CIVISTA MEDICAL CENTER INC: Form 990, tax year 2010

View the entire original 990 at ProPublica ↗

Organization: CIVISTA MEDICAL CENTER INC (EIN 52-0445374)
Tax period: 2010-07-01 to 2011-06-30
Filed: 2012-03-29
IRS object ID: 201200899349301060
Schema version: 2010v3.7
Source: Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header
Form 990
Schedule A
Schedule B
Schedule C
Schedule D
Schedule F
Schedule H
Schedule I
Schedule J
Schedule K
Schedule O
Schedule R

Return header ReturnHeader

Field	Value	IRS element (for citing)
Timestamp	2012-03-29T13:54:37-04:00	Timestamp
Tax Period End Date	2011-06-30	TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

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

Preparer Firm US Address PreparerFirmUSAddress

Field	Value	IRS element (for citing)
Address Line1	1676 International Drive	AddressLine1
City	McLean	City
State	VA	State
ZIP Code	22102	ZIPCode

Field	Value	IRS element (for citing)
Return Type	990	ReturnType
Tax Period Begin Date	2010-07-01	TaxPeriodBeginDate

Filer Filer

Field	Value	IRS element (for citing)
EIN	520445374	EIN

Name Name

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

Field	Value	IRS element (for citing)
Name Control	CIVI	NameControl
Phone	3016094130	Phone

US Address USAddress

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

Officer Officer

Field	Value	IRS element (for citing)
Name	NOEL CERVINO	Name
Title	PRESIDENT & CEO	Title
Date Signed	2012-03-27	DateSigned
Authorize Third Party	true	AuthorizeThirdParty

Preparer Preparer

Field	Value	IRS element (for citing)
Name	SCOTT SHERMAN KPMG LLP 703-286-839	Name
Phone	7032868000	Phone

Field	Value	IRS element (for citing)
Tax Year	2010	TaxYear
Build TS	2016-02-24 21:20:13Z	BuildTS

Form 990 IRS990

Field	Value	IRS element (for citing)
Name Of Principal Officer Person	NOEL CERVINO	NameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

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

Field	Value	IRS element (for citing)
Gross Receipts	105445758	GrossReceipts
Group Return For Affiliates	false	GroupReturnForAffiliates
Organization501c3	X	Organization501c3
Web Site	www.civista.org	WebSite
Type Of Organization Corporation	X	TypeOfOrganizationCorporation
Year Formation	1980	YearFormation
State Legal Domicile	MD	StateLegalDomicile
Activity Or Mission Description	CIVISTA MEDICAL CENTER PROVIDES EXCELLENT CARE TO EACH PATIENT IN A SAFE, CARING AND FAMILY-CENTERED ENVIRONMENT.	ActivityOrMissionDescription
Nbr Voting Members Governing Body	15	NbrVotingMembersGoverningBody
Nbr Independent Voting Members	14	NbrIndependentVotingMembers
Total Nbr Employees	1016	TotalNbrEmployees
Total Nbr Volunteers	129	TotalNbrVolunteers
Total Gross UBI	155988	TotalGrossUBI
Net Unrelated Business Txbl Income	35260	NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year	27613	ContributionsGrantsPriorYear
Contributions Grants Current Year	1677803	ContributionsGrantsCurrentYear
Program Service Revenue Prior Year	101981695	ProgramServiceRevenuePriorYear
Program Service Revenue CY	103083914	ProgramServiceRevenueCY
Investment Income Prior Year	131108	InvestmentIncomePriorYear
Investment Income Current Year	109879	InvestmentIncomeCurrentYear
Other Revenue Prior Year	526449	OtherRevenuePriorYear
Other Revenue Current Year	544515	OtherRevenueCurrentYear
Total Revenue Prior Year	102666865	TotalRevenuePriorYear
Total Revenue Current Year	105416111	TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year	93470	GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY	86592	GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year	0	BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY	0	BenefitsPaidToMembersCY
Salaries Etc Prior Year	45152262	SalariesEtcPriorYear
Salaries Etc Current Year	47133035	SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year	0	TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY	0	TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year	0	TotalFundrsngExpCurrentYear
Other Expense Prior Year	55574825	OtherExpensePriorYear
Other Expenses Current Year	53602980	OtherExpensesCurrentYear
Total Expenses Prior Year	100820557	TotalExpensesPriorYear
Total Expenses Current Year	100822607	TotalExpensesCurrentYear
Revenues Less Expenses Prior Year	1846308	RevenuesLessExpensesPriorYear
Revenues Less Expenses CY	4593504	RevenuesLessExpensesCY
Total Assets BOY	125692844	TotalAssetsBOY
Total Assets EOY	128003508	TotalAssetsEOY
Total Liabilities BOY	108395171	TotalLiabilitiesBOY
Total Liabilities EOY	103718743	TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY	17297673	NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY	24284765	NetAssetsOrFundBalancesEOY
Info In Schedule O Part III	X	InfoInScheduleOPartIII
Mission Description	Civista Medical Center is a not-for-profit hospital created to provide excellence in acute healthcare and preventive services in Charles County and the surrounding communities.	MissionDescription
Significant New Program Services	false	SignificantNewProgramServices
Significant Change	false	SignificantChange
Expense	75910376	Expense
Grants	86592	Grants
Revenue	103083914	Revenue
Description	Civista Medical Center 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 (CCDOTT), has conducted a Health Needs Assessment of Charles County every 5 years. Beginning calendar year 2011, in accordance with new regulations, the Health Needs Assessment will be conducted every 3 years. The data included in this report was collected in calendar year 2011. Civista Medical Center and the Charles County Department of Health collaborated to complete a comprehensive health needs assessment (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 part 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 was 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: 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/Alzheimer's 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 10 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. Focus Groups Included representatives from the following organizations: 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 " Minister's Alliance of Charles County " CC Department of Social services " Maryland Foundation for Quality healthcare " Health Partner's Clinic " Shiloh Community United Methodist Church " CC Nursing and Rehabilitation Center " Alzheimer's 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 Sheriff's Office " So MD Delegates " Charles County Community Foundation " Community Physicians " Charles County Fire and Rescue Board Accomplishments: Civista Medical Center provided over $4.1 million in charity care, health professions education, community benefit operations, community health improvement services, subsidized health services, cash and in-kind donations and community building activities in FY2011. This year, we provided and supported programs and activities such as: screenings and education; Heart disease; blood pressure screenings; stroke screenings; education programs such as stroke risk reduction; and Lowering your Cholesterol and Vitamin D classes. Cancer screenings such as prostate screening, breast and cervical exams and tobacco cessation program, Community education programs and services such as, ACS's Look Good Feel Better Program, advanced directives, arthritis and osteoporosis, breastfeeding, community disaster drills, school career days, WE CAN! Childhood Obesity Program and Faith-Based Health Expo. Support groups such as Stroke Support, Parkinson's support group, Pink Ladies and Sister's at Heart. Clinics and clinic services such as pre natal and OB 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 Southern 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 Child Advocacy Partnership, community events such as Christmas Connection, ACS'S Relay for Life, Alzheimer's Walk, March of Dimes, and Safe Nights.	Description
Total Program Service Expense	75910376	TotalProgramServiceExpense
Described In501 C3	true	DescribedIn501C3
Schedule B Required	true	ScheduleBRequired
Political Activities	false	PoliticalActivities
Lobbying Activities	true	LobbyingActivities
Donor Advised Funds	false	DonorAdvisedFunds
Conservation Easements	false	ConservationEasements
Collections Of Art	false	CollectionsOfArt
Credit Counseling	false	CreditCounseling
Term Or Permanent Endowments	false	TermOrPermanentEndowments
Report Land Bldg Equip	true	ReportLandBldgEquip
Report Invest Oth Securities	false	ReportInvestOthSecurities
Report Prog Rel Invest	false	ReportProgRelInvest
Report Other Assets	true	ReportOtherAssets
Report Other Liabilities	true	ReportOtherLiabilities
Report Fin48 Footnote	true	ReportFin48Footnote
Independent Audit Financial Stmt	false	IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt	true	ConsolidatedAuditFinancialStmt
School	false	School
Foreign Office	false	ForeignOffice
Foreign Activities	true	ForeignActivities
More Than5000 K To Organizations	false	MoreThan5000KToOrganizations
More Than5000 K To Individuals	false	MoreThan5000KToIndividuals
Professional Fundraising	false	ProfessionalFundraising
Fundraising Activities	false	FundraisingActivities
Gaming	false	Gaming
Hospital	true	Hospital
Financial Stmt Attached	true	FinancialStmtAttached
Grants To Organizations	true	GrantsToOrganizations
Grants To Individuals	false	GrantsToIndividuals
Schedule J Required	true	ScheduleJRequired
Tax Exempt Bonds	true	TaxExemptBonds
Invest Tax Exempt Bonds	false	InvestTaxExemptBonds
Escrow Account	false	EscrowAccount
On Behalf Of Issuer	false	OnBehalfOfIssuer
Excess Benefit Transaction	false	ExcessBenefitTransaction
Prior Excess Benefit Transaction	false	PriorExcessBenefitTransaction
Loan To Officer Or DQP	false	LoanToOfficerOrDQP
Grant To Related Person	false	GrantToRelatedPerson
Bsnss Rltnshp With Organization	false	BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member	false	BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp	false	OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions	false	DeductibleNonCashContributions
Deductible Contributions Of Art	false	DeductibleContributionsOfArt
Terminated	false	Terminated
Partial Liquidation	false	PartialLiquidation
Disregarded Entity	false	DisregardedEntity
Related Entity	true	RelatedEntity
Related Org Controlled Entity	true	RelatedOrgControlledEntity
Transaction Related Entity	true	TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org	false	TransfersToExemptNonChrtblOrg
Activities Conducted Partnership	false	ActivitiesConductedPartnership
Schedule O Required	true	ScheduleORequired
Number Forms Transmitted With1096	237	NumberFormsTransmittedWith1096
Number W2 G Included	0	NumberW2GIncluded
Compliance With Backup Witholding	true	ComplianceWithBackupWitholding
Number Of Employees	1016	NumberOfEmployees
Employment Tax Returns Filed	true	EmploymentTaxReturnsFiled
Unrelated Business Income	true	UnrelatedBusinessIncome
Form990-T Filed	true	Form990-TFiled
Foreign Financial Account	true	ForeignFinancialAccount
Name Of Foreign Country	CJ	NameOfForeignCountry
Prohibited Tax Shelter Trans	false	ProhibitedTaxShelterTrans
Taxable Party Notification	false	TaxablePartyNotification
Non Deductible Contributions	false	NonDeductibleContributions
Quid Pro Quo Contributions	false	QuidProQuoContributions
Form8282 Property Disposed Of	false	Form8282PropertyDisposedOf
Funds To Pay Premiums	false	FundsToPayPremiums
Premiums Paid	false	PremiumsPaid
Indoor Tanning Services	false	IndoorTanningServices
Info In Schedule O Part VI	X	InfoInScheduleOPartVI
Nbr Voting Governing Body Members	15	NbrVotingGoverningBodyMembers
Number Independent Voting Members	14	NumberIndependentVotingMembers
Family Or Business Relationship	false	FamilyOrBusinessRelationship
Delegation Of Management Duties	true	DelegationOfManagementDuties
Changes To Organizing Docs	false	ChangesToOrganizingDocs
Material Diversion Or Misuse	false	MaterialDiversionOrMisuse
Members Or Stockholders	false	MembersOrStockholders
Election Of Board Members	false	ElectionOfBoardMembers
Decisions Subject To Approval	false	DecisionsSubjectToApproval
Minutes Of Governing Body	true	MinutesOfGoverningBody
Minutes Of Committees	true	MinutesOfCommittees
Officer Mailing Address	false	OfficerMailingAddress
Local Chapters	false	LocalChapters
Form990 Provided To Governing Body	true	Form990ProvidedToGoverningBody
Conflict Of Interest Policy	true	ConflictOfInterestPolicy
Annual Disclosure Covered Persons	true	AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement	true	RegularMonitoringEnforcement
Whistleblower Policy	true	WhistleblowerPolicy
Document Retention Policy	true	DocumentRetentionPolicy
Compensation Process CEO	true	CompensationProcessCEO
Compensation Process Other	false	CompensationProcessOther
Investment In Joint Venture	false	InvestmentInJointVenture
States Where Copy Of Return Is Filed	MD	StatesWhereCopyOfReturnIsFiled
Upon Request	X	UponRequest

