2014-05-12T11:12:23-05:00 2013-06-30 COHEN RUTHERFORD KNIGHT PC 6903 ROCKLEDGE DRIVE SUITE 500 BETHESDA MD 208171800 990 2012-07-01 521452024 Carroll Hospital Center Inc % DAVID MCCORMICK CARR 4108716859 200 Memorial Avenue Suite Westminster MD 21157 KEVIN KELBLY 4108716695 2014-05-08 true TINA C ECKLOFF 3018281008 2014-05-08 2012 2015-11-30 17:44:51Z John Sernulka 200 MEMORIAL AVE WESTMINSTER MD 21774 238095644 false X www.carrollhospitalcenter.org X 1957 MD OUR COMMUNITIES EXPECT AND DESERVE SUPERIOR MEDICAL TREATMENT, COMPASSIONATE CARE, AND EXPERT GUIDANCE IN MAINTAINING THEIR HEALTH AND WELL-BEING. 15 11 2012 381 3091071 925000 3719011 224019831 223774228 4597814 9982049 372793 292795 229915438 237768083 155000 155000 0 0 106909146 111629729 0 0 0 107142153 98249996 214206299 210034725 15709139 27733358 338128205 364271504 233448150 227307898 104680055 136963606 OUR COMMUNITIES EXPECT AND DESERVE SUPERIOR MEDICAL TREATMENT, COMPASSIONATE CARE, AND EXPERT GUIDANCE IN MAINTAINING THEIR HEALTH AND WELL-BEING. AT CARROLL HOSPITAL CENTER, WE OFFER AN UNCOMPROMISING COMMITMENT TO THE HIGHEST QUALITY HEALTH CARE EXPERIENCE FOR PEOPLE IN ALL STAGES OF LIFE. WE ARE THE HEART OF HEALTH CARE IN OUR COMMUNITIES. false false 178758724 155000 223774228 Carroll Hospital Center, a 189 licensed bed acute care facility located in Westminster, Maryland offers the latest in medical technology and services, combined with a state-of-the-art facility and top-notch, skilled medical professionals, caring for patients with compassion. Currently, there are more than 400 physicians representing 38 specialties on our medical staff in addition to over 1,700 individuals employed by the Hospital - making CHC the second largest employer in Carroll County. The organization operates an acute care hospital serving the communities located in Carroll and surrounding counties as well as parts of Pennsylvania. In accordance with our tax-exempt function the organization operates an emergency room open to all persons regardless of their ability to pay and had 56,428 patient visits last year. The hospital participates in Medicare and Medicaid programs, has a governing body comprised of independent persons representative of the community, all financial surpluses the hospital generates are used exclusively to further the charitable purposes of the organization and its medical staff is open to all qualified physicians in the area. As the only hospital in Carroll County, we offer our community a full array of services including, emergency services, comprehensive cancer care, pediatrics, maternity, geriatrics, the latest minimally invasive surgical procedures and advanced total and partial joint replacement procedures. In the year ending June 2012, Carroll Hospital Center recorded 14,889 inpatient admissions and observation stay cases, 1,084 births and 8,034 surgical procedures, all contributing to a total of 188,000 patient encounters for the period. In line with our mission-"Our communities expect and deserve superior medical treatment, compassionate care, and expert guidance in maintaining their health and well-being. At Carroll Hospital Center, we offer an uncompromising commitment to the highest quality health care experience for people in all stages of life. We are the heart of health care in our communities." - the hospital also provides planned community benefit activities to improve access to health care and improve the overall health of our community. Our mission is pursued in collaboration with our related organizations: Carroll County Health Services, Carroll Hospice, The Partnership for a Healthier Carroll County (our community advocacy arm), and The Carroll Hospital Center Foundation (Also listed in Part VI) for more information on these subsidiaries, please see their individual Forms 990. 178758724 true true false true false false false false true true true true true true false false true false false true false false false false false true true true false true true false false false false false false false true true true false false false false true true true true false false true 256 0 true 2012 true true true true CJ false false false false false false false false false X 15 11 true false false false false false false true true false false true true true true true true true true true true CA MD X DAVID MCCORMICK 4108716859 200 MEMORIAL AVE Westminster MD 21157 CHARLES O FISHER JR 1.0 1.0 X 0 0 0 MIRIAM BECK 1.0 1.0 X X 0 0 0 ETHAN SEIDEL PHD 1.0 1.0 X X 0 0 0 JOHN SERNULKA 35.0 5.0 X X 429447 0 272417 KIMBERLY JOHNSTON MD 1.0 1.0 X 0 0 0 HAROLD WALSH 1.0 1.0 X 0 0 0 HELEN W WHITEHEAD 1.0 1.0 X X 0 0 0 SYED HOSAIN MD 1.0 1.0 X 0 0 0 THOMAS WELLIVER 1.0 1.0 X 0 0 0 JEFFREY A WOTHERS 1.0 1.0 X 0 0 0 W DENNIS THOMAS 1.0 1.0 X 0 0 0 GERALD LEE STURGILL 1.0 3.0 X 0 0 0 LARRY VAN SANT SR 1.0 2.0 X 0 0 0 JOHN STEERS MD 1.0 1.0 X 0 0 0 MARTIN HILL 1.0 1.0 X 0 0 0 LESLIE SIMMONS 40.0 0.0 X 379123 0 11704 KEVIN KELBLY 34.0 6.0 X 380667 0 17246 KEVIN SMOTHERS 40.0 0.0 X 435459 0 11054 STEPHANIE REID 40.0 0.0 X 189798 0 8264 JED ROSEN 40.0 0.0 X 395653 0 6454 M ELLEN FINNERTY MYERS 20.0 20.0 X 248329 0 7797 JOYCE ROMANS 40.0 0.0 X 234489 0 7979 TRACEY ELLISON 40.0 0.0 X 216720 0 11870 DAVID LOUDER 39.0 1.0 X 348787 0 5014 ROBERT WHITE 40.0 0.0 X 187912 0 14130 CRIS COLEMAN 40.0 0.0 X 198515 0 14549 BOB EDMONDSON 40.0 0.0 X 172557 0 3814 FLAVIO KRUTER 39.0 1.0 X 1074489 0 22839 JOHANNA DIMENTO 40.0 0.0 X 347371 0 3187 DAVID SALINGER 39.0 1.0 X 632796 0 12389 DEE HUBBARD 40.0 0.0 X 271538 0 9167 AMANDEEP SINGH 40.0 0.0 X 276329 0 9367 6419979 0 449241 29 false true false CENTRAL MD REHABILITATION 4259 HARNEY RD TANEYTOWN MD 21787 physical therapy 2977174 CARROLL COUNTY ANES ASSOCIATION PO BOX 75193 BALTIMORE MD 21275 ANESTHESIA services 1800370 carroll county radiology 7253 ambassador rd BALTIMORE MD 21244 radiology services 708890 DIGITRACE CARE SERVICES 200 CORPORATE PLACE PEABODY MA 01960 neurology services 635900 BRENDA RAY CCS 674 LAKE SANTEE DR NORTH AUGUSTA SC 29841 CODING FOR BILLING 785590 29 3679011 40000 3719011 NET PATIENT SERVICE REVENUE 212865775 212865775 CAFETERIA/VEND. 912756 912756 LAB 621500 3069539 3069539 OTHER OPERATING REVENUE 6926158 6926158 223774228 9953704 -90597 10044301 0 0 443616 327561 116055 0 116055 22129 93926 28345 28345 28345 28345 0 0 0 CARROLL COUNTY MED SERVICES MGMT FEE 541610 90000 90000 OTHER REVENUE 86740 86740 176740 237768083 220791429 3091071 10166572 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200 MEMORIAL AVE WESTMINSTER MD 21157

X CARROLL HOSPITAL CENTER 1 true X X X X X X X X 12 true false true X X X X X X X X X X X false false true true 300. true 375. true X X X X true true X X X X X X true false X X X X true X false false 5 carroll county radiology

7253 ambassador road baltimore MD 21244

imaging center carroll county radiology

1430 progress way ste 108 eldersburg MD 21784

imaging center carroll county radiology

193 stoner ave ste 200 westminster MD 21157

imaging center carroll county radiology

1 village square westminster MD 21157

imaging center carroll county radiology

844 washington road ste 102 westminster MD 21157

