2020-05-12T14:48:56-05:00 2019-06-30 560747981 DIXON HUGHES GOODMAN LLP 1410 SPRING HILL ROAD 5TH FLOOR TYSONS VA 22102 990 2018-07-01 522347324 CALVERT HEALTH SYSTEM INC CALV 4105354000 100 HOSPITAL ROAD PRINCE FREDERICK MD 20678 DEAN TEAGUE PRESIDENT & CEO 4105354000 2020-04-22 1 AMY BIBBY P00445891 7039700400 2020-04-22 96.255.208.156 2020-04-22 13:46:41 ED P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 839A658C77C9BD915FB92B1F12127266767FB63C 2018 2021-01-29 14:40:06Z DEAN TEAGUE 100 HOSPITAL ROAD PRINCE FREDERICK MD 20678 22034036 0 X WWW.CALVERTHEALTHMEDICINE.ORG X 2000 MD CALVERT HEALTH SYSTEM, INC. WAS ORGANIZED AND AT ALL TIMES OPERATES EXCLUSIVELY FOR THE BENEFIT OF CALVERTHEALTH MEDICAL CENTER. CALVERT HEALTH SYSTEM, INC. MANAGES ITS SUBSIDIARIES IN ORDER TO PROMOTE AND SUPPORT PUBLIC HEALTH PROGRAMS AND SERVICES FOR THE COMMUNITY. 20 17 177 0 0 0 0 0 16570558 17843208 14293087 3822181 592936 238996 31456581 21904385 0 0 0 0 12841753 12325780 0 0 0 9859950 11335808 22701703 23661588 8754878 -1757203 133522656 111116936 7608215 9088910 125914441 102028026 CALVERT HEALTH SYSTEM, INC. WAS ORGANIZED AND AT ALL TIMES OPERATES EXCLUSIVELY FOR THE BENEFIT OF CALVERTHEALTH MEDICAL CENTER. CALVERT HEALTH SYSTEM,INC. MANAGES ITS SUBSIDIARIES IN ORDER TO PROMOTE AND SUPPORT PUBLIC HEALTH PROGRAMS AND SERVICES FOR THE COMMUNITY. 0 0 21997570 18082204 PROVISION OF AN ARRAY OF PRIMARY CARE AND SECONDARY CARE PHYSICIAN SERVICES TO MEMBERS OF THE CALVERT HEALTH SYSTEM COMMUNITY IN ORDER TO PROVIDE THE CALVERT HEALTH SYSTEM COMMUNITY, WHICH IS MORE RURAL IN NATURE AND HAS SOME CONCERNS REGARDING ACCESS TO CARE, WITH CONVENIENT ACCESS TO A COORDINATED NETWORK OF PHYSICIANS. OPERATE EXCLUSIVELY FOR THE CHARITABLE PURPOSE OF COORDINATING THE MANAGEMENT OF THE CALVERT HEALTH SYSTEM AND PROMOTING PUBLIC HEALTHCARE PROGRAMS AND THE PROVISION OF MEDICAL SERVICES TO OUR COMMUNITY. 21997570 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 1 0 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 1 0 1 16 0 177 1 0 0 0 0 0 0 0 0 0 0 0 0 X 20 17 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 0 0 0 X CAROLYN HEITHAUS 4105358241 100 HOSPITAL ROAD PRINCE FREDERICK MD 20678 ANTHONY BUTTERS DIRECTOR 1.50 1.50 X 0 0 0 BARBARA GARDNER DIRECTOR 1.00 1.00 X 0 0 0 ERIC FRANKLIN DIRECTOR 2.00 2.00 X 0 0 0 GYAN SURANA DIRECTOR 1.00 1.00 X 0 0 0 KAREN O'BRIEN DIRECTOR 2.00 2.00 X 0 0 0 KATHY DICKINSON DIRECTOR 1.00 1.00 X 0 0 0 LOUJEANIA JOHNSON DIRECTOR 1.00 1.00 X 0 0 0 MARK DAVIS DIRECTOR 1.00 1.00 X 0 0 0 SALLY SHOWALTER DIRECTOR 1.00 1.00 X 0 0 0 SAM NAZZARO DIRECTOR 1.00 2.00 X 0 0 0 SAMUEL FOSTER DIRECTOR 1.00 1.00 X 0 22598 0 STEPHANIE DABULIS DIRECTOR 1.00 1.00 X 0 0 0 RICHARD FLEMING DIRECTOR 1.00 4.00 X 0 0 0 WILFRED EHRMANTRAUT DIRECTOR 3.50 3.50 X 0 40000 0 FRED BUMGARNER EX-OFFICIO 3.00 3.00 X 0 0 0 KENNETH ABBOTT EX-OFFICIO 41.00 1.00 X 422228 0 18917 KEVIN NIETMANN EX-OFFICIO (LEFT FYE 6/30/19) 1.00 1.00 X 0 0 0 HENRY TRENTMAN CHAIRPERSON (LEFT FYE 6/30/19) 2.00 3.00 X X 0 0 0 TERRI WOLFLEY CHAIRPERSON 2.00 4.00 X X 0 0 0 CLIFF STEWART VICE CHAIRPERSON 10.00 10.00 X X 0 0 0 KEVIN BETZ TREASURER 2.50 2.50 X X 0 0 0 DAVID SHOWERS SECRETARY 2.00 2.00 X X 0 0 0 DEAN TEAGUE PRESIDENT & CEO 5.00 43.00 X X 0 595349 110644 CAROLYN HEITHAUS VP FINANCE & CFO 5.00 43.00 X 0 354274 29446 SAAD HAQUE PHYSICIAN 40.00 X 546296 0 20623 BILAL AHMED PHYSICIAN 40.00 X 693763 0 30556 ERVIND BHOGTE PHYSICIAN 40.00 X 486901 0 31076 APARAJITA MAHATA PHYSICIAN 40.00 X 387919 0 32308 BARBARA ESTES PHYSICIAN 40.00 X 366314 0 13240 2903421 1012221 286810 34 0 1 0 WEATHERBY LOCUMS INC PO BOX 972633 DALLAS TX 75397 LOCUM TENENS PHYSICIAN 247231 ANNE ARUNDEL HEALTHCARE ENTERPRISES 201 DEFENSE HIGHWAY SUITE 150 ANNAPOLIS MD 21401 CLINICAL PHYSICIAN SERVICES 140400 2 NET PATIENT SERVICE REVENUE 621110 17843208 17843208 17843208 3924029 3924029 27803 129651 0 -129651 27803 -101848 -101848 DENTAL REVENUE 621110 175227 175227 OTHER REVENUE 621110 51593 51593 PEDS HOPSITAL REVENUE 621110 7162 7162 5014 5014 238996 21904385 18082204 0 3822181 313227 313227 10495117 9873517 621600 374433 352899 21534 495079 463710 31369 647924 610661 37263 450368 450368 308153 308153 663064 663064 48728 48728 310398 305412 4986 244449 244449 1134344 1064357 69987 10831 10579 252 43790 43391 399 219530 219530 415657 415657 MEDICAL SUPPLIES 6699217 6699217 PURCHASED SERVICES 624988 511023 113965 OTHER 131628 127486 4142 REPAIRS AND MAINTENANCE 30663 30663 23661588 21997570 1664018 0 6667283 6490635 2389154 2439779 1321199 1350508 113051 187885 278217 207997 2945490 2590521 227763 354969 108247008 84839935 9725465 9713722 4181129 5260236 149189 65000 223198 206270 133522656 111116936 1643017 1535681 5965198 7553229 7608215 9088910 X 125914441 102028026 125914441 102028026 133522656 111116936 X -1757203 2143488 -24272700 X X 0 1 X 1 0 X X 1 CALVERTHEALTH MEDICAL CENTER 520619000 3 1 27833700 0 1 27833700 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 SCHEDULE A, PART I, LINE 12(B) DURING 2013 CALVERT HEALTH SYSTEM, INC. SUBMITTED FORM 8940 TO THE IRS REQUESTING AN INITIAL DETERMINATION OF THE ORGANIZATION'S TYPE II SUPPORTING ORGANIZATION STATUS (UNDER SECTION 509(A)(3)). CALVERT HEALTH SYSTEM, INC. RECEIVED THE IRS DETERMINATION LETTER IN SEPTEMBER 2015. SCHEDULE A, PART I, LINE 12(G) CALVERT HEALTH SYSTEM, INC. IS THE PARENT ORGANIZATION OF THE ENTIRE CALVERT HEALTH SYSTEM, WHICH INCLUDES CALVERTHEALTH MEDICAL CENTER. 