2012-05-15T12:40:30-05:00 2011-06-30 COHEN RUTHERFORD KNIGHT PC 6903 ROCKLEDGE DRIVE SUITE 500 BETHESDA MD 208171800 990 2010-07-01 521452024 Carroll Hospital Center Inc CARR 4108716859 200 Memorial Avenue Westminster MD 21157 Kevin Kelbly 2012-05-14 3018281008 2010 2016-02-24 21:20:13Z John Sernulka 200 MEMORIAL AVE WESTMINSTER MD 21774 206214157 false X www.carrollhospitalcenter.org X 1957 MD OUR COMMUNITIES EXPECT AND DESERVE SUPERIOR MEDICAL TREATMENT, COMPASSIONATE CARE, AND EXPERT GUIDANCE IN MAINTAINING THEIR HEALTH AND WELL-BEING. 15 12 1958 3692824 1176242 1090000 190619219 201412609 4311044 3179446 773491 532102 196879996 206214157 115000 115000 0 0 96985712 97467463 0 0 0 100640157 91916180 197740869 189498643 -860873 16715514 300967431 313981970 206812673 195306839 94154758 118675131 OUR COMMUNITIES EXPECT AND DESERVE SUPERIOR MEDICAL TREATMENT, COMPASSIONATE CARE, AND EXPERT GUIDANCE IN MAINTAINING THEIR HEALTH AND WELL-BEING. AT CARROLL HOSPITAL CENTER, WE OFFER AN UNCOMPROMISING COMMITMENT TO THE HIGHEST QUALITY HEALTH CARE EXPERIENCE FOR PEOPLE IN ALL STAGES OF LIFE. WE ARE THE HEART OF HEALTH CARE IN OUR COMMUNITIES. false false 160054843 115000 198252757 Carroll Hospital Center, a 189 licensed bed acute care facility located in Westminster, Maryland offers the latest in medical technology and services, combined with a state-of-the-art facility and top-notch, skilled medical professionals, caring for patients with compassion. Currently, there are more than 400 physicians representing 38 specialties on our medical staff in addition to over 1,700 individuals employed by the Hospital - making CHC the second largest employer in Carroll County. The organization operates an acute care hospital serving the communities located in Carroll and surrounding counties as well as parts of Pennsylvania. Carroll County's population alone is currently estimated to be 204,400. In accordance with our tax-exempt function the organization operates an emergency room open to all persons regardless of their ability to pay and had over 54,000 patient visits last year. The hospital participates in Medicare and Medicaid programs, has a governing body comprised of independent persons representative of the community, all financial surpluses the hospital generates are used exclusively to further the charitable purposes of the organization and its medical staff is open to all qualified physicians in the area. As the only hospital in Carroll County, we offer our community a full array of services including, emergency services, comprehensive cancer care, pediatrics, maternity, geriatrics, the latest minimally invasive surgical procedures and advanced total and partial joint replacement procedures. In the year ending June 2011, Carroll Hospital Center recorded 15,833 inpatient admissions and observation stay cases, 1,119 births and approximately 9,200 surgical procedures, all contributing to a total of 330,000 patient encounters for the period. In line with our mission-"Our communities expect and deserve superior medical treatment, compassionate care, and expert guidance in maintaining their health and well-being. At Carroll Hospital Center, we offer an uncompromising commitment to the highest quality health care experience for people in all stages of life. We are the heart of health care in our communities." -the hospital also provides planned community benefit activities to improve access to health care and improve the overall health of our community. Our mission is pursued in collaboration with our related organizations: Carroll Hospice, The Partnership for a Healthier Carroll County (our community advocacy arm), and The Carroll Hospital Center Foundation (Also listed in Part VI) for more information on these subsidiaries, please see their individual Form 990's. While we have attempted to summarize our program service accomplishments below, we urge those interested to access more detailed and complete information at www.CarrolHospitalCenter.org. In cooperation with our many community partners, including The Partnership, we seek to make measurable and sustainable progress in improving the health of the communities we serve. We gauge our progress by how effectively we identify and positively impact the underlying root causes associated with poor community health. To track and trend our progress as a community, The Partnership has organized Healthy Carroll Vital Signs - Measures of Community Health. This data is provided by various sources and is updated each year. When combined with our newly-acquired Healthy Communities Institute data, the hospital has access to the most up-to-date, comprehensive information on our community's health. Through The Partnership, Carroll Hospital Center has been involved in numerous health status assessment projects specific to our community and is in the process of conducting a comprehensive Community Health Needs Assessment. Once completed in June 2012, the assessment will provide the hospital with the important and current needs and opinions of members of our community as well as more in-depth information from key community leaders. Collectively the data will provide the hospital with the crucial information it needs to continue to make well informed decisions when it comes to effectuating positive change in the health status of our communities. Previous health needs assessments have sparked the hospital to develop key services such as Access Carroll (in coordination with the Carroll County Health Department and The Partnership), a clinic for uninsured patients and The Women's Place, a center for health and wellness for women that provides a full range of educational, complementary health and patient navigation services, a breast center and cancer boutique. Hospital staff also have helped to develop and participate in numerous committees and work groups to address age, gender and ethnic-specific living and health care issues. In addition, the hospital's focus on wellness is one that provides our community with hundreds of free education programs, screenings and support groups each year for everything from childbirth and disease prevention to nutrition and breast, prostate and skin cancers. The hospital also has committed significant resources to make certain there is an adequate supply of primary care and specialty physicians in our service area. Ensuring our communities have access to quality and medical expertise is a priority for our organization. That's why we continue to develop Carroll Health Group, our hospital-owned network of medical providers, which currently includes 32 Physicians and 11 Other Providers (PA, NP) in 19 office locations throughout Carroll and surrounding counties. During the most recent reporting period the organization provided a total of $3,011,868, $2,463,708 at cost, in charity/uncompensated care to the community. Additionally the organization expended approximately $19,147,524 (Net of Revenues) on programs and activities benefitting the communities we serve. These programs and activities included hospice services, physician support, education programs, screenings, support groups, health professional education and community contributions and required approximately 492,000 staff hours. 