imaging center PART I, LINE 3C For patients that experience a medical hardship (medical debt that exceeds 25% of household income), Carroll Hospital Center also provides discounted care for individuals earning up to 500% of the federal poverty guidelines. If a patient has received reduced cost medically necessary care due to a medical hardship, the patient or any immediate family member of the patient living in the same household shall remain eligible for reduced cost medically necessary care when seeking subsequent care at the same hospital during the 12 month period beginning on the date on which the reduced cost medically necessary care was initially received. In addition, some patients are presumed to be eligible for financial assistance discounts on the basis of life circumstances. These patients that the Hospital has determined presumptively qualify for financial assistance are not required to complete additional forms or provide additional information and are granted 100% financial assistance discounts. The Hospital internally documents any and all recommendations to provide presumptive financial assistance discounts from patients and other sources, such as physicians, community or religious groups, internal or external social services or financial counseling personnel. The following are examples of patient situations that may reasonably assist in the determination of presumptive eligibility for financial assistance: (1) Patient has received care from and/or has participated in Women's, Infants and Children (WIC) programs, (2) patient is homeless and/or has received care from a homeless clinic, (3) patient's family is eligible for and is receiving food stamps, (4) patient's family is eligible for and is participating in subsidized school lunch programs, (5) patient qualifies for other state or local assistance programs that are unfounded or the patient's eligibility has been dismissed due to a technicality (i.e. Medicaid spend-down), (6) family or friends of a patient have provided information establishing the patient's inability to pay, (7) the patient's street address and documentation evidencing status in an affordable or subsidized housing development, (8) patient/guarantor's wages are insufficient for garnishment, as defined by state law, or (9) patient is deceased, with no known estate. PART I, LINE 5A CARROLL HOSPITAL CENTER DOES NOT DENY FINANCIAL ASSISTANCE TO ANY PATIENT ELIGILBE FOR FREE OR DISCOUNTED CARE UNDER ITS FINANCIAL ASSISTANCE POLICY REGARDLESS OF WHETHER OR NOT THE FINANCIAL ASSISTANCE BUDGET WAS EXCEEDED. PART I, LINE 7A, COLUMN C THE METHODOLOGY USED TO CALCULATE CHARITY CARE COST WAS A COST-TO-CHARGE RATIO DERIVED FROM WORKSHEET 2, RATIO OF PATIENT CARE-TO-CHARGES. PART I, LINE 7A 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 HOSPITAL. MARYLAND'S UNIQUE ALL-PAYOR SYSTEM INCLUDES A METHOD FOR REFERENCING UNCOMPENSATED CARE IN EACH PAYOR'S RATES, WHICH DOES NOT ENABLE MARYLAND HOSPITALS TO BREAKOUT ANY OFFSETTING REVENUE RELTED TO UNCOMPENSATED CARE. PART I, LINE 7B 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 HOSPITAL. MARYLAND'S UNIQUE ALL-PAYOR SYSTEM INCLUDES A METHOD FOR REFERENCING UNCOMPENSATED CARE IN EACH PAYOR'S RATES, WHICH DOES NOT ENABLE MARYLAND HOSPITALS TO BREAKOUT ANY OFFSETTING REVENUE RELTED TO UNCOMPENSATED CARE. COMMUNITY BENEFIT EXPENSES ARE EQUAL TO MEDICAID REVENUES IN MARYLAND, AS SUCH, THE NET EFFECT IS ZERO. THE EXCEPTION TO THIS IS THE IMPACT ON THE HOSPITAL FOR ITS SHARE OF MEDICAID ASSESSMENT. IN RECENT YEARS THE STATE OF MARYLAND HAS CLOSED FISCAL GAPS IN THE STATE MEDICAID BUDGET BY ASSESSING HOSPITALS THROUGH THE RATE-SETTING SYSTEM. FOR TAX YEAR 2012 CARROLL HOSPITAL CENTER'S MEDICAID BUDGET DEFICIT UNFUNDED ASSESSMENT AMOUNTED TO $932,226. PART I, LINE 6A MARYLAND HOSPITALS ARE REQUIRED TO SUBMIT AN ANNUAL COMMUNITY BENEFIT REPORT TO THE HEALTH SERVICES COST REVIEW COMMISSION (HSCRC) THAT DESCRIBES THE PROGRAMS AND SERVICES OFFERED THAT ARE DESIGNED TO PROMOTE THE HEALTH AND WELLNESS OF THE COMMUNITIES SERVED. THESE REPORTS ARE AVAILABLE TO THE PUBLIC ON THE HSCRC WEBSITE (WWW.HSCRC.STATE.MD.US). ADDITIONALLY, CARROLL HOSPITAL CENTER MAKES AVAILABLE ITS COMMUNITY BENEFIT REPORT ON ITS WEBSITE (WWW.CARROLLHOSPITALCENTER.ORG) PART I, LINE 7G Carroll Hospital Center incurred $7.16 million of net community benefit expense as a result of undertaking subsidized health services. A shortage of primary or specialty providers has perhaps posed the most significant challenges in inpatient care delivery. Substantial physician subsidies have become necessary to ensure that all patients requiring anesthesia and pediatric, psychiatric, obstetrical and critical and general medical care have the access they need once admitted to the hospital, including 24/7 coverage. Carroll Hospital Center has hospitalist programs in each of these areas and allocates a significant amount of resources sustaining the programs. In FY13, approximately $6.4 million was spent in ensuring care for all patients and recruiting and retaining Physicians - of which $4.8 million has been reported as subsidized health services. Equally important is access to physicians on an outpatient basis, not just for the uninsured, but also for all patients in our growing community. To ensure our community has access to quality physicians, Carroll Hospital Center continually monitors statistically calculated need by developing a comprehensive medical staff development plan based on the health care needs of our medical service area. The report includes both an analysis of the hospital's service area and specific recommendations regarding appropriate staffing levels in a variety of medical specialties. The physician needs assessment methodology used is based on a qualitative standard established by the Internal Revenue Service (IRS). The report guides the hospital's recruiting strategy, helps us to prioritize recruiting efforts and allows the hospital to place contingencies on recruited physicians to ensure they see medically underserved, uninsured, Medicare and Medicaid patients. While Carroll Hospital Center cares for patients with no means to pay their medical expenses throughout the hospital, it is seen most acutely in the Emergency Department (ED), where many uninsured patients often come for primary and emergent care. Since all patients presenting to the ED are treated for any medical condition regardless of their ability to pay for care, the uninsured population poses a significant challenge not only to the hospital, but also to physicians providing care in the hospital and in the ED. Due in part to a lack of, or minimal reimbursement, it has become increasingly difficult to find specialists to provide on-call services for the ED around-the-clock. The more serious issue is that this trend affects not only our uninsured patients, but all patients seeking treatment in our ED. The likelihood that patients present more acutely in the uninsured population and the accompanying increased potential for malpractice claims also has contributed to specialists choosing not to cover nonpaying patients in the ED. That gap is most significant in surgical specialties including, orthopaedics, otolaryngology (ENT), general surgery and plastic surgery. There also has been increasing reluctance from other specialties with significant ED volumes, including vascular surgery, neurosurgery and neurology. To help ease the effects of uncompensated care on physicians and address the gap in care for our patients, Carroll Hospital Center has continued two major, costly initiatives to address the gap proactively. First, the hospital contracts with 10 medical specialties to ensure 24/7 coverage in the ED. Implemented in 2006, those specialties include neurosurgery; general, plastic, vascular and oral surgery; orthopaedics; urology; podiatry; ophthalmology and ENT. Additionally, the growing volumes