The Books Are In Care Of TheBooksAreInCareOf

Field	Value	IRS element (for citing)
Name Person	JIM CLAGUE	NamePerson
Telephone Number	3016095154	TelephoneNumber

Address US AddressUS

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

Field	Value	IRS element (for citing)
Info In Schedule O Part VII	X	InfoInScheduleOPartVII

Form990 Part VII Section A Form990PartVIISectionA (26 entries)

TitleTitle	Average Hours Per WeekAverageHoursPerWeek	Individual Trustee Or DirectorIndividualTrusteeOrDirector	Reportable Comp From OrganizationReportableCompFromOrganization	Reportable Comp From Related OrgsReportableCompFromRelatedOrgs	Other CompensationOtherCompensation	OfficerOfficer	Key EmployeeKeyEmployee	Highest Compensated EmployeeHighestCompensatedEmployee	FormerFormer
KHADAR BAIG
DIRECTOR	3.0	X	0	0	0
WAYNE BARNES
DIRECTOR	3.0	X	0	0	0
JAMES BURKE
DIRECTOR	3.0	X	0	0	0
MICHAEL CADY
DIRECTOR	3.0	X	0	0	0
C DEVADASON
EX-OFFICIO	3.0	X	0	0	0
LOUIS JENKINS JR
VICE CHAIR	3.0	X	0	0	0	X
CANDICE QUINN KELLY
EX-OFFICIO	3.0	X	0	0	0
SARA MIDDLETON
CHAIR	3.0	X	0	0	0	X
VAN MITCHELL
DIRECTOR	3.0	X	0	0	0
SEETARAMAYYA NAGULA
DIRECTOR	3.0	X	0	0	0
ASHVIN J PATEL MD
CHIEF OF STAFF	4.0	X	0	0	0	X
SURYAKANT PATEL
DIRECTOR	3.0	X	0	0	0
BARBARA STEPURA
DIRECTOR	3.0	X	0	0	0
RICHARD WINKLER
SECRETARY/TREASURER	3.0	X	0	0	0	X
NOEL CERVINO
PRESIDENT & CEO	40.0	X	445695	0	63432	X
ERIK BOAS
CFO	40.0		239415	0	21308	X
MARK DUMAIS
CHIEF INFO OFFICER	40.0		182189	0	24816	X
MELANIE SAGE
VICE PRESIDENT PATIENT CARE	40.0		164191	0	18732		X
GARY HERBEK
COO	40.0		228060	0	22717		X
MARILYN GREGORY
CLINICAL NURSE IV	40.0		164064	0	6356			X
LISA WILTROUT
PHYSICIAN	40.0		141491	0	4891			X
JOAN HUMULOCK
CLINICAL NURSE IV	40.0		140603	0	3692			X
STACEY COOK
VICE PRESIDENT, HR	40.0		147506	0	20655			X
KATHERINE MIDDLETON
RN, OR	40.0		131247	0	5933			X
CHRISTINE STEFANIDES
FORMER PRESIDENT & CEO			111214	0	19222				X
KEVIN BURBULES
FORMER CHIEF INFO OFFICER			146735	0	18404				X

