CIVISTA MEDICAL CENTER INC: Form 990, tax year 2009
View the entire original 990 at ProPublica ↗
- Organization
- CIVISTA MEDICAL CENTER INC (EIN 52-0445374)
- Tax period
- 2009-07-01 to 2010-06-30
- Filed
- 2011-05-12
- IRS object ID
- 201111329349301411
- Schema version
- 2009v1.7
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule C
- Schedule D
- Schedule F
- Schedule H
- Schedule I
- Schedule J
- Schedule K
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2011-05-12T08:41:57-05:00 | Timestamp |
| Tax Period End Date | 2010-06-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | KPMG LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1676 International Drive | AddressLine1 |
| City | McLean | City |
| State | VA | State |
| ZIP Code | 22102 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2009-07-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 520445374 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Civista Medical Center Inc | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | CIVI | NameControl |
| Phone | 3016094130 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 5 Garrett Ave | AddressLine1 |
| Address Line2 | PO Box 1070 | AddressLine2 |
| City | La Plata | City |
| State | MD | State |
| ZIP Code | 20646 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | NOEL CERVINO | Name |
| Title | PRESIDENT AND CEO | Title |
| Date Signed | 2011-05-10 | DateSigned |
| Authorize Third Party | true | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | SCOTT SHERMAN KPMG LLP 703-286-8398 | Name |
| Phone | 7032868000 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2009 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | NOEL CERVINO | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 5 Garrett Ave | AddressLine1 |
| City | LA PLATA | City |
| State | MD | State |
| ZIP Code | 20646 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 102666865 | GrossReceipts |
| Group Return For Affiliates | false | GroupReturnForAffiliates |
| Organization501c | X | Organization501c |
| Web Site | www.civista.org | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1980 | YearFormation |
| State Legal Domicile | MD | StateLegalDomicile |
| Activity Or Mission Description | CIVISTA MEDICAL CENTER PROVIDES EXCELLENT CARE TO EACH PATIENT IN A SAFE, CARING AND FAMILY-CENTERED ENVIRONMENT. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 15 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 14 | NbrIndependentVotingMembers |
| Total Nbr Employees | 1010 | TotalNbrEmployees |
| Total Nbr Volunteers | 160 | TotalNbrVolunteers |
| Total Gross UBI | 170519 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 60778 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 1079540 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 27613 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 95312096 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 101981695 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 818420 | InvestmentIncomePriorYear |
| Investment Income Current Year | 131108 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 510815 | OtherRevenuePriorYear |
| Other Revenue Current Year | 526449 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 97720871 | TotalRevenuePriorYear |
| Total Revenue Current Year | 102666865 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 0 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 93470 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 41428443 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 45152262 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 57457699 | OtherExpensePriorYear |
| Other Expenses Current Year | 55574825 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 98886142 | TotalExpensesPriorYear |
| Total Expenses Current Year | 100820557 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | -1165271 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 1846308 | RevenuesLessExpensesCY |
| Total Assets BOY | 118804555 | TotalAssetsBOY |
| Total Assets EOY | 121283439 | TotalAssetsEOY |
| Total Liabilities BOY | 105154344 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 108395171 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 13650211 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 12888268 | NetAssetsOrFundBalancesEOY |
| Mission Description | Civista Medical Center provides excellent care to each patient in a safe, caring and family-centered environment. Civista fosters a healthier community by providing service education and access to care in concert with other community organizations. The organization strives to be the preeminent healthcare provider for our community through enhanced facilities, technology and equipment, an excellent record of quality care and patient safety, a highly responsive emergency services delivery, a skilled workforce and excellent physician partners and financial health to assure funds for re-investment. | MissionDescription |
| Significant New Program Services | false | SignificantNewProgramServices |
| Significant Change | false | SignificantChange |
| Expense | 66401044 | Expense |
| Grants | 93470 | Grants |
| Revenue | 101981695 | Revenue |
| Description | Civista Medical Center Community Benefits Program utilizes a planned, managed, organized, and measured approach to meeting the identified community needs of the area we serve. The mission is to improve overall community health by improving access to health care, enhancing the health of the community, advancing healthcare knowledge and working with health - providing agency partners. Civista Medical Center in Partnership with the Charles County Department of Health, has conducted a Needs Assessment of Charles County every 5 years. Beginning 2011, in accordance with new regulations, the Needs Assessment will be conducted every 3 years. The data included in this report was collected in 2006 and the updated assessment is in process and due to be completed in 2011. This survey includes responses from health care providers as well as community residents. Additionally, The Charles County Community Foundation, in cooperation with Civista Medical Center, Charles County Department of Health, The United Way of Charles County and the Charles County Government conducted a Priority Needs Assessment for Charles County in 2008. In April 2009, the Charles County Local Management Board conducted a Needs Assessment. The Maryland Physician data is from the Maryland Health Commission's 2008 report. The data from all of these reports is included in the Needs Assessment update and is shared with all of the members of Partnerships for a Healthier Charles County (PHCC) of which Civista Medical Center is a founding member. PHCC consists of more than 60 community member organizations from a broad spectrum of health-related services and includes representatives from State and Local Government. The Steering Committee of PHCC consists of leadership from four community organizations in addition to Civista