of uninsured patients has caused the hospital to recently institute an additional policy which allows physicians who see patients without a payment source in the ED to be reimbursed for physician services by the hospital at current Medicare rates. While payment for ED call may help with the gaps in coverage for the uninsured, it bears a significant financial toll on the hospital. The expense to pay physicians for ED call has cost the hospital $621,744 in FY13. All the initiatives and support listed above would not be provided if Carroll Hospital Center did not provide them. As the only hospital in the county, it is our primary responsibility to provide these services for the uninsured and underinsured, as well as all community members. No other organization or individual in the county would be able to provide all of these comprehensive services in the areas that the hospital does. PART I LINE 7F 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 AMOUTN FOR THE SAME SERVICES DELIVERED AT THE SAME HOSPITAL. MARYLAND'S UNIQUE ALL-PAYOR SYSTEM INCLUDES A METHOD FOR REFERENCING UNCOMPENSATED CARE IN EACH PAYOR'S RATES, WHICH DOES NOT ENABLE MARYLAND HOSPITALS TO BREAKOUT ANY OFFSETTING REVENUE RELATED TO UNCOMPENSATED CARE. PART III, LINE 4 CARROLL HOSPTIAL CENTER INCURRED $5,686,000 BAD DEBT EXPENSE DURING THE TAX YEAR 2012. THIS REFLECTS THE AMOUNT OF GROSS PATIENT CHARGES UNCOLLECTED FROM PATIENTS THAT DID NOT QUALIFY FOR FINANCIAL ASSISTANCE. PER AUDIT REPORT (1N "PROVISION FOR BAD DEBTS):"PATIENT ACCOUNTS RECEIVABLE ARE REDUCED BY PROVISION FOR BAD DEBTS. IN EVALUATING THE COLLECTABILITY OF ACCOUNTS RECEIVABLE, THE HEALTH SYSTEM ANALYZES HISTORICAL COLLECTIONS AND WRITE-OFFS AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE PROVISION FOR BAD DEBTS AND PROVISION FOR UNCOLLECTIBLE ACCOUNTS. MANAGEMENT REGULARLY REVIEWS ITS ESTIMATE AND EVALUATES THE SUFFICIENCY OF THE ALLOWANCE FOR BAD DEBTS. THE HEALTH SYSTEM ANALYZES CONTRACTUAL AMOUNTS DUE FROM PATIENTS WHO HAVE THIRD PARTY COVERAGE AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS. FOR PATIENT ACCOUNTS RECEIVABLE ASSOCIATED WITH SELF-PAY PATIENTS, WHICH INCLUDES THOSE PATIENTS WITHOUT INSURANCE COVERAGE EXISTS FOR A PORTION OF THE BILL, THE HEALTH SYSTEM RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS FOR PATIENTS THAT ARE UNABLE OR UNWILLING TO PAY FOR THE PORTION OF THE BILL REPRESENTING THEIR FINANCIAL RESPONSIBILITY. ACCOUNT BALANCES ARE CHARGED OFF AGAINST THE ALLOWANCE FOR BAD DEBTS AFTER ALL MEANS OF COLLECTION HAS BEEN EXHAUSTED. BECAUSE THE HOSPITAL DOES NOT PURSUE COLLECTION OF AMOUNTS DETERMINED TO QUALIFY AS CHARITY CARE, SUCH AMOUNTS ARE NOT REPORTED AS GROSS PATIENT SERVICE REVENUE. BAD DEBT EXPENSE REPORTED ON LINE 2 REFLECTS ACTUAL PATIENT CHARGES THAT HAVE BEEN DETERMINED TO BE UNCOLLECTIBLE FOR PATIENTS THAT HAVE NOT QUALIFIED FOR CHARITY CARE. BAD DEBT EXPENSE MAY ALSO INCLUDE ADDITIONAL "BAD DEBT PROVISIONS" FOR DOUBTFUL ACCOUNTS BASED ON MANAGEMENT'S ESTIMATES OF FUTURE ACCOUNT COLLECTIONS BASED ON CHARGES IN SERVICE MIX AND PAYOR MIX. CARROLL HOSPITAL CENTER INC. DETERMINES ELIGIBILITY FOR FINANCIAL ASSISTANCE THROUGH OTHER VARIOUS MEANS (CREDIT REPORTS, DEBT AND ASSET REVIEWS, AND REFERRALS FROM THE HOSPITAL'S BILLING AGENTS) WHEN THE PATIENT HAS NOT COMPLETED THE FINANCIAL ASSISTANCE APPLICATION. IF A DETERMINATION IS MADE REGARDING THE PATIENT'S INABILITY TO PAY, THE ACCOUNT CAN BE APPROVED FOR FINANCIAL ASSISTANCE ON A PRESUMPTIVE BASIS RATHER THAN BE REFLECTED AS BAD DEBT EXPENSE. OF THE REMAINING BAD DEBT EXPENSE, IT IS ESTIMATED THAT $413,372 AT COST (10%) MAY BE ATTRIBUTABLE TO PATIENTS ELIGIBLE FOR FINANCIAL ASSISTANCE/CHARITY CARE. PART III, LINE 8 CARROLL HOSPITAL CENTER'S TAX YEAR 2012 (FISCAL YEAR 2013) MEDICARE COST REPORT SUBMISSION WAS UTILIZED AS THE SOURCE DOCUMENT TO REPORT MEDICARE TOTAL REVENUE AND ALLOWABLE COSTS. PART III, LINE 9B For those patients that do not initially apply or qualify for financial assistance, the organization continues to monitor whether the patient may qualify for financial assistance. If the patient is found to be eligible for financial assistance, at any point (including once collection efforts have begun), the organization will approve the patient for financial assistance. Collection efforts will be stopped immediately once the patient is found to qualify for financial assistance under the organization's financial assistance policy. Patients determined to be eligible for financial assistance subsequent to the date of service may be eligible for a refund of payments made if it is determined that the patient was eligible for financial assistance at the time of service. PART V, LINE 3 THE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) TOOK INTO ACCOUNT INPUT FROM REPRESENTATIVES OF THE COMMUNITY SERVED BY THE HOSPITAL FACILITY, INCLUDING PERSONS WITH SPECIAL KNOWLEDGE OF OR EXPERTISE IN PUBLIC HEALTH, AS WELL AS LEADERS AND REPRESENTATIVES OF MEDICALLY UNDERSERVED, LOW-INCOME, AND MINORITY POPULATIONS. THE CHNA WRITTEN REPORT INCORPORATED EXPERTISE AND PARTICIPATION FROM SUCH COMMUNITY LEADERS AND REPRESENTATIVES AS WELL AS LEADERS IN PUBLIC HEALTH, INCLUDING REPRESENTATIVES FROM THE CARROLL COUNTY HEALTH DEPARTMENT. AS PART OF THE CHNA, A KEY INFORMANT SURVEY OF 54 COMMUNITY LEADERS FROM A BROAD RANGE OF ACADEMIC, BUSINESS, GOVERNMENT, NON-PROFIT, PUBLIC HEALTH AND HEALTH CARE FIELDS WAS UNDERTAKEN. AMOUNG THE INDIVIDUALS WHO COMPLETED THE KEY INFORMANT SURVEY WERE REPRESENTATIVES FROM SUCH COMMUNITY ORGANIZATIONS AS THE ARC CARROLL COUNTY, CHANGE INC., Y OF CENTRAL MARYLAND, AND THE WOMEN'S PLACE, AS WELL AS PUBLIC HEALTH EXPERTS INCLUDING A WIDE RANGE OF PHYSICIANS AND NUMEROUS MEMBERS OF THE CARROLL COUNTY HEALTH DEPARTMENT. IN ADDITION, THE CHNA INCLUDES FINDINGS FROM THE MARYLAND STATE HEALTH IMPROVEMENT PROCESS (SHIP), CARROLL COUNTY SHIP PROFILE AND CARROLL COUNTY LOCAL HEALTH IMPROVEMENT PLAN. FURTHERMORE, LEADERS FROM CARROLL COUNTY HEALTH DEPARTMENT AND THE PARTNERSHIP FOR A HEALTHIER CARROLL COUNTY ARE MEMBERS OF A COMMITTEE THAT HELPS OVERSEE THE DEVELOPMENT AND EXECUTION OF THE CHNA PLAN. PART V, LINE 6 DURING THE 2012 TAX YEAR, CARROLL HOSPITAL CENTER ADOPTED AN IMPLEMENTATION STRATEGY THAT ADDRESSED THE COMMUNITY HEALTH NEEDS THAT WERE IDENTIFIED IN THE CHNA WRITTEN REPORT. CARROLL HOSPITAL CENTER BEGAN TO EXECUTE THE IMPLEMENTATION STRATEGY DURING 2012, INCLUDING BY UNDERTAKING THE FOLLOWING ACTIONS: IDENTIFIED NEED EXAMPLE 1: CANCER: MELANOMA THE MELANOMA INCIDENCE RATE IN CARROLL COUNTY IS SIGNIFICANTLY HIGHER THAN THE MARYLAND AND U.S. INCIDENCE RATE. HOSPITAL INITIATIVE: SKIN CANCER SCREENINGS, AWARENESS & EDUCATION PROGRAMS (ON-GOING) PRIMARY OBJECTIVE: TO REDUCE THE MELANOMA INCIDENCE RATE WITH EDUCATION ON PREVENTION, AND EARLY DETECTION THROUGH SKIN CANCER SCREENINGS AND AWARENESS EDUCATION. KEY PARTNERS: CARROLL HOSPITAL CENTER, CARROLL COUNTY HEALTH DEPARTMENT, PARTNERSHIP FOR A HEALTHIER CARROLL COUNTY, CARROLL COUNTY PUBLIC SCHOOLS AND BOYS & GIRLS CLUB. OUTCOMES: OUTCOMES ARE EVALUATED BY NUMBER OF PEOPLE EDUCATED ON IMPORTANCE OF PROTECTIVE MEASURES; SKIN CANCER SCREENING PARTICIPATION AND MELANOMA OCCURANCE RATE (INJURY TO SKIN OCCURS EARLIER IN A PERSON'S LIFE THAN WHEN MELANOMA USUALLY OCCURS). ACTIVITIES UNDERTAKEN BY CARROLL HOSPITAL CENTER TO MEET IDENTIFIED NEED DURING 2012 TAX YEAR INCLUDE: SAFER IN THE SHADE (SUN AWARENESS) 172 STUDENTS FROM SCHOOL FOR AT-RISK STUDENTS, AND OTHER FAMILIES SKIN CANCER AWARENESS EDUCATION: 888 PEOPLE SALON