160054843 true true false true false false false false true true true true true true false false true false false true false false false false false true true true false true true false false false false false false false false true false false false false false true true true true false false true 233 0 true 1958 true true true false false false false false false false false false false X 15 12 true false false false false false false true true false false true true true true true true true true true true CA MD X DAVID MCCORMICK 4108716859 200 MEMORIAL AVE Westminster MD 21157 X CHARLES O FISHER JR 1.0 X 0 0 0 CHARLES FISHER SR 1.0 X 0 0 0 MIRIAM BECK 1.0 X 0 0 0 PAULA LANGMEAD 1.0 X 0 0 0 ETHAN SEIDEL 1.0 X 0 0 0 JOHN SERNULKA 35.0 X X 291984 0 292083 STEPHAN HOCHULI MD 1.0 X 0 0 0 KIMBERLY JOHNSTON MD 1.0 X 0 0 0 STANLEY H TEVIS III 1.0 X 0 0 0 HAROLD WALSH 1.0 X 0 0 0 HELEN W WHITEHEAD 1.0 X 0 0 0 CHRISTOS BALLAS MD 1.0 X 0 0 0 THOMAS WELLIVER 1.0 X 0 0 0 JEFFREY A WOTHERS 1.0 X 0 0 DENNIS THOMAS 1.0 X 0 0 0 LESLIE SIMMONS 38.0 X 278385 0 24101 KEVIN KELBLY 34.0 X 303120 0 29988 KEVIN SMOTHERS 40.0 X 366121 0 22772 STEPHANIE REID 40.0 X 155779 0 7033 DAVID HORN 40.0 X 188775 0 23172 M ELLEN FINNERTY MYERS 40.0 X 192915 0 4949 JOYCE ROMANS 40.0 X 198223 0 14976 TRACEY ELLISON 40.0 X 172101 0 19892 DANILO PERUNOVICH 40.0 X 184371 0 13876 CYNTHIA ROLDAN 40.0 X 174445 0 3078 JEROME MARAVE 40.0 X 210263 0 19753 DANILO V SANTOS 40.0 X 187300 0 13932 EDYTA OSWIECIMKA 40.0 X 163532 0 18620 KIMBERLY MOREAU 40.0 X 150193 0 24520 3217507 0 532745 70 false true false CENTRAL MD REHABILITATION 4259 HARNEY RD TANEYTOWN MD 21787 REHAB 3005060 CARROLL COUNTY ANES ASSOCIATION PO BOX 75193 BALTIMORE MD 21275 ANESTHESIA 1802745 carroll county radiology 7253 ambassador rd BALTIMORE MD 21244 mri 783960 DIGITRACE CARE SERVICES 200 CORPORATE PLACE PEABODY MA 01960 Sleep Studies 666550 university of md physicians 419 w redwood st ste 660 BALTIMORE MD 21201 physicians 658333 30 1090000 1090000 NET PATIENT SERVICE REVENUE 194771483 194771483 CAFETERIA/VEND. 798131 798131 LAB 621500 3569383 3569383 OTHER OPERATING REVENUE 2273612 2273612 201412609 3179446 870 3178576 0 0 442102 442102 442102 409531 32571 0 0 0 0 0 CARROLL COUNTY MED SERVICES MGMT FEE 541610 90000 90000 90000 206214157 198252757 3692824 3178576 115000 115000 0 0 0 2403976 0 2403976 0 0 78355992 69652245 8703747 0 4342488 3857380 485108 0 6551084 5819249 731835 0 5813923 5164438 649485 0 0 0 0 0 519862 1565 518297 0 247500 0 247500 0 7858 0 7858 0 0 231741 0 231741 0 8337408 7833641 503767 0 621820 8237 613583 0 855882 538583 317299 0 5090673 0 5090673 0 0 0 0 0 3751339 2634079 1117260 0 441163 167876 273287 0 0 92613 69954 22659 0 6889101 6889101 0 0 0 13233722 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625578 0.00350 31629284 17825678 13803606 0.07620 207586 207586 0.00110 33845980 17859263 15986717 0.08830 36309688 17859263 18450425 0.10190 406772 103863 302909 0.00170 448930 448930 0.00250 855702 103863 751839 0.00420 true 6861384 686138 83961449 62855055 21106394 X true true cc radiology llc imaging center 0.60000 0.40000 1 1 CARROLL HOSPITAL CENTER INC

200 MEMORIAL AVE WESTMINSTER MD 21157

X CARROLL HOSPITAL CENTER INC 1 5 carroll county radiology

7253 ambassador road baltimore MD 21244

imaging center carroll county radiology

1430 progress way ste 108 eldersburg MD 21784

imaging center carroll county radiology

193 stoner ave ste 200 westminster MD 21157

imaging center carroll county radiology

1 village square westminster MD 21157

imaging center carroll county radiology

844 washington road ste 102 westminster MD 21157

imaging center PART I, LINE 3B FOR PATIENTS THAT EXPERIENCE A MEDICAL HARDSHIP (MEDICAL DEBT THAT EXCEEDS 25% OF HOUSEHOLD INCOME), CARROLL HOSPITAL CENTER ALSO PROVIDES DISCOUNTED CARE FOR INDIVIDUALS EARNING UP TO 500% OF THE FEDERAL POVERTY GUIDELINES. PART I, LINE 5A CARROLL HOSPITAL CENTER DOES NOT DENY FINANCIAL ASSISTANCE TO ANY PATIENT ELIGILBE FOR FREE OR DISCOUNTED CARE UNDER ITS FINANCIAL ASSISTANCE POLICY REGARDLESS OF WHETHER OR NOT THE FINANCIAL ASSISTANCE BUDGET WAS EXCEEDED. PART I, LINE 7A, COLUMN C THE METHODOLOGY USED TO CALCULATE CHARITY CARE COST WAS A COST-TO-CHARGE RATIO DERIVED FROM WORKSHEET 2, RATIO OF PATIENT CARE-TO-CHARGES. PART I, LINE 7A MARYLAND'S REGULATORY SYSTEM CREATES A UNIQUE PROCESS FOR HOSPITAL PAYMENT THAT DIFFERS FROM THE REST OF THE NATION. THE HEALTH SERVICES COST REVIEW COMMISSION (HSCRC) DETERMINES PAYMENT THROUGH A RATE-SETTING PROCESS AND ALL PAYORS, INCLUDING GOVERNMENTAL PAYORS, PAY THE SAME AMOUNT FOR THE SAME SERVICES DELIVERED AT THE HOSPITAL. MARYLAND'S UNIQUE ALL-PAYOR SYSTEM INCLUDES A METHOD FOR REFERENCING UNCOMPENSATED CARE IN EACH PAYOR'S RATES, WHICH DOES NOT ENABLE MARYLAND HOSPITALS TO BREAKOUT ANY OFFSETTING REVENUE RELTED TO UNCOMPENSATED CARE. PART I, LINE 7B MARYLAND'S REGULATORY SYSTEM CREATES A UNIQUE PROCESS FOR HOSPITAL PAYMENT THAT DIFFERS FROM THE REST OF THE NATION. THE HEALTH SERVICES COST REVIEW COMMISSION (HSCRC) DETERMINES PAYMENT THROUGH A RATE-SETTING PROCESS AND ALL PAYORS, INCLUDING GOVERNMENTAL PAYORS, PAY THE SAME AMOUNT FOR THE SAME SERVICES DELIVERED AT THE HOSPITAL. MARYLAND'S UNIQUE ALL-PAYOR SYSTEM INCLUDES A METHOD FOR REFERENCING UNCOMPENSATED CARE IN EACH PAYOR'S RATES, WHICH DOES NOT ENABLE MARYLAND HOSPITALS TO BREAKOUT ANY OFFSETTING REVENUE RELTED TO UNCOMPENSATED CARE. COMMUNITY BENEFIT EXPENSES ARE EQUAL TO MEDICAID REVENUES IN MARYLAND, AS SUCH, THE NET EFFECT IS ZERO. THE EXCEPTION TO THIS IS THE IMPACT ON THE HOSPITAL FOR ITS SHARE OF MEDICAID ASSESSMENT. IN RECENT YEARS THE STATE OF MARYLAND HAS CLOSED FISCAL GAPS IN THE STATE MEDICAID BUDGET BY ASSESSING HOSPITALS THROUGH THE RATE-SETTING SYSTEM. FOR TAX YEAR 2010 CARROLL HOSPITAL CENTER'S MEDICAID BUDGET DEFICIT UNFUNDED ASSESSMENT AMOUNTED TO $504,659. PART I, LINE 3C N/A PART I, LINE 6A MARYLAND HOSPITAL'S ARE REQUIRED TO SUBMIT AN ANNUAL COMMUNITY BENEFIT REPORT TO THE HEALTH SERVICES COST REVIEW COMMISSION (HSCRC) THAT DESCRIBES THE PROGRAMS AND SERVICES OFFERED THAT ARE DESIGNED TO PROMOTE THE HEALTH AND WELLNESS OF THE COMMUNITIES SERVED. THESE REPORTS ARE AVAILABLE TO THE PUBLIC ON THE HSCRC WEBSITE (WWW.HSCRC.STATE.MD.US). ADDITIONALLY, CARROLL HOSPITAL CENTER MAKES AVAILABLE ITS COMMUNITY BENEFIT REPORT ON ITS WEBSITE (WWW.CARROLLHOSPITALCENTER.ORG) PART I, LINE 7G CARROLL HOSPITAL CENTER PROVIDED $13,803,606 OF NET COMMUNITY BENEFIT THROUGH SUBSIDIZED HEALTH SERVICES. THIS INCLUDES PHYSICIAN SUPPORT SPENDING