2012-03-29T07:56:16-05:00 2011-06-30 KPMG LLP 1676 International Drive McLean VA 22102 990 2010-07-01 522155576 CIVISTA HEALTH INC CIVI 3016094000 PO BOX 1070 LA PLATA MD 206461070 NOEL CERVINO 2012-03-27 true SCOTT SHERMAN KPMG LLP 703-286-839 7032868000 2010 2016-02-24 21:20:13Z NOEL CERVINO PO BOX 1070 LA PLATA MD 206461070 228222 false X WWW.CIVISTA.ORG X 1998 MD CIVISTA HEALTH IS THE PARENT COMPANY OF A REGIONAL INTEGRATED HEALTH SYSTEM SERVING THE HEALTH NEEDS OF CHARLES COUNTY AND THE CITIZENS OF SOUTHERN MARYLAND. 15 14 0 0 24536 0 0 0 0 0 0 203686 0 24536 0 228222 0 0 0 0 0 0 0 0 0 0 137724 0 137724 0 90498 0 2694673 0 2604175 0 90498 X CIVISTA HEALTH, INC. IS A NOT-FOR-PROFIT HEALTHCARE SYSTEM CREATED TO PROVIDE EXCELLENCE IN ACUTE HEALTHCARE AND PREVENTIVE SERVICES IN CHARLES COUNTY AND THE SURROUNDING COMMUNITIES. false false 0 0 0 CIVISTA HEALTH IS THE PARENT COMPANY OF A REGIONAL INTEGRATED HEALTH SYSTEM SERVING THE HEALTH NEEDS OF CHARLES COUNTY AND THE CITIZENS OF SOUTHERN MARYLAND. CIVISTA HEALTH, INC. 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 HEALTH, INC., IN PARTNERSHIP WITH THE CHARLES COUNTY DEPARTMENT OF HEALTH (CCDOH), 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 HEALTH, INC. 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 HEALTH, INC., 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 AND WE CAN! CHILDHOOD OBESITY PROGRAM, 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. 0 true false false false false false false false false true false false true true true false true false false false false false false false false false false false true false false false false false false false false false false false false false true true true false false true 0 0 true 0 false false false 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 false MD X JIM CLAGUE 3016095154 5 GARRETT AVENUE LA PLATA MD 20646 X KHADAR BAIG 1.0 X 0 0 0 WAYNE BARNES 1.0 X 0 0 0 JAMES BURKE 1.0 X 0 0 0 MICHAEL CADY 1.0 X 0 0 0 C DEVADASON 1.0 X 0 0 0 LOUIS JENKINS JR 1.0 X 0 0 0 CANDICE QUINN KELLY 1.0 X 0 0 0 SARA MIDDLETON 1.0 X 0 0 0 VAN MITCHELL 1.0 X 0 0 0 SEETARAMAYYA NAGULA 1.0 X 0 0 0 ASHVIN J PATEL MD 1.0 X 0 0 0 SURYAKANT PATEL 1.0 X 0 0 0 BARBARA STEPURA 1.0 X 0 0 0 RICHARD WINKLER 1.0 X 0 0 0 NOEL CERVINO 1.0 X X 0 445695 63432 ERIK BOAS 1.0 X 0 239415 21308 0 685110 84740 0 false true false 0 0 0 0 0 0 24536 0 24536 24536 0 24536 0 203686 0 203686 203686 0 0 203686 0 0 0 0 228222 0 24536 203686 0 0 0 0 0 0 0 0 0 0 0 7864 7864 0 0 0 0 0 0 0 0 0 0 0 0 0 57045 57045 0 28785 28785 155 0 155 0 PROFESSIONAL FEES 29746 29746 UTILITIES AND MAINTENANCE 8359 8359 TAXES 5770 5770 137724 0 137724 0 2111032 28784 0 2082248 0 287094 0 325331 0 2694673 0 5496 0 1347970 0 1250709 0 2604175 X 0 90498 0 90498 0 2694673 90498 X false true true X false X X X false false