Medical Center; Charles County Public Schools, College of Southern Maryland and the Charles County Department of Health. This information was shared with all of our partner agencies to identify community health needs in Charles County. This data serves as the planning and evaluation mechanism for Civista Medical Center's community benefits program. Accomplishments: Civista Medical Center provided over $4.1 million in charity care, unpaid Medicaid costs, community health improvement services, subsidized health services, cash and in-kind donations and community building activities in fy2010. This year, we provided and supported programs and activities such as: screenings and education: Heart disease: screenings such as Matters of the Female Heart - heart risk screening for women, stroke screenings, blood pressure screenings, and diabetes education and screenings; education programs such as stroke risk reduction, and Lowering your Cholesterol classes. Cancer: screenings such as prostate and colorectal cancer, tobacco cessation program, cervical and breast screenings exams, education as well as the Pink ladies and Sisters at Heart Support Groups, and ACS' Relay for Life Survivor Support. Community education programs and services such as 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 and Ostomy Support Group. Clinics and clinic services such as pre natal and OB clinic, flu vaccine 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 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 Commission for Women, Charles County child advocacy partnership, healthcare roundtable community events such as Christmas Connection, Relay for Life, Alzheimer's Walk, March of Dimes, and safe nights. | Description |
| Total Program Service Expense | 66401044 | TotalProgramServiceExpense |
| Described In501 C3 | true | DescribedIn501C3 |
| Schedule B Required | false | ScheduleBRequired |
| Political Activities | false | PoliticalActivities |
| Lobbying Activities | true | LobbyingActivities |
| Donor Advised Funds | false | DonorAdvisedFunds |
| Conservation Easements | false | ConservationEasements |
| Collections Of Art | false | CollectionsOfArt |
| Credit Counseling | false | CreditCounseling |
| Term Or Permanent Endowments | false | TermOrPermanentEndowments |
| Balance Sheet Amounts Reported | true | BalanceSheetAmountsReported |
| Independent Audit Financial Stmt | false | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | true | ConsolidatedAuditFinancialStmt |
| School | false | School |
| Foreign Office | false | ForeignOffice |
| Foreign Activities | true | ForeignActivities |
| More Than5000 K To Organizations | false | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividuals |
| Professional Fundraising | false | ProfessionalFundraising |
| Fundraising Activities | false | FundraisingActivities |
| Gaming | false | Gaming |
| Hospital | true | Hospital |
| Grants To Organizations | true | GrantsToOrganizations |
| Grants To Individuals | false | GrantsToIndividuals |
| Schedule J Required | true | ScheduleJRequired |
| Tax Exempt Bonds | true | TaxExemptBonds |
| Invest Tax Exempt Bonds | false | InvestTaxExemptBonds |
| Escrow Account | false | EscrowAccount |
| On Behalf Of Issuer | false | OnBehalfOfIssuer |
| Excess Benefit Transaction | false | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | false | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | false | LoanToOfficerOrDQP |
| Grant To Related Person | false | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | false | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | false | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | false | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | false | DeductibleNonCashContributions |
| Deductible Contributions Of Art | false | DeductibleContributionsOfArt |
| Terminated | false | Terminated |
| Partial Liquidation | false | PartialLiquidation |
| Disregarded Entity | false | DisregardedEntity |
| Related Entity | true | RelatedEntity |
| Related Org Controlled Entity | true | RelatedOrgControlledEntity |
| Transfers To Exempt Non Chrtbl Org | false | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | false | ActivitiesConductedPartnership |
| Schedule O Required | true | ScheduleORequired |
| Number Forms Transmitted With1096 | 196 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | true | ComplianceWithBackupWitholding |
| Number Of Employees | 1010 | NumberOfEmployees |
| Employment Tax Returns Filed | true | EmploymentTaxReturnsFiled |
| Unrelated Business Income | true | UnrelatedBusinessIncome |
| Form990-T Filed | true | Form990-TFiled |
| Foreign Financial Account | true | ForeignFinancialAccount |
| Name Of Foreign Country | CJ | NameOfForeignCountry |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTrans |
| Taxable Party Notification | false | TaxablePartyNotification |
| Non Deductible Contributions | false | NonDeductibleContributions |
| Quid Pro Quo Contributions | false | QuidProQuoContributions |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | false | FundsToPayPremiums |
| Premiums Paid | false | PremiumsPaid |
| Nbr Voting Governing Body Members | 15 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 14 | NumberIndependentVotingMembers |
| Family Or Business Relationship | false | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | true | DelegationOfManagementDuties |
| Changes To Organizing Docs | false | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuse |
| Members Or Stockholders | false | MembersOrStockholders |
| Election Of Board Members | false | ElectionOfBoardMembers |
| Decisions Subject To Approval | false | DecisionsSubjectToApproval |
| Minutes Of Governing Body | true | MinutesOfGoverningBody |
| Minutes Of Committees | true | MinutesOfCommittees |
| Officer Mailing Address | false | OfficerMailingAddress |
| Local Chapters | false | LocalChapters |
| Form990 Provided To Governing Body | true | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | true | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | true | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | true | RegularMonitoringEnforcement |
| Whistleblower Policy | true | WhistleblowerPolicy |
| Document Retention Policy | true | DocumentRetentionPolicy |
| Compensation Process CEO | true | CompensationProcessCEO |
| Compensation Process Other | false | CompensationProcessOther |
| Investment In Joint Venture | false | InvestmentInJointVenture |
| States Where Copy Of Return Is Filed | MD | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | JIM CLAGUE | NamePerson |
| Telephone Number | 3016095154 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 5 GARRETT AVE | AddressLine1 |
| City | La Plata | City |
| State | MD | State |
| ZIP Code | 20646 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (25 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | OfficerOfficer | Key EmployeeKeyEmployee | Highest Compensated EmployeeHighestCompensatedEmployee | FormerFormer |
