate in a program deemed as a Center of Excellence. In FY2012 we performed thoracic and GYN robotics cases as our robotics program began. We have participated in the SCIP Quality improvement project for continual improvements in care following evidence based medicine. 214145953 208466686 311185776 true true false true false false false false false true true false true false true false false true false false true false false false false false true true true false true true false false false false false true false false false false true false false false true true true true false false true 301 0 true 3233 true true true false false false false false false false false false X 18 13 true false false false true true true true true false true false true true true true true true true true true false MD X MICHELLE MAHAN 2405663300 400 WEST 7TH STREET FREDERICK MD 21701 Thomas A Kleinhanzl 40.0 X X 700823 0 155432 Neil Waravdekar MD 10.0 X X 42319 0 0 Ravi Yalamanchili 6.0 X X 66499 0 0 Adriane Wodey 6.0 X X 0 0 0 Anne Herbert Rollins 6.0 X X 0 0 0 E James Reinsch 2.0 X X 0 0 0 Marvin Ausherman 2.0 X 0 0 0 James R Dixon 2.0 X 0 0 0 Gregory P Dormitzer 2.0 X 0 0 0 Bernard Gouin 2.0 X 0 0 0 Theodore Luck 2.0 X 0 0 0 J Frederick Manning 2.0 X 0 0 0 Joann Ramsburg 2.0 X 0 0 0 Adriana Roa BSN 2.0 X 0 0 0 Rev Roger W Wilmer Jr 2.0 X 0 0 0 Gerald Winnan MD 2.0 X 0 0 0 Shawn Wolf 2.0 X 0 0 0 Saeed Zaidi Md 2.0 X 1000 0 0 P Gregory Rausch MD 6.0 X 12883 0 0 Greg Powell PhD 8.0 X 0 0 0 John Molesworth DO 10.0 X 38997 0 0 Michelle Mahan 40.0 X 375640 0 64944 John Verbus 40.0 X 372760 0 39123 Manuel A Casiano 40.0 X 337731 0 68322 Kenneth R Coffey II 40.0 X 186802 0 28691 Hannah R Jacobs 40.0 X 149903 0 8115 Rose A Labriola 40.0 X 272122 0 25410 Terry P O'Malley 40.0 X 199161 0 40867 David Quike 40.0 X 247732 0 41398 Craig F Rosendale 40.0 X 187752 0 26913 Donald R Schilling 40.0 X 192473 0 22629 Lucy A Shamash 40.0 X 230036 0 16722 Jennifer G Teeter 40.0 X 157935 0 20774 Jim R Williams 40.0 X 194547 0 27217 Jared R Berkowitz 40.0 X 355730 0 19782 Paul N Chomiak 40.0 X 438131 0 24624 Elhamy D Eskander 40.0 X 382593 0 33609 Brian M O'Connor 40.0 X 383987 0 33976 Brian T Tully 40.0 X 354437 0 20064 5881993 0 718612 141 false true false TXTEAM REHAB INC 4625 East Stop 11 Road INDIANAPOLIS IN 46237 7390414 PRIME DOC OF FREDERICK PA PO Box 7568 ASHEVILLE NC 28802 2133254 ALLIANCE RADIOSURGERY LLC PO Box 6600 NEWPORT BEACH CA 92658 1945320 SLEEPMED DIGITRACE CARE SERVICES 200 Corporate Place PEABODY MA 01960 1051980 FIRST COLONIES ANESTHESIA ASSOCIATE 7490 New Technology Way FREDERICK MD 21703 1051094 23 1544404 26592 1544404 Inpatient Revenue 624100 168299302 168299302 Outpatient Revenue 621400 173056704 173056704 Transcription Services 561000 460187 460187 Group Purchasing (Premier) 525990 778773 768930 9843 Hitech and Medical Home Revenues 621610 4818644 4818644 2228423 2228423 349642033 3632188 3632188 0 0 572964 572964 572964 572964 44020960 55913 41773753 122248 2247207 -66335 2180872 2180872 0 0 0 Cafeteria and Coffee Shop 722210 1257794 1257794 Mt. 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ASC 740 FOOTNOTE DISCLOSURE FORM 990, SCHEDULE D, PART X, LINE 2 THERE WAS NO ASC 740 FOOTNOTE IN THE AUDITED FINANCIAL STATEMENTS BECAUSE THERE WERE NO MATERIAL UNCERTAIN TAX POSITIONS AS OF JUNE 30, 2012. Central America and the Caribbean 1 Investments 6574661 Central America and the Caribbean 1 Program Services Self-insurance 2347614 2 2 8922275 8922275 true false true false false false true true X true X true X true true true false true true 6928711 6928711 0.02060 31120266 21965939 9154327 0.02730 38048977 21965939 16083038 0.04790 2464195 871460 1592735 0.00470 115495 115495 0.00030 15424981 1968152 13456829 0.04010 174700 174700 0.00050 18179371 2839612 15339759 0.04560 56228348 24805551 31422797 0.09350 false 13840654 1384065 124665018 112121288 12543730 X true true 1 1 FREDERICK MEMORIAL HOSPITAL