false CIVISTA MEDICAL CENTER INC 520445374 03 true true true 0 CIVISTA HEALTH AUXILIARY 521131193 09 true true true 0 2 0 966919 966919 1133301 28544 1104757 10812 240 10572 2082248 DUE FROM AFFILIATES 80305 PREMIER RECEIVABLE 245026 325331 0 Due to Affiliate 1250709 1250709 FIN 48 SCHEDULE D FIN 48 FOOTNOTE CIVISTA MEDICAL CENTER, INC., CIVISTA HEALTH FOUNDATION, INC., AND CIVISTA HEALTH, INC. WERE RECOGNIZED AS PUBLIC CHARITIES GENERALLY EXEMPT FROM FEDERAL INCOME TAXATION UNDER 501(C)(3) OF THE INTERNAL REVENUE CODE PURSUANT TO DETERMINATION LETTERS ISSUED BY THE IRS IN 1980, 1986, AND 2001, RESPECTIVELY. CIVISTA CARE PARTNERS, INC. (CCP) IS A FOR PROFIT ENTITY SUBJECT TO FEDERAL AND STATE INCOME TAXES, WHICH ARE RECORDED UNDER FASB ACCOUNTING STANDARDS CODIFICATION (ASC) TOPIC 740, ACCOUNTING FOR INCOME TAXES (ASC 740). ACCORDINGLY, INCOME TAXES ARE ACCOUNTED FOR UNDER THE ASSET AND LIABILITY METHOD. UNDER THIS METHOD, DEFERRED TAX ASSETS AND LIABILITIES ARE RECOGNIZED FOR THE FUTURE TAX CONSEQUENCES ATTRIBUTABLE TO TEMPORARY DIFFERENCES BETWEEN THE FINANCIAL STATEMENT CARRYING AMOUNTS OF EXISTING ASSETS AND LIABILITIES AND THEIR RESPECTIVE TAX BASES AND OPERATING LOSS AND CREDIT CARRY FORWARDS. DEFERRED TAX ASSETS AND LIABILITIES ARE MEASURED USING ENACTED TAX RATES EXPECTED TO APPLY TO TAXABLE INCOME IN THE YEARS IN WHICH THOSE TEMPORARY DIFFERENCES ARE EXPECTED TO BE RECOVERED OR SETTLED. THE EFFECT ON DEFERRED TAX ASSETS AND LIABILITIES OF A CHANGE IN TAX RATES IS RECOGNIZED IN INCOME IN THE PERIOD THAT INCLUDES THE ENACTMENT DATE. false false false false false false false false false NOEL CERVINO 0 303519 0 132000 0 10176 0 50848 0 12584 0 509127 0 0 ERIK BOAS 0 182112 0 54900 0 2403 0 19582 0 1726 0 260723 0 0 CONFLICT OF INTEREST POLICY PART VI, SECTION B, 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. KEY EMPLOYEES ARE EXEMPT ADMINISTRATIVE AND NON-EXEMPT EMPLOYEES WHO HAVE THE AUTHORITY TO MAKE COMMITMENTS FOR CIVISTA'S RESOURCES. 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. PROCESS FOR DETERMINING COMPENSATION PART VI, SECTION B, LINE 15 CIVISTA MEDICAL CENTER 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. 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. 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. HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:NOEL CERVINO TITLE:PRESIDENT & CEO HOURS:40 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:ERIK BOAS TITLE:CFO HOURS:40 CIVISTA MEDICAL CENTER INC 5 GARRETT AVE LA PLATA MD 20646 520445374 SUPPORT MD 501(c)(3) 3 CIVISTA HLTH 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 HEALTH C CORP 3312208 7476013 1.00000 false false false false false false false false false false false false false false false false false true CIVISTA MEDICAL CENTER r 160064 CIVISTA MEDICAL CENTER r 1046002