INCURRED BY THE HOSPITAL ($4.2 MILLION) TO PROVIDE ON-SITE PHYSICIAN COVERAGE TO HOSPITAL OBSTETRICAL, PEDIATRIC, CRITICAL CARE, AND MEDICAL/SURGICAL PATIENTS, AS WELL AS EMERGENCY DEPARTMENT ON-CALL COVERAGE. ADDITIONALLY, CARROLL HOSPITAL CENTER INDIRECTLY SUBSIDIZES THE OPERATING LOSSES ASSOCIATED WITH ITS WHOLLY-OWNED CORPORATE SUBSIDIARY'S (CARROLL COUNTY MED-SERVICES) EMPLOYED PHYSICIAN ENTERPRISES (ELEVEN WHOLLY-OWNED PHYSICIAN PRACTICE LIMITED COMPANIES DISREGARDED FOR TAX PURPOSES). CARROLL HOSPITAL CENTER FUNDS THE OPERATING LOSSES ($9.6 MILLION) THAT ARE INCURRED DIRECTLY BY CARROLL COUNTY MED-SERVICES. AS A RESULT, CARROLL HOSPITAL CENTER HAS INCLUDED THE $9.6 MILLION OPERATING LOSS ASSOCIATED WITH THE FUNDING OF THE PHYSCIAN ENTERPRISES AS A COMMUNITY BENEFIT ON SCHEDULE H. ALL THE INITIATIVES AND SUPPORT LISTED ABOVE WOULD NOT BE PROVIDED IF CARROLL HOSPITAL CENTER DID NOT PROVIDE THEM. AS THE ONLY HOSPITAL IN THE COUNTY, IT IS OUR PRIMARY RESPONSIBILITY TO PROVIDE THESE SERVICES FOR THE UNINSURED AND UNDERINSURED, AS WELL AS ALL COMMUNITY MEMBERS. THERE IS NOT ANY OTHER ORGANIZATION OR INDIVIDUAL IN THE COUNTY THAT WOULD BE ABLE TO PROVIDE ALL OF THESE COMPREHENSIVE SERVICES IN ALL OF THE AREAS That THE HOSPITAL DOES. PART I LINE 7 MARYLAND'S REGULATORY SYSTEM CREATES A UNIQUE PROCESS FOR HOSPITAL PAYMENT THAT DIFFERS FROM THE REST OF THE NATION. THE HEALTH SERVICES COST REVIEW COMMISSION (HSCRC) DETERMINES PAYMENT THROUGH A RATE-SETTING PROCESS AND ALL PAYORS, INCLUDING GOVERNMENTAL PAYORS, PAY THE SAME AMOUTN FOR THE SAME SERVICES DELIVERED AT THE SAME HOSPITAL. MARYLAND'S UNIQUE ALL-PAYOR SYSTEM INCLUDES A METHOD FOR REFERENCING UNCOMPENSATED CARE IN EACH PAYOR'S RATES, WHICH DOES NOT ENABLE MARYLAND HOSPITALS TO BREAKOUT ANY OFFSETTING REVENUE RELATED TO UNCOMPENSATED CARE. PART III, LINE 4 CARROLL HOSPTIAL CENTER INCURRED $6,861,384 BAD DEBT EXPENSE DURING THE TAX YEAR 2010. THIS REFLECTS THE AMOUNT OF GROSS PATIENT CHARGES ($8,388,000) UNCOLLECTED FROM PATIENTS THAT DID NOT QUALIFY FOR FINANCIAL ASSISTANCE DISCOUNTED BY CHC'S COST-TO-CHARGE RATIO CALCULATED FROM WORKSHEET 2, RATIO OF PATIENT CARE COST-TO-CHARGES. PER AUDIT REPORT (1M): "NET PATIENT SERVICE FOR THE HOSPITAL REFLECTS ACTUAL CHARGES TO PATIENTS BASED ON RATES ESTABLISHED BY THE STATE OF MARYLAND HEALTH SERVICES COST REVIEW COMMISSION (HSCRC) IN EFFECT DURING THE PERIODS IN WHICH SERVICES ARE RENDERED, NET OF CONTRACTUAL ADJUSTMENTS. CONTRACTUAL ADJUSTMENTS REPRESENT THE DIFFERENCE BETWEEN AMOUNTS BILLED BY THE HOSPITAL AND AMOUNTS PAID BY THIRD-PARTY PAYORS. BECAUSE THE HOSPITAL DOES NOT PURSUE COLLECTION OF AMOUNTS DETERMINED TO QUALIFY AS CHARITY CARE, SUCH AMOUNTS ARE NOT REPORTED AS REVENUE". BAD DEBT EXPENSE REFLECTS ACTUAL PATIENT CHARGES THAT HAVE BEEN DETERMINED TO BE UNCOLLECTIBLE FOR PATIENTS THAT HAVE NOT QUALIFIED FOR CHARITY CARE. BAD DEBT EXPENSE MAY ALSO INCLUDE ADDITIONAL "BAD DEBT PROVISIONS" FOR DOUBTFUL ACCOUNTS BASED ON MANAGEMENT'S ESTIMATES OF FUTURE ACCOUNT COLLECTIONS BASED ON CHARGES IN SERVICE MIX AND PAYOR MIX. CARROLL HOSPITAL CENTER INC. DETERMINES ELIGIBILITY FOR FINANCIAL ASSISTANCE THROUGH OTHER VARIOUS MEANS (CREDIT REPORTS, DEBT AND ASSET REVIEWS, AND REFERRALS FROM THE HOSPITAL'S BILLING AGENTS) WHEN THE PATIENT HAS NOT COMPLETED THE FINANCIAL ASSISTANCE APPLICATION. IF A DETERMINATION IS MADE REGARDING THE PATIENT'S INABILITY TO PAY, THE ACCOUNT CAN BE APPROVED FOR FINANCIAL ASSISTANCE ON A PRESUMPTIVE BASIS RATHER THAN BE REFLECTED AS BAD DEBT EXPENSE ($686,138 AT COST) MAY BE ATTRIBUTABLE TO PATIENTS ELIGIBLE FOR FINANCIAL ASSISTANCE/CHARITY CARE. PART III, LINE 8 CARROLL HOSPITAL CENTER'S TAX YEAR 2010 (FISCAL YEAR 2011) MEDICARE COST REPORT SUBMISSION WAS UTILIZED AS THE SOURCE DOCUMENT TO REPORT MEDICARE ALLOWABLE COSTS OF CARE (PART III, LINE 6) RELATING TO PAYMENTS ON (PART III, LINE 5) PART III, LINE 9B for those patients that do not initially apply or qualify for financial assistance, the organization continues to monitor whether the patient may qualify for financial assistance. If the patient is found to be eligible for financial assistance, at any point (including once collection efforts have begun), the organization will approve the patient for charity care. Collection efforts will be stopped immediately once the patient is found to qualify for charity care under the organization's financial assistance policy. NEEDS ASSESSMENT PART VI, LINE 2 THROUGH OUR COMMUNITY ADVOCACY ARM, THE PARTNERSHIP FOR A HEALTHIER CARROLL COUNTY, CHC HAS BEEN INVOLVED IN NUMEROUS HEALTH STATUS ASSESSMENT PROJECTS SPECIFIC TO OUR COMMUNITY. AN ORIGINAL CARROLL COMMUNITY HEALTH ASSESSMENT IN 1997 PRIORITIZED EIGHT BROAD AREAS WHERE IMPROVEMENT OPPORTUNITIES EXISTED. THAT NUMBER WAS EXPANDED TO 11, FOLLOWING SUCCESSIVE ASSESSMENTS. UPDATED TO THE ORIGINAL ASSESSMENT WERE ALSO COMPLETED IN 2005 AND INCLUDED TWO UPDATES, ONE SPECIFIC TO HOUSEHOLDS WITHOUT CHILDREN UNDER THE AGE OF 18 AND THOSE WITH CHILDREN UNDER THE AGE OF 18. OUR RESULTS WERE STRIKINGLY SIMILAR TO THE LEADING INDICATORS IN THE US GOVERNMENT'S HEALTHY PEOPLE 2010 PROJECT. OPERATING UNDER THE GUIDANCE OF THE SURGEON GENERAL'S OFFICE AND THE SECRETARY OF THE DEPARTMENT OF HEALTH AND HUMAN SERVICES, HEALTHY PEOPLE 2010 IS THE PREVENTION AGENDA FOR THE NATION. ALL IDENTIFIED IMPROVEMENT AREAS HAVE BEEN UPDATED TO PROVIDE HEALTHY PEOPLE 2010 OBJECTIVES. ALL IDENTIFIED IMPROVEMENT AREAS WILL BE REVIEWED AND INCORPORATED INTO OUR COMMUNITY BENEFIT PLAN AS FEASIBLE AND APPROPRIATE. IN COOPERATION WITH OUR COMMUNITY PARTNERS. WE SEEK TO MAKE MEASURABLE, SUSTAINABLE, LONG-TERM PROCESS. WE GAUGE OUR PROGRESS RELATED TO OUR EFFORTS ON THE UNDERLYING ROOT CAUSES ASSOCIATED WITH THESE ISSUES, AND AGAIN, WITH AND THROUGH OUR MANY PARTNERS, WE STRIVE TO ADDRESS ROOT CAUSES. TO TRACK AND TREND OUR PROGRESS AS A COMMUNITY, THE PARTNERSHIP HAS ORGANIZED HEALTHY CARROLL VITAL SIGNS - MEASURES OF COMMUNITY HEALTH. THIS DATA IS PROVIDED BY VARIOUS SOURCES INCLUDING THE CARROLL COUNTY HEALTH DEPARTMENT AND OTHER BRANCHES OF THE CARROLL COUNTY GOVERNMENT AS WELL AS THROUGH HOSPITAL-BASED COMMUNITY OUTREACH ACTIVITIES AND EDUCATION (DATA CHARTS AVAILABLE ON-LINE AT WWW.HEALTHYCARROLL.ORG). SINCE NOT ALL OF THE DATA CHARTS ARE UPDATED EACH YEAR, DATA CHARTS ARE REVIEWED ANNUALLY AND UPDATED AS DATA IS AVAILABLE. THE PARTNERSHIP DEVELOPED A DASHBOARD REPORT TO TRACK PROGRESS AND OUTCOMES OF KEY INDICATORS (DASHBOARD AVAILABLE ON-LINE AT WWW.HEALTHYCARROLL.ORG AND PROVIDED AS SUPPORT IN QUESTION 5). OTHER ASSESSMENTS USED INCLUDE: ELDER NEEDS HEALTH ASSESSMENT: COMPLETED IN FEBRUARY 2008, (REPORT AVAILABLE IN ITS ENTIRETY ON-LINE AT WWW.HEALTHYCARROLL.ORG). COMMUNITY BENEFIT PROGRAM INITIATIVES ARE DECIDED UPON PRIMARILY BY THE INPUT, WORK AND ANNUAL STRATEGY PLANNING OF THE FOLLOWING: 1. PATIENTS 2. THE PARTNERSHIP FOR A HEALTHIER CARROLL COUNTY (WITH OUR COMMUNITY PARTNERS INCLUDING THE CARROLL COUNTY HEALTH DEPARTMENT) 3. THE LEARNING CENTER 4. THE WOMEN'S PLACE 5. THE HOSPITAL'S MULTIDISCIPLINARY COMMUNITY BENEFIT PLANNING AND REVIEW TEAM 6. THE HOSPITAL'S EXECUTIVE TEAM AND BOARD OF DIRECTORS IN ADDITION, TO KEEP OUR FINGER ON THE PULSE OF PERTINENT ISSUES AND CONTINUE TO BE PROACTIVE IN INDENTIFYING AND CREATIVELY MEETING THE UNIQUE NEEDS OF OUR COMMUNITY ON AN ONGOING BASIS, THE PARTNERSHIP HAS DEVELOPED AND FACILITATES THE FOLLOWING LEADERSHIP TEAMS FOCUSED ON THE 11 CORE HEALTH IMPROVEMENT AREAS IDENTIFIED IN OUR ORIGINAL COMMUNITY HEALTH ASSESSMENT: 1. ACCESS TO HEALTH CARE - COLLABORATES WITH COMMUNITY PARTNERS TO IMPROVE ACCESS TO HEALTH CARE FOR THE UNINSURED AND UNDERINSURED. 