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501 WEST SEVENTH STREET FREDERICK MD 21701

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1562 OPPOSSUMTOWN PIKE FREDERICK MD 21701

OUTPATIENT HLTH SRVC FACILITY UNION BRIDGE FAMILY PRACTICE

104 NORTH MAIN STREET UNION BRIDGE MD 21791

PHYSICIAN PRACTICE FMH Home Medical Equipment and Supplies

605 East Church Street FREDERICK MD 21701

DURABLE MEDICAL GOODS ORGANIZATION FMH Home Health Services

605 East Church Street Suite 2 FREDERICK MD 21701

HOME HEALTH NURSING ORG Hospice of Frederick County

PO Box 1799 516 Trail Ave FREDERICK MD 21702

HOSPICE CARE ORGANIZATION FMH Rose Hill Rehab Services

1562 Opossumtown Pike FREDERICK MD 21702

REHABILITATION CLINIC FMH CRESTWOOD

7211 Bank Court FREDERICK MD 21703

OUTPATIENT HLTH SRVC FACILITY FMH WELLNESS CENTER

5500 BUCKEYSTOWN PIKE FREDERICK MD 21702

HEALTH SERVICE CENTER FMH ECHO AND VASCULAR LAB

1560 OPPOSSUMTOWN PIKE FREDERICK MD 21702

HEALTH SERVICE CENTER FMH URBANA

3430 WORHTINGTON BLVD FREDERICK MD 21704

OUTPATIENT HLTH SRVC FACILITY FMH IMMEDIATE CARE

850 OAK STREET FREDERICK MD 21702

WALK-IN CLINIC SUPPLEMENTAL INFORMATION PART I, LINE 7B For the last 30 years, Maryland hospitals have met their community benefit obligations in a unique manner that builds the costs of uncompensated care (charity care and patient bad debt) and graduate medical education into the rates that hospitals are reimbursed by all payors. The system is based in federal and state law and benefits all Maryland residents, including those in need of financial assistance to pay their hospital bills. Maryland is the only state in which all payors (governmentally-insured, commercially-insured, or self-pay) are charged the same price for services at any given hospital. Under this system, Maryland hospitals are regulated by a state agency -the Health Services Cost Review Commission (HSCRC)-that is required to: -Publicly disclose information on the cost and financial position of hospitals; -Review and approve hospital rates; -Collect information detailing transactions between hospitals and firms with which their trustees have a financial interest; and, -Maintain the solvency of efficient and effective hospitals. Since 2000, the rate setting commission has had its own framework for reporting hospitals' community benefits and issuing a report annually regarding hospitals' community benefit totals. That report is available on http://www.hscrc.state.md.us/ Because of this unique structure Maryland hospitals' community benefits numbers will not compare with the rest of the nation's hospitals. However, Maryland hospitals meet or exceed the community benefit standard established by the IRS in 1969. Additional detail illustrating this can be found within this Schedule H report. PART I, LINE 7, COLUMN (F) Our total expense from Form 990, Part IX, Line 25, Column (A) is $349,689,352. The bad debt expense included in this amount is $13,840,654. This left a total expense of $335,848,698 for purposes of calculating Line 7, Column (F). PART I, LINE 7 Amounts were calculated using the cost-to-charge ratio derived from Worksheet 2. PART III, Line 4 The amount included in part III, line 2 is the