INDUSTRY SKIN CANCER EDUCATION: 67 PEOPLE SKIN CANCER SCREENINGS 90 PARTICIPANTS: 57 REFERRED FOR FOLLOW-UP 27 QUESTIONNAIRES RETURNED FROM REFERRED: 1 SQUAMOUS CELL, 1 BASAL CELL, MULTIPLE PRECANCEROUS AREAS FROZEN OR REMOVED NO-TANNING PLEDGE/SKIN CANCER EDUC. AT HIGH SCHOOLS: 226 STUDENTS ESTIMATED COSTS OF UNDERTAKING SUCH ACTIVIITES DURING FY 2013: $55,000 IDENTIFIED NEED EXAMPLE 2 BETTER ACCESS TO CARE HOSPITAL INITIATIVE: PROVIDE FINANCIAL AND OPERATIONAL SUPPORT TO ACCESS CARROLL, A PATIENT-CENTERED AND INTEGRATED HEALTH CARE HOME FOR LOW-INCOME RESIDENTS OF CARROLL COUNTY, MARYLAND. PRIMARY MEDICAL CARE IS PROVIDED BY VOLUNTEER PHYSICIANS, NURSES AND OTHER MEDICAL PROFESSIONALS. BY REMOVING TRADITIONAL BARRIERS TO QUALITY HEALTH CARE, ACCESS CARROLL STRIVES TO HELP PATIENTS MAINTAIN GOOD HEALTH AND LEARN TO MANAGE ANY ACUTE OR CHRONIC ILLNESSES. PRIMARY OBJECTIVE: TO PROVIDE PRIMARY CARE SERVICES TO LOW-INCOME RESIDENTS OF CARROLL COUNTY. TO PROVIDE CARE COORDINATION SERVICES TO LOW-INCOME RESIDENTS OF CARROLL COUNTY. KEY PARTNERS: CARROLL COUNTY HEALTH DEPARTMENT OUTCOMES: OUTCOMES ARE EVALUATED BY THE NUMBER OF NEW PATIENTS AND PATIENT ENCOUNTERS, AS WELL AS TYPES OF SERVICES OFFERED. ACTIVITIES UNDERTAKEN BY CARROLL HOSPITAL CENTER TO MEET IDENTIFIED NEED DURING 2012 TAX YEAR INCLUDE: NEW PATIENTS SEEN AT ACCESS CARROLL: 495 TOTAL ENCOUNTERS AT ACCESS CARROLL: 5,941 OPENED EXPANDED FACILITY WITH DENTAL SERVICES EXPANDED CARE COORDINATION SERVICES: SPECIALTY CARE REFERRALS (SPECIALISTS, HIGH END DIAGNOSTICS, SURGERIES): 965 CARE COORDINATION SERVICES (NOT INCLUDED ABOVE): 2,954 * SSI/SSDI APPLICATIONS * HOMELESSNESS SERVICES (SOAR) * INDIVIDUALIZED CASE MANAGEMENT SESSIONS - "BILLS AND PILLS" CASE MANAGEMENT * PUBLIC ASSISTANCE APPLICATIONS - INCLUDING MA, PAC, SNAP, SAIL, HOUSING, FOOD * TRANSPORTATION SERVICES TOTAL CARE COORDINATION DOCUMENTED: 3,919 APPROXIMATE COST OF PROVIDING STAFF AND HOSPITAL RESOURCES TO ACCESS CARROLL DURING 2012: $321,808 APPROXIMATE COST TO CARROLL HOSPITAL CENTER OF PROVIDING FREE DIAGNOSTIC & LAB SERVICES FOR ACCESS CARROLL PATIENTS: $295,855 TOTAL APPROXIMATE COSTS TO CARROLL HOSPITAL CENTER OF SUPPORTING ACCESS CARROLL DURING 2012: $617,663 PART V, LINE 7 PURSUANT TO THE CHNA UNDERTAKEN BY CARROLL HOSPITAL CENTER, 20 COMMUNITY HELATH NEEDS WERE IDENTIFIED. THEN, WORKING COLLABORATIVELY, HOSPITAL AND COMMUNITY PUBLIC HEALTH LEADERS, AS WELL AS, THE HOSPITAL'S COMMUNITY BENEFIT PLANNING COMMITTEE, BEGAN PRIORITIZING THE FOCUS FOR ACTION IN THE NEXT THREE YEARS. IN PARTICULAR, A JOINT STRATEGIES MEETING was convened to help determine the prioritization of the identified community health needs. During the joint strategy meeting, each of the 20 identified community health needs was addressed. Taking into consideration the limited financial resources available to the hospital, the 20 identified needs were prioritized by hospital and community public health leaders on the following criteria: community impact, urgency, size, severity, alignment with Carroll Hospital Center/The Partnership for a Healthier Carroll County and return on investment. Final criteria selection was determined by the Executive Council members of Carroll Hospital Center, in collaboration with The Partnership for a Healthier Carroll County Board. PURSUANT TO THIS PRIORTIZATION PROCESS, it was determined that the needs The Carroll Hospital Center hospital facility would attempt to address would be narrowed DOWN TO SEVEN (7) KEY COMMUNITY BENEFIT ISSUES. AMOUNG THOSE NEEDS THAT THE HOSPITAL FACILITY DETERMINED IT WOULD NOT SPECIFICALLY focus upon addressing WERE: HEALTH CARE TRANSPORTATION, MOTOR VEHICLE DEATHS, AGE DISCRIMINATION, ARTHRITIS, ASTHMA, FLU, AND ORAL HEALTH CARE. PART V, LINE 18 THE HOSPITAL FACILITY OR AN AUTHORIZED THIRD PARTY DID NOT UNDERTAKE ANY OF THE COLLECTION ACTIONS NOTED IN PART V, SECTION B, LINE 17 BEFORE MAKING REASONABLE EFFORTS TO DETERMINE ANY PATIENTS ELIGIBILITY UNDER THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY. IN ORDER TO HELP DETERMINE PATIENTS' ELIGIBILITY UNDER THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY, THE HOSPITAL UNDERTAKES A NUMBER OF ACTIONS, INCLUDING NOTIFYING PATIENTS OF THE FINANCIAL ASSISTANCE POLICY ON ADMISSION, NOTIFYING PATIENTS OF THE FINANCIAL ASSISTANCE POLICY PRIOR TO DISCHARGE, NOTIFYING PATIENTS OF THE FINANCIAL ASSISTANCE POLICY IN COMMIUNICATIONS WITH THE PATIENTS' BILLS, AND DOCUMENTING ITS DETERMINATION OF WHETHER PATIENTS WERE EILIGIBLE FOR FINANCIAL ASSISTANCE UNDER THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY. PART V, LINE 20 THE HOSPITAL FACILITY PROVIDES A DISCOUNT OF AT LEAST 25% OFF OF GROSS CHARGES FOR THE PROVISION OF EMERGENCY AND OTHER MEDICALLY NECESSARY CARE TO ANY INDIVIDUAL THAT IS ELIGIBLE FOR DISCOUNTED CARE UNDER THE HOSPITAL FACILITY'S FINANCIAL ASSISTANCE POLICY AND AT LEAST 15% OFF OF GROSS CHARGES FOR THE PROVISION OF EMERGENCY AND OTHER MEDICALLY NECESSARY CARE TO ANY INDIVIDUAL THAT QUALIFIES UNDER THE MEDICAL HARDSHIP PROVISIONS OF THE HOSPITAL FACILITY'S FINANCIAL ASSISTANCE POLICY. PURSUANT TO THE HEALTH SERVICES COST REVIEW COMMISSION (HSCRC) ALL-PAYOR SYSTEM FOR HOSPITALS IN THE STATE OF MARYLAND, THE GREATEST DISCOUNT OFF OF GROSS CHARGES FOR THE PROVISION OF EMERGENCY AND OTHER MEDICALLY NECESSARY CARE PERMITTED TO ANY COMMERCIAL INSURER OR MEDICARE IS ONLY 6% AS A RESULT, THE HOSPTIAL FACILITY WAS ABLE TO DETERMINE THAT THE MAXIMUM AMOUNT CHARGED TO INDIVIDUALS THAT WERE ELIGIBLE FOR FINANCIAL ASSISTANCE UNDER THE HOSPITAL FACILITY'S FINANCIAL ASSISTANCE POLICY WAS NOT GREATER THAN THE AMOUNT GENERALLY BILLED TO INDIVIDUALS WHO HAVE INSURANCE COVERING SUCH CARE. PART V, LINE 22 The Hospital facility does not charge any individuals that it knows are eligible for financial assistance an amount equal to the gross charge for any service. The Hospital uses the charge master rates for a service as a starting point against which the discounts mandated in the hospital facility's financial assistance policy are applied to determine the amount actually billed to patients eligible under the financial assistance policy. The hospital facility will not collect payment from any patient eligible under the financial assistance policy in excess of the reduced amount that is actually billed to such financial assistance patient. NEEDS ASSESSMENT PART VI, LINE 2 Monitoring the health status of the community is an ongoing and interactive process engaged in by the Hospital, with substantial involvement from our community via The Partnership for a Healthier Carroll County, Inc. ("The Partnership"), an entity established by the Hospital and the Carroll County Health Department specifically to assess unmet health needs in the community, expand the capacity for health and quality of life improvement in the community, serve as a collaborative vehicle for interaction with the community, and with our community, to drive the effort to create a healthier Carroll County. The Partnership is a related Section 501(c)(3) tax-exempt organization of the Hospital, which receives a majority of its operating funds from contributions made directly by the Hospital. Improvement in the core health improvement areas (C.H.I.A.s) is one of the Hospital's goals. The C.H.I.A.s are the need areas requiring individual and organizational action to achieve targeted improved status using the U.S. Department of Health and Human Services' Healthy People 2020 targets as the benchmark. The Hospital participates actively in many of the