2. CANCER: AMERICAN CANCER SOCIETY LEADERSHIP COUNCIL - WORKS TO REDUCE CANCER INCIDENCE AND MORTALITY IN CARROLL COUNTY. 3. INTERPERSONAL VIOLENCE: DOMESTIC VIOLENCE COORDINATING COUNCIL - FOCUSES ON ISSUES OF DOMESTIC VIOLENCE IN COUNTY. AFFILIATED WITH FAMILY AND CHILDREN'S SERVICES OF CENTRAL MARYLAND, CARROLL COUNTY. 4. ELDER HEALTH - SEEKS TO INCREASE QUALITY AND YEARS OF HEALTHY LIFE FOR CARROLL COUNTIANS OVER AGE 65. 5. HEART HEALTH IMPROVEMENT - SEEKS TO IMPROVE THE CARDIOVASCULAR HEALTH AND QUALITY OF LIFE OF ADULTS AND CHILDREN THROUGH PREVENTION, DETECTION, AND TREATMENT OF RISK FACTORS. 6. L.E.A.N. CARROLL - MULTI-DISIPLINARY HOSPITAL/COMMUNITY GROUP WORKING TO ADDRESS CHILDHOOD OBESITY IN CARROLL COUNTY THROUGH LIFESTYLE, EDUCATION, ACTIVITY AND NUTRITION. 7. MENTAL HEALTH: SUBCOMMITTEE OF THE BEHAVIORAL HEALTH AND ADDICTIONS ADVISORY COUNCIL - SUPPORTS EFFORTS TO IMPROVE THE MENTAL HEALTH OF CARROLL COUNTY RESIDENTS. A MENTALLY HEALTHY COMMUNITY IS INDICATED BY MANY FACTORS INCLUDING: LOW SUICIDE ATTEMPT RATES, AND INCREASED NUMBER OF COUNTY RESIDENTS WHOSE INSURANCE COVERS MENTAL HEALTH SERVICES, AN ADEQUATE NUMBER OF OUTPATIENT SERVICES, AND A DECREASE IN THE STIGMA ASSOCIATED WITH MENTAL ILLNESS AND EMOTIONAL DISTURBANCES. 8. PREVENTION & WELLNESS PARTNERS - COORDINATES PROJECTS TO IMPROVE HEALTH OUTCOMES FOR PEOPLE IN CARROLL COUNTY AS MEASURED BY IMPROVEMENT IN LIFESTYLE/BEHAVIOR INDICATORS. 9. RESOURCE CONSERVATION COALITION - WORK GROUP FORMED TO PROMOTE HEALTH AND QUALITY OF LIFE FOR ALL COUNTY RESIDENTS THROUGH A HEALTHIER ENVIORMENT AND MANAGED GROWTH AND DEVELOPMENT AND WATER QUALITY STANDARDS. 10.POSITIVE YOUTH & FAMILY DEVELOPMENT - SCHOOL READINESS PROVIDES INFORMATION TO PARENTS AND COMMUNITY ON WAYS TO ENSURE THAT CHILDREN ENTER SCHOOL WITH THE SKILLS NEEDED FOR LEARNING. 11.SUBSTANCE ABUSE: SUB-COMMITTEE OF THE BEHAVIORAL HEALTH AND ADDICTIONS ADVISORY COUNCIL - FOCUSES ON ALL ISSUES OF SUBSTANCE ABUSE IN CARROLL COUNTY. PRODUCES SUBSTANCE ABUSE DIRECTORY (2008 VERSION). WORKS TOWARDS GAPS IN SERVICE THAT HAVE BEEN IDENTIFIED, INCLUDING NEED FOR A LONG-TERM TREATMENT FACILITY FOR HEROIN USERS, LACK OF SPACE/CAPACITY FOR CURRENT RESIDENTAL PROGRAMS, INSUFFICIENT DETOX SERVICES, INADEQUATE SERVICES FOR ADOLESCENTS WITH CO-OCCURING DISORDERS, AND A NEED FOR MORE PREVENTION SERVICES. THE ADDTIONAL PARTNERS UTILIZED IN COMMUNITY NEEDS ASSESSMENTS WERE: 1. BEHAVIORAL HEALTH AND ADDICTIONS ADVISORY COUNCIL - STATE APPOINTED LOCAL GROUP TO EVALUATE CONTINUUM OF CARE IN SUBSTANCE ABUSE AND MENTAL HEALTH FIELDS IN THE COUNTY. SERVES AS QUASI-BOARD OF DIRECTORS FOR THE CARROLL COUNTY CORE SERVICES AGENCY. ALSO COORDINATES TRAINING PROGRAMS, PROGRAMS DESIGNED TO REDUCE THE STIGMA ASSOCIATED WITH PSYCHIATRIC DISORDERS, AND PUBLIC AWARENESS PROGRAMS. 2. CARING CARROLL, INC. - OPERATES CARING CARROLL, A FAITH IN ACTION VOLUNTEER CARE GIVING PROGRAM. HELPS TO MEET THE NON-MEDICAL NEEDS OF ISOLATED ELDERLY, ILL, DISABLED, OR FRAIL CARROLL COUNTY RESIDENTS STRIVING TO REMAIN INDEPENDENT IN THEIR OWN HOMES. 3. CARROLL COUNTY LOCAL MANAGEMENT BOARD - WORKS TO IMPROVE THE LIVES OF CHILDREN AND FAMILIES IN CARROLL COUNTY. DEVELOPS AND MANAGES COMMUNITY-BASED FAMILY SERVICES. 4. MID-WESTERN REGION HIGHWAY SAFETY TASK FORCE - CARROLL COUNTY COMPREHENSIVE HIGHWAY TRAFFIC SAFETY TASK FORCE. FUNDS LAW ENFORCEMENT, INCLUDING OVERTIME FOR DUI ENFORCEMENT, AGGRESSIVE DRIVING, MOTORCYCLE, AND PEDESTRIAN ENFORCEMENT. EDUCATION AND AWARENESS PROGRAMS ON YOUNG/OLDER DRIVER ISSUES, OCCUPANT PROTECTION, CHILD PASSENGER SAFETY, BICYCLE, ALCOHOL, AGGRESSIVE DRIVING AND MORE. 5. RISKY BUSINESS PLANNING COMMITTEE - PLANS ANNUAL TRAINING/ AWARENESS-RAISING CONFERENCE IN JUNE FOR PROVIDERS REGARDING ISSUES OF TEEN RISKY BEHAVIORS, SUCH AS PREGNANCY, DRUG USE, AND SUICIDE. 6. TOBACCO COALITION (CARROLL COMMUNITY HEALTH TOBACCO COALITION) LOCAL HEALTH COALITION THAT SEEKS TO DECREASE TOBACCO USE AND EXPOSURE TO SECONDHAND SMOKE IN CARROLL COUNTY. PATIENT EDUCATION AND ELIGIBILITY FOR ASSISTANCE PART VI, LINE 3 CARROLL HOSPITAL CENTER (CHC) HAS A NUMBER OF PROGRAMS TO ASSIST PATIENTS WITH THEIR PAYMENT OBLIGATIONS. FIRST, WE PROVIDE A MEDICAID ENROLLMENT SERVICE TO PATIENTS WHO QUALIFY FOR MEDICAL ASSISTANCE. THIS SERVICE ASSISTS PATIENTS WITH PAPERWORK AND WILL EVEN PROVIDE TRANSPORTATION IF NEEDED. THIS PAST YEAR, CHC ASSISTED 310 PATIENTS IN APPLYING FO THE STATE'S MEDICAL ASSISTANCE PROGRAM. IN ADDITION, THE HOSPITAL HELD A, FREE ENROLLMENT SESSION FOR "COVER THE UNINSURED DAY' FOR UNINSURED COMMUNITY MEMBERS TO COME IN TO SEE IF THEY QUALIFIED FOR MEDICAL OR FNINANCIAL ASSISTANCE. FOR PATIENTS WHO DO NOT QUALIFY FOR MEDICAID COVERAGE, CHC HAS AN IN-HOUSE FINANCIAL ASSISTANCE PROGRAM. OUR ELIGIBILITY STANDARDS ARE MORE LENIENT THAN EVEN THOSE PROPOSED BY THE MARYLAND HOSPITAL ASSOCIATION GUIDELINES. WE WRITE OFF 100% OF THE BILL FOR PATIENTS WHOSE INCOME IS BELOW 300% OF THE FEDERAL POVERTY GUIDELINES (FPG) AND WRITE OFF A PORTION OF THE BILL FOR PATIENTS WHOSE INCOME IS BETWEEN 301%-375%OF THE FPG. WHEN PATIENTS EXPRESS THEIR INABILITY TO PAY FO SERVICES, OUR STAFF WORKS TO FIND THE BEST POSSIBLE OPTION FOR THEM BY DISCUSSING IN DETAIL THEIR SITUATION. THE FAMILY IS INVOLVED IN THOSE CONVERSATIONS TO THE EXTENT THE PATIENT FEELS COMFORTABLE. THE HOSPITAL ALSO HAS A PROCESS IN PLACE FOR PATIENTS TO HAVE FINANCIAL ASSISTANCE DECISIONS RECONSIDERED AND THAT PROCESS IS CLEARLY OUTLINED IN OUR FINANCIAL ASSISTANCE POLICY AND IN INFORMATION PROVIDED TO OUR PATIENTS. IN ADDITION, FOR PATIENTS WITH INCOME BELOW 500% OF THE FPG AND WHOSE MEDICAL DEBT AT CHC IS IN EXCESS OF 25% OF THEIR HOUSEHOLD INCOME, THE HOSPITAL HAS A MEDICAL HARDSHIP PLAN THAT PROVIDES FOR REDUCED-COST CARE. THE HOSPITAL POSTS A SUMMARY OF ITS POLICY INFORMING PATIENTS OF THE AVAILABILITY OF FINANCIAL ASSISTANCE. IN ALL REGISTRATION AND INTAKE AREAS FOR ALL PATIENTS TO SEE. IN ADDITION, DETAILED INFORMATION ON OUR FINANCIAL ASSISTANCE POLICY IS INCLUDED IN EVERY ADMISSION FOLDER, ON BILLS MAILED TO PATIENTS AND ON THE HOSPITAL'S WEBSITE (WWW.CARROLLHOSPITALCENTER.ORG). COMMUNITY INFORMATION