2011-05-12T08:41:57-05:00 2010-06-30 KPMG LLP 1676 International Drive McLean VA 22102 990 2009-07-01 520445374 Civista Medical Center Inc CIVI 3016094130 5 Garrett Ave PO Box 1070 La Plata MD 20646 NOEL CERVINO 2011-05-10 true SCOTT SHERMAN KPMG LLP 703-286-8398 7032868000 2009 2016-02-24 21:20:13Z NOEL CERVINO 5 Garrett Ave LA PLATA MD 20646 102666865 false X www.civista.org X 1980 MD CIVISTA MEDICAL CENTER PROVIDES EXCELLENT CARE TO EACH PATIENT IN A SAFE, CARING AND FAMILY-CENTERED ENVIRONMENT. 15 14 1010 160 170519 60778 1079540 27613 95312096 101981695 818420 131108 510815 526449 97720871 102666865 0 93470 0 0 41428443 45152262 0 0 0 57457699 55574825 98886142 100820557 -1165271 1846308 118804555 121283439 105154344 108395171 13650211 12888268 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. false false 66401044 93470 101981695 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. 66401044 true false false true false false false false false true false true false false true false false false false false true true false true true false false false false false false false false false false false false false false false true true false false true 196 0 true 1010 true true true true CJ false false false false false false false 15 14 false true false false false false false true true false false true true true true true true true false false MD X JIM CLAGUE 3016095154 5 GARRETT AVE La Plata MD 20646 WAYNE COOPER 3.0 X 0 0 0 DELORES DATCHER 3.0 X 0 0 0 C DEVADASON 3.0 X 0 0 0 SARA MIDDLETON 3.0 X X 0 0 0 SURYAKANT PATEL 3.0 X 0 0 0 BARBARA STEPURA 3.0 X 0 0 0 KHADAR BAIG 3.0 X 0 0 0 VAN MITCHELL 3.0 X 0 0 0 LOUIS JENKINS JR 3.0 X X 0 0 0 SEETARAMAYYA NAGULA 3.0 X 0 0 0 RICHARD WINKLER 3.0 X 0 0 0 MICHAEL CADY 3.0 X 0 0 0 ASHVIN J PATEL MD 4.0 X X 0 0 0 JAMES BURKE 4.0 X X 0 0 0 NOEL CERVINO 40.0 X 372801 0 6692 ERIK BOAS 40.0 X 148315 0 2320 CATHY DELLIGATTI 40.0 X 151336 0 20303 KEVIN BURBULES 40.0 X 156068 0 34985 GARY HERBEK 40.0 X 203071 0 19544 JOAN HUMULOCK 40.0 X 130907 0 7738 MARILYN E GREGORY 40.0 X 135593 0 6356 KANIKA HAMPTON 40.0 X 129538 0 18227 EILEEN FRANCES STOPA 40.0 X 124585 0 4200 KATHERINE MIDDLETON 40.0 X 138048 0 7074 CHRISTINE STEFANIDES X 307041 0 0 1997303 0 127439 24 true true false 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 23 27613 27613 NET PATIENT REVENUE 900099 101981695 101981695 101981695 131108 131108 0 0 0 0 0 0 ANSWERING SERVICE 561000 170280 170280 CAFETERIA AND COFFEE BAR SALES 900099 292647 292647 APPLICATION FEES 900099 9250 9250 54272 54033 239 526449 102666865 102044978 170519 423755 93470 93470 0 0 0 648530 648530 0 0 37046113 29636890 7409223 0 1041396 833117 208279 0 3698388 2847759 850629 0 2717835 2119911 597924 0 150000 0 150000 0 365765 0 365765 0 181438 0 181438 0 0 0 0 11420092 6852055 4568037 0 422403 316802 105601 0 0 0 0 2832690 1472999 1359691 0 30106 7527 22579 0 0 0 3227565 0 3227565 0 0 5149235 36045 5113190 0 2003907 0 2003907 0 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 100820557 66401044 34419513 0 24142941 29116660 9140952 10886077 1533892 1588468 1185201 854589 118632613 53211565 69663504 65421048 85735 75000 13052330 13341597 118804555 121283439 14978874 16336955 59107135 58529039 21804652 20920214 9263683 12608963 105154344 108395171 X 13650211 12888268 13650211 12888268 118804555 121283439 X false true true X false X false false false false false false false false true 11344 11344 false Lobbying Activities 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. 2232162 1098740 1133422 42152904 35080097 7072807 74247547 17032728 57214819 65421048 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 13341597 0 ADVANCES FROM THIRD PARTIES 2240611 ACCRUED INTEREST PAYABLE 1344632 ACCRUED PENSION COSTS 8003140 DUE TO AFFILIATE 570715 DUE TO PREMIER 53090 LEASE LIABILITIES 396775 12608963 FIN 48 Footnote The organization accounts for uncertainty in income taxes in accordance with FIN 48 (as codified). The organization's audited financial statements do not include any liabilities for uncertain tax positions. Central America and the Caribbean Program Services insurance 1699120 1699120 true true true X true X false true true false true true 1543401 1543401 0.01510 1543401 1543401 0.01510 37 169149 627385 120 627265 0.00610 7 344 408701 408701 0.00400 9 50 1900706 709061 1191645 0.01170 20 2532 93470 93470 0.00090 73 172075 3030262 709181 2321081 0.02270 73 172075 4573663 709181 3864482 0.03780 3 4061 4061 7 88 34986 34986 0.00030 5 7984 7984 0.00010 1 1 4084 4084 5 4 197740 197740 0.00190 21 93 248855 248855 0.00230 true 4454115 30707476 35585746 -4878270 X true true CIVISTA MEDICAL CENTER INC

5 GARRETT AVE LA PLATA MD 20646

X X X 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 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. 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. 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. 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. 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. 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. 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. 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. 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. MD true 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 2 Part I, Line 2 Civista Medical Center makes financial and in-kind contributions to various charitable organizations in the community. X X X X false false false false false false false false false 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 Maryland Health and Higher Educational Facilities 520936091 574217ul7 2005-02-09 60097615 BUILD ADDITION AND RENIVATE HO false false 60097615 4511625 3796282 51789708 2007 false false true true false false false false true true true false false false false false 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. CIVISTA HEALTH INC 5 GARRETT AVE LA PLATA MD 20646 522155576 PARENT MD 501(c)(3) 11C N/A CIVISTA HEALTH FOUNDATION INC 616 E CHARLES ST LA PLATA MD 20646 521414564 FUNDRAISING MD 501(c)(3) 11A CIVISTA HLTH CIVISTA HEALTH AUXILIARY INC 5 GARRETT AVE LA PLATA MD 20646 521131193 AUXILIARY MD 501(c)(3) 9 CIVISTA HLTH CIVISTA CARE PARTNERS INC 5 GARRETT AVE LA PLATA MD 20646 522176314 HEALTHCARE MD CIVISTA HLTH C Corp false false false false false false false false false false false true true true false true true true CIVISTA HEALTH 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