C.H.I.A. Leadership Teams comprised of diverse individuals and organizations from throughout the hospital's service area, who share expertise and interest in the CHIA. With support and guidance from The Partnership, those leadership teams develop and implement action plans specifically intended to accomplish targeted results. "Healthy Carroll Vital Signs" (described below) are then affirmed, are specific to each CHIA Leadership Team and serve as one of the primary tools for measuring and reporting results to the Hospital leadership and to the community. Recently the Hospital has collaborated with The Partnership with respect to an assessment of health needs via Maryland's State Health Improvement Process (S.H.I.P.), which was organized to produce a Local Health Improvement Plan (L.H.I.P.). The Partnership organization enthusiastically agreed to serve as the local coalition required in the S.H.I.P. process. This provided Carroll Hospital Center yet another opportunity for linkage to important, validated information about health needs in our community and ongoing opportunities to collaborate with our local and state health department regarding implementation strategies for targeted results. Pursuant to the S.H.I.P. assessment, thirty-nine "High Impact Objectives" were identified by the staff at Maryland's Department of Health and Mental Hygiene. A Carroll County specific data profile served as the baseline document. After thorough analysis, a local team, which included the hospital, produced a Local Health Improvement Plan (L.H.I.P.) addressing five priority need areas. The S.H.I.P. and L.H.I.P. provide another important set of very useful information and is being fully integrated within the hospital's first IRS compliant Community Health NEeds Assessment (CHNA) and community benefit planning processes. The Hospital and The Partnership have conducted multiple previous needs assessments, have made real progress towards community engagement in these processes and have integrated annual measurement systems into the health improvement work known as "Healthy Carroll Vital Signs (HCVS)." These measures build on national benchmarks and improvement targets such as HP 2020. Future editions of Healthy Carroll Vital Signs will also integrate S.H.I.P. 2014 benchmarks and improvment targets. DURING THE 2012 TAX YEAR, the Hospital CONDUCTED ITS FIRST COMMUNITY HEALTH NEEDS ASSESSMENT IN COMPLIANCE WITH IRS REQUIREMENTS ("CHNA"). SHORTLY THEREAFTER, THE HOSPITAL BEGAN TO UNDERTAKE CERTAIN INITIATIVES IDENTIFIED IN THE CHNA IMPLEMENATION STRATEGY TO BEGIN TO ATTEMPT TO MEET IDENTIFIED COMMUNITY HEALTH NEEDS. THE INITIATIVES UNDERTAKEN DURING THE 2012 TAX YEAR TO HELP MEET IDENTIFIED COMMUNITY HEALTH NEEDS ARE FURTHER DESCRIBED IN THE DISCLOSURE TO PART V, SECTION B, LINE 6. PATIENTS EDUCATION OF ELIGIBILITY FOR ASSISTANCE PART VI, LINE 3 CARROLL HOSPITAL CENTER (CHC) HAS A NUMBER OF PROGRAMS TO ASSIST PATIENTS WITH THEIR PAYMENT OBLIGATIONS. FIRST, WE PROVIDE A MEDICAID ENROLLMENT SERVICE TO PATIENTS WHO QUALIFY FOR MEDICAL ASSISTANCE. THIS SERVICE ASSISTS PATIENTS WITH PAPERWORK AND WILL EVEN PROVIDE TRANSPORTATION IF NEEDED. THIS PAST YEAR, CHC ASSISTED 310 PATIENTS IN APPLYING FOR THE STATE'S MEDICAL ASSISTANCE PROGRAM. IN ADDITION, THE HOSPITAL HELD A, FREE ENROLLMENT SESSION FOR "COVER THE UNINSURED DAY' FOR UNINSURED COMMUNITY MEMBERS TO COME IN TO SEE IF THEY QUALIFIED FOR MEDICAL OR FNINANCIAL ASSISTANCE. FOR PATIENTS WHO DO NOT QUALIFY FOR MEDICAID COVERAGE, CHC HAS AN IN-HOUSE FINANCIAL ASSISTANCE PROGRAM. OUR ELIGIBILITY STANDARDS ARE MORE LENIENT THAN EVEN THOSE PROPOSED BY THE MARYLAND HOSPITAL ASSOCIATION GUIDELINES. WE WRITE OFF 100% OF THE BILL FOR PATIENTS WHOSE INCOME IS BELOW 300% OF THE FEDERAL POVERTY GUIDELINES (FPG) AND WRITE OFF A PORTION OF THE BILL FOR PATIENTS WHOSE INCOME IS BETWEEN 301%-375% OF THE FPG. WHEN PATIENTS EXPRESS THEIR INABILITY TO PAY FOR SERVICES, OUR STAFF WORKS TO FIND THE BEST POSSIBLE OPTION FOR THEM BY DISCUSSING IN DETAIL THEIR SITUATION. THE FAMILY IS INVOLVED IN THOSE CONVERSATIONS TO THE EXTENT THE PATIENT FEELS COMFORTABLE. THE HOSPITAL ALSO HAS A PROCESS IN PLACE FOR PATIENTS TO HAVE FINANCIAL ASSISTANCE DECISIONS RECONSIDERED AND THAT PROCESS IS CLEARLY OUTLINED IN OUR FINANCIAL ASSISTANCE POLICY AND IN INFORMATION PROVIDED TO OUR PATIENTS. IN ADDITION, FOR PATIENTS WITH INCOME BELOW 500% OF THE FPG AND WHOSE MEDICAL DEBT AT CHC IS IN EXCESS OF 25% OF THEIR HOUSEHOLD INCOME, THE HOSPITAL HAS A MEDICAL HARDSHIP PLAN THAT PROVIDES FOR REDUCED-COST CARE. THE HOSPITAL POSTS A SUMMARY OF ITS FINANCIAL ASSISTANCE POLICY, INFORMING PATIENTS OF THE AVAILABILITY OF FINANCIAL ASSISTANCE, IN ALL REGISTRATION AND INTAKE AREAS FOR ALL PATIENTS TO SEE. IN ADDITION, DETAILED INFORMATION ON OUR FINANCIAL ASSISTANCE POLICY IS INCLUDED IN EVERY ADMISSION FOLDER, ON BILLS MAILED TO PATIENTS AND ON THE HOSPITAL'S WEBSITE (WWW.CARROLLHOSPITALCENTER.ORG). COMMUNITY INFORMATION PART VI, LINE 4 AS THE ONLY HOSPITAL IN THE COUNTY, CHC'S PRIMARY SERVICE AREA IS THE ENTIRE COUNTY. THE HOSPITAL DOES, HOWEVER, ALSO SERVE PORTIONS OF BALTIMORE, FREDERICK AND MONTGOMERY COUNTIES AS WELL AS AREAS IN SOUTHERN PENNSYLVANIA. THE GENERAL DEMOGRAPHICS FOR OUR PRIMARY COMMUNITY (CARROLL COUNTY) ARE LISTED BELOW: POPULATION TOTAL POPULATION 2012: 167,217 POPULATION PERCENT CHANGE 2011 TO 2012: 0% PERSONS UNDER 5 YEARS PERCENT 2012: 4.9% PERSONS UNDER 18 YEARS PERCENT 2012: 23.3% PERSONS 65 YEARS AND OVER PERCENT 2012: 14.3% FEMALE PERSONS, PERCENT 2012: 50.6% RACE WHITE PERSONS: 93.3% BLACK PERSONS: 3.4% AMERICAN INDIAN AND ALASKA NATIVE PERSONS: 0.2% ASIAN PERSONS: 1.6% NATIVE AMERICAN AND OTHER PACIFIC ISLANDER: 0 PERSONS REPORTING TWO OR MORE RACES: 1.5% PERSONS OF HISPANIC OR LATINO ORIGIN: 2.8% WHITE PERSONS NOT HISPANIC: 90.8% SOURCE: SOURCE US CENSUS BUREAU: STATE AND COUNTY QUICKFACTS. FAMILY TOTAL NUMBER OF HOUSEHOLDS (2007-2011): 59,314 AVERAGE HOUSEHOLD SIZE (2007-2011): 2.75 PERSONS SOURCE: US CENSUS BUREAU: STATE AND COUNTY QUICK FACTS. ECONOMICS MEDIAN HOUSEHOLD INCOME (2007-2011): $83,325 PERSONS BELOW POVERTY LEVEL, PERCENT (2007-2011): 5.6% SOURCES: CARROLL COUNTY DEPARTMENT OF ECONOMIC DEVELOPMENT AND US CENSUS BUREAU: STATE AND COUNTY QUICKFACTS. OTHER SIGNIFICANT DEMOGRAPHIC CHARACTERISTICS ACCORDING TO AMERICAN COMMUNITY SURVEY (2012) THE PERCENTAGE OF UNINSURED PATIENTS IN CARROLL COUNTY IS 6.8%. IN TY 2012, OF THE CARROLL COUNTY RESIDENTS THAT WERE HOSPITALIZED (EITHER AT CHC OR OTHER HOSPITALS), 10.3% WERE ENROLLED IN MEDICAL ASSISTANCE PROGRAMS IN CARROLL COUNTY, WHICH INCLUDES MCHIP, PAC, AND MEDICAL ASSISTANCE. THE AVERAGE LIFE EXPECTANCY WITH CARROLL COUNTY WAS 79.5. PROMOTION OF COMMUNITY HEALTH PART VI, LINE 5 Carroll Hospital Center, founded in 1961, is the sole hospital serving the jurisdiction of Carroll County, Maryland with a FY 2013 population estimated at more than 168,000 persons. Carroll Hospital Center is the second -largest employer in Carroll County with over 1,750 Associates in FY 2013. Carroll Hospital Center is accredited with commendation by the Joint Commission. Our governing body is comprised predominantly of independent leaders representative of our community who assure that all financial surpluses the hospital generates are used exclusively to further the charitable purposes of the organization. We are a not-for-profit organization with diverse service lines including comprehensive acute care such as medical, surgical, peri-natal, pediatrics, psychiatry, medical and radiation