PART VI, LINE 4 AS THE ONLY HOSPITAL IN THE COUNTY, CHC'S PRIMARY SERVICE AREA IS THE ENTIRE COUNTY. THE HOSPITAL DOES, HOWEVER, ALSO SERVE PORTIONS OF BALTIMORE, FREDERICK AND MONTGOMERY COUNTIES AS WELL AS AREAS IN SOUTHERN PENNSYLVANIA. THE GENERAL DEMOGRAPHICS FOR OUR PRIMARY COMMUNITY (CARROLL COUNTY) ARE LISTED BELOW: POPULATION TOTAL POPULATION 2010: 167,134 POPULATION PERCENT CHANGE 2000 TO 2010: 10.8% POPULATION 2000: 150,897 PERSONS UNDER 5 YEARS PERCENT 2010: 5.4% PERSONS UNDER 18 YEARS PERCENT 2010: 24.7% PERSONS 65 YEARS AND OVER PERCENT 2010: 13.0% FEMALE PERSONS, PERCENT 2010: 50.6% RACE WHITE PERSONS: 92.9% BLACK PERSONS: 3.2% AMERICAN INDIAN AND ALASKA NATIVE PERSONS: 0.2% ASIAN PERSONS: 1.4% NATIVE AMERICAN AND OTHER PACIFIC ISLANDER: 0 PERSONS REPORTING TWO OR MORE RACES: 1.5% PERSONS OF HISPANIC OR LATINO ORIGIN: 2.6% WHITE PERSONS NOT HISPANIC: 91.2% SOURCE: SOURCE US CENSUS BUREAU: STATE AND COUNTY QUICKFACTS. FAMILY TOTAL NUMBER OF HOUSEHOLDS (2009): 59,915 AVERAGE HOUSEHOLD SIZE (2009): 2.77 PERSONS SOURCE: 2009 AMERICAN COMMUNITY SURVEY 1-YEAR ESTIMATES. ECONOMICS MEDIAN HOUSEHOLD INCOME (2007/2008): $78,653 PERSONS BELOW POVERTY LEVEL, PERCENT, 2009: 5.9% SOURCES: CARROLL COUNTY DEPARTMENT OF ECONOMIC DEVELOPMENT AND US CENSUS BUREAU: STATE AND COUNTY QUICKFACTS. OTHER SIGNIFICANT DEMOGRAPHIC CHARACTERISTICS ACCORDING TO THE MD BRFSS (MARYLAND BEHAVIORAL RISK FACTOR SURVEILLANCE SURVEY) (AVERAGE 2008-2010 DATA) THE PERCENTAGE OF UNINSURED PATIENTS IN CARROLL COUNTY IS 7.4%. IN FY 2011, OF THE CARROLL COUNTY RESIDENTS THAT WERE HOSPITALIZED (EITHER AT CHC OR OTHER HOSPITALS), 7.2% WERE MEDICAID ADMISSIONS. PROMOTION OF COMMUNITY HEALTH PART VI, LINE 5 Carroll Hospital Center, a 189 licensed bed acute care facility located in Westminster, Maryland offers the latest in medical technology and services, combined with a state-of-the-art facility and top-notch, skilled medical professionals, caring for patients with compassion. Currently, there are more than 400 physicians representing 38 specialties on our medical staff in addition to over 1,700 individuals employed by the Hospital - making CHC the second largest employer in Carroll County. The organization operates an acute care hospital serving the communities located in Carroll and surrounding counties as well as parts of Pennsylvania. Carroll County's population alone is currently estimated to be 204,400. In accordance with our tax-exempt function the organization operates an emergency room open to all persons regardless of their ability to pay and had over 54,000 patient visits last year. The hospital participates in Medicare and Medicaid programs, has a governing body comprised of independent persons representative of the community, all financial surpluses the hospital generates are used exclusively to further the charitable purposes of the organization and its medical staff is open to all qualified physicians in the area. As the only hospital in Carroll County, we offer our community a full array of services including, emergency services, comprehensive cancer care, pediatrics, maternity, geriatrics, the latest minimally invasive surgical procedures and advanced total and partial joint replacement procedures. In the year ending June 2011, Carroll Hospital Center recorded 15,833 inpatient admissions and observation stay cases, 1,119 births and approximately 9,200 surgical procedures, all contributing to a total of 330,000 patient encounters for the period. In line with our mission-"Our communities expect and deserve superior medical treatment, compassionate care, and expert guidance in maintaining their health and well-being. At Carroll Hospital Center, we offer an uncompromising commitment to the highest quality health care experience for people in all stages of life. We are the heart of health care in our communities." -the hospital also provides planned community benefit activities to improve access to health care and improve the overall health of our community. Our mission is pursued in collaboration with our related organizations: Carroll Hospice, The Partnership for a Healthier Carroll County (our community advocacy arm), and The Carroll Hospital Center Foundation (Also listed in Part VI) for more information on these subsidiaries, please see their individual Form 990's. While we have attempted to summarize our program service accomplishments below, we urge those interested to access more detailed and complete information at www.CarrolHospitalCenter.org. In cooperation with our many community partners, including The Partnership, we seek to make measurable and sustainable progress in improving the health of the communities we serve. We gauge our progress by how effectively we identify and positively impact the underlying root causes associated with poor community health. To track and trend our progress as a community, The Partnership has organized Healthy Carroll Vital Signs - Measures of Community Health. This data is provided by various sources and is updated each year. When combined with our newly-acquired Healthy Communities Institute data, the hospital has access to the most up-to-date, comprehensive information on our community's health. Through The Partnership, Carroll Hospital Center has been involved in numerous health status assessment projects specific to our community and is in the process of conducting a comprehensive Community Health Needs Assessment. Once completed in June 2012, the assessment will provide the hospital with the important and current needs and opinions of members of our community as well as more in-depth information from key community leaders. Collectively the data will provide the hospital with the crucial information it needs to continue to make well informed decisions when it comes to effectuating positive change in the health status of our communities. Previous health needs assessments have sparked the hospital to develop key services such as Access Carroll (in coordination with the Carroll County Health Department and The Partnership), a clinic for uninsured patients and The Women's Place, a center for health and wellness for women that provides a full range of educational, complementary health and patient navigation services, a breast center and cancer boutique. Hospital staff also have helped to develop and participate in numerous committees and work groups to address age, gender and ethnic-specific living and health care issues. In addition, the hospital's focus on wellness is one that provides our community with hundreds of free education programs, screenings and support groups each year for everything from childbirth and disease prevention to nutrition and breast, prostate and skin cancers. The hospital also has committed significant resources to make certain there is an adequate supply of primary care and specialty physicians in our service area. Ensuring our communities