2012-03-29T13:54:37-04:00 2011-06-30 KPMG LLP 1676 International Drive McLean VA 22102 990 2010-07-01 520445374 Civista Medical Center Inc CIVI 3016094130 5 Garrett Ave PO Box 1070 La Plata MD 20646 NOEL CERVINO 2012-03-27 true SCOTT SHERMAN KPMG LLP 703-286-839 7032868000 2010 2016-02-24 21:20:13Z NOEL CERVINO 5 Garrett Ave LA PLATA MD 20646 105445758 false X www.civista.org X 1980 MD CIVISTA MEDICAL CENTER PROVIDES EXCELLENT CARE TO EACH PATIENT IN A SAFE, CARING AND FAMILY-CENTERED ENVIRONMENT. 15 14 1016 129 155988 35260 27613 1677803 101981695 103083914 131108 109879 526449 544515 102666865 105416111 93470 86592 0 0 45152262 47133035 0 0 0 55574825 53602980 100820557 100822607 1846308 4593504 125692844 128003508 108395171 103718743 17297673 24284765 X 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. false false 75910376 86592 103083914 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. 75910376 true true false true false false false false false true false false true true true false true false false true false false false false false true true true false true true false false false false false false false false false false false false false false false true true true false false true 237 0 true 1016 true true true true CJ false false false false false false false false X 15 14 false true false false false false false true true false false true true true true true true true false false MD X JIM CLAGUE 3016095154 5 GARRETT AVE La Plata MD 20646 X KHADAR BAIG 3.0 X 0 0 0 WAYNE BARNES 3.0 X 0 0 0 JAMES BURKE 3.0 X 0 0 0 MICHAEL CADY 3.0 X 0 0 0 C DEVADASON 3.0 X 0 0 0 LOUIS JENKINS JR 3.0 X X 0 0 0 CANDICE QUINN KELLY 3.0 X 0 0 0 SARA MIDDLETON 3.0 X X 0 0 0 VAN MITCHELL 3.0 X 0 0 0 SEETARAMAYYA NAGULA 3.0 X 0 0 0 ASHVIN J PATEL MD 4.0 X X 0 0 0 SURYAKANT PATEL 3.0 X 0 0 0 BARBARA STEPURA 3.0 X 0 0 0 RICHARD WINKLER 3.0 X X 0 0 0 NOEL CERVINO 40.0 X X 445695 0 63432 ERIK BOAS 40.0 X 239415 0 21308 MARK DUMAIS 40.0 X 182189 0 24816 MELANIE SAGE 40.0 X 164191 0 18732 GARY HERBEK 40.0 X 228060 0 22717 MARILYN GREGORY 40.0 X 164064 0 6356 LISA WILTROUT 40.0 X 141491 0 4891 JOAN HUMULOCK 40.0 X 140603 0 3692 STACEY COOK 40.0 X 147506 0 20655 KATHERINE MIDDLETON 40.0 X 131247 0 5933 CHRISTINE STEFANIDES X 111214 0 19222 KEVIN BURBULES X 146735 0 18404 2242410 0 230158 31 true true false MARYLAND INPATIENT CARE SPECIALISTS 2007 TIDEWATER COLONY WAY STE 1-A ANNAPOLIS MD 21401 PHYSICIANS 1300000 DIGITRACE CARE SERVICES INC 200 CORPORATE PLACE STE 58 PEABODY MA 01960 EEG PURCHASED SERV 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 24 1587803 90000 0 1677803 NET PATIENT REVENUE 900099 103083914 103083914 103083914 139526 139526 0 0 29647 -29647 -29647 -29647 0 0 0 ANSWERING SERVICE 561000 155988 155988 CAFETERIA AND COFFEE BAR SALES 900099 331070 331070 APPLICATION FEES 900099 5000 5000 52457 52457 544515 105416111 103141371 155988 440949 86592 86592 0 0 0 627700 502160 125540 0 0 38553382 30842706 7710676 0 1135979 908783 227196 0 3961570 3169256 792314 0 2854404 2283523 570881 0 200000 0 200000 0 404096 0 404096 0 300651 0 300651 0 67500 0 67500 0 0 0 10160566 8128453 2032113 0 174327 130745 43582 0 0 0 0 2109300 1096836 1012464 0 36613 9153 27460 0 0 0 3175167 0 3175167 0 0 4454144 4142354 311790 0 2123376 0 2123376 0 SUPPLIES AND DRUGS 17088729 15892518 1196211 0 BAD DEBT 7208495 7208495 0 0 OTHER 1841943 242249 1599694 0 EQUIPMENT RENTAL AND MAINT 3835478 1265708 2569770 0 TELEPHONE 422595 845 421750 0 100822607 75910376 24912231 0 29116660 33434372 10886077 9697092 1588468 1533556 854589 895718 103000316 39881340 65421048 63118976 75000 0 17751002 19323794 125692844 128003508 16336955 14668027 58529039 57930947 20920214 20008435 12608963 11111334 108395171 103718743 X 13665143 23796141 3632530 488624 17297673 24284765 125692844 128003508 X 4593504 2393588 X false true true X false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 78982 78982 false Lobbying Activities 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. 72170257 17425704 54744553 2288604 1190862 1097742 28541455 21264774 7276681 0 0 0 63118976 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 19323794 0 ADVANCES FROM THIRD PARTIES 3409780 ACCRUED INTEREST PAYABLE 1336007 ACCRUED PENSION COSTS 4197886 DUE TO AFFILIATE 247418 LEASE LIABILITIES 420131 MALPRACTICE IBNR 1500112 11111334 FIN 48 Footnote The organization accounts for uncertainty in income taxes in accordance with FIN 48 (as codified). The organization's audited financial statements do not include any liabilities for uncertain tax positions. Central America and the Caribbean Program Services insurance 1651125 1651125 1651125 true false true false false false true true true X true X true true true false true true 1410086 1410086 0.01410 1410086 1410086 0.01410 36 168619 533851 650 533201 0.00530 7 280 330757 330757 0.00330 7 145 1643721 181814 1461907 0.01460 15 1772 123141 123141 0.00120 65 170816 2631470 182464 2449006 0.02440 65 170816 4041556 182464 3859092 0.03850 3 142 7790 275 7515 0.00010 7 13 36522 36522 0.00040 1 10617 10617 0.00010 3 20 3990 3990 2 447 447 5 253270 253270 0.00250 21 175 312636 275 312361 0.00310 true 5766796 29165785 35194893 -6029108 X true true 1 1 Civista Medical Center

5 Garrett Ave La Plata MD 20646

X X X Civista Medical Center 1 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, true 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) 21600 FMV Equipment Equipment 3 Part I, Line 2 Civista Medical Center makes financial and in-kind contributions to various charitable organizations in the community. X X X X false false false false false false false false false 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 MARYLAND HEALTH AND HIGHER EDUCATIONAL FACILITIES 520936061 574217UL7 2005-02-09 60097615 HOSPITAL ADDITIONS/RENOVATIONS false false false 60097615 4511625 3796282 51789708 2007 false false true true false false false false true 0.00000 0.00000 0.00000 true true false false false false false SEE SCHEDULE O 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. 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 CIVISTA CARE PARTNERS INC 5 GARRETT AVE LA PLATA MD 20646 522176314 HEALTHCARE MD CIVISTA HLTH C Corp false false false false false false false false false false false true true true false true true true 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