oncology, adult intensive care and cardiovascular services, including emergency Percutaneous interventional heart surgery. Both home-based and inpatient Hospice care is provided through our affiliated agency, Carroll Hospice Inc. Diverse diagnostic services are provided at multiple locations and include both laboratory and radiologic capabilities. We participate in Medicare and Medicaid programs. There are more than 400 Physicians representing 38 specialties on our medical staff whose membership is open to all qualified area physicians. We operate an Emergency Department (ED) serving all persons regardless of ability to pay. The ED had over 56,000 patient visits in FY 2013 and we also recorded 14,889 inpatient AND OBERVATION ADMISSIONS, 1,084 births and approximately 8,034 surgical procedures. An extensive network of hospital operated physician practices assures adequate availability of both primary and specialty care physicians throughout the service area-meeting the Carroll Hospital Center standards of excellence and incorporating the same values and principles. Building on our long tradition of collaboration with our local residents, the hospital in joint effort with the Carroll County Health Department, established The Partnership for a Healthier Carroll County, Inc. (The Partnership) in 1999 to link hospital strengths, alongside those of other well-established community partners to achieve an improved health status. The Partnership is a related Section 501(c)(3) tax-exempt organization of Carroll Hospital Center, which receives a majority of its operating funds from contributions made directly by the Hospital. The Partnership was established to: * Assess unmet health needs in our community * Expand the capacity for health and quality of life improvement in our community * Serve as our collaborative vehicle for interaction with the community * Drive the effort to create a healthier Carroll County community. This strategy has allowed Carroll Hospital Center to remain continually well-connected to the community, to leverage our resources in action alongside those of other key organizations and agencies (particularly, the Carroll county health department) and to assure measurable results. Monitoring the health status of the community is an ongoing and interactive process engaged in by Carroll Hospital Center and The Partnership. Carroll Hospital Center and The Partnership pursue improvement in the core health improvement areas (CHIAs) via Leadership Teams comprised of diverse individuals and organizations who share expertise and interest in the CHIA. Those leaders develop and implement action plans specifically intended to accomplish targeted results. "Healthy Carroll Vital Signs" are then affirmed, are specific to each CHIA Leadership Team and serve as one of the primary tools for results reporting. www.HealthyCarroll.org is The Partnership's website where current secondary data, national benchmarks, improvement targets and best practice references are easily available, are as current as available and are available to anyone at no cost. Carroll Hospital Center has long recognized that promoting the Health of its community is one of its essential responsibilities. Extensive community outreach and learning programs are offered by the hospital with an emphasis on disease prevention, early intervention and wellness. In FY 2012 we expanded on an integrated approach to population health; seeking to assure access to excellent health care and disease management assistance. Our integrated approach recognizes and strives to eliminate barriers such as transportation challenges or limited abilities to purchase essential prescription products; it also includes more in-community care coordination and assistance with navigating the often complex world of health care associated services. CHC is one of the founding and funding partners in a unique and highly successful integrated primary care center known as Access Carroll. Inc. At Access Carroll, Inc. the barriers of low income and ineligibility for state, federal or other insurance assistance are being eliminated for significant numbers of Carroll County residents who are receiving the same stellar integrated primary and specialty care services needed to manage their acute and/or chronic disease issues as their higher income and insured neighbors. In addition to primary and specialty medical care and care management navigation assistance, the Access Carroll patients receive diagnostic laboratory and radiology services, prescription assistance (more than $1,000,000 retail value in FY 2012 from Pharmaceutical Prescription Assistance Programs coordinated by Access Carroll) and more. Carroll Hospital Center contributed $321,808 to Access Carroll in FY13 to cover salary and benefit expenses for the executive director, one full time RN case manager and two part-time positions (aide and development specialist), as well as additional funds toward their facility move and expansion. The hospital also provides laboratory and diagnostic imaging services to Access Carroll captured under Charity Care, which totaled $295,855 in FY13. Many Carroll Hospital Center affiliated physicians and specialists donate their time to and accept referrals from Access Carroll. In FY13, Access Carroll had 9,860 patient encounters. These health promotion efforts are in addition to programs and services that seek to also help people change their lifestyles to move toward a state of optimal health in mind, body and spirit. Carroll Hospital Center demonstrates its commitment to improving the health and wellness of the communities it serves by providing services and programs that address critical needs, including health care to vulnerable or underserved people; public health programs; and health education, screening and prevention services. As reported in the Fy 2013 State of Maryland Health Services Cost Review Commission (HSCRC) Community Benefit Report, Carroll Hospital Center provided $18,020,053 (net of revenues) on programs and activities benefiting the communities we serve. These programs and activities included hospice services, physician support, charity/uncompensated care, education programs, health screenings, support groups, health professions education and community contributions. The hospital's community education and wellness efforts are led by community educators in The Women's Place and The Learning Center departments, in coordination with The Partnership for a Healthier Carroll County, so as to maximize strategies and programs in addressing community health needs. Carroll Hospital Center, in Fy 2013, had 30,310 encounters in Community Health Education activities, 1,848 encounters for Support Groups, 132 encounters for Self-help programs and 1,775 encounters for screenings. Carroll Hospital Center offers these programs and services not only to address the needs of people with chronic or acute medical issues, but also to address prevention and education to keep our population well. people attended the three presentations, including cooking demonstrations & education on topics such as healthy bones and reducing your risk for cancer * nutrition screenings - 13 people participated in nutrition screenings one-on-one with a diatition. AFFILIATED HEALTH CARE SYSTEM PART VI, LINE 6 Carroll Hospital Center is part of an affiliated health care system that provides an array of health care services to its community. The Hospital, as a sole community provider, provides both inpatient and outpatient care, including essential