have access to quality and medical expertise is a priority for our organization. That's why we continue to develop Carroll Health Group, our hospital-owned network of medical providers, which currently includes 32 Physicians and 11 Other Providers (PA, NP) in 19 office locations throughout Carroll and surrounding counties. During the most recent reporting period the organization provided a total of $3,011,868, $2,463,708 at cost, in charity/uncompensated care to the community. Additionally the organization expended approximately $19,147,524 (Net of Revenues) on programs and activities benefitting the communities we serve. These programs and activities included hospice services, physician support, education programs, screenings, support groups, health professional education and community contributions and required approximately 492,000 staff hours. THE HOSPITAL'S EDUCATION AND WELLNESS INITIATIVES ARE DRIVEN BY THE WOMEN'S PLACE, THE LEARNING CENTER AND THE PARTNERSHIP FOR A HEALTHIER CARROLL COUNTY. THESE EDUCATION ARMS OF THE HOSPITAL WORK COLLABORATIVELY TO ADDRESS THE LARGEST NUMBER OF COMMUNITY HEALTH CARE NEEDS AND WELLNESS INITIATIVES WITHOUT DUPLICATING SERVICES OR PROGRAMS. TOGETHER, IN FY11, THE HOSPITAL HAD 7,997 ENCOUNTERS FOR COMMUNITY HEATLH EDUCATION, 2,364 ENCOUNTERS FOR SUPPORT GROUPS, 1,734 ENCOUNTERS FOR FREE AND LOW-COST SCREENINGS AND 214 ENCOUNTERS FOR SELF-HELP PROGRAMS. THESE PROGRAMS, SUPPORT GROUPS AND SCREENINGS ARE NOT ONLY DIRECTED TO PATIENTS WITH A VARIETY OF CHRONIC AND ACUTE MEDIAL ISSUES RANGING FROM CANCER AND DIABETES TO HEART DISEASE AND ARTHRITIS BUT MANY ARE FOCUSED ON PREVENTION AND EDUCATION TO KEEP OUR POPULATION WELL. FIVE EXAMPLES OF PROGRAMS WITH MEASURABLE OUTCOMES ARE OUTLINED BELOW: A. LOSE to Win: Wellness Challenge DESCRIPTION:12-week collaborative community program to promote weight loss and wellness. This innovative and rigorous 12-week program features: 1. Unlimited access to exercise sessions at Merritt Athletic Club 2. Weekly group nutritional classes at Martin's Food Market 3. Weekly weigh-ins and regular blood pressure checks 4. Prize incentives 5. Pre- and post-program comprehensive blood profiles EVALUATION DATES: Fall 2010: September 2 - November 18, 2010 Spring 2011: February 24 - May 12, 2011 RESULTS/EVALUATION: AS A RESULT OF A HEALTHY COLLABORATION BETWEEN CARROLL HOSPITAL CENTER AND ITS PARTNERS IN THE SOUTH CARROLL (ELDERSBURG) AREA, MARTIN'S FOOD MARKET, MERRITT ATHLETIC CLUB AND LOCAL BEAUTY SALONS, THE LOSE TO WIN WELLNESS CHALLENGE HAS MARKED THE END TO ANOTHER SUCCESSFUL YEAR. RESULTS FOR ALL PROGRAMS ARE LISTED BELOW. FALL 2010 Total pounds lost - 383 lbs Percentage lost - 7.3% Number of participants who lost 10 pounds or more - 15 Number of participants who lost 20 pounds or more - 8 Number of participants who lost 30 pounds or more - 3 Percentage of weight lost by winner - 14.3% Pounds lost by winner - 59.6 lbs SPRING 2011 Total pounds lost - 272 lbs Percentage lost - 7.4% Number of participants who lost 10 pounds or more - 11 Number of participants who lost 20 pounds or more - 6 Number of participants who lost 30 pounds or more - 2 Percentage of weight lost by winner - 16.4% Pounds lost by winner - 29 lbs People saw significant reductions in blood sugar and blood sugar control (based on fasting Blood Sugar) during each of the three programs. B. TOTAL HEALTH EXPO: THE HEALTH & WELLNESS EVENT FOR THE ENTIRE FAMILY DESCRIPTION:The free event included: Free and low-cost Screenings Health information booths Kids activities Interactive educational displays Physical activities Adult CPR class Complementary health mini-treatments Medical assistance enrollment & information Healthy lunch free for all attendees And more! DATE OF EVENT: October 30, 20 AFFILIATED HEALTH CARE SYSTEMS Carroll Hospital Center is part of an affiliated health care system that provides an array of health care services to its community. The Hospital, as a sole community provider, provides both inpatient and outpatient care, including essential health care services such as obstetrics, emergency services, pediatric, and critical care, which would likely otherwise not be provided within Carroll County due to their unprofitable nature (high cost services with relatively low reimbursement). Additionally, the Hospital is the sole member and employer of eleven physician practices, which provide primary and specialty care services to the community. The provision of these physician services helps meet an identified community health need for additional primary and specialty care physicians in the community. The eleven physician practices run at a substantial operating loss ($6.6 million in 2010), which is funded by contributions from Carroll Hospital Center. Carroll Hospice, an affiliate of Carroll Hospital Center, provides inpatient hospice care, as well as residential hospice and palliative care, to patients nearing the end-of-life. Carroll Hospice provides pain management and symptom control and helps coordinate home and inpatient services. In order to provide comprehensive and compassionate care, Carroll Hospice utilizes an interdisciplinary team, including physicians, nurses, social workers, clergy, pharmacists, and home health aides. Further, Carroll Hospice provides bereavement care for family members for up to thirteen months. STATE FILING OF COMMUNITY BENEFIT REPORT 990 SCHEDULE H, PART VI MD, true PARTNERSHIP FOR HEALTHIER CARROLL COUNTY 95 CARROLL ST WESTMINSTER MD 21157 115000 Hospital contribution to support the programs of the Partnership 1 part i, line 2 The grant provided is to a related organization that is controlled by the organization and is a joint venture with the Carroll County Health department. The Partnership for a Healthier Carroll County is a 501(c)(3) tax-exempt organization that is dedicated to improving the health and quality of life of individuals living in Carroll County, Maryland. X X true true X X X X X false true false false false false false false false JOHN SERNULKA 228722 0 33110 0 30152 0 274095 0 17988 0 584067 0 LESLIE SIMMONS 238846 0 16699 0 22840 0 6689 0 17412 0 302486 0 KEVIN KELBLY 261419 0 16233 0 25468 0 12576 0 17412 0 333108 0 DAVID HORN 169643 0 8044 0 11088 0 5760 0 17412 0 211947 0 M ELLEN FINNERTY MYERS 173239 0 8880 0 10796 0 4440 0 509 0 197864 0 KEVIN SMOTHERS 319846 0 21061 0 25214 0 5361 0 17411 0 388893 0 JOYCE ROMANS 177795 0 8597 0 11831 0 2984 0 11992 0 213199 0 TRACEY ELLISON 154649 0 7541 0 9911 0 2616 0 17276 0 191993 0 CYNTHIA ROLDAN 174283 0 0 0 162 0 2216 0 862 0 177523 0 JEROME MARAVE 209075 0 0 0 1188 0 8927 0 10826 0 230016 0 DANILO V SANTOS 183592 0 0 0 3708 0 1973 0 11959 0 201232 0 EDYTA OSWIECIMKA 163274 0 0 0 258 0 6940 0 11680 0 182152 0 STEPHANIE REID 143978 0 5339 0 6462 0 6229 0 804 0 162812 0 KIMBERLY MOREAU 137939 0 5796 0 6458 0 7198 0 17322 0 174713 0 DANILO PERUNOVICH 