Field	Value	IRS element (for citing)
Total Reportable Comp From Org	2242410	TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs	0	TotalReportableCompFrmRltdOrgs
Total Other Compensation	230158	TotalOtherCompensation
Number Individuals GT100 K	31	NumberIndividualsGT100K
Formers Listed	true	FormersListed
Total Comp GT150 K	true	TotalCompGT150K
Compensation From Other Sources	false	CompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1	CityAddressOfContractor/AddressUS/City	StateAddressOfContractor/AddressUS/State	ZIP CodeAddressOfContractor/AddressUS/ZIPCode	Description Of ServicesDescriptionOfServices	CompensationCompensation
MARYLAND INPATIENT CARE SPECIALISTS
2007 TIDEWATER COLONY WAY STE 1-A	ANNAPOLIS	MD	21401	PHYSICIANS	1300000
DIGITRACE CARE SERVICES INC
200 CORPORATE PLACE STE 58	PEABODY	MA	01960	EEG PURCHASED SERV	599675
ROI ELIGIBILITY SERVICES CORP
1920 GREENSPRING DR STE 200	TIMONIUM	MD	21094	PT ACCTG PURCH SERV	592564
MAYFLOWER TEXTILE SERVICE
PO BOX 20659	BALTIMORE	MD	21223	LAUNDRY	398752
NDG COMMUNICATIONS INC
105 CENTENNIAL STREET SUITE K	LA PLATA	MD	20646	MARKETING	264148

Field	Value	IRS element (for citing)
Number Of Contractors GT100 K	24	NumberOfContractorsGT100K
Related Organizations	1587803	RelatedOrganizations
Government Grants	90000	GovernmentGrants
All Other Contributions	0	AllOtherContributions
Total Contributions	1677803	TotalContributions

Program Service Revenue ProgramServiceRevenue

Field	Value	IRS element (for citing)
Description	NET PATIENT REVENUE	Description
Business Code	900099	BusinessCode
Total Revenue Column	103083914	TotalRevenueColumn
Related Or Exempt Function Income	103083914	RelatedOrExemptFunctionIncome

Field	Value	IRS element (for citing)
Total Program Service Revenue	103083914	TotalProgramServiceRevenue

Investment Income InvestmentIncome

Field	Value	IRS element (for citing)
Total Revenue Column	139526	TotalRevenueColumn
Exclusion	$139,526	ExclusionAmount

Income From Invest Bond Proceeds IncomeFromInvestBondProceeds

Field	Value	IRS element (for citing)
Total Revenue Column	0	TotalRevenueColumn

Royalties Revenue RoyaltiesRevenue

Field	Value	IRS element (for citing)
Total Revenue Column	0	TotalRevenueColumn

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

Field	Value	IRS element (for citing)
Other	29647	Other

Gain Or Loss GainOrLoss

Field	Value	IRS element (for citing)
Other	-29647	Other

Net Gain Or Loss Investments NetGainOrLossInvestments

Field	Value	IRS element (for citing)
Total Revenue Column	-29647	TotalRevenueColumn
Exclusion	-$29,647	ExclusionAmount

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

Field	Value	IRS element (for citing)
Total Revenue Column	0	TotalRevenueColumn

Net Income From Gaming NetIncomeFromGaming

Field	Value	IRS element (for citing)
Total Revenue Column	0	TotalRevenueColumn

Net Income Or Loss NetIncomeOrLoss

Field	Value	IRS element (for citing)
Total Revenue Column	0	TotalRevenueColumn

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescription	Business CodeBusinessCode	Total Revenue ColumnTotalRevenueColumn	Unrelated Business RevenueUnrelatedBusinessRevenue	ExclusionExclusionAmount	Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome
ANSWERING SERVICE	561000	155988	155988
CAFETERIA AND COFFEE BAR SALES	900099	331070		$331,070
APPLICATION FEES	900099	5000			5000

Miscellaneous Revenue MiscellaneousRevenue

Field	Value	IRS element (for citing)
Total Revenue Column	52457	TotalRevenueColumn
Related Or Exempt Function Income	52457	RelatedOrExemptFunctionIncome

Field	Value	IRS element (for citing)
Total Other Revenue	544515	TotalOtherRevenue

Total Revenue TotalRevenue

Field	Value	IRS element (for citing)
Total Revenue Column	105416111	TotalRevenueColumn
Related Or Exempt Function Income	103141371	RelatedOrExemptFunctionIncome
Unrelated Business Revenue	155988	UnrelatedBusinessRevenue
Exclusion	$440,949	ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

Field	Value	IRS element (for citing)
Total	86592	Total
Program Services	86592	ProgramServices

Grants To Domestic Individuals GrantsToDomesticIndividuals

Field	Value	IRS element (for citing)
Total	0	Total

Foreign Grants ForeignGrants

Field	Value	IRS element (for citing)
Total	0	Total

Benefits To Members BenefitsToMembers

Field	Value	IRS element (for citing)
Total	0	Total

Comp Current Officers Directors CompCurrentOfficersDirectors

Field	Value	IRS element (for citing)
Total	627700	Total
Program Services	502160	ProgramServices
Management And General	125540	ManagementAndGeneral
Fundraising	0	Fundraising

Comp Disqual Persons CompDisqualPersons

Field	Value	IRS element (for citing)
Total	0	Total

Other Salaries And Wages OtherSalariesAndWages

Field	Value	IRS element (for citing)
Total	38553382	Total
Program Services	30842706	ProgramServices
Management And General	7710676	ManagementAndGeneral
Fundraising	0	Fundraising

Pension Plan Contributions PensionPlanContributions

Field	Value	IRS element (for citing)
Total	1135979	Total
Program Services	908783	ProgramServices
Management And General	227196	ManagementAndGeneral
Fundraising	0	Fundraising

Other Employee Benefits OtherEmployeeBenefits

Field	Value	IRS element (for citing)
Total	3961570	Total
Program Services	3169256	ProgramServices
Management And General	792314	ManagementAndGeneral
Fundraising	0	Fundraising

Payroll Taxes PayrollTaxes

Field	Value	IRS element (for citing)
Total	2854404	Total
Program Services	2283523	ProgramServices
Management And General	570881	ManagementAndGeneral
Fundraising	0	Fundraising

Fees For Services Management FeesForServicesManagement

Field	Value	IRS element (for citing)
Total	200000	Total
Program Services	0	ProgramServices
Management And General	200000	ManagementAndGeneral
Fundraising	0	Fundraising

Fees For Services Legal FeesForServicesLegal

Field	Value	IRS element (for citing)
Total	404096	Total
Program Services	0	ProgramServices
Management And General	404096	ManagementAndGeneral
Fundraising	0	Fundraising

Fees For Services Accounting FeesForServicesAccounting

Field	Value	IRS element (for citing)
Total	300651	Total
Program Services	0	ProgramServices
Management And General	300651	ManagementAndGeneral
Fundraising	0	Fundraising

Fees For Services Lobbying FeesForServicesLobbying

Field	Value	IRS element (for citing)
Total	67500	Total
Program Services	0	ProgramServices
Management And General	67500	ManagementAndGeneral
Fundraising	0	Fundraising

Fees For Services Prof Fundraising FeesForServicesProfFundraising

Field	Value	IRS element (for citing)
Total	0	Total

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

Field	Value	IRS element (for citing)
Total	0	Total

Fees For Services Other FeesForServicesOther

Field	Value	IRS element (for citing)
Total	10160566	Total
Program Services	8128453	ProgramServices
Management And General	2032113	ManagementAndGeneral
Fundraising	0	Fundraising

Advertising Advertising

Field	Value	IRS element (for citing)
Total	174327	Total
Program Services	130745	ProgramServices
Management And General	43582	ManagementAndGeneral
Fundraising	0	Fundraising