health care services such as obstetrics, emergency services, pediatric, and critical care, which would likely otherwise not be provided within Carroll County due to their unprofitable nature (high cost services with relatively low reimbursement). Additionally, the Hospital is RELATED TO A GROUP PHYSICIAN PRACTICE (Carroll Health Group), which provides primary and specialty care services to the community. The provision of the physician service helps meet an identified community health need for additional primary and specialty care physicians in the community. Carroll Hospice, an affiliate of Carroll Hospital Center, provides inpatient hospice care, as well as residential hospice and palliative care, to patients nearing the end-of-life. Carroll Hospice provides pain management and symptom control and helps coordinate home and inpatient services. In order to provide comprehensive and compassionate care, Carroll Hospice utilizes an interdisciplinary team, including physicians, nurses, social workers, clergy, pharmacists, and home health aides. Further, Carroll Hospice provides bereavement care for family members for up to thirteen months. STATE FILING OF COMMUNITY BENEFIT REPORT 990 SCHEDULE H, PART VI MD, true PARTNERSHIP FOR HEALTHIER CARROLL COUNTY 95 CARROLL ST WESTMINSTER MD 21157 522156892 501(C)(3) 155000 Hospital contribution to support the programs of the Partnership 1 part i, line 2 The grant provided is to The Partnership for a Healthier Carroll County a related organization that is controlled by the organiYation and is a joint venture with the Carroll County Health department. The Partnership for a Healthier Carroll County is a 501(c)(3) tax-exempt organization that is dedicated to improving the health and quality of life of individuals living in Carroll County, Maryland. X X true true X X X X X false true false false false false false false false JOHN SERNULKA 263023 0 136955 0 29469 0 268789 0 3628 0 701864 0 0 0 LESLIE SIMMONS 289026 0 60724 0 29373 0 7785 0 3919 0 390827 0 0 0 KEVIN KELBLY 283992 0 67426 0 29249 0 11908 0 5338 0 397913 0 0 0 JED ROSEN 374598 0 20280 0 775 0 2450 0 4004 0 402107 0 0 0 M ELLEN FINNERTY MYERS 188873 0 47786 0 11670 0 6674 0 1123 0 256126 0 0 0 KEVIN SMOTHERS 334942 0 72607 0 27910 0 5367 0 5687 0 446513 0 0 0 JOYCE ROMANS 190099 0 32028 0 12362 0 4362 0 3617 0 242468 0 0 0 TRACEY ELLISON 177617 0 27978 0 11125 0 6354 0 5516 0 228590 0 0 0 FLAVIO KRUTER 788319 0 284436 0 1734 0 16802 0 6037 0 1097328 0 0 0 JOHANNA DIMENTO 339997 0 0 0 7374 0 2585 0 602 0 350558 0 0 0 DAVID SALINGER 494289 0 103098 0 35409 0 6352 0 6037 0 645185 0 0 0 DEE HUBBARD 248774 0 21990 0 774 0 3632 0 5535 0 280705 0 0 0 STEPHANIE REID 158687 0 22749 0 8362 0 7204 0 1060 0 198062 0 0 0 AMANDEEP SINGH 258246 0 17901 0 182 0 3680 0 5687 0 285696 0 0 0 DAVID LOUDER 281161 0 48332 0 19294 0 3872 0 1142 0 353801 0 0 0 ROBERT WHITE 156820 0 22186 0 8906 0 12052 0 2078 0 202042 0 0 0 CRIS COLEMAN 166429 0 23666 0 8420 0 8602 0 5947 0 213064 0 0 0 BOB EDMONDSON 97393 0 70000 0 5164 0 1346 0 2468 0 176371 0 0 0 PART I LINE 1A The Hospital has taken the position that it will include in taxable W-2 wages for the President and CFO certain business expenses that the IRS may question as not being tax deductible, so long as such expenses have a direct connection to the promotion of the Hospital's health care services. For 2012, these expenses were less than 3,000 in aggregate, for the President and CFO. Health or social club dues or initiation fees for the President were reimbursed by the Hospital and included on the President's W-2. The amount of the reimbursed fees was considered in the process for determining the President's compensation. nonqualified retirement plan The following employees participated in the organization's 457(f) deferred compensation plans and were paid and/or credited with the following amounts: John Sernulka - 260,400 A MARYLAND HEALTH AND HIGHER EDUCATION FAC AUTHORITY 520936091 574217B53 2006-12-07 36179115 HOSPITAL RENOVATIONS AND EQUIPMENT false false false B MARYLAND HEALTH & HIGHER EDUCATIONAL FAC AUTHORITY 520936091 000000000 2010-06-30 15000000 HOSPITAL RENOVATIONS AND EQUIPMENT false false false C MARYLAND HEALTH & HIGHER EDUCATIONAL FAC AUTHORITY 520936091 574218HJ5 2012-05-31 93596537 REFUND 2002 BONDS, FAC ACQ, RENOVA false false false A 0 0 38913827 3218009 0 0 683750 0 0 35012068 0 0 2009 false false true true B 1018770 0 15000000 0 0 0 255500 0 0 14744500 0 0 2010 false false true true C 1003750 0 93596537 0 0 0 100764 0 0 11457373 78596537 3441863 2012 true false false true A false false true true false 0.00000 0.01000 0.01000 false false 0.00000 false true B false false true true false 0.00000 0.01000 0.01000 false false 0.00000 false true C false false true true true true 0.00000 0.01000 0.01000 false false 0.00000 false true A false false false true false false 0 false false false 0 false true B false true false false true false 0 false false false 0 false true C false true false false true false 0 false false false 0 false true A true B true C true SUPPLEMENTAL INFORMATION 0 DIFFERENCES BETWEEN ISSUE PRICE REPORTED IN PART I, COLUMN E AND TOTAL PROCEEDS REPORTED IN PART II, LINE 3 ARE ATTRIBUTABLE TO INVESTMENT EARNINGS AND CHANGES IN AMOUNTS REQUIRED TO BE HELD IN RESERVE FUNDS. part iv, line 2c, column A 0 The 2006 bond rebate computation was performed on 8/10/2011. KATHLEEN PALAIA SISTER DIRECTOR 67715 EMPLOYEE OF THE HOSPITAL false HEATHER GREEN DAUGHTER OF AN OFFICER 67611 EMPLOYEE OF THE HOSPITAL false CHELSEA BEAUVAIS DAUGHTER OF AN OFFICER 61338 EMPLOYEE OF THE HOSPITAL false ROBERT J BEAUVAIS SON-IN-LAW OF AN OFFICER 54619 EMPLOYEE OF THE HOSPITAL false RANDY C GREEN JR SON-IN-LAW OF AN OFFICER 82218 EMPLOYEE OF THE HOSPITAL false HAROLD WALSH MEMBER AT LARGE 155965 EVAPCO PURCH EQUIP false JOHN STEERS MD BOARD MEMBER 569796 INDEPENDENT CONTRACT W/ CHG false JOHN STEERS MD BOARD MEMBER 83820 RENT OF SUITE false JOHN STEERS MD BOARD MEMBER 11700 MEDICAL DIRECTOR FEES false JOHN STEERS MD BOARD MEMBER 31117 ED ON CALL false AMANDA VETTER DAUGHTER OF BOARD MEMBER 55068 EMPLOYEE OF HOSPITAL/FOUND false FAMILY OR BUSINESS RELATIONSHIP PART VI, LINE 2 MIRIAM BECK AND JEFF WOTHERS HAVE A MOTHER-N-LAW/SON-N-LAW RELATIONSHIP. DESCRIPTION OF REVIEW PROCESS PART VI LINE 11 The Hospital's Form 990 is reviewed in detail between the preparer, an outside accounting firm, and the Finance Department of the Hospital. A copy of the draft Form 990 is presented to the Hospital's Risk, Audit and Compliance ("RAC") Committee, at which time RAC Committee members may ask any questions or provide comments regarding the draft Form 990. Prior to filing the Form 990, the Hospital provides a copy of the Form 990 to each member of the Board of Directors for their review, questions, and comments, which feedback is then incorporated into the filed Form 990. CONFLICTS MONITORING AND ENFORCEMENT PART VI LINE 12C The Conflict of Interest Policy applies to Carroll Hospital Center and its direct and indirect subsidiaries and parent organization. Review of Disclosure Statements/Report to the Board. The Chief Executive Officer of the Hospital Organization, the Governance Committee and the Corporate Compliance Officer shall review the matters disclosed in the Disclosure Statements and shall submit to the Hospital Organization's Board of Directors an annual summary or spreadsheet of the disclosures and his or her recommendation for the resolution of any conflicts disclosed. In formulating recommendations, the