amount of charges written off of patient accounts after pursuing payment and other alternatives such as qualifying the patient for charity care or for state and federal government programs. The charges are reduced to approximate cost using the cost to charge ratio computed in schedule h, worksheet 2. Any adjustments or payments received on accounts previously written off to bad debt have the impact of reducing the reported bad debt cost. fmh adopted FASB-issued ASU 2011-07 which provided guidance on the presentation and disclosure of patient service revenue, provisions for bad debts, and the allowance for doubtful accounts for certain health care entities effective for the fiscal year ending June 30, 2012. The Hospital's policy is to write off all patient accounts that have been identified as uncollectible. An allowance for doubtful accounts is recorded for accounts not yet written off that are anticipated to become uncollectible in future periods. Insurance coverage and credit information are obtained from patients when available. No collateral is obtained for accounts receivable. Accounts receivable from third-party payors have been adjusted to reflect the difference between charges and the estimated reimbursable amounts. Recoveries of previously written off patient receivables are recorded when received. PART III, LINE 8 AMOUNTS WERE CALCULATED USING THE COST-TO-CHARGE RATIO CALCULATED USING WORKSHEET 2. PART III, LINE 9B Patients who qualify for charity care or financial assistance are specifically excluded from the collection process. Part V, Sec B, Line 19d Maryland's HSCRC determines rates charged. NEEDS ASSESSMENT IN 2011, THE COMMUNITY FOUNDATION OF FREDERICK COUNTY COMMISSIONED A FREDERICK COUNTY HUMAN NEEDS ASSESSMENT. ONE OF THE PRIORITY AREAS COVERED IN THE ASSESSMENT WAS THE COUNTY'S HEALTH NEEDS. THREE AREAS WERE IDENTIFIED IN THE ASSESSMENT AS REQUIRING SPECIAL ATTENTION: 1. AFFORDABLE HEALTH CARE 2. A "MEDICAL HOME" FOR LOW-INCOME FAMILIES AND INDIVIDUALS 3. THE NEED FOR AFFORDABLE MENTAL HEALTH SERVICES LOCAL HEALTH IMPROVEMENT PRIORITY SETTING SUMMIT FREDERICK MEMORIAL HOSPITAL PARTNERED WITH THE FREDERICK COUNTY HEALTH DEPARTMENT AND THE FREDERICK COUNTY HEALTH CARE COALITION TO SPONSOR AND PARTICIPATE IN THE LOCAL HEALTH IMPROVEMENT PRIORITY (LHIP) SETTING SUMMIT. THE PURPOSE OF THE DAY-LONG SUMMIT WAS TO ESTABLISH THE PRIORITIES FOR HEALTH IMPROVEMENT IN FREDERICK COUNTY AND TO DEVELOP GOALS AND ACTION PLANS TO ACHIEVE IMPROVEMENT IN THOSE PRIORITY AREAS THROUGH COMMUNITY ENGAGEMENT. FREDERICK COUNTY LOCAL HEALTH IMPROVEMENT PLAN (LHIP) THE FREDERICK HEALTH IMPROVEMENT PLAN SETS FREDERICK-SPECIFIC OBJECTIVES FOR IMPROVING THE HEALTH OF FREDERICK COUNTY RESIDENTS. IN ADDITION, THE LHIP PRESENTS ACTION STEPS FOR HOW TO ACHIEVE THESE OBJECTIVES. THE PRIORITY AREAS INCLUDED IN THE DOCUMENT WERE CHOSEN BY THE OCTOBER 2011 SUMMIT ATTENDEES. ATTENDEES THEN MET IN WORKGROUPS TO CLARIFY AND DEFINE THE TOP 5 PRIORITIES FOR LOCAL HEALTH IMPROVEMENT. THOSE AREAS ARE: 1. MENTAL HEALTH 2. AFFORDABLE DENTAL CARE 3. WELLNESS & PREVENTION 4. HEALTH INEQUITIES AWARENESS 5. ACCESS TO CARE WHAT IS THE RELATIONSHIP OF THE LHIP TO HEALTHY PEOPLE 2020? HEALTHY PEOPLE 2020 