|---|---|---|---|---|---|---|---|---|---|
| WAYNE COOPER | |||||||||
| EX-OFFICIO | 3.0 | X | 0 | 0 | 0 | ||||
| DELORES DATCHER | |||||||||
| DIRECTOR | 3.0 | X | 0 | 0 | 0 | ||||
| C DEVADASON | |||||||||
| EX-OFFICIO | 3.0 | X | 0 | 0 | 0 | ||||
| SARA MIDDLETON | |||||||||
| VICE CHAIR | 3.0 | X | 0 | 0 | 0 | X | |||
| SURYAKANT PATEL | |||||||||
| DIRECTOR | 3.0 | X | 0 | 0 | 0 | ||||
| BARBARA STEPURA | |||||||||
| DIRECTOR | 3.0 | X | 0 | 0 | 0 | ||||
| KHADAR BAIG | |||||||||
| DIRECTOR | 3.0 | X | 0 | 0 | 0 | ||||
| VAN MITCHELL | |||||||||
| DIRECTOR | 3.0 | X | 0 | 0 | 0 | ||||
| LOUIS JENKINS JR | |||||||||
| SECRETARY/TREASURER | 3.0 | X | 0 | 0 | 0 | X | |||
| SEETARAMAYYA NAGULA | |||||||||
| DIRECTOR | 3.0 | X | 0 | 0 | 0 | ||||
| RICHARD WINKLER | |||||||||
| DIRECTOR | 3.0 | X | 0 | 0 | 0 | ||||
| MICHAEL CADY | |||||||||
| DIRECTOR | 3.0 | X | 0 | 0 | 0 | ||||
| ASHVIN J PATEL MD | |||||||||
| CHIEF OF STAFF | 4.0 | X | 0 | 0 | 0 | X | |||
| JAMES BURKE | |||||||||
| CHAIR | 4.0 | X | 0 | 0 | 0 | X | |||
| NOEL CERVINO | |||||||||
| PRESIDENT & CEO | 40.0 | 372801 | 0 | 6692 | X | ||||
| ERIK BOAS | |||||||||
| CFO | 40.0 | 148315 | 0 | 2320 | X | ||||
| CATHY DELLIGATTI | |||||||||
| VICE PRESIDENT PATIENT CARE | 40.0 | 151336 | 0 | 20303 | X | ||||
| KEVIN BURBULES | |||||||||
| CHIEF INFO OFFICER | 40.0 | 156068 | 0 | 34985 | X | ||||
| GARY HERBEK | |||||||||
| COO | 40.0 | 203071 | 0 | 19544 | X | ||||
| JOAN HUMULOCK | |||||||||
| CLINICAL NURSE PACU | 40.0 | 130907 | 0 | 7738 | X | ||||
| MARILYN E GREGORY | |||||||||
| CLINICAL NURSE OR | 40.0 | 135593 | 0 | 6356 | X | ||||
| KANIKA HAMPTON | |||||||||
| PHYSICIAN | 40.0 | 129538 | 0 | 18227 | X | ||||
| EILEEN FRANCES STOPA | |||||||||
| CLINICAL NURSE PACU | 40.0 | 124585 | 0 | 4200 | X | ||||
| KATHERINE MIDDLETON | |||||||||
| RN OR | 40.0 | 138048 | 0 | 7074 | X | ||||
| CHRISTINE STEFANIDES | |||||||||
| FORMER PRESIDENT & CEO | 307041 | 0 | 0 | X | |||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 1997303 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 127439 | TotalOtherCompensation |
| Number Individuals GT100 K | 24 | NumberIndividualsGT100K |
| Formers Listed | true | FormersListed |
| Total Comp GT150 K | true | TotalCompGT150K |
| Compensation From Other Sources | false | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| MARYLAND INPATIENT CARE SPECIALISTS | |||||
| 2007 TIDEWATER COLONY WAY STE 1-A | ANNAPOLIS | MD | 21401 | PHYSICIANS | 1083333 |
| DIGITRACE CARE SERVICES INC | |||||
| 200 CORPORATE PLACE STE 58 | PEABODY | MA | 01960 | EEG PURCHASED SERV | 640650 |
| ROI ELIGIBILITY SERVICES CORP | |||||
| 1920 GREENSPRING DR STE 200 | TIMONIUM | MD | 21094 | PT ACCTG PURCH SERV | 603276 |
| BIO-MEDICAL APPLICATIONS OF MD | |||||
| PO BOX 64741 | BALTIMORE | MA | 21264 | DIALYSIS PURCH SERV | 352729 |
| MAYFLOWER TEXTILE SERVICE | |||||
| PO BOX 20659 | BALTIMORE | MD | 21223 | LAUNDRY | 328989 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 23 | NumberOfContractorsGT100K |
| Related Organizations | 27613 | RelatedOrganizations |
| Total Contributions | 27613 | TotalContributions |
Program Service Revenue ProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | NET PATIENT REVENUE | Description |
| Business Code | 900099 | BusinessCode |
| Total Revenue Column | 101981695 | TotalRevenueColumn |
| Related Or Exempt Function Income | 101981695 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 101981695 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 131108 | TotalRevenueColumn |
| Exclusion | $131,108 | ExclusionAmount |
Income From Invest Bond Proceeds IncomeFromInvestBondProceeds
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Royalties Revenue RoyaltiesRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Net Income From Fundraising Events NetIncomeFromFundraisingEvents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Net Income From Gaming NetIncomeFromGaming
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Net Income Or Loss NetIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Other Revenue Misc OtherRevenueMisc (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Unrelated Business RevenueUnrelatedBusinessRevenue | ExclusionExclusionAmount | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|---|---|
| ANSWERING SERVICE | 561000 | 170280 | 170280 | ||
| CAFETERIA AND COFFEE BAR SALES | 900099 | 292647 | $292,647 | ||
| APPLICATION FEES | 900099 | 9250 | 9250 |
Miscellaneous Revenue MiscellaneousRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 54272 | TotalRevenueColumn |
| Related Or Exempt Function Income | 54033 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 239 | UnrelatedBusinessRevenue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 526449 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 102666865 | TotalRevenueColumn |
| Related Or Exempt Function Income | 102044978 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 170519 | UnrelatedBusinessRevenue |
| Exclusion | $423,755 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 93470 | Total |
| Program Services | 93470 | ProgramServices |
Grants To Domestic Individuals GrantsToDomesticIndividuals
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Foreign Grants ForeignGrants
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Benefits To Members BenefitsToMembers
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 648530 | Total |
| Management And General | 648530 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Comp Disqual Persons CompDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 37046113 | Total |
| Program Services | 29636890 | ProgramServices |
| Management And General | 7409223 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1041396 | Total |
| Program Services | 833117 | ProgramServices |
| Management And General | 208279 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3698388 | Total |
| Program Services | 2847759 | ProgramServices |
| Management And General | 850629 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2717835 | Total |
| Program Services | 2119911 | ProgramServices |
| Management And General | 597924 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 150000 | Total |
| Program Services | 0 | ProgramServices |
| Management And General | 150000 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 365765 | Total |
| Program Services | 0 | ProgramServices |
| Management And General | 365765 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 181438 | Total |
| Program Services | 0 | ProgramServices |
| Management And General | 181438 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Fees For Services Lobbying FeesForServicesLobbying
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Prof Fundraising FeesForServicesProfFundraising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 11420092 | Total |
| Program Services | 6852055 | ProgramServices |