Chief Executive Officer shall consult with appropriate officers of the Hospital Organization and counsel as necessary. The Board of Directors of the Hospital Organization, acting in the best interests of the Hospital Organization, shall have sole discretion to make all final decisions regarding conflicts of interest, other than those regarding gifts to Hospital Organization employees which shall be resolved by the appropriate supervisory executive. However, no person shall be involved in considering the existence of an actual or potential conflict of interest, in the management and oversight of a conflict relationship, or in the determination of discipline for violations of this Policy, if that person is a party or potential party to that conflict. All final decisions regarding conflicts of interest shall be reflected in a revised annual summary or spreadsheet of conflict disclosures which will be shared with each director. The Chair and Vice-Chair of the Board, and all Board committee chairs, shall have this revised summary or spreadsheet available at the time of all Board and Board committee meetings in case a matter involving a potential conflict arises. CONFLICT OF INTEREST RECUSAL PROCEDURE FOR BOARD MEETINGS Whenever a Hospital Organizations' Board or Board committee is to consider a transaction or an arrangement with another organization, entity or individual in which or with whom a person covered by this Policy has a relationship creating an actual or potential conflict of interest, the following procedures shall be employed: A. The interested person must fully disclose the actual or potential conflict of interest to the Board; B. The interested person should be asked to leave the meeting during discussion of the potential conflict and any related votes, but the interested person may make a statement or answer any questions on the matter before departing the meeting; C. If appropriate, the Board or Board committee may appoint a non-interested person or committee to investigate alternatives to the proposed transaction or arrangement; D. To consider the proposed transaction or arrangement, the Board must: 1. find, by a majority vote of directors then in office, not counting the interested person, that the proposed transaction or arrangement is in the Hospital Organization's best interest and for the Hospital Organization's own benefit, it is fair and reasonable, and that, after reasonable investigation, the Hospital Organization cannot obtain a more advantageous transaction or arrangement using reasonable efforts; and 2. vote on the transaction or arrangement, approval requiring a majority vote of directors then in office, not counting the interested person. E. The minutes should include: (1) the name of the person disclosing the conflict of interest and a description of the conflict; (2) the Board's determination of whether there is a conflict; (3) the names and votes of persons present for the discussions and votes relating to the transaction or arrangement; and (4) the content of those discussions including the Board's determination of whether or not the transaction or arrangement is in the Hospital Organization's best interest, fair and reasonable, and the best reasonably available alternative Ongoing Duty to Disclose One's Own or Others' Conflicts of Interest. As an actual or potential conflict of interest can arise at any time, any actual or potential conflict must be disclosed promptly in writing by use of a supplemental Disclosure Statement, as soon as its existence is or should be known. If a person is in doubt about a situation, the person should consult with the Chief Executive Officer, Board Chairman or the Hospital Organization's Compliance Officer. Persons should err on the side of disclosure so that a conflict of interest assessment can be made. The potential conflict will be referred to the Governance committee for review and a response will be provided within 14 days. Noncompliance with the policy: The Organization's Board of Directors retains broad power and sole discretion under this Policy to: (1) determine the existence of actual or potential conflicts of interest; (2) subject conflict of interest relationships to appropriate oversight, management, conditions, restrictions and prohibitions; and (3) impose appropriate sanctions. A breach of this Policy can become grounds for discipline, up to and including removal from office or, for management personnel, termination of employment. It may also result in cessation of business with a vendor and in liability for damages. Grounds for discipline include, but are not limited to: A. willful failure to sign and return the Conflict of Interest Disclosure Statement in accord with this Policy; B. a material misstatement or omission in the Disclosure Statement; C. willful failure to disclose an actual or potential conflict of interest at any time in accord with the requirements of this Policy; D. willful participation in a vote or decision involving a transaction which raises an undisclosed conflict of interest; or E. willful disclosure or use of confidential information regarding the affairs, business or plans of a Hospital Organization for any purpose other than in furtherance of the affairs and best interests of the Hospital Organization. PROCESS FOR DETERMINING COMPENSATION PART VI LINE 15 THE EXECUTIVE COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS OF CARROLL HOSPITAL CENTER, WHICH IS COMPRISED OF INDEPENDENT BOARD MEMBERS DETERMINED TO BE FREE OF ANY CONFLICT OF INTEREST, IS CHARGED WITH DETERMINING EXECUTIVE COMPENSATION AND ESTABLISHING PERFORMANCE CRITERIA ACCORDING TO AN APPROVED COMPENSATION PHILOSOPHY. THE COMMITTEE WORKS WITH AN INDEPENDENT EXECUTIVE COMPENSATION CONSULTING AND ADVISORY FIRM THAT PROVIDES MARKET SURVEY DATA CONCERNING COMPENSATION AND BENEFIT LEVELS FOR FUNCTIONALLY COMPARABLE HEALTHCARE EXECUTIVES IN SIMILAR HOSPITALS ACROSS THE REGION AND THE NATION BASED ON SEVERAL FACTORS INCLUDING SIZE, GEOGRAPHY, HOSPITAL TYPE AND COMPLEXITY. THE COMMITTEE REVIEWS AND APPROVES THE COMPENSATION OF THE SENIOR EXECUTIVES AND ENSURES THAT ALL FORMS OF EXECUTIVE COMPENSATION ARE REASONABLE, APPROPRIATE AND CONSISTENT WITH ITS COMPENSATION PHILOSOPHY. CARROLL HOSPITAL CENTER HAS A WRITTEN POLICY REGARDING THE REVIEW OF PHYSICIAN COMPENSATION TO ENSURE THE PAYMENTS BETWEEN THE HOSPITAL AND THE PHYSICIAN ARE BOTH COMMERCIALLY REASONABLE AND NOT GREATER THAN FAIR MARKET VALUE FOR THE SERVICES RENDERED. THE POLICY APPLIES TO CARROLL HOSPITAL CENTER AND EACH OF ITS SUBSIDIARIES/AFFILIATES. PURSUANT TO THE POLICY, CARROLL HOSPITAL CENTER, IN ORDER TO ENSURE THE PAYMENTS TO PHYSICIANS ARE COMMERCIALLY REASONABLE AND CONSISTENT WITH FAIR MARKET VALUE, UNDERTAKES A NUMBER OF REVIEW ACTIVITIES, INCLUDING REVIEWING COMPENSATION INFORMATION FROM COMPENSATION SURVEYS AND RELIABLE DATA SUCH AS RECENT EARNINGS AND THIRD PARTY VALUATIONS. DOCUMENT AVAILABILITY PART VI, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. RECONCILIATION OF NET ASSETS PART XI, LINE 5 BOOK/TAX DIFFERENCE K-1 $(2,029,207) transfer of net assets (5,925,743) minimum pension liab 8,343,093 investment in foundation 851,678 investment in hospice 244,951 ----------- TOTAL $1,484,772 RENTAL INCOME AND EXPENSES RENT AND ROYALTY SUMMARY CARROLL HOSPITAL CENTER (CHC) HAS A LEASE WITH AN UNRELATED THIRD PARTY FOR THE USE OF SPACE IN THE FISHER BUILDING. CHC SUBLEASES SPACE IN THE FISHER BUILDING TO SUBTENANTS AT ITS LEASE COST. 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