PROVIDES SCIENCE-BASED, 10-YEAR NATIONAL OBJECTIVES FOR IMPROVING THE HEALTH OF ALL AMERICANS. FOR THREE DECADES, HEALTHY PEOPLE HAS ESTABLISHED BENCHMARKS AND MONITORED PROGRESS OVER TIME IN ORDER TO ENCOURAGE COLLABORATIONS ACROSS SECTORS; GUIDE INDIVIDUALS TOWARD MAKING INFORMED HEALTH DECISIONS; AND MEASURE THE IMPACT OF PREVENTION ACTIVITIES. THE FREDERICK COUNTY LOCAL HEALTH IMPROVEMENT PLAN FOCUSES ON A SMALL SUBSET OF THE CDC'S HEALTHY PEOPLE 2020 OBJECTIVES SO THAT (1) WE CAN FOCUS ON FACTORS THAT ARE MOST CRITICAL TO HEALTH EQUITY AND IMPROVING THE HEALTH OF ALL FREDERICK COUNTY RESIDENTS, (2) AND WE CAN MEASURE OUR SUCCESS AND IMPROVE OUR LEADERSHIP IF OUR PLANS AREN'T MEETING OUR GOALS. FREDERICK REGIONAL HEALTH SYSTEM'S COMMUNITY BENEFITS PROGRAM THE FINDINGS OF THE SURVEY TOOLS DESCRIBED ABOVE COINCIDE REMARKABLY WELL WITH THE HEALTH SYSTEM'S INTERNAL DATA THAT CLEARLY INDICATES THAT RESOURCES NEED TO FOCUS UPON THE SAME 5 AREAS OF NEED IDENTIFIED BY THE LOCAL HEALTH IMPROVEMENT PLAN AND THE HUMAN NEEDS ASSESSMENT. THESE DOCUMENTS AND OUR CLOSE WORKING RELATIONSHIP WITH THE FREDERICK COUNTY HEALTH DEPARTMENT AND THE FREDERICK COUNTY HEALTH CARE COALITION WILL HELP TO FOCUS THE HEALTH SYSTEM'S COMMUNITY BENEFITS PROGRAM MOVING FORWARD. FMH WILL ALLOCATE RESOURCES TO ADDRESS MORE SPECIFICALLY THOSE IDENTIFIED COMMUNITY NEEDS, WHILE CONTINUING TO PROVIDE EDUCATIONAL AND SUPPORT PROGRAMS, EARLY DETECTION SCREENINGS AND WELLNESS CLASSES, COUNSELING AND DEMONSTRATIONS TO A BROADER AUDIENCE IN OUR COMMUNITY. PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE Frederick Memorial Hospital posts its charity care policy and financial assistance contact information in admission areas, the FMH Emergency Department, and in all of our satellite facilities in areas where eligible patients are likely to present. FMH provides a summary of the Charity Care Policy and financial assistance contact information to all patients at the time of admission to the hospital. FMH admissions personnel discuss the availability of various government benefits such as Medicaid or state programs with patients and/or their family members, and they assist patients with qualification for the programs. Frederick Memorial Hospital increased its efforts to provide financial assistance to its patients through a variety of initiatives. FMH increased ITS financial assistance for catastrophic situations. In our program, patients may receive financial assistance if their bill is 25% or more of their annual income. In FY11 a financial counselor met with patients who had no insurance the day after admission to explain our financial assistance program and the state's medical assistance program. Because the meeting with the patient was early in their stay, the patient's accumulated charges typically did not reach a catastrophic stage. Therefore, we had patients who left the hospital without a detailed catastrophic financial assistance discussion and without a Financial Assistance application. Now, every inpatient or outpatient who accumulates $10,000 or more in charges will receive a second visit from a financial counselor along with a financial assistance application. Also, we mail these patients another