Office Expenses OfficeExpenses

Field	Value	IRS element (for citing)
Total	0	Total

Information Technology InformationTechnology

Field	Value	IRS element (for citing)
Total	0	Total

Royalties Royalties

Field	Value	IRS element (for citing)
Total	0	Total

Occupancy Occupancy

Field	Value	IRS element (for citing)
Total	2109300	Total
Program Services	1096836	ProgramServices
Management And General	1012464	ManagementAndGeneral
Fundraising	0	Fundraising

Travel Travel

Field	Value	IRS element (for citing)
Total	36613	Total
Program Services	9153	ProgramServices
Management And General	27460	ManagementAndGeneral
Fundraising	0	Fundraising

Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials

Field	Value	IRS element (for citing)
Total	0	Total

Conferences Meetings ConferencesMeetings

Field	Value	IRS element (for citing)
Total	0	Total

Interest Interest

Field	Value	IRS element (for citing)
Total	3175167	Total
Program Services	0	ProgramServices
Management And General	3175167	ManagementAndGeneral
Fundraising	0	Fundraising

Payments To Affiliates PaymentsToAffiliates

Field	Value	IRS element (for citing)
Total	0	Total

Depreciation Depletion DepreciationDepletion

Field	Value	IRS element (for citing)
Total	4454144	Total
Program Services	4142354	ProgramServices
Management And General	311790	ManagementAndGeneral
Fundraising	0	Fundraising

Insurance Insurance

Field	Value	IRS element (for citing)
Total	2123376	Total
Program Services	0	ProgramServices
Management And General	2123376	ManagementAndGeneral
Fundraising	0	Fundraising

Other Expenses OtherExpenses (5 entries)

DescriptionDescription	TotalTotal	Program ServicesProgramServices	Management And GeneralManagementAndGeneral
SUPPLIES AND DRUGS	17088729	15892518	1196211
BAD DEBT	7208495	7208495	0
OTHER	1841943	242249	1599694
EQUIPMENT RENTAL AND MAINT	3835478	1265708	2569770
TELEPHONE	422595	845	421750

Total Functional Expenses TotalFunctionalExpenses

Field	Value	IRS element (for citing)
Total	100822607	Total
Program Services	75910376	ProgramServices
Management And General	24912231	ManagementAndGeneral
Fundraising	0	Fundraising

Savings And Temp Cash Investments SavingsAndTempCashInvestments

Field	Value	IRS element (for citing)
BOY	29116660	BOY
EOY	33434372	EOY

Accounts Receivable AccountsReceivable

Field	Value	IRS element (for citing)
BOY	10886077	BOY
EOY	9697092	EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

Field	Value	IRS element (for citing)
BOY	1588468	BOY
EOY	1533556	EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

Field	Value	IRS element (for citing)
BOY	854589	BOY
EOY	895718	EOY

Field	Value	IRS element (for citing)
Land Buildings Equipment Basis	103000316	LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec	39881340	LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

Field	Value	IRS element (for citing)
BOY	65421048	BOY
EOY	63118976	EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

Field	Value	IRS element (for citing)
BOY	75000	BOY
EOY	0	EOY

Other Assets Total OtherAssetsTotal

Field	Value	IRS element (for citing)
BOY	17751002	BOY
EOY	19323794	EOY

Total Assets TotalAssets

Field	Value	IRS element (for citing)
BOY	125692844	BOY
EOY	128003508	EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

Field	Value	IRS element (for citing)
BOY	16336955	BOY
EOY	14668027	EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

Field	Value	IRS element (for citing)
BOY	58529039	BOY
EOY	57930947	EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

Field	Value	IRS element (for citing)
BOY	20920214	BOY
EOY	20008435	EOY

Other Liabilities OtherLiabilities

Field	Value	IRS element (for citing)
BOY	12608963	BOY
EOY	11111334	EOY

Total Liabilities TotalLiabilities

Field	Value	IRS element (for citing)
BOY	108395171	BOY
EOY	103718743	EOY

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

Unrestricted Net Assets UnrestrictedNetAssets

Field	Value	IRS element (for citing)
BOY	13665143	BOY
EOY	23796141	EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

Field	Value	IRS element (for citing)
BOY	3632530	BOY
EOY	488624	EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	17297673	BOY
EOY	24284765	EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	125692844	BOY
EOY	128003508	EOY

Field	Value	IRS element (for citing)
Info In Schedule O Part XI	X	InfoInScheduleOPartXI
Reconcilation Revenue Expenses	4593504	ReconcilationRevenueExpenses
Reconcilation Other Changes	2393588	ReconcilationOtherChanges
Method Of Accounting Accrual	X	MethodOfAccountingAccrual
Accountant Compile Or Review	false	AccountantCompileOrReview
FS Audited	true	FSAudited
Audit Committee	true	AuditCommittee
Financial Statement Consolidated	X	FinancialStatementConsolidated
Federal Grant Audit Required	false	FederalGrantAuditRequired

Schedule A IRS990ScheduleA

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

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

Field	Value	IRS element (for citing)
Contributor Number	RESTRICTED	ContributorNumber

Contributor Name Business ContributorNameBusiness

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

Contributor Address US ContributorAddressUS

Field	Value	IRS element (for citing)
Address Line1	RESTRICTED	AddressLine1
Address Line2	RESTRICTED	AddressLine2
City	RESTRICTED	City
State	RESTRICTED	State
ZIP Code	RESTRICTED	ZIPCode

Field	Value	IRS element (for citing)
Aggregate Contributions	RESTRICTED	AggregateContributions

Schedule C IRS990ScheduleC

Field	Value	IRS element (for citing)
Total Grassroots Lobbying		TotalGrassrootsLobbying
Total Direct Lobbying		TotalDirectLobbying
Total Lobbying Expenditures		TotalLobbyingExpenditures
Other Exempt Purpose Expenditures		OtherExemptPurposeExpenditures
Total Exempt Purpose Expenditures		TotalExemptPurposeExpenditures
Lobbying Nontaxable		LobbyingNontaxableAmount
Grassroots Nontaxable		GrassrootsNontaxableAmount
Tot Lobbying Grassroot Minus Non Tx		TotLobbyingGrassrootMinusNonTx
Tot Lobby Expend Mns Lobbying Nontx		TotLobbyExpendMnsLobbyingNontx
Volunteers	false	Volunteers
Paid Staff Or Management	false	PaidStaffOrManagement
Media Advertisements	false	MediaAdvertisements
Mailings Members	false	MailingsMembers
Publications Or Broadcast	false	PublicationsOrBroadcast
Grants Other Organizations	false	GrantsOtherOrganizations
Direct Contact Legislators	false	DirectContactLegislators
Rallies Demonstrations	false	RalliesDemonstrations
Other Activities	true	OtherActivities
Other Activities	$78,982	OtherActivitiesAmount
Total Lobbying Expenditures IIB	78982	TotalLobbyingExpendituresIIB
Not Described In501c3	false	NotDescribedIn501c3

Form990 Schedule C Part IV Form990ScheduleCPartIV

Field	Value	IRS element (for citing)
Identifier	Lobbying Activities	Identifier
Explanation	The organization does not engage in any direct lobbying activities. The organization pays Baxter Baker a monthly fee to represent Civista as well as other Maryland hospitals to assist in lobbying and advertising for the hospitals. 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 8.65% and 24.42% of member dues were used for lobbying purposes and as such, the organization has reported this amount on Schedule C, part II-B as lobbying activities.	Explanation

Schedule D IRS990ScheduleD

Field	Value	IRS element (for citing)
Art Public Exhibition Amts		ArtPublicExhibitionAmts
Held Works Of Art Amts		HeldWorksOfArtAmts
Land		Land

