2011-05-12T08:41:57-05:00 2010-06-30 KPMG LLP 1676 International Drive McLean VA 22102 990 2009-07-01 522155576 Civista Health Inc CIVI 3016094000 PO Box 1070 La Plata MD 206461070 NOEL CERVINO 2011-05-10 true SCOTT SHERMAN KPMG LLP 703-286-839 7032868000 2009 2016-02-24 21:20:13Z Noel Cervino PO BOX 1070 LA PLATA MD 206461070 0 false X WWW.CIVISTA.ORG X 1998 MD CIVISTA HEALTH IS THE PARENT COMPANY OF A REGIONAL INTEGRATED HEALTH SYSTEM SERVING THE HEALTH NEEDS OF CHARLES COUNTY AND THE CITIZENS OF SOUTHERN MARYLAND. 15 14 0 0 7824 3324 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 CIVISTA HEALTH PROVIDES EXCELLENT CARE TO 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. false false Civista health is the parent company of a regional integrated health system serving the health needs of Charles County and the citizens of Southern Maryland. Civista Health, Inc. Community Benefits Program utilizes a planned, managed, organized, and measured approach to meeting the identified community needs of the area we serve. The mission is to improve overall community health by improving access to health care, enhancing the health of the community, advancing healthcare knowledge and working with health - providing agency partners. Civista Health, Inc., in Partnership with the Charles County Department of Health, 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 Health, Inc, 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. 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 Health's community benefits program. Accomplishments: Civista Health 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. true false false false false false false false false true false true false false false false false false false false false false false true false false false false false false false false false false false false false true true false true 0 0 true 0 true true false false 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 false false false MD X JIM CLAGUE 3016095154 5 GARRETT AVENUE LA PLATA MD 20646 X WAYNE COOPER 1.0 X 0 0 0 DELORES DATCHER 1.0 X 0 0 0 C DEVADASON 1.0 X 0 0 0 SARA MIDDLETON 1.0 X X 0 0 0 SURYAKANT PATEL 1.0 X 0 0 0 BARBARA STEPURA 1.0 X 0 0 0 NOEL CERVINO 40.0 X X 0 372801 6692 KHADAR BAIG 1.0 X 0 0 0 VAN MITCHELL 1.0 X 0 0 0 LOUIS JENKINS JR 1.0 X X 0 0 0 SEETARAMAYYA NAGULA 1.0 X 0 0 0 RICHARD WINKLER 1.0 X 0 0 0 MICHAEL CADY 1.0 X 0 0 0 ASHVIN J PATEL MD 1.0 X X 0 0 0 JAMES BURKE 1.0 X X 0 0 0 ERIK BOAS 40.0 X 0 148315 2320 0 521116 9012 0 false true false 0 0 0 0 7824 -7824 0 0 0 0 0 0 0 0 7824 -7824 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X 0 0 0 0 X false true true X false X X X false false false CIVISTA MEDICAL CENTER INC 520445374 03 true true true 0 CIVISTA HEALTH AUXILIARY 521131193 04 true true true 0 2 FIN 48 Schedule D Fin 48 Footnote Civista Medical Center, Inc., Civista Health Foundation, Inc., and Civista Health, Inc. were recognized as public charities generally exempt from federal income taxation under 501(c)(3) of the Internal Revenue Code pursuant to determination letters issued by the IRS in 1980, 1986, and 2001, respectively. Civista Care Partners, Inc. (CCP) is a for profit entity subject to federal and state income taxes, which are recorded under FASB Accounting Standards Codification (ASC) Topic 740, Accounting for Income Taxes (ASC 740). Accordingly, income taxes are accounted for under the asset and liability method. Under this method, deferred tax assets and liabilities are recognized for the future tax consequences attributable to temporary differences between the financial statement carrying amounts of existing assets and liabilities and their respective tax bases and operating loss and credit carry forwards. Deferred tax assets and liabilities are measured using enacted tax rates expected to apply to taxable income in the years in which those temporary differences are expected to be recovered or settled. The effect on deferred tax assets and liabilities of a change in tax rates is recognized in income in the period that includes the enactment date. false false