financial assistance application with a cover letter stating that due to the balance of their bill, they may qualify for financial assistance. FREDERICK MEMORIAL HOSPITAL ATTEMPTS TO IDENTIFY AND NOTIFY ALL PATIENTS ELIGIBLE FOR FINANCIAL ASSISTANCE. ALL PATIENTS ARE NOTIFIED AT THE TIME OF REGISTRATION OF OUR FINANCIAL ASSISTANCE POLICY. DESPITE OUR EFFORTS, WE ESTIMATE AS MUCH AS 10% OF OUR BAD DEBT EXPENSE COULD BE THE RESULT OF A LACK OF INFORMATION ON PATIENTS THAT WOULD OTHERWIS true Frederick Community College 7932 Opossumtown pike Frederick MD 21702 520743590 501(c)(3) 100000 0 CASH N/A Support of Allied Health Education Program 1 0 Form 990, Schedule I Description of Organization's Procedures for Monitoring the Use of Grants THE HOSPITAL PROVIDES FUNDING TO A LOCAL COMMUNITY COLLEGE (501(C)(3)) IN AN EFFORT TO ENHANCE ITS ALLIED HEALTH PROGRAM. THROUGH THIS PROGRAM, A FORMAL EDUCATION FORUM IS ESTABLISHED RESULTING IN FULLY ACCREDITED PROGRAMS THAT MEET THE HOSPITAL'S NEEDS. X true true X X X X X false true false false false true false false false Thomas A Kleinhanzl 538976 0 158508 0 3339 0 140143 0 15289 0 856255 0 0 0 Manuel A Casiano 301303 0 34106 0 2322 0 53297 0 15025 0 406053 0 0 0 Kenneth R Coffey II 166646 0 17834 0 2322 0 14033 0 14658 0 215493 0 0 0 Hannah R Jacobs 149797 0 0 0 106 0 6968 0 1147 0 158018 0 0 0 Rose A Labriola 247013 0 22787 0 2322 0 12907 0 12503 0 297532 0 0 0 Michelle Mahan 306947 0 66371 0 2322 0 52758 0 12186 0 440584 0 0 0 Terry P O'Malley 175134 0 20463 0 3564 0 28959 0 11908 0 240028 0 0 0 David Quike 222503 0 24689 0 540 0 31378 0 10020 0 289130 0 0 0 Craig F Rosendale 166508 0 17680 0 3564 0 15075 0 11838 0 214665 0 0 0 Donald R Schilling 172429 0 17722 0 2322 0 10762 0 11867 0 215102 0 0 0 Lucy A Shamash 194576 0 34650 0 810 0 4809 0 11913 0 246758 0 0 0 Jennifer G Teeter 139821 0 16872 0 1242 0 9118 0 11656 0 178709 0 0 0 John Verbus 314939 0 55499 0 2322 0 31436 0 7687 0 411883 0 0 0 Jim R Williams 173541 0 18684 0 2322 0 15337 0 11880 0 221764 0 0 0 Jared R Berkowitz 355514 0 0 0 216 0 5638 0 14144 0 375512 0 0 0 Paul N Chomiak 437771 0 0 0 360 0 10216 0 14408 0 462755 0 0 0 Elhamy D Eskander 381561 0 0 0 1032 0 19201 0 14408 0 416202 0 0 0 Brian M O'Connor 382403 0 0 0 1584 0 19568 0 14408 0 417963 0 0 0 Brian T Tully 354245 0 0 0 192 0 5656 0 14408 0 374501 0 0 0 Supplemental Compensation Information SCHEDULE J, PART I, LINE 1 FREDERICK MEMORIAL HOSPITAL HOLDS TWO CORPORATE MEMBERSHIPS TO A LOCAL GOLF/COUNTRY CLUB THAT ARE USED BY THE CHIEF EXECUTIVE OFFICER AND THE CHIEF FUND DEVELOPMENT OFFICER OF THE HOSPITAL. WHILE THE MAJORITY OF THE FEES ASSOCIATED WITH THE CLUB DUES, ETC. IS BUSINESS RELATED, GENERAL PERSONAL USE EXPENSES ARE REIMBURSED BACK TO THE HOSPITAL BY THESE INDIVIDUALS AS NEEDED. SCHEDULE J, PART I, LINE 4B Frederick Memorial Hospital has one 457(f) non-qualified deferred compensation plan for certain members of senior management. Under the plan, they may contribute amounts from their compensation to the plan and may receive a discretionary employer contribution. Employees are fully vested in all employee contributions to the plan. Vesting in employer contributions occurs in accordance with the underlying