166614 0 6732 0 11025 0 1767 0 12109 0 198247 0 PART I LINE 1A The Hospital has taken the position that it will include in taxable W-2 wages for the President and CFO certain business expenses that the IRS may question as not being tax deductible, so long as such expenses have a direct connection to the promotion of the Hospital's health care services. For 2010, these expenses were less than 3,000 in aggregate, for the President and CFO. Health or social club dues or initiation fees for the President were reimbursed by the Hospital and included on the President's W-2. The amount of the reimbursed fees was considered in the process for determining the President's compensation. nonqualified retirement plan The following employees participated in the organization's 457(f) deferred compensation plans and were paid and/or credited with the following amounts: John Sernulka - 260,900 maryland health and higher education fac authority 520936091 574217b53 2006-12-07 36179115 HOSPITAL RENOVATIONS AND EQUIP false false false MARYLAND HEALTH AND HIGHER EDUCATION FAC AUTHORITY 520936091 000000000 2010-06-30 15000000 HOSPITAL RENOVATIONS AND EQUIP false false false 37718099 2023640 683750 35012068 2009 false false true true 312040 15000000 255500 14100077 644423 2010 false false false true false false true false true 0.00000 0.00000 0.00000 true false false true false true 0.00000 0.01000 0.01000 true false false false false false false false true false false false false DIFFERENCE BETWEEN AMOUNT ON PART I, COLUMN E AND PART II, LINE 3 THE DIFFERENCE IS DUE TO INVESTMENT EARNINGS. KATHLEEN PALAIA SISTER/DAUGHTER DIRECTOR 81354 EMPLOYEE OF THE HOSPITAL false HEATHER SIMMONS DAUGHTER OF AN OFFICER 71810 EMPLOYEE OF THE HOSPITAL false CHELSEY SIMMONS DAUGHTER OF AN OFFICER 11155 EMPLOYEE OF THE HOSPITAL false FAMILY OR BUSINESS RELATIONSHIP PART VI LINE 2 CHARLES FISHER SR AND CHARLES FISHER JR HAVE A FATHER/SON RELATIONSHIP. CHARLES FISHER SR AND CHARLES FISHER JR HAVE A BUSINESS RELATIONSHIP. MIRIAM BECK AND JEFF WOTHERS HAVE A MOTHER-N-LAW/SON-N-LAW RELATIONSHIP. DESCRIPTION OF REVIEW PROCESS PART VI LINE 11 The Hospital's Form 990 is reviewed in detail between the preparer, an outside accounting firm, and the Finance Department of the Hospital. A copy of the draft Form 990 is presented to the Hospital's Risk, Audit and Compliance ("RAC") Committee, at which time RAC Committee members may ask any questions or provide comments regarding the draft Form 990. Prior to filing the Form 990, the Hospital provides a copy of the Form 990 to each member of the Board of Directors for their review, questions, and comments, which feedback is then incorporated into the filed Form 990. CONFLICTS MONITORING AND ENFORCEMENT PART VI LINE 12C The Conflict of Interest Policy applies to Carroll Hospital Center and its direct and indirect subsidiaries and parent organization. Review of Disclosure Statements/Report to the Board. The Chief Executive Officer of the Hospital Organization, the Governance Committee and the Corporate Compliance Officer shall review the matters disclosed in the Disclosure Statements and shall submit to the Hospital Organization's Board of Directors an annual summary or spreadsheet of the disclosures and his or her recommendation for the resolution of any conflicts disclosed. In formulating recommendations, the Chief Executive Officer shall consult with appropriate officers of the Hospital Organization and counsel as necessary. The Board of Directors of the Hospital Organization, acting in the best interests of the Hospital Organization, shall have sole discretion to make all final decisions regarding conflicts of interest, other than those regarding gifts to Hospital Organization employees which shall be resolved by the appropriate supervisory executive. However, no person shall be involved in considering the existence of an actual or potential conflict of interest, in the management and oversight of a conflict relationship, or in the determination of discipline for violations of this Policy, if that person is a party or potential party to that conflict. All final decisions regarding conflicts of interest shall be reflected in a revised annual summary or spreadsheet of conflict disclosures which will be shared with each director. The Chair and Vice-Chair of the Board, and all Board committee chairs, shall have this revised summary or spreadsheet available at the time of all Board and Board committee meetings in case a matter involving a potential conflict arises. CONFLICT OF INTEREST RECUSAL PROCEDURE FOR BOARD MEETINGS Whenever a Hospital Organizations' Board or Board committee is to consider a transaction or an arrangement with another organization, entity or individual in which or with whom a person covered by this Policy has a relationship creating an actual or potential conflict of interest, the following procedures shall be employed: A. The interested person must fully disclose the actual or potential conflict of interest to the Board; B. The interested person should be asked to leave the meeting during discussion of the potential conflict and any related votes, but the interested person may make a statement or answer any questions on the matter before departing the meeting; C. If appropriate, the Board or Board committee may appoint a non-interested person or committee to investigate alternatives to the proposed transaction or arrangement; D. To consider the proposed transaction or arrangement, the Board must: 1. find, by a majority vote of directors then in office, not counting the interested person, that the proposed transaction or arrangement is in the Hospital Organization's best interest and for the Hospital Organization's own benefit, it is fair and reasonable, and that, after reasonable investigation, the Hospital Organization cannot obtain a more advantageous transaction or arrangement using reasonable efforts; and 2. vote on the transaction or arrangement, approval requiring a majority vote of directors then in office, not counting the interested person. E. The minutes should include: (1) the name of the person disclosing the conflict of interest and a description of the conflict; (2) the Board's determination of whether there is a conflict; (3) the names and votes of persons present for the discussions and votes relating to the transaction or arrangement; and (4) the content of those discussions including the Board's determination of whether or not the transaction or arrangement is in the Hospital Organization's best interest, fair and reasonable, and the best reasonably available alternative Ongoing Duty to Disclose One's Own or Others' Conflicts of Interest. As an actual or potential conflict of interest can arise at any time, any actual or potential conflict must be disclosed promptly in writing by use of a supplemental Disclosure Statement, as soon as its existence is or should be