| Management And General | 4568037 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 422403 | Total |
| Program Services | 316802 | ProgramServices |
| Management And General | 105601 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Royalties Royalties
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2832690 | Total |
| Program Services | 1472999 | ProgramServices |
| Management And General | 1359691 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 30106 | Total |
| Program Services | 7527 | ProgramServices |
| Management And General | 22579 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3227565 | Total |
| Program Services | 0 | ProgramServices |
| Management And General | 3227565 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Payments To Affiliates PaymentsToAffiliates
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 5149235 | Total |
| Program Services | 36045 | ProgramServices |
| Management And General | 5113190 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2003907 | Total |
| Program Services | 0 | ProgramServices |
| Management And General | 2003907 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Other Expenses OtherExpenses (5 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral | FundraisingFundraising |
|---|---|---|---|---|
| SUPPLIES AND DRUGS | 16151456 | 15020854 | 1130602 | 0 |
| BAD DEBT | 5315173 | 5315173 | 0 | 0 |
| OTHER | 3599936 | 406173 | 3193763 | 0 |
| EQUIPMENT RENTAL AND MAINT | 4368351 | 1441556 | 2926795 | 0 |
| TELEPHONE | 356708 | 713 | 355995 | 0 |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 100820557 | Total |
| Program Services | 66401044 | ProgramServices |
| Management And General | 34419513 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 24142941 | BOY |
| EOY | 29116660 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 9140952 | BOY |
| EOY | 10886077 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1533892 | BOY |
| EOY | 1588468 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1185201 | BOY |
| EOY | 854589 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 118632613 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 53211565 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 69663504 | BOY |
| EOY | 65421048 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 85735 | BOY |
| EOY | 75000 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 13052330 | BOY |
| EOY | 13341597 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 118804555 | BOY |
| EOY | 121283439 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 14978874 | BOY |
| EOY | 16336955 | EOY |
Tax Exempt Bond Liabilities TaxExemptBondLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 59107135 | BOY |
| EOY | 58529039 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 21804652 | BOY |
| EOY | 20920214 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 9263683 | BOY |
| EOY | 12608963 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 105154344 | BOY |
| EOY | 108395171 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 13650211 | BOY |
| EOY | 12888268 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 13650211 | BOY |
| EOY | 12888268 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 118804555 | BOY |
| EOY | 121283439 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | false | AccountantCompileOrReview |
| FS Audited | true | FSAudited |
| Audit Committee | true | AuditCommittee |
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Federal Grant Audit Required | false | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Grassroots Lobbying | TotalGrassrootsLobbying | |
| Total Direct Lobbying | TotalDirectLobbying | |
| Total Lobbying Expenditures | TotalLobbyingExpenditures | |
| Other Exempt Purpose Expenditures | OtherExemptPurposeExpenditures | |
| Total Exempt Purpose Expenditures | TotalExemptPurposeExpenditures | |
| Lobbying Nontaxable | LobbyingNontaxableAmount | |
| Grassroots Nontaxable | GrassrootsNontaxableAmount | |
| Tot Lobbying Grassroot Minus Non Tx | TotLobbyingGrassrootMinusNonTx | |
| Tot Lobby Expend Mns Lobbying Nontx | TotLobbyExpendMnsLobbyingNontx | |
| Volunteers | false | Volunteers |
| Paid Staff Or Management | false | PaidStaffOrManagement |
| Media Advertisements | false | MediaAdvertisements |
| Mailings Members | false | MailingsMembers |
| Publications Or Broadcast | false | PublicationsOrBroadcast |
| Grants Other Organizations | false | GrantsOtherOrganizations |
| Direct Contact Legislators | false | DirectContactLegislators |
| Rallies Demonstrations | false | RalliesDemonstrations |
| Other Activities | true | OtherActivities |
| Other Activities | $11,344 | OtherActivitiesAmount |
| Total Lobbying Expenditures IIB | 11344 | TotalLobbyingExpendituresIIB |
| Not Described In501c3 | false | NotDescribedIn501c3 |
Form990 Schedule C Part IV Form990ScheduleCPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | Lobbying Activities | Identifier |
| Explanation | The organization does not engage in any direct lobbying activities. The organization pays 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 8.73% and 23.76% of member dues were used for lobbying purposes and as such, the organization has reported this amount on Schedule C, part II-B as lobbying activities. | Explanation |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Art Public Exhibition Amts | ArtPublicExhibitionAmts | |
| Held Works Of Art Amts | HeldWorksOfArtAmts | |
| Land | Land | |
| Buildings | Buildings |
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 2232162 | OtherCostOrOtherBasis |
| Depreciation | 1098740 | Depreciation |
| Book Value | 1133422 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 42152904 | OtherCostOrOtherBasis |
| Depreciation | 35080097 | Depreciation |
| Book Value | 7072807 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 74247547 | OtherCostOrOtherBasis |
| Depreciation | 17032728 | Depreciation |
| Book Value | 57214819 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 65421048 | TotalOfBookValueLandBuildings |
Other Assets OtherAssets (10 entries)
| DescriptionDescription | Book ValueBookValue |
|---|---|
| SECURITY DEPOSITS | 8719 |
| OTHER CURRENT RECEIVABLES | 35480 |
| INV CHES POTOMAC HEALTHCARE | 2403544 |
| ASSETS LIMITED TO USE | 6513485 |
| PHYSICIANS LOAN | 125000 |
| INVEST IN JV FREESTATE | 15441 |
| DEFERRED FINANCING COSTS | 2307627 |
| INVESTMENT PREMIER | 13641 |
| INVESTMENT MARYLAND ECARE | 10000 |
| DUE FROM AFFILIATES | 1908660 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | 13341597 | TotalBookValueOtherAssets |
| Federal Income Tax Liability | 0 | FederalIncomeTaxLiability |
Other Liabilities OtherLiabilities (6 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| ADVANCES FROM THIRD PARTIES | $2,240,611 |
| ACCRUED INTEREST PAYABLE | $1,344,632 |
| ACCRUED PENSION COSTS | $8,003,140 |
| DUE TO AFFILIATE | $570,715 |
| DUE TO PREMIER | $53,090 |
| LEASE LIABILITIES | $396,775 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 12608963 | TotalOfAmounts |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | FIN 48 Footnote | Identifier |