1731059 1473236 257823 1212656 1117285 95371 1775 1775 354969 ALTERNATIVE INVESTMENTS 9713722 F 9713722 DUE TO AFFILIATES 7553229 7553229 X PART X, LINE 2: THE SYSTEM IS EXEMPT FROM FEDERAL INCOME TAX UNDER SECTION 501(C)(3) OF THE IRC AS A PUBLIC CHARITY. THE SYSTEM IS ENTITLED TO RELY ON THIS DETERMINATION AS LONG AS THERE ARE NO SUBSTANTIAL CHANGES IN ITS CHARACTER, PURPOSES, OR METHODS OF OPERATION. MANAGEMENT HAS CONCLUDED THAT THERE HAVE BEEN NO SUCH CHANGES AND, THEREFORE, THE SYSTEM'S STATUS AS A PUBLIC CHARITY EXEMPT FROM FEDERAL INCOME TAXATION REMAINS IN EFFECT. THE STATE IN WHICH THE SYSTEM OPERATES ALSO PROVIDES GENERAL EXEMPTION FROM STATE INCOME TAXATION FOR ORGANIZATIONS THAT ARE EXEMPT FROM FEDERAL INCOME TAXATION. HOWEVER, THE SYSTEM IS SUBJECT TO BOTH FEDERAL AND STATE INCOME TAXATION AT CORPORATE TAX RATES ON ITS UNRELATED BUSINESS INCOME. EXEMPTION FROM OTHER STATE TAXES, SUCH AS REAL AND PERSONAL PROPERTY TAXES, IS SEPARATELY DETERMINED. THE SYSTEM HAD NO UNRECOGNIZED TAX BENEFITS OR SUCH AMOUNTS WERE IMMATERIAL DURING THE PERIODS PRESENTED. FOR TAX PERIODS WITH RESPECT TO WHICH NO UNRELATED BUSINESS INCOME WAS RECOGNIZED, NO TAX RETURN WAS REQUIRED. MANAGEMENT HAS ALSO CONSIDERED THE IMPACT OF UNRELATED BUSINESS ACTIVITIES AND HAS CONCLUDED THAT THE SYSTEM IS NOT SUBJECT TO UNRELATED BUSINESS TAX OR ANY OTHER TAXES THAT COULD BE IMPOSED BY THE IRC OR STATE TAXING AUTHORITIES. AS SUCH, NO PROVISION IS MADE FOR INCOME TAXES AND NO ASSET OR LIABILITY HAS BEEN RECOGNIZED FOR DEFERRED TAXES. CENTRAL AMERICA AND THE CARIBBEAN - ANTIGUA & BARBUDA, ARUBA, BAHAMAS, 0 0 INVESTMENTS 66560 EUROPE (INCLUDING ICELAND & GREENLAND) - ALBANIA, ANDORRA, AUSTRIA, BELGIUM 0 0 INVESTMENTS 9647162 0 0 0 0 0 0 9713722 0 9713722 0 0 1 1 0 0 0 1 0 0 0 0 0 0 0 KENNETH ABBOTT EX-OFFICIO 209953 0 142284 0 69991 0 11109 0 7808 0 441145 0 0 0 DEAN TEAGUE PRESIDENT & CEO 0 421588 0 161877 0 11884 0 99593 0 11051 0 705993 0 0 CAROLYN HEITHAUS VP FINANCE & CFO 0 262800 0 90160 0 1314 0 29023 0 423 0 383720 0 0 SAAD HAQUE PHYSICIAN 409048 0 108171 0 29077 0 12375 0 8248 0 566919 0 0 0 BILAL AHMED PHYSICIAN 473365 0 211203 0 9195 0 12375 0 18181 0 724319 0 0 0 ERVIND BHOGTE PHYSICIAN 363658 0 34915 0 88328 0 12375 0 18701 0 517977 0 0 0 APARAJITA MAHATA PHYSICIAN 279701 0 108218 0 0 0 24687 0 7621 0 420227 0 0 0 BARBARA ESTES PHYSICIAN 284585 0 81729 0 0 0 12375 0 865 0 379554 0 0 0 PART I, LINE 3 CALVERTHEALTH MEDICAL CENTER COMPENSATES THE EXECUTIVES OF THE ORGANIZATION. THE ORGANIZATION RELIES ON CALVERTHEALTH MEDICAL CENTER TO UTILIZE THE FOLLOWING METHODS IN ESTABLISHING COMPENSATION: -CONTEMPORANEOUS SUBSTANTIATION OF THE DECISION-MAKING PROCESS -FORM 990 OF OTHER ORGANIZATIONS -WRITTEN EMPLOYMENT CONTRACT -INDEPENDENT COMPENSATION CONSULTANT -COMPENSATION SURVEY OR STUDY -APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE PART I, LINE 4B THE FOLLOWING EMPLOYEE(S) CONTRIBUTED TO (EMPLOYEE AND EMPLOYER PORTION) A RELATED ORGANIZATION'S 457(F) DEFERRED COMPENSATION PLAN: DEAN TEAGUE: $87,218 CAROLYN HEITHAUS: $16,648 FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS REVIEWED BY THE AUDIT COMMITTEE OF THE CALVERT HEALTH SYSTEM, INC. BOARD OF DIRECTORS AFTER COMPLETION AND PRIOR TO SUBMISSION TO THE IRS. THE DOCUMENT IS DELIVERED TO THE COMMITTEE MEMBERS PRIOR TO