Buildings Buildings

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	72170257	OtherCostOrOtherBasis
Depreciation	17425704	Depreciation
Book Value	54744553	BookValue

Leasehold Improvements LeaseholdImprovements

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	2288604	OtherCostOrOtherBasis
Depreciation	1190862	Depreciation
Book Value	1097742	BookValue

Equipment Equipment

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	28541455	OtherCostOrOtherBasis
Depreciation	21264774	Depreciation
Book Value	7276681	BookValue

Other Land Buildings OtherLandBuildings

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

Field	Value	IRS element (for citing)
Total Of Book Value Land Buildings	63118976	TotalOfBookValueLandBuildings

Other Assets OtherAssets (10 entries)

DescriptionDescription	Book ValueBookValue
SECURITY DEPOSITS	3684
OTHER CURRENT RECEIVABLES	36936
INV CHES POTOMAC HEALTHCARE	2867151
ASSETS LIMITED TO USE	6493301
PHYSICIANS LOAN	222589
INVEST IN JV FREESTATE	15441
DEFERRED FINANCING COSTS	2150670
INVESTMENT MARYLAND ECARE	10000
DUE FROM AFFILIATES	3571346
ECON INT IN NET ASSETS OF FDTN	3952676

Field	Value	IRS element (for citing)
Total Book Value Other Assets	19323794	TotalBookValueOtherAssets
Federal Income Tax Liability	0	FederalIncomeTaxLiability

Other Liabilities OtherLiabilities (6 entries)

DescriptionDescription	AmountAmount
ADVANCES FROM THIRD PARTIES	$3,409,780
ACCRUED INTEREST PAYABLE	$1,336,007
ACCRUED PENSION COSTS	$4,197,886
DUE TO AFFILIATE	$247,418
LEASE LIABILITIES	$420,131
MALPRACTICE IBNR	$1,500,112

Field	Value	IRS element (for citing)
Total Of Amounts	11111334	TotalOfAmounts

Form990 Schedule D Part XIV Form990ScheduleDPartXIV

Field	Value	IRS element (for citing)
Identifier	FIN 48 Footnote	Identifier
Explanation	The organization accounts for uncertainty in income taxes in accordance with FIN 48 (as codified). The organization's audited financial statements do not include any liabilities for uncertain tax positions.	Explanation

Schedule F IRS990ScheduleF

Accts Actvs Out US Table AcctsActvsOutUSTable

Field	Value	IRS element (for citing)
Region	Central America and the Caribbean	Region
Type Of Activities Conducted	Program Services	TypeOfActivitiesConducted
Specific Services Provided	insurance	SpecificServicesProvided
Total Expenditures	1651125	TotalExpenditures

Field	Value	IRS element (for citing)
Subtotal Amount Spent	1651125	SubtotalAmountSpent
Total Amount Spent	1651125	TotalAmountSpent
Transfer To Foreign Corp	true	TransferToForeignCorp
Interest In Foreign Trust	false	InterestInForeignTrust
Own Foreign Corp	true	OwnForeignCorp
Passive Foreign Invest Co	false	PassiveForeignInvestCo
Foreign Partnership	false	ForeignPartnership
Boycott Countries	false	BoycottCountries

Schedule H IRS990ScheduleH

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

Charity Care At Cost CharityCareAtCost

Field	Value	IRS element (for citing)
Total Community Benefit Expense	1410086	TotalCommunityBenefitExpense
Net Community Benefit Expense	1410086	NetCommunityBenefitExpense
Percent Of Total Expense	0.01410	PercentOfTotalExpense

Total Charity Care TotalCharityCare

Field	Value	IRS element (for citing)
Total Community Benefit Expense	1410086	TotalCommunityBenefitExpense
Net Community Benefit Expense	1410086	NetCommunityBenefitExpense
Percent Of Total Expense	0.01410	PercentOfTotalExpense

Community Health Services CommunityHealthServices

Field	Value	IRS element (for citing)
Number Of Activities Or Programs	36	NumberOfActivitiesOrPrograms
Persons Served	168619	PersonsServed
Total Community Benefit Expense	533851	TotalCommunityBenefitExpense
Direct Offsetting Revenue	650	DirectOffsettingRevenue
Net Community Benefit Expense	533201	NetCommunityBenefitExpense
Percent Of Total Expense	0.00530	PercentOfTotalExpense

Health Professions Education HealthProfessionsEducation

Field	Value	IRS element (for citing)
Number Of Activities Or Programs	7	NumberOfActivitiesOrPrograms
Persons Served	280	PersonsServed
Total Community Benefit Expense	330757	TotalCommunityBenefitExpense
Net Community Benefit Expense	330757	NetCommunityBenefitExpense
Percent Of Total Expense	0.00330	PercentOfTotalExpense

Subsidized Health Services SubsidizedHealthServices

Field	Value	IRS element (for citing)
Number Of Activities Or Programs	7	NumberOfActivitiesOrPrograms
Persons Served	145	PersonsServed
Total Community Benefit Expense	1643721	TotalCommunityBenefitExpense
Direct Offsetting Revenue	181814	DirectOffsettingRevenue
Net Community Benefit Expense	1461907	NetCommunityBenefitExpense
Percent Of Total Expense	0.01460	PercentOfTotalExpense

Cash And In Kind Contributions CashAndInKindContributions

Field	Value	IRS element (for citing)
Number Of Activities Or Programs	15	NumberOfActivitiesOrPrograms
Persons Served	1772	PersonsServed
Total Community Benefit Expense	123141	TotalCommunityBenefitExpense
Net Community Benefit Expense	123141	NetCommunityBenefitExpense
Percent Of Total Expense	0.00120	PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

Field	Value	IRS element (for citing)
Number Of Activities Or Programs	65	NumberOfActivitiesOrPrograms
Persons Served	170816	PersonsServed
Total Community Benefit Expense	2631470	TotalCommunityBenefitExpense
Direct Offsetting Revenue	182464	DirectOffsettingRevenue
Net Community Benefit Expense	2449006	NetCommunityBenefitExpense
Percent Of Total Expense	0.02440	PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

Field	Value	IRS element (for citing)
Number Of Activities Or Programs	65	NumberOfActivitiesOrPrograms
Persons Served	170816	PersonsServed
Total Community Benefit Expense	4041556	TotalCommunityBenefitExpense
Direct Offsetting Revenue	182464	DirectOffsettingRevenue
Net Community Benefit Expense	3859092	NetCommunityBenefitExpense
Percent Of Total Expense	0.03850	PercentOfTotalExpense

Economic Development EconomicDevelopment

Field	Value	IRS element (for citing)
Number Of Activities Or Programs	3	NumberOfActivitiesOrPrograms
Persons Served	142	PersonsServed
Total Community Building Expense	7790	TotalCommunityBuildingExpense
Direct Offsetting Revenue	275	DirectOffsettingRevenue
Net Community Building Expense	7515	NetCommunityBuildingExpense
Percent Of Total Expense	0.00010	PercentOfTotalExpense

Community Support CommunitySupport

Field	Value	IRS element (for citing)
Number Of Activities Or Programs	7	NumberOfActivitiesOrPrograms
Persons Served	13	PersonsServed
Total Community Building Expense	36522	TotalCommunityBuildingExpense
Net Community Building Expense	36522	NetCommunityBuildingExpense
Percent Of Total Expense	0.00040	PercentOfTotalExpense

Leadership Development LeadershipDevelopment

Field	Value	IRS element (for citing)
Number Of Activities Or Programs	1	NumberOfActivitiesOrPrograms
Total Community Building Expense	10617	TotalCommunityBuildingExpense
Net Community Building Expense	10617	NetCommunityBuildingExpense
Percent Of Total Expense	0.00010	PercentOfTotalExpense