plan documents. All assets of the plan are held in a separate trust. Total Hospital contributions to this plan were $191,707 and there were no payments from the Plan during the year. SCHEDULE J, PART I, LINE 6A THE EXECUTIVE COMPENSATION PROGRAM IS DESIGNED TO CARRY OUT THE HEALTH SYSTEM MISSION, TO ACHIEVE THE CHARITABLE PURPOSE, TO ATTRACT, RETAIN, MOTIVATE AND REWARD EXECUTIVE MANAGEMENT, AND TO MAINTAIN A COMPETITIVE POSITION WITH PEER ORGANIZATIONS IN THE REGION. OVERSIGHT OF THE EXECUTIVE COMPENSATION PROGRAM IS PROVIDED BY THE EXECUTIVE COMPENSATION COMMITTEE OF THE BOARD, COMPOSED OF THE BOARD CHAIR, VICE CHAIR, IMMEDIATE PRECEDING CHAIR, CHAIR OF THE FINANCE COMMITTEE AND CHAIR OF THE GOVERNANCE COMMITTEE. ANNUALLY, THE COMMITTEE REVIEWS AND RECOMMENDS TO THE BOARD VARIABLE PAY GOALS FOR THE COMING YEAR, AND PAYMENT LEVELS BASED ON PERFORMANCE FOR THE CURRENT YEAR. THE EXECUTIVE COMPENSATION PHILOSOPHY OF THE BOARD PROVIDES FOR BASE COMPENSATION AT THE 50TH TO 60TH PERCENTILE WITH VARIABLE PAY DESIGNED TO PROVIDE A TARGET OPPORTUNITY FOR TOTAL COMPENSATION TO REACH THE 75TH PERCENTILE. VARIABLE PAY CRITERIA ARE CLINICAL QUALITY (33%), CUSTOMER SERVICE (11%), PEOPLE (11%), FINANCIAL VIABILITY (28%), AND GROWTH (17%). GOALS USING THE VARIABLE PAY CRITERIA ARE ESTABLISHED AT BOTH THE CORPORATE AND INDIVIDUAL LEVEL. INDIVIDUAL PAYMENTS ARE BASED ON PERFORMANCE AGAINST CORPORATE GOALS, INDIVIDUALS GOALS, AND DISCRETION OF THE BOARD. MARYLAND HEALTH & HIGHER EDUC FACILITIES AUTHORITY 520936091 574217Y25 2008-07-09 72160000 SEE PART VI false false false 0 0 72160000 0 0 0 975844 166621 0 0 71017535 0 2008 true false true true false true false false 0.00800 0.00000 0.00800 false false true true UBS AG STAMFORD 3.8 false false false 0 false true DESCRIPTION OF TAX-EXEMPT BONDS 0 SCHEDULE K, PART I, COLUMN F THE MHHEFA SERIES 2008 REVENUE BONDS, ISSUED ON JULY 9, 2008 WERE A REFUNDING OF THE SERIES 2006 BONDS, WHICH WERE ISSUED ON MAY 23, 2006. MANAGEMENT PRACTICES AND PROCEDURES SCHEDULE K, PART III, LINE 7 THE ORGANIZATION HAS POLICIES AND PROCEDURES IN PLACE TO ENSURE TAX-EXEMPT BOND POST ISSUANCE COMPLIANCE, BUT WRITTEN POLICIES ARE BEING CREATED AND EVALUATED AND WILL BE ADOPTED BY THE FMH BOARD PRIOR TO JUNE 30, 2013. PAUL CHOMIAK SEE SCH L, PART V X 649518 81190 false false true 81190 LOANS TO AND FROM INTERESTED PERSONS SCHEDULE L, PART II PURPOSE OF LOAN: PHYSICIAN RECRUITMENT AND INCOME GUARANTEE AGREEMENT. X 1 26592 FMV false true false ORGANIZATION'S MISSION STATEMENT FORM 990, PART III, LINE 1 The mission of Frederick Memorial Hospital, Inc. is to contribute to the health and well-being of area residents by providing quality healthcare in a caring, cost efficient, safe and convenient manner through a coordinated program of prevention, diagnosis and treatment, rehabilitation, and support. DESCRIPTION OF RELATIONSHIPS FORM 990, PART VI, QUESTION 2 MARVIN AUSHERMAN, DIRECTOR OF FMH, INC. IS ENGAGED IN AN INDIRECT BUSINESS RELATIONSHIP WITH THOMAS KLEINHANZL, JOHN VERBUS, KENNETH COFFEY, JAMES REINSCH AND ANNE HERBERT ROLLINS. FORM 990, PART VI, QUESTION 6 The sole member of the organization is Frederick Regional Health System. FORM 990, PART VI, QUESTION 7A The sole