false false false false false false false NOEL CERVINO 0 322038 0 40000 0 10763 0 5712 0 980 0 379493 0 0 ERIK BOAS 0 148217 0 0 0 98 0 2181 0 139 0 150635 0 0 CONFLICT OF INTEREST POLICY PART VI, SECTION B, LINE 12C THE CONFLICTS MONITORING AND ENFORCEMENT POLICY IS ESTABLISHED TO PROHIBIT ACTIVITIES THAT MAY CONFLICT OR APPEAR TO CONFLICT WITH CIVISTA'S BUSINESS. EMPLOYEES IN KEY POSITIONS AT CIVISTA HAVE AN OBLIGATION TO CIVISTA TO AVOID CONFLICT OF INTEREST SITUATIONS. KEY EMPLOYEES ARE EXEMPT ADMINISTRATIVE AND NON-EXEMPT EMPLOYEES WHO HAVE THE AUTHORITY TO MAKE COMMITMENTS FOR CIVISTA RESOURCES. ALL KEY EMPLOYEES MUST SIGN A DISCLOSURE OF BUSINESS INTEREST/CONFLICT OF INTEREST STATEMENT. IT IS THE POLICY OF CIVISTA THAT KEY EMPLOYEES DISCLOSE ANY DETAIL OF ANY ACTIVITIES OR INTERESTS WHICH MAY CONFLICT OR APPEAR TO CONFLICT WITH CIVISTA'S BUSINESS. CONFLICT OF INTEREST BEHAVIORS ARE VARIED; HOWEVER, IT WOULD BE PROHIBITED FOR AN EMPLOYEE TO BE DIRECTLY CONNECTED IN ANY MANNER WITH ANY BUSINESS OR ENTITY WHICH SELLS OR PROVIDES MATERIALS, SUPPLIES, EQUIPMENT, FACILITIES OR SERVICES TO OR WHICH IS IN DIRECT OR INDIRECT COMPETITION WITH OR WHICH IS A CUSTOMER OF CIVISTA. ALL EMPLOYEES SHALL REFRAIN FROM ANY CONDUCT DURING THE PERFORMANCE OF THEIR DUTIES THAT HAS THE APPEARANCE OF IMPROPRIETY OR THAT COULD REASONABLY BE CONSTRUED AS CONTRARY TO THE INTERESTS AND MISSION OF THIS ORGANIZATION. AN EMPLOYEE MAY NOT ACCEPT CASH IN ANY AMOUNT OR OTHER PERSONAL GIFTS HAVING ANY VALUE OR ANY OTHER PERSONAL FAVORS FOR PERFORMANCE WHICH GOES BEYOND COMMON COURTESY IN THE PERFORMANCE OF HIS/HER JOB DUTIES FROM ANYONE WITH WHOM CIVISTA HAS OR IS LIKELY TO HAVE ANY BUSINESS DEALINGS. THESE INDIVIDUALS MAY INCLUDE AN EMPLOYEE, PERSPECTIVE EMPLOYEES, CUSTOMERS, COMPETITORS OR VENDORS. AN EMPLOYEE MAY NOT DISCLOSE DIRECTLY OR INDIRECTLY ANY INFORMATION OF ANY KIND ACQUIRED IN THE COURSE OF EMPLOYMENT OR ASSOCIATION WITH CIVISTA OR USE ANY SUCH INFORMATION TO FURTHER ANY PERSONAL INTERESTS OR TO THE DETRIMENT OF CIVISTA. ANY EMPLOYEE WHO HAS KNOWLEDGE OF ACTIVITIES THAT HE OR SHE BELIEVES MAY VIOLATE ANY OF THESE PROCEDURES HAS AN OBLIGATION TO REPORT THEM IMMEDIATELY TO THEIR SUPERVISOR/DEPARTMENT MANAGER OR THE VICE PRESIDENT, HUMAN RESOURCES. ANY INDIVIDUAL WHO KNOWINGLY VIOLATES THIS POLICY IS SUBJECT TO DISCIPLINARY ACTION UP TO AND INCLUDING DISCHARGE IN ADDITION TO POTENTIAL CRIMINAL PROSECUTION. WHILE ALL 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. PROCESS FOR DETERMINING COMPENSATION PART VI, SECTION B, LINE 15 CIVISTA MEDICAL CENTER UTILIZES AN INDEPENDENT COMPENSATION COMMITTEE, AN INDEPENDENT COMPENSATION CONSULTANT, A WRITTEN EMPLOYMENT CONTRACT, A COMPENSATION SURVEY OR STUDY, AND APPROVAL BY THE BOARD/COMPENSATION COMMITTEE. THE CHIEF EXECUTIVE OFFICER/PRESIDENT AND THE EXECUTIVE COMMITTEE OF THE BOARD REVIEWS AND APPROVES THE COMPENSATION FOR THE ORGANIZATION'S TOP MANAGEMENT OFFICIALS AND OTHER OFFICERS AND KEY EMPLOYEES. THE SALARY OF MANAGEMENT EMPLOYEES ARE BASED A MARKET STUDY OF COMPARABLE POSITIONS, EDUCATION, AND EXPERIENCE AS RELATED TO THE MANAGER'S POSITION. IN ORDER TO DETERMINE THE MANAGER'S SALARY, THE COMPENSATION AND BENEFITS SPECIALIST COMPLETES A RELATIVE MARKET STUDY TO OBTAIN INFORMATION ABOUT COMPARABLE JOBS IN THE HEALTHCARE INDUSTRY. HUMAN RESOURCES EVALUATES THE MARKET STUDY AND THEN MAKES A RECOMMENDATION. HUMAN RESOURCES ALSO USES DATA PREPARED BY INDEPENDENT COMPENSATION CONSULTANTS. AFTER DECIDING ON THE COMPENSATION OF THE MANAGEMENT EMPLOYEE, THE DECISION IS DOCUMENTED IN THE EXECUTIVE COMMITTEE MINUTES. THE YEAR THAT THIS PROCESS WAS LAST UNDERTAKEN FOR THESE TYPES OF POSITIONS WAS IN THE CURRENT YEAR. THE CHIEF EXECUTIVE OFFICER/PRESIDENT IS THE ONLY EMPLOYEE WHO HAS A WRITTEN CONTRACT. EFFECTIVE OCTOBER 1, 2009, THE CHIEF EXECUTIVE OFFICER, CHIEF FINANCIAL OFFICER, 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. 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. 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. 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