Coalition Building CoalitionBuilding

Field	Value	IRS element (for citing)
Number Of Activities Or Programs	3	NumberOfActivitiesOrPrograms
Persons Served	20	PersonsServed
Total Community Building Expense	3990	TotalCommunityBuildingExpense
Net Community Building Expense	3990	NetCommunityBuildingExpense

Health Improvement Advocacy HealthImprovementAdvocacy

Field	Value	IRS element (for citing)
Number Of Activities Or Programs	2	NumberOfActivitiesOrPrograms
Total Community Building Expense	447	TotalCommunityBuildingExpense
Net Community Building Expense	447	NetCommunityBuildingExpense

Workforce Development WorkforceDevelopment

Field	Value	IRS element (for citing)
Number Of Activities Or Programs	5	NumberOfActivitiesOrPrograms
Total Community Building Expense	253270	TotalCommunityBuildingExpense
Net Community Building Expense	253270	NetCommunityBuildingExpense
Percent Of Total Expense	0.00250	PercentOfTotalExpense

Total Total

Field	Value	IRS element (for citing)
Number Of Activities Or Programs	21	NumberOfActivitiesOrPrograms
Persons Served	175	PersonsServed
Total Community Building Expense	312636	TotalCommunityBuildingExpense
Direct Offsetting Revenue	275	DirectOffsettingRevenue
Net Community Building Expense	312361	NetCommunityBuildingExpense
Percent Of Total Expense	0.00310	PercentOfTotalExpense

Field	Value	IRS element (for citing)
Bad Debt Expense Reported	true	BadDebtExpenseReported
Bad Debt Expense	$5,766,796	BadDebtExpenseAmount
Amount Reimbursed By Medicare	29165785	AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare	35194893	CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall	-6029108	MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

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

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

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA

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

Name Name

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

Address Address

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

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

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB

Hospital Facility Name HospitalFacilityName

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

Field	Value	IRS element (for citing)
Hospital Facility Number	1	HospitalFacilityNumber

Form990 Schedule H Part VI Form990ScheduleHPartVI (2 entries)

IdentifierIdentifier

ExplanationExplanation

Schedule H Supplemental Information

Part I, Line 6a: AN ANNUAL COMMUNITY BENEFIT REPORT IS PREPARED FOR EACH FISCAL YEAR ENDING JUNE 30. THIS REPORT IS SUBMITTED TO THE HEALTH SERVICES COST REVIEW COMMISSION (HSCRC), A STATE REGULATORY AGENCY, BY DECEMBER 31 OF EACH YEAR. IN ADDITION, A SUMMARY OF THE COMMUNITY BENEFITS PROVIDED BY THE MEDICAL CENTER IS LOCATED ON OUR WEBSITE: HTTP://WWW.CIVISTA.ORG/FUSEACTION-ABOUTUS.SHOWCOMMUNITYBENEFITS.HTM 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 AMOUNT FOR THE SAME SERVICES DELIVERED AT THE SAME HOSPITAL. MARYLAND'S 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 BENEFIT EXPENSES ARE EQUAL TO MEDICAID REVENUES IN MARYLAND, AS SUCH, THE NET EFFECT IS ZERO. ADDITIONALLY, NET REVENUES FOR MEDICAID SHOULD REFLECT THE FULL IMPACT ON THE HOSPITAL OF ITS SHARE OF THE MEDICAID ASSESSMENT. 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. Part III, Line 8: IN MARYLAND, THE HEALTH SERVICES COST REVIEW COMMISSION (HSCRC) STARTED SETTING HOSPITAL RATES IN 1974. AT THAT TIME, THE HSCRC APPROVED RATES APPLIED ONLY TO COMMERCIAL INSURERS. IN 1977, THE HSCRC NEGOTIATED A WAIVER FROM MEDICARE HOSPITAL PAYMENT RULES FOR MARYLAND HOSPITALS TO BRING THE FEDERAL MEDICARE PAYMENTS UNDER HSCRC CONTROL. MEDICARE REIMBURSES MARYLAND HOSPITALS ACCORDING TO RATES ESTABLISHED BY THE HSCRC AS LONG AS THE STATE CONTINUES TO MEET A TWO-PART TEST. THIS TWO-PART WAIVER TEST ALLOWS MEDICARE TO PARTICIPATE IN THE MARYLAND SYSTEM AS LONG AS TWO CONDITIONS ARE MET: - ALL OTHER PAYERS PARTICIPATING IN THE SYSTEM PAY HSCRC SET RATES AND - THE RATE OF GROWTH IN MEDICARE PAYMENTS TO MARYLAND HOSPITALS FROM 1981 TO THE PRESENT IS NOT GREATER THAN THE RATE OF GROWTH IN MEDICARE PAYMENTS TO HOSPITALS NATIONALLY OVER THE SAME TIME FRAME. Needs Assessment: Civista Health 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 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. 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: mortality, population and demographic data, nationality, infant mortality, heart disease, stroke, hypertension, access to health care/health insurance, cancer, asthma, injuries, diabetes, obesity, osteoporosis, arthritis, dementia/Alzheimer's 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 10 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. Focus Groups Included representatives from the following organizations: 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 Minister's Alliance of Charles County CC Department of Social services Maryland Foundation for Quality healthcare Health Partner's Clinic Shiloh Community United Methodist Church CC Nursing and Rehabilitation Center Alzheimer's 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 Sheriff's Office So MD Delegates Charles County Community Foundation Community Physicians Charles County Fire and Rescue Board Surveys from Community Stakeholders 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%). Part III, Line 9b: Regardless of the status of collections, if a patient applies for financial assistance and meets the eligibility requirements, the balance is written off according to the percentage they qualify for. Patient Education on Eligibility for Assistance: Civista Medical Center posts its charity care policy, or a summary thereof, and financial assistance contact information in admissions areas, emergency rooms, other areas of the facility in which eligible patients are likely to present. Patients are provided counseling, if applicable, on available financial assistance options upon admission and/or discharge including eligibility for government or State benefits. Assistance is provided where applicable, on completion of paperwork for such programs. In addition, the policy is available on the Civista website (www.civista.org) and is posted in the local paper twice each year.

Community Information:

Charles County Geographic and Demographic Profile: Charles County is a largely rural jurisdiction located approximately 18 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 Maryland's twenty four counties and accounts for about 5 percent of Maryland's 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 county's 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. Current US Census 2010 estimates are that the population now exceeds 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, and by 2000, there were 261.5 individuals per square mile an increase of 19.2 percent. This percent change in population growth continued from 2000 to 2010 when Charles County experienced a 21.6% increase in population. The percent change in the population growth for Charles County has been markedly greater than the change seen in the Maryland state population growth (9.0%). As the population of the county changes, the diversity of the county also increases. The African American population has experienced the greater increases in population. In 2000, African Americans made up 26% of the total Charles County population; by 2009, they now comprise 41% of the total county population. For 2009, minorities make up 49.7% of the Charles County population. The Hispanic community has also seen increases over the past few years. They now comprise 4.3% of the total county population. This is one of the highest percentages among the 24 Maryland jurisdictions. The age breakdown of the Charles County population shows a young population between the ages of 18 44 years. The juvenile population (under 17 years) makes up 27% of the Charles County population. The 2009 Charles County gender breakdown is approximately 50/50. Males make up 48.7% of the population, and females make up 51.3% of the county population. Employment and economic indicators for the county are fairly strong. The 2005-2009 US Census estimates for Charles County found that 73.8% of the population is currently in the labor work force. The Charles County median household income was $85,899, well above the Maryland median household income of $69,193. The percentage of all Charles County people whose income in the past 12 months is below the poverty level is 4.9%. The estimate of people with no health insurance coverage in Charles county is 9.4%. The percentage of Charles County residents who have public health insurance is 17.4%. The life expectancy from birth for a Charles County resident as calculated for 2008 2009 was 78.1 years. This is similar to the state average life expectancy of 78.6 years. There were a total of 871 deaths in Charles County in 2009. The 2007 2009 Charles County all cause mortality rate was 845.2 per 100,000 population. This rate is higher than the Maryland state all cause mortality rate of 768.4 per 100,000 population. The number one cause of death for the time period 2009 and for the time period 2007-2009 was heart disease. The 2007-2009 Charles County heart disease death rate was 228.5 per 100,000. This is also higher than the Maryland state rate of 196.8 per 100,000. Charles County had higher 2007-2009 mortality rates than Maryland for heart disease, cancer, chronic lower respiratory disease, accidents, and diabetes mellitus. Two thirds of the deaths in Charles County in 2009 were among the White population. They make up approximately half of the total county population. When comparing by 2009 calculated crude death rates, the rate is much higher in the White population. The 2009 Charles County White death rate was 739.9 per 100,000. This is much higher than the Charles County total 2009 crude death rate of 612.4 per 100,000 and higher than the death rates for Blacks (468.8), for Asians and Pacific Islanders (308.2), and for Hispanics (142.8). There is a high level of home ownership in Charles County (81.9%). The median value of a housing unit in Charles County is higher than the Maryland average ($352,000 vs. $326,400). The average number of people in a Charles County household is 2.84 persons. Charles County residents are a commuter population. They spend an average of 40.5 minutes of travel time to work each day. Charles County has a larger percentage of high school graduates than Maryland (90.2% vs. 87.5%); however, Charles County has a smaller percentage of individuals with a bachelor's degree or higher than Maryland does (25.4% vs. 35.2%). Community building activities: Civista Medical Center sponsors community building initiatives for example: 1. Physician recruitment efforts through funded Physician Recruitment position at Civista Medical Center; Staff participation in groups such the Maryland Healthcare Roundtable, Maryland Healthcare Commission; Management Agreement with University of Maryland Medical System. Recruitment of physicians to Charles County concentrating in the high priority areas of the 83 specialties lacking; Physician recruiter retained by Civista; Evaluation by number of physicians successfully recruited and placed. a. In November 2009, Civista Health signed Management Agreement with University of Maryland Medical System with physician recruitment as major initiative. b. According to the Maryland Health Commission, 83 physician specialties are in shortage in the Southern Maryland area. Of particular lack in Charles County is Obstetrics and Gynecology. In 2009, only 6 OB/GYN physicians were providing care at Civista- 4 of whom are employed by Civista Medical Center and also provider care for prenatal clinic for the uninsured and underinsured. The rising infant mortality rate in Charles County raised the recruitment of OB/GYN practitioners to priority one. Recruitment efforts are ongoing for other physician specialties are ongoing for orthopedics, oncology, general surgery and gastroenterology. 2. Civista Medical Center participates as a lead organization in Partnerships for a Healthier Charles County (PHCC), a 70 plus member organization of health providing not for profits, businesses, and organizations. The other lead organizations are Charles County Department of Health, Charles County Public Schools and College of Southern Maryland. Through PHCC, the Community Heath Needs Assessment is completed. 3. Emergency/Disaster Preparedness Civista Medical Center participates in joint disaster preparedness drills and planning sessions with federal, county, state and regional entities for issues such as H1N1, NEIMS and inaugural disaster planning and preparedness. additionally, Civista participates in Indian Head Naval Base disaster support. Disaster preparedness medical equipment is purchased for emergency purposes. Promotion of Community 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. State filing of community benefit report MD,

Schedule I IRS990ScheduleI

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

Recipient Table RecipientTable (3 entries)

Address Line1AddressUS/AddressLine1	CityAddressUS/City	StateAddressUS/State	ZIP CodeAddressUS/ZIPCode	EIN Of RecipientEINOfRecipient	IRC SectionIRCSection	Amount Of Cash GrantAmountOfCashGrant	Purpose Of GrantPurposeOfGrant	Amount Of Non Cash AssistanceAmountOfNonCashAssistance	Method Of ValuationMethodOfValuation	Description Of Non Cash AssistanceDescriptionOfNonCashAssistance
Health Partners Inc
PO Box 1865	Waldorf	MD	20604	521767044	501(c)(3)	49992	Donation
Charles County Department of Health
250 Williams Street	La Plata	MD	20646	522046030	501(c)(3)	15000	Prostate Cancer Program
Habitat for Humanity International Inc
PO BOX 2734	LA PLATA	MD	20646	521715451	501(c)(3)		Equipment	21600	FMV	Equipment

Field	Value	IRS element (for citing)
Total Nbr Of501 C3 And Govt Grants	3	TotalNbrOf501C3AndGovtGrants

Form990 Schedule I Part IV Form990ScheduleIPartIV

Field	Value	IRS element (for citing)
Identifier	Part I, Line 2	Identifier
Explanation	Civista Medical Center makes financial and in-kind contributions to various charitable organizations in the community.	Explanation

Schedule J IRS990ScheduleJ

Field	Value	IRS element (for citing)
Compensation Committee	X	CompensationCommittee
Independent Consultant	X	IndependentConsultant
Compensation Survey	X	CompensationSurvey
Board Or Committee Approval	X	BoardOrCommitteeApproval
Severance Payment	false	SeverancePayment
Supplemental Nonqual Retire Plan	false	SupplementalNonqualRetirePlan
Equity Based Comp Arrangement	false	EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org	false	CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs	false	CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org	false	CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs	false	CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments	false	AnyNonFixedPayments
Initial Contract Exception	false	InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (9 entries)

Base Compensation Filing OrgBaseCompensationFilingOrg	Comp Based On Related OrgsCompBasedOnRelatedOrgs	Bonus Filing OrgBonusFilingOrg	Bonus Related OrgsBonusRelatedOrgs	Other Compensation Filing OrgOtherCompensationFilingOrg	Other Compensation Related OrgsOtherCompensationRelatedOrgs	Deferred Comp Filing OrgDeferredCompFilingOrg	Deferred Comp Related OrgsDeferredCompRelatedOrgs	Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg	Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs	Total Compensation Filing OrgTotalCompensationFilingOrg	Total Compensation Related OrgsTotalCompensationRelatedOrgs	Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg	Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
NOEL CERVINO
303519	0	132000	0	10176	0	50848	0	12584	0	509127	0	0	0
ERIK BOAS
182112	0	54900	0	2403	0	19582	0	1726	0	260723	0	0	0
MARILYN GREGORY
164064	0	0	0	0	0	2600	0	3756	0	170420	0	0	0
STACEY COOK
140006	0	7500	0	0	0	10832	0	9824	0	168162	0	0	0
MARK DUMAIS
177885	0	0	0	4304	0	19303	0	5513	0	207005	0	0	0
MELANIE SAGE
156691	0	7500	0	0	0	16500	0	2232	0	182923	0	0	0
GARY HERBEK
220560	0	7500	0	0	0	16500	0	6217	0	250777	0	0	0
CHRISTINE STEFANIDES
111214	0	0	0	0	0	19015	0	207	0	130436	0	0	0
KEVIN BURBULES
139235	0	7500	0	0	0	14972	0	3432	0	165139	0	0	0

Schedule K IRS990ScheduleK

Form990 Schedule K Part I Form990ScheduleKPartI

Issuer Name IssuerName

Field	Value	IRS element (for citing)
Business Name Line1	MARYLAND HEALTH AND HIGHER EDUCATIONAL FACILITIES	BusinessNameLine1