known. If a person is in doubt about a situation, the person should consult with the Chief Executive Officer, Board Chairman or the Hospital Organization's Compliance Officer. Persons should err on the side of disclosure so that a conflict of interest assessment can be made. The potential conflict will be referred to the Governance committee for review and a response will be provided within 14 days. Noncompliance with the policy: The Organization's Board of Directors retains broad power and sole discretion under this Policy to: (1) determine the existence of actual or potential conflicts of interest; (2) subject conflict of interest relationships to appropriate oversight, management, conditions, restrictions and prohibitions; and (3) impose appropriate sanctions. A breach of this Policy can become grounds for discipline, up to and including removal from office or, for management personnel, termination of employment. It may also result in cessation of business with a vendor and in liability for damages. Grounds for discipline include, but are not limited to: A. willful failure to sign and return the Conflict of Interest Disclosure Statement in accord with this Policy; B. a material misstatement or omission in the Disclosure Statement; C. willful failure to disclose an actual or potential conflict of interest at any time in accord with the requirements of this Policy; D. willful participation in a vote or decision involving a transaction which raises an undisclosed conflict of interest; or E. willful disclosure or use of confidential information regarding the affairs, business or plans of a Hospital Organization for any purpose other than in furtherance of the affairs and best interests of the Hospital Organization. PROCESS FOR DETERMINING COMPENSATION PART VI LINE 15 THE EXECUTIVE COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS OF CARROLL HOSPITAL CENTER, WHICH IS COMPRISED OF INDEPENDENT BOARD MEMBERS DETERMINED TO BE FREE OF ANY CONFLICT OF INTEREST, IS CHARGED WITH DETERMINING EXECUTIVE COMPENSATION AND ESTABLISHING PERFORMANCE CRITERIA ACCORDING TO AN APPROVED COMPENSATION PHILOSOPHY. THE COMMITTEE WORKS WITH AN INDEPENDENT EXECUTIVE COMPENSATION CONSULTING AND ADVISORY FIRM, YAFFE & COMPANY, THAT PROVIDES MARKET SURVEY DATA CONCERNING COMPENSATION AND BENEFIT LEVELS FOR FUNCTIONALLY COMPARABLE HEALTHCARE EXECUTIVES IN SIMILAR HOSPITALS ACROSS THE REGION AND THE NATION BASED ON SEVERAL FACTORS INCLUDING SIZE, GEOGRAPHY, HOSPITAL TYPE AND COMPLEXITY. THE COMMITTEE REVIEWS AND APPROVES THE COMPENSATION OF THE SENIOR EXECUTIVES AND ENSURES THAT ALL FORMS OF EXECUTIVE COMPENSATION ARE REASONABLE, APPROPRIATE AND CONSISTENT WITH ITS COMPENSATION PHILOSOPHY. THE COMMITTEE CONTEMORANEOUSLY DOCUMENTS ITS DECISIONS IN MEETING MINUTES. DOCUMENT AVAILABILITY PART VI, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. RECONCILIATION OF NET ASSETS PART XI, LINE 5 UNREALIZED GAIN $ 4,498,951 BOOK/TAX DIFFERENCE K-1 (1,013,121) INTEREST RATE ADJUST ON INVEST 4,319,029 ----------- TOTAL $7,804,859 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:CHARLES O FISHER JR TITLE:DIRECTOR HOURS:2 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:CHARLES FISHER SR TITLE:DIRECTOR HOURS:1 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:MIRIAM BECK TITLE:DIRECTOR HOURS:1 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:PAULA LANGMEAD TITLE:DIRECTOR HOURS: HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:ETHAN SEIDEL TITLE:DIRECTOR HOURS:1 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:JOHN SERNULKA TITLE:PRESIDENT HOURS:5 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:STEPHAN HOCHULI MD TITLE:BOARD MEMBER HOURS: HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:KIMBERLY JOHNSTON MD TITLE:BOARD MEMBER HOURS: HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:STANLEY H TEVIS III TITLE:BOARD MEMBER HOURS:9 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:HAROLD WALSH TITLE:BOARD MEMBER HOURS:1 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:HELEN W WHITEHEAD TITLE:BOARD MEMBER HOURS:1 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:CHRISTOS BALLAS MD TITLE:BOARD MEMBER HOURS: HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:THOMAS WELLIVER TITLE:BOARD MEMBER HOURS: HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:JEFFREY A WOTHERS TITLE:BOARD MEMBER HOURS: HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:DENNIS THOMAS TITLE:BOARD MEMBER HOURS: HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:LESLIE SIMMONS TITLE:CHIEF OPERATING OFFICER HOURS:2 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:KEVIN KELBLY TITLE:SR VP FINANCE CFO HOURS:6 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:KEVIN SMOTHERS TITLE:CHIEF MEDICAL OFFICER HOURS: HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:STEPHANIE REID TITLE:ASSISTANT VICE PRESIDENT HOURS: HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:DAVID HORN TITLE:VICE PRESIDENT HOURS: HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:M ELLEN FINNERTY MYERS TITLE:VICE PRESIDENT HOURS: HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:JOYCE ROMANS TITLE:VICE PRESIDENT HOURS: HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:TRACEY ELLISON TITLE:VICE PRESIDENT HOURS: HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:DANILO PERUNOVICH TITLE:VICE PRESIDENT HOURS: HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:CYNTHIA ROLDAN TITLE:PHYSICIAN HOURS: HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:JEROME MARAVE TITLE:PHYSICIAN HOURS: HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:DANILO V SANTOS TITLE:PHYSICIAN HOURS: HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:EDYTA OSWIECIMKA TITLE:nurse HOURS: HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:KIMBERLY MOREAU TITLE:asst vice president HOURS: CARROLL HOSPITAL CENTER MOB INVEST LLC 200 MEMORIAL AVENUE WESTMINSTER MD 21157 271528355 INVESTMENTS MD 0 2015421 CHC CARROLL COUNTY HEALTH SERVICES INC 200 MEMORIAL AVE WESTMINSTER MD 21157 520691413 SUPPORT ORG MD 501(c)(3) 509(A)(3) N/A CARROLL HOSPITAL CENTER FOUNDATION INC 200 MEMORIAL AVE WESTMINSTER MD 21157 521115038 FOUNDATION MD 501(c)(3) 503(A)(3) CHC CARROLL HOSPICE INC 292 STONER AVE WESTMINSTER MD 21157 521565870 HOSPICE MD 501(c)(3) 170(B)(1A) CHC cc radiology llc 7253 AMBASSADOR RD BALTIMORE MD 21244 522190849 RADIOLOGY MD CARROLL HOSP CT 1345003 false false 0.60000 CARROLL COUNTY MED SERVICES INC 200 MEMORIAL AVE WESTMINSTER MD 21157 521891102 MEDICAL SERVI MD CHC C CORP 13109103 16319122 1.00000 CEN-MAR ASSURANCE CO po box 1085 grand cayman CJ ky1-1102 986011607 insurance CJ CHC C CORP 2046200 9443919 1.00000 true false true false false false false false true false false false true true false true false true CARROLL HOSPITAL CENTER FOUNDATION C 1090000 cen-mar p 75576 carroll county med services a,n,p 562047