member, Frederick Regional Health System, has the power to appoint the president/CEO and the directors of Frederick Memorial Hospital. FORM 990, PART VI, QUESTION 7B The sole member, Frederick Regional Health System, must approve the incurrence of debt if such debt exceeds a certain amount to be designated by the member, capital expenditures exceeding a certain amount to be designated by the member, the decision to dissolve or liquidate, the creation of a subsidiary, and amendments to the bylaws. DESCRIBE THE PROCESS USED BY MANAGEMENT/GOVERNING BODY TO REVIEW 990 FORM 990, PART VI, QUESTION 11B FORM 990 IS PREPARED IN CONJUNCTION WITH OUTSIDE TAX ACCOUNTANTS AND REVIEWED BY UPPER MANAGEMENT PRIOR TO PROVIDING A COPY TO THE BOARD. A COPY OF FORM 990 WILL BE PROVIDED TO ALL MEMBERS OF THE BOARD PRIOR TO FILING. DESCRIPTION OF PROCESS TO MONITOR TRANSACTIONS FOR CONFLICTS OF INTEREST FORM 990, PART VI, QUESTION 12C THE FREDERICK MEMORIAL HOSPITAL, INC. BOARD OF DIRECTORS IS COMMITTED TO MEETING ITS FIDUCIARY RESPONSIBILITIES AND MAINTAINING ITS DUTY OF LOYALTY TO THE HOSPITAL AND THE COMMUNITY IT SERVES. TO THIS END, THE BOARD WILL EXERCISE VIGILANCE IN IDENTIFYING ANY CONFLICTS OF INTEREST. THE BOARD WILL ALSO MAINTAIN TRANSPARENCY AND OBJECTIVITY IN MAKING DECISIONS ABOUT CONFLICTS OF INTEREST SO THAT THE ORGANIZATION'S MISSION IS ALWAYS THE FIRST PRIORITY. THE CHAIRPERSON (OR VICE CHAIRPERSON IF THE CHAIR IS INVOLVED) WILL NOTIFY ALL DIRECTORS OF A REPORTED CONFLICT OF INTEREST AND DECIDE WHETHER TO TAKE THE MATTER TO THE FULL BOARD TO DECIDE WHETHER A CONFLICT EXISTS AND, IF SO, WHAT ACTION TO TAKE, OR WILL REFER THE MATTER TO THE GOVERNANCE COMMITTEE FOR AN IN-DEPTH EXAMINATION, SUMMARY, AND RECOMMENDATION PRIOR TO A FULL BOARD DISCUSSION AND DECISION. IF TIME IS OF THE ESSENCE, THE CHAIRPERSON OR VICE CHAIRPERSON WILL TAKE THE MATTER TO THE EXECUTIVE COMMITTEE FOR DISCUSSION AND A DECISION, AND WILL THEN NOTIFY THE FULL BOARD. WHERE A CONFLICT OF INTEREST HAS BEEN IDENTIFIED, THE BOARD MEMBER SHALL NOT VOTE OR BE PRESENT FOR THE DISCUSSION OR THE VOTE REGARDING THE TRANSACTION AT EITHER THE FULL BOARD, EXECUTIVE COMMITTEE, OR GOVERNANCE COMMITTEE MEETINGS, EXCEPT TO ANSWER QUESTIONS THAT MAY BE ASKED OF HIM OR HER. TO PREVENT ACTUAL OR PERCEIVED INFLUENCE ON THE BOARD'S DECISION, THE CONFLICTED MEMBER IS PROHIBITED, AFTER INITIAL DISCLOSURE, FROM DISCUSSING THE CONFLICT OF INTEREST EITHER FORMALLY OR INFORMALLY WITH FELLOW DIRECTORS OR WITH MEMBERS OF THE MANAGEMENT. THERE WILL BE AN ANNUAL REVIEW OF ALL BOARD MEMBERS' AND OFFICERS' TRANSACTIONS PREPARED BY THE ADMINISTRATION AND REVIEWED BY THE GOVERNANCE COMMITTEE AND THE FULL BOARD OF DIRECTORS. AT THAT TIME, ALL DIRECTORS WILL BE REMINDED OF THE IRS INTERMEDIATE SANCTIONS REGULATION THAT ESTABLISHES EXCISE TAXES AS A SANCTION AGAINST ADMINISTRATORS AND DIRECTORS OF TAX-EXEMPT ORGANIZATIONS WHO PARTICIPATE IN "EXCESS BENEFIT TRANSACTIONS" (E.G., UNREASONABLY HIGH EMPLOYMENT COMPENSATION OR BUSINESS DEALS). The President and CEO shall be responsible for monitoring transactions or arrangements in which a director or officer may have a conflict of interest and for assuring that the director or officer serves the