THE COMMITTEE MEETING SO THAT THEY CAN REVIEW THE INFORMATION AND RESPOND TO OR QUESTION ANY OR ALL OF THE DATA. THE CHIEF EXECUTIVE OFFICER AND CHIEF FINANCIAL OFFICER ARE PRESENT AT THE AUDIT COMMITTEE MEETING. PRIOR TO SUBMISSION TO THE IRS, A COPY OF THE FINAL FORM 990 IS POSTED ON THE BOARD OF DIRECTORS PORTAL WHICH IS PASSWORD-PROTECTED. ALL BOARD MEMBERS ARE NOTIFIED BY EMAIL THAT THE FORM 990 HAS BEEN POSTED ON THE PORTAL AND IS AVAILABLE FOR REVIEW. ANY ADDITIONAL COMMENTS OR QUESTIONS FROM BOARD MEMBERS ARE RESPONDED TO PRIOR TO FILING THE FORM 990. FORM 990, PART VI, SECTION B, LINE 12C CALVERT HEALTH SYSTEM, INC. AND SUBSIDIARIES (THE HEALTH SYSTEM) HAVE A CONFLICT OF INTEREST PROCESS. AT ITS CORE ARE THREE DISTINCT POLICIES; ONE EACH FOR THE BOARD OF DIRECTORS, MEDICAL STAFF, AND ALL EMPLOYEES AND ASSOCIATES OF THE HEALTH SYSTEM. THESE POLICIES REQUIRE ALL ORGANIZATIONAL LEADERSHIP, AS WELL AS RANK AND FILE ASSOCIATES IN KEY POSITIONS OR WITH RELATIONSHIPS WITH OUTSIDE PARTIES THAT DO BUSINESS WITH THE HEALTH SYSTEM, TO DISCLOSE ANY ACTUAL OR POTENTIAL CONFLICT OF INTEREST. ANNUAL DISCLOSURES ARE REQUIRED AND DOCUMENTED WITH A FURTHER REQUIREMENT TO PROMPTLY SUPPLEMENT WHEN AN ACTUAL OR POTENTIAL CONFLICT IS DISCOVERED OR CREATED. THE HEALTH SYSTEM REQUIRES THAT THESE POLICIES BE CONSTRUED BROADLY TO AVOID THE APPEARANCE OF IMPROPER ACTIVITY AND REQUIRES DISCLOSURE AND RESOLUTION OF POTENTIAL CONFLICTS AS WELL. THE PROCESS IS OVERSEEN BY THE CHIEF COMPLIANCE OFFICER OF THE HEALTH SYSTEM WHO HAS ACCESS TO EXTERNAL RESOURCES, INCLUDING OUTSIDE COUNSEL. REMEDIES RANGE FROM DISCLOSURE AND MONITORING FOR THE MOST ATTENUATED POTENTIAL CONFLICTS TO RESIGNATION/TERMINATION FOR UNRESOLVABLE CONFLICTS. FORM 990, PART VI, SECTION B, LINE 15 CALVERTHEALTH MEDICAL CENTER (CHMC) DETERMINES THE COMPENSATION OF THE CEO, OFFICERS AND KEY EMPLOYEES. CHMC UTILIZES A WRITTEN EMPLOYMENT CONTRACT, AN INDEPENDENT COMPENSATION CONSULTANT, A COMPENSATION SURVEY OR STUDY AND APPROVAL BY BOARD/COMPENSATION COMMITTEE TO DETERMINE COMPENSATION OF ITS CEO. CHMC UTILIZES AN INDEPENDENT COMPENSATION CONSULTANT, A COMPENSATION SURVEY OR STUDY AND APPROVAL BY THE BOARD/COMPENSATION COMMITTEE TO DETERMINE COMPENSATION OF ITS OFFICERS AND KEY EMPLOYEES. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S CONFLICTS OF INTEREST POLICY, AUDITED FINANCIAL STATEMENTS AND 990 RETURNS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XI, LINE 9: DISTRIBUTION FROM CMH II HOLDING 11,000. DISTRIBUTION FROM CMH HOLDING 50,000. NET ASSETS TRANSFER FROM CHMC TO FUND OPERATIONS 3,500,000. DISTRIBUTION TO CHMC -27,833,700. PART XII LINE 2B THE ORGANIZATION'S FINANCIAL STATEMENTS ARE AUDITED BY AN INDEPENDENT ACCOUNTING FIRM AS PART OF THE CONSOLIDATED AUDIT OF THE HEALTH SYSTEM. FORM 990, PART XII, LINE 2C: THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. 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