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

Form990 Schedule K Part II Form990ScheduleKPartII

Field	Value	IRS element (for citing)
Total Proceeds	60097615	TotalProceeds
Amount In Reserve Fund	4511625	AmountInReserveFund
Issuance Costs From Proceeds	3796282	IssuanceCostsFromProceeds
Capital Expenditures	51789708	CapitalExpenditures
Year Of Subst Completion	2007	YearOfSubstCompletion
Current Refunding	false	CurrentRefunding
Advance Refunding	false	AdvanceRefunding
Final Allocation Made	true	FinalAllocationMade
Adequate Books And Recds Maintaind	true	AdequateBooksAndRecdsMaintaind

Form990 Schedule K Part III Form990ScheduleKPartIII

Field	Value	IRS element (for citing)
Owning Bond Financed Property	false	OwningBondFinancedProperty
Any Lease Arrangements	false	AnyLeaseArrangements
Mngment Cntrct Bond Financd Prprty	false	MngmentCntrctBondFinancdPrprty
Any Research Agreements	false	AnyResearchAgreements
Bond Counsel Routinely Engaged	true	BondCounselRoutinelyEngaged
Prcntge Prvt Business Use By Others	0.00000	PrcntgePrvtBusinessUseByOthers
Percentage Of Prvt Business Re UBI	0.00000	PercentageOfPrvtBusinessReUBI
Total Private Business Use	0.00000	TotalPrivateBusinessUse
Post Issuance Compliance Procdrs	true	PostIssuanceComplianceProcdrs

Form990 Schedule K Part IV Form990ScheduleKPartIV

Field	Value	IRS element (for citing)
Form8038 T Filed	true	Form8038TFiled
Variable Rate Issue	false	VariableRateIssue
Hedge Identified In Books And Recds	false	HedgeIdentifiedInBooksAndRecds
Gross Proceeds Invested In GIC	false	GrossProceedsInvestedInGIC
Gross Proceeds Invested	false	GrossProceedsInvested
Exception To Rebate	false	ExceptionToRebate

Form990 Schedule K Part V Form990ScheduleKPartV

Field	Value	IRS element (for citing)
Identifier	SEE SCHEDULE O	Identifier

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (7 entries)

IdentifierIdentifier	Return ReferenceReturnReference	ExplanationExplanation
DESCRIPTION OF 990 REVIEW PROCESS	PART VI, LINE 11	The process for reviewing the Form 990 begins with Civista's Staff Accountant working with the Controller in reviewing the first Draft Form 990. The Staff Accountant and Controller will coordinate with the independent accounting firm, KPMG, to update any necessary changes. While the Controller schedules the services of KPMG 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 KPMG 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.
PROCESS FOR DETERMINING COMPENSATION	PART VI, LINE 15	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. Effective October 1, 2009, the chief executive officer, chief financial officer, chief medical officer and chief information officer are employees of the University of Maryland Medical System (UMMS) and their compensation packages are determined per an UMMS executive compensation committee.
CONFLICTS MONITORING AND ENFORCEMENT	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 employees 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. 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.
DOCUMENTATION AVAILABILITY	PART VI, LINE 19	THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST.
MANAGEMENT SERVICES AGREEMENT	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, the Chief Medical Officer, and the Chief Information 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. Effective July 1, 2011, the company entered into an affiliated agreement with UMMS, whereby UMMS became the sole corporate member of the company. The residents of the region served by the company will benefit from accelerated deployment of clinical programs and technologies and improved access to physicians.
SCHEDULE K		Part I AMOUNTS CUSIP NUMBERS -------- $ 540,000 574217UL7 555,000 574217UM5 575,000 574217UN3 590,000 574217UP8 610,000 574217UQ6 630,000 574217UR4 650,000 574217US2 675,000 574217UT0 700,000 574217UU7 730,000 574217UV5 760,000 574217UW3 790,000 574217UX1 820,000 574217UY9 7,900,000 574217UZ6 10,425,000 574217VA0 32,050,000 574217VB8 $59,000,000 BONDS AT REDEMPTION PRICE Part II Of the proceeds reported as issuance costs, $1,180,000 of the proceeds were used for bond issuance costs (including underwriters' discount) and $2,616,282 of the proceeds were used for credit enhancement.
OTHER CHANGES IN NET ASSETS	FORM 990, PART XI, LINE 5	CHANGE IN MINIMUM PENSION LIABILITY 3,682,607 NET ASSETS RELEASED FROM RESTRICTION (1,289,019) ----------- TOTAL TO PART XI, LINE 5 2,393,588 BEGINNING NET ASSETS WERE ADJUSTED TO INCLUDE THE MEDICAL CENTER'S ECONOMIC INTEREST IN THE NET ASSETS OF CIVISTA HEALTH FOUNDATION.

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (3 entries)

Address Line1AddressUS/AddressLine1	CityAddressUS/City	StateAddressUS/State	ZIP CodeAddressUS/ZIPCode	EINEIN	Primary ActivitiesPrimaryActivities	Legal Domicile StateLegalDomicileState	Exempt Code SectionExemptCodeSection	Public Charity StatusPublicCharityStatus	Direct Controlling Entity NADirectControllingEntityNA	Business Name Line1DirectControllingEntityName/BusinessNameLine1
CIVISTA HEALTH INC
5 GARRETT AVE	LA PLATA	MD	20646	522155576	PARENT	MD	501(C)(3)	11C	N/A
CIVISTA HEALTH FOUNDATION INC
616 E CHARLES ST	LA PLATA	MD	20646	521414564	FUNDRAISING	MD	501(C)(3)	11A		CIVISTA HLTH
CIVISTA HEALTH AUXILIARY INC
5 GARRETT AVE	LA PLATA	MD	20646	521131193	AUXILIARY	MD	501(C)(3)	9		CIVISTA HLTH

Form990 Schedule R Part IV Form990ScheduleRPartIV

Name Of Related Org NameOfRelatedOrg

Field	Value	IRS element (for citing)
Business Name Line1	CIVISTA CARE PARTNERS INC	BusinessNameLine1

Address US AddressUS

Field	Value	IRS element (for citing)
Address Line1	5 GARRETT AVE	AddressLine1
City	LA PLATA	City
State	MD	State
ZIP Code	20646	ZIPCode

Field	Value	IRS element (for citing)
EIN	522176314	EIN
Primary Activity	HEALTHCARE	PrimaryActivity
Legal Domicile State	MD	LegalDomicileState

Direct Controlling Entity Name DirectControllingEntityName

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

Field	Value	IRS element (for citing)
Type Of Entity	C Corp	TypeOfEntity

Field	Value	IRS element (for citing)
Receipt Of Int Ann Rents Royalties	false	ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org	false	GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org	false	GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org	false	LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org	false	LoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other Org	false	SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org	false	PurchaseOfAssetsFromOtherOrg
Exchange Of Assets	false	ExchangeOfAssets
Rental Of Facilities To Other Orgs	false	RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs	false	RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs	false	PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs	true	PerformOfServicesByOtherOrgs
Sharing Of Facilities	true	SharingOfFacilities
Sharing Of Paid Employees	true	SharingOfPaidEmployees
Reimbursement Paid To Other Org	false	ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org	true	ReimbursementPaidByOtherOrg
Other Transfer To Other Org	true	OtherTransferToOtherOrg
Other Transfer From Other Org	true	OtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable (10 entries)

Transaction TypeTransactionType	Amount InvolvedAmountInvolved
CIVISTA HEALTH INC
Q	1206066
CIVISTA HEALTH FOUNDATION INC
R	1015000
CIVISTA HEALTH FOUNDATION INC
Q	1340000
CIVISTA HEALTH FOUNDATION INC
P	217422
CIVISTA HEALTH FOUNDATION INC
N	201332
CIVISTA CARE PARTNERS INC
R	250000
CIVISTA CARE PARTNERS INC CCS LLC
R	220437
CIVISTA CARE PARTNERS INC CCS LLC
Q	105142
CIVISTA CARE PARTNERS INC CCP LLC
R	575000
CIVISTA CARE PARTNERS INC CCP LLC
Q	460000