organization's best interests. OFFICES & POSITIONS FOR WHICH PROCESS WAS USED, & YEAR PROCESS WAS BEGUN FORM 990, PART VI, QUESTIONS 15A & 15B THE EXECUTIVE COMPENSATION PROGRAM IS DESIGNED TO CARRY OUT THE HEALTH SYSTEM MISSION, TO ACHIEVE THE CHARITABLE PURPOSE, TO ATTRACT, RETAIN, MOTIVATE AND REWARD EXECUTIVE MANAGEMENT, AND TO MAINTAIN A COMPETITIVE POSITION WITH PEER ORGANIZATIONS IN THE REGION. OVERSIGHT OF THE EXECUTIVE COMPENSATION PROGRAM IS PROVIDED BY THE EXECUTIVE COMPENSATION COMMITTEE OF THE BOARD, COMPOSED OF THE BOARD CHAIRMAN, VICE CHAIRMAN, IMMEDIATE PRECEDING CHAIRMAN, CHAIRMAN OF THE FINANCE COMMITTEE AND THE CHAIRMAN OF THE GOVERNANCE COMMITTEE. THE EXECUTIVE COMPENSATION PHILOSOPHY OF THE BOARD PROVIDES FOR BASE COMPENSATION AT THE 50TH TO 60TH PERCENTILE OF OUR PEER GROUP. IN ADDITION TO THE BOARD'S COMPENSATION COMMITTEE, WE UTILIZED AN EXTERNAL INDEPENDENT CONSULTANT AND MARKET SURVEYS FOR ALL EXECUTIVE MANAGEMENT COMPENSATION. THE PRESIDENT AND CEO HAS A WRITTEN EMPLOYMENT CONTRACT. WRITTEN POLICIES AND PROCEDURES FOR JOINT VENTURES FORM 990, PART VI, QUESTION 16B FREDERICK MEMORIAL HOSPITAL USES LEGAL COUNSEL WHEN EVALUATING ANY POTENTIAL JOINT VENTURES WITH FOR-PROFIT ENTITIES. IN ADDITION, TAX EXPOSURES RELATED TO THESE ENTITIES ARE CONSIDERED ANNUALLY IN THE PREPARATION OF THE FIN 48 MEMO REQUIRED AS PART OF THE AUDIT OF THE CONSOLIDATED FINANCIAL STATEMENTS. FMH IS IN THE PROCESS OF COMPILING A FORMAL POLICY IN THIS AREA AND WRITTEN POLICIES WILL BE ADOPTED PRIOR TO 6/30/13. AVAIL OF GOV DOCS, CONFL. OF INTEREST POLICY & FIN STMTS TO GEN PUBLIC FORM 990, PART VI, QUESTION 19 GOVERNING DOCUMENTS AND THE CONFLICT OF INTEREST POLICY ARE AVAILABLE UPON REQUEST. FREDERICK MEMORIAL HOSPITAL, INC. CONSOLIDATED ANNUAL AUDITED FINANCIAL STATEMENTS ARE AVAILABLE AT WWW.FMH.ORG. OTHER CHANGES IN NET ASSETS OR FUND BALANCES FORM 990, PART XI, LINE 5 UNREALIZED LOSS ON INVESTMENT SECURITIES AND EBURG ($4,038,143) UNREALIZED LOSS ON INTEREST RATE SWAP ($6,797,708) PENSION ADJUSTMENT ($10,303,587) TRANSFER TO FMH FROM EMMITSBURG, NET ($1,227,876) CHANGE IN TEMP RESTRICTED NET ASSETS ($56,622) RELEASES FROM RESTRICTION $198,171 OTHER $2,428 ----------- TOTAL ($22,223,337) AVERAGE HOURS WORKED FOR A RELATED ORGANIZATION FORM 990, PART VII, SECTION A, COLUMN B THE FOLLOWING INDIVIDUALS ALSO WORK FOR HOSPICE OF FREDERICK, INC., A RELATED ORGANIZATION. THOMAS KLEINHANZL 1 HOUR JOHN VERBUS 4 HOURS MICHELLE MAHAN 1 HOUR EMMITSBURG PROPERTIES LLC 521910823 Holding Invts MD 105439 406796 NA Hospice of Frederick County Inc 521164513 HOSPICE CARE MD 501(c)(3) 7 true Frederick Regional Health System 454133096 Health System MD 501(c)(3) 11b false Monocacy Health Partners LLC 453007639 Physician Org MD 501(c)(3) 7 false Frederick Health Services Corporation 521851661 MANAGEMENT CO. MD N/A C Corp 868572 10054214 1.00000 Frederick Surgical Services Corporation 521642334 Holding Company MD FHSC C CORP 336446 1964454 1.00000 Monocacy Insurance Ltd 981011570 Insurance MD NA C Corp false false false false false false false false false false false false false true true true false false Hospice of Frederick County Inc n 799634 FMV Frederick Health Services Corporation n 192388 FMV