| Explanation | The organization accounts for uncertainty in income taxes in accordance with FIN 48 (as codified). The organization's audited financial statements do not include any liabilities for uncertain tax positions. | Explanation |
Schedule F IRS990ScheduleF
Accts Actvs Out US Table AcctsActvsOutUSTable
| Field | Value | IRS element (for citing) |
|---|---|---|
| Region | Central America and the Caribbean | Region |
| Type Of Activities Conducted | Program Services | TypeOfActivitiesConducted |
| Specific Services Provided | insurance | SpecificServicesProvided |
| Total Expenditures | 1699120 | TotalExpenditures |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Amount Spent | 1699120 | TotalAmountSpent |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | true | CharityCarePolicy |
| Written Policy | true | WrittenPolicy |
| FPG Reference Free Care | true | FPGReferenceFreeCare |
| Pcent200 | X | Pcent200 |
| FPG Reference Discounted Care | true | FPGReferenceDiscountedCare |
| Pcent300 | X | Pcent300 |
| Free Disc Care Medically Indigent | false | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | true | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | true | ExpensesExceededBudget |
| Unable To Provide Care | false | UnableToProvideCare |
| Annual Community Benefit Report | true | AnnualCommunityBenefitReport |
| Report Publically Available | true | ReportPublicallyAvailable |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 1543401 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 1543401 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01510 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 1543401 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 1543401 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01510 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 37 | NumberOfActivitiesOrPrograms |
| Persons Served | 169149 | PersonsServed |
| Total Community Benefit Expense | 627385 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 120 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 627265 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00610 | PercentOfTotalExpense |
Health Professions Education HealthProfessionsEducation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 7 | NumberOfActivitiesOrPrograms |
| Persons Served | 344 | PersonsServed |
| Total Community Benefit Expense | 408701 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 408701 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00400 | PercentOfTotalExpense |
Subsidized Health Services SubsidizedHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 9 | NumberOfActivitiesOrPrograms |
| Persons Served | 50 | PersonsServed |
| Total Community Benefit Expense | 1900706 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 709061 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1191645 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01170 | PercentOfTotalExpense |
Cash And In Kind Contributions CashAndInKindContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 20 | NumberOfActivitiesOrPrograms |
| Persons Served | 2532 | PersonsServed |
| Total Community Benefit Expense | 93470 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 93470 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00090 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 73 | NumberOfActivitiesOrPrograms |
| Persons Served | 172075 | PersonsServed |
| Total Community Benefit Expense | 3030262 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 709181 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 2321081 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.02270 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 73 | NumberOfActivitiesOrPrograms |
| Persons Served | 172075 | PersonsServed |
| Total Community Benefit Expense | 4573663 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 709181 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 3864482 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.03780 | PercentOfTotalExpense |
Economic Development EconomicDevelopment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 3 | NumberOfActivitiesOrPrograms |
| Total Community Building Expense | 4061 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 4061 | NetCommunityBuildingExpense |
Community Support CommunitySupport
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 7 | NumberOfActivitiesOrPrograms |
| Persons Served | 88 | PersonsServed |
| Total Community Building Expense | 34986 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 34986 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00030 | PercentOfTotalExpense |
Coalition Building CoalitionBuilding
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 5 | NumberOfActivitiesOrPrograms |
| Total Community Building Expense | 7984 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 7984 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00010 | PercentOfTotalExpense |
Health Improvement Advocacy HealthImprovementAdvocacy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 1 | NumberOfActivitiesOrPrograms |
| Persons Served | 1 | PersonsServed |
| Total Community Building Expense | 4084 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 4084 | NetCommunityBuildingExpense |
Workforce Development WorkforceDevelopment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 5 | NumberOfActivitiesOrPrograms |
| Persons Served | 4 | PersonsServed |
| Total Community Building Expense | 197740 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 197740 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00190 | PercentOfTotalExpense |
Total Total
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 21 | NumberOfActivitiesOrPrograms |
| Persons Served | 93 | PersonsServed |
| Total Community Building Expense | 248855 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 248855 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00230 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | true | BadDebtExpenseReported |
| Bad Debt Expense | $4,454,115 | BadDebtExpenseAmount |
| Amount Reimbursed By Medicare | 30707476 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 35585746 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | -4878270 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | X | CostToChargeRatio |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | true | WrittenDebtCollectionPolicy |
| Provision For Charity Care | true | ProvisionForCharityCare |
Form990 Schedule H Part V Form990ScheduleHPartV
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CIVISTA MEDICAL CENTER INC | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 5 GARRETT AVE | AddressLine1 |
| City | LA PLATA | City |
| State | MD | State |
| ZIP Code | 20646 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| General Medical And Surgical | X | GeneralMedicalAndSurgical |
| Er24 Hours | X | Er24Hours |
Form990 Schedule H Part VI Form990ScheduleHPartVI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Annual Community Benefit Expln | 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 | AnnualCommunityBenefitExpln |
| Costing Method Used | Schedule H, Line 7a, Column (d) 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. Schedule H, Line 7b, Columns (c) through (f) 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. Schedule H, Line 7f Column (c) 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. Schedule H, Line 7f Column (d) 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. | CostingMethodUsed |
| Bad Debt Footnote | CIVISTA REPORTS BAD DEBT EXPENSE IN ACCORDANCE WITH GENERALLY ACCEPTED ACCOUNTING PRINCIPLES (GAAP) AND HFMA STATEMENT NO. 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. | BadDebtFootnote |
| Shortfall As Community Benefit | 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. | ShortfallAsCommunityBenefit |
| Debt Collection Policy | Regardless of the status of collections, if a patient applies for Charity and meets eligibility the balance is written off according to the percentage they qualify for. | DebtCollectionPolicy |
| Needs Assessment | Civista Medical Center, in partnership with the Charles County Department of Health, has conducted a Needs Assessment of Charles County every 5 years. Beginning 2011, in accordance with new regulations, the Needs Assessment will be conducted every 3 years. The data included in this report was collected in 2006 and the updated assessment is in process and due to be completed in 2011. This survey includes responses from health care providers as well as community residents. Additionally, The Charles County Community Foundation, in cooperation with Civista Medical Center, Charles County Department of Health, The United Way of Charles County and the Charles County Government conducted a Priority Needs Assessment for Charles County in 2008. In April 2009, the Charles County Local Management Board conducted a Needs Assessment. The Maryland Physician data is from the Maryland Health Commission's 2008 report. The data from all of these reports is included in the Needs Assessment update and is shared with all of the members of Partnerships for a Healthier Charles County (PHCC) of which Civista Health is a founding member. PHCC consists of more than 60 community member organizations from a broad spectrum of health related services and includes representatives from State and Local Government. The Steering Committee of PHCC consists of leadership from four community organizations in addition to Civista Health; Charles County Public Schools, College of Southern Maryland and the Charles County Department of Health. | NeedsAssessment |
| Patient Education 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. In addition, the policy is available on the Civista website and is posted in the local paper twice each year. | PatientEducationAssistance |
| Community Information | Charles County is mostly a rural county located on the Southern Maryland Peninsula, bordered by Prince George's County to the north, Calvert County to the east, and St. Mary's County to the south. Charles sits about 15 miles south of the Washington Capitol Beltway, 18 miles from Washington, D.C, and 54 miles southwest of Baltimore. The northern part of the county is the "development district" where commercial, residential and business growth is focused, so that the remainder of the county can retain its rural character. The major communities of Charles County are La Plata, the county seat; Port Tobacco, Indian Head, and the planned community of St. Charles. The main commercial cluster is Hughesville Waldorf White Plains. There are three nursing homes in Charles County, two are located in La Plata and one is located in Waldorf. In addition to the nursing homes there are two adult day care centers one in La Plata and one in Waldorf. These facilities provide care for the elderly citizens of Charles County, assisting family members by providing day time activities for those elderly citizens still in the home families. The County has one 129 bed hospital-Civista, located in the county's seat, La Plata. Charles County continues to experience rapid growth, expanding its population from 47,678 to 120,546 in the 2000 census. Current U.S. Census estimates are that the population now exceeds 140,444. This magnitude of growth can be seen in the change in population density, with an increase of 15% in the period from 2000 to 2005. While there are only 307 people per square mile over the total area of Charles County, there are 821 people per square mile of developed land. The population density is concentrated mainly in the northern end of the County. The census describes a population that is young, with a medium age of 35 years, and approximately 26% is under the age of 17, 41% is between the ages of 18 44, 25% is between the ages of 45 64; and 8% of the county's population 65 or over. The average household size is 2.85 with the average family size 3.23. The marital status of the county for males is 15, 962 never married, 28,913 now married, 1,467 separated, 924 widowed, and 5,680 divorced. For females 17,792 never married, 28,699 now married, 1,796 separated, 4,018 widowed, 5,563 divorced. The African American population is the largest minority group within Charles County. African American comprised 85% of the Charles County minority population. Though the American Indian/ Alaskan Native population makes up a very small percentage of the total county population, Charles County has the highest proportion of this minority than any of the jurisdiction in the state of Maryland. American Indians and Alaskan Natives make up 0.8% of the total county population. Employment and economic indicators for the county are strong. In 2006 the employed population for 16 years and older was 108,609. The commute to work includes 56,379 vehicles driven alone, 8,084 vehicles used for carpooling, 5,459 individuals use public transportation (excluding taxicabs), 546 individuals walk, 348 individuals use other means, and 2,421 individuals work from home. In 2006, the mean household income was $95,033. Charles County has a rate of 6.4% of all families who were living below the poverty level in 2006. African Americans were twice as likely to report that they were below the poverty level as Whites in the county. However, the rates of poverty in Charles County are significantly lower than the Maryland average rate and the United States rate. Poverty rates for Asians, American Indian/ Alaskan Native, and Hispanics could not be calculated due to small sample sizes. Within Charles County, the number of individuals with a bachelor's degree or higher in the White and African American populations is less than the Maryland average. The percentage of college educated African American residents in Charles County is higher than the United States average and only slightly below the Maryland state average. For the Asian population, the Charles County percentage is exactly the same as the Maryland state average and higher than the United State average. Educational attainment statistics were not available for the American Indian/Alaskan Native and Hispanic populations due to small sample sizes. There are no visible racial disparities in the percentage of individuals who have less than a high school diploma. The percentage for Whites, African Americans, and Asians was approximately 11 percent. The rate among the White population was similar on a county, state, and national level. The rate for the African American population was less on a county level than the state and national averages. The rate for the Asian population was less than the national average though slightly higher than the state average. The same patterns of decline in cancer mortality rates have been seen in Charles County. In 2004, cancer was the leading cause of death in Charles County. The age adjusted death rate for overall cancer from 2003 2005 in Charles County was 222.4 per 100,000. This rate exceeds the state overall cancer death rate of 190 per 100,000. For 1998 2002, lung and bronchus cancer incidence in Charles County is 66.9 per 100,000 and mortality is 59.9 per 100,000. On a county level, both the incidence and mortality rates for overall cancer and lung/bronchus cancer have decreased since the previous cancer report data. The county incidence rate for lung/ bronchus cancer has dropped below the State incidence (68.0); however, the county mortality rate has remained slightly higher than the state mortality (58.1) rate for lung/bronchus cancer. When comparing cancer mortality among racial groups, there was a reversed disparity for cancer mortality between the periods of 1999 2003. The White cancer mortality rate (approximately 230 per 100,000) is slightly higher than the African American cancer mortality rate (approximately 225 per 100,000), though the difference is not statistically significant. The White cancer mortality rate exceeds the state average rate and is one of the highest among all of the Maryland jurisdictions. The African American cancer mortality rate is the sixth lowest among the Maryland jurisdictions and is well below the Maryland and national rates. The minority population is increasing rapidly in Charles County. But with increases in the minority populations, increases in minority health disparities have not been observed. For many chronic and communicable diseases, rates appear to be similar for both the White and African American population. The biggest health disparities have been seen for heart disease, breast and cervical cancer, and diabetes. For some conditions, reverse disparities have occurred, such as lung cancer and all cause cancer mortality and stroke mortality. | CommunityInformation |
| 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. | CommunityBuildingActivities |
| Other Information | 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. | OtherInformation |
| Reports Filed With States | MD | ReportsFiledWithStates |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Records Maintained | true | RecordsMaintained |
Recipient Table RecipientTable (2 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EIN Of RecipientEINOfRecipient | IRC SectionIRCSection | Amount Of Cash GrantAmountOfCashGrant | Amount Of Non Cash AssistanceAmountOfNonCashAssistance | Method Of ValuationMethodOfValuation | Description Of Non Cash AssistanceDescriptionOfNonCashAssistance |
|---|---|---|---|---|---|---|---|---|---|
| Health Partners Inc | |||||||||
| PO Box 1865 | Waldorf | MD | 20604 | 521767044 | 501(c)(3) | 50000 | |||
| American Cancer Society | |||||||||
| 250 Williams Street | Atlanta | GA | 30303 | 131788491 | 501(c)(3) | 8012 | FMV | in-kind | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Nbr Of501 C3 And Govt Grants | 2 | TotalNbrOf501C3AndGovtGrants |
Form990 Schedule I Part IV Form990ScheduleIPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | Part I, Line 2 | Identifier |
| Explanation | Civista Medical Center makes financial and in-kind contributions to various charitable organizations in the community. | Explanation |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | X | CompensationCommittee |
| Independent Consultant | X | IndependentConsultant |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | false | SeverancePayment |
| Supplemental Nonqual Retire Plan | false | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | false | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | false | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | false | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | false | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | false | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | false | AnyNonFixedPayments |
| Initial Contract Exception | false | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (6 entries)
| Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| CATHY DELLIGATTI | |||||||||||||
| 151336 | 0 | 0 | 0 | 0 | 0 | 12012 | 0 | 8291 | 0 | 171639 | 0 | 0 | 0 |
| NOEL CERVINO | |||||||||||||
| 322038 | 0 | 40000 | 0 | 10763 | 0 | 5712 | 0 | 980 | 0 | 379493 | 0 | 0 | 0 |
| KEVIN BURBULES | |||||||||||||
| 156068 | 0 | 0 | 0 | 0 | 0 | 29780 | 0 | 5205 | 0 | 191053 | 0 | 0 | 0 |
| CHRISTINE STEFANIDES | |||||||||||||
| 290405 | 0 | 0 | 0 | 16636 | 0 | 0 | 0 | 0 | 0 | 307041 | 0 | 0 | 0 |
| GARY HERBEK | |||||||||||||
| 203071 | 0 | 0 | 0 | 0 | 0 | 13015 | 0 | 6529 | 0 | 222615 | 0 | 0 | 0 |
| ERIK BOAS | |||||||||||||
| 148217 | 0 | 0 | 0 | 98 | 0 | 2181 | 0 | 139 | 0 | 150635 | 0 | 0 | 0 |
Schedule K IRS990ScheduleK
Form990 Schedule K Part I Form990ScheduleKPartI
Issuer Name IssuerName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Maryland Health and Higher Educational Facilities | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Issuer EIN | 520936091 | IssuerEIN |
| CUSIP Number | 574217ul7 | CUSIPNumber |
| Date Issued | 2005-02-09 | DateIssued |
| Issue Price | 60097615 | IssuePrice |
| Description Of Purpose | BUILD ADDITION AND RENIVATE HO | DescriptionOfPurpose |
| Defeased | false | Defeased |
| On Behalf Of Issuer | false | OnBehalfOfIssuer |
Form990 Schedule K Part II Form990ScheduleKPartII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Proceeds | 60097615 | TotalProceeds |
| Amount In Reserve Fund | 4511625 | AmountInReserveFund |
| Issuance Costs From Proceeds | 3796282 | IssuanceCostsFromProceeds |
| Capital Expenditures | 51789708 | CapitalExpenditures |
| Year Of Subst Completion | 2007 | YearOfSubstCompletion |
| Current Refunding | false | CurrentRefunding |
| Advance Refunding | false | AdvanceRefunding |
| Final Allocation Made | true | FinalAllocationMade |
| Adequate Books And Recds Maintaind | true | AdequateBooksAndRecdsMaintaind |
Form990 Schedule K Part III Form990ScheduleKPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Owning Bond Financed Property | false | OwningBondFinancedProperty |
| Any Lease Arrangements | false | AnyLeaseArrangements |
| Mngment Cntrct Bond Financd Prprty | false | MngmentCntrctBondFinancdPrprty |
| Any Research Agreements | false | AnyResearchAgreements |
| Bond Counsel Routinely Engaged | true | BondCounselRoutinelyEngaged |
| Post Issuance Compliance Procdrs | true | PostIssuanceComplianceProcdrs |
Form990 Schedule K Part IV Form990ScheduleKPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form8038 T Filed | true | Form8038TFiled |
| Variable Rate Issue | false | VariableRateIssue |
| Hedge Identified In Books And Recds | false | HedgeIdentifiedInBooksAndRecds |
| Gross Proceeds Invested In GIC | false | GrossProceedsInvestedInGIC |
| Gross Proceeds Invested | false | GrossProceedsInvested |
| Exception To Rebate | false | ExceptionToRebate |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (6 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| DESCRIPTION OF 990 REVIEW PROCESS | PART VI, LINE 11 | The process for reviewing the Form 990 begins with Civista's Staff Accountant working with the Controller in reviewing the first Draft Form 990. The Staff Accountant and Controller will coordinate with the independent accounting firm, KPMG, to update any necessary changes. While the Controller schedules the services of KPMG to present the Final Draft Form 990 to the Finance Committee of the Board of Directors, the Chief Financial Officer will review the document before the Final Draft is generated. Once all necessary corrections are made, copies of the Final Draft Form 990 will be provided to the Finance Committee prior to the meeting for their review (which will be required to be kept confidential until the Form 990 is finalized and signed). The Final Draft Form 990 will be presented by KPMG at the Finance Committee meeting for questions and final approval. Once the Finance Committee approves the Form 990 to be signed, the President and Chief Executive Officer will sign as Civista's authorized signer. The Final Form 990 will be provided to the full Board of Directors for informational purposes before filing. |
| PROCESS FOR DETERMINING COMPENSATION | PART VI, LINE 15 | THE ORGANIZATION UTILIZES AN INDEPENDENT COMPENSATION COMMITTEE, AN INDEPENDENT COMPENSATION CONSULTANT, A WRITTEN EMPLOYMENT CONTRACT, A COMPENSATION SURVEY OR STUDY, AND APPROVAL BY THE BOARD/COMPENSATION COMMITTEE. THE CHIEF EXECUTIVE OFFICER/PRESIDENT AND THE EXECUTIVE COMMITTEE OF THE BOARD REVIEWS AND APPROVES THE COMPENSATION FOR THE ORGANIZATION'S TOP MANAGEMENT OFFICIALS AND OTHER OFFICERS AND KEY EMPLOYEES. THE SALARY OF MANAGEMENT EMPLOYEES ARE BASED A MARKET STUDY OF COMPARABLE POSITIONS, EDUCATION, AND EXPERIENCE AS RELATED TO THE MANAGER'S POSITION. IN ORDER TO DETERMINE THE MANAGER'S SALARY, THE COMPENSATION AND BENEFITS SPECIALIST COMPLETES A RELATIVE MARKET STUDY TO OBTAIN INFORMATION ABOUT COMPARABLE JOBS IN THE HEALTHCARE INDUSTRY. HUMAN RESOURCES EVALUATES THE MARKET STUDY AND THEN MAKES A RECOMMENDATION. HUMAN RESOURCES ALSO USES DATA PREPARED BY INDEPENDENT COMPENSATION CONSULTANTS. AFTER DECIDING ON THE COMPENSATION OF THE MANAGEMENT EMPLOYEE, THE DECISION IS DOCUMENTED IN THE EXECUTIVE COMMITTEE MINUTES. THE YEAR THAT THIS PROCESS WAS LAST UNDERTAKEN FOR THESE TYPES OF POSITIONS WAS IN THE CURRENT YEAR. THE CHIEF EXECUTIVE OFFICER/PRESIDENT IS THE ONLY EMPLOYEE WHO HAS A WRITTEN CONTRACT. EFFECTIVE OCTOBER 1, 2009, THE CHIEF EXECUTIVE OFFICER, CHIEF FINANCIAL OFFICER, AND CHIEF MEDICAL 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 EMPLOYESS 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. |
| 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 AND THE CHIEF MEDICAL 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. |
| 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 Schedule K, 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. |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (3 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Direct Controlling Entity NADirectControllingEntityNA | Business Name Line1DirectControllingEntityName/BusinessNameLine1 |
|---|---|---|---|---|---|---|---|---|---|---|
| CIVISTA HEALTH INC | ||||||||||
| 5 GARRETT AVE | LA PLATA | MD | 20646 | 522155576 | PARENT | MD | 501(c)(3) | 11C | N/A | |
| CIVISTA HEALTH FOUNDATION INC | ||||||||||
| 616 E CHARLES ST | LA PLATA | MD | 20646 | 521414564 | FUNDRAISING | MD | 501(c)(3) | 11A | CIVISTA HLTH | |
| CIVISTA HEALTH AUXILIARY INC | ||||||||||
| 5 GARRETT AVE | LA PLATA | MD | 20646 | 521131193 | AUXILIARY | MD | 501(c)(3) | 9 | CIVISTA HLTH | |
Form990 Schedule R Part IV Form990ScheduleRPartIV
Name Of Related Org NameOfRelatedOrg
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CIVISTA CARE PARTNERS INC | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 5 GARRETT AVE | AddressLine1 |
| City | LA PLATA | City |
| State | MD | State |
| ZIP Code | 20646 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 522176314 | EIN |
| Primary Activity | HEALTHCARE | PrimaryActivity |
| Legal Domicile State | MD | LegalDomicileState |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CIVISTA HLTH | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Type Of Entity | C Corp | TypeOfEntity |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | false | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | false | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | false | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | false | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | false | LoansOrGuaranteesFromOtherOrg |
| Sale Of Assets To Other Org | false | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | false | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | false | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | false | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | false | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | false | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | true | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | true | SharingOfFacilities |
| Sharing Of Paid Employees | true | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | false | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | true | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | true | OtherTransferToOtherOrg |
| Other Transfer From Other Org | true | OtherTransferFromOtherOrg |
Transactions Related Orgs Table TransactionsRelatedOrgsTable (10 entries)
| Transaction TypeTransactionType | Amount InvolvedAmountInvolved |
|---|---|
| CIVISTA HEALTH FOUNDATION INC | |
| R | 620000 |
| CIVISTA HEALTH FOUNDATION INC | |
| Q | 500000 |
| CIVISTA HEALTH FOUNDATION INC | |
| P | 73142 |
| CIVISTA HEALTH FOUNDATION INC | |
| N | 184661 |
| CIVISTA HEALTH FOUNDATION INC | |
| L | 188570 |
| CIVISTA CARE PARTNERS INC | |
| R | 665000 |
| CIVISTA CARE PARTNERS INC | |
| N | 124685 |
| CIVISTA CARE PARTNERS INC CCS LLC | |
| N | 788503 |
| CIVISTA CARE PARTNERS INC CCS LLC | |
| Q | 955421 |
| CIVISTA CARE